Muscle Fragment Research Articles

Reappraisal of the Previously Described False Localizing Sign at C1-2 in Cases of Spontaneous Intracranial Hypotension

BACKGROUND AND OBJECTIVES: We present an illustrative case of spontaneous intracranial hypotension (SIH) in the setting of a suspected C1-2 cerebrospinal fluid (CSF) leak that was successfully treated with muscle, collagen, and epidural blood patch. We examined the literature to identify similar cases reporting Cl-2 retrospinal fluid collections identified on imaging in the setting of SIH and quantified the success of targeted treatment to this area despite previous reports that caution about a “C1-2 false localizing sign.” METHODS: A systematic search was performed identifying cases of SIH resulting from CSF leak with C1-2 fluid collection observed on imaging. PubMed, Google Scholar, and Web of Science were queried, and articles were screened for possible inclusion by 2 authors and supervised by the senior author. RESULTS: In total, 28 studies were included with a total of 32 patients. The number of patients in each study with C1-2 fluid collections, number of patients with fluid collections at multiple levels, specific intervention used, and outcomes of each intervention were recorded, with a focus on whether treatment occurred at the levels exhibiting fluid signal. CONCLUSION: Although the C1-2 fluid signal in SIH has previously been described as a “false localizing sign,” our study indicates that treating this level as the source of CSF leak results in successful and durable outcomes. Most SIH cases with signal at C1-2 did not have a fluid signal at any other level and were treated successfully and most commonly through epidural blood patch at the C1-2 level. Symptom resolution was also reported after direct repair of C1-2 CSF leaks through primary closure, Gelfoam patch, and muscle fragment with fibrin. In patients with SIH, C1-2 fluid signal, and no other source of CSF leak identified on imaging, surgical intervention at the C1-2 level seemed to have a high success rate.

Angiogenesis precedes myogenesis during regeneration following biopsy injury of skeletal muscle

BackgroundAcute injury to skeletal muscle damages myofibers and fragment capillaries, impairing contractile function and local perfusion. Myofibers and microvessels regenerate from satellite cells and from surviving microvessel fragments, respectively, to restore intact muscle. Established models of injury have used myotoxins and physical trauma to demonstrate the concurrence of myogenesis and angiogenesis during regeneration. In these models, efferocytosis removes cellular debris while basal laminae persist to provide guidance during myofiber and microvessel regeneration. It is unknown whether the spatiotemporal coupling between myofiber and microvascular regeneration persists when muscle tissue is completely removed and local guidance cues are lost.MethodsTo test whether complete removal of skeletal muscle tissue affects the spatiotemporal relationship between myogenesis and angiogenesis during regeneration, subthreshold volumetric muscle loss was created with a biopsy punch (diameter, 2 mm) through the center of the gluteus maximus (GM) in adult mice. Regeneration into the void was evaluated through 21 days post-injury (dpi). Microvascular perfusion was evaluated in vivo by injecting fluorescent dextran into the circulation during intravital imaging. Confocal imaging and histological analyses of whole-mount GM preparations and tissue cross-sections assessed the growth of microvessels and myofibers into the wound.ResultsA provisional matrix filled with PDGFRα+ and CD45+ cells spanned the wound within 1 dpi. Regenerating microvessels advanced from the edges of the wound into the matrix by 7 dpi. Nascent microvascular networks formed by 10 dpi with blood-perfused networks spanning the wound by 14 dpi. In striking contrast, the wound remained devoid of myofibers at 7 and 10 dpi. Myogenesis into the wound was apparent by 14 dpi and traversed the wound by 21 dpi. Regenerated myofibers and microvessels were disorganized compared to the uninjured muscle.ConclusionsFollowing punch biopsy of adult skeletal muscle, regenerating microvessels span the wound and become perfused with blood prior to myofiber regeneration. The loss of residual guidance cues with complete tissue removal disrupts the spatiotemporal correspondence between microvascular and myofiber regeneration. We conclude that angiogenesis precedes myogenesis during regeneration following subthreshold volumetric muscle loss.

ODP475 Developing suppurative thyroiditis

Abstract Suppurative thyroiditis is rare and associated with significant mortality. A high level of suspicion and aggressive management is needed to reduce the risk of serious outcomes. A 67-year-old male with a medical history including diabetes type 2, cognitive impairment, and ESRD presented with decreased appetite and lethargy for a few days. He presented with fever, tachycardia, and hypertension. There was a non-tender fullness around the anterior neck region. Initial laboratory tests revealed leukocytosis to 24K/uL, lactic acid of 5. 0 mmol/L, ESR 100 mm/hr, CRP 419 ng/dl, and blood culture was positive for gram-positive cocci in clusters for which he was started on iv vancomycin and piperacillin/tazobactam. CT scan on admission showed a probable inflammatory process in the neck originating from the thyroid bed, concerning acute thyroiditis and developing abscess/abscesses vs. very atypical presentation of thyroid cancer. Thyroid ultrasound showed diffuse thyroid enlargement with heterogeneous echogenicity. Repeat CT obtained due to apparent thyroid enlargement with erythema and tenderness on examination and fever on day 7 showed extensive heterogeneous thyroid enlargement with ill-defined margins to the adjacent soft tissue structures. A modified barium swallow revealed severe oropharyngeal dysphagia leading to thyroid fine-needle aspiration of both thyroid lobes by interventional radiology and subsequent urgent incision and drainage (I&D) of the right neck and thyroid biopsy under general anesthesia by ENT. I&D showed purulent drainage from the thyroid. Cultures were positive for MRSA. Surgical pathology reported a necrotic muscle and abscess and fragment of thyroid tissue. Thyroid function tests (TFTs) on admission revealed a TSH 0.31 mcIU/ml (reference: 0.30 - 5. 0 mcIU/ml) and a free T4 of 2.21 ng/dl (reference: 0.76- 1.46 ng/dl) and repeat TFTs with a TSH of 0.30 mcIU/mL, free T4 of 1.87 ng/dL, free T3 of 2.15 pg/ml (reference: 2.18- 3.98 pg/ml), consistent with sick euthyroid syndrome. TPO and TSI were negative. Subsequently, the patient's fever resolved, and the neck swelling improved. He continued IV vancomycin for a month. TFTs six weeks later showed an elevated TSH of 13.10 mcIU/ml and normal free T4 of 1. 03 ng/dl. Conclusion MRSA suppurative thyroiditis is rare, and its diagnosis may be delayed due to its indolent course, especially in immunocompromised patients. Therefore, a high index of clinical suspicion is needed for this endocrine emergency in a patient presenting with fever and neck swelling. While an early FNA of the thyroid is likely to aid in diagnosing thyroid infection, TFTs may be variable and not helpful. Presentation: No date and time listed

Transcranial microsurgical decompression of the optic canal in surgical treatment of meningiomas of the sellar region

Transcranial microsurgical decompression of the optic canal in surgical treatment of meningiomas of the sellar region

Management of presacral bleeding.

The objective of this video is to demonstrate a variety of available techniques that can be used in the management of acute presacral bleeding. In this video, we demonstrate different methods for the management of presacral bleeding utilizing a fresh frozen cadaver. Presacral bleeding is a potentially catastrophic complication that can be encountered during pelvic surgery, particularly sacrocolpopexy. Various techniques exist to achieve hemostasis in the event of uncontrolled bleeding. This video demonstrates some of the available methods that may be employed in the management of presacral bleeding. The methods demonstrated in this video include direct pressure, pelvic packing, gelatin matrix, bone wax, thumb tack, surgical clip, suture, oxidized regenerated cellulose, omental flap, electrocautery, muscle fragment welding, gelatin matrix combined with thrombin, and microporous polysaccharide spheres. Familiarity with these techniques and product availability will aid in the management of acute presacral bleeding.

EXPERIENCE OF SURGICAL TREATMENT OF THE CAROTID BODY TUMOR AND TUMORS WITH INVASION AT THE CAROTID VESSELS

The analysis of the structure and results of surgical treatment of 72 patients who were hospitalized in the department of vascular surgery Lviv regional hospital for the period 1995 to 2017. Among the 42 cases was diagnosed carotid body tumors (1-st study group) and at 30 patients was (2-nd control group) other tumors of the neck. In first group structure of surgery operation was: tumor removal and suturing the vascular wall defects - 76%, resection and shortening of the common carotid artery - 21%, expansion of the internal carotid artery - 3%, ligation of the external carotid artery - 10%, lymphadenectomy - 28%, prosthetic vascular wall - 3%, the tumor resection - 3%, internal jugular vein ligation - 7%, excision of fragment muscle - 3%, nerve resection - 14%. In the second group, the following surgical operations were performed: removal of the tumor and suturing of the defects of the vascular wall - 96%, lymphadenectomy - 48% tumor resection - 30%, ligation of the internal jugular vein - 14%, removal of the muscle fragment - 4% , resection of nerves - 13%. In group 1, intraoperative complications were observed in 1 (3.4%) cases, which were manifested by massive bleeding from the tumor, requiring a repeated surgical intervention to stop the bleeding. Postoperative complications were observed in 1 (3.4%) cases when acute cerebral ischemia developed. In 1 (3.4%) cases, tumor recurrence was observed after 9 years. Clinic experience shows that surgery is an effective treatment for carotid body tumor and tumors with invasion into vessels of the neck, providing a low rate of complications, a full recovery or long-term remission

Efficacy of rectus muscle fragment welding in the control of presacral venous bleeding.

The incidence of presacral venous bleeding during rectal resection is low, but this complication can be severe and even lethal. Occasionally, the traditional methods - such as pelvic gauze packing and the use of metallic thumbtacks - are not effective. When combined with their complications and difficulties, these failures have resulted in numerous creative procedures with which to control this complication. In 1994, the indirect electrocoagulation method, which is performed via a fragment of the rectus abdominis muscle of the abdomen, was introduced to control presacral venous bleeding. From January 2002 to December 2015, five of 872 patients with rectal cancer and one patient with rectal metastasis of gastric cancer developed presacral venous bleeding, and this technique was used in every case. Haemostasis was permanent in all cases. There were no complications such as infection or rebleeding. In our experience, indirect electrocoagulation via a fragment of the rectus abdominis muscle of the abdomen is a rapid, easily executed and effective method for controlling presacral venous bleeding during rectal resection.

Pathological Features of Bovine Pericardium Implanted Into Mice Abdominal Wall after Preservation with Glutaraldehyde or Glycerin

Background: Lately, the use of biological materials has been widely indicated in surgical procedures to restore structure and function of injured tissues. Bioimplants require different conservation techniques; among these, glutaraldehyde preservation stands out owing to its higher antimicrobial efficiency as compared to glycerin. In view of the need to determine a concentration of glutaraldehyde that can act as a biocide but do not cause undesirable tissue reactions, this study aimed to identify and quantify gross and microscopic tissue alterations after implantation of bovine pericardium, which was preserved in various concentrations of glutaraldehyde, in the abdominal wall of mice.Materials, Methods & Results: Fresh pericardia from 18 bovines were fractioned into 1cm2 samples and treated with a 98% glycerin solution for 30 days (control group), or 0.625%, 1%, and 1.5% glutaraldehyde solution for 18 days (experimental groups). An abdominal muscle fragment was excised from each mouse, and a 1-cm2 fragment of preserved pericardium was implanted in the area. Sixty mice (n = 15 per treatment) divided into groups were observed for 7, 14, and 30 days, and five animals from each group were euthanized at each time point for gross and microscopic examination. Fragments of the implants and adjacent skin lesions were harvested, fixed in formalin, and processed for routine histology and microscopic analysis. Both the type of inflammatory infiltrate and the repair process of the tissue response were similar between the groups that received glycerin-preserved pericardium and those that were subjected to pericardium preserved with 0.625% glutaraldehyde. Animals that received 1% glutaraldehyde-preserved implants and were examined 30 days thereafter exhibited a chronic, intense reaction with fibrosis and necrosis of the abdominal wall muscles, as well as calcification and presence of giant cells, when compared to the animals examined at 7 and 14 days in the same treatment group. These changes were also present and more intense in animals that received 1.5% glutaraldehyde-preserved pericardium examined at 14 and 30 days later, with tissue destruction and impaired incorporation of the implant into the adjacent muscle tissue.Discussion: The continuous cell destruction observed in animals treated with implants preserved with 1% or 1.5% glutaraldehyde is a hallmark of chronic inflammation, since several inflammatory cell molecules contribute to this lesion. A cycle is created: continuous degradation sustains inflammation, and inflammatory molecules contribute to the process of cell destruction. Consequently, we conclude that the use of glutaraldehyde at concentrations of 1 or 1.5% is not feasible for preservation of biological materials. Tissue repair was chronologically more effective in the group treated with glycerinpreserved implants, since animals treated with glutaraldehyde-preserved implants needed a longer period to restore due to presence of a persistent inflammatory response, immunogenicity, calcification, and deficient remodeling. The ideal preservative for biological materials should not cause chronic and/or intense inflammatory reaction in order to preserve the implant’s structure and allow its perfect incorporation into the tissue, even if the chosen preservative is flexible and exhibits disinfectant properties. Therefore, we conclude that glutaraldehyde at concentrations of 0.625% to 1% is suitable as a preservative for biomaterials because the tissue reaction it causes is tolerable; additionally, glutaraldehyde at concentrations close to 1% has been described to have sterilizing properties.

Inhibitory effects of daidzein on intestinal motility in normal and high contractile states

Context: Daidzein is a naturally occurring compound and has various health benefits. However, its effects on intestinal smooth muscle contractility remain unknown.Aims: The present study was to characterize the effects of daidzein on the contractility of isolated jejunal smooth muscle and its underlying mechanisms.Methods: Ex vivo assay was selected as the major method to determine the effects of daidzein on the contractility of isolated jejunal smooth muscle fragment (JSMF).Results: Daidzein (5–160 µmol/L) inhibited the contractility of JSMF in normal contractile state and in a dose-dependent manner. Daidzein also inhibited the contractility of JSMF induced by ACh, histamine, erythromycin and high Ca2+, respectively, and decreased charcoal propulsion in the small intestine in vivo. The inhibitory effects of daidzein were partially blocked by phentolamine or propranolol and were abolished in the presence of varapamil or at Ca2+-free assay condition. However, the inhibitory effects of daidzein on jejunal contraction were not significantly influenced by nitric oxide (NO) synthase inhibitor L-NG-nitro-arginine (l-NNA). Daidzein was also found to directly inhibit the phosphorylation and Mg2+-ATPase activity of smooth muscle myosin.Discussion and Conclusion: The results implicated that α- and β-adrenergic receptors were involved in the inhibitory effects produced by daidzein rather than via NO pathway. As a phytoestrogen, daidzein has shown its potential value in relieving the hypercontractility of small intestine.

Observation of successful treatment of penetrating traumatic brain injury followed by nasal liquorrhea for 61 years

An observation of penetrating traumatic brain injury, made by awl in childhood, followed by remittent nasal liquorrhea and purulent meningoencephalitis for 61 years, is given.For diagnosis clarifying biochemical study of nasal secretion, rhinologic study, MRI and CT-cisternography of the brain were performed. Liquor fistula was closed in two stages, ethmoid bone meningocele, causing obturation of left half of the nose, was removed.On the first stage, using transnasal approach, ethmoid bone meningocele was removed, on the next stage liquor fistula was discharged, using transcranial intradural approach. Anterior cranial fossa base defect was closed with temporal muscle fragment and fixed with fibrin-thrombin glue.

Electrocoagulación sobre un fragmento de músculo recto anterior abdominal para el control de la hemorragia presacra durante la resección rectal

IntroductionPresacral venous haemorrhage during rectal movement is low, but is often massive, and even fatal. Our objective is the “in vitro” determination of the results of electrocoagulation applied to a fragment of muscle on the sacral bone surface during rectal resection due to a malignant neoplasm of the rectum. Material and methodSingle-pole coagulation was applied “in vitro” with the selector at maximum power on a 2×2cms muscle fragment, applied to the anterior side of the IV sacral vertebra until reaching boiling point. The method was used on 6 patients with bleeding of the presacral venous plexus. ResultsIn the “in vitro” study, boiling point was reached in 90seconds from applying the single-pole current on the muscle fragment.Electrocoagulation was applied to a 2×2cm rectal muscle fragment in 6 patients with presacral venous haemorrhage, using pressure on the surface of the presacral bone, with the stopping of the bleeding being achieved in all cases. ConclusionsThe use of indirect electrocoagulation on a fragment of the rectus abdominis muscle is a straightforward and highly effective technique for controlling presacral venous haemorrhage.

Characteristics of deslanoside-induced modulation on jejunal contractility

To characterize the dual effects of deslanoside on the contractility of jejunal smooth muscle. Eight pairs of different low and high contractile states of isolated jejunal smooth muscle fragment (JSMF) were established. Contractile amplitude of JSMF in different low and high contractile states was selected to determine the effects of deslanoside, and Western blotting analysis was performed to measure the effects of deslanoside on myosin phosphorylation of jejunal smooth muscle. Stimulatory effects on the contractility of JSMF were induced (45.3% ± 4.0% vs 87.0% ± 7.8%, P < 0.01) by deslanoside in 8 low contractile states, and inhibitory effects were induced (180.6% ± 17.8% vs 109.9% ± 10.8%, P < 0.01) on the contractility of JSMF in 8 high contractile states. The effect of deslanoside on the phosphorylation of myosin light chain of JSMF in low (78.1% ± 4.1% vs 96.0% ± 8.1%, P < 0.01) and high contractile state (139.2% ± 8.5% vs 105.5 ± 7.34, P < 0.01) was also bidirectional. Bidirectional regulation (BR) was abolished in the presence of tetrodotoxin. Deslanoside did not affect jejunal contractility pretreated with the Ca(2+) channel blocker verapamil or in a Ca(2+)-free assay condition. The stimulatory effect of deslanoside on JSMF in a low contractile state (low Ca(2+) induced) was abolished by atropine. The inhibitory effect of deslanoside on jejunal contractility in a high contractile state (high Ca(2+) induced) was blocked by phentolamine, propranolol and L-NG-nitro-arginine, respectively. Deslanoside-induced BR is Ca(2+) dependent and is related to cholinergic and adrenergic systems when JSMF is in low or high contractile states.

Unusual recurrence of trigeminal neuralgia after microvascular decompression by muscle interposal

SummaryBackgroundPatients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression (MVD) typically undergo less invasive procedures in the hope of providing pain relief. However, re-operation should be considered in selected patients.Case ReportA 48-year-old woman presented with recurrent trigeminal neuralgia (TN) 3 years following microvascular decompression (MVD). The patient underwent brain magnetic resonance angiography (MRA), which did not reveal neurovascular compression; therefore surgical re-exploration was carried out. During the operation, the fifth cranial nerve was seen without impingement from any blood vessels; however, a very firm tissue was observed and identified as the muscle fragment from the previous MVD procedure. The fifth cranial nerve was carefully separated from the muscle. Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura.ConclusionsOur findings, along with similar cases reported in the literature, support the development of new inert materials and alternative surgical strategies that can limit TN recurrence.

Experimental allergic encephalomyelitis in pituitary-grafted Lewis rats.

Treatment of susceptible rats with dopaminergic agonists that reduce prolactin release decreases both severity and duration of clinical signs of experimental allergic encephalomyelitis (EAE). To assess to what extent the presence of an ectopic pituitary (that produces an increase in plasma prolactin levels mainly derived from the ectopic gland) affects EAE, 39 male Lewis rats were submitted to pituitary grafting from littermate donors. Another group of 38 rats was sham-operated by implanting a muscle fragment similar in size to the pituitary graft. All rats received subcutaneous (s.c.) injections of complete Freund's adjuvant (CFA) plus spinal cord homogenate (SCH) and were monitored daily for clinical signs of EAE. Animals were killed by decapitation on days 1, 4, 7, 11 or 15 after immunization and plasma was collected for prolactin RIA. In a second experiment, 48 rats were immunized by s.c. injection of a mixture of SCH and CFA, and then received daily s.c. injections of bromocriptine (1 mg/kg) or saline. Groups of 8 animals were killed on days 8, 11 or 15 after immunization and plasma prolactin was measured. Only sham-operated rats exhibited clinical signs of the disease when assessed on day 15 after immunization. A progressive decrease in plasma prolactin levels was observed in pituitary-grafted rats, attaining a minimum 15 days after immunization, whereas plasma prolactin levels were increased during the course of the disease in sham-operated rats. Plasma prolactin levels were higher in pituitary-grafted rats than in sham-operated rats 1 day after immunization, but lower on days 7, 11 and 15 after immunogen injection. Further supporting a correlation of suppressed prolactin levels with absence of clinical signs of EAE, rats that were administered the dopaminergic agonist bromocriptine showed very low plasma prolactin levels and did not exhibit any clinical sign of EAE. These results indicate that low circulating prolactin levels coincide with absence of clinical signs of EAE in Lewis rats.

Distally Based Sural Fasciomusculocutaneous Flap for Chronic Calcaneal Osteomyelitis in Diabetic Patients

Chronic calcaneal osteomyelitis is a difficult surgical problem, especially in diabetic patients. After aggressive surgical eradication of nonviable soft tissue and infected bone, there will be a large soft-tissue and bony defect. A distally based sural fasciomusculocutaneous flap including the sural nerve and a midline cuff of the gastrocnemius muscle can be useful for covering the defect. This flap is designed on the proximal half of the posterior calf and has an adequate blood supply derived from retrograde perfusion of the vascular axis of the sural nerve to the musculocutaneous perforators of the gastrocnemius muscle. The patency of the peroneal artery should be confirmed by Doppler ultrasound or angiography before surgery. If there are any vascular problems, this flap will not be used to avoid complications resulting from poor flap circulation. This approach has been used for 11 diabetic patients in the past 2 years. All flaps survived completely and all wounds healed uneventfully. The authors found that the flap was reliable and technically simple to design and execute. This 1-stage procedure not only preserves the major arteries of the injured leg but has also proved valuable for filling bony defect and treating bony infection because it provides a well-vascularized muscle fragment. Compared with other tissue transfers, this flap has special characteristics for use on diabetic patients with chronic calcaneal osteomyelitis.

Management of Massive Presacral Bleeding During Low Pelvic Surgery - An Alternative Technique

Although massive presacral bleeding during rectal mobilization is uncommon, it can rapidly destabilize a patient. So, effective hemostasis is critical in severe presacral hemorrhage due to the fatal course of this complication. Among the reported methods are packing, thumbtacks, inflatable devices, muscle tamponade, muscle fragment welding and application of endoscopic staplers. Local hemostatic agents in conjunction with other methods such as diathermy, cyanoacrylate tissue adhesives and application of bone wax are among other alternatives which may help to treat this serious complication. The aim of this study is to describe the anatomic and physiologic basis of our mode of treatment, which is new in the literature approach, treating two patients with presacral bleeding during low anterior resection for rectal cancer. The technique is the early clamping of the infrarenal aorta and suture ligation of the bleeding points from the presacral plexus.

Validating the Use of Rectus Muscle Fragment Welding to Control Presacral Bleeding During Rectal Mobilization

The incidence of presacral bleeding during rectal mobilization is low, but such bleeding may be massive and even fatal. Haemostasis can be difficult to achieve using conventional methods because of the complex interlacing of the venous network at the sacral periosteum. Historically, pelvic packing and metallic thumbtacks have been the more commonly used methods in our institution. However, the need for repeat surgery to remove the packs and the difficulties encountered in tack application have forced us to explore other methods. In 1994, the procedure termed muscle fragment welding, which uses electrocautery through a rectum muscle fragment, was introduced to control presacral bleeding. From January 1999 to February 2002, six of 416 patients undergoing pelvic surgery in our institution developed massive presacral haemorrhage and therefore, this technique was used. Haemostasis was immediate and permanent. No major untoward postoperative events such as re-bleeding or infection were noted. One cas developed a second-degree burn in the right elbow due to a misplaced ground conduction plate. Rectus muscle fragment welding is , in our experience, an effective and practical method of controlling presacral haemorrhage.

Muscle fragment welding for control of massive presacral bleeding during rectal mobilization: a review of eight cases.

Although massive presacral bleeding during rectal mobilization is uncommon, it can rapidly destabilize a patient. Traditional attempts at control include tamponade with pelvic packing and application of sacral thumbtacks. The aim of this review is to describe the anatomic basis of injury and summarize our experience with this challenging problem, with emphasis on the simple, readily available, effective technique of rectus abdominis muscle fragment welding. A retrospective review of eight patients who underwent muscle fragment welding for presacral bleeding incurred during rectal mobilization was undertaken. This technique involves harvesting a small piece of rectus abdominis muscle, which is held in place with a forceps to occlude the bleeding site. Electrocautery adjusted to the highest setting is then applied to the forceps to "weld" closed the bleeding point. Control of presacral bleeding was achieved in all eight patients (3 males) with this technique without complications attributable to this method. Previous attempts at pelvic packing failed in all eight patients. Muscle fragment welding is a safe, readily available, and highly effective method of controlling massive presacral bleeding.

Biological and histopathological characterization together with nucleic acids analysis of a Trypanosoma cruzi strain from Marília, São Paulo State

The aim of this report was to study the biological and histopathological behavior of a Trypanosoma cruzi strain, which is found in the region of Marília. The strain was isolated in 1997, by artificial xenodiagnosis. Twenty-five swiss mice were intraperitoneally inoculated. Eleven were used for observation of parasitemia and trypomastigotes morphology and 14 were sacrificed after 17, 23, 30, 60 and 180 days post-infection. Heart, esophagus, liver, colon, and skeletal muscle (fragment of the right thigh) were collected for histopathological study. LIT culture medium was accomplished for DNA analysis. The results showed predominance of broad forms, low parasitemia with mean peaks of 860 trypomastigotes/5mul of blood of the 20th day of infection. No animal died in the acute phase of infection. Histopathological analysis showed several pseudocysts of amastigotes in heart, rare in skeletal muscle and colon with discreet inflammatory process. When Famema strain was compared with Y strain, which was isolated from a patient who lived in the same area, a distinct behaviour and biological characteristics were observed. However, DNA analysis placed them in same group, hence displaying the proximity of these strains.

The Distally Based Lesser Saphenous Venofasciocutaneous Flap for Ankle and Heel Reconstruction

Finding an appropriate soft-tissue grafting material to close a wound located over the ankle and heel can be a difficult task. The distally based lesser saphenous venofasciocutaneous flap mobilized from the posterior aspect of the upper leg, used as an island pedicle skin flap, can be useful for this purpose. The vascular supply to the flap is derived from the retrograde perfusion of the accompanying arteries of the lesser saphenous vein. These arteries descend along both sides of the lesser saphenous vein to the distal third of the leg, either terminating or anastomosing with the septocutaneous perforators of the peroneal artery. Between February of 1999 and March of 2001, four variants of this flap were applied in 21 individuals, including 11 fasciocutaneous, five fascial, three sensory, and two fasciomyocutaneous flaps. Skin defects among all patients were combined with bone, joint, and/or tendon exposure. The authors found that the flap was reliable and technically simple to design and execute. This one-stage procedure not only preserves the major arteries and the sural nerve of the injured leg, but it also has proved valuable for covering a weight-bearing heel and filling a deep defect, because it potentially provides protective sensation and a well-vascularized muscle fragment. When conventional local flaps are inadequate, this flap should be considered for its reliability and low associated morbidity.