Variations in health behaviours among inner city 12-year-olds from four ethnic groups.

OBJECTIVES: To describe factors that contribute to variations in health-related behaviours and attitudes among inner city 12-year-olds. To see if there was an identifiable patterning by ethnic group. DESIGN: Semi-structured interviews with a stratified sample of 12-year-old students and their parents from four ethnic groups, attending state secondary schools in two inner London boroughs. RESULTS: Bangladeshi young people were significantly more likely to receive school meals. There was no variation in reported snacking between the groups. Girls and Bangladeshi students were less likely to report exercising outside school (33% of Bangladeshi boys reported not exercising outside school compared to 5% of boys from all other groups). Bangladeshi boys and their parents were more likely to report that bullying or worries about racial violence prevented them from going out after school. White young people were more likely to report experimenting with and the regular use of cigarettes and alcohol. Use of alcohol and cigarettes was also associated with gender, religion and strength of religious observance. White parents were the least likely to report restricting their child's social activities as a way of influencing behaviour and expressed more concerns about their child's potential for health-damaging behaviour than parents in all other groups. CONCLUSION: This study shows that ethnicity alone is insufficient and inadequate in explaining variations in health behaviours among inner city teenagers. A complex mix of personal, cultural and social factors including ethnicity shape the behaviours and attitudes of these young people.

Nasal reconstruction with the expanded forehead flap.

This report details the experience with nine patients over a 3-year period who had partial or total nasal reconstruction using an expanded forehead flap. The history of nasal reconstruction is reviewed, emphasizing the evolution of the forehead flap as the ideal donor site. The author's experience with skin expansion of the forehead to produce a thin ideal flap is presented in detail. Complications of the procedure are reviewed. Technical considerations to achieve a good result are emphasized. The forehead donor site is minimal and well accepted. This procedure provides a solution to a major problem with partial and total nasal reconstruction.

Constriction of the internal nasal valve in rhinoplasty: treatment and prevention.

The anatomy and functional physiology of the internal nasal valve and the potential problems that may develop with it during rhinoplasty are discussed. The operative maneuvers that may compromise the nasal valve serve as a basis for explaining a treatment approach. Treatment primarily deals with the problems generated by scar contraction, excision of lining and cartilage, and malposition of various nasal parts. In rhinoplasty, one must preserve the integrity of the internal nasal valve by preventing scar constriction and maintaining cartilage support. All intranasal incisions should be closed carefully with meticulous suturing. The surgeon should strive to preserve the medial attachment of the upper lateral cartilage to the septum. The caudal border of the upper lateral cartilage should not be trimmed. Lining should not be excised at the level of the internal valve, or distally. If scar constriction occurs or cartilage instability develops, the goal of treatment is restoration of valve function by excision of all scar tissue, repositioning the cartilage framework, and reconstruction using full-thickness and composite skin-cartilage grafts. The value of the intracartilaginous incision in preventing injury to the internal nasal valve is emphasized. Many of the established procedures in rhinoplasty that may endanger the nasal valve are discussed.

Recent advances in neck lift.

In reconstruction of the redundant neck, combining skin lift, muscle lift, and suction lipectomy gives superior results more often than use of only one of these. The history of the development of the operation is reviewed. Points in preoperative planning, stressing the extent of the platysma muscle and volume of submandibular fat in obtaining good results, are emphasized. Pertinent anatomy of the subcutaneous musculoaponeurotic platysma system is reviewed. Specific points of operative technique are reviewed, such as my preference to elevate the skin in the neck prior to suction lipectomy. Variances in technique related to thin, "normal," and obese patients are discussed.

Progress in rhytidectomy by platysma-SMAS rotation and elevation.

Our experience in 1 1/2 years of follow-up with 64 patients with a musculofascial flap to support the lower face and anterior neck is presented. We anticipate that the skilled plastic surgeon will find this procedure helpful for the aesthetic reconstruction of the aging face and neck.

Use of a muscle flap in lower blepharoplasty.

An adjunctive technique for lower lid blepharoplasty is presented. This operative procedure uses the principle of anchoring the upper margin of the lower lid by suturing a triangular muscle flap from it to the lateral-superior part of the orbital rim. This more effective support for the lower lid margin permits one to excise more redundant tissue without getting an ectropion.

Treatment of a large hemangioma by dermal overgrafting. Case report.

A large capillary hemangioma was treated by cutaneous dermal overgrafting, with control of the ulceration, infection, and bleeding for 10 years to date. The patient has been successfully rehabilitated.

Pacinian neuroma, an unusual cause of finger pain.

Two cases of painful lesions of the fingers are presented. Both proved to be Pacinian neuromata, and they are the sixth and seventh such cases reported in the literature. This lesion is rare, but it should be considered in the differential diagnosis of painful lesions of the hand.

Intraoral reconstruction in head and neck cancer surgery.

Numerous techniques are available to resurface the oral cavity. These range from the very simple and straightforward to the very difficult and complex. Certainly for small lesions, local excision and direct approximation of mucosa is all that is necessary. For larger defects, particularly those which will require some other form of reconstruction, additional tissue must be brought into the operative defect. For superficial excisions, skin or mucosal grafts are adequate to resurface the mouth. For areas of extensive resection, flaps of some type are required. The use of local random flaps, regional arterialized flaps, and myocutaneous flaps have been described. The decision for their use must be as individual as each patient. Free flap transfer has specific theoretical benefits. The advantages and disadvantages of each technique have been presented and, it is hoped, will allow the reconstructive surgeon greater latitude in selecting a technique of reconstruction.

Clinical applications of free flap transfer in the burn patient.

Free microvascular flap transfer is indicated in situations in which flap coverage is required and no local flap is available. The technique of transfer of a groin flap based on the superficial circumflex iliac vessels was described. The procedure has been applied to two patients with acute electrical burns with extensive soft-tissue loss, three patients with scar contractures, and one with osteoradionecrosis. Satisfactory results were achieved in all patients. The procedure is contraindicated if recipient or donor vessels are abnormal or inadequate, and in the face of fulminating infection, general debility, and obesity. With scrupulous attention to indications and contraindications, the procedure is safe, reliable, and a valuable addition to the surgeon's armamentarium.