Robert M. Goldwyn

Mammary ducts in the areola: implications for patients undergoing reconstructive surgery of the breast.

&NA; The use of selective excision of the nipple with preservation of the areola (“nipple coring”) has been advocated for patients undergoing subcutaneous or total glandular mastectomy. This is based on the assumption that all the mammary ducts in the nipple‐areola complex are located in the nipple and that the areola is devoid of mammary ductal tissue. To investigate this issue, we performed nipple coring on eight consecutive mastectomy specimens, excised the areolas, and submitted them in their entirety for histologic examination. Mammary ducts identical in appearance to extralobular ducts in the breast parenchyma were identified in the dermis of the areola in all eight cases. These ducts were present throughout the areola, including the most peripheral aspects. We conclude that mammary ducts are a normal component of the areolar dermis and that nipple coring does not result in the removal of all mammary ductal tissue from the nipple‐areola complex. This observation should be taken into consideration by reconstructive surgeons considering preservation of the areola in patients undergoing subcutaneous or total glandular mastectomy. (Plast. Reconstr. Surg. 92: 1290, 1993.)

Why Not Say It Clearly: A Guide to Scientific Writing

When I received this book, my first reaction was a query: Should the title have a question mark? When I noted the authors name, I concluded that the title must be correct. Long respected as an editor, author, medical historian, and philosopher, Dr Lester King has written a book that reflects his many capabilities. Why Not Say It Clearly contains practical points for any writer, novice to professional. Fortunately, this is more than a how to book, whose shortcoming would have been emphasis on technique at the expense of perspective. As Dr King observes, the problem in medical publication is not simply the lack of clarity, but the dearth of value. A helpful friend or a good editor can salvage a poor paper if it has an original idea or important data. That the content of so many journals comes from papers given at meetings ensures a flood of material

Symposium on Basic Science in Plastic Surgery

A consequence of specialization of any sort is the inevitable loss of contact with basic principles and knowledge. To narrow this unfortunate gap, the Educational Foundation of the American Society of Plastic and Reconstructive Surgeons, in April of 1975, sponsored a symposium, from which this book is derived. General topics considered were the experimental method, infection, wound healing, transplantation, biology, the fate of transplanted tissues, and pedicle flaps. This book is not meant to be a text of basic science relative to plastic surgery. A symposium rarely lends itself to an orderly progression of information. The informal give-and-take that characterizes an excellent symposium may detract from the format and readability of the proceedings of that symposium. This volume, however, contains many excellent chapters on, for example, collagen structure and metabolism; influence of mechanical forces on burns; scar contracture and hypertrophy; grafts of mucous membrane; dermis fat; cartilage and bone; the

Surgical Disorders of the Adrenal Gland: Physiologic Background and Treatment

This monograph is clearly the best yet produced on the investigational and clinical aspects of surgical disorders of the adrenal gland. Since the authors are eminent in this field, both in terms of basic physiologic discoveries and of innovative contributions to endocrine surgery, it is not surprising that a sense of immediacy, authenticity, even excitement comes across to the reader. An excellent foundation concerning the normal mechanisms of endocrine control, the pharmacologic actions of the hormones, and the underlying pathophysiologic processes involved is provided as an introduction to the surgical aspects of each of the diseases. The thorough discussions of the surgical management of Cushing syndrome, primary aldosteronism, and pheochromocytoma are up to date and well grounded in investigational fact. A separate, well-illustrated chapter is devoted to surgical approaches to the adrenal gland. This chapter reflects, as evidenced both by the opinions expressed and by the styles of writing, contributions

High Hopes and Malpractice

It is myopic and misleading to consider the malpractice phenomenon apart from the society in which it occurs. Yet, this context has received too little attention. Most litigation arises when the medical outcome falls short of the patients expectations. Accountability is soon the issue, and the physician, the hospital, personnel—each or all—become the culprits, sometimes justifiably, often not. The purpose of this communication is not to absolve the incompetent and negligent, but to examine some factors that engender the malpractice sequence. An apparent paradox in our culture is the mixture of myth and science, of rationality and irrationality. Technological prowess has led us to expect that all is possible. We are primed to expect more than we are likely to receive. It is hard not to become a victim of false hopes in a land where cigarette smokers are depicted as winning a pliant beauty, not a fatal cancer; where

Thickness of Skin Graft Blade-Reply

To the Editor.—Dr. Gastons letter was referred to Dr. Vecchione, who, in turn, conferred with the Becton, Dickinson Company about the thickness of that portion of the No. 15 Bard-Parker knife blade used by him to assess graft thickness. Dr. Gaston, indeed, spotted the error. Instead of 0.17×10−3 cm thickness, as given in the Archives, it should have been 3.6×10−2 cm since the blade thickness will vary between 0.0368 and 0.0394 cm (0.0145 and 0.0394 inches) in both the stainless steel and carbon blades. But, in the words of another physician, Oliver Wendell Holmes, The brightest blade grows dim with rust.

Recent Advances on Pain: Pathophysiology and Clinical Aspects

The editors have compiled formal presentations, commentaries, and postpresentation discussions of a group of prominent scientists and clinicians at the international symposium Recent Progress on Pain Pathophysiology and Clinics held in Florence, Italy, in April 1972. The papers presented in this book reflect the impressive upsurge of interest in chronic pain as a major disease state during the past decade and contain the latest information on some basic aspects of pain, including neurophysiology, biochemistry, pharmacology, and psychology. The clinical aspect of pain management deals primarily with diagnosis and application of some therapeutic tools, including systemic drugs, neurosurgical operations, nerve blocks, operant conditioning, and psychotherapy. The authors include in their presentations their vast personal clinical experiences on the diagnostic and therapeutic tools they have used, and share with the reader their successes and failures. While the book is not designed to teach the reader how to perform analgesic blocks nor how

Anatomy of the Head and Neck

In the authors words, this book represents the effort to mold a series of informal lectures and do an anatomical base line which an otologist, oral surgeon, ophthalmologist, laryngologist, or whatever, may acknowledge peculiar to the successful practice of his specialty. It arose as the result of Dr. Passs teaching gross anatomy to freshman medical students at the University of Miami and Harvard Medical Schools and also his giving a postdoctoral course in the anatomy of the head and neck at Columbia University. The worthwhile aspect of this publication is that it gives information to the amateur and professional alike. The reason is that those who are learning anatomy do not know it and those who supposedly had learned it, rarely know it. Often, the practitioner, so pragmatically oriented, is able to do his surgery with an alarmingly meager fund of anatomical knowledge. It would probably be a good idea

Hair Transplant Surgery

Written by a dermatologist with considerable experience in hair transplants, this book contains helpful instruction for performing the technique. The author has studied well the variants of male pattern baldness. This knowledge is a prerequisite for proper patient selection and for correctly planning the new hairline. There is a good section on complications and poor results, their avoidance and management. Illustrations are excellent, and information is abundant on doing this surgery in the office. Compared with plastic surgeons, many of whom also do hair transplants, the author, and most dermatologists, use clean hands (not gloves) and do not suture the donor sites. In my opinion, failure to do so causes more postoperative bleeding (34% of 50 dermatologists who responded to a questionnaire by the author reported this complication) and definitely begets more scarring. There is also a reluctance to use strips of hair as grafts. These require sterile technique, closure

Management of Acute Hand Injuries: A Biological Approach.

In the authors words, the objective of this book is to provide the surgeon with a basic approach to the management of acute hand injuries founded on the biology of tissue repair and regeneration. Recognizing that the result of a hand injury and operation depends not only on technique, but also on biological processes, they have written a thoughtful volume that emphasizes the what and why rather than how. By gathering what is known, interpreting it in terms of fundamentals, and placing it in a useful perspective, they are following the route of the new hand surgeon, exemplified by Peacock and Van Winkle in their Surgery and Biology of Wound Repair . The first section of Management of Acute Hand Injuries presents in detail the response to trauma of skin, cartilage, tendon, bone, and nerve. A later portion correlates the method of initial management with the ultimate biological activity of the