Crescentic flap for the reconstruction of the nose after skin cancer resection

Purpose Non-melanoma skin cancers are the most frequent skin tumours; in 25.5% of cases, they are reported to affect the nasal area. For an excellent surgical outcome, first of all the radical excision of the lesion is important, with appropriate margins of healthy skin in order to avoid recurrences. Moreover is important to achieve a good aesthetical result, avoiding distortion of the aesthetic units and preserving their functions. Material and methods We have applied the modified crescentic flap, described by Smadja in 2007, to 24 nasal skin defects left by oncologic surgery. It consists of the crescent-shaped resection of Burow's triangle all around the alar groove that allows the advancement of the flap to the tip of the nose, hiding the scar in the alar groove. Results The outcome and the long-term follow-up were completely satisfactory both for patients and for surgeons. Conclusion For skin defects localized in the midline or paramedian line of the dorsum of the nose, the crescentic flap seems to be a good solution to obtain the better aesthetic result with respect to both anatomy and function of the nasal area, sparing the patient a second intervention or an overly invasive procedure

The interpretation of multilingual tax treaties

The purpose of the thesis is to (i) single out and clarify the most common types of issues emerging in the interpretation of multilingual tax treaties (i.e. tax treaties authenticated in two or more languages), and (ii) suggest how the interpreter should tackle and disentangle such issues under public international law, with a particular emphasis on the kinds of arguments he should use and the kinds of elements and items of evidence he should rely upon in order to support his construction of the treaty. In order to address such issues, the author has developed a normative (prescriptive) legal analysis based on modern linguistic and, more specifically, semantic theories. However, since the purpose of the study is to suggest how the interpreter should now tackle and disentangle those issues, the author has also carried out a positive (prescriptive) analysis, which highlights the generally accepted principles and rules of treaty interpretation, in order (i) to carve out from his (non-ideal) normative legal theory the results potentially conflicting with such generally accepted principles and rules and (ii) to show how his normative legal theory might be applied to solve interpretative issues in cases where no common solution has been reached yet.Grenzen van fiscale soevereinitei

High Magnification Digital Dermoscopy of Basal Cell Carcinoma: A Single-centre Study on 400 cases.

The aim of this study was to assess the frequency of classic dermoscopic basal cell carcinoma (BCC) features and the sensitivity of new descriptors, such as light brown nests (homogeneous and structured) only visible employing a high magnification digital videomicroscope. A retrospective analysis of 2,024 highly magnified digital images referring to 400 BCCs was performed by 3 independent observers, who assessed 11 classic BCC descriptors and the new ones. Light brown nests were detected in 40.5% of BCCs. Homogeneous ones were observable in 17.8%, and structured nests in 32.8%. Light brown nests were visible in 14.3% of non-pigmented lesions, whereas in the pigmented groups these were observed in 42-54% of the cases. We suggest that brown nests described in this study may improve early recognition of superficial BCCs and of non-pigmented or slightly pigmented ones that may lack classic dermoscopic patterns

Clinical applications of in vivo and ex vivo confocal microscopy

Confocal laser scanning microscopy (CLSM) has been introduced in clinical settings as a tool enabling a quasi-histologic view of a given tissue, without performing a biopsy. It has been applied to many fields of medicine mainly to the skin and to the analysis of skin cancers for both in vivo and ex vivo CLSM. In vivo CLSM involves reflectance mode, which is based on refractive index of cell structures serving as endogenous chromophores, reaching a depth of exploration of 200 \ub5m. It has been proven to increase the diagnostic accuracy of skin cancers, both melanoma and nonmelanoma. While histopathologic examination is the gold standard for diagnosis, in vivo CLSM alone and in addition to dermoscopy, contributes to the reduction of the number of excised lesions to exclude a melanoma, and to improve margin recognition in lentigo maligna, enabling tissue sparing for excisions. Ex vivo CLSM can be performed in reflectance and fluorescent mode. Fluorescence confocal microscopy is applied for \u201creal-time\u201d pathological examination of freshly excised specimens for diagnostic purposes and for the evaluation of margin clearance after excision in Mohs surgery. Further prospective interventional studies using CLSM might contribute to increase the knowledge about its application, reproducing real-life settings

Terapia combinata laser CO2 e PDT nei basaliomi nodulari ed infiltranti

Il basalioma è la forma di tumore cutaneo maligno più comune nella razza caucasica; esistono numerose soluzioni terapeutiche per il suo trattamento. Scopo del nostro studio è stato quello di trattare basaliomi nodulari ed infiltranti utilizzando la combinazione di laser CO2 e successiva terapia fotodinamica sulle stesse lesioni. Sono state trattate 4 lesioni su altrettanti pazienti: 2 presentavano basaliomi infiltranti e 2 basaliomi nodulari. Il periodo medio di follow-up è stato di 8 mesi. Le lesioni trattate sono state fotografate e sottoposte a valutazione con videodermoscopia e microscopio laser confocale prima e dopo i trattamenti, ad intervalli di tempo standardizzati. Tutte le lesioni hanno mostrato un’eccellente risposta terapeutica e nessuna complicanza significativa è stata riscontrata. L’utilizzo sequenziale di laser CO2 e terapia fotodinamica, nel trattamento dei basaliomi infiltranti e nodulari, ha determinato una guarigione completa degli stessi, dimostrandosi un’eccellente opzione terapeutica con ottimi outcome estetici. Tali procedure permettono di evitare interventi invasivi su sedi esteticamente rilevanti, in pazienti con lesioni multiple o recidivanti ed affetti da comorbidità severe e in terapia con anticoagulanti

Multiphoton Laser Microscopy and Fluorescence Lifetime Imaging for the Evaluation of the Skin

Multiphoton laser microscopy is a new, non-invasive technique providing access to the skin at a cellular and subcellular level, which is based both on autofluorescence and fluorescence lifetime imaging. Whereas the former considers fluorescence intensity emitted by epidermal and dermal fluorophores and by the extra-cellular matrix, fluorescence lifetime imaging (FLIM), is generated by the fluorescence decay rate. This innovative technique can be applied to the study of living skin, cell cultures and ex vivo samples. Although still limited to the clinical research field, the development of multiphoton laser microscopy is thought to become suitable for a practical application in the next few years: in this paper, we performed an accurate review of the studies published so far, considering the possible fields of application of this imaging method and providing high quality images acquired in the Department of Dermatology of the University of Modena

Improving diagnostic sensitivity of combined dermoscopy and reflectance confocal microscopy imaging through double reader concordance evaluation in telemedicine settings: A retrospective study of 1000 equivocal cases

Background: Reflectance confocal microscopy (RCM) is an imaging device that permits non-invasive visualization of cellular morphology and has been shown to improve diagnostic accuracy of dermoscopically equivocal cutaneous lesions. The application of double reader concordance evaluation of dermoscopy-RCM image sets in retrospective settings and its potential application to telemedicine evaluation has not been tested in a large study population. Objective: To improve diagnostic sensitivity of RCM image diagnosis using a double reader concordance evaluation approach; to reduce mismanagement of equivocal cutaneous lesions in retrospective consultation and telemedicine settings. Methods: 1000 combined dermoscopy-RCM image sets were evaluated in blind by 10 readers with advanced training and internship in dermoscopy and RCM evaluation. We compared sensitivity and specificity of single reader evaluation versus double reader concordance evaluation as well as the effect of diagnostic confidence on lesion management in a retrospective setting. Results: Single reader evaluation resulted in an overall sensitivity of 95.2% and specificity of 76.3%, with misdiagnosis of 8 melanomas, 4 basal cell carcinomas and 2 squamous cell carcinomas. Combined double reader evaluation resulted in an overall sensitivity of 98.3% and specificity of 65.5%, with misdiagnosis of 1 in-situ melanoma and 2 basal cell carcinomas. Conclusion: Evaluation of dermoscopy-RCM image sets of cutaneous lesions by single reader evaluation in retrospective settings is limited by sensitivity levels that may result in potential mismanagement of malignant lesions. Double reader blind concordance evaluation may improve the sensitivity of diagnosis and management safety. The use of a second check can be implemented in telemedicine settings where expert consultation and second opinions may be required

IL RECEPIMENTO DELLA C.D. DAC 6 MELL'ORDINAMENTO TRIBUTARIO ITALIANO. Analisi sistematica e profili applicativi.

La collettanea nasce con il fine di portare all’attenzione degli studiosi della materia non solo la necessaria disamina tecnica delle disposizioni unionali, come attuate nell’ordinamento interno, ma anche un inquadramento sistematico di tale disciplina nel suo contesto europeo di riferimento e una critica costruttiva alle (plurime) deficienze della stessa in termini di proporzionalità ed eccessiva compressione dei diritti dei contribuenti. Si è cercato di rispondere alle esigenze sollevate da un tale progetto attraverso il qualificato contributo di accademici e professionisti, che hanno analizzato la disciplina di recepimento della DAC 6 nell’ordinamento tributario italiano