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Papers by Michelangelo Giovanni Vestita
ABSTRACTIMPORTANCETumescent local anesthesia (TLA, whereby anesthesia is achieved by injection of... more ABSTRACTIMPORTANCETumescent local anesthesia (TLA, whereby anesthesia is achieved by injection of a highly diluted solution of local anesthesia into skin and subcutaneous tissues) is a technique for delivering anesthesia for superficial surgical procedures. TLA obviates the need for general anesthesia or intravenous sedation in most cases. Pain control and TLA-related complications are key factors in determining the success of TLA.OBJECTIVETo conduct a systematic review of the English medical literature’s data regarding pain control and TLA-related complications in TLA surgical cases to determine its efficacy and safetyEVIDENCE REVIEWThe review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Searches of both the MEDLINE and EMBASE databases were performed. Articles using 10-point quantitative scales were included in the pain analysis. Complications were tabulated from cohort studies, case series, and case r...
Dermatology Research and Practice
From 2005 to 2010, 20 consecutive patients with fully manifested neurofibromatosis type 1 (NF1) u... more From 2005 to 2010, 20 consecutive patients with fully manifested neurofibromatosis type 1 (NF1) underwent elective neurofibroma resection at our institution (Departments of Plastic Surgery and of Odontostomatology). Specimens were photographed under optical microscope and confocal laser scanning microscopy (CLSM) with ultra-high accuracy of detail, including depth of field. Patients were followed up for a minimum of 4 years and up to a maximum of 12 years, postsurgery. While all nonrecurring lesions showed intense fluorescence, six of the seven lesions with absence of fluorescence under CLSM recurred at a mean of 5.5 years after surgical excision. Among the re-excised lesions, 3 were diagnosed as malignant at the subsequent removal. Despite the limitation of a small cohort, CLSM appears to be a simple and low-cost technique to differentiate forms of neurofibromas with low and high risk of recurrence and malignant degeneration.
Journal of Burn Care & Research
The Open Dermatology Journal
Objective: To evaluate the effects of 1% topical propranolol in liposomal gel in 3 patients with ... more Objective: To evaluate the effects of 1% topical propranolol in liposomal gel in 3 patients with plantar ulcers. Methods: We enrolled 3 patients with 3 ulcers who had completed the WHO recommended treatment regimen. The ulcers were cleaned with sterile normal saline, and 1% topical propranolol in liposomal gel was applied 2 times/day for 3 months, or less if complete healing was reached before. Assessment of ulcer re-epithelization was recorded at baseline, 6 weeks, and 3 and 6 months after initiation of treatment. Results: Response in the form of granulation tissue formation started by the second week. Substantial reduction in size subsequently continued over the next 3 months. Two of the 3 patients showed complete healing of the ulcers at the 6 months follow up. In the 3rd patient, the ulcer showed only modest signs of healing. Surprisingly, in all patients, the sensory function was restored, particularly in terms of pain. Some motor functional recovery at the ulcer site and surro...
The Open Dermatology Journal
F1000Research
Proteus syndrome (PS) is a postnatal mosaic overgrowth disorder, progressive and disfiguring. It ... more Proteus syndrome (PS) is a postnatal mosaic overgrowth disorder, progressive and disfiguring. It is clinically diagnosed according to the criteria reported by Biesecker et al. We describe the case of a 49-year-old woman who presented with a 10-year history of pauci-symptomatic infiltrating plaque lesions on the sole and lateral margin of the left foot, which had been diagnosed as a keloid. The patient had a positive history for advanced melanoma and a series of subtle clinical signs, such as asymmetric face, scoliosis, multiple lipomas on the trunk, linear verrucous epidermal nevi, and hyperpigmented macules with a mosaic distribution. Even if the clinical presentation was elusive, she had enough criteria to be diagnosed with PS. This case describes the first evidence, to the best of our knowledge, of pauci-symptomatic PS in adulthood, reports its rare association with advanced melanoma, and illustrates the importance of even minor cutaneous clinical signs, especially when atypical,...
F1000Research
We report the case of a 33 year-old woman who came to our attention with slowly enlarging exophyt... more We report the case of a 33 year-old woman who came to our attention with slowly enlarging exophytic masses of the palate, histologically characterized by sub-epithelial fibrous proliferation with packed collagen bundles and increased fibroblasts number. We describe the condition of idiopathic fibrous hyperplasia, its diagnosis and its surgical treatment, which in our case was carried out with the aid of a custom made thermal printed plaque used as a scaffold.
Journal of Surgical Dermatology
We report a rare case of giant plexiform neurofibroma in a patient affected by type-1 neurofibrom... more We report a rare case of giant plexiform neurofibroma in a patient affected by type-1 neurofibromatosis and we describe the correct surgical management of such lesions in order to avoid intra- and post-op blood loss related complications.
Pediatric dermatology, 2017
Dermatologic Therapy, 2016
Clinical and Experimental Dermatology, 1987
NEW …, 2010
A 53-year-old woman came to our outpatient unit presenting with a small ovalar pigmented nodule i... more A 53-year-old woman came to our outpatient unit presenting with a small ovalar pigmented nodule in the right sub-mammary fold, which was diag-nosed as a suspected atypical melanocytic lesion by her primary care physician. The lesion had gradually undergone significant changes in ...
Journal of the American Academy of Dermatology, 2017
Plastic and Reconstructive Surgery, 2016
Ejd European Journal of Dermatology, Jul 1, 2013
Mycobacterium marinum is a non-tuberculous photochromogenic mycobacterium, commonly responsible f... more Mycobacterium marinum is a non-tuberculous photochromogenic mycobacterium, commonly responsible for fish and amphibious infections world-wide. Contagion in humans typically follows minor hand trauma from aquarium keeping and manifests as a granulomatous infection of the skin. Dissemination is rare and almost exclusive to immunosuppressed hosts. 15 cases of M. marinum fish tank related infection are hereby reported. The site of infection was the upper limbs in all cases. 3 patients presented a single papulo-verrucous lesion, while the remaining 12 showed a sporotrichoid clinical pattern. Diagnosis was reached by history and clinical examination and further supported by one or more of the following criteria: histology, culture, acid fast bacilli identification from histologic specimen and PCR. 2 to 3 months minocycline treatment showed efficacy in 13 individuals, another case was treated with rifampicin-isoniazid association, yet another showed spontaneous regression over a 3 month period.
Dermatitis, 2016
Chemical leukoderma, often clinically mimicking idiopathic vitiligo and other congenital and acqu... more Chemical leukoderma, often clinically mimicking idiopathic vitiligo and other congenital and acquired hypopigmentation, is an acquired form of cutaneous pigment loss caused by exposure to a variety of chemicals that act through selective melanocytotoxicity. Most of these chemicals are phenols and aromatic or aliphatic catechols derivatives. These chemicals, however, are harmful for melanocytes in individuals with an individual susceptibility. Nowadays, chemical leukoderma is fairly common, caused by common domestic products. The presence of numerous acquired confetti- or pea-sized macules is clinically characteristic of chemical leukoderma, albeit not diagnostic. Other relevant diagnostic elements are a history of repeated exposure to a known or suspected depigmenting agent at the sites of onset and a macules distribution corresponding to sites of chemical exposure. Spontaneous repigmentation has been reported when the causative agent is avoided; the repigmentation process is perifollicular and gradual, taking place for a variable period of weeks to months.
ABSTRACTIMPORTANCETumescent local anesthesia (TLA, whereby anesthesia is achieved by injection of... more ABSTRACTIMPORTANCETumescent local anesthesia (TLA, whereby anesthesia is achieved by injection of a highly diluted solution of local anesthesia into skin and subcutaneous tissues) is a technique for delivering anesthesia for superficial surgical procedures. TLA obviates the need for general anesthesia or intravenous sedation in most cases. Pain control and TLA-related complications are key factors in determining the success of TLA.OBJECTIVETo conduct a systematic review of the English medical literature’s data regarding pain control and TLA-related complications in TLA surgical cases to determine its efficacy and safetyEVIDENCE REVIEWThe review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Searches of both the MEDLINE and EMBASE databases were performed. Articles using 10-point quantitative scales were included in the pain analysis. Complications were tabulated from cohort studies, case series, and case r...
Dermatology Research and Practice
From 2005 to 2010, 20 consecutive patients with fully manifested neurofibromatosis type 1 (NF1) u... more From 2005 to 2010, 20 consecutive patients with fully manifested neurofibromatosis type 1 (NF1) underwent elective neurofibroma resection at our institution (Departments of Plastic Surgery and of Odontostomatology). Specimens were photographed under optical microscope and confocal laser scanning microscopy (CLSM) with ultra-high accuracy of detail, including depth of field. Patients were followed up for a minimum of 4 years and up to a maximum of 12 years, postsurgery. While all nonrecurring lesions showed intense fluorescence, six of the seven lesions with absence of fluorescence under CLSM recurred at a mean of 5.5 years after surgical excision. Among the re-excised lesions, 3 were diagnosed as malignant at the subsequent removal. Despite the limitation of a small cohort, CLSM appears to be a simple and low-cost technique to differentiate forms of neurofibromas with low and high risk of recurrence and malignant degeneration.
Journal of Burn Care & Research
The Open Dermatology Journal
Objective: To evaluate the effects of 1% topical propranolol in liposomal gel in 3 patients with ... more Objective: To evaluate the effects of 1% topical propranolol in liposomal gel in 3 patients with plantar ulcers. Methods: We enrolled 3 patients with 3 ulcers who had completed the WHO recommended treatment regimen. The ulcers were cleaned with sterile normal saline, and 1% topical propranolol in liposomal gel was applied 2 times/day for 3 months, or less if complete healing was reached before. Assessment of ulcer re-epithelization was recorded at baseline, 6 weeks, and 3 and 6 months after initiation of treatment. Results: Response in the form of granulation tissue formation started by the second week. Substantial reduction in size subsequently continued over the next 3 months. Two of the 3 patients showed complete healing of the ulcers at the 6 months follow up. In the 3rd patient, the ulcer showed only modest signs of healing. Surprisingly, in all patients, the sensory function was restored, particularly in terms of pain. Some motor functional recovery at the ulcer site and surro...
The Open Dermatology Journal
F1000Research
Proteus syndrome (PS) is a postnatal mosaic overgrowth disorder, progressive and disfiguring. It ... more Proteus syndrome (PS) is a postnatal mosaic overgrowth disorder, progressive and disfiguring. It is clinically diagnosed according to the criteria reported by Biesecker et al. We describe the case of a 49-year-old woman who presented with a 10-year history of pauci-symptomatic infiltrating plaque lesions on the sole and lateral margin of the left foot, which had been diagnosed as a keloid. The patient had a positive history for advanced melanoma and a series of subtle clinical signs, such as asymmetric face, scoliosis, multiple lipomas on the trunk, linear verrucous epidermal nevi, and hyperpigmented macules with a mosaic distribution. Even if the clinical presentation was elusive, she had enough criteria to be diagnosed with PS. This case describes the first evidence, to the best of our knowledge, of pauci-symptomatic PS in adulthood, reports its rare association with advanced melanoma, and illustrates the importance of even minor cutaneous clinical signs, especially when atypical,...
F1000Research
We report the case of a 33 year-old woman who came to our attention with slowly enlarging exophyt... more We report the case of a 33 year-old woman who came to our attention with slowly enlarging exophytic masses of the palate, histologically characterized by sub-epithelial fibrous proliferation with packed collagen bundles and increased fibroblasts number. We describe the condition of idiopathic fibrous hyperplasia, its diagnosis and its surgical treatment, which in our case was carried out with the aid of a custom made thermal printed plaque used as a scaffold.
Journal of Surgical Dermatology
We report a rare case of giant plexiform neurofibroma in a patient affected by type-1 neurofibrom... more We report a rare case of giant plexiform neurofibroma in a patient affected by type-1 neurofibromatosis and we describe the correct surgical management of such lesions in order to avoid intra- and post-op blood loss related complications.
Pediatric dermatology, 2017
Dermatologic Therapy, 2016
Clinical and Experimental Dermatology, 1987
NEW …, 2010
A 53-year-old woman came to our outpatient unit presenting with a small ovalar pigmented nodule i... more A 53-year-old woman came to our outpatient unit presenting with a small ovalar pigmented nodule in the right sub-mammary fold, which was diag-nosed as a suspected atypical melanocytic lesion by her primary care physician. The lesion had gradually undergone significant changes in ...
Journal of the American Academy of Dermatology, 2017
Plastic and Reconstructive Surgery, 2016
Ejd European Journal of Dermatology, Jul 1, 2013
Mycobacterium marinum is a non-tuberculous photochromogenic mycobacterium, commonly responsible f... more Mycobacterium marinum is a non-tuberculous photochromogenic mycobacterium, commonly responsible for fish and amphibious infections world-wide. Contagion in humans typically follows minor hand trauma from aquarium keeping and manifests as a granulomatous infection of the skin. Dissemination is rare and almost exclusive to immunosuppressed hosts. 15 cases of M. marinum fish tank related infection are hereby reported. The site of infection was the upper limbs in all cases. 3 patients presented a single papulo-verrucous lesion, while the remaining 12 showed a sporotrichoid clinical pattern. Diagnosis was reached by history and clinical examination and further supported by one or more of the following criteria: histology, culture, acid fast bacilli identification from histologic specimen and PCR. 2 to 3 months minocycline treatment showed efficacy in 13 individuals, another case was treated with rifampicin-isoniazid association, yet another showed spontaneous regression over a 3 month period.
Dermatitis, 2016
Chemical leukoderma, often clinically mimicking idiopathic vitiligo and other congenital and acqu... more Chemical leukoderma, often clinically mimicking idiopathic vitiligo and other congenital and acquired hypopigmentation, is an acquired form of cutaneous pigment loss caused by exposure to a variety of chemicals that act through selective melanocytotoxicity. Most of these chemicals are phenols and aromatic or aliphatic catechols derivatives. These chemicals, however, are harmful for melanocytes in individuals with an individual susceptibility. Nowadays, chemical leukoderma is fairly common, caused by common domestic products. The presence of numerous acquired confetti- or pea-sized macules is clinically characteristic of chemical leukoderma, albeit not diagnostic. Other relevant diagnostic elements are a history of repeated exposure to a known or suspected depigmenting agent at the sites of onset and a macules distribution corresponding to sites of chemical exposure. Spontaneous repigmentation has been reported when the causative agent is avoided; the repigmentation process is perifollicular and gradual, taking place for a variable period of weeks to months.