The split tibialis anterior muscle flap �C A simple solution for longitudinal middle third tibial defects

Background:

The tibialis anterior flap is an underused flap, mainly because it is not an expendable muscle and is small in size.

Aim:

To study the use of the tibialis anterior muscle flap for longitudinal middle third tibial defects.

Materials and Methods:

We have analysed the use of tibialis anterior flap in five patients by the function preservation technique.

Results and Conclusion:

Function preservation techniques used in the harvesting of this flap will be able to cover narrow and linear defects on middle third of tibia comfortably. Size and pliability of the muscle must be assessed before initiation of harvesting of the flap. Flap harvesting is initiated by a saggital split incision to preserve maximum blood supply to the muscle. Transverse incisions may be employed to obtain the desired reach of the flap. This flap is a simple alternative for linear wounds with small transverse dimensions on middle third of the leg, where the tibialis anterior muscle is uninjured.KEY WORDS: Longitudinal tibial defect, tibialis anterior function preservation, tibialis anterior flap     

Anatomical basis of dimple creation �C A new technique: Our experience of 100 cases

Background:

Cheek dimples are usually considered as an attractive feature of facial beauty. Unfortunately, not all beautiful girls have dimples. Literature on dimple creation surgery is sparse.

Aims:

We used a new and simple technique for dimple creation, passing a transcutaneous bolster stitch after scraping off the dermis of all mucomuscular attachments. Our aim was to analyse the positive and negative findings of this technique.

Materials and Methods:

We used this procedure in creation of 100 dimples under local anaesthesia as a daycare procedure and analysed the results.

Results and Conclusion:

This procedure is safe, reliable and easily reproducible. As no tissue is excised, chances of bleeding and haematoma formation are negligible. With this procedure, the patient satisfaction rate is very high, and patients seen long time after surgery continue to be pleased with their surgically created dimples.KEY WORDS: Anatomical basis of dimple creation, dimple creation, natural dimples     

Fuzzy cognitive map in differential diagnosis of alterations in urinary elimination: A nursing approach

PurposeTo develop a decision support system to discriminate the diagnoses of alterations in urinary elimination, according to the nursing terminology of NANDA International (NANDA-I).MethodsA fuzzy cognitive map (FCM) was structured considering six possible diagnoses: stress urinary incontinence, reflex urinary incontinence, urge urinary incontinence, functional urinary incontinence, total urinary incontinence and urinary retention; and 39 signals associated with them. The model was implemented in Microsoft Visual C++^® Edition 2005 and applied in 195 real cases. Its performance was evaluated through the agreement test, comparing its results with the diagnoses determined by three experts (nurses). The sensitivity and specificity of the model were calculated considering the expert's opinion as a gold standard. In order to compute the Kappa's values we considered two situations, since more than one diagnosis was possible: the overestimation of the accordance in which the case was considered as concordant when at least one diagnoses was equal; and the underestimation of the accordance, in which the case was considered as discordant when at least one diagnosis was different.ResultsThe overestimation of the accordance showed an excellent agreement (kappa = 0.92, p < 0.0001); and the underestimation provided a moderate agreement (kappa = 0.42, p < 0.0001). In general the FCM model showed high sensitivity and specificity, of 0.95 and 0.92, respectively, but provided a low specificity value in determining the diagnosis of urge urinary incontinence (0.43) and a low sensitivity value to total urinary incontinence (0.42).ConclusionsThe decision support system developed presented a good performance compared to other types of expert systems for differential diagnosis of alterations in urinary elimination. Since there are few similar studies in the literature, we are convinced of the importance of investing in this kind of modeling, both from the theoretical and from the health applied points of view.LimitationsIn spite of the good results, the FCM should be improved to identify the diagnoses of urge urinary incontinence and total urinary incontinence.     

Follistatin-Like 3 Mediates Paracrine Fibroblast Activation by Cardiomyocytes

Follistatins are extracellular inhibitors of the TGF-?? family ligands including activin A, myostatin and bone morphogenetic proteins. Follistatin-like 3 (FSTL3) is a potent inhibitor of activin signalling and antagonises the cardioprotective role of activin A in the heart. FSTL3 expression is elevated in patients with heart failure and is upregulated in cardiomyocytes by hypertrophic stimuli, but its role in cardiac remodelling is largely unknown. Here, we show that the production of FSTL3 by cardiomyocytes contributes to the paracrine activation of cardiac fibroblasts, inducing changes in cell adhesion, promoting proliferation and increasing collagen production. We found that FSTL3 is necessary for this response and for the induction of cardiac fibrosis. However, full activation requires additional factors, and we identify connective tissue growth factor as a FSTL3 binding partner in this process. Together, our data unveil a novel mechanism of paracrine communication between cardiomyocytes and fibroblasts that may provide potential as a therapeutic target in heart remodelling.     

Versicherungsrechtliche Medizin

International Journal of Legal Medicine -     

Heparin and mucopolysaccharide polysulfuric acid ester permeate human skin

After topical application of commercial preparations containing heparin and heparinoids (MPS) in concentrations of 30,000 up to 150,000 IE/100 g, the individual layers of the skin show more or less increased heparinization, which can be traced by means of the permeation chamber technique. The average concentration of heparin and MPS in the dermal layers containing capillaries is about 0.1-0.5 IE/ml and 400-40,000 ng/ml, respectively, depending on the quality of the horny layer. We did not find any evidence for the permeation being activated either by DMSO, urea, or other accelerators. Repeated exposition to the preparation within 4 hours, however, resulted in increased permeation of heparin and MPS. The amount of the gel or ointment applied was of no significance.