Rectus “wrap around” flap for salvage of an infected ascending aortic graft

An application of the rectus abdominis muscle flap to salvage an infected prosthetic graft of the ascending thoracic aorta is presented. The length of this flap along with its width and thickness allows it to be wrapped around prosthetic grafts of the ascending aorta in a spiral fashion. This rectus muscle wrap around flap method is straightforward involving the use of one muscle rather than multiple muscles. The abdominal cavity is not opened as with the use of omentum. The procedure can be accomplished in a short time which is important in the critically ill patient.     

正常人眼球直肌Pulley功能位置的动态磁共振成像研究

目的研究正常人眼球运动动态磁共振成像（MRI）4条直肌Pulley（滑车）的功能性位置。方法采用西门子公司Sonata1.5T超导型MRI扫描仪,应用眼球运动动态MRI技术,获取20名正常人（20个眼眶）眼球原在位及上转、下转、内转、外转20度时垂直于眶轴的眼眶冠状位MRI图像。以眼球中心为原点建立三维坐标系,应用ScionImage医学图像测量软件分别测量各层面眼球垂直转动时水平直肌、眼球水平转动时垂直直肌的横截面质心。根据各层面直肌横截面质心的坐标值建立直线回归方程,分别求得眼球垂直转动时内、外直肌径路及眼球水平转动时上、下直肌径路直线回归曲线斜率变化最大的一点,即为该直肌Pulley的功能性位置。对4条直肌Pulley相对于眼球中心的坐标值（X、Y）进行统计。结果内直肌Pulley位于眼球中心后4mm,内14.7mm,下0.3mm;外直肌Pulley位于眼球中心后8mm,外9.8mm,下0.3mm;上直肌Pulley位于眼球中心后6mm,内1.6mm,上11.5mm;下直肌Pulley位于眼球中心后6mm,内4.4mm,下12.7mm。结论应用眼球运动动态MRI技术,分析眼球转动时直肌径路的变化,可证实4条直肌Pulley的存在并确定其功能位置。     

Management of sacral and perineal defects following abdominoperineal resection and radiation with transpelvic muscle flaps

PURPOSES: In this study we present our experience with treating persistent sacral and perineal defects secondary to radiation and abdominoperineal resection with or without sacrectomy. METHODS: Fifteen consecutive patients were treated with an inferiorly based transpelvic rectus abdominis muscle or musculocutaneous flap. RESULTS: Fourteen of the 15 patients achieved healing, and 7 patients had no complications. The remaining eight patients required one or more operative debridements and/or prolonged wound care to accomplish a healed wound. Our technique for the dissection and insetting of the transpelvic muscle flap is presented. CONCLUSION: The difficult postirradiated perineal and sacral wounds can be healed with persistent surgical attention to adequate debridement, control of infections, and a well-vascularized muscle flap. The most satisfying aspects for patients are the discontinuance of foul-smelling discharge, discontinuation of multiple, daily dressing changes, and reduction in the degree of chronic pain.Read at the meeting of the Midwestern Association of Plastic Surgeons, Bismarck, North Dakota, June 15 to 18, 1992.     

The effects of voluntary contraction effort on quadriceps femoris electromyogram median frequency in humans: a muscle and sex comparison

The purpose of this study was to examine the effect of voluntary contraction efforts on the median frequency (f _med) of the electromyogram (EMG) recorded from the quadriceps femoris muscle in healthy men and women. A group of 30 healthy volunteers (15 men, 15 women) were assessed for EMG activity of the vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF) muscles during isometric contractions with the knee at 60° flexion. Subjects performed a series of 5 s maximal voluntary isometric contractions that anchored the perceptual range with a "10" on a 10-point scale. Sub-maximal isometric contractions were then separately performed at the following perceived effort levels on the 10-point scale: 1, 2, 3, 4, 5, 6, 7, 8 and 9, in a random order. Subjects were instructed to maintain the contraction at each perceived level of effort for 5 s. The f _med of the three muscles was assessed using a power spectrum analysis performed over 11 consecutive, 512 ms, epochs overlapping each other by half their length during the middle 3 s of each contraction. The f _med for each of the 11 epochs was then determined for each muscle, followed by calculation of the means and normalized coefficients of variation [(standard deviation/mean)×100%] for each contraction. The results demonstrated that the mean f _med of VL was significantly greater than those of the other two muscles, and that f _med of RF was significantly greater than that of VM. The VL muscle demonstrated a significant increase in mean f _med across the contraction efforts, compared to the VM and RF muscles that displayed a significant decrease. The men displayed significantly higher f _med values for the VM muscle than did the women, as well as showing a significantly greater increase across the contraction efforts for the VL muscle. The variability of f _med was shown to be significantly higher for the VM muscle, compared to the VL and RF muscles. The findings of this study suggest that the f _med statistic is most sensitive to contraction intensity efforts for the VL muscle, and that men display significantly higher values for the VL and VM muscles, compared to women. Electronic Publication     

Functional combination of tapering profiles and overlapping arrangements in nonspanning skeletal muscle fibers terminating intrafascicularly

Using digital image analysis and several anatomical methods, morphometric analysis of nonspanning fibers which had tapering profiles at their intrafascicular termination sites and represented overlapping arrangements within the fiber fascicles was performed in the rat rectus abdominis. Special emphasis was focused on dimensional relationships occurring between overlapping portions and tapering segments and sarcomere lengths in non- and overlapping portions. Nonspanning fibers were found to overlap each other for more than 40% of their length. In length, their overlapping portions generally corresponded to their tapering segments, which were also greater than 40% of the fiber length. In addition, despite the presence of overlapping linkages, nonspanning fibers maintained a fairly uniform length irrespective of their overlapping and non-overlapping portions. Overlapping linkages in fibers without tapering profiles have a larger cross-sectional area in the overlapping portion than in the non-overlapping one, resulting in a phenomenon which will cause different sarcomere lengths between the two portions during fiber stretching. The present results suggest that tapering profiles in the overlapping portion ensure uniform sarcomere lengths within nonspanning fibers, thereby providing mechanical stability in each fiber. © 1993 Wiley-Liss, Inc.     

腹直肌肌电图运动单位电位正常值的建立

目的:建立腹直肌肌电图(EMG)运动单位动作电位(MUAP)各参数正常值。方法:测定109例正常人腹直肌EMG的MUAP的时限、波幅及多相波。结果:腹直肌EMG的MUAP参数分别为:波幅373．78±56．46μV,时限9．95±1．13 ms,多相波19．40％±1．52％。结论:腹直肌EMG各参数能可靠、稳定地测出,有助于脊髓胸段下运动神经元病变的检测。     

Strabismus and diplopia as complications after cataract surgery with IOL implantation

Summary In our Department of Orthoptics we have seen an increasing number of patients suffering from diplopia after cataract surgery with IOL implantation. Between 1993 and 1997 the total number of patients with this problem was 24 (2.7 % of all patients, mean age 71 years, age range 38–88). We addressed the question of whether there is a common pattern of motility dysfunction. Methods: After evaluation of the clinical history and the basic ophthalmological findings the following parameters were examined: binocular function (Bagolini test), squint angles (Maddox cross), ocular motility. Results: The 24 patients could be divided up into three groups. Group 1 consisted of 9 patients (mean age 82 years, range 64–88) who complained about diplopia because of strabismus incomitans with vertical deviation and restricted motility on the first day after surgery. In 8 of the 9 patients strabismus surgery was done. Group II consisted of 10 patients (mean age 66 years, range 38–77) who noticed diplopia and strabismus within 7 days after surgery. We found various kinds of heterotropia. Seven of these patients were operated on and two had a prism correction. Group III consisted of 5 patients (mean age 67 years, range 61–78). Their already known strabismus paralyticus or concomitans deteriorated, leading to diplopia in some cases. All patients in this group were operated on. Discussion: For group I we believe that retro-, para- or peribulbar anesthesia caused the motility dysfunction. In groups II and III it is unlikely that local anesthesia had a causative role. The prolonged disruption of binocular vision and the abrupt change in the sensory situation after the cataract operation with lens implantation may be the leading causes for strabismus or deterioration of a preexisting strabism, respectively. Conclusions: These patients need a subtil meticulous diagnostic work-up and follow-up because of the possibility of early surgical therapy, which has a good prognosis. Evaluation of binocular vision and eye movements prior to cataract surgery appears to be helpful for later strabismic surgery.      

Erdheim-Chester disease with intramuscular lipogranuloma

We report on a rare manifestation of Erdheim-Chester disease with intramuscular lipogranuloma. The patient was a 66-year-old man who noted a soft tissue mass in the right quadriceps femoris muscle. Radiographs revealed symmetrical osteosclerosis in the diametaphysis of both femora and tibiae. An open biopsy revealed a proliferation of lipid-laden histiocytes in the femoral bone marrow and the quadriceps femoris muscle. To our knowledge, this is the second case of Erdheim-Chester disease involving muscle. Received: 4 October 1999 Revision requested: 18 November 1999 Revision received: 1 December 1999 Accepted: 2 December 1999     

Rectus abdominis myocutaneous flap in radical oncopelvic surgery: A safe and useful procedure

AIMS: The aim of this retrospective study was to evaluate the usefulness of rectus abdominis myocutaneous (RAM) flaps to treat locally advanced pelvic gynaecological or digestive tumours. METHODS: We reviewed 46 patients, who received RAM flaps after radical oncopelvic surgery, including: (a) total vaginal reconstruction (TVR); (b) partial vaginal reconstruction (PVR); (c) perineal reconstruction (PR). RESULTS: Between 1989 and 1998, 46 patients underwent pelvi-perineal reconstruction with RAM flaps after radical pelvic surgery for carcinoma of the cervix (n=22), anal carcinoma (n=11), rectal carcinoma (n=7), or other pelvic tumours types (n=6). There were two post-operative deaths. Overall surgical morbidity was 45, 6% (n=21). Specific morbidity of the RAM flap was 21, 7% (n=10). Global re-intervention rate was 13% (n=6). CONCLUSION: Rectus abdominis myocutaneous flap in radical oncopelvic surgery is useful for vaginal or perineal reconstruction and prevention of pelvic collections after extended resections with a low rate of associated morbidity.