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Biomedical subjects

C Rubino

Publications and source records attributed to C Rubino.

34 records · Page 2Linked to original sources

Increased risk of second cancers following breast cancer: role of the initial treatment.

OBJECTIVES AND METHODS: The risk of second primary malignancies (SMN) was studied in a cohort of 4,416 one-year survivors of a breast cancer. The role of the menopausal status and of the initial treatment modalities (surgery, radiotherapy, and chemotherapy) was investigated. RESULTS: Excluding second primary breast cancer and non-melanoma skin cancer, a total of 193 (4.4%) patients developed a SMN between 1973 and 1992, compared with 136 expected (Standardised Incidence Ratio, SIR = 1.4, 95% CI (1.2-1.6)). No trend towards either an increase or a decrease was noted in the SIR with time after treatment (p = 0.2). The greatest increase in the relative risk concerned soft tissue cancers (SIR = 13.0, 95% CI: 6.8-22.3), followed by leukaemia (SIR = 3.1, 95% CI: 1.7-5.0), melanoma (SIR = 2.7, 95% CI: 1.4-4.8), kidney (SIR = 2.5, 95% CI: 1.2-4.5), ovary (SIR = 2.0, 95% CI: 1.2-3.1) and uterine tumours (SIR = 1.9, 95% CI: 1.4-2.5). The SIR was 3.0 (95% CI 1.8-4.7) in women under 40 at the time of the breast cancer, 1.9 (95% CI: 1.4-2.4) in those aged 40-49 and 1.2 (95% CI 1.0-1.4) in those aged 50 or more. In the 2,514 women who had received radiotherapy as initial treatment without chemotherapy, the SIR for all SMN was 1.6 (95% CI: 1.1-2.3) fold higher than in those who had not received radiotherapy as initial treatment. CONCLUSION: In conclusion, this study confirms the increased risk of second malignancies in women treated for a breast cancer, and particularly in those who were younger at the time of treatment for breast cancer. Our results also suggest that radiotherapy may play a role in the onset of these second lesions.

Adult↗

Clinical use of a new axial chondro-mucosal flap in wide full-thickness eyelid reconstructions.

BACKGROUND AND OBJECTIVE: Full thickness reconstruction of more than half of an eyelid, mainly of the upper one, is a challenge for the surgeon. In 1992, for the first time, the authors reported the use of an axial chondro-mucosal flap from the nose for reconstruction of the tarsoconjunctival plane of a full thickness defect of an eyelid. This article reports and discusses the results of the follow-up of 18 patients operated on using the above technique during the period June 1991-March 1997. PATIENTS AND METHODS: Apart from the oncological evaluation, the following parameters were assessed: position, closure, the presence of epiphora, length of the palpebral rim, rim opening, levator function, an aesthetic balance of the eyelids, and donor site morbidity. The follow-up ranged from 6 to 40 months. RESULTS: The axial chondro-mucosal flap was clinically viable in all patients. One patient showed a 2 mm lagophthalmos. Static parameters were within normal ranges. In upper eyelid reconstruction, an 8 to 18 mm. levator function (mean 13 mm) was shown. CONCLUSION: The authors discuss their complications and results and feel that this flap, associated with full thickness skin grafts, may be considered a first choice technique, in expert hands, in complex full thickness upper eyelid reconstruction, and a possible alternative in lower eyelid reconstruction, for wide defects when the use of other flaps is compromised.

Adult↗

Cost-minimization analysis of prophylactic granulocyte colony-stimulating factor after induction chemotherapy in children with non-Hodgkin's lymphoma.

BACKGROUND: Colony-stimulating factors promote the proliferation of certain bone marrow cell populations. The primary objective of treating patients with these factors prophylactically following chemotherapy is to reduce the risk of infection, thereby minimizing the need for hospitalization and parenteral antibiotics. The use of colony-stimulating factors in children is widespread, despite the absence of conclusive supportive data and the high cost of these drugs. Consequently, the cost-benefit ratio of using prophylactic colony-stimulating factors is an important issue in cancer therapy. METHODS: During the period from January 1994 through June 1996, 149 afebrile children with newly diagnosed non-Hodgkin's lymphoma were randomly assigned either to receive granulocyte colony-stimulating factor (G-CSF) (lenograstim; 5 microg/kg body weight per day subcutaneously) or not to receive it (the control) at the end of the first two courses of induction chemotherapy with cyclophosphamide, vincristine, prednisone, doxorubicin, and methotrexate. A cost-minimization analysis was performed to assess the cost of chemotherapy in each group and to quantify how much could be economized by prescribing G-CSF. RESULTS: The total cost for induction chemotherapy was $29,765 in the G-CSF-treated group and $30,774 in the control group, indicating that the treatment strategy with G-CSF was slightly less expensive than the strategy without G-CSF (mean difference = $1009; 95% confidence interval = -$1474 to $3492). CONCLUSION: Treatment with G-CSF following chemotherapy in children with non-Hodgkin's lymphoma--previously shown to be of limited clinical benefit--also does not appear to reduce the costs of chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗

Island chondromucosal flap from the nose in reconstruction of the eyelid. A light and scanning electron microscopic study.

Specimens from the reconstructed eyelids of two out of 15 patients operated on using an island chondromucosal flap from the nose were observed under light and scanning electron microscopy (EM) to study the histological and ultrastructural features of nasal epithelium transferred as a flap to the lids, the microscopic appearance of the other tissues of the flap, and its vascularisation. Both light and scanning EM images showed that nasal epithelium, when transferred as part of a flap for reconstruction of the eyelid, maintains its differentiation for many months. The lumen of arteries and veins can be observed in sagittal sections within the flap, suggesting that their course is parallel to its long axis. The absence of fibrosis or muscle fibre degeneration together with a highly cellular cartilage are indirect indications of good vascularity. These data support the reliability of the island chondromucosal flap from the nose in reconstruction of the eyelid.

Aged↗

Venous flaps and perivenous areolar tissue: an experimental study in rats.

Since plastic surgeons are continually looking for new possibilities for the clinical transfer of tissue, they are very interested in investigating capillary blood flow. Recently, several authors have investigated the role of veins in experimental island venous flaps. In the present study, the authors attempt to clarify the importance of plasmatic imbibition and perivenous tissue as single nourishment sources in experimental island skin flaps deprived of arteries, and consisting of both axial and random zones. This study demonstrates the importance of perivenous areolar tissue in flap survival; the "initial plasmatic imbibition" was not able to keep the flaps viable. Due to the previously demonstrated presence of small arteries in the pedicle of "venous flaps," these flaps should no longer be considered as purely venous. In the reported rat model, it was not possible to harvest a flap without arterial inflow.

Animals↗

Accessory slip of the palmaris longus muscle.

We discuss the case of a patient presenting an accessory slip of the palmaris longus (PL) muscle, which caused symptoms of median nerve compression on his left forearm. An asymptomatically anomalous distal PL belly contralaterally is also reported, and the clinical relevance and diagnosis of PL anomalies are discussed.

Adult↗

Island chondro-mucosal flap and skin graft: a new technique in eyelid reconstruction.

We report a new technique of large full thickness eyelid defect reconstruction using an axial island chondro-mucosal flap from the lateral aspect of the nose and a full-thickness skin graft. The flap is harvested undermining the skin and the subperiosteal plane and taking a strip of upper lateral cartilage and nasal mucosa. It is transposed to reconstruct the tarso-conjunctival plane of the missing eyelid and the skin defect repaired with a skin graft. The donor defect is repaired by direct closure. Satisfactory results were obtained in 3 patients. In our opinion, the technique is a reliable choice when dealing with large full thickness defects of the upper eyelid, and, in selected cases, of the lower eyelid.

Adenocarcinoma, Sebaceous↗

Free flap failure in a patient with a long standing, infected, squamous cell carcinoma.

A 40-year-old patient presented with a long history of a pilonidal sinus, which had been operated on several times during the last 20 years. On clinical examination the patient had a large tumour in the sacral and perineal region, with involvement of the rectal wall. General surgeons first attempted to excise the tumour with wide healthy margins, and close the wound by local flaps. After partial flap necrosis and wound dehiscence, the patient underwent a reconstruction with a free latissimus dorsi myocutaneous flap. During the anastomosis it was noted that the recipient vessel walls were brittle, mainly at the arterial site, so the arterial anastomosis had to be done three times. Despite this the artery thrombosed again 12 hours later. Biopsy specimens were taken from the anastomotic sites and studied under light microscopy. There were signs of acute intramural inflammation, with many polymorphonuclear leukocytes present in microabscesses, and spots of necrosis in the elastic layer at the site of the recipient artery. In conclusion, the long lasting infection was considered to be the main factor that caused the anastomosis to fail, leading to thrombosis, through alteration of the vessel walls. The anomalies in the vessel walls were found at some distance from the clinically diseased area, further than is usually found in acute infection. The use of primary arteriovenous vein graft anastomosis can be made on undamaged vessels, and possibly a less traumatic anastomosis such as the "sleeve" type, should be considered for similar cases.

Abscess↗

[The cancerous recurrence of a pleomorphic adenoma of the parotid. Comments on a case].

After taking the clinical case examined as a starting point and supporting the data obtained with a literature analysis of the cancerous relapse of a parotid pleomorphic adenoma, the Authors suggested a suitable surgical operation (total parotidectomy with conservation of the facial nerve) in the treatment of parotid pleomorphic adenoma. Doing so, it is possible to avoid a relapse of neoplasm and a possible transformation into malignancy. Furthermore it might prevent the formation of parotid carcinoma.

Adenocarcinoma↗

[Surgical treatment of blepharoptosis in patients with mitochondrial myopathies. Apropos of 4 cases].

The authors briefly describe the commonest forms of mitochondrial myopathies particularly those associated with disorders of ocular motility. They report their series of four patients suffering from ptosis of the eyelid caused by mitochondrial myopathies. The ptosis was corrected surgically in all cases by means of Müller's muscle adaptation technique. The authors discuss their results and the indication for this technique.

Adult↗

A technical refinement to prevent supratip deformity in aesthetic rhinoplasty: "the trapezoid peak".

BACKGROUND: The relationship between appropriate caudal dorsum resection and supratip deformity or inadequate tip projection currently is clear. Correct quadrangular cartilage management seems to have a basic role in the final tip aspect after aesthetic rhinoplasty. METHODS: Primary aesthetic rhinoplasty was performed for 38 Caucasian patients. A septal refinement was used for patients requiring extra tip support and not requiring grafts. RESULTS: The minimum follow-up period was 1 year. No supratip deformity was noted after surgery. The tip and midvault had adequate projection. CONCLUSIONS: The described maneuver sustains the alar cartilage without sutures, preventing supratip deformity, sustaining soft tissues, and avoiding loss of tip projection.

Follow-Up Studies↗

[Clinical use of resorbable polymer mini-plates in mandibular fractures: a one-year experience].

The authors describe their experience in rigid fixation of maxillo-facial fractures with resorbable plates made from poly-L-lactic acid. Seven cases are presented, with a one-year follow-up or longer. Plate resorption was evaluated by means of echographic examination, repeated every three months. All fractures healed well, with no complications. Finally, advantages and limits of the material are considered, as well as its future prospects and margins of improvement.

Adolescent↗