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Indicazioni e tecniche di ricostruzione microchirurgica nelle lesioni iatrogeniche del nervo laringeo inferiore nella chirurgia del collo
No full textLe lesioni del nervo laringeo inferiore (N.L.I.) sono tra le possibili complicanze della chirurgia del collo e del mediastino. Tutta la chirurgia del mediastino e della regione anteriore del collo, compresa la chirurgia della carotide e dei vasi epiaortici, nonché gli accessi anteriori alla colonna cervicale, sono gravati dal rischio di una lesione di tale nervo. Sono state, inoltre, descritte in letteratura lesioni ricorrenziali iatrogeniche nella chirurgia di distretti lontani dal decorso del nervo, a seguito di errori tecnici legati all’uso della maschera laringea, in corso di anestesia generale.
È comunque nella chirurgia della tiroide che la lesione iatrogenica del N.L.I. acquista un’incidenza significativa, in considerazione degli stretti rapporti anatomici tra esso e la ghiandola tiroide.
La paralisi ricorrenziale è una grave complicanza della chirurgia tiroidea, non solo dal punto di vista del deficit della fonazione, ma anche, e soprattutto, dei disturbi della ventilazione. È stato infatti documentato come la riduzione del flusso aereo, conseguente a lesione ricorrenziale unilaterale, sia assimilabile a quella determinata da una stenosi tracheale del 30%.
L’incidenza di questa complicanza si è ridotta dal 30% di Billroth e Wolfer (1844) allo 0.3-3% delle più recenti casistiche, grazie alle acquisizioni in campo anatomico ed al miglioramento della tecnica chirurgica. Dovremmo, quindi, considerare attualmente inammissibili percentuali di lesioni ricorrenziali superiori all’1%.
Oggi le lesioni del N.L.I. possono essere riparate con tecniche di ricostruzione microchirurgiche. La ricostruzione del nervo può essere effettuata tramite neurorrafia termino-terminale, fascicolare, od utilizzando un innesto sia intervenendo immediatamente, sia intervenendo in un tempo successivo.
Alternativamente si può eseguire un’anastomosi tra il N.L.I. e l’ansa dell’ipoglosso, in particolare la branca terminale diretta al muscolo sterno-tiroideo.
Scopo della tesi è una revisione critica dei casi di ricostruzione del N.L.I. con tecnica microchirurgica e dei principi di tecnica chirurgica nella identificazione e preparazione del N.L.I. nella chirurgia del collo. Vengono discussi i risultati delle ricostruzione del N.L.I., dopo lesione iatrogenica, in pazienti provenienti da centri chirurgici diversi, eseguite dal 1991 all’Aprile 2003, nell’Unità di Microchirurgia (Coordinatore: Prof. Andrea Ortensi) del Dipartimento di Scienze Chirurgiche dell’Università di Roma “La Sapienza”, trattati sia con neurorrafia termino-terminale che con reinnervazione mediante ansa dell’ipoglosso.The inferior laryngeal nerve (ILN) injury are among the possible complications of surgery of the neck and mediastinum.
All surgery of the mediastinum and the anterior neck, including carotid surgery and neck vessels, as well as access to the anterior cervical spine, are burdened by the risk of damage to that nerve.
Have been also described in the literature recurrent lesions in surgery of iatrogenic districts away from the course of the nerve, as a result of technical errors related to the use of the laryngeal mask, in the course of general anesthesia.
It is still in surgery of the thyroid and iatrogenic lesions of the recurrent laryngeal nerve acquires a significant impact, given the close anatomical relationships between it and the thyroid gland.
The paralysis recurrent is a serious complication of thyroid surgery, not only from the point of view of the deficit of the phonation, but also, and above all, of disorders of ventilation. It has been documented as the airflow, resulting in recurrent lesion unilateral, is comparable to that determined by a tracheal stenosis of 30%.
The incidence of this complication was reduced by 30% of Billroth and Wolfer (1844) to 0,3-3% of the most recent series, thanks to the acquisitions of anatomy and improved surgical technique. We should, therefore, currently considered unacceptable rates of recurrent lesions greater than 1%.
Today lesions of the ILN can be repaired with microsurgical reconstruction techniques. The reconstruction of the nerve neurorrhaphy can be performed by end to end, sort, or by using a grafting is intervening immediately, either by acting at a later time.
Alternatively one can perform an anastomosis between the ILN and the loop of the hypoglossal, in particular the branch terminal direct to the sternothyroid muscle.
The aim of the thesis is a critical review of the cases of reconstruction of the ILN with microsurgical techniques and principles of surgical technique in the identification and preparation of the ILN in surgery of the neck. It discusses the results of reconstruction of the ILN after iatrogenic injury in patients from different surgical centers, carried out from 1991 to April 2003, the Unit of Microsurgery (Coordinator: Prof. Andrea Ortensi) Department of Surgical Sciences University of Rome "La Sapienza", is treated with termino-terminal neurorrhaphy or with reinnervation by the hypoglossal loop
Use of optical magnification and microsurgical technique in general surgery
No full textThe full benefits of magnified vision in all disciplines of video-assisted surgery are well known and appreciated for many years. The use of microsurgery in limb transplants and microvascular free flaps has now been standardized and used for many years. On the other hand, a special emphasis must be put on the advantage that can be achieved by the use of optical magnification during microsurgery operations, in general surgery
Ricostruzione microchirurgica del nervo ricorrente
No full textLe lesioni del nervo laringeo inferiore (N.L.I.) sono tra le possibili complicanze della chirurgia del collo e del mediastino. Tutta la chirurgia del mediastino e della regione anteriore del collo, compresa la chirurgia della carotide e dei vasi epiaortici, nonché gli accessi anteriori alla colonna cervicale, sono gravati dal rischio di una lesione di tale nervo. Sono state, inoltre, descritte in letteratura lesioni ricorrenziali iatrogeniche nella chirurgia di distretti lontani dal decorso del nervo, a seguito di errori tecnici legati all’uso della maschera laringea, in corso di anestesia generale.
È comunque nella chirurgia della tiroide che la lesione iatrogenica del N.L.I. acquista un’incidenza significativa, in considerazione degli stretti rapporti anatomici tra esso e la ghiandola tiroide.
La paralisi ricorrenziale è una grave complicanza della chirurgia tiroidea, non solo dal punto di vista del deficit della fonazione, ma anche, e soprattutto, dei disturbi della ventilazione. È stato infatti documentato come la riduzione del flusso aereo, conseguente a lesione ricorrenziale unilaterale, sia assimilabile a quella determinata da una stenosi tracheale del 30%.
L’incidenza di questa complicanza si è ridotta dal 30% di Billroth e Wolfer (1844) allo 0,3-3% delle più recenti casistiche, grazie alle acquisizioni in campo anatomico ed al miglioramento della tecnica chirurgica. Dovremmo, quindi, considerare attualmente inammissibili percentuali di lesioni ricorrenziali superiori all’1%.
Oggi le lesioni del N.L.I. possono essere riparate con tecniche di ricostruzione microchirurgiche. La ricostruzione del nervo può essere effettuata tramite neurorrafia termino-terminale, fascicolare, od utilizzando un innesto sia intervenendo immediatamente, sia intervenendo in un tempo successivo.
Alternativamente si può eseguire un’anastomosi tra il N.L.I. e l’ansa dell’ipoglosso, in particolare la branca terminale diretta al muscolo sterno-tiroideo
Zn(II)-curc targets p53 in thyroid cancer cells
Full text linkP53 mutation is a common event in many cancers, including thyroid carcinoma. Defective p53 activity promotes cancer resistance to therapies and a more malignant phenotype, acquiring oncogenic functions. Rescuing the function of mutant p53 (mutp53) protein is an attractive anticancer therapeutic strategy. Zn(II)-curc is a novel small molecule that has been shown to target mutp53 protein in several cancer cells, but its effect in thyroid cancer cells remains unclear. Here, we investigated whether Zn(II)-curc could affect p53 in thyroid cancer cells with both p53 mutation (R273H) and wild-type p53. Zn(II)-curc induced mutp53H273 downregulation and reactivation of wild-type functions, such as binding to canonical target promoters and target gene transactivation. This latter effect was similar to that induced by PRIMA-1. In addition, Zn(II)-curc triggered p53 target gene expression in wild-type p53-carrying cells. In combination treatments, Zn(II)-curc enhanced the antitumor activity of chemotherapeutic drugs, in both mutant and wild-type-carrying cancer cells. Taken together, our data indicate that Zn(II)-curc promotes the reactivation of p53 in thyroid cancer cells, providing in vitro evidence for a potential therapeutic approach in thyroid cancers
Semeiotica e clinica del distretto cervico-facciale
No full textIl capo e il collo sono caratterizzati dalla presenza di ossa e muscoli che costituiscono l’impalcatura di sostegno delle prime vie aeree e digestive. Esistono poi numerose fasce che separano compartimenti nel cui interno decorrono una complessità di strutture vascolari, nervose e linfatiche. La conoscenza anatomica di questo distretto è di fondamentale importanza per lo studio della semeiotica e la comprensione della storia naturale delle patologie.The head and neck are characterized by the presence of bones and muscles that make up the support structure of the upper airways and digestive. Then there are many bands that separate compartments inside which shall run a complexity of vascular structures, nerve and lymph. The anatomical knowledge of this district is of fundamental importance for the study of semiotics and understanding of the natural history of the disease
Microsurgical distal sympathectomy in chronic vasospastic syndromes of the hand.
No full textThe authors propose a microsurgical technique to treat upper limb chronic digital ischemia that is resistant to medical therapy. The adventitiectomy technique on digital arteries is used here to remove the fibrous tissue and the vasoconstrictor sympathetic nervous fibers contained in it. This operation is a valid alternative to traditional proximal sympathectomy
Gentian violet induces wtp53 transactivation in cancer cells
No full textRecent studies suggest that gentian violet (GV) may have anticancer activity by inhibiting for instance NADPH oxidases (Nox genes) whose overexpression is linked to tumor progression. Nox1 overexpression has been shown to inhibit transcriptional activity of the oncosuppressor p53, impairing tumor cell response to anticancer drugs. The tumor suppressor p53 is a transcription factor that, upon cellular stress, is activated to induce target genes involved in tumor cell growth inhibition and apoptosis. Thus, its activation is important for efficient tumor eradication. In this study, we examined the effect of GV on wild-type (wt) p53 activity in cancer cells. We found that GV was able to overcome the inhibitory effect of the NADPH oxidase Nox1 on p53 transcriptional activity. For the first time we show that GV was able to directly induce p53/DNA binding and transcriptional activity. In vitro, GV markedly induced cancer cell death and apoptotic marker PARP cleavage in wtp53-carrying cells. GV-induced cell death was partly inhibited in cells deprived of p53, suggesting that the anticancer activity of GV may partly depend on p53 activation. GV is US Food and Drug Administration approved for human use and may, therefore, have therapeutic potential in the management of cancer through p53 activation
HIPK2 in Angiogenesis: A Promising Biomarker in Cancer Progression and in Angiogenic Diseases
Full text linkAngiogenesis is the formation of new blood capillaries taking place from preexisting functional vessels, a process that allows cells to cope with shortage of nutrients and low oxygen availability. Angiogenesis may be activated in several pathological diseases, from tumor growth and metastases formation to ischemic and inflammatory diseases. New insights into the mechanisms that regulate angiogenesis have been discovered in the last years, leading to the discovery of new therapeutic opportunities. However, in the case of cancer, their success may be limited by the occurrence of drug resistance, meaning that the road to optimize such treatments is still long. Homeodomain-interacting protein kinase 2 (HIPK2), a multifaceted protein that regulates different molecular pathways, is involved in the negative regulation of cancer growth, and may be considered a “bona fide” oncosuppressor molecule. In this review, we will discuss the emerging link between HIPK2 and angiogenesis and how the control of angiogenesis by HIPK2 impinges in the pathogenesis of several diseases, including cancer
Therapeutic approaches enhancing peripheral nerve regeneration
Full text linkPeripheral nerve injury is a common occurrence and represents a major economic burden for society. The development of novel strategies to enhance peripheral nerve regeneration is, therefore, of great relevance. Conventional treatments include surgical repair of the damaged nerves for minor injuries, whereas autologous nerve grafts are required to recover longer interruptions. However, despite great surgical advances, functional recovery is often poor. Although it is well known that the peripheral nervous system has a greater regenerative capacity than the central nervous system and, considering the scientific ad- vancements and knowledge in regenerative medicine, clinical applications appears still limited. This review provides an overview of the methodological ap- proaches currently under study, aimed at enhancing peripheral nerve regeneration. In particular, tissue engineering, cell therapy and pharmacological ap- proaches will be discussed
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