Safe dissection of the distally based anterolateral thigh flap.

Background The distally based anterolateral thigh (ALT) flap is an interesting reconstructive solution for complex soft tissue defects of the knee. In spite of a low donor site morbidity and wide covering surface as well as arch of rotation, it has never gained popularity among reconstructive surgeons. Venous congestion and difficult flap dissection in the presence of a variable anatomy of the vascular pedicle are the possible reasons.Methods An anatomical study of 15 cadaver legs was performed to further clarify the blood supply of the distally based ALT. Our early experience with the use of preoperative angiography and a safe flap design modification that avoids distal intramuscular skeletonization of the vascular pedicle and includes a subcutaneous strip ranging from the distal end of the flap to the pivot point is presented.Results The distally based ALT presents a constant and reliable retrograde vascular contribution from the superior genicular artery. Preoperative angiography reliably identified and avoided critical Shieh Type II pedicled flaps. The preservation of a subcutaneous strip ranging from the distal flap end to the upper knee was associated with the absence of venous congestion in a short case series.Conclusions Preoperative angiography and a flap design modification are proposed to allow the safe transfer of the distally based ALT to reconstruct soft tissue defects of the knee.

Article - "And there I was", 1952

An article that was originally published in Air Facts in 1951, is published again in the Bozeman Daily Chronicle in 1952. In the scrapbook kept by Mrs. Rungeling, there is a typwritten note that explains the events surrounding the second publication, "This story was initially printed in AIR FACTS, a flight magazine published in New York City. It was read by a Flight School in Bozeman, Montana. They wrote to me asking if I would give them permission to have the whole story printed in the Bozeman newspaper as an ad for their flying school. This is a copy of the story which was in the Bozeman newspaper". The article/story begins "This story is for non-flyers who are scared of airplanes, especially woman". This is the story of Dorothy Rungeling's first flight in a plane back in 1948 and her initial fears concerning flying.

Description du développement épiphysaire du tarse et du grasset équin à l’IRM et au CT : un pas vers la compréhension de l’OCD

L’ostéochondrite disséquante (OCD) est un défaut focal du processus d’ossification endochondrale en des sites spécifiques au niveau épiphysaire. Elle est caractérisée par la présence de fragments ostéochondraux pouvant se détacher de la surface articulaire. Cette maladie a un impact majeur sur les performances athlétiques des chevaux. Les deux hypothèses principales présentement véhiculées quant à sa pathogénie sont une nécrose ischémique du cartilage de croissance et une altération du métabolisme de la matrice de collagène de type II au sein du cartilage de croissance. Malgré de nombreuses années de recherche sur le sujet, plusieurs aspects de cette maladie demeurent inconnus. L’objectif de cette étude était de décrire le développement épiphysaire équin au niveau du membre pelvien à l’aide de l’imagerie médicale afin de déterminer si des variations du processus de maturation à certains sites pouvaient être un facteur prédisposant au développement de lésions d’OCD. Des membres pelviens de fœtus et de jeunes poulains ont été étudiés post-mortem. L’épiphyse du fémur distal, tibia distal et du talus ont été examinées par tomodensitométrie (CT) et résonnance magnétique 1.5 Tesla (IRM) dans le but de documenter le degré et le patron d’ossification, la régularité du front d’ossification, de même que le pourcentage du diamètre épiphysaire demeurant occupé par le complexe de cartilage articulaire-épiphysaire, et ce au niveau de certains sites prédéterminés. Les centres secondaires d’ossification (SOCs) ont été détectés pour la première fois à 7 mois de gestation (MOG) au niveau de l’épiphyse fémorale distale et à 8 MOG au niveau de l’épiphyse tibiale distale et du talus. À 8-9 MOG la lèvre latérale de la trochlée fémorale, la malléole médiale du tibia (MM) et la partie crâniale de la crête intermédiaire du tibia distal (DIRT(Cr)), tous des sites prédisposés à la maladie, avaient le plus haut pourcentage de cartilage de tous les sites évalués. Post-partum, le pourcentage de cartilage de la MM et de la DIRT(Cr) sont demeurés importants. Le CT et l’IRM ont su illustrer le développement épiphysaire équin et soutenir d’avantage le fait qu’un cartilage plus épais à certains sites articulaires pourrait avoir un rôle dans le développement de lésions d’OCD.

Facial artery musculomucosal flap for reconstruction of skull base defects

Facial Artery Musculomucosal Flap in Skull Base Reconstruction Xie L. MD, Lavigne F. MD, Rahal A. MD, Moubayed SP MD, Ayad T. MD Introduction: Failure in skull base defects reconstruction can have serious consequences such as meningitis and pneumocephalus. The nasoseptal flap is usually the first choice but alternatives are necessary when this flap is not available. The facial artery musculomucosal (FAMM) flap has proven to be successful in head and neck reconstruction but it has never been reported in skull base reconstruction. Objective: To show that the FAMM flap can reach some key areas of the skull base and be considered as a new alternative in skull base defects reconstruction. Methods: We conducted a cadaveric study with harvest of modified FAMM flaps, endoscopic skull base dissection and maxillectomies in 13 specimens. Measures were taken for each harvested FAMM flap. Results: The approximate mean area for reconstruction from the combination of the distal FAMM and the extension flaps is 15.90 cm2. The flaps successfully covered the simulated defects of the frontal sinus, the ethmoid areas, the planum sphenoidale, and the sella turcica. Conclusion: The FAMM flap can be considered as a new alternative in the reconstruction of skull base defects. Modifications add extra length to the traditional FAMM flap and can contribute to a tighter seal of the defect as opposed to the FAMM flap alone.

Eficacia del plasma rico en plaquetas en procedimientos médicos estéticos faciales . Evaluación en contorno de ojos.

Introducción: En la actualidad se están implementando nuevas técnicas, para el tratamiento de líneas de expresión facial. El Plasma Rico en Plaquetas (PRP) utiliza factores de crecimiento humano autólogos con fines médicos estéticos. El objetivo de este trabajo fue evaluar el tratamiento con plasma rico en plaquetas en el manejo del rejuvenecimiento periocular. Materiales y métodos: Estudio descriptivo retrospectivo en una cohorte de 27 pacientes entre 30 a 70 años de ambos sexos,tratados con PRP sin tratamientos médicos estéticos previos . Se compararon fotografías del sistema VISIA®, previo y posterior el PRP, para determinar los cambios del área periocular. Con análisis comparativo de medias utilizando pruebas t de student. Resultados: De 27 historias clínicas revisadas 96,3% eran mujeres, la edad promedio fue de 52.67 años. Se observaron cambios clínicos satisfactorios en el manejo del foto envejecimiento periocular con mejoría estadísticamente significativa entre el promedio inicial y el post tratamiento en arrugas, textura y porfirinas (p: 0.000). No se observaron diferencias estadísticamente significativas entre los grupos de edad (p = 0,62). Los pacientes analizados posterior al tratamiento se encuentran en mejor estado que el 63,78% de la población de su mismo sexo, edad y fototipo de piel. Los eventos adversos fueron disminuyendo en su frecuencia en cada una de las sesiones siguientes. Discusión: El PRP proporciona una mejoría global en los parámetros de envejecimiento periocular lo cual se correlaciono con los estudios previos in vitro. Conclusiones: El PRP es seguro y eficaz en contorno de ojos.

Impacto de dos técnicas quirúrgicas sobre la recaída local de carcinoma de mama en pacientes de una clínica de Bogotá D.C.

Introducción: El carcinoma de mama es el tumor maligno más frecuente entre las mujeres y representa una significativa mortalidad en los países en vías de desarrollo. Según datos del Instituto Nacional de Cancerología en el 2010 se reportaron 672 nuevos casos de cáncer de mama, lo que representó el 18% de todos los tumores malignos en mujeres. Durante las últimas 3 décadas las técnicas quirúrgicas para el tratamiento del cáncer de mama han presentado un cambio significativo y proponen disminución de procedimientos agresivos y radicales, intervenciones como: mastectomía radical modificada, cirugía conservadora y la disección de ganglio centinela son ejemplos claros de esta evolución asociado al incremento de la reconstrucción mamaria inmediata. Metodología: Estudio observacional tipo cohorte retrospectivo en el cual se revisó una base de datos de pacientes con cáncer de mama de las cuales 632 fueron sometidas a mastectomía radical con preservación de piel y complejo areola-pezón y mastectomía radical con preservación de piel sin preservación del complejo areola-pezón, los dos procedimientos asociados a reconstrucción mamaria inmediata y se comparó la frecuencia de recaída local entre los dos grupos. Resultados: De las 632 pacientes estudiadas al 30.5% se les realizo preservación del complejo areola pezón. Las mujeres a quienes se les realizó preservación del complejo areola pezón presentaron menor sobrevida a la recaída local a 10 años (80.51%) comparado con las mujeres a quienes no se les preservó el complejo areola pezón (87.40%), sin embargo no se encontró diferencia estadísticamente significativa para determinar que las probabilidades de sobrevida sean diferentes. Discusión: No se evidenció diferencia estadísticamente significativa entre los 2 procedimientos quirúrgicos (con y sin preservación del complejo areola pezón) en relación a la recaída local, estudios retrospectivos no han evidenciado una mayor tasa de recaídas locales en pacientes a quienes se les preserva el complejo areola-pezón, sin embargo hacen falta estudios prospectivos y aleatorizados que puedan otorgar un mayor sustento científico que garantice la seguridad de la preservación del complejo areola-pezón.

Ensemble-based data assimilation and the localisation problem

The “butterfly effect” is a popularly known paradigm; commonly it is said that when a butterfly flaps its wings in Brazil, it may cause a tornado in Texas. This essentially describes how weather forecasts can be extremely senstive to small changes in the given atmospheric data, or initial conditions, used in computer model simulations. In 1961 Edward Lorenz found, when running a weather model, that small changes in the initial conditions given to the model can, over time, lead to entriely different forecasts (Lorenz, 1963). This discovery highlights one of the major challenges in modern weather forecasting; that is to provide the computer model with the most accurately specified initial conditions possible. A process known as data assimilation seeks to minimize the errors in the given initial conditions and was, in 1911, described by Bjerkness as “the ultimate problem in meteorology” (Bjerkness, 1911).

Comparison between two surgical techniques for root coverage with an acellular dermal matrix graft

Aim: The aim of this randomized, controlled, clinical study was to compare two surgical techniques with the acellular dermal matrix graft (ADMG) to evaluate which technique could provide better root coverage. Material and Methods: Fifteen patients with bilateral Miller Class I gingival recession areas were selected. In each patient, one recession area was randomly assigned to the control group, while the contra-lateral recession area was assigned to the test group. The ADMG was used in both groups. The control group was treated with a broader flap and vertical-releasing incisions, and the test group was treated with the proposed surgical technique, without releasing incisions. The clinical parameters evaluated before the surgeries and after 12 months were: gingival recession height, probing depth, relative clinical attachment level and the width and thickness of keratinized tissue. Results: There were no statistically significant differences between the groups for all parameters at baseline. After 12 months, there was a statistically significant reduction in recession height in both groups, and there was no statistically significant difference between the techniques with regard to root coverage. Conclusions: Both surgical techniques provided significant reduction in gingival recession height after 12 months, and similar results in relation to root coverage.

Flap vs. ""flapless"" surgical approach at immediate implants: a histomorphometric study in dogs

Aim To compare the remodeling of the alveolar process at implants installed immediately into extraction sockets by applying a flap or a ""flapless"" surgical approach in a dog model. Material and methods Implants were installed immediately into the distal alveoli of the second mandibular premolars of six Labrador dogs. In one side of the mandible, a full-thickness mucoperiosteal flap was elevated (control site), while contra-laterally, the mucosa was gently dislocated, but not elevated (test site) to disclose the alveolar crest. After 4 months of healing, the animals were sacrificed, ground sections were obtained and a histomorphometric analysis was performed. Results After 4 months of healing, all implants were integrated (n=6). Both at the test and at the control sites, bone resorption occurred with similar outcomes. The buccal bony crest resorption was 1.7 and 1.5 mm at the control and the test sites, respectively. Conclusions ""Flapless"" implant placement into extraction sockets did not result in the prevention of alveolar bone resorption and did not affect the dimensional changes of the alveolar process following tooth extraction when compared with the usual placement of implants raising mucoperiosteal flaps. To cite this article:Caneva M, Botticelli D, Salata LA, Souza SLS, Bressan E, Lang NP. Flap vs. ""flapless"" surgical approach at immediate implants: a histomorphometric study in dogs.Clin. Oral Impl. Res. 21, 2010; 1314-1319.doi: 10.1111/j.1600-0501.2009.01959.x.

Influence of lateral pressure to the implant bed on osseointegration: an experimental study in dogs

Aim To study osseointegration and bone-level changes at implants installed using either a standard or a reduced diameter bur for implant bed preparation. Material and methods In six Labrador dogs, the first and second premolars were extracted bilaterally. Subsequently, mesial roots of the first molars were endodontically treated and distal roots, including the corresponding part of the crown, were extracted. After 3 months of healing, flaps were elevated and recipient sites were prepared in all experimental sites. The control site was prepared using a standard procedure, while the test site was prepared using a drill with a 0.2 mm reduced diameter than the standard one used in the contra-lateral side. After 4 months of healing, the animals were euthanized and biopsies were obtained for histological processing and evaluation. Results With the exception of one implant that was lost, all implants were integrated in mineralized bone. The alveolar crest underwent resorption at control as well as at test sites (buccal aspect similar to 1 mm). The most coronal contact of bone-to-implant was located between 1.2 and 1.6 mm at the test and between 1.3 and 1.7 mm at the control sites. Bone-to-implant contact percentage was between 49% and 67%. No statistically significant differences were found for any of the outcome variables. Conclusions After 4 months of healing, lateral pressure to the implant bed as reflected by higher insertion torques (36 vs. 15 N cm in the premolar and 19 vs. 7 N cm in the molar regions) did not affect the bone-to-implant contact. To cite this article:Pantani F, Botticelli D, Garcia IR Jr., Salata LA, Borges GJ, Lang NP. Influence of lateral pressure to the implant bed on osseointegration: an experimental study in dogs.Clin. Oral Impl. Res. 21, 2010; 1264-1270.doi: 10.1111/j.1600-0501.2009.01941.x.

Immunohistochemical, tomographic and histological study on onlay iliac grafts remodeling

The information concerning the molecular events taking place in onlay bone grafts are still incipient. The objective of the present study is to correlate the effects of perforation of resident bone bed on (1) the timing of onlay autogenous graft revascularization; (2) the maintenance of volume/density of the graft (assessed through tomography); and (3) the occurrence of bone remodeling proteins (using immunohistochemistry technique) delivered in the graft. Thirty-six New Zealand White rabbits were subjected to iliac crest onlay bone grafting on both sides of the mandible. The bone bed was drill-perforated on one side aiming at accelerating revascularization, whereas on the other side it was kept intact. After grafts fixation and flaps suture all animals were submitted to tomography on both mandible sites. Six animals were sacrificed, respectively, at 3, 5, 7, 10, 20 and 60 days after surgery. A second tomography was taken just before sacrifice. Histological slides were prepared from each grafted site for both immunohistochemistry analysis [osteopontin, osteocalcin, type I collagen and vascular endothelial growth factor (VEGF) anti-bodies] and histometric analysis. The values on bone volume measured on tomography showed no statistic significance (P >= 0.05) between perforated and intact sites. Grafts placed on perforated beds showed higher bone density values compared with non-perforated ones at 3 days (P <= 0.05). This correlation was inverted at 60 days postoperatively. The findings from VEGF labeling revealed a tendency for earlier revascularization in the perforated group. The early revascularization of bone grafts accelerated the bone remodeling process (osteocalcin, type I collagen and osteopontin) that led to an increased bone deposition at 10 days. The extended osteoblast differentiation process at intermediate stages in the perforated group cooperated for a denser bone at 60 days.

Konstruktion och design av två glassförpackningar i kartongkvaliteten Frövi Light

This degree project was made in cooperation with AssiDomän Frövi and Charlotte Andersson and the main objectivehas been to create to ice cream pacbges from 250 gsm Frövi Light board. The paekages are intended to be easilyresealable while decreasing in size together with the ice cream. The project also describes the food packaging labelsand symbols currently present in the European common market.Both capsules utilize a separate lid for resealing. One of the paekages (Capsuie A) is indended to be cut along withthe ice cream and thereby decrease in size. The other one (Capsuie B) uses a series of flaps for contracting and expandingwhich enab1es adjusting of the size without cutting the package up.The design for Capsuie A is created both as a series of flavours with a super-hero theme intended for children andwith a colfee flavour for a maturer audience. For Capsule B, a design was created for a sorbet.

Estudo de recapeamentos asfálticos de pavimentos através de ensaios acelerados

O objetivo deste estudo é avaliar o desempenho de recapeamentos asfálticos, aplicados sobre pavimentos severamente trincados, através do acompanhamento da degradação ocorrida em função do tráfego. Foram testados dois tipos de recapeamentos: uma camada de 5,6 cm de espessura, em concreto asfáltico convencional e um tratamento superficial duplo, modificado por polímero SBS. Os recapeamentos asfálticos foram aplicados sobre uma pista experimental já trafegada e realizou-se, artificialmente, um trincamento padronizado buscando reproduzir efeitos similares àqueles provocados pelo fenômeno de fadiga. Utilizou-se a técnica de ensaios acelerados de pavimentos através da utilização de um simulador linear de tráfego, com rodado duplo. A carga de semi-eixo de 50 kN adotada proporcionou a degradação do pavimento três meses de ensaio para cada recapeamento. O monitoramento do pavimento, em termos estruturais e funcionais, fez-se pelo levantamento periódico de deflexões, bacias deflectométricas, afundamentos de trilha de roda e o controle do surgimento de trincas na superfície. Para melhor quantificar e compreender os fenômenos de degradação estrutural, instrumentou-se a pista experimental com sensores (células de tensão total e strain gages) na interface entre pavimento trincado e recapeamentos, obtendo-se tensões e deformações nestes locais, considerados críticos no desempenho de pavimentos recapeados. Durante os períodos de ensaio, foram monitoradas as condições pluviométricas e temperaturas do ar e pavimento. A determinação dos módulos elásticos das camadas das estruturas testadas foi efetuada pela aproximação das bacias obtidas em campo com os dados gerados em uma simulação numérica, através do programa computacional FLAPS. Percebeu-se que, além do tráfego, o trincamento no recapeamento em tratamento superficial foi devido à condição estrutural inicial do pavimento existente, severidade do trincamento artificial incompatível com a espessura desse tipo de restauração e baixas temperaturas. Quanto ao recapeamento em concreto asfáltico, percebeu-se que o maior trincamento surgiu em áreas sem trincas artificiais subjacentes, partindo do fundo da camada asfáltica do pavimento existente, em função da pouca rigidez da camada granular.

Trabalho móvel: em trânsito por aeroportos e aviões

Argumenta-se na contemporaneidade que o trabalho adquiriu a possibilidade de ser realizado “a qualquer hora e em qualquer lugar” e que, particularmente, pode ser realizado em movimento, enquanto a pessoa que trabalha desloca-se de um lugar a outro. Este estudo investiga esse último, o trabalho móvel; em especial, aquele que envolve o uso de tecnologias de informação e comunicação e realizado enquanto a pessoa que trabalha desloca-se por meio do sistema de transporte aéreo. Este projeto explora, especificamente, o desempenho de espaço-tempos de trabalho em terminais de aeroportos e em aviões. Para tanto, adota a abordagem teórico-metodológica Teoria Ator-Rede que considera o social um movimento de associações entre elementos heterogêneos e os espaço-tempos, incluindo aqueles de trabalho, efeitos de modos como humanos e não humanos relacionam-se entre si. A estratégia metodológica envolveu uma combinação de observação de campo, auto-observação e entrevistas com pessoas que vivem a experiência do trabalho móvel. A coleta de dados compreendeu: (a) horas de observação de pessoas e situações, em alguns terminais de aeroportos no Brasil e em voos entre a cidade de São Paulo e outras capitais do país, e (b) entrevistas semiestruturadas com pessoas que, com certa frequência, deslocam-se para trabalhar por meio do sistema de transporte aéreo. Como resultado, este estudo contribui para as análises sobre o fenômeno do trabalho móvel, realizado em aeroportos e aviões, e destaca: os atores envolvidos, bem como os agentes que levam esses atores a agir; a quantidade de objetos ativos na manifestação do fenômeno; e as controvérsias envolvidas com o tema. Além disso, aponta elementos empíricos (i) que revelam lugares em que os fenômenos de trabalho móvel se manifestam esporadicamente, de modo disperso, como “bolhas”, e (ii) que se contrapõem à ideia que é possível trabalhar “a qualquer hora e em qualquer lugar”. As contribuições deste estudo ecoam resultados de pesquisas desenvolvidas sobre trabalho móvel, assim como apresentam particularidades, como a metáfora da bolha, amplificações de aspectos pouco presentes nos textos sobre o tema e elementos peculiares do trabalho móvel investigado no espaço-tempo da pesquisa