Bedside Sublingual Video Imaging of Microcirculation in Assessing Bacterial Infection in Cirrhosis

Bacterial infections are common in cirrhosis and can lead to life-threatening complications. Sidestream dark-field (SDF) imaging has recently emerged as a noninvasive tool for capturing real-time video images of sublingual microcirculation in critically ill patients with sepsis. The objective of this study was to assess the utility of SDF in determining underlying infection in patients with cirrhosis. Sublingual microcirculation was compared among patients with compensated cirrhosis (Group A, n = 13), cirrhosis without sepsis (Group B, n = 18), cirrhosis with sepsis (Group C, n = 14), and sepsis only (Group D, n = 10). The blood flow was semi-quantitatively evaluated in four equal quadrants in small (10–25 mm); medium (26–50 mm); and large (51–100 mm) sublingual capillaries. The blood flow was described as no flow (0), intermittent flow (1), sluggish flow (2), and continuous flow (3). The overall flow score or microvascular flow index (MFI) was measured for quantitative assessment of microcirculation and predicting power for concurrent infection in cirrhosis. Marked impairment was observed at all levels of microvasculature in Groups B and C when compared with Group A. This effect was restricted to small vessels only when Group B was compared with Group C. MFI < 1.5 was found to have highest sensitivity (100%) and specificity (100%) for infection in decompensated cirrhosis. SDF imaging of sublingual microcirculation can be a useful bedside diagnostic tool to assess bacterial infection in cirrhosis

X-RAY STUDY OF STEP MORPHOLOGY ON A CLEAVED MGO(100) SURFACE

Using a surface sensitive X-ray scattering technique, we investigated the atomic-scale step structure on a cleaved MgO(100) single crystalline surface. We show that the fine structure of a crystal truncation rod (CTR) contains distinct step peaks at L = 0.33 and 0.50 reciprocal lattice units. The data analyzed by a recently developed 1D model indicate that the cleaved MgO surface has in-plane positional correlation lengths of about 2000 angstrom, ten times longer than that of out-of-plane correlation length. We find the presence of surface step structures of two and three atomic layer steps with nearly equal abundance. We estimate the average terrace sizes of 105 x 79 and 200 x 157 angstrom2 for the two and three layer steps, respectively.X1112sciescopu

Vessel geometry and microvascular hand-sewn end-to-end anastomoses using Alexis Carrell’s technique: is the intuition of the Nobel Prize still valuable?

Background We review here our substantial experience in using Alexis Carrel’s technique with a geometrical optimization for microsurgical end-to-end anastomoses. Methods The technique used for microsurgical end-to-end anastomoses is described. We performed a retrospective analysis of head and neck free flaps where we used the described microsurgical anastomoses technique at Bufalini Hospital in Cesena, Italy. Patients’ demographic data, intraoperative findings, and postoperative progress, including complications, were accurately re- corded. We also recorded the cases where vessel size discrepancy was observed intraoperatively, either arterial or venous. Results The described technique has been used in 300 consecutive flaps in the last 18 years, with an average of 16 free flaps per year. No significant problems were encountered using this simple technique. Comprehensive flap survival was 98%. We had 5 free flap failures, and in all cases, the main problem was not related to the microvascular anastomoses. Vessel size discrepancy was recorded in 25% of the total. Conclusions Alexis Carrel’s technique for microvascular end-to-end anastomoses is still a very efficient end safe technique. Our geometrical optimization of it is a useful trick to keep in mind for the microvascular surgeon, especially in hospitals with a small volume of microsurgical procedures per year