Coverage of exposed hardware after lower leg fractures with free flaps or pedicled flaps

Abstract. – OBJECTIVE: The placement of osteosynthetic materials in the leg may be complicated by hardware exposure. Successful soft tissue reconstruction often provides a critical means for limb salvage in patients with hardware exposure in the leg. Free flaps are currently considered the standard surgical procedure for soft tissue coverage of the wounds with internal hardware exposure. However, to date, no conclusive literature shows the superiority of a specific type of flap. MATERIALS AND METHODS: The current review compares data from the literature concerning outcomes and complications of free and pedicled flaps for exposed osteosynthetic material preservation in the leg. RESULTS: A total of 81 cases from twelve different articles presenting internal hardware exposure of the leg were analyzed in our study. Thirty-two patients underwent immediate reconstructive surgery with pedicled flaps, while forty-nine patients underwent free flap reconstruction. The overall survival rate for pedicled flaps was 96.77%, while for free flaps it was 97.77%. The overall implant preservation rate was 78.12% for pedicled flaps and 53.33% for free flaps. With reference to postoperative complications, the overall complication rate was 46.87% for pedicled flaps and 10.20% for free flaps. CONCLUSIONS: No significant difference was found in terms of overall flap survival. However, a significant difference was found regarding successful implant preservation (78.12% in the pedicled flap group vs. 53.33% in the free flap group). In particular, the first observation appears to be in contrast with the current trend of considering the free flaps the first choice procedure for soft tissue coverage of the wounds with internal hardware exposure. Nevertheless, a higher occurrence of postoperative complications was observed in the pedicled flap group (46.87% vs. 10.20%). The choice of the most appropriate reconstructive procedure should take into account several issues including the size of the wounds with internal hardware exposure, the possibility of soft tissue coverage with pedicled flaps, the availability of recipient vessels, general conditions of the patients (such as age, diabetes, smoking history), patients’ preference and presence of a microsurgical team. However, according to the results of this review, we believe that pedicled flap reconstruction should be reconsidered as a valid alternative procedure for skin tissue loss with hardware exposure whenever it is possible

Geokimia Batubara Untuk Beberapa Industri

Dewasa ini perkembangan batubara sebagai sumber energi alternatif mampu bersaing dengan sumber daya utama yaitu minyak dan gas bumi. Banyak kerugian dan kerusakan yang terjadi akibat tidak diketahuinya karakteristik batubara. Batubara yang tidak memenuhi persyaratan dapat menghasilkan produktivitas yang rendah. Agar produktifitas industri yang memakai batubara tetap terjaga efesiensi dan efektifitasnya maka karakteristik geokimia batubara dari suatu daerah penambangan harus diketahui terlebih dahulu.Untuk mengetahui karakteristik geokimia dilakukan dengan cara analisa proksimat yaitu menentukan kandungan air, kandungan zat terbang, kandungan abu dan kandungan karbon tetap, dan analisa ultimat untuk menentukan kandungan karbon, kandungan sulfur, kandungan hidrogen dan kandungan oksigen. Selain kedua analisa tersebut juga terdapat sifat-sifat penting batubara untuk industri yaitu coal size High Heating Value (HHV), Hardgrove Grindability Index (HGI), ash funshion characteristic, nilai kalor (calorific value) serta sifat caking dan coking.Karakteristik geokimia batubara dalam bidang industri terutama Untuk PLTU diperlukan spesifikasi batubara dengan rata-rata adalah HHV 5242 kcl/kg, moisture 23 %, volatile matter 30,3 %, kandungan abu 7,8 %, kandungan sulfur 0,4 %, dan HGI-nya adalah 61,8. Indusri semen adalah nilai kalor cukup tinggi > 6000 cl/gr, volatile matter medium maksimum 36-42 %, moisture maksimum 12 %, kadar abu maksimum 6 %, kadar sulfur maksimum 0,8 %, kadar alkali dalam abu maksimum 2 % dan variasi kualitas tidak lebih dari 10 % . Untuk industri pengolahan logam, persyaratan batubaranya adalah nilai kalori tinggi > 6000 cl/gr, kandungan C dan H dominan, volatile matter harus mengandung CO / C, kandungan abu maksimal 6 %, sulfur kurang dari 0,0025 %, moisture dan fosfor rendah

Prescripción de antibióticos en la infección del tracto urinario: adecuación a criterios de calidad en atención primaria

ObjetivoDeterminar la prevalencia de insuficiencia renal crónica (IRC) sin tratamiento sustitutivo (TSR), describir el tipo de enfermedades renales primarias y los factores de riesgo asociados que pueden favorecer su evolución hacia la insuficiencia renal terminal.DiseñoEstudio descriptivo, transversal.EmplazamientoPoblación atendida por un centro de atención primaria.ParticipantesMayores de 14 años con historia clínica abierta en el CAP Bon Pastor.ResultadosDurante el período 1-I-1997 hasta 1-XII-1997 se revisaron 12.241 historias clínicas. Se identificaron 64 pacientes que cumplían criterios de IRC sin TSR; prevalencia, 5.228 pacientes por millón de habitantes (pmp) (IC del 95%, 3.950–6.510 pmp). Un 71,9% era varón, la edad media era de 72 años (DE, 13,5). La media de la última creatinina plasmática fue de 2 mg/dl (DE, 0,66). La frecuencia según tipo de nefropatía fue: glomerular, 3 (4,7%); diabética, 5 (7,8%); intersticial, 3 (4,7%); vascular (HTA), 41 (64,1%); indeterminada, 2 (3,1%), e inclasificable, 10 (15,6%). Los factores de riesgo asociados en estos pacientes fueron: hipertensos, 47 (73,4%); diabéticos, 16 (25%); hipercolesterémicos, 26 (40,6%); consumidores crónicos de analgésicos, 20 (31,3%), y 10 (15,6%), fumadores. Un 51,6% de los pacientes presentaba otras enfermedades cardiovasculares.ConclusionesLa prevalencia estimada de IRC sin TRS en la población es de 5.228 pmp, y la hipertensión es el factor de riesgo más frecuente asociado a esta patología.ObjectiveTo determine the prevalence of chronic renal failure (CRF) without replacement treatment (RT), and to describe the primary renal diseases and associated risk factors that might favour its evolution to terminal renal failure.DesignCross-sectional, descriptive study.SettingPopulation attended at a primary care centre (PCC).ParticipantsOver-14s with a clinical history opened at the Bon Pastor PCC.ResultsBetween the 1st of January 1997 and the 1st of December 1997, 12241 clinical histories were reviewed. 64 patients were identified who satisfied criteria of CRF without RT, a prevalence of 5228 patients per million inhabitants (95% CI, 3,950–6,510). 71.9% were men, and mean age was 72 (SD, 13.5). The most recent plasma creatinine averaged 2 mg/dl (SD, 0.66). Frequency according to kind of nephropathy was: 3 (4.7%) glomerular, 5 (7.8%) diabetic, 3 (4.7%) interstitial, 41 (64.1%) vascular (hypertension), 2 (3.1%) indeterminate and 10 (15.6%) unclassifiable. Associated risk factors in these patients were: 47 (73.4%) with hypertension, 16 (25%) diabetic, 26 (40.6%) with hypercholesterolaemia, 20 (31.3%) chronic consumers of analgesics, and 10 (15.6%) smokers. 51.6% of the patients suffered other cardiovascular illnesses.ConclusionsThe estimated prevalence in the population of CRF without RT is 5,228 per million inhabitants. Hypertension is the risk factor most closely associated with this pathology

The Magellanic zoo: Mid-infrared Spitzer spectroscopy of evolved stars and circumstellar dust in the Magellanic Clouds

We observed a sample of evolved stars in the Large and Small Magellanic Clouds (LMC and SMC) with the Infrared Spectrograph on the Spitzer Space Telescope. Comparing samples from the SMC, LMC, and the Galaxy reveals that the dust-production rate depends on metallicity for oxygen-rich stars, but carbon stars with similar pulsation properties produce similar quantities of dust, regardless of their initial metallicity. Other properties of the oxygen-rich stars also depend on metallicity. As the metallicity decreases, the fraction of naked (i.e. dust-free) stars increases, and among the naked stars, the strength of the 8 um absorption band from SiO decreases. Our sample includes several massive stars in the LMC with long pulsation periods which produce significant amounts of dust, probably because they are young and relatively metal rich. Little alumina dust is seen in circumstellar shells in the SMC and LMC, unlike in Galactic samples. Three oxygen-rich sources also show emission from magnesium-rich crystalline silicates. Many also show an emission feature at 14 um. The one S star in our sample shows a newly detected emission feature centered at 13.5 um. At lower metallicity, carbon stars with similar amounts of amorphous carbon in their shells have stronger absorption from molecular acetylene (C_2H_2) and weaker emission from SiC and MgS dust, as discovered in previous studies.Comment: ApJ, in press, about 27 pages, 29 figure

Quantitation of Human Seroresponsiveness to Merkel Cell Polyomavirus

Merkel cell carcinoma (MCC) is a relatively uncommon but highly lethal form of skin cancer. A majority of MCC tumors carry DNA sequences derived from a newly identified virus called Merkel cell polyomavirus (MCV or MCPyV), a candidate etiologic agent underlying the development of MCC. To further investigate the role of MCV infection in the development of MCC, we developed a reporter vector-based neutralization assay to quantitate MCV-specific serum antibody responses in human subjects. Our results showed that 21 MCC patients whose tumors harbored MCV DNA all displayed vigorous MCV-specific antibody responses. Although 88% (42/48) of adult subjects without MCC were MCV seropositive, the geometric mean titer of the control group was 59-fold lower than the MCC patient group (p<0.0001). Only 4% (2/48) of control subjects displayed neutralizing titers greater than the mean titer of the MCV-positive MCC patient population. MCC tumors were found not to express detectable amounts of MCV VP1 capsid protein, suggesting that the strong humoral responses observed in MCC patients were primed by an unusually immunogenic MCV infection, and not by viral antigen expressed by the MCC tumor itself. The occurrence of highly immunogenic MCV infection in MCC patients is unlikely to reflect a failure to control polyomavirus infections in general, as seroreactivity to BK polyomavirus was similar among MCC patients and control subjects. The results support the concept that MCV infection is a causative factor in the development of most cases of MCC. Although MCC tumorigenesis can evidently proceed in the face of effective MCV-specific antibody responses, a small pilot animal immunization study revealed that a candidate vaccine based on MCV virus-like particles (VLPs) elicits antibody responses that robustly neutralize MCV reporter vectors in vitro. This suggests that a VLP-based vaccine could be effective for preventing the initial establishment of MCV infection