An alar base flap to correct nostril and vestibular stenosis and alar base malposition in rhinoplasty

Nostril and vestibular stenoses can be properly reconstructed by composite grafts from the alar lobule or ear. However, when alar base malposition accompanies the nostril stenosis, composite grafting will enlarge the nostril but not correct the alar base displacement. An alar base flap designed as a crescent adjacent to the alar base, elevated, and transposed on subcutaneous and musculocutaneous perforators corrects the nostril stenosis and repositions the alar base simultaneously. Anterior, active rhinomanometry demonstrates a substantial increase in mean nasal airflow from this reconstructive maneuver alone. The author has used the flap successfully in 29 secondary rhinoplasty patients; survival has been uniformly complete even when the donor tissue has been scarred or burned. All rhinoplasties were performed endonasally, however; the survival of this flap performed simultaneously with open rhinoplasty has not been established.     

Effects of Breathe Right on snoring: a polysomnographic study

The nasal vestibule is a major site of resistance to airflow in healthy subjects. A high nasal resistance may increase snoring. Activation of the alae nasi and alar retraction reduce resistance to airflow and improve ventilation. The Breathe Right (BR) device has been proposed to reduce or eliminate snoring by improving nasal breathing. We assessed the efficacy of BR on sleep quality and snoring during 2 full-night polysomnographies, the first without and the second with BR. Ten non-apnoeic snorers were studied. Snoring was present during 22-98% of total sleep time during the control night. Ear-nose-throat examination disclosed a nasal valve anomaly in five subjects, objectivated by anterior and posterior rhinomanometry. Quality of sleep and snoring were not influenced by BR, even when different sleep stages were analysed separately. No difference in snoring index was found between snorers with or without nasal valve anomaly. We conclude that BR is ineffective in relieving snoring in non-apnoeic snorers.     

Hox gene expression in a single Caenorhabditis elegans cell is regulated by a caudal homolog and intercellular signals that inhibit wnt signaling

In Caenorhabditis elegans males, a row of epidermal precursor cells called seam cells generates a pattern of cuticular alae in anterior body regions and neural sensilla called rays in the posterior. The Hox gene mab-5 is required for two posterior seam cells, V5 and V6, to generate rays. In mab-5 mutant males, V5 and V6 do not generate sensory ray lineages but instead generate lineages that lead to alae. Here we show that two independent regulatory pathways can activate mab-5 expression in the V cells. First, the caudal homolog pal-1 turns on mab-5 in V6 during embryogenesis. Second, a Wnt signaling pathway is capable of activating mab-5 in the V cells during postembryonic development; however, during normal development Wnt signaling is inhibited by signals from neighboring V cells. The inhibition of this Wnt signaling pathway by lateral signals between the V cells limits the number of rays in the animal and also determines the position of the boundary between alae and rays.     

Suppression of heat-induced HSF activation by CDDP in human glioblastoma cells

To confirm whether or not the alar cartilage of the unilateral cleft lip nose is primarily hypoplastic as compared with the noncleft side, 35 unilateral cleft lip nasal patients who had no previous nasal surgery underwent direct measurement of the lateral crus of alar cartilage on both sides during their nasal tip plasties. Both lower lateral cartilages were dissected freely, and the thickness was measured at the intercrural, middle, and distal portions. The width was measured at the widest portion, and the length was measured from the intercrural point to the distal end. Two-mm-punch biopsies were obtained from each cartilage for histologic study. The lateral crus of the cleft side was no smaller than that of the noncleft side. Histologically, no difference was ascertained. In conclusion, we think the lateral crus of the alar cartilage of the cleft side is not hypoplastic. Therefore, external factors such as soft-tissue defect or external abnormal vector force are more attributable than intrinsic factors to the development of cleft lip nasal deformity.     

Oswaldocruzia venezuelensis sp. n. (Nematoda:Trichostrongylina, Molineoidea), a parasite of Bufo marinus from Venezuela

A new species of Oswaldocruzia Travassos, 1917, a parasite of Bufo marinus L. from Venezuela, is described. Like most Neotropical Oswaldocruzia, Oswaldocruzia venezuelensis sp. n. is characterized by spicules with three principal branches: blade, shoe and fork, and by a division of the fork within the distal third of the spicule length. O. vaucheri Ben Slimane et Durette-Desset, 1993 is the most closely related species due to its caudal bursa of type II and its cervical alae of the same shape but it differs in the following characters: the position of the papillae of rays 4 situated nearer the papillae of rays 3 rather than rays 5, a higher percentage of the ridges in the oesophageal region, the cervical alae three times longer and sharp and the spicular fork divided less deeply.     

Frontonasal flap for reconstruction of complete alar defects

BACKGROUND: It is difficult to reconstruct a satisfactory ala. Axial frontonasal flap has been common in reconstruction of nasal tip. We modified this flap to reconstruct nasal ala. OBJECTIVE: A modified axial frontonasal flap was applied for reconstruction of complete unilateral alar defects in two patients. METHODS: Skin from an intact nasal tip covered the alar defect. The resulting defect in the nasal tip was covered with dorsal skin from the nose. Extended mucosa or a hinged nasolabial flap was used to line the mucosal side of the reconstructed ala. RESULTS: The outcome judged by shape, and texture, was satisfactory. This technique can be employed under field block. CONCLUSION: The modified frontonasal flap is one of the ideal techniques to reconstruct an entire nasal ala.     

PCR-mediated recombination: a general method applied to construct chimeric infectious molecular clones of plasma-derived HIV-1 RNA

A PCR-based approach was developed that provides a powerful tool for engineering recombinant molecules without reliance on restriction sites. DNA sequences were first amplified by high-fidelity PCR using Pfu polymerase; they were then used both as 'megaprimers' and templates in subsequent asymmetric long PCR amplifications to form chimeric clones. To demonstrate the technique, we constructed chimeric full-length HIV-1 clones derived from reverse-transcribed plasma viral RNA and proviral LTRs. Biologic characterization of these clones showed that most were infectious in tissue culture and sequence analysis demonstrated an error rate of only one base change in 20 kb of DNA sequence. For PCR-mediated recombination, it is necessary to know the sequence of the 3' and 5' overlapping regions of the desired PCR products. This method may be extended to include construction of chimeras between any DNA fragments lacking sequence homology. Such chimeras may be constructed by introducing overlapping sequences to one of the fragments. To ensure that unwanted mutations have not been introduced into the clones constructed by this method, each clone should be sequenced. Our results demonstrate that by using a high-fidelity polymerase and highly controlled PCR conditions, the PCR-introduced error rate can be greatly minimized. This new procedure may be used to construct infectious chimeras of HIV or SIV for studies of vaccines and pathogenesis. Moreover, the method is designed to exchange viral genes at precise boundaries to study individual gene products from different HIV genomes. It can also be used to construct expression vectors for production of specific proteins or delivery vectors for gene transfer and gene therapy. Finally, the technique described here provides a versatile tool to transfer genes or gene fragments from different sources for genetic investigation and engineering.     

Elaboration of an alternative, segmental, cartilage-sparing tip graft technique: experience in 405 cases

Despite the value of tip grafting in many rhinoplasty patients, adequate donor cartilage may be unavailable in secondary and even primary patients whose donor sites have been harvested previously or whose septal cartilage is calcified. Furthermore, by enlarging the lobule, tip grafts can create undesirable postoperative disproportions in some patients. These two observations have stimulated the elaboration of a tip graft method (which evolved from the Sheen technique) that uses small amounts of autogenous donor material to augment only those lobular segments that require increased contour or support, without necessarily increasing overall lobular volume. This article reports experience with; the technique in a 405-patient study group. Segmental tip grafting is performed endonasally through access incisions along the caudal edge of one alar cartilage. Grafts augment each third of the tip lobule and anterior columella (corresponding to each of the alar cartilage crura) depending on the aesthetic objective; multiple grafts are always placed. Selective augmentation limits the overall increase in lobular size. The method is not suitable for those patients needing substantial augmentation (58 of 463 tip-grafted patients in the 6-year study period), in which case the author still prefers the Sheen technique. The records of the 405-patient study group (40 percent primary rhinoplasty, 60 percent secondary rhinoplasty) indicate a total nasal revision rate of 14 percent; 6 percent were tip revisions. Tip revisions were more frequent in secondary patients but not in patients with thin skin. Reoperation percentages decreased during the study term, so that the tip revision rate was 12 percent in the first 12 months of study but only 4 percent in the last 12 months (p < 0.0008). The primary indication for tip grafting has evolved since the author's earlier practice experience: in the past 3 years of the study, 77 percent of primary patients and 80 percent of secondary patients underwent grafting principally to improve lobular contour, not tip projection (p < 0.0005). A segmental, cartilage-sparing tip graft technique can provide both projection and contour for primary and secondary rhinoplasty patients. Nevertheless, tip imperfections remain the most common reason for revision in the author's practice.     

Combination of an island advancement flap and a composite graft for reconstruction of the nasolabial defect

BACKGROUND: The alar region is one of the most difficult areas of the face to reconstruct. Up until now, various methods have been demonstrated for achieving the best possible results in terms of cosmetic appearance and function. This report deals with a combination of a random pattern flap and a free composite graft, carried out in two stages. OBJECTIVE: In order to reconstruct the alar region, an island advancement flap as well as a composite graft from the contralateral ear were used. METHODS: The defect in the cheek-upper lip region was closed using an island advancement flap. In a second operation 2 weeks later, the reconstruction of the alar region was attempted using a composite graft from the right ear. RESULTS: The reconstruction of the contour of the wing of the nose succeeded in a satisfactory manner. There are no functional restrictions on nose breathing. CONCLUSIONS: The combination of an island advancement flap with a composite graft from the ear for the reconstruction of the alar region is essentially a less invasive operation that can be carried out under local anaesthesia and that represents an addition to the previously stated methods.     

Problems of perinatal neurology

An analysis of more than 1000 cases of early organic brain lesions has demonstrated that in 54% of them the etiology of neurological disturbances was an antenatal pathology, in 38%-intranatal and in 8%-postnatal. The prevention of perinatal disorders of the nervous system is considered as a complex problem including measures of health prevention for the future mothers, control over the development of pregnancy, perfection of obstetric aid, effective measures for the prevention of tissue hypoxia and its sequalae, elaboration of methods of rehabilitative therapy, work with personnel.     

Effect of alae nasi activation on maximal nasal inspiratory airflow in humans

The upper airway is a complicated structure that is usually widely patent during inspiration. However, on inspiration during certain physiological and pathophysiological states, the nares, pharynx, and larynx may collapse. Collapse at these locations occurs when the transmural pressure (Ptm) at a flow-limiting site (FLS) falls below a critical level (Ptm'). On airway collapse, inspiratory airflow is limited to a maximal level (VImax) determined by (-Ptm')/Rus, where Rus is the resistance upstream to the FLS. The airflow dynamics of the upper airway are affected by the activity of its associated muscles. In this study, we examine the modulation of VImax by muscle activity in the nasal airway under conditions of inspiratory airflow limitation. Each of six subjects performed sniffs through one patent nostril (pretreated with an alpha agonist) while flaring the nostril at varying levels of dilator muscle (alae nasi) EMG activity (EMGan). For each sniff, we located the nasal FLS with an airway catheter and determined VImax, Ptm', and Rus. Activation of the alae nasi from the lowest to the highest values of EMGan increased VImax from 422 +/- 156 to 753 +/- 291 ml/s (P < 0.01) and decreased Ptm' from -3.6 +/- 3.0 to -6.0 +/- 4.7 cmH2O (P < 0.05). Activation of the alae nasi had no consistent effect on Rus. VImax was positively correlated with EMGan, and Ptm' was negatively correlated with EMGan in all subjects. Our findings demonstrate that alae nasi activation increases VImax through the nasal airway by decreasing airway collapsibility.     

Occipital condyle fracture and ligament injury: imaging by CT

The true incidence of fracture of the occipital condyles is unknown. It may be associated with instability at the craniocervical joint. CT is the modality of choice for the demonstration of these fractures, but its use for imaging of the associated ligament injury has not been reported. In order to demonstrate normal anatomy, occipital condyle fracture and ligament injury, and to estimate the incidence of this lesion, 21 children and young adults with high-energy blunt craniocervical injury were examined prospectively. Thin-slice, axial, contiguous, CT was performed from the base of C2 to above the foramen magnum. Bone and soft tissue windows and coronal, sagittal, and curvilinear 2D reconstructions were performed. Five occipital condyle fractures were identified in four patients (19 %), with demonstration of alar ligament injury in two cases and local hematoma in one. In four, artifacts or rotation precluded assessment of ligaments. In all remaining cases normal bone and ligament anatomy was demonstrated. Fracture of the occipital condyles following craniocervical injury is not uncommon in children and young adults. Normal bone and ligament anatomy and pathology can be safely and clearly demonstrated in seriously injured patients and others using this CT technique. Increased awareness of this entity and a low threshold for performing CT should avoid the potentially serious consequences of a missed diagnosis.     

MR-cholangiopancreatography using three-dimensional Fourier transfer fast asymmetric spin-echo method (3DFT-FASE)--clinical evaluation

MR-cholangiopancreatography (MRCP) is a new and non-invasive method. With the three-dimensional Fourier transform fast asymmetric spin-echo (3DFT-FASE) method that allows data collection as volume and three-dimensional expression, a higher spatial resolution can be obtained in the direction of both slab thickness and in-plane. In this method, analysis by multi planar reconstruction (MPR) and observation from various angle by maximum intensity projection (MIP) are available. Although further studies are required to shorten the imaging time to stop breathing only once, to use the respiratory gating or navigator echo, clinically useful diagnosis are possible utilizing by the advantages of the 3DFT method.     

Clinical evaluation of a test for immediate and quantitative determination of urinary albumin-to-creatinine ratio. A brief report

A technique is proposed for positioning the nasal oxygen cannula during facial surgery performed under local anesthesia and intravenous sedation. By placing the nasal prongs in the nostrils, and passing the tubing along the alar grooves, nasal dorsum, and forehead, the surgeon has full access to the preauricular areas, temporal regions, cheeks, nasolabial folds, and oral commissures. This method is easy to perform, provides secure positioning of the nasal oxygen, and allows access to areas of the face not possible with conventional placement of the oxygen cannula.     

Value of scaphal graft in secondary rhinoplasties

The scaphal cartilaginous area is a most suitable anatomic site for cartilaginous graft harvesting. These grafts allow reconstruction of a flat dorsum, or a rounded dome, or alar cartilages or can be used for an extended tip graft. In some cases, both scaphes may be harvested. Raising of the grafts does not leave any sequelae when performed correctly. We have an experience of 20 cases. The main advantage of this graft is its flatness, which makes it ideal for the nasal dorsum. It has to be tailored, moderately crushed and included in a collagen "surgicel" in order to break the shape memory, slightly curved at its borders. We have used scaphal autografts in 15 cases of secondary rhinoplasties, 2 cases of cleft lip repair and in 3 cases of tertiary rhinoplasties. They solved most problems of missing cartilage, when minor defects had to be treated. These grafts will not solve major tissue defects which must be repaired by bone autografts, mostly iliac bone harvesting in our experience. The results of scaphal autografts are stable after 5 years. Resorption is moderate when the graft is correctly inserted, in an extramucosal pocket. The aesthetic result is maintained with a mean follow up of 2 years for 15 cases. The scaphal area of the ear therefore appears to be a favorable donor site for secondary, nose repair; it is easy to harvest, with inconspicuous morbidity and allows the raising of a good, flat and sculpturable material for cartilaginous nose replacement. Achieves the objectives of ore informed patients asking for artistic perfection.     

Transposition of a skin flap from the nasal dorsum for repair of skin loss on the nasal wing. Apropos of 9 clinical cases

The authors use a transposition island skin flap from the nasal dorsum for repair of the ala nasi. It is a modification of the stalk-flap advocated by Edgerton in 1967 to augment the columella. The flap is vascularized by branches of the anterior ethmoidal artery. The main modifications are;-the size of the flap which is 50 mm long and 15 mm wide;-the vascular pedicle is not dissected; this makes the flap very reliable;-the outstanding vascularization of this flap is corroborated by the fact that, in the same stage, it may be lined with a partially composite chondrocutaneous graft. The composite graft is taken from the concha and repaired with the Masson procedure. This flap is a very easy procedure for alar cutaneous repair for partial alar reconstruction, it is possible to fold the flap onto itself after resecting a 2 mm transverse skin strip, making the distal extremity a secondary skin island flap which ensures the lining of the proximal part. For total alar reconstruction and hemi-rhinoplasty; the flap is lined with a composite graft, which allows a one-stage thin reconstruction. The flap was used in 9 patients. In one case, there was a total skin necrosis, while half of the fasciomuscle layer survived.     

A method to increase the sensitivity of mutation specific oligonucleotide hybridization using asymmetric polymerase-chain reaction (PCR)

We propose a simple and reliable method to increase the sensitivity of mutation specific oligonucleotide hybridization (MSOH) at least 2.5 times, when it is used to detect mutations in samples of DNA from tumor tissues. The method is based on using single stranded (ss) DNA, amplified by asymmetric PCR, as a target for MSOH analysis. During the first step, genomic DNA, isolated from tissue samples, has to be amplified by "standard", symmetric PCR, with sense and antisense primers in equimolar concentration. This amplification can be performed in a diminished volume of reaction mixture. In the second step obtained double stranded (ds) PCR DNA-product can be used as a template for asymmetric PCR, using only a single primer. The ss DNA must be complementary to the set of mutation specific oligonucleotides. By this innovation we have been able to clarify questionable results of MSOH using ds DNA as a target. Comparing MSOH from ss DNA to that from ds DNA, the observed rate of Gs-alpha mutations in thyroid tumor tissue samples increased to 16.7% (14/66) from 6% (4/66).     

Isolation and partial structure determination of a clonidine-displacing substance from bovine lung and brain

A large scale extraction and isolation method was developed for the purification of clonidine-displacing substance (CDS) activity from bovine lung or brain. This optimised method used direct freeze drying of tissue, hexane removal of lipids, and methanol extraction of CDS activity. Using a bioassay directed isolation strategy a new CDS compound was purified from an extract of bovine lung. The isolation strategy involved subsequent steps of flash C-18 chromatography, ion exchange, size exclusion, and C-18 HPLC. An HPLC detection method was developed and applied to show that the new CDS is present in both lung and brain tissue. Spectroscopic data for this new CDS indicates that it is related to guanosine, but is not noradrenaline, adrenaline, histamine, agmatine, guanosine, GMP, GDP or GTP.     

Massive hemoptysis from a pulmonary artery aneurysm associated with an emphysematous bulla

A new method for specific reamplification of DDRT-PCR products is presented. After transient ligation of the primary DDRT-PCR fragments into a T-vector, the cDNAs of interest were reamplified by hemi-nested PCR and thermally asymmetric cycles. In contrast to the originally described protocol, this method of reamplification is specific, sensitive, reproducibly gives a high yield of DNA and allows direct sequencing of the reamplified product without purification or cloning.     

Alar fold resection in horses: 24 cases (1979-1992)

Between 1979 and 1992, the alar folds were resected bilaterally in 22 horses and unilaterally in 2 horses. Abnormal respiratory tract noise and exercise intolerance were the primary complaints prior to surgery. Significantly (P = 0.01) more Standardbreds underwent resection of the alar folds, compared with the number of Standardbreds in the hospital population during the same period. The alar folds palpated abnormally thick in 13 horses and normal in 11 horses. Temporary dilatation of the nares with mattress sutures or clips lessened the respiratory tract noise and improved exercise tolerance in all 8 horses in which the diagnostic test was performed. Manual elevation of the alar folds reduced respiratory noise in the 11 horses evaluated. Long-term follow-up evaluation by telephone was available for 14 horses. All surgical incisions had healed cosmetically. Respiratory tract noise was decreased, and exercise tolerance improved in 10 of 14 (71%) horses. Complete charted racing information was obtained for 16 horses. Fourteen horses started their first race a mean of 118 days (range, 13 to 321 days) after surgery. The mean number of starts after surgery was 51, with 14 of 16 (88%) horses starting more than 6 times after surgery. Of the 16 horses, 8 horses raced at least 3 times before and after surgery; 4 had improved racing performance, 2 had similar performance, and 2 had decreased performance. Five Standardbreds never raced, and 1 Standardbred raced once before surgery.(ABSTRACT TRUNCATED AT 250 WORDS)