The step technique for the reconstruction of lower lip defects after cancer resection. A follow-up study of 165 cases

One hundred and sixty-five patients with localized cancer of the lower lip were excised and reconstructed over a 25-year period using Bengt Johanson's step technique. Eight-eight percent of the tumors were less than 2 cm in size and 65% were of high histopathological differentiation. Fifty-six percent were reconstructed with bilateral step flaps. Nine local recurrences appeared in 5 patients, none of whom died of lip cancer. Eight patients later developed regional metastases and 3 of these patients died of lip cancer. The 5-year survival rate was 98%. The step technique is recommended for reconstruction of lip defects of up to 2/3 of the lower lip and may, in larger resections, be combined with either a fan flap or an Estlander flap. The outstanding functional results are due to the use of adjacent tissue for the reconstruction which preserves the normal arrangement of muscles, vessels and nerves.     

Tissue reactions around two alloplastic ligament substitute materials: experimental study on rats with carbon fibres and polypropylene

The early connective tissue reactions around two alloplastic and prosthetic materials, carbon fibre and polypropylene were examined in 30 rats. Each of the materials was implanted into three sites: under the skin, intraperitoneally and into a femoral bone tunnel. Microscopic and scanning electron microscopic findings at 1, 3, 6, 9 and 12 wk post-operatively are described. The amount of granulation tissue around the carbon fibres was more prominent in all the environments, but the connective tissue remained less mature and less organized during the whole follow-up compared to that of the polypropylene. There was no ingrowth of bone between the bundles of the artificial materials in the bony tunnels. The differences in the early cellular reactions and scar tissue maturation in the interstices of these two materials are probably due to the structural differences rather than to the surface properties of the materials.     

Surgical approach in severe cases of maxillonasal dysplasia (Binder's syndrome)

Binder's syndrome or maxillonasal dysplasia is a malformation characterized by an extremely flat and retruded nose. Severe cases of the syndrome do also have a retrognatic maxilla often combined with an open bite deformity which demands a combined surgical solution with both maxillary osteotomy and secondary nose correction. The two-stage surgical procedure in the advanced cases of maxillonasal dysplasia has in our opinion been preferable to a Le Fort II osteotomy. Two cases with severe Binder's syndrome where the two-stage procedure has been performed will be presented and the surgical approach discussed.     

Meningitis due to Gemella haemolysans after radiofrequency trigeminal rhizotomy.

Meningitis due to Gemella haemolysans developed in a 73 year old woman after thermolysis of the Gasserian ganglion for trigeminal neuralgia. The taxonomy of this organism is discussed, and previous cases of infection are reviewed.     

Interaction of single-dose ezetimibe and steady-state cyclosporine in renal transplant patients

This open-label, single-period study evaluated the single-dose pharmacokinetics of ezetimibe (EZE) 10 mg in the setting of steady-state cyclosporine (CyA) dosing in renal transplant patients. A single 10-mg dose of EZE was coadministered with the morning dose of CyA (75-150 mg twice a day). Total EZE (sum of unconjugated, parent EZE and EZE-glucuronide; EZE-total) AUC(0-last) and Cmax were compared to values derived from a prespecified database of healthy volunteers. Geometric mean ratios (90% CIs) for (EZE + CyA)/EZE alone for EZE-total AUC((0-last)) and Cmax were 3.41 (2.55, 4.56) and 3.91 (3.13, 4.89), respectively. Compared to healthy controls, EZE-total AUC((0-last)) was 3.4-fold higher in transplant patients receiving CyA; similar exposure levels were seen in a prior multiple-dose study in which EZE 50 mg was administered to healthy volunteers without dose-related toxicity. Because the long-term safety implications of both higher EZE exposures and undetermined effect on CyA are not yet understood, the clinical significance of this interaction is unknown.     

Contrast sensitivity in 10 year old preterm and full term children: a population based study

AIMS: To determine the contrast sensitivity (CS) in 10 year old prematurely born children, previously included in a population based study on the incidence of retinopathy of prematurity (ROP), and in full term controls. METHODS: This study included 205 prematurely born children and 215 children born at term, from the same geographical area and study period. CS was assessed monocularly with the Vistech 6500 test at five spatial frequencies (1.5-18 cycles/deg). RESULTS: Prematurely born children had statistically significant lower CS at all frequencies, compared to full term ones. The mean differences in logarithmic CS were 0.03 (1.5 cycles/deg), 0.09 (3 cycles/deg), 0.10 (6 cycles/deg), 0.12 (12 cycles/deg), and 0.19 (18 cycles/deg). Even when the children with ROP and neurological disorders were excluded there was a difference between the two groups. Children who had been treated with cryotherapy had the lowest CS. CONCLUSION: CS was lower in 10 year old prematurely born children than in full term ones of the same age. Whether this finding affects their visual function in daily life is uncertain.     

Autologous blood transfusion--a review

The discovery of HIV and other transfusion-transmissible infections has increased the demand for alternatives to allogeneic blood transfusion. One such alternative is autologous transfusion. This review presents an analysis of autologous transfusion. We conclude that autologous transfusion should form part of a strategy to minimise the risk associated with allogeneic transfusion in Nigeria and other developing countries.     

Carcinoma of Meckel's diverticulum.

Acute intestinal obstruction in a women, aged 56, was caused by a highly malignant adenocarcinoma arising in a Meckel's diverticulum. Despite radical surgery, the tumour recurred after four months, and the patient died nine months after her first operation. This confirms the general bad prognosis associated with carcimomas of Meckel's diverticulum.