Treatment of Recurrent Tracheocutaneous Fistulas in the Irradiated Neck with a Two Layers-Two Flaps Combined Technique.

The development of a tracheocutaneous fistula (TCF) is a well-documented complication after tracheostomy, especially in chronic morbid patients, in whom tubes or cannulas are left in place over time, or in irradiated patients. Surgical treatments are therefore needed which range from simple curettage and dressings to local skin flaps, muscle flaps and, in the more complex cases, microsurgical free tissue transfers. We present a novel combined technique used to successfully treat recurrent TCFs in irradiated patients, involving a superiorly based turnover fistula flap and a sternocleidomastoid transposition flap.

Laser treatment of angiofibromas in tuberous sclerosis.

Tuberous sclerosis complex is an autosomal dominant disorder that can cause nonmalignant hamartomas in any organ. Angiofibromas are the most disturbing marker of the disease because they are conspicuously present on the face. We report the case of a 15-year-old girl affected by tuberous sclerosis, whose facial angiofibromas were satisfactorily treated by a green light vascular laser (532 nm).

A rapid genetic counselling and testing in newly diagnosed breast cancer is associated with high rate of risk-reducing mastectomy in BRCA1/2-positive Italian women.

BACKGROUND: Risk-reducing mastectomy (RRM) decreases breast cancer (BC) risk in BRCA1/2 mutation carriers by up to 95%, but the Italian attitude towards this procedure is reluctant. PATIENTS AND METHODS: This is an observational study with retrospective design, using quantitative and qualitative research methods, aimed at evaluating the attitude towards RRM by rapid genetic counselling and testing (RGCT), at the time of BC diagnosis, compared with traditional genetic counselling and testing (TGCT), after previous BC surgery. Secondary aims were to investigate patient satisfaction after RRM and the rate of occult tumour in healthy breasts. A total of 1168 patients were evaluated: 1058 received TGCT, whereas 110 underwent RGCT. RESULTS: In TGCT, among 1058 patients, 209 (19.7%) mutation carriers were identified, with the rate of RRM being 4.7% (10 of 209). Conversely in RGCT, among 110 patients, 36 resulted positive, of which, 15 (41.7%) underwent bilateral mastectomy at the BC surgery time, showing an overall good satisfaction, measured by interpretative phenomenological analysis 12 months after the intervention. CONCLUSIONS: Our study shows that RGCT in patients with a hereditary profile is associated with a high rate of RRM at the BC surgery time, this being the pathway offered within a multidisciplinary organization.

Endoscopic forehead lift for ptosis of the brow caused by facial paralysis.

Twelve patients with ptosis of the brow caused by facial nerve paralysis were treated by endoscopic forehead lift. Four had an isolated paralysis of the temporal branch of the facial nerve and in eight the entire facial nerve was affected. In two of these patients the facial paralysis was bilateral, caused by Finnish hereditary amyloidosis. A standard subperiosteal endoforehead approach was used and the forehead was fixed by biodegradable pins (n = 8), anchor screws (n = 3), or a suture to the posterior scalp (n = 1). The procedure was a success in 10 patients, and failed in two after initially good results. The endoscopic brow lift is a good method of treating ptosis of the brow caused by paralysis of the temporal branch of the facial nerve.

Treatment of Romberg's disease with parascapular free flap and polyethylene porous implants.

Romberg's disease is a rare condition characterized by progressive hemifacial atrophy. The atrophic process typically has its onset in the first or second decade of life, it continues for a few years (usually 2, but up to 10), and then it stops spontaneously. The subcutaneous tissue is the first to be involved by the disease, followed by muscles, bones, and, rarely, the skin. The etiology of the disease is unknown. The only available treatment is surgical. Several techniques have been reported in the literature, from fat transplant, to silicon prostheses, to the use of flaps. We present our experience in successfully treating six patients (3 males and 3 females) affected by Romberg's hemifacial atrophy of intermediate or severe degree. A technique including a free parascapular microvascular flap with the adjunct of porous polyethylene implants was used. Further correction was performed with remodeling or resuspension.

Leishmaniose tegumentar americana na regiäo nordeste do Estado de Säo Paulo - Brasil / American tegumentary leishmaniasis in the norheastern state of Säo Paulo - Brasil

Os autores descrevem um surto de leishmaniose tegumentar americana (LTA) instalado na regiao nordeste do Estado de Sao Paulo em 1992. Após a notificaçao de doze casos humanos em uma área rural do município de Itupeva, foi realizado um inquérito epidemiológico, destacando-se 34 por cento de positividade da populaçao à Reaçao Intradérmica de Montenegro. Constatou-se uma grande diversidade da fauna flebotomínica local, com predominância de L. migonei, L. intermedia e L. whitmani, tanto no domicílio, quanto na margem da mata. Ressalta-se a presença na margem da mata de L. longipalpis.