The use of the orbital septum in inferior palpebral reconstruction: the pocket technique

BACKGROUND: Surgery involving massive inferior palpebral demolition often imposes the use of free flaps for the reconstruction of the anterior and posterior lamellae. PURPOSE: We describe a surgical technique which provides for the use of a homologous pedunculated elastic flap on which we wrap the free flap as in a pocket, in order to guarantee that the free flap itself takes root better. METHODS: A study of 10 patients admitted to our hospitals for massive inferior palpebral demolition surgery between March 2002 and November 2004 was undertaken, and clinical records (age, sex, involved site of lesions, surgery technique) were accurately noted: in all patients we performed the 'pocket technique'. RESULTS: The pocket technique has encouraged optimal attachment of the implanted free tissue, in absence of necrotic phenomena or tissue extrusion. CONCLUSIONS: Reconstructive surgery of the inferior eyelid avails itself of consolidated techniques. In case of extreme tissue reduction, the variation we wish to suggest is simple to understand and easy to perform, significantly reducing inflammatory reaction and/or post-surgical rejection, allowing excellent aesthetic results.     

Decreased interhemispheric functional connectivity in autism

The cortical underconnectivity theory asserts that reduced long-range functional connectivity might contribute to a neural mechanism for autism. We examined resting-state blood oxygen level-dependent interhemispheric correlation in 53 males with high-functioning autism and 39 typically developing males from late childhood through early adulthood. By constructing spatial maps of correlation between homologous voxels in each hemisphere, we found significantly reduced interhemispheric correlation specific to regions with functional relevance to autism: sensorimotor cortex, anterior insula, fusiform gyrus, superior temporal gyrus, and superior parietal lobule. Observed interhemispheric connectivity differences were better explained by diagnosis of autism than by potentially confounding neuropsychological metrics of language, IQ, or handedness. Although both corpus callosal volume and gray matter interhemispheric connectivity were significantly reduced in autism, no direct relationship was observed between them, suggesting that structural and functional metrics measure different aspects of interhemispheric connectivity. In the control but not the autism sample, there was decreasing interhemispheric correlation with subject age. Greater differences in interhemispheric correlation were seen for more lateral regions in the brain. These findings suggest that long-range connectivity abnormalities in autism are spatially heterogeneous and that transcallosal connectivity is decreased most in regions with functions associated with behavioral abnormalities in autism. Autism subjects continue to show developmental differences in interhemispheric connectivity into early adulthood.     

IL-12 directly stimulates expression of IL-10 by CD5+ B cells and IL-6 by both CD5+ and CD5- B cells: possible involvement in age-associated cytokine dysregulation

Constitutive expression of p35 and p40 IL-12 mRNA was detected in splenic macrophages isolated from aged mice. Macrophages were also implicated as the cell type responsible for the dysregulated IL-6 and tumor necrosis factor (TNF)-alpha commonly observed to be constitutively produced by lymphoid cells from aged donors. A role for IL-12 in the aging process was suggested when it was found that recombinant IL-12 (rIL-12) directly stimulated splenic CD5+ B cells to secrete IL-10, and both CD5+ and CD5- B cells could be directly induced to produce IL-6 in response to rIL-12. Furthermore, splenocytes from aged animals cultured in the presence of anti-IL-12 antibodies demonstrated a significant reduction in spontaneous IL-6, IL-10 and IFN- gamma production. Based on these observations it was concluded that IL- 12 might be responsible for the dysregulated production of IL-10 and IFN-gamma known to occur in aged animals. Treatment of aged animals with low doses of dehydroepiandrosterone sulfate, previously established to be immunocorrective in immunosenescent animals, reduced the age-associated alterations in IL-12 mRNA and protein expression. The mechanisms responsible for the abnormal constitutive expression of inflammatory cytokines by the macrophages of aged animals may play an important afferent role in establishing the immunosenescent phenotype.      

Anti-D in a D-positive renal transplant patient

BACKGROUND: The detection of anti-D in a D-positive renal transplant recipient is unusual and may arise by several potential mechanisms. These include passive transfer of alloantibody and the presence of autoanti-D or alloanti-D that is due to microchimerism when the allograft is from a D-negative donor. In the latter case, overt hemolysis has been seen or suspected. The occurrence of anti-D in a D- positive renal transplant recipient without hemolysis, which is most likely attributable to microchimerism, is reported. CASE REPORT: A 51- year-old group O, D-positive woman, who was serologically HLA type A1, A2; B8, B44; DR3, DR6, DR52; DQ1, DQ2, underwent the transplantation of a kidney from a cadaveric donor who was serologically HLA type A1, A2; B8, B44; DR13, DR17, DR52; DQ1, DQ2. The donor was known to be D- negative and immunized to D. No blood components or derivatives were administered at the time of organ graft. Ten weeks after the transplant, the direct antiglobulin test was positive in the recipient, and anti-D was eluted. Polymerase chain reaction amplification using primers to distinguish DR13 (donor) from DR14 alleles (recipient split of DR6) in the peripheral blood showed the recipient to be DR14. No DR13 could be detected, and thus microchimerism could not be confirmed. However, in the peripheral blood, GM and KM allotyping of the serum (GM A,F,X B,G and KM 1,3) and eluate (G1M F, KM 3) showed a pattern of allotypes most consistent with an alloantibody. Eleven months after transplantation, the graft continued to function; the direct antiglobulin test was still positive, and elution of anti-D persisted. CONCLUSION: This case of anti-D in a D-positive renal transplant recipient is attributed to microchimerism, despite the lack of confirmation by genotypic analysis of the peripheral blood. It raises the possibility that microchimerism may be a more common phenomenon in solid allograft recipients than is realized.     

Hypothesized predictors of patient–physician trust and distrust in the elderly: implications for health and disease management

This study notes the differences between trust and distrust perceptions by the elderly as compared with younger populations. Given the importance of trust and distrust in compliance, changing behaviors, and forming partnerships for both health and disease management, it is necessary to be able to measure patient–doctor trust and distrust (PDTD). Following recent conceptualizations on trust and distrust as coexistent states, this study hypothesizes predictors of PDTD. We are proposing that these predictors form the basis for designing, developing and validating a PDTD scale (PDTDS). It is important to capture the trust–distrust perceptions of older patients as they confront the complexities and vulnerabilities of the modern healthcare delivery system. This is necessary if we are to design interventions to change behaviors of both the healthcare provider and the older patient.     

The Diagnosis of Intra-abdominal Abscesses in Patients with Severe Crohn's Disease

A series of 24 patients with severe relapses of Crohn's diseaseresponding poorly to conventional treatment with corticosteroidswas studied to determine the incidence of intra-abdominal abscessesand the best means to detect them. Ultrasound scans proved to be difficult to interpret and unreliable.Computed tomography demonstrated abnormal bowel thickening inmost cases, and showed seven of the eight intraabdominal abscesses.¹¹¹In leucocyte scintigraphy always demonstrated inflamed areasof bowel, but underestimated the extent of disease in threepatients and overestimated it in five. All eight abdominal abscesseswere detected, and there were no false-positive results. Itwas always possible to distinguish the abscess from inflamedbowel wall. Intra-abdominal abscess is not uncommon in patients with severerelapses of Crohn's disease which are not responsive to corticosteroidtherapy, being present in about one-third of patients. ¹¹¹Inleucocyte scintigraphy is a simple and helpful test for differentiatingbetween active inflammatory bowel disease and complicating abscesses,contributing significantly to the management of patients withsevere Crohn's disease