A self-assembling ß-peptide hydrogel for neural tissue engineering.

We report a new class of ß-peptide based hydrogel for neural tissue engineering. Our ß-peptide forms a network of nanofibres in aqueous solution, resulting in a stable hydrogel at physiological conditions. The hydrogel shows excellent compatibility with neural cells and provides a suitable environment for cells to adhere and proliferate.

[Imaging indication for low back pain in the adult population]. / Indications a l'imagerie dans la lombalgie chez l'adulte.

Low back pain is a frequent symptom-related reason for visits to a general physician. In case of acute low back pain, the only situation that requires a radiologic exam is when are present. This article specifies which anamnestic symptoms and past medical events are to be considered as such, and suggests what kind of radiologic exam should be done depending on the situation. It also mentions the psycho-social factors that favour a chronicisation of the problem and that should be identified in order to be taken care of. When low back pain becomes a chronic condition, there is a lack of scientific evidences/evidence based medicine and the actual recommendations whether or not to ask for imaging studies are based upon experts opinions. Medical follow-up is essential.

[When D-dimers within normal limits do not equate to normal D-dimers]. / Lorsque des D-dimères dans la norme ne sont pas égaux à des D-dimères normaux.

Pulmonary embolism is a difficult diagnosis that may be missed because of an aspecific clinical presentation. Being the most accurate to confirm or exclude the disease is a matter of concern, as effective treatment exists and a possibly fatal outcome without it. Scores and guidelines can help us. However, they cannot replace clinical sense. What are the options when laboratory results put us on the wrong track, such as in a patient with a clinical presentation suggestive of a pulmonary embolism, but whose D-dimers are within the normal range?

[How to perform and interpret spirometry in primary care]. / Pratique et interprétation de la spirométrie au cabinet du médecin de premier recours.

Spirometry is a simple test, which has a central role in the early diagnosis and management of diseases that are very prevalent and may become symptomatic late in their evolution. This manuscript explores all the necessary steps for an optimal use of spirometry (choice of equipment, quality control, technique, and interpretation). Spirometry is easy to perform in a primary care setting and its use should be encouraged among primary care physicians. We discuss the indications of this test in the follow up of patients and cover the situations that need referral to the specialist.

[Relevant publications in ambulatory general internal medicine in 2007]. / Médecine interne générate ambulatoire: quelques enseignements de la littérature.

Screening procedures for genital Chlamydia infection, cancer risks linked to oral contraceptives, indications and efficacy of HPV vaccination, and diagnostic tools for celiac disease in adults; these are just a few of the general practice themes that were reviewed and analysed in 2007 by residents and chief residents at the Community medicine and primary care Service of the Geneva University Hospitals. These commented summaries, intended for all our colleagues, constitute Geneva's contribution to the literature data base initiated in 2005 by chief residents in Lausanne.

Post-burn head and neck reconstruction using tissue expanders.

Tissue expanders have become useful adjuvants in reconstruction after burn. This study reviews experience with of tissue expanders in the treatment of head and neck burns, from April 2002 to February 2007; 82 expanders were used for 72 patients, all of whom underwent reconstruction at least 6 months after complete healing. The only major difference in this study from other techniques was the preoperative approach for selecting flaps and implants. The use is described of tissue expanders to enhance the area and provide suitable tissue for large expanded flaps for reconstruction of the face and neck. This was based on previous laboratory studies demonstrating that large flaps with very narrow pedicles remain well vascularised and can be transposed to cover very large defects. Satisfactory results were achieved after reconstruction in all cases. Tissue expansion, if carefully planned and conducted, is part of the treatment of choice for post-burn reconstruction of the head and neck, allowing an expanded flap suitable for versatile coverage.

[Municipal practitioner: a new concept and a new function for the primary care practitioner]. / Médecin communal: un nouveau concept et une nouvelle fonction pour le médecin de premier recours.

Among the various initiatives to endow Geneva of a health system with intermediate structures between practitioners and hospitals, numerous proposals were made, but all of them are omitting the fact that the doctor, a central element of such a system, could be also too much or too few decentralized. In this prospect, the concept of "municipal doctor" was developed. It is described in the context of a global municipal project to develop the social multi-generation link within the framework of a complete revision of the center of the village.

[Fever and weight loss in a 57-year-old patient]. / Fièvre et perte de poids chez une patiente de 57 ans.

Presentation of a 57-year-old female patient with fever of unknown origin, asthenia, and weight loss for I month. History and examination were unremarkable. Blood analysis showed an important inflammatory syndrome. Other paraclinic tests were all normal. Finally, sophisticated exams (CT-scan, and FDG PET-scan) allowed the diagnosis of giant cell arteritis, confirmed by biopsy of the temporal arteries. Differential diagnosis and treatment are discussed.

Treatment of flexion contractures following burns in extremities.

In order to release and cover defects in burn contractures over joints, several surgical procedures have been proposed. Skin grafting is easy to do, but it requires immobilization, and tends to contract again, different types of flaps without skin grafting are alternatives. These flaps have their specific indications, limitations and some disadvantages such as a bulky, unattractive appearance in donor or recipient sites, partial necrosis, and sometimes patients dissatisfaction. Considering these points, the authors proposed a new technique composed of a Y-V advancement in the middle and two scar releases proximal and distal to the joint which were covered with full thickness skin grafts. This seems to have some advantages in both case of technique and more patients satisfaction. In the current study, the authors presented their results with different methods of treatment, which they performed for burn flexion contractures in limbs. Ninety-one operations were performed in 74 patients, the method of reconstruction included skin grafting in 43 contractures, local flaps in 16, pediculated flaps in 11, and the new combined approach in 21 cases. Width of scar was one of the main factors for selection of choice option. This proposed technique is especially appropriate for scars which cover 10-60% of joint surface area. Advantages of this combined technique are coverage of joint area with a pretty normal skin flap, and enough scar lengthening due to combination of Y-V advancement and skin grafted released areas.

Surgical correction of the overgrown columellar labial junction: complementary method.

The overgrown columellar labial junction remains a controversial and neglected aspect of rhinoplasty. The authors encountered this problem in a large number of their patients and found that routine techniques were not sufficient to correct it. They therefore developed a complementary method in rhinoplasty that is safe and easy to handle, with long-lasting, satisfactory results for both the patient and the surgeon. This method has provided not only better stability on the columellar base, but also good aesthetic results. The study involved 43 rhinoplasty patients with a follow-up period of approximately 1.5 years. This report analyzes the surgical anatomy related to the overgrown columellar labial junction. Pre- and postoperative aspects of cases involving overgrown columellar labial junctions and surgical procedures are discussed.

Postburn reconstruction of nipple-areola complex.

Reconstruction of burned nipple-areola complex is a significant problem. Many techniques are available. Most have been fraught with loss of nipple projection within 6 months. Local flaps seem to give better results. Drawbacks of these procedures in burned patients are excessive nipple flattening and difficulty in nipple reconstruction due to the low amount of subcutaneous fat and thin dermis because of tight scar. The modified star flap is a derivative of the skate design and includes the significant advantage of primary closure of the donor site. This article describes some modifications to the star flap, intended to decrease nipple flattening and improve flap stabilization, even in burned breasts. We performed seven nipple reconstructions in six young females who were victims of childhood burn injury. The final projection of nipples was 5 +/- 1mm. We think that our technique is a good alternative to previous ones and may be applied in all burned patients.

Eyebrow reconstruction following burn injury.

Facial burns represent between one-fourth and one-third of all burns. Absence of the eyebrows or distortions in their position alter the character of the face. Thus, eyebrow repair or reconstruction can be an important "finishing touch" in the overall reconstruction of a burned face. Generally, there are three ways to reconstruct the eyebrow: use of superficial temporal artery island flap; composite graft from scalp; and mini or micrografts from scalp. This report presents 20 patients reconstructed with the above techniques. Eleven patients (eight male and three female) with superficial temporal artery island flaps; seven patients (two male and five female) with composite grafts from scalp; and two patients (female) with minigrafts. The results suggest that superficial temporal artery island flaps were more suitable for males and composite graft for females who generally require thinner and less dense eyebrows. Our experience with minigrafts for burn alopecia has not been adequate. Here in this article, different methods of eyebrow reconstruction are presented with the greater emphasis on superficial temporal artery flap.

Expanded occipito-cervico-pectoral flap for reconstruction of burned cervical contracture.

Postburn neck contracture and hypertrophic scarring can cause functional limitation and aesthetic disfigurement. Reconstruction of severe deformities and scar of neck following healing from burns confronts the surgeon with some of the most challenging problems in reconstructive surgery. Through knowledge of available reconstructive technique accurate diagnosis of tissue deficiency and secondary distortion, imaginative planning and definitive, careful execution of ones surgical plan are the bare minimum items for achieving improvement in a burned deformed neck. The aim of this article is to assess the role of expanded occipito-cervico-pectoral (o-c-p) flap for reconstruction in a series of four patients with severe burn scar of neck and involvement of shoulder back but intact anterior aspect of chest. This is an alternative method of reconstruction burn scar of neck area.

Columella reconstruction with the Washio flap.

Satisfactory reconstruction of the columella area is always challenging. An 8-year-old girl underwent columellar reconstruction 7 years after bilateral cleft lip surgery using a temporo-parieto-auricular flap. This method was found to be useful for columellar reconstruction with good colour and aesthetic result.

Metabolic changes during recovery in normothermic versus hypothermic patients undergoing surgery and receiving general anesthesia and epidural local anesthetic agents.

BACKGROUND: Mild hypothermia is accompanied by metabolic changes. Epidural local anesthetic agents attenuate the surgical stress response, but it is not known whether they modulate thermal stress. METHODS: Thirty patients undergoing colorectal surgery, performed by one surgical team, received epidural 0.5% bupivacaine to achieve T3-S5 sensory block. They were then assigned randomly to two groups of 15 patients each. The control or unwarmed group was left to cool during surgery, whereas active warming was used in the warmed group. General anesthesia was induced by thiopentone, vecuronium, fentanyl, nitrous oxide in oxygen, and enflurane. At the end of surgery, both groups received epidural 0.25% bupivacaine to maintain a T5-L3 sensory block. Aural canal (core) and skin surface (15 sites) temperatures; oxygen consumption; pain visual analogue score; and concentrations of epinephrine, norepinephrine, glucose, cortisol, lactate, and free fatty acids in plasma were measured before epidural blockade, 30 min after epidural blockade, at the end of surgery, and for 4 h after surgery. Patients and those measuring the outcomes were unaware of group allocation. RESULTS: Core and mean skin temperatures decreased significantly in the control group (P < 0.001) but not in the warmed group. Catecholamine concentrations in plasma decreased significantly after epidural block, and although concentration of epinephrine in plasma increased from baseline sharply in the control group at the end of surgery (P = 0.004), it decreased in the warmed group (P = 0.007). During recovery, there was no difference between the two groups for norepinephrine concentrations in plasma, body weight-adjusted oxygen consumption, pain visual analogue score, and metabolites. CONCLUSIONS: The postoperative metabolic changes obtained with epidural block were similar except for an attenuated concentration of epinephrine in normothermic patients compared with those who were mildly hypothermic.

The effect of fibular malreduction on contact pressures in an ankle fracture malunion model.

Nine fresh-frozen cadaveric specimens were disarticulated through the knee, and the soft tissues, except for the interosseous ligaments and interosseous membrane, were removed to the level of the ankle. The subtalar joint was secured with screws in neutral position (approximately 5 degrees of valgus). Contact pressures in the tibiotalar joint were measured with use of low-grade pressure-sensitive film, which was placed through an anterior capsulotomy. For each measurement, 700 newtons of load was applied to the specimen for one minute. The film imprints were scanned, and the contact pressures were quantitated in nine equal quadrants over the talar dome. A fracture-displacement device was secured to the distal end of the fibula; the device allowed for individual or combined displacements consisting of shortening, lateral shift, and external rotation of the fibula. The ankle was maintained in neutral flexion. The ligamentous injury associated with a pronation-lateral rotation fracture of the ankle was simulated by dividing the deep fibers of the deltoid ligament, the anterior-inferior tibiofibular ligament, and the interosseous membrane to a point that was an average of fifty-three millimeters proximal to the ankle joint. Baseline contact area and contact pressure in the joint were determined, followed by measurements after two, four, and six millimeters of shortening of the fibula; after two, four, and six millimeters of lateral shift of the fibula; and after 5, 10, and 15 degrees of external rotation of the fibula. The three types of displacement were tested individually as well as in combination. The simulated deformities were found to cause a shift of the contact pressure to the mid-lateral and posterolateral quadrants of the talar dome, with pressures as high as 4.1 megapascals. A corresponding decrease in the contact pressures was noted in the medial quadrants of the talar dome. The highest pressures were recorded for maximum shortening of the fibula, the combination of maximum shortening and lateral shift, the combination of maximum shortening and external rotation, and the combination of maximum shortening, lateral shift, and external rotation. In general, increases in each displacement variable corresponded to increasing contact pressures.

Fluoro nissl green: a novel fluorescent counterstain for neuroanatomy.

Fluorescent neuroanatomic techniques, such as immunofluorescence and retrograde and anterograde tracing studies, derive great utility from their specificity. However, the specificity can be a drawback as well, in that it may be difficult to assess labeled neurons or neural processes in their cytoarchitectonic context. We report the characteristics of a newly synthesized fluorescent counterstain, Fluoro Nissl Green (3,8-diamino-10H-quindoline) with spectral characteristics similar to fluorescein. This Nissl-like counterstain can be used as a green neuronal counterstain for red-emitting markers such as rhodamine and Di-I.