Lateral thigh free flap for head and neck reconstruction.

Objectives: To present the technique of lateral thigh free flap reconstruction in the head and neck and review the use of this procedure in 58 head and neck defect reconstructions.

Study Design: Retrospective review in the setting of a tertiary, referral, and academic center.

Methods: Retrospective review of patient records in cases of lateral thigh free flap reconstruction for head and neck defects.

Chemotherapy in advanced prostate cancer.

In the United States, prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death in men. Prostate cancer is a rare disease before age 40; however, the prevalence increases quickly to 80% by the age of 80, and with increasing life expectancy, hormone-refractory prostate cancer (HRPC) will soon represent the most common cancer in the male population in the United States and other Western countries. The evolution of early prostate cancer is variable and extends over many years; some tumors progress slowly or not at all, whereas others may progress more rapidly and be fatal after a few years.

Cyclooxygenase-2 alters transforming growth factor-beta 1 response during intestinal tumorigenesis.

Background: Recent investigation suggests that cyclooxygenase-2 plays an important role in colorectal carcinogenesis. Transforming growth factor-beta1 (TGF-beta 1) is one of the most potent stimulators of cyclooxygenase-2 expression. A key step in intestinal tumorigenesis involves alteration of the normal cellular response to TGF-beta 1.

Intraspinal delivery of neurotrophin-3 using neural stem cells genetically modified by recombinant retrovirus.

Neural stem cells have been shown to participate in the repair of experimental CNS disorders. To examine their potential in spinal cord repair, we used retroviral vectors to genetically modify a clone of neural stem cells, C17, to overproduce neurotrophin-3 (NT-3). The cells were infected with a retrovirus construct containing the NT-3.

Rhinocerebral mucormycosis: a case of a rare, but deadly disease.

Rhinocerebral mucormycosis is a rare fungal infection of the nasal cavity and sinuses that can spread to the orbits and cranium within days. Its presentation can be confused with those of sinusitis, viral infections, diabetic ketoacidosis, or carotid sinus thrombosis, and it is often missed at early presentation. Survival is directly linked to early detection and treatment.

Implantable cardioverter-defibrillator follow-up: what everyone needs to know.

Over the past few years, remarkable advances in the treatment of ventricular tachycardia, ventricular fibrillation, and sudden cardiac death have occurred. One of the most significant treatment modalities has been the addition of the implantable cardioverter-defibrillator (ICD). Because of the rapidly expanding indications for ICD therapy, it is common for internists, family practitioners, emergency room physicians, and general cardiologists to treat defibrillator patients.

Peripheral arterial occlusion in acute promyelocytic leukemia.

A 16-year-old Caucasian teenager developed fatigue, abdominal pain, pneumonia, and subsequently acute vascular occlusion of the left superficial femoral artery. Vascular assessment and heparin therapy lead to bone marrow aspiration and a diagnosis of acute promyelocytic leukemia. Treatment with chemotherapy prevented loss of limb and avoided further vascular surgery.

The selective effects of alcohol on automatic and effortful memory processes.

Automatic and effortful memory processes were evaluated in a 2-session, within-subjects design involving an alcohol challenge and a no-alcohol condition. Free recall of a 90-word list measured effortful processing. Estimation of word frequency from the same list measured automatic processing.

Usefulness of Telfa pads in the histologic assessment of stereotactic-guided breast biopsy specimens.

Stereotactic core-needle biopsies (SCNBs) are being increasingly used for the diagnosis of breast lesions. Focal mammographic calcifications are often considered significant and sampled by SCNB. We compared diagnostic outcomes in breast tissue cut from 59 core biopsy blocks using Telfa pad embedding with those of 48 routinely embedded blocks.

Transplants of fibroblasts genetically modified to express BDNF promote regeneration of adult rat rubrospinal axons and recovery of forelimb function.

Adult mammalian CNS neurons do not normally regenerate their severed axons. This failure has been attributed to scar tissue and inhibitory molecules at the injury site that block the regenerating axons, a lack of trophic support for the axotomized neurons, and intrinsic neuronal changes that follow axotomy, including cell atrophy and death. We studied whether transplants of fibroblasts genetically engineered to produce brain-derived neurotrophic factor (BDNF) would promote rubrospinal tract (RST) regeneration in adult rats.

A current activated on depletion of intracellular Ca2+ stores can regulate exocytosis in adrenal chromaffin cells.

Exocytosis in excitable cells is strongly coupled to Ca2+ entry through voltage-gated channels but can be evoked by activation of membrane receptors that release Ca2+ from inositol 1,4, 5-trisphosphate-sensitive internal stores. In many cell types, depletion of Ca2+ stores activates Ca2+ influx across the plasma membrane, a process known as capacitative or store-operated Ca2+ entry. This influx is mediated by a number of voltage-independent, Ca2+-selective currents.

A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims.

Ninety-six female assault victims with chronic posttraumatic stress disorder (PTSD) were randomly assigned to 4 treatment conditions: prolonged exposure (PE), stress inoculation training (SIT), combined treatment (PE-SIT), or wait-list control (WL). Treatment consisted of 9 twice-weekly, individual sessions. Independent evaluations were conducted at pretreatment; posttreatment; and 3-, 6-, and 12-month follow-ups.

Induction of microtubule-associated protein 1B expression in Schwann cells during nerve regeneration.

Microtubule-associated protein 1B (MAP1B) is expressed at high levels during development of the nervous system and is localized primarily in neurons while specific phosphorylated isoforms of MAP1B are localized exclusively in growing axons. The levels of MAP1B are down regulated in most regions of the adult CNS, but remain high in neurons and axons of the PNS. This study demonstrates that the expression of MAP1B is induced in adult Schwann cells following sciatic nerve lesion and regeneration.

Temporal expression of TGF-beta1, EGF, and PDGF-BB in a model of colonic wound healing.

Background: Dehiscence of colonic anastomoses is a multifactorial phenomenon. One mechanism by which this can occur is a deficiency of colonic submucosal collagen. Peptide growth factors (PGFs) have been shown to play a role in the synthesis, deposition, and maturation of collagen.

The surgical pathologist's approach to fine needle aspiration.

The diagnostic process begins with triage of the FNAB, depending on the patient's problem. Portions of the specimen can then be set aside for appropriate immunocytochemistry, hormone receptors analysis, electron microscopy, flow cytometry, or molecular studies. Microscopic evaluation, as in surgical pathology, begins with scanning objective examination of tissue architecture, followed by study of cellular characteristics, and finally the nuclear features.

Information-processing characteristics of explicit time estimation by patients with schizophrenia and normal controls.

The information-processing characteristics of time estimation have not been well-documented. This research investigated explicit time estimation to test whether (1) it can occur "automatically" and (2) the cognitive function generally known as "working memory" predicts accuracy of time estimation. Data on two tasks requiring explicit time judgement (time interval estimation and production) are reported for a sample of 43 normal, healthy controls and 19 inpatients with chronic schizophrenia.

Sequential biannual prevalence studies of pressure ulcers at Allegheny-Hahnemann University Hospital.

To assess the prevalence, documentation and care of pressure ulcers, and the effect of teaching and prevention strategies in a 750-bed university hospital, one-day studies were conducted in 1993, 1995, and 1997. Data gathered was used to evaluate areas in need of improvement and find cost-effective ways to reduce the prevalence of pressure ulcers. The overall prevalence of ulcers decreased from 18 percent in 1993 to 10 percent in 1995 and 1997.

Relation of serum anticholinergicity to cognitive status in schizophrenia patients taking clozapine or risperidone.

Background: A potential beneficial outcome of treatment with certain of the atypical neuroleptics is the reduced risk of cognitive impairment, stemming from purported low affinity for cholinergic receptors. In vitro experiments have shown that clozapine is highly anticholinergic and risperidone is minimally so. In vivo tests of the anticholinergic burden imposed by these medications and its potential cognitive consequences are needed.

Aneurysms of the pancreaticoduodenal arteries: a change in management.

Since the first report of an aneurysm involving the pancreaticoduodenal arteries a century ago, only 83 cases have been reported in our collective review of the English literature. Their presentation varies from indistinct abdominal pain to hemorrhagic shock, often making the diagnosis onerous. The mortality rate in this patient group has been significant, and in cases reported since 1980, the mortality rate remains at 17% (7 deaths/42 reported cases).

Efficacy of anticoagulation post-inferior vena caval filter placement.

Anticoagulation with heparin or Coumadin is usually effective in the management of deep vein thrombosis; however, if anticoagulation treatment is contraindicated, is ineffective, or leads to adverse effects, inferior vena caval (IVC) placement of a filter is indicated. The purpose of this study is to determine whether increased early adverse effects are present in patients not given anticoagulation medication after placement of an IVC filter. The records of 240 consecutive patients who received IVC filter placement were reviewed for indications for placement, as well as for whether patients received anticoagulation medication on discharge.

Short-term changes in the Ca2+-exocytosis relationship during repetitive pulse protocols in bovine adrenal chromaffin cells.

Stimulus-secretion coupling was monitored with capacitance detection in bovine chromaffin cells recorded in perforated patch mode and stimulated with trains of depolarizing pulses. A subset of stimulus trains evoked a response with a Ca2+-exocytosis relationship identical to that obtained for single depolarizing pulses (Engisch and Nowycky, 1996). Other trains evoked responses with enhanced or diminished Ca2+ efficacy relative to this input-output function.

Options for diabetic patients with chronic heel ulcers.

The presence of a heel ulcer in the diabetic patient is usually due to neuropathy, vasculopathy, or both. Diagnostic testing including noninvasive assessment by nerve conduction velocity and Doppler pressure measurements can provide the basis for subsequent treatment. The diagnosis of osteomyelitis is assisted by plain radiographs, isotope definition, and/or magnetic resonance imaging (MRI).

Efficacy of lorazepam and haloperidol for rapid tranquilization in a psychiatric emergency room setting.

The efficacy of a benzodiazepine was compared with that of a neuroleptic for the rapid tranquilization of patients presenting at a psychiatric emergency room service. Thirty-seven highly agitated patients exhibiting psychotic symptoms were randomly assigned to receive either 2 mg lorazepam or 5 mg haloperidol as needed every 30 min for 4 h. Administration route was either intramuscular injection or oral concentrate.

Cigarette smoking and lung cancer trends. A light at the end of the tunnel?

Objective: To update the epidemic curves for lung cancer in the United States by gender in relation to the temporal trends in adult current cigarette smoking prevalence.

Methods: The design of the study was ecologic, based on population figures. Available data on the prevalence of current cigarette smoking from 1920 to 1990 were plotted in conjunction with age-adjusted lung cancer mortality rates from 1930 to 1992 for each sex.