Publications by authors named "Rajiv Grover"

23 Publications

  • Page 1 of 1

The Evidence for Adjunctive Facelift Procedures.

Facial Plast Surg 2018 Dec 28;34(6):624-630. Epub 2018 Dec 28.

Department of Plastic Surgery, King Edward VII's Hospital, London, Greater London, United Kingdom.

Facelift surgery is a popular treatment but exhibits high variation among practitioners in terms of both core technique and adjunctive measures. This review identified significant evidence addressing the role of pre-infiltration, drains, fat grafting, fibrin tissue adhesives, hilotherapy, and other miscellaneous adjuncts. Based on the authors' assessment of the current literature, there is reasonable supportive evidence for pre-infiltration, fat grafting and laser skin resurfacing, which appear to be safe and effective in appropriately selected patients. Drain use is not mandatory but may confer some benefit. Conversely the evidence for the use of fibrin tissue adhesives and hilotherapy is not compelling.
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http://dx.doi.org/10.1055/s-0038-1675750DOI Listing
December 2018

Treatment of chronic hepatitis C genotype 3 with Sofosbuvir-based therpy: a real-life study.

Hepatol Int 2017 May 31;11(3):277-285. Epub 2017 Mar 31.

Himalayan Institute of Medical Sciences, Dehradun, UttarKhand, India.

Background And Aims: Recently, Sofosbuvir was launched in India at affordable cost. We conducted a real-life study to determine the efficacy and safety of Sofosbuvir plus Ribavirin, with and without peginterferon-alfa 2a, in patients with chronic hepatitis C (CHC) genotype 3, the commonest genotype in South Asia.

Methods: This study included data of CHC patients from 11 sites in northern India between March 2015 and December 2015 (n = 1203). Patients with CHC genotype 3 (n = 931), who were treated with either Sofosbuvir 400 mg plus weight-based Ribavirin, daily ×24 weeks (n = 432) (dual therapy), or Peginterferon-α2a 180 mcg weekly, Sofosbuvir 400 mg plus weight-based Ribavirin, daily ×12 weeks (n = 499) (triple therapy) were included for analysis. Primary outcome was the proportion of patients achieving sustained viral response at 12 weeks post-therapy.

Results: The overall SVR rates were 91 and 92% in the dual and triple therapy arms, respectively. The SVR rates in treatment experienced were 67 and 74% versus 93 and 96% in naïve patients, on the dual and triple therapy arms, respectively. The SVR rates of cirrhotics were 73 and 75% on the dual and triple treatment arms, respectively. The SVR rates were low in the experienced cirrhotic patients: 44% (dual therapy) and 58% (triple therapy). Common adverse events were fatigue, headache, and myalgia.

Conclusion: Both dual and triple therapy regimes resulted in SVR rates of >95% in CHC genotype 3 who were naive non-cirrhotics. However, the SVR rates were low in treatment-experienced cirrhotics.
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http://dx.doi.org/10.1007/s12072-017-9794-1DOI Listing
May 2017

Facilitating shared decision-making with breast augmentation patients: Acceptability of the PEGASUS intervention.

J Plast Reconstr Aesthet Surg 2017 Feb 24;70(2):203-208. Epub 2016 Nov 24.

Centre for Appearance Research, Department of Health & Social Sciences, Faculty of Health & Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK.

Background: PEGASUS is an intervention to facilitate shared decision-making by helping prospective patients consider their expectations of surgery, so that surgeons have a clear understanding of their individual goals. To date, shared decision-making interventions within aesthetic surgery are lacking. The present mixed methods study therefore explored the acceptability of implementing PEGASUS into routine private practice with breast augmentation patients and aesthetic providers.

Method: Seventeen women presenting for breast augmentation surgery from three practices received the PEGASUS intervention pre-operatively and completed a process evaluation post-operatively. Semi-structured interviews exploring 3 aesthetic providers' experiences of using PEGASUS were subjected to a thematic analysis, whilst a content analysis was conducted on the 77 goals identified by patients.

Results: The majority of patients reported that the PEGASUS intervention was relevant, helpful and useful, and they felt comfortable during it. Qualitatively, patients and aesthetic providers found that PEGASUS enabled them to reflect on and discuss about their expectations from surgery. Aesthetic providers discussed some of the issues and barriers associated with implementing PEGASUS in routine private practice, factors that must be considered prior to further evaluation.

Conclusion: This study provides preliminary support for the acceptability of PEGASUS to breast augmentation patients and to aesthetic providers working in the private sector.
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http://dx.doi.org/10.1016/j.bjps.2016.11.013DOI Listing
February 2017

Desipramine prevents cardiac gap junction uncoupling.

Naunyn Schmiedebergs Arch Pharmacol 2012 Nov 11;385(11):1063-75. Epub 2012 Sep 11.

Clinic for Cardiology, University of Leipzig, Leipzig, Germany.

Background And Purpose: Uncoupling of cardiac gap junction channels is an important arrhythmogenic mechanism in ischemia/reperfusion. Antiarrhythmic peptide AAP10 (H-Gly-Ala-Gly-Hyp-Pro-Tyr-CONH(2)) has been shown to prevent acidosis-induced uncoupling and ischemia-related increase in dispersion. Previous structure-effect investigations and subsequent computer modeling studies indicated that the tricyclic antidepressant desipramine may exert similar effects as AAP10.

Methods: We assessed the binding of (14)C-AAP10 to membranes of rabbit cardiac ventricles and its displacement with desipramine in a classical radioligand binding and competition study. Gap junction currents were measured between isolated pairs of human atrial cardiomyocytes under normal and acidotic (pH 6.3) conditions with or without 1 μmol/l desipramine using dual whole-cell voltage clamp. The effect of 1 μmol/l desipramine was assessed in isolated rabbit hearts (Langendorff technique) undergoing local ischemia by coronary occlusion with 256-channel electrophysiological mapping and subsequent analysis of connexin43 (Cx43) expression, phosphorylation (Western blot), and subcellular localization (immunohistology).

Results: We found saturable (14)C-AAP10 binding to cardiac membranes (K (D), 0.29 ± 0.11 nmol/l; B (max), 42.5 ± 7.2 pmol/mg) which could be displaced by desipramine with a K (D.High) = 0.14 μmol/l and a K (D.Low) = 22 μmol/l. Acidosis reduced the gap junction conductance in human cardiomyocyte pairs from 24.1 ± 4.7 to 11.5 ± 2.5 nS, which could be significantly reversed by desipramine (26.6 ± 4.8 nS). In isolated hearts, ischemia resulted in significantly increased dispersion of activation-recovery intervals, loss of membrane Cx43, and dephosphorylation of Cx43, which all could be prevented by desipramine.

Conclusion: Desipramine seems to prevent the uncoupling of cardiac gap junctions and ischemia-related increase in dispersion.
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http://dx.doi.org/10.1007/s00210-012-0795-2DOI Listing
November 2012

Efficacy and safety of botulinum toxin type A in the treatment of lateral crow's feet: double-blind, placebo-controlled, dose-ranging study.

Dermatol Surg 2009 Oct 20;35(10):1478-86. Epub 2009 Jul 20.

Clinique Iena, Paris, France.

Background: Botulinum toxin type A (BoNT-A) is frequently used to treat crow's feet; the optimal dose for each toxin preparation should be established.

Objective: To compare the efficacy and safety of three doses of BoNT-A with placebo to treat crow's feet.

Methods: Subjects with moderate to severe crow's feet at maximum smile (mild to severe at rest) were randomized to a single bilateral BoNT-A treatment (15, 30, or 45 U) or placebo. Outcome measures included evaluation of crow's feet by an independent panel from blinded photographs at maximum smile, investigator assessment, and patient satisfaction.

Results: Independent panel assessments (Week 4) showed that all BoNT-A doses resulted in significant improvements in crow's feet severity at maximum smile (p<.001); a clear dose-response effect was seen. Improvement over placebo was seen in the 30-U and 45-U groups to Week 12. Investigator assessment showed significant improvement for all doses for 12 weeks at maximum smile and rest (p< or =.01). Patient satisfaction was significantly greater for all doses than for placebo for 16 weeks (all p<.05). All doses were well tolerated. CONCLUSION BoNT-A (15, 30, or 45 U) is an effective and safe treatment for mild to severe crow's feet.
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http://dx.doi.org/10.1111/j.1524-4725.2009.01261.xDOI Listing
October 2009

Non-diarrheal celiac disease: a report of 31 cases from northern India.

Indian J Gastroenterol 2007 May-Jun;26(3):122-6

Department of Gastroenterology, G B Pant Hospital, New Delhi, India.

Background And Aims: Non-diarrheal presentation of celiac disease (CD) is being increasingly recognized. Data on this form of CD from India are limited.

Methods: Consecutive patients with CD presenting to a tertiary referral center in northern India over a 3-year period were studied, with special emphasis on non-diarrheal celiac disease (NDCD). Diagnosis was based on the presence of autoantibodies typical of CD (IgA anti-tissue transglutaminase antibodies and/ or IgA endomysial antibodies), abnormal duodenal biopsy and response to gluten-free diet (GFD). Clinical, hematological and histological responses were assessed over a one-year period after instituting GFD.

Results: Of 86 patients with CD, 31 (16 children, 15 adult) had NDCD. Mean (SD) age of these children (12 boys) and adults (4 male) was 10.2 (4.2) y and 35.3 (12.0) y, respectively. Failure to thrive was the most common (11/16) presentation in children, as was refractory anemia in adults (10/15). Malabsorption was found in 8 adults (54%) and 10 children (64%) with NCCD. The duration from onset of symptoms to diagnosis was 2.9 (1.5) y in children and 3.3 (0.3) y in adults. There was significant improvement in body weight (children--baseline 18.9 [5.8] Kg, follow up 27.4 [12.4] Kg; adults--baseline 47.6 [18.2] Kg, follow up 54.9 [5.1] Kg) and hemoglobin (children--8.1 [2.0] g/dL to 11.2 [1.4] g/dL; adults--7.3 [2.3] g/dL to 9.7 [1.7] g/dL) in both groups after one year of GFD; duodenal biopsy also improved, with a majority of patients attaining normal to IIIa Marsh grading. Five adults and all children had evidence of metabolic bone disease at presentation, which did not revert completely with GFD. Eight adults and nine children showed dietary transgression 6 weeks after starting GFD.

Conclusion: NDCD ac-counted for nearly one-third of all cases with CD at our center, with 'failure to thrive' and refractory anemia being the most common presentations in children and adults, respectively.
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October 2007

The efficacy of surgical drainage in cervicofacial rhytidectomy: a prospective, randomized, controlled trial.

Plast Reconstr Surg 2007 Jul;120(1):263-270

London, United Kingdom From the King Edward VII's Hospital Sister Agnes.

Background: Postoperative drainage is often used instinctively in face lifting on the assumption that it may reduce the likelihood of complications. This potential benefit should be balanced against cost, discomfort, and the possibility of provoking bleeding and hematoma on removal. Evidence-based decisions on drainage are problematic, since no prospective studies have examined its role. This study was designed to address this issue directly.

Methods: Fifty consecutive patients undergoing face lift over a 3-month period were randomized to drainage of one side of the face only, with the contralateral side serving as a paired control. Bruising, swelling, and hematoma or seroma were assessed objectively, independently of the operating surgeon and subjectively by the patients.

Results: Postoperative hematoma and edema were not influenced by the use of drains (p > 0.5). Patients reported no difference between the two sides with respect to swelling (p = 0.6) or discomfort (p = 0.5). However, drains produced a statistically significant reduction in postoperative bruising both on clinical assessment (p = 0.005) and patient assessment (p = 0.002).

Conclusions: This article represents the first prospective, randomized, controlled trial assessing the use of postoperative drainage in facial rejuvenation surgery. Surgical drains do not influence postoperative complications, but they do significantly reduce bruising and so may facilitate the patient's return to normal activity.
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http://dx.doi.org/10.1097/01.prs.0000264395.38684.5aDOI Listing
July 2007

Early postoperative efficacy of fibrin glue in face lifts: a prospective randomized trial.

Plast Reconstr Surg 2007 Jan;119(1):433-434

King Edward VII Hospital, London, United Kingdom.

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http://dx.doi.org/10.1097/01.prs.0000233612.16881.faDOI Listing
January 2007

Injectable hyaluronic acid implant for malar and mental enhancement.

Dermatol Surg 2006 Jul;32(7):881-5; discussion 885

The Cranley Clinic for Dermatology, London, United Kingdom.

Background: The use of a thicker injectable implant version of one of the hyaluronic acid dermal fillers (Restylane SubQ, Q-Med, Uppsala, Sweden) is described.

Objective: A group of treated patients has been studied for more than 1 year. Restylane SubQ was injected to the submuscular plane of the upper cheeks and chin to observe efficacy of augmentation and side effect profile, and further observations were made of the duration of benefit.

Methods: Patient details--72 patients were treated, 68 for upper cheek augmentation, 2 for chin augmentation, and 2 for both areas. Four patients received second injections 8 weeks after the first to increase augmentation.

Results: Patients all showed a persistence of benefit during the posttreatment observation period of up to 64 weeks. Four patients had minor side effects that resolved with local treatment and time. Four patients had second injections to complete augmentation without complications.

Conclusions: Restylane SubQ is a useful injectable agent to augment and lift upper cheeks and recontour chins. Further efficacy studies seem justified.
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http://dx.doi.org/10.1111/j.1524-4725.2006.32190.xDOI Listing
July 2006

The anatomy of the aging face: volume loss and changes in 3-dimensional topography.

Aesthet Surg J 2006 Jan-Feb;26(1S):S4-9

Facial aging reflects the dynamic, cumulative effects of time on the skin, soft tissues, and deep structural components of the face, and is a complex synergy of skin textural changes and loss of facial volume. Many of the facial manifestations of aging reflect the combined effects of gravity, progressive bone resorption, decreased tissue elasticity, and redistribution of subcutaneous fullness. A convenient method for assessing the morphological effects of aging is to divide the face into the upper third (forehead and brows), middle third (midface and nose), and lower third (chin, jawline, and neck). The midface is an important factor in facial aesthetics because perceptions of facial attractiveness are largely founded on the synergy of the eyes, nose, lips, and cheek bones (central facial triangle). For aesthetic purposes, this area should be considered from a 3-dimensional rather than a 2-dimensional perspective, and restoration of a youthful 3-dimensional facial topography should be regarded as the primary goal in facial rejuvenation. Recent years have seen a significant increase in the number of nonsurgical procedures performed for facial rejuvenation. Patients seeking alternatives to surgical procedures include those who require restoration of lost facial volume, those who wish to enhance normal facial features, and those who want to correct facial asymmetry. Important factors in selecting a nonsurgical treatment option include the advantages of an immediate cosmetic result and a short recovery time.
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http://dx.doi.org/10.1016/j.asj.2005.09.012DOI Listing
June 2009

Transdermal injection of Restylane SubQ for aesthetic contouring of the cheeks, chin, and mandible.

Aesthet Surg J 2006 Jan-Feb;26(1S):S28-34

Initial experience in transdermal administration of Restylane SubQ for augmentation of the cheek and chin suggests that the product is easy to administer via this route and that it provides a stable aesthetic result. Local adverse reactions are consistent with those expected of an alloplastic filler material and appear to be related to the injection procedure/site rather than to the product itself. In the event of overcorrection or the appearance of superficial irregularities (nodules), any excess material can readily be removed by needle aspiration. Several measures can be taken to increase the likelihood of a satisfactory aesthetic outcome and minimize the risk of treatment complications with Restylane SubQ. One such measure is to deposit the product in small aliquots at multiple sites (using a multiple tunneling technique) to avoid pooling within the soft tissues. Treatment sites with poor soft-tissue cover pose a challenge because of the high risk of surface irregularities. In cheek augmentation procedures, Restylane SubQ should be placed below the zygomatic arch where the subcutaneous tissue is more fibrous, thereby providing a possible barrier to implant mobility. The chin appears to be particularly well suited to volume augmentation with Restylane SubQ because its dense fibrous tissue creates naturally occurring pockets for product placement. In summary, transdermal administration of Restylane SubQ is a convenient, noninvasive procedure for chin and cheek contouring and for rejuvenation of the mid and lower face.
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http://dx.doi.org/10.1016/j.asj.2005.10.002DOI Listing
June 2009

Optimizing treatment outcome with Restylane SubQ: the role of patient selection and counseling.

Authors:
Rajiv Grover

Aesthet Surg J 2006 Jan-Feb;26(1S):S18-21

Restylane SubQ has been developed to meet the growing demand for minimally invasive cosmetic procedures that correct loss of facial soft tissue volume and provide a nonpermanent solution for facial rejuvenation. This new product in the Restylane product family is based on the same non-animal stabilized hyaluronic acid (NASHA) gel as all other Restylane products, but contains larger gel particles than existing products. This characteristic allows for optimal volume expansion when injected subcutaneously or supraperiostally. Possible indications for Restylane SubQ include cheek augmentation in young patients with flat malar bone as an alternative to cheek implants. Other indications could be midface rejuvenation in patients who either feel it is too early for a face lift, or who are ready for a face lift but are unwilling to undergo surgery. Another possible use could be chin augmentation-pure augmentation as an alternative to chin implantation, or simply rejuvenation of the chin profile to enhance projection in patients with early chin ptosis. A common principle in all these possible indications is that the aesthetic outcome obtained with Restylane SubQ largely depends on appropriate patient selection and counseling. Facial tissue structure is an important consideration when selecting patients for treatment with Restylane SubQ, since treatment success is dependent on adequate soft-tissue cover for the injected product, as well as soft tissue support to prevent mobility.
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http://dx.doi.org/10.1016/j.asj.2005.09.002DOI Listing
June 2009

CD44v3 levels in primary cutaneous melanoma are predictive of prognosis: assessment by the use of tissue microarray.

Int J Cancer 2006 Mar;118(6):1460-4

The RAFT institute of Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex HA6 2RN, United Kingdom.

Despite the use of sentinel node biopsy techniques, the search continues for other strategies to improve the accuracy of estimating prognosis in melanoma patients. Various biomarkers have previously been studied for use in this role, but none has yet achieved acceptance in routine practice. We have applied the novel technology of tissue microarray for the high throughput screening of a cohort of 120 primary cutaneous melanoma specimens for expression of the transmembrane glycoprotein CD44, splice variant 3 (v3), which has previously been implicated in tumor progression. A highly significant correlation between CD44v3 expression and Breslow thickness, Clark's level and patient age was demonstrated (Spearman correlation p < 0.001). Regarding clinical outcome, CD44v3 expression was shown to be significantly associated with better outcome (chi(2) = 7.2219, p = 0.0072). Furthermore, subgroup analysis revealed a sequentially improved survival probability associated with the intensity of CD44v3 staining (chi(2) = 12.5162, p = 0.0058). Analysis in a Cox multivariate model, however, did not show CD44v3 to be independently predictive of prognosis. The implications of these findings are considered, and the use of CD44v3 as a potential prognostic marker or a target for therapeutic manipulation are discussed.
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http://dx.doi.org/10.1002/ijc.21504DOI Listing
March 2006

nm23 as a prognostic marker in primary cutaneous melanoma: evaluation using tissue microarray in a patient group with long-term follow-up.

Melanoma Res 2005 Oct;15(5):435-40

The RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex, UK.

The accurate estimation of prognosis in patients with melanoma is of increasing importance with novel adjuvant therapies on the horizon. The current prediction of prognosis employs techniques involving sentinel lymph node biopsy, which carries an associated morbidity and is of little use in patients who develop direct distant metastases or direct in-transit metastases. New strategies or factors are therefore needed to improve the accuracy of determination of prognosis. nm23 is a putative metastasis suppressor; however, conflicting data exist as to its role in melanoma progression and its use as a potential prognostic marker. The purpose of this study was to use the technique of tissue microarray to study a cohort of melanoma patients with long-term follow-up data in order to ascertain its potential use as a prognostic marker. One hundred and twenty patients with primary cutaneous melanoma were included in the tissue microarray and a commercially available immunohistochemical marker for nm23 was used for protein detection. nm23 expression was strongly correlated with Clark's level (P<0.001), Breslow depth (P=0.002) and patient age (P=0.014). nm23 expression was significantly associated with a poor patient outcome (chi2=7.2219, P=0.0072). Further analysis revealed that the intensity of nm23 expression also correlated with patient outcome (chi2=11.3281, P=0.0035). However, on multivariate analysis, nm23 was shown not to be an independent marker of prognosis. The results of this study, when taken with the existing literature, suggest a role for nm23 in melanoma disease progression. However, its use as a prognostic marker in routine practice does not appear to be justified.
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http://dx.doi.org/10.1097/00008390-200510000-00012DOI Listing
October 2005

Identification of P-cadherin in primary melanoma using a tissue microarrayer: prognostic implications in a patient cohort with long-term follow up.

Ann Plast Surg 2005 Sep;55(3):316-20

RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex HA6 2RN, U.K.

Sentinel lymph node biopsy is the most accurate technique for establishing melanoma patient prognosis but is associated with morbidity and is of little value in those tumors that first metastasize to sites other than the regional nodal basin. Noninvasive methods of establishing prognosis are therefore desirable. We have used the novel technology of tissue microarray to study a cohort of 120 patients with melanoma with long-term follow-up data for the expression of P-cadherin. The tissue microarray was successfully constructed and stained. Loss of P-cadherin expression was found to be significantly correlated with outcome (log rank chi2 = 10.1336, P = 0.0015). The results suggest a fundamental role for P-cadherin in melanoma progression and identify it as a potential prognostic marker and a possible target for therapeutic manipulation.
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http://dx.doi.org/10.1097/01.sap.0000171429.19320.ceDOI Listing
September 2005

Development of a tissue array for primary melanoma with long-term follow-up: discovering melanoma cell adhesion molecule as an important prognostic marker.

Plast Reconstr Surg 2005 Feb;115(2):367-75

RAFT Institute of Plastic Surgery and the Gray Cancer Institute, Mount Vernon Hospital, Northwood, Middlesex, United Kingdom.

Refining current prognostic capability is essential for improving the management of melanoma. This study was undertaken to develop a tumor array for the rapid assessment of novel prognostic markers in a series of specimens from melanoma patients with 7- to 10-year follow-up. A melanoma database of 120 patients with archival specimens was created after histopathological review of original specimens. A tissue array was developed allowing 480 biopsy samples from the 120 primary melanoma specimens to be embedded into a single paraffin block. This was sectioned and stained for the adhesion marker melanoma cell adhesion molecule (MCAM); after further review, 76 of the 120 specimens were suitable for further analysis. The slides were assessed by two independent observers without previous knowledge of the clinical outcome for staining positivity and stain intensity. Assessment of association between MCAM and clinicopathological features was carried out using chi-squared analysis, and univariate and Cox multivariate analyses were performed on the data. There was a high correlation between MCAM intensity and both Clark's level and Breslow thickness (Spearman correlation p < 0.001 for both). The data revealed that MACM was a highly specific prognostic marker for survival in univariate analysis (chi2 = 18, p < 0.0001). Subgroup analysis by stratification of the staining intensity revealed a sequentially worsening survival with increasing staining intensity (chi2 = 22.33, p < 0.0001). Multivariate analysis of survival showed MCAM to be an independent prognostic marker more accurate than all other clinicopathological parameters (p < 0.0001), including the Breslow depth. Further analysis within only intermediate-thickness tumors showed MCAM intensity added further refinement to outcome prediction (chi2 = 22.33, p < 0.0001). The tissue array provided a rapid method of analyzing up to 480 specimens within a single paraffin block. This will benefit many areas of plastic surgery research. The identification of adhesion markers revealed a valuable prognostic marker for predicting outcome and a potential target for therapeutic manipulation.
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http://dx.doi.org/10.1097/01.prs.0000148417.86768.c9DOI Listing
February 2005

Validation of tissue microarray for the immunohistochemical profiling of melanoma.

Melanoma Res 2004 Feb;14(1):39-42

RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex, HA6 2RN, UK.

Tissue microarray technology allows high throughput profiling of cancer specimens by immunohistochemical staining. Protein expression varies throughout tumour specimens resulting in heterogeneous staining patterns, which has led to doubts as to the accuracy of tissue microarray. In an effort to validate the use of tissue microarray for melanoma immunohistochemical investigation, a study was conducted comparing the concordance of MCAM staining between whole tumour specimens and tissue microarray core biopsies. Data on full tissue sections were compared with the results of one to four 0.6 mm core biopsies per tumour on a tissue array. It was revealed that concordance of tissue array core biopsies in quadruplicate compared with full-section analysis for the expression and intensity of expression of MCAM.
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http://dx.doi.org/10.1097/00008390-200402000-00006DOI Listing
February 2004

Endoscopic brow lift: a personal review of 538 patients and comparison of fixation techniques.

Plast Reconstr Surg 2004 Apr;113(4):1242-50; discussion 1251-2

Department of Plastic Surgery, Wellington Hospital, London, United Kingdom.

Since the introduction of endoscopic brow lifting in the mid-1990s, it has become widely accepted as a method for rejuvenation of the upper third of the face. Despite the multitude of brow fixation techniques, there are few long-term studies providing accurate analysis of outcome. The aims of this investigation were to evaluate the long-term objective results of endoscopic brow lifting and to establish whether the technique of fixation altered the longevity of aesthetic outcome. The outcome of endoscopic brow lifts carried out on 538 consecutive patients over a 6-year period was assessed. For each patient, midpupil-to-brow distance was measured preoperatively and at intervals postoperatively. Two different fixation methods were compared: fibrin glue (n = 189, group 1; 104 records available) and polydioxanone sutures tied through bone tunnels (n = 349, group 2; 220 records available). In 214 patients, an upper lid blepharoplasty was performed simultaneously (85 in group 1 and 129 in group 2). At 1 month postoperatively, each fixation technique had produced a significant change in mean pupil to brow height (5.93 mm in group 1 and 6.21 mm in group 2, with no significant difference between the two methods; p = 0.17). However, when measurements were compared more than 3 months postoperatively (mean, 9.4 months), there was a significant difference, with some relapse in the patients treated with fibrin glue (p < 0.01). However, in group 2 (tunnel fixation), measurements remained stable, with 6.21 mm at 1 month compared with 6.16 mm long term (no significant difference, p = 0.34). In contrast, in group 1 (fibrin glue), measurements showed significant reduction, with a 1-month result of 5.93 mm and a long-term outcome of 3.79 mm (p < 0.01). Upper lid blepharoplasty had no effect on the long-term outcome of either group (p > 0.3 in group 1, p > 0.4 in group 2). Complications were few in both groups. In group 1, there was one infection, two instances of significant alopecia (both temporary), and one reoperation for relapse. In group 2, four patients required minor surgical revision of a lateral port scar and three minor areas of temporal alopecia, which recovered in less than 3 months. One patient had a paresis of the frontal branch that had recovered after 4 months. The endoscopic brow lift is therefore a safe and effective technique for increasing mean pupil to brow height. Fixation with polydioxanone sutures tied through bone tunnels produces a significantly more stable result than fibrin glue, without greater risk. This lends weight to experimental evidence that periosteal fixation must be maintained for at least 6 weeks to be secure.
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http://dx.doi.org/10.1097/01.prs.0000110206.25586.78DOI Listing
April 2004

Reducing complications in cervicofacial rhytidectomy by tumescent infiltration: a comparative trial evaluating 678 consecutive face lifts.

Plast Reconstr Surg 2004 Jan;113(1):398-403

Tumescent infiltration has been widely used in body-contouring surgery to facilitate dissection and reduce blood loss. Although its use in facial surgery has been suggested, there are presently no comparative studies of its efficacy. The aim of this study was to investigate the long-term outcome in a large series of consecutive face lifts performed with and without tumescence. During a 6-year period, 678 consecutive face lifts were performed: 449 without tumescence and 229 with tumescent infiltration using 200 ml on each side of the face. The spectrum of techniques included the extended superficial musculoaponeurotic system (SMAS) procedure, the lateral SMASectomy, the extended supraplatysmal plane lift, and the cutaneous face lift. Complications, such as hematoma, skin necrosis, alopecia, and scar quality, were compared between groups using Fisher's exact test. The use of tumescent infiltration facilitated dissection, particularly in the neck. Postoperative swelling and bruising were reduced in the tumescent group. In comparisons of major complications between groups, no difference was seen in hematoma rate (p > 0.5), although the incidence of other complications was significantly reduced by tumescent infiltration. Significant reduction was observed in the rate of skin necrosis (p = 0.03), alopecia (p = 0.006), hypertrophic scarring (p = 0.001), stretched scarring (p = 0.003), and scar revision (p < 0.001). This is the first comparative study of tumescent infiltration in facial rejuvenation surgery. Tumescence made dissection easier and significantly reduced the incidence of troublesome complications. The surgical technique and aesthetic implications for rejuvenation surgery are discussed.
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http://dx.doi.org/10.1097/01.PRS.0000097297.89136.8DDOI Listing
January 2004

Avoiding hematoma in cervicofacial rhytidectomy: a personal 8-year quest. Reviewing 910 patients.

Plast Reconstr Surg 2004 Jan;113(1):381-7; discussion 388-90

Hematoma remains the most common complication of rhytidectomy and can lead to prolonged facial edema and skin necrosis. A number of ancillary procedures have been suggested to reduce hematoma, including dressings, drains, fibrin glue, tumescence, and adrenaline. The aim of this study was to investigate the statistical effect of these parameters on hematoma incidence in a large series of face lifts. Over an initial 6-year period, 678 consecutive face lifts were performed and included in the first part of the study. The effect of dressings, drains, fibrin glue, and tumescence on hematoma rate was investigated retrospectively. In the second part of the study, the specific effect of adrenaline was analyzed while all other parameters were kept constant. The 229 patients with adrenaline-containing infiltrations were compared with the 232 patients whose infiltration had no adrenaline. Retrospective analysis of both groups was performed using Fisher's exact test. In the first part of the study investigating 678 consecutive face lifts, no difference in hematoma rate (4.4 percent overall) was observed with the use of dressings (p > 0.5), drains (p > 0.4), fibrin glue (p > 0.6), or tumescence (p > 0.5). In the second part of the study, the specific effect of withdrawing adrenaline in a comparative group of 461 face lifts significantly reduced the incidence of hematoma requiring surgical evacuation (p < 0.0001). There was also a significant reduction in the incidence of minor hematoma requiring only aspiration (p = 0.02). There was no change in the incidence of any other face lift complications observed during this part of the study. This study found a significant reduction in the incidence of hematoma following face lifting. Although many of the suggested ancillary methods used to reduce hematoma did not produce any statistical reduction in the incidence of this complication, the exclusion of adrenaline had a profound effect. The technique and implications with respect to safety and outcome are described.
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http://dx.doi.org/10.1097/01.PRS.0000097291.15196.78DOI Listing
January 2004

Use of oncogene expression as an independent prognostic marker for primary melanoma.

Ann Plast Surg 2003 Feb;50(2):183-7

RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex HA6 2RN, UK.

For 25 years, the Breslow depth of primary tumors has remained the most accurate prognostic test of survival for primary melanoma. However a number of studies have indicated that outcome for intermediate-thickness melanomas (0.75-2.49 mm) is often at variance with that predicted by the Breslow depth. This study investigated c-myc oncogene expression in 92 primary tumors of intermediate thickness using flow cytometry. Oncoprotein expression was detected in 87 tumors (95%) with a median positivity of 48% (range, 0%-96%). Survival analysis performed using the Kaplan-Meier method revealed a significant association between oncoprotein positivity and clinical outcome (p < 0.01, log-rank test). Multifactorial analysis of survival using Cox's proportional hazards model revealed c-myc oncoprotein to be an independent prognostic marker more accurate than all other clinicopathological parameters including the Breslow depth (chi(2) = 9.68, p< 0.01). Estimation of c-myc oncoprotein is therefore recommended as a powerful prognostic marker for intermediate-thickness primary melanoma.
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http://dx.doi.org/10.1097/01.SAP.0000032308.89737.EADOI Listing
February 2003

Pharmacological modification of gap junction coupling by an antiarrhythmic peptide via protein kinase C activation.

FASEB J 2002 Jul 8;16(9):1114-6. Epub 2002 May 8.

Clinic for Cardiac Surgery, University of Leipzig, Heart Center, 04289 Leipzig, Germany.

Antiarrhythmic peptides enhance gap junction current in pairs of cardiomyocytes and coupling in cardiac tissue. To elucidate the underlying mechanisms, we investigated the effects of the antiarrhythmic peptide AAP10 (GAG-4Hyp-PY-CONH2) on pairs of adult guinea pig ventricular cardiomyocytes and pairs of HeLa cells transfected with rat cardiac connexin 43 (Cx43). By using a double-cell voltage-clamp technique in pairs of cardiomyocytes, we found that under control conditions the gap junction conductance (gj) steadily decreased with time (by -0.292 +/- 0.130 nS/min). Use of 50 nmol/L AAP10 reversed this rundown and increased gj (by +0.290 +/- 0.231 nS/min, Pa). In HeLa-Cx43 cells, AAP10 exerted the same electrophysiological effect. In these cells, AAP10 activated PKC (determined by using ELISA) in CGP54345-sensitive manner and significantly enhanced incorporation of 32P into Cx43 with dependence on PKC. If G-protein coupling was inhibited with 1 mM GDP-BS, we found the effects of AAP10 on 32P incorporation were also completely abolished. Next, we performed a radioligand binding study with 14C-AAP10 as radioligand and AAPnat as competitor. We found saturable binding of 14C-AAP10 to cardiac membrane preparations, which could be displaced with AAPnat. The Kd of AAP10 was 0.88 nmol/L. We conclude that 1) AAP10 increases gj both in adult cardiomyocytes and in transfected HeLa-Cx43 cells, 2) AAP10 exerts its effect via enhanced PKC-dependent phosphorylation of Cx43, 3) AAP10 activates PKCa, and 4) a membrane receptor exists for antiarrhythmic peptides in cardiomyocytes.
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http://dx.doi.org/10.1096/fj.01-0918fjeDOI Listing
July 2002