No description available.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 12 uppsatser.

Intermittent blood flow in tumour microvasculature is believed to contribute to heterogeneity in tumour oxygen delivery; transient vessel nonperfusion is thought to result in acutely hypoxic cells resistant to conventional radiotherapy. This thesis describes three main areas of work: (1) the development of a histologic method capable of detecting intermittent blood flow in experimental tumours at the single vessel level; (2) the quantification and characterization of tumour blood flow fluctuations in the murine SCCVII carcinoma; and (3) the modification of tumour blood flow and the reduction of flow heterogeneity using vasoactive drugs. A double staining technique involving the sequential intravenous injection of two fluorescent vascular markers was used to detect transient episodes of tumour vessel nonperfusion. The stains employed were Hoechst 33342 and the carbocyanine dye, DiOC₇(3), both of which have short (< 3 minutes) circulation half-lives and preferentially stain cells adjacent to perfused blood vessels. When injections of the vascular markers are separated by some interval, each stain defines only those tumour vessels which were perfused during the few minutes immediately post-injection; thus, two "pictures" of tumour microvascular flow are obtained and tumour vessels subject to periods of nonperfusion can be easily visualized in frozen sections since they are outlined by one stain but not the other. Using the double staining technique, in which Hoechst 33342 and then DiOC₇(3) are administered intravenously 20 minutes apart to unrestrained C3H/He mice, staining mismatch (indicative of transient vessel nonperfusion) is regularly observed in subcutaneous SCCVII carcinoma. Vessels stained with DiOC₇(3) only (reperfusion of previously nonperfused vessels) or with H33342 only (nonperfusion of previously perfused vessels) are observed in approximately equal numbers. The percentage of tumour vessels subject to intermittent flow is a function of SCCVII tumour size: tumours ≤100 mg do not exhibit statistically significant amounts of mismatch. At sizes > 100 mg, overall staining mismatch is significantly increased over background levels and maximum mismatch is observed at tumour sizes >400 mg (8.6 ±2.9%). In most tumours, transient vessel nonperfusion is more pronounced in central tumour regions. In addition to mismatch observed in individual vessels, large "patches" of unequal staining are also seen. Anaesthesia or restraint do not significantly influence intermittent blood flow. The above information suggests that transient episodes of tumour vessel nonperfusion occur as a consequence of flow reduction in a feeding vessel; vessels in central regions of large tumours may be susceptible to collapse as a result of elevated tumour interstitial pressure. In the SCCVII tumour, a small number of peripheral vessels possess vascular smooth muscle and thus may be capable of vasomotor activity. The importance of perfusion pressure in the control of tumour microcirculatory flow was examined using vasoactive drugs. Hydralazine, a vasodilator which lowers blood pressure, causes a profound reduction in tumour RBC flow to 8.7 + 6.4% of pretreatment values in unanaesthetized mice. The drug causes collapse of central tumour vessels: following a dose of 10mg/kg intravenously, 36±16% of vessels are completely nonperfused, as detected using the double staining technique. Conversely, elevation of blood pressure using the vasoconstrictor angiotensin II results in a 2-3x increase in tumour blood flow. In addition, angiotensin II infusion significantly reduces the number of tumour vessels subject to transient nonperfusion from 8.1 % to 2.0%. However, intermittent blood flow in the SCCVII carcinoma can also be influenced by nonvasoactive drugs: nicotinamide, the amide form of vitamin B3, reduces episodes of transient nonperfusion. In summary, intermittent blood flow has been characterized in a transplanted murine squamous cell carcinoma using a novel fluorescent double staining method which allows the detection of flow fluctuations in solid tumours at the microvascular level. If transient episodes of nonperfusion occur in human tumours and result in impaired oxygen or drug delivery, then such flow fluctuations may be an important factor limiting tumour cure or local control by radiotherapy or chemotherapy. / Medicine, Faculty of / Pathology and Laboratory Medicine, Department of / Graduate

Foi realizado um estudo clínico prospectivo analisando os resultados obtidos no tratamento de 23 pacientes portadores de lesões do revestimento cutâneo de dimensões iguais ou menores a 20 cm de comprimento por 10 cm de largura com a utilização do retalho microcirúrgico lateral do braço ampliado distalmente ao epicôndilo lateral do cotovelo. Todos os pacientes foram tratados pelo Grupo de Mão e Microcirurgia do Instituto de Ortopedia da Faculdade de Medicina da Universidade de São Paulo, no período de dois anos, 2003 à 2005. Na presente casuística, tivemos 69.5% de pacientes do sexo masculino, 73.9% de origem traumática e a região receptora foi o membro inferior em 65.2% dos casos. A idade variou de 6 anos até 62 anos, com média de 32 anos. O seguimento mínimo foi de 5 meses. Houve sucesso na realização de 100% dos retalhos. As dimensões dos retalhos realizados neste trabalho variaram em comprimento, de 9 cm até 20 cm, com média de 14 cm e em largura, de 3 cm até 8 cm, com média de 5.5 cm. A maior distância entre o epicôndilo lateral e a extremidade distal do retalho utilizada neste estudo foi de 8 cm, variando de 2 cm até 8 cm, com média de 4.9 cm. O retalho microcirúrgico lateral do braço ampliado distalmente ao epicôndilo lateral do cotovelo mostrou-se seguro para a cobertura cutânea de lesões de dimensões iguais ou menores a 20 cm de comprimento por 10 cm de largura, com o prolongamento do retalho até 8 cm distal ao epicôndilo lateral / This prospective clinical study investigates the results of treatment of 23 patients with cutaneous lesions of no more then 20 cm of length by 10 cm of width, by means of a microsurgical lateral arm flap, distally extended by the elbow lateral epicondilyle. All patients came from the Hand and Microsurgery Group of the \"Instituto de Ortopedia da Faculdade de Medicina\" of the \"Universidade de São Paulo\", in a two years period from 2003 till 2005. Our population comprises the following basic statistics: 69.5% males, 73.9% of traumatic origin, the receiving region was the lower members in 73.9% of the cases. Age ranged form 6 to 64 years old, average 32 years. The minimum follow up was of 5 (five) months. The procedure was successful in 100% of the cases. The flap length dimension ranged from 9 cm up to 20 cm, with average 14 cm. The flap width dimension ranged from 3 cm up to 8 cm, with average 5.5 cm. The greater distance from the lateral epicondyle up to the end of the skin flap in this study was of 8 cm, ranging from 2 cm up to 8 cm, with 4.9 cm average. The microsurgical lateral arm flap, distally to lateral epicondyle showed itself to be safe for cutaneous covering of lesions of 20 cm or less length and 10 cm of less width, with the distal extension of the skin flap up to 8 cm from the lateral epicondyle

A hemorragia alveolar é uma síndrome que pode ocorrer como manifestação de uma série de doenças, cada uma com eventos fisiopatológicos diferentes resultando em sangramento pulmonar. A análise histológica detalhada destes pacientes pode auxiliar no entendimento desta síndrome. Neste estudo nós fizemos a revisão e descrição dos achados das lâminas de tecido pulmonar e do prontuário médico de 48 pacientes falecidos por hemorragia alveolar nos anos de 1999 a 2004. A maioria apresentou hemorragia de característica difusa (87,5%), predominantemente alveolar (79,2%), sem sinais de recorrência (79,2%) e com presença de fibrina (81,3%). As outras características avaliadas foram: vasculite (8,3%), trombose intravascular (27,1%),esclerose arterial (31,3%), capilarite (41,7%), acometimento intersticial (35,4%), acometimento venoso (41,7%), presença de sinais de infecção (50%), membrana hialina (25%). Com os registros médicos, classificamos os pacientes nas seguintes síndromes clínicas: congestão pulmonar (29,17%), coagulopatia (25%), sepse (27,08%) e inflamação (18,75%). Após as análises clínica e histológica, fizemos a correlação entre estes dados e encontramos que os pacientes com diagnóstico de congestão apresentaram menor presença de fibrina e de acometimento intersticial e maior presença de sangramento focal. O sangramento por coagulopatia se caracterizou por menor presença de fibrina e ausência de sinais de sangramento recorrente. Os pacientes com infecção clínica, histologicamente apresentaram fibrina e sinais de infecção no tecido pulmonar, já os pacientes com diagnóstico de inflamação se caracterizaram pela presença de fibrina, esclerose arterial e sangramento focal. Concluindo, nosso estudo sugere que alguns padrões histológicos são mais comuns em determinadas síndromes clínicas, e podem ser úteis no diagnóstico causal da hemorragia alveolar / Alveolar haemorrhage is a syndrome presented by many diseases each one with its particular physiopathologic mechanism resulting in pulmonary bleeding. The detailed histological analysis of these patients can help understanding this syndrome. In this study we reviewed and described histological findings of lung slides and medical records from patients whose cause of death was alveolar haemorrhage between 1999 and 2004. Most patients presented diffuse (87,5%), mainly alveolar (79,2%) rather than interstitial and recent bleeding with no signs of recurrence (79,2%). We also observed the presence of: fibrin (81,3%), vasculitis (8,3%), intravascular thrombosis (27,1%), arterial sclerosis (31,3%), capillarity (41,7%), interstitial involvement (35,4%), venous involvement (41,7%), signs of infection on lung tissue (50%) and hyaline membrane (25%). Clinically we classified the patients as having one of the following syndromes: pulmonary oedema due to congestive heart failure (CHF- 29,17%), coagulation disorders (25%), sepsis (27,08%) and systemic inflammation (18,75%). After correlating clinical and histological data we found CHF to have lower presence of fibrin and interstitial involvement and a greater presence of focal bleeding. Coagulation disorders were characterized by no signs of recurrent bleeding and a lower presence of fibrin than infection and inflammation. Patients with clinical diagnosis of systemic inflammation had a greater presence of fibrin and arterial sclerosis than other clinical syndrome and patients with clinical diagnosis of sepsis showed presence of signs of infection in lung tissue no matter the clinical site of infection. In conclusion, our study suggests that some histological patterns happens more commonly in determined clinical syndromes and can help diagnosing the cause of bleeding .

本研究採用結紮眼血管的方法誘發短暫性視網膜缺血，針對同缺血時間同存活時間化成年金黄地鼠中視網膜節細胞的存活和小型膠質細胞的激活。首先，我們的據顯示，和假缺血手術組相對應的存活時間比較，暫時性視網膜缺血10分鐘或30分鐘沒有導致視網膜節細胞的存活明顯下。暫時性視網膜缺血60分鐘再灌注後7天，視網膜節細胞的存活下至58%，14後為51%，28後為44%。暫時性視網膜缺血120分鐘之後再灌注7天，視網膜節細胞的存活急劇下，僅保22%，至14天，僅剩17%, 之後節細胞的死亡速減緩，至28天時，仍由18%存活。視網膜缺血10分鐘、30分鐘、60分鐘和120分鐘均引起大小型膠質細胞激活，激活在第七天達到頂峰，之後在14天和28天顯著並逐步下。相關性分析發現損傷後7天，視網膜節細胞的死亡和視網膜節細胞層中的小型膠質細胞存在緊密的相關性。 / 其次，我們首次證實缺血性預處僅有於提高視網膜節細胞對抗視網膜缺血/再灌注損傷，還對視神經斷後的視網膜節細胞同樣具有保護作用。結果顯示無是5分鐘還是10分鐘的缺血性預處，無是軸突橫斷術前1天還是前3天實施預處，都對視網膜節細胞有明顯的保護作用。在缺血性預處對抗神經橫斷損傷的實驗組, 的表達只表現在陽性細胞上的明顯優勢，但占全部存活細胞的百分比存在差；而缺血性預處對抗視網膜缺血再灌注損傷的實驗組，的陽性節細胞的無論還是存活百分比都存在差。在預處組和假處組的比較中， 的表達也只是陽性細胞上較多，占全部存活細胞的百分比存在差。在缺血性預處加視網膜缺血分鐘的實驗組中，我們測視網膜矢片中各層的厚。結果顯示，缺血性預處組中，視網膜的整體厚和節細胞層的厚都與正常組相當，而假處組中，這層的厚明顯減少。 / 進一步地，我們研究遠端缺血性後處對視網膜節細胞對抗視神經軸突橫斷術的保護作用。我們選用鉗夾右股動脈作為遠端缺血性後處的方法，鉗夾股動脈分鐘，之後放開，再鉗夾再放開，共個循環。結果顯示，軸突橫斷術后分鐘實施缺血性后處組，視網膜節細胞的存活較假處組明顯增加，包括術後天和天；軸突橫斷術后小時實施缺血性後處組，視網膜節細胞的存活只在術後天較假處組明顯較多，但在天的實驗組，者的差消失；軸突橫斷術小時實施缺血性後處組，視網膜節細胞的存活比假處組多。在缺血性後處的實驗中，視神經橫斷術后分鐘實施遠端缺血性後處的實驗組與假處組比較，的表達僅表現在陽性細胞上的明顯增加，而且占全部存活細胞的百分比也明顯增加。的表達與預處實驗組的結果相似，只存在上的優勢。 / 我们的實驗證明，缺血性預處在對抗視神經橫斷和視網膜缺血的損傷中，可以為節細胞提供有效的保護作用，遠端缺血性後處可以對抗視神經橫斷損傷提高節細胞的存活。陽性節細胞在三個同條件的實驗中，表現出同的結果，这可能暗示遠端缺血性後處對抗視神經橫斷術的損傷，節細胞的再生能較優，與遠端缺血性後處對抗視神經橫斷術的神經保護作用有一定關。的表達在三個實驗組中，處組與假處組比較，均只表現出陽性細胞上的優勢，占存活細胞的百分比就存在差，可能意味著與缺血性預處和後處的保護作用關係不大。 / Ligature of the ophthalmic vessels (LOV) was used as an animal model to study transient retinal ischemia/reperfusion in adult hamsters. Firstly, we quantified the loss of retinal ganglion cells (RGCs) and activation of microglia after10 min, 30 min, 60 min or 120 min retinal ischemia at 7, 14 and 28 days post-ischemia. The results showed that after 10-min or 30-min retinal ischemia, the number of RGCs had no significant decrease compared to sham LOV group at 7 days. In the retinal ischemia 60 min group, there were 58% of the RGCs population remained alive at 7 days, 51% at 14 days and 44% at 28 days post-ischemia, respectively. In the retinal ischemia 120 min group, the number of RGCs was reduced to 22% at 7 days and 17% at 14 days, but cell death slowed down from 14 to 28 days. Meanwhile, the number of microglia was increased sharply at 7 days and decreased gradually from 7 to 28 days. At the same time, it was found that the loss of RGCs and activation of microglia in the ganglion cell layer at 7 days post-insult existed strong positive correlation. / Secondly, the effects of ischemic preconditioning (IPC) were proved to promote RGCs survival after axotomy or retinal ischemia 120 min. It was presented firstly that a 5 or 10 min brief IPC which performed 1 or 3 days prior to axotomy enhanced the RGCs survival at 7 days and 14 days post-axotomy. The number of HSP27-positive RGCs was significantly higher in the IPC plus axotomy subgroup compared with the sham-operated subgroup, while the percentage of HSP27-positive RGCs did not show significant difference between subgroups. For the IPC plus retinal ischemia 60 min group, both the number and the percentage of HSP27-positive RGCs had no significant difference between IPC and sham-operated subgroups. The number of HSP70-positive RGCs exhibited significant difference but not the percentage in IPC plus axotomy or retinal ischemia 60 min experimental groups. The thicknesses of the whole retina and GCL were similar to the normal value in the IPC plus ischemia 60 min subgroup, while in the sham-operated subgroup, these two values decreased significantly. / Consequently, the effect of remote ischemic postconditioning (RIPostC) was also explored to promote RGCs survival after axotomy. Four cycles of 10 min occlusion and 10 min release of the right femoral artery were initiated on animals at 10 min, 6 h or 24 h after axotomy. In the10 min group, the effect of RIPostC on promoting RGCs survival was significant at both 7 and 14 days post-injury. In the 6 h group, the survival of RGCs was more in the RIPostC treatment subgroup at 7 days, while there was no significant difference at 14 days post-axotomy. In the 24 h group, RGC survival was not significantly different at 7 days post-axotomy. Both the number and the percentage of HSP27-positive RGCs were significantly higher in the RIPostC treatment subgroup. The results of the induction of HSP70 only showed a priority in absolute number of the HSP70-positive RGCs in the RIPostC treatment subgroup. / In summary, the effect of IPC has been proved that it could protect RGCs against axotomy and retinal ischemia/reperfusion injury, in addition, the application of RIPostC also protected RGCs from axotomy. The proportion of HSP27-positive RGCs increased significantly in the process of RIPostC against axotomy, which may clue that the ability of axonal regeneration is stronger which induced by the RIPostC intervention. The upregulation of HSP27 might play a role in the neuroprotection of the RIPostC against axotomy. The expression of HSP70 maybe plays a little role in the neuroprotection of the IPC and RIPostC. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Liu, Xia. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 182-196). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract --- p.i / Abstract in Chinese --- p.iv / Acknowledgements --- p.vii / Table of Abbreviations --- p.viii / Table of Contents --- p.ix / Chapter Chapter 1 --- General Introduction --- p.1 / Chapter Chapter 2 --- Changes of retinal ganglion cells and microglia after different types of injuries / Introduction --- p.38 / Materials and Methods --- p.43 / Results --- p.49 / Discussion --- p.57 / Figures and tables --- p.71 / Chapter Chapter 3 --- Ischemic preconditioning protect retinal ganglion cells against axotomy and retinal ischemia/reperfusion injury and expression of heat shock protein 27 and 70 / Introduction --- p.93 / Materials and Methods --- p.98 / Results --- p.103 / Discussion --- p.109 / Figures and tables --- p.116 / Chapter Chapter 4 --- Remote ischemic postconditioning protect retinal ganglion cells against axotomy and expression of heat shock protein 27 and 70 / Introduction --- p.143 / Materials and Methods --- p.147 / Results --- p.150 / Discussion --- p.154 / Figures and tables --- p.161 / Chapter Chapter 5 --- General Discussion --- p.175 / References --- p.182

A hemorragia alveolar é uma síndrome que pode ocorrer como manifestação de uma série de doenças, cada uma com eventos fisiopatológicos diferentes resultando em sangramento pulmonar. A análise histológica detalhada destes pacientes pode auxiliar no entendimento desta síndrome. Neste estudo nós fizemos a revisão e descrição dos achados das lâminas de tecido pulmonar e do prontuário médico de 48 pacientes falecidos por hemorragia alveolar nos anos de 1999 a 2004. A maioria apresentou hemorragia de característica difusa (87,5%), predominantemente alveolar (79,2%), sem sinais de recorrência (79,2%) e com presença de fibrina (81,3%). As outras características avaliadas foram: vasculite (8,3%), trombose intravascular (27,1%),esclerose arterial (31,3%), capilarite (41,7%), acometimento intersticial (35,4%), acometimento venoso (41,7%), presença de sinais de infecção (50%), membrana hialina (25%). Com os registros médicos, classificamos os pacientes nas seguintes síndromes clínicas: congestão pulmonar (29,17%), coagulopatia (25%), sepse (27,08%) e inflamação (18,75%). Após as análises clínica e histológica, fizemos a correlação entre estes dados e encontramos que os pacientes com diagnóstico de congestão apresentaram menor presença de fibrina e de acometimento intersticial e maior presença de sangramento focal. O sangramento por coagulopatia se caracterizou por menor presença de fibrina e ausência de sinais de sangramento recorrente. Os pacientes com infecção clínica, histologicamente apresentaram fibrina e sinais de infecção no tecido pulmonar, já os pacientes com diagnóstico de inflamação se caracterizaram pela presença de fibrina, esclerose arterial e sangramento focal. Concluindo, nosso estudo sugere que alguns padrões histológicos são mais comuns em determinadas síndromes clínicas, e podem ser úteis no diagnóstico causal da hemorragia alveolar / Alveolar haemorrhage is a syndrome presented by many diseases each one with its particular physiopathologic mechanism resulting in pulmonary bleeding. The detailed histological analysis of these patients can help understanding this syndrome. In this study we reviewed and described histological findings of lung slides and medical records from patients whose cause of death was alveolar haemorrhage between 1999 and 2004. Most patients presented diffuse (87,5%), mainly alveolar (79,2%) rather than interstitial and recent bleeding with no signs of recurrence (79,2%). We also observed the presence of: fibrin (81,3%), vasculitis (8,3%), intravascular thrombosis (27,1%), arterial sclerosis (31,3%), capillarity (41,7%), interstitial involvement (35,4%), venous involvement (41,7%), signs of infection on lung tissue (50%) and hyaline membrane (25%). Clinically we classified the patients as having one of the following syndromes: pulmonary oedema due to congestive heart failure (CHF- 29,17%), coagulation disorders (25%), sepsis (27,08%) and systemic inflammation (18,75%). After correlating clinical and histological data we found CHF to have lower presence of fibrin and interstitial involvement and a greater presence of focal bleeding. Coagulation disorders were characterized by no signs of recurrent bleeding and a lower presence of fibrin than infection and inflammation. Patients with clinical diagnosis of systemic inflammation had a greater presence of fibrin and arterial sclerosis than other clinical syndrome and patients with clinical diagnosis of sepsis showed presence of signs of infection in lung tissue no matter the clinical site of infection. In conclusion, our study suggests that some histological patterns happens more commonly in determined clinical syndromes and can help diagnosing the cause of bleeding .

Greater Victoria, a conurbation of about 335,000 people located in southwestern British Columbia, Canada, is subject to significant seismic hazards. The major regional seismic factor is the offshore Juan de Fuca tectonic plate, subducting beneath North America along the 1,100 km-long Cascadia Subduction Zone (CSZ), a megathrust fault. This environment generates three types of potentially damaging earthquakes—shallow, subduction, and deep. This research examines how the Transfusion Medicine (TM) component within transfusing facilities in Greater Victoria and the balance of Vancouver Island might function following these types of earthquakes. A shallow earthquake of magnitude (M)7 or greater that occurs near enough could heavily damage critical infrastructure in Greater Victoria. Decisions regarding the alternatives of (a) rapidly relocating a facility for storing and/or processing blood products within or near Greater Victoria or (b) transporting people injured in an earthquake to transfusing hospitals in or beyond Greater Victoria, or (c) both (a) and (b), may need to be made within the first few hours following a locally destructive earthquake. A subduction event (M8 to 9.2) in the CSZ could reduce or halt production of blood products in nearby Vancouver, diminish the supply of stored blood in southwestern coastal British Columbia, and sharply increase demand for blood products. Post-subduction-event conditions would likely result in a temporary shortage of blood products in at least two regional health authorities, and would test the response of a few key related functions within smaller, more remote health care facilities. A subduction event also would impact ground transportation routes, airports, and wharves, making the transportation of blood products to and around Vancouver Island more difficult. The researcher interviewed several professionals whose work supports the blood contingency emergency response by the Canadian Blood Services, the Vancouver Island Health Authority (VIHA), and the British Columbia Ministry of Health, to obtain information that could help maintain the TM function in post-quake circumstances. To prepare informants to answer questions regarding the health care implications of these earthquakes, the researcher generated--per earthquake type--order of magnitude estimates of the numbers of hospitalizations that would likely result in Greater Victoria or/and Vancouver Island. The study examines the inventorying and transportation of blood products, some communication, decision-making, and blood product distribution considerations—plus the hazard mitigation and vulnerability reduction aspects—that could be included in an earthquake-specific blood contingency plan for VIHA transfusing facilities. It also considers how VIHA could sustain the function of the TM Laboratory role within transfusing hospitals during post-earthquake circumstances in which some of their facilities for storing, monitoring, analyzing, or transfusing blood products are inoperable. The risks of damaging earthquakes, and accompanying tsunamis affecting populated areas and health system assets in coastal British Columbia, are real. Implementing the recommendations of this study may help various players involved in the regional processing, distribution and allocation of blood products to: (a) define a more efficient response to earthquake impacts upon their operations, (b) reduce injury to people and damage to crucial equipment used in the health system, and ultimately, (c) save lives. / Graduate / 0769 / 0368 / 0766 / sanderson.b1@gmail.com

Foi realizado um estudo clínico prospectivo analisando os resultados obtidos no tratamento de 23 pacientes portadores de lesões do revestimento cutâneo de dimensões iguais ou menores a 20 cm de comprimento por 10 cm de largura com a utilização do retalho microcirúrgico lateral do braço ampliado distalmente ao epicôndilo lateral do cotovelo. Todos os pacientes foram tratados pelo Grupo de Mão e Microcirurgia do Instituto de Ortopedia da Faculdade de Medicina da Universidade de São Paulo, no período de dois anos, 2003 à 2005. Na presente casuística, tivemos 69.5% de pacientes do sexo masculino, 73.9% de origem traumática e a região receptora foi o membro inferior em 65.2% dos casos. A idade variou de 6 anos até 62 anos, com média de 32 anos. O seguimento mínimo foi de 5 meses. Houve sucesso na realização de 100% dos retalhos. As dimensões dos retalhos realizados neste trabalho variaram em comprimento, de 9 cm até 20 cm, com média de 14 cm e em largura, de 3 cm até 8 cm, com média de 5.5 cm. A maior distância entre o epicôndilo lateral e a extremidade distal do retalho utilizada neste estudo foi de 8 cm, variando de 2 cm até 8 cm, com média de 4.9 cm. O retalho microcirúrgico lateral do braço ampliado distalmente ao epicôndilo lateral do cotovelo mostrou-se seguro para a cobertura cutânea de lesões de dimensões iguais ou menores a 20 cm de comprimento por 10 cm de largura, com o prolongamento do retalho até 8 cm distal ao epicôndilo lateral / This prospective clinical study investigates the results of treatment of 23 patients with cutaneous lesions of no more then 20 cm of length by 10 cm of width, by means of a microsurgical lateral arm flap, distally extended by the elbow lateral epicondilyle. All patients came from the Hand and Microsurgery Group of the \"Instituto de Ortopedia da Faculdade de Medicina\" of the \"Universidade de São Paulo\", in a two years period from 2003 till 2005. Our population comprises the following basic statistics: 69.5% males, 73.9% of traumatic origin, the receiving region was the lower members in 73.9% of the cases. Age ranged form 6 to 64 years old, average 32 years. The minimum follow up was of 5 (five) months. The procedure was successful in 100% of the cases. The flap length dimension ranged from 9 cm up to 20 cm, with average 14 cm. The flap width dimension ranged from 3 cm up to 8 cm, with average 5.5 cm. The greater distance from the lateral epicondyle up to the end of the skin flap in this study was of 8 cm, ranging from 2 cm up to 8 cm, with 4.9 cm average. The microsurgical lateral arm flap, distally to lateral epicondyle showed itself to be safe for cutaneous covering of lesions of 20 cm or less length and 10 cm of less width, with the distal extension of the skin flap up to 8 cm from the lateral epicondyle

Objetivo: Avaliar os efeitos do citrato de sildenafila na circulação do clitóris em mulheres na pós-menopausa com disfunção orgástica avaliadas por Doppler. Casuística e métodos: Foram selecionadas 22 mulheres atendidas no Setor de Ginecologia Endócrina e Climatério da Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Destas, 11 constituíram o grupo que recebeu 50mg de citrato de sildenafila (Grupo A) e outras 11 o grupo controle (Grupo B-placebo). Em todas aplicaram-se a entrevista Questionário de sexualidade HC e Escala de Griss. A circulação do clitóris foi avaliada por meio de Doppler nos tempos 0(T0), 1(T1) uma hora após a ingestão do comprimido e após 15 (T15) dias de tratamento. Resultados: Os resultados mostraram diferenças estatisticamente significativas, ao avaliarmos alterações nas medidas dos diferentes momentos (T0, T1,.T15), quando comparamos os 2 grupos (medicamento x placebo), utilizando-se os índices de resistência e velocidade. Conclusão: Podemos inferir melhora apresentada pelo grupo A (citrato de sildenafila), consideravelmente superior ao demonstrado pelo grupo B (placebo). / This study has as objective to evaluate the effects of Sildenafil Citrate in the circulation of the clitoris in women in post-menopause with orgastic dysfunction, appraised through color-pulse Doppler. 22 women were selected in the Endocrine Gynecology and Climacteric clinic of Hospital das Clínicas. 11 women received 50mg of Sildenafil Citrate (Group A) and 11 women received Placebo (Group B). All the women were submitted to the interview “Sexuality Questionnaire HC" and to GRISS Scale. The circulation of the clitoris was evaluated through Doppler in different moments: 0 (T0), 1(T1) one-hour after the ingestion of the tablet and 15 (T15) 15-days of treatment. The results showed differences, statistically significant, when evaluating the measures of the different moments (T0, T1, .T15). When comparing the 2 groups (medicine x placebo), using resistance and speed indexes, we can infer that the improvement presented by Group A (Sildenafil Citrate) is considerably superior to the improvement demonstrated by the Group B (placebo).