Berend van der Lei

Female Attitudes Regarding Labia Minora Appearance and Reduction With Consideration of Media Influence

BACKGROUND Labia minora (LM) appearance and reduction have gained increasing media attention in The Netherlands. OBJECTIVE To determine the prevailing female view about LM appearance and reduction and the role of the media in shaping that view. METHODS From October 2007 to January 2008, questionnaires designed to elicit prevailing female opinion were distributed to and completed by several groups of females. Survey participants included female medical students at the University of Groningen (n = 394; average age, 22 +/- 3 yrs); patients visiting the outpatient Department of Obstetrics and Gynaecology of the Medical Centre Leeuwarden (n = 51; average age, 40 +/- 13 yrs); and female patients visiting Heerenveen, a private clinic (n = 37; average age, 41 +/- 10 yrs). RESULTS Most participants (95%) frequently examined their own LM. Almost half of the participants (43%) found the appearance of their LM important and 71% thought that their appearance was normal. Almost all participants (95%) have known about the possibility of LM reduction for the past 2.2 years. Most participants (78%) heard about LM reduction through a media source. Fourteen percent of the total sample found the appearance of their LM to be abnormal, 7% had considered LM reduction, and 0.42% had undergone such a procedure. CONCLUSIONS Our survey demonstrates that the appearance of LM is important to women and that almost all women surveyed have heard about LM reduction during the past 2.2 years. Our findings probably reflect the influence of increased media attention on this issue in The Netherlands.

New-fill injections may induce late-onset foreign body granulomatous reaction.

A 64-year-old healthy woman presented to our clinic with an atrophic upper lip conforming to her age. New-Fill (one flacon) was used to augment her upper lip. The patient did not report for follow-up until 14 months after injection. She had noticed a firm mass in her upper lip that was particularly notable during mimic movement. There was no trauma or disease in the patient’s history. On physical examination, a solid painless mass with a size of 5 to 6 mm was palpable. According to the patient, the size of the mass had decreased, so no further action was taken. A follow-up appointment was made but she did not visit until 5 month later; at this time two masses were clearly notable in her upper lip both at rest and during mimic movement (Fig. 1, above). Under local anesthesia, the upper lip was explored. Several white lumps with a diameter of 5 to 10 mm were found and removed (Fig. 1, below). Histopathological investigation demonstrated a foreign body giant-cell reaction with pseudo-encapsulation (Fig. 2, above). Several histiocytic cells and giant cells containing NewFill were visible (Fig. 2, below).

Regeneration of the arterial wall in microporous, compliant, biodegradable vascular grafts after implantation into the rat abdominal aorta

SummaryThe ultrastructure of a new type of vascular graft, prepared from a mixture of polyurethane (95 weight %) and poly-L-lactic acid (5 weight %), was examined six weeks after implantation into the abdominal aorta of rats. These microporous, compliant, biodegradable, vascular grafts function as temporary scaffolds for the regeneration of the arterial wall.Smooth muscle cells, covering the grafts, regenerated a neo-media underneath an almost completely regenerated endothelial layer (neo-intima). These smooth muscle cells varied in morphology from normal smooth muscle cells to myofibroblasts. They were surrounded by elastic laminae and collagen fibers.Macrophages, epithelioid cells, multinucleated giant cells, fibroblasts and capillaries were present in the disintegrating graft lattices. The epithelioid cells and multinucleated giant cells engulfed polymer particles of the disintegrating grafts.The regeneration of the endothelial and smooth muscle cells is similar to the natural response of arterial tissue upon injury. The presence of macrophages, epithelioid cells, multinucleated giant cells, fibroblasts and capillaries in the graft lattices resembles the natural response of tissue against foreign body implants. Both of these responses result in the formation of a neo-artery that possesses sufficient strength, compliance and thromboresistance to function as a small caliber arterial substitute.

Autologous vein supported with a biodegradable prosthesis for arterial grafting

To evaluate the potential of a supporting, compliant, biodegradable prosthesis to function as a temporary protective scaffold for autologous vein grafts in the arterial circulation, we implanted vein grafts into the carotid arteries of rabbits, either with (composite grafts) or without (control grafts) such a supporting prosthesis, and evaluated them up to 6 weeks. The control vein grafts showed edema and severe medial disruption with infiltration of polymorphonuclear cells on day 1. Over the study, irregular fibrocyte formation resulted in the formation of a fibrotic vein wall. In contrast, the composite vein grafts showed preservation of smooth muscle cell layers and elastic laminae with a minor inflammatory response. Regular proliferation of fibroblasts, which in some areas were circularly oriented, was observed. We conclude that a supporting, compliant, biodegradable prosthesis can function as a protective scaffold for vein grafts in the arterial circulation, thus reducing damage to the vein graft wall and allowing gradual arterialization.

Scarless Umbilicoplasty A New Umbilicoplasty Technique and a Review of the English Language Literature

Many techniques have been described for umbilicoplasty after abdominoplasty, but none of these techniques seems ideal. In this report, we wish to report a new “scarless” umbilicoplasty technique, which bears many of the characteristics of an ideal technique: it is easy to perform and results in the complete absence of visible scars and with a preferred vertical orientation. The aesthetic results of this technique are subjectively and objectively evaluated as compared with the classic umbilicoplasty and these results are discussed among the English language literature. In the period of 2004 to 2005, a series of 138 female patients have had an abdominoplasty with either the classic umbilicoplasty (n = 31) or with our scarless umbilicoplasty (n = 107). After a follow-up period of at least 3 (of 6) months, a questionnaire was send to all of these patients to evaluate patient satisfaction. Twenty-five patients from the classic umbilicoplasty group responded, 53 patients from the scarless umbilicoplasty group. Age (mean 45 with range, 22–66 years) and body mass index (29 with range, 22–35) did not differ among both groups. Also a random selection of fifteen photos from both groups was analyzed and rated according to the system of Strasser by an independent panel. There were no major complications in both groups, but in the classic group, there were some cases with hypertrophic scarring. Patients who underwent the scarless umbilicoplasty technique graded the appearance of their umbilicus significantly better on shape, depth, hygiene, and scar. No significant differences were found in grading size and wound healing. Objective evaluation of the photos demonstrated significant better results for the scarless umbilicoplasty technique. Based on our subjective and objective analysis we conclude that our new technique of the scarless umbilicoplasty features many of the characteristics of the ideal umbilicoplasty: a rather simple and reliable method for creating a natural looking umbilicus when performing an abdominoplasty.

Long-term results of arthrodesis of the carpometacarpal joint of the thumb

We reviewed 48 arthrodeses of the carpometacarpal joint of the thumb in 39 patients being treated for osteoarthritis. The mean follow-up period was 90 months (range 14 months-17 years). In 28 (58%) hands pain relief was excellent and in 6 (12%) good. Mobility was significantly reduced ( p < 0.002). Mean key pinch (52.9 N) and grip strength (219.5 N) were comparable with the unoperated hand (51.0 and 239.1 N, respectively). Hand function was near normal. In 29 hands an additional operation was needed to remove the osteosynthesis material; 14 hands failed to unite. Osteoarthritis of the scaphotrapezial joint increased significantly faster in the operated hands than in the unoperated ones ( p < 0.0001). A soft tissue procedure (such as flexor carpi radialis interposition arthroplasty) is advised instead of arthrodesis, because of the large number of reoperations, based on non-union and removal of the osteosynthesis material. From a survey of published papers we conclude that arthrodesis of the carpometacarpal joint of the thumb can best be done by stapling and bone grafting.We reviewed 48 arthrodeses of the carpometacarpal joint of the thumb in 39 patients being treated for osteoarthritis. The mean follow-up period was 90 months (range 14 months-17 years). In 28 (58%) hands pain relief was excellent and in 6 (12%) good. Morbility was significantly reduced (p < 0.002). Mean key pinch (52.9 N) and grip strength (219.5 N) were comparable with the unoperated hand (51.0 and 239.1 N, respectively). Hand function was near normal. In 29 hands an additional operation was needed to remove the osteosynthesis material; 14 hands failed to unite. Osteoarthritis of the scaphotrapezial joint increased significantly faster in the operated hands than in the unoperated ones (p < 0.0001). A soft tissue procedure (such as flexor carpi radialis interposition arthroplasty) is advised instead of arthrodesis, because of the large number of reoperations, based on non-union and removal of the osteosynthesis material. From a survey of published papers we conclude that arthrodesis of the carpometacarpal joint of the thumb can best be done by stapling and bone grafting.

No (wo)man is an island--the influence of physicians' personal predisposition to labia minora appearance on their clinical decision making: a cross-sectional survey.

INTRODUCTION Physicians are increasingly presented with women requesting a labia minora reduction procedure. AIM To assess the influencing factor of personal predisposition in general practitioners, gynecologists, and plastic surgeons to labia minora appearance in relation to their willingness to refer for, or perform, a surgical labia minora reduction. METHODS Cross-sectional self-administered questionnaire survey. Between May 2009 and August 2009, 210 physicians were surveyed. Primary care: general practitioners working in the north of the Netherlands. Secondary care: gynecologists and plastic surgeons working in five hospitals in the north of the Netherlands. MAIN OUTCOME MEASURES A five-point Likert scale appraisal of four pictures showing a vulva, each displaying different sizes of labia minora, indicating a physicians personal predisposition, manifesting as willingness to refer for, or perform, a labia minora reduction. RESULTS A total of 164/210 (78.1%) physicians completed the questionnaire, consisting of 80 general practitioners, 41 gynecologists, and 43 plastic surgeons (96 males, 68 females). Ninety percent of all physicians believe, to a certain extent, that a vulva with very small labia minora represents societys ideal (2-5 on the Likert scale). More plastic surgeons regarded the picture with the largest labia minora as distasteful and unnatural, compared with general practitioners and gynecologists (P < 0.01), and regarded such a woman as a candidate for a labia minora reduction procedure (P < 0.001). Irrespective of the womans labia minora size and the absence of physical complaints, plastic surgeons were significantly more open to performing a labia minora reduction procedure than gynecologists (P < 0.001). Male physicians were more inclined to opt for a surgical reduction procedure than their female colleagues (P < 0.01). CONCLUSIONS The personal predisposition of physicians (taking account of their specific gender and specialty) concerning labia minora size and appearance influences their clinical decision making regarding a labia minora reduction procedure. Heightened awareness of ones personal predisposition vis-à-vis referral and willingness to operate is needed.

Pectus Excavatum Reconstruction With Silicone Implants Long-Term Results and a Review of the English-Language Literature

Pectus excavatum, or funnel chest, is an anterior chest wall deformity, characterized by a depressed sternum. Frequently used techniques for pectus excavatum repair are extensive thoracic surgical corrections at a young age. At an adult age, custom-made silicone implants can be used as a less extensive surgical option. Thus far, there are only a limited number of reports in the English-language literature concerning this treatment modality. We evaluated our series of 16 patients treated with custom-made silicone implants, assessing complications, patient satisfaction, and aesthetic outcome. Seven patients (44%) had complications, mostly seroma formation (31%). Ten of 12 patients (83%), who were evaluated at the long-term, reported improved patient satisfaction and 9 of 13 patients (69%), in whom aesthetic results were assessed, had a good or excellent aesthetic outcome. Our study, combined with a review of the English-language literature, demonstrates that there is a place for custom-made silicone implants in the treatment of pectus excavatum, especially in less severe cases at an adult age. Preoperative counseling with emphasis on the likelihood of seroma formation is advocated.

Adipose Tissue-Derived Stromal Cells Inhibit TGF-beta 1-Induced Differentiation of Human Dermal Fibroblasts and Keloid Scar-Derived Fibroblasts in a Paracrine Fashion

Background: Adipose tissue–derived stromal cells augment wound healing and skin regeneration. It is unknown whether and how they can also influence dermal scarring. The authors hypothesized that adipose tissue–derived stromal cells inhibit adverse differentiation of dermal fibroblasts induced by the pivotal factor in scarring, namely, transforming growth factor (TGF)-&bgr;. Methods: TGF-&bgr;1–treated adult human dermal fibroblasts and keloid scar–derived fibroblasts were incubated with adipose tissue–derived stromal cell–conditioned medium and assessed for proliferation and differentiation, particularly the production of collagen, expression of SM22&agr;, and development of hypertrophy and contractility. Results: TGF-&bgr;1–induced proliferation of adult human dermal fibroblasts was abolished by adipose tissue–derived stromal cell–conditioned medium. Simultaneously, the medium reduced SM22&agr; gene and protein expression of TGF-&bgr;1–treated adult human dermal fibroblasts, and their contractility was reduced also. Furthermore, the medium strongly reduced transcription of collagen I and III genes and their corresponding proteins. In contrast, it tipped the balance of matrix turnover to degradation through stimulating gene expression of matrix metalloproteinase (MMP)-1, MMP-2, and MMP-14, whereas MMP-2 activity was up-regulated also. Even in end-stage myofibroblasts (i.e., keloid scar–derived fibroblasts), adipose tissue–derived stromal cell–conditioned medium suppressed TGF-&bgr;1–induced myofibroblast contraction and collagen III gene expression. Conclusion: The authors show that adipose tissue–derived stromal cells inhibit TGF-&bgr;1–induced adverse differentiation and function of adult human dermal fibroblasts and TGF-&bgr;1–induced contraction in keloid scar–derived fibroblasts, in a paracrine fashion.

Degradation of a supporting prosthesis can optimize arterialization of autologous veins

In a previous study, we implanted autologous vein grafts in the carotid artery of rabbits supported by a compliant, biodegradable prosthesis to prevent vein wall damage due to the higher arterial pressure. We showed that such a supporting prosthesis indeed reduces damage to these vein grafts and allows for more regular and gradual arterialization than that afforded by unsupported vein grafts. To evaluate the influence of the rate of biodegradation of such a supporting prosthesis on the process of arterialization of autologous vein grafts, we implanted vein grafts supported with prostheses, which degrade within 3 weeks (group I), 6 weeks (group II), or 3 months (group III), into the carotid artery of rabbits, and then evaluated them up to 6 weeks after implantation. At 6 weeks, the group I vein grafts showed a thinner vein wall than did the adjacent artery during dilatation. In group II, the vein wall thickness and luminal diameter had completely adjusted to that of the adjacent carotid artery. The group III vein grafts showed a significantly thinner vein wall in the absence of dilatation. All supported vein grafts showed regular longitudinally oriented and, in some areas, circularly oriented cell layers, together with thin elastic laminae, which were most pronounced in group II. We conclude that a supporting, compliant prosthesis can stimulate, regulate, and optimize the arterialization of autologous vein grafts in rabbits. If the rate of degradation is carefully chosen, the radius and wall thickness of the vein graft can completely adjust to that of the adjacent artery.(ABSTRACT TRUNCATED AT 250 WORDS)