Blood flow is translated into biochemical inflammatory or anti-inflammatory signals based onshear stress type, by means of sensitive endothelial receptors. Recognition of the phenomenon is of ...paramount importance for enhanced insights into the pathophysiological processes of vascular remodeling. The endothelial glycocalyx is a pericellular matrix, identified in both arteries and veins, acting collectively as a sensor responsive to blood flow changes. Venous and lymphatic physiology is interconnected; however, to our knowledge, a lymphatic glycocalyx structure has never been identified in humans. The objective of this investigation is to identify glycocalyx structures from ex vivo lymphatic human samples. Lower limb vein and lymphatic vessels were harvested. The samples were analyzed by transmission electron microscopy. The specimens were also examined by immunohistochemistry. Transmission electron microscopy identified a glycocalyx structure in human venous and lymphatic samples. Immunohistochemistry for podoplanin, glypican-1, mucin-2, agrin and brevican characterized lymphatic and venous glycocalyx-like structures. To our knowledge, the present work reports the first identification of a glycocalyx-like structure in human lymphatic tissue. The vasculoprotective action of the glycocalyx could become an investigational target in the lymphatic system as well, with clinical implications for the many patients affected by lymphatic disorders.
In the field of breast reconstruction, products and techniques are continuing to evolve to ensure good clinical and quality outcomes. This article reviews the published literature regarding the use ...of fetal bovine-derived acellular dermal matrix (SurgiMend, SurgiMend PRS and SurgiMend PRS meshed), focusing on safety, clinical outcomes and surgical techniques.
Abstract The association between malignancy and autoimmune myositis has been largely described and confirmed by numerous epidemiological studies. The temporal relationship between the two pathologic ...conditions can vary: malignancy may occur before, at the same time or following the diagnosis of myositis. Beside these observations, the molecular mechanisms underlying this association are still unknown, even though it has been demonstrated a possible antigenic similarity between regenerating myoblasts and some cancer cell populations. To better identify peculiar histopathologic features common to cancer and myositis, we screened muscle biopsies from patients affected with polymyositis, dermatomyositis, myositis in association to cancer, and from patients affected with newly diagnosed cancer, but without myositis. Similarly to the histopatologic features that were observed in the muscle from myositis patients, especially in those with cancer associated myositis, in patients affected with malignancy at the clinical onset of disease we observed early sign of myopathy, characterized by internally nucleated and regenerating myofibers, most of them expressing the neural cell adhesion molecule. The hypothesis that in a particular subset of individuals genetically predisposed to autoimmunity, an initial subclinical tumor-induced myopathy may result in an autoimmune myositis, represents a further intriguing link behind the association of these two conditions.
Abstract Aim Aim of this study is an updated review of our case series (72 patients) as well as available literature on the Multiple Symmetric Lipomatosis (MSL), a rare disease primarily involving ...adipose tissue, characterized by the presence of not encapsulated fat masses, symmetrically disposed at characteristic body sites (neck, trunk, proximal parts of upper and lower limbs). Data synthesis The disease is more frequent in males, associated to an elevated chronic alcohol consumption, mainly in form of red wine. Familiarity has been reported and MSL is considered an autosomic dominant inherited disease. MSL is associated to severe clinical complications, represented by occupation of the mediastinum by lipomatous tissue with a mediastinal syndrome and by the presence of a somatic and autonomic neuropathies. Hyper-alphalipoproteinemia with an increased adipose tissue lipoprotein-lipase activity, a defect of adrenergic stimulated lipolysis and a reduction of mitochondrial enzymes have been described. The localization of lipomatous masses suggests that MSL lipomas could originate from brown adipose tissue (BAT). Moreover, studies on cultured pre-adipocytes demonstrate that these cells synthetize the mitochondrial inner membrane protein UCP-1, the selective marker of BAT. Surgical removal of lipomatous tissue is to date the only validated therapeutic approach. Conclusions MSL is supposed to be the result of a disorder of the proliferation and differentiation of human BAT cells.
The injection of collagenase followed by cord manipulation is one of the most popular treatments for Dupuytren's contracture. This is traditionally performed under local anesthesia or regional nerve ...block potentially with sedation. Neither the treatment with collagenase, nor the wide-awake anesthesia are novel techniques for hand surgeons. Nevertheless, we report the first experience of cord manipulation using the wide-awake approach. In this prospective study, we compared the pain perception of patients who underwent wide-awake anesthesia versus traditional local anesthesia. We recorded the pain sensation on a visual analog scale (VAS) (0 to 10) during anesthetic injection, during cord manipulation and before discharge. Wide-awake anesthesia significantly reduced pain levels during anesthetic injection (p=0.003) and cord manipulation (p=0.0009). Pain levels did not differ significantly right before discharge in the two groups (p=0.54). Wide-awake anesthesia can be successfully applied to cord manipulation after collagenase injection in Dupuytren's contracture. This way, it is possible to improve the patient's subjective perspective of the procedure.
L’injection de collagénase suivie d’une manipulation de la corde est l’un des traitements les plus répandus de la maladie de Dupuytren. Ceci est traditionnellement réalisé sous anesthésie locale ou bloc nerveux régional, éventuellement sous sédation. Ni le traitement avec la collagénase, ni la WALANT ne sont des techniques nouvelles pour les chirurgiens de la main. Néanmoins, nous rapportons ici la première expérience de manipulation de cordes en utilisant l’approche WALANT. Dans cette étude prospective, nous avons comparé la perception de la douleur des patients ayant subi une WALANT par rapport à l’anesthésie locale traditionnelle. Nous avons enregistré la sensation de douleur sur l’échelle visuelle analogique (EVA) (0 à 10), pendant l’injection d’anesthésique, pendant la manipulation de la corde et avant la sortie du patient. La WALANT a considérablement réduit les niveaux de douleur pendant l’injection d’anesthésique (p=0,003) et la manipulation de la corde (p=0,0009). Les niveaux de douleur ne différaient pas significativement juste avant la sortie dans les deux groupes (p=0,54). Une WALANT peut être appliquée avec succès à la manipulation des cordes après injection de collagénase dans la maladie de Dupuytren. De cette façon, il est possible d’améliorer la perception subjective du patient sur la technique.
Reconstruction of the dorsum of the hand and fingers is one of the main challenges in hand surgery. Regional flaps from the forearm, free flaps, or pocket procedures are options when multiple digits ...are injured with tendon damage and bone exposure. These procedures can be technically demanding and are often plagued by a texture mismatch. We conducted an anatomical study of 20 fresh frozen hands. The second, third and fourth intermetacarpal spaces were analyzed with the aim of defining the vascular foundation of dorsal hand adipofascial-turnover flaps based on dorsal metacarpal artery (DMA) perforators, analyzing their potential for reconstruction procedures on the dorsum of the hand. In three cases, the 4th intermetacarpal space lacked the DMA. A mean of 3.5 arterial communications were found between the DMA and palmar arterial system. Each hand had 11 ± 2 dorsal skin perforators, which were equally distributed among different intermetacarpal spaces. At least one perforator was present in each one-third of the space. The most distal perforators were the largest in all spaces but missing in two hands. A clinical case of multiple index finger to little finger reconstruction with this new multi-dorsal metacarpal artery perforator (mDMAP) adipofascial turnover flap is presented. Our anatomical study confirmed previous descriptions of the anatomy of the dorsum of the hand. It supports the safety of the mDMAP adipofascial turnover flap based on all distal arterial perforator for the simultaneous reconstruction of index to little finger injuries. Similarly, adipofascial turnover flaps can be raised from more proximal perforators arising from DMAs if more than one intermetacarpal space is included.
La reconstruction du dos de la main et des doigts représente l'un des principaux défis de la chirurgie de la main. Les lambeaux régionaux de l'avant-bras, les lambeaux libres ou les empochements sont envisagés en cas de blessures à plusieurs doigts avec lésion tendineuse et exposition osseuse. Ces techniques peuvent être techniquement exigeantes et sont souvent affectées par une inadéquation esthétique. Nous avons mené une étude anatomique sur 20 mains fraîches congelées. Les 2ème, 3ème et 4ème espaces intermétacarpiens ont été analysés dans le but de définir la base vasculaire de lambeaux de rotation adipofasciaux de la face dorsale de la main à partir de perforateurs des artères métacarpiennes dorsales (DMCA) analysant leur potentiel pour la reconstruction du dos de la main. Dans trois cas, le 4ème espace intermétacarpien n'avait pas de DMCA. Une moyenne de 3,5 communications artérielles a été trouvée entre la DMCA et le système artériel palmaire. Chaque main présentait 11 ± 2 perforateurs cutanés dorsaux, qui étaient également répartis entre les différents espaces. Dans chaque tiers de l'espace, au moins un perforateur était présent. Les perforateurs les plus distaux étaient les plus larges dans tous les espaces et manquaient sur deux mains. Un cas clinique de reconstruction d’une lésion multiple allant de l’index au petit doigt avec un nouveau lambeau de rotation adipofascial multi perforateur de l'artère dorsale-métacarpienne (mDMCAp) est présenté. L'étude anatomique a confirmé la description précédente de l'anatomie du dos de la main. Elle confirme la sécurité du lambeau de rotation adipofascial mDMCAp basé sur tous les perforateurs artériels distaux pour la reconstruction simultanée des blessures de l’index au petit doigt. De même, les lambeaux de rotation adipofasciaux peuvent être levés à partir de perforateurs plus proximaux provenant de DMCA si plus d'un espace est inclus.
Basal cell carcinoma (BCC) is the most common form of cancer, with a high impact on the public health burden and social costs. Despite the overall prognosis for patients with BCC being excellent, if ...lesions are allowed to progress, or in a small subset of cases harboring an intrinsically aggressive biological behavior, it can result in local spread and significant morbidity, and conventional treatments (surgery and radiotherapy) may be challenging. When a BCC is not amenable to either surgery or radiotherapy with a reasonable curative intent, or when metastatic spread occurs, systemic treatments with Hedgehog inhibitors are available. These guidelines were developed, applying the GRADE approach, on behalf of the Italian Association of Medical Oncologists (AIOM) to assist clinicians in treating patients with BCC. They contain recommendations with regard to the diagnosis, treatment and follow-up, from primitive tumors to those locally advanced or metastatic, addressing the aspects of BCC management considered as priorities by a panel of experts selected by AIOM and other national scientific societies. The use of these guidelines in everyday clinical practice should improve patient care.
•This AIOM Guideline on BCC provides key recommendations for managing basal cell carcinoma.•It covers clinical and pathological diagnosis, treatment and follow-up.•Addressing systemic treatments for BCC unresponsive to surgery/radiotherapy.•GRADE approach: transparent, evidence-based and comprehensive guidelines.•Expert consensus: panel of experts selected by AIOM contribute to priority aspects of BCC management.
Cutaneous squamous cell carcinoma (CSCC) accounts for ∼20%-25% of all skin tumors. Its precise incidence is often challenging to determine due to limited statistics and its incorporation with mucosal ...forms. While most cases have a favorable prognosis, challenges arise in patients presenting with locally advanced or metastatic forms, mainly appearing in immunocompromised patients, solid organ transplantation recipients, or those facing social difficulties. Traditionally, chemotherapy and targeted therapy were the mainstays for advanced cases, but recent approvals of immunotherapeutic agents like cemiplimab and pembrolizumab have revolutionized treatment options. These guidelines, developed by the Italian Association of Medical Oncologists (AIOM) using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, aim to guide clinicians in diagnosing, treating, and monitoring patients with CSCC, covering key aspects from primitive tumors to advanced stages, selected by a panel of experts selected by AIOM and other national scientific societies. The incorporation of these guidelines into clinical practice is expected to enhance patient care and address the evolving landscape of CSCC management.
•This AIOM guideline on CSCC provides key recommendations for managing CSCC.•It covers clinical and pathological diagnosis, treatment, and follow-up.•Addressing systemic treatments, like cemiplimab, for CSCC unresponsive to surgery/radiotherapy.•GRADE approach: transparent, evidence-based, and comprehensive guidelines.•Expert consensus: panel of experts selected by AIOM contribute to priority aspects of CSCC management.
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