Extensor digitorum brevis rotational muscle flap for lower leg and ankle coverage

BACKGROUND

Soft tissue reconstruction around the ankle has been a challenging problem. This article reports our experience using the extensor digitorum brevis muscle flap; some technical variations are discussed.

METHODS

The extensor digitorum brevis muscle flap is vascularized by the well-defined lateral tarsal artery, a branch of the dorsalis pedis artery originating at the level of the inferior extensor retinaculum. This flap was used for coverage of soft tissue defects in the lower leg and the ankle in 10 patients with various injuries.

RESULTS

All flaps survived completely. Complications included delayed healing of donor skin in two cases. Flap elevation was possible even in the traumatized donor foot.

CONCLUSION

The advantages of this flap include constant and reliable blood supply, easy and rapid flap dissection, adequate bulk, and one-stage procedure. However, disadvantages include the small size of the flap and the sacrifice of the dorsalis pedis artery.

Hairy cell leukemia in Hong Kong Chinese: a 12-year retrospective survey

BACKGROUND

Hairy cell leukemia (HCL) is a unique chronic B cell lymphoproliferative disease (B-LPD), with distinct clinical and pathological features, and excellent treatment response to 2-chlorodeoxyadenosine (2-CDA) and pentostatin. There have been few reports of HCL from oriental countries.

PATIENTS AND METHODS

A retrospective survey of HCL in six major hematology units in Hong Kong over a 12-year period.

RESULTS

There were 18 cases of HCL identified. Most patients presented with fever, splenomegaly and monocytopenia. Lymphadenopathy was present in three patients, and open biopsy revealed tuberculosis infection in two cases. Seven cases received interferon and 12 cases received 2-CDA. Four patients died from bronchogenic carcinoma, cerebral vascular accident, fulminant hepatitis B virus reactivation and malignant melanoma. The remaining 14 patients are in clinical remission at a median of 6 years' follow-up; two are also surviving from second malignancies (thyroid papillary carcinoma and renal cell carcinoma).

CONCLUSIONS

Parallel to the low incidence of B-LPD in Chinese, the incidence of HCL (0.035/100000 population per year) is much lower than in Western series. Other clinical features such as male dominance, clinical presentation, response to 2-CDA treatment, and association with second malignancy are similar to Western reports. However, two common complications in the Chinese population are the fulminant reactivation of hepatitis B infection and disseminated tuberculosis infection.

Thermal-Dependent dehydration process and intramolecular cyclization of lisinopril dihydrate in the solid state

The pathway of dehydration and intramolecular cyclization of lisinopril dihydrate in the solid state was investigated using differential scanning calorimetry (DSC), thermogravimetric analysis (TGA) and a combination of thermal analyzer with Fourier transform infrared microspectroscopy (thermal FT-IR microscopic system). The results indicate that the dehydration from the solid-state lisinopril dihydrate had a two-step process from dihydrate to monohydrate at 76 degrees C and then from monohydrate to anhydrate at 99-101 approximately C, which could be clearly observed from the above three methods. Only the thermal FT-IR microscopic system could give vital information on diketopiperazine (DKP) formation via intramolecular cyclization in anhydrous lisinopril. A new peak at 1670 cm(-1) assigned to the carbonyl band of DKP formation was clearly evidenced. The water of reaction byproduct was liberated at a temperature >157 degrees C and appeared on the IR spectra near 3200-3400 cm(-1). Moreover, the peak at 1574 cm(-1) assigned to carboxylate shifted to 1552 cm(-1) due to the DKP formation. The peak at 1670 cm(-1) related to the DKP formation changed slightly in intensity from 147 degrees C and significantly near 157 degrees C. DSC and TGA methods were poor for use in supplying information on DKP formation in lisinopril. The thermal FT-IR microscopic system is useful from the view point that it can quickly and directly show the solid-state stability of drug.

Percutaneous release of abductor pollicis brevis muscle fibrosis in a bowler--a case report

The authors reported a patient with abductor pollicis brevis muscle fibrosis of the right thumb, stemming from a bowling injury that had occurred 6 years previously. At that time in the acute stage, a Chinese bonesetter treated the injury using manipulation, massage and herbal drugs. Abduction contracture of the patient's right thumb developed. She began to experience chronic pain at dorsal side of her right thumb and discovered that she could not move her thumb into a retro position. When she came into our hospital, physical examination revealed an abduction contracture of patient's right thumb, the angle of separation was 60 degrees, and the angle of circumduction was fixed at 90 degrees. In addition, a fibrotic band was palpable in abductor pollicis brevis muscle. The patient responded well to percutaneous release and physical therapy. As far as we know, this is an unusual case, which has not been reported before.

Differentiation of hair growth cycle from scalp hair roots for the diagnosis of glucose-6-phosphate dehydrogenase deficiency in neonates

Hair analysis can be used as a screening tool in the diagnosis of genetic diseases. The scalp hair roots of 67 normal neonates and 39 neonates with glucose-6-phosphate dehydrogenase (G6PD) deficiency were analysed using Fourier transform infrared (FT-IR) microspectroscopy to differentiate the stages of the hair growth cycle and to diagnose the genetic disorder on the basis of spectral differences. We have demonstrated that FT-IR microspectroscopy is a rapid and effective noninvasive diagnostic method to differentiate scalp hair roots of normal neonates into the anagen, catagen or telogen phases of the hair growth cycle, using IR spectral differences within the 3000-2800 cm(-1) region and the IR peak area ratio of 2854 cm(-1)/2873 cm(-1) or 1084 cm(-1)/amide II band (p<0.001). Moreover, G6PD-deficient neonates could be accurately diagnosed from telogen phase hair roots owing to significant differences in IR peak area ratios of 2854 cm(-1)/2873(-1) or 1084 cm(-1)/amide II band compared to normal values in healthy neonates. The result suggests that the application of FT-IR microspectroscopy may be capable not only of differentiating the hair growth cycle into anagen, categen or telogen phases but also of detecting G6PD deficiency. Hair root analysis promises to be a useful complement to serum and urine analysis in the diagnosis of genetic diseases.

Effect of skin-penetrating enhancers on the thermophysical properties of cholesteryl oleyl carbonate embedded in a thermo-responsive membrane

The effect of skin-penetrating enhancers such as propylene glycol (PG), Azone and ethanol on the thermophysical properties of cholesteryl oleyl carbonate (COC) was investigated using differential scanning colorimetry (DSC) and microscopic Fourier-transform infrared (FT-IR) spectroscopy. The results indicate that PG did not influence the DSC thermograms and IR spectra of COC in the different ratios of COC and PG mixture; whereas Azone interacted with COC not only to lower the semectic-cholesteric phase transition temperature of COC but also to induce a new IR spectral peak at 1653 cm(-1) which shifted from the carbonyl stretching band (1636 cm(-1)) of Azone. Ethanol did not interact with COC, but it influenced the IR spectral peak intensity of COC at 1253 cm(-1). The peak intensity at 1253 cm(-1) gradually rose with the time of ethanol evaporation and was similar to that of the temperature effect. The solubility parameter was also used to explain the miscibility and interaction between COC and PG, Azone or ethanol.

Dome corrective osteotomy for cubitus varus deformity

Between 1994 and 1998, 15 patients had corrective dome-shaped osteotomy of the humerus for posttraumatic cubitus varus deformity. Thirteen patients had surgery before puberty and two patients had surgery after puberty. In the prepuberty group, all the osteotomies were done by a posterior approach with triceps muscle splitting, and cross pins were used to fix the osteotomy. In the postpuberty group, the osteotomies were done by a posterior approach with olecranon osteotomy, and reconstructive plates were used for fixation. The average followup was 2 years and 4 months. Preoperative carrying angle ranged from 19 degrees to 31 degrees varus (average, 26.2 degrees) and postoperative carrying angle ranged from 7 degrees to 15 degrees valgus (average, 10.7 degrees). No loss of correction was observed and all osteotomies united. The preoperative and postoperative differences of the lateral condylar prominence index ranged from -67% to +6% (average, -30.1%). After reviewing these cases, a dome-shaped osteotomy was found to have the following advantages for correction of cubitus varus deformity: the osteotomy site is more stable than a lateral closing wedge osteotomy for maintaining the correction obtained; the domed osteotomy avoids having the lateral condyle becoming prominent; and the posterior scar is more cosmetically acceptable than the lateral scar in the lateral closing wedge osteotomy.

Ipsilateral fractures of the femoral neck and shaft

Ipsilateral femoral shaft and neck fractures are difficult to treat. From 1989 to 1998, we treated 18 patients with these complex fractures. There were 14 male and 4 female with an average age of 40 years. Most resulted from high-energy trauma. The average follow-up period is 41 months. All but one of the fractures united well. The mean time to union is 5.2+/-2.3 months in the diaphysis and 4.16+/-2 months in the neck. No cases of the femoral neck fracture or osteonecrosis of the femoral head were observed during the follow-up period. Fourteen cases were treated with a standard protocol of plates for diaphyseal fractures and lag screws or dynamic hip screws (DHS) fixations for the femoral neck fractures. There were 13 good and 1 fair functional results. Two neglected neck fractures were treated with interlocking nailing for diaphyseal fracture with fair results. We conclude that a plate on the shaft and sliding hip screws or separate screws in the hip is a reliable method for ipsilateral femoral neck and shaft fractures.

Three-dimensional control of light in a two-dimensional photonic crystal slab

Optoelectronic devices are increasingly important in communication and information technology. To achieve the necessary manipulation of light (which carries information in optoelectronic devices), considerable efforts are directed at the development of photonic crystals--periodic dielectric materials that have so-called photonic bandgaps, which prohibit the propagation of photons having energies within the bandgap region. Straightforward application of the bandgap concept is generally thought to require three-dimensional (3D) photonic crystals; their two-dimensional (2D) counterparts confine light in the crystal plane, but not in the perpendicular z direction, which inevitably leads to diffraction losses. Nonetheless, 2D photonic crystals still attract interest because they are potentially more amenable to fabrication by existing techniques and diffraction losses need not seriously impair utility. Here we report the fabrication of a waveguide-coupled photonic crystal slab (essentially a free-standing 2D photonic crystal) with a strong 2D bandgap at wavelengths of about 1.5 microm, yet which is capable of fully controlling light in all three dimensions. These features confirm theoretical calculations on the possibility of achieving 3D light control using 2D bandgaps, with index guiding providing control in the third dimension, and raise the prospect of being able to realize unusual photonic-crystal devices, such as thresholdless lasers.

Simultaneous formation and detection of the reaction product of solid-state aspartame sweetener by FT-IR/DSC microscopic system

The solid-state stability of aspartame hemihydrate (APM) sweetener during thermal treatment is important information for the food industry. The present study uses the novel technique of Fourier transform infrared microspectroscopy equipped with differential scanning calorimetry (FT-IR/DSC microscopic system) to accelerate and determine simultaneously the thermal-dependent impurity formation of solid-state APM. The results indicate a dramatic change in IR spectra from 50, 110 or 153 degrees C, which was respectively attributed to the onset temperature of water evaporation, dehydration and cyclization processes. It is suggested that the processes of dehydration and intramolecular cyclization occurred in the solid-state APM during the heating process. As an impurity, 3-carboxymethyl-6-benzyl-2,5-diketopiperazine (DKP) degraded from solid state APM via intramolecular cyclization and liberation of methanol. This was evidenced by this novel FT-IR/DSC microscopic system in a one-step procedure.

Organic esters of plasticizers affecting the water absorption, adhesive property, glass transition temperature and plasticizer permanence of eudragit acrylic films

The materials used in film coating technology are very important tools for pharmaceutical applications. The effects of four organic esters used as plasticizers (triacetin, diethyl phthalate (DEP), dibutyl phthalate (DBP) and tributyl citrate (TBC)) on the water absorption behavior and adhesive property of Eudragit films and on the glass transition temperature (T(g)) and plasticizer permanence of Eudragit E film were investigated. The results indicate that the water absorption of these Eudragit films was dependent on the type of Eudragit polymers and plasticizers used. Eudragit E film plasticized with triacetin showed a slight water absorption, but when plasticized with DEP, DBP or TBC did not. All Eudragit RL films showed significant uptake of water, but Eudragit RS films exhibited a lesser degree of water absorption. The adhesion (tack value) of all Eudragit films was markedly increased when the concentration of plasticizer was greater than 25%. Eudragit E film exhibited a greater adhesiveness than the Eudragit RL or RS film, particularly with higher plasticizer concentration. Weight loss of the Eudragit E film plasticized with triacetin or DEP was more pronounced with aging, but when plasticized with DBP or TBC weight loss was not seen. The results indicate that TBC may be the best choice of plasticizer for Eudragit film, particularly for the Eudragit E film.

In vitro degradation and dissolution behaviours of microspheres prepared by three low molecular weight polyesters

Three low-molecular weight polyesters, poly(L-lactic acid) (PLA), copoly(lactic acid/glycolic acid) (PLGA) and poly(delta-valerolactone) (PV), were used to prepare water-soluble sodium diclofenac-loaded microspheres by using the oil-in-oil (o/o) emulsification-solvent evaporation method. Their micromeritic and physicochemical properties, and degradation and dissolution behaviours were determined in vitro. The results indicate that high encapsulation efficiency and better monodispersity might be achieved by the o/o emulsification-solvent evaporation method, depending on the amount of drug loading used. The slower evaporation of organic solvent from the system during microencapsulation seemed to modify the crystallinity of drug and polyester in the microspheres, determined by powder x-ray diffractometry and differential scanning calorimetry. The in vitro degradation rate of all the microspheres in pH7.4 phosphate buffer solution showed first-order kinetics and ranked in the order of PLGA > PLA > PV microspheres. Furthermore, the first-order release rate was also found in all the microspheres after an initial drug burst and ranked in the order of PLGA> PLA > PV microspheres, too. The relationship between degradation and dissolution behaviours of these microspheres is discussed.

Demonstration of highly efficient waveguiding in a photonic crystal slab at the 1.5-microm wavelength

Highly efficient transmission of 1.5-microm light in a two-dimensional (2D) photonic crystal slab waveguide is experimentally demonstrated. Light waves are shown to be guided along a triple-line defect formed within a 2D crystal and vertically by a strong index-guiding mechanism. At certain wavelength ranges, complete transmission is observed, suggesting lossless guiding along this photonic one-dimensional conduction channel.

Evaluation of optic disc changes in severe myopia

PURPOSE

To evaluate the changes in the optic nerve head in highly myopic subjects by means of confocal laser scanning opthalmoscope.

METHODS

Using laser scanning and a three-dimensional image analysis system, we studied 114 young (21.4 +/- 1.4 years), highly myopic subjects with refractive errors greater than -8.0 D and a control group of 29 subjects (18.9 +/- 1.2 years) with myopia of -3.0 D or less. Measurements included cycloplegic refraction, corneal curvature, biometric axial length, and morphometric values of the optic disc obtained with a laser scanning disc analyzer.

RESULTS

The optic disc area in highly myopic eyes was similar to that in mildly myopic eyes. However, regression analysis revealed that the optic disc area increased with axial length in subjects with severe myopia. The cup/disc ratio, the disc depth, the neuroretinal rim area, and the tilting of the disc were not significantly different between the severe and mild myopia groups.

CONCLUSIONS

These findings may be useful in further investigations of myopic progression and of the mechanisms responsible for the development of myopic complications.

Failure of the locking mechanism between the acetabular metal shell and the polyethylene liner after primary total hip arthroplasty--a case report

The short and intermediate-term clinical and radiographic results associated with Harris-Galante II porous-coated acetabular modular cup without cementing have been excellent in most patients. Nevertheless, its modular design introduced the potential for failure of the locking mechanism. There are four pairs of locking ties on the rim of metal shell to fix the polyethylene liner within it. Failure of any locking tine would result in less rigid fixation between the metal shell and the polyethylene liner and potentially produce instability or even disassembling of the liner. Only nine cases have been reported previously about the fractures of the locking tine, but it has never been reported in literature in Taiwan. We report a case with fracture of one tine following minor trauma at five years after primary total hip arthroplasty. During reoperation, scratching injury on the outer surface of the polyethylene liner in contact with the inferior tines of the metal shell was noted. Although no disassembling of the liner was noted, the remaining locking mechanism was found to be less rigid when the liner was taken out of the shell. The locking mechanism of HG II cup may be mechanically weak and may fail without major trauma; therefore, its design ought to be improved in an attempt to prevent postoperative dissociation of the polyethylene liner.

Characteristics of foot and mouth disease virus in Taiwan

Since March 1997 two strains of foot and mouth disease (FMD) virus have found their way into Taiwan, causing severe outbreaks in pigs and in Chinese yellow cattle. Outbreaks occurred in March 1997 were caused by a pig-adapted virus strain (O/Taiwan/97) which did not infect other species of cloven-hoofed animals by natural route. The epidemic spread over the whole region of Taiwan within two months and the aftermath was 6,147 pig farms infected and 3,850,746 pigs destroyed. In June 1999, the second strain of FMD virus (O/Taiwan/99) was isolated from the Chinese yellow cattle in the Kinmen Prefecture and in the western part of Taiwan. By the end of 1999, Chinese yellow cattle were the only species infected and those infected cattle did not develop pathological lesions. Seroconversions of serum neutralization antibody and on non-structural protein (NSP) antibodies were the best indicators for infection in non-vaccinated herds. The infected animals, however, excreted infectious levels of virus to infect new hosts. Based on the detection of the specific antibody to FMD virus, and virus isolation from oesophageal-pharyngeal (OP) fluid samples, ten herds of Chinese yellow cattle located in Kinmen and Taiwan were declared to have been infected. During the period of January to March 2000, however, five outbreaks caused by FMD virus similar to the O/Taiwan/99 virus occurred in four prefectures of Taiwan. The infected species included goats, Chinese yellow cattle and dairy cattle. Those outbreaks have caused high mortality in goat kids under two weeks old and also developed typical clinical signs of infection in dairy cattle.

Primary antiphospholipid syndrome manifested as venous stasis retinopathy

Primary antiphospholipid syndrome is a condition in which antiphospholipid antibodies may be present without any associated medical disorder. Thrombosis is the hallmark of this syndrome. We report the case of a 22-year-old female with the chief complaint of floating spots in the right eye for two months. No underlying connective tissue disease or systemic disease was noted. Ophthalmic examination revealed retinal hemorrhage, retinal vein engorgement and optic disk swelling in the right eye only, and normal visual acuity in both eyes. Retinal fluorescein angiography showed venous stasis and branch vein leakage in the right eye. An antibody profile revealed the presence of immunoglobulin G anticardiolipin antibodies, which confirmed the diagnosis of primary antiphospholipid syndrome.

Thermographic study of palmar and facial skin temperature of hyperhidrosis patients before and after thoracic sympathectomy

PURPOSE

The purpose of this study was to investigate the roles of the second thoracic sympathetic segment in the sympathetic innervation of the hands and face, and to compare skin temperature changes in the palms, fingers, face, and neck of palmar hyperhidrosis (PH) patients before and after endoscopic thoracic sympathectomy.

METHODS

Twenty-two patients, 14 women and eight men, with severe PH were treated with endoscopic ablation of the T2 segment. The skin temperatures of the hands, neck, and face were assessed by infrared thermography both before and after operation.

RESULTS

All obtained satisfactory relief of PH. Before sympathectomy, thermography revealed that the palmar skin temperature (PST) was significantly lower than the facial temperature by 1.3 degrees C (paired t-test, p < 0.005). After sympathectomy, thermography showed significant elevations in temperature mainly of the thenars, palms, digits, and nose, but not of the forehead, mandible, or neck (ANOVA, p < 0.05 with Bonferroni t-test). The variations in PST among PH patients were much greater preoperatively than postoperatively. More prominent postoperative PST elevation was found in PH patients with lower preoperative PST (r = 0.898, p < 0.001).

CONCLUSIONS

These findings demonstrate that the T2 segment is the key source of sympathetic innervation to the hand and that the T2 segment contributes only trivial sympathetic innervation to the face. The results of the present thermography studies offer descriptive information about the autonomic innervation of the upper thoracic sympathetic trunk.

Causes of interruption of radiotherapy in nasopharyngeal carcinoma patients in Taiwan

BACKGROUND

Nasopharyngeal cancer (NPC) is now curable with early diagnosis and radiotherapy treatment. In the past several decades, few studies have investigated why some patients fail to complete the recommended full course of radiotherapy.

METHODS

A total of 3273 nasopharyngeal carcinoma patients were treated at the Radiation Oncology Department of Linkou Chang Gung Memorial Hospital in a span of 18 years from 1979 to 1996. Among these patients, 276 did not complete the full course of treatment of radiation therapy. The medical records of these patients were reviewed to determine the factors contributing to treatment interruption.

RESULTS

Of the 276 patients whose treatment was interrupted, 120 (43.5%) were unable to endure the acute side effects of radiation therapy and were afraid of the possible complications resulting from the treatment; 57 (20.7%) had doubts about the diagnosis or had the subjective perception that the treatment offered would be ineffective in view of the severity of their disease; 50 (18.1%) resorted to folk prescriptions; 17 (6.2%) were faced with socioeconomic problems; 15 (5.4%) sought treatment at another hospital owing to transport considerations; 10 (3.6%) stopped radiation therapy and switched to chemotherapy for palliative management; seven (2.5%) resorted to praying, god worshipping and taking incense powder and magic elixirs because their families were against any established therapy.

CONCLUSIONS

The acute side effects and complications caused by radiation therapy were the major factors influencing patients' decisions to discontinue treatment. This finding suggests that more attention should be paid to providing care with regard to the acute side effects of radiotherapy and to reinforcing pretreatment education.

Beta-catenin, a novel prognostic marker for breast cancer: its roles in cyclin D1 expression and cancer progression

Beta-catenin can function as an oncogene when it is translocated to the nucleus, binds to T cell factor or lymphoid enhancer factor family members, and transactivates its target genes. In this study, we demonstrate that cyclin D1 is one of the targets of beta-catenin in breast cancer cells. Transactivation of beta-catenin correlated significantly with cyclin D1 expression both in eight breast cell lines in vitro and in 123 patient samples. More importantly, we found that high beta-catenin activity significantly correlated with poor prognosis of the patients and was a strong and independent prognostic factor in breast cancer. Our studies, therefore, indicated that beta-catenin can be involved in breast cancer formation and/or progression and may serve as a target for breast cancer therapy.

Direct angioplasty of totally occluded left main coronary artery in acute myocardial infarction complicated by cardiogenic shock: report of two cases and literature review

Acute total occlusion of the left main coronary artery is usually characterized by a rapid course of deterioration that challenges therapeutic intervention. Unlike subtotal occlusion of the left main coronary artery, acute total occlusion of the left main coronary artery is extremely rare and has a grave prognosis. Most patients with this problem die suddenly or go into cardiogenic shock. Direct percutaneous transluminal coronary angioplasty (PTCA) was performed on 2 patients, both suffering from cardiogenic shock due to acute total occlusion of the left main coronary artery. Both patients underwent coronary artery bypass surgery subsequently. One patient, who had substantial intercoronary collaterals, remained asymptomatic at 31 months of follow-up. The other, who had no intercoronary collateral circulation, expired 3 days after coronary artery bypass surgery. We conclude that direct PTCA to the acutely occluded unprotected left main coronary artery in cardiogenic shock patients is a potentially life-saving procedure, and the presence or absence of collaterals from the dominant right coronary artery will influence the clinical outcome.

Greater tuberosity osteotomy for treatment of impinge rotator cuff tear

Forty-two consecutive patients in whom an impingement of rotator cuff tear had been treated with greater tuberosity osteotomy and repair were evaluated by relief of pain, return of range of motion and strength of shoulder. The oriental acromion is thin and easy to break during the traditional acromioplasty procedures. When the decompression is achieved by osteotomy on the greater tuberosity which is the common location of cuff tear, not only is adequate decompression achieved but also the coracoacromial ligament is preserved. Comparison of the results of greater tuberosity osteotomy with those of previous acromioplasty studies shows they are mostly similar. At present, these techniques can be recommended for use by Chinese orthopaedic surgeons who have to deal with the typical oriental bony structures.