Transposition of the malpositioned nipple-areola complex in breast reconstruction with implants.

BACKGROUND: The goal of breast reconstruction after breast cancer is to obtain symmetrical breasts, including the nipple-areola complex. However, in some cases the nipple-areola complex may not be symmetrical even though a symmetrical breast shape has been created. In such cases the nipple-areola complex has been transpositioned, leaving a scar to close the wound or skin graft in the original position. METHODS: To treat this problem, skin surrounding the areola is removed and two pedicles are created to bear the nipple-areola complex. The nipple-areola complex is then moved to the proposed position and the surrounding circular edge of the skin is closed using a purse-string suture. RESULTS: The author performed this technique in three nipple-areolae of two patients. All the nipple-areolae were transposed to the proposed position to create symmetrical breasts without any complications. CONCLUSION: This technique can be used when the malpositioned nipple-areola complex is not too far from the proposed position. The nipple-areola complex can be moved without leaving any scar at the original position of the complex.

DNA Damage Levels Determine Cyclobutyl Pyrimidine Dimer Repair Mechanisms in Alfalfa Seedlings.

Ultraviolet radiation in sunlight damages DNA in plants, but little is understood about the types, lesion capacity, and coordination of repair pathways. We challenged intact alfalfa seedlings with UV doses that induced different initial levels of cyclobutyl pyrimidine dimers and measured repair by excision and photoreactivation. By using alkaline gel electrophoresis of nonradioactive DNAs treated with a cyclobutyl pyrimidine dimer-specific UV endonuclease, we quantitated ethidium-stained DNA by electronic imaging and calculated lesion frequencies from the number average molecular lengths. At low initial dimer frequencies (less than ~30 dimers per million bases), the seedlings used only photoreactivation to repair dimers; excision repair was not significant. At higher damage levels, both excision and photorepair contributed significantly. This strategy would allow plants with low damage levels to use error-free repair requiring only an external light energy source, whereas seedlings subjected to higher damage frequencies could call on additional repair processes requiring cellular energy. Characterization of repair in plants thus requires an investigation of a range of conditions, including the level of initial damage.

Primary small cell carcinoma of the esophagus with achalasia in a patient in whom pro-gastrin-releasing peptide and neuron-specific enolase levels reflected the clinical course during chemotherapy.

We report a case of primary small cell carcinoma of the esophagus in a patient with achalasia in whom pro-gastrin-releasing peptide (ProGRP) and neuron-specific enolase (NSE) levels were measured. Although chemotherapy markedly reduced the size of the primary tumor and lymph node metastases, it had no effect on liver metastases. The tumor marker levels decreased after chemotherapy as the primary tumor and lymph node metastases decreased in size, and they increased as the liver metastases enlarged. However, there was a discrepancy between the levels of ProGRP and NSE during the patient's clinical course. We demonstrate the usefulness of measuring ProGRP and NSE levels to assess the effect of chemotherapy in patients with esophageal small cell carcinoma.

Influence of mood and adjustment to cancer on compliance with chemotherapy among breast cancer patients.

Approximately 75% of the 181,000 breast cancer patients newly diagnosed in 1992 will survive for at least 5 yr, but survival often depends on receiving adjuvant chemotherapy. We determined that mood variables and attitude toward cancer could predict compliance with IV-administered chemotherapy. The participants were seventy-four women diagnosed with primary breast cancer receiving treatment at a state-supported medical center in one of three southeastern metropolitan areas in the U.S. Most patients were members of minority and lower socioeconomic groups. The design was prospective in the sense that mood and attitude variables were assessed before determination of compliance. Two psychological instruments were used in this study, the Mental Adjustment to Cancer (MAC) Scale and the Affects Balance Scale (ABS). Patients who kept fewer than 85% of their appointments were classified as noncompliant; those keeping 85% or more were classified as compliant. Sixty-three percent of the patients for whom the compliance information was complete were classified as compliant; 37% were noncompliant; and four patients were not included in the analysis because their records were incomplete. The discriminant function was able to correctly classify 86% of the patients according to chemotherapy compliance, a 36% improvement over the chance level. High scores on MAC Fighting Spirit and ABS Anxiety, Depression, and Vigor scales were associated with greater adherence to a chemotherapy regimen. High scores on ABS Guilt and Hostility scales predicted lower levels of compliance.

In isolated DNA, formamidopyrimidine-DNA glycosylase-sensitive sites determined by electrophoresis correspond to the amount of 8-oxo-7,8-dihydro-2'-deoxyguanosine by HPLC-ECD.

Several methods have been developed for determining the amount of 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) in DNA. In the present study, we compared an electrophoretic method that uses formamidopyrimidine-DNA glycosylase (FPG protein) with a HPLC-ECD method. Firstly, we produced 8-oxodG in lambda DNA with methylene blue and visible light and cleaved it in one-half of the modified DNA enzymatically with FPG protein. Then, we determined the number of FPG protein-sensitive sites by electrophoresis (Y) and the number of 8-oxodGs by HPLC-ECD (X) per 10(5)dG of isolated DNA. Simple regression analysis of the data showed Y=1.07X+1.52 to be the most likely relationship. The correlation coefficient was 0.97. The values obtained by the two methods were very similar. This result is noteworthy because the number of FPG protein-sensitive sites determined by other methods have not yet come close to the number obtained by HPLC-ECD. Thus, this method might be more quantitative than other methods that measure FPG protein-sensitive sites. Another reason this electrophoresis method might be more useful than HPLC-ECD is that we can determine some other types of oxidative DNA damage well, by changing the DNA glycosylase.

Extended transverse rectus abdominis musculocutaneous flap.

The transverse rectus abdominis musculocutaneous flap is widely used for breast reconstruction, but it does not have a rich blood supply. A previous article described the inclusion of superficial epigastric vessels and superficial circumflex iliac vessels to "supercharge" the flap. Subsequent experience has shown that the external pudendal vessels also can be used for "supercharging."

Eyelid reconstruction in pachydermoperiostosis.

Our experience with an unusual case of pachydermoperiostosis is described. This case was accompanied by enlargement of the eyelids, excessive secretions, and difficulty in opening the eyes. Partial and serial excisions of the upper and lower eyelids were done to correct the thickened eyelids. As a result of the operations, this patient can open his eyes fully and the secretions have decreased.

Extended transverse rectus abdominis musculocutaneous flap.

Blood circulation within the conventional TRAM flap is not generous, and the contralateral random portion of the flap may result in fat or skin necrosis. However, this random portion can be extended safely and used for reconstruction by including the superficial epigastric vessels and the superficial circumflex iliac vessels and by anastomosing either of these to the recipient vessels. We have experienced this extended TRAM flap in two patients without any complications.

Effects of Pentoxifylline on flap survival.

Based on our experimental studies in rats and our clinical experiences, Pentoxifylline appears to have a potential application in the treatment of a skin flap in danger of necrosis. We believe that improving the deformability of red blood cells by increasing ATP content is an important factor in flap survival.

Biloma during steroid therapy for minimal change nephrotic syndrome.

A 27-year-old man, who had been on steroid therapy for 2 months for his nephrotic syndrome, suddenly developed intra-abdominal bile collection (biloma). He had no previous history of abdominal surgery, trauma, or any disease of the hepatobiliary system. The cause of the biloma formation was due, probably, to cholecystitis in the absence of calculi and a pinhole size perforation in the wall of gall bladder. It was assumed to be closely related to the high-dose steroid therapy over a prolonged period, which would likely suppress the repair process of the locally damaged biliary system.

Generalized Wegener's granulomatosis responding to sulfamethoxazole-trimethoprim monotherapy.

Wegener's granulomatosis (WG) has two different clinical phases: the initial phase and generalized phase. In patients with generalized WG, both steroids and cyclophosphamide have generally been used. We report a case of generalized WG that was temporarily, but successfully treated with sulfamethoxazole-trimethoprim (S/T) alone. S/T therapy reduced the elevated levels of soluble IL-2 receptor and IL-6 in parallel with improvement of the patient's symptoms and urinary protein excretion. In view of the high incidence of lethal adverse effects of cytotoxic drugs, S/T monotherapy may be worth trying not only for initial phase WG but also for generalized WG with careful follow-up when the patient is not acutely ill.

Atypical Fabry's disease presenting with cholesterol crystal embolization.

We describe a 65-year-old man who presented with pulmonary hemorrhage and progressive renal insufficiency three months after resection surgery for an abdominal aortic aneurysm. Intensive treatment with corticosteroids and hemodialysis were not effective, and the patient died. Postmortem examination of the kidneys revealed widespread cholesterol clefts within the renal arterioles and a number of lamellar inclusion bodies were observed by electron microscopy. The diagnosis of Fabry's disease was made by the absence of plasma alpha-galactosidase A activity. This was a very rare case of subclinical Fabry's disease coexistent with cholesterol crystal embolization, mimicking pulmonary-renal syndrome.

Varicella pneumonia in a healthy adult presenting with severe respiratory failure.

We describe a case of varicella pneumonia in a 24-year-old healthy man presenting with severe respiratory failure. A chest radiograph showed diffuse, bilateral airspace consolidation; additional complications included liver dysfunction and thrombocytopenia. However, treatment with intravenous acyclovir and gamma-globulin improved his clinical symptoms and signs. A greater than four-fold change in paired titers of the varicella-zoster virus antibody was observed. Bronchoalveolar lavage performed during the recovery phase revealed increased total cell and lymphocyte counts and a decreased CD4:CD8 ratio of T lymphocytes. Transbronchial lung biopsy findings were compatible with a diagnosis of interstitial pneumonia.

Subjective judgements of clarity and intelligibility for filtered stimuli with equivalent speech intelligibility index predictions.

The purpose of this investigation was to determine whether subjective judgments of clarity or intelligibility would be rated equally among conditions in which speech was equated for predicted intelligibility (using the Speech Intelligibility Index, SII) but varied in bandwidth. Twenty listeners with normal hearing rated clarity and intelligibility for sentence material (Hearing In Noise Test) in speech-shaped noise at six paired low- and high-pass filtered conditions in which SII was equated for each pair. For three paired conditions, predicted intelligibility increased as SII increased monotonically (0.3, 0.4, 0.5). In the remaining paired conditions, SII continued to increase monotonically (0.6, 0.7, 0.8) but predicted intelligibility was held at a maximal level (> or = 95%). Predicted intelligibility was estimated from the transfer function relating SII to speech recognition scores determined in preliminary experiments. Differences in ratings between paired low- and high-pass filtered sentences did not reach statistical significance for either clarity or intelligibility, indicating that the spectral differences at equivalent SIIs did not influence the judgments for either of the two dimensions. For conditions in which predicted intelligibility increased, both clarity and intelligibility ratings increased in a similar manner. For conditions in which predicted intelligibility was maximized, intelligibility ratings remained the same statistically across conditions while clarity ratings changed modestly. Although high correlations were observed between clarity and intelligibility ratings, intelligibility ratings were consistently higher than clarity ratings for comparable conditions. The results indicated that listeners with normal hearing produced clarity and intelligibility ratings for the same speech material and experimental conditions that were highly related but differed in magnitude. Caution is required when substituting clarity for intelligibility.

Redundant leading and following zeros in comparative numerical judgment.

The objective was to provide a more comprehensive understanding of how people make numerical comparative judgments when digits are contained in numbers with redundant leading or following zeros, e.g., 00080 and 800.000. These sequences of numbers often appear on computer display terminals (VDT) as line numbers, but surprisingly little research has been done on this. The experiment manipulated three aspects of numerical stimuli: (1) redundant leading zeros, (2) redundant following zeros, and (3) length of string of digits. The subjects were to push one of the two button-switches to respond whether two stimulus numbers shown on the computer screen were equal or unequal. The target stimuli contained several forms of redundant zeros, and each performance was assessed by response RT of the subjects. Analysis indicated five significant findings: (1) Redundant leading zeros hindered performance, (2) The effect of redundant following zeros depended on the stimulus type, (3) Over-all, longer digits took more processing time, (4) The RTs for the second-block trials were significantly faster than the first, and (5) Task performance was facilitated when the redundant zero representations were identical in both stimuli of a pair. Nonlexicographic processing seems to occur when feature identification can be used for numerical identification, that is, when the format is consistent. The research has implications for those in computer science to provide numerical formats which make comparative judgments as easy as possible.

An examination of graduate students' statistical judgments: statistical and fuzzy set approaches.

The present study examined how statistical significance levels are treated and interpreted by graduate students who use hypothesis-testing in their scientific investigation. To test underlying psychological aspects of hypothesis-testing, the idea of fuzzy set theory was employed to identify the uncertain points in judgments. 34 graduate students in a psychology department made judgments about hypothetical statistical decisions. The results indicated that (1) the majority of these students treated significance levels on a continuum and rated them according to the magnitude of statistical significance; (2) the subjects shifted their decisions based on the types of hypothetical scenarios but not by the sample sizes; instead, they interpreted a smaller sample size as being less reliable. (3) The subjects frequently chose formally used statistical terms, e.g., Significant and Not Significant, more than graduated verbal expressions, e.g., Marginally Significant and Borderline Significant; and (4) the Fuzziness (degree of confidence in decision-making) was dependent on individuals and existed more in the critical points of transition where judgments are most difficult. The Fuzziness Index illustrated the subtle shifts of human decision-making patterns in statistical judgments. Underlying decision uncertainties and difficulties can be illustrated by functions generated from fuzzy set theory, which may more closely resemble human psychological mechanism. This integrative study of fuzzy set theory and behavioral measurements appears to provide a technique that is more natural for examining and understanding imprecise boundaries of human decisions.