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Congenital achalasia: facts and fantasies.

Achalasia, a poorly relaxing lower esophageal sphincter, produces a functional obstruction and the expected symptoms of dysphagia, regurgitation and eventually weight loss. The cause of achalasia remains largely unknown in Western countries, Chagas' disease being the most frequent etiology in Brazil. We report on two sets of monozygotic male twins with typical manifestations of achalasia. The majority of authors attribute a limited contribution unless achalasia is related to a multisystem disorder, like the triple-A or Allgrove's syndrome, an autosomal recessive disease characterized by the triad of adrenocorticotropic hormone (ACTH) resistant adrenal insufficiency, achalasia and alacrima. The four cases reported demonstrated the genetic influence of achalasia in patients without multisystem disorders. We believe that idiopathic achalasia is a syndrome with similar clinical, pathological, radiological and manometric evolution, but with a great variety of etiological agents, one of them being the congenital form.

Adolescent↗

The current status of surgery for endometrial carcinoma: facts and fantasy.

Surgery is the prime method of therapy for endometrial carcinoma. However, in nearly all cases radiotherapy is combined with it either before or after operation. High risk factors include hyperoestrinism, cervical spread, myometrial invasion, cellular anaplasia, and metastatic spread to adnexa, vagina and the pelvic lymph nodes. The latter involvement of the last factor is analysed in some detail, on the base of 216 dissections with an incidence of 8%. Analysis of other authors' findings are reviewed on the basis of autopsy and selection. The place for Wertheim hysterectomy is discussed, also vaginal hysterectomy and the timing of surgery when irradiation is given preoperatively. The author's statistics are derived from a previous study of 468 patients treated between 1956 and 1971.

Female↗

Innocents abroad: Western fantasies of childhood and the iconography of emergencies.

In this paper I explore the emotional interests maintained by the imagery of children used in Third World emergencies. Boundaries between adult and child are reproduced through relations of paternalism between North and South, such that the infantilisation of the South exemplified in imagery of children works to secure the competence and maturity of the Northern donor. Drawing on both analyses of the cultural origins and meanings of concepts of childhood and psychoanalytic perspectives, I suggest that media coverage of disasters arouses both identification and strategies to ward off and protect from the anxiety this brings. The gendered as well as geographical distribution of qualities of children's innocence and experience are discussed, drawing on both general imagery of children and recent coverage of children and child-saving, particularly in the former Yugoslavia. Developing analyses of 'disaster pornography', the paper explores how children appear as the principal focal objects onto which attention is pinned and as the signifiers of distress. This is at the cost of dehumanizing both children, their families and their cultures, and rendering them passive objects of a western gaze which seeks to confirm its own agency and omnipotence to ward off its own insecurities. While aid organisations and campaigns necessarily engage with, and sometimes collude with, these reactions, the paper ends by suggesting that there may be strategies whereby images of children can function to comment on rather than maintain prevailing colonial and paternalistic relations.

Advertising↗

Soft tissue augmentation 2006: filler fantasy.

As an increasing number of patients seek esthetic improvement through minimally invasive procedures, interest in soft tissue augmentation and filling agents is at an all-time high. One reason for this interest is the availability of botulinum toxin type A, which works superbly in the upper face. The rejuvenation of the upper face has created much interest in injectable filling agents and implant techniques that work equally well in the restoration of the lower face. One of the central tenets of soft tissue augmentation is the concept of the three-dimensional face. The youthful face has a soft, full appearance, as opposed to the flat, pulled, two-dimensional look often achieved by more traditional surgical approaches. Injectable filling agents can augment and even at times, replace pulling. Additionally, with the lip as the focal center of the lower face, subtle lip enhancement is here to stay, and is in fact, the number one indication for injectable fillers. Moreover, minimally invasive soft tissue augmentation offers cosmetic enhancement without the cost and recovery time associated with more invasive procedures. As more and more physicians take interest in minimally invasive surgery, courses in cosmetic surgery techniques are becoming increasingly popular at the medical meetings of many specialties. Today, physicians have a much larger armamentarium of techniques and materials with which to improve facial contours, ameliorate wrinkles, and provide esthetic rejuvenation to the face. For a substance or device to be amenable for soft tissue augmentation in the medical community, it must meet certain criteria. It must have both a high "use" potential, producing cosmetically pleasing results with a minimum undesirable reactions, and have a low abuse potential in that widespread or incorrect or indiscriminate use would not result in significant morbidity. It must be nonteratogenic, noncarcinogenic, and nonmigratory. In addition, the agent must provide predictable, persistent correction through reproducible implantation techniques. Finally, the substance, agent or device must be approved by the U.S. Food and Drug Administration, which assures purity, safety, and accessibility, as well as much-needed information regarding use. Having a thorough understanding of the filling agents available, their indications and contraindications, as well as having thorough knowledge of implant technique are vital in providing the patient with an esthetically pleasing result.

Biocompatible Materials↗

Numbers of receptor sites from Scatchard graphs: facts and fantasies.

Data for ligand and receptor binding presented in the format of a Scatchard graph are compared with the same data shown as bound ligand plotted against the logarithm of free ligand. From this comparison it is apparent that extrapolations in the Scatchard graph to yield total number of receptor sites are generally not correct.

Kinetics↗