Latissimus dorsi free flaps in the elderly: an alternative to below-knee amputation

The purpose of this paper is to document that free-flap surgery may be applied in specific circumstances to elderly patients with extensive vascular insufficiency and wound coverage problems. Below-knee amputation may be a direct but not necessarily desirable answer to the elderly patient with these problems. The problems of increased energy of ambulation, prosthetic fit, and psychological depression are all accentuated in the elderly. Three free-flap patients of an average age of 80 are presented with successful wound coverage, control of ischemic pain, and early return to an independent ambulatory state. The latissimus free flap seems to be an appropriate tool for this purpose. The T-pedicle is especially suited to bridge segmental vascular deficits seen in this population. We conclude that in specific situations, this approach may be an alternative to amputation in the elderly.     

Pectoralis major musculocutaneous flaps: long-term follow-up of hypopharyngeal reconstruction

We have reviewed our experience with 25 patients who have undergone major head and neck resections and required hypopharyngeal pectoralis major flap reconstruction. Six patients were alive 1 year following reconstruction and five patients consented to evaluation of flap function with endoscopy, with biopsy, barium swallow, and esophageal manometrics. The patients were older (61 +/- 6 years) and the flaps were large (42 +/- 9 cm2). Barium studies were the most useful method of evaluating these patients. Postoperative stricture and laryngeal aspiration were found in two patients. Biopsy of the flap demonstrated loss of keratin in the overlying epidermis, while the gross appearance was more like the surrounding mucosa. A review of dietary intake in these cases revealed that two patients weighed less than their preoperative weights, while another refused oral feedings despite a good functional result. Three of five patients preferred gastrostomy feedings to oral alimentation.     

Bacteriocin: safest approach to preserve food products

Start of the 21st century with its universal call to feed the hungry is an appropriate time to refocus attention on food security and especially the impact of biopatenting on poor communities who are the primary victims of hunger in our world. Antibacterial metabolites of lactic acid bacteria and Bacillus spp have potential as natural preservatives to control the growth of spoilage and pathogenic bacteria in food. Among them, bacteriocin is used as a preservative in food due to its heat stability, wider pH tolerance and its proteolytic activity. Due to thermo stability and pH tolerance it can withstand heat and acidity/alkanity of food during storage condition. Bacteriocin are ribosomally synthesized peptides originally defined as proteinaceous compound affecting growth or viability of closely related organisms. Research is going on extensively to explore the nascent field of biopreservation. Scientists all over the world are showing their keen interest to isolate different types of bacteriocin producing strains and characterize bacteriocin produced by them for food preservation.     

The Cronin push-back palate repair with nasal mucosal flaps: a speech evaluation

This is a retrospective study of 92 cleft palate patients who had been repaired with the Cronin push-back palate repair with nasal mucosal flaps. The patients were evaluated by a speech pathologist for intelligibility, articulation, and resonance and rated using a 5-point scale devised for this study. Readily intelligible speech was present in 78 percent. Normal articulation was present in 66 percent. Normal resonance was present in 78 percent of the total subject group. Secondary procedures were performed in 14 percent of the group. Repaired clefts of the soft palate achieved a high rate of normal intelligibility, articulation, and resonance. Repaired submucous clefts and short palates achieved the lowest percent of normal articulation and resonance. Educational placement, hearing, and type of structural deformity all appear to influence the ultimate communication outcome.     

White gels: an easy way to preserve methylene blue stained gels

Methylene blue can be used as a stain for visualizing nucleic acids in polyacrylamide gel electrophoresis. However, its relatively low sensitivity and reversible binding make it a temporary stain that diffuses from the gel relatively fast. Here we describe a very simple method for fixing methylene blue bands in nucleic acid polyacrylamide gels. The procedure makes the methylene blue stain permanent and increases the visibility of the bands, also contributing to increasing the sensitivity of methylene blue.     

Circumcising human subjects: An evaluation of experimental foreskin amputation using the Declaration of Helsinki

This paper explores ethical considerations for active studies of circumcision, i.e., the amputation of the foreskin, in the form of a case study of three major trials performed in African countries in the early 2000s. The paper outlines the function of the foreskin and method and history of its amputation as well as its current use in attempting to combat the global AIDS crisis. These trials are then interrogated in accordance with the Declaration of Helsinki. In particular, the irreversible nature of amputation is given great consideration. The case studies are found to have serious failures in terms of the modern iteration of the Declaration of Helsinki. This paper calls for extreme scrutiny in accordance with international norms relating to the ethical treatment of human subjects in a research context of studies of circumcision if and when they are proposed again.     

Heavy-meromyosin-decorated actin filaments: a simple method to preserve actin filaments for rotary shadowing

It has become accepted that deep-freeze-drying at or below -90 degrees C is necessary to preserve the structure of supramolecular assemblies such as actin filaments (AFs) for metal shadowing. This has kept the metal shadowing technique from widespread use in the study of proteins complexed with AFs because of the limited availability of the apparatus for deep-freeze-drying. I report here that adsorption to freshly cleaved mica, treatment with buffered uranyl acetate in glycerol solution, rinsing, and removal of liquid eliminate the need of freeze-drying to preserve the structure of AFs. This technique, in combination with metal shadowing, was applied to the study of AFs decorated with heavy meromyosin (HMM). It was observed that (1) when HMM molecules are associated with single AFs in the majority of cases only one head of each HMM molecule makes contact at the point furthest from the neck region; (2) binding of HMM causes bundling of AFs, probably by the two heads of each molecule binding different filaments; and (3) the binding of HMM to the bundled AFs appears to be more stable than that to a single AF. This method of specimen preparation requires no freeze-drying and is therefore easily applicable to other large protein complexes.     

Nipple reconstruction using the C-V flap technique: a long-term evaluation

Numerous procedures are available for nipple reconstruction with no true universal favorite. This study presents long-term follow-up data for nipple reconstruction using the C-V flap technique. Patients were identified by searching the Breast Reconstruction Database, and they were asked to return for a follow-up visit. All those who underwent nipple reconstruction using the C-V flap technique between January of 1992 and December of 1996 were reviewed in an attempt to conduct a long-term follow-up evaluation. The response was poor, and 11 patients participated in the study and returned for follow-up. They all completed a questionnaire, which focused on patient satisfaction using a visual analogue scale. Nipple measurements were taken with a caliper and compared with the opposite breast for symmetry. Fourteen nipple reconstructions were evaluated in 11 patients with an average follow-up of 5.3 years. All patients had undergone transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions. Patient satisfaction was 42 percent with nipple projection, 62 percent with pigmentation, and 26 percent with sensation. Overall patient satisfaction with the procedure was 81 percent. Average nipple projection of the reconstructed nipple was 3.77 mm and was not statistically different when compared with the opposite nipple. Long-term subjective evaluation of the C-V flap technique does report a loss in nipple projection; however, overall patient satisfaction at 5.3 years is good, as is the ability to restore symmetry with the opposite breast.     

Quieting response training: long-term evaluation of a clinical biofeedback practice

Clinical evidence for the long-term effectiveness of biofeedback related relaxation training is accumulating. The purpose of this report is to describe the population, self-regulation procedure, outcome criteria, and final outcome for patients who received Quieting Response (QR) training. Data from 340 patients who completed at least the first follow-up at 3 months is presented. Primary presenting symptoms were headaches, 72%; primary and secondary Raynaud's, 14%; hypertension, 4%; irritable colon, 4%; and miscellaneous, 6%. QR training integrated EMG and thermal feedback with deep breathing, progressive relaxation, and autogenic exercises presented on cassette tapes. Eight 1-hour weekly sessions were given, with emphasis on daily home exercises. Follow-up evaluations were at 3 months, 6 months, 1 year, and 2 years. Outcome was based on change in frequency, severity, and duration of symptoms; changes in medication; and secondary benefits. Quieting Response training was found to be most beneficial for patients with primary Raynaud's disease (18 of 23 patients, or 78% successful), classic migraines (9 of 13, or 69%), and common migraines (20 of 32, or 62%), followed by mixed headaches (79 of 131, or 60%), Raynaud's plus other symptoms (9 of 15, or 60%), and the irritable colon syndrome (7 of 13, or 54%). Less successful were patients with headaches plus other symptoms (16 of 37, or 43%), muscle contraction headaches (13 of 33, or 39%), secondary Raynaud's phenomenon (4 of 10, or 40%), and essential hypertension (5 of 15, or 33%). Speculations about the differing outcomes across symptom groups were made.     

Mites (Acari,Mesostigmata) in boreal Scots pine forest floors: effect of distance to stumps

Coarse woody debris (CWD) is a basic component of forest ecosystems and it plays a crucial role in species-poor boreal forests. Generally, previous studies have focused on differences between the forest floor and decaying logs of various tree species. The impact of distance to CWD has been investigated mainly for forest-floor snails and some groups of macrofauna, but not yet for mesostigmatid mites communities. We hypothesized that the effect of CWD decreases with increasing distance from CWD. To test this hypothesis we conducted a study in relatively species-poor Finnish boreal forest (at ca. 100 km northwest of Helsinki). In total, 81 samples were collected in 2007 from nine Scots pine (Pinus sylvestris) stumps, three microhabitats (CWD, soil/litter at 0.5 m from a stump and soil/litter at 1.5 m from a stump) and in three main directions (9 stumps × 3 microhabitats × 3 directions). Overall, 1965 mesostigmatid mites were collected representing 24 species. The mean number of mite species collected was significantly different between decaying stumps and forest litter; however, there was no significant difference between the litter samples at 0.5 and 1.5 m distance. The evenness index was significantly lower for samples collected from stumps than for litter in close (0.5 m) or far (1.5 m) distance. The most frequently encountered mite species were Veigaia nemorensis, Parazercon radiatus and Zercon zelawaiensis.     

An evaluation of eight methods of using fluorescein to predict the viability of skin flaps in the pig

The brightness of the fluorescence of fluorescein can be increased by the use of special (interference) filters that allow visualization of the dye when much smaller doses have been given. Standard random-pattern skin flaps were made in pigs and low (1 mg/kg) and high (500 mg) doses of fluorescein were given intravenously. The dye distribution in the flaps was evaluated visually, photographically, and with a dermofluorometer. All the methods proved reasonably accurate in predicting survival, although in an occasional flap, readings by all the methods were off by as much as 3.5 cm. The traditional Wood's lamp visualization proved to be as accurate as any of the newer methods. The inaccuracies of the fluorescein test are probably inherent in the method, since it only measures vascularity at the time the dye is given--and blood supply can change. The main advantage of low-dose fluorescein is that it allows repeated injections at reasonably close intervals. For serial observations, the dermofluorometer is unquestionably the best method.     

Free microvascular muscle flaps with skin graft reconstruction of extensive defects of the foot: a clinical and gait analysis study

Over the past 4 years at the Massachusetts General Hospital 18 patients have been treated for extensive defects (mean size 130 cm2) of the foot at or below the medial and lateral malleoli. These patients have been treated with free muscle flaps covered with thick split-thickness skin grafts. Full muscle flap survival has been seen in each patient, and all patients are currently ambulatory. A subgroup of nine patients are weight-bearing directly upon their skin grafts covering transferred muscle. All patients are walking without chronic breakdown over a mean follow-up of over 19 months with the exception of a single patient who has had breakdown in a region of redundant improperly tailored muscle flap. None of the skin grafted muscles has significant cutaneous sensibility. Detailed gait analysis of these patients has confirmed the weight-bearing capabilities of free muscle flaps with skin grafts and has proven to be an excellent method of foot reconstruction evaluation. It would appear from this study that cutaneous sensibility may not be necessary for successful reconstruction of the weight-bearing surface of the foot. This method of reconstruction should be considered when local tissues are not suitable for plantar foot reconstruction.