[Almindeligt Hospital -- a large and considerable building]. / Almindeligt Hospital -- en stor og anseelig bygning.

In the year 1769 a newly erected big public institution was inaugurated in Copenhagen. It was built to accommodate 700 paupers. 200 out of these, who were unable to look after themselves, were given full board, while the others had to pay for their meals out of money they gained by doing the odd jobs in or outside the institution. A small infirmary of 16 beds had in 1790 grown to 154 beds and in 1807 to more than 400. In addition to the care of patients with chronic diseases, the public treatment of syphilis and scabies now had to be attended to. In 1808 the infirmary was divided into two units, one medical and one surgical. It was not until 1855 that a department for venerea and skin diseases was established. In 1845 1500 persons lived in the buildings: 110 employees, 1074 paupers and 316 patients. These packed crowds and bad sanitary conditions led to disaster when the cholera epidemic broke out in 1853. Consequently the Copenhagen Municipal Hospital was built and in 1863 most of the patients from the institution were transferred to this hospital. Nevertheless, in 1890, 1700 paupers and disabled patients still remained in the crowded old buildings. In 1892 it was decided that the entire institution whould move to new premises in Nørre Alle, the present Old Peoples Home. The following year the old buildings were demolished.

Results following reduction mammaplasty as evaluated by the patients.

Reduction mammaplasty was performed on 365 patients using the technique of Pers and Bretteville-Jensen. Two to 13 years after the operation, the patients were asked to complete questionnaires; the answers were analyzed and compared with answers from a smaller group of patients who had undergone surgery with McKissock's technique. Primary complications to the procedure were few, and it is remarkable that total necrosis of the nipple was absent in the series. More than 80% of the patients had their general expectations fulfilled, but one third in both groups found the resulting scars unacceptable. The character of the scars seems to be more important than the location. Primary complications were more frequent in overweight patients, and preoperative weight regulation is recommended. An improvement in the character of scars after reduction mammaplasty would be beneficial, and detailed preoperative information is essential if postoperative disappointment is to be avoided.

Primary results following surgical treatment of pressure sores.

A review of 103 surgically closed pressure sores shows unsatisfactory results. Following a critical analysis of the various complications several alterations in the surgical treatment are suggested. The improvements include a more rational antibiotic treatment, two-stage operations, different flaps and the use of fibrin sealant.

Streptococcal gangrene of the eyelids. Case reports.

Following a brief review of the literature, three patients with fulminating periocular infections resulting in necrosis of the eyelids are reported on. The case histories demonstrate certain common features, different aetiological factors and diverse end results. The pathogenesis, microbiology and treatment are discussed.

The repair of soft tissue defects in the lower leg. A comparison of different flap techniques.

The results following reconstruction of soft tissue defects in the lower leg in 102 patients with 19 cross-leg flaps, 49 muscle flaps, 17 dorsalis pedis island flaps and 26 free composite island flaps were compared regarding the pattern of primary healing, time taken to heal and costs. The cross-leg flap appeared to be the least dependable method of reconstruction and most expensive way of reestablishing stable soft tissue coverage. Muscle flaps and dorsalis pedis island flaps appeared to be preferable and equal alternatives to cross-leg flaps in the proximal and distal part of the lower leg, respectively. Free composite island flaps also appeared advantageous compared to cross-leg flaps, and seem to be indicated when simpler means of reconstruction are inadequate or would yield a similar result at higher overall costs.

Some general surgical principles as applied to aesthetic surgery.

Control of bleeding is a keystone in surgery. Hemostasis usually leaves dead tissue behind. The use of fibrinogen-thrombin-spray may become an alternative to ligation and electrocoagulation. As pressure prevents the proliferation of fibroblasts, tight suturing may delay wound healing. It is proposed that facial injuries often heal with scarcely visible scars because the suturing becomes slack as oedema subsides.

A crossover comparative study with two bulk laxatives.

Twenty elderly in-patients suffering from severe constipation were treated once daily for 2 weeks with each of two bulk laxatives. The preparations were allocated randomly as the first and second preparation. Agiolax, the new preparation, contained 15 mg senna glucosides, the old preparation, Lunelax comp., contained 25 mg senna glucoside A + B per dose. Both preparations worked well and no side-effects were seen.

Plastic surgery in a large hospital.

It may be debated whether the interaction between plastic surgery and other specialties is important enough to justify the presence of a department of plastic surgery in a large teaching hospital. To provide some data on which to base such discussion we have analysed the interaction at the Rigshospitalet in Copenhagen over a ten year period (1970-1980). In the plastic surgery department almost 10% of all the operations were on patients from the wards of ther departments. One tenth of these operations were combined operations carried out in collaboration with surgeons from other specialties. Otherwise intractable conditions may be cured by such combined activity and a properly organised "skin-grafting service" pays handsome dividends by shortening the healing time for ulcers within the hospital.

The trapezius myocutaneous flap used for closure of pharyngeal fistulas.

A procedure for the closure of pharyngeal fistulas utilizing an upper trapezius myocutaneous flap is described. The anatomical basis of the flap is reviewed. The operative technique is described and applied in 2 cases. The excellent vascularity of the flap is stressed.

Psychological assessment before and after augmentation mammaplasty.

Twenty patients selected for augmentation mammaplasty paid for by the Health Service, were evaluated pre- and postoperatively by psychological and psychiatric examinations. Some 70% deviated from the normal psychological picture, with symptoms of remarkable similarity. The follow-up investigation one year after the operation revealed an unchanged basic personality structure, but the alteration to the breasts had relieved the patients from their previous distress and shyness and made them feel less inhibited. An attempt was made to predict the benefit each patient would gain from the operation, and the results were usually found to exceed the expectations. Only one patient was disappointed. In no case had the operation aggravated the preoperative psychological condition. Preoperative psychiatric examination of such patients would probably not provide any better selection.

The closure of urinary-vaginal fistulas.

Reported series of urinary-vaginal fistulas repaired by a vaginal approach show at least 85% primary closure. However, many patients have had several unsuccessful operations elsewhere prior to the final repair. This means that regularly successful closure is possible, but it demands a certain "know-how" and engagement. In search for the general principles leading to such successful primary closure, different published techniques have been studied. It appears that the essential features are the establishment of a proper distance between the inner vesical and the outer vaginal epithelium and the creation of broad raw surfaces to be ajoined. The operation should not involve any risk of enlarging the existing fistula, and the transfer of normal tissue to the site of the repair and the interposition of tissue between the cavities to be separated are sound reconstructive procedures. A personal technique based on these principles is presented. The gynecologists of to-day most often refer urinary-vaginal fistulas to the urologists, who almost without exception prefer a suprapubic transvesical approach. It is strongly recommended that the large majority of urinary-vaginal fistulas should be repaired by the vaginal approach which is a minor intervention. The plastic surgeon should be engaged in the management of urinary-vaginal fistulas.