Mastoplastia reductiva a pedículo súpero-interno-posterior / Pedicle reductive mastoplasty supero-internal-posterior

El propósito del siguiente trabajo es presentar una modifi cación de la técnica de mastoplastia reductiva a pedículo supero interno descripta por el Dr. Gagliardi E. P. y colaboradores en el año 1985. La importancia de esta modifi cación se basa en el agregado de un tercer pedículo, el posterior, basado en las perforantes intercostales de los espacios segundo y tercero. Esta técnica puede ser utilizada en pacientes con hipertrofi a mamaria severa y gigantomastia, y nos brinda una máxima seguridad del pedículo neurovascular, facilidad en el ascenso del complejo areola pezón, disminución de la necrosis en la intersección de las cicatrices, buena conformación y proyección de la mama.

Assessment of sleep apnea syndrome in treated acromegalic patients and correlation of its severity with clinical and laboratory parameters.

BACKGROUND: Sleep apnea syndrome (SAS) is a frequent disorder in acromegalic patients and its frequency ranges from 45 to 87.5% of patients. Obstructive SAS is the prevailing form in acromegaly and its pathogenesis is based on craniofacial deformations and thickening of soft tissues and mucosas of upper airways and bronchi. Central and mixed types are less frequent. Respiratory complications, and SAS in particular, may contribute to the increased mortality observed in acromegaly. AIM: Aim of the present study is to assess the presence of SAS in acromegalic patients, its features and to correlate the severity of SAS with factors such as disease duration, body mass index (BMI), smoking, GH/IGF-I serum levels, associated comorbidities. SUBJECTS AND METHODS: Polygraphy (SOMNOcheck Effort Weinmann V2.05) was performed in 25 consecutive acromegalic patients (9 men and 16 women). Statistical analysis was performed with Mann-Whitney's test and Spearman coefficient. RESULTS: Fourteen out of 25 patients (56%) were affected by SAS. The prevailing form was obstructive SAS (12/14 patients). Smoking, female gender, and presence of lung disease appear to lead to a more severe form. We also found that the prevalence of hypertension was significantly higher in the group of patients with SAS, whereas no correlation was proved among SAS and disease duration, GH/IGF-I serum levels, somatostatin analogs treatment, BMI, and associated comorbidities. CONCLUSIONS: SAS is a frequent complication of acromegaly. Severe forms seem to be correlated with smoking and lung disease. Therefore, all acromegalic patients should be subjected to a polygraphic study for an early diagnosis and treatment and smoking should be discouraged.

[Possible relationship between childhood malaise and psychiatric disorders in adulthood. Preliminary study on an in-patient sample from the psychiatric unit of the general hospital in Pavia]. / Possibili rapporti tra disagio infantile e patologia psichiatrica adulta. Studio preliminare su un campione di utenti del SPDC di Pavia.

The authors report the preliminary data of a study which aims to identify the variables (socio-demographic, clinical and nosographic) which may be used to predict the evolution of psychiatric disorders. A retrospective follow-back study was carried out using the medical records and any other documentation available from medical and psychological centers in order to identify the evolutionary stages of disease and possible pre-disease antecedents. The sample group examined was selected from users attending the Diagnosis and Treatment Psychiatric Unit at Pavia Hospital who were found to have undergone infantile neuropsychiatric outpatient or hospital treatment during childhood. The preliminary phase of the study reports the results of the first 42 cases. The predictive value of the diagnosis made during childhood emerges from an analysis of the results and consequently emphasises the need to orient Infantile Neuropsychiatric structure not only towards diagnosis and care but also, towards a more strictly therapeutic action.

Nutritional implications of significant small bowel resection.

Nutrition support of the patient with short bowel syndrome is determined by the extent and location of bowel resection, the functional status of residual bowel, and presence or absence of the ileocecal valve. The authors discuss the consequences and treatments for bowel resection.

Bezafibrate-induced myopathy: no evidence for defects in muscle metabolism.

A 58-year-old man with chronic renal failure developed severe muscle pain and tenderness 1 week after starting bezafibrate 400 mg daily. Serum creatine kinase was 32,280 U/l. Muscle biopsy revealed scattered necrotic fibers and mild type 2b atrophy. Muscle total and free carnitine were at the upper limits of the normal range. Biochemical investigations of muscle homogenate showed normal carnitine pelmityl transferase (CPT) as well as normal individual glycolytic and mitochondrial enzyme activities. Withdrawal of the drug was followed by rapid clinical improvement. Our study casts doubt on the hypothesis that bezafibrate is able to affect muscle metabolic pathways. It is likely that the drug acts on cholesterol constituents of the muscle membrane, producing discontinuities of the sarcolemma and initiating cell necrosis.