Batting .500: experience with the fibular free flap in the achondroplastic patient.

OBJECTIVES: To describe the use of the fibular free flap in the achondroplastic patient and to report the potential pitfalls of free flap surgery on this group of patients. DESIGN: Retrospective chart analysis. METHODS: We reviewed our experience with two fibular free flaps in this rare situation. RESULTS: This is the largest series of fibular free flaps reported on the achondroplastic patient. An acute adrenal event resulted in hypothermia and hypotension and ultimately led to the failure of our first reconstructive attempt. Corrective measures were taken during the secondary reconstruction to prevent these systemic issues from coming into play, which ultimately led to a successful free fibular transfer. CONCLUSION: Free fibular transfer is possible for facial reconstruction in the achondroplastic patient, and success can be improved if measures are taken to prevent systemic complications of hypothermia and hypotension in the case of an acute adrenal event.

[Management of the pediatric dental patient with metabolic and hormonal disorders: prevention and treatment].

Metabolic and hormonal disorders can compromise the safety of child undergoing dental treatment. This article focuses on type I Diabetes mellitus and adrenal cortex disorders, which are more common in children. The pediatric dentist should be fully aware of the child's medical status and modify the treatment plane accordingly. Special attention should be made to the management of the anxious child with or without the need for pharmacological management. This article presents schematic flow chart for treatment emergencies in the diabetic patient and also protocols of treating the child who suffers from primary or secondary adrenal insufficiency.

Adrenocortical suppression in workers employed in manufacturing synthetic glucocorticosteroids: solutions to a problem.

Earlier studies showed gross adrenocortical suppression in three workers employed in manufacturing synthetic glucocorticoids. A further nine had either recognisable abnormalities of their responses to tetracosactrin or evidence of chronic skin contact with glucocorticoids. By 1978 the mean morning cortisol concentration of 20 workers employed in active steroid processes was 235 nmol/1 +/- 28.6 (8.5 microgram/ml +/- 1.04), which was significantly lower than the value of 428 nmol/l +/- 37.7 (15.5 microgram/ml +/- 1.40) obtained in a control group of 19 men (p less than 0.005). The mean morning cortisol of workers employed in processing steroids believed to be physiologically inactive, 306 nmol/l +/- 22.4 (11.1 microgram/ml +/- 0.81), was also significantly lower than this control group (0.01 greater than p greater than 0.005). Improvement of protection for workers together with operational and plant changes resulted in a significant rise in the mean morning cortisol values of workers until, in 1979, men employed in all steroid processes had concentrations that did not differ from those of a control group.

Electron microscopic studies of the effect of ACTH and flavin-adenine dinucleotide on adrenocortical atrophy of rats treated with dexamethasone phosphate.

In a previous paper the authors described the morphologic observations that the concomitant administration of ACTH and flavin-adenine dinucleotide (FAD) to hypophysectomized rats exerted a more potent preventive effect on atrophy of the adrenal cortex of the animals than the single administration of ACTH. The present study was made to electron-microscopically observe the effect of concomitant administration of ACTH and FAD on atrophy of the adrenal cortex induced with the administration of dexamethasone (Dx). The zona fasciculata of the adrenal gland of rats treated with Dx+ACTH+FAD was morphologically closer in cell organelles such as smooth-surfaced endoplasmic reticulum, mitochondria and chylomicrons to that of control animals than the counterpart of animals treated with Dx+ACTH only. The zona fasciculata of the adrenal cortex of animals treated with Dx+FAD was morphologically similar to that of animals treated with Dx only. These findings suggested that FAD would potentiate the adrenocorticotropic action of ACTH through its physiologic action.