[The internal thoracic vessels as alternative recipient vessels for microsurgical reconstruction in the head and neck area in patients with a vessel-depleted neck]. / Die Arteria und Vena thoracica interna als alternative Anschlussgefäße für die mikrochirurgische Rekonstruktion von Defekten im Kopf- und Halsbereich beim gefäßverarmten Hals.

The microsurgical reconstruction of defects in the head and neck area after local recurrent or secondary tumours is a very demanding procedure, since the recipient vessels for free flap transfer are usually absent, strongly damaged or because of previous radiation therapy very vulnerable. In these cases, it is often necessary to search an alternative to the classical recipient vessels--branches of the external carotid artery and internal and external jugularis vein. The authors present a clinical series where the internal mammary vessels were chosen as free flap recipient in the vessel-depleted neck. 11 patients were examined, in whose the extended dissected internal mammary vessels were selected as recipient for free flaps. There was no flap loss in the series. A venous anastomosis had to be revised due to bleeding on the fourth postoperative day. In one patient both sides were used simultaneously for 2 different flaps (jejunum+VRAM "vertical rectus abdominis myocutaneous flap"). Despite the general opinion that this procedure has disadvantages--like short pedicle and morbidity of the donor side at the thoracic wall--which could bring intra- and postoperative complications, it shows that in patients with previous surgeries or radiation therapy of the neck the internal mammary (after further distal preparation) as recipient vessels represent an attractive alternative to the A-V Loops.

[Free and pedicled muscle transfer as a therapy option in urological surgery]. / Der freie und gestielte Muskeltransfer als Therapieoption in der urologischen Chirurgie.

Various demands of reconstruction define restoration technique. The basic principle involves optimal anatomical and functional reconstruction with concurrent minimal donor-site morbidity. Dependent on the aetiology of the defect, there are various reconstructive possibilities available for obtaining an optimal result. An immediate single stage reconstruction, with the best possible result for the individual patient as the primary consideration, can be carried out by interdisciplinary teams. In this overview, the most common indications and principles of flap choice are presented in relation to the reconstructive requirements necessary for early rehabilitation of the patient or the earlier start of necessary adjuvant therapy.

Targeted delivery of antineoplastic agent to bone: biodistribution studies of technetium-99m-labeled gem-bisphosphonate conjugate of methotrexate.

UNLABELLED: A methotrexate-bisphosphonate conjugate containing a peptide bond has been found to possess over five times greater antineoplastic activity against osteosarcoma in experimental animal models compared with methotrexate alone. METHODS: The conjugate was labeled with 99mTc in the presence of stannous ions to determine biologic distribution, with special reference to osseous tissue. Biodistribution studies were carried out in mice after intravenous administration of the labeled conjugate. Radionuclide imaging of rabbits was also performed. RESULTS: The labeled conjugate behaved like a bone-seeking agent. CONCLUSION: The present study indicates that the concept of treating osteosarcoma or metastatic tumors of bone with this class of agents has a firm basis.

Comparison of transverse strength and dimensional variations between die stone, die epoxy resin, and die polyurethane resin.

This study compared transverse strength and dimensional variations of die stone, epoxy resin, and polyurethane resin. The polyurethane resin was tested unfilled, then filled with 20%, 40%, and 60% silica, by weight. Transverse strength was evaluated for five test strips for each material, and an original calibration plate technique closely simulating intraoral conditions was introduced to evaluate dimensional accuracy. Two series of five measurements for dimensional variations were recorded on each test strip. The first series was 15 minutes after removal from mold and the second series of 5 minutes a week later. The results were computed with a parametric ANOVA and Scheffe's test at 95% confidence level (p < or = 0.05). These results confirmed that die stone recorded the least dimensional change but was rigid and brittle, whereas epoxy resin and polyurethane resin had suitable mechanical properties including greater dimensional variations. Incorporating silica filler in polyurethane resins also reduced their transverse strength and sponsored minimal dimensional variations.

Depression and chronic fatigue in children. A masquerade ball.

Major depression disease is uncommon in children; it occurs mostly in children with a depressed parent or in children under major psychosocial stress such as physical or sexual abuse. Most depression in children is masked, i.e., the child presents with signs or symptoms such as headaches, abdominal pain, muscle weakness, vomiting, dizziness, hyperactivity, or school avoidance. Careful evaluation of the history is required to assist in the diagnosis. Some basic laboratory tests should be done to rule out organic disease. Psychiatric referral should be carried out after an appropriate evaluation.

Structure-activity relationships in platelet-activating factor (PAF). 5. Synthesis and in vitro antagonistic activities of ketophosphonates.

The synthesis of new ketophosphonate isosteres of biosynthetic precursors of ether glycerophospholipids resistant to phospholipase C is described following two routes depending on whether the alkoxy chain is introduced before or after the phosphonic moiety. The common intermediates are ketophosphonic acids: better yields were obtained by attaching the n-octadecyl chain to epichlorohydrin, opening and oxidation, blockage of the resulting ketone as the chlorohydrazone, followed by an Arbuzov reaction or by azoene formation and Michael addition. These ketophosphonates differing in chain length in position 3 exhibit potent agonistic activities on rabbit platelets which increase with the number of methylene groups between the phosphonate and the ammonium moieties.

[Distribution and causes of injuries in seat belt-wearing automobile passengers]. / Untersuchungen zu Verletzungsmuster und -ursache gurtgeschützter PKW-Insassen.

We analized 71 car head-on collisions with 100 persons involved wearing seat belts. All 31 passengers with faulty belt function (group II) suffered injuries, 7 of them fatal. 69 passengers with correct belt function were only slightly injured if at all (group I). The majority of the injuries in group I are those of the chest and lower extremities, in group II, however, of the head and lower extremities. The "absolute degree of trauma" revealed the maximal extent of trauma for group II in the region of head, chest and pelvis/abdomen. Increased deformation of the vehicle results in an increase of severe injuries especially in passengers of group II.