Biomedical subjects
Silvia Scevola
Publications and source records attributed to Silvia Scevola.
Effect of exercise and strength training on cardiovascular status in HIV-infected patients receiving highly active antiretroviral therapy.
A routine evaluation of lipid metabolism and body fat distribution along with a careful cardiovascular risk stratification according to international guidelines are required for HIV-infected patients receiving highly active antiretroviral therapy. Intervention includes evaluation of patients for both epidemiological and clinical factors, and for anthropometric and biochemical parameters. Diet counseling, prescription of antihyperlipidemic drugs and exercise training are the cornerstones of programs devoted to protecting patients from side effects of therapies that compromise quality of life and the functions of organs like the pancreas and heart that are involved in lipid disorders.
Does the removal of pectoralis minor impair the function of pectoralis major?
The treatment of long-standing unilateral facial palsy with cross-facial nerve graft and free pectoralis minor muscle flap to the face has been the elective choice for more than 300 patients during the last 20 years at Mount Vernon Hospital in Northwood, United Kingdom. In this study, the authors assessed the residual donor-site morbidity in the chest after the procedure. During the second stage of the operation, the medial and the lateral pectoral nerves are divided at a proximal level from the plexus. Due to the common innervation shared by the two pectoral muscles, a consequent change in pectoralis major muscle function can be expected, but so far no study has been carried out to find out whether or not this occurs. The authors have performed a subjective and an objective study on a voluntary sample of 38 patients previously operated on for facial palsy with pectoralis minor muscle transfer. Cosmetic and functional outcomes were recorded. The subjective evaluation was obtained through a questionnaire. The objective evaluation was obtained through physical examination (inspection and palpation). The following quantitative parameters were determined: thickness of the muscle, arm muscle circumference, power produced at contraction, and muscle fiber activity. Subjectively, six patients (15.8 percent) reported a reduction in the force of the muscle, and 10 patients (26.3 percent) noticed a change in muscular thickness at the site of the operation. Objectively, the results of the electromyogram were almost normal in all of the muscles sampled (17 patients). Occasionally, minor changes from the normal pattern were seen in the lower half of pectoralis major. The dynamometer adduction test showed a significant reduction in the force developed on the operated side when it was the dominant side (p = 0.02), whereas no difference was shown in the group of patients who underwent operations on the nondominant sides (p = 0.18). The pectoral fold and the arm muscle circumference did not show any difference between the side operated on and the nonoperated side. This clinical study confirms that the use of the pectoralis minor muscle as a neurovascular free flap for face reanimation is associated with a low morbidity at the donor site. The authors believe that the medial pectoral nerve has a marginal role in pectoralis major muscle innervation in contrast to the classic anatomic descriptions and some of the positions of the official surgical literature regarding the actual function of this nerve.
Drains and seromas in TRAM flap breast reconstruction.
Surgeons who perform transverse rectus abdominis musculocutaneous (TRAM) flaps have differing opinions about how many drains are required in the breast and abdomen to prevent seroma. The authors therefore decided to review their experience to determine whether the number of drains influenced the incidence of seroma. All patients who underwent breast reconstruction using TRAM or deep inferior epigastric perforator flaps at The University of Texas M. D. Anderson Cancer Center from January 1, 1995 to June 20, 2000 and whose charts could be retrieved were included in the study. The number of drains used was correlated with the presence or absence of seroma and wound infection in both the abdomen and the breast. Significance was analyzed using the Chi-squared and Fisher's exact tests. There were 608 patients and 768 reconstructive procedures in this series (160 reconstructions were bilateral). Of patients who had only one drain in the abdomen, seroma developed in 9 patients (7.1%), whereas of those having two drains in the abdomen, seroma developed in only 10 patients (2.1%) (p = 0.006). Also, of patients who had only one drain in the breast, seroma developed in the breast in 47 patients (9.1%), and in those with two drains, seroma developed in only 11 patients (4.3%) (p = 0.02). There were no significant differences in the infection rate in either the breast or the abdomen, although the trends favored a lower infection risk when two drains were used. The authors found that using two drains in both the abdomen and the breast can reduce the risk for seroma without increasing the risk for infection. This study supports the use of two drains in both the breast (one each beneath the TRAM flap and in the axilla) and abdomen (beneath the abdominoplasty flap) for patients undergoing breast reconstruction using the TRAM flap.