A new semisynthetic ergot peptide alkaloid: DCN 203-922

We report the synthesis, stereochemistry and preliminary pharmacological evaluation of DCN 203-922, a novel ergot alkaloid of the cyclol type, which contains in its peptide moiety the uncommon amino acid L-allo-isoleucine.

Partial excision of residual burn lesions

Most burn victims have unattractive residual lesions, which may include hypertrophic donor sites, unsightly skin grafts, hypertrophic scars, and mature scars with altered pigmentation or texture. Some of these lesions can be treated by total excision in one or more stages or they can be reconstructed utilizing grafts, flaps, Z-plasties, or tissue expansion. But frequently these procedures are either not indicated or not elected by the patient. In such a situation, the only surgical option is partial excision, with the goal of making the lesion less conspicuous and more easily concealed by clothing. Whether or not such partial excisions are worthwhile is the obvious question. We could not find an answer in the literature and therefore decided to review our own experience. Between 6/30/81 and 3/12/86, 92 such procedures were performed and followed in 25 patients. Partial excision of hypertrophic donor sites, unsightly skin grafts, and hypertrophic scars did yield improved appearance in most patients. However, partial excision of mature scars, ie, areas of altered pigmentation or texture, did not have the same success. We continue to treat the first three types of lesions in this fashion but no longer include the latter.

Impairment, time out of school, and time off from work after burns

Objective measurement of impairment after burns is important to patients, physicians, lawyers, and insurance companies. Even so, we could not find any references in the English literature describing how to objectively rate the physical impairment of burn survivors. The American Medical Association (AMA) has published the book Guides to Evaluation of Permanent Impairment, which is commonly used by surgeons to rate injuries. We decided to use this document to rate the impairment of burn patients. We studied patients who were treated at the University of Washington Burn Center during the years 1981, 1982, and 1983; survived the injury; were hospitalized 5 or more days or were skin grafted; and were followed until their condition was fixed (usually 12 months). This group included 325 patients. The mean age was 28.2 years and the mean total body surface area burned (TBSA) was 11.6 percent. We measured whole-man impairment (WMI) as described by the Guides to the Evaluation of Permanent Impairment. The mean whole-man impairment was 7.7 percent. In addition, we recorded time off from work and out of school after burns. The average time off from work was 12.7 weeks, and the average time out of school was 8.5 weeks. We conclude that the AMA publication can be used to rate burn patients and that the whole-man impairment of burn survivors is quite low if amputation, loss of range of motion, and nerve damage can be prevented.

Excision of burns of the face

Sequential excision of burns is now a common technique. Nevertheless, standard texts, when describing the treatment of facial burns, recommend allowing spontaneous separation of the eschar and then grafting on granulation tissue if healing does not occur. This method yielded disappointing results for us and the reconstructive procedures required were of great magnitude. Therefore, in January of 1979, we began primary excision and grafting of those face burns not essentially healed at 10 days. We have now treated 16 consecutive patients (approximately 5 percent of all face burns) in this manner who are at least 12 months postinjury. Three were lost to follow-up, leaving 13 for evaluation. This method yields better appearance and function than that obtained by allowing spontaneous healing over more than 3 weeks or grafting on granulation tissue and decreases the magnitude of subsequent reconstruction.

Orbital osteoma in Gardner's syndrome

A 30-year-old woman developed proptosis secondary to a left ethmoidal compact osteoma. At age 29 years, a mandibular eburnated (ivory) osteoma was excised. At age 25 years, multiple adenomatous polyps of the colon were resected. Her father, age 61 years, had multiple intestinal polyps and bilateral mandibular osteoma. A 24-year-old sister had an osteoma of the forehead. Gardner's syndrome is an autosomal dominantly inherited disorder characterized by intestinal polyposis, various skin and soft tissue tumors, and osteomas of the bony skeleton. Orbital osteomas occur rarely.

The nasolabial flap: a problem and its correction

The excision of small cutaneous malignancies of the nose frequently results in defects that are appropriate for closure with a nasolabial flap. However, in the older male patient with thick nasal skin, the flap frequently undergoes the trapdoor phenomenon, producing a bulky, unsightly mass. This problem can be corrected, however, by excision of the redundant skin and subcutaneous tissue, leaving a graftable base that can be resurfaced with a full-thickness postauricular skin graft. This method of revision appears superior to just elevating and thinning the flap.

Six polymorphic crystal forms of alpha-cobratoxin

Six different crystal forms of the long neurotoxin alpha-cobratoxin isolated from the venom of Naja naja siamensis have been obtained and the conditions for their crystallisation are described. Heavy atom derivatives for two of these forms have been prepared and have proven suitable for high-resolution X-ray studies and, with one of them, a 0.28-nm resolution structure has been determined. All but one of the crystal forms were grown between pH 2 and pH 3. Two novel suggestions are made which may be applicable to other protein crystallisation studies. One involves cocrystallisation with mercurous iodide and the other describes a two-step microdialysis procedure, first against salt solution, followed by dialysis against poly(ethylene glycol).