The Asplund-Davies vertical scar breast reduction technique preserves the sub-areolar skin thickness in the long term: a matched comparative study with the inverted T technique.

BACKGROUND AND AIM: The inverted T technique, a popular method of breast reduction, relies on stretching the skin over glandular breast tissue to create the breast shape. The Asplund-Davies vertical scar method of breast reduction by contrast uses glanduloplasty to create the desired breast shape, achieving tension-free skin closure. Indeed the skin at the end of the vertical scar technique is wrinkled. It is known from tissue expansion literature that when skin is placed under tension the dermis becomes thinner. In this pilot cross-sectional study we compared breast skin thickness between two matched groups of patients undergoing breast reduction either with the inverted T or the vertical scar techniques, to determine whether the method of breast reduction impacts on breast skin thickness in the long term. MATERIALS AND METHOD: With a high frequency ultrasound machine the breast skin thickness of 24 breasts, 12 in each group, was measured by an independent consultant radiologist. Patients were matched in terms of age, time since operation, Fitzpatrick skin type, preoperative cup size and the amount of tissue resected. RESULTS: The breast skin in the inverted T group was significantly thinner than the vertical scar group (P<0.001). The inverted T group also had thinner skin in comparison to its control point (P<0.05). The vertical scar group had comparable skin thickness compared to its control point (P>0.05). CONCLUSION: This pilot study suggests that tension-free closure of skin with the vertical scar technique maintains breast skin thickness. Maintenance of breast skin thickness in this group may in turn contribute to the long term preservation of breast shape and form.

Occurrence of neoclassical facial canons in Caucasian primary school pupils and university students.

INTRODUCTION: The study concentrates on nine neoclassical facial references, canons. SAMPLE AND METHODS: These neoclassical canons are studied and compared in two groups of young Caucasian population as follows: 160 students were studied, namely 60 primary school boys at the age of seven and 100 young men at the age ranging from 22 to 25 studying at the Comenius University and Slovak Technical University in Bratislava. The following anthropometric parameters were measured: ten heights, five widths, and two angles. CONCLUSION: Some of neoclassical canons have not appeared in our measured group at all. Other canons although present, were present less frequently then their variations. Comparisons with literature are discussed (Tab. 9, Fig. 9, Ref. 7). Full Text (Free, PDF) www.bmj.sk.

Long-term safety and efficacy of poly-L-lactic acid in the treatment of HIV-related facial lipoatrophy.

OBJECTIVE: We evaluated the long-term safety and efficacy of injectable poly-L-lactic acid (PLLA) for the correction of facial lipoatrophy. METHODS: This was a randomized, open-label, comparative, single-centre study of injected PLLA in patients with HIV-related facial lipoatrophy. Thirty subjects were randomized to immediate or delayed PLLA treatments, administered as three sets of bilateral injections, 2 weeks apart, into the deep dermis above the buccal fat pad. Week 24 results have been published previously (Moyle et al, HIV Medicine 2004, Vol. 5, pp. 82-87). Long-term efficacy was assessed at a recall visit using visual analogue scales (VASs) to record patient satisfaction, and by the Hospital Anxiety and Depression Scale (HADS). Patients also reported any adverse events (AEs) during the treatment period and at the recall visit. RESULTS: Twenty-seven patients returned for the recall visit, a minimum of 18 months post final study treatment. Fourteen of these patients were excluded from the recall visit because of additional treatment with PLLA. Improvements in VAS scores for facial appearance were sustained from baseline to the recall visit in both randomization groups (P<0.05 and P<0.001). Trends in improvement in HADS scores were also noted, with patients in the delayed group experiencing significant improvements in depressive symptoms (P<0.05). One case of injection-site induration and nine cases of injection-site nodules were noted at the recall visit, none of which was described as serious or severe. CONCLUSIONS: Physical and psychological benefits of PLLA are sustained over at least 18 months. Delayed AEs include mild nodularity at the treatment site.

A randomized open-label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection.

BACKGROUND: Polylactic acid (PLA, New-Fill; Medifill, London, UK and Dermic Labs, a division of Eventis, Strasbourg, France) injections into the deep dermis increase fibroblast numbers and collagen production. The substance is widely used in medical applications including cosmetic procedures. METHODS: HIV-positive individuals with facial lipoatrophy (based on physician assessment) were randomized to immediate (weeks 0, 2 and 4) or delayed (weeks 12, 14 and 16) PLA given as three bilateral injections 2 weeks apart into the deep dermis overlying the buccal fat pad. Assessments included facial ultrasound, visual analogue scales, the Hospital Anxiety and Depression Scale (HADS) and assessment using photographs at weeks 0, 12 and 24. RESULTS: All 30 patients completed 24 weeks of treatment. The median age of the patients was 41 years, with a mean of 80 months of nucleoside reverse transcriptase inhibitor (NRTI) therapy and a mean of 44 months of prior protease inhibitor (PI) therapy. The median CD4 count was 428-460 cells/microL, with 47% of patients in the immediate-treatment group and 93% of patients in the delayed-treatment groups with <50 HIV-1 RNA copies/mL at baseline. No differences in immunological, virological, biochemical, haematological or metabolic parameters emerged during the study. Injections were well tolerated with only two adverse events (cellulitis and bruising) recorded, one of which delayed treatment by 1 week. There were no discontinuations. Patient visual analogue assessments, photographic assessments, and anxiety and depression scores improved with treatment. At week 12, immediate-treatment patients had significantly better visual analogue scores (7 vs. 1, P<0.001) and lower anxiety scores (6 vs. 9, P=0.056) than delayed-treatment patients. Benefits on visual analogue and HADS scores persisted until week 24. CONCLUSIONS: PLA injections led to improvements in patient self-perception, anxiety and depression scores in individuals with facial lipoatrophy. Adverse events were uncommon. The benefits of PLA persisted for at least 18 weeks beyond the last injection.

[Cephalometric analysis of distance x-ray images in children with orofacial clefts]. / Kefalometrická analýza dialkových rtg snímok detí s orofaciálnymi rázstepmi.

The authors with the help of cephalometric RTG analysis study the changes of facial skeleton in children with orofacial clefts and the treatment results. Cephalometric analysis was performed on distance X-rays in patients with orofacial clefts from the whole Slovak republic in the number of 178, with age of 7.8 and 9 years. According to the type of the fissure the patients were divided in four groups. The control group consisted of 46 healthy children with the same age. The method of Schwartz was used (1958). The analysis revealed some characteristic changes in patients with orofacial clefts, which document that not only local disorder of lips, alveolar process and palate develops in these patients, but the fissure defect affects also more distant parts of visceral skeleton and important growth centers. (Tab. 5, Fig. 1, Ref. 14.)

[Intestinal enzyme activity in patients with strongyloidiasis]. / Aktivnost' kishechnykh fermentov u bol'nykh strongiloidozom.

Enterokinase and alkaline phosphatase activities in the duodenal juice and fecal extract of 37 strongyloidosis patients living in moderate climate and 17 inhabitants of the tropics have been studied. In 60.7% inhabitants of the regions with moderate climate and 80% from the tropics decreased enterokinase activity in duodenal juice has been observed, while the decrease in alkaline phosphatase activity in fecal extract has been noted in 87.8% and 71.4% cases, respectively. After convalescence from 1 to 6 months, no normalization of intestinal enzymatic activity has been observed.

[Experience with the use of nemocide (pyrantel pamoate) in nematodiases]. / Opyt primeneniia nemotsida (pirantelia pamoata) pri nematodozakh.

The clinical efficacy of and tolerance to the nemocide pyranthel pamoate produced by "IPCA" (India) and applied to nematodiasis treatment have been investigated. A high efficacy of the drug (94.4-100%) for ascariasis, enterobiasis and ancylostomiasis treatment has been established. The drug is well tolerated by adults and induces slight short-term alterations of hepatic functional activity in 5-10-year-old children.