Mitigating nipple areolar complex (NAC) ischemia following mastopexy augmentation using nitroglycerin application and methylprednisolone: a case report.

A patient who underwent bilateral wise-pattern mastopexy augmentation with threatened nipple-areolar complex necrosis was successfully managed medically with IV methylprednisolone and topical nitroglycerin ointment as immediate consultation with the operating surgeon was not possible.

Nanoparticle-based 'turn-on' scattering and post-sample fluorescence for ultrasensitive detection of water pollution in wider window.

Ultrasensitive detection of heavy metal ions in available water around us is a great challenge for scientists since long time. We developed an optical technique that combines Rayleigh scattering of UV light (365 nm) and post-sample fluorescence detection from colloidal silver (Ag) nanoparticles (NPs) having a surface plasmon resonance (SPR) band at 420 nm. The efficacy of the technique is tested by the detection of several model toxic ions, including mercury, lead, and methylmercury in aqueous media. The light scattering from the Hg-included/inflated Ag NPs at 395 nm was observed to saturate the light sensor even with ppm-order concentrations of Hg ions in the water sample. However, the pollutant is not detected at lower concentrations at this wavelength. Instead, the fluorescence of a high-pass filter (cut-off at 400 nm) at 520 nm is applied to detect pollutant concentrations of up to several hundreds of ppm in the water sample. We also detected lead and methylmercury as model pollutants in aqueous media and validated the efficacy of our strategy. Finally, we report the development of a working prototype based on the strategy developed for efficient detection of pollutants in drinking/agricultural water.

Anatomical relationship of Roos' type 3 band and the T1 nerve root.

BACKGROUND: The most common clinical presentation of thoracic outlet syndrome stems from compression of the lower trunk of the brachial plexus or ulnar nerve. A plethora of anatomical variations have been implicated in the cause of thoracic outlet syndrome. Roos' identification and classification of scalene muscle and fibrous bands have added an additional dimension to understanding its cause and subsequent treatment. Understanding the anatomy and relationship of this band with the lower trunk of the brachial plexus is of paramount importance. METHODS: As part of the authors' long-term study of the type 3 band in relation to the brachial plexus, 70 embalmed cadavers were dissected to yield 100 first thoracic ribs. Fibrous bands, when present, were studied in relation to the brachial plexus. RESULTS: A fibrous band consistent with Roos' type 3 was identified and found to occur in 35 percent of first ribs and 41 percent of cadavers. The mean size was 3.45 × 0.27 cm. Origins and insertions are described. Contrary to Roos' own description, however, the authors observed that Roos' type 3 band was anterior to the T1 nerve root, creating a tunnel through which the T1 nerve root must pass before joining the C8 nerve root. CONCLUSIONS: The authors believe that the type 3 band, when present, can create a tunnel that compresses the T1 nerve root against the first rib, potentially predisposing susceptible individuals to thoracic outlet syndrome. Clinical studies are needed to determine whether correlations between type 3 bands and thoracic outlet syndrome exist.

A silyl radical formed by muonium addition to a silylene.

Muonraker: irradiation of the stable silylene N,N'-bis(2,6-diisopropylphenyl)-1,3-diaza-2-silacyclopent-4-en-2-ylidene with muons produced a radical that was identified as the monomeric muonium adduct from its muon spin rotation (µSR) spectrum. The muon hyperfine constant for this radical is 931 MHz, the largest ever recorded for a free radical.

A bis(silaselenone) with two donor-stabilized Si=Se bonds from an unexpected stereoconvergent hydrolysis of a diselenadisiletane.

SiSe matters: Diselenadisiletane 2, formed from direct reaction of a racemic silylene 1 with elemental selenium, gives the first bis(silaselenone) upon hydrolysis with water (3; see picture, C gray, H white, N blue, O red, Se purple, Si green; d(Si=Se) = 215 pm). The reaction is stereoconvergent: only racemic forms of 3 are obtained from a mixture of racemic and meso forms of 2.

The use of an innovative device for wound closure after upper extremity fasciotomy.

INTRODUCTION: The purpose of this paper is to evaluate the Silver Bullet Wound Closure Device (SBWCD, Boehringer Laboratories, Norristown, PA), a new device for delayed primary closure of fasciotomy wounds. MATERIALS AND METHODS: A retrospective review was performed over a period of 36 months of all patients with an upper extremity fasciotomy that could not be closed primarily. Cases that underwent fasciotomy closure with the SBWCD were separated from the patients that had a split thickness skin graft (STSG). RESULTS: Seven patients had their wound closed with the SBWCD within 10 days (mean of 7.4 days). The seven patients that underwent STSG had their wound closed in an average of 8.4 days. The average number of days between the day of the fasciotomy incision and the date of the placement of the SBWCD was 1.9 days. STSGs were placed on the fasciotomy wounds on an average of 10.3 days after the date of the fasciotomy incision. We found that the SBWCD allowed for starting to approximate the edges of the fasciotomy wound at an earlier time when compare to STSG (2.1 vs 10.3 days). CONCLUSIONS: We feel that the SBWCD as a one-stage procedure provides a consistent and efficacious way to manage upper extremity fasciotomy wounds while minimizing the morbidity associated with STSG. Elimination of a second-stage procedure reduces hospital costs. Our findings may help to inform surgeons about an available alternative when an upper extremity fasciotomy wound is not amenable to primary closure.

Halogen-containing tetrametallic aluminium alkoxides.

New halogen-containing tetrametallic aluminium alkoxides of formula [Al{(mu-OEt)2AlMeCl}3] ( 2-cis; 2-trans), and [Al{(mu-OEt)2AlBr2}3] ( 4), have been synthesized by combining Al(OEt)3 and Me2AlCl (for 2) or EtAlBr2 (for 4). They were fully characterized by (1H, 27Al) NMR, IR, mp, elemental analysis, and single-crystal X-ray diffractometry. The chloride analogue of 4, [Al{(mu-OEt)2AlCl2}3] ( 3), prepared previously using a different route, was also prepared here by combining Al(OEt)3 and EtAlCl2.

Mononuclear Schiff base boron halides: synthesis, characterization, and dealkylation of trimethyl phosphate.

A series of mononuclear boron halides of the type LBX(2) [LH = N-phenyl-3,5-di-tert-butylsalicylaldimine, X = Cl (2), Br (3)] and LBX [LH2 = N-(2-hydroxyphenyl)-3,5-di-tert-butylsalicylaldimine, X = Cl (7), Br (8); LH2 = N-(2-hydroxyethyl)-3,5-di-tert-butylsalicylaldimine, X = Cl (9), Br (10); and LH2 = N-(3-hydroxypropyl)-3,5-di-tert-butylsalicylaldimine, X = Cl (11), Br (12)] were synthesized from their borate precursors LB(OMe)2 (1) (LH = N-phenyl-3,5-di-tert-butylsalicylaldimine) and LB(OMe) [LH2 = N-(2-hydroxyphenyl)-3,5-di-tert-butylsalicylaldimine (4), N-(2-hydroxyethyl)-3,5-di-tert-butylsalicylaldimine (5), N-(3-hydroxypropyl)-3,5-di-tert-butylsalicylaldimine (6)]. The boron halide compounds were air and moisture sensitive, and upon hydrolysis, compound 7 resulted in the oxo-bridged compound 13 that contained two seven-membered boron heterocycles. The boron halide compounds dealkylated trimethyl phosphate in stoichiometric reactions to produce methyl halide and unidentified phosphate materials. Compounds 8 and 12 were found to be the most effective dealkylating agents. On reaction with tert-butyl diphenyl phosphinate, compound 8 produced a unique boron phosphinate compound LB(O)OPPh2 (14) containing a terminal phosphinate group. Compounds 1-14 were characterized by 1H, 13C, 11B, 31P NMR, IR, MS, EA, and MP. Compounds 5, 6, and 11-14 also were characterized by single-crystal X-ray diffraction.

Aluminum phosphinate and phosphates of salen ligands.

A new dealkylation reaction between organophosphate esters and Salen aluminum bromide compounds has been used to prepare three new aluminum salen compounds salen((t)Bu)AlOP(O)Ph2 (1) (salen = N,N'-ethylenebis(3,5-di-tert-butylsalicylideneimine)), [(MeOH)Alsalen((t)Bu)[OMePO2(O)]Alsalen((t)Bu)[OMePO2(O)]Alsalen((t)Bu)]Br (2), and [salpen((t)Bu)AlO]2[(BuO)2PO]2 (3) (salpen = N,N'-propylenebis(3,5-di-tert-butylsalicylideneimine)). Compounds 1.MeOH, 2, and 3 were characterized by single-crystal X-ray diffraction. Compound 1 is the first example of a monomeric aluminum Schiff base phosphinate. Compound 2 is a cationic Salen aluminum phosphate, and compound 3 contains an aluminophosphate ring. This work is the first example of the intentional use of an aluminum-based dealkylation reaction to form new compounds.

Five-coordinate aluminum bromides: synthesis, structure, cation formation, and cleavage of phosphate ester bonds.

The alkane elimination reaction between Salen((t)Bu)H(2) ligands and diethylaluminum bromide was used to prepare three Salen aluminum bromide compounds salen((t)Bu)AlBr (1) (salen = N,N'-ethylenebis(3,5-di-tert-butylsalicylideneimine)), salpen((t)Bu)AlBr (2) (salpen = N,N'-propylenebis(3,5-di-tert-butylsalicylideneimine)), and salophen((t)Bu)AlBr (3) (salophen = N,N'-o-phenylenenebis(3,5-di-tert-butylsalicylideneimine)). The compounds contain five-coordinate aluminum either in a distorted square pyramidal or a trigonal bipyramidal environment. The bromide group in these compounds could be displaced by triphenylphosphine oxide or triphenyl phosphate to produce the six-coordinate cationic aluminum compounds [salen((t)Bu)Al(Ph(3)PO)(2)]Br (4), [salpen((t)Bu)Al(Ph(3)PO)(2)]Br (5), [salophen((t)Bu)Al(Ph(3)PO)(2)]Br (6), and [salophen((t)Bu)Al[(PhO)(3)PO)](2)]Br (7). All the compounds were characterized by (1)H, (13)C, (27)Al, and (31)P NMR, IR, mass spectrometry, and melting point. Furthermore, compounds 1-3 and 5-7 were structurally characterized by single-crystal X-ray diffraction. Compounds 1-3 dealkylated a series of organophosphates in stoichiometric reactions by breaking the ester C-O bond. Also, they were catalytic in the dealkylation reaction between trimethyl phosphate and added boron tribromide.

Salvage of infected prosthetic grafts of the great vessels via muscle flap reconstruction.

OBJECTIVE: The infection of an aortic prosthetic graft presents a difficult challenge for surgeons. Conservative treatments such as debridement and antibiotic irrigation routinely fail, and patient survival rates are low. Literature has indicated that flap procedures often provide better treatment. In the present article, we report our experience utilizing pectoralis major muscle flaps, occasionally coupled with latissimus dorsi, rectus abdominis, and/or serratus anterior flaps, to wrap infected grafts and fill dead space. PATIENTS: Between 1990 and 2004, 10 patients were brought to our attention with infections of prosthetic grafts of the great vessels (7 men and 3 women; mean age, 53 years). Infections in nine patients involved an ascending aortic graft, while one patient had an infected pulmonary artery graft. DESIGN: Following diagnosis and exploration, an initial debridement is performed, followed by 48 h of antibiotic irrigation. A definitive muscle flap procedure is then utilized to fill dead space and clear the infection, followed by an appropriate antibiotic regimen. RESULTS: The infections in all 10 patients were cleared using the muscle flap procedure. Two patients required a tapered-dose regimen of oral steroids, one of whom also required a secondary flap procedure due to the advanced stage of infection. Two other patients later died due to unrelated complications; however, autopsies revealed that operative sites had healed successfully. Patients were followed up for a period of 2 months to 2 years, and recurrence was not found. CONCLUSIONS: Our outcomes suggest that muscle flap procedures, specifically utilizing the pectoralis major and regional muscles, should be kept in mind in the management of life-threatening infections of aortic grafts. Due to the limited number of patients in this study, we feel more research with a larger volume of cases is warranted.

Role of heme oxygenase-1 in endotoxemic acute renal failure.

The pathogenesis of septic acute renal failure (ARF) involves systemic vasodilation with compensatory upregulation of vasoconstrictors. This can lead to renal vasoconstriction and ARF. Heme oxygenase (HO) is the rate-limiting step in heme metabolism and produces carbon monoxide (CO) and biliverdin. HO-1 is an inducible form of the enzyme and is expressed in response to cell injury. It was hypothesized in endotoxemia, induction of HO-1 would lead to increased production of the vasodilator CO, lower blood pressure, and decrease renal function. The role of HO-1 was therefore examined in a mouse model of endotoxemia. One group of mice received LPS alone and were compared with mice that received LPS in addition to an inhibitor of HO-1, zinc protoporphyrin (ZnPP). Treatment of mice with LPS resulted in significant increases in the protein expression of HO-1 compared with controls treated with vehicle. Immunohistochemical analysis localized this upregulation to both the proximal and distal tubules as well as the vasculature. Hemodynamic studies were performed during endotoxemia and the mean arterial pressure (MAP) was found to be significantly higher in the HO-1 inhibitor-treated compared with vehicle-treated mice (78 +/- 3 vs. 64 +/- 2 mmHg, P < 0.01). It was found that the inhibitor group had higher renal blood flows (RBF) also during endotoxemia (1.8 +/- 0.2 vs. 0.68 +/- 0.1 ml/min, P < 0.01). Furthermore, when renal vascular resistance (RVR) was calculated, there was a significant decrease in RVR in the inhibitor group (43.5 +/- 3.4 vs. 95.9 +/- 11.3 mmHg.ml(-1).min(-1), P < 0.01). In concert with the hemodynamic data, glomerular filtration rate (GFR), as measured by inulin clearance, was higher in the HO inhibitor compared with the vehicle controls during endotoxemia (111.5 +/- 19.5 vs. 66.0 +/- 3.5 microl/min, P < 0.05). In summary, during endotoxemia ARF, inhibiting HO-1 with ZnPP resulted in the protection of renal function. The renal protection was associated with significantly improved systemic hemodynamics, less renal vasoconstriction, and a higher GFR.

Fracture management of civilian gunshot wounds to the hand.

Civilian gunshot wounds to the hand are typically caused by low-velocity weapons, which create a localized pattern of soft-tissue and bone injury that usually allows for early definitive treatment. A retrospective chart review of 72 patients treated for 98 gunshot wound fractures at an urban level I trauma center was conducted to evaluate the results of limited debridement and early definitive fracture fixation of urban gunshot wound fractures of the hand. The incidence of hand fractures, means of fracture fixation, number of operations, occurrence of infection, and level of patient compliance were determined. Twenty-nine fractures were managed definitively with reduction and splinting in the emergency department or intensive care unit. Sixty-eight fractures were treated surgically, at a mean of 2 days after injury. Eleven patients required more than one operation. The overall infection rate was 8 percent and was not influenced by the fracture fixation method. All infections were superficial and resolved with antibiotics alone. Thirty-nine percent of patients were lost to follow-up after hospital discharge and 85 percent of patients were lost to follow-up before documented fracture healing. Twenty-six percent of patients were lost to follow-up with a removable fixation device in place. Limited debridement and early definitive fracture fixation are associated with low rates of complications for typical civilian handgun wound fractures. Cases with extensive injury or contamination do require a staged approach to treatment. Poor patient compliance in the urban trauma setting should be expected and may affect the management plan.