Dan Mahler

The biologic behavior of basal cell carcinoma: analysis of recurrence in excised basal cell carcinoma: Part II.

On the basis of a study of 188 cases of basal cell carcinoma of the face, the differences between the characteristics of recurrent and incompletely excised lesions are stressed. There was almost no difference in the recurrence rate of completely excised lesions and those in which there was histologic evidence of tumor at one of the margins. On the basis of these findings, a policy of conservative management of incompletely excised basal cell carcinoma is outlined.

On the History of the Free Skin Graft

Skin graft procedures had already been performed prior to Reverdins great discovery. Skin grafting apparently originated with the Hindus 3,000 years ago, but until the beginning of the nineteenth century only a few trials were reported. In the first half of the nineteenth century, skin graft procedures were done by Baronio, Cooper, Bünger, and Dieffenbach. Berts experimental work in 1963 opened the way for the pioneers Reverdin, Ollier, Wolfe, and Thiersch, who contributed the free skin graft.

The biologic behavior of basal cell carcinoma: Part I.

The influence of histopathologic and clinical factors on the biologic behavior of basal cell carcinoma of the face is discussed on the basis of a retrospective study of 188 cases. Fourteen different parameters were studied and correlated with the histologic type and the frequency of incomplete excision of the lesions. The highest frequency of incompletely excised tumors was seen with the adenocystic and morphea types and with Clark level III lesions. The adenocystic type appeared to be the most aggressive form, with the highest frequency of thick lesions and the most marked mitotic activity. The histologic parameters studied provide more information about the behavior of basal cell carcinoma than the conventional subdivision into solid, morphea, and adenocystic types.

Retromammary versus Retropectoral Breast Augmentation??? A Comparative Study

Repeated postaugmentation capsular formation following retromammary silicone implantation led surgeons to seek an alternative procedure. In 1968 Dempsey and Latham first reported the “subpectoral” route for location of the implant. Since then little data has been published comparing retromammary and retropectoral breast augmentation. The aim of this study is to compare the two procedures in terms of various factors affecting the physical and emotional well-being of the breast-augmented patient: breast firmness (according to Bakers classification), patient approval, the surgeons judgment, and the husbands or partners evaluation are all weighed. The study included 40 patients, 20 of whom underwent retromammary augmentation, the remaining 20 retropectoral augmentation. All 40 responded to a questionnaire designed to elicit comparative data. A detailed analysis of the results was made, leading to the following conclusions: first, patient approval was largely the same in the two groups, although slightly higher in the retropectoral group. However, both surgeons and husbands preferred the retropectoral method of prosthesis insertion.

On the history of the treatment of burns

Abstract The diverse methods employed in treating burns throughout the history of mankind, the classification of burns, the complications and the therapeutic armamentarium are discussed, to point out the course of evolution of and difficulties in treating burns. … And there went out fire from the Lord and devoured them and they died before the Lord…

A simple method for the correction of the inverted nipple.

A procedure is described in which a direct approach to the underlying pathology of the inverted nipple is undertaken. The inverted nipple is raised as desired by freeing it from the surrounding tissue by vertical and horizontal undermining and then is stabilized by purse-string suture. It can be performed as an office procedure under local anesthesia. This procedure is simple, reliable, not time-consuming, leaves no visible scars, and requires no special or bulky dressing.

Incurable recurrences of basal cell carcinoma of the mid-face following radiation therapy

Summary Irradiation of basal cell carcinoma of the mid-face is complicated in certain cases by uncontrolled spread of the tumour. Four such cases are presented of widespread local infiltration by the tumour. A slow painful death, resultant directly from the effects of local invasion, occurred in three of the patients with the fourth patient tragically moving to the same inevitable conclusion. The anatomical features of the mid-face may account for this type of spread. There may also be an alteration of tumour-host relationship following radiotherapy. Surgery, rather than irradiation, is the treatment of choice for basal cell carcinoma of the mid-face.

The correction of the prominent ear

The prominent ear was first noted in the medical literature to be a social and psychological disturbance in 1881, when Ely suggested the first technique for the correction of this condition. Since Ely many surgeons have tried to find the best solution for this deformity; however, because of the specific cartilagenous architecture of the auricle, no one has yet designed an acceptable and secure technique.The successful reconstructured auricle should be the result of tackling all components of the deformity, namely, the absence of the antihelix and the aloofing of the concha from the mastoid. Mustardes technique and the various anterior scoring methods do not deal with the conchal component of the protruded ear, nor do they give a fully satisfactory formation of the antihelix when one of these methods is used alone.This article presents the authors preferred technique for reconstructing the auricle, simultaneously using Mustardes mattress sutures, Cochranes anterior scoring of the antihelix, and the approximating of the concha to the mastoid.

Burns caused by bromine and some of its compounds

Our experience with infrequent and unfamiliar types of injury caused by various compounds of bromine are described and discussed. While bromine containing compounds share some of the characteristics of other common causes of chemical burns, they also have a specific, exclusive mode of affecting the skin. The delay in the appearance of clinical signs and symptoms is an important factor to be considered by those who treat injuries caused by bromine or some of its compounds, or by those who may be the first to see persons who are injured by these agents. As most of the injuries occur at work (92 per cent) it is in these industrial premises that considerable stress should be made of the importance of wearing protective clothing in order to reduce local damage and prevent systemic effects. Prompt first aid, by thorough washing with large volumes of water reduces the extent and depth of the injury.

Chin Augmentation???A Restrospective Study

A retrospective study of 480 Silastic chin implants is summarized and analyzed. The surgeons own variations on the operative procedure are detailed, including the staging of the simultaneous nose–chin operation in which the chin work is started first, with a temporary interval for hump removal, followed by termination of the chin work and a return to the nose operation. A variation in the handling of the Silastic implant is described in which parallel incisions are made on its inner side to avoid dead space and undesired tension. The results of the 480 cases are presented. The overall complications rate was 2.3%, though the total percentage of implants removed was only 1.46.