Scratching off senile warts.
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Curettage↗
Biomedical subjects
G Lemperle
Publications and source records attributed to G Lemperle.
Elevated levels of testosterone receptors in keloid tissue: an experimental investigation.
Testosterone-binding receptor protein analyses were performed in keloids of 24 patients. According to their clinical appearance (hyperemia, pain, rapid growth, etc.), the lesions were subdivided into regions of minor and major clinical keloid activity. Biopsies were taken from active and inactive parts of the keloids, respectively, as well as from normal adjacent skin. The mean receptor amount in femtomoles per milligrams of tissue was 0.046 for active (SD = 0.037), 0.038 for inactive keloidal lesions (SD = 0.032), and 0.012 for normal skin. The corresponding receptor amount per microgram of DNA was 3.356 fmol (SD = 2.171) for active, 2.077 fmol (SD = 1.427) for inactive keloidal, and 1.010 fmol (SD = 1.190) for normal tissue. Statistical evaluation was performed using a two-way analysis of variance, with the two factors being individual subject and type of tissue. When differences were found, then Tukey's comparison was done to assess where those differences were. Comparisons of the receptor amount per milligram of tissue significant at the 0.05 level revealed significant differences between active keloid tissue and normal skin tissue and inactive and normal tissue (p < 0.01) respectively, while different receptor amount per microgram of DNA was significant between active and inactive and active and normal tissue (p < 0.01). These data suggest that elevated androgen receptor levels exist in clinical active keloid tissue and that possible therapeutic means might include topical antiandrogen therapy.
Adolescent↗
The tuberous breast deformity: classification and treatment.
To date there are many descriptive terms for the tuberous breast deformity but there is no widely accepted nomenclature. A retrospective study was undertaken of 68 tuberous breasts and the operative corrections performed. The deformities were classified into four types. Type I (hypoplasia of the lower medial quadrant), type II (hypoplasia of the lower medial and lateral quadrants, sufficient skin in the subareolar region), type III (hypoplasia of the lower medial and lateral quadrants, deficiency of skin in the subareolar region) and type IV (severe breast constriction, minimal breast base). Areolar prolapse, usually regarded as a major symptom, was only found in 30 (44%) deformed breasts. Postoperative review of 51 breasts in 31 patients showed that type I cases treated by reduction mammaplasty of adequately sized breasts or augmentation of hypoplastic breasts had excellent results. These procedures with additional spreading of the breast tissue in type II deformities give good results. Severe cases (types III and IV) treated by augmentation and tissue spreading procedures have an unsatisfactory shape and have a 'second crease' deformity. For types III and IV, additional skin in the subareolar region by tissue expansion or flap procedures is necessary. There is no one method to correct 'the' tuberous breast but there are many procedures which should be used according to the type of deformity. The classification developed could end the confusion in nomenclature.
Breast↗
[Treatment of wrinkles by Artecoll implant and resurfacing with the CO2 laser].
In general, all biological materials are resorbed in places where they do not belong. Therefore, artificial substances have to be implanted under deep skin folds and skin defects in order to achieve a permanent skin augmentation. Artecoll, a suspension of polymethylmetcrylate (PMMA)-microspheres in collagen solution, has been proven, for more than 5 years, to underlay wrinkles effectively without noticeable side-effects. Small wrinkles around the eyes, the mouth and cheeks, however, have to be treated by dermabrasion, chemical peel or vaporization by CO2-laser. Using all three methods, the effectiveness depends on the depth of skin traumatisation. Resurfacing using the CO2-laser has the advantage of absolute precision, no bleeding, less swelling and faster healing-but still high costs.
Adult↗
PMMA microspheres (Artecoll) for skin and soft-tissue augmentation. Part II: Clinical investigations.
Artecoll is an injectable implant for long-lasting correction of wrinkles and other skin defects. Artecoll consists of fine polymethyl-methacrylate (PMMA) microspheres suspended 1:3 in a 3.5% collagen solution. The microspheres are characterized by exceptional surface smoothness, homogenicity, and purity. The size of the microspheres of 30-40 microns diameter is small enough to allow subdermal implantation using a 27-gauge needle. Phagocytosis and dislocation of the implant is prevented by fast encapsulation of each single microsphere with connective tissue. Increased scarring but no granuloma formation has been detected as is common with other injectable implants with irregular surfaces. The experience from more than 600 patients and a prospective study in 118 patients with 200 implantation sites were evaluated. The good early results have continued for 5 years. Of the patients evaluated, 89.5 percent were satisfied and would ask for the treatment again. The overall complication rate is very low, and prolonged redness or visible granules are due to implantations that are too superficial. Other applications in soft-tissue augmentation are discussed.
Biocompatible Materials↗
Free transplantation of fat autografts expanded by tissue expanders in rats.
Inguinal fat pads of 28 rats were expanded by tissue expanders for 10 days and transplanted to the back of the same animal. The non-expanded contralateral inguinal fat pads were also transplanted and served as controls. Histology showed that adipocytes lose their lipid droplets under mechanical pressure; the expanded adipocytes have an elongated contour with a central nucleus. By the end of the expansion period, the thickness of the fat pads had decreased by 53%. One week after transplantation, expanded fat grafts had regained their previous volume with little sign of necrosis. Among normal adipocytes numerous smaller cells, containing multiple vacuoles, were seen. In contrast, about 25% of the substance of the non-expanded control fat graft consisted of necrotic oil cysts. These findings indicate that pre-expanded fat grafts survive better.
Adipose Tissue↗
Effect of cortisone on capsular contracture in double-lumen breast implants: ten years' experience.
Two groups of patients are compared with respect to capsular contracture after insertion of silicone breast prostheses. Six hundred seventy four women received single-lumen gel prostheses and 700 received double-lumen prostheses with cortisone. The addition of 12.5 mg of prednisolone to double-lumen prostheses diminished capsular contracture (Baker II to IV) dramatically; in patients with simple augmentation from 19% to 4.9%, in patients with subcutaneous mastectomy from 54% to 14.9%, and in patients with breast reconstruction from 64% to 24.4%. The use of double-lumen implants has three distinct advantages: (1) There is no bleeding and therefore no contact of the body with the silicone gel. (2) There is no danger of ruptured implants, even if the outer shell shows leakage. (3) If prednisolone is administered, capsular contracture is prevented to a significant degree.
Contracture↗
Calf augmentation with new solid silicone implants.
Calf augmentation has been standardized by the use of banana-shaped silicone gel implants for almost 20 years. Capsule formation and resulting distignement, dislocation, gel bleeding, and implant rupture are rare but unpleasant complications. A new implant of solid silicone (McGhan, Santa Barbara, CA, USA) in the anatomical shape of one belly of the M. gastrocnemius placed subfascially appears to overcome these problems.
Adolescent↗
[A three-year aid program for plastic surgery in Peshawar (Pakistan). Ongoing management of severely injured patients of the Afghanistan war: 1,528 large operations, 5,171 smaller interventions, 15,932 patients examined].
Since 1980 Interplast Germany has sent many plastic surgeons to developing countries. In 1989 a new Interplast Germany program for helping Afghan refugees in Pakistan's Peshawar was started. The Federal Republic of Germany financed the first two years; thereafter, the European Community and Help supported the project. Twenty-four teams with 123 nurses, surgeons and anesthesiologists operated on 1,528 patients in two hospitals. In the same period 5,171 smaller operations have been performed and 15,932 patients have been examined. Low expense for the teams, good support by officials, and professional administration have made this project highly effective for 3 years.
Adult↗
External skin excision in the sebaceous nose and supratip deformity.
Some sebaceous noses cannot be properly reduced in size because of redundant skin. After standard rhinoplasty some noses develop a supratip deformity that recurs even after subcutaneous removal of the scar tissue. These noses can be corrected only by wedge-shaped skin excision. Most patients much prefer a pleasantly shaped nose, even at the cost of a midline scar on the nose. Most surgeons are hesitant to add scars to the face. However, the vast experience with wounds following accidents, tumor excisions, or corrections of malformations has shown that generally scar formation on the nose is inconspicuous. Nineteen patients were treated successfully by skin excision at the time of primary rhinoplasty or by a second operation.
Adult↗
Reduction of capsular formation around silicone breast implants by D-penicillamine in rats.
In a controlled study in 109 female rats we evaluated the effect of soluble D-Penicillamine in doses of 10 mg/ml or 100 mg/ml on capsular formation around semipermeable 2 cm3 mini-prostheses. This was compared with methylprednisolone 1 mg/ml or 10 mg/ml, and a group given saline served as controls. The drugs were injected into the lumen. Capsular wet weight and capsular tensile strength were measured after a period of 40 days. Rats given D-Penicillamine showed a significant, dose-dependent, reduction in wet weight and tensile strength compared with the saline group. There was no significant difference between the groups given D-Penicillamine and those given steroids. Topical treatment with diffused D-Penicillamine can significantly reduce the amount of capsular formation around silicone implants. This drug, which is highly specific for the systemic treatment of fibrotic diseases, should be evaluated further to use in reducing capsular formation.
Animals↗
Efficacy, tolerability and pharmacokinetics of teicoplanin in patients undergoing breast surgery.
In a prospective open trial, 21 female patients undergoing breast surgery received a single intravenous bolus injection of teicoplanin, 400 mg, 30 minutes before the operation. During surgery, (1 hour after teicoplanin administration), samples of breast and fat tissue and serum were collected; 24 hours and 48 hours after dosing, samples of wound exudate were taken. Teicoplanin concentrations were determined using the RASA method. Teicoplanin levels were lowest in fat tissue. Teicoplanin levels in wound exudate were found to be satisfactorily high. However, teicoplanin levels in fat and breast tissue and in wound exudate exceeded the MIC90 for various staphylococcus strains, such as S. aureus and S. epidermidis. No local or systemic adverse reactions were observed during the trial. Teicoplanin was well tolerated. Preliminary results from this trial, therefore, indicate that teicoplanin may be a suitable antibiotic for use in the prophylaxis of infection in breast surgery.
Adult↗
[Progress in the use of tissue expanders for defect closure of the body surface--experimental principles].
The principle of soft tissue expansion has been applied in widespread techniques in the field of plastic and reconstructive surgery since Radovan (1976) presented a method in which silicone expanders were subcutaneously implanted. Many experimental and clinical reports have been published since then, dealing particularly with the histomorphology, vascularization, and pathophysiology of expanded skin as well as with surgical techniques. Our own study intends to identify the effects of tissue expanders on the biomechanical, biochemical, and morphological qualities of expanded skin, and to determine the influence of pharmacological therapy during expansion.
Animals↗
[Siliconoma and rheumatic symptoms--a familial and a questionable complication of silicone implantation].
Ruptured silicone-gel filled implants after breast augmentation or reconstruction may cause siliconomas. These lesions frequently develop years later and should be surgically excised. Since the use of modern double lumen implants they do not occur anymore. The possibility of a correlation between silicone implants and the incidence of rheumatologic disorders is critically evaluated by case reports from the world literature. Up to now, no statistically significant cumulation of these disorders in women with silicone implants can be observed.
Breast↗
PMMA microspheres for intradermal implantation: Part I. Animal research.
In search of a biocompatible implant for the correction of small deficiencies within the dermal corium as in wrinkles and acne scars, polymethylmethacrylate (PMMA) microspheres, 10 to 63 microns in diameter, were dispersed in Tween 80 medium and injected intradermally and subdermally into the abdominal skin of rats. Histological examination of specimens for up to 7 months revealed a modest tissue reaction, forming a delicate fibrous capsule around each individual microsphere within 4 months. Foreign body giant cells were seen rarely (in up to 1.5% of all cells). No break-down, corrosion, or phagocytosis of the spheres was observed at 7 months. The Tween 80 dispersion medium did not produce any histologically detectable reaction. Because PMMA products (Paladon, Palacos) have been used in medicine for almost 50 years without causing biological degradation or cancer, the material may be applied safely in the form of microspheres (Arteplast) in corium and subcutis of human patients with wrinkles or acne scars.
Animals↗
[Surgical treatment of male baldness using Juri's crescent flap].
This is a report on thirty six patients with male pattern baldness, surgically treated with one or two parieto-occipital flaps according to Juri. In six patients with isolated occipital baldness, specially designed flaps were used. Since male baldness usually is genetically determined and hairroots of the temporo-occipital scalp remain active throughout life, one can expect that they continue growing within the transposed flaps. There are three indications for parieto-occipital flaps: 1. psychological burden of the patient, 2. genetic background in the family of young patients, and 3. prior punch hair grafts whose roots have atrophied.
Adult↗
A distally based first web flap in the foot.
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Foot↗