About locoregional recurrence risk after lipofilling in breast cancer patients: our experience.

AIM: Lipofilling is a part of the clinical practice for breast reshaping in patients who underwent surgery for breast cancer. A strong debate in the Literature is open about a higher risk of cancer relapse caused by growth factors produced by adipocyte stem cells after their engraftment in the recipient tissue. Nowadays there is no agreement over the use of autologous fat tissue for the correction of aesthetic defects following breast conservative surgery. METHODS: We have considered 151 patients who underwent a breast conservative surgery in the period April 2004-April 2009, followed by one or more lipofilling sessions in the period June 2006-August 2012. A careful pre-operative evaluation of the tumor characteristics has been made, through imaging exams, MRI included. An intraoperative evaluation of the tumor dimensions and its distance from the surgical edges has also been made, followed by a microscopic analysis through a shaving technique. Lipofilling has been offered to all the patients on average 24 months after surgery. RESULTS: We have found no cancer relapses after a mean follow up of 45 months (17-76) after lipofilling and of 69 (27-100) months after surgery. CONCLUSIONS: Considering oncologic surgery, we can affirm that lipofilling is safe for the risk of cancer relapses, if performed using all the parameters included in our clinical protocol.

Laparoscopic adhesiolysis: consensus conference guidelines.

AIM: Laparoscopic adhesiolysis has been demonstrated to be technically feasible in small bowel obstruction and carries advantages in terms of post-surgical course. The increasing dissemination of laparoscopic surgery in the emergency setting and the lack of concrete evidence in the literature have called for a consensus conference to draw recommendations for clinical practice. METHODS: A literature search was used to outline the evidence, and a consensus conference was held between experts in the field. A survey of international experts added expertise to the debate. A public jury of surgeons discussed and validated the statements, and the entire process was reviewed by three external experts. RESULTS: Recommendations concern the diagnostic evaluation, the timing of the operation, the selection of patients, the induction of the pneumoperitoneum, the removal of the cause of obstructions, the criteria for conversion, the use of adhesion-preventing agents, the need for high-technology dissection instruments and behaviour in the case of misdiagnosed hernia or the need for bowel resection. CONCLUSION: Evidence of this kind of surgery is scanty because of the absence of randomized controlled trials. Nevertheless laparoscopic skills in emergency are widespread. The recommendations given with the consensus process might be a useful tool in the hands of surgeons.

End-to-side innervated sensate radial forearm flap in the hand: A 5-year follow-up.

Optimal functional reconstruction of the palmar surface of the hand requires good sensibility especially for the thumb and the radial side of the fingers. We report the long-term results of a distally based radial forearm flap (RFF) used for soft tissue coverage in the palm, index and middle finger and an end-to-side neurorrhaphy between the lateral antebrachial cutaneous nerve (LACN) and the proper palmar digital nerve of the middle finger to restore sensation. At 5 years' follow-up, the patient's sensory recovery was assessed through static and moving two-point discrimination, light touch sensation, pain perception, hot and cold temperature perception, an electrophysiological study and sweat test. An S3+ sensory recovery on the British Medical Research Council scale, as modified by Mackinnon and Dellon, was noted together with a good perception in the palm compared to decreased perception in the volar surface of the proximal phalanx. These findings prove that the RFF can provide good functional coverage of the palm together with good sensitivity by end-to-side reinnervation.

Rehabilitación oral adhesiva: diagnóstico y tratamiento. Caso clínico / Adhesive oral rehabilitation: diagnosis and treatment. A clinical case

El objetivo de este reporte de caso clínico es presentar una rehabilitación integral adhesiva resuelta por alumnos de grado de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), bajo un protocolo de abordaje terapéutico que simplifica su realización. Esta sistematización hace foco en un abordaje completamente aditivo con la finalidad de devolver la salud, la función y la estética de manera predecible. Un paciente de 55 años concurrió a la consulta por motivos estéticos. En el diagnóstico se evidenciaron desgastes severos producto de la parafunción. Se realizó una rehabilitación oral adhesiva seleccionando a la cerámica vítrea como material restaurador. El diagnóstico y la comprensión de su etiología son fundamentales para realizar un tratamiento conservador con restauraciones adheridas y con alto grado de predictibilidad, que se prolongará en el tiempo, gracias a la utilización de una placa orgánica y a los controles de mantenimiento correspondientes (AU)