Nanofat Accelerates and Improves the Vascularization, Lymphatic Drainage and Healing of Full-Thickness Murine Skin Wounds

The treatment of wounds using the body's own resources is a promising approach to support the physiological regenerative process. To advance this concept, we evaluated the effect of nanofat (NF) on wound healing. For this purpose, full-thickness skin defects were created in dorsal skinfold chambers of wild-type mice. These defects were filled with NF generated from the inguinal subcutaneous adipose tissue of green fluorescent protein (GFP)+ donor mice, which was stabilized using platelet-rich plasma (PRP). Empty wounds and wounds solely filled with PRP served as controls. Wound closure, vascularization and formation of granulation tissue were repeatedly analyzed using stereomicroscopy, intravital fluorescence microscopy, histology and immunohistochemistry over an observation period of 14 days. PRP + NF-treated wounds exhibited accelerated vascularization and wound closure when compared to controls. This was primarily due to the fact that the grafted NF contained a substantial fraction of viable GFP+ vascular and lymph vessel fragments, which interconnected with the GFP- vessels of the host tissue. Moreover, the switch from inflammatory M1- to regenerative M2-polarized macrophages was promoted in PRP + NF-treated wounds. These findings indicate that NF markedly accelerates and improves the wound healing process and, thus, represents a promising autologous product for future wound management.

Fatter Is Better: Boosting the Vascularization of Adipose Tissue Grafts

Adipose tissue resorption after fat grafting is a major drawback in plastic and reconstructive surgery, which is primarily caused by the insufficient blood perfusion of the grafts in the initial phase after transplantation. To overcome this problem, several promising strategies to boost the vascularization and, thus, increase survival rates of fat grafts have been developed in preclinical studies in recent years. These include the angiogenic stimulation of the grafts by growth factors and botulinum neurotoxin A, biologically active gels, and cellular enrichment, as well as the physical and pharmacological stimulation of the transplantation site. To transfer these approaches into future clinical practice, it will be necessary to establish standardized procedures for their safe application in humans. If this succeeds, the surgical outcomes of fat grafting may be markedly improved, resulting in a significant reduction of the physical and psychological stress for the patients.

Duodenogastric reflux: an update

Although the role of duodenogastric reflux in the pathogenesis of reflux gastritis is firmly established, for other foregut diseases, such as chronic gastritis, esophagitis, functional dyspepsia, peptic ulcer, and malignancy, it remains controversial and only speculative. The aim of this paper is to review merits and flaws of the methods currently used for the detection of duodenogastric reflux, with emphasis on the newly developed method for 24-h bilirubin detection in the gastric and esophageal content, by a fiberoptic small-size probe (Bilitec 2000), and to summarize recent advances in understanding the role of duodenogastric reflux in foregut disorders, in an attempt to identify topics for future research.

Streptococcal toxic shock-like syndrome. Report of two cases from Italy

Two cases of streptococcal toxic shock-like syndrome that occurred at our hospital are described. They represent the second and third cases reported from Italy. Both patients were women, had a portal of entry from cutaneous infection of a limb and suddenly developed high degree fever, severe hypotension, necrotizing fasciitis, acute renal failure, hepatic damage, thrombocytopenia and bleeding from a stress-related duodenal ulcer. One patient was leukopenic. The first patient needed resuscitation in the intensive care unit and emergency surgical debridement of the affected limb, whereas the second improved with medical therapy, but needed duodenal surgery for uncontrolled bleeding. Both patients slowly recovered and survived. Finally, a short update on the pathogenesis of the syndrome is also presented.

Pancreatic carcinoma: differences between patients with or without diabetes mellitus

In order to assess the prevalence and type of diabetes mellitus in patients with pancreatic carcinoma and if the risk factors for the cancer have a different distribution among diabetics and non-diabetics, we reviewed the charts of 127 histologically and/or cytologically proven pancreatic carcinomas consecutively diagnosed from 1977 to 1989 and referred to our Primary Care Hospital from the attending physician. 48 out of 127 (37.7%) subjects were found to be diabetic; 3 had long standing insulin dependent diabetes mellitus, 10 long standing non insulin dependent diabetes mellitus and 35 (73% of all diabetics) new onset diabetes mellitus. 5 out of 10 long standing non insulin dependent diabetics showed secondary failure to oral antidiabetic agents and weight loss in the last six months before the diagnosis of pancreatic carcinoma. When compared to non-diabetics, all diabetics were older (p = 0.05), drank less alcohol (p = 0.047) and had a higher rate of previous neoplasms (p = 0.005). New onset diabetics had a less advanced cancer than those of long standing (p = 0.009). Our study calls for a careful search for pancreatic carcinoma in new onset diabetes of elderly and in long standing, weight losing, non insulin dependent diabetics on secondary failure to oral antidiabetic agents and support the hypothesis that diabetes associated pancreatic carcinoma may bear an its own etiopathogenesis.

[Digestive hemorrhage secondary to biliary ileus. Endoscopic diagnosis]

A rare case of gastrointestinal hemorrhage is presented. The cause of bleeding was ulcer of the descending duodenum due to erosion of an impacted gallstone. Oral endoscopy made possible a preoperative diagnosis and, pushing the gallstone, made surgery easier. The patient underwent enterolithotomy and had a completely uneventful course.

[The diagnostic use of laparoscopy in liver pathology in light of the evolution of imaging diagnosis]

We considered 87 patients suffering from chronic hepatic pathology. 62 patients have resulted suffering from cirrhosis or chronic active hepatitis, 25 from neoplasias. In the patient's group with chronic liver disease the humoral tests were not able to differentiate between cirrhosis or chronic active hepatitis. In the present retrospective experience echography showed sensibility 0.53 and specificity 0.91. In cirrhosis group, sensibility 0.5 and specificity 0.60 in chronic active hepatitis, sensibility 0.8 and specificity 0.95 in the neoplasia group. Peritoneoscopy showed sensibility 0.97 and specificity 0.93 in the cirrhosis group and sensibility 0.90 and specificity 1.00 in the neoplasia group. We had one case of major complication: hemoperitoneum from tear of adhesion secondary to previous laparotomy. We can conclude that peritoneoscopy is an useful procedure in the study of liver chronic disease and it still finds indication in selected cases of focal illness.