Adipocyte-released insulin-like growth factor-1 is regulated by glucose and fatty acids and controls breast cancer cell growth in vitro.

AIMS/HYPOTHESIS: Type 2 diabetes and obesity are associated with increased risk of site-specific cancers. We have investigated whether metabolic alterations at the level of adipose-derived differentiating cells may affect specific phenotypes of breast cancer cells. METHODS: Growth profiles of breast cancer cell lines were evaluated in co-cultures with differentiated adipocytes or their precursor cells and upon treatment with adipocyte conditioned media. Production and release of cytokines and growth factors were assessed by real-time RT-PCR and multiplex-based ELISA assays. RESULTS: Co-cultures with either differentiated mouse 3T3-L1 or human mammary adipocytes increased viability of MCF-7 cells to a greater extent, when compared with their undifferentiated precursors. Adipocytes cultured in 25 mmol/l glucose were twofold more effective in promoting cell growth, compared with those grown in 5.5 mmol/l glucose, and activated mitogenic pathways in MCF-7 cells. Growth-promoting action was also enhanced when adipocytes were incubated in the presence of palmitate or oleate. Interestingly, 3T3-L1 and human adipocytes released higher amounts of keratinocyte-derived chemokine/IL-8, the protein 'regulated upon activation, normally T expressed, and secreted' (RANTES), and IGF-1, compared with their precursor cells. Their levels were reduced upon incubation with low glucose and enhanced by fatty acids. Moreover, both undifferentiated cells and differentiated adipocytes from obese individuals displayed about twofold higher IGF-1 release and MCF-7 cell growth induction than lean individuals. Finally, inhibition of the IGF-1 pathway almost completely prevented the growth-promoting effect of adipocytes on breast cancer cells. CONCLUSIONS/INTERPRETATION: IGF-1 release by adipocytes is regulated by glucose and fatty acids and may contribute to the control of cancer cell growth in obese individuals.

Reconstruction of lower eyelid and periorbital district: an orbicularis oculi myocutaneous flap.

The upper eyelid has long been considered a good source of skin graft, but it is infrequently used as a unipedicled flap, based either medially or laterally, to reconstruct the skin of the lower eyelid. Here we describe a procedure in which we use the upper eyelid skin and underlying orbicularis muscle as a myocutaneous flap to reconstruct the lower eyelid and periorbital region.

Architecture of European plastic surgery.

The architecture of European Plastic Surgery was published in 1996 [Nicolai JPA, Scuderi N. Plastic surgical Europe in an organogram. Eur J Plast Surg 1996; 19: 253-256.] It is the objective of this paper to update information of that article. Continuing medical education (CME), science, training, examination, quality assurance and relations with the European Commission and Parliament all are aspects covered by the organisations to be discussed.

Reconstruction of the upper lip and philtrum.

The procedure used to repair upper lip defects depends on various factors: size and location of the defect, the conditions of neighbouring tissues, and the aetiology of the deformity. A single-stage procedure rarely gives a satisfactory cosmetic outcome in patients who have also lost the philtrum or a philtral crease. Here, we describe a single-step procedure for the reconstruction of the upper lip and philtrum that resulted in a good aesthetic appearance.

Sentinel lymph node detection by lymphoscintigraphy in malignant melanoma.

AIMS AND BACKGROUND: Sentinel lymph node (SLN) detection is currently employed in patients with malignant melanoma (MM) to spare them unnecessary lymph node dissection. METHODS AND STUDY DESIGN: We investigated 241 patients (130 men and 111 women, median age, 50 years (range, 14-92) with MM (192 before and 51 after surgical biopsy); two of them had more than one melanoma lesion. In each patient approx. 10 MBq of 99mTc Nanocoll in 0.1 mL (Nycomed Amersham Sorin; particle size range, 3-80 nm) was injected intradermally around the MM lesion or surgical scar. Dynamic acquisition was performed for 20 minutes (20 frames/min) and the study was concluded within four hours of injection. Using an external radioactive marker, the skin over the SLN was marked with China ink. RESULTS: 294 SLNs were scintigraphically identified: 117 in the inguinal region, 147 in the axillae, four in the submandibular region, three in the laterocervical region and 23 at other sites. In two patients no drainage was detected. In 43 patients more than one sentinel node was identified. In 13 patients with lesions located in the trunk the tracer drained towards multiple lymph node stations or unexpected lymph nodes (nine cases). Histology and immunohistochemistry diagnosed MM in 25 SLNs; 19 were positive for metastasis with hematoxylin-eosin staining, five with Hmb45 and one with CD68 immunostaining. All 25 detected lymphatic basins were excised. In nine of these basins there was metastatic involvement of at least one other lymph node besides the SLN. During follow-up which ranged from six to 86 months, metastatic disease was found in only one patient with a histologically negative SLN six months after surgery. CONCLUSIONS: This study confirms the utility of scintigraphic SLN detection in patients with MM. In most of the cases the procedure led the surgeon to evaluate the drainage area, which is unpredictable for lesions in the trunk and may be difficult to delineate using only patent blue dye. Furthermore, in approximately 10% of cases we observed dual drainage from individual lesions, mainly those located on the trunk. We will proceed to compare the results obtained during follow-up with those of an investigational group of patients with melanoma who were not subjected to lymphoscintigraphy for SLN detection in order to obtain well-founded information on the prognostic value of this technique.

[Laboratory model of a microvascular free flap in the rat: the epigastric flap]. / Modello sperimentale di lembo libero microchirurgico nel ratto: il lembo epigastrico.

BACKGROUND: Soft tissue defects are mostly managed surgically by free microvascular flaps. The progressive development of techniques and the availability and reliability of new different and free flaps encouraged this surgical approach. Thus, there is a constant need of free flap models to reproduce in laboratory. The experience with the use of the epigastric free flap in the rat as a laboratory model for microsurgical trainees is presented. In our microsurgical flap model the anastomoses were constantly performed on the femoral vessels. METHODS: The flap was used in 25 rats during the practical sessions of periodical experimental microsurgery courses. The main steps were: flap harvesting on the superficial epigastric vessels; flap anastomosis on the femoral vessels; pedicle section; microvascular anastomosis. RESULTS: The epigastric free flap showed to be an easy surgical model. The mean duration of the exercise was 2 hours and 11 minutes. These surgical times were considered acceptable to the requirement of a laboratory model. CONCLUSIONS: The epigastric free flap in the rat is a reproducible experimental model which is still up to date in microsurgical training.

Redefinition of the helical rim in cauliflower-ear surgery.

Cauliflower ear is a serious deformity of the auricle induced by single or repeated injury to the external ear. Few papers deal with surgical techniques for correcting this deformity. We describe the use of ipsilateral excess cartilage to restore the helical rim.

Ambulant vacuum-assisted closure of skin-graft dressing in the lower limbs using a portable mini-VAC device.

A skin graft may fail to adhere to the recipient site because of fluid collecting between the graft and the area being treated. We have devised a simple procedure, consisting of a vacuum-sealed dressing, to fix skin grafts on the lower limbs. A fully portable, battery-operated aspirator continuously draws secretions through a vacuum-sealed dressing, preventing accumulation of fluid underneath the graft. Patients are not confined to bed, thus reducing nursing time. The procedure was applied successfully in seven out of nine patients treated for ulcers of the lower limbs.

p53, cyclin-D1, PCNA, AgNOR expression in squamous cell cancer of the lip: a multicenter study.

BACKGROUND: The development of squamous cell carcinoma of the lower lip is an interesting model of photocarcinogenesis because of the structural and topographic characteristics of the lips. The purpose of this study was to evaluate the expression of immunohistochemical markers on the lips of patients with lower lip squamous cell carcinoma (LLSCC), compared with a control population. METHODS: Of the 98 subjects involved in the study, 58 were suffering from squamous cell carcinoma of the lower lip. The remaining 40 acted as a control. The case studies were taken from six university and hospital dermatology and plastic surgery departments. Questionnaires were administered to assess the risk factors for LLSCC. The cases involving squamous cell carcinoma underwent surgical excision and punch biopsy specimens were obtained from 20 control patients. Tissues were prepared in 5-microm-thick sections to carry out the following immunohistochemical study: PCNA, p53, AgNOR, cyclin-D1, bcl-2. RESULTS: The lower lip was the predominant location of squamous cell carcinoma, with the following factors playing important roles: chronic sun exposure, history of smoking, alcohol use and familial risk of cutaneous tumors. The male/female ratio in our survey was 5:1. The p53 protein was positive in approximately 50% of SCC cases and in 20% of controls. This protein is mostly associated with chronically photoexposed skin areas. AgNOR positivity increased with the loss of cellular differentiation; a progressive increase in size and a poorly defined shape were evident in poorly differentiated carcinomas. CONCLUSIONS: The results of this multicenter study showed that there is a noticeable difference in the expression of PCNA, p53, cyclin-D1, and AgNOR in tissues from patients with LLSCC and controls.

Comparative study on biocompatibility and absorption times of three absorbable monofilament suture materials (Polydioxanone, Poliglecaprone 25, Glycomer 631).

Monofilament synthetic absorbable suture materials offer excellent glide characteristics and cause minimal tissue trauma as a result of their smooth monofilament structure and gradual bio-absorption. An investigation was conducted on 72 rats to compare three types of monofilament absorbable suture material (Polydioxanone, Poliglecaprone 25, Glycomer 631), with respect to their clinical characteristics, tissue inflammatory reaction and suture absorption times. The results identified different qualities for each suture: Poliglecaprone 25 and Glycomer 631 suture materials were found to be less reactive than Polydioxanone in rat skin. However, because of their extremely low tissue reaction values, all three materials were deemed particularly suitable for use as intracuticular sutures. Absorption times in rat skin were less than 3 months for Poliglecaprone 25, between 3 and 6 months for Glycomer 631 and 6 months for Polydioxanone. The differences in suture characteristics which were detected in our study can help in the surgical selection of the most appropriate suture material.

Progressive skin extension: clinical and histological evaluation of a modified procedure using Kirschner wires.

We describe a modification of a skin traction system for progressive skin extension before excision of skin lesions. The traction device consists of Kirschner wires and plastic straps. It results in more homogeneous traction and greater sparing of healthy skin as compared with the earlier silicone bar method. Moreover, the procedure results in lower rates of infection, skin necrosis and breakage of the cutaneous bridges. Histological changes to the treated skin area are similar to those obtained with skin expansion procedures.

[The intradermal cutaneous suture with separate stitches using a resorbable monofilament (Polyglecaprone 25)]. / Sutura cutanea intradermica a punti staccati con monofilamento riassorbibile (Poliglecaprone 25).

The introduction of sutures using Polyglecaprone 25 (Monocryl--Ethicon SpA) has facilitated the use of intradermal suture with separate stitches owing to its flexibility and softness, with extremely satisfactory aesthetic results. The authors report their experience regarding the use of this new material from May 1995 to April 1996 in 250 cases of intradermal suture with separate stitches. The paper also describes a few technical details and emphasis their advantages.

Reconstruction of hypospadias with a vertical preputial island flap. A follow-up study of 127 patients.

The preputial island flap technique presented here was described by Scuderi for a one-stage repair of hypospadias. The operation utilizes a subcutaneous pedunculated preputial flap, designed dorsally along the vertical axis of the penis and transposed ventrally to reconstruct the new urethra. This surgical procedure is useful in distal and proximal hypospadias or in cases with short or absent prepuce, when the dorsal coating of the penis can be used. The technique permits a complete release of the chordee and a meatus placed at the apex of the glans. One hundred and twenty-seven patients treated during the period 1982 to 1987 were analysed. All patients had a urodynamic check and some also had a urethroscopic evaluation of the new urethra. The incidence of complications (8.65%) was very low compared with other techniques.

[A case of pseudocyst of the right adrenal gland. Clinical case report]. / Su di un caso di pseudocisti del surrene destro. Contributo clinico.

A case of pseudocyst of an asymptomatic right suprarenal gland found by chance is reported. Some aetiopathogenetic, anatomopathological and clinico-radiological aspects of the condition are discussed and, after reviewing the possible complications that may arise out of a suprarenal cyst, the value of surgery is stressed.

[Enzymatic changes in the lymph in the thoracic duct and right lymphatic duct during extracorporeal circulation in the dog (author's transl)]. / Modifications enzymatiques de la lymphe du canal thoracique et du canal lymphatique droit au cours de la circulation extracorporelle chez le chien.

The authors analysed the various enzymes in the lymph of the thoracic duct and the right lymphatic duct in a series of 15 dogs submitted to extracorporeal circulation, the experimentors noted a series of diffuse cellular lesions which involved transiently the main organs. This lesion seems only to occur at first; independent of the duration of the by-pass, probably due to hypoxia following the rapid and massive introduction of priming. Our conclusion from this research is that lymph analysis is more revealing for knowledge of enzyme behaviour than blood analysis. A differential study of lymph in the right lymphatic duct and in the thoracic duct is surprisingly much less important.