Rupture of abdominal fascial fusion lines: an unusual complication of rectus abdominis flap.

Two cases of rectus abdominis muscle flaps complicated by disruption of the abdominal wall due to avulsion of the anterior rectus sheath from adjacent fascia are reported. Abnormal transmission of intraabdominal pressure is suggested as the cause. A polyglactin mesh patch for the prevention of abdominal disruption is described.

Induction of endotoxin tolerance with monophosphoryl lipid A in peritonitis: importance of localized therapy.

Endotoxin is a principle mediator of septic shock during peritonitis. Induction of endotoxin tolerance with monophosphoryl lipid A (MPL), a nontoxic derivative of lipid A, improves survival from peritonitis. The induction of tolerance with intravenous versus intraperitoneal administration of MPL before peritonitis was compared.

Sagittal section septoplasty: an intrinsically stabilized septoplasty.

The principles and methods of nasal septoplasty are reviewed. The design of a septoplasty technique based on cartilage preservation and intrinsic stabilization of the septum is discussed. An operative technique using sagittal incision of the septum to create overlapping flanges of cartilage is described.

The "circummuscular" free TRAM pedicle: a trap.

A variation of the deep inferior epigastric system is presented in which the vessels or their dominant branches do not enter the rectus muscle at any point on its deep surface. Full submuscular exploration of the deep inferior epigastric pedicle is proposed as a necessity (prior to muscle section) if flap loss is to be avoided during efforts to raise free TRAM flaps with minimal muscle harvest.

Tracer imaging in lung cancer.

Lung cancer is the leading cause of death from cancer in males. Adequate staging is essential if proper treatment is to be administered. Current morphological imaging modalities are confronted with problems in the staging of lung cancer, in the evaluation of treatment response, and in establishing whether a residual mass is due to fibrosis, residual tumors or local recurrence.

Diabetic lumbar radiculopathy: sciatica without disc herniation.

Three patients with diabetic radiculopathy (DR) are presented. The clinical aspects of DR, its management, and differential diagnosis are reviewed. Diabetic radiculopathy commonly presents with severe unilateral pain of sudden onset that is usually located in the lower extremity, frequently in the proximal segments.

Nondepolarizing relaxants: new concepts and new drugs.

Less than a decade ago, the only nondepolarizing neuromuscular blocking drugs available to the anesthetist were traditional long-acting drugs such as pancuronium and d-tubocurarine. The revolution that began 10 years ago in our use of relaxants promises to continue unabated into the next decade. Changes in our clinical use of these drugs will be sparked not just by the introduction of new drugs but also by a greater understanding of the pharmacokinetic/pharmacodynamic principles that govern onset and recovery.

Restoring the breast to match the normal side.

Although breast symmetry is for most patients a reconstructive goal of the highest order, the alteration of a normal breast may, for many women, constitute another "branding." Our patients have chosen overwhelmingly to leave their normal breasts "untouched" since having been given the opportunity to do so. Treatment planning and surgical methods are described that have made possible symmetrical results without change in the normal breast.

Alcohol use and abuse in the frail, homebound elderly: a clinical analysis of 103 persons.

We studied alcohol use and abuse in 103 frail, homebound elderly individuals cared for in a long-term home health care program from July 1991 to February 1992. Their average age was 80.63 years.

Altered leukocyte immunophenotypes in septic shock. Studies of HLA-DR, CD11b, CD14, and IL-2R expression.

To evaluate the role of cellular activation markers and functional surface molecules in sepsis, specific immunophenotypes on peripheral blood leukocytes were studied in 40 subjects consisting of the following: (1) patients with septic shock; (2) patients with sepsis; (3) critically ill nonseptic patients; and (4) normal control subjects. These assays included phagocyte adhesion molecule CD11b expression, monocyte receptors HLA-DR and CD14, and lymphocyte activation markers IL-2R and HLA-DR. Patients with septic shock and sepsis had significantly increased neutrophil CD11b expression compared with normal subjects.

Relationships between image cytometric DNA index, proliferation fraction and multiploidy and conventional nuclear grade in breast carcinoma.

High nuclear grade, DNA aneuploidy, and elevated proliferation fraction tend to be mutually associated in breast carcinomas, defining a subset of carcinomas with more aggressive behavior. We sought to examine more closely the interrelations between nuclear grade and DNA cytometric parameters (aneuploidy, proliferation fraction, and multiploidy) in breast carcinomas based on our assumption that DNA content is the major determinant of nuclear appearances used in grading tumors. We obtained estimates of the strength of correlation (correlation and contingency coefficients) between nuclear grade and DNA index, proliferation fraction, and multiploidy within a series of 87 consecutively accessioned breast carcinoma specimens studied by conventional histologic methods and by computer-assisted image analysis of Feulgen-stained imprints.

Splenectomy in patients with AIDS and AIDS-related complex.

Objective: To study the effect of splenectomy in HIV-infected patients.

Design: A retrospective chart review of patients admitted to St Vincent's Hospital who had splenectomies and were HIV-positive.

Setting: All patients were treated at St Vincent's Hospital, New York City, New York, USA.

Ciprofloxacin susceptibility testing by MIC and disk elution of drug-resistant Mycobacterium tuberculosis and Mycobacterium avium complex.

The ability to provide susceptibility data for certain species of mycobacteria can be clinically useful. In this study, the disk elution method for susceptibility testing was adapted for testing ciprofloxacin against mycobacterial isolates. Of the 75 Mycobacterium tuberculosis isolates tested, including 23 multiply drug-resistant isolates, 96% were susceptible to ciprofloxacin at a breakpoint concentration of 2 micrograms/ml.

Orbital retractors for posterior segment surgery.

Successful retinal detachment surgery is greatly aided by proper visualization of and access to the intended surgical field. Two retractors, one having a single blade and the other a double blade, have been developed to aid retinal detachment surgery.

The history of the founding of the Society for Clinical and Experimental Hypnosis: a brief communication.

An account of the founding of the Society for Clinical and Experimental Hypnosis during the years 1949 to 1956 is presented with details of its early development, purposes, and functions. The Society gave rise to the International Journal of Clinical and Experimental Hypnosis, the International Society of Hypnosis, and the American Boards of Medical Hypnosis, Psychology, and Dentistry.

Hypersensitivity to common indoor aeroallergens in asthmatic patients.

To study whether inhalant allergy to specific allergens is associated with inner city asthma, adult emergency room asthmatic patients (n = 41), and controls (n = 34) were examined for immediate hypersensitivity to six common indoor allergens using both skin tests and serologic tests. A highly significant association was observed between cat epidermis-specific IgE and asthma (P < .01) and this constituted the strongest association for a single allergen.

Severe phenytoin-induced bone marrow depression and agranulocytosis treated with human recombinant granulocyte-macrophage colony-stimulating factor. Case report.

An unusual instance of severe and potentially lethal depression of the bone marrow is described as a result of the administration of phenytoin for seizure prophylaxis. The patient was treated successfully by prompt cessation of phenytoin and intravenous administration of human recombinant granulocyte-macrophage colony-stimulating factor.

Skin testing with food, codeine, and histamine in exercise-induced anaphylaxis.

A 33-year-old Chinese woman with exercise-induced anaphylaxis after ingesting Chinese seafood noodle soup, was studied for skin test reactivity to food, histamine, and codeine. Prick skin tests were negative for shrimp, wheat, and chicken soup base, but were positive at 5 to 6 mm (wheal diameter) to the whole broth after it had been combined with the other ingredients. No significant (> 3 mm) wheals were observed in eight controls who were simultaneously tested with the broth.

Sinus obliteration for chronic oro-antral fistula: a case report.

This report describes a patient with chronic oro-antral fistula resulting from tooth extraction. Several local flap procedures failed to close the fistula, which was complicated by chronic sinusitis. Ultimately, cure was achieved via antral obliteration using vascularised temporoparietal fascia, sparing remaining maxillary alveolar bone.

Progressive supranuclear palsy: clinical presentation and rehabilitation of two patients.

Progressive supranuclear palsy (PSP), is an infrequent movement disorder characterized by supranuclear ophthalmoplegia, pseudobulbar palsy, and axial dystonia with frequent and unpredictable falls, usually backward. Median survival from time of diagnosis is two years. When diagnosis is reached, the patients are usually disabled and unable to ambulate independently.