Arthroplasty of the interphalangeal joint of the great toe using costal osteochondral grafting.

Although many reports have been published on the usefulness of costal cartilage grafting in the reconstruction of interphalangeal joints of fingers, there are only a few published reports on the reconstruction of interphalangeal joints of toes. We describe a 21-year-old woman with a tissue defect of the dorsum pedis and a partial defect of the interphalangeal joint of the great toe caused by a motor-vehicle accident. We attempted arthroplasty using a free latissimus dorsi myocutaneous flap and a costal osteochondral graft. The grafted rib and cartilage survived, allowing the patient to resume functional ambulation for day-to-day activities. Arthroplasty using costal osteochondral grafts seems to be an effective means of reconstructing the interphalangeal joints of toes.

Treatment of osmidrosis with the Cavitron ultrasonic surgical aspirator.

BACKGROUND: Axillary osmidrosis is an uncomfortable condition that can be a personal or social handicap. OBJECTIVE: The objective was to present the treatment of osmidrosis with the Cavitron ultrasonic surgical aspirator (CUSA). MATERIALS AND METHODS: Fifteen patients (3 males and 12 females) underwent surgery for bilateral axillary osmidrosis with the CUSA. RESULTS: The outcome of this operation with the CUSA was evaluated by the patients themselves according to the following criteria. Postoperative improvement was evaluated as good when the odor was decreased by >75%, fair when it was decreased by > or =50 and < or =75%, and poor when it was decreased by <50%. A total of 15 patients (3 males and 12 females) were evaluated. Eight patients (53.3%) had a good result, 6 patients (40%) had a fairly good result, and 1 patient (6.7%) had a poor result. None of the patients experienced any complications, such as skin necrosis, infection, or serous cyst. One dissatisfied patient underwent reoperation and achieved a good result after the second procedure. CONCLUSIONS: This treatment of osmidrosis with the CUSA achieves satisfactory therapeutic efficacy.

A combined flap reconstruction for full-thickness defects of the medial canthal region.

The medial canthus is an aesthetically and functionally important area. Adequate consideration of the local anatomy is essential when reconstructing this area. We developed a combined flap technique with a simple combination of standard flaps for the treatment of extensive defects of the nose and upper and lower eyelids, including full-thickness medial canthus defect. In our technique, a median forehead island flap is used for the nasal region, the anterior surface of the eyelid is reconstructed along aesthetic unit, and the posterior surface is reconstructed with a palatal mucoperiosteal graft. A cheek flap is then used for the reconstruction of the lower eyelid. When reconstructing a small defect of the upper eyelid, the upper eyelid is advanced, while a V-Y advancement flap within the upper eyelid is used for a large defect. To reconstruct the acute angle of the medial canthus, a 0.3 mm titanium wire was passed through the tip of the tarsal plate of the upper and lower eyelids to be reconstructed and was fixed in the perforated nasal bone on the affected side. Using this technique, the acute angle of the medial canthus is well preserved after surgery, and is located symmetrically with its counterpart on the intact side. Our technique provides good reconstructive results and should serve as a valid alternative for the reconstruction of this area.

Aggressive conservative therapy for refractory ulcer with diabetes and/or arteriosclerosis.

A foot ulcer due to diabetes and/or arteriosclerosis obliterans (ASO) frequently results in an intractable condition that resists treatment. To cope with this condition, we have developed a combination therapy that includes conventional conservative therapy plus surgical therapy. This aggressive conservative therapy using aggressive debridement, trafermin (Fiblast Spray, Kaken, Japan) treatment and vacuum-assisted closure (VAC) therapy was adopted to treat seven patients suffering from diabetes and ASO-related refractory foot ulcer accompanied by bone exposure. With the exception of one patient who died during the treatment, the remaining six patients obtained limb salvage. The mean time to cure was 8.3 months. This approach should be considered before amputation. Some patients may refuse amputation or cannot tolerate highly invasive surgical treatment including tissue transplantation. In such cases, this aggressive conservative therapy can be employed as a highly useful and reproducible technique requiring simple techniques.

Accumulation of glucose in keloids with FDG-PET.

OBJECTIVE: Glucose metabolism has not been investigated in human (in vivo) keloids. In the present study, we performed positron emission tomography (PET) with fluorine-18-fluorodeoxyglucose (FDG) to examine glucose metabolism in keloids. MATERIALS AND METHODS: Five patients (2 men and 3 women) with typical keloids having a thickness of more than 5 mm were studied. HEADTOME-IV SET-1400W-10 (Shimadzu, Tokyo, Japan) was employed for PET studies. Transmission scanning was performed on each patient. After fasting for more than 4 hours, the patients were injected intravenously with FDG 185-370 (MBq) following each transmission scan. Emission scans were performed 40-55 min after injection. For quantitative evaluation, the regions of interest (Circles ROIs: 6 mm in diameter) were placed on all the keloid lesions and surrounding tissues, and then their standardized uptake value (SUV = the tissue concentration/the activity injected per body weight) was calculated. RESULTS: FDG was defined as showing the accumulation in keloids when its uptake was relatively higher in the keloid than that in the surrounding tissue. The SUV of the keloids ranged from 1.0 to 2.74, with a mean of 1.79. CONCLUSION: FDG-PET was performed in 5 patients with keloids and low-grade accumulation of FDG was observed in all lesions. This indicated that glucose metabolism was accelerated in keloids.

Improvement of the radial forearm donor site by compression with hydrocolloid dressing and adhesive sponge.

CONCLUSIONS: With our method, general improvement is obtained as compared with traditional split-thickness skin grafting of the radial forearm flap donor site. As our method is simple and easy, the same results can be obtained wherever and by whomever it is performed. OBJECTIVE: The radial forearm flap is associated with complications of graft take and a poor aesthetic appearance despite its usefulness in reconstructing the oral cavity and oropharynx. We describe a simple technique for improvement of the radial forearm donor site. PATIENTS AND METHODS: We studied 12 patients who underwent reconstruction with radial forearm free flaps following resection of oral or oropharyngeal tumors. We covered the donor site defect using traditional split-thickness skin grafts and performed aftercare with a hydrocolloid dressing and an adhesive sponge to retain moisture and apply compression. After the treatment series, color matching, texture matching, depressive deformity, and hypertrophic scar were evaluated. RESULTS: The results of comprehensive evaluation of the two patients with premature discontinuation of compression were good. One patient was assigned only 1 point for hypertrophic scar, and another only 1 point for color match. The evaluation of the other 10 patients was excellent.

Clear-cell hidradenoma of the forearm in a young boy.

We treated a 5-year-old boy with clear-cell hidradenoma of the forearm. Our literature search found only one previous report of this disease occurring during the first decade of life, and the present patient is the first with involvement of the limbs. This presentation demonstrates that clear-cell hidradenoma needs to be considered in the differential diagnosis of cutaneous tumors even in young children, which is of interest because malignant transformation can occur.

Aggressive basal cell carcinoma in the nasal region.

It is extremely rare for basal cell carcinoma (BCC) to metastasize, so it is often only simply excised. However, BCC may cause severe local tissue destruction, which often extends to surrounding muscle, cartilage, and bone; it is then termed "aggressive" BCC. We evaluated the safety margin and the reconstruction method in four cases of nasal BCC that were diagnosed as aggressive BCC histopathologically or by imaging, including magnetic resonance imaging (MRI) and computerized tomography (CT) and then treated by excision. The results showed that the larger the aggressive BCC was, the smaller the histopathological safety margins became. The lateral nasal region was classified into three regions, and individual reconstruction was performed according to anatomical unit, resulting in favorable outcomes. Nasal BCC should be closely examinated, it requires a careful treatment strategy similar to that for other malignant skin tumors.

Q-switched alexandrite laser therapy for pigmentation of the lips owing to Laugier-Hunziker syndrome.

BACKGROUND: Laugier-Hunziker (LH) syndrome is a rare benign condition in which hyperpigmentation of the lips and buccal mucosa occurs with no systemic associations. OBJECTIVE: We report the response to treatment with the Q-switched alexandrite laser (QSAL) because there are few reports on therapy for LH syndrome. METHODS: The QSAL was used for pigmentation of the lips in a 63-year-old woman with LH syndrome. Laser irradiation was done at 5.0 J/cm2 with a 3 mm spot size. RESULTS: There was 100% clearance of pigmentation of the lips with a single laser treatment, and recurrence was not observed after 6 months. CONCLUSION: The QSAL is very effective for pigmentation owing to LH syndrome.

Partial matricectomy with a CO2 laser for ingrown toenail after nail matrix staining.

BACKGROUND: Ingrown toenail is a common nail disease that causes pain, discomfort, and difficulty in walking. It is treated with either conservative therapy or surgery. OBJECTIVE: To present a new surgical approach to ingrown toenail. MATERIALS AND METHODS: For 19 ingrown toenail borders of 14 toes in 14 patients (1 male and 13 females), the nail matrix was stained with methylene blue and then partial matricectomy was performed with a CO2 laser. RESULTS: There was no recurrence at 18 nail borders after a mean follow-up period of 13.4 months, whereas a spike grew at one border but caused no walking pain. No serious complications occurred. Cosmetic improvement was also satisfactory. CONCLUSIONS: Partial nail matricectomy with a CO2 laser after staining the nail matrix with methylene blue allows visual confirmation of the completeness of cauterization.

Mucous-flap method for cleft-lip revision using transverse everted full-length lower-lip flap.

In patients who had undergone the first surgery for cleft lip and in whom the volume of tissue was smaller for the upper lip than for the lower lip, transfer of tissue from the lower lip using a full-length mucous flap allowed the tissue volume of the upper lip to be increased and external appearance of the lips to be improved. The subjects of this study were 6 patients who underwent this surgery between February and September 2001 and were followed for up to 3 years postoperatively. This surgery can be performed under topical anesthesia, without necessitating restriction on mouth opening and oral ingestion. Furthermore, it allows easy adjustment of the tissue volume in both upper and lower lips. This operative procedure is recommended for cases of cleft lip where surgical treatment has been performed before and the tissue volume is smaller in the upper prolabium than in the vermilion.

A splint for pincer nail surgery: a convenient splinting device made of an aspiration tube.

BACKGROUND: To treat pincer nail, both conservative therapy and surgical therapy have been reported. However, there is no consensus about the best method of treatment. OBJECTIVE: The use of a splint prepared from an aspiration tube after pincer nail surgery is introduced. METHODS: Pincer nail was treated by surgery with splinting in seven patients (nine toes). RESULTS: Nine toes from seven patients were evaluated. The postoperative follow-up period ranged from 6 to 37 months (mean 17.7 months). An excellent result was obtained in eight toes, but ingrowth of the nail occurred in one toe. The cosmetic improvement was marked and satisfactory. CONCLUSION: This splint is cheap and easy to make, can prevent contracture of the nail matrix and nail bed, can reduce pain, and allows direct observation of the nail bed because it is transparent. Thus, this technique seems to be convenient and useful.

Expression of damage-induced neuronal endopeptidase (DINE) mRNA in peri-infarct cortical and thalamic neurons following middle cerebral artery occlusion.

Damage-induced neuronal endopeptidase (DINE) is a unique nerve-injury associated molecule, which was recently identified in a peripheral nerve injury model. The aim of this study was to determine the expression profiles and distribution of DINE in adult rats after middle cerebral artery (MCA) occlusion. Focal cerebral ischemia induced late-onset and prolonged expression of DINE mRNA in the peri-infarct cortex and specific nuclei of thalamus. Double labeling using immunohistochemistry and in situ hybridization revealed that DINE mRNA was exclusively expressed in cells that were positive to a neuronal marker NeuN. Previously established knowledge on neuroanatomical fiber connection suggests that DINE mRNA was expressed in areas projecting their axons to or through the core region of the infarction. This unique expression profile was similar to that of activating transcription factor-3 (ATF-3), which is a marker of nerve-injured neuron. More than 98% of ATF-3 immunoreactive neurons simultaneously expressed DINE mRNA, suggesting that DINE expression is observed in injured neurons of CNS as well as PNS. Since DINE expression promotes antioxidant activity, our results suggest that DINE may act as a neuroprotective molecule in neurons under ischemic insult.

Transgenic mouse overexpressing the Akt reduced the volume of infarct area after middle cerebral artery occlusion.

Transgenic mouse lines expressing the active form Akt gene under the control of the damage-induced neuronal endopeptidase (DINE) promoter were made from three different founder mice, and its neuroprotective potential against ischemic brain damage was investigated. Twenty-four hours after middle cerebral artery occlusion, two DINE-Akt-transgenic mouse lines displayed reductions of the infarcted area by 35% compared to the wild-type littermate. RT-PCR assays showed a high level of transgene in response to ischemic brain damage in these lines. These results suggest that the DINE promoter is a useful promoter, which responds to neuronal insults and that the Akt-induced neuroprotective effect against ischemic damage is potent in vivo.

Biphasic expression of activating transcription factor-3 in neurons after cerebral infarction.

It has been demonstrated that some of immediate early genes such as c-Jun are induced immediately and transiently following focal cerebral ischemia. Here we newly characterize the activating transcription factor (ATF)-3 as a focal ischemia associated immediate early gene. Using in situ hybridization and immunohistochemistry, we compared the expression profile of ATF-3 with those of ATF-2 and c-Jun after middle cerebral artery (MCA) occlusion. Focal cerebral ischemia induced two temporal and spatial patterns of ATF-3 expression. Early and transient induction of ATF-3 mRNA was observed in the core and margins of the cortex immediately after MCA occlusion. Late-onset and prolonged expression of ATF-3 mRNA and its protein were specifically identified in the peri-infarct cortex and thalamus where neurons survive at least 1 month. The expression profiles of ATF-3 and c-Jun were virtually similar, but c-Jun expression was also observed in other regions of the brain in control rats. Expression of ATF-2 was ubiquitously seen in neuronal cells throughout the brain in normal rats, but was suppressed in ischemic regions. Double immunohistochemical labeling revealed concurrent expression of ATF-3 and phospho-c-Jun in neurons. We conclude that the transcription factor ATF-3 is a suitable marker of neurons subjected to ischemic insult directly and indirectly, and that cooperative works of ATF-3 and c-Jun may be crucial triggers of various transcriptional responses to the ischemic insult.

Comparison of the neuropathogenicity of two SSPE sibling viruses of the Osaka-2 strain isolated with Vero and B95a cells.

Two sibling viruses, Fr/V and Fr/B, of the subacute sclerosing panencephalitis (SSPE) virus Osaka-2 strain were isolated from a small biopsy specimen of the brain of an SSPE patient by cocultivation with two different cell lines, Vero and B95a cells, respectively. These two sibling viruses differ from each other in their molecular mechanisms of defective M protein expression. In this study, we found that the Fr/B virus could scarcely form syncytium foci on Vero cells, although the Fr/V virus could do so on both Vero and B95a cells, showing a similar relation of cell tropism between recent field isolates and laboratory strains of the measles virus. Severe neurovirulence of both Fr/V and Fr/B viruses was observed in hamsters inoculated intracerebrally with less than 100 PFU, in contrast to the negative neurological and pathological findings in hamsters inoculated even with more than 10(5) PFU of their possible progenitor measles virus. Comparative sequence analysis of inoculated viruses and reisolated viruses from diseased hamster brains showed few variations at a region containing the P-M gene junction, indicating that the inoculated viruses propagated in the brains and induced neurovirulence. All these results suggest that SSPE virus isolated with a lymphoid cell line is similar in neuropathogenicity to that isolated with a nonlymphoid cell lines, irrespective of differences in the molecular mechanism of M protein defectiveness.