The silicone gel breast implant controversy: current status and clinical implications.

The silicone breast implant controversy has amassed a great deal of media coverage in the past year. Unfortunately, separating fact from fiction has been extremely frustrating and difficult, not only for physicians but for women who have either had or are considering cosmetic or reconstructive surgery of the breast. At a recent meeting attended by most of the board eligible and certified Plastic and Reconstructive Surgeons in the State of Arkansas, it was felt that a consensus statement was needed to clarify the issues and inform other Arkansas physicians of the most up to date information. The result is a fairly comprehensive review which will require your indulgence. Breast implants are placed not only by Plastic and Reconstructive Surgeons, but by Otolaryngologists, "Facial Plastic Surgeons", Obstetricians/Gynecologists, General Surgeons, Dermatologists and Family Practitioners. We believe it is the ethical and legal responsibility of the physicians who elect to perform these procedures to provide adequate care and follow-up for these patients when either real or perceived problems arise. Accurate information, reassurance and occasionally re-operations are required for many of these patients.

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.