An unusual "venous circle" of the internal mammary vein encountered during microvascular anastomosis and implications for practice.

The internal mammary vessels are commonly used for anastomosis in breast reconstruction. The anatomy when using the 2nd ICS has been shown to be predictable and hence preferentially used by the senior author. We present an unusual case of internal mammary vein bifurcation and immediate confluence forming a 'venous circle'.

In vitro comparison of quantitative computed tomography and broadband ultrasonic attenuation of trabecular bone.

In vitro measurements of os calces and trabecular bone samples have been carried out using broadband ultrasonic attenuation (BUA) and quantitative computed tomography (QCT). The correlation between the measurements was 0.92 and 0.86 for the heelbones and the trabecular samples respectively, and the QCT and BUA correlated equally well with the physical density of the samples, indicating that the new ultrasonic technique is potentially useful for the evaluation of trabecular bone for the diagnosis of osteoporosis.

An effect of ischemia on myocardial dihydropyridine binding sites.

The [3H]nitrendipine binding activity of sarcolemmal fragments isolated from aerobically perfused or ischemic rat hearts was studied. After 90 min aerobic perfusion, two populations of binding sites were detected--high affinity sites with KD of 0.24 +/- 0.04 nM and Bmax 313 +/- 110 fmol/mg protein, and low affinity sites with KD of 47.6 +/- 8.7 nM and Bmax 12.4 +/- 1.88 pmol/mg protein. Sixty minutes global ischemia significantly reduced the KD of the low (15.8 +/- 2.9 nM, P less than 0.03) but not of the high (0.22 +/- 0.05 nM) affinity sites. Under these same conditions the Bmax of both the high (82.4 +/- 14.5 fmol/mg protein, P less than 0.03) and low (6.1 +/- 1.7 pmol/mg protein, P less than 0.01) affinity binding sites was reduced but the sites retained their selectivity, with nifedipine displacing bound [3H]nitrendipine more potently than D600. Bay K 8644, when added upon reperfusion, promoted a dose-related increase in Ca2+ entry which was reduced by nifedipine, indicating that dihydropyridine binding sites can be activated after 60 min ischemia.

The interaction of ultrasound with cancellous bone.

The Biot theory is used in an attempt to explain the frequency dependence of ultrasonic attenuation, f(alpha), in cancellous bone. Measurements of f(alpha) in samples of cancellous bone are compared with values calculated using parameters established from bone samples by statistical histomorphometry. Ultrasonic attenuation in cancellous bone correlates with trabecular bone volume but the Biot theory, although producing qualitative agreement produces quantitative results which are significantly deviant using parameters presently available. At the present time, too many of the Biot parameters are insufficiently defined for cancellous bone, to allow a complete test of the model.

Problems in the case for psychotherapeutic integration.

The arguments in favor of therapeutic integration are summarized and evaluated. Weaknesses of the position are: (1) the false claim that all therapies are equally effective; (2) the lack of a clear and accurate specification of what makes a school of therapy "legitimate"; (3) the lack of a clear case for an accurate and comprehensive list of common elements across therapies; (4) a lack of clarity concerning "clinical strategy"; (5) the incorrect claim that cognitive therapy provides a useful and neutral meta-language; (6) inadequate evidence of trends toward integration; (7) fallacious reasoning based on these alleged trends; and (8) a misunderstanding of the history and philosophy of science.

Improving the early detection of malignant melanoma.

The early detection of cutaneous melanoma is known to be associated with reduced mortality. In order to improve early detection of suspicious skin lesions a Pigmented Lesion Clinic (PLC) was set up at Mount Vernon Hospital in January 1993. Its aims were to provide a rapid method of expert assessment and treatment for malignant skin tumours as well as reassurance for patients with benign lesions. In the first 2 years, 1779 new patients were seen and 674 lesions excised, of which 18% were malignant. Comparison of the Breslow thicknesses of melanomas diagnosed via the PLC revealed a significant shift towards thinner early tumours when compared with the two previous years (chi 2 = 12.8, P < 0.01) and during the same time period via normal routes of referral (chi 2 = 8.68, P < 0.02). The running of such a service and its hidden benefits are discussed.