State-Dependent Optical Lattices for the Strontium Optical Qubit

We demonstrate state-dependent optical lattices for the Sr optical qubit at the tune-out wavelength for its ground state. We tightly trap excited state atoms while suppressing the effect of the lattice on ground state atoms by more than 4 orders of magnitude. This highly independent control over the qubit states removes inelastic excited state collisions as the main obstacle for quantum simulation and computation schemes based on the Sr optical qubit. Our results also reveal large discrepancies in the atomic data used to calibrate the largest systematic effect of Sr optical lattice clocks.

Munchausen's Syndrome—Masquerading as Necrotizing Fasciitis

We would like to present a novel form of Munchausen's syndrome which presented us with a difficult problem in the midst of the recent media hysteria regarding flesh eating bacteria. This condition, first described by Richard Asher in 19511, is often very difficult to diagnose and it is not, therefore, surprising that the victims have been through several epsiodes of treatment before the suspicions of staff are raised. It owes its name to a fictitious character, Baron Karl Friedrich Hieronymus Freihess von Munchausen, who recounted extraordinary and wildly exaggerated exploits of adventure and daring, not unlike patients who present with this condition.

Our enquiries revealed that the laid down procedure when faced with a patient with this condition is that the regional medical officer (RMO) should be contacted. It is then his responsibility to contact other RMOs, who in turn pass the information on to accident and emergency consultants in their area.

Altered colonic function and microbiota profile in a mouse model of chronic depression

BACKGROUND

Depression often coexists with the irritable bowel syndrome (IBS) which is characterized by alterations in gut function. There is emerging evidence that the microbial composition (microbiota) of the gut is altered in IBS, but the basis for this is poorly understood. The aim of this study was to determine whether the induction of chronic depression results in changes in the colonic function and in its microbial community, and to explore underlying mechanisms.

METHODS

Bilateral olfactory bulbectomy (OBx) was used to induce depression-like behavior in mice. Colonic function was assessed by measuring muscle contractility, pellet excretion, c-fos activity, and serotonin levels. Microbiota profiles were obtained using denaturing gradient gel electrophoresis (DGGE). The hypothalamic-pituitary axis (HPA) was assessed by the hypothalamic expression of corticotropin-releasing hormone (CRH). In separate studies, mice without OBx received CRH via intracerebroventricular (ICV) infusion for 4 weeks prior to assessing colonic function and microbiota profiles.

KEY RESULTS

Olfactory bulbectomy mice demonstrated chronic depression- and anxiety-like behaviors associated with elevated central CRH expression and increases in c-Fos activity, serotonin levels, and motility in the colon. These changes were accompanied by an altered intestinal microbial profile. Central CRH administration produced similar changes in behavior and motility and altered the microbiota profile in the colon.

CONCLUSIONS & INFERENCES

The induction of chronic depression alters motor activity and the microbial profile in the colon likely via activation of the HPA. These findings provide a basis for linking the behavioral and gastrointestinal manifestations of IBS.

Prospective parallel randomized trial of the MultiCyte™ ThinPrep(®) imaging system: the Scottish experience

BACKGROUND

Computer-assisted screening of cervical liquid-based cytology (LBC) preparations using the ThinPrep® Imaging System (TIS) has shown improved qualitative and quantitative gains. The use of Multicyte™ has not been described in a well-established national screening programme with a low incidence of high-grade dyskaryosis.

OBJECTIVES

To assess the impact of computer-assisted screening within the Scottish Cervical Screening Programme (SCSP).

METHODS

Two groups of three laboratories, each sharing a ThinPrep® Imager, screened 79 366 slides randomized to test and 90 551 to control arms by laboratory accession. Screeners were not blinded. Standard laboratory reporting profiles of the SCSP, sensitivity, specificity and false-negative rates of all grades of LBC abnormalities with respect to final cytology reports, predictive value for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) on histology; and screening rates were compared for both arms.

RESULTS

Inadequate and negative reporting rates were significantly lower and low-grade reporting rates significantly higher in the imager arm. Imager-assisted screening showed significantly better specificity than manual screening with respect to the final cytology result. There was no evidence of a significant difference in the detection of CIN2+ or CIN3 +. Positive, abnormal and total predictive values (high-grade, low-grade and all abnormal cytology found to be CIN2+, respectively) were similar in both arms. Productivity was significantly higher in the imager arm.

CONCLUSION

  Computer-assisted screening in a well established screening programme showed significantly improved productivity without loss of quality. These findings should inform future policy for cervical screening programmes.

The anxiolytic effect of Bifidobacterium longum NCC3001 involves vagal pathways for gut-brain communication

BACKGROUND

The probiotic Bifidobacterium longum NCC3001 normalizes anxiety-like behavior and hippocampal brain derived neurotrophic factor (BDNF) in mice with infectious colitis. Using a model of chemical colitis we test whether the anxiolytic effect of B. longum involves vagal integrity, and changes in neural cell function. Methods  Mice received dextran sodium sulfate (DSS, 3%) in drinking water during three 1-week cycles. Bifidobacterium longum or placebo were gavaged daily during the last cycle. Some mice underwent subdiaphragmatic vagotomy. Behavior was assessed by step-down test, inflammation by myeloperoxidase (MPO) activity and histology. BDNF mRNA was measured in neuroblastoma SH-SY5Y cells after incubation with sera from B. longum- or placebo-treated mice. The effect of B. longum on myenteric neuron excitability was measured using intracellular microelectrodes.

KEY RESULTS

Chronic colitis was associated with anxiety-like behavior, which was absent in previously vagotomized mice. B. longum normalized behavior but had no effect on MPO activity or histological scores. Its anxiolytic effect was absent in mice with established anxiety that were vagotomized before the third DSS cycle. B. longum metabolites did not affect BDNF mRNA expression in SH-SY5Y cells but decreased excitability of enteric neurons.

CONCLUSIONS & INFERENCES

In this colitis model, anxiety-like behavior is vagally mediated. The anxiolytic effect of B. longum requires vagal integrity but does not involve gut immuno-modulation or production of BDNF by neuronal cells. As B. longum decreases excitability of enteric neurons, it may signal to the central nervous system by activating vagal pathways at the level of the enteric nervous system.

Surgical management of uterine prolapse

The surgical management of uterine prolapse requires an apical suspension procedure, with or without uterine removal. Options in the surgical treatment of uterine prolapse encompass the open, laparoscopic, or vaginal approaches. Vaginal apical suspension procedures include the uterosacral vaginal vault suspension, sacrospinous ligament fixation, iliococcygeus fascia suspension, and the McCall or Mayo culdoplasty. The abdominal sacral colpopexy may be performed via laparotomy or laparoscopy. Uterine preservation techniques include the Manchester procedure, sacrospinous hysteropexy, laparoscopic sacral hysteropexy and laparoscopic uterosacral vault suspension. Most of the data for subjective and objective outcomes for these prolapse procedures are from uncontrolled retrospective case series. Currently there is no definitive gold standard procedure to favor a particular route in the treatment of uterine prolapse. Thus, the optimal procedure to treat uterine prolapse depends on the specific defects that are present, as well as considerations such as the patient's age, comorbidities, activity level, desire for future fertility, history of prior prolapse surgery in other compartments, patient preference, as well as the skill and comfort level of the surgeon with the particular surgery.

Endothelial progenitor cells in pterygium pathogenesis

PURPOSE

The pathogenesis of pterygium is not well known, and controversy exists about the cell origins and the nature of initial trigger required for its development. We investigated whether endothelial progenitor cells (EPCs) are involved in pathogenesis of pterygium and the mechanism underlying the selective recruitment of EPCs during this process.

METHODS

We studied 13 normal controls and 28 pterygium patients (primary (n=15), recurrent (n=13)). Substance-P, vascular endothelial growth factor (VEGF), and stem cell factor (SCF) were measured in plasma and tears using ELISA, and circulating CD34(+) and c-kit(+) mononuclear cells (MNCs) by flow cytometry. Anterior segment fluorescein angiography (FAG) was performed to evaluate hypoxic conditions in the early stage of pterygium. Surgically removed pterygial tissues were analyzed immunohistochemically using the progenitor cell markers, CD34, c-kit, VEGFR-1, and VEGFR-2.

RESULTS

Anterior segment FAG findings showed an increase in non-perfusion areas and attenuated vessels in the nasal limbus during early-stage pterygium. Circulating CD34(+) MNCs and c-kit(+) MNCs were increased in pterygium groups compared with normal controls. Systemic and local cytokines including SP, VEGF, and SCF in pterygium groups were also elevated and showed positive correlations with CD34(+) and c-kit(+) MNC numbers. Immunohistochemical analysis of pterygium showed strong progenitor cell marker immunoreactivities.

CONCLUSIONS

EPCs might be involved in pterygium development, and ocular hypoxia triggers this neovascularization by recruiting EPCs derived from the bone marrow via the production of systemic and local cytokines.

Oxyntomodulin increases energy expenditure in addition to decreasing energy intake in overweight and obese humans: a randomised controlled trial

BACKGROUND

Oxyntomodulin has recently been found to decrease body-weight in obese humans and may be a potential anti-obesity therapy.

OBJECTIVE

To determine whether oxyntomodulin alters energy expenditure, in addition to reducing energy intake, in 'free-living' overweight and obese volunteers.

DESIGN

Randomized double-blind controlled cross-over trial.

SETTING

Community and hospital-based.

PARTICIPANTS

Fifteen healthy overweight and obese men and women (age: 23-49 years, BMI: 25.1-39.0 kg/m(2)). All volunteers completed the study protocol.

INTERVENTIONS

Four-day subcutaneous self-administration of pre-prandial oxyntomodulin, three times daily. Participants were advised to maintain their normal dietary and exercise regimen.

MEASUREMENTS

(1) Energy expenditure, measured by indirect calorimetry and combined heart rate and movement monitoring; (2) energy intake, measured during a study meal.

RESULTS

Oxyntomodulin administration reduced energy intake at the study meal by 128+/-29 kcal (P=0.0006) or 17.3+/-5.5% (P=0.0071), with no change in meal palatability. Oxyntomodulin did not alter resting energy expenditure; but increased activity-related energy expenditure by 143+/-109 kcal/day or 26.2+/-9.9% (P=0.0221); total energy expenditure by 9.4+/-4.8% (P=0.0454) and physical activity level by 9.5+/-4.6% (P=0.0495). A reduction in body weight of 0.5+/-0.2% was observed during the oxyntomodulin administration period (P=0.0232).

CONCLUSION

Oxyntomodulin increases energy expenditure while reducing energy intake resulting in negative energy balance. This data supports the role of oxyntomodulin as a potential anti-obesity therapy.

Ghrelin increases food intake in obese as well as lean subjects

OBJECTIVE

To investigate whether effects on food intake are seen in obese subjects receiving exogenous administration of ghrelin.

DESIGN

Randomised, double-blind, placebo-controlled study of intravenous ghrelin at doses 1 pmol/kg/min and 5 pmol/kg/min.

SUBJECTS

In all, 12 healthy lean subjects (mean body mass index (BMI) 20.5+/-0.17 kg/m(2)) and 12 healthy overweight and obese subjects (mean BMI 31.9+/-1.02 kg/m(2)).

MEASUREMENTS

Food intake, appetite and palatability of food, ghrelin and other obesity-related hormones, growth hormone.

RESULTS

Low-dose infusion of ghrelin increased ad libitum energy intake at a buffet meal in the obese group only (mean increase 36.6+/-9.4%, P<0.01.) High-dose ghrelin infusion increased energy intake in both groups (mean increase 20.1+/-10.6% in the lean and 70.1+/-15.5% in the obese, P<0.01 in both cases.) Ghrelin infusion increased palatability of food in the obese group.

CONCLUSION

Ghrelin increases food intake in obese as well as lean subjects. Obese people are sensitive to the appetite-stimulating effects of ghrelin and inhibition of circulating ghrelin may be a useful therapeutic target in the treatment of obesity.

Flame bums: a forgotten danger of diathermy?

Diathermy and spirit-based skin preparations are both used on a daily basis in most hospital theatres. We report a case illustrating the potential hazards of this combination and discuss the management of its complications and possibilities of their prevention.

A-A Type, Arterialized, Venous, Flow-Through, Free Flap for Simultaneous Digital Revascularization and Soft Tissue Reconstruction???Revisited

Significant soft tissue injuries to palmar surfaces are frequently associated with digital vessel damage. Flap coverage might have to be combined with microsurgical revascularization using vein grafts if the digit is to be salvaged. Two cases of simultaneous digital revascularization and soft tissue reconstruction using an arterialized, venous flow-through flap are presented in detail. These flaps initially "pinked up" for 24 to 48 hours. This was followed by a period of venous congestion lasting approximately 1 week, after which flap perfusion gradually returned to normal. Good long-term functional and cosmetic results were achieved. Distal finger perfusion was maintained in both cases. This technique, although previously described, has not been popularized. It should be considered early in reconstruction of ischemic digits requiring simultaneous vascular and soft tissue reconstruction.

Pancreatic polypeptide reduces appetite and food intake in humans

Pancreatic polypeptide (PP) is a gut hormone released from the pancreas in response to ingestion of food. Plasma PP has been shown to be reduced in conditions associated with increased food intake and elevated in anorexia nervosa. In addition peripheral administration of PP has been shown to decrease food intake in rodents. These findings suggest that PP may act as a circulating factor that regulates food intake. Therefore we investigated the effect of intravenous infusion of PP (10 pmol/kg/min) on appetite and food intake in a randomised double-blind placebo-controlled crossover study in ten healthy volunteers. Infusion of PP reduced appetite and decreased the energy intake at a buffet lunch two hours post-infusion by 21.8 +/- 5.7% (P < 0.01). More importantly the inhibition of food intake was sustained, such that energy intake, as assessed by food diaries, was significantly reduced both the evening of the study and the following morning. Overall PP infusion reduced cumulative 24-hour energy intake by 25.3 +/- 5.8%. In conclusion our data demonstrates that PP causes a sustained decrease in both appetite and food intake.

Apolipoprotein E genotype in Korean schizophrenic patients

The apolipoprotein E (APOE) epsilon4 allele is a known risk factor for the development of Alzheimer's disease, however, an association of the APOE genotype with schizophrenia is controversial. We investigated the association in 60 Korean schizophrenic patients and 60 healthy controls. APOE genotypes were identified by reverse hybridization-based line probe assay. There were significant differences in the distribution of APOE genotypes between schizophrenic patients and controls. APOE epsilon2 and epsilon3 allele frequencies in schizophrenic patients were significantly different from those in controls. Our results suggest that APOE alleles seem to be operative in the pathogenesis of schizophrenic disorders.

Antimicrobial resistance surveillance of bacteria in 1999 in Korea with a special reference to resistance of enterococci to vancomycin and gram-negative bacilli to third generation cephalosporin, imipenem, and fluoroquinolone

The trend of antimicrobial resistance of bacteria isolated from patients in 30 Korean hospitals in 1999 was analyzed with a particular attention to cefotaxime- or fluoroquinolone-resistant gram-negative bacilli, imipenem-resistant Pseudomonas aeruginosa, and vancomycin-resistant enterococci. Adequacy of susceptibility testing, and any change in the frequencies of isolated species were also analyzed. The results showed that only 20% and 30% of hospitals tested the piperacillin-tazobactam and cefoxitin susceptibility of Enterobacteriaceae, respectively, only 24% of hospitals the piperacillin-tazobactam susceptibility of P. aeruginosa, and 17% of hospitals the fusidic acid susceptibility of staphylococci. Among the isolates 26.3% were glucose-nonfermenting gram-negative bacilli, and 34.7% of Enterococcus were Enterococcus faecium. Slight decline of cefotaxime-resistance rate to 20% was noted in Klebsiella pneumoniae, while fluoroquinolone-resistance rate was 68% in Acinetobacter baumannii. The ceftazidime- and imipenem-resistance rates were 17% and 18%, respectively in P. aeruginosa. The vancomycin-resistance rate of E. faecium rose significantly to 15.1%, but the rates varied significantly depending on hospitals suggesting presence of different degree of selective pressure or nosocomial spread. In conclusion, the prevalence of imipenem-resistant P. aeruginosa and the increase of vancomycin-resistant E. faecium were the particularly worrisome phenomena observed in this study.

Rapid species identification of coagulase negative Staphylococci by rRNA spacer length polymorphism analysis

OBJECTIVES

The identification of coagulase-negative staphylococci (CNS) is carried out mainly through conventional methods, commercial identification kits, and molecular biology-based methods. We evaluated the efficiency of PCR analysis of tRNA intergenic spacer length polymorphism (tDNA-ILP) and 16S-23S intergenic spacer length polymorphism (16S-23S ILP), and also that of restriction analysis of 16S-23S intergenic spacer amplification products (RA 16S-23S), for the rapid and accurate identification of CNS species.

METHODS

The PCR assays of rRNA spacer length polymorphisms were tested with nine reference type strains and 122 clinical isolates. The results were compared with those obtained by conventional methods and the Vitek system for clinical isolates.

RESULTS

Seventy-eight (63.9%) of 122 strains were identified as the same species with conventional identification, the Vitek GPI system, tDNA-ILP, and RA 16S-23S. The 16S-23S ILP analysis did not produce distinguishable PCR fragments. The results of tDNA-ILP analysis were in agreement with those of RA 16S-23S to the species level for 98.2% except for unknown patterns (eight isolates).

CONCLUSIONS

These results indicate that tDNA-ILP and RA 16S-23S analysis are potentially valuable tools for rapid and accurate CNS identification.

alpha-Galactosidase A from Pseudomonas fluorescens subsp. cellulosa: cloning, high level expression and its role in galactomannan hydrolysis

A library of Pseudomonas fluorescens subsp. cellulosa genomic DNA, constructed in lambda ZAPII, was screened for alpha-D-galactosidase activity. The DNA inserts from six galactosidase-positive clones were rescued into plasmids. Restriction digestion and Southern analysis revealed that each of the plasmids contained a common DNA sequence. The sequence of the Pseudomonas DNA in one of the plasmids revealed a single open reading frame (aga27A) of 1215 bp encoding a protein of M(r) 45900, designated alpha-galactosidase 27A (Aga27A). Aga27A exhibited extensive sequence identity with alpha-galactosidases in glycoside hydrolase 27, and appeared to be a single domain protein. The recombinant alpha-galactosidase was expressed at high levels in Escherichia coli and the biophysical properties and substrate specificity of the enzyme were evaluated. The data showed that Aga27A was a mesophilic neutral acting non-specific alpha-galactosidase. Both P. fluorescens subsp. cellulosa mannanase A (ManA) and Aga27A hydrolyse the polymeric substrate, carob galactomannan. Sequential hydrolysis with AgaA followed by ManA, or ManA followed by AgaA enhanced product release. The positive effects of sequential hydrolysis are discussed.

Visual loss in pregnancy

A 36-year-old preeclamptic woman presented with bilateral visual loss upon recovery from anesthesia following cesarean section. Visual acuity was hand motion OU. Pupillary responses to light were normal, without a relative afferent pupillary defect. Treatment consisted of control of blood pressure and the patient's vision improved to 20/25 OU within 3 days.

Korean Nationwide Surveillance of Antimicrobial Resistance of bacteria in 1997

Antimicrobial-resistant bacteria are known to be prevalent in tertiary-care hospitals in Korea. Twenty hospitals participated to this surveillance to determine the nationwide prevalence of resistance bacteria in 1997. Seven per cent and 26% of Escherichia coli and Klebsiella pneumoniae were resistant to 3rd-generation cephalosporin. Increased resistance rates, 19% of Acinetobacter baumannii to ampicillin/sulbactam, and 17% of Pseudomonas aeruginoa to imipenem, were noted. The resistance rate to fluoroquinolone rose to 24% in E. coli, 56% in A. baumannii and 42% in P. aeruginosa. Mean resistance rates were similar in all hospital groups: about 17% of P. aeruginosa to imipenem, 50% of Haemophilus influenzae to ampicillin, 70% of Staphylococcus aureus to methicillin, and 70% of pneumococci to penicillin. In conclusion, nosocomial pathogens and problem resistant organisms are prevalent in smaller hospitals too, indicating nosocomial spread is a significant cause of the increasing prevalence of resistant bacteria in Korea.

What do plastic surgeons do?

The image of plastic surgery as portrayed by the media is of concern to all plastic surgeons. In order to assess knowledge about the specialty, a questionnaire was devised and given to five groups of participants: general practitioners, medical students, nurses, plastic surgical out-patient attendees, and the general public. The results revealed that general practitioners, nurses and medical students in the Cambridge area are, on the whole, knowledgeable about the role of plastic surgery. However, the general public are not so well educated and 23.7% of them could not think of five conditions treated by plastic surgeons, and felt that burns and cosmetic problems were the commonest conditions dealt with. Improved liaison with general practitioners, other specialties and more teaching of undergraduates, coupled with more effective promotion of the skills on offer might permit better use to be made of the specialty.

Gynaecomastia: have Webster's lessons been ignored?

Five cases of cosmetically unacceptable and hypertrophic scarring are presented that follow excision of gynaecomastia by surgeons who used incisions other than the periareolar approach. A periareolar technique of subcutaneous mastectomy is described and recommended.

Silicone gel-filled breast implants and connective tissue diseases

Recent worldwide press and media speculation that silicone implants may be linked to an increased incidence of breast cancer, other cancers, and connective tissue diseases-particularly systemic sclerosis-is a current cause for concern to the medical profession and public alike. We conducted a cross-sectional study of the prevalence of connective tissue diseases, as well as signs and symptoms associated with these conditions, in women who had received a silicone gel-filled breast implant for either breast augmentation or breast reconstruction following mastectomy for breast cancer compared with women without implants in South East Scotland. We compared 317 patients who had had a silicone gel-filled breast implant inserted with matched controls. We found no increased incidence of antinuclear antibodies or rheumatoid factor in the study groups. We detected one case of rheumatoid arthritis in the reconstruction group and one in matched controls, but no cases of any other connective tissue disease. No cases were found among the augmentation patients or their controls. No differences were found in symptoms or physical signs of connective tissue diseases between the study patients and their controls. This study has failed to find any case for a link between silicone gel-filled breast implants and connective tissue diseases.

Patient satisfaction following insertion of silicone breast implants

Because of allegations linking silicone implants with cancer and connective tissue diseases and mounting media coverage, women with silicone breast implants are extremely concerned, despite the lack of evidence showing a link between silicone gel-filled breast implants and connective tissue diseases or cancer. To assess whether or not this group of women were satisfied with their operations, we sent all women who had silicone breast implants inserted in the south-east of Scotland between 1982 and 1991 a quality of life questionnaire. One hundred and two breast augmentation and 212 breast reconstruction patients replied. Not everyone answered every question. The majority of women in our study, 84% (79/94) and 91.8% (192/209) of augmented and reconstructed patients, respectively, stated that they were satisfied with their operations, although only about half were very satisfied. Although 91.2% (270/296) of all the women were aware of the allegations with 29.7% (88/296) concerned, only 3% (9/296) of all the women felt that there was cause for concern. It would appear that, although most women with silicone breast implants are aware of the accusations regarding silicone and systemic illnesses, the adverse publicity has only given a small number of them a cause for concern and the majority are satisfied with the outcome of their operation and perceive the benefits to outweigh the risks.

The detection of breast implant rupture using ultrasound

Because little or no information exists about the life span of silicone implants, there is a need for a non-invasive and sensitive diagnostic tool for assessing their integrity. It is extremely difficult to diagnose rupture of these implants clinically. The aims of this study were to assess how many of our patients--in particular asymptomatic women--had ruptured implants and whether or not ultrasound was an effective tool in excluding rupture and reassuring anxious patients. All patients in the south east of Scotland who had a silicone gel-filled breast implant inserted between the years 1982-1991 were invited to take part in an investigation into morbidity due to silicone implants. We screened 307 asymptomatic patients with 385 implants and only found one patient with a ruptured silicone implant. One other patient had a ruptured saline implant and one implant was found to have leaked. We found ultrasound to be a quick, reliable, cheap and safe method of screening for implant rupture which can be used to reassure an anxious patient that her implants are intact.

A flap for segmental loss of a digital nerve. The Venkataswami flap revisited

The use of a V-Y advancement flap for reconstruction of a volar/lateral soft tissue defect in a digit involving segmental loss of the neurovascular bundle of up to 10 mm at middle phalangeal level is described. This flap allows immediate reconstruction with primary repair of the nerve and gives good functional results. Two cases are presented.

Basal cell carcinomas: do they need to be followed up?

Basal cell carcinoma (BCC) is the commonest of the malignant skin tumours. The follow-up of patients following excision of these lesions varies immensely. The aim of this study was to assess the need for outpatient follow-up of patients who had a primary BCC excised. A retrospective study was performed using the case notes of 206 patients who had a primary BCC excised in Bangour General Hospital in the years 1986 and 1987. Fourteen were excluded from the study, leaving 192 patients with 215 lesions. The overall recurrence rate was 5.1% with 39% of lesions recurring if the tumour was incompletely excised compared with 1% if it was excised completely. Complete excision is therefore the key to surgical control and we feel that there is no need to follow up patients routinely if the BCC has been completely excised.

Silicone gel breast implants, breast cancer and connective tissue disorders

Recent worldwide media speculation that silicone gel-filled breast implants may be linked to an increased incidence of breast and other cancers, and connective tissue disease (particularly systemic sclerosis) has caused concern to the medical profession and public alike. Until carefully controlled studies have been performed to prove the safety of these implants, the US Food and Drug Administration has restricted their use to research and breast reconstruction. Research has so far failed to prove a causative relationship between silicone implants and cancer or connective tissue disorders.