Suitable Vessels Research Articles

A randomized controlled trial and cost-effectiveness analysis of early cannulation arteriovenous grafts versus tunneled central venous catheters in patients requiring urgent vascular access for hemodialysis

ObjectiveEarly cannulation arteriovenous grafts (ecAVGs) are proposed as an alternative to tunneled central venous catheters (TCVCs) in patients requiring immediate vascular access for hemodialysis (HD). We compared bacteremia rates in patients treated with ecAVG and TCVC. MethodsThe study randomized 121 adult patients requiring urgent vascular access for HD in a 1:1 fashion to receive an ecAVG with or without (+/−) an arteriovenous fistula (AVF; n = 60) or TCVC+/−AVF (n = 61). Patients were excluded if they had active systemic sepsis, no anatomically suitable vessels, or an anticipated life expectancy <3 months. The primary end point was the culture-proven bacteremia rate at 6 months, with the trial powered to detect a reduction in bacteremia from 24% to 5% (α = .05, β = .8). Secondary end points included thrombosis, reintervention, and mortality. A cost-effectiveness analysis was also performed. ResultsCulture-proven bacteremia developed in 10 patients (16.4%) in the TCVC arm ≤6 months compared with two (3.3%) in the ecAVG+/−AVF arm (risk ratio, 0.2; 95% confidence interval, 0.12-0.56; P = .02). Mortality was also higher in the TCVC+/−AVF cohort (16% [n = 10] vs 5% [n = 3]; risk ratio, 0.3; 95% CI, 0.08-0.45; P = .04). The difference in treatment cost between the two arms was not significant (£11,393 vs £9692; P = .24). ConclusionsCompared with TCVC+/−AVF, a strategy of ecAVG+/−AVF reduced the rate of culture-proven bacteremia and mortality in patients requiring urgent vascular access for HD. The strategy also proved to be cost-neutral.

Automatic Puncture System Based on NIR Image and Ultrasonic Image

In view of modern clinical treatment and care, venipuncture has a very important position, but in order to train a medical staff with high level skill of puncture need to spend a lot of time, human and material resources. For this reason, in this paper, an automatic system that can achieve venipuncture is proposed, which can replace the medical staff and achieve the puncture process. The automatic venipuncture system, combined with NIR imaging and ultrasound imaging technology, the overall plane information is obtained by NIR image, depth information and fine positioning of the plane information is obtained by ultrasound image. By way of image processing, the NIR image is enhanced and segmented, getting the spatial location of the vein. And the most suitable blood vessel segments were selected by piecewise straight fitting. Then the location ultrasonic probe should be placed is determined. Then the ultrasound image with the blood vessel in the vicinity of the longitudinal centreline can be obtained. All the information of blood vessel have been obtained, then the machine can be driven to achieve venipuncture.

The Flawed "Tools of Empire": Clive Dewey, Steamboats on the Indus.

The Flawed "Tools of Empire"Clive Dewey, Steamboats on the Indus Michael Adas (bio) Despite the deceptively modest range of historical processes and geographical coverage suggested by its title, Clive Dewey's Steamboats on the Indus: The Limits of Western Technological Superiority in South Asia (New York: Oxford University Press, 2014. Pp. 360. $130) is a book of importance not only for social scientists and engineers interested in the history of science and technology, but for scholars and practitioners engaged in the study of South Asia, Western colonialism, and cross-cultural transfers. From the first paragraphs it is clear this is a work that is the product of decades, perhaps a career, of meticulous and thoroughgoing research, primarily in often difficult-to-access (and make sense of) archival and primary sources in India, Pakistan, and Great Britain. At times the detail can be overwhelming, but Dewey writes well and laces his narrative with insightful observations and broader arguments that build to cogent critiques and correctives to prevalent interpretations regarding the impact of innovative technologies. He specifically focuses on dominant assumptions about the ways in which the advantages of industrialization made possible the rise of the West and its colonization of much of the rest of the world. The prodigious effort that went into Dewey's magnum opus and the well-grounded, provocative arguments that his labors yield very likely account for the skills and expense that went into making what is a visually splendid book. The text is complemented by ample illustrations—from technical drawings to Anglo-Indian watercolors—that enable the reader to visualize the complex relationships between machines and boats and the often-insurmountable difficulties of navigating the many branches of the Indus River system. [End Page 578] Although Dewey includes consideration of bridges, ferries, and related subjects, his main focus is on the mid-nineteenth-century introduction of coal-fueled steamboats by the British and the effects of that process on the diverse array of sail-driven "country" boats, built and operated by local Indian craftsmen and crews. Since that competition is central to the broader arguments that are previewed in his subtitle stressing "The Limits of Western Superiority in South Asia," I will focus my review on the ways in which his core comparisons challenge widely held assumptions about how technology is transferred across cultures and the impact of industrial techniques and modes of transportation and communication on "traditional" societies. Dewey begins with an engaging discussion of the formidable challenges posed by those who sought to open the Indus River system to navigation of any kind. Rather than a single main channel, the Indus is a web of several major tributaries and smaller streams. In its lower reaches where centuries of silt accumulation have formed a vast alluvial plain, its many outlets are shallow and thus prone to shifting the course of their flow to the sea frequently. The gorges and rapids in the upper spans of the river pose very different problems for navigators, and treacherous curves and daunting shifts in depth according to the rhythms of the monsoon seasons impede travel over the whole length of the Indus system. As Dewey argues in the core chapters of the study that follows, though heralded as marvels of industrial engineering in the early and mid-nineteenth century, steamships were perhaps the least suitable vessels for travel or transport on the Indus River. They were hampered by a multitude of problems, from the bulk and weight of their steam engines that caused them to run aground in the ubiquitous shallows and impeded travel upstream in the rainy season when water levels were highest, to their shallow-drafts which caused them to careen through the channels, often colliding with the riverbanks. The daunting obstacles to penetration from the sea that the Indus posed for naval forces were in part responsible for the delayed British interest in bringing the Sind and the Punjab into their Indian Empire, which had been expanding in the subcontinent since the middle of the eighteenth century. Early-nineteenth-century conflicts with the local kingdoms, particularly those controlled by the Sikhs, and growing threats from Afghan peoples in the interior, compelled ever-greater British involvement...

The internal thoracic vein for the breast and thoracic surgical reconstruction: anatomy of the valves

The internal mammary veins (IMV) are suitable vessels for thoracic wall reconstruction thanks to their relatively predictable anatomy and because they are less affected by atherosclerosis, injury or scarring of previous surgery and radiotherapy. Their position near to the lateral border of the sternum allows easier access for surgeon and the possibility of placing the most vascularized part of a flap for breast reconstruction in the medial thoracic region [1]. As the complexity of reconstruction has increased, the use of the caudal portion of IMV has been reported as a convenient option for additional venous drainage. This procedure, requires retrograde blood flow that could be altered by the presence of efficient valves in the IMV. In this study, we evaluated 32 IMVs dissected from 16 fresh cadaver thoracic walls. Retrograde blood flow and the presence of valves were investigated. We observed an efficient flow in 18 IMVs, partial flow in 7 IMVs and no flow in 5 IMVs. In these last, single and/or multiple sacciform swelling and competent valves were macroscopically observed. Histomorphological analysis by Haematoxylin and Eosin and Masson-Goldner Trichrome staining confirmed their presence. In addition, some rudimental valves, not identified macroscopically, were found during histomorphological analysis. Taking together, these data highlight the possible presence of complete or rudimental valves in IMV. This aspect should be considered when retrograde flow of IMV as a single venous drainage was performed during surgical breast and thoracic reconstruction.

Effect of regional versus local anaesthesia on outcome after arteriovenous fistula creation: a randomised controlled trial

Arteriovenous fistulae are the optimum form of vascular access in end-stage renal failure. However, they have a high early failure rate. Regional compared with local anaesthesia results in greater vasodilatation and increases short-term blood flow. This study investigated whether regional compared with local anaesthesia improved medium-term arteriovenous fistula patency. This observer-blinded, randomised controlled trial was done at three university hospitals in Glasgow, UK. Adults undergoing primary radiocephalic or brachiocephalic arteriovenous fistula creation were randomly assigned (1:1; in blocks of eight) using a computer-generated allocation system to receive either local anaesthesia (0·5% L-bupivacaine and 1% lidocaine injected subcutaneously) or regional (brachial plexus block [BPB]) anaesthesia (0·5% L-bupivacaine and 1·5% lidocaine with epinephrine). Patients were excluded if they were coagulopathic, had no suitable vessels, or had a previous failed ipsilateral fistula. The primary endpoint was arteriovenous fistula patency at 3 months. We analysed the data on an intention-to-treat basis. This study was registered with ClinicalTrials.gov (NCT01706354) and is complete. Between Feb 6, 2013, and Dec 4, 2015, 163 patients were assessed for eligibility and 126 patients were randomly assigned to local anaesthesia (n=63) or BPB (n=63). All patients completed follow-up on an intention-to-treat basis. Primary patency at 3 months was higher in the BPB group than the local anaesthesia group (53 [84%] of 63 patients vs 39 [62%] of 63; odds ratio [OR] 3·3 [95% CI 1·4-7·6], p=0·005) and was greater in radiocephalic fistulae (20 [77%] of 26 patients vs 12 [48%] of 25; OR 3·6 [1·4-3·6], p=0·03). There were no significant adverse events related to the procedure. Compared with local anaesthesia, BPB significantly improved 3 month primary patency rates for arteriovenous fistulae. Regional Anaesthesia UK, Darlinda's Charity for Renal Research.

Composite sequential bypass using profunda vein hitchhike

Patients with long-segment occlusions of the iliac and femoral arteries often undergo sequential bypass procedures. There exists a subgroup of patients who have no suitable vessels in the groin. We report our experience with a new technique of using the profunda vein as a hitchhike point in our series of seven patients (eight limbs) with critical ischemia and occlusion at the iliac or aortic level with reformation of infrageniculate arteries and no reformation in the groin. The proximal graft was anastomosed to the profunda vein, which was ligated proximal to the anastomosis. The saphenous vein graft was taken from the distal end of the polytetrafluoroethylene graft and anastomosed to the appropriate tibial arteries. The procedure was technically successful in all the patients. The median follow-up was 8months (range, 0-30). The profunda vein as a hitchhike point gives an excellent outcome in the short and medium term in this uncommon group of patients.

Reconstruction of gluteal defects related to Nicolau Syndrome secondary to intramuscular injection of diclofenac sodium with negative pressure wound therapy followed by skin graft.

Objective: Nicolau syndrome, synonymously livedo-like dermatitis or embolia cutis medicamentosa is a rare complication of drug injection leading to locoregional necrosis of the skin, adipose and muscular tissue. Underlying physiopathology is not well unserstood and there is no standart guideline for its management. However, after the demarcation of necrosis, debridement and for large wounds reconstruction is mandatory. Even though vast majority of the Nicolau syndrome cases were reported by other disciplines but the plastic surgery, there may be further need for reconstructive procedures for wound closure. Material and Methods: Present study included eight patients admitted to our wound care center for necrosis at the gluteal region after intramuscular injection of diclofenac sodium who were treated with debridement, negative pressure wound therapy and skin grafts. Patients’ ages, genders, body mass indexes, underlying diseases were documented. Sizes of the lesions were measured. Injection, hospitalization, skin graft operation and discharge dates were recorded. Results: All the wounds healed uneventfully but with depressed scars. Mean duration of hospitalization was 23.5 (range, 15-34) days. Conclusion: In the present article, we reported that even if the hospitalization time is longer and cosmetic result is poorer, skin grafting after sufficient times of vacuum assited wound therapy administration is a reliable method. We do not recommend this method as the first choice but if there is not adequate adjacent soft tissue for harvesting flaps or if a suitable perforator vessel is not found for peforator flap harvest, this reliable method should be kept in mind.

Complete Coronary Revascularization Improves Survival in Octogenarians

Completeness of revascularization is important for patients undergoing coronary artery bypass graft surgery, but information on its long-term impact in octogenarian patients is lacking. From 1986 to 2004, 525 consecutive patients aged 80 years or more (mean age 82 ± 3 years) underwent coronary artery bypass graft surgery and were followed for a minimum of 10 years or until death. Outcome was stratified based on extent of revascularization, defined as total (graft to every diseased vessel), complete (graft to each region but not every diseased vessel), or incomplete (bypass not done to all suitable regions or vessels). Follow-up of 3,155 patient-years (mean follow-up 73 ± 54 months) was 99% complete. Overall operative mortality was 8% (41 of 525), and was lower for elective than for urgent/emergent cases (4.2% versus 16% ± 6%, p< 0.001, respectively). There was a trend toward higher operative mortality with incomplete (13% ± 6%) versus complete (8% ± 4%) or total revascularization (6% ± 3%; p= 0.09). For operative survivors, mean survival was significantly improved with total and complete revascularization (6.9 and 6.8 years, respectively), compared with incomplete revascularization (5.4 years, p < 0.008). For total, complete, and incomplete revascularization, survival at 5 years was 61% ± 3%, 61% ± 4%, and 47% ± 5%, respectively. Ten-year survival was 27% ± 3%, 21% ± 3%, and 16% ± 4% (p= 0.01), respectively, in these groups. Incomplete revascularization in octogenarians is associated with decreased long-term survival when compared with total or complete revascularization. There was no survival benefit with total over complete revascularization. Octogenarians can have good long-term survival, especially with adequate revascularization.

In vitro cultivation of hairy roots of Plumbago rosea L. in a customized Reaction kettle for the production of plumbagin—An anticancer compound

Biosynthesis of plumbagin using hairy root cultures of Plumbago rosea L. can be made economical only by scaling-up cultures in suitable vessels under conditions optimal for maximum yield of biomass and plumbagin. However, the major limitation faced in the scaling-up of hairy roots is the development of appropriate culture vessels that will allow maximum growth of interconnected root mat with less shear stress. Design of economical and low energy requiring scaling-up culture system for hairy roots with emphasis on physical parameters like inoculum state, nutrient mixing, aeration, inoculum support etc., is very important for root cultures. A novel, culture vessel model using a Reaction kettle (2L) was attempted for successful scaling-up of P. rosea hairy roots. The roots cultured in Murashige and Skoog basal liquid medium for 25days in a Reaction kettle (2L) customized with a polypropylene mesh for support and a fish tank aerator for aeration yielded maximum biomass and plumbagin. Twelve-fold increase in root biomass with highest plumbagin content of 1.5% dry weight (DW) was obtained in Reaction kettle whereas, shake flask cultures produced only five fold biomass enhancement with 1.1% DW plumbagin. The present experiments demonstrated the suitability of the customized Reaction kettle with adequate filtered air for the scaling-up of hairy root cultures for secondary metabolite production. This is the first report on exploiting a Reaction kettle for in vitro scaling-up of organ cultures.

Preoperative Computed Tomography Angiography for Evaluation of Feasibility of Free Flaps in Difficult Reconstruction of Head and Neck.

Free tissue transfer has been advocated for anatomic and functional reconstruction of soft tissue defects after surgical removal of an extensive recurrent tumor and/or arising from previous irradiation in the head and neck. We report a case series of difficult reconstruction in the head and neck in which preoperative computed tomography (CT) angiography was utilized to evaluate the feasibility of free flap reconstruction. The preoperative radiological evaluation was performed to determine the availability of reliable vessels for anastomosis in free flap reconstruction. If none was found, regional pedicle flap or palliative treatment was applied instead. The use of CT angiography allows the clinical surgeon to perform precise surgical planning with greater confidence. This may improve surgical results, thereby potentially reducing perioperative morbidity. Twenty CT angiograms were obtained from 20 patients. All patients were men with a mean age of 57.2 years (range, 42-72 years) and were scheduled to undergo difficult reconstruction in the head and neck. All patients (20/20 [100%]) suffered from oral squamous cell carcinoma. They had all received extensive operations and radiation therapy. Eighteen patients (18/20 [90%]) had completed a course of perioperative irradiation. The CT angiography reports were used to perform detailed preoperative surgical planning accordingly. The findings of CT angiography were classified into 3 groups: group I: normal CT angiography (patent recipient arteries) (Fig. 3); group II: abnormal CT angiography (recipient vessels were present but stenosis or atherosclerotic lesions were noted) (Fig. 4); group III: abnormal CT angiography with no patent recipient arteries in bilateral sides of the neck (Fig. 5); CT angiography results were correlated to the operative findings. The patients were classified into 3 groups based on the angiographic findings. Six patients (6/20 [30%]) were assigned to group I, 8 patients (8/20 [40%]) to group II, and 6 patients (6/20 [30%]) to group III. In groups I and III, all patients (12/12 [100%]) underwent the treatment according to the original preoperative detailed planning. No flap failure was noted in these 2 groups. In group II, 4 patients' recipient vessels (4/8 [50%]) possessed adequate blood flow intraoperatively; hence, microvascular free flaps were transplanted. Venous congestion in 1 case (1/4 [25%]) was noted. The remaining patients in this group (4/8 [50%]) underwent reconstruction with pedicle flaps rather than free flaps because of the lack of suitable target vessels intraoperatively. All flaps (4/4 [100%]) survived. Among the patients who were treated surgically, intraoperative findings were in accordance with those predicted by CT angiography. The total abnormality rate of CT angiography was 70%. Vascular abnormalities detected as a result of preoperative CT angiography led to changes in the operative plan in 50% (10/20) of the patients. The use of CT angiography should be considered for difficult microsurgical reconstructions in the head and neck. When an abnormality in vascular anatomy is detected by CT angiography, the surgeon is advised to consider altering the operative plan accordingly. This allows precise operation, thereby maximizing the possibility of an optimal outcome. Changing the operative plan based on results of CT angiography may also help to avoid the difficult situation in which the surgeon finds that there are no suitable recipient vessels for free flap reconstruction during the operation. In addition, CT angiography enables surgeons to conduct the preoperative surgical planning with greater confidence, thereby potentially enhancing the success rate of difficult reconstructions in the head and neck, which in turn would tend to improve the perioperative course for the patient and consequently to improve results by decreasing vascular complication rates.

Internal Mammary Vessels: Alternate Recipient Vessels in Microvascular Head and Neck Reconstruction

The application of microvascular free tissue transfer for reconstruction of the head and neck is well established. Improved outcomes, as well as surgical and technologic advances, have broadened the applications of microvascular free flaps in these defects. Postoperative complications such as pharyngocutaneous fistulas, tracheal or esophageal stenoses, or recurrent pathology may occasionally require secondary or even tertiary reconstruction with free tissue transfers. The disrupted anatomy and fibrotic changes resulting from primary reconstruction, neck dissection, and irradiation present the surgeon with a high risk of provoking vascular or nervous injury when dissecting in previously operated or irradiated sites. This prompts a search for alternative recipient vessels for microvascular anastomosis. The transverse cervical, inferior thyroid, and thyrocervical trunk arteries have all been proposed as alternative recipient vessels. The internal mammary vessels (IMVs) have a proven record in breast reconstruction, but recently have been found to have an application in special circumstances in head and neck reconstruction. This investigation describes the advantages of the IMVs as suitable recipient vessels for head and neck reconstruction when access to traditional vasculature is unavailable.

Reconstruction of the Lower Extremity with Cross-Leg Free Flaps

Background The absence of suitable adjacent recipient vessels for microvascular anastomosis due to trauma poses a major challenge to the reconstructive surgeon. The anterior and posterior tibial vessels of the contralateral leg are the two other alternatives for use as recipient vessels for microvascular anastomosis. This method is known as the cross-leg free flap. Methods Twenty-seven patients (20 males, 7 females) underwent cross-leg free flap operations due to absence of a suitable adjacent recipient vessel between 2007 and 2015. The mean soft tissue defect dimension was 12 × 11 cm (smallest: 6 × 7 cm; largest: 20 ×14 cm). Gustilo type 3B tibia fractures were present in 19 patients, but no fractures were present in the other 8. Six different flaps were used: 14 anterolateral thigh flaps, 6 latissimus dorsi flaps, 3 gracilis muscle flaps, 2 vastus lateralis musculocutaneous flaps, 1 tensor fascia latae flap, and 1 deep inferior epigastric perforator flap. Results Two anterolateral thigh flaps failed, while the rest of the flaps survived completely. There were no donor-site complications. Conclusion We think that the cross-leg free flap method can be safely and successfully used with all flap types in complex lower extremity injuries in which the adjacent recipient vessel option is unavailable.

Transcatheter closure of coronary arterial fistula: A single-center experience

Background: Transcatheter closure of coronary artery fistula has emerged as an alternative to surgery. The management of coronary artery fistula is complicated, and recommendations have been based on anecdotal cases or very small retrospective series. Objective: The objective of this study is to determine the safety, feasibility, and immediate and intermediate follow-up results of the transcatheter closure of coronary arterial fistula. Methods: We reviewed the records of all patients presenting with significant coronary arterial fistulae between January 2011 and May 2014. Those with additional complex cardiac disease requiring surgical management were excluded from the study. A total of nine patients aged 11 months to 58 years with congenital coronary arterial fistulae underwent percutaneous transcatheter closure using various devices between January 2011 and March 2014. The immediate closure results and clinical follow-up were reviewed using information from a database or telephone calls to the center. Results: Fistulae originated from the right coronary artery in 4 patients (44.4%), left circumflex coronary artery in 3 patients (33.3%), and left anterior descending coronary artery in 2 patients (22.2%). The drainage site was the right atrium in 5 patients (55.6%), right ventricle in 2 patients (22.2%), left ventricle in 1 patient (11.1%), and coronary sinus in 1 patient (11.1%). All of the patients (100%) underwent successful transcatheter closure using the various devices. Angiography after device deployment revealed complete occlusion in 7 patients (77.7%) and trivial to mild residual flow in 2 patients (22.2%). Two patients (22.2%) had transient ST-T wave changes after the procedure. The Amplatzer Vascular Plug II was used in four patients (44.4%), Amplatzer Duct Occluder II was used in three patients (33.3%), and Lifetech Duct Occluder was used in two patients (22.2%). The left ventricular end-diastolic volume decreased from a mean baseline value of 82.77 ± 4.55 ml/m 2 to 77.22 ± 3.49 ml/m 2 at 1 month after the procedure (P = 0.001) and had normalized in all of the patients at 2 months postprocedure. The cardiothoracic ratio decreased from a mean baseline value of 0.57 ± 0.035 to 0.53 ± 0.02 at the 1-month follow-up and further decreased to 0.50 ± 0.007 at 2 months (P Conclusion: Transcatheter closure of coronary arterial fistula is feasible and safe in anatomically suitable vessels and is a promising alternative to surgery in most patients.

Transcatheter closure of coronary artery fistulas in infants and children: A French multicenter study.

The short-term efficacy and safety of transcatheter closure (TCC) for the management of coronary artery fistulas (CAFs) was investigated in pediatric patients. CAFS are rare with potentially severe complications and their management is still a matter of debate. Percutaneous closure appears to be the treatment of choice in anatomically suitable vessels but limited data are available in the pediatric population. This retrospective, observational, multicenter, national study included patients under 16 years of age who underwent TCC of a congenital CAF. Patients with additional congenital heart defect were excluded. 61 patients (36 girls, 25 boys) with a median age of 0.6 year [0-15.4] at diagnosis and 3.9 years [0-16] at procedure were included. The CAF was large in 48 patients (79%); it was distal in 23 (38%) and proximal in 22 (36%). Most patients (77%) were asymptomatic at diagnosis. Clinical signs of congestive heart failure were present in seven patients (11%). Perioperative complications included three cases of ST elevation myocardial infarction (exclusively during attempted closure of a distal CAF), three devices migrations, and one case of leg ischemia. One patient died after surgical closure of a large distal CAF that could not be closed by TCC. Follow-up data were collected for 43 patients (70%) for a median of 91 days [0-4,824]. The Kaplan-Meyer estimate for complete occlusion at 2 years was 73 ± 7.6%. TCC in the pediatric population appears to be effective and associated with few complications.

Simultaneous Reconstruction of Forefoot and Hindfoot Defects with a Thoracodorsal-Axis Chimeric Flap.

Simultaneous Reconstruction of Forefoot and Hindfoot Defects with a Thoracodorsal-Axis Chimeric Flap.

Embolization of a giant hypervascularized choroid plexus papilloma with onyx by direct puncture: a case report

Choroid plexus papilloma is a rare intracranial neoplasm derived from choroid plexus epithelium accounting for less than 1 % of all brain tumors. These tumors are highly vascularized, and tumor resection is difficult, especially in small children, due to severe intraoperative bleeding. Preoperative embolization is helpful to reduce intraoperative bleeding, but it may not be possible in small children or if the tumor has no suitable feeding vessels for embolization. We present the case of a 2-year-old girl with a giant choroid plexus papilloma. An attempt of tumor resection was previously performed in another clinic, but the surgery was aborted due to massive intraoperative bleeding and only a biopsy was done. Angiography showed no suitable vessels for embolization. A new attempt of tumor removal was carried out, but again, severe intraoperative bleeding occurred and only a partial resection was possible. Intratumoral embolization with onyx through direct percutaneous puncture was performed. Radical tumor removal was possible after two additional surgeries. Intraoperative blood loss was 345 ml (first surgery = only partial removal), 250 ml (second procedure = 1/3 of tumor volume resected), and 250 ml (third surgery = total removal). The patient presented no additional deficits. Intratumoral percutaneous embolization with onyx was very helpful in reducing intraoperative bleeding in this case. Safe radical tumor resection was possible. This technique may be useful for those surgeons dealing with highly vascularized tumors, especially in small children. No report of intratumoral embolization with onyx in cases of intracerebral tumors could be found in the literature.

The effect of buried fibres on offshore pipeline plough performance

Ploughing is a technique often used to bury offshore pipelines in the seabed. During this process the operator must ensure that a sufficiently deep, level trench is produced while towing the plough with the available bollard pull of a suitable trenching support vessel. This paper reports experimental work investigating the effect that encountering fibres or reinforcing elements such as buried tree branches in the soil (e.g. relict debris from deltaic flood washout) may have on the ploughing operation. It is shown that fibres in soil can have a reinforcing effect and hinder plough progress by both increasing tow force and leading to potential ‘ride-out’ of the plough (significant loss of trenching depth). This behaviour is correlated with the percentage of fibre reinforcement volume in sand and a simple method is provided to estimate changes in tow force and plough inclination during ploughing operations.

Dual-peptide-modified alginate hydrogels for the promotion of angiogenesis

The ability to supply suitable blood vessel system is a major challenge for artificial thick tissue engineering. Angiogenesis is a key point during the process of microvascular formation. Many bioactive molecules such as extra cellular matrix (ECM) proteins and adhesion peptides derived from the ECM are applied to promote angiogenesis. In this work, two adhesion peptides, YIGSR and REDV, were selected to modify sodium alginate (ALG) to obtain YIGSR- and REDV-alginate conjugates (ALG-YIGSR, and ALG-REDV, respectively). We mixed the two peptide-conjugates together in a series of concentration ratios to prepare bioactive surfaces for in vitro studies and hydrogel scaffolds for in vivo studies. In vitro studies showed that surfaces modified with 1.09 pmol/mm2 peptide had the best affinity to human umbilical vein endothelial cells (HUVECs) than that with high or low concentrations of peptides. In addition, surfaces modified with dual peptides could significantly promote HUVECs proliferation, where ALG-YIGSR:ALG-REDV at a mole ratio of 5:1 exhibited the best enhancement ability. Furthermore, the in vivo angiogenesis results demonstrated that hydrogel scaffolds composed of mixed ALG-YIGSR and ALG-REDV at the 5:1 ratio had angiogenic induction potential by stimulating new blood vessel formation, and showed higher blood vessel density than scaffolds composed of a single peptide. These results demonstrated that a mixed combination of peptide alginate conjugates could be a potential scaffold to stimulate and induce angiogenesis in tissue engineering applications.

P0163 Free thin anterolateral thigh flap versus free radial forearm reconstruction after hemiglossectomy: A functional assessment

Background We aimed to compare free thin anterolateral flap with free radial forearm flap in the reconstruction of hemiglossectomy defects, and to introduce our methods and experiences in the tongue reconstruction with the free thin anterolateral flap. Methods Clinicopathological data from 46 cases with tongue carcinoma were obtained from the Institute and Hospital of Stomatology, Nanjing University Medical School from December 2009, to December 2013. All patients initially underwent hemiglossectomy, immediately followed by the reconstruction with free thin anterolateral thigh flap or free radial forearm flap. We compared the incidence of vascular crisis, speech, swallowing, and donor site morbidity between these two methods. Findings 12 patients had undergone reconstruction after hemiglossectomy with free thin anterolateral thigh flap; 34 patients had undergone reconstruction with free radial forearm flap. No obvious differences were noted in the incidence of vascular crisis, speech, and swallowing, were found between the two groups. In the free thin anterolateral thigh flap group, flap survival was 100%; In the free radial forearm flap group, flap survival was 97.1%. Interpretation Free thin anterolateral thigh flap could an alternative to free radial forearm flap for hemiglossectomy defect reconstruction given its versatility in design, long pedicle with a suitable vessel diameter, and negligible donor site morbidity.

Three continuous suction drainages to avoid severe pancreatic fistula in patients with soft pancreas after pancreaticoduodenectomy

s / Pancreatology 14 (2014) S1eS129 S116 Conclusion: Pancreatoduodenectomywithportal vein resection and left renal grafting is a safe procedure without risk of renal failure. During CT a collateral flow through left ovarian veinwere observed. The left renal vein is an adequate vessel for grafting because of relatively easy access with a good chance to obtain a vessel of suitable length and vessel diameter.