Pulmonary hypertension is associated with impaired exercise performance in patients with systemic sclerosis.

OBJECTIVE: The aim of this study was to evaluate the exercise tolerance by expired gas analysis during stress test in patients with Systemic Sclerosis (SSc). METHODS: Eighteen women (mean age 48.56+/-12.48 years) affected by SSc were studied. A complete echocardiographic examination including pulmonary artery systolic pressure estimation, pulmonary function tests, diffusion lung capacity for carbon monoxide (DLCO), and exercise test were performed. During exercise, breath-by-breath expired gas analysis was performed. RESULTS: Seven patients (39%) had baseline pulmonary systolic hypertension (group A) and 11 patients (61%) did not (group B). Six patients had reduced DLCO values. Both maximal oxygen consumption (VO2max) and anaerobic threshold (VO2AT) values were markedly decreased compared to the predicted values. Seven of 18 patients were unable to complete a maximal exercise (5 of whom affected by pulmonary systolic hypertension). Group A patients showed reduced VO2max, VO2AT, and O2 pulse compared with patients with group B patients (p=0.004, 0.017, and 0.013, respectively); VO2max, VO2AT and O2 pulse were significantly correlated to baseline pulmonary artery systolic pressure. CONCLUSIONS: An exercise intolerance in patients affected by SSc is present. Impairment of exercise performance is associated with pulmonary hypertension.

[Filling materials in the repair and esthetic surgery of the breast. Historical notes]. / I materiali di riempimento nella chirurgia riparatrice ed estetica della mammella. Cenni storici.

The biological and synthetic materials employed over the years for filling breasts after mastectomy or for congenital malformations are reviewed. At the start of the century, breast shape and volume were changed by adipose tissue grafts. In the 50s and 60s dermo-fibro-adipose grafts and later auto-grafts and grafts of the large epiploon were used. Synthetic materials have also developed, from early century attempts using paraffin injections to the discovery for industrial use of plastics. Following the first polyvinyl prostheses, Cronin developed silicon prostheses for medical purposes and in later years these went through numerous changes in form, volume and design up to the recent skin expanders. Polyurethane has also been used in attempts to reduce capsular retraction.

[Conservative surgery and esthetic rehabilitation of carcinoma of the breast]. / Chirurgia conservativa e riabilitazione estetica nel carcinoma mammario.

A careful review of the literature stimulated these comments on current developments in conservative surgery as an alternative to radical mastectomy in stage I and II breast cancer with particular reference to their implications for cosmetic rehabilitation. It is emphasised that the data so far available indicate comparable results in terms of locoregional recurrences, metastases and survival. It is also pointed out that the efficacy of the conservative techniques reflects new concepts of the natural history of breast cancer. The hope is expressed that these encouraging data will be confirmed by more extensive and systematic clinical experiment in order to minimise the indications to more radical surgery which notoriously has such devastating physical and psychological effects that it takes extremely complex and demanding plastic surgery to reshape the patient to psychological sexual and social health.

[Reconstruction of the breast after radical mastectomy in cancer. Reconstruction of the breast volume]. / La ricostruzione della mammella dopo mastectomia radicale per cancro. Ricostruzione del volume mammario.

After underlining the serious psychological consequences of radical mastectomy for carcinoma and the importance of breast reconstruction for the patient's complete recovery, the paper briefly reviews the main reconstruction techniques employed in restoring breast volume which is essentially achieved by inserting an artificial prosthesis below a myocutaneous skin flap often taken from the great dorsal. Some mention is also made of recently developed alternative techniques.

[Development of the surgical technics in abdominoplasty]. / L'evoluzione delle tecniche chirurgiche nelle addominoplastiche.

The entire literature on abdominoplasty is reviewed with a description of the various techniques developed since the introduction of the operation.

[Treatment of tissue loss in surgery of the scalp. An analysis of 89 patients brought to our attention]. / Il trattamento delle perdite di sostanza nella chirurgia del cuoio capelluto. Un'analisi di 89 pazienti giunti alla nostra osservazione.

The recent computerisation of operating theatre and forensic files facilitated a retrospective study of 136 plastic surgery operations performed on 89 patients presenting traumatic or surgical scalp tissue loss in the San Camillo Hospital, Rome between 1/1/1980 and 31/12/1987. The study provided some useful data for the planning of the surgical approach to this delicate anatomical area. Where the dimensions of the defect and the trophic condition of the local tissues permitted, the best functional and cosmetic results were obtained by using flaps of contiguous skin. In this field, new prospects are offered by the introduction of skin expanders whose gradual and controlled distension of the skin permit excellent functional and cosmetic results.

[Reconstruction of the breast after radical mastectomy in cancer. Reconstruction of the areola-nipple complex and the symmetry of the 2 breasts]. / La ricostruzione della mammella dopo mastectomia radicale per cancro. Ricostruzione del complesso areola capezzolo e della simmetria tra i due seni.

After pointing out the need for reconstruction of the nipple-areola complex and the restoration of symmetry between the two breasts after radical mastectomy for cancer, the paper briefly examines the techniques currently available for the achievement of these "finishing touches" that usually take longer then the primary and fundamental breast reconstruction.

[Treatment of fractures of the mandible: a new type of external fixator]. / Trattamento delle fratture della mandibola: un nuovo tipo di fissatore esterno.

The use of external fixators in the treatment of complex mandibular fractures is described, as are the advantages offered by the technique which permits accurate, controlled reduction of the bone fragment without immobilising the temporomandibular joint.

[Complications of septorhinoplasty]. / Complicanze nella settorinoplastica.

A review of the literature on complications in septorhinoplasty is presented. Though rare, complications may arise in the surgical treatment of such a delicate anatomical area as the nasal septum and both theoretical and practical knowledge of the problem is necessary in order to prevent and/or handle such unexpected events. Complications are grouped according to aetiopathogenesis into infectious, haemorrhagic, traumatic, systemic and miscellaneous.