The Canadian Society for Aesthetic Plastic Surgery 40th Annual Meeting: September 20 & 21, 2013, Vancouver,British Columbia

After studying the anatomy of 10 fresh cadavers, we developed a technique for the treatment of the cervical area during face lifts. We called this technique PLATYSMA-SUSPENSION and PLATYSMA-PEXY rather than plication. This technique consists of suspending the free edge of the platysma muscle and fixing it to a resistant tissue close to the earlobe (Loré’s fascia or temporo-parotid fascia). The anterior triangle of the neck was well defined and there was no need to undermine the platysma muscle because of a perfect sliding plane between the platysma and sternocleidomastoid muscles. This technique is both simple and effective. It generates long-lasting results, without the inconveniences or complications associated with other techniques.

MATERIALS AND METHODS:

Ten fresh cadavers (ie, 20 hemifaces) were subjected to the proposed technique. They were photographed and filmed at all stages.Ten more cadavers were dissected to study the submental area and we discovered that the best way to recreate the cervico mental angle and to rebuild the floor of the mouth is to use a digastric corset so that we could rebuild the retaining ligaments between the platysma/digastric and mylohyoïd muscles.More than 100 patients were operated by the senior author; they underwent platysma-suspension and platysma-pexy of the fascia described by Loré; associated in difficult necks (Knize 3 and 4 necks) with the digastric corset. The patients were followed-up for a minimum of 12 months.

CONCLUSION:

PLATYSMA-SUSPENSION and PLATYSMA-PEXY in the fascia described by Loré is an extremely long-lasting and effective technique in cervical lifting. It generates impressive results, even in the most inferior portion of the neck. It redefines the entire anterior triangle, especially the sternocleidomastoid muscle and the mandibular contours. Furthermore, PLATYSMA-SUSPENSION minimizes the risk of nerve injury and hematoma by preventing deep and unnecessary dissections because the superficial cervical fascia has a perfect sliding plane between the platysma and the deepest structures of the neck.In difficult necks, we do associate a digastric corset using a submental incision.Pre-op botulinum toxin injections appears to be of great interest leaving the muscle at rest during the post-operative phase.

• Can J Plast Surg. 2013 Winter; 21(4): 253–255.
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• 2: Facial Palsy: Lengthening Temporalis Myoplasty and Smile Reanimation

Can J Plast Surg. 2013 Winter; 21(4): 253.

2: Facial Palsy: Lengthening Temporalis Myoplasty and Smile Reanimation

D LabbéAuthor information Copyright and License information DisclaimerCaen, FranceCopyright ©2013 Canadian Society of Plastic Surgeons. All rights reserved     

Histopathological assessment of lymph nodes in upper gastrointestinal cancer: does triple levelling detect significantly more metastases?

Background

For cancers of the upper gastrointestinal tract it is standard to examine one section/level, from paraffin blocks containing lymph node tissue, for metastatic tumour.

Aims

To determine whether significantly more metastases can be detected by assessing two additional levels.

Methods

101 archival upper gastrointestinal cancers were evaluated. All negative lymph nodes were examined at two additional levels separated by 100 μm and stained by H&E. The slides were examined for the presence of metastases.

Results

1143 lymph nodes, that were originally clear of metastases, were examined at a further two levels (three levels in total); 23 additional metastases were identified in 17 patients. Eleven of these patients were already stage N1 before examination of the additional levels. However, six patients were originally N0, and were therefore upgraded to N1.

Conclusions

Examining lymph nodes at three levels did detect more metastatic deposits than examination of one section/level. In six patients this changed the N stage from N0 to N1. This would have significant prognostic and management implications.Approximately 15 000 people develop cancer of the oesophagus, oesophagogastric junction and stomach in the UK each year, and in the developing world adenocarcinoma of the gastro‐oesophageal junction is increasing in incidence faster than any other type of gastrointestinal cancer.^1,2 Surgical resection remains the mainstay of potentially curative treatment, but is high risk and long‐term survival is disappointing.The most commonly used staging system in the UK for upper gastrointestinal tumours is the TNM classification system of tumours.³ Lymph node status is one of the most significant, if not the most significant, indicator of prognosis in such cancers.^4,5,6,7 The TNM classification places patients with lymph node tumour deposits in category N1 for oesophageal cancer and N1, N2 or N3 for gastric cancer depending on the number of lymph nodes involved. There is no separate TNM classification for tumours of the oesophagogastric junction, and it can be difficult at times for the pathologist to decide which staging classification to use (oesophageal or gastric) for such tumours. There is a lack of evidence based guidance on how best to sample lymph nodes from upper gastrointestinal tumours.The Royal College of Pathologists'' minimum dataset for gastric carcinoma states that lymph nodes identified within the resection specimen should be cut through their greatest diameter and one half taken for microscopy.⁸ The Royal College of Pathologists'' minimum dataset for oesophageal cancer does not comment on how lymph nodes should be sampled; however it does state that there was not enough evidence at the time of publication to support the use of immunohistochemistry and serial sections to detect micrometastases.⁹ Drafts of the revised datasets for reporting oesophageal and gastric carcinomas are available on the Royal College of Pathologists website.^10,11 The revised draft copy of the oesophageal dataset recommends the use of TNM5 over TNM6, but there is still no advice on how to sample lymph nodes. The revised draft copy of the gastric dataset states all lymph nodes found should be sampled, but there is no additional advice on how to do this. In best practice guidelines for handling oesophageal resection specimens, the recommendation for lymph node sampling is to sample lymph nodes clearly replaced by tumour and to completely sample all lymph nodes that appear tumour free.¹² The College of American Pathologists recommends evaluating all lymph nodes, but again does not comment on how best to do this.¹³On review of the literature, there appears to be little information on the value of serial sections of lymph nodes within oesophageal and gastric carcinomas to detect metastatic carcinoma. In some subspecialty areas, the use of serial sections has been examined. In the area of breast pathology, the National Health Service Breast Screening Programme, published in 1995, did recommend examination of lymph nodes less than 5 mm at two levels.¹⁴ However, in the more recent publication (January 2005), examination of levels was stated not to be routinely necessary.¹⁵ However, it is recommended that lymph nodes should be sliced at intervals of approximately 3 mm or less, perpendicular to the long axis, as this is an effective and simpler alternative to serial sectioning to detect small metastatic deposits in lymph nodes. The use of triple levelling has been assessed in colorectal carcinoma, and in a study of 100 colorectal carcinoma resection specimens, 12 extra metastases, in 11 patients, were discovered within lymph nodes at levels 2 and 3, which were negative in level 1.¹⁶Despite the lack of information on serial sectioning there have been numerous publications, examining the detection of micrometastases with immunohistochemistry in lymph nodes from resection specimens of the oesophagus and stomach. These studies show an increase in the detection of micrometastases of between 10% and 40%.^{17,18,19,20,21,22} The detection of micrometastases did not appear to be related to prognosis in the majority of studies examining oesophageal carcinoma, (predominantly squamous in type); however, there did appear to be a reduction in prognosis in patients with micrometastases from gastric adenocarcinomas.An audit was completed to examine the value of performing three serial sections on lymph nodes from carcinomas of the oesophagus, gastro‐oesophageal junction and stomach to detect increased numbers of metastases.     

The selective poly(ADP-ribose) polymerase-1(2) inhibitor, CEP-8983, increases the sensitivity of chemoresistant tumor cells to temozolomide and irinotecan but does not potentiate myelotoxicity

The effect of the potent and selective poly(ADP-ribose) (PAR) polymerase-1 [and PAR polymerase-2] inhibitor CEP-8983 on the ability to sensitize chemoresistant glioblastoma (RG2), rhabdomyosarcoma (RH18), neuroblastoma (NB1691), and colon carcinoma (HT29) tumor cells to temozolomide- and camptothecin-induced cytotoxicity, DNA damage, and G(2)-M arrest and on the potentiation of chemotherapy-induced myelotoxicity was evaluated using in vitro assays. In addition, the effect of the prodrug CEP-9722 in combination with temozolomide and/or irinotecan on PAR accumulation and tumor growth was also determined using glioblastoma and/or colon carcinoma xenografts relative to chemotherapy alone. CEP-8983 sensitized carcinoma cells to the growth-inhibitory effects of temozolomide and/or SN38 increased the fraction of and/or lengthened duration of time tumor cells accumulated in chemotherapy-induced G(2)-M arrest and sensitized tumor cells to chemotherapy-induced DNA damage and apoptosis. A granulocyte-macrophage colony-forming unit colony formation assay showed that coincubation of CEP-8983 with temozolomide or topotecan did not potentiate chemotherapy-associated myelotoxicity. CEP-9722 (136 mg/kg) administered with temozolomide (68 mg/kg for 5 days) or irinotecan (10 mg/kg for 5 days) inhibited significantly the growth of RG2 tumors (60%) or HT29 tumors (80%) compared with temozolomide or irinotecan monotherapy, respectively. In addition, CEP-9722 showed "stand alone" antitumor efficacy in these preclinical xenografts. In vivo biochemical efficacy studies showed that CEP-9722 attenuated PAR accumulation in glioma xenografts in a dose- and time-related manner. These data indicate that CEP-8983 and its prodrug are effective chemosensitizing agents when administered in combination with select chemotherapeutic agents against chemoresistant tumors.     

Interleukin-6 enhances growth factor-dependent proliferation of the blast cells of acute myeloblastic leukemia

The effects of recombinant interleukin-6 (IL-6) on the proliferation of blast precursors present in the peripheral blood of patients with acute myeloblastic leukemia (AML) was investigated. IL-6 had little effect by itself; however, it synergized with granulocyte macrophage colony- stimulating factor (GM-CSF) and interleukin-3 (IL-3) in the stimulation of AML blast colony formation. Responsiveness of blast progenitors to IL-6 was heterogeneous. On normal bone marrow cells the same synergy was observed on granulocyte and monocyte precursors (GM-CFC), while there was no significant effect on erythroid and multipotential precursors.     

Community-based falls prevention: lessons from an Interprofessional Mobility Clinic

Falls are a common and serious risk with an aging population. Chiropractors commonly see firsthand the effects of falls and resulting injuries in their senior patients and they can reduce falls risk through active screening. Ongoing research has provided proven approaches for making falls less likely. Screening for falls should be done yearly for all patients 65 years and older or in those with a predisposing medical condition. Additional specific falls prevention professional education would enable the chiropractor to best assist these patients. Collaboration and communication with the patient’s family physician offers an opportunity for improved interprofessional dialogue to enhance patient care related to falls risk. Frequently falls prevention strategies are implemented by an interprofessional team. Chiropractors increasingly contribute within multidisciplinary teams. Collaboration by the chiropractor requires both simple screening and knowledge of health care system navigation. Such awareness can permit optimal participation in the care of their patient and the best outcome.