Benign symmetric lipomatosis Launois-Bensaude successfully treated with extensive plastic surgery.

Benign symmetric lipomatosis is a rare condition predominantly seen in male patients. The etiology is unknown, and therapy is difficult, although liposuction has had effect. We describe a 38-year-old male patient who had suffered from severe adipositas since the age of 7. Due to an ulceration in the groin, he later needed intensive care, and in order to normalize his condition, extensive surgical treatment became necessary.

[Benign symmetric lipomatosis--Launois-Besaude syndrome. A case report]. / Benign symmetrisk lipomatose--Launois-Bensaudes syndrom. En kasuistikk.

We describe the case of a 38-year-old male with a benign symmetrical lipomatosis Launois-Bensaude. He has suffered from severe obesity since the age of seven. At the age of 30, hypogonadism was diagnosed and treated. He developed a Pickwick-syndrome, with hypokapnia and secondary polycytemia. Ulcerations developed on the lower parts of his legs, which were treated conservatively for many years at our dermatological clinic. Because of intertriginous dermatitis in the right groin, he treated himself with external corticosteroids containing dequalonium. Ulceration and fatty necrosis followed, necessitating extensive plastic surgical intervention, with removal of approximately 30 kg of skin and adipose tissue.

Quality of the capsule in reconstructions with textured or smooth silicone implants after mastectomy.

Many women desire some kind of reconstruction after mastectomy for breast cancer to improve the cosmetic result. Since the introduction of silicone breast implants, capsular contracture has been the most common complication of breast augmentation or reconstruction. The aim of the present study was to evaluate the capsule quality in patients with breast cancer who had undergone reconstructions with either textured (rough) or smooth silicone implants after simple or modified radical mastectomy. Forty-three consecutive patients had reconstructions with textured silicone implants (49 implants) and were evaluated 32 months post-operatively in a prospective clinical trial. The last 43 consecutive patients who had reconstructions with bilumen smooth silicone implants (49 implants) acted as controls. The results were graded by Baker's classification. Among the patients with textured implants only 9% (4/47) was graded as having moderate or severe capsular contracture in contrast to 24% (11/46) in patients with bilumen smooth-surface implants (p < 0.05). These results confirm previous reports that favour textured silicone implants in breast augmentation and reconstruction.

[Waiting lists and reality. Revision of the waiting list for reduction of breast hyperplasia in health region 1]. / Ventelister og virkelighet. Revisjon av ventelisten for mammahyperplasti i helseregion 1.

The Red Cross Hospital is the only public hospital providing plastic surgical services for the Oslo population. The waiting list for reduction mammaplasty had become unacceptably long. Some women had been waiting for as long as 4.5 years. We therefore decided to reexamine all the 309 patients in question. Only 22% were cleared for operation. 19% were removed temporarily from the waiting list due to obesity (awaiting weight reduction). The remainder was found to be either mainly motivated or to be motivated for mainly oesthetic reasons and therefore not eligible for public health funding.

Early tongue resection for Beckwith-Wiedemann macroglossia.

Dentists are aware of the extraordinary influence an active thrusting tongue can have on dental development. In the presence of the profound muscle hypertrophy characteristic of macroglossia in the Beckwith-Wiedemann syndrome, a compelling need exists for surgical reduction of the tongue as early in life as possible. This report describes our clinical experience with 3 children, 1 referred late and the other 2 treated within the first year of life.

Jejunal diverticulosis with perforation and peritonitis. Case report.

Non-Meckelian diverticula of the jejunum and ileum are reported to occur in 0.3-4.6% of all autopsies. A case with the rare complication of perforation and peritonitis is reported. The perforated diverticulum, partly hidden by the mesenteric fat may be hard to detect. The condition should therefore be looked for specifically by the surgeon when laparotomy fails to disclose perforation in the usual locations.

Plasma acetate concentrations during canine haemorrhagic shock.

Acetate, pyruvate, lactate and NEFA concentrations, as well as acid-base-parameters were followed during bleeding, stable hypotension and re-infusion in five dogs. Mean arterial blood pressures were kept at 30 mmHg during the shock phase. An increase in acetate concentrations (P less than 0.01) was found in arterial as well as in venous plasma samples. The maximal mean acetate concentration was 0.19 mmol/l (during reinfusion) as compared to 0.06 mmol/l prior to bleeding. There was no difference between arterial and inferior caval venous concentrations. A definite correlation (r = 0.81, P less than 0.02) was found between blood pyruvate and plasma acetate concentrations. There was no correlation between plasma glucose or NEFA and acetate concentrations or between blood excess lactate and plasma acetate. The plasma acetate accumulation was negligible compared to the concomitant lactate accumulation (1:60), and did not contribute to the metabolic acidosis of shock. The correlation between acetate and pyruvate concentrations may indicate that pyruvate is the main substrate of acetate production in hypovolemic shock.

Utilization of exogenous acetate during canine haemorrhagic shock.

Plasma acetate and lactate, as well as acid-base-parameters were followed during acetate (dogs I-V) or lactate (dogs VI-X) loading during stable hypotension (mean arterial blood pressure 30 mmHg). Acetate or lactate were infused at a constant rate of 4 mmol/kg/h as 0.5 mol/l solutions (50% as the sodium salt, 50% as the free acid) without simultaneous treatment of the volume deficit. The acetate metabolizing capacity was well preserved even in profound haemorrhagic shock. The actual loads were rapidly removed, while the equivalent lactate loads caused progressive accumulation of the lactate ion. Acetate loading did not aggravate the lactic acidosis, and the acid-base-parameters showed a more favourable development during acetate loading than during lactate loading. Acetate may thus be given during haemorrhagic shock without the same risk of accumulation that is carried by the equivalent amounts of lactate.

Acetate production and substrate availability in the dog.

Arterial plasma acetate, glucose and NEFA concentrations were measured during loading with glucose/insulin and fat emulsion/heparin, and during epinephrine and norepinephrine stimulation in dogs. The expected alterations in glucose and NEFA concentrations were found. Acetate concentrations were not influenced, and remained constant in all experiments. Since acetate removal from the body pool is mainly concentration dependent, it may be concluded that acetate production was constant under the conditions described. "Overflow disposal" of AcSCoA to yield free acetate in cases of high rates of AcSoA-production does not occur as long as the Krebs cycle is intact.

A gas chromatographic method for determination of acetate levels in body fluids.

A simple, sensitive and accurate gas chromatographic method for the determination of acetate in plasma and urine is described. Following precipitation of proteins by perchloric acid and removal of potassium perchlorate by precipitation with KOH, acetic acid is quantitated by injection of the acidified sample on a highly polar column. A flame ionization detector is used. Propionic acid is added to the sample initially as internal standard. The sample volume required for the analysis is 0.5 ml. The standard curve is linear in the range from 0.01 to 10 mmol/l. Recovery of added acetate is complete, and the coefficient of variation is less than 4% even at low concentrations. The concentration of free acetate in plasma from 10, and urine from 4, healthy humans ranged from 0.04 to 0.07 and 0.09 to 0.24 mmol/l, respectively.

Intra-aortic balloon pumping in the treatment of cardiogenic shock following open-heart surgery.

Intra-aortic balloon pumping (IABP) was used in the treatment of 29 patients in cardiogenic shock refractory to pressor drugs subsequent to open-heart surgery. Nineteen patients recovered from the shock primarily, but four died later in hospital. The remaining 15 were discharged alive. Peroperative electromagnetic flow measurements in one patient showed a 23% increase in aortic flow and a 26% increase in aortocoronary bypass flow when pumping was started.