Pretreatment with alternate day modified fast will permit higher dose and frequency of cancer chemotherapy and better cure rates.

It is established that calorie restriction (CR) increases the resistance of cells to various stressors such as oxidative damage, excitotoxins, mercury and acetaminophen. Alternate day feeding (ADF) may confer greater stress resistance than daily CR of 30% or 40%. A recent study in three strains of mouse showed that a fast of 48 or 60 h prevented toxic effects due to administration of doses 2-4 times the maximum human dose of etoposide, a chemotherapy agent which acts through increased oxidative stress. In addition, mice inoculated with neuroblastoma survived longer when pretreated with fasting, then given high dose etoposide, as well as not exhibiting toxicity. This increased survival was construed as evidence of differential stress resistance between normal and cancer cells, the cancer cells being only partially protected by the pretreatment fast. In clinical practice, increased differential stress resistance could lead to the use of much higher doses of chemotherapy agents, and in the absence of toxicity, make it possible to repeat the treatment to kill residual cancer cells. Humans are unlikely to comply with a total fast of longer than 24 or 48 h, which may be insufficient to activate the same gene expression process. Based on published data we estimate that an optimal time period for development of stress resistance is 2-3 weeks when alternate day feeding is employed. Our previously published experience suggests that 2-3 weeks of alternate day modified fast in which subjects eat ad libitum one day and <20% of one's estimated caloric requirement the next will confer a similar stress resistance. Compliance with this diet is high and greater maintenance of body weight is feasible. We hypothesize that a pretreatment of 2-3 weeks with the alternate day modified fast will improve outcomes in cancer chemotherapy, decreasing morbidity and raising cure rates.

Vaginoplasty for gender confirmation.

Male-to-female surgery for properly diagnosed gender dysphoria, conducted as an interdisciplinary rehabilitation program, may be a valid endeavor in many cases. Successful surgical results have been obtained by those skilled in this type of surgery.

Pathophysiology and treatment of decorative tattoos with reference to argon laser treatment.

Pathophysiology, psychosocial implications, and treatment modalities for decorative tattoos are reviewed in this article. There still exists a need for a precise, noninvasive technique that will not leave secondary scar deformities. Laser physiology and technologic refinements may offer the best hope for such a treatment.

Cardiac asystole secondary to carotid sinus compression in the face-lift operation.

We present 3 cases of carotid sinus compression with cardiac asystole which occurred in healthy patients undergoing routine rhytidectomies. The mechanism is discussed and suggestions are made regarding preoperative evaluation and operative management.

Results of phalloplasty.

We present our experience with a method of phalloplasty which can be applied by reconstructive surgeons to cases of penile loss from diverse etiologies. The complications with this method have been frequent, but not life-threatening. Achievement of the stated objectives is obtained in a sufficiently high proportion of cases to make this a method whorthwhile to use until a clearly superior method can be demonstrated.

Complications following silicone injections for augmentation of the contours of the face.

We report 5 patients who have had severe inflammatory reactions following the injection of liquid silicone for augmentation of the facial contour. We offer an approach to the treatment of this complication which, although not resulting in complete resolution, has at least markedly ameliorated these patients' signs and symptoms.

Uses of the rectus femoris myocutaneous flap.

The rectus femoris myocutaneous flap is quite useful for definitive immediate coverage of complex wounds within its territorial arc. We describe 4 cases to illustrate the capabilities of this flap. The indications for, the anatomy of, and the surgical technique for transfer, as well as the functional sequelae in two nonparaplegic patients are discussed.

A finite-element facial model for simulating plastic surgery.

CAPS (Computer-Aided Plastic Surgery) is a prototype computer program that uses a three-dimensional graphic model of a human face and incorporates a finite-element mathematical model of the physical properties of the soft tissue. This program can estimate the biomechanic consequences of ablation and rearrangement of tissue. The results of two hypothetical surgeries on the face are presented: A surgeon could use this program as a sketch pad to predict and compare the outcome of facial plastic procedures on a patient-specific model. The relation of this program to previous work is discussed, and directions for research and possible applications are addressed.

Customized silicone implants of the breast and chest.

Custom-fabricated silicone implants were used in 17 patients to reconstruct thoracic deformities associated with pectus excavatum, hypoplasia of the thorax, and radical mastectomy. The implants have been in place an average of 2 1/2 years. Custom implants have been permanently removed in only two of these patients. These implants can provide accurate, complex contour restoration without creating donor defects. However, problems of extrusion, capsule formation, slippage, and infection requiring implant removal are characteristic of nonautogenous materials. Because these are foreign bodies, well-vascularized soft-tissue coverage is especially essential to retain these implants.

Results of argon laser exposure of capillary hemangiomas of infancy--preliminary report.

Argon laser photocoagulation of capillary hemangiomas of infancy ("strawberry marks") has been described in three cases. Treatment in the first case was necessitated by repeated alarming hemorrhage. The second case was treated totally and resulted in immediate induced resolution of the hemangioma, which preceded (by 9 months) the spontaneous involution of an untreated control comparison area and resulted in virtually complete blanching without secondary deformity. The third case demonstrated the laser's ability to stop rapid growth immediately. Spontaneous involution then ensued naturally and was complete 12 months later. It should be emphasized that the argon laser is not recommended for the routine treatment of a normally spontaneously involuting hemangioma. Each case must be examined and the usual indications for intervention should be present. The argon laser has demonstrated the ability to coagulate vascular lesions such as port wine hemangiomas and telangiectasias and can be expected to have a similar favorable effect on the aggressive, rapidly expanding juvenile hemangioma, although further clinical documentation clearly remains to be demonstrated.

Breast reconstruction following mastectomy: a comparison of submuscular and subcutaneous techniques.

An analysis of the benefits of submuscular versus subcutaneous implantation was made on mastectomy patients. Ninety-one breast were reconstructed following mastectomy. In 30 breasts, the implants were placed subcutaneously; in 19, subpectorally, and in 42, beneath both the pectoralis and the serratus. The follow-up averaged 2 to 3 years, and recent cases included postoperative tonometry measurements to quantitate the degree of capsular contraction. In addition, 12 cadaver dissections were done to delineate muscle insertion and origins. Results indicate that (1) submuscular implants are clearly superior to subcutaneous ones; (2) subpectoral implantation requires complete detachment of the muscular origin from the ribs; (3) subserratus implantation provides extra muscular coverage, but dissection is more difficult owing to its firm rib attachment; and (4) the subserratus technique provided the lowest incidence of capsular contracture, although the breast was slightly flatter initially, but improved with time.