Review and update on the use of the microanastomotic coupler device for arterial anastomosis in free tissue transfer.

While a simple interrupted sutured anastomosis remains the gold standard in microsurgery, the introduction of the microanastomotic coupler device (MACD) has decreased procedure time and thrombosis risk, and improved the patency of venous anastomoses. The aim of this review is to update the evidence-based advantages of the MACD on arteries, based on clinical and experimental data, and to compare them to the hand-sewn approach in free flap transfer. All relevant articles that appeared in the PubMed and Medline/Ovid databases during the past three decades were reviewed. After exclusions, 11 studies were retained and discussed. The MACD had a generally shorter arterial anastomosis time, with improved flap survival and reduced ischaemia compared with the hand-sewn approach. The use of the MACD in arterial anastomosis is an efficient and less time-consuming alternative to the hand-sewn technique, provided that the selection of vessels is appropriate and the vessel diameter is large enough to do the anastomosis.

Effect of denervation on burn wound healing.

The skin is a natural barrier between the interior milieu of the organism and its environment. This barrier has multiple physiological functions and may be affected by an array of pathologies including wounds and burns. The present study aims to determine the effect of the nervous system on wound healing. Specifically, this study tested the effect of denervation by chemical ablation on the burn wound healing process using guanethidine for denervation of the sympathetic postganglionic neurons and resiniferatoxin for denervation of the sensory capsaicin-sensitive fibres. Animals were divided into 8 different groups: (1) control group, (2) sensory denervated and burned, (3) sensory denervated non-burned, (4) sympathetic denervated and burned, (5) sympathetic denervated non-burned, (6) vehicle sensory burned, (7) vehicle sympathetic burned, (8) non-denervated burned. We measured different morphologic and biochemical parameters such as wound surface area, histological alterations and mast cells. In addition, NGF, IL-1ß, IL-6 and IL-8 levels were determined using the ELISA technique. The gross observations, the histological data including mast cell modulation, as well as the molecular data, speak in favour of a significant delay in burn wound healing caused by sensory denervation. On the other hand, results support the positive role of sympathetic denervation in speeding up the healing process. The dual effect of the nervous system on burn wound healing is being documented in an animal model for the first time.

La peau est une barrière naturelle entre le milieu intérieur et son environnement. Elle a des fonctions physiologiques multiples et peut être atteinte par de nombreuses pathologies parmi lesquelles plaies et brûlures. Cette étude a pour but d'évaluer les effets du système nerveux sur la cicatrisation et plus particulièrement ceux de la dénervation chimique par guanéthidine des neurones sympathiques post ganglionnaires ainsi que celle des fibres sensitives à capsaïcine par résiniferatoxine. Des animaux ont été répartis en 8 groupes : (1) contrôle, (2) dénervation sensitive + brûlure, (3) dénervation sensitive sans brûlure, (4) dénervation sympathique + brûlure, (5) dénervation sympathique sans brûlure, (6) solvant de résiniferatoxine + brûlure, (7) solvant de guanéthidine + brûlure, (8) pas de dénervation + brûlure. Nous avons mesuré plusieurs paramètres morphologiques et biochimiques parmi lesquels la surface brûlées, les anomalies histologiques et la fonction mastocytaire. NGF, IL1b, IL6 et IL8 ont été mesurés par méthode ELISA. L'observation clinique, les données histologiques dont la modulation mastocytaire ainsi que les données moléculaires orientent vers un ralentissement de la cicatrisation après dénervation sensitive alors que la dénervation sympathique l'accélère. C'est la première fois que ces effets opposés des dénervations sélective est observée chez l'animal.

Pulmonary actinomycosis presenting as post-obstructive pneumonia.

Actinomycosis is a chronic suppurative infection caused by filamentous Gram-positive bacilli, leading to a purulent discharge due to sulfur granule formation. Thoracic actinomycosis represents around 20% of Actinomyces infections, with endobronchial involvement being fairly uncommon. Pulmonary actinomycosis should be considered in the differential diagnosis of non-resolving lobar pneumonia or a lobar mass suspicious for malignancy on endobronchial biopsy. A case of endobronchial actinomycosis presenting as post-obstructive pneumonia and mimicking right upper lobe endobronchial carcinoma, which was associated with foreign body aspiration, is reported here.

[Impact of low socioeconomic status on the demography and co-morbidities of asthma]. / Influence du niveau socioéconomique bas sur la démographie et les comorbidités de l'asthme.

OBJECTIVES: Asthma is a frequent and serious chronic respiratory disease which is sometimes fatal. It involves all ages and all social subclasses. The goal of our study was to determine the demography of asthma in a low socio-economic community in Lebanon and to describe its association with various epidemiologic factors. MATERIALS AND METHODS: The computerized data of 44.814 patients of a nongovernmental organization (Hariri Foundation), in Lebanon were reviewed. Asthmatic patients diagnosed by a health professional on the basis of medical criteria during the period from January 2003 to June 2005 were included in the analysis. The socio-economic characteristics of this population were retrieved and their geographical distributions were depicted. The study focused on the association of asthma with cutaneous and ocular allergies, depression, obesity and alcohol consumption. RESULTS: The majority of asthmatic patients (75%) belonged to a low socio-economic environment with a salary lower than $200 per month. 31% were illiterate. 583 (1.3%) of patients on the database were asthmatic. The rate in children was higher (2.08%) than in adults (1.09%). The majority of asthma occurred among subjects from Bekaa valley and South Lebanon. Asthma was associated more strongly with being an ex-smoker (OR 4.37; 95% CI 2.38, 8.02) than being a current smoker (OR 1.44; 95% CI 1.11, 1.87). A significant and strong association was found with depression (OR 25.6; 95% CI 3.32, 197.6), obesity (OR 4.09, 95% CI 1.31, 12.73) and with regular alcohol consumption (OR 11.78; 95% CI 1.55, 89.44). CONCLUSION: This study describes the association of asthma in this population with low socio-economic status. By defining the demographic characteristics of the asthma population the Ministry of Health and the medical organizations concerned should be better able to manage the condition. This study confirms, in a Lebanese population, the epidemiological associations described in other populations around the world.

Changes in resistances of endotracheal tubes with reductions in the cross-sectional area.

BACKGROUND AND OBJECTIVES: Partial obstruction of endotracheal tubes due to accumulation of secretions and mucus plugs can increase the tube resistance and subsequently impose increased resistive load on the patient. This study was performed to determine the changes in the resistance of endotracheal tubes of sizes 7.5, 8.0 and 8.5 mm with different degrees and locations of endotracheal tube narrowing. METHODS: Reductions of 10%, 25%, 50% and 75% in the endotracheal tube's cross-sectional areas were created at different sites along the axes of the tube connected to an artificial lung. While ventilating with a constant inspiratory flow, a 1 s end-inspiratory occlusion manoeuvre was applied and the resulting plateau pressure was determined. The resistance was calculated as (peak airway pressure--plateau pressure)/peak inspiratory flow. RESULTS: Significant increases in the endotracheal tube's resistances were observed as the tube's cross-sectional area reduction was increased from 25% to 50% and from 50% to 75% for the 7.5 mm endotracheal tube, from 25% to 50% for the 8.0 mm endotracheal tube, and from 50% to 75% for the 8.5 mm endotracheal tube. Changes of the endotracheal tube resistances were not affected by the site of cross-sectional area reductions along the axes of the tubes. CONCLUSIONS: For endotracheal tubes of sizes 7.5, 8.0 and 8.5 mm, significant changes in the tubes resistances are observed when the partial obstructions of the tubes exceed certain critical values. The location of the partial obstruction did not affect the changes in the endotracheal tube resistances.

Pulmonary-renal syndrome in a patient with fibrillary glomerulonephritis.

A patient presented with a rapid deterioration in renal function requiring dialysis. Renal biopsy demonstrated fibrillary glomerulonephritis. The patient was treated with steroids and cyclophosphamide and recovered sufficient renal function to discontinue dialysis. However, as immunosuppressive therapy was withdrawn, renal function worsened and the patient developed pulmonary hemorrhage and respiratory distress. Immunosuppressive therapy was reinstituted. During treatment the patient's renal function improved and pulmonary manifestations resolved. This case is further evidence that fibrillary glomerulonephritis can present as a pulmonary-renal syndrome and can respond to aggressive treatment with immunosuppressive agents.