Increase in skin perfusion pressure after maggot debridement therapy for critical limb ischaemia.

Skin perfusion pressure (SPP) is the perfusion pressure at the skin level, and it can serve as an index of peripheral circulation in the skin and subcutaneous tissue. We report a 78-year-old man with critical limb ischaemia who, despite having undergone several catheter interventions, still had severe ulcers with exposed bone on his right foot. We performed transmetatarsal amputation. The tissue around the surgical site became necrotic several days later, and did not respond to conservative therapy. Therefore, we opted for maggot debridement therapy (MDT), given that maggots favour necrotic tissue. After the therapy, SPP around the ulcer increased from 12 to 54 mmHg on the dorsal aspect, and from 17 to 44 mmHg on the plantar aspect. Wound healing was successfully activated by MDT, leading to complete healing within 2.5 months after MDT. We believe that MDT probably contributed to increase the blood supply to the ischaemic wound.

Observation of orbital waves as elementary excitations in a solid.

A basic concept in solid-state physics is that when some kind of symmetry in a solid is spontaneously broken, collective excitations will arise. For example, phonons are the collective excitations corresponding to lattice vibrations in a crystal, and magnons correspond to spin waves in a magnetically ordered compound. Modulations in the relative shape of the electronic clouds in an orbitally ordered state could in principle give rise to orbital waves, or 'orbitons', but this type of elementary excitation has yet to be observed experimentally. Systems in which the electrons are strongly correlated-such as high-temperature superconductors and manganites exhibiting colossal magnetoresistivity-are promising candidates for supporting orbital waves, because they contain transition-metal ions in which the orbital degree of freedom is important. Orbitally ordered states have been found in several transition-metal compounds, and orbitons have been predicted theoretically for LaMnO3. Here we report experimental evidence for orbitons in LaMnO3, using Raman scattering measurements. We perform a model calculation of orbiton resonances which provides a good fit to the experimental data.