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Biomedical subjects

J F Thornton

Publications and source records attributed to J F Thornton.

5 recordsLinked to original sources
PubMed2001

Breast cancer after augmentation mammaplasty: treatment by skin-sparing mastectomy and immediate reconstruction.

Breast conservation has been associated with poor cosmetic outcome when used to treat breast cancer in patients who have undergone prior augmentation mammaplasty. Radiation therapy of the augmented breast can increase breast fibrosis and capsular contraction. Skin-sparing mastectomy and immediate reconstruction are examined as an alternative treatment.Six patients with prior breast augmentation were treated for breast cancer by skin-sparing mastectomy and immediate reconstruction. One patient underwent a contralateral prophylactic skin-sparing mastectomy. Silicone gel implants had been placed in the submuscular location in five patients and in the subglandular position in one patient a mean of 10.2 years (range, 6 to 20 years) before breast cancer diagnosis. The mean patient age was 41.3 years (range, 33 to 56 years). Four independent judges reviewed postoperative photographs to grade the aesthetic results in comparison with the opposite native or reconstructed breast. The American Joint Committee on Cancer staging was stage 0 in one patient, stage I for four patients, and stage II for one patient. Five of the six patients presented with a palpable breast mass. Latissimus dorsi flap reconstruction was performed in four patients (bilaterally in one) and a transverse rectus abdominis muscle (TRAM) flap was used in two patients. Three patients were treated by skin-sparing mastectomy with preservation of the breast implant (two patients with latissimus flaps, and one patient with a TRAM flap). The tumor location necessitated the removal of implants in two patients (one patient with a latissimus flap and one with a TRAM. A saline implant was placed under the latissimus flap after gel implant removal. The patient who underwent bilateral skin-sparing mastectomies desired explantation and placement of saline implants. No remedial surgery was performed on the opposite breast to achieve symmetry. Complications occurred in two patients at the latissimus dorsi donor site (seroma in one patient, and seroma and infection in one). Five patients underwent complete nipple reconstructions. The mean duration of follow-up was 33.6 months (range, 15.5 to 70.3 months), and there were no recurrences of breast cancer. The aesthetic results were judged to be good to excellent in all cases.Skin-sparing mastectomy and immediate reconstruction can be used in patients with prior breast augmentation, with good to excellent cosmetic results. Depending on the tumor and implant location, the implant may be preserved without compromising local control.

Adult↗
PubMed1981

Schizophrenia: group support for relatives.

This paper outlines the organization and evolution of educational-support groups for the families and friends of schizophrenic patients. The organization involved three phases of expanding services to this target population. Our findings are that: a) relatives experience stage-specific reactions to the fact of schizophrenia in the family; b) topic areas for discussion tend to be the same in different groups; c) as total attendance grows (larger groups), individual attendance rate drops; d) the groups tend to evolve into self-led committees; e) the maximum benefit from the groups, as reported by the participants, is the opportunity to share common, painful experiences. Future goals lie in the encouragement of relative-run community organizations for schizophrenia and the clarification of the role of families in the development and course of the illness.

Attitude↗
PubMed1980

To be or not to be a psychiatric chief resident. Factors in selection.

The issues involved in selecting a psychiatric chief resident have been examined. Problems associated with this position include poorly defined objectives and role; lack of training for the job; a marginal position at the interface of groups that at times are in conflict, leading to situations of divided loyalties and unrealistic performance expectations. Qualities seen as desirable in a chief resident have been discussed. In addition to the usual personal qualities which command respect these include organizing ability, leadership potential, mediation skills, the capacity for self direction and humour. Factors which make the position attractive and factors relevant to appropriate evaluation are considered. To improve the performance and job satisfaction of chief residents, the following points are suggested: The expectations related to the position should be clarified in terms of specific objectives when the candidate is selected or elected. Whom he reports to and whom he works for should be clear. Before, or soon after, assuming office the chief resident should have exposure to teaching or supervision in group dynamics, consultation skills and mental health administration.

Humans↗