Clinical uses of CO2 laser in plastic surgery.

The author demonstrates what can be done with the CO2 laser in the ultrapulse mode and in the continuous wave mode. In his four and a half years of experience he has seen that the result one gets after six months lasts for a longer time. If, after this time, the result is not satisfactory for the patient and for the surgeon, he offers a new laser treatment free of charge.

The role of the computer imaging system in modern aesthetic plastic surgery.

The author describes his 10-year experience of using computer imagery for the preparation of surgical procedures and their predictability. The final results prove to be comparable with those programmed, in particular, in the case of rhinoplasty and liposuction. In the case of operations for rejuvenation, the computer is of some help. However, for the patient, the clinical demonstration in front of a mirror is more effective. As for surgical interventions on the breast, whether for enlargement or for reduction, it is very difficult to anticipate the final result with a computer.

How reliable are textured implants used in breast surgery? A review of 510 implants.

Five hundred ten implants were used in 273 patients. The follow-up was between 3 months and 8 years. Four hundred nineteen prostheses were used for subglandular breast augmentation, 91 for subpectoral breast reconstruction. All the breasts were checked personally: 397 augmented breasts and 86 reconstructed breasts-94.7%. The objective criterion was the Baker classification: grades I and II, good result; and grades III and IV, poor result. Results were as follows: Baker I, 397 breasts; Baker II, 78 breasts (I + II, 98.3%); Baker III, 5 breasts; Baker IV, 3 breasts (III + IV, 1.7%). Three prostheses were removed after 3, 4, and 6 years because the textured surface was totally damaged. Two bilumen prostheses lost the saline fluid. The complication rate due to the implants was very low.

Predictability of the computer imaging system in primary rhinoplasty.

One hundred consecutive cases of primary rhinoplasty were planned with a computer imaging system. All the preoperative and one-year postoperative profile pictures were discussed with the patients. Not one patient complained that the planned result was not achieved, and all patients considered the postoperative picture identical to the planned preoperative screen picture. To analyze the results better, a comparison between computer screen and postoperative profile lines was made. Two orthographic negatives were made: one of the picture from the computer screen, the other from the slide one year after rhinoplasty. The negatives are of the same proportions, i.e., the distance between eye and mouth is the same. The negatives were converted into line drawings using a photographic process called solarization. The two resulting lines were superimposed to produce the final picture. The differences in position of other features of the face are due to different positions of mouth, head, hair, and expression or slide changes in the camera angle. Using a computer to plan rhinoplasty allows the surgeon to eliminate patients with unrealistic expectations, to analyze the patients' wishes better, and to plan the operation more accurately.

[Ulcerated breast cancer of the young patient: a case report]. / Das exulzerierte Mammakarzinom der jungen Patientin: ein Fallbericht.

A 29-year-old woman presented with an exulcerating cancer of the right breast. She underwent a total mastectomy and axillary clearance which revealed a pathological stage of T4 N+ (21/23) M0. She received chemotherapy followed by radiation therapy and by chemotherapy again. 30 months later, a contralateral breast cancer was diagnosed. A close team-work of gynaecologist, plastic surgeon, medical and radiation oncologists allowed to combine the operation with the reconstruction of both breasts together with chemotherapy and irradiation of the left chest wall (the tumor was focally infiltrating the pectoralis muscle). We would like to show that a reconstruction of the breast in a young woman presenting with a bad prognosis can be carried out provided a well-organized team-work.

[Effect of primary surgical treatment on breast reconstruction]. / Einfluss der primären chirurgischen Behandlung auf die Mammarekonstruktion.

How the primary surgical treatment influences the mamma reconstruction, we show on examples. If the ablatio has been made correctly, the reconstruction can be realized with a simple technique.

Lipoplasty of the abdomen and lateral thighs.

Liposuction, today, has become a routine technique for plastic surgeons and is frequently also used by nonspecialists. To obtain the best results, it is necessary to follow more rigorous standards of patient selection with a technique that is safely performed in the best possible way. The patients' expectations must be realistic and carefully considered. I try to demonstrate with illustrations that, by respecting these norms, the preoperative objectives set by the surgeon and the patient can be regularly reached.

[Small cell bronchus carcinoma: surgery or not?]. / Das kleinzellige Bronchuskarzinom: Chirurgie ja oder nein?

According to literature the operability rate of small cell carcinoma of the bronchi varies from 6 to 26%. Out of this group of patients the 5-year survival rate is 0--5%. During the 8 years from 1965 to 1973 we observed 65 patients suffering from small cell bronchial carcinoma. All were men. The average age was 56.5 years. Out of this group of 65 patients 13 underwent operations. In 7 cases pneumonectomy, in 1 case lobectomy were performed. 3 patients became radical pneumonectomy. In 2 cases thoracotomy was performed. On the average the operated patients survived for 6.1 months. Out of the 13 patients 12 died during the first year and one patient survived 2 years after the operation. Out of the 52 patients who were found to be inoperable 42 had radiotherapy. In 2 patients additional chemotherapy was given. In the group of 52 patients, 58% died during the first 6 months and 85% died during the first year after diagnosis. 3 patients survived 13, 14 and 15 months respectively and one patient died 35 months after diagnosis. We come to the conclusion that surgery has not brought any advances in the treatment of this tumour. Our bad experience is shared by most authors. Indications for surgical treatment of this tumour therefore are extremely limited.

[Results following radical pneumonectomy for bronchial carcinoma]. / Resultate nach erweiterten Lungeneingriffen wegen Bronchuskarzinoms.

Between 1968 and 1978 82 radical pneumonectomies were performed in our clinic because of a bronchial epidermoid carcinoma. In 49 patients the operation was performed at least 5 years ago (December 31, 1973). 23 patients had a radical pneumonectomy with intrapericardial ligation of the vessels, atriumwall resection or pericardial resection (group A). In addition 13 patients had a dissection of the mediastinal lymphnodes (group B). In the remaining patients (n = 13) parts of the thoracic wall had to be removed (group C). The postoperative lethality (30 days) is 17.6% in group A, 38.5% in group B (2 patients died because of hematogenous metastases, 2 of pulmonary embolism and 1 of generalized pneumonia) and 10% in group C. The 5-year survival is 13% for group A, 8% for group B and 10% for group C.

[Bronchiolo-alveolar cell carcinoma]. / Das Bronchioloalveolarzellkarzinom.

15 cases of bronchiolo-alveolar cell carcinoma were observed at the Dept. of Surgery of the University Hospital of Zurich from 1961 to 1976. The mean age of these patients was 56 years. The sex distribution was 13 males and 2 females. Five cases were discovered accidentally; the symptoms of the remaining 10 were uncharacteristic. Cytology, bronchoscopy and mediastinoscopy were negative at early stages. Diagnosis was made by histologic examination of the specimens only. Needle biopsy, performed routinely over recent years, proved helpful in 4 cases. In 12 out of 14 patients, lobectomy was considered 'radical'; nevertheless, only 2 survived more than 5 years. The disseminated form of the bronchiolo-alveolar cell carcinoma is characterized by a particularly poor prognosis. According to our experience and to the literature, only the solitary, nodular type shows a more favourable outlook.

[Therapy of pleural empyema after pneumonectomy with open-window drainage and continuous rinsing]. / Die Therapie des Pleuraempyems nach Pneumonektomie durch Thoraxfensterung bzw. kontinuierliche Spülung.

From 1961 to 1977 24 thoracic empyemas (=4,75%) after 507 pneumonectomies were observed at the Surgical Clinic A of the Zurich University Hospital. Two methods for the management of this condition are discussed: open-window drainage (CLAGETT) and continuous rinsing of the pleural cavity (LUIZY). The first mentioned method proved to be a palliative one in our patients: no thoracostomy could be re-closed operatively. Two thoracic windows healed up spontaneously without recurrence of an empyema; one patient died shortly after the operation from respiratory insufficiency. Of the five patients treated by continuous rinsing, four were cured as for their empyema, but one of the latter died from renal insufficiency. In one case an open-window drainage finally had to be accomplished.