Multi-impulsivity among bulimic patients in Japan

OBJECTIVE: Studies in Western world patients suggest the possible existence of a subgroup of patients with bulimia nervosa (BN) who display multiple problems with impulsivity, such as suicidal attempts. We assessed impulsive behaviors among BN patients in Japan to discuss them crossculturally. METHOD: Impulsive behaviors in 64 BN patients were assessed and multi-impulsivity (MI) was defined according to the definition proposed by Fichter, Quadflieg, and Rief (Psychological Medicine, 24, 591-604,1994). RESULTS: Nineteen patients (30%) met the definition of MI. BN patients with MI had more severe clinical features, such as concurrent depressive and anxious symptoms, global functioning, and higher prevalence of borderline personality disorder than BN patients without MI. DISCUSSION: These results showed the similarities between BN patients with MI in Japan and those patients in the Western world in clinical and psychopathological characteristics and a life-time incidence of each impulsive behavior. These findings may suggest culturally free bases for linkage between BN and MI.     

Die vierte Naht im MACS-Lift

The main drawback of the classic MACS-lift is the poor lifting effect in the medial neck and submandibular area, which results in a suboptimal aesthetic outcome in cases of severe excesses of neck skin, as well as poor outcome in cases of severe platysmal banding. To overcome these limitations, we describe a modification of the original technique, which maximizes the rejuvenation effect on the neck while keeping the proven advantage of short and less visible scars. Modifying the technique by introducing a 4^th SMAS suture to perform lateral platysma plication through a caudally extended dissection 3?C4?cm below the mandibular arch/jaw line creates a more accentuated submandibular angle resulting in a sharper, more defined jaw line. Combined with extensive submandibular liposuction/lipectomy and in some cases closed platysma myotomy, this technique creates a concave submandibular space which enables redraping of a large volume of midneck skin, often eliminating the need for additional posterior or anterior cervicoplasty (??convex becomes concave??).