Lymphovenous anastomosis and debulking procedure for treatment of combined severe lower extremity and genital lymphedema: A case report

Lymphedema most commonly occurs after cancer treatment and can affect limbs and genitalia. Genital lymphedema (GL) is a rare condition and can be disabling psychologically and physically. It often occurs along with lower extremity lymphedema (LEL). Conservative and physiologic reconstructive surgery such as lymphaticovenous anastomosis (LVA) offer good treatment options for LEL. GL however remains a reconstructive dilemma. The most effective surgical therapies in advanced GL are still debulking procedures in properly selected patients. Here, we present the surgical treatment of a 51 ‐year‐old male patient with advanced and combined genital and right lower extremity lymphedema after Hodgkin lymphom treatment in the childhood. We performed multiple LVA to the right ankle joint, distal lower leg and lateral knee and 2 months later patient reported a significant decrease of pain and pressure in affected limb while the scrotal and penis lymphedema did not show any signs of improvement at all. Four months later, 4.9 kg of excessive lymphedematous tissue from the genital area was resected and covered by split‐thickness skin grafts from the unaffected left upper thigh. The postoperative course was uneventful and 3 weeks postoperatively the skin graft healed completely. Follow up at 6 months showed reasonable cosmetic and functional outcomes and the patient reported a significant improvement of quality of life. We believe that debulking procedures and LVA may be combined in advanced GL and LEL and may provide good outcomes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146626/1/micr30331.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146626/2/micr30331_am.pd

Phylogeography and Genetic Ancestry of Tigers (Panthera tigris)

Eight traditional subspecies of tiger (Panthera tigris), of which three recently became extinct, are commonly recognized on the basis of geographic isolation and morphological characteristics. To investigate the species' evolutionary history and to establish objective methods for subspecies recognition, voucher specimens of blood, skin, hair, and/or skin biopsies from 134 tigers with verified geographic origins or heritage across the whole distribution range were examined for three molecular markers: (1) 4.0 kb of mitochondrial DNA (mtDNA) sequence; (2) allele variation in the nuclear major histocompatibility complex class II DRB gene; and (3) composite nuclear microsatellite genotypes based on 30 loci. Relatively low genetic variation with mtDNA, DRB, and microsatellite loci was found, but significant population subdivision was nonetheless apparent among five living subspecies. In addition, a distinct partition of the Indochinese subspecies P. t. corbetti into northern Indochinese and Malayan Peninsula populations was discovered. Population genetic structure would suggest recognition of six taxonomic units or subspecies: (1) Amur tiger P. t. altaica; (2) northern Indochinese tiger P. t. corbetti; (3) South China tiger P. t. amoyensis; (4) Malayan tiger P. t. jacksoni, named for the tiger conservationist Peter Jackson; (5) Sumatran tiger P. t. sumatrae; and (6) Bengal tiger P. t. tigris. The proposed South China tiger lineage is tentative due to limited sampling. The age of the most recent common ancestor for tiger mtDNA was estimated to be 72,000–108,000 y, relatively younger than some other Panthera species. A combination of population expansions, reduced gene flow, and genetic drift following the last genetic diminution, and the recent anthropogenic range contraction, have led to the distinct genetic partitions. These results provide an explicit basis for subspecies recognition and will lead to the improved management and conservation of these recently isolated but distinct geographic populations of tigers

The Social Structure if the Hill Juang

This is a study of the Hill Juang, a tribe of shifting cultivators in Orissa, India. It is based on fifteen months of field research in Keonjhar District, Orissa, in 1960-62, made possible by a Predoctoral Research Training Fellowship awarded by the Social Science Research Council, New York

Restatement of the Law of Torts

Here in these late sections (Division Ten, Volume Four) of the Restatement of Torts, the American Law Institute\u27s most recent effort to promote certainty and clarity and so to avoid either a confused common law system or rigid legislative codes, are tucked away certain chapters on what property teachers have been accustomed to call natural rights. Of these, Chapter 41 deals with Invasions of Interests in the Private Use of Waters ( Riparian Rights ), Chapter 40 with Invasions of Interests in the Private Use of Land (Private Nuisance) and Chapter 39 with Invasions of Interests in the Support of Land