[Abdominal morbidity following TRAM flap breast reconstruction--patient-reported outcome measures]. / Die subjektive Wahrnehmung abdomineller Symptome nach Brustrekonstruktion mit gestielter und freier TRAM Lappenplastik.

PURPOSE/BACKGROUND: Excellent aesthetic outcomes have been demonstrated with TRAM flap breast reconstruction. However, abdominal wall morbidity after TRAM flap breast reconstruction has not been accurately evaluated in terms of patient symptoms or patient quality of life. To further examine this issue, we performed a cross-sectional survey of TRAM flap breast reconstruction patients utilising questions from a patient-related outcome measure questionnaire. PATIENTS AND METHOD: The questions were posed to post-mastectomy breast reconstruction patients. Items pertaining to abdominal wall symptoms and satisfaction with the outcome were reported on a 5-point Linkert Scale (1=very satisfied/no symptoms to 5=very dissatisfied/frequent symptoms). RESULTS: The study population consisted of 270 patients who underwent pedicled (n=183) or free (n=87) TRAM flap procedures. The frequency of abdominal wall symptoms reported on abdomen-specific questionnaire items was increased in the pedicled TRAM group relative to the free TRAM group. This included "tightness or pulling in abdomen" (2.34 vs. 2.01); "abdominal pain, bloating, or discomfort" (2.11 vs. 1.69); "difficulty doing everyday activities requiring the use of your abdominal muscles" (2.11 vs. 1.67); and "abdominal weakness" (2.36 vs. 1.8). CONCLUSION: We found a relatively low frequency of abdominal symptoms in the TRAM flap patients as a whole. However, there was a tendency towards increased abdominal symptoms in the pedicled TRAM patients compared to the free TRAM patients. As the population sizes in this study are somewhat limited, future studies with increased patient numbers may find greater differences between pedicled and free TRAM patients. In addition, studies evaluating the patients' abdominal wall symptoms pre- and postoperatively may allow for a detailed analysis of abdominal wall morbidity in post-mastectomy TRAM patients.

Breast cancer local recurrence after breast reconstruction.

The primary aim of surgery in breast cancer is to achieve local control of disease. Secondly, improving quality of life and patient satisfaction is of utmost importance. While the positive effect of postmastectomy reconstruction on the psychological well-being of women with breast cancer has been demonstrated, evidence-based data on its oncological safety remain sparse. There is concern that the presence of autologous tissue or an implant may mask locoregional recurrence. Furthermore, there is little agreement on the appropriateness of routine radiological surveillance of these patients as well as on the surgical treatment of locoregional recurrence. We attempt to review the impact of breast reconstruction on the incidence and detection of locoregional recurrence and discuss treatment options.

MAP1B is required for axon guidance and Is involved in the development of the central and peripheral nervous system.

Microtubule-associated proteins such as MAP1B have long been suspected to play an important role in neuronal differentiation, but proof has been lacking. Previous MAP1B gene targeting studies yielded contradictory and inconclusive results and did not reveal MAP1B function. In contrast to two earlier efforts, we now describe generation of a complete MAP1B null allele. Mice heterozygous for this MAP1B deletion were not affected. Homozygous mutants were viable but displayed a striking developmental defect in the brain, the selective absence of the corpus callosum, and the concomitant formation of myelinated fiber bundles consisting of misguided cortical axons. In addition, peripheral nerves of MAP1B-deficient mice had a reduced number of large myelinated axons. The myelin sheaths of the remaining axons were of reduced thickness, resulting in a decrease of nerve conduction velocity in the adult sciatic nerve. On the other hand, the anticipated involvement of MAP1B in retinal development and gamma-aminobutyric acid C receptor clustering was not substantiated. Our results demonstrate an essential role of MAP1B in development and function of the nervous system and resolve a previous controversy over its importance.

Knowledge of and attitudes toward aging among non-elders: gender and race differences.

Although the aging process begins at birth, fears about late adulthood can foster anxiety in younger cohorts about this time of life. This study examines the relationship between non-elderly subjects' (n = 884, 18-55 years) knowledge of and anxieties regarding personal aging and their gender and race. We hypothesized that non-elderly women and persons of color, those who will experience multiple jeopardy in their own late life, would report greater anxiety about their own aging process than did men and majority group members. Women did report lower income and education levels, less knowledge of aging, greater anxiety related to their own aging process, and more time involved in caregiving activities. People of color also differed from Caucasians in certain dimensions of knowledge and anxiety. Implications from these results include the creation of public educational strategies and the organization of women and minorities to more actively address the development and shape of age-related policies.

Telemedicine for older adults.

Although telemedicine is not a new concept, health care assessment and treatment approaches which incorporate technology have expanded greatly over the past decade. Telemedicine has been used successfully with all age groups across the lifespan. However, telemedicine programs can serve an important function in home health care to support older adults in their own homes and communities. This article provides a summary of the types and outcomes of community-based telemedicine programs for elderly patients. In addition, practice and policy challenges in telemedicine are discussed.

The admission process in nursing homes: a clinical model for ethical decision-making.

With increases in the number of older persons in our society, especially in the ranks of the oldest-old, practitioners in long-term-care settings will be faced with greater numbers and more complex issues in the nursing home admission process. This article discusses and includes case examples of some of the major problems involved in nursing home admission. Furthermore, the article proposes a clinical model which helps practitioners identify and organize information about admissions to select an appropriate course of action.