Association study of NlaIII and MspI genetic polymorphisms of catechol-O-methyltransferase gene and susceptibility to schizophrenia.
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Adult↗
Biomedical subjects
F C Wei
Publications and source records attributed to F C Wei.
Association of TaqI A polymorphism of dopamine D2 receptor gene and tardive dyskinesia in schizophrenia.
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Adult↗
Further evidence of no association between Ser9Gly polymorphism of dopamine D3 receptor gene and schizophrenia.
Dopamine D3 receptor (DRD3) was demonstrated to have important implications in schizophrenia, because it binds antipsychotic drugs and is abundant in the limbic system of the brain. Several groups attempted to find an association between a serine-to-glycine polymorphism at codon 9 of the DRD3 gene (Ser9Gly) and schizophrenia; however, the results were inconsistent. We conducted a case-control association study in Han Chinese schizophrenic patients from Taiwan, to examine the relationship of this serine-to-glycine polymorphism and schizophrenia. We noted no significant differences of genotype distribution, allele frequencies, or homozygosity proportion of this polymorphism between schizophrenic patients (N = 178) and controls (N = 100). When patients were divided according to sex, or presence or absence of family history, the differences were still not significant. Our study does not support the contention that the Ser9Gly polymorphism of the DRD3 gene plays a major role in schizophrenia.
Alleles↗
Step-wise lengthening for delayed repair of avulsion of the flexor pollicis longus.
Repair of late avulsion of the flexor pollicis longus tendon at insertion is a rare but difficult problem. A 52-year-old female labourer presented with a 3-month history of inability to flex her right thumb at the interphalangeal joint. Avulsion of the flexor pollicis longus tendon at its insertion was noted on exploration. Because the tendon had contracted and could not be reinserted directly, a technique of step-wise lengthening was used for reinsertion. Two months after operation, the patient resumed her daily activities and went back to work with satisfactory use of her right thumb. This report highlights the possibility of using a simple technique when there is no other alternative.
Female↗
Free tissue transfer for leg reconstruction in children.
Twenty-five free tissue transfers for reconstruction after lower limb trauma or release of scar contractures were performed in 23 children over an 8-year period. The ages ranged from 2 to 14 years (mean 7.1 years). Fourteen (61%) patients had major associated injuries. The reconstruction sites were all in the distal leg. The overall vascular success rate was 96%. Three patients underwent re-explorations because of vascular insufficiency. One flap failed and two were salvaged. The causes of vascular complications were considered to be inadequate debridement of an avulsed vessel, venous kinking and inadequate protection of the vascular pedicle. The three cases with vascular insufficiency were children with associated injuries on the ipsilateral leg proximally. Postoperative complications were not uncommon (28%). Six of the seven complications occurred in patients with major associated injuries. The mean follow-up was 57 months. Long-term problems such as a limping gait, frequent flap ulcers, toe contracture or a bulky flap were common. Our results suggest that free tissue transfer is reliable and safe for the reconstruction of major leg injuries in children. Associated injuries proximal to the reconstructed defects on the ipsilateral leg predispose to more vascular complications. Since postoperative complications and long-term morbidity are common in children, special precautions should be taken with the preoperative assessment, planning, execution of surgery and postoperative care to achieve better results.
Accidents, Traffic↗
Excision of subcutaneous tissue for the treatment of axillary osmidrosis.
Axillary osmidrosis is a distressing problem. Medical treatment is often inadequate. Local excision of the apocrine and eccrine glands is the most effective method available but is often accompanied by significant morbidity. We report a modified surgical technique for the treatment of this condition. From January 1994 to December 1995, 46 patients (38 females, 8 males) with axillary osmidrosis have been treated by excision of the subcutaneous tissue via two transverse incisions, without removing skin. Sutures are used to anchor the skin to the axillary fascia. There is no need for a complicated tie-over dressing and postoperative arm restriction. All patients were followed up for a minimum of 6 months (average 11.6 months). The patients were asked to complete a questionnaire. The results of malodour elimination were classified as good, fair and poor. Forty-one (89.1%) of the patients had good results, four (8.7%) had fair results, and one (2.2%) had a poor result. The average convalescent time was 9.2 days. Twenty-six patients (57%) were very satisfied and recommended this procedure. Only one patient (2%) regretted having the operation. This operation has the advantages of a high success rate, low complication rate, and rapid recovery for the treatment of axillary osmidrosis.
Adolescent↗
Pilot in vitro toxicity study of 5-ALA and Photofrin in microvascular endothelial cell cultures.
Complicated hemangiomas are unique problems in which intervention with the proper laser can be an ideal solution. In this study we evaluated the toxicity of 5-Aminolevulinic acid (5-ALA) and Photofrin using in vitro models. The in vitro toxicity of 5-ALA and Photofrin was examined in a microvascular endothelial cell (MEC) culture system. The measurement of the percentage of MEC killed by various drug concentration using fluorescence viability assay. MEC incubated with 5-ALA at various concentrations for evaluation of dark toxicity showed less than a 50% cell kill. A comparison of different intervals of subcultured MEC showed that the early subculture (3 days after primary culture) is more vulnerable than later subculture (7 days after). Cells treated with Photofrin at various concentrations exhibited less than 50% cell kill (dark toxicity). The comparison of different intervals of subculture (3 days and 7 days after primary culture) showed a result similar to that of 5-ALA. All controls showed 0% cell kill. In conclusion, both 5-ALA and Photofrin are capable of destroying human microvascular endothelial cells in vitro. Drug concentrations and the power density for photodynamic therapy should be considered and will be included in our subsequent studies.
Aminolevulinic Acid↗
Resurfacing a circumferentially degloved hand by using a full-thickness skin graft harvested from an avulsed skin flap.
Twelve patients with circumferentially degloved hands were treated with full-thickness skin grafts harvested from defatted avulsed flaps. All injuries were industrial accidents caused by various roller machines, not crush injuries. Of these 12 patients, 9 patients were degloved from the wrist level and 3 patients were degloved from the forearm. There were 11 distally based skin flaps and one flap was completely detached. Four patients were avulsed distally to the mid palm, with volar neurovascular bundles damaged at the "fenestrae" of the palm, which resulted in devascularization of the involved fingers. Among them, distal fingers were successfully revascularized by microsurgical techniques in 3 patients. The full-thickness skin grafts were prepared from the attached, avulsed skin flap to avoid junctional hypertrophic scarring. The graft was then secured to its anatomic position with multiple skin staples to improve skin graft take. Initial take of the graft averaged 93% (range, 85%-100%). Compared with conventional methods, this approach provides a higher rate of skin take and better cosmetic and functional results.
Adolescent↗
Reversed arterial flow in free flap surgery for leg reconstruction.
A lower leg open fracture with an accompanying extensive soft-tissue defect may require free flap transfer to resurface the wound. In open-leg fracture injuries the major arteries are frequently damaged during the injurious event. When the antegrade arterial blood flow is not available for arterial inflow to the free flap, end-to-side arterial anastomoses or a venous graft from a proximal healthy artery is an appropriate solution. Reversed arterial flow is another technique that may be used to provide arterial inflow to the free flap. We report 5 patients with open tibial fracture injuries that were successfully covered using latissimus dorsi muscle free flaps with reverse arterial inflow and either antegrade venous outflow (4 patients) or retrograde outflow (1 patient). This technique is indicated when (1) the defect is not located at the site adjacent to the residual antegrade artery, (2) a long vein graft might pass through severely scarred soft tissue, or (3) after failure in end-to-side anastomosis with accompanying insufficient antegrade proximal arterial flow but good distal arterial reflux.
Adolescent↗
Mandibular reconstruction with fibular osteoseptocutaneous free flap and simultaneous placement of osseointegrated dental implants.
Insertion of osseointegrated dental implants several months after mandibular reconstruction using vascularized composite bone grafts has proved to be a successful method to achieve mastication and complete oral rehabilitation. Theoretically with primary placement of implants into the new mandible a better access to the bone is achieved, interdental relationships are easier to determine, and oral rehabilitation can be attained in a shorter period of time. Previous results describing this approach, however, are inconclusive and controversial. This review describes our experience with primary insertion of dental implants into fibular flaps used for mandibular reconstruction during ablative surgery. Adequate selection of patients for this combined procedure depends mainly on the pathological nature of the mandible and perioperative radiotherapy. Preoperative determination of soft-tissue and bone requirements, number of osteotomies, rigid fixation method, and familiarity with the use of osseointegrated implants are important factors that must be considered for adequate surgical planning and to achieve good results.
Dental Implantation, Endosseous↗
Management of large infected tibial defects with antibiotic beads local therapy and staged fibular osteoseptocutaneous free transfer.
Fifteen patients with tibial fractures complicated by large infected tibial defects were treated with a two-stage protocol. In the first stage, antibiotic-impregnated polymethylmethacrylate bead chains were used to obliterate the debrided osseous defect, and a meshed porcine skin was used for temporary wound coverage. In the second stage, the bead chains were removed, and the defects were reconstructed with a microvascularized fibular osteoseptocutaneous free transfer. The time between the first and second stages of treatment was 2 to 6 weeks. The bone defects ranged from 6 to 16 cm, and the skin defect areas ranged from 10 to 82 cm2. Wound healing and bony union were achieved in all 15 cases. An additional muscle flap or skin graft was required for only three patients with a large skin defect. Minor pin tract infections were seen in two patients. Stress fractures in three cases were successfully managed with bracing, external skeletal fixation or plating, and cancellous bone grafting. All of the most recent roentgenograms showed good consolidation and hypertrophy of grafted fibular bones. No recurrence of osteomyelitis was observed during an average follow-up period of 50 months (range, 36-86 months). We therefore conclude that this treatment protocol provides rapid recovery from osteomyelitis. The fibular osteoseptocutaneous graft is a useful method for the reconstruction of a large tibial defect, and it also offers the unique advantage of simultaneously reconstructing a moderate skin defect.
Adult↗
The functional outcome of lower-extremity fractures with vascular injury.
Salvage of lower-extremity Gustilo type IIIC fractures is difficult, time-consuming for the patients and physicians, and not universally successful because of poor functional outcomes. Even if successful with limb salvage, the functional result may be unsatisfactory because of mutilating injuries to muscle and nerve, bone loss, and the presence of chronic infection. From July 1991 until July 1994, revascularizations of open IIIC fractures were attempted for wounds with Mangled Extremity Severity Score (MESS) < or = 10. The functional results were evaluated at 2 years after injury. Thirty-six lower-extremity revascularizations were performed on 34 patients, including 1 patient with bilateral distal tibial IIIC fractures and a child with IIIC femoral fracture accompanied by ipsilateral distal tibial amputation. Excluded were patients with below-ankle IIIC fractures as well as patients who underwent immediate amputation at admission. After the revascularization, seven patients with IIIC fractures (7 of 36, 19.4%) underwent secondary amputation within 1 week. At the 2-year follow-up, the overall secondary amputation rate was 25% (9 of 36) and the salvage rate was 75% (27 of 36). Those were no deaths. Of the 29 salvaged limbs among these 27 patients, 23 limbs (23 of 29, 79.3%) required secondary coverage procedures that included 12 free flap transfers (12 of 29, 41.4%). Every patient needed subsequent reconstructive surgery to achieve an acceptable functional result. In this series, MESS was able to predict the secondary amputation rate and the functional result. Sixteen of the 17 limb-salvaged patients with MESS < or = 7 were able to achieve minimal functional requirements, whereas 3 of the 10 patients with MESS = 8 to 10 failed to achieve minimal functional requirements at the 2-year follow-up. Using statistical analysis, we found that the salvaged limbs with MESS < or = 9 exhibited a significant difference in achieving adequate function compared with limbs with MESS > 9. Using our protocol for treatment for IIIC fractures, the threshold for immediate amputation can be raised from MESS = 7 to MESS = 9. Our conclusions are (1) more severely injured limbs have poor functional results, (2) every patient needs subsequent reconstructive surgery, and (3) the MESS may be helpful in decision-making.
Adolescent↗
Free fibula osteoseptocutaneous graft for reconstruction of segmental femoral shaft defects.
Seventeen major reconstructions of the femoral shaft using vascularized fibula osteoseptocutaneous grafts were performed from August 1984 to September 1993. Patients were 14 males and 3 females, with an average age of 34 years. All patients had sustained high-energy trauma in motor vehicle crashes and had bone defects averaging 10 cm. The skeletal defect was primary attributable to bone loss at the time of injury (2 cases) or secondary after infection and sequestrectomy (15 cases). Vascularized fibular transfer was performed at an average of 6 months after trauma. The fibular graft was inserted as a single strut in 10 cases and as a double-barrel composite in 7 cases. Patients were evaluated at an average of 43 months after surgery. All grafts eventually united, and no patient showed evidence of recurrent or persistent infection. The average time to radiologic union was 8 months, and the average time to full weight bearing was 14 months. Secondary bone grafting and internal fixation were required in five cases because of delayed union, stress fracture, or screw loosening. All cases of delayed union and stress fracture were in those reconstructed by single-strut fibular graft. Four cases (24%) required quadriceps plasty and arthrolysis. The final average arc of active knee motion was from 0 to 80 degrees. Limb length discrepancy ranged from 0 to 7 cm (average, 3 cm). Five cases (29%) had varus deformity averaging 30 degrees. The fibular graft hypertrophied to 100% of the femoral circumference in cases followed for 3 years. Donor site morbidity was negligible. At the time of final follow-up, 13 patients had returned to their original jobs, two were permanently disabled because of below-knee amputation, and two were retired. The study suggests that vascularized fibula osteoseptocutaneous transfer is a valuable procedure for reconstruction of large, previously infected femoral shaft defects.
Adolescent↗
Metacarpal hand: classification and guidelines for microsurgical reconstruction with toe transfers.
Metacarpal hand refers to the hand that has lost its prehensile ability through amputation of all fingers with or without amputation of the thumb. Functional restoration can be achieved by a wide variety of microvascular toe transfer techniques. When deciding which procedure should be used, careful consideration must be given to the level of amputation of the fingers as well as the functional status of the remaining thumb. In this article we propose a classification for the various patterns of the metacarpal hand along with guidelines for selection of the proper toe transfer procedure.
Adult↗
Distally based sural island flap for foot and ankle reconstruction.
The distally based sural island flap is vascularized by the cutaneous perforating branches of the peroneal artery. Three variants of this flap were used for reconstruction of 19 patients with defects in the ankle and in both dorsal and plantar surfaces of the foot. Four adipofascial sural flaps were used to cover the exposed Achilles tendons. Twelve fasciocutaneous sural flaps were used to resurface defects in the ankle region as well as in the non-weight-bearing area of the heel. Another four sural flaps, innervated by the lateral sural cutaneous nerve, were used to resurface the weight-bearing areas of the heel. The advantage of this flap is a constant and reliable blood supply without sacrifice of major arteries or sensory nerves. It also has the potential for reinnervation and can be performed in a single stage without microsurgery.
Adolescent↗
Use of the vascular pedicle of a previously transferred muscle as the recipient vessel for a subsequent vascularized bone flap.
In six complex lower extremity defects, we have been able to reconstruct combined bone and soft-tissue defects with primary free-muscle transfer, followed by secondary free vascularized bone transfer. Indications for this technique are long segmental bone defects of the tibia associated with large soft-tissue defects, which are not suitable for one-stage composite bone and soft tissue transfer. In the first stage of reconstruction, a well-vascularized muscle flap is used to obliterate the soft-tissue defect to prevent infection. At the second stage, a fibula osteocutaneous flap from the contralateral leg is used to complete the reconstruction. The vascular pedicle of the first muscle flap surrounded by fibrofatty cuff, serves as the recipient vessels free of scar at the time of the second vascularized bone transfer. This method provides great advantages in two-stage free-flap reconstruction of complicated cases in which localization of suitable recipient vessel is technically difficult.
Adolescent↗
Toe-to-hand transfer for traumatic digital amputations in children and adolescents.
In the period from July of 1990 to August of 1994, 45 toe or toe tissue transfers were performed in 28 children and adolescents with traumatic amputation of digits. The average age at the time of transfer was 12 years (range, 3 to 16 years), and the median age was 10 years. The methods of reconstruction included transfer of 6 trimmed great toes, 2 great toe pulps, 24 second toes, 1 vascularized metatarsophalangeal joint from the second toe, 2 third toes, 4 combined second and third toes. and 1 combined third and fourth toes. All of the transferred toes, except one second toe, ultimately survived. Exploration and reanastomosis were required in three cases owing to arterial insufficiency. Partial pulp loss occurred in two digits. Follow-up ranged from 1 to 5 years (average, 3 years). Bony union occurred uneventfully in all patients. Two-point discrimination averaged 5 mm (static) and 6 mm (moving). Active range of the motion averaged 69, 38, and 13 degrees at the metaphalangeal proximal interphalangeal and distal interphalangeal joints of the reconstructed fingers, respectively, and 15 degrees at the interphalangeal joint of the reconstructed thumbs. None of the children required subsequent tenolysis. Pulp plasty was performed in nine digits in seven patients. Radiologically, the transferred phalanges showed the some growth as the non-transferred ones. Trimming the great toe before transfer did not result in premature physeal closure or growth retardation. The donor foot maintained a satisfactory appearance. None of the patients complained of difficulty in running or jumping. Toe-to-hand transfer in children, performed meticulously, can provide a valuable option for reconstruction of traumatic digit loss.
Adolescent↗
Reconstruction of a large thoracoabdominal wall defect with a flow-through forearm flap and a latissimus dorsi-groin flap.
We report a case of a 45-year-old man with a recurrent, large, invasive dermatofibrosarcoma protuberans over the left lower chest and abdomen. Wide surgical excision of the tumor created a major thoracoabdominal wall defect. Wound coverage was achieved by using a flow-through forearm flap and an inferiorly based latissimus dorsi-groin flap. Follow-up at 1 year revealed no local recurrence or herniation.
Abdominal Muscles↗