Protective effect of human recombinant copper-zinc superoxide dismutase (hr-cuznsod) on intermediate burn survival in rats

Objectives. Superoxide dismutase, acting as a scavenger of oxygen free radicals, has shown mixed results in increasing survival from burn wounds. We previously demonstrated that human recombinant copper-zinc superoxide dismutase could increase the survival of failing ischaemic flaps in a rat model. Because of the similar pathophysiology of tissue ischaemia in flaps and intermediate zone burns, we conducted a later study employing two groups of rats with standardized intermediate burns, to ascertain whether or not human recombinant copper-zinc superoxide dismutase could increase intermediate burn zone survival in rats. The results showed that post-burn human recombinant copper-zinc superoxide dismutase failed to improve intermediate burn zone survival. We decided to undertake a new study to ascertain whether there was a protective effect of human recombinant copper-zinc superoxide dismutase in intermediate burns. Methods. This controlled study employed two groups of rats, one of which received prophylactic treatment with human recombinant copper-zinc superoxide dismutase before the induction of standardized intermediate burns. Results. The results showed that pre-burn human recombinant copper-zinc superoxide dismutase also failed to improve intermediate burn zone survival. Conclusions. Further studies are needed to fully understand the effect of oxygen free radicals in burn wound pathophysiology and to determine whether human recombinant copper-zinc superoxide dismutase has a place in the clinical management of burns.

Effect of high dose and low dose aspirin on survival of random pattern flaps in rats

This paper studies which of the physiological effects of aspirin is responsible for increasing the survival of random flaps in rats, found in an earlier experiment. We wished to confirm that the antiaggregating--antithrombotic effect was responsible for the increased survival of flaps without microvascular anastomosis. Three groups of rats with standardised random pattern flaps were used. The first two were given aspirin 200 mg/kg (high dose, n = 27) or 40 mg/kg (low dose, n = 21) and the third (n = 28) acted as controls. The beneficial effects of aspirin were restricted to the high dose group. Since the low dose group also showed antiaggregation of platelets, but without the anti-inflammatory or vasodilatory effects, the results indicate that the antiaggregating effect alone was not responsible for the increased survival of the flaps.

Cleft lip in the Talmud

The authors address the problem of why the cleft lip anomalad is not mentioned even once in the Talmud, which contains detailed reports of numerous other forms of pathology and congenital anomalies. It also attempts to define the Sandal deformity, one of the most common congenital anomalies mentioned in the Talmud. It is assumed that cleft lip, the most common major facial defect, existed at the time of the Talmud. It is proposed that the Sandal deformity was actually made up of a number of entities grouped together because of a theorized common etiology, and that the cleft lip entity is included in the Sandal anomalad. This deformity, in its various forms, included, besides cleft lip, aborted tissue and products of gestation. They are all related to the common etiology of a twin gestation during which one fetus presses against the other causing the deformity. The Sandal was noted to look like the Sandal fish or sole, for which it is named. When photos of the Sandal fish and the cleft lip deformity are compared, a similarity is seen. In addition, this deformity apparently was thought to be fatal, and none of these babies survived. It is theorized that cleft lip babies were allowed to die because they were considered nonviable in the eyes of Jewish law. Supporting evidence for the ideas presented by the authors is derived from the talmudic texts and commentaries. If the Sandal does indeed include the cleft lip entity, the citation in the Mishnah (70-200 AD) makes it the earliest historical reference to the cleft lip deformity.

Multiple glomus tumor: a case report and review of the literature

Multiple glomus tumors are extremely rare and differ from the more common solitary glomus tumors in their clinical presentation and histological features. The authors report a case of multiple glomus tumors of the right hand in a 65-year-old man, its treatment, and a review of the features of this uncommon tumor. The tumor usually presents as a painful, firm, purplish, solitary nodule of the extremities, especially in the nail bed. Multiple glomus tumors are described as softer, more compressible, bluish nodules and they occur with less frequency than solitary tumors. They are often inherited in an autosomal dominant pattern. The authors present a case of multiple glomus tumors of the right hand, in which many small, painful, red papules were grouped in the right hypothenar region. The patient was treated by wide excision of the lesion and coverage of the defect with an ulnar artery forearm flap.

["Modern" combined abdominoplasty]

Cosmetic abdominoplasties have been the subject of many criticisms because of their frequent disadvantages and complications. Although the length of the scar depends on anatomical conditions, diffuse adipose infiltration of the abdominal wall, the often excessively low umbilicus (surrounded by a circular scar characteristic of the operation), and the postoperative risks, severely limited the aesthetic quality of the final result. A new therapeutic approach, based on recent technical progress and old, but neglected surgical techniques, provides results which appear to be satisfactory. Liposuction, particularly performed at the beginning of the operation, regularly thins the abdominal wall and constitutes a useful complement to the so-called superficial method and especially the more extensive use of ultrasound, which has become almost essential in certain regions. Neo-umbilicoplasty according to an original hourglass plan and an abdominoplasty using four skin flaps provide a natural result, with no visible scar, and allow harmonious positioning of the umbilicus. This technique constitutes an interesting alternative to the limited possibilities of classical repositioning. Liposuction of the pubic region and lowering of the pubic hair line also improve the aesthetic possibilities. Although not all of the various disadvantages of aesthetic abdominoplasty have yet been resolved, their frequency has been markedly decreased and this therapeutic approach, which also constitutes a line of research, allows a more optimistic view of this operation, for which the indications must remain selective and rigorous. Various classifications are described to guide the choice of treatment based on analysis of clinical signs.

Motivation for rhinoplasty: changes in 5970 cases, in three groups, 1964 to 1997

The motivational factors were divided into three categories: (1) independent decision, (2) observation of previous patients, and (3) external influences. The results of the percentage breakdown of the patients in our present study are compared with previous results are presented in 1983 in this journal. Once again, the independent decision of the patient was the most important factor in deciding to have cosmetic rhinoplasty, followed by their observation of results in other patients. These two factors have been the motivation in approximately 80% of all the patients in all three studies. The age breakdown of cosmetic rhinoplasty patients shows that after the age of 21, as patients get older, a smaller and smaller percentage of patients was motivated for surgery by independent decision alone. These older patients need external influences to motivate them to have surgery. In most cases, the desire for surgery had smoldered in them since adolescence, and they needed an external "OK" to have it done.

Question mark ear: a method for repair

We present a rare case of bilateral question mark ears together with our method to correct the deformity. We discuss the developmental theory of this anomaly, and review the literature. We describe our technique to correct this deformity using advancement-rotation flaps taken from both sides of the ear cleft.

Anthropomorphic breast measurement: protocol and results in 50 women with aesthetically perfect breasts and clinical application

This paper presents a simple protocol for the measurement and evaluation of the difficult physiognomy of the female breast and the application of the protocol in clinical practice. The protocol includes measurement of the breast and its landmarks and their relevant position from fixed skeletal points. Volume was measured with the Grossman-Roudner device. The protocol provides a useful tool in the accurate evaluation of patients preoperatively and in the assessment of surgical results. The protocol is compared with the two previously reported protocols. The paper presents the anthropomorphic measurements of 50 women with aesthetically perfect breasts utilizing this protocol. Aesthetically perfect was defined as a nonptotic breast in which no common aesthetic procedure would be considered appropriate (excluding augmentation) to enhance the breast's form. Results were compared with those reported in the two previous studies. The paper presents the clinical correlation obtained by statistical analysis of the results of the measurements of the 50 women. Although the results of the measurements indicate the range and variance in the aesthetically perfect breast, there still was a statistically significant correlation of some of the parameters of the breast and torso shape to breast volume. This correlation can be used preoperatively to predict desired breast shape and volume in breast augmentation, reduction, and reconstruction. Clinical application of the concepts proposed will lead to better surgical goal orientation and improve evaluation of surgical results. A formula for calculating appropriate breast size based on torso parameters is presented.

Five generations with steatocystoma multiplex congenita: a treatment regimen

We present our treatment regimen of modified excisions for cysts of steatocystoma multiplex congenita in seven members of a family afflicted with this disease spread over five generations. The family's disease is restricted to the head and neck region. A review of the literature of this rare disease is included, and our method of treatment is described.

Adiposis dolorosa (Dercum's disease): 10-year follow-up

Adiposis dolorosa is a disease characterized by painful, subcutaneous fatty tumors. This disorder usually occurs in obese, postmenopausal women and is associated with weakness and mental disturbances such as depression, confusion, lethargy, and dementia. The cause is unknown, and there is no specific treatment. Pain may be relieved by steroids, intravenous lidocaine, or analgesics. Surgical treatment consists of excision or liposuction of the painful masses. We present two cases of adiposis dolorosa in men, with a follow-up of more than 10 years.

Liver disease in the Talmud

Diseases of the liver have been of interest to physicians throughout the ages. There are references to hepatic diseases in ancient writings on medicine as far back as the Egyptian papyrii (1). In this article, I deal with the multiple references to the liver and liver disease that are found in the books of the Talmud. The areas discussed include anatomy, physiology, trauma, liver disease, jaundice, cholelithiasis, and hematemesis. The modes of therapy and their theory give an interesting perspective to Middle Eastern medicine 1,500 years ago.

Scapulectomy with latissimus dorsi musculocutaneous flap in the treatment of sarcoma of the upper back

We present a patient in whom scapulectomy was performed to treat a huge malignant fibrous hystiocytoma of the back. Computed tomographic examination showed the tumor to have invaded the musculature of the upper back and about the scapula. To achieve adequate surgical excision, a major portion of the skin and soft tissue of the upper back was excised in conjunction with subtotal scapulectomy. The defect, with exposed vertebral spines and transected scapula, was covered with an ipsilateral latissimus dorsi musculocutaneous flap. Now, four years postoperatively, the patient has no evidence of recurrent disease and has good use of his arm. Total or partial excision of the scapula is rarely performed and poses unique problems. As our case demonstrates, scapulectomy (combined with musculocutaneous flap) is well tolerated, and surgeons should not be discouraged from using it when appropriate.

The odd or even bullet

A simple mathematical rule is presented to account for the number of bullets that may be left in the body of a gunshot victim. Two illustrative cases are described.

Rhinoplasty update: preoperative evaluation of 4,040 cases

A total of 4,040 cases of cosmetic rhinoplasty surgery was evaluated in terms of sex distribution, age, marital status, and motivating factors. There was a male to female ratio of 1:15.9. Of the 1,880 patients operated on between 1975 and 1980, there were 40.2% females and 33.3% males over the age of 24 years. This is an increase over a previous patient group of 2,160 patients treated between 1964 and 1974, in which older women comprised 26.8% and older men 24% of those treated. The proportion of married patients has increased since 1975, with 29.1% of the women married and 11.4% of the men (versus 18.6% and 4.8%, respectively, for the earlier period). Motivating factors included the patient's own desire for a change, external influences such as advice from family or friends, and observation of someone who had undergone rhinoplasty successfully.

Treatment of mild breast asymmetry

Three young woman had mild breast asymmetry that was corrected by a wedge partial subcutaneous mastectomy through a circumareolar incision. Results and patients satisfaction were excellent, with almost no scarring.

Simple method for 60-degree Z-plasty

The 60-degree two-flap Z-plasty is extremely useful and versatile. Its success depends upon accurate construction of the flaps. In the past, the intraoperative measurements required have been either quite involved or quite inaccurate. We present a simple but accurate method for planning the 60-degree two-flap Z-plasty.

Preventing complications of subclavian vein catheterization

The proximity of the subclavian vein to several important structures of the arm, neck and chest make serious complications in subclavian catheterization occur in 0.4% to 9.9% of cases. Complications can be in immediate, chronic and late categories. An understanding of the anatomy, venography and a step-by-step technique of catheterization will help prevent complications and assist the physician in recognizing them when they occur.

Lip and laryngeal flaps for reconstruction of the floor of the mouth following glossectomy

Following glossectomy, the reconstruction of the floor of the mouth is a major problem facing the head and neck surgeon. We have devised split-lip and laryngeal mucosal flaps for this. In selected patients, they have a significant advantage over distant skin flaps. The initial postoperative deformity, from the lip being drawn into the mouth, is corrected by a secondary operation with split-skin graft reconstruction of the vestibule. These lip and laryngeal flaps do not require a delay procedure prior to the cancer surgery, and the operating time is considerably reduced. The cosmetic and functional results have been satisfactory.

Emergency care of the reimplantation patient

Emergency care of the reimplantation candidate involves care of the patient as well as the severed part. The part should be cooled rapidly to 0-4 C (32-39.2 F) after gentle cleansing with normal saline solution or Ringer's lactate. The stump should be gently irrigated with normal saline and pressure dressing applied. The suitability of the reimplantation candidate, chances for survival of the amputated part, and likelihood of eventual rehabilitation should be evaluated.