Topical Treatment with Bergamot Flavonoid-Based Gel in Post-Surgical Wounds after Hemorrhoidectomy: Preliminary Results

Background: Haemorrhoidal Disease (HD) is a very diffuse anorectal condition that involves a large part of the population, both male and female of every age. Among the several procedures proposed to treat HD, conventional excisional surgery remains one of the most performed, it is characterized by important post-operative pain whose historical knowledge often scare the patients. The pain is mainly related to the anal wounds and the healing speed surely influence the post-operative course. The aim of this study was to evaluate the effect of using Benebeo Gel® on post-operative wound healing after open haemorrhoidectomy. Methods and Results: This was an observational prospective study conducted in the Proctological and Pelvic Floor Clinical Centre (PPFCC) of the University Hospital of Pisa. From April 2019 to January 2020 all the 175 patients aged between 18 and 75 undergone to open hemorrhoidectomy were enrolled. The post-operative follow-up was scheduled as follows: 7 day, 15 day, 22 days and 30 days after surgery. The primary end point was: time taken to get complete wound healing with a re-epithelized tissue. Secondary endpoints were: evaluate post-operative pain using VAS scale, bleeding, discharge and overall patients satisfaction about the procedure and the topical gel. All the patients were instructed to take topical gel by using the cannula provided with the product put it into the finger phalanx and then upon injured area twice a day (once in the morning after defecation and once before sleeping) for 25 days after. The administration of the product begins in 4th post-operative day. The mean post-operative pain at 7 days was 6±2, at 15 days 4±1 at 22 day 3 and at 30 days was 2±1. The mean time to get complete wound healing was 23±4 days. Conclusions: He present study aimed to evaluate the efficacy of a new topical gel mainly composed by bergamot-derived flavonoids and hyaluronic acid in patients treated with excisional hemorrhoidectomy. The results after 2 weeks of treatment seems to be promising with a very good clinical outcome and patient satisfaction within 1 month.

Retroperitoneal Angiomyolipoma in A Woman of Childbearing Age: A Case Report

Introduction: Extrarenal angiomyolipoma is an uncommon disease entity and is rare in the retroperitoneum. This lesion shows three benign components, including mature adipose tissue, thick-walled blood vessels, and smooth muscles. Case Report: This report describes a 37-year-old woman who presented with incidental right retroperitoneal mass in prenatal checkup. The patient underwent excisional surgery. Histological examinations and the immunohistochemical study revealed angiomyolipoma. Based on the diagnosis, the patient received no more treatment. After 3 years of close followup examinations, no recurrence was observed. Conclusion: This diagnosis is often confused with many other entities in retroperitoneum. Thus, imaging and histologic correlation are required. Proper diagnosis is essential for further patient management and avoids unnecessary treatment.

CoCoss-Trial: Concurrent Comparison of Self-Sampling Devices for HPV-Detection

High-risk human papillomavirus (hr-HPV) infection of the cervicovaginal tract is known to be the major cause of cervical cancer. Similar to various other countries, Germany introduced an organized combined screening including cytology and HPV testing in 2020. The participation rate was around 70% in the past. Self-testing for hr-HPV infections could be an option to increase the participation rate. Two dry vaginal self-sampling devices and a device for the self-collection of first-void urine were evaluated in combination with a PCR-based hr-HPV test regarding their clinical performance (sensitivity for high-grade cervical intraepithelial neoplasia, CIN 2+). A cervical smear taken by a clinician during colposcopy was used as reference. This open prospective multicenter trial recruited patients referred to the two participating colposcopy clinics (Hannover Medical School and IZD Hannover, Germany) with abnormal results from cervical cancer screening from 05/2020 to 11/2020. All patients received three CE-certified self-sampling devices (FLOQSwabs, COPAN, Italy; Evalyn Brush, Rovers Medical Devices, the Netherlands; Colli-Pee FV-5000, Novosanis, Wijnegem, Belgium) with instructions to read and apply at home in a pre-specified alternating order without medical assistance. HPV testing was performed after adequate preservation and DNA extraction. Histological results from colposcopy or cervical excisional surgery after self-sampling were used as the gold-standard. The data of 65 patients were analyzed. All invasive cancer cases and over 90% of the CIN 3 lesions were found to be hr-HPV positive with all three self-collection devices. All devices were considered easy to use without any difficulties following the written instructions. Hr-HPV testing of self-collected first-void urine and dry vaginal self-samples showed a high sensitivity for CIN 3+ comparable to that of a clinician-taken smear. Self-sampling was well accepted as it is convenient and easy to use.

Recurrent Schowannoma With Extensive Xanthomatous Changes: A Case Report

Schwannoma is one of the most common benign intracranial tumors, which originates from the Schwann cells of neural structures in the upper part of the vestibular branch of the eighth cranial nerve. This report describes a 64-year-old woman with headache and vertigo who had a past surgical history of acoustic schwannoma about 10 years ago. The patient underwent excisional surgery. Histological examinations revealed schwannoma with extensive xanthomatous changes. Immunohistochemistry staining confirmed the diagnosis. Base on the diagnosis, the patient received no more treatment. After 6 months of close follow-up examinations, no recurrence and complication were observed. Schwannoma could be seen with a vast variety of histologic changes. Recurrence of Schownnoma is uncommon in patients without neurofibromatosis, but it should be considered in a proper clinical context.

Evaluation of post-operative complications after mastectomy performed without perioperative antimicrobial prophylaxis in dogs

Background Mastectomy is the most common procedure for treatment of mammary tumours. Dogs undergoing mastectomy have a risk of developing surgical site infections (SSI) and other postoperative complications. However, potential risk factors associated with such complications have been sparsely investigated. Thus, the objective of this retrospective study was to determine the incidence of, and identify risk factors for, SSI and non-SSI postoperative complications after mastectomy performed without perioperative antimicrobial prophylaxis in privately owned otherwise clinically healthy dogs. Results Medical records were reviewed retrospectively for 135 client-owned female dogs, 10–35 kg in weight and three to 10 years of age, which had undergone mastectomy due to mammary tumours at three referral animal hospitals in Sweden over a 3-year period. Twelve (8.9%) dogs developed SSI, and 21 dogs (17.1%) dogs suffered a non-SSI postoperative complication. The incidence of SSI and all complications (SSI and non-SSI) were higher in dogs that had two to three (SSI: P = 0.036 and all complications: P = 0.0039) and four to five (SSI and all complications: P = 0.038) mammary glands excised, compared to dogs that had one mammary gland excised. The incidence of SSI was 1.7% (n = 1/60) in dogs that had one gland removed. The incidence of non-SSI postoperative complications was higher in dogs with a higher body weight (P = 0.02). Conclusions The incidence of SSI was lower than or similar to previously reported incidences of SSI in dog populations that have undergone tumour excisional surgery, despite the fact that dogs in the present study had not received perioperative antibiotics. Dogs that had two or more glands excised had an increased risk of developing SSI and non-SSI complications compared to dogs that had one gland excised. Furthermore, higher BW was associated with an increased risk of non-SSI complications. Results from the study indicate that routine use of perioperative antibiotics in tumour excisional surgery can be questioned, at least in single gland mastectomy in otherwise clinically healthy dogs.

Successful basal cell carcinoma defect reconstruction using combination of rotation and advancement flap: Two case reports

Defects resulting from surgical procedure may be challenging to reconstruct depending on the size and location. In case of large defects, primary closure is often not possible and thus requires skin flap or graft. In such cases, skin flap is advantageous as it produces a similar color and texture with the surrounding tissue. Skin flap techniques such as advancement flap, rotation flap dan transposition flap are useful in closing small defects. In moderate to large-sized defects, especially in areas with high tension, a combination of more than one type of flap might be necessary. This report describes two cases of large defects on the temple and cheek following basal cell carcinoma excisional surgery which were successfully closed using a combination of rotation and advancement flaps. Both patients showed excellent functional and cosmetic outcome.

Scalp, forehead, and calvarial reconstruction

Reconstruction of the scalp and forehead fall broadly into two categories: trauma and malignancy. Traumatic injuries include lacerations, avulsions, burns, and penetrating injuries. Excisional surgery is predominately due to cutaneous malignancies such as squamous and basal cell carcinomas. In both groups of patients, it is important to understand both the anatomical subunits requiring reconstruction and which layers are deficient in the soft tissues and bone. This can be further complicated by previous surgery and radiotherapy.

Evaluation of the Factors Affecting the Cure Rate of Cervical Intra-Epithelial Neoplasia Recurrence Using Defective Models

Background: Treatment of cervical intraepithelial neoplasia is very important since if it remains untreated, it may progress to cervical cancer. It is usually treated with excisional surgery. This study aimed to find the factors affecting the cure rate of cervical intraepithelial neoplasia recurrence after surgery using defective models. Study design: A retrospective cohort study. Methods: Excisional surgery was performed on 307 patients with high-grade cervical intraepithelial neoplasia, from 2009 to 2017. The patients were followed up until recurrence based on histopathology report. Hematologic factors were measured before surgery. The cure rates were estimated using defective models with a Gamma frailty term and the results were compared. Results: Neutrophil-to-lymphocyte ratio (NLR) (P<0.001) and excised mass size (P<0.001) had significant impacts on cure rates, and their cut-off values were 1.9 (P<0.001) and 15 mm2 (P<0.001), respectively. Patients with lower neutrophil-to-lymphocyte ratios and larger excised tissues had higher cure rates. Defective 3-parameter Gompertz distribution with gamma frailty term had the best fit to the data, and its estimated cure rates were 98% among patients with an excised mass size of >15 mm2 and NLR of <1.9, 84% among patients with an excised mass size of >15 mm2 and NLR of >1.9, 79% among patients with an excised mass size of <15 mm2 and NLR of <1.9, and 30% among patients with an excised mass size of <15 mm2 and NLR of >1.9. Conclusion: Cervical intraepithelial neoplasia must be identified and treated before its progress. Excision of more tissues during excisional surgery, especially when the NLR of the patient is high, can help to prevent cervical intraepithelial neoplasia recurrence.

Osteoid Osteoma of Mandible as an Uncommon Site: A Case Report

Osteoid osteoma is a benign bone-forming tumor. Besides, it is small and painful, consisting of osteoid and woven bone, and surrounded by a thick layer of reactive bone formation. The tumor is self-limited or needs to be removed by surgery. This report describes a 16-year-old male with congenital deafness who presented with a right mandibular swelling initiated 2 years ago. The patient underwent excisional surgery. Histological examinations revealed a benign bone-forming tumor, compatible with osteoid osteoma. Radiologic and histologic correlation confirmed the diagnosis. Base on the diagnosis, the patient received no more treatment. After 4 years of close follow-up examinations, no recurrence was observed in the patient. Osteoid osteoma is often confused with numerous other entities in uncommon sites. Thus, imaging and histologic correlations are required. Proper diagnosis is necessary for further patient management in this respect.