Dual-isotope myocardial imaging: feasibility, advantages and limitations. Preliminary report on 231 consecutive patients

Two hundred and thirty-one patients underwent dual-isotope myocardial imaging (rest thallium-201 followed by stress technetium-99m sestamibi). The feasibility of the procedure was excellent: camera scheduling flexibility was improved and the duration of the procedure was less than that of a classical stress-redistribution procedure. Interpretation of defects due to image attenuation was facilitated by the different attenuation properties of 201Tl and 99mTc-sestamibi in 11 of 19 patients. 201Tl cross-over on 99mTc was found to be 15% +/- 3% with doses of 201Tl and 99mTc-sestamibi of 3 and 10 mCi, respectively, and 7% +/- 2% with doses of 3 and 20 mCi. This protocol should preferentially be reserved for patients with a history of myocardial infarction and/or a basal left ventricular dysfunction, in whom assessment of myocardial viability is of major interest. Extensive clinical validation of the dual-isotope procedure is required and optimal acquisition and reconstruction parameters should be established.

The inframammary midline triangle in reduction mammaplasty: the renewal of an old idea

The junction between the inframammary and vertical suture lines after reduction mammaplasty is a weak point well known to plastic surgeons. This junction is prone to either necrosis or disruption, or both, in some cases. A small triangle of skin left in that location may prevent this problem. This is done routinely in all the cases of McKissock reduction mammaplasty, but it could be employed in any other techniques as well. The cosmetic appearance is good. The method, which is not new and has been used in the past, has been found very helpful and is described here along with its advantages.

Very deep burns of the hand due to low voltage electrical laboratory equipment: a potential hazard for scientists

A low voltage (24 V) electrical deep burn of the hand injured a professor of applied physics when performing an experiment in his laboratory. The potential hazard of the equipment is described, the injuries are reported and the literature is reviewed.

Case study: full thickness chemical burn of the abdomen and chest

An 81 year old patient, suffering from Alzheimer's disease sustained a full thickness HCI Acid burn of her abdomen and chest wall due to leakage of gastric content from her gastrostomy feeding tube. The controversial management of such a patient is discussed and early surgical treatment is recommended.

The use of sandpaper in chemical peeling combined with dermabrasion of the face

The combined use of chemical peel and dermabrasion of the face was widely accepted since the first reports of DuPont and Horton. We present a refinement of this combined method by introducing the use of a simple diathermy head cleaner (Surgikos, Inc) as a safer method of face abrasion. This disposable device, available at every surgical theater allows a better control of the abrasive tool, permits a more accurate depth of the abrasion, and reduces the incidence of unexpected complications in this combined technique.

Chemical burn due to contact with soda lime on the playground: a potential hazard for football players

Two football players were treated for chemical burns of their genitalia and medial thighs caused by contact with soda lime used to line a playground. The cases are reported and the unusual mechanism causing the injury is described.

A rare case of arhinia with severe airway obstruction: case report and review of the literature

A rare case of a newborn suffering from arhinia with complete airway obstruction is reported. The complexity of the life-threatening airway obstruction is described and adequate treatment is reported. The relevant literature is reviewed, and the different approaches to treatment are discussed.

Nasal tampon packing in rhinoplasty: a simple and safe method of hemostasis

To absorb bleeding and pack the nasal cavities after rhinoplasty, a sterile commercial vaginal tampon was used. It has the following advantages: high absorbency, round configuration, and safety removal cord included to preclude gliding into the nasopharynx.

Phosphorous pentachloride chemical burn--a slowly healing injury

A 51-year-old chemical engineer sustained phosphorous pentachloride partial skin thickness burns over 20 per cent of his body surface area. Although macroscopically and microscopically the wound seemed to be superficial, the course of clinical healing of this injury was very slow and painful. Retrospectively this burn should have been treated by early excision and grafting.

Comparison of N-acetylcysteine and mesna as uroprotectors with ifosfamide combination chemotherapy in refractory germ cell tumors

From January 1983 through August 1988, 318 consecutive patients with refractory germ cell neoplasms were treated with ifosfamide-containing combination chemotherapy. The patients received ifosfamide at 1.2 gm/m2/day with cis-platin 20 mg/m2/day for 5 days and etoposide 75 mg/m2/day for 5 days or vinblastine 0.11 mg/kg on days 1 and 2 for each cycle. Of 277 evaluable patients, NAC was used as an uroprotector in the initial 86 patients while the latter 191 consecutive patients received mesna to reduce urothelial toxicity. Dosages of NAC was 2.0 gm po q 6 hr and for mesna 120 mg/m2 IV push prior to ifosfamide and then 1200 mg/m2/day as continuous infusion of 5 consecutive days. All patients received 3.0 liters of normal saline per day. The number of courses of chemotherapy given in the two groups were similar. Twenty-four of the 86 patients (27.9%) receiving NAC developed hematuria (13 patients - grade 1, 4 patients - grade 2, and 7 patients - grade 3 toxicity). While 8 out of 191 (4.2%) mesna patients developed hematuria (6 - grade 1 and 2 - grade 3) (p < 0.0001). The incidence of severity of renal toxicity was similar in the two groups. Ifosfamide dosage was reduced solely for urothelial toxicity in 11 patients receiving NAC compared with none of the patients receiving mesna (p < 0.0001). Chemotherapy response was similar in the two groups. In conclusion, mesna provides better urothelial protection from ifosfamide-induced toxicity than NAC and allows better maintenance of the drug dosage.

Late onset of extensive brain damage and hypertension in a patient with high-voltage electrical burns

An 11-year-old boy sustained high-voltage electrical and flame burns over 85% of his body surface area, 75% of which were full-thickness burns. After 4 months of treatment and multiple operations and skin graftings before his discharge from hospital, he exhibited irritability, hallucinations, and eventually, seizures and respiratory and cardiac arrest. He was resuscitated successfully. Diffuse bilateral brain damage was observed by means of computerized tomography and magnetic resonance imaging. Acute hypertension (up to 290/220 mm Hg) developed the following day. Recovery began 48 hours later. Most clinical symptoms and the hypertension resolved within 1 week. However, the computerized tomographic scans and magnetic resonance imaging findings persisted but were resolved within 2 months. Irritability and low tolerance for frustration were the only remaining symptoms at the time of a 12-month follow-up examination.

[A decade of experience in craniofacial surgery]

Our craniofacial surgery team includes experts from the following fields: plastic surgery, neurosurgery, ophthalmology, genetics, neurology, orthodontics, pedodontics, facial rehabilitation, psychiatry, social work, anesthesiology and intensive care. Craniofacial surgery became to a large extent pediatric surgery, following evidence that careful, early surgery does not impair growth and that development following surgery is almost normal. The malformations that were repaired included those of the Crouzon and Apert syndromes, requiring frontal remodelling and advancement of the middle third of the facial skeleton; hypertelorism in which orbits were moved to the midline; large craniofacial clefts in which the hemiface from either side was moved to the midline; and different types of craniostenosis in which frontal advancement and remodelling with reconstruction of the vault was performed. The series consisted of 78 patients who presented between 1979-1989. 3 illustrative cases are described.

Congenital double lip: report of five cases and a review of the literature

Congenital double lip is a rare entity. During the last 10 years, we performed surgery on 5 patients with this deformity. The patients are reported with a special mention of the embryology, and the relevant literature is reviewed.

Giant melanoma of the inner thigh: a homeopathic life-threatening negligence

The strange case of a 37-year-old modern, Western woman who presented with a giant black mass on her inner right thigh is presented. She was treated 10 months before this present admission by an excision of a nodular melanoma, and she was treated, thereafter, by a homeopathic practitioner until she came late to follow-up. The woman is discussed with special attention to the fact that alternative medicine does not always constitute good advice, and the relevant literature is reviewed.

Reconstruction of a completely burned nose by a free dorsalis pedis flap

A 25-year-old female with a scarred and contracted nose following burns, because the upper limbs could not be used as donor areas, had a free dorsalis pedis flap used to reconstruct the nose 18 months post-burn. The case is reported and the literature reviewed.

Silver sulphadiazine-induced haemolytic anaemia in a glucose-6-phosphate dehydrogenase-deficient burn patient

A 20-year-old soldier sustained 35 per cent body surface area burns by open flames. He was treated with topical application of 1 per cent silver sulphadiazine (SSD) twice daily. Four days postburn he developed acute haemolytic anaemia. Withdrawal of SSD was followed by complete recovery. A glucose-6-phosphate dehydrogenase (G6PD) deficiency was proven by pathological Motulski tests. Although the hazards of SSD are well indicated by the manufacturers, there appear to be no written reports of haemolysis induced by this drug in G6PD-deficient patients.