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Scevola S.,University of Pavia | Nicoletti G.,University of Pavia | Neri A.,Salvatore Maugeri Research and Care Institute | Faga A.,University of Pavia
Indian Journal of Plastic Surgery | Year: 2014

Madelung's disease is characterised by multiple symmetric abnormal fat masses in the head, neck and upper limbs. Surgical excision or liposuction is the only realistic available option, although palliative in nature. The serial intralipotherapy with phosphatidylcholine/deoxycholate has been proposed as a non-invasive treatment of Madelung's disease. The authors used serial intralipotherapy with phosphatidylcholine/deoxycholate in two patients affected by Madelung's disease. Three injections per lesion per patient were performed with 1 month's interval. Pre- and 6 months′ post-treatment dimensions were assessed with ultrasound scan and patients were observed along a 5 years′ clinical follow-up. A 42.5% average size reduction was reported in all treated lesions. About 33% recurrence rate was observed in the 5 years′ follow-up. We confirm the efficacy of intralipotherapy in the non-invasive palliative treatment of Madelung's disease, as a valid option to reduce the volume and limit the growth of the pathological adipose masses. Source

Kloth J.S.L.,Netherlands Cancer Institute | Pagani A.,Fondazione S. Maugeri | Verboom M.C.,Leiden University | Malovini A.,Salvatore Maugeri Research and Care Institute | And 6 more authors.
British Journal of Cancer | Year: 2015

Background: Tyrosine kinase inhibitors (TKIs) are associated with prolongation of the QTc interval on the electrocardiogram (ECG). The QTc-interval prolongation increases the risk of life-threatening arrhythmias. However, studies evaluating the effects of TKIs on QTc intervals are limited and only consist of small patient numbers. Methods: In this multicentre trial in four centres in the Netherlands and Italy we screened all patients who were treated with any TKI. To evaluate the effects of TKIs on the QTc interval, we investigated ECGs before and during treatment with erlotinib, gefitinib, imatinib, lapatinib, pazopanib, sorafenib, sunitinib, or vemurafenib. Results: A total of 363 patients were eligible for the analyses. At baseline measurement, QTc intervals were significantly longer in females than in males (QTcfemales =404 ms vs QTcmales =399 ms, P=0.027). A statistically significant increase was observed for the individual TKIs sunitinib, vemurafenib, sorafenib, imatinib, and erlotinib, after the start of treatment (median ΔQTc ranging from +7 to +24 ms, P<0.004). The CTCAE grade for QTc intervals significantly increased after start of treatment (P=0.0003). Especially patients who are treated with vemurafenib are at increased risk of developing a QTc of ≥470 ms, a threshold associated with an increased risk for arrhythmias. Conclusions: These observations show that most TKIs significantly increase the QTc interval. Particularly in vemurafenib-treated patients, the incidence of patients at risk for arrhythmias is increased. Therefore, especially in case of combined risk factors, ECG monitoring in patients treated with TKIs is strongly recommended. © 2015 Cancer Research UK. All rights reserved. Source

Nicoletti G.,Plastic and Reconstructive Surgery | Nicoletti G.,University of Pavia | Nicoletti G.,Salvatore Maugeri Research and Care Institute | Sasso A.,Plastic and Reconstructive Surgery | And 7 more authors.
Clinical, Cosmetic and Investigational Dermatology | Year: 2014

A randomized, prospective, controlled study was carried out at the Plastic and Reconstructive Surgery Unit of the University of Pavia, Salvatore Maugeri Research and Care Institute, Pavia, Italy, to evaluate the psychological benefits from corrective medical camouflage (CMC) following surgical treatment for skin cancer of the face. Twenty-four female patients, following recovery from facial skin cancer surgery, were enrolled in the study over a period of 1 year. The study was performed using two health-related quality of life tests, the Satisfaction Profile (SAT-P) test and the Body Uneasiness Test (BUT). The patients were randomized into two groups: group A, patients undergoing CMC; and group B, controls. Both the SAT-P and BUT demonstrated statistically significant better results in the treated patients versus the controls in the following functional parameters: Psychological Functionality (PsF), Physical Functionality (PhF), and Work Performance (WP) for the SAT-P test and Compulsive Self-Monitoring (CSM) for the BUT. The PsF demonstrated a better result 6 months post-treatment. Such a difference was particularly significant when comparing the performance at 6 months versus that at 3 months. The PhF demonstrated a better outcome at 6 months post-treatment. The WP demonstrated a better result comparing the performance at 6 months versus that at 3 months. The CSM demonstrated a better outcome at 6 months post-treatment. The CMC promoted a significant improvement in patients' physical appearance and in their self-image and perceived social role as a means of their desire to disguise their body disfiguration. © 2014 Nicoletti et al. Source

Jaber O.,University of Pavia | Vischio M.,University of Pavia | Faga A.,University of Pavia | Faga A.,Salvatore Maugeri Research and Care Institute | And 2 more authors.
Archives of Plastic Surgery | Year: 2015

The closure of any circular or asymmetric wound can result in puckering or an excess of tissue known as a ‘dog ear’. Understanding the mechanism of dog ear formation is a fundamental requirement necessary to facilitate an appropriate treatment. Many solutions have been reported in the literature, but in all cases, the correction entails the extension of the scar and the sacrifice of the dermal plexus. Here, we propose a novel technique of dog ear correction by using a three-bite suture that sequentially pierces the deep fascial plane and each dog ear’s margin, thus allowing for flattening the dog ear by anchoring the over-projecting tissue to the deep plane. The three-bite technique proved to be a fast, easy, and versatile method of immediate dog ear correction without extending the scar, while maintaining a full and complete local skin blood supply. © 2015, The Korean Society of Plastic and Reconstructive Surgeons. Source

Nicoletti G.,University of Pavia | Nicoletti G.,Salvatore Maugeri Research and Care Institute | Brenta F.,University of Pavia | Brenta F.,Salvatore Maugeri Research and Care Institute | And 5 more authors.
Foot | Year: 2014

Background: New advances in regenerative surgery may increase the potential for rehabilitation in the injured foot. Objectives: A clinical prospective observational study was carried out to assess the effectiveness of lipofilling to improve the functional recovery of the injured foot. Methods: Four patients with anatomical-functional impairment following repair of post-traumatic soft tissue loss of the foot were involved in the study. All of the patients complained of pain in the repaired plantar weight bearing area, skin instability, recurrent ulcerations and were walking on crutches.A combined plastic surgery and technical orthopaedic assessment identified the plantar areas requiring anatomical changes for load redistribution. Two selective sequential lipofillings with a 12 weeks' time interval were performed. Manufacturing of custom-made plantar insoles and/or shoes followed each surgical procedure. Results: After the treatment all of the patients progressively recovered both a better plantar load distribution and a local soft tissue stability, referred the remission of chronic pain and discontinued the use of crutches. Conclusion: Lipofilling proved to be an effective and versatile surgical technique for both reconstructive and regenerative purposes. The interaction between the Plastic Surgery staff and the Orthopaedic Technician outlined a successful multidisciplinary approach model for the rehabilitation of the injured foot. © 2014 The Authors. Source

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