Francesco Massoni

Original Technique for Penile Girth Augmentation Through Porcine Dermal Acellular Grafts: Results in a 69‐Patient Series

INTRODUCTION Although different techniques for augmentation phalloplasty have been reported in the medical literature, this issue is still highly controversial, and none of the proposed procedures has been unanimously approved. AIMS The aim of this study is to describe an innovative surgical technique for penile girth augmentation with porcine dermal acellular grafts, through a small transverse incision at the penile base, along the penopubic junction. METHODS Between 2000 and 2009, 104 patients were referred to our institution for penile enhancement. After a preoperative psychosexual consultation and a general medical assessment, 69 patients were deemed suitable good candidates for surgery. The average penis circumference was measured at the mid-length of the penis and was 8.1 cm (5.4-10.7 cm) and 10.8 cm (6.5-15.8 cm) during flaccidity and erection, respectively. All patients received penile augmentation with porcine dermal acellular grafts. MAIN OUTCOME MEASURES Results evaluation of an innovative technique for penile girth augmentation through exogenous porcine grafts and small penobubic incision. RESULTS Postoperative measurements were performed at 6 and 12 months. At the 1-year follow-up, the average penis circumference was 11.3 cm (8.2-13.2 cm, 3.1 cm mean increase) during flaccidity and 13.2 cm (8.8-14.5 cm, 2.4 cm mean increase) during erection. No major complications occurred in the series. Minor complications were resolved with conservative treatment within 3 weeks. Sexual activity was resumed from 1 to 2 months after surgery. The psychosexual impact of the operation was beneficial in the majority of cases. CONCLUSION Penile girth enlargement with acellular dermal matrix grafts has several advantages over augmentation with autogenous dermis-fat grafts: the elimination of donor site morbidity and a significantly shorter operation time. With this approach, through a short dorsal incision at the base of the penis, the scar is concealed in a crease covered by pubic hair and thus hardly visible.

Foreign bodies ingestion: What responsibility?

The ingestion of foreign bodies is one of the most important and difficult emergencies for a physician to diagnose. Accidental ingestion is more common in children, in patients with dental implants, in individuals with mental disability and in drug users. Voluntary ingestion is found in patients who are psychologically unstable, in prisoners or those who attempt suicide. Foreign bodies may be divided into food as fish bones, chicken bones, food bolus, meat, etc. or real foreign bodies such as orthodontic implants, needles, pins, glass, coins, etc. The authors present a case of management, from the medicolegal point of view, of a female patient age 80, who complained, for some weeks of modest pain in the left iliac fossa, and afterwards the endoscopy showed a toothpick into the wall of the sigmoid colon. Assessed of the clinical status of the patient presented severe cardiac comorbidities so that before processing the patient to a second resolutive endoscopy, it was necessary to obtain the hemodynamic stability. However the management of cases of accidental ingestion of foreign bodies is particularly difficult. Medical errors can arise from the very first contact with the patient resulting in delays in appropriate treatment. The doctor to avoid compromising its position on medical liability, must use all the knowledge and diligence known by the art and science of medicine.

Hunting the Risk NPY and ACE Polymorphisms as Predictors of Cardiovascular Diseases: Case Report and Review of the Literature

Many research efforts were addressed to identify individuals at high risk for multifactorial diseases, such as cardiovascular alterations and related diseases. Great interest was paid to investigate the genetic liability in multifactorial illnesses. The prognosis of high-risk patients might be greatly ameliorated using genetic predisposition risk factors, such as the polymorphisms of neuropeptide Y (NPY) and Angiotensin converting enzyme (ACE) genes. Epidemiologic results suggest that selected polymorphisms of both NPY and ACE might be helpful to improve the evaluation of patients, offering a powerful prognostic tool and paving the way to novel molecular therapeutic strategies. We present a case report of a male, sudden-death from myocardial infarction, presenting with left ventricular hypertrophy. The patient carried polymorphisms of ACE and NPY genes, respectively ACE genotype ID and NPY genotype T-399C, actually considered as risk factors.

Cardiac death by rupture of the right ventricular wall and hemopericardium

Right Ventricular (RV) rupture is a rare and dangerous complication of acute myocardial infarction. There are limited reports on RV free wall rupture. In this paper we describe the outcome of an autopsy case of cardiac death by rupture of the free wall of the right ventricle in a 51-year-old man with coronary artery disease and hypertrophic-sclerotic cardiomyopathy.

New surgical technique for ventral penile curvature without circumcision

To describe and report on our variant of penile corporoplasty, the ‘double‐breasted’ corporoplasty, with penoscrotal and infrapubic access not requiring circumcision. The medicolegal aspects of treatment are also discussed.

Quality of life in dementia sufferers: diet and exercise in an evaluatory role.

BACKGROUND Among the myriad of factors modulating quality of life assessments estimated in patients presenting a variety of cognitive impairments, the distinctive and critical influence of diet and exercise cannot be overestimated. OBJECTIVE The objective of this study was to review the evidence to confirm the association between these health-endowering agents and cognitive performance in People With Dementia as well as providing a correlation between Mini Mental State Examination scores and available anthropometric data. METHODS The authors tested the hypothesized correlation on a sample of subjects with instrumentally confirmed cognitive impairment using parameters as Body Mass Index and calf circumference. RESULTS The results confirm the hypothesis and suggesting the possible use of anthropometric data in the process of objective evaluation of the patient with cognitive impairment that could also be used for forensic medicine.

The Portal Hypertensive Gastropathy: A Case and Review of Literature.

Upper gastrointestinal bleeding is a cause of high risk for morbidity and mortality. It has been debated in alcoholic cirrhosis, if alcohol exerts an exclusive and causal role upon gastropathy or whether it is linked to cirrhotic portal hypertension. The authors describe an autopsy report regarding mortality caused by gastric bleeding in a 53-year-old patient who suffered from cirrhosis. Literature has evidence of direct, marked damage of alcohol upon the gastric mucosa and there is noteworthy statistical data implying the revaluation of the pathogenesis of the bleeding.

Post Vaccinal Temporary Sensorineural Hearing Loss

In our systematic research we identified four studies concerning the onset of neurological adverse events following vaccination and two excluding this association. A 33-year-old Italian man, belonging to the Italian Army was hospitalized because he suffered from vertigo, nausea and sudden right hearing loss not classified (NDD), that set in 24 h after the administration of tetanus-diphtheria and meningococcal vaccines. Some neurological events arising after vaccination are very difficult to treat. In our case, the functional recovery on low and medium frequencies was possible about 6 months after the morbid event.

Early Diagnosis of Cardiovascular Diseases in Workers: Role of Standard and Advanced Echocardiography

Cardiovascular disease (CVD) still remains the main cause of morbidity and mortality and consequently early diagnosis is of paramount importance. Working conditions can be regarded as an additional risk factor for CVD. Since different aspects of the job may affect vascular health differently, it is important to consider occupation from multiple perspectives to better assess occupational impacts on health. Standard echocardiography has several targets in the cardiac population, as the assessment of myocardial performance, valvular and/or congenital heart disease, and hemodynamics. Three-dimensional echocardiography gained attention recently as a viable clinical tool in assessing left ventricular (LV) and right ventricular (RV) function, volume, and shape. Two-dimensional (2DSTE) and, more recently, three-dimensional speckle tracking echocardiography (3DSTE) have also emerged as methods for detection of global and regional myocardial dysfunction in various cardiovascular diseases and applied to the diagnosis of subtle LV and RV dysfunction. Although these novel echocardiographic imaging modalities have advanced our understanding of LV and RV mechanics, overlapping patterns often show challenges that limit their clinical utility. This review will describe the current state of standard and advanced echocardiography in early detection (secondary prevention) of CVD and address future directions for this potentially important diagnostic strategy.

Post-mortem morphological alterations of human peripheral nerve

Abstract Post-mortem morphological modifications in median nerve samples collected at different times after death were studied in subjects with known circumstances and times of death. Histological analyses were performed by light and electron microscopy on single fiber and on transversal sections. Results of morphological observations evidenced the progressive disappearance of myelin over time according to a process similar to Wallerian degeneration occurring in vivo. Electron microscope analysis of transversal sections evidenced four steps through which post-mortal myelin degradation proceeded, from the initial structure modification (after 12 h from death) to the complete collapse and the simultaneous appearance of dropsy bumps toward the axon (after 48 h from death). The post-mortal demyelinization process can reasonably be thought to have a multifocal origin. Post-mortem alterations of nerve fibers do not evolve simultaneously and in a uniform manner in all the fibers of the same nerve, where different factors come into play, particularly fiber gauge.