Lynn Ogden

Digital venous anatomy

The veins of the digits and their valves were studied in nine cadaveric hands by sequential angiography, microdissection, routine histology, cross-sectional microradiography, and corrosion casting. The findings revealed a pattern of dorsal venous arches situated over each digit. Connections between those arches were at the level of the metacarpal heads, the point at which most of the palmar venous blood joins the dorsal system by intercapitular veins. A system of valves, which were arranged so as to direct flow from distal to proximal, from palmar to dorsal, and from radial to ulnar in the hand, was present in all veins as far distal as the pulp.

Clinical and morphologic features of hepatic angiosarcoma in vinyl chloride workers

Fifteen male workers exposed to vinyl chloride developed angiosarcoma of the liver. Thirteen died of disease and two are currently living for short periods after diagnosis. Their ages ranged from 36 to 58 years (average 47.5 years). Their exposure time ranged from 4 to 27.8 years (average 16.9 years). The most common presenting symptoms were fatigue, weight loss, and abdominal pain. Hepatomegaly followed by splenomegaly were the most common physical findings. Biochemical profiles yielded variable results and proved to be of little value in the detection or diagnosis. Of eight patients autopsied, distant organ involvement was present in two cases, duodenal involvement in one, and direct extension of tumor to adjacent organs or tissues in four additional ones. The remainder, diagnosed by open liver biopsy, revealed no tumor extension. The gross features of the tumors were hemorrhagic necrosis, cystic degeneration, fibrosis, and apparent multicentricity. The histologic features were those of the typical angiosarcoma found in a variety of sites with a wide range of cellular differentiation. The histologic diagnosis was often impaired by the extensive tumor necrosis. Elsewhere in the liver subcapsular fibrosis, a distinct type of portal fibrosis, and endothelial cell hyperplasia with or without sinusoidal dilatation were noted. The reduction of industrial chemical exposure has already been achieved and will hopefully eliminate this chemically related tumor in the future. There is, however, a significant group of previously exposed workers who will require careful monitoring to detect functional abnormalities of the liver and possible early neoplastic changes.

Sensory and motor fiber differentiation with Karnovsky staining

We examined four acetylthiocholine methods based on Karnovskys procedure--two fast-acting requiring 1 hour and two slow-acting requiring 24 hours. We compared these with our modification, which requires less than an hour and is simple to use. Rabbit sciatic nerves and spinal cords were used to compare methods. Our modification showed clearer differentiation than other fast-acting methods and staining identical to slow-acting methods. In blind examination of radial nerve specimens stained with our method, motor and sensory fascicles were correctly identified, showing sensitivity and specificity of 100%. In 12 clinical cases, our method produced staining in the proximal stump as long as 16 months after injury and in the distal stump as long as 5 days after injury. In 10 of 12 patients, this staining helped in aligning motor fascicles to motor fascicles and sensory fascicles to sensory fascicles.

True aneurysm of digital artery

Abstract A case of a true aneurysm of the ulnar digital artery of the long finger following trauma is presented. Treatment by ligation and excision resulted in relief of symptoms. To our knowledge, a case of true aneurysm of a digital artery has not been previously reported.

The role of the epiphyseal and metaphyseal circulations on longitudinal growth in the dog: an experimental study.

An experimental model using the immature canine proximal fibular epiphysis was developed to isolate and investigate the effects of the epiphyseal and metaphyseal circulations on longitudinal growth. Experimental constructs studied the epiphyseal circulation, the epiphyseal and metaphyseal circulations, a devascularized growth plate, and a control group. Twenty-four limbs were studied by serial x-ray films and microangiographic and histologic analyses at time of death, 24 weeks after surgery. The data from this preliminary study show that both metaphyseal and epiphyseal circulations are necessary for predictable longitudinal growth.

The use of end-to-side nerve grafts to reinnervate the paralyzed orbicularis oculi muscle.

Facial paralysis is a serious neurologic disorder, particularly when it affects the eye. Loss of the protective blink reflex may lead to corneal ulceration and, possibly, visual loss. The purpose of this study was to compare different nerve-grafting techniques to reanimate the paralyzed eyelid. Sixteen adult dogs (25 kg each) were allocated into four groups. Denervation of the left hemi-face was performed in all cases. One dog served as a control animal (group I). Group II dogs (n = 5) underwent end-to-side coaptation of the nerve graft to the intact palpebral branch and end-to-end coaptation to the denervated palpebral branch. Group III dogs (n = 5) underwent end-to-end coaptation of the nerve graft to the intact palpebral branch and end-to-end coaptation to the denervated palpebral branch. Group IV dogs (n = 5) underwent end-to-side coaptation of the nerve graft to the intact and denervated palpebral branches. The animals were monitored for 9 months after the surgical procedures, to allow adequate time for reinnervation. The dogs were postoperatively monitored with clinical observation, electrophysiologic testing, video motion analysis, and histologic assessments. Clinical observation and electrophysiologic testing demonstrated the production of an eye blink in the denervated hemi-face in all experimental groups. There was a trend toward increased speed of reinnervation for group III animals (end-to-end coaptations). It was concluded that end-to-side coaptation can produce a contralateral synchronous eye blink in a clinically relevant, large-animal model.

Blood Flow and Tissue Survival in the Rabbit Venous Flap

The extent of venous flow, revascularization, local fluid imbibition, and metabolic status was evaluated in an experimental venous flap model. Thirty-six rabbits divided into six groups of six rabbits each had a 3.5 x 2.5 cm venous flap elevated along the thoracoepigastric vein, connected only by its proximal and distal vein, and sutured back. A composite graft of the same size was created on the contralateral side. Venous flaps survived 14 days, while composite grafts consistently did not. The vascular network was partially filled with fluorescein tracer within an hour after flap creation, even with an underlying Silastic sheet. Filling improved over several days, consistent with rapid revascularization. Composite grafts showed no immediate filling and delayed revascularization. Venous flow was apparently insufficient to enhance metabolism, since both glucose and lactate levels were equivalent between venous flaps and composite grafts. This supports the concept that an enhanced revascularization may be the primary mechanism of survival for venous flaps.

Ectopic subgaleal meningioma and familial neurofibromatosis

A 14-year-old male adolescent presented with progressive enlargement of the forehead and a history of familial neurofibromatosis. Plain x-ray films of the skull, computed tomography scanning, and carotid angiography were performed prior to removal of the tumor. Pathologic verification of an ectopic subgaleal meningioma prompted the report of this rare tumor.

Comparison of one- and two-stage nerve grafting of the rabbit median nerve

The hypothesis that improved axonal regeneration occurs through nerve grafts when scarred tissue is removed and distal coaptation completed during a delayed, secondary operation was tested in a rabbit model. The ulnar nerve was used as a donor nerve graft to a final three-centimeter deficit of the contralateral median nerve. This was done either in one stage or in two stages, with resection of scar and coaptation at the distal site done ten weeks later. Evaluation included nerve conduction velocity, compound action potential area, muscle contraction force, muscle weight, and axon counts. Two-stage nerve grafts at 24 weeks were significantly inferior to one-stage grafts only in compound action potential area. Both nerve grafts showed significant improvement in function from twenty-four to sixty-two weeks as measured by nerve conduction velocity; two-staged grafts in addition showed a significant increase in compound action potential area and twitch contraction force. The data are inconclusive regarding the absolute superiority of two-stage versus one-stage grafting. Different timing for the second stage may be required.

Composite tissue allograft (CTA): tolerance induction without graft vs host disease (GvHD)

Vijay Gorantla MD, Gustavo Perez-Abadia MD, Kaustubha Prabhune MD, Haldun Orhun MD, Thanos Kakoulidis MD, Ramsey Majzoub MD, Claudio Maldonado PhD, Gary Anderson PhD, Lynn Ogden MD, Warren Breidenbach MD, Suzanne Ildstad MD, John Barker MD, PhD. Division of Plastic and Reconstructive Surgery, Institute for Cellular Therapeutics, Department of Surgery, University of Louisville & Christine M. Kleinert Institute. University of Louisville, 511 South Floyd St, 320 MDR Bldg, Louisville, KY, 40292, USA. Tel (502) 852-0166.