Tattooing in reconstruction of the nipple and areola: a new method.

In order to produce the characteristic color of the nipple-areola complex and in unilateral reconstructions to match the other side, a modified tattooing method has been introduced. The quite different requirements between reconstruction and ornamental studio tattooing can only be satisfied by different techniques. For the first time, pigment particles have been suspended in a gel rather than adsorbed on an opaque mineral. Our porcine study has shown how the pigment is distributed in the dermis without penetration of the gel particles. The first 16 of the authors' 29 patients have been reviewed with an analysis of their appearance. Using this new method, a third achieved a completely natural appearance and two-thirds were judged to be intermediate, compared with an unnatural, although sometimes acceptable, result in all the earlier conventional tattoos.

Single-stage correction of constriction ring syndrome.

The accepted method of treatment for the constricting ring syndrome of the extremities is serial excision and repair with Z-plasties. A series of 4 patients operated upon in different centers by single-stage excision of the ring and multiple Z-plasty repair is presented. In 1 patient there was absence of a major nerve trunk underneath and distal to a constriction ring. None of the patients suffered any significant circulatory embarrassment. This surgical approach is anatomically sound and clinically safe. It should be considered as an alternative method of treatment to the currently accepted procedure.

Hyperthermia after discontinuance of levodopa and bromocriptine therapy: impaired dopamine receptors a possible cause.

Hyperthermia, with no signs of any underlying infection, may occur in the course of neuroleptic malignant syndrome, fatal catatonia, heat stroke, or malignant hyperthermia. We describe hyperthermia as a complication after discontinuance of antiparkinsonian treatment with levodopa/carbidopa and bromocriptine. Impaired nigrostriatal, hypothalamic, and mesolimbic dopaminergic functions could be involved in pathogenesis.

Surgical treatment of radiation-induced scalp lesions.

The treatment of scalp lesions induced by ionising radiation in four patients is described. In each case the technique used was different. Three required several operations and a prolonged hospital stay. The fourth patient, in whom a free flap was used, underwent a single operation. In selected patients with reasonable general health free tissue transfer may provide the best solution to such difficult management problems.

[Myasthenia and sleep]. / Myasthénie et sommeil.

A Central Nervous System (CNS) acetylcholine receptors involvement in Myasthenia Gravis (MG) has been suggested but never fully demonstrated. On the other hand, although the question concerning the neurotransmitters connected to REM sleep is still unsettled, the importance of acetylcholine as a neurotransmitter involved in the maintenance of this sleep stage has been outlined. The spontaneous night sleep organization has been studied in 9 male subjects with MG and results are compared with those obtained in normal subjects matched for age and sex. Statistically significant differences have been found: 1) slow-waves sleep better represented in MG patients; 2) average REM period length shorter in MG patients; 3) instability of the EEG consisting in a tendency toward lightening of sleep. These findings may confirm the presence of a disturbance in the CNS cholinergic activity of MG patients.