Salvage of infected vascular graft via 'perivascular venous banding' technique coupled with rectus abdominis myocutaneous muscle flap transposition.

This is the case of a severe Pseudomonas aeruginosa biological vascular graft infection, completely involving the perianastomotic tract of a femoro - femoral crossover bypass and resulting in repeated bleeding from the offended vessel wall. After the failure of a sartorious rotational muscle flap transposition into the infected groin wound, this 'high-grade' vascular graft infection was finally treated successfully by wrapping a great saphenous vein patch reinforcement circumferentially around the damaged biological vascular conduit and filling the infected wound with a rectus abdominis myocutaneous muscle flap transposition. The aim of this report is to illustrate this novel, to our knowledge, 'perivascular venous banding' technique and to evaluate the prospective of future testing of this surgical procedure. Starting from this singular case, we will also review the role of the rotational muscle flaps in the conservative management of major vascular graft infections.

Colorectal cancer screening: results of a 5-year program in asymptomatic subjects at increased risk.

BACKGROUND AND AIMS: The province of Ferrara has one of the highest incidences of colorectal cancer (CRC) in Italy. In January 2000, we set up a colonoscopy screening program focussing on first-degree relatives of CRC patients. We now report the results 5 years after the beginning of the project. SCREENEES AND METHODS: In October 1999, we started a campaign stressing the usefulness of colonoscopy for the first-degree relatives of CRC patients. Subjects included in the screening program were aged between 45 and 75 years with at least one first-degree relative affected by CRC. They were invited to an interview where a physician suggested colonoscopy as a screening option. RESULTS: In 5 years, 776 subjects were interviewed and 733 (94.4%) agreed to an endoscopic examination (M/F:375/401; mean age 55 years): 562 colonoscopies were performed. Adenomas and cancers were found in 122 (21.7%) and 12 (2.1%) subjects, respectively. Histological examination in 181 persons with lesions (32.8%) showed (most serious lesion quoted) 47 hyperplastic polyps (26% of all lesions), 2 serrated adenomas (1.1%), 68 tubular adenomas (48%), 24 tubulovillous adenomas (13.3%), 9 adenomas with high grade dysplasia (5%) and 12 adenocarcinomas (6.6%). The majority of the cancers were at an early stage (8 Dukes A and 3 Dukes B). Sedation was used in only 42 colonoscopies (7.5%). CONCLUSIONS: A colonoscopy-based screening in this selected high-risk population is feasible. Even without sedation subjects readily agreed to the endoscopic procedure. We identified a significant number of advanced neoplasms and cancers at an early stage suggesting that this could be a useful tool in early identification of CRC.

[Expanders and the prosthetic short line in breast reconstruction after mastectomy: experience with the first 130 surgically treated cases]. / Gli espansori e la linea protesica "short" nella ricostruzione mammaria post mastectomia: esperienza sui primi 130 casi operati.

Breast reconstruction as now to be consider as a complementary treatment of breast cancer surgery. Between 1998-1999 we developed a project of collaboration with Polytech-Silimed Europe Gmbh for a new textured tissue expander. This new system allows expansion of the middle and lower quadrant of the breast acting a physiologic ptosis of the breast. Authors report their experience on the first 130 patients.

[Five hundred sixty-nine flaps used in reconstruction of the head and neck: morbidity analysis and results]. / Cinquecentosessantanove lembi utilizzati nelle ricostruzioni per tumori di testa e collo: analisi su morbilità e risultati.

Aim of the study is to provide high-level results in terms of functionality and softness of the tissues achieved with different reconstructive techniques performed in oncological surgery of the head and neck. Test group was composed of 528 patients recovered with a diagnosis of head and neck cancer. We performed 569 flaps: myocutaneous, cutaneous and fasciocutaneous, and free flaps. The clinical outcome and the morpho-functional evaluation show that free flaps can ensure excellent results, especially in defined anatomical areas such as the cervical-esophageal region, jaw and tongue. As to myocutaneous and cutaneous/fasciocutaneous flaps, they are still the first reconstructive choice, according to their minimal or no functional implications.

[Mechanical microanastomosis in reconstructive surgery of the neck and face]. / Le microanastomosi meccaniche in chirurgia ricostruttiva del distretto cervico-facciale.

Aim of the study is to report our preliminar experience with MCA Coupler System in mechanical microanastomoses performed in head and neck reconstructive surgery. During almost 7 months we performed 7 end-to-end venous anastomoses: 3 of them regarding the cephalic district. We had no vascular thrombosis, vascular congestion or flap loss. Mean time of execution of anastomosis with MCA Coupler System was 10 minutes. In our experence it is essential the choice of the appropriate size of the device and a good dissection of recipient vessels. In our opinion the Coupler System is an easy applicable device, and an efficient alternative to manual micro-anastomoses.

[Free radial forearm flap and myocutaneous flaps in oncological reconstructive surgery of the oral cavity, Comparison of functional results]. / Il lembo libero radiale di avambraccio ed i lembi miocutanei nella chirurgia ricostruttiva oncologica del cavo orale. Implicazioni funzionali a confronto.

In modern multi-disciplinary cancer treatment, rehabilitation and functional results represent utmost intent in reconstructive surgery of the oral cavity. Even in cases where the stage of disease is advanced) and the perspective of survival is limited, it is possible to achieve an acceptable quality of life. The authors report, in this study, the morpho-functional results and the morbidity observed in glossectomies in which the reconstruction was performed using three different methods. In a total of 264 reconstructive flaps of the head and neck regions, the authors considered three groups of 15 patients that had had reconstruction after the demolitive procedure. Respectively these groups were divided by the followed methods: free forearm flap, pectoralis major myocutaneous flap and nasolabial flap. The morbidity showed an extremely low rate of flap loss in all the groups, but "minor" complications, such as fistulas and leakages, were significantly more frequent in the myocutaneous flaps group. Functional evaluation for speech and deglutition showed good results in most patients. Extremely severe postoperative conditions as a permanent NG tube or incomprehensible speech had been observed in less than 15% of the cases. Particularly, the pectoralis major flap, showed its best functional performances in the total or subtotal glossectomies with a sacrifice of the muscles of the oral floor. The free forearm flap is reliable and safe with its low thickness and pliability, especially for partial glossectomies. The nasolabial flap was confirmed to be the first reconstructive choice for selected limited resections of the tongue and of the antero-lateral floor. With this experience it is possible, even in more complex free flaps, to reduce the time consumption and the complication rate. Free flaps do not substitute routinely myocutaneous and conventional flaps, but they represent the "ideal" reconstructive alternatives for specific and selected indications.

[Reconstruction using pedicle and free flaps in partial or total resections of the hypopharyngeal-esophageal tract]. / La ricostruzione con lembi peduncolati e lembi liberi nelle resezioni parziali o totali del tratto ipofaringo-esofageo.

Modern surgical treatment of cancer of the hypopharyngo-esophageal cannot be conditioned by the reconstructive procedures. Reconstructive options are based on the size and position of the defect in this important anatomical region. Currently the reconstruction of the hypopharyngo-esophageal tract allows a rapid and suitable restoration of the vital functions, a low morbidity and shortened hospital stay. The purpose of this study was to compare the various reconstructive approaches in terms of morbidity and functional results. Between January 1990 and June 1994, 17 patients with hypopharyngo-esophageal tract malignancies and one with a stenosis received treatment. The reconstructive procedures included 19 flaps: five myocutaneous pectoralis major flaps, one myocutaneous trapezius flap, five deltopectoral flaps, one radial forearm free flap and seven free jejunal grafts. There were six complications: one total necrosis and two stenosis in the free jejunal grafts group, one partial necrosis and one dehiscence in two myocutaneous pectoralis major flaps and one stenosis in a deltopectoral flap. Based on our studies, we believe that the free jejunal graft is the first choice for total reconstruction of the hypopharyngo and cervical esophageal tract. However the radial forearm free flap is certainly a valid solution for subtotal hypopharyngo-esophageal reconstruction. Pedicled flaps and particularly the myocutaneous pectoralis major flaps are a good alternatives for limited reconstructions (< 50%) of the hypopharyngo-esophageal tract.

[Reconstructive oncologic surgery of the head and neck. Morbidity and comparative results of conventional and myocutaneous flaps]. / Chirurgia ricostruttiva oncologica cervico-facciale. Morbilità e risultati comparativi tra lembi convenzionali e miocutanei.

The authors analyzed the data obtained from their experiences in extensive head and neck resections, and, reconstructive treatments using myocutaneous and conventional flaps. They tried to evaluate comparatively the reconstructive approach, in terms of morbidity and functional results. The 145 cases of advanced had and neck cancer, treated from January 1990 to January 1994, were considered in this study. The reconstructive procedures consisted of 193 flaps. In this study, 106 were myocutaneous flaps (pectoralis major or trapezius flap); 72 were conventional flaps (fasciocutaneous, cutaneous or muscular only) and the remainder were 15 free flaps. The morbidity related to both flap procedures had been low: 33% in myocutaneous flaps versus 11% in conventional flaps. This report demonstrated the versatility, usefulness, and reliability of both kinds of these reconstructive procedures, especially in intra-oral reconstruction. The expected morphological and functional results were quite encouraging in terms of swallowing and speech.

[The rectus abdominis free flap in reconstructive surgery of the head and neck]. / Il lembo libero di muscolo retto addominale nella chirurgia ricostruttiva cervico-facciale.

The Authors describe their preliminary experience with rectus abdominis free flap in reconstructive surgery of the head and neck. Out of the 29 cases of microsurgery in treating head and neck tumours, four inferior rectus abdominis free tissue transfers were used: two for complex intraoral reconstruction and two for composite facial defects. There was one flap loss due to late infection in the region of anastomosis, while there were two complications in the remaining three cases. The morphological and functional results have proved to be highly satisfactory. The flap, based on the deep inferior epigastric vessels, appears to be versatile in terms of skin island design, thickness and length of the pedicle. As with the forearm free flap, the inferior rectus abdominis has the advantage of offering the possibility of simultaneous demolition and reconstruction in one surgical session. The Authors conclude that the low morbidity concerned with this microvascular flap, also reported in international literature, confirm its validity as a soft tissue transfer in the in the treatment of advanced head and neck cancer.

[Morbidity and the morphofunctional aspects of myocutaneous flaps used in the head and neck area]. / Morbilità e aspetti morfo-funzionali in 73 lembi mio-cutanei utilizzati nel distretto cervico-facciale.

The authors analysed the data obtained from their experiences in extensive head and neck resections as well as reconstructive treatments using myocutaneous flaps. They tried to evaluate the reconstructive approach in terms of morbidity and functional results. Sixty-nine patients, treated from January 90 to November 92 for advances intra-oral cancer, were considered in this study. The reconstructive procedure in 68 cases was the pectoralis major myocutaneous flap while in 5 cases the trapezius flap was utilized. Even though the oncological results were poor, the functional ones were quite encouraging. In fact, the assessment of speech and swallowing was extremely satisfactory in 83% of the cases. The morbidity related to both flap procedures was low and the patients' life quality was good. Indeed, the use of a free flap offers additional advantages, without necessarily compromising safety of the reconstruction. Free flaps in general allow greater leeway in flap design and donor-site choice than pedicled flaps. Several reports have already demonstrated the versatility, usefulness and reliability of these flaps, especially in intra-oral reconstruction. The intricate nature of microsurgery and the expense of microsurgical equipment inhibit this kind surgery in many institutions around the world where the standard myocutaneous flaps would be a more practical procedure. In conclusion, even those patients with a poor prognosis may be considered potential candidates for demolitive and reconstructive treatment with which satisfactory results may be obtained.

[Excisional and reconstructive treatment of stage IV tumors in the oral cavity. Results and limits]. / Trattamento exeretico e ricostruttivo dei tumori del cavo orale al IV stadio. Risultati e limiti.

The patients with advanced stages of intraoral cancer, having a limited life expectancy, are often considered non-surgical cases. Radiochemotherapy does not warrant an acceptable quality of life. The authors analysed the data obtained from their experiences in resections that had been extensive, as well as, reconstructive treatment of these kinds of neoplasms. They tried to evaluate the demolitive and reconstructive approach, in terms of morbidity, functional results and survival rate. Thirty-six patients, treated from January 1990 to August 1991 for advanced intraoral cancer, were considered in this study; 58% of the cases had primary tumors and 42% had recurrences. The reconstructive procedure used in all cases, was the pectoralis major myocutaneous flap. Even though the expected oncological results had been poor, the functional ones, had been quite encouraging. In fact, the assessment of speech and swallowing was extremely satisfactory, respectively in 82% and 89% of cases. The morbidity related to the flap procedure had been low. The quality of the residual life of the patients was good, especially if compared with the life of those patients who had not been treated. In conclusion, the authors maintain that even patients with limited prognosis may be considered as potential candidates for demolitive and reconstructive treatment.

[Immediate breast reconstruction. A retrospective analysis of 7 years' experience]. / La ricostruzione mammaria immediata. Analisi retrospettiva su 7 anni di esperienza.

The collaboration between oncological and plastic surgeons proved to be essential in the multifaceted treatment of the neoplasms and high-risk lesions of the breast. It guarantees psychological advantages, and improves the quality of life of the patient, who is a candidate for demolition surgery. The authors analyse the results obtained over a 7-year period, through their experiences of 98 immediate breast reconstructions performed after subcutaneous simplex, Patey or Halsted mastectomies. They assessed the validity of this approach due to the brilliant esthetic results obtained, the minimal surgical time, and the low morbidity.

[Postmastectomy breast reconstruction using myocutaneous rectus abdominalis flap. Our experience]. / La ricostruzione mammaria dopo mastectomia con lembo miocutaneo di retto addominale. Nostra esperienza.

The paper compares the results of 34 patients undergoing reconstructive surgery following radical mastectomy using a TRAM flap with those reported in the literature. The parameters taken into consideration in this study were indications for reconstructive surgery, morbidity and the results of reconstruction. The monopedicle flap offered good cosmetic results and a low rate of complications if correctly and selectively used. This selection should exclude high-risk patients. The bipedicle flap is an effective alternative and the morbidity rate was no higher among the abdominal donor.

[Application of high-pressure liquid chromatography in the analysis of urinary metabolites of aromatic solvents]. / Applicazioni della cromatografia liquida ad alte prestazioni nell'analisi dei metaboliti urinari dei solventi aromatici.

The introduction of HPLC methods in industrial toxicology represents a valuable tool for the routine monitoring of workers occupationally exposed to aromatic solvents. The HPLC method described here permits the simultaneous determination of metabolites of ethylbenzene, styrene, toluene, xylene isomers, benzene, phenol and cresol isomers in diluted urine samples. Pretreatment of urine samples with steam distillation is necessary only for determination of phenol and cresols because of their low concentrations. A comparison between a GLC and the HPLC procedure for mandelic and phenylglyoxylic acids confirmed the satisfactory performance of the HPLC method.

Significance of arsenic metabolic forms in urine. Part I: Chemical speciation.

The aim of this research has been to develop analytical procedures whereby the various chemical forms of arsenic present in urine can be distinguished and further data on the biotransformation of absorbed arsenic can be acquired. The separation of inorganic arsenic ( InAs ), monomethylarsonic acid ( MMAA ), and dimethylarsinic acid ( DMAA ) in urine was performed by ion-exchange chromatography on AG 50 W-X8 resin. Arsenic was then measured directly on the eluted fractions by atomic absorption spectrophotometry, after the reduction of arsenic to the correspondent arsine. In 160 subjects with no occupational exposure to arsenic compounds, InAs , MMAA , DMAA each accounted for about 10% of the total arsenic urinary excretion (17.2 +/- 11.1 micrograms/1), thus indicating that in the normal population over 60% of arsenic in urine is present in other organic forms. After eating marine food, there was a marked increase of urinary output of arsenic, but no increase was observed in InAs , MMAA and DMAA urinary excretion. In the biological monitoring of exposure to inorganic arsenic, particularly in the case of high urinary excretion values, the differentiation of the excreted forms of arsenic is necessary to establish with certainty the source (industrial or alimentary) of arsenic.