Surgical treatment of gynecomastia: liposuction combined with subcutaneous mastectomy.

The purpose of the present work has been to evaluate surgical treatment of gynecomastia performed by liposuction combined with subcutaneous mastectomy. It was designed as a prospective consecutive registration of 21 patients (28 breasts) operated in a four month period. Treatment was done in local anaesthesia in the out-patient clinic. Treatment was in one patient complicated with a haematoma. In 86% of cases the patients were satisfied with the postoperative result. Liposuction combined with surgical excision of the gland performed as an out-patient treatment in local anaesthesia is followed by few complications and good cosmetic results.

[Primary breast reconstruction in connection with mastectomy for breast cancer. Indication, procedure and immediate surgical results]. / Primaer brystrekonstruktion i forbindelse med mastektomi ved mammacancer. Indikation, procedure og umiddelbare operative resultater.

Mastectomy and immediate reconstruction of 122 breasts were performed in 109 patients in close collaboration between plastic surgeons and general surgeons. In 56 patients reconstruction was performed using tissue expanders including 13 bilateral operations, 29 patients had a latissimus dorsi myocutaneous flap and 24 a free transverse rectus abdominis myocutaneous flap. There were 27 postoperative local complications in 122 reconstructions (22%), in five the reconstruction was lost. Only patients clinically in stage I were considered for reconstruction. After histopathological staging 27 patients received systemic treatment and 10 local radiotherapy as well. There was no complication during systemic therapy related to reconstruction. In 10 cases local radiotherapy was performed in full, with a delay of four weeks in one patient and a need for correction of the radiation field during treatment in one patient.

[Primary breast reconstruction after mastectomy for breast cancer]. / Primaer brystrekonstruktion efter mastektomi for cancer mammae.

Primary breast reconstruction in connection with mastectomy is a well-established procedure. The reconstruction may be carried out by the submuscular implantation of a prosthesis, in some cases preceded by tissue expansion. In situations where there is insufficient skin--or muscle-coverage, a musculocutaneous transposition flap may be used. The aim of breast reconstruction is to prevent the psychosocial sequelae of mastectomy. From experiences with secondary reconstruction, it seems that the reconstruction especially helps correct loss of feminine identity and negative body-image. Certain investigations indicate that primary reconstruction results in a clearly reduced postoperative psychological stress, whereas the extent of social and sexual sequelae seems not to vary when compared to results of secondary reconstruction. Conditions for adjuvant treatment as well as for follow-up concerning loco-regional tumour reappearance do not seem to be affected by the reconstruction. In studies published to date, consisting of relatively small patient groups and short observation periods, numbers without relapse and overall survival are found to be equivalent to that following mastectomy without reconstruction.

Silicone mammary implants and connective tissue disease.

The American Food and Drug Administration recently restricted the use of silicone gel-filled mammary implants for breast augmentations and reconstructions because a number of case reports had suggested that there was an association between silicone and connective tissue disease. We have found 36 such case reports published since 1982. Systemic sclerosis is the most common reported diagnosis (n = 15). Implants were removed from 15 patients, in nine of whom symptoms improved. The mechanism behind the postulated relationship is obscure, and most authors focused on an auto-immune-like response to silicone, which acts directly as a hapten or as an adjuvant. We found no conclusive evidence to implicate silicone mammary implants in connective tissue diseases. We do, however, recommend removal of implants from patients with severe connective tissue diseases. Patients with symptoms or active connective tissue disease should not be considered for silicone implants.

[Silicone breast implants and connective tissue disease]. / Silikone-brystimplantater og bindevaevssygdomme.

The American Food and Drug Administration (FDA) recently introduced a temporary stop for silicone breast prosthesis implants. The reason is a suspected connection between silicone implants and the development of autoimmune disease. The present authors have reviewed the 32 cases of connective tissue disease which have hitherto been reported in the literature, of these 13 were cases of systemic sclerodermia. On the basis of approximately 2 million silicone prosthesis implants which were introduced in USA alone during the past 20 years, approximately 200 cases of systemic sclerodermia would be anticipated. Nevertheless, the fact that several patients had spontaneous remission of their chronic disease after removal of the silicone implant speaks in favour of a possible connection. It is concluded that on account of the limited number of cases of connective tissue disease which have been reported in patients with silicone implants, insufficient evidence is present to stop implantation of these. Implantation of prostheses filled with saline are recommended for patients with connective tissue disease.

Grafting of human autogenous keratinocytes cultured in vitro.

A rapid method of producing epithelial material suitable for covering skin defects after burns and avulsions is presented. In vitro grown keratinocytes suspended as single cells in human plasma were applied to the wound surface and covered with distended meshed xenograft. In this way it was possible in five clinical cases to obtain 25-80% epithelial coverage of wounds up to 200 times as wide as the donor area.

[Epidemiology of burns. A follow-up from a 20-year period at Odense hospital]. / Brandskaders epidemiologi. 20 års opgørelse fra Odense Sygehus.

The numbers of patients admitted with burns, as an expression of the incidence of burns, registered in the Burns Unit, Odense University Hospital were compared for two ten-year periods: 1968-1977 and 1978-1987. A total of 1,548 hospitalized patients were involved. The etiology of the accidents, distributed according to sex, age and degree of severity and the number of deaths were calculated. A significant decrease in the total number of burning accidents was demonstrated, mainly due to the decrease in children aged 0-5 years and 6-15 years. Where the youngest children were concerned, this decrease was due to a decline in the number of scalds but also because of reductions in the number of contact burns and electrical and corrosive injuries. This was corrected for the altered age distribution with relatively fewer children during the second decade.

[Lesions of the male urethra]. / Mandlige urethralaesioner.

In cases where there is clinical suspicion of urethral lesion, blind urethral catheterization should never be performed. Establishment of a suprapubic catheter is a safe and adequate primary treatment. Retrograde urethrography may be undertaken in the subsequent diagnostic process and, in cases of simple contusions without interruption of continuity, urethral catheterization is performed. In addition, intravenous urography should be undertaken to reveal possible simultaneous lesions of the upper urinary tract. Anterior lesions rarely require further treatment whereas posterior lesions with interruption of continuity should be treated in specialized departments with special expertise in this type of lesion. Partial ruptures frequently heal without stricture formation requiring treatment. In cases of complete rupture, the best results, as regards development of late sequelae, are obtained by delayed reconstruction carried out three to four months after the trauma in the form of a two-stage operation employing a perineal skin-flap and secondary reanastomosis. In all types of urethral lesion, control miction-cystourethrography is recommended one year after the final treatment on account of the risk of stricture formation.

Congenital bilateral eventration of the diaphragm in a pair of male twins.

We present a case of congenital bilateral eventration of the diaphragm in a pair of male twins. The case is associated with severe pulmonary hypoplasia. Both infants died in the neonatal period. An exposure to Thiotepa in the first trimester of the pregnancy is a possible etiologic factor.

A case of squamous cell lung carcinoma with tetrasomy 7 and chromosome 1 C-band polymorphism.

Hyperdiploidy was observed in about 20% of the metaphase cells from a short-term culture of a squamous cell carcinoma of the lung. C-, G-and R-banding of both tumour and lymphocyte preparations showed constitutional C-band abnormalities in both homologues of chromosome No. 1. Based on these banding studies, the tumour karyotype was determined as: 48, XY, inv(1)(pter----q11::q21----qter), -1, -11, +7, +7, +19, +del(1) (pter----q11::q21----qter).

The influence of resection margin on prognosis in clinical stage I malignant melanoma of the lower leg.

The incidence of local recurrence and cumulative survival rate were compared for two groups of patients with stage I malignant melanoma of the lower leg. Group 1 included 119 patients treated from 1964 to 1978 with a wide local excision extending to the ankle. Group 2 included 58 patients treated from 1978 to 1981 with a 5 cm incision margin in all directions. Lesions within both groups were comparable based on measurements of tumor thickness. However, level of invasion indicated significantly more advanced lesions in the first group. Risk of local recurrence was related to thickness and ulceration. There were no statistically significant differences in frequency of local recurrences or cumulative survival rates between the two groups.

Ultrastructure of psoriatic epidermis.

The ultrastructure of human affected and unaffected psoriatic epidermis was studied in skin biopsies from 5 patients and 3 normal controls. Transmission electron microscopic investigations revealed abnormalities in all cell layers of the affected epidermis. Common to psoriatic keratinocytes from affected epidermis was the reduction of tonofilaments. The essential ultrastructural changes were located in the stratum granulosum and stratum corneum. Thus, absence of the fusion between the keratohyalin granules and the tonofilaments was found in stratum granulosum. The keratinocytes of the stratum corneum showed a large accumulation of ribosomes and vesicles resembling lipid vesicles.

A case of meningioma with frequent relapses and a hyperhaploid stemline.

A meningioma of the meningotheliomatous type showed frequent relapses after surgery. Cytogenetic analysis of a tumor biopsy after the last relapse showed a highly aberrant hyperhaploid stemline.

Bone and joint tuberculosis in Denmark.

Epidemiologic data on 100 patients with bone and joint tuberculosis reported in Denmark from 1980 to 1984 are presented. The annual incidence of skeletal tuberculosis remained unchanged during the period, although most other forms of tuberculosis showed a decreasing trend. Eighteen per cent of all the cases of bone and joint tuberculosis were found among young first generation immigrants, notably from Asia. In the native Danish population, bone and joint tuberculosis was almost exclusively found among the elderly. The lesions were most common in the spine and hip. Thirty per cent of the patients had a previous history of pulmonary tuberculosis.

Isolated carpometacarpal dislocation of the thumb. Case report.

Traumatic isolated dislocation of the first carpometacarpal joint, treated with internal fixation and immobilisation for 6 weeks, yielded satisfactory results. However, clinical and X-ray examination at 18 months follow-up demonstrated slight instability. Open reduction and suture of ligament and capsule should be considered.

Dermatome shaving of psoriasis.

Dermatome shaving was performed in 20 patients with chronic recalcitrant plaque psoriasis. The level of shaving was just beneath the superficial dermal vascular plexus. Healing was achieved in 2 weeks. After 1 year, six patients had shown no recurrence; 10 patients had a few guttate elements in the shaved area, while four patients had significant recurrence. Recurrences were related to residual acanthotic epidermis left after shaving. A general recommendation of surgical treatment for psoriasis would be hazardous on the basis of these results. However, shaving may constitute an alternative treatment of recalcitrant plaques of limited extent.