Melanocyte autologous grafting for treatment of leukoderma

Patients with three types of leukoderma--vitiligo, idiopathic guttate hypomelanosis, and postinflammatory leukoderma--had successful repigmentation after transplantation of autologous melanocytes. The procedure was performed easily by producing blisters on normal skin and on depigmented lesions. Blisters were produced by suction or by freezing with liquid nitrogen. The roof of the blister from donor skin was grafted to the raw surface of the recipient site. Repigmentation was visible within 7 to 14 days. Direct immunofluorescence staining with bullous pemphigoid antibodies suggested that the separation of the epidermis from the dermis occurs within the lamina lucida. Histochemical studies confirmed the absence of dopa-positive cells in the areas of leukoderma prior to grafting. Melanocytes were present in the successful grafts.     

The transitional bridge in early implant loading: history, design, installation, perspectives

The progress made in implantology since the work of Pr. Branemark has led to the development of early functional implant loading. This satisfies one of our patients' primary goals: restoration of fixed dentition as quickly as possible. This article describes the history, design, installation technique, and perspectives for the transitional prosthesis, the most important component of this early loading concept.     

Clinical Features of Wrist Drop Caused by Compressive Radial Neuropathy and Its Anatomical Considerations

Objective

Posture-induced radial neuropathy, known as Saturday night palsy, occurs because of compression of the radial nerve. The clinical symptoms of radial neuropathy are similar to stroke or a herniated cervical disk, which makes it difficult to diagnose and sometimes leads to inappropriate evaluations. The purpose of our study was to establish the clinical characteristics and diagnostic assessment of compressive radial neuropathy.

Methods

Retrospectively, we reviewed neurophysiologic studies on 25 patients diagnosed with radial nerve palsy, who experienced wrist drop after maintaining a certain posture for an extended period. The neurologic presentations, clinical prognosis, and electrophysiology of the patients were obtained from medical records.

Results

Subjects were 19 males and 6 females. The median age at diagnosis was 46 years. The right arm was affected in 13 patients and the left arm in 12 patients. The condition was induced by sleeping with the arms hanging over the armrest of a chair because of drunkenness, sleeping while bending the arm under the pillow, during drinking, and unknown. The most common clinical presentation was a wrist drop and paresthesia on the dorsum of the 1st to 3rd fingers. Improvement began after a mean of 2.4 weeks. Electrophysiologic evaluation was performed after 2 weeks that revealed delayed nerve conduction velocity in all patients.

Conclusion

Wrist drop is an entrapment syndrome that has a good prognosis within several weeks. Awareness of its clinical characteristics and diagnostic assessment methods may help clinicians make diagnosis of radial neuropathy and exclude irrelevant evaluations.     

人鼻腔粘膜的微血管立体构型——扫描电子显微镜观察

本文应用微血管腐蚀铸型—扫描电镜观察的方法,研究了2例幼几鼻腔粘膜区的微血管系统的立体构型。在扫描电镜下,初级微动脉互相吻合形成初级微动脉拱,次级微动脉互相吻合形成次级微动脉拱,两种微动脉拱类似“立体桥”外型式配布。毛细血管网的构型各有特点,在鼻前庭区其形态分两类:①螺旋形毛细血管袢;②多袢形毛细血管树。鼻道区的毛细血管网呈重叠式配布。在粘膜的基底面,可见有动脉与静脉伴行。毛细血管从不同方向和不同空间注入微静脉。本文还论述了鼻粘膜区微血管的类型与生理功能的关系,对认识鼻粘膜区的微循环特征和鼻病的过程有一定的临床意义。     

The arcade of Fröhse : an anatomic study

Summary An anatomic study of the appearance and consistency of the upper arcade of the superficial layer of the supinator m. was carried out on 106 elbow-joint dissections. A classification of the structure was drawn up in order to discern the criteria for normality. An arcade of a tendinous nature (arcade of Fröhse) was encountered in the majority of cases (64.1%). At first sight, it could not be ascribed a compressive role affecting the posterior branch of the radial n. Macroscopic examination of the nerve prior to its entry under the supinator arcade revealed the presence of macroscopic lesions in 42.9% of cases. This high incidence does not permit any conclusions regarding the pathologic significance of this type of lesion.

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L'arcade de Fröhse: étude anatomique

Résumé Une étude anatomique de l'aspect et de la consistance de l'arcade supérieure du faisceau superficiel du m. supinateur a été réalisée sur 106 préparations de coudes. Une classification basée sur la structure a été établie afin de dégager des critères de normalité. Une arcade tendineuse (arcade de Fröhse) est rencontrée dans la majorité des cas (64.1%). On ne peut lui attribuer à priori un rôle de compression du rameau profond du n. radial. L'observation macroscopique du nerf avant son passage sous l'arcade du m. supinateur révèle la présence d'altérations macroscopiques dans 42.9% des cas. Cette incidence élevée ne nous permet pas de conclure à la signification pathologique de ce type d'altération.

     

Posterior interosseous nerve of the elbow at the arcade of Frohse: Ultrasound appearance in asymptomatic subjects

PurposeTo assess the normal values of the antero-posterior (AP) diameter of the posterior interosseous nerve (PIN) of the elbow as it passes beneath the arcade of Frohse and to search for PIN-diameter differences between the upstream, entry point and downstream of the arcade.Material and methodsThirty asymptomatic patients prospectively underwent bilateral B-mode ultrasound of the PIN of the elbow. There were 15 men and 15 women with a mean age of 30.2 ± 5.31 (SD) years (range: 26–43 years). Of these, 23 patients were right-handers (23/30; 77%) and 7 were left handers (7/30; 23%). AP diameter of the PIN was measured in long axis at three different locations including the entry point of the arcade, 5-mm upstream and 5-mm downstream the arcade. A comparison between the three measurements was performed using paired t-test.ResultsThe mean AP diameters of the PIN were 0.83 ± 0.21 (SD) mm (range: 0.43–1.31 mm), 0.6 ± 0.17 (SD) mm (range: 0.29–1.16 mm) and 0.49 ± 0.13 (SD) mm (range: 0.26–0.86 mm) at 5-mm upstream, entry point of the arcade and 5-mm downstream the arcade of Frohse, respectively. Significant drops in PIN diameter were found between upstream and the arcade (−0.23 mm; 27%; P < 0.001), between the arcade and downstream (−0.11 mm; 17%; P < 0.001), and between upstream and downstream the arcade (−0.34 mm; 40%; P < 0.001).ConclusionDisparity in AP diameter of the PIN of the elbow in the arcade of Frohse is a normal finding and should not be erroneously interpreted as entrapment when present alone.     

Spectrum of congenital mitral valve abnormalities associated with solitary undifferentiated papillary muscle in adults

BackgroundCongenital anomaly wherein the mitral valve leaflets are directly attached to the papillary muscle(s) (PM) with or without short under-developed chords is rarely reported in adults. Patients with two PMs with an intervening fibrous bridge have also been included under this head in previous studies.MethodsEchocardiography enables accurate evaluation of the morphology and function of valve leaflets, chordae tendineae, and PM. This report describes a series of six patients aged 56–84 years who had abnormal mitral valve with a large solitary and anomalously inserted PM seen over a period of 3 years. Only those patients who had a single pillar or bridge-like PM and either absent tendinous chords or small under-developed chords were included in the analysis.ResultsAmong 9600 consecutive echocardiograms performed, six patients met the criteria of an abnormal mitral valve with solitary large PM. Two patients underwent mitral valve replacement with partial excision of the PM wherein echocardiographic observations were confirmed. The patients were previously followed with the diagnosis of hypertrophic cardiomyopathy (3) and rheumatic mitral valve disease (3). Multi-planar reconstruction of 3D echocardiographic images provided incremental value in assessing the detailed patho-anatomy of PMs in these cases.ConclusionIn adult patients, a high index of suspicion is required to detect congenital mitral stenosis/regurgitation with large solitary PM (resembling a parachute mitral valve) which may masquerade as hypertrophic cardiomyopathy or rheumatic mitral valve disease.     

Redefining the "Arcade of Struthers"

PURPOSE: To define the anatomy and presence of the arcade of Struthers, its anatomic variations, and potential sites of compression of the ulnar nerve. METHODS: In 11 fresh specimen dissections, the ulnar nerve was followed from the brachial plexus through the anterior compartment into the posterior compartment through the intermuscular septum and the arcade of Struthers on to the cubital tunnel. The arcade was identified, dissected, measured, and photographed. All anatomic variations were documented. RESULTS: The arcade of Struthers and intermuscular septum were present in all 11 specimens. The arcade was not merely an opening in the septum nor was it a short band as typically described: the arcade was better described as a fibrous canal with an average length of 5.7 cm. Its openings at either end were 3.9 and 9.6 cm proximal to the medial epicondyle. The structural components of the canal consisted of the fibrous tissue of the intermuscular septum, the internal brachial ligament, the deep fascia of the triceps, and the epimysium of the triceps muscle itself. The ulnar nerve was bound tightly within the entire canal in one case. In all specimens the nerve had an hourglass indentation at the proximal opening of the canal between the intermuscular septum and the internal brachial ligament. CONCLUSIONS: The arcade of Struthers consists of a fibrous canal. The tightest point is the proximal end of the canal at the intermuscular septum that represents the clinically relevant site of entrapment or compression of the ulnar nerve.     

骨胳肌微血管立体构筑的扫描电镜观察

本文报道应用微血管腐蚀铸型扫描电镜技术,观察了2例3岁男童的翼内肌和咬肌的微血管系统。在扫描电镜下观察,可见微动脉的分支分为三种类型;1.树叉样边分支;2.对称性分支;3.细丛状分支。本文描述了动脉和静脉铸型表面上的内皮细胞核压痕的差别;前毛细血管括约肌压痕的形态特征;拱形动脉的Ⅱ级吻合形式及其生理学意义。毛细血管铸型的直径为5.6±1.9μm。2～3条静脉湍毛细血管汇合成毛细血管后微静脉。可见1条独立的毛细血管直接注入微静脉干。上述形态学因素在骨胳肌的微循环方面,有着重要的生理学意义。