Controlled tissue expansion for correcting amputation stump scar

The authors describe the recently developed technique of tissue expansion to correct a problem-causing amputation scar. The technique involves the use of a progressively distended silicone bag placed under the skin to gradually stretch the skin so as to provide sufficient excess skin to allow plastic closure and elimination of the scarred tissue that had interfered with the use of a prosthesis.

A second opsin gene expressed in the ultraviolet-sensitive R7 photoreceptor cells of Drosophila melanogaster

We have identified a second Drosophila opsin gene, Rh4, which is expressed specifically in the ultraviolet-sensitive R7 photoreceptor cells. The two R7 opsins, Rh3 and Rh4, are expressed in nonoverlapping subsets of R7 cells. The Rh4 opsin shares 72% amino acid identity with Rh3, but is only about 35% homologous with the other 2 Drosophila opsins, ninaE and Rh2. Twenty-eight amino acids are conserved among all 4 invertebrate and 5 vertebrate opsin genes thus far sequenced, suggesting that these residues play an important role in rhodopsin function.

The risk of breast cancer in postmenopausal women who have used estrogen replacement therapy

We studied the association between estrogen replacement therapy (ERT) and the risk of breast cancer as part of the Cancer and Steroid Hormone Study. All subjects in the analysis were postmenopausal women enrolled from eight geographic areas. Women 25 to 54 years old with newly diagnosed breast cancer were identified through population-based tumor registries and diagnosed between Dec 1, 1980, and Dec 31, 1982. Controls were selected from the same eight geographic areas by the random digit dialing of residential telephone numbers. Analyses included 1369 cases and 1645 controls. Among women with bilateral oophorectomy, the relative risk of breast cancer for women who had ever used ERT was 1.3, compared with women who had never used ERT. Among women who had undergone hysterectomy but who still had at least one ovary, the relative risk was 1.1; among women who reported a natural menopause, the relative risk was 0.8. Overall, the risk of breast cancer did not appear to increase appreciably with increasing ERT duration or latency, even for durations and latencies of 20 years or longer.

Prescription of above-knee and below-knee prostheses

New developments in socket design, materials and fabrication are briefly reviewed. A series of charts is presented which summarize the below-knee and above-knee prescription procedures followed at the Veterans Administration Prosthetics Center.

Aspects of stoma care in general practice

A survey of stoma care in general practice is reported. It demonstrates a wide diversity in the patterns of care provided to ostomates, with only half of the general practitioners reporting regular follow-up by a member of the health care team. Dealing with appliance difficulties was found to be an aspect of stoma care in which a majority of general practitioners have little confidence. The district nurse and stoma nurse are considered to be the most valuable sources of back-up. It is suggested that structured follow-up of ostomates by the primary care team might influence the level of morbidity among this group of patients.

Serotonin-lesion myoclonic syndromes. I. Neurochemical profile and S-1 receptor binding

This paper and the following one describe the effects of L-5-hydroxytryptophan (5-HTP) (after 3 intracisternal injections of 5,7-dihydroxytryptamine (DHT], fenfluramine (FF), p-chloroamphetamine (PCA) and drug combinations on (i) brain regional amine concentration (HPLC with LEC) and serotonin S-1 receptor binding; and (ii) 'serotonergic' behaviors in the same adult rats. Serotonin (5-HT) neurotoxins produced significantly different regional profiles of 5-HT depletion. Multiple DHT injections caused a 90-100% depletion of 5-HT concurrently in neocortex, hippocampus, striatum, septum/accumbens, pons, cerebellum, and cervical cord. Only PCA significantly depleted midbrain. Drug combinations with DHT resembled DHT alone rather than additive depletions, except for PCA + DHT, which produced a hybrid pattern of depletion. The S-1 binding assay, using cold 5-HT to displace [3H]5-HT, was performed with and without ascorbate, EDTA, CaCl2, and pargyline. Without ascorbate, binding was specific, saturable, region-dependent, and non-linear with high (Kd 1-3 nM) and low affinity (10-20 nM) components but no cooperativity (0.8 less than nH less than 1.0). Bmax and Kd did not differ significantly between vehicle- and drug-treated animals in neocortex, hippocampus, striatum, thalamus, hypothalamus, midbrain, pons, medulla, cervical cord, cerebellum, or septum/accumbens two weeks after lesioning, while the assay did detect a 60% reduction in Bmax induced by ascorbic acid (1 mM). The effects of assay conditions exceeded the changes sometimes reported in S-1 receptor Bmax after 5-HT lesions.

Rescue of the Drosophila phototransduction mutation trp by germline transformation

Phototransduction is the process by which light-stimulated photoreceptor cells of the visual system send electrical signals to the nervous system. Many of the steps that follow the initial event in phototransduction, absorption of light by rhodopsin, are ill-defined. The fruitfly, Drosophila melanogaster, provides a means to dissect phototransduction genetically. Mutations such as transient receptor potential (trp) affect intermediate steps in phototransduction. In order to facilitate molecular studies of phototransduction, the trp gene was isolated and its identity was confirmed by complementing the mutant trpCM allele of the trp gene by P-element mediated germline transformation of a 7.1-kilobase DNA fragment. Expression of the trp gene begins late in pupal development and appears to be limited to the eyes and ocelli.

Cesarean section. Risk and benefits for mother and fetus

We studied the effects of cesarean section on neonatal mortality for breech infants and low--birth weight vertex infants using data from the Georgia neonatal surveillance network on 392,241 singleton deliveries between 1974 and 1978. The risk of neonatal death for breech infants weighing 4,000 g or less delivered vaginally was significantly higher than the risk for those delivered by cesarean section. The lower the birth weight, the higher the risk for a vaginal breech delivery. For breech infants weighing 1,000 to 2,500 g, the risk was almost 21/2 times greater for a vaginal delivery v a cesarean delivery. The best outcome for high-risk vertex infants weighing 1,000 to 1,500 g was for those delivered by cesarean section in a tertiary perinatal center. An increase in the cesarean section rate may be associated with increased neonatal survival; however, the benefits must be weighed against the costs of an increased maternal mortality and morbidity.

Is there a future for social work in HMOs?

Health Maintenance Organizations (HMOs) are a popular form of health care delivery in many parts of the United States. To what extent are social workers an integral part of this health care delivery system? The authors present the findings of a study that surveyed the role of social workers in HMOs and conclude that if social workers are to have a future in this system, they must advocate for themselves professionally and politically.

Devices to enable persons with amputation to participate in sports

Participation in physically challenging competitive sports is as important to some persons with amputations as are work and leisure, both of which are ordinarily of a sedentary character. Sports participation contributes not only to physical but also to psychologic well-being. The manner in which a prosthetic clinic team can aid in this aspect of rehabilitation is discussed. Some of the more sophisticated prostheses prescribed to enable participation in sports include above-knee and below-knee water-resistant prostheses for swimmers, an adjustable foot-ankle unit for the proficient swimmer and scuba diver, prostheses and special equipment for skiers, special devices for golfers with upper extremity or lower extremity amputations, and various commercially available terminal devices to enable persons with an upper extremity amputation to bowl, to hold a fishing pole and reel, to play baseball, to hold tools, to fire a pistol, and to swim.

Prosthetic fitting problems of the quasi-Syme amputation

Unless the original Syme amputation technique has been precisely followed, an amputation stump capable of tolerating little or no end-bearing will frequently result. Such a stump must be fitted with a below knee type of prosthesis as if the patient were a below-knee amputee. Even though it is not designed for other than a below-knee amputation, the socket can be modified to provide a satisfactory prosthesis for a Quasi-Syme stump.

The risk of childbearing re-evaluated

To determine the completeness of reporting of maternal deaths after live born deliveries in Georgia for 1975 and 1976, we matched death certificates with corresponding birth certificates for women of reproductive age. For these two years, more intensive searching led to our finding a minimum of a 27 per cent higher number of maternal deaths than that found by routine death certificate surveillance. When the delivery-death interval was not restricted to 42 days, use of the record linkage method led to a 50 per cent increase in reporting of maternal deaths. We recommend that special efforts be made to obtain more complete reporting of all pregnancy-related deaths and that completeness of reporting be periodically evaluated for all states.

The orthopedic surgeon and rehabilitation engineering

Rapid advancements in technology in the past 30 years have brought about a close relationship between medicine and engineering. Part of this has been the close association of orthopedics and the prosthetics and orthotics technologies. In recent years, advances in other aspects of rehabilitation engineering have taken place; these have been partly based on the technology established by research in prosthetics and orthotics. The rapid progress in rehabilitation engineering now demands the attention of orthopedists. The role of the rehabilitation engineer is defined, and some examples are given of the kinds of problems confronted by the rehabilitation engineering clinic team. Especially as further progress takes place, the orthopedic surgeon and the prosthetist-orthotist need to obtain more knowledge of the technical aids needed to restore independence to the disabled.

Cell concentration as a factor in precursor incorporation by tobacco leaf protoplasts or separated cells

Freshly isolated protoplasts or separated cells prepared from leaves of Nicotiana tabacum L. cvs. Xanthincor Turkish Samsun exhibit substantially greater incorporation of [(3)H] leucine and [(3)H] uridine into protoplast protein and RNA, respectively, when dilute rather than concentrated suspensions are incubated. This phenomenon is considered to result from a dilution of the labeled precursors in the incubation medium by nonlabeled precursors of cellular origin.