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).

Aesthetic comparison between synthetic glue and subcuticular sutures in thyroid and parathyroid surgery: a single-blinded randomised clinical trial.

The aim of our study was to compare, in terms of aesthetic results, the use of synthetic glue to intradermal absorbable sutures in postthyroidectomy and parathyroidectomy wound closure in a single blinded, randomised, per protocol equivalence study. From September 2008 to May 2010, patients undergoing thyroid or parathyroid surgery (with an external approach) at the Otolaryngology Department of the University Hospital of Modena were assessed for eligibility. In total, 42 patients who had had synthetic glue application on surgical incisions (A) and 47 patients who had subcuticular sutures on their surgical incisions (B) were enrolled. The mean of the endpoint (based on the Wound Registry Scale) of group A at 10 days was 1.4, while that in group B (based on the Stony Brook Scar Evaluation Scale) was 2.9. Statistically significant (p = 0.002) and clinically significant (difference of the means = 1.5) differences in the aesthetic results were found between groups A and B at 10 days, with better results in group B. On the other hand, at 3 months, the mean of the endpoint in group A was 3.1 while that in group B was 2.8; no statistically significant (p = 0.62) or clinically significant (difference in means = 0.3) differences were found between groups A and B. In conclusion, synthetic glue differs from subcuticular suture in post-thyroidectomy or post-parathyroidectomy incision for early aesthetic results, with better outcomes for subcuticular sutures. At 3 months, there were no differences in aesthetic outcomes between groups. Moreover, sex, incision length, age, cold/hot blade and correspondence of the incision with a wrinkle in the skin did not seem to influence aesthetic outcomes with this type of incision.

Long-term psychometric outcomes of facial lipoatrophy therapy: forty-eight-week observational, nonrandomized study.

The aim of this observational, prospective, nonrandomized study was to assess long-term psychometric outcomes of surgical treatment of HIV-related facial lipoatrophy. Two hundred ninety-nine participants (70.8% male) consecutively attending the Metabolic Clinic of Modena and Reggio Emilia University from November 2005 to July 2006, undergoing surgical interventions for HIV-related facial lipoatrophy were enrolled. Fifty-four (18.1%) underwent facial lipofilling, which consists of the harvesting of a small, intact parcel of fatty tissue with processing that removes the nonviable components and of the transport of fatty parcels through a small cannula to implant the graft in a manner that provides nutrition and anchors the fat to the host tissue. After an initial lipofilling, 24 (8%) needed polylactic acid injections to correct cheek asymmetry, 91 (30.4%) received only polylactic acid infiltrations, and 130 (43.5%) polyacrylamide infiltrations only. Subjective outcome measures were face aesthetic satisfaction, body image perception, depression evaluated by a visual analogue scale (VAS), the Assessment of Body Change and Distress questionnaire (ABCD), and by the Beck Depression Inventory questionnaire, respectively. Objective measure was cheek thickness evaluated by a 7.5-MHz frequency ultrasound probe perpendicular to the skin surface at the nasolabial fold, the corner of the mouth, the zygomatic arch, and centrally between these points in the buccal fat pad area. Both subjective and objective variables were evaluated at baseline and 48 weeks after end of surgical treatment. All 299 participants had significant improvement of the aesthetic satisfaction for the face (VAS from 2.9 +/- 2.1 to 6.2 +/- 2.1, p < 0.0001), of body image satisfaction (ABCD question 7 from 3.8 +/- 1 to 3.1 +/- 1 p < 0.0001 and ABCD question 8 from 70.7 +/- 16.7 to 77.2 +/- 17.2 p < 0.0001), of depression score (Beck score from 11.4 +/- 8.3 to 9.4 +/- 7.8 p = 0.001). Participants experienced a significant augmentation of both cheeks' thickness (right cheek from 4.3 +/- 1.9 mm to 9.5 +/- 3 mm p < 0.0001, left cheek from 4.4 +/- 2 mm to 9.6 +/- 3.1 mm, p < 0.0001). Our data suggest that facial surgery is an important option in the treatment of HIV-related lipoatrophy as an integral part of the management of HIV infection, because of the important and lasting psychological benefits.

Una síntesis versátil y eficiente de nuevas cefalosporinas «caballo de Troya» / An efficient and versatile synthesis of new Trojan-horse cephalosporins

Se describe un procedimiento útil para la síntesis de nuevas cefalosporinas de doble acción. Estas moléculas podrían representar una herramienta fascinante para el tratamiento de enfermedades infeccio- infecciosas sas bacterianas, ya que presentan una posible actividad inhibidora hacia las bacterias que Expresan la â-lactamasa. La principal ventaja de este enfoque sintético de tres pasos reside en su versatilidad, que permite la preparación sistemática de un amplio conjunto de nuevas moléculas

A useful synthesis of new dual-action cephalosporins is reported. These molecules could represent a fascinating tool for treatment of bacterial infectious diseases, since they display a possible inhibitor activity towards â-lactamase expressing bacteria. The major advantage of this 3-step synthetic approach lies in its versatility, which allows the systematic preparation of a wide pool of new molecules

DNA damage by tobacco smoke and some antiblastic drugs evaluated using the Comet assay.

The Comet assay was used in human leukocytes to detect, in vivo, DNA strand-breaks induced by smoking habit to evaluate the test sensitivity to an environmental factor, and by several antiblastic drugs to note their effectiveness at single cell level. Differences related to smoking habit, gender and age are evident. Melphalan shows the widest DNA damage. The damage induced by etoposide can be ascribed to the balancing between the production of strand-breaks and cross-links which limit the migration of DNA fragments. Interferon, fludarabine, prednisone, and oncocarbide appear to induce unexpected strand-breaks. Single cell gel electrophoresis (SCGE) is highly effective in revealing the association between DNA damage and environmental, genetic, and acquired factors, providing further data on the possible applicability of this assay in genotoxic human surveillance in addition to established tests. Moreover, the ability to point out cell subpopulations varying in mean damage levels could allow detection of potentially emerging drug-resistant populations.

[Primary neoplasms of the jejunum-ileum. The clinico-diagnostic and surgical therapy considerations: the clinical cases and a retrospective study of our experience]. / Le neoplasie primitive del digiuno-ileo. Considerazioni clinico-diagnostiche e di terapia chirurgica: contributo casistico e studio retrospettivo della nostra esperienza.

Primary tumors of the jejunum-ileum are rare and constitute about 2% of gastrointestinal neoplasms. The first clinically reported small bowel tumor was a jejunal carcinoma described in 1824 by Sorlin. The authors reviewed our surgical experience of 9 patients treated at the Department of General Surgery of the "E. Franchini" Hospital of Montecchio Emilia (Re) during a 13-years period from 1984 to 1997. On the basis of literature on the topic, the following are taken into consideration, the history, the incidence, the epidemiology, the aetiopathogenesis, the clinical characteristics, the diagnostic, the surgical therapy of these tumors. The subjects included 6 males and 3 females. The average age of the patients was 66 years, with a male predominance ratio of 2:1. Of the seven primary malignant tumors observed, two patients had adenocarcinomas, two had leiomyosarcomas, two had lymphomas and one carcinoid. The benign tumors were respectively leiomyomas and small intestinal stromal tumor. The most common signs and symptoms were abdominal pain and obstruction of the intestine. Preoperative diagnosis was established in 4 of these patients only by roentgenographic examinations, in 2 by ultrasound scan, in 2 by ultrasound scan and computed tomography, in 1 by endoscopic examination. All the 9 tumors were resected: in 7 patients (77.7%) the resection were considered as curative and in 2 patients (22.3%) palliative. All operated patients were staged by the TNM-classification using pathological and surgical reports. The staging of the disease was the following: 2 patients with stage 1 (T2N0M0), 2 patients with stage II (T4N0M0), 3 patients with stage III (1 with T3N1M0 and 2 with T4N1M0), 2 patients with stage IV (T4N1M1). Survival correlated with the different TNM stage: the median survival time was 60 months for stage I, 60.5 months for stage II, 40 months for stage III and 18 months for stage IV.

Aneurysm of right retroesophageal subclavian artery.

A case of aneurysm involving an anomalous right subclavian artery arising from the aortic arch and passing posteriorly to the esophagus is reported. Ischemic syndrome and neurological impairment of the right arm were the symptoms at onset. The diagnostic and operative approach is discussed underlining the technical problems of this type of surgery. The case was successfully treated by resection of the retroesophageal arterial segment and the aneurysm through left thoracotomy and right supraclavicular incision.

Aneurysms of the thoracoabdominal aorta.

Five cases of thoracoabdominal aneurysms are reviewed. These cases were observed during the last 10 years and their incidence was 4% of all aortic aneurysms admitted in the same period. In all the patients the Crawford's technique by graft inclusion with visceral vessel reattachment by direct suture, without by-pass, was adopted. Of the five patients, two underwent elective surgery and three emergency surgery. While the mortality rate in the patients operated on election was 0%, on emergency it was 66,6%.

Portal decompression through direct side-to-side mesocaval anastomosis in the management of certain forms of portal hypertension.

When performing a portosystemic shunt in patients with portal hypertension due to pre-hepatic block, a number of technical problems may arise. In these cases direct side-to-side mesocaval anastomosis through an interruption of the duodenum is favoured by the Authors. Two personal cases of young patients successfully treated by this procedure are reported. In both cases a central splenorenal shunt had been previously performed to treat a pre-hepatic block. The patients presented with recurrent gastrointestinal bleeding, which resulted from delayed thrombosis.