[Effects of Salvia przewalskii Maxim. on high-altitude pulmonary hypertension in rats and its mechanism].

OBJECTIVE: To investigate the interventive effects of Salvia przewalskii Maxim.(SPM)on high-altitude pulmonary hypertension(HAPH)in rats and possible mechanism. METHODS: The male SD rats were randomly divided into the control group, the hypoxia group and SPM(0.5 g/kg,1 g/kg and 2 g/kg) group. There were 14 rats in each group. The rats in control group were feed in Xining(with an altitude about 2 260 m), and the other group rats were all feed in Maduo county people's hospital(with an altitude about 4 260 m). The rats in SPM groups were treated with SPM at the doses of 0.5 g/kg,1 g/kg and 2 g/kg by gavage respectively (100 g/ml). The rats in control and the hypoxia groups were received equal volume of distilled water, once a day. After 4 weeks, the mean pulmonary artery pressure (mPAP) of rats was measured and the same part of lung tissue of each rat was collected and stored in liquid nitrogen. Then the relative mRNA expression levels of the proliferation cell nuclear antigen(PCNA), the cell cycle dependent kinase 4(CDK4), CyclinD1, RhoA, ROCK1, ROCK2 in lung tissues of each group rats were all tested by RT-PCR. RESULTS: Compared with the control group, the mPAP and the relative mRNA expression levels of PCNA, CDK4, CyclinD1, RhoA, ROCK1 and ROCK2 were increased significantly in the hypoxia group(P＜0.01). Compared with the hypoxia group, the mPAP and the relative mRNA expression levels of PCNA, CDK4, CyclinD1, RhoA, ROCK1 and ROCK2 in the lung tissues of the SPM group rats were all decreased significantly(P＜ 0.05 or P＜0.01). CONCLUSION: SPM can prevent the HAPH in rats, and the mechanisms may be related to the inhibition of the excessive proliferation of smooth muscle cells in pulmonary artery and the excessive activation of the RhoA/Rho kinase(ROCK) signaling pathway.

[Vulvar form reconstruction in extended radical vulvectomy of vulvar carcinoma].

OBJECTIVE: To evaluate the method of vulvar reconstruction after extended vulvectomy. METHODS: Retrospectively, fourteen cases of vulva carcinoma were treated by radical wide local excision, and the defects were repaired with anterolateral thigh flap and inferior pedicle rectus abdominal myocutaneous flap. After the flap was harvested, it was put on the defect through the tunnel between the donor and the recipient site and the vulvae was reconstructed. RESULTS: All the flaps were survived except 1 anterolateral thigh flap with partial necrosis. One patient was infected at the groin incision but the flap and the grafted skin were survived. The patients were treated with change of the dressing and recovered after skin grafting. All other incisions were healed with first intention. The partial necrosis area was about 4 cm x 6 cm, it healed at 36 postoperative days after free skin grafting. The reconstructed vulvae were plump and elastic. It appeared like the normal vulvae and there was no contraction of the vagina. CONCLUSIONS: Vulvar reconstruction with the anterolateral thigh flap and rectus abdominal flaps after the radical vulvectomy could make the patients recover easily. It produces almost normal appearance and function of the vulvae, reduces the time of wound healing. The patient could have the next therapy more quickly and the quality of life improves. It has wide application value in clinics.

Clinical analyses of clustered microcalcifications after autologous fat injection for breast augmentation.

BACKGROUND: Autologous fat injection for breast augmentation has been disputed with regard to its complications for many years, especially regarding calcifications, most of which present with benign features. In previous studies, clustered microcalcifications were not observed after fat injection for breast augmentation, which are usually regarded as malignant calcifications. METHODS: From July of 1999 to December of 2009, autologous fat injection for breast augmentation was performed for both breasts in 48 patients. Eight patients with clustered microcalcifications found by mammography after surgery were analyzed retrospectively. For the nonpalpable breast lesions in three patients, the clustered microcalcifications were resected with the help of needle localized breast biopsy. The palpable lump, including clustered microcalcifications, was resected 1 cm away from its border in the other patients. All of the specimens were submitted to pathologic examination. RESULTS: The digitized mammographic films of eight of 48 patients (16.7 percent) showed clustered microcalcifications after autologous fat injection, which were highly suspected of being breast carcinoma microcalcifications, whereas all pathologic examinations indicated fat necroses. CONCLUSIONS: Clustered microcalcifications can be found after autologous fat injection for breast augmentation, which cannot be distinguished from malignancy. The mammographic confusion constitutes the problem rather than the success of the procedure itself, and the method should continue to be prohibited.

[Analysis of Millard II technique for correcting secondary deformities of unilateral cleft lip].

OBJECTIVE: To analyze the Millard II technique for correcting secondary deformities of unilateral cleft lip. METHODS: The Millard II technique was used to correct secondary deformities of unilateral cleft lip in 42 patients from March of 2003 to September of 2004. Dissection was made between the alar cartilage and skin, and the alar cartilage was suspended. RESULTS: The postoperative follow-ups with 3 approximately 6 months revealed good results of the symmetrical nostrils and philtrums, prolonged columella nasi, good-shaped cupid's bow, and invisible scar. CONCLUSIONS: The Millard II technique could be an ideal method to correct secondary deformities of unilateral cleft lip. Releasing and suspending alar cartilage spontaneously at the same time can correct nasal deformity adequately.

[Microsurgical tissue transfer for the reconstruction of hemifacial atrophy (Parry-Romberg syndrome)].

OBJECTIVE: To reconstruct the soft tissue defect of the hemifacial with free anterolateral thigh fascioadipose flaps or scapular dermal-adiposal flap. METHODS: The free anterolateral thigh fascioadipose flaps based on the perforators of lateral circumflex femoral artery or scapular dermal-adiposal flap based on the circumflex scapular artery has been designed and reconstructed hemifacial atrophy with the donor artery and vein anastomosed to the facial artery and vein. RESULTS: Anterolateral thigh fascioadipose flaps were performed in 7 patients. Scapular dermal-adiposal flap was applied in 1 patient. All the flaps survived well and aesthetic appearance of reconstructed face achieved good result. CONCLUSIONS: The microsurgical tissue transfer, especially the free anterolateral thigh fascioadipose flap is a good and reliable choice for hemifacial reconstruction.

[A new technique of upper-middle face rhytidectomy without destroying the configuration of sideburn].

OBJECTIVE: To introduce a safe, effective and lasting rhytidectomy technique without destroying the configuration of sideburn. METHODS: The operation is performed through the coronal incision, the temporal incision that is paralleled to the nasolabial sulcus, and the preauricular incision in the sideburn. Multi-layer dissection of facial tissue is made. RESULTS: 46 patients with aging face have been treated using this technique since 2002. All patients obtained good curative effects without any severe complications. CONCLUSIONS: This operation technique may maintain the natural configuration of the preauricular area and sideburn, result obscure incision scar and avoid harming important nerves or vessels. Multi-layer dissection accords with anatomical principles and produces a lasting curative effect.

[Preventive effect of chitosan on capsular contracture after implantation of silicone gel-filled mammary implants in rats].

OBJECTIVE: To study the preventive effect of chitosan on capsular contracture after implantation of silicone gel-filled mammary implants in rats. METHODS: 18 SD female rats were divided into three groups randomly. Small silicone gel-filled mammary implants were implanted under each side of latissimus dorsi muscle. Chitosan was injected into left cavities as experimental sides, and nothing was injected into right cavities as control sides. 4, 8 and 12 weeks postoperation, specimens were dissected and observed using light microscope, and area density of collagen both type I and type III were also detected. RESULTS: Fibrous capsules around implants consist of two layers: dense layer and loose layer. 4 weeks postoperation, total thickness of the experimental sides was less than that of the control sides (P < 0.01). Area density of collagen either type I or type III of the experimental sides was lower than that of the control sides (P < 0.01). Both 8 and 12 weeks postoperation, total thickness of the experimental sides was less than that of the control sides (P < 0.05). Area density of collagen type I of the experimental sides was lower than that of the control sides (P < 0.05). Area density of collagen type III was of no statistical difference between the experimental sides and the control sides (P > 0.05). CONCLUSIONS: Chitosan can remarkably prevent capsule contracture during the early period after implantation of silicone gel-filled mammary implants.

[The periareolar approach management of postoperative complications of breast augmentation by injected polyacrylamide hydrogel].

OBJECTIVE: To analysis various complications of 30 patients of breast augmentation by injected polyacrylamide hydrogel and discuss the treatment through periareolar incision. METHODS: All patients were classified according to the different complications. Open suction technique and partial mastectomies via periareolar incisions were performed in all patients, Only one patient had immediately breast reconstruction with prosthesis, five patients received secondarily breast prostheses implantation via a axillary incision. RESULT: All the symptoms were relieved after remove of polyacrylamide hydrogel. CONCLUSIONS: Polyacrylamide hydrogel should be prohibited for injected breast augmentation at present. A double-blinded randomized clinical study, controlled animal experiments and a large sample questionnaire survey for complications are necessary. The periareolar approach is valuable technique and can remove polyacrylamide hydrogel as completely as possible.

[Twice delaying of the expanded flap].

OBJECTIVE: To introduce a new method for enlarging the survival area of an expanded flap. METHODS: After the skin expander was inflated with enough injection, the first delaying was performed. In the operation, two incisions were made in the skin and subcutaneous tissue superficial to the expander capsule on both sides of the long axis of the expanded flap. After 10 to 14 days, the second delaying followed, in which one pedicle was divided to form a unilateral-pedicled, super-long random flap. When the flap was transferred to the recipient Since 2000,this technique has been used in 16 patients. All the area, the door site was closed directly. RESULTS: flaps survived completely. CONCLUSIONS: The technique of twice delaying can enlarge the survival area of the expanded skin flap.

[Clinical application of the fibrous capsule to prevent muscle tendon adhesion].

OBJECTIVE: To observe the effect of fibrous capsule to prevent the flexor tendon adhesion. METHODS: Six bum patients with 33 digits were treated with the fibrous capsule of the expanded flaps which was used to wrap the exposed flexor tendon in zone III in order to prevent the flexor tendon adhesion. RESULTS: From 1999-2001 ,all of the patients were followed up to 1-3 years. The functions, assessed with the TAM method, were excellent in 18 digits, fair in three and poor in one. The excellent and good rate was 87.88%. CONCLUSION: The fibrous capsule could be used to prevent or reduce the tendon adhesion.

[The neuro-vascular anatomical study of breast and it's signification in reduction mammaplasty].

OBJECTIVE: to investigate the pattern of the blood supply and the nerve distribution of breast, in order to find a way for short-scar reduction mammaplasty. METHODS: Twelve adult women cadavers were investigated for the vascularture of the anterior thorax and the nerve distribution of the breasts by using the blood vessel casting, specimen transparency technique and the autopsy. Based on the anatomical study, a modified double-circle reduction mammaplasty technique was designed to treat 28 patients with hypertrophical breasts. RESULTS: There existed two- or three-layers vasculature in the anterior thorax. The extensive vertical vascular anastomoses were found among the three layers. The cutaneous perforators, penetrated out of the pectoralis major muscle, were formed a dense vessel network in the retromammary space. The vertical vessels thereafter emerged from the network, passed through gland and linked to the subcutaneous vessels. These vertical vessels were smaller and denser above the fourth intercostal space, but they were larger and sparser below the fourth intercostal space. The innervation of the nipple-areola mainly came from the lateral deep branches of the 4th intercostal nerve. It appeared S-shape running into the dropped breasts. The 28 patients were successfully treated with the modified technique, except one case with the loss of the nipple-areola sense. CONCLUSION: The modified double-circle reduction mammaplasty could maximally fulfill the blood supply to the remained gland and the innervations to the nipple-areola, by keeping the advantages of the traditional technique such as invisible scar, good projection and the long lasting results. It could also be a safe and reliable technique.