Immediate unilateral breast reconstruction and contralateral breast augmentation with bilateral free deep inferior epigastric perforator flaps.

A 42-year-old woman was referred for consideration of left-sided mastectomy and immediate reconstruction. She previously had a bilateral breast augmentation using silicone implants. She desired to maintain her breast size and natural appearance. Owing to the availability of sufficient abdominal tissue, the option of an immediate unilateral breast reconstruction and contralateral augmentation with a differentially split deep inferior epigastric perforator flaps was offered to the patient. The patient had a successful reconstructive and contralateral symmetrising procedure with an uneventful postoperative recovery. She was satisfied with her breast size, which was achieved without the use of implants. In selected patients the free deep inferior epigastric perforator flap provides an appropriate option for unilateral breast reconstruction and contralateral breast augmentation. It has numerous advantages including making use of available excess abdominal tissue and avoiding implant related complications.

Short term effects of cocoa consumption on blood pressure.

Hypertension, defined as diastolic pressure ≥ 90 mmHg and systolic pressure ≥ 140 mmHg, is a major cause of morbidity and mortality among black populations globally. Several studies have shown that prolonged consumption of cocoa or cocoa containing products leads to decreased blood pressure (BP) in hypertensives. In this study, we investigated the flavonoid content of the top selling cocoa/cocoa based products in Trinidad and Tobago and attempted to determine if consumption of cocoa had any immediate impact on blood pressure levels. The flavonoid content of three 100% cocoa powder products and four cocoa based formulas was measured using a modified Folin-Ciocalteu procedure. The brand with the highest flavonoid content, 372 gallic acid equivalents, was selected to evaluate the short-term impact of cocoa consumption on blood pressure. Thirty-six participants comprising nineteen hypertensives and seventeen persons with normal blood pressure had their blood pressure recorded on three separate days using ambulatory blood pressure monitors; the blood pressure was recorded every half hour for eight hours. On the first day, the participants received no intervention but on the second and third days, they received either the intervention (5 g cocoa in 125 ml water) or a placebo, in any order. Statistical analysis conducted using t-test statistic and a 95% confidence interval revealed that whether participants regularly took antihypertensive medication or not, a single intervention of cocoa induced decreases in both the diastolic and systolic BPs that were significant (p = 0.0001). Mean decreases of between 8 mmHg and 18 mmHg were observed.

Operation notes illustrated with digital images.

We would like to report on our experience of illustrating our operation notes with pre-, per- and post-operative digital images.

Autologous free tissue breast reconstruction using the internal mammary perforators as recipient vessels.

Perforator flaps have become popular for autologous free tissue breast reconstruction because they reduce the donor site morbidity. It is possible to apply the this principle to the recipient site. We present our experience of using the perforating vessels from the internal mammary artery and vein as recipient vessels for autologous free tissue breast reconstruction flaps in 21 out of 54 consecutive cases (39%). We discuss the technique and its advantages.

The treatment of early cutaneous capillary haemangiomata (strawberry naevi) with the tunable dye laser.

We have treated 39 early cutaneous capillary haemangiomata, in 24 infants, with the tunable dye laser at a wavelength of 585 nm (SPTL 1b, Candela Corporation, Wayland, MA, USA). The average age at first treatment was 13 weeks. The first signs of involution were seen at 19 weeks of age. Complete resolution of the lesions was seen in 61. 5% of haemangiomata at an average age of 39 weeks. Two haemangiomata did not respond to laser treatment and were treated successfully with intralesional steroid injection. There were no complications of laser treatment. The natural history of the treated haemangiomata was significantly shorter than historical evidence suggests for untreated lesions. Haemangiomata may be treated safely and effectively with the tunable dye laser in the early weeks of life leading to accelerated involution and resolution.

Ruby laser irradiation (694 nm) of human skin biopsies: assessment by electron spin resonance spectroscopy of free radical production and oxidative stress during laser depilation.

Human skin biopsies (hair-bearing scalp skin and non-hair-bearing breast skin) were treated with t-butylhydroperoxide, irradiated with UV light (UVR) or irradiated with 694 nm ruby laser red light. Free-radical production and oxidative stress were assessed with electron spin resonance spectroscopy (ESR) using the ascorbate radical as a marker. In comparison with both UVR and t-butyl-hydroperoxide (which readily induce the ascorbate radical in hair-bearing and hairless skin), 694 nm red light does not result in the formation of the ascorbate radical in detectable concentrations. Spin-trapping experiments with the spin trap 5,5-dimethyl-1-pyrroline N-oxide (DMPO) showed that while free radicals could be detected after treatment of skin with t-butylhydroperoxide, radicals could not be trapped after laser treatment. Treatment of lasered skin (containing DMPO) with t-butylhydroperoxide produced radical adducts as well as the ascorbate radical, demonstrating that the laser neither depletes endogenous ascorbate nor the preadministered spin trap. It is concluded that 694 nm red light does not induce oxidative stress in human skin in levels comparable either to t-butyl hydroperoxide or UV light.

Treatment of traumatic tattoos with the Nd YAG laser: a series of nine cases.

Inadequate primary skin cleansing for dirt-ingrained skin abrasions can result in disfiguring traumatic tattoos. We present nine cases of traumatic tattoos treated with the Nd YAG laser. In six cases the pigmentation was completely cleared and in three cases minimal pigmentation remained. The Nd YAG laser offers effective late treatment of traumatic tattoos with many advantages over conventional destructive treatment modalities. The best treatment is still immediate debridement and cleaning.

Treatment of poikiloderma of Civatte with the pulsed dye laser: a series of seven cases.

Seven patients with poikiloderma of Civatte were treated successfully with the pulsed dye laser. One patient's treatment was complicated by scarring, which appeared 4 months after the treatment.