Bilio-intestinal bypass for the treatment of obesity.

AIM: This study was a retrospective assessment of the results of bilio-intestinal bypass (a variation of the jejuno-ileal bypass, in which the intestinal blind loop is anastomosed to the gallbladder). METHODS: Seventy-five patients underwent the Eriksson bilio-intestinal bypass since 2003 to January 2009. Mean weight prior to surgery was 115.17 (SD±17.74 kg; range 82-177 kg). Mean preoperative BMI (Body Mass Index) was 41.75 kg/m2 (SD±4.42; range 35-60). Primary criteria taken into consideration have been: weight loss, blood tests, reversal rate and complications. RESULTS: One year after surgery BMI reported a mean decrease of 28.31% (SD±2.49%) from a mean of 41.75 to a mean 29.72. The mean follow-up is 26.81 months (SD±17.41 months; range 1-72 months). Blood glucose levels at one year follow-up were normalized, shifting from a mean of 138.5 (SD±23.8) to 86.2 (SD±2.6) mg/dL. Diabetic patients were all able to stop hypoglicemic drugs. Serum total cholesterol and triglycerides concentrations decreased of a mean of 31% and 44%. Morbidity was acceptable (two cases of enterorrhage, one biliary leak, one intra-abdominal abscess all treated conservatively). Reversal rate was 2.67%. No mortality was registered. CONCLUSION: Bilio-intestinal bypass is effective in inducing weight loss and metabolic improvement. This procedure is particularly indicated for the heavily obese who do not accept alimentary restrictions but are willing to submit to long-term monitoring.

Focus on the breast fascial system: a new approach for inframammary fold reconstruction.

Anatomists and surgeons have underestimated the importance of understanding the anatomic connective frame of the inframammary region. The submammary fold does not originate as a self-governing unit but depends on breast mould and on a fine superficial fascial system suspension. The authors investigated the inframammary fold anatomy and subcutaneous breast territory in cadaver and live dissection with histologic analyses, without sharing the theories about superficial fascia splitting and inframammary ligament existence. The authors have understood that a reliable and fine correction of inframammary fold contour in breast reconstruction may only be achieved by an empirical surgical procedure that exclusively concerns the restoration of the superficial fascial system. The literature on this subject is reviewed. Fascial anchoring surgery, after capsulotomy and superficial fasciotomy, without lower thoracic advancement flap or deep subcutaneous undermining, was performed for 100 breast reconstructions after biodimensional device programming. Technique and results are also discussed.

Progressive hemifacial atrophy in a patient with lupus erythematosus.

This is a single case report describing a young woman with progressive facial atrophy that began at age 15. After she underwent commissuroplasty and collagen injection at age 29, her symptoms continued to progress, and she was ultimately shown to have serologic evidence of systemic lupus. She had a "remission of symptoms" after commencement of medical treatment (chloroquine and topical steroids) for her lupus. The association of progressive hemifacial atrophy and lupus is not new. This case and other cases associated with different autoimmune diseases suggest an autoimmune collagen-vascular origin for some cases of progressive facial atrophy. Furthermore, there is a need to modify the surgical approach in light of concurrent disease.

Clinical evaluation of techniques used in the surgical treatment of progressive hemifacial atrophy.

We critically review 13 patients with progressive hemifacial atrophy treated with three basic surgical procedures (free flap transplantation, alloplastic implants, micro-fat injections 'lipofilling') and further ancillary techniques. In spite of the satisfactory results achieved with the procedures, with the exception of alloplasts, we feel that lipofilling may be considered an interesting solution for soft tissue augmentation of the face especially for moderate adipose defects, due to its repeatability, no donor site morbidity, no complications at the recipient site such as lesions resulting from dissection, bleeding, necrosis, etc. This technique can be performed in a day-hospital with short surgery time, at low cost and without a highly skilled team. For severe grades of adipose atrophy, because of the low blood supply to these tissues which interferes with take of any type of autograft, we think that free flaps actually represent one of the best solutions for soft tissue augmentation.

Experimental methodology for digital breast shape analysis and objective surgical outcome evaluation.

Outcome evaluation in cosmetic and reconstructive surgery of the breast is commonly performed visually or employing bi-dimensional photography. The reconstructive process in the era of anatomical implants requires excellent survey capabilities that mainly rely on surgeon experience. In this paper we present a set of parameters to unambiguously estimate the shape of natural and reconstructed breast. A digital laser scanner was employed on seven female volunteers. A graphic depiction of curvature of the thoracic surface has been the most interesting result. Further work is required to provide clinical and instrumental validation to our technique.

MRI of the inner ear: use of modified GRASS and fast spin-echo sequences. A preliminary study.

We report our experience with MRI of the normal and pathological inner ear with fast spin-echo and modified gradient recalled at steady state sequences. Although earlier studies on temporal bone MRI were discouraging, improvements in MR technology combined with the use of paramagnetic contrast media can make MRI a useful diagnostic tool for the assessment of inner ear pathology. Conventional spin-echo imaging seems not to be the modality of choice because of the relatively thick slices and the long acquisition times.

Experimental study of a sleeve microanastomotic technique.

Sleeve anastomosis is an end-to-end variant (i.e., end in end) that makes it possible to suture two vessels quickly and with few stitches. Various methods have been described in the literature concerning experimental surgery (microsurgery and transplantation) and clinical microsurgery. The authors tested for a method that would eliminate narrowing of the inserted vessel segment and that would improve efficiency and feasibility of the technique. The experimental study was performed in 60 rats weighing 200 to 400 g. Telescoping microanastomosis consists of hemi-invagination of a 2-mm-caliber artery at high pressure (subrenal aorta), sidecut of the distal wall of the external arterial segment, and suture with three endoluminal stitches. A total of 61 anastomoses were subdivided in three groups: (1) one-sleeve anastomosis, (2) double-sleeve anastomosis with interposition of an arterial graft, and (3) a control series of conventional end-to-end anastomoses. Patency rates of 95% to 100% at 1 week and 1 month demonstrated no differences among groups.

Anterior craniofacial resection for malignant ethmoid tumors--a series of 91 patients.

BACKGROUND: Anterior craniofacial resection is now recognized as the best treatment for ethmoid tumors involving the cribriform plate with or without invasion of anterior cranial fossa. METHODS: Ninety-one patients underwent an anterior craniofacial resection for ethmoid malignant tumors at the Milan Cancer Institute between 1987 and 1994. The patient population was divided into two sections (30 and 61 patients) based upon some important variants (type of craniotomy, antibiotic treatment, postoperative care). RESULTS: The mean age was 53.4 years (range, 24 to 78 years). There were 62 men and 29 women. Forty-nine patients had a recurrence after previous treatments (surgery and/or radiotherapy). The subdivision by histology was as follows: 50 cases of adenocarcinoma, 16 cases of epidermoid and undifferentiated carcinoma, 8 cases of esthesioneuroblastoma, 5 cases of adenoid cystic carcinoma, 5 cases of melanoma, and 6 rare tumors. The stages (according to our new staging) were as follows: 37 cases with T2, 27 cases with T3, and 27 cases with T4. The mean follow-up was 47 months. Seven patients died after surgery (6 in the first series). The survival at 3 and 5 years was, respectively, 52% and 47%, and the disease-free survival (DFS) was 30% and 24%, with a statistically significant difference at multivariate analysis in favor of patients without prior treatment (p = .033) or T2 versus T3 and T4 (p<.007). CONCLUSIONS: An anterior craniofacial resection should be performed in cases of ethmoid tumors reaching or eroding the cribriform plate. A scrupulous intra- and postoperative approach is necessary to avoid severe complications. The patients often survive for a long time with recurrence ongoing. Our new staging identifies the critical extensions of ethmoid tumors.