Germinating seedlings and mature shoots of Cuscuta campestris respond differently to light stimuli during parasitism but not during circumnutation.

Seedlings of the parasitic plant genus Cuscuta (dodder) locate hosts by circumnutation, coil around the host near soil level and form a haustorium, establishing a primary parasitism beneath the canopy. Mature shoots elongating from the parasitic region parasitize other hosts on the upper surfaces of their canopy. Although parasitism by dodder is stimulated by blue and far-red light, and inhibited by red light, the responses to light signals during the developmental stages are not comprehensively understood. Therefore, we compared the effects of different types of light on both circumnutation and parasitism by germinating seedlings and mature shoots of Cuscuta campestris. Seedlings established parasitism under blue and far-red light, but not under red light, as has been reported repeatedly. By contrast, mature shoots exhibited coiling around the host and haustoria formation even under a red light as well as under blue and far-red light. These findings indicate that C. campestris modified its response to red light during the transition from young seedlings to mature shoots, facilitating parasitism. Light quality did not affect the circumnutation of either seedlings or mature shoots, indicating that circumnutation and the coiling movement that leads to parasitism were regulated by different environmental signals.

Regulatory Modules Involved in the Degradation and Modification of Host Cell Walls During Cuscuta campestris Invasion.

Haustoria of parasitic plants have evolved sophisticated traits to successfully infect host plants. The degradation and modification of host cell walls enable the haustorium to effectively invade host tissues. This study focused on two APETALA2/ETHYLENE RESPONSE FACTOR (ERF) genes and a set of the cell wall enzyme genes principally expressed during the haustorial invasion of Cuscuta campestris Yuncker. The orthogroups of the TF and cell wall enzyme genes have been implicated in the cell wall degradation and modification activities in the abscission of tomatoes, which are currently the phylogenetically closest non-parasitic model species of Cuscuta species. Although haustoria are generally thought to originate from root tissues, our results suggest that haustoria have further optimized invasion potential by recruiting regulatory modules from other biological processes.

Changes in the blood flow of the femoral artery by botulinum toxin A in rats.

We examined the changes in blood flow in the femoral artery caused by botulinum toxin A in rats. Blood flow was measured using laser Doppler flowmetry. We used male Sprague-Dawley-derived rats weighing between 350 and 400 g. The study was performed on 6 groups; each of them consisted of 30 rats (control and botulinum toxin A 0.5, 1, 2, 4, and 8 units). The laser Doppler flowmetry revealed that blood flow in the femoral artery increased by the third day in the groups injected with 1 or more units of botulinum toxin A. In the groups injected with 8 units of botulinum toxin A, we recognized an increase of blood flow from the second day. Our results suggest that botulinum toxin A is concerned in improving blood flow.

Classification of recipient veins in microsurgical flap reconstructions of the lower extremities.

It is difficult to cure severe open fractures of the lower extremities due to the frequent occurrence of severe damage to soft tissues or blood vessels, as well as bone defects, and concomitant infection, such as osteomyelitis. If appropriate treatment is not performed, long-term complications, such as nonunion of the bone, intractable ulcers, or other disorders, may arise. Between 1993 and 2010, we reviewed the records of 27 patients, and 28 limbs were treated. A total of 31 free-tissue transfers were performed on these 28 limbs. In this study, we classified the degree of damage based on the operative appearance of the condition of the recipient vein. A state that was normal or near-normal was described as type I-normal. A vein that was buried under a scar, but was comparatively easy to detach and retained a moderate adventitia was classified as type II-moderate. A vein with close adhesion between the wall and the scar that was not easy to detach was described as type III-severe. We also examined the relationships between recipient vein type and each of the following: (1) concomitant injury, (2) bone reconstruction, (3) preoperative infection, (4) length of time from injury to reconstruction, (5) eventual reoperation, and (6) flap necrosis. The results showed that there was a statistically significant relationship between recipient vein type and each of the following: bone reconstruction, preoperative infection, eventual reoperation, and flap necrosis. The selection of recipient vein is a factor that greatly affects the outcome of reconstruction of open fractures of the lower extremities. It is important to preoperatively estimate the condition of recipient vein even though it is difficult to preoperatively assess the condition. In some cases, only recipient veins in poor condition can be found intraoperatively on the affected leg. Under such circumstances, a cross-leg flap or a vein graft should be performed without hesitation to use recipient veins in a better condition.

Changes in the blood flow and prevention of vasospasm of the femoral artery by topical application of lidocaine in rats.

Free-tissue transfer with anastomosis has become an important microsurgical technique. Sometimes vasospasm occurs after anastomosis. We examined the changes in blood flow and the effect on the treatment of vasospasm of the femoral artery of rats. The rat models of vasospasm were generated by topical application of epinephrine. We topically applied 2% lidocaine as a single dose (0.2 mL) and a continuous infusion (1.0 mL/h). Our results suggest that although the effect lasts for a short period, a single application of 2% lidocaine has a rapid effect and is effective for treating a sudden manifestation of vasospasm. In contrast, continuous topical application may be more effective for maintaining the blood flow and preventing vasospasm. Therefore we believe that persistent vasospasm should first be treated with several topical applications of lidocaine; if this helps improve the condition, continuous topical application can be subsequently used as a preventive measure.

Medial plantar venous flap technique for volar oblique amputation with no defects in the nail matrix and nail bed.

BACKGROUND: Skin grafting is a simple technique used during volar oblique amputation; however, it is not appropriate to use this technique if the bone or tendon is exposed. Moreover, in volar oblique amputation, if the severed section is large and elongated, skin grafting makes the lack of volume conspicuous, and reconstruction with a V-Y advancement flap occasionally results in a nail deformity that resembles a parrot's beak. We used a medial plantar venous flap for the correction of large volar oblique amputation. METHODS: Reconstructive surgery was performed on patients with volar oblique amputation in whom the proximal severed volar regions extended from the nail matrix to the distal interphalangeal (DIP) joint. The medial plantar venous flap was harvested, the distal subcutaneous vein or communicating vein of the medial plantar area was anastomosed to the proper digital artery, and the proximal vein of the flap was anastomosed to the dorsal subcutaneous vein of the stump of the digit. RESULTS: The flaps survived in all the patients. At 12 months after the surgery, all the treated fingers had attained a good shape. Patients who underwent reconstruction with medial plantar venous flaps attained good sensory restoration. CONCLUSION: In volar oblique amputation, if the remaining nail matrix and nail bed are uninjured, then patients can expect the restoration of shape, function and sensory input after surgery. In this study, we used the medial plantar venous flap for large volar oblique amputation cases and obtained good results.

A novel approach for preventing the development of persistent vasospasms after microsurgery for the extremities: intermittent topical lidocaine application.

Vasospasm is often encountered after harvesting the recipient artery in tissue transfer surgery, particularly in the extremities. Further, after anastomosis, thrombosis is a major complication arising due to vasoconstriction. Therefore, we decided to apply lidocaine topically on the recipient artery to prevent postoperative vasospasm. We had applied lidocaine topically on the recipient artery in seven patients with persistent vasospasm before the completion of the surgery. After surgery, 0.2 mL lidocaine (4%) was directly applied on the vascularized region every 15 minutes for the first 3 hours, every 30 minutes for the next 3 hours, and every 1 hour for the next 18 hours. Although four patients experienced a disturbance in the blood flow immediately after the surgery, they showed improvements after lidocaine application. In three of these four patients, vasospasm was also suspected to occur at 15 minutes after the surgery; however, topical application of lidocaine was found to be effective in these patients. Thrombosis was not observed in any case. We believe that if the site of lidocaine application is appropriate, even a small dose of low-concentration lidocaine (4%) can produce an adequate effect. Moreover, the intervals between lidocaine applications should be carefully considered.

Location of communicating veins for medial plantar venous flap.

BACKGROUND: The medial plantar venous flap is suitable for reconstruction of the palmar surface of the finger. However, it is sometimes difficult to detect and harvest the distal subcutaneous vein of the flap. In such a situation, the communicating vein can be used as a distal vein for the flap. However, the location of these veins is not obvious. METHODS: By using 20 feet from 10 cadavers and ultrasound imaging for 40 feet from 20 healthy individuals, we investigated the location of communicating veins. RESULTS: In cadavers, 11 communicating veins (45.8%, n = 24) were located in the area above the abductor hallucis muscle and 12 veins (50%) in the area below it. Ultrasound imaging revealed 15 bifurcations of the communicating veins (31.3%, n = 48) in the upper area and 27 bifurcations in the lower area of the medial plantar region (56.3%). CONCLUSION: It was observed that the communicating veins were concentrated in the areas above and below the abductor hallucis muscle.

A simplification for harvesting medial plantar venous flap with communicating veins: usefulness of preoperative ultrasound imaging.

BACKGROUND: The medial plantar venous flap is ideally suited for reconstruction of injuries to the palmar surface of the finger. However, when the distal veins of such flaps are narrow, harvesting is no longer simple and anastomosis to the digital artery presents a challenge. METHODS: Using ultrasound imaging, we investigated the presence or absence of communicating veins in the medial plantar region in 40 feet of 20 healthy individuals. In addition, we performed preoperative ultrasound imaging in 8 patients. RESULTS: The investigation in healthy individuals revealed a mean number of 1.2 communicating veins in the medial plantar region. Communicating veins were confirmed preoperatively in 6 of our 8 patients. CONCLUSION: Preoperative ultrasound imaging to investigate the course and diameter of subcutaneous veins and communicating veins in the medial plantar region allows the flap design to be determined appropriately and for the surgery to proceed more simply.

The place of chemical leeching with heparin in digital replantation: subcutaneous calcium heparin for patients not treatable with systemic heparin.

BACKGROUND: In patients with replanted digits, systemic heparinization or other techniques may be used for prevention of thrombosis of the vascular anastomoses or to prevent coagulation at the drainage site (e.g., a fish-mouth incision or partially removed nail). However, systemic heparin may be contraindicated or require cautious administration in certain patients. The authors injected calcium heparin subcutaneously into the congested replanted digits of seven patients with a history of or undergoing treatment for hemorrhoids or gastric ulcer and drained the congestion by means of a fish-mouth incision. METHODS: With this method, 0.8 ml (20,000 U) of calcium heparin for subcutaneous injection was diluted with 1.2 ml of saline to prepare a solution containing 1000 U in 0.1 ml; this calcium heparin solution (1000 U) was initially injected into the tip of the congested digit. If required, additional doses of 500 U each were administered every 24 hours until the congestion improved. RESULTS: No worsening of bleeding from hemorrhoids or gastric ulcer was seen after the administration of calcium heparin in these patients. Regarding duration of action, continuous bleeding for approximately 6 hours was obtained after subcutaneous injection of 1000 U, and thereafter, adequate drainage was achieved for approximately 24 hours by stimulating the drainage site. CONCLUSIONS: Among patients in whom systemic heparin is contraindicated or who require cautious administration, this is a very effective technique in those in whom congestion fails to improve despite thrombectomy, patients in whom thrombectomy or vascular reanastomosis is not possible, and patients with congestion caused by narrow anastomosed veins.

Finger palmar surface reconstruction using medial plantar venous flap: possibility of sensory restoration without neurorrhaphy.

BACKGROUND: Because plantar anatomic features are similar to those of the palmar surface of the finger, palmar surface finger reconstruction using a medial plantar venous flap enables grasping without slippage, results in strength that can withstand friction, and provides a cushioning effect. Furthermore, sensory restoration is thought to be excellent due to the similarity of the tissues. METHODS: We performed finger palmar surface reconstruction in 6 patients using venous flap without harvesting the medial plantar subcutaneous nerve branch and assessed the sensory restoration using a static 2-point discrimination test (s-2PD), moving 2-point discrimination test (m-2PD), and Semmes-Weinstein test (S-W test). RESULTS: The mean s-2PD at 12 months after surgery was 8.6 mm, the mean m-2PD was 6.00 mm, and the S-W test score was 3.84-3.22 CONCLUSION: These findings indicate that sensory improvement can be obtained by finger palmar surface reconstruction without grafting of the medial plantar subcutaneous nerve branch to the digital nerve.

Intramuscular benign lipoma of the temporalis muscle.

An intramuscular lipoma within the musculature of the head and neck is unusual. Most of them are infiltrating lipomas, and we know of no description of a well-circumscribed lipoma of the temporalis muscle. We present a 64-year-old woman who had a non-pulsatile, soft, mobile mass in the right temporal fossa. The lesion 11 x 8 x 3 cm in size was diagnosed using magnetic resonance imaging, it was resected, and she has recovered well with a good cosmetic result.

Staged cranial reconstruction after epidural abscess associated with dural substitute exposure.

UNLABELLED: Cadaveric dura mater was widely used for a long time but has recently been associated with the transmission of Creutzfelt-Jakob disease. Expanded polytetrafluoethylene sheet has been suggested as a suitable alternative in Japan. Recently epidural abscesses associated with exposure to Expanded polytetrafluoethylene have been on the increase in Japan. We experienced one case of staged cranial reconstruction for chronic ulcer of the head associated with MRSA epidural abscess. SURGICAL TECHNIQUE: the exposed expanded polytetrafluoethylene must be completely removed along with the skin. Reconstruction of dura mater should be made watertight with the application of autologous free fascia lata collected from the paralyzed thigh. Autologous free fascia lata is reconstructed with the rectus abdominis muscle so that there is no dead space remaining. Calvarial bone should be reconstructed in a separate operation as at a second stage.