Muscle dysmorphia in male weightlifters: a case-control study

OBJECTIVE: Muscle dysmorphia is a form of body dysmorphic disorder in which individuals develop a pathological preoccupation with their muscularity. METHOD: The authors interviewed 24 men with muscle dysmorphia and 30 normal comparison weightlifters, recruited from gymnasiums in the Boston area, using a battery of demographic, psychiatric, and physical measures. RESULTS: The men with muscle dysmorphia differed significantly from the normal comparison weightlifters on numerous measures, including body dissatisfaction, eating attitudes, prevalence of anabolic steroid use, and lifetime prevalence of DSM-IV mood, anxiety, and eating disorders. The men with muscle dysmorphia frequently described shame, embarrassment, and impairment of social and occupational functioning in association with their condition. By contrast, normal weightlifters displayed little pathology. Indeed, in an a posteriori analysis, the normal weightlifters proved closely comparable to a group of male college students recruited as a normal comparison group in an earlier study. CONCLUSIONS: Muscle dysmorphia appears to be a valid diagnostic entity, possibly related to a larger group of disorders, and is associated with striking and stereotypical features. Men with muscle dysmorphia differ sharply from normal weightlifters, most of whom display little psychopathology. Further research is necessary to characterize the nosology and potential treatment of this syndrome.     

Staged TRAM Breast Reconstruction: Combining the Advantages of Tissue Expansion with Surgical Delay

The TRAM flap has become the gold standard in breast reconstruction but suffers from the disadvantages of poor color match, different texture, and impaired sensation compared to the normal breast. This study reports on a two-stage procedure to address these problems. The first stage consists of insertion of a tissue expander and surgical delay of the TRAM flap. The second stage consists of removal of the tissue expander and transposition of a deepithelized TRAM flap into the tissue expanded cavity. (The capsule is excised.) Four cases of breast reconstruction are reported. The advantage of this procedure is that it offers the benefits of tissue expansion, viz., normal color match, texture, and sensation, and in addition, reconstruction is achieved with autologous tissue by a pedicled TRAM flap. The vascularity of the TRAM is enhanced by a surgical delay procedure.     

Risk assessment in clinical pharmacy

Medication error forms a major proportion of the errors in the medical system. Despite many studies of adverse drug events, there are no systematic ways of ensuring safety, or of assessing how safe a pharmaceutical system is. Risk assessment is required in hazardous industries such as nuclear power or oil and gas. Risk assessments involve identifying the defences and assessing their effectiveness and are relatively uncommon in clinical pharmacy , as opposed to reactive approaches involving incident analyses. Risk factors, that degrade barriers, can be identified and their effect measured. A risk assessment structure for pharmacy processes is proposed that can also be used to support incident investigation and analysis processes and provide a standard for audit.     

The use of pedicled expanded flaps for aesthetic resurfacing of the burned face

Reconstruction of extensive, deep burns of the face is a challenging problem in plastic surgery. The authors report the use of tissue expanders placed in the upper chest for facial resurfacing after burn injuries in 4 patients. The expanders are hyperinflated. The flap is then advanced upward to resurface an aesthetic unit of the face with the pedicle intact. The pedicle is divided 2 weeks later. The method of reconstruction allows a large area of facial resurfacing to be performed without fear of flap loss or flap retraction impairing the cosmetic result. This technique has the disadvantage of being a staged procedure and cannot be performed in those with burns of the upper chest.     

Aesthetic correction of a contour deformity of the neck with buried expanded flaps

This case report describes the use of two tissue expanders to correct a contour deformity of the neck, secondary to radical block dissection and radiotherapy for a recurrent parotid tumor. One flap was deepithelialized and then buried under the other to create the necessary bulk. This technique provided tissue similar in texture and color to the adjacent skin, and there is minimal donor site morbidity. It is, however, a staged procedure.     

Combined pedicled flaps for grade IIIB tibial fractures in children: a report of two patients

Severe open tibial fractures in children are associated with notable morbidity and require early aggressive management to ensure a successful outcome. Free flaps are currently the gold standard in distal extremity reconstruction in which large soft-tissue defects exist, as is often the case with grade IIIB fractures. In severe lower limb trauma, however, free flaps are associated with a relatively high risk of failure, particularly when definitive soft-tissue coverage is delayed. Alternative methods of soft-tissue reconstruction may, therefore, occasionally require consideration. The authors describe the combined use of three pedicled flaps to attain soft-tissue coverage in 2 children with grade IIIB tibial fractures. These three flaps are individually in common use for lower limb soft-tissue coverage, are simple to raise, and in combination can cover extensive soft-tissue defects of the lower extremity. The major vascular axes of the limb are not sacrificed; however, the aesthetic result is modest.     

Morphology of developing olfactory axons in the olfactory bulb of the rabbit (Oryctolagus cuniculus): a Golgi study

Transient expression of axon collaterals plays an important role in enabling neurons to find appropriate targets during development. In the olfactory bulb, the numbers of both sensory neurons and their targets, the glomeruli, increase markedly during the postnatal period. In the present study, the morphology of developing olfactory axons in the olfactory bulb of 1-21-day-old rabbits was analyzed using stereological methods and the rapid Golgi technique. The findings demonstrated a change in axon morphology from the olfactory nerve layer to the glomeruli suggestive of a sequence in axon development. In the olfactory nerve layer, axons typically had knob-like growth cones and a few collateral branches. Close to glomeruli, axons increased in thickness, formed rather complex and irregular growth cones, and typically gave off many collaterals. Within glomeruli, the axons formed terminal branches and boutons. Extraglomerular branches were apparently removed once axons had entered a glomerulus, insofar as these branches often displayed morphological signs of degeneration. In contrast, collateral branches ending in the same glomerulus remained, indicating that formation of collaterals may assist olfactory axons in locating glomerular targets.