Sphere-enhanced microwave ablation (sMWA) versus bland microwave ablation (bMWA): technical parameters, specific CT 3D rendering and histopathology.

PURPOSE: This study was designed to compare technical parameters during ablation as well as CT 3D rendering and histopathology of the ablation zone between sphere-enhanced microwave ablation (sMWA) and bland microwave ablation (bMWA). METHODS: In six sheep-livers, 18 microwave ablations were performed with identical system presets (power output: 80 W, ablation time: 120 s). In three sheep, transarterial embolisation (TAE) was performed immediately before microwave ablation using spheres (diameter: 40 ± 10 µm) (sMWA). In the other three sheep, microwave ablation was performed without spheres embolisation (bMWA). Contrast-enhanced CT, sacrifice, and liver harvest followed immediately after microwave ablation. Study goals included technical parameters during ablation (resulting power output, ablation time), geometry of the ablation zone applying specific CT 3D rendering with a software prototype (short axis of the ablation zone, volume of the largest aligned ablation sphere within the ablation zone), and histopathology (hematoxylin-eosin, Masson Goldner and TUNEL). RESULTS: Resulting power output/ablation times were 78.7 ± 1.0 W/120 ± 0.0 s for bMWA and 78.4 ± 1.0 W/120 ± 0.0 s for sMWA (n.s., respectively). Short axis/volume were 23.7 ± 3.7 mm/7.0 ± 2.4 cm(3) for bMWA and 29.1 ± 3.4 mm/11.5 ± 3.9 cm(3) for sMWA (P < 0.01, respectively). Histopathology confirmed the signs of coagulation necrosis as well as early and irreversible cell death for bMWA and sMWA. For sMWA, spheres were detected within, at the rim, and outside of the ablation zone without conspicuous features. CONCLUSIONS: Specific CT 3D rendering identifies a larger ablation zone for sMWA compared with bMWA. The histopathological signs and the detectable amount of cell death are comparable for both groups. When comparing sMWA with bMWA, TAE has no effect on the technical parameters during ablation.

Donor-derived transplant acceptance-inducing cells in composite tissue allotransplantation.

BACKGROUND: Composite tissue allotransplantation (CTA) is a newly emerging field of transplantation. Immunological research in CTA has been intensified due to the recent clinical success of hand and face transplantation. Establishing immunological tolerance by adoptive transfer of ex vivo cultured tolerance-inducing cell types is of growing interest. Transplant acceptance-inducing cells (TAICs) are a type of deactivated immunoregulatory macrophages. METHODS: A total of 36 allogeneic hind limb transplantations in the rat were performed in six groups. Group A (Lewis (LW) â†’ Brown-Norway (BN)) received Lewis-donor-derived TAICs locally (i.m.). Group B (LW â†’ BN) received Lewis-donor-derived TAICs systemically (i.v.) and group C (Sprague Dawley (Sp-D) â†’ BN) served as a control group receiving Lewis-donor-derived TAICs systemically (i.v.). Groups D (LW â†’ BN), E (LW â†’ BN), and F (BN â†’ BN) also served as control groups with group D receiving no immunosuppression, group E receiving FK506 and prednisolone and group F receiving no immunosuppression with isograft transplantations (BN â†’ BN). The timing of rejection was assessed by clinical observation and histological findings. RESULTS: Rejection of the allogeneic hind limb occurred on average 7.7 days after transplantation in group A and 7.4 days in group B. Rejection was significantly delayed (Log-rank test, p < 0.01) compared to groups C and D, where rejection of the allogeneic hind limb occurred on average 5.8 days and 5.6 days after transplantation. No rejection was seen in groups E and F. CONCLUSION: For the first time, TAICs have been applied in a CTA model and demonstrated a significant immunosuppressive effect. Even though the immunomodulatory effect is relatively modest, the results of this study justify subsequent research on TAIC therapy to improve experimental and clinical outcome after CTA.

[Plastic surgery for the treatment of gynaecomastia following hormone therapy in prostate carcinoma]. / Die plastische chirurgische Therapie der Gynäkomastie nach antihormoneller Therapie bei Prostatakarzinom.

Gynecomastia is a potential side effect of hormone therapy for prostate cancer. In large, randomized, placebo controlled studies approximately 50% or more of patients with prostate cancer experienced gynecomastia attributable to various mechanisms. Although it is mostly reported as mild to moderate, gynecomastia is one of the reasons most frequently cited for premature discontinuation of such treatment. Prophylactic radiotherapy and prophylactic tamoxifen have been shown to decrease the incidence of hormone-induced gynecomastia; nevertheless, there are still cases of refractory gynecomastia, and in these plastic surgery is needed for correction. Gynecomastia is a benign enlargement of the male breast, requiring no treatment unless it is a source of embarrassment and/or distress for the adolescent or man affected. The indications for surgical treatment of gynecomastia are founded on two main objectives: restoration of the male chest shape and diagnostic evaluation of suspected breast lesions. The authors believe that the complete circumareolar technique with no further scarring creates the best aesthetic results with fewer complications. When this is used in combination with liposuction very pleasing aesthetic results can be achieved.

[Surgical concept and results of necrotizing fasciitis]. / Chirurgisches Konzept und Ergebnisse bei nekrotisierender Fasziitis.

BACKGROUND: Necrotizing fasciitis (NF) is still a source of high morbidity and mortality. These difficult cases are increasingly referred to burn centers due to special wound and critical care issues. Here we examine our institution's recent experience with a large series of NF. METHOD: We performed a retrospective chart review of 32 consecutive patients over a 10-year period with NF who required radical surgical debridement and surface reconstruction. RESULTS: Overall survival was 85%, with average length of stay of 74.0+/-7.5 days for survivors (S) and 68.8+/-6.3 days for nonsurvivors (NS) (P>0.05). Time until first operation was 5.2 days in S and 3.4 days in NS (P<0.05). Patient age averaged 51.1+/-11.2 years for S and 57.0+/-12.0 years for NS (P<0.05). Survivors averaged 1.6 relevant comorbidities and NS averaged 3.6 (P<0.05). Affected total body surface (TBS) per patient averaged 6.8+/-3.3% for S and 10.2+/-5.1% for NS (P<0.05). All NS had affection of the trunk, and none of the patients with exclusive affection of extremities died. CONCLUSIONS: There were frequent delays in diagnosis and referrals to our institution, and progress can be made in educating the medical community to identify these patients. Not only the affected TBS and location but also comorbidities, age, and immediate surgical treatment are important prognostic factors. Referral to a specialized facility such as a burn center is urgently recommended for optimal surgical intervention, wound care, and critical care management.