Local anesthesia in breast augmentation

The Authors report their experience in the application of local anesthesia during breast prosthesis implantation.     

Prevention and treatment of complications of inflatable penile prosthesis surgery: a review article

Over the last 16 years more than 3,000 procedures involving multi-component inflatable penile prosthesis have been performed. A variety of types of complications have been encountered, including mechanical problems with the prosthesis, intraoperative complications, postoperative complications, problems with infection and patient dissatisfaction. During the course of this experience we have made some observations and developed techniques to minimize and treat the complications seen with both routine and difficult inflatable penile prosthesis implantation surgery.     

Technical note: appearances on ultrasound of impalpable injection port in a double chamber breast prosthesis

Breast reconstruction utilizing tissue expansion is being increasingly practised by both plastic and general surgeons. Our current experience for both immediate and delayed reconstruction is with the double chamber Becker prosthesis. The prosthesis with the resulting breast mound has on occasions rendered the injection port difficult to localize by palpation. We have found ultrasound useful in identifying impalpable ports and in facilitating needle insertion into the injection dome.     

The comparative characteristics of methods for breast reconstruction after a mastectomy

Ablation of the breast because of cancer is a damaging operation leading the patients on a heavy psycho trauma. At the background of the main disease--cancer, deformation of the chest wall, caused by mastectomy their depression deteriorates. Therefore the breast reconstruction today is considered as an indivisible part of the complex treatment process. The techniques by means of witch the reconstruction could be achieved are: implantation of breast prosthesis, pedicle or free myocutaneous flaps. We enclose the comparative characteristic of the treatment results of 70 patients using different techniques.     

Plasti-pore implants in middle ear surgery

Plasti-pore, a high-density polyethylene sponge, was one of the earliest biocompatible materials developed specifically for implantation in the middle ear. It is one of the most nonreactive materials known when tested in simulated biochemical exposure to pseudoextracellular fluid. The two basic prosthetic designs are the total ossicular replacement prosthesis and the partial ossicular replacement prosthesis. Plasti-pore implants have now been used for 20 years and are widely accepted by otologic surgeons. The basic properties of the material, implant design, and surgical techniques involved using these prostheses are reviewed in this article.     

Gamma scintigraphy of a 123I-labelled N-(2-hydroxypropyl)methacrylamide copolymer-doxorubicin conjugate containing galactosamine following intravenous administration to nude mice bearing hepatic human colon carcinoma

A surgical method for treatment of the extremely hypoplastic tuberous breast is described. It is based on turning differently shaped glandular flaps to correct the deformity, followed by insertion of a prosthesis, and, where necessary, correction of areola size and position and adjustment of the skin of the inferior pole. The results so far have afforded total and recurrence-free aesthetic correction of the usual deformities. The underlying aim of the operation is to transform a hypoplastic tuberous breast into a simple hypoplasia without discarding gland tissue which can be used to thicken the most deficient mammary area.     

The breast and sports: issues for the clinician

Although a number of recent reviews have focused on the effects of exercise and sports on menstrual function, minimal emphasis has been placed on how the breast is affected. Increasing numbers of female athletes are participating in previously male-dominated contact sports; the effect on overall breast health from medium-to-high impact activities remains to be seen. This article reviews the basic anatomy and embryology of breast tissue, outlines various problems of the breast that the adolescent athlete may encounter, and offers management strategies for such problems.     

Postoperative acute pulmonary edema: a rare presentation of pheochromocytoma

The Duromedics bileaflet pyrolitic carbon mechanical prosthesis was introduced by Hemex in 1982 and subsequently acquired by Baxter. This communication documents a case of sudden leaflet fracture of a Duromedics mitral valve 48 months after implantation, which was managed successfully by replacement with a St. Jude Medical mechanical prosthesis. The patient presented in acute distress with paroxysmal atrial tachycardia and pulmonary edema. Transesophageal echocardiography was used to diagnose the leaflet fracture. The fracture had occurred transversely, with the fragments embolizing bilaterally to the iliofemoral arteries. These were removed at a subsequent operation. Cases of such fractures of the Duromedics prosthesis have been reported, with cavitation damage being the postulated mechanism.     

Complications with infection and foreign body reaction after silicon implant arthroplasty in the second metatarsophalangeal joint in an adolescent: a case report

A 21-year-old otherwise healthy male was referred to our clinic due to severe pain, deformation, development of fistules, and swelling of the second metatarsophalangeal joint of the right foot. He presented a history of two previous operations. At the age of 13, a 2-cm. resection of the distal part of the proximal phalanx was performed due to severe hammertoe deformity. At the age of 19, a partial phalanx resection and implantation of a silicon elastomer ball-shaped joint spacer was performed due to second metatarsophalangeal joint instability. After this operation, the patient suffered from fistules that appeared in the second metatarsophalangeal region. Following referral to our clinic, the patient was operated on. The proximal phalanx was removed along with the prosthesis which had slipped from the metatarsophalangeal joint into the proximal phalanx with the ends of the prosthesis perforating the skin. Debridement of infected tissue and implantation of gentamicin containing beads were performed. Bacterial specimens revealed growth of coagulase-negative staphylococci. Microscopic examination of the debrided tissue showed signs of acute and chronic inflammation. Postoperatively, the patient was treated with antibiotics and healing was uneventful. This case advocates the need for proper selection criteria and strict indications in patients with joint disease needing an arthroplasty.     

Stapedectomy--fistula repair

Perilymphatic fistulae have been proposed to occur most frequently on the short side of the graft in stapedectomized patients. The usual recommendation in fistula cases has been replacement of the entire prosthesis by a piston and tissue graft complex. In this case the stapedectomy had been performed, using a polyethylene Shea strut, 15 years previously. The air-bone gap had been closed during this entire period. A fistula was suspected after sudden hearing loss developed after barotrauma. At the time of exploratory tympanotomy, a fistula was noted on the long side of the oval window graft. It was elected to leave the polyethylene tube prosthesis in place because of its solid fixation, both laterally and medially. The fistula was closed by subcutaneous tissue graft.     

The use of Holmstrom's flap in breast reconstruction

The authors consider 12 cases of breast-reconstruction after mastectomy, made with the Holmstrom's flap, to verify the validity and the real utility of this way of reconstruction. It has been made a follow-up of 4 years, to verify, in course of time, the characteristics of the reconstructed breasts. All the patients have been operated in a general surgery department. The Holmstrom's flap has been prevalently used in patients, during immediate reconstruction. The breast reconstruction, made with this fascio-cutaneous transposition flap, requires the use of prosthesis. The operating time has a very short duration. The breast reconstruction, made with this method, requires a very short staying in hospital. The nipple-areola complex reconstruction has been made in a second time, few months later. The patients have been examined periodically, to verify, immediately, the result of the flap and, later, the quality of the new breast's shape and the occurrence of capsular contracture. The results achieved with this reconstructive method are a good shape and ptosis as to confer great naturalness to the new breast. The authors conclude that, even if they use the TRAM-flap as first choice in breast-reconstruction, the Holmstrom's flap is a reconstructive technique of great utility in immediate breast reconstruction, that is able to give very good aesthetic results.     

Breast cancer arising in surgical scars

Twelve women who developed breast cancer at the site of old surgical scars in the breast are presented. Six had had former breast biopsies, 3 drainage of breast abscesses, and 3 developed breast cancer in old thoracotomy scars transversing the breast. The combination of trauma as an oncogen and scar tissue as a functional and immunological locus minoris resistentia seems to play a major role in the development of breast cancer in this group of patients. The associaton of breast cancer, scar, and trauma would not be coincidental. Increased attention drawn to this entity may lead to a rise in the number of cases diagnosed among patients with breast scars after biopsies, abscesses, trauma, or foreign body implantation.     

Effect of oligosaccharides on rejection and reperfusion injury after lung transplantation

PURPOSE: We developed two models that are modifications of our original poly(2-hydroxyethyl methacrylate) (PHEMA) core-and-skirt keratoprosthesis. In these keratoprostheses, the mechanical strength of the skirt has been considerably increased with divinyl glycol (DVG) as a cross-linking agent during polymerization. In one (KPro I), methyl methacrylate (MMA) was added as comonomer to increase cell adhesion, and in the other (KPro II), HEMA was polymerized with DVG without comonomer. The aim of this study was to evaluate the process of healing and biocolonization and to ascertain whether KPro I demonstrates better ingrowth than the mechanically stronger KPro II, after implantation in rabbit eyes. METHODS: Ten rabbits were used for each model and studied at five predetermined end points up to 26 weeks. The device was implanted as a full-thickness keratoprosthesis covered with a conjunctival flap. RESULTS: Neither prosthesis demonstrated extrusion or retroprosthetic membrane formation. There was no significant difference between the two types of prosthesis with respect to tissue ingrowth and surrounding tissue melting. Histologically, inflammation was not severe, but calcification was seen in most specimens. Evidence of biodegradation of the prosthesis also was seen. CONCLUSION: In our original keratoprosthesis, fibrovascular invasion had occurred into the prosthetic skirt, but wound dehiscence and low mechanical strength resulted in an unfavorable outcome. In this series, the mechanical properties were improved, and KPro II was stronger than KPro I. Therefore KPro II would be the preferred polymer combination for surgical manipulation. However, biodegradation and calcification require further investigation into the degree and significance of these adverse reactions.     

A new finger joint prosthesis

A new finger joint prosthesis is being developed for the proximal and distal interphalangeal positions. Currently available "joint spacer" prostheses provide relief from pain and cosmetic improvement, but relatively poor long-term function. The new prosthesis employs a mechanical hinge at the joint. It is fabricated from titanium alloy (6A14V). The hinge mechanism avoids direct metal to metal contact by using high density polyethylene bearings. In vitro tests of the hinge mechanism have passed 75 million cycles of continuous flexure without failure (n = 12). The hinge also incorporates a mechanical limit stop to prevent hyperextension. The hinge mechanism is enclosed in a sealed elastomeric jacket that isolates the hinge from connective tissue ingrowth. The jacket, equivalent to an artificial synovial membrane, has an integrally textured exterior surface designed to promote tissue attachment to the implant to stabilize tissue capsule formation around the joint. To test the in vivo efficacy of the new design, a series of 12 devices were implanted in the knee joint position of adult rabbits. A jacketed prosthesis was implanted on one side, whereas 2 weeks later an unjacketed control was implanted contralaterally. The animals then were maintained for an 8 week period. At sacrifice, the implants were removed, and the response of the surrounding tissues was studied histologically. At the time of implantation, the range of motion of the joints was approximately 100-105 degrees. There was a progressive loss in range of motion observed in both groups. The fibrous tissue capsule around the jacketed implants, however, was significantly reduced in thickness compared with the controls (mean thickness, 1.5 mm vs. 4.5 mm).(ABSTRACT TRUNCATED AT 250 WORDS)     

One hundred years of orthopedics in the Netherlands. VII. biomaterials

The use of biomaterials in orthopaedics is becoming increasingly important. They are widely used in artificial joints, as bone replacement material and as resorbable material. Also (recombinant) bone morphogenetic proteins are used. Classification of biomaterials is based on composition (animal or human tissue, metals, polymers, ceramics or composites) or on biological reactions after implantation (bio-inert, bio-tolerant or bio-active). Depending on location and function biomaterials have to meet requirements with respect to durability (artificial joints), fixation (total hip prosthesis), flexibility (artificial ligaments), solubility (suture wire) and stiffness (plates and screws). The development of biomaterials is in full swing, focussing on the decrease of wear and the increase of durable fixation of artificial joints, and the induction of cells to form bone and cartilage tissue.     

Porous-type tracheal prosthesis sealed with collagen sponge

BACKGROUND: Reconstruction of a long section of the trachea is clinically problematic. Tracheal reconstructions using prostheses have met with limited success due to local infection, hemorrhage, luminal stenosis and prosthesis dislocation. METHODS: We have designed a porous type of tracheal prosthesis in which the mesh is sealed with collagen sponge. We used this prosthesis (50 mm in length) to reconstruct the cervical trachea in 10 mongrel dogs and evaluated its efficacy. RESULTS: One dog died due to an accident with anesthesia at 6 weeks and 1 of suffocation at 10 weeks. The other 8 dogs had an uneventful postoperative course until they were killed between 6 and 24 months after implantation. At sacrifice, all the prostheses had become completely incorporated into the host. Microscopic examination revealed advanced formation of a new epithelial lining in 1 dog at 6 months, and a confluent epithelial lining was observed in another dog at 12 months. Central stenosis was not significant in any of the animals. CONCLUSIONS: This tracheal prosthesis gives good results in canine tracheal reconstruction, and appears very promising for the clinical repair of tracheal defects.     

Outcome after reinfection following reimplantation hip arthroplasty

Between 1976 and 1992, reinfection developed in 34 patients treated for an infected total hip arthroplasty with removal of the prosthesis and implantation of another prosthesis. These patients included 15 men and 19 women with a mean age of 62 years. Infection recurred an average of 2.2 years after reimplantation of the new prosthesis. Followup after the diagnosis of reinfection averaged 5.1 years. Reinfection after an attempt at reimplantation total hip arthroplasty was seldom compatible with a good functional outcome. Resection arthroplasty was reliable in eradicating reinfection but led to poor function and was associated with persistent pain. Although reimplantation of a third prosthesis allowed 3 patients to achieve an excellent result, the 8 hips that failed a third reimplantation attempt had the worst functional results in this study. The results from the present series suggest that reinfection after an attempt at reimplantation is a contraindication to further attempts at a 1-stage reimplantation of another prosthesis. Those patients in whom the same single microorganism has been identified from the failed primary total hip and from the failed first reimplantation, however, may be reasonable candidates for an attempt at a 2-stage reimplantation of a third prosthesis, particularly when a deficiency in prior antibiotic therapy or surgical technique can be identified.     

Tumor suppressor activity of the TGF-beta pathway in human cancers

Immunodeficient animals, principally nude mice, when used in appropriately designed studies have been shown to be useful for the experimental analysis of human breast cancer metastasis. As with many other human tumors, the implantation of breast cancer cells into an anatomically appropriate tissue (the mammary fatpad) results in increased tumor take and incidence of metastasis for certain cell lines compared with subcutaneous injection. Testing a number of widely available human breast cancer cell lines identified the MDA-MB-435 cell line as the most metastatic, producing lung and lymph node metastases in a high proportion of nude and severe combined immunodeficient (SCID) mice after injection in the mammary fatpad. Mixing human breast cancer cells with normal fibroblasts or with Matrigel also increases the tumor incidence and growth rates in nude mice. Different routes of injection can be used to assess the ability of human breast cancer cells to form metastatic lesions in the lungs (i.v. injection), the liver (injection in the spleen), the brain (direct or intracarotid artery injection) and the bone marrow and bone (injection into the left ventricle of the heart). These different approaches demonstrate the potential of experimental studies of human breast cancer growth and metastasis using immunodeficient mice; this model is valuable for experiments that test the role of metastasis-associated genes and the efficacy of novel forms of therapy.     

Distribution of organosilicon polymers in augmentation mammaplasties at autopsy

Silicone-containing breast implants have been used since 1963 for cosmetic augmentation and breast reconstruction. Currently, there is intense debate regarding the extent and mechanism of migration of silicone from the area of implant. The current study compares tissue distribution of organosilicon polymers between women with and without silicone breast implants to determine the extent of silicone migration from breast implants. Samples were collected at autopsy from 15 individuals with bilateral breast implants with no known history of chest trauma and from 14 age- and sex-matched controls. Capsule, breast, axillary lymph nodes, abdominal fat, liver, lung, and spleen were collected for analysis of organosilicon polymers by atomic absorption spectrometry and for examination by light microscopy. Blood was collected for analysis of rheumatoid factor and antinuclear antibodies. Silicone was observed microscopically in at least one capsule section from all implant cases and in at least one lymph node in 8 of 15 implant cases. Silicone was not observed in lymph nodes from control cases. Organosilicon polymers were extracted from tissue using heptane, and the silicon content of the extract was quantitated by atomic absorption spectrometry. Silicon was detected in all capsules; statistically significant increases of organosilicon polymers were measured in axillary lymph nodes, breast, and abdominal fat from individuals with silicone breast implants when compared with the nonimplant group. Measurable amounts of organosilicon polymers were found in tissues from the nonimplant group. Suitable blood specimens were analyzed for the presence of rheumatoid factor and antinuclear antibodies. All nine implant cases tested were negative for the presence of antinuclear antibodies. Three implant cases which were tested for rheumatoid factor also were negative. We conclude that organosilicon polymers routinely migrate from the site of breast implantation to regional tissues near the implant site. Tissues from nonimplant cases often contained measurable amounts of organosilicon polymers, and tissue distribution was variable within any single individual: this is consistent with the wide-spread use and form of organosilicon polymers.     

Breast reconstruction after mastectomy: problems in position, size, and shape

Having learned that healed mastectomy wounds will stretch sufficiently to accommodate an implanted prosthesis, we must pay more attention to the position, and shape of the breast mound created by the prosthesis. We have briefly discussed our methods and the considerations we feel are important in this regard, but, even after extensive experience, we confess that the problems are still with us. Clearly, surgical methods and prostheses must improve.