The V-flap and the Berlin tulip flap: two new concepts in conventional flap techniques

Microsurgical operations are costly and technologically demanding. We have therefore developed new conventional flap techniques using state-of-the-art knowledge of skin anatomy and circulation. The V-flap is a combination of the V-Y advancement flap and two Limberg flaps [2]. Sixty patients treated by the new flap technique have shown a low rate of complication. Even when used in difficult regions of the body or in very large defects, the V flap has proven to be very effective. It has been adopted as a standard flap technique in our hospital. The Berlin tulip flap is another very reliable flap. To form the tulip flap, the outer corners of a subcutaneous pedicle flap are curved backwards. When detached, they can be transposed to the healthy tissue on the contralateral side. This completely relieves the midzone, which then can be safely closed in the same manner as a V-Y flap. The Berlin tulip flap is particularly useful for covering trunk defects and managing sacral ulcers in paraplegics.Correspondence to: E. Vaubel     

Influence of the dosing interval on prolactin release after remoxipride.

1. The prolactin response following administration of the D2-dopamine receptor antagonist remoxipride was studied in eight healthy male volunteers. The purpose of the study was to investigate the duration of a refractory period of prolactin release following two doses of remoxipride. A further aim was to compare the prolactin response following remoxipride and thyrotropin release hormone (TRH) during the refractory period. The subjects received two 30 min intravenous (i.v.) infusions of remoxipride 50 mg with different time intervals between the two doses, in a randomized six period crossover design. The time intervals between the two remoxipride doses were 2, 8, 12, 24 and 48 h. On one occasion the remoxipride dose was followed by an i.v. injection of TRH after 2 h. 2. The plasma peak prolactin concentrations obtained after the first remoxipride dose correspond to a maximal release of prolactin according to earlier studies. A small second peak of prolactin was observed after 2 h. The release was gradually increased with longer time intervals between the consecutive doses. The refractory period for a second prolactin release similar to the first one after remoxipride was found to be 24 h for most of the subjects. 3. TRH resulted in a faster and higher increase in prolactin response of a shorter duration than after remoxipride administered 2 h after the first dose.     

Neuroradiological manifestations of intracranial sarcoidosis

Six cases of sarcoidosis involving the central nervous system are reported with the neuroradiological findings and appearance on computed tomography. Communicating hydrocephalus with sarcoid arachnoiditis is the most common finding, but arteritis and masses have also been reported. Two rare cases of intracerebral masses are included. The radiological findings and clinical histories are reviewed with emphasis on the use of CT and complete neuroradiological studies for patients with possible central nervous system sarcoidosis.     

Timing and course of neonatal intracranial hemorrhage using real-time ultrasound

Knowledge of the timing and course of neonatal intracranial hemorrhage is essential in determining the etiology of hemorrhage, since the key to preventing neurologic damage in newborns is to define preventable causes and to treat the complications of hemorrhage. In an intensive study of 49 neonates delivered less than or equal to 32 weeks gestation, the initial hemorrhage typically occurred in the first three days of life, with 36% occurring on day 1, 32% on day 2, and 18% on day 3. Most of the major hemorrhages (Grades III and IV) occurred on day 1, although ventricular enlargement occurred at a variable time after the initial insult. By the sixth day, 91% of all intracranial hemorrhage had occurred.