Hand and microvascular surgery. Evolution to present practice

Over the past 25 years, hand and microvascular surgery have emerged and flourished as a super specialty plastic surgery. Successful replantation of a completely amputated extremity on position is now not enough without adequate functional outcome. Free tissue transfer has evolved into a reliable reconstructive option in the treatment of complicated wounds.

The split calvarial graft donor site in the elderly: a study in cadavers

In 37 cadavers of average age 75.5 years, the calvarium was studied. In all, the diploe and outer and inner tables were found to be definite layers. Although the parietal bone thickness did decrease with age in this study, there was no correlation between age and the outer table or diploe thickness. No significant change with age occurred in the occipital bone. Although this study supports the use of split calvarial grafts in older patients without the necessity for a craniotomy, the relative brittleness of this bone in this population should be considered.

Absence of alpha 2(1) procollagen synthesis in a clone of SV40-transformed WI-38 human fibroblasts

Normal diploid human embryonic lung fibroblasts (WI-38) produce type I collagen of chain composition [alpha 1(1)]2.alpha 2(1) together with small amounts of type III collagen. We have examined the synthesis and secretion of type I collagen in a clone of SV40-transformed WI-38 fibroblasts (SVWI-38). These cells produced only 20-25% of the total collagen synthesized by their normal counterparts, with no detectable synthesis of alpha 2(1) chains and deposited a type I trimer consisting of overmodified alpha 1(1) chains. Two-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis of cyanogen bromide peptides of collagens isolated from cells cultured either in the presence or absence of alpha,alpha-dipyridyl revealed that this overmodification occurred along the entire length of the alpha 1(1) chains. Analysis of poly(A+) RNA by Northern blot analysis and total RNA by slot blot analysis using cloned type I procollagen cDNA probes revealed that no alpha 2(1) mRNA was present in the SVWI-38 cells. Primer extension of the RNA confirmed this finding. The SVWI-38 cells had a normal chromosome number, but contained 28 normal and 18 abnormal and marker chromosomes. Restriction mapping of the entire alpha 2(1) procollagen gene did not reveal any gross deletions or insertions within this gene, nor was the gene hypermethylated in the transformed cells, when compared with their normal counterparts. One interesting feature, however, was the fact that certain CpG dinucleotides in the alpha 2(1) gene were methylated in the normal as well as the transformed cells. These SV40-transformed WI-38 fibroblasts therefore do not produce any alpha 2(1) collagen chains due to transcriptional inactivation of their genes.

DRG-driven change in burn wound management: a success story

We have devised an algorithm employing the exclusive use of biosynthetic dressing (Biobrane) to treat the less extensive burn wounds of patients under DRG 460. This protocol has allowed us to decrease the hospital stay of these patients by 46 percent and turn this patient group from a deficit for the hospital to a substantial profit.

The burned hemophiliac

Reports of the care of burned hemophiliac patients requiring cutaneous autografting are rare. A 28-year-old white male with classic hemophilia A sustained a 30.5% total body surface area burn. The patient received standard topical antimicrobial therapy and the majority of his burn wound healed. While undergoing therapy, multiple tooth extractions were recommended. On postburn day 25 the patient underwent multiple tooth extractions plus excision and grafting of his unhealed burn after preoperative infusion of cryoprecipitate. Despite a maximum factor VIII concentration of only 23%, no remarkable bleeding occurred from the excision sites, the skin graft donor site, or the tooth extraction wounds. Preoperative infusion of cryoprecipitate does not appear to be required for split-thickness skin graft harvest or excision of burns within the dermis.

Chemical burns

In chemical skin injuries, reduction of the time of exposure to the causative agent and recognition of systemic toxicity are necessary to lessen the severity of the insult, reduce morbidity, and maximize survival. During a 17-year period (1969 through 1985), 87 (2.1%) of the 4,212 burned patients admitted to the U.S. Army Institute of Surgical Research sustained chemical burns. Twelve of 87 patients died (13.8%). White phosphorous, the most common causative agent, produced cutaneous injury in 49 patients. Acids (13 patients), alkalies (ten patients), and organic solvents (five patients) were the other common causes of injury. Initial treatment consisted of water lavage. Later wound management was carried out with topical antibiotic therapy and excision and grafting as necessary. Systemic toxicity due to phenol, nitrate, and formate absorption occurred, as did acute tubular necrosis following copper sulfate treatment of white phosphorus burns. Inhalation injury occurred in five patients. A decrease in hospital stay for chemically injured patients was observed. To minimize chemical injury, clothing should be removed promptly and water lavage begun. Systemic toxicity and inhalation injury are rare but often severe and increase mortality.

Heterotopic bone formation in burned patients

Heterotopic bone formation about joints and in soft tissues is known to cause joint immobilization and permanent physical impairment in burned patients. Despite aggressive physical therapy aimed at prevention, heterotopic bone formation still occurs in a small percentage of patients. Prolonged immobilization in concert with trauma or burn about the involved joint is recognized as being responsible for this heterotopic bone formation. Specifically, immobilization of extremities, particularly the elbow and upper extremity, should be minimized by early grafting for preservation of function. As burn therapy has enabled increasing numbers of patients to survive extensive burns, it is imperative that preservation of function not be ignored and that attention be directed at improved function early in the postburn course.

Regional differentiation in the stomach of the green anole

The stomach of Anolis carolinensis (Reptilia: Iguanidae) has four histologically and histochemically distinct regions. The gastroesophageal junction has an acidic surface mucin and no glands. The cardia has an acidic surface mucin and mucous glands. This acidic mucin appears to contain neither sulfates nor sialic acid. The fundus has a neutral surface mucin and mucoserous glands. The pylorus has a neutral surface mucin and mucous glands.

Palladium toning of silver-impregnated reticular fibers

Palladium toning is much less expensive than gold toning. Ten minutes in 0.05% potassium hexachloropalladate in 4 N hydrochloric acid tones silver-impregnated reticular fibers as well as 3 min in 0.2% aqueous gold chloride does. Differences in toning of the background depend on the silver stain.

Expression of rat mRNA coding for hormone-stimulated adenylate cyclase in Xenopus oocytes

Beta-Adrenergic agonist-stimulated hyperpolarization, whole-cell cAMP accumulation, and activity of isoproterenol-stimulated membrane-bound adenylate cyclase (EC 4.6.1.1) in Xenopus laevis ovarian oocytes are entirely dependent on the presence of nascent follicle cells. A method was developed to remove rapidly and completely all extra-oocyte cell types to yield defolliculated oocytes that exhibited normal viability and resting membrane potentials yet lacked beta-adrenergic receptor (beta AR)-stimulated responses. Purified follicle membranes contained beta AR-stimulated adenylate cyclase activity, whereas oocyte cell membranes did not. Purified oocyte membrane preparations from X. laevis oocytes previously microinjected with C6-2B rat astrocytoma mRNA, and subsequently defolliculated, exhibited novel beta AR and forskolin-stimulated adenylate cyclase activity. These experiments demonstrate that oocytes expressed rat C6-2B mRNA coding for the beta-adrenergic receptor and the components necessary for forskolin-stimulated adenylate cyclase activity.

Regulation of methionine synthesis in Escherichia coli: effect of metJ gene product and S-adenosylmethionine on the in vitro expression of the metB, metL and metJ genes

The regulation of the expression of three Escherichia coli met genes, metB, which codes for cystathionine gamma-synthetase (EC 4.2.99.9), metL, which codes for aspartokinase II-homoserine dehydrogenase II (EC 2.7.2.4-EC 1.1.1.3) and metJ, which codes for the methionine regulon aporepressor, has been studied using highly purified DNA-directed in vitro protein synthesis systems. In a system where the entire gene product is synthesized, the expression of the metB and metL genes is specifically inhibited by MetJ protein (repressor protein) and S-adenosylmethionine (AdoMet). In a simplified system that measures the formation of the first dipeptide of the gene product (fMet-Ala for the metJ gene), MetJ protein and AdoMet partially repress (approximately 40-60%) metJ gene expression. Thus, the metJ gene can be partially autoregulated by its gene product.

Cloning of the methionine regulatory gene, metJ, of Escherichia coli K12 and identification of its product

Both wild-type and mutant forms of the methionine regulatory gene, metJ, of Escherichia coli K12 have been cloned in derivatives of pBR322. In cells carrying plasmids with a functional copy of metJ, the methionine regulon appears to be repressed even under conditions of methionine limitation. Maxicell labeling experiments show that the plasmids code for a small peptide (12 kilodaltons) only when they carry a functional copy of metJ. The lesions in five independently isolated metJ mutants are located in, or slightly upstream from, a coding sequence proposed to be metJ by Saint-Girons, I., Duchange, N., Cohen, G. N., and Zakin, M. M. [1984) J. Biol. Chem. 259, 14282-14285).

Insertion mutagenesis of the metJBLF gene cluster of Escherichia coli K-12: evidence for an metBL operon

The effects of Mu or transposon 5 insertions on the expression of genes of the metJBLF cluster show that metB and metL form an operon, transcribed from metB to metL, and that metF and metJ are independently transcribed.

Evidence that ectoderm influences the differentiation of muscle in the limb of the embryonic chick

Intact limb buds from stage 19 to 21 embryos differentiate to contain both cartilage and muscle in culture. If the limb ectoderm is removed, the limb mesoderm cells differentiate as cartilage and connective tissue but not as muscle. Intact limb buds from stage 19 embryos differentiate both cartilage and muscle when grafted to the chorioallantoic membrane, but differentiate only cartilage and connective tissue if the ectoderm is removed. The significance of limb ectoderm to muscle differentiation can be observed as late as stage 24. Both the prospective cartilage region and the prospective soft tissue region from the limb of a stage 24 embryo differentiate cartilage and muscle in the presence of limb ectoderm, but differentiate little, if any, muscle in the absence of limb ectoderm. The results indicate that the dorsal and ventral ectoderm have some influence on muscle differentiation.

Citrobacter infections in humans: experience at the Seattle Veterans Administration Medical Center and a review of the literature

The genus Citrobacter is a distinct group of human pathogens comprising three species: Citrobacter freundii (biotypes a and b), Citrobacter amalonaticus, and Citrobacter diversus. In this review the clinical and microbiologic experience during 1972-1978 at the Seattle Veterans Administration Medical Center (Seattle, Wash.) with 298 isolates of Citrobacter is analyzed in relation to a survey of the literature. The most common sources of citrobacter isolates were urine, sputum, and soft tissue exudates. Members of this genus can cause neonatal meningitis and, perhaps, gastroenteritis in both children and adults. Although deep tissue infections due to Citrobacter have been reported only occasionally, in this study a large number of cultures of peritoneal fluid and bone contained Citrobacter. Most isolates of Citrobacter were from elderly, debilitated patients and either represented secondary infections or were of indeterminate clinical significance.

Inhibition of growth in young mice treated with pentazocine: reversal by naltrexone

One week old mice were injected subcutaneously once daily with d,1-methadone (5 mg/kg), pentazocine, naltrexone, naloxone, nalorphine or nalbuphine, each at 10 mg/kg. The remaining half of each litter was used as control. Only methadone and pentazocine groups showed reduced weight gain after 3 weeks of treatment (P < 0.01). Injection of pentazocine in dosages of 5-20 mg/kg inhibited weight gain and protein synthesis in a dose-related manner. The incorporation of labeled leucine was followed in brain, liver and muscles. Methadone and pentazocine groups showed a significant decrease in protein synthesis in all tissues studied. The nalbuphine, nalorphine, naloxone, and naltrexone-treated groups incorporated leucine normally, correlating with normal weight gain. These data suggest that pentazocine, unlike the other mixed agonist-antagonists and antagonists, adversely affects the growth of very young animals when administered chronically. A specific opioid effect is suggested by the fact that naltrexone given concomitantly with the pentazocine prevents development of the biochemical lesion.

Calibration of time derivatives of forced vital capacity by explosive decompression

A simple, portable, inexpensive device is described that simulates expiratory flow curves for calibration of spirometers. A 4-L metal cylinder filled with copper mesh is fitted with a precision manometer. The pressure is increased to twice atmospheric and released by explosive decompression through 4 easily interchangeable resistors. The ratio of forced expiratory volume in one second to forced vital capacity ranged from 0.80 to 0.25, thus encompassing the range from normal to severe obstruction. Accuracy was defined by 25 measurements of forced vital capacity that differed by no more than 0.5% from the actual cylinder volume. Repeatability was reflected by a standard deviation of at most 0.04 L/s for one-second forced expiratory volume, mid-expiratory flow, and instantaneous flows at 50 and 25% of the forced vital capacity. Peak flow was less reproducible. Calibrations of a water spirometer at increased altitude and at temperatures from 4 degrees to 37 degrees C revealed no significant changes in volume or flow rates. Standard values have remained unchanged for 2.5 yr. Three volume spirometers and 2 primary flow devices were tested extensively.

A technique for the removal of provisionally placed cast restorations

A technique has been described to quickly and safely remove castings following the initial trial evaluation or provisional cementation.

Inhibition by d,l-methadone of RNA and protein synthesis in neonatal mice: antagonism by naloxone or naltrexone

Neonatal mice were injected once daily with d,l-methadone in a dosage of 2 mg/kg. The remaining half of the litter was injected with saline. After one week the incorporation of labeled uridine and labeled leucine was significantly (P less than 0.05) reduced in skeletal muscle. Longer treatment with methadone impaired RNA and protein synthesis in liver, heart, skeletal muscle and brain. The percentage reduction RNA was log-dose related. When methadone was discontinued for 1 week following 4 weeks of treatment, incorporation of precursors into RNA and protein was found to be normal. A specific opioid effect is suggested by the finding that naltrexone or in part, naloxone, given concomitantly with with the methadone prevents development of the biochemical lesion.

Inhibition of growth in young mice treated with d,1-methadone

Neonatal mice were treated with d,1-methadone, 1-alpha-acetylmethadol (LAAM) or the narcotic antagonists, naloxone, nalorphine or levallorphan. Litter mates were injected with normal saline solution and handled in the same way. Treatment began on the second postpartum day and continued daily or on alternate days for up to 6 weeks. Injection of methadone in dosages of 2 mg/kg to mg/kg inhibited weight gain in a log dose-related fashion. LAAM, 1 mg/kg or 2 mg/kg also retarded weight gain. Mice gained weight normally when naloxone, 10 mg/kg was injected with methadone, 2 mg/kg. Furthermore the daily injection of d-methadone, 4 mg/kg, did not inhibit weight gain nor did any of the narcotic antagonists. There findings indicate that growth inhibition induced by methadone is a stereospecific, opioid effect.

Further characterization of the androgen receptor in rat testis

Immature rat testes contain a specific binding protein for testosterone (T) and 5alpha-dihyrotestosterone (DHT) with physico-chemical properties similar to the cytoplasmic androgen receptors in the epididymis and ventral prostate but different from the testicular androgen-binding protein (ABP). Like the androgen receptors in the prostate and epididymis, it has a sedimentation coefficient of about 7 S at low ionic strength, is eluted in or close to the void volume on Sephadex G-200 gel filtration (Stokes radius greater than 80 A), has an isoelectric point of about 5.6-6.0 (mean) 5.8 and a relative mobility (Rf) of 0.4 in 3.25% acrylamide gels. Following the injection of 3H-labeled testosterone, T and DHT are bound selectively by the receptor. Relatively more [3H]T than [3H]DHT is present in bound and free fractions as well as in total testicular 105,000 g supernatant. Similar results are obtained from testicular incubations with equimolar amounts of [3H]T and [3H]DHT at 0 degrees C in vitro. Saturation of receptor sites is achieved by incubation of testis supernatants with increasing amounts of [3H]T at 0 degrees C. The number of available binding sites following post-hypophysectomy regression is estimated to be about 9 fmoles/mg protein, and the apparent equilibrium constant of dissociation is 7 X 10(-10) M. The temperature stability and sulfhydryl dependence of the testicular androgen receptor are similar to androgen receptors in other organs. Binding is destroyed by heating the supernatants at 50 degrees C for 30 min and by exposure to p-chloromercuriphenylsulfonate (1 mM) at 0 degrees C for 60 min. Furthermore, like other androgen receptors, the half-time of dissociation of testicular androgen-receptor complexes at 0 degrees C is extremely slow (t1/2 greater than 35 h). Separation of seminiferous tubules from interstitial tissue showed that a major portion of these receptors were localized within the seminiferous tubules.

Regulation of seminiferous tubular function by FSH and androgen

Seminiferous tubules contain a cytoplasmic androgen receptor similar to the receptors in the epididymis and ventral prostate. The presence of a cytoplasmic receptor indicates that androgens maintain spermatogenesis by a direct action on certain types of cells within the seminiferous tubule. The Sertoli cell appears to be one of the cell types containing androgen receptors and the receptor might also be present in spermatogonia, primary spermatocytes, or peritubular cells. The Sertoli cell is stimulated by FSH to produce an androgen-binding protein which may serve to increase the accumulation of androgen in the seminiferous epithelium and make it available for binding by intracellular androgen receptors. This may be a way in which FSH enhances the action of androgen on spermatogenesis. Androgens act on the Sertoli cell to increase its response to FSH. This action of androgens on the Sertoli cell results in increased production of androgen-binding protein and may enhance the production of other substances which exert trophic effects on spermatogenesis.

Androgen receptor in nuclei of rat testis

Testis nuclei of hypophysectomized rats selectively accumulate labeled testosterone and 5alpha-dihydrotestosterone following the injection of tritiated testosterone in vivo. Testosterone and 5alpha-dihydrotestosterone are bound to macromolecules in nuclei and can be extracted with 0.5 M KCl. Accumulation of protein bound radioactive androgens in nuclei of isolated seminiferous tubules is similar to that of whole testis. The relative amounts of testosterone and dihydrotestosterone in purified nuclei were similar to the relative amounts bound to cytoplasmic receptors, suggesting that cytoplasmic androgen-receptor complexes may be transported into the nuclei. Binding of labeled androgen is saturable and inhibited by prior injection of unlabeled testosterone or cyproterone acetate. Nuclear binding sites are destroyed by the proteolytic enzyme pronase, but not by DNase. Like the cytoplasmic androgen-receptor complexes in rat testis, nuclear androgen-protein complexes are heat labile and dissociate slowly at 0 degrees C. androgens fail to accumulate in testis nuclei of the Stanley-Gumbreck androgen insensitive rat, a species lacking cytoplasmic androgen receptors in testis and other androgen target tissues.

Interaction of biogenic amines with ethanol

Ethanol through its primary catabolite, acetaldehyde, competitively inhibits oxidation of aldehyde dehydrogenase substrates. As a consequence biogenic amines form increased quantities of alcohols rather than the corresponding acids. During this biotransformation, condensation reactions between deaminated and intact amines may occur which can yield tetrahydropapaverolines. These compounds are closely related to precursors of opioids which is cause to link ethanol abuse to morphine addiction. There is, however, no pharmacological or clinical evidence suggesting similarities between ethanol dependence or opiod addiction. Acetaldehyde plays an additional role in alkaloidal formation in vitro. Biogenic amines may react with acetaldehyde to form isoquinoline or carboline compounds. Some of these substances have significant pharmacological activity. Furthermore, they may enter neural stores and displace the natural neurotransmitter. Thus, they can act as false neurotransmitters. Some investigators believe that chronic ethanol ingestion leads to significant formation of such aberrant compounds which may then upset autonomic nervous system balance. This disturbance may explain the abnormal sympathetic activity seen in withdrawal. While these ideas about the etiology of alcohol abuse have a definite appeal, they are naturally based on in vitro preliminary work. Much study of the quantitative pharmacology of these compounds in animals is required before judgement can be made as to the merits of the proposed hypotheses. In the meantime, pharmacological studies on the ability of ethanol to depress respiration in the mouse has revealed that unlike opioids or barbituates, respiratory depression induced by ethanol requires the presence in brain of serotonin. This neurotransmitter also mediates the respiratory effects of several other alcohols but curiously, not chloral hydrate, yet this compound is purported to alter biogenic amine metabolism much like ethanol. Thus, the response to ethanol can be pharmacologically separated from other major narcotic classes such as opioids and barbiturates by respiratory depression effects. The specific requirement for serotonin mediation exhibited by ethanol and several other alcohols opens the door for a rational therapeutic approach to the treatment of alcohol abuse. At the same time, this finding tends to lessen the probability that alcoholism is in some way connected with the formation of addictive alkaloids.

Growth retardation in young mice treated with d1-methadone

Newborn mice injected daily for 6 weeks with dl-methadone in dosages of 2 to 8 milligrams per kilogram grew significantly more slowly than their saline-treated littermates. Litters given d-methadone, 4 milligrams per kilogram, grew normally. Concomitant treatment with naloxone, 10 milligrams per kilogram, prevented growth inhibition. A weight deficit persisted in mice observed 6 weeks after cessation of methadone treatment.