The Journal of surgical research
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Clavicular pseudoarthrosis is a rare condition, the management of which should not be underestimated because it requires re-operations and causes serious morbidity or even a lifelong handicap. ⋯ A single operation was adequate in seven cases; two operations were adequate in four cases and three operations were adequate in one case. Fractures healed properly in 11 cases, but in some cases mild-to-moderate symptoms still persisted post-operatively. The results of 13 patients who underwent various surgical procedures show that a reconstruction plate should be the first choice of osteosynthesis, followed by a dynamic-compression plate, and a semitubular plate should be the last choice. To conclude, with this kind of treatment of clavicular pseudoarthrosis, we achieved a high degree of patient satisfaction, as well as objective improvements in status reports.
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Gene therapy has been recently introduced as a novel approach to treat ischemic tissues by using the angiogenic potential of certain growth factors. We investigated the effect of adenovirus-mediated gene therapy with transforming growth factor-beta (TGF-beta) delivered into the subdermal space to treat ischemically challenged epigastric skin flaps in a rat model. ⋯ In this study, the authors were able to demonstrate that adenovirus-mediated gene therapy using TGF-beta ameliorated ischemic necrosis in an epigastric skin flap model, as confirmed by significant reduction in the necrotic zones of the flap. The results of this study raise the possibility of using adenovirus-mediated TGF-beta gene therapy to promote perfusion in random portion of skin flaps, especially in high-risk patients.
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Opioid peptides, which can induce mammalian hibernation, may provide protection against subcellular and molecular changes during hypothermic myocardial ischemia. This study examined the differential effects of the three known myocyte opioid receptors, Mu (micro), Delta (delta), and Kappa (kappa), in augmenting myocardial ischemic tolerance. ⋯ This study demonstrates that the micro-receptor does not appear to confer a beneficial effect. However, selective delta- and kappa-agonists provide significant myocardial protection. Moreover, hearts pretreated with an opioid antagonist showed a marked decrement in both functional and metabolic integrity. These results taken together would imply a positive and negative constitutive role of delta- and kappa-opioids in the regulation of myocardial ischemic tolerance. This utilization of opioid receptor stimulation may have profound clinical applications.
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Cardioprotective strategies are needed to prevent perioperative myocardial dysfunction in high-risk patients undergoing cardiac surgery. Despite accumulating evidence that statins exert lipid-independent cardioprotective effects, these have been ascribed primarily to improvements in endothelial function and neutrophil-endothelial interaction. The direct effects of statins on cardiomyocytes (independent of endothelial cells) remain unknown. ⋯ This effect was mediated via an increase in NO release, decrease in myocyte ET-1 production/action, and an increase in protein kinase Akt activation. We demonstrate, for the first time, novel protective effects of pravastatin in human ventricular cardiomyocytes independent of endothelial cells or other cell types. Statin therapy may restore ischemic hearts to full functional integrity during cardioplegic arrest through a direct effect on cardiomyocyte survival.
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Our knowledge of afferent nerve fiber reinnervation of grafted skin following third-degree burn is limited by a lack of quantitative histological and psychophysical assessment from the same cutaneous area. The current study compares fiber profile and functional recovery measurements in injured and control skin from the same subject. ⋯ Observations support the hypothesis that sensory regeneration is fiber-size-dependent in burn-graft skin. The findings that substance P fiber growth increased while total fiber count decreased and that thermal threshold showed the greatest degree of functional recovery suggest that unmyelinated neurons have the greater ability to transverse scar tissue and reinnervate grafted skin following third-degree burn injury.