Stefano Gentileschi

Up-regulation of pro-inflammatory genes as adaptation to hypoxia in MCF-7 cells and in human mammary invasive carcinoma microenvironment

The role of tumor cells in synthesizing pro‐inflammatory molecules is still controversial. Here we report that hypoxic treatment of the MCF‐7 human mammary adenocarcinoma cell line induced activation of hypoxia‐inducible factor 1α (HIF‐1α) and nuclear factor‐kappa B (NF‐κB). Importantly, hypoxia regulated expression of alarmin receptors such as the receptor for advanced glycation end products (RAGE) and the purinoreceptor (P2X7R), and up‐regulated inflammatory response (IR) genes such as the inducible enzymes nitric oxide synthase (NOS2), cycloxygenase (COX2), and the acute‐phase protein pentraxin‐3 (PTX3). Hypoxia also stimulated chemokine (C‐X‐C motif) receptor 4 (CXCR4) mRNA synthesis. In fact, the CXCR4 ligand stromal‐derived factor‐1α (SDF‐1α) increased invasion and migration of hypoxic MCF‐7 cells. Inhibition of HIF‐1α by chetomin and NF‐κB by parthenolide reduced mRNA and protein expression of the studied molecules and prevented invasion of hypoxic MCF‐7 cells. Moreover, solid invasive mammary tumor microenvironment was analyzed after laser‐capture microdissection (LCMD) comparing tumor versus host normal tissue. Nuclear translocation of HIF‐1α and NF‐κB and up‐regulation of IR, CXCR4, estrogen receptor α (ERα), and epithelial growth factor receptor (EGFR) was observed in tumor but not in host normal tissue in the absence of a local inflammatory leukocyte infiltrate. We conclude that under hypoxic conditions MCF‐7 cells acquire a pro‐inflammatory phenotype, and that solid human mammary carcinoma evidenced a similar activation of HIF‐1α, NF‐κB, and IR genes in malignant tumor cells as compared to the normal host tissues. We suggest a role for IR activation in the malignant progression of transformed cells.

“Kris Knife” Brachioplasty After Bariatric Surgery and Massive Weight Loss

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

Micro- and macroscopic tissue modifications after bariatric surgery: effects of different procedures-a pilot study.

The most effective treatment for morbid obesity has demonstrated to be bariatric surgery. Despite enormous benefits, skin tissue aberrations are inevitable consequences. Our study was focused on micro- and macroscopic modifications in patients who had previously undergone gastric bypass. These preliminary data suggest that tissue alterations, partly responsible for high wound complications rate, may differ among patients undergoing both different and same weight loss procedures.Level of Evidence VThis 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.

L-Shaped Lipothighplasty.

BackgroundIn addition to the already-known postoperative complications in patients formerly obese, for medial thigh lift, there are many more problematic issues. The main ones are represented as follows: by the frequent downward displacement of the scars that become, in this way, extremely visible; by the distortion of the vulva or scrotal region; by serious and disabling disorders of the lymphatic system; and by the early recurrence of ptosis in this anatomical site. Materials and MethodsFrom 2004 to 2010, 16 patients with moderate to severe laxity of the medial area of the thighs were treated by an L-shaped medial thigh lift after selective liposuction. Ten have been previously treated with biliopancreatic diversion and 6 have been previously treated with gastric bypass. Mean (standard deviation [SD]) height before bariatric surgery was 1.62 (0.08) m, mean (SD) weight was 141.53 (23.12) kg, and mean (SD) body mass index was 57.13 (8.21) kg/m2. After the intervention, mean (SD) weight decreased to 81.12 (16.43) kg, whereas mean (SD) body mass index decreased to 31.83 (8.51) kg/m2. ResultsAfter L-shaped lipothighplasty, 13 patients (81%) had no complications in the postoperative period. No skin necrosis, hematoma, seroma, or thromboembolic events were reported. Two patients experienced hypertophic scarring and 1 patient had a wound infection because of poor hygienic care. ConclusionsThe medial lifting technique defined as L-shaped lipothighplasty is a valid, fast, and safe technique and can reduce early and late postoperative complications in a critical and troublesome area for the surgeon who is going to correct the deformity.

The “Triple-Plane Technique” for Breast Augmentation

Breast augmentation is one of the most frequently performed aesthetic surgery procedures. In the United States, it is the second most commonly performed aesthetic surgery procedure among women, according to the American Society of Aesthetic Plastic Surgery statistics. Different choices available to the surgeon deal with the pocket plane, the skin incisions, and the type of implant. This report describes the results from a retrospective review of the authors’ experience with the “triple-plane technique” and its different indications according to breast types. Findings have shown that this technique is suitable for many different types, shapes, and sizes of breasts; that it offers very good and natural results; and particularly, that these results last over time.

Bilateral upper and lower lid fatty herniation: an unusual presentation of non-Hodgkin's lymphoma

We report the case of a patient presenting with eyelid hernias who required bilateral upper and lower blepharoplasty; histological examination of the excised fat revealed B-cell non-Hodgkins lymphoma. At diagnosis, the disease was already systemically advanced, but the patient was asymptomatic. No sign of disease had been detected in the preoperative tests. The bilateral orbital presentation of a systemic lymphoma is very rare, and is usually accompanied and revealed by exophthalmos, increased tear secretion, diplopia and decreased visual acuity. To our knowledge, this is the first case in which lid hernias were the first and only clinical sign of such a systemic disease.

Abdominal Subcutaneous Mass After Laser-Assisted Lipolysis and Immediate Multiple Treatments with a Dual-Wavelength Laser, Vacuum and Massage Device

UNLABELLED Body contouring by means of minimally invasive procedures is a growing trend. Current approaches to body contouring often involve a combination of surgical techniques (eg, laser-assisted liposuction) and a series of noninvasive device-based treatments aimed at accelerating recovery and improving aesthetic outcomes. In this case study, we describe a 38-year-old woman who presented with an abdominal-wall mass that resembled a tumor when assessed with magnetic resonance imaging. Twenty-six months before presenting to our office, the patient had undergone laser lipolysis and a series of treatments with a device that delivered dual-wavelength laser energy and vacuum-assisted massage. To address the patients concerns, we removed the mass and performed abdominal dermolipectomy. No postoperative complications occurred, and the patient was highly satisfied with the aesthetic outcome. The results of histologic studies indicated that the mass was pseudocystic and fluid-filled, surrounded by a fibrous capsule, and characterized as a foreign-body granuloma. Further analysis is warranted regarding the safety of laser lipolysis without aspiration combined with a device delivering dual-wavelength laser energy and vacuum-assisted massage. LEVEL OF EVIDENCE 5 Risk.

Postabdominoplasty Wound Dehiscence in Bariatric Patients: Biliopancreatic Diversion Versus Gastric Bypass: A Preliminary Study

BackgroundSurgical procedures with an extended follow-up and therefore recognized as safe in literature are classified into 2 categories: procedures limiting the introduction of food mechanically (restrictive interventions such as adjustable gastric banding, vertical banded gastroplasty, and sleeve gastrectomy) or functionally (mini gastric bypass or gastric bypass) and procedures limiting absorption (mainly biliopancreatic diversion [BPD]). Materials and MethodsSeventy-nine patients who underwent postbariatric abdominoplasty to correct serious flaws resulting from weight loss surgery were included in this retrospective study. Dehiscence of the surgical wound was carefully investigated between the population previously submitted to BPD and gastric bypass. The data were analyzed by correlating the incidence of postoperative dehiscence by Fisher exact test, with a statistical significance level of P < 0.05. ResultsAmong the 42 abdominoplasties after BPD, dehiscence rate was 33% (14 patients), whereas in the group of 37 patients who underwent gastric bypass, the occurrence of dehiscence was 8% (3 patients).The Fisher exact test highlighted previously performed BPD as statistically significant for the onset of postoperative dehiscence (P = 0.012). ConclusionsThere is a great need to validate these data on large or multicentric studies. The previous bariatric surgery procedure may play a role similar to so many other widely investigated risk factors such as smoking and body mass index, and some categories of patients should require even more attention in the preoperative, intraoperative, and postoperative management.

Was the Surgeon a Satisfactory Informant? How to Minimize Room for Claims

Patient demand and expectations for plastic surgery have significantly increased over recent decades, leading to an increasing trend in claims. This—arguably, the result of a progressive lack of communication between surgeons and patients—becomes apparent in inadequate informed consent, as previously highlighted by Patel et al.1 Surgeons have the moral and legal obligation to adequately clarify for their patients everything concerning such operations and cannot perform any procedure without written patient consent. In fact, this aspect of the process allows patients to take active part in their own health care.2 Well-informed patients generally have good compliance and few anxieties and malpractice claims to raise. Despite this, the everyday clinical process may offer a different scenario: the legal formula of informed consent often becomes a mere act of hurriedly …

Vacuum-Assisted Breast Implant Insertion in Primary Augmentation Mammaplasty

We read with great interest the article by Savaci and colleagues [1] published in your journal regarding the use of a drainage tube to facilitate breast implant replacement. In fact, they suggested a useful and repeatable trick to exploit during secondary augmentation mammoplasty. Breast augmentation is the cosmetic surgical procedure most commonly performed in the United States. In 2010, nearly 300,000 women underwent this operation [2], most of them for cosmetic reasons. Minimal incisions to introduce the prostheses usually are preferable. However it may be a difficult, time-consuming, and risky procedure to perform. Thus, a system facilitating breast implant insertion through an incision of minimal length can be useful. In 2004, Savaci et al. [1], taking into consideration that only in an empty space can be filled with something, elaborated a successful method for breast implant replacement (secondary augmentation) using a simple drainage tube. Starting with the same assumptions that inspired these authors, we decided to append the tube to a suction system to further reduce air behind the prosthesis and to maximize the benefits. Our trick consists of exploiting a Redon tube (a closed high-vacuum drainage system) appended to a suction system to remove air from the surgical pocket, decreasing its resistance to implant insertion. From 2004 to 2008, our study enrolled 115 patients with an average age of 37 years (range, 20–51 years) and a mean body mass index (BMI) of 23.7 kg/m (range, 21.9–26.2 kg/m). They all underwent primary breast augmentation with implants. Actually, in contrast to Savaci et al., we performed only primary augmentation mammaplasties, meaning that we created the surgical pocket ex novo in all cases. This procedure was performed bilaterally for 111 patients and unilaterally for the remaining patients. All procedures were accomplished exclusively for cosmetic reasons. Our incision was along the inferior EMIperiareolar line, which usually is sufficient for introducing most prostheses sizes. Although other approaches (transaxillary and submammary) could benefit from the trick we propose, we opted for the periareolar route because it is associated, according to our experience and the literature [3], with several specific advantages. After the incision, we performed a ‘‘triple-plane’’ dissection [4] to create the surgical pocket for implant placement. At this site, before prosthesis introduction, we inserted the multiple-hole part of a drainage tube through the same skin incision, with no need for lengthening. We used a typical, commercially available Ch 14 sterile polyvinylchloride (PVC) Redon drainage tube with a standard length of 50 cm and a diameter of 4.6 mm. The exit end of the tube was connected to a vacuum system with an applied suction of -10 ± 3 cmHg switched on during implant placement (Fig. 1). Povidone-iodine irrigation of the pocket and the skin incision margins was provided. Furthermore, the breast implants were immersed in a povidone-iodine solution before they were introduced. In all cases, textured anatomic silicone gel breast prostheses were used. The implant sizes ranged from 180 to 350 ml, with 75% of the implants smaller than 250 ml. The implant pocket was kept open by Mathieu retractors to avoid collapse during aspiration (Fig. 2). R. Bracaglia M. D’Ettorre (&) S. Gentileschi D. Tambasco Department of Plastic and Reconstructive Surgery, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168 Rome RM, Italy e-mail: marco.dettorre@hotmail.it