[The carotid artery as recipient vessel: troubleshooting for free jejunal transfer after esophagectomy in preradiated patients]. / Gefäßanschluss an die A. carotis communis: Problemlösung bei freier Jejunuminterposition nach Ösophagektomie und Bestrahlung.

BACKGROUND: In the treatment of esophageal cancer neoadjuvant radiotherapy often leads to vascular damage of the usual recipient arteries for free jejunal transfer. End-to-side anastomosis to the carotid artery could be a potential alternative. PATIENTS AND METHODS: A total of 70 patients with locally advanced carcinoma of the esophagus underwent esophagectomy after neoadjuvant radiochemotherapy. In all patients reconstruction was carried out with a free jejunal transfer. Smaller vessels could be used for anastomoses in 54 of these patients and in 16 cases the jejunal flap artery was attached to the carotid artery. RESULTS: Out of 54 patients 9 (17%) with microvascular anastomoses to the smaller vessels needed surgical intervention for ischemia. In 16 patients with anastomosis to the carotid artery no significant failure of perfusion occurred. CONCLUSION: The carotid artery as recipient vessel in free jejunal transfer seems to be a safe therapeutic option for intestinal reconstruction of preradiated esophageal cancer with good functional results.

Efeitos do extrato de Ginkgo biloba (EGb 761) e da natação repetida sobre a memória, ansiedade e atividade motora de ratos / Effects of Ginkgo biloba extract (EGb 761) and repeated swimming on memory, anxiety and motor activity of rat

O extrato de Ginkgo biloba (EGb 761) e exercícios físicos isoladamente são capazes de modificar as funções cognitivas e aliviar os sintomas de ansiedade. Contudo, estes tratamentos em conjunto devem ser caracterizados. Em nossa pesquisa, verificamos que a administração oral repetida do extrato (40 ou 80 mg/kg/dia) e o exercício de natação ao qual os ratos eram submetidos causaram aumento de entradas destes animais nos braços fechados do labirinto em cruz elevado e diminuição da imobilidade dos mesmos no campo aberto, sugerindo um aumento de suas atividades motoras. Além disso, o exercício de natação aumentou a exploração no campo aberto e o tratamento com EGb 761 cancelou este efeito, sugerindo a interação entre EGb 761 e exercício de natação, provavelmente com um mesmo substrato neurobiológico capaz de minimizar a atividade exploratória em ratos nadadores. Análises comportamentais sobre o teste de reconhecimento de objetos mostraram que, quando submetidos a exercício de natação e/ou tratamento com EGb 761 durante testes de 24 horas, os ratos nadadores levaram mais tempo explorando os novos objetos do que os familiares. Estes resultados mostram que o EGb 761 e os exercícios, ambos isolados ou em conjunto, têm um poderoso efeito sobre a memória de longo-prazo. Entretanto, o proposto efeito ansiolítico do EGb 761 e de exercícios de natação pode ser questionado.

Either ingestion of a Ginkgo biloba proprietary extract (EGb 761) or physical exercise can enhance cognitive functioning and alleviate symptoms of anxiety; however, their combined effects have yet to be characterized. Rats subjected to repeated oral administration of the extract (40 or 80 mg/kg/day) and swimming exercise exhibited an increased number of closed-arm entries in the elevated plus-maze and decreased immobility in the open , suggesting an increase in motor activity. In addition, the exercise of swimming increased the exploration of the open and chronic treatment with EGb 761 could cancel this effect; this indicates interaction between EGb 761 and swimming exercise, which may show a common neurobiological substrate, capable of reducing exploratory activity in swimming rats. Analysis of behavior in the object-recognition test showed that rats subjected to swimming exercise and/or treatment with EGb 761, during tests of 24 hours, spent more time exploring novel objects than familiar ones. These results show that EGb 761 and/or physical exercise have powerful effects on long-term memory. However, the proposed anxiolytic characteristics of EGb 76 and swimming exercise may be questioned.

[Calvarial reconstruction by customized bioactive implant]. / Rekonstruktion der Kalvaria durch ein präfabriziertes bioaktives Implantat.

Osseous craniofacial defects are commonly seen problems after operative treatment of craniosynostoses. This case report describes a calvarial reconstruction by means of computer-aided fabrication of a customised implant. Three-dimensional imaging is followed by computer-aided design and fabrication of a medical grade PCL-TCP biodegradable scaffold using the rapid prototyping technology fused deposition modelling (CAD/CAM). After six months the implant was well integrated, no defect area could be palpated any more and a beginning bony consolidation could be detected via CT.

[Structural fat grafting for rejuvenation of the dorsum of the hand]. / Autologe Fettgewebstransplantation ("Structural Fat Grafting") zur ästhetischen Verjüngung der Hand.

In parallel with aging, increasing skin laxity and subcutaneous atrophy occur in many regions of the human body. Apart from the most obvious facial region, where most aesthetic operations for rejuvenation are done, also the dorsum of the hand is continuously visible in daily life. This region exhibits skin laxity, subcutaneous atrophy and age-related pigmentations in a comparable manner to the face. Autologous transplantation of fatty tissue (structural fat grafting, lipofilling) enables subcutaneous regeneration by refilling the subcutaneous space and hence reducing some of the age-related degenerative process. This paper illustrates the special operative technique on the hand in the form of a case report. Furthermore, 3D surface laser scanning permits an objective evaluation of the permanent volume effect over time. In the presented case a volume effect of 69% of the injected volume was measured after 6 months follow-up time. This amount of injected tissue seems to be integrated as a graft and results in a reduction of subcutaneous atrophy in terms of a true regeneration. Structural fat grafting of the dorsum of the hand is thus a method of regenerative medicine. Together with other methods which reduce the age-related pigmentations, it plays a key role in our treatment concept for rejuvenation of the hand.

[The effect of acute cellular rejection on liver function following orthoptic liver transplantation. Quantitative functional studies with the 14C-aminopyrine breath test]. / Einfluss der akuten zellulären Abstossung auf die Leberfunktion nach orthotoper Lebertransplantation. Quantitative Funktionsuntersuchungen mit dem 14C-Aminopyrin-Atemtest.

To test the effect of acute cellular rejection on liver function as represented by cytochrome-P-450 enzyme activity, the 14C-aminopyrine breath test (ABT) was performed prospectively in 46 patients (31 men, 15 women; mean age 48 [15-66] years) who had undergone a total of 50 orthotopic liver transplantations. Routine biochemical tests were performed daily until the 30th postoperative day, while the ABT was done daily on days 1-10 and three times weekly on days 11-30, and liver puncture biopsies were obtained once weekly or more often if there was clinical suspicion of rejection. Histologically confirmed cellular rejection occurred within the stated period of observation in eight patients (five women, three men; median age 45 [18-59] years). Results of routine laboratory tests (transaminases, bilirubin, thromboplastin time), as well as bile-flow and body temperature, did not vary uniformly. On the other hand, results of ABT at the time of rejection showed a decrease in all patients by an average of 65% (P < 0.01). Changes in the ABT preceded those in other tests by 1-2 days in four patients, being the only measurable functional abnormality in one. All rejection episodes responded to glucocorticoid pulse-treatment (three times 1 g methyl-prednisolone). Using ABT results as criterion, liver function became normal after the glucocorticoid injection within 4-11 days. These data indicate that the ABT is suitable in the routine monitoring of transplant function, thus facilitating early diagnosis and controlled treatment of acute cellular rejection.