Vacuum-assisted closure therapy in reconstructive surgery.

In 1997, supported by experimental work, Argenta published a clinical report describing a variety of complicated wounds whose treatment responded successfully to negative pressure dressings using a vacuum-assisted closure system (VAC) (Kinetic Concepts Inc., San Antonio, TX). This system has been successfully used in the fields of orthopaedics and traumatology, general surgery, plastic and reconstructive surgery and gynaecology/obstetrics for a large variety of complicated wounds located in several regions, particularly in the torso and extremities. To the best of our knowledge, the use of the VAC therapy in treating free flaps surgical wounds has not been discussed in the literature. Since 2009 at the Novara Major Hospital, we have been using the VAC therapy in selected cases for difficult and complicated wounds of the maxillofacial region. The purpose of this study is to describe and discuss three cases undergoing VAC therapy followed by loco-regional flaps in the management of exposed bone after fibular free flap. The advantages and disadvantages of VAC therapy in treating complicated wounds have been reported by several studies; compared with conventional wet-to-dry dressings, this system eliminates interstitial oedema, exudates and debrides while increasing blood perfusion leading to a more rapid promotion of wound healing with less bacterial loading. Although surgical debridement, wet-to-dry dressing changes and antibiotic treatment are the mainstay in managing maxillofacial wounds, VAC therapy can be used to obtain primary closure or to prepare the wound bed until definitive reconstruction is carried out. In our opinion, the VAC technique is an innovative therapy, and at our institution represents the standard of care for the majority of complicated wounds.

Quantum chemical study of the photocoloration reaction in the napthoxazine series.

Ab initio and semiempirical quantum mechanical calculations were performed to study the electronic spectra of spiroxazine photochromic compounds as well as the corresponding photoisomers. Ground-state geometries were optimized based on density functional theory (DFT). Excitation energies of the different forms were calculated using the time-dependent density functional theory (TD-DFT) method. Semiempirical calculations including configuration interactions were performed to detail the mechanism of ring opening in excited states. On the basis of the obtained potential energy profile, a complete mechanism of photocoloration able to clarify some experimental findings is provided. A correlation of the experimental quantum yield of photocoloration with the calculated properties as a function of substituent effects is proposed.

Metastases to parotid gland from cancers of the upper airway and digestive tract.

Forty-four cases of parotid metastases were diagnosed and treated in the period 1968-1994. In 10 patients (23%), the primary tumour was sited in the mucosal layer of the upper airway or digestive tract: oropharynx (n=3), larynx (n=3), nasopharynx (n=2), hypopharynx (n=1) and the maxillary sinus (n=1). Histologically, the primary tumour was squamous cell carcinoma in 9 cases and adenocarcinoma in one. One patient received surgical treatment only, two patients surgery and postoperative radiotherapy, one radiotherapy only, four chemotherapy and two symptomatic treatment only. Only one patient is alive, disease-free, 5 years after treatment. The other patients died: six within 1 year, two within 2 years and one within 3 years of diagnosis.

A new spiro[indoline-naphthoxazinic] spin trapping agent.

The synthesis and characterisation of a new spin trapping agent of the spiro[indoline-naphthoxazinic] family is reported. The EPR results of spin trapping experiments are also described, which indicate the ability of this nitrone to react with carbon-, oxygen- and sulphur-centered radicals.

[The otoneurological assessment of radiotherapy-induced brain stem involvement in patients with rhinopharyngeal neoplasms]. / Valutazione otoneurologica della sofferenza troncoencefalica radioindotta in pazienti con neoplasie della rinofaringe.

The authors report a study in which otoneurological tests were employed in order to determine the possibility of radio-induced alterations in the brainstem of patients with a rhinopharyngeal carcinoma, which extended to basicranial structures, who had undergone radiotherapy. The case report includes 16 patients; 10 males and 6 females, aged from 37 to 82, all with rhinopharyngeal tumors. All the subjects underwent Co 60 radiotherapy (44-68 Gy); the brainstem received from 40 to 100% of the total dose. Otoneurological evaluation prior to and following radiotherapy was performed employing pure tone audiometry, ABR, rotatory tests, saccadic eye movements, smooth pursuit. After RT treatment, ABR analysis revealed an abnormal wave I-V interpeak interval in 40% of the cases and pathologic in 37%. Smooth pursuit, saccades and sinusoidal rotation analysis showed important alterations respectively in 21%, 6% and 12% of the subjects. The most significant variations were in patients who received more than 60 Gy. The data gathered regarding abnormalities of otoneurological parameters indicate a probable close relationship between these modifications and precocious radio-induced brainstem damage.