David T. Sharpe

Textured or smooth implants for breast augmentation? Three year follow-up of a prospective randomised controlled trial

Silicone breast implant surface texturing has been shown to reduce the short-term incidence of adverse (Baker III/IV) capsular contracture in augmentation mammaplasty in double-blind randomised controlled trials. It is, however, undetermined whether the textured surface merely delays the onset of severe contracture or its effect on capsular contraction is persistent. The current study reviewed, after three years, 49 of the 53 patients who had undergone subglandular breast augmentation mammaplasty in a randomised double-blind study with textured or smooth silicone gel-filled implants in 1989. The incidence of adverse capsular contracture was 59% for smooth implants and 11% for textured ones (P = 0.001; chi 2 = 10.60). Eight patients (31%) with smooth prostheses underwent breast implant exchange for severe capsular contracture between the one and three year assessments, compared with a revisional surgery rate of only 7.4% (2/27 patients) for the textured group (P < 0.04). These adverse capsular contracture and revisional breast implant surgery rates clearly demonstrate that the effect of textured implants in reducing capsular contracture in augmentation mammaplasty found at one year is maintained at three years, and suggest that it may be long lasting.

Use of tissue expansion techniques to create skin flaps for vaginoplasty. Case report

Case report A 14-year-old schoolgirl with primary amenorrhoea had had abdominal pain for 5 months. Puberty had started at the age of 11 and was now complete. Cryptomenorrhoea had been diagnosed at her local hospital and had been drained vaginally 2 weeks preceding referral. The vagina was totally absent throughout most of its length and 2.5 inches of blunt dissection had been necessary to reach the menstrual fluid. The referring gynaecologist could palpate the cervix in the short upper vagina. The drainage track had closed following this procedure and a further attempt to establish a permanent connection between the upper reproductive tract and the exterior had also failed. The patient was referred with recurrence of acute abdominal pain and a high temperature. On admission to our hospital the fistulous tract between a normal vaginal introitus and the uterus had completely stenosed. Ultrasound demonstrated a normal renal system and a pelvic miss. I .aparoscopy confirmed the diagnosis o f pyometra and demonstrated a large unilateral tubo-ovarian abscess. N~irnerous endometriotic depoqits were also noted in the pelvis. The abscess was drained through the laparoscope by nieans of a Verres’ needle. The patient was then given intravenous metronidazole, gentainicin and a depot injection o f

Sensitivity and specificity of the empirical lymphocyte genome sensitivity (LGS) assay: implications for improving cancer diagnostics

Lymphocyte responses from 208 individuals: 20 with melanoma, 34 with colon cancer, and 4 with lung cancer (58), 18 with suspected melanoma, 28 with polyposis, and 10 with COPD (56), and 94 healthy volunteers were examined. The natural logarithm of the Olive tail moment (OTM) was plotted for exposure to UVA through 5 different agar depths (100 cell measurements/depth) and analyzed using a repeated measures regression model. Responses of patients with cancer plateaued after treatment with different UVA intensities, but returned toward control values for healthy volunteers. For precancerous conditions and suspected cancers, intermediate responses occurred. ROC analysis of mean log OTMs, for cancers plus precancerous/suspect conditions vs. controls, cancer vs. precancerous/suspect conditions plus controls, and cancer vs. controls, gave areas under the curve of 0.87, 0.89, and 0.93, respectively (P<0.001). Optimization allowed test sensitivity or specificity to approach 100% with acceptable complementary measures. This modified comet assay could represent a stand‐alone test or an adjunct to other investigative procedures for detecting cancer.—Anderson, D., Najafzadeh, M., Gopalan, R., Ghaderi, N., Scally, A. J., Britland, S. T., Jacobs, B. K., Reynolds, P. D., Davies, J., Wright, A. L., Al‐Ghazal, S., Sharpe, D., Denyer, M. C., Sensitivity and specificity of the empirical lymphocyte genome sensitivity (LGS) assay: implications for improving cancer diagnostics. FASEB J. 28, 4563–4570 (2014). www.fasebj.org

Skin nodules after semipermanent cosmetic dermal filler.

The authors present what they believe is only the third reported incidence of orofacial granulomas after injection of semipermanent cosmetic filler.

Cervical midline Z-plasty revision surgery for pseudoxanthoma elasticum

A 30-year-old woman with known pseudoxanthoma elasticum was referred for surgical correction of extensive loose neck skin. She underwent a standard rhytidectomy, which produced minimal improvement. Revision surgery using a vertical elliptical skin excision, incorporating a Z-plasty was undertaken 3 months later and resulted in a satisfactory outcome.

Bilateral pyoderma gangrenosum complicating minimal access cranial suspension face lift.

We present the case of a previously healthy 53-year-old woman upon whom a minimal access cranial suspension (MACS) face lift and bilateral upper and lower blepharoplasty were performed. Her preauricular wounds recurrently broke down postoperatively, and after surgically excluding stitch granuloma, a diagnosis of pyoderma gangrenosum was made. The wound breakdown resolved with topical steroid treatment. Our case highlights the need to be aware of pyoderma gangrenosum to avoid unnecessary surgery.