The postauricular cutaneous advancement flap for repairing ear rim defects.

BACKGROUND: Due to the ear's complicated anatomy and closely adherent anterior skin, repairing ear rim defects is often difficult. OBJECTIVE: We describe a simple postauricular cutaneous advancement flap for correcting ear rim defects of varying sizes. METHODS: Skin tumors involving the ear rims of 12 patients were excised. A postauricular cutaneous advancement flap was designed to correct the resulting defects. RESULTS: The postauricular cutaneous advancement flap provided excellent cosmetic results in our 12 patients. Minimal superficial necrosis of the flap was observed in one patient. CONCLUSION: Utilizing relatively loose postauricular skin, this postauricular advancement flap can cover helical rim defects of varying sizes with excellent cosmetic results and low complication rates.

Morton's interdigital neuroma: a comprehensive treatment protocol.

One hundred fifteen patients with signs and symptoms of Mortons' interdigital neuroma were studied in an attempt to evaluate the efficacy of a staged treatment program. The first stage consisted of patient education, footwear modifications, and metatarsal head relief. The second stage consisted of a steroid/local anesthetic injection into the affected interspace. The third stage was surgical excision of the inflamed interdigital nerve. Overall, 97 of 115 patients (85%) believed that they had improved with the treatment program. Twenty-four patients (21%) eventually required surgical excision of the nerve and 23 of 24 patients (96%) had satisfactory results. The results of the staged treatment protocol were very satisfactory and patient satisfaction was high.

Conservative treatment of plantar heel pain: long-term follow-up.

In order to evaluate the long-term results of patients treated conservatively for plantar heel pain, a telephone follow-up survey was conducted. After eliminating those patients with worker's compensation-related complaints and those with documented inflammatory arthritides, data on 100 patients (58 females and 42 males) were available for review. The average patients was 48 years old (range 20-85 years). The average follow-up was 47 months (24-132 months). Clinical results were classified as good (resolution of symptoms) for 82 patients, fair (continued symptoms but no limitation of activity or work) for 15 patients, and poor (continued symptoms limiting activity or changing work status) in 3 patients. The average duration of symptoms before medical attention was sought was 6.1, 18.9, and 10 months for the three groups, respectively. The three patients with poor results all had bilateral complaints, but had no other obvious risk factors predictive of their poor result. Thirty-one patients stated that, even with the understanding that surgical treatment carries significant risk, they would have seriously considered it at the time medical attention was sought; twenty-two of these patients eventually had resolution of symptoms. Although the treatment of heel pain can be frustrating due to its indolent course, a given patient with plantar fasciitis has a very good chance of complete resolution of symptoms. There is a higher risk for continued symptoms in over-weight patients, patients with bilateral symptoms, and those who have symptoms for a prolonged period before seeking medical attention.

Triple arthrodesis in adults.

Twenty-two adult patients who underwent a triple arthrodesis because of hindfoot pain and/or deformity were reviewed retrospectively with a minimum 3-year follow-up. All procedures were performed by the same surgeon using a two-incision technique and internal fixation. Objective results were good in eight (36%) patients, fair in 13 (59%), and poor in one (5%). There were two asymptomatic nonunions of the talonavicular joint, no infections, and no neuromas. Eleven patients had radiographic evidence of tibiotalar arthritis, and eleven patients had midfoot arthritic changes that had progressed after the operation. Patient satisfaction with the procedure was high, and 21 of 22 (95%) patients felt that they were improved overall and would have the surgery again if indicated. Although the procedure is technically demanding, patient satisfaction is high and complications can be kept to a minimum if proper surgical technique is utilized.

Correction of hallux valgus with metatarsocuneiform stabilization.

51 feet in 30 patients were evaluated clinically and radiographically an average of 27.6 months after undergoing a modified McBride bunionectomy with a metatarsocuneiform stabilization. An inlay block of bone was used after achieving corrected position of the first metatarsal. The retrospective review included an anteroposterior x-ray, in which definite trabecular bridging was present in only 25.5% of the cases. The metatarsocuneiform joint was asymptomatic regardless of its x-ray appearance. The average intermetatarsal angle was reduced from 14.6 degrees to 8.7 degrees. This procedure attempts to restore near-normal anatomy, thereby preventing transfer metatarsalgia from shortening or elevation of the first metatarsal. Acceptable correction is possible in both moderate and severe deformities.

Corrective shoes and inserts as treatment for flexible flatfoot in infants and children.

We performed a prospective study to determine whether flexible flatfoot in children can be influenced by treatment. One hundred and twenty-nine children who had been referred by pediatricians, and for whom the radiographic findings met the criteria for flatfoot, were randomly assigned to one of four groups: Group I, controls; Group II, treatment with corrective orthopaedic shoes; Group III, treatment with a Helfet heel-cup; or Group IV, treatment with a custom-molded plastic insert. All of the patients in Groups II, III, and IV had a minimum of three years of treatment, and ninety-eight patients whose compliance with the protocol was documented completed the study. Analysis of radiographs before treatment and at the most recent follow-up demonstrated a significant improvement in all groups (p less than 0.01), including the controls, and no significant difference between the controls and the treated patients (p greater than 0.4). We concluded that wearing corrective shoes or inserts for three years does not influence the course of flexible flatfoot in children.

Oxygen binding of modified hemoglobins in solution.

SFHS modified by covalent incorporation of pyridoxal phosphate using NaCNBH3 as reducing agent had P50 values of 21-25mm Hg, and was insensitive to the addition of BPG. The Hill slope of the modified product was 2.34, demonstrating good functional cooperativity of the subunits. Oxygen carrying capacity, calculated as the ratio of O2 content to the concentration of functional hemoglobin, was found to be about 1.3, very close to the "textbook" ratio of 1.34 for whole blood. These values were achieved with oxygen saturation values over 90% and methemoglobin levels of less than 3%. The results obtained from pyridoxalation using NaCNBH3 contrasted sharply with those obtained using NaBH4, which yielded a product having high oxygen affinity and high methemoglobin values. This latter product was poorly saturated with oxygen at ambient pressures and demonstrated a significantly lowered oxygen carrying capacity. The NaBH4 product was also insensitive to the addition of BPG; the reason for this was not ascertained. SFHS-P by the borohydride method thus exhibited marked deficiencies relative to that prepared with cyanoborohydride, as defined by the characterizations employed for this study.

Membranolytic effects of crystalline monosodium urate monohydrate.

We studied the effect of heat treatment and subsequent rehydration of heated monosodium urate monohydrate (MSUM) crystals on the physicochemical characteristics and ability of the crystals to cause hemolysis of erythrocytes (measure of membranolytic potential). MSUM crystals dehydrated slowly on heating at 200 degrees from 1-5 h and rehydration to 100% monohydrate was complete within 30 min. Heating at 250 degrees for 2 h caused rapid dehydration to anhydrous MSU and rehydration was incomplete up to 17 h. Zeta potential and percent hemolysis of MSUM crystals decreased after heating and rehydration. This reduction in percent hemolysis may be due to the reduction in surface potential (measured as zeta potential) of the crystals.

Foot growth rate in children age one to six years.

Previous guidelines suggested that children age 2 to 6 years require a shoe size change every 1 to 2 months. Our study of foot growth in 112 children enrolled in a prospective treatment protocol for flatfoot demonstrates that children age 12 to 30 months will require shoe size change every two to three months but that foot growth slows over the subsequent four years, necessitating shoe size change only every 4 months in children up to 4 years of age and every 6 months in children from age 4 to 6 years.

Morphological and functional differentiation of Kirsten murine sarcoma virus-transformed rat adrenocortical cell lines.

This study was undertaken to examine relationships of the phenotype of malignant cells to target cell properties and to events early in the transformation process. Eighteen transformed lines were obtained by Kirsten murine sarcoma virus infection of cells from adrenal glands of rats ages 4 to 30 weeks, at first or second passages in culture. They were grown either as fibroblastic adrenocortical stem cells or as more differentiated epithelial cells, depending on culture conditions. Of 14 lines examined for their capacity to synthesize corticosteroids, 11 converted [14C]pregnenolone to progesterone, and one converted to deoxycorticosterone. In vivo, seven lines produced tumors resembling pleomorphic carcinomas, six lines grew as sarcomas, four grew as mixed tumors, and one line produced anaplastic tumors. Distinguishing features in culture of the carcinoma-producing lines were early onset and rapid progression of morphological transformation, a noncohesive epithelial cell form in some lines, lack of extracellular matrix, and, possibly, and origin in older animals. In contrast, sarcoma-producing cells were fibroblastic and cohesive, produced extracellular matrix, and transformed morphologically after longer and less well-defined periods in culture. The variation in histopathology was unrelated to the differentiation of the target cells and to the capacity of the transformed cells to synthesize corticosteroids. The results show that adrenocortical cells, transformed by Kirsten murine sarcoma virus after short-term culture, usually retain some functional differentiation and sometimes resemble human adrenocortical carcinomas histologically. The susceptibility of adrenocortical cells to Kirsten murine sarcoma virus raises the possibility that mesodermally derived epithelia in general may be target tissues for C-type sarcoma viruses.

Regulation by calmodulin of the calcium affinity of the calcium-transport ATPase in human erythrocytes.

The Ca2+ affinity of (Mg2+ + Ca2+)-ATPase in human red blood cells is regulated by a number of intracellular factors, including the association of the enzyme with the cytosolic Ca2+ binding protein, calmodulin. Ghosts prepared by hypotonic lysis in the presence of 0.1 mM CaCl2, or by a gradual stepwise hemolysis procedure, contain an EDTA-extractable protein whose effects are mimicked by calmodulin, whereas ghosts prepared by extensive washes in the absence of added CaCl2 lack calmodulin and contain only a high molecular weight heat stable activator. Purified calmodulin from human red cells or bovine brain shifts the apparent Ca2+ affinity of (Mg2+ + Ca2+)-ATPase activity in extensively washed ghosts to a high Ca2+ affinity state. The shift was most apparent in ghosts in which the Ca2+ affinity was decreased by EDTA treatment. Calmodulin increased the velocity of (Mg2+ + Ca2+)-ATPase in the EDTA-treated ghosts about 36-fold at a low (1.4 microM) Ca2+ concentration, compared with 6-fold before EDTA treatment. The maximum shift in apparent Ca2+ affinity occurred only in the presence of saturating concentrations of calmodulin. It is concluded that red cell calmodulin confers to the Ca2+ transport ATPase the ability to increase its apparent Ca2+ affinity, as well as its maximum velocity, in response to increases in intracellular Ca2+.

A protein activator of Mg2+-dependent, Ca2+-stimulated ATPase in human erythrocyte membranes distinct from calmodulin.

Treatment of extensively washed erythrocyte membranes with 0.1mm-EDTA decreased their Mg(2+)-dependent, Ca(2+)-stimulated ATPase [(Mg(2+)+Ca(2+))-ATPase] activity. An activator released by this treatment restored the (Mg(2+)+Ca(2+))-ATPase to its original value in a Ca(2+)-dependent manner. This activator was different from calmodulin, as determined by a number of criteria. It was retained on an Amicon XM-100 ultrafiltration membrane (molecular-weight cut-off 100000); it appeared in the void volume of Sephadex G-100 and G-75 columns; it was not retained on a DEAE-cellulose ion-exchange column at ionic strengths similar to those used to retain calmodulin; and it maximally activated (Mg(2+)+Ca(2+))-ATPase activity less than calmodulin and at a higher Ca(2+) concentration. Like calmodulin, the activator is heat-stable. The activator fraction isolated on a 2.5-15% sucrose gradient in 0.16m-KCl showed a single band of mol.wt. 63000 and no calmodulin on 10%-polyacrylamide/sodium dodecyl sulphate gels. A trace amount of calmodulin was detected in the activator fraction by radioimmunoassay (approx. 10pg/ml of ;ghosts'), but this amount was insufficient to account for the (Mg(2+)+Ca(2+))-ATPase activation. Furthermore, calmodulin-binding protein failed to inhibit (Mg(2+)+Ca(2+))-ATPase activity by more than 10-20% in the membrane preparations from which the activator was extracted. It was concluded that erythrocyte membranes contain a (Mg(2+)+Ca(2+))-ATPase activator that may attenuate the activation of the Ca(2+)-transport ATPase by calmodulin.

Protrusio acetabuli in Marfan's syndrome.

In an unselected series of 14 patients with Marfan's syndrome, protrusio acetabuli was documented by both presence of a center edge (CE) angle of 40 degrees or more and crossing of the teardrop by the femoral head. The disorder was unilateral in 8 patients, bilateral in 6. Since most of the CE angles were measured on scoliosis roentgenograms, the measurements were made in a control group with an average CE angle of 33.1 degree, compared with an average of 43.4 degree in the Marfan's group. One of the hips with protrusio was associated with chondrolysis. Protrusio acetabuli is a common abnormality of persons with Marfan's syndrome. It may be related to the same mesenchymal tissue disorder that predisposes these persons to scoliosis, chest wall deformities, and other skeletal malformations.

Exercise cardiac output following Skylab missions: the second manned Skylab mission.

Cardiac output was measured during preflight and postflight exercise-stress tests on the Skylab astronauts. In the postflight tests immediately following the 28-, 59-, and 84-d earth orbital missions, the astronauts exhibited an approximate 30% decrease in cardiac output coupled with an approximate 50% decrease in cardiac stroke volume during exercise. These changes were accompanied by elevated heart rates and significant (p less than 0.01) increases in total systemic peripheral vascular resistance. Mean arterial pressure was unchanged. The hemodynamic alterations were transient in that all parameters returned to normal preflight values within 30 d of the end of the orbital period. Duration of the zero-G exposure did not appear to influence either the magnitude of the hemodynamic changes or the time-course of their return to normal. These results are discussed in relation to other cardiovascular findings and possible mechanisms responsible for the observations are outlined.

Physiological response to exercise after space flight--Apollo 14 through Apollo 17.

Submaximal exercise stress tests were conducted preflight and postflight on the Apollo 14-17 crewmen. A bicycle ergometer was utilized to evoke target heart rates up to 160 beats/min while respiratory gas exchange, blood pressure, and cardiac output were measured. Three preflight tests were conducted during the month prior to flight to establish baseline values for postflight comparisons. Tachycardia was evidenced at rest and during exercise immediately postflight. This transitory tachycardia compensated for reduced stroke volume. Systolic blood pressure was reduced during exercise stress, but no consistent changes were observed in diastolic blood pressure. With the exception of the Apollo 15 crewmen, all crewmen had returned to preflight response levels by the day of following recovery. No changes were observed in mechanical or respiratory efficiency immediately postflight.