Abdominoplasty Improves Low Back Pain and Urinary Incontinence.

BACKGROUND: The authors studied the incidence of low back pain and urinary incontinence in the postpartum population presenting for abdominoplasty, and the extent of improvement following the operation. METHODS: This multicenter prospective study used validated questionnaires: the Oswestry Disability Index for back pain and the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form for urinary incontinence. Questionnaires were administered preoperatively and at 6 weeks and 6 months postoperatively. RESULTS: Results cover 214 patients from nine centers. The mean age was 42.1 years, the mean parity was 2.5, and the mean body mass index was 26.3 kg/m. The mean surgical statistics were as follows: weight removed, 1222 g; liposuction volume, 795 ml; and diastasis, 4.5 cm. Eighty-seven percent of the abdominoplasties were either radical, high lateral tension, or high oblique tension. The mean Oswestry Disability Index score preoperatively was 21.6 percent, and 8.8 percent had no back pain. The mean score was 8 percent at 6 weeks and 3.2 percent at 6 months. These results are statistically significant. The mean International Consultation on Incontinence Questionnaire score preoperatively was 6.5; of the patients assessed, 27.5 percent had no incontinence. This score fell to 1.6 at 6 weeks, and the same, 1.6, at 6 months. These results are also statistically significant. Preoperative predictors of back pain were body mass index greater than 25 kg/m and umbilical hernia; predictors of incontinence were age older than 40 years and vaginal deliveries. There were no significant predictors of postoperative back pain or urinary incontinence improvement at 6 months. All methods of abdominoplasty produced similar improvement. CONCLUSION: Abdominoplasty with rectus repair creates a significant improvement in the functional symptoms of low back pain and urinary incontinence. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Melanoma metastatic to a ruptured silicone breast implant capsule.

Metastasis to the breast is rare and most commonly represents spread from a contra-lateral primary mammary carcinoma. Metastasis of solid non-mammary carcinoma is very rare and melanoma and neuro-endocrine bronchogenic carcinoma are the more common primary neoplasms implicated. In up to half of affected individuals, there may be no prior diagnosis of malignancy. Breast metastasis by melanoma to our knowledge has never been described to an augmented breast, moreover, to a ruptured implant capsule.

Temporal expression of activin in acute burn wounds--from inflammatory cells to fibroblasts.

Activin A is a member of the transforming growth factor-beta (TGF-beta) family of cytokines and growth factors and upregulation of this protein has been linked with a number of disease processes associated with chronic inflammation and fibrosis. Its potential involvement in burns has not yet been investigated. We therefore studied the localization of activin in tissue sections from excised mid- and deep dermal and full thickness cutaneous burn by immunohistochemistry. There was cell-specific temporal expression in tissues with prominent expression from day 4 onwards in lymphocytes and histiocytes and expression from day 8 onwards in reactive fibroblasts and endothelial cells. Immunopositivity over the first 18 days persisted in reactive fibroblasts and lymphocytes although the latter were in most circumstances decreasing in number. These data are consistent with activin A being central to the inflammatory and repair phases occurring in burnt skin and early scar formation. Modulation of activin expression and actions may, therefore, be a target for the management of burns.

Thrombotic complications of venous aneurysms.

BACKGROUND: Venous aneurysms are rare vascular anomalies that have been reported to occur throughout the body. We report a unique variation, namely a thrombosed subclavian vein aneurysm. METHODS: A review of the records of patients with documented venous aneurysms presenting to the St George Hospital and their associated imaging was made. A literature search for articles pertaining to venous aneurysms was performed. RESULTS: Four cases of venous aneurysms were identified; one subclavian vein, one inferior vena cava and two popliteal. The clinical course of these cases is detailed, along with a review of the literature. CONCLUSIONS: Venous aneurysms are infrequent findings and indicate that the patient is at significant risk of thrombosis. Popliteal vein aneurysms should be treated surgically.