Adam D. Perry

Breast Cancer Cell-Derived Fibroblast Growth Factor 2 and Vascular Endothelial Growth Factor Are Chemoattractants for Bone Marrow Stromal Stem Cells

Objective:Recent efforts by the scientific community to characterize the complex interplay between different cell types involved in the development of tumors have led us to investigate the roles of vascular endothelial growth factor (VEGF) and fibroblast growth factor 2 (FGF2) in the development of breast cancer. Methods:Using modified Boyden chamber assays, we measured the in vitro migration effect on murine mesenchymal stem cells (MSCs). Additionally, we assayed for the presence of receptors for these growth factors on MSCs, and for the presence of VEGF and FGF2 in breast cancer-conditioned media. We measured the change in migration of MSCs toward breast cancer when we depleted these growth factors from breast cancer-conditioned media. Further, we conducted a series of standard curve migration assays for basal media supplemented with physiologic concentrations of VEGF and FGF2. Results:Analysis of gene expression and protein analysis demonstrated the expression of FGF2 and VEGF by the breast cancer cells, and the presence of VEGF (FLK1) and FGF2 receptors on the MSCs. We also demonstrated a reduction in migration when we antibody-depleted VEGF and FGF2 from breast cancer-conditioned media. Additionally, we found the physiologic concentrations of VEGF and FGF2 at 12 and 15 ng/mL, respectively. Conclusions:We demonstrate that VEGF and FGF2 induce migration of MSCs are secreted by breast cancer cells, their receptors are present on MSCs, and depletion of these growth factors reduces migration, and are therefore 2 relevant growth factors for MSC migration toward breast cancer cells.

The volume-outcome relationship for immediate breast reconstruction.

Background: Efforts to improve the quality of surgical care in the United States have led many organizations to advocate the use of high-volume hospitals for complex surgical procedures and/or comprehensive multidisciplinary care. The benefits, if any, of selective referral to high-volume hospitals for immediate breast reconstruction are relatively unknown. It is this gap in knowledge that forms the basis for the current study. Methods: Using Californias Office of Statewide Health Planning and Development discharge database, all patients undergoing immediate breast reconstruction from January 1, 1998, to December 31, 1999, were identified. Information regarding demographic, comorbidity, complication, and hospital volume characteristics was obtained. Patient comorbidity was graded using a modified version of the Charlson score. Annual hospital volume was categorized into patient quartiles. Multivariate logistic regression was performed to identify predictors of surgical complications. Results: A total of 2691 patients were included: 1271 had immediate autogenous tissue reconstruction and 1420 had immediate tissue expander placement. The complication rate was 11.6 percent among patients undergoing autogenous reconstruction and 2.4 percent among patients receiving tissue expanders. For autogenous reconstruction, complications were more likely in patients with comorbidities (odds ratio, 2.24) and in patients receiving care at very-low-volume (less than eight) and medium-volume (20 to 41) hospitals (odds ratio,1.81 and 1.90, respectively). For tissue expander reconstruction, patient comorbidity (odds ratio, 2.42) was the only significant predictor of complications. Conclusions: Hospital volume appears to be an important predictor of patient outcome with regard to autogenous reconstruction but not tissue expander reconstruction. Patient comorbidity predicts complications for both autogenous and tissue expander reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

High septal osteotomy in rhinoplasty for the deviated nose

When attempting to straighten a patients healed, deviated bony nasal dorsum, deviation of the central structure (high dorsal septum and medial nasal bones) must be addressed following the completion of medial and lateral osteotomies. When hump resection is not performed, blunt fracture (digitally or with forceps) of the deviated central structure is not a reliable method of mobilization, often leading to postoperative nasal drift. An intranasal osteotomy technique to mobilize the central structure of the nose is described, called “high septal osteotomy.” Review of 25 cases suggests high septal osteotomy, supplemented as needed by resection of overlapping septal elements, can be performed safely and efficaciously, permitting stable midline reduction of the nasal pyramid. The technique is not advocated when hump resection is performed, as it is unnecessary and could destabilize the dorsum. Even aggressive maneuvers to mobilize the bony dorsum may fail if not performed properly with meticulous attention to completion of all osteotomies.

The Supraclavicular Artery Island Flap (SCAIF) as an Ideal Option in Head & Neck Reconstruction

Background: At our institution, the Supraclavicular Artery Island Flap (SCAIF) has become a reliable, firstchoice option for fasciocutaneous coverage of complex Head & Neck defects. No studies have compared the outcomes of reconstructions performed with SCAIFs and free flaps directly. The aim of our study was to compare outcomes between SCAIFs and free fasciocutaneous flaps (FFF) via a single surgeon’s experience at a County Hospital.