For the patients-especially for the young women - the congenital deformity of the breast is a problem for the psychosocial development in the adolescence. Many operative procedures for correction of tuberous breast have been described in recent years. Most of these methods however fail to address the issue of the contracting ring with unstable results. Our surgical technique for the correction of tuberous breast deformities is a single stage approach with a combination of an augmentation with anatomical silicone implant for the hypoplasia of the gland. A form correction of the breast glandular tissue by an unfurling procedure is done to correct the constricting ring that herniates into the nipple-areola complex. We describe our surgical technique with suggestions for achieving optimal results. Our combined treatment is based on the fact that the existing breast hypoplasia treated with a silicone implant would not correct the deformity of the breast gland. Therefore, the simultaneous correction of the constricted breast gland is performed and gives patients a longlasting stable result in one single procedure.
Adolescent ; Male ; Female ; Humans

BACKGROUNDReportedly, patients with persistent refractory angina due to end-stage coronary artery disease (CAD) not amenable to traditional revascularization techniques have experienced symptomatic relief following laser revascularization, either surgical transmyocardial revascularization (TMR) or percutaneous myocardial revascularization (PMR). In spite of several hypotheses (i.e., channel patency, placebo effect, denervation, neoangiogenesis), the mechanism of action and the benefit remains controversial.

METHODSA prospective trial utilizing positron emission tomography (PET) was conducted as an attempt to correlate quantified myocardial blood flow (MBF) to clinical improvement following PMR. Thirteen consecutive patients with angina class > II in spite of maximal medical treatment underwent PMR with a holmium: yttrium-aluminum-garnet (Ho:YAG) laser. MBF at rest and under hyperemia was assessed by [(13)N]ammonia PET at baseline, 3 and 6 months following PMR.

RESULTSMean angina class and exercise tolerance time improved at 6 months compared with baseline (P < 0.001). The clinical results were accompanied with an improvement in hyperemic MBF (P = 0.05) and a reduction in minimal coronary resistance (MCR; P < 0.05) in PMR-treated segments. Opposite effects, reduced hyperemic MBF and increased MCR, were observed in nontreated segments. The increase in MCR in nontreated segments revealed the favorable therapeutic impact achieved in PMR-treated segments.

CONCLUSIONThe results of this trial utilizing a quantitative technique to quantify myocardial perfusion link clinical improvement post-PMR to neoangiogenesis and consistently improved microcirculation.

Aged ; Coronary Artery Disease ; diagnostic imaging ; physiopathology ; surgery ; Coronary Circulation ; Female ; Humans ; Male ; Middle Aged ; Myocardial Revascularization ; methods ; Positron-Emission Tomography ; Vascular Resistance