Long-Term Results of Intralesional Triamcinolone Acetonide Injections in Keloid Treatment

Background: Intralesional triamcinolone acetonide (TAC) injections are often used as the first alternative for treating keloid scarring. The long-term outcome of this treatment is unclear. Also, undesirable local side effects have been recognized in clinical work and literature but they have been labelled as harmless and rare. Methods: We documented the long-term outcome of intralesional TAC injections in the treatment of keloid scars in Tampere University Hospital. The main objectives were to investigate the remission rate and the occurrence of local side effects. We assessed 105 patients (46 women, 59 men) with 138 TAC treated keloid scars at the outpatient clinic. The keloids were photographed and assessed with Patient and Observer Scar Assessment Scale (POSAS). Results: Of the 138 keloids, 90 (65%) were clinically in remission. Local side effects, including atrophy of the skin or the subdermal fat, telangiectasia and cortisone traces, occurred in 55% of the cases. The number of injections did not correlate with remission rate or the occurrence of local side effect. ROC curve analysis showed that surface area >620 mm2 was a prognostic factor for not responding to TAC treatment. Conclusion: According to this study, intralesional TAC injections seem to be effective in the treatment of small keloids but not in larger than 620 mm2. Local side effects were more frequent than previously reported and occurred even after just 1 injection. The side effects seem to be permanent in nature.fi=vertaisarvioitu|en=peerReviewed

Tissue reconstructions after sacrectomies performed for primary sacral tumors

English abstrac

Surgical and patient-reported outcomes after total knee arthroplasty requiring soft tissue flap reconstruction – A 12-year experience from high-volume arthroplasty hospital

Publisher Copyright: © 2022 Elsevier LtdBackground: This study investigates the outcomes of complex knee joint reconstructions performed by an orthoplastic surgery team at a tertiary referral hospital. Methods: Retrospective review of all the total knee arthroplasty (TKA)/revision TKA (rTKA) procedures with soft tissue flap reconstruction performed between 2008 and 2019 was conducted. Patients were stratified into two groups according to the urgency of surgery: scheduled non-complicated (SNC) and emergent complicated (EC). The whole study cohort was also categorized into non-infected and infected groups. Results: Of 20,184 TKAs operated, 58 patients required flap reconstruction (SNC group n = 27; EC group n = 31). The most common reconstruction was medial gastrocnemius flap (74%). Mean follow-up time was 31.9 months. Functional knee joint salvage was achieved in 96.3% the SNC group and in 80.6% the EC group patients (p = 0.07). Transfemoral amputation rates were 3.7% in the SNC group vs. 6.5% in the EC group (p = 0.36). Oxford Knee Score was 34.5 vs. 25.5 (p = 0.21), and range of motion was 100⁰ vs. 93⁰ (p = 0.37) in the SNC and EC groups, respectively. Superior functional knee joint salvage rates were achieved in the non-infected group compared to the infected group (97.1% vs. 75.0%, p = 0.004). However, the transfemoral amputation rate was nearly three-fold in the infected group (8.3% vs. 2.9%, p = 0.36). Estimated five-year survival with functional knee joint was higher in the non-infected group (p = 0.03). Conclusions: Both the SNC and EC groups had similar acceptable limb salvage rates, and functional and PROM outcomes. Infection reduces the probability of a functional knee joint after TKA and flap reconstruction.Peer reviewe

Yhdistettyjen kuljetusten hiilidioksidipäästöjen vähennyspotentiaali Suomessa

Selvityksessä arvioitiin tilastollisin perustein yhdistettyjen kuljetusten mahdollisuuksia ja vaikutuksia liikenteen kasvihuonekaasupäästöihin. Riippuen tavaralajien määrästä ja kuljetusten koontialueiden laajuudesta, yhdistetyt kuljetukset vähentäisivät liikenteen hiilidioksidipäästöjä tilastollisen kuljetuspotentiaalin perusteella arvioituna 18 000–30 000 tonnia vuonna 2030. Arviossa toiminta olisi käynnissä kuudella yhteysvälillä. Yhdistetyt kuljetukset vähentäisivät Fossiilittoman liikenteen tiekartan 1,65 miljoonan tonnin tavoiteltua hiilidioksidipäästövähenemää 1,1–1,8 % vuoteen 2030 mennessä. Tilastollisen kuljetuspotentiaalin siirtyminen täysin yhdistettyihin kuljetuksiin ei käytännössä ole mahdollista. Todennäköisesti niitä operoitaisiin vain osalla tarkastelluista yhteysväleistä, jolloin päästövähenemä olisi pienempi. Toisaalta kuljetuksia voi siirtyä ulkomaan liikenteen reiteiltä kasvattaen kuljetuspotentiaalia. Yhdistettyjen kuljetusten käynnistäminen vaatii investointeja rataverkkoon, terminaaleihin ja kotimaan liikenteessä uuteen vaunukalustoon. Ulkomaan liikenteen yhdistetyt kuljetukset voidaan käynnistää nykyisellä vaunukalustolla. Tarvitaan myös sitoutunut operaattori, joka tuottaa palvelun liiketaloudellisesti kestävästi kuljetusasiakasta ja operaattoria hyödyttäen. Nykyisen verotuen lisäksi tukimuotona voisivat olla ympäristöperusteiset verohelpotukset

Phase 1 Lymfactin (R) Study : Short-term Safety of Combined Adenoviral VEGF-C and Lymph Node Transfer Treatment for Upper Extremity Lymphedema

Objective: To study the safety and tolerability of Lymfactin (R) treatment combined with microvascular lymph node transfer surgery in patients with upper limb lymphedema. Background: Upper limb lymphedema is a common clinical challenge after breast cancer surgery and/or radiotherapy. Lymfactin (R) is an adenovirus type 5-based gene therapy involving expression of human vascular endothelial growth factor C (VEGF-C) in the damaged tissue. It aims to correct deficient lymphatic flow by promoting the growth and repair of lymphatic vessels. Methods: In Phase I, Lymfactin (R) was combined with microvascular lymph node transfer surgery to study the safety and tolerability of Lymfactin (R) and the biodistribution of the viral vector in patients with upper limb lymphedema. Results: Fifteen patients with breast cancer-associated secondary lymphedema of the upper arm were recruited between December 2016 and February 2018. Three patients received a lower dose (1 x 10(10)) and 12 a higher dose (1 x 10(11)) of viral particles, respectively. No dose-limiting toxicities were observed, and the study was completed with the pre-determined maximum dose. Commonly reported adverse events during the 12-month follow-up were common cold, fever, gastroenteritis, pain in the operation area, headache, muscle ache and elevated liver enzymes. Serious adverse events consisted of two erysipelas infections in the lymphedema arm (requiring hospitalization) and one hematoma of the flap donor site. Conclusions: After 12 months' follow-up, results indicate that Lymfactin (R) is well tolerated. The study continues with a 36-months efficacy and 5 years safety follow-up of the patients. The oncological safety aspects of Lymfactin (R) will require a longer follow-up period. (c) 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Pub-lished by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)Peer reviewe

A Review of Indocyanine Green Fluorescent Imaging in Surgery

The purpose of this paper is to give an overview of the recent surgical intraoperational applications of indocyanine green fluorescence imaging methods, the basics of the technology, and instrumentation used. Well over 200 papers describing this technique in clinical setting are reviewed. In addition to the surgical applications, other recent medical applications of ICG are briefly examined

Transverse myocutaneous gracilis flap reconstruction is feasible after pelvic exenteration : 12-year surgical and oncological results

Introduction: Pelvic exenteration (PE) is the only curative treatment for certain locally advanced intrapelvic malignancies. PE has high morbidity, and optimal reconstruction of the pelvic floor remains undetermined. Materials and methods: A retrospective chart review was performed at a tertiary university center to assess the surgical and oncological outcomes of 39 PE procedures over a 12-year period. The majority of patients (n = 25) underwent transverse musculocutaneous gracilis (TMG) flap reconstruction for pelvic floor reconstruction. Results: The 1- and 5-year overall survival (OS) was 72% (95%CI 58%-86%) and 48% (95%CI 31%-65%), respectively. In multivariate analysis, lymph node metastasis (HR 3.070, p = 0.024) and positive surgical margins (HR 3.928, p = 0.009) were risk factors for OS. In this population, 71.8% of the patients had at least one complication. The complication rate was 65.4% and 84.6% for patients with versus without flap reconstruction, respectively (p = 0.191). The length of stay was longer for patients with a major complication 16,0 +/- 5,9 days vs. 29,4 +/- 14,8 days, p = 0.001, but complications did not affect OS. Conclusion: For selected patients, PE is a curative option for locally advanced, residual, or recurrent intrapelvic tumors. Pelvic floor and vulvovaginal defects can reliably be reconstructed using TMG flaps. TMG flaps are favored in our institution over abdominal-based flaps because the donor site morbidity is reasonable and TMG does not interfere with enterostomy. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.Peer reviewe

Aspartylglycosaminuria in the Finnish population: Identification of two point mutations in the heavy chain of glycoasparaginase

Aspartylglycosaminuria is an inherited lysosomal storage disease caused by deficiency of glycoasparaginase (EC 3.5.1.26) and occurs with higher frequency among Finns than other populations. We have purified human glycoasparaginase and determined about 90% of the amino acid sequence of its light subunit and >70% of that of its heavy subunit by Edman degradation and mass spectrometry. Additional sequence data were obtained from the cloning and subsequent nucleotide analysis of a cDNA corresponding to the normal human glycoasparaginase gene. The enzyme is encoded by a single mRNA as a single polypeptide that is posttranslationally processed to generate the subunits and is glycosylated. After preparing first-strand cDNA from leukocyte and fibroblast total RNA, we used the polymerase chain reaction to amplify the glycoasparaginase cDNA of eight Finnish aspartylglycosaminuria patients. We demonstrate that the Finnish patients' mRNA sequence differed from the normal sequence by two single-base changes six nucleotides apart from one another in the heavy chain of glycoasparaginase. The first change resulted in the replacement of arginine by glutamine (R161Q), whereas the second change resulted in a cysteine to serine substitution (C163S). Both mutations resulted in novel restriction endonuclease sites and were present in all eight Finnish aspartylglycosaminuria patients originating from different pedigrees, but they were absent from Finnish and non-Finnish controls and a non-Finnish case of aspartylglycosaminuria. These results indicate molecular homogeneity in aspartylglycosaminuria alleles in the Finnish population

Implementing an orthoplastic treatment protocol for open tibia fractures reduces complication rates in tertiary trauma unit

Introduction: Open tibia fracture (OTF) causes a considerable increase in morbidity and risk for complications compared to closed fractures. The most significant OTF complication leading to morbidity is commonly considered to be fracture-related infection (FRI). In September 2016, Tampere University Hospital (TAUH) introduced a treatment protocol for OTFs based on the BOAST 4 guideline. The aim of this study is to investigate the outcomes before and after implementation of the OTF treatment protocol. Materials and methods: A retrospective cohort study was conducted using handpicked data from the patient record databases of TAUH from May 1, 2007, to May 10, 2021. For patients with OTF, we collected descriptive information, known risk factors for FRI and nonunion, bony fixation method, possible soft tissue reconstruction method, information about the timing of internal fixation and soft tissue coverage, and timing of primary operation. As outcome measures, we collected information on FRI, reoperation due to non-union, flap failure, and secondary amputation. We then compared the incidence of complications before and after the implementation of the OTF treatment protocol at TAUH. Results: After predefined exclusions, a total of 203 patients with OTF were included. Of these, 141 were treated before and 62 after the implementation of the OTF treatment protocol. The FRI rate in the pre-protocol group was significantly higher compared to the protocol group (20.6% vs 1.6%, p = 0.0015). The incidence of reoperation due to nonunion was also significantly higher in the pre-protocol group (27.7% vs 9.7%, p = 0.0054). According to multivariable analysis, definitive fixation and soft tissue coverage performed in separate operations was an independent risk factor for both FRI and reoperation due to nonunion. Conclusions: After implementation, the BOAST 4 based OTF treatment protocol reduced the rate of FRI and reoperation due to nonunion in patients with OTF treated at TAUH during the study period. We, therefore, recommend the implementation of such a treatment protocol in all major trauma centers treating patients with OTF. Furthermore, we also recommend the immediate referral of patients with complex OTF from hospitals lacking the preconditions to provide BOAST 4 based treatment to specialized centers.Peer reviewe

Glycosaparaginase from human leukocytes. Inactivation and covalent modification with diazo-oxonorvaline

The apparent active site of human leukocyte glycoasparaginase (N4-(beta-acetylglucosaminyl)-L-asparaginase EC 3.5.1.26) has been studied by labeling with an asparagine analogue, 5-diazo-4-oxo-L-norvaline. Glycoasparaginase was purified 4,600-fold from human leukocytes with an overall recovery of 12%. The purified enzyme has a Km of 110 microM, a Vmax of 34 mumol x l^-1 x min^-1, and a specific activity of 2.2 units/mg protein with N4-(beta-N-acetylglucosaminyl)-L-asparagine as substrate. The carbohydrate content of the enzyme is 15%, and it exhibits a broad pH maximum between 7 and 9. The 88-kDa native enzyme is composed of 19- kDa light (L) chains and 25-kDa heavy (H) chains and it has a heterotetrameric structure of L2H2-type. The glycoasparaginase activity decreases rapidly and irreversibly in the presence of 5-diazo-4-oxo-L- norvaline. At any one concentration of the compound, the inactivation of the enzyme is pseudo-first-order with time. The inhibitory constant, K1, is 80 microM and the second-order rate constant 1.25 x 10^(3) M^-1 min^-1 at pH 7.5. The enzyme activity is competitively protected against this inactivation by its natural substrate, aspartylglucosamine, indicating that this inhibitor binds to the active site or very close to it. The covalent incorporation of [5-14C]diazo-4-oxo-L-norvaline paralleled the loss of the enzymatic activity and one inhibitor binding site was localized to each L-subunit of the heterotetrameric enzyme. Four peptides with the radioactive label were generated, purified by high performance liquid chromatography, and sequenced by Edman degradation. The sequences were overlapping and all contained the amino-terminal tripeptide of the L-chain. By mass spectrometry, the reacting group of 5-diazo-4-oxo-L-norvaline was characterized as 4-oxo-L- norvaline that was bound through an alpha-ketone ether linkage to the hydroxyl group of the amino-terminal amino acid threonine