Reconstrucción de rodilla con doble colgajo de gemelo / Knee reconstruction with double gemelar muscular flap

Los traumatismos de miembros inferior representan un reto importante para el cirujano plástico en cuanto a su reconstrucción cuando no se dispone de técnicas microquirúrgicas. En el presente trabajo se presentan 2 casos de reconstrucción de rodilla con doble colgajo muscular de gemelo, en los que se demuestra que se pueden utilizar simultáneamente los dos gemelos sin dejar ninguna secuela estética importante ni funcional en la deambulación de lospacientes. Hasta donde podemos conocer, no existe en la literatura nacional ni internacional un reporte de casos con esta aplicación, ya que siempre se ha empelado un solo músculo precisamente por el temor a alterar la función deflexo-extensión del pie (AU)

Lower limb traumatism has always been a problem for plastic surgeon when in the moment of the surgical reconstruction we have not microsurgical techniques. In this paper, we present 2 cases of knee reconstruction using a double gemelar muscular flap, showing how is possible the simultaneous use of the two muscles without aesthetic or functional sequels. As we know, there is no national or international report of cases with this muscular reconstruction; it has been usual to use only one muscle, in order to avoid problems in the flexo-extension movements of the foot (AU)

Effects of low molecular weight sulfated galactan fragments from Botryocladia occidentalis on the pharmacological and enzymatic activity of sPLA2 from Crotalus durissus cascavella.

Low molecular weight fragments of sulfated galactans (Boc-5 and Boc-10) from the red algae Botryocladia occidentalis significantly inhibited Crotalus durissus cascavella sPLA2 enzymatic activity. Equimolar ratios of sPLA2 to Boc-5 or Boc-10 resulted in allosteric inhibition of sPLA2. Under the conditions tested, we observed that both Boc-5 and Boc-10 strongly decreased edema, myonecrosis, and neurotoxicity induced by native sPLA2.

Colgajo de So en reconstrucción de miembro inferior / So muscle flap in lower limb reconstruction

El tratamiento de la extremidad inferior siempre ha sido una dura prueba para el cirujano plástico. La situación anatómica de la tibia, desprovista de protección muscular en su aspecto anterior, la hace altamente vulnerable ante cualquier traumatismo de la extremidad. Toda lesión a este nivel exige un tratamiento óseo y cutáneo adecuados, que deben realizarse primariamente y en forma conjunta. En el presente trabajo describimos 3 casos de pacientes con traumatismos de extremidad inferior, fracturas acompañadas de pérdida de sustancia, en los cuales se practicaron colgajos musculares para reconstruir las partes afectadas. Estos colgajos, en primera instancia se tomaron del músculo sóleo, pero encontramos el inconveniente del grosor exagerado que presentaba la cobertura a pesar de su atrofia posterior y del defecto estético desagradable que quedaba en la zona donante. Por todo ello realizamos una variante: en lugar de tomar la mitad del músculo como indica la técnica convencional, tomamos solo un cuadrante que sobrevivió a expensas de un solo pedículo vascular dominante. El cuadrante restante sirvió para hacer menos notorio el defecto de la zona donante. Los 3 casos tuvieron éxito y los pacientes están muy satisfechos con los resultados estéticos. Presentamos una alternativa quirúrgica innovadora de Colgajo de Sóleo que se puede aplicar satisfactoriamente para la cobertura de defectos de miembro inferior, al cual hemos llamado colgajo de So (AU)

Lower limb treatment has always been a headache to the plastic surgeon. Tibial anatomy, doesn´t has frontal muscle protection and it´s vulnerable in any trauma. Every lesion in the lower limb must be treated by traumatologyst and plasticsurgeon. In this study we present 3 patients with lower limb trauma, fractures and soft tissue lost, treated with muscle flapto cover affected parts. First, we took the flaps from soleous muscle, but we had problems with flap thickness and with the disgusting defect crated in the donor site. So we have created a variety: instead of taking half of the muscle, we took just a quarter, which survived with only one dominant vessel. The other quarter improved de defect in the donor site. The 3patients were successful and they are happy with the results .We present an innovative surgical variant in muscle Soleous flap that can be useful in lower limb reconstruction, and that we have denominated So flap (AU)

In vitro inhibition of oral streptococci binding to the acquired pellicle by algal lectins.

AIMS: The initial colonization of the tooth by streptococci involves their attachment to adsorbed components of the acquired pellicle. Avoiding this adhesion may be successful in preventing caries at early stages. Salivary mucins are glycoproteins that when absorbed onto hydroxyapatite may provide binding sites for certain bacteria. Algal lectins may be especially interesting for oral antiadhesion trials because of their great stability and high specificity for mucins. This work aimed to evaluate the potential of two algal lectins to inhibit the adherence of five streptococci species to the acquired pellicle in vitro. METHODS AND RESULTS: The lectins used were extracted from Bryothamnion triquetrum (BTL) and Bryothamnion seaforthii (BSL). Fluorescence microscopy was applied to visualize the ability of fluorescein isothiocyanate-labelled lectins to attach to the pellicle and revealed a similar capability for both lectins. Streptococcal adherence assays were performed using saliva-coated microtitre plates. BSL inhibited more than 75% of Streptococcus sanguis, Streptococcus mitis, Streptococcus sobrinus and Streptococcus mutans adherence, achieving 92% to the latter. BTL only obtained statistically significant results on S. mitis and S. sobrinus, whose adherence was decreased by 32.5% and 54.4%, respectively. CONCLUSION: Algal lectins are able to inhibit streptococcal adherence. SIGNIFICANCE AND IMPACT OF THE STUDY: Our results support the proposed application of lectins in antiadhesion therapeutics.

Isolation and characterization of a new agglutinin from the red marine alga Hypnea cervicornis J. Agardh.

The biochemical characterization of a new lectin (Hypnea cervicornis agglutinin or HCA) isolated from the Brazilian red alga H. cervicornis is reported. The haemagglutinating activity of the lectin was only inhibited by the glycoprotein porcine stomach mucin at a minimum inhibitory concentration of 19 microg x mL(-1). No haemagglutination inhibition was detected after the addition of simple sugars. The MALDI-TOF molecular masses of native and reduced and carbamidomethylated HCA were, respectively, 9196.6 Da and 9988.2 Da, indicating that the primary structure of the protein is crosslinked by 7 disulfide bonds. This unusual structural feature among lectins, along with its N-terminal sequence and amino-acid composition, clearly shows that HCA belongs to a protein family distinct from the isolectins Hypnin A1 and A2 isolated from the related Japanese alga Hypnea japonica. On the other hand, HCA displayed a high degree of similarity to the agglutinin from the Brazilian species Hypnea musciformis. Our data indicate the occurrence of structural diversity among lectins of closely related species living in distant ecosystems, i.e., the Pacific coast of Japan and the Atlantic coast of Brazil, and support the hypothesis that the lectin content (lectinome) might serve as a biomarker for taxonomical purposes.

Purification and characterization of a new lectin from the red marine alga Hypnea musciformis.

A lectin from the red marine alga Hypnea musciformis (HML) was purified by extraction with 20 mM PBS, precipitation with 70% saturated ammonium sulphate, ion-exchange DEAE-Cellulose chromatography and RP-HPLC. The 9.3 kDa polypeptide agglutinates erythrocytes from various sources and shows oligomerization tendencies under certain MALDI-TOF/MS conditions. Preliminary N-terminal sequencing and biological assays strongly suggest that the HML may belong to a new class of algae lectins.

Dual effects of sulfated D-galactans from the red algae Botryocladia occidentalis preventing thrombosis and inducing platelet aggregation.

Sulfated D-galactans occur on the red algae Botryocladia occidentalis as three fractions that differ in their sulfate content. Fractions F2 and F3 are potent anticoagulants. Like heparin, they enhance thrombin and factor Xa inhibition by antithrombin and/or heparin cofactor II. The inhibition potency increases simultaneously with the sulfate content of the fractions. The antithrombotic activity of these sulfated D-galactans was investigated on an experimental thrombosis model in which thrombus formation was induced by a combination of stasis and hypercoagulability. In contrast with heparin. the sulfated D-galactans showed a dual dose-response curve preventing thrombosis at doses up to approximately 0.5 mg/ kg body weight but losing the effect at higher doses. This unexpected behavior is probably due to a combined action of the sulfated D-galactan as anticoagulant and also as a strong inducer of platelet aggregation. In platelet-depleted animals the antithrombotic activity at higher dose of sulfated D-galactan is restored and almost total inhibition of thrombus formation is achieved. The sulfated D-galactan has no hemorrhagic effect even at high doses, possibly as a consequence of its effect on platelet aggregation. At comparable dose heparin has an intense bleeding effect. These results indicate that new polysaccharides, with well-defined structures, can help to distinguish events, such as antithrombotic and anticoagulant activities, bleeding and platelet-aggregating effects, which are obscure when induced simultaneously by a single compound.

Structure and anticoagulant activity of sulfated galactans. Isolation of a unique sulfated galactan from the red algae Botryocladia occidentalis and comparison of its anticoagulant action with that of sulfated galactans from invertebrates.

We have characterized the structure of a sulfated d-galactan from the red algae Botryocladia occidentalis. The following repeating structure (-4-alpha-d-Galp-1-->3-beta-d-Galp-1-->) was found for this polysaccharide, but with a variable sulfation pattern. Clearly one-third of the total alpha-units are 2,3-di-O-sulfated and another one-third are 2-O-sulfated. The algal sulfated d-galactan has a potent anticoagulant activity (similar potency as unfractionated heparin) due to enhanced inhibition of thrombin and factor Xa by antithrombin and/or heparin cofactor II. We also extended the experiments to several sulfated polysaccharides from marine invertebrates with simple structures, composed of a single repeating structure. A 2-O- or 3-O-sulfated l-galactan (as well as a 2-O-sulfated l-fucan) has a weak anticoagulant action when compared with the potent action of the algal sulfated d-galactan. Possibly, the addition of two sulfate esters to a single alpha-galactose residue has an "amplifying effect" on the anticoagulant action, which cannot be totally ascribed to the increased charge density of the polymer. These results indicate that the wide diversity of polysaccharides from marine alga and invertebrates is a useful tool to elucidate structure/anticoagulant activity relationships.

Padräo de sensibilidade de 117 amostras clínicas de Staphylococcus aureus isoladas em 12 hospitais / Sensitivity pattern of 117 clinical isolates of Staphylococcus aureus from 12 hospitals

OBJETIVO. Avaliar o padräo de sensibilidade in vitro de amostras clínicas de Staphylococcus aureus sensíveis (ossa) e resistentes à oxacilina (ORSA) a outros antimicrobianos que podem ser utilizados no tratamento de infecçöes estafilocócicas. MATERIAL E MÉTODO. Foram analisadas 117 amostras clínicas de S. aureus isoladas em vários hospitais de Säo Paulo. Também foram incluídas amostras isoladas em Campinas, SP, e Joäo Pessoa, PB. A avaliaçäo da sensibilidade in vitro aos antimicrobianos foi realizada pela técnica de microdiluiçäo em caldo, utilizando os procedimentos preconizados pelo National Committee for Clinical Laboratory Standards (NCCLS). Foi avaliada a concentraçäo inibitória mínima (MIC) para 24 antimicrobianos da classe dos beta-lactâmicos, fluoroquinolonas, aminoglicosídeos, glicopeptídeos, macrolídeos, lincosaminas e estreptograminas. Foram avaliadas tanto drogas disponíveis comercialmente quanto as que ainda se encontram em fase de pesquisa. A resistência cruzada entre dez fluoroquinolonas foi avaliada em 24 amostras. RESULTADOS. Os glicopeptídeos, o RP-59500 e a mupirocina foram os antimicrobianos que apresentaram maior atividade in vitro contra amostras de ORSA (100 por cento sensibilidade). Oitenta e sete por centro das amostras de OSSA foram sensíveis à ciprofloxacina (MIC50, 0,25 mug/mL), enquanto que, para os ORSA, a sensibilidade foi de apenas 38 por cento (MIC50 > 4mug/mL). A resistência cruzada pra as fluoroquinolonas foi observada mesmo para drogas nÒo disponíveis comercialmente. As fluoroquinolonas que permaneceram ativas contra amostras resistentes à ciprofloxacina (clinafloxacina e WIN-57.273) apresentaram MICs 8 a 64 vezes mais elevados que as amostras sensíveis à ciprofloxacina, sugerindo que, quando lançadas na prática clínica, esses MICs possam se elevar ainda mais, inviabilizando o uso clínico desses compostos. CONCLUSÃO. Os resultados do presente estudo mostraram uma alta taxa de resistência a antimicrobianos das amostras de S. aureus nos hospitais do Brasil, restando poucas opçöes para o tratamento de infecçöes causadas por ORSA.

[Sensitivity pattern of 117 clinical isolates of Staphylococcus aureus from 12 hospitals]. / Padrão de sensibilidade de 117 amostras clínicas de Staphylococcus aureus isoladas em 12 hospitais.

OBJECTIVE: To evaluate the antimicrobial susceptibility pattern of oxacillin susceptible (OSSA) and resistant Staphylococcus aureus (ORSA) isolates to other antimicrobial agents that can be used for the treatment of staphylococcal infections. MATERIAL AND METHOD: We evaluated 117 clinical S. aureus isolates from several São Paulo hospitals. Clinical isolates from Campinas, SP and from João Pessoa, PB, were also included. The in vitro susceptibility testing was performed by broth microdilution as described by the National Committee for Clinical Laboratory Standards (NCCLS). The minimum inhibitory concentration (MIC) was evaluated for 24 antimicrobial agents, including beta-lactams, fluoroquinolones, aminoglycosides, glycopeptides, macrolides, lincosamides and streptogramins. Both commercially available and experimental drugs were included in the study. Cross-resistance among fluoroquinolones was evaluated by susceptibility testing 24 isolates to 10 fluoroquinolones. RESULTS: The antimicrobial agents that showed the highest in vitro activity were the glycopeptides, the streptogramin RP-59.500, and the mupirocin (100% susceptibility). Eighty-seven percent of the OSSA and only 38% of the ORSA isolates were susceptible to ciprofloxacin (MIC50 0.25 microgram/mL and > 4 micrograms/mL, respectively). Cross-resistance among fluoroquinolones were noted even for the experimental drugs. Two fluoroquinolones remained active against ciprofloxacin-resistant isolates, clinafloxacin and WIN-57.273. However, the ciprofloxacin-resistant isolates had MICs eight-to 64-fold higher than the ciprofloxacin-susceptible isolates, suggesting that the MICs may continue to increase when these fluoroquinolones become commercially available. CONCLUSION: Our results showed a high rate of antimicrobial resistance among S. aureus from the Brazilian hospitals. Very few drugs can still be used for the treatment of staphylococcal infections.