Benefits and pitfalls of vertical scar breast reduction.

A quality assurance study was undertaken three years after beginning the vertical scar breast reduction technique. We examined the rate of early and late complications (major and minor) and compared these to the formerly used inverted-T scar and L scar breast reduction techniques. Inverted-T scar breast reductions have an early complication rate of up to 20% and a late complication rate of 20-30%. Our vertical scar breast reduction is a modified Lassus technique, incorporating a geometrically based and measurable preoperative marking of the breast, a superior pedicle, a central breast resection, an intraoperative positioning of the nipple-areola complex, and occasionally a periareolar skin resection.In the time span examined (September 1998-December 2001) 153 patients could be included in the study. The resection weight per breast ranged from 60 to 1262 g (mean 390+/-210 g, median 380 g). The early complication rate (hematoma, seroma, wound dehiscence, wound infection and necrosis) was 21.6%. Of these cases, 19.6% were minor complications. The late complication or imperfection rate was evaluated very strictly using the standardized, extended scheme of Ferreira (problems of volume, shape, symmetry, areola, scars and position of the breast on the thorax) and was 26%. Major late complications necessitating a reoperation occurred in 11.1% of cases. These complication rates compare well to those of other vertical breast reduction techniques and T scar reductions in our own clinic and in the literature. Given that the vertical scar breast reduction method also results in shorter scars and a significantly better, long-lasting breast projection, this technique is clearly justified to remain the standard method at our clinic.

Malignant tumors associated with nevus sebaceous: therapeutic consequences.

Nevus sebaceous has been considered a relatively infrequent and unimportant congenital hamartoma for plastic surgeons unless the lesions are so big that they require a demanding defect closure. As the dignity of such tumors is primarily benign and the malformed sebaceous glands are localized abnormally high in the dermis, the temptation is appealing not to excise these tumors any more but to eradicate them by laser beam therapy. Yet a nevus sebaceous not only affects sebaceous glands but includes various other malformations of the affected skin and its appendages. In addition, different malignant tumors may occur in nevus sebaceous, even in children and young adults. We encountered 4 such malignant tumors of 18 nevi sebaceous operated on from 1989 to 1997. All nevi had been unsuspicious macroscopically. In three patients, one of them only 15 years old, an associated basal cell carcinoma was found. In the fourth patient there was a mixture of three additional tumors, a cystadenoma, a keratoacanthoma, and a basal cell carcinoma, besides the sebaceous malformations. These findings have two consequences: first, to continue surgical treatment of nevus sebaceous instead of dermabrasion or dermablation and to have the specimen examined histologically and, second, to excise such tumors as early in childhood as possible.

[The development of malignant tumors in nevus sebaceus--therapeutic consequences]. / Die Entwicklung maligner Tumoren auf dem Boden eines Nävus sebaceus--Therapeutische Konsequenzen.

OBJECTIVE: Nevus sebaceus has been considered a relatively infrequent and unimportant congenital hamartoma for plastic surgeons, unless the lesions are so big that they require a large closure of the defect. As such tumors are primarily of a benign nature and the malformed sebaceus glands are located abnormally high in the dermis, surgeons are tempted not to excise the tumors but to eradicate them by dermabrasion or laser beam therapy. Yet, a nevus sebaceus does not only affect sebaceus glands but includes various other malformations of the affected skin and its appendages. In addition, different malignant tumors may occur in nevus sebaceus, even in children and young adults. MATERIALS AND METHODS: We encountered 4 such malignant tumors out of 18 nevus sebaceus operated from 1989 to 1997. All nevi had been clinically inconspicuous. RESULTS: In three patients, one of them being only fifteen years old, an associated basal cell carcinoma was found. The fourth patient had a mixture of three additional tumours, a cystadenoma, a keratoacanthoma and a basal cell carcinoma besides the sebaceous malformations. CONCLUSION: These findings have two consequences. The first is to continue surgical treatment of nevus sebaceus instead of dermabrasion or dermablation and to have the specimen examined histologically. The second consequence is to excise such tumors as early as possible.

[Subjective tolerance to transesophageal echocardiography]. / Subjektive Toleranz der transösophagealen Echokardiographie.

Transesophageal echocardiography (TEE) is a new semi-invasive diagnostic tool in cardiology. We studied tolerance of TEE. 95 out of 121 consecutive patients were interviewed using a detailed, structured questionnaire (42 questions). Most patients (97%) received midazolam prior to TEE. TEE was tolerated well by 89% (n = 84) of the patients. Patients receiving a higher dose of midazolam (> 0.04 mg/kg bodyweight) tolerated TEE better than those in the lower-dose group (p < 0.0005), but they experienced side effects more often (p < 0.05) and did not tolerate fatigue as well (p < 0.0005). TEE was tolerated less well by younger patients (age < or = 45 years); they experienced more often local irritation than older patients due to the endoscope (52% versus 20% in older patients, p < 0.005) and complained more often about dysphagia (70% versus 24%) and sore throat (60% versus 19%) (p < 0.0005) after TEE. Patients < or = 45 years reported more side effects by midazolam than older patients, such as palpitations (30% versus 2%), hiccups (17% versus 0%), poor concentration (20% versus 3%), nausea (13% versus 2%), ataxia (17% versus 3%) or fatigue (88% versus 59%) (p < 0.05 to 0.0005). Females were more often afraid of TEE (53%) and the endoscope (56%) than males (35% and 23%, p < 0.08 and p < 0.002) and also disliked the endoscope more often (42%) than men (19%, p < 0.03). Some women complained about headaches after TEE (10%), whereas men did not (p < 0.05). Thus, TEE, after premedication with midazolam, is subjectively well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)