Use of transpelvic rectus abdominis musculocutaneous flap for anal cancer salvage surgery.

BACKGROUND: Perineal wounds following abdominoperineal resection (APR), for persistent or locally recurrent anal cancer, are associated with poor healing secondary to irradiation therapy. The results of APR combined with a vertical rectus abdominis musculocutaneous (VRAM) flap transposed transpelvically to cover the perineal defect are presented. METHODS: Between 1994 and 2000, 105 patients were diagnosed and treated for anal cancer. Twenty-two (21 per cent) underwent a salvage operation owing to persistent or locally recurrent disease. In eight patients, before 1996, the perineum was closed primarily with serious wound complications in five. In the final 14 patients, primary perineal reconstruction with a VRAM flap was performed. RESULTS: Median age was 65.5 (range 45-78) years. Median follow-up was 14.5 (range 3-41) months. There were no flap-related complications and primary healing was achieved in all patients. Median hospital stay was 17 (range 14-72) days. There were two major complications related to the laparotomy and abdominal closure. CONCLUSION: Combining the salvage operation with a VRAM flap facilitates primary healing after surgical treatment for persistent or locally recurrent anal cancer. A single-stage primary reconstructive procedure is feasible, with an acceptable complication rate and high level of patient satisfaction.

[Functional limitation of the forearm after shaft fracture in childhood. Possible role of the antebrachial interosseous membrane: MRI and ultrasound studies]. / Funktionseinschränkung des Unterarms nach Schaftfraktur im Kindesalter. Möglicher Einfluss der Membrana interossea antebrachii (MIA): MRT- und Ultraschalluntersuchungen.

Based on follow-up examinations of 16 patients aged 5 to 15 years, the integrity of the interosseous membrane following forearm shaft fracture was evaluated. The examinations which included magnetic resonance imaging (MRI) and ultrasound scanning of both the fractured and the nonfractured forearms were conducted 4 to 81 months after fracture. Using a 1.5 T MR tomograph, we obtained 20 cross-sectional images arranged over the entire length of the forearm which was in neutral position, while sonographicly at 7.5 MHz we obtained cross-sectional views of the proximal, middle and distal forearm thirds with the forearm in pronation, neutral position and supination at a time. The MR image of the interosseous membrane is a thin hypointense line, occasionally showing low contrast irregularities on the fractured side such as thickenings, tears or curvature inconstancies which would suggest membrane alterations. However, these alterations appear to be less than expected. They are not clearly seen in the ultrasound views, where the interosseous membrane is found as an echorich line. According to our preliminary results, there seems to be a correlation between MR-detected interosseous membrane alterations and initial fracture dislocation as well as functional fracture outcome, particularly forearm rotation.

[Professional development of media in general practice]. / Professionelle Entwicklung von Medien in der Praxis.

In the German state Niedersachsen, the practical advantage of computers as an information medium in the out-patient care was tested in the medical practice for two years. In a two year study, acceptance, suitability, and the didactic quality of new information software for practice computers were investigated in 20 medical practices. Under the supervision of the KVN, the support of a Multi-Medica Corporation and IBM as well as numerous university departments, the multimedia software was prepared and further developed during the trial in the medical practice. It became clear, that videos, pictures, and text as short information units were helpful for the information of patients. The quick access and the simple and clear presentation is crucial for their usage. Teaching software for patients and multimedia programs for the continuing education of physicians have to be looked at separately. For this, longer information units might be necessary.

[Magnetic resonance tomography (MRT) of the hand in chronic polyarthritis]. / Magnetische Resonanztomographie (MRT) der Hand bei chronischer Polyarthritis.

Forty hands of 39 patients with rheumatic joint disease were examined by MRT. The method differentiates between inflammatory exudative and proliferative processes in soft tissues and bone. T2-weighted images provided criteria for judging the activity of the disease. MRT provided better demonstration of the soft tissues than just conventional radiography. The methods were of equal value for showing bone lesions. MRT is suitable as a means of diagnosing rheumatoid changes in the hand.

Impaired mitogen-induced interferon-gamma production in rheumatoid arthritis and related diseases.

Peripheral blood lymphocytes from patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), progressive systemic sclerosis (PSS), Reiter's disease, osteoarthritis, and from healthy volunteers were investigated for interferon-gamma (IFN-gamma) production after mitogen activation. Phytohaemagglutinin stimulation revealed an impaired IFN-gamma production in RA, SLE, and PSS but normal levels in Reiter's disease and osteoarthritis. In RA this deficiency was also seen after pokeweed mitogen, OKT3, and concanavalin A activation. No major differences were found in interleukin 2 (IL-2) production and cell proliferation. The IL-2 receptor expression was reduced on stimulated RA lymphocytes. The deficient IFN-gamma production was compensated in RA by co-stimulation of PHA or OKT3 with phorbol myristic acetate (PMA). In addition, the combination of the calcium ionophore A 23187 and PMA induced a strong IFN-gamma secretion in all patient groups and in the controls.

Cell membrane lipid fluidity and receptor expression in Moloney- and Friend virus-transformed cells.

Normal and malignant cells show differences in cell membrane lipid fluidity (CMF) which influence the expression of membrane receptors and may interfere with cell function. Friend virus (FLV) and Moloney virus (MLV) infected hematopoietic and lymphoid cells were monitored for CMF (fluorescence polarization) and for transferrin (TFC) and thymic (Thy) receptors (FITC-labelled monoclonal antibodies). CMF was modulated with cholesterol hemisuccinate (CHS), phospholipids (PL) and DMSO. Erythropoietic stem cells exhibit an increased persistent CMF within minutes after FLV infection; transferrin receptors are expressed, yet no hemoglobin is synthesized. CHS rigidification reduces TFC expression with differentiation of cells and hemoglobin synthesis, yet transformed cell populations do not react uniformly. Thymic lymphocytes, instead, do not exhibit changes in Thy expression upon CHS treatment although cell membranes become rigidified. Separate experiments showed these cells not being "transformed" per se but blocked in differentiation because of viral destruction of thymic epithelial cells with loss of thymopoietin in vivo. Thus viral cell transformation is followed by non-rigid but persistent membrane fluidization interfering with only selective receptor expression.