[Free microvascular rectus abdominis muscle flap for soft tissue reconstruction of the lower leg and foot: results and donor site defect]. / Der freie mikrovaskuläre Rectus abdominis-Muskellappen zur Weichteilrekonstruktion am Unterschenkel und Fuss: Ergebnisse und Hebedefekt.

The free rectus abdominis muscle flap is now a routine procedure for the reconstruction of soft tissue defects in the lower extremity. We present the follow-up of 21 out of 27 patients operated in our clinic between 1986 and 1994. The recipient leg always showed a stable soft-tissue coverage. Clinical or radiological signs of osteitis were not found. In many of the cases, where the transplantion was to the ankle region, the muscle bulk led to an alteration of the shape of the leg, without impairment of function. When harvested through a low transverse abdominal incision, the aesthetic results in the donor site are convincing. The functional donor site defect is negligible as long as only a segment of the muscle is used. Abdominal muscle tests showed good results when only a segment of the muscle was used. The patients reported no impairment in daily life. Abdominal wall weakness was present only when the entire muscle was harvested. There was one hernia after postoperative wound infection and secondary wound healing. In all other cases, the abdominal wall was stable. In the segmental use of the free rectus abdominis muscle flap, the good results obtained in our examination correlate to the high degree of patient satisfaction.

Expression of CD44-v6-containing isoform on breast tissue adjacent to silicone breast implants.

Although a variety of studies exists, the silicone controversy is still going on. In the present study we investigated the expression of the activation markers CD44-v6, intracellular adhesion molecule 1 (ICAM-1), and HLA class II molecules on breast epithelia adjacent to a silicone gel-filled breast implants (SGBI). Using an indirect immunoperoxidase procedure 12 tissue samples from implant recipients were investigated and 6 tissue samples from patients with slight breast hyperplasia were used as controls. Expression of CD44-v6 was found on ductal epithelia in all specimens from implant recipients, HLA-DR was expressed in all specimens, HLA-DQ in 3 of 10, and ICAM-1 in 8 of 12. In contrast, neither CD44-v6 nor HLA-DQ nor ICAM-1 were expressed on ductal epithelia from patients with slight breast hyperplasia, and HLA-DR was only weakly expressed in 2 of 6 patients. These data show that CD44-v6 can be expressed by benign cells under certain conditions, which may indicate an abnormal state of activation in breast tissue adjacent to an SGBI.

Incorporation of 1-deoxy-D-xylulose into isoprene and phytol by higher plants and algae.

In further substantiating the novel mevalonate-independent pathway for isoprenoid biosynthesis, which generates isopentenyl diphosphate (IPP) via 1-deoxy-D-xylulose-5-phosphate, labeling experiments with 1-[2H(1)]deoxy-D-xylulose were performed with various higher plants and algae: efficient incorporation was observed into isoprene emitted by Populus, Chelidonium, and Salix, into the phytol moiety of chlorophylls in a red alga (Cyanidium), in two green algae (Scenedesmus, Chlamydomonas), and a higher plant (Lemna). By contrast, 13C-mevalonate applied was incorporated into isoprene and phytol to a much lower extent or not at all. This demonstrates that this '1-deoxy-D-xylulose-5-phosphate pathway' for biosynthesis of plastidic isoprenoids is widely distributed in photosynthetic organisms.

Backward masking of words and faces: evidence for different processing speeds in the hemispheres?

Two tachistoscopic experiments with a lateralized presentation of function words and faces were carried out to investigate the influence of temporal factors and type of masking on visual field asymmetries. Accuracy, represented by signal detection measures (d' and beta), was calculated separately for the two visual fields, for various interstimulus intervals, and for noise and pattern masking. In both experiments, d' increased with prolonged temporal delay between target and mask. In the lexical decision task, visual field interacted with mask type confirming that only in the pattern mask condition did an advantage of the right visual field emerge. In the facial decision task, however, visual field interacted with interstimulus interval, confirming that, in the left visual field, the facial information escaped the masking effect earlier than in the right visual field. In the facial task, there was a higher response criterion (beta) in the left visual field. By applying different types of masks, visual processing of lexical stimuli can be disrupted at distinct stages where perceptual asymmetries are present to a varying extent. The results of both experiments suggest that words and faces are differentially affected by masking procedures.

Eye movement modifies motion trajectory of a moving target.

Smooth pursuit eye movements have strong modulating effects on perceived motion both temporally and spatially. Abrupt changes in the direction of a target cause non-veridical perceived velocity and trajectory pattern when a visual cues appear with the moving target. In addition, this condition of non-veridical velocity and trajectory perception increases no visual cues are presented. Non-veridical perception was also connected with target velocity: the more difficult the eye pursuit, the more frequent was the non-veridical perception.

Increase of immunologically relevant parameters in correlation with Baker classification in breast implant recipients.

A variety of studies have suggested a possible immune reaction to silicone implants, although an increased frequency of rheumatic disorders among implant recipients could not be established. Several immunologically relevant humoral parameters were investigated in 239 breast implant recipients. The following parameters were determined: immunoglobulin G and M, complement C3 and C4, rheumatoid factor, C-reactive protein, antinuclear antibodies, antimitochondrial antibodies, and antithyroglobulin and antimicrosomal antibodies of the thyroid gland. Levels of complement C3 were elevated in 42.5% of the patients. No difference could be observed between silicone gel-filled and saline-filled implant recipients. Complement C4 was increased in 21.3% of the patients and a parallel relationship was observed between elevated C4 and C3 levels (p < 0.0015). In 28% of the patients, the antithyroglobulin titer was elevated > 200 U/ml. No difference was found between silicone gel-filled and saline-filled implant recipients. Elevation of antimicrosomal antibodies existed in 14.3% of the patients and was correlated significantly with antithyroglobulin antibodies (p < 0.0347). In accordance with the classification developed by Baker, we observed a significant correlation between capsule fibrosis types Baker I and II, and elevated C3 values (p < 0.0004) in silicone gel-filled but not in saline-filled implant recipients. Additionally, a correlation was found between increased antithyroglobulin titers (< 200 U/ml) and capsule fibrosis types Baker I and II (p < 0.0001) in this group. In the study presented here, an increase of several humoral parameters could be demonstrated in breast implant recipients, although we failed to correlate these findings with any clinical symptoms.

Temporary ectopic implantation for salvage of amputated digits.

Temporary ectopic implantation for salvage of amputated parts is a fascinating idea. The first successful case, to our knowledge, of preserving digits by means of temporary ectopic implantation to the contralateral forearm is presented and this treatment concept is discussed. The indication for temporary ectopic implantation is an amputation injury with associated extensive soft tissue damage in which immediate replantation with either adequate shortening or preservation of length does not seem feasible, although the amputated part itself is uninjured and should therefore be salvaged. The groin, axilla and lower arm are compared as possible recipient sites for ectopic implantation. Early replantation of the ectopic implanted parts will provide superior functional results although replantation may be technically more demanding. The function of a replanted extremity after ectopic implantation will probably always be inferior to a comparable, immediately replanted extremity.

Visual field asymmetries in schematic persistence.

A modified partial-report technique was used as a tool to study hemispheric asymmetries in schematic persistence. Two types of stimuli were presented: (1) verbal stimuli consisting of function words and nonsense words, and (2) pictures of faces and nonfaces. The stimulus items were arranged bilaterally in a circular array around the fixation point and the participants' task was to decide whether the probed item was a correct or distorted version of each stimulus type. Delay time between stimulus set and marker ranged from 0 ms to 360 ms. Calculating a sensitivity measure of accuracy, distinctive visual field differences emerged which depended on the nature of the stimuli; that is, a left field advantage for facial stimuli and a right field advantage for lexical stimuli. In addition, performance decreased linearly as delay time between probe and marker increased. The present results indicate that on a level of schematic persistence perceptual hemispheric asymmetries are already strongly present.

[Donor site morbidity in free rectus abdominis muscle flaps]. / Die Spendermorbidität beim freien Musculus rectus abdominis-Lappen.

To evaluate donor-site morbidity, we used a questionnaire, which was answered by 196 patients. 152 patients underwent a medical examination. The follow-up ranged from six month to ten years. The results of this retrospective study are presented. In 16,8%, we found hernia of the abdominal wall at the donor-site and relaxation was noticed in 32% of the cases. Painful symptoms of different degrees were reported by 50% of the patients.

[Results of follow-up of Matti-Russe surgical treatment of scaphoid pseudarthroses]. / Nachuntersuchungsergebnisse von operativ nach Matti-Russe behandelten Kahnbeinpseudarthrosen.

Sixty patients after Matti-Russe procedures for scaphoid non-union were investigated. In 85%, autologous corticocancellous bone grafting was successful. Wrist function was good in 65% of the cases. 68% of the patients were satisfied with the result of the operation. Patients younger than 30 years at the time of the operation and with the diagnosis of scaphoid non-union not older than two years showed the best results. In cases with long-time follow-up investigation after Matti-Russe procedure (more than nine years), wrist function as well as the patient's self-estimation become significantly poorer.

[Second toe transplantation in loss of a long finger. Indications--planning--technique]. / Zweitzehentransplantation bei Langfingerteilverlust. Indikation--Planung--Technik.

Transplantation of the second toe is a routinely employed method in reconstructive hand surgery. Most often it is used for thumb or midhand amputations. Following partial amputations of digits distal to the MP-joints, toe transplantations are less frequently employed. However, function as well as cosmesis of the hand after partial amputation of digits can considerably be improved by toe transplantation. The length of the reconstructed finger is a most important aspect of operative planning which has influence on operative technique as well as functional and aesthetic results. A smooth junction at the base of the transplanted toe should be maintained. This can be achieved by adequate soft-tissue reduction and exclusion of the metatarsophalangeal joint. Anastomoses of the subcutaneous venous and plantar as well as dorsal arterial vascular systems are recommended.

On the confounding effects of phosphor persistence in oscilloscopic displays.

Phosphor persistence has been a source of confounding in studies of temporal integration in vision. We examined the confounding by assessing the effects of the persistence of two commonly-used phosphors (P15 and P31) on performance of a temporal-integration task. In one experiment we eliminated the visibility of phosphor persistence by closing two mechanical shutters upon display termination. In a second experiment we estimated the duration of phosphor persistence by displaying the image behind closed shutters which opened upon display termination. No detectable persistence was every produced by P15 phosphor. By contrast, P31 phosphor produced persistence that lasted several hundred milliseconds even when a veiling light was projected on the screen. We ascribe the earlier instances of confounding to inadequate interpretation of the technical data on phosphor decay.

Specific effects of the benzodiazepine midazolam on visual receptive fields in light and dark adapted human subjects.

Psychophysical experiments in humans have revealed similar characteristics of visual receptive fields as were found in cats and monkeys from retinal ganglion cell recordings. In addition, in some retinal ganglion cells of cats the GABA antagonist bicuculline decreases the activity of the inhibitory surround. These findings led to two predicitions: 1) benzodiazepines will selectively increase the inhibitory surround of human visual receptive fields, 2) after dark adaptation, no free GABA will be available in the synapses and benzodiazepines will have no effect on the visual system. Characteristics of human receptive fields were determined by subthreshold summation: the contrast threshold of a vertical line was measured dependent on the distance of two parallel flanking lines whose contrast was below threshold. Both hypotheses were confirmed: the threshold in the inhibitory region of receptive fields was specifically increased in a dose-dependent manner by midazolam PO (7.5 mg: P < 0.05; 15 mg: P < 0.01). In dark-adapted subjects no effect of midazolam was found. Control experiments with atropine (1 mg IV), sulpiride (100 mg IM), and levodopa (100 mg PO) showed no specific effect. The visual system may be a model to bridge the gap between animal and human psychopharmacology.

Attention and eye movement control: an overview.

A review of recent experimental and theoretical findings is presented which relates the results of neurophysiological and psychological research on attention and eye movement to cognitive theorizing. With respect to the relation between shifts of attention and saccadic eye movements, several experiments have demonstrated that it is possible to dissociate the line of attention from the gaze direction. On the other hand, there is some indirect (although not yet conclusive) evidence that saccadic eye movements always produce a concomitant shift of attention. Another question is whether there is a moment-to-moment control of each consecutive saccade and latency or whether indirect control models (i.e. planning several saccades in advance) are more appropriate. The function of attentional processes which have to coordinate stimulus driven (bottom-up) and concept driven (top-down) mechanisms are discussed and related to some studies investigating local and global scanpaths.

[Stelzner self-healing cecal fistula--course of healing and complications]. / Die selbstheilende Coecalfistel nach Stelzner--Heilungsverlauf und Komplikationen.

A retrospective study of 83 patients who underwent caecal fistula as described by Stelzner during the five-year period between 1979 to 1984 was carried out. 26 fistulas were performed after low anterior resection, 54 after anterior resection and 3 after left hemicolectomy. In 10.8% the operative closure of the fistula was necessary. An anastomotic insufficiency could be recognized clinically in 3.8%. The overall complication rate was 21.7%. The caecal fistula seems to be an effective procedure with a lower complication rate than the temporary colostomy.

Influence of diazepam and methylphenidate on identification of rapidly presented letter strings: diazepam enhances visual masking.

The effect of diazepam (0, 5, 10 mg) and methylphenidate (0, 5, 10 mg) on the identification of briefly displayed letter strings composing words was investigated. Each letter was presented for 70 ms. The interstimulus interval (ISI) between two successive letters was 10, 100 or 200 ms. The length of the words (WL) was three, five, seven or nine letters. The dependent variable was the number of correctly identified words. As predicted, strong visual masking effects, the strength of which was dependent on ISI and WL, appeared. In the 10 ms condition, diazepam at both doses, but not methylphenidate, further enhanced masking. It is suggested that the results reflect the effect of GABA on masking, and support certain psychological theories about the inhibitory neuronal pathways that are involved in masking. The human peripheral visual system is a promising model for the experimental assessment and integration of pharmacodynamic, neurophysiological and psychological observations.

Cytostatic effect of macrophages from non-immunised mice on mastocytoma P-815 cells in vitro.

Peritoneal macrophages from non-immunised C57/bl, C3H, and DBA/2 mice were examined for their capability of inhibiting the growth of mastocytoma P-815 cells in vitro. The rate of tumour cell growth was measured by the uptake of 125IUDR into the DNA of the tumor cells. Sodium thioglycollate-induced macrophages as well as resident macrophages inhibited the growth of allogeneic tumor cells distinctly, when incubated for 48 h. The effect depended on the effector to target cell ratio. Tumor cell growth was still reduced at a ratio of one macrophage to one tumor cell. A decrease in the proliferative activity of mastocytoma cells was observed in the presence of non-stimulated and non-immune macrophages from DBA/2 mice. This decrease in target cell proliferation, however, occurred more slowly.