Nipple-areola complex reconstruction techniques: A literature review.

Many techniques for nipple-areola complex (NAC) reconstruction are described. Clarity is required on the currently available options. Since a complete list of all the techniques described until now is not available, a possibly comprehensive literature overview was carried out from 75 papers (years 1946-2015). The local flap was the most frequently described technique for the nipple reconstruction with no significant difference in complications' rate among the various types of techniques. Complications in nipple reconstruction were 46.9% after graft, 7.9% after local flap, and 5.3% in case of flaps with autologous graft/alloplastic/allograft augmentation, while complications in areola reconstruction were 10.1% after graft, and 1.6% after areola tattoo. Flaps appear to be more reliable than grafts in nipple reconstruction, while tattoo is thought to be safer than graft in areola reconstruction. The loss of projection, although considerable (45%-75%), had not significant impact on patients' satisfaction. Due to contraction, overcorrection of 25-50% of the desired result is advisory when adopting local flaps, in order to prevent loss of projection. The use of flaps with autologous graft/alloplastic/allograft augmentation (cartilage, fat, calcium hydroxylapatite, acellular dermal matrix, polymethylmethacrylate, biologic collagen) showed a minor loss of nipple projection but may expose to a relative increased number of postoperative flap necrosis.

[Calciphylaxis: a multidisciplinary approach]. / Calcifilassi: approccio multidisciplinare.

Calcific uremic arteriolopathy (CUA) is a rare syndrome characterized by medial calcification of the small arteries and ischemia of the subcutaneous tissue that progresses to non-healing ulcers and gangrene. It is common in patients with end-stage renal disease (ESRD), associated with high morbidity and mortality, and there is no standard treatment at the present time. We report a case of CUA developing in a 70-year-old woman on dialysis, with a normal plasma concentration of parathyroid hormone but a body mass index of 40 kg/m(2) and receiving oral anticoagulant therapy. She was successfully treated with a multidisciplinary approach focused on medical and surgical therapy.

Developmental Eye Movement Test: reliability and symptomatology.

BACKGROUND: The Developmental Eye Movement Test (DEM) is a widely used visual skill test, especially in the context of a vision therapy evaluation. It is intended to diagnose oculomotor dysfunction (OMD) and can also identify deficient rapid automatized naming. As such, its reliability and associated symptomatology are important. METHODS: The DEM test-retest reliability was investigated within two populations: a group of 53 office patients who were participating in vision therapy evaluation in a private optometry practice, and a smaller group of 13 subjects at their school. One to four weeks separated the test and retest for both groups. We also studied the relationship between results on a questionnaire of symptoms associated with OMD and DEM test performance in these two populations. RESULTS: The first administration of the DEM significantly correlated with the second for all four of its scores for both groups. The office group had higher intra-class correlation coefficients than the school group. There was good agreement between test and re-test in terms of pass-fail classification for the office group. Symptomatic subjects performed poorer than asymptomatic subjects on the DEM. Failing the DEM Ratio, the score used to diagnose OMD, identified 90% of the subjects who were symptomatic. CONCLUSIONS: The DEM has good intra-subject test-retest reliability for all four of its scores when it is administered in an office setting to patients participating in a vision therapy evaluation. It also has good consistency in classifying patients as pass or fail. Performance on the DEM relates to certain symptoms that are associated with OMD.

Methyldopa-related convergence insufficiency.

A case report of convergence insufficiency related to the use of methyldopa is presented. Methyldopa is a systemic antihypertensive agent. It has sympatholytic properties which lower blood pressure by decreasing peripheral vascular resistance. The proposed effects of methyldopa on binocular vision are reduced accommodative convergence and increased demand on fusional convergence. These effects would create a susceptibility to convergence insufficiency. To my knowledge, an association between methyldopa and convergence insufficiency has not been previously reported.

Clinical comparison of the threshold-related and single-intensity strategies of the Humphrey Field Analyzer.

The threshold-related, eccentricity-compensated strategy was compared to the single-intensity strategy using a minimal test point distribution. Forty-two eyes known to be free of any visual field defect and 44 eyes with documented defects were tested with each screening strategy. The threshold-related, eccentricity-compensated strategy yielded a slightly poorer sensitivity (84.4%) and specificity (97.6%) than the single-intensity sensitivity (90.9%) and specificity (100%). An explanation for this decreased sensitivity is offered. The 40-point test was useful for some general screening. Recommendations are made for appropriate utilization and interpretation.