Removal of the Outer Table of the Skull for Reconstruction of Full-Thickness Scalp Defects with a Dermal Regeneration Template

BACKGROUND The reconstruction of large defects of the scalp after wide excisional surgery of cutaneous malignancies is challenging. When the pericranium must be resected due to safety considerations, the exposed bone complicates reconstructive approaches.
OBJECTIVE The objective was to develop an improved technique for reconstructive surgery of full-thickness scalp defects.
METHODS Full-thickness scalp defects of up to 126 cm² in size with exposure of denuded bone were treated by partial removal of the outer table of the skull. The diploic space exposed by this treatment showed petechial bleeding and was covered with a dermal regeneration template (Integra, Integra Lifesciences Corp., Plainsboro, NJ). After transformation of the template by vascularization and by proliferation of fibroblasts, an ultrathin skin graft was transplanted onto the neodermis.
RESULTS Thirteen patients with cutaneous malignancies of the scalp were treated using this technique. The defects were transplanted within a median postoperative time period of 29 days (± 4 days) and showed good cosmetic results and stable scars. After a follow-up period of 6 months, no local recurrences were observed.
CONCLUSION This reconstructive procedure allows closure and rapid healing of large scalp defects in which the pericranium had to be resected.     

Erfahrungen mit dem CACH-Medium zum Nachweis von Trichomonaden und Hefepilzen bei Frauen mit Scheidenentzündungen

Das 1960 von W. A. MÜLLER entwickelte CACH-Medium hat sich gut für den kulturellen Nachweis von Trichomonaden und Hefepilzen in Vaginal- und Urethrasekret von Frauen mit Scheidenentzündungen, die die Ambulanz der Frauenklinik aufsuchten, bewährt. Die Zubereitung des Anreicherungsmediums und die Untersuchungstechnik zur Ermittlung dieser Mikroben werden beschrieben. Die mitgeteilten Erfahrungen stützen sich auf die Ergebnisse, die bei der mykologischen und parasitologischen Untersuchung von 1526 Vaginal- bzw. Urethraabstrichen von 639 Frauen mit Scheidenentzündungen erzielt werden konnten.     

Generalized Hailey-Hailey disease

A woman of 60 developed a generalized erythroderma. The case history revealed classical symptoms of Hailey-Hailey disease for 17 years. Light- and electron microscopic investigations confirmed the diagnosis of generalized Hailey-Hailey disease—an extremely rare condition. Two additional cases with widespread clinical manifestations are presented. These observations underline the fact that the whole epidermis is genetically disturbed and may react to various insults with suprabasal acantholysis.     

Simplification of local therapy of psoriasis with 8-methoxypsoralen

Local 8-methoxypsoralen black-light treatment was carried out on sixty-two patients. For the first time, oil was employed as a preparation base in order to increase the transparency and so the effectiveness of irradiation. Also the need for a descaling pretreatment was avoided. In investigations still being carried out, 27.5% patients showed very good improvement, 48-4% good and 24-2% unsatisfactory results of treatment. In many cases, less than fifteen irradiation sessions were necessary for clinical healing. However, to obtain a uniform pigmentation, additional irradiation proved necessary.     

Cardiac Output Versus Pacing Rate at Rest and with Exercise in Dogs with AV Block

To achieve maximum benefit from exercise (rate)-responsive pacing in subjects with sinus node dysfunction and AV block, it is necessary to determine the pacing rate (HR) which produces maximum cardiac output (CO) under specified exercise conditions. However, the CO-HR relationship for exercise has not been systematically investigated. To permit determination of the optimum HR, CO was measured at rest and with exercise for different pacing rates. Seven dogs with complete AV block and permanently implanted ventricular pacemakers were exercised on a treadmill for 5 min at each of four pacing rates (55, 76, 101, 116/min) and at two constant exercise levels (225 and 560 kg.m/min). CO was determined by impedance cardiography during the resting state preceding exercise and during a brief period (10-20 s) immediately after exercise, and was expressed as a percent of the CO determined at rest with HR = 55/min. A three-phase pattern of CO versus HR appears to exist for exercise as for rest. For exercise, starting from a low HR, CO increases markedly; a "plateau" is reached during which moderate increase in CO is achieved by increasing HR. At very rapid pacing rates, CO may actually decrease with further increase in HR. The results of this study suggest that a subject-specific optimum HR exists for each constant exercise level. Moreover, the methodology employed in the study is applicable to the identification of optimum HR for any exercise (rate)-responsive pacemaker.     

Changes in AV Node Conduction Curves Following Slow Pathway Modification

GELLER, J.C., et al. : Changes in AV Node Conduction Curves Following Slow Pathway Modification. Dual AV node physiology often persists after successful slow pathway (SP) ablation, and the mechanism of tachycardia elimination is unresolved. Therefore, AV node conduction curves were analyzed following successful ablation (  4 ± 1  energy applications) in 85 consecutive patients (58 women, age  50 ± 2  years) with typical AVNRT. Twenty-seven patients (32%) had complete elimination (group 1) whereas 58 (68%) patients had persistence (group 2) of dual AV node physiology. A significant increase in the AV node Wenckebach cycle length (WB-CL) was observed in both groups (  310 ± 9 to 351 ± 15 ms  in group 1, and  325 ± 8 to 369 ± 9 ms  in group  2, P < 0.05  ). A decrease in the fast pathway (FP) ERP (  339 ± 15 to 279 ± 12 ms  ) and an increase in the maximum FP AH interval (  141 ± 5 to 171 ± 7  ) were observed only in group 1 (P < 0.05). In group 2, no change in the SP ERP (  267 ± 7 to 280 ± 10 ms  ) was observed, and the change in the maximum SP-AH following ablation showed a significant inverse relation to the maximum SP-AH at baseline in group 2. In conclusion, (1) an increase in the WB-CL is observed independent of the persistence or elimination of dual physiology after successful ablation; (2) when dual physiology is eliminated, significant changes in the FP ERP and the maximum FP-AH occur; (3) when dual physiology persists, FP physiology and the SP ERP remain unchanged, and a significant inverse relation between the change in the maximum SP-AH following ablation and the maximum baseline SP-AH is observed.     

Neonatal rat cartilage has the capacity for tissue regeneration

One of the most relevant issues in future medicine is tissue regeneration. Transplantation medicine alone cannot solve the problem of incurable conditions of vital organs. One approach to this might be the replication of the spontaneous regeneration that is found in embryonic/neonatal tissue. In this study, a tissue model for basic investigation of regeneration mechanisms in vivo was established. We demonstrated by histology and immunohistochemical staining for types I and II collagen that neonatal rat cartilage unlike adult cartilage has the capacity for rapid scarfree regeneration after full-thickness incision. The underlying mechanism was identified in the preserved proliferative capacity of neonatal chondrocytes. This in vivo model should prove useful in further studies of the role of cellular (e.g., GA cell cycle regulators) and extracellular (e.g., cytokines) factors in tissue regeneration and wound healing.     

Role of provocation poliomyelitis in vaccine-associated poliomyelitis

The impact of different vaccine administrations in the Federal Republic of Germany, in relation to vaccine-associated paralytic poliomyelitis (VAPP) was studied. (This only means that on the basis of the temporal relation of vaccination and onset, the vaccine cannot be ruled out as possible cause.) Oral polio vaccine (OPV) was given between 1963 and 1977 only and recommended simultaneously with inactivated vaccines (DT/DPT) between 1980 and 1985. In the first period 10 VAPP cases occurred among 9.96 million estimated vaccinees aged under 2 years. In the second period 6 cases of provocation poliomyelitis (PRP) were found among 2.9 million estimated OPV/DT/DPT vaccinees of the same age group. Statistically the VAPP/PRP frequencies in the two periods studied did not achieve significance.     

En bloc mobilization of the inferior vena cava and large hypervascular right renal tumors with or without inferior vena cava thrombus: Posterior ligation of the renal artery

We describe our approach of posterior ligation of the renal artery during resection of large hypervascular right renal tumors. This technique uses en bloc mobilization of the inferior vena cava and renal tumor to ligate the renal artery at its origin from the aorta. In our experience, the use of this posterior approach for renal artery ligation is safe and effective, even with large renal tumors with multiple collaterals and/or lymph nodes making the identification of the renal artery difficult.