The use of multifolded pericranial flaps as "plugs" and "pads"

Pericranial flaps are thin and, hence, their volumes are small. Therefore, their use for soft-tissue augmentation has not been popular. In this article, the author introduces a new concept: the use of a multifolded pericranial flap as a "plug" or a "pad" for localized contour defects. Eight patients were included in the study. In all cases, an anteriorly based pericranial flap was used, and the flap was folded on itself several times to increase its bulk. The results were satisfactory in all patients. The literature on the topic is reviewed, and the blood supply of pericranial flaps is discussed.     

"Brilliant Blue G" and "Membrane Blue Dual" assisted vitrectomy for macular hole

The aim of this study is to evaluate vital dyes "Brilliant Blue G" (BBG) and "Membrane Blue Dual" (MBD) for intraoperative staining of the inner limiting membrane (ILM) during vitrectomy for macular hole (MH). Retrospective, comparative case series on 18 eyes with macular holes who underwent "23 and 25 gauge" pars plana vitrectomy. Main outcome measurements were staining intensity and characteristics, visual acuity, visual field, OCT measurements and complications over a period of 6 months. With the help of BBG and MBD successfully was removed complete ILM in 14 eyes. Postoperative visual acuity was improved in 12 patients, unchanged in 2 patients and worse in 4 patients. Central retinal thickness showed significant postoperative reduction with closure of macular hole. OCT values range were from -10 to -250 microm. No visual field defects and no adverse effects were found. BBG and MBD successfully identificate internal limiting membrane during vitrectomy for MH. Good anatomical and functional results are achieved with the use of both vital dyes.     

Solution of genetic problems of ecology using the automated system "Bioscreen C" (SOS-Chromotest program)

Comparative experiments on the use of the automated system Bioscreen C (SOS-chromotest program) and the Eims tests for estimating the SOS-inducing and mutagenic activity of chemical compounds belonging to 5 different classes showed that the system was obviously promising and safe in rapid screening of environmental mutagens and carcinogens. Advantages of the system use as well as its prospects, specificity and limitations were revealed.     

Summary--Measuring "bone quality"

The idea of bone quality is well-established in the literature and represents a real conundrum in the treatment of osteoporosis. On the one hand, there are measurements for patients that predict fracture risk for the population as a whole, but between individual patients, one will fracture but another will not, despite the fact that all of the technical measurements we use to predict fracture risk are the same. There are, of course, many aspects of bone mechanical properties that cannot yet be measured in patients. The session began with a discussion of what bone quality is, then the speakers presented work on novel aspects of bone properties that could help explain why fracture prediction in vivo is inexact.     

Effect of "fast track" admission for acute myocardial infarction on delay to thrombolysis.

OBJECTIVE--To evaluate the impact of a fast track triage system for patients with acute myocardial infarction. DESIGN--Comparison of delays in admission to hospital and in receiving thrombolytic treatment before and after introducing fast track system with delays recorded in 1987-8. Patients fulfilling clinical and electrocardiographic criteria for myocardial infarction were selected for rapid access to the cardiac care team, bypassing evaluation by the medical registrar. SETTING--Major accident and emergency, cardiac and trauma centre. SUBJECTS--359 patients admitted to the cardiac care unit during 1 February to 31 July 1990 with suspected acute infarction. MAIN OUTCOME MEASURES--Accuracy of diagnosis and delay from arrival at hospital to thrombolytic treatment. RESULTS--248 of the 359 patients had myocardial infarction confirmed, of whom 127 received thrombolytic treatment. The fast track system correctly identified 79 out of 127 (62%) patients who subsequently required thrombolytic treatment. 95% (79/83) of patients treated with thrombolysis after fast track admission had the diagnosis confirmed by electrocardiography and enzyme analysis. The median delay from hospital admission to thrombolytic treatment fell from 93 minutes in 1987-8 to 49 minutes in fast track patients (p less than 0.001). Delay in admission to the cardiac care unit was reduced by 47% for fast tract patients (median 60 minutes in 1987-8 v 32 minutes in 1990, p less than 0.001) and by 25% for all patients (60 minutes v 45 minutes, p less than 0.001). CONCLUSION--This fast track system requires no additional staff or equipment, and it halves inhospital delay to thrombolytic treatment without affecting the accuracy of diagnosis among patients requiring thrombolysis.     

Survey of "do not resuscitate" orders in a district general hospital.

OBJECTIVE--To evaluate the local use of written "Do not resuscitate" orders to designate inpatients unsuitable for cardiopulmonary resuscitation in the event of cardiac arrest. DESIGN--Point prevalence questionnaire survey of inpatients'' medical and nursing records. SETTING--10 acute medical and six acute surgical wards of a district general hospital. PARTICIPANTS--Questionnaires were filled in anonymously by nurses and doctors working on the wards surveyed. MAIN OUTCOME MEASURES--Responses to questionnaire items concerning details about each patient, written orders not to resuscitate in the medical case notes and nursing records, whether prognosis had been discussed with patients'' relatives, whether a "crash call" was perceived as appropriate for each patient, and whether the "crash team" would be called in the event of arrest. RESULTS--Information was obtained on 297 (93.7%) of 317 eligible patients. Prognosis had been discussed with the relatives of 32 of 88 patients perceived by doctors as unsuitable for resuscitation. Of these 88 patients, 24 had orders not to resuscitate in their medical notes, and only eight of these had similar orders in their nursing notes. CONCLUSIONS--In the absence of guidelines on decisions about resuscitation, orders not to resuscitate are rarely included in the notes of patients for whom cardiopulmonary resuscitation is thought to be inappropriate. Elective decisions not to resuscitate are not effectively communicated to nurses. There should be more discussion of patients'' suitability for resuscitation between doctors, nurses, patients, and patients'' relatives. Suitability for resuscitation should be reviewed on every consultant ward round.     

Use of therapeutic polycomponent vaccine "Immunovac VP-4" for the treatment of chronic bacterial prostatitis

A complex of clinical and laboratory examinations of patients with bacterial chronic prostatitis was carried out. The patients were divided into two groups: 55 patients treated by the method of immunotherapy and 20 patients (controls) undergoing basic therapy. Immunotherapy was carried out with the use of polycomponent vaccine VP-4 containing Staphylococcus aureus, Klebsiella pneumoniae, Proteus vulgaris and Escherichia coli antigens. Vaccinal therapy was indicated in cases with infection focus associated with opportunistic bacteria, a prolonged torpid course of prostatitis and when different schemes of etiotropic therapy proved to be ineffective. The vaccine was introduced in 4 or 5 subcutaneous injections at an interval of 5-7 days. The study revealed that in cases of chronic prostatitis accompanied by microecological and immune disturbances the use of complex therapy allowed to achieve good clinical and laboratory results in 91% of the patients. In the patients undergoing immunotherapy the elimination of opportunistic bacteria from the urogenital tract and the restoration of affected microflora occurred.     

Rigid fixation of the calvaria in craniosynostosis without using "rigid" fixation

Early observations of intracranial translocation of metal wires, plates, and screws used for infant skull surgery have led some surgeons to investigate alternative forms of fixation. The purpose of this study was to review a series of infants and children in whom absorbable suture fixation was used as the sole method of fixation in cranial vault remodeling. Standard osteotomies were successfully modified to permit the use of this less rigid form of fixation. Over a 6-year period, 142 cranial vault procedures were performed, primarily for craniosynostosis, using absorbable sutures (2-0 polydioxanone). Patients who did not have absorbable suture fixation, or who had a combination of absorbable sutures with another form of fixation, were excluded from this review. Records were reviewed for results (assessed by both the treating surgeon and an independent anthropologist) and for complications. The average age of patients was 2 years, 7 months (range, 1 month to 16 years). The clinical results were judged as follows: grade I (excellent), 49 percent; grade II (minor imperfections), 48 percent; grade III (small surgical procedure needed), 2 percent; and grade IV (complete reoperation required), 1 percent. Anthropologic results were similarly distributed: excellent, 36 percent; good, 56 percent; fair, 8 percent; and poor, 0 percent. Those 3 to 8 percent of patients who were found to have the poorest results were all noted to have syndromes, and it appeared that an inherent lack of growth was the primary basis for the low score. There were no deaths or major complications in this series of patients. The smaller complications identified were infections [four cases (2.8 percent)] and transient cerebrospinal fluid leak [two cases (1.4 percent)]. The most important factor in determining whether absorbable suture fixation was sufficient was the size of a preexisting calvarial defect. Although concerns have been raised about a possible link between absorbable suture fixation and subsequent poor reossification, no such association was noted in this review. The primary disadvantage of using absorbable sutures was the lack of rigidity provided. Advantages included lower costs, speed of application, and the absence of observed intracranial translocation. In conclusion, the use of absorbable suture fixation (with modifications in osteotomy design) was associated with both acceptable aesthetic outcomes and low complication rates. Craniofacial surgeons may wish to consider the use of absorbable sutures as another option for bone fixation in treatment of craniosynostosis.     

Reduction mammaplasty using the inferior glandular "pyramid" pedicle: experiences with 300 patients

A comprehensive review of 300 patients undergoing reduction mammaplasty (576 breasts) based on an inferior glandular pedicle is presented. The average age was 31.7 years, weight 146.6 lbs., and the amount of tissue removed 1313.6 gm. No deepithelialization of the skin was performed, and average operating time was 174 minutes. The average distance the nipple-areola complex was moved was 12 cm, with the longest being 22.5 cm. Fifty-seven percent had fibrocystic mastopathy on histologic analysis, and no malignancies were found, even in patients who had undergone a previous mastectomy for breast carcinoma. The most common complication (3.1 percent) was minor suture line necrosis along the infra-mammary crease. All healed without intervention. There was no necrosis or sensory loss to the nipple-areola complex in any patient, and cosmesis was excellent. The analysis also showed that the use of epinephrine, injected subcutaneously just prior to the operation, significantly decreased intraoperative blood loss (p less than 0.0005), regardless of the amount of tissue removed, and eliminated the need for transfusions.     

Dichromatic color language: "reds" and "greens" don't look alike but their colors do.

When protanopes or deuteranopes arrange the Farnsworth Dichotomous Test colors in order of similarity, they reveal their lack of red/green hue discriminations by alternating chips that the normal trichromat sees as reddish and greenish test colors. The dichromatic orderings follow a systematic variation in saturation of blue hues through neutral and into yellow hues as described by theory for each of the two types. Some dichromats who show the typical test behavior nevertheless use reddish and greenish hue terms appropriately when instructed to name the same test colors. Lightness cues are probably used by these dichromats in the naming task but ignored in the perceptual similarity task. Thus, unlike normal trichromats, who use similar names for perceptually similar colors, dichromats may use dissimilar names for perceptually similar colors. In this way they can achieve concordance with the normative language system despite its discordance with their impoverished color perceptions.     

Development of a "reverse capture" autoantibody microarray for studies of antigen-autoantibody profiling

Diagnosing cancers based on serum profiling is a particularly attractive concept. However, the technical challenges to analysis of the serum proteome arise from the dynamic range of protein amounts. Cancer sera contain antibodies that react with a unique group of autologous cellular antigens, which affords a dramatic amplification of signal in the form of antibodies relative to the amount of the corresponding antigens. The serum autoantibody repertoire from cancer patients might, therefore, be exploited for antigen-antibody profiling. To date, studies of antigen-antibody reactivity using microarrays have relied on recombinant proteins or synthetic peptides as arrayed features. However, recombinant proteins and/or synthetic peptides may fail to accurately detect autoantibody binding due to the lack of proper PTMs. Here we describe the development and use of a "reverse capture" autoantibody microarray. Our "reverse capture" autoantibody microarray is based on the dual-antibody sandwich immunoassay platform of ELISA, which allows the antigens to be immobilized in their native configuration. As "proof-of-principle", we demonstrate its use for antigen-autoantibody profiling with sera from patients with prostate cancer and benign prostate hyperplasia.     

The "beggar's" hand and the "unshakable" hand in children with total obstetric brachial plexus palsy

A total 12 consecutive children with secondary deformities following total obstetric brachial plexus palsy were included in this retrospective study. In all patients, the main complaints were two socially disabling hand postures: the "beggar's" hand and/or the "unshakable" hand. All children had a supinated forearm with no active pronation and were teased by their friends, who called them "beggars." When the impairment was severe and involved the right hand and wrist, children also complained that they were not able to shake hands. The management approach to these children was described, with the main aim of surgery being the correction of the abnormal posture. Other simultaneous tendon transfers were also performed to improve hand function if there were suitable musculotendinous units. Successful reconstruction was accomplished in all patients. Preoperatively, some children refused to go to school because of teasing, and most did not want to interact socially. After surgery, all children attended school regularly, and parents reported much better social interaction. However, the functional gain was never enough to dramatically improve the daily use of the limb. The contralateral normal limb remained the dominant one for all daily activities, including writing and eating.     

Tumor idiotype vaccines. VI. Synergistic anti-tumor effects with combined "internal image" anti-idiotypes and chemotherapy

Anti-Id antibodies that have biologic activity as stimulators of specific immunity have been used in experimental vaccines and tumor protection models. However, very little is known about the therapeutic potential of anti-Id antibodies in animals and men. In this study we explored the combination of anti-Id and chemotherapy in a murine tumor system for which we had previously generated protective anti-Id mAb. First, we investigated various protocols by using a protective anti-Id in active immunization. Mice preimmunized before tumor transfer and challenged again after tumor survived significantly longer. Next, we explored the use of soluble anti-Id as immunostimulator in tumor-bearing mice. Although this treatment did not induce long-term survival, it significantly increased survival time. Interestingly, this anti-Id effect was dose dependent, whereby large and small doses had no effect. Finally, stimulatory anti-Id therapy and cyclophosphamide (Cy) treatment was combined. Tumor bearing mice were given a single dose of Cy followed by different doses of soluble anti-Id. The optimal effect on tumor growth and survival was achieved with 80 mg/kg Cy and 10 micrograms/mouse of anti-Id, where 80% of mice survived longer than 100 days. These results provide guidelines for developing clinical protocols for cancer patients by using combination therapy of anti-Id and chemotherapy.     

Switching mechanism of a cyclic enzyme system: role as a "chemical diode"

We previously showed with computer simulations that cyclic enzyme systems play a role in metabolic switching events. In the present study, the detailed switching mechanism was investigated by clarifying the relationship between the switching mode and the phase-difference of two sinusoidal inputs to the cyclic enzyme system. The switching time could be predicted theoretically. Half-wave and full-wave rectifications were observed when the phase-difference of two sinusoidal inputs is equal to pi. This result indicates the possibility that this cyclic enzyme system is available for use as a switching circuit (biochip) in a bio-computer.     

Optimization of "Photosens" pharmakokinetics by biodegradable nanospheres]

The present study is dedicated to investigation of pharmacokinetics of the colloidal delivery system based on polybutylcyanoacrylate nanoparticles for the II generation photosensitizer Photosense. Free or nanoparticle-bound Photosense was injected intravenously in healthy rats in the dose 15 mg/kg. It was shown that pharmacokinetic curve of the free drug was characterized by peak concentration while plasma concentrations of nanoparticulate Photosense were relatively steady. Elimination of nanoparticulate Photosense was more rapid comparing to the free drug. It is noteworthy that nanoparticles did not enhance liver uptake of the drug. Lung level of nanoparticulate drug was found to be lower and spleen uptake was enhanced. More important is the fact that nanoparticles provided two-fold decrease of Photosense skin concentration which is potentially important for decrease of drug-related skin phototoxicity. The above data provide evidence that optimization of Photosense pharmacokinetic parameters could be achieved by the use of nanoparticles.     

"I" becomes "L": modification of vertical mammaplasty

The problems of the vertical mammaplasty by Lejour (i.e., gathering the skin envelope in one vertical suture, frequent secondary healing problems, and later sagging of the inferior glandular part in the case of large and very large breasts) are well known. A simple modification of the Lejour technique, that is, adding a lateral inframammary scar to shorten the vertical scar length, is presented. The modified L technique was used in 45 patients (90 breasts) between October of 1999 and August of 2001. With an average follow-up of 13 months, the jugular notch-to-nipple distance was 21 cm, the vertical scar length was 8.4 cm, the lateral inframammary scar length was 11 cm, and the average resection weight was 625 g per breast (range, 200 g to 2080 g). Even among patients who had very large glandular bases and resection weights it was possible to achieve a breast base reduction, modeling the glandular corpus to a harmonic, well-projecting, and youthful shape. Slight wound-healing problems with spontaneous cicatrization within 2 weeks occurred in six patients. In two patients who exhibited gigantomastia up to 2080 g per breast, partial mamilla necrosis occurred on one side. Ninety-one percent of the patients reported being "very satisfied" with the outcome, and 9 percent reporting being "satisfied." The authors' modification of the vertical mammaplasty to an L-shaped scar technique enables the surgeon to apply the principles of the Lejour technique for higher resection weights and diminishes wound-healing problems, and it is still a scar-minimizing technique that results in a scar-free cleavage. It is easy to learn and an ideal standard technique for a teaching hospital.     

"Right" stay in hospital after sugery: randomised controlled trial.

A randomised controlled trial was carried out on 100 patients to compare the effects of discharge after certain pre-specified clinical criteria had been fulfilled--"right" stay--with those of discharge at an arbitrary 10 days after surgery--"fixed" stay. The operations concerned (cholecystectomy and vagotomy) were more hazardous than those previously included in studies of early discharge. Patients in the right-stay group were discharged, on average, 7-6 days after operation--that is, two days earlier than those in the fixed-stay group. In terms of clinical progress, social factors such as return to work, and the acceptability to patients and relatives of the implications of right stay, patients in this group fared as well as those in the fixed-stay group, and in some respects slightly better. Right stay entailed the transfer of some work from hospital to community medical and nursing staff, but this also was acceptable. The concept and use of the right-stay principle is of value in planning the postoperative discharge of suitable patients.     

High versus "low" dose corticosteroids in recipients of cadaveric kidneys: prospective controlled trial.

Corticosteroids have the major role in the immunosuppressive treatment of patients who have received renal transplants. Despite their extensive use there is still debate about the appropriate dose that will prevent rejection of the renal allograft with the least morbidity. From March 1979 to November 1981 a randomised controlled trial of high (33 patients) v low oral dose (34 patients) of prednisolone along with azathioprine was conducted in recipients of first cadaveric transplants who had received a blood transfusion within six months of transplantation. The main difference in outcome between the two groups was a high incidence of some infections in the high dose group. Patient mortality, graft survival, transplant function, and number of rejection episodes were indistinguishable in the two groups, but rejection episodes tended to occur later in the high dose group. These findings suggest that the use of lower doses of corticosteroids soon after cadaveric renal transplantation does not jeopardise graft survival and results in lower patient morbidity.     

"Altered Short-Term Dynamics of Cardio-Respiratory Interaction during Propofol-Induced Yawning"

"Cardiac and respiratory oscillations have been shown to interact with each other. This interaction could reflect autonomic nervous system functionality. Propofol-induced yawning during anesthesia induction seems to be associated with sympathetic activation. Presumptively, there is high linearity among interaction of different physiologic system behaviors. Recently, investigators used coherence analysis to quantify the existence and strength of linearity between system signals for study of cardio-respiratory interaction under different physiological conditions. In this investigation, we used a method of time-frequency coherence function to analyze ECG and respiration signals to investigate the linearity of cardio-respiratory dynamics in patients undergoing routine propofol induction procedures for elective surgery. In this prospective, observational clinical study, a total of 84 eligible patients were enrolled. The patients were categorized into yawning and no-yawning groups during propofol induction. During induction, both groups demonstrated significant reduction in high frequency coherence (coh-HF) with simultaneously significant increase in very low frequency coherence (coh-VLF) compared to the pre-induction period. As yawning occurred, the yawning group had more significant changes of cardio-respiratory coherences than the no-yawning group at coh-LF and coh-VLF bands. The yawning group also showed loss of linearity at high frequency band (coh-HF > 0.5) as compared with the pre-induction period, and also showed increases in linearity at low (coh-LF > 0.5) and very low (coh-VLF > 0.5) frequency bands compared with the no-yawning group. Propofol-induced yawning alters cardio-respiratory dynamics with changes of linearity between cardio-vascular and respiratory system behaviors."     

The "Dry" Silver Method and Its Proper Use

SYNOPSIS. The "dry" silver method is redescribed with special attention to the possible difficulties encountered in its use. This method first revealed the silverline or neuroformative system of the ciliates, and is considered the best method for the demonstration of this structure. The valuable results obtainable with this technique are pointed out and illustrated with appropriate photomicrographs.