Diabetic neuropathy is a common complication of diabetes that may be associated both with considerable morbidity (painful polyneuropathy, neuropathic ulceration) and mortality (autonomic neuropathy). The epidemiology and natural history of diabetic neuropathy is clouded with uncertainty, largely caused by confusion in the definition and measurement of this disorder. We have reviewed various clinical manifestations associated with somatic and autonomic neuropathy, and we herein discuss current views related to the management of the various abnormalities. Although unproven, the best evidence suggests that near-normal control of blood glucose in the early years after diabetes onset may help delay the development of clinically significant nerve impairment. Intensive therapy to achieve normalization of blood glucose also may lead to reversibility of early diabetic neuropathy, but again, this is unproven. Our ability to manage successfully the many different manifestations of diabetic neuropathy depends ultimately on our success in uncovering the pathogenic processes underlying this disorder. The recent resurgence of interest in the vascular hypothesis, for example, has opened up new avenues of investigation for therapeutic intervention. Paralleling our increased understanding of the pathogenesis of diabetic neuropathy, refinements must be made in our ability to measure quantitatively the different types of defects that occur in this disorder. These tests must be validated and standardized to allow comparability between studies and more meaningful interpretation of study results.

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To determine the diagnostic value of various cutaneous sensory modalities in diabetic neuropathy, we studied cutaneous perception at the dominant hallux of 113 subjects (32 normal healthy controls and 81 diabetic subjects). The cutaneous sensory perception tests included warm and cold thermal perception, vibration, touch-pressure sensation, and current perception testing (CPT). The sensitivity of each modality when specificity is held greater than 90% was as follows: warm = 78%, cold = 77%, vibration = 88%, tactile-pressure = 77%, 5-Hz CPT = 52%, 250-Hz CPT = 48%, and 2000-Hz CPT = 56%. Combination thermal and vibratory gave optimum sensitivity (92-95%) and specificity (77-86%). We conclude that vibratory and thermal testing should be the primary screening tests for diabetic peripheral neuropathy. Other modalities may be of use only in specific situations.

The treatment of breast cancer has evolved significantly from the original surgical technique described by Halsted. The reconstruction of the breast has also been a large interest among surgeons and patients. The history of breast reconstruction dates back to the 1800s with an attempt to transplant a lipoma to a mastectomy site. Several techniques ranging from the ''walking flap'' of Gilles to the free perforator flap using autogenous tissue for recreation of a breast ''mound'' have been established and refined. The use of tissue expanders for breast reconstruction has also been perfected over the last three decades. Breast reconstruction, which was once admonished in the early part of the 20th century, has now become a routine choice for women undergoing breast cancer surgery. KEYWORDS: Reconstruction, breast, history, cancer, surgeryBreast cancer affects one of every nine women and accounts for at least one third of all new cancers yearly. Its incidence is highest among white women. Breast cancer rates increased 3.8% per year through the 1980s, but this increase has stabilized over the 1990s to the present.Breast cancer is second only to lung cancer as the primary source of cancer deaths in women. In fact, the breast cancer death rate in women between the ages of 20 and 59 surpasses all other cancer-related deaths. As of last year, the breast cancer death rate remains the greatest in the African-American population. 1

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