Value of tissue expansion in total reconstruction of the external ear]

By recalling the imperatives of auricular reconstruction, the author analyses the indications for tissue expansion in this area. This expansion can be performed preoperatively or intraoperatively, directly on the ear, indirectly, away from the ear. In the light of his experience, illustrated by three clinical cases, the author considers preoperative indirect expansion to be the most useful, by placing the expander underneath the scalp.     

Clinical application of repeated tissue expansion

Acetabular fractures due to bone insufficiency are rare and difficult to diagnose based on clinical findings alone. Plain films are often normal for a long period of time. We report two cases of acetabular fractures in women aged 78 and 90 years, respectively. An acetabular fracture should be considered in elderly females with sudden onset of pain in the groin occurring immediately upon weight-bearing, a clinostatic syndrome, and increased radionuclide uptake by the acetabulum. Computed tomography and magnetic resonance imaging are useful when the diagnosis remains in doubt.     

Design-enhanced breast reduction: an approach for very large, very ptotic breasts without a vertical incision

BACKGROUND: The impact of atrial fibrillation (AF) on mortality, stroke, and medical costs is unknown. METHODS: We conducted a prospective cohort study of hospitalized Medicare patients with AF and 1 other cardiovascular diagnosis (CVD) compared with a matched group without AF (n = 26,753), randomly selected in 6 age-sex strata from 1989 MedPAR files of more than 1 million patients diagnosed as having AF. Stroke rates were also determined in another cohort free of CVD (n = 14,267). Total medical costs after hospitalization were available from a 1991 cohort. Cumulative mortality, stroke rates, and costs following index admission were adjusted by multivariate and proportional hazard regression analyses. RESULTS: Mortality rates were high in individuals with CVD, ranging from 19.0% to 52.1% in 1 year. Adjusted relative mortality risk was approximately 20% higher in patients with AF in all age-sex strata during each of the 3 years studied (P < .05). Incidence of stroke was high in individuals with CVD, 6.2% to 15.4% in 1 year, with and without AF, and was at least 5-fold higher than in individuals without CVD. In those with CVD, stroke rates were approximately 25% higher in women with AF (P < .05) but only 10% higher in men. Adjusted total Medicare spending in 1 year was 8.6- to 22.6-fold greater in men, and 9.8- to 11.2-fold greater in women with AF (P < .05). Second- and third-year costs were increased as well. CONCLUSION: Prevention of AF and treatment of patients with AF and associated CVD may yield benefits in reduced mortality and stroke as well as reducing health care costs.     

Clinical evaluation of the role of gastrinemia and tumor tissue sensitivity to gastrin in cancer of the large intestines

This study examined the role of vocational behaviors in the treatment of 80 crack users. The study had two general aims: (a) to predict which crack users had acquired jobs after 30 days in treatment; and (b) to examine if vocational behaviors assessed at admission and follow-up accounted for variations in recovery motivation, psychological functioning, and treatment completion. Multivariate analyses identified four predictors (race, having a polysubstance problem, 12-step sponsor, and specific job skill) of job acquisition. Multivariate analyses also indicated that past year employment was negatively related to recovery motivation but positively related to psychological functioning and treatment completion, and that job acquisition was negatively related to one measure of recovery motivation but positively related to psychological functioning. Future research should use multiple group designs to examine the effects associated with including a vocational component in treatment programs.     

Experimental study on rapid expansion of soft tissue

Nine white pigs weighing about 15 kg were divided into three groups: rapid expansion group (REG), conventional expansion group (CEG) and control group (CON). Expansion was carried out under monitoring of interal pressure of the expander and blood flow of the skin over the expander. After completion of expansion, hemodynamic, physical, histologic and ultrastructure changes of the expanded skin were measured and recorded. The study showed: (1) The immediate retraction ratios of skin of three groups were 41.37%, 20.82% and 10.01%, respectively (P < 0.01). (2) The thickness of the epidermis of the three groups was not statistically different, though the dermis of the expanded skin was thinner than that of the control (P < 0.01). (3) The density of collagen in the dermis of the three groups was 80.57 +/- 5.47, 79.49 +/- 6.31 and 82.72 +/- 2.69, respectively; the density of elastin of the three groups was 2.88 +/- 1.24, 2.77 +/- 0.74 and 2.56 +/- 0.63, respectively (P < 0.05). We concluded that the delay phenomenon of the expanded flap depends mainly on the intensity of expansion. The immediate retraction ratio of the rapidly expanded skin was greater than that of conventionally expanded skin. Rapid expansion also results in tissue hypertrophy but does not cause destruction of collagen. With proper calculating the size of the defect and estimating immediate skin retraction, rapid expansion is feasible in clinical applications.     

Mammography versus clinical examination of the breasts

Using published data from screening trials, this article compares two-modality (mammography and clinical examination) and single-modality (clinical examination alone) screening by evaluating cancer detection rates, program sensitivities, mode of cancer detection in two-modality screening, nodal status at time of detection, survival 10 years post-diagnosis, and breast cancer mortality 10 years after entry. Consistently, two-modality screening achieved higher cancer detection rates and program sensitivity estimates than either modality alone; mammography alone achieved higher rates than clinical examination alone; interval cancer detection rates between screening examinations were higher following clinical examination alone than mammography alone; single-modality screening with mammography failed to detect breast cancers identified by clinical examination alone; the sensitivity of mammography was lower in younger than older women, while the reverse was true for clinical examination; and mammography identified a higher proportion of node-negative breast cancer than clinical examination. We conclude that combining clinical breast examination with mammography is desirable for women age 40-49 because mammography is less sensitive in younger than older women. Careful training and monitoring are, however, as essential with clinical examiners as with mammographers.     

Histomorphologic evaluation of guinea pig skin and soft tissue after controlled tissue expansion

To evaluate the histologic changes attendant on tissue expansion in the guinea pig, self-inflating implants were placed in the dorsal subcutaneous space and the tissue response was sequentially studied at periods ranging from 1 to 18 weeks. Fixation artifacts have been minimized. The cellular response is relatively benign. The epidermis does not undergo thinning during expansion, although dermis and panniculus carnosus become significantly thinner. Atrophy of panniculus muscle is demonstrable. This study supports the hypothesis that tissue expansion results in a net gain of donor tissue.     

Inhibition of tissue repair by spironolactone: role of mineralocorticoids in fibrous tissue formation

The complete removal of the fluorescent cysteine derivative 4-(aminosulfonyl)-7-fluoro-2,1,3-benzoxadiazole (ABD-F) from an intact protein has not been demonstrated even after extended treatment with a reducing agent. It has been suggested that this may be due to incomplete denaturation under the conditions employed. We were interested in investigating this phenomenon utilizing small peptides containing individual ABD-labeled cysteine residues. After incubating the fluorescent peptides in the presence of a reductant, it was shown that the ABD label could be completely removed from all of the cysteine-containing peptides investigated. Therefore, delabeling irreversibility is due to residual structure in proteins. Electrospray ionization mass spectrometry (ESI-MS) was used to determine the molecular mass of each peptide after removal of the ABD lavel. The ESI-MS data were consistent with the generation of a free sulfhydryl. The generation of the free sulfhydryl was further substantiated when a delabeled peptide was completely relabeled with ABD-F in the absence of reductant.     

Bilateral primary lymphoma of the breasts detected in pregnancy

The authors report a case of bilateral primary malignant lymphoma of the breast presenting during pregnancy in a 24-year-old woman. After delivery of a healthy premature infant by Caesarean section, polychemotherapy was employed. The efficacy of the treatment could not be evaluated since the patient died within a very short period of time. Autopsy and histological examination revealed infiltration of Burkitt-type lymphoma in the breast, ovary, brain, liver, kidney, adrenal gland, pancreas, stomach, bone marrow and myocardium.     

Transposition flaps adn full-thickness skin grafts used as interposition tissue: progressive physiological expansion

Expressing proteins and polypeptides as fusions to ubiquitin offers the advantage of an often dramatic increase in yield, and the ability to produce any desired amino-terminal residue upon ubiquitin cleavage. The recent availability of cloned ubiquitin-cleaving enzymes has enhanced this technique for both bacterial and eukaryotic host systems.     

Reconstruction of lateral skull base oncological defects: the role of free tissue transfer

The present study was performed to investigate the age-dependent changes in body composition and the possible role of growth hormone (GH), insulin-like growth factor (IGF)-I and IGF-binding protein-3 (IGFBP-3) in these changes in postmenopausal Japanese women. A total of 161 Japanese women aged 45-88 years (mean 62) were enrolled in the cross-sectional study. Body composition (bone mineral content (BMC), lean body mass (LBM) and fat) was measured by dual-energy X-ray absorptiometry, and the percentage of BMC, LBM and fat was calculated by dividing each absolute value of body composition by total body mass. Urinary GH concentration divided by creatinine in nocturnal urine samples collected just after waking was used as an index of endogenous GH secretion. Serum levels of IGF-I and IGFBP-3 were measured by RIA. Urinary GH levels as well as serum levels of IGF-I and IGFBP-3 declined with age. BMC, %BMC and LBM also declined with age, while fat mass and %fat did not obviously change with age. Urinary GH levels as well as serum levels of IGF-I and IGFBP-3 correlated positively with BMC, even if age was taken into account. On the other hand, urinary GH correlated negatively with fat and %fat. In contrast, serum levels of IGF-I and IGFBP-3 correlated positively with fat and %fat. LBM did not correlate with either urinary GH or serum IGFBP-3 levels but exhibited a weakly positive correlation with serum IGF-I level. The present study suggests that the GH-IGF-I-IGFBP-3 axis positively regulates bone mass, and that GH and IGF-I-IGFBP-3 inversely regulate fat mass, i.e. GH negatively and IGF-I-IGFBP-3 positively regulates it.     

Biorheological features of some soft tissues under a surgical tissue expansion procedure

The aim of this study was to investigate the effects of a surgical tissue expansion procedure on the biomechanical features of the expanded soft tissues. In this procedure a silicone balloon "expander" is surgically inserted into a tissue and inflated. The tissue mass increases under the stretch of the expander. The increased tissue can then be used as an autologous source for the surgical reconstruction of organs. In this article, dog saphenous neurovascular bundle was used. Expanded saphenous nerves, arteries and veins were harvested and their biomechanical features and ultrastructural, histological changes were studied. The stress relaxation features, the continuous spectrum of relaxation time, and the stress-strain relationship of expanded and control specimens were measured. Results show that within two or three weeks after placement of the expanders, the biomechanical properties of expanded saphenous nerves, arteries and veins began to deviate from those of their controls, and the differences between them were proportional to the volume of inflation; but when the expanding period was 15 weeks or longer, the properties of expanded specimens and their controls became close again. Histological study showed that the content of collagenous fibers in blood vessel walls decreased after expansion. The content of elastic fibers in blood vessel walls first increased, then returned to normal, and finally decreased. Ultrastructural studies showed that when elongated by 25-40%, the expanded nerves had well preserved axons and showed fewer smooth myelin sheaths only in the middle and distal part of the expansion.     

Need for expansion of forensic psychiatrists' role in sexual harassment cases

Apparently intimidated by the current climate of political correctness, forensic psychiatrists in sexual harassment cases often limit themselves to a determination of damages. Yet they are in a unique position to help in the resolution of more complex issues: they need not merely accept plaintiffs' allegations at face value, as treating psychiatrists generally do, but can assess credibility and identify psychodynamics that could be crucial in the clarification of legal questions such as "welcomeness." This article discusses the significance of pertinent data, such as a history of childhood sexual abuse, but emphasizes that such information does not necessarily invalidate the plaintiffs allegations. It also reviews the obstacles that can stand in the way of a complete psychiatric examination and thereby limit the forensic psychiatrist's ability to help the courts. Increased involvement by forensic psychiatrists could contribute to a more impartial evaluation of sexual harassment cases and help establish the distinction between valid claims and frivolous ones.     

Maintaining large weight losses: The role of behavioral and psychological factors.

Few studies have examined predictors of weight regain after significant weight losses. This prospective study examined behavioral and psychological predictors of weight regain in 261 successful weight losers who completed an 18-month trial of weight regain prevention that compared a control condition with self-regulation interventions delivered face-to-face or via the Internet. Linear mixed effect models were used to examine behavioral and psychological predictors of weight regain, both as main effects and as interactions with treatment group. Decreases in physical activity were related to weight regain across all 3 groups, and increased frequency of self-weighing was equally protective in the 2 intervention groups but not in the control group. Increases in depressive symptoms, disinhibition, and hunger were also related to weight regain in all groups. Although the impact of changes in restraint was greatest in the Internet group and weakest in the face-to-face group, the latter was the only group with increases in restraint over time and consequent decreases in magnitude of weight regain. Future programs should focus on maintaining physical activity, dietary restraints, and frequent self-weighing and should include stronger components to modify psychological parameters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)