Emotional and psychosocial adjustment of women to breast reconstruction and detection of subgroups at risk for psychological morbidity

Thirty-four women who had undergone breast reconstruction after mastectomy for breast cancer were evaluated as to their emotional and psychosocial adjustment. Standardized psychological tests and a self-report questionnaire were used, along with the surgeon's evaluation of the aesthetic success of the reconstruction. Two psychodiagnostic tests were found to be of use in identifying maladjusted women who do not gain optimal benefit from the reconstruction: a questionnaire that evaluates the level of depression (Beck) and another that assesses the level of optimism (Cantrill). No correlation was observed between the surgeon's evaluation of the reconstruction's aesthetic success and the women's satisfaction. It was found that there are two groups of emotional-high-risk women: single women and women receiving adjuvant therapy. It is suggested that emotional-high-risk patients be given psychological support concerning the importance of the mastectomy and their reaction to breast reconstruction.     

Differences in General Knowledge of AIDS, Its Transmission and Prevention among Israelis Aged 18-19 years

A survey of knowledge, beliefs, and behavior relating to AIDSwas carried out among 781, 18–19 year-old military recruitsin Israel (348 males and 433 females) in November 1988. Althoughgeneral knowledge of the disease was reasonably good there weremisconceptions about the transmission and prevention of AIDS.Males had a better general knowledge of the disease; femaleswere more knowledgeable about ways of avoiding infection. Knowledgeof AIDS was positively related to previous intercourse, althoughthis was more marked among females. In order to ensure thatboth males and females are equally knowledgeable about the modesof behavior necessary for avoiding exposure to the AIDS viruseducational campaigns should place greater emphasis on practicalinformation regarding prevention of the disease rather thanon general aspects.     

Preoperative ultrasonic measurements of the thickness of cutaneous malignant melanoma.

Preoperative measurements of the thicknesses of pigmented skin lesions by high-resolution sonography have been studied. Fourteen nevi and 15 malignant melanomas were examined and their thicknesses compared with those measured on both paraffin and frozen sections. Linear regression coefficients of r2 = 9.22 and r2 = 9.23, respectively, were found. This good correlation suggests that sonography may be of value as a guide in predicting prognosis and in determining the proper course of treatment for patients with malignant melanoma.     

Injuries of the great auricular nerve in rhytidectomy

The great auricular nerve is most frequently injured in the course of rhytidectomy. Frequency of such injuries is many times higher than that of all other nerves combined. Estimate of such frequency cannot be obtained because many surgeons pay little attention to this complication. Patients often accept the discomfort of anesthesia of the external ear as a normal sequel of the operation, although an occasional neurotic patient may complain of the sensation of having his ear cut off. If the proximal end of the cut nerve becomes attached to the skin flap, neuroma will cause a trigger point on the lateral part of the neck. This may lead to a bizarre complaint of migraine-like pain on the side of the face. Two patients with neuroma of the great auricular nerve were seen, 1 and 2 years, respectively, after rhytidectomy. Diagnosis was confirmed by an operation. Repair of this nerve, either at the time of the operation or several years later, has a very favorable prognosis.The anatomy of this nerve and the precautions necessary to avoid injury during rhytidectomy will be discussed.     

Pseudolymphoma of the earlobes due to ear piercing

Keloids are commonly seen as a complication of earlobe piercing. As biopsies are usually not performed routinely in many instances, some of the lesions might, in fact, represent other entities, such as cutaneous pseudolymphoma. Contrary to keloids, for which surgery alone is not recommended, a simple excision or superficial x-ray is sufficient in such cases.     

Complications of liquid nitrogen cryosurgery for verrucae over bony prominences

Liquid nitrogen cryosurgery is the most frequently used surgical treatment for verrucae. Its success rate is high and complications are rare. However, liquid nitrogen should be used with great care over bony prominences where skin and subcutaneous tissues are thin. We present 3 patients in whom the treatment of simple warts over bony prominences by liquid nitrogen resulted in full-thickness loss of skin. In 2 of them, extensor tendons of fingers were exposed and had to be covered with flaps. We conclude that expertise of the physician is of paramount importance in preventing similar complications in cryosurgery of verrucae.     

Sociodemographic factors and the declining prevalence of anti-hepatitis A antibodies in young adults in Israel: implications for the new hepatitis A vaccines.

In order to examine changes in the epidemiology of hepatitis A virus (HAV) infection in Israel during the past decade, a sero-epidemiological study was carried out in 1989 in a random sample of 1153 members of the permanent army, aged 21-30 years. Of the males 59.2%, and 54.3% of the females were anti-HAV antibody positive (p = 0.22). At all ages, the highest prevalence was in those of North African origin, followed by those of Asian, native Israeli and Western origin. There was a marked decline in the prevalence of antibodies in later birth cohorts, (from 74.4% in those born in 1959-1960, to 47.8% in those born in 1967-1968). Age, ethnic origin, number of siblings, more than two younger siblings and smoking were independently significantly associated with anti-HAV antibodies. Despite an overall decline in family size in later birth cohorts, ethnic differences remain prominent. These findings suggest that when the new active hepatitis A vaccines become available, their use in small children should dramatically reduce the incidence of diseases in highly endemic areas by limiting intrafamilial spread of the disease.