NIPPLE-AREOLA COMPLEX RECONSTRUCTIVE TECHNIQUES APPLIED TO BREAST RECONSTRUCTION:A SYSTEMATIC REVIEWWritten by Susanna Polotto
Nipple-areola complex (NAC) reconstruction is an essential component of each breast re-construction technique as it plays a major role in achieving optimal aesthetic results. Its goal is to obtain an appropriately located, sized, shaped, colored and textured NAC when compared to the controlateral one or to ideal landmarks. Several surgical techniques have been developed to obviate the neo-nipple's loss of projection and contracture, mostly due to an inadequate NAC vascularization. Local flaps are the best choice when provided with a well-vascularized and sufficiently thick soft tissue, while grafts are better when there is a lack of local tissue and a donor zone is required to provide an adequate volume to the NAC. An autologous cartilage graft can also be used in similar situations to provide a long-lasting projected nipple. Tattooing is often used both to improve a newly created NAC and as an alternate two-dimensional reconstructive technique.
Cardiovascular Disease is the number one cause of death in the World. Although ad-vances in treatment and intervention have reduced the mortality rate in patients with coronary artery disease, the number of patients with refractory myocardial ischemia and congestive heart failure is rapidly increasing. "Cellular therapy" represents an important new approach in the treatment of cardiovascular disease and the scientific community needs to establish not only the appropriate type and timing of cellular administration but also the diagnostic gold standard to better enable the study of subjects before and after cellular therapy.
We present the case of a 58 year old woman, who achieved complete response taneous melanoma metastasis after treatment with ipilimumab at 3 mg/Kg. The was given dacarbazine as a first line treatment for her cutaneous metastasis and response was achieved. However, after 26 cycles of chemotherapy, the cutaneous progressed, so ipilimumab was chosen as a second line treatment. The patient ble for the compassionate use of ipilimumab.Two weeks after the fourth ipilimumab, a complete response of most cutaneous metastasis was noted, with response of the remaining lesions, which were still regressing at the last follow-Ipilimumab, which was recently reported to improve survival in patients with melanoma, represents a most promising immunotherapeutic drug and it has proved for patients with advanced melanoma as a first- and second-line treatment FDA and as a second-line treatment by the European Medicines Agency (EMA).
The incidence of melanoma is increasing worldwide. Prognosis for metastatic melanoma is poor; early detection of recurrent or metastatic disease may improve therapy strategies and survival. Several possible biomarkers for melanoma have been investigated. S-100B was found to be a sensitive and specific serological tumor marker; furthermore, its con-centrations are correlated with the clinical stage of disease. Serum S-100B is also an inde-pendent prognostic factor for survival and can be used to monitor response to treatment. We present the case of a 55 year old woman, whose diagnosis of melanoma distant me-tastases was suggested by a progressive increase in serum S-100B levels, while other blood tests, physical exam and imaging techniques, including PET/TC and CT-scan, were negative. S-100B is currently the most accurate biomarker in melanoma patients; its role in the management of melanoma patients has been the object of study and it has been documented as a valuable independent prognostic factor. The case we present shows that S-100B levels may also be useful in the early detection of melanoma recurrences, even when imaging techniques are negative.
We describe the case of a 42 year old woman who presented malignant melanoma on an 8-cm acquired speckled lentiginous nevus on the inferior part of her leg. Although melanoma arising in speckled lentiginous nevus is a rare occurrence, dermatologists and plastic surgeons need to be aware that it may occur.