The anatomy of the subscapular-thoracodorsal arterial system: study of 100 cadaver dissections

The results of 100 cadaver dissections of the subscapular-thoracodorsal arterial system are presented. These results confirm the anatomical reliability of the thoracodorsal artery and report the consistent presence of a branch of the thoracodorsal artery to the serratus anterior muscle. The branches to serratus anterior were of sufficient dimensions to support either a latissimus dorsi flap or a serratus anterior flap. A direct cutaneous branch from the thoracodorsal artery to the skin of the axilla was identified in only 47% of the dissections.

The radial forearm island flap in upper limb reconstruction

The radial forearm island flap may be used for resurfacing areas of skin in the upper limb. It allows a safe one stage reconstruction of skin loss providing thin, pliable and innervated skin cover. We present five cases which demonstrate the versatility of the flap.

Neurophysiological and psychological disorders and occupational exposure to organic solvents

A number of reports, particularly from Scandinavian countries, claim that painters and workers in other trades in which prolonged occupational exposure to organic solvents may occur develop a type of mental illness characterized principally by impairment of memory and co-ordination and some deterioration of personality. The condition, called 'organic solvent disease', is recognized as a cause of premature retirement and is classed as an occupational disease in certain countries. The conclusions of these reports have been contested and the existence of such a disease entity has been questioned. The publications reporting adverse neurological, neurophysiological and psychological disorders in solvent-exposed workers, and the methods used to determine adverse effects, have therefore been evaluated. In addition, data from animal behavioural studies have been examined but were found to have little or no to have little or no relevance to the reported human disease. The human data indicate that, of the solvents studied, only CS2 provided clear evidence of neurotoxic damage detectable by clinical and pathological examination as well as by neurophysiological measurements (e.g. nerve conduction velocity and nerve action potentials) or neuropsychological techniques (e.g. Rorschach inkblot test and WAIS intelligence tests). In the case of several other solvents and mixtures of solvents commonly used in industry, the evidence of CNS impairment, based principally on the response to questionnaires and the results of neuropsychological and neurophysiological examinations was questionable. A critical evaluation of the reliability of these methods in detecting minor deviations from normal and of their ability to provide acceptable evidence of CNS dysfunction or damage leaves little doubt that these methods are of value in investigating personality, intelligence and memory in the clinical examination of individual patients. However, evidence indicates that they are not suitable for use in epidemiological studies, principally because the variability of response in normal individuals is ill-defined and insufficiently investigated. The same conclusion was arrived at in evaluating the contribution of electroencephalography, computerized axial tomography scanning and other electrophysiological examinations to the diagnosis of brain changes in groups of solvent-exposed and unexposed workers. Furthermore, the personality changes identified (by neuropsychological tests) in painters and other workers exposed to solvents could well be produced by ageing, exposure to lead or mercury, excessive alcohol intake, psychoactive drugs or the ordinary stresses of everyday life.(ABSTRACT TRUNCATED AT 400 WORDS)

Experience with the radial forearm flap in 14 cases

In 14 cases aged 9-79 years the radial forearm flap has been used for reconstruction. Of 4 island flaps, 2 were distally based (1 with nerve anastomosis) and 2 proximally based (1 innervated). Of the free flaps, 7 were for intra-oral lining following major resection and 3 of these included hemi-radius for mandibular reconstruction. Most flaps were put into a hostile environment resulting from chronic infection and/or radiotherapy or fast neutron therapy. Two flaps failed including one osseocutaneous free flap. Important anatomical, pre-operative and operative aspects are considered, including a description of the timed Allen test, and potential pitfalls and refinements are described.

Preferred sites for electron transfer between cytochrome c and iron and cobalt complexes

The kinetics of oxidation of eight different singly substituted 4-carboxy-2,6-dinitrophenyl (CDNP) horse ferrocytochromes c, modified at lysine 7, 13, 25, 27, 60, 72, 86, or 87, and of one trinitrophenyl horse ferrocytochrome c, modified at lysine 13, by the 3- and 3+ inorganic complexes hexacyanoferrate(III) (Fe(CN)6(3-) ) and tris(1,10-phenanthroline)cobalt(III) (Co(phen)3(3+) ) have been characterized. The influence of the modified residues on the bimolecular rate constants for these reactions define the protein molecular surface involved. The site of electron exchange for both oxidants appears to be the solvent accessible edge of the heme prosthetic group or a closely related structure on the "front" surface of the molecule. The reaction with Fe(CN)6(3-) is most strongly influenced by modification of lysine 72, a residue to the left of the exposed heme edge. (CDNP lysine 72 cytochrome c yields a 3.6-fold decrease in the bimolecular rate constant, as compared to that for the native protein.) However, it is the region around lysine 27, to the right of the heme edge, that is most influential in the reaction with Co(phen)3(3+). (CDNP-lysine 27 cytochrome c exhibits a 7.3-fold increase in the rate constant, as compared to that for the native protein.) The kinetics of reaction of the CDNP-lysine 13, 60, 72, and 87 modified cytochromes c with Fe(CN)5(4-aminopyridine)2- as oxidant and Fe(CN)5(4-aminopyridine)3- and Fe(CN)5-(imidazole)3- as reductants have also been determined and further illustrate the influence of electrostatics on the kinetics of such protein-small molecule electron exchanges.

Interaction of cytochrome c with the blue copper proteins, plastocyanin and azurin

Bimolecular rate constants have been determined for the reactions of native horse cytochrome c, eight 4-carboxy-2,6-dinitrophenyl (CDNP-) cytochromes c singly modified at lysines 7, 13, 25, 27, 60, 72, 86, or 87 and one 2,3,6-trinitrophenyl cytochrome c singly modified at lysine 13, with the blue copper proteins, plastocyanin (from parsley leaves) and azurin (from Pseudomonas aeruginosa). Plastocyanin, a protein having a negative charge of about -7, yields a bimolecular rate constant with native ferrocytochrome c of 1.5 x 10(6) M-1 S-1, which decreases with the modified cytochromes c to a minimum of 7.5 x 10(5) M-1 S-1 for the CDNP-lysine 13 derivative. Conversely azurin, a protein with an overall negative charge of only about -1 to -2, exhibits bimolecular rate constants with native ferrocytochrome c of 6.6 x 10(3) M-1 S-1 at pH 6.1 and 4.0 x 10(3) M-1 S-1 at pH 8.6, which increase upon modification of the cytochrome c to a maximum of 4.1 x 10(4) M-1 S-1 at pH 6.1 and 2.7 x 10(4) M-1 S-1 at pH 8.6, for the CDNP-cytochrome c modified at lysine 72. This behavior indicates that: 1) the reaction of cytochrome c occurs at a negatively charged site on plastocyanin, whereas azurin behaves as a positively charged reactant, the electrostatics governing to a large extent the relative reactivities of the modified cytochromes c; 2) in both cases the interaction domain on cytochrome c is located on the "front" surface of the protein and encompasses the solvent accessible edge of the heme prosthetic group, as is the case for all the reactions of cytochrome c with its mitochondrial protein redox partners, as well as for small inorganic redox complexes; and 3) the bimolecular rate constants for plastocyanin and azurin are orders of magnitude slower and the effects of lysine modifications far smaller than for the reactions with physiological systems, indicating that: (a) the electric fields generated by the reactants do not align them, prior to electron transfer, as effectively as for the physiological reaction partners of cytochrome c; and (b) there is an absence of a precise molecular fit between cytochrome c and the nonphysiological redox partners.

Tetracyano-2,2-bipyridineiron(iii), an improved electron acceptor for the spectrophotometric assay of beta-oxidation and of succinate dehydrogenase in intact mitochondria

A recently described direct reading assay for beta-oxidation and for succinate oxidation in intact mitochondria using [Fe(CN)6]3- as final electron acceptor [Osmundsen & Bremer (1977) Biochem. J. 164. 621--633] has been improved by using instead tetracyano-2,2-bipyridineiron(III) [Fe(CN)4(bpy)]-, which gives a 2.6 times greater absorbance change on reduction. Some physical and kinetic properties of [Fe(CN)4(bpy)]- are described. The use of exogenous cytochrome c(III) as electron acceptor was also tested; this gives the largest absorbance change, although the absolute rate of reaction is only approx. one-third of that using [Fe(CN)6]3- or [Fe(CN)4(bpy)]-.

Predicting the dose of warfarin for therapeutic anticoagulation

The validity of a previously described technique for predicting warfarin requirements based on the anticoagulant response to a fixed loading dose was assessed prospectively in 57 patients. There was a close relationship between the predicted and initially observed daily warfarin dose required to maintain the patient within the therapeutic range for anticoagulation. The significant relationship between predicted and observed maintenance dose persisted at 4 and 12 weeks although it decreased with increasing time. The relationship between observed and predicted maintenance requirement of warfarin was not affected by the concomitant use of intermittent intravenous injections of heparin when 9 hr was allowed to elapse between the previous dose of heparin and the thrombotest estimation on which the prediction was based. It is concluded that the method is valuable in predicting an individual's warfarin requirement, although it does not obviate the need for regular monitoring of anticoagulant control.

Comparative reliability of nasal pharyngoscopy and videofluorography in the assessment of velopharyngeal incompetence

A panel of three has reviewed a series of 100 videotape records of nasopharyngoscopy, basal fluorography and lateral fluorography made of patients being investigated for velopharyngeal incompetence. The quality of each record was assessed and estimates of movement made as a basis for comparison of the three methods. Nasopharyngoscopy and lateral fluorography provide a high proportion of material with good definition of the velopharyngeal isthmus (80%). Basal fluorography is less reliable (60%). Lateral fluorography was found to be unreliable as a measure of velopharyngeal incompetence, while estimates of movement from the other two were compatible. Basal fluorography is the procedure of choice in young children. Nasendoscopy provides good quality information more often than basal fluorography in patients over the age of eight and is markedly superior in the presence of a pharyngeal flap.

The role of cytosolic proteins in the intracellular transport of haem in rat liver. A dual-label approach

After consecutive injections of delta-amino[3H]- and -[14C]-laevulinic acid, the incorporation of the two labels into haem associated with different subfractions of the liver was determined. Marked differences in the 14C/3H ratios were observed between haem associated loosely and tightly with microsomes and mitochondria and haem associated with three subfractions of the cytosol obtained by gel filtration. The effect of changing the amounts of delta-aminolaevulinic acid injected and of changing the interval between injections and killing of the animal on the ratios of labels in the haem of each subfraction was studied. The results are discussed in terms of the flow of haem from the mitochondria to other parts of the cell via putative cytosolic carrier proteins.

A world survey of anticoagulation practice in clinical microvascular surgery

A retrospective survey of the use of anticoagulant agents in clinical microvascular surgery was carried out using a questionnaire sent to over 100 centres in different parts of the world. Replies were received from 73 centres where replant and free flap surgery is carried out with the help of microvascular anastomoses. The results are listed and discussed.

Kinetic data for redox reactions of cytochrome c with Fe(CN)5X complexes and the question of association prior to electron transfer

Use of rigorous equilibration kinetics to evaluate rate constants for the Fe(CN)6 4- reduction of horse-heart cytochrome c in the oxidized form, cyt c (III), has shown that limiting kinetics do not apply with concentrations of Fe(CN)6 4- (the reactant in excess) in the range 2-10 x 10(-4) M, I = 0.10 M (NaCl). The reaction conforms to a first-order rate law in each reactant, and at 25 degrees C, pH 7.2 (Tris), it is concluded that K for association prior to electron transfer is less than 200 M-1. From previous studies at 25 degrees C, ph 7.0 (10(-1) M phosphate), I = 0.242 M (NaCl), a value K = 2.4 x 10(3) M-1 has been reported. Had such a value applied, some or all of the redox inactive complexes Mo(CN)8 4-, Co(CN)6 3-, Cr(CN)6 3-, Zr(C2O4)4 4- present in amounts 5-20 x 10(-4) M would have been expected to associate at the same site and partially block the redox process. No effect on rats was observed. With the reductants Fe(CN)5(4-NH2-py)3- and Fe(CN)5(imid)3-, reactions proceeded to greater than 90% completion and rate laws were again first order in each reactant. Rate constants (M-1 sec-1) at 25 degrees C, pH 7.2 (Tris), I = 0.10 M (NaCl), are Fe(CN)6 4- (3.5 x 10(4)), Fe(CN)5(4-NH2py)3- (6.7 x 10(5), and Fe(CN)5(imid)3- (4.2 x 10(5). Related reactions in which cyt c(II) is oxidized are also first order in each reactant, Fe(CN)6 3- (9.1 x 10(6)), Fe(CN)5(NCS)3- (1.3 x 10(6)), Fe(CN)5(4-NH2py)2- (3.8 x 10(6) at pH 9.4), and Fe(CN)5(NH3)2- (2.75 x 10(6) at ph 8). Redox inactive Co(CN)6 3- (1.0 x 10(-3) M) has no effect on the reaction of Fe(CN)6 3- which suggests that a recent interpretation for the Fe(CN)6 3- oxidation of cyt c(II), I = 0.07 M, may also require reappraisal.

Combining psychometric data on brain damage and the influence of aging

60 young and middle-aged patients (age 20 to 52 yr.) with generalized and chronic brain damage were individually matched for age, social class, education, and occupational history with normal control subjects with no history of brain damage. Both groups were given a battery of cognitive tests which included Clément's Digit Code test, Memory-for-Designs, Trail Making, the Spiral Aftereffect, Elithorn's mazes, Mill Hill vocabulary, Progressive Matrices, and the Synonym test. The discriminative efficiency of each measure was examined individually and in combination using discriminant function analysis. The most efficient individual discriminator was the Digit Code. When this was combined with the Trail Making Part B, correct over-all classification was 80%. No other addition improved discrimination significantly. Thus a battery of tests taking 10 min. to administer was as effective as the larger battery which took more than 2 hr. The gradient of test scores with age was examined cross-sectionally for each measure. For most tests, gradients were larger for the brain-damaged than for the control group.

The effects of continuous exposure to carbon monoxide on auditory vigilance in man

Six different groups of non-smoking young male subjects were studied separately for 18 consecutive days each in a closed controlled-environmental human exposure chamber. Each group was subjected to a 5-day control period in fresh air followed successively by an 8-day period of continuous exposure to 50 ppm, 15 ppm or 0 ppm (control) by volume of carbon monoxide (CO) in air, and a 5-day recovery period in fresh air. The subjects performed a 1-h auditory vigilance task every day at the same time of day in a fixed qualitative, quantitative, and temporal relationship with food intake, consumption of stimulating beverages, physical activity, and sleep. It was concluded that such CO exposure, involving the continuous carriage of carboxyhaemoglobin loads up to 7%, was without significant effect on auditory vigilance.

Pharmacokinetics, beta-adrenoceptor blockade and anti-hypertensive action of labetalol during chronic oral treatment

1 beta-Adrenoceptor blockade, plasma labetalol concentrations and anti-hypertensive actions were investigated at 2 hourly intervals during the interdose period of chronic oral therapy in six hypertensive patients. 2 beta-adrenoceptor blockade varied during the inter-dose period and was maximal 2 and 4 h after the oral dose (P < 0.05). 3 Systolic pressure rose during the interdose period (P < 0.05). A significant correlation was found between the degree of beta-adrenoceptor blockade and the change in systolic pressure at 2 h after the oral dose. 4 Efficacy of labetalol as a beta-adrenoceptor antagonist and anti-hypertensive drug was assessed 2 h after an oral dose during chronic eight hourly dosage in sixteen hypertensive patients. Pharmacokinetics of labetalol were studied in the same patients. 5 Peak plasma labetalol concentration occurred 2 h after the oral dose and subsequently the plasma concentration declined monoexponentially. 6 The steady state concentration (CSS) of labetalol was correlated significantly with the daily oral dose in mg kg-1, the mid point labetalol concentration (Cmax+Cmin) divided by 2 and the isoprenaline dose ratio-1 at 2 h after the oral dose. 7 No correlation was found between the antihypertensive effect and the CSS ng ml-1 labetalol or between the isoprenaline dose ratio-1 and the CSS labetalol ng ml-1.

Glycosylated haemoglobin in pregnancy

A study of the use of glycosylated haemoglobin (glyco Hb) levels to identify the pregnant woman with abnormal glucose tolerance and as an adjunct in the control of the diabetic pregnant patient was undertaken. There was no difference in glyco Hb levels in pregnant women with normal or abnormal glucose tolerance. Mean glyco Hb levels were found to increase with the progress of pregnancy. Serial estimations of glyco Hb level in diabetic pregnant women reflected the degree of overall control, but were inadequate, when compared with serial glucose estimations, to assess the often rapidly-changing requirements of pregnancy.

Pharmacokinetics and pharmacodynamics of warfarin at steady state

1 The relationship between warfarin dose, total and free plasma warfarin concentration, and anticoagulant effect was examined at several steady-state levels in fifteen patients during withdrawal of warfarin therapy. 2 Total plasma clearance was significantly correlated with the free fraction in plasma (r=0.955). 3 There was an age related decline in the dose of warfarin, and in the total and free plasma warfarin concentrations required to produce the same anticoagulant effect. However, neither total nor free plasma warfarin clearances varied with age. 4 Individual patients' log concentration-effect relationships were linear above a prothrombin ratio of 1.2 and there was a significant correlation (r=-0.586) between the slope and the free fraction of warfarin in plasma. It is suggested that plasma protein binding may reflect the interaction between warfarin and its effector site in the hepatocyte.

Factors affecting warfarin requirements. A prospective population study

In 228 ambulatory patients receiving treatment with warfarin, there was a progressive decline in the dose required to produce an equivalent degree of anticoagulant control with increasing age from the third decade onwards. However, the relationship between age and dose was significant only in patients receiving warfarin after episodes of venous thromboembolism or because of coronary artery disease. Patient weight was also related to warfarin requirements, although it was less important a determinant than age.