Oncoplastic breast surgery: initial experience at the Centro Clinico de Estereotaxia-CECLINES, Caracas, Venezuela.

BACKGROUND: Breast-conserving surgery (BCS) may sometimes lead to deformities in the remaining breast. Oncoplastic surgery (OPS) aims to improve our aesthetic results even in the case of major volume resections. The purpose of this study is to provide an objective evaluation of our initial experience with OPS, mainly based on the levels of satisfaction reported by both patients and surgeons. PATIENTS AND METHODS: This prospective study was performed at CECLINES in Caracas, Venezuela, between January 2011 and October 2012. It involved 107 consecutive patients in two groups: 52 patients with level II OPS versus 55 patients with 'standard' BCS (SBCS). We evaluated the level of satisfaction and cosmetic outcome at 6 and 12 months post-operation using a score from 1 (bad) to 5 (excellent). The cosmetic score was recorded during the follow-up by the surgeon, by phone calls, and photographs were reviewed by a panel of four observers. RESULTS: The participation rate in the cosmetic outcome/level of satisfaction evaluation was 100% at 6 months and 96.2% at 12 months. The average tumour size was 23 mm [standard deviation (SD): 13.5] for the OPS group versus 17.6 mm (SD: 8.3) for the SBCS group (p = 0.017). The average weight for the surgical specimen was 101 g (range: 30-512 g) in the OPS group versus 60.4 g (range: 20-135 g) in the SBCS group (p = 0.004). The OPS techniques most performed were round block 40.3% (21/52), inverted T mammoplasty 26.8% (14/52) and vertical scar mammoplasty 15.3% (8/52). Of all the patients, 51.9% (27/52) had symmetrisation procedures performed distributed according to the period of the study: 77.2% (17/22) in 2011, 56.6% (17/30) in 2012, and 18.1% (6/33) in 2013. The rate of complications was 5.7% (3/52) in the OPS group and 0% for the SBCS group (p < 0.005). The average cosmetic score at 6 months by patients in the OPS group was 4.4; patient satisfaction scores of 4 (good) and 5 (excellent) were 88.4%. In the SBCS group at 6 months, the mean score reported by patients was 4.2, with scores 4-5 being 83.4% (p = 0.644). The cosmetic score by surgeons in the OPS group at 6 months was 4.5; the surgeon satisfaction scores of 4-5 were 94.2%. In the SBCS group, the surgeons' mean score at 6 months was 4.1, with 84.5% of scores being 4 or 5 (p < 0.005). The final cosmetic score by patients in the OPS group at 12 months was 4.5; patient satisfaction scores of 4-5 were 90.4%. In the SBCS group, the final mean score at 12 months by patients was 4.2, with 77.5% of scores being 4 or 5 (p < 0.005). The final cosmetic score by surgeons in the OPS group at 12 months was 4.5; surgeon satisfaction scores of 4-5 were 92.3%. In the SBCS group, the surgeons' final mean score at 12 months was 4.1, with 84.5% of scores being 4 or 5 (p < 0.005). CONCLUSIONS: OPS provides good satisfaction rates. An SBCS when an OPS is not indicated mostly results in good satisfaction levels and cosmetic scores. Usually, the results remain stable after 6 months. The use of OPS allows the excision of bigger lesions and surgical specimens. Symmetrisation procedures are not always required. With the appropriate patient selection, the rate of complications is low for both OPS and SBCS.

Uniaxial Hugoniostat: a method for atomistic simulations of shocked materials.

An new equilibrium molecular-dynamics method (the uniaxial Hugoniostat) is proposed to study the energetics and deformation structures in shocked crystals. This method agrees well with nonequilibrium molecular-dynamics simulations used to study shock-wave propagation in solids and liquids.

Orientation dependence in molecular dynamics simulations of shocked single crystals

We use multimillion-atom molecular dynamics simulations to study shock wave propagation in fcc crystals. As shown recently, shock waves along the <100> direction form intersecting stacking faults by slippage along 111 close-packed planes at sufficiently high shock strengths. We find even more interesting behavior of shocks propagating in other low-index directions: for the <111> case, an elastic precursor separates the shock front from the slipped (plastic) region. Shock waves along the <110> direction generate a leading solitary wave train, followed (at sufficiently high shock speeds) by an elastic precursor, and then a region of complex plastic deformation.

Laparoscopic jejunostomy with an 18-mm trocar.

We describe our technique to perform laparoscopic jejunostomies with an 18-mm trocar. This procedure facilitates the exteriorization of the proximal bowel and construction of the jejunostomy. We describe our laparoscopic technique in nine patients with severe neurologic conditions (two in the postoperative period of a cerebral aneurysm in a coma, three patients with severe head injury, and four patients with cerebrovascular strokes). The operative time ranged from 20 to 75 min (average, 44.38 min). Nutrition was initiated 24 h after the placement of the jejunostomy. Tolerance of the enteral nutrition was excellent in all cases. One major complication occurred, minor leakage around the feeding tube 3 weeks after the jejunostomy was constructed. The jejunostomy was removed without further consequences. Laparoscopy is an effective technique for the creation of feeding jejunostomies. We believe that this minimally invasive approach is an alternative for patients requiring long-term postpyloric enteral feeding.

Trastornos del sueño en edad pediátrica / Sleep disorders in childhood

Se realiza un estudio de 99 pacientes con trastornos del sueño en el Departamento de Salud Mental del Hospital Pediátrico Provincial Docente " Jose Luis Miranda" de Santa Clara en el año 1984. Se encuentra que el mayor porciento de las muestras presentaban sonambulismo, seguido de los terrores nocturnos. Los antecedentes de daño orgánico, antecedentes patológicos familiares, ambiente familiar inadecuado y trastornos psiquiátricos, alcanzan cifras significativas. El estudio electroencefalográfico resultó de gran valor en el diagnóstico de patología asociada en estos trastornos. Se infiere la importancia del adecuado manejo por parte del facultativo, a este tipo de paciente

Comportamiento de la enfermedad meningocócica en los últimos 5 años en la provincia de Villa Clara / Meningococcal disease in the last 5 years in Villa Clara province

Se analiza la tendencia francamente descendente de la letalidad por enfermedad Meningocócica en los últimos 5 años en la provincia de Villa Clara, donde el Hospital Pediátrico Provincial Docente "Jose L. Miranda" constituye el núcleo de mayor atención a pacientes con esta enfermedad. Se estudian los factores que influyen en el descenso de la letalidad, fundamentalmente en los años 1982 y 1983, con tasas de 15 porciento y 13,2 porciento respectiviamente. De la investigación efectuada sobre el tema, se concluye que el elemento fuendamental de la enfermedad, reside en el diagnóstico precoz de la misma y este a su vez en la orientación y actualización del personal médico. Se establece comparación entre los pacientes diagnosticados como presuntivos y aquellos a los cuales no se le realizó el diagnóstico. Se ofrecen los resultados que arrojan que en los años 1982 y 1983 no hubo fallecidos entre los presuntivos, siendo el ingreso precoz, la observación del paciente y la antibioticoterapia, los elementos que tuvimos en cuenta en estos pacientes, fundamentalmente en el menor de 3 años. Se hace recomendaciones generales que se consideran de utilidad para disminuir la letalidad provocada por la enfermedad