Aesthetic outcome of breast implant removal in 85 consecutive patients

As we began to see increasing numbers of women concerned about their gel-filled breast implants, we became aware that we could not advise them with any degree of confidence what they might expect in terms of aesthetic result after implant removal. We decided to review the records and outcomes over a 2-year period of a number of patients who underwent implant removal. Eighty-five consecutive patients were reviewed, 69 of whom had undergone cosmetic augmentation and 16 of whom had breast reconstruction with silicone gel implant(s). Thirty-nine of the 69 cosmetic augmentation patients had removal of implants alone, and 27 had removal accompanied by mastopexy. Three had reaugmentation with saline-filled implants; one had replacement with saline-filled implants. Fifteen of the 16 reconstruction patients underwent autogenous tissue transfer. Preoperative and postoperative photographs of all patients were mixed randomly and rated by two independent raters in four aesthetic categories on a five-point scoring system. Repeatability was measured several weeks later, when each rater scored randomly selected photographs from this patient pool. The patients also performed their own outcome evaluations by means of questionnaire. We discovered that cosmetic augmentation patients who undergo implant removal only often suffer adverse aesthetic results. The postremoval appearance of many cosmetic augmentation patients actually will be improved over their preoperative appearance when mastopexy is performed in conjunction with implant removal. The study demonstrated that patients with certain body types could expect a particular outcome; i.e., women with asthenic builds and older patients with lax, striated breast skin generally had unsatisfactory aesthetic outcomes with implant removal only. Patients selected for autogenous breast reconstruction had favorable results, with extended latissimus dorsi and TRAM flaps yielding equally good outcomes. The study allows us to offer patients an optimistic view of postoperative results following breast implant removal. We have begun to advise selected patients that implant removal accompanied by mastopexy provides a more pleasing aesthetic outcome than implant removal alone.     

Conservative surgery for stage I ovarian carcinoma in women of childbearing age

OBJECTIVE: To assess the results of a policy of tailored conservative surgical management for young women with stage I ovarian carcinomas. DESIGN: Retrospective study. PARTICIPANTS: Ninety-nine women aged 40 years or younger who underwent either primary surgery in our department or were referred after primary surgery performed elsewhere. METHODS: Of the 99 women in our study, 56 underwent fertility-sparing surgery and 43 more radical surgery. Minimal requirements for conservative management were adequate staging and complete information about the therapeutic options. Factors important in the choice of the treatment were, age, wish to preserve fertility, histologic type and grade, and the stage of the tumour. RESULTS: Conservative treatment was conducted in 84% of nulliparous and in 33% of parous women; 62% of grade 1 tumours, 48% of grade 2, and 50% of grade 3 were treated conservatively. With a median follow up of seven years, we observed five recurrences (9%) of carcinoma in women treated conservatively and five (12%) in those treated more radically. Two women (one in each treatment arm) were saved after recurrence. Two recurrences after conservative surgery involved the residual ovary (3.6%). Two women developed borderline tumour in the contralateral ovary and both were treated by surgery. CONCLUSION: After adequate staging and accurate information is given to the patient, conservative treatment may be safe in some women with early ovarian cancer. The risk of recurrence in the contralateral ovary is low. Conservative surgery may be also considered in some Stage I grade 3 tumours and in some women with stage JC tumours.     

Determination of land and ocean reflective, radiative, andbiophysical properties using multiangle imaging

Knowledge of the directional and hemispherical reflectance properties of natural surfaces, such as soils and vegetation canopies, is essential for classification studies and canopy model inversion. The Multi-angle Imaging SpectroRadiometer (MISR), an instrument to be launched in 1998 onboard the EOS-AM1 platform, will make global observations of the Earth's surface at 1.1-km spatial resolution, with the objective of determining the atmospherically corrected reflectance properties of most of the land surface and the tropical ocean. The algorithms to retrieve surface directional reflectances, albedos, and selected biophysical parameters using MISR data are described. Since part of the MISR data analyses includes an aerosol retrieval, it is assumed that the optical properties of the atmosphere (i.e. aerosol characteristics) have been determined well enough to accurately model the radiative transfer process. The core surface retrieval algorithms are tested on simulated MISR data, computed using realistic surface reflectance and aerosol models, and the sensitivity of the retrieved directional and hemispherical reflectances to aerosol type and column amount is illustrated. Included is a summary list of the MISR surface products     

Effect of annealing in an atomic-hydrogen atmosphere on the properties of amorphous hydrated silicon films and the parameters of p-i-n structures based on them

The decrease in the density of dangling silicon-silicon bonds in a-Si:H films as a result of annealing in an atomic-hydrogen atmosphere is determined by their density in the initial (nonannealed) film. The change in the total hydrogen density in a-Si:H films, annealed in an atomic-hydrogen atmosphere, is determined by the type of silicon-hydrogen bonds and the impurity content: The hydrogen content can decrease to 1 at. % in the presence of monohydride bonds (2020 cm⁻¹) and no change is observed in the hydrogen content in the presence of oxygen (≲0.1 at. %). A decrease in the defect density as a result of annealing in an atomic-hydrogen atmosphere is observed for all films. The Staebler-Wronski effect — AM-1 irradiation for 10 h — is observed for all films irrespective of the total hydrogen density, the type of silicon-hydrogen bonds, and the presence of oxygen. Fiz. Tekh. Poluprovodn. 32, 620–626 (May 1998)     

Strengthening of soils during construction under chalk karst conditions

The experience of the State Joint-Stock Company for Stabilization of Bases and Structures (Gidrospetsstroi) in eliminating a technogenic chalk karst under complex hydrogeological conditions is reported. The causes of formation of the karst at a depth of 30–40 m and methods of eliminating piping and karstification by injecting cement grouts into the chalk by a special technology are examined. Translated from Osnovaniya, Fundamenty i, Mekhanika Gruntov, No. 3, pp. 21–23, May–June, 1994.     

Effect of insulin versus sulfonylurea therapy on cardiovascular risk factors and fibrinolysis in type II diabetes

1. The synthesis and release of nitric oxide may play a role in the pathogenesis of peripheral vasodilatation and hyperdynamic circulation observed in liver cirrhosis. In this work, we analysed the synthesis of nitric oxide by the lympho-mononuclear cells of peripheral blood from patients with chronic alcoholic and non-alcoholic liver disease and we identified the isoform of nitric oxide synthase involved in the increased nitric oxide synthesis. 2. Patients were classified following clinical and histological criteria in non-alcoholic cirrhotic, alcoholic cirrhotic and non-cirrhotic chronic liver disease. We studied clinical and analytical characteristics, haemodynamic parameters and endotoxin levels in these patients. 3. Cirrhotic patients showed an increase of cardiac output and a decrease of peripheral vascular resistance. These patients had higher levels of plasma endotoxin than those observed in the control group. N omega-Nitro-L-arginine methyl ester (L-NAME)-inhibitable nitrite production from mononuclear lymphocyte cells was higher in patients than in the control group, the highest levels being in non-alcoholic cirrhotic patients, and the lowest levels in patients with non-cirrhotic alcoholic liver disease. 4. Immunocytochemistry studies revealed a positive immunoreactivity for the inducible isoform of nitric oxide synthase in lympho-mononuclear cells that was more evident in non-alcoholic than in alcoholic cirrhotic patients. By Northern blot, inducible nitric oxide synthase mRNA expression was observed only in lymphomononuclear cells from non-alcoholic cirrhotic patients. 5. Our patients show a correlation between nitric oxide synthesis, endotoxin levels and haemodynamic parameters. 6. These findings indicate that lympho-mononuclear cell stimulation may play a role in elevated nitric oxide production in hepatic cirrhosis. Thus, this increased nitric oxide synthesis could be implicated in the pathogenesis of the haemodynamic disturbances frequently found in cirrhotic patients. This increase seems to be induced, at least in part, by activation of an inducible isoform of nitric oxide synthase.