Combined use of ultrasound-assisted liposuction and limited-incision platysmaplasty for treatment of the aging neck.

BACKGROUND: Many techniques have been introduced for the surgical treatment of the aging neck. In this study the combination therapy of ultrasound-assisted liposuction and limited-incision platysmaplasty for cervicofacial rejuvenation is presented. METHODS: Fifteen female patients (age = 43-75 years) were treated for grade II-III (n = 2), III (n = 6), and grade IV (n = 7) cervicomental angle deformity. The outcome of surgery was retrospectively evaluated by a panel. RESULTS: Ultrasonic energy was applied for an average of 2 min (range = 45 s-6.5 min). The mean aspiration volume was 125 ml. No immediate or delayed adjuvant skin reduction was needed in any of the patients. No complications were encountered in this series. After treatment significant improvement of the cervicomental angle was observed. CONCLUSION: For treatment of all grades of the aging neck we advocate the combination of UAL and limited-incision platysmaplasty. This combination therapy has little morbidity and leads uniformly to significant improvement of the cervicomental angle.

Repeated ankle sprains and delayed neuromuscular response: acceleration time parameters.

STUDY DESIGN: A comparative study. OBJECTIVES: To assess whether in subjects with unilateral chronic ankle instability the dynamic reaction time of the affected ankle differs from the healthy ankle and from ankles of a control group. BACKGROUND: Reaction time is an essential element in joint protection against sudden unexpected excessive movement requiring fast and coordinated muscle action. During a sudden ankle inversion movement, a reflex action of the evertor muscles is needed to counteract the movement. Adequate neuromuscular response is crucial and a delayed response could contribute to inversion trauma and subsequently to chronic ankle instability. The isokinetic dynamometer acceleration time (ACC-TIME) provides valuable information on dynamic neuromuscular ability. MATERIAL AND METHODS: Patients with unilateral chronic ankle instability (n = 11) and healthy individuals in a control group (n = 11) were tested on an isokinetic dynamometer during 3 sets of 3 reciprocal inversion/eversion movements of both ankles at 30 degrees/s and 120 degrees/s. Analysis of variance models were used to compare the ACC-TIME of the affected ankle to the unaffected ankle of the same subjects and a control group. RESULTS: For the evertor muscles at 30 degrees/s and 120 degrees/s a significantly prolonged ACC-TIME was found when comparing the affected ankles to the contralateral ankles and both ankles of the control group. For the invertor muscles at 120 degrees/s a significantly prolonged ACC-TIME was found when comparing the affected ankle to the unaffected ankles of patients and those of the control group. CONCLUSIONS: Because the most important evertor muscles are innervated by the fibular nerve, the significantly prolonged ACC-TIME of the affected ankle is consistent with the finding of a lower motor nerve conduction velocity of the fibular nerve after inversion trauma. The results support the concept of a delayed neuromuscular response as an important factor in the etiology of chronic ankle instability.

The significance of angiogenesis in malignant pheochromocytomas.

The purpose of this study was to investigate tumor angiogenesis in a series of benign and malignant pheochromocytomas and to determine whether there is a correlation between angiogenesis and the presence of distant metastases. In this study, the CD31 monoclonal antibody was selected to measure intratumoral microvessel density. Nineteen patients with malignant pheochromocytomas and nineteen patients with benign pheochromocytomas who underwent operation were studied. In order to quantify intratumoral microvessel density, the total number of pixels of CD31-positive reactivity was assessed and expressed as a percentage of the total tissue area in the analyzed field. Analysis of variance revealed a statistically significant correlation between malignancy and intratumoral microvessel density (p = 0.0009). Although there was a considerable variability in the intratumoral microvessel density from tumor to tumor within both the benign and the malignant group, a percentage of more than 28.5% anti-CD31 stained area was found only in malignant tumors. In conclusion, this study shows that the mean intratumoral microvessel density in malignant pheochromocytomas is increased approximately twofold as compared with benign tumors. However, the clinical significance of this prognostic marker is rather weak, because only 4 of the 19 malignant pheochromocytomas had microvessel density higher than this threshold of 28.5%.