Open fractures: a new fixation method in cross-leg cases (arm-leg).
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Pyoderma gangrenosum is a rare condition which is sometimes associated with ulcerative colitis and Crohn's disease. The pathological basis is not completely understood but it may be caused by vasculitis. The lesions are typically said to have purple overhanging edges and a necrotic base. The condition may also occur with rheumatoid arthritis, multiple myeloma and leukaemia. The treatment of choice is systemic steroids but it may also respond to azathioprine, minocycline or clofazimine.
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The patterns of myographic activity in the flexor and extensor tibiae muscles of the locust which accompany learned tibial extension were examined. Three distinct motor strategies were identified: (1) repeated flexion-extension movements, each of which resulted in a momentary excursion beyond the required, pre-set joint angle (demand angle) and in sum met the criterion for learning; (2) changes in basic muscle tonus, which resulted in maintained shifts in tibial position without discernible myographic activity; (3) tonic activity in the single slow excitatory motoneuron of the extensor tibiae ( SETi ) which produced maintained tibial extension. These strategies were selectively employed depending on the particular range of joint angle required. These strategies were compared and their effectiveness evaluated using a variety of behavioral criteria. Neuronal mechanisms which might underlie each of these strategies are discussed.
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A 50-year-old male presented with a T4 N0 squamous cell carcinoma of the floor of the mouth and alveolus. Treatment included a partial mandibulectomy with a free osseocutaneous fibula flap reconstruction. He made a good postoperative recovery and was given adjuvant radiotherapy. No problems were reported with the donor site or ankle. Five months after harvesting the flap the patient sustained a fracture of the medial malleolus having jumped over a ditch playing golf. This was treated successfully with a below knee plaster of Paris cast. The interosseous membrane was not ruptured in the accident indicating that the distal fibula left in situ was adequate to maintain the integrity of the mortice. A degree of ankle instability may be present after fibula flap harvest which is only revealed by athletic activity. (c) 2000 Harcourt Publishers Ltd Copyright 2000 The British Association of Plastic Surgeons DOI: 10.1054/bjps.1999.3227.
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