The role of component separation in the treatment of severe diastasis recti abdominis: a new indication for a known technique.

OBJECTIVE: Diastasis of the rectus abdominis muscle (DRAM) is a widening of linea alba, it also could be accompanied by abdominal bulging. DRAM is often a cause of quality-of-life impairment, especially when it is of large dimensions. Repair with direct rectus plication is the most common treatment for Diastasis Recti Abdominis (DRA), but it can result in high recurrence rates. The authors aimed to show their results in applying the component separation technique in wide DRA cases. PATIENTS AND METHODS: From January 2015 to July 2018, 43 patients with DRA ≥ 10 cm at 3 cm over the umbilicus have been treated with component separation technique associated to panniculectomy. A biologic mesh was positioned onlay in cases of weakness along the semilunaris lines. RESULTS: DRA repair was achieved in all cases. All patients completed the 1-year follow-up and no recurrence nor major complication were registered. Minor complications were observed in 12 (27.9%) cases. CONCLUSIONS: This is the first study describing the component separation technique use in cases of DRA without hernia, associated to abdominoplasty surgery. Preliminary results were encouraging, but larger series are required.

Blue autofluorescence in protein aggregates "lighted on" by UV induced oxidation.

Oxidation of amino acid side chains in protein structure can be induced by UV irradiation leading to critical changes in molecular structure possibly modifying protein stability and bioactivity. Here we show, by using a combination of multiple spectroscopic techniques and Fluorescence Lifetime Imaging, that UV-light exposure induces irreversible oxidation processes in Ubiquitin structure. In particular, the growth of a new autofluorescence peak in the blue region is detected, that we attribute to tyrosine oxidation products. Blue autofluorescence intensity is found to progressively increase also during aggregation processes leading to the formation of aggregates of non-amyloid nature. Significantly, analogous spectral modifications are found in amyloid fibrils from human insulin and Amyloid-ß peptide grown under UV exposure. Experimental results reveal a substantial overlap between the fluorescence signal here attributed to tyrosine oxidation and the one referred in literature as "Amyloid autofluorescence". These findings clearly represent a caveat about the specificity of the blue fluorescence peak measured for amyloids, especially when grown in conditions in which tyrosine residues may be oxidized. Moreover, our results once again highlight the close link between the formation of amyloid aggregates and protein damage resulting from oxidative stress, as these neurotoxic aggregate species are found to contain damaged residues.

Postmitotic control of sensory area specification during neocortical development.

The mammalian neocortex is subdivided into cytoarchitectural areas with distinct connectivity, gene expression and neural functions. Areal identity is initially specified by rostrocaudal and mediolateral gene expression gradients in neuroepithelial and radial glial progenitors (the 'protomap'). On further differentiation, distinct sets of gene expression gradients arise in intermediate progenitors and postmitotic neurons, and are necessary to implement areal specification. However, it is still unknown whether postmitotic gene expression gradients can determine areal identity independently of protomap gradients. Here we show, by cell type-restricted genetic loss- and gain-of-function, that high levels of postmitotic COUP-TFI (Nr2f1) expression are necessary and sufficient for the development of sensory (caudal) areal identity. Our data indicate a crucial role for postmitotic patterning genes in areal specification and reveal an unexpected plasticity in this process, which may account for complex and evolutionarily novel structures characteristic of the mammalian neocortex.

New head-mounted miniaturized microscope in hypospadia surgical correction.

AIM: The aim of this paper was to report our experience using VarioscopeÒM5 in hypospadia surgical correction. To suggest the use of microsurgical principles that can result in the successful repair of hypospadias with a few complications. METHODS: Forty-three patients (age 12-16 months), affected by hypospadia, underwent longitudinal dorsal preputial island flap (Scuderi's technique) surgical procedure. All the procedures were performed with Varioscope®M5. This new device is a head-mounted miniaturized microscope which combines a microsurgical microscope illumination and magnification with the freedom of loupes. RESULTS: In 39 (91.1%) of the patients the postoperative course was uneventful. One patient (2.3%) developed urethral fistula and a second intervention was necessary to correct it. He was affected by fourth degree hypospadia. In 3 patients (6.6%) we observed a mild stenosis. Urethral strictures were dilated during multiple sessions, by weekly introduction of catheters of progressively increasing caliber. At 3 months after surgery all urethral strictures had been solved by non surgical treatment, thus decreasing complication rate of the surgical procedure from 8.9% to 2.3%. Evaluation of flow rate was repeated at 3 weeks, 6 and 12 months. The aesthetic outcome was evaluated by the parents on a VAS scale. Results were judged optimal (8-9 out of 10). CONCLUSION: In order to achieve a better aesthetic and functional outcome and to reduce complications we deem a perfect flap dissection and anastomosis necessary. A well lighted and magnified surgical field is essential to achieve the best result due to the small anatomical structures involved in the surgical technique we have adopted. The Varioscope®M5 offers essential advantages in this regard.

Extracranial association of arteriovenous and venous malformations. Case report.

Association of multiple vascular malformations of the face is a rare condition. An arteriovenous malformation (AVM) with a venous malformation as the draining vein is also a rarity. We report a case of extracranial mixed vascular malformations that deformed the normal architecture of the lower face. Removal of the AVM was followed by stability of the jaw and tongue malformation, indicating the AVM used the venous malformation as its draining vein. This approach spared the patient severe cosmetic and functional sequelae.

Hypericum perforatum L. subsp. perforatum induces inhibition of free radicals and enhanced phototoxicity in human melanoma cells under ultraviolet light.

OBJECTIVES: Our interest continues in discovering phytocomplexes from medicinal plants with phototoxic activity against human melanoma cells; thus the aim of the present study was to assess antioxidant, anti-inflammatory and phototoxic activity of Hypericum perforatum L. subsp. perforatum, and relate these properties to the plant's chemical composition. MATERIALS AND METHODS: Components of H. perforatum subsp. perforatum were extracted by hydroalcoholic solution and chemical profiles of preparations (HyTE-3) performed by HPTLC. Linoleic acid peroxidation and DPPH tests were used to assess antioxidant activity, while MTT assay allowed evaluation of anti-proliferative activity with respect to A375 human melanoma cells after irradiation with UVA dose, 1.8 J/cm(2) . Inhibition of nitric oxide production of macrophages was also investigated. RESULTS: HyTE-3 indicated better antioxidant activity with ß-carotene bleaching test in comparison to DPPH assay (IC50 = 0.89 µg/ml); significant phototoxicity in A375 cells at 78 µg/ml concentration resulted in cell destruction of 50%. HyTE-3 caused significant dose-related inhibition of nitric oxide production in murine monocytic macrophage cell line RAW 264.7 with IC50 value of 342 µg/ml. CONCLUSIONS: The H. perforatum subsp. perforatum-derived product was able to suppress proliferation of human malignant melanoma A375 cells; extract together with UVA irradiation enhanced phototoxicity. This biological activity of antioxidant effects was combined with inhibition of nitric oxide production.

Effects of individual and combined dietary weight loss and exercise interventions in postmenopausal women on adiponectin and leptin levels.

BACKGROUND: Excess body weight and a sedentary lifestyle are associated with the development of several diseases, including cardiovascular disease, diabetes and cancer in women. One proposed mechanism linking obesity to chronic diseases is an alteration in adipose-derived adiponectin and leptin levels. We investigated the effects of 12-month reduced calorie, weight loss and exercise interventions on adiponectin and leptin concentrations. METHODS: Overweight/obese postmenopausal women (n = 439) were randomized as follows: (i) a reduced calorie, weight-loss diet (diet; N = 118), (ii) moderate-to-vigorous intensity aerobic exercise (exercise; N = 117), (iii) a combination of a reduced calorie, weight-loss diet and moderate-to-vigorous intensity aerobic exercise (diet + exercise; N = 117), and (iv) control (N = 87). The reduced calorie diet had a 10% weight-loss goal. The exercise intervention consisted of 45 min of moderate-to-vigorous aerobic activity 5 days per week. Adiponectin and leptin levels were measured at baseline and after 12 months of intervention using a radioimmunoassay. RESULTS: Adiponectin increased by 9.5% in the diet group and 6.6% in the diet + exercise group (both P ≤ 0.0001 vs. control). Compared with controls, leptin decreased with all interventions (diet + exercise, -40.1%, P < 0.0001; diet, -27.1%, P < 0.0001; exercise, -12.7%, P = 0.005). The results were not influenced by the baseline body mass index (BMI). The degree of weight loss was inversely associated with concentrations of adiponectin (diet, P-trend = 0.0002; diet + exercise, P-trend = 0.0005) and directly associated with leptin (diet, P-trend < 0.0001; diet + exercise, P-trend < 0.0001). CONCLUSION: Weight loss through diet or diet + exercise increased adiponectin concentrations. Leptin concentrations decreased in all of the intervention groups, but the greatest reduction occurred with diet + exercise. Weight loss and exercise exerted some beneficial effects on chronic diseases via effects on adiponectin and leptin.

Evaluation of negative pressure vacuum-assisted system in acute and chronic wounds closure: our experience.

Negative-pressure therapy or vacuum-assisted closure (VAC) has been used in clinical applications since the 1940's and has increased in popularity over the past decade. This dressing technique consists of an open cell foam dressing put into the wound cavity, a vacuum pump produces a negative pressure and an adhesive drape. A controlled sub atmospheric pressure from 75 to 150 mmHg is applied. The vacuum-assisted closure has been applied by many clinicians to chronic wounds in humans; however it cannot be used as a replacement for surgical debridement. The initial treatment for every contaminated wound should be the necrosectomy. The VAC therapy has a complementary function and the range of its indications includes pressure sores, stasis ulcers, chronic wounds such as diabetic foot ulcers, post traumatic and post operative wounds, infected wounds such as necrotizing fasciitis or sternal wounds, soft-tissue injuries, bone exposed injuries, abdominal open wounds and for securing a skin graft. We describe our experience with the VAC dressing used to manage acute and chronic wounds in a series of 135 patients, with excellent results together with satisfaction of the patients.

Evaluation of phototoxic potential of aerial components of the fig tree against human melanoma.

OBJECTIVES: To date, Ficus carica L. cultivar Dottato (F. carica) has not been studied from a phototoxic point of view. In the present work, aerial components of F. carica from Italy, were examined to assess their antioxidant and phototoxic activity on human melanoma cells. A relationship between antioxidant, phototoxic activities and chemical composition has also been investigated. MATERIALS AND METHODS: Coumarin and fatty acid content in F. carica leaves, bark and woody parts were examined and compared by capillary GC and GC/MS. Polyphenolic content was also determined. Linoleic acid peroxidation and DPPH test were used to assess antioxidant activities, and MTT assay was used to evaluate anti-proliferative activity, on C32 human melanoma cells, after irradiation with a UVA dose of 1.08 J/cm(2). RESULTS: Leaves demonstrated the best antioxidant and anti-proliferative activity in comparison to bark and wood. In particular, leaves were shown to possess the highest anti-radical activity and inhibition of peroxidation, with IC(50) values of 64 and 1.48 µg/ml respectively. The leaves had highest anti-proliferative activity with IC(50) value of 3.92 µg/ml. The phytochemical investigation revealed different composition between the coumarins, psoralen and bergapten, fatty acids, polyphenols and flavonoid content among plant parts. CONCLUSIONS: Data obtained indicate that this type of fig tree may constitute an excellent source of bioactive compounds, such as phenolics, coumarins and fatty acids. This study offers a new perspective in developing others formulations potentially useful in photodynamic therapy for treatment of non-melanoma skin cancers.

["Skin reducing mastectomy" and immediate breast reconstruction with Becker 35 contour profile breast implant: our experience]. / "Skin reducing mastectomy" e ricostruzione immediata con protesi/espansore Becker 35 contour profile. Nostra esperienza.

AIM: We describe in this paper our experience with the technique of skin-reducing mastectomy in the treatment of breast cancer. METHODS: Between October 2005 and April 2010 in our Center 33 patients underwent breast surgery utilizing the skin-reducing mastectomy technique and immediate breast reconstruction with expansor/definitive implant Becker 35 contour profile. Contralateral symmetrization was performed in the same operation. All selected patients satisfied inclusion critera either for nipple-sparing mastectomy or prophylactic mastectomy. We selected patients who had large ptosic breasts: areola-submammary fold >8 cm and jugular-nipple distance >25 cm. After histologic exam to confirm the lack of retroareolar tissue infiltration the nipple was preserved in a superior flap. RESULTS: Twenty-four out of 33 patients (72.7%) did not suffer from complications. In 9 patients (27.3%) we observed early complications. During follow-up we observed in 24 patients (72.7%) Baker I capsular contracture, in 9 patients (27.3%) Baker II capsular contracture. Esthetic results of symmetry, shape and volume were good to optimal. Patients' satisfaction was similar. During the follow up (6-33 months, average 17.7 months) no patient suffered from breast cancer recurrence. CONCLUSION: The "skin-reducing mastectomy" reduces mutilation and unsightly scar visibility. It gives a pleasant aesthetic outcome without hindering oncological safety.

Effects of zafirlukast on capsular contracture: long-term results.

Capsular contracture is a distressing complication after breast augmentation for both the patient and surgeon. Although capsular contracture is a multifactorial process, one common denominator in the successful treatment of this complication is believed to be the abatement of inflammation. Leukotriene antagonists have recently emerged as effective prophylactic agents in reactive airway diseases. A prospective study was carried out on 60 female patients (120 prostheses implanted) with mild/severe capsular contracture in at least one breast. The hardness of capsular contracture was assessed by means of the mammary compliance method. Patients received zafirlukast (Accolate®) for a 6-month period. Mammary compliance was assessed at the start of the study and thereafter monthly, during drug intake and for one year after drug withdrawal. The results show a significant decrease in breast compliance values in the first 6 months, followed by a significant increase one year after the end of drug intake. Indeed, zafirlukast-treated patients displayed a 6.93 percent reduction in mammary compliance after 1 month, 14.42 percent after 3 months, 22.05 percent after 6 months and 22.52 percent after 7 months (1 month after the withdrawal of the drug). Thereafter, mammary compliance values gradually increased. A 5.47 percent reduction in mammary compliance was observed 1 year after drug withdrawal. The present study suggests that zafirlukast may be effective in reducing breast capsule distortion in patients with long-standing contracture, though reduced capsular contracture values are strictly related to the duration of drug intake.

Cachrys pungens Jan inhibits human melanoma cell proliferation through photo-induced cytotoxic activity.

OBJECTIVE: To date, plants belonging to the genus Cachrys have not been amply studied. In the present study, aerial components of Cachrys pungens Jan from Italy, were examined to assess their free radical-scavenging and antioxidant activity, and their phototoxicity on A375 melanoma cells. In view of potential pharmaceutical applications, a relationship between antioxidant, phototoxic activities and polyphenolic composition has also been investigated. MATERIALS AND METHODS: Content of sterols, terpenes, fatty acids and coumarins was assessed by gas chromatography-mass spectrometry and GC. Total phenolic content was also determined. Antioxidant activity of the methanol extract and fractions of C. pungens Jan was assessed using DPPH scavenging assay and ß-carotene bleaching test. Plant phototoxicity was also investigated in this human tumour cell line (amelanotic melanoma). RESULTS: Analysis of the chloroform extract was particularly interesting, as it led to identification of many coumarins, of which five were linear and one angular furanocoumarins. Methanol and ethyl acetate fractions exhibited substantial antioxidant activity. Moreover, chloroform extract and isolated coumarin fraction had strong phototoxic activity on UVA-induced A375 cells after irradiation at UVA dose of 1.08 J/cm. CONCLUSIONS: Plant-derived natural compounds are an important source for development of cancer-fighting drugs. This study has demonstrated strong phototoxic activity of the coumarin fraction of C. pungens, a plant which, to our knowledge, has never been studied before. This investigation offers a new perspective for developing other formulations potentially useful in photodynamic therapy for treatment of non-melanoma skin cancers as well as melanomas.

[The distally based sural neurocutaneous flap in reconstruction of lower limb: our experience]. / Il lembo neurocutaneo surale a base distale nella ricostruzione dell'arto inferiore: nostra esperienza.

BACKGROUND: Our study concerns eight patients who have undergone surgery at the Department of Plastic, Reconstructive and Aesthetic Surgery of the University of Perugia, for the reconstruction of lower limb using the distally based sural neurocutaneous flap for covering loss of substance of various origin, from October 2007 to November 2009. PATIENTS AND METHODS: The aim of our study is to demonstrate the reliability of distally based neurocutaneous sural flap in reconstruction of lower limb following a loss of substance of different nature involving the lower third of the leg. Eight patients were on systemic and local clinical conditions that can not be undergoing surgery with use of free flap. In five patients (62%) the loss of substance had been caused by traffic accident while another patient (12%) had been the victim of an accident at work. Two patients (26%) had suffered from pressure ulcers and were unstable with regard to the vascularisation. RESULTS: We observed no cases of total necrosis of the flap and in all eight patients we showed good healing. Follow up was 2, 4, 6, and 9 months after surgical intervention. CONCLUSION: Our study has shown that the use of the distally based sural neurocutaneous flap in reconstruction of lower limbs, as a salvage procedure, is still a valid alternative procedure to free tissue transfer. Because of reduced operative times, reduced anaesthetic risk, reduced risk of total flap necrosis and reduced costs, it could be considered as a preferable choice in selected cases.

The use of poly-lactic acid to improve projection of reconstructed nipple.

PURPOSE: Nipple-areola reconstruction represents an important step for final mammary reconstruction. Many techniques have been described. The drawback is the progressive nipple projection loss with time from 50% to over 70% of the initial projection. In this report, we evaluated the effect of injectable poly-lactic acid (PLLA) to improve projection of reconstructed nipples. RESULTS: We selected 12 patients with a residual nipple projection between 0.1 and 2 mm. The patients were injected locally inside the nipple with 0.5 ml of PLLA (dilution 1:4) every 4 weeks for 4 times. At the study end, patients were satisfied with results. No adverse effects were observed. After one year, an increase of nipple projection ranging from 0.5 to 3.5 mm was obtained with an average increase of 2.3 mm (282%) and this variation was statistically significant (p < 0.0001). CONCLUSION: The use of injectable PLLA is a simple and effective procedure to improve projection of reconstructed nipple.

L-specular plasty versus double-round plasty: two new techniques for earlobe split repair.

BACKGROUND: Split earlobes can be classified into two groups: congenital and traumatic. The congenital group can be divided into three categories: anterior, posterior with doubled earlobe, and sagittal. The traumatic group can be divided into two categories: complete and incomplete. This report describes and compares two new techniques the authors have developed for split earlobe repair: L-specular plasty and double-curve-specular plasty. Both techniques are simple to perform and deliver a good aesthetic result. METHODS: A series of 30 patients with split earlobes underwent surgery from September 2007 to September 2009. All the patients enjoyed good health with no organic pathologies. All the patients had surgery under local anesthesia. The L-specular plasty technique was used to treat 15 patients (13 complete splits, 2 incomplete splits). The remaining 15 patients (13 complete splits, 2 incomplete splits) were treated with the double-curve-specular plasty. RESULTS: Skin necrosis was not reported for any of the treated patients. Sutures are completely removed after 2 weeks. The sutures for three patients were removed after 20 days due to slow cicatrization. Repiercing of the ear may occur after 6 months. One patient (8%) experienced a wound infection, treated successfully with systemic antibiotic therapy. Two patients (16%) experienced hypertrophic scars. Only two patients (16%) had recurrence during a mean follow-up period of 13.4 months (range, 6-24 months: September 2007-2009). CONCLUSION: Both double-curve-specular plasty and L-specular plasty are simple, reliable procedures. They both deliver very good aesthetic results thanks to the curve incisions that follow the natural shape of the earlobe. However, the patients treated with double-curve-specular plasty reported greater satisfaction in the outcome of their surgery.

[Aminoacids and hyaluronic acid in topical treatment of bedsores. Clinical report]. / Il trattamento topico di ulcere da pressione con aminoacidi e acido ialuronico. Caso clinico.

Pressure ulcers are evolutive tissue of the skin, derma and subcutaneous layer. If not treated properly, but sometimes despite that, they may even reach muscles and bones. Nutritional status of the patient is the most important and potentially reversible factor which can contribute to wound recovery. Several studies underline in particular the importance of the proteic and caloric intake in order to stimulate the formation of granulation tissue and collagen. We thought giving the nutrients for wound repair directly on the wound bed, topically, therefore using the wound bed as exchange surface and presuming the wounded tissues are able to absorb, metabolize and ultimately use the aminoacids to repair the damage. The goal of our work is to describe the clinical case patient treated with a new active wound dressing releasing aminoacids and hyaluronic acid.

The use of pectoralis major myocutaneous flap as "salvage procedure" following intraoral and oropharyngeal cancer excision.

BACKGROUND: The benefits and superiority of free flaps for head and neck reconstruction are well recognized. However, in some instances, especially in elderly and critical patients with advanced intraoral and oropharyngeal cancers or in patients with underlying systemic syndromes (i.e. uncontrolled diabetes, cardio-pulmonary failure, renal insufficiency), the use of pectoralis mayor myocutaneous flap may be a preferable option with fewer risks for the patient. PATIENTS AND METHODS: We present a series of 12 pectoralis major myocutaneous flaps, performed from January 2007 to June 2008, in 12 critical patients who presented with advanced carcinomas of the oral cavity and oropharynx. In all cases, histology showed (T3-T4)-(N0-N3)-M0 squamous cell carcinomas. Tumors were: 4 intraoral (33%), 2 in the oropharynx (16%), 5 in the hypopharynx (41%) and 1 of the skin left auricle (8%). RESULTS: There were no flap loss. Partial skin necrosis (<10%) occurred in 1 case (8%); one patient (8%) developed wound infection treated successfully with systemic antibiotic therapy. Minor oro cutaneous fistulas developed in 2 patients (16%). At the follow-up 4 patients (34%) died after 4 months, 2 patients (16%) had recurrence of disease, 6 patients (50%) showed no evidence of disease. CONCLUSION: The use of pectoralis major myocutaneous flap as a salvage procedure in immediate reconstruction following ablative surgery of head and neck cancers is still a valid alternative procedure to free tissue transfer. Because of reduced operative times, reduced anaesthetic risk, reduced risk of total flap necrosis and reduced costs, it could be considered as a preferable choice in selected cases.

[Leg ulcers in patient affected by polycythemia vera in treatment with hydroxycarbamide. Case report]. / Ulcere cutanee in paziente con policitemia vera in trattamento con idrossicarbamide. Case report.

Leg ulcers are a frequent and serious complication of polycythemia vera (PV). They are caused by a synergic action of vascular, neurological and infectious physiopathologic mechanisms. Furthermore, cytostatic therapies commonly employed to control the myeloproliferative disease negatively interfere on the development of granulation tissue, slowing down the recovery of the ulcer. We describe the case of a 70 years old woman with PV, who had calcaneous and perimalleolar ulcers. They were so painful that they made it almost impossible for her to sleep and walk normally. These ulcers were particularly resistant to common topical therapy. Further and accurate investigations showed that these ulcers were a complication of hydroxycarbamide therapy employed and they were not a complication of the ematologic disease. Leg ulcers during hydroxycarbamide therapy are a relatively frequent but underestimated condition. Pathogenesis is bound to numerous factors, i.o. cellular damage and tissutal hypoxia, consequent of drug induced macroerythrosis. In our patient drug substitution and prosecution of topic therapies allowed the recovery of the leg ulcers, particularly serious for both, extensiveness and symptoms.

["Step technique" in the treatment of the loss of substance of the lower lip]. / Tecnica "a scaletta" nel trattamento delle perdite di sostanza del labbro inferiore.

The most frequent pathology of the lower lip is the neoplastic pathology and squamous cell carcinoma is the most clinically diagnosed. Wide excision is the correct surgical approach but it may cause severe morpho-functional and aesthetic damages. At the Plastic and Reconstructive Department of Policlinico Umberto I, " Sapienza" University of Rome, from 2005 to 2008 36 patients were treated, 19 only by surgical excision (Group I) and 17 by Johanson's technique (Group II). Follow-up was at 6 and 12 months to evaluate the morpho-functional outcome, the asymmetry and the healing. Moreover a questionnaire of 9 items was proposed to patients to evaluate functional and aesthetic results. Data showed that Johansons' s flap achieves the same results of the complete surgical excision but with better morpho-functional and aesthetic outcomes, greater satisfaction and same staying in hospital for patients.