The ulnar digital artery perforator flap: A new flap for little finger reconstruction - A preliminary report

An ulnar digital artery perforator flap was used for little finger reconstruction. The flap has a reliable blood supply, being perfused by a constant sizeable perforator. This paper describes a study of a cadaveric dissection with methylene blue dye that was conducted to prove the rationality and reliability of the blood supply. The position of the perforator is confirmed intraoperatively by an exploratory incision before committing to the distal incision. The flap used to cover the flexor aspect of the little finger in three cases yielded positive results. To our knowledge, a digital artery perforator flap of this nature is unprecedented. We propose to call this flap the B.J. Flap after our institute.     

Digital imaging of the chest

During the past several years, image acquisition in nuclear medicine, computed tomography, ultrasonography, subtraction angiography, and magnetic resonance has been by digitization. Despite these advances, research in the development of digital imaging in conventional radiography has lagged behind. Although studies with a variety of digital techniques have been carried out on several fronts, we still do not possess a method that has captured the imagination of the majority of radiologists and other physicians to a point where it could replace conventional screen-film imaging. This article reviews the current status and general principles of the technology, focusing on the four digital radiographic techniques that have shown the greatest promise - film digitization, an image intensifier - based system, photostimulable phosphor plates, and a scanned projection system. The physical aspects of each of the four systems and the clinical results that have been reported to date, as well as the advantages and disadvantages of each system, are presented.     

Training and education in perinatal and neonatal care

The Health Services program in Maharashtra, India has admirable plans, ideas, policies, and strategies for training and education in perinatal and neonatal care, but has not been able to implement them adequately. Therefore managers should undergo training to learn workable skills to effectively supervise and guide the maternal and child health (MCH) component of the program. Recognizing the inability to reach all women, despite the wish to do so, MCH services now concentrate their efforts to cover 100% of primigravidas and 1st born children. They have been neglected when MCH services attempted to provide health care for everyone. This approach reduces the workload of MCH personnel. Further, it allows for more time to educate mothers on prenatal care and care for their 1st child. This approach may encourage these mothers to seek care during subsequent pregnancies. Since age of marriage and female education play important roles in perinatal mortality, MCH workers educate the community about them. Specifically, they provide population education to females 12-24 years old. Health services need to train MCH workers from physicians to health workers at post partum centers. Presently training is done by individual institutions, but an integrated program needs to be created. Staff in institutions that provide MCH services should develop effective aids, however, before adequate training begins. MCH services emphasize quality in providing immunization (100 Point Programme) thereby building credibility and attracting more people to be immunized. Maharashtra state has developed a monitoring plan to evaluate MCH services and devise appropriate interventions. No studies had yet been conducted as of 1989.     

In vivo study of the distribution, affinity for cartilage and metabolism of glycosaminoglycan polysulphate (GAGPS, Arteparon)

37 patients suffering from osteoarthritis and 10 arthritic patients received intramuscular (i.m.), partly also intraarticular (i.ac.) injections of GAGPS; whereupon pharmacokinetics in serum, synovial fluid, urine, and cartilage were investigated. Cartilage was obtained during endoprosthetic hip surgery. The concentrations were determined by radiochemistry, partly after gel chromatography and electrophoresis respectively. Serum levels in patients with osteoarthritis after i.m. administration of 50 mg were 0.55 microgram/ml 3 hrs later, and 0.11 microgram/ml 24 hrs later. Patients with arthritis showed similar serum levels which were slightly higher after i.ac. injection, and which rose proportionally when the dosage was increased to 125 mg. With the arthritic patients, also the concentrations in the synovium were comparable, in the cases with osteoarthritis concentrations were slightly higher, which in both cases suggests that the synovial membrane is promptly penetrated. However, the concentrations in cartilage following a dosage of 50 mg within 24 hours rose as high as 1.45 micrograms/g which corresponds roughly to three times the serum level 3 hours after application. According to biochemical data, injections of 1 to 2 micrograms/ml should yield chondroprotective effects. Hitherto therapy has relied mainly on i.ac. injections; it may now be expanded by the i.m. route of administration. GAGPS was bound to serum proteins, in the synovia, however, it was found unbound. The main portion of the compound excreted via urine within 12 hrs (30 to 40 percent) was mainly unaltered; later, a partial degradation of the chain length and of the degree of sulfation was observed. Animal experiments on rats showed an increased affinity of GAGPS to inflamed tissues (Freund's adjuvant, carageenan edema).     

Tumoroxygenierung unter kombinierter Ganzkörperhyperthermie und Polychemotherapie Untersuchungen am Beispiel eines Rezidivkarzinoms der Mundhöhle

Background and objective. Previous studies have reported synergistic effects of combined hyperthermia and chemotherapy and/or irradiation. The response to irradiation and chemotherapy of well-oxygenated and vascularized tumors generally is better than that of hypoxic tumors. Therefore, tumor oxygenation is recognized as an important predictive factor in the therapy of malignant tumors. In practice, the head and neck area remains outside of the hyperthermia chamber during whole-body hyperthermia. It was the aim of this study to evaluate if the head and neck region receives sufficient warmth and, if so, if tumor oxygenation increases accordingly. Patients/methods. Whole-body hyperthermia, as heat radiation (Enthermics Medical Systems RHS-7500), was applied to the narcotised 60-year-old male patient with a local recurrence tumor pT₃ pN_2b M₀ squamous cell carcinoma of the oral cavity. Tumor oxygenation and temperature were measured by LICOX catheters via one-point measurement during the entire hyperthermia treatment (3.5 h). Parallelly, chemotherapy (ifosfamide/Carboplatin) was given in four cycles (one cycle/month). Results. With a latency of 10 min the increase of intratumoral temperature was comparable to temperatures achieved in the esophagus. The maximum intratumoral temperature was 41.8°C. The average increase in tumor oxygenation was more than 100%. The clinical outcome in the case presented was a partial tumor remission (PR). Conclusions. During combined whole-body hyperthermia and polychemotherapy, tumor oxygenation is also significantly improved in the head and neck area, despite the fact that the head and neck area remained outside the hyperthermia chamber. The intratumoral temperature was comparable to esophageal and rectal temperatures.     

Pharmacological treatment options for <Emphasis Type="Italic">mast cell activation disease</Emphasis>

Mast cell activation disease (MCAD) is a term referring to a heterogeneous group of disorders characterized by aberrant release of variable subsets of mast cell (MC) mediators together with accumulation of either morphologically altered and immunohistochemically identifiable mutated MCs due to MC proliferation (systemic mastocytosis [SM] and MC leukemia [MCL]) or morphologically ordinary MCs due to decreased apoptosis (MC activation syndrome [MCAS] and well-differentiated SM). Clinical signs and symptoms in MCAD vary depending on disease subtype and result from excessive mediator release by MCs and, in aggressive forms, from organ failure related to MC infiltration. In most cases, treatment of MCAD is directed primarily at controlling the symptoms associated with MC mediator release. In advanced forms, such as aggressive SM and MCL, agents targeting MC proliferation such as kinase inhibitors may be provided. Targeted therapies aimed at blocking mutant protein variants and/or downstream signaling pathways are currently being developed. Other targets, such as specific surface antigens expressed on neoplastic MCs, might be considered for the development of future therapies. Since clinicians are often underprepared to evaluate, diagnose, and effectively treat this clinically heterogeneous disease, we seek to familiarize clinicians with MCAD and review current and future treatment approaches.     

谷氨酸脱羧酶抑制剂L-苹果酸对小鼠学习记忆的影响

跳台法和Y迷宫法试验表明,小鼠po L-苹果酸600mg·kg^-1连续5d后对记忆的获得、巩固和再现均有明显的改善作用,并能促进空间辨别学习能力;L-苹果酸改善记忆的作用能被NMDA受体拮抗剂氯胺酮所拮抗。脑内游离氨基酸测定显示,L-苹果酸可明显降低小鼠脑内GABA水平,提高Glu/GABA比值。实验结果表明,脑内GABA水平下降,Glu/GABA比值升高对学习记忆有正性调节作用。