Treatment of auricular pseudocyst with aspiration and local pressure.

An auricular pseudocyst is a fluid filled cavity unlined by epithelium in the intracartilaginous space of the ear. Clinically, it presents as a painless outpouching on the upper anterior surface of the auricle with sterile straw coloured fluid found upon aspiration. If left untreated, permanent deformity of the pinna may result. Treatment of the pseudocysts has varied in the literature with techniques involving aspiration alone or incision and drainage; however, due to the high recurrence rates with these methods more aggressive therapies have been instituted. Although these techniques have achieved reasonable results with few recurrences, their invasive nature and chemotherapeutic and toxic agents used have caused significant morbidity. We present treatment of an auricular pseudocyst by simple aspiration and local pressure application using an auricular prosthesis formulated with the creation of a moulage fitted to the ear by our prosthetist. This minimally invasive and simplistic approach can avoid some of the complications related to other therapies, such as cartilage deformity, depigmentation of skin, and scarring and yields optimal cosmetic results.

Increasing diagnostic yield in allergic fungal sinusitis.

Diagnosis of allergic fungal sinusitis (AFS) in patients who present with rhinosinusitis and polyposis is based upon certain clinical, histopathological and mycological histopathological criteria are the demonstration of fungal hyphae in allergic mucin and absence of tissue invasion in the excised polyps. Previous reports have indicated difficulty in demonstrating fungal hyphae on histological examination in up to 75 per cent of cases. Analysis of a series of 25 patients with AFS, suggested methods to ensure demonstration of fungal hyphae and thus increase diagnostic yield in cases with suspected AFS. criteria. Specific diagnostic

The Internet as a source of information on breast augmentation.

The Internet was evaluated as a source of information for the layperson on the topic of breast augmentation. Three commonly used search engines (Excite, AOL, and Yahoo) were employed using the term "breast augmentation." These sites were then evaluated by each of three experienced plastic surgeons for their quality and content. Separately, 17 health Web sites were identified as authoritative by means of recommendation in lay publications. Each "supersite" was accessed, and its search engine was used. The top 10 hits for "breast augmentation" on each site were then evaluated by the senior author for content (Matthews). We found the majority of sites identified by the general search engines (AOL, Excite, Yahoo) to be physician Web sites. Forty-one unique sites were found that applied to the topic. Four of the "hits" did not actually apply to the topic. In general, the applicable Web sites contained limited but accurate procedural details and offered an interactive forum, most commonly email responses. Photographic documentation was given in less than half the sites reviewed, and most of the results shown were only "good" outcomes. Most sites did not discuss any complications of surgical procedures, but those that did were usually accurate. Eighty-three percent of the sites were biased toward a particular surgical technique. The reviewers believe that only about 15 percent of the sites were acceptable to recommend to their patients. The senior author accessed 17 Web sites that are considered authoritative health information Web sites. Each of these sites was searched for information on breast augmentation by means of its internal search engine. Only 29 percent (5 of 17) had any information in their top 10 hits. Three sites had only chat transcripts. One site had limited but accurate information with a link to the American Society of Plastic Surgeons, and one site had scientific information on product safety. No site met the criteria of accurate, complete information on the surgical procedure of breast augmentation. This study demonstrates that it is difficult for the average layperson to get authoritative information quickly and easily on at least one aspect of cosmetic surgery.

Abdominal wall reconstruction with an expanded rectus femoris flap.

The expanded rectus femoris flap has several advantages for massive abdominal wall reconstruction. The expanded flap can easily reach the xyphoid, and it has impressive width. The donor site can be closed primarily with an acceptable scar. The muscle remains innervated and functional, which may help prevent bulging. When performing the surgery in conjunction with intra-abdominal procedures, such as fistula repair, a simultaneous two-team approach can be used without awkward positioning. The expansion provides some thinning of the muscle, providing a contour more like that of the native abdomen. Its use should be considered in cases of abdominal wall defects extending above the umbilicus.

Prenatal pressure necrosis of the scalp.

A case of full-thickness pressure necrosis of the scalp in a newborn is reported. This is a rare injury, with only four similar prior reports found in the literature. The presumed mechanism of injury is pressure of the infant's head against the mother's bony pelvis. A spectrum of injury can be seen, from temporary alopecia to complete scalp necrosis. Risk factors include prolonged ruptured membranes and prolonged labor.

Site-specific immunosuppression using a new formulation of topical cyclosporine A with polyethylene glycol-8 glyceryl caprylate/caprate.

PURPOSE: Dermal application of immunosuppressants can be an effective means of achieving site-specific immunosuppression (SITE) on skin allografts in burn wound management and in the treatment of various immune skin disorders. We have previously reported success with topical cyclosporine A (tCsA) in the treatment of skin allograft rejection in rats. Using a new tCsA formulation with a penetration enhancer (PE), polyethylene glycol-8 (PEG-8) glyceryl caprylate/caprate (Labrasol, Gattefossé, St. Priest, France), in a trinary drug delivery system, we hypothesized that we would induce SITE and significantly delay rejection of dual skin allografts in rats. METHODS: Dual rat skin allografts from Lewis x Brown-Norway (LBN) donors were grafted to Lewis (Lew) recipients. Experimental animals (EXP, n = 7) received a 10-day course of systemic cyclosporine (sCsA, 8 mg/kg/day) followed by topical application. One of the two allografts on each experimental animal received tCsA/PE application (5 mg/kg/day) until sacrifice (tCsA/PE-treated). The other allograft received vehicle only (vehicle-treated). Allogeneic controls (ALLO-CON, n = 9) received no sCsA or tCsA. First signs of rejection were determined based on the initial observation of erythema, hair loss, flakiness, and/or scabs. RESULTS: The mean time to rejection for ALLO-CON allografts was 6.3 +/- 0.7 days (t test, P = 0.0013); for vehicle-treated allografts, 12.3 +/- 3.8 days (paired t test, P = 0.0146); and for tCsA/PE-treated allografts, 25.6 +/- 5.4 days. The disparity of days to rejection between dual allografts in the ALLO-CON group was 0.0 +/- 0.0 day and that between the tCsA/PE- and vehicle-treated dual allografts was 13.3 +/- 3.9 days (t test, P = 0.0016). CONCLUSIONS: A new formulation of tCsA in a trinary drug delivery system is successful at delaying the onset of rejection in dual skin allografts in rats by SITE, and PEG-8 glyceryl caprylate/caprate may represent a potentially effective transdermal penetration enhancer.

A teaching device for Furlow palatoplasty.

The Furlow double-opposing z-plasty technique of palate repair has become a common treatment for cleft palate. The procedure is more complicated than other methods of palate closure and is difficult for the trainee to visualize; It is even more difficult for the layperson without prior understanding of the concept of z-plasty to understand. A simple, inexpensive, portable model is described that shows the key elements of the repair and can be used for parent, patient, student, and resident teaching.

Prenatal counseling for cleft lip and palate.

Prenatal diagnoses of cleft lip and palate can occur during both routine screening obstetrical ultrasound and high resolution obstetrical ultrasound done for other reasons. The affected family or obstetrician may request prenatal consultation with the plastic surgeon. To define this population, a survey was done of all families who were referred to our cleft program with a prenatal diagnosis of cleft between 1990 and 1994. Of 80 newborn referrals, 13 had a prenatal diagnosis of cleft. These children had a higher incidence of bilateral cleft than our average population (53.8 percent versus 28.7 percent, p < 0.03, chi square test). No isolated cleft palates were identified. Nine families were available for follow-up. Only one-third of the families felt that they had been given adequate information about clefts from their obstetrician or ultrasonographer. All who had prenatal contact with the cleft team felt it was valuable. A review of prenatal diagnosis of cleft is given including limitations. Specific counseling information is discussed.

Plastic surgical considerations in lighting injuries.

Lightning injuries affect 1,000 to 1,500 people per year in the United States. While fatalities are uncommon, lightning frequently causes injuries within the treatment purview of the plastic surgeon. Recognition of common patterns of lightning injury, their prognosis, and treatments are important for the plastic surgeon. Lightning injury, although electrical, is very different from other more common electrical injuries. Burn injuries are seen, but are usually superficial and heal without surgery. Deep-tissue injury is rare. Neurovascular compromise of the extremities is common and may lead to plastic surgical consultation for intervention. Spontaneous recovery is the rule, however. Several patients are described who illustrate these injuries, and treatment guidelines are proposed.

Environmental isolation of Cryptococcus neoformans var. neoformans from Vellore.

We have isolated C. neoformans from various environmental niches, including our hospital environment. Twenty one samples of weathered pigeon droppings and 86 samples of Eucalyptus bark and debris were collected from various sites around the hospital and college. C. neoformans var. neoformans was isolated from 14 of the 21 (67%) samples of weathered droppings of pigeons collected from the ledges of windows of wards and departmental buildings in the hospital. C. neoformans was not isolated from any of the Eucalyptus samples. These findings document for the first time the presence of C. neoformans var. neoformans in the hospital environment. Although ubiquitous in the environment, its presence in hospital surroundings stresses the need for systematic cleaning of sites inhabited by pigeons. However, we failed to isolate C. neoformans from the limited number of Eucalyptus samples examined.

Nasal reconstruction with autologous rib cartilage: a 43-year follow-up.

Autogenous costal cartilage has long been a popular material for nasal augmentation. The history of autogenous cartilage transplantation is reviewed. Two patients are presented who underwent nasal augmentation with autologous costal cartilage with a 43-year follow-up on each patient.

Regions of the cloned Vibrio cholerae rfb genes needed to determine the Ogawa form of the O-antigen.

The O-antigen of the lipopolysaccharides of Vibrio cholerae 01 can exist in two forms termed Inaba and Ogawa. We used a complementation system to demonstrate that the Ogawa phenotype is dominant over the Inaba phenotype. By using a set of deletions affecting the Ogawa rfb genes, we identified two regions which are needed to confer the Ogawa phenotype. In vitro mutagenesis of the cloned Ogawa rfb genes resulted in the isolation of variants with the Inaba phenotype. The results are interpreted with respect to previous studies demonstrating interconversion between the two forms of the V. cholerae O-antigen.

Cholelithiasis: a differential diagnosis in abdominal "crisis" of sickle cell anemia.

A review of the most recent literature on biliary tract disease in sickle cell (HbSS) disease has shown gallstones to be present in approximately 67 percent of affected patients. There is adequate evidence to urge all physicians to be aware of the contributions of gall bladder disease to the abdominal symptoms of sickle cell anemia. Frequently, because it is difficult to distinguish between the painful "crises" and gall bladder disease, the latter diagnosis is not considered.This article submits that investigative procedures of the gall bladder, in all patients with HbSS disease and abdominal crises, should be performed. If gallstones are present, elective cholecystectomy in the adequately prepared patient seems to be justified.

The effect of peripherally fenestrated contact lenses on corneal edema.

To determine the effect of peripherally fenestrated contact lenses on central corneal edema, 6 subjects (12 eyes) wore steeply fitted lenses of identical dimensions but with various numbers of 0.1-mm diameter peripheral fenestrations for 3-hr periods. At the end of the wearing periods, thickening, steepening, and central clouding of the cornea were generally reduced as the number of fenestrations was increased. However, 20 fenestrations were required before the edema was reduced to a clinically acceptable level.