Inframalleolar bypass in limb salvage. Late results

STUDY OBJECTIVE: The objective of this retrospective study was to report the long-term results of distal revascularization at the ankle in patients with critical ischemia. PATIENTS AND METHODS: From January 1989 to November 1999, 50 inframalleolar bypasses were performed in 49 patients (35 males and 14 females with a mean age of 75 years [range: 51 to 95 years]). Twenty-five patients (50%) were diabetics. All patients presented with critical ischemia of the lower limb. Distal anastomosis was performed at the retromalleolar posterior tibial artery in 28 cases (56%), pedal artery in 20 cases (40%) and distal fibular artery in two cases (4%). Bypasses were performed using a greater saphenous vein (n = 38), a cryopreserved arterial allograft (n = 9), or a PTFE graft (n = 2). A composite graft with greater saphenous vein and arterial allograft was performed in two cases. RESULTS: There were two early postoperative deaths. One patient presented a blow-out of the distal anastomosis that required bypass ligation and subsequent leg amputation. Early thrombosis of the graft occurred in four cases, leading to major amputation in three cases. No patients were lost to follow-up and mean follow-up was 26.7 months (range: 1 to 86 months). Graft thrombosis occurred in 15 patients and led to amputation in 6 cases. Bypass graft patency rate was 72% and 61% at 1 year and 3 years, respectively, yielding a 80% limb salvage rate at 3 years. The 3-year actuarial survival rate was 53%. CONCLUSION: Inframalleolar bypasses are a valuable tool in patients with critical ischemia. The lower limb salvage rate is satisfactory in this elderly population. Based on this experience, angiography with good run-off and, when necessary, a surgical approach to verify patency of the arteries at the ankle should always be performed before undertaking a major amputation.     

An intravitreal biodegradable sustained release naproxen and 5-fluorouracil system for the treatment of experimental post-traumatic proliferative vitreoretinopathy

BACKGROUND/AIMS: To determine the potential of an intravitreal sustained release naproxen and 5-fluorouracil (NA/5-FU) codrug for the treatment of experimental proliferative vitreoretinopathy (PVR) in a model for trauma associated tractional retinal detachment (TRD). METHODS: Sustained release pellets were prepared by covalently linking naproxen to 5-fluorouracil. Drug release was tested in vitro and toxic effects were evaluated by electroretinography and light microscopy. Traumatic PVR was induced in pigmented rabbits by performing a scleral laceration, followed by repair and intravitreal injection of 0.4 ml of autologous blood. Thirty six eyes were treated with a sustained release implant containing 1.5 mg NA/5-FU as a codrug and 36 control eyes were submitted to surgery alone. Eyes were evaluated for TRD by serial indirect ophthalmoscope examination at different time points followed by postmortem fundus evaluation of the enucleated eye RESULTS: The NA/5-FU pellets were found to provide linear release of 5-FU and naproxen over the 30 day duration of the in vitro release test. Both the severity of PVR grade and the percentage of eyes with moderate or worse tractional detachment were significantly lower in eyes treated with the codrug pellet. There were no drug related toxic effects evident on histopathological or electroretinograph examination of eyes containing the NA/5-FU pellet. CONCLUSIONS: The results suggest that this NA/5-FU codrug device effectively inhibits the progression of PVR in a rabbit trauma model that closely resembles PVR in humans. Additional studies to add knowledge to these initial findings and to clarify the potential of the codrug device for the treatment of human PVR are warranted.     

Heavy Metal Uptake by Euplotes mutabilis and its Possible Use in Bioremediation of Industrial Wastewater

A ciliate protozoan, Euplotes mutabilis, isolated from heavy metal laden industrial wastewater, has been shown to tolerate multiple heavy metals thus suggesting its significance in bioremediation of industrial effluents. This ciliate tolerated Zn²⁺ up to 33 μg/mL, Cd²⁺ up to 22 μg/mL and Ni²⁺ up to 18 μg/mL. The ciliate could uptake 85% Zn²⁺, 84% of Cd²⁺ and 87% of Ni²⁺ after 96 h of inoculation of growth medium containing 10 μg/mL of Zn²⁺ and 5 μg/mL of Cd²⁺ and Ni²⁺, with actively growing ciliates. After 6 days of incubation the ciliate removed 87% Cd²⁺, 92% Ni²⁺, and 93% Zn²⁺ from the wastewater. The heavy metal uptake capability of Euplotes mutabilis may be employed for metal detoxification operations.     

Activité antimycobactérienne des extraits de deux espècesmarocaines du genre Cistus

Cistus albidus and Cistus salvifolius, two species of the family Cistaceae, are common in the Mediterranean Basin. They have therapeutic properties. In this study, the antimycobacterial activity of these two species is evaluated. The incorporation of aqueous and ethanol extracts in the agar medium, disk diffusion method and minimal inhibitory concentration assay have shown that extracts of both plants have an antimycobacterial effect. The fractions responsible for the observed activity were identified after fractionation of extracts by thin layer chromatography (TLC) and coverage of the chromatographic plate with a liquid culture of Mycobacterium smegmatis. The phytochemical tests carried out showed that the molecules responsible for the antimycobacterial activity are polyphenols for both plants.     

Spontaneous resolution of severe aplastic anemia following thymic hemorrhage

Over the last 7 years we have seen more than 200 severe aplastic anemia patients at this centre. Three of them developed an unusual complication in the form of thymic hemorrhage. Following this complication, all 3 patients recovered partially from their aplastic anemia, without any need for further immunosuppression. These cases show possible ways to manipulate the thymus gland as a management strategy for this disease.