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Pregnant women and their infants are a vulnerable but neglected population in tuberculosis (TB) control efforts. Recent advances in TB prevention, diagnosis and treatment have implications for their care, despite their frequent exclusion from research. We have conducted a meta-review of current evidence and clinical guidelines for TB prevention, diagnosis and management in pregnant women and neonates, focusing on review articles published since 2010. The actual burden of TB in pregnancy is unmeasured, but has been estimated at 216,500 cases per year. Although the effect of pregnancy on TB risk is uncertain and controversial, two large whole-of-population studies found that pregnancy was associated with a two- to three-fold increase in risk of TB. Congenital TB is rare but extremely serious. Neonates exposed to TB after delivery will be at high risk of disease, and preventive therapy is recommended once disease has been ruled out. At present, there is limited evidence regarding the performance of different screening strategies for pregnant women, appropriate drug dosing for either pregnant women or neonates, and the safety of most second-line drugs in pregnancy. High quality evidence on these topics is needed, as are detailed guidelines to inform efforts by TB control programs and clinicians working with pregnant women and their infants.

Es wird uker eine Methode des Femurtotalersatzes unter gleichzeitiger Verwendung von Huft- und Kniegelenktotalendoprothesen berichtet. Der Keramikuberzug der Prothese aus Titan wurde plasmagespruht, um die Prothesenlockerung zu verhuten. Die Methode ermoglicht den Extremitatenerhalt und fuhrt zur sofortigen vollen Belastbarkeit der Extremitat. Sie kann bei gewissen nicht-malignen Knochentumoren und Knochenerkrankungen mit ausgedehnten destruierenden Herden im ganzen Oberschenkelknochen zur Anwendung kommen. Bei 3 Patienten wurde sie mit guten Ergebnissen angewandt. Das Follow-up der operierten Patienten betrug durchschnittlich 54 (32–70) Monate. Die Art der durchgefuhrten Eingriffe und die Vorteile des Verfahrens werden vorgesetllt.

In this study, a simple and reliable experimental model for lymphedema is described. In the middle portion of albino rats' hind lower leg, leaving the saphenous vessels and the accompanying lymphatics intact, all other soft tissues are incised circularly. After retraction of the cut ends of muscles, the skin edge of the ventral side is sutured to that of the dorsal side to envelope the muscles of both cut ends and the saphenous vessels and lymphatics. Resection of lymphatics or circular strip of soft tissues is not performed. In 48 of 50 rats' legs, measurements were made of leg circumference and the diameter of the lymphatics; in addition changes of lymphatic contractility were observed. These measurements, observations and histopathological studies showed a consistent picture of lymphedema. The clinical implication of this observation is that a small number of lymphaticovenous anastomoses will not correct lymphedema and that the quality of the results will correlate with the number of anastomoses. In studying the findings of experimental lymphedema, some other clinical phenomena are explained and modifications of the operative procedure of microlymphaticovenous anastomosis for treating lymphedema are suggested.

Three techniques that use distal arteries for microvascular reconstruction in forearm and hand surgery are described: (1) distal based supply from the deep branch of the radial artery, (2) proximal reversal of the radial artery, and (3) distal based supply from the ulnar artery. Nine cases are described to illustrate the use of these techniques: three vascularized bone grafts, three toe-to-hand transfers, one free cutaneous flap, one brachial artery reconstruction, and one replantation of an amputated palm. The technique offers a number of advantages: (1) it eliminates the need for vein grafts, (2) it requires only a single arterial microvascular anastomosis, (3) it minimizes microvascular size discrepancies, (4) the distal artery can be prepared in the same operative field as the rest of the reconstruction, and (5) the technique enables an undamaged artery to be brought into a zone of trauma and used as a recipient vessel. The technique has the disadvantage that it sacrifices part of the collateral circulation to the hand and it is therefore important to check the blood supply to the hand preoperatively.

The authors' modified rat open cremaster muscle preparation as a model to study vasospasm by in vivo microscopy is presented. Vasospasm of cremaster microvessels was induced using adrenaline. Spasmolytic action after topical application of various pharmacologic solutions was evaluated. Phentolamine has the strongest spasmolytic action to arterial spasm, thus, it appears that phentolamine may be the spasmolytic agent of choice. NAA, papaverine and reserpine show a degree of vasospasm reversal while magnesium sulfate and danshen compound are ineffective. Tolazoline has a biphasic action to spasmodic vessels. Lidocaine has a strong spasmodic effect on cremaster arterioles. The authors therefore propose that the local application of tolazoline or lidocaine as a spasmolytic agent in microsurgery should be revised.

In order to solve the loosening problem of endoprosthesis, a titanium-based alloy bone and joint prosthesis with plasma-sprayed ceramic coating was developed by the authors. By the fabrication powdered alumina or zirconium oxide were melted in an electric arc by a temperature of 10,000 K and sprayed onto the metallic prosthesis. The coating was 0.3 to 0.6 mm in thickness and had innumerable micropores. The pores were 50 to 200 microns in diameter. The metallic bone and joint prosthesis with plasma-sprayed ceramic coating exhibits characteristics of metal and ceramic, such as high mechanical strength, high resistance to corrosion and elution and good biocompatibility. According to our experimental study, the plasma-sprayed ceramic coating allows tissue ingrowth into its micropores and prevents the loosening of the prosthesis. Successful cases have been experienced through 10 years clinical application.

The authors developed a titanium-based alloy artificial total femur incorporating its total hip and total knee joints with plasma-sprayed ceramic coating 0.3 to 0.6 mm in thickness and a myriad of micropores of 50-200 microns in diameter. On the basis of reliable data obtained in the animal experiments and physical testing, the prosthesis was applied clinically with satisfactory results. This paper reports the results of two patients with a follow-up of 42-70 months.

A method of prosthetic replacement using total femur incorporating its total hip and knee joints is reported. On the surface of the titanium endoprosthesis was plasma-sprayed a ceramic coating to prevent loosening of the prosthesis. It can preserve the limb and restore the function in a short period. It can be used in certain non-malignant tumours and diseases of the bone with extensively destructive lesions of the entire femur. This method was used in 3 patients with good results. The operated patients were followed-up for 32-70 (mean 54) months. Types of procedures and advantages of the operation are presented.

Autogenous interpositional microarterial grafting of 204 saphenous branches of albino rat femoral arteries with an external diameter of 0.3 to 0.5 mm resulted in an immediate patency rate of 100%. Morphological studies included light microscopy (LM) and scanning electron microscopy (SEM). The patency rate as assessed by exploration with combined LM and SEM observations at 72 h was 68.2%. The late patency rate was related to blade tip pressure of the double approximator clip used in the microanastomosis. The patency rate with a clip with a blade tip pressure of 22 g was 54.1 % and that with a clip with a blade tip pressure of 2 g was 83%. When arterial occlusion lasted less than 30 min, the late patency rate was 82.4% to 88%. If arterial occlusion lasted for as long as 1 h, the late patency rate of vessels occluded by a clip with a blade tip pressure of 22 g dropped to 29.2%. These results demonstrate that an interpositional microarterial graft as small as 0.5 mm in external diameter is clinically feasible.

A method of prosthetic replacement using total femur with total hip and knee joints is reported. On the surface of the titanium endoprosthesis a ceramic coating was plasma-sprayed to prevent loosening of the prosthesis. By this method the limb can be preserved and the function restored within a short period. It can be used in certain cases of non-malignant tumors and diseases of the bone with extensive destructive lesions of the entire femur. This method was used on 3 patients with good results. The patients operated on were followed up for 32-70 (mean 54) months. The procedures and advantages of the operation are presented.

Lymphedema of the female external genitalia is seldom reported and can be psychologically distressing to the patient. On the basis of microlymphaticovenous operations for lymphedema of the extremities, a new microsurgical operation has been developed for treating lymphedema of the female external genitalia and applied clinically in six patients with good results. Edema of the female external genitalia and of the lower part of the abdominal wall has been reduced postoperatively, the chylorrhea has disappeared and the blisters on the vulva have vanished. The operative techniques and the anatomic basis of the operation are described, the six patient histories are illustrated and the correlation between number of anastomoses and quality of results are discussed herein.

The findings from dissections, injection studies, and angiograms of 180 specimens of the anterior portion of left and right iliac crests taken from 90 cadavers are reported. These findings suggested that the deep circumflex iliac vessels were suitable for use as a nutritive pedicle in microvascular free transfer of iliac bone. Therefore, the technique of microvascular free transfer of iliac bone based on these vessels was developed and applied clinically in 2 cases with good results. The advantages and disadvantages of using the superficial circumflex iliac vessels or the deep circumflex iliac vessels as the vascular pedicle for iliac grafts also are discussed.

The findings from dissection, injection studies, corrosion specimens, and angiograms in 300 specimens of the iliogluteal region taken from 150 cadavers are reported. These findings suggest that the deep superior branches of the superior gluteal vessels may serve a nutritive pedicle in microvascular free transfer of iliac bone. Therefore, the operative technique has been developed and applied clinically with good results. The selection of different vessels as a nutritive pedicle for the free transfer of iliac bone is discussed.

Lymphedema of female external genitalia is an uncommon disorder, for which ablative treatment procedures have been used in the past. Such an operation is most traumatic and achieved unsatisfactory results. On the basis of our experiences in treating lymphedema of the extremities by lymphaticovenous anastomosis, the author developed a microlymphaticovenous operation for treating this condition. From March 1980 to November 1984, a total of 6 patients with lymphedema of female external genitalia were operated and good results were achieved. The edema of the vulva, clitoris, mons veneris and of the lower part of the abdominal wall has been reduced, the chylorrhea disappeared and the blisters on the edematous vulva vanished. On the basis of our clinical experiences in treating lymphedema of female external genitalia by microlymphaticovenous anastomoses, we believe, that the anastomoses should be performed early and their number should be sufficiently high. The indication, types of procedures and advantages of the operation are presented.

The authors have previously described four types of intrinsic contracture in the first intermetacarpal web space. They now report a fifth group in which all the muscles in the space are involved. In this condition the thumb is flexed and adducted, and there is also radial deviation of the index finger with hyperextension of the proximal interphalangeal joint. These deformities are produced by contractures of the adductor pollicis, the flexor pollicis brevis and the first dorsal interosseous muscles. Three patients with this type of contracture are described. Operation produced an excellent result in each case, but it is essential to achieve complete correction. in a prospective study

Since 1980, 110 cases of lymphedema have been treated by microlymphaticovenous anastomosis. Of these 110 patients, 91 with obstructive lymphedema of lower limbs were reviewed. The immediate and long-term results have been very satisfactory. Excellent and good results were obtained in 79.1 percent. An average reduction in circumference of the affected limb of 6.4 cm and an average reduction of excess volume of 59.2 +/- 29.5 percent (representing 703 +/- 850 ml) were obtained. Subjective symptoms and objective signs were improved. Four patients (4.4 percent) showed poor results owing to severe fibrosis of neighboring tissue; no lymphatics could be located for anastomosis. As the authors gained experience with the operation over the last 3 years, they modified the operative procedure, the anastomotic technique, and the selection of collective lymphatics. The data obtained suggest that the quality of results is proportional to the number of anastomoses. In order to obtain the best results, the criteria for selection of patients and avoidance of postoperative relapse are discussed. Finally, a test for determination of the indications for microlymphatic surgery is described.

Between 1980 and 1986, 110 patients with lymphedema of the extremities (n = 98), male and female external genitalia (n = 9), breast (n = 2), and face (n = 1) were treated microsurgically. Microsurgery for primary (n = 6) and secondary (n = 104) lymphedema at present consists of anastomosis between collective lymphatics and veins. Ninety-eight patients with lymphedema of the extremities were followed-up for 26 months. The immediate and long-term results have been very satisfactory. Excellent and good results were obtained in 76.5%. An average reduction in circumference of the affected limb of 6.2 cm and an average reduction of excess volume of 59.2 +/- 29.5% (representing 703 +/- 850 ml) were obtained. These results prove that by standardized technique the microlymphaticovenous anastomoses can produce a good therapeutic result. On the basis of our clinical experience in treating lymphedema by microlymphaticovenous anastomoses, we believe that the anastomoses should be performed early and their number should be sufficiently high. Indications, types of procedures and advantages of the operation are presented.

Scrotoplasty has been used in the treatment of scrotal elephantiasis but it is most traumatic and achieved unsatisfactory results. The author developed a microlymphatico-venous procedure to treat elephantiasis of the scrotum and applied it clinically with good results. The scrotal size was immediately reduced to a nearly normal value. The indication, types of procedures and advantages of the operation are presented.