Rupture of the gastrocnemius muscle at its distal musculotendinous junction: conservative treatment and outcomes in 11 dogs

CASE HISTORY

Medical records from three veterinary referral centres and a university veterinary teaching hospital in Australia and the USA were reviewed to identify dogs with a diagnosis of distal gastrocnemius musculotendinous junction rupture (DGMJR) that were treated without surgery between 2007 and 2020.

CLINICAL AND IMAGING FINDINGS

All dogs (n = 11) presented with unilateral, pelvic limb lameness and bruising, swelling or pain on palpation at the distal musculotendinous junction. The diagnosis was confirmed with ultrasound or MRI in six dogs; radiographs were used to excluded stifle and tarsus pathology in four dogs; and five dogs were diagnosed on physical examination findings.

TREATMENT AND OUTCOME

All dogs were managed conservatively, either with complete confinement alone (n = 10; median 9 weeks), external coaptation alone (n = 1), or a combination of both (n = 4). Sporting dogs (n = 7) were completely confined (median 22 weeks) for longer periods than companion dogs (n = 3; median 5 weeks).A good to excellent outcome was achieved for all cases in this cohort. The seven sporting dogs achieved an excellent outcome; returning to their previous level of sport, with complete resolution of lameness and recovery of a normal tibiotarsal stance. The four companion dogs achieved a good outcome; returning to their previous level of activity but with persistently increased tibiotarsal standing angle compared to the contralateral limb.

CLINICAL RELEVANCE

Conservative treatment represents a viable treatment option for dogs with a rupture of the gastrocnemius muscle at its distal musculotendinous junction.

The treatment of all MRI-defined low rectal cancers in a single expert centre over a 5-year period: is there room for improvement?

AIM

Outcomes following treatment for low rectal cancer still remain inferior to those for upper rectal cancer. A clear definition of 'low' rectal cancer is lacking and consensus is more likely using a definition based on MRI criteria. This study aimed to determine disease presentation and treatment outcome of low rectal cancer based on a strict anatomical definition.

METHOD

A low rectal cancer was defined as one with a lower border below the pelvic attachment of the levator muscles on sagittal MRI. One hundred and eighty consecutive patients with tumours defined by this criterion between 2006 and 2011 were identified from a prospectively managed departmental database.

RESULTS

One hundred and eighteen patients (66%) underwent curative resection and 12 (7%) palliative resection. Eleven patients (6%) were entered into a 'watch and wait' (W&W) protocol; 10 others (5%) were not fit to undergo any operation. Some 26 patients (14%) had nonresectable local or metastatic disease. An R0 resection was the most important factor influencing survival after curative surgery. R+ resections occurred in 12% of non-abdominoperineal excisions, 11% of abdominoperineal excisions and 47% of extended resections. Overall survival was similar in the curative resections compared with the W&W patients. In 23 of the 96 (24%) treated with neoadjuvant chemoradiotherapy there was a persistent clinical or a pathological complete response.

CONCLUSION

In curative resections, a clear margin is the most important determinant of survival. In 24% of the patients treated with neoadjuvant chemoradiotherapy, surgery could potentially have been avoided. There is scope for improvement in the treatment of locally advanced rectal cancers.

Bilateral alveolar bone grafting: a report of 55 consecutively-treated patients

A retrospective study was undertaken to evaluate the long-term results of bilateral alveolar bone grafting carried out at Great Ormond Street Hospital from 1983 to 1993. Fifty-five consecutive complete bilateral cleft lip and palate patients (36 males and 19 females) who had the operation were included in this study. The total number of cleft sites was 110. At the time of alveolar bone grafting, the mean age of the patients was 12.3 years with a range of 8.4-19.9 years. Cancellous bone from the iliac crest was grafted into the alveolar cleft areas. The cleft sites were studied in two groups according to whether the cleft canine had erupted prior to bone grafting or not. The erupted canine group was composed of 43 cleft sites and the unerupted canine group of 67 sites. At the time of this study, the cleft canine had subsequently erupted at 101 sites. Anterior occlusal radiographs were taken before and after bone grafting. The minimum period of observation after alveolar bone grafting was one year. Criteria described previously were utilized to assess the height of the interdental septum. The results show that bone grafting before canine eruption has a higher clinical success rate compared with that carried out after canine eruption. The critical variable affecting the quality of bilateral alveolar bone grafting is the timing of the surgery.

Alveolar bone grafting: a review of 115 patients

The results of alveolar bone grafting carried out at The Hospital for Sick Children, Great Ormond Street, London, UK, between January 1982 and January 1989 were assessed. Cancellous bone from the iliac crest was grafted to alveolar cleft defects in 115 patients (63 male and 52 female). Eighty-seven unilateral (58 left and 29 right) and 28 bilateral clefts were operated on. The mean age at the time of operation was 11.5 years, with a range of 8.08-18.75 years. The cleft canine had erupted prior to bone grafting in 58.4 per cent. At the time of this study the cleft had erupted in 96.35 per cent and was unerupted in 3.65 per cent of sites. Radiographs were taken at regular intervals and assessed according to previously reported criteria. Eighty-six per cent were clinically successful (Type I and II). In Type III 10.95 per cent had less than three-quarters of the normal interdental septal height and 2.18 per cent failed (Type IV). In addition, 3.6 per cent of sites showed cervical root resorption affecting the adjacent incisor and 1.4 per cent internal resorption of the cleft canine.

Three-dimensional analysis techniques--Part 2: Laser scanning: a quantitative three-dimensional soft-tissue analysis using a color-coding system

New methods for measuring and averaging three-dimensional soft-tissue morphology and change from laser scans using a color millimetric scale are described. The techniques were employed to measure facial differences between a group of Class I skeletal males and females. The surgical change in one patient following bimaxillary surgery is also illustrated. The combination of the laser scanning technique and the new color coding system probed to be a simple, noninvasive, effective, and easily interpreted method for measuring three-dimensional soft-tissue differences and change across the facial complex.

Three-dimensional analysis techniques--Part 1: Three-dimensional soft-tissue analysis of 24 adult cleft palate patients following Le Fort I maxillary advancement: a preliminary report

The three-dimensional, facial soft-tissue changes of 24 patients with various cleft types following transpalatal Le Fort I osteotomy were measured using laser scanning techniques, radial measurements, and a color millimetric scale. There was a varying degree of midface retrusion in the different cleft groups, and a very similar pattern of retrusion over the nasal complex. Each group of patients showed a varying degree of relapse postsurgically, but there was a failure in all the cleft groups to correct the lack of nasal projection.

Three-dimensional analysis techniques--Part 4: Three-dimensional analysis of bone and soft tissue to bone ratio of movements in 24 cleft palate patients following Le Fort I osteotomy: a preliminary report

The three-dimensional changes in the bone and the ratio of soft tissue to bone movement were investigated in a group of 24 cleft palate patients following Le Fort I osteotomy. CT scans were taken for each patient preoperatively and 1 year postoperatively. The scans were superimposed, radial measurements calculated, and the changes illustrated by two separate color scales. In all of the groups, there was a fairly consistent pattern of movement over the mandible. The soft tissues moved in a 1.25:1 ratio over the chin and canine regions, and reduced to 1:1 over the body. In the maxilla, there was a 1:1 movement in the midline increasing to 1.25:1 bilaterally over the alar bases for both the bilateral clefts and clefts of the secondary palate groups. In the unilateral cleft group, however, there was a greater degree of movement over the cleft than over the noncleft side.

Failed pharyngoplasty and subsequent management

An investigation of 18 patients who had experienced "surgical failure' following pharyngoplasty for the correction of velopharyngeal dysfunction was undertaken in an attempt to identify the causes. These included poor case selection, poor surgical design and execution. Subsequent management of this group included three modalities of treatment; of the three, a carefully designed and executed surgical procedure produced the most satisfactory results in this particular patient cohort.

Three-dimensional nasal changes following maxillary advancement in cleft patients

Three-dimensional laser surface scanning of the face was performed before and after Le Fort I maxillary advancement in 24 patients with replaced clefts of the lip and palate. The surgery resulted in advancement of the upper lip and para-alar tissues and an increase in the relative prominence of the nose within the face. These changes were produced at the expense of an increase in nasal width and a reduction in nasal tip protrusion. The changes in nasal morphology showed significant variation among patients.

A three-dimensional soft tissue analysis of fifteen patients with Class II, Division 1 malocclusions after bimaxillary surgery

A three-dimensional soft tissue study of the results of surgery in a group of 15 women with Class II, Division I malocclusions after orthognathic surgery was performed with laser scans. A group of 30 women with Class I malocclusions ages between 19 and 25 years were used as controls. Laser scans were taken before surgery, 3 months after surgery, and at least 1 year after retention. The skeletal 2 patients were shown to have a narrowing of the face over the maxillary complex, checks, the nose, as well as around the alar bases, the so called "adenoid facies." There was also the expected mandibular deficiency. The effects of the bimaxillary surgery were not simply confined to the maxilla and the mandible, with soft tissue changes extending as far as the outer canthi of the eyes. There was very little relapse in the group as a whole from the third month to 1 year after surgery. This technique has proved to be a simple noninvasive method of measuring three dimensionally. It has proven to be a very useful tool in auditing surgical outcome and measuring surgical relapse.

Early experience with cryopreserved saphenous vein allografts as a conduit for complex limb-salvage procedures

PURPOSE

The lack of a suitable alternative to autogenous vein is often the limiting factor for complex lower extremity vascular reconstruction, especially when previously placed grafts have failed. Cryopreserved saphenous vein allografts have been used as an alternative conduit. This report reviews our early experience with this conduit in a series of complex redo revascularization procedures for limb salvage when no suitable autogenous vein was available.

METHODS

Thirty-five patients underwent 39 lower extremity bypass grafts on 36 limbs. These patients had undergone a combined total of 72 prior revascularization procedures on the symptomatic limb, an average of two procedures per patient. Only five bypasses were performed as a primary procedure. There were 18 men and 17 women with a mean age of 71 years. Sixteen of the patients had diabetes. Thirty-four bypasses were performed for rest pain or ulceration, four for disabling claudication, and one for replacement of an aneurysmal vein graft. There were 35 femorotibial, three below-knee femoropopliteal, and one femoropedal reconstruction. Twenty-five grafts were constructed with cryopreserved vein only, whereas 14 were composite grafts; 10 were constructed with polytetrafluoroethylene, one with Dacron, and three with spliced native saphenous vein. The mean follow-up was 9 months (range 1 to 25 months).

RESULTS

There was one early death (< 30 days) and two late deaths. Two patients died with a patent graft. There have been 12 early graft closures and an additional 17 late failures, resulting in primary cumulative graft patency rates of 67%, 56%, 43%, 28%, and 14% at 1, 3, 6, 12, and 18 months, respectively. Surgically correctable causes, including technical error and anastomotic stenosis, could be identified in 13 of the 29 graft failures. Salvage of failed grafts resulted in secondary cumulative graft patency rates of 87%, 77%, 61%, 46%, and 37% at these same intervals. There was no significant difference in primary or secondary graft patency rates related to diabetes, ABO graft compatibility, graft composition or orientation, indication for surgery, state of the outflow tract, or site of distal anastomosis. Limb salvage was attained in 24 (67%) of the 36 limbs. Two amputations were necessary despite patent grafts.

CONCLUSIONS

Because of the poor overall graft patency rates, cryopreserved saphenous vein allografts should be used only as a last resort when no alternative autogenous conduit is available. Unless patency rates superior to those achievable with currently available prosthetic or biologic conduits can be attained by adjunctive measures such as routine anticoagulation or immunosuppressive therapy, the use of cryopreserved saphenous vein allografts for lower extremity revascularization should be deferred until improved preparation techniques provide a more durable conduit.

A three-dimensional analysis of bone and soft tissue to bone ratio of movements in 17 Skeletal II patients following orthognathic surgery

The three-dimensional changes in the bone and the ratio of soft tissue to bone movement were investigated in a group of 17 Skeletal II patients following orthognathic surgery. CT scans were taken for each patient pre-operatively and 1 year post-operatively. The scans were superimposed, radial measurements calculated, and the changes illustrated by two separate colour scales. There was a constant ratio of movement over the maxillae with the central part of the upper lip being moved in a 1:1 ratio, increasing to a 1.25:1 ratio over the canine regions and 1.5:1 ratio over the paranasal areas. In the mandible there was a constant ratio of 1.25:1 over the chin, mentalis, and canine regions bilaterally. The ratio reduced to 1:1 over the body of the mandible.

Excision of a Clival and Upper Cervical Pheochromocytoma by an Extended Maxillotomy Approach: A Case Report

By use of an extended maxillotomy approach, greater surgical access is provided to the midline skull base in comparison with lateral approaches. We describe this technique used to debulk a tumor extending from the sphenoid sinus across the craniocervical junction to the second cervical vertebrae.

Le Fort I maxillary osteotomy: is it possible to accurately produce planned pre-operative movements?

The planned preoperative maxillary movements for five groups of patients requiring orthognathic surgery were prospectively compared to the actual surgical movements achieved in the operating theatre. There was a very poor success rate in achieving predicted movements in all the patient groups. There is a need to test and implement a reliable method of assisting the surgeon in spatially orientating the jaws on the operating table.

A three dimensional analysis of soft and hard tissue changes following bimaxillary orthognathic surgery in skeletal III patients

The three dimensional changes in the bone and the ratio of soft tissue to bone movement were investigated in a group of 16 Skeletal III patients following orthognathic surgery. Computerised tomogram scans were taken for each patient pre-operatively and 1 year postoperatively. The scans were superimposed, radial measurements calculated, and the changes illustrated by two separate colour scales. There was no constant pattern of movement in the maxilla or mandible in these patients. However, following a Le Fort 1 osteotomy there was commonly a 1:1 ratio in the midline which increased to 1.25:1 at the alar bases and over the canine regions bilaterally. There was also a 1.25:1 ratio or greater over the chin and mentalis regions following mandibular set back.

A three-dimensional soft tissue analysis of 16 skeletal class III patients following bimaxillary surgery

A three-dimensional soft tissue study of the results of surgery in a group of 16 skeletal Class III adult patients following orthognathic surgery was carried out using laser scans (Arridge et al., 1985). The patient group was compared to a control group of the same population. Laser scans were taken prior to surgery, 3 months post-surgery, and at least 1 year after retention. Preoperative comparison to the control groups revealed that the facial disproportion related to both the maxilla and the mandible. Le Fort I advancements resulted in broadening of the lateral aspects of the nose, advancement of the dorsum, and overcorrection of the alar bases. There was a degree of change over the cheeks bilaterally, because of alterations in the general drape of the soft tissues. There was a degree of overcorrection in the female group following mandibular set back but the male group were still more prognathic, when compared to the control group. There was a marked degree of relapse in the mandible from 3 months to 1 year postoperatively, with a resultant anterior movement of the maxillary arch. Laser scanning has proved to be a simple non-invasive method of measuring three-dimensionally, and is a very useful tool in auditing surgical outcome and measuring surgical relapse.

Stability of surgical correction of patients with Skeletal III and Skeletal II anterior open bite, with increased maxillary mandibular planes angle

The surgical correction of eleven Class III patients and 10 Class II patients with a long face, increased maxillary mandibular planes angle and anterior open bite was undertaken using bimaxillary surgical procedures. Lateral skull radiographs were examined pre-operatively, 48 hours, and 1 year post-operatively, to quantify the amount and direction of surgical change achieved and the subsequent stability. There was no consistent pattern in the actual movements achieved in either group of patients in the maxillae or the mandibles. Some of the cases being impacted and continuing to impact, others impacting then relapsing. In the Class III patients some of the mandibular set backs remained stable others relapsing and some continuing to move posteriorly. However, despite these inconsistent patterns, there was a 7-degree reduction in the maxillary mandibular planes angle which relapsed by 1.7 degrees over the first year. The overbite was increased from -6 mm to +3.1 mm post-operatively and this relapsed at the 1 year stage to +2.4 mm. The overjet reduced from -4 to 1.7 mm and continued to improve to -0.9 mm at the 1-year stage. In the Class II patients some of the mandibular advancements remained stable others relapsing and some continuing to advance. However, despite these inconsistent patterns there was a 9-degree reduction in the maxillary mandibular planes angle which reduced by a further degree at the 1 year stage. The overbite was increased from -4.6 to -1.6 mm post-operatively and this remained stable at the 1 year stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Vitamin A absorption in cystic fibrosis: risk of hypervitaminosis A

Vitamin A status was examined in nine adult cystic fibrosis patients and six adult control subjects, together with an assessment of their ability to absorb 10,000 IU of retinyl palmitate from a test meal, taken with appropriate pancreatic enzyme supplements. Median baseline values for plasma retinol and carotene, as well as median serum retinol binding protein concentrations, were significantly lower in cystic fibrosis patients than in control subjects. One cystic fibrosis patient had a raised fasting plasma retinyl ester concentration suggestive of chronic hypervitaminosis A, but no symptoms of toxicity. Measures of vitamin A absorption were also significantly lower in cystic fibrosis patients, although there was considerable overlap with control values. No correlation was observed between measures of baseline status and vitamin A absorption. Measurement of plasma retinyl esters may be an appropriate investigation in those patients considered to be at risk of chronic hypervitaminosis A.

Increased susceptibility to peroxide-induced haemolysis with normal vitamin E concentrations in cystic fibrosis

Vitamin E status was assessed in 22 patients with cystic fibrosis and 9 controls by measuring concentrations of the vitamin, vitamin E:lipid ratios and peroxide-induced haemolysis in plasma and erythrocytes. For a given concentration of plasma or erythrocyte alpha-tocopherol, erythrocytes of patients with cystic fibrosis were more susceptible to peroxide-induced haemolysis than controls. This susceptibility should be countered by supplementation with vitamin E to maintain higher than normal concentrations of circulating alpha-tocopherol-greater than 4.8 mmol alpha-tocopherol/mol cholesterol.

Kinetics of a rapid, luminol dependent chemiluminescence signal induced in HL-60 cells by amphotericin B and other stimulants

Addition of the polyene antibiotic amphotericin B or tissue culture medium to nondifferentiated HL-60 cells in the presence of luminol induces a chemiluminescence signal that reaches a peak value within a few seconds and decays exponentially in less than a minute. The kinetics of the signal and its modulation by superoxide dismutase, catalase, and horseradish peroxidase are consistent with a series of solution biochemical processes with a rate-determining step corresponding to the disproportionation of a luminol-superoxide complex. The effects of the enzymes demonstrate that superoxide is a precursor to the rate-determining intermediate and that both catalase and peroxide enhance a reaction that competes with the rate-limiting process.

A mathematical method for the comparison of three-dimensional changes in the facial surface

Many attempts have been made to measure and compare the changes in the facial surface brought about by facial reconstructive surgery. Three-dimensional (3-D) analyses have largely consisted of qualitative descriptions rather than a quantitative treatment of these changes. Until recently, the lack of availability of 3-D data for the face and head has limited the advancement of these techniques. However, with 3-D information readily available from a laser scanning system which we have constructed, a technique has been applied which describes mathematically the facial shape and changes occurring in the face in terms of fundamental surface types. The method is described and used to compare the faces of two patients (one a cleft palate patient and the other a long-face, Class II malocclusion patient) before and after surgery along with the clinical description of the surgery, the resulting facial changes, the actual surgery performed, and the predicted surgical expectation. A strong relationship is found between the surface type description and the clinical observations. The implications of the method for surgery, facial aesthetics, and other disciplines are discussed.

Mandibular reconstruction using vascularised fibula

The osteocutaneous fibula flap has been used to reconstruct large segments of mandible in cases following ablation for cancer or radionecrosis. The bone can be cut to the appropriate shape and the fasciocutaneous flap may be used simultaneously to provide oral cavity lining or skin cover. The technique is described and its successful use in seven patients is reported with details of the complications encountered.

The Sri Lankan Cleft Lip and Palate Project: the unoperated cleft lip and palate

Since 1984, the Sri Lankan Cleft Lip and Palate Project has developed a large surgical and research program collecting records on over 500 subjects with unrepaired cleft lip and palate. In addition, 410 operations were performed by Project and will be followed by individual reports on facial growth and morphology, speech, surgical and anesthetic aspects, and the otologic significance of cleft palate in this issue and subsequent ones.

Surgical correction of temporomandibular joint ankylosis

A better understanding of facial growth processes and pathophysiology of temporomandibular joint ankylosis should lead to an improved surgical outcome. Surgical anatomy, pathophysiology, and treatment options are reviewed. Suggestions for varying the procedure in patients in whom facial growth is not complete are discussed.

Superficial femoral pseudoaneurysm and arterial thromboembolism caused by an osteochondroma

A 13-year-old boy with a symptomatic distal femoral osteochondroma was found to have a pseudoaneurysm of the superficial femoral artery caused by the tumor and occlusion of the anterior tibial artery due to arterial thromboembolism. Excision of the exostosis followed by saphenous vein grafting resulted in an excellent clinical recovery.

Le Fort I maxillary osteotomies in cleft palate cases. Surgical changes and stability

Surgical and postsurgical changes in maxillary position following transpalatal osteotomy at the le Fort I level in 30 patients with clefts of lip and palate were evaluated cephalometrically. By superimposing on natural reference structures, a more accurate and detailed evaluation of change in maxillary position was possible than by using conventional cephalometric analyses. The mean horizontal advancement was 9 mm, with a mean vertical change of 3 mm. While it is customary to express postsurgical relapse as a percentage of surgical change (in this case 7% mean horizontal relapse and 23% mean vertical relapse), the most remarkable finding to emerge from this study was the variability in surgical and postsurgical change which would be obscured by concentrating on descriptive statistics. Postsurgical change was related to the amount of surgical change, but the correlation coefficients are quite low, and so other factors must be responsible for a significant proportion of any relapse.

Familial pseudohyperkalaemia: inhibition of erythrocyte K+ efflux at 4 degrees C by quinine

1. Mechanisms responsible for increased erythrocyte K+ efflux in vitro have been investigated in a patient with familial pseudohyperkalaemia. Mean net K+ efflux (4 degrees C) was 108 nmol h-1 10(-9) erythrocytes, seven times greater than the mean for controls (15.2 nmol h-1 10(-9) erythrocytes). Net K+ efflux was not increased at 22 degrees C or 37 degrees C and losses at 4 degrees C were reversed by subsequent incubation at 37 degrees C. 2. Erythrocyte glucose consumption (4 degrees C) was 14 nmol h-1 10(-9) erythrocytes, similar to the mean for controls of 16.8 nmol h-1 10(-9) erythrocytes. This suggests that the increased net K+ efflux (4 degrees C) was not associated with abnormal energy consumption and was therefore unlikely to be due to an abnormality of the Na+, K+-pump. 3. Incubation of erythrocyte suspensions with ouabain (0.1 mmol/1) or frusemide (1 mmol/1) at 4 degrees C or 37 degrees C resulted in no differences in K+ efflux between patient and controls. Incubation with quinine (2 mmol/1), an inhibitor of the erythrocyte Ca2+-dependent K+ channel, reduced net K+ efflux at 4 degrees C, but the effect persisted in Ca2+-depleted erythrocytes, implying that quinine was acting in a non-specific fashion. 4. Chemical pathologists and clinicians must be aware of this condition if inappropriate treatment of pseudohyperkalaemia is to be avoided.

Distributions of fluorescence decay times for parinaric acids in phospholipid membranes

Analysis of fluorescence decay data for probes incorporated into model or biological membranes invariably requires fitting to more than one decay time even though the same probe exhibits nearly single-exponential decay in solution. The parinaric acids (cis and trans) are examples of this. Data are presented for both parinaric acid isomers in dimyristoylphosphatidylcholine membranes collected to higher precision than normally encountered, and the fluorescence decays are shown to be best described by a smooth distribution of decay times rather than by a few discrete lifetimes. The temperature dependence of the fluorescence decay reveals a clear shift in the distribution to longer lifetimes associated with the membrane phase transition at 23.5 degrees C. The physical significance is that fluorescence lifetime measurements appear to reflect a physical process with a distribution of lifetimes rather than several distinct physical processes.

Reflotron assays of alanine aminotransferase and gamma-glutamyltransferase in whole-blood samples evaluated

We evaluated the Reflotron (Boehringer Mannheim) system for measuring activities of alanine aminotransferase (EC 2.6.1.2) and gamma-glutamyltransferase (EC 2.3.2.2). Within- and between-day precision were comparable with conventional analytical methods. The linear range of the methods extended to more than 40-fold the upper limit of the reference range. The methods were not influenced by moderate changes in blood rheology and also tolerated some variation in sample volume applied. We consider these methods to be suitable for use in satellite or physicians' office laboratories (with appropriate training of operators), and they can produce results that agree satisfactorily with those determined in routine laboratory practice.

Reflotron assays of alanine aminotransferase and gamma-glutamyltransferase in whole-blood samples evaluated

We evaluated the Reflotron (Boehringer Mannheim) system for measuring activities of alanine aminotransferase (EC 2.6.1.2) and gamma-glutamyltransferase (EC 2.3.2.2). Within- and between-day precision were comparable with conventional analytical methods. The linear range of the methods extended to more than 40-fold the upper limit of the reference range. The methods were not influenced by moderate changes in blood rheology and also tolerated some variation in sample volume applied. We consider these methods to be suitable for use in satellite or physicians' office laboratories (with appropriate training of operators), and they can produce results that agree satisfactorily with those determined in routine laboratory practice.

Development at Cold-Hardening Temperatures : The Structure and Composition of Purified Rye Light Harvesting Complex II

Light harvesting complex II (LHCII) was purified from cold-hardened (RH) and nonhardened winter rye (RNH) (Secale cereale L. cv Puma) employing a modified procedure of JJ Burke, CL Ditto, CJ Arntzen (Arch Biochem Biophys 187: 252-263). Triton X-100 solubilization of thylakoid membranes followed by three successive precipitations with 100 mm KCl and 10 mm MgCl(2) resulted in yields of up to 25% on a chlorophyll (Chl) basis and a purity of 90 to 95%, based on polypeptide analysis within 4 hours. Polypeptide and pigment analyses, 77 K fluorescence emission and room temperature absorption spectra indicate the LHCII obtained by this modified method is comparable to LHCII obtained by other published methods. Comparison of purified RH and RNH LHCII indicated no significant differences with respect to polypeptide, amino acid, Chl, and carotenoid compositions as well as no differences in lipid content. However, RH LHCII differed from RNH LHCII specifically with respect to the fatty acid composition of phosphatidyldiacylglycerol only. RH LHCII exhibited a 54% lower trans-Delta(3)-hexadecenoic acid level associated with PG and a 60% lower oligomeric LHCII:monomeric LHCII (LHCII(1):LHCII(3)) than RNH LHCII. Both RH and RNH LHCII exhibited a 5-fold enrichment in PG specifically. Complete removal of PG by enzymic hydrolysis resulted in a significant reduction in the oligomeric content of both RH and RNH LHCII such that LHCII(1):LHCII(3) of RH and RNH LHCII preparations were the same. This confirms that this specific compositional change accounts for the structural differences between RH and RNH LCHII observed in situ and in vitro.

Reconstruction of the middle third of mandible

The radial forearm flap is established as a suitable method of providing bone with soft tissue lining or skin cover in reconstruction of the mandible. A simple and effective method of modelling the radius to provide the appropriate contour to the anterior arch of the mandible is described.

Maxillary myxoma in a child of 11 months. A case report

A myxoma of the maxilla in an infant is presented. It was initially treated as an inflammatory lesion. Failure to respond led to biopsy, which showed that the lesion was neoplastic; initially an incorrect diagnosis was made and totally inappropriate treatment was given. Reassessment of the biopsy material established the correct diagnosis and appropriate management was initiated.