Internal Vessels Research Articles

Covering implantable left ventricular assist device (DuraHeart®) with free flap

Severe donor shortage in Japan makes the waiting period for heart transplantation extremely long and the left ventricular assist devices (LVADs) are often used for bridge-to-transplant. We present three cases of infected and exposed DuraHeart LVAD system treated with free flaps. Four free flaps (two latissimus flaps and two anterolateral thigh flaps) were transferred using the right internal thoracic vessels or left deep inferior epigastric vessels as recipients. The potential significance of the continuous low pressure blood flow generated by the LVAD system on microvascular patency has not been previously reported. All flaps survived and worked efficiently to control the infection and cover the devices. Heart transplantation was conducted in the two of three patients. Free flap transfer is an efficient treatment for the patients with infected and exposed implantable LVAD.

Looking a bit superficial to the pleura.

BackgroundThe internal thoracic artery (ITA) is a descendant branch of the subclavian artery. The former is located bilaterally in both internal sides of the thorax near the sternum and is accompanied by two internal thoracic veins (ITV). From a practical point of view, the ITA (and the ITV) identification is important because these vessels can be injured when pericardiocentesis with the parasternal approach is used. Other advantage of the ITA recognition is to check the patency of the ITA grafts in coronary artery revascularizated patients with new onset chest pain. The purpose of this article is to introduce a simple ultrasonographic technique for recognition of the aforementioned vessels and to highlight the utility of this finding in clinical practice.FindingsWith linear probe and along paraesternal line, the internal thoracic vessels are recognized on grayscale imaging as an anechoic tubular structure immediately anterior to pleural line. Color Doppler identifies a pulsatile (ITA) and a non-pulsatile (ITV) flow. Spectral Doppler normally shows a high resistance velocity profile in non-grafted ITA and a phasic flow in ITV. A biphasic low resistance velocity profile is normally expected in the grafted and permeable ITA.ConclusionsThe ITA (non-grafted) and ITV are recognized routinely along the parasternal line. The operators should identify these vessels when the parasternal approach pericardiocentesis is required and should also consider obtaining spectral Doppler images to check permeability of grafted ITA in coronary artery bypass graft patients with chest pain.

Substraction Acetazolamide SPECT Co-registered to MRI in Moyamoya Disease

A 48-year-old-woman suffering from recurrent left hemipalsy was referred to the hospital. MRI showed hyperintense lesions in periventricular white matter. Cerebral angiography revealed stenosis in the bilateral internal carotid and hypertrophic collateral vessels at the brain base, compatible with moyamoya syndrome. A visual comparison between perfusion SPECT with and without acetazolamide is employed in evaluation of these patients. Nevertheless, this traditional evaluation has some drawbacks associated with the variability between the 2 SPECT images and the lack of anatomical information. We propose a quantitative method based on the realigment, normalization, substraction, and co-registration of the 2 perfusion SPECT with MRI.

Sentinel lymph node dissection combined with meticulous histology increases the detection rate of nodal metastases in prostate cancer

To evaluate benefits of sentinel lymph node (SLN) biopsy for staging accuracy in prostate cancer. Extended pelvic lymph node dissection (ePLND) is a preferred staging tool; however, it may underestimate the incidence of nodal involvement. Eighty patients with estimated risk of lymphadenopathy above 5 % based on Briganti nomogram had Tc-99m-labeled nanocolloid injected into the prostate. Planar lymphoscintigraphy and single-photon emission computed tomography/CT were performed to localize SLNs. Radioguided SLN dissection was followed by backup ePLND comprising external iliac, obturator and internal iliac regions. All SLNs were serially sectioned every 150 μm and examined using hematoxylin and eosin; immunohistochemical staining was applied every 300 μm. A total of 335 SLNs were detected, and 17 % were located outside ePLND template. Nodal metastases were diagnosed in 32 patients (40 %). Without radioguided SLN localization, solitary metastases posteriorly to the branches of the internal ilaic vessels, in pararectal and common iliac regions would not have been removed in five of 32 patients (16 %). Using standard histology protocol, we would have diagnosed metastases in 23 patients with median size of 2.8 mm. Serial sectioning of SLN and immunohistochemistry led to the detection of metastases in additional nine patients (28 %) with median size of 0.2 mm. ePLND comprised 83 % of SLNs, at least one SLN laid outside its template in 28 % of patients. ePLND and SLN dissection combined with nodal serial sectioning and immunohistochemistry increased the detection rate of nodal metastases by 68 % in comparison with ePLND alone and standard histology protocol.

Shoulder silhouette and axilla reconstruction with free composite elbow tissue transfer following interscapulothoracic amputation

Interscapulothoracic amputation (ISTA) encompasses the removal of the upper limb, scapula and clavicle. As the reconstructive and oncologic limb-saving techniques improved, the indications for this formidable procedure decreased. However, it is still the appropriate procedure in cases with extensive oncologic or traumatic involvement of the shoulder girdle. Following ISTA, the surgeon is not only faced with a large defect but also with severe functional and aesthetic impairments. A solution to these problems is the immediate reconstruction with a free composite transfer from the amputated extremity. We successfully treated three oncologic cases and one traumatic case using this technique. The recipient vessels included the subclavian artery and vein in three cases and the internal thoracic vessels in one case. After a mean follow-up time of 4.5 years, two of the three tumour patients were free of recurrent disease. In all cases stable wound closure was achieved. Three out of four patients would opt for surgery again, in spite of the high occurrence of complications. One patient died after a 14-year event-free postoperative course. We conclude that the defect following ISTA can be successfully covered using a free composite tissue transfer of the amputated disease-free elbow and forearm, while simultaneously reconstructing the shoulder silhouette and axilla. This procedure reduces functional and aesthetic impairments and improves the quality of life.

Synthesis of Laboratory Ultrasound Contrast Agents

Ultrasound Contrast Agents (UCAs) were developed to maximize reflection contrast so that organs can be seen clearly in ultrasound imaging. UCAs increase the signal to noise ratio (SNR) by linear and non-linear mechanisms and thus help more accurately visualize the internal organs and blood vessels. However, the UCAs on the market are not only expensive, but are also not optimized for use in various therapeutic research applications such as ultrasound-aided drug delivery. The UCAs fabricated in this study utilize conventional lipid and albumin for shell formation and perfluorobutane as the internal gas. The shape and density of the UCA bubbles were verified by optical microscopy and Cryo SEM, and compared to those of the commercially available UCAs, Definity® and Sonovue®. The size distribution and characteristics of the reflected signal were also analyzed using a particle size analyzer and ultrasound imaging equipment. Our experiments indicate that UCAs composed of spherical microbubbles, the majority of which were smaller than 1 um, were successfully synthesized. Microbubbles 10 um or larger were also identified when different shell characteristics and filters were used. These laboratory UCAs can be used for research in both diagnoses and therapies.

EComment. Nuss pectus excavatum repair: friend or foe?

In their recent article, Yuksel and coworkers conducted a prospective study of the internal thoracic artery (ITA) blood flow after placement of Nuss bar for the treatment of pectus excavatum (PEx). Yuksel and coworkers clearly demonstrated that the blood flow of these arteries is affected in 44% and 38% of patients with complete unilateral and bilateral obstruction, respectively [1]. Since ITAs are widely used for coronary bypass grafting, a history of PEx Nuss repair could impede the potential use of the ITA for coronary revascularization in the long term. We congratulate the authors for this interesting description of an unexpected effect of the Nuss procedure. In fact, other types of ITA lesions have already been reported following this technique. Besides perioperative injuries requiring emergent thoracotomy (2 cases in the English literature), Nuss bar pressure on the undersurface of the anterior chest wall or bar dislocation may result in: 1. ITA pseudoaneurysm treated successfully with selective embolization with coils [2]; 2. ITA rupture into the pleural cavity and consecutive life-threatening haemothorax requiring emergent thoracotomy or angiographic embolization [3–5]. In contrast, during the Ravitch-type PEx repair, the careful subperichondrial resection of elongated cartilages protects the internal thoracic vessels from perioperative damage. Furthermore, no delayed ITA lesions have been described in the literature following this procedure. In the discussion, Yuksel and coworkers list minor and severe complications associated with the Nuss repair [1]. Some of them are impressive, rendering the safety of the method questionable, in addition with the above-mentioned ITA injuries. Finally, the relevant article by Yuksel and coworkers describing an unexpected adverse effect of the Nuss repair validates our previous option of correcting PEx deformities exclusively by means of a simplified Ravitch-type technique. Conflict of interest: none declared

Laparoscopic Varicocelectomy Carried Out with the LigaSure Device in 52 Patients

We describe the effective use of the bipolar vessel-sealing device: LigaSure for the division of the internal spermatic vessels in a laparoscopic varicocelectomy. A total of 52 males with varicocele (left-side n = 49, and bilateral n = 3) were included in this study. Blunt dissection was used to isolate the packet of spermatic vessels. The packet of spermatic vessels was divided using a bipolar diathermy system, the LigaSure Precise. It was clear that the operative time was significantly reduced compared to the method using clips, which was done before the development of this kind of device. In another experiment to examine the effect of vessel sealing, it was confirmed that the LigaSure has performance comparable to the clips. Despite the result that the Harmonic scalpel was less effective in vessel sealing, our study found it difficult to determine which is superior, LigaSure or clips, in terms of operative time, relapse rate and complication.

The Structure of Internal Blood Vessels in Mongolian Fetal Vertebral Bodies

Purpose: Investigate specific characteristic of blood supply of fetal vertebral bodies. Material & Methods: 16 - 30 week aged 20 fetuses (10 male, 10 female) were used for the study. Norms and requirements of Bio-Medical Ethics have not been violated in the use of human material in the study. Black-ink perfusion and cast of substance absorbing X-ray were applied in the fetuses. Results: Three concentric zones could be distinguished in the vascular architecture of the fetal vertebral bodies. 1) The peripheral zone of perichondrial vessels; 2) The intermediate zone of radial vessels. 3. The central zone of the ossification centre vessels. We used black-ink perfusion and cast of substance absorbing X-ray were applied in the fetuses. Periosteum of fetal vertebral bodies are distributed originating from fine arteries of 70 - 120 diameter and arterioles of 30 - 50 diameter which are part of arteries of network of micro blood circulation. Venules are followed along two sides of this arteriole and short precapillaries are branched out in tree-like manner from it forming capillary network surrounding arteriole and capillary plexuses. Postcapillaries branched from the network are being emerged the venules accompanied arterioles. Conclusions: Micro blood circulatory system of the vertebrae has angion structure. The peripheral zone of perichondrial vessels has combined blood supply surrounded by blindly ending capillary network drained up and down from the central zone. The central zone of vertebral body is supplied with blood by the main arteriole.

Acute Abdominal Pain in an End Stage Renal Disease Patient

An 81-year-old female with history of end stage renal disease on hemodialysis presented with worsening of abdominal pain of 2 days’ duration. The pain started as a dull ache over the lower abdomen 2 months earlier, diffuse but especially prominent over the lower quadrant, and was unrelieved by analgesic medications. On physical examination her whole abdomen was diffusely tender, but the lower quadrant was extremely tender with palpable nodular lesions. Her laboratory work showed a normal amylase and lipase level along with a white cell count of 13.5K/CUMM (3.5–10.6 K/CUMM), calcium of 10.6 mg/dL (8.2–10.6 mg/dL), phosphorus of 5.9 mg/dL (2.3–5.0 mg/dL) and intact PTH 880 pg/mL (18–86 pg/mL). She had a computed tomography of the abdomen and pelvis (Figure), which showed multiple soft tissue densities in the lower quadrant of anterior abdominal wall, while the ultrasound of her abdomen (Video) revealed subcutaneous nodule with internal septations and calcified vessels. Both these findings in the setting of end stage renal disease were consistent with calciphylaxis, a rare, and often fatal, complication. Although ulceration is considered a hallmark of calciphylaxis, it can also present as non-ulcerative nodular lesions, as in our patient.1 Various putative risk factors for calciphylaxis include obesity; serum aluminum is greater than 25 ng/mL and serum calcium phosphorus product more than 70.2 Treatment is multifaceted, including strict control of secondary hyperparathyroidism, maintenance of calcium phosphate product below 55 mg2/dL2 using non-calcium containing phosphate binders, administration of intravenous sodium thiosulfate with each dialysis (6–12 weeks), and a trial of prednisone tapered over a period of a couple of weeks.1 With the above treatment, she had significant improvement of symptoms. Our case highlights the need for emergency physicians to be cognizant of this life-threatening complication in end stage renal disease patients and of the fact that calciphylaxis has different modes of presentation, among which is acute abdominal pain. Figure. Computed tomography of the abdomen and pelvis without contrast showing multiple soft tissue densities in the anterior abdominal wall (A). Calcification of blood vessels within the abdomen and pelvis was also noted (B). Video. Ultrasound of abdomen revealing subcutaneous nodule. Click here to view.(8.9M, mpg)

Subinguinal Varicocelectomy With Loupes Only, Sans Surgical Microscope

Dear Editor, I would like to comment Abdelrahman and Eassa on their important paper on the assessment of loupe-assisted subinguinal varicocelectomy in infertile men (1). Methodology was complete, including a group of patients and another of controls, of adequate sample size, defined with valid inclusion and exclusion criteria, and followed-up at 3 and 6 months with measures of seminal count/morphology and relevant hormones. As for surgical anatomy and technique, the authors correctly approached internal spermatic veins after opening the internal spermatic fascia. They correctly mention a ‘compartment of the vas’ internal to the internal spermatic fascia. Many experts, however, erroneously state that the vas sits outside the internal spermatic fascia (2). The vas indeed lies internal to the internal spermatic fascia (i.e. in the spermatic cord’s internal compartment) but is further ensheathed by a membranous layer continuing from the respective layer of the abdominopelvic extraperitoneal tissue. The internal spermatic vessels, nerves and lymphatics all within the internal compartment are similarly packed by another membranous sheath (3). The authors preserved the veins of the vas, “except when abnormally engorged veins were evident”. My preference is not to ligate these, but instead cremasteric veins plus their anastomoses with the external pudendal vein. The cremasteric veins are found between the internal and external spermatic fasciae, i.e. in the cord’s external compartment. Intact veins of the vas serve for venous flow after ligation of the internal spermatic and cremasteric veins. Gubernacular veins were not ligated; consequently the testis was not delivered. I concur: if sacrificed, testicular venous return relies only on the small deferential veins (3). With loupes only (sans surgical microscope), 0% recurrence and 0% hydrocele were achieved; admirable rates, totally comparable with those of subinguinal varicocelectomy under microscope -better than rates of others using loupes [2.9% hydrocele, 2.9% reccurence (4)]. Complication rates of subinguinal varicocelectomy without loupes— 15% hydrocele, 10% recurrence seem higher than others’ 7.3% hydrocele, 2.63% recurrence (5), which, however, merge inguinal and subinguinal procedures. In statistical analysis, the authors unfortunately disregarded their paired and time-series design, and performed multiple, pair-wise comparisons, increasing probability of type I error. Instead, analysis should start with testing for normal distribution; if so, a 2-way-ANOVA for repeated measurements would reveal an overall difference; then post-hoc analysis should follow to detect differences between duos of data. In case of non-normal distribution, Friedman test should be applied for the time-series triplets of each group, and Mann-Whitney U-tests for duos of data at each time point (6). In conclusion, the paper strongly supports loupe-assisted subinguinal varicocelectomy in infertile adults. It can be ameliorated in surgical anatomy regarding compartments of the spermatic cord, and has pitfalls in statistical analysis. Nevertheless, the paper has great virtues: excellent surgical results and justified semen and hormonal findings. What I liked most was the honest declaration ‘so it [this technique] should be used, especially in developing countries where the microsurgery equipment is not available every where”. I hope the authors obtain this equipment. I look forward to reading their next paper on microsurgical subinguinal varicocelectomy.

EComment. The risk of loss of the breast flap after coronary artery bypass grafting

We read with great interest the article by Currie et al. [1] regarding the feasibility of using the internal thoracic artery for coronary artery bypass grafting (CABG) and for breast reconstruction. The authors concluded that a skeletonised left internal thoracic artery harvested at the fourth intercostal space can reach the target vessel in the majority of cases; therefore CABG using the left internal thoracic artery is feasible in women with left breast reconstruction by an autologous flap with pedicles anastomosed to internal thoracic vessels. The internal thoracic vessels are considered as the first-choice donor vessels for microvascular breast reconstruction, and the selection of adequate recipient vessels is of utmost importance for a successful microsurgical result. Many surgeons have designated the internal thoracic vessels as the pedicle of choice especially in cases of delayed breast reconstruction because this approach requires harvesting a shorter pedicle, avoids axillary scaring and decreases postoperative shoulder discomfort [2-3]. Exposure of internal thoracic vessels is technically challenging, it requires removal of a portion of the third rib and scrupulous technique when preparing the vein. The veins can be very fragile thus rendering the outflow inadequate, on the other hand, the venous anatomy is unpredictable and represents one major drawback of this technique [3]. The free transverse rectus abdominis musculocutaneous (TRAM) flap is the most commonly used autologous flap in breast reconstruction. It is needless to say that the inferior epigastric vessels are dissected along with the TRAM flap [2]. To reduce the possibility of the loss of the autologous flap after CABG, one should not use the left TRAM flap to reconstruct the left breast. Reverse blood flow in the internal thoracic artery depends on musculophrenic artery and superior epigastric artery, the latter one depends mainly on the inferior epigastric artery [4]. We recommend using the right TRAM flap or other flaps such as gluteal flap when considering reconstruction of the left breast in women with an increased risk of cardiovascular disease. We also agree with Al-Benna et al., who advocate warning patients against the potential loss of the internal thoracic artery for CABG in a consent form before free flap breast reconstruction [5]. Conflict of interest: none declared.

Massive Posttraumatic Bleeding: Epidemiology, Causes, Clinical Features, and Therapeutic Management

Bleeding typically results as a consequence of derangements of primary hemostasis, secondary hemostasis, or both, and can be dramatically amplified by the presence of other predisposing conditions, especially inherited bleeding disorders. Life-threatening hemorrhages are, however, almost exclusively caused by penetrating wounds, blunt traumas of chest and abdomen, suicide attempts, amputations, bone fractures with concomitant injury to internal organs and blood vessels, and shearing forces from sudden rotation, violent flexion, extension, or deceleration injuries. The pathogenesis of posttraumatic bleeding is complex and multifaceted. The most dramatic phenomenon that always accompanies major hemorrhages is the abrupt and considerable loss of intravascular volume, that further leads to hypovolemic shock, also known as hemorrhagic shock, culminating with peripheral ischemia, especially in those tissues where oxygen delivery is more critical (i.e., central nervous system and myocardium). The mortality rate of severe posttraumatic bleeding can be as high as 50%, especially when an appropriate treatment is not established in a timely manner. The damage control sequence basically entails a four-step approach including damage control surgery, damage control resuscitation with fluid restoration, and hemocomponents administration, as well as correction of the coagulopathy with platelets, antifibrinolytic (e.g., tranexamic acid), and/or procoagulant agents such as fresh frozen plasma, prothrombin complex concentrate, or recombinant-activated Factor VII.

Laparoscopic classification of the impalpable testis

Purpose We present a classification for the nonpalpable testis (NPT) based on laparoscopic findings and suggest guidelines for the interpretation of these findings. Patients and methods From October 2002 to December 2010, 121 patients with NPT underwent laparoscopy at two tertiary centers of Pediatric surgery in Egypt. The lower abdomen and pelvis were inspected to identify the following structures and their inter-relationships: the internal inguinal ring (and its patency), spermatic vessels, vas deferens, and testis. The laparoscopic findings were documented by one of the authors who attended all procedures, and video recordings were available in some cases. Further management was dependent on laparoscopic findings, classification, and plan of treatment. Results The study included 117 patients with 142 nonpalpable testes. Their mean age was 4.9 years. Among patients with unilateral NPT, a contralateral palpable undescended testicle was always associated with a viable NPT (100%), whereas a contralateral scrotal testis had an equal chance (50%) of finding a viable NPT, without a significant difference whether it was right or left sided. Conclusion Failure of normal testicular descent leads to a spectrum of anatomical variations that can be precisely and safely defined by laparoscopy in about two-thirds of patients with nonpalpable testes. In the remaining one-third of patients, including inguinal exploration after laparoscopy can help us to exclude a missed viable inguinal testis. Keywords : cryptorchidism, laparoscopy, testis

Rapid Dispatches Highlights

BioTechniquesVol. 53, No. 4 Rapid Dispatches HighlightsOpen AccessRapid Dispatches HighlightsNathan BlowNathan BlowSearch for more papers by this authorPublished Online:3 Apr 2018https://doi.org/10.2144/000113933AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit A ‘2 for 1' cloning dealProtein interaction assays are a key approach in understanding protein complexes and cellular signaling. Several such interaction assays, including two-hybrid methods, Forster resonance energy transfer (FRET), and bimolecular fluorescence complementation (BiFC), have been described and expanded in recent years. One challenge that still exists when using these approaches is obtaining equivalent expression of the potential interacting protein pairs, especially in cases where the fusion proteins are expressed from different plasmids. In an attempt to remedy this issue, Christopher Grefen and Michael Blatt from the University of Glasgow report in Rapid Dispatches a simplified methodology that enable the simultaneous cloning of two genes into two different, independent cloning cassettes. The cloning methodology introduced by the authors takes advantage of site-specific recombination wherein each cassette is flanked by a differing attR site and selection element. To demonstrate the utility of their new cloning approach, the authors constructed a vector for improved ratiometric BiFC (rBiFC) analysis. Here, the two genes of interest are cloned simultaneously into the rBiFC vector, which also possesses a RFP gene under control of the same promoter creating an internal marker for expression control. The authors demonstrate the effectiveness of analyzing protein interactions using their rBiFC system by examining interactions between calcineurin B-like (CBL) proteins and the specific serine-threonine kinases these proteins recruit. Although validated by the authors in a plant system and for ratiomeric BiFC, the cloning approach, as well as the rBiFC assay, should prove applicable to other organisms and systems in the future. See “A 2in1 cloning system enables ratiometric bimolecular fluorescence complementation (rBiFC).”Category: Molecular BiologyStudying gliomas in 3DThe evaluation of cerebral gliomas for malignancy is critical to proper patient survival. Histopathology is mandatory for a definitive diagnosis, but specific immunologic or molecular markers are needed. In a Benchmark article recently published at Rapid Dispatches, a team of researchers led by Lila Kucheryavykh from Universidad Central del Caribe described the use of the fluorescent substrate, 4-(4-(dimethylamino)-styryl)-N-methylpyridinium iodide (ASP+), to label glioma cells during the early stages of tumor development. In contrast to the hematoxylin and eosin staining that is often performed when examining tissue slices, ASP+ staining allowed the visualization of 3D structure within living brain slices. In experiments examining the effectiveness of ASP+ staining, glioma cells were implanted into 12-16 week-old mice and staining was performed three weeks post implantation. Imaging of the ASP+ stained tissue allowed reliable 3D visualization of blood vessel configurations and internal tumor cavities for up to two weeks post implantation. The authors did check if ASP+ staining was toxic using a Live/Dead Cytotoxicity kit (it was not), and whether or not the stain also worked with human glioma cells (it did). Taken together, Kucheryavykh et al. demonstrate that ASP+ staining is a simple and effective approach for visualizing gliobastoma tumor cells along with the internal tumor structure and blood vessels, in 3D, in living brain slices during the early stages of tumor development. See “Visualization of implanted GL261 glioma cells in living mouse brain slices using fluorescent 4-(4-(dimethylamino)-styryl)-N-methylpyridinium iodide (ASP+).”Category: Microscopy/ImagingCell patterning: where's the tape?When it comes to patterning cells on a surface, researchers often take advantage of microfabrication techniques that are capable of producing specific patterns of cells in the micrometer range. The challenge for general users is that such microfabrication approaches also require a clean room along with photolithography equipment and knowledge of fabrication techniques. While non-photolithography methods have been described, many are limited in scope and still require materials not traditionally found in a lab. In a new Benchmark article in Rapid Dispatches, Raquel Perez-Castillejos and her colleagues at the New Jersey Institute of Technology describe their new approach to patterning mammalian cells using adhesive tape. The authors used standard office tape in combination with poly(dimethylsiloxane) to pattern cells with sub-millimeter precision. In a proof-of-concept experiment, the authors performed a wound-healing assay using their tape approach to place cells. This new method, which is being called tape-based soft lithography, should open the technique of cell patterning to a greater number of labs in the years to come. See “Adhesive-tape soft lithography for patterning mammalian cells: application to wound-healing assays.”Category: Cell BiologyMicrofluidic compartments made by casting PDMS on patterned adhesive tape.(A) Sequence of steps to prepare a master with adhesive tape (steps 1–4) and subsequently, to fabricate a system of microfluidic compartments by replicating the tape-based master with PDMS (steps 5–9).FiguresReferencesRelatedDetails Vol. 53, No. 4 Follow us on social media for the latest updates Metrics History Published online 3 April 2018 Published in print October 2012 Information© 2012 Author(s)PDF download

Contrast-enhanced ultrasonography of the rabbit VX2 tumor model: Analysis of vascular pathology

The accuracy of diagnosing tumors may be improved significantly by detecting the microvascular distribution. Indeed, contrast-enhanced ultrasonography (CEUS) has shown a distinct advantage in detecting microvasculature. This study aimed to determine the angiogenic characteristics of VX2 tumors in rabbits using CEUS. A total of 17 rabbits were injected with 0.5 ml VX2 cell suspension into the muscles of both hind legs to prepare the VX2 tumor models. At 14, 21, 28 and 35 days after tumor inoculation, CEUS was performed on the rabbits with 0.3 ml SonoVue following a local anesthesia. The pathological findings of the tumors were compared. A total of 12 rabbits survived after being inoculated with the tumor cells and developed a total of 38 tumors. The size of the tumors ranged from 1.12 to 10.85 cm. Using CEUS, all tumors demonstrated rim enhancement with some unenhanced regions. Enhancement began from the peripheral region and quickly showed internal reticular vessels. Regardless of the tumor size or the presence of necrosis, no complete enhancement of the tumors was observed. On microscopic examination, VX2 tumor cells were detected in striated muscles, immature blood capillaries and fibrosis tissues scattered in tumor nests. Immunohistochemical examination revealed that CD34+ cells appeared mainly in the muscles adjacent to vessels. In conclusion, CEUS may be an efficient method to evaluate angiogenesis and blood perfusion in VX2 tumors.

Le lambeau de gracilis à palette transversale : une nouvelle technique de reconstruction mammaire autologue

The transverse musculocutaneous gracilis free flap allows a wider range of indications in autologous breast reconstruction. They extend far beyond traditional dorsal, abdominal and gluteal flaps. The authors present their experience in using this innovative procedure. The cutaneous and adipose part of the flap consists in a horizontal ellipse centered on the gracilis muscle in the upper thigh. The distal part of the muscle is released without neither visual control nor additional incision. The flap vascular pedicle is microanastomosed to the recipient internal thoracic vessels in the third intercostal space. Eleven patients, with a mean age of 44 years (29-62) and a BMI of 24 (19-32) underwent this procedure. Surgery was performed on either one side (n=6) or two (n=5), in indications of immediate (n=5) or delayed reconstruction (n=6). The main operative parameters (time, vessel diameter, pedicle length, flap volume) as well as postoperative follow-up were studied. Mean time of surgery was 4h33 (3-6 hours). Pedicle measured 6.2 cm (5-7.5) and diameter of the artery was 19 mm (15-30). Average weight of the flap was 344g (270-498). Two cases of partial necrosis occurred in the posterior cutaneous part of the flap (1cm(3) and 3 cm(3)). They were treated using controlled wound healing. Sequelae in the donor site proved minimal as the scar was placed in the crural crease and the gluteal fold. No major functional defect was noted after mean follow-up of six months. The transverse musculocutaneous gracilis free flap allows natural and durable reconstruction while reducing cosmetic and functional sequelae in the donor site. It proves to be particularly useful in bilateral immediate reconstructions following skin-sparing mastectomy. This surgical option offers new opportunities to long-limbed women without abdominal excess wishing autologous breast reconstruction.

Three-dimensional optoacoustic imaging as a new noninvasive technique to study long-term biodistribution of optical contrast agents in small animal models

We used a 3-D optoacoustic (OA) tomography system to create maps of optical absorbance of mice tissues contrasted with gold nanorods (GNRs). Nude mice were scanned before and after injection of GNRs at time periods varying from 1 to 192 h. Synthesized GNRs were purified from hexadecyltrimethylammonium bromide and coated with polyethylene glycol (PEG) to obtain GNR-PEG complexes suitable for in vivo applications. Intravenous administration of purified GNR-PEG complexes resulted in enhanced OA contrast of internal organs and blood vessels compared to the same mouse before injection of the contrast agent. Maximum enhancement of the OA images was observed 24 to 48 h postinjection, followed by a slow clearance trend for the remaining part of the studied period (eight days). We demonstrate that OA imaging with two laser wavelengths can be used for noninvasive, long-term studies of biological distribution of contrast agents.

Microsurgical Subinguinal Varicocelectomy in Children, Adolescents, and Adults: Surgical Anatomy and Anatomically Justified Technique

Microsurgical varicocelectomy has become the gold standard in adults because of low recurrence and postoperative hydrocele rates; it is increasingly applied in children and adolescents. This review aims to provide the surgeon with the necessary surgical anatomy of the spermatic cord and with a step-by-step, anatomically justified description of technique, toward clearer comprehension and improved application. The anatomic compartments of the spermatic cord are delineated by the external and internal spermatic fasciae. Venous drainage of testis-epididymis is accomplished by the internal spermatic, deferential, and external spermatic (cremasteric) veins. All 3 anastomose at the caudal pole of testis, and then via gubernacular veins with the posterior scrotal veins. Another anastomosis exists between a cremasteric branch and anterior scrotal veins, which gives the external pudendal vein. Subinguinal approach offers access to varicose spermatic veins and collaterals. Use of surgical microscope offers identification of small veins, preservation of arteries, lymphatics, and nerves, and appreciation of spermatic cord fasciae, which permits the development of two surgical planes. In the surgical plane of internal spermatic vessels, internal spermatic veins are ligated, whereas the testicular artery and innervation, as well as lymphatics, are preserved. In the plane of cremasteric vessels and vas, cremasteric veins are ligated, whereas the cremasteric artery, vas deferens and its vasculature, lymphatics, and the genital branch of genitofemoral nerve are preserved. Delivery of the testis to ligate gubernacular veins is at the discretion of the surgeon. Finally, venous return is effected by deferential and scrotal veins, or, when gubernacular veins are ligated, by deferential veins only.

Benjamin Alcock (1801–?) and his canal

Benjamin Alcock (1801-?) was a prominent anatomist from Ireland who is remembered most for his description of the pudendal canal. He was privileged to train under the great Irish anatomist, Abraham Colles. Following his training and several early teaching engagements, he was appointed as the first Professor of Anatomy and Physiology at Queen's College, Cork. He became a Fellow of the Royal College of Surgeons in Ireland. After several years of teaching at Queen's College, Alcock was forced to resign after a dispute over the Anatomy Act of 1832, during which he conveyed his disapproval of participation in the procurement of corpses for the school. Several years after his resignation, he left for the United States and removed himself from the view of the profession. His anatomical contributions were published in The Cyclopaedia of Anatomy and Physiology. The description he gave of the sheath enclosing the pudendal nerve and internal pudendal vessels is his most famous contribution to the literature. He is remembered eponymously for Alcock's canal. This article's intent is to clearly and concisely depict the life and contribution of Benjamin Alcock.