[Mastopexy]. / Mastopexie.

Mastopexy is one of the most popular cosmetic surgery procedures. Complications are rare but imperfections in results can occur. The main imperfections affect the nipple-areolar complex, the volume of the segment II, the progression of the segment III as well as the cicatrization. We will consider the different techniques to prevent or treat them in case of occurrence.

[Interpersonal therapy (IPT) in child psychiatry and adolescent]. / Thérapie interpersonnelle (TIP) en psychiatrie de l'enfant et de l'adolescent.

INTRODUCTION: Depression disorder may become the first cause of morbidity by 2030, according to the World Health Organization. It is actually one of the main causes of disease and handicap in children aged from 10 to 19. The major risk is suicide, whose prevalence is estimated, in France, around 6.7 for 100,000, which is probably underestimated. At present, the discussions about prescription of antidepressants in an adolescent's depression remain intense which is why psychotherapy becomes the first choice of treatment. We propose here to present one of them, Interpersonal PsychoTherapy (IPT), which remains largely unknown in France, and its adaptations in the adolescent population. PRESENTATION OF IPT: IPT is a brief psychotherapy, structured in twelve to sixteen sessions, which was created by Klerman and Weissman in the seventies inspired by the biopsychosocial model of Meyer, interpersonal theory of Sullivan, and attachment theory of Bowlby. It is divided into three parts: the initial phase, the intermediate phase, and the termination phase. ADAPTATION FOR ADOLESCENTS: IPT was adapted for adolescents by Mufson in 1993, but a few modifications must be considered. Parental implication is the first. Indeed, parents, rather than the adolescent, often ask for the consultation; but it is the latter who benefits from the therapy. Parents may be met at some point in the therapy, for example between each phase and at the end. The initial phase is very close for the adolescent as for the adult; but the therapist must be careful about employing the "sick role" which can be used by the adolescent to avoid school, and as a consequence, to exacerbate the interpersonal deficit. The intermediate phase focuses on one of the four interpersonal issues: complicated bereavement, role transition, interpersonal role disputes, and interpersonal deficit. Complicated bereavement may become problematic when prolonged or when the adolescent had complicated relations with the deceased. The therapist essentially works on emotion verbalization. The role of transition is very common during adolescence: children become adults, they pass from high school to college, or their parents get divorced, etc. The patient and the therapist work on giving up the old role with its emotional expression (guilt, anger, and loss), and acquiring new skills, and identifying positive aspects of the new role. Interpersonal role disputes are common during adolescence, with parents or teachers for example. To determine a treatment plan, the therapist may first determine the stage of the role dispute, among impasse, renegotiation, or dissolution, and then work on the communication mode of the patient. At the least, the interpersonal deficit may be the most difficult area to work on because of the risk of psychiatric comorbidity. The therapist must be especially careful about anxious disorder which may complicate the psychotherapy and for which IPT is not the best therapy. The termination phase focuses on the new skills and abilities and works on the future without therapy. IPT is one of the psychotherapies recommended in the treatment of depression disorder in the international recommendations. But in France, all psychotherapies are considered equally. This may be a consensual approach, but the authors wonder if it is the best, especially to motivate research in the psychotherapy field. OTHER INDICATIONS: Finally, IPT has been developed in other indications in the past years, and many others are presently in research projects: depression during pregnancy, prevention of depression relapse, eating disorders, attention deficit and hyperactivity disorder, self-harm for example. CONCLUSION: Its validity, simplicity and efficacy should stimulate psychiatrists and residents to train themselves to IPT.

[Diogenes syndrome and Hoarding disorder: Same or different?] / Syndrome de Diogène et Hoarding disorder : une même entité ?

INTRODUCTION: In 2013, the American Psychiatric Association published the DSM-5. In this new version, new diagnoses were proposed including the Hoarding disorder. In the French semeiology, the Diogenes syndrome is described, among other symptoms, by a pathological tendency to accumulate objects called syllogomania which is very close to hoarding. This paper explores the similarities and differences between the two syndromes. DESCRIPTION: The Diogenes syndrome was first described in 1966 but was officially named for the ancient Greek philosopher in 1975 by Clark. Its frequency is around five for 100,000 persons. Many aetiologies have been known to be associated with the Diogenes syndrome: schizophrenia, dementia - especially frontotemporal type, anxiety disorders, mood disorders, and substance abuse - especially alcohol abuse. The diagnostic requires one major criterion, the inability to ask for medical or social help, and one of three minor criteria: a pathological relationship to the body, which leads to somatic illness; a pathological relationship to the society, which leads to a progressive exclusion from it; and finally, a pathological link with objects. This last criterion is very interesting because it is closely related to the Hoarding syndrome: indeed, patients with syllogamania, as also named, have a tendency to hoard every object they find. At the end, their homes are full of useless objects, and some living places can be unusable because they are cluttered and congested. This last point is similar to the definition given in the DSM-5 for the Hoarding disorder which describes a persistent difficulty parting with possessions; distress associated with discarding possessions; and accumulations that congest and clutter active living areas. The Hoarding disorder was first part of the Obsessive and compulsive disorders, but it has progressively appeared that it could be individualized with its own prevalence of 2.3% to 14% lifetime. Genetical studies have shown that at least 50% of patients suffering from excessive hoarding had a relative with a dimension of hoarding. Finally, Mattaix-Cols et al. decided to create a new syndrome in the DSM-5, and the Hoarding disorder was born. DISCUSSION: The discussion begins with relationships between the Hoarding disorder and the Diogenes syndrome. A patient with hoarding, and a poor insight, could be very isolated, and could persist in a lack of calling for help, because of not being aware of his pathology. Thus, it could be diagnosed as a Hoarding syndrome with a poor insight, or as a Diogenes syndrome, with the first major criterion (lack of calling for help) and one of the three minor criteria, the syllogomania, or hoarding. Moreover, some authors have described old people living for many years with a tendency to hoard. Progressively, some of them had a congested and cluttered home, and a few were living in squalor, a description very close to the Diogenes syndrome. Finally, we discuss the comorbidity of Hoarding disorder and Diogenes syndrome. In particular, the first one is associated with Attention deficit and hyperactivity disorders; and some authors also described the links between ADHD, bipolar disorder and frontotemporal dementia which is one of the aetiologies of the Diogenes syndrome. A psychodynamic model in which ADHD, Hoarding disorder and Diogenes syndrome are linked can be imagined, and the last one could be an overlooked evolution of the two first syndromes. CONCLUSION: In conclusion, we can imagine a dimensional model, based on two dimensions: hoarding and squalor. Hoarding disorder is the major expression of the first dimension, and Diogenes syndrome the major expression of the second. Both of them could be a different expression of one central aetiology. More studies are needed to complete this vision.

Breast base anomalies: treatment strategy for tuberous breasts, minor deformities, and asymmetry.

A variety of breast deformities of differing appearances can be grouped together within an extensive syndrome that is characterized by anomalies of the breast base and preferentially involves the lower quadrants. Tuberous breasts are the most typical, but not the only, form of the deformity. The authors studied a series of 37 patients who had breast surgery, and they used a classification of three types: I, II, and III (in increasing order of severity). In type I breasts (minor form), only the lower medial quadrant is deficient; in type II breasts, both lower quadrants are deficient; and in type III breasts, all four quadrants are deficient. The study showed a predominance of minor forms (54 percent of breasts operated on) and of combinations including at least one minor form (81 percent of patients). Seventy percent of women had a breast asymmetry of more than 100 g. Only 27 percent of breasts operated on were hypotrophic, 45 percent were of normal volume, and 28 percent were hypertrophic. The authors propose a procedure to treat the minor forms of the deformity, using a mammaplasty with a superior pedicle and a lower lateral dermoglandular flap to fill the deficient lower medial quadrant. They define the indications of the classic techniques according to the type of deformity and stress the frequent need for secondary revision.

[Breast reconstruction after mastectomy for cancer]. / Reconstruction du sein après mastectomie pour cancer.

In spite of advances in breast cancerology, partial or total mastectomy still has wide indications and remains a mutilative procedure. Since its introduction over thirty years ago, breast reconstruction has become an accepted, codified and efficient procedure. The techniques which can be used can be broadly divided into two categories: reconstructions with implants, which have been greatly improved by skin expansion techniques, and reconstructions using myocutaneous flaps. Whatever method is used, the breast is modeled during the reconstruction procedure and surgery is frequently necessary to obtain a symmetric opposite breast; a good knowledge of plastic surgery is thus a requisite.

A predetermined design for easier aesthetic abdominoplasty.

The authors have presented a predetermined design of cutaneous resection for abdominoplasty without relocation of the umbilicus. The design is characterized by two lateral tips, pointing upward, and a central dome. The upper and lower edges of the cutaneous incision are of the same length, which prevents puckers and allows optimal evolution of the scar. The median cutaneous resection removes the horizontal base of the triangular area of pubic hair, producing a lower final scar and giving the mons pubis a more youthful appearance. The lateral cutaneous resections allow transverse redraping of the abdominal skin, and the oblique scars, placed in the natural folds, are easily concealed even under brief attire. Unlike individual resection techniques that require practice and experience, this technique is perfectly codified and can be carried out by less experienced surgeons.

Primary non-Hodgkin's lymphoma of the esophagus.

Squamous cell carcinoma and adenocarcinoma constitute the majority of malignancies of the esophagus. Although lymphoma may involve any part of the gastrointestinal tract either primarily or secondarily, esophageal involvement is rare. We describe two cases of primary esophageal non-Hodgkin's lymphoma and review the literature, with particular attention to roentgenographic studies, esophagoscopic findings, and endoscopic biopsy results.

Partial restoration of pancreatic function by exogenous secretin in rats with ceruletide-induced acute pancreatitis.

Pharmacological doses of ceruletide administered intravenously to unconscious rats uniformly induces acute pancreatitis (AP) as well as a striking reduction in pure pancreatic juice (PPJ) and protein output. High-dose intravenous secretin administered to rats with ceruletide-induced AP effects a reestablishment of PPJ flow and a significant increase in PPJ protein output. Light microscopy of the pancreas in ceruletide-induced AP rats revealed marked acinar cell vacuolization and intense interstitial edema. By contrast, pancreatic histology in AP rats treated with high-dose secretin revealed a distinct lessening of acinar cell vacuolization and interstitial edema. We have established that high-dose intravenous secretin given to rats with ceruletide-induced AP is (1) not harmful, (2) reestablishes PPJ flow and evokes a partial restoration of protein output, and (3) appears to reduce pancreatic histopathology when compared to non-secretin-treated rats with AP.

[Irradiation of the patient and its costs in the usual diagnostic procedures for disk hernia. Radiculography, spinal phlebography and tomodensitometry]. / Etude de l'irradiation du patient et du coût dans les procédures diagnostiques usuelles des hernies discales. Radiculographie, phlébographie rachidienne et tomodensitométrie.

Three methods are currently employed for the diagnosis of sciatica due to disc lesions: radiculography, spinal phlebography, and computed tomography. Though their indications vary according to the author, it seemed worthwhile to compare radiation delivered by each of them, because of the often young age of the patients. Dosimetric studies using a Rando Phantom enabled calculation of doses to the skin, spinal cord, and gonads. Results indicated that low doses were delivered by the scanner, relatively high doses by spinal phlebography, and intermediate doses by radiculography. These findings suggest that the initial examination preoperatively in cases of simple sciatica due to herniated disc should be a CT scan whenever possible. Phlebography, on the contrary, and particularly in young women, should be used only exceptionally, as a result of the high doses delivered to the ovaries even during technically simple explorations.

Some experimental results on W values for heavy particles.

The total ionization produced by ions stopped in argon and tissue-equivalent (TE) gas has been measured in the energy range 25-500 keV. A large ionization chamber was used for this study. The chamber was alternately operated as a proportional counter and as a ionization chamber to measure particle rate and the total ionization produced by them, respectively. The average energy loss per ion pair (W value) was found to be dependent on both the energy and mass of the incident ions. For argon gas the accelerated ions were H+, He+, Ar+; the W value ranges from 23.72eV for 25 keV H+ to 63.12 eV for 50 keV Ar+; Irregularities in the W value were found for He+ in the region 70-130 keV. For TE gas the accelerated ions were H+, He+, C+, N+, O+; the W value ranges from 29.13 eV for 25 keV H+ to 51.45 eV for 50 keV O+. Comparisions with existing data show a good agreement in the absolute values for TE gas and in the relative variations in argon gas. Differences between absolute values in argon might be due to impurities in composition.