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The spatial distribution and relative abundance of gap-junctional connexin40 and connexin43 correlate to functional properties of components of the cardiac atrioventricular conduction system.

Electrical coupling between heart muscle cells is mediated by specialised regions of sarcolemmal interaction termed gap junctions. In previous work, we have demonstrated that connexin42, a recently identified gap-junctional protein, is present in the specialised conduction tissues of the avian heart. In the present study, the spatial distribution of the mammalian homologue of this protein, connexin40, was examined using immunofluorescence, confocal scanning laser microscopy and quantitative digital image analysis in order to determine whether a parallel distribution occurs in rat. Connexin40 was detected by immunofluorescence in all main components of the atrioventricular conduction system including the atrioventricular node, atrioventricular bundle, and Purkinje fibres. Quantitation revealed that levels of connexin40 immunofluorescence increased along the axis of atrioventricular conduction, rising over 10-fold between atrioventricular node and atrioventricular bundle and a further 10-fold between atrioventricular bundle and Purkinje fibres. Connexin40 and connexin43, the principal gap-junctional protein of the mammalian heart, were co-localised within atrioventricular nodal tissues and Purkinje fibres. By applying a novel photobleach/double-labelling protocol, it was demonstrated that connexin40 and connexin43 are co-localised in precisely the same Purkinje fibre myocytes. A model, integrating data on the spatial distribution and relative abundance of connexin40 and connexin43 in the heart, proposes how myocyte-type-specific patterns of connexin isform expression account for the electrical continuity of cardiac atrioventricular conduction.

Animals↗

A radiographic evaluation of the availability of bone for placement of miniscrews.

Monocortical screws are increasingly being used to enhance orthodontic anchorage. The most frequently cited clinical complication is soft tissue irritation. It is thus clinically advantageous for these miniscrews to be placed in attached mucosa. The purpose of this study was to (1) determine radiographically the most coronal interradicular sites for placement of miniscrews in orthodontic patients and (2) determine if orthodontic alignment increases the number of sites with adequate interradicular bone for placement of these screws. Sixty panoramic radiographs (n = 30 pretreatment, n = 30 posttreatment) of orthodontic patients were obtained from an archival database after Institutional Review Board approval. Selection criteria included minimal radiographic distortion and complete eruption of permanent second molars. Interradicular sites were examined with a digital caliper for presence of three and four mm of bone. If three or four mm of bone existed, then a vertical measurement from the cementoenamel junction (CEJ) to first measurement was made. In addition, the magnification error inherent in panoramic radiographs was estimated. Ninety-five percent confidence intervals were calculated for the vertical distances from the CEJ to the horizontal bone location. Bone stock for placement of screws was found to exist primarily in the maxillary (mesial to first molars) and mandibular (mesial and distal to first molars) posterior regions. Typically, adequate bone was located more than halfway down the root length, which is likely to be covered by movable mucosa. Inability to place miniscrews in attached gingiva may necessitate design modifications to decrease soft tissue irritation.

Alveolar Process↗

In vitro assessment of dentinal permeability after the use of ultrasonic-activated irrigants in the pulp chamber before internal dental bleaching.

This in vitro study aimed to assess dentin permeability quantitatively after the use of different irrigants into the pulp chamber, with or without ultrasonic activation, before the application of an internal bleaching agent. Thirty maxillary anterior teeth, treated endodontically, were randomly assigned to six groups, according to the irrigant used: group I, distilled water; group II, 17% EDTA; group III, 1% sodium hypochlorite; for groups IV, V, and VI, respectively, the same solutions were used, but were ultrasonicated. In groups I, II, and III, the irrigant that filled the pulp chamber was left undisturbed for 15 s and was then aspirated; in groups IV, V, and IV, the irrigants were placed into the pulp chamber, ultrasonic-activated for 15 s, and were then aspirated. This sequence was repeated three times for all groups. Afterwards, for all groups, the pulp chamber was dried, filled with a bleaching agent, and sealed with glass ionomer cement. At each change of the whitening agent, these procedures were repeated. Then, the temporary restorations were removed, access cavities were cleaned, and teeth were immersed in a 10% copper sulfate aqueous solution, submitted to vacuum and immersed in a 1% rubianic acid alcohol solution. Copper ion penetration was revealed by the rubianic acid. After staining, roots were removed at the cemento-enamel junction (CEJ) and sectioned in a mesiodistal direction starting from the cervical plug level. The sections were thinned, observed under an optical microscope, the images were digitized, and copper ion penetration was measured in each section using a specific software. Means and SD were: group I, 2.41 (+/-1.45); group II, 5.22 (+/-1.79); group III, 8.32 (+/-2.55); group IV, 3.73 (+/-0.89); group V, 14.83 (+/-4.99); and group VI, 10.51 (+/-2.65). Statistical analysis using two-way anova and Tukey test showed that, regardless of the irrigant, ultrasonication increased dentinal permeability (P < 0.01). Comparing the overall effectiveness of the tested solutions, EDTA yielded the greatest increase in dentinal permeability (P < 0.01). Based on these results, it may be concluded that use of ultrasonic-activated irrigants in the pulp chamber, before the accomplishment of internal dental bleaching procedures, may result in a remarkable increase of dentin permeability, which may enhance the efficiency of the whitening agent.

Chelating Agents↗

Ultrasound crack detection in a simulated human tooth.

OBJECTIVE: Currently, diagnosis of cracked teeth generally depends upon the overall clinical assessment, or on exclusion of other clinical possibilities, not primarily on the direct identification of cracks themselves. Owing to its short wavelength in hard tissues and associated high resolution, ultrasound has the potential to allow detection of cracks within tooth structure. However, ultrasound detection of dental cracks has not previously been achieved. The purpose was to determine if an ultrasound imaging system was capable of imaging cracks in simulated tooth structure. METHODS: A complete ultrasound system including a novel transducer made of PLZT-98, a novel gallium-indium alloy coupling agent, and customized electronic and digital signal processing (DSP) algorithms was developed for the specific application of optimizing crack detection within teeth. A simulated tooth with a known and uniform internal structure and acoustic properties similar to those of natural enamel and dentin was designed to model a human tooth with a crack located in dentin deep to the dentino-enamel junction (DEJ). The distance between the DEJ and a crack of the simulated tooth were calculated. RESULTS: The system unequivocally distinguished between areas with and without a simulated crack. CONCLUSION: A unique ultrasound dental crack detection system using a novel transducer; a novel coupling agent; and customized electronic and digital signal processing (DSP) algorithms has been validated in a simulated tooth.

Algorithms↗

Marginal bone level in an adult Danish Population.

PURPOSE: To investigate the prevalence and distribution of marginal bone loss in the Danish population. MATERIALS AND METHODS: Six hundred and sixteen randomly selected Danish adults (304 females and 312 males), mean age of 42 years (range 21-63 years) underwent a full-mouth radiographic survey consisting of 14 periapicals and two bitewings. The marginal bone level was measured with a digital caliper in mm, rounded off to the nearest 0.1 mm. The measurements were performed at the mesial and distal aspect of the tooth, from the cemento-enamel junction to the marginal bone. These measurements were used to calculate the marginal bone level (A) in mm for each tooth and each patient. Three thresholds were defined: normal marginal bone level (A < 3 mm), borderline marginal bone level (3 mm < or = A < 4 mm) and reduced marginal bone level (A > or = 4 mm). RESULTS: The prevalence of reduced marginal bone level in the individual and the frequency of teeth with reduced marginal bone level were almost similar. A reduced marginal bone level was evenly distributed among the tooth groups. Approximately 12% had reduced marginal bone level, 12% were in the borderline marginal bone level group, and the remaining 76% had a normal marginal bone level. The marginal bone level was ever more reduced with increasing age. No significant difference in bone level was observed between genders. CONCLUSIONS: The prevalence of reduced marginal bone level in a random Danish population is approximately 12% and is comparable to findings in other European countries.

Adult↗

Digital radiography in the evaluation of oesophageal motility disorders.

AIMS: To develop a simple technique for examination of the oesophagus by digital radiography and to assess its role in the evaluation of motility disorders of the oesophagus. MATERIALS AND METHODS: Forty-nine patients and 44 control subjects underwent manometry and digital examination of the oesophagus. The digital study consisted of two parts: firstly examination of the pharynx and cervical oesophagus using 15 ml of fluid barium in anterio-posterior (AP) and lateral views, with image acquisition of four frames/s for 2 s. Secondly, examination of the thoracic oesophagus and oesophagogastric junction using 25 ml of barium in two prone oblique and one supine AP series, with image acquisition of one frame/s for 20 s. Oesophageal transit time (OTT) was measured in each case. Abnormal or non-peristaltic contractions were described regarding their morphology, time of visualization and length. The presence or absence of hiatal hernia, reflux or any associated organic lesions was noted. RESULTS: Digital radiography diagnosed 14 cases of achalasia and 28 cases of non-specific oesophageal motility disorder (NOMD). Normal OTT was 11.95 +/- 1.304 s. The OTT was prolonged (16 s or more) in all patients except five; four of these were cases of NOMD. Abnormal contractions were classified into circular and longitudinal types. The circular non-obliterating type was commoner. Achalasia was diagnosed in all cases, as failure of relaxation of the inferior oesophageal sphincter was always present and easily depicted by digital radiography. Abnormal contractions in the body of the oesophagus were elicited in 57% of cases of achalasia. The sensitivity of digital radiography in detecting oesophageal motility disorders was 85.7% based on the presence of abnormal contractions and 91.6% by eliciting a prolonged OTT. CONCLUSIONS: Examination of the oesophagus by digital radiography is simple, non-invasive, reproducible, rapid and without discomfort to patients. It allows the diagnosis of motility disorders of the oesophagus by detecting abnormal contractions and/or prolonged OTT and showed any associated organic lesions.Aly, Y. A. (2000). Clinical Radiology 55, 561-568.

Adolescent↗

The basement membrane zone of the nail.

The anatomy of the epidermis, dermis and subcutaneous tissues of the nail apparatus is distinct from that of non-appendageal skin. Apart from the demonstration of the longitudinal configuration of the dermal-epidermal junction of the nail bed, there have been no studies of the composition of the basement membrane zone of the nail apparatus. We obtained three human accessory digits, including one thumb, all of which had been amputated for cosmetic reasons, and were without known pathology. Specimens were stained with a battery of monoclonal and polyclonal antibodies which target normal basement membrane zone antigens, and studied by indirect immunofluorescence. This study demonstrated that the four distinct regions of the nail, namely the proximal nail fold, the nail matrix, the nail bed and the hyponychium expressed all the target antigens found in the normal non-appendageal basement membrane. In particular, there was normal expression of the epidermal-associated antigens, the 220- and 180-kDa bullous pemphigoid antigens, and the alpha 6 beta 4 integrin. There was also normal expression of the lamina lucida antigens LH39, GB3 and laminin. It is of interest that the dermal-associated components, namely the 285-kDa linear IgA antigen, the extracellular matrix glycoproteins chondroitin sulphate, type VII collagen and its closely associated proteins, and the poorly characterized antigen for LH24 and LH39 were all normally expressed. Fibronectin, which is not a normal basement membrane zone component, was diffusely expressed in the extracellular matrix, but did not accentuate the basement membrane zone.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Monoclonal↗

[The application of intravascular ultrasound imaging in the diagnosis of aortic dissection].

OBJECTIVE: To evaluate the role of intravascular ultrasound (IVUS) imaging in the diagnosis of aortic dissection. METHODS: Eighty-two patients with aortic dissection were admitted. The role of IVUS was evaluated and compared with CT, MRI, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), Duplex scanning and digital subtraction angiography (DSA). RESULTS: The different laminar appearance of the outer wall of the true and false lumen, characteristic alterations in the true and false lumen junction and the thrombosis in the false lumen detected by IVUS were useful to differentiate the true from the false lumen. Static and dynamic narrowing, causing visceral ischemia could be detected by IVUS imaging. The detection rate of entry site by IVUS was 100%, higher than CT (28%), MRI (22%), TTE (2%) and TEE (61%), P < 0.01, having no statistic difference with DSA (88%). The detection rate of the distal end of the dissection by IVUS was 100%, higher than Duplex (21%), P < 0.01, but had no statistic difference as compared with CT (89%) and MRI (86%). The detection rate of visceral arteries by IVUS was 98%, higher than CT (56%), MRI (57%), Duplex (17%) and DSA (66%), P < 0.01. The aortic diameter measured by IVUS was correlated well with CT measurement (r = 0.94, P < 0.01). CONCLUSIONS: A full picture of aortic dissection can be obtained using IVUS imaging. It has an advantage over routine examinations in detecting visceral artery origin and clarifying visceral ischemia causes.

Adult↗

Effects of general anesthetics on intercellular communications mediated by gap junctions between astrocytes in primary culture.

BACKGROUND: Astrocytes represent a major nonneuronal cell population in the central nervous system (CNS) and are actively involved in several brain functions. These cells are coupled by gap junctions (GJ) into a syncytial-like network resulting in cellular communication through ionic and metabolic exchange between adjacent astrocytes. Whether anesthetics affect astrocyte function is not known. In the present study, the effects of general anesthetics on GJ permeability were investigated in primary cultures of mouse striatal astrocytes. METHODS: Junctional permeability was determined by using the fluorescent probe Lucifer yellow and the scrape loading/dye transfer technique. Confluent cells were preincubated 5 min with various concentrations of anesthetic agents and GJ permeability was estimated by measuring the area occupied by the dye from digitalized images taken 8 min after cell loading. RESULTS: Of the intravenous anesthetics tested, only propofol (P: 10(-4) M, P < 0.01 and 10(-5) M, P < 0.05) and etomidate (ET: 10(-4) M, P < 0.05, but not 10(-5) M) induced a significant reduction of GJ permeability. In contrast, diazepam (10(-5) M), morphine (10(-4) M), ketamine (10(-4) M), thiopental (10(-4) M), and clonidine (10(-7) M) did not affect junctional permeability. In addition, the halogenated anesthetics halothane, enflurane, and isoflurane induced a dose-dependent closure of GJ. For halothane, enflurane, and isoflurane, the maximum effect was achieved with a 10(-4) M, 1.6 x 10(-3) M, and 10(-3) M anesthetic concentration, respectively. Removal of volatile anesthetics resulted in the restoration of the control fluorescence area between 15 and 45 min. The time course of recovery of GJ permeability was examined more precisely for shorter periods of halothane administration (5 min, 1 mM). Under these conditions, the rate of dye spread returned to control values following anesthetic washout, while, during the same period of time, complete uncoupling of GJ was still observed in the presence of a 1 mM halothane concentration. CONCLUSIONS: These results indicate that general anesthetics differentially affect GJ permeability in cultured astrocytes. This uncoupling effect (closure of gap junctions) may contribute to the mechanisms of action of some anesthetic agents (primarily volatile anesthetics) at the level of the CNS by altering astrocyte communication.

Anesthetics↗

Manifestation of the limb prepattern: limb development in the absence of sonic hedgehog function.

The secreted protein encoded by the Sonic hedgehog (Shh) gene is localized to the posterior margin of vertebrate limb buds and is thought to be a key signal in establishing anterior-posterior limb polarity. In the Shh(-/-) mutant mouse, the development of many embryonic structures, including the limb, is severely compromised. In this study, we report the analysis of Shh(-/-) mutant limbs in detail. Each mutant embryo has four limbs with recognizable humerus/femur bones that have anterior-posterior polarity. Distal to the elbow/knee joints, skeletal elements representing the zeugopod form but lack identifiable anterior-posterior polarity. Therefore, Shh specifically becomes necessary for normal limb development at or just distal to the stylopod/zeugopod junction (elbow/knee joints) during mouse limb development. The forelimb autopod is represented by a single distal cartilage element, while the hindlimb autopod is invariably composed of a single digit with well-formed interphalangeal joints and a dorsal nail bed at the terminal phalanx. Analysis of GDF5 and Hoxd11-13 expression in the hindlimb autopod suggests that the forming digit has a digit-one identity. This finding is corroborated by the formation of only two phalangeal elements which are unique to digit one on the foot. The apical ectodermal ridge (AER) is induced in the Shh(-/-) mutant buds with relatively normal morphology. We report that the architecture of the Shh(-/-) AER is gradually disrupted over developmental time in parallel with a reduction of Fgf8 expression in the ridge. Concomitantly, abnormal cell death in the Shh(-/-) limb bud occurs in the anterior mesenchyme of both fore- and hindlimb. It is notable that the AER changes and mesodermal cell death occur earlier in the Shh(-/-) forelimb than the hindlimb bud. This provides an explanation for the hindlimb-specific competence to form autopodial structures in the mutant. Finally, unlike the wild-type mouse limb bud, the Shh(-/-) mutant posterior limb bud mesoderm does not cause digit duplications when grafted to the anterior border of chick limb buds, and therefore lacks polarizing activity. We propose that a prepattern exists in the limb field for the three axes of the emerging limb bud as well as specific limb skeletal elements. According to this model, the limb bud signaling centers, including the zone of polarizing activity (ZPA) acting through Shh, are required to elaborate upon the axial information provided by the native limb field prepattern.

Animals↗

Effect of shaking of corneal endothelial preservation.

PURPOSE: To investigate the effect of shaking on corneal endothelial preservation. METHODS: Thirty-six dog corneal buttons were obtained under standard eye bank procedure, after the animals had been sacrificed for cardiovascular experiments in the surgical department. They were equally divided into two groups. In Group I, buttons were put in Dexsol preservative medium and preserved at 4 degrees C. In Group II, buttons were put in Dexsol preservative medium and shaken in a shaking incubator at a speed of 5 rpm. at 4 degrees C for 10 h. After shaking, they were returned to a 4 degrees C refrigerator until examination. Three buttons from each group underwent specular microscopy, scanning electron microscopy (SEM), and alizarin red with trypan blue stain examinations on days 0, 1, 3, 5, 7 and 9, respectively. RESULTS: In Group I, intercellular borders became blurred under specular microscopy, beginning on day 5. However, endothelial cell count did not change significantly until day 9. Intercellular digitations and wrinkling of intercellular borders were seen under alizarin red with trypan blue stain and SEM examination, beginning on day 3. Pleomorphism and ill-defined intercellular junctions were seen under SEM on day 7. There was no obvious denudement of the endothelial sheet, but a few scattered exfoliations were seen in Group I. In Group II, endothelial cell count did not decrease on day 1, but an endothelial image could not be obtained by specular microscopy 3 days after treatment. Alizarin red with trypan blue stain and SEM examination revealed that the endothelial cells were denuded from the Descemet's membrane three days after shaking. Severe stromal edema was seen under SEM five days after shaking. CONCLUSIONS: The results showed that shaking had a detrimental effect on endothelial cell preservation. Vigorous shaking should be avoided during transportation of corneal buttons. It is advisable to perform penetrating keratoplasty as soon as possible upon receiving transported donor corneas.

Animals↗

Digital logic gate using quantum-Dot cellular automata

A functioning logic gate based on quantum-dot cellular automata is presented, where digital data are encoded in the positions of only two electrons. The logic gate consists of a cell, composed of four dots connected in a ring by tunnel junctions, and two single-dot electrometers. The device is operated by applying inputs to the gates of the cell. The logic AND and OR operations are verified using the electrometer outputs. Theoretical simulations of the logic gate output characteristics are in excellent agreement with experiment.

Journal Article↗

Assessing dentin color changes from nightguard vital bleaching.

BACKGROUND: At-home bleaching with 10 percent carbamide peroxide in a custom-fitted tray has been reported to change the color of dentin. The purpose of this study was to validate the color change of dentin and to determine whether the color change was uniform or occurred from the outside (the dentinoenamel junction) to the inside (the pulpal wall). METHODS: The authors sectioned 10 extracted human teeth incisogingivally through the midfacial long axis, and sealed their cut surface against glass microscope slides. Identifying marks were placed on the glass over the tooth sections to serve as a color control and in the dentinal areas closest to the dentinoenamel junction and the pulpal wall. Teeth were bleached for 10 days with 10 percent carbamide peroxide. Photographs were taken from the glass-covered side of the teeth, digitized and converted to gray-scale levels (consisting of 256 shades of gray ranging from black to white). Marked areas were measured with a National Institutes of Health Image software program and analyzed statistically for changes in lightness between the control marks and the inner and outer dentinal marks over time. RESULTS: Paired t-tests and analysis of variance indicated a significant increase in lightness (P = .01) for the inner and outer dentinal areas during bleaching compared with the control areas. No significant differences were found in the rate of change for the inner and outer dentinal areas (P = .89). CONCLUSIONS: The increase in lightness confirms that a significant color change occurred in the dentin during bleaching with 10 percent carbamide peroxide. This change occurred throughout the dentin at a uniform rate, rather than from the outside inward. CLINICAL IMPLICATIONS: The results of this study show that at-home bleaching with 10 percent carbamide peroxide can change the color of dentin, which is important to treat intrinsic stains from tetracycline treatment, trauma and aging or inherited discolorations. The bleaching material easily penetrates the tooth to change the dentin color at the same rate throughout, indicating that the type of stain may be the important factor in determining bleaching success.

Absorptiometry, Photon↗

Effect of latrunculin-A on morphology and actin-associated adhesions of cultured human trabecular meshwork cells.

PURPOSE: Determine the effects of the actin cytoskeleton disrupting compound latrunculin-A (LAT-A) on morphology, cytoskeleton, and cellular adhesions of cultured human trabecular meshwork (HTM) cells. METHODS: HTM cells were cultured to high confluence with endothelial-like morphology and treated with LAT-A at different doses and duration. Topography of living cells was evaluated by videomicroscopy. Distribution and organization of the actin-based cytoskeleton, vinculin- and paxillin-containing focal contacts, and beta-catenin-rich intercellular adhesions were determined by immunofluorescence and digital microscopy. RESULTS: LAT-A induced pronounced but highly reversible rounding of HTM cells, intercellular separation, and disruption of actin filaments. beta-catenin-rich intercellular adherens junctions were particularly sensitive to LAT-A. Vinculin- and paxillin-containing focal contacts were only partially affected and appeared to be more resistant to the drug than the intercellular interactions. CONCLUSIONS: The increase in outflow facility in the living primate eye induced by LAT-A may be due to the disorganization and disruption of the actin cytoskeleton and its associated cellular adhesions in the trabecular meshwork.

Actins↗

[Marginal fit of dental restorations and the periodontium in Swiss army recruits].

The present study analyzed the relationship between periodontal health adjacent to filled and unfilled tooth sites in young men (recruits). The status of oral health of 419 Swiss army recruits, aged 19 to 20 years was assessed by determining Plaque Index (PI), Retention Index (RI) and Gingival Index (GI) as well as Pocket Probing Depth (PPD) and Probing Attachment Loss (PAL). In addition, the level of alveolar bone was measured using digitized bite-wing radiographs with an enlargement of 4.5x. Filling margins were assessed and the distance between the alveolar bone crest and the cemento-enamel junction (CEJ) measured to the nearest one tenth of a millimeter. These data were compared with the clinical parameters. A total of 8'050 sites were examined. 765 or 9.5 of the sites in the posterior area were filled. 119 of them showed filling overhangs larger than 0.2 mm. Thus, 1.5 % of the examined sites had a significant overhanging margin. All clinical parameters had greater values at filled than at unfilled sites. The differences were statistically not significant. Even the sites with margins overhanging more than 0.8 mm (n=14) did not show significantly different parameters compared to unfilled sites. The comparison with a similar study involving recruits 11 years earlier assessed that the recruits of 1996 had less and smaller filling overhangs. This, in turn, means that, in Switzerland restorative dentistry in young males has been markedly improved during the 1980's and 1990's.

Adult↗

Application of dynamic computed tomography to physiologic imaging of renal artery stenosis before and after angioplasty.

This study describes the application of dynamic Computed Tomography (CT) of the kidneys to the diagnosis and evaluation of the physiology of renal artery stenosis before and after angioplasty. The CT imaging parameters are discussed in relationship to findings from other imaging modalities, which include renal arteriography, intravenous digital subtraction angiography, and radionuclide renography. Time density graphs of the renal cortex and medulla were obtained by the use of region of interest cursors, and the corticomedullary junction time (CMJT) was determined. The CMJT was prolonged in the setting of renal artery stenosis and was improved after angioplasty. Simple visual inspection alone provided sufficient information to diagnose renal artery stenosis. The pathophysiology of renal artery stenosis and the meaning of the abnormal findings is discussed. Dynamic CT provides a unique noninvasive means for cross-sectional physiologic imaging. The role of dynamic CT in the evaluation of renovascular hypertension and physiologic imaging in other areas requires further investigation.

Angioplasty, Balloon↗

The anatomical variables of the sapheno-popliteal junction visualization by radiological and echographic examinations.

Increasing interest on the short saphenous vein has been induced by its employment as autologus graft in arterial surgery and for being held responsible for the onset and development of varicose veins of the lower limbs and postoperative recurrence. These two clinical conditions require a more precise assessment of the short saphenous anatomy and its variables previously described in literature. A verify of the anatomical variations of the sapheno-popliteal junction and of the short saphenous outlet in 528 not randomized limbs was performed in separate groups by the following methods: High Resolution Echography, preoperative ascending Phlebography, preoperative Digital Phlebography, intraoperative Selective Phlebography. A high number of anatomical variations was found (29.8%) and the conclusion was that modest differences between published data by other Authors and the results of this study were found. The ideal diagnostic approach for these anatomical variations is the intraoperative Selective Phlebography in cases systematically selected by preoperative High Resolution Echography.

Humans↗

Arteritis and brachial plexus neuropathy as delayed complications of radiation therapy.

Radiation-induced arteritis of large vessels and brachial plexus neuropathy are uncommon delayed complications of local radiation therapy. We describe a 66-year-old woman with right arm discomfort, weakness, and acrocyanosis that developed 21 years after local radiation for breast adenocarcinoma. Arteriography revealed arteritis, with ulcerated plaque formation at the subclavian-axillary artery junction, consistent with radiation-induced disease, and diffuse irregularity of the axillary artery. Electromyography showed a chronic brachial plexopathy. The patient's acrocyanosis, thought to be due to digital embolization from her vascular disease, improved with antiplatelet therapy. The concurrent combination of radiation-induced arteritis and brachial plexopathy is uncommon but should be considered in patients presenting with upper extremity pain or weakness after radiation therapy.

Adenocarcinoma↗