[Plastic surgery in day hospital conditions: comparison between two hospital models]

Personal experience of plastic surgery carried out in Day Hospital conditions is reported. The experience took place within the hospital structure through two different organisational models called here transversal and divisional organisation models: characteristic of the former is that it uses a dedicated interdivisional structure within the hospital involving the centralization of all day-surgery activities, whereas the latter organizes Day Surgery activities within the operating unit whose structures it shares. On the basis of a comparison between the two models we were able to note advantages and disadvantages. We can review our experience in brief by stating that our own preference went to the transversal model which presents the indubitable advantage of being a logistic structure which is hinged on daytime activity and is ready therefore to satisfy on the one hand the needs of this type of patient and, on the other, the needs of the structure itself in efficiency terms. We propose to correct the disadvantages of the transversal model which can be outlined in its lack of homogeneity in the pathology treated and in the subtraction of the criterion of clinical priority in waiting lists through the attainment of a critical dimensional threshold such as to permit programmable sessions with patients with homogeneous pathology (i.e. belonging to the same hospital unit) and through the maintenance of a certain number of Day Hospital beds (around 25%) reserved for new emergency clinical cases.

Ultrasound assisted liposuction for the palliative treatment of Madelung's disease: a case report

Benign Symmetric Lipomatosis (Madelung's disease) is a rare disease, characterized by massive fatty deposits in the neck, the shoulders, and the upper extremities. The deformity is associated with chronic alcohol use, malignant tumors of the upper airways, neuropathy, diabetes mellitus, hyperlipidemia, and other metabolic disorders. Although the deformity is prone to recurrence, surgical removal via lipectomy or liposuction provides the only way of palliation. This paper describes the treatment of a 51-year-old man with a history of alcoholism and liver cirrhosis. He reported masses in his cervical and facial regions that had gradually enlarged over a period of 6 years. He also developed respiratory symptoms due to the fatty compression of his upper airways. Our experience with ultrasound-assisted liposuction for the palliative treatment of this disease is reported.

Do superficial epigastric veins of rats have valves?

The rat is a good model for experimental studies on the haemodynamic patterns of free-flap transfer but models involving the superficial epigastric vein have not been supported by the demonstration of the anatomical presence or absence of valves inside it. We performed a morphological study to assess whether or not valves are present inside the superficial epigastric vein of the rat. Segments of superficial epigastric veins were explanted from fifteen Sprague-Dawley rats. The lumen was studied with scanning electron microscopy after longitudinal or transverse incision of the venous walls. No valves were detected and we saw no evidence of their accidental removal. As most human veins do have valves, the clinical implications of haemodynamic data on reverse-flow island flaps obtained in rats must be considered very carefully.

Sulphuric acid burned women in Bangladesh: a social and medical problem

In August-September 1998 an Italian medical team, composed of a plastic surgeon, an anaesthesiologist, an infectious diseases specialist and a psychologist, assisted by a local non-government organization (Narripokkho), studied a cohort of Bangladeshi women injured by sulphuric acid. The goals of the mission were: (1) recognition of the magnitude of the phenomenon of acid being intentionally thrown at women; (2) evaluation of the type and severity of burns; (3) preparation of a tentative schedule of surgical treatment of the lesions; (4) organization of local facilities; (5) training of doctors and nurses.

[Plastic surgery in the setting of a public hospital day care unit]

BACKGROUND

The authors describe the advantages and disadvantages of plastic surgery performed in a day-care public hospital unit.

METHODS

A retrospective study was made of the day-surgery activities over 16 months (1998-1999) as part of a centralized system. Data were compared to day-surgery activities undertaken in 1997 using a non-centralized system. The study was based in the Macchi Foundation Hospital in Varese. A total of 179 patients were treated from all age group whose clinical, intellectual and social characteristics enabled them to be treated using a day-hospital regime. The pathologies treated can be classified into six groups: benign skin pathologies, malignant skin pathologies, scar pathologies, hand disorders, burns and others. All operations were performed as planned under general, local or regional anesthesia with the help of an anesthetist.

RESULTS

The centralized system has a number of advantages of a social and technical kind; there are few disadvantages, mainly consisting in the impossibility of using this approach for emergency surgery and its overall rigidity.

CONCLUSIONS

This form of surgery provides a service that stands out for its quality, organisational efficiency and low cost.

Reversal of cachexia in patients treated with potent antiretroviral therapy

The introduction of HAART has changed the nutritional status of HIV patients. In the pre-protease inhibitor (PI) era, more than 60% of HIV-positive persons presented with protein energy malnutrition (PEM) and vitamin and mineral deficit. This caused progressive physical-metabolic wasting (wasting syndrome/cachexia) and increased susceptibility to opportunistic infections and drug toxicity. PEM was a concurrent cause in 80% of deaths attributed to AIDS. Since 1996, the year in which PIs were introduced, the number of patients dying as a result of AIDS has decreased by two thirds, and cachexia is no longer the AIDS terminal phase in developed countries. But different patterns of nutritional status changes have appeared in association with the use of newer anti-HIV therapies and with longer survival of HIV-infected patients. A new clinical and laboratory syndrome--lipodystrophy syndrome--now affects patients receiving PI-based therapy. This syndrome consists of changes in body shape that are caused by an abnormal redistribution of fat. Fat accumulates in the abdominal area (truncal and visceral obesity), in the axillary pads (bilateral symmetric lipomatosis), and in the dorsocervical pads ("buffalo hump," "bull neck") but decreases in the legs, arms, and nasolabial and cheek pads (peripheral lipodystrophy). Hyperlipidemia and insulin resistance are also frequently present (metabolic syndrome X). Pathogenic mechanisms of lipid and fat tissue disturbances are discussed in this article, and the clinical approach to patient management and therapeutic options for lipodystrophy and lipid dysmetabolism is evaluated.

Aesthetic reductive rhinoplasty to facilitate reconstruction of the nose

The authors present an original approach to the problem of the reconstruction of the nasal pyramid after a demolition for neoplasia. Reductive rhinoplasty is done at the same time as demolition, so that the remaining gap in the soft tissues is reduced to the point where it can be repaired with a local flap. The positive aspects of this method are its excellent aesthetic results, comparative ease, and quick execution. The negative aspects are it is limited to defects of less than half of the nasal pyramid and it cannot be used for defects of nostrils; there have also been isolated cases of psychological problems from the sudden physical change.

Plastic surgery in the early nineteenth century: notes on the collections in the University of Pavia's Museum of History

The authors present the documents of plastic surgery preserved in the University of Pavia's History of the University Museum. They include clinical papers, drawings, surgical instruments, and anatomic preparations. Most of these documents relate to the activity of Luigi Porta, who was a general and plastic surgeon and professor in the Medical School of the University of Pavia from 1832 to 1875.

A mucosal island flap to repair vermilion defects of the lips

This article describes a one-stage technique to reconstruct up to one-third of the vermilion after full-thickness excision of the lips. It is based on a mucosal elliptically shaped random island flap from the inner lip, combined with a conventional skin flap from the surrounding area. The procedure can be performed under local anesthesia. Healing is achieved in 8 days. The technique has been employed in 9 patients, both on lower and on upper lips and even on different sides of the same lip. The results are aesthetically and functionally good.

Collagen glycosylation in human granulation tissue and scar

Some biochemical characteristics of collagen extracted from granulation tissue were studied and compared with those of normal skin and scar. By using electrophoretic techniques the type III collagen content was confirmed to be significantly greater in granulation tissue and lower in scar with respect to normal skin. The chromatographic determination of hydroxylysine (Hyl) glycosides in collagen extracted from granulation tissue showed a significant increase in both the degree of Hyl glycosylation and in the di-/monoglycoside ratio, while both parameters turned out to be lower in scar. These data suggest that the degree of Hyl glycosylation and the di-/monoglycoside ratio could represent an index of the degree of collagen fiber maturation.

A new method to visualize Langer's lines

After reviewing Langer's papers on lines of cleavage in the skin, experiments were done that showed a correspondence between those lines and the directions that hairs stream.