This article introduces a new method of thumb reconstruction with the use of an iliac bone graft and a free neurovascular wrap-around flap from the big toe, previously reported by Morrison et al. in 1980. Using this method it is possible to reconstruct a thumb similar to the missing part without total sacrifice of the toe. There is no mobile portion in the reconstructed thumb and motion is provided only by intact joint of traumatized thumb. In thumb reconstruction, it is possible to preserve the nail and its pulp, thus preventing swivelling of the nail and loss of pulp sensation as well as ensuring continued nail growth. This is achieved by free tissue transfer from the 1st web space of the foot, innervated by the deep peroneal nerve and supplied by the dorsalis pedis artery with relatively large diameter. Three cases of thumb reconstruction were performed with this method. Follow up was done for an average of 11.3 months; the rate of viability was 100% with excellent appearance; the 2-point discrimination averaged 8.3 mm.
Arteries ; Discrimination (Psychology) ; Follow-Up Studies ; Foot ; Hallux ; Joints ; Methods ; Peroneal Nerve ; Sensation ; Thumb ; Toes ; Transplants

Degloving injuries of the fingers result in avulsion of skin and subcutaneous tissue from the underlying deep fascia, the arterial supply is embarrassed and necrosis may result. Theoretically primary microvascular replantation may be a complete solution, however, the prognosis in terms of both immediate and long term function following avulsed digits is poor. The ideal reconstruction aims at retension of mobility and restoration of a skin cover that is adherent, has a sensibility approaching the norm, and is free from pain. A method of finger reconstruction for an avulsion injury using a free neurovascular wrap-around flap from the big toe may be a choice of treatment for both esthetic and functional aspects.
Fascia ; Fingers ; Hallux ; Methods ; Necrosis ; Prognosis ; Replantation ; Skin ; Subcutaneous Tissue

The SPECT radiopharmaceuticals labeled with I-123 for dopamine transporter imaging have been used to measure dopamine transporters in patients with movement disorders. However, a cyclotron produced I-123 limits its availiability and ease of use as a radioisotope to be labeled with pharmaceuticals in routine clinical diagnostic procedures. Recently, new radiopharmaceuticals for Tc-99m which has optimal characteristic for SPECT imaging have been developed to overcome the limits of using I-123. The purpose of this study was to compare the quality of [Tc-99m]TRODAT-1 with [I-123]IPT SPECT data and then to evaluate the usefulness of [Tc-99m]TRODAT-I SPECT by using three noninvasive simplified quantitative methods. TRODAT-1 labeled with Tc-99m(15.93+/-0.82 mCi) and IPT labeled with I-123(6.60+/-0.11 mCi) were injected into five normal controls. Dynamic [Tc-99m] TRODAT-I SPECT scans of brain were performed for 10 minutes each over 180 minnutes, and for 20 minutes at 4 hrs and 5 hrs. [I-123IPT SPECT scans were performed for 5 minutes each over 120 minutes. Time activity curves were generated for the left basal ganglia(LBG), right basal ganglia(RBG), and occipital cortex(OCC). Dopamine transporter parameters were obtained using (BG-OCC)/OCC, graphical method(Rv), and area ratio method(RA). TRODAT-1 and IPT SPECT imaging showed high uptake at the level of the basal ganglia. (BG-OCC)/OCC ratios for TRODAT-1 and IPT were 0.80+/-0.14, and 3.22+/-0.81, Rvs were 0.62+/-0.12, and 2.30+/-0.35, and RAs were 0.37+/-0.08 and 1.73+/-0.31, respectively. In conclusion, further improvement of [Tc-99m]TRODAT-I imaging characteris- tics may be required to estimate the dopamine transporter concentrations in human brains although it shows clear BG localization.
Basal Ganglia ; Brain ; Cyclotrons ; Dopamine Plasma Membrane Transport Proteins* ; Dopamine* ; Humans ; Movement Disorders ; Radiopharmaceuticals ; Tics ; Tomography, Emission-Computed, Single-Photon*

No abstract available.
Defecography* ; Hernia*

Rieger's syndrome is a rare autosomal dominant developmental anomaly characterized by ocular and systemic abnomalities. These disorders are typically bilateral and usually diagnosed at birth or in the childhood. The most common ocular defects are hypoplasia of the iris, a prominent Schwalbe's line with iris strands and corectopia. A large number of patients have glaucoma due to devel-opmental defects of the anterior chamber angle structure. The authors experienced a case of Rieger's syndrome which was found in 31-year-old female, who had characteristic ocular and other systemic abnormalities. Associated glaucoma was well controlled by filtering surgery.
Adult ; Anterior Chamber ; Atrophy ; Edema ; Female ; Filtering Surgery ; Frontal Lobe ; Glaucoma* ; Glioblastoma ; Humans ; Intracranial Pressure ; Iris ; Neurofibromatoses ; Optic Atrophy ; Optic Nerve ; Optic Nerve Diseases* ; Parturition ; Skin

No abstract available.
Replantation*

From March 1983, 20 patients had undergone reconstruction of the upper limb with 22 vascularized composite tissue grafts. The microsurgical procedures had several advantages for reconstruction of injured upper limbs as follows: 1. Free tissue transfer was quite an important and attractive procedure for reconstruction of an injured limb, expecially an upper limb. 2. Free vascularized transfer of composite tissue with its overlying skin was a reliable technique to obtain full thickness soft tissue coverage of a severely injured upper limb when more conservative procedures, such as the use of skin graft or local muscle flaps, had failed or were not feasible. 3. A simple skin flap could be transfered to close an open wound of the limb, but a sensory flap or a special flap such as a nail-skin, tendon-skin or muscle-skin flap was a much better donor for reconstructing the function of the upper limb. 4. When appropriate, the wrap-around procedure was the method of choice for thumb reconstruction because the great toe was preserved. The procedure provided length, stability and adequate sensibility for a functional pinch and grasp. 5. The cosmetic effect of a second-toe transplant might be inferior to the wrap-around flap, but it had the great advantage of being able to provide mobile joints in the reconstructed thumb. As far as the donor foot was concerned, no patients had real trouble functional impairment.
Extremities ; Foot ; Hand Strength ; Humans ; Joints ; Methods ; Microsurgery ; Skin ; Thumb ; Tissue Donors ; Toes ; Transplants ; Upper Extremity ; Wounds and Injuries

A number of methods have been introduced for support the orbital floor following a maxillectomy without orbital exenteration or severe facial trauma. These methods including skin graft and muscular sling provided the unsatisfactory results, like as diplopia, orbital ptosis, enophthalmos and severe facial deformity. Therefore the bone and soft tissue reconstructions using microvascular free flaps were performed recently by many surgeons, but long time operation, donor site morbidity, postoperative large scar, and ptosis of the flap were pointed out as disadvantages of free flap reconstruction. Vascularized calvarial bone flap, a modified method of free calvarial bone graft, was adequate for reconstruction of the orbital floor and the infraorbital rim as a horizontal buttress, especially in case of poor vascular bed and postradiated state. The authors introduced the vascularized calvarial bone flap for the orbital floor and the infraorbital rim reconstruction in 3 cases of maxillectomy, and could be obtained satisfactory results aesthetically and functionally.
Cicatrix ; Congenital Abnormalities ; Diplopia ; Enophthalmos ; Free Tissue Flaps ; Humans ; Orbit* ; Skin ; Tissue Donors ; Transplants

No abstract available.
Neurilemmoma* ; Neurofibromatoses* ; Neurofibromatosis 2*

STATEMENT OF PROBLEM: Macroscopic and especially microscopic properties of implant surfaces play a major role in the osseous healing of dental implants. Dental implants with modified surfaces have shown stronger osseointegration than implants which are only turned (machined). Advanced surface modification techniques such as anodic oxidation and Ca-P application have been developed to achieve faster and stronger bonding between the host bone and the implant. PURPOSE: The purpose of this study was to investigate the effect of surface treatment of titanium dental implant on implant stability after insertion using the rabbit tibia model. MATERIAL AND METHODS: Three test groups were prepared: sandblasted, large-grit and acid-etched (SLA) implants, anodic oxidized implants, and anodized implants with Ca-P immersion. The turned implants served as control. Twenty rabbits received 80 implants in the tibia. Resonance frequencies were measured at the time of implant insertion, 2 weeks and 4 weeks of healing. Removal torque values (RTV) were measured 2 and 4 weeks after insertion. RESULTS: The implant stability quotient (ISQ) values of implants for resonance frequency analysis (RFA) increased significantly (P < .05) during 2 weeks of healing period although there were no significant differences among the test and control groups (P > .05). The test and control implants also showed significantly higher ISQ values during 4 weeks of healing period (P < .05). No significant differences, however, were found among all the groups. All the groups showed no significant differences in ISQ values between 2 and 4 weeks after implant insertion (P > .05). The SLA, anodized and Ca-P immersed implants showed higher RTVs at 2 and 4 weeks of healing than the machined one (P < .05). However, there was no significant difference among the experimental groups. CONCLUSION: The surface-modified implants appear to provide superior implant stability to the turned one. Under the limitation of this study, however, we suggest that neither anodic oxidation nor Ca-P immersion techniques have any advantage over the conventional SLA technique with respect to implant stability.
Dental Implants ; Imidazoles ; Immersion ; Nitro Compounds ; Osseointegration ; Rabbits ; Tibia ; Titanium ; Torque