Optimising breast reconstruction. A clinical study on autologous breast reconstruction

Denne avhandlingen omhandler metoder for å optimalisere utfallet av brystrekonstruksjon ved bruk av kroppseget vev. Det første delarbeidet beskriver en kirurgisk teknikk som kombinerer to lapper fra henholdsvis buken (DIEP og TRAM lapper) og ytre deler av brystkassen (LICAP lapp) for å oppnå større volum og penere fasong på det rekonstruerte brystet hos kvinner med lite overskuddsvev på buken. LICAP lapp til brystrekonstruksjon er tidligere beskrevet, men en ny design på lappen resulterte i et bedre estetisk resultat enn med tidligere brukt teknikk. Det andre delarbeidet beskriver verdien termografi for å kartlegge lokalisasjonen av blodkar under huden (perforanter) til i planlegging av brystrekonstruksjon ved bruk av lapper fra øvre del av ryggen (TDAP lapp). Samme visualiseringsteknikk ble også funnet nyttig under og etter kirurgisk behandling for å overvåke blodforsyningen i det rekonstruerte brystet. Termografi er gunstig ved at en unngår potensielt farlige og mer arbeidskrevende teknikker som baseres på røntgenstråling eller intravenøse kontrastmidler, som ellers er hyppig brukt. Tidligere studier av intravenøs væskebehandling ved større kirurgi har vist at altfor liberal væsketilførsel kan øke risikoen for komplikasjoner og forlenge sykehusoppholdet. I det tredje delarbeidet ble to forskjellige strategier for intraoperativ væskebehandling sammenlignet, i forbindelse med mikrokirurgisk brystrekonstruksjon ved abdominale lapper. Resultatene viste at en restriktiv intravenøs væskebehandling i kombinasjon med bruk av noradrenalin og propofol, for å motvirke blodtrykksfall og gi økt blodforsyning til det transplantert vevet, var forenlig med færre komplikasjoner og kortere sykeleie. Spesielt forekom komplikasjoner relatert til det transplanterte vevet i betydelig mindre grad i pasientgruppen med lavere total intraoperativ væskevolum. Kombinasjon av lappeplastikker ved mikrokirurgisk brystrekonstruksjon, termografi for å sikre adekvat blodforsyning og en restriktiv intraoperativ væsketerapi er faktorer som kan bidra til er bedre resultat og mindre risiko ved avansert rekonstruktiv brystkirurgi.Breast reconstruction using the patient’s own tissue is common, but the surgical procedures can be complex. This project evaluated new methods to reduce the risks for complications and improve overall outcome after such surgery. In patients with limited surplus tissue on the lower abdomen, larger breast volume and improved aesthetic outcome was achieved when an abdominal free tissue transplant was combined with a local flap from the axillary area. Registration of heat radiation from the skin surface proved a valuable and safe technique to ensure proper flap design before tissue transplantation and to monitor flap blood perfusion during and after surgery, enabling swift correction of compromised flap perfusion. On assessment of intraoperative fluid management, a restricted fluid infusion combined with vasoactive drugs to ensure adequate blood pressure was correlated with less postoperative complications and shorter hospital stay as compared to a more liberal fluid management

The value of dynamic infrared thermography in pedicled thoracodorsal artery perforator flap surgery

Background: Dynamic infrared thermography (DIRT) is a noninvasive imaging technique that can provide indirect and real-time information on skin perfusion by measuring skin temperature. Although used in flap surgery, there are no reports on its value in procedures using a pedicled thoracodorsal artery perforator (TDAP) flap. The aim of this study was to assess the usefulness of DIRT in preoperative perforator mapping and in monitoring intra- and postoperative flap perfusion of pedicled TDAP flaps. Methods: This prospective study comprised 21 patients (21 flaps) scheduled for reconstructive surgery with a TDAP flap. Perforator mapping was done by DIRT, handheld unidirectional Doppler ultrasound, and computer tomography angiography. Intra- and postoperative flap perfusion was assessed by clinical signs and with the use of DIRT and handheld unidirectional Doppler ultrasound. Results: Perforator mapping with DIRT showed that first-appearing bright hotspots were always associated with arterial Doppler sounds and suitable perforators intraoperatively. Computer tomography angiography presented useful information on the thoracodorsal artery branching pattern but was less beneficial for perforator mapping. Intra- and postoperative flap monitoring with DIRT was more useful than handheld unidirectional Doppler ultrasound and clinical signs to detect early arterial and venous perfusion problems. DIRT demonstrated that TDAP flap perfusion is a dynamic process with an increase in perfusion during the first operative days. Nineteen flaps survived, of which 3 sustained distal necrosis. Two flaps were lost due to inadequate blood perfusion. Conclusion: DIRT provides valuable real-time information for perforator mapping and for monitoring TDAP flap perfusion intra- and postoperatively

Roles of Cholesterol and Lipids in the Etiopathogenesis of Alzheimer's Disease

Alzheimer's disease is the principal cause of dementia throughout the world and the fourth cause of death in developed economies.This brain disorder is characterized by the formation of brain protein aggregates, namely, the paired helical filaments and senile plaques. Oxidative stress during life, neuroinflamamtion, and alterations in neuron-glia interaction patterns have been also involved in the etiopathogenesis of this disease. In recent years, cumulative evidence has been gained on the involvement of alteration in neuronal lipoproteins activity, as well as on the role of cholesterol and other lipids in the pathogenesis of this neurodegenerative disorder. In this review, we analyze the links between changes in cholesterol homeostasis, and the changes of lipids of major importance for neuronal activity and Alheimer's disease. The investigation on the fine molecular mechanisms underlying the lipids influence in the etiopathogenesis of Alzheimer's disease may shed light into its treatment and medical management

Severe thiamine deficiency in eastern Baltic cod (Gadus morhua)

The eastern Baltic cod (Gadus morhua) population has been decreasing in the Baltic Sea for at least 30 years. Condition indices of the Baltic cod have decreased, and previous studies have suggested that this might be due to overfishing, predation, lower dissolved oxygen or changes in salinity. However, numerous studies from the Baltic Sea have demonstrated an ongoing thiamine deficiency in several animal classes, both invertebrates and vertebrates. The thiamine status of the eastern Baltic cod was investigated to determine if thiamine deficiency might be a factor in ongoing population declines. Thiamine concentrations were determined by chemical analyses of thiamine, thiamine monophosphate and thiamine diphosphate (combined SumT) in the liver using high performance liquid chromatography. Biochemical analyses measured the activity of the thiamine diphosphate-dependent enzyme transketolase to determine the proportion of apoenzymes in both liver and brain tissue. These biochemical analyses showed that 77% of the cod were thiamine deficient in the liver, of which 13% had a severe thiamine deficiency (i.e. 25% transketolase enzymes lacked thiamine diphosphate). The brain tissue of 77% of the cod showed thiamine deficiency, of which 64% showed severe thiamine deficiency. The thiamine deficiency biomarkers were investigated to find correlations to different biological parameters, such as length, weight, otolith weight, age (annuli counting) and different organ weights. The results suggested that thiamine deficiency increased with age. The SumT concentration ranged between 2.4-24 nmol/g in the liver, where the specimens with heavier otoliths had lower values of SumT (P = 0.0031). Of the cod sampled, only 2% of the specimens had a Fulton's condition factor indicating a healthy specimen, and 49% had a condition factor below 0.8, indicating poor health status. These results, showing a severe thiamine deficiency in eastern Baltic cod from the only known area where spawning presently occurs for this species, are of grave concern

MediaEval 2017 Predicting Media Interestingness Task

Non peer reviewe

Higher CSF/serum free-T4 ratio is associated with improvement of quality of life during treatment with L-thyroxine

Up to 20% of individuals with primary hypothyroidism treated with L-thyroxine still suffer from severe symptoms. These are supposedly brain derived and involve both cognitive and emotional domains. Previously, no consistent relationship has been found between thyroid hormones (TH) or TSH levels in blood and quality of life (QoL). Recently, we reported an association between cerebrospinal fluid (CSF)/serum free-thyroxine (f-T4) ratio and QoL, in juvenile hypothyroid patients. Here, we investigated if CSF/serum f-T4 ratio and QoL estimates correlate also during L-thyroxine treatment. Moreover, the CSF biomarker neurogranin (Ng) was used as a biomarker for synaptic function and integrity in clinical research. Ng is partially controlled by TH and therefore we investigated the relationship between QoL parameters and Ng levels. Patients diagnosed with primary hypothyroidism were investigated using vital parameters, serum and CSF analyses of TH, TSH, Ng and QoL questionnaires. Similar procedures were performed after 6 months of treatment. The most marked associations with QoL were found for CSF/serum f-T4 ratio, which was strongly related to several QoL parameters such as the mental subscore of SF-36 (r = 0.83, p <.0005). Ng, which did not differ from that in our healthy controls, was lower in some patients during treatment and higher in others. However, the change in Ng during treatment was significantly correlated with QoL parameters including the mental subscore of SF-36 (r = −0.86, p <.0001). In addition, the CSF/serum f-T4 ratio correlated with the change in Ng (r = −0.75, p =.001). Our results suggest that the ratio between CSF and serum f-T4 is an important biomarker for QoL during treatment of patients with primary hypothyroidism, so far in research, but in the future maybe also in clinical settings. Moreover, this ratio also correlates with the changes in Ng levels during L-thyroxine treatment, further supporting the impact of the TH balance between serum and CSF on QoL