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Studio pilota per la valutazione della tollerabilità delle protesi tipo Hydrogel
No full textBackground. During the 90s the widely publicised controversy regarding the use of silicone gel breast implants stimulated research into alternative alloplastic filling materials. In this context, a new type of breast implant, containing Carboxymethylcellulose at 3.7% in the form of Hydrogel, was introduced into the European market. Methods. A preliminary pilot study was carried out to evaluate the tolerability and reliability of breast implants pre-filled with Hydrogel. A group of 12 consecutive patients was recruited for this purpose and underwent plastic surgery for breast augmentation or reconstruction (20 implants) at the Department of Plastic and Reconstructive Surgery at the University of Genoa between December 1996 and October 1997. All patients were then followed up for a minimum of 3.5 years. The mean age of patients was 50 years and ranged from 28 to 67 years old. After surgery the patients were examined at 4 weeks (evaluation of any immediate complications), 3 months, 6 months and 1 year (evaluation of any delayed complications). Results. No immediate complications were reported in any patient. After 3.5 years of follow-up, the degree of capsular contraction according to Baker in these patients varies between 1 and 2. In general, the implants were very soft to touch even some time after surgery, above all in patients undergoing breast augmentation. Four implants (20%) were removed from 3 patients for reasons unconnected to the implants themselves (because of neoplasm in one case and due to inadequate volume in the other two patients). No case of rupture has been reported. Conclusions. This pilot study appears to confirm the validity of implants prefilled with Hydrogel in reconstructive or cosmetic breast surgery. A larger population and longer periods of minimum follow-up are obviously required to confirm these results over the long term
Purpura fulminans in a 16-year-old girl: Clinical and ethical aspects
No full textPurpura fulminans (PF) is a severe clinical disorder mostly characterized by progressive vascular collapse and disseminated intravascular coagulopathy (DIC). The most frequent presentation is following meningococcal infection. PF leads to serious complications including multiple organ failure (MOF) until death in 3-12% of cases. However, a number of disabilities have been reported. We report a case of a young girl with septic shock, high fever, purple rash on the legs and buttocks. Clinical and laboratory tests confirmed N. meningitidis infection. Medical treatment included antibiotics and pain killers. Surgical treatments included multiple escharectomies, skin grafts and the amputation of the distal phalanx of the right foot. Psychological support was guaranteed. After 75 days of hospital stay, the patient was discharged with an acceptable aesthetic and functional result. The possibility to conduct extensive surgical treatments, although life-saving, constituted a decision of strong ethical criticality, but in this case the patient has understood the importance of the proposed treatments. PF represents a challenging issue in clinical practice, both for the medical assessment, both for the surgical treatment. Younger patients require more care for the acceptance and sharing of the therapeutic process. Even the cases earlier treated may have residual disabilities. A multidisciplinary team can optimize and improve the quality of life of minors. Psychological support and a very intensive rehabilitation are necessary for the integration back into society. Good communication between healthcare professionals and young people is essential
Purpura fulminans in a 16-year-old girl: clinical and ethical aspects
No full textPurpura fulminans (PF) is a severe clinical disorder mostly characterized by progressive vascular collapse and disseminated intravascular coagulopathy (DIC). The most frequent presentation is following meningococcal infection. PF leads to serious complications including multiple organ failure (MOF) until death in 3-12% of cases. However, a number of disabilities have been reported. We report a case of a young girl with septic shock, high fever, purple rash on the legs and buttocks. Clinical and laboratory tests confirmed N. meningitidis infection. Medical treatment included antibiotics and pain killers. Surgical treatments included multiple escharectomies, skin grafts and the amputation of the distal phalanx of the right foot. Psychological support was guaranteed. After 75 days of hospital stay, the patient was discharged with an acceptable aesthetic and functional result. The possibility to conduct extensive surgical treatments, although life-saving, constituted a decision of strong ethical criticality, but in this case the patient has understood the importance of the proposed treatments. PF represents a challenging issue in clinical practice, both for the medical assessment, both for the surgical treatment. Younger patients require more care for the acceptance and sharing of the therapeutic process. Even the cases earlier treated may have residual disabilities. A multidisciplinary team can optimize and improve the quality of life of minors. Psychological support and a very intensive rehabilitation are necessary for the integration back into society. Good communication between healthcare professionals and young people is essential
Factors affecting symmetrization of the contralateral breast: a 7-year unilateral postmastectomy breast reconstruction experience.
No full textAlthough a number of studies compare different techniques of breast reconstruction, information documenting the factors that affect breast symmetry after unilateral mastectomy and reconstruction seems to be scarce. A statistical analysis of 606 patients undergoing unilateral mastectomy and breast reconstruction performed during a 7 year period was undertaken in an endeavor to identify these factors. Patients were classified according to time of reconstruction, method of reconstruction, type of implant, and mastectomy type. Contralateral procedures included mastopexy, augmentation, and reduction mammaplasty. Delayed reconstruction more frequently required a symmetrization than an immediate reconstruction. The percentage of contralateral procedures was higher for implant reconstructions than for autologous reconstructions, and the type of mastectomy was significantly associated with the symmetrization procedure. The findings showed that non-skin-sparing mastectomy (non-SSM) needed symmetrization surgery more frequently than did SSM procedures. The data suggest a preoperative collaboration and case study between oncologic and plastic surgeons to apply, when possible, SSM with immediate implant breast reconstruction, resulting in fewer symmetrization procedures and the best aesthetic follow-up result. These factors need to be considered when mastectomy and reconstruction are planned in order to optimize the aesthetic result together with the development of breast surgery specialty units
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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