Extending the reach of island cutaneous flaps

The advancement of island cutaneous flaps beyond 2 cm is facilitated by an understanding of underlying vascular anatomy. Recent studies demonstrate the perforating cutaneous blood vessels of the body. When extensive mobility is required, an island cutaneous flap should be centered over these vessels. The perforating cutaneous vessels and, if necessary, the axial vessels are identified, which permits vigorous dissection of restraining fascia and muscle. Clinical experience during the past 14 years suggests that the medial face is an ideal location for island cutaneous flaps. Flap design in the trunk and extremities incorporates known septal and subcutaneous fascial perforators. Fourteen of 53 island cutaneous flaps were advanced distances greater than 2 cm without significant complications.     

Molecular biology: an overview.

An overview of molecular biology is presented for the practicing surgeon. Definitions of the constructs and activity of DNA, RNA, and protein synthesis are defined. These principles are illustrated in their use in recombinant DNA technologies. A glossary is provided for the terms utilized.     

Direct identification of beta-adrenergic receptors on isolated bovine parathyroid cells.

The radioiodinated beta-blocker iodohydroxybenzylpindolol ([125I]HYP) has been used to identify directly and characterize beta-adrenergic receptors in isolated bovine parathyroid cells. [125I]HYP was bound rapidly and reversibly to isolated bovine parathyroid cell membranes. Scatchard analysis revealed a single class of binding sites with high affinity (4 X 10(10M-1) and low capacity (0.7 pmol/mg). Saturation analysis of [125I]HYP binding to intact bovine parathyroid cells suggested a site with similar affinity on whole cells and with a binding capacity of 5000-10,000 sites/cell. True dissociation constants (Kd's) for beta-adrenergic agonists and antagonists were in good agreement with activation constants (KA'S) and inhibition constants (KI'S) for effects on adenylate cyclase in membrane preparations. These constants also were in reasonable agreement with KA'S and KI'S previously shown for effects of agonists and antagonists on cAMP accumulation and PTH release in whole cells. This study shows by direct analysis that beta-adrenergic receptors exist on isolated bovine parathyroid cells, and that there is close coupling between receptor binding, effects on cAMP and hormonal release. This represents still another system in which [125I]HYP has been successfully used to study beta adrenergic receptors in membrane as well as intact cell preparations.     

Improved Results in Newborns Undergoing Coarctation Repair

Among 172 children who underwent repair of coarctation of the thoracic aorta from June 1, 1967, to June 1, 1979, there were 50 who were less than 6 weeks old. A review was undertaken to assess mortality and postoperative residual hypertension in this newborn age group.Forty-five (90%) had one or more associated congenital cardiac lesions, which were repaired or palliated at the time of coarctation repair. The three most common associated lesions were patent ductus arteriosus (74%), atrial septal defect (74%), and ventricular septal defect (62%). Thirty-one newborns underwent resection with primary end-to-end repair with 8 deaths (26%), and 18 underwent Dacron patch angioplasty and 1 underwent subclavian angioplasty with 4 deaths (21%).Of the 38 survivors, 36 (95%) had good pedal pulses on postoperative clinical examination 3 months to eleven years postoperatively. Seventeen (45%) had upper and lower extremity blood pressure measured; 2 (5%) showed residual upper extremity hypertension (greater than 2 standard deviations above the mean and a gradient less than 20 mm Hg). One of these 2 patients has undergone repeat repair.Based on this low mortality and infrequent need for repeat repair, we advocate aggressive early operation and judicious use of palliative procedures in newborns, when indicated, for associated defects.     

Renal uptake of Tl-201 in hypertensive patients undergoing myocardial perfusion imaging

The detection of renovascular disease (RVD) has particular relevance in hypertensive patients (HP) who have symptoms of target organ damage. To evaluate the possibility of RVD in HP undergoing myocardial perfusion scintigraphy for chest pain symptoms, posterior renal images were obtained at 1-3 hours after Tl-201 injection. Analog and computer images were obtained for 5 minutes in 45 HP; 12 patients with no history of hypertension or renal disease served as normal controls. For qualitative analysis, images were coded and read by three observers as to symmetry of renal uptake. Differential renal uptake of Tl-201 (DRU) was quantitated on computer images. In normal controls, uptake was agreed on as symmetric. In HP, 6 patients had marked asymmetry of DRU and 4 had possibly significant asymmetry; 2 had decreased uptake in both kidneys suggesting bilateral RVD or nephrosclerosis. Objective correlation with DRU was obtained in 10 HP who had contrast angiography, confirming 4 cases of unilateral RVD and 2 of bilateral RVD. Thirteen patients also had renography with Tc-99m DTPA; differential renal function by this modality correlated well with DRU of Tl-201 (r = 0.98). Thus, DRU of Tl-201 can be used as a supplement to myocardial scintigraphy to identify HP who require further evaluation and treatment of RVD.     

A spectacle device to treat facial nerve paralysis.

We describe a new method to prevent ocular complications in facial nerve palsy. A device mounted on a spectacle frame senses the blink of the normal eye and closes the lids of the paretic eye by levers which rest on the upper and lower lids. It provides a physiologic replacement of function and prevents corneal exposure.