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After pointing out the need for reconstruction of the nipple-areola complex and the restoration of symmetry between the two breasts after radical mastectomy for cancer, the paper briefly examines the techniques currently available for the achievement of these "finishing touches" that usually take longer then the primary and fundamental breast reconstruction.

The use of external fixators in the treatment of complex mandibular fractures is described, as are the advantages offered by the technique which permits accurate, controlled reduction of the bone fragment without immobilising the temporomandibular joint.

A careful review of the literature stimulated these comments on current developments in conservative surgery as an alternative to radical mastectomy in stage I and II breast cancer with particular reference to their implications for cosmetic rehabilitation. It is emphasised that the data so far available indicate comparable results in terms of locoregional recurrences, metastases and survival. It is also pointed out that the efficacy of the conservative techniques reflects new concepts of the natural history of breast cancer. The hope is expressed that these encouraging data will be confirmed by more extensive and systematic clinical experiment in order to minimise the indications to more radical surgery which notoriously has such devastating physical and psychological effects that it takes extremely complex and demanding plastic surgery to reshape the patient to psychological sexual and social health.

The 10-year survival rate of 66 patients discharged after an acute myocardial infarction associated with intraventricular conduction delay is reported. The whole population under study consisted of 321 patients followed for 10 years or until death. In 46 patients (69.7%) the conduction delay was a definite complication of infarction, in 15 (22.7%) it preceded the acute event and in 5 (7.5%) the time of onset was undetermined. Mortality in the presence of a conduction delay was 74.2% in 10 years vs 39.2% in its absence (p less than .001). Death was sudden in 41.6% of fatalities when a conduction defect was present and 28% in its absence (p less than .01). The 10-year survival was 55% in patients with conduction defects and QRS less than .12 sec duration, 23.8% if QRS was between .12 and .14 sec, and 4% when QRS duration was greater than .14 sec. 72% of patients of this latter group was in NYHA class 3 or 4, whereas 70% of patients with QRS less than .12 sec and 47% of patients with QRS .12 to .14 sec were in class 1 or 2. These data show that long-term prognosis of conduction delay associated to myocardial infarction is poor and stratification of risk of death is possible among these patients on the basis of QRS duration.

The biological and synthetic materials employed over the years for filling breasts after mastectomy or for congenital malformations are reviewed. At the start of the century, breast shape and volume were changed by adipose tissue grafts. In the 50s and 60s dermo-fibro-adipose grafts and later auto-grafts and grafts of the large epiploon were used. Synthetic materials have also developed, from early century attempts using paraffin injections to the discovery for industrial use of plastics. Following the first polyvinyl prostheses, Cronin developed silicon prostheses for medical purposes and in later years these went through numerous changes in form, volume and design up to the recent skin expanders. Polyurethane has also been used in attempts to reduce capsular retraction.

After underlining the serious psychological consequences of radical mastectomy for carcinoma and the importance of breast reconstruction for the patient's complete recovery, the paper briefly reviews the main reconstruction techniques employed in restoring breast volume which is essentially achieved by inserting an artificial prosthesis below a myocutaneous skin flap often taken from the great dorsal. Some mention is also made of recently developed alternative techniques.

A review of the literature on complications in septorhinoplasty is presented. Though rare, complications may arise in the surgical treatment of such a delicate anatomical area as the nasal septum and both theoretical and practical knowledge of the problem is necessary in order to prevent and/or handle such unexpected events. Complications are grouped according to aetiopathogenesis into infectious, haemorrhagic, traumatic, systemic and miscellaneous.

Functional results of resection arthroplasty are currently considered poor. In 104 hip prosthesis removals after either septic or aseptic loosening, pain, walking, joint motility, life style, and patient's opinion were evaluated. A satisfactory result was recorded in 72% of cases. Prognosis is poorer in patients who are young, have septic loosening, and have poor residual mobility. Resection arthroplasty should be considered a salvage procedure in cases of septic loosening and/or bone stock deficiency after a failed total hip arthroplasty.

In the present study, we have evaluated the relationship between serum ferritin (SF) levels, 'hemochromatosis allele(s)', blood transfusions and iron parenteral administration in 69 hemodialysis patients. We demonstrated significantly higher SF levels in patients with hemochromatosis allele(s) (HA+) than in patients without hemochromatosis alleles (HA-). In addition, HA+ patients who had received blood transfusions up to 15 months prior to the study had SF levels even higher than those without blood transfusions. On the other hand, HA- patients had normal levels of SF, independent of blood transfusions. After intravenous administration of 1 g iron saccharate, SF levels were significantly higher only in HA+ transfused patients. In conclusion, our study demonstrated that HA+ patients are at a higher risk of iron overload and therefore the use of transfusional and/or parenteral iron should be strictly limited.

The entire literature on abdominoplasty is reviewed with a description of the various techniques developed since the introduction of the operation.