Excision of epithelial tumors: CO2 laser versus conventional methods.

In a comparative experimental study, excisions of a transplanted Lewis lung carcinoma in BDF1 mice were performed by means of the CO2 laser and conventional methods, namely common scalpel and diathermy. The results showed a significant reduction in tumor recurrence and animal mortality rates (27.5% vs. 75% and 45%) after tumor excision with the laser in the early stage (5th day) of tumor development. This finding, in addition to the surgical properties of the CO2 laser, suggests that early excision using this modality is a rational treatment of this type of tumor.

Gender differences in platelet count and its association with cigarette smoking in a large cohort in Israel.

Cigarette smoking has an effect on platelet function and aggregation although the sensitivity of platelet count in reflecting this phenomenon is not known. The association of platelet count with smoking habits was examined in a cohort of 5017 Israeli industrial workers aged 20-64 years. Males had a significantly lower age-adjusted mean platelet count than females (225,600 vs 247,800/microliters; p less than 0.001). Female smokers had lower platelet counts than non-smokers (231,000 for heavy vs 252,000 for never smokers) with a strong dose-response relationship (p less than 0.0001), whereas among males platelet count was slightly higher in smokers (224,000 for non-smokers vs 227,000 for heavy smokers; p = 0.243). The difference in platelet count between the sexes remained almost identical after controlling for smoking status and hematocrit. In multiple regression analysis, the negative association between smoking and platelet count in women remained highly significant (p less than 0.001) after controlling for ethnic origin, alcohol consumption, body mass, hematocrit, cholesterol and HDL-cholesterol, whereas for males the slight positive association was not significant. The reduced platelet count observed in males compared with females and in female smokers, suggests that platelet count may reflect sex differences in hemostasis and the effects of smoking on the hemostatic system. This may have implications for the mechanisms underlying the pathogenesis of ischemic heart disease and should be explored further.

Prevalence and control of hypertension in a large cohort of occupationally-active Israelis examined during 1985-1987: the Cordis Study.

In view of the many changes in the approach to the detection and management of hypertension that have occurred, the paucity of current data on this subject in Israel limits the possibilities of making international comparisons or evaluating trends. This study contributes recent information on the occupationally-active population. Between 1985 and 1987, blood pressures were measured and interview data obtained on awareness and treatment of hypertension in a sample of 3677 male and 1573 female employees in 21 Israeli industries, examined in the CORDIS Study. In the age group 35-64 years, the age-standardized prevalence of hypertension (greater than or equal to 160/95 mm Hg or treated) using the same standard population as the WHO MONICA Study was 17.1% for men and 16.1% for women. The prevalence for men was somewhat below the median country compared with the MONICA centres, whereas for women it was closer to the median. Marked ethnic differences were evident, with those of Western origin having the highest prevalence, and those of Asian origin, the lowest. Of the hypertensives, 35.6% of the men and 33.3% of the women were unaware of their condition. Among men aware, 82.8% were receiving treatment and 59.8% of them were under control; the corresponding percentages for women were 86.2% and 72.8%. Older people were more likely to be aware of their hypertension and receiving treatment. Beta-blockers and diuretics were the predominant drugs of choice.(ABSTRACT TRUNCATED AT 250 WORDS)

Elevated concentrations of elements and abnormalities of neuromuscular junctions in tongue muscles of Down's syndrome.

X-ray spectrometry was used to measure the concentrations of calcium, iron, copper and zinc in tongue muscles from patients with Down's syndrome (DS) undergoing partial glossectomy. Similar measurements on samples from autopsies served as controls. Electron microscopy was used to examine neuromuscular junctions. The calcium and copper were significantly elevated and correlated in DS while the iron and zinc showed little change. The copper increase is probably connected with the known high level of Zn-Cu superoxide dismutase (SOD), coded for by chromosome 21. (In DS there is a trisomy 21). The excess of SOD may interfere with free radicals needed for excitation-contraction coupling and may be instrumental in damaging junctional membranes. The high calcium may result from such membrane damage. It is suggested that neuromuscular junction pathology, either genetic or free radical induced, may cause the tongue weakness in DS.

Myofibers in tongues of Down's syndrome.

Muscle samples from the anterior part of the tongue in 15 patients with Down's syndrome (undergoing partial glossectomy), and 6 post-mortem controls, were examined histochemically. In most cases there was a Type 2 myofiber hypertrophy and preponderance, with frequent type 'grouplet' formation. In four cases examined ultrastructurally, hyperplastic, disorganized and atrophic neuromuscular junctions were seen. These preliminary ultrastructural findings suggest that synaptic morphometry could be a rewarding method of studying neuromuscular deficits in Down's syndrome.

Case report: ofloxacin-induced hypersensitivity vasculitis.

Since its introduction in 1985, the new fluoroquinolone antibiotic ofloxacin has gained widespread use, and much information has accumulated about its possible adverse effects. Skin reactions have been uncommon, and there have been very few reports about hypersensitivity vasculitis directly related to ofloxacin. The authors report such a case, in which the patient needed plastic surgery because of severe vasculitis in both legs.

Urgent delivery, the treatment of choice in term pregnant women with extended burn injury.

Two pregnant patients at term, suffering from major burn wounds, were treated in our burn unit during the year 1995, both were delivered immediately after admission by caesarean section. One of them had smoke inhalation injury which needed mechanical ventilation, both mothers and newborns survived. In spite of low maternal carboxyhaemoglobin the fetal cord blood carboxyhaemaglobin was high, supporting an objective physiological basis for the previous empirical conclusion of early delivery in pregnant patients at term with extensive burn injury (50 per cent TBSA and more). This obvious favourable outcome highlights the importance of urgent delivery in term pregnant women suffering a major burn injury.

Reconstruction of the vulva with V-Y advanced myocutaneous gracilis flap.

Reconstruction of the vulva with V-Y advanced triangular myocutaneous gracilis flap(s) is reported. Seven patients were treated with this technique following radical vulvectomy with two minimal complications. The reliability of this known flap and the usefulness of the V-Y advancement are stressed and make it a simple and successful technique.

Purse-string suture for nipple projection.

A simple and useful technique for nipple projection is reported. A buried, subcutaneous, purse-string suture is placed through prick holes and, when tied, gives a nipple mound, without the need of skin incisions, flaps, or undermining. This procedure can be applied to inverted, missing, and/or ill-defined nipples.

Posttraumatic unilateral blepharospasm treated by selective facial neurectomy.

A patient who presented with posttraumatic ptosis of the right upper eyelid proved to be a case of unilateral blepharospasm with facial palsy of the forehead. He was successfully treated with selective facial neurectomy.

Passing the cartilage graft through.

Cartilage grafts could be passed to their exact destination using suction-tube-needle combination so that fixation of the graft is more accurate. This is routinely used for tip grafts and dorsum of the nose grafts, and it could be used elsewhere.

Wrap-around cartilage flap for correction of unilateral cleft lip nose deformity.

A turnover contralateral cephalic alar cartilage flap is suggested for the correction of cleft nose alar deformity. The cartilage flap from the normal side wraps around the deficient medial crus and acting as a pulley reposition and augments the affected alar cartilage. The satisfactory and long-lasting results obtained in our small series seem to justify this approach for improving cleft nasal deformities, and we think it should be available in our surgical armamentarium.

Intraoperative expansion of the palate by the tumescent technique.

Intraoperative rapid expansion of soft tissue of the palate is reported. Tissue is recruited by repeated injections of an isotonic solution in a tumescent-like technique, thus producing increasing swelling of the palatal soft tissue. Straight direct closure of palatal clefts and fistulas is achieved with minimal scarring at the midline, no secondary healing of raw surfaces, and satisfactory and encouraging results.

The securing of a polyethylene tube prior to intravascular dye injection in anatomic microcirculation research: the three-tie technique.

A simple and reliable method for securing the cannulated polyethylene tube to the blood vessel wall prior to intravascular dye injection is described. The three-tie technique has been used in many vascular anatomic studies without any leakage of the injection fluid taking place around the tube.

Chordee: different concept and new trend of treatment.

Chordee or ventral curvature of the penis is commonly associated with and occasionally without hypospadias. The usual recommended treatment is excision of the fibrous tissue that is responsible for the bowing. This results in a proximal retraction of the meatus. With a different concept and explanation of the ventral curvature, we treat this abnormal condition as a shortage of tissue. More than a hundred consecutive cases of chordee with and without hypospadias were treated by skin release and dorsal to ventral transposition of preputial skin as well as hypospadias repair. The whole procedure is simple, planned as a single-stage operation with less morbidity or fewer complications. The meatus is not pushed back proximally, no dissection distal to the meatus is performed, and there is no need for tissue excision. The results were very successful, with no recurrence of the ventral curvature.

The surgical anatomy of the fat in the upper eyelid medial compartment.

The surgical anatomy of the upper eyelid fat in the medial compartment was investigated in 388 patients and in 12 cadavers. We found two individual fat pads comprising this compartment. The difference among the investigated cases was found to be the extent of their separation. In 16.7 percent of the cadavers' eyelids the fat pads were entirely separated, in 45.8 percent they were separated to about half their length, while in 37.5 percent only the tips were separated. Among the patients in whom only the protruded fat was inspected, 59.8 percent of the fat pads were separated, and in the rest, only the tips were isolated. On histologic examination we could always identify two well-circumscribed fat pads, each surrounded by a fibrocollagenous tissue. At the level of their interconnection, a loose fibroareolar tissue was found. In practice, during blepharoplasty, both fat pads should be addressed in order to achieve the expected results.

The prevention of cardiac arrhythmias produced in an animal model by the topical application of a phenol preparation in common use for face peeling.

We have shown in an animal model that complex ventricular arrhythmias produced by topical application of a phenol preparation that is used in face peeling can be prevented by a brisk diuresis at the time of application or by gradual application of the phenol preparation. We recommend that continuous cardiac monitoring and recording be performed in patients having topical phenol applications in order to determine the true incidence of cardiac arrhythmias and to ascertain if they are prevented by a forced diuresis, by the gradual application of the preparation, or by a combination of both.

Enhancing the survival of aspirated human fat injected into nude mice.

Injection of aspirated fat is now the most commonly used technique for the filling of depressed areas. Partial absorption of the injected fat is the main limitation of this procedure. Cariel T.M. is an enriched serum-free cell culture medium, its ability to enhance the survival of human aspirated fat grafts was investigated in the nude mouse model. A volume of 0.75-cc Cariel preprocessed fat was injected under the scalp skin of 16 nude mice in the experimental group, and the same volume of saline preprocessed fat was injected to 15 control group of mice. Significant maintenance of the weight, 46 percent in the experimental group compared with 29 percent in the control group (p < 0.008), and the volume, 44 percent in the experimental group compared with 31 percent in the control group (p < 0.026), was observed, after 15 weeks, in this newly used model. It seems that addition of the nutrients enriched with anabolic hormones enabled the survival and take of more adipose cells in the graft.

Rehabilitation of the face in patients with Down's syndrome.

Fifty patients with Down's syndrome underwent surgery for improvement of the facial stigmata. Partial glossectomy, lateral canthoplasty, and nose, cheek, and chin augmentation were the common procedures. With a follow-up of 18 to 24 months, the results were recorded by a multidisciplinary team with similar judgments on the glossectomy, the most satisfactory procedure, and some discrepancy on the other procedures, canthoplasty, and cheek augmentation. There were no infections or extrusion of prostheses, and a rather high incidence of extrusion of prostheses, and a rather high incidence of bone resorption was noted in the mandibular area. The facial changes were satisfactory in the majority of the cases in both medical and nonmedical evaluation and improved self-confidence, especially in the older patients. The satisfactory results here presented advocate certain procedures for attenuation of the Down's syndrome stigmata and improvement of some functions by diminishing the size of the tongue.

Effect of hyperbaric oxygen on a rat transverse rectus abdominis myocutaneous flap model.

The single-pedicle transverse rectus abdominis myocutaneous (TRAM) flap is frequently associated with partial flap necrosis. Hyperbaric oxygen has previously been shown to increase the survival of skin flaps, although there has been no investigation of possible beneficial effects of hyperbaric oxygen on survival of the TRAM flap. The present study compares the effectiveness of hyperbaric oxygen therapy, normobaric 100% oxygen, a hyperbaric air-equivalent mixture, and no treatment at all (control group), in the prevention of TRAM flap necrosis in a rat model. Forty-eight animals were randomly assigned to one of the four above-mentioned groups. The surviving area of the flap was evaluated 7 days after surgery. The hyperbaric oxygen treatment protocol consisted of five 9-minute sessions breathing 100% oxygen at a pressure of 2.5 atmospheres absolute during the first 48 hours, starting within 1 hour of surgery. The areas of surviving skin paddles ranged from 38.5 percent in the control group to 52.5 percent in the group treated with hyperbaric oxygen. One-way analysis of variance indicated that flap area survival was significantly greater in the hyperbaric oxygen group (F = 2.69, p = 0.05). Tukey's pairwise comparison and the two-sample t test indicated that the group treated with hyperbaric oxygen differed significantly from the control group (Tukey's critical value = 3.8, rejection level = 0.05, t test p = 0.01). Our results suggest that the hyperbaric oxygen treatment protocol used improves survival in the rat TRAM flap. However, the optimal treatment protocol to achieve this objective even in the rat seems to be variable, and further studies are required before extrapolating these data to human applications.