Paget's disease primarily involving the scrotum.

Three cases of Paget's disease primarily involving the scrotum are reported. One case exhibited positive staining for prostate specific antigen (PSA) and was associated with an underlying, invasive poorly differentiated adenocarcinoma of unknown primary. The other cases were not associated with any underlying or visceral malignancy. The literature on Paget's disease primarily involving the scrotum including clinical presentation, differential diagnosis, treatment, prognosis, and possible histogenetic mechanisms of this disease is discussed.

Cleft palate closure at 3 to 7 months of age: a preliminary report.

The evolution and present criteria for early soft palate closure are reviewed. A definitive group of patients (operated on at 3 to 7 months of age) is reviewed at least 2 years following their surgery. They are compared with our general clinic population (operated on at 12 to 18 months of age) and had significantly fewer secondary operations for velopharyngeal incompetence. The possible advantages and disadvantages of early soft palate closure are discussed.

Monitoring tissue elimination of fluorescein with the perfusion fluorometer: a new method to assess capillary blood flow.

Visual assessment of tissue staining after intravenous fluorescein is a common technique for predicting viability of questionably perfused tissue. The development of the perfusion fluorometer has permitted quantification of tissue fluorescein, providing increased precision. This study employed this instrument to calculate fluorescein elimination from rats with and without raised dorsal pedicle flaps. Control animals exhibited homogeneous patterns of fluorescein elimination consistent with first-order kinetics. Elimination in experimental animals was assessed after the animals received full back skin flaps with the cephalad pedicle remaining intact. Three distinct patterns of elimination were noted in each flap. In the cephalad portion, elimination was similar to control. At the caudad end, no elimination was noted. Midflap, fluorescein was eliminated slowly. These elimination patterns predicted ultimate viability 14 days postoperatively, as they correspond to viable, dystrophic, and transitional sections, respectively (P less than 0.001). We conclude that perfusion fluorometry can assess capillary flow in healthy and ischemic tissue by documenting elimination as well as delivery of fluorescein.

Quantification of tissue fluorescein delivery and prediction of flap viability with the fiberoptic dermofluorometer.

Quantitative fluorescence assessment with the fiberoptic dermofluorometer has been introduced to overcome the inadequacies of ultraviolet inspection following intravenous administration of fluorescein. Initial applications in the pedicle flap of the rat have indicated that this method can predict flap viability with reproducible precision and accuracy. This minimally invasive technique should be of considerable assistance to the evaluation of hypoperfused states in laboratory and clinical situations.

Dermatofibrosarcoma protuberans of the head and neck.

Dermatofibrosarcoma protuberans of the head and neck is an unusual, slowly growing malignant tumor of the dermis which is locally infiltrative and recurs persistently. Fifteen cases of dermatofibrosarcoma of the head and neck were studied in detail as to age and sex of patient, location of the tumor, clinical course, and ultimate outcome. Four tumors were of the forehead, four were of the scalp, three were of the chin, two were of the anterior neck, one was of the lateral face, and one was of the postauricular region. Initial diagnosis was sometimes inaccurate, and initial treatment was often inadequate. The treatment of choice following diagnosis is wide local excision and careful follow-up examination.

Multilayer film elements for clinical analysis: applications to representative chemical determinations.

Using the general concept of a dry multilayer analytical element, we can change chemical procedures and configurations to assay several blood components. In the assay of serum urea nitrogen, urease in the reagent layer catalyzes the hydrolysis of urea. A semipermeable membrane excludes aqueous base, but allows ammonia to diffuse to an underlying indicator layer. For the amylase determination, the enzyme hydrolyzes a dyed-starch substrate coated on top of the spreading layer; this produces small fragments, which diffuse to a registration layer. The increase of absorbance at 540 nm is correlated with amylase activity. Bilirubin complexes with a cationic polymer at the interface between the spreading and reagent layers. The direct reading at 460 nm allows determination of total bilirubin in the range 1 to 500 mg/liter. Tirglycerides are hydrolyzed in the spreading layer, and the resulting soluble glycerol readily diffuses into the reagent layer, where it is phosphorylated and subsequently oxidized by glycerophosphate oxidase to yield dihydroxyacetone phosphate and hydrogen peroxide. Peroxidase catalyzes production of a color commensurate with the hydrogen peroxide produced.

Correction of lower eyelid ptosis in the anophthalmic orbit with an autogenous ear cartilage graft.

We describe the correction of lower eyelid ptosis in patients with an anophthalmic orbit, using ear cartilage grafts. This procedure has been particularly useful in the scarred or previously reconstructed lower eyelid.

Transport changes associated with growth control and malignant transformation.

We can distinguish two classes of membrane transport changes in cultured cells: (a) growth-rate contingent changes are those which occur in coordination with the onset of density-dependent inhibition of growth; (b) transformation-specific changes are those which occur when cells become transformed, and which can be detected even when normal and transformed cells are growing at the same rate. Growth-rate contingent changes include the density-dependent changes in phosphate, nucleoside, glucose, amino acid, and potassium transport. Only one transformation-specific transport change has been found in Rous-transformed chicken embryo fibroblasts: an increased rate of hexose transport. The variation in potassium transport are associated with variations in the number of ouabain binding sites in the membrane. The molecular basis for changes in the rate of hexose transport is unknown, although gross changes in membrane bilayer composition and "fluidity" seem not to be involved. In analyzing the regulation of hexose transport activity, we find that decreased cAMP may play a role in the transformation-specific increase in hexose transport, but that fibrinolytic activity is not necessary.