The primacy of the Vianeo family in the invention of nasal reconstruction technique.

The birth of plastic surgery is identified with the history of rhinoplasty, which was practiced in ancient India when nose amputations were a common practice. Nose reconstruction was the most frequent surgical operation required in India at that time, and it was based on the use of a forehead flap and called an Indian method. The revolution of this technique took place in the south of Italy in the 15th century with the introduction of "the Italian method" invented by 2 families: the Brancas from Sicily and the Vianeos from Calabria. In our opinion, many questions remain as to why the Branca and Vianeo families began nose reconstruction; how and from whom they learned this technique; and which of the 2 families was first to practice it. Gustavo Branca has been always considered as the inventor of the Italian method. Historical references date Brancas in the first half of 15th century and Vianeos in the second half of the same century, but the dates can be inverted. Vianeos are no more the successor, but they are contemporary or immediately predecessors because by our documentation Vincenzo Vianeo, first surgeon of his family, performed rhinoplasty operation in the early years of the 15th century.

[Fournier's gangrene. A case report]. / Espressività clinica della sindrome di fournier. A proposito di un caso.

Fournier's gangrene is a rare pathology, whose aetiopathogenesis is very varied and much debated. In most cases, it occurs in debilitated patients with chronic diseases involving tissue ischaemia. Despite substantial progress in scientific research, it carries a high mortality rate because of the rapidity with which it sets in and evolves, presenting therefore as a medical and surgical emergency. Although this syndrome has long beenknown, it is still difficult to treat and the subject of considerable debate. The authors report a case of Fournier's gangrene of an idiopathic nature, not corresponding to any of the forms described in the literature, which gave rise to a number of medical and surgical considerations, demonstrating the importance of prompt treatment capable of arresting its course and preparing the affected areas for reconstructive surgery.

Repositioning of posterior auricular muscle combined with conventional otoplasty: a personal technique.

Prominent ears are the most common deformity of the external ear in children. Since 1881 various treatments have been described but the choice of procedure still remains at the surgeon's preference. A posterior auricular muscle malposition is frequently present in prominent ear deformity even though this muscle shows only a rudimentary function in man. This article presents a technique to reposition the posterior auricular muscle as an adjunct to conventional otoplasty. A quadrangular cartilage paddle, where the muscle inserts, is raised with the muscle as a chondro-muscular flap that can be advanced and reset more peripherally. Eighty consecutive patients, followed up for at least 12 months, have been reviewed. The posterior auricular muscle repositioning combined with a lozenge shaped conchectomy has been successfully performed in 103 ears. The cartilage paddle proved to be a strong support which facilitates the re-insertion of the muscle. Repositioning of posterior auricular muscle allows a more anatomical correction of both ear's projection and slope improving symmetry with the contralateral side.

Prognostic significance of reverse transcriptase-polymerase chain reaction-negative sentinel nodes in malignant melanoma.

BACKGROUND: Polymerase chain reaction (PCR) is a molecular biology technique that can detect a single metastatic cell in 10(6) to 10(7) normal cells. Its use has been proposed as an additional new method for the detection of malignant melanoma nodal metastases in the sentinel lymph node (SLN) to improve the detection rate guaranteed so far by standard histology (hematoxylin and eosin; H&E) and immunohistochemistry (IHC). METHODS: Since October 1995, 137 patients with primary cutaneous melanoma (Breslow thickness,.75-4 mm) have undergone surgery for selective lymphadenectomy. To identify the SLNs, every patient had preoperative lymphoscintigraphy and a vital dye perilesional injection, followed by a gamma probe-guided operation. RESULTS: In 134 patients at least one SLN was detected, with a detection rate of 98%. Every SLN was examined by H&E and IHC (S-100 antigen and HMB-45 protein). The messenger RNA codifying for tyrosinase and MART-1 (melanoma antigen recognized by T cells) was used as the target sequence for the reverse transcriptase (RT)-PCR. The results showed 11% positive SLNs with IHC and H&E examination and 63% with RT-PCR. No recurrence was noted at follow-up in the group with RT-PCR-negative nodes (absence of false-negative cases). CONCLUSIONS: In our experience, RT-PCR SLN negativity is achieving a very favorable prognostic significance. However, RT-PCR positivity is still to be evaluated. Furthermore, results obtained with this method have been shown so far to be independent of Breslow's tumor thickness.