Glioma of the tongue.

A case of glioma of the tongue that was treated successfully by simple excision and repair is presented. It may represent neural tissue that remains in the occipital somites that differentiate into the tongue muscles. Histologically, it consists of sheets of glial tissue. The literature is reviewed, and the case is discussed.

Breast reconstruction after mastectomy.

UNLABELLED: This activity is designed for primary care physicians. GOAL: To appreciate the significant advances and current techniques in breast reconstruction after mastectomy and realize the positive physical and emotional benefits to the patient. OBJECTIVES: 1. Understand basic and anatomic principles of breast reconstruction. 2. Discuss the options for breast reconstruction: a) immediate versus delayed; b) autologous tissue versus implant; and c) stages of reconstruction and ancillary procedures. 3. Provide a comprehensive overview of the risks and benefits of, as well as the alternatives to, each approach so primary care physicians can counsel patients effectively.

Restoration of breast contour with autologous tissue after removal of implants.

There is increasing demand for removal of silicone-gel and saline implants. We report our experience with reconstruction using autologous tissue after explantation. We used the dual-pedicle dermoparenchymal mastopexy, previously reported, and the de-epithelialized transverse rectus abdominis muscle pedicle, both of which have produced satisfactory results. There have been no significant complications, and patients have expressed satisfaction with the lasting results of both techniques.

Pseudolymphoma of the breast.

A 27-year-old woman presented with a chronic mastitis treated by subcutaneous mastectomy and a deepithelialized TRAM flap reconstruction. The pathology indicated pseudolymphoma of the breast, a rare benign condition. The course of treatment and a brief description of the pathology are given.

Sternal keloids: successful treatment employing surgery and adjunctive radiation.

Traditional treatment of keloids by surgery or surgery combined with other techniques has met with limited success. Successful treatment of sternal keloids by surgical excision and skin grafting, followed by radiation therapy is reported. Eleven patients, ranging in age from 14 to 66 years, were so treated. The groin was used as a donor site in all patients. Postoperative radiotherapy was administered to suture lines only, using three doses of 500 cGy each, such that 1,500 cGy was delivered within 7 to 14 days of surgery. The protocol was followed without variation in all patients. Follow-up ranged from 1 to 24 years. Only 1 patient demonstrated recurrence. Six patients received postoperative, episodic steroid injections for localized itching or nodule formation. None of these patients demonstrated recurrence of their keloids.

A prospective randomized double blind study of perioperative antibiotic use in the grafting of ulcers of the lower extremity.

We conducted a prospective, randomized, double blind study of the use of a perioperative antibiotic in the skin grafting of arterial and venous ulcers of the lower extremity. Ninety-four patients were randomized and 90 were available for analysis. There was no statistically significant difference in graft "take" or incidence of recipient site infection in the antibiotic versus the no antibiotic group.

Dual-pedicle dermoparenchymal mastopexy.

Mastopexy for treatment of breast ptosis, with or without augmentation or reduction, is often followed by recurrent ptosis. A new mastopexy technique is described which appears to offer long-term correction. After conservative resection of excess skin, the breast parenchyma is elevated from the chest wall, and redundant caudal deepithelialized breast tissue is divided into two equal (or unequal) superiorly based pedicles. These are criss-crossed (as in folding of arms), overlapped, and secured to the pectoral fascia in a position cephalad to the nipple-areolar complex. This technique, dual-pedicle dermoparenchymal mastopexy (DPM), forms a cone of the breast tissue and provides a "cradle" of support. It permits insertion of a prosthesis if needed. Based, in part, on concepts of traditional and more recently described pedicled breast reductions, it enjoys the advantage of preserving skin attachment to underlying unresected breast parenchyma. In addition, it repositions ptotically displaced breast parenchyma into a cephalad position and fixes it (the "pexy") to the chest wall. A 10-year experience is presented with representative cases to illustrate the basic mastopexy and its use with augmentation or reduction.

Diazepam and fentanyl as adjuncts to local anesthesia.

A method is presented for supplementing local anesthesia with intravenous diazepam and fentanyl. Ease of administration and high patient acceptance in over 1500 cases is discussed.

Pigmentation after dermabrasion: an avoidable complication.

A 20-year retrospective study of patients undergoing dermabrasion is reported. All patients included in this study met the strict criteria of a minimum of a 6-month follow-up examination, abstention from exposure to sun, and photographic documentation. Fifty-nine percent were seen at 1 year or more, and 41 percent were seen at 5 years or more. Unfavorable pigmentation as a result of dermabrasion was encountered in only eight patients. In seven, this receded with the passage of time. The eighth was lost to follow-up. Hypopigmentation was noted in three patients: two blacks and one Caucasian. Persistent redness occurred in three Caucasian patients. Recurring pigmentation with exposure to sun, continuing years after the procedure, was reported in two black patients and two Caucasian patients. Hispanic patients appear to be more aware of subtle pigmentary and textural changes. Adverse pigmentation does not appear to be an inevitable consequence of dermabrasion in patients who abstain from exposure to sun in the initial postoperative period. Dermabrasion is viewed as a valuable surgical procedure for improvement of acne and other scar deformities.

Effect of hemorrhage and anoxia on hepatic gluconeogenesis and potassium balance in the rat.

Previous investigations have demonstrated impairment of hepatic gluconeogenic activity during both hypovolemia and sepsis, but the mechanisms responsible remain unclear. The present study was designed to determine the influence of lack of oxygen on gluconeogenesis independent of humoral factors, products of ischemic peripheral tissues or pH changes. Livers obtained from Sprague-Dawley rats fasted 24 hours were perfused with Krebs-Henseleit buffer containing 5 mM lactate for 30 minutes. In the control group (n = 8) perfusion was continued; in others, anoxia was induced by perfusing with buffer equilibrated with 95% N2 and 5% CO2 for periods of 15, 30, or 60 minutes (n = 4, 5, and 5, respectively). The initial conditions were then reinstituted for an additional 45 minutes. Anoxia caused hepatic release of K+, indicative of disordered hepatic cellular ionic gradients and an abrupt cessation of gluconeogenesis. Reoxygenation partially reversed these alterations but some impairment of gluconeogenesis persisted and the degree of uptake of K+ from the perfusion media was decreased as the duration of anoxia increased. The degree of restoration of gluconeogenesis after a period of anoxia was closely associated with restoration of cellular uptake of K+. By comparison, livers taken from hypovolemic animals maintained at a mean arterial blood pressure of 40 mm Hg until the beginning of the decompensatory stage of shock exhibited a gluconeogenic capacity of only 41% of control animals and was comparable to the compromise induced by between 30 and 60 minutes of anoxia. These results suggest that the abilities to restore hepatic electrolyte balance and gluconeogenesis after oxygen deprivation are affected in parallel and may reflect a common dependence on the restoration of ATP stores after the insult.

Amniotic fluid adenosine 3',5' - monophosphate in prostaglandin-induced midtrimester abortions.

Cyclic adenosine 3'5-monophosphate (cAMP) was serially measured in the amniotic fluid (AF) of 9 patients undergoing midtrimester abortions induced by intraamniotic prostaglandins. The results demonstrate an increase in AF cAMP ranging from 2- to 7-fold within the 6 hours of observation. The fetal heart tones were closely monitored by a Doppler instrument and the time from injection of abortifacient to fetal demise (IDT) and to fetal expulsion (IAT) was accurately recorded. No correlation between the rate of AF cAMP increase and IDT or IAT could be demonstrated. The concentration of cAMP in amniotic fluid obtained from patients with fetal demise in utero was lower than that found in AF of fetuses of corresponding gestational age where the fetus was alive. The significance of AF cAMP as a potential indicator of fetal distress is discussed.