Abdominal wall transplantation with microsurgical technique.

Many patients undergoing intestinal or multivisceral transplantation have a past history of complete midgut removal with the loss of the domain of the abdominal compartment or have severely damaged abdominal walls from repeated laparotomies, tumours or enterocutaneous fistulae. These patients may encounter severe abdominal wall closure problems at the end of transplantation, resulting in increased morbidity and mortality. It is, therefore, of paramount importance to properly cover transplanted organs in order to reduce postoperative complications. Abdominal wall transplantation was recently proposed for closure of patients undergoing both small-bowel and multivisceral transplantation: the results are encouraging. However, the technical procedure proposed requires the procurement of long segments of iliac vessels as far as the vena cava and the aorta. Since donor multiorgan procurement involves many surgical teams, the removal of these vessels, with the abdominal graft, led to their unavailability for vascular surgeons. Here we present three consecutive cases of abdominal wall transplantation in which, by taking advantage of microsurgical experience, we were able to carry out a transplantation of the abdominal wall by direct anastomosis of the epigastric vessels, obtaining a very good outcome.

Urokinase-type plasminogen activator up-regulates the expression of its cellular receptor through a post-transcriptional mechanism.

We have recently reported that the urokinase-type plasminogen activator (uPA) up-regulates the cell surface expression of its own receptor (uPAR) in several cell types, independently of its enzymatic activity. uPA has no effect on kidney 293 cells which do not express uPAR and then cannot bind uPA. Kidney cells, transfected with the coding region of uPAR cDNA, express very large amounts of uPAR and respond to uPA stimulation by regulating uPAR both at mRNA and protein levels. uPA effect occurs also in the presence of the transcriptional inhibitor dichloro-ribobenzimidazole, whereas it is abolished by the protein synthesis inhibitor cycloheximide. Moreover, uPA-dependent uPAR up-regulation correlates with the increase of a complex between the coding region of uPAR mRNA and an unknown cellular factor. We then propose that uPA regulates uPAR expression at a post-transcriptional level, by promoting the binding of uPAR mRNA to a stabilizing factor.

Ultrasound-assisted breast reduction and mastopexy.

BACKGROUND: The development of technology for ultrasound-assisted lipoplasty (UAL) offers the aesthetic surgeon a new tool for breast surgery procedures including breast reduction, breast lift, and the correction of mild- to medium-degree ptosis. OBJECTIVE: The authors report on a series of 120 patients who underwent breast surgery with the use of UAL from 1995 through 2000. METHODS: Preoperative screening, including mammography, was performed to evaluate breast tissue and determine whether patients were good candidates for surgery. Variants of Klein's tumescent solution were infiltrated, depending on the form of anesthesia administered. Stab incisions 2-cm long were made at the axillary line and 2 cm below the inframammary crease to allow entry of a 35-cm solid titanium probe. With use of a 50% power setting, ultrasound energy was applied from 10 to 15 minutes to up to 30 minutes to emulsify the fat. Ultrasound stimulation of the superficial layers of subcutaneous tissue was applied to promote retraction of the breast skin. RESULTS: A mean of 500 mL of fat emulsion from each breast was obtained without major complications. Nipple elevation of up to 5 cm was possible if a large-volume reduction was performed in combination with ultrasound stimulation of the subcutaneous layer. CONCLUSIONS: The use of UAL to achieve breast reduction and mastopexy is both safe and effective for selected patients when performed by a surgeon experienced in the technique. (Aesthetic Surg J 2001;21:493-506.).

rhVEGF and experimental rat skin flaps: systemic or local administration and morphological characteristics.

Skin flap survival is a significant problem in skin surgery; in particular, inadequate arterial or venous blood supply results in necrosis of the distalmost portion. The aim of this study was to evaluate the ability of Vascular Endothelial Growth Factor (VEGF) of modifying the morphological features of skin flaps. Bilateral epigastric skin flaps were raised in 16 Wistar male rats. The epigastric artery and vein of the left flaps were clamped and then injected with rhVEGF (8 rats) or saline (8 rats). The right flaps were not clamped and received rhVEGF or saline systemically. The rats were euthanized on the seventh day and flap skin samples collected. Tissue fragments were subject to immunohistochemical (rhVEGF, VEGFr, VIII factor, CD34 antibodies), ultrastructural and morphostructural investigations. The results showed that rhVEGF improved the condition of flaps and that systemic administration was effective in promoting the development of an adequate vascular network.