ABSTRACT
BACKGROUND: The laterally based bilobed flap is commonly used for the reconstruction of small- to medium-sized defects of the distal portion of the nose; However, when this flap is used to repair defects that are larger, more cephalic, or more lateral on the nose, there is a risk for lower nasal distortion. Reorienting the base superiorly preserves the advantages of the traditional design while minimizing this risk. OBJECTIVE: To demonstrate the design, execution, and efficacy of the superiorly based bilobed flap. METHODS: A retrospective review examined all superiorly based bilobed flaps performed by 1 surgeon (J.C.) in 2000-2016 after tumor extirpation by Mohs micrographic surgery at a single institution. RESULTS: A total of 41 surgical defects were closed with 40 flaps between June 2000 and August 2016 (1 patient had 2 defects closed with a single flap). Of the tumors, 55% were located on the nasal dorsum, and the median of the longest postoperative tumor axis was 1.4 cm. Follow-up was available for 40 flaps, and no infections, hematomas, or episodes of full-thickness necrosis were observed. LIMITATIONS: Data were collected retrospectively from a single institution without a standardized assessment tool for aesthetic outcomes. CONCLUSION: The superiorly based bilobed flap is useful for nasal reconstruction.
Subject(s)
Nose Neoplasms/surgery , Rhinoplasty/methods , Surgical Flaps , Surgical Wound/surgery , Esthetics , Humans , Mohs Surgery/adverse effects , Reoperation , Retrospective Studies , Surgical Wound/etiologyABSTRACT
Romidepsin is the second histone deacetylase inhibitor (HDACi) approved for the treatment of advanced stages of cutaneous T-cell lymphoma (CTCL). Recent in vitro data suggest that HDACis suppress immune function although these findings have not been confirmed in patients. Thus, we serially examined the cellular immune function of eight CTCL patients undergoing treatment with three cycles of romidepsin. We measured the patients' natural killer (NK) and dendritic cell (DC) function and performed an in vitro terminal deoxynucleotidyl transferase dUTP nick end labeling assay to measure cellular apoptosis. Patients' NK cell cytolytic activity decreased from baseline to the third cycle of treatment (P = 0.018) but stimulation with a toll-like receptor (TLR) agonist increased this activity (P = 0.018). At baseline, a TLR agonist could both activate patients' DC (P = 0.043) and stimulate interleukin-12 protein production (P = 0.043) but both were suppressed after the first cycle of romidepsin. Finally, we observed increased specificity for romidepsin-induced CD4+ tumor cell apoptosis and dose-dependent increases in cellular apoptosis of healthy cells in multiple lineages (P < 0.05). These findings raise concern that HDACis suppress immune function in CTCL patients and they support the concurrent use of multiple immune stimulatory agents to preserve the host immune response.
Subject(s)
Depsipeptides/pharmacology , Histone Deacetylase Inhibitors/pharmacology , Immunity, Cellular/drug effects , Killer Cells, Natural/drug effects , Leukocytes, Mononuclear/drug effects , Sezary Syndrome/immunology , Skin Neoplasms/immunology , Adjuvants, Immunologic/therapeutic use , Apoptosis/drug effects , Cells, Cultured/drug effects , Cells, Cultured/immunology , Cytotoxicity, Immunologic/drug effects , Depression, Chemical , Depsipeptides/adverse effects , Depsipeptides/therapeutic use , Drug Screening Assays, Antitumor , Histone Deacetylase Inhibitors/adverse effects , Histone Deacetylase Inhibitors/therapeutic use , Humans , Imidazoles/pharmacology , In Vitro Techniques , Interferon-alpha/pharmacology , Interleukin-12/pharmacology , Leukocytes, Mononuclear/immunology , Lymphocyte Count , Lysosomal-Associated Membrane Protein 1/analysis , Neoplasm Proteins/antagonists & inhibitors , Quinolines/pharmacology , Sezary Syndrome/drug therapy , Skin Neoplasms/drug therapy , T-Lymphocytes, Regulatory/drug effects , Toll-Like Receptor 7/agonists , Toll-Like Receptor 8/agonistsABSTRACT
Tonic pupils react poorly to light but constrict during viewing of a near stimulus. Adie's name is typically used in association with tonic pupils, but a review of Adie's articles reveals that he described the syndrome of tonic pupils and absent reflexes and not the pupillary abnormality per se. Therefore, it would be more appropriate to refer to a tonic pupil as simply a "tonic pupil" and leave Adie's name for the syndrome.
