Cardiac pathology in chronic alcoholics: a preliminary study

BACKGROUND

Ethyl alcohol exerts both positive and negative effects on the cardiovascular system. Alcoholic cardiomyopathy, produced by direct or indirect mechanisms, is well-documented. An important, but seldom appreciated effect is an increase in iron deposition in the myocardium, which can add to the cardiac dysfunction. The present study was planned to document the pathological features and iron levels in the cardiac tissue of patients who were chronic alcoholics and correlate these characteristics with the liver pathology and iron content.

MATERIALS AND METHODS

An autopsy-based prospective study of 40 consecutive patients compared with ten age matched controls (no history of alcohol intake). Histopathological changes like the morphology of the cardiac myocytes, degree of fibrosis (interstitial, interfiber, perivascular, and replacement), presence of inflammatory cells, increased capillary network, and adipose tissue deposition were noted and graded. These were also correlated with the liver pathology. The iron content in the heart and liver were measured by using calorimetry.

RESULTS

All cases had increased epicardial adipose tissue with epicardial and endocardial fibrosis, prominence of interstitial and interfiber fibrosis, myofiber degeneration, and increased capillary network; this was particularly prominent in patients with cirrhosis. Elemental iron level in heart tissue was raised in the cases relative to controls.

CONCLUSIONS

Alcohol produces subclinical changes in the myocardium, with an increased iron content, which may be the forerunner for subsequent clinical cardiac dysfunction.

A simple technique of skin graft fixation in the oral cavity

Suturing a graft in the oral cavity is rather cumbersome. Not only do the edges have to be sutured but also the graft has to be opposed firmly to the wound by quilting stitches. This is a time consuming procedure and can be technically demanding. The loss of an intraoral graft leads to contracture and post operative trismus and a reduced maximal inter incisor distance. We have been using a simple technique for skin graft fixation in the oral cavity, which in our opinion is quick, works extremely well and consistently gives good results.

The venoneuroadipofascial pedicled distally based sural island myofasciocutaneous flap: case reports

Complex soft-tissue defects of the lower third of the leg, the heel and the ankle still present a challenge for the reconstructive surgeon. In addition to skin replacement, many of these defects require muscle bulk, which promotes the healing of open bone fractures, effectively fills osteomyelitic cavities and deep three-dimensional defects, and helps to reconstruct the Achilles tendon. In an anatomical study, we developed a new flap based on the 'neuromuscular concept'. This flap consists of a paddle of gastrocnemius muscle and a skin paddle based distally on the sural venoneuroadipofascial pedicle supplied by the lower peroneal perforators. Three cases are presented to illustrate the versatile use of this flap.

The venoneuroadipofascial pedicled distally based sural island myofasciocutaneous and muscle flaps: anatomical basis of a new concept

Reconstruction of soft-tissue defects of the lower third of the leg, the heel and the foot remains a challenge. The distally based sural neurocutaneous flap has been used effectively to resurface these defects. However, the paucity of bulk in this flap makes it inadequate for complex post-traumatic or post-ablative soft-tissue reconstruction. We dissected 20 freshly amputated lower limbs after injecting them with a mixture of lead oxide and gelatin. We found muscular branches of the accompanying artery of the sural nerve to the gastrocnemius muscle in all 20 limbs. This led us to conceptualise the distally based venoneuroadipofascial pedicled island sural myofasciocutaneous and muscle flaps. These flaps are useful for the reconstruction of complex soft-tissue defects of the lower third of the leg, the heel and the foot.