Use of contralateral rectus femoris flap: an alternative for covering exposed femoral vessels of the thigh

Myocutaneous coverage of large defects in the thigh following resection of tumors is necessary to ensure adequate protection of the underlying femoral vessels. The usual muscles employed as flaps to achieve this protection are ipsilateral sartorius, rectus femoris, tensor fasciae latae, gracilis, rectus abdominis, or vastus lateralis. However, for situations in which these muscles are not available, the surgeon needs an alternative flap. This report details the successful use of the contralateral rectus femoris muscle to cover exposed femoral vessels in the upper and middle thirds of the thigh. Findings of anatomical dissections confirm that, by freeing the muscle at its origin, its reach can be extended about 6 cm. Postoperatively, no functional deficits resulted from the flap and no damage to the skin graft occurred with radiation therapy. Use of the contralateral rectus femoris flap should therefore be considered when a reliable alternative to conventional flaps must be employed.     

Excess incidence of treatment of end-stage renal disease in Mexican Americans

Mexican Americans are the second largest minority group in the United States (8.73 million people according to the 1980 US census) and are known to have an excess prevalence of obesity and non-insulin-dependent diabetes mellitus, but similar or lower rates of hypertension when compared with non-Hispanic whites. To our knowledge, no data are available on incidence of end-stage renal disease in this population. Using a data base from the Texas Kidney Health Program, a division of the Texas Department of Health, and the 1980 US census for the state of Texas, the authors calculated age-adjusted incidence of treatment of end-stage renal disease in Mexican Americans, non-Hispanic whites, and blacks for the years 1978-1984. Mexican Americans and blacks have an excess of treatment of end-stage renal disease (all etiologies combined) compared with non-Hispanic whites (incidence ratios of 3 and 4, respectively). For diabetes-related end-stage renal disease, Mexican Americans have an incidence ratio of 6, while blacks have an incidence ratio of 4 compared with non-Hispanic whites. For Mexican Americans, this excess is higher than would be expected on the basis of their underlying prevalence of diabetes. The incidence of hypertensive end-stage renal disease in Mexican Americans was 2.5 times higher than in non-Hispanic whites, which is higher than expected given the lack of excess in their underlying prevalence of hypertension. The high prevalence of diabetes in Mexican Americans explains some, but not all, of the excess of treatment of end-stage renal disease in this population.     

Blood flow into brown fat of rats is greater after a high carbohydrate than after a high fat test meal

Postprandial oxygen uptake of whole animals and rate of blood flow into the scapular and cervical brown adipose tissue (BAT) of Osborne-Mendel male rats (200 g) were compared for those receiving a high carbohydrate meal or an equicaloric high fat meal. Blood flow was determined by the use of radiolabeled microspheres injected into the left ventricle of anesthetized animals, 2-3 hours after the test meal. In vivo oxygen uptake was elevated by about 10% (P less than 0.05) and blood flow by more than 100% (P less than 0.05) in the group receiving the high carbohydrate meal compared to the high fat meal. The rate of blood flow into tissues other than brown fat was not significantly altered by the composition of the test meal. These tissues included heart, gastrocnemius and soleus muscles, GI tract and white adipose tissue. Our data suggest that a high carbohydrate meal is more thermogenic than a high fat meal, and that the difference in the magnitude of the thermic effect produced by the two meals is paralleled by a corresponding difference in brown fat thermogenesis.     

Anatomic reconstruction and functional rehabilitation of oromandibular defects with rigid internal fixation

Fifteen consecutive patients undergoing extensive surgery for head and neck cancer involving the oral cavity and oropharynx were reconstructed using the technique of rigid internal fixation combined with various vascularized flaps. The follow-up ranged from 6 to 18 months. Modifications in various myocutaneous or vascularized free flaps combined with an analysis of the radiation physics necessary to make this procedure a viable alternative for immediate and delayed mandibular reconstruction will be discussed. Consistently satisfactory functional and cosmetic results have been achieved.     

Eye movements and blinks: their relationship to higher cognitive processes

Information about the timing of spontaneous eye blinks was abstracted while subjects performed a detection and identification task. We found blinks to be time-locked to saccadic eye movements involved in the identification of peripherally presented stimuli. The larger the required eye movement, the greater the likelihood of blink occurrence. Blink latencies were found to be significantly shorter for centrally, as compared to peripherally presented stimuli, and blinks were more likely to be associated with eye movement returning gaze to a central location than with movements associated with the identification of peripherally presented information. Thus, we conclude that the spontaneous or endogenous eye blink is triggered by aspects of information processing, and that blink latencies can be used as one tool for evaluating the level of complexity of such processing under a wide variety of task demands.     

Cemented total knee arthroplasty for gonarthrosis in patients 55 years old or younger

The results of 68 cemented total knee arthroplasties (TKAs) in 50 patients with gonarthrosis who were 55 years old or younger at the time of surgery were reviewed. These patients were operated on between 1979 and 1987 and were followed for an average of 6.2 years. The average age of the patients was 50 years. Patients were evaluated by the Hospital for Special Surgery knee score. The average preoperative score was 53, and the average follow-up score was 90. Overall, 55 TKAs were rated as excellent and 13 as good. Using the knee rating score advocated by the Knee Society, the average postoperative score was 92 for pain and 84 for function. There were four successful reoperations for patellar component loosening, all in metal-backed patellae. The femoral and tibial components in these patients were intact, and at the follow-up period, two knees were rated as excellent and two as good. Detailed roentgenographic evaluation demonstrated that 20% of tibial components had radiolucencies in at least one zone on the anteroposterior roentgenogram and in 11% on the lateral roentgenogram. Femoral radiolucencies occurred in only 2% of knees. Patellar radiolucencies in one or more zones occurred in 20% of knees that had not had patellar revision. No complete or progressive radiolucencies at the bone-cement interface were noted for any component, and no components were considered to be roentgenographically loose. Cemented TKAs can achieve excellent long-term results in patients younger than 55 years old with gonarthrosis of the knee. These results compare with those obtained in published reports on older age groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Epidemic postsurgical Candida parapsilosis endophthalmitis. Clinical findings and management of 15 consecutive cases

Fifteen cases of postoperative Candida parapsilosis endophthalmitis occurring secondary to a contaminated lot of an irrigating solution were studied. All patients underwent a vitreous tap or diagnostic and therapeutic vitrectomy. Eleven of the 15 specimens were positive for the organism. Fourteen patients were treated with pars plana vitrectomy surgery. All patients were treated with intravitreal amphotericin B and systemic amphotericin B and 5-fluorocytosine. Two clinical recurrences were successfully treated with intravitreal amphotericin B, removal of the pseudophakos, and oral ketoconazole. The intraocular lens was retained in 11 of the 14 pseudophakic patients. Final visual acuities ranged from 20/25 to no light perception with eight of 15 patients having 20/60 or better visual acuities. Measurable levels of intraocular amphotericin B were found after systemic amphotericin B administration. Two patients with totals of 20 and 30 micrograms of intravitreal amphotericin B over 48 and 96 hours, respectively, had near normal ERGs one year later. Posterior capsulotomy and vitrectomy appear to decrease amphotericin B toxicity and allow sequential intraocular injection of this drug within a short time period.