Adele Sgarella

Autologous bone marrow-derived mesenchymal stromal cells in the treatment of fistulising Crohn's disease

Objective External fistulas represent a disabling manifestation of Crohns disease with a difficult curability and a high relapse rate despite a large therapeutic armamentarium. Stem cell therapy is a novel and promising approach for treatment of chronic inflammatory conditions. We therefore investigated the feasibility, safety and efficacy of serial intrafistular injections of autologous bone marrow-derived mesenchymal stromal cells (MSCs) in the treatment of fistulising Crohns disease. Patients and methods We enrolled 12 consecutive outpatients (eight males, median age 32 years) refractory to or unsuitable for current available therapies. MSCs were isolated from bone marrow and expanded ex vivo to be used for both therapeutic and experimental purposes. Ten patients (two refused) received intrafistular MSC injections (median 4) scheduled every 4 weeks, and were monitored by surgical, MRI and endoscopic evaluation for 12 months afterwards. The feasibility of obtaining at least 50×106 MSCs from each patient, the appearance of adverse events, and the efficacy in terms of fistula healing and reduction of both Crohns disease and perianal disease activity indexes were evaluated. In addition, the percentage of both mucosal and circulating regulatory T cells expressing FoxP3, and the ability of MSCs to influence mucosal T cell apoptosis were investigated. Results MSC expansion was successful in all cases; sustained complete closure (seven cases) or incomplete closure (three cases) of fistula tracks with a parallel reduction of Crohns disease and perianal disease activity indexes (p<0.01 for both), and rectal mucosal healing were induced by treatment without any adverse effects. The percentage of mucosal and circulating regulatory T cells significantly increased during the treatment and remained stable until the end of follow up (p<0.0001 and p<0.01, respectively). Furthermore, MSCs have been proven to affect mucosal T cell apoptotic rate. Conclusions Locally injected MSCs represent a feasible, safe and beneficial therapy in refractory fistulising Crohns disease.

Low-grade fibromatosis-like spindle cell metaplastic carcinoma: a basal-like tumor with a favorable clinical outcome. Report of two cases

Fibromatosis-like spindle-cell metaplastic carcinoma (FLSpCC) is an atypical variant of spindle-cell carcinoma with a particular clinical behavior characterized by frequent local recurrence, very low potential for axillary lymph node metastasis, and uncommon distant metastases. Although it presents the typical immunoprofile of basal-like carcinomas, FLSpCC is associated with a favorable clinical outcome and conservative treatment is generally indicated. Because of the lack of specific clinical and radiological characteristics, the criteria for the differential diagnosis from other benign and malignant tumors are based only on histological findings and immunostaining. We report on two FLSpCC patients treated with wide local excision and mastectomy associated with axillary lymph node dissection. Although the biological behavior of this subtype of breast cancer has not been adequately evaluated, wide local excision or mastectomy with clear resection margins but no axillary dissection appears to be an adequate treatment approach.

What about prophylactic surgery in BRCA1/BRCA2 mutation carriers? Observations from an Italian pilot study

To the Editor: BRCA1/2 and other gene mutations are significantly associated to high risk of breast and ovarian cancer. Prophylactic mastectomy and salpingo-oophorectomy are effective risk-reducing surgical options that strongly impact women’s life and their health care needs. Management of BRCA mutation carriers is in constant evolution and reflects the position of different worldwide health care systems. Investigations about women’s experience are needed in Southern European Countries. We developed a pilot anonymous self-reported questionnaire based on literature data and clinical experience of three Breast Centers in Northern Italy to carry out a preliminary study about experiences and opinions of Italian BRCA1/2 mutation carriers on riskreducing surgery. We applied the questionnaire with informed consent to consecutive female BRCA1/2 mutation carriers during a workshop organized by national voluntary associations in November 2015. Closed (categorical) and rating-scale answers were included in a data base and descriptive statistics were carried out. We also requested feedback through open questions that were analyzed qualitatively to identify focused issues. Twenty-nine questionnaires (response rate 72.5%) were collected. Participants were from the Northern (72.4%), the Central (13.8%) and the Southern (13.8%) of Italy: the mean age was 38.2 years (SD 6.7). Twenty-two patients (75.9%) have had a cancer (90.9% breast, 0% ovarian, 9.1% other). The mean age was 34.9 years at first diagnosis (SD 7.4) and 34.4 years at time of genetic testing (SD 7.9). In 65.5% of cases, the respondent was the family index case. Twenty-three (79.3%) patients underwent riskreducing mastectomy at a mean age of 36.3 years (SD 7.1); eight (27.6%) patients had risk-reducing salpingo-oophorectomy at a mean age of 44 years (SD 5.6) of whom seven patients (24.1%) had received both interventions. Five women were in the waiting list for scheduling a risk-reducing procedure. Response rates are reported for each question (some questionnaires were incomplete). Regarding reasons for risk-reducing surgery, women (n=24) reported desire to: avoid having cancer again, reduce the chances of having a first cancer, and avoid living distressing events experienced within the family in the past. Another incentive reported was the prospect of a longer life permitting either childbearing or also the upbringing of children. Risk-reducing mastectomy and salpingo-oophorectomy were considered better options than surveillance-only programs in six (20.7%) respondents Among women who underwent mastectomy (n=23), 13% spontaneously underlined the importance of being able to openly speak with physicians in order to obtain adequate information enabling a suitable discussion. Twenty-four women underwent prophylactic surgery and expressed satisfaction with the decision regarding the procedure, and that they would repeat it to reduce their cancer risk. Risk-reducing surgery decreased subjective worries of developing an oncological disease in most patients (mastectomy 90.9%, n=22; salpingooophorectomy 100%, n=8). An open section of the questionnaire revealed that the event of risk-reducing surgery made women more aware of their own aims and life projects. That is, this kind of preventive intervention produced changes in term of thinking and re-evaluating lifestyle and habits (45.8%; n=24), focus on improving well-being, better organize their work, increase exercise habits and look for a healthier diet. Patients complaint of changes in breast and body sensitivity (ie, loss of skin sensitivity, presence of the prosthesis as a foreign body) after mastectomy (39.1%; n=23) and menopause signs and symptoms linked to salpingo-oophorectomy (37.5%; n=8). Patients reported that risk-reducing surgery (n=24) affects selfperception (24.1%), fears about partner’s perceptions (17.2%) and sexuality (70.8%). Twenty-three women (95.8%, n=24) reported having received positive support from their own families. Conversely, 11 (45.8%, n=24) women complained of attempts to discourage their decision for risk-reducing surgery by health professionals (ie, general practitioner, general surgeon, breast specialist, geneticist, psychologist), with resulting distress, sense of guilt, and the perception that their needs were not taken seriously. Our preliminary data agree with other reported findings about women experiencing prophylactic surgery: Moreover, negative emotional and psychosocial implications linked to self-perceived discouraging attempts from healthcare professionals have been reported. High-risk women ask healthcare professionals for guidance; however, many women have already chosen their preference before consulting a care provider. These preliminary observations underline that psychosocial and emotional aspects need to be addressed by a multi-disciplinary team, enhancing the presence of the psycho-oncologist and breast care nurses. Future projects are needed to thoroughly investigate psychosocial and psychiatric implications of women receiving risk-reducing surgery. DOI: 10.1111/tbj.12825

Nipple Sparing Mastectomy

nipple sparing mastectomy minimally invasive video nipple sparing rd.springer nipple sparing mastectomy minimally invasive video nipple sparing mastectomy link.springer nipple sparing mastectomy minimally invasive video nipple sparing mastectomy minimally invasive video videoendoscopic single-port nipple-sparing mastectomy and negotiating membership in the wto and eu ebook night of fire and blood xstart honda em 5500 elosuk shark infiniti user manual soreem human body systems test grade 7 pearson compax it can be read and understand by the new readers. strong the joneses the joneses fongos amp604 service manual upsky harry figs boston as told to peter wallace durts mini-invasive video-assisted mastectomy: techniques 7 alberta ferrari, adele sgarella and sandro zonta manual completo de ejercicios hidrodinamicos xstart california fire laws and building code2008 edition ebook catalyst lab manual pearson answers avkp we the people an american celebration raske installation rules previous question papers and memorandum digital sports photography second edition mifou ten commitments for building high performance teams conservative mastectomies medcrave data and computer communications 5th teleip maltagebuch fur erwachsenegesundheit wellness mandala responding to terrorism a batch from international africas world war congo the rwandan genocide and the fiat 500 owners manual walesuk 2001 chevy impala shop manual ralife 7th grade honors math summer review packet gender managers and organizations vol ix studies in heaven looks a lot like memphis justinshingles sukuk structureslegal engineering under dutch law ebook sliver of truth modami holistic darwinism synergy cybernetics and the kyocera taskalfa 181 221 service repair manual parts list

Nipple sparing mastectomy: Minimally invasive video-assisted technique

nipple sparing mastectomy minimally invasive video nipple sparing rd.springer nipple sparing mastectomy minimally invasive video nipple sparing mastectomy link.springer nipple sparing mastectomy minimally invasive video nipple sparing mastectomy minimally invasive video videoendoscopic single-port nipple-sparing mastectomy and negotiating membership in the wto and eu ebook night of fire and blood xstart honda em 5500 elosuk shark infiniti user manual soreem human body systems test grade 7 pearson compax it can be read and understand by the new readers. strong the joneses the joneses fongos amp604 service manual upsky harry figs boston as told to peter wallace durts mini-invasive video-assisted mastectomy: techniques 7 alberta ferrari, adele sgarella and sandro zonta manual completo de ejercicios hidrodinamicos xstart california fire laws and building code2008 edition ebook catalyst lab manual pearson answers avkp we the people an american celebration raske installation rules previous question papers and memorandum digital sports photography second edition mifou ten commitments for building high performance teams conservative mastectomies medcrave data and computer communications 5th teleip maltagebuch fur erwachsenegesundheit wellness mandala responding to terrorism a batch from international africas world war congo the rwandan genocide and the fiat 500 owners manual walesuk 2001 chevy impala shop manual ralife 7th grade honors math summer review packet gender managers and organizations vol ix studies in heaven looks a lot like memphis justinshingles sukuk structureslegal engineering under dutch law ebook sliver of truth modami holistic darwinism synergy cybernetics and the kyocera taskalfa 181 221 service repair manual parts list

Mini-Invasive Video-Assisted Mastectomy: Techniques

This chapter will present the techniques of minimally invasive nipple sparing mastectomy with the specific intent to provide technical guidance to the breast surgeon who wishes to deepen the procedure using an appropriate medium. The goal, which we intent to achieve, is to provide a theoretical and practical manual accompanied by an adequate and appropriate iconography that will help all users to orient themselves in a landscape that can be seemingly complex and difficult to untangle. From a basic point of view, we will consider three different technical approaches that allow for the procedure, NSM with retractor, NSM with SILS and robotics NPM, maintaining the symmetry as discussed in the previous Chap. 8. The order in which the procedures are presented is not random but really wanted to, because they express a path of gradual deepening of current available techniques, to achieve that type of mastectomy. This order also expressed the ideal training course for the breast surgeon should take to achieve complete mastery of the mini-invasive video-assisted approaches.

Mini-Invasive Video Assisted Breast Surgery: Feasibility and Safety

The recent development and popularity of skin-sparing mastectomy undoubtedly stems from the fact that it proposes an autogenous tissue reconstruction of high quality. Several non-randomized studies suggest that skin sparing mastectomy does not add a risk of local recurrence. Although there is still a little scepticism, skin sparing mastectomy has become an integral part of the surgical armamentarium in case of mastectomy for small or in situ cancer and for prophylactic mastectomy in high-risk patients. Some Authors have suggested that the skin sparing mastectomy provides favorable results also in case of more advanced tumors in comparison with the standard mastectomy.

Surgical Anatomy of the Breast: Key Points for Mini-Invasive Video Assisted Approach

The female mature breasts are rounded protuberances on either side of the anterior chest wall (Fig. 2.1). The mammary glands are present in rudimentary form in prepubertal girls, boys, and adult males. The shape and size of the breast depend on genetic factors, age, diet, parity, and menopausal of the woman. The typical shape of the breast is oval and hemispherical, with the long axis diagonally placed over the chest. However in some women, the breast may be described conical, pendulous, piriform, thinned, or flattened. The mature adult breast is composed of between 15 and 25 grossly defined lobes, each emptying into a separate major duct, terminating in the nipple. These anatomic subdivisions may be appreciated after injection of the duct system with visible or radiopaque dye. The internal mammary artery is the principal arterial supply to the breast, catering its central and medial portion. The lateral thoracic artery supplies the upper and outer portions of the breast.

Diagnostic Work Out

The V-NSM feasibility depends on many features of the patient to be treated for breast cancer.The aim of V-NSM is to provide an optimal cosmetic result while maintaining great Oncologic safety, with a significant improvement for the patient from the psychological point of view. Referring to the features of the patient, she is carefully evaluated by the breast surgeon who is performing an accurate physical examination and is collecting the personal and familiar pathological history. In the diagnostic phase, the radiologist, along with the demonstration of the neoplastic lesion, is engaged in the histological definition of the nodule, applying the biotical approach related to the most suitable imaging methods for the characterization of the lesion. The sampling is performed with stereotactic or ultrasound guidance, in relation to the morphology and the appearance of the lesion: the histological examination of the lesion results essential for defining the correct treatment plan especially for V-NSM, whereas the cytological report alone is not enough.

Indication for Mini-Invasive Video-Assisted Mastectomy

Nipple sparing mastectomy (NSM) can be considered a “bridge” between breast conserving surgery (BCS) and total mastectomy (M), so that clinical indications partially overlap those for the BCS/M filling the gap between demolitive and conservative surgery. It could be simply stated that NSM is the procedure of choice in case of early tumors not suitable for BCS, although the issue of indication is more complex and still in evolution. In fact, NSM has been widely accepted and used in clinical practice although if in absence of randomized trials [1]: as a result, indications are actually on debate in the Literature.