Individual differences in social homeostasis

The concept of “social homeostasis”, introduced by Matthews and Tye in 2019, has provided a framework with which to consider our changing individual needs for social interaction, and the neurobiology underlying this system. This model was conceived as including detector systems, a control center with a setpoint, and effectors which allow us to seek out or avoid additional social contact. In this article, we review and theorize about the many different factors that might contribute to the setpoint of a person or animal, including individual, social, cultural, and other environmental factors. We conclude with a consideration of the empirical challenges of this exciting new model.

Adding the missing voice: How self-report of autistic youth self-report on an executive functioning rating scale compares to parent report and that of youth with attention deficit hyperactivity disorder or neurotypical development

LAY ABSTRACT

Executive functions are often impaired in autistic people and relate to important outcomes such as mental health, success in school and work, and quality of life. Evaluating executive functions helps autistic people, clinicians, and families identify targets for external supports and skill building. Youth self-report of executive function has not been studied, yet we know that self-report from autistic youth is key to understanding other cognitive/behavioral phenomena in autism such as anxiety, obsessions/compulsions, sensory sensitivities, and repetitive behaviors. We investigated self- and parent-report of executive function problems in 197 autistic youth without intellectual disability (ages 11-18 years), including the magnitude and profiles of executive function problems autistic youth report across subdomains of executive function. We compared autistic self-report with that of 114 youth with attention deficit hyperactivity disorder without intellectual disability and 197 neurotypical youth. We found that autistic youth report significant executive function problems compared to neurotypical youth and a distinctive profile of challenges in comparison to attention deficit hyperactivity disorder youth. Parents and their autistic children diverged regarding the magnitude of the youth's executive function difficulties, but both identify inflexibility as the most impaired executive function subdomain. Autistic youth and their parents were somewhat more concordant in their report of executive function problems than youth with attention deficit hyperactivity disorder and their parents, but only showed moderate concordance at best. These findings elevate the importance of asking autistic youth directly about their executive functioning when engaging them in assessment and intervention, or researching executive functions in autism.

Efficacy and safety of two different antifungal pastes in infants with diaper dermatitis: a randomized, controlled study

BACKGROUND

Diaper dermatitis (DD) is the most common type of irritative dermatitis in infancy. It is frequently complicated by Candida superinfection.

OBJECTIVE

Comparison of efficacy and safety of two antifungal pastes (Imazol = 1% clotrimazole; Multilind = 100,000 IU nystatin/g + 20% zinc oxide) in infants with DD.

METHODS

A total of 96 infants were included in this multi-centre, controlled, randomized, evaluator-blinded phase IV trial and treated with pastes containing either clotrimazole (n = 45) or nystatin (n = 46) twice daily for 14 days. In all, 91 children (age 12.1 +/- 5.3 months; 48 females) with DD were evaluable. Total symptom score after 7 days (TSS7) was assessed as primary parameter. Secondary efficacy parameters were TSS at 14 days (TSS14), clinical and microbiological cure rates and global assessment (GA) of clinical response.

RESULTS

TSS improved markedly with both pastes. Decreases in symptom score were 4.5 +/- 2.1 (day 7) and 6.1 +/- 1.9 (day 14) with clotrimazole compared with 4.2 +/- 2.3 and 5.4 +/- 2.4 with nystatin (P < 0.0001). With respect to TSS14, clotrimazole was superior to nystatin (P = 0.0434). Clinical cure rate was higher with clotrimazole [36.2% (day 7) and 68.1% (day 14)] compared with 28.6% and 46.9% (nystatin). GA was very good in 26 (55.3%) clotrimazole-treated children (nystatin: 16 [32.7%], P = 0.0257). Frequency of adverse events was comparable in both treatment groups.

CONCLUSION

Clotrimazole was superior to nystatin with respect to reduction in symptom score and GA. Microbiological cure rate was 100% for both agents. Both treatments were safe and well-tolerated.

The influence of x-ray contrast agents in computed tomography on the induction of dicentrics and gamma-H2AX foci in lymphocytes of human blood samples

The aim of this study was to investigate and quantify two biomarkers for radiation exposure (dicentrics and gamma-H2AX foci) in human lymphocytes after CT scans in the presence of an iodinated contrast agent. Blood samples from a healthy donor were exposed to CT scans in the absence or presence of iotrolan 300 at iodine concentrations of 5 or 50 mg ml(-1) blood. The samples were exposed to 0.025, 0.05, 0.1 and 1 Gy in a tissue equivalent body phantom. Chromosome aberration scoring and automated microscopic analysis of gamma-H2AX foci were performed in parts of the same samples. The theoretical physical dose enhancement factor (DEF) was calculated on the basis of the mass energy-absorption coefficients of iodine and blood and the photon energy spectrum of the CT tube. No significant differences in the yields of dicentrics and gamma-H2AX foci were observed in the absence or presence of 5 mg iodine ml(-1) blood up to 0.1 Gy, whereas at 1 Gy the yields were elevated for both biomarkers. At an iodine concentration of 50 mg ml(-1) serving as a positive control, a biological DEF of 9.5 +/- 1.4 and 2.3 +/- 0.5 was determined for dicentrics and gamma-H2AX foci, respectively. A physical DEF of 1.56 and 6.30 was calculated for 5 and 50 mg iodine ml(-1), respectively. Thus, it can be concluded that in the diagnostic dose range (radiation and contrast dose), no relevant biological dose-enhancing effect could be detected, whereas a clear biological dose-enhancing effect could be found for a contrast dose well outside the diagnostic CT range for the complete radiation dose range with both methods.

Antiseptic efficacy of a low-dosed topical triclosan/chlorhexidine combination therapy in atopic dermatitis

The topical application of triclosan as an antistaphylogenic antiseptic has proven beneficial in atopic dermatitis. Especially in lipophilic carriers, triclosan is applied in a concentration range between 1 and 5%, usually 2%. However, as a phenol, triclosan is not undisputed and may result in local exacerbation of the disease by eliciting irritative secondary reactions, especially in high concentrations. Chlorhexidine is also an antiseptic which is very effective against Staphylococci and nearly equivalent to triclosan with respect to its antistaphylogenic efficacy. In light of this, the combination of the two active substances in very low concentrations offers a possible option of using the additive effects of the two substances to minimize the risk of side effects. In a uniform W/O emulsion carrier alternatively containing 0.3% triclosan combined with 0.34% chlorhexidine dihydrochloride or 2.0% triclosan, the antibacterial efficacy against Gram-positive skin bacteria could be proven in a preclinical comparison with a reference preparation containing fusidic acid. Subsequently, the pathogen-reducing effect was examined in a clinical study of the influence on clinical severity in patients with atopic dermatitis. Both investigation methods showed that the two test preparations were slightly inferior to the reference preparation, but result in the same degree of pathogen reduction and improvement in the severity of existing atopic dermatitis in direct comparison. The overall results support the conclusion that a combination of triclosan and chlorhexidine in low concentrations as well as the existing antiseptic standard of a 2% triclosan preparation are suitable for pathogen reduction and thus for improving atopic dermatitis.

Resection of thoracic dumbbell neurinomas: Single postero-lateral approach or combined posterior and transthoracic approach?

Dumbbell tumours are those with an intraspinal and a paraspinal component, connected through a frequently enlarged and eroded intervertebral foramen. Most dumbbell tumours are located in the thoracic spine, and most of them are schwannomas. The extraspinal tumour extension is usually larger than the intraspinal tumour part, but the intraspinal tumour component commonly causes the typical symptoms: local pain and symptoms from spinal cord compression in the thoracic spine. Diagnosis is best established by magnetic resonance imaging with and without contrast agent injection. Controversy exists as to whether to remove thoracic dumbbell tumours using a single posterior approach with posterolateral extension or using a combined posterior and transthoracic approach. We report the removal of a dumbbell neurinoma at T6/7 using a single posterior midline approach with laminectomy and costo-transversectomy and review the literature regarding the approaches to thoracic dumbbell tumours.

1H-Magnetresonanz-Spektroskopie von Hirntumoren

Magnetic resonance spectroscopy facilitates non-invasive determination of metabolic changes in vivo. The main metabolites are the neuronal marker N-acetylaspartate (NAA), cholines reflecting membrane turnover, creatine, lactate, and mobile lipids. Primary brain tumours exhibit reduced NAA and increased choline resonances compared to normal brain, and these abnormalities increase with higher malignancy. Increasing choline resonances on follow-up studies correlate with tumour progression, whereas the reduction of initially increased choline resonances indicates a transition from viable tumour to necrotic tissue. Metastases as non-neuroectodermal tumours lack NAA, but demonstrate elevated choline, lactate and lipid resonances. Lymphomas are characterised by massively increased lipid resonances with markedly elevated choline. Prominent alanine resonances are often observed in meningioma. Cystic/necrotic lesions demonstrate elevated lactate regardless of their aetiology. The characteristic finding of prominent resonances from acetate, succinate, and alanine, of leucine, isoleucine and valine in untreated bacterial abscesses allows the differentiation of bacterial abscesses from cystic/necrotic brain tumours.

[Current use and possible future applications of the magnetization transfer technique in neuroradiology]

Magnetization transfer (MT) imaging is a special MR technique used for selective suppression of the MR signal of protons bound on macromolecules. The most important applications in neuroradiology are (1) detection of subtle changes in otherwise normal-appearing cerebral white matter, for instance in multiple sclerosis (MS), Wallerian degeneration, and hydrocephalus, (2) differentiation of white matter lesions with high signal on T (2)-weighted MR-images, like MS plaques, brain infarctions, and brain edema, (3) follow-up of cerebral white matter diseases using volumetric MT techniques, and (4) improvement in delineating of contrast enhancing brain lesions, such as cerebral metastases. We describe the physical rationale of the MT technique and present the most important current and possible future applications of MT imaging to answer clinical and scientific questions in neuroradiology.

[Comparison of a sulfate-free polyethylene glycol (PEG) solution with a standard solution for colonoscopy preparation]

In order to ameliorate the unpleasant salty taste of a standard PEG-electrolyte lavage solution and thus improving acceptance of colonoscopy cleansing, a new sulfate-free, low sodium PEG-solution has been developed as long as 10 years ago. Comparative studies regarding acceptance showed conflicting results. This study was intended to compare the standard solution L (Cololyt) with the sulfate-free solution S (Colo-Sol) on a prospective basis in a collective of average gastroenterology outpatients. The 144 patients who underwent colonoscopy ingested 1 liter of solutions L and S each on the evening before and another liter of the preferred solution (preference) in the morning of the day of examination. Moreover the taste of both solutions was rated (grading scale 0-10). Tolerance and efficacy were registered as well. Preference and thus acceptance presented very well-balanced. Solution L was preferred as frequent (by 50.7% of patients) as solution S (49.3%) which was originally claimed to be better tasting. The respective preferred solutions were rated equal with mean +/- SD values of 6.6 +/- 2.2 for L and 7.0 +/- 1.9 for S. Efficacy and tolerance did not differ from a clinical point of view.

Molecular analysis of ammonia oxidation and denitrification in natural environments

This review summarizes aspects of the current knowledge about the ecology of ammonia-oxidizing and denitrifying bacteria. The development of molecular techniques has contributed enormously to the rapid recent progress in the field. Different techniques for doing so are discussed. The characterization of ammonia-oxidizing and -denitrifying bacteria by sequencing the genes encoding 16S rRNA and functional proteins opened the possibility of constructing specific probes. It is now possible to monitor the occurrence of a particular species of these bacteria in any habitat and to get an estimate of the relative abundance of different types, even if they are not culturable as yet. These data indicate that the composition of nitrifying and denitrifying communities is complex and apparently subject to large fluctuations, both in time and in space. More attempts are needed to enrich and isolate those bacteria which dominate the processes, and to characterize them by a combination of physiological, biochemical and molecular techniques. While PCR and probing with nucleotides or antibodies are primarily used to study the structure of nitrifying and denitrifying communities, studies of their function in natural habitats, which require quantification at the transcriptional level, are currently not possible.

Parotidectomy: a plastic approach

Three disadvantages are frequent after parotidectomy: a scar affecting the neck, a deep hollow between the sternocleidomastoid muscle and the mandible (the larger the resection is, the deeper is the hollow), and a sweat secretion. These disadvantages can be prevented or reduced by using four simple procedures: (1) using a facelift incision; (2) using a very simple and original "trick," by displacing outward the posterior belly of the digastric muscle; (3) using a flap with an upper pedicle taken from the sternocleidomastoid muscle; and (4) using a double free graft, taken from the superficial and deep temporal fascias. These two grafts lay down on the net constituted by the preceding flaps. They line the skin, thus blocking the wrong innervation.

[Colonic preparation with sodium phosphate. Prospective, randomized, placebo-controlled double blind study with various antiemetics]

The well established bowel cleansing method using a polyethylene glycol-based solution (Fordtran) is limited by the necessity of large volume intake, which proves difficult for many patients. Therefore, a new method using small volumes (2 x 90 ml) of oral sodium phosphate is employed more and more frequently. Its only disadvantage is the occurrence of considerable nausea or occasional vomiting in about 25% of patients. To ascertain whether nausea could be reduced, 426 patients were given an antiemetic (ondansetron, metoclopramide, cisapride) or placebo on a randomized, double-blind basis, one hour before sodium phosphate intake.

RESULTS

sodium phosphate was well tolerated in 69.2% of the patients on placebo, 73.6% on cisapride, 76.5% on metoclopramide and 80.4% on ondansetron. Taking all four groups together, male patients exhibited much better tolerance (86.1%) than females (66.1%). Severe nausea and/or emesis was noted in 22.4% of patients on placebo, 21.7% on cisapride, 17% on metoclopramide and 14% on ondansetron. In over 90% of patients colon cleansing was rated as good to very good. This was largely independent of the severity of nausea. 129 patients who had undergone former polyethylene glycol-based lavage judged sodium phosphate to be more tolerable and easier to complete. Considering known contraindications (symptomatic congestive heart failure and/or renal failure), no serious adverse event was noted in any of the 426 patients investigated. In accordance with several recent studies, we consider sodium phosphate solution at present the procedure of choice for colon cleansing. Compared to Fordtran, patient acceptance is far better and cleansing quality superior. Routine antiemetic comedication for reducing possible nausea/vomiting is not worthwhile. On the other hand, this study confirms our former impression of enhanced colon cleansing after administration of an additional mild laxative before sodium phosphate, without interfering with patient acceptance.

Ciprofloxacin pharmacokinetics in burn patients

Many drugs exhibit altered pharmacokinetic parameters in burn patients. We prospectively evaluated the pharmacokinetics of ciprofloxacin in eight burn patients with active infections. Each patient received a 400-mg dose of ciprofloxacin intravenously (i.v.) every 8 h, with each dose infused over 1 h by using a rate control device. Blood samples for analysis of plasma ciprofloxacin concentrations, determined by high-performance liquid chromatography, were obtained immediately predose, at the end of the infusion, and 1, 2, 3, 4, 5, 6, and 7 h after the end of the infusion. Urine was collected from 0 to 2, 2 to 4, and 4 to 8 h following the same dose, and an aliquot was saved for determination of the ciprofloxacin concentration. Urine was also collected for 24 h prior to this dose for measurement of creatinine clearance (CLCR). Pharmacokinetic parameters were estimated by noncompartmental analysis. Mean maximum and minimum plasma ciprofloxacin concentrations were 4.2 +/- 1.1 and 0.70 +/- 0.55 microgram/ml, respectively. Mean values for clearance (CL), renal clearance (CLR), volume of distribution, terminal elimination rate constant, half-life (t1/2), and area under the concentration-time curve (AUC) were 29.1 +/- 17.5 liters/h, 13.5 +/- 10.1 liters/h, 1.75 +/- 0.41 liters/kg, 0.222 +/- 0.098 h-1, 4.5 +/- 3.9 h, and 20.7 +/- 16.6 micrograms.h/ml, respectively. CL was higher and t1/2 was shorter than noted in previous studies of acutely ill, hospitalized patients. A good correlation was noted between creatinine clearance CL(CR) and both total ciprofloxacin CL (r = 0.85) and CLR (r = 0.84). A moderate inverse correlation was noted between percent body surface area burned and total ciprofloxacin CL (r = -0.55). An AUC/MIC ratio above 125 SIT-1 (where SIT is serum inhibitory titer), which has been strongly correlated with clinical response and time to bacterial eradication, was achieved in five of eight patients (63%) with a MIC of 0.25 microgram/ml. At a ciprofloxacin dosage of 400 mg i.v. every 12 h, an AUC/MIC ratio above 125 SIT-1 would have been achieved in only two of eight patients (25%). We conclude that ciprofloxacin CL is highly variable, but generally increased, in burn patients compared with that in acutely ill, general medical and surgical patients. Because of an increase in CL, a ciprofloxacin dosage of 400 mg i.v. every 8 h is more likely to produce the desired response in burn patients than the same dose given every 12 h.

[Helicobacter pylori eradication therapy with bismuth citrate/amoxycillin combination therapy]

The efficacy of a new combination preparation containing bismuth citrate and amoxicillin in one tablet was compared with the efficacy of bismuth citrate monotherapy in a randomised double-blind study on the eradication of Helicobacter pylori. The study involved 70 H. pylori positive (antrum biopsies showing a positive urease test) patients with non-ulcer dyspepsia and chronic gastritis. The treatment period was 14 days; 35 patients in group 1 received 2 tablets tid containing the bismuth citrate amoxicillin combination (BIAM tablet; 250 mg amoxicillin base and 120 mg bismuth); 35 patients in group 2 were treated with 2 tablets tid containing bismuth citrate (BI tablet; 120 mg bismuth). Total daily dose was therefore 1500 mg amoxicillin + 720 mg bismuth in group 1 patients resp. 720 mg bismuth in group 2 patients. 4 weeks after therapy H. pylori could not be histologically detected in the antrum of 22 patients (63%) in group 1 and 8 patients (24%) in group 2. Thus in group 1 (BIAM) a significantly higher eradication rate (p < 0.001) was shown than in group 2 (BI). Inflammation characterized by the infiltration of polymorphonuclear cells was significantly (p < 0.01) less pronounced in group 1 (BIAM) than in group 2 (BI) 4 weeks after the end of treatment. Gastrointestinal distress was quantified by evaluation of 13 different symptoms using a fourpoints scale at the beginning of the study and after 2 and 6 weeks. The sum of scores decreased by 81% in group 1 (BIAM) and 71% in group 2 (BI) after 6 weeks.

Proboscis lateralis: treatment of two atypical cases

Proboscis lateralis (PL) is a rare congenital malformation of the nose. We describe two atypical cases of proboscis we treated to obtain symmetrical nostrils. We used the PL as a donor tissue. Due to the variable aspects of this malformation, achieving an aesthetical goal remains a surgical challenge.

Subfascial lifting

The authors demonstrate by anatomical dissection that inaccuracies made by classical anatomists have worried plastic surgeons for many years. They demonstrate that continuity between the parotid fascia and the fibrous platysma has not been recognized. In addition, anatomists in the past have not been aware that the platysma is a unique type of fasciomuscular layer because in contrast to conventional anatomical opinions, the platysma has no bony attachment to the mandible.

Overnight salivary caffeine clearance: a liver function test suitable for routine use

The feasibility of measuring caffeine clearance from saliva (SCl) was assessed in ambulatory patients with liver disease and in a control group, and the results were compared with quantitative liver function tests. For this purpose, the subjects were given 280 mg caffeine p.o. in decaffeinated coffee powder between noon and 4 p.m., and caffeine concentrations were measured in saliva (using an enzyme immunoassay) before bedtime and upon arising. In the cirrhotics (n = 29), SCl was 0.58 +/- S.D. 0.45 ml per min X kg, thus being reduced to approximately one-third of drug-free, nonsmoking controls (1.53 +/- 0.46, n = 18); although patients with noncirrhotic liver disease showed intermediate values (0.95 +/- 0.47), their reduction in SCl was significant (p less than 0.001). SCl was correlated with indocyanine green fractional clearance, galactose elimination capacity and aminopyrine breath test; however, the closest relationship (Rs = 0.80) was observed with the aminopyrine breath test. It is suggested that the measurement of SCl represents a noninvasive and innocuous procedure for quantifying hepatic microsomal function, and is suitable for routine use. Since a.m. saliva concentrations of caffeine are highly correlated (Rs = -0.94) with SCl, further simplification of the test to a single-point measurement appears possible.

Effect of liver function on the metabolism of prednisone and prednisolone in humans

The systemic availability of total prednisone and unbound prednisolone, and the urinary excretion of 6 beta-hydroxyprednisolone, were measured after an oral dose of prednisone and an i.v. dose of prednisolone in 22 patients covering a wide range of liver function (galactose elimination capacity ranging from 3.3 mg/min X kg body wt to 9.2 mg/min X kg body wt). The area under the plasma concentration versus time curves of prednisolone and of prednisone decreased with increasing galactose elimination capacity. This dependency of the steroid concentrations on liver function was attributed to a decreased metabolic clearance and not to an increased systemic availability of the steroid given p.o. in patients with impaired liver function. The fractional excretion and the fractional clearance of 6 beta-hydroxyprednisolone declined with decreasing metabolic clearance rate of prednisolone or with decreasing galactose elimination capacity. Thus, the enzymes involved in the 6 beta-hydroxylation are not spared as liver function declines, and the exposure to the biologically active unbound prednisolone is increased in patients with impaired liver function in relation to the amount of prednisone or prednisolone administered.

Effect of dietary caffeine on airway reactivity in asthma

The potential influence of dietary caffeine on bronchoprovocation challenges with carbachol was examined in 7 patients with asymptomatic asthma. In a double-blind fashion placebo or caffeine (6 mg/kg body weight; equivalent to approximately 4 cups of coffee) solved in orange juice was administered, and carbachol challenges were performed. The average peak serum concentration achieved 60 min after dosing was 7.6 +/- SD 2.1 mg/l. These caffeine levels did not produce any appreciable attenuation of the bronchoconstrictor response to carbachol inhalations. It thus appears that dietary caffeine is barely a cause of erroneous interpretations of bronchoprovocation challenges with carbachol.

Experience with collagen injection for the correction of contour deficiencies

The author reports on the successful use of collagen injections after surgery for the correction of inter-superciliary lines and missing tissue lesions after rhinoplasty. Less successful results were obtained with naso-labial lines or lesions of excess tissue after rhinoplasty. Caution is advised in the use of collagen injections for congenital lesions.

[Quantification of the drug-metabolizing enzyme system in liver diseases: a comparison between antipyrine saliva clearance and the aminopyrine breath test]

The metabolic activity of the hepatic cytochrome P450 system was studied in 53 ambulatory subjects. 18 of these were cirrhotics and 23 had non-cirrhotic liver disease, documented by biopsy, serologic, ultrasound or computerized tomography findings, and characterized by quantitative liver function tests, such as galactose elimination capacity and indocyanine green fractional clearance. For comparison, 12 normal control subjects were also included. All subjects were given 10 mg/kg body weight antipyrine and saliva concentrations determined with an HPLC-method at 24 and 48 hours after dosing. Antipyrine saliva clearance (ASC) was calculated according to a two-point method (Cl1), and compared with a one-point method (Cl2) using the 24 h sample only. These subjects also underwent an aminopyrine breath test (ABT), breath samples being collected at regular intervals during 60 minutes following injection of a tracer dose of 1.5 muCi (14C-dimethylamino)antipyrine. Cl1 and Cl2 correlated strongly (r = 0.93). On the basis of smaller variations (particularly in control subjects), better definition of disease severity and convenience and time saving, Cl2 is to be preferred. Comparison of Cl2 with ABT showed that both procedures apparently quantify overlapping enzymatic activities. However, the relationship between Cl2 and ABT values, albeit highly significant (r = 0.72), suggests that only about half of the variables are subject to the same determinant. In addition, a positive intercept of the regression line extrapolated to the Cl2 axis points to quantitatively important extrahepatic breakdown of antipyrine. The results suggest that, in view of the wide variation in normal values (presumably in part influenced by exogenous pollutants), ASC only provides an approximation of hepatic metabolic activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Parotid fascia and face lifting: a critical evaluation of the SMAS concept

Classical anatomists were mistaken in their description of the parotid and masseteric regions. According to their description, the fascia superficialis (or SMAS) would be in continuity with the platysma. Data from fresh cadaver dissections, histology, and embryology indicate, on the contrary, that it is the parotid fascia, which is continuous with the platysma. Comparative anatomy provides further confirmatory evidence, demonstrating that the parotid fascia is only the uppermost part of a muscle that has undergone fibrous degeneration. This muscle is the "primitive" platysma. In consequence, the sub-SMAS dissection plane is too superficial and creates a purely fatty flap. Conversely, deep dissection below the parotid fascia (and therefore below the primitive platysma) respects the true anatomic features and guarantees the solidity of the flap and the safety of the facial nerve.

[The parotid fascia]

The parotid fascia is not the superficial layer of the investing layer of the cervical fascia. The dissection of 21 cadavers, the histological studies and the compared anatomy of 3 apes show that the parotid gland lies between the platysma muscle on the lateral side and the superficial layer of the cervical fascia on the medial side. The upper part of the platysma, large muscle in apes, has regressed as a fibrosis layer in man.

Volumetric measurements of the cerebrospinal fluid spaces in demented subjects and controls

Forty-seven subjects 65 to 80 years of age, of whom 20 were demented and 27 were normal, were studied by computed tomography. Volumetric indices of ventricular (V%) and sulcal size (S%) were determined by pixel counts without knowledge of clinical status. V% was 5.30 (+/- 1.92) for the controls and 10.46 (+/- 4.78) for the demented subjects. S% was 6.14 (+/- 2.51) for the controls and 10.61 (+/- 3.32) for the demented subjects. In each case, differences between the two groups were significant (P less than 0.0001). When a subsample of 29 scans were analyzed using linear and volumetric measurements, the linear measurements showed less pronounced differences between the demented subjects and the controls. These findings explain the conflicting results of different investigators concerning variations in ventricular and sulcal size in dementia and normal aging.

SMAS in rhytidectomy

The continuity between the aponeurotic facial fascia and the platysma is an anatomical fact which can be useful in performing face-lift surgery. We have used a "suspender flap" that we fix securely to the periosteum of the mastoid. This fixation using a face-to-face adhesion gives a harmonious and strong lifting of the lower third of the face and creates an acute cervicofacial angle. After 2 years of systematic use of this flap as a routine procedure, we have had no complications related to the procedure itself. Scarring of the skin behind the ear is better than after a purely cutaneous lifting, probably because there is less tension on the skin. Early results have been satisfactory. Further follow-up needs to be done to determine long-term results.

[Congenital arterio-venous malformations. Long-term therapeutic effects of arterial ligatures. A plea for their abandon in favour of more recent procedures (author's transl)]

It is well known that proximal arterial ligations have no curative effect on arterio-venous malformations, unfortunately however they are still employed. The immediate and late consequences of such ligatures have been studied by analysing 36 out of 142 cases of arterio-venous malformations. These ligatures interfere with ulterior treatment. At present such a treatment relies on a combination of radio-surgical treatment associated with embolization and complete surgical excision of the malformation, whenever it is possible.

[Our technique of hetero-lateral facio-facial anastomosis by means of nerve autografting in the treatment of permanent peripheral facial paralysis]

The authors describe the technique used in 12 surgical cases of heterolateral facio-facial anastomosis by nerve autograft in the treatment of permanent peripheral facial paralyses. Their main contention is that section of 50 p. 100 of the neurones of the peripheral branches of the facial nerve on the unaffected side does not impair motricity to any extent and that it therefore is possible to anastomose the proximal portion of some healthy branches to the corresponding distal portion of the affected side by placing between them a graft from the external saphenous nerve. The principles for fascicular suture as defined by Seddon and later by Millesi are followed. The technique differs from that made popular by Smith and later by Smii inasmuch as: --the bilateral, hidden face-lift incision makes possible a final passive musculotegumentary suspension of the paralysed side immediately improving the patient's appearance while the nerve re-establishes itself; --retrograde interfascicular dissection on the paralysed side allows precious centimetres to be gained; --pinpointing of the nerve suture area is possible by the placing of a silicone-coated ring with a clip some distance away.

[Facial injuries]

In spite of a certain reduction in their numbers, facial injuries still raise frequent problems for general surgeons. Car accidents are now less commonly responsible than motorcycle accidents. In the most complex cases, one may find lesions of the soft parts and bony lesions in association. The wounds should be examined carefully, all foreign bodies removed and should only be sutured if one is certain tht the subjacent structures are undamaged, e.g. facial bony canals are often damaged in vertical wounds of the cheek situated behind the anterior border of the masseter muscle. As far as bony lesions are concerned, they rarely give rise to typical breakdowns of the suture lines described by Lefort, but more commonly cause true dislocations which are impossible to describe. Fractures are often undiagnosed owing to oedema which masks them, e.g. those of the malar bone and of the orbit and even those of the nose. This failure to diagnose them is serious for, at a later stage, surgical correction is more difficult and the prejudice is then not only esthetic but also functional, e.g. causing diplopia. Clinical examination of a patient with trauma of the face includes a series of simple gestures which a general surgeion should carry out in order to avoid failure to diagnose such lesions. Although he may not treat them all, he sould recognise them and decide which have priority in the treatment of multiple injuries. Careful inspection and palpation usually permit one to detect bony lesions which XRays then demonstrate only by careful choice of appropriate views.