Surgical Management of Submucous Cleft Palate by Radical Muscle Dissection Veloplasty: Speech Outcomes in Patients with 22q11.2 Deletion Syndrome

OBJECTIVE

To evaluate the benefit of anatomical muscle dissection repair for velopharyngeal insufficiency (VPI) in patients with submucous cleft palate (SMCP) with 22q11.2 deletion syndrome.

DESIGN

Retrospective blinded randomised analysis of a surgeon's management over 10 years.

SETTING

The study was performed at a specialised Paediatric hospital in the United Kingdom.

PATIENTS

Children with SMCP and 22q11.2 deletion syndrome.

INTERVENTIONS

All participants underwent radical muscle dissection veloplasty.

OUTCOMES MEASURED

Pre- and post- operative measurements included severity of anatomical defect, speech samples and lateral images which were digitised, randomised then externally and blindly analysed using validated techniques. Stata software was used to perform statistical analysis.

RESULTS

57 children with 22q11.2 deletion syndrome were included in this analysis. Intra-operatively, the majority of cases were identified as SMCP Grade I anomalies. Post-operatively, a statistically significant improvement in hypernasality, resting palate length, palate length at maximum closure, palate excursion and gap size at maximum closure was observed. Secondary surgery was performed for 59% of patients by ten years.

CONCLUSION

Muscle dissection repair improves hypernasality, palate closure function and the closure gap in patients with 22q11.2 deletion syndrome. Although over 50% of patients may require further surgery, muscle dissection repair should be a first step due to its utility at a younger age, when invasive investigations are impossible, its lower morbidity, speech and language benefits or altering the plans for less obstructive secondary surgery when it lead to reduced velo-pharyngeal gap and improved palate mobility even when adequate velo-pharyngeal closure was not achieved.

Topical growth factor preparations for facial skin rejuvenation: A systematic review

BACKGROUND

Cosmeceutical preparations containing growth factors (GFs) are widely used for facial rejuvenation.

OBJECTIVE

We performed a systematic review to assess the evidence regarding their safety and effectiveness for facial rejuvenation.

METHODS

Electronic databases (Cochrane Library, EMBASE, MEDLINE, and Scopus) were searched from 2000 to October 2022 for prospective trials and case series assessing topical GF preparations for facial rejuvenation in 10 or more participants.

RESULTS

Thirty-three studies, including 9 randomized controlled trials (RCTs) and 24 uncontrolled case series, representing 1180 participants receiving 23 different topical preparations containing GFs met the inclusion criteria and were included. Of the 33 studies, nine used a placebo or active control. The GF preparations were applied twice daily in all except two studies, with a mean treatment duration of 3 months. Based on the investigator's assessment, preparations containing GFs induce a modest improvement in skin texture (median < 50%), fine lines/wrinkles (median < 35%), and overall facial appearance (median < 20%) versus baseline. Participant-assessed improvement was generally higher than investigator-assessed response. Three comparative RCTs showed no statistically significant differences between treatments. Studies were limited by heterogeneity with regard to the source and number of GFs used in the preparations, information about additional ingredients, and lack of standardization in the outcome measures. The preparations were associated with a low risk of adverse events. The persistence of the clinical improvements beyond 6 months is not known.

CONCLUSIONS

Administration of topical preparations containing GFs appears to be effective for facial skin rejuvenation, as demonstrated by the investigator- and participant-reported outcome measures.

Submucous Cleft Palate (SMCP): Indications and Outcomes of Radical Muscle Dissection Palatoplasty in Children Under 4 Years of Age

To delineate the indications, referral sources and outcomes of radical muscle dissection palate repair in the first 4 years of life for patients with submucous cleft palate (SMCP).

This study presents a retrospective analysis of a single surgeon's management.

All children were treated at Great Ormond Street Hospital, United Kingdom.

Twenty-three children with nonsyndromic SMCP were included in this study.

All participants underwent radical muscle dissection repair before their fourth birthday.

Parameters analyzed included: referral sources, indications for referral, extent of anatomical abnormality, and postoperative outcomes.

Paediatricians provided the largest proportion of referrals to the cleft lip and palate clinic (39%) due to the presence of cleft lip/palate on prenatal scans or during neonatal examination. Over half (n = 12, 52%) of patients had severe anatomical anomalies being in grade IV (score 8-9), with the classical triad present to some extent in all but 2 of the patients. The main indication for surgery was nasal regurgitation of food and liquid (n = 9, 35%) followed by hypernasality (n = 6, 21%), difficulty feeding (n = 3, 8%), and severe anatomical defect (n = 2; 4%). Postoperatively, the presenting complaint improved in the majority of cases.

Nonsyndromic SMCP is often missed, though may present with nasal regurgitation, feeding problems, and/or hypernasality, though may be missed in nonsyndromic children. Early radical muscle dissection repair in the first 4 years of life is safe and effective, facilitating normal speech development.

Topical growth factors and home-based microneedling for facial skin rejuvenation

BACKGROUND

Cosmeceutical products are an important therapeutic option for facial rejuvenation. Of these, topical application of growth factors has been shown to increase dermal collagen synthesis, improve skin texture, and reduce fine lines and wrinkles. Limited data exist for the use of growth factors in combination with microneedling.

OBJECTIVE

This prospective, single-center, uncontrolled study evaluated the efficacy of topical growth factor treatment in conjunction with transdermal delivery of growth factors via home-based microneedling for facial skin rejuvenation.

PATIENTS/METHODS

Eleven healthy female individuals aged 33-61 years, with mild-moderate facial wrinkling were included in the study. Over 3 months, participants received twice-daily application of a topical recombinant human growth factor preparation (SkinGenuity^® Regenerative and Reparative Serums) along with twice-weekly transdermal delivery of growth factors using a home-based microneedling (0.2 mm) device. Objective skin analysis (VISIA^® ) and a subjective patient-reported outcome (FACE-Q^® ) assessment measuring satisfaction with appearance were performed at baseline and after 3 months.

RESULTS

Objective skin analysis showed a significant improvement in skin texture (17.6%, p < 0.001), wrinkles (17.3%, p < 0.001), red areas (12.4%, p =0.004), and brown spots (6.0%, p =0.03) at 3 months follow-up. FACE-Q scales showed a significant improvement from baseline, including satisfaction with skin, facial appearance, nasolabial folds, cheeks, and lower face/jawline (all p ≤ 0.02). Numerical improvement in adverse effects related to skin was also observed (p = 0.07). No serious adverse effects were reported.

CONCLUSIONS

Three months of twice-daily topical growth factor treatment in conjunction with transdermal delivery of growth factors via microneedling improved skin analysis parameters and participant-reported outcome measures, indicative of facial skin rejuvenation.

A Systematic Review of the Literature of Delayed Inflammatory Reactions After Hyaluronic Acid Filler Injection to Estimate the Incidence of Delayed Type Hypersensitivity Reaction

BACKGROUND

Hyaluronic acid (HA) dermal filler injection is believed to be a safe procedure. However, with the increase in the number of performed procedures and indications, the number of product-related complications, especially delayed inflammatory reactions, has also increased. Delayed-type hypersensitivity (DTH) reaction is one of these delayed inflammatory reactions, which is preventable by performing a pretreatment skin test.

OBJECTIVES

The authors sought to find the incidence of delayed inflammatory reactions and DTH reaction after HA injection and to determine whether a pretreatment skin test is worthwhile to be performed.

METHODS

The authors conducted a systematic literature review of all the relevant prospective studies, retrospective studies, and case reports on delayed inflammatory reactions and DTH reaction after HA filler injection.

RESULTS

The incidence of delayed inflammatory reactions calculated from the prospective studies was 1.1% per year, and that of possible DTH reaction was 0.06% per year. Most retrospective studies estimated a percentage of delayed inflammatory reactions of less than 1% in 1 to 5.5 years. The incidence of DTH reaction would be lower than that. Among all the DTH cases reported, only about 5% of them were proven to be genuine DTH reactions.

CONCLUSIONS

The incidence of both delayed inflammatory reactions and DTH reaction is low. There is evidence that genuine DTH reactions caused by HA fillers approved by the Food and Drug Administration do exist. This adverse event can be prevented by performing a pretreatment skin test. However, the incidence of DTH reaction is so low that the pretreatment skin test is not mandatory if Food and Drug Administration-approved HA fillers are used.

LEVEL OF EVIDENCE: 4

Volume restoration of hands with polycaprolactone by cannula delivery; a prospective single center consecutive case series evaluation

Background: Dorsal hand volume loss results in the perception of aging appearance. Several volumizing fillers have been used for this correction.Objective: To report restoration of dorsal hand volume using cannula delivery of Polycaprolactone (PCL) microspheres and to assess efficacy, duration, and safety up to 3 years post treatment.Method: Fifteen patients with volume loss of their hands were evaluated by clinical examination, photography and a hand volume grading scale. PCL was injected by 25 G cannula after locating dorsal veins using a viewing laser to avoid intravascular injections. Patients' satisfaction and grade of severity were reevaluated at early (3-6 months) and late (12-18 months) timepoints following the procedure. A second treatment was offered if desired by the patient.Results: Eight participants required one treatment session to achieve satisfaction. Five had two treatments. Patients requiring a second treatment were reassessed after 12 months. All patients had improvements on the severity score by the end of the evaluation period. Side effects were minimal and transient. No patients developed bruising.Conclusion: PCL injections are reliable method for hand volumization. Results persisted for up to 3 years in some patients. Laser vein viewer and cannula delivery ensure uniform injections and avoid intravascular injuries.

Robotics in Cleft Surgery: Origins, Current Status and Future Directions

The field of robotic surgery is an exciting and growing field that has bolstered its way to become a mainstream application in a number of surgical disciplines. The application of robotic surgery in cleft surgery is novel and has captivated many with the benefit it provides: the slender and small arms with wrist articulation at the instrument tip; motion scaling; tremor elimination; and high fidelity, three-dimensional visualization make the robot a very attractive platform for use in confined spaces with small surgical targets. The story of the origin of robotic surgery in cleft surgery is an interesting one, and one that has arisen from other allied surgical specialities to render robotic cleft surgery as its own specialised field. A field that has coined its own terms and has demonstrated a number of applications for its use. This review details the origins of robotic cleft surgery, its evolution and its current status and elaborates on future directions to enhance its application.

Use of Augmented Reality in Reconstructive Microsurgery: A Systematic Review and Development of the Augmented Reality Microsurgery Score

BACKGROUND

 Augmented reality (AR) uses a set of technologies that overlays digital information into the real world, giving the user access to both digital and real-world environments in congruity. AR may be specifically fruitful in reconstructive microsurgery due to the dynamic nature of surgeries performed and the small structures encountered in these operations. The aim of this study was to conduct a high-quality preferred reporting items for systematic reviews and meta-analyses (PRISMA) and assessment of multiple systematic reviews 2 (AMSTAR 2) compliant systematic review evaluating the use of AR in reconstructive microsurgery.

METHODS

 A systematic literature search of Medline, EMBASE, and Web of Science databases was performed using appropriate search terms to identify all applications of AR in reconstructive microsurgery from inception to December 2018. Articles that did not meet the objectives of the study were excluded. A qualitative synthesis was performed of those articles that met the inclusion criteria.

RESULTS

 A total of 686 articles were identified from title and abstract review. Five studies met the inclusion criteria. Three of the studies used head-mounted displays, one study used a display monitor, and one study demonstrated AR using spatial navigation technology. The augmented reality microsurgery score was developed and applied to each of the AR technologies and scores ranged from 8 to 12.

CONCLUSION

 Although higher quality studies reviewing the use of AR in reconstructive microsurgery is needed, the feasibility of AR in reconstructive microsurgery has been demonstrated across different subspecialties of plastic surgery. AR applications, that are reproducible, user-friendly, and have clear benefit to the surgeon and patient, have the greatest potential utility. Further research is required to validate its use and overcome the barriers to its implementation.

A Critical Review of Botulinum Toxin Type A in the Prophylactic Treatment of Chronic Migraine in Adults

BACKGROUND

Migraine is a severe, disabling condition, ranked by World Health Organization as the sixth highest cause of disability worldwide. It greatly affects patients' quality of life, functionality, and physical and mental health. The financial burden of migraine on the UK economy is conservatively estimated at £3.42 billion per year.

OBJECTIVES

The authors sought to perform an evidence-based literature review of the safety and efficacy of botulinum toxin type A (onaBoNTA) in the prophylactic treatment of adult patients suffering with chronic migraine (CM) compared to placebo. After the best evidence is identified, it will be utilized to formulate a protocol for doctors managing CM in their aesthetic clinic.

METHODS

A comprehensive search of the current literature on the topic was performed by H.M. using Pubmed MEDLINE electronic database on March 1, 2018. All articles up to and inclusive of this date were included. Articles were limited to human studies and those in the English language. In vitro and animal studies were excluded.

RESULTS

A total of 260 articles were identified. Of these, the excellent-quality, high-strength (level 1A) trials were short-listed to answer the research question.

CONCLUSIONS

There is high-quality, level 1A evidence to support onaBoNTA treatment in adults with CM is well tolerated and considered safe. However, it is associated with increased risk of adverse events and still some uncertainty exists associated with the degree onaBoNTA improves outcome measures compared to placebo. These data have been used to formulate The London Aesthetic Migraine Protocol (LAMP) to provide safe, evidence-based guidance for appropriately trained and experienced aesthetic practitioners to manage CM in their aesthetic clinics.

LEVEL OF EVIDENCE: 1

London calling Gaza: The role of international collaborations in the globalisation of postgraduate burn care education

Burn injuries represent a significant epidemiological problem, with the vast majority occurring in low- to middle-income countries. These regions also represent areas where lack of socioeconomic growth and geopolitical instability pose additional barriers not only to healthcare provision but also to the acquisition of continuing professional development. Long-distance, web-based learning programmes ('tele-education') have been identified as a successful and powerful means of propagating up-to-date medical education and training in poor-resource, isolated or conflict-ridden regions. This report evaluates the role of tele-education in delivering a distance-learning Master's degree in Burn Care to a group of 11 healthcare professionals working in the occupied Palestinian territories (OPT), which was funded as part of a collaboration between Queen Mary University of London and IMET-Pal (International Medical Education Trust - Palestine). We present our experience in delivering the programme in a conflict-ridden part of the world, which includes the specific adaptations to tailor the programme to regional needs as well the unique challenges faced by students and faculty in enhancing the educational value of this unique initiative. The academic achievements of this group of healthcare professionals were found to be comparable to historical student cohorts from privileged socioeconomic backgrounds and the majority of students felt that participation in the programme contributed to a direct improvement to their daily burn care practices. The successful outcomes achieved by our students support the constantly emerging evidence that targeted, well-delivered, long-distance learning programmes can become powerful tools in combating inequalities in global healthcare and health education.

Evolution of an evidence-based supermicrosurgery simulation training curriculum: A systematic review

BACKGROUND

Supermicrosurgery (SM) involves operating on vessels with calibers from 0.3-0.8 mm. SM requires skills beyond those of conventional microsurgery. Current microsurgery courses do not prepare a junior surgeon for such a challenge. Several models have been developed to assist in the early learning curve, but their true purpose, benefit, and validation have not been addressed. This systematic literature review summarizes the existing SM simulation models, and their likely impact on microsurgery training for small-caliber vessel-based procedures is assessed.

METHODS

An electronic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. From the literature search, 90 potential articles from MEDLINE and 300 articles from other databases were identified and screened. Twenty-five studies were screened against the inclusion criteria by two independent reviewers for a final critical analysis.

RESULTS

Thirty-six articles were included in the reviewing process, and 15 SM simulation training models were identified. The simulation models were classified as nonbiological or biological and as ex vivo or in vivo. None of these models demonstrated validity. However, critical analysis of the full-text articles established the clinical correlation of each model along with the specific skill demonstrated. A novel ladder-based curriculum was established. Further, an expert's questionnaire generated a Likert scale and the clinical impact of each SM simulation training model.

CONCLUSION

This is the first review to highlight the clinical relevance of SM models and the need for validation. Currently, a variety of training models in SM appear to enable the acquisition of specific skills, and the clinical impact of a selection is recognized in a proposed SM simulation training curriculum.

Art or Science? An Evidence-Based Approach to Human Facial Beauty a Quantitative Analysis Towards an Informed Clinical Aesthetic Practice

BACKGROUND

Patients often seek guidance from the aesthetic practitioners regarding treatments to enhance their 'beauty'. Is there a science behind the art of assessment and if so is it measurable? Through the centuries, this question has challenged scholars, artists and surgeons.

AIMS AND OBJECTIVES

This study aims to undertake a review of the evidence behind quantitative facial measurements in assessing beauty to help the practitioner in everyday aesthetic practice.

METHODS

A Medline, Embase search for beauty, facial features and quantitative analysis was undertaken.

SELECTION CRITERIA

Inclusion criteria were studies on adults, and exclusions included studies undertaken for dental, cleft lip, oncology, burns or reconstructive surgeries. The abstracts and papers were appraised, and further studies excluded that were considered inappropriate. The data were extracted using a standardised table. The final dataset was appraised in accordance with the PRISMA checklist and Holland and Rees' critique tools.

RESULTS

Of the 1253 studies screened, 1139 were excluded from abstracts and a further 70 excluded from full text articles. The remaining 44 were assessed qualitatively and quantitatively. It became evident that the datasets were not comparable. Nevertheless, common themes were obvious, and these were summarised.

CONCLUSION

Despite measures of the beauty of individual components to the sum of all the parts, such as symmetry and the golden ratio, we are yet far from establishing what truly constitutes quantitative beauty. Perhaps beauty is truly in the 'eyes of the beholder' (and perhaps in the eyes of the subject too).

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Benslimane's Artistic Model for Females' Gaze Beauty: An Original Assessment Tool

Background

The aim of this paper is to analyze the aesthetic characteristics of the human females’ gaze using anthropometry and to present an artistic model to represent it: “The Frame Concept.” In this model, the eye fissure represents a painting, and the most peripheral shadows around it represent the frame of this painting. The narrower the frame, the more aesthetically pleasing and youthful the gaze appears.

Materials and Method

This study included a literature review of the features that make the gaze appear attractive. Photographs of models with attractive gazes were examined, and old photographs of patients were compared to recent photographs. The frame ratio was defined by anthropometric measurements of modern portraits of twenty consecutive Miss World winners. The concept was then validated for age and attractiveness across centuries by analysis of modern female photographs and works of art acknowledged for portraying beautiful young and older women in classical paintings.

Results

The frame height inversely correlated with attractiveness in modern female portrait photographs. The eye fissure frame ratio of modern idealized female portraits was similar to that of beautiful female portraits idealized by classical artists. In contrast, the eye fissure frames of classical artists’ mothers’ portraits were significantly wider than those of beautiful younger women.

Conclusion

The Frame Concept is a valid artistic tool that provides an understanding of both the aesthetic and aging characteristics of the female periorbital region, enabling the practitioner to plan appropriate aesthetic interventions.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A3 online Instructions to Authors. www.springer.com/00266.

Twelve tips for postgraduate or undergraduate medics building a basic microsurgery simulation training course

Microsurgery is used in a variety of surgical specialties, including Plastic Surgery, Maxillofacial Surgery, Ophthalmic Surgery, Otolaryngology and Neurosurgery. It is considered one of the most technically challenging fields of surgery. Microsurgical skills demand fine, precise and controlled movements, and microsurgical skill acquisition has a steep initial learning curve. Microsurgical simulation provides a safe environment for skill acquisition before operating clinically. The traditional starting point for anyone wanting to pursue microsurgery is a basic simulation training course. We present twelve tips for postgraduate and undergraduate medics on how to set up and run a basic ex-vivo microsurgery simulation training course suitable for their peers.

Perforator chimerism for the reconstruction of complex defects: A new chimeric free flap classification system

Complex defects present structural and functional challenges to reconstructive surgeons. When compared to multiple free flaps or staged reconstruction, the use of chimeric flaps to reconstruct such defects have many advantages such as reduced number of operative procedures and donor site morbidity as well as preservation of recipient vessels. With increased popularity of perforator flaps, chimeric flaps' harvest and design has benefited from 'perforator concept' towards more versatile and better reconstruction solutions. This article discusses perforator based chimeric flaps and presents a practice based classification system that incorporates the perforator flap concept into "Perforator Chimerism". The authors analyzed a variety of chimeric patterns used in 31 consecutive cases to present illustrative case series and their new classification system. Accordingly, chimeric flaps are classified into four types. Type I: Classical Chimerism, Type II: Anastomotic Chimerism, Type III: Perforator Chimerism and Type IV Mixed Chimerism. Types I on specific source vessel anatomy whilst Type II requires microvascular anastomosis to create the chimeric reconstructive solution. Type III chimeric flaps utilizes the perforator concept to raise two components of tissues without microvascular anastomosis between them. Type IV chimeric flaps are mixed type flaps comprising any combination of Types I to III. Incorporation of the perforator concept in planning and designing chimeric flaps has allowed safe, effective and aesthetically superior reconstruction of complex defects. The new classification system aids reconstructive surgeons and trainees to understand chimeric flaps design, facilitating effective incorporation of this important reconstructive technique into the armamentarium of the reconstruction toolbox.

Submucous Cleft Palate: A Systematic Review of Surgical Management Based on Perceptual and Instrumental Analysis

Objective

Submucous cleft palate (SMCP) is a congenital condition associated with abnormal development of the soft palate musculature. In a proportion of cases, this results in velopharyngeal insufficiency (VPI), the treatment for which includes pharyngeal flap surgery, pharyngoplasty, and palate reconstruction. The aim of this paper is to determine whether there is superiority of one or more types of surgical procedure over the others in improving speech in patients with VPI secondary to SMCP.

Methodology

Nine databases, including MEDLINE and EMBASE, were searched between inception and January 2013 to identify articles published relating to the surgical management of SMCP. Only studies that reported outcome measures for postoperative speech were included in the systematic review.

Results

Twenty-six studies analyzing the outcomes of surgery for VPI in patients with SMCP met the inclusion criteria. In these studies, speech outcomes were measured either in a binary fashion (i.e., normal speech or evidence of VPI) or using scales of VPI severity. Of the 26 studies, only two utilized blinded speech assessment, and 12 included both preoperative and postoperative speech assessment.

Conclusions

The review found little evidence to support any specific surgical intervention. This is in large part due to the inclusion of mixed etiologies within study populations and the lack of unbiased validated preoperative and postoperative speech assessment. Further methodologically rigorous studies need to be conducted to provide a secure evidence base for the surgical management of SMCP.

Laparoscopic Gastric and Biliary Bypass: A Single-Center Cohort Prospective Study

PURPOSE

Relief of gastric outlet and distal biliary obstruction may be accomplished by open surgery or by minimally invasive techniques including endoscopic and laparoscopic approaches. We examined the feasibility and safety of laparoscopic gastric and biliary bypass in all patients with malignant and benign disease requiring surgical relief of obstructive symptoms.

MATERIALS AND METHODS

Patients with benign duodenal stricture or inoperable malignancy underwent therapeutic laparoscopic bypass surgery. Prophylactic gastric or biliary bypass was added in selected patients with nonmetastatic malignancy.

RESULTS

Twenty-eight patients (17 of them female) with a median age of 67 years (range, 26-81 years) underwent 29 laparoscopic bypass procedures for malignant (n = 23) or benign (n = 6) disease. One patient who underwent a Roux-en-Y gastrojejunostomy for non-steroidal anti-inflammatory drug induced ulcer disease developed stenosis of the stoma that required laparoscopic refashioning 2 months later, accounting for the 29th procedure reported herein in 28 patients. Surgery included the construction of a single gastric (n = 16) or biliary (n = 5) bypass or a double bypass (n = 8), and an additional prophylactic bypass in 5 of 23 cancer patients (21.8%). All procedures were completed laparoscopically. The median operative time was 90 minutes (range, 60-153 minutes) and mean postoperative hospital stay was 4 days (range, 3-6 days). Complications developed following 4 procedures (13.8%) and 1 patient died (3.4%). No complications occurred in patients with prophylactic bypass. One patient required laparoscopic revision of the gastroenterostomy 2 months postoperatively, for benign disease. No recurrence of obstructive symptoms was observed in cancer patients during follow-up.

CONCLUSION

Laparoscopic bypass surgery for distal biliary and gastric obstruction in patients with benign or malignant disease results in low morbidity and mortality and short postoperative hospital stay. The addition of prophylactic bypass in patients with nonmetastatic unresectable malignancy appears safe and effective.

Circulating immune complex levels in patients with schistosomiasis and complications

Circulating immune complexes (CIC), adult schistosome antibody, and total immunoglobulin concentrations were estimated in sera from 35 chronic Schistosoma mansoni patients with different infection intensities and different pathological complications. High CIC levels were present in about one-third (10/35) of the sera. Most of the patients (9/10) with elevated CIC levels also had hepatomegaly or hepatosplenomegaly. This finding is significant in the pathogenesis of schistosomal liver fibrosis and may also apply to other liver diseases, especially cirrhosis. No correlation was found between infection intensity as judged by stool egg counts and CIC levels. A reverse relationship was observed between the level of anti-adult worm IgG and CIC levels. CIC levels were elevated within 7 and 28 days after treatment in most patients. Hypergammaglobulinaemia was detected in most sera.