Revascularización y reimplante digital. Revisión de conceptos actuales / Digital reimplantation adn revascularization. current concets

El reimplante es la obra maestra del cirujano de mano, donde incluye la técnica microquirúrgica para la anastomosis de arteria, vena y reparación del nervio, la osteosíntesis de los huesos y el manejo de tejidos blandos como los tendones y la piel Indicaciones absolutas, amputación del pulgar, el pulgar es quizás el elemento más importante de la mano, dado que le da funcionalidad a la extremidad, sin importar la movilidad final ni la sensibilidad debe reimplantarse el pulgar. No se debe intentar el reimplante en lesiones aplastantes de los dedos, amputación en más de un nivel, presencia de lesiones que amenacen la vida del paciente, enfermedades graves del paciente, isquemia prolongada, amputaciones en paciente con alteraciones psiquiátricas. Clasificación según Tamai es la mas utilizada. Se explica además como se debe transportar la parte amputada. La técnica microquirúrgica es lo mas importante para el desenlace. La rehabilitación física y posibles complicaciones.

Reimplantation is the masterpiece of the hand surgeon, which includes the microsurgical technique for artery anastomosis, vein and nerve repair, osteosynthesis of the bones and the management of soft tissues such as tendons and skin. Absolute indications, Amputation of the thumb: the thumb is perhaps the most important element of the hand because it gives functionality to the limb, regardless of the final mobility or sensitivity it should be reimplanted. Reimplantation should not be attempted in crushing lesions of the fingers. Crush injury of the fingers may have multilevel amputation and microcirculation injury that may not be susceptible of repair. Amputation at more than one level, the presence of life-threatening injuries, serious illnesses of the patient, prolonged ischemia, amputations in a patient with psychiatric disorders. Tamai Classification is the most used. We explain the correct way to transport the amputated part. The microsurgical technique is the most important in order to avoid complications. We also explain the physical therapy and complications.

Beneficial effects of hirudotherapy in a chronic case of complex regional pain syndrome / 中西医结合学报

We report about hirudotherapy in a patient with chronic complex regional pain syndrome (CRPS) in the right hand. CRPS is a multifactorial disease associated with disabling pain as well as sensory and motor deficits. The optimal therapeutic management is based on personalized multimodal treatment approaches; however, hirudotherapy has not been described in the available literature. To date, we have completed five medicinal leech treatments. Altogether, hirudotherapy led to rapid and substantial relief of symptoms, especially with respect to pain intensity ratings and skin temperature asymmetries. In addition, the patient's active and passive agility of the affected limb improved obviously.

Micro Flora Associated with Freshwater Medicinal Leeches in Taif City, Saudi Arabia

Microflora (Cyanobacteria, Algae and Fungi) associated with the freshwater leech namely, Limnatis niloticawere observed for this particular study. The number of catch leeches was higher at Saiysad fresh water bodies (5-28 taxa) than that of Gahdeer Albannat water (1 taxon) throughout the wet season. The Saiysad water contains low oxygen and is highly polluted in comparison to other water bodies. The green algae and diatoms constitute the main bulk of the phytoplankton population of the following two water bodies. Though cyanobacteria in this particular water body of Saiyasad fresh water are much higher in respect to the others, so as the number of leeches are also higherin it respectively. Twenty-one fungal species those are representing 10 genera were collected from the Leech samples (jaws, pharynx and intestine) on the culture media of Potato Dextrose Agar. After th isolation of fungus were done from its carried devices Then also the phytoplanktons show a rapid growth in the respective medium.

The functional diversity of leech salivary gland secretions and its application / 中国生化药物杂志

Secretion of the salivary glands of leeches contains more than 100 bioactive substances,in recent years it has become the focus of many researchers'attention, which was the most extensive and in-depth study of the salivary glands of leeches anticoagulant and inhibit the biological activity of platelet aggregation substance, and some species have been successfully applied to the treatment of cardiovascular diseases.in addition, a growing number of studies have found that leech salivary gland secretion also has antibacterial, antitumor, analgesic, vasodilator, anti-inflammatory, wound healing and other biological functions.Thus, leech salivary gland secretion with functions of biological diversity.Moreover, the leech is not just for the treatment of human diseases, but also applied to the treatment of several diseases of animals.This review expatiating the functional diversity of leech salivary secretions by consulting a large number of iterature , that the use of leech salivary gland secretion and other blood-sucking animal salivary gland secretions functions provide a useful reference.

The Relationship between Explanation and Patient Compliance in Hirudotherapy

BACKGROUND: The use of leeches can effectively increase the salvage rate of flap congestion. However, the first reaction from patients and carers in using leeches in clinical fields is strong aversion. This can be due to the fact that development of our culture from agriculture to industrial society, coming across leeches became fairly rare. Also because of the biological traits that leeches carry; staying attached to a leg or other body parts of the host, sucking blood, and leaving wounds. METHODS: This study was conducted through questionnaires, divided into many subgroups. We scaled the compliance of the two therapies, with or without leech. Maximum scale of 10 showing no rejective response to the therapy and minimum scale of 0 showing the greatest rejective response. RESULTS: Overall subjects' compliance was improved after explaining the benefits of hirudotherapy. Irrelevant to the explanation, there was no significant difference in general compliance between male and female. Young-aged group and medical personnel or people studying medicine showed higher compliance over older-aged group and the general public. CONCLUSION: In the terms of general social cognition, recognizing leech as a therapeutic material may not be welcomed at first, but provided with proper information and explanations, overall compliance of patients and carers can be improved and consequently result in superior outcomes in flap salvage.

Direct Open Venous Drainage: An Alternative Choice for Flap Congestion Salvage

In this report, we present a scalp defect reconstruction with lateral arm free flap. We highlight the difficulty in obtaining a recipient vein and the venous drainage managed through an open end of the donor vein. A 52-year-old woman presented with a pressure sore on the left scalp. A lateral arm free flap was transferred to cover this 8x6 cm defect. The arterial anastomosis was successful, but no recipient vein could be identified within the wound bed. Instead, we used a donor venous end for the direct open venous drainage. In order to keep this exposed venous end patent, we applied heparin-soaked gauze dressing to the wound. Also, the vein end was mechanically dilated and irrigated with heparin solution at two hour intervals. Along with fluid management and blood transfusion, this management was continued for the five days after the operation. The flap survived well without any complication. Through this case, we were able to demonstrate that venous congestion can be avoided by drainage of the venous blood through an open vessel without the use of leeches.

Reconstruction of the Medial Canthus Using an Ipsilateral Paramedian Forehead Flap

BACKGROUND: The medial canthus is an important area in determining the impression of a person's facial appearance. It is composed of various structures, including canthal tendons, lacrimal canaliculi, conjunctiva, the tarsal plate, and skin tissues. Due to its complexity, medial canthal defect reconstruction has been a challenging procedure to perform. The contralateral paramedian forehead flap is usually used for large defects; however, the bulkiness of the glabella and splitting at the distal end of the flap are factors that can reduce the rate of flap survival. We reconstructed medial canthal defects using ipsilateral paramedian forehead flaps, minimizing glabellar bulkiness. METHODS: This study included 10 patients who underwent medial canthal reconstruction using ipsilateral paramedian forehead flaps between 2010 and 2012. To avoid an acute curve of the pedicle, which can cause venous congestion, we attempted to make the arc of the pedicle rounder. Additionally, the pedicle was skeletonized from the nasal root to the glabella to reduce the bulkiness. RESULTS: All patients had basal cell carcinoma, and 3 of them had recurrent basal cell carcinoma. All of the flaps were successful without total or partial flap loss. Two patients developed venous congestion of the flap, which was healed using medicinal leeches. Four patients developed epiphora, and 2 patients developed telecanthus. CONCLUSIONS: Large defects of the medial canthus can be successfully reconstructed using ipsilateral paramedian forehead flaps. In addition, any accompanying venous congestion can be healed using medicinal leeches.

Caracterización de la comunidad bacteriana aerobia en sanguijuelas (Hirudinea), Haementeria sp. (Glossiphoniidae) y Oxytychus ornatus (Macrobdellidae) de El Bagre, Antioquia / Characterization of the aerobic bacterial community in leeches Haementeria sp (Hirudinea: Glossiphoniidae) y Oxytychus ornatus (Hirudinea: Macrobdellidae) de El Bagre, Antioquia

Se ha incrementado el uso terapéutico de las sanguijuelas y se ha demostrado que ellas pueden inocular bacterias causantes de infecciones en el 20% de los pacientes. El hallazgo en Antioquia de dos especies de sanguijuelas promisorias para hirudoterapia motivó este estudio para identificar las bacterias en la superficie, la probóscide y el intestino de estos anélidos y evaluar su sensibilidad a antibióticos. Las sanguijuelas estudiadas se identificaron como Haementeria sp., y Oxytychus ornatus. Muestras de la superficie, boca e intestino de ambos anélidos se inocularon en agar sangre, agar sangre con ampicilina y agar eosina azul de metileno. La identificación de las bacterias y su sensibilidad a antibióticos se evaluaron por el método automatizado Vitek (Biomerieux®). Se hicieron en total 26 aislamientos pertenecientes a 12 especies de nueve géneros. Enterobacter cloacae fue la especie más frecuente en ambos anélidos. Las bacterias fueron sensibles a los antibióticos comúnmente empleados en las infecciones causadas por este tipo de microorganismos. Se sugiere hacer profilaxis con antibióticos en los pacientes que reciban terapia con los anélidos investigados e implementar los protocolos estandarizados para el lavado de los animales antes de su uso y para el aseo de los acuarios en donde se los mantenga.

Therapeutic use of leeches (hyrudotherapy) has increased, and it has been shown that they can transmit bacteria associated with infections in 20% of patients. Two species of leeches have been found in Antioquia, Colombia, apparently promising for such therapy. This study was done to identify bacteria in the surface, mouth and intestine of these species and to test the antibiotic sensitivity of the isolates. The studied species were Haementeria sp., and Oxytychus ornatus. Specimens were obtained from their surface, mouth and intestine. Blood agar, blood agar with ampicillin, and eosine-methylene blue agar were used as culture media. Identification and sensitivity tests were carried out with the Vitek (Biomerieux®) automated method. A total of 26 isolates was obtained belonging to 12 species and nine genera. Isolates were sensitive to the commonly used antibiotics. We suggest to do antibiotic prophylaxis in patients undergoing hyrudotherapy, and to implement standardized protocols to disinfect the animals before use and for the cleaning of the aquarium where they are kept.

Clonagem, expressão e caracterização de um inibidor de agregação plaquetária proveniente dos complexos salivares de sanguessugas Haementeria depressa / Cloning, expression and characterization of a platelet aggregation inhibitor from Haementeria depressa leech salivary complexes

Animais hematófagos possuem em sua saliva substâncias que permitem a fluidez do sangue, para o sucesso de sua alimentação. Com isso, têm sido descritos diversos componentes com atividades nos diferentes processos hemostáticos (coagulação, fibrinólise e agregação plaquetária). O complexo salivar da sanguessuga Haementeria depressa vem sendo estudado através de bioquímica clássica e análises transcriptômica e proteômica deste tecido determinaram o perfil dos transcritos e das proteínas produzidas. Dentre os transcritos mais abundantes foram encontrados três clones (H06A09, H06A02 e L02F02) que apresentaram 45%, 87% e 94% de similaridade ao LAPP, um inibidor de agregação plaquetária da sanguessuga Haementeria officinallis, a produção destes componentes pelo tecido foi confirmada pela análise proteômica. O LAPP é um inibidor que age pela via do colágeno e possui cerca de 14 kDa e pI de 4,0 e inibe a ligação da plaqueta ao colágeno tanto pelo epítopo do FvW quanto pelo domínio a2b1. Assim, o objetivo do presente trabalho foi clonar, expressar e caracterizar a proteína recombinante ativa, a partir do clone H06A09 para estudos de atividade desta molécula. Para obter a proteína recombinante de interesse inicialmente a clonagem do transcrito foi realizada com sucesso em vetor pAE, porém, a expressão em sistema procarioto apresentou alguns obstáculos já que a molécula não tinha atividade. Uma nova estratégia foi proposta, sendo realizada clonagem em vetor pPIC9K e expressão em sistema eucariótico (leveduras Pichia pastoris - GS115). Desta forma, o presente trabalho caracteriza o primeiro inibidor recombinante de agregação plaquetária pela via do colágeno proveniente de sanguessugas Haementeria depressa, e comprova que apesar de apresentar 45% de similaridade estrutural ao LAPP é um inibidor com características funcionais diferentes, e com grande potencial a ser estudado.

Hematophagous animals have in their saliva substances that maintain the blood fluidity to the success of their feeding. Therefore, components have been described by their activities in the hemostatic processes (coagulation, fibrinolysis and platelet aggregation).The salivary complex of Haementaria depressa leech has been studied by classical biochemical and transcriptomic and proteomic analysis of this tissue determined the profile of transcripts and proteins produced by it. Among the most abundant transcripts were found three clones (H06A09, H06A02 e L02F02) that showed 45%, 87% e 94% of similarity to LAPP, an inhibitor of platelet aggregation from Haementeria officinallis, the components production was confirmed by proteomic analysis. LAPP is a inhibitor that acts by collagen pathway and has around 14 kDa and pI of 4.0, and inhibits the binding of platelet to collagen by both the epitope domain of vWF as the a2b1. Thereby, the aim of this study was to clone, express and characterize the active recombinant protein from the clone H06A09 for studies of activity of this molecule. To obtain the recombinant protein initially cloning of transcript was successfully performed in pAE vector, however, the protein expressed in prokaryotic system presented some obstacles not presenting activity. A new strategy was proposed, being held in pPIC9K vector and expression in eukaryotic system - yeast Pichia pastoris (GS115). Thus, this study characterized the first recombinant inhibitor of platelet aggregation through collagen pathway from Haementeria depressa leeches, and proves that despite having 45% structural similarity to the LAPP is an inhibitor with different functional characteristics, and great potential to be studied.

Biodiversity and ecology of Hirudinea (Annelida) from the Natural Reserve of Isla Martín García, Río de la Plata, Argentina / A Biodiversidade e a Ecologia de Hirudinea (Annelida) da Reserva Natural da Ilha Martín García, na Argentina

The Island of Martin Garcia lies at the confluence of the Uruguay and Paraná Rivers (upper Río de la Plata). This island is an outcrop of the crystalline basement. Due to basalt exploitation the island exhibits several ponds covered by carpets of free-floating macrophytes. Seven major environmental variables were measured: water and air temperature, percentage of oxygen saturation, dissolved oxygen, electrical conductivity, total dissolved solids and pH. Eleven leech species were found, Helobdella striata, H. diploides, H. adiastola and H. hyalina were new records. UPGMA clustering of species based on their occurrence in different ecological conditions revealed three main species groups. Canonical Correspondence Analysis (CCA) explained 97.2 percent of the correlation between species and environmental variables. H. triserialis shows the widest range of tolerance, H. hyalina shows positive relationships to conductivity; H. diploides shows a high correlation with dissolved oxygen, H. striata, H. lineata, and S. similis are negatively correlated with water temperature, and H. simplex is positively correlated with pH. Relationships between the species richness (S) and the sampling sites were negatively correlated with water temperature and positively correlated with dissolved oxygen. Leech biodiversity from the water bodies of Martín García Island, shows a great diversity of species and a wide plasticity regarding the characteristics of the environmental factors considered.

A Ilha Martín García encontra-se na afluência dos Rios Uruguay e Paraná (no Rio de la Plata superior) e constitui um afloramento do maciço cristalino de Brasília. Por causa da exploração do basalto, formaram-se lacunas que apresentam tapetes de vegetação flutuantes e macrófitas enraizadas. Mediram-se sete variáveis físico-químicas da água: temperatura do ar e da água, porcentagem de saturação de oxigênio, oxigênio dissolvido, condutividade elétrica, sólidos totais dissolvidos e pH. Encontraram-se onze espécies de sanguessuga, como Helobdella striata, H. diploides, H. adiastola e H. hyalina que constituem novos registros para a ilha. A análise de agrupamento baseado na ocorrência das espécies em condições ecológicas diferentes revelou três grupos principais. A análise canônica da correspondência sugere que a distribuição das espécies relaciona-se às variáveis ambientais consideradas, 97,2 por cento da correlação entre as espécies e as variáveis se distribui no eixo dois do diagrama de ordenamento. As variáveis com maior flutuação foram a condutividade e o pH. H. triserialis foi a espécie mais tolerante às variáveis ambientais; H. hyalina se relacionou positivamente com a condutividade; H. diploides teve alta correlação com o oxigênio dissolvido; H. striata, H. lineata e Semiscolex similis relacionaram-se negativamente com a temperatura da água e H. simplex, positivamente com o pH. As relações entre a riqueza de espécies (S) e os lugares de amostras foram negativas com a temperatura da água e positivas com o oxigênio dissolvido. Os corpos da água da Ilha Martín García mostram uma grande biodiversidade de espécies de sanguessuga, assim como uma ampla ductilidade com relação aos fatores ambientais considerados.

Sanguijuelas (Hirudinea: Glossiphoniidae) asociadas a Cryphiops caementarius (Decapoda: Palaemonidae) del Río Limarí, Chile / Leeches (Hirudinea: Glossiphoniidae) associated to Cryphiops caementarius (Decapoda: Palaemonidae) of the Limarí River, Chile

Two leech species were found parasitizing the shrimp Cryphiops caementarius from Limarí river, Chile. These ectoparasites can act as population regulators or development inhibitors in their host; however the biological characteristics of this host-parasite interaction are unknown. We analyze the inter-specific differences of the parasitism and its relation with host size and sex using quantitative descriptors. Abundance, prevalence, intensity and range were estimated with respect to host size and sex. The leeches belong to two species of Glossiphonidae: Helobdella triserialis and H. duplicata. Forty-seven percent of the hosts were parasitized by one or both leech species. H. triserialis was found only in the pleopod of the hosts with the highest prevalence values (42%), intensity (2.9) and range (1-11). H. duplicata was found only in the branchial filaments with 7 % prevalence, an intensity of 1.7 and a range of 1-4. The host's total length and sex can explain the variation in leech intensity and infection prevalence. However, when only the host's sex is considered, prevalence only increased with size in female hosts. Morphological characteristics of the females could explain the greater H. triserialis intensity in the base of the pleopod and would be related to a greater abdomen development.

Inhibitory effects of Co-SZ eye drops on apoptosis of lens epithelial cells and their signal transduction mechanisms / 中国病理生理杂志

AIM: To investigate the inhibitory effect of Co-SZ eye drops on apoptosis of lens epithelial cells(LEC) induced by H_2O_2 and to study the cellular and molecular mechanisms.METHODS:(1) All lenses of Sprague-Dawley rats were incubated with H_2O_2 and Co-SZ eye drops.The apoptosis rates of LEC were determined by TUNEL method.The changes of LEC ultrastructure and the formation of apoptotic body were observed by electron microscopy.(2) Bovine LEC were incubated with H_2O_2 and Co-SZ eye drops.The inhibitory of LEC apoptosis was detected by MTT after incubation.The changes of fractional DNA content in LEC were detected by flow cytometry(FCM).[Ca~(2+)]i,cAMP and cGMP of LEC were determined by spectrofluoremeter and radioimmunoassay,respectively.RESULTS: The LEC apoptosis rates in Co-SZ eye drops group were decreased significantly compared with H_2O_2 group by TUNEL.The ultrastructure changes in LEC of Co-SZ eye drops group were lighter than that in H_2O_2 group.The LEC apoptosis rates of Co-SZ eye drops group were dose-dependently decreased significantly compared with H_2O_2 groups via MTT assay.LEC apoptosis induced by H_2O_2 was inhibited by Co-SZ eye drops,and showing dose-dependent.The DNA contents in LEC of Co-SZ group were increased.The [Ca~(2+)]i and cAMP in Co-SZ group were decreased obviously.The cGMP was increased.CONCLUSION: The LEC apoptosis induced by H_2O_2 was inhibited by Co-SZ eye drops.The mechanism of apoptosis inhibition by Co-SZ eye drops maybe contribute to the increase in DNA content.The signal transduction mechanisms are related to the decrease in [Ca~(2+)]i and cAMP and the increase in cGMP.

Protective effect of Co-SZ eye drop on galactose cataract in rats / 中国病理生理杂志

AIM: To investigate the effects of Co-SZ eye drop on galactose cataract in rats. METHODS: Based on folk remedy, SZ eye drop was made from leech, as a modified SZ eye drop, Co-SZ eye drop was enriched in Zinc and Vitamin C. In the present study, animal model of galactose cataract in SD rats was used. All animals were randomly divided into 3 groups : control group(using 0.9 % NaCl instead of SZ and Co SZ), SZ group and Co-SZ group. Lens opacities were examined dynamically in each groups via FS-3V slit-lamp microscope. Superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), glutathione (GSH) and soluble protein (SP) in the lenses were measured in 15 days. RESULTS: Both the Co-SZ and SZ eye drops could significantly delay and alleviate galactose cataract in rats, with better effect of Co-SZ than SZ eye drop. The antioxidant index indicated that SOD, GSH-Px, GSH in Co-SZ and SZ group were significantly higher than that in control group. Furthermore, SOD, GSH-Px in Co-SZ group were higher than that in SZ group significantly. CONCLUSION: Co-SZ eye drops could significantly delay and alleviate galactose cataract in rats, the effect is much better than SZ eye drops. The different effect between SZ and Co-SZ eye drops could be raised from the different content of Zinc, which is involved in anti-oxidation.

Biological activities of four kinds of leeches / 中成药

AIM: To provide scientific references for leeches by means of the antithrombin,antitrypsin and antichymotrypsin activities of the four kinds of leeches. METHODS: Using antithrombin,antitrypsin and antichymotrypsin activity analysis methods,the four kinds of leeches,they were,Whitmania pigra Whitman,Hirudo nipponia Whitman,Hirudo medicinalis Linnaeus,Hirudinaria manillensis Lesson,were detected. RESULTS: The blood-sucking leeches except whitnania pigra whitman had high antithrombin activity,and these four kinds of leeches were the same antitrypsin and antichymotrypsin activities. CONCLUSION: These three biological activity methods could be considered as reliable indexes in assessing the qualitity of leeches.