[Lower body contouring procedures]. / Körperstraffungen : Von der Bauchdeckenplastik bis zum Bodylift.

Indications for most forms of abdominoplasty are slight weight fluctuations or pregnancy. The steadily increasing number of patients with greater weight loss as well as the growing number of bariatric operations subsequently leads to a significant increase in body contouring procedures and places new challenges on plastic surgeons. After major weight loss patients present with extremely variable deformities in the lower and upper trunk as well as the extremities, which have to be treated individually with an appropriate procedure. The restoration of the lower trunk presents the first stage of the entire reconstruction process. The various modifications of abdominoplasty procedures with their various incision patterns and scar courses and the circumferential lower trunk dermatolipectomy represent advanced operations for every individual case. Plastic surgeons should be fully aware of differences and indications of every available procedure in the area of the lower trunk and should have the ability to offer the entire repertory for each individual deformity. A high postoperative patient satisfaction results from a customized procedure selection, the optimal implementation with a correspondingly low rate of complications and above-average patient care.

Surgical management of chronic actinic dermatitis.

SUMMARY: Chronic actinic dermatitis (CAD) is a persistent, ultraviolet (UV) radiation-induced eczema by either UVA, UVB or visible light. We present the case of a 48-year-old woman suffering from severe CAD. Various therapeutic approaches, including topical and local corticosteroids and other systemic immunosuppressives, were used without success, making surgical treatment the only option. Two sessions of manual dermabrasion were necessary to improve the cutaneous disorder. We document the successful treatment of a severe case of CAD with dermabrasion. Chronic actinic dermatitis (CAD) describes a serious and persistent photoinduced skin disorder. It is usually characterised by a perennial, chronic dermatitis that predominantly affects sun-exposed sites, but may also affect shaded sites or even present as erythroderma. Daily application of sun protection has to be combined with topical and local corticosteroids and other systemic immunosuppressives. However, these various therapeutic regimens are often limited by severe side-effects and consecutive failure of therapy. [Dawe RS, Ferguson J. Diagnosis and treatment of chronic actinic dermatitis. Dermatol Ther 2003;16:45-51 [review], Hawk JL, Magnus IA. Chronic actinic dermatitis: an idiopathic photosensitivity syndrome including actinic reticuloid and photosensitive eczema [proceedings]. Br J Dermatol 1979;101(Suppl. 17):24.].

[Body contouring surgery in the massive weight loss patient]. / Körperstraffung nach morbider Adipositas.

An increasing number of patients desire body contouring surgery after massive weight loss, whether from bariatric surgery or a change in lifestyle. The fact that many body regions lose their elasticity and tissue-tension has led to stepwise treatments including abdominoplasty, thigh lift, buttocks and hip lift or liposuction. However, these procedures often do not treat the reason for the deformities. The lower body lift first described by Ted Lockwood in 1993 is a procedure that allows simultaneous skin resection and tightening of different regions including the abdomen, buttocks, hips, and thighs. In this article the authors present their 10-year experience with the body lift. Patient selection, technical details, pre- and postoperative care, complications, and expected results are all discussed.

[Strategical approach for the treatment of the horizontal laxity of the lower lid]. / Strategisches Vorgehen in der Behandlung der horizontalen Lidverlängerung.

Horizontal laxity of the lower lid is often unrecognized and leads to a wrong treatment. The proper analysis of periorbital anatomy is most important to identify the pathophysiology in each case. Typically, the lateral canthal tendon becomes lax, resulting in eyelid malpositions. The mainstay of treatment includes tightening of either the inferior crus of the lateral canthal tendon or repositioning the entire lateral canthal tendon. The types of procedure performed will be reviewed in detail. The evaluation of the tarsal strip and the lateral dermal orbicular pennant flap as unique reconstructive tools and as adjuncts to aesthetic surgery will be discussed.

[Male breast contouring after massive weight loss]. / Bruststraffungen beim Mann nach starkem Gewichtsverlust.

Morbid obesity is an increasing problem of our present affluent society. Simultaneously with a duplication of the number of obese patients in the course of the 20th century, a significant and continual increase can be recognized in patients introducing, after massive weight loss, to plastic surgeons due to improvements in bariatric surgery can be recognized simultaneously. The male breast, a body-region that symbolizes manhood and strength and often remaining as a deflated skin-envelope, is one of the most disturbing body regions, causing extreme lack of confidence in post-weight-loss patients. In this context there are alternative procedures which can be applied locally or in combination with other body-contouring procedures in flanking regions.

Employment of liver tissue slice analysis to assay hepatotoxicity linked to replicative and nonreplicative adenoviral agents.

Whereas virotherapy has emerged as a novel and promising approach for neoplastic diseases, appropriate model systems have hampered preclinical evaluation of candidate conditionally replicative adenovirus agents (CRAds) with respect to liver toxicity. This is due to the inability of human viral agents to cross species. We have recently shown the human liver tissue slice model to be a facile means to validate adenoviral replication. On this basis, we sought to determine whether our ex vivo liver tissue slice model could be used to assess CRAd-mediated liver toxicity. We analyzed and compared the toxicity of a conditionally replicative adenovirus (AdDelta24) to that of a replication incompetent adenovirus (Adnull [E1-]) in mouse and human liver tissue slices. To accomplish this, we examined the hepatic apoptosis expression profile by DNA microarray analyses, and compared these results to extracellular release of aminotransferase enzymes, along with direct evidence of apoptosis by caspase-3 immunhistochemical staining and TUNEL assays. Human and mouse liver tissue slices demonstrated a marked increase in extracellular release of aminotransferase enzymes on infection with AdDelta24 compared to Adnull. AdDelta24-mediated liver toxicity was further demonstrated by apoptosis induction, as detected by caspase-3 immunohistochemical staining, TUNEL assay and microarray analysis. In conclusion, concordance of CRAd-mediated apoptosis in both the human and the mouse liver tissue slice models was demonstrated, despite the limited replication ability of CRAds in mouse liver slices. The results of this study, defining the CRAd-mediated apoptosis gene expression profiles in human and mouse liver, may lay a foundation for preclinical liver toxicity analysis of CRAd agents.

A human adenoviral vector with a chimeric fiber from canine adenovirus type 1 results in novel expanded tropism for cancer gene therapy.

The development of novel therapeutic strategies is imperative for the treatment of advanced cancers like ovarian cancer and glioma, which are resistant to most traditional treatment modalities. In this regard, adenoviral (Ad) cancer gene therapy is a promising approach. However, the gene delivery efficiency of human serotype 5 recombinant adenoviruses (Ad5) in cancer gene therapy clinical trials to date has been limited, mainly due to the paucity of the primary Ad5 receptor, the coxsackie and adenovirus receptor (CAR), on human cancer cells. To circumvent CAR deficiency, Ad5 vectors have been retargeted by creating chimeric fibers possessing the knob domains of alternate human Ad serotypes. Recently, more radical modifications based on 'xenotype' knob switching with non-human adenovirus have been exploited. Herein, we present the characterization of a novel vector derived from a recombinant Ad5 vector containing the canine adenovirus serotype 1 (CAV-1) knob (Ad5Luc1-CK1), the tropism of which has not been previously described. We compared the function of this vector with our other chimeric viruses displaying the CAV-2 knob (Ad5Luc1-CK2) and Ad3 knob (Ad5/3Luc1). Our data demonstrate that the CAV-1 knob can alter Ad5 tropism through the use of a CAR-independent entry pathway distinct from that of both Ad5Luc1-CK2 and Ad5/3-Luc1. In fact, the gene transfer efficiency of this novel vector in ovarian cancer cell lines, and more importantly in patient ovarian cancer primary tissue slice samples, was superior relative to all other vectors applied in this study. Thus, CAV-1 knob xenotype gene transfer represents a viable means to achieve enhanced transduction of low-CAR tumors.