The effect of hypothermia and tissue perfusion on extended myocutaneous flap viability.

The salutary effect of hypothermia and tissue perfusion on extending the ischemic tolerance of the canine latissimus dorsi myocutaneous flap was demonstrated in this experimental study. A total of 175 flaps from 89 adult mongrel dogs were elevated with one-half the flaps perfused with iced Collins renal preservation solution. With the exception of control flaps kept at ambient temperature, the remaining flaps were stored at 4 degrees C for periods ranging from 24 to 192 hours followed by transplantation into the groins of recipient dogs, with anastomosis of the thoracodorsal artery and vein in an end-to-side manner to the femoral artery and vein, respectively. The study was divided into two distinct sections. The acute phase involved the transplantation of 77 flaps into random recipient dogs, and following a 3-hour period of systemic perfusion, the flaps were removed, weighed, and sectioned for later histologic study. Progressive increase in flap weight was observed up to 96 hours of hypothermia with a sharp decline in weight at 120 hours of hypothermia. The increase in flap weight in the nonperfused flaps was significantly greater than the previously perfused flaps. Histologically, at 120 hours of hypothermia, loss of vascular integrity was noted, suggestive of a no-reflow phenomenon. In the second, or extended-flap, study, 98 flaps were transplanted into the groins of the original donor animal and allowed to remain in situ for a 2-week period. The flaps were then carefully observed for viability, removed, and sectioned for histologic study. Hypothermic support of up to 96 hours extended viability in both perfused and nonperfused flaps, although beyond this hypothermic period viability was seen only in previously perfused flaps. The clinical implications of this study include hypothermic perfusion of a major-extremity amputation prior to replantation or the temporary storage of a free myocutaneous flap.

Atypical fibrous histiocytoma of the thoracic spine. Case report.

A 14-year-old boy presented with mid-thoracic pain, leg weakness, and bladder dysfunction. Plain x-ray films and bone scan were normal whereas myelography demonstrated an extradural mass extending from T-2 to T-5. Exploration revealed a large tumor adherent to dura and bone. Pathological verification of an atypical fibrous histiocytoma prompted the report of this rare tumor of the vertebral column.

Meningoencephalitis caused by Histoplasma capsulatum: occurrence in a renal transplant recipient and a review of the literature.

A case of meningoencephalitis caused by histoplasmosis in a renal transplant patient is described. The diagnosis was made postmortem. The clinicopathological features of 39 additional cases of central nervous system (CNS) invasion by histoplasmosis were reviewed. In the great majority of instances (92.1%), CNS involvement occurred in the disseminated form of the disease. Diagnosis was proved by culturing the fungus from bone marrow, blood, lymph nodes, or liver. Neurological symptoms and signs and cerebrospinal fluid (CSF) changes did not occur until extensive brain damage had resulted. Difficulty in culturing the organism in the (CSF) caused a further delay in making an early diagnosis of CNS involvement. The use of meningeal and brain biopsy specimens in conjunction with the electroencephalogram (EEG) may help in making an earlier diagnosis of CNS involvement.

Ultrastructure of primary and metastatic ovarian carcinoids: analysis of 11 cases.

The ultrastructure of 11 ovarian carcinoids was investigated. The 6 carcinoids with an insular pattern primary in the ovary or metastatic to it from the ileum displayed granules that were pleomorphic (dumbbell and reniform shaped) and varied from 90 to 410 mum, with an average diameter of 210 mum. Five trabecular carcinoids primary in the ovary or metastatic to if from the pancreas contained uniformly round granules with an average diameter of 185 mum and a range of 150-210 mum. These data confirm other reports that pleomorphic granules are typically associated with insular carcinoids of the midgut, and round granules with trabecular carcinoids of the foregut and hindgut.