Importance of long-term monitoring of patients with breast reconstructions: a case of 10-year cancer recurrence.

We report a case of breast cancer recurrence in a 41 -year old female ten years post mastectomy, and two years post tertiary DIEP flap reconstruction. Reconstructed patients, especially those with aggressive cancers, must be informed of long term risk of recurrence and monitored long term following mastectomy and reconstruction.

Glutamatergic modulation of synaptic-like vesicle recycling in mechanosensory lanceolate nerve terminals of mammalian hair follicles.

Our aim in the present study was to determine whether a glutamatergic modulatory system involving synaptic-like vesicles (SLVs) is present in the lanceolate ending of the mouse and rat hair follicle and, if so, to assess its similarity to that of the rat muscle spindle annulospiral ending we have described previously. Both types of endings are formed by the peripheral sensory terminals of primary mechanosensory dorsal root ganglion cells, so the presence of such a system in the lanceolate ending would provide support for our hypothesis that it is a general property of fundamental importance to the regulation of the responsiveness of the broad class of primary mechanosensory endings. We show not only that an SLV-based system is present in lanceolate endings, but also that there are clear parallels between its operation in the two types of mechanosensory endings. In particular, we demonstrate that, as in the muscle spindle: (i) FM1-43 labels the sensory terminals of the lanceolate ending, rather than the closely associated accessory (glial) cells; (ii) the dye enters and leaves the terminals primarily by SLV recycling; (iii) the dye does not block the electrical response to mechanical stimulation, in contrast to its effect on the hair cell and dorsal root ganglion cells in culture; (iv) SLV recycling is Ca(2+) sensitive; and (v) the sensory terminals are enriched in glutamate. Thus, in the lanceolate sensory ending SLV recycling is itself regulated, at least in part, by glutamate acting through a phospholipase D-coupled metabotropic glutamate receptor.

Trapezoid fractures: report of 11 cases.

PURPOSE: Trapezoid fractures are rare. Mostly single cases reports appear in the literature. The purpose of this study was to review 11 patients treated for trapezoid fractures at our center. METHODS: We reviewed all trapezoid fractures that presented over the past 10 years at our institution. We reviewed case notes regarding mechanism of injury, fracture pattern, mode of diagnosis, and time to diagnosis and treatment. RESULTS: We treated 11 patients for trapezoid fractures over the 10-year period. A correct diagnosis was made in 5 cases on initial evaluation. Most trapezoid fractures were diagnosed on computed tomographic scan. The fracture plane was predominantly sagittal. Coronal fractures could not be diagnosed on plain radiographs. CONCLUSIONS: Fractures of the trapezoid should be suspected from the mechanism of injury, in particular, axial force, and from local tenderness. These fractures may be underdiagnosed. We recommend computed tomography rather than plain radiography alone in case of clinical suspicion. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.

Evidence based surgery--do we practice what we preach?

BACKGROUND: Good surgical practice assumes knowledge of the current literature. However, we suspect that published clinical recommendations are not always followed by the department producing the research. We sought to assess whether clinical recommendations made by surgical units are followed within their own department. We carried out a prospective study of the British Journal of Surgery and contacted individual departments to assess whether recommendations made by the senior author were being followed. METHODS: Journal articles between January 2005 and December 2006 were reviewed with respect to any recommendations made from research findings. Individual departments were contacted by telephone and an appropriate individual was asked whether the recommendations were being followed by the lead author. RESULTS: Sixty-six units were successfully contacted and 49 (74%) followed their own recommendations, leaving 17 (26%) who did not. CONCLUSION: Most surgical units who publish recommendations in the British Journal of Surgery implement changes within department. However, there is significant proportion who don't practice what they preach.