Finasteride is standard medical treatment for androgenetic alopecia; however, no large studies with 5 years or more of follow up have been performed in Japan. The authors followed Japanese men with androgenetic alopecia treated with finasteride for 5 years to evaluate long-term treatment efficacy. Of 903 men treated with finasteride (1 mg/day), 801 patients were evaluated over 5 years by modified global photographic assessment. Although the proportion of improvement was high (99.4%), modified global photographic assessment scores after 5 years of treatment were lower in patients with more advanced disease as measured by the modified Norwood-Hamilton scale. After separating patients into "sufficient" and "insufficient" efficacy groups according to the modified global photographic assessment score after 5 years (scores ≥6 and <6, respectively), multivariate analysis showed that independent risk factors of insufficient efficacy were age at start of treatment of 40 years or more (P = 0.021) and classification on the modified Norwood-Hamilton scale (P < 0.001), whereas presence of stress at start of treatment was a negative predictor (P = 0.025). In conclusion, continuous finasteride treatment for 5 years improved androgenetic alopecia with sustained effect among Japanese. Younger age and less advanced disease at start of treatment were the key predictors of higher finasteride efficacy.
Lymph node metastasis of cutaneous squamous cell carcinoma ("SCC") affects the prognosis. A variety of risk factors of lymph node metastasis have been reported. Predicting lymph node metastasis prior to surgery, which is a major treatment method for cutaneous SCC, contributes to the effects of treatment. Factors that can be obtained prior to surgery were weighed between a lymph node metastasis group and a non-metastasis lymph node group. One hundred and sixty-four cutaneous SCC patients were operated on. The following factors, which can be obtained prior to surgery, were compared between the lymph node metastasis group and the non-metastasis lymph node group: age, sex, tumour size, symptom period, lesions, and local recurrence. The detection rate from lymph node metastasis of the sentinel lymph node biopsy using the blue dye technique was studied. Among all subjects, lymph node metastasis was observed in 17 cases (10.4%). Lower lip SCC was observed only in the higher metastasis rate. Significant local recurrence occurred more frequently in the lymph node metastasis group. For other factors, no significant difference was observed between the lymph node metastasis group and the non-metastasis lymph node group. A sentinel lymph node biopsy was given in 21 cases, two false-negative cases were observed, and local recurrence and lymph node metastasis were observed postoperatively. Operation should be given to the lower lip SCC and local recurrence cases considering lymph node metastasis. It is hard to say that the sentinel lymph node biopsy of cutaneous SCC using the blue dye technique has sufficient detection rates.
Finasteride is a standard medical treatment for androgenetic alopecia; however, no long-term study of up to 10 years has been performed in Japan. Therefore, we evaluated the efficacy and safety of 1 mg/day finasteride in 532 Japanese men who were treated for androgenetic alopecia for 10 years. We performed subjective evaluations, using questionnaires administered to patients, in addition to the objective evaluation by doctors. The efficacy was assessed using the Norwood-Hamilton scale and modified global photographic assessment score, the standardized 7-point rating score using scalp photographs. For the Norwood-Hamilton classifications, stages IIa and IIv were combined as II, IIIa and IIIv were combined as III, IVa was combined as IV, and Va was combined as V. The proportions of patients with improvement (score ≥ 5) and prevention of disease progression (score ≥ 4) were 91.5% and 99.1%, respectively. The Norwood-Hamilton classification grading improved by approximately 1 grade from 3.35 ± 1.11 to 2.55 ± 1.30 after the 10-year treatment. The groups that showed Norwood-Hamilton: I/II/III and IV/V/VI/ VII at the first visit showed statistically significant differences in the modified global photographic assessment score at the 10-year treatment subjective evaluation (6.27 ± 0.62 vs 5.52 ± 0.78, P<0.001). Furthermore, the quantitative analysis of the objective evaluation using the questionnaire was also significantly different (P<0.001). During the study period, no serious adverse reaction was recognized. Long-term (10-year) treatment with 1 mg/day finasteride in Japanese men with androgenetic alopecia showed high efficacy in subjective and objective evaluations.
The selection of recipient vessels is crucial when reconstructing traumatized lower extremities using a free flap. When the dorsalis pedis artery and/or posterior tibial artery cannot be palpated, we utilize computed tomography angiography to verify the site of vascular injury prior to performing free flap transfer. For vascular anastomosis, we fundamentally perform end-to-side anastomosis or flow-through anastomosis to preserve the main arterial flow. In addition, in open fracture of the lower extremity, we utilize the anterolateral thigh flap for moderate soft tissue defects and the latissimus dorsi musculocutaneous flap for extensive soft tissue defects. The free flaps used in these two techniques are long and include a large-caliber pedicle, and reconstruction can be performed with either the anterior or posterior tibial artery. The preparation of recipient vessels is easier during the acute phase early after injury, when there is no influence of scarring. A free flap allows flow-through anastomosis and is thus optimal for open fracture of the lower extremity that requires simultaneous reconstruction of main vessel injury and soft tissue defect from the middle to distal thirds of the lower extremity.
It is important to understand the anatomical characteristics of forehead wrinkles in order to perform a forehead lift. This study aimed to elucidate the mutual relationships among tissues composing the forehead using computer software that enables the stereoscopic observation of the tissues studied in arbitrary directions. The specimens were obtained from five cadavers and prepared in serial sagittal sections. Three-dimensional images were prepared by inputting the forehead wrinkle data obtained from serial sagittal sections. Consequently, the forehead skin was found to be fixed to the superficial galea aponeurotica through fibrous septa, suggesting that movement of the frontalis muscle would be transmitted to the skin, not through the fibrous septa alone, but from the superficial galea aponeurotica closely attached to the frontalis muscle through the fibrous septa. Since the forehead muscles exhibit a stereostructure where the corrugator supercilii muscle supports three superficial forehead muscles, including the frontalis muscle, the orbicularis oculi muscle, and procerus muscle on the periosteal side, it was presumed that a sufficient effect would not be attained unless the corrugator supercilii muscle was operated on concurrently in conjunction with these muscles during a procedure involving the superficial forehead muscles in a forehead lift. Based on the findings from the three-dimensional images obtained, effective tissue treatments could be achieved by performing (1) dissection between the superficial galea aponeurotica and the frontalis muscle, (2) dissection between the deep galea aponeurotica and the periosteum, and (3) a procedure incorporating the forehead muscles in order.
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