Venous skin flaps: an experimental study and report of two clinical distal island flaps

An experimental study of saphenous flaps in 26 dogs is reported, which confirmed the work of Baek et al. (1985) that venous flaps can survive. In addition, it showed that venous island flaps could survive after division of the venous pedicle proximally or distally, or as free flaps, providing through flow was re-established by venous anastomoses. In this study no flaps survived on a single venous pedicle without through flow. Two successful clinical cases of venous flaps are also reported, in which through flow was re-established by a simple venous anastomosis. One of these flaps threatened to become necrotic until the thrombosed anastomosis was successfully redone.     

Concentration and distribution pattern of selected micronutrients in preterm and term milk from urban Brazilian mothers during early lactation

The purpose of this study was to assess the concentration and binding pattern of zinc, iron, folate and vitamin B12 in milk of Brazilian women of low socioeconomic status giving birth at term or preterm, during early lactation. Protein, fat, total solids and ash concentrations were also determined. Protein and zinc concentrations decreased significantly as lactation proceeded whereas milk fat and folate increased with the lactation period. Total solids, ash, iron and vitamin B12 remained unchanged. Zinc was present mainly in the whey fraction while less than half of the total iron was present in this fraction, with no significant change due to stage of lactation. Unsaturated folate and vitamin B12 binding capacities and percentage of saturation of the folate binding protein increased with the stage of lactation. The vitamin B12 binding protein was highly unsaturated in all samples. There was no significant difference between term and preterm samples in the parameters investigated. Correlation analysis between milk components indicated significant relationships between total solids and fat, total zinc and whey zinc, folate and total folate binding capacity, unsaturated and total folate binding capacity, and unsaturated and total B12 binding capacity. In general, the nutrient concentrations found in this study are in good agreement with published data on milk composition of women from developed countries, with the possible exceptions of folate, which was lower, and iron, which was higher. The correlation of folate concentration with its binding protein found in this work supports the hypothesis of a regulatory role for folate levels in milk exerted by the folate binding protein in the mammary gland.     

Erythema induratum (of Bazin) in a patient with endometrial tuberculosis

We report erythema induratum in a patient who was found to have active endometrial tuberculosis. This case report emphasizes the importance of an exhaustive search for active tuberculosis in patients with erythema induratum, especially in countries where tuberculosis is prevalent, as the indiscriminate treatment of erythema induratum with steroids may be harmful.     

Effects of retinol on proliferation, cell adherence and extracellular matrix synthesis in a liver myofibroblast or lipocyte cell line (GRX).

We have studied the effect of retinol on an established murine cell line (GRX), representative of liver connective tissue cells. This cell line has myofibroblast characteristics; under retinol treatment it is induced into the lipocyte (Ito-cell) phenotype. Retinol decreased the proliferation rate in the entire cell population. It increased cell adherence to the substrate, which was correlated with the increased secretion of fibronectin. Collagen secretion was specifically decreased, whilst the total protein secretion remained stable. Heparan sulphate was decreased in the pericellular compartment, but other glycosaminoglycans were not affected by retinol treatment. Modulations of pericellular components induced by retinol may alter the relations among liver mesenchymal cells, and may be related to vitamin-A-induced modifications of the homoeostasis of hepatic connective tissue and hepatic fibrosis.     

Effect of converting enzyme inhibitors in cardiac insufficiency mortality in the elderly]

In a retrospective study we analyse two populations of aged patients in congestive heart failure, one treated with ACE inhibitors other not and the other with conventional therapy. Both populations received the same medication (diuretics and digitalis) and are equivalent in age, sex distribution, NYHA functional class and echocardiographic left ventricular parameters. Comparing the mortality of the two populations at the first, second and third year of follow-up, a statistically significant reduction in mortality was found on the ACE inhibitors treated population, at the first year. However, this reduction did not reach statistical significance at second and third years. The results are similar to trials in which the effects of ACE inhibitors are studied on general populations in heart failure.     

Prophylactic antibiotherapy in urological surgery

The aim of prophylactic antibiotic therapy in urological surgery is the prevention of local or systemic infections. The authors treated 100 patients prophylactically; 62 were treated with amikacin and 38 with cefotaxime. Of the 62 patients treated with amikacin, 18 had infectious complications. Of the 38 patients treated with cefotaxime, ten had infectious complications. We conclude that in the Hospital do Desterro the incidence of infectious complications is high, despite antibiotic prophylaxis.Das Ziel der Antibiotikaprophylaxe bei urologischen Operationen ist die Verhinderung von lokalen und systemischen Infektionen. Die Autoren führten bei 100 Patienten eine Prophylaxe durch; 62 Patienten wurden mit Amikacin und 38 Patienten mit Cefotaxim behandelt. Von den 62 mit Amikacin behandelten Patienten hatten 18 und von den 38 mit Cefotaxim behandelten Patienten hatten zehn Patienten infektiöse Komplikationen. Daraus ergibt sich, daß trotz Antibiotikaprophylaxe das Auftreten infektiöser Komplikationen im Hospital do Desterro hoch ist.

---

Dr.Calais da Silva's discussion could not be presented during the meeting because of an unforeseen event, but the kindly provided us with this discussion.