Bonney's blue dye for occult ganglion cyst removal: Technical Note.

We describe a technique using Bonney's blue dye for occult ganglion cyst removal that can help reduce incision size, extent of dissection and operative time, as well as predicting the likely success of surgery based on location of the ganglion relative to the blue dye.

Results of syndactyly release using a modification of the Flatt technique.

The results of 144 congenital syndactyly releases over a 12-year period by a single surgeon using a modified Flatt technique (dorsal hourglass flap, interdigitating zigzag flaps, and full-thickness skin grafts) are analyzed considering the association of skin grafts and web creep. The mean follow-up was 5 years. There were seven cases of graft failure, only one of which developed web creep. Web creep occurred in 4.2% of web releases. The results suggest that avoiding longitudinal straight-line scars across the web space may be an important factor in avoiding web creep when performing the modified Flatt technique described.

Improved patient awareness and satisfaction using procedure specific consent forms in carpal tunnel decompression surgery.

Carpal tunnel decompression (CTD) is a common procedure amenable to procedure specific consent forms (PSCFs). These may help better inform patients and so increase patient satisfaction with the consent process. We assessed the use of a PSCF for CTD. The PSCF mentions eight complications of carpal tunnel surgery and alternative non-operative treatments. Two groups of 40 patients each were compared prospectively. Patients in one group were issued with a PSCF prior to admission whereas those in the other group were not. After standard pre-operative consent, patients were interviewed prior to surgery and assessed for their awareness of complications and alternative treatment options. The patients who received a PSCF showed greater awareness of different complications and alternative treatments and reported greater satisfaction with the consent process. We conclude that using PSCFs is a very useful and inexpensive adjunct to improve patient awareness and satisfaction with the consent process.

Reconstruction of a thumb defect with Integra following wide local excision of a subungual melanoma.

We present the case of a patient with a 1.2mm Breslow thickness subungual melanoma of the thumb who refused the standard treatment of amputation. He underwent a 1cm wide local excision of the lesion down to bone and the defect was covered with Integra and later grafted. The evidence for increasingly conservative treatment of subungual melanoma is growing. He remains disease free and is left with a fully functional thumb and a good cosmetic result.

Late vascular complication after blunt trauma.

The left clavicle of a 52-year-old patient was fractured at a road traffic accident in 1991. Three months after uneventful recovery axillary vein thrombosis developed on the side of the trauma, which was treated conservatively. One year after the trauma embolization of the left hand developed. The cause was an intimal tear with application thrombus, which were successfully excised. The case proves the importance of awareness of late vascular complications after blunt traumas.

Pathogenesis of chronic bacterial prostatitis in an animal model.

A reproducible rat model of chronic bacterial prostatitis was developed using a defined bacterial pathogen (Escherichia coli) to study the pathogenesis and persistence of chronic bacterial prostatitis. The progression of inflammation and its consequences from acute to chronic prostatitis were documented with microbiological, histological, ultrastructural and immunological data. Chronic bacterial prostatitis in this model was associated with sparse glycocalix-enclosed protected bacterial microcolonies within the prostatic acini and ducts which appeared to stimulate a persistent local and systemic immunological reaction resulting in chronic inflammation of the gland. This model has many striking similarities to the natural history of human chronic bacterial prostatitis.

Stimulation of calcitonin secretion by beta-calcitonin gene related peptide in rats.

The presence of calcitonin gene-related peptide (CGRP) in both C-cells and nerve fibres around the thyroid blood vessels and follicles suggests that it may play a dual role, one of which may be in hormone secretion. Beta-CGRP injected intracerebroventricularly (icv) (1.875 nmol) caused a significant increase in the calcitonin CT) content of the C-cells in rat thyroid glands. The calcitonin content of the thyroids was determined by a radioimmunoassay using two antibodies and the results were expressed as ng CT/mg of fetal tissue. A significant rise in CT content of the thyroids occurred (5.5 +/- 0.5 n = 6), compared with the controls (3.5 +/- 0.1 n = 6). It is presumed that this change reflects an increase in the rate of secretion of CT in the thyroid glands of those rats so treated. The peptide might act on the central nervous system to stimulate the catecholamine outflow from the thyroid nerves and thereby increase the secretion rate of CT.

Immunoregulation in Heymann nephritis. I. Cell marker studies.

Immunoregulation was examined in rats with Heymann nephritis (HN), an established model of membranous glomerulonephropathy (MGN). There is little known of the cellular immune events for the induction and maintenance of the autoimmune response in HN. The cell marker studies utilized fluorescein (FITC)-labelled monoclonal antibodies directed to B cells (Mark-I), and T cell subsets: pan T (ER-I), helper/inducer T (ER-2) and suppressor/cytotoxic T (ER-3). Lymphoid subsets were compared in spleen, lymph nodes, peripheral blood and bone marrow, of normal and diseased rats. Animals were investigated during the induction and chronic phases of disease. The induction of HN was associated with an early, significant, but transient increase of the non-specific myeloid component of the defence system. Subsequently, a significant increase was seen in the number of cells of the B lymphocyte lineage in HN animals, which coincided well with the overall increased humoral immune responsiveness. No alterations in the T lymphocyte subsets were noted during the development of this experimental autoimmune disease.

Immunoregulation in Heymann nephritis. II. Functional studies.

In this study, the functional properties of the cells involved in the immunoregulation of Heymann nephritis (HN) have been investigated. HN is a disease model in the rat where the pathology closely resembles membranous glomerulonephropathy (MGN) in man. This autoimmune model is induced by injection of renal tubular antigen (RTA) incorporated in Freund's complete adjuvant (FCA). The strong B cell and plasma cell response in the chronic phase of HN, as determined by cell marker analyses, is predominantly antigen-non-specific. The secondary response pattern found was not only to RTA upon repeated immunization, but also to non-related antigen (SRBC). Although cell marker studies have indicated no major quantitative changes in the T cell population throughout the development of HN, a severe deregulation of the cellular immune response is observed especially during the induction period of HN. This was shown by a strong decrease of the mitogen-induced proliferative response and IL-2 production. This phenomenon is caused by both defective cellular components and inhibitory serological factors. Finally, in the chronic phase, these aberrations gradually return to normal.

Passive Heymann nephritis in pre- and post-natal rats.

Passive Heymann nephritis (PHN) was induced in pre- and post-natal rats by a single intra-peritoneal injection of 0.2 ml of a rabbit anti-rat kidney fraction 3 (rKF3) antibody. Immune complex formation occurred only in those glomeruli or parts of glomeruli which were open to the circulation. Double staining of kidney sections for the glomerular nephritogenic antigen and rabbit IgG, 2 days after the injection of the antibody showed an identical distribution of both components in the glomeruli. In rats killed more than 4 days after the injection of the anti-rKF3 antibody, the nephritogenic antigen could be demonstrated in the subcapsular glomeruli, in the absence of rabbit IgG; and the same applied when the kidneys had reached maturity. When the injected antibody was expected to be present in the circulation, no nephritogenic antigen was demonstrated in the glomeruli in the absence of the heterologous IgG. These observations indicate that the nephritogenic antigen appears in the glomerulus at the same time as the glomerular capillary loops open to the circulation. Unlike PHN in the adult rat, the immune complexes in the glomeruli of neonatal rats do not persist longer than 84 days.

Stimulation of circulating autoantibody levels in the rat with established progressive passive Heymann nephritis.

Rats with established progressive passive Heymann nephritis (PPHN) were stimulated with tubular nephritogenic antigen derived from rat kidney fraction 3 (rKF3) or heterologous antibody to the eKF3 antigen. Rats stimulated with antigen had elevated levels of circulating autoantibody and increased amounts of rat IgG in a beaded pattern around the glomerular capillaries. The brush border (BB) region of the proximal convoluted tubules also stained for rat IgG. Rats stimulated with antibody had similar changes, but in addition the injected antibody was demonstrated in the glomerular deposits and in the BB region of the proximal convoluted tubules. Proteinuria was markedly increased in the antibody injected rats. This study indicates that the cells of the 'primed' immune system of rats with PPHN can be stimulated by 'additional' rKF3 antigen or antibody to it, to produce increased levels of circulating autoantibody. It is suggested that the progression of PPHN is dependent on the availability and access of the nephritogenic autoantigen to the immune system and that autoantigen may be released by autoantibody.

Effect of cationic proteins on the glomerular deposition of anionic proteins and immune complexes.

When 3 mg of cationized human IgG (cIgG, pI greater than 9) was injected intravenously into mice and followed 15 min later by 3 mg anionized bovine serum albumin (aBSA, pI = 4), deposits were detected along the capillary loops and in the mesangium. Additional infusion of immunoaffinity-purified rabbit anti-BSA antibodies 1 h later led to their deposition at the same location. Intravenous injection of an equivalent amount of preformed BSA-anti-BSA or aBSA-anti-BSA immune complexes into mice with glomerular planted cIgG gave rise to few deposits. Similarly, the perfusion of preformed aBSA-anti-BSA complexes in isolated rat kidneys with planted cIgG led to granular deposition of both, but the intensity of staining was less than when sequential perfusions were used. Cationic macromolecules bound to the glomerulus may lead to the deposition of anionic macromolecules and anionic immune complexes.