Biomedical subjects
Publications and source records attributed to S Tsukada.
An unusually high division of the median nerve in the forearm is reported. Recognition of this anatomical variation can help plastic surgeons make the proper diagnosis when encountering an incomprehensible clinical sign in the vicinity of the median nerve.
We report the articulation results in 87 4-year-old children with overt cleft palates who had been repaired at age 1 by the same surgeon and were found to have no factors obstructing their speech-language development. We further present data on developmental courses before age 4 in 81 subjects and after age 4 in 64 subjects. Forty-five of the 87 subjects showed normal articulation: 24 had already acquired normal speech sounds and 21 were still in the course of normal development. In this group only 1 patient showed incompetent velopharyngeal closure. Abnormal articulation was found in 42, among whom only 4 showed incompetent velopharyngeal closure. The most common abnormal articulatory type was palatalized articulation (70%), which had been seldom found in earlier studies. Palatalized articulation showed less of a tendency to correct itself spontaneously than did glottal stops. Abnormal articulation improved spontaneously after 4 years of age in some subjects. The significance of detailed postsurgical follow-up and the necessity of accumulation of more data are emphasized.
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A case involving medial calf, free cutaneous flap based on the posterior tibial artery for one-stage reconstruction of soft tissue and main vessel damage is presented. Flap anatomy is outlined, and operative techniques for transfer are detailed, in a case of deep contact burn of an arm.
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We have seen 11 cases of congenital onychodysplasia over the past six years. Associated anomalies were present in six patients, most of whom had an anomaly of the hand. Roentgenograms of the affected fingers showed hypoplasia, narrowing at the distal third of the distal phalanx, and bifurcation of the distal phalanx. The etiology of this condition is unknown, but clinical study suggested that ischemia of the finger at a certain period of embryonic life might play an important part in its pathogenesis.
The arterial blood supply of the duplicated thumb was studied in 42 hands using the angiography technique. The developing factor of the duplicated thumb also may hinder the developing process of the limb artery, especially in the early stage when the median artery develops. In 73.8 percent of duplicated thumbs, two digital arteries were present, and 96.8 percent of them had one digital artery in each member. Simple ablation of the supernumerary digit leaves the thumb with a single end-arterial blood supply. The developmental mechanism of the duplicated thumb may depend not on duplication of the limb bud, but on splitting of the limb mesenchyme. The group of type VII of Wassel's classification was different from the other types in terms of origin of the digital artery distributing blood to the duplicated thumb.
The absorption and distribution of silver has been studied in 8 burned patients treated with silver sulphadiazine cream by electron-microscopic examination. Biopsies were taken from the burn wounds and from epithelized areas surrounding wounds. Only 1 to 2 patients treated for 12 days was observed to have silver deposits in the cytoplasm of both the epidermal cells and sweat glands. The silver deposits appeared as roughly round and oval bodies of varied size. The results indicated that very little of the silver moiety in silver sulphadiazine cream penetrated the body through the wound.
3 young Japanese sisters with congenital alpha 2-plasmin inhibitor (alpha 2-PI) deficiency are reported. They have mild umbilical bleeding and/or repeated prolonged bleeding after minor trauma, but rarely spontaneous bleedings. The most characteristic hemostatic findings were shortened whole blood clot lysis time and euglobulin lysis time. Activities of all hemostatic factors except alpha 2-PI were within normal range. Both functional and immunological absence of alpha 2-PI were found in the plasma, and this failure to detect alpha 2-PI was not corrected by the addition of the patient's plasma of the first described case of alpha 2-PI deficiency. Clinical and laboratory data revealed that these patients were probably homozygous for alpha 2-PI deficiency and born of heterozygous parents, but not of consanguineous ones. Bleeding episodes due to deficiency of alpha 2-PI in these patients were well controlled by an antifibrinolytic agent, tranexamic acid.
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A case is reported in which a giant cell tumor of the distal end of the radius was treated by massive resection and reconstruction with a free vascularized bone graft taken from the fibula. The postoperative course was uneventful. Angiograms made eight weeks after surgery showed patent anastomoses. One year after surgery there was no evidence of recurrence of the tumor, and roentgenograms showed no degenerative changes and bony union with hypertrophy at the junction of the radius and the graft. An excellent clinical result was obtained, and the patient was able to return to his original occupation as an illustrator.
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We present our new approach for preserved subcutaneous vascular network (PSVN) skin transplantation. To confirm the revascularization of the grafts, we undertook a microscopic study and found that, because of the rich anascroscopic study and found that, because of the rich anastomotic communication between the recipient vessels and the PSVN on the undersurface of the skin graft, successful adaptation to the recipient bed is achieved--enhancing the transplantability of the skin graft. We also noted that the absence of injury to the dermis of the graft permits the undersurface of the graft to be in contact with the raw surface with a minimum of scar formation. Finally, neither contracture nor wrinkling of the skin grafts was observed during the six-year follow-up study.