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Background. In December 2019, a Coronavirus 2019 epidemic (COVID-19) was reported, caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which occurred in the city of Wuhan, Hubei province, China. Perceived risk of contracting diseases has led many Governments and Healthcare Organizations to implement a variety of control and protection measures for the population, in particular for health professionals who have made contact with positive Covid-19 patients. In this publication, we have carried out a review of the information available, in order to share the prevention and protection measures for health and safety at work, which a University Hospital of Pavia, in Northern Italy, has remodulated, according to the changed scenario in which professionals finds themselves carrying out their profession in the post lockdown, in account to the specificity of processes and methods of work organizing, which overall, they serve to characterize risks, in order to be able to prevent them in the best possible way for patients, visitors and healthcare professionals.Introduzione. Nel dicembre 2019, è stata segnalata un’epidemia di Coronavirus 2019 (COVID-19), causata da una grave sindrome respiratoria acuta coronavirus 2 (SARS-CoV-2), avvenuta nella città di Wuhan, nella provincia di Hubei, in Cina. La percezione del rischio di contrarre malattie, ha portato molti Governi e Organizzazioni Sanitarie ad attuare una varietà di misure di controllo e protezione per la popolazione, in particolare per gli operatori sanitari, che hanno avuto contatti con pazienti Covid-19 positivi. In questa pubblicazione, abbiamo effettuato una revisione delle informazioni disponibili, al fine di condividere le misure di prevenzione e protezione per la salute e la sicurezza sul lavoro, che un Ospedale Universitario di Pavia, nel nord Italia ha rimodulato, secondo il mutato scenario in cui gli operatori sanitari si ritrovano a svolgere la loro attività nel post lockdown, in considerazione della specificità dei processi e dei metodi di organizzazione del lavoro, che nel complesso servono a caratterizzare i rischi, al fine di poterli prevenire nel miglior modo possibile per pazienti, visitatori e operatori sanitari.

Although fingertip injuries account for a high proportion of trauma patients, the correct surgical approach is still debated. The authors compared the traditional conservative approach and a new treatment based on the injection of liposuction aspirate fluid.Forty consecutive patients with a fingertip injury were dichotomized into group A (control group; conservative approach) and group B (treatment group). Group B underwent liposuction, followed by filtration of the lipoaspirate in a closed device (MyStem EVO kit), allowing the nonenzymatic separation of liposuction aspirate fluid, which was then injected at the site of injury. Objective outcomes were time for healing, strength, mobility of joint, and touch and sensory function. Subjective outcomes were cold intolerance, pain, hand disability, and aesthetic result. An aliquot of liposuction aspirate fluid was sent to the laboratory for cellular isolation and analysis by flow cytometry and in vitro differentiation assays.The average healing time was 22.3 days in group B and 24.9 days in group A (p0.05). Eighty-five percent of group B patients and 67 percent of group A patients scored normal to diminished superficial sensibility (p0.05). Group A had higher pain and cold intolerance scores (p0.05). Group B scored greater aesthetic and disabilities outcome results (p0.05). The cell isolation yield was 8.3 × 10(5)/ml, with a percentage of viable cells of 74.3 percent. Flow cytometry identified a mesenchymal immunophenotype, and in vitro osteogenic and adipogenic induction confirmed the bilinear potential of the isolated cells.This clinical study demonstrates for the first time the regenerative potential of liposuction aspirate fluid adipose-derived stem cells in a clinical application.Therapeutic, II.

The purpose of the study was to evaluate the long-term effectiveness and safety profile of Baerveldt glaucoma implant (BGI) in patients with refractory glaucoma operated using a modified technique to avoid postoperative complications.A total of 160 eyes from 147 glaucomatous patients were enrolled in a consecutive interventional noncomparative case series. All the patients were treated with a 350-mm BGI using a modified technique. Intraocular pressure (IOP), the number of medications, the complications, and the postoperative interventions were reported preoperatively and during the follow-up. Postoperative IOP and the rate of complications were the primary outcome measures. The complete and qualified surgical success was the second endpoint.BGI obtained a mean IOP reduction from 31.8±6.4 mm Hg (baseline) to 14.4±3.5 mm Hg after a mean follow-up period of 38.4±9.6 months. The mean number of medications reduced between preoperative (n=3.17±1.03) and postoperative period (n=0.58±0.83) (P0.0001). Cumulative probability of maintaining an IOP between 5 and 21 mm Hg and/or a 25% or greater reduction in IOP was 78.7% at 1 year and 72.1% at 4 years, including 39 eyes (24.4%) in which postoperative interventions were required (qualified success). If we exclude those eyes from the analysis, the probability of complete success was 93.4% at 1 year and 91.4% at 4 years in 75.4% of the eyes.This modified technique achieved a high percentage of surgical success during the whole follow-up time and was effective in preventing the most serious immediate complications of nonvalved tube shunts.

The current study compares two hyaluronic acid fillers, Ial System Duo and Belotero Basic/Balance, for the treatment of wrinkles. This is a single-center, double-blind randomized controlled study. Inclusion criteria consisted of subjects with bilateral nasolabial wrinkles. Each subject was treated with both products: One was applied on the right side and the other on the left side of the face. The quantity of product injected and any problems or local reactions (erythema, edema, pain or itching) were recorded and reassessed at 3 and 6 months and then monthly until complete absorption of the product. The Wrinkle Severity Rating Scale (WSRS) and the Global Aesthetic Improvement Scale (GAIS) were used for the assessment, as well as an ultrasound measurement of the skin thickness. Complete data were available for 59 subjects. At 3 and 6 months, both products showed improvement in the WSRS and GAIS score in the areas treated compared to pre-treatment assessments, although no significant differences were observed between them. No resulting significant differences were observed on skin thickness among the two products, which were completely reabsorbed in 285 ± 34 days (Ial System Duo) and 277 ± 34 days (Belotero Basic/Balance; Student’s t test: p = 0.2181). No significant differences were observed with regard to the subject’s satisfaction and adverse events. The Ial System Duo achieves long-term permanence (more than 9 months confirmed by ultrasound) in correction of moderate and severe wrinkles, similar to Belotero Basic/Balance. Both products showed a high safety profile and a high degree of subject and physician satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The use of bisected hair follicles in hair transplantation has been previously reported, but the capacity of each half to regenerate the entire hair has not been clarified.To evaluate duplicative surgery rate of success and to analyze the cell populations involved in hair regeneration.We screened 28 patients undergoing duplicative surgery. Approximately 100 hair follicles from each patient were horizontally bisected and implanted. Upper and lower portions were stained for the known epithelial stem cell markers CD200, p63, beta1-integrin, CD34, and K19.Similar percentages of hair regrowth after 12 months were observed when implanting the upper (72.7 +/- 0.4%) and lower (69.2 +/- 1.1%) portions. Expression of CD200, p63, and beta1-integrin was detected in both portions, whereas K19 and CD34 stained different cell populations in the upper and lower fragment, respectively.Duplicative surgery might represent a successful alternative for hair transplantation, because both portions are capable of regenerating a healthy hair. Moreover, our results suggest the possible presence of stem cells in both halves of the follicle.

Baldness can occur as a consequence of several causes. Temporary or permanent, cicatricial or not, a sign of a metabolic dysfunction or other disorders, alopecia requires, more than any other disease, a correct etiopathogenic understanding, both of its psychological impact and to avoid worsening due to an inadequate treatment.

Aniridia is a bilateral iris aplasia/hypoplasia, associated with other ocular anomalies arising during the childhood: nystagmus, photophobia, amblyopia, keratopathies, cataract and lens luxation, glaucoma, fovea and optic nerve hypoplasia. In 6–75 % of cases aniridia is accompanied by a dysgenetic secondary glaucoma caused by an iridogoniodysgenesis for abnormal migration of neural crest neuroectodermal cells, and a higher vulnerability of the optic nerve head for possible microstructural alterations in lamina cribrosa. Congenital glaucoma associated with aniridia is uncommon. The poor young patient collaboration for several clinical and instrumental analyses entails in many cases the need of examinations under general anesthesia. Medical therapy represents the first step, whereas low-responsive patients may undergo laser treatments (transscleral diode laser cyclophotocoagulation or cyclocryotherapy) and/or surgery (trabeculectomy with or without antimetabolites). Refractory cases, frequently with an early onset, require glaucoma drainage devices (Molteno implant, Ahmed valve, or Baerveldt tube shunt). A prophylactic goniotomy can be performed with a long-term effectiveness in reducing risks of aniridic glaucoma onset or progression.

The eyebrows have a combined linguistic and affective function and play a key role in facial expressions. Eyebrows loss (madarosis) has various etiologies [1, 2] and may cause disfigurement and discomfort. Eyebrow transplantation is the best aesthetically acceptable procedure that is performed to improve the patient’s appearance and self-esteem. Reconstruction techniques using micrografts of various sizes usually yield good results. Transplantation methods vary from physician to physician; some use a 18-21-G needle with stick-and-place, some use implanters, and others use premade incisions with a tiny microblade, such as a 15 Sharpoint, and place the grafts afterward. The success of reconstruction depends on the surgeon’s knowledge of eyebrow anatomy and his or her ability to reproduce the angle and direction of single-hair grafts to achieve natural results [3]. Here we report our successful, easy approach, with more than 90 cases of eyebrow reconstruction by follicular unit transplant (FUT). Eyebrow design is critical [4] and has three key points: symmetry, direction, and angle. We obtained perfect symmetry by drawing the eyebrow on transparent paper, which is then used as a template for the design of a perfectly symmetrical contralateral eyebrow (Fig. 1). The donor hair is the scalp, in the occipital area, where a strip with an appropriate number of bulbs is harvested. Strip harvesting is about 45 to preserve the adjacent bulbs. Extensive dissection of at least a 1-2-cm margin to suture the donor area without tension ensures a good scar. Micrografts are prepared by means of magnification, and each hair graft is transplanted microsurgically into an incision prepared for it by using of a needle bayonet of 18/19 G (Fig. 2a). This needle is extremely handy; it simplifies and speeds up the creation of the microincision. It overcomes the main difficulty of the eyebrow transplant, reproducing the very acute angle between the hair-stem and the skin. Indeed, this needle is inserted with ease at an acute angle, virtually flat to the skin (Fig. 2b), reproducing the correct original anatomy and shortening the operative time. On average, 100-300 follicular unit grafts are transplanted microsurgically (Fig. 3). Patients who have this eyebrow transplantation for both reconstructive and aesthetic reasons (Fig. 3) are generally very satisfied. The presented technique simplifies the precise, oriented placement of single-hair grafts and has been time-tested by the senior author for the last 20 years. The bayonet needle is a novel and simple approach to FUT, with satisfactory results and a very low complication rate. It is safe, effective, minimally invasive, and very handy in allowing rapid movement. Furthermore, it has no additional costs because it is packed on the operating table by a 18/19-G needle. The results of our technique are natural, beautifully shaped, and contoured. The one problem is that the hair will continue to grow, which necessitates trimming the hair monthly. After a few years, hair transplants adapt to the recipient site by a mechanism that we call ‘‘field effect,’’ as in pubic restoration [5] and other ectopic transplants. However, this is a minor problem for most patients because the defect is caused by a disfigurement due to oncological surgery (Fig. 4), radiotherapy (Fig. 5), burns or severe Electronic supplementary material The online version of this article (doi:10.1007/s00266-011-9712-1) contains supplementary material, which is available to authorized users.

Hemangiomas are proliferative lesions characterized by increased endothelial cell turnover. Lip hemangiomas can distort lip anatomy and are at increased risk of ulceration and/or bleeding, which lead to impaired function and disfigurement. Surgery can provide active treatment but it can be problematic because vermilion tissue is unique and not found elsewhere on the body. Since there is no similar tissue that can easily be used for reconstructing missing vermilion, its preservation is essential for a satisfactory cosmetic result. We present the case of a 74 year old woman suffering from a large hemangioma of the mid-face and particulary with an angiomatous ulcerated lesion at the level of the lower lip. We describe clinical management and surgical treatment of this pathology.

One limiting factor of hair transplantation is the amount of hair available in the patient donor scalp. Several techniques have been proposed as steel punches, multiblade knives, FUE (follicular unit extract) and single-strip harvesting. The authors introduce a modified surgical scalpel with a No. 10 blade to minimize side effects. This scalpel is folded at 120-degree angle and allows the incision to be parallel to the hair follicles and help the surgeon to avoid resection of the hair during dissection. The authors propose this modified scalpel as a new ideal instrument for removing the donor area in hair transplantation.

Sebaceous carcinoma (SC) is a rare malignant tumor derived from the adnexal epithelium of sebaceous glands. It has been traditionally classiWed into two variants on the basis of its location, extraocular and ocular sebaceous carcinoma. Extraocular sebaceous carcinoma is rare (25% of reported cases [1, 2]) and occurs most commonly on the face and scalp, but they have been reported to occur almost anywhere on the body. It can exhibit such a diVerent variety of histologic patterns and clinical presentations, and the diagnosis is often delayed for months to years. These carcinomas are commonly associated with Muirr Torre Syndrome (MTS). The MTS consists of a rare autosomal dominant condition characterized by the association of cutaneous sebaceous neoplasms (sebaceous adenoma, sebaceous epithelioma, or sebaceous carcinoma, basal cell carcinoma with sebaceous diVerentiation, with or without keratoacanthomas) and the presence of at least one internal malignancy [3–8]. The biologic behavior of SC depends on the site, but particularly debated whether there is a diVerent aggressiveness of origin. Most of the literature reports that ocular tumors are highly malignant neoplasms with frequent locoregional and/or distant metastasis and intracanial extension [9–13]; extraocular sebaceous carcinoma on the other hand are considered as slow growing tumors of low malignant potential [9, 10, 14, 15]. In fact 15–30% of the patients aVected by ocular SC developed metastasis to the lymphnodes; widespread metastatic disease secondary to extraocular SC is very uncommon. Classically it has been considered that when metastases occur, only regional lymphnodes were involved [16, 17]. Many authors consider the presence of histologic and immunohistochemistry indices prognostically unfavorable (small diVerentiation, presence of vascular or lymphocytic invasion and presence of a pattern of pagetoid cells) [9, 18–20]. The discussion on the biologic aggressiveness of the neoplasia is still open. To support the opinion that the behavior of extraocular SC is not signiWcantly diVerent from those arising in the ocular region, this report describes a highly aggressive scalp SC in an MTS case.

Summary The report describes the case of an adult patient presenting a severe, serologically proven, Toxocara endophthalmitis, unresponsive to the common surgical and medical approach (vitrectomy, anti-parasitic treatment followed by high-dose corticosteroids). The association of oral cyclosporin A to a lower dose of prednisone was successful in achieving a long-term control of the ocular inflammation without systemic side effects.

Neuromelanin (NM) accumulates as a function of age in normal human substantia nigra (SN) but is relatively depleted in the SN of patients with Parkinson disease (PD). Several studies have been performed to further our understanding of the role of NM in neuronal aging and neurodegenerative mechanisms of PD. To this purpose, NM from human SN was isolated and its structure and molecular interactions were investigated. Cysteinyl-dopamine was shown to be one precursor of NM synthesis. A striking affinity of NM for specific metals, lipids, drugs and pesticides was found in vitro, and in animal and human brain postmortem studies. Because of these affinities, NM seems to play a protective role in the human brain by blocking toxic molecules. On the other hand, experiments in cell culture indicate that NM can activate microglia, eliciting the release of cytotoxic factors that can induce neurodegeneration.

In this study, a comparative analysis of metal-related neuronal vulnerability was performed in two brainstem nuclei, the locus coeruleus (LC) and substantia nigra (SN), known targets of the etiological noxae in Parkinson's disease and related disorders. LC and SN pars compacta neurons both degenerate in Parkinson's disease and other Parkinsonisms; however, LC neurons are comparatively less affected and with a variable degree of involvement. In this study, iron, copper, and their major molecular forms like ferritins, ceruloplasmin, neuromelanin (NM), manganese-superoxide dismutase (SOD), and copper/zinc-SOD were measured in LC and SN of normal subjects at different ages. Iron content in LC was much lower than that in SN, and the ratio heavy-chain ferritin/iron in LC was higher than in the SN. The NM concentration was similar in LC and SN, but the iron content in NM of LC was much lower than SN. In both regions, heavy- and light-chain ferritins were present only in glia and were not detectable in neurons. These data suggest that in LC neurons, the iron mobilization and toxicity is lower than that in SN and is efficiently buffered by NM. The bigger damage occurring in SN could be related to the higher content of iron. Ferritins accomplish the same function of buffering iron in glial cells. Ceruloplasmin levels were similar in LC and SN, but copper was higher in LC. However, the copper content in NM of LC was higher than that of SN, indicating a higher copper mobilization in LC neurons. Manganese-SOD and copper/zinc-SOD had similar age trend in LC and SN. These results may explain at least one of the reasons underlying lower vulnerability of LC compared to SN in Parkinsonian syndromes.

Childhood glaucoma" is a heterogeneous group of severe pediatric conditions often associated with significant visual loss and characterized by elevated intraocular pressure (IOP) and optic-disk cupping. Successful IOP control is crucial but challenging and most often achieved surgically, with medical therapy playing a supportive role. There are many classifications of childhood glaucoma, but they can simply be divided into primary, in which a developmental abnormality of the anterior chamber angle only exists, and secondary, in which aqueous outflow is reduced due to independent mechanisms that secondarily impair the function of the filtration angle. The worldwide prevalence of childhood blindness ranges from 0.03% in high-income countries to 0.12% in undeveloped countries. The majority of cases do not have an identified genetic mutation and, where the mutation is known, the genes often account for only a small proportion of cases. Several pathogenetic mechanisms are known to contribute to the development of childhood glaucoma. Whatever the cause, it results in a reduced aqueous outflow at the level of the trabecular meshwork. Age of onset and magnitude of the elevated IOP largely determine the clinical manifestation the high variability of clinical manifestations. Glaucoma from any cause in a neonate and infant is characterized by the classic triad of epiphora, photophobia, and blephar- ospasm, and could be associated with eye enlargement (buphthalmos) and Haab striae. The eye examination, usually performed under general anesthesia, includes: tonometry, anterior-segment examination, gonioscopy, corneal diameter and axial length measurement, dilated fundoscopy with optic-nerve-head evaluation. Medical therapy, considering the high frequency of side effects, is generally used as temporizing IOP-lowering treatment before surgery or as adjuvant treatment postoperatively in case of partially successful procedures for refractory glaucomas. Surgery is the nodal point of the management of refractory childhood glaucoma, so it is crucial to opt for a