169 research outputs found

    Application of the Lalonde (horizontal-only scar) breast reduction technique for correction of gynaecomastia in dark skinned patients

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    Surgical correction of gynaecomastia correction sometimes necessitates skin reduction in addition to resection of glandular tissue and liposuction of the fat deposits. Many skin reduction techniques have been described but all suffer from very noticeable and often poor scars that can manifest as hypertrophic or keloid scars in patients with dark skin. Three large gynaecomastia patients undergoing a modification of the Lalonde “no vertical scar” breast reduction technique designed to reduce the extent of scarring were reviewed. The Lalonde “no vertical scar” technique was successfully applied to three patients of African extraction with acceptable postoperative scarring. A description of the technique and the cosmetic results are presented. The Lalonde technique of female breast reduction can be applied to the treatment of male breast enlargement in patients at high risk of scar complications. It provides an alternative to the more widely used concentric skin reduction techniques. To our knowledge, this is the first report in literature of the application of the Lalonde “no vertical scar” surgical technique to the treatment of gynaecomastia in patients with darkly pigmented skin

    How Is the Language of Imagery in lyric’s of Amir Khosro Dehlavi

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    Whenever there is an amazing resurrection in a nation’s language which leads to create an artistic masterpiece in that language, it is called literature. For this reason, we can differentiate between literary language and daily or spoken language. Writers and literates from various countries will often try to utilize a literary approach in order to make their utterances and poems more attractive and popular through the use of written imagery and artily, illustratively capturing the emotion of the written words. Amir Khosro Dehlavi; who is a well-known Hindi poet, has mastered the illustrative nature of the Farsi language to compose his euphonious lyric poems. In reviewing his work, we will try to evaluate the context of his poems and the way he has used imaginary and artily language structures, consisting of words, combinations, sentences and phrases in his lyrics, as well as evaluating the way he introduces an imagery approach to his poems

    Postmastectomy Breast Reconstruction With the Totally Autologous Latissimus Dorsi Flap in the Thin, Small-Breasted Woman: Give It More Thought!

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    Introduction: Thin women have fewer autologous tissue breast reconstructive options than their higher body mass index counterparts—due to a lack of adequate donor sites. They are therefore usually offered expander/implant techniques. The total autologous latissimus dorsi flap is generally used in “well-padded” individuals, as they have enough fat on their back on which a completely autologous reconstruction could be based. When implant-based reconstruction is contraindicated (for instance due to planned adjuvant radiotherapy) or unacceptable to the patient, the total autologous latissimus dorsi flap can provide adequate tissue volume by utilizing the additional back fat deposits even in the thin, small-breasted patient. This option is often overlooked by many surgeons. Our case series assesses indications and patient and surgeon satisfaction with the cosmetic outcome of this technique. Methods: The oncological and clinical details of 6 patients with breast cancer who underwent total autologous latissimus dorsi myocutaneous flap immediate breast reconstruction by a single surgeon over an 8-year period were reviewed. An objective assessment of satisfaction with the cosmetic result was made by whether any additional surgical interventions (ipsilateral fat grafting/implant augmentation or contralateral liposuction/ reduction) were needed or not. A subjective assessment of breast symmetry by the surgeon using photographic records was also undertaken. The aesthetic outcomes were also objectively quantified using the BCCT.core software, initially developed for assessing the results of breast conservation surgery. Results: All 6 patients had small breasts and a low or normal body mass index. The mastectomies were performed for invasive carcinoma (n = 3) and extensive high-grade ductal carcinoma in situ (n = 3). Four had axillary surgery (2 sentinel lymph node biopsies and 2 axillary clearances), and 3 received adjuvant radiotherapy. All were happy with their reconstructive outcomes, and none suffered major postoperative complications or disease recurrence. None requested or needed any subsequent ipsilateral adjustment or contralateral symmetrizing procedures. Subjectively, the reconstructions provided acceptable or excellent cosmetic results. The cosmetic results were categorized as excellent or good on the BCCT.core scoring system. Conclusion: This underutilized method of totally autologous breast reconstruction in thinner patients with lower body mass indexes yielded good, well-accepted cosmetic results without recourse to adjustment procedures, contralateral balancing surgery, or complex microvascular surgery. We recommend that the total autologous latissimus dorsi flap should be given more consideration when planning immediate breast reconstruction in this challenging group of thin, small-breasted patients

    Timberlake Wertenbaker’s After Darwin: Identity and Ethics in the Interplay of Theatre and Science

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    After the success of Michael Frayne’s Copenhagen in 1998, a surge of interest was ignited among playwrights in writing about science by merging form and content to convey scientific ideas in a theatrical way. One of the best examples of the use of this interdependence of formal and thematic properties to theatrically communicate science is Timberlake Wertenbaker’s After Darwin. Wertenbaker introduces different aspects of the theory of evolution such as mutation, natural selection, extinction, and the survival of the fittest into the structure of the play to reveal the impact of Darwinism on the construction of identity and ethical imperatives in modern world. This study shows how these aspects of Darwinism are built into the structure of After Darwin, with reference to Wertenbaker’s treatment of identify and ethics. Prior studies have discussed ethics, identity, and evolution as separate entities. This study examines them as a single, integrated whole to reveal their interconnectedness and their significance in the theatrical and structural conveyance of science in After Darwin

    Utilizing the Total Design Method in medicine: maximizing response rates in long, non-incentivized, personal questionnaire postal surveys

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    Introduction: Maximizing response rates in questionnaires can improve their validity and quality by reducing non-response bias. A comprehensive analysis is essential for producing reasonable conclusions in patient-reported outcome research particularly for topics of a sensitive nature. This often makes long (≄7 pages) questionnaires necessary but these have been shown to reduce response rates in mail surveys. Our work adapted the “Total Design Method,” initially produced for commercial markets, to raise response rates in a long (total: 11 pages, 116 questions), non-incentivized, very personal postal survey sent to almost 350 women. Patients and methods: A total of 346 women who had undergone mastectomy and immediate breast reconstruction from 2008–2014 (inclusive) at Addenbrooke’s University Hospital were sent our study pack (Breast-Q satisfaction questionnaire and support documents) using our modified “Total Design Method.” Participants were sent packs and reminders according to our designed schedule. Results: Of the 346 participants, we received 258 responses, an overall response rate of 74.5% with a useable response rate of 72.3%. One hundred and six responses were received before the week 1 reminder (30.6%), 120 before week 3 (34.6%), 225 before the week 7 reminder (64.6%) and the remainder within 3 weeks of the final pack being sent. The median age of patients that the survey was sent to, and the median age of the respondents, was 54 years. Conclusion: In this study, we have demonstrated the successful implementation of a novel approach to postal surveys. Despite the length of the questionnaire (nine pages, 116 questions) and limitations of expenses to mail a survey to ~350 women, we were able to attain a response rate of 74.6%

    The success story of graphite as a lithium-ion anode material – fundamentals, remaining challenges, and recent developments including silicon (oxide) composites

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    Lithium-ion batteries are nowadays playing a pivotal role in our everyday life thanks to their excellent rechargeability, suitable power density, and outstanding energy density. A key component that has paved the way for this success story in the past almost 30 years is graphite, which has served as a lithium-ion host structure for the negative electrode. And despite extensive research efforts to find suitable alternatives with enhanced power and/or energy density, while maintaining the excellent cycling stability, graphite is still used in the great majority of presently available commercial lithium-ion batteries. A comprehensive review article focusing on graphite as lithium-ion intercalation host, however, appeared to be missing so far. Thus, herein, we provide an overview on the relevant fundamental aspects for the de-/lithiation mechanism, the already overcome and remaining challenges (including, for instance, the potential fast charging and the recycling), as well as recent progress in the field such as the trade-off between relatively cheaper natural graphite and comparably purer synthetic graphite and the introduction of relevant amounts of silicon (oxide) to boost the energy and power density. The latter, in fact, comes with its own challenges and the different approaches to overcome these in graphite/silicon (oxide) composites are discussed herein as well
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