Hairline aesthetics and styling in hair replacement surgery

Punch grafting and flap surgery are proven methods of correcting baldness. Using either method, the location and shape of a new hairline on the frontal and temporal scalp is one of the most important aspects of hair replacement surgery. If the hairline is not aesthetic, the results can be unacceptable or even devastating for the patient and surgeon alike. The principles of planning the frontal and temporal hairline are presented using punch grafts as well as flaps. Postoperative styling of the "new" hair will vary depending upon the method used to transfer the hair (flaps or grafts), the local factors involved (texture, direction, density, tufting, etc.), as well as the patient's preference. The various advantages and disadvantages of styling possibilities with each method are presented. These factors should be discussed with the patient preoperatively.     

Is the smoking decision an 'informed choice'? Effect of smoking risk factors on smoking beliefs

The argument that people freely choose to smoke assumes that individuals at the point of initiation of smoking (often in adolescence) hold accurate beliefs about smoking. Smoking beliefs and the presence of known smoking risk factors were assessed in interviews with a sample of 895 urban young people. The respondents greatly overestimated the prevalence of adult and peer smoking, negative attitudes of their peers were greatly underestimated, a large proportion believed that they would be less likely than other people to contract a smoking-related illness if they became smokers, and there was a general lack of understanding of the adverse consequences experienced upon smoking cessation. These misperceptions were more common among youngsters who were smokers, who intended to smoke, or who had friends or family members who smoked. Because misinformation among young people is widespread and those at greatest risk for smoking are the most misinformed, the tobacco industry's argument that the decision to smoke reflects an "informed choice" is without merit.     

Orbital trauma and reconstruction

This article reviews the most recent topics of investigation concerning orbital trauma and reconstruction. During the past year there have been many articles of interest regarding management of the sequelae to orbital trauma, pathophysiologic process in orbital injury, diagnostic techniques, as well as operative methods, materials, and complications. Recent research has focused on the pathophysiology of traumatic optic neuropathy and visual compromise in orbital hemorrhage. Theories regarding the etiology of atraumatic spontaneous enophthalmos are described. In the realm of orbital reconstruction, rigid fixation systems have ben extensively investigated for use in orbital and facial trauma. Investigators have begun to address the question of potential complications from rigid fixation in children.     

Patient-centeredness and its correlates among first year medical students

OBJECTIVE: This research was performed to study the attitudes that medical students hold concerning their relationships with patients, and whether such attitudes are gender-related, affect career plans, and influence their evaluation of psycho-social and biomedical issues. METHODS: One hundred fifty-three first year students at the Boston University School of Medicine completed the Patient-Practitioner Orientation Scale (PPOS), a scale that differentiates between a patient-centered vs. doctor-centered orientation toward medical practice, indicated their interest in community and primary care practice, and rank ordered psycho-social and biomedical clinical issues in terms of their perceived relative importance. RESULTS: The data revealed that female medical students were more patient-centered, and that (across sexes) patient centeredness was positively associated with an interest in community and primary care practice and the ranking of psycho-social issues. CONCLUSIONS: These findings indicate that differences in the practice attitudes of males and females exist very early on in medical training, and that these differences are associated with anticipated career choices. They also suggest that the PPOS may prove useful in measuring the attitudes of practicing physicians toward their clinical roles and might predict physicians' behavioral strategies and patient medical outcomes.     

Genetic mapping of modifier loci affecting malignant hypertension in TGRmRen2 rats.

BACKGROUND: Genetic background has a major influence on the manifestation of multifactorial diseases such as hypertension in which severe complications may be caused through an interaction with additional factors, which may be genetically determined. We have previously described a genetic model of malignant hypertension (MH) in rats carrying the mouse Ren2 gene (TGRmRen2-27), in which the phenotype is dependent on the genetic background. METHODS: Using a single homozygous TGRmRen2-27 male as transgene donor, we produced two F1 populations with (a) 100% penetrance of MH in progeny heterozygous for the Fischer F344 genetic background and (b) 58.5% penetrance in progeny heterozygous for the Lewis genetic background. To identify the modifier loci affecting the phenotype, a cohort of 252 males was produced by breeding the same single male with Fischer-Lewis F1 females. The progeny were phenotyped for clinical and pathological features of MH. RESULTS: Genome-wide screening and quantitative trait loci (QTL) analysis identified two loci, on chromosome 10 (LOD 4.4) and on chromosome 17 (LOD 3.9) close to the Ace and At1 genes, respectively, which contribute to the lethal MH phenotype. Their influence on mortality was consistent with a multiplicative effect of the two loci. In addition, we found higher plasma angiotensin-converting enzyme activity in progeny receiving the Fischer allele than in progeny receiving the Lewis allele (123.5 +/- 9.5 vs. 91.8 +/- 4.9 U/liter, P < 0.01), suggesting the association of angiotensin-converting enzyme and MH. CONCLUSIONS: Our study demonstrates the application of a transgene as a "major gene" to facilitate the identification of modifier loci, which can affect the phenotype of MH, and reveals Ace and At1 as candidate genes involved in the manifestation of the MH phenotype.     

Low-friction arthroplasty of the hip using alumina ceramic and cross-linked polyethylene. A ten-year follow-up report

We report the results of our continued review of 14 hip arthroplasties using alumina ceramic femoral heads with cross-linked polyethylene cups. There have been no complications and a very low rate of penetration. This was 0.02 mm per year after an initial 'bedding-in' period of two years. There has been no change in the mean rate between our earlier study at six years and the current results at 10 to 11 years. The use of these bearing surfaces appears to reduce the potential amount of polyethylene debris and may provide the next logical stage in the development of the Charnley low-friction arthroplasty.     

Charnley low-frictional torque arthroplasty of the hip. 20-to-30 year results

We reviewed 261 patients with 320 Charnley low-friction arthroplasties who had a mean follow-up of 22 years 10 months (20 to 30). Of these, 93.9% considered the operation to be a success; 82.3% were free from pain and 11.6% had occasional discomfort. Satisfactory function was achieved in 59.6% and 62% had an excellent range of movement. The clinical results did not correlate well with the radiological appearance; radiologically loose components did not affect the clinical outcome. The main long-term problem was wear and loosening of the UHMWPE cup. Our findings suggest that the radiological appearance of the arthroplasty is a more reliable indication of the state of the arthroplasty than the clinical results.