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Background: Diastasis recti abdominis (DRA) indicates an abnormal separation of the rectus abdominal muscles from the midline, resulting in abdominal bulging. Recent literature shows a correlation between DRA and back pain, stress urinary incontinence. Primary goal of this study is to check the correlation between DRA correction in abdominoplasty and improvement of urinary symptoms., Materials and Methods: This is a prospective study on patients with post-pregnancy rectus diastasis who underwent surgical correction of diastasis through conventional abdominoplasty. All patients were asked to complete the ICIQ-FLUTS questionnaire, which assesses urinary disorders, and the SF-36 questionnaire, aimed at quantifying health-related quality of life. The questionnaires were administered to patients the day before surgery and one year after surgery., Results: The recruited patients (n = 51) were then stratified on the presence or absence of stress urinary incontinence. Of the 39 patients with preoperative incontinence, the average scores of the ICIQ-FLUTS were analyzed. In particular, for the questions relating to stress urinary incontinence a statistically significant difference was reported between the preoperative mean and the 1-year mean for all questions (p value<0.05). As regards quality of life, comparing the average scores of each question of SF-36 there is an improvement in the values of all the variables of the questionnaire., Conclusion: The strength of this study, which distinguishes it from other literature, is that the changes in abdominal pressure post-abdominoplasty which should lead to a worsening of stress incontinence, do not cause it. On the contrary, we have demonstrated the improvement of this symptom after conventional abdominoplasty surgery in most patients., Level of Evidence Iv: 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., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Mommy-makeover is becoming very popular to help them reshaping their own bodies and restoring self-perception, hardly stressed by childbearing-related changes. However, debate exists in the literature concerning safety and aesthetic outcome in patients undergoing combined procedures. The study aims to shed a light on advantages and disadvantages in mommy-makeover technique compared to conventional abdominoplasty with a particular attention to psychological aspects., Materials and Methods: In total, 37 women were enrolled at Campus Bio-Medico Hospital in Rome between October 2019 and January 2022. All of the patients were eligible for both abdominoplasty only and mommy-makeover. We proposed to the patients both procedures explaining risks and benefits; then, based on the preference of the single patient, we performed either mommy-makeover (Group A) or abdominoplasty alone (Group B). In order to evaluate patients' satisfaction and safety, multiple questionnaires were administered 9-month postoperatively (BUT, POSAS, visual perception, etc.)., Results: The sample analyzed was composed of 37 patients (treatment group = 18, control group = 19). In the pre-post comparisons of BUT-A performed, there were statistically significant differences recorded in both groups and for all observed variables. The significance values were all less than 1% (p < 0.01)., Conclusions: Combined surgery proved not to be inferior in terms of patient safety. At the same time, the effectiveness in improving diastasis-related symptoms is fully comparable with single surgery. Treatment group showcases a considerable superiority in terms of body-image perception improvement and overall patient satisfaction., Level of Evidence Iv: 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 ., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background and Purpose: Autosomal recessive cobblestone-like cortical malformation of the brain, with no eye or muscle involvement, has been reported in patients with biallelic mutations in ADGRG1 (formerly GPR56) and in other brain surface defects (eg, variants in COL3A1). We reported the intra-uterine brain MRI (iu-MRI), post-mortem MRI (pm-MRI), and neuropathology findings of a new ADGRG1 mutation in a fetus at early gestation. Imaging findings were compared with those of the sibling harboring the same mutation, to provide insights about the evolving morphology of such malformation., Methods: A 21-week fetus underwent iu-MRI for a suspected cortical anomaly on ultrasound. After the MRI results, the termination of the pregnancy was carried out. A pm-MRI scan and autopsy were performed. A neuropathology-imaging correlation was achieved. The 5-year old sibling affected by developmental impairment also underwent a brain MRI. Both subjects underwent a genetic investigation., Results: Two patterns of abnormality of the cerebral surface were identified on both fetal MRI: one at the vertex resembling a cobblestone-cortex due to neuronal overmigration into the subarchnoid space and the other in the occipital areas resembling polymicrogyria. These details closely matched the neuropathology findings. MRI findings of the sibling consisted of typical ADGRG1/GPR56-related brain findings showing a polymicrogyric-like cortex, also reported as bilateral frontal-parietal polymicrogyria. A flattened pons and small cerebellar vermis were present in both cases. Genetic testing demonstrated a novel homozygous variant c.1484T>C in the c gene in both cases., Conclusion: Our findings provide further evidence of the overlap of ADGRG1/GPR56-related brain dysgenesis with cobblestone-like cortical malformation of the brain., (© 2023 American Society of Neuroimaging.)

Purpose: To describe the correlation between fetal imaging (in vivo and ex vivo) and neuropathology in two fetuses at early gestational age (GA) with isolated thick corpus callosum (CC), a rare finding whose pathological significance and neuropathology data are scarce., Methods: Two fetuses at 21-week GA underwent fetal MRI (fMRI) for suspected callosal anomalies at ultrasound (US). After fMRI results, termination of pregnancy (TOP) was carried out and post-mortem MRI (pmMRI) was performed. Neuropathology correlation consisted in macro and microscopic evaluation with sections prepared for hematoxylin-eosin and immunohistochemistry staining., Results: Fetal imaging confirmed in both cases the presence of a shorter and thicker CC with respect to the reference standard at the same GA, without a clear distinction between its different parts. Moreover, on pmMRI, an abnormal slightly T2-weighted hyperintense layer along the superior and inferior surface of CC was noted in both cases. At histopathology, these findings corresponded to an increased amount of white matter tracts but also to an abnormal representation of embryological structures that contribute to CC development, naming induseum griseum (IG) and the glioepithelial layer (GL) of the "callosal sling." After reviewing the literature data, we confirmed the recent embryological theory regarding the CC development and provide new insights into the pathophysiology of the abnormal cases., Conclusions: An abnormally thick CC at the early fetal period could be associated to an abnormal representation of the midline glia structures, so to result in potential disturbance of the axon guidance mechanism of callosal formation and eventually in CC dysgenesis., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Context.—: SARS-CoV-2 can undergo maternal-fetal transmission, heightening interest in the placental pathology findings from this infection. Transplacental SARS-CoV-2 transmission is typically accompanied by chronic histiocytic intervillositis together with necrosis and positivity of syncytiotrophoblast for SARS-CoV-2. Hofbauer cells are placental macrophages that have been involved in viral diseases, including HIV and Zika virus, but their involvement in SARS-CoV-2 is unknown., Objective.—: To determine whether SARS-CoV-2 can extend beyond the syncytiotrophoblast to enter Hofbauer cells, endothelium, and other villous stromal cells in infected placentas of liveborn and stillborn infants., Design.—: Case-based retrospective analysis by 29 perinatal and molecular pathology specialists of placental findings from a preselected cohort of 22 SARS-CoV-2-infected placentas delivered to pregnant women testing positive for SARS-CoV-2 from 7 countries. Molecular pathology methods were used to investigate viral involvement of Hofbauer cells, villous capillary endothelium, syncytiotrophoblast, and other fetal-derived cells., Results.—: Chronic histiocytic intervillositis and trophoblast necrosis were present in all 22 placentas (100%). SARS-CoV-2 was identified in Hofbauer cells from 4 of 22 placentas (18.2%). Villous capillary endothelial staining was positive in 2 of 22 cases (9.1%), both of which also had viral positivity in Hofbauer cells. Syncytiotrophoblast staining occurred in 21 of 22 placentas (95.5%). Hofbauer cell hyperplasia was present in 3 of 22 placentas (13.6%). In the 7 cases having documented transplacental infection of the fetus, 2 (28.6%) occurred in placentas with Hofbauer cell staining positive for SARS-CoV-2., Conclusions.—: SARS-CoV-2 can extend beyond the trophoblast into the villous stroma, involving Hofbauer cells and capillary endothelial cells, in a small number of infected placentas. Most cases of SARS-CoV-2 transplacental fetal infection occur without Hofbauer cell involvement.

Data on fetal MRI in L1 syndrome are scarce with relevant implications for parental counseling and surgical planning. We identified two fetal MR imaging patterns in 10 fetuses harboring L1CAM mutations: the first, observed in 9 fetuses was characterized by callosal anomalies, diencephalosynapsis, and a distinct brainstem malformation with diencephalic-mesencephalic junction dysplasia and brainstem kinking. Cerebellar vermis hypoplasia, aqueductal stenosis, obstructive hydrocephalus, and pontine hypoplasia were variably associated. The second pattern observed in one fetus was characterized by callosal dysgenesis, reduced white matter, and pontine hypoplasia. The identification of these features should alert clinicians to offer a prenatal L1CAM testing., (© 2021 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)

Background: Mastectomy represents a deep burden for women with breast cancer. Very little is known about the psychological consequences over time and the quality of life (QoL) of women so treated, with or without breast reconstruction (BR)., Patients and Methods: A total of 709 patients underwent mastectomy with or without BR between 2002 and 2012 at one institution. Among 468 surviving patients, a 60-query QoL questionnaire on personal issues including some European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire items was presented either by email, letter, or telephone interview., Results: Of those questioned, 328 patients participated, whereas 140 (30%) declined the invitation or were unavailable. The median age was 63 years (range, 30-93 years). Stage I or II of disease was recorded in 73% of patients. Immediate BR was performed in 168 (51%) of 328 patients. Of the remaining patients, only 7 (4%) of 160 proceeded to delayed BR. Younger women had significantly worse Emotional Functioning and Social Functioning (SF) scores (P < .001), independently of tumor stage, and immediate BR improved that (P = .02). SF score was also worsened by chemotherapy (P = .03). Cognitive Functioning score was independent of age, BR, stage, or adjuvant therapies. Body Image and Sexual Functioning scores improved with BR (P < .03), and age was a strong co-variable (P < .001). On multivariate analysis, immediate BR was correlated with age and preoperative plastic surgery consultation. Some 68 (21%) of 328 patients regretted their decision or were disappointed with their choice regarding BR., Conclusions: Younger patients with breast cancer report a worse impact on their Emotional Functioning and SF scores after mastectomy, both of which are improved by BR. Reconstructing the breast at the time of mastectomy has a significant impact on Body Image and Sexual Functioning scores. A preoperative plastic surgeon consultation improves the rate of immediate BR, whereas delayed reconstruction is rarely adopted. Some 20% of patients are disappointed in or regret their decision regarding BR. We need to improve our management in consideration of these findings., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The term PROS (PIK3CA-Related Overgrowth Spectrum) indicates a wide spectrum of overgrowth disorders related to somatic mutations in PIK3CA (phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha) pathway. We present three cases with PIK3CA mutation and clinical characteristics encompassing MCAP (megalencephaly-capillary malformation) condition but lacking all criteria to a certain diagnosis, most of all showing prevalent and peculiar involvement of cerebellar structures at MRI (magnetic resonance imaging) mainly consisting in cortical rim thickening and abnormal orientation of folia axis. These cases expand the spectrum of intracranial MRI features in PIK3CA disorders.

Merkel cell carcinoma is a rare cutaneous carcinoma, featured by an aggressive clinical course and a mortality rate of 28% at 2 years. A 71-year-old female was affected by a 4.1-cm-wide locally advanced Merkel cell carcinoma of the upper eyelid, previously misdiagnosed as chalazion, with involvement of the extraocular muscles. Although the tumor showed a macroscopic spontaneous regression in size after the incisional biopsy, the mass was treated with neoadjuvant chemotherapy and surgical excision. Good functional and aesthetic result with preservation of the eyeball and absence of tumor recurrence were achieved at 3-year follow-up. In our experience, the combination of the inflammatory cascade due to the incisional biopsy and neoadjuvant chemotherapy led to the regression of a locally advanced large Merkel cell carcinoma of the eyelid.

Background: Septal deviations represent a major cause of aesthetic disorders and respiratory obstruction. The traditional septoplasty techniques may often be inadequate to treat severe deviations. Recently, we described a modified extracorporeal septoplasty approach based on partial resection of the cartilaginous septum, with preservation of a superocaudal L-strut measuring approximately 0.5 cm in height. At 6-month follow-up, we demonstrated this technique to be functionally and aesthetically effective in addressing mild to severe septal deviation. The aim of the present study was to evaluate the long-term outcomes of this technique in the patients included in the initial prospective study, followed up during a period of 4 to 6 years., Methods: One hundred fifty-three patients underwent modified extracorporeal septoplasty from January 2006 to June 2009. One hundred twenty of these patients were included in the present study. Patients were grouped according to the preoperative septal deviation as follows: mild (one-third reduction of the nasal cavity), moderate (half reduction), and severe (two-thirds reduction). Follow-up ranged from 4 to 6 years. Respiratory flow improvement was assessed with active anterior rhinomanometry; subjective evaluation of the respiratory function was obtained by mean of Nasal Obstruction Symptom Evaluation (NOSE) scale. Active anterior rhinomanometry values and NOSE scores were compared with the results obtained preoperatively and at 6-month postintervention., Results: In the whole cohort, rhinomanometric analyses and NOSE scores at long-term follow-up demonstrated a statistically significant improvement in inspiratory flow and obstructive symptoms (P = 0.0122 and P < 0.0001, respectively) compared to preoperative values. In group analysis, a significant improvement in NOSE scores was found in patients with severe (P < 0.0001) and moderate (P < 0.0001) deviations. A significant improvement in inspiratory flow was reported in the severe (P < 0.0001) and moderate (P = 0.0212) deviation groups., Conclusions: The modified extracorporeal septoplasty technique proved to be functionally effective at long-term follow-up in cases of moderate or severe septal deviation: the improvements in respiratory function and obstructive symptoms found 6 months postoperatively were maintained at 4 to 6 years postintervention. With this technique, structural support is achieved without destabilizing the keystone area; moreover, conservative remodeling of the quadrangular cartilage allows the use of septal cartilage grafts in secondary or revision rhinoplasty.

Background: Nipple-sparing mastectomy (NSM) has been recently implemented to improve cosmetic outcome after mastectomy, but it is rarely considered today after neoadjuvant chemotherapy (NCH)., Patients and Methods: Among 275 NSMs performed from January 2007 to January 2015, 186 cases, with a minimum follow-up of 12 months, were carried out for invasive or intraductal carcinoma. Patients were considered for NSM if there were no clinical and radiological evidence of invasion or close proximity (<1 cm) to the nipple-areola complex (NAC). We compared patients operated with NSM after NCH (Group I N = 51) with those who underwent primary surgery (Group II, N = 135)., Results: At a median follow-up of 35 months, 166/186 patients were alive and disease-free (89.7%). Three local relapses (1.6%) were observed, all in the skin flap outside the NAC in Group I: (6%; p < 0.01). No NAC recurrences have been recorded, in either group. Nipple loss due to full thickness necrosis or resection for insufficient margins was recorded in 31 cases (17%); 12 in Group I (24%) and 19 in Group II (14%) (P = 0.1). This event decreased by half in the second part of the study (21/93 vs 10/93) (P = 0.03)., Conclusions: NSM after NCH is not associated with a statistically significant difference in terms of post-operative complications, total nipple loss for necrosis or margins, and results improve with experience. The loco-regional relapse rate was higher after NCH, yet it was consistent with traditional mastectomy in the high-risk setting. There is no need to avoid NSM after NCH for locally advanced cancers, if the retro-areolar margins of resection are clear at the time of surgery., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

A functional c-Kit/Kit ligand (KitL) signalling network is required for tumour angiogenesis and growth, and therefore the c-Kit/KitL system might well be a suitable target for the cancer immunotherapy approach. We herein describe a strategy that targets membrane-bound KitL (mbKitL) via DNA vaccination. The vaccination procedure generated antibodies which are able to detect mbKitL on human tumour endothelial cells (TECs) and on the breast cancer cell line: TSA. DNA vaccination, interferes with tumour vessel formation and transplanted tumour growth in vivo. Histological analysis demonstrates that, while tumour cell proliferation and vessel stabilisation are impaired, vessel permeability is increased in mice that produce mbKitL-targeting antibodies. We also demonstrate that vessel stabilisation and tumour growth require Akt activation in endothelial cells but not in pericytes. Moreover, we found that regulatory T cells (Treg) and tumour infiltrating inflammatory cells, involved in tumour growth and angiogenesis, were reduced in number in the tumour microenvironment of mice that generate anti-mbKitL antibodies. These data provide evidence that mbKitL targeted vaccination is an effective means of inhibiting tumour angiogenesis and growth., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Lactobacilli are able to induce upregulation of co-stimulatory molecules in DCs with Th1 cytokines production and increase in Treg activity. This could explain the observed effectiveness of the prolonged administration of lactobacilli in the prevention of allergic disorders in infants and envisage the possible use of bacteria expressing the allergen for the specific immunotherapy of allergic diseases. Hence, we evaluated Streptococcus thermophilus (ST) expressing rBet v 1 as allergen delivery tool and adjuvant factor for immunotherapy in Betv1-sensitized mice. rBet v 1 gene was introduced and expressed in ST (ST[rBet v 1]). BALB/c mice were sensitized with rBet v 1 and then treated with either ST alone, ST[rBet v 1], or the combination of ST and rBet v 1, for 20 days. After 2 aerosol challenges, Treg frequency, in vitro allergen-induced cytokines, rBet v 1-specific IgE and IgG2a, and bronchial histology were made in harvested spleen, sera, and lung. Results were compared with those obtained from not-treated/sensitized mice. ST[rBet v 1] induced immunological and histological changes typical of successful SIT: increased frequency of Tregs and expression of Foxp3; decreased allergen-specific IgE/IgG2a ratio; decrease of in vitro rBet v 1-induced IL-4 from spleen cells; increased allergen-induced IL-10 and IFN-γ; drop of bronchial eosinophilia. ST and ST+rBet v 1 combination, even though induced a slight increase in the frequency of Tregs and moderate allergen-induced IL-10, were ineffective in reducing bronchial eosinophilia, allergen induced IL-4 and rBet v 1-specific IgE/IgG2a ratio. ST[rBet v 1] has tolerogenic and Th-1 skewing properties and efficiently delivers the allergen to the gut immune-system restraining and readdressing the established specific Th2 response toward the allergen in mice.

Background: Severe nasoseptal deviations still represent challenging situations for plastic surgeons. Septal surgery plays a central role in the management of complex cosmetic and functional problems, and should be considered as a basic procedure in nasal surgery. The classic septoplasty approach seems to be unsuitable for severe septal deviations. Other authors have found the standard extracorporeal septoplasty approach more reliable for a correct functional and cosmetic surgery. However, a drawback of this technique is the destabilization of the keystone area. In an effort to minimize the risk of destabilization, we have modified the classic technique with a more conservative approach that spares the dorsal cartilage and a portion of the caudal septum., Methods: This study included 153 patients who underwent primary rhinoplasty from January 2006 to June 2009. The purpose was to evaluate the effectiveness of this technique in terms of objective (Active Anterior Rhinomanometry) and subjective (Nasal Obstruction Symptom Evaluation [NOSE] scale) improvements of the respiratory function and in terms of postoperative complications. There was a significant improvement in mean NOSE score at 3 and 6 months postoperatively. Rhinomanometrical assessment showed a significant increase of the nasal inspiratory flow at 3 and 6 months after surgery. No complications were reported., Conclusions: The results obtained with NOSE score and with rhinomanometrical assessment revealed that this technique increases patient's quality of life and nasal respiratory function, respectively. Furthermore, our approach avoids the most important complication of classic extracorporeal septoplasty, thus preserving a structured support of the nasal archway.

Embolia cutis medicamentosa, also known as Nicolau's syndrome, is a rare complication due to i.m. injections. Its real incidence is actually underestimated. Many drugs have been associated with it, but at the time only a few studies showed a related pathogenetic mechanism. Symptoms consist of immediate local pain, edema and cutaneous, subcutaneous and even muscular necrosis occurring in the first 48 h. The type of treatment depends mostly on time of diagnosis. A medical resolution can be achieved through heparin and cortisone injections within the first 48 h. Surgical debridement has to be considered as the main treatment in case of late diagnosis. We present three cases of Nicolau's syndrome presenting to us in a short period of time that we treated with surgical debridement.

Introduction: Granular cell tumour, also known as Abrikossoff's tumour, is a rare entity occurring in the skin as well as in internal organs, more common among the third to fifth decade of life. It has often been described as a peripheral neuroectodermal tumour and its clinical behaviour is usually benign although malignant and multifocal forms are also known to occur., Case Presentation: We report a case of multiple granular cell tumour in a 17-year-old Caucasian woman who presented with a nodular lesion in the popliteal cave, diagnosed as an Abrikossoff's Tumour, followed 2 years later by another soft tissue mass in the neck., Conclusion: This case is quite rare: only a few cases were presented in literature with an extended period of time before the clinical presentation of subsequent disease.

Eccrine spiradenoma is an uncommon but well recognized benign adnexal tumour of the eccrine sweat glands. It can appear at any age, but the highest rate of incidence is observed among young adults, without any sex predilection. The commonest clinical presentation is a solitary blue-red dermal or subcutaneous cystic nodule, ranging from 0.3 to 5 cm in diameter. Malignant transformation is a rare phenomenon, presenting as a rapidly enlarging nodule within a long-standing lesion. We report a case of eccrine spiradenoma in a thirty-six-year-old man who presented with a recurrent soft-tissue neoplasm of the forehead, with cytological atypia. The differential diagnosis of this tumour, as well as its possible malignant transformation, is discussed.

Aims: Burns occur rarely after breast reconstruction, and results from loss of sensory and thermoregulatory skin functions. We aimed to investigate the pathophysiological processes leading to these injuries., Method: Cases described in the literature are reviewed and discussed. Three cases of burn complicating the outcome of two implants and one autologous breast reconstruction are newly reported., Discussion: The ineffectiveness of skin thermoregulatory reflexes, caused by different surgical procedures, plays an essential role in the pathogenesis of burns to reconstructed breasts; tissue expansion and radiotherapy are also essential aetiological factors.