[Guidelines for the safe outpatient practice of aesthetic surgery]. / Linee guida per un esercizio sicuro della Chirurgia Estetica in regime ambulatoriale.

This paper presents guidelines for the safe outpatient practice of aesthetic surgery. These guidelines have been prepared by the Lombard Association of Plastic Surgery for Outpatients (ALChiPlA), an association confined to board certified plastic surgeons and holders of official authorizations issued by the Lombard ASL to perform outpatient surgery. The cornerstone of these guidelines is the health and safety of patients, who are turning to this type of surgery in ever increasing numbers. This is the first and thus far the only attempt of its kind and its value is increased by the fact that it has been prepared by specialists who have been carrying out this type of surgery in outpatient situations for years.

Reconstruction of the retroauricular fold: a personal technique.

In auricular reconstruction emphasis is placed on carving the rib-cartilage framework. The three-dimensional frame is very important in obtaining a good anatomical shape but often a good shape is not complemented by a good projection of the auricle. In order to avoid obliteration of the retroauricular fold we use a cartilage wedge covered by a local fascial flap. We have treated 17 ears in 16 patients with this technique and have obtained satisfactory results in all cases, achieving a mean projection of 1.7cm between the mastoid plane and the helical rim.

[Intestinal occlusion caused by actinic ileitis]. / L'occlusione intestinale da ileite attinica.

During the 5-year period from 1988 to 1992, 6 patients underwent operation for radiation-induced small bowel obstruction at the General Surgery II, IRCCS Policlinico S. Matteo of Pavia. Based on this experience and reports in the literature, physiopathology, pathologic findings, and operative technics are discussed.

[Massive hemorrhage caused by colonic diverticulosis]. / L'emorragia massiva da diverticolosi colica.

Massive hemorrhage from diverticular disease of the colon is a very difficult problem in abdominal emergency surgery. The pathogenesis of bleeding colonic diverticulosis is strictly correlated to the angioarchitecture of the colonic diverticular wall. Here the vasa recta penetrate the colonic wall from the serosa to the submucosa through connective tissue septa. Injurious factors arising from the colonic or diverticular lumen can produce an eccentric damage to the luminal side with intimal thickening, segmental weakening of the artery and its rupture with massive bleeding. Conventional barium enema is not able to show the source of the hemorrhage in the majority of the bleeding patients; colonoscopy, as primary emergency procedure, has significant positive findings in 41.5%-83.7% of patients. Radionuclide bleeding scans have a sensitivity rate of 86%-94%. Emergency arteriography localizes the bleeding source in higher rates ranging from 58% to 86% and is successful after intraarterial infusion of vasopressin or embolization in 47%-92% of patients. Surgical treatment for continued bleeding from diverticular disease is controversy. Segmental resection should be performed on patients with localized bleeding sources (positive arteriogram). Laparotomy, anterograde irrigation and intraoperative colonoscopy are indicated in patients with multiple bleeding sites and negative arteriography. Because the right colon is the most common site of bleeding in same cases is necessary to perform a subtotal colectomy with ileorectal anastomosis. Blind resections particularly in the elderly patients present high rebleeding rate (> 60%) and high mortality (30%) with sepsis accounting for the majority of deaths.

[A case of Merkel carcinoma with facial localization]. / Un caso di carcinoma di Merkel a localizzazione facciale.

A case of Merkel carcinoma is reported. It concerns a 40-year-old lady, who had first noticed the lesion one year before she came to our observation. The authors point out the rarity of this tumour, whose not distinctive gross appearance (firm, sessile tumour with well circumscribed margins; hyperhemic overlaying skin; slowly increasing volume) may suggest other macroscopic diagnoses such as intradermal nevus or nodular basalioma. The authors also point out the usefulness of a prompt correct clinical diagnosis of this lesion, whose clinical behaviour may be highly aggressive.