The Development, Application and Analysis of an Enhanced Recovery Programme for Major Oesophagogastric Resection.

BACKGROUND: Enhanced recovery programmes improve outcomes in surgery, but their implementation after upper gastrointestinal resection has been limited. The aim of this study was to compare short-term outcomes for patients undergoing oesophagogastric surgery in an enhanced recovery programme (EROS). METHODS: EROS was developed after a multidisciplinary meeting by multiple rounds of revision. EROS was applied to all patients undergoing major upper GI resection at a university teaching hospital in the UK from 20/9/13, with data reviewed at 18/09/15. EROS was assessed to identify predictors for compliance. RESULTS: One hundred six patients underwent major upper GI resection including 81 oesophagectomies, 24 gastrectomies and 1 colonic interposition graft. Major complications (Clavien Dindo ≥3) occurred in 12 patients with 1 in-hospital death. Thirty-five patients (44%) were discharged on target day 8 of the EROS programme. Age and complications were independently associated with missing this discharge target. CONCLUSION: Enhanced recovery is feasible and safe after major upper gastrointestinal surgery.

Palbociclib:CDK4/6 inhibition in the treatment of ER-positive breast cancer.

Maintaining cell-cycle control has become a mainstay in treatment for many cancers. Cell-cycle manipulation can be especially valuable in breast cancer tumor cells that will often express hormone receptors that are amenable to anti-hormone receptor-targeted therapies. Despite these treatments, patients often progress, leading to other targeted agents being investigated to help promote progression-free survival. Cyclin-dependent kinases (CDKs) have been identified as contributors in the process of cell division. Combining inhibitors of CDKs with traditional endocrine treatments has shown significant progression-free survival in patients with metastatic breast cancer. One such CDK inhibitor, palbociclib, has shown great promise in the treatment of hormone receptor-positive breast cancer. In this article we review the traditional hormonal treatments of breast cancer, how CDK inhibition is beneficial in the treatment of this disease, and the preclinical and clinical data supporting the use of this medication.

Face lifting: problems, solutions, and an outcome study.

The superficial musculoaponeurotic system (SMAS) platysma rotation flap with platysmal transection from the deep surface has been the author's face-lift technique to correct jowls, submental laxity, and platysma bands since 1982. An outcome study of 10 consecutive face-lift operations is presented to demonstrate the efficacy of correction of lower face and neck aging and the duration of the improvement. Reappearance of platysma bands has been the earliest and most frequent sign of recurrent aging changes. A technique for directly dealing with platysma bands in the submental and cervicomental location is described, and follow-up results up to 3 years are shown.

Update: lifting the malar fat pad for correction of prominent nasolabial folds.

The malar fat pad suspension technique is a safe and effective method for rejuvenation of the aging midface. When combined with the SMAS-platysma rotation flap face-lift as a multi-vector technique, most of the changes that occur with aging are addressed and corrected in an anatomic fashion, resulting in an aesthetically pleasing result. Careful attention to the tension and position of the suspension suture enhances the improvement of the infraorbital flattening as well as correcting the excessive prominence of the nasolabial fold.

Does steroid medication reduce facial edema following face lift surgery? A prospective, randomized study of 30 consecutive patients.

A prospective, double-blinded study of 30 consecutive face lift patients was conducted to determine if the administration of corticosteroid medication would reduce postoperative facial edema. Half the patients received steroid medications in a random fashion. Three independent plastic surgeons who were blinded to the study rated facial swelling by comparing preoperative and postoperative photographs using a scale of 1 to 4. The data were tabulated and subjected to statistical analysis. There were no significant differences in facial swelling between the steroid-treated group and the untreated patients on any occasion.

Elevation of the malar fat pad superficial to the orbicularis oculi muscle for correction of prominent nasolabial folds.

The technique of elevation of the midface malar fat pad for correction of prominent nasolabial folds is described as part of the multiple vector facelift operation. Facial anatomy of aging, indications for operation, patient selection, postoperative follow-up, and complications are reviewed. Early postoperative and 3-year follow-up photographs of representative younger, middle-aged, and older patients are shown.

Lifting the malar fat pad for correction of prominent nasolabial folds.

The anatomic presence of a discrete malar fat pad has not been widely recognized. In his paper on the "deep plane rhytidectomy," Hamra describes the increased thickness of the subcutaneous fat over the anterior midface. Cadaver and clinical studies confirm the consistent presence of a localized subcutaneous malar fat pad overlying the body of the zygoma and maxilla. Downward displacement of the infraorbital skin and underlying malar fat pad causes an increased prominence of the nasolabial fold. The surgical dissection of the malar fat pad starts from the malar eminence at the plane of the orbicularis oculi muscle and superficial to the origin of the zygomaticus and levator muscles, which are invested by the SMAS. There is an easily dissected plane deep to the fat pad that extends to the nasolabial crease. Surgical correction of the prominent nasolabial fold is enhanced by undermining the malar fat pad and advancing it laterally by traction on the skin flap with additional upward fixation by sutures between the lateral edge of the fat pad and the subcutaneous fascia at the lateral malar eminence.

The anatomy of the skin and fascial layers of the face in aesthetic surgery.

The superficial musculo-aponeurotic system (SMAS) has been described as a discrete fascial layer that divides the subcutaneous fat into two distinct layers. The authors discuss the anatomic significance of this system in facial aesthetic surgery.

SMAS-platysma facelift. A bidirectional cervicofacial rhytidectomy.

The technique of SMAS-platysma facelift has been reviewed. The deep layer lift with the SMAS-platysma myocutaneous flap of the anterior neck and lower face facilitates correction of submental deformities without the necessity of direct approach with a submental incision. Wide superficial undermining of the upper and mid-cheek skin which is pulled laterally for correction of the nasolabial fold achieves a bidirectional facelift. The author's experience over six years with 460 patients who had a SMAS-platysma facelift indicates that the operation can be performed safely with a low incidence of complications.

SMAS-platysma face lift.

Correction of laxity in the submental area and of hypertrophic neck cords has been enhanced with the SMAS-platysma face life over that which was achieved with a standard skin face lift. Evaluation of a 6-year experience with the SMAS-platysma face lift reveals that the operation can be safely performed with an acceptably low incidence of complications. The incidence of hematoma and associated complications is less than that which occurs when cervical and submental defatting is performed in conjunction with a skin face lift.

Cosmetic surgical procedures for the aging face.

In the past decade there has been a remarkable increase in the number of patients having cosmetic operations to achieve a more youthful appearance. Demographic, social and economic factors in our society have contributed to this phenomenon, along with an increase in the number of trained plastic surgeons. Moreover, there recently have been major technical advances in aesthetic surgical procedures, including innovations in anesthetic techniques. The newer procedures for forehead-plasty, blepharoplasty and face lift are based on improved understanding of the facial anatomy. The operations are more complex and extensive, but experience has shown that they can be done safely. Correction of the changes of facial aging has been enhanced and the duration of the result has been prolonged.