Effect of Arabinogalactans on Induction of White-Opaque Somatic Embryos of Avocado (Persea americana Mill.) cv. Duke-7.

The development of somatic embryogenesis in avocado (Persea americana Mill.) has been hampered by different chronic problems. One such problem is the low level of induction of white-opaque somatic embryos (WOSEs) during the process of obtaining full avocado plants. We detected the induction of multiple WOSEs promoted after the placement of three or four small WOSEs over the embryogenic callus of Duke-7. Among the other possible chemical inductors of the Arabinogalactans (AGPs), we identified a family of extracellular plant proteoglycans implicated in many aspects of the in vitro induction of somatic embryos (SE). We extracted AGPs directly from embryogenic cultures of avocado. When the induction/proliferation medium of embryogenic avocado calli (MS-0.1 mg L-1 Picloram) was supplemented with 1-2 mg L-1 AGP, the induction rate of good-quality WOSEs from the embryogenic callus increased significantly (more than ten times that of the control without AGP) and this effect persisted for at least five subcultures after the initial treatment with AGP. AGP also modified the texture and quality of the callus. The effect of AGP extends to other cultivars and proliferation media. Our objectives were to improve the induction of WOSEs and study the effect of AGP in the somatic embryogenesis of avocado.

Tinea faciei inflamatoria que simula un síndrome de Sweet / Inflammatory Tinea Faciei Mimicking Sweet’s Syndrome

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A technique for arthroscopic all-inside suturing in the wrist.

A technique for arthroscopic all-inside suturing in the wrist is presented. The procedure allows placement of the knot inside the joint without additional incisions. We have applied it in cases of dorsal, foveal and coronal tears of the triangular fibrocartilage. No special instrument is required apart from a Tuohy needle.

Sagittal rotational malunions of the distal radius: the role of pure derotational osteotomy.

Sagittal rotational malunion after distal radius fractures was identified in eight patients by the presence of a "hinge" point on the volar cortex on the lateral radiograph, and the ulnar head being shorter than the anterior lip of the radius on the posterior-anterior radiograph. The surgical correction consisted of preplating the distal fragment with a volar locking plate before an osteotomy through the "hinge" point, and correcting the dorsal tilt of the distal fragment. Any dorsal defect was filled with cancellous bone graft from the olecranon. Pain, range of motion and grip all improved. Disabilities of arm, shoulder and hand score changed from 54 to six. Dorsal sagittal tilt improved by 26 degrees , from -23 degrees to +3 degrees . Ulnar variance improved by 3 mm, from +1.5 to -1.5 mm, becoming identical to the opposite side. A pure derotational osteotomy corrected the apparent shortening of the radius and restored the volar tilt.

Reconstrucción de pérdidas de sustancia de pulpejo / Pulp defects reconstruction

Las pérdidas de sustancia de pulpejos constituyen uno de los motivos de consulta más frecuentes en las salas de urgencias. Un tratamiento inadecuado puede ser la fuente de múltiples secuelas y ocasionar la anulación funcional del dedo. Nuestro objetivo terapéutico debe ir dirigido a aportar una cobertura adecuada, y sensible, manteniendo la máxima longitud posible y prestando atención a la recuperación funcional. Los autores describen distintas opciones terapéuticas en función del tamaño y localización del defecto (AU)

Pulp defects are one of the most usual cases seen in emergencies rooms. An inadequate initial treatment may turn into a disaster for the finger itself and for the overall hand function. Our aim should be to achieve a wound coverage good quality with satisfactory sensitive recovery, as long as to preserve all possible length of the finger and promote postoperative functional rehabilitation. The authors describe different treatments depending on the size and location of the defect (AU)

Injerto osteocondral vascularizado de la base del tercer metatarsiano para los callos viciosos intraarticulares del extremo distal del radio / Use of a vascularized osteochondral graft from the base of the third metastarsal to address intraarticular malunions of the distal radius

Objetivo. La reconstrucción de defectos articulares postraumáticos constituye un difícil reto para el cirujano. Se presenta nuestra experiencia con injertos osteocondrales vascularizados tomados de la base del tercer metatarsiano para reconstruir grandes defectos en la superficie articular distal del radio.Casos clínicos. Se han intervenido 3 adultos con defectosarticulares en radio distal, con pérdidas masivas de cartílago no candidatos a corrección con osteotomía articular. En 2 casos se reconstruyó la fosa semilunar (y sigmoidea) y en el otro la escafoidea. El tiempo desde la fractura varió de 3 a 18 meses. En todos se trasplantó la base del tercer metatarsianopediculado en la arteria y venas dorsales del pie conuna isla cutánea de monitor, revasculada mediante anastomosis terminolaterales a la arteria radial y venas de la tabaquera anatómica.Resultados. No se presentaron complicaciones vasculares.Tras la intervención el rango de flexoextensión mejoró una media de 65°; la fuerza, 52 kg y el dolor medio medido por una escala visual analógica pasó de 9 a 1,16. Respecto a la zona donante, no hubo problemas de metatarsalgia, ni en la marcha. Un paciente refería molestias en el dorso del pie, con el calzado apretado, por un probable neuroma del nervio peroneo profundo, que mejoró a los doce meses.Conclusiones. El trasplante de un injerto osteocondral vascularizado de la base del tercer metatarsiano constituye una alternativa terapéutica para el tratamiento de los defectos masivos de la carilla articular de radio distal. La secuela donante ha sido mínima (AU)

Purpose. Post-traumatic joint defect reconstruction constitutes a significant challenge for any surgeon. We hereby present our experience of using vascularized osteochondral grafts from the base of the third metatarsal to reconstruct large defects on the distal articular surface of the radius.Case reports. Surgery was performed on three adults witharticular defects in their distal radius and massive cartilage loss who were not eligible for correction through articular osteotomy. In 2 cases, the semilunar notch, and sigmoid cavity, were reconstructed; the scaphoid fossa was reconstructed in the third. Time from fracture to surgery went from 3 to 18 months. In all cases, a transplant was made of a pediculatedgraft of the base of the third metatarsal pedicled onthe dorsal foot veins and arteries with a skin island, revascularized through termino lateral anastomoses to the radial artery and to the veins of the anatomic snuff boxt (AU)

High prevalence of infections in patients with systemic lupus erythematosus and pulmonary haemorrhage.

The main objective of this study is to describe the presence of infections in patients with pulmonary haemorrhage and systemic lupus erythematosus. Patients with systemic lupus erythematosus and pulmonary haemorrhage were thoroughly evaluated in the first 48 hours with imaging plus bronchoscopy and bronchoalveolar fluid analysis. If needed, videoassisted thoracoscopy and lung biopsy were performed too. In all, search for bacterial, mycobacterial and fungal infections proceeded. Appropriate blood, bronchoalveolar fluid and tissue cultures were taken. Patients were treated with antibiotics and corticosteroids in case of infection. Otherwise, they received initial intravenous methylprednsiolone pulses for 3 days as standard therapy for pulmonary haemorrhage in systemic lupus erythematosus. Additional treatment with immunosuppressives was further decided by the treating physicians. Fourteen events in 13 patients were evaluated. In eight events (57%), an infection was demonstrated. Aetiological agents included Pseudomonas sp. and Aspergillus fumigatus. Four patients died, three of them because of the pulmonary infection and one because of cerebral haemorrhage secondary to severe systemic hypertension, 48 hours after methylprednisolone treatment. Patients with systemic lupus erythematosus and pulmonary haemorrhage have a high prevalence of infections. The influence of pulmonary haemorrhage in the setting of systemic lupus erythematosus needs further study to establish adequate treatment and to reduce the high mortality of this complication.

Colgajo microvascular corticoperióstico de cóndilo femoral para las pseudoartrosis diafisarias recalcitrantes de extremidad superior / Microvascular corticoperiosteal flap of the femoral condyle in the treatment of recalcitrant shaft nonunions in the upper limb

Objetivo. Presentar nuestra experiencia en el tratamiento de pseudoartrosis recalcitrantes en la extremidad superior mediante colgajos corticoperiósticos microquirúrgicos. Material y método. Cinco adultos (18-54 años), intervenidos antes de su traslado a nuestro centro en varias ocasiones (entre 3 y 7 veces), fueron tratados de pseudoartrosis diafisarias de la extremidad superior (dos húmeros, dos cúbitos y un radio). Tras el desbridamiento radical y osteosíntesis, el defecto óseo se rellenó con injerto de esponjosa y un colgajo corticoperióstico del cóndilo femoral, anastomosado a los vasos locales. Todos los casos comenzaron la movilización inmediata sin protección. Resultados. La supervivencia de los colgajos fue del 100%, sin complicaciones postoperatorias. Se consiguió la consolidación radiológica en menos de tres meses en todos los casos. Tres pacientes recuperaron el rango completo de movilidad articular y dos el rango de movilidad funcional. Conclusión. Los colgajos corticoperiósticos pueden ayudar a solventar pseudoartrosis recalcitrantes en la extremidad superior, incluso en casos de antecedentes de infección. Puede ser apreciado un evidente puente óseo en las radiografías 2 meses después del procedimiento

Materials and methods. Five adults (18-54 years of age), operated before referral to our centre on different occasions (3-7 times), were treated for upper limb shaft nonunion (2 humerus, 2 ulnas and 1 radius). After radical debridement and osteosynthesis, the bone defect was filled with cancellous bone graft and a corticoperiosteal flap from the femoral condyle, with anastomosis of local blood vessels. In all cases immediate mobilization was initiated without protection. Results. Flap survival was 100%, there were no postoperative complications. Healing determined by X-rays was seen in less than 3 months in all cases. Three patients recovered complete joint functional range of motion (ROM). Conclusion. Corticoperiosteal flaps can help to resolve recalcitrant nonunions in the upper limb, even in cases that have suffered infection. An obvious bone bridge can be seen in X-rays 2 months after the procedure

Transferencias del segundo y tercer dedo del pie en tándem para reconstrucción de la mano metacarpiana / Reconstruction of metacarpal hand by combined second and third toe transfer

Introducción. Las amputaciones multidigitales representan un auténtico desafío para el cirujano. En amputaciones proximales al pliegue comisural, el método óptimo de reconstrucción es un colgajo combinado de segundo y tercer dedos del pie. El objetivo de este trabajo es presentar los resultados funcionales conseguidos en cinco pacientes, los cuales recibieron transferencias del segundo y tercer dedo del pie en tándem para rehabilitar mutilaciones graves de la mano. Material y método. Desde 1995 hemos realizado 95 transferencias de dedos del pie a la mano con una supervivencia de 94/95. Cinco pacientes de edades comprendidas entre los 21 y 53 años, que habían sufrido amputaciones de 5 dedos (3 casos) y 4 dedos (2 casos), fueron tratados mediante la transferencia de un colgajo combinado de segundo y tercer dedo en tándem. Todos fueron intervenidos en fase aguda o subaguda. Cuatro de ellos habían sufrido la amputación del pulgar, cuya reconstrucción se realizó mediante trasplante de dedo gordo del pie en los tres casos y con reimplante ectópico del dedo medio (de urgencia) en un caso. La reconstrucción del pulgar primó sobre las otras y se hizo una semana antes que la de los dedos con el colgajo tándem. Resultados. Todos los trasplantes sobrevivieron. El seguimiento mínimo fue de seis meses tras la operación. En todos los casos se consiguió, al menos, una pinza trípode estable. En el pie no hubo casos de entrecruzamiento, dolor permanente en la marcha o déficit funcionales manifiestos. La encuesta sobre la secuela estética objetiva revela que ésta es importante para nosotros, pero no tanto para el enfermo. Todos repetirían y aconsejarían la misma a otros enfermos que se encontrasen en igual situación. Conclusión. La complejidad de la reconstrucción de la mano metacarpiana implica consideraciones en la posición y número de dedos transferidos, en el manejo de la pérdida de sustancia asociada y en la gestión de vasos receptores. La transferencia combinada del segundo y tercer dedo permite la recuperación de la pinza trípode y un alto grado de satisfacción de los pacientes. La secuela, estéticamente mayor, es compensada en nuestra opinión por la mayor estabilidad en la prensión y en la pinza. La intervención es recomendable para pacientes que hayan sufrido amputaciones de tres dedos trifalángicos proximales al pliegue comisural

Introduction. Multidigital amputations are a formidable challenge for the surgeon. In the case of amputations near the digital commissure the best reconstruction can be achieved using a combined flap of the 2nd and 3rd toes. The aim of this study is to present the functional results achieved in 5 patients who underwent combined 2nd and 3rd toe transplants to rehabilitate severely mutilated hands. Materials and methods. Since 1995 we performed 95 toe-to-hand transplants with a survival rate of 94/95. Five patients (ages 21­53 years) that had suffered amputations of 5 fingers (3 cases), and 4 fingers (2 cases), underwent 2nd and 3rd toe flap combined transplants. All were operated on during the acute or subacute phase. Four of the patients that had suffered a thumb amputation underwent reconstruction by means of a big toe transplant in 3 cases and emergency ectopic middle toe reimplantation in 1 case. Thumb reconstruction was considered a priority and performed one week before the toe flap tandem transplants. Results. All the transplants survived. Minimum postoperative followup was 6 months. In all cases at least one stable tripod pincer grasp was achieved. As to the foot, there were no cases of toe crossover, permanent pain during gait or manifest functional impairment. The objective survey on cosmetic sequelae revealed that these were important to us but not so important for the patients. The patients would all choose to undergo the operation again and would advise other patients in the same situation to have this type of surgery. Conclusions. The complexity involved in the reconstruction of a metacarpal hand implies consideration of such issues as the position and number of toes to be transplanted and the management of associated tissue loss and blood supply. The combined transplant of the 2nd and 3rd toes allows recovery of a tripod pincer grasp and results in a high degree of patient satisfaction. The greater cosmetic sequelae are offset, in our opinion, by the greater pincer grasp stability. This type of surgery is recommended for patients that have suffered amputations of three fingers with three phalanges proximal to the commissural fold

Vascularised corticoperiosteal grafts from the medial femoral condyle for difficult non-unions of the upper limb.

The vascularised corticoperiosteal graft was introduced by Sakai and Doi, in 1991, as a means to achieve bony union under unfavourable conditions. We present our experience with this vascularised graft, taken from the femoral condyle, in six patients with difficult non-unions (5) or other bony problems (1) in the upper limb. In five cases, a long bone defect--two humeral, two ulnar and one radial--was involved. All had had between three and seven previous operations. Two of the non-unions were secondary to infection. The others had had conventional grafting on two or three previous occasions each. In the sixth case, a corticoperiosteal graft was used to promote healing in a combined carpometacarpal and intercarpal dislocation with a very poor bed. All of the grafts survived without complications and all of the bones healed radiologically in less than three months. Three patients achieved a normal range of motion and two obtained a functional range of motion with only slight limitations. The carpometacarpal arthrodesis was healed soundly at five weeks.

Massive hand crush: the role of a free muscle flap to obliterate the dead space and to clear deep infection.

Death of tissue and/or deep infection leading to amputation is not an uncommon course of events after massive crush injuries of the central part of the hand. Management of this injury faces the dual problem of having to carry out debridement in the central part of the hand which is radical enough to remove all dead tissue but which, in itself, creates a huge dead space in the depths of the wound. Inadequate debridement and/or leaving a dead space which fills with fluid and detritus behind the flexor tendons leads on to infection, devascularisation of the fingers and amputation. This paper presents the results of very radical debridement of the hand dorsal to the flexor tendons, including the intermetacarpal spaces, and filling the dead space with a well-vascularised free muscle flap in two hands which were referred in a pre-amputation stage, with one already being infected. Both hands were salvaged.

Advanced glycosylation end products in skin, serum, saliva and urine and its association with complications of patients with type 2 diabetes mellitus.

BACKGROUND: The accumulation of advanced glycation end products (AGEs) has a key role in the pathophysiology of diabetes complications. Comparison of AGEs measurement in serum, skin, saliva and urine has not been reported. AIMS: To compare AGEs in serum, skin, saliva and urine in patients with Type 2 diabetes mellitus, with complications at different stages. MATERIALS AND METHODS: We examined 50 patients with Type 2 diabetes mellitus (40 women and 10 men) grouped according to the progression of neuropathy, nephropathy and retinopathy. The AGEs content in serum, skin, saliva and urine was measured by spectrofluorometry HPLC. RESULTS: The patients had a mean age of 56.5 +/- 7.7 yr and 12.8 +/- 6.7 yr since diagnosis. AGEs in skin correlated with years since diagnosis (p = 0.0005). AGEs in serum, skin and saliva increased with the progression of complications, nevertheless, in urine a trend to diminution was found. In the group with end-stage renal disease (ESRD), AGEs in serum increased in greater proportion. In order to account for the decreased AGEs clearance, we corrected the values for creatinine levels, and AGEs in skin gave a better association with complications. CONCLUSIONS: The AGEs measurement in skin, serum and saliva are useful to evaluate diabetes complications. AGEs in skin are associated with years since diagnosis of diabetes. Correction for renal function might discriminate AGEs in situ formation from accumulation.

[Severity of dyspnea during exercise: similarities and differences between patients with COPD or pulmonary fibrosis]. / Similitudes y diferencias en el grado de disnea durante el ejercicio en pacientes con EPOC y fibrosis pulmonar.

To understand the mechanisms leading to dyspnea during exercise and to identify possible predictive factors, we compared dyspnea at rest (baseline)and during exercise in 27 patients with chronic obstructive pulmonary disease (COPD) and 39 pulmonary fibrosis (PF) patients. We also compared spirometry and blood gases at rest and after exercise,which consisted of a 12-minute walking test (12 WT). Heart rate and oxygen saturation (SaO2) were recorded every two minutes during the 12 WT. Distance walked was also recorded. Although dyspnea changed during the 12 WT in both groups (p < 0.001),the maximum level of dyspnea reached in the two groups was not statistically different. COPD patients walked farther than did PF patients (782 +/- 182 m vs. 618 +/- 225 m, respectively;p = 0.002) and paused less often during the 12 WT than did PF patients(0.18 +/- 0.55 vs. 0.82 +/- 1.55, respectively; p <0.05). After adjusting for diagnosis, age, sex, baseline dyspnea,distance walked and pauses during the 12 WT, we found that only SaO2 was significantly related to severity of dyspnea during exercise. We conclude that there are important differences in degree of dyspnea experienced during exercise by COPD and PF patients and that SaO2 is the only variable that predicts severity of dyspnea.

Similitudes y diferencias en el grado de disnea durante el ejercicio en pacientes con EPOC y fibrosis pulmonar / Severity of dyspnea during exercise: similarities and differences between patients with COPD or pulmonary fibrosis

Con el objeto de entender los mecanismos de la disnea durante el ejercicio y posibles factores de predicción, evaluamos la disnea basal y en ejercicio en 27 pacientes con enfermedad pulmonar obstructiva crónica (EPOC) y 39 con fibrosis pulmonar. Además, se realizó una espirometría, una medición de gases arteriales en reposo y una caminata de 12 min (PC12). Durante la PC12 se midió la frecuencia cardíaca, la saturación de oxígeno (SaO2) cada 2 min y la distancia recorrida. Aunque hubo cambios en la disnea a lo largo de la prueba de ejercicio en ambos grupos (p < 0,001), el grado máximo de disnea no fue estadísticamente significativo entre los grupos estudiados. Los pacientes con EPOC recorrieron distancias mayores que los individuos con fibrosis pulmonar (782 ñ 182 y 618 ñ 225 m, respectivamente; p = 0,002) y evidenciaron un menor número de pausas durante la PC12 que los sujetos con fibrosis pulmonar (0,18 ñ 0,55 frente a 0,82 ñ 1,55, respectivamente; p < 0,05). Después de ajustar por diagnóstico, edad, sexo, disnea basal, distancia total recorrida y pausas en la PC12, sólo la SaO2 se asoció significativamente con el grado de disnea durante el ejercicio. En resumen, hay diferencias importantes en el grado de disnea durante el ejercicio entre pacientes con EPOC y fibrosis pulmonar, y la SaO2 es la única variable capaz de predecirla. (AU)

Dynamic rhinoplasty for the plunging nasal tip: functional unity of the inferior third of the nose.

To achieve permanent results for the correction of a drooping nasal tip, it is important to understand the mechanism responsible for the caudal rotation of the tip when a person speaks or smiles. This mechanism can be considered to depend on a "functional unity" formed by three components: (1) the cartilaginous framework (alar cartilages and accessories acting as a single structure); (2) muscular motors (m. levator labii superioris alaeque nasi and depressor septi nasi); and (3) gliding areas (apertura piriformis, the valvular mechanism between the upper lateral cartilages and alar cartilages, the lax tissue of the nasal dorsum, and the membranous septum). We describe a new anatomical and functional concept responsible for the plunging of the nasal tip. When a person smiles, the functional unit is activated by a combination of two forces acting simultaneously in opposite directions that rotate the tip caudally and elevate the nasal base. The levator moves the alar base upward and the depressor pulls the tip caudally. To correct the drooping tip, the transcartilaginous incision is extended laterally, and the lateral portion of the alar arch is dissected free from the skin and the mucosa, thus exposing the accessory cartilages. The arch is then severed at the level of the accessories to allow the cephalad rotation of the domes. The muscle insertions are dissected free from the accessories and a section of the muscle and, if necessary, the accessory cartilages, is removed. From January of 1991 onward, 312 patients have had this ancillary procedure performed in addition to the basic rhinoplasty technique.

Bacteriology in burn patients undergoing mechanical ventilation.

In this paper the authors introduce a retrospective study of the incidence of infectious processes in the Burns Unit of the Cruces Hospital (Bilbao), in those patients treated between 1995 and 1998, and who needed, for different reasons, mechanical ventilatory support. The most common microorganisms found in wound cultures, plugged telescoping catheter and blood cultures and analyse variations throughout the stay in the Burns Unit are described.