Temporary cosmetic painted prostheses in anophthalmic surgery: an alternative to early postoperative clear conformers.

PURPOSE: To evaluate the use and safety of temporary, cosmetic, painted prostheses as an alternative to clear conformers immediately post removal of eye or socket surgery in children and adults. PATIENTS AND METHODS: A 2-year, two-centre, retrospective audit of 54 patients undergoing enucleation, evisceration, secondary implant or socket reconstruction receiving a temporary painted prosthesis as an alternative to clear conformers immediately post surgery. Patient questionnaire and review of clinical notes was conducted for all patients. RESULTS: We reviewed 54 consecutive patients (22 females, 32 males, mean age 18.6 years, range 6 days to 82 years) who received cosmetic painted prostheses from January 2009 to December 2010. Procedures included: evisceration with primary implant (5), enucleation with primary implant (37), secondary implant (9), dermis fat graft (2) and fornix reconstruction with buccal graft (1). Complications included: pyogenic granuloma (2), mucous discharge (2) and exposure (2). All adults found their prosthesis comfortable, and no problems were reported by the parents of the children included in this study. In all, 46 patients (88% of respondents) returned to normal activities within 2 weeks. The temporary prosthesis fell out at least once in 25% of cases. In all, 90% of respondents expressed a definite preference towards the painted shell over a clear shell. CONCLUSION: Temporary cosmetic painted prostheses placed immediately after removal of the eye or socket surgery are well tolerated and preferred to standard clear shells. Painted prostheses, matched to the contralateral iris are a valuable option in anophthalmic surgery as an alternative to traditional clear conformers.

The diabetic foot: magnetic resonance imaging evaluation.

Fourteen diabetic patients with suspected foot infection and/or neuropathic joint (Charcot Joint) were evaluated with magnetic resonance imaging (MRI) in an attempt to assess the extent of the infection and also to distinguish infection from the changes seen with neuroarthropathy. The majority of patients with infection had more than one site of involvement and the following diagnoses were made by MRI evaluation: osteomyelitis (n = 8), abscess (n = 7), neuropathic joint (n = 5), septic arthritis (n = 4), and tenosynovitis (n = 4). Clinical or surgical/pathological confirmation of the MRI diagnoses was obtained in all but nine sites of infection or cases of neuropathic joint. If the two diagnostic categories of septic arthritis and tenosynovitis are excluded, all but four of the MRI diagnoses were confirmed. A distinctive pattern for neuroarthropathy was identified in five cases, consisting of low signal intensity on T1- and T2-weighted images within the bone marrow space adjacent to the involved joint. We conclude that MRI is a valuable adjunct in the evaluation of the diabetic foot, and that it provides accurate information regarding the presence and extent of infection in this subset of patients. MRI has proven particularly helpful in differentiating neuroarthropathy from osteomyelitis.

Experimental infections of the musculoskeletal system: evaluation with MR imaging and Tc-99m MDP and Ga-67 scintigraphy.

Acute osteomyelitis, soft-tissue infection, or both were experimentally produced in 38 New Zealand white rabbits, and three-phase technetium-99m methylene diphosphonate, gallium-67, and magnetic resonance (MR) images were obtained 7 or 14 days after infection. There was no significant difference between radionuclide studies and MR images in the detection of osteomyelitis, but MR imaging was significantly more sensitive (100% vs. 69%; P less than .01) in the detection of soft-tissue infection. In addition, cellulitis could not be distinguished from soft-tissue abscess on radionuclide studies, whereas MR imaging was 92% accurate in depicting soft-tissue abscesses. Further research is necessary to determine how to relate these findings to true human clinical situations.

Infections of the musculoskeletal system: high-field-strength MR imaging.

Twenty-two patients with clinical findings consistent with osteomyelitis, soft-tissue infection, or both were studied with magnetic resonance (MR) imaging at 1.5 T. Another 15 patients with joint effusion but no clinical or laboratory signs of infection served as controls. Soft-tissue abscesses, osteomyelitis, joint and tendon sheath effusion, and cellulitis were well depicted on MR imaging, allowing the correct diagnosis of presence and extent of infection in all but two cases. MR imaging was as sensitive as technetium-99m methylene diphosphonate bone scintigraphy in demonstrating osteomyelitis and was more specific and more sensitive than other scintigraphic techniques in demonstrating soft-tissue infections, primarily because of its superior spatial resolution. Computed tomography, performed in seven cases, was as accurate as MR imaging in demonstrating bone and soft-tissue infections. Infected and noninfected synovial effusions had the same signal intensity, but associated findings such as soft-tissue fluid collections or osteomyelitis made the distinction possible.

Nerve injuries: management and rehabilitation.

The final result of nerve repair depends on the technique of repair, postoperative rehabilitation, and patient motivation. The first two aspects are largely in the control of the surgeon, whereas the significant aspect of patient motivation is controlled by the patient and the therapist together.

Management and rehabilitation of extensor tendon injuries.

The keys to the treatment of extensor tendon injuries are knowledge of the anatomic characteristics of the area, the correct position of immobilization of the wrist and fingers, and the timing for institution of active and resistive exercises.

Human chromosomal heteromorphisms in American blacks. VI. Higher incidence of longer Y owing to non-fluorescent (nf) segment.

Sixty normal male American blacks were selected to study the length of fluorescent (f), non-fluorescent (nf), and total length of the Y chromosome by the QFQ technique. The length of the Y chromosome was classified into five groups: very small, small, average, large, and very large. The frequencies of Y/F indices for these groups were 0.0, 3.33, 56.67, 30.00, and 10.00%, respectively. The variation in the total length of the Y chromosome was accounted for by variations in the length of the nf as well as the f segment. A longer Y was noted in blacks owing to an increase in size of the nf segment in comparison with a normal Caucasian population. Forty percent of American blacks had large or very large Y chromosomes, while this class comprised only 18.3% of Caucasians, which is significantly different (p less than 0.05). Furthermore, the length of the Y chromosome was normally distributed among Caucasians, while among blacks the distribution was skewed to the left. The mean Y/F, f/F, and nf/F indices were 1.09 +/- 0.10, 0.42 +/- 0.09, and 0.67 +/- 0.04, respectively.

High performance liquid chromatographic determination of sorbic acid in wine.

A method is described for the qualitative and quantitative determination of 2,4-hexadienoic acid (sorbic acid) by high performance liquid chromatography (HPLC). The results show excellent reproducibility (+/- 2.55%) and agree well with values obtained using the official AOAC ultraviolet method for both fortified wine and commercial wines. Sorbic acid is separated by HPLC, using a strong anion exchange resin, Zipax SAX, eluted with 0.01M Na2B4O7, and detected using UV (254 nm) detector. Sodium benzoate is used as an internal standard.