Case Report on Botulinum Toxin Treatment for Complex Regional Pain Syndrome in a Digit Reconstruction.

Objective:To evaluate subcutaneous Botulinum toxin type A (BTX-A) efficacy in alleviating severe allodynia in complex regional pain syndrome (CRPS) type II post-digit reconstruction. Methods: After surgical debridement and flap reconstruction for post-traumatic necrosis, a CRPS type II patient received subcutaneous BTX-A. Assessments tracked symptom changes and daily life improvements. Discussion:There are various CRPS management modalities, including rehabilitation and pharmacology. The limited efficacy of conventional non-steroidal antiinflammatory drugs contrasts with promising subcutaneous BTX-A, offering rapid pain relief. Conclusion:Our case underscores the efficacy of subcutaneous BTX-A in CRPS type II, prompting further research and safe outpatient protocol development.

Anatomical variations of the vascular supply of the cutaneous component of the serratus anterior myocutaneous flap: a systematic review.

Although appealing from a reconstructive standpoint, the incorporation of the overlying skin in a serratus anterior muscle flap has not yet seen widespread use, due to considerations with its blood supply. In the present study, a systematic review of the literature has been performed, evaluating studies that investigated the vascular anatomy and variations of serratus anterior myocutaneous flap. The anatomy of the cutaneous blood supply, the size of the cutaneous territory, the design of the skin paddle and the reconstructive goals were analysed. The results showed that the main blood supply originates from the intramuscular anastomoses between intercostal artery perforators and the serratus artery branch in the form of choke vessels. Complementary perfusion from true intramuscular vessel anastomoses or from direct serratus artery cutaneous perforators could contribute to the skin blood supply but only in 25% of the cases. The design of the flap is elliptical with its long axis over the harvested muscle slips and maximum width is 6-8 cm. A myocutaneous serratus anterior flap could be applied in a variety of reconstructive fields, most commonly for head and neck defects. A delay procedure would considerably enhance the perfusion of the cutaneous component and improve the overall viability of the flap.

Enzymes (isoenzyme system) as homeostatic mechanisms the isoenzyme (ADA2) of adenosine deaminase of human monocytes-macrophages as a regulator of the 2'deoxyadenosine.

Regarding homeostatic mechanisms in the enzyme (isoenzymes) and substrate system we show through a simulation model obtained by STELLA II software that: (i) a pair of isoenzymes (Is1 and Is2) that have different affinity for the substrate (Is2 affinity < Is1 affinity), can constitute an efficient homeostatic mechanism: by varying the relative concentration of the isoenzymes in the system, the levels of the substrate can be controlled; (ii) the isoenzymes ADA1 and ADA2 of adenosine deaminase (ADA) that have different affinity for the substrate 2'deoxyadenosine (ADA2 has very weak affinity for 2'deoxyadenosine) constitute, inside human Monocytes-Macrophages, a homeostatic mechanism that assures an up-regulation of 2'deoxyadenosine and a down-regulation of a second substrate (adenosine) for which the affinity of the two isoenzymes is similar.

Serum adenosine deaminase activity in HIV positive subjects. A hypothesis on the significance of ADA2.

Adenosine deaminase activity (ADA) was assayed in the serum of 137 HIV positive subjects: 131 intravenous drug abusers, 3 female partners of HIV positive abusers, 1 son of HIV positive abuser and 2 blood-transfused patients, subdivided into the following groups: 73 asymptomatic, 15 with ARC, 37 with LAS, 5 with L-AIDS and 7 with AIDS. Results show an increase of ADA activity in 100% of L-AIDS group, in 64% of AIDS group, in 62% and 42% of LAS and ARC groups, respectively, and in 36% of the asymptomatic groups. These findings must be confirmed with wider series in order to be further and better evaluated. According to relative substrate specificities, optimal pH and Km, enzymatic activity can be attributed principally to the ADA2 isoenzyme. The probability that ADA2 originates exclusively from the Monocyte-Macrophage cell system (MoMaCS) which actively releases this enzyme in the presence of live parasites in the cells' interior, is discussed. Moreover, it was hypothesized that in the MoMaCS the enzyme constitutes a microbicidal mechanism independent of the respiratory burst.

[HIV infection in northwestern Sardinia]. / L'infezione da HIV nella Sardegna nord occidentale.

The prevalence of anti HIV antibodies was investigated in the sera of 150 drug addicts and of 62 patients not drug addicts hospitalized in the Institute of Infectious diseases of the University of Sassari in the years 1980-86. No seropositivity was detected in not drug addicts patients in the years of observation and in the drug addict ones in the years 1980-81-82. The seropositivity discovered in 1983 in 24% of drug addicts raised to 75% in the first 8 months of 1986. As regards the prevalence of anti HIV antibodies in 1986 the sera of different categories were investigated. Seropositivity was detected in 55% of 20 drug addicts prisoners, in 6.25% of 16 homosexual men, 13 of which prisoners and 3 drug addicts, in 3.7% of 27 transfused individuals, 26 of which under dyalitical treatment, and in 33.3% of sexual partners of HIV positive patients. Anti HIV antibodies were not detected in the sera of 20 laboratory workers, 22 prisoners with a negative history for homosexuality and drug addiction, 45 prison guards and 100 individuals taken at random from general population. The stages of infection in 27 drug addicts were classified according to Atlanta CDC criteria as follows: 63% of cases asymptomatic, 22.2% persistent generalized lymphoadenopathy, 7.4% minor clinical features, 3.7% serious clinical picture, 3.7% full clinical picture of AIDS.

[2'Deoxyadenosine/adenosine deaminase ratio in pleural and peritoneal effusions. Diagnostic significance]. / Rapporto 2'deossiadenosina/adenosina deaminasi nei versamenti pleurici e peritoneali. Significato diagnostico.

It has been observed that adenosine deaminase activity in human beings differ between serum and tissues reference to optimal pH, Km and relative substrate specificity. Based upon the ratio between the activity of deaminase on 2'deoxyadenosine and adenosine, we may distinguish between a "serum type" enzyme and a "tissue type" enzyme. In sample of pleural and peritoneal fluid extracted from 92 patients with variable pathology, we have found the existence of a "tissue type" enzyme in three patients having empyemic pleural effusions and ten with malignant systemic pathology.

[Serum 2'deoxyadenosine/adenosine deaminase ratio in clinical diagnosis]. / Rapporto 2'deossiadenosina/adenosina deaminasi del siero nella diagnosi clinica.

In humans Adenosine Deaminase activity (ADA) differs in serum and tissues in pH optimum, Km, and relative substrate specificity. Thus, on the basis of a major or a minor activity on 2'Deoxyadenosine, a "serum type"enzyme can be distinguished from a "tissue type" enzyme. The examination of ADA or relative substrate specificity (ratio 2'Deoxyadenosine/adenosine deaminase) in the serum of 174 patients with variant pathology, revealed the occurrence of a "tissue type" enzyme in sera of acute Lymphoblastic Leukaemia patients.