Skin-reducing mastectomy and one-stage implant reconstruction with a myodermal flap: A safe and effective technique in risk-reducing and therapeutic mastectomy

Introduction: Immediate reconstruction following mastectomy for breast cancer has been shown to be oncologically safe and associated with improved psychosocial outcomes for patients. Bostwick described a technique for one-stage implant based reconstruction, combining skin-sparing mastectomy with concurrent reduction of the skin envelope. This report reviews the experience of a single centre using skin-reducing mastectomy and one-stage implant reconstruction in both early stage breast cancer and risk-reducing mastectomy, with specific reference to frequency of complications, implant loss and oncological outcomes.

Methods and results: A retrospective review was undertaken to identify women who had undergone skin-reducing mastectomy and one-stage implant reconstruction using a de-epithelialised dermal flap, between October 2008 and October 2012. One hundred and four consecutive mastectomies, with reconstruction, were performed by two surgeons on 64 patients. No complications were seen in 43.8% of patients. At three months, four implants were lost (3.8% of breast reconstructions, 6.3% of patients), due to either peri-implant infection or mastectomy skin flap necrosis. One patient required unplanned return to theatre for evacuation of a haematoma. Minor mastectomy skin flap necrosis was seen in 10 breasts (9.6% of reconstructed breasts) and superficial wound infection in 8 breasts (7.7% of reconstructed breasts). All of these complications were managed conservatively and none required operative intervention. At a median follow up of 35 months (4-53 months) there had been one episode of ipsilateral axillary nodal recurrence.

Conclusion: One-stage implant reconstruction using a myo-dermal flap technique following skin-reducing mastectomy is safe and should be considered in selected patients. Most complications are minor and will resolve with conservative management. Major complications such as implant failure or immediate reoperation, were relatively uncommon (6.3% patients, 3.8% of reconstructed breasts). Early follow-up suggests that oncological outcomes are satisfactory, but longer follow-up is required to substantiate this. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Probing spin-orbit-interaction-induced electron dynamics in the carbon atom by multiphoton ionization

We use R-matrix theory with time dependence (RMT) to investigate multiphoton ionization of ground-state atomic carbon with initial orbital magnetic quantum number M_L=0 and M_L=1 at a laser wavelength of 390 nm and peak intensity of 10(14) W/cm(2). Significant differences in ionization yield and ejected-electron momentum distribution are observed between the two values for M_L. We use our theoretical results to model how the spin-orbit interaction affects electron emission along the laser polarization axis. Under the assumption that an initial C atom is prepared at zero time delay with M_L=0, the dynamics with respect to time delay of an ionizing probe pulse modeled by using RMT theory is found to be in good agreement with available experimental data.

Effect of shotpeening on sliding wear and tensile behavior of titanium implant alloys

Titanium has good biocompatibility and so its alloys are used as implant materials, but they suffer from having poor wear resistance. This research aims to improve the wear resistance and the tensile strength of titanium alloys potentially for implant applications. Titanium alloys Ti–6Al–4V and Ti–6Al–7Nb were subjected to shotpeening process to study the wear and tensile behavior. An improvement in the wear resistance has been achieved due to surface hardening of these alloys by the process of shotpeening. Surface microhardness of shotpeened Ti–6Al–4V and Ti–6Al–7Nb alloys has increased by 113 and 58 HV(0.5), respectively. After shotpeening, ultimate tensile strength of Ti–6Al–4V increased from 1000 MPa to 1150 MPa, higher than improvement obtained for heat treated titanium specimens. The results confirm that shotpeening pre-treatment improved tensile and sliding wear behavior of Ti–6Al–4V and Ti–6Al–7Nb alloys. In addition, shotpeening increased surface roughness.

Implant-retained overdentures did not have a significant improvement in dietary intake

DESIGN: Randomised controlled trial.

INTERVENTION: Patients aged 65 or above edentate for a minimum of five years, with sufficient bone for two implants in the anterior mandible, were recruited. Those with systemic disease that contraindicated implants or had a low mini-mental state evaluation score were excluded. Patients in both groups had a standard maxillary complete denture fabricated. Patients randomised to the treatment group received a two-implant mandibular overdenture while those in the control group received a standard mandibular complete denture. Three 24-hour dietary recalls were collected by telephone interviews at baseline and at 12 months.

RESULTS: 255 patients were randomised: 128 received a standard complete denture (CD) and 127 a two-implant mandibular overdenture (IOD). 127 patients were available at 12-month follow up, 114 in the CD group and 103 in the IOD group. No significant between-group differences were found.

CONCLUSIONS: Although there is much evidence supporting the adoption of two-implant mandibular overdenture (IOD) treatment as the standard of care for edentate patients, this evidence does not include an improvement in dietary intake at one year for medically healthy independent edentate elders when given no specific dietary counselling.

Accelerated rehabilitation of an edentulous patient with an implant retained dental prosthesis: a case report

This case report details the successful rehabilitation of an edentulous patient using a complete upper prosthesis and a lower implant retained overdenture. The provision of care was split between a specialist centre and a primary care setting. This approach reduced inconvenience to the patient. Modern surgical and prosthodontic techniques also reduced the total delivery time. After initial consultation a new set of complete dentures was prescribed with changes in design to the originals. The patient was also planned for placement of two mandibular implants to stabilise and retain the mandibular denture. The first line of treatment involved provision of a new set of dentures constructed by the patient's general dental practitioner. Dental implants were then placed in a specialist centre and the patient returned to the dental practice for attachment of the lower denture to the dental implants. The benefits and success of mandibular implant retained dentures are well documented. With delivery of the overdenture, the patient reported increased satisfaction with his prostheses which allowed him to eat a greater range of foods and enabled him to feel confident when speaking and socialising.

The Well-Aligned Orbit of Wasp-84b: Evidence for Disk Migration of a Hot Jupiter

We report the sky-projected orbital obliquity (spin–orbit angle) of WASP-84 b, a 0.69MJup planet in an 8.52 day orbit around a G9V/K0V star, to be λ = −0.3 ± 1.7°. We obtain a true obliquity of ψ = 17.3 ± 7.7° from a measurement of the inclination of the stellar spin axis with respect to the sky plane. Due to the young age and the weak tidal forcing of the system, we suggest that the orbit of WASP-84b is unlikely to have both realigned and circularized from the misaligned and/or eccentric orbit likely to have arisen from high-eccentricity migration. Therefore we conclude that the planet probably migrated via interaction with the protoplanetary disk. This would make it the first “hot Jupiter” (P d < 10 ) to have been shown to have migrated via this pathway. Further, we argue that the distribution of obliquities for planets orbiting cool stars (Teff < 6250 K) suggests that high-eccentricity migration is an important pathway for the formation of short-orbit, giant planets.

On the alignment of debris discs and their host stars' rotation axis - implications for spin-orbit misalignment in exoplanetary systems

It has been widely thought that measuring the misalignment angle between the orbital plane of a transiting exoplanet and the spin of its host star was a good discriminator between different migration processes for hot-Jupiters. Specifically, well-aligned hot-Jupiter systems (as measured by the Rossiter-McLaughlin effect) were thought to have formed via migration through interaction with a viscous disc, while misaligned systems were thought to have undergone a more violent dynamical history. These conclusions were based on the assumption that the planet-forming disc was well-aligned with the host star. Recent work by a number of authors has challenged this assumption by proposing mechanisms that act to drive the star-disc interaction out of alignment during the pre-main-sequence phase. We have estimated the stellar rotation axis of a sample of stars which host spatially resolved debris discs. Comparison of our derived stellar rotation axis inclination angles with the geometrically measured debris-disc inclinations shows no evidence for a misalignment between the two.

The Rossiter-McLaughlin effect reloaded: Probing the 3D spin-orbit geometry, differential stellar rotation, and the spatially-resolved stellar spectrum of star-planet systems

When a planet transits its host star, it blocks regions of the stellar surface from view; this causes a distortion of the spectral lines and a change in the line-of-sight (LOS) velocities, known as the Rossiter-McLaughlin (RM) effect. Since the LOS velocities depend, in part, on the stellar rotation, the RM waveform is sensitive to the star-planet alignment (which provides information on the system’s dynamical history). We present a new RM modelling technique that directly measures the spatially-resolved stellar spectrum behind the planet. This is done by scaling the continuum flux of the (HARPS) spectra by the transit light curve, and then subtracting the infrom the out-of-transit spectra to isolate the starlight behind the planet. This technique does not assume any shape for the intrinsic local profiles. In it, we also allow for differential stellar rotation and centre-to-limb variations in the convective blueshift. We apply this technique to HD 189733 and compare to 3D magnetohydrodynamic (MHD) simulations. We reject rigid body rotation with high confidence (>99% probability), which allows us to determine the occulted stellar latitudes and measure the stellar inclination. In turn, we determine both the sky-projected (λ ≈ −0.4 ± 0.2◦) and true 3D obliquity (ψ ≈ 7+12 −4 ◦ ). We also find good agreement with the MHD simulations, with no significant centre-to-limb variations detectable in the local profiles. Hence, this technique provides a new powerful tool that can probe stellar photospheres, differential rotation, determine 3D obliquities, and remove sky-projection biases in planet migration theories. This technique can be implemented with existing instrumentation, but will become even more powerful with the next generation of high-precision radial velocity spectrographs.