The In Vitro Activity of Fluconazole, Amphotericin B and Echinocandins Against Cyberlindnera fabianii Planktonic Cells and Biofilms

Until recently, little was known about the susceptibility pattern of Cyberlindnera fabianii (Cy. fabianii) planktonic cells and biofilms regarding the most frequently administered systemic antifungals, despite the high mortality rate and its potential role in catheter-related infections. In the current study, the activity of fluconazole, amphotericin B and echinocandins (anidulafungin, caspofungin and micafungin) was determined against planktonic and sessile cells of Cy. fabianii clinical isolates (n = 8). Planktonic minimum inhibitory concentrations (MICs) ranged from 1 to 2, from 0.25 to 1, from 0.015 to 0.06, from 0.03 to 0.12 and from 0.25 to 0.5 mg/l for fluconazole, amphotericin B, anidulafungin, caspofungin and micafungin, respectively. One-day-old biofilms were highly resistant to fluconazole (MIC ranged from 512 to > 512) compared to planktonic counterparts, but not to amphotericin B (MIC ranged from 0.25 to 2 mg/l) and echinocandins (MIC ranged from 0.06 to 2 mg/l). Based on the calculated planktonic killing rates, the highest activity was observed in the case of anidulafungin (k values ranged from 0.37 to 2.09), while micafungin, caspofungin, amphotericin B and fluconazole exerted 0.46–1.47, 0.14–0.86, −0.03 to 2.08 and −0.15 to 0.09 killing rate value ranges, respectively. The obtained in vitro planktonic and sessile susceptibility patterns suggest that echinocandins and amphotericin B may be the most reliable treatment option for the treatment of Cy. fabianii infections.

Taxamat: Automated biodiversity data management tool - Implications for microbiome studies

Working with biodiversity data is a computationally intensive process. Numerous applications and services provide options to deal with sequencing and taxonomy data. Professional statistics software are also available to analyze these type of data. However, in-between the two processes there is a huge need to curate biodiversity sample files. Curation involves creating summed abundance values for chosen taxonomy ranks, excluding certain taxa from analysis, and finally merging and downsampling data files. Very few tools, if any, offer a solution to this problem, thus we present Taxamat, a simple data management application that allows for curation of biodiversity data files before they can be imported to other statistics software. Taxamat is a downloadable application for automated curation of biodiversity data featuring taxonomic classification, taxon filtering, sample merging, and downsampling. Input and output files are compatible with most widely used programs. Taxamat is available on the web at http://www.taxamat.com either as a single executable or as an installable package for Microsoft Windows platforms.

Follow-up Study of Microflora Changes in Crevicular Gingival Fluid in Obese Subjects After Bariatric Surgery

The objective of our study was to investigate the effect of weight loss on the crevicular microflora following bariatric surgery. Crevicular fluid samples were taken from 57 subjects: 22 were in the normal control group; 18 in the obese control group; and 17 patients had had bariatric surgery, who underwent a repeat sampling 6 to 12 months after the operation. Crevicular fluid samples were analyzed by MALDI-TOF MS analysis. After surgery and weight loss, the mean germ count increased, albeit not significantly. Also, Candida albicans and non-albicans Candida species: C. dubliniensis, C. kefyr, and C. lusitaniae appeared after surgery (p < 0.05) in subjects where Neisseria was either absent throughout or eliminated after surgery. However, periodontitis did not develop during this time in our subjects.

Multi-aspect candidates for repositioning: data fusion methods using heterogeneous information sources

Drug repositioning, an innovative therapeutic application of an old drug, has received much attention as a particularly costeffective strategy in drug R&D Recent work has indicated that repositioning can be promoted by utilizing a wide range of information sources, including medicinal chemical, target, mechanism, main and side-effect-related information, and also bibliometric and taxonomical fingerprints, signatures and knowledge bases. This article describes the adaptation of a conceptually novel, more efficient approach for the identification of new possible therapeutic applications of approved drugs and drug candidates, based on a kernel-based data fusion method. This strategy includes (1) the potentially multiple representation of information sources, (2) the automated weighting and statistically optimal combination of information sources, and (3) the automated weighting of parts of the query compounds. The performance was systematically evaluated by using Anatomical Therapeutic Chemical Classification System classes in a cross-validation framework. The results confirmed that kernel-based data fusion can integrate heterogeneous information sources significantly better than standard rank-based fusion can, and this method provides a unique solution for repositioning; it can also be utilized for de novo drug discovery. The advantages of kernel-based data fusion are illustrated with examples and open problems that are particularly relevant for pharmaceutical applications.

First occurrence of periosteal chondroma (juxtacortical chondroma) in Uromastyxmaliensis (Reptilia: Sauria: Agamidae)

The occurrence of a periosteal chondroma (juxtacortical chondroma) in an adult male Uromastyx maliensis is documented for the first time. The chondroma developed near the right shoulder joint from the periosteal membrane, causing partial atrophy in the surrounding skeletal muscles. In the chondroma tissues widespread central necrosis and secondary calcium salt deposition were observed. Monomorphic chondrocytes were irregularly spread in the chondromucin matrix. The lizard had locomotor problems due to irritation of the periosteum and reduced movement of the bones constituting the shoulder joint caused by the chondroma.

Factors affecting survival of bacteriophage on tomato leaf surfaces

The ability of bacteriophage to persist in the phyllosphere for extended periods is limited by many factors, including sunlight irradiation, especially in the UV zone, temperature, desiccation, and exposure to copper bactericides. The effects of these factors on persistence of phage and formulated phage (phage mixed with skim milk) were evaluated. In field studies, copper caused significant phage reduction if applied on the day of phage application but not if applied 4 or 7 days in advance. Sunlight UV was evaluated for detrimental effects on phage survival on tomato foliage in the field. Phage was applied in the early morning, midmorning, early afternoon, and late evening, while UVA plus UVB irradiation and phage populations were monitored. The intensity of UV irradiation positively correlated with phage population decline. The protective formulation reduced the UV effect. In order to demonstrate direct effects of UV, phage suspensions were exposed to UV irradiation and assayed for effectiveness against bacterial spot of tomato. UV significantly reduced phage ability to control bacterial spot. Ambient temperature had a pronounced effect on nonformulated phage but not on formulated phages. The effects of desiccation and fluorescent light illumination on phage were investigated. Desiccation caused a significant but only slight reduction in phage populations after 60 days, whereas fluorescent light eliminated phages within 2 weeks. The protective formulation eliminated the reduction caused by both of these factors. Phage persistence was dramatically affected by UV, while the other factors had less pronounced effects. Formulated phage reduced deleterious effects of the studied environmental factors.

Bacteriophages for plant disease control

The use of phages for disease control is a fast expanding area of plant protection with great potential to replace the chemical control measures now prevalent. Phages can be used effectively as part of integrated disease management strategies. The relative ease of preparing phage treatments and low cost of production of these agents make them good candidates for widespread use in developing countries as well. However, the efficacy of phages, as is true of many biological control agents, depends greatly on prevailing environmental factors as well as on susceptibility of the target organism. Great care is necessary during development, production and application of phage treatments. In addition, constant monitoring for the emergence of resistant bacterial strains is essential. Phage-based disease control management is a dynamic process with a need for continuous adjustment of the phage preparation in order to effectively fight potentially adapting pathogenic bacteria.

Integration of Biological Control Agents and Systemic Acquired Resistance Inducers Against Bacterial Spot on Tomato

Two strains of plant growth-promoting rhizobacteria, two systemic acquired resistance inducers (harpin and acibenzolar-S-methyl), host-specific unformulated bacteriophages, and two antagonistic bacteria were evaluated for control of tomato bacterial spot incited by Xanthomonas campestris pv. vesicatoria in greenhouse experiments. Untreated plants and plants treated with copper hydroxide were used as controls. The plant growth-promoting rhizobacteria or a tap water control were applied as a drench to the potting mix containing the seedlings, while the other treatments were applied to the foliage using a handheld sprayer. The plant growth-promoting rhizobacteria strains, when applied alone or in combination with other treatments, had no significant effect on bacterial spot intensity. Messenger and the antagonistic bacterial strains, when applied alone, had negligible effects on disease intensity. Unformulated phage or copper bactericide applications were inconsistent in performance under greenhouse conditions against bacterial spot. Although acibenzolar-S-methyl completely prevented occurrence of typical symptoms of the disease, necrotic spots typical of a hypersensitive reaction (HR) were observed on plants treated with acibenzolar-S-methyl alone. Electrolyte leakage and population dynamics experiments confirmed that acibenzolar-S-methyl-treated plants responded to inoculation by eliciting an HR. Application of bacteriophages in combination with acibenzolar-S-methyl suppressed a visible HR and provided excellent disease control. Although we were unable to quantify populations of the bacterium on the leaf surface, indirectly we determined that bacteriophages specific to the target bacterium reduced populations of a tomato race 3 strain of the pathogen on the leaf surface of acibenzolar-S-methyl-treated plants to levels that did not induce a visible HR. Integrated use of acibenzolar-S-methyl and phages may complement each other as an alternative management strategy against bacterial spot on tomato.

Management of Tomato Bacterial Spot in the Field by Foliar Applications of Bacteriophages and SAR Inducers

Various combinations of the harpin protein, acibenzolar-S-methyl, and bacteriophages were compared for controlling tomato bacterial spot in field experiments. Harpin protein and aciben-zolar-S-methyl were applied every 14 days beginning twice before transplanting and then an additional four applications throughout the season. Formulated bacteriophages were applied prior to inoculation followed by twice a week at dusk. A standard bactericide treatment, consisting of copper hydroxide plus mancozeb, was applied once prior to inoculation and then every 7 days, while untreated plants served as an untreated control. Experiments were conducted in north and central Florida fields during fall 2001, spring 2002, and fall 2002. In three consecutive seasons, acibenzolar-S-methyl applied in combination with bacteriophage or bacteriophage and harpin significantly reduced bacterial spot compared with the other treatments. However, it did not significantly affect the total yield compared with the standard or untreated control. Application of host-specific bacteriophages was effective against the bacterial spot pathogen in all three experiments, providing better disease control than copper-mancozeb or untreated control. When results of the disease severity assessments or harvested yield from the bacteriophage-treated plots were grouped and compared with the results of the corresponding nonbacteriophage group, the former provided significantly better disease control and yield of total marketable fruit.

Improved Efficacy of Newly Formulated Bacteriophages for Management of Bacterial Spot on Tomato

Bacteriophages are currently used as an alternative method for controlling bacterial spot disease on tomato incited by Xanthomonas campestris pv. vesicatoria. However, the efficacy of phage is greatly reduced due to its short residual activity on plant foliage. Three formulations that significantly increased phage longevity on the plant surface were tested in field and greenhouse trials: (i) PCF, 0.5% pregelatinized corn flour (PCF) + 0.5% sucrose; (ii) Casecrete, 0.5% Casecrete NH-400 + 0.5% sucrose + 0.25% PCF; and (iii) skim milk, 0.75% powdered skim milk + 0.5% sucrose. In greenhouse experiments, the nonformulated, PCF-, Casecrete-, and skim milk-formulated phage mixtures reduced disease severity on plants compared with the control by 1, 30, 51, and 62%, respectively. In three consecutive field trials, nonformulated phage caused 15, 20, and 9% reduction in disease on treated plants compared with untreated control plants, whereas plants treated with PCF- and Casecrete-formulated phage had 27, 32, and 12% and 30, 43, and 24% disease reduction, respectively. Plants receiving copper-mancozeb treatments were included in two field trials and had a 20% decrease in disease in the first trial and a 13% increase in the second one. Skim milk-formulated phage was tested only once and caused an 18% disease reduction. PCF-formulated phage was more effective when applied in the evening than in the morning, reducing disease on plants by 27 and 13%, respectively. The Casecrete-formulated phage populations were over 1,000-fold higher than the nonformulated phage populations 36 h after phage application.

Increasing the injection volume by dilution improves the onset of motor blockade, but not sensory blockade of ropivacaine for brachial plexus block

BACKGROUND AND OBJECTIVE

Ropivacaine used for axillary plexus block provides effective motor and sensory blockade. Varying clinical dosage recommendations exist. Increasing the dosage by increasing the concentration showed no improvement in onset. We compared the behaviour of a constant dose of ropivacaine 150 mg diluted in a 30, 40 or 60 mL injection volume for axillary (brachial) plexus block.

METHODS

A prospective, randomized, observer-blinded study on patients undergoing elective hand surgery was conducted in a community hospital. Three groups of patients with a constant dose of ropivacaine 150 mg, diluted in 30,40 or 60 mL NaCl 0.9%, for axillary plexus blockade were compared for onset times of motor and sensory block onset by assessing muscle strength, two-point discrimination and constant-touch sensation.

RESULTS

Increasing the injection volume of ropivacaine 150 mg to 60 mL led to a faster onset of motor block, but not of sensory block, in axillary plexus block, compared with 30 or 40 mL volumes of injection.

CONCLUSIONS

The data show that the onset of motor, but not of sensory block, is accelerated by increasing the injection volume to 60 mL using ropivacaine 150 mg for axillary plexus block. This may be useful for a more rapid determination of whether the brachial plexus block is effective. However, when performing surgery in the area of the block, sensory block onset seems more important.

[Periarterial sympathectomy of the radial and ulnar arteries in Raynaud's phenomenon--a preliminary study]

PURPOSE

Assessment of the post-operative results of peripheral sympathectomy in Raynaud's phenomenon.

METHODS

Six patients with therapy refractory Raynaud's phenomenon underwent a 4 cm long adventitial stripping of the radial and ulnar arteries proximal to the wrist. The nerve of Henle was followed up to the surface of the palmar arch and resected. The pre- and postoperative examinations were performed using the help of a questionnaire, telethermography and infra-red laser reflexion rheography.

RESULTS

All but two patients (two hands) were free of complaints (four patients, six hands), the three ulcers on the finger tips healed well. According to the questionnaire there was a dramatic improvement in the quality of life of the patients.

CONCLUSION

In the follow-up period of two years, there was no recurrence. Adventitial stripping of the radial and ulnar arteries and resection of the nerve of Henle proximal to the wrist have demonstrated favourable results in the treatment of therapy-resistant complaints in Raynaud's phenomenon.

[The sympathetic axons of the nerves of the hand]

PURPOSE

In the hand surgery literature, more and more studies seem to indicate that the number of sympathetic fibers in the median and the ulnar nerves varies. However, there are no studies that confirm this suspicion.

METHOD AND MATERIAL

Six hours post mortem samples were taken from the median and ulnar nerves, the superficial branch of the radial nerve, and from all digital nerves (each five females and males, average age 78 years). 13 samples were taken from one hand. To make sympathetic fibers visible, the immunohistochemical staining technique with tyrosinhydroxylase (TH) antibodies was used. Quantitative assessment of the sympathetic axons was made in whole cross-sections of the nerve. Statistical evaluation was performed with Wilcoxon rank-sum tests.

RESULTS

The TH-positive axons are arranged in groups and are located in the endoneurium. No isolated sympathetic fibers were found in the peri- and epineurium. TH-positive axons were present on the arterial walls including the smallest arterioles. Proximal to the wrist, the median nerve has more sympathetic fibers than the ulnar nerve. The number, however, of the fibers was the same in each fascicle. A comparison of the digital nerves shows significant differences only between the radial nerve of the thumb and the ulnar nerve of the ring finger and between the radial nerve of the index finger and the ulnar nerve of the little finger.

CONCLUSION

Although the median nerve proximal to the wrist has on average 20 fascicles and the ulnar nerve only 14, the number of fibres in each fascicle is the same. Therefore, based on the present study we conclude that there is no significant difference in the sympathetic fiber distribution of the two nerves.

Functional impairment of the abdominal wall following laparoscopic and open cholecystectomy

BACKGROUND

Subcostal incisions for open cholecystectomy (OC) denervate the right upper and middle abdomen.

METHODS

Sensory and abdominal muscle function (Janda's muscle function test, Cybex 6000) was evaluated. Healthy volunteers (10 women, 12 men) were compared with 13 women and 12 men after OC and 11 women and 11 men after laparoscopic cholecystectomy (LC). For computed tomography (CT) studies, a spiral scanner was used.

RESULTS

Of the OC patients, 21 (95.5%) complained of dys- and anesthesias below the incision. Of the LC patients, only nine (2.4%) reported anesthesias around the port sites. Normal subjects scored significantly higher in muscle strength (p <.01). LC patients scored higher than OC patients at 10 degrees and 20 degrees trunk flexion (p <.05). Depending on the flexion angles, the men in all groups developed 30-114% more muscle power than the women. Denervation of the abdominal muscles was confirmed by CT.

CONCLUSION

OC reduced skin sensitivity and abdominal muscle function. Although the procedure is minimally invasive, LC also causes sensory and functional losses, albeit minor ones.

[Proximal neuropathy of the median nerve]

In a 77 year old man the rare clinical picture of a complete lesion of the median nerve at the upper arm is described. During removal of a "neurinoma" at the upper arm, inadvertedly the general surgeon had also transsected the median nerve. However diagnosis was delayed due to electrodiagnostic tests, which erronously interpreted the volume conduction of the neigbouring nerves as partial function, and later even as improvement of the median nerve function. Clinically he presented with "orators" hand. He was unable to pinch thumb and index finger, Sensory loss was noted at the fingertip 2 and 3, atrophy of the abductor pollicis brevis muscle and trophic skin changes with an ulcer at the tip of the index finger. Nerve revision confirmed the median nerve transsection. Intraoperative nerve stimulation could not elicit distal muscle stimulation. Sural nerve transplant was performed and within one year a positive Tinel sign progressing 20 cm distally to the operation site, without distal motor or sensory changes was observed.

The nerve of Henle: an anatomic and immunohistochemical study

The topography of the nerve of Henle was reviewed. Fifty-two human cadaveric upper extremities were studied. In 30 (58%) the nerve was well defined; in 22 (42%) its origin from the ulnar nerve was unidentifiable. The palmar cutaneous branch of the ulnar nerve separated from the ulnar nerve 5 to 11 cm distal to the medial epicondyle of the humerus to divide into its terminal branches in the distal forearm. Four patterns were detected: ulnar, radioulnar, vessel-related, and radial. These shared a consistent vascular branch, which sent 2 branches to the ulnar artery just proximal to the distal ulnar tunnel. Using a tyrosine hydroxylase antibody-based immunohistochemistry technique the nerve was shown to carry sympathetic fibers. Motor fibers were ruled out with Karnovsky's stain, which was used in combination with the tyrosine hydroxylase method in 10 specimens.

[Bursitis calcarea--an often overlooked and falsely diagnosed illness of the hand]

OBJECTIVE

To compare surgical and conservative management in patients with acute calcific bursitis of the hand, a rare condition often misdiagnosed because of its unspecific symptoms.

METHOD

Four patients with calcific bursitis at the metacarpophalangeal or distal interphalangeal joints or the pisiform are presented. Of these, 3 underwent surgery, while one was treated conservatively. Clinical and radiological symptoms and signs are described.

RESULTS

The 3 patients treated surgically returned to work on the 10th postoperative day, while the patient who refused surgery needed rehabilitation for 4 weeks.

CONCLUSION

Surgery to remove the calcium deposits enables patients to resume work earlier than after conservative treatment which may take weeks.

[Is transposition of the ulnar nerve in ulnar nerve sulcus syndrome really indicated?]

Anterior transposition of the ulnar nerve in cubital tunnel syndrome requires ligation of the segmental epineural vessels over 8 to 10 cm in order to free up and mobilize the nerve along its new course. As a result, the blood supply of ulnar nerves already compromised by entrapment is likely to be harmed even more. For the past three years we chose to perform simple decompression of the nerve with or without external/internal neurolysis on 33 patients (34 arms). After a follow-up time of six months to three years (mean 12 months), the outcome was evaluated by complete examination of hand function and by electrophysiologic studies. Four patients were excluded from the analysis due to short follow-up times. Four underwent decompression for mild entrapment symptoms, six for moderate symptoms, and 19 for severe symptoms. The functional outcome was rated as excellent in 26.7% (eight patients) and as good in 33.3% (ten patients). In group 3 (severe entrapment symptoms), seven patients (23.3%) showed moderate results and in four patients (13.3%) the outcome was poor. Considering that most of our patients had severe entrapment with advanced muscle atrophy, the overall outcome of decompression was satisfactory.

[Complications of endoscopic carpal tunnel operations]

This report is about four female patients admitted to our hospital because of pain, dysaesthesia and paraesthesia following endoscopic release of the carpal tunnel, who underwent revisional surgery. Intraoperatively, we found a partial lesion of the median nerve in two cases and an incomplete release of the ligament in the remaining two cases. The complete decompression and epineurotomy of the median nerve and a nerve graft in two patients resulted in clinical improvement.

[Long-term outcome of surgical therapy of acute necrotizing pancreatitis]

This paper discusses the long-term results after surgical treatment of necrotizing pancreatitis. Thirty-one patients were examined 3 years after the operation. The development of diabetes was the main problem in 29% of the patients and depended on the amount of pancreatic tissue resected (never after necrosectomy, in 47% after pancreatic resection; P = 0.005, Fischer's exact test). Of the patients, 77% were in good general condition and 68% were able to work. In 50% of the patients abdominal wall function was impaired but most of them could cope with this insufficiency. Of the patients with alcohol-induced pancreatitis, 75% were abstinent. Considering the severity of the disease, long-term results after surgical treatment of necrotizing pancreatitis are satisfactory.

Modifications of the paraspinous muscle flap: anatomy and clinical application

Soft-tissue defects of the back, particularly involving the paravertebral tissues, are generally covered with myocutaneous, muscle, or fasciocutaneous flaps. The case of a 64-year-old man with a paravertebral malignant fibrous histiocytoma is reported. To ensure adequately radical margins, the ipsilateral trapezius and latissimus dorsi muscles as well as the costal periosteum and the spinous processes were resected between T9 and T12. The resulting defect was covered with a pedicled latissimus dorsi flap and an island flap of the paravertebral muscles. Prompted by this case, we studied the blood supply of the paravertebral muscles in 10 cadavers. The vasculature was visualized after flushing with colored latex and microsurgical dissection. Another 4 specimens were subjected to angiography and tomography. In the majority of cases (8 of 10), three perforators emerging from the intercostal arteries were identified. These were found to communicate in a longitudinal and vertical direction. Before piercing the fascia, they ramified in three layers matching the layers of the paravertebral muscles. Since the intercostal arteries were shown to communicate through anastomoses of adequate caliber, the paravertebral muscles appear to be useful candidates for proximally or distally pedicled transposition or island flaps.

[Compartment syndrome. Frequently missed, with severe sequelae]

Experience and late results in patients with a compartment syndrome which was either missed or diagnosed too late are reported. In the case of 14 patients we were consulted after a delay of 24 h, in another three patients 48 h after the causative event. At that time the diseased extremity was severely swollen, blistered and extremely painful. Ten patients presented with loss of sensitivity; in eight the peripheral pulses were not palpable. CPK was elevated in nine patients (up to 30,000); in six patients CPK was not determined. Causative factors included vascular occlusion (n = 6), paravenous infusions or injections (n = 4), compression in heroin or alcohol abusers (n = 4) and infections secondary to i.m. injections, sepsis or snake bites (n = 4). One patient developed a compartment syndrome after the closure of a muscular hernia. The late results were sobering: eight limbs had to be amputated, another 13 showed muscle necrosis necessitating necrosectomy, and both transitory and persistent median, ulnar, radial and peroneal nerve damage was observed. Our experience shows that dermatofasciotomy should be done on a more generous scale, because it obviously prevents sequelae and because the late complications following inadequately treated compartment syndromes are grave.

Two-dimensional elastic properties of human skin in terms of an incremental model at the in vivo configuration

The two-dimensional biomechanical behaviour and the collagen content of human skin samples from different anatomical sites was examined. The axes of minimum and maximum shrinkage after excision were determined and correlated with the 'Langer' cleavage lines. Test equipment was developed to restore the original geometry and to measure the loads acting perpendicular to the circumference of the skin specimens. These loads were normalized with respect to the thickness and collagen content and considered as the in vivo tension generated by the surrounding skin area. Using the in vivo geometry of the specimen as reference a set of incremental strains was applied. After stress relaxation was completed the final values of stresses were recorded and related to the incremental strains. The two-dimensional stress-strain relationship was the basis for the evaluation of the incremental elastic moduli. Orthotropic mechanical behaviour was found mainly in regions of reduced in vivo tension. The relationship between the degree of anisotropy at the in vivo configuration and the morphological structure is discussed.

[Intra- and postoperative nerve lesions and their treatment]

Injuries to the central or peripheral nerves caused by medical intervention are called iatrogenic nerve lesions. The caudal relationship between medical intervention and iatrogenic nerve injuries is frequently not very clear. Careful pre- and post-operative examination of the patient, however, will in most instances reveal a nerve lesion in a timely manner. Iatrogenic nerve lesions in the clinical cases available to us were predominantly due to indirect influences, such as pressure, insertion of a retractor or heat; we discovered that only in a few cases a nerve was partially or completely severed or damaged by the material used for osteosynthesis. The pre- and postoperative clinical neurological and electrophysiological examinations of our patients were performed by a neurologist. Nerve-repair was achieved by neurolysis in 19 cases; a primary or secondary suture was performed in three cases. A nerve graft was used in five cases to regain continuity. Those patients (nearly 75%) who underwent restitutive surgery within an six-month period after iatrogenic injury in the primary operation were treated successfully. These results suggest that timely treatment is decisive for good outcome.

Are growth alterations a consequence of surgery for prominent ears?

This study was undertaken to detect growth alterations after surgery for prominent ears. The cartilage excision technique was used in all 77 patients seen for follow-up. Two hundred students served as controls. Auricular measurements were done according to standardized guidelines of anthropometry. There was no significant difference between the retroauricular angle in the surgical group and in controls. The morphologic ear length in the surgical group was significantly smaller than in controls. Maximum ear length was significantly greater in men. Our measurements in the control group were significant below the reference values reported in the literature. Comparing the ear index of both groups with published data, we found a harmony between the width and the length of the ear. We could demonstrate that prominent ears were significantly larger in all other dimensions and that auricular growth does not stop following surgery for prominent ears with the cartilage excision method. We also evaluated subjective criteria such as tolerance to cold, scar formation, and patient satisfaction.

Are growth alterations a consequence of surgery for prominent ears?

This study was undertaken to detect growth alterations after surgery for prominent ears. The cartilage excision technique was used in all 76 patients seen for follow-up. Two hundred students served as controls. Auricular measurements were done according to standardized guidelines of anthropometry. There was no significant difference in the retroauricular angle between the surgical group and controls. The morphologic ear length in the surgical group was significantly smaller than in controls. Maximum ear length was significantly greater in men. Our measurements in the control group were significant below the reference values reported in the literature. Comparing the ear index of both groups with published data, we found a harmony between the width and the length of the ear. We could demonstrate that prominent ears were significantly larger in all other dimensions and that auricular growth does not stop following surgery for prominent ears with the cartilage excision method. We also evaluated subjective criteria such as tolerance to cold, scar formation, and patient satisfaction.

[Functional and electromyographic long-term results following primary microsurgical repair of the recurrent laryngeal nerve]

Six patients with unilateral recurrent nerve paralysis underwent phoniatric follow-up after neurolysis or primary microsurgical repair of the recurrent laryngeal nerve. Four patients were controlled by electromyography of the vocal muscle 14 to 80 months post-operatively. In six patients the paralyzed vocal cords were in median to paramedian position with sustained muscle tonus. Phoniatric parameters were found to be close to the average range in healthy persons. EMG findings indicated degenerative neurogenous paralyses in two patients, signs of reinnervation in another. In one case biphasic action potentials could be recorded.

Experience with 60 inferior rectus abdominis flaps

We report on our experience with the inferior rectus abdominis flap. Since 1984, 60 patients have been operated on with this technique. The inferior rectus abdominis flap was used as a free flap, island flap or pedicle flap (inferiorly based). Pure muscle flaps served to fill bone defects in patients with chronic osteomyelitis or as a biologic cover of infected vascular prostheses following multiple vascular surgery in the groin. The myocutaneous and fasciocutaneous rectus flaps served to cover soft tissue defects of the upper and lower extremities after accidents, degloving and radical tumour surgery. We present data from our collective patients to document the benefits of the inferior rectus abdominis flap and recommend this technique as a safe surgical modality to manage large-surface soft tissue defects.

[Psychosocial effects of plastic surgery reconstruction of the female breast following amputation for malignant/benign tumor]

A total of 98 woman (malignant/benign tumors of the breast, mastectomy with/without subsequent reconstructive surgery as well as healthy controls) were examined in terms of subjective well-being, psychosomatic reaction patterns, subjective impairment due to mastectomy and satisfaction with the outcome of reconstructive surgery in this empiric retrospective study. In addition, numerous sociographic data were obtained. On the average, the examined women were satisfied with the outcome of reconstructive surgery and tended to be disappointed with regard to the desired psychosocial improvement. Objective tests demonstrate that subjective well-being was less favorable after reconstructive breast surgery than in women without reconstruction. In the group "benign tumor with subsequent reconstruction" the reaction to emotional strain was significantly more characterized by regressive behavior and withdrawal than in the group "benign tumor without reconstruction". In the group "malignant tumor with reconstruction" this difference was less pronounced. On the basis of these results we cannot confirm the assumption that reconstructive surgery of the breast has a supportive function.

[Isolated rupture of the vinculum longum superficiale (V1) following blunt trauma]

The anatomy and topography of the vincula are described. Their role in the blood supply to the flexor tendons is reviewed in the light of current reports. The authors present the case history of a 59-year old patient with blunt trauma to the middle finger of the right hand. This patient suffered from severe pain in the area of the proximal phalanx and the PIP joint of the third finger, as well as from reduced extension with a deficit of 20 degrees in the PIP joint. The differential diagnosis and clinical picture are discussed. The operative findings suggest a rare instance of detachment or rupture of the vinculum of the intact superficial flexor tendon.

[A rare combination of true and false aneurysm of the palm of the hand]

The authors report on a patient having a simultaneous true and false aneurysm along the superficial palmar arch. The clinical diagnosis was substantiated by ultrasound and angiography and the findings confirmed histologically. The classification of aneurysms according to their etiology and pathological anatomy is discussed. The clinical symptoms as well as alternative surgical procedures are illustrated with particular emphasis placed on the restoration of adequate peripheral blood circulation in the digits via microvascular anastomosis.

Sonoanatomy of the muscles of facial expression

Primary anatomic studies served for identification and differentiation of the individual mimetic muscles. As a second step, we investigated the clinical potential of ultrasound imaging to visualize the mimetic musculature in 15 volunteers. This examination technique was used to diagnose pathological alterations, especially associated with facial palsy. The excellent sonographic visualization of the mimetic musculature indicates that this technique may be a valuable adjunct in the diagnosis and differentiation of facial palsy, as well as in planning plastic surgery and reconstructive procedures, and in follow-up care.

[Clinical imaging of the mimetic muscles using high resolution ultrasound]

In comparison to other techniques, high resolution ultrasound has proved to be a good method for clinical imaging of muscles. By free selection of the scan plane and multidimensional viewing it is possible to represent each muscle from origin to insertion and to observe them during function. Pathology produces different types of echogenity. By imaging an EMG needle electrode the exact position within the muscle can be demonstrated. The result of the EMG study can therefore be related to small individual muscles or muscle segments, which are below the size suitable for clinical examination.

Photogrammetry of the muscles of facial expression

The present study has attempted to determine the volume, square measure as well as length, width and thickness of the individual muscles of facial expression by photogrammetry. 15 fresh male head specimens were employed for a careful dissection of muscle layers. The volume was measured using the immersion procedure. The mean values of each parameter together with the standard deviation were summarized. The results suggest that this novelty in the representation of the mimetic muscles will facilitate the planning of corrective interventions in plastic surgery. Moreover, photogrammetry offers additional information on the required size and measurements of donor muscles.

Sonography of the tongue and floor of mouth. Part I: Anatomy

Normal structures of the tongue and floor of the mouth were studied using anatomic sections cut with a stainless steel band saw. The sections were performed on the same planes as used in US and CT scanning. The ultrasound studies were carried out with 20 young and healthy volunteers. CT images were obtained from head-neck preparations that were subsequently used for anatomic sectioning. On comparing these sections to US and CT images, normal structures including intrinsic and extrinsic tongue muscles, vessels and salivary glands were identified. Knowledge of the anatomic landmarks is mandatory for optimal US image reading.

Sonoanatomy of the shoulder

With the aid of ultrasound we tried to visualize the muscles of the shoulder region, the collum scapulae, the axillary artery and vein and the brachial plexus. We were successful with exception of the vessels and the nerves. Knowledge of the anatomical landmarks is essential in ultrasound image reading.

[Real-time sonography in the diagnosis and follow-up of malignant tongue tumors. I. Anatomic basis]

Normal structures of the tongue and floor of the mouth were studied using anatomic sections cut with a stainless steel band saw. The sections were performed on the same planes as used in US and CT scanning. The ultrasound studies were carried out with 20 young and healthy volunteers. CT images were obtained from head/neck preparations that were subsequently used for anatomic sectioning. On comparing these sections to US and CT images, normal structures including intrinsic and extrinsic tongue muscles, vessels and salivary glands were identified. Knowledge of the anatomic landmarks is mandatory for optimal US image reading.