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Queirolo P, Cinquini M, Argenziano G, Bassetto F, Bossi P, Boutros A, Clemente C, de Giorgi V, Del Vecchio M, Patuzzo R, Pennachioli E, Peris K, Quaglino P, Reali A, Zalaudek I, Spagnolo F. Guidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma: a GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. ESMO Open 2024; 9:103005. [PMID: 38688192 PMCID: PMC11067535 DOI: 10.1016/j.esmoop.2024.103005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
Cutaneous squamous cell carcinoma (CSCC) accounts for ∼20%-25% of all skin tumors. Its precise incidence is often challenging to determine due to limited statistics and its incorporation with mucosal forms. While most cases have a favorable prognosis, challenges arise in patients presenting with locally advanced or metastatic forms, mainly appearing in immunocompromised patients, solid organ transplantation recipients, or those facing social difficulties. Traditionally, chemotherapy and targeted therapy were the mainstays for advanced cases, but recent approvals of immunotherapeutic agents like cemiplimab and pembrolizumab have revolutionized treatment options. These guidelines, developed by the Italian Association of Medical Oncologists (AIOM) using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, aim to guide clinicians in diagnosing, treating, and monitoring patients with CSCC, covering key aspects from primitive tumors to advanced stages, selected by a panel of experts selected by AIOM and other national scientific societies. The incorporation of these guidelines into clinical practice is expected to enhance patient care and address the evolving landscape of CSCC management.
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Affiliation(s)
- P Queirolo
- Division of Melanoma, Sarcomas and Rare Tumors, IRCCS European Institute of Oncology, Milan
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - G Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples
| | - F Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Padua
| | - P Bossi
- IRCCS Humanitas Research Hospital, Milan
| | - A Boutros
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa
| | - C Clemente
- Surgical Pathology Department, IRCCS Galeazzi Sant'Ambrogio, Milan
| | - V de Giorgi
- Dermatology Unit, Azienda USL Toscana Centro, Florence; Section of Dermatology, Department of Health Sciences, University of Florence, Florence
| | - M Del Vecchio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Patuzzo
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Unit, Milan
| | - E Pennachioli
- Division of Melanoma, Sarcomas and Rare Tumors, IRCCS European Institute of Oncology, Milan
| | - K Peris
- Dermatology, Department of Medicine and Translational Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology, Department of Medical and Surgery Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - P Quaglino
- Department of Medical Sciences, Clinic of Dermatology, University of Turin, Turin
| | - A Reali
- Radiation Oncology Department, Michele e Pietro Ferrero Hospital, Verduno
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste
| | - F Spagnolo
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova; Department of Surgical Sciences and Integrated Diagnostics (DISC), Plastic Surgery Division, University of Genova, Genoa, Italy.
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2
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Queirolo P, Cinquini M, Argenziano G, Bassetto F, Bossi P, Boutros A, Clemente C, de Giorgi V, Del Vecchio M, Patuzzo R, Peris K, Quaglino P, Reali A, Zalaudek I, Spagnolo F. Guidelines for the diagnosis and treatment of basal cell carcinoma: a GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. ESMO Open 2023; 8:102037. [PMID: 37879235 PMCID: PMC10598491 DOI: 10.1016/j.esmoop.2023.102037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common form of cancer, with a high impact on the public health burden and social costs. Despite the overall prognosis for patients with BCC being excellent, if lesions are allowed to progress, or in a small subset of cases harboring an intrinsically aggressive biological behavior, it can result in local spread and significant morbidity, and conventional treatments (surgery and radiotherapy) may be challenging. When a BCC is not amenable to either surgery or radiotherapy with a reasonable curative intent, or when metastatic spread occurs, systemic treatments with Hedgehog inhibitors are available. These guidelines were developed, applying the GRADE approach, on behalf of the Italian Association of Medical Oncologists (AIOM) to assist clinicians in treating patients with BCC. They contain recommendations with regard to the diagnosis, treatment and follow-up, from primitive tumors to those locally advanced or metastatic, addressing the aspects of BCC management considered as priorities by a panel of experts selected by AIOM and other national scientific societies. The use of these guidelines in everyday clinical practice should improve patient care.
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Affiliation(s)
- P Queirolo
- Division of Melanoma, Sarcomas and Rare Tumors, European Institute of Oncology, Milan
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - G Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples
| | - F Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Padua
| | - P Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia
| | - A Boutros
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa
| | - C Clemente
- UO SMEL-2, Surgical Pathology, Department of Pathology and Laboratory Medicine, IRCCS-Policlinico San Donato, Milan
| | - V de Giorgi
- Dermatology Unit, Azienda USL Toscana Centro, Florence; Section of Dermatology, Department of Health Sciences, University of Florence, Florence
| | - M Del Vecchio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Patuzzo
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Unit, Milan
| | - K Peris
- Dermatology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - P Quaglino
- Department of Medical Sciences, Clinic of Dermatology, University of Turin, Turin
| | - A Reali
- Radiation Oncology Department, Michele e Pietro Ferrero Hospital, Verduno
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste
| | - F Spagnolo
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa; Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy.
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3
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Costa AL, Vindigni V, Tiengo C, Brambullo T, Perozzo FAG, Galeano MR, Colonna MR, Bassetto F. Regenerative potential of the sural neuroadipofascial flap in the treatment of chronic ulcers of the lower third of the leg. Eur Rev Med Pharmacol Sci 2023; 27:11-17. [PMID: 37129331 DOI: 10.26355/eurrev_202304_31317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Surgical reconstruction of soft tissue defects in the distal third of the lower limbs has always been challenging for surgeons. The adipofascial flaps are made up of vascularized adipose tissue, which plastically conforms to the site to be reconstructed with its rich presence of stem cells. In this study, we resumed our case history of reverse neuroadipofascial sural flap, and we evaluated the stability of the scar to verify if this type of reconstruction can ensure long-term results and its regenerative power. PATIENTS AND METHODS In this retrospective cohort study, we analyzed 32 patients who had undergone lower limb reconstruction with the sural neuroadipovenous flap. RESULTS A total of 32 patients were included in the study. The average age was 62.2 years. Chronic skin ulcer was the cause of the defects in 13 (40.6%) patients, chronic wound after trauma in 7 (21.9%) patients, wheel bedsores in 4 (12.5%) patients, osteomyelitis in 5 (15.6%) patients, exposed internal hardware in 2 (6.3%) patients, dog bite in 1 (3.1%). The site defect comprised 11 heels (34.4%), 4 external malleoli (12.5%), three medial malleoli (9.4%), 12 lower third of the leg (37.5%), and two dorsa of the foot (6.3%). In all cases, defects were covered with reverse sural island flap. The dimension of the flap ranged from 5 to 9 cm in length and from 3 to 7 in width. Six patients showed early or later postoperative complications. CONCLUSIONS The neuroadipofascial sural flap is versatile, fast, and easy-to-perform to cover a chronic defect in the distal part of the lower limb, including both the malleoli and the heel, due to its long vascular pedicle. Consistent with the studies carried out in other districts, the present study confirms the remarkable regenerative power of the vascularized adipose tissue at the level of complex wounds of the lower third of the leg.
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Affiliation(s)
- A L Costa
- Department of Neurosciences, Clinic of Plastic Reconstructive and Aesthetic Surgery, Padua University Hospital, Padua, Italy.
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Gianesini S, Rimondi E, Raffetto JD, Melloni E, Pellati A, Menegatti E, Avruscio GP, Bassetto F, Costa AL, Rockson S. Human collecting lymphatic glycocalyx identification by electron microscopy and immunohistochemistry. Sci Rep 2023; 13:3022. [PMID: 36810649 PMCID: PMC9945466 DOI: 10.1038/s41598-023-30043-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
Blood flow is translated into biochemical inflammatory or anti-inflammatory signals based onshear stress type, by means of sensitive endothelial receptors. Recognition of the phenomenon is of paramount importance for enhanced insights into the pathophysiological processes of vascular remodeling. The endothelial glycocalyx is a pericellular matrix, identified in both arteries and veins, acting collectively as a sensor responsive to blood flow changes. Venous and lymphatic physiology is interconnected; however, to our knowledge, a lymphatic glycocalyx structure has never been identified in humans. The objective of this investigation is to identify glycocalyx structures from ex vivo lymphatic human samples. Lower limb vein and lymphatic vessels were harvested. The samples were analyzed by transmission electron microscopy. The specimens were also examined by immunohistochemistry. Transmission electron microscopy identified a glycocalyx structure in human venous and lymphatic samples. Immunohistochemistry for podoplanin, glypican-1, mucin-2, agrin and brevican characterized lymphatic and venous glycocalyx-like structures. To our knowledge, the present work reports the first identification of a glycocalyx-like structure in human lymphatic tissue. The vasculoprotective action of the glycocalyx could become an investigational target in the lymphatic system as well, with clinical implications for the many patients affected by lymphatic disorders.
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Affiliation(s)
- S. Gianesini
- grid.8484.00000 0004 1757 2064Department of Translational Medicine, LTTA Centre, University of Ferrara, Ferrara, Italy ,grid.265436.00000 0001 0421 5525Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, USA
| | - E. Rimondi
- grid.8484.00000 0004 1757 2064Department of Translational Medicine, LTTA Centre, University of Ferrara, Ferrara, Italy
| | - J. D. Raffetto
- grid.265436.00000 0001 0421 5525Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, USA ,grid.38142.3c000000041936754XSurgery Department, VA Boston Healthcare System, Harvard University, Boston, USA
| | - E. Melloni
- grid.8484.00000 0004 1757 2064Department of Translational Medicine, LTTA Centre, University of Ferrara, Ferrara, Italy
| | - A. Pellati
- grid.8484.00000 0004 1757 2064Department of Translational Medicine, LTTA Centre, University of Ferrara, Ferrara, Italy
| | - E. Menegatti
- grid.8484.00000 0004 1757 2064Environmental Sciences and Prevention Department, University of Ferrara, Ferrara, Italy
| | - G. P. Avruscio
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic and Vascular Sciences, Hospital-University of Padua, Padua, Italy
| | - F. Bassetto
- grid.5608.b0000 0004 1757 3470Department of Neuroscience, Clinic of Plastic Surgery, University of Padova, Padua, Italy
| | - A. L. Costa
- grid.5608.b0000 0004 1757 3470Department of Neuroscience, Clinic of Plastic Surgery, University of Padova, Padua, Italy
| | - S. Rockson
- grid.168010.e0000000419368956Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, USA
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5
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Iafrate M, Leone N, Mancini M, Prayer T, Bassetto F, Moro FD. Domestic trauma with penile and scrotum skin degloving and testicular avulsion. J Surg Case Rep 2021; 2021:rjab175. [PMID: 34055285 PMCID: PMC8153698 DOI: 10.1093/jscr/rjab175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 11/30/2022] Open
Abstract
Traumatic lesions of male external genitalia are certainly less frequent than the other body sites and in the majority of cases they are caused by work accidents in the metalworking environment or by gunshot wounds. We present a rare case of traumatic degloving lesion of the male external genitalia with avulsion of the left testis caused by an accidental fall from the ladder. Reconstructive surgery was carried out in a single procedure, obtaining an excellent esthetic and functional result.
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Affiliation(s)
- M Iafrate
- Urological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - N Leone
- Urological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - M Mancini
- Urological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - T Prayer
- Urological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - F Bassetto
- Plastic and Reconstructive Surgery Unit, University of Padua, Padua, Italy
| | - F Dal Moro
- Urological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
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6
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Messana F, Faccio D, Sonda R, Scortecci L, Tiengo C, Bassetto F. Wide-awake anesthesia in Dupuytren's contracture treated with collagenase. Hand Surg Rehabil 2020; 40:93-96. [PMID: 32961287 DOI: 10.1016/j.hansur.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022]
Abstract
The injection of collagenase followed by cord manipulation is one of the most popular treatments for Dupuytren's contracture. This is traditionally performed under local anesthesia or regional nerve block potentially with sedation. Neither the treatment with collagenase, nor the wide-awake anesthesia are novel techniques for hand surgeons. Nevertheless, we report the first experience of cord manipulation using the wide-awake approach. In this prospective study, we compared the pain perception of patients who underwent wide-awake anesthesia versus traditional local anesthesia. We recorded the pain sensation on a visual analog scale (VAS) (0 to 10) during anesthetic injection, during cord manipulation and before discharge. Wide-awake anesthesia significantly reduced pain levels during anesthetic injection (p=0.003) and cord manipulation (p=0.0009). Pain levels did not differ significantly right before discharge in the two groups (p=0.54). Wide-awake anesthesia can be successfully applied to cord manipulation after collagenase injection in Dupuytren's contracture. This way, it is possible to improve the patient's subjective perspective of the procedure.
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Affiliation(s)
- F Messana
- Clinic of Plastic Surgery, University Hospital of Padua, Via Nicolò Giustiniani 2, Padua, PD 35128, Italy.
| | - D Faccio
- Clinic of Plastic Surgery, University Hospital of Padua, Via Nicolò Giustiniani 2, Padua, PD 35128, Italy
| | - R Sonda
- Clinic of Plastic Surgery, University Hospital of Padua, Via Nicolò Giustiniani 2, Padua, PD 35128, Italy
| | - L Scortecci
- Clinic of Plastic Surgery, University Hospital of Padua, Via Nicolò Giustiniani 2, Padua, PD 35128, Italy
| | - C Tiengo
- Clinic of Plastic Surgery, University Hospital of Padua, Via Nicolò Giustiniani 2, Padua, PD 35128, Italy
| | - F Bassetto
- Clinic of Plastic Surgery, University Hospital of Padua, Via Nicolò Giustiniani 2, Padua, PD 35128, Italy
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7
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Facchin F, Messana F, Sonda R, Faccio D, Tiengo C, Bassetto F. COVID-19: Initial experience of hand surgeons in Northern Italy. Hand Surg Rehabil 2020; 39:332-333. [PMID: 32376511 PMCID: PMC7196548 DOI: 10.1016/j.hansur.2020.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/03/2022]
Affiliation(s)
- F Facchin
- Hand Surgery and Microsurgery Unit, University of Padova/Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - F Messana
- Hand Surgery and Microsurgery Unit, University of Padova/Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - R Sonda
- Hand Surgery and Microsurgery Unit, University of Padova/Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - D Faccio
- Hand Surgery and Microsurgery Unit, University of Padova/Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - C Tiengo
- Hand Surgery and Microsurgery Unit, University of Padova/Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - F Bassetto
- Hand Surgery and Microsurgery Unit, University of Padova/Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
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Abstract
In the field of breast reconstruction, products and techniques are continuing to evolve to ensure good clinical and quality outcomes. This article reviews the published literature regarding the use of fetal bovine-derived acellular dermal matrix (SurgiMend, SurgiMend PRS and SurgiMend PRS meshed), focusing on safety, clinical outcomes and surgical techniques.
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Affiliation(s)
- F Bassetto
- Plastic Surgery Department, Padova University, Italy
| | - L Pandis
- Plastic Surgery Department, Padova University, Italy
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Pontini A, Munivrana I, Valente M, Bassetto F. Comparison of reasorbeable mini anchor versus non reasorbeable: histological evaluation in an experimental rabbit model. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2013.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A. Pontini
- Department of Medico-Surgical Specialties, Hand Unit, Institute of Plastic Surgery, University of Padova, Italy
| | - I. Munivrana
- Department of Diagnostic Medical Sciences, Section of Special Pathology, University of Padova, Italy
| | - M.L. Valente
- Department of Medico-Surgical Specialties, Hand Unit, Institute of Plastic Surgery, University of Padova, Italy
| | - F. Bassetto
- Department of Medico-Surgical Specialties, Hand Unit, Institute of Plastic Surgery, University of Padova, Italy
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10
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Griguolo G, Miglietta F, Dieci M, Vindigni V, Bassetto F, De Antoni E, Polico I, Marchet A, Baldan E, Vernaci G, Saibene T, Michieletto S, Guarneri V. Oncological outcome of fat grafting for breast reconstruction after cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tocco-Tussardi I, Boccella S, Bassetto F. The instructional value of international surgical volunteerism from a resident's perspective. Ann Burns Fire Disasters 2016; 29:146-150. [PMID: 28149239 PMCID: PMC5286992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/22/2016] [Indexed: 06/06/2023]
Abstract
The aim of this article is to document the experience of the author who volunteered as a resident for 6 months at a districtlevel hospital in central Kenya. Peculiarities emerging from the report are: specificity of the experience to plastic reconstructive surgery; highly complex reconstructive procedures performed under direct supervision of a qualified mentor; exposure to diverse approaches through collaboration with different volunteer plastic surgeons; enhancement of long-term surveillance; and opportunity to expand surgical knowledge outside one's field of specialty. The humanitarian setting allows maximal exposure and learning and can play a significant role in the resident's education.
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Affiliation(s)
- I. Tocco-Tussardi
- Plastic Surgery Residency Program Class of 2015, University of Padova, Padova, Italy
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - S. Boccella
- Help for Life Foundation Onlus, Padova, Italy
| | - F. Bassetto
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Padova, Italy
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12
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Tocco-Tussardi I, Presman B, Cherubino M, Garusi C, Bassetto F. Microsurgery "without borders": new limits for reconstruction of post-burn sequelae in the humanitarian setting. Ann Burns Fire Disasters 2016; 29:66-70. [PMID: 27857655 PMCID: PMC5108232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/10/2015] [Indexed: 06/06/2023]
Abstract
Post-burn contractures account for up to 50% of the workload of a plastic surgery team volunteering in developing nations. Best possible outcome most likely requires extensive surgery. However, extensive approaches such as microsurgery are generally discouraged in these settings. We report two successful cases of severe hand contractures reconstructed with free flaps on a surgical mission in Kenya. Microsurgery can be safely performed in the humanitarian setting by an integration of: personal skills; technical means; education of local personnel; follow-up services; and an effective network for communication.
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Affiliation(s)
- I. Tocco-Tussardi
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Padova, Italy
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - B. Presman
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - M. Cherubino
- Plastic Surgery Unit, Department of Biotechnologies and Sciences of Life, University of Insubria/Varese, Varese, Italy
| | - C. Garusi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy
| | - F. Bassetto
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Padova, Italy
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13
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Enzi G, Busetto L, Sergi G, Coin A, Inelmen EM, Vindigni V, Bassetto F, Cinti S. Multiple symmetric lipomatosis: a rare disease and its possible links to brown adipose tissue. Nutr Metab Cardiovasc Dis 2015; 25:347-353. [PMID: 25770761 DOI: 10.1016/j.numecd.2015.01.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 02/06/2023]
Abstract
AIM Aim of this study is an updated review of our case series (72 patients) as well as available literature on the Multiple Symmetric Lipomatosis (MSL), a rare disease primarily involving adipose tissue, characterized by the presence of not encapsulated fat masses, symmetrically disposed at characteristic body sites (neck, trunk, proximal parts of upper and lower limbs). DATA SYNTHESIS The disease is more frequent in males, associated to an elevated chronic alcohol consumption, mainly in form of red wine. Familiarity has been reported and MSL is considered an autosomic dominant inherited disease. MSL is associated to severe clinical complications, represented by occupation of the mediastinum by lipomatous tissue with a mediastinal syndrome and by the presence of a somatic and autonomic neuropathies. Hyper-alphalipoproteinemia with an increased adipose tissue lipoprotein-lipase activity, a defect of adrenergic stimulated lipolysis and a reduction of mitochondrial enzymes have been described. The localization of lipomatous masses suggests that MSL lipomas could originate from brown adipose tissue (BAT). Moreover, studies on cultured pre-adipocytes demonstrate that these cells synthetize the mitochondrial inner membrane protein UCP-1, the selective marker of BAT. Surgical removal of lipomatous tissue is to date the only validated therapeutic approach. CONCLUSIONS MSL is supposed to be the result of a disorder of the proliferation and differentiation of human BAT cells.
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Affiliation(s)
- G Enzi
- Department of Medicine, University of Padua, Italy
| | - L Busetto
- Department of Medicine, University of Padua, Italy.
| | - G Sergi
- Department of Medicine, University of Padua, Italy
| | - A Coin
- Department of Medicine, University of Padua, Italy
| | - E M Inelmen
- Department of Medicine, University of Padua, Italy
| | - V Vindigni
- Institute of Plastic Surgery, University of Padua, Italy
| | - F Bassetto
- Institute of Plastic Surgery, University of Padua, Italy
| | - S Cinti
- Department of Experimental and Clinical Medicine & Diagnostic Electron Microscopy, United Hospitals, University of Ancona (Politecnico delle Marche), Italy
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Bassetto F, Staffieri A, Reho F, Facchin F, Shehata J, Maged D, Tiengo C. Management of complex pediatric burn scars in a humanitarian collaboration. Ann Burns Fire Disasters 2015; 28:46-49. [PMID: 26668562 PMCID: PMC4665182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 09/15/2014] [Accepted: 09/17/2014] [Indexed: 06/05/2023]
Abstract
Burn scars still represent a challenge to the reconstructive surgeon. Their management requires a specific expertise and set up involving the possibility of long term rehabilitation and follow up. Cases encountered in humanitarian missions present additional issues. Often the local environment is not suitable for an appropriate treatment plan, requiring the case to be transferred to a foreign country for surgical care as part of an integrated international and multidisciplinary management. We present the case of a three year-old patient injured in a bomb explosion during the Arab Spring and suffering from severe scar contracture limiting thoracic and upper limb movement. After initial consultation at distance, transfer to our country was organized and an intensive surgical and rehabilitative program was carried out over three months. After five months, the patient returned to his home country where a supportive network had been set up for continued rehabilitation, ensuring follow up for over a year and ultimate success.
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Affiliation(s)
- F. Bassetto
- Clinic of Plastic Surgery, University of Padova, Padua, Italy
| | - A. Staffieri
- ENT Department, University of Padova, Padua, Italy
| | - F. Reho
- Clinic of Plastic Surgery, University of Padova, Padua, Italy
| | - F. Facchin
- Clinic of Plastic Surgery, University of Padova, Padua, Italy
| | - J. Shehata
- Institute of Hygiene and Public Health, Catholic University, Rome, Italy
| | - D. Maged
- Italian hospital Umberto Primo in Cairo, Cairo, Egypt
| | - C. Tiengo
- Clinic of Plastic Surgery, University of Padova, Padua, Italy
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15
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Scarpa C, Borso GF, Vindigni V, Bassetto F. Polyurethane foam-covered breast implants: a justified choice? Eur Rev Med Pharmacol Sci 2015; 19:1600-1606. [PMID: 26004599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Even if the safety of the polyurethane prosthesis has been the subject of many studies and professional and public controversies. Nowadays, polyurethane covered implants are very popular in plastic surgery for the treatment of capsular contracture. MATERIALS AND METHODS We have identified 41 papers (1 is a communication of the FDA) by using search browsers such as Pubmed, Medline, and eMedicine. Eleven manuscripts have been used for an introduction, and the remaining thirty have been subdivided into three tables whose results have been summarized in three main chapters: (1) capsular formation and contracture, (2) complications, (3) biodegradation and cancer risk. RESULTS (1) The polyurethanic capsule is a well defined foreign body reaction characterized by synovial metaplasia, a thin layer of disarranged collagen fibers and a high vascularization. These features make possible a "young" capsule and a low occurrence of capsular contracture even over a long period (10 years); (2) the polyurethane implants may be difficult to remove but there is no evidence that they cause an increase in the other complications; (3) there is no evidence of polyurethane related cancer in long-term studies (after 5 years). CONCLUSIONS Polyurethane foam covered breast implants remain a valid choice for the treatment of capsular contracture even if it would be very useful to verify the ease of removal of the prosthesis and to continue investigations on biodegradation products.
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Affiliation(s)
- C Scarpa
- Plastic Surgery Unit, School of Medicine, University of Padova, Padova, Italy.
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16
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Martinello T, Perazzi A, Iacopetti I, Vindigni V, Bassetto F, Patruno M. New regenerative strategies for tendon repair and regeneration. Ann Anat 2014. [DOI: 10.1016/j.aanat.2014.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Tussardi IT, Vindigni V, Bassetto F, Zavan B. Abstract 180. Plast Reconstr Surg 2013. [DOI: 10.1097/01.prs.0000430122.33616.ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Abstract
Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's tumour, is an uncommon benign vascular lesion characterized by small multiple, endothelial-lined, papillary structures with hyaline stalks. It appears to be a reactive condition involving excessive proliferation of endothelial cells in normal blood vessels or in vascular malformations, perhaps in response to blood vessel injury or thrombosis. The lesions are small, superficial, reddish-blue nodules, usually in the head, neck or hand. Distinction from pyogenic granuloma and angiosarcoma usually requires pathological examination. Complete surgical excision is the treatment of choice. Four cases affecting the finger are presented together with histological features.
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Affiliation(s)
- L Sartore
- Department of Plastic and Reconstructive Surgery, University of Padova Hospital, Padova, Italy.
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19
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Bassetto F, Vindigni V, Scarpa C, Doria A. Breast prostheses and connective tissue disease (CTD): myth or reality? Aesthetic Plast Surg 2010; 34:257-63. [PMID: 19802514 DOI: 10.1007/s00266-009-9422-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 09/14/2009] [Indexed: 10/20/2022]
Abstract
Since their first appearance, breast prostheses have been criticized as being both responsible for and giving rise to systemic disease. The literature contains many reports on the subject, and theories were controversial from the 1980s to the 2000s. The aim of this review was to gather together the most important studies on breast prostheses and systemic disease, with particular attention to connective tissue disease (CTD), in order to verify any relationship between silicone breast implants and the occurrence of pathologies.
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20
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Zampieri S, Valente M, Adami N, Biral D, Ghirardello A, Rampudda ME, Vecchiato M, Sarzo G, Corbianco S, Kern H, Carraro U, Bassetto F, Merigliano S, Doria A. Polymyositis, dermatomyositis and malignancy: a further intriguing link. Autoimmun Rev 2009; 9:449-53. [PMID: 20026430 DOI: 10.1016/j.autrev.2009.12.005] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 12/14/2009] [Indexed: 01/16/2023]
Abstract
The association between malignancy and autoimmune myositis has been largely described and confirmed by numerous epidemiological studies. The temporal relationship between the two pathologic conditions can vary: malignancy may occur before, at the same time or following the diagnosis of myositis. Beside these observations, the molecular mechanisms underlying this association are still unknown, even though it has been demonstrated a possible antigenic similarity between regenerating myoblasts and some cancer cell populations. To better identify peculiar histopathologic features common to cancer and myositis, we screened muscle biopsies from patients affected with polymyositis, dermatomyositis, myositis in association to cancer, and from patients affected with newly diagnosed cancer, but without myositis. Similarly to the histopatologic features that were observed in the muscle from myositis patients, especially in those with cancer associated myositis, in patients affected with malignancy at the clinical onset of disease we observed early sign of myopathy, characterized by internally nucleated and regenerating myofibers, most of them expressing the neural cell adhesion molecule. The hypothesis that in a particular subset of individuals genetically predisposed to autoimmunity, an initial subclinical tumor-induced myopathy may result in an autoimmune myositis, represents a further intriguing link behind the association of these two conditions.
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Affiliation(s)
- S Zampieri
- Laboratory of Translational Myology of the Interdepartmental Research Center of Myology, c/o Department of Biomedical Science, University of Padova, Italy
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21
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Sergi G, Perissinotto E, Zucchetto M, Enzi G, Manzato E, Giannini S, Bassetto F, Inelmen EM, Baldo G, Rinaldi G, Coin A. Upper limb bone mineral density and body composition measured by peripheral quantitative computed tomography in right-handed adults: the role of the dominance effect. J Endocrinol Invest 2009; 32:298-302. [PMID: 19636194 DOI: 10.1007/bf03345715] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND To investigate the impact on bone and muscle of pathological conditions involving only one of the upper limbs, it is important to know the physiological differences due to the dominance effect. AIM To evaluate any physiological differences between dominant and non-dominant upper limbs in terms of bone mineral density (BMD), muscle mass, and muscle density at different levels. SUBJECTS AND METHODS The study considered 60 right-handed healthy adults, 30 men and 30 women. Cortical BMD, muscle area, and muscle density were investigated by pQCT-XCT-3000 Stratec at the proximal radius, trabecular and total BMD at the distal radius, and trabecular and cortical BMD at the second phalanx of the third finger. Hand grip strength was also measured. RESULTS No significant differences in BMD were found between the dominant and non-dominant upper limbs at any of the sites considered, in men or women. Muscle density was also similar on the two sides, whereas muscle area at the proximal radius was significantly lower on the non-dominant side in both men [4177.5+/-475.1 vs 4009.3+/-552.7 mm2; Delta%: 4.1%; 95% confidence interval (CI) 1.7%-6.5%] and women (2903.9+/-470.9 vs 2720.3+/-411.7 mm2; Delta%: 6.1%; 95%CI 4.3%-7.9%). Hand grip strength proved greater on the right side in both men (48.5+/-8.8 vs 45.2+/-8.7 kg; Delta% 7.1; p<0.001) and women (29.1+/-4.3 vs 27.0+/-5.1 kg; Delta% 7.1; p<0.001). CONCLUSION The dominance effect does not seem to influence trabecular or cortical BMD at any of the sites in the upper limb. Muscle density is not modified by dominance, while muscle area is reduced on the non-dominant side and this should be borne in mind when the effect of pathological conditions on the body composition of a single forearm is investigated.
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Affiliation(s)
- G Sergi
- Division of Geriatrics, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy.
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22
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Curic L, Azzena B, Bassetto F, Perţea M, Luncă S. [Postmastectomy breast reconstruction--outcome on 33 consecutive cases]. Rev Med Chir Soc Med Nat Iasi 2009; 113:453-458. [PMID: 21495351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED Nowadays postmastectomy breast reconstruction for breast cancer, seems to receive greater acceptance than in the past due to three important reasons: the improvement of the methods and techniques of plastic surgery; the new improved materials used as breast prosthesis; the better informed patients. The aim of this study is to review the outcomes of breast reconstruction performed for patients with mastectomy for breast cancer. MATERIAL AND METHOD The medical records of 33 consecutive patients who underwent breast reconstruction, during a one year period, at a large municipal hospital were reviewed retrospectively. The main parameters studied were type of reconstruction, morbidity rate and type and number of reoperations. RESULTS Among 33 patients , a number of 30 patient (90.9%) had theirs breasts reconstructed using a prostesis material and for 3 patients (9.1%) a flap type reconstruction was used. Immediate breast reconstruction was the preferred method of reconstruction. No major complications were noted. Minor complications were present in 4 patients (12.5%): infection (1 case), haematoma (1 case), skin necrosis (1 case), device extrusion due to local infection (1 case). CONCLUSIONS Immediate breast reconstruction using expander and implant technique offers very good outcomes with low morbidity rate, excellent cosmetic results and consists in small, reliable and perfect reproductible operations.
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Affiliation(s)
- Laura Curic
- Spitalul Clinic de Urgenţe Sf. Ioan Iaşi, Clinica de Chirurgie Plastică si Microchirurgie Reconstructivă, Universitatea de Medicină si Farmacie Gr.T. Popa Iaşi
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23
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Macchi V, Vigato E, Porzionato A, Tiengo C, Stecco C, Parenti A, Morra A, Bassetto F, Mazzoleni F, De Caro R. The gracilis muscle and its use in clinical reconstruction: An anatomical, embryological, and radiological study. Clin Anat 2008; 21:696-704. [PMID: 18773484 DOI: 10.1002/ca.20685] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- V Macchi
- Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Padova, Italy
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24
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Bassetto F, Bassiri Gharb B, Rampazzo A, Busetto L, Pigozzo S, Nolli M. Reply to: Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women. Br J Plast Surg 2005; 58:747-9. [PMID: 15925345 DOI: 10.1016/j.bjps.2005.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Accepted: 02/09/2005] [Indexed: 05/02/2023]
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25
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Lombardi AM, Fabris R, Bassetto F, Serra R, Leturque A, Federspil G, Girard J, Vettor R. Hyperlactatemia reduces muscle glucose uptake and GLUT-4 mRNA while increasing (E1alpha)PDH gene expression in rat. Am J Physiol 1999; 276:E922-9. [PMID: 10329987 DOI: 10.1152/ajpendo.1999.276.5.e922] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An increased basal plasma lactate concentration is present in many physiological and pathological conditions, including obesity and diabetes. We previously demonstrated that acute lactate infusion in rats produced a decrease in overall glucose uptake. The present study was carried out to further investigate the effect of lactate on glucose transport and utilization in skeletal muscle. In chronically catheterized rats, a 24-h sodium lactate or bicarbonate infusion was performed. To study glucose uptake in muscle, a bolus of 2-deoxy-[3H]glucose was injected in basal condition and during euglycemic-hyperinsulinemic clamp. Our results show that hyperlactatemia decreased glucose uptake in muscles (i.e., red quadriceps; P < 0.05). Moreover in red muscles, both GLUT-4 mRNA (-30% in red quadriceps and -60% in soleus; P < 0.025) and protein (-40% in red quadriceps; P < 0.05) were decreased, whereas the (E1alpha)pyruvate dehydrogenase (PDH) mRNA was increased (+40% in red quadriceps; P < 0.001) in lactate-infused animals. PDH protein was also increased (4-fold in red gastrocnemius and 2-fold in red quadriceps). These results indicate that chronic hyperlactatemia reduces glucose uptake by affecting the expression of genes involved in glucose metabolism in muscle, suggesting a role for lactate in the development of insulin resistance.
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Affiliation(s)
- A M Lombardi
- Endocrine Metabolic Laboratory, Department of Medical and Surgical Sciences, University of Padova, 35100 Padova, Italy
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