Le lambeau libre de gracilis à palette cutanée transversale permet d’étendre les indications de reconstruction mammaire autologue au-delà des classiques lambeaux dorsaux, abdominaux et fessiers. Les ...auteurs présentent leur expérience concernant l’utilisation de cette nouvelle technique.
La palette cutanéo-graisseuse du lambeau était taillée en fuseau horizontal centré sur le gracilis à la racine de la cuisse. La partie distale du muscle était libérée à l’aveugle sans incision supplémentaire. Le pédicule vasculaire du lambeau était microanastomosé aux vaisseaux thoraciques internes dans le troisième espace intercostal. Onze patientes, âgées de 44ans en moyenne (29–62) avec un indice de masse corporelle (IMC) moyen de 24 (19–32), ont bénéficié de cette intervention. La procédure était unilatérale (n=6) ou bilatérale (n=5) pour des indications de reconstruction mammaire immédiate (n=5) ou différée (n=6). Les principaux paramètres opératoires (durée, diamètre des vaisseaux, longueur du pédicule, volume du lambeau) et les suites postopératoires (complications, séquelles) ont été étudiés.
L’intervention durait quatre heures et 33 minutes en moyenne (trois à six heures). Le pédicule vasculaire mesurait 6,2cm de long (5–7,5) et le diamètre de l’artère 1,9mm (1,5–3). Le poids moyen des lambeaux s’élevait à 344g (270–498). Deux cas de nécrose partielle intéressant la pointe cutanéo-graisseuse postérieure (1 cm3 et 3 cm3) ont nécessité une cicatrisation dirigée. Les séquelles au site donneur se sont révélées minimes, la cicatrice étant placée dans le sillon génitocrural et le sillon sous-fessier. Il n’existait pas de déficit fonctionnel majeur après six mois de suivi moyen.
Le lambeau libre de gracilis à palette transversale offre une reconstruction naturelle et définitive tout en limitant les séquelles esthétiques et fonctionnelles du site donneur. Il est particulièrement intéressant pour les reconstructions bilatérales et immédiates après mastectomie et conservation de l’étui cutané. Cette option chirurgicale ouvre des horizons nouveaux aux femmes longilignes, dépourvues d’excès abdominal, qui souhaitent une reconstruction mammaire autologue.
The transverse musculocutaneous gracilis free flap allows a wider range of indications in autologous breast reconstruction. They extend far beyond traditional dorsal, abdominal and gluteal flaps. The authors present their experience in using this innovative procedure.
The cutaneous and adipose part of the flap consists in a horizontal ellipse centered on the gracilis muscle in the upper thigh. The distal part of the muscle is released without neither visual control nor additional incision. The flap vascular pedicle is microanastomosed to the recipient internal thoracic vessels in the third intercostal space. Eleven patients, with a mean age of 44 years (29–62) and a BMI of 24 (19–32) underwent this procedure. Surgery was performed on either one side (n=6) or two (n=5), in indications of immediate (n=5) or delayed reconstruction (n=6). The main operative parameters (time, vessel diameter, pedicle length, flap volume) as well as postoperative follow-up were studied.
Mean time of surgery was 4h33 (3–6hours). Pedicle measured 6.2cm (5–7.5) and diameter of the artery was 19mm (15–30). Average weight of the flap was 344g (270–498). Two cases of partial necrosis occurred in the posterior cutaneous part of the flap (1cm3 and 3 cm3). They were treated using controlled wound healing. Sequelae in the donor site proved minimal as the scar was placed in the crural crease and the gluteal fold. No major functional defect was noted after mean follow-up of six months.
The transverse musculocutaneous gracilis free flap allows natural and durable reconstruction while reducing cosmetic and functional sequelae in the donor site. It proves to be particularly useful in bilateral immediate reconstructions following skin-sparing mastectomy. This surgical option offers new opportunities to long-limbed women without abdominal excess wishing autologous breast reconstruction.
With technological advances in magnetic resonance angiography (MRA), spatial resolution of 1-mm perforating vessels can reliably be visualized and accurately located in reference to patients' ...anatomic landmarks without exposing patients to ionizing radiation or iodinated contrast, resulting in optimal perforator selection, improved flap design, and increased surgical efficiency. As their experience with MRA in breast reconstruction has increased, the authors have made changes to their MRA protocol that allow imaging of the vasculature in multiple donor sites (buttock, abdomen, and upper thigh) in one study. This article provides details of this experience with multiple donor site contrast-enhanced MRA.
Falls are one of the leading causes of injuries among the elderly. Therefore, distinguishing fallers and performing preventive actions is vitally important. A new variation of the gait energy image ...(GEI) called coloured gait energy image (CGEI) is proposed for classifying subjects as fallers and non-fallers and for visualising their gait patterns. Eight elderly fallers, eight elderly non-fallers and eight young subjects performed timed up and go (TUG) test, which is one of the well-known clinical tools for fall risk assessment and contains two gait sequences. Subjects were also asked to perform two other variations of the TUG test, namely TUG with manual load and TUG with cognitive load. Gait sequences were extracted from the TUG test based on the opinion of three human observers. Then the gait cycles were automatically extracted from the walking sequence and divided into three phases, corresponding to double support and first and second half of single support. Next, the GEI of each phase was generated and formed one of the colour components of CGEI. Histogram-based features obtained from CGEI were then used to classify the video collected from walking sequences of elderly fallers and non-fallers. Correct classification rate was improved by approximately 27% compared with the standard TUG test.
Human extracellular superoxide dismutase (EC-SOD) is involved in the defence against oxidative stress induced by the superoxide radical. The protein is a homotetramer stabilised by hydrophobic ...interactions within the N-terminal region. During the purification of EC-SOD from human aorta, we noticed that material with high affinity for heparin–Sepharose formed not only a tetramer but also an octamer. Analysis of the thermodynamic stability of the octamer suggested that the C-terminal region is involved in formation of the quaternary structure. In addition, we show that the octamer is composed of both aEC-SOD and iEC-SOD folding variants. The presence of the EC-SOD octamer with high affinity may represent a way to influence the local concentration of EC-SOD to protect tissues specifically sensitive to oxidative damage.
Background: The WISH-type S-form brace, is considered to improve hip function and gait in patients presenting with painful hip osteoarthritis (OA).
Objectives: To evaluate the effects of the brace on ...functional mobility.
Study Design: Cross sectional survey.
Methods: The Timed Up & Go Test (TUG) was performed with right and left turns separately in each subject.
Results: In the patients with the bilateral hip brace, the average time to complete the TUG (8.3 ± 1.7 seconds) was significantly shorter than in those without the brace (9.4 ± 2.9 seconds). On the other hand, for the patients with unilateral hip OA, the improvement of TUG with the hip brace was significant in turning the unbraced leg inside (7.4 ± 1.1 vs. 7.6 ± 1.2 seconds), while not turning the braced leg inside (7.5 ± 1.1 vs. 7.6 ± 1.2 seconds). Furthermore, significant improvement of TUG was found at three-month follow-up and maintained until the 12-month follow-up assessment. This improvement was independent of the application of the brace at the assessment.
Conclusions: The direct effect of the hip brace may be related to the hip function in the turning phase of TUG. In addition, mechanical improvements due to daily exercise may provide an indirect, but essential, effect of the brace on TUG performance.
Clinical relevance
From a functional mobility viewpoint, the present WISH-type hip brace may contribute to risk reduction of future falls in hip OA patients.
The use of “Standard Maneuvering Orders” for tugboats, vocabulary and phrases mutually pre-agreed between ships and tugboats, is essential for the former to provide clear direction for the latter ...when berthing or un-berthing safely. Tugboats will need time to change their posture before they take actions in response to orders from persons responsible for ships’ maneuvering. Therefore, when giving directions to change tugboats’ posture, persons who handle their ships are required to send out tug orders, with regard to “delay time,” a gap be-tween the orders from ships and the actions taken by tugboats. “Tug Orders” standardized and used in Japan are composed of the following three factors concerning towage work: tugboat’s motion, direction and engine power, but the author’s research shows that there are “Non-standard” special maneuvering orders other than those “standardized,” which causes such problems as a gap in perception between pilots and tugboat’s opera-tors, etc. The purpose of this paper is to research the delay time between orders for and actions by tugboats and consider the appropriate and safe timing of providing instructions to them, and then to propose globally-authorized “Standard Maneuvering Orders for tugboats”, discussing a problem involved in the use of the special orders used in Japan, and the way in which tug orders are used in other countries.
The small societies of primitively eusocial wasps have provided interesting testing grounds for reproductive skew theory because all individuals have similar reproductive potential, which is unusual ...in social insects but common in vertebrate societies. Aggression is a key parameter in testing the theory, but empirical studies have seldom quantified aggression together with the entire array of other relevant variables. The few studies that have done so were recently criticized for failing to control for the overall level of social activity. We analysed behaviour and reproductive partitioning patterns in the stenogastrine wasp
Parischnogaster mellyi. We used aggression of the subordinate (β) breeder as key variable and analysed how relatedness, body size, number of breeders and productivity affect the interaction between the reproductive skew and the aggression while controlling for nest activity and actual interaction time between α and β. We showed that (1) more even reproductive partitioning (lower reproductive skew) is associated with higher levels of aggression initiated by the β subordinate independent of colony activity and (2) none of the currently available reproductive skew models is convincingly supported. Comparison of our results with earlier studies suggests that a common aggression-based mechanism for reproductive partitioning may apply across all primitively eusocial wasps despite complications arising from variable activity levels; however, currently available models may not apply.
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