RESUMEN

The thermophilic fungus Scytalidium thermophilum produces a novel bifunctional catalase with an additional phenol oxidase activity (CATPO); however, its phenol oxidation spectrum is not known. Here, 14 phenolic compounds were selected as substrates, among which (+)-catechin, catechol, caffeic acid, and chlorogenic acid yielded distinct oxidation products examined by reversed-phase HPLC chromatography method. Characterization of the products by LC-ESI/MS and UV-vis spectroscopy suggests the formation of dimers of dehydrocatechin type B (hydrophilic) and type A (hydrophobic), as well as oligomers, namely, a trimer and tetramer from (+)-catechin, the formation of a dimer and oligomer of catechol, a dimer from caffeic acid with a caffeicin-like structure, as well as trimeric and tetrameric derivatives, and a single major product from chlorogenic acid suggested to be a dimer. Based on the results, CATPO oxidizes phenolic compounds ranging from simple phenols to polyphenols but all having an ortho-diphenolic structure in common. The enzyme also appears to have stereoselectivity due to the oxidation of (+)-catechin, but not that of epicatechin. It is suggested that CATPO may contribute to the antioxidant mechanism of the fungus and may be of value for future food and biotechnology applications where such a bifunctional activity would be desirable.

Asunto(s)

RESUMEN

BACKGROUND: Curcumin has been shown to decrease ischemia-reperfusion (I/R) injury in kidney or brain tissues. In this study, the effects of curcumin were evaluated in skeletal muscle during I/R injury. MATERIALS AND METHODS: Hind limb ischemia was induced by clamping the common femoral artery and vein. After 4 h ischemia, the clamp of the femoral vessels of animals was taken off and the animal underwent 2 h reperfusion. We measured plasma concentrations of interleukin-1ß (IL-1ß) and tumor necrosis factor-α (TNF-α) using enzyme-linked immunosorbent assay (ELISA). The right gastrocnemius muscle was harvested and immediately stored at -30°C for the assessment of superoxide dismutase (SOD), catalase (CAT) activities, and measurement of glutathione (GSH), malondialdehyde (MDA), and protein oxidation (PO) levels. Curcumin (100 mg/kg), α-tocopherol, and normal saline (10 mL /kg1) were administered intraperitoneally 1 h prior reperfusion. RESULTS: Plasma TNF-α or IL-1ß levels increased significantly in I/R group. The plasma levels of these proinflammatory cytokines were reduced in curcumin group. Muscle tissues of I/R groups revealed significantly higher antioxidant enzyme (superoxide dismutase, glutathione peroxidase, catalase) activities, and increased levels of malondialdehyde, nitric oxide, and protein carbonyl content compared with the SHAM group. Levels of these parameters in muscle revealed significant reductions in the I/R + curcumin group compared witho the I/R group. Curcumin has more potent antioxidant activity than vitamin E in the skeletal muscle I/R. CONCLUSION: In this study, protective effects of curcumin against skeletal muscle ischemia-reperfusion injury have been revealed. We underscore the necessity of human studies with curcumin that would be hypothetically beneficial preventing skeletal muscle I/R injury.

Asunto(s)

RESUMEN

AIM: Anterior plagiocephaly usually occurs with premature synostosis of the ipsilateral half of the coronal suture. The forehead is flattened on the affected side, with a backward and upward displacement of the affected orbit. The bulging of the calvaria may occur in the contralateral parietal area. MATERIAL AND METHODS: This article presents the surgical techniques used over 7 years to treat plagiocephalic children. Eleven patients with unilateral coronal synostosis treated during 2003-2010 were analyzed retrospectively. The study included reviews of pre and postoperative computed tomography scans, operative techniques, clinical outcomes and complications. Unilateral orbital advancement with "tongue in groove" was performed in 5, and bilateral orbital advancement in 6 cases. Pre and postoperative anthropometric measurements were used to document the amount of advancement of the elevated and recessed orbita, and the amount of withdrawal of the contralateral side. RESULTS: The mean age of the patients at time of surgery was 11 months. The preoperative values of the orbital height and retrusion were 0.68 cm and 1.87 cm, respectively. They were recorded as -0.1cm and 0,63 cm, postoperatively. Mean follow-up was 36 months, neither neurological sequelae nor other significant complications were encountered. CONCLUSION: The surgical corrections have resulted in significant improvements in skull shape and high patient/parent satisfaction.

Asunto(s)

RESUMEN

Axial pattern flaps are characterized by a single vascular pedicle that supplies the whole flap and carry the danger of flap loss. For this reason, monitoring and early identification of vascular perfusion is important for flap prognosis. The most commonly used method for flap monitoring is clinical assessment, but it has certain limitations. The bioelectrical properties of tissues can be affected by ischemic conditions, and a preliminary study showed that the bioelectrical resistance of blood was decreased under thrombotic conditions. In this controlled study, the resistance values of the axial flaps were calculated during thrombosis. A total of 28 rats were randomly divided into a control group (n = 14) and an experimental group (n = 14). Axial flaps were elevated based on the inferior epigastric pedicle. For the ischemic group, microvascular clamps were placed in the ischemic group to produce artificial thrombosis from day 1 of the experiment. Bioelectrical resistance was measured every 30 minutes for the first 6 hours and then daily after that. The resistance values from the ischemic group decreased progressively, and 150 minutes after the clamping, the difference became statistically significant (P < 0.05). The results showed that the assessment of flap resistance is a valuable tool and may allow early recognition of a compromise in the vascular system before clinical signs become obvious.

Asunto(s)

RESUMEN

We present a case of neural fibrolipoma arising from the digital nerve in the index finger of the right hand. A 31-year-old man was referred with a soft tissue mass in the ulnar aspect of the index finger of his right hand, which had gradually enlarged during the past seven years. Histological examination of an excisional biopsy specimen identified a neural fibrolipoma, which is a differential diagnosis of a lipomatous lesion of the digits.

Asunto(s)

RESUMEN

We tested the hypothesis that the intrinsic vascular plexus of the motor nerve could support viability in a rat hindlimb muscle flap. In a preliminary study, we examined the course and vascularity of the sciatic nerve, the peroneal nerve, and the peroneous longus muscle in the rat hindlimb via anatomic dissection, microangiography, and histologic study (n = 10 animals). On the basis of this examination, the peroneous longus muscle was chosen as our experimental model in this study. In 12 animals, the peroneus longus was acutely elevated, which severed all tendinous and vascular structures, this left the muscle pedicled on the motor nerve only (Group I). Animals in Group II underwent a staged elevation of the flap with division of the vascular pedicle, the tendon of insertion, and the tendon of origin during separate procedures that were 5 days apart (n = 12). Muscle viability was evaluated by gross inspection, measurement of muscle weight and length, nitroblue tetrazlium (NBT) staining, microangiography, and histology. NBT staining demonstrated that immediate elevation of the peroneus longus muscle flaps led to an average necrotic area of 80.6% +/- 9.8% (Group I). A significant improvement in viability was observed for muscle flaps of animals in Group II, with peroneus longus muscle necrosis averaging 25.6% +/- 9.3%. Microangiography demonstrated that the intrinsic vascularity of nerve was increased dramatically in Group II. These data support the hypothesis that the intrinsic vascular plexus of the motor nerve of a skeletal muscle can support at least partial viability of a muscle flap. However, this vascular axis is inadequate to support complete viability of a muscle flap if the flap is elevated immediately. If a staged elevation affects a surgical delay, the viability of a muscle flap elevated on a neural pedicle can be increased significantly. With adjustments in the delay procedure, this strategy may allow transfer of muscle flaps when maintenance or reconstitution of the primary vascular axis is not possible.

Asunto(s)

RESUMEN

BACKGROUND: Cutaneous cholesterol embolization syndrome occurs as a result of cholesterol embolization from atherosclerotic plaques lining the walls of arteries and arterioles. It can occur sporadically but is more commonly associated with iatrogenic manipulation via invasive vascular procedures or therapies (anticoagulation or thrombolytics) The three most common organ systems afflicted by cholesterol emboli include the kidneys, gastrointestinal system, and skin. MAIN OBSERVATIONS: We present two patients with cutaneous cholesterol embolization A 74-year-old with no prior disease or trauma was referred to the hospital with the acute chest pain. After 24-48 he developed livedo reticularis, followed by necrotic areas like bilaterally on hips and in the lumbar region. The second patient, 69-year-old man with a history of hyperglycemia, hyperlipidaemia, and hypertension was referred with weight loss, bilateral livedo reticularis, severe pain of lower extremities and impaired renal function. The toes first became cyanotic and than skin necrosis developed. Skin biopsy revealed presence of cholesterol clefts in the lumina of small arteries and arterioles. In both patients the necrotic skin and subcutaneous tissue had been debrided. Daily dressing was applied and tissue defects underwent secondary healing. CONCLUSION: The diagnosis of cholesterol embolization relies on clinical and histologic examination. Both, diagnosis and treatment needs a multidisciplinary approach, especially in cases of multi-organ involvement.

RESUMEN

BACKGROUND: Major defects of the lower lip are challenging to the reconstructive surgeon. The major goals in treating total lower lip defects are reconstruction of the external skin and mucosal lining and maintenance of oral competence and sphincter function. The authors describe reconstruction of total lower lip and larger full-thickness defects including the cheek and commissure by means of a composite anterolateral thigh-fascia lata free flap. METHODS: The flap was harvested with 5-cm fascial extensions at the superior and inferior margins. The flap was folded over the fascia lata to restore the intraoral lining and cover the external skin defect. Fascia lata extensions were divided longitudinally into two fascial strips at both margins of the flap. Two strips were tunneled through the orbicularis muscle in the upper lip and sutured to each other and to the orbicularis muscle. The remaining two strips were anchored to the zygomatic bone periosteum by permanent sutures. This procedure was used in 11 patients. RESULTS: In all cases, disease was advanced squamosus cell carcinoma. The patients' ages ranged from 37 to 72 years. Nine patients had cancer of the lower lip and two patients had a buccal cancer involving the lip. The entire lower lip, bilateral modiolus, and part of the cheek were resected in all patients, and mandibulectomy was performed in three patients. Flap survival was 100 percent. One patient died 10 days after the operation because of cardiopulmonary arrest. At the end of the 1-year follow-up period, all patients had good oral continence at rest and had achieved sufficient oral competence when eating. Eight patients were able to resume a regular diet and two patients could eat a soft diet. CONCLUSIONS: This flap is a good choice for reconstruction of the extensive head and neck defects. We think that anterolateral thigh-fascia lata composite flap has maximum reconstructive capacity and minimal donor-site morbidity. This flap has many advantages over the radial forearm flap and should replace to the composite radial forearm palmaris longus tendon flap when total lower lip reconstruction is concerned.

Asunto(s)

RESUMEN

We report a 10-year-old girl with synchronous multiple pilomatrixomas. Pilomatrixomas are generally solitary tumors; synchronous multiple tumors are very rare. Multiple or recurring tumors may be found in association with various syndromes, and multiple tumors may be familial. Concurrent disorders were not identified in our patient and the etiology of her pilomatrixomas was not understood. Thorough examination of the patient and long-term follow-up are necessary with these tumors.

Asunto(s)

Asunto(s)

RESUMEN

High-energy trauma from road accidents and work-related injuries is the most common cause of lower-limb traumatic amputations. Many of these cases require extensive debridement and substantial bone shortening for primary closure because of crushing and/or avulsion of the involved parts. Since 1998, the authors have replanted or revascularized five lower limbs in five patients. Free tissue transfers have been used to cover soft-tissue defects during replantation and revascularization in all patients. The numbers and kinds of free flaps include one latissimus dorsi muscle, two transverse rectus abdominis musculocutaneous (TRAM), and two anterolateral thigh fasciocutaneous flaps. Survival of the replanted and revascularized limbs and transferred flaps was obtained in four patients. Below-knee amputation was performed because of flap necrosis and extensive infection in one patient. Simultaneous free-tissue transfers may be used simultaneously with lower limb replantation or revascularization to obtain functional extremities in appropriately selected patients. The indications for lower limb salvage may be enhanced and successful results may be obtained in one stage, with low complication rates and shorter hospital stays. The authors report their experience with simultaneous free tissue transfers and lower limb replantation or revascularization.

Asunto(s)

RESUMEN

The surgeon may, on occasion, wish to perform a relatively minor procedure on a single finger with some types of tourniquet at the base of the finger. A potential complication of a digital tourniquet is neurovascular damage due to excessive tissue pressure and prolonged application time. We presented a case where a hand surgery and digital tourniquet was forgotten on the finger for one and a half days. Although neurovascular compromise had occurred, the left index finger was successfully saved after extensive medical treatment and leech therapy.

Asunto(s)

RESUMEN

The authors present their experience using the free anterolateral thigh fasciocutaneous flap for head and neck and extremity reconstruction. From January 2000 through March 2002, 28 free anterolateral thigh flaps were transferred to reconstruct various soft-tissue defects. All patients were operated by two teams. All flaps were elevated based on one perforator only. The sizes of the flaps ranged from 9 x 11 to 20 x 26 cm. The success rate was 96.5% (27 of 28), with one partial failure. The cutaneous perforators were always found. Septocutaneous perforators were found in 3 of 28 patients (10.7%). Musculocutaneous perforators (89.3%) were found in the remaining patients, and the number of perforators ranged from two to five (average, three perforators). In 4 patients, flaps were used for sensate reconstruction. The authors used the anterolateral thigh flap as a thin flap in 10 patients. Mean follow-up was 13.5 months (range, 2-25 months). Soft-tissue reconstruction with the free anterolateral thigh flap in various regions of the body provides an excellent functional and cosmetic result with minimal donor site morbidity. The anterolateral thigh flap has many advantages over other conventional free flaps and it seems to be an ideal choice for the reconstruction of soft-tissue defects.

Asunto(s)

RESUMEN

In the art of plastic surgery, the reconstruction of tissue defects to obtain cosmetic and functional recovery is the major concern. Skin grafting is the most frequently used procedure for reconstructing defects of various size and anatomical localizations. On the other hand, donor-site problems associated with this invaluable procedure are inevitable. Various methods are used in the postoperative management of the partial-thickness donor site created during the harvest of a split-thickness skin graft. Each technique has the potential for complications of fluid loss, excessive pain, prolonged period of healing and immobilization, hypertrophic scarring, and undesirable pigmentation. Donor-site pain is probably the most disturbing complication in the early postoperative period. The aim of this article is to point out the significance of donor-site pain, which has not been emphasized thoroughly in the literature, and to introduce flap skin as a potential graft donor site for patients in whom reduction of donor-site morbidity is of primary concern. The principal goal of the technique described in this article is to eliminate donor-site pain by harvesting the graft from the flap that is insensate after the elevation. In 15 patients, the overlying skin of the flap that had been used for reconstructive purposes was used as the donor site (group I). In the remaining 23 patients, the posterolateral thigh was used as the donor site (group II). Donor-site discomfort was recorded during the first 8 days postoperatively using a visual analogue scale. To analyze the data, we used the Friedman test, Dunn's multiple comparison test, and Mann-Whitney U test. It was observed that the visual analogue scale of both of the groups showed a significant decrease within days (group I, p < 0.0001; group II, p < 0.0001). The mean pain scores were significantly lower in group I than in group II (p < 0.0001). When donor-site pain is of primary concern, this procedure provides uneventful and comfortable healing while avoiding postoperative pain in the donor site. For that reason, this technique might be used in appropriate cases to minimize donor-site pain.

Asunto(s)

RESUMEN

The use of the anterolateral thigh fasciocutaneous flap in the reconstruction of soft-tissue defects around the knee among burn patients is described. The anterolateral thigh fasciocutaneous flap was used for eight patients (all male; mean age, 45 years; age range, 32 to 60 years). Flexion contracture was observed for seven patients with unhealed wounds and one patient with a healed burn wound. The anterolateral thigh flap was used as a free flap for six patients and as a distally based island flap for two patients. The flaps ranged from 8 to 17 cm in width and from 12 to 30 cm in length. Seven flaps were based on a musculocutaneous perforator, and two of them were thinned before transfer to the defect. A true septocutaneous perforator was observed in only one case. The mean follow-up period was 12.5 months (range, 3 to 23 months). Only one flap exhibited distal superficial necrosis, which did not compromise the final result. All patients returned to ambulatory status in 15 to 22 days. Extensor splints were applied to prevent mobilization of the skin graft at the flap donor site for only 7 days. The anterolateral thigh flap has many advantages for the reconstruction of postburn flexion contracture of the knee, as follows: (1) very large thin flaps can be elevated, (2) the two-team approach is possible, (3) color and texture matches are good, (4) the donor-site scar can be easily hidden, and (5) the technique allows early mobilization and patients can return to normal daily activity in a short time. Free or distally based anterolateral thigh flaps are a good choice, both aesthetically and functionally, for the reconstruction of soft-tissue defects of the knee region.

Asunto(s)

Asunto(s)

RESUMEN

Twenty-four digital artery island flaps with reversed flow were used to reconstruct 23 patients with fingertip injuries in the authors' clinic between June 1998 and August 2000. No nerve coaptation was performed in these patients. Patient age ranged between 18 and 35 years. All patients were evaluated at clinical follow-up for active range of motion, appearance, patient satisfaction, two-point discrimination, hypersensitivity and cold intolerance, previous hand injury, and flap viability in the repaired finger. Based on their experience, the authors consider that this procedure has several disadvantages: relatively high flap loss, sacrifice of one of the two major arteries of the finger, it is a time-consuming method, it is a difficult flap dissection, there is a requirement for loupe and microsurgical equipment. The authors think that this flap should not be the first choice for fingertip reconstruction especially for patients who have possibility of reinjuring their hands because of their jobs.

Asunto(s)

Asunto(s)