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The continuous wave CO2 laser lacks a number of draw-backs of the pulsed Ruby laser, and seems attractive for tumor surgery. We compared the CO2 laser with conventional surgery in experiments on mice bearing the Cloudman S91 melanoma. We had the same rate of local recurrence and lung metastasis in both techniques.
INTRODUCTION: In patients with symptomatic scaphoid nonunion there was an increased evidence of progressive osteoarthrosis expressed as instability of the wrist [1, 2]; it is defined as a scapholunate angle of more than 70 degrees or a radiolunate angle of more than 10 degrees. Intercarpal instability causes unnatural joint movement of the wrist. This disorganization of the wrist mechanism associated with hypermobility of the schapoid bone induces degenerative changes [3]. Arthritic changes begin at the distal scaphoid-radial styloid joint and later progress to the capitolunate joint. A similarity was noted with rotatory instability of the scaphoid bone associated without fracture [2]. If mid-carpal joint exists the joint becomes unstable, the lunate rotates backwards and carpal bones show the so-called concertina deformity [4] or dorsal intercalated segment instability pattern [5]. AIM: We tried to determine the factors of risk and prognostic indicators of degenerative arthritis. METHOD: In this study 40 patients with painful nonunion of the scaphoid bone were analysed. Duration of nonunion was 1.43 year (range from 8 months to 15 years). Roentgenograms of the hand were done in anteroposterior, lateral and oblique projections. Fracture location and configuration were determined as described by Russe. Instability was determined by measuring the scapholunate and radiolunate angle in the lateral roentgenogram. Scapholunate angle more than 70 degrees and radiolunate angle more than 10 degrees were considered abnormal. To asses the amount of carpal collapse the carpal index was determined as described by Youm [6]. Abnormal value was 0.50 or less (normal value: 0.54 +/- 0.03). Four roentgenographic groups were established based on the extent of degenerative changes [7]. Group I showed no sign of degenerative changes. Group II had sclerotic lesions in fracture margins with or without a cystic formation. Group III showed lesions of radioscaphoid arthritis, including joint-space narrowing and pointing the radial styloid. Group IV had lesions of generalized arthritis of the wrist. RESULTS: Duration of nonunion was not in correlation with development of osteoarthritic changes (p = 0.644, p > 0.05) (Table 1). Progressive degenerative changes correlated well with radiolunate angle (p = 0.398, p < 0.05), capitolunate angle (p = 0.381, p < 0.05) and carpal index (p = 0.392, p < 0.05) (Table 2). The average values of intercarpal angles increased with progression of osteoarthritic changes (Table 3). There were 14 (35%) proximal third located fractures and 26 (65%) in the middle third or waist. There was a statistically strong correlation between location of the fracture in proximal third and presence of degenerative changes (p = 0.341, p < 0.01) (Table 4). Intensity of arthritic changes showed no statistically significant correlation regarding untreated fractures (p = 0.665, p > 0.05). DISCUSSION: In our study the most significant factors associated with arthritis were instability of the wrist and fracture location at the proximal third of the scaphoid bone. Mack [7] reviewed forty-seven symptomatic nonunions of the scaphoid and found a correlation between the presence of arthritis and the duration of nonunion. Also, he concluded that instability of the wrist can occur as late phenomenon in previously stable nonunion. Similar results were noted by Ruby [8] in his series. Conclusion of these authors was that the incidence of degenerative changes increased with the time after fracture of the scaphoid bone occurred [8-12]. We demonstrated that in untreated fractures associated with carpal instability, arthritis developed much earlier. Fourteen (35%) patients in our study were not treated and 92.8% belonged to Group II and Group III, with average time of nonunion duration of 27.2 months. Lunate dorsiflexion is a useful guide to carpal instability. In our experience the lunate silhouette is easily visualized on a lateral roentgenogram even in the presence of degenerative arthritis. There is a high probability that degenerative changes will occur. We recommend that a scaphoid nonunion associated with carpal instability should be operated before degenerative changes develop.
The argon laser and the ruby laser have been used to open the pigment layer in three cases of surgically incomplete peripheral iridectomy. The technique, its advantages and complications, were discussed. On two additional eyes, full-thickness argon laser iridectomy was unsuccessful.
To decide on an alternate procedure for placement of central vein catheters other than percutaneous access of the subclavian vein, we conducted a study of 46 women who underwent placement of a central venous catheter utilizing the cephalic vein procedure at Ruby Memorial Hospital at West Virginia University in Morgantown. Of these patients, 96% had a successful placement of a catheter into the subclavian vein following dissection of the cephalic vein within the deltopectoral groove. There were no cases of pneumothorax or injury to the great vessels during the surgical procedure, which is a significant advantage for women who often have significant pleural effusions.
Pancreatic cancer accounts for over 28,000 deaths a year in the United States. Since incidence rates and outcomes in a rural academic hospital setting have not previously been reported, we reviewed all patient records at Ruby Memorial Hospital in Morgantown from 1/90 to 12/99. Our study revealed 32,231 cancer patients during this time, of which 152 (0.5 percent) were diagnosed with pancreatic cancer. Only 32 (21.2 percent) patients had resectable tumors at time of diagnosis. The mean age of these patients was 67 years (range 34-83 years) and only 36 percent of operable patients were male. The majority of tumors (26 or 81 percent) were found in the pancreatic head, and 97 percent of the tumors were adenocarcinomas. Only three patients (9.3 percent) had well-differentiated tumors, with poorly and moderately differentiated histologies making up 40 percent and 50 percent, respectively. Operations performed included pancreaticoduodenectomy in 26 patients, total pancreatectomy in four patients, and distal pancreatectomy in two patients. There was only one perioperative death (3.1 percent). A total of 75 percent of the of the group underwent postoperative chemotherapy, mostly with fluorouracil-based monotherapy. Postoperative survival rate was 47 percent at one year, 25 percent at two years, and 9.6 percent at three years. No survival advantage was demonstrable in adjuvant treated patients. Our results show for the first time that pancreatic cancer is managed well in a rural hospital setting with equivalent short and long-term outcomes. The social and economic advantages of local patient care are supported by these results and warrant further study.
Retrograde transneuronal tracing with rabies virus from the right orbicularis oculi muscle was used to identify neural networks underlying spontaneous, reflex, and learned blinks. The kinetics of viral transfer was studied at sequential 12 hr intervals between 3 and 5 d after inoculation. Rabies virus immunolabeling was combined with the immunohistochemical detection of choline acetyltransferase expression in brainstem motoneurons or Fluoro-Ruby injections in the rubrospinal tract. Virus uptake involved exclusively orbicularis oculi motoneurons in the dorsolateral division of the facial nucleus. At 3-3.5 d, transneuronal transfer involved premotor interneurons of trigeminal, auditory, and vestibular reflex pathways (in medullary and pontine reticular formation, trigeminal nuclei, periolivary and ventral cochlear nuclei, and medial vestibular nuclei), motor pathways (dorsolateral quadrant of contralateral red nucleus and pararubral area), deep cerebellar nuclei (lateral portion of interpositus nucleus and dorsolateral hump ipsilaterally), limbic relays (parabrachial and Kölliker-Fuse nuclei), and oculomotor structures involved in eye-eyelid coordination (oculomotor nucleus, supraoculomotor area, and interstitial nucleus of Cajal). At 4 d, higher order neurons were revealed in trigeminal, auditory, vestibular, and deep cerebellar nuclei (medial, interpositus, and lateral), oculomotor and visual-related structures (Darkschewitsch, nucleus of the posterior commissure, deep layers of superior colliculus, and pretectal area), lateral hypothalamus, and cerebral cortex (particularly in parietal areas). At 4.5 and 5 d the labeling of higher order neurons occurred in hypothalamus, cerebral cortex, and blink-related areas of cerebellar cortex. These results provide a comprehensive picture of the premotor networks mediating reflex, voluntary, and limbic-related eyelid responses and highlight potential sites of motor learning in eyelid classical conditioning.
In spite of inadequate budgets, significant research and development studies have been made on laser medical instrumentation applications for both diagnosis and treatment. Diagnostic instrumentation includes the laser microprobe for cation microanalyses, cytofluorometry, interferometry, transillumination, holography and acoustical holography, and communications and information handling. Laser investigative surgical instrumentation includes lasers of argon, carbon dioxide, neodymium-YAG, and ruby, which are used as optical scalpels. Advantages of laser surgical instrumentation include precision, color absorption for lasers in the visible light range, and hemostasis.
This is a case report of an 89-year-old woman with a lentigo maligna treated with alexandrite and ruby lasers. The lentigo maligna never completely resolved despite multiple treatments. Marked cosmetic improvement, how-ever, was obtained. No adverse sequelae have occurred.
The cell DNA content of forty-eight Citrus calli of different genotype were measured by using the Ploidy Analyser. The results showed that 93.8% out of forty-eight Citrus calli had double DNA content except that Ruby. Weizhang and Kinnow had little varied cells and did not show second peak. Moreover, Pineapple, Meiwa kumquat, Changsha, Russ navel, Guoqing No. 4 and Carter had DNA varied cells including triploids and aneuploids based on the DPAC software analyse. Among the forty-eight Citrus calli, Pineapple had the highest of the DNA varied cells, which was up to 18.57%, Anliucheng had the lowest, 4.07%. There existed significant difference in the variation among genotypes by Duncan Analyse. At the same subcultured medium and at the same subcultured period, the effect of cultural duration on the variation of calli was not significant.
Vitiligo is an acquired idiopathic hypomelanotic disorder characterized by circumscribed depigmented maculae. It can be treated in many ways. The choice of therapy is individually adjusted depending on various factors, such as the patient age, type and stage of disease, and affected body site. Current treatment modalities include psoralen with exposure to ultraviolet A (PUVA) radiation therapy, narrow-band UVB therapy, topical corticosteroids, depigmentation therapy with monobenzylether of hydroquinone, and surgical treatments (minigrafting, thin split-thickness grafting, suction blister grafting, micropigmentation). There are also some new treatment modalities, such as 308-nm excimer laser, vitamin D analogues, tacrolimus, depigmentation with Q-switched ruby laser, and grafting of cultured melanocytes.
Albino mouse retinas were irradiated with a ruby pulse laser. After irradiation, an increase in acid mucopolysaccharide was observed in the interreceptor matrix.
Clinical lasers are of two types. Soft lasers are essentially an aid to healing, with relatively few rigorous studies available to support their use. Surgical hard lasers, however, can cut both hard and soft tissues, replacing the scalpel and drill in many areas. After initial experiments with the ruby laser, most clinicians have been using argon, carbon dioxide, and now Nd:YAG systems. The first dental laser based on a Nd:YAG engine provides handpieces of similar size to conventional instrumentation, and being fed by a fibre-optic "cable," has the flexibility for intra-oral use that the carbon dioxide lasers, widely used in oral surgery, lack. Furthermore, extensive clinical investigation has demonstrated their safety in clinical practice, and the fact that procedures can usually be performed without a local anaesthetic is obviously seen as an advantage by patients. Sterilizing as it cuts, the Nd:YAG laser promises to find uses not only in caries removal and soft tissue surgery but also in periodontics and endodontics.
The abdominal aortae of non-arteriosclerotic (virgin) and arteriosclerotic (breeder) Sprague-Dawley rats were exposed by laparotomy and a microscopically discreet locus within the inner media was subjected to non-thermal injury by a pulsed ruby laser beam (300 joules/cm2). Animals were killed every two days for 8 days. The non-arteriosclerotic rats manifested increased mesenchymal cell activity at the site of injury followed by intimal ground substance accumulation populated by mesenchymal cells and culminating with medial scarring with extensive loss of elastic lamellae. The arterioscelrotic aortae displayed no medial mesenchymal cell reaction but immediately below the lesion site there was active differentiation of intimal mesenchymal cells into cartilaginous cells and eventual transformation of both the intima and media into large C-shaped bars of cartilaginous tissue. It is believed that laser beam injury accelerated the differentiation of the already disturbed mesenchymal cells of the arteriosclerotic animals in the direction of mature cartilage to strengthen a weakened aortic wall.
Amalgam tattoo is an iatrogenic lesion caused by traumatic implantation of dental amalgam into soft tissue. Amalgam tattoo is the most common localized pigmented lesion in the mouth. In a study of a mass screening oral examination in the United States, it was found in about 0.4-0.9% of the adult population and in Sweden in about 8%. Clinically, amalgam tattoo presents as a dark gray or blue, flat macule located adjacent to a restored tooth. Most are located on the gingiva and alveolar mucosa followed by the buccal mucosa and the floor of the mouth. Microscopic examination reveals that amalgam is present in the tissues in two forms: as irregular dark, solid fragments of metal or as numerous, discrete fine, brown or black granules dispersed along collagen bundles and around small blood vessels and nerves. In most lesions, it is presented in both forms. The biologic response to the amalgam is related to particle size, quantity and elemental composition of the amalgam. Large fragments often become surrounded by dense fibrous connective tissue. Smaller particles are associated with mild to moderate chronic inflammatory response with individual macrophages engulfing small amalgam particles. Occasionally, the reaction takes the form of foreign body granuloma in which macrophages and multinucleated giant cells are present. Some of the multinucleated giant cells also contain amalgam particles. Diagnosis of amalgam tattoo is usually obvious from the location and clinical appearance. A radiograph is recommended to confirm the presence of metallic particles, but absence of radiographic evidence does not rule out the possibility, since particles are often too fine or widely dispersed to be visible on radiographs. When there is no radiographic evidence or an adjacent restored tooth, biopsy is recommended to rule out an early melanoma. Once the diagnosis of amalgam tattoo has been established, no additional treatment is necessary except for cosmetic reasons. If the pigmentation is cosmetically unacceptable, surgical excision and transplantation of oral mucosal tissue has been suggested. Q-switched ruby laser and Q-switched alexandrite laser have also been used with favorable results.
Amalgam tattoo is an iatrogenic lesion caused by traumatic implantation of dental amalgam into soft tissue. Amalgam tattoo is the most common localized pigmented lesion in the mouth. In a study of a mass screening oral examination in the United States, it was found in about 0.4-0.9% of the adult population and in Sweden in about 8%. Clinically, amalgam tattoo presents as a dark gray or blue, flat macule located adjacent to a restored tooth. Most are located on the gingiva and alveolar mucosa followed by the buccal mucosa and the floor of the mouth. Microscopic examination reveals that amalgam is present in the tissues in two forms: as irregular dark, solid fragments of metal or as numerous, discrete fine, brown or black granules dispersed along collagen bundles and around small blood vessels and nerves. In most lesions, it is presented in both forms. The biologic response to the amalgam is related to particle size, quantity and elemental composition of the amalgam. Large fragments often become surrounded by dense fibrous connective tissue. Smaller particles are associated with mild to moderate chronic inflammatory response with individual macrophages engulfing small amalgam particles. Occasionally, the reaction takes the form of foreign body granuloma in which macrophages and multinucleated giant cells are present. Some of the multinucleated giant cells also contain amalgam particles. Diagnosis of amalgam tattoo is usually obvious from the location and clinical appearance. A radiograph is recommended to confirm the presence of metallic particles, but absence of radiographic evidence does not rule out the possibility, since particles are often too fine or widely dispersed to be visible on radiographs. When there is no radiographic evidence or an adjacent restored tooth, biopsy is recommended to rule out an early melanoma. Once the diagnosis of amalgam tattoo has been established, no additional treatment is necessary except for cosmetic reasons. If the pigmentation is cosmetically unacceptable, surgical excision and transplantation of oral mucosal tissue has been suggested. Q-switched ruby laser and Q-switched alexandrite laser have also been used with favorable results.
This report identified S-RNase genes (S genes) of sweet cherry (Prunus avium L.), presented the sequences of S genes by using a pair of specific primers PruC2 and PruC4R based on the conserved regions C2 and RC4 of Rosaceous S-RNase genes and researched the S gene specific products from the genomic DNAs of different cultivars in which most of the S genotypese were unknown. The bands of PCR were cloned and their sequences were compared in GenBank. Four S genes were defined and the conclusion was made that all the same bands from PCR in the agarose gel had the same length and sequence of nucleic acid and were the same kind of S gene. The lengths of the amplified S genes are as follows: S1 is 677 bp, S3 762 bp, S4 945 bp, S6 456 bp. The S genotypes (S gene genotypes) of the tested self-incompatible cultivars were identified as follows: 'Hongdeng', 'Hongyan' and 'Early ruby', as same as 'Van', were S1 S3; 'Jueze', 'Hongfeng' and 'Napoleon' were S3S4; 'Dazi' was S1 S6; 'Changbahong' was S1 S4; 'Elton' was S3S6. The self-compatibile cultivars 'Waiyin No.7' and 'Stella' had the same S genotypes S3 S4'.
Acute carbon monoxide poisoning is the most common cause of poison-related deaths in the U.S. A 21-year-old white woman was referred to Ruby Memorial Hospital after exposure to carbon monoxide (CO) from a faulty furnace. She developed acute weakness, dyspnea, nausea and vomiting. An electrocardiogram revealed sinus tachycardia, non-specific ST-T wave abnormalities, and a prolonged QTc interval. The chest X-ray revealed pulmonary edema and the 2-D echocardiography revealed decreased left ventricular systolic function with an ejection fraction of 25%. She was treated with high-flow oxygen and supportive medical therapy with complete resolution of the left ventricular dysfunction six weeks later. She has been followed for over one year without medical therapy and without recurrence of her symptoms. This case illustrates that the depressant effect of CO poisoning on the myocardium can be reversed in the short term with supportive medical therapy and recovery sustained in the long term without medical therapy.
The finding of toxic shock syndrome (TSS) is a rare, potentially fatal illness that physicians often associate with young, menstruating females. However, TSS is not exclusively a disease of females. We report the unusual case of an adult male patient who presented to the Emergency Department at Ruby Memorial Hospital in Morgantown with toxic shock syndrome secondary from a fish tooth suffered while trout fishing. The diagnostic features of TSS and treatment are also discussed in this article.