Using the split Latram for better breast projection in breast reconstruction.

Over the years, although methods of breast reconstruction have improved, the ability to build a symmetrical projecting breast has not. When stacked Meme implants were used, better projection was obtained. Folding the transverse rectus abdominis musculocutaneous flaps allows for good projection; however, the breast is then quite wide and large. For smaller breast women with projection and some larger breasted women as well, splitting and stacked flaps give a much better result. We now do this procedure with simultaneous Latram and mastectomy surgery in fewer than 3 hours.

Giant myofibroblastoma of the male breast.

Myofibroblastoma of the breast is a rare, benign neoplasm, seen predominantly in men. The gross appearance is that of a well-circumscribed nodule, characteristically small, seldom exceeding 3 cm. We report a case of giant myofibroblastoma measuring 10 cm and weighing 169 g in the breast of an 83-year-old man. Light microscopic, immunohistochemistry, and electron microscopic features are described. Histologically, these neoplasms may exhibit a varied cellularity that can be misinterpreted as sarcoma. However, they lack marked cellular pleomorphism, tumor necrosis, and mitosis and are characteristically composed of plump and long bipolar, spindly cells arranged in swirling fascicles with intervening broad collagen bands. As we report, immunostaining is strongly positive for vimentin, desmin, and muscle common antigen and negative for cytokeratins and S-100-associated protein. Electron microscopy shows predominantly cells suggestive of myofibroblastic differentiation. The patient has remained free of disease 2 years after mastectomy.

Hemostasis in experimental pulmonary injury.

Fibrin Seal (consisting of fibrinogen, cold insoluble globulin, factor XIII, antiplasmin, platelet growth factor, thrombin, and calcium chloride), cryoprecipitate, at Avitene were applied to areas of pulmonary wedge resections in dogs and cynomologus monkeys in an attempt to stop bleeding and air leakage. In the control groups, hemorrhage persisted. Comparing the three hemostatic agents used. Avitene was the least effective followed by cryoprecipitate. Fibrin Seal was most effective. In all cases, it eliminated both air leakage and bleeding.

Attempts to bypass the need for splenectomy in splenic injury.

Within the last decade spleen salvage has been a controversial issue. Only recently, with the advances and utilization of modern technology in surgery, spurred by a better understanding of this immunologically important organ, preservation has become a reality. Numerous approaches have been suggested. Reported is a simple method of applying a new agent, Fibrin Seal (FS), to control hemorrhage from splenic injury. In a controlled study using 14 mongrel dogs, it is compared to the hemostatic ability of cryoprecipitate with thrombin and Avitene. FS is an adhesive material with hemostatic qualities consisting of fibrinogen, factor XIII, antiplasmin, cold-insoluble globulin, and platelet growth factor. FS appears to have cohesive and adhesive properties that result in more efficient hemostasis than the controls. FS conforms to the spleen surface, allowing manipulation of the organ without dislodgement of the coagulum. Follow-up laparotomy showed minimal tissue reaction. On the basis of these data, consideration of FS as an important hemostatic agent warrants clinical investigation.

The application of tissue adhesives in small bowel anastomoses.

One layer everted end-to-end anastomosis was performed on the small bowel of mongrel dogs. Cultures of Serratia marcescens were injected into the lumen. Twenty-four hours later the animals were reexplored, and peritoneal cultures were observed. In animals where Fibrin Seal (consisting of fibrinogen, cold insoluble globulin, factor XIII, platelet growth factor, antiplasmin, thrombin, and calcium chloride) was applied to the suture line, negative cultures were found except for two experiments in which dehiscence or contamination from the Serratia injection site occurred.

Porteus Maze Test performance of retarded young adults and nonretarded children.

Performances of retarded young adults on the Porteus Maze Test were compared with those of first- through fourth-grade nonretarded children. The retarded subjects, approximately matched on MA with the fourth-grade group, performed at the level of the first graders and were reliably poorer than the third and fourth graders. This MA lag of at least 2 years is consistent with the MA lag previously found on strategic games and puzzles. The retarded and first-grade groups spent more time completing mazes than did the other groups.