ABSTRACT
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.
Subject(s)
Mammaplasty/methods , Surgical Flaps/methods , Breast Neoplasms/surgery , Female , Humans , Mastectomy/methods , Time FactorsABSTRACT
BACKGROUND: Twenty patients treated for lentigo maligna of the face with cryosurgery developed benign lentiginous hyperpigmentation mimicking a recurrence. OBJECTIVE: When cryosurgery is used in the treatment of lentigo maligna, it is important to know whether repigmentation of the scar represents true recurrence or a benign process. METHODS: Twenty patients were treated with cryosurgery for lentigo maligna of the face. Within a follow-up period of 7 to 80 months, frequent clinical observations were made. RESULTS: Lentiginous hyperpigmentation developed within the treatment area in eight patients. Histologic investigation revealed recurrence of lentigo maligna in three and benign hyperpigmentation in five. CONCLUSION: Genetic factors and UV exposure after cryosurgery may favor the development of benign lentiginous hyperpigmentation. Because recurrence of lentigo maligna must be considered, histologic evaluation of repigmentation is mandatory.
Subject(s)
Cryosurgery/adverse effects , Facial Dermatoses/etiology , Facial Neoplasms/surgery , Lentigo/etiology , Melanoma/surgery , Skin Neoplasms/surgery , Aged , Aged, 80 and over , Atrophy , Cryosurgery/methods , Epidermis/pathology , Facial Dermatoses/pathology , Facial Neoplasms/pathology , Female , Follow-Up Studies , Humans , Keratinocytes/pathology , Lentigo/pathology , Male , Melanins , Melanocytes/pathology , Melanoma/pathology , Middle Aged , Neoplasm Recurrence, Local , Skin Neoplasms/pathologySubject(s)
Arteriovenous Malformations/complications , Gastrointestinal Hemorrhage/etiology , Stomach/blood supply , Angiography , Arteries/pathology , Arteriovenous Malformations/diagnostic imaging , Arteriovenous Malformations/pathology , Embolization, Therapeutic , Female , Gastrointestinal Hemorrhage/therapy , Gelatin Sponge, Absorbable/therapeutic use , Hematemesis/etiology , Humans , Middle Aged , Phlebography , Veins/pathologyABSTRACT
It is frequently stated that a positive fungal culture is of little clinical significance unless the culture is obtained on repetitive blood specimens. We analyzed the mortality associated with a positive culture for Candida species in ICU patients from several locations over a 3-month period. Criteria for inclusion in this study were: (1) residence in the ICU for at least 4 days, (2) no GI tract alimentation during this period, and (3) administration of at least one antibiotic during this period. Forty-four patients fit these criteria; 23 had positive Candida cultures from at least one site and 12 (52%) died. Four of 21 patients (19%) who did not grow Candida died. Cultures of urine and sputum were most likely to be positive. Positive cultures from the urine, sputum, or wound were associated with at least a 50% mortality. This suggests that routine sputum and urine cultures may be of substantial clinical therapeutic and prognostic significance. Two patients had positive blood cultures and both died. No single class of antibiotics, surgical complications or underlying disease predisposed to these results. It is concluded that the presence of a single positive culture for Candida from any site in the critically ill surgical patient kept without GI alimentation and on any antibiotic is a grave prognostic sign which requires further attention.
