Evaluation of "neocollateral" ligament formation by magnetic resonance imaging after total excision of the proximal interphalangeal collateral ligaments.

The presence of palpable thickening and maintenance of stability within weeks of total excision of the proximal interphalangeal (PIP) joint collateral ligaments is an established, although somewhat mysterious, phenomenon. To further investigate this postoperative thickening, magnetic resonance imaging (MRI) scans were obtained on 10 joints in 9 patients who had undergone total ligament excision for posttraumatic stiff PIP joints 3 months to 14 years earlier. Although the ultrastructure of these newly formed structures is yet unknown, their palpable consistency, MRI contour, distribution, and signal intensity suggest the formation of a new soft tissue structure, albeit scar, which has all the attributes of a collateral ligament. This MRI of a "neocollateral ligament" would help explain the consistent observation of complete joint stability within weeks following total excision of both PIP joint collateral ligaments. All patients from the 14-year span sampled were found to have a similar, consistent, linear low signal density structure crossing the joint margins and essentially identical to that of a normal collateral ligament.

Reduction mammaplasty for gigantomastia using inferiorly based pedicle and free nipple transplantation.

Patients with gigantomastia have severely distorted anatomical breast structures. Reduction mammaplasty in such cases using the inferiorly based pedicle containing the nipple-areola complex can be technically difficult, yield poor results, and cause postoperative complications such as nipple necrosis and loss. Alternative traditional methods such as amputation mammaplasty with free nipple-areola transplantation usually results in a flattened, nonaesthetic breast with poor projection. This unacceptable result is due to the lack of central breast tissue required for normal anatomical projection. Herein, we describe a method of reduction mammaplasty for gigantomastia combining free nipple transplantation and an inferiorly based pyramidal parenchymal flap for augmentation of breast fullness and nipple projection.

Traumatic tattoo removal: comparison of four treatment methods in an animal model with correlation to clinical experience.

The acute or emergency treatment of traumatic tattoos has been based on the principles of immediate and thorough removal of all particles. The delayed treatment of traumatic tattoos has classically been with overgrafting or dermabrasion. We developed an animal model for traumatic tattoos. Two levels of wounds were made (shallow and deep). Each group consisted of five guinea pigs with one consistent level of wounding. Four treatment methods were applied: carbon dioxide laser, argon laser, overgrafting, and dermabrasion. The results were evaluated by trained observers on a gross basis. Although no statistically significant differences were found within these small groups, clinical experience in a small group of patients suggests that carbon dioxide laser may prove to be useful in the delayed treatment of traumatic tattoos. Eight patients have been treated over a 4-year period. Satisfactory total or subtotal foreign body removal of various agents (road tar, cement, cooper particles) has been achieved.

Structure of a guinea pig common precursor to a MSEL-type neurophysin and copeptin.

From guinea pig posterior pituitaries, a MSEL-type neurophysin (neurophysin containing methionine-2, serine-3, glutamic acid-6 and leucine-7), a glycopeptide referred to as copeptin and their common precursor have been purified to homogeneity and sequenced. The performed acid-oxidized precursor, subjected to trypsin hydrolysis, has given 9 peptides, 6 of which (T1-T6) identical to those given by oxidized MSEL-neurophysin except that T6 has an additional C-terminal arginine residue when compared to its homologue. The other 3 tryptic peptides (T7-T9) are identical to those given by copeptin. The 132-residue precursor therefore comprises a MSEL-type neurophysin (93 residues) and copeptin (38 residues) linked by an arginine residue. The molar proportion of this bound form compared with the free polypeptides is approximately 20%. It is believed that this precursor is a part of the vasopressin-MSEL-neurophysin-copeptin precursor incompletely processed during the transport from hypothalamus to neurohypophysis.

The EEG in centenarians.

1. The EEGs of ten centenarians were described. 2. In most healthy centenarians, posterior dominant rhythms are within the lower part of the alpha range (average 8.62 c/sec). 3. Although slowing of the posterior dominant rhythm at age 100 is greater than in younger groups, there is no evidence in this study of a progressive decrease in frequency during the two decades between 80 and 100 years. 4. Most records of centenarians contained other abnormalities, either of diffuse slowing or of slow wave foci, the latter most often in the left temporal area. 5. The relationship of the observed EEG changes to the process of aging as distinct from reduced cerebral metabolism and blood flow resulting from disease is discussed.