[Observations about a case of giant splenic cyst]. / Osservazione a proposito di un caso di cisti gigante della milza.

The Authors, on the basis of a case of giant spleen cyst with positive tumoral markers, analyse some epidemiological and clinical aspects related to splenic non parasitic cysts. They affirm the priority of the conservative surgery, whenever possible, followed by an appropriate follow-up, although in this case their therapeutic choice was radical, due to the lack of residual parenchyma. In accordance with the data of several publications, as well as on the basis of the results obtained, the conservative approaches have been reevaluated, above all in view of the modern findings related to the function of the spleen. The conservative approach cannot be carried out in the following cases: neoplastic diseases, increase of the tumoral markers serum levels, total involvement of the splenic parenchyma by cysts.

[Ultrasonic dissector for total thyroidectomy: results of prospective randomized study]. / Tiroidectomia totale con impiego del dissettore ad ultrasuoni: risultati di uno studio prospettico randomizzato.

In the last years, the introduction and employment in surgery of the dissectors of last generation (ultrasounds, radiofrequency, etc.) have contributed to a remarkable improvement and simplification of the performances and the surgical techniques. The present study has the aim to verify, on the basis of the experience made in the last two years and through a careful comparisons with operations performed in the usual way, the advantages of employment of ultrasonic dissector in thyroid surgery and if besides such advantages it is possible to obtain real and substantial reductions of the complications. To such aim a randomized perspective study has been lead, confronting two groups of 60 patients, submitted to total thyroidectomy in Chair of General Surgery and Surgical Physiopathology of the University of Palermo-Complex Operating Unit of General Surgery. In all patients have been considered age, sex, histological diagnosis, length of the incision, time (from the incision until suture of skin), entity of the bleeding, hospital stay, post-operative consequences and total costs of thyroidectomy. The elaboration of the obtained data shows the advantages following to the use of the dissectors of last generation: reduction of the times, reduction of the complications, better tolerance of the operation by patients, better rationalization of the resources.

The enzymatic activities of CD38 enhance CLL growth and trafficking: implications for therapeutic targeting.

The ecto-enzyme CD38 is gaining momentum as a novel therapeutic target for patients with hematological malignancies, with several anti-CD38 monoclonal antibodies in clinical trials with promising results. In chronic lymphocytic leukemia (CLL) CD38 is a marker of unfavorable prognosis and a central factor in the pathogenetic network underlying the disease: activation of CD38 regulates genetic pathways involved in proliferation and movement. Here we show that CD38 is enzymatically active in primary CLL cells and that its forced expression increases disease aggressiveness in a xenograft model. The effect is completely lost when using an enzyme-deficient version of CD38 with a single amino-acid mutation. Through the enzymatic conversion of NAD into ADPR (ADP-ribose) and cADPR (cyclic ADP-ribose), CD38 increases cytoplasmic Ca(2+) concentrations, positively influencing proliferation and signaling mediated via chemokine receptors or integrins. Consistently, inhibition of the enzymatic activities of CD38 using the flavonoid kuromanin blocks CLL chemotaxis, adhesion and in vivo homing. In a short-term xenograft model using primary cells, kuromanin treatment traps CLL cells in the blood, thereby increasing responses to chemotherapy. These results suggest that monoclonal antibodies that block the enzymatic activities of CD38 or enzyme inhibitors may prove therapeutically useful.

Functional and aesthetic consequences in the forearm after harvesting the Chinese flap.

We have evaluated the donor site after harvesting the chinese flap in 40 patients operated at the Clinic of Plastic and Aesthetic Surgery of Brno between 1989 and 1994. We conclude that: 1--The hand function is not oustandly altered after harvesting the flap, but in our study 11 patients (27.5%) indicated that they have some limitation or impairment of their hand function. 2--Tolerance to forearm deformity is considerable, but it depends on degree of the defect for which the flap is transferred: 25 patients (62.5%) would like to elect a different flap. 3--It is necessary to think about cosmetic consequences of the chinese flap and consider other possibilities of the flap choice. Secondary defect may be for the patient a problem even several years after operation.

Treatment of a maxillary defect following resection of carcinoma.

A group of 37 oncological patients with tumours of the head and neck where extensive resection of the face, maxilla or mandible or calva was necessary, comprised five patients with a typical defect after resection of part of the maxilla including half of the palate and exenteration of the orbit. This extensive defect causes discomfort to the patient and his environment--functional i.e. impaired speech, and cosmetic. A satisfactory solution during reconstruction of the maxilla without the need of skeletal reconstruction is microsurgical transplantation of a narrow flap of the latissimus dorsi, usually with two cutaneous islands--one to close the palate and the other to close the orbit and face.

Microsurgical reconstruction during treatment of oncological diseases of head and neck.

In 37 oncological patients where extensive resections of the face, maxilla, mandible or calva were necessary, microsurgical reconstructions were used in 27 cases as primary operations at the time of resection, and in 10 cases delayed or secondary operations were made. 49 flaps were used. In five cases two flaps were used in a single stage reconstruction, i.e. one flap for reconstruction of the mandible or buccal and on the other for facial side of the face. During operations a multidisciplinary approach of the surgical team comprising a maxillofacial surgeon, ENT and plastic surgeon is preferred.