Congenital clefts of the nose: principles of surgical management.

Congenital clefts of the nose are rare and highly variable. Because there are few examples, standard methods for treatment do not exist. Therefore each patient must be evaluated and managed individually with respect to anatomic elements, timing, and sequence of reconstruction.

Evolving concepts of craniomaxillofacial fracture management.

Few areas in plastic surgery have changed as rapidly as the management of complex facial fractures. This article delineates five principles governing current management of the patient with injuries of the craniomaxilloficial skeleton.

Alterations in plasma copper, zinc, and ceruloplasmin levels in patients with thermal trauma.

This review was undertaken to elucidate the trends in copper, zinc, total serum protein, and ceruloplasmin levels in patients with thermal trauma. Medical records of pediatric and adult patients were retrospectively reviewed. The findings showed a significant linear decline in mean plasma copper, ceruloplasmin, and total serum protein during the first three days postburn, followed in general by a gradual rise in levels; however, patients with burns larger than 60% TBSA maintained copper, zinc, and ceruloplasmin levels significantly below the lower limits of normal during the observation period. Significant decrements in copper, zinc, total serum protein, and ceruloplasmin levels have been demonstrated in these patients. Trace metal determinations should be obtained in patients with significant burns soon after admission and routinely throughout their hospital course. Specific trace metal supplementation should be administered when indicated.

The current evaluation of nonpalpable breast lesions.

To understand the suspected low yield of malignant neoplasms from biopsies guided by needle localization, we reviewed 122 biopsies performed from January 1985 to November 1986 at University Hospital and Arkansas Baptist Medical Center, Little Rock. The positive biopsy rates were 3.5% and 10.6%, respectively. After review of these cases, the following guidelines for biopsy were developed: (1) Do not perform a biopsy on a low-density mass less than 1 cm in diameter. (2) Do not perform a biopsy for asymmetric density or questionable mass. (3) Do not perform a biopsy for secondary signs of malignancy such as skin thickening or asymmetric vasculature. (4) Biopsy is indicated for clustered calcifications, a dominant mass greater than 1 cm in diameter, stellate lesions, or interval change from a previous mammogram. These changes resulted in a positive biopsy rate of 15% for the period from November 1986 through April 1987.

The effect of rapid resuscitation upon cardiac index following thermal trauma in a porcine model.

Minipigs were divided into four experimental groups: nonburned control (C); burn, minimal resuscitation (MR); burn, standard resuscitation (SR); and burn, rapid resuscitation (RR). Resuscitation was begun 30 minutes postburn and hemodynamics were measured through 24 hours postburn. At 30 minutes postburn, the three burn groups demonstrated a significant decrease in cardiac index % (CI%). At 1 1/2 hours postburn, the RR group CI% was significantly greater than for the SR group and not significantly different from that of controls. At 2 hours postburn, fluid was abruptly decreased in the RR group and the salutary effect on CI promptly dissipated. In this model, the early decrement in CI following thermal injury is responsive to rapid resuscitation, concluding that the etiology of decreased CI following thermal trauma is at least partially due to inadequate volumes of fluid administration in the early postburn period.