A manoeuvre to cover exposed metal using a de-epithelialised "turn-over" fasciocutaneous flap

This paper describes a technical manoeuvre to accommodate an exposed metal implant used in the treatment of a fracture of the tibia within a "turn-over" de-epithelialised fasciocutaneous flap. The need for such a procedure in this particular case is commented upon. A discussion is also included on the nature of the blood supply to the integument based on available information.

Postprandial lipemia. A key for the conversion of high density lipoprotein2 into high density lipoprotein3 by hepatic lipase

In this study, we have investigated the effects of alimentary lipemia in 15 normotriglyceridemic individuals on high density lipoproteins2 (HDL2) with respect to structure, composition, and substrate efficacy for hepatic lipase in vitro. In the study subjects, HDL2 levels ranged widely from 4.7 to 151.7 mg/dl plasma. HDL2 were isolated in the postabsorptive (pa) state and in the postprandial (pp) state, i.e., 7 h after ingestion of a standard fatty meal. In going from the pa state to the pp state, HDL2 exhibited higher flotation rates and lower densities due to a decreased proportion of protein (38.7----36.2%) and a higher abundance in phospholipid (32.5----34.9%). There was a variable increase in triglyceride at the expense of cholesteryl esters; this increase was correlated positively with the magnitude of pp lipemia (r = 0.69, P less than 0.01) and inversely with HDL2 levels (r = -0.72, P less than 0.01). Hdl2 fractions were incubated with human hepatic lipase in vitro. Product lipoproteins formed from lipolysis of pa-HDL2 and triglyceride-poorer pp-HDL2 were reduced in phospholipid content (by 25 and 50%, respectively) but remained in the size and density range of native HDL2. By contrast, a major fraction of triglyceride-richer pp-HDL2 was converted to particles with density, size, and apoprotein composition of native HDL3. Changes consistent with these findings in vitro were observed in vivo also, where 15 h postprandially, individuals with high-level lipemia showed a decrease in HDL2 and rise in HDL3, while those with lower-level lipemia did not. This study indicates that the magnitude of postprandial lipemia determines the proportion of triglyceride in pp-HDL2, which in turn determines whether or not HDL2 are converted to HDL3 by hepatic lipase action.

Symptomatic radiation-induced pericarditis in Hodgkin's disease

This is a retrospective review of 193 evaluable patients treated with radiation therapy to the mediastinum for Stages I, II and III-A Hodgkin's disease. Eligible patients were those receiving 3000 rad or more to the mediastinum and no chemotherapy prior to the radiation. During the study period, 13 patients developed symptomatic pericarditis. The interval post treatment to the development of symptoms was six to 34 months. The incidence of pericarditis was studied as a function of: (1) the dose of radiation at a depth of 2 cm, 5 cm and the midplane of the mediastinum; (2) the ratio of anterior to posterior weighting of dose; (3) the presence or absence of intrathoracic tumor; (4) the size of the tumor when present; and (5) the fraction of the heart exposed to the radiation beam. There was a significant increase in the incidence of pericarditis with an increased dose of radiation at 2 cm, 5 cm and midplane depths and also with the presence of a large intrathoracic tumor. A reduction in mediastinal dose is recommended.

Radical muscle mobilisation in the surgical repair of a unilateral cleft lip: a follow up report

This is a follow-up report on an earlier paper (Thatte, 1981) in which the idea of radical mobilisation of the orbicularis oris muscle in the treatment of unilateral cleft lip was presented. This paper includes eight late post-operative photographs of cases with unilateral cleft lip treated by radical mobilisation of muscle and suture without any recourse to incisions in the philtral area to gain height on the non-cleft side. Legends for the post-operative photographs describe our assessment of the results. Observations made while operating on these cases are noted. A discussion is included to view the manoeuvre of mobilisation of muscle against the background of existing methods of treatment of unilateral cleft lip. A postscript is added.

The culture of chick embryo mesoderm cells in hydrated collagen gels

Chick embryo mesoderm cells are various stages of differentiation were cultured in three-dimensional matrices of hydrated collagen. The tissues used were: stage 5 mesoderm from regions adjacent to the primitive streak; stage 12 mesoderm, comprising somitic, unsegmented (segmental plate) and lateral plate mesoderm; and stage 18 sclerotome. Explants were examined by phase contrast microscopy, including time-lapse, and scanning and transmission electron microscopy. The cells showed an increased ability to adhere to, and move in, the collagen gel with advancing stage. Of the stage 12 tissues, the unsegmented mesoderm was initially the slowest to grow out of the explant. Sclerotome cells showed by far the greatest ability to move within the gel. Where the collagen fibrils were randomly oriented, the cell morphology was polypodial and advancing lamellipodia showed clear undulations at their leading edges. A distinction was drawn between these undulations and the classical major ruffles which are seen in two-dimensional culture to uplift and pass back along the cell surface. The latter were not seen in the collagen matrix and were presumably suppressed by the three-dimensional culture configuration while the leading edge undulations were not. Ultrastructural examination showed that the cells possessed patches of amorphous material on their surface, which was sometimes interposed between the plasma membrane and collagen fibrils. Addition of hyaluronic acid (2 mg/ml) had an effect only the segmented mesoderm, where outgrowth was enhanced. Although the addition of plasma fibronectin (50 micrograms/ml) to the cultures did not affect any of the tissues, the removal of this substance, by antifibronectin antiserum or by the use of fibronectin depleted serum, inhibited outgrowth in most cases. The only tissue not reproducibly inhibited in this way was sclerotome. Alignment of the collagen fibres by the explants was observed, accompanied by an elongation of the outgrowing cells which, in bipolar form, preferentially moved up and down the aligned tracts. Scanning electron microscopy suggested that cell processes attached to, and presumably exerted tension on, bundles of fibrils thereby pulling them into line. Cell-to-cell contact was not accompanied by contact paralysis as judged by time-lapse micrography.

Action of acetylcholine on the atropinised heart of the frog during summer months

During summer months high doses of acetylcholine produced positive inotropic and chronotropic actions in 19 out of 22 preparations of atropinised perfused heart of the frog. Hexamethonium failed to block both the positive inotropic and chronotropic actions of Ach. Interestingly another ganglion blocking agent mecamylamine as well as beta adrenergic blocking agent propranolol blocked the positive inotropic action but not the positive chronotropic action.

The use of de-epithelialised "turn over" flaps in the hand

Two examples are presented of the application of the principles of de-epithelialised "turn over" flaps in the hand. These flaps were used to resurface a post-infective volar skin defect on a finger and to correct an adduction contracture in the first web space of the hand. The reasons for their use and their advantages are briefly discussed.

A survey of leprosy deformities in a closed community

Out of 1011 leprosy patients, 200 (20%) cases with permanent deformities were found in the Leprosy Control Unit, Raxaul (East Champaran), Bihar. The statistical data of selected patients and the types of various deformities are presented. The prevalence rate and incidence pattern of deformities reported by other workers are compared.

Effect of bladder distension on dosimetry in gynecological implants

In order to quantitate the impact of bladder distension on implant position and on radiation dosage to various parts of the bladder, 24 patients with gynecological neoplasms underwent computed tomographic scanning of the pelvis following insertion of afterloading intracavitary applicators. Shifting of the applicators due to bladder distension was measured at and two inches above the level of the vaginal ovoids. By maintaining a residual vesical volume of 200-300 ml with contrast material, radiation exposure to a large part of the bladder was reduced significantly while only a minor displacement of the implant system was noted.

Observation of cultured embryonic epithelial cells in side view

Epithelial cells from the early chick embryo were explanted and grown on a strip of coverglass which was positioned in a culture chamber in such a way that the cells could be filmed in side view. Ruffling of the cells at the leading edge of the sheet (marginal cells) appeared similar to the ruffles at the leading lamella of fibroblasts. The ruffles of the sub-marginal cells showed different characteristics, being longer and not propagated successively as were the marginal ruffles. Superimposition of cells was always the result of the active movement of a non-yolky cytoplasmic process underneath a yolky process (i.e. underlapping). The non-yolky processes appeared to be strongly adherent to the substrate in comparison with the yolky processes, which were easily displaced. Active movement of cells or lamellae on the dorsal surface of the sheet was never observed. Preliminary ultrastructural evidence is presented which suggests that the strongly adherent non-yolky processes possess well-defined microfilament tracts associated with the ventral plasma membrane, while the poorly adherent processes do not possess such tracts.

Effect of a conditioning method on general safety test in guinea pigs

Prior to utilization for safety tests, one group of guinea pigs was selected after a 1-week conditioning period, on the basis of physical appearance and a 5% body weight gain. Those in a second group were selected shortly after being received, on the basis of their physical appearance. All guinea pigs were maintained under identical management conditions during the safety tests. The number of guinea pigs that gained weight from both groups were compared. The conditioning method used resulted in significant (p less than 0.001) increase in the number of guinea pigs that maintained or increased body weight during general safety tests.