Plastic surgery in the Norwegian undergraduate medical curriculum: students' knowledge and attitudes. A nationwide case-control study.

OBJECTIVE: Changes in medical education have resulted in less available time for plastic surgery, which might jeopardise the availability of plastic surgery for patients. The aims of this study were to investigate the level of knowledge within and attitudes towards plastic surgery among medical students, and find predictors for a wish to pursue a career in plastic surgery. METHODS: A previously used questionnaire was sent to all clinical medical students. Law students were used as a control group. RESULTS: Thirty per cent of all clinical medical students in the country responded. The majority of students considered education in plastic surgery valuable/very valuable and 23% were considering it as a career. Nonetheless, about half of the students were unaware of the plastic surgical education at their faculty and reported non-academic sources of learning. Only 44% of medical students were able to name five common plastic surgical procedures and 8% were unable to name any. Law students were superior to medical students in the task (p = 0.005). Forty-two per cent of medical students were successful in indicating on which body parts plastic surgeons operate, whereas law students were less successful (p = 0.001). Male gender and positive valuing of clinical attachment could predict a wish for a career in plastic surgery. CONCLUSION: In some aspects, medical students are only as knowledgeable as their non-medical peers. These results call for higher quality plastic surgery teaching, to secure referral of the correct patients and successful specialist recruitment to plastic surgery.

Glucose concentration in seromas after plastic surgery: a pilot study.

Previously, glucose concentration has been presumed to be similar in seroma, lymph, and plasma. However, there are few studies actually measuring glucose concentration in seroma. The aim of this pilot study was to determine if the glucose concentration in seroma is similar to that in plasma, as it has previously been presumed. Biochemical analysis of seroma was performed on 11 patients that had undergone plastic surgery. Fluid was taken from the drains between postoperative day 3 and 6. The median glucose concentration was 3.09 millimolar (mM) (range 2.25-3.89 mM). Glucose concentration in seroma does not seem to be similar to that of plasma and lymph that has previously been presumed. The result of this pilot study warrants further investigation to determine the span of normal glucose concentration, its development over time, its relation to plasma glucose concentration, and how it is affected by infection.

Development of a pressure-measuring device to optimize compression treatment of lymphedema and evaluation of change in garment pressure with simulated wear and tear.

The use of compression garments in treating lymphedema following treatment of genital (penis, testes, uterus, cervical) and breast cancer treatment is a well-established practice. Although compression garments are classified in compression classes, little is known about the actual subgarment pressure exerted along the extremity. The aims of this study were to establish an in vitro method for measuring subgarment pressure along the extremity and to analyze initial and over time subgarment pressure of compression garments from three manufacturers. The measurements were performed with I-scan(®) (Tekscan Inc.) pressure measuring equipment once a week during a period of 4 weeks. Wear and tear was simulated by washing and putting on the garments on plastic legs every day. There was a statistically significant difference between the garments of some of manufacturers. There was no difference between garments from the same manufacturer. No significant decrease of subgarment pressure was observed during the trial period. The study demonstrated that Tekscan pressure-measuring equipment could measure subgarment pressure in vitro. The results may indicate that there was a difference in subgarment pressure exerted by garments from different manufacturers and that there was no clear decrease in subgarment pressure during the first four weeks of usage.

The influence of wavelength and probe configuration on findings of a skin vasoconstriction test when using laser Doppler perfusion devices.

The aim of this study was to establish the degree to which a standardized test based on laser Doppler blood flow measurement is dependent on the particular equipment set-up being used. For this purpose, we examined finger skin blood flow with laser Doppler instruments in 20 healthy subjects. In laser Doppler perfusion monitoring (LDPM), we used a custom-made probe with two detecting fibers placed 0.25 and 1.2 mm from the illuminating fiber, respectively, and two laser Doppler perfusion imagers (LDPI) with a wavelength of 632.8 nm and 780 nm, respectively. Warming of the hand was achieved with a Peltier element, and reflex vasoconstriction was induced by immersing the other hand for 3 min into a water bath kept at 15 degrees C. As a measure for the change in skin blood flow, a vasoconstriction index (VAC: cooling/before cooling) was calculated and used for the comparison of the different devices. VAC values gathered around 0.6 for all devices. However, LDPI with a wavelength of 632.8 nm showed a slightly higher VAC index, and the difference was significant. We conclude that using a standardized test is the most appropriate for monitoring changes in blood flow rather than recording and comparing discrete values in intermittent recordings. Although a difference was noted when comparing the devices, different fiber separations and wavelengths seem then to be of little consequence.

Sympathetic and parasympathetic neuropathy are frequent in both type 1 and type 2 diabetic patients.

OBJECTIVE: The aim of this study was to evaluate the frequency of sympathetic versus parasympathetic neuropathy among type 1 and type 2 diabetic patients. RESEARCH DESIGN AND METHODS: There were 43 patients with type 1 and 17 with type 2 diabetes who were investigated. Sympathetic nerve function was assessed by measurement of the vasoconstriction (VAC) index by laser Doppler perfusion imaging of a locally heated finger followed by indirect cooling. Parasympathetic nerve function was assessed by R-R interval variation during deep breathing as measured by the expiration/inspiration (E/I) ratio. Results were expressed as age-corrected z scores in SD; VAC index >1.64 SD and E/I ratio <-1.64 SD were considered abnormal. RESULTS: VAC index was abnormal in 40% with type 1 and 41% with type 2 diabetes, whereas the E/I ratio was abnormal in 42% with type 1 and 65% with type 2 diabetes. There was a clear association between VAC index and E/I ratio among type 1 (rs=0.525; P=0.0002) but not among type 2 (rs=0.10) diabetic patients. Among type 2 diabetic patients, the degree of dysfunction was most severe regarding parasympathetic function (P=0.0167). CONCLUSIONS: Sympathetic and parasympathetic neuropathy were frequent in both type 1 and type 2 diabetic patients. However, there was a difference between the two types of diabetes. Sympathetic and parasympathetic nerve functions correlated in type 1 but not in type 2 diabetic patients. The explanation for this discrepancy might be that parasympathetic nerve function was most severely affected among type 2 diabetic patients.

Laser Doppler perfusion monitoring of skin blood flow at different depths in finger and arm upon local heating.

The purpose of the study was to elucidate the vasodilatory response to local heating of the skin at two depths in two locations. To accomplish this, we measured skin blood flow in 12 healthy subjects using laser Doppler perfusion monitoring. A probe with two fibers separated 0.14 mm (superficial) and 0.25 mm (deeper) from the illuminating fiber was first attached to the distal phalanx of the index finger and thereafter to the dorsal forearm skin. Local heating was caused with a thermostatic probe holder set at 40 degrees C. We studied the perfusion value and its two components, velocity and concentration. All registrations were also subjected to frequency analysis. Laser Doppler values were generally higher in the fingertip than in forearm skin. Heating caused increased values at both locations. Concentration increased relatively more than velocity and this was most obvious in the forearm. There were only slight differences in response between superficial and deeper vascular components. Frequency analysis revealed a peak in perfusion and velocity obviously related to the heartbeat. Movement of the column of blood thus reached the peripheral vascular network without changing concentration. We conclude that local heating increases skin blood flow in fingertip and forearm skin by different adjustments of blood cell concentration and velocity, presumably depending on differing vascular anatomy and physiological control, but differences are of a rather minor character. Furthermore, responses differ just slightly in superficial compartments as probed with fibers separated up to 0.25 mm.