Thumb reconstruction by pedicled transfer of the second toe

Microsurgery and free tissue transfer play a vital role in the modern practice of reconstructive surgery. Prior to the advent of microsurgical free tissue transfer pedicle flaps were the workhorse of a reconstructive surgeon. We report a case of thumb reconstruction by pedicled transfer of the second toe with functional and aesthetic outcome. This case was performed in Pakistan where microsurgical facilities were not available.

Daphwazirin, biscoumarin glycopyranoside from Daphne oleoides

Daphwazirin, a new biscoumarin glycoside (1), along with four known compounds (2), (3), (4) and (5) has been isolated from the roots of Daphne oleoides. Its chemical structure is established as 7-hydroxy-8-[2-oxo-2H-1-benzopyran-7'-(O-alpha-L-rhamnosyl)-6'-yl]-2H-1-benzopyran-2-one through spectroscopic techniques and chemical analysis.

Ursene type nortriterpene from Debregeasia salicifolia

A new triterpene, 3beta-19alpha-dihydroxy-30-norurs-12-ene (1), has been isolated from the methanolic extract of Debregeasia salicifolia stems. Its structure has been elucidated with the help of one- and two-dimensional NMR and NOE studies. Lupeol, beta-sitosterol, stigmasterol and oleanolic acid are also reported for the first time from this species.

Innovations in flap design: modified groin flap for closure of multiple finger defects

The groin flap is frequently used for covering soft-tissue defects of the hand. It is normally utilised as a single unit to cover the defect. When used for coverage of multiple digital defects, it requires syndactylisation of the digits with a further procedure to divide the syndactylised digits some time after division of the main pedicle. We report a new technique of fashioning 'daughter flaps' from the groin flap at the time of elevation, and their use to cover full-thickness burns to the dorsum of PIP joints in both hands thus avoiding the need for syndactylisation of the digits.

Infection of bovine immunodeficiency virus and bovine leukemia virus in water buffalo and cattle populations in Pakistan

A survey of antibodies to bovine immunodeficiency virus (BIV) known as bovine lentivirus and bovine leukemia virus (BLV) was conducted with samples from water buffalo and cattle populations in Pakistan. A total of 370 water buffaloes and 76 cattle were tested, and 10.3% and 15.8%, respectively, were found positive for anti-BIV p26 antibodies determined by Western blotting, while 0.8% of water buffaloes and no cattle were positive for anti-BLV antibodies determined by immunodiffusion test. BIV-seropositive water buffaloes and cattle were found to have BIV proviral DNA in the peripheral blood mononuclear cells determined by nested polymerase chain reaction. This is the first report of BIV infections in water buffaloes.

A technique for repair of the 'unrepairable' cleft palate

The 'unrepairable' cleft palate may be described as one in which the width of the cleft exceeds the sum of the widths of the palatal shelves. A report of such a case is presented, and the technique used to repair the cleft using bilateral buccinator musculomucosal flaps is described. It is offered as a suggested technique for the management of such cases in the future.

Long term outcome of early active mobilization following flexor tendon repair in zone 2

We reviewed 34 patients with 65 zone 2 flexor tendon injuries in 39 digits whose outcome had been prospectively studied in an earlier investigation at a mean of 10.6 years after repair. Grip strength was assessed using a Jamar dynamometer. Outcome of grip strength in relation to normal data indicated an excellent or good outcome in 94% of patients, fair in 3% and poor in 3%. Using the grading system recommended by the American Society for Surgery of the Hand, the active range of motion was graded as excellent or good in 75% of digits, fair in 15% and poor in 10%. These results compare favourably with those of the original study with 5/39 of digits showing an improvement from good to excellent. Sixteen of the 34 of patients continued to suffer from cold sensitivity.

The effects of maternal magnesium sulfate treatment on newborns: a prospective controlled study

OBJECTIVE

To evaluate the effects of maternal magnesium sulfate treatment on newborn outcome.

METHODS

Subjects were newborn infants delivered at > or = 34 weeks of gestation whose mothers received a minimum of 12 hours of intravenous MgSO4 therapy before delivery. Control infants were the next born infants of similar gestational age. Outcome recorded at delivery included Apgar scores, whether resuscitation was required, and whether respiratory depression or decreased tone were noted by the physician in attendance. Pneumocardiograms on magnesium-exposed and control infants, obtained within 6 to 18 hours after delivery, were analyzed postdischarge by a single investigator who was blinded to group. The nursery course, feeding patterns, time to first stool, and time to first void were recorded. All patient care decisions, including admission to the neonatal intensive care unit (NICU) or term nursery, were independent of study protocol.

RESULTS

A total of 26 magnesium-exposed and 26 control infants were enrolled. The mean total dose of MgSO4 before delivery was 51.2+/-24 gm; the mean duration of therapy was 23.1+/-10 hours. The mean maternal serum magnesium level before delivery was 5.8+/-1.1 mg/dl. The infants' mean cord or initial serum magnesium level was 5.2+/-1.0 mg/dl, which correlated with the maternal magnesium level before delivery (r=0.81, p < 0.001). MgSO4-exposed infants had a higher incidence of hypotonia and lower median Apgar scores than control infants (p < 0.001). However, there was no association between adverse outcomes and maternal serum magnesium concentrations at delivery, duration of treatment, or dose of MgSO4. No difference in dose or length of maternal MgSO4 treatment was noted between infants admitted to term nursery and those admitted to NICU. Pneumocardiogram data were similar between MgSO4-exposed and control infants (all p > or = 0.16). There were no significant differences in number of episodes of feeding intolerance or in time to first stool or void between MgSO4-exposed and control infants (all p > or = 0.31).

CONCLUSION

Infants born to mothers treated with MgSO4 were more likely to be hypotonic and have lower Apgar scores at birth. Beyond the immediate postdelivery period, there were no additional complications in this cohort attributable to prenatal MgSO4 exposure. We suggest that pediatricians attend deliveries of magnesium-exposed infants.

The V-Y Palmar flap

We describe a V-Y palmar flap that allows both skin advancement and scar lengthening, and which has proved useful in the treatment of Dupuytren's disease.

Radial artery aneurysm in a case of neurofibromatosis

Vasculopathy as part of the syndrome of neurofibromatosis is well recognised, although rarely identified clinically. A recent report describes a case with rupture of an aneurysm of the superficial femoral artery. We present a case of radial artery aneurysm, a previously unreported complication of neurofibromatosis affecting the upper limb.

Development of a simple enzyme immunoassay for blood haptoglobin concentration in cattle and its application in improving food safety

OBJECTIVE

To verify the role of haptoglobin, a major acute-phase reactant protein in cattle, as a marker to identify health/disease status in cattle and further assess its potential in improving food safety.

SAMPLE POPULATION

Serum samples from various cattle groups: clinically normal cattle comprising steers (n = 157) and culled dairy cows (n = 92) before death (antemortem [AM]); retained carcasses (n = 57) railed off the line during postmortem (PM) inspection; and apparently AM normal culled dairy cows (n = 57).

PROCEDURE

Efficacy of the simplified monoclonal antibody-based enzyme immunoassay was established by comparing results of haptoglobin tests performed independently on aliquots of serum samples by 3 laboratories.

RESULTS

Haptoglobin concentration was significantly (P< or = 0.0001) different between the PM retained carcass group (n = 57) and the AM steer (n = 157) and culled dairy cow (n = 92) groups. In addition, haptoglobin concentration in AM steers (n = 157) and culled dairy cows (n = 92) was significantly (P < or = 0.0012) different, possibly reflecting a higher percentage of underlying pathologic or inflammatory conditions in animals of the latter group. Evaluation in 3 laboratories of sera from a group of culled dairy cows (n = 57), each laboratory performing a different test procedure, indicated that correlation of haptoglobin concentrations was good between the reported test procedure and the unmodified test and the classical hemoglobin-binding assay that measures peroxidase activity.

CONCLUSION

Haptoglobin determination is effective in identifying diseased and healthy cattle. It may be a potentially important tool for application at the farm and slaughterhouse as an aid in improving food safety.

A new twist to the myocutaneous turnover flap for closure of a spinal defect

We have described the deepithelialized myocutaneous turnover of a gluteus maximus island flap based on the superior gluteal vessels used for closure of an acquired midline defect of the lower back complicated by cerebrospinal fluid fistula. Cerebrospinal fluid fistula, although a rare complication of an acquired midline back defect, further adds to the reconstructive challenge of such a wound. As this case illustrates, cerebrospinal fluid fistula can have serious and potentially life-threatening implications and so demands rapid surgical intervention. Dural patching with fascia lata graft having already failed, reconstruction was achieved using a well vascularized deepithelialized cutaneous patch on a gluteus maximus island turnover flap. The technique of deepithelializing a skin island for dural repair could be applied to any myocutaneous flap used in reconstruction of a midline back defect complicated by cerebrospinal fluid leak. This provides a method of dural repair and reconstruction of the defect in one step and obviates the need for cerebrospinal fluid diversion.

An anomalous muscle in the hand

An anomalous muscle crossing the wrist joint is described. The morphology and clinical relevance of this and other unnamed muscles occurring at the wrist are discussed.

The use of the second dorsal metacarpal artery for vascularized bone graft. An anatomical study

We present the results of fresh cadaver hand dissections and dye injection studies to help in raising a vascularized bone graft from the index or middle metacarpals based on the second dorsal metacarpal artery. This vascularized bone graft could be used for treating nonunion of the scaphoid and other carpal bones.

A regional audit of hand and wrist injuries. A study of 4873 injuries

This study reports the characteristics, causes and disposal of isolated injuries to the hand and wrist presenting to six accident and emergency departments over a period of 4 months. The rate of isolated injury to the hand or wrist was 6.6%. The male: female ratio was 2.2: 1, with the mean age for injury being 26.4 years in men and 29.2 years in women. The modal age group for injury was 21-25 years in men and 11-15 years in women. The right and left hand were injured almost equally. The dominant hand was more commonly injured although this was influenced by the cause of injury: 16.3% were caused by a fall; 15% by sport; and 7% were work/machinery related. 13.3% were referred to specialities for further treatment.

Early active mobilization after second stage flexor tendon grafts

We assessed the results of nine two-stage tendon reconstructions. The tendon graft was the ipsilateral palmaris longus tendon inserted into a tunnel which had been previously created by a silicone spacer. Early active mobilization was commenced 48 hours after surgery according to a previously described protocol (Small et al, 1989). Using the grading system of Kleinert and Verdan (1983) the results were: one excellent, two good, five fair and one poor. Using the Buck-Gramcko et al (1976) grading system there were three excellent, two good, two satisfactory and two poor results. There were no cases of tendon graft rupture or dehiscence of the junction between tendon and graft.

Florid reactive periostitis of the thumb

A case of florid reactive periostitis of the thumb is presented. This is a rare pseudosarcomatous lesion which generally has a benign radiographic appearance, but on histology it may be mistaken for a malignant process. The clinical behaviour may simulate a malignant tumour but after local excision there is very little propensity for recurrence. Local resection is the recommended treatment. Surgeons and pathologists should consider the possibility of florid reactive periostitis before making a diagnosis of sarcoma in the hand.

Prevalence of sand fly fever, West Nile, Crimean-Congo hemorrhagic fever, and leptospirosis antibodies in Pakistani military personnel

To determine the prevalence of antibodies to viral diseases known or suspected to be present in Pakistan, we studied 570 sera from three groups of adults; two of the groups were involved in outbreaks of hepatitis, and the third included men admitted to a hospital for evaluation of febrile illnesses. Immunoglobulin G antileptospiral antibody was found in 1 to 6% of the subjects, with the highest rate in enlisted military personnel hospitalized for febrile illness. One man in the group with febrile illness had significantly elevated immunoglobulin M antileptospiral antibody titers. However, in a group of recruits experiencing suspected non-A, non-B hepatitis, 19 (11%) of 173 had a 4-fold rise in immunoglobulin M antibody to leptospirosis. Antibody to sand fly fever viruses was found in 27 to 70%. Antibody to West Nile virus was present in 33 to 41% of subjects. Antibody reactive with Japanese encephalitis virus was present in 25%, but plaque reduction neutralization tests suggested this to be cross-reaction with West Nile virus. All 212 specimens tested for antibody to Crimean-Congo hemorrhagic fever and Hantaan viruses were negative. This study indicates that diseases known to be prevalent in other areas of southwest Asia and the Middle East are also prevalent in northern Pakistan and may impact on those traveling or working in this area.

Liposomes preparation methods

In this article information about various methods of liposome preparation (including the large scale manufacture) has been reviewed. The advantages and disadvantages of the methods have been described in terms of size distribution and encapsulation efficiency.

Complications associated with suction drains after microvascular anastomeses

Two head and neck cases in which free flaps were used for reconstruction are presented. The circulation of the flaps was compromised due to problems directly associated with suction drains. The methods of drain fixation are discussed.

Review article : stability and uses of liposomes

The present article reviews information about the stability and uses of liposomes.

Stability of phosphoinosit1des containing liposomes: effects of triton x-100, temperature and 68 rpm

The stability of phosphoinositide containing liposomes was investigated. It was found that 2% of triton X-100 completely released entrapped carboxyfluorescein. The release of carboxyfluorescein occurred the most of 58 degrees C (78% at 2 hours) and the least at 4 degrees C (5.4% at 118 hours). When stored at 68 RPM (at 25 degrees C) about the 20% carboxyfluorescein was released at 48 hours, but when the liposomes were kept at 25 degrees C for the same period of time, the release was about 10%.

Stability of aminophylline

The stability of aminophyline was studied in the presence of four tablet excipients (callu1ose starh, glucose and lactose) and nine intravenous fluids (water for injection, dextrose. 10% normal saline, dextrose normal saline 5%, Ringer lactate, Ringer, aminoplasmal 5%, lipofundin 10%, total parenteral nutrition solution TPNS). Ten percent mixtures of the powder drug with the excipients were kept at 5 degrees C, room temperature (27+/-3 degrees C), 45 degrees C and in direct sunlight for 30 days. The degradation of the drug increases with increase in temperature and on exposure to sunlight. The degradation is particularly intense in the presence of glucose and lactose and change in colour from white to yellow occurs in such mixtures. At 45 degrees C and in sunlight both pure drug and its mixtures change colour during the storage period. In intravenous fluids, the drug (1 g/L) is stable and physically compatible for 2 days at 5 degrees C, 27+/-3 degrees C and 45 degrees C except in lipofundin 10% and TPNS where the drug is stable for only 12 hours at 45 degrees C. Yellow tinge appears in the admixtures containing dextrose after 2 days at room temperature and at 45 degrees C.

Simple, efficient and simultaneous determination of anabolic steroids in human urine

A high performance liquid chromatographic method for the determination of free anabolic drug "sustanon 250" (Organon) is developed. Four testosterone esters, propionate, phenylpropionate, isocaproate and decanoate were detected simultaneously and quantitatively in only 15 minutes. The percentage extraction in dichloromethane of the four testosterone esters from doped urine was 88, 87, 89 and 94% respectively. The separation recorded at 254 nm using analytical column ODS-C18 and methanol as an eluent, showed no interference of naturally occurring steroids. This method can be used for pharmacokinetic studies, routine analysis in pharmaceutical industry, routine therapeutic surveillance and in drug abuse by sportsmen.

New refractive method for laser thermal keratoplasty with the Co:MgF2 laser

We have observed corneal curvature changes from laser thermal keratoplasty with a Co:MgF2 laser. We studied corneal curvature changes in rabbits and have identified specific treatment patterns and laser parameters that can correct myopia and astigmatism. These corneal changes, some as large as 8 diopters, have been stable for at least one year, and slitlamp examination demonstrates clear central corneas with normal appearance.

Separation of liposome populations differing in phosphoinositide content by chromatography on immobilized neomycin

A method is presented by which liposomal populations can be separated based on their content of phosphatidylinositol 4,5-bisphosphate (PIP2). Neomycin is reductively coupled to sepharose 2B and used as the stationary phase in column chromatography. Liposomes of egg lecithin (EL) plus acidic phospholipid containing as little as 10 mol% PIP2 are quantitatively retained in 0.2 M NaCl, while liposomes containing other anionic lipids are recovered to 70-97%. It is possible that lipid redistribution of the bilayers upon contact with the sepharose:neomycin adduct may result in the formatin of multiple populations, and the percent retention by the column for each of the EL:phosphoinositide liposomes would be determined by the new equilibrium established as a result of these interactions. When mixed liposomal populations were chromatographed, the recovery in the 0.2 M NaCl eluates was the sum of the individual recoveries, and there is no significant interchange of lipids between the two liposome populations. It is suggested that this procedure may be useful in the preparation of asymmetric liposomes by facilitating separation of populations devoid of PIP2 in the outer leaflet from unreacted liposomes after enzymatic treatment of symmetric PIP2-containing liposomes.

Complexation of tetracyclines with metal ions in relation to photosensitization

It has been shown by spectroscopy and by a Photosensitive Index method, involving measurements of interfacial tension, that Cu2+ and Ni2+ form 2:1 complexes with oxytetracycline and 1:1 complexes with demethylchlortetracycline. Fe2+, Zn2+, Mg2+ and Ca2+ form weaker 1:1 complexes with both drugs. The possibility is discussed of using metal ions to reduce photosensitization by tetracyclines in-vivo.

Effects of ultraviolet light on lecithin monolayers in the presence of fluorescein dyes and tetracycline drugs

A Langmuir trough was employed to measure the effects of u.v. irradiation on the force area characteristics of monolayer films of lecithin spread on aqueous solutions of some dyes and tetracycline drugs both in the absence and presence of Ca2+ and Ni2+. Irradiation caused photochemical reactions which resulted in the expansion of the films and the extent of reaction was measured by the Photosensitive Indices. The reaction with tetracyclines was inhibited by adding Cu2+ or Ni2+ to the substrate. The kinetic orders of the reactions are given.

Photosensitization by fluorescein dyes and tetracycline drugs at an oil/water interface

Measurements were made of the changes that occur in the interfacial tension of isopropylbenzene when floating on water containing between 10(-5) and 10(-3) M of various fluorescein dyes and tetracycline drugs and irradiated for up to 240 min with ultraviolet light. Singlet oxygen was found to be an active intermediate in the reactions. The results are discussed in relation to adverse photosensitization in-vivo due to fluorescein dyes and tetracycline drugs.

Primary meningococcal pericarditis

We have described two patients with primary meningococcal pericarditis. The first patient required open surgical drainage. In the second patient, pericardiectomy was eventually required. Thirteen cases of primary meningococcal pericarditis have now been reported. All the patients survived, in contrast to purulent pericarditis of other causes.