The Effectiveness of Sternocleidomastoid Flap Versus Superficial Musculoaponeurotic System Flap for the Prevention of Frey Syndrome and Facial Depressed Deformity in Parotid Surgery for Pleomorphic Adenoma.

The purpose of this study was to compare 2 types of reconstruction techniques: sternocleidomastoid (SCM) flap and superficial musculoaponeurotic system (SMAS) flap after partial parotidectomy (PP) for preventing Frey syndrome (FS) and concave facial depressed deformity. A total of 99 patients underwent PP for pleomorphic adenoma of the parotid gland. The patients were divided in 2 groups according to the dimension of the tumor: tumors less than 3 cm (group A, 47 patients) and tumors greater than or equal to 3 cm (group B, 52 patients). The patients in the 2 groups were assigned to 3 subgroups: PP without reconstruction (subgroup 1), PP and reconstruction with SMAS flap (subgroup 2), PP, and reconstruction with SCM flap (subgroup 3). In group A, the results of FS subjective symptoms, positivity of Minor starch test, and the median score of cosmetic results assessed with Visual Analogue Scale were as follows: in subgroup 1: 20%, 35%, 6; in subgroup 2: 13.3%, 13,3%, 8; in subgroup 3: 0%, 8.3%, 9. In patients of group B, the results were as follows: 60%, 73.3%, 3 in subgroup 1; 28.5%, 35.7%, 5 in subgroup 2; and 8.6%, 8.6%, 8 in subgroup 3. The study demonstrates a statistical difference (P < 0.05) both for subjective symptoms and for objective symptoms of FS when comparing the subgroup of SCM flap with the subgroup of PP without reconstruction for tumors greater than 3 cm. In tumors less than 3 cm, although there is an improvement of symptoms using SMAS or SCM, there is no statistical significance. The SCM is able to reduce the risk of the onset of both objective and subjective symptoms, whereas SMAS flap has a protective effect only in objective symptoms. The cosmetic results in this study were statistically significant both with SMAS and SCM but when comparing SCM versus SMAS the best results were for SCM.

Multidisciplinary approach and anesthetic management of a surgical cancer patient with methylene tetrahydrofolate reductase deficiency: a case report and review of the literature.

INTRODUCTION: Hyperhomocysteinemia is a known risk factor for myocardial infarction, stroke, peripheral vascular disease, and thrombosis. Elevated plasma homocysteine levels have been demonstrated in patients with recurrent episodes or a single episode of thrombosis. Here we describe the development of cardiovascular disease as a complication of a surgical intervention in a patient with colorectal cancer and hyperhomocysteinemia. CASE PRESENTATION: A 65-year-old Caucasian man complained of pain and constipation, attributed to previously diagnosed adenocarcinoma (stage IIB) of the hepatic flexure. An anamnestic investigation showed that he had undergone two surgical interventions. During both, he suffered thrombotic postoperative complications, a deep vein thrombosis of the upper extremity after the first operation and retinal vein occlusion after the second. He was diagnosed with hyperhomocysteinemia associated with a homozygous C677T mutation of the gene encoding the enzyme methylenetetrahydrofolate reductase. Our patient was initially treated with folic acid and high-dose B vitamins. On day 7 he underwent a right hemicolectomy. Anesthesia was performed with sevoflurane in 40% O2 and without the use of nitrous oxide. Postoperatively, our patient remained on folic acid and B vitamins and was without immediate or subsequent complications. CONCLUSIONS: Neoplastic disease and related surgery followed by the administration of chemotherapeutic drugs alter the hemostatic balance in cancer patients. Those suspected of also having a thrombophilic disease require a thorough laboratory diagnostic workup, including a molecular analysis aimed at identifying the genetic mutation responsible for the hyperhomocysteinemia, as indicated. The case described in this report highlights the importance of a multidisciplinary approach that includes expertise in peri-operative anesthesia, surgery, oncology, and hematology.

Characterisation and evaluation of paramagnetic fluorine labelled glycol chitosan conjugates for (19)F and (1)H magnetic resonance imaging.

Medium molecular weight glycol chitosan conjugates have been prepared, linked by an amide bond to paramagnetic Gd(III), Ho(III) and Dy(III) macrocyclic complexes in which a trifluoromethyl reporter group is located 6.5 Å from the paramagnetic centre. The faster relaxation of the observed nucleus allows modified pulse sequences to be used with shorter acquisition times. The polydisperse materials have been characterised by gel permeation chromatography, revealing an average molecular weight on the order of 13,800 (Gd), 14,600 (Dy) and 16,200 (Ho), consistent with the presence of 8.5, 9.5 and 13 complexes, respectively. The gadolinium conjugate was prepared for both a q = 1 monoamide tricarboxylate conjugate (r1p 11.2 mM(-1) s(-1), 310 K, 1.4 T) and a q = 0 triphosphinate system, and conventional contrast-enhanced proton MRI studies at 7 T were undertaken in mice bearing an HT-29 or an HCT-116 colorectal tumour xenograft (17 µmol/kg). Enhanced contrast was observed following injection in the tail vein in tumour tissue, with uptake also evident in the liver and kidney with a tumour-to-liver ratio of 2:1 at 13 min, and large amounts in the kidney and bladder consistent with predominant renal clearance. Parallel experiments observing the (19)F resonance in the holmium conjugate complex using a surface coil did not succeed owing to its high R2 value (750 Hz, 7 T). However, the fluorine signal in the dysprosium triphosphinate chitosan conjugate [R1/R2 = 0.6 and R1 = 145 Hz (7 T)] was sharper and could be observed in vivo at -65.7 ppm, following intravenous tail vein injection of a dose of 34 µmol/kg.

Paramagnetic 19F chemical shift probes that respond selectively to calcium or citrate levels and signal ester hydrolysis.

Paramagnetic magnetic resonance chemical shift probes containing a proximal CF(3) group have been characterised. Different systems have been created that report reversible changes in calcium ion concentrations in the millimolar regime, signal the presence of citrate selectively in competitive aqueous media and allow the monitoring of remote ester/amide hydrolysis in relayed, irreversible transformations. Chemical shift non-equivalence is amplified by the presence of the proximate lanthanide ion, with a mean separation between the CF(3) group and the metal ion of 6.4 Å found for a thulium complex, in an X-ray structure of the metal complex aqua adduct. The enhanced rate of longitudinal relaxation of the (19)F nucleus allows faster data acquisition.

Plasma glutamine decreases immediately after surgery and is related to incisiveness.

Glutamine (gln) is the most abundant free amino acid in the blood. It is involved in important metabolic and biochemical processes, like cell proliferation and oxidative stress. Previous studies have demonstrated that gln concentration in human plasma decreases in several conditions such as sepsis, ischemia-reperfusion, trauma, major surgery and burn. The aim of the present work was to compare the acute effects of different types of surgical interventions and of anesthetization on blood gln concentration. Plasma samples from 88 subjects (30 males and 58 females) were collected before and after major or minor surgery and the gln concentration was analyzed with high-performance liquid chromatography. The results showed that plasma gln concentration after surgery was lower than pre-surgery values and that in major surgery the decrease of gln was higher than in minor surgery. No significant effect was shown for sex or type of anesthesia. These results demonstrate the importance of a gln supplementation before a surgical intervention and show that the amount of gln supplementation should also be adjusted based on the type of surgery.

Coastal dune systems and disturbance factors: monitoring and analysis in central Italy.

This study describes the conservation status of dune systems in relation to disturbance factors in the coastal stretch of the Viterbo province, Latium Region, Italy. Particular emphasis was given to the bioindication value of plant communities and their sequence. Each plant community was considered as a "habitat" in accordance with Annex I of the Directive 92/43/EU. Stress factors, such as sand dynamic and erosion, and anthropogenic pressures, such as trampling and bathing settlements, influence the sequence of habitats and weaken the system of relations that makes these coenoses to occur in extreme conditions. The choice to carry out surveys along wide transects, recording different data, allowed to explore the use of habitats as bioindicators. Comparing sites characterized by the same extension in a homogeneous area, it was possible to expand the use of canonical correspondence analysis (CCA) as a tool to correlate habitat composition and disturbance factors. The application of CCA showed a high correlation of degradation and habitat loss with coastal erosion, trampling and presence of waste. Furthermore, floristic surveys allowed the application of different biodiversity indices to quantify species richness of sampled areas. The conservation status of the sites investigated was found to be diverse, from the total disappearance of the mobile dune habitats to their complete sequence. The proposed methodology has been useful to fulfill the objective of the work and is applicable to other case studies in the Mediterranean.

Design principles and theory of paramagnetic fluorine-labelled lanthanide complexes as probes for (19)F magnetic resonance: a proof-of-concept study.

The synthesis and spectroscopic properties of a series of CF(3)-labelled lanthanide(III) complexes (Ln=Gd, Tb, Dy, Ho, Er, Tm) with amide-substituted ligands based on 1,4,7,10-tetraazacyclododecane are described. The theoretical contributions of the (19)F magnetic relaxation processes in these systems are critically assessed and selected volumetric plots are presented. These plots allow an accurate estimation of the increase in the rates of longitudinal and transverse relaxation as a function of the distance between the Ln(III) ion and the fluorine nucleus, the applied magnetic field, and the re-rotational correlation time of the complex, for a given Ln(III) ion. Selected complexes exhibit pH-dependent chemical shift behaviour, and a pK(a) of 7.0 was determined in one example based on the holmium complex of an ortho-cyano DO3A-monoamide ligand, which allowed the pH to be assessed by measuring the difference in chemical shift (varying by over 14 ppm) between two (19)F resonances. Relaxation analyses of variable-temperature and variable-field (19)F, (17)O and (1)H NMR spectroscopy experiments are reported, aided by identification of salient low-energy conformers by using density functional theory. The study of fluorine relaxation rates, over a field range of 4.7 to 16.5 T allowed precise computation of the distance between the Ln(III) ion and the CF(3) reporter group by using global fitting methods. The sensitivity benefits of using such paramagnetic fluorinated probes in (19)F NMR spectroscopic studies are quantified in preliminary spectroscopic and imaging experiments with respect to a diamagnetic yttrium(III) analogue.

New and low-cost auto-algometry for screening hypertension-associated hypoalgesia.

OBJECTIVE: The aim of the present work was to measure the pain threshold in hypertensive patients with a new auto-algometry method. DESIGN AND SETTING: Auto-algometry consists of asking the subjects to push their fingers against a fixed round-tip needle until they feel a pain sensation. An electronic force transducer permits the measurement of the force applied by the subjects and storage of the data on a personal computer. Eight tests are performed twice on each subject on the tip and back of four fingers. For each test, the maximal applied force (grams) is defined as pain threshold. The overall discomfort during the entire procedure is reported by the subjects on a 0 (no discomfort) to 10 (intolerable pain) scale. PATIENTS AND INTERVENTIONS: A group of hypertensive patients (n = 22) and a group of normotensive subjects (n = 22) underwent the auto-algometry examination. RESULTS: The pain threshold was higher in hypertensive patients compared with normotensive subjects. All discomfort scores referred by the subjects fell within the 4-6 range. CONCLUSION: The data obtained from this study indicate that the auto-algometer as described here can detect hypoalgesia associated with hypertension.

19F NMR based pH probes: lanthanide(III) complexes with pH-sensitive chemical shifts.

Experimental measurements and theoretical analysis of magnetic properties, structural dynamics and acid-base equilibria for several lanthanide(III) complexes with tetraazacyclododecane derivatives as 19F NMR chemical shift pH probes are presented; pKa values vary between 6.9 and 7.7, with 18 to 40 ppm chemical shift differences between the acidic and basic forms for Ho(III) complexes possessing T1 values of 10 to 30 ms (4.7-9.4 T, 295 K).