Efficacy of intralesional 5-fluorouracil and triamcinolone in the treatment of keloids

BACKGROUND

Keloids are a common problem with significant recurrence rates despite intralesional steroid treatment and multimodal therapy.

OBJECTIVE

The purpose of this study was to evaluate the efficacy of using a 5-fluorouracil (5-FU)/steroid mixture to treat keloids over the past 7 years, comparing the results with use of steroid treatment alone.

METHODS

Patient charts from 1999 to 2006 were reviewed. Patients were stratified into 3 groups: (1) 5-FU/steroid without excision; (2) 5-FU/steroid with excision; and (3) steroid treatment with excision. The percentage of lesion size reduction and symptoms were evaluated.

RESULTS

A total of 102 keloids were identified in a retrospective review. Patients who underwent the 5-FU/steroid combination with excision had a 92% average reduction in lesion size compared with 73% in the group of patients who did not receive 5-FU. Patients who received 5-FU/steroid without excision had an average lesion size reduction of 81%. Differences in complication rates were not statistically significant.

CONCLUSIONS

Combination 5-FU/triamcinolone is superior to intralesional steroid therapy in the treatment of keloids.

The Influence of Brow Shape on the Perception of Facial Form and Brow Aesthetics

BACKGROUND

Previous studies have described the ideal shape of the aesthetic brow. These studies were based on fashion models, who typically have ideal oval faces. In people with different facial shapes, makeup artists modify brow shape to give the illusion of an oval shape. The purpose of this investigation was to compare the classically described ideal brow to the modified brow for each facial shape.

METHODS

The faces of five models were morphed into round, square, oval, and long facial shapes. The eyebrows were digitally removed. A makeup artist drew the brows specifically for each facial shape. In a second set of prints, the brow shape was based on the previously published criteria. Seventy-eight people were asked which face they believed was more aesthetic.

RESULTS

There was no significant difference between the classic and the modified eyebrow in the oval or round facial shapes. In the square and long facial shapes, the modified brow was found to be more attractive in 62.7 percent and 58.7 percent of the subjects, which is statistically significant (p < 0.05).

CONCLUSIONS

The ideal brow may differ from the classic description when applied to the long or square face. In long faces, a flatter brow may give the illusion of fullness. In the square face, an accentuated lateral curvature may help soften the angles of the face. It may be difficult to achieve these modifications surgically, but it is important to be aware of the effect that brow shape has on facial shape.

Computer-generated three-dimensional animation of the mitral valve

OBJECTIVE

Three-dimensional motion-capture data offer insight into the mechanical differences of mitral valve function in pathologic states. Although this technique is precise, the resulting time-varying data sets can be both difficult to interpret and visualize. We used a new technique to transform these 3-dimensional ovine numeric analyses into an animated human model of the mitral apparatus that can be deformed into various pathologic states.

METHODS

In vivo, high-speed, biplane cinefluoroscopic images of tagged ovine mitral apparatus were previously analyzed under normal and pathologic conditions. These studies produced serial 3-dimensional coordinates. By using commercial animation and custom software, animated 3-dimensional models were constructed of the mitral annulus, leaflets, and subvalvular apparatus. The motion data were overlaid onto a detailed model of the human heart, resulting in a dynamic reconstruction.

RESULTS

Numeric motion-capture data were successfully converted into animated 3-dimensional models of the mitral valve. Structures of interest can be isolated by eliminating adjacent anatomy. The normal and pathophysiologic dynamics of the mitral valve complex can be viewed from any perspective.

CONCLUSION

This technique provides easy and understandable visualization of the complex and time-varying motion of the mitral apparatus. This technology creates a valuable research and teaching tool for the conceptualization of mitral valve dysfunction and the principles of repair.

Lip height and lip width after extended Mohler unilateral cleft lip repair

The purpose of this study was to evaluate the symmetry in lip height and lip width after extended Mohler unilateral cleft lip repair, with long-term follow-up monitoring. In the Mohler repair procedure, Millard's C-flap is used to fill the entire defect created by the downward rotation of the medial lip element. Because a lateral advancement flap is not transposed into this defect, Mohler repair is often expected to produce a short lip. In a retrospective study of 120 patients, anthropometric measurements were made on black-and-white photographs. Of those patients, 49 met the study criterion of having a set of photographs taken 13 months or less postoperatively and another set taken at least 2 years postoperatively. The distance from the Cupid's bow peak to a line tangent to the base of the columella (lip height) and the distance from the Cupid's bow peak to the ipsilateral commissure (lip width) were measured with a Vernier caliper. The medial intercanthal distance was also measured, for standardization of all measurements. All values were normalized to the mean intercanthal distance at age 6, as reported by Farkas. Matched-pair test analyses were used to assess the statistical significance of differences in cleft-side versus non-cleft-side measurements for each group, as well as changes with time. No statistically significant difference in cleft side versus non-cleft-side lip height for the two groups or with time was observed (< or =13 months, p = 0.28; >2 years, p = 0.08; change with time, p = 0.69). Statistically significant differences in lip width between the cleft side and the non-cleft side were observed for both time groups. The average difference in lip width at 1 to 13 months was 8.6 percent (p < 0.001). The average difference in lip width at 2 years or more postoperatively was 5.8 percent (p < 0.001). In comparisons of early versus late measurements, it was noted that lip width significantly increased with time (mean, 0.91 mm; p = 0.035). The findings suggest that extended Mohler repair does not produce a short lip. Interestingly, lip width was observed to be significantly smaller on the cleft side in the immediate postoperative period. However, this deficiency was observed to decrease significantly during long-term follow-up monitoring.