Objective The vertical mammaplasty improves the breast morphology,and reduces the operative scar.However,the nipple-and-areola complex (NAC) has the risk of necrosis on those severe patients.In this report,we performed the vertical incision scar reduction mammaplasty based on Würinger's horizontal septum to reduce the NAC necrosis possibility.Methods Typical Lejour mosque-dome design was performed.The inferior part of glandular tissue and skin were excised.The NAC was elevated to normal position with medial-superior pedicle based on the horizontal septum.The breast morphology was modified with lateral and medial glandular pillar suturing using nonabsorbent thread.For reducing the vertical scar,the lower breast flap was thinned to induce the skin contraction.Results 27 patients with breast hypertrophy were operated from May 2009 to October 2012.1 patient had unilateral breast reduction,and 6 patients with 8 breasts had partial wound dehiscence.They were treated conservatively with topical dressings.No complete NAC necrosis occurred.Conclusions The vertical reduction mammaplasty based on Würinger's horizontal septum is a safe and effective approach,and the NAC necrosis possibility is reduced with this procedure.

10.3969/j.issn.1007-3969.2013.04.00X

Objective To assess clinical features and treatment of angiosarcoma.Methods A retrospective study was carried out among seven patients hospitalized for angiosarcoma in the Department of Plastic Surgery,Zhongshan Hospital of Fudan University from January 2004 to March 2012.Clinical behaviors,therapeutic strategies and outcomes of angiosarcoma were analyzed in these patients.Results Of the seven patients,four were male,and three were female,with a median age of 67 years (range,37-77 years).Clinical presentations were various,including irregular ulcerous nodular masses in four patients,localized ulcer in one patient,and irregular erythematous nodules in two patients.All the patients were treated surgically with or without postoperative adjuvant therapy.Pathological examination revealed various degrees of differentiation and atypia of tumor cells,as well as obvious proliferation of endothelial cells,and all of these patients were diagnosed as angiosarcoma.Immunohistochemical analysis revealed a positive staining for CD31 and CD34.After surgical treatment,angiosarcoma recurred in four patients with the median time to the first recurrence being 3.5 months (range,1-6 months),cerebral metastasis occurred in one patient 5 months later,and two patients died.Conclusions Angiosarcoma is a rare and heterogeneous sarcoma with diverse clinical presentations.Local wide resection is the cornerstone of angiosarcoma treatment,and adjuvant therapy may improve its prognosis.

OBJECTIVETo evaluate the therapeutic effect of pedicled muscular flaps combined with partial thoracotomy for treatment of pythorax-resulted wounds and defects.

METHODS35 cases with pythorax-resulted refractory infected wound and dead space, were retrospectively analyzed. The wound and dead space were eliminated with pedicled muscular flaps, including latissimus dorsi muscular flaps and serratus anterior muscle flaps in 21 patients, pectoralis major muscle flaps with rectus muscle flaps in 8 patients, latissimus dorsi muscul flaps and vertical rectus muscle flaps in other 6 patients.

RESULTS34 flaps survived completely except for 1 verticle rectus muscular flap with partial necrosis at distal end. Primary healing was achieved in 29 cases. The other 6 cases were discharged with drainage. Among the 6 cases, 3 cases healed spontaneously, 2 cases underwent reoperation, 1 case need long-term drainage in the fistula.

CONCLUSIONPedicled muscular flap, combined with partial thoracotomy can effectively treat refractory wound and dead space resulted by pythorax.

Combined Modality Therapy ; methods ; Empyema, Pleural ; surgery ; Humans ; Myocutaneous Flap ; transplantation ; Pectoralis Muscles ; transplantation ; Reoperation ; Retrospective Studies ; Superficial Back Muscles ; transplantation ; Thoracotomy ; methods ; Wound Healing

Objective To analyze CT manifestations of chest wall Askin tumor and to illustrate its CT diagnostic and differentially diagnostic key points.Methods Eleven cases of chest wall Askin tumors were pathologically confirmed in our hospital between May 2006 and November 2014.Of them,10 cases were children and adolescents,and 9 cases had chest pain as the first symptom.All patients received plain CT scan,while 7 cases received contrast enhanced scan.CT signs of this group were retrospectively analyzed,including the location,quantity,shape,size,density,adjacent tissue invasion and distant metastasis of the tumors.Results CT examination showed a single oval mass on the chest wall in all 11 cases.The tumor was located completely within the thoracic cavity in 10 cases,while a tumor's main part was within thoracic cavity.Nine tumors had long diameters of more than 9 cm.All the tumors were heterogeneous without calcification,wherein 10 cases showed necrosis and cystic degeneration.On contrast enhanced scan,7 cases showed heterogeneously mild to moderate enhancement.All tumors invaded adjacent tissues,including 7 cases of bone damage of a single rib,and 7 cases of pleural involvement,wherein 6 cases had pleural effusion.No remote metastases were found in this group.Conclusions CT manifestations of Askin tumors of chest wall have some characteristics,and familiarity with these manifestations is conducive to diagnosis and differential diagnosis of this disease.

Objective To investigate the treatment outcome and failure in patients with primary mediastinal large B-cell lymphoma(PMBL). Methods Between Jan. 1992 and Oct. 2006, a total of 46 patients with pathologically confirmed PMBL were reviewed, including 14 with Ann Arbor Stage I disease, 23 with Stage Ⅱ disease,3 with Stage Ⅲ disease and 6 with Stage Ⅳ disease. Stage Ⅰ+Ⅱ disease was present in 80% of the patients. All patients were treated with chemotherapy ,and 29 also received radiotherapy. Twenty-seven patients(59%) were treated with first generation regimen(CHOP),9(20%) with third generation regimens (MACOP-B, ProMACE/CytaBOM, m-BACOD, or ProMACE-MOPP), and 10(22%) with high-dose chemotherapy (HDCT/APBSCT). Rituximab was administered to 16 patients (35%). For most patients who received radiotherapy,an involved field was used with a median dose of 45 Gy in 23 fractions.Results The rate of complete remission, partial remission and progression disease was 41%, 30% and 24% ,respectively. The 5-year overall survival rate(OS) for all patients was 35%. The 2- and 5-year OS was 79% and 63% for stage Ⅰ+Ⅱ and 51% and 0 for stage Ⅲ+Ⅳ ,respectively(X2=4.35 ,P=0. 037).The 2-year progression free survival rate was 63 % and 11%, respectively (X2=17.77, P=0.1300). The 5-year OS was 80% for the patients with CR,50% for those with PR,and 0 for those with progression disease(X2= 19.58 ,P=0.003 ). With a median follow-up of 22 months, progression disease and relapse occurred in 19 patients. Conclusions Survival of patients with advanced stage PMBL is poor. Further studies areneeded to confirm the optimal treatment. Radiotherapy often plays a pivotal role in local control.

OBJECTIVETo investigate the roles of microfilaments in the expression of collagenase and TIMP-1 in normal and hypertrophic scar.

METHODSCell culture and Northern blot hybridization methods were used in this study.

RESULTSAfter the disruption of microfilaments with cytochalasin B, mRNA contents of collagenase and TIMP-1 both increased significantly in normal and hypertrophic scar fibroblasts.

CONCLUSIONThe result suggest that the microfilament cytoskeleton may regulate the synthesis and degradation of ECM, which may be a mechanism of gene regulation during wound healing.

Actin Cytoskeleton ; physiology ; Cells, Cultured ; Collagenases ; genetics ; Fibroblasts ; metabolism ; Humans ; RNA, Messenger ; analysis ; Tissue Inhibitor of Metalloproteinase-1 ; genetics ; Wound Healing ; physiology

erall survival.

Objective To analyze clinical characteristics of diffuse large B-cell lymphonma(DL BCL) of Waldeyer's ring(WR-DLBCL) comparing with those of nodal DLBCL(N-DLBCL).Methods 181 patients consecutively diagnosed as primary WR-DLBCL(80) or N-DLBCL(101) were retrospectively reviewed.According to Ann Arbor staging system,57,83,26 and 15 patients had stage Ⅰ ,Ⅱ ,Ⅲ and Ⅳ disease,respectively.Patients with stageⅠ-Ⅱ disease were treated with chemotherapy and radiotherapy, whereas patients with stage Ⅲ-Ⅳ disease received primary chemotherapy. Results Comparing with N-DL BCL,pafients with WR-DLBCL presented with more stage Ⅱdiseases,more frequent involvement of adjacent organs and tissues,less B-symptoms,less involvement of spleen and lower lactate dehydrogenase (LDH) and β2-microglobulin(β2M) level.The 5-year overall survival(OS) rate of all patients was 76% for WR-DLBCL and 56% for N-DLBCL(x2 =2.43,P=0.119) ,respectively.The corresponding OS rate for stage Ⅰ and Ⅱ diseases was 78% for WR-DLBCL and 58% for N-DLBCL(X2 = 2.76,P =0.097),respectively.On univa riate analysis,elevated LDH,IPI and elevated β2 M were prognostic predictors for WR-DLBCL patients, whereas elevated β2 M,bulky tumor and IPI were associated with poor OS for N-DLBCL patients.On multiva riate analysis,elevated LDH and β2M were prognostic predictors for all patients. Conclusions Comparing with N-DLBCL,WR-DLBCL represents distinct clinical features and prognosis.

Objective To define the patterns of local extension and nodal involvement in patients with early stage nasal NK/T-cell lymphoma, and to improve the delineation of clinical target volume.Methods Two hundred and twenty-two patients consecutively diagnosed with nasal NK/T-cell lymphoma were reviewed.All patients had stage Ⅰ E/Ⅱ E diseases.CT/MRI images were reviewed to determine the local invasion of adjacent organs or structures and involvement of lymph node.Results 143 of 222(64%) patients had primary tumor extended into adjacent organs or structures from nasal cavity.According to the incidence rates of tumor extension, the involved organs or structures were subclassified into three subgroups:high risk (≥40%):ethmoid sinus (60%) and maxillary sinus (55%);intermediate risk (5%-40%):nasopharynx (39%), skin (22%), oropharynx (12%), orbit (10%), and hard palate (10%);and low risk (≤5%):sphenoid sinus (3%), soft plate (3%),frontal sinus (3%) and skull base (1%).Cervical lymph node metastasis occurred in 16%(36/222) of the patients and these patients were staged as Ⅱ E.Thirty-three patients with stage Ⅱ E disease had available images and were analyzed for the pattern of nodal involvement.Submandibular or submental (57%) and the upper cervical lymph nodes (57%) were the most commonly involved sites of nodal region.For the 24 patients with primary tumor located in the unilateral nasal cavity, 54% presented with contralateral cervical lymph node metastasis.Whereas for the 9 patients with primary tumor located in the bilateral nasal cavity, 57% had bilateral cervical lymph node metastasis.For the 88 patients with extensive stage Ⅰ E disease who did not receive irradiation to the cervical lymph node, only one patient (1%) had disease relapse in cervical lymph node.Furthermore, all patients with disease extended to nasopharynx (n= 23) or oropharynx (n= 8) did not receive prophylactic cervical lymph node irradiation, and none of them developed cervical lymph node relapse.Conclusions The delineation of clinical target volume for early stage nasal NK/T-cell lymphoma should be determined by the risk of involvement of paranasal structures and cervical lymph node.Prophylactic neck irradiation is not recommended for patients with stage Ⅰ disease.