Spinal brucellosis. A case with "cauliflower" appearance on CT.
In this case report, we present a patient with an unusual appearance on vertebral CT due to spinal brucellosis. This "cauliflower" sign may be specific to this disease.
Aged↗
Biomedical subjects
E Tan
Publications and source records attributed to E Tan.
Free flap cover of acute hand injuries.
Eighteen free flap reconstructions of acute hand trauma were compared with 12 groin flap repairs as historical controls. The free flap group had a similar success rate, with fewer operations (though the same total operating time) and shorter hospital stay than the groin flap group. Complications were the same in both groups, but less secondary procedures were necessary in the free flap group. If flap cover is necessary, free flaps are a better way of obtaining skin cover in acute hand trauma.
Hand Injuries↗
Late arterial thrombosis in a replanted thumb: a case report.
A case of arterial occlusion occurred nine years after replantation of a thumb. Factors implicated were smoking and repeated blunt trauma to the first web space. The digit was successfully revascularized after excision of a segment of thrombosed arterial vein graft.
Adult↗
The veno-arteriolar reflex in free skin flaps.
The veno-arteriolar reflex was measured in 10 subjects in whom an area of denervated skin was present in the lower limb following free flap transfer of skin and subcutaneous tissue 3 weeks to 2 years previously. The vasoconstrictor response to dependency was measured in the skin of the flap, in adjacent innervated skin and after chemical dilatation of cutaneous vessels in the skin of the flap. This veno-arteriolar reflex resulting in a reduction of blood flow of 30-40% was present and equal in both normal and denervated skin. The response was abolished by chemical vasodilatation. The results indicate that sympathetic innervation is not essential for the veno-arteriolar reflex, and suggest that myogenic mechanisms may be more important than previously believed.
Adult↗
Progressive hemifacial atrophy with localized scleroderma.
We describe a patient with localized scleroderma in association with homolateral atrophy of the tongue and marked ipsilateral facial hemiatrophy which was confirmed histologically. CT scan coronal sections of the face showed severe atrophy of the tongue and facial muscles. The EMG studies failed to demonstrate a neurogenic or myogenic process.
Adult↗
Lack of benefit of clonidine treatment for short stature in a double-blind, placebo-controlled trial.
Twelve short (more than two standard deviations below the mean height for age), prepubertal children (ten boys, two girls) who had a normal peak growth hormone (GH) response to provocative stimulation with clonidine (more than 10 ng/ml) were enrolled in a double-blind, placebo-controlled, crossover study of the effects of a single, nightly dose of clonidine (0.1 mg/m2 by mouth). The children's mean age was 7.2 years (range 3.6-10.5 years). The results of 6 months of clonidine therapy were compared with those of 6 months of placebo. Clonidine therapy resulted in no significant difference in height standard deviation score, growth velocity, bone age, 24 h integrated GH concentration, peak GH response to clonidine stimulation, levels of insulin-like growth factor 1, or predicted height by the RWT method. In contrast to other studies, this study shows no sustained increases in GH production or in improved growth velocity with long-term administration of a single daily dose of clonidine. Furthermore, this study demonstrates the need for well-designed, placebo-controlled trials in paediatrics.
Age Determination by Skeleton↗
A free flap system in sheep.
Five successful free flap transfers have been performed using the deep circumflex iliac artery system in sheep. The system is capable of providing cutaneous, myocutaneous, or osteomyocutaneous flaps, and details regarding these flaps are described.
Animals↗
Microvascular ear replantation.
Three cases of attempted ear replantation are presented. Successful revascularisation was achieved in all patients. However, in one case venous congestion and necrosis of the ear occurred at 7 days. Thorough initial debridement of skin and cartilage plus systemic heparinisation and haemodilution upon completion of the vascular anastomoses are considered important technical factors. When compared with other forms of reconstruction, ear replantation gives a superior result and is therefore advocated whenever possible.
Adult↗
Origin of tonic GABAergic inputs to vasopressor neurons in the subretrofacial nucleus of the rabbit.
The aims of this study were to determine (1) whether the vasomotor effects reflexly elicited by baroreceptor stimulation are dependent upon gamma-aminobutyric acid (GABA) receptors in the subretrofacial (SRF) nucleus in the rostral ventrolateral medulla; (2) the extent to which inputs other than those arising from peripheral baroreceptors, or transmitted via the nucleus tractus solitarius (NTS), contribute to the tonic GABAergic inhibition of SRF vasopressor cells. Following bilateral injection of a mixture of the GABA antagonist bicuculline methiodide (500 pmol) and GABA agonist muscimol (500 pmol) into the SRF nucleus, the sympathoinhibitory response normally evoked by a rise in arterial pressure (induced by inflating an aortic cuff) was abolished in 4 out of 8 rabbits and reduced in the remainder. For the whole group, the mean reduction in this response was 71%. In other experiments, the pressor response produced by injection of bicuculline methiodide into the SRF nucleus was still present after (1) destruction of the intermediate portion of the NTS, and (2) complete removal of the brain rostral to the pons. We conclude that (1) an inhibitory GABAergic input into the SRF nucleus is an important component of the central pathways mediating baroreceptor inhibition of sympathetic vasomotor tone; (2) the SRF nucleus also receives tonic GABAergic inputs that are intrinsic to the lower brainstem and are independent of baroreceptor or other cardiovascular inputs relayed by the NTS.
Animals↗
The sheep as a model for grade III human tibial trauma.
The sheep provides a suitable model for simulation of grade III human tibial trauma. Management in humans can easily be simulated in the sheep. But variability can be controlled, and the effect of particular methods of management can be compared more accurately than in the human situation, with more scientific assessment possible.
Animals↗
Mandibular reconstruction with vascularized iliac crest: a 10-year experience.
Since 1978, 35 patients have undergone mandibular reconstruction with vascularized iliac crest. During this time, the technique of raising and shaping the iliac crest has undergone a series of modifications. Initially, osteocutaneous segments based first on the superficial circumflex iliac system and later on the deep circumflex iliac system were used. More recently, only the inner table of the ilium has been employed, and where intraoral lining is required, an ulnar forearm free flap has been added. Thirty-two patients were reconstructed successfully. Of the three anastomotic failures, one bony segment was able to survive as a free graft. There were no donor-site complications. With continued experience, operative morbidity has been minimized, while the technique has been modified to tailor the reconstruction to the specific requirements of the patient. It is concluded that vascularized iliac crest provides the most appropriate mandibular reconstruction for a range of congenital and acquired defects.
Adolescent↗
Free tissue transfer to the lower extremity.
The results of 100 free microvascular transfers to the lower limb are presented. These show a high success rate with successful salvage of 95 limbs. The major complications were infection and delayed healing, osteomyelitis, and non-union. Early skin cover, within 14 days of injury, reduced the incidence of complications by half. Aggressive debridement and provision of early skin cover should be the aim of management of tibial trauma with tissue loss.
Adolescent↗
Cost-effectiveness of free tissue transfer.
In a review of 61 patients with compound injuries to the upper and lower extremities. Operating Theatre costs were added to the costs of inpatient hospitalization after commencement of reconstruction with either a pedicled flap or free tissue transfer. The cost of pedicled groin flap to the upper limb and cross leg flap groups was double that of comparable free tissue transfer groups. The cost of abdominal tube pedicle to the lower limb was three times greater than for the free flap technique. The conclusion is drawn that apart from general advantages to the patient, the cost to the community is significantly reduced.
Arm Injuries↗
Clinical observations on nail changes in psoriasis.
410 cases of psoriasis [282 males (68%) and 127 females (31%)] were interviewed and examined to study the nail changes. The prevalence of nail changes was 78.0% (males = females). Common changes were pitting (67.5%) and onycholysis (67.2%). Dystrophy of varying degrees occurred in 35.0%, subungual hyperkeratosis in 24.7%, discoloration in 18.4%, loss of nails in 2.8% and pustulation in 1.3%. Pitting and onycholysis was the most common combination (45.6%). Nail changes were significantly more common in patients who have moderate to severe psoriasis as compared with patients with mild psoriasis; in patients who have psoriasis for greater than 5 years as compared with patients who have psoriasis for less than 5 years; and in patients older than age 50 as compared with those aged less than 50. A definite correlation was found between the prevalence of nail changes and the presence of scalp and periungual psoriasis, and the presence of joint involvement.
Arthritis↗
Clinical implications of immunologic phenotyping in cutaneous T cell lymphoma.
The composition of cutaneous lesions from 158 patients with confirmed cutaneous T cell lymphoma, 91 patients with suspected cutaneous T cell lymphoma, and 145 patients with lymphoid disorders other than cutaneous T cell lymphoma was quantitated in situ with the use of commercially available murine monoclonal antibodies that identify the Pan T, T-helper/inducer (Th), T cytotoxic/suppressor (Ts), and Pan B lymphocyte subsets. On average, cutaneous infiltrates of confirmed cutaneous T cell lymphoma were found to contain significantly more Th and less Ts or Pan B cells compared to benign lymphoid disorders. Moreover, when analyzed in terms of the type of lesion examined by biopsy, the absolute amount of Th cells progressively expands with increasing magnitudes of infiltrate in the dermis while the amount of Ts and Pan B cells remains relatively constant among lesions. A useful diagnostic criterion (anti-Leu 1/4 greater than or equal to 70% and anti-Leu 3a/anti-Leu 2a ratio greater than or equal to 6) correctly discriminated between cutaneous T cell lymphoma and non-cutaneous T cell lymphoma in 87.5% of cases. A positive immunodiagnostic result also may be useful for the prediction of subsequent histopathologic confirmation of cutaneous T cell lymphoma in patients who have suspect lymphoid infiltrates, such as alopecia mucinosis or idiopathic generalized erythroderma, when first seen. With the use of multivariate analysis, stage and possibly the percentage of Th cells within the T cell component in cutaneous infiltrates were covariates with significant relationships to survival in patients with confirmed cutaneous T cell lymphoma. In addition, Ts cells in infiltrates did not correlate significantly with observed responses to topical treatment and subsequent course in pretumorous mycosis fungoides. These results indicate that Ts cells play little biologic role in modifying the natural history of cutaneous T cell lymphoma.
Antibodies, Monoclonal↗
Sister Mary Joseph's nodule.
A case of ovarian carcinoma that spread to the umbilicus and resulted in Sister Mary Joseph's nodule is described in which the mode of metastasis can be demonstrated. To our knowledge, this is the first report of confirmed contiguous extension from the peritoneal surface.
Aged↗
[Complex partial epileptic seizures as the initial symptom of subacute sclerosing panencephalitis].
A 18 year-old boy, without a previous history, presented with psychomotor seizures and, 4 months after, mental deterioration. EEG showed focal epileptic abnormalities characterized by high amplitude spike waves in the left temporal region. Periodic complexes appeared after administration of Diazepam. CT scan showed mild cortical atrophy in the left temporal region. Measles virus HI antibody titers were 1/2048 in the serum and 1/64 in the CSF. The patient died one year after the first complex partial seizures.
Adolescent↗
Monitoring free vascularised jejunum grafts.
A reliable method of monitoring free vascularised jejunum to the head and neck region has been used in six patients. Preliminarily, the jejunum island flap is subdivided into major and minor segments. Transferred to the neck, the major part is used to reconstruct the oesophageal or pharyngeal defect, while the minor part supplied by the same segmental mesenteric artery is exteriorised through the neck incision. After five days direct monitoring, the marker segment is clamped, tied and excised before suturing the neck wound under local anaesthesia. No failures of the graft occurred. The effectiveness of this technique has surpassed all previously published and unpublished methods.
Aged↗