Transumbilical breast augmentation: a practical review of a growing technique

BACKGROUND: The transumbilical breast augmentation procedure has been described in the literature since 1993. This indirect route for implant placement has received both criticism and praise over the years, without a comprehensive assessment of the procedure from the perspective of the patient. The growing patient demand for the procedure, combined with the increased use by surgeons, prompts a review of the procedure and a discussion of its pros and cons, including tabulated patient satisfaction data. METHODS: A retrospective chart review of 245 transumbilical breast augmentations performed by the second author from 2002 to 2004, including the 1-year patient satisfaction surveys, is presented. Additionally, complications from the procedure are also tabulated and compared with the complications published by our studies' dominant implant manufacturer in their 1-year follow-up published data. The patients were asked to rate their postoperative pain, numbness, firmness, size satisfaction, rippling, and overall satisfaction. Data were compiled and statistical analysis was performed using chi methods. RESULTS: The study revealed a strong negative correlation between both the study parameters of prepectoral implant location and postoperative firmness and the survey result of overall satisfaction (P = 0.0041). Conversely, numbness, pain, and rippling, long felt to be linked to satisfaction, were shown to have no statistical correlation with satisfaction. A strong positive correlation with satisfaction was seen with retropectoral (submuscular) implant location. The complications from transumbilical breast augmentation in our study were hematoma = 1 (0.4%), umbilical wound infection = 8 (3.2%), deflation = 3 (1.2%), tunnel seromas = 5 (2.0%), asymmetry = 10 (4.1%), capsular contracture = 9 (3.7%), implant infection (0.0%). These complication rates were comparable or less than other published methods of breast prosthesis implantation. CONCLUSIONS: Transumbilical breast augmentation is a safe and effective method for breast implant placement in selected patients. Patient satisfaction weighs heavily on implant location and postoperative firmness and less on other variables. The procedure is associated with a complication rate comparable with other methods and finds itself growing in demand and popularity secondary to high patient satisfaction.     

Benzylpiperazine: a drug of abuse?

N-benzylpiperazine (BZP) is the active ingredient in recreational 'party' or 'p.e.p.' pills, which are used to provide a stimulant, euphoric effect akin to that of methylenedioxymethamphetamine (MDMA, 'ecstasy'). BZP predominantly affects dopamine neurotransmission in a similar fashion to known 'drugs of abuse', such as methamphetamine and cocaine, which strongly suggests BZP has abuse liability. BZP is illegal in many countries including the United States of America and Australia, yet it remains legal in the United Kingdom, Canada and New Zealand. There has been little research, to date, on the neurological consequences of high dose or chronic exposure of BZP. Here we provide a comprehensive review of the information currently available on BZP and suggest a need for further research into the mechanisms of action, long-term effects and potentially addictive properties of BZP.     

Structure of Escherichia coli Hfq bound to polyriboadenylate RNA

Hfq is a small, highly abundant hexameric protein that is found in many bacteria and plays a critical role in mRNA expression and RNA stability. As an “RNA chaperone,” Hfq binds AU-rich sequences and facilitates the trans annealing of small RNAs (sRNAs) to their target mRNAs, typically resulting in the down-regulation of gene expression. Hfq also plays a key role in bacterial RNA decay by binding tightly to polyadenylate [poly(A)] tracts. The structural mechanism by which Hfq recognizes and binds poly(A) is unknown. Here, we report the crystal structure of Escherichia coli Hfq bound to the poly(A) RNA, A₁₅. The structure reveals a unique RNA binding mechanism. Unlike uridine-containing sequences, which bind to the “proximal” face, the poly(A) tract binds to the “distal” face of Hfq using 6 tripartite binding motifs. Each motif consists of an adenosine specificity site (A site), which is effected by peptide backbone hydrogen bonds, a purine nucleotide selectivity site (R site), and a sequence-nondiscriminating RNA entrance/exit site (E site). The resulting implication that Hfq can bind poly(A-R-N) triplets, where R is a purine nucleotide and N is any nucleotide, was confirmed by binding studies. Indeed, Hfq bound to the oligoribonucleotides (AGG)₈, (AGC)₈, and the shorter (A-R-N)₄ sequence, AACAACAAGAAG, with nanomolar affinities. The abundance of (A-R-N)₄ and (A-R-N)₅ triplet repeats in the E. coli genome suggests additional RNA targets for Hfq. Further, the structure provides insight into Hfq-mediated sRNA-mRNA annealing and the role of Hfq in RNA decay.     

Fasciola hepatica: morphological effects of a combination of triclabendazole and clorsulon against mature fluke

A study has been carried out to investigate the morphological effects of half-strength triclabendazole (TCBZ), half-strength clorsulon, and a combination of these two drugs against mature Fasciola hepatica. The Cullompton TCBZ-susceptible isolate was used for these experiments. Flukes were incubated for 24 h in vitro in TCBZ sulphoxide (7.5 μg/ml), clorsulon (5 μg/ml), or a combination of the two drugs. For the in vivo experiment, rats were dosed with TCBZ (6.25 mg/kg body weight), clorsulon (5 mg/kg body weight), or a combination of the two drugs and flukes recovered after 48 h. Surface changes to the flukes were assessed by scanning electron microscopy. Treatment with the combination of drugs produced greater disruption to the flukes than the individual drugs at half-strength, both in vivo and in vitro. Disruption to the tegument of the flukes induced by the individual drugs at half-strength was relatively minor and less than that caused by the drugs at full-strength. The results suggest that there are additive effects between TCBZ and clorsulon, which may be indicative of synergy: the use of drug combinations would be of value in the treatment of triclabendazole-resistant fluke.     

Dentist preferences for patients: dimensions and associations with provider, practice, and service characteristics

Provider-patient relations may influence the nature of care provided. The aim of this study was to examine dentist preferences for patients, relate these to characteristics of dentists and practices, and to services provided. A random sample of Australian dentists completed mailed questionnaires (response = 60.3%). Four factor-based subscales and an overall scale (Selectivity) were derived from a 37-item battery. The 4 subscales comprised treatment adherence (behavior relevant to the treatment situation), personal adaptability (willingness to cooperate when expected to do so), social interactiveness (positive affect, communicativeness, and appreciativeness), and enabling characteristics (willing and able to pay, and good dental knowledge). Reliability was adequate (Cronbach’s α = 0.71–0.90). Treatment adherence was associated with higher orthodontic rates, but a lower extraction rate; social interactiveness was associated with higher extraction and denture rates; personal adaptability was associated with higher orthodontic rates, but lower general/miscellaneous service rates; enabling characteristics was associated with higher endodontic and crown and bridge rates; selectivity was associated with higher rates of diagnostic, preventive, and total services per visit. The associations with service rates indicated that provider preferences were related to treatment behavior that could affect the mix of services, indicating that the nature of care provided may be influenced by the provider-patient relation.     

Plasma myeloperoxidase levels in patients with chronic heart failure

Increased oxidative stress and endothelial dysfunction are commonly observed in patients with chronic heart failure (HF). The relation between myeloperoxidase (MPO), an inflammatory marker with mechanistic links to plaque vulnerability and abnormal ventricular remodeling, and degrees of severity in chronic HF has not been reported. Plasma MPO levels were measured in 105 normal controls (no history of HF or left ventricular dysfunction) and 102 patients with chronic systolic HF (left ventricular ejection fraction <50%), and the relations among plasma MPO levels, plasma B-type natriuretic peptide levels, and the left ventricular ejection fraction were examined. Plasma MPO levels in patients with chronic systolic HF were significantly elevated compared with those of healthy controls (1,158 +/- 2,965 vs 204 +/- 139 pM, p <0.0001). Plasma MPO levels increased in parallel with increasing New York Heart Association class (p <0.0001) and were correlated with plasma B-type natriuretic peptide levels (Spearman's r = 0.39, p <0.0001). Levels of MPO were strongly associated with the prevalence of HF (unadjusted odds ratio 30.3, 95% confidence interval 11.1 to 94.5) and remained significant when adjusted for age and B-type natriuretic peptide (odds ratio 27.7, 95% confidence interval 3.6 to 371.1). In conclusion, in a cohort of patients with chronic HF, plasma MPO levels were elevated compared with those of normal controls and were associated with worsening functional class.