Women gain weight and fat mass despite lipectomy at abdominoplasty and breast reduction.

OBJECTIVES: In animal models, fat removal results in compensatory weight gain. No study has reported measurement of weight following lipectomy in humans. We have examined changes in weight in patients who underwent lipectomy. METHODS: In a retrospective analysis, 16 patients who had abdominoplasty and 17 patients who underwent bilateral breast reduction were compared with 16 patients who had carpal tunnel syndrome release. Following this, a prospective study was carried out on 7 subjects awaiting abdominoplasty and 12 subjects awaiting bilateral breast reduction surgery. RESULTS: In the retrospective study, all three patient groups gained weight following surgery. The abdominoplasty group was heavier before surgery and showed greatest weight gain but there was no statistically significant difference in weight gain between the groups. In the prospective study, the abdominoplasty group had a mean fat removal of 1.77 kg and breast reduction group had a mean of 3.22 kg. Eighteen months following surgery the abdominoplasty group showed a significant mean increase in body weight (mean increase: 4.82 kg) and body mass index (BMI) (mean increase: 1.66 kg/m(2)). In the bilateral breast reduction group, there was a non-significant mean gain in weight (mean increase: 0.67 kg) and BMI (mean increase: 0.21 kg/m(2)). CONCLUSIONS: Patients undergoing lipectomy during abdominoplasty and bilateral breast reduction will gain weight in the long term. This weight gain probably reflects the expected gain in weight without surgery as a similar finding is observed in patients who have undergone surgery without lipectomy. These results highlight the limitation of lipectomy as a weight control measure.

The future of ethnic minority nurses in the NHS.

The subject of discrimination especially with regard to the ethnic minority workforce in the NHS was the focus of a specially commissioned Task Force funded by the Department of Health and the King's Fund in 1991 followed by the PSI Report published last year to help health authorities to address racial discrimination. The first of these reports, for example, states quite clearly that 'racial inequalities between managers and staff in the service are glaring... black and ethnic minority staff will not join or remain in a service which they do not see to be providing good and fair employment prospects. This perhaps influenced the Secretary of State for Health, in 1993, to set up a programme of action which included a number of targets to be achieved. Goal seven, for example, specifically addresses nursing by stating that NHS authorities and trusts are to set local objectives to achieve representation of ethnic minority nurses at ward manager level within 5 years. This programme seems to focus on the issue of equal opportunities but although in does make reference to 'racial harassment' it does not include 'racism'. Hence the purpose of this paper is to address the issues of equal opportunities and anti-racism from a theoretical and practice base. It also intends to offer alternatives for the way forward by focusing on local initiatives.

Homeostasis: restoring the internal wellbeing in patients/clients.

This article gives a historical perspective of homeostasis and explores the concepts surrounding the term. The importance of the internal environment and the dynamic nature of homeostasis are discussed. Issues of homeostatic control and maintenance are highlighted and the role of feedback mechanisms is clarified. A rationale is presented to support the argument that the objective of holistic nursing care is to restore physical and emotional homeostasis, i.e. to facilitate the restoration of the internal wellbeing in our clients/patients. Two aspects of a non-homeostatic model of health, namely the mind-body dualism and the reductionist approach, are considered.