BACKGROUND: Repairing dorsal nasal defects is a frequent challenge for dermatologic surgeons, mainly due to the high frequency of basal cell carcinomas on this site. Obvious scars, mismatched skin and distortion of the nasal contour are the surgical hazards that must be avoided in these cases. AIM: Our aim was to perform surgery involving a simple flap in order to repair medium to large defects on the dorsal side of the nose. METHODS: The dorsal horizontal advancement flap was studied in 12 patients, in order to evaluate the benefits and limits of this surgical procedure. RESULTS: The resulting scars on most of our patients were well-camouflaged among their natural skin lines, and there was neither distortion of the alar contour nor the nostril. CONCLUSIONS: This flap is easy to perform and, in selected cases, provides an outstanding alternative to second-intention healing, full-thickness skin grafts, transposition, rotation and pedicle flaps. 相似文献
Fibroblasts incorporated within collagen gels induce a cell-mediated contraction of the gel to form a three-dimensional, tissue-like structure by a mechanism thought to mimic wound contraction in vivo . In this study a gel contraction model was used to investigate the ability of fibroblasts derived from adult gingiva, adult skin and fetal skin to organise a collagen matrix. In addition the effects of interleukin-1β (IL-1β) on the contraction process was also investigated. Over the concentration range 5-50 U/ml, IL-1β induced a statistically significant inhibition of gel contraction in all fibroblast cell types ( P <0.05), although fetal fibroblasts appeared least responsive and gingival fibroblasts most responsive to the inhibitory effects of this cytokine. Comparison of gel contraction by the different fibroblast strains indicated that fetal and gingival fibroblasts shared similar contraction kinetics. For the adult skin fibroblasts, three of five strains studied showed significantly diminished levels of gel contraction compared to fetal and gingival cells. This apparent difference in fibroblast phenotype may, at least in part, explain the fetal-like wound healing pattern seen in the oral mucosa. 相似文献
Four patients between 58 and 81 years of age undergoing investigation and endoscopic biopsy for gastric carcinoma also were subjected to direct-vision fine needle aspiration cytology of their mucosal lesions which yielded malignant cells. The relevance of this technique is discussed regarding both intrinsic and extrinsic lesions of the gastrointestinal tract. 相似文献
Temporary inactivation of the cerebellar interposed nuclei was used to assess the role of the intermediate cerebellum in
the performance of forelimb cutaneo-muscular reflexes in the cat. The following types of reflexive responses were evaluated:
the classically conditioned and unconditioned forelimb withdrawal responses and the forelimb tactile placing, hopping and
magnet responses. The experiments tested the hypothesis that the intermediate cerebellum is involved in the performance of
all the above forelimb reflexes. The forelimb withdrawal reflex was classically conditioned in a newly developed paradigm
in which animals were first operantly conditioned to stand on four elevated platforms. Trained animals were microinjected
with a γ-aminobutyric acid (GABA) agonist, muscimol, in the interposed nuclei, and the effects of inactivation of the intermediate
cerebellar output on the forelimb reflexes were examined. The main findings of these experiments are that unilateral muscimol
inactivation of the interposed nuclei in the cat abolished the expression of the classically conditioned limb flexion reflex,
suppressed the performance of the unconditioned withdrawal reflex and, in parallel, downregulated the tactile placing, hopping
and magnet postural responses in the ipsilateral forelimb. These observations are inconsistent with concepts indicating exclusive
involvement of the intermediate cerebellum in the classically conditioned reflexes elicited by aversive stimuli. On the contrary,
they support the hypothesis of a more global involvement of this structure in learned and unlearned defensive flexion reflexes
and in automatic postural response systems.
Received: 29 July 1996 / Accepted: 26 September 1996 相似文献
Intestinal intraepithelial lymphocytes (iIEL) are primarily CD8 cells and most of them have a CD28? phenotype, the phenotype of effector cytotoxic T cells. We asked whether the predominance of CD8+ CD28? T cells in the gut may result from peripheral blood T cells preferentially migrating to the iIEL compartment and adhering to iEC. Compared with CD4 cells, adhesion of resting CD8+ T cells to iEC cell lines was significantly higher. Adhesion could be blocked with a MoAb to gp180, a molecule expressed on iEC which is known to interact with CD8/lck. No significant difference in the level of adhesion was observed between CD8+ CD28+ and CD8+ CD28? T cells. Thus CD8 cells may preferentially migrate to the iIEL compartment, but loss of CD28 expression could occur in situ after migration. Consistent with this hypothesis, the CD8+ CD28? cells became enriched after co-culturing T cells with iEC cell lines and primary iEC. Induction of the CD8+ CD28? phenotype in cord blood and adult T cells was observed in co-cultures with iEC and also with mitogens and superantigens. In the latter case, CD28 down-modulation was seen specifically in the Vβ subset targeted by the superantigen, indicating that loss of CD28 expression is a direct result of T cell receptor (TCR)-mediated stimulation. The combined results suggest that CD8+ CD28? T cells are antigen experienced T cells, and that they may have a survival advantage in the presence of gut epithelial cells in vitro. This may contribute to the predominance of CD8+ CD28? T cells in the iIEL compartment. 相似文献
Background: Remifentanil is commonly used to replace nitrous oxide in general anesthesia to avoid the side effects of the latter. However, there are reports that intraoperative remifentanil infusion can lead to acute opioid tolerance. In this study, the authors tried to determine the dose of remifentanil comparable in efficacy to 70% nitrous oxide and to evaluate its effect on postoperative pain and morphine consumption after colorectal surgery using isoflurane anesthesia.
Methods: Sixty adult patients undergoing open colorectal surgery were randomly assigned to receive either remifentanil or 70% nitrous oxide along with isoflurane anesthesia. After morphine analgesia titration in the postanesthesia care unit, patient-controlled analgesia was commenced. Morphine consumption and pain were scored at rest and during cough or movement for 24 h.
Results: The mean remifentanil infusion rate was 0.17 [mu]g [middle dot] kg-1 [middle dot] min-1. The median visual analog pain score on arrival in the postanesthesia care unit was 1 (0-10) in the nitrous oxide group and 3 (0-9) in the remifentanil group (P < 0.05). Otherwise, there was no difference in pain scores at 5, 10, and 15 min and no difference in the total morphine consumption during the stay in the postanesthesia care unit. The two groups had similar total morphine consumption in the first 24 h and pain scores at rest and during movement. The incidence of postoperative nausea and vomiting was 10% in both groups. There was no difference in the sedation scores. 相似文献
We carried out a postal survey of randomly selected orthopaedic surgeons in the North East of England, enquiring about outpatient
follow-up patterns after primary total hip replacement. The aim was to compare and contrast the number and timing of appointments
as well as assess the involvement of orthopaedic nurse practitioners (ONP). The number of visits in the first post-operative
year varied between two and five. The average duration before the first, second and third follow-up was 5 weeks, 4 months
and 13 months respectively. Ninety-three percent of the consultants follow their patients indefinitely. For the patients who
are followed for life, 71% are seen in the ONP clinic and 29% in the consultant clinic. Fifty percent of the consultants sub-specialising
in lower limb arthroplasty follow their patients up to 1 year, after which the care is taken over by an orthopaedic nurse
practitioner, compared to 70% of the general orthopaedic consultants. With increasing number of total hip replacement operations
being performed, guidelines and consistency would be desirable in order to make the follow-up of patients efficient in terms
of the time and cost. 相似文献