Respecting the aesthetic units in the surgery of palpebral malignancy

Summary The authors, based on their own experience in this field suggest their own therapeutical view which can be described as follows: a much more frequent use of plastic procedures using sliding flaps from the cheek, associated usually with chondromucosal free grafts from the septum, will give not only much better aesthetic results but also a better guarantee against neoplastic recurrence due to the possibility of being able to carry out a much larger ablation.     

Suction-assisted lipectomy does not increase the risk of random flap necrosis in a randomized study in pigs

Thirty-two dorsally based random flaps were raised in eight Yorkshire pigs (26–31 kg) after infiltration with 200 mL of dilute lidocaine (0.1%) with epinephrine (1:1,000,000) into each flap. Prior to elevation 16 of the flaps were treated with syringe-assisted liposuction, while the remaining flaps served as controls. One week postoperatively the viability of the flaps was assessed with computer-assisted planimetry of the necrotic area and by measurement of capillary blood flow using radioactive microspheres. The mean area of necrosis was nearly identical in the flaps treated with liposuction and in the control flaps, and there was no statistically significant difference in blood flow between the groups. The results show that liposuction performed with the super-wet or tumescent technique can be done prior to elevation of flaps in pigs without increasing the risk of flap necrosis.     

170. Operative Korrektur der Phimose im Kindesalter mit der Plastibell-Methode

Zusammenfassung Auf der Basis von Bildern der verschiedenen Operationsphasen und -ergebnissen wird die Technik der Plastibell-Methode gezeigt. Sie bedeutet eine einfache, komplikationslose Möglichkeit zur Korrektur der angeborenen oder erworbenen Phimose und ist ebenso verwendbar bei routinemäßiger Beschneidung Neugeborener. Postoperativer Heilverlauf und Nachuntersuchungsergebnisse bei über 400 Fällen sind als gut zu bezeichnen. Das Plastibell-Verfahren, besonders gut im ambulanten Bereich durchführbar, wird als Methode der Wahl empfohlen.     

Deformation: Its application to cosmetic facial surgery

The principles of deformation have come to our attention through the study of technical skills in art. It creates emphasis on the motif of a work by transformation and results in the illusionary phenomenon that makes the total appearance more harmonious and impressive. With this artistic technical concept compounded with our surgical experiences, we designed the deformation technique for facial corrective surgery. Introducing some distinctive cases applying this technique, we show its advantages over the see a defect, correct the defect limitations to present surgical techniques and the good effect of the patient's mind and attitudes.Presented at the 17th Annual Meeting of the American Society for Aesthetic Plastic Surgery, Los Angeles, California, April 20, 1983     

The Normal and Malignant Mammary Gland: A Fresh Look with ERβ Onboard

Estrogens are important for the development and function of the normal mammary gland as well as for development of mammary cancer. The frontline therapy for treatment of estrogen receptor (ER)⁴ positive breast cancer is antiestrogens. A second estrogen receptor (ER) is also expressed in the breast but it has not been measured because it is not detected by the immunoassays used to detect ER. In many cell systems ER has actions which are opposite to those of ER and this finding has raised questions about the role of ER in the development and treatment of breast cancer.     

Wnt Proteins in Mammary Development and Cancer

Secreted proteins of the Wnt family play widespread roles in the regulation of embryonic development, and aberrant activation of the canonical Wnt/beta-catenin pathway is one of the most frequent signaling abnormalities known in human cancer. While the consequences of Wnt signaling in development are diverse at the cellular level, they are often concerned with cell fate determination. Recent data also indicate that Wnt proteins influence the self-renewal of stem cells in certain tissues. In the mammary gland, Wnt signals are strongly implicated in initial development of the mammary rudiments, and in the ductal branching and alveolar morphogenesis that occurs during pregnancy. Transgenic expression of Wnt1 or Wnt10b in the mouse mammary gland leads to lobuloalveolar hyperplasia with a major risk of progression to carcinoma. Recent evidence suggests that this phenotype is associated with expansion of a multipotent progenitor cell population. In human breast cancer, evidence of beta-catenin accumulation implies that the canonical Wnt signaling pathway is active in over 50% of carcinomas. However, specific mutations that might account for this activation of signaling have not yet been identified.     

62. Medikamentöse Thrombose-Prophylaxe mit Anticoagulantien

ZusammenfaBung Die postoperative und posttraumatische Thromboembolie-Prophylaxe kann, ohne nachweisbare Zunahme des Blutungsrisikos, die Zahl der Lungenembolien und der Venenthrombosen, die zum postthrombotischen Syndrom führen können, um den Faktor 10 senken. Die Prophylaxe mit Heparin ist allen anderen Behandlungsarten überlegen. Dabei ist die pauschalierte Dosis weniger effektiv als die auf das Körpergewicht bezogene. Ein Minimalprogramm an Laborkontrollen kann unerwünschte Nebenwirkungen verhindern.     

Otoplasty for prominent ears

A technique for correction of prominent ears is described. It combines the advantages of simplicity and accuracy and provides satisfactory results. Essential points of the technique are (1) perichondral cartilage scratching at the superior crus and antihelical fold according to Stenström, (2) mattress sutures applied to the perichondrium and soft tissues at the medial surface, and to these we add (3) the trimming of the tail of the helix, thinning of the antitragus, and a double-spindle skin excision at the medial auricular surface. In patients with insufficient curling of the helical rim (shell-ear deformity) the base of the helical arch is scratched at its medial surface.     

Comparison of adrenoceptor subtype expression in porcine and human bladder and prostate

We have quantified and characterized ₁-, ₂-and -adrenoceptor subtypes in porcine bladder detrusor and bladder neck, human bladder detrusor, and porcine and human prostate. ₁-, ₂- and -adrenoceptor were identified in radioligand binding studies using [³H]prazosin, [³H]RX 821002 and [¹²⁵I]iodocyanopindolol, respectively, as the radioligands. In porcine male and female detrusor and bladder neck and male prostate, adrenoceptors were detected in the order of abundance > _{2 1} (not detectable), with no major differences between the sexes or between detrusor and bladder neck. In human detrusor and prostate the order of abundance was > _{2 1} (not detectable) and ₁ > ₂. respectively. The ₂-adrenoceptors in all tissues were homogeneously of the _2A-subtype as evidenced by competition binding studies with yohimbine, prazosin, ARC 239 and oxymetazoline. The -adrenoceptors represented a mixed population with a dominance of the ₂-subtype in all tissues as demonstrated by competition binding with ICI 118,551 and CGP 20,712A. We conclude that pigs may be a suitable model for studies of detrusor function with respect to adrenoceptor expression. They may be less suitable for studies of bladder neck or prostate function.     

118. Diagnostik und chirurgische Behandlung des thoracoabdominalen Aortenaneurysma (TAA)

Zusammenfassung 14 von 21 Patienten mit TAA (40–76 Jahre) wurden mit der ingraft technique nach Crawford operiert. 11 Patienten waren symptomatisch (5 Penetration, 3 progrediente Dissektion, 3 Ruptur) Grundlage der morphologischen Diagnostik bildeten CT und Angiographie. Die Erkrankung reichte von der linken A. subclavia bis zu den Beckenarterien bei 8 Patienten und betraf den distalen thoracoabdominalen Abschnitt in 6 Fällen. Kompensierte Niereninsuffizienz (9 Fälle) mit erheblichem Hypertonus (6 Fälle) waren neben coronarer Herzkrankheit die wesentlichen Risikofaktoren. – 11 Patienten (80%) überlebten den Eingriff, in einem Fall mit Paraplegie. Von den drei Todesfällen waren 2 Patienten über 70 Jahre alt und erlitten eine Paraplegie (gesamt 20 %). Nierenfunktionsstörungen traten in Abhängigkeit von der Ischämiezeit auf, erforderten jedoch nur einmal vorübergehend Hämodialyse. Verbesserte überlebens- und Komplikationsrate ohne Shunt kennzeichnen die Methode.     

Hyperhidrosis and its surgical treatment

Summary 111 sections of high thoracic sympathectomies in 60 cases suffering from primary palmar hyperhidrosis are reported. Surgical results and postoperative complications are discussed in detail. Complications were few in number and were of a transitory nature. No mortality occurred in our series. Various surgical and nonsurgical procedures of treatment are reviewed. Surgical intervention remains the treatment of ehoice in essential idiopathic hyperhidrosis.     

Effect of cranioplasty on cerebrospinal fluid hydrodynamics in patients with the syndrome of the trephined

Summary Forty patients with cranial bone defects after craniectomy underwent extensive cerebrospinal fluid (CSF) hydrodynamic investigations by means of a CSF infusion test before and after cranioplasty. The results of these investigations were related to the clinical signs of the patients before and after cranioplasty and to the size and location of the skull bone defect. Twenty-two patients were considered to have the syndrome of the trephined (ST). The remaining patients were either free of symptoms or had symptoms not related to ST.CSF hydrodynamic variables that were changed before and normalized after cranioplasty include the following: Resting pressure, sagittal sinus pressure, buffer volume, elastance at resting pressure and pulse variations at resting pressure. The changes were statistically significant mainly in ST patients who were also relieved of their symptoms after cranioplasty.This investigation was approved by the Ethical committee, Umeå University Hospital and supported by grants from the Swedish Medical Research Council (Project No. 04X-04125) and from the Amanda Vilhelmina and Per Algot Mångbergs Foundation for Medical Research, University of Umeå.     

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Nodal and Cripto-1: Embryonic Pattern Formation Genes Involved in Mammary Gland Development and Tumorigenesis

Members of the TGFbeta superfamily and EGF-CFC family, such as Nodal and Cripto, are important mediators of anterior-posterior and left-right axis specification during embryogenesis. In this paper, we review the role of Nodal and Cripto as critical morphogen-like molecules, with an emphasis on Nodal and EGF-CFC signaling during embryonic pattern formation. New evidence from gene expression and transgenic mouse studies have shown that both Nodal and Cripto-1 are expressed within the mammary duct and that modulation of these genes can disrupt normal branching morphogenesis resulting in epithelial disorganization and defective ductal architecture. We describe these new findings and propose that Cripto and Nodal are candidate mammary morphogens. Finally, the data linking overexpression of Cripto and perturbations of Cripto signaling to cell transformation and tumor formation are discussed. The fact that Cripto can modulate multiple pathways suggests it may act to deregulate growth inhibitors/homeostasis factors early in the cell transformation process and then activate prosurvival pathways dependent on MAPK and PI3K/Akt later in fully transformed phenotypes.     

18. Funktion und Bedeutung eines Tumorzentrums in Nachsorge und Rehabilitation

Zusammenfassung Nachsorge und Rehabilitation der Tumorkranken setzt eine bestmögliche Integration von medizinischen, psychosozialen und anderen rehabilitativen Maßnahmen voraus. Tumorzentren bieten dafür die besten Voraussetzungen. Der Onkologische Arbeitskreis nimmt dabei, zusammen mit dem Klinischen Krebsregister eine zentrale Stellung ein. Ein konsequentes Nachsorgeverfahren ist notwendig, wobei Primärbehandlung und Nachsorge fließend ineinander übergehen. Auf dem Gebiet der Rehabilitation liegen noch wenige praktische Erfahrungen vor, so daß die Tumorzentren auch auf diesem Sektor eine Schrittmacherfunktion auszuüben haben.     

An “all-season” mammoplasty

A reduction mammoplasty must produce a reduction in volume, a natural lasting shape, and minimal residual scarring. Many attempts to achieve this goal have been developed in recent years. The author described, in 1970, a vertical technique achieving an important reduction and a good shape but with the appearance of the end of the vertical scar below the brassiere line. In 1977, the author [3] modified the technique by the adjunction of a small horizontal scar to eliminate the inconvenience of the visible part of the vertical scar. In this article the author describes his technique which appears to be suitable for most types of breast deformities.     

A versatile procedure for the closure of small skin defects

The author describes a method for the primary, direct closure of wide skin lesions, combining the lazy S, crown, and the H-advancement flap techniques. The lazy S edges of the flaps permit the satisfactory use of adjacent surrounding skin with good aesthetic results, when the flaps alone would otherwise be placed under too much strain.     

Developmental CSF cysts of the posterior fossa

Summary 20 cases of operated developmental CSF cysts are surveyed: 8 Dandy-Walker syndromes and 12 extraaxial arachnoid cysts. A CSF shunt is the only possible operation for Dandy-Walker syndrome and a single shunt from the cyst is preferable to a double shunt; the success rate is 50%. Congenital extraaxial arachnoid cysts, which arise from a developmental anomaly of the roof of the hindbrain or primitive leptomeningeal spaces, must be differentiated from acquired arachnoid cysts. Those of this series fall into two groups: midline and lateral. Supravermian midline cysts resemble the Dandy-Walker syndrome in several respects, including the frequent recourse to a shunt operation and the uncertain distant prognosis, whilst the other extra-axial cysts usually simulate a cerebellar tumor. Lateral cysts may, however, present peculiar symptoms such as a homolateral motor deficit that does not always respond to surgery, and an oscillating symptomcomplex. Surgical removal is the treatment of choice both for subvermian midline and lateral cysts but subsequent shunting may be necessary to control persisting hydrocephalus. The long term prognosis is generally excellent for subvermian midline cysts but may be only fair for lateral cysts.     

Antisense TGF-β2 Immunotherapy for Hepatocellular Carcinoma: Treatment in a Rat Tumor Model

Background: The overexpression of transforming growth factor-beta (TGF-) in hepatocellular carcinoma (HCC) appears to induce immunosuppression toward the tumor cells. Methods: A rat HCC cell line, Morris hepatoma rat cell line (MRH)-7777 (MRH), was transfected with antisense TGF-2 in pCEP-4 vector and used as immunotherapy against the development of wild-type tumors. An enzyme-linked immunosorbent assay (ELISA) confirmed that TGF-2 production was markedly lower for antisense modified cells as compared to wild-type tumor cells. Tumors were initiated by injecting MRH cells into the flanks of Buffalo rats. This was followed by biweekly vaccinations with irradiated MRH cells (unmodified, pCEP-4 alone, or antisense TGF-2 modified). Results: In the group that received irradiated MRH unmodified cells, 55% of rats died from tumor burden, and 36% developed tumor regression. In the group that received irradiated MRH cells modified with pCEP-4 vector alone, 50% died from tumors and 33% had spontaneous regression. In animals treated with pCEP-4/TGF- antisense modified cells, none developed tumors. Cell-mediated cytotoxicity assays demonstrated a twofold increase in lytic activity in the effector cells of the animals treated with antisense modified cells. Conclusions: These results demonstrate the successful treatment of HCC tumors in rats by a HCC vaccine genetically altered with antisense TGF-2. Decreased production of TGF- in HCC vaccine enhances immunogenicity against wild-type HCC tumor cells.Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, New Orleans, Louisiana, March 16-19, 2000.