Characterization of mouse switch variant antibodies by matrix-assisted laser desorption ionization mass spectrometry and electrospray ionization mass spectrometry.

The amino acid sequences of mouse monoclonal antibodies have been characterized completely by mass spectrometry. Antibodies used in the present study were derived from mouse switch variant cell lines that produce four kinds of immunoglobulin Gs (IgGs). The amino acid sequences of these antibodies had not been estimated from the corresponding DNA sequence, so the sequences of IgGs derived from other strains were used as references in this study. Intra- and interchain disulfide bonds of the IgGs were reduced and carboxymethylated and the products were subjected to proteolytic digestion. The existence of N-linked oligosaccharides also was taken into account. The capabilities and limitations of matrix-assisted laser desorption ionization-time-of-flight mass spectrometry and capillary liquid chromatography-electrospray ionization mass spectrometry are discussed in the structural characterization of the antibodies. Based on our results, allotypes of the antibodies examined are discussed. This study shows that amino acid sequences of proteins, such as IgG, can be investigated without information about the corresponding DNA sequence if appropriate reference sequences derived from other strains can be used.

Reconstruction of incomplete syndactyly of the toes using both dorsal and plantar flaps.

A new modified method for surgical correction of simple incomplete syndactyly of the toes has been devised. This procedure involves both a dorsal and a plantar skin flap and does not require a skin graft. Reconstruction of syndactyly using only skin flaps situated near the toes almost always results in skin deficiency. Use of a plantar flap from the sole provides sufficient skin for one toe and can be closed primarily. Fourteen cases involving 11 patients have been treated by this method, which is described herein.

Umbilical reconstruction after repair of omphalocele and gastroschisis.

This article presents our technique of umbilical reconstruction after the repair of omphalocele and gastroschisis. We have treated 8 patients with an average follow-up period of 13 months (range, 6 approximately 24 months). No major complications have occurred; minor complications have included delayed wound healing, decreased umbilical depth, and hematoma. Our procedure is especially useful for patients who have a midline abdominal scar and relatively intact bilateral rectus abdominis muscles. Most of the patients and their parents have been satisfied with the results of umbilical reconstruction.

The outcome of long-term follow-up after palatoplasty.

The speech outcome was studied retrospectively in 140 cleft-palate patients who underwent push-back palatoplasty. Velopharyngeal function and articulation disorders were evaluated serially at 4, 7, 10, and more than 10 years of age. On comparison of velopharyngeal function between 4 years of age and the most recent review (>10 years), it was unchanged in 90 patients (64.3 percent), whereas it showed deterioration in 14 patients and showed improvement in 8 patients. The other 28 patients underwent pharyngeal flap surgery; this group also included patients with functional deterioration. Changes of velopharyngeal function often occurred between 4 and 7 years of age but sometimes occurred after 10 years of age. Articulation disorders were observed in 49 subjects (35.0 percent) at 4 years of age. Many of the patients with glottal stop showed improvement from 4 to 7 years of age. Palatalized articulation showed less improvement than glottal stop (p < 0.01). The number of patients with articulation disorders decreased significantly between 4 years of age and the most recent review (p < 0.001). These findings suggest that speech does not become stable before 10 years of age and that patients with cleft palate should be carefully followed until they are beyond this age.

A retrospective study of speech development in patients with submucous cleft palate treated by four operations.

Fifty patients with submucous cleft palate (SMCP) who had had four different operations were reviewed. The operations were pushback palatoplasty (n = 18), pharyngeal flap (n = 21), pushback palatoplasty combined with a pharyngeal flap (n = 8), and Furlow palatoplasty (n = 3). Postoperatively the speech of 8, 19, 7, and 2 patients, respectively, improved so that it was within normal limits. A secondary pharyngeal flap was done for six patients, each of whom had previously had a pushback palatoplasty. They all improved, five achieving relatively normal speech, and one good speech. No patient developed hyponasality or airway compromise associated with the pharyngeal flap. The results show that pharyngeal flap and pushback palatoplasty combined with a pharyngeal flap seem to be more reliable procedures than pushback palatoplasty for patients with SMCP.

Reduction of peritonitis with the rectus abdominis muscle flap in a CAPD patient.

An adolescent maintained on continuous ambulatory peritoneal dialysis (CAPD) for 8 years had relapsing peritonitis involving peritoneal catheter tunnel infections. We attempted catheter removal and replacement simultaneously, with the catheter covered cylindrically by a rectus abdominis muscle flap to prevent recurrent tunnel infections. During 3 years of follow-up, there have been no episodes of peritonitis involving tunnel infection. Our modified insertion technique can eradicate tunnel infection, thus reducing peritonitis.

Full-thickness skin graft from the ulnar aspect of the wrist to cover defects on the hand and digits.

Skin defects on the volar surface of the hand and digits are commonly treated with skin grafts. Many donor sites capable of providing adequate skin have already been reported. Ideal conditions for the donor site depend on skin color, texture, durability, and size. The authors describe the use of a new donor site for harvesting skin grafts to repair relatively small skin defects on the hand and digits. They used full-thickness skin grafts from the ulnar aspect of the wrist to reconstruct burn contractures and syndactyly in 20 patients. Their grafts provided an ideal color and texture match, and normal function of the hand and digits was restored. The donor site was closed directly, and the resulting scar was inconspicuous.

Repair of mild umbilical hernia.

A mild, persistent umbilical hernia that does not cause any functional problem is often ignored. The authors have devised a new technique to treat the mild, protrusive deformity of the umbilicus without associated complications. In this report, the new operative procedure is introduced. The authors have treated 72 patients with this method and have obtained good results.