Correlation between Quantity of Transferred Lymph Nodes and Outcome in Vascularized Submental Lymph Node Flap Transfer for Lower Limb Lymphedema.

BACKGROUND: Vascularized lymph node transfer has shown promising results in the treatment of lower limb lymphedema, but little is known about the number of lymph nodes needed for the transfer to achieve optimal results. This study investigated the correlation between number of transferred lymph nodes in submental vascularized lymph node transfer and outcomes regarding limb circumference reduction and cellulitis incidence. METHODS: Thirty-five patients who had received vascularized submental lymph node transfer to an ankle for lower limb lymphedema following gynecologic cancer treatment were included in the study. Limb circumference was determined by means of tape measurement preoperatively and postoperatively and was used to calculate the circumferential difference. Ultrasonography was performed postoperatively to determine the number of lymph nodes within the transferred flap. Patients were divided into groups A through C depending on the number of transferred lymph nodes: 1 or 2 (n = 10), 3 or 4 (n = 14), and 5 to 8 (n = 11), respectively. RESULTS: The mean age of the patients was 60.0 ± 9.2 years. All flaps survived. The mean improvement of circumferential difference for the whole cohort was 19.8 ± 9.2 percent. Groups B and C both had significantly higher improvements in the circumferential difference than group A (p = 0.04 and p = 0.02, respectively), but when compared to each other, the difference was nonsignificant. All groups had significant reductions in the incidence of cellulitis postoperatively. CONCLUSIONS: Submental vascularized lymph node transfer for lower limb lymphedema reduced the incidence of cellulitis, regardless of the number of transferred lymph nodes. The transfer of three or more lymph nodes provided significantly better outcome regarding limb circumference reduction than the transfer of two or fewer lymph nodes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Microsurgically aided upper lip replantation - case report and literature review.

A case with a patient who suffered an upper lip amputation and a lower lip laceration due to dog bite is presented. The amputated segment was replanted using microsurgical technique. The operative technique and postoperative care is presented, as well as a review of the current literature on the subject.

Application of service oriented architecture for sensors and actuators in district heating substations.

Hardwired sensor installations using proprietary protocols found in today's district heating substations limit the potential usability of the sensors in and around the substations. If sensor resources can be shared and re-used in a variety of applications, the cost of sensors and installation can be reduced, and their functionality and operability can be increased. In this paper, we present a new concept of district heating substation control and monitoring, where a service oriented architecture (SOA) is deployed in a wireless sensor network (WSN), which is integrated with the substation. IP-networking is exclusively used from sensor to server; hence, no middleware is needed for Internet integration. Further, by enabling thousands of sensors with SOA capabilities, a System of Systems approach can be applied. The results of this paper show that it is possible to utilize SOA solutions with heavily resource-constrained embedded devices in contexts where the real-time constrains are limited, such as in a district heating substation.

Sex reassignment surgery for transsexuals.

PURPOSE OF REVIEW: The purpose of this article is to report on the most recent findings on the current surgical treatments for sex reassignment surgery for both male-to-female and female-to-male transsexuals. RECENT FINDINGS: For male-to-female sex reassignment surgery, researches aim to refine the inverted peno-scrotal flap surgical technique in order to increase the neovaginal length and width, prevent complications and ameliorate the cosmetic outcome.Bowel segment vaginoplasty, used mainly for secondary cases, is becoming more and more common.For female-to-male sex reassignment surgery, the radial forearm flap is the only procedure that has proved to fulfil most of the patient expectations; however, because of a high complications rate, long recovery time and a large number of the required operations, and the absence of guarantee that patients will be satisfied, the free radial forearm flap is not the best option for every patient. Alternatives such as abdominal/groin flap, thigh flap and metaidoioplasty are very much used. SUMMARY: In order to provide the best care for transsexual patients, centres performing sex reassignment surgery should co-operate and implement both the refinements and the new techniques offered and/or requested.

Fate of patients with obstructive jaundice.

BACKGROUND/OBJECTIVE: Systematic data are limited on the etiology and prognosis of unselected patients with obstructive jaundice (OJ). We aimed to review the clinical features, etiology, and prognosis of patients with OJ. METHODS: All adult patients with bilirubin >or= 5.85 mg/dL (100 micromol/L) at a university hospital in Sweden in 2003-2004 were identified. Medical records from patients with OJ were reviewed. RESULTS: Seven hundred and forty-nine patients were identified, of whom 241 (32%) had OJ (median age 71 years, 129 women). No one was lost to follow-up. The biliary obstruction of 154 patients (64%) was a result of a malignancy: 69 patients (46%) had pancreatic cancer, 44 (29%) had cholangiocarcinoma (CC), 5 (3%) had papilla vateri cancers, and 36 patients (23%) had other malignancies. Of the 87 patients with a benign obstruction, 57 (65%) had choledocholithiasis, 7 (8%) had biliary strictures, 6% had PSC, and the obstruction of 16 patients (20.7%) had other causes. A total of 115 of the 242 patients (48%) had abdominal pain associated with jaundice, whereas 52% had painless jaundice. Thirty-four percent of patients with a malignant obstruction had abdominal pain versus 71% of patients with a benign obstruction (P < .05). At the end of follow-up, only 5% (8 patients) with a malignant obstruction were alive versus 78% with a benign obstruction. CONCLUSIONS: Obstructive jaundice was the cause of the severe jaundice of one third of patients. Most cases of OJ were a result of a malignancy, which carried a very poor prognosis, with a 2-year mortality rate of 95%.

Multifocal lenses in coral reef fishes.

The optical properties of crystalline lenses were studied in eleven species of coral reef fish from the Red Sea in Eilat, Israel. Three species each of diurnal planktivores, nocturnal planktivores and diurnal herbivores constituted three groups of animals with little within-group variability. In addition we studied two predators, which differed with respect to body size, prey preference, hunting method and diel activity period. All species studied have multifocal lenses. There were statistically significant differences in the optical properties of the lenses between the first three groups and between the predatory species. The properties of the lenses correlate well with known complements of visual pigments and feeding habits. Lenticular zones focusing ultraviolet light were found in two diurnal planktivores. The optical properties of the lens seem to be specifically adapted to the visual needs of each species.