Anatomosurgical study of the superficial and deep circumflex iliac arteries

Summary An anatomical study of the superficial and deep circumflex iliac arteries in 43 formalin-fixed cadavers is presented. The origin, calibre, course, branches, symmetry and variations of the vessels are pointed out as well as their special features related to surgical applications.

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Etude anatomochirurgicale des artères circonflexes iliaques superficielle et profonde: bases anatomiques de la confection du lambeau libre iliaque composé cutanéo-osseux

Résumé Une étude anatomique des artères circonflexes iliaque superficielle et profonde est effectuée sur 43 cadavres formulés. L'origine, le calibre, le trajet, les branches, la symétrie et les variations des vaisseaux sont mis en évidence ainsi que leurs caractères particuliers en vue d'une application chirurgicale.

     

Endogenous IL-4 and IFN-gamma are essential for expression of Th2, but not Th1 cytokine message during the early differentiation of human CD4+ T helper cells

CD4+ T cells can be divided into several distinct effector subpopulations, including Th1 and Th2. Human Th1 cells are essential for the establishment of cellular immune responses, whereas Th2 cells for immunoglobulin E synthesize by B cells and immunoregulation. This study determines the involvement of exogenously and endogenously produced T cell-derived cytokines during early differentiation of naive CD4+ T cells into Th1 and Th2 cells. Cytokine gene expression of purified experienced and naive CD4+T cells in the presence or absence of Th-directing cytokines and neutralizing anti-cytokine antibodies, was determined at early (20 and 40 h) time points, after in vitro activation. These studies demonstrated that: (1) endogenously produced, T cell-derived cytokines (interferon [IFN]-gamma and interleukin [IL]-4), play an important role in the regulation of early gene expression of Th2, but not Th1 type cytokines; (2) Th1-related cytokines, IFN-gamma, and IL-2, are preferentially expressed in cultures directed toward Th1, as compared with Th2; and (3) IL-4 and IFN-gamma showed early message expression in both differentiating populations, indicating a mixed profile of Th1 and Th2 cytokine production in early human Th cell development. These findings point to the critical role for endogenously produced cytokines in the early differentiation of human Th1 or Th2 cells.     

Influence of selant fibrin on the wound healing of the pigs vocal folds

Fibrin sealants or fibrin glue are products made from human plasma proteins, which mimic the final pathway of the coagulation cascade. Its application to stimulate the healing process has been a topic of debate in the literature. The use of fibrin sealants in phonosurgery has been empirical; there have been no studies that investigate the action of fibrin sealant in Reinke's space.AimTo evaluate the effect of fibrin glue in healing of the vocal folds of pigs after surgical manipulation.Materials and MethodsThis was a prospective and experimental study. Six animals had both vocal folds incised. Sealant was applied in one of them; the other served as a control. After three months, the animals were sacrificed and a collagen count was carried out.ResultsThe side on which glue was applied had an average of 27.8% against 20.4% of the side without glue.ConclusionThe collagen concentration in the samples where the fibrin sealant was applied was significantly higher compared to samples without glue. Thus, the presence of a fibrin sealant stimulates fibrogenesis in this tissue.     

A new biliary access technique for the long-term endoscopic management of intrahepatic stones

Intrahepatic stone disease poses a difficult postoperative management problem due to frequent stone recurrence. Most of the methods proposed for long-term access to the intrahepatic biliary tree require multiple sessions of additional, usually invasive, procedures. An alternative method for endoscopic long-term access to the intrahepatic ducts, represented by a side-to-side anastomosis between the isolated Roux-en-Y jejunal limb of the bilioenteric bypass and the duodenum (duodenojejunostomy), was used in eight patients with retained and/or recurrent stones after surgical treatment of intrahepatic stone disease. There were no short- or long-term complications or mortality associated with the duodenojejunostomy. Postoperative endoscopic access to the intrahepatic ducts was successfully achieved in five of six patients: one with stone recurrence, one with a left hepatic duct stricture and stone recurrence and one with known retained postoperative stones. In two patients, no stones were found at endoscopy. Side-to-side duodenojejunostomy may be useful in the long-term endoscopic management of recurrent intrahepatic biliary stone disease and should be indicated whenever a bilioenteric anastomosis is performed for the treatment of bilateral intrahepatic stone disease. Introduction     

Single nocturnal dose of ranitidine in the treatment of duodenal ulcer: results of an open multicenter, comparative trial

This prospective multicentric randomized open trial was designed to evaluate the efficacy of ranitidine 150 mg bid vs 300 mg nocte in the short-term (4 weeks) treatment of duodenal ulcer in 15 Brazilian centers. On the basis of a randomization table 190 patients with endoscopically confirmed duodenal ulcer were allocated to receive either ranitidine 150 mg bid (94 pts) or 300 mg nocte (96 pts). The 2 treatment groups were well matched for age, sex, duration of ulcer disease, number and size of ulcers, duration of current episode, intensity of ulcer pain, alcohol and coffee intake and smoking habits. They were endoscopically controlled at the end of the 4 weeks. At 4 weeks 78 of 94 patients (83.0%) had their ulcers healed with the 150 mg bid regimen as opposed to 79 of 96 patients (82.3%) allocated to the 300 mg nocte dosage. This difference was not statistically significant. Ulcer symptoms diminished with treatment in both groups. The tolerability and compliance was excellent in both groups. The results show that ranitidine 300 mg nocte is as effective in the short-term treatment of duodenal ulcer as ranitidine 150 mg bid. Considering the greater simplicity of administration enhancing patient compliance, the treatment with 300 mg nocte is preferable.