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Myopathic blepharoptosis is a congenital anomaly of the eyelid. The levator muscle does not function because of primary myogenic atrophy. Different procedures based on eyelid suspension, or the simple or combined resection of the eyelid have been described. A simple dynamic suspension of the tarsus to the check ligament of the superior fornix, neither sacrificing nor adding any tissue was used for 89 procedures on 71 consecutive patients with primary myopathic blepharoptosis. Their mean age at operation was 16 years (range 2-58) and the follow up ranged from 2 months to 12 years. Ptosis was unilateral in 53 patients (33 left, 20 right) and bilateral in 18. Preoperatively 27 had mild ptosis (1-2 mm), 33 moderate (3-4 mm), and 29 severe (>4 mm). The patients were divided into two groups: not previously operated on (50 patients/63 eyelids) and previously operated on by other techniques (21 patients/26 eyelids); both groups were compared for duration of procedure, normalisation rate, and number of revisions. In the unoperated group the normalisation rate was 81% (51 eyelids), and to achieve a good final result nine eyelids were revised once, while just three were reoperated on twice (19%). In the group previously operated on the normalisation rate was 69% (18 eyelids), while 3 eyelids needed one revision (12%). In unilateral cases the normalisation rate was 79% (42 eyelids) and in bilateral 75% (27 eyelids). In unilateral blepharoptosis there were 13% of revisions (7 eyelids) while bilaterally there were 22% (8 eyelids). Despite a previous operation, the operating time of a unilateral correction was similar in both groups, while the number of revisions needed to achieve the final result was low for unilateral ptosis, but higher for bilateral ones. This simple atraumatic suspension technique produced an improvement in all cases and it seemed useful in both primary and secondary cases.

A total of 37 patients have had chin augmentation procedures with HTR-polymer ® implants. Indications were mandibular retrognathia in connection with dentofacial deformities in 13 and the remaining 24 had a normal occlusion. Three patients with micrognathia also had juvenile rheumatoid arthritis. The patients have been followed for at least one year and in 17 cases up to five years both clinically and radiographically. Cephalometric measurements of the effects and stability of augmentation showed that chin augmentation has highly predictable results, and few side-effects.

A new surgical procedure for the treatment of all types of congenital blepharoptosis is described: suspension of the eyelid to the check ligament of the superior fornix. This is a dynamic suspension technique by which the check ligament, which is an extension of Tenon's capsule and normally inserts into the superior conjunctival fornix, is brought forward and sutured to the tarsus, which raises the eyelid. This technique does not sacrifice or add any tissue and is simple to repeat if necessary. Sixty-two patients were operated on using the technique and followed up for a mean of 23 months (range 3 months to 9.6 years). In a group of patients not operated on before for ptosis, 50 eyelids were raised with 74% normalisation, 22% improvement, and one eyelid each that showed only slight change or overcorrection. In a group of patients with 27 eyelids operated on before using other techniques, 67% of the eyelids were normalised, 30% were improved, and only one eyelid showed no change. In conclusion, this new technique has proved to be quite successful in raising the level of the upper eyelid in congenital blepharoptosis, with results at least comparable to those of most other techniques. The advantages with the check ligament over other techniques are the minimal trauma of the surgery, its simplicity, and its repeatability.

Fifty-four patients were studied a mean of five years after their breasts had been reconstructed between 1984 and 1990 using the lateral thoracodorsal (LTD) flap in combination with either a thin shell, non-low-bleed (n = 35) or a thick shell, low bleed (n = 19) silicone gel implant. The rate of capsular contracture (Baker III-IV) was 11% in the first group and 10% in the second according to a modified Baker classification. Open capsulotomy was common in both groups of patients (15/35 in the first group and 13/19 in the second). Investigation by applanation tonometry of the capsular contracture agreed with the modified Baker classification. The cosmetic results were evaluated clinically and from photographs. Best scores were recorded for scars and ptosis in both evaluations. There were no significant differences between the general cosmetic results in the two groups. The patients graded their estimations of the final outcome of their breast reconstruction on a 10-point visual analogue scale (VAS); the mean for the first group was 8.7 and for the second 9.2. None of the patients regretted her operation and they would all recommend the procedure to another patient.

Strictures and ruptures of the bulbomembranous urethra have traditionally been treated by a two-stage scrotal skin inlay technique (Johanson B. Reconstruction of the male urethra in strictures. Acta Chir Scand 1953; Suppl 176). For the last 10 years we have treated the patients instead with a skin-dartos island flap pedicled on intertesticular septal vessels. The skin island has been taken from the scrotum, the penile base, or the penile shaft. Twenty-five consecutive patients were treated until 1993 and followed up for at least 5 years. Five of the patients had had open urethroplasty before. Fifteen of the patients had urethral strictures and 10 had complete ruptures. Of the 25 patients 6 had to have a further operation; in 4 patients this was because of restricture, in 1 patient a urethral pouch had to be reduced, and in the final patient the operation was both for restricture and pouch formation. At final follow-up impaired micturition occurred in three patients: two of them had had a ruptured urethra treated previously, and one had a chronic infectious stricture. Problems related to hirsutism were low. No obvious advantage was detected from using distal penile skin, so a skin-dartos island from the penile base is advocated. In conclusion, a one-stage skin-dartos island flap pedicled on the intertesticular septal vessels may be recommended in the treatment of both strictures and complete ruptures in the bulbomembranous urethra.

A modified S-flap method for nipple reconstruction with two local opposing skin flaps, was used for a series of 21 women with a mean age of 50 years (range 30-64). Four patients had bilateral breast reconstructions, so the total number of reconstructed nipple areola complexes (NAC) was 25. The patients were examined 29-46 months (mean 36) after the reconstruction with particular reference paid to projection, size, sensation, and colour of the nipples. The patients also answered a questionnaire about their assessment of the final result. The mean projection of the nipples was 3.9 mm (range 0-9). Five patients had various degrees of necrosis of the skin flaps. One third of the women had some sensation in their reconstructed nipples. Two thirds of the nipples were pale. The patients estimated the final result as 8.2 (range 1-10) on a visual analogue scale.

Traditional open rhinoplasty produces a scar on the columella. To avoid such a scar and still obtain a wide exposure of the nasal framework, the bilateral paramarginal incisions close to the columella were extended into the nasal floors, and a wide undermining of the base of the columella was performed. The nasal tip with the crura together could then be presented through one of the nostrils. Conditions similar to those of the traditional open rhinoplasty wer thus achieved. The technique has been used in selected patients for 8 years with satisfactory results. In conclusion, the open rhinoplasty without transcolumellar incision can replace the traditional transcolumellar open rhinoplasty technique.

Ten patients with microgenia had their chins augmented with HTR® polymer implants. The implants were inserted intraorally and fixed rigidly with a titanium screw. The postoperative course was uneventful except in one patient who had wound dehiscence and was resutured. This patient and all the others were clinically and radio-graphically stable at one year follow up.

The outline of the surgical treatment of a primary cutaneous malignant melanoma may be divided into the problems of biopsy, definitive excision and reconstruction of the defect. An excisional, in contrast to an incisional, biopsy provides the full scope of prognostic parameters and should be used whenever possible. General anesthesia is not necessary, and frozen-section examination is inaccurate. An immediate excision biopsy should therefore be performed under local anesthesia as an outpatient procedure. Whenever possible, a margin of 10 mm should be used, as this would mean an adequate and definitive treatment in melanomas up to 1 mm, and possibly 2 mm, in Breslow thickness. In melanomas more than 1-2 mm in thickness a 3-cm free margin instead of a 5-cm free margin is recommended. Many patients, especially those with trunk lesions with a 3-cm free margin may not need a complicated repair, such as a skin graft or a flap. The excision in depth is recommended to be carried perpendicular to the skin and inclusion of underlying fascia is optional, as no study has proved it to be beneficial. The defect after the excision should whenever possible be closed directly. If this is not possible the defect is covered with either a skin graft or a flap and the latter is recommended from both a cosmetic and a functional point of view. If a skin graft has been used, the secondary defect may be reconstructed with a skin expansion technique.

Background Growth inhibition of the ossification center, "the external trabecular network," would result in localized hypoplasia of nasomaxillary structures, resulting in the typical features of the Binder syndrome patient, with the retracted columella/lip junction and a lack of the normal triangular flare in the lower part of the columella. This study focused on a long-term follow-up of more than 5 years for three different grafting techniques. Methods Ninety-two patients with Binder syndrome were subjects for consecutive reconstructive plastic surgery between 1972 and 1995. The primary surgical approach was degloving the midface subperiosteally, and reconstruction was identical but differed in the grafts used: septum repositioning (n = 26), L-shaped bone graft (n = 51), or L-shaped cartilage graft (n = 15). Anthropometric variables on digitalized profile photographs were used. Results The angle of convexity of the face at the tip of the nose (glabella-pronasale-pogonion) improved in all three groups from 155 to 158 degrees to 144 to 149 degrees at the short-term follow-up and to 148 to 149 degrees at the long-term follow-up. The nasolabial angle changed, from a narrow angle of 76 to 88 degrees in all groups before surgery, to 100 to 106 degrees at the long-term follow-up after surgery. Conclusions The L-shaped bone graft was favorably used in the depressed nasal dorsum, whereas frontal repositioning of the septum was optimal when the upper part of the nose was considered normal. The consistency in tip projection for all groups over time may be explained by the extensive surgical release of the soft tissues before grafting.

Maxillonasal dysplasia is characterized by a concave facial profile and a flat nose. The etiology of Binder syndrome is skeletal hypoplasia around the piriform aperture and excavations-fossae prenasales, bilaterally in the nasal floor-which are pathognomonic. There is no real shortage of the soft tissues. In 2 medical centers in Sweden and Mexico, different grafts were used for reconstruction, but the focus was similar, filling out the maxilla anterior to the nasal floor and supporting the nasal framework to normalize tip projection. The basis for this study was to compare the long-term results between bone grafts in Sweden and cartilage grafts in Mexico. Sixteen patients from both groups were available for long-term follow-up. Simplified digital analysis of anthropometric variables were performed in the short-term and long-term follow-ups. The Swedish group had primary at the mean age of 21.3 years, whereas mean follow-up period was 16.8 years later. The Mexican group had primary at the age of 13.6 years, and the follow-up period was 8.4 years. Secondary correction was necessary in 25% of the patients in the bone graft group (Sweden) and in 19% of patients in the cartilage group (Mexico). Bone grafts slightly relapsed in tip projection and remodeled to some extent in the nasolabial angle. Cartilage grafts showed stability in the tip projection quotients and resulted in a postoperative normalization of the nasolabial angle but developed a slight relapse between the short-term and long-term follow-ups. Both techniques were stable in nose tip-length ratio, and a normalization of anthropometric variables was demonstrated in all the long-term follow-ups. Both the bone and cartilage graft techniques at the 2 centers rendered the intended result of an increased and normalized angle of convexity of the face and nasal tip projection. An experience in the properties and behavior of either graft is necessary to get a long-term stable outcome.

Ninety-four consecutive patients (19 who underwent mastopexy, and 75 who underwent reduction mammaplasty) were reviewed. They had all been operated on using a sliding manoeuvre for transfer of the nipple-areola complex on its underlying parenchyma, which has been in use for reduction mammaplasty in our unit since 1978. This makes it possible to slide the nipple-areola complex on the glandular tissue by making incisions in the de-epithelialised dermal zone on both sides of the areola, and leaving a dermal bridge above. The technique increases the mobility of the nipple-areola complex without jeopardising the blood supply, and is a combination of horizontal and superior pedicle techniques. The patients had been followed up for three to six months, except for five who had been followed up for five to six years. Minor early complications occurred in two patients. The sliding nipple technique is applicable to most types of mammary ptosis and hypertrophy, except those with a sclerotic and stiff parenchyma.

Probably the most common method of constructing a vagina in patients with the Mayer-Rokitansky-Kuster syndrome is the technique popularised by McIndoe and Banister in 1938. A cavity is created between the rectum and urethra-bladder complex and is lined with split-thickness skin grafts. One of the disadvantages of using split-thickness skin grafts is the incidence of late contraction of the neovagina. To avoid this problem full-thickness skin grafts have been used, but their take is less reliable. A new technique to improve the take of skin grafts is the VAC-system (vacuum assisted closure, KCI) which has proved to be particularly valuable in grafting difficult anatomical sites. We have used the VAC-system in the construction of a vagina in one case with split-thickness skin grafts and in two cases with full-thickness skin grafts. In all three cases the take was excellent with little discomfort for the patients. It was not necessary to stent the neovagina in the postoperative period and coitus was possible within a month of operation.

Thirty-two patients with involutional blepharoptosis were treated by reattachment of the levator aponeurosis and followed up for a minimum of one year. The median age of the patients was 68 years and they were predominantly female and had bilateral ptosis. Seven (22%) needed revisional surgery because of undercorrection. Results were evaluated using scoring from 1-4 where 1 is normal, 2 mild ptosis, 3 moderate ptosis, and 4 severe ptosis. After one operation the degree of ptosis improved from 3.2 to 1.3. Half the patients had simultaneous procedures, usually blepharoplasty, but the mean duration of operation was still only 34 minutes (range 15-77). The recovery period was short and complication rate low.

In an attempt to clarify the topography of the structures at the roof of the orbit we dissected the anterior cranial fossas of seven cadavers. Structures such as the periorbita, levator muscle of the upper eyelid and its aponeurosis, as well as Tenon's capsule with its continuation into the check ligament of the superior fornix were identified. The technique for correction of congenital blepharoptosis by suspension of the check ligament of the superior fornix to the tarsus was mimicked and its function clarified.

In a retrospective study the results of breast reconstruction with 146 lateral thoracodorsal flaps operated on during the period 1991-94 at the Departments of Plastic Surgery at the Sahlgrenska University Hospital in Goteborg and the Stockholm Soder Hospital were evaluated. The median age of the 135 patients was 51 years (range 37-74). About two thirds of the patients were also operated on on the opposite side at the same time; and this was done more often in Stockholm, which partly explains the longer operating time in Stockholm. Perioperative bleeding (median 100 ml, range 25-400) was similar in both groups. Median postoperative bleeding, which was measured only in Stockholm, was 300 ml (range 30-1000). Seromas were seen only in Goteborg where postoperative drains were rarely used. The rate of early complications (infection and partial necrosis) were higher in Stockholm where more flaps were raised in irradiated tissue. We conclude that the results were similar in the two centres, and the thoracodorsal flap gives good results. The incidence of early morbidity could be reduced by excluding patients who had been irradiated, by inserting drains, and by giving antibiotic prophylaxis.

A follow up study that compared the results from two plastic surgical centres comprised 95 patients after breast reconstruction with the lateral thoracodorsal (LTD) flap combined with either a smooth or textured saline-filled implant. It was conducted a median of 39 months (range 15-67) after the reconstruction. We investigated the size of the reconstructed breast and LTD flap, symmetry of the breasts, orientation of the mastectomy scar, and the rate of capsular contracture, which were similar in the two centres. However, according to the modified Baker classification and applanation tonometry reconstructions with smooth-surfaced implants and drainage of the implant pocket resulted in softer breasts (p = 0.03). The LTD flap technique in breast reconstruction was a good choice, particularly for women who required a minor breast reconstruction, and the technique can be recommended for suitable patients.

A 3-year-old girl presented with a constricted ear (Tanzer type 2B) on the right. This was repaired in two stages: the helix was opened up and then, when she was 17 years old, the helical fold was reconstructed under local anaesthesia with a bipedicled tube flap from behind the ear. The cosmetic result was good, and the two ears were symmetrical.

Several years of trouble-free operation with pre-denitrification at the Himmerfjärden WWTP concerning bulking and foaming have been followed by an unstable period. Two bulking incidents with no foaming by Microthrix parvicella were found to be caused by ethanol addition. Other bulking and foaming occurrences by Microthrix could be correlated to the production of volatile fatty acids in some of the sludge treatment steps. It is possible that a more widespread use in society of washing and cleaning products based on vegetable oils has promoted the ability of Microthrix to compete with floc-forming organisms, especially when ethanol or volatile fatty acids are present.

A 20-year-old man with Waardenburg's syndrome presented with breathing difficulties and aesthetic problems with the nose. He was successfully treated with composite grafts from the auricles.

During a ten-year period 17 patients with total congenital absence of the vagina were treated by a split-skin inlay grafting technique. The average age at the time of operation was 21 years. Associated malformations, mostly afflicting the urinary tract, were found in 9 patients. The skin graft was applied on a perforated hollow acrylic mould, 12 cm long and 4 cm in diameter. The acrylic mould was removed on the tenth day and a soft silicon mould was then utilized for at least 6 months. The mean hospitalization time was 28 days. The grafts took completely in 11/17 patients and in the remaining cases the take averaged 80%. There was no major complication, such as fistulas, in the series. With the exception of two patients with male hermaphroditism all patients were contented with the operation and stated that they had a satisfactory sex-life. In 9/17 patients, a closer follow-up including a biopsy was made. The average depth of the vaginas was 8 cm (range, 6 to 10 cm), and the average diameter 3 cm (range 2.5 to 4 cm). The histological studies consistently showed that the original skin morphology was maintained in the recipient site.

In order to study the mechanisms involved in the resorption of collagen and the appearance of fat in maturing granulation tissue, steel wire mesh cylinders were implanted in skin folds on white rabbits. The tissue formed within the cylinders was removed after 3, 4, 5, 6 and 8 weeks and investigated by means of electron microscopy and enzyme histochemisty. By light microscopy, an early production of collagen was found, which diminished from the fourth week. At the fifth week, blood vessels and macrophages appeared and the collagen density decreased sharply. Simultaneously, intense activity of diaphorases was observed. By electron microscopy, typical long narrow fibroblasts with a densely packed endoplasmatic reticulum were found. These cells had collagen fibres close to the cell walls. From the fourth week on. a collagen-free zone with amorphous content was observed around the fibroblasts where at the same time the nucleus was displaced towards one of the poles and the cisterns in the endoplasmatic reticul...

Clinical and pathologic anatomic parameters were studied in 50 patients with maxillonasal dysplasia (Binder's syndrome). The skeletal deformity causing the flat and low-set nose was in typical patients a palpable depression in the anterior nasal floor (fossa prenasalis) and a localized maxillary hypoplasia in the alar base region. Class III malocclusion was found in 54 percent. In 6 percent of the patients a slope (sulcus prenasalis) was found instead of a fossa in the anterior nasal floor, and in one patient a rudimentary fossa was found. Concomitant malformations were noted in 18 percent, and a hereditary connection was seen in 16 percent. The etiology is discussed in relation to the development of the premaxilla and the appearance of a secondary external trabecular network of bone in the canine region. An inhibition of the latter ossification center would explain the localized hypoplasia in the floor and walls of the piriform aperture in maxillonasal dysplasia.

The concentration of collagen, RNA and DNA was measured in 2 to 8 week old granulation tissue collected from steel wire mesh cylinders implanted in bipedicle tube flaps. Granulation tissue collected from cylinders implanted in skin folds was used as control. Up to weeks 3 and 4 the concentration of collagen increased. The pattern was similar in the skin flap and the skin fold groups, except for a higher concentration of collagen in the controls at week 4. The cell density, as measured by DNA, was high in both groups at week 2 and then decreased. RNA was also high at week 2 and then fell similarly in the two groups. Between weeks 4 and 6 the collagen decreased in concentration as well as total amount in both groups, indicating that the degradation of collagen exceeded its synthesis during this period. In the control group the cell density at weeks 5 and 6 was increased and the activity of acid phosphatase and β-glucuronidase showed a peak at week 5. These findings were interpreted as an invasion of macroph...

The protein synthesis and the collagen synthesis by 2- to 7-week-old granulation tissue from implanted cylinders in bipedicle tube flaps on rabbits were measured in vitro by the incorporation of 14C-proline in proteins and in collagen hydroxyproline. Granulation tissue from cylinders implanted in skin folds were used as controls. In the skin flap group the protein synthesis was high at week 2, after which it decreased to week 5. In the controls the protein synthesis was the same as in the skin flap group at week 2. A decrease occurred between weeks 2 and 4 and a further decrease between weeks 6 and 7. At weeks 5 and 6 the protein synthesis was higher in the controls than in the skin flap group, but at week 7 it was the reverse. The collagen synthesis was high and equal in both groups at weeks 2 and 3 and then decreased to weeks 4 and 5. Between weeks 6 and 7 a further decrease was found in the controls, but not in the skin flap group.

Histological studies were performed on granulation tissue from cylinders implanted 2 to 8 weeks and 4 months in bipedicle tube flaps on rabbits. Tissue from cylinders implanted in skin folds were used as controls. Flap and control tissue showed similar changes over the weeks. At weeks 2 and 3 the tissue was rich in cells, blood vessels and collagenous fibres. At week 4 the tissue showed transitional changes to week 5, when there were zones of loosely textured tissue with fine, fragmented collagen fibres. At week 5 some of the loose tissue was replaced by fat. Macrophages and inflammatory cells had appeared. By week 7 the fatty and collagenous tissue was mature and macrophages and inflammatory cells had disappeared.

A fasciocutaneous transposition flap, the lateral thoracodorsal flap, has been used in 114 cases of breast reconstruction. This flap is raised from the lateral and dorsal aspects of the thoracic wall at the level of the submammary crease, and the size may be varied from 12 to 22 cm in length and 6 to 12 cm in width. The lateral thoracodorsal flap is used with an implant and forms the lateral part of the reconstructed breast. A natural ptotic breast shape is achieved in a single-stage procedure. Complications such as partial necrosis and infection have occurred in 3.5 and 2.5 percent of cases, respectively. The procedure is simple and has at our unit largely replaced the use of the latissimus dorsi musculocutaneous flap in extensive postmastectomy defects. In less disfiguring defects, the lateral thoracodorsal flap has taken the place of direct implantation because the reconstructed breast obtains a more pleasing shape by augmentation of the lower lateral pole.

Early postoperative manipulation of breast implants in patients who underwent breast reconstruction utilizing a lateral thoracodorsal falp is described. This manipulation did not reduce the rate of firm capsular contracture after the reconstruction with the flap, but only postponed its development. Open capsulotomies, however, yielded stationary soft breasts to a statistically significant extent. The patient's acceptance, of the reconstructed breast as a natural part of her own, body was high. It was not influenced by the occurrence of firm capsular contracture.

This paper is a summary of a committee working for the Swedish Water and Wastewater Works Association (VAV). The purpose of the report is to present the possibilities today to measure, present and analyze data and control treatment plants. The typical audience is the operator, the process engineer, or the consulting engineer. The methods presented are all known from different disciplines, but are here presented in a form that connects the methods to wastewater treatment operation. Unlike any manual of practice the report is not a concensus report of current practice-Rather it is an attempt to show the potential of modern methods for data analysis and control. This will help the potential equipment or computer buyer to specify relevant demands for the system. The fact that any wastewater treatment plant is highly dynamic has to be reflected both in measurements and in control. The report discusses relevant sampling times for different measurements, both from the inherent dynamics and from the variability of the disturbances. Current design practice is almost always based on steady state analysis, and disturbances are too often controlled by larger tank volumes rather than relevant control actions. In order to obtain relevant data analysis the purpose of the measurement has to be clearly stated. Interesting and relevant measurement variables are listed. Moreover, a short survey of existing instrumentation and its status is presented. The transfer of data from the primary sensor to the computer has to be carefully designed. Once the data is in the computer, the data structure must be specified. The different compromizes between storage capacity, data formats and other relevant information are discussed. Simple measurement handling is described before statistical analysis is discussed. Numerous examples demonstrate the results. Some methods for parameter estimation and model building from measurement data are discussed, particularly with the purpose to make the methods available for on-line use. It is shown how estimated models can be used for the operation of plants. Different control methods are discussed. The basic kind of local control to keep the plant running is first mentioned, but more emphasis is laid on plant quality control, like dissolved oxygen, return sludge and waste sludge control. Dynamic models offer interesting possibilities for plant simulation, and simulators are being developed, that can support the operator with further predictive information. Some future possibilities of knowledge-based systems for process diagnosis are further discussed. They offer new possibilities to use natural language for systematic error analysis and diagnostic searches.

The case of an 18-year-old female with absence of the right breast, sternocostal part of the major pectoral muscle and total absence of the minor pectoral muscle and the latissimus dorsi muscle, is presented. She also had decreased sweating capacity and absence of terminal hairs in the central part of her right axilla. Histological examination of skin specimens from this area of the axilla demonstrated hypoplasia of the apocrine sweat glands, but normal eccrine sweat glands, indicating an apocrine dependent axillary sweating function. The breast was constructed using a direct subcutaneous prosthesis implant, giving a final result that was good in regard to shape and softness. This provides grounds for reconsidering the use of the latissimus dorsi muscle flap in breast constructions in Poland's syndrome.

203 cancers of the eyelid were operated on in 193 patients. 65% of the tumours occurred in males and the peak incidence was at 75 years. 60% afflicted the lower eyelids and 21% the medial canthi. Basal cell carcinoma were found in 182 specimens and spinocellular carcinoma in only 8. Malignant melanoma, Meibomian gland carcinoma and rhabdomyosarcoma appeared each in one patient, the latter representing the only fatal case in eyelid cancer. All cancers were excised with a free margin around 5 mm. The standard procedures of reconstruction of the eyelid defect were a fullthickness skin graft in cases where conjunctiva and tarsus could be preserved (97 cases), and a tarsoconjunctival flap in full-thickness defects of the lower eyelid (58 cases). Other methods used were wedge excision and direct approximation in very small lesions involving the lid margin, an infratarsal island flap from the lower eyelid for medium-sized to large defects in the upper lid and a forehead or scalp flap after exenteration of the orbit. 18/203 cancers recurred and 12 of these were primarily regarded as radically treated. Seven of the latter were reoperated after more than 3 years and may in fact be new tumours. No metastases were found. The various reconstructive procedures are discussed in detail

The blood flow through granulation tissue in bipedicle tube flaps on rabbits was measured during 6 weeks by 133Xenon clearance from implanted steel wire mesh cylinders. Wire mesh cylinders implanted in skin folds were used as controls in another group of animals. In addition both groups of animals had cylinders implanted in subcutaneous pockets. The clearance from the latter cylinders was similar each week. The groups were therefore considered equal in their general circulatory status. The clearance increased similarly in skin flap and skin fold cylinders to week 2, which was ascribed to the development of capillaries in the granulation tissue. From week 2 to week 4 the clearance decreased in skin flap cylinders, probably owing to a decreasing regional blood flow through the flaps. This assumption was supported by the finding of a smaller concentration of hemoglobin, regarded as a measure of the capillary density, in the granulation tissue of skin flap cylinders. After week 4 fat appeared in the granulati...

A case is presented where a myocutaneous latissimus dorsi flap was used to cover a defect resulting from irradiation injury to the neck region in a young woman. The advantage of this flap is the donor scar which is less disfiguring than flaps from the anterior chest usually chosen in such cases. The flap is taken the shortest way to the head- and neck region, through the axilla, under the insertion of the major pectoral muscle, and through the trigonum deltoideopectorale.

The oxygen consumption rate (Qo2) of granulation tissue from cylinders implanted in bipedicle tube flaps of rabbits was measured weeks 2 to 7 in vitro in a Biological Oxygen Monitor®. Granulation tissue from cylinders implanted in skin folds was used as control. The Qo2 of granulation tissue decreased slowly as the oxygen tension in the medium fell. All measurements were made at an oxygen tension of 75 mmHg. At week 2 the Qo2 of granulation tissue in flaps was high and a decrease occurred between week 2 and week 4. A further decrease took place between weeks 6 and 7 and a very low Qo2 was found at week 7. Control granulation tissue showed a higher Qo2 than skin flap granulation tissue at weeks 3, 4, 5 and 7.

s Based on operational data from full scale treatment plants a critical comparison is made between different biological-chemical process combinations. Experiences of complementary treatment by use of deep-bed filters or microstrainers are discussed. Several examples are given of process combinations which have substantially reduced the operational costs.

During a 10-year period 149 patients with non-traumatic lesions of the lower lip were operated with various methods. To overcome certain functional drawbacks with the procedures used in the early cases a new technique was developed and used in 102 cases. In order to preserve functional orbicular continuity and intact labial commissures, one or two advancement flaps from the remaining parts of the lower lip were moved in a stepwise fashion to bridge the defect. The step technique could be used for defects up to two-thirds of the lower lip, which constituted adequate resection in the vast majority of the lower lip cancers in the present series. The functional and cosmetic results of this method were satisfactory regarding sensibility, mobility, symmetry and width of the oral orifice. 69 cases of primary cancer of the lower lip had a 3 year cure rate of 100%. 27 cases treated for recurrent cancer after radiotherapy and/or earlier surgical treatment had an overall 3-year cure rate of 77%. The importance of ad...

In search for a free microvascular flap which would give abundant reconstructive material as well as a satisfactory donor site the free abdominoplasty flap was developed. The flap is designed on the area between the umbilicus, the pubic region and the anterior superior iliac spines and is based on the inferior epigastric vessels on one side only. In eight regular abdominoplasty procedures elevation of this flap and keeping the blood flow intact through the isolated vessels did not jeoparding the viability of the flap. Angiography of the specimens showed a good perfusion. The free abdominoplasty flap has been used for breast reconstruction in 2 cases of radical mastectomy. The first was failure because of venous thrombosis. In the second case 3 veins were anastomosed, 2 venae comitantes to the inferior epigastric vein and the contralateral superficial epigastric vein and the result was favourable.

This paper is a summary of a committee working for the Swedish Water and Wastewater Works Association (VAV). The purpose of the report is to present the possibilities today to measure, present and analyze data and control treatment plants. The typical audience is the operator, the process engineer, or the consulting engineer. The methods presented are all known from different disciplines, but are here presented in a form that connects the methods to wastewater treatment operation. Unlike any manual of practice the report is not a concensus report of current practice-Rather it is an attempt to show the potential of modern methods for data analysis and control. This will help the potential equipment or computer buyer to specify relevant demands for the system. The fact that any wastewater treatment plant is highly dynamic has to be reflected both in measurements and in control. The report discusses relevant sampling times for different measurements, both from the inherent dynamics and from the variability of the disturbances. Current design practice is almost always based on steady state analysis, and disturbances are too often controlled by larger tank volumes rather than relevant control actions. In order to obtain relevant data analysis the purpose of the measurement has to be clearly stated. Interesting and relevant measurement variables are listed. Moreover, a short survey of existing instrumentation and its status is presented. The transfer of data from the primary sensor to the computer has to be carefully designed. Once the data is in the computer, the data structure must be specified. The different compromizes between storage capacity, data formats and other relevant information are discussed. Simple measurement handling is described before statistical analysis is discussed. Numerous examples demonstrate the results. Some methods for parameter estimation and model building from measurement data are discussed, particularly with the purpose to make the methods available for on-line use. It is shown how estimated models can be used for the operation of plants. Different control methods are discussed. The basic kind of local control to keep the plant running is first mentioned, but more emphasis is laid on plant quality control, like dissolved oxygen, return sludge and waste sludge control. Dynamic models offer interesting possibilities for plant simulation, and simulators are being developed, that can support the operator with further predictive information. Some future possibilities of knowledge-based systems for process diagnosis are further discussed. They offer new possibilities to use natural language for systematic error analysis and diagnostic searches.

One hundred and sixty-five patients with localized cancer of the lower lip were excised and reconstructed over a 25-year period using Bengt Johanson's step technique. Eighty-eight percent of the tumors were less than 2 cm in size and 65% were of high histopathological differentiation. Fifty-six percent were reconstructed with bilateral step flaps. Nine local recurrences appeared in 5 patients, none of whom died of lip cancer. Eight patients later developed regional metastases and 3 of these patients died of lip cancer. The 5-year survival rate was 98%. The step technique is recommended for reconstruction of lip defects of up to 2/3 of the lower lip and may, in larger resections, be combined with either a fan flap or an Estlander flap. The outstanding functional results are due to the use of adjacent tissue for the reconstruction which preserves the normal arrangement of muscles, vessels and nerves.

A consecutive series of 564 patients with localized (Stage I) melanoma treated by wide excision only were followed for at least 5 years. The median tumor thickness was 1.50 mm, and 30 % were ulcerated. The female/male ratio was 54/46. The overall survival rates were 80 % at 5 years and 73 % at 10 years. The survival rates were statistically significantly better for females, even when tumor thickness and ulceration were taken into consideration. Twenty percent developed regional node metastases after an average remission period of 13 months. The actuarial survival rates after node dissection were 32 % at 5 years and 27 % at 10 years. A subgroup with an exceptionally poor prognosis and a high rate of regional node dissemination was looked for. Only 26 % of the intermediate thickness group (1.50–3.99 mm, Breslow) developed nodal metastasis, whereas patients with thick lesions (> 4 mm) had a metastasis rate of 43 %. Patients with thick lesions may therefore benefit more from elective node dissection than patients with lesions of intermediate thickness. Patient characteristics, e.g., sex and tumor characteristics (ulceration), may prove to be of importance in a prospective trial on elective node dissection.

pO2, pCO2, pH and lactate concentration were measured in wound fluid accumulated in steel wire mesh cylinders implanted in both ends of bipediclc tube flaps. Cylinders implanted in skin folds were used as controls Wounds in bipedicle tube flaps as well as in control tissue were hypoxic and acidotic during the first 3-week period. During the following 3-week period the oxygen tension and acid-base status were normal in control tissue, while a certain degree of hypoxia and hypercapnia persisted in skin flap granulation tissue. By week 7 the nutritional environment was normal also in the flaps. An imbalance thus existed between the nutritional supply and the metabolic requirement in the wounds in both the skin folds and in the skin flaps up to week 4. In the skin flaps this inbalance persisted up to week 7.

In the treatment of cicatricial entropion it may be necessary to bring new tissue to the lid margin after this has been split and the eyelashes have been everted. A bipedicled tarsoconjunctival flap from the proximal part of the tarsus forms a stable and non-irritant new lid rim for both the upper and the lower eyelid. The donor site is closed by advancement of the conjunctiva of the fornix. Three case histories are presented.

Temperature was measured in wound fluid accumulated in cylinders which had been implanted in both ends of bipedicle tube flaps 2 to 8 weeks previously. Cylinders implanted in skin folds were used as controls. The temperature in the cylinders is influenced by local heat production from metabolic processes and by increasing insulation due to growth of hair and of tissue in the cylinders. These factors were similar in both groups, however, as is shown by an equal healing potential. The changes and differences of temperature corresponded essentially to the clearance of 133Xenon during the first 4 weeks. After week 4 133Xenon clearance cannot be used as an indicator of blood flow. The temperature was lower in skin flap than in skin fold cylinders at weeks 5 and 6. It was concluded that temperature is a better indicator of blood flow than is 133Xenon after week 4 and that blood flow was lower in flaps during weeks 5 and 6, as well as in weeks 3 and 4, as was shown in a previous study. No difference in temperatu...