Gynecomastia Management: An Evolution and Refinement in Technique at UT Southwestern Medical Center.

Gynecomastia is a benign proliferation of male breast glandular tissue. Gynecomastia can affect men at any stage of life. Traditional treatment options involved excisional surgeries with periareolar or T-shaped scars, which can leave more visible scars on the chest.

The inverted-v chevron umbilicoplasty for breast reconstruction and abdominoplasty.

The umbilicoplasty is a key component of abdominoplasty and closure of autologous abdominal wall donor sites in breast reconstruction (TRAM/DIEP). The aesthetically-pleasing umbilicus tends to be small and vertically-oriented in nature, with superior hooding and shadow, inferior retraction and slope, and positioning at the topmost level of the iliac crest. In this Featured Operative Technique, the authors describe their technique for performing an inverted-V chevron umbilicoplasty, which is their method of choice for restoring the umbilicus to an aesthetic and youthful appearance with minimal scarring.

Correction of frontonasoethmoidal encephalocele: the HULA procedure.

Background: The frontonasoethmoidal encephalomeningocele deformity involves central herniation of a glial mass that "pushes outward" and deforms the medial orbit, medial canthus, nasomaxillary process, and nasal structures without resulting in hypertelorbitism. The authors studied a modification of the "Chula" repair, called the HULA procedure (H = hard-tissue sealant, U = undermine and excise encephalocele, L = lower supraorbital bar, A = augment nasal dorsum), which provided complete correction of the midline hard and soft-tissue structures using an intracranial and extracranial approach.

Methods: Filipino patients with frontonasoethmoidal encephalomeningoceles were treated by a civilian/military humanitarian team at Tripler Army Hospital (n = 12).

Operational tolerance to class I disparate lungs can be induced despite pretransplant immunization with class I allopeptides.

Background: Using a class I-disparate swine lung transplant model, we examined whether an intensive course of tacrolimus could induce operational tolerance and whether preoperative allopeptide immunization would prevent the development of tolerance.

Methods: Left lung grafts were performed using class I-disparate (class II-matched) donors. Recipients were treated with 12 days of postoperative tacrolimus.

Heart and en-bloc thymus transplantation in miniature swine.

Background: Donor-specific tolerance to organ allografts might be induced by cotransplantation of a sufficient amount of vascularized donor thymus. To facilitate donor thymus-induced cardiac allograft tolerance, we have developed a novel technique for heart and en-bloc thymus transplantation in swine.

Methods: Donor heart and en-bloc thymus grafts were prepared by a technique that preserves the entire arterial supply and venous drainage of the right thymic lobe.

Indirect recognition of MHC class I allopeptides accelerates lung allograft rejection in miniature swine.

The role of indirect allorecognition in graft rejection is examined in two experiments using a swine lung transplantation model. First, two swine received class I mismatched grafts without immunosuppression; another two recipients were treated postoperatively with cyclosporine (CsA). These swine exhibited acute and chronic rejection, respectively.

Advances in strategies for inducing central tolerance in organ allograft recipients.

Encouraging results in large animal models and from the clinic have been reported recently suggesting that the deliberate induction of transplantation tolerance using central deletional protocols may be closer to becoming a reality. The induction of central tolerance would be especially applicable to pediatric organ transplant recipients. In this review, we discuss three promising protocols of central tolerance induction and why they are relevant to pediatric organ transplantation.