The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation.

To investigate the safety and clinical efficacy of AA-PRP injections for pattern hair loss. AA-PRP, prepared from a small volume of blood, was injected on half of the selected patients' scalps with pattern hair loss. The other half was treated with placebo. Three treatments were given for each patient, with intervals of 1 month. The endpoints were hair re-growth, hair dystrophy as measured by dermoscopy, burning or itching sensation, and cell proliferation as measured by Ki-67 evaluation. At the end of the 3 cycles of treatment, the patients presented clinical improvement in the mean number of hairs, with a mean increase of 18.0 hairs in the target area, and a mean increase in total hair density of 27.7 ( number of hairs/cm(2)) compared with baseline values. Microscopic evaluation showed the increase of epidermis thickness and of the number of hair follicles two weeks after the last AA-PRP treatment compared to baseline value (P < 0.05). We also observed an increase of Ki67(+) keratinocytes of epidermis and of hair follicular bulge cells and a slight increase of small blood vessels around hair follicles in the treated skin compared to baseline (P < 0.05).

P.R.L. platelet rich lipotransfert: our experience and current state of art in the combined use of fat and PRP.

The authors report their experience about the use of P.R.L. PLATELET RICH LIPOTRANSFERT method (platelet rich plasma mixed fat grafting) in 223 patients affected by soft tissue defects (ulcers, Romberg syndrome, Hemifacial atrophy, loss of substance, and signs of aging). This paper introduces the reader to PRP therapy and reviews the current literature on this emerging treatment modality, showing at the current clinical use of PRP in plastic and reconstructive surgery, with description of innovative methods and future prospects. This technique provides a promising alternative to surgery by promoting safe and natural healing. Here recent studies concerning the use of PRP in the treatment of chronic ulcers and soft tissue defect are reviewed.

Traumas of the middle skull base with TMJ involvement. Case report.

The authors report their experience with temporomandibular joint (TMJ) traumas involving breakage of the roof of the glenoid cavity, an infrequent event that occurs in those cases in which, as a result of the condylar neck not fracturing, the traumatic energy is transmitted to the middle skull base. As the literature contains no valid series for establishing standardized protocols for the treatment of these fractures, we propose our own orthopedic-functional approach. The patient observed by us had suffered a cranio-facial trauma and presented the classical symptoms and signs of TMJ traumas and complete bilateral Bell paralysis. He was subjected to a CAT scan and then to 2-stage treatment consisting of functional rest with liquid diet followed by physiotherapy. An almost total recovery in TMJ function was observed after 1 month. At 1-year follow-up the facial paralysis had resolved completely. On the basis of our experience, breakages of the glenoid cavity can be compared, in terms of treatment procedure, to intracapsular fractures of the TMJ with surgery confined to cases of ankylosis sequelae. To avoid the onset of ankylosis careful control of clinical, functional and radiological follow-up is required.

[New view in the mammary asymmetry treatments]. / Nuove prospettive nel trattamento delle asimmetrie mammarie.

AIM: Breast asymmetry is a huge chapter of breast abnormalities. Surgical therapy is the exclusive one. The breast of women can vary in shape, volume and position, thus creating esthetic, social and psychological problems. METHODS: We classified breast asymmetry into 6 categories and then we treated them with different surgical techniques: reduction mammaplasty according to Planas; augmentation mammaplasty with prosthesis; grafts or both; ultimately mamma-prosthesis (association of mastopexy and prosthesis). We obtained satisfactory esthetic results often with one surgery procedure. Rarely we performed 2 or more procedures of symmetry. We treated 77 patients suffering from breast asymmetry. We excluded in this study the giant-mammary asymmetry (anomaly determined by severe and asymmetric mammary hypertrophy). RESULTS: We found a low number of complications at short and long term. These results are likely due to the ability of the surgeon in the appropriated preoperative evaluation of the patients and of their expectancy and correct surgical techniques. CONCLUSIONS: We tried to obtain 3 results: shape and position of the sick breast as same as possible to the contralateral breast and less evident scars located in hidden regions.

Reconstruction of partially amputated external ear with costal cartilage graft: case report.

Many causes are responsible for secondary anomalies of the outer ear, such as: car accidents, sport- or work-related accidents, assaults, bites from animals or humans, benign or malignant tumours, burns and the effects of surgical interventions of the ear (plastic surgery on the ear or attempts at correction of primary malformations of the ear). The anatomical complexity of the ear makes its reconstruction particularly complicated with post-operative results that are often disappointing. The Authors describe their experience in the reconstruction of a partially amputated outer ear following a dog bite. The therapeutic protocol required various surgical stages. Initially, a cutaneous expander was applied at the level of the mastoid in order to ensure a sufficient quantity of local skin. The second stage was to remove cartilage from the ribs, followed by construction of a cartilaginous model of the ear and its insertion into the subcutaneous mastoid region after removal of the cutaneous expander and any residual ear cartilage. The last stage was to separate the neo-formed outer ear from the mastoid skin with the insertion of a cartilage graft to the posterior region of the reconstructed ear. This graft was covered by the occipital fascia rotated at 180 degrees and by a skin graft removed from the pubis. The postoperative result was satisfactory with recuperation of a good aesthetic appearance of the ear. Aim of the present report is to describe the surgical technique employed in the reconstruction of secondary anomalies of the ear and to highlight errors committed during this procedure. These considerations have allowed us to stress some fundamental elements in the reconstruction of the ear. In particular, the watershed was the awareness that we had to create a cartilaginous model that respected, as far as possible, the anatomy of the outer ear with all its ridges, trenches and cavities. This as well as ensuring a sufficient quantity of local skin in order to cover the cartilaginous graft and, therefore, reduce the risk of exposing the cartilage and subsequent infection, to guarantee an optimal end result.

Abnormalities of canines eruption.

The aim of this article is to present the personal experience on the treatment of 2 groups of patients presenting the same problem: the recovery of teeth 13 and 23 in the dental arch. The 1(st) group consists of adult patients aged approximately 20-28 years with a retained position of the permanent canines and permanence of the respective deciduous teeth in the dental arch. In the 2(nd) group, the loss of the deciduous teeth had not been followed by the physiological eruption of the permanent teeth. The authors' aim is to demonstrate that similar orthodontic treatments can represent valid solutions for the treatment of pathologies with different etiopathogenesis.

[Skull base fractures with TMJ involvement: literary review and case report]. / Fratture della base cranica con interessamento dell'ATM: review della letteratura e presentazione di un caso clinico.

The authors report their experience in the treatment of middle skull base fractures with TMJ involvement of ten patients affected by fractures of the glenoid cavity and of the petrous part of the temporal bone, with TMJ disfunction and facial nerve palsy. The treatment has been based on functional rest, a liquid diet for 5 days and than a functional physiotherapy aimed at rehabilitation of the TMJ. The efficacy of treatment has been showed after 2 months by restoring the dental occlusion and the TMJ's function in nine out of ten cases. Three out of four patients (75%) at the same control showed a full resolution of the facial nerve palsy. At an eighth month's follow-up all the cases had a complete resolution of the symptoms. Finally no significant studies have been reported in literature to set standardized protocols for the treatment of glenoid cavity fractures. According to the experience of authors the fractures of the medium cranial base involving the glenoid cavity should be treated as the current trends of intracapsular TMJ fractures. The orthopedic-functional treatment turns out particularly efficacious when there isn't a reduction of mandibular vertical heights.

[Diabetic foot. Physiopathology, clinical aspects, and recent therapeutic approaches]. / Il piede diabetico. Fisiopatologia, clinica e recenti orientamenti terapeutici.

Diabetic foot is a complication of diabetes mellitus occurring in 15% of patients that is of specific surgical interest. Over the past few years, preventive measures and the use of new therapeutic resources has reduced the number of patients undergoing demolitive surgery. The authors present a concise but at the same time sufficiently detailed picture of modern knowledge of the physiopathology, clinical aspects and current therapeutic guidelines for diabetic foot. In particular, they analyse the validity of various forms of complementary treatment to surgery, including techniques to stimulate tissue repair processes, hyperbaric oxygen therapy and laser therapy, and they underline the importance of using a multidisciplinary approach to this pathology. To this end, they review all the articles on the subject reported on Medline from 1992 to June 1998, presenting and commenting on the most significant results.

Mechanisms of bone resorption: analysis of proinflammatory cytokines in peritoneal macrophages from titanium implant--an experimental design.

Cytokines, and interleukin-6 in particular, are inflammatory peptide mediators that are extensively studied as regulators of bone tissue homeostasis. They seem to be involved in osteoclast activation and bone resorption and probably play a role in osseointegrated implant rejection. In this study we investigate the ability of titanium implants to cause an imbalance in the homeostatic equilibrium of cytokines using the peritoneal cavity of DB-A2 mice as a model. The inflammatory response was evaluated as a messenger ribonucleic acid expression determined by the semiquantitative reverse transcriptase--polymerase chain reaction technique in peritoneal macrophages from titanium-implanted mice. Interleukin-6 release was detected by a specific quantitative enzyme-linked immunosorbent assay. Our results have shown that titanium implants do not significantly stimulate the proinflammatory cytokine system compared to the control group. The enzyme-linked immunosorbent assay test confirms, after a peak in secretion at day 1 compared with basal levels, a clear decrease in interleukin-6 at basal levels on following control at 6 and 9 days after implantation. The study of the interaction between implanted biomaterials and inflammatory mediators seems to be very promising. Perhaps a better understanding of the mechanisms of bone resorption could lead to finding a new clinical solution for patients with osseointegrated implant rejection.

[Cultured human urothelium. Possible application in reconstructive surgery of the urinary tract]. / L'urotelio umano coltivato. Possibilità applicative nella chirurgia ricostruttiva delle vie urinarie.

The authors focus on and analyse a number of problems linked to urinary tract reconstruction, with special reference to urethral surgery in patients suffering from hypospadias. After having examined a number of approaches used over this period, the authors underline the possible new applications and future lines of research offered by cell culture techniques in the fields of urology and plastic surgery.

[Mechanical physiopathology of remodeling peri-implant bone. The role of cytokine]. / Meccanismi fisiopatologici di rimodellamento dell'osso peri-implantare. Ruolo delle citochine.

For a number of years titanium osteointegrated implants have represented a major step forward in dentistry, plastic and maxillofacial surgery, providing a lively stimulus to research both in their application and in the experimental field. The study of osteointegration has led to a more detailed knowledge of bone remodelling regulation mechanisms and the biological mediators involved. In this review the authors examine the role played by cytokines in the homeostasis of bone tissue, paying special reference to the phase of osteoclast activation and its possible effects on peri-implant bone resorption. The authors focus in particular on the effects of interleukin-6 (IL-6) as an important osteotropic factor and a hypothetical target on which to act in order to modulate its effects for therapeutical purposes.

Immediate TRAM flap breast reconstruction in an obese patient with relapsing benign phyllodes tumor: report of a case.

The authors present a case of relapsing benign phyllodes cystosarcoma of the breast in an obese female treated with a simple mastectomy and an immediate reconstruction using a bipedicled transverse rectus abdominis musculocutaneous (TRAM) flap. After a brief review of treatment options for phyllodes tumors, they discuss the advantages of TRAM flap breast reconstruction, suggesting that it may also be applied in obese patients.

[Plastic surgery of the abdominal wall in laparocele in a patient with previous kidney transplant]. / Plastica della parete addominale per laparocele in paziente con pregresso trapianto renale.

The authors report the case of a patient undergoing kidney transplant from a non-related but compatible living donor who subsequently developed a voluminous incisional hernia affecting almost the entire small intestine in the right iliac fossa, the site of earlier surgery. After having analysed the problems involved when a transplant patient requires further surgery owing to the chronic administration of drugs, the authors describe the case. The patient was treated using the insertion of a prolene graft and remodelling the abdominal wall in correspondence with the lower quadrants using abdominoplasty without repositioning the umbilicus.

[Surgical treatment of rhinophyma using dermo-epidermal graft. A case report]. / Trattamento chirurgico del rinofima con innesto dermo-epidermico. Caso clinico.

Rhinophyma is a nosographical form that has always attracted attention, even among non-experts, owing to the marked aesthetic damage it often causes. Several types of surgery have been proposed for its treatment in an attempt to elaborate a technique that is easy to apply and guarantees satisfactory results in clinical and aesthetic terms. After a short review of the general aspects of the pathology, the authors illustrate the case of a patient with rhinophyma treated with a full thickness dermo-epidermic graft, and emphasise that this surgical solution, provided that the indications are correct, is still a valid alternative.

SPECT in the long-term evaluation of osteointegration in intraoral and extraoral implantology.

Scintigraphic methods used in intraoral and extraoral implantology allow the evaluation of bone metabolism in the peri-implant zones, providing anatomic images and functional dynamics information on the osteointegration process. Twenty-five patients who underwent implantation operations for the application of intra- and extraoral prostheses were studied using technetium 99 m single photon emission computed tomographic (SPECT) procedures to evaluate osteointegration dynamics at 3 weeks, and 3, 6, 12, and 24 months. The study demonstrates that radiation emission peaks 3 weeks after surgery with the maximal bone remodeling activity and 6 months after surgery after the functional loading of the implants only in intraoral fixtures. High uptake past the eighth month after surgery has never been detected and must be considered abnormal. SPECT offers the possibility of obtaining a three-dimensional reconstruction of the photon emission of selected structures. The use of these nuclear medicine methods in addition to traditional-type radiological procedures introduces new possibilities, although still in the clinical experimentation phase, for early diagnosis and inserted implant prognosis.

Titanium bone-integrated implants in extraoral facial prosthetic rehabilitation: surgical planning and long-term follow-up.

The authors report on their clinical experience in the reconstruction of complex facial deformities using titanium osseo-integrated implants for the retention of soft silicone prostheses. They also evaluate the importance of this surgical technique as a viable alternative to traditional reconstructive procedures using autologous grafts, both in patients with severe osteomuscular defects and corrective surgery of unsuccessful reconstruction operations. The patients who underwent implantation operations were studied by CT 3D and 99m Tc SPECT (Single Photon Emission Computerized Tomography) procedures to evaluate osseo-integration at 3 weeks, 3, 6, 12, 24 months. The study demonstrates that the radiation emission peaks three weeks after surgery with the maximum bone remodeling activity, and after the functional loading of the implants, 3 months after surgery. High uptake past the eight month after surgery has never been detected and must be considered abnormal. SPECT offers the possibility of obtaining a three dimensional reconstruction of the photon emission of selected structures. The use of these nuclear medicine methods in addition to traditional-type radiological procedures introduce new possibilities, although still in the clinical experimentation phase, for the long-term follow-up of the inserted implants in craniofacial rehabilitation.

[The use of osteointegrated implants in plastic surgery. Ear reconstruction]. / L'impiego degli impianti osteointegrati in chirurgia plastica. Ricostruzione del padiglione auricolare.

The authors present the case of a 14-year-old patient suffering from first branchial arch syndrome with agenesia of the auricle in which the auricle was reconstructed using osteointegrated implants. The patient had previously undergone numerous attempts at reconstruction using traditional methods, all of which had failed. In order to ensure an accurate preoperative evaluation, the patient was studied using CT with a standard technique and three-dimensional image reconstruction for a qualitative and quantitative evaluation of bone thickness so as to allow the optimal positioning of fixtures. This test also revealed the existence and good degree of development of the middle and internal ear. The Authors then proceeded to implant 4 titanium fixtures into the mastoid process of the temporal bone, three of which were used for fixing the auricle prosthesis and one for the insertion of a bone anchored hearing aid. The epithesis, in soft silicon, was modelled to match the contralateral ear with excellent aesthetic results.

[Primary hydatid cyst of the coracobrachial muscle. A clinical case]. / Cisti da echinococco primaria del muscolo coracobrachiale. Caso clinico.

Primary localization of hydatidosis in the musculoskeletal system is a quite rare occurrence. We report a case of a 67 year old man with an infestation of the coracobrachialis muscle. We discuss several instrumental and serologic diagnosis methods and the hypothesis of a primary muscular localization.

[Obstruction of the Le Veen shunt: a new surgical solution]. / L'ostruzione dello shunt di Le Veen: nuova soluzione chirurgica.

The authors propose an alternative which has been proved valid in four cases of peritoneovenous shunt with an occluded Le Veen valve for venous thrombosis implanted in cirrhotic patients with refractory ascites. After having explored the various possibilities using the vessels adjacent to the superior cava branch, the authors resolved the problem of reimplanting the valve by using an access route through the saphenous vein and inferior vena cava. Using this technique it was possible to reactivate the shunt with a marked improvement in the recurrent ascitic state and above all shunt functionality, and consequently in the clinical conditions and quality of life of these patients.

[Darier-Ferrand dermatofibrosarcoma. General aspects and personal experience]. / Il dermatofibrosarcoma di Darier-Ferrand. Aspetti generali ed esperienza personale.

The Darier-Ferrand dermatofibrosarcoma is a cutaneous lesion with a clinic and recidivant progress that appears in both sexes in the same measure. The metastasis are rare. The authors describe a kind of treatment effected in 13 cases arrived to their observation.