A novel surgical approach to calcinosis cutis using a collagen-elastin matrix.

Calcinosis cutis is a cutaneous disorder characterised by abnormal deposition of calcium in the dermis. Treatment of this condition has variable success rates and includes medical, topical and surgical management. Here we describe a case of a woman with a painful calcinosis lesion on the buttocks, treated with excision and application of a bovine collagen-elastin dermal regeneration template, a thin, porous membrane consisting of a native bovine type I, II and V collagen-fibre template coated with elastin hydrolysate. The patient's wound healed without complication and without the use of a skin graft. She remains recurrence free at 10-month follow up, with satisfactory outcome.

Heterologous reconstruction and radiotherapy: the role of latissimus dorsi flap as a salvage.

AIM: The versatility and effectiveness of the latissimus dorsi flap as salvage in complicated heterologous reconstructions, especially with regards to radiotherapy, is examined in this retrospective review of our 10-year experience. METHOD: Twenty-eight patients with complicated heterologous reconstruction were divided into three groups: (1) 15 patients with mastectomy and immediately expander reconstruction and radiation; (2) 9 patients with previous QUART, salvage mastectomy and immediate expander reconstruction; (3) 4 patients with radical mastectomy without radiation. RESULTS: The most common complications were capsular contracture and radiodermitis in Group 1, cutaneous fistula in Group 2. Recipient site complications, after latissimus dorsi flap, were observed in seven patients (five smokers), five in Group 1, two in Group 2. Cosmetic result was scored excellent and good in 25 patients (89%). CONCLUSION: This study shows as a favourable and cosmetically satisfactory reconstruction can be achieved when combining an implant with a latissimus dorsi flap allowing the salvage of the entire heterologous reconstruction.

[The evaluation of the appropriateness of instrumental exams in cardiology. The case of echocardiography]. / La valutazione dell'appropriatezza degli esami strumentali in cardiologia. Il caso dell'ecocardiografia.

BACKGROUND: The aim of this study was to evaluate the appropriateness and utility rates of echocardiograms performed in 309 patients in an outpatient clinical setting. METHODS: Data were collected by means of a questionnaire filled in by the cardiologists who performed the examinations. Appropriateness was evaluated according to international guidelines and scored as class I: appropriate, class II: doubtful appropriateness, class III: inappropriate; the exam was deemed useful if it was able to influence the clinical decision-making; normalcy rate was also checked. The relationship between both the referring physicians and motivation of the exam and its appropriateness, and the relationship between appropriateness and both the normalcy rate and utility of the exam were assessed. RESULTS: An echocardiogram was requested by the cardiologist in 46% of patients; the more common reasons for the exam were arterial hypertension (26%), cardiac murmur (18%), palpitations (15%), and known coronary artery disease (10%). The echocardiogram was appropriate (class I) in 25% of patients, doubtfully appropriate (class II) in 39% of patients and inappropriate (class III) in 36% of patients. The appropriateness rate between the cardiologists was similar to that of other prescribing clinicians (p = NS). The highest class III rate was found in patients with hypertension, while the highest class I rate was found in patients with a cardiac murmur (p < 0.01). Normalcy rate was lower in class I than in class II and III exams (p < 0.001). The utility rate was higher in class I (76%) than in class II (13%) and III (< 1%) exams (p < 0.01). CONCLUSIONS: International guidelines can be used effectively and safely to identify (not to prescribe) the useless echocardiograms.