Curcumin upregulates S100 expression and improves regeneration of the sciatic nerve following its complete amputation in mice.

The repair of peripheral nerve injury after complete amputation is difficult, and even with anastomosis, the rapid recovery of nerve function remains challenging. Curcumin, extracted from plants of the genus Curcuma, has been shown to have anti-oxidant and anti-inflammatory properties and to improve sciatic nerve crush injury in rats. Here, we determined whether curcumin had neuroprotective effects following complete peripheral nerve amputation injury. BALB/c mice underwent complete sciatic nerve amputation, followed by an immediate epineurium anastomosis. Mice were intragastrically administered curcumin at doses of 40 (high), 20 (moderate), and 10 mg/kg/d (low) for 1 week. We found that myelin in the mice of the high- and moderate-dose curcumin groups appeared with regular shape, uniform thickness, clear boundary, and little hyperplasia surrounding the myelin. High and moderate doses of curcumin markedly improved both action potential amplitude of the sciatic nerves and the conduction velocity of the corresponding motor neurons, and upregulated mRNA and protein expression of S100, a marker for Schwann cell proliferation, in L4-6 spinal cord segments. These results suggest that curcumin is effective in promoting the repair of complete sciatic nerve amputation injury and that the underlying mechanism may be associated with upregulation of S100 expression.

Anomalies of the placenta and umbilical cord in twin gestations.

The frequency of twin gestations has increased over the last few decades, mainly due to maternal age at childbearing, and the use of assisted reproductive technologies. Twins are at higher risk of aneuploidy, structural anomalies, and placental abnormalities. Some of the placental and umbilical cord abnormalities found in twin gestations are nonspecific and can be found in singleton gestations (ie, placenta previa, placental abruption, single umbilical artery, velamentous cord insertion, vasa previa, etc). However, other anomalies are unique to twin gestations, and are mainly associated with monochorionic twins-these include intraplacental anastomosis and cord entanglement. Most of these conditions can be diagnosed with ultrasound. An accurate and early diagnosis is important in the management of twin gestations. Determination of chorionicity, amnionicity, and the identification of placental anomalies are key issues for the adequate management of twin pregnancies. Pathologic placental examination after delivery can help in assessing the presence of placental and umbilical cord abnormalities, as well as providing information about chorionicity and gaining insight into the potential mechanisms of disease affecting twin gestations.

[Glomuvenous malformations]. / Glomuvenöse Malformationen.

SYMPTOMS: A patient presented suffering from neural pain in the medial foot for a period of over 20 years. DIAGNOSIS: Diagnostic showed a widely spread soft-tissue tumor consisting of confluent glomuvenous malformations that was responsible for the immense pain syndrome.The solitary or multiform-appearing knots are not compressible and manifest as the characteristic syndromes of regional pain, sensitivity to coldness, or local pressure pain. Alternatively, the patient could also be completely symptom-free. TREATMENT: Because of the dimension of the tumor and the degree of suffering, a radical resection with simultaneous microsurgical reconstruction was carried out. Twelve weeks postoperatively, healing of the flap stabilized, the foot is fully weight-bearing, and the patient is pain-free.

Anastomosis intestinal: ¿manual o mecánica?, ¿en un plano o en dos planos? / Intestinal anastomosis: manual or mechanical? One plane or two planes?

Introducción. En la actualidad se recomiendan de manera indiferente varios métodos de anastomosis gastrointestinal. Sin embargo, no existe información clara y relevante al medio colombiano que establezca sus indicaciones precisas. Se hizo una revisión del tema para determinar la efectividad de la sutura intestinal en uno o dos planos y las indicaciones precisas de la sutura mecánica. Materiales y métodos. Se realizó una búsqueda de la literatura para identificar artículos que compararan sutura en un plano contra sutura en dos planos y sutura manual versus mecánica en cirugía gastrointestinal. Los artículos se revisaron según los criterios de apreciación crítica de la literatura de JAMA. Se extrajeron los datos de la efectividad de los estudios y se analizaron sus alcances. Resultados. Se identificaron tres revisiones sistemáticas y dos ensayos clínicos. Para cirugía de emergencia en enfermedad traumática  y no traumática no hay información acerca del tipo de sutura. En anastomosis íleon-colon la frecuencia de dehiscencia de anastomosis fue menor para sutura mecánica. (OR=0,34; IC95 0,14-0,82). En anastomosis colon-colon no hubo diferencias entre los tipos de sutura. Respecto a la sutura en uno o dos planos, no hay información de adecuada calidad metodológica. Conclusión. La realización de una sutura en un plano o en dos planos no ofrece diferencia alguna con respecto a los desenlaces clínicos relevantes. El uso de la sutura mecánica está indicado de forma obligatoria en los casos de anastomosis íleon-colon. Para las anastomosis colorrectales es probable que la sutura mecánica ofrezca adecuados resultados y su uso es recomendable. Para las anastomosis entero-entéricas y colon-colon intraperitoneales, el uso de las suturas mecánicas no ofrece ventajas en términos de dehiscencia de la anastomosis.

Introduction. Different methods of intestinal anastomosis are currently recommended. In Colombia there is lack of clear and relevant information supporting their precise respective indications. We completed a literature review in order to determine the effectiveness of the one plane and two planes intestinal suture and the precise indications of the mechanical suture.Material and methods. A literature search was performed for the identification of articles comparing the one plane suture and the two plane suture, as well as the manual versus the mechanical suture in gastrointestinal surgery. Articles were reviewed according to the JAMA literature critical appreciation criteria. Effectiveness and pertinence range of data were analyzed.Results. Three systematic reviews and two clinical trials were identified. Both sensitivity and specificity of the systematic reviews were above 90%. As for the individual studies, sensibility was above 90% and specificity 47% to 100%. Conclusion. The one plane or two plane suture do not show any differences in respect to relevant clinical end results. Mechanical suture appears of obligatory indication in ileo-colic anastomoses. In colo-rectal anastomoses, probably mechanical suture exhibits adequate results, and its use is recommended. In intraperitoneal entero-enteral and colo-colic anastomoses, mechanical suture does not offer advantage in regard to anastomotic dehiscence.

DSA in digital replantations / 中华放射学杂志

ObjectiveTo assess revascularization and vessel anastomosis in digital replantations with DSA.MethodsTwelve cases of digital replantations underwent digital subtract angiography during 2 to 4 days after fingers reattachment. The vessel anastomosis,hemodynamics,stenosis and discontinuation were investigated.The unobstructed and smooth anastomosis was suggested as early stage survival of the reattached fingers,the spasm and stenosis of the reattached vessels were considered as mild vascular crisis,and the discontinuation of hemodynamics were indicated as severe vascular crisis.ResultsThe total 27 vessels were clearly displayed on DSA.Of these vessels,23 vessels were unobstructed and smooth,all digits were survived.Diagnosis coincidence of early stage survival was 100%(23/23). Two vessels were obstructed,which were testified having thrombus by operation research.The other 2 vessels were spasm,the digits were also survived ultimately by expectant treatment.All 4 abnormal vessel anatomosis were found by DSA.Conclusion DSA is important modality in assessing revascularization and blood circulation for digital replantations,guiding in dealing with the vascular crisis,and in predicting early stage survival of the reattached digits.