Muscular response to the first three months of deflazacort treatment in boys with Duchenne muscular dystrophy.

OBJECTIVE: Duchenne muscular dystrophy (DMD) patients are often treated with glucocorticoids; yet their precise molecular action remains unknown. METHODS: We investigated muscle biopsies from nine boys with DMD (aged: 7,6±2,8 yrs.) collected before and after three months of deflazacort treatment and compared them to eight healthy boys (aged: 5,3±2,4 yrs.). mRNA transcripts involved in activation of satellite cells, myogenesis, regeneration, adipogenesis, muscle growth and tissue inflammation were assessed. Serum creatine kinase (CK) levels and muscle protein expression by immunohistochemistry of selected targets were also analysed. RESULTS: Transcript levels for ADIPOQ, CD68, CDH15, FGF2, IGF1R, MYF5, MYF6, MYH8, MYOD, PAX7, and TNFα were significantly different in untreated patients vs. normal muscle (p⟨0.05). Linear tests for trend indicated that the expression levels of treated patients were approaching normal values (p⟨0.05) following treatment (towards an increase; CDH15, C-MET, DLK1, FGF2, IGF1R, MYF5, MYF6, MYOD, PAX7; towards a decrease: CD68, MYH8, TNFα). Treatment reduced CK levels (p⟨0.05), but we observed no effect on muscle protein expression. CONCLUSIONS: This study provides insight into the molecular actions of glucocorticoids in DMD at the mRNA level, and we show that multiple regulatory pathways are influenced. This information can be important in the development of new treatments.

Including the platysma muscle in a cervicofacial skin rotation flap to enhance blood supply for reconstruction of vast orbital and cheek defects: anatomical considerations and surgical technique.

The surgical technique introduced in this work describes a modification of the rotation skin flap that includes the platysma muscle in order to improve the blood supply of the flap. This modified rotation flap enables sufficient reconstruction of extended regions following ablative surgery of the head and neck. The anatomy and clinical application of a bilayer cervicofacial skin-platysma rotation flap is described in 6 patients. Flap design ensures sufficient blood perfusion mainly via the occipital artery, the superficial cervical artery and the transverse cervical artery; venous drainage is achieved by the external jugular vein and by randomised vascularisation. The surgical procedures led to sufficient and successful reconstruction of the orbital and cheek region. Further oncological management, such as neck dissection and total parotidectomy could be performed through the flap approach because of the adequate exposure of neck structures. Due to the sensory supply reaching the flap dorsally, sensibility in the reconstructed region could be regained in all patients. This modified skin-platysma rotation flap represents an appropriate surgical technique for safe and simple closure of vast orbital and cheek defects with enhanced blood supply, which enables the extended mobilization required after ablative surgery of the orofacial region.

Exposure of implants using a modified multiple-flap transposition vestibuloplasty.

AIM: To introduce a minimally invasive operation to improve the condition of the soft tissues around the implants in an atrophied mandible, at the same time, as uncovering the implants. PATIENTS AND METHOD: A multiple-flap transposition vestibuloplasty was done in 11 patients after the insertion of four implants in the interforaminal region of an atrophied mandible. Improvement in soft tissues and successful exposure of implants and attached gingiva were evaluated during a follow-up period of 55 months. All the patients were operated on local anaesthesia as outpatients. RESULTS: Adequate exposure of implants and an area of attached gingiva 4-9 mm wide were attained. There was no bleeding on probing or local infection. CONCLUSION: The transposition multiple-flap vestibuloplasty is a simple and minimally invasive method of improving the condition of soft tissue after insertion of implants. It does not limit the patients' routine activities and avoids staged operations.