Cutaneous complications associated with breast augmentation: A review.

Breast augmentation is one of the most popular and safe cosmetic procedures performed by plastic surgeons worldwide. Although breast implants are available in a number of different materials, silicone-filled implants remain the most common type. However, prior to the development of breast implants, various materials were injected into the soft tissues of the breasts to increase breast volume, which caused cutaneous complications and disfigurement. This review details the history of breast augmentation, the current methods used in augmentation surgery, and associated cutaneous complications.

Analysis of the cephalometric changes in the first 3 months after spring-assisted cranioplasty for scaphocephaly.

BACKGROUND: Spring-assisted cranioplasty (SAC) has become an accepted treatment for patients with sagittal craniosynostosis; however, the early effects of springs on skull dimensions have never been assessed with objective measurements in the literature. The present study evaluated the changes in skull dimensions and intracranial volume (ICV) during the first 3 months after SAC for sagittal synostosis. METHODS: Sixteen patients with sagittal synostosis underwent SAC. The cephalic index (CI) and the distance between the spring foot plates were chronologically measured until spring removal at 3 months. Pre- and post-treatment CT scans available for 6 patients were used to assess changes in head shape. Thirteen patients underwent objective aesthetic assessment using pre- and post-operative photographs. Statistical analysis was performed using the linear mixed model for chronological data, t-test statistics for normative data comparisons and Wilcoxon's signed rank test for non-parametric data. RESULTS: For scaphocephalic patients, pre-operative and post-operative CIs were 0.70 and 0.74 (p = 0.001), respectively. Cranial widening towards normative values was observed (p = 0.0005). A continuous expansion in the distance between the spring foot plates was observed over the treatment period. Frontal and occipital angles were not affected by SAC despite apparent clinical improvements in frontal bossing and occipital prominence. CT analysis demonstrated relative reduction in the anterior cranial volume (p = 0.01) and relative expansion of the superior occipital volume (p = 0.03). CONCLUSIONS: Spring expansion was most marked in the hours following spring insertion. The expansion rate reduced to the minimum by day 1 post-operatively. Clinical benefits of SAC resulted from an increase in the bi-temporal width that camouflaged the frontal bossing. Improvement in occipital prominence was due to superior occipital volume expansion, allowing the occiput to remodel to a more rounded shape.

Sialoblastoma arising in ectopic salivary gland tissue.

Sialoblastoma is a rare, congenital or perinatal tumour predominately affecting the parotid or submandibular salivary glands. We report a case of sialoblastoma arising in ectopic salivary gland tissue in the anterior cheek of a female infant. This lesion clinically and on ultrasound mimicked a haemangioma. Following imaging and tissue diagnosis, the lesion was surgically excised with clear margins. The patient remained disease free at 6 months follow up.

Vascular endothelial growth factor gene therapy in ischaemic rat skin flaps.

Gene therapy with the complementary DNA (cDNA) of the angiogenic cytokine vascular endothelial growth factor (VEGF) has emerged as a promising strategy in the treatment of myocardial and lower-limb ischaemia. The objective of this study was to determine whether these principles could be applied to a recognised model of skin-flap ischaemia. Plasmid vectors including the cDNA of green fluorescent protein (GFP) and one of three VEGF isoforms (A165, B167 or B186) were constructed, and their base sequences confirmed. GFP expression was used as a marker of successful in vitro transfection of human endothelial cells with each plasmid. The plasmids were then administered subcutaneously to rat abdominal skin flaps surgically rendered ischaemic, and the percentage of viable tissue was assessed at 1 week. Angiograms of the flaps and histological preparations of flap tissue were assessed for evidence of angiogenesis. The survival of flaps treated with VEGF A165 or B167 cDNA was significantly greater than that of controls (P < 0.05). The survival of flaps treated with VEGF B186 cDNA was greater than that of controls, but statistical significance was not reached. Angiograms and microvessel density counts failed to produce evidence of angiogenesis. With improved delivery strategies, VEGF may have a role in the management of surgical ischaemia.

Lead adsorption onto "red soils" as function of environmental conditions.

The adsorption characteristics of the "Red Soil" with respect to lead were studied as function of different experimental conditions. Lead adsorption was investigated as function of the complexing capacity of the liquid phase (background electrolyte NaClO4, NaCl, CH3COONa e EDTA), pH (experimental range 4-7) and ionic strength (experimental range 0.001-0.35 M), by determining the adsorption isotherms at the different conditions. Experimental results allowed to identify the presence of different sorption sites, acting on lead removal through different mechanisms (ion exchange and surface complexation). These sorption sites are differently affected by changing the experimental conditions. Adsorption representation in terms of free metal was not able to describe the experimental behaviour, especially when different charged species can be formed and might be sorbed at the surface with different affinities. Particular attention was given to the optimisation of the experimental system based on the flow-through reactor set-up, in order to carry out adsorption tests more representative of the field situation.

Resistance forces acting on suture needles.

Understanding the resistance forces encountered by a suture needle during tissue penetration is important for the development of robotic surgical devices and virtual reality surgical simulators. Tensile forces applied to skin and tendon during suturing were measured. Fresh sheep achilles tendons were tensioned with a static load 4.9 N, 9.8 N or 19.6 N and sheepskin with 0.98 N, 2.9 N or 4.9 N static load. A straight 2/0 cutting suture needle in series with a load cell on a materials testing machine penetrated the tissue at 90 degrees with a velocity of 1, 5 or 10mm/s for each tissue tension (n=5). Continuous load versus displacement data was obtained and penetration load and stiffness were noted. The load versus displacement curve for skin during needle penetration demonstrated two characteristic peaks, corresponding to initial penetration and emergence of needle from the undersurface of the tissue. Increasing the tension within the tissue (skin and tendon) increased the amount of force required to penetrate the tissue with a suture needle (p<0.05). Needle displacement rate did not affect the resistance to needle penetration (p<0.05). This study provides a simple model for measuring force-feedback during needle penetration of soft tissues and is a good starting point for future studies of the penetration resistance properties of human tissues.

Grasper trauma during laparoscopic cholecystectomy.

BACKGROUND: The present study characterized the histopathological nature of laparoscopic grasper trauma during laparoscopic cholecystectomy in a prospective, blinded trial in order to establish a model for laparoscopic grasper trauma. The null hypothesis that graspers cause no histologically distinct tissue injury was tested. METHODS: The gall bladders of 19 patients undergoing laparoscopic cholecystectomy were examined. The area of gall bladder that had been grasped by Debakey laparoscopic forceps was excised (sample), along with an area of gall bladder that had not been grasped (control). Paired specimens were examined by a pathologist (blinded) to identify which was 'sample' and which was 'control' and to assess for histological markers of crushed tissue injury. The data were analysed by chi-squared or Fisher's exact tests. RESULTS: The pathologist was able to identify the sample (gripped) specimen in 13 of the 19 cases. In the remaining six cases the pathologist was unable to determine the specimen that had been gripped due to either absence of damage (four cases), or severe inflammation precluding assessment (two cases). The ability of the pathologist to distinguish the sample from the control specimen was significant (chi-squared test, P = 0.003). Of the histological markers of crushed tissue injury, focal thinning of the gall bladder wall and epithelial loss were present in significantly more sample (gripped) specimens than control specimens (chi-squared test, P = 0.0002 and P < 0.0001, respectively). CONCLUSIONS: Laparoscopic graspers cause tissue trauma that can be assessed histologically. The current study presents a relevant, reproducible, ethically acceptable human model for assessing the interaction between laparoscopic graspers and soft tissues.

Patterns of failure at the instrument-tissue interface.

BACKGROUND: The effect of jaw design on grip security and tissue trauma is poorly understood. This project establishes an in vitro model of the instrument-tissue interface. MATERIALS AND METHODS: Aluminum jaws with teeth of differing size and shape gripped fresh sheep stomach with variable apposing (squeeze) pressure. The tissue was extracted at a rate of 50 mm/min until either the grip or the tissue failed. The load at which the grip failed, the maximum (peak) load generated, and the mode of failure were noted. The data were analyzed using ANOVA and a post hoc Duncan's multiple range test when appropriate. RESULTS: Increasing the apposing pressure increased grip security. Grip security of 1- and 2-mm pitch teeth were significantly greater than for plane jaws and smaller-pitch teeth (P < 0.001). Of the wave pattern jaws, 2-mm pitch waves also had significantly greater grip security than plane jaws and smaller pitch waves (P < 0.01). Wave pattern jaws produced significantly less tissue trauma than teeth (P < 0.0001). CONCLUSIONS: Increasing the size of instrument teeth increases grip security but at the expense of tissue trauma. Wave pattern jaws result in significantly less tissue trauma than teeth. This model measures grip security precisely and allows for comparison between jaws of different patterns.

Does the sheep mandible relapse following lengthening by distraction osteogenesis?

AIM: Distraction osteogenesis is a technique used to lengthen the shortened mandible. However, the long term stability of the distracted mandibular bone is not known. The aim of this study was to assess if the sheep mandible relapses following lengthening, and to assess the quality of distracted bone up to 1 year post lengthening. METHODS: Twenty-four sheep had bilateral external mandibular distractors applied, with three sheep as controls. Titanium marker screws were positioned both proximal and distal to the distraction zone in all sheep. Following a 5 day latency period, the interdental gap was distracted 1 mm/day for 20 days, with a subsequent 20 day consolidation period. Ante-mortem serial X-rays were used to assess for relapse by measuring the distance between the screws. The animals were sacrificed at either 3, 6, 9 or 12 months post-distraction. At post mortem, the distance between the screws was re-measured. The distracted bone was assessed mechanically and histologically. RESULTS: The mean mandibular lengthening obtained was 13.2 mm. There was no relapse of the mandible over 12 months. The distracted bone had attained the strength and stiffness of undistracted bone by 6 months post-distraction (p < 0.05). Histological evaluation revealed significant amounts of lamellar bone by 6 months post-distraction. CONCLUSIONS: No relapse occurred for 12 months post distraction lengthening. The bone formed following distraction was stable and of good quality. These findings lend support to the use of distraction osteogenesis in clinical practice.

Studies on mosquitoes (Diptera:Culicidae) and anthropic environment. 12-host-seeking behaviour of Anopheles albitarsis s.l. in south-eastern Brazil.

Results obtained with Anopheles albitarsis s.l. catches mainly performed through human bait at the Ribeira Valley region, SP (Brazil), are reported. Two species of the complex were recognized, namely An. albitarsis s.s. and species B. This latter predominated both in the rice fields and in the dwelling environments. The crepuscular rhythms showed an unimodal sunset pattern with most blood-seeking females caught during dusk. The absence of differences between indoor and outdoor behavior was confirmed for both species of the complex.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment. 11--Biting activity and blood-seeking parity of Anopheles (Kerteszia) in south-eastern Brazil.

An. (Ker.) cruzii and An. (Ker.) bellator were monitored by the use of human bait and Shannon trap collections during a one-year period in 1994. Indoor and outdoor collections were made on human bait and inside the forest environment a Shannon trap was used. Both were undertaken in the evening crepuscular period. Results showed a greater abundance of An. cruzii in the forest, where as An. bellator was more abundant in the domiciliary environment. Through the application of the Polovodova method an age grading was established. Computing the parous and nulliparous females with Christopher's Stage III and above, more than 30.0% of blood-seeking specimens of both anophelines had had a previous blood meal. The higher abundance of An. bellator as compared with that of An. cruzii in the domiciliary environment may be explained by the influence of the neighboring low-lying coastal islands of the estuary system.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment. 10- Survey of adult behaviour of Culex nigripalpus and other species of Culex (Culex) in south-eastern Brazil.

A survey of adult behaviour of Culex (Culex) species was carried out from August 1992 through December 1993 in a human modified (anthropic) environment in the Ribeira Valley, S. Paulo State, Brazil. Culex nigripalpus dominated the catches at several sites and it's tendency to increase in the anthropic environment became quite clear. Nevertheless no high level of synanthropy was demonstrated. So it seems that the mosquito may have a restricted role in natural arbovirus cycles. Nonetheless, Cx. nigripalpus must be considered a potential vector of arboviruses, especially St. Louis encephalitis virus outside dwellings.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment. 9-Synanthropy and epidemiological vector role of Aedes scapularis in south-eastern Brazil.

Behaviour comparisons of Aedes scapularis and Ae. serratus are presented. Results were obtained by sampling Aedes adult mosquitoes at several places in the rural anthropic environment in the Ribeira Valley region of S. Paulo State, Brazil. Aedes dominance was shared by those two species, but Ae. scapularis showed a clear tendency to frequent the modified environment, while Ae. serratus was to be found in the more preserved ones, here represented by the vestigial patchy forests. Regarding the open cultivated land and the dwelling environments, Ae. scapularis preponderates. Considering the regional development phases, this mosquito showed a remarkable increase in the modified environment differently from Ae. serratus that underwent a considerable decrease in migrating from the forest to the anthropic environment. As a consequence of these results it is reasonable to conclude that Ae. scapularis may be considered as an epidemiologically efficient vector and that it quite probably played this role in the Rocio encephalitis and other arbovirus epidemics.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment. 8--Survey of adult behaviour of Spissipes Section species of Culex (Melanoconion) in south-eastern Brazil.

A study of Spissipes Section of Culex (Melanoconion) adults behaviour was carried out from August 1992 through December 1993 in human dominated (anthropic) environment in the Ribeira Valley, S. Paulo State, Brazil. By sampling at several sites it the dominance of Culex ribeirensis and Cx. sacchettae became evident even through a total number of ten species was recorded. Those two mosquitoes showed a clear tendency to frequent the domiciliary environment where they were caught, both indoor and outdoor, through the use of the human bait. In the outside environments, the residual patchy forests seems to display a concentration role, from which these adults spread to the open land and reach the dwellings. As their vector competence has been demonstrated through the virus isolations in natural conditions, it is advisable to pay attention to the presence of these mosquitoes in the man-made environment.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment. 7-behaviour of adults Nyssorhynchus anophelines with special reference to Anopheles albitarsis s.l. in south-eastern Brazil.

Results obtained with catches performed at several sites of the Ribeira Valley, SP (Brazil) are reported. Collections with Shannon type traps showed a concentration of An.albitarsis s.l. in the Experimental Farm of Pariquera-Açu County, associated with the development of irrigated rice cultivation. Two species of the complex, named A and B, were recognized. Species B predominated in the samples. Indoor and outdoor crepuscular human bait captures were performed a the domiciliary environment. The two species showed a generally low William's media valve of 0.2, the highest value obtained was 1.6. No differences were found between indoor and outdoor behaviours between the two species of the complex.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment. 6--Breeding in empty conditions of rice fields in south-eastern Brazil.

Studies on culicid breeding in empty rice fields were carried out during the cultivation cycle from May to November 1993. This period corresponded to stages 1 and 2, when empty conditions prevailed. Breeding occurred in stage 1 and the first part of stage 2, corresponding respectively to fallow uncultivated and ploughing situations. No breeding was found to take place during the second part of stage 2 when transient floods and harrowing occurred. The predominant species were Aedes scapularis, Culex nigripalpus and Cx. mollis. The Pilosus Group of Culex (Melanoconion) was found at lower densities. Some epidemiological considerations are presented.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment. 5--breeding of Anopheles albitarsis in flooded rice fields in south-eastern Brazil.

Studies on breeding Anopheles albitarsis and association with rice growth in irrigated paddy fields were carried out during the rice cultivation cycle from December 1993 to March 1994. This period corresponded to the length of time of permanent paddy flooding. Breeding occurred in the early stage up until five weeks after transplantation when rice plant height was small. That inverse correlation may give potential direction to control measures.