Burma revisited

The author, who had spent a year with a mobile field hospital in Burma in 1944 during World War II, was able to visit Rangoon for 5 days in 1977 with the assistance of a grant from the Association of Anaesthetists of Great Britain and Ireland. Some impressions of life in Burma today are given, especially in relation to the problem of providing an anaesthetic service for the main hospitals in Rangoon and the work of Professor Win Maung, FFARCS and his University department. The author also describes some of the aid which it has been possible to organise since his return to the United Kingdom and outlines requirements for the future.     

Immunofluorescence assay for antinuclear factor: a nonspecific test in hospitalized medical patients.

Serum from 149 randomly selected hospitalized medical patients was tested for the presence of antinuclear factor (ANF) by the conventional immunofluorescence technique. Patients with positive and negative results were then compared as to clinical history, particularly previous drug exposure, physical findings, and levels of C-reactive protein and immune complexes in the serum. The frequency of ANF positivity was found to be very high (23%). Although the presence of ANF was significantly correlated (P less than 0.02) with a higher age, it was not significantly related to any other clinical or laboratory feature assessed. It was concluded that ANF testing cannot serve as a blind diagnostic screening tool for connective tissue diseases because of its nonspecificity.     

Reducing Opposed Multilobed Flaps Results in Fewer Complications Than Traditional Repair Techniques When Closing Medium-Sized Defects on the Leg after Excision of Skin Tumor

BACKGROUND: The reducing opposed multilobed (ROM) flap involves a series of transpositions effected cephalic and caudal to the primary defect, sequentially mobilized toward and then into the primary defect. OBJECTIVE: To compare the ROM flap with other techniques to close defects below the knee after excision of skin tumor. METHOD: This retrospective study compares 140 defects closed with a ROM flap with 85 defects closed with traditional techniques. RESULTS: A total of 225 defects between 11 and 44 mm in diameter were excised over 3 years from July 1, 2002. There were 140 defects closed by ROM flap and 85 non-ROM closures including 29 "O-to-Z" flaps and 12 bilateral transposition flaps. A total of 111 squamous cell carcinomas, 64 basal cell carcinomas, and 11 melanoma were excised. ROM flap closures developed 20 complications (14.3%): 13 infections, 5 partial dehiscence, and 2 partial end flap necrosis. Non-ROM closures developed 27 complications (31.8%): 13 infections, 6 partial end flap necrosis, 4 partial dehiscence, 2 wound depression, 1 hemorrhage, and 1 persisting pain. Three ROM and 7 non-ROM cases suffered two complications. The total complication rate was significantly lower with ROM flaps (p=.003), including lower end flap necrosis incidence (p=.027). CONCLUSION: The ROM flap results in fewer complications than traditional techniques when closing defects 11 to 45 mm in size on the leg and foot. In particular, end flap necrosis incidence is lower with ROM flap closure.     

99mTc–Evans Blue Dye for Mapping Contiguous Lymph Node Sequences and Discriminating the Sentinel Lymph Node in an Ovine Model

Background The aim of this study was to investigate the potential of ^99mTc–Evans blue for discriminating the sentinel lymph node in multitiered lymph node sequences by using an ovine model. ^99mTc–Evans blue is an agent that has both radioactive and color signals in a single dose. Previous studies in smaller animal models suggested that this agent could have advantages over the dual-injection technique of radiocolloid/blue dye. Methods Doses of ^99mTc–Evans blue (∼ 21 MBq) containing Evans blue dye (approximately 4 mg) were administered to the hind limbs or fore limbs of sheep to map the lymphatic drainage patterns, validate its ability to identify the sentinel lymph node, and examine the reproducibility of the technique. The study protocol was repeated with ^99mTc–antimony trisulfide colloid and Patent Blue V dye. After the operative exposure, lymph nodes were identified with the gamma probe and then excised and analyzed for radioactivity (percentage of injected dose) and blue color. Results After the administration of ^99mTc–Evans blue, all lymph nodes harvested (35 of 35) in either short chains or long basins were hot and blue. The sentinel lymph nodes concentrated more radioactivity than the second-tier nodes to the extent of 2:1 to 215:1. For radiocolloid/Patent Blue V, the ratios were lower, at 2:1 to 3:1. Conclusions ^99mTc–Evans blue was found to better discriminate the sentinel lymph node than ^99mTc–antimony trisulfide colloid/Patent Blue V in variable multitier lymph node anatomy, and it is an agent that promises to have positive clinical applications.