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At least 37 records · Page 2Linked to original sources
PubMed2001

Reduction in voiding cystourethrographies after the introduction of contrast enhanced sonographic reflux diagnosis.

BACKGROUND: Voiding urosonography (VUS) using the intravesical application of an US contrast medium (Levovist) has been shown to have very high sensitivity and specificity in the diagnosis of vesicoureteric reflux (VUR) compared to voiding cystourethrography (VCUG). OBJECTIVE: To determine the extent of reduction of VCUGs after adding VUS to the diagnostic algorithm of VUR. MATERIALS AND METHODS: Over 2 years, 449 children (162 boys, 287 girls) were referred for diagnosis of possible VUR. The selection of a particular reflux examination was based on pre-defined criteria. VUS was performed primarily in girls and follow-up cases. The indications for VCUG were as follows: (a) boys - first examination for VUR, (b) specific request for urethra or bladder imaging, (c) girls - when VUR was diagnosed in the VUS and no VCUG had been done previously, and (d) inadequate VUS. RESULTS: VCUGs were primarily carried out in 141 cases. VUSs were performed in 308 patients. In 69 of these patients a VCUG followed during the same examination session. Thus 239 of 449 patients underwent only VUS, resulting in reduction of the VCUGs by 53 %. CONCLUSIONS: The number of VCUGs was significantly reduced as a result of the implementation of VUS as part of the routine diagnostic imaging modality for VUR. Consequently, the number of children that would have been exposed to ionising radiation was reduced by over half.

Adolescent↗
PubMed2003

Vesicoureteral reflux: comparison between urosonography and radionuclide cystography.

Our aim was to compare contrast-enhanced color Doppler voiding urosonography (VUS) and direct radionuclide voiding cystography (DRVC) to determine the usefulness of ultrasonography (US) in the detection and grading of vesicoureteral reflux (VUR). In this study, the two techniques were performed simultaneously on a group of 64 children referred for the evaluation of VUR. DRVC detected VUR in 54/128 ureterorenal units, and VUS confirmed reflux in 44 (81%). Only in two cases was the reflux not confirmed by DRVC (97% specificity). Ten units with minimal grade I VUR detected by DRVC were not identified by VUS. For identification of grade II and III reflux, sensitivity of VUS reached 100%. Ten units with grade I VUR at DRVC presented grade II at VUS. Eleven units with grade II VUR at DRVC presented grade III at VUS. In conclusion, contrast-enhanced VUS is a useful diagnostic tool for the detection of VUR in children. Our data suggest a higher diagnostic accuracy of urosonography compared to radionuclide cystography in the determination of the grade of VUR; this may have significant consequences on the management of young patients affected by VUR.

Child↗
PubMed2003

Cyclic voiding urosonography in detecting vesicoureteral reflux in children.

Three methods are currently used to identify vesicoureteral reflux (VUR) in children, namely X-ray voiding cystourethrography (VCUG), radionuclide voiding cystography (RVC), and, recently, echo-enhanced voiding urosonography (VUS). It is known that the sensitivity of VCUG and RVC for detecting VUR can be improved by using cyclic procedures, such as repeated bladder filling and voiding. The purpose of our prospective study was to evaluate whether the cyclic procedure is superior to the conventional (one cycle only) procedure in VUS also. VUS was performed in 49 patients, aged 1.4-15.8 years (mean 4.1 years). After the first micturition, the catheter was left in place and the whole procedure was repeated under the same conditions. The results of the first and second cycles and the combined procedure were compared. In the initial cycle, 7 of 35 (20%) refluxing renal units that were detected in the second cycle and 4 of 26 (15%) children with at least unilateral VUR were missed. Cyclic VUS detected 25% more VURs than the conventional (one cycle only) VUS ( P=0.049) and revealed 50% more VUR III than the first cycle. Our results suggest that cyclic VUS is superior to conventional VUS.

Adolescent↗
PubMed1984

Energetics of isometric contraction in porcine carotid artery.

The rate of ATP utilization ( JATP ) and unloaded shortening velocity ( Vus ) of porcine carotid artery were studied during tension development and maintenance to assess the importance of mechanisms proposed to account for its high economy of tension maintenance. Previous work from our laboratory established that the rate of O2 consumption ( JO2 ) can be used to measure rates of tissue phosphagen utilization as early as 30 s after initiation of contraction. Studies at 37 degrees C of tissue JO2 indicated the following. 1) The basal JO2 was 0.069 +/- 0.017 mumol O2 X min-1 X g-1) (n = 10). During steady-state tension maintenance suprabasal JO2 was 0.079 +/- 0.012 mumol O2 X min-1 X g-1 for tissues stimulated with KCl (n = 11) and 0.213 +/- 0.022 (n = 3) for tissues stimulated with KCl + histamine. 2) For both stimulation conditions an initial elevated (peak) suprabasal JO2 was observed that correlated with the rate of tension development. The peak suprabasal JO2 was approximately twice the steady-state suprabasal JO2 measured 10 min after stimulation. 3) There was no significant change in JO2 during tension redevelopment after a rapid length step at 15-20 min after stimulation (n = 4). Studies of Vus indicated the following. 1) During steady-state tension maintenance Vus was 0.008 +/- 0.001 tissue lengths/s for tissues stimulated with KCl (n = 13) tissue lengths/s for tissues stimulated with KCl + histamine (n = 6). 2) An initial twofold peak in Vus was observed at 0.25-0.5 min in that decreased to steady-state levels by 4 min after KCl stimulation, whereas minor decreases in Vus still occurred until 10-20 min after KCl + histamine stimulation. 3) The measured transient in Vus , although biphasic, does not temporally correlate with the transient in JO2 even after the JO2 time course was corrected for delays resulting from O2 diffusion and the electrode response time. The mechanism underlying the observed maximum change of two- to fourfold in both JATP and Vus is not sufficient to account for the high economy of tension maintenance.

Animals↗
PubMed2003

In vivo effects of an Er:YAG laser, an ultrasonic system and scaling and root planing on the biocompatibility of periodontally diseased root surfaces in cultures of human PDL fibroblasts.

BACKGROUND AND OBJECTIVES: The aim of the present study was to investigate the in vivo effects of an Er:YAG laser (ERL), an ultrasonic system and scaling and root planing (SRP) on the biocompatibility of periodontally diseased root surfaces in cultures of human periodontal ligament fibroblasts (PDL). STUDY DESIGN/MATERIALS AND METHODS: Forty single rooted teeth, considered for extraction due to severe periodontal destruction, have been randomly assigned to the following groups: (1) ERL at 160 mJ/pulse and 10 Hz, or (2) Vector ultrasonic system (VUS), or (3) SRP using hand instruments, or (4) untreated control (C). Immediately after instrumentation, all test and control teeth were extracted and root specimens (4 mm2) were prepared from all mesial and distal surfaces (n=80). Following the prescribed treatments, the root specimens were incubated with human PDL fibroblast cultures. Adherent cells were stained with methylene blue and counted using a reflected light microscope and the cell density per mm2 was calculated. Additionally, the cell morphology was investigated using SEM (n=8 teeth). RESULTS: Cell counts within each group yielded the following means and standard deviations (cells/mm2): ERL, 111+/-27; VUS, 75+/-25; SRP, 41+/-17; control, 25+/-11. Analysis of variance (ANOVA) revealed significant differences in the number of attached cells between the test and control groups (P<0.001, P<0.001, P<0.01, respectively). ERL and VUS treated specimens showed significantly higher numbers of cells/mm2 than the SRP group (P<0.001, respectively). The difference between the ERL and VUS group was statistically significant (P<0.001). CONCLUSIONS: The results of the present study indicate that (i) ERL, VUS, and SRP promote the attachment of PDL fibroblasts on previously diseased root surfaces, (ii) periodontally diseased root surfaces inhibit the adherence of PDL fibroblasts, and (iii) the surface structure of ERL and VUS instrumented roots seem to offer better conditions for the adherence of PDL fibroblasts than SRP.

Aged↗
PubMed2006

Cyclic contrast-enhanced harmonic voiding urosonography for the evaluation of reflux. Can we keep the cost of the examination low?

The purpose of this study was to evaluate whether a second cycle of contrast-enhanced voiding urosonography (VUS) with no added contrast medium (CM) can increase the detection rate of vesicoureteral reflux (VUR). One hundred twelve consecutive children with a mean age of 2.9 years with 224 kidney-ureter units (KUU) underwent two cycles of contrast-enhanced harmonic VUS. The first cycle of VUS was performed with 3.5-12.5 ml of suspension 300 mg/ml SH U 508 A and was followed immediately by a second cycle with only saline without adding CM. VUR was detected in 57 KUU from 44 children (39%) at the first cycle of VUS. Eight of the remaining 68 non-refluxing children (12%) demonstrated VUR at the second cycle (P=0.045). Most cases of missed reflux at the first cycle were grade II (75%). However, in two KUU from two children missed reflux was grade III. In one child reflux (grade II) was missed on the second cycle. Comparing the second cycle of VUS with the first cycle, concordant findings regarding the presence or absence as well as the grade of reflux were found in 94% of KUU. A second cycle of contrast-enhanced harmonic VUS with no added CM discloses significantly more cases of VUR at no additional cost for the examination.

Adolescent↗
PubMed2025

Clinical and genetic variant re-analysis among pediatric probands undergoing genetic testing for arrhythmia syndromes.

BACKGROUND: Despite increases in genetic testing, longitudinal data regarding changes in diagnostic yield and variant reclassification for inherited arrhythmia syndromes are limited. OBJECTIVE: Determine longitudinal changes in diagnostic yield and variant classification. METHODS: Single-center retrospective study of probands <18 years undergoing genetic testing for suspected inherited cardiac conditions associated with arrhythmias, 2007 to 2018. Variants were classified as diagnostic (pathogenic/likely pathogenic), non-diagnostic (benign/likely benign [B/LB]), or variants of uncertain significance (VUS). Variant reclassification was performed in October 2023 using VarSome and American College of Medical Genetics criteria. We evaluated results by era (early 2007-2013 vs. later 2014-2018, coinciding with Sanger and next-generation sequencing, respectively) and by likelihood of disease based on clinical evaluation. RESULTS: Of 306 probands, initial testing was 23.2% diagnostic, 55.6% non-diagnostic (33.7% no variant, 21.9% B/LB), and 21.2% VUS. When comparing eras, diagnostic yield decreased (34.1%-15.3%), VUS increased (9.3%-29.9%), and non-diagnostic remained similar (55% to 57%). Variants for 22.7% (46/203) of probands with &#x2265;1 variant changed: 9.9% of diagnostic variants (7/71) downgraded to VUS or non-diagnostic, and 60.0% of VUS changed (23.1% upgraded, 36.9% downgraded). B/LB variants did not change. Probands with higher disease likelihood had 6-times the odds of diagnostic results compared to lower disease likelihood, regardless of era (odds ratio 6.3, 95% confidence interval 3.2-12.4, P < .0001). CONCLUSION: Variant reclassification led to changes in 23% of probands, both downgrading and upgrading status, even among probands initially thought to be pathogenic. When comparing later to earlier eras, VUS variants increased while diagnostic yield decreased. Findings support the need for variant re-interpretation and periodic reclassification over time.

Humans↗
PubMed2006

Discrepancy between power-Doppler voiding urosonography and voiding cystourethrography is not relevant for the management of primary vesicoureteric reflux.

AIM: The aim of this study was to assess if discrepancy between power-Doppler voiding urosonography (PD-VUS) and voiding cystourethrography (VCUG) affects the management of patients with primary vesicoureteric reflux (VUR). MATERIALS AND METHODS: Fifty-six children with suspected or known VUR were assessed both by PD-VUS and VCUG. Two independent observers, both pediatric surgeons, each aware of the results of only one imaging modality, advised children's management according to present care standards. Agreement between diagnostic findings at the two imaging modalities and between therapeutic advice of the two observers was evaluated using kappa statistics. RESULTS: PD-VUS diagnosed VUR in 3 patients and 6 ureteral units more than VCUG. VCUG showed VUR in 2 ureteral units, but in no patient more than PD-VUS. Accuracy of PD-VUS compared with VCUG was 92.8% and 94.6% considering ureteral units and patients, respectively. The two observers disagreed about the management of 4 (7%) of 56 cases. Agreement was significant (P < .001) both between findings at the two imaging modalities and between management options advised by the two independent observers. CONCLUSION: Vesicoureteric reflux management based on PD-VUS findings is consistent with a management based on standard VCUG.

Child↗
PubMed2003

Simultaneous voiding cystourethrography and voiding urosonography.

PURPOSE: To compare the diagnostic accuracy of contrast-enhanced voiding urosonography (VUS) and voiding cystourethrography (VCUG) during simultaneous performance of both examinations. MATERIAL AND METHODS: A total of 24 children, 16 girls and 8 boys, with a mean age of 3.5 years referred for reflux examination were recruited for the study. After transurethral bladder catheterization, radiographic contrast medium, followed directly by the US contrast medium, were administered. Fluoroscopic VCUG and VUS were carried out concurrently in the same patient. When 1 kidney was scanned by ultrasound, fluoroscopy was performed on the contralateral side. RESULTS: In 19 of the 47 kidney-ureter-units (KUU) vesicoureteral reflux (VUR) was detected. In 16 units the reflux was detected by both VCUG and VUS. In 3 KUUs the reflux was detected only at VCUG. All 3 cases were grade 1. Taking the VCUG as the reference standard, VUS had 84% sensitivity, 100% specificity, 100% and 90% positive and negative predictive values, respectively. CONCLUSION: A dependable comparison could be achieved by performing VCUG and VUS at the same time and under the same conditions. It reconfirmed that VUS is reliable in the exclusion or verification of reflux.

Child, Preschool↗
PubMed2002

Clinical interpretation and recommendations for patients with a variant of uncertain significance in BRCA1 or BRCA2: a survey of genetic counseling practice.

The intent of this study was to document current practices in breast cancer genetic counseling and identify areas of variability for patients with a variant of uncertain significance (VUS) in the BRCA1 or BRCA2 gene. Registered members of the National Society of Genetic Counselors (NSGC) Cancer Special Interest Group (SIG) were sent an invitation via electronic mail to participate in an online questionnaire. The questionnaire was divided into three sections: clinical experience, clinical meaning, and risk perceptions and clinical recommendations for clinical situations involving a VUS. Fifty-seven of the eligible members responded. During the pre-test counseling session for a BRCA risk assessment patient, the vast majority of counselors (80.7%) mention VUS as a possible test result. Nearly half, 49.1%, report having given such a result to their patients at least one to four times. However, only 63.2% felt as though their patients understood the meaning of a VUS result. When asked to conclude the implication of a VUS and make medical management recommendations, the responses were varied. Nevertheless, a good proportion of counselors expressed the importance of testing other family members to help clarify the proband's risk and aid in medical management issues. Although the recent recommendations by the American College of Medical Genetics suggest standards for the interpretation of sequence variations, they do not provide guidelines for making clinical recommendations based on these variations. The results of this study reveal significant diversity in the personal interpretation of a VUS result, leading to various clinical recommendations, and suggest a need for clinical management recommendations as well.

Female↗
PubMed2006

Usefulness of contrast-enhanced ultrasonography with abdominal virtual ultrasonography in assessing therapeutic response in hepatocellular carcinoma treated with radiofrequency ablation.

OBJECTIVE: Contrast-enhanced computed tomography (CECT) is regarded as the gold standard for assessing the efficacy of radiofrequency ablation (RFA) against hepatocellular carcinoma (HCC). We evaluated the efficacy of virtual ultrasonography (VUS) with contrast-enhanced ultrasonography (CEUS) vs. CECT for assessing the response to RFA. MATERIALS AND METHODS: Study 1: The therapeutic responses in 22 patients with 26 HCC nodules were assessed by CEUS with VUS as well as by CECT. The efficacy of treatment was based on whether the safety margin was greater than 5 mm after RFA. Study 2: In seven patients with seven HCC nodules, the nodules were treated by RFA and the therapeutic efficacy was assessed by CEUS with VUS. The number of RFA sessions was assessed. RESULTS: Compared with CECT, CEUS with VUS had a specificity of 77%, a sensitivity of 91.6%, and an accuracy of 84%. When the therapeutic response to RFA was analyzed by CECT only, 1.86 +/- 0.69 assessments (mean) were required, while when response was assessed by CEUS with VUS, 1.14 +/- 0.38 CECT assessments were required (P = 0.03). CONCLUSION: CEUS with VUS is effective in assessing the therapeutic response to RFA of HCC. Moreover, the number of CECT scans required is reduced by this approach.

Abdomen↗
PubMed1988

Dependence of force, velocity, and O2 consumption on [Ca2+]o in porcine carotid artery.

The relationship between extracellular calcium concentration ([Ca2+]o), isometric force (Fo), unloaded shortening velocity (Vus), and the rate of ATP utilization (JATP) were studied in vascular smooth muscle (VSM) during the steady state of an isometric contraction at 37 degrees C. Experiments were conducted on porcine carotid artery media strip and ring preparations that were stimulated with 109 mM KCl substituted for NaCl. Unloaded shortening velocity was estimated by the "slack" test method. Both Fo and Vus were dependent on [Ca2+]o. Vus at 7.5 mM [Ca2+]o was 1.7 times greater than Vus at 1.6 mM [Ca2+]o. The difference in force at these two Ca2+ concentrations was more variable than Vus, but in general was less than the change in Vus. The rate of ATP utilization was assessed from steady-state measurements of tissue O2 consumption. Increasing [Ca2+]o in the range of 0.15-7.5 mM resulted in an increase in both JATP and Fo. The relation between JATP and Fo was nonlinear with JATP increasing proportionately more than Fo between 1.6 and 7.5 mM Ca2+. The calcium-dependent increase in JATP appears to be primarily related to contractile protein interaction, since the effect of [Ca2+]o on JATP was substantially reduced during stimulation at short muscle lengths (Lmin), where tension development is absent. The economy of tension maintenance was 3.3. times greater when measured in the [Ca2+]o range of 0.15 and 1.6 mM than when measured at 1.6 to 7.5 mM [Ca2+]o. These data indicate that [Ca2+]o may regulate both the number and the rate of cycling of cross bridges in porcine carotid artery.

Adenosine Triphosphate↗
PubMed2003

Contrast ultrasound of the urethra in children.

The aim of this study was to report our experience with transperineal ultrasound in studying the urethra, as a complementary technique to contrast-enhanced voiding urosonography (VUS). The VUS was performed in 350 patients (244 males, 106 females) less than 4 years of age, and complemented with perineal US. Ultrasound of the kidneys and bladder was obtained before and during bladder filling and post-voiding. The urethra and the neck of the bladder were evaluated sagittally by transperineal ultrasound (5-7.5 MHz) before, during, and after voiding. Only cases of posterior urethral valves diagnosed at VUS were followed by voiding cystourethrography (VCUG), which was performed on a different day. A satisfactory evaluation of the urethra was obtained in 332 cases (94.86%): (a). normal urethra ( n=328); and (b). posterior urethral valves ( n=4). In the latter 4 cases there was concordance between results at VUS and VCUG. Eighteen cases (5.14%) were excluded from the study because the quality of the examination was suboptimal. Transperineal US offers an initial imaging modality for studying urethral pathology and thus may complement VUS.

Child, Preschool↗
PubMed2002

Voiding urosonography with ultrasonography contrast medium in children.

Voiding urosonography (VUS) with ultrasonography contrast medium is a new modality in the detection of vesicoureteral reflux (VUR) in children. The purpose of this study was to evaluate the diagnostic accuracy of VUS compared with voiding cystourethrography (VCUG) in the detection of VUR. One hundred and eighteen patients, aged 3 weeks to 16 years, with 234 ureterorenal units, were investigated by VUS with ultrasonography contrast medium and radiographic VCUG in one session. The indications were predominantly urinary tract infection and follow-up of previously detected VUR. During the sonographic examination, the bladder was filled with saline solution and an ultrasonography contrast medium (Levovist) was administered through a catheter. Reflux was diagnosed when echogenic bubbles were observed in the ureter or in the renal pelvis. Afterwards, conventional VCUG was performed. Concordant findings were obtained in 210 of 224 ureterorenal units (93.7%). Reflux was excluded by both methods in 174 units (77.7%). With the VCUG as the reference, the sensitivity of VUS was 90%, the specificity 94.6%, the positive predictive value 78.3%, and the negative predictive value 97.8%. The accuracy was 93.7%. In conclusion, VUS with ultrasonography contrast medium is a reliable diagnostic tool for the detection of VUR in children.

Adolescent↗
PubMed2026

The potential clinical benefit of routine comprehensive genomic profiling in non-small cell lung cancer for the detection of prognostic co-mutations - A multicenter next generation sequencing study.

INTRODUCTION: Non-driver mutations such as TP53, STK11 and KEAP1 are clinically relevant in determining immunotherapy efficacy in patients with non-small cell lung cancer (NSCLC). The aim of this study is to determine the prevalence and clinical relevance of variations in TP53, STK11 and KEAP1 in patients in the analysis of NSCLC, using targeted next-generation sequencing. METHODS: This real-life prospective multicenter cohort study from July 2022 until October 2023 utilized samples of patients in the analysis of NSCLC. The samples were subjected to a targeted DNA NGS panel and, if indicated, RNA sequencing. The outcome of the molecular diagnostics was retrieved, including driver alterations and more in-depth analysis of TP53, STK11 and KEAP1. RESULTS: In 134 of the 437 samples an actionable genomic alteration (AGA) was detected. Of the remaining samples, 213 carried a mutation in either TP53, STK11 and/or KEAP1, while 90 harbored either variants of unknown significance (VUS) (16) or no variant (74). In-depth analysis showed 77 alterations of STK11, with 56 pathogenic and 21 VUS. Most STK11 variants were identified in exon 1, which is hypothesized to be correlated to an oncogenic isoform. Moreover, variants in KEAP1 were mostly VUS, with 48 VUS and 24 mutations. Lastly, 264 TP53 alterations, of which 249 pathogenic and 15 VUS, occurred, with an even spread in the DNA-binding domain. CONCLUSION: This study demonstrated the broad spectrum of variants in STK11, KEAP1 and TP53 in routine panel-based DNA NGS, with 70.3% of the samples without AGA showing a potential clinically relevant mutation in TP53, STK11 and/or KEAP1.

Humans↗
PubMed2025

A functional assay to classify RB1 variants of uncertain significance.

PURPOSE: The RB1 gene encodes the retinoblastoma protein (pRB) playing a major role in cell cycle control, particularly by its interaction with E2F transcription factors. Familial forms of retinoblastoma are caused by germline pathogenic variants in the RB1 gene predisposing to retinoblastoma and other tumors. By analyzing the RB1 gene in patients with retinoblastoma, we found that missense variants often remain variants of uncertain significance (VUS). METHODS: To classify RB1 VUS, we developed a functional assay evaluating their impact on the ability of pRB to inhibit the activity of the E2F1 promoter, with a luciferase reporter gene. A set of 14 pathogenic/likely pathogenic and benign/likely benign RB1 variants was used for validation. RESULTS: We tested 16 VUS detected in patients with retinoblastoma and found that 9 VUS reduced the ability of pRB to inhibit E2F1 promoter. Among them, the (RB1) c.2263T>G p.(Phe755Val) variant showed a reduced level of pRB on Western blot, suggesting a defect in pRB stability. By applying the criterion PS3_moderate of the American College of Medical Genetics and Genomics/Association for Molecular Pathology classification to this functional assay, 5 of the 9 VUS with functional impact could be classified as likely pathogenic. CONCLUSION: This functional assay can improve the molecular diagnosis of retinoblastoma predisposition by a better determination of pathogenic/likely pathogenic RB1 variants.

Humans↗
PubMed2000

Free tissue transfer provides durable treatment for large nonhealing venous ulcers.

BACKGROUND: Most venous ulcers (VUs) will heal with conventional treatment, which focuses on improving regional venous hemodynamics. This treatment, however, often fails to heal large, recurrent VUs that are associated with severe lipodermatosclerosis (LDS). These complicated ulcers may require correction of local venous hemodynamics and replacement of the surrounding LDS with healthy tissue. We report our experience managing 24 especially difficult VUs with debridement and free flap coverage. PATIENTS AND METHODS: Between 1987 and 1997, 25 free flap procedures were performed in 22 patients for 24 recalcitrant VUs. Ulcers had been present for a mean of 5.24 years and had failed to heal with conservative therapy and split-thickness skin grafts (STSGs) (mean, 2.2). Eleven patients (46%) had exposed bone, tendon, or joint. At operation the area of LDS was excised, and all perforating veins were ablated. The defects after excision ranged from 100 to 600 cm(2) (mean, 237 cm(2)). The free flap was inset within the defect and covered with an STSG. RESULTS: We healed all 24 ulcers with free tissue transfer (one patient required a second flap after the first failed). There were no deaths. Local complications that required repeat STSG occurred in three (13%) of the 24 successful flap transfers. Four other flaps had minor local complications that healed with local wound care. Follow-up was available for 21 of the 24 successful flap transfers. No recurrent ulcers were identified in the territory of the flap after a mean of 58 months, but three patients had new ulcers in the same leg after 6 to 77 months. Patients with severe complications were hospitalized longer than those with minor or no complications (45.7 vs 12.8 days, P <.01), and their hospital charges were greater ($76,681 vs $30,428, P <.01). CONCLUSION: Free tissue transfer can provide rapid healing and long-term relief from severe VUs that are unable to be treated with conventional therapy. This technique improves venous hemodynamics, removes all liposclerotic tissue, provides an abundant blood supply, and resolves the tissue-related components of chronic ulceration. Although further work is needed to determine the optimal indications, this technique provides a durable treatment for especially recalcitrant ulcers.

Adolescent↗
PubMed1994

Contractile properties and myosin phenotype of single motor units from neonatal rats.

The unloaded shortening velocity (Vus), twitch time to peak force (TTP), and myosin heavy chain (MHC) composition of motor units from soleus muscles of neonatal rats (7-8 and 16-18 days) were compared. The Vus range was from 2.2 to 7.1 fiber lengths (fl).s-1 and was unchanged from 7-8 to 16-18 days. TTP shifted from 7-8 (range, 66-120) to 16-18 days (range, 41-95). MHC-specific antibody staining of motor units revealed a correlation between MHC and Vus of individual motor units. Slowest motor units contained type I MHC. Intermediate Vus motor units contained both embryonic, neonatal, and/or type IIa MHCs. Fastest motor units contained neonatal and/or type IIa MHCs. These findings demonstrate that an individual motor unit of a neonatal muscle contains a nonrandom distribution of fiber types. The range of myosins present within the motor units of the soleus translates into a range of possible Vus.

Animals↗