Reversal of Tetracycline Resistance in Escherichia coli by Noncytotoxic bis(Tryptophan)s.

Nine bis(tryptophan) derivatives (BTs) and two control compounds were synthesized and tested for antimicrobial activity against two Escherichia coli strains and a Staphylococcus aureus strain. The effects of linker type, shape, and conformational rigidity were manifested in dramatic differences in altering tetracycline potency when coadministered with that antibiotic. A reversal of resistance was observed for an E. coli strain having a TetA efflux pump. Survival of mammalian cells was assayed with good result.

A large multicenter outcome study of female genital plastic surgery.

INTRODUCTION: Female Genital Plastic Surgery, a relatively new entry in the field of Cosmetic and Plastic Surgery, has promised sexual enhancement and functional and cosmetic improvement for women. Are the vulvovaginal aesthetic procedures of Labiaplasty, Vaginoplasty/Perineoplasty ("Vaginal Rejuvenation") and Clitoral Hood Reduction effective, and do they deliver on that promise? For what reason do women seek these procedures? What complications are evident, and what effects are noted regarding sexual function for women and their partners? Who should be performing these procedures, what training should they have, and what are the ethical considerations? AIM: This study was designed to produce objective, utilizable outcome data regarding FGPS. MAIN OUTCOME MEASURES: 1) Reasons for considering surgery from both patient's and physician's perspective; 2) Pre-operative sexual functioning per procedure; 3) Overall patient satisfaction per procedure; 4) Effect of procedure on patient's sexual enjoyment, per procedure; 5) Patient's perception of effect on her partner's sexual enjoyment, per procedure; 6) Complications. METHODS: This cross-sectional study, including 258 women and encompassing 341 separate procedures, comes from a group of twelve gynecologists, gynecologic urologists and plastic surgeons from ten centers in eight states nationwide. 104 labiaplasties, 24 clitoral hood reductions, 49 combined labiaplasty/clitoral hood reductions, 47 vaginoplasties and/or perineoplasties, and 34 combined labiaplasty and/or reduction of the clitoral hood plus vaginoplasty/perineoplasty procedures were studied retrospectively, analyzing both patient's and physician's perception of surgical rationale, pre-operative sexual function and several outcome criteria. RESULTS: Combining the three groups, 91.6% of patients were satisfied with the results of their surgery after a 6-42 month follow-up. Significant subjective enhancement in sexual functioning for both women and their sexual partners was noted (p = 0.0078), especially in patients undergoing vaginal tightening/perineal support procedures. Complications were acceptable and not of major consequence. CONCLUSIONS: While emphasizing that these female genital plastic procedures are not performed to correct "abnormalities," as there is a wide range of normality in the external and internal female genitalia, both parous and nulliparous, many women chose to modify their vulvas and vaginas. From the results of this large study pooling data from a diverse group of experienced genital plastic surgeons, outcome in both general and sexual satisfaction appear excellent.

Atypical presentation of metastatic basal cell carcinoma.

Basal cell carcinoma is an indolent, slow-growing tumor that rarely metastasizes. Approximately 70% of tumors occur in the head and neck regions. If a basal cell tumor metastasizes, it usually spreads to the regional lymph nodes first, followed by the lungs. We describe a patient with basal cell carcinoma of the right lower extremity with skin metastases. Skin biopsy of one tumor revealed fibroepithelioma of Pinkus, a rare variant of basal cell carcinoma.

Noninvasive skin measurements after CO(2) and erbium laser resurfacing.

BACKGROUND: Improvement in skin after laser resurfacing depends on treatment to a precise level. The target treatment level will depend on skin type, anatomic location, and severity of the presenting problem. The development of noninvasive skin measurements that correlate with histologic changes would provide a useful intraoperative guide for treatment. OBJECTIVE: The relationship among different types of lasers and levels of applied energy; objective real-time noninvasive measures of the skin; and histologic condition were studied in an attempt to gain information that could aid in achieving safer and more predictable laser skin resurfacing. METHODS: The paraspinal skin of Yorkshire hybrid pigs was used for the study. In pig 1, study sites were treated with the Ultrapulse CO(2) laser (Coherent, Inc, Santa Clara, CA) with the CP-G at 300 ml for 0 to 5 passes. The Sciton Contour erbium: YAG llaser (Contour, Sciton, Palo Alto, CA) set at 200 mum of pure ablation was used to treat a separate but adjacent area for 0 to 5 passes. Treated sites and control sites were evaluated by measurements of biomechanical properties, digital imaging, and barrier integrity. In pig 2, the study was repeated with the Sciton Contour erbium:YAG laser at 10 different energy levels. Full-thickness punch biopsy specimens were obtained immediately after treatment and correlated with the biomechanical measures. RESULTS: After the third pass with the CO(2) laser, there was no additional tissue ablation or change in surface biophysical measurements. There was an apparent increase in inflammation in the lower dermis with passes 4 and 5 seen on day 2 biopsies that suggested deeper thermal effects. The erbium laser continued to ablate with increasing applied energy. The change in viscoelastic creep correlated with the laser energy applied and inversely correlated with the remaining dermal depth of the skin after laser treatment. CONCLUSIONS: The measurement of immediate changes in viscoelastic creep should be further studied as a means of guiding intraoperative erbium laser resurfacing. Histologic evaluation suggests that the erbium:YAG laser may be a more effective tool for dermal ablation than the CO(2) laser.

Skin resurfacing for the burned patient.

It has been estimated that 2 million people per year have burns requiring medical attention in the United States. The available and expert clinicians in dedicated burn centers around the country have cared successfully for these patients and given them a second chance at a functional life. It still behooves current-day plastic surgeons to be knowledgeable and adept in their care, not only because they may be called upon at times to manage some of the smaller acute burns, but also because many of the general principles of burn reconstruction and wound management are relevant to other areas of general plastic surgery. Acute burns should be dealt with like any other major trauma with the ABCs of aggressive resuscitation and airway management. Like any other wound, debridement and nutrition are important (i.e., early escharectomy of the burn wound and enteral nutrition during the hypermetabolic state). Early coverage of the open wound is essential to limit bacterial colonization and prevent infection and to reduce fluid and electrolyte and heat loss. If autografts are not available immediately, temporary coverage with one of the above-mentioned barrier materials should be used. Still, autografts, when available, should be the burn surgeon's first choice. Donor sites may be reharvested to provide more autograft than was anticipated with large-percentage TBSA burns. Physicians should keep in mind the advantages (and disadvantages) of using the scalp and back. As far as research and technological advances in the area of plastic surgery, burn surgery may be the most progressive, with the evolution of biologic tissue-engineered skin substitutes and the research of growth factors in healing. Further improvements in tissue engineering and technology should result in even more effective skin substitutes and hence better functional and aesthetic outcomes with economic efficiency in large burns.