A Novel Lactiferous Duct Preserving Method for Inverted Nipples: An Inlay Wrap-Around Flaps Supporting the Nipple Column

BACKGROUND: Inverted nipples can pose aesthetic and functional problems, especially for young women. The objectives of inverted nipple correction are both sufficient aesthetic projection of the nipple and postoperative functional preservation of the lactiferous ducts. Recurrence of nipple inversion is still an unsolved problem in many cases. We present a new nipple suspension technique using nipple- and areola-based dermal flaps for correcting inverted nipples and preserving the lactiferous duct to minimize the risk of recurrence. METHODS: We corrected six inverted nipples in three patients, which were classified as grade II using the Han and Hong classification of nipple inversion. The anteroposterior and lateral medical-quality photographs of the respective patients were identified for nipple protrusion and recurrence during a 6-month follow-up period to evaluate aesthetical goal and assess the sensitivity of the nipple to confirm preservation of the main lactiferous ducts. Surgical details are described within the main text. RESULTS: Preoperative and postoperative photography revealed good nipple protrusion during the 6-month follow-up period without any complications such as skin necrosis and recurrence. We were unable to directly identify breast-feeding function because all three patients were young and unmarried women. However, we assumed preservation of the main lactiferous duct since no nipple sensory change was identified in the postoperative examination when compared with the preoperative examination. CONCLUSIONS: With this method, we were able to confirm the hardness of the column and minimize the injury of the main lactiferous duct.

A Study on the Communication Gap and Different Understandings between Doctor and Patient about Burn Treatment in the Burn Center of a University Hospital

PURPOSE: Burn is an unusual medical situation with limited information open to common people. This study was designed to evaluate the communication gap and different understandings between doctor and patient about burn treatment and to improve quality of the treatment. METHODS: Cross-sectional studies were done with interview and questionnaire. 25 doctors and nurses of burn ward and 50 burn patients in Han-gang Sacred Heart Hospital Burn Center were participated. To understand the communication gap and different perception between doctors' and patients' on 1) burn sequela and recovery, 2) disease course and prognosis, 3) healing environment, cost, hospitalization, 4) nurse-physician collaboration, 5) psychiatric consultation, 6) extra incentive were analyzed. RESULTS: Patients tend to expectation positive answer about their prognosis from their physician but they have recognized chronic and negative prognosis of burn treatment. Patients want to know clear and detailed explanation about their test result or treatment methods. Physicians thought that it is important to consider patients' economic status and provide different treatment principle. Short duration of hospitalization is not related to the anxiety of rehabilitation. Patients thought that nurses could manage superficial or repeated treatment. It is more likely that physicians warn the disadvantages of psychiatric consultation than patients. Both groups thought that extra incentive or gratitude money is not helpful for the doctor patient relationship. CONCLUSION: Given the discrepant views of physicians and patients on the burn treatment, physician should be aware of the discrepancies and attempts to resolve any differences.

Corneal Endothelial Changes in Dentatorubropallidoluysian Atrophy (DRPLA)

PURPOSE: To report a patient with dentatorubropallidoluysian atrophy (DRPLA) accompanied by a corneal endothelial change. METHODS: The ophthalmic findings in a 37-year-old man with cerebellar ataxia, showing cerebellar atrophy on magnetic resonance imaging and was diagnosed with DRPLA based on DNA analysis, which revealed an expansion of the CAG repeats at the DRPLA locus, were compared with those of healthy control subjects. This study examined the best corrected visual acuity, the light reflex, the slit lamp examination, the topography, the fundus findings, the fluorescein angiography (FAG), the visual field, the electroretinography (ERG), and the specular microscopy. RESULTS: The best-corrected visual acuity was 1.0 on both eyes by the Han visual chart, and the other ocular findings were within the normal limits. The only abnormal finding was significantly lower corneal endothelial cell density (876 and 941 cells/mm2 respectively) compared to the normal level. CONCLUSIONS: Corneal endothelial cell loss is the only an important finding of DRPLA, and the corneas of DRPLA patients should be examined specifically by specular microscopy.