Body contouring of the arms and brachioplasty.

Massive weight loss patients suffer severe arm deformity, extending through the axilla and onto the chest. We found current operations inadequate, often with conspicuous scars. The L-brachioplasty was evolved to treat the entire deformity through the excision of two right angle unequal ellipses, leaving natural contours and an unobtrusive L-shaped scar. The upper body deformity consists of loose upper arm skin, oversized axilla, descent of the posterior axillary fold, flattening and elongation of the anterior axillary fold, and lateral chest rolls of skin. By tissue gathering and pinching, a hemi-ellipse is drawn over the lower half of the inner arm, sweeping up to the deltopectoral groove. Then a shorter ellipse is extended through the axilla onto the chest. These ellipses are connected by an inverted V-resection through the axilla. After skin resection the wound margins are closed with a triangular flap advancement of the posterior axillary fold. The result is a properly contoured reduced arm, axilla, and lateral chest with a sweeping inverted L-scar coursing upward along the lower medial arm to cross the dome of the axilla and then drop vertically along the mid lateral chest. Over the past four years more than fifty weight loss patients have been treated with aesthetic reshaping of the upper arm leaving inconspicuous scars and only minor complications. There have been 8 scar revisions, including two Z-plasties for contracture. The rationale and results compare favorably with contemporary techniques. L-brachioplasty is our procedure of choice for the massive weight loss patient and can be selectively applied to the aging arm.

Neuroprotective effects of pramipexole in young and aged MPTP-treated mice.

This study examined the effect of pramipexole (PPX), a selective dopamine (DA) D(3)/D(2) agonist, on 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced damage to the nigrostriatal dopamine system in young (8-week-old) and aged (12-month-old) mice. Co-administration of PPX and MPTP to young or aged mice, followed by 2 or 14 days of additional PPX treatment, significantly attenuated MPTP-induced striatal DA loss. Pramipexole treatment also significantly attenuated the loss of tyrosine hydroxylase immunoreactive neurons (TH-IR) within the substantia nigra pars compacta (SNc) in both young and aged animals. Effects of PPX administration on dopaminergic cell survival were confirmed in Nissl-stained sections and by quantitation of retrogradely labeled Fluorogold-positive SNc neurons. Protective effects of PPX on striatal DA levels and SNc DA neuron survival were similar in young and aged animals, although the magnitude of these effects was significantly less in aged animals. These findings support the early initiation of PPX therapy in Parkinson's disease patients.

Application of finite element analysis for assessing biocompatibility of intra-arterial catheters and probes.

A commercial finite element modeling program (FIDAP) was adapted to compute the fluid dynamics of laminar blood flow around an intra-arterial catheter and/or sensor probe. The model provided an accurate transient solution to the Navier-Stokes equations under pulsatile blood flow conditions. To simulate the compliance in the catheter tubing set, a second order convolution integral was incorporated into the boundary conditions. The saline drip rate and catheter compliance could be specified, and the bulk blood flow, blood pressure, and heart rate were varied to simulate specific patient conditions. Analysis of the transient solution was used to assess probable sites for thrombus activation and deposition. The transient velocity and pressure fields identified regions of separated flow and recirculation. The computed shear rates and stresses were used to predict hemolysis, platelet activation, and thrombus formation. Analysis of particle paths provided an estimate of residence times and thrombus deposition sites.