Inframalleolar Bypass Grafts for Limb Salvage

AbstractObjectiveTo report our experience of long-term results of inframalleolar bypass.DesignRetrospective analysis.Materials and methodsWe analysed 122 inframalleolar bypasses performed between January 1991 and June 2005 in 116 patients. Most patients were treated for critical ischaemia (97%). The indication for the use of podalic arteries was a lack of tibial arteries with run-off to the foot. The dorsalis pedis was predominantly used for distal anastomoses (62.3%) and the greater saphenous vein (84.4%) as the conduit. The follow-up periods ranged from 1 to 60 months. The endpoints analysed were graft patency, limb salvage, preservation of deambulation and survival rate.ResultsThe cumulative patency was 58.2% at 3 years and 53.4% at 5 years. The best results were achieved with the devalvulated greater saphenous veins. Limb salvage was 70.0% at 3 years and 50.4% at 5 years, with preserved deambulation rates of 57.3% and 47.1%, respectively. There were 36 major and 45 minor amputations. At 3 years, the survival rate was 50.2% and the surgical mortality 13%. Female sex was associated with worse results for cumulative patency and limb salvage (P<0.01).ConclusionsIn the long term, inframalleolar bypass is a satisfactory option for limb salvage

Bone Flap Management In Neurosurgery

Bone flap removal procedure is growing in frequency in neurosurgical practice. Decompressive craniotomy has gained more scientifical evidences of its therapeutical value in post-traumatic brain swelling, in cerebrovascular diseases and in brain edema non - responding to clinical treatment after elective surgeries. Bone flap destination after craniotomy has many possible fates. We present a literature review of bone flap management in neurosurgical practice: technical preservation of bone flaps (under the scalp, in the abdominal wall, frozen), when to remove the bone flap and what to do when it is dropped during the craniotomy or is infected.172133137Movassaghi, K., Ver Halen, J., Ganchi, P., Amin-Hanjani, S., Mesa, J., Yaremchuk, M.J., Cranioplasty with subcutaneously preserved autologous bone grafts (2006) Plast Reconstr Surg, 117 (1), pp. 202-206Hauptli, J., Segantini, P., New tissue preservation method for bone flaps following decompressive craniotomy (1980) Helv Chir Acta, 47 (1-2), pp. 121-124Tybor, K., Fortuniak, J., Komunski, P., Papiez, T., Andrzejak, S., Jaskólski, D., Supplementation of cranial defects by an autologous bone flap stored in the abdominal wall (2005) Neurol Neurochir Pol, 39 (3), pp. 220-224Josan, V.A., Sgouros, S., Walsh, A.R., Dover, M.S., Nishikawa, H., Hockley, A.D., Cranioplasty in children (2005) Childs Nerv Syst, 21 (3), pp. 200-204Flannery, T., McConnell, R.S., Cranioplasty: Why throw the bone flap out? (2001) Br J Neurosurg, 15 (6), pp. 518-520Krishnan, P., Bhattacharyya, A.K., Sil, K., De, R., Bone flap preservation after decompressive craniectomy - experience with 55 cases (2006) Neurol India, 54 (3), pp. 291-292Korfali, E., Aksoy, K., Preservation of craniotomy bone flaps under the scalp (1988) Surg Neurol, 30 (4), pp. 269-272Goel, A., Deogaonkar, M., Subgaleal preservation of calvarial flaps (1995) Surg Neurol, 44 (2), pp. 181-182. , Aug;, discussion 182-3Pasaoglu, A., Kurtsoy, A., Koc, R.K., Kontas, O., Akdemir, H., Öktem, I.S., Cranioplasty with bone flaps preserved under the scalp (1996) Neurosurg Rev, 19 (3), pp. 153-156Iwama, T., Yamada, J., Imai, S., Shinoda, J., Funakoshi, T., Sakai, N., The use of frozen autogenous bone flaps in delayed cranioplasty revisited (2003) Neurosurgery, 52 (3), pp. 591-596Winkler, P.A., Stummer, W., Linke, R., Krishnan, K.G., Tatsch, K., The influence of cranioplasty on postural blood flow regulation, cerebrovascular reserve capacity, and cerebral glucose metabolism (2000) Neurosurg Focus, 8 (1), pp. e9Matsuno, A., Tanaka, H., Iwamuro, H., Takanashi, S., Miyawaki, S., Nakashima, M., Analyses of the factors influencing bone graft infection after delayed cranioplasty (2006) Acta Neurochir (Wien), 148 (5), pp. 535-540Yacubian-Fernandes, A., Laronga, P.R., Coelho, R.A., Ducati, L.G., Silva, M.V., Prototyping as an alternative to cranioplasty using methylmethacrylate: Technical, 62 (3 B), pp. 865-868. , note. Arq Neuropsiquiatr 2004;Chiarini, L., Figurelli, S., Pollastri, G., Torcia, E., Ferrari, F., Albanese, M., Cranioplasty using acrylic material: A new technical procedure (2004) J Craniomaxillofac Surg, 32 (1), pp. 5-9Korinek, A.M., Risk factors for neurosurgical site infections after craniotomy: A prospective multicenter study of 2944 patients. The French Study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord. Service Epidemiologie Hygiene et Prevention (1997) Neurosurgery, 41 (5), pp. 1073-1079Bruce, J.N., Bruce, S.S., Preservation of bone flaps in patients with postcraniotomy infections (2003) J Neurosurg, 98 (6), pp. 1203-1207Auguste, K.I., McDermott, M.W., Salvage of infected craniotomy bone flaps with the wash-in, wash-out indwelling antibiotic irrigation system. Technical note and case series of 12 patients (2006) J Neurosurg, 105 (4), pp. 640-644Jankowitz, B.T., Kondziolka, D.S., When the bone flap hits the floor (2006) Neurosurgery, 59 (3), pp. 585-59

Bioevaluation of the nutritional status of rice (Oriza sativa L. cv. IAC-165) and bean (Phaseolus vulgaris L. cv. carioca) plants using 15N and 32P

Arroz e feijão foram cultivados em soluções nutritivas em presença de três níveis de N, P e K. O método da bioavaliação do estado nutricional em que raízes destacadas absorvem elementos marcados, no caso presente 15N e 32P, foi comparado com o de diagnose foliar. Foram tiradas duas conclusões principais: 1) os bioensaios mostraram ser um procedimento rápido e útil para o diagnóstico do estado nutricional das duas espécies, visto haver correlação significativa negativa entre absorção e produção de matéria seca; 2) a absorção de dois isótopos pelas raízes da planta previamente submetida a níveis diferentes de N e de P na solução foi inversamente proporcional aos teores foliares desses elementos.Rice and bean plants were grown in nutrient solution in the presence of three levels of N, P and K. The method of the bioevaluation of the nutricional status, in which excised roots are allowed to take up tagged elements, in this case 15N and 32P, was compared with foliar analysis. Two main conclusions were drawn: 1) the bioevaluation proved to be an useful and rapid procedure for the diagnosis of the nutricional status of both species, since there was a significant negative correlation between absorption of N and P and dry matter yield; 2) the uptake of the tagged ions with either element by the roots of plants grown under deficient levels of N and P in the nutrient solution was inversely proportional to the leaf concentration of both nutrients

Neurolysin knockout mice generation and initial phenotype characterization

The oligopeptidase neurolysin (EC 3.4.24.16; Nln) was first identified in rat brain synaptic membranes and shown to ubiquitously participate in the catabolism of bioactive peptides such as neurotensin and bradykinin. Recently, it was suggested that Nln reduction could improve insulin sensitivity. Here, we have shown that Nln knockout mice (KO) have increased glucose tolerance, insulin sensitivity and gluconeogenesis. KO mice have increased liver mRNA for several genes related to gluconeogenesis. Isotopic label semi-quantitative peptidomic analysis suggests increase in specific intracellular peptides in gastrocnemius and epididymal adipose tissue, which likely is involved with the increased glucose tolerance and insulin sensitivity in the KO mice. These results suggest the exciting new possibility that Nln is a key enzyme for energy metabolism and could be a novel therapeutic target to improve glucose uptake and insulin sensitivity

Non-linear Liouville and Shr\"odinger equations in phase space

Unitary representations of the Galilei group are studied in phase space, in order to describe classical and quantum systems. Conditions to write in general form the generator of time translation and Lagrangians in phase space are then established. In the classical case, Galilean invariance provides conditions for writing the Liouville operator and Lagrangian for non-linear systems. We analyze, as an example, a generalized kinetic equation where the collision term is local and non-linear. The quantum counter-part of such unitary representations are developed by using the Moyal (or star) product. Then a non-linear Schr\"odinger equation in phase space is derived and analyzed. In this case, an association with the Wigner formalism is established, which provides a physical interpretation for the formalism

Mayaro Fever Virus, Brazilian Amazon

In February 2008, a Mayaro fever virus (MAYV) outbreak occurred in a settlement in Santa Barbara municipality, northern Brazil. Patients had rash, fever, and severe arthralgia lasting up to 7 days. Immunoglobulin M against MAYV was detected by ELISA in 36 persons; 3 MAYV isolates sequenced were characterized as genotype D