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Diagnosis of wrist pain can be difficult to determine with clinical examination and conventional imaging techniques alone. Bone SPECT-CT (single-photon emission tomography with computerized tomography) is a hybrid imaging technique that overlays functional bone scintigraphy in tomographic/3D mode with conventional CT. Data from the two modalities are complementary; areas of abnormal bone metabolism can be localized with anatomical precision, hitherto lacking in conventional bone scans, while structural information from the CT scan further embellishes the diagnostic information. Over the last 6 years, one surgeon (David Evans) has used bone SPECT and later bone SPECT-CT as an additional line of investigation. This is a series of 21 consecutive patients with wrist pain that could not be diagnostically resolved with the usual combination of history, examination, and conventional imaging, and therefore underwent bone SPECT-CT. Clinical and imaging findings, management, and outcomes of these cases are discussed to explore the potential role of this hybrid functional modality in hand and wrist surgical practice., (Copyright © 2016. Published by Elsevier Ltd.)

Serine proteinases modulate the interaction of tumor cells with extracellular matrix components during extravasation and metastasis. The serine proteinase tissue kallikrein has been previously demonstrated in several human adenocarcinomas, and we presently report the localization of immunoreactive kallikrein and its mRNA in pancreatic adenocarcinoma. In addition, a synthetic peptide-based inhibitor specific for tissue kallikrein (FE999024) was used in our studies to explore a possible role for kallikrein in cancer cell invasiveness. Matrigel invasion assays were performed with a human breast-cancer cell line, MDA-MB-231, which expresses tissue kallikrein in culture. In the presence of FE999024 invasion through Matrigel was inhibited in a dose-dependent manner to a maximum of 39%. We also developed a novel ex vivo assay in which breast cancer cells are infused into the pulmonary circulation of artificially ventilated explanted rat lungs. At intervals up to 6 hours after infusion pulmonary invasion was quantified by bronchial alveolar lavage to recover human cancer cells from the airspace. Invading cells in the lung interstitium were also quantified after immunohistochemistry with a monoclonal antibody specific for human cytokeratin 18. The synthetic kallikrein inhibitor attenuates breast cancer cell invasion into the airspace by 33% when quantified by lavage recovery and up to 34% as quantified in the lung interstitium by cytokeratin 18 immunostaining. Our results indicate tissue kallikrein may participate in the invasion and metastasis of human adenocarcinomas. The newly developed explanted rodent lung assay should be useful for the study of cancer cells, neutrophils, or other extravasating cells.

An incision is described in which the two ends of an elliptical excision are displaced. This can be used in two situations; in the reduction in length of one side of a digit and in the excision of two lesions close together., (Copyright 2000 The British Association of Plastic Surgeons.)

A 21-year-old man is reported in whom flap tissue was required to reconstruct the face and nose following burns. The whole of both forearms were used as radial forearm flaps for both cheeks, both lower eyelids, the right upper eyelid, upper and lower lips and chin. A Tagliacozzi arm flap and a dorsalis pedis flap were used for the nose. The ears were resurfaced using grafted skin along the line of the superficial temporal arteries. No thinning of the flaps was required and some facial muscle attachments to the forearm deep fascia led to more recovery of facial movement than might be expected with a flap reconstruction.

The identification of a lead ligand from a library of compounds for a specific target requires both a selection process and a method to assess relative affinities. Using a tandem-column chromatographic technique, we have developed a novel and rapid method for determination of relative affinities for ligands binding to a specific target molecule. We demonstrate, using known ligands for the lipid A region of lipopolysaccharide, that the relative affinities of these ligands can be determined and may be used to characterize the competitive interaction between ligands for the same target. The method can be adapted toward screening of soluble libraries of peptides and small molecules and those ligands exhibiting a desired affinity can be rapidly selected for further characterization/development.

Surgery for invasive squamous cell carcinoma involving the tongue base usually necessitates a total glossectomy because complete tumour resection requires sacrifice of both lingual arteries leaving a non-viable anterior tongue. A case is presented in which both lingual arteries were sacrificed to achieve complete tumour excision and the remaining anterior two-thirds of the tongue were successfully revascularized by through-flow from a radial forearm free flap which was used for pharyngeal reconstruction. This technique offers hope of preservation of the tongue when radical surgery would otherwise lead to its removal.

Recommendations for the surgical treatment of clinodactyly have centered on techniques of osteotomy with or without bone grafting. However, the limiting factor to the correction may be tension in the soft tissues. A new technique to correct clinodactyly is described utilising an opening wedge osteotomy and bone grafting plus a bipedicled neurovascular step-advancement flap to correct the soft tissue deficiency. The procedure has been performed in five cases.

A study of the effect of screening and treatment of middle ear effusions in cleft palate children throughout the first four years of life gave a modest reduction in the incidence of persistent effusions at four years, but prevented tympanic perforations and attic retractions. There was no demonstrable advantage in terms of speech, and an insignificant advantage in terms of language development.

An island flap is described for fingertip reconstruction, based on one neurovascular bundle. The design incorporates the stepladder principle, which ensures the provision of ample skin with full tactile sensibility in the required position, without the risk of longitudinal volar scarring and with good nail support when necessary. Fourteen such repairs have been carried out with satisfactory results and no complications.

Experience in correction of prominent ears as an out-patient procedure under local anaesthetic in 52 patients is described. Adults and children aged 9 and over are suitable for this form of treatment. A review of 44 patients has revealed 100% patient satisfaction and a low complication rate. Infection has occurred in two ears. An objective appraisal of the results is given.

The ability of UV endonuclease beta of Deinococcus radiodurans to act as a pyrimidine dimer DNA glycosylase was investigated. Cell-free extracts of D. radiodurans exhibiting UV endonuclease beta activity failed to generate incisions in irradiated DNA that liberated free-thymine residues upon photoreversal with 254-nm light. This is in marked contrast to the pyrimidine dimer UV glycosylase of Micrococcus luteus that does liberate such residues. The result suggests that UV endonuclease beta incises DNA by true endonuclease action.

In order to reduce the incidence of skin edge necrosis following dissection of the inguinal lymph nodes, an abdominal rotation flap has been used to help with closure. This allows excision of the most vulnerable skin, and closure without tension. Our experience in 13 groin dissections is presented, with skin edge necrosis in one patient (7.6%). This is compared with previously reported series and the reasons for the precarious blood supply to the skin following groin dissection are discussed.

An endonuclease that incises lightly ultraviolet-irradiated supercoiled plasmid DNA was identified in cell-free extracts of Deinococcus radiodurans R1 wild-type. The endonuclease was absent from strains mutant in the uvsC, uvsD or uvsE genes identifying it as 'UV endonuclease beta' responsible for the initial incision step of one excision-repair pathway for the removal of pyrimidine dimers from D. radiodurans DNA in vivo. The enzyme was purified free from contaminating nuclease activities and was partially characterised. The enzyme has an apparent molecular weight of 36 000, is ATP-independent, caffeine-insensitive and is inactivated by N-ethylmaleimide. It also has a novel requirement for manganese ions distinguishing it from all other known DNA-repair enzymes.