The "modified" winch stitch.

BACKGROUND: The methods described to achieve intraoperative tissue expansion have drawbacks. OBJECTIVE: To report an intraoperative tissue expansion technique using standard suture material and hemostats to create a "modified" winch stitch. METHODS: A continuous running suture is placed with both ends left free. A "fixed" hemostat is placed above the skin at one end. After pulling at the other end with a second hemostat, a third hemostat is placed proximal to this hemostat just above the skin, which is left in place to produce stretching. The second and third hemostats are then used in an alternating pulling and holding fashion. RESULTS: This method produces significant tissue expansion. If the desired degree of approximation is achieved, the ends of the suture can be tied together, as in the previously described winch stitch. CONCLUSION: The modified winch stitch is a simple and inexpensive means to facilitate closure of wounds under a significant amount of tension.

The efficacy of 308nm laser treatment of psoriasis compared to historical controls.

UVB treatment with a 308nm excimer laser has shown promise in the treatment of localized psoriasis. There is no placebo or comparison treatment controlled trial studying efficacy of the laser, however. The purpose of this report is to compare the results of a study of 308nm laser treatment of psoriasis to published results of other psoriasis treatments. Data on the efficacy of 308nm laser treatment of psoriasis were obtained from a previously published case series, supplemented by reanalysis of the data to estimate the median time to success using Kaplan-Meier methods. These results were compared to those from other studies identified by a Medline search. Treatment success was measured by estimating the percentage of patients who achieve 75% improvement in the severity of psoriasis. Patients treated in the 308nm laser study had similar disease severity as those in topical treatment studies and less severe disease than those treated in studies using standard phototherapy or systemic therapy. A greater percentage of patients achieved 75% improvement with the UVB laser treatments than was reported for other forms of phototherapy or systemic therapy with acitretin or low dose cyclosporine, and did so more rapidly. The UVB laser study patients achieved the 75% improvement endpoint in an average of 46% fewer treatments than was observed in other phototherapy studies. Laser treatment and topical calcipotriene had similar efficacies, and both were more effective than topical tazarotene or topical fluocinonide. As compared to topical therapies, the time to achieve 75% improvement favored the UVB laser. 308nm laser treatments for psoriasis are clearly more effective than placebo and are comparable to or more effective than many other standard treatments for psoriasis.

International research through networking: an old idea with new tools.

The growth and refinement of electronic media capabilities, Internet, other electronic highways, fiber optics, microwaves, and satellites will have major impact on researchers and scholars, facilitating the timely sharing of information. The balance of time saved and money available may be the crucial issues in the rapidity of development. The dissemination of research results to a large audience through electronic journals, bulletin boards and data bases will become a dominant force in the formal publication of such results, with instant feedback from colleagues. The productivity of scientists and the quality of their research will be higher through better communications. Networking, however, is more than communications. It is shared interests and interaction, building on information received and provided and creating a relationship and a knowledge base to enhance international research.

Induction of cytosolic phospholipase A2 in human leukocytes by lipopolysaccharide.

Stimulation of peripheral blood leukocytes with lipopolysaccharide results in the synthesis of inflammatory cytokines including interleukin-1 beta, interleukin-6, tumor necrosis factor-alpha and prostaglandin E2 correlating with an increase in phospholipase A2 activity. Mammalian cells contain several phospholipase A2 isoforms including the 14-kDa secretory isoform and the more recently described high-molecular-mass cytosolic isoform. It is commonly believed that during inflammatory responses secretory phospholipase A2 becomes activated. However, we could not detect secretory phospholipase A2 nor its corresponding mRNA after lipopolysaccharide-induced activation. By contrast, we found increased mRNA levels for cytosolic phospholipase A2 following activation of peripheral blood leukocytes when levels were compared to non-stimulated controls. Our results demonstrate that cytosolic phospholipase A2, rather than the secretory isoform may be the mediator of the lipopolysaccharide-induced inflammatory cascade in human peripheral blood leukocytes.