Max Brödel (1870–1941): his life and his role in the development of surgery

Summary. Max Br?del (1870–1941), from Leipzig, Germany, is often referred to in the USA as the father of modern medical illustration and mentioned in the same breath as Leonardo da Vinci or Andreas Vesal. After a classical formal art education in Leipzig he worked in Carl Ludwig's laboratory of physiology and anatomy, where he came in contact with American physicians. In 1894, the anatomist F. P. Mall convinced him to work for the recently inaugurated Johns Hopkins School of Medicine in Baltimore, where he collaborated with world-famous surgeons such as H. A. Kelly, W. S. Halsted, and H. Cushing. His illustrations were characterized by meticulous observation, both realistic and explanatory intention, technical superiority, and artistic merit. In 1911 he established the first “Department of Art as applied to Medicine”. Here, he proved to be an innovative artist, a creative scientist, and an inspiring and skillful instructor. By the time of Br?del's retirement in 1939, 160 students had graduated as medical illustrators. His pupils spread his principles and style throughout the USA and Canada, and several similar academic programs for medical illustration have been founded in these countries.      

Gastrointestinal anastomoses. Factors affecting early complications.

A retrospective review of gastric and colonic anastomoses during a recent 12-month period was performed at the Mayo Clinic. One hundred sixty-nine patients had gastroduodenal or gastrojejunal anastomoses (Group I). Five hundred nineteen patients had ileocolonic or ileorectal (222) and colocolonic or colorectal (297) anastomoses (Group II). Major anastomotic complication rates for Group I patients were: leaks, 1%; hemorrhage, 2%; and stenosis or obstruction, 2%. Reoperations and deaths secondary to anastomotic complications during the postoperative period were 2% and 0.6%, respectively. Corresponding rates for Group II were 2%, 1%, and 4%, with reoperative and anastomotic death rates of 1% and 0.2%, respectively. In Group I patients, length of operation had a significant effect (p less than 0.01) on anastomotic complications. In Group II patients, a significant increase in complications was related to the presence of obstruction (p less than 0.001), recent weight loss (greater than 10 pounds) (p less than 0.02), malignancy (p less than 0.04), and sepsis (p less than 0.05).     

Dermatitis in bulb growers

A damaged skin forms a health hazard in flower-bulb growers as it enables higher permeation rates For pesticides than normal skin. Therefore, an investigation was performed into the skin condition of 103 bulb growers and 49 controls. Contact dermatitis of the hands was of the same order (11 and 10%) in both groups. However, minor signs of dermatitis were seen more often in bulb growers (30 versus 8%, p <0.05). Most growers had contact with narcissus sap during the investigation. This irritant sap, as well as many other skin contacts with irritants such as hyacinth dust and pesticides, seemed to be responsible for many skin complaints. Contact serialization was suspected in 19 growers and 3 controls. Patch tests showed that contact sensitization existed to pesticides in probably 10, and to flower-bulb extracts in 4 growers. Reactions to propachlor were not regarded as very reliable as the test concentration seemed to be marginally irritant. There were only a few allergic reactions to narcissus (3) and tulip (2) and none to hyacinth. This investigation showed that minor irritant contact dermatitis was frequent in bulb growers, and indicated that contact sensitization to pesticides and bulbs seemed to be a less frequent but important cause of dermatitis.     

Sources of unwanted variability in measurement and description of skin surface topography

Background/aims: Quantitative measurement of skin roughness has proved to be a valuable tool in the efficacy-control of external applications, but it suffers from not yielding easily comparable results. The most important sources of inter-observer variability are high-pass filters used to separate roughness and waviness, and low-pass filters which result from the finite resolution of the instrument or from the finite sampling interval of digital measurement. In the present study, the effects of high-pass filters and sampling intervals on the roughness measured were investigated. Methods: Dynamically focusing optical profilometry was used to measure the surfaces of negative replicas of healthy human skin. High-pass cut-off wavelengths and sampling intervals were varied systematically. Results/conclusions: Virtually unbiased estimates for the roughness parameters K, Sk, R_q, and R_a can be obtained using sampling intervals of 40 or even 80 μm. Regarding these roughness parameters, it is far better to do more scans than to shorten the sampling interval. The roughness parameters R_z, R_p, R_t, R_pm, R_max, P_t, on the other hand are very sensitive to the influence of the sampling interval; to achieve satisfying estimates, the sampling interval should be no longer than 2 to 5 urn; as an important parameter’of the measurement, it is worthy of remark and should always be indicated. The way the mean square roughness R_q depends on the cut-off wavelength is not well described by the Sayles-Thomas-relation R_q～λ_c^0.5. If the power-spectrum |h*(v)|² approximates sufficiently to a power law, |h*(v)|²～v^δ, a better estimate is given by R_q～λ_c^γ with γ=-(δ+1)/2. In many cases, γ=1 or R_q～λ_c will suffice.     

Management of sacral and perineal defects following abdominoperineal resection and radiation with transpelvic muscle flaps

PURPOSES: In this study we present our experience with treating persistent sacral and perineal defects secondary to radiation and abdominoperineal resection with or without sacrectomy. METHODS: Fifteen consecutive patients were treated with an inferiorly based transpelvic rectus abdominis muscle or musculocutaneous flap. RESULTS: Fourteen of the 15 patients achieved healing, and 7 patients had no complications. The remaining eight patients required one or more operative debridements and/or prolonged wound care to accomplish a healed wound. Our technique for the dissection and insetting of the transpelvic muscle flap is presented. CONCLUSION: The difficult postirradiated perineal and sacral wounds can be healed with persistent surgical attention to adequate debridement, control of infections, and a well-vascularized muscle flap. The most satisfying aspects for patients are the discontinuance of foul-smelling discharge, discontinuation of multiple, daily dressing changes, and reduction in the degree of chronic pain.Read at the meeting of the Midwestern Association of Plastic Surgeons, Bismarck, North Dakota, June 15 to 18, 1992.     

Magnetization transfer contrast (MTC) and tissue water proton relaxation in vivo

In this study the exchange between 1H magnetization in "free" water (1Hf) and that in a pool with restricted motion (1Hr) was observed in tissues in vivo using NMR saturation transfer methods. Exchange between these two pools was demonstrated by a decrease in the steady-state magnetization and relaxation times of 1Hf with radiofrequency irradiation of 1Hr. The pseudo-first-order rate constant for the movement of magnetization from 1Hf to 1Hr was approximately 1 s-1 in kidney and approximately 3 s-1 in skeletal muscle in vivo. Proton NMR imaging demonstrated that this exchange was tissue specific and generated a novel form of NMR image contrast. The extent of exchange between 1Hf and 1Hr as well as the topological correlation of the exchange with relaxation weighted images suggests that this pathway is a major determinant of the observed relaxation properties of water 1H in vivo.     

New copolymethacrylates with azo-chromophores in the side chain

The synthesis and characterization of new poly({6-[4-(4-cyanophenylcarbamoyl)phenoxy]hexyl methacrylate}-co-{6-[4-(4- cyanophenylazo)phenoxy]hexyl methacrylate}) are reported. Their liquid-crystalline properties are investigated using differential scanning calorimetry, polarizing microscopy and X-ray diffraction techniques. The glass transition temperatures and the clearing points can be influenced by variation of the copolymer composition. The substances offer a relatively broad temperature range of mesomorphic properties suitable for photochemical studies.     

Localization of a gene for otosclerosis to chromosome 15q25-q26

Among white adults otosclerosis is the single most common cause of hearing impairment. Although the genetics of this disease are controversial, the majority of studies indicate autosomal dominant inheritance with reduced penetrance. We studied a large multi- generational family in which otosclerosis has been inherited in an autosomal dominant pattern. Five of16 affected persons have surgically confirmed otosclerosis; the remaining nine have a conductive hearing loss but have not undergone corrective surgery. To locate the disease- causing gene we completed genetic linkage analysis using short tandem repeat polymorphisms (STRPs) distributed over the entire genome. Multipoint linkage analysis showed that only one genomic region, on chromosome 15q, generated a lod score >2.0. Additional STRPs were typed in this area, resulting in a lod score of 3.4. STRPs FES (centromeric) and D15S657 (telomeric) flank the 14. 5 cM region that contains an otosclerosis gene.