[Oncoplastic surgery for the treatment of breast cancer]. / Chirurgia oncoplastica nel trattamento dei tumori della mammella.

Surgery is still the gold standard in breast cancer. Also if the elective treatment, thanks to the adjuvant therapy, ha became more conservative than once was, breast surgery remains, in the mind of the woman affected by breast cancer, a demolitive surgery. The collaboration bet-ween the breast surgeon and the plastic surgeon has to be closer than it is, in order to obtain the total asportation of the tumor and an esthetic result that limits the psychological trauma to the woman. Oncoplastic surgery is the answer to these human and medical necessities, giving the correct approaches about breast volume, tumor volume, radicality of the treatment and esthetic outcome. This review will focus on different oncoplastic approaches, to help improving both the esthetic outcome of breast cancer resection and the likelihood of surgeons obtaining wide surgical margins in preparation for breast-conserving radiotherapy.

Cell kinetics evaluation of colorectal tumors after in vivo administration of bromodeoxyuridine.

Although several biomarkers have been tested, Dukes' (or TNM) stage at diagnosis is still considered the only prognostic factor of clinical relevance in colorectal cancer. Among the various biomarkers, the fraction of cells engaged in DNA synthesis has been extensively investigated as an indicator of tumor aggressiveness. Bromodeoxyuridine (BUdR) is a non-radioactive thymidine analogue which is incorporated into DNA during the S-phase of cycling cells. In order to evaluate the relationships between cell kinetics and morphologic variables, 500 mg of BUdR were given i.v. to 46 patients with colorectal cancer prior to surgery. After operation, a large tumor sample was taken and processed for immunohistochemical detection of BUdR-labeled cells in various regions of the neoplasm and in normal colorectal mucosa. Smaller superficial tumor specimens were also incubated with 3H-thymidine (3H-TdR) for the autoradiographic identification of labeled cells. In the 43 evaluable tumors, the overall BUdR labeling index (BLI, percent of labeled cells) was significantly higher in carcinoma (20.30 +/- 0.86%, SEM) than in normal colonic mucosa (6.51 +/- 0.49%). BLIs in central and peripheral regions of carcinoma were closely correlated (r = 0.48, p = 0.003). In 21 neoplasms a high correlation between overall BUdR and 3H-TdR labeling index in the same tumor was observed (r = 0.57, p = 0.007). No evident association between overall BLI and clinical or morphologic parameters of the tumor was seen, including number of capillaries and ras-p21 protein expression. We conclude that BUdR immunostaining after in vivo administration of BUdR is a simple method for studying cell kinetics in various regions of colorectal cancer. BUdR labeling data are comparable to those obtained with in vitro incorporation of 3H-TdR.

Multicentre experience in the treatment of burns with autologous and allogenic cultured epithelium, fresh or preserved in a frozen state.

This report describes the clinical results obtained from a multicentre experience of the use of autologous and allogenic cultured human epidermal cells in the treatment of partial and full skin thickness burns. A laboratory has been organized to supply cultured epithelium to Burns Units in different cities. From May 1986 to December 1988, 58 patients with an age range of 1 to 59 years, and with burns covering between 7 and 95 per cent of the body surface area, have been treated. Graftable cultured epithelium can be frozen and remain viable if stored in a skin bank. Such grafts were used successfully to treat patients with partial and full skin thickness wounds.

[Aerobic bacterial flora in cutaneous lesions and in venous catheters of severely burned patients]. / La flora batterica aerobica nelle lesioni cutanee e nei cateteri venosi dei grandi ustionati.

Bearing in mind the complexity of the topic and its variability owing to the progress made in antibiotic management, and the development of many concepts concerning the pathogenesis and biochemistry of major burns, the already massive literature is supplemented by the addition of relatively recent data to enable comparisons to be made with regard to the quality and frequency of isolation of the bacterial flora observed in such patients, and above all their sensitivity to currently employed antibiotics. The investigation was conducted on patients admitted to the Turin CTO Major Burns Centre between 1972 and 1977. Initially (1972-1975), a microbiological examination was made of purulent secretions from wounds. Subsequently, management was prevalently directed to the early excision of injured surfaces, and attention was therefore directed to the indwelling venous catheters used in treatment and parenteral alimentation. In cases examined in parallel, moreover, there was often a substantial similarity between wound and catheter flora, and when only one species was present in the wounds, the catheter was often sterile. Furthermore, numerous data were collected from antibiograms relating to the most frequently encountered micro-organisms. These usually displayed wide resistance spectra, especially with respect to the most commonly used of historically oldest antibiotics, whereas their resistance to those recently introduced was generally lower. The question of provenance (from the patient himself, the hospital or its medical and paramedical staff) is also examined. Reference is made to a point that has recently become important in the treatment of burns, namely the ascertainment of the degree of contamination not only on the surface, but also in the immediate sub-surface of the lesions, so as to permit a suitable excision of the eschar and skin transplantation. When a sufficient number of findings exist to support this new concept, it will certainly give rise to further studies and research aimed at bringing new, important data to this so rich and multiform topic.

Late results following treatment of deep burns of the hands.

During a 10-year period, 467 patients with burns involving the hands have been treated, 290 of whom during the past 5 years. Two groups of patients were examined: the first were those who had received treatment between 1967 and 1971 using the exposure method and the reconstruction with skin grafts only after the spontaneous separation of the eschars, and the second, using the closed method and early or late excision of the necrotic tissue followed by covering with split-thickness grafts. In this second group are included also those patients whose burns can be classified as medium depth at the time of admission but in whom experience has shown that one is dealing with lesions with a tendency to become deeper during the post-burn period. For these cases a dermabrasion of the lesions was performed without covering with free grafts. In the cases subjected to surgery using the technique of tangential excision and dermabrasion in order to reach the more difficult areas such as the interdigital spaces, dermabrasion was only performed between the 2nd and the 28th day. The removal of the burned tissue was followed by covering with free grafts, except in those cases in which the depth was in doubt. The results obtained have demonstrated that in the first group the scars have led to serious invalidating consequences which have necessitated long and complex surgical reconstruction programmes. In the second group almost complete function has been restored with the aid of only minimal surgical correction, most often in the interdigital spaces. We would like to emphasize the usefulness of surgery in those cases on the borderline between medium and full thickness. The tendency of these lesions to become deeper has often led to scars which are very similar to those following the deep lesions.

Considerations on early surgery in the treatment of extensive burns.

The results obtained with early surgical treatment of burns have been re-examined from various aspects. Early escharectomy, which tranforms the necrobiotic tissue into a surgical lesion, reduces the chemical factors of inflammation, lowers the lactic acid level and depresses the activity and disordered proliferation of the fibroblasts and the consequent laying down of immature collagen which is responsible for the pathological evolution of the burn scar. The removal of toxic material with proteasic activity, the reduction in the risk of sepsis, the saving of work for the immunopoietic mechanism, a reduction in the weight loss through improved nitrogen balance and an increase in the anabolic phase of muscular metabolism by early movement as well as a shortening of the period of hospitalization--all are factors in favour of the early surgical technique. Better healing is obtained by the elimination of the necrotic tissue, a reduction in the haematologic tissue inflammation mediators, an increase in the antibacterial defence following the reconstruction of the skin surface with covering materials and the rapid articular reduction; not to mention the inhibition of the formation of granulation tissue.

[Use of amino acids in major burns]. / L'impiego degli aminoacidi nei grandi ustionati

The results of protein deficiency in major burn cases are examined. They include diminished organ resistance, deleyed wound haeling, proneness to infection, and increased sensitivity to liver-toxic substances, leading to the protracted course of the patient's conditions. Since his caloric intake also needs to be increased, the importance of protein replacement is apparent. A standardised 15-day treatment with daily administrations of 1000 cc of a 7.5% natural amino acid solution was experimented during the period following shock, to prevent loss of amino acids through the vessel walls, since permeability is high in this periodo. Marked improvement in blood proteins was noted, with normalisation in some instances. No chagens in blood chemistry attributable to the treatment were noted.

[Coagulation disorders due to burns. Disseminated intravascular coagulation (DIC) and its possible prevention]. / I disturbi coagulativi conseguenti all'ustione. La C.I.D. (coagulazione intravasale disseminata) e la sua possibile prevenzione

Coagulation data were studied in 77 patients with severe burns divided into two groups (A, 45 cases, and B, 32 cases). Increased PDF, platelet deficiency, enhanced fibrinogen turnover, and paracoagulation tests showing disseminated intravascular coagulation were frequent in both groups. Platelet deficiency was significantly more frequent in group A (64.9% of cases) than in group B (37.5%). Patients in the latter group received small subcutaneous doses of heparin from the moment of admission.

[Histopathology of the liver in patients with severe burns. Preliminary biopsy study]. / Istopatologia del fegato nei grandi ustionati. Studio bioptico preliminare

Liver histobiopsy was carried out in 21 patients with burns of from 25 to 75 percent, between the 2nd and 125th day following trauma. The most frequent type of lesion encountered was albuminoid degeneration and hydropic ballooning of the cytoplasm to the point that the parenchyma assumed a "vegetable" appearance. No steatosis intervenes until the 6th-8th day after the burn and where it was not present previously, is a sign that the patient's condition is worsening. Total, or nearly total, disappearance of glycogen from the sections is an indication that the patient is worsening; in effect in patients who died, biopsy carried out shortly beforehand revealed the extreme paucity of PAS-positive material in the hepatocytes.