Robert M. Woolf

Pulmonary complications following abdominal lipectomy.

Previous reports underestimate the morbidity of a lipectomy, having focused on mortality statistics. Alterations of respiratory kinetics leading to complications do not always correlate with the usual signs and symptoms of respiratory failure. Patients at increased risk, namely, those with obesity, a smoking history, or lung disease, deserve special attention, including appropriate pulmonary function studies in the preoperative and postoperative phase. The following studies are indicated in the preoperative assessment of the high-risk patient: (1) vital capacity, (2) arterial blood gases, and (3) chest radiograph.

Unsatisfactory results in augmentation mammoplasty: Chest and breast asymmetry.

Mild to moderate and at times, rather severe forms of asymmetry are overlooked preoperatively by the patient and even at times, by the physician. Preoperative awareness of breast and chest asymmetry is important in proper planning for surgery in order to gain maximum balance. Awareness of the asymmetries that may exist also enables a physician to be more realistic in stating limitations of the expected results from surgery.Unsatisfactory results, noted postoperatively, can usually be related to the anatomy evident preoperatively. Unsatisfactory results are, at times, unavoidable, but when they occur unexpectedly, one must ask if it is the breast or the chest that is at fault. The proper selection of procedure, the proper selection or variance of implants for augmentation, and the proper placement, often times in irregular fashion, of implant materials are essential for good results. A plea is made for more detailed attention to the preoperative anatomy of the breast and the thoracic cage and for better planning in augmentation surgery.

Tattooing the cornea.

T HE first recorded case of purposefu1 tatooing of the cornea occurred in 1870 when von Wecker [I] injected India ink into a scarred cornea. He noted previously “that in workmen wounded by the explosion of mines, the grains of powder remained in the cornea without producing any remarkable haziness in the surrounding tissue.” Williams [2] and Calhoun [?J in 1873 presented the first cases of tattooing the cornea in this country. In 1874 Mathewson [4] first suggested the possibility of tattooing the skin to concea1 or correct dishgurements“WhiIe thinking of this matter of conceaIing discolorations of the cornea by tattooing, it occurred to me that the same principIe might be applied to the reIief of dishgurements of the face and neck, such as those produced by extensive nevi or other permanent discolorations of the skin, some coloring being used which would produce a natura1 flesh tint.” Tattooing the cornea was abandoned temporariIy untiI 1925 when Knapp [T] attempted to stain a cornea1 scar with gold chIoride. At operation the scar was denuded of its epitheIium, after which a cotton applicator, moistened with a I per cent soIution of gold chIoride, was appIied to the denuded scar for two or three minutes. HoIth [6] tried Knapp’s method, but was not successfu1. Kreiker [7] attempted to coIor the buIbar conjunctiva of an albino using a 5 per cent soIution of goId chIoride, but the reaction was “too severe.” Aust [8] aIs0 produced a severe iritis when this soIution entered the anterior chamber. Karelus [9] recommended “subepitheIia1 tattooing” in which he circumscribed the scar with a scaIpe1 and undermined a11 of the scarred area except one smaI1 pedicIe. The ffap thus formed was turned up; the undersurface was painted with India ink which was allowed to dry, and the ffap was repIaced. Other investigators used different materiaIs-choroidal pigment obtained from animaIs, potassium ferrocyanide, iron sesquichIoride and pIatinum chIoride [IO]; however, these resuIted in faiIures for the most part which Iead Pischel [II], in 1930, to state that “most resuIts have been disappointing, both to the patient and to the surgeon. A fine black pupi achieved with much effort and pain becomes, in the course of a few days, woefuIIy Iight again. Therefore, any improvement in technique or resuIts must be weIcomed.” This chaIIenge was accepted by us [12] approximateIy ten years ago, and some of the resuIts obtained in tattooing we11 over IOO eyes wiI1 be presented herein.