Reubicación del ombligo al realizar un colgajo TRAM / Umbillical repositioning in TRAM flap

Describimos un método simple para reubicar el ombligo en los casos de plicatura abdominal unilateral consecutiva a la rotación de un colgajo TRAM. El ombligo se desplaza a lo largo de una incisión hecha en la aponeurosis anterior del músculo recto abdominal contralateral. Este procedimiento no debilita la musculatura abdominal contralateral, mantiene el ombligo estable, sin estenosis, y evita la formación de cicatrices hipertróficas a su alrededor. Tras este procedimiento los pacientes conservan una resistencia abdominal normal, pudiendo realizar esfuerzo y ejercicio sin manifestar áreas de debilidad (AU)

A new method of umbilical repositioning by incising the anterior rectus sheath and rectus abdominis muscle is reported for cases of unilateral abdominal wall plication during the TRAM flap operation. This method does not weaken the contralateral abdominal muscles, keeps the umbilicus stable and nonstenotic, and it avoids hypertrophic scars. With this technique, patients have normal abdominal strength, performing abdominal strain and general exercise without areas of weakness in the abdominal wall (AU)

Umbilical transposition in TRAM flap: a simple horizontal translocation.

A simple method of umbilical repositioning by incising the anterior rectus sheath and rectus abdominis muscle is reported for cases of unilateral abdominal wall plication during the TRAM flap operation. This method keeps the umbilicus stable and nonstenotic, and it avoids hypertrophic scars, which result from other techniques such as direct suturing of the stalk to the skin. Although this method might weaken contralateral muscle activity, the patients we operated on maintained their ability to perform sit-ups, and no periumbilical weakening was noticed.

Evolution from endoscopic to miniinvasive facelift: a logical progression?

Endoscopy has revolutionized the field of aesthetic surgery, permitting the advent of cosmetic surgery via minimal incisions. The procedures are modifications of subperiosteal lifting techniques which grew out of craniofacial surgery. Nonetheless, the cumbersome instrumentation and changes in operator technique have led to the development of a subperiosteal facelift through minimal incisions without the aid of endoscopy. This miniinvasive approach has yielded equivalent results to our endoscopic rhytidectomies in appropriate patients, with reduced morbidity, edema, and operating time. Further, it permits the avoidance of preauricular scars in the majority (84%) of patients; 63 cases are presented, with a follow-up of up to 4 years.

Regional dermolipectomy as treatment for sequelae of massive weight loss.

Dermolipectomy is the most important procedure for treatment of the deformities engendered by massive weight loss. It remains the only treatment for excising redundant skin. Although liposuction is useful for removing fatty deposits without traditional surgical incisions, its application is limited by the ability of the skin to contract and conform to the newly sculpted figure. Thus liposuction may serve as an adjunct when treating the sequelae of weight loss but not as a primary procedure. In response to changing expectations, reconstructive surgeons have developed increasingly ingenious and specific dermolipectomy procedures to minimize or hide scars, lessen morbidity, and enhance function. Liposuction in combination with dermolipectomy has expanded the applicability of traditional procedures to a wider variety of patients. Surgical history, patient selection, surgical planning, a spectrum of regional dermolipectomy procedures, and potential complications are discussed herein.

Liposuction: procedure for focal volume reduction and body contour remodeling.

Liposuction is the most commonly used procedure for focal reduction of body fat deposits and remodeling the body contour. The procedure consists in aspirating fat from lamellar deposits using a vacuum source connected to a cannula that is passed bluntly through fatty tissue. Adjuncts to the procedure include infiltration of solutions to aid in fat removal or to limit blood loss and the application of ultrasonic energy to lyse fat cells before suction aspiration. Surgical history, theory, procedures, indications, potential complications, and guidelines are discussed herein.

Vitreopapillary traction as a cause of elevated optic nerve head.

PURPOSE: To identify vitreopapillary tractional forces as a possible cause of optic nerve head elevation. METHODS: Case reports. Two patients aged 64 and 84 years underwent detailed ocular examination and B-scan ultrasonography. RESULTS: Both patients had a unilateral elevated optic nerve head with normal color vision, normal pupillary responses, and full kinetic perimetry. Biomicroscopic and B-scan ultrasonographic evaluation confirmed the presence of vitreopapillary traction. CONCLUSIONS: Vitreopapillary traction can cause unilateral optic nerve head elevation. The posterior hyaloid should be evaluated in patients with optic nerve head elevation.

Angle-closure glaucoma as an initial presentation of systemic lupus erythematosus.

PURPOSE: To study a patient with bilateral uveal effusions and secondary glaucoma as an initial manifestation of systemic lupus erythematosus. DESIGN: A case report. METHODS: The patient presented with bilateral uveal effusions and angle-closure glaucoma. A detailed ocular examination with ultrasonography and a comprehensive medical evaluation with laboratory testing were performed. RESULTS: The ocular examination revealed bilateral uveal effusions with angle-closure and elevated intraocular pressures. A systemic evaluation revealed bilateral pleural effusions and laboratory values consistent with systemic lupus erythematosus. After medical and laser therapy failed to lower the intraocular pressure, partial thickness sclerectomies, linear sclerostomies, and choroidal drainage were successful in controlling the glaucoma. CONCLUSIONS: Uveal effusion with secondary glaucoma can be a presenting sign for systemic lupus erythematosus. If antecedent ocular abnormalities are not present, a systemic evaluation is warranted in assessing a patient with uveal effusions and secondary angle-closure glaucoma. Partial-thickness sclerectomies, linear sclerostomies, and choroidal drainage may be effective in lowering intraocular pressure.

Heat shock protein expression in human placenta and umbilical cord.

We examined the level of heat shock proteins (HSPs) present in umbilical cord vessels and placenta following delivery. A 10 cm segment of fresh umbilical cord was obtained immediately after delivery and a placental biopsy was obtained following the third stage of labor. Apgar scores, cord pHs, and pertinent histories were recorded. Tissues were prepared and analyzed for HSP mRNA by in situ hybridization, Western blot, and immunohistochemistry. Sixteen patients were studied. HSP72 mRNA was selectively expressed in the vascular smooth muscle in all cord arteries and veins. This correlated with marked expression of HSP72 protein in the vascular media. Both HSP72/73 mRNA and protein expression were noted diffusely in the placenta. HSP27 protein was highly expressed in umbilical cords with lower levels present in placentas. There were no correlations between method of delivery, gestational age, Apgar score, cord pH, or fetal outcome to the magnitude or distribution of the HSP response. This is the first demonstration of HSP expression in the human maternal-fetal circulation.

Impaired wound healing in Cushing's syndrome: the role of heat shock proteins.

BACKGROUND: Glucocorticoids impair wound healing and cause surgical morbidity. Heat shock proteins are essential to cellular stress tolerance and are associated with glucocorticoids. The adrenal heat shock protein response is under hypothalmic-pituitary-adrenal-axis control, whereas the vascular response is associated with alpha-1 receptors. Because heat shock proteins affect cellular stress responses and are under hypothalmic-pituitary-adrenal-axis control in other tissues, we postulated an association between heat shock proteins and glucocorticoids in healing wounds. METHODS: Modified Hunt-Schilling wound chambers were implanted subcutaneously in rats. They received subcutaneous time-release dexamethasone (25 mg) or placebo pellets. Wound chamber heat shock protein 25 and heat shock protein 72/73 were serially assayed for 21 days with western analysis and immunocytochemistry. RESULTS: Dexamethasone caused Cushing's syndrome with approximately 10% weekly weight-loss and adrenal atrophy. Total wound tissue decreased 90% with profound differences in molecular wound responses manifested by decreased heat shock protein 25, 72, and 73 in animals treated with dexamethasone despite equal protein loads. Furthermore, dexamethasone caused heat shock protein 72 redistribution by immunocytochemistry. CONCLUSIONS: This study represents the first description of heat shock proteins in a wound healing model and demonstrates tissue-specific decrease of heat shock proteins with glucocorticoid therapy. Thus the heat shock protein response is intimately associated with normal wound healing and is profoundly altered in subjects with Cushing's syndrome. Manipulation of this response may have clinical importance in wound healing.

Adrenergic regulation of adrenal and aortic heat shock protein.

BACKGROUND: Surgical stress results in catecholamine secretion and selective induction of the major heat shock protein (HSP70) in the adrenal gland and in the vasculature. The adrenal response is cortical-specific and corticotropin-dependent. The vascular response occurs in the smooth muscle and is corticotropin-independent. We previously suggested that the vascular response was associated with adrenergic receptor stimulation. Herein, we report a series of experiments designed to test the hypothesis that aortic HSP70 messenger RNA (mRNA) induction occurs as a direct and specific response to alpha 1-adrenergic receptor stimulation. METHODS: Acute and chronic indwelling central venous catheter models were developed in the Wistar rat through which the following agents were infused: the alpha 1 agonist phenylephrine (0.14 mg/kg), the beta agonist isoproterenol (0.8 mg/kg), the alpha 1 antagonist prazosin (1 mg/kg), prazosin followed by phenylephrine, or saline solution alone. Hemodynamic responses were monitored; catecholamines were measured by high-performance liquid chromatography; 60 minutes after infusion, the animals were killed, and the adrenal glands and aortas were assayed for HSP70 mRNA expression on Northern blots. RESULTS: Alpha 1 stimulation with phenylephrine resulted in marked hypertension, a reflexive bradycardia, and marked induction of aortic HSP70 mRNA. This effect could be completely abolished when the alpha 1 antagonist prazosin was administered before phenylephrine treatment. The beta agonist isoproterenol failed to induce aortic HSP70. A significant catecholamine response only occurred after prazosin administration. CONCLUSIONS: These studies show a functional interaction between alpha 1 receptor stimulation and vascular HSP mRNA induction.

Identification and purification of a factor that binds to the Mlu I cell cycle box of yeast DNA replication genes.

In Saccharomyces cerevisiae, the genes encoding at least 10 enzymes involved in DNA replication are periodically expressed in the late G1 and S phases of the cell cycle. All of these genes have one copy or more of the sequence ACGCGT, which conforms to the recognition site for the Mlu I restriction endonuclease. For the CDC21, CDC9, and POL1 genes, the Mlu I site has been shown to be absolutely required for periodic transcription. Using nuclear extracts fractionated by conventional and oligonucleotide affinity chromatography, we have purified a 17-kDa protein that recognizes the Mlu I motif. Synthetic oligonucleotides containing mutated Mlu I sites do not bind the protein. In contrast, synthetic oligonucleotides derived from the CDC2, CDC6, and CDC21 genes, which are expressed with the same timing as POL1, bind purified protein efficiently.

A cell cycle-responsive transcriptional control element and a negative control element in the gene encoding DNA polymerase alpha in Saccharomyces cerevisiae.

Transcription of the POL1 gene of Saccharomyces cerevisiae, which encodes DNA polymerase alpha, the DNA polymerase required for the initiation of DNA replication, has previously been shown to be cell cycle regulated. To understand how the POL1 gene senses cell cycle position, we have investigated the cis-acting elements that respond to the factors that govern cell cycle progression. In this report we demonstrate that a region of 54 nucleotides containing the repeated element ACGCGT, which conforms to an Mlu I restriction endonuclease recognition site, contains all information necessary for transcriptional activation and cell cycle responsiveness. Although oligonucleotides lacking either one or both of the repeated Mlu I sites can function as an upstream activating sequence, the presence of at least one Mlu I site stimulates expression and, moreover, is absolutely essential for cell cycle regulation. A synthetic oligonucleotide corresponding to a 19-base-pair sequence in the POL1 promoter containing one Mlu I site can function as an autonomous cell cycle-responsive upstream element (upstream activation sequence) with temporal regulation indistinguishable from that previously described for the POL1 gene. Thus, the Mlu I site is an essential part of a cis-acting element responsible for the observed periodic activation. This sequence differs from previously defined cell cycle-responsive transcriptional control elements in the yeast HO endonuclease and histone genes. We also present evidence for a negative regulatory element in the 5' flanking region of the Mlu I upstream activation sequence.

The cdc22 gene of Schizosaccharomyces pombe encodes a cell cycle-regulated transcript.

Two independent DNA sequences, of 5.6 and 2.4 kb in size, were isolated from Schizosaccharomyces pombe gene libraries on the basis of their ability to rescue the temperature-conditional lethality conferred by a cdc22 mutation. Integration of these sequences into the S.pombe genome by homologous recombination, followed by genetic mapping, demonstrated that the site of integration of the 5.6 kb fragment is tightly linked to the cdc22 locus, while that of the 2.4 kb fragment is unlinked. This shows that the 5.6 kb fragment carries the authentic cdc22 gene while the 2.4 kb fragment carries and extragenic suppressor sequence. The cdc22 transcript was identified by Northern blot analysis and shown to be 3.3 kb in size. The level of the transcript during the cell cycle was investigated in synchronous cultures prepared by elutriation. The cdc22 transcript is cell cycle regulated, reaching a maximum level during late G1/S phase, at least 12-fold higher than the minimum level observed in mid G2.

Practical approach to the loss of smell.

Loss of the sense of smell can be easily confirmed in any physician's office by having the patient try to identify various odors. The etiology of anosmia can be extremely varied, including nasopharyngeal disorders such as rhinitis and tumors; neurologic conditions such as head trauma, neoplasms, vascular lesions and infections of the central nervous system; viral infections; familial and congenital disorders; drugs; industrial exposure; endocrine diseases, and several other disorders. The prognosis of anosmia is guarded, and its treatment depends on the etiology.