Minimal-incision brachioplasty: a first-choice option in arm reduction surgery.

LEARNING OBJECTIVES: The reader is presumed to have a broad understanding of plastic surgery procedures and concepts. After studying the article, the participant should be able to:Physicians may earn 1 hour of Category 1 CME credit by successfully completing the examination based on material in this article. The examination begins on page 309. BACKGROUND: Many women complain that the combination of loose skin and excess fat deposits in the upper-arm area inhibits them from wearing sleeveless clothing. Most of these women are reluctant to undergo arm reduction surgery in part because of the highly visible scar that results from a standard brachioplasty. OBJECTIVE: A new arm reduction technique is described that significantly reduces both the arm circumference and the visual vertical height of the arm when held outstretched, while concealing the scars so as to not inhibit the wearing of sleeveless clothing. METHODS: Nine patients aged 25 to 75 years underwent the minimal-incision brachioplasty procedure. This included lipoplasty of the upper arm, wide-axillary and upper-arm skin excision, and dermal suspension of the upper-arm skin to the axillary fascia. The patients' arm circumferences were photographed and measured preoperatively and postoperatively. RESULTS: All patients achieved significant reductions (15% to 25%) in arm circumference measurements as measured at the levels of the distal deltoid insertion and at the mid arm. The scars in all patients were smooth and flat, without hypertrophy. Most of the hair-bearing axillary skin was removed with this procedure, a side effect that all patients viewed as positive. All but one patient expressed satisfaction with the results. CONCLUSIONS: The minimal-incision brachioplasty technique can be used as the first-choice procedure in arm reduction. Slight modifications of the procedure may be necessary in patients with massively obese arms and in older patients with poor skin tone and minimal elasticity.(Aesthetic Surg J 2001;21:301-310.).

Correlation of TGF beta 1 overexpression with down-regulation of proliferation-inducing molecules in HPV-11 transformed human tissue xenografts.

The epidemiologic association of human papillomavirus (HPV) infection with dysplasia and cervical cancer is well established. Transforming growth factor beta 1 (TGF beta 1) has regulatory effects on a broad spectrum of cell types and is a growth inhibitory protein for epithelial cells. To examine the phenotype of experimentally generated, HPV-11 transformed human tissues, we looked at expression of TGF beta 1 and a number of proliferation-enhancing molecules which are known to be regulated by TGF beta 1, including bcl-2, c-myc, c-Ha-ras, c-jun and NFkB. HPV-11 transformed xenografts showed up-regulation of TGF beta 1 expression and down-regulation of the expression levels of bcl-2, c-myc, c-Ha-ras, c-jun and NFkB. These results suggest that TGF beta 1 may exert antiproliferative effects on HPV-11 transformed papillomas by down-regulating different proliferation-enhancing molecules.

Simultaneous determination of some antibacterial drugs in isosensitest broth using high-performance liquid chromatography with solid-phase extraction.

A method is described for the simultaneous determination of combinations of some antibacterial drugs in a matrix of isosensitest broth. A double solid-phase extraction procedure is described in which trimethoprim and dibromopropamidine isethionate together with 4-chlorophenylbiguanide as internal standard are freed from endogenous components by a cation-exchange extraction cartridge and subsequently removed and individually separated by reversed-phase ion-pair chromatography. Sulfadiazine, sulfamerazine and p-aminobenzoic acid, unretained by ion exchange, are similarly isolated for chromatography by adsorption on a CH-bonded phase cartridge and individually assayed using the same chromatographic system. The rationale of the pre-treatment and chromatography is described and the quantitative aspects of the analyses of selected combinations of these drugs are reported.

Determination of antibacterial agents in microbiological cultures by high-performance liquid chromatography.

A general high-performance liquid chromatographic (HPLC) procedure is described which allows the assay of several antibacterial drugs in combination in a matrix of bacterial cell cultures. The drugs assayed were dibromopropamidine, trimethoprim, sulphadiazine and sulphamerazine. It is also shown that p-aminobenzoic acid, which is an essential metabolite of many micro-organisms, does not interfere and can itself be quantified. The method uses solid-phase extraction on a cyclohexyl-bonded silica with subsequent separation of the analytes by reversed-phase HPLC. Tetrabutylammonium is used in order to reduce the retention of trimethoprim and dibromopropamidine and quantification is by ultraviolet detection at 254 nm. The analytical characteristics of the proposed method are shown for certain drug combinations.

Crohn's disease-associated carcinoma. A poorly recognized complication of inflammatory bowel disease.

We have reviewed eight cases of Crohn's disease associated carcinoma (CDAC) of the bowel treated at Saint Barnabas Medical Center since 1977. Five patients had colorectal carcinoma in areas of dysplasia within histologically recognizable Crohn's disease. One of the large bowel carcinomas was a diffusely infiltrating signet ring adenocarcinoma (linitis plastica), three were mucinous carcinomas, and one contained both cell types. Survival ranged from 4 to 55 months. Three patients developed ileal carcinomas in areas of dysplasia within histologically recognizable Crohn's disease. One of the ileal cancers was a moderately differentiated adenocarcinoma; two were poorly differentiated adenocarcinomas. Survival ranged from 8 to 44 months. The dysplastic changes seen in the bowel adjacent to the tumors in these patients were identical to the characteristic pre-cancerous (dysplastic) changes well described in ulcerative colitis. The histopathologic changes seen in this high-risk group of patients are also similar to those of previously reported CDAC. Those patients with the more diffuse dysplastic changes might have been detected before the development of invasive cancer had they undergone periodic colonoscopic surveillance. One patient in the series with an asymptomatic lesion was, in fact, identified at surveillance colonoscopy. It would appear that Crohn's disease patients have a similar risk for carcinoma previously recognized in ulcerative colitis patients and that surveillance protocols should be developed for this group of patients.

Attributions of responsibility in adolescent cancer patients and their parents.

Attributions of responsibility have been shown to be important determinants of illness behavior in adults. This study examines the salience of attributional judgements among adolescents with cancer. Patients and their parents were categorized according to their attributions of responsibility for the cause of and solution to the adolescent's health problems into one of four attributional models. Of the four possible models, only two were represented: the medical and compensatory. Only 37.5% of parent/child pairs were concordant for model choice. Patients whose attributions conformed to those of the compensatory model sought more information (F = 5.1, (P = .03), were satisfied with the information supplied (F = 3.5, P = .07), and expressed the belief that a greater percentage of prescribed medications needed to be taken if a cure was to result (F = 4.1, P = .05). Side effects were more often experienced by patients whose responsibility attributions exemplified the medical model (F = 5.09, P = .03). Model concordance did not relate to parent/child agreement on health-related beliefs, patient age, sex, or compliance measures (P greater than .05). No relationship was found between parent-child model concordance and patient's self-reported medication compliance. The present data do not support the notion that attributions of responsibility for cause and solution of cancer should be important targets of interventions designed to increase medication compliance among cancer patients.

Adjustment to amputation among adolescent oncology patients.

With increased patient survival, the psychosocial consequences of amputation in cancer patients has become increasingly important. The following study examined the psychosocial correlates of amputation in 16 male and 17 female Brazilian adolescent patients aged 10-20 years who had lost a limb to cancer. Interviews were conducted within 12 months of amputation. Eighty-two percent indicated that they were involved in preoperative decision making, but only 58% understood the limitations in functioning after undergoing an amputation. Before surgery, the most frequently chosen confidante was the mother, followed by a sibling, staff member, and a friend. The major postoperative problems in these patients were walking, pain, and social issues. Overall, 75% of the amputees felt they were independent in and out of the home. Most individuals (66.6%) had, but fewer (58%) wore, their prosthesis. Prior to amputation, 30 patients were enrolled in school and 13 had a job. Of 15 who returned to school, 67% could not keep up with the school work and 93% had problems getting along with their classmates. Of five patients who returned to their jobs, no one reported discrimination in hiring or promotion; however, four workers felt they had lost a job because of their amputation, and two reproted having to change jobs. Many had altered their lifestyles to suit their disability, but the social and educational adjustment of these patients appears promising. Proper education of school faculty, classmates, and medical staff may enhance the adjustment of adolescent cancer amputees.

The role of parent-adolescent concordance in compliance with cancer chemotherapy.

In an attempt to examine factors affecting compliance with orally administered chemotherapy agents, we have examined the relation of agreement of parents and their adolescent children on various treatment-related issues and compliance with cancer chemotherapy. In a longitudinal study, 16 parent/cancer patient pairs were interviewed regarding their knowledge and understanding of illness, medications, and treatment, and their medication compliance. Adolescent responses matched closely those of parents on topics pertaining to medication dose, frequency, number, and purpose. Age was positively correlated with agreement for medication instructions. Disagreements were more commonly found in patients under 17 years of age. Compliance was greater when parents and patients agreed on who was responsible for medication administration, and on their understanding of medication instructions, number, and effectiveness. Treatment of the adolescent oncology patient should include consideration of psychosocial developmental factors, encourage parent-child communication, and place less reliance on self-administered therapy.

Pulmonary cytologic examination in the identification of the second primary carcinoma of the lung.

Multiple primary carcinomas of the lung were histologically confirmed in 23 male patients. Five were synchronous neoplasms. Seventeen of the second pulmonary cancers originated in the contralateral lung. The major cell type was epidermoid (17/23), and in 11 patients the tumor was similar in histologic features to the first lesion. Examination of pulmonary secretions as a diagnostic aid in the identification of the second malignant neoplasm was employed for 73.9% (17/23) of the patients. With a single exception, these were obtained at the second diagnostic hospitalization rather than as an outpatient monitoring procedure. Only nine patients had a series of cytologic preparations consisting of three consecutive early morning sputa, bronchial washings/brushings, and a postbronchoscopy sputum. A cytodiagnosis of cancer was established in 82.4% (14/17) of the cases and preceded histologic verification in ten. Radiologic evidence of a second primary was noted in only 56.5% (13/23) of the patients. Pulmonary cytologic examination as a monitoring procedure was not employed in the outpatient follow-up for 64 patients surviving pulmonary cancer for 18 months or longer. Posttherapeutic studies were obtained on 39.1% (25/64) of the hospitalized patients. Thirty-two percent (8/25) were collected concurrently with tissue biopsies for the confirmation of recurrence or metastasis. Patients with primary pulmonary cancers resected for cure should be monitored on a regular basis to include the cytologic examination of three consecutive early morning sputa and a chest radiograph.