Differentiation between Cistus L. (Sub-) Species (Cistaceae) Using NMR Metabolic Fingerprinting

The genus Cistus is taxonomically complex, as taxonomic classification of individual species based on morphological criteria is often difficult and ambiguous. However, specific species contain valuable natural products, especially terpenoids and polyphenols, which exert various biological effects and might therefore be used for treatment of a broad array of disorders. Hence, a fast and reliable method for clear identification of different Cistus (sub-) species is required. Approaches for analysis of secondary metabolite profiles, e.g., with NMR, might remedy the challenging classification of Cistus (sub-) species and help to identify specific markers for differentiation between them. In the present study, 678 samples from wild-growing Cistus populations, including 7 species and 6 subspecies/varieties thereof, were collected in 3 years from populations in 11 countries all over the Mediterranean basin. Samples were extracted with buffered aqueous methanol and analysed with NMR. From the resulting 1D-¹H-NOESY and J-Res profile spectra, marker signals or spectral regions for the individual (sub-) species were identified with multivariate statistical tools. By examining the NMR profiles of these extracts, we were able to identify discriminators and specific markers for the investigated Cistus (sub-) species. Various influencing factors, like (sub-) species, wild harvestings of different populations from several countries, numerous collection sites, different years, and cultivation in greenhouses have been considered in this work. As the here identified markers are independent from these influencing factors, the results can be considered a robust model and might be used for future differentiation between Cistus (sub-) species.

What Else Is in Salviae officinalis folium? Comprehensive Species Identification of Plant Raw Material by DNA Metabarcoding

Quality control of drugs consists of identifying the raw material to avoid unwanted admixtures or exchange of material as well as looking for abiotic and biotic contaminations. So far, identity and microbial contamination are analyzed by separate processes and separate methods. Species identification by their DNA ("DNA barcoding") has the potential to supplement existing methods of identification. The introduction of next-generation sequencing methods offers completely new approaches like the identification of whole communities in one analysis, termed "DNA metabarcoding". Here we present a next-generation sequencing assessment to identify plants and fungi of two commercial sage samples (Salvia officinalis) using the standard DNA barcoding region "internal transcribed spacer" consisting of internal transcribed spacer 1 and internal transcribed spacer 2, respectively. The main species in both samples was identified as S. officinalis. The spectrum of accompanying plant and fungal species, however, was completely different between the samples. Additionally, the composition between internal transcribed spacer 1 and internal transcribed spacer 2 within the samples was different and demonstrated the influence of primer selection and therefore the need for harmonization. This next-generation sequencing approach does not result in quantitative species composition but gives deeper insight into the composition of additional species. Therefore, it would allow for a better knowledge-based risk assessment than any other method available. However, the method is only economically feasible in routine analysis if a high sample throughput can be guaranteed.

Phytogenic pigments in animal nutrition: potentials and risks

Phytogenic pigments are secondary plant compounds responsible for coloring effects in plant tissues. In particular, phenolic flavonoids and terpenoid carotenoids, but also rare compounds like curcumin and betalain, form this group of biochemical agents used in animal nutrition. From the perspective of ecological mutuality between plants and animals, these compounds are of crucial importance because they serve as visual attraction for herbivores but also signal nutritional and/or health-promoting values. This review focuses on the properties of phytogenic pigments which are likely to impact feed intake and preferences of livestock. Also natural prophylactic and/or therapeutic properties and, in particular, the potential of pigments to enhance quality and health value of animal products for human consumption are important issues. Nevertheless, reasonable limits of use due to possible adverse indications have been suggested recently. Pathways of digestion, metabolism and excretion in animals play a crucial role not only in the evaluation of effectiveness but also in the prediction of potential risks for human consumption. The popularity of natural feed additives is growing; therefore, more research work is needed to better understand metabolic pathways in the animal's body and to better estimate the potentials and risks of pigmenting plant compounds used in animal nutrition.

Mid-term results of ligament tenodesis in treatment of scapholunate dissociation: a retrospective study of 20 patients

The purpose of this retrospective study was to assess the modified Brunelli technique for the treatment of chronic irreparable complete scapholunate ligament rupture, causing a reducible carpal malalignment without secondary osteoarthritis. A total of 20 patients were treated using this technique. At a mean follow-up period of 24 months (range 6-53, SD 15), pain on a visual analogue scale had improved from 6 (range 3-10) to 3 (range 0-7). Function measured with the DASH score had improved from 37 (range 11-90) to 20 (range 0-53). Range of motion was reduced in flexion by a mean of 19° (range 10-45), and in extension by a mean of 14° (range 0-35). Mean grip strength at last follow-up was 81% of the uninjured hand (range 50-100%) Three patients developed scapholunate advanced collapse (stage II) requiring salvage surgery. Scapholunate ligament reconstruction with the modified Brunelli technique showed satisfactory results in this study. Extended studies are needed to determine the long-term benefits of this reconstructive procedure.

LEVEL OF EVIDENCE

IV.

Essential oil composition variability among natural populations of Pinus mugo Turra in Kosovo

Pinus mugo Turra, is a native pine species in central and southern Europe, growing in high mountains area (altitudes 1.800-2.300 m.a.s.l.). In Kosovo, it is one of the native pines too, distributed in high altitudes in the Sharri Mountains and Albanian Alps Mountains. Its populations represent an important wealth of essential oil resources available, which make this species very important in terms of economic values. The chemical composition and yields of the essential oils of dwarf pine (Pinus mugo Turra) needles, twigs and cones from six wild populations in Kosovo were investigated with the aim to assess their natural variability. The identity of P. mugo was confirmed by morphology and DNA barcoding. Sixty-two compounds were identified representing 69-95 % of the total identified compounds. The yield ranged from 0.3-0.8 % v/w in needles, 1.0-2.4 % v/w in twigs and 0.1-0.5 % v/w in cones, depending on the origin of plant material and plant organs. α-Pinene (needles: 16.9-24.5 %; twigs: 4.5-8.8 %; cones: 3.1-5.6 %), β-pinene (needles: 1.5-5.4 %; twigs: 2.2-15.4 %; cones: 1.3-14.2 %), δ-3-carene (needles: 15.4-27.8 %; twigs: 24.0-51.6 %; cones: 10.5-31.5 %), limonene + β-phellandrene (needles: 1.9-5.9 %; twigs: 12.6-24.2 %; cones: 2.1-9.3 %), (E)-caryophyllene (needles: 4.4-8.9 %; twigs: 4.0-10.8 %; cones: 10.3-26.9 %) and germacrene D (needles: 4.0-8.3 %; twigs: 0.2-6.19 %; cones: 0.1-12.4 %) were the major components of the essential oil. Principal component analysis (PCA) and hierarchical cluster analyses (HCA) suggests that the population of P. mugo clustering is not related to their geographic location, but rather seemed to be linked to local selective forces acting on chemotype diversity. Low variability related to their geographic location has an economic importance since samples originating from different locations in Kosovo can treated with same standards.

Essential oil diversity of European Origanum vulgare L. (Lamiaceae)

This investigation focused on the qualitative and quantitative composition of essential oil compounds of European Origanum vulgare. Extracts of 502 individual O. vulgare plants from 17 countries and 51 populations were analyzed via GC. Extracts of 49 plants of 5 populations of Israeli Origanum syriacum and 30 plants from 3 populations of Turkish Origanum onites were included to exemplify essential oil characteristics of 'high-quality' oregano. The content of essential oil compounds of European O. vulgare ranged between 0.03% and 4.6%. The monoterpenes were primarily made up of sabinene, myrcene, p-cymene, 1,8-cineole, β-ocimene, γ-terpinene, sabinene hydrate, linalool, α-terpineol, carvacrol methyl ether, linalyl acetate, thymol and carvacrol. Among the sesquiterpenes β-caryophyllene, germacrene D, germacrene D-4-ol, spathulenol, caryophyllene oxide and oplopanone were often present in higher amounts. According to the proportions of cymyl-compounds, sabinyl-compounds and the acyclic linalool/linalyl acetate three different main monoterpene chemotypes were defined. The cymyl- and the acyclic pathway were usually active in plants from the Mediterranean climate whereas an active sabinyl-pathway was a characteristic of plants from the Continental climate.

DNA-based identification of Calendula officinalis (Asteraceae)

PREMISE OF THE STUDY

For the economically important species Calendula officinalis, a fast identification assay based on high-resolution melting curve analysis was designed. This assay was developed to distinguish C. officinalis from other species of the genus and other Asteraceae genera, and to detect C. officinalis as an adulterant of saffron samples.

METHODS AND RESULTS

For this study, five markers (ITS, rbcL, 5' trnK-matK, psbA-trnH, trnL-trnF) of 10 Calendula species were sequenced and analyzed for species-specific mutations. With the application of two developed primer pairs located in the trnK 5' intron and trnL-trnF, C. officinalis could be distinguished from other species of the genus and all outgroup samples tested. Adulterations of Calendula DNA in saffron could be detected down to 0.01%.

CONCLUSIONS

With the developed assay, C. officinalis can be reliably identified and admixtures of this species as adulterant of saffron can be revealed at low levels.

Vascularized medial femoral condyle graft for management of scaphoid non-union

The purpose of this study was to assess the results of the management of difficult scaphoid non-unions using a vascularized medial femoral condyle graft. We operated on 30 patients with necrosis of the proximal pole or with severe humpback deformity or who presented with persistent non-union despite previous surgery. Twenty-four cases in our series showed full consolidation and six cases showed persistent non-union. The free vascularized medial femoral condyle bone graft can provide not only structural support, but also a consistent and good blood supply that results in excellent rates of union. Level of evidence: IV.

[Case report: acute carpal tunnel syndrome with prolapse of the median nerve]

We report a case of an 80-year-old woman with an acute carpal tunnel syndrome. This was based on an acute episode of chondrocalcinoses and accompagnied by a prolaps of the median nerve into a gap of the forearm fascia as result of a cut injury in childhood.

The complete chloroplast genome of Origanum vulgare L. (Lamiaceae)

Oregano (Origanum vulgare L., Lamiaceae) is a medicinal and aromatic plant maybe best known for flavouring pizza. New applications e.g. as natural antioxidants for food are emerging due to the plants' high antibacterial and antioxidant activity. The complete chloroplast (cp) genome of Origanum vulgare (GenBank/EBML/DDBJ accession number: JX880022) consists of 151,935 bp and includes a pair of inverted repeats (IR) of 25,527 bp separated by one small and one large single copy region (SSC and LSC) of 17,745 and 83,136 bp, respectively. The genome with an overall GC content of 38% hosts 114 genes that covering 63% of the genome of which 8% were introns. The comparison of the Origanum cp genome with the cp genomes of two other core lamiales (Salvia miltiorrhiza Bunge and Sesamum indicum L.) revealed completely conserved protein-coding regions in the IR region but also in the LSC and SSC regions. Phylogenetic analysis of the lamiids based on 56 protein-coding genes give a hint at the basic structure of the Lamiales. However, further genomes will be necessary to clarify this taxonomically complicated order. The variability of the cp within the genus Origanum, studied exemplarily on 16 different chloroplast DNA regions, demonstrated that in 14 regions analyzed, the variability was extremely low (max. 0.7%), while only two regions showed a moderate variability of up to 2.3%. The cp genome of Origanum vulgare contains 27 perfect mononucleotide repeats (number of repeats>9) consisting exclusively of the nucleotides A or T. 34 perfect repeats (repeat lengths>1 and number of repeats>3) were found, of which 32 were di-, and 2 were trinucleotide repeats.

Genomic characterization, molecular cloning and expression analysis of two terpene synthases from Thymus caespititius (Lamiaceae)

The identification, isolation and functional characterization of two genes encoding two monoterpene synthases-γ-terpinene synthase (Tctps2) and α-terpineol synthase (Tctps5)-from three chemically distinct Thymus caespititius (Lamiaceae) genotypes were performed. Genomic exon-intron structure was also determined for both terpene synthase genes, revealing an organization with seven exons and six introns. The cDNA of Tctps2 was 2,308 bp long and had an open reading frame of 1,794 bp encoding for a protein with 598 amino acids. Tctps5 was longer, mainly due to intron sequences, and presented high intraspecific variability on the plants analyzed. It encoded for a protein of 602 amino acids from an open reading frame of 1,806 bp comprising a total of 2,507 bp genomic sequence. The amino acid sequence of these two active Tctps genes shared 74 % pairwise identity, ranging between 42 and 94 % similarity with about 50 known terpene synthases of other Lamiaceae species. Gene expression revealed a multi-product Tctps2 and Tctps5 enzymes, producing γ-terpinene and α-terpineol as major components, respectively. These enzymatic results were consistent with the monoterpene profile present in T. caespititius field plants, suggesting a transcriptional regulation in leaves. Herewith reported for the first time for this species, these two newly characterized Tctps genes improve the understanding of the molecular mechanisms of reaction responsible for terpene biosynthesis and chemical diversity found in T. caespititius.

Remarks on boiling water reactor stability analysis – part 2: stability monitoring

In part 1 of this article we explained the partly relative complex solution manifold of the differential equations describing the stability behaviour of a BWR, in particular the coexistence of different types of solutions, such as the coexistence of unstable limit cycles and stable fixed points are of interest from the operational safety point of view. The part 2 is devoted to the surveillance of the stability behaviour. We summarize some stability monitoring methods and suggest to support stability tests by RAM-ROM analyses in order to reveal in advance the stability “landscape” of the BWR in a parameter region high sensitive for appearing of linear unstable states. The analysis of an especial stability test, performed at NPP Leibstadt (KKL), makes it clear that the measurement results can only be interpreted by application of bifurcation analysis.

Remarks on boiling water reactor stability analysis – part 1: theory and application of bifurcation analysis

Modern theoretical methods for analysing the stability behaviour of Boiling Water Reactors (BWRs) are relatively reliable. The analysis is performed by comprehensive validated system codes comprising 3D core models and one-dimensional thermal-hydraulic parallel channel models in the frequency (linearized models) or time domain. Nevertheless the spontaneous emergence of stable or unstable periodic orbits as solutions of the coupled nonlinear differential equations determining the stability properties of the coupled thermal-hydraulic and neutron kinetic (highly) nonlinear BWR system is a surprising phenomenon, and it is worth thinking about the mathematical background controlling such behaviour. In particular the coexistence of different types of solutions, such as the coexistence of unstable limit cycles and stable fixed points, are states of stability, not all nuclear engineers are familiar with. Hence the part I of this paper is devoted to the mathematical background of linear and nonlinear stability analysis and introduces a novel efficient approach to treat the nonlinear BWR stability behaviour with both system codes and so-called (advanced) reduced order models (ROMs). The efficiency of this approach, called the RAM-ROM method, will be demonstrated by some results of stability analyses for different power plants.

Validation of a quantitative assay of arbutin using gas chromatography in Origanum majorana and Arctostaphylos uva-ursi extracts

INTRODUCTION

Arbutin is a skin-whitening agent that occurs naturally in the bark and leaves of various plants. It is commonly quantified in plant extracts and skin-whitening products by HPLC.

OBJECTIVE

To develop an alternative gas chromatographic method for the separation and quantification of arbutin in Origanum majorana and Arctostaphylos uva-ursi extracts.

METHODOLOGY

N,O-Bis(trimethylsilyl)acetamide and trimethylchlorosilane were used as silylation reagents, and the gas chromatographic separation of silylated extracts and standards was performed using a DB-5 narrow bore column. GC-MS was used for the compound identification, and the quantification was carried out by GC-FID. The quantitative results were compared with those of HPLC analysis.

RESULTS

The developed method gave a good sensitivity with linearity in the range 0.33-500 mg/mL and recovery >98%, allowing the quantification of arbutin in O. majorana and A. uva-ursi extracts. The relative standard deviations (RSD) relating to intra-day and inter-day precision were <0.002% and <4.8%, respectively. The GC results correlated well with those obtained by HPLC analysis.

CONCLUSION

The analysis of marjoram and bearberry samples showed that the established GC method was rapid, selective, and demonstrated that arbutin could be screened alternatively by gas chromatography.

Identification of Verbena officinalis based on ITS sequence analysis and RAPD-derived molecular markers

Verbenae herba is a widely used drug and consists of the aerial parts of Verbena officinalis (Verbenaceae). Until now, the identification has been performed based on morphological and phytochemical analyses, which are not reliable enough to distinguish Verbena officinalis from other relevant species of the genus Verbena. Hence, impurities and adulterants, negatively influencing the therapeutic effect of the drug, may remain undetected. In an attempt to generate an accurate authentication method we used two different DNA-based approaches: comparison of ITS sequences and molecular markers (RAPD). Both approaches generally enabled discrimination of V. officinalis from the rest of the genus despite the intraspecific variation existing within V. officinalis. The application of the two independent methods, supporting each other, increases the security of identification. For better reproducibility and faster analysis, however, a SCAR marker and primers for HRM were derived from the RAPD results. The SCAR marker could distinguish V. officinalis from all other verbena species except its closest relative V. hastata, while discrimination of V. officinalis even from V. hastata was unproblematic with HRM.

Composition of essential oil compounds from different Syrian populations of Origanum syriacum L. (Lamiaceae)

The chemical compositions of the essential oil compounds of 117 individual plants belonging to 11 Syrian populations of Origanum syriacum L. (Lamiaceae) were studied by GC-FID and GC-MS. The composition was dominated by carvacrol and/or thymol with a high degree of polymorphism in the occurrence of these two compounds between the different populations. In three populations carvacrol was dominating, with thymol being present only in minor amounts, whereas in only one population thymol was the main compound, with carvacrol only in traces. In all other populations both carvacrol and thymol were present as major compounds. No geographical pattern could be detected for the occurrence of the chemotypes. Thymoquinone, a promising anticancer candidate, was present in the extracts in a wide range between 0.04 and 23.7%.

Oregano: a source for peroxisome proliferator-activated receptor gamma antagonists

Peroxisome proliferator-activated receptors (PPARs) are drug targets for several perturbations of metabolic syndrome, defined as the coexistence of obesity, hyperglycemia, hypertension, and hyper/dyslipidemia. In this study, PPAR activation by oregano (e.g., Origanum vulgare) and its components was tested. Oregano extracts bind but do not transactivate PPARgamma, and binding affinity differs among different oregano extracts. The extracts contain PPARgamma antagonists (e.g., quercetin, luteolin, rosmarinic acid, and diosmetin), selective PPARgamma modulators (e.g., naringenin and apigenin), and PPARgamma agonists (e.g., biochanin A). Oregano extract and isolated compounds in the extract antagonize rosiglitazone-mediated DRIP205/TRAP220 recruitment to PPARgamma, pointing to oregano extracts as putative food supplements for weight reduction. Rosmarinic acid and biochanin A, PPARalpha agonists, may ameliorate the lipid profile. By endothelial nitric oxide synthase activation, oregano extract could prevent atherosclerosis. The results warrant further investigation of oregano extract for its potential to prevent and ameliorate metabolic syndrome and its complications.

A strategy to setup codominant microsatellite analysis for high-resolution-melting-curve-analysis (HRM)

Background

High resolution melting curve analysis (HRM) is a technique that measures exactly the decreasing fluorescence of intercalating dye in the process of dissociation of double stranded DNA. The measurement is immediately following PCR in a one-step, closed-tube method. The shape of the melting curve depends on the GC content, length and sequence of the amplicon. Hence it is a powerful, fast and cheap method to detect Single Nucleotide Polymorphisms (SNPs) and other mutations.

Results

Here we present a strategy to set up microsatellite analysis for HRM including the correct assignment of heterozygous samples by comparative analysis and artificial mixtures of samples. The approach is demonstrated on two Simple Sequence Repeat (SSR) loci of different complexity in the genus Origanum. Following this strategy all alleles of our sample sets could be classified correctly.

Conclusion

HRM can be used in microsatellite analysis and other codominant marker systems implementing a protocol of comparative melting curve assignment with artificial mixtures of samples to overcome difficulties in correctly assigning heterozygous samples. The method is faster, more sensitive and cheaper than standard protocols for microsatellite analysis.

Essential Oil Compounds of Origanum Vulgare L. (Lamiaceae) from Corsica

The essential oil compounds of 274 individual plants belonging to 13 populations of Origanum vulgare L. (Lamiaceae) from Corsica were studied by GC/FID and GC/MS. On the basis of their monoterpene chemistry three different chemotypes were obvious in the Origanum populations: The first and most common type was a ‘cymyl’ type, with either carvacrol (0.6–65.5%) or thymol (0.0–49.5%) as the main compound. The second, which was very rare, was a ‘sabinyl’ type with sabinene (7.8–20.2%) and cis-sabinene hydrate (0.7–24.8%) as main compounds. The third type was a ‘mixed’ type combining compounds of the ‘cymyl’ and the ‘sabinyl’ pathway. The ‘mixed’ type was rich in cis-sabinene hydrate (0.0–52.4%) and γ-terpinene (0.6–35.4%).

[Clinical presentation, diagnosis and treatment of the carpal tunnel syndrome]

The carpal tunnel syndrome is the most common of the compression syndromes. The leading symptom is the "falling asleep" of the radial-sided fingers. The diagnosis is confirmed by the neurological examination. In the early stage, conservative treatment is justified, but in the advanced stage surgical decompression (carpal tunnel release) involving splitting of the transverse carpal ligament is indicated. In the hands of an experienced hand surgeon the operation is a routine procedure with a low complication rate.

Der fortgeschrittene karpale Kollaps: Resektion der proximalen Handwurzelreihe (PRC) oder mediokarpale Teilarthrodese? Eine vergleichende Studie

Between July 2000 and February 2002, 26 wrists were treated because of SLAC, SNAC and radiocarpal arthrosis after fracture of the distal radius. In 14 cases proximal row carpectomy (PRC) and in twelve cases limited midcarpal arthrodesis (LWF) was performed. Follow-up was after a mean time of 16.8 (PRC) and 13.7 months (LWF) on ten wrists each. There was one complication in the PRC group and two in the LWF group. In all cases significant reduction of extension/flexion was observed with a mean range of motion of 69 degrees (PRC) and 71 degrees (LWF). The reduction of pain postoperatively was almost identical in both groups. Comparing grip-strength to the unoperated hand, we measured 26 compared to 39 kg in the PRC group and 28 compared to 46 kg in the LWF group, respectively. The DASH-score for the LWF group was 30 points and therefore better than the 36 points for the PRC group.

[Individual perforator flaps of the upper extremity]

Perforator flaps allow an individual flap design on the basis of a preoperative ultrasound examination. Aim of the present study is a preliminary evaluation of results and technical pitfalls of this new technique in the use for flap coverage on the dorsum of the hand and the elbow region. Since 1999, seven individually designed pedicled perforator flaps were prepared on the upper extremity. In four cases, defects on the dorsum of the hand and in a further three defects in the elbow region were treated. In the latter cases the flaps were harvested in a mainly epifascial plane, without dissecting the perforating vessels down to their origin. Five flaps were based on perforating vessels of the interosseous arteries, a further two from the lateral collateral humeral artery. Three out of four pedicled perforator flaps used on the dorsum of the hand healed completely. One flap was lost because of venous insufficiency due to the lack of wrist immobilisation. In the elbow region, two out of three defects were successfully covered with an individual perforator flap. One flap was lost due to venous insufficiency, a further needed an additional split-skin graft with a partial flap loss. The main advantage of the presented technique remains the possibility of individual flap design. However, the donor-site defect is almost negligible since in most cases a primary closure of the donor site was possible. The main arteries remained untouched leaving the blood supply to the hand unchanged. Nevertheless, the mainly epifascial harvest of the perforating vessels in the elbow region has the disadvantage of a short pedicle together with a high degree of torsion which leads to an increased risk of flap loss due to venous insufficiency.

[Perforator flap-plasty and applications to hand surgery]

In contrast to the classical fasciocutaneous and musculocutaneous flaps, perforator flaps are supplied only by a single perforating branch. The aim of this paper is to present the surgical technique and to discuss the use of perforator flaps in hand surgery. Our previous studies have demonstrated the reliability of a preoperative Doppler for planning perforator flaps in reconstructive surgery of the breast: With 286 preoperatively localized perforating branches, a total of 162 were confirmed in intraoperative dissection. In 37 out of these 46 perforator flaps (80%), a preoperatively localized perforating branch could be used. Based on these results, the individual design of perforator flaps harvested on the forearm for defects on the dorsum of the hand is possible. In a preoperative Doppler exam, a perforating branch, i.e. of the posterior interosseous artery, can be localized. The intraoperative confirmation of the perforating branch allows the successful defect coverage with a distally pedicled flap without taking fascia or septum. In our experience, this possibility of planning an individually designed perforator flap is the major advantage for applications of the perforator flap technique in hand surgery. This is especially true in cases where the harvest of a fasciocutaneous flap is unreliable or impossible due to anatomic variations. On the other hand, the dissection of the pedicle is technically demanding and the individual distribution of the perforating branches requires a high degree of flexibility. However, we do consider this new technique to be a further extension in the armamentarium for soft-tissue coverage of the hand.

[Treatment and outcome of complications after free flap-plasty]

Free tissue transplantation is a routine procedure in reconstructive surgery. Although a lot of free flap techniques have been described, the postoperative management of complications has gained only little interest. Nevertheless, complications of perfusion after free tissue transplantation are not rare and require a systematic approach. The aim of this study is to classify perfusion failures with a simple grading system prospectively on a large clinical series and to evaluate the results of treatment to improve management. In the past ten months, 70 consecutive free flaps have been performed. By the end of the operation, the operating surgeon gave a prognosis concerning the probability of a possible perfusion complication. Postoperative monitoring was done exclusively by clinical examination (colour, time for recapillarisation and bleeding after puncture). According to these parameters, arterial and venous insufficiencies have been classified into four grades. After recording type, time and treatment of a postoperative complication, the result of treatment was rated subjectively and a cause was noted when possible. The final result was classified either as total flap loss, partial flap loss or successful tissue transplantation. A total of 28 (40%) complications, which were treated with an average of 2.1 options, were recorded. The ratio between arterial and venous failure was 15:13. In 21 cases surgical intervention became necessary (intraoperative n = 12, postoperative n = 9). The arising complication was diagnosed correctly in nine cases by the operating surgeon. In ten cases, the cause of the complication remained unclear. In 18 cases, the complication was treated successfully without any flap loss. In six cases partial flap loss was observed and in four cases a total flap loss had to be accepted. Our results confirm that only few objective criteria for treatment options with perfusion failures after free tissue transplantation exist. Nevertheless, the presented classification is a useful tool for standardized evaluation of the results. The various salvage techniques result in positive outcomes for most of the patients.

[Pedicled versus free TRAM flap for breast reconstruction]

In breast reconstruction, the free TRAM-flap offers many advantages over the pedicled TRAM-flap. Due to its superior perfusion, the free flap rarely develops necrosis. Shaping of the flap is easier due to the lack of the thick muscle pedicle. Because the rectus muscle is spared, there is minimal donor site morbidity. However, the necessary microvascular anastomoses reduced the acceptance of the free TRAM-flap. During a 13-months period, 51 breast reconstructions were performed in 41 patients, 31 unilateral and ten bilateral. 45 flaps served for delayed reconstruction and six flaps for immediate reconstruction. The operations were performed by two teams working simultaneously. The average operating time was 3.9 hours for unilateral and 6.9 hours for bilateral delayed reconstruction. For immediate reconstruction, 6.2 and 6.3 hours were required for uni- and bilateral procedures, respectively. In 38 flaps, the thoracodorsal vessels served as recipient vessels; 13 flaps were anastomosed to the internal mammary artery and vein. Postoperative complications were observed in 13 patients. Three vessel anastomoses had to be revised. In one flap, a partial necrosis occurred; in two flaps hematoma evacuation was necessary. Two patients suffered from fat necroses at the abdomen and one umbilicus was lost. Skin irritations and seromas at the abdomen occurred in five patients. Pulmonary embolism was diagnosed in one patient three weeks postoperatively. Abdominal hernias or bulging in the epigastric area were not observed up to 15 months after reconstruction. These results reveal a low complication rate for breast reconstruction with the free TRAM-flap. The advantages of this technique as compared to the pedicled technique are discussed.

Impossible harvest of the posterior interosseous artery flap: a report of an individualised salvage procedure

Although the posterior interosseous artery flap represents a reliable technique to provide vascularised skin cover for the dorsum of the hand, the dissection of the flap is often very difficult because of anatomical variants. The weakest part of the vascularisation is the middle third of the posterior interosseous artery. Whenever it is discovered during the operation that such a flap is impossible to harvest, or likely to be unreliable, there is an immediate need to choose an alternative. Such a case is reported here. The individual anatomical situation allowed the dissection of a flap, the pedicle of which carried its blood supply from a perforating branch of the anterior interosseous artery. The technique described offers an individual solution to the problem of skin coverage when the harvest of the posterior interosseous artery is impossible.

[Plastic surgery in soft tissue reconstruction in large extremity defects]

Soft-tissue defects in the extremities vary greatly, depending on the trauma mechanism, localization and a number of factors related to the patient's physical condition. We offer an overview of the plastic surgery methods in reconstruction of different soft-tissue defects in the extremities, beginning with the diagnostic, clinical and radiological measures that make classification of soft-tissue defects possible, and then giving a concentrated view of the appropriate reconstruction methods. Collaboration between traumatology and plastic surgery seems to be especially important in lesions in the extremities.

[The scapula flap--overview and personal experiences]

Since the first report in the literature by Dos Santos in 1980, the scapula flap has become one of the most commonly used fascio-cutaneous free flaps. This is due to its numerous advantages and its few inconvenients. Because of the constant anatomy, the minor donor site defect and its good aesthetic result, the scapula flap replaced other more traditional flaps such as the radial forearm or the latissimus dorsi flap. Being a flap of the "subscapular artery system", it offers the possibility to be harvested "en bloc" with the other flaps of this system for complex reconstruction procedures. In our opinion, the scapula flap is the treatment of choice to treat cutaneous defects of the lower extremity which could not be covered by local flaps. In head-neck reconstruction, the colour and texture of the skin offered by this flap is superior to other free flaps. A thick, well visible horizontal scar in the donor site is the only real inconvenience of the scapula flap. It seems that the parascapula-flap (Nassif et al. 1982) which offers the same properties as the scapula flap is on the way to replace the scapula flap in the future. After a six-year experience with this flap we will present a current concept review and our own experience based on 30 cases. Moreover, we would like to report on some technical refinements.

Enhancement of host resistance against virus infections by MTP-PE, a synthetic lipophilic muramyl peptide--I. Increased survival in mice and guinea pigs after single drug administration prior to infection, and the effect of MTP-PE on interferon levels in sera and lungs

Muramyl tripeptide-phosphatidylethanolamine (MTP-PE, CGP 19835) displays prophylactic antiviral activity in mice infected with influenza viruses A and B, parainfluenza 1 virus or herpes simplex type 1 viruses (HSV/1) and in guinea pigs infected with herpes simplex type 2 viruses (HSV/2). MTP-PE is effective when given in a single intranasal dose as early as 1-4 weeks before infection. In the case of HSV/2 infections, prophylactic effectiveness can be demonstrated after a single topical application into the vagina seven days before infection. Antiviral effects are observed in response to doses as little as 0.001 mg/kg bodyweight. The activity of the substance seems to be inversely related to the size of the viral inoculum, but poor dose-effect relation is demonstrable in a dose-range extending over four to five orders of magnitude. Furthermore, the compound is devoid of antiviral effects in vitro. MTP-PE does not induce interferon (IFN) in serum and lung, nor does it influence kinetics or quantity of serum and lung IFN content in the course of viral infections. However, when given intranasally 7 days before an oral dose of tilorone, increased levels of IFN in lung suspensions are observed.

Effect of low-dose somatostatin infusion on pancreatic and gastric endocrine function in lean and obese nondiabetic human subjects

The present study was designed to compare, in lean and obese nondiabetic subjects, basal and postprandial levels of peripheral venous plasma insulin, glucagon, gastrin, pancreatic polypeptide (PP), glucose, triglycerides, and somatostatin-like immunoreactivity (SLI) during the infusion of synthetic somatostatin-14 or saline. Thirty-five minutes before the ingestion of the test meal, an infusion of synthetic somatostatin-14 was started at a rate of 0.5 ng/kg X min and was increased to 1.0 ng/kg X min 30 min after consumption of the meal and lasted for another 90 min. During the infusion of saline, basal peripheral vein levels of insulin, gastrin, and triglycerides were elevated in obese subjects, whereas basal plasma SLI levels were significantly lower compared with the lean controls. Basal glucagon and PP levels were similar in both groups. After the ingestion of the meal, augmented concentrations of insulin and gastrin were observed in the obese subjects, whereas postprandial SLI and PP levels were reduced. Chromatography of fasting plasma revealed all measurable SLI to be confined to the void volume fractions of a Bio-Gel P-10 column. The rise in SLI after the meal was due to an increase of SLI co-eluting with somatostatin-28 and somatostatin-14. During the infusion of somatostatin, only basal insulin levels were significantly lower in the obese subjects, whereas no change of any basal hormone level was observed in the lean group. During the infusion of somatostatin, SLI levels were elevated by 20-30 pg/ml in both groups compared with the saline controls. During the infusion rate of 0.5 ng/kg X min, only postprandial PP levels were reduced significantly in the obese group, while all the other parameters were unaffected in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)