Polydimethylsiloxane: An effective immune adjuvant and slow-release cytokine medium for local cancer treatment.

BACKGROUND AND AIM: Silicone oil or gel has well-defined chemotactic properties on monocytes and lymphocytes in vivo . It results in fibrotic reaction when spread into the human tissues either incidentally or purposely and can slowly release any physically-enclosed lyophilized compounds due to its viscosity. Our aim is to investigate whether polydimethylsiloxane could be considered as an effective medium in the local treatment of cancer. MATERIALS AND METHODS: Our study was conducted between January 2004 and December 2006 on 15 patients with various types of cancer. The criteria for selection included patients with locally-advanced tumor that was rapidly growing and life threatening and those who had poor quality of life and general wellbeing. The patients were already discharged from the cancer centre before joining the study, after they had already received their chemoradiation protocol. Once a week for one month, different areas of the tumor were injected with 0.25 ml of polydimethylsiloxane medical grade (viscosity: 350 centistokes at 30 degrees C), mixed with 300,000 units of lyophilized human IL-2. Tumor biopsies were taken before the study was started and one week after the last injection for the histopathological analysis of the percentage of severe inflammatory reaction using an image analysis system. CT scans of the tumor were taken before the injection cycle was started and one week after the last injection in order to determine the percentage change in the size of the tumor. The quality of life and general wellbeing of the patients was assessed at the beginning of the stud, and one week after the study was over by using the Karnofsky performance test. RESULTS: Our treatment was well tolerated by the patients. They had a significant improvement in their quality of life and general well being ( p = 0.0005). The prognosis of the patients before the beginning of the study ranged between 1 and 6 months, while their overall survival after treatment was between 2 and 12 months, with three patients still remaining alive. A significant decrease in the tumor size was observed at the end of the study in 12 patients ( p p 2 = 0.968; p CONCLUSION: Polydimethylsiloxane could be used as an effective cytokine medium in the local treatment of cancer. When injected inside the tumor, it is capable of creating and modulating an effective, slow and persistent antitumor immune response. Moreover, it is capable of improving the overall survival as well as the quality of life and general well being of the cancer patients.

Breast reduction and subsequent cancer: a prophylactic perspective.

The aim of this paper was to evaluate the impact of breast-gland remodelling, for cosmetic or functional purposes, on cancer incidence during long-term post-surgical follow-up. We reviewed the literature investigating the ratio between the amount of breast tissue resected and cancer incidence during follow-up. Our analysis of the published data suggested that hypertrophic breast remodelling decreases the risk of breast and other types of cancer in post-operative patients. The actual risk reduction for patients over 40 years of age is related to the weight of the surgical specimens during the previous operation. Our conclusions support the use of breast-reduction surgery as a preventive measure in patients complaining of symptomatic breast enlargement, especially those with a family history of breast cancer.

Delayed nipple-sparing modified subcutaneous mastectomy: rationale and technique.

The problem of nipple-areola complex (NAC) preservation during mastectomy is a very intriguing and stimulating issue. In fact, in order to perform an oncologically safe operation, no mammary tissue (enclosed in the main galactophoric ducts) should remain; on the other hand, without the blood supply coming from the breast gland, NAC viability is greatly impaired because the surrounding vascular dermal network is not developed enough to support its metabolic requirements. We suggest therefore a two-step surgical procedure. The first step, on an outpatient basis with local tumescent anesthesia, is a mini-invasive cutting and coagulating procedure. It addresses the autonomization of the vascular supply to the NAC by detaching the galactophore stalk from the nipple and coagulating the deep vascular plexus. The second step, under general anesthesia and again with tumescent technique, removes the breast within its capsule, with careful checks of any remnant and adequate approach to the axilla. A subpectoralis prosthesis completes the procedure. In our view, this technique is electively suitable for prophylactic mastectomy, but also for stage I breast cancer, 2.5 cm from the NAC and 1.5 cm from the skin and pectoralis fascia, and it is very safe, simple, and effective.

The anal bag: a modern approach to fecal incontinence management.

In the past 30 years, colostomy and urostomy bags have dramatically improved the quality of life of ostomy patients. However, the anatomical characteristics and physiological motility of the pelvic floor have hampered the development of suitable disposable containers that can be applied directly to the anus. Use of a recently developed anal bag that insulates the anus and peri-anal area and collects stool was evaluated in two inpatient care settings in Italy from 1994 to 2004. The study included four nurses and eight physicians (four gastroenterologists, two cardiologists, and two gerontologists) involved in the care of 120 patients (65 men, 55 women, ages 45 to 96 years). The study population consisted of patients who were elderly and bedridden (47), had pressure ulcers (15), were affected by fecal incontinence or bedridden in intensive care (10), had coronary problems (10), and were receiving high-dose chemotherapy (10); patients who had undergone anorectal surgery (28) were added to the study to evaluate the anal bag for postoperative use to prevent contamination and contain exudate and fluid. Study participants were divided into groups based on length of anal bag use (3 days, 1 week, or 4 months or more). Objective evaluation at each bag change included skin reactions to the adhesive. Study participants feelings and perceptions as well as nurse and physician evaluations of the anal bag were assessed using questionnaires and four-point rating scales. No adverse reactions to the product were observed and none of the high-risk patients developed a pressure ulcer. The majority of patients (91, 76%) tolerated the bag well and reported it was not painful to remove or apply (102, 85%). Nurses and physicians all considered the device easy to use and appreciated its potential to prevent contamination and cross-contamination. This device may help improve the management of fecal incontinence and prevent complications.

[New abdominal wall reconstruction technique with a plastic-rehabilitative intent (back pain improvement)]. / Nuova tecnica di ricostruzione della parete addominale con intento plastico-riabilitativo.

Many abdominal wall reconstruction techniques have generally failed to pay attention to a number of anatomical considerations concerning the continuity of the thoraco-lumboabdominal fascia that envelops the dorsal and ventral muscles. We have introduced a new surgical technique (round mesh) developed to improve the abdominal wall weakness or pathology (hernia, laparocele) with the aim of restoring the muscular synergy between the anterior and posterior trunk compartments, thus improving sacroiliac stability, posture, and standing effort endurance. One hundred patients of both sexes were enrolled in this investigation. All were affected by abdominal wall impairment, frank hernia or laparocele, and had been complaining of lumbar and sciatic pain for long periods without any definite intervertebral disk pathology. They underwent pre- and postoperative subjective and objective evaluation and insertion of a prefascial polypropylene mesh with a posterior martingale that passes across the spine and paravertebral muscles, ending in two wider rectangles that are criss-crossed ventrally and finally sutured to the iliopubic brim. All the patients improved either subjectively or objectively with the round mesh procedure. This new technique is particularly useful in cases of reduction or impairment of the recti abdominis, transverse and oblique muscles, because simple suture and plication of these muscles is no guarantee of long-term functional restoration.

Phylogeography of Y-chromosome haplogroup I reveals distinct domains of prehistoric gene flow in europe.

To investigate which aspects of contemporary human Y-chromosome variation in Europe are characteristic of primary colonization, late-glacial expansions from refuge areas, Neolithic dispersals, or more recent events of gene flow, we have analyzed, in detail, haplogroup I (Hg I), the only major clade of the Y phylogeny that is widespread over Europe but virtually absent elsewhere. The analysis of 1,104 Hg I Y chromosomes, which were identified in the survey of 7,574 males from 60 population samples, revealed several subclades with distinct geographic distributions. Subclade I1a accounts for most of Hg I in Scandinavia, with a rapidly decreasing frequency toward both the East European Plain and the Atlantic fringe, but microsatellite diversity reveals that France could be the source region of the early spread of both I1a and the less common I1c. Also, I1b*, which extends from the eastern Adriatic to eastern Europe and declines noticeably toward the southern Balkans and abruptly toward the periphery of northern Italy, probably diffused after the Last Glacial Maximum from a homeland in eastern Europe or the Balkans. In contrast, I1b2 most likely arose in southern France/Iberia. Similarly to the other subclades, it underwent a postglacial expansion and marked the human colonization of Sardinia approximately 9,000 years ago.

Origin, diffusion, and differentiation of Y-chromosome haplogroups E and J: inferences on the neolithization of Europe and later migratory events in the Mediterranean area.

The phylogeography of Y-chromosome haplogroups E (Hg E) and J (Hg J) was investigated in >2400 subjects from 29 populations, mainly from Europe and the Mediterranean area but also from Africa and Asia. The observed 501 Hg E and 445 Hg J samples were subtyped using 36 binary markers and eight microsatellite loci. Spatial patterns reveal that (1). the two sister clades, J-M267 and J-M172, are distributed differentially within the Near East, North Africa, and Europe; (2). J-M267 was spread by two temporally distinct migratory episodes, the most recent one probably associated with the diffusion of Arab people; (3). E-M81 is typical of Berbers, and its presence in Iberia and Sicily is due to recent gene flow from North Africa; (4). J-M172(xM12) distribution is consistent with a Levantine/Anatolian dispersal route to southeastern Europe and may reflect the spread of Anatolian farmers; and (5). E-M78 (for which microsatellite data suggest an eastern African origin) and, to a lesser extent, J-M12(M102) lineages would trace the subsequent diffusion of people from the southern Balkans to the west. A 7%-22% contribution of Y chromosomes from Greece to southern Italy was estimated by admixture analysis.

Circumferential mesh in abdominal wall reconstruction: indications, technical notes and case report.

The authors describe an original technique of abdominoplasty aiming at correcting ventral muscles, hypotonia, and relaxation, especially in formerly obese patients, pluriparae women, and patients with neuromuscular impairment. The technique encloses regular dermolipectomy, laparocele or hernia reduction (if existing), ventral fascia plication on the midline, and suprafascial application of a purposely built polypropylene mesh. The mesh consists of three continouos segments: two lateral, wider, rectangular segments to be fixed on the ventral area and one central and narrower (like a belt) segment to be inserted posteriorly into the deep subcutaneous tissue above the dorsal muscles and the spine. The vehicle of inserting circumferential mesh includes introducing a smooth, hollow rod through a small lateral skin access. Then, the two lateral segments are extended and criss-crossed over the abdominal muscles and are fixed to the iliac periosteum. This allows the dorsal and ventral muscles to be contained and supported by the mesh during prolonged standing and exercise.