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The embedding of ossicular chain specimens in plastic.

The following objects were specifically designed for teaching material to the medical students. Dried human auditory ossicles were bleached in 30% hydrogen peroxide solution and then, embedded in a good quality plastic. The plastic mass was shaped into a ball 5 cm in diameter, and the surface of which was polished with a good finish. The merits of the objects may be listed as follows; 1) A permenant preservation of the objects is possible because they are embedded in heat- and chemical-resistant material. 2) The objects are handy for use in the lecture room and easily observed by the students because of the magnifying effect of the plastic covering.

Anatomy↗

[Surgical management of periocular basal cell carcinoma using frozen section control and immediate plastic reconstruction--indications and methods in 106 patients].

PURPOSE: To review our first experiences with the surgical removal of basal cell carcinoma (BCC) utilizing frozen section control and immediate plastic reconstruction. PATIENTS AND METHODS: We analyzed the accuracy of clinical diagnosis, methods of surgical excision, plastic repair and recurrence rates in 162 consecutive patients who underwent surgical excision utilizing either frozen section (n = 106) or biomicroscopic control (n = 56) between January 1991 and June 1996. Specimens used for intraoperative frozen-section monitoring were also fixed, processed, and sectioned for permanent sections and served as postoperative controls for the frozen sections (n = 43). RESULTS: The accuracy of clinical diagnosis was 86% (n = 189). In 106 patients with BCC excised with frozen section control, there were no recurrences reported after a mean follow-up of 2.9 years. The mean surgical defect measured 55% of total eyelid length (range 10%-100%). The incidence of morphea pattern was 34%. Intraoperative re-excisions due to frozen sections positive for tumor were necessary in 31% of cases. Permanent postoperative sections of the tissue that had been used for intraoperative frozen sections confirmed in 97.5% of patients (n = 43) the preliminary findings made with frozen sections. In 56 patients with BCC excised with biomicroscopic control, three tumors recurred (5%) after a mean follow-up of 4.4 years. The mean surgical defect measured 42% of total eyelid length (range 16%-100%). The incidence of morphea type was 23%. CONCLUSION: Surgical removal utilizing frozen section control and immediate plastic repair appears to represent a reliable and effective option in the management of selected patients with periocular BCC.

Adult↗

An Internet compendium of analytical methods and spectroscopic information for monomers and additives used in food packaging plastics.

An internet website (http:¿cpf.jrc.it/smt/) has been produced as a means of dissemination of methods of analysis and supporting spectroscopic information on monomers and additives used for food contact materials (principally packaging). The site which is aimed primarily at assisting food control laboratories in the European Union contains analytical information on monomers, starting substances and additives used in the manufacture of plastics materials. A searchable index is provided giving PM and CAS numbers for each of 255 substances. For each substance a data sheet gives regulatory information, chemical structures, physico-chemical information and background information on the use of the substance in particular plastics, and the food packaging applications. For monomers and starting substances (155 compounds) the infra-red and mass spectra are provided, and for additives (100 compounds); additionally proton NMR are available for about 50% of the entries. Where analytical methods have been developed for determining these substances as residual amounts in plastics or as trace amounts in food simulants these methods are also on the website. All information is provided in portable document file (PDF) format which means that high quality copies can be readily printed, using freely available Adobe Acrobat Reader software. The website will in future be maintained and up-dated by the European Commission's Joint Research Centre (JRC) as new substances are authorized for use by the European Commission (DG-ENTR formerly DGIII). Where analytical laboratories (food control or other) require reference substances these can be obtained free-of-charge from a reference collection housed at the JRC and maintained in conjunction with this website compendium.

Data Display↗

The safety and applications of acellular human dermal allograft in ophthalmic plastic and reconstructive surgery: a preliminary report.

PURPOSE: To describe the uses and determine the safety of a commercially available acellular dermal allograft in ophthalmic plastic and reconstructive surgery. The existing literature regarding current applications and results using acellular dermal allograft is reviewed. METHODS: The study design was a retrospective, noncomparative case series. Participants consisted of 63 consecutive patients undergoing ophthalmic plastic and reconstructive surgery using an acellular dermal matrix graft. The main intervention was placement of a dermal allograft. Outcome measures included the degree of clinical improvement and complications for each patient. RESULTS: We used AlloDerm (LifeCell Corporation, The Woodlands, TX, U.S.A.) as a posterior lamellar conjunctival spacer graft, a soft tissue interpositional graft, and an orbital implant wrapping material. Clinical improvement was noted in all cases. There were no complications attributable to the acellular dermal matrix material. CONCLUSIONS: We describe several novel ophthalmic plastic and reconstructive surgical applications using acellular dermal allograft tissue. This material may be used safely as a posterior lamellar conjunctival spacer graft, a soft tissue interpositional graft, and a wrapping material. Clinically, the allograft appears to be biocompatible, nontoxic, and nonallergenic in the orbit, eyelid, and midfacial tissues. Long-term data and studies comparing the efficacy of acellular dermal allograft with conventional materials are necessary.

Coated Materials, Biocompatible↗

After plastic surgery: adolescent-reported appearance ratings and appearance-related burdens in patient and general population groups.

The aim of this study was to determine the effects of appearance-related surgery on psychosocial functioning during adolescence. To this end, changes in bodily attitudes and appearance-related burdens in adolescents undergoing corrective (for aesthetic deformities) and reconstructive (for congenital or acquired deformities) surgery were compared with those in a general population sample.A group of 184 adolescent plastic surgery patients (corrective, n = 100; reconstructive, n = 84), and a comparison group of 83 adolescents at random selected from three municipalities (corrective, n = 67; reconstructive, n = 16), aged 12 to 22 years, were studied at two time points with a 6-month interval. The plastic surgical patients were studied presurgically and postsurgically. Using fully structured telephone interviews and postal questionnaires, adolescents' ratings of their appearance, bodily satisfaction and attitudes, and appearance-related burdens were obtained. All patients reported a significant decrease in burdens after surgery compared with the comparison group, indicating a much more prominent improvement in the patient sample compared with the developmental changes that may be expected to occur in adolescence. The corrective patient group reported least burdens after the operation. More specifically, the "breasts" group benefited most from the operation, indicating that breast corrections are rewarding interventions. The findings of this study imply that adolescents can be regarded as good candidates for plastic surgery. They gain bodily satisfaction, and they are relieved of many appearance-related burdens. Physical, social, and psychological burdens related to appearance satisfaction improve considerably in both corrective and reconstructive adolescent patients.

Adolescent↗

Planning elective operations on patients who smoke: survey of North American plastic surgeons.

Patient smoking status affects many aspects of plastic surgery, including patient selection, counseling, management, and outcomes. No specific recommendations for performing elective procedures on patients who smoke are available. The goal of this study was to determine the current practice standards and attitudes toward this often controversial topic. In September of 2000, 1600 members of the American Society for Aesthetic Plastic Surgery were sent questionnaires, 955 of which were returned. Questions elicited categorical answers, either dichotomous or multiple choice. Data were evaluated using logistic regression and the chi-square and binomial tests. Our results show that 60 percent (p < 0.01) of plastic surgeons routinely perform a less than optimal procedure on their patients who smoke. The survey measured willingness to perform various operative procedures on patients who smoke and types of smoking cessation aids offered. Of those physicians who require patients to quit smoking before surgery, only 16.7 percent (p < 0.01) would perform a nicotine test if they suspected noncompliance. Interestingly, 28.6 percent (p < 0.01) of the physicians responding admit to a smoking history, whereas only 1.5 percent (p < 0.01) continue to smoke, compared with the national smoking rate of almost 25 percent. Physicians who are previous smokers are less likely to offer smoking cessation aids than those who have never smoked, and the proportion not offering aids increases as the amount of previous smoking increases (p = 0.02). This study shows that a wide range of opinions exists on which elective surgical procedures should be performed on patients who smoke. Furthermore, the physician's prior smoking history influences this decision. No clear consensus exists on how best to treat patients who smoke who request elective surgeries. Although surgeons would prefer to operate on nonsmokers, they are faced with a significant population of patients who use tobacco. No clear consensus exists on how best to treat these individuals. Advancements in wound healing research and smoking cessation aids will provide more insight into this treatment dilemma.

Attitude of Health Personnel↗

Altered Excitation-Inhibition Balance and mGluR1/5-Driven Plasticity in the Motor Cortical Surface in a Rat Model of Parkinson's Disease.

Parkinson's disease (PD) is characterized by progressive dopaminergic degeneration and maladaptive motor cortical plasticity. However, the cellular pathways underlying cortical surface activity in the primary motor cortex (M1) remain unclear, despite serving as a potential target for electrotherapy. We investigated the excitatory-inhibitory (E-I) balance and synaptic plasticity of superficial M1 circuits in a unilateral 6-hydroxydopamine (6-OHDA)-induced rat model of PD. Using extracellular local field potential and whole-cell patch recordings from the contralateral and ipsilateral M1 hemispheres of hemi-parkinsonian rats, we observed a significantly elevated field excitatory postsynaptic potential (fEPSP) input-output function but unchanged intrinsic neuronal excitability in the M1 superficial layer. An altered relative contribution between alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR)- and N-methyl-D-aspartate receptor (NMDAR)-mediated transmission was reflected by a significantly increased AMPA/NMDA ratio. Markedly reduced inhibitory synaptic tone was also evidenced by the decreased amplitude and frequency of spontaneous inhibitory postsynaptic currents (sIPSCs), supporting an E-I imbalance favoring excitation in PD. Furthermore, group I metabotropic glutamate receptor (mGluR1/5)-dependent long-term depression (LTD) was abolished in the ipsilateral PD hemisphere, whereas NMDAR-dependent LTD remained intact. In summary, dopamine depletion appears to enhance network excitation and disrupt mGluR1/5-mediated control of M1 surface circuitry. Our findings identify altered cortical surface mGluR-dependent plasticity in the hemi-parkinsonian model; however, the relationship between these electrophysiological alterations and individual motor outcomes remains to be determined.

Animals↗

[Fifty years of plastic surgery in the Netherlands. VI. Microsurgery].

Use of the operating microscope created many new possibilities in plastic, reconstructive and hand surgery. Initially most work was done in digital replantation and, somewhat later, in transfers of toes for reconstruction of amputated thumbs. Microvascular surgery, however, appeared to be a technique suitable for more applications. Anatomical research of the blood supply of skin, fascia, muscle and bone identified flaps that could be carried by pedicle vessels. Transfer of these flaps and revascularization by microvascular anastomoses of the pedicle vessels set the stage for free flaps. In a few decades microsurgical techniques in plastic surgery fully matured. With free flap surgery single-stage and complex reconstructions could be achieved leading to earlier mobilization and better restoration of function with a shorter hospital stay. Today, microvascular free tissue transfer is an essential part of plastic and reconstructive surgery. Further advances in microsurgery and free tissue transfers deserve to be mentioned: pre-fabrication of free flaps, reduction of donor site morbidity, development of artificial conduits and instrumentation and finally homologous transplantations.

Hand Injuries↗

[The second chart. A retrospective critical analysis of hospital stays of long duration in a public plastic surgery department].

A nine-month retrospective survey related to the long-duration hospital stays was carried out in our plastic surgery department. Twenty five patients were concerned by a more than 21 days hospitalization, the sum of which reached 1,098 days. These figures corresponded to 1.4% of the patients and 14.5% of the hospitalization days. A critical analysis was based on four principles: 1--a plastic surgery department is exclusively devoted to plastic surgery, 2--nursing cares required by the healing of a soft tissues defect don't usually need hospitalization, 3--even if it has a wide surface and/or if it is located on the lower limbs, a skin graft doesn't usually require more than ten days of hospitalization, 4--without complications, a free tissue transfer doesn't usually require more than 15 days of hospitalization. Application of these principles showed that 633 days (58%) could have been theoretically spared. Consequently, it could have permitted to treat a greater number of patients. The cause of delaying patient exit was related to the surgeon in all but one cases. It was associated in 16% of cases with a bed shortage in the convalescent or nursing homes. As hospitalization durations longer than 25 days seemed unwarranted to the authors even in the most complex cases, they suggest a simple way to alert surgeons of their department to the long-duration stays. As the department patient's chart represents 13 days of hospitalization, they ask surgeons make a decision upon planning the exiting of patients before adding a second chart.

Adult↗

Plastic surgery: a component in the comprehensive care of cancer patients.

Plastic surgery represents a small but critical component of the comprehensive care of cancer patients. Its primary role in the treatment of cancer patients is to extend the ability of other surgeons and specialists to more radically treat cancer, offering patients the best opportunity for cure. Although the most convincing data for improved psychosocial well-being through plastic surgery is in the setting of breast cancer reconstruction after mastectomy, it is reasonable to assume that all patients who undergo major reconstruction to minimize deformity due to cancer therapy feel some improvement in quality of life. This article will provide an overview of the role of plastic surgery in cancer treatment.

Breast↗

[Interdisciplinary status of plastic, esthetic and reconstructive surgery in Austria].

To evaluate the actual status of interdisciplinary treatment involving plastic surgery in Austria in 1993 and 1994, standardised questionnaires were sent to all Departments of Plastic Surgery and to 129--mainly surgically orientated--medical departments in Vienna. The survey revealed that more than 50 percent of interdisciplinary co-operation took place with the departments of traumatology, general surgery and dermatology. The demand for co-operation with plastic surgeons was especially felt in tumor surgery, peripheral nerve surgery and hand surgery. An additional demand for co-operation represented larger soft tissue defects and congenital anomalies.

Austria↗

Intracapsular plastic lens loop fixation in the rabbit.

The fixation of two-loop intraocular plastic lenses has been studied in the laboratory. Twenty rabbit eyes underwent extracapsular lens extraction and placement of plastic lens loops within the capsular remnants. Placement was successful in 25 of 40 (62.5%) attempts. The placement of intracapsular lens loops was studied histologically, and the structural alterations were seen to be minimal. There was virtually no cellular response to the implantation of the plastic lenses, even in the areas of tissue contact.

Animals↗

The rate of sulfur hexafluoride escape from a plastic syringe.

Sulfur hexafluoride (SF6) gas is widely used for internal tamponade during retinal reattachment surgery and is commonly injected into the eye from a 10-mL plastic syringe. The rate of diffusion of SF6 out of a plastic syringe has not bee studied. We measured the percentage of SF6 gas in a 10-mL plastic syringe by gas chromatography, confirmed by infrared spectrometry. Measurements were obtained immediately after aspiration, and at 30 s and 10, 15, 60, 90, and 120 minutes, and 18 hours. A marked decrease in SF6 concentration, from 97% at 30 s to 76% at 60 minutes and 2% at 18 hours, was noted. The results were highly reproducible. Sulfur hexafluoride gas should be injected into the patient's eye as soon as possible after aspiration from the tank to ensure accurate concentrations.

Chromatography, Gas↗

A specific curriculum in facial plastic surgery. Effect on residency training.

There has been a dramatic change in the degree of exposure to facial plastic surgery by the otolaryngology resident in the past decade. The amount of this exposure and the method of presentation of aesthetic concepts and procedures varies. We favor a specific curriculum in facial plastic surgery for the residency training program. The effect of this curriculum is measured by statistical analysis of resident-generated aesthetic surgery cases in one year following the introduction of this curriculum into the teaching program. These data are compared with the same period one year prior to the initiation of the program. Tympanoplasty, mastoidectomy, and tonsillectomy case numbers served as controls for statistical comparison over the same time period. These data serve as a guide to residency programs in determining the most effective means of providing optimum facial plastic surgery exposure to their trainees.

Curriculum↗

The effect of new technologies on plastic surgery.

Plastic surgery has always been a technique- and technology-driven surgical discipline, given that there is no regional anatomic focus. There has been a remarkable evolution in technique over the last 25 years with an increased understanding of anatomy leading to a whole host of new and more reliable flaps, which has transformed reconstructive surgery, breast reconstruction being one notable example. The development and maturation of microsurgery has led to the full fruition of anatomic principles. With better understanding of blood supply to the skin, fascia, muscle, and bone, many traditional reconstructive procedures are constantly being superseded by the new, ingenious use of various tissue flaps. Advances in technology will accomplish another transformation of the specialty, notably the recent advances in tissue engineering, the potential of gene therapy, new alloplastic materials, and computer-assisted imaging technology. It would be impossible to address all of the recent advances in this rapidly expanding field of surgery in a short article. We have selected a few topics that we thought would be the most interesting to all surgeons to give a wide view of a variety of challenges addressed by the modern plastic surgeon. Major advances in surgery often come from cross-fertilization between specialties, and plastic surgeons have frequently been involved in this process.

Growth Substances↗

Drosophila larval neuromuscular junction: molecular components and mechanisms underlying synaptic plasticity.

Understanding the mechanisms that mediate synaptic plasticity is a primary goal of molecular neuroscience. The Drosophila larval neuromuscular junction provides a particularly useful model for investigating the roles of synaptic components in both structural and functional plasticity. The powerful molecular genetics of this system makes it possible to uncover new synaptic components and signaling molecules, as well as their function in the intact organism. Together with the mouse hippocampus and Aplysia dissociated cell culture, the Drosophila larval neuromuscular junction has been among the most valuable model systems for examining the molecular and cellular basis of neuronal plasticity.

Animals↗

Molecular basis for induction of ocular dominance plasticity.

The most dramatic example of experience-dependent cortical plasticity is the shift in ocular dominance that occurs in visual cortex as a consequence of monocular deprivation during early postnatal life. Many of the basic properties of this type of synaptic plasticity have been described in detail. The important challenge that remains is to understand the molecular basis for these properties. By combining theoretical analysis with experiments in vivo and in vitro, some of the elementary molecular mechanisms for visual cortical plasticity have now been uncovered.

Animals↗

LTD, LTP, and the sliding threshold for long-term synaptic plasticity.

LTD of synaptic transmission is a form of long-term synaptic plasticity with the potential to be as significant as LTP to both the activity-dependent development of neural circuitry and adult memory storage. In addition, interactions between LTP and LTD and the dynamic regulation of the gain of synaptic plasticity mechanisms are also very important. In particular, the computational ability of LTD to properly counterbalance LTP may be essential to maintaining synaptic strengths in the linear range, and to maximally sharpen the ability of synapses to compute and store frequency-based information about the phase relation between synapses. Experimental data confirm the presence of an activity-dependent "sliding threshold" with the expected properties. That is, when levels of neuronal activity are high, indicating circumstances increasing the likelihood of inducing LTP, compensatory changes cause the suppression of LTP and an enhanced likelihood of LTD. Conversely, we would predict that low levels of synaptic activity would shift the threshold in favor of greater LTP and less LTD, a hypothesis which has yet to be tested. The sliding threshold for LTP and LTD also has implications for underlying cellular mechanisms of both forms of long-term synaptic plasticity. If the thresholds for LTP and LTD are tightly and reciprocally co-regulated, that could imply that at least one component of LTD is a true depotentiation caused by reversal of a change mediating LTP. If so, the intuitively simplest hypothesis is that phosphorylation of AMPA glutamate receptors causes LTP of synaptic e.p.s.p.s, while dephosphorylation of the same site or sites causes depotentiation LTD. Of course, this hypothesis would refer only to a postsynaptic component of both LTP and LTD. There has been a recent report that, in neonatal rat hippocampus, a form of LTD that is expressed developmentally earlier than LTP appears to have a postsynaptic induction site, but is expressed as decreased presynaptic transmitter release (Bolshakov and Siegelbaum, 1994). Whether these properties will be retained as LTD matures is unknown, as is the likelihood that, if a component of LTP is expressed presynaptically, depotentiation of that presynaptic component can also occur. Equally unclear is the persistence of LTD relative to LTP. The few rigorous long-term anatomical studies available suggest that the latest phases of LTP may be expressed as changes in dendritic spine shapes and/or synaptic morphology. While heterosynaptic LTD has been reported to have a duration of weeks in vivo (Abraham et al., 1994), we do not know whether LTP-induced morphological changes that take many days to appear can be reversed in an activity-dependent manner. An important feature of the consolidation of memories may turn out to be the slow development of LTP that is resistant to reversal by LTD. While we still at an earlier stage in our understanding of the mechanisms underlying LTD compared to LTP, some things are becoming clear. LTD is induced by afferent neuronal activity that is relatively ineffective in exciting the postsynaptic cell--an "anti-hebbian" condition. This property, coupled with the hebbian properties of LTP and the dynamic nature of membrane conductances, necessarily confers upon synapses the ability to compute and store the results of a covariance function. However, the role of such a computation in processing and/or memory is unclear. In addition, LTD appears to require the activation of NMDA and metabotropic subtypes of glutamate receptors, release of Ca2+ from intracellular stores, and an increase in intracellular [Ca2+] that is lower than that necessary to induce LTP. The early evidence is consistent with some overlap of targets for modification by LTP and LTD, with some forms of LTD likely to be a reversal, or "depotentiation," of previous LTP, perhaps through dephosphorylation of AMPA receptors.

Animals↗