Zigzag V-Y advancement flap for medial canthal defect after tumor excision

A zigzag V-Y advancement flap based on the angular artery is used to repair the medial canthal defect after tumor excision. Only the middle-third subcutaneous attachments to the flap are left intact, which contain the vascular pedicle. The advancing zigzag edges of the flap can be naturally inserted around both limbs of the medial canthus, and this disperses the tendency to linear contracture and "trap-door" scarring. The described technique is an excellent choice for medial canthal defect, providing a well-contoured and aesthetically pleasing reconstruction.

The effect of ultrasonic scaling therapy in periodontitis III. A longitudinal study over three years

The purpose of the present study was to examine and evaluate the effect of clinical trials of non-surgical periodontal therapy (NSPT) by ultrasonic scaling alone for three years. A total of 51 individuals (27 males; 24 females) ranging in age from 21 to 61 years with moderately to extremely advanced periodontitis were studied following baseline assessments which included gingival index, plaque index, probing pocket depths, and probing attachment levels (PALs). The patients were subjected to NSPT by using supra- and subgingival scaling with ultrasonic instrumentation alone. The results showed that this therapy resulted in a pronounced and significant reduction (p < 0.001) of gingival inflammation and dental plaque formation for the 3 years of study. In addition, a significant reduction of probing depth as well as an obvious gain of PALs were found greater in sites with initial depth of 4-6 mm and 7 mm or more (p < 0.001) than those in sites with initial probings of 1-3 mm (p > 0.05) at each survey time point.

A clinical analysis of necrotizing fasciitis: a review of 54 cases

Necrotizing fasciitis is a severe and sometimes life-threatening soft tissue infection that is characterized by rapidly widespreading necrosis of fascia and subcutaneous tissue. Fifty-four cases of necrotizing fasciitis were reviewed over a 5-year period. Among them, 25 patients (46%) had diabetes mellitus. The majority of the wound bacterial cultures (71%) yielded a mixed growing. There were negative cultures in six patients, and single organism growth in 14 patients (29%). The predominant organisms growth were Streptococci, Staphylococci, and Escherichia coli. The overall mortality rate was 22% (12/54). Death was caused by systemic septic complications in these patients. All 12 mortalities resulted from delayed debridement (averaging 25 days after initial symptoms appeared). Our study indicates that the early recognition and prompt debridement of all necrotic tissue is essential for reducing the mortality rates of this potentially lethal condition.

Prevention of SIV infection in macaques by (R)-9-(2-phosphonylmethoxypropyl)adenine

The efficacy of pre- and postexposure treatment with the antiviral compound (R)-9-(2-phosphonylmethoxypropyl)adenine (PMPA) was tested against simian immunodeficiency virus (SIV) in macaques as a model for human immunodeficiency virus (HIV). PMPA was administered subcutaneously once daily beginning either 48 hours before, 4 hours after, or 24 hours after virus inoculation. Treatment continued for 4 weeks and the virologic, immunologic, and clinical status of the macaques was monitored for up to 56 weeks. PMPA prevented SIV infection in all macaques without toxicity, whereas all control macaques became infected. These results suggest a potential role for PMPA prophylaxis against early HIV infection in cases of known exposure.

Reconstruction of the upper leg and knee with a reversed flow saphenous island flap based on the medial inferior genicular artery

Soft-tissue defects around the knees and below-the-knee amputation stumps are difficult to reconstruct. We present an option for reconstruction of these defects. Reversed flow saphenous island flaps, based on the medial inferior genicular artery, were successfully transferred in 6 patients. All wounds healed well postoperatively. The donor defect can be closed directly when the width is less than 7 cm. This is a thin and reliable fasciocutaneous flap that is useful in covering defects around the knee joint, popliteal fossa, upper half of the leg, and below-the-knee amputation stump.

In vitro production of interleukin-6 by human gingival, normal buccal mucosa, and oral submucous fibrosis fibroblasts treated with betel-nut alkaloids

This study aimed to assess the possibility of a direct effect of betel-nut alkaloids arecoline and arecaidine on cell proliferation and interleukin-6 (IL-6) production by cultured fibroblasts from human normal gingiva, buccal mucosa and oral submucous fibrosis (OSF) buccal mucosa in vitro. Confluent monolayers of fibroblasts were incubated with or without alkaloids in the presence of 10% fetal calf serum for 48 h at 37 degree C in 5% CO2 and air. At the end of the culture period, supernatants were collected and assayed for IL-6 level. The cell proliferation was monitored by determining 5-bromo-2'-deoxy-uridine (BrdU) incorporated into cellular DNA. Except for the fact that arecoline inhibited cell growth at 100 micrograms/ml, arecoline and arecaidine had similar dose-dependent stimulant effects on the proliferation of these three groups fibroblasts. Concentrations of IL-6 in the control culture supernatants were greatest in healthy gingival fibroblasts, followed by normal buccal mucosa and OSF. Also, the presence of fetal calf serum could stimulate IL-6 release. Except for arecoline at the 100 microgram/mg, there were no significant differences in IL-6 levels between treated and control cultures of the same group when the data were expressed with mean +/- S.D.. However, two of six individuals' normal buccal mucosa fibroblasts significantly released less IL-6, and some cases of OSF and healthy gingiva exhibited slightly higher levels of IL-6 when cells were exposed to arecoline or arecaidine in cultures. Such findings suggests that arecoline and arecaidine can enhance cell proliferation and affect fibroblasts to synthesize IL-6. Furthermore, IL-6 may be a contributing molecular factor in the pathological features noted in OSF.

Human follicular fluid and mouse cumulus cells act synergistically to enhance preimplantation mouse Balb/cJ embryo development

PROBLEM

The development of preimplantation mammalian embryos in vitro is less than optimal. Follicular fluid and cumulus cells have both been used, independently, to improve preimplantation embryo quality in culture.

METHOD

To determine the ability of mouse cumulus cell coculture in the presence of human follicular fluids to support preimplantation mouse Balb/cJ embryo development in vitro.

RESULTS

Culture of preimplantation mouse Balb/cJ embryo's independently in human follicular fluid or on mouse cumulus cells had no significant affect on blastocyst. The coculture of mouse Balb/cJ preimplantation-stage embryos on mouse cumulus cells in the presence of human follicular fluid significantly (P < 0.01) improved blastocyst development and the total number of cells per blastocyst.

CONCLUSION

Cumulus cells and follicular fluid have a positive synergistic affect on preimplantation mouse Balb/cJ embryo development and formation in vitro.

Reconstruction of the totally degloved little finger with a bilobed digital neurovascular island flap

Treatment of a completely degloved finger injury is a challenge to plastic surgeons. We used a simple method, a bilobed digital neurovascular island flap harvested from the dorsolateral side of the middle and proximal phalanges of the ring finger, to reconstruct the complete degloved little finger. This method provides a one-stage operation for coverage of the degloved little finger and also results in good sensation and an acceptable appearance.

Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan

A hospital-based case-control study of matched pairs was conducted to explore (a) the relationship between the use of betel quid chewing, cigarette smoking, alcohol drinking and oral cancer and (b) synergism between these factors. The case group consisted of 104 male and 3 female oral cancer patients and these were compared with 194 male and 6 female matched controls. We found by univariate analysis that alcohol consumption, smoking, betel quid chewing, educational level and occupation were associated with oral cancer. The adjusted odds ratios were to be found elevated in patients who were smoking and betel quid chewing. After adjusting for education and occupation covariates, the incidence of oral cancer was computed to be 123-fold higher in patients who smoked, drank alcohol and chewed betel quid than in abstainers. The synergistic effects of alcohol, tobacco smoke and betel quid in oral cancer were clearly demonstrated, but there was a statistically significant association between oral cancer and betel quid chewing alone. Swallowing betel quid juice (saliva extract of betel quid produced by chewing) or including unripened betel fruit in the quid both seemed to enhance the risks of contracting oral cancer.

Levels of interleukin-1 beta and interleukin-8 in gingival crevicular fluids in adult periodontitis

Recent in vitro findings indicate that cytokines represent an important pathway of connective tissue destruction in human periodontitis. The biological effects of interleukin-1 beta (IL-1 beta) and interleukin-8 (IL-8) are relevant in this regard, and the objective of this study was to compare the levels of these molecules in gingival crevicular fluids (GCF) from patients with adult periodontitis (experimental group) and from individuals with clinically healthy gingiva (control group). GCF was collected for 30 seconds using a periopaper strip and the volume of the sample determined. Following elution of the fluid, assays for IL-1 beta and IL-8 were carried out by ELISA. The concentrations (ng/ml) of cytokines were calculated in the original volume of GCF on each strip. The total amounts (pg/site) of cytokines were expressed as the concentrations multiplied by volumes of GCF: The total amounts of IL-1 beta and IL-8 of the experimental group were significantly higher than the control group. The total amounts of both cytokines were markedly reduced following phase 1 periodontal treatment. The clinical parameters were positively related to the total amounts of IL-1 beta and IL-8. IL-1 beta concentrations and total amounts were also positively related to IL-8 suggesting that the GCF IL-8 levels are influenced by local IL-1 beta activities. These data indicate that the total amounts of IL-1 beta and IL-8 exhibited dynamic changes upon severity of periodontal disease. The levels of IL-1 beta and IL-8 in GCF are valuable in detecting the inflammation of periodontal tissue.

Increased lysyl oxidase activity in fibroblasts cultured from oral submucous fibrosis associated with betel nut chewing in Taiwan

Growth characteristics and lysyl oxidase activity of fibroblasts derived from human normal mucosa (NM) and oral submucous fibrosis (OSF) associated with betel nut chewing were compared in cell cultures. The growth rates of cultured cells were identified by plating 5 x 10(5) cells/35 mm culture dish (Day 0) and every 24 hours cell proliferation was determined by quantifying the cell number (using a hemocytometer). The third to seventh passages were used. A medium without serum but supplemented with 5 mg/ml bovine serum albumin was substituted for the original medium at the subconfluent period and cultured for an additional 24 h. The medium was collected and used for assays of protein content and lysyl oxidase activity. Lysyl oxidase activity was assayed with [4,5-3H]--lysine labelled purified chick--embryo aorta elastin substrate. After incubation for 10 h at 37 degrees C, the enzyme activity was measured from 3HHO (tritiated water) separated by ultrafiltration using Amicon C-10 micro-concentrators. The results showed the mean doubling time of OSF fibroblasts was 3.2 days and of NM fibroblasts was 3.6 days. NM fibroblasts became confluent at day 6 as determined by cell number, while OSF fibroblasts were confluent by Day 5. Furthermore, the immunoenzymatic assay for BrdUrd incorporation revealed that OSF fibroblasts proliferate significantly faster than NM fibroblasts under standard culture conditions. Both total protein content (10.84 +/- 1.15 mg/ml) and lysyl oxidase activity (3558.6 +/- 345.5 cpm/10(6) cell) in OSF fibroblasts were greater than in NM fibroblasts (6.35 +/- 0.96 mg/ml and 2436.0 +/- 352.6 cpm/10(6) cell). The results of this study provide evidence that fibroblasts derived from oral submucous fibrosis (OSF) tissue and normal mucosa (NM), although similar in many respects, exhibit specific differences in proliferation rates and lysyl oxidase activity. Moreover, collagen deposition in OSF tissue may, at least in part, be ascribed to increased lysyl oxidase activity.

Clinical evaluation of different treatment methods for oral submucous fibrosis. A 10-year experience with 150 cases

Over a 10-year period (1982-1991); a total of 150 patients divided into two groups with varying degrees of oral submucous fibrosis (OSF) were treated by either medical or surgical therapies. Medical treatment involved (a) conservative oral administration of vitamin B-complex, buflomedial hydrochloride and topical triamcinolone acetonide 0.1%, or (b) conventional submucosal injections of a combination of dexamethasone and hyaluronidase, or (c) a combination of both (a) and (b). The surgical group was treated by the excision of fibrotic tissues and covering the defect with split-thickness skin, fresh human amnion, or buccal fat pad (BFP) grafts. Treatment was chosen according to the stage of clinical progression to gain maximal interincisal distance (ID). The cases were followed up by monthly examinations for at least two years, or when possible even longer. A combination of (a) and (b) medical treatment was satisfactory in cases of mild impairment (ID > 20 mm) but in the long term it led to symptomatic relief only. Surgical therapy, on the other hand, when accepted by the patients, led to a significant improvement of trismus in cases of severe limitation (ID < 20 mm). Following this strategy, an additional ID increase was observed in all patients. BFP grafting was particularly successful in diminishing scarring after two years as compared with the other two grafts. Together with a cessation of the betel quid chewing habit before and after therapy, these treatment regimens combined with daily mouth opening exercises were found to be necessary to manage OSF cases in early and advanced stages of progression.

Cutaneous vasoconstrictor response induced by inspiratory gasp in relation to sex and age

1. Vasoconstrictor responses to inspiratory gasp were determined in fingertip skin by laser Doppler flowmetry in relation to age and gender of healthy adults. Variations of the responses were examined together with variations in body mass index and vital capacity. 2. In the absence of any significant difference in the baseline blood flow, the index of vasoconstrictor response (per cent change) induced by inspiratory gasp was higher in young males than in young females (71.4% versus 59.4%; P < 0.05), and in the same direction as the change in vital capacity determined in the same laboratory setting. Similar parallel differences in the indexes of vasoconstrictor response and vital capacity existed between young and middle-aged males, suggesting that the differences observed were not due to gender or age per se. 3. Strong positive correlations between the index of the vasoconstrictor response and vital capacity in the same subject were found when young males and females were pooled together and when young and middle-aged males were pooled together. Furthermore, after graded inspiratory gasp, graded vasoconstrictor response was observed in the same subject, indicating a close relationship between the depth of inspiration (magnitude of stimulus) and the index of the vasoconstrictor response (reactivity). 4. We concluded that the index of the vasoconstrictor response induced by inspiratory gasp depends significantly on the magnitude of the vital capacity. These results provide a new approach for quantifying dynamic changes in skin blood flow and raise caveats about comparing differences in neurovascular functions using single measurements of vasoconstrictor response induced by inspiratory gasp as an index.

Running Y-V-plasty for burn scar contracture

Seventeen patients with 24 regions received running Y-V-plasties to release burn scar contractures over a 3-year period. The scar band can be completely interrupted and lengthened without the need for undermining and transposition of the skin flaps, circulatory embarrassment of the flaps can be avoided. The wound morbidity was extremely low, and no recurrence of the contracture was noted during follow-up periods. The running Y-V-plasty has unique advantages for the treatment of cord-like or linear burn scar contractures. This approach resulted in shorter hospital stay and allows early mobilization of the involved extremities.

Modelling the relative metabolic occurrence of alkyl-nitrogen bond cleavage using structure-reactivity maps

Over a broad range of tertiary N-methyl amines, whenever alkyl-nitrogen bond cleavage was observed, N-demethylation was also observed. Alkyl-nitrogen bond cleavage in rings, alkyl-nitrogen bond cleavage if the carbon of the N-dealkylation reaction-site is in a ring and the nitrogen atom of the reaction-site is not in a ring, and dedimethylamination are not likely to occur relative to N-demethylation. Structure-reactivity relationships for other N-dealkylations, such as N-debenzylation, N-dethiophenation, and N-dedimethylaminoethylation of tertiary amines were evident from a visual inspection of the structure-reactivity map. Structure-reactivity maps proved to be a useful tool for ascertaining structural environments influencing the relative occurrence of alkyl-nitrogen bond cleavage in tertiary N-methyl amines.

Ectopic supernumerary teeth as a predisposing cause in localized periodontitis. Case report

Supernumerary teeth are relatively common in the maxillary incisor and molar areas. However, bilateral ectopic, fully erupted supernumerary mesiodentes are relatively rare. The present case documents a patient with localized periodontitis of the maxillary first and second molars associated with bilaterally erupted supernumerary teeth located in proximity to the buccal embrasure space between the molars. Combined clinical data suggested that these ectopic mesiodentes predisposed or contributed to the development of localized periodontitis.

Efficacy of 9-(2-phosphonylmethoxyethyl)adenine treatment against chronic simian immunodeficiency virus infection in macaques

Long-tailed macaques chronically infected with simian immunodeficiency virus (SIV) were treated for 4 or 8 weeks with daily subcutaneous doses of the antiretroviral compound 9-(2-phosphonylmethoxyethyl)adenine (PMEA). The efficacy of PMEA was evaluated by monitoring cell-free virus in plasma, virus titer and viral DNA in peripheral blood mononuclear cells, and absolute numbers of lymphocyte subsets. In mock-treated control macaques, virus titers changed minimally. However, in treated macaques, PMEA exhibited impressive effects, leading to the disappearance of virus in the blood within the first week of treatment and lasting through the fourth week of treatment. The results indicate that PMEA can effectively reduce SIV in chronically infected macaques and offer an optimistic perspective for therapeutic intervention against human immunodeficiency virus infection.

Reverse digital artery neurovascular cross-finger flap

Soft tissue loss with digital nerve defect in the finger was reconstructed with the reverse digital artery neurovascular cross-finger flap in two cases with favorable results. The flap harvested from the lateral side of the proximal phalanx of the neighboring healthy finger is nourished by a distally based digital artery. The flap contained a segment of digital nerve dorsal branch, which is used to bridge the nerve gap in the wound while the flap is used to reconstruct the soft tissue defect concomitantly. The reverse digital artery neurovascular cross-finger flap seems to be a useful addition to the options for complicated finger damage involving soft tissue loss and nerve defect.

PCR amplification and DNA sequencing of SRV-2 from archived tumor tissues

Fibroproliferative tumors, known as retroperitoneal fibromatosis (RF) are predominantly associated with type D simian retrovirus serotype 2 (SRV-2) infections in pigtailed macaques (Macaca nemestrina) at the University of Washington Regional Primate Research Center (UWRPRC). In this report we examined genetic changes that occurred in SRV-2/Washington (SRV-2/WA) from archived RF tissues and from fresh tissue and lymphocytes. DNA was extracted from paraffin-embedded RF tumor tissues and was used to amplify a portion of the SRV-2/WA genome encoding an open reading frame, 3'orf. Since 3'orf is encoded in an alternate reading frame within the outer membrane glycoprotein (gp70) env gene, sequences of 3'orf also provide information on a portion of env gp70. To define the changes that have occurred in this portion of the viral genome, we compared the nucleotide and deduced amino acid sequences amplified from the various tumor tissues. The paraffin section PCR revealed that all samples containing amplifiable DNA harbored SRV-2/WA genomes. DNA sequence analysis showed that the 3'orf/gp70 portion of the SRV-2/WA genome was nearly identical in all tissues but was distinguishable from the prototype SRV-2/OR isolate from Celebes black macaques (M. nigra). A T-cell activating domain (Env residues 233-249) was 100% conserved in the SRV-2/WA isolates.

[A study on sex hormones in gingival crevicular fluid and black pigmented bacteria in subgingival plaque of pregnant women]

Gingivitis is one of the most common oral diseases. It is caused by dental plaque and by the factors produced/released from it. The black pigmented bacteria in subgingival dental plaque are thought to be the periodontopathogens. Prevotella intermedia and Porphyromonas gingivalis have been shown to be closely associated with human gingivitis. Prevetella intermedia can use female sex hormones such as progesterone or estradiol as a source of nutrients. In pregnant women, the concentrations of progesterone and estradiol are markedly increased in serum and both are accumulated and found in the gingival tissue. The purpose of this study was to test levels of female sex hormones in gingival crevicular fluid and to observe the relationship between hormones and black pigmented bacteria in subgingival plaque. The results showed that the amount of progesterone found in the gingival crevicular fluid and percentage of black pigmented bacteria in subgingival plaque of pregnant women were markedly higher than in the postpartum stage. The percentage of black pigmented bacteria was positively correlated with the progesterone level, pregnancy and the severity of the gingivitis. Severity of the gingivitis was positively correlated with both the plaque index and the percentage of black pigmented bacteria in subgingival plaque.

Clinical application of the distally based medial adipofascial flap for soft tissue defects on the lower half of the leg

OBJECTIVE

Reconstruction of soft tissue defects on the lower half of the leg.

DESIGN

The distally based medial adipofascial flap nourished by the lower perforator originating from the posterior tibial artery was harvested, and the pivot point of flap transposition is 9 to 12 cm above the tip of the medial malleolus.

MATERIALS AND METHODS

Twelve cases of open tibial fracture associated with soft tissue defects on the lower half of the leg were reconstructed with this flap. The cases consisted of ten males and two females, and their ages ranged from 16 to 71 (averaging 41 years).

MEASUREMENTS AND MAIN RESULTS

Size of the flap varied from 4 x 7 cm to 5 x 18 cm. Eleven flaps had good perfusion and survived completely. Tip necrosis of the flap occurred in one case. In the early postoperative period, take of the meshed split-thickness skin graft on the flap was not complete. All wounds, however, were resurfaced completely without the need of a second grafting. Discharging sinuses occurred in one case, which was managed by removal of infected bony fragments. All the donor sites were closed primarily, and desquamation of wound edges occurred occasionally.

CONCLUSIONS

The distally based medial adipofascial flap was a reliable and effect local flap for the reconstruction of soft tissue defects on the lower half of the leg.

Characterization of infectious type D retrovirus from baboons

Infectious virus resembling type D simian retrovirus (SRV) was isolated from Ethiopian baboons (Papio cynocephalus) (SRV-Pc) housed at the University of Washington Regional Primate Research Center. When baboon peripheral blood mononuclear cells (PBMC) or tissues were cocultured with the H-9 human T-cell line or the Raji human B-cell line, large multinucleated syncytia positive for SRV-2 antigens were observed microscopically. Immunoblot analysis of purified SRV-Pc from cell culture supernatants demonstrated that the viral core and envelope proteins reacted with rabbit anti-SRV-2 serum. Fresh PBMC and cocultured cells were positive by polymerase chain reaction using two different sets of SRV-2 primers. Preliminary sequence analysis of two separate isolates from portions of the SRV-Pc p27 and gp20 regions revealed homology with SRV-1, SRV-2, and Mason-Pfizer monkey virus. The homologies in the p27 segment were 91-94% and the homologies in the gp20 segment were 72-75%.

Spontaneous perforation of the left hepatic duct--a case report

We report on a patient with spontaneous perforation of the left hepatic duct who presented with abdominal pain, jaundice and fever. The correct diagnosis was not established until extravasation of contrast medium from the left hepatic duct, as demonstrated by the cholangiogram, was observed. The patient developed two bile-stained intraperitoneal encapsulated fluid collections, which were diagnosed by ultrasonography, and high bilirubin levels in the fluid aspirated from the encapsulations, which were also found at operation. Closure of the perforation with sutures, decortication of the encapsulations and choledocholithotomy for stone extraction with T-tube insertion were performed. Recovery was complete at follow-up examinations.