Cutaneous sarcoidosis at sites of previous laser surgery

A 33-year-old patient was referred for evaluation and treatment of enlarging scars in areas where full-face carbon dioxide (CO2) laser resurfacing had been performed previously. The patient denied any systemic illness and was in good health at the time of presentation. This is a case report of isolated sarcoidosis limited to the skin associated with CO2 laser resurfacing.     

The use of a closed expandable prosthesis for pediatric sarcomas

PURPOSE: The purpose of this paper is to review our experience with a non-invasive expandable prosthesis for skeletally immature patients following limb-salvage for malignant tumors about the knee. MATERIALS & METHODS: Between 1998 and 2002, Repiphysis prostheses (Wright Medical Technology, Memphis, Tenn.) were implanted in 18 patients. 16 patients had at least 12 months follow-up. There were 10 males and 8 females. The diagnosis was Stage IIB osteosarcoma in all patients. Sites included femur 14, and 4 proximal tibias. The average age was 10.7 years (range 8-16); the average age for males was 12 years and females, 9 years. Fifteen of the prostheses were implanted at the time of surgical resection and the remainder was conversions of previous surgery. RESULTS: Follow-up averaged 24.8 months (range 12-47). Fourteen patients have undergone a total of 58 lengthening procedures. Average expansion 38 mm per patient (range, 10-76 mm). An average of 8.5 mm per lengthening procedure. There was only one failure to lengthen. ISOLS functional scores averaged 83.5%. For those with a current functional prosthesis, the ISOLS score averaged 94%. Three patients have reached maximal expansion and converted to a conventional prosthesis. There were complications in 7 patients: 2 expandable component fractures, 1 femoral component fracture, 2 stem fractures, 1 stem loosening and 1 deep infection. Of the two expandable component fractures, 1 patient reached full expansion and was converted to an endoprosthesis. The femoral component fracture and 2 stem fractures were revised to a new prosthesis 13 months post-op and are functioning well. The 1 loose stem was revised to an APC. CONCLUSIONS: The Repiphysis prosthesis utilizes energy stored in a spring that is held compressed by a locking mechanism. Controlled release of the locking mechanism via an external electromagnetic field allows for lengthening of the device. In our early experience, the functional results were excellent similar to conventional modular devices. Complications should be anticipated but are salvageable. This device allows limb salvage in pediatric patients when amputation would be otherwise chosen.     

Fractures in pediatric Ewing sarcoma

PURPOSE: To determine the incidence, timing, and clinical significance of long-bone fractures in children with Ewing sarcoma family of tumors (ESFT). PATIENTS AND METHODS: We retrospectively reviewed 93 consecutive cases of ESFT of the long bones seen at a single institution over the course of a 37-year period. RESULTS: Fracture occurred in 14 (15%) of 93 patients with long-bone ESFT, most commonly in the femur. Approximately 30% of patients with tumors of the femur had fractures at some point in the course of their disease. The incidence of fracture was highest among patients with tumors of the proximal third of the femur (50%); these fractures were usually present at the time of initial diagnosis. Nine (64%) of the 14 fractures occurred after the start of radiotherapy, and three of these were associated with either local recurrence or second malignancy. CONCLUSIONS: Patients with femoral ESFT are at high-risk for fracture. If fractures occur after the completion of therapy, recurrence or second malignancy should be suspected.     

Biosynthetic origin of hygromycin A

Hygromycin A, an antibiotic produced by Streptomyces hygroscopicus, is an inhibitor of bacterial ribosomal peptidyl transferase. The antibiotic binds to the ribosome in a distinct but overlapping manner with other antibiotics and offers a different template for generation of new agents effective against multidrug-resistant pathogens. Reported herein are the results from a series of stable-isotope-incorporation studies demonstrating the biosynthetic origins of the three distinct structural moieties which comprise hygromycin A. Incorporation of [1-(13)C]mannose and intact incorporation of D-[1,2-(13)C(2)]glucose into the 6-deoxy-5-keto-D-arabino-hexofuranose moiety are consistent with a pathway in which mannose is converted to an activated L-fucose, via a 4-keto-6-deoxy-D-mannose intermediate, with a subsequent unusual mutation of the pyranose to the corresponding furanose. The aminocyclitol moiety was labeled by D-[1,2-(13)C(2)]glucose in a manner consistent with formation of myo-inositol and a subsequent unprecedented oxidation and transamination of the C-2 hydroxyl group to generate neo-inosamine-2. Incorporation of [carboxy-(13)C]-4-hydroxybenzoic acid and intact incorporation of [2,3-(13)C(2)]propionate are consistent with a polyketide synthase-type decarboxylation condensation to generate the 3,4-dihydroxy-alpha-methylcinnamic acid moiety of hygromycin A. No labeling of hygromycin A was observed when [3-(13)C]tyrosine, [3-(13)C]phenylalanine, or [carboxy-(13)C]benzoic acid was used, suggesting that the 4-hydroxybenzoic acid is derived directly from chorismic acid. Consistent with this hypothesis was the observation that hygromycin A titers could be reduced by addition of N-(phosphonomethyl)-glycine (an inhibitor of chorismic acid biosynthesis) and restored by coaddition of 4-hydroxybenzoic acid. The convergent biosynthetic pathway established for hygromycin A offers significant versatility for applying the techniques of combinatorial and directed biosynthesis to production of new antibiotics which target the ribosomal peptidyl transferase activity.     

Primary carcinoma of fallopian tube--a case study

Primary carcinoma of fallopian tube is a rare entity. We report an interesting case of primary carcinoma of fallopian tube with contralateral lymph node involvement. The clinicopathological findings and its management is presented.     

Autografts of uncrushed and crushed bone and cartilage. Experimental observations and clinical implications.

This study evaluated autografts of bone and cartilage, uncrushed and crushed, in the perichondrial space of the ear and subcutaneously in the paraspinal region in rabbits six weeks and six months after transplantation. The results support the belief that in a clinical setting it is important to preserve perichondrium because it facilitates growth of new cartilage. This study suggests that when autogenous tissue is to be used for subcutaneous augmentation, it is best to use crushed or uncrushed cartilage or uncrushed bone because they remain viable. In the perichondrial space, crushed and uncrushed cartilage grafts not only remain viable but also induce growth of new cartilage and bone. Autogenous crushed bone does not survive in the perichondrial space of the rabbit ear.     

活体肝部分移植术后中、长期管理

0　引言　 1989- 0 7全球首例活体肝部分移植术成功以来 ,这一手术先后在 30余个国家和地区开展 ,至 1996 - 0 8全球累计总例数已愈 70 0例 ,我院于 1997- 0 6 - 30在日本京都大学Tanaka Koichi教授的指导下 ,成功地开展了 1例活体肝部分移植术 ,至今患者已健康生存 1.5 a,现就其术后中长期管理结合文献总结如下 :1　临床资料1.1　病例　患者为 10岁女性 ,诊断为先天性弥漫性肝内胆管囊性扩张症、复发性胆管炎、肝硬变症 ,1997- 0 6 - 30在全麻下行活体肝部分移植术 ,供体为患儿 40多岁的父亲 ,手术顺利 ,术后早期临床资料已作过报告 [1 ] …     

Interpeduncular fossa sign: CT criterion of subarachnoid hemorrhage

A retrospective study of 100 cerebral computed tomography scans interpreted as displaying subarachnoid hemorrhage was undertaken to determine the frequency of blood in the interpeduncular fossa as a useful radiographic sign. The results indicate that the interpeduncular fossa sign is second only to blood in the Sylvian fissure-circular sulcus area as a reliable indicator of subarachnoid hemorrhage on CT scans.     

Resident work hours and working environment in otolaryngology. Analysis of daily activity and resident perception

OBJECTIVE.--To analyze the working environment and work hours of a cohort of otolaryngology--head and neck surgery residents. DESIGN.--Environmental analysis questionnaire and a log of daily activities. SETTING.--Residents were on a clinical rotation system. PARTICIPANTS.--Fifty-nine residents from six programs, including three public and three private institutions, from geographically diverse regions of the country were involved in the study. Residents were equally distributed from their second year through their fifth year of postgraduate work. All eligible residents participated in and completed the study. INTERVENTION.--The environmental analysis survey was designed to elicit resident perception of different aspects of their working environment. The daily activity log required the resident to report on activities for each half-hour period for 7 consecutive days. RESULTS.--Residents were on call an average of 52.8 hours (2.2 days) and worked 79.4 hours per week. Seventy-five percent believed that the level of faculty supervision and the degree of resident responsibility was about right. Two major inefficiencies were the time involved in completion of paperwork and the lack of nonmedical support services. Thirty-one percent of the residents responded that fatigue resulted in substandard patient care 10% of the time. Forty-seven percent responded that their educational experience was substandard 25% of the time secondary to fatigue. Two thirds responded that the demands of residency training had a negative impact on their family and personal life. CONCLUSIONS.--Seventy percent of the otolaryngology--head and neck surgery residents surveyed at six institutions believe that an 80-hour workweek, including being on call every third night with no more than 24 hours of continuous work without sleep, approximates a reasonable, maximum work schedule. Residents working the longest hours expressed concern about rendering substandard care and developing negative attitudes toward patients. Noneducational inefficiencies were identified and solutions were proposed. Demands of residency training, even within guidelines established as reasonable, can have detrimental effects on residents' educational activities and personal life.