Perforator flaps have become popular for autologous free tissue breast reconstruction because they reduce the donor site morbidity. It is possible to apply the this principle to the recipient site.We present our experience of using the perforating vessels from the internal mammary artery and vein as recipient vessels for autologous free tissue breast reconstruction flaps in 21 out of 54 consecutive cases (39%). We discuss the technique and its advantages.

Proponents of endoscopic carpal tunnel release have been advocating the technique for more than 10 years but there is still debate about its efficacy, safety and cost-effectiveness. We have performed a randomized, prospective, blind trial to compare early outcome after single portal endoscopic or open carpal tunnel surgery and to assess the cost-effectiveness of the procedures. There were no significant differences in symptom and functional activity scores, grip strength or anterior carpal pain in the first 3 months. For those in employment, we found a statistically significant difference between the two treatment groups with the endoscopic group returning to work, on average, 8 (95% CI, 2-13 days) days sooner than the open group. This translates into a cost saving to industry. There were no major neurovascular complications in either group. On the basis of these findings, we recommend that endoscopic carpal tunnel release should be considered in the employed as a cost-effective procedure, but perhaps not in the general population as a whole.

A correlative bright-field and hyperspectral analysis of full-thickness, cutaneous wounds in a porcine model was undertaken to investigate the efficacy of hyperspectral imaging as an alternate method for wound identification. Analysis of a randomly selected specimen yielded distinct spectral signatures for cutaneous regions of interest including the epidermis, injured dermis, and normal dermis. The scanning of the entire specimen group using these hyperspectral signatures revealed an exclusionary, pseudo-color pattern whereby a central wound region was consistently defined by a unique spectral signature. An algorithm was derived as an objective tool for the comparison of the wound regions defined by the hyperspectral classification versus the pathologists' manual tracings. The dimensions of the wound identified in the hyperspectral assay did not differ significantly from the wound region identified by the pathologists using standard bright-field microscopy. These data indicate that hyperspectral analysis may provide a high-throughput alternative for wound estimation that approximates standard bright-field imaging and pathologist evaluation.

This study compares the accuracy of computer-aided goniometry with standard goniometry. 109 finger joint angles at the extremes of flexion and extension were measured by a senior hand therapist using standard goniometry. Lateral digital photographs were then taken of the hands and the same angles were read from these by computer. There was good correlation (r(2)=0.975) between the results. Computer goniometry averaged 1 degrees (95%Cl=0 degrees -+2 degrees ) more than the standard goniometry. We feel that computer goniometry of finger joints is accurate and compares well with standard goniometry.

Fully cooked chicken breast strips were surface inoculated to contain 9 log10 (CFU/g) Salmonella Senftenberg or Listeria innocua. The inoculated products were vacuum packaged in 0.2-mm-thick barrier bags (241 by 114 mm), then steam pasteurized at 88 degrees C in a continuous process for 26 to 40 min or in a batch process for 33 to 41 min. After the treatments, the products were analyzed for the survivors of Salmonella or Listeria. The models were developed to correlate the surviving rate of Salmonella and Listeria with cooking time for both continuous and batch processes. A cooking time of 34 min was needed to achieve 7 logs of the reduction in a batch process. To achieve the same log reduction, a longer (6 min) cooking time was needed in a batch process than in a continuous process. The results from this study will be useful for processors to evaluate postcooking treatment procedures for ready-to-eat meat products.

BACKGROUND: The use of the MIB-1 labeling index (LI) as a potential prognostic marker for patients with primary brain tumors is controversial. Many studies advocating its prognostic usefulness have suggested discrete MIB-1 LI cut-off values, above which patients have significantly worse outcomes. However, interobserver variability associated previously with MIB-1 LI calculation has not been reported despite the fact that the degree of interobserver variability impacts the clinical usefulness of such cut-off values. METHODS: MIB-1 LIs were calculated independently using a standardized protocol by six pathologist observers for 50 astrocytic gliomas of varying grades. The level of interobserver agreement was determined by calculating kappa statistics for pairwise pathologist comparisons using MIB-1 LI cut-off values of 2.5%, 5.0%, 8.0%, 11.0%, and 15.0%. Spearman rank correlation coefficients were used to assess the pairwise associations between observer MIB-1 LIs. RESULTS: Although there was general agreement among pathologists regarding whether an MIB-1 LI for a given astroglial tumor was low, moderate, or high based on the analysis of correlation, a high level of interobserver variability was associated with the determination of specific MIB-1 LIs. The highest level of agreement occurred using a cut-off value of 5.0%, with pairwise kappa statistics for this value ranging from 0.52 to 0.80. CONCLUSIONS: The high level of interobserver variability suggests that proposed discrete MIB-1 LI prognostic cut-off values most likely are not useful clinically for predicting outcome for individual patients with primary brain tumors. Further prospective studies are needed investigating the prognostic usefulness of MIB-1 LI ranges that optimize interobserver agreement.

Eighty palmar segmental aponeurectomies were performed between 1993 and 1999 for well-localized palmar cords with metacarpophalangeal flexion contracture. A retrospective patient review with a minimum follow-up of 1-year demonstrated a 6% rate of recurrent metacarpophalangeal flexion and two minor complications. Segmental aponeurectomy rather than limited fasciectomy is recommended for this type of disease.

The January Cases of the Month (COM): A case of intracranial metastatic nodular sclerosing Hodgkin's disease without dural attachment in a 37-year-old previously stage III male is presented with a brief review of the literature. Both the primary tumor in the lymph node biopsy and the metastatic brain tumor showed similar histopathology and a immunohistochemical profile typical for Hodgkin's Disease. After chemotherapy, there are no signs of recurrence or systemic disease on follow-up for five months.

The surgical technique for carrying out pollicization has been organized into 10 steps. The procedure emphasizes not only maximizing function of the transposed index finger to the position of the thumb, but also giving the transposed digit the appearance of a thumb.

The traditional treatment of choice for urachal carcinoma has been either an open radical cystectomy or the more recently accepted extended partial cystectomy and umbilectomy. Recently a laparoscopic technique has been reported. We report for the first time a robot-assisted technique for an extended partial cystectomy with en bloc umbilectomy for the management of urachal carcinoma in a 49-year-old man.

The procedure of individual production of endoprothesis of glenoid fossa isolated with the aim of preserving the conditions for further orthognatic surgery is described. Operative treatment of the patients with TMJ anchylosis and concomitant face skull deformation was carried out. Good results were achieved that testified to perspectivity of this technique for wide clinical practice.

The treatment of choice for urachal carcinoma has traditionally been an open approach, either by radical cystectomy or the more recently adopted bladder-sparing approach of extended partial cystectomy and umbilectomy. We report for the first time a laparoscopic technique for an extended partial cystectomy with en bloc umbilectomy for the management of urachal carcinoma in a 41-year-old man.

In addition to a surgical technique tailored to the disease stage, postoperative aftercare is important for favorable long-term results. An appropriate bandaging technique prevents formation of a postoperative hematoma,which promotes scar formation or development of relapsed Dupuytren's disease.

The Authors describe sinus pilonidalis disease and report their experience of two principal surgical techniques: the closed method and the Limberg cutaneous skin flap. They conclude that both the methods are recommended for a good clinical result.

Surgical closure of leg ulcers has to be preceded by treatment of their etiologies in order to avoid recurrences. Best coverage technique is achieved with the use of a meshed split thickness skin graft, harvested with a dermatoma. Skin graft take depends on the vascular quality of the recipient bed, on the technique used and also on the post-operative care.

The authors tackle the subject of surgical treatment of benign diseases of breast. They show the importance to get a good result either pathologically or aesthetically. About this consideration they related operating techniques for various kinds of benign disease of breast, that assure the preservation or the aesthetical restoration of this region that is so psychologically important for a woman.

A sinus tract was formed and an abscess occurred in the pulp space after a flexor tendon graft was anchored to the distal end of the nail. Treatment included drainage of the abscess and excision of the sinus tract.

The technique of dissecting Dupuytren's contracture through a straight incision placed along the contracting band and deferring Z-plasty to be performed as a secondary procedure is safe, simple, and short and allows maximum skin viability and earliest mobilisation.