The effect of venous obstruction in infected pedicle flap

A new model of soft-tissue infection is used to investigate the effect of the local wound environment on the septic focus. Island pedicle flaps were raised on the buttock of 24 adult ewes and multiply inoculated with Staphylococcus aureus. Flaps with bacterial inoculation, without compromise of venous outflow, showed distal necrosis (mean +/- SEM percent of surface area, 25.8% +/- 8.6%) and developed septic foci with bacterial counts one log less than the amount injected. Flaps with inoculation and venous outflow obstruction underwent subtotal necrosis (mean percent of surface area, 73.3% +/- 11.2%) and had counts two logs higher than the nonobstructed flaps but without discrete septic foci. Flaps without inoculation, with or without venous obstruction, survived completely. Venous outflow obstruction is shown herein to potentiate tissue necrosis by raising bacterial counts in a septic focus and preventing defensive abscess formation by the host.     

Alcoholism and substance abuse teaching in child psychiatry residency programs

In order to determine the needs and goals of substance abuse teaching, vis-à-vis child psychiatry training, a questionnaire was sent to the training directors at every child psychiatry program accredited by the Accreditation Council of Graduate Medical Examination. The results demonstrated that most child psychiatry programs schedule at least some didactic time specifically for substance abuse topics. However, only 59% of the training directors felt that their fellows were adequately educated to identify and at least initially manage a drug abusing adolescent.     

A new implant system in head and neck surgery]

Defects in the head and neck region following extensive tumor removal are sometimes difficult to reconstruct by local or free flaps. An epithesis is a recommended alternative in defects of the ear, the nose or the orbital region. Nevertheless problems may arise in the appropriate fixation of the epithesis. With the intermobile-cylinder-implant-system (IMZ), the epithesis is firmly fixed by means of osseointegration of the implants and an abutment in the area of the defect. The various steps of the operation and clinical applications are presented.     

Global surveillance and forecasting of AIDS

The short-term forecasting of future AIDS cases has been attempted by statistical extrapolations of the observed curve of reported AIDS cases. In areas where such reporting is very incomplete or has only recently started, extrapolation is not possible and an epidemiologically-based forecasting model has been developed to estimate the annual number of AIDS cases which may have occurred and to project the annual number and distribution of AIDS cases for up to ten years. This model, which relies on the current understanding of the epidemiology and natural history of HIV infections and on the available HIV serologic survey data, is used to provide estimates and short-term projections of AIDS cases for the USA, Europe, Africa and the world.     

Anterior limbic alpha-like activity: a low resolution electromagnetic tomography study with lorazepam challenge.

OBJECTIVE: To verify findings of an independently regulated anterior limbic alpha band source. METHODS: In a randomised cross-over study, the spontaneous EEG was recorded in nine healthy subjects after i.v. lorazepam or placebo. Intracerebral current densities within classical frequency bands were estimated with low resolution electromagnetic tomography [LORETA] and compared between groups with t-statistical parametric mapping [SPM[t]]. A region-of-interest [ROI] based method was used to compare frontal and occipital alpha band activity changes. RESULTS: Irrespective of treatment group, local maxima of alpha band power were localised both in the occipital lobe, Brodman area [BA] 18, and in the anterior cingulate cortex [ACC], BA 32. Statistical parametric mapping showed reduced parieto-occipital, but unaltered frontal alpha band power after lorazepam. This result was confirmed by ROI-based comparison of BA 18 and BA 32. CONCLUSIONS: There was an anterior limbic maximum of alpha band activity which, unlike occipital alpha, was not suppressed by lorazepam. SIGNIFICANCE: The well-known anterior alpha band components may originate from a narrowly circumscribed source, located in the ACC. Frontal and occipital alpha band activities appear to be independently regulated.     

Catfish stings to the hand

Catfish skin toxin and the venom from their dorsal and pectoral spines may cause a menacing sting. Although these stings are often innocuous, severe tissue necrosis may occur. The hand is the most common site of catfish stings. Two cases of catfish stings of the hand are presented. In one of these cases gangrene of the long and small fingers developed requiring amputation. Symptoms are caused by hemolytic, dermonecrotic, edema-promoting, vasospastic, and lethal components of the venom and skin toxins. Local or regional anesthesia is administered to relieve pain and vasospasm. Empiric intravenous antibiotics are administered to cover common aquatic organisms. Wounds with progressive worsening of erythema, swelling, pain, or cyanosis should be irrigated to wash out residual toxin, and debrided of any retained spine fragments or necrotic tissue.