Effect of Personality Traits and Emotion Regulation Strategies on Risky Behaviors in Adolescents.

The current study investigated the effects of personality traits and emotion regulation strategies on high-risk behaviors among adolescents (N = 1,572). This study used a cross-sectional and correlational research design. Multiple linear regression was used for analysis. A 1-unit increase in extraversion and neuroticism led to a 0.391- and 0.365-unit increase in high-risk behaviors, respectively. However, a 1-unit increase in agreeableness and conscientiousness led to a 0.307- and 0.365-unit decrease in high-risk behaviors, respectively (p < 0.05). A 1-unit increase in external and internal dysfunctional emotion regulation strategies led to a 1.34- and 0.548-unit increase in high-risk behaviors, respectively. However, a 1-unit increase in internal functional emotion regulation strategies led to a 0.641-unit decrease in high-risk behaviors (p < 0.05). Regression analysis showed that age, school type, sex, grade level, father's educational level, father's child-rearing style, and school performance were associated with more high-risk behaviors (p < 0.05). There were correlations between some personality traits, emotion regulation strategies, sociodemographic characteristics, and high-risk behaviors. Early intervention programs targeting dysfunctional personality traits and emotion regulation skills in adolescence may prevent the development of risky behaviors in adulthood. [Journal of Psychosocial Nursing and Mental Health Services, 62(2), 23-36.].

The relationship between basic psychological needs and emotional and behavioral problems in middle school students.

BACKGROUND: Basic psychological needs are universal sources of mental growth and development. PURPOSE: This study investigated the relationship between basic psychological needs and emotional and behavioral problems in middle school students. METHODOLOGY: This study adopted a cross-sectional and correlational research design. The sample consisted of 1099 students from three middle schools with different socioeconomic backgrounds. Data were collected using a sociodemographic characteristics questionnaire, the Strengths and Difficulties Questionnaire, and the Basic Psychological Needs Scale (BPNS). The data were analyzed using multiple linear regression analysis. RESULTS: A one-unit increase in autonomy, competence, and relatedness led to a 0.312, 0.263, and 0.312 decrease in emotional and behavioral problems, respectively (p < 0.05). The regression analysis showed that gender (female), academic performance (poor), mother's parenting style (authoritarian), and father's parenting style (permissive) were the risk factors affecting participants' emotional and behavioral problems (p < 0.05). CONCLUSIONS: Our results indicate that some basic psychological needs and sociodemographic characteristics make middle school students more likely to develop emotional and behavioral problems. Authorities should develop interventions on basic psychological needs to promote emotional and behavioral development. Researchers should assess the effectiveness of those interventions.

Vertical Mammaplasty with Retromammary En Bloc Breast Suspension.

BACKGROUND: In a vertical mammaplasty, various types of pedicles have been proposed for the nipple-areola transposition. The preparation of any type of nipple-areola flap necessitates disconnecting the nipple-areola from the breast gland, except for the pedicle bearing glandular part. These flap-dependent techniques not only impair the functions of the breast but also do not provide enough fullness to the upper pole. METHOD: No specific nipple-areola flap preparation is made. Reduction is obtained by a transverse excision from the lowermost part of the breast gland. Apart from this, no cut into the gland is needed. Liposuction, wide skin elevation and extended retromammary dissection permit the en bloc suspension of the breast. PATIENTS AND RESULTS: The study enrolled a total of 85 patients with 170 breasts. Mastopexy or minor reduction less than 100 gr was applied for 49 breasts; moderate reduction, 100-399 gr, for 67 breasts; and a large reduction of more than 400 gr for 54 breasts. No complete or incomplete nipple-areola necrosis was seen. The success rate for achieving upper pole fullness was compared between groups for reduction amount, age and body mass index (BMI). CONCLUSION: The functions of the breast organ are preserved in the en bloc suspension technique. In patients with dense breasts, a good upper pole fullness was achieved with a high success rate. Young patients and patients with a body mass index below 25 are suitable for this technique. However, the same success rate could not be achieved in elderly patients with fatty breasts. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Autologous Breast Augmentation Using Abdominal Dermis Fat Strip Grafts: A Preliminary Report.

BACKGROUND: Abdominoplasty and augmentation mastopexy are often performed in the same operation. Although silicone breast implants are usually used for breast augmentation, resected abdominal dermis fat tissue can be used for this purpose. We describe a new autologous breast augmentation technique using dermis fat grafts obtained from a simultaneous abdominoplasty operation. METHODS: This new technique was used in eight breasts of four patients who requested abdominoplasty and augmentation mastopexy operations in the same session. First, excess abdominal skin was de-epithelized. Dermis fat strips were harvested either in situ or extracorporeally from this area. The prepared strips were then inserted into the pectoralis major muscle during the mastopexy operation. RESULTS: The patients were followed up for 7 months to 6 years. No infection or other problems regarding the technique were observed. Magnetic resonance imaging obtained from one patient showed graft survival after 2 years. A slight augmentation, presumably 50 to 100 mL, was observed per breast in all of the patients. CONCLUSION: Dermis fat strips obtained from an abdominoplasty operation can be used to obtain slight augmentation during mastopexy in patients requesting both of these operations in the same session. Validation of this new technique requires more experience with additional patients. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

Correction of nipple divergence in reduction mammaplasty: pillar extension flap.

BACKGROUND: Lateral displacement of the nipple-areola complex becomes more obvious after reduction mammaplasty if it is not corrected. When performing mammaplasty, the Wise or vertical pattern incision lines should encompass the entire areola to prevent positioning of a pigmented area adjacent to the closure line. A high, laterally displaced areola can be repositioned using the circumvertical technique. However, in cases of breast ptosis with a laterally displaced areola, the limbs of the Wise or vertical pattern incision lines need to be modified. Transposition of the nipple-areola complex to a slightly higher location or larger area may also prevent distortion. This article describes a new modification of the vertical limbs of the Wise or vertical pattern mammaplasty that can help improve results. METHODS: This new technique was used in 16 breasts of 10 patients who underwent reduction mammaplasty. In these patients, the areola extended beyond the Wise or vertical pattern incision lines drawn on the breast. The residual areola on the lateral pillar was excised, and a matching extension was added to the medial pillar (pillar extension flap). RESULTS: No cases of skin necrosis were observed. Six of the ten patients were followed up for at least 6 months, and all were satisfied with postoperative breast shape and nipple location. CONCLUSIONS: The pillar extension flap is a suitable technique for correction of lateral nipple displacement during reduction mammaplasty. This procedure can be performed alone or in combination with other techniques. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Management of the lateral walls in crooked nose.

In crooked noses, the lateral walls are different in shape and symmetry. Although the septum is very important to obtain a straight nose, identical and symmetrical lateral walls are needed for a straight looking nasal dorsum. As well as the septum, lateral walls also contribute in nasal skeletal support and stability. Thus, obtaining identical and symmetrical lateral walls is important. In order to obtain symmetrical and stable lateral walls, the requirements are to equalize the height, to set in a symmetric location and finally to stabilize the symmetry. These requirements must be taken into consideration while performing the steps of rhinoplasty, namely, hump resection, osteotomies and stabilization by spreader grafts or flaps. Here, we describe the management of the lateral walls in crooked nose in 7 cases.

A double-layered, stepped spreader graft for the deviated nose.

BACKGROUND: In deviated noses, a beveled hump resection is recommended to preserve the shorter nasal wall. Even with this precaution, in some patients, the shorter wall does not reach the planned dorsal level when the lateral wall is transposed toward the midline after the lateral osteotomy. METHOD: A double-layered, stepped spreader graft was used on the shorter wall side to construct symmetrical lateral nasal walls. The composite graft was constructed by fixing a smaller cartilage graft to the side of the dorsal border of a slightly larger than normal standard spreader graft. The smaller graft component adds height to the shorter lateral wall while the larger one functions as a usual spreader graft. RESULTS: Stepped spreader grafts were used in 4 primary and 2 secondary rhinoplasty cases. All compound grafts were harvested from the septal cartilage except for one of the secondary cases, in which auricular cartilage was used. Two patients received a usual spreader graft on the contralateral side. Postoperatively, none of the patients exhibited significant recurrent deviation, and acceptable symmetrical dorsal esthetic lines were obtained in all patients. CONCLUSION: This technique should be considered whenever the height of the lateral wall is shorter than desired after centralization of a deviated nose. Reconstruction of the shorter wall by adding height with a stepped spreader graft results in a more stable dorsum that resists relapse. Dorsal esthetic lines can also be reconstructed at the same time.

Three-dimensional modeling of nasal septal deviation.

BACKGROUND: Some deviated nasal septa can never be straightened completely due to their 3-dimensional (3-D) nature. Based on a study of models and clinical cases, a basic classification and treatment strategy was proposed for 3-D septal deviations. METHODS: Basic types of 3-D septal L struts were crafted from pieces of thick plastic sheeting. By a carefully placed through-and-through incision in the angle area and overlapping the resultant segments, the models became 2 dimensional (2-D). We used this technique intraoperatively, in some cases resecting the overlapping area of septal tissue, along with a septal extension graft, in 11 patients who were followed up for more than 6 months. RESULTS: External nasal deviation due to a deviated septum was obvious in 5 cases, and all were relieved postoperatively. Preoperative breathing difficulties were improved in 7 of 8 patients. CONCLUSION: Correction of 3-D septal L deformity can be successfully performed by constructing 2-D L struts by making a full-thickness incision of the angle area and then overlapping the segments. This approach is especially beneficial in those having a septal extension graft that need a perfectly straight caudal septum upon which to fix the extension graft.

A simplified use of septal extension graft to control nasal tip location.

BACKGROUND: For defining the shape and projection of the nasal tip, the bilateral and symmetric batten-type septal extension grafts proposed by Byrd and colleagues have drawbacks. The main problems are stiffness of the nasal tip and thickening of the septum in the nasal valve area. METHODS: Since 1998, unilateral single-batten grafts, and more frequently, bilateral asymmetric batten grafts as compared with Byrd's bilateral symmetric application, have been used for 72 patients in our facility. RESULTS: At the 6-month postoperative follow-up assessment, tip projection was found to be satisfactory in 61 patients. Less than desired projection occurred in three cases and overprojection in two cases. Nasal lobule deviation was evident in one patient. The loss of the columellar break point was evident in five cases. CONCLUSION: Unilateral or asymmetric bilateral batten grafts facilitate adjustment of the nasal tip intraoperatively. This technique results in a more pliable nasal tip in the horizontal plane. Construction of a three-layered cartilage in the nasal valve area is not needed, and the nasal airway is preserved. With this modification, a reliable and predictable nasal tip location is obtained with a minimum of graft usage.

A case of large mucinous adenocarcinoma arising in a long-standing fistula-in-ano.

BACKGROUND: Chronic anal fistulas are not rare conditions, however, the development of a carcinoma in a long-standing fistula-in-ano is rare. METHODS: The case of a 77-year-old male with a large perianal mucinous adenocarcinoma arising in a long-standing fistula-in-ano is presented. RESULTS: Perianal biopsy revealed mucinous adenocarcinoma. Abdominal CT, double contrast barium examination and flexible sigmoidoscopy revealed no other tumoral lesion in the colon and rectum. CONCLUSION: The patient underwent abdominoperineal resection including wide tumor excision on the gluteal region. The final reconstruction was performed by bilateral gracilis musculocutaneous flaps. Due to clinical and histopathological evidence it was thought that a curative resection had been performed. To date he is clinically disease free.

Needle-guided shave excision with ultrasonographic assistance: a new technique.

BACKGROUND: A lack of control in the deep margin of shave excision is a drawback of this technique. OBJECTIVE: To describe a more precise shaving technique by sonography with the use of a fine injector needle as a depth marker. METHODS: After having examined the invasion levels of 40 benign skin lesions, a fine injector needle was intentionally threaded into the dermis horizontally just beneath the required shaving plane. Correct placement of the needle was ensured by sonographic examination after possible reinsertion trials. Large lesions needed several needles to be inserted. The tissue above the needles was then shaved off, whereas the deep dermal layer was protected. RESULTS: Histologic examination revealed that 77% of superficial and intermediate-thickness lesions were removed totally without disturbing the derma-fat junction. CONCLUSION: The needle-guided technique was found to be effective in the control of the deep margin of shave excision.