Analysis of Sentinel Node Biopsy and Clinicopathologic Features as Prognostic Factors in Patients With Atypical Melanocytic Tumors.

BACKGROUND: Atypical melanocytic tumors (AMTs) include a wide spectrum of melanocytic neoplasms that represent a challenge for clinicians due to the lack of a definitive diagnosis and the related uncertainty about their management. This study analyzed clinicopathologic features and sentinel node status as potential prognostic factors in patients with AMTs. PATIENTS AND METHODS: Clinicopathologic and follow-up data of 238 children, adolescents, and adults with histologically proved AMTs consecutively treated at 12 European centers from 2000 through 2010 were retrieved from prospectively maintained databases. The binary association between all investigated covariates was studied by evaluating the Spearman correlation coefficients, and the association between progression-free survival and all investigated covariates was evaluated using univariable Cox models. The overall survival and progression-free survival curves were established using the Kaplan-Meier method. RESULTS: Median follow-up was 126 months (interquartile range, 104-157 months). All patients received an initial diagnostic biopsy followed by wide (1 cm) excision. Sentinel node biopsy was performed in 139 patients (58.4%), 37 (26.6%) of whom had sentinel node positivity. There were 4 local recurrences, 43 regional relapses, and 8 distant metastases as first events. Six patients (2.5%) died of disease progression. Five patients who were sentinel node-negative and 3 patients who were sentinel node-positive developed distant metastases. Ten-year overall and progression-free survival rates were 97% (95% CI, 94.9%-99.2%) and 82.2% (95% CI, 77.3%-87.3%), respectively. Age, mitotic rate/mm2, mitoses at the base of the lesion, lymphovascular invasion, and 9p21 loss were factors affecting prognosis in the whole series and the sentinel node biopsy subgroup. CONCLUSIONS: Age >20 years, mitotic rate >4/mm2, mitoses at the base of the lesion, lymphovascular invasion, and 9p21 loss proved to be worse prognostic factors in patients with ATMs. Sentinel node status was not a clear prognostic predictor

Double free transverse upper gracilis flap breast reconstruction: advantages of using LD flap as a salvage solution

The lower abdominal tissue is still the most common donor site used for free autologous breast reconstruction. If this site is not available, multiple secondary choices exist. The transverse upper gracilis flap is a valuable choice and it can be used alone or in combination with other flaps. We present a case of a 49-year-old patient who underwent delayed unilateral breast reconstruction by using a double transverse upper gracilis flap. Due to venous thrombosis, the flap inserted in the lower pole was lost. We managed the complication tailoring a latissimus dorsi flap to close the defect. We reported the advantages of the latissimus dorsi flap as a rescue solution and its superior aesthetic result in this particular case. Breast reconstruction with transverse upper gracilis flap in addition to the latissimus dorsi flap allowed us to obtain an adequate breast volume avoiding the use of breast implants as desired by the patient. We thought that the double free transverse upper gracilis flap for delayed, or immediate unilateral reconstruction of small to moderate breast could be a valuable option to avoid the use of implants and when abdominal tissue is not available. However, it should be taken into consideration the shortness of the transverse upper gracilis pedicle, the necessity to perform a retrograde flow anastomosis at the level of the internal mammary, and the discrepancy of skin color tones with the receiving site. The latissimus dorsi flap was an excellent rescue solution and put in evidence the aesthetic superiority of this flap compared to the transverse upper gracilis flap

Surgical deactivation of occipital migraine trigger site

BACKGR OUND: Following the pioneering work of Guyuron et al. in 2001, an impressive body of literature demonstrated that the inflammation of peripheral nerves caused by chronic compression from surrounding structures (e.g., muscles, blood vessels) might trigger migraines. In this study, we report our experience with a minimally invasive surgical procedure for occipital migraine headache treatment. METHODS: From June 2011 until January 2019, we performed 246 MH decompression surgeries in patients with either frontal, occipital, or temporal migraine trigger sites. Among them, 130 surgeries were performed to treat occipital migraine (90 bilateral and 40 unilateral). In 108 occipital migraines, we found a dilated occipital artery in close connection with the greater occipital nerve (GON) and we ligated the vessel without any other surgical manoeuvres. R ESULTS: After a mean follow-up of 21 months (range: 3-67 months), patients with occipital migraine had positive response in 94.9% (86.8% complete relief and 8.1% significant improvement), and 5.1% did not get any better. CONCLUSIONS: Occipital migraine is a common and debilitating condition that can be treated successfully with surgery. According to our experience, a dilated occipital artery is usually responsible for nerve compression, mostly the greater occipital nerve. Clinical outcome of our surgical procedure based on artery ligation seems to prove the validity of this hypothesis

New Rome metro line C: approach for safeguarding ancient monuments

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Prediction of the effects induced by the Metro C construction on an old masonry building

The paper reports the main results obtained through a numerical study aimed to predict the effects induced on an old masonry building by the tunnelling operations for the construction of Metro C line, in Rome. To achieve high quality of prediction, full 3D finite elements numerical analyses are carried out. The most important features simulated are: i) the advancement of tunnel front; ii) the pressure for front support; iii) the TBM geometry (weight and conicity of shield); iv) the tail void grouting; v) the building structure. A simple elastic perfectly plastic model with Mohr-Coulomb strength criterion and tension cut off is used for describing both soil and masonry behaviour. Preliminary analyses using different mesh density and tolerated error are carried out to optimize the complete analyses achieving an acceptable compromise between calculation time and accuracy of the results. In the usual range of pressure distributions for front support, the study underlines the light influence on stresses and strains distribution of the values adopted. The analysis of stress and strain distributions in the building structure before and after tunnel construction, numerically obtained, allows us to assess the category of damage in term of potential cracks induced and also in term of reduction of structural safety level

Identifying locally advanced basal cell carcinoma eligible for treatment with vismodegib : an expert panel consensus.

Basal cell carcinoma (BCC) is the most common skin cancer worldwide. Most occur on the head and neck, where cosmetic and functional outcomes are critical. BCC can be locally destructive if not diagnosed early and treated appropriately. Surgery is the treatment of choice for the majority of high-risk lesions. Aggressive, recurrent or unresectable tumors can be difficult to manage. Until recently, no approved systemic therapy was available for locally advanced or metastatic BCC inappropriate for surgery or radiotherapy. Vismodegib provides a systemic treatment option. However, a consensus definition of advanced BCC is lacking. A multidisciplinary panel with expertise in oncology, dermatology, dermatologic surgery and radiation oncology proposes a consensus definition based on published evidence and clinical experience