Cervical sympathetic chain schwannoma: a case report.

Nerve sheath tumours arising from the sympathetic chain are extremely rare and are a diagnostic challenge. We report the case of a 31- year-old man who presented with an asymptomatic right cervical swelling. He was evaluated with sonography, CT, MR and angiography. Surgical excision of the lesion was performed, and histological examination revealed a schwannoma. The differential diagnosis of such tumours and their management are discussed.

Anthropological and ethical reflections on the production and use of embryonic stem cells.

Stem cells and their potential therapeutic application have generated tremendous public interest, great enthusiasm among researchers and intense commercial interest. There are diverse sources of stem cells. According to their origin and their biological characteristics, they are classified as embryonic stem cells, germline stem cells and tissue stem cells. Until now, the most concrete therapeutic results have come from some adult tissue stem cells, with promising prospects also being offered by umbilical cord stem cells. Regarding embryonic stem cells, there is concern that they would be difficult to control in vivo. Nonetheless, many researchers are still pursuing their potential uses, convinced that they will be useful not only for study, but also for therapy, especially as a result of their high capacity for self-renewal as well as their broad potential for differentiation. This discussion which is eminently scientific in nature, and not lacking in ethical and political repercussions, will not be entered into above all regarding the allocation of available intellectual and economic resources.

Selective lymph node dissection in patients with intermediate thickness melanoma: our experience.

The role of elective lymph node dissection (ELND) for the treatment of cutaneous melanoma has been debated for many years. Actually, the value of ELND is seriously questioned because an increasing of overall survival rates has not been demonstrated. The lymphatic mapping technique, initially performed by an intradermic injection of vital blue dye, subsequently improved by the use of radioguided surgery (RGS), proved effective for the detection of clinical occult lymph node metastasis. We performed a sentinel node biopsy on 71 patients with stage pT2/T3N0M0 melanoma. Vital blue dye mapping alone was performed on 39 patients; the remaining 32 patients had a combined lymphatic mapping with both blue dye and RGS. The sentinel node (SN) was complexively identified in 69/71 (97.2%) patients. Sixteen patients (23.2%) were found to have metastatic melanoma cells in their SN(s); all these patients underwent lymph node dissection of the affected basin. Our experience confirmed that the intraoperative detection of sentinel nodes using both blue dye and radio-guided surgery is an effective and reliable technique for selecting patients to be submitted to lymph node dissection.

[Intraoperative expansion of scalp flaps. Quantitative assessment]. / Espansione intraoperatoria di lembi di scalpo. Valutazione quantitativa.

BACKGROUND: The aim of this study was to test the ex-vivo biomechanical properties of acutely expanded scalp flaps, in order to quantitatively assess the efficacy of acute scalp expansion. METHODS: A total of 14 fresh male cadavers were used for the study. In each cadaver, a rectangular (4 x 10 cm), laterally-based flap was designed on each side of the scalp, starting from the superior margin of the external auditory canal. One randomly-selected flap per each scalp underwent acute-intermittent expansion (3-minute expansion-3-minute rest cycle per three times with the maximal expansion achievable), while the contralateral flap served as control. After the expansion process, the acutely-expanded flaps were measured to assess if the applied biomechanical stress have determined any changes in their dimensions. The biomechanical properties (stress/strain ratio, mean stiffness) of both expanded and control flaps were then assessed by means of a dynamometer and a force-transducer. RESULTS: The obtained data showed that the biomechanical benefits provided by acute scalp expansion were not statistically different (p < 0.05) from those obtained by simple subgaleal undermining. Neither any change of length nor any gain in the compliance have been observed in the acutely-expanded flaps as compared to control scalp flaps. CONCLUSIONS: In our opinion, a possible explanation (to be further validated) for the lack of effect of acute scalp expansion might be that inelastic galea aponeurotica did not allow the mechanical creep to exploit the inherent elastic properties of the overlying scalp skin.

Cleft lip: a histochemical and ultrastructural analysis of lip muscles.

AIMS: In order to evaluate the pathogenesis of cleft-lip in relation to both the anatomical and structural anomalies of the mesenchymal tissues, the authors concluded that the presence of structural anomalies in the examined tissues could not explain the malformation, but might be a consequence of it. Delayed muscular development, asymmetrical distribution of the muscular fibres and their anomalous insertion suggest that the anatomical/functional loss clinically detectable in the orbicular muscle could be the result of a perinatal dysmorphological process rather than of a simple mesenchymal hypoplasia. METHODS: Schendel et al. suggested that a metabolic defect in the mitochondrial function could cause a deficiency in cell migration and proliferation responsible for the malformation in question. To establish whether the pathogenesis of the cleft-lip is associated with an alteration in mitochondrial functionality, eight patients affected by unilateral cleft-lip were subjected to a biopsy of the orbicular muscle during the course of reparative surgery. RESULTS: The results obtained showed: 1) a great variation in the size of muscle fibres; 2) the absence of ragged red fibres; 3) a normal oxidative function in the muscle fibres examined; 4) the absence of typologically significant groupings positive for myofibral ATPases. Furthermore, the morphology of the mitochondria was preserved in all cases and neither inclusions nor morphological or volumetric changes were detected. CONCLUSIONS: This preliminary data did not confirm the constant presence of mitochondrial pathology responsible for the malformation in question. In our opinion, the growth deficiency of the maxillary segment could be ascribed to the cicatrization of the surgical repair of the cleft-lip.

Mini-laparoscopic cholecystectomy.

BACKGROUND/AIMS: The authors describe their experience in performing cholecystectomy using mini-laparoscopy in selected cases of uncomplicated cholelithiasis. This involved making one 10 mm, one 5 mm and two 2 mm incisions. METHODOLOGY: From July 1996 to August 1997, 60 cholecystectomies were performed using mini-laparoscopy, out of a total of 203 video-laparocholecystectomies performed during the same period. RESULTS: Average length of the operations was 36 minutes from insertion of the first trocar to extraction of the gallbladder. All patients were discharged in the second day after surgery. No short-term intra- or post- operative complications occurred. CONCLUSIONS: The benefits of mini-cholecystectomy are potential advantages in improved appearance, reduced pain, better respiratory function, fewer wall complications. Therefore, the authors believe that mini-laparoscopy should not be assessed in terms of percentage of use or success, but rather considered as a part of the laparoscopic method to be used in selected cases.