Three unusual histopathological presentations of angiolymphoid hyperplasia with eosinophilia

Abstract

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a poorly understood benign vasculoproliferative disorder. Histopathologicaly, the lesions are composed of a dermal or subcutaneous proliferation of blood vessels of varying sizes with plump and bland endothelial cells, which often show vacuolization and protrusion of the cytoplasm into the lumen. The vascular proliferation is admixed with a diffuse inflammatory infiltrate composed of lymphocytes, eosinophils, and mast cells. Lymphoid follicles with germinal centers can sometimes be seen. Additionally, fibrosis is a common accompanying feature. Some clinical and histopathological variants of ALHE have already been described in the literature. In this report, we present three rare associations of ALHE that have not been previously described. Case 1 was a 73-year-old woman with a lesion on her right medial thigh. Examination showed ALHE admixed with a chronic lymphocytic leukemic (CLL) infiltrate. Case 2 was a 55-year-old woman with a lesion on her right anterior ankle, which was a syringocystademoma papilliferum coexisting with an ALHE. Case 3 was a 54-year-old man with a lesion on the left medial thigh, which showed overlapping features of IgG4-related disease associated with areas of ALHE. Given these multiple and diverse associations, it seems likely that ALHE may be a reactive rather than neoplastic process.

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Cutaneous Extranodal NK/T Cell Lymphoma Mimicking Cellulitis in a HIV Positive Patient without Lymphopenia

Abstract

We present the case of a 28-year-old male with a history of HIV with a 1-month history of a steadily enlarging, firm painful lesion on the right posterior shoulder. The patient was initially treated for cellulitis given his clinical picture. Histopathologic examination revealed an angiocentric and dermal proliferation of markedly atypical lymphoid cells with numerous mitoses and apoptotic bodies along with broad zones of necrosis. Biopsy revealed the presentation to be consistent with NK/T-cell lymphoma. The cutaneous lesions from NK/T-cell lymphoma can often be initially mistaken for cellulitis, therefore this malignancy should be included on the differential in a patient HIV/AIDS.

http://ift.tt/2iLcObs

Effect of Perineural Dexamethasone on the Duration of Single Injection Saphenous Nerve Block for Analgesia After Major Ankle Surgery: A Randomized, Controlled Study.

Background and Objectives: Patients undergoing major elective ankle surgery often experience pain from the saphenous nerve territory persisting beyond the duration of a single-injection saphenous nerve block. We hypothesized that perineural dexamethasone as an adjuvant for the saphenous nerve block prolongs the duration of analgesia and postpones as well as reduces opioid-requiring pain. Methods: Forty patients were included in this prospective, randomized, controlled study. All patients received a continuous sciatic catheter and were randomized to receive a single-injection saphenous nerve block with 10 mL of 0.5% bupivacaine with 1:200,000 epinephrine with addition of 1 mL of saline or 1 mL of 0.4% (ie, 4 mg) dexamethasone. The primary outcome was duration of saphenous nerve block estimated as the time until the first opioid request. Secondary outcomes were opioid consumption and pain. Results: The mean (SD) duration of the saphenous nerve block until first opioid request was 29.4 (8.4) hours in the dexamethasone group and 23.2 (10.3) hours in the control group (P = 0.048). The median opioid consumption [interquartile range] during the first 24 hours was 0 mg [0-0] versus 1.5 mg [0-14.2] in the dexamethasone and control groups, respectively. Nonparametric comparison of opioid consumption from 0 to 24 hours was statistically significant. The opioid consumption was similar in the two groups in the time interval 24 to 48 postoperative hours. Conclusion: Perineural dexamethasone as an adjuvant for the single-injection subsartorial saphenous nerve block can prolong analgesia and reduce opioid-requiring pain after major ankle surgery. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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Is there a role of food additives in recurrent aphthous stomatitis? a prospective study with patch testing

Abstract

Background

Recurrent aphthous stomatitis (RAS) is a common disease of the oral mucosa with an unknown etiology. This study aimed to determine if food additives play a role in the etiology of RAS as well as to determine if patch testing can be used to detect which allergens cause RAS.

Methods

This prospective study included 24 patients with RAS and 22 healthy controls. All the participants underwent patch testing for 23 food additives.

Results

In total, 21 (87.5%) RAS patients and 3 (13.6%) controls had positive patch test reactions to ≥1 allergens; the difference in the patch test positivity rate between groups was significant (P < 0.05). The most common allergen that elicited positive patch test results in the patient group was cochineal red (n = 15 [62.5%]), followed by azorubine (n = 11 [45.8%]) and amaranth (n = 6 [25%]).

Conclusions

The present findings show that food additives might play a role in the etiology of RAS and that patch testing could be a method for determining the etiology of RAS.

http://ift.tt/2iofRtw

A Tribute to Tony Bull—Surgeon, Teacher, Leader, Gentleman (1934–2016)

Facial plast Surg 2016; 32: 579-584
DOI: 10.1055/s-0036-1594257

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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A Tribute to Tony Bull—Surgeon, Teacher, Leader, Gentleman (1934–2016)

Facial plast Surg 2016; 32: 579-584
DOI: 10.1055/s-0036-1594257

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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Worldwide Perspectives in Facial Plastic Surgery

Facial plast Surg 2016; 32: 585-586
DOI: 10.1055/s-0036-1597957

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Worldwide Perspectives in Facial Plastic Surgery

Facial plast Surg 2016; 32: 585-586
DOI: 10.1055/s-0036-1597957

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Optimizing the Soft Tissue Triangle, Alar Margin Furrow, and Alar Ridge Aesthetics: Analysis and Use of the Articulate Alar Rim Graft

Facial plast Surg 2016; 32: 646-655
DOI: 10.1055/s-0036-1596049

The alar lobule, alar margin, and soft triangle facet are receiving more attention in the literature as critical elements to address both preoperatively and during rhinoplasty. We have found that the use of the articulated alar rim graft (AARG) corrects deficiencies in these areas as well as provides mechanical stability to the external valve. In this article, we describe indications for AARG, describe in detail the procedure for AARG placement, and highlight the transformation AARGs can achieve in two illustrated case studies.
[...]

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Optimizing the Soft Tissue Triangle, Alar Margin Furrow, and Alar Ridge Aesthetics: Analysis and Use of the Articulate Alar Rim Graft

Facial plast Surg 2016; 32: 646-655
DOI: 10.1055/s-0036-1596049

The alar lobule, alar margin, and soft triangle facet are receiving more attention in the literature as critical elements to address both preoperatively and during rhinoplasty. We have found that the use of the articulated alar rim graft (AARG) corrects deficiencies in these areas as well as provides mechanical stability to the external valve. In this article, we describe indications for AARG, describe in detail the procedure for AARG placement, and highlight the transformation AARGs can achieve in two illustrated case studies.
[...]

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Aesthetic Rhinoplasty as a Surface-Contour Operation: From Analysis to Surgery—Personal Concepts

Facial plast Surg 2016; 32: 587-598
DOI: 10.1055/s-0036-1597146

Numerous beautiful rhinoplasty results have been created by closed rhinoplasty techniques over the past 100 years. This operation was mainly a "reduction" surgery. Overaggressive reduction rhinoplasty is not a hallmark of the closed approach per se, but represents the result of inappropriate aesthetic appraisal, inadequate technical execution, or lack of sound anatomical understanding. Clearly, an operation based primarily on reduction intrinsically exposes the surgeon to the possibility of excessive diminution of support structures and consequently undesirable side effects. The advent of the external approach in the 1970s marked a paradigm shift. In the early 1990s, the external approach witnessed further development with the introduction of "structural rhinoplasty," a deconstruction procedure followed by structural reconstruction. Opponents of the external approach felt that opening every nose can result in an overkill, specifically because the vast majority of patients presenting for cosmetic rhinoplasty neither desire nor require major reconstruction of the nose. In the last decade, the poorly named "closed" approach, once the pariah of rhinoplasty, has been rethought especially in the light of the undesirable long-term side effects, reappraised, and found a new lease of life as "endonasal rhinoplasty." The personal surgical evolution of the senior author (P. P.) has created the concept of "hybrid endonasal rhinoplasty" (HER), where the term "hybrid" implies the incorporation of anatomical concepts and sophisticated suturing–grafting techniques developed by "openers" into the theoretical and technical corpus of HER. The senior author (P. P.) pondered over heterogenous concepts such as filling-reshaping, derived from the so-called medical rhinoplasty, and embodied these concepts into a purely surgical endonasal perspective. Consequently, aesthetic rhinoplasty can be considered a "surface-contour" operation. Nasal analysis, preoperative work-up, surgical logic, and operative techniques have been rethought. The patient is only interested in nasal appearance, not in its anatomy, so deconstructing the nose to change the subtle and demanding interplay of light and shadow is in many cases an overkill. Our emphasis should be on those structures that can be tackled and result in the ultimate aim of altering the aesthetic aspects of surface anatomy. Surface HER can deliver on all these counts.
[...]

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Aesthetic Rhinoplasty as a Surface-Contour Operation: From Analysis to Surgery—Personal Concepts

Facial plast Surg 2016; 32: 587-598
DOI: 10.1055/s-0036-1597146

Numerous beautiful rhinoplasty results have been created by closed rhinoplasty techniques over the past 100 years. This operation was mainly a "reduction" surgery. Overaggressive reduction rhinoplasty is not a hallmark of the closed approach per se, but represents the result of inappropriate aesthetic appraisal, inadequate technical execution, or lack of sound anatomical understanding. Clearly, an operation based primarily on reduction intrinsically exposes the surgeon to the possibility of excessive diminution of support structures and consequently undesirable side effects. The advent of the external approach in the 1970s marked a paradigm shift. In the early 1990s, the external approach witnessed further development with the introduction of "structural rhinoplasty," a deconstruction procedure followed by structural reconstruction. Opponents of the external approach felt that opening every nose can result in an overkill, specifically because the vast majority of patients presenting for cosmetic rhinoplasty neither desire nor require major reconstruction of the nose. In the last decade, the poorly named "closed" approach, once the pariah of rhinoplasty, has been rethought especially in the light of the undesirable long-term side effects, reappraised, and found a new lease of life as "endonasal rhinoplasty." The personal surgical evolution of the senior author (P. P.) has created the concept of "hybrid endonasal rhinoplasty" (HER), where the term "hybrid" implies the incorporation of anatomical concepts and sophisticated suturing–grafting techniques developed by "openers" into the theoretical and technical corpus of HER. The senior author (P. P.) pondered over heterogenous concepts such as filling-reshaping, derived from the so-called medical rhinoplasty, and embodied these concepts into a purely surgical endonasal perspective. Consequently, aesthetic rhinoplasty can be considered a "surface-contour" operation. Nasal analysis, preoperative work-up, surgical logic, and operative techniques have been rethought. The patient is only interested in nasal appearance, not in its anatomy, so deconstructing the nose to change the subtle and demanding interplay of light and shadow is in many cases an overkill. Our emphasis should be on those structures that can be tackled and result in the ultimate aim of altering the aesthetic aspects of surface anatomy. Surface HER can deliver on all these counts.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Optimizing Outcomes with Clinical Data Registries

Facial plast Surg 2016; 32: 636-637
DOI: 10.1055/s-0036-1596047

Clinical data registries are platforms to extract, store, analyze, and disseminate large amounts of clinical data. The type of data contained in clinical data registries varies by the registry, and may include patient demographics, clinical examination findings, imaging and laboratory results, procedures performed, and patient-reported outcomes. When large numbers of participants submit data to a clinical data registry the data can then be analyzed in aggregate to answer new clinical questions. Analyses on the data may be performed to show outcomes over time, compare procedures, evaluate care patterns, among others. With the launch of an otolaryngology-specific clinical data registry, Regent, facial plastic and reconstructive surgeons have the opportunity to participate in a clinical data registry for the first time. Through broad participation in the registry, the specialty has a chance to optimize patient outcomes in a manner never before possible.
[...]

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Optimizing Outcomes with Clinical Data Registries

Facial plast Surg 2016; 32: 636-637
DOI: 10.1055/s-0036-1596047

Clinical data registries are platforms to extract, store, analyze, and disseminate large amounts of clinical data. The type of data contained in clinical data registries varies by the registry, and may include patient demographics, clinical examination findings, imaging and laboratory results, procedures performed, and patient-reported outcomes. When large numbers of participants submit data to a clinical data registry the data can then be analyzed in aggregate to answer new clinical questions. Analyses on the data may be performed to show outcomes over time, compare procedures, evaluate care patterns, among others. With the launch of an otolaryngology-specific clinical data registry, Regent, facial plastic and reconstructive surgeons have the opportunity to participate in a clinical data registry for the first time. Through broad participation in the registry, the specialty has a chance to optimize patient outcomes in a manner never before possible.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Rhytidoplasty: SMAS Imbrication Vector Comparison

Facial plast Surg 2016; 32: 599-606
DOI: 10.1055/s-0036-1597145

To determine if there are aesthetic differences in patients who have undergone a SMAS lifting with predominantly oblique-horizontal vectors versus predominantly oblique-vertical vectors. To determine if there are aesthetic differences in the results of the neck using sutures placed in specific areas of the platysmal muscle versus randomly placed sutures for platysmal plication to the mastoid. Comparative, retrospective, blind, and randomized study. Evaluation of preoperative and postoperative photographs of 54 patients who underwent predominantly oblique-horizontal SMAS lifting versus 53 patients who underwent predominantly oblique-vertical traction of the SMAS flap, reviewed by three external, unbiased facial plastic surgeons in a blind study. A 7-point scale was used to grade the improvement of the face and the neck. In the face, SMAS lifting with predominantly oblique-vertical vectors used during the procedure offer statistically better results (p ≤ 0.001) in comparison to predominantly oblique-horizontal vectors in the aesthetical improvement of the malar eminence, melolabial fold and jowls. In the neck, both techniques offer excellent results, but the sutures used for platysmal plication in specific areas offer no statistical differences in aesthetical results from those sutures that are randomly placed in the platysmal muscle. In our study of 107 patients, SMAS lifting using predominantly oblique-vertical vectors seem to have better results than using predominantly oblique-horizontal vectors. For the neck, we do not find statistical differences between randomly placed sutures for platysmal plication versus sutures placed in specific areas of the muscle.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Suspension Threads

Facial plast Surg 2016; 32: 662-663
DOI: 10.1055/s-0036-1597541

Suture threads are a minimally invasive surgical technique for facial rejuvenation. Its use was initiated by Sulamanidze et al with propylene after Serdev introduced suture with polycaproamide; however, these types of suture increased inflammatory reaction. For correction of the aging face, surgeons are devising more procedures with fewer incisions and shorter postoperative recovery periods. Many of these procedures use absorbable and nonabsorbable sutures in the dermis and subcutis to lift lax skin. The polydioxanone suture is currently a great option for antiaging treatment, because besides the ease of applicability and good results, it also has a low incidence of adverse reactions.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Rhytidoplasty: SMAS Imbrication Vector Comparison

Facial plast Surg 2016; 32: 599-606
DOI: 10.1055/s-0036-1597145

To determine if there are aesthetic differences in patients who have undergone a SMAS lifting with predominantly oblique-horizontal vectors versus predominantly oblique-vertical vectors. To determine if there are aesthetic differences in the results of the neck using sutures placed in specific areas of the platysmal muscle versus randomly placed sutures for platysmal plication to the mastoid. Comparative, retrospective, blind, and randomized study. Evaluation of preoperative and postoperative photographs of 54 patients who underwent predominantly oblique-horizontal SMAS lifting versus 53 patients who underwent predominantly oblique-vertical traction of the SMAS flap, reviewed by three external, unbiased facial plastic surgeons in a blind study. A 7-point scale was used to grade the improvement of the face and the neck. In the face, SMAS lifting with predominantly oblique-vertical vectors used during the procedure offer statistically better results (p ≤ 0.001) in comparison to predominantly oblique-horizontal vectors in the aesthetical improvement of the malar eminence, melolabial fold and jowls. In the neck, both techniques offer excellent results, but the sutures used for platysmal plication in specific areas offer no statistical differences in aesthetical results from those sutures that are randomly placed in the platysmal muscle. In our study of 107 patients, SMAS lifting using predominantly oblique-vertical vectors seem to have better results than using predominantly oblique-horizontal vectors. For the neck, we do not find statistical differences between randomly placed sutures for platysmal plication versus sutures placed in specific areas of the muscle.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2hvcFrj

Suspension Threads

Facial plast Surg 2016; 32: 662-663
DOI: 10.1055/s-0036-1597541

Suture threads are a minimally invasive surgical technique for facial rejuvenation. Its use was initiated by Sulamanidze et al with propylene after Serdev introduced suture with polycaproamide; however, these types of suture increased inflammatory reaction. For correction of the aging face, surgeons are devising more procedures with fewer incisions and shorter postoperative recovery periods. Many of these procedures use absorbable and nonabsorbable sutures in the dermis and subcutis to lift lax skin. The polydioxanone suture is currently a great option for antiaging treatment, because besides the ease of applicability and good results, it also has a low incidence of adverse reactions.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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How to Harmonize the Ethnic Nose

Facial plast Surg 2016; 32: 620-624
DOI: 10.1055/s-0036-1597660

The demand for cosmetic surgery has significantly increased in the past few years mainly due to economic rise witnessed in Brazil. The state of Bahia has predominately Afro-descendant population with the same countrywide scenario, where the surgeon must be able to face challenges such as the specifics demands of rhinoplasty in an ethnic nose. It represents not only a different nasal variety from the Caucasoid, but also a complex anatomical feature, with its own peculiarities, as thicker and oilier skin, with bulky fibrous fatty tissue with numerous sebaceous glands. The nose tip features both inadequate projection and definition, including a short columella and underdeveloped nasal spine. The lower lateral cartilages are lower and thinner if compared with Caucasian noses. The nasal septum is short and fragile, whereas the dorsum is low and wide with deep nasion and wide obtuse angles between nasal bones. Finally, yet importantly, the nose base has increased interalar distance and excess of alar wing, with an ovoid, horizontal, and open nostril. Considering all these uniqueness, the existing challenges to approach an ethnic nose are clear. It requires skill and accurate surgical maneuvers to seek facial harmony while maintaining the characteristics that define the individual ethnicity and identity.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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How to Harmonize the Ethnic Nose

Facial plast Surg 2016; 32: 620-624
DOI: 10.1055/s-0036-1597660

The demand for cosmetic surgery has significantly increased in the past few years mainly due to economic rise witnessed in Brazil. The state of Bahia has predominately Afro-descendant population with the same countrywide scenario, where the surgeon must be able to face challenges such as the specifics demands of rhinoplasty in an ethnic nose. It represents not only a different nasal variety from the Caucasoid, but also a complex anatomical feature, with its own peculiarities, as thicker and oilier skin, with bulky fibrous fatty tissue with numerous sebaceous glands. The nose tip features both inadequate projection and definition, including a short columella and underdeveloped nasal spine. The lower lateral cartilages are lower and thinner if compared with Caucasian noses. The nasal septum is short and fragile, whereas the dorsum is low and wide with deep nasion and wide obtuse angles between nasal bones. Finally, yet importantly, the nose base has increased interalar distance and excess of alar wing, with an ovoid, horizontal, and open nostril. Considering all these uniqueness, the existing challenges to approach an ethnic nose are clear. It requires skill and accurate surgical maneuvers to seek facial harmony while maintaining the characteristics that define the individual ethnicity and identity.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Transpalpebral Eyebrow Lift

Facial plast Surg 2016; 32: 631-635
DOI: 10.1055/s-0036-1596048

Forehead rejuvenation goals are to raise the eyebrow, attenuate forehead wrinkles, and decrease glabellar frown lines. Endoscopic forehead lift represents a significant progress, even replacing the classic coronal and pretriquial techniques. The transpalpebral eyebrow lift allows safe direct visualization of anatomic structures comparable to the allowed by the endoscopic-assisted technique but dispenses the endoscopic instrumentation, is less expensive, and takes less time to learn. Transpalpebral eyebrow lift is a technique that produces satisfactory results in mild-to-moderate eyebrow ptosis improving eyebrow lateral third ptosis and glabellar wrinkles.
[...]

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Transpalpebral Eyebrow Lift

Facial plast Surg 2016; 32: 631-635
DOI: 10.1055/s-0036-1596048

Forehead rejuvenation goals are to raise the eyebrow, attenuate forehead wrinkles, and decrease glabellar frown lines. Endoscopic forehead lift represents a significant progress, even replacing the classic coronal and pretriquial techniques. The transpalpebral eyebrow lift allows safe direct visualization of anatomic structures comparable to the allowed by the endoscopic-assisted technique but dispenses the endoscopic instrumentation, is less expensive, and takes less time to learn. Transpalpebral eyebrow lift is a technique that produces satisfactory results in mild-to-moderate eyebrow ptosis improving eyebrow lateral third ptosis and glabellar wrinkles.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Endoscopic Brow Elevation and Reshaping

Facial plast Surg 2016; 32: 607-614
DOI: 10.1055/s-0036-1594255

One of the first signs of aging belongs to the upper third of the face. At the same time, the height and shape of the eyebrows are key points of the periorbital aesthetics. A "tired" or "sad" look implies that the complex eyebrow–upper eyelid are showing one or more of these signs. Different surgical techniques as well as nonsurgical have been described to treat this area, every one of them aiming at making the patient look rested and natural. The objective of this study is to describe a technique for endoscopic browlifting, consisting of minimal incisions, a biplanar dissection, and a different fixation technique designed for helping reshape the brow. Twenty-five patients who fulfilled the criteria for the study were analyzed for brow-position changes in height and shape. All the patients were treated by the senior authors using the technique described. This particular surgical technique has shown the advantage of being minimally invasive and effective. Careful analysis of the patient should be made to decide both the technique and the changes desired by the patient and the surgeon. The authors believe the technique described is another option for approaching and fixating the eyebrow.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Endoscopic Brow Elevation and Reshaping

Facial plast Surg 2016; 32: 607-614
DOI: 10.1055/s-0036-1594255

One of the first signs of aging belongs to the upper third of the face. At the same time, the height and shape of the eyebrows are key points of the periorbital aesthetics. A "tired" or "sad" look implies that the complex eyebrow–upper eyelid are showing one or more of these signs. Different surgical techniques as well as nonsurgical have been described to treat this area, every one of them aiming at making the patient look rested and natural. The objective of this study is to describe a technique for endoscopic browlifting, consisting of minimal incisions, a biplanar dissection, and a different fixation technique designed for helping reshape the brow. Twenty-five patients who fulfilled the criteria for the study were analyzed for brow-position changes in height and shape. All the patients were treated by the senior authors using the technique described. This particular surgical technique has shown the advantage of being minimally invasive and effective. Careful analysis of the patient should be made to decide both the technique and the changes desired by the patient and the surgeon. The authors believe the technique described is another option for approaching and fixating the eyebrow.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Rebuilding the Middle Vault in Rhinoplasty: A New Classification of Spreader Flaps/Grafts

Facial plast Surg 2016; 32: 638-645
DOI: 10.1055/s-0036-1597144

After hump removal in reduction rhinoplasty, one of the main steps is to rebuild the middle vault. Spreader grafts have long been the main tool for the surgeon. Within the last two decades, the spreader flaps have started to be very popular as well. In accordance with the experience and technical preferences of the surgeon, there are many different options. In this article, the spreader grafts are classified as traditional, modified, splinting, and reconstructive. The spreader flaps are designed in accordance with their relationship with the septum and the spreader grafts.
[...]

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Rebuilding the Middle Vault in Rhinoplasty: A New Classification of Spreader Flaps/Grafts

Facial plast Surg 2016; 32: 638-645
DOI: 10.1055/s-0036-1597144

After hump removal in reduction rhinoplasty, one of the main steps is to rebuild the middle vault. Spreader grafts have long been the main tool for the surgeon. Within the last two decades, the spreader flaps have started to be very popular as well. In accordance with the experience and technical preferences of the surgeon, there are many different options. In this article, the spreader grafts are classified as traditional, modified, splinting, and reconstructive. The spreader flaps are designed in accordance with their relationship with the septum and the spreader grafts.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Treatment Strategy for Revision Rhinoplasty in Asians

Facial plast Surg 2016; 32: 615-619
DOI: 10.1055/s-0036-1594254

Revision rhinoplasty in Asian patients is associated with problems related to the use of grafts or implant materials. Moreover, the septal cartilage of Asian individuals is generally weak and small, which makes it particularly vulnerable to injury or secondary deformity during primary surgery. Hence, there is an increased demand for major reconstruction of the septal cartilage framework during revision surgery in Asian patients. In revision rhinoplasty of the nose in Asian patients, appropriate management of the graft or implant is vital. The common problems resulting in the need for revision surgery include displacement, malposition, extrusion, recurrent inflammation, and infection of dorsally implanted alloplastic material. A short-nose deformity following silicone rhinoplasty is also a common problem that is difficult to manage. Furthermore, residual or recurrent deviation of the deviated nose, undercorrection of the convex nasal dorsum, and tip graft-related complications are frequently encountered problems that require revision. In revision rhinoplasty for Asian patients, autologous tissues, such as conchal cartilage and costal cartilage, play a pivotal role for use as a new dorsal implant or building block for major septal reconstruction. Therefore, it is imperative for surgeons to familiarize themselves with the appropriate use of autologous tissues, particularly costal cartilage.
[...]

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Treatment Strategy for Revision Rhinoplasty in Asians

Facial plast Surg 2016; 32: 615-619
DOI: 10.1055/s-0036-1594254

Revision rhinoplasty in Asian patients is associated with problems related to the use of grafts or implant materials. Moreover, the septal cartilage of Asian individuals is generally weak and small, which makes it particularly vulnerable to injury or secondary deformity during primary surgery. Hence, there is an increased demand for major reconstruction of the septal cartilage framework during revision surgery in Asian patients. In revision rhinoplasty of the nose in Asian patients, appropriate management of the graft or implant is vital. The common problems resulting in the need for revision surgery include displacement, malposition, extrusion, recurrent inflammation, and infection of dorsally implanted alloplastic material. A short-nose deformity following silicone rhinoplasty is also a common problem that is difficult to manage. Furthermore, residual or recurrent deviation of the deviated nose, undercorrection of the convex nasal dorsum, and tip graft-related complications are frequently encountered problems that require revision. In revision rhinoplasty for Asian patients, autologous tissues, such as conchal cartilage and costal cartilage, play a pivotal role for use as a new dorsal implant or building block for major septal reconstruction. Therefore, it is imperative for surgeons to familiarize themselves with the appropriate use of autologous tissues, particularly costal cartilage.
[...]

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Isotretinoin Use in Thick-Skinned Rhinoplasty Patients

Facial plast Surg 2016; 32: 656-661
DOI: 10.1055/s-0036-1596045

One of the characteristics of mestizo patients can be the thick sebaceous skin associated with a poor osteocartilaginous underlying nasal structure. In spite of using a proper structural approach where grafts and sutures are used to define the nasal tip, frequently the results are suboptimal. Surgical techniques have been described to reduce the thickness of the skin-soft tissue envelope, but these frequently give unreliable results. The monitored use of isotretinoin given orally as a complement after performing a rhinoplasty can adequately control the production of the sebaceous glands and thin the skin-subcutaneous tissue envelope in a uniform fashion without compromising the underlying bony and cartilaginous structures of the nose. Patients ideally should be treated jointly with a dermatologist and be followed closely to monitor hepatic function. Follow-up after 2 years with pre- and postoperative pictures shows improved definition of the nasal tip and dramatic improvement on sebaceous gland production.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Isotretinoin Use in Thick-Skinned Rhinoplasty Patients

Facial plast Surg 2016; 32: 656-661
DOI: 10.1055/s-0036-1596045

One of the characteristics of mestizo patients can be the thick sebaceous skin associated with a poor osteocartilaginous underlying nasal structure. In spite of using a proper structural approach where grafts and sutures are used to define the nasal tip, frequently the results are suboptimal. Surgical techniques have been described to reduce the thickness of the skin-soft tissue envelope, but these frequently give unreliable results. The monitored use of isotretinoin given orally as a complement after performing a rhinoplasty can adequately control the production of the sebaceous glands and thin the skin-subcutaneous tissue envelope in a uniform fashion without compromising the underlying bony and cartilaginous structures of the nose. Patients ideally should be treated jointly with a dermatologist and be followed closely to monitor hepatic function. Follow-up after 2 years with pre- and postoperative pictures shows improved definition of the nasal tip and dramatic improvement on sebaceous gland production.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Table of contents  |  Abstract  |  Full text

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Use of “Submental Muscular Medialization and Suspension” to improve the Cervicomental Angle

Facial plast Surg 2016; 32: 625-630
DOI: 10.1055/s-0036-1594259

Many techniques have been presented over recent decades to address the neck contour in facial cosmetic surgery. Despite advances, limitations remain when dealing with the obtuse cervicomental angle. The authors describe a technique for improving the obtuse cervicomental angle. Submental muscular medialization and suspension is a simple yet highly effective surgical technique that can result in dramatic and enduring improvement in the cervicomental angle.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Use of “Submental Muscular Medialization and Suspension” to improve the Cervicomental Angle

Facial plast Surg 2016; 32: 625-630
DOI: 10.1055/s-0036-1594259

Many techniques have been presented over recent decades to address the neck contour in facial cosmetic surgery. Despite advances, limitations remain when dealing with the obtuse cervicomental angle. The authors describe a technique for improving the obtuse cervicomental angle. Submental muscular medialization and suspension is a simple yet highly effective surgical technique that can result in dramatic and enduring improvement in the cervicomental angle.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Dome Division: A Viable Technique Today?

Facial plast Surg 2016; 32: 664-670
DOI: 10.1055/s-0036-1593748

Dome division can still be regarded as a valid surgical procedure today in some particular cases of revision rhinoplasty where the scarring is so extensive as to make precise isolation of the alar cartilages impossible. The presence of asymmetry of the nasal tip, a recurrent feature in the results of rhinoplasty, constitutes the primary indication, as division makes it immediately possible to restore balance between the two domes in such cases. The technique also proves useful in cases of overprojection of the tip as a result of rhinoplasty. Moreover, the procedure has been improved by precise suturing of the cartilaginous stumps so as to avoid its frequently reported complications, arising essentially from the vulnerability of the domal arch to the distorting forces of cicatricial retraction and its resulting lack of stability over time. In this connection, the authors attach crucial importance to direct suturing of the cartilaginous stumps in accordance with a now standardized method that is easy to execute and offers lasting, stable results. This approach makes it possible to re-establish continuity of the cartilaginous domal arch in a form unquestionably closer to the physiological anatomical conformation.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Dome Division: A Viable Technique Today?

Facial plast Surg 2016; 32: 664-670
DOI: 10.1055/s-0036-1593748

Dome division can still be regarded as a valid surgical procedure today in some particular cases of revision rhinoplasty where the scarring is so extensive as to make precise isolation of the alar cartilages impossible. The presence of asymmetry of the nasal tip, a recurrent feature in the results of rhinoplasty, constitutes the primary indication, as division makes it immediately possible to restore balance between the two domes in such cases. The technique also proves useful in cases of overprojection of the tip as a result of rhinoplasty. Moreover, the procedure has been improved by precise suturing of the cartilaginous stumps so as to avoid its frequently reported complications, arising essentially from the vulnerability of the domal arch to the distorting forces of cicatricial retraction and its resulting lack of stability over time. In this connection, the authors attach crucial importance to direct suturing of the cartilaginous stumps in accordance with a now standardized method that is easy to execute and offers lasting, stable results. This approach makes it possible to re-establish continuity of the cartilaginous domal arch in a form unquestionably closer to the physiological anatomical conformation.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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The Facial Adipose Tissue: A Revision

Facial plast Surg 2016; 32: 671-682
DOI: 10.1055/s-0036-1596046

Recent advantages in the anatomical understanding of the face have turned the focus toward the subcutaneous and deep facial fat compartments. During facial aging, these fat-filled compartments undergo substantial changes along with other structures in the face. Soft tissue filler and fat grafting are valid methods to fight the signs of facial aging, but little is known about their precise effect on the facial fat. This narrative review summarizes the current knowledge about the facial fat compartments in terms of anatomical location, histologic appearance, immune-histochemical characteristics, cellular interactions, and therapeutic options. Three different types of facial adipose tissue can be identified, which are located either superficially (dermal white adipose tissue) or deep (subcutaneous white adipose tissue): fibrous (perioral locations), structural (major parts of the midface), and deposit (buccal fat pad and deep temporal fat pad). These various fat types differ in the size of the adipocytes and the collagenous composition of their extracellular matrix and thus in their mechanical properties. Minimal invasive (e.g., soft tissue fillers or fat grafting) and surgical interventions aiming to restore the youthful face have to account for the different fat properties in various facial areas. However, little is known about the macro- and microscopic characteristics of the facial fat tissue in different compartments and future studies are needed to reveal new insights to better understand the process of aging and how to fight its signs best.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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The Facial Adipose Tissue: A Revision

Facial plast Surg 2016; 32: 671-682
DOI: 10.1055/s-0036-1596046

Recent advantages in the anatomical understanding of the face have turned the focus toward the subcutaneous and deep facial fat compartments. During facial aging, these fat-filled compartments undergo substantial changes along with other structures in the face. Soft tissue filler and fat grafting are valid methods to fight the signs of facial aging, but little is known about their precise effect on the facial fat. This narrative review summarizes the current knowledge about the facial fat compartments in terms of anatomical location, histologic appearance, immune-histochemical characteristics, cellular interactions, and therapeutic options. Three different types of facial adipose tissue can be identified, which are located either superficially (dermal white adipose tissue) or deep (subcutaneous white adipose tissue): fibrous (perioral locations), structural (major parts of the midface), and deposit (buccal fat pad and deep temporal fat pad). These various fat types differ in the size of the adipocytes and the collagenous composition of their extracellular matrix and thus in their mechanical properties. Minimal invasive (e.g., soft tissue fillers or fat grafting) and surgical interventions aiming to restore the youthful face have to account for the different fat properties in various facial areas. However, little is known about the macro- and microscopic characteristics of the facial fat tissue in different compartments and future studies are needed to reveal new insights to better understand the process of aging and how to fight its signs best.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Associations between Both Lignan and Yogurt Consumption and Cardiovascular Risk Parameters in an Elderly Population: Observations from a Cross-Sectional Approach in the PREDIMED Study

Publication date: Available online 29 December 2016
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Anna Creus-Cuadros, Anna Tresserra-Rimbau, Paola Quifer-Rada, Miguel Angel Martínez-González, Dolores Corella, Jordi Salas-Salvadó, Montse Fitó, Ramon Estruch, Enrique Gómez-Gracia, José Lapetra, Fernando Arós, Miquel Fiol, Emili Ros, Lluís Serra-Majem, Xavier Pintó, Juan José Moreno, Miguel Ruiz-Canela, Jose Vicente Sorli, Josep Basora, Helmut Schröder, Rosa Maria Lamuela-Raventós
BackgroundThe study of dietary patterns is gaining interest. Although the health benefits of yogurt and lignans have been investigated separately, to our knowledge there are no studies on their associative effects.ObjectiveThe aim of this study was to evaluate a possible association between yogurt and lignans using biomarkers of cardiovascular disease risk in an elderly population.DesignWe conducted a cross-sectional analysis of the association between baseline dietary information and cardiovascular risk parameters using food frequency questionnaires.ParticipantsWe enrolled 7,169 Spanish participants of the PREDIMED (Prevención con Dieta Mediterránea) study (elderly men and women at high cardiovascular risk) from June 2003 to June 2009.Main outcome measuresCardiovascular risk parameters, including cholesterol, triglycerides, glucose, body mass index, weight, waist circumference, and blood pressure were measured.Statistical analysisGeneral linear models were used to assess the relationship between categorical variables (yogurt, total dairy intake, lignans, and yogurt plus lignans) and cardiovascular risk parameters.ResultsThe consumption of either yogurt or lignans seems to have beneficial effects on human health, but the consumption of both showed greater improvement in some cardiovascular health parameters. Indeed, participants with a higher consumption of both yogurt and lignans showed lower total cholesterol (estimated β-coefficients=−6.18; P=0.001) and low-density lipoprotein cholesterol levels (β=−4.92; P=0.005). In contrast, participants with lower yogurt and lignan consumption had a higher body mass index (β=0.28; P=0.007) and weight (β=1.20; P=0.008).ConclusionsHigh lignan and yogurt consumption is associated with a better cardiovascular risk parameters profile in an elderly Mediterranean population. Further research is warranted to determine the mechanisms and consequences of this potential effect.



http://ift.tt/2iwmw1U

The immune infiltrate in prostate, bladder and testicular tumors: an old friend for new challenges

Publication date: Available online 30 December 2016
Source:Cancer Treatment Reviews
Author(s): Cinzia Solinas, Nieves Martinez Chanzá, Ahmad Awada, Mario Scartozzi
In genito-urinary tumors immunotherapy has been administered for a long time: Calmette-Guèrin Bacillus as adjuvant treatment in high risk patients with non-muscle invasive urothelial bladder cancer and interleukin-2 and interferon-α in metastatic kidney cancer. The vaccine Sipuleucel-T has been recently approved by United States Food and Drug Administration for the treatment of castration resistant prostate cancer patients with asymptomatic or minimally symptomatic disease, given the 22% reduction of mortality risk in this group. Recently immunotherapeutic agents targeting inhibitory immune checkpoint molecules lead to improved outcomes and lasting anti-tumor effects in a variety of hematological and solid malignancies, including urogenital tumors. The benefit from these treatments has been observed in a proportion of subjects, raising a need in optimizing patients' selection. The composition and activity of a pre-existing immune infiltrate may aid in identifying ideal candidates to immunotherapy, with possible implications for the clinical management of neoplastic diseases from earlier to later stages.



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Impact of targeted therapies in metastatic renal cell carcinoma on patient-reported outcomes: methodology of clinical trials and clinical benefit

Publication date: Available online 30 December 2016
Source:Cancer Treatment Reviews
Author(s): M. Dos Santos, P.E. Brachet, C. Chevreau, F. Joly
BackgroundMolecular targeted therapies have improved progression-free survival (PFS) without translating systematically into overall survival (OS) for patients with metastatic renal cell carcinoma (mRCC). In this population, patient-reported outcomes (PROs) have become a significant outcome. We evaluated the methodological quality of the assessment of PROs in randomised controlled trials (RCTs) and the clinical benefit of the different treatments including survival and quality of life (QoL).MethodsA systematic review identified RCTs published between January 2005 and July 2014. They were evaluated according to 11 items derived from the 2013 CONSORT PROs reporting guidelines. Survival outcomes and PROs main results were analysed and the magnitude of clinical benefit was assessed with the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS).Results12 RCTs were included with a total of 22 publications. The mean CONSORT score for all items was 4.5 on an 11-point scale. No publication reported the power of the PROs analysis and only one reported a PRO hypothesis. 50% of studies did not interpret PROs in relation to clinical outcomes and only 18% discussed specific limitations of PROs and their implications for generalizability. By adding the QoL criterion to PFS, 4 trials (36.4%) obtained a high level of proven clinical benefit according to the ESMO-MCBS.ConclusionThe methodology for assessing PROs in mRCC is not optimal. Efforts should focus on defining PROs endpoint and increasing the quality of reporting of QoL.New-generation therapies in mRCC should demonstrate a gain not only in survival but also in QoL to be included in the therapeutic arsenal.



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Exploring the possible mechanisms of blunted cardiac reactivity to acute psychological stress

Publication date: Available online 30 December 2016
Source:International Journal of Psychophysiology
Author(s): Ryan C. Brindle, Anna C. Whittaker, Adam Bibbey, Douglas Carroll, Annie T. Ginty
Blunted cardiovascular reactivity to acute psychological stress has been linked to a range of adverse health and behavioral outcomes. However, the origins of blunted reactivity remain unclear. The current study aimed to explore the following possibilities: different appraisals of task stressfulness and/or difficulty, diminished task effort, or reduced physiological capacity to respond. Individuals characterized, via pre-screening, as blunted (n=17) or exaggerated (n=16) heart rate (HR) reactors to acute psychological stress (socially evaluative mental arithmetic) were exposed to a psychological stress, cold pressor and exercise tasks during a follow-up testing session while HR and blood pressure (BP) were measured. At follow-up, groups again mounted significantly different HR reactions to psychological stress, despite reporting similar levels of subjective stress and difficulty, and achieving similar tasks scores (measure of task effort) at both testing sessions. In response to the cold pressor and exercise blunted and exaggerated reactors displayed similar HR and BP responses. Results indicated that blunted reactors do not differ from exaggerated reactors on appraisals of task stressfulness or difficulty, or objective task effort, and do possess the physiological capacity to respond to other laboratory challenges. Other sources of blunted stress reactivity remain to be explored.



http://ift.tt/2ijHrWh

Local recurrence of cutaneous mixed tumor (chondroid syringoma) as malignant mixed tumor of the thumb 20 years after initial diagnosis

ABSTRACT

Benign cutaneous mixed tumor (chondroid syringoma) is the cutaneous counterpart of the benign mixed tumor (pleomorphic adenoma) of salivary glands, consisting of both epithelial and mesenchymal elements. The incidence of cutaneous mixed tumor is rare, composing < 0.01% of all primary skin tumors. Herein, we report a case of malignant mixed tumor which recurred in the right thumb 20 years after the reported initial diagnosis of a benign mixed tumor at this site. Histologically, the lesion consisted of highly atypical and infiltrative cells in cords and ductal structures, with an adjacent focus of residual benign mixed tumor present. Perineural invasion of multiple dermal and subcutaneous nerves was also seen. . Immunohistochemical staining was strongly and diffusely positive for CK5/6 and p63, with patchy positive S100 and CK7 staining. Wide excision was performed, with no evidence of recurrence or over metastasis five years later.

http://ift.tt/2ijM4Q1

Extra-acral cutaneous sclerosing perineurioma with CD34 fingerprint pattern.

Abstract

Sclerosing perineuroma is a variant of extraneural perineurioma that, as a rule, occurs in acral sites. However, it has also been occasionally reported in non-acral regions. Recently, CD34 expression in a pattern reminiscent of the human fingerprint has been observed in a subset of perineuriomas, but this immunohistochemical finding has not been documented in non-acral sclerosing perineuriomas. We report a case of sclerosing perineurioma presenting CD34 expression in a fingerprint-like pattern on the skin of the neck (a previously unreported site for this neoplasm) of a 56-year-old man. Additionally, alpha smooth-muscle actin showed a similar pattern of expression, suggesting that the cell population implicated in the remarkable immunolabeling is most likely fibroblastic/myofibroblastic. Other immunohistochemical findings included EMA and claudin1 - positive lesional cells, and the absence of S100, GLUT1, MUC4, and desmin.

http://ift.tt/2io8i6h

A Rare Case of Cutaneous Oncocytic Hidradenoma

Abstract

Oncocytes are epithelial cells characterized by their abundant eosinophilic and finely granular cytoplasm. Their histologic appearance is due to excessive amounts of cytoplasmic mitochondria. Oncocytes generally occur in the setting of benign neoplasms. Oncocytomas, or tumors composed primarily of oncocytes, are typically found in the kidneys. Other common sites include the salivary, thyroid, and parathyroid glands. Oncocytic metaplasia has only been rarely reported in various cutaneous neoplasms. We report a case of an elderly male presenting with a 5 millimeter erythematous papule on his left scalp, who underwent a shave biopsy showing a nodular, dermal-based adnexal tumor with prominent ductal differentiation, composed of multiple small, well-formed lumina surrounded by enlarged, bland-appearing epithelioid cells. CK7, EMA, and mCEA immunohistochemical stains were positive, consistent with adnexal differentiation. PTAH and LFB stains highlighted the cytoplasmic granules, consistent with mitochondria. The overall findings were consistent with oncocytic nodular hidradenoma. Oncocytic hidradenoma is a very rare entity, with only 1 previously reported case in the literature.

http://ift.tt/2ijNM43

MRI-guided functional anatomy approach to prostate brachytherapy

Publication date: Available online 29 December 2016
Source:Brachytherapy
Author(s): Payal D. Soni, Alejandro Berlin, Aradhana M. Venkatesan, Patrick W. McLaughlin
PurposeTo provide an MRI based functional anatomy guide to prostate brachytherapy.Methods and MaterialsWe performed a narrative review of periprostatic functional anatomy and the significance of this anatomy in prostate brachytherapy treatment planning.ResultsMRI has improved delineation of gross tumor and critical periprostatic structures that have been implicated in toxicity. Furthermore, MRI has revealed the significant anatomic variants and the dynamic nature of these structures that can have significant implications for treatment planning and dosimetry.ConclusionsThe MRI-based functional anatomy approach to prostate brachytherapy takes into account extent of disease, its relation to the patient's individual anatomy, and functional baseline to optimize the therapeutic ratio of prostate cancer treatment.



http://ift.tt/2iKSKFV

Lipid Desaturation Is a Metabolic Marker and Therapeutic Target of Ovarian Cancer Stem Cells

Publication date: Available online 29 December 2016
Source:Cell Stem Cell
Author(s): Junjie Li, Salvatore Condello, Jessica Thomes-Pepin, Xiaoxiao Ma, Yu Xia, Thomas D. Hurley, Daniela Matei, Ji-Xin Cheng
Lack of sensitive single-cell analysis tools has limited the characterization of metabolic activity in cancer stem cells. By hyperspectral-stimulated Raman scattering imaging of single living cells and mass spectrometry analysis of extracted lipids, we report here significantly increased levels of unsaturated lipids in ovarian cancer stem cells (CSCs) as compared to non-CSCs. Higher lipid unsaturation levels were also detected in CSC-enriched spheroids compared to monolayer cultures of ovarian cancer cell lines or primary cells. Inhibition of lipid desaturases effectively eliminated CSCs, suppressed sphere formation in vitro, and blocked tumor initiation capacity in vivo. Mechanistically, we demonstrate that nuclear factor κB (NF-κB) directly regulates the expression levels of lipid desaturases, and inhibition of desaturases blocks NF-κB signaling. Collectively, our findings reveal that increased lipid unsaturation is a metabolic marker for ovarian CSCs and a target for CSC-specific therapy.

Graphical abstract

Teaser

Cheng and colleagues using Raman spectroscopic imaging find that ovarian cancer stem cells contain unusually high levels of unsaturated lipids and show evidence that this metabolic difference could be used as a marker for these cells and as a new target for CSC-specific therapy.


http://ift.tt/2ie3Y9b

Induction of Expansion and Folding in Human Cerebral Organoids

Publication date: Available online 29 December 2016
Source:Cell Stem Cell
Author(s): Yun Li, Julien Muffat, Attya Omer, Irene Bosch, Madeline A. Lancaster, Mriganka Sur, Lee Gehrke, Juergen A. Knoblich, Rudolf Jaenisch
An expansion of the cerebral neocortex is thought to be the foundation for the unique intellectual abilities of humans. It has been suggested that an increase in the proliferative potential of neural progenitors (NPs) underlies the expansion of the cortex and its convoluted appearance. Here we show that increasing NP proliferation induces expansion and folding in an in vitro model of human corticogenesis. Deletion of PTEN stimulates proliferation and generates significantly larger and substantially folded cerebral organoids. This genetic modification allows sustained cell cycle re-entry, expansion of the progenitor population, and delayed neuronal differentiation, all key features of the developing human cortex. In contrast, Pten deletion in mouse organoids does not lead to folding. Finally, we utilized the expanded cerebral organoids to show that infection with Zika virus impairs cortical growth and folding. Our study provides new insights into the mechanisms regulating the structure and organization of the human cortex.

Graphical abstract

Teaser

The growth and structural formation of the human cortex can be modeled in vitro using cerebral organoids. In this article, Li, Muffat, and colleagues show that enhancing the PTEN-AKT signaling pathway leads to the generation of human cerebral organoids that are expanded in size and display surface folding.


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A Quiescent Bcl11b High Stem Cell Population Is Required for Maintenance of the Mammary Gland

Publication date: Available online 29 December 2016
Source:Cell Stem Cell
Author(s): Shang Cai, Tomer Kalisky, Debashis Sahoo, Piero Dalerba, Weiguo Feng, Yuan Lin, Dalong Qian, Angela Kong, Jeffrey Yu, Flora Wang, Elizabeth Y. Chen, Ferenc A. Scheeren, Angera H. Kuo, Shaheen S. Sikandar, Shigeo Hisamori, Linda J. van Weele, Diane Heiser, Sopheak Sim, Jessica Lam, Stephen Quake, Michael F. Clarke
Stem cells in many tissues sustain themselves by entering a quiescent state to avoid genomic insults and to prevent exhaustion caused by excessive proliferation. In the mammary gland, the identity and characteristics of quiescent epithelial stem cells are not clear. Here, we identify a quiescent mammary epithelial cell population expressing high levels of Bcl11b and located at the interface between luminal and basal cells. Bcl11b^high cells are enriched for cells that can regenerate mammary glands in secondary transplants. Loss of Bcl11b leads to a Cdkn2a-dependent exhaustion of ductal epithelium and loss of epithelial cell regenerative capacity. Gain- and loss-of-function studies show that Bcl11b induces cells to enter the G0 phase of the cell cycle and become quiescent. Taken together, these results suggest that Bcl11b acts as a central intrinsic regulator of mammary epithelial stem cell quiescence and exhaustion and is necessary for long-term maintenance of the mammary gland.

Graphical abstract

Teaser

Bcl11b interacts with cell-cycle regulators to induce a quiescent state. Cai et al. describe a quiescent mammary stem cell population labeled by Bcl11b and located at the luminal-basal interface that supports mammary gland regeneration. Bcl11b sustains this population by inducing cell-cycle regulators that promote the dormant state.


http://ift.tt/2ie6NXQ

O to Z local skin flap: The role for managing depressed facial scar after resolution of odontogenic source of infection

Amin Rahpeyma, Saeedeh Khajehahmadi

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):278-279



http://ift.tt/2hSI6x2

Cooling devices in laser therapy

Anupam Das, Aarti Sarda, Abhishek De

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):215-219

Cooling devices and methods are now integrated into most laser systems, with a view to protecting the epidermis, reducing pain and erythema and improving the efficacy of laser. On the basis of method employed, it can be divided into contact cooling and non-contact cooling. With respect to timing of irradiation of laser, the nomenclatures include pre-cooling, parallel cooling and post-cooling. The choice of the cooling device is dictated by the laser device, the physician's personal choice with respect to user-friendliness, comfort of the patient, the price and maintenance costs of the device. We hereby briefly review the various techniques of cooling, employed in laser practice.

http://ift.tt/2hSF4bW

Diode laser ear piercing: A novel technique

Bibilash Babu Suseela, Preethitha Babu, Ravi Kumar Chittoria, Devi Prasad Mohapatra

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):263-265

Earlobe piercing is a common office room procedure done by a plastic surgeon. Various methods of ear piercing have been described. In this article, we describe a novel method of laser ear piercing using the diode laser. An 18-year-old female patient underwent an ear piercing using a diode laser with a power of 2.0 W in continuous mode after topical local anaesthetic and pre-cooling. The diode laser was fast, safe, easy to use and highly effective way of ear piercing. The advantages we noticed while using the diode laser over conventional methods were more precision, minimal trauma with less chances of hypertrophy and keloids, no bleeding with coagulation effect of laser, less time taken compared to conventional method and less chance of infection due to thermal heat effect of laser.

http://ift.tt/2hB9HXl

Use of dermatoscope to monitor the repigmentation of various vitiligo surgical procedures

Balakrishnan Nirmal

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):286-287



http://ift.tt/2hAZSJ6

Overview of local flaps of the face for reconstruction of cutaneous malignancies: Single institutional experience of seventy cases

Jagdeep K Rao, Kaustubh Sharad Shende

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):220-225

Context: The most common malignant tumours of the face are basal cell carcinoma, squamous cell carcinoma and melanoma. While the results of skin graft are less than satisfactory for large areas to cover, distant flaps are bulky with a poor colour match. Local fasciocutaneous flaps provide reasonable option for reconstruction of facial defects with good colour and texture match and good success rate. Aims: This study aimed to analyse the various modalities of reconstruction after resection of facial malignancies and their advantages and disadvantages. Settings and Design: This was a retrospective study. Materials and Methods: Of 70 patients, 34 were managed with V-Y advancement flap, 24 with nasolabial flap, 8 with median forehead flap and 4 with standard forehead flap cover. The duration of follow-up ranged from 6 months to 2 years. Statistical Analysis Used: Nil. Results: Of 34 V-Y advancement flaps, 2 showed suture dehiscence at the apex of triangle which was allowed to heal secondarily with regular dressings. All the 24 nasolabial flaps were healthy without any complication. All patients had satisfactory functional and cosmetic outcomes. Conclusions: In our experience, local flaps give the best results and are the first choice for reconstruction of the face. Most defects can be best closed by nasolabial, V-Y advancement and forehead flap. Outstanding functional and cosmetic results can be achieved. Proper execution requires considerable technical skill and experience.

http://ift.tt/2hSCm68

Outcome of flap surgeries in dermatosurgical unit at a tertiary care centre in India with a review of literature

Gorur Kalappa Divya, Kanathur Shilpa, Sacchidanand Sarvajnamurthy, Eswari Loganathan, Biju Vasudevan, GB Chitrika, C Madhura, DV Lakshmi

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):226-231

Introduction: Flap surgeries are an excellent choice for closing large defects following trauma, excision of carcinomas or removal of large lesions. This article is a prospective interventional study of various flap surgeries performed at a tertiary care centre with their outcome in dermatosurgical unit. Materials and Methods: A total of 35 flap surgeries performed from January 2012 to December 2014 formed part of the study. Data were recorded for each case including age, sex, indications and type of flap surgery and any occurrence of complications. Results: Out of the 35 patients, basal cell carcinoma was the most common indication for surgery in 22 patients, followed by Bowen's disease in five, dermatofibroma in three and porocarcinoma in two. Other indications were squamous cell carcinoma, tuberous xanthoma, myxoid cyst and nevus sebaceous. Rhomboid flap and rotaion flap were done in 12 patients each, V-Y plasty in three patients, advancement flap, crescentic advancement flap and O-Z plasty were done in two patients each, O-Z plasty was done in two patients, A-T plasty and H plasty were done in one patient each. Common complications observed were flap necrosis seen in three patients and one patient developed hematoma on the second post-operative day, hypertrophic scar in one case and recurrence of BCC. Conclusion: Malignant and pre-malignant lesions were common indications in our study. Excellent outcome of flap surgeries promises to be a birdie stroke in the armamentarium of dermatosurgeons.

http://ift.tt/2hB04rE

Onychomatricoma: A case report with 5-year follow-up

Cleide Eiko Ishida, Bruna Melhoranse Gouveia, Tullia Cuzzi, Marcia Ramos-e-Silva

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):270-273

The authors present a case of onychomatricoma, a rare benign tumour of the nail matrix, first described by Baran and Kint in 1992. The lesion appeared on the proximal nail fold, covering half the nail of the second left finger. The nail was thickened and yellowish with longitudinal melanonychia. It was surgically removed with very satisfactory aesthetic results even after 5 years. A review on the subject is also presented.

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Reduction of blister formation time in suction blister epidermal grafting in vitiligo patients using a household hair dryer

Shweta Arora, Bikash Ranjan Kar

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):232-235

Background: Suction blister epidermal grafting (SBEG) is a simple and effective way of surgical repigmentation in vitiligo. The major problem faced is the time taken for the formation of blisters. Temperature at the suction site is one of the factors affecting the blister formation time. Aims and Objectives: To reduce the blister formation time in SBEG by increasing the surface temperature to 44°C. Materials and Methods: This is a left-right comparison study. Total seven patients with lip vitiligo involving both the angles of lips were enrolled. Suction syringes were applied on both the thighs of all the patients. On the right thigh, blisters were raised as per the procedure standardised by Gupta et al. On the left thigh, similar procedure was used, but a hair dryer was used additionally to increase the surface temperature of the skin to 44°C. The time taken for the formation of well-formed, dome-shaped, unilocular blister was noted. Results: The mean time taken for the formation of blister on the right thigh was 121.1 ± 6.2 min and on the left thigh was 69.6 ± 5.4 min. All the seven patients were started on PUVASOL after SBEG. There was complete repigmentation of the grafted sites in all the patients after 2 months. Conclusion: Hair dryer is easily available, affordable and simple to use and the time saved during the procedure is quite significant.

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Angiolymphoid hyperplasia with oeosinophilia showing promising result with intralesional radio-frequency ablation therapy: A new cost-effective and hassle-free modality of treatment

Chintaginjala Aruna, Senthil Kumar Alagappan, Ramamurthy Damaraju Venkata Satya Bhaskara, Sruthi Kondaveeti

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):281-283



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Comparative study to evaluate the efficacy of radiofrequency ablation versus trichloroacetic acid in the treatment of xanthelasma palpebrarum

Praveen Kumar Shanmugam Reddy, Sumathy Tharayil Kunneth, Shyam Prasad Arakali Lakshminarayana, Suparna Madivalara Yallappa, Ranganathan Chandrashekara, Shivaswamy Kanakapura Nanjundaswamy

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):236-240

Background: Xanthelasma palpebrarum (XP) is a metabolic disorder involving the eyelids. Radiofrequency(RF) surgery and trichloroacetic acid (TCA) applications have been listed among the procedures for XP, but comparative studies are not available. Aim: To compare the efficacy of radiofrequency surgery versus trichloroacetic acid application in the treatment of XP. Settings and Design: 20 consecutive cases of XP attending dermatology, medicine and endocrinology out-patient departments of M.S.Ramaiah teaching hospital were enrolled for the study. It was an open-label clinical trial conducted in our hospital for a duration of 1 year. Materials and Methods: 20 consecutive patients conforming to inclusion criteria were selected for the study. For each patient, lesions were treated with radiofrequency ablation on one side and TCA application on the other side. Results: RF ablation was done for 12 patients over right eye lesions and 8 patients over the left eye lesions. TCA applications were done for 8 patients over right eye lesions and 12 patients over left eye lesions. 70% of lesions treated with RF ablation had a score of improvement of 4 and 70% of lesions treated with TCA application had a score of improvement of 4, at 4 weeks of follow-up. At four weeks of follow-up 40% in RF group and 15% in TCA group had scarring and 45% in RF group and 30% in TCA group had pigmentation. Conclusion: RF ablation as compared to TCA application, required fewer sessions for achieving more than 75% clearance of lesions. However, TCA applications were associated with fewer complications comparatively.

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Crossing surgical borders: Where are we, where are we going and can we find the way?

Niti Khunger

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):213-214



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Papular acne scars of the nose and chin: An under-recognised variant of acne scarring

Faisal R Ali, Michael Kirk, Vishal Madan

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):241-243

Background: Scarring following acne vulgaris is common and can be of profound psychosocial consequence. Aims and Objectives: We have clinically noted a variant of acne scarring, overlooked by previous categorisation schemes, which we have denominated as papular acne scars of the nose and chin. We sought to characterise these novel entities further. Materials and Methods: Initially, we identified 14 patients with papular acne scars of the nose and chin in a cosmetic dermatology clinic, of whom two were female and rest were male. We then prospectively evaluated 100 consecutive patients attending our tertiary referral acne isotretinoin clinic and 49 patients attending a general dermatology clinic. Results: Amongst 149 patients, from a general dermatology and tertiary acne clinic, soft papular scars were noted in four patients, distributed on the nose and chin. Three of the four patients were male, three patients had additional acne scars and the median age was 23.5. Conclusions: We have identified 18 patients with papular acne scars of the nose and chin and propose that this new category should be added to acne scarring classification schemes. Future work should be directed at corroborating the epidemiology of such lesions and describing effective treatment modalities.

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Familial disseminated cutaneous glomuvenous malformation: Treatment with polidocanol sclerotherapy

Aditi Jha, Niti Khunger, K Malarvizhi, V Ramesh, Avninder Singh

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):266-269

Glomuvenous malformations (GVMs) present as asymptomatic multiple pink-to-blue nodules or plaques. Disseminated lesions are rare, representing 10% of all the cases. Familial cases are caused by mutations in the glomulin gene. A young male presented with multiple bluish-to-dusky red-coloured nodules 10-15 in numbers over the trunk, limbs and buttocks since 12 years of age. They ranged in size from 1 to 3 cm, partially to non-compressible and tender on palpation. There was no history of any systemic complaint. His sister and mother had similar lesions but in a limited distribution. Biopsy showed multiple ectatic dilated vascular channels lined by multiple layers of glomus cells consistent with the diagnosis of GVM. The biopsy of the lesions from the mother and sister also showed similar features. Mutation analysis for glomulin gene could not be done because of the unavailability of the facility at our setting. He underwent sclerotherapy with 3% polidocanol every 2 weeks, and there was significant improvement in the lesions after six sessions of sclerotherapy. The patient is under follow-up and there is no recurrence of the lesions over treated sites after 6 months.

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Outcome of dermal grafting in the management of atrophic facial scars

Kanathur Shilpa, S Sacchidanand, Budamakuntla Leelavathy, Padmanabha Shilpashree, Gorur Divya, Rammurthy Ranjitha, DV Lakshmi

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):244-248

Background: Scars over the face are cosmetically and psychologically disturbing. Various techniques have been described and are being practiced in the management of these scars. Aims and Objectives: This study was undertaken to study the safety, effectiveness of using dermal grafts as fillers in the management of facial scars due to acne, chickenpox, trauma or any others. Materials and Methods: Fifteen patients with atrophic facial scars of varied aetiology and willing for surgery were considered for dermal graft technique. After pre-operative workup, subcision was done 2 weeks before planned surgery. Depending on the type of scar, grafts were inserted using pocket or road railing techniques. Scar improvement was assessed based on patient satisfaction. Results: Linear scars showed excellent improvement. Acne, varicella and traumatic scars also showed good improvement. However, two patients did not appreciate improvement due to marked surface irregularities as the scars were elevated. They were further subjected to LASER and chemical peel resurfacing. Conclusion: Dermal grafting can be used in the management of any round to oval facial scar which is soft, prominent and at least 4-5 mm across; linear scars at least 2-3 mm across and 3-4 cm in length. However, scars with prominent surface irregularities need further resurfacing techniques along with dermal grafting. Limitations: Limitations of the study include small sample size, and only subjective assessment of the scar has been taken into consideration to assess the outcome.

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It is the cooperation, stupid!

Somesh Gupta

Journal of Cutaneous and Aesthetic Surgery 2016 9(4):274-277

The rise of aesthetics in medicine has resulted from society's acknowledgement of the importance of physical beauty. This has led to an emerging conflict between allied specialties. The author introduces the concept of "Aesthetic Socialism" according to which everyone should have an opportunity to enhance or restore the beauty where it is missing or when it is lost due to disease, trauma or ageing. However, there are multiple aspects of aesthetics, which can not be addressed by a single specialty, therefore author recommends interdisciplinary cooperation rather than conflict to achieve aesthetic socialism.

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