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Biomedical subjects

N Scuderi

Publications and source records attributed to N Scuderi.

At least 37 records · Page 2Linked to original sources
PubMed1998

Recurrent cutaneous leiomyosarcoma.

Cutaneous leiomyosarcoma is a rare tumour, accounting for 2.3% to 6.5% of all soft tissue sarcomas. The case of a young patient with a cutaneous leiomyosarcoma on the right gluteal region is here presented. The lesion misdiagnosed as a keloid after primary excision of histiocytoma had a two-year history, had been excised twice. The tumour was widely excised, and the wound closed primarily. No recurrence or distant metastasis are reported 26 months after the initial presentation. Clinical, histological, immunohistochemical features and surgical strategies of the reported case are discussed and compared with literature.

Adult↗
PubMed1997

Ultrasonic liposculpturing: extrapolations from the analysis of in vivo sonicated adipose tissue.

The ultrasonic liposculpturing technique is currently gaining increasing popularity. Although ultrasound is an accepted part of our diagnostic medical practice, the way in which it interacts with solid living tissue is still a complex and unsolved biophysical problem. Very few studies, if any, have followed the effects of diffusion of this intriguing technique on the fields of biosafety and interaction mechanisms. We evaluate the results of our standard ultrasound liposculpturing technique in order to recognize the physical mechanism-thermal, cavitational, or "direct"-involved in the damaging process. Our microscopic analysis of sonicated adipose tissue confirms that ultrasound is highly selective in its action, producing disruption of macromolecules and cellular structures probably through microstreaming tissue movement. The results of ultrasonic liposculpturing and standard suction lipoplasty are compared. The main advantages of this new technique are the possibility of a very selective destruction of adipose tissue and the prospective solution to such delicate problems as the irregularity of cellulite.

Adipose Tissue↗
PubMed1997

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↗
PubMed1997

A hemodynamic approach to clinical results in the TRAM flap after selective delay.

The delay phenomenon in the transverse rectus abdominis myocutaneous (TRAM) flap was studied by means of a laser-Doppler flowmeter and an echo color-flow Doppler device. Twenty-eight patients who underwent breast reconstruction with a TRAM flap in our hospitals were analyzed. Eighteen of them underwent selective delay 1 month before the major surgical procedure, and of them, 15 completed the reconstructive procedure. Ten patients were used as a control group and underwent TRAM flap breast reconstruction without selective delay. Cutaneous blood flow in the TRAM flaps was measured in 20 patients with a laser-Doppler flowmeter, and measurements were taken before, during, and after the surgical procedure, following a standardized protocol, as in Tuominen's original scheme. Variations in the cutaneous blood flow in the standard TRAM flap (10 patients) confirmed data obtained from the literature, i.e., an increase when elevating the cutaneous and subcutaneous parts of the flap and a decrease when ligating the deep inferior and superficial epigastric vessels. Compared with the standard TRAM flap, blood flow in the delayed flaps (10 patients) seemed to be more stable, without falling under the baseline. When elevating the cutaneous and subcutaneous parts of the flap (phase 3), blood flow values reached 120.2 percent (SEM 46.8 percent) on the random side and 131.6 percent (p < 0.009, SEM 9.58 percent, standard deviation 30.3 percent) on the axial side. During phase 4 (cutting the rectus muscles), blood flow values reached 115.0 percent (SEM 40.5 percent) on the random side and 102.8 percent (SEM 1.2 percent, standard deviation 3.8 percent, p < 0.049) on the axial side. In order to obtain further hemodynamic data, 10 patients who underwent selective vascular delay 1 month prior to breast reconstruction with a delayed TRAM flap in our hospitals were then studied by means of an echo color-flow Doppler device. Two of these patients also had been studied with the laser-Doppler flowmeter. Superior epigastric artery diameter (in millimeters) and resistivity (expressed as Pourcelot's index) were measured before and after selective delay of the deep and superficial inferior epigastric vessels, following a standardized protocol. Measurements were taken with 7.5- and 10-MHz linear probes at a point located after the origin of the costomarginal artery. In every patient an increase in the superior epigastric artery diameter and a decrease in the resistivity index were observed, and this was statistically significant. In the nonirradiated patients, the increase in the average diameter of the superior epigastric artery was 98.1 percent, and the average resistivity index decrease was 14.1 percent. In the irradiated patients, the increase in the average diameter of the superior epigastric artery was 35.5 percent, and the average resistivity index decrease was 29.8 percent. In conclusion, laser-Doppler flowmeter evaluations show that cutaneous blood flow in the delayed flap is more constant and undergoes fewer variations than that in the standard TRAM flap. In addition, echo color-flow Doppler indicates that the basis for the increase in the vascular territory of the superior epigastric artery caused by the delay maneuver is an increase in the superior epigastric artery diameter, always accompanied by a decrease in the resistivity index. Two different mechanisms seem to us to be related to these modifications in the blood circulation. In the nonirradiated patients, superior epigastric artery dilation prevails, whereas in the irradiated patients, a decrease in the resistivity index is the dominant mechanism of compensation. These hemodynamic findings well support the decrease in flap necrosis reported in our series (standard TRAM: 30 percent; delayed TRAM: 7.1 percent).

Adult↗
PubMed1996

Combined radius and ulna reconstruction with a free fibula transfer.

A 20-year-old man sustained a high energy injury to his right forearm resulting in comminuted open fractures of the forearm with 6 cm bone loss of the radius and 7 cm bone loss of the ulna. A bone segment was removed from the middle of a free fibula transfer to produce a single flap with two vascularised bone segments to reconstruct both the radius and ulna defects. Step osteotomies were stabilised with a single lag screw for each fracture line and, with a rigid external fixation device on the ulna, two vein grafts were used to anastomose the flap pedicle to the recipient vessels in the forearm. The postoperative period was uneventful. X-rays and scintigrams confirmed good healing of the fractures and normal perfusion of the flap so that the external fixation device could be removed 3 months after surgery. One year after the injury, the patient underwent a functional evaluation showing excellent results with very good preservation of rotation of the forearm.

Adult↗
PubMed1996

Divided nevus of the eyelid: a case report.

Divided nevus of the eyelid as a rare pathologic entity and develops during fetal growth, when the two eyelids are still fused together. Its surgical treatment is mostly based on full thickness skin grafts. We report a case of a 22-year-old woman with a congenital divided nevus affecting the left upper and lower eyelid. The patient was treated in our Department because of the onset of a purple red nodule in the lower part of the nevus. We examined the case from embryological, histopathological, clinical, and diagnostic standpoints, and discuss surgical options in order to reach an optimal functional and aestetic result.

Adult↗
PubMed1995

Epidemiological data on burn injuries in Angola: a retrospective study of 7230 patients.

This study describes the work carried out at the Burn Unit of the Neves Bendinha Hospital, Luanuda, Angola, during the 3-year period July 1991 to June 1994. During this period we admitted 2569 burned patients to our burn unit, and 4661 were treated on an outpatient basis. The data from the patients were analysed to indicate the distribution according to age, sex, TBSA, cause of the lesion and mortality. Our study gives some epidemiological data on burns in an undeveloped country undergoing a war, outlining the specific problems compared to the reality in civilized countries.

Adolescent↗
PubMed1994

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↗
PubMed1994

Multiple CT imaging in pressure sores.

In patients affected by pressure sores, bones can be reached easily by the infection. This suggested a new way for a more precise diagnostic evaluation, looking at the most recent technological knowledge, which can offer a better evaluation of single lesions for a better planning of surgical operations. The possibility of performing multiple imaging under a CT guide, as well as a simple technique for contrast permanence within the sore, led the authors to demonstrate the validity of modern CT scanning as a main diagnostic method.

Bone Diseases↗
PubMed1994

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↗
PubMed1994

Antitumor agents: extravasation, management, and surgical treatment.

We discuss our experience with antineoplastic drug extravasation. Between December 1988 and December 1990, 40 patients with cytostatic extravasation with lesions of varying seriousness were observed. In these patients, whenever possible, depending on the amount of time that elapsed since the accident and on the severity of the lesion, conservative therapy was done. The procedure consisted of local injection of a considerable amount of saline solution (20-90 ml, depending on the site of extravasation) and topical occlusive applications of corticosteroids locally. In all patients this was sufficient to avoid tissue necrosis. Treatment of a few patients deviated from these procedures because surgery was performed that ranged from the simple excision of infiltrated tissue to a more complex procedure of free flaps. On the basis of our experience, we discuss the role of early surgery when preventive measures and drug therapy are insufficient because of drug effects at the tissue level. In this series we did not perform early surgery.

Adolescent↗
PubMed1993

Reconstruction of ischial pressure ulcers by skin expansion.

Ten patients, eight of whom were paraplegic, have had ischial pressure ulcers treated by skin expansion. Skin expanders 680 ml in size were inserted subcutaneously on the posterior aspect of the thigh. They were filled during a short period without complications, the filling being monitored with a cutaneous tonometer. At a second operation the ulcers were repaired easily with the expanded flaps. After a few weeks the patients were able to undergo a programme of rehabilitation that included sitting with the expanded flaps. No ulcers recurred during a median follow-up of 12 months (range 8-34).

Adult↗
PubMed1991

Tissue expansion in the treatment of pressure ulcers.

The authors report their experience using skin expanders in 11 patients with severe bed sores. The expanders, with different volumes, from 250 to 1000 cc, were generally overfilled using the cutaneous tonometer. In fact, with the information revealed by this apparatus on the skin in expansion, the authors were able to reduce the filling intervals without risking ulceration. In their experience, the results obtained were satisfactory: All patients treated achieved surgical recovery. The authors see a wide future for skin-expander use in pressure-ulcer treatment. They have a working hypothesis about using expanders to progressively advance sensitive skin in areas subject to ulceration. This hypothesis is based on the possibility of reexpanding the same flap several times, as has been seen in the treatment of other types of pathology.

Adult↗
PubMed1990

Reconstruction of hypospadias with a vertical preputial island flap. A follow-up study of 127 patients.

The preputial island flap technique presented here was described by Scuderi for a one-stage repair of hypospadias. The operation utilizes a subcutaneous pedunculated preputial flap, designed dorsally along the vertical axis of the penis and transposed ventrally to reconstruct the new urethra. This surgical procedure is useful in distal and proximal hypospadias or in cases with short or absent prepuce, when the dorsal coating of the penis can be used. The technique permits a complete release of the chordee and a meatus placed at the apex of the glans. One hundred and twenty-seven patients treated during the period 1982 to 1987 were analysed. All patients had a urodynamic check and some also had a urethroscopic evaluation of the new urethra. The incidence of complications (8.65%) was very low compared with other techniques.

Child, Preschool↗
PubMed1990

[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↗
PubMed1990

[Glaucoma as etiopathogenic hypothesis of amaurosis after blepharoplasty. Apropos of a clinical case].

Amaurosis after blepharoplasty is a complication which is considered to be rare, but which nevertheless deserves extreme attention. Although various hypotheses have been proposed (and sometimes proved) its etiopathogenesis is still uncertain. The observation of a case of temporary loss of vision after blepharoplasty, which promptly regressed after medical therapy, led us to a revision of the most common causes of amaurosis, and to formulate, for this case, the etiopathogenetic hypothesis of acute glaucoma, which has already been reported in scientific literature, but without any case report.

Aged↗