Resistin, central obesity, and type 2 diabetes.

Resistin, an adipocyte-derived cytokine, causes insulin resistance and glucose intolerance in mice. We investigated whether resistin expression was higher in human abdominal adipose tissue than other adipose tissue depots. We extracted RNA from 32 adipose tissue samples (13 subcutaneous abdominal, seven omentum, six thigh, and six breast). Quantitative PCR was used to determine resistin mRNA expression. Resistin mRNA concentrations were similar in both the subcutaneous abdominal and omental depots. The abdominal depots showed a 418% increase in resistin mRNA expression compared with the thigh. Increased resistin expression in abdominal fat could explain the increased risk of type 2 diabetes associated with central obesity.

Tissue-expanded visor flap in burn surgery.

Severe postburn scarring of the lower face in the adult male may cause loss of mustache and beard in addition to other complications. The resulting unacceptable boyish appearance in 3 such patients was treated with tissue-expanded visor flap reconstruction. Complications, which were few, minor, and temporary, included moderate postoperative hematoma, hair-bearing skin loss in the region of the sideburns, and hair growth in an unwanted direction. The flap is safe to perform, with adequate blood supply, and achieved the goal of the operation, which is the restoration of a masculine appearance. The major advantage of this procedure is that the donor site morbidity and alopecia associated with the classic visor flap is virtually eliminated.

Treatment of full skin thickness burn injury using cultured epithelial grafts.

This report presents the experience gained from 26 patients treated with autogenic cultured epithelial grafts (auto-CEG). All auto-CEG were applied to wounds clinically defined as full skin thickness injury. In total 89 separate sites were grafted. The overall estimate of 'take' ranged from 0 to 98 per cent with a mean value of 15 per cent. The highest level of 'take' (43 per cent) was observed when auto-CEG were applied to wounds which had been previously covered with allogenic split-thickness skin grafts. An increased incidence of wound colonization with pathogenic species of bacteria corresponded with a decreased graft 'take'. Ps. aeruginosa and Staph. aureus were found to be present on 32.6 per cent and 60.5 per cent of wound swabs respectively, where 10 per cent or less 'take' of auto-CEG was seen, indicating that bacterial infection is in part responsible for graft failure. However, in 20.9 per cent of such instances, no growth of bacteria was detected, perhaps suggesting that certain wound beds may not present the correct physical environment necessary to support proliferating epithelial cells isolated from their underlying dermal component.

Metastatic basal cell carcinoma.

A case of metastasizing basal cell carcinoma is presented. Although primary surgical excision appeared complete, local recurrence continued over the following 5 years terminating in metastases to lungs, kidneys, bones and lymph nodes.

Use of tissue expanders after burns and other injuries.

During the first year of use of tissue expansion at the Birmingham Accident Hospital, 24 patients had expansion procedures at 29 sites. Most of these were to revise burn scars. A number of complications occurred and five procedures were abandoned. The advantages and problems of the technique are discussed.

Finger in his eye.

A 21-year-old soldier sustained a schrapnel blast injury during an accident with a mortar fuse. Surgical repair included the use of one of his reconstructed metacarpal bones to repair the orbital floor. The remainder of the orbital floor was repaired using maxillary bone. It proved an excellent method of repairing this patient's orbital floor.

Occupational overuse disorders in a university.

Many of the keyboard and technical staff of a University with a large component of research activity, have presented to the Health Service with discomfort in the neck, shoulders and upper limb. A description of the University organization is offered to suggest possible reasons for the high incidence. Strategies that were undertaken to confront the problem are presented. The advantages of prevention rather than intervention are yet again demonstrated.

Neonatal septicaemia due to a nutritionally deficient streptococcus. A case report.

A case of neonatal septicaemia due to a nutritionally deficient streptococcus is described. Unusual features were abdominal distension and excessive nasogastric aspirate with infrequent stools. Recovery followed treatment with intravenous penicillin and gentamicin. Attention is drawn to the possibility of missing such infections unless culture media are supplemented with vitamin B in cases in which staining of the blood culture reveals Gram-positive cocci which fail to grow on standard plates.

Congenital hypertrophic pyloric stenosis and associated anomalies in the genitourinary tract.

Genitourinary anomalies were looked for in patients with congenital hypertrophic pyloric stenosis. In a prospective series of 64 patients investigated by intravenous pyelography, 13 were abnormal (20.6%). In a retrospective series of 232 patients, 6 had anomalies of the upper urinary tract (2.7%). In this latter series the incidence of inguinal hernia (3.4%), undescended testes (3.0%), and hypospadias (0.9%) was determined. In another 10 patients urinary tract anomalies (5), urinary infection (2), and a significant family history (3) were found associated with congenital pyloric stenosis. As the incidence of these anomalies is greater than expected, which suggests an interrelationship, a hypothesis has been proposed linking genetic factors and the metabolism of gastrin with the etiology of congenital hypertrophic pyloric stenosis.