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This study investigates whether tissue recoil or patient intrinsic factors influence the final position of the nipple areola
complex (NAC) after reduction mammoplasty.
The age, pre-operative ptosis, BMI and weight of the tissue resected were recorded as patient intrinsic factors in 37 patients
undergoing reduction mammoplasty. The “spring-back” value was defined as the distance from the sternal notch to a nipple landmark
on the breast meridian with the patient sitting up, minus the same measurement repeated with the patient recumbent to eliminate
the pull of gravity on the breast. Spring back was measured pre-operatively for the nipple and nipple mark then post-operative
for the nipple. The difference in centimeters between the final post-operative distance from the sternal notch to the nipple
and the level intended by the pre-operative nipple mark was termed the “judgment error.” The final position of the post-operative
nipple and the judgment error was compared to the spring-back values and patient intrinsic factors.
Pre-operative ptosis was statistically related to increasing patient BMI and mass of tissue resected per breast. Pre-operative
spring-back values for the nipple increased with increasing ptosis, BMI and decreasing age. Spring-back values were greater
in the lower pole of the breast than in the upper pole. The final position of the nipple was higher than the pre-operative
mark in 65% of cases, lower in 8% and as marked in 27% of cases. The post-operative NAC was, on average, 0.6 cm higher than
planned pre-operatively. The post-operative distance from the sternal notch to the nipple increased with increasing pre-operative
ptosis, mass of breast tissue resected per breast and all three spring-back values. The difference between the level of the
pre-operative mark and the final nipple position showed a weak correlation with post-operative spring-back values.
The parameters of ptosis, BMI, weight of tissue resected per breast and pre-operative nipple spring back reflect body habitus
and breast size. Spring-back values vary between the upper and lower pole of the breast. The final NAC position was higher
than that intended at pre-operative marking in the majority of cases. The surgeon instinctively marks the nipple lower in
patients with greater pre-operative ptosis and in whom a larger resection is anticipated. Judgment error did not relate to
intrinsic factors nor to pre-operative spring-back values; hence, these parameters cannot be applied as predictive tools for
more accurate pre-operative marking of the nipple position. This study suggests that the pre-operative nipple mark should
be placed, with the patient sitting up, at least 23 cm from the sternal notch and 0.6 cm lower than the final position estimated
using the inframammary crease as a landmark.
An invited commentary on this paper is available at . 相似文献
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Ramon Edmundo D Bautista Steven Godwin David Caro 《Journal of clinical neurophysiology》2007,24(1):16-21
Patients frequently present to the emergency room (ER) with mental status changes without obvious cause. The EEG is underused in this population. The authors investigated whether an abbreviated EEG (AbEEG) can be incorporated in the early evaluation of these patients to provide useful information. A 5-minute AbEEG was performed using a preformed electrode placement system on 25 patients who presented to the ER with mental status changes of unknown cause. AbEEG findings were categorized as normal, showing diffuse abnormalities, focal abnormalities, electrographic seizures, or uninterpretable. Using retrospective chart review, the authors determined if the cause of mental status change was a diffuse encephalopathy or a nonneurologic event (DENNE), a focal brain abnormality, nonconvulsive status epilepticus (NCSE), psychogenic, or unknown, and if particular AbEEG findings were associated with specific causes of altered sensorium. The AbEEG identified NCSE in two patients who presented with new-onset seizures. The presence of diffuse slowing on the AbEEG was highly suggestive of mental status changes due to DENNE. AbEEGs can be successfully incorporated in the early evaluation of patients who present to the ER with mental status changes of unknown cause and provide useful information in this setting. 相似文献
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Short-Ti inversion-recovery pulse sequence: analysis and initial experience in cancer imaging 总被引:2,自引:0,他引:2
Inversion recovery (IR), commonly considered a pulse sequence capable of producing T1-weighted images with excellent display of normal anatomy, is versatile: The null point and peak time provide a useful, succinct summary of the properties of IR and its capacity for producing both T1- and T2-weighted images. Shortening of the inversion time (TI) and creation of a short-TI inversion-recovery (STIR) pulse sequence increases sensitivity to malignancy and other abnormalities by making the effects of prolonged T1 and T2 on signal intensity additive and by nulling the signal from fat. The authors examined over 300 patients with various malignancies and compared STIR images with T1- and T2-weighted images obtained at 0.5 T. In 43 cases, signal-difference-to-noise ratios (SD/Ns) were calculated between tumor, fat, and muscle. In general, STIR images demonstrated tumor as a conspicuously high-intensity area in a background of muted, discernible anatomic detail. The good contrast achieved with STIR sequences between tumor and fat (SD/N = 18.1) and tumor and muscle (SD/N = 12.9) consolidated into a single image the information contained separately on T1- and T2-weighted images, which facilitates efficient detection and localization of malignancy. 相似文献
8.
Sixteen cases of histopathologically proved solitary rectal ulcer syndrome were encountered. Fifteen patients underwent barium enema study; in nine cases the findings--including rectal stricture, granularity of the mucosa, and thickened rectal folds-were nonspecific. In six cases the study was normal. All patients had a long history of defecation disorders, and defecography was performed in all. In seven cases, intussusception of the rectal wall was seen; in another case the intussusception was accompanied by a rectocele. One case showed rectal prolapse. In four cases, failed relaxation of the puborectalis occurred and prevented the passage of the bolus; in another case there was abnormal perineal descent. In two patients studies were normal. In patients with defecation disorders, the possibility of this syndrome should be considered. Defecography is the method of choice for establishing the diagnosis. 相似文献
9.
Akinola Ladipo Ladeinde Mobolanle Olugbemiga Ogunlewe Babatunde Olamide Bamgbose Wasiu Lanre Adeyemo Oluseyi Folake Ajayi Godwin Toyin Arotiba Jelili Adisa Akinwande 《Quintessence international, dental digest》2006,37(1):69-74
OBJECTIVE: The aim of the study was to review all the cases of ameloblastoma seen at the Oral and Maxillofacial Surgery Clinic of the Lagos University Teaching Hospital, Nigeria, between 1980 and 2003. METHODS AND MATERIALS: In this retrospective study, case files and biopsy reports of new cases of ameloblastoma covering a 24-year period were retrieved and analyzed for sex, age on presentation, histologic type, and site distribution. RESULTS: A total of 207 cases of ameloblastoma were seen in the given period. One hundred and ninety-eight (95.7%) were benign, and 9 (4.3%) were malignant. A male-to-female ratio of 1.1:1 was found. The average ages on presentation for ameloblastoma and ameloblastic carcinoma were 31.67 and 46.44 years, respectively. The lesion was found to be more common in the premolar-molar region of the mandible. The most common histologic type was follicular ameloblastoma (25.1%). Nine (4.3%) cases of ameloblastic carcinoma were also reported. CONCLUSIONS: Ameloblastoma with a predilection for the posterior mandibular region is relatively common in our environment. Sex and site distributions are similar to previous reports in the literature. 相似文献
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