Some remarks on breast reduction by the “B” technique

The main disadvantage of the popular techniques for breast reduction are the scars left around the breasts. We present our experience with the B technique for breast reduction, which creates a much smaller size scar that is well hidden under the brassiere. Our conclusion is that the B technique is the method of choice for most breast reductions.     

Cranioplasty of an extremely large cranial defect caused by transitional meningioma with a knitted polypropylen-polyester prothesis “Codubix”

Summary The authors report a case of transitional cell meningioma of the convexity which destroyed a large portion of the calvarium and invaded subcutaneous tissue. The tumour was totally removed and a large cranial defect/430 cm² in size/ was filled with a polypropyleno-polyester knitted prothesis Codubix with an excellent result.The problems of chronioplastic closure of such an unusually large skull defect and the advantages of the use of the material Codubix are discussed.     

Association of meningiomas with dural “tails”; Surgical significance

Summary Intracranial meningiomas are characteristically benign tumours with a tendency to recur following surgical resection. Our group is investigating the pathogenesis of meningioma recurrence. In our initial studies we identified two cases of dural tails associated with intracranial meningiomas. Gadolinium-enhanced magnetic resonance images were utilized to identify the dural tails preoperatively. These images aided us in performing a more complete surgical resection of the meningiomas. Histopathological confirmation of meningotheliomatous cell infiltration into the dural tails demonstrates their surgical significance.     

Simplified design of the “B” technique mammoplasty

The preoperative design of the B technique mammoplasty is somewhat complicated and less precise than that of other methods of breast reduction. A new maneuver for simplification of the design is presented.     

Oral animation in the decision for chin augmentation

Oral animation, such as opening and closing the lips, smiling, or laughing, leads to muscular tension over the skin and the soft tissues of the chin. The S-like labiomental line presents a variable scope of curves, from a full curve, through lazy-S, to a straight line. The different profiles of the chin thus achieved enable the plastic surgeon during preoperative planning to decide whether or not to perform chin augmentation in addition to the required rhinoplasty. Anatomical, functional, and clinical data are presented and discussed.     

Benigner hellzelliger Lungentumor (≫Sugar Tumor≪)

Zusammenfassung Es wird ein Fall eines benignen hellzelligen Lungentumors (sugar tumor) bei einem 69jährigen Mann vorgestellt. In der Weltliteratur wurden bisher nur 16 ähnliche Fälle beschrieben. Probleme der Diagnose sowie der Pathogenese werden erörtert.

---

Benign clear cell tumor (sugar tumor) of the lungCase report and review of the literature

Summary A case of a benign clear cell tumor of the lung (sugar tumor) in a 69 year old man is presented. The world literature lists only 16 similar cases to date. Problems concerning diagnosis and pathogenesis are discussed.

     

“Tear-Drop Augmentation Mastopexy”: A Technique to Augment Superior Pole Hollow

Breast ptosis classification systems focus on the inferior descent of the nipple, as well as the descent and distribution of the breast parenchyma below the inframammary fold. Common problems, such as development of a superior pole hollow and an excessive width of the superior pole, extending into the axilla, are not addressed. Few procedures specifically address these deficiencies, and even less information is available in terms of preventative maneuvers when augmentation is desired as an adjunct. Round implants worsen the problem by creating a superior pole shelf, and anatomic implants are unreliable alternatives. Here, we present a technique—tear-drop augmentation mastopexy—that addresses superior pole hollow, excess superior pole width, as well as breast ptosis and hypomastia. Patients with moderate to severe breast ptosis (Regnaults classification), tubular breast deformity, and deformities secondary to previous breast surgery are included in the study. Skin is deepithelialized through a circumareolar incision, and a skin-fat flap is elevated completely encircling the breast. A 2-cm area of parenchyma is left attached to the skin in the lower half of the breast. Breast parenchyma in the superior half of the breast is then advanced and plicated in a superiomedial direction to move the nipple areolar complex to the desired new position. Care is taken to redefine the pectoralis major muscle at its axillary border. A 3-cm incision is then placed in the inferior part of the parenchyma at the 6 oclock position to create a subpectoral pocket for placement of the implant. The tunnel is then closed to separate the implant pocket from the subcutaneous dissection. Residual dermal flap is used to define, and add durability to the parenchyma reshaping procedure. A 3-0 mersiline (Ethicon, Somerville, NJ) blocking suture is used for a uniform circumareolar skin closure. Patients (n:35), ages 17–48, underwent tear-drop augmentation mastopexy between January 1999 and September 2002 for correction of the breast ptosis, tubular breast deformity, and deformities secondary to previous aesthetic breast surgery. The average follow-up was 2 years. All patients displayed type 1 or 2 (Baker classification) capsules. One subcutaneous hematoma and one subcutaneous seroma were seen, which were both treated by percutaneous aspiration. No submuscular hematomas, infections, skin or nipple losses, or hypertrophic scars were noted. Patient satisfaction was high. A more natural tear-drop breast shape was created with an improvement in the superior pole hollow and narrowing of the superior breast. The smallest breasts did not benefit from this technique for elimination of the superior pole shelf, as correction was proportional to the amount of breast tissue available for superior advancement. The tear-drop augmentation mastopexy is a novel technique for correction of the breast ptosis with augmentation, avoiding problematic development of superior pole hollow and excess superior width. This technique is also well applied to tubular breast deformity as well as to secondary breast procedures. Long-term follow-up demonstrates a safe and reproducible result with high patient satisfaction. This technique may solve several problems associated with breast ptosis surgery, which before were not specifically addressed, and the technique warrants further investigation.     

Correction of breast ptosis utilizing a “fold over” de-epithelialized lower thoracic fasciocutaneous flap

In the operation described, vascularized dense connective tissues, consisting of two layers of dermis or fascia, are supplied from below the inframammary fold and shaped surgically into a supportive subcutaneous cup. The reconstruction adds to the effect of the dermal mastopexy for the treatment of breast ptosis. This fasciocutaneous type of flap also augments the breast, and a pleasing projection may be achieved without resorting to an implant. The degree of augmentation depends upon the thickness of the subcutis donor site.     

33. Der „kalte” Schilddrüsenknoten

Zusammenfassung Der kalte Schilddrüsenknoten gilt als typischer Verdachtsbefund für ein Schilddrüsencarcinom. Seine tatsächliche Dignität ist mit klinischen Mitteln sowie Szintigraphie und Sonographie letztlich nicht zu klären. Das beste abgrenzende Selektionskriterium ist die Feinnadel-Punktionscytologie, wodurch mit Gültigkeit für das Kropfendemiegebiet etwa die Hälfte als suspekte Befunde von dem anderen Teil hochwahrscheinlich gutartiger Veränderungen getrennt und für die Operationsindikation reserviert werden kann.     

Inverted nipple: The new method of correction

A new technique for correcting inverted nipples is described. It consists of the sectioning of the only genetic factor—the resistance of the collagen fibers—by undermining, under the control of a palper. The trophicity of the nipple is assured by a circular umbrella musculocutaneous flap containing the superficial vascular system. A subdermal cutaneous notch blocks the nipple and prevents any recurrence.     

Treatment of alar cartilages: Should the “domes” be interrupted?

The author emphasizes that conservative rhinoplasty techniques are frequently satisfactory, but in certain techniques there is a limit to which nasal tips can be reshaped. In certain circumstances, therefore, interruption of the domes of the alar cartilages is suggested to achieve the most satisfactory aesthetic results.     

Suction-assisted lipectomy does not increase the risk of random flap necrosis in a randomized study in pigs

Thirty-two dorsally based random flaps were raised in eight Yorkshire pigs (26–31 kg) after infiltration with 200 mL of dilute lidocaine (0.1%) with epinephrine (1:1,000,000) into each flap. Prior to elevation 16 of the flaps were treated with syringe-assisted liposuction, while the remaining flaps served as controls. One week postoperatively the viability of the flaps was assessed with computer-assisted planimetry of the necrotic area and by measurement of capillary blood flow using radioactive microspheres. The mean area of necrosis was nearly identical in the flaps treated with liposuction and in the control flaps, and there was no statistically significant difference in blood flow between the groups. The results show that liposuction performed with the super-wet or tumescent technique can be done prior to elevation of flaps in pigs without increasing the risk of flap necrosis.     

121. Modifizierte Technik der „Ersatzklappen”-Operation an der V. poplitea bei postthrombotischem Syndrom

Zusammenfassung Die Technik der Ersatzklappen-Operation an der V. poplitea bei postthrombotischem Syndrom wurde vom Initiator durch die Verwendung einer 24cm langen Silicone-Sehne modifiziert. Die Silicone-Sehne wird zwischen A. und V. poplitea durchgezogen, ihr mediales Ende an die Gracilissehne und ihr laterales Ende um die Bicepssehne vernäht. Bei 31 durchgeführten Operationen konnte klinisch und phlebographisch bei allen eine regelrechte Ersatzklappen-Funktion und eine Besserung der venösen Hämodynamik des Beines festgestellt werden.     

Arthrolyse «élargie» de la tibio-tarsienne

Résumé A propos de 12 cas de raideur en équin de l'articulation tibio-tarsienne, les auteurs présentent leur technique d'arthrolyse «élargie» qui leur a toujours permis de corriger l'attitude vicieuse du pied. Ils analysent les résultant obtenus et définissent les indications de cette intervention.Ils insistent sur l'intérêt qu'il y a à réorienter sans section osseuse, le secteur de mobilité de la tibio-tarsienne, en conservant les surfaces articulaires.

---

Extended arthrolysis of the tibio-tarsal articulation

Summary The authors describe a technique of extended arthrolysis in 12 cases of tibio-tarsal equinus. This has consistently corrected the defective position of the foot. The results are analysed and the indications are defined.The importance of reorientating the sector of the tibio-tarsal mobility without bone section is stressed and the conservation of all articular surfaces.

Chargé de recherche à l'INSERM     

Deformation: Its application to cosmetic facial surgery

The principles of deformation have come to our attention through the study of technical skills in art. It creates emphasis on the motif of a work by transformation and results in the illusionary phenomenon that makes the total appearance more harmonious and impressive. With this artistic technical concept compounded with our surgical experiences, we designed the deformation technique for facial corrective surgery. Introducing some distinctive cases applying this technique, we show its advantages over the see a defect, correct the defect limitations to present surgical techniques and the good effect of the patient's mind and attitudes.Presented at the 17th Annual Meeting of the American Society for Aesthetic Plastic Surgery, Los Angeles, California, April 20, 1983     

Laparoscopic bipolar strip-tease appendicectomy

Since its conception, several techniques have been described for laparoscopic appendicectomy. We describe a technique which utilizes a 5-mm bipolar forceps designed to coagulate and cut tissues at the same time; 50 pediatric patients underwent laparoscopic appendicectomy for acute appendicitis using this stripping and teasing technique. No bleeding complications occurred. There were only two postoperative abscesses in the series. We believe that the bipolar laparoscopic striptease appendicectomy technique as developed by the senior author is safe, quick, and effective, even for severe appendicitis.     

Fibrinogen osaka IV: A congenital dysfibrinogenemia found in a patient originally reported in relation to surgery,now defined to have an Aα arginine-16 to histidine substitution

We discovered a congenital heterozygous dysfibrinogen in a patient and reported this case in relation to surgery some time ago (Jpn J Surg (1988) 18:43–46).³ Further studies on the isolated abnormal population of fibrinogen derived from this patient have revealed that fibrinopeptide A was not cleaved by ancrod, a snake venom-derived thrombin-like enzyme, but by thrombin, slowly but completely. The released fibrinopeptide A components, being the A, AY, and AP peptides, were all found to be abnormal, as evidenced by slightly earlier elution positions on high-performance liquid chromatography, compared with the normal counterparts. By analyzing their amino acid sequence, we have identified an arginine to histidine substitution at position 16 of the A chain, the thrombin cleavage site. Utilizing insolubilized abnormal fibrinogen, we confirmed that the polymerization site assigned to the central E domain, the A site, was exposed by thrombin, but not by ancrod. This dysfibrinogen, designated as fibrinogen Osaka IV, is the second abnormal molecule with an A arginine-16 to histidine substitution identified among Japanese families.     

Tumor necrosis factor-α blocking agent as a treatment for nephrotic syndrome

We report a 13-year-old boy with refractory nephrotic syndrome (minimal change with mesangial proliferation) who failed the standard treatment protocols. There was some temporary response to large steroid doses, but even the Mendoza protocol could not induce remission. We show suppression of the proteinuria with Infliximab (Remicade) with tapering of steroids. Serial serum levels of tumor necrosis factor (TNF)- are shown and discussed. We suggest studying the TNF- blocking agents as optional treatment for nephrotic syndrome.Editorial comment Before the decision was made to accept this report for publication, it was carefully considered by both medical and ethical experts with special regard for the acknowledged relationship between the patient and one of the treating physicians. We believe that this hypothesis paper may be of interest to our readership.