Paths of thoracic epidural catheters in children undergoing the Nuss procedure for pectus excavatum repair.

PURPOSE: To investigate the paths of thoracic epidural catheters in children, this retrospective study was performed. METHODS: We investigated 73 children aged 4 to 12 (mean ± SD 7.8 ± 2.3) years, who underwent the Nuss procedure for pectus excavatum repair under combined general and epidural anesthesia over a 5-year period at Tokyo Metropolitan Police Hospital. Following induction of general anesthesia, we inserted a radiopaque epidural catheter via the T5/6 or T6/7 interspace and advanced for 5 cm cephalad in the thoracic epidural space. We evaluated the paths of the epidural catheters on plain chest radiographs after surgery. RESULTS: The median level for the catheter tip location was T3 (range C6-T7), while the median number of vertebrae crossed by the catheter tips was 2.5. In most children, the catheters advanced straight for the first 2-3 cm (1-1.5 vertebrae) in the thoracic epidural space. However, they continued to advance straight in only 25 children, while they exhibited curved or coiled paths in the remaining 48. The catheter tips were located at higher levels in children with straight epidural catheter paths [median (range) T2 (C6-T4)] than in those with curved or coiled paths after the initial 2-3 cm [median (range) T4 (T2-T7)] (p < 0.0001). CONCLUSIONS: Our findings indicate that the course of epidural catheters in children is unpredictable after the first 2-3 cm in the thoracic epidural space. Clinicians should be aware of such findings, although further studies are required for confirmation.

Agrobacterium tumefaciens-mediated transformation of the vegetative dikaryotic mycelium of the cultivated mushroom Flammulina velutipes.

Agrobacterium tumefaciens was used to transform the vegetative dikaryotic mycelium of Flammulina velutipes using a hygromycin B resistance gene as selectable marker. The gene coding for urogen III methyltransferase (cob) was introduced into F. velutipes dikaryotic cells. The resulting transformant cells generated a bright red fluorescence, indicating that cob is promising as a reporter gene in F. velutipes.

Characterization of a gene coding for a putative adenosine deaminase-related growth factor by RNA interference in the basidiomycete Flammulina velutipes.

A full-length cDNA coding for a putative adenosine deaminase (Fv-ada) was isolated from the basidiomycete Flammulina velutipes. Fv-ada encodes a polypeptide consisting of 537 amino acid residues, which has a consensus sequence conserved among adenosine deaminase-related growth factors (ADGF) found in several metazoa, including chordates and insects. Fv-ada transcript was detected at all stages of growth in dikaryotic F. velutipes cells, with a peak at the primordial stage. Heterologous expression of Fv-ada in the yeast Pichia pastoris produced recombinant Fv-ADA that catalyzed the conversion of adenosine to inosine. Dikaryotic mycelia from F. velutipes were transformed with the binary plasmid pFungiway-Fv-ada, which was designed to suppress the expression of Fv-ada through RNA interference. The growth rates of the resulting transformants were retarded in response to the degree of suppression, indicating that Fv-ada plays an important role in the mycelial growth of F. velutipes. These results suggested that ADGF could function as growth factors in fungi, as is seen in other eukaryotes.

Breast reconstruction with perforator-based inframammary de-epithelized flap: a case report.

Patients with silicon gel-injected breasts sometimes appear even now, demanding removal of this foreign body. These requests are often challenging for us-the removal leaves distortion of the breast contour. Musclocutaneous flap transfer is a good method for reconstruction, but scar formation for flap harvest is a problem. Most patients are reluctant to accept these scars. Reconstruction with prostheses has been another method. But the absence of subcutaneous tissue and degenerated muscle make implantation difficult. For one of these patients, the authors applied a method for breast reconstruction with perforator-based inframammary flap. After the removal of the siliconoma with surrounding degenerated tissues, a crescent-shaped skin flap was designed on the inframammary area. Preserving perforators into the flap, it was elevated with adipose tissue. After the skin was de-epthelized, the adipose tissue and skin flap were turned over to make the breast protrusion. The donor site is closed primarily. Ten months after the operation, there was little atrophy of the reconstructed breast, and the patient is satisfied with the result, especially with the softness of the reconstructed breast. Although this method has limitation for volume, less morbidity for donor site and volume reduction in inframammary area are advantageous. In conclusion, this inframammary flap seems to be a good tool for breast surgery.