Relationship between the anion/cation relative orientation and the catalytic activity of nitrogen acyclic carbene–gold catalysts

The role of the ligand in determining the ion pair structure of the [(NAC)Au(η²-3-hexyne)]⁺ BF₄⁻ catalysts and how the position of the anion (positions A, B and C) influences their catalytic performance in the intermolecular alkoxylation of alkynes have been studied.

Is laparoscopic right colectomy more effective than open resection? A meta-analysis of randomized and nonrandomized studies

AIM

The aim of this systematic review was to compare laparoscopic and/or laparoscopic-assisted right colectomy (LRC) with open right colectomy (ORC). Many randomized clinical trial have shown that laparoscopic colectomy benefits patients with improved short-term outcomes and comparable overall survival in respect to the open approach. These results, however, could not be applied to right colectomy owing to its wide range of resection and more complicated vascular regional anatomy.

METHOD

We performed a meta-analysis of the literature in order to compare LRC vs ORC by examining 21 end-points including operative and recovery outcomes, early postoperative mortality and morbidity, and oncological parameters. A subgroup analysis of patients undergoing right colectomy for cancer was carried out. The meta-analysis was conducted following all aspects of the Cochrane Handbook for systematic reviews and Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA) statement. The search strategies were developed using the following electronic databases: PubMed, EMBASE, OVID, Medline, Cochrane Database of Systematic Reviews, EBM reviews and CINAHL until March 2011. We included randomized and non randomized studies that compared the LRC vs ORC for benign disease and malignant neoplasm irrespective of publication status. Only studies in English, French, German, Spanish and Italian languages were considered for inclusion. Emergency right colectomies were excluded. To perform the statistical analysis we used the odds ratio (OR) for categorical variables and the weighted mean difference (WMD) for continuous variables. An intention-to-treat analysis was performed.

RESULTS

Seventeen studies, 15 nonrandomized clinical trials and two randomized clinical trials, involving a total of 1489 patients, were identified. The mean operative time was longer in the group of patients undergoing LRC [weighted mean difference (WMD) = 37.94, 95% CI: 25.01 to 50.88; P < 0.00001]. Intra-operative blood loss (WMD = -96.61; 95% CI: -150.68 to -42.54; P = 0.0005), length of hospital stay (WMD = -2.29; 95% CI: -3.96 to -0.63; P = 0.007) and short-term postoperative morbidity (OR = 0.64; 95% CI: 0.49 to 0.83; P = 0.0009) were significantly in favour of LRC.

CONCLUSION

Laparoscopic-assisted right colectomy results in less blood loss, a shorter length of hospital stay and lower postoperative short-term morbidity compared with ORC.

Stem cells and breast cancer, where we are? A concise review of literature

There is an analogy between embryogenesis and cancer and the attention is on increasing the rate of cell division and on a small percentage of perennial cells . The key to understanding is to be found in the properties of these cells developed in the form of perennial totipotency, multipotency and unipotent. The normal life cycle involves epigenetic mechanisms that are deregulated in cancer cells, these tumor cells appear to belong to deregulation since its progeny. Here is a review of the literature on embryogenesis of the breast, endocrine system interactions Delna the proper development and functioning of the various cell lines and to the importance of cancer stem cells.

The sentinel node biopsy in patients with thick melanoma: outcome analysis from a single-institution database

BACKGROUND

We examined the impact of sentinel lymph node (SLN) biopsy among patients with primary melanoma that exceeded 4.0 mm in Breslow thickness, treated in our Institution from 1998 until 2009.

PATIENTS AND METHODS

According to Kaplan-Meier statistics, overall survival (OS) and disease-free survival (DFS) were assessed in patients with: i) disseminated disease at diagnosis with respect to patients undergoing SLN biopsy and ii) positive SLN and negative SLN. The effect of age, thickness and number of positive SLN on survival was also calculated.

RESULTS

Forty-three patients with thick melanoma were included (29 men and 14 women; mean age 65 ± 17 years, tumor thickness ranging from 4 to 20 mm). Thirteen patients (30%) were not eligible for SLN biopsy due to metastatic disease or poor clinical condition. Biopsy was performed on 30 patients: 14 with positive SLN (46.7%, group A) and 16 with negative SLN (53.3%, group B). Seven patients (50%) died in group A and 2 patients (13%) in group B (mean follow-up 28 and 59 months, respectively); all 7 patients in group A and no patient in group B died because of melanoma. OS and DFS were both significantly higher in group B than group A.

CONCLUSION

Our experience demonstrates a high rate of positive SLNs in patients with thick melanoma, and significant differences regarding the general outcomes between those with positive and negative SLNs, the latter group having a good prognosis despite the thick primary tumor. This observation stresses the importance of SLN biopsy as a staging tool in patients with thick melanoma.

[Breast cancer metastasis in distal phalanx of the big toe. Case report]

Breast cancer represents the most prevalent malignancies in women and bone is the first site of metastasis in 26-50% of cases. Usually metastasis involve limbs in 16%. We present a rare case of 47-year-old woman, who underwent to monolateral mastectomy for lobular cancer. After 8 years from surgery, she presented pain, swelling and functional limitations, gradually increasing, to the left big toe. X-rays and MRI showed a lucent area of bone destruction on the shaft of the distal phalanx of the left big toe. Surgical biopsy on the excised bone assessed for breast cancer metastasis.

Evaluation of early dynamic splinting versus static splinting for patients with transposition of the extensor carpi radialis longus to the extensor pollicis longus

We present a group of 20 patients who underwent transposition of the extensor carpi radialis longus to the extensor pollicis longus between April 2003 and September 2007. The group was divided into ten patients with an early dynamic splint and ten patients with a static plaster cast following the standard rehabilitation protocols. We compared these two rehabilitation protocols. The post-rehabilitation total range of motion was 87.5 degrees in the dynamic group and 58.75 degrees in the patients treated by the static protocol. The total time of rehabilitation was 10.2 weeks in the dynamic and 14.2 weeks in the static group. The overall mean follow-up was 12.2 weeks. We conclude that early dynamic splinting brings shorter recovery time, shorter time off work and significantly better movement of the thumb.

The effect of blood around a flap pedicle on flap perfusion in an experimental rodent model

BACKGROUND

The vasospasm has been studied to a considerable extent in the neurosurgical literature. Little experimental and basic scientific literature about vasospasm of flap pedicle is available in the field of reconstructive microsurgery. The purpose of the study was to investigate the effect of presence of blood around the pedicle on a flap perfusion.

MATERIAL AND METHODS

Blood flow through a right groin flap was continuously measured using Laser Doppler flowmetry on 40 male Wistar rats. A segment of the flap's pedicle was surgically cleared of adventitia and bathed in blood. The blood used was either collected from the tail of the rat (group A) or from the bleeding branch of the pedicle itself (group B). The differences between the signal amplitudes before and after exposure of the pedicle to blood were recorded.

RESULTS

The presence of blood around the pedicle resulted in a significant decrease in perfusion of the flap in both groups. However, no significant differences in the duration of impaired blood flow between the groups were observed.

CONCLUSIONS

In conclusion, the presence of blood around the vascular pedicle may cause a significant decrease in the perfusion of a flap, while the origin of the blood does not appear to be an important factor.

The value of clinical diagnosis of digital glomus tumors

Glomus tumors are benign neoplasms that differentiate from the glomus apparatus. This neoplasm is clinically characterized by a typical symptomatological triad: paroxysmal pain, pinpoint pain and hypersensitivity to cold. The diagnosis is usually clinical, but can be confirmed by instrumental tests such as X-ray, MRI, selective arteriography and most commonly by ultrasound, with or without Doppler. Surgical resection of the glomus tumor is the definitive treatment with resolution of all symptoms. From 1997 to 2007, 21 surgically-treated cases were reviewed and here we report the clinical assessment that was used. The nine most recent cases of glomus tumor underwent surgery after clinical assessment alone. In our opinion clinical examination is the most effective method to diagnose this type of tumor and in selected cases it may be sufficient to undergo surgical therapy.

Nipple-sparing mastectomy. Preliminary results

Nipple-sparing mastectomy (NSM) combines a skin-sparing mastectomy with preservation of the Nipple Areola Complex (NAC), intraoperative pathological assessment of the nipple tissue core, and immediate reconstruction, thereby permitting better cosmesis for patients undergoing total mastectomy. Radiotherapy of the NAC was carried out in every single patient after surgery. The procedure was first performed on selected patients following a clinical research protocol. From January 2003 to June 2004, 10 patients underwent nipple sparing mastectomy followed by reconstruction (4 of them decided also to undergo a prophylactic mastectomy on the other breast) at the Breast Unit, Policlinico Monteluce, Perugia, Italy. Patients had been accurately selected before the operation following some criteria previously assessed by a team of specialists including the breast surgeon, the oncological physician, the radiotherapist and the plastic surgeon. Histology of the 10 NSMs confirmed invasive carcinoma in 3 cases and in situ carcinoma in the remainder. Superficial necrosis of the NAC that settled down spontaneously without consequences occurred in 2 cases; loss of sensitivity of the NAC in 4 patients; 1 patient developed haematoma. No asymmetry was reported. All women were clear of cancer after the treatment. Nipple-sparing mastectomy is the procedure of choice on selected patients.

Lateral canthoplasty--10-year experience

Lateral canthoplasty is a useful method to restore eyelid function and to protect the ocular surfaces. The success of the procedure depends on the proper analysis of periorbital anatomy as it relates to the specific indication for lateral canthoplasty. We report the experience with 129 lateral canthoplasties with emphasis on the evaluation of newer techniques that better address anatomic and functional requirements. Between 1994 and 2004, 129 lateral canthoplasties were performed in 105 patients, only for reconstructive purpose. A variety of surgical techniques have been described for lateral canthoplasty, and the evolution of the operative technique for lateral canthoplasty has been toward an operation that corresponds with the anatomy of the individual. Indications for the procedure include senile ectropion, tumors, cicatritial retraction, trauma, entropion, and congenital cleft. The evaluation of the newer procedures of lateral canthoplasty as unique reconstructive tools will be discussed.

Ear reconstruction after cancer excision

Cancers which involve the external ear are difficult to eradicate and recur and develop metastases more often than tumours in other areas of the skin. The anatomy of the external ear presents a difficult reconstructive challenge so that various surgical techniques have been described for its reconstruction, but many of these are complex procedures and are inappropriate in the older population suffering from skin tumours. We carried out a retrospective study of the patient who underwent ear reconstruction after cancer excision analyzing the data concerning the type of cancer, the surgical procedures and the follow up. We conclude that all major defects involving one-quarter or more of the auricle can be repaired with a combination of skin flaps and a chondrocutaneous flap from the affected auricle. Sentinel node biopsy may be a useful tool in diagnosing early lymphatic spread.