Long-term evaluation of modified Tanzer ear reconstruction.
This article presents the author's experience using the Tanzer technique with modifications. Included also are changes in technique based on results from long-term follow-up studies.
Biomedical subjects
Publications and source records attributed to O Fukuda.
This article presents the author's experience using the Tanzer technique with modifications. Included also are changes in technique based on results from long-term follow-up studies.
A case of intracavernous aneurysm secondary to septic cavernous sinus thrombosis demonstrating sequential dynamic angiographic changes is reported. Serial angiograms of a 32-year-old man with septic cavernous sinus infection revealed a normal study, stenosis, recovery of stenosis, and aneurysmal formation. Superficial temporal-middle cerebral artery anastomosis and internal carotid artery ligation were performed because of progressive ophthalmoplegia. Neurological deficit rapidly disappeared. Anigiographic changes and surgical treatment of septic cavernous sinus thrombosis are discussed.
A new experimental model is presented, using isohistogenic Lewis rats and microsurgical techniques. Transplantation of the head and forelimbs of the infantile rat was done to the groin of an adult rat. The goal was to study the effects of ischemia on brain tissue. This model also proved useful for other experiments in studies of facial and cranial bone growth. The model presented proved efficient for the study goals, and long-term experiments were possible. The maximum ischemia time tolerated by brain tissue was found to be somewhere between 60 min and 120 min.
The Peltier stack, which allows quantitative measurement of cerebral blood flow (CBF) by means of thermal diffusion, has a probe too large for use in small animals. However, it is difficult to measure CBF by a thermal diffusion method involving the use of a constantan heating wire, because of heat conduction between the two gold plates. The authors developed a new thermal diffusion flow probe, using a constantan wire as a heat source rather than the Peltier stack. With the new probe, separation of the gold plates and attachment of a pair of long thermocouples minimize heat conduction between the two plates. Moreover, the probe itself is considerably smaller than that of the Peltier stack. The new probe was inserted to the subdural space of rabbits and the voltage (V; mV) was measured with an amplifier by the circuit of constant current method. CBF (F; ml/100 g/min) was measured simultaneously by the hydrogen clearance method in the adjacent cortex. A regression equation of F = 29, 111 (1/V-1/226) was obtained between 35 pairs of F and V (r = 0.92, p less than 0.001), which verified that CBF can be accurately measured with the new probe.
Sequential changes of magnetic resonance imaging (MRI) in sixteen patients with acute cerebral infarction are studied in comparison with the findings of computed tomography (CT). The sixteen patients were examined within 36 hours from the onset of symptoms on resistive type MRI (0.15T) using T1 weighted image (IR2000/500) and T2 weighted image (SE2000/80), and on CT. In general, large infarcted lesions of the cortex-subcortex seemed to be visualized earlier than small lesions of the basal ganglia and brainstem. In 8 patients, the infarcted lesions were detected on MRI earlier than on CT. For example, early detecting time within 12 hours were 2, 6, 7, and 10 hours after onset. In two patients of this group, lesions were detected on T2-weighted image earlier than on T1-weighted image. In two cases, small lesions of the brainstem were detected only on MRI. The size of abnormal findings gradually developed and reached a maximum on days 5 to 7 sequentially. The difference between infarction and perifocal edema was not clear even on MRI. The changes gradually subsided and assumed a stable size after about 2 months. Contrast enhancement effect was observed in four patients. In two of these cases, the signal intensity of T2-weighted imaging was decreased just at the region which was enhanced with contrast medium. MRI is useful for early diagnosis of ischemic cerebral infarction, and may elucidate some aspects of the pathophysiology of ischemic stroke.
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We report a very rare case of acute poststreptococcal glomerulonephritis (PSGN) occurring in the eighth gestational month. The pregnancy succeeded despite initially severe nephrotic syndrome, and after delivery there was a complete recovery to normal renal function. Fetal prognosis was also good. The diagnosis of PSGN was made based on serological examinations and postpartum renal biopsy. Light and electron microscopic findings showed that the glomerular lesions were different from those of typical pre-eclampsia.
Three cases of hereditary lateral cervical fistulas are reported. The patients had lateral cervical fistulas bilaterally and different types of auricular malformations. The mothers of the patients also had lateral cervical fistulas. Moreover, one mother had bilateral microtias and the other mothers bilateral preauricular fistulas. The literature is reviewed and discussed.
In order to examine whether or not facial bones are themselves able to regulate their own growth, we devised a new experimental model in which we transplanted the whole head of an infant rat to the body of an isohistogeneic adult rat by means of microvascular anastomoses. The advantage of this model is that the transplanted head has neither scars nor any moving soft tissues that could modify growth around facial bones. Using this model, we conducted a study of the nasomaxillary region that has led us to conclude that facial bones do in fact regulate their own growth. The results also suggested that facial bone sutures play a more active role in the growth process than presently suspected.
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The pathogenesis of migraine has not been completely understood. However, it is generally accepted that the prodromal symptoms encountered in classic migraine usually result from vasoconstriction of intracranial vessels, while the headache itself results from dilation of other cranial vessels, often branches of the external carotid artery. Despite of increasing refinement in angiographic technique, many authors demonstrate the difficulty of interpreting abnormal radiographic findings in patients of migraine. We experienced recently a rare case who complained of migraine with neurological disorder manifesting for dynamic changes of cerebral arteries on sequential angiography. This 39-year-old man was admitted to our hospital with complaint of classic migraine accompanied with transient hemiparesis of the left side. Curious dynamic changes were noted sequentially on the repeated angiograms sequentially during his hospitalization. The carotid angiogram on admission showed narrowing at the right M1 portion. The second angiogram obtained at the fourth hospital day showed reduction of the narrowing, and occlusion of the right angular artery. The patient was treated with Ergotamine. The third angiogram taken after admission for the period of 1 month showed increased stenosis at the right M1 portion. Isolated angiitis of central nervous system was suspected because of such sequential dynamic angiographic changes, and steroid therapy was started. However he began to suffer from hemiparesis of left side one week after the treatment. Therefore, EC-IC bypass was performed, and his symptoms were improved gradually. Migraine is one of the common neurologic disorders countered in clinical practice. This report suggests that careful observation is needed in patients of migraine.
A case of neurilemoma originating from the ansa cervicalis is presented. Available literature is reviewed, and the rarity of the tumor is discussed. It is believed that some cases of neurilemoma in which the nerve of origin was not identified may in reality have originated from the ansa cervicalis.
Experimental toxemia of pregnancy in late gestation in rabbits was induced by constricting the aorta below the renal arteries on day 21 of gestation. Light and transmission electron microscopic examination of glomeruli on day 29 revealed only a slight swelling of endothelial cells. The angioarchitecture was also investigated using scanning electron microscopic examination of methyl methacry corrosion casts of the glomeruli. The kidney in experimental toxemia was characterized by a reduction of glomerular vessel diameter compared to that of normal pregnant rabbits. This probably resulted from enlargement of the endothelial cells, suggesting a reduced blood supply to the glomerulus. These findings suggest that interference with the blood supply to the pregnant uterus is an important factor in the development of the renal lesion of experimental toxemia of pregnancy in the rabbit.
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A natural oral commissure is not easily achieved in cases of macrostomia associated with branchial arch syndrome. A technique designed to preserve the existing commissure using a composite flap advanced to the required position is presented. The flap consists of the vermilion at the angle of the mouth and a small amount of adjacent skin together with mucosa and submucous soft tissue. The flap is shifted after excision of medial sections of vermilion of the upper and lower lips. The donor site defect is closed using a Z-plasty or W-plasty. The technique was utilized in 8 patients with satisfactory results. It is especially suitable in patients with mild degrees of cleft and well-preserved contour of the corners.
A young man with deafness, a characteristic face, and deformities of the hands and feet was diagnosed as having the otopalatodigital syndrome. The literature is reviewed and discussed.
One-hundred and sixty-six patients were followed up for a year following transplantation of costal cartilage, and we studied the relationship between the clarity of contours of the reconstructed ear and the condition of the scar on the anterior chest following removal of the cartilage. The contours of the reconstructed ear were evaluated on a four-point scale, and the condition of the scar on the anterior chest was evaluated on a three-point scale. Our results showed that in patients with a predisposition to develop wide or hypertrophic scars on the anterior chest, the contours of the ears were often observed to be poorly defined.