Intraoperative tissue expansion in rhytidectomy revisited

Intraoperative tissue expansion is an adjunct that has been used during rhytidectomy to rejuvenate the face and neck. This technique has been thought to allow for additional skin resection and, thus, increased skin tightening during rhytidectomy. The stretch of the skin by expansion should allow for additional skin resection before closure. Also, when the force of the underlying expander is removed, the expanded skin would recoil and the advancement of the flap should become tighter, with improved results. The technique achieved some popularity a few years ago but has received little recent attention. In this study, the authors attempted to compare face-lift results of adjunctive intraoperative tissue expansion during rhytidectomy with similar techniques without intraoperative expansion. The results of 50 female patients who underwent rhytidectomy for midface rejuvenation by a single operating surgeon composed the study group. Twenty-five of the patients had undergone rhytidectomy that addressed the cheek, chin, and neck areas without expansion (nonexpanded rhytidectomy group). The other 25 patients (expanded rhytidectomy group) had adjunctive intraoperative tissue expansion performed with the rhytidectomy. A tissue expander was temporarily placed beneath the rhytidectomy flaps on each side and expanded in a standard manner before final skin resection and closure. Frontal and lateral photographs were evaluated by 54 examiners. Preoperative and postoperative photographs of the 50 patients were viewed side-by-side by the examiners. The patients were presented in blind fashion and random order. The examiners graded the results of each patient on a scale of improvement from 1 to 10, with 10 being the maximum level of improvement. The scores were recorded and statistically evaluated by using the two-sample test. Evaluation of the examiners' scores showed that the mean rating given to patients in the expanded rhytidectomy group was 5.07 (SD = 1.12). The mean rating for the nonexpanded rhytidectomy group was 5.27 (SD = 1.57). When the two groups were compared using the two-sample test, the difference between the two was not statistically significant (p = 0.6127). Intraoperative tissue expansion as an adjunct to rhytidectomy did not result in improved facial rejuvenation in this patient series. The authors' impression is that the benefits of tissue expansion do not justify the added expense, time, and risks associated with using tissue expansion during rhytidectomy.

bFGF promotes the survival of entorhinal layer II neurons after perforant path axotomy

Infusion of basic fibroblast growth factor (bFGF) prevents the loss of cholinergic neurons in the septum/diagonal band of broca following fimbria-fornix transection. However, an in vivo test of whether bFGF will also rescue injured non-cholinergic or cortical neurons has not been carried out. Previous studies have shown that the majority of layer II stellate neurons utilize an excitatory amino acid as their neurotransmitter. In order to determine if bFGF acts on non-cholinergic cortical neurons, a paradigm was developed to examine whether or not bFGF could spare layer II entorhinal stellate cells from axotomy induced death or atrophy. Axotomy of the medial entorhinal cortex fibers projecting to the dentate gyrus of the hippocampal formation via the perforant path lead to retrograde cell loss in entorhinal cortex. Fourteen or thirty days after a unilateral knife cut axotomy of the perforant path, layer II of medical entorhinal cortex showed a 28% decrease in large stellate neurons as well as many weakly stained, hollow cells compared to the non-lesioned side or naive controls. Layer IV neurons, however, which do not project via the perforant path, showed little detectable change in the number of cells ipsilateral to the knife-cut as compared to the contralateral side. Intraventricular infusion of bFGF over a period of 14 days reduced the 28% cell loss to less than 6%. Thus, bFGF is capable of preventing cortical neuronal loss and/or atrophy associated with retrograde degeneration of non-cholinergic neurons following axotomy.

Radiation therapy for chest recurrences following induction chemotherapy in small cell lung cancer

Once small cell lung cancer fails induction chemotherapy, second line drugs are usually ineffective, accounting for mostly partial responses in the order of 0-20% and a median survival of 6-10 weeks. A review of patients with relapsed small cell lung cancer was carried out at the University of Maryland. Of 51 such patients, 44 received thoracic irradiation at the time of relapse. Excluding 8 patients who received insufficient treatment, the series consists of 36 patients (27 with limited and 9 with extensive disease) and represents the largest experience with relapsed small cell lung cancer subjected to radiation alone. Total radiation doses were 60 Gy in 11, 45-55 Gy in 14, and 38-42 Gy in the remaining 11 patients. No second line chemotherapy was given simultaneously with radiation at time of relapse and it was only given subsequently during the course of the disease to four patients. Responses to radiation were seen in 28 (77%) with 9 (25%) complete and 19 (52%) partial. The median survival was 16-40 weeks varying with disease extent, response, and total dose. Subsequent failures occurred in chest (34%) and distant sites (66%). A dose-response curve was attempted; the higher doses achieved as much as 75% local control. A poor response to induction chemotherapy did not predict a poor radiation response at time of relapse. Nearly 2/3 of patients who had not responded to induction chemotherapy responded to radiation at the time of relapse. The post-recurrence survival after radiation therapy was as long as or longer than the recurrence-free interval after induction chemotherapy, and this clearly demonstrates the value of radiation in achieving excellent palliation and good quality of life in these patients. Thoracic irradiation is recommended as a therapeutic alternative for locally recurrent small cell lung cancer after induction chemotherapy.