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The efficiency of anti-tumour drug strongly depends on its dose. Higher drug doses and exposure times usually result in better treatment. It is why the implementation of high-dose treatment is always attractive. However, most of the drug delivery techniques meet essential limitations. In isolated regional perfusion a tumour can be exposed to high-dose therapeutic influence but the target organ may be isolated from the rest of circulatory system only for a relatively short period of time. During systemic injection of anti-tumour agents dose limitations are dictated by side toxicity danger. Viperidae venoms are known to cause local stagnation of blood flow and blood-tissue exchange processes in the place of snakebite. In present paper we suggest to use Viperidae snake venoms in addition to anti-tumour drugs for regional anti-cancer therapy. We suppose that Viperidae venoms will assist in drug localization. We state that their usage will help in high-dosage therapy implementation.

BackgroundCytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has an emerging role in the treatment of peritoneal malignancies. The CRS-HIPEC approach has known treatment-related toxicities. This study sought to determine the predictors of major postoperative complications after CRS-HIPEC in a high-volume center.MethodsFrom a single-institution database, this study investigated complications experienced by patients undergoing CRS-HIPEC. Multiple preoperative and operative factors were analyzed for their ability to predict 60-day Clavien grade 3 and greater (major) complications by logistic regression. A predictive model was created from preoperative factors using multivariate logistic regression. The model was tested by Akaike's information criterion, the Hosmer and Lemeshow Goodness-of-Fit Test, the receiver operating characteristic, and the Youden Index.ResultsThe study evaluated 247 patients undergoing CRS-HIPEC. The primary tumor site was the appendix in 166 cases (67.2%), the colorectal area in 51 cases (20.6 %), the peritoneum (mesothelioma) in 22 cases (8.9%), the ovary in 5 cases (2%), and the small bowel in 3 cases (1.2%). The median peritoneal cancer index was 14 (range 0-29), and 235 patients (95.1%) had a complete (CC-0/1) cytoreduction. Major complications occurred for 41 patients (16.6%), classified as grade 3 in 33 cases (13.4%), grade 4 in 5 cases (2%), and grade 5 (deaths) in 3 cases (1.2%). The factors predictive of major complications in the multivariate analysis were a Charlson Comorbidity Index (CCI) score higher than 0 [odds ratio (OR), 2.505; p = 0.035], presence of preoperative symptoms (OR 1.951; p = 0.064), and prior resection status [no resection or prior CRS-HIPEC (OR 2.087) vs. prior resection without CRS-HIPEC (OR 3.209); p = 0.046]. These variables were used to create a tool predictive of postoperative complications.ConclusionPresence of symptoms, CCI, and prior resection status predict major complications and define a low-risk population after CRS-HIPEC.

In recent years, there has been a shift in the donor demographics with an increase in donation after circulatory death (DCD). Livers obtained from DCD donors are known to have poorer outcomes when compared to donors after brainstem death and currently only a small proportion of DCD livers are used. This review outlines the recent technological developments in liver DCD donation, including clinical studies using normothermic regional perfusion and extracorporal machine perfusion of livers from DCD donors.

In 2016, peritoneal carcinomatosis can be considered as a chronic disease that can be treated and sometimes cured. Hyperthermic Intra PEritoneal Chemotherapy (HIPEC) is a procedure developed in the eighties. Combined with CytoReductive (CR) surgery, this protocol underwent a considerable expansion in Washington Cancer Institute. CR combined with HIPEC was demonstrated to be the only curative treatment for PseudoMyxoma Peritonei syndrome (PMP). It is actually approved in the management of peritoneal carcinomatosis of ovarian, colorectal, or peritoneal primitive (mesothelioma) origin but is still studied for gastric cancer. CR/HIPEC is associated with an important mortality and morbidity. This article takes stock of indications to CR/HIPEC.

The great potential of donation after cardiac death (DCD) in expanding the liver donor pool is limited by the inferior results due to the ischemic injury.1 Normothermic regional perfusion (NRP) and hypothermic machine perfusion (HMP) can improve the transplantation outcome.2,3 These technologies may

This review summarizes the state-of-the-art in electrical impedance tomography (EIT) for ventilation and perfusion imaging. EIT is a relatively new technology used to image regional impedance distributions in a cross-sectional area of the body. After the introduction, a brief overview of the recent history is provided followed by a review of the literature on regional ventilation monitoring using EIT. Several recently presented indices that are useful to extract information from EIT image streams are described. Selected experimental and clinical findings are discussed with respect to future routine applications in intensive care. Finally, past and ongoing research activities aimed at obtaining cardiac output and regional perfusion information from EIT image streams are summarized.

Tracer kinetic modeling for quantification of perfusion and capillary wall permeability is a well-established approach, applied to various imaging modalities. In this review, methods employing intravascular as well as diffusible nonradioactive contrast agents for characterization of tissue microcirculation and microvasculature are described. The article focuses on perfusion and permeability imaging by MRI, particularly for brain applications, and the use of alternative medical imaging methods, such as CT and ultrasound, is also briefly introduced.

Submitted by LEANDRO AMERICO RAFAEL (leamerico@hotmail.com) on 2016-04-25T16:38:33Z No. of bitstreams: 1 Tese Farmacocinética- Artigos.pdf: 1355351 bytes, checksum: cfac2b6198fb08023053c48d3352ad2f (MD5) Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-04-26T19:56:10Z (GMT) No. of bitstreams: 1 rafael_la_dr_bot_par.pdf: 546556 bytes, checksum: 3269e8581fbc4e84f54cfd321323ea78 (MD5) Made available in DSpace on 2016-04-26T19:56:10Z (GMT). No. of bitstreams: 1 rafael_la_dr_bot_par.pdf: 546556 bytes, checksum: 3269e8581fbc4e84f54cfd321323ea78 (MD5) Previous issue date: 2015-12-17 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) A Perfusão regional de antimicrobianos (PRA) é uma técnica que possibilita aumentar a concentração de antimicrobianos em infecções que acometem a porção distal dos membros, abaixo ou na altura dos ossos rádio, carpo e tarso, contribuindo para a sua eliminação. Essa técnica utiliza baixas doses de antimicrobiano, se comparada com a terapia sistêmica utilizando o mesmo fármaco. Dessa forma, aumenta a eficácia do mesmo, devido às elevadas concentrações do antimicrobiano nos tecidos distais dos membros, além de minimizar os riscos de toxicidade. O objetivo do estudo foi avaliar a farmacocinética da gentamicina no plasma e líquido sinovial de equinos hígidos, após administrações em doses únicas, por via intravenosa e intravenosa regional, e avaliar as alterações vasculares ocasionadas pela perfusão regional. Foram utilizados 12 equinos hígidos (8 fêmeas e 4 machos), mestiços, com idade variando de 8 a 15 anos, e pesando 354,8±42,3 kg, divididos aleatoriamente em dois grupos de seis cada. O grupo intravenoso-GIV recebeu 6,6 mg/kg de sulfato de gentamicina por via sistêmica (veia jugular) e o grupo torniquete tubular-GTT recebeu 2,2 mg/kg de sulfato de gentamicina adicionado à solução fisiológica q.s.p. 40 mL, por via regional (veia cefálica), após o posicionamento de um torniquete tubular de látex no terço médio do rádio. As amostras de sangue da veia jugular e líquido sinovial das articulações radiocárpica e metacarpofalângica de todos os animais foram coletadas antes da administração da gentamicina e após 15 minutos, 30 minutos, 1 hora, 2, 4, 6, 8, 12, 24, 48 e 72 horas. A concentração de gentamicina foi mensurada através do método de Cromatografia Líquida de Alta Eficiência (CLAE) e as alterações vasculares através da ultrassonografia Doppler. As análises estatísticas foram realizadas através do programa Graphpad Prism 6, empregando-se o teste Mann Whitney nos momentos entre os grupos e teste de Kruskal-Wallis com pós-teste Dunns nos momentos dentro dos grupos. O nível de significância foi definido como P

Superselective ophthalmic artery chemotherapy (SOAC) has recently been proposed as an alternative to intravenous chemoreduction for advanced intraocular retinoblastoma. Preliminary results appear promising in terms of tumor control and eye conservation, but little is known regarding ocular toxicity and visual prognosis. In this study, we report on the vascular adverse effects observed in our initial cohort of 13 patients.The charts of 13 consecutive patients with retinoblastoma who received a total of 30 injections (up to 3 injections of a single agent per patient at 3-week interval) of melphalan (0.35 mg/kg) in the ophthalmic artery between November 2008 and June 2010 were retrospectively reviewed. RetCam fundus photography and fluorescein angiography were performed at presentation and before each injection. Vision was assessed at the latest visit.Enucleation and external beam radiotherapy could be avoided in all cases but one, with a mean follow-up of 7 months. Sectoral choroidal occlusive vasculopathy leading to chorioretinal atrophy was observed temporally in 2 eyes (15%) 3 weeks to 6 weeks after the beginning of SOAC and retinal arteriolar emboli in 1 eye 2 weeks after injection. There was no stroke or other clinically significant systemic side effects except a perioperative transient spasm of the internal carotid artery in one patient. Vision ranged between 20/1600 and 20/32 depending on the status of the macula.Superselective ophthalmic artery chemotherapy was effective in all patients with no stroke or other systemic vascular complications. Unlike intravenous chemoreduction, SOAC is associated with potentially sight-threatening adverse effects, such as severe chorioretinal atrophy secondary to subacute choroidal occlusive vasculopathy or central retinal artery embolism, not to mention the risk of ophthalmic artery obstruction, which was not observed in this series. Further analysis of the risks and benefits of SOAC will define its role within the therapeutic arsenal. Meanwhile, we suggest that SOAC should be given in one eye only and restricted to advanced cases of retinoblastoma, as an alternative to enucleation and/or external beam radiotherapy.

The use of donation after circulatory death (DCD) has increased significantly to face the persistent mismatch between supply and demand of organs for transplantation. While controlled (c) DCDs have warm ischemic time (WIT) that can be estimated, the WIT is often inexact and extended in uncontrolled DCD (uDCD), making assessment of injury difficult. We aimed at investigating the effects of cold ischemia on potential donor organ damage in the course of nRP by assessing the dynamic variations of transaminases and creatinine values in 17 uDCD donors. In our series, lactate values did not show significant changes during the study period (P = 0.147). Creatinine values did not significantly changed while transaminases progressive increased throughout the study period, even if it was significant only for AST (P = 0.035). According to our data, nRP duration affects splanchnic organs, being the liver sensitive to hypoperfusion, and serial biochemical measurements could help in detecting organ functional status.

To determine whether brain temperature measured by using preoperative proton magnetic resonance (MR) spectroscopy could help identify patients at risk for cerebral hyperperfusion after carotid endarterectomy (CEA).Institutional review board approval and informed consent were obtained. Acquisition of proton MR spectroscopic data by using point-resolved spectroscopy without water suppression was performed before CEA in the bilateral cerebral hemispheres of 84 patients with unilateral internal carotid artery stenosis (or =70%) and without contralateral internal carotid artery steno-occlusive disease. Brain temperature was calculated from the chemical shift difference between water and N-acetylaspartate signals at proton MR spectroscopy. Cerebral blood flow (CBF) was also measured by using single photon emission computed tomography and N-isopropyl-p-[(123)I]-iodoamphetamine before and immediately after CEA and on the 3rd postoperative day. The relationship between each variable and the development of post-CEA hyperperfusion (CBF increaseor = 100% compared with preoperative values) was evaluated with univariate statistical analysis followed by multivariate analysis.A linear correlation was observed between preoperative brain temperature difference (the value in the affected hemisphere minus the value in the contralateral hemisphere) and increases in CBF immediately after CEA (r = 0.763 and P.001) when the preoperative brain temperature difference was greater than 0. Cerebral hyperperfusion immediately after CEA was observed in nine patients (11%). Elevated preoperative brain temperature difference was the only significant independent predictor of post-CEA hyperperfusion. When elevated brain temperature difference was defined as a marker of hemodynamic impairment in the affected cerebral hemisphere, use of preoperative brain temperature difference resulted in 100% sensitivity and 87% specificity, with a 47% positive predictive value and a 100% negative predictive value for the prediction of post-CEA hyperperfusion. Hyperperfusion syndrome developed on the 3rd and 4th postoperative days in two of the nine patients who exhibited hyperperfusion immediately after CEA.Brain temperature measured by using preoperative proton MR spectroscopy may help identify patients at risk for post-CEA cerebral hyperperfusion.

BackgroundNormothermic regional perfusion, whereby the donor is placed on an extracorporeal circuit to circulate oxygenated blood to the abdominal viscera after death, is increasingly being used in controlled donation after circulatory death (DCD) donation. We evaluated the joint experience of the t

V / Q scintigraphy remains even today exceptionally well-suited for diagnosis of pulmonary embolism. The combination of ventilation and perfusion scintigraphy in this sequence is standard. Suitable tracers for ventilation scintigraphy are Technegas and Krypton-81m, with wet aerosols as second-choice alternatives. Acquisition in SPECT-technique is optimal. Regional perfusion defects with maintained ventilation (V / Q mismatch) correlate to pulmonary embolism without diagnostic limitations. Evaluation by means of PIOPED criteria should be rejected. Increased attention should be paid to partially-occluding embolisms, since they also influence the prognosis. Relevant alternative diagnoses refer to respiratory tract obstruction (V / Q match with intact v. Euler-Liljestrand reflex) and functional right-left shunt (V / Q reverse mismatch with impaired v. Euler-Liljestrand reflex).

Mesotheliome peritoneal : traitement par l’association chirurgie de cytoreduction et chimiotherapie hyperthermique intraperitoneale G. Passot, E. Cotte, C. Brigand, A.-C. Beaujard, S. Isaac, F.-N. Gilly, O. Glehen Le mesotheliome peritoneal malin est une pathologie rare dont l’evolution spontanee reste fatale. Les traitements locoregionaux, associant chirurgie de cytoreduction et chimiotherapie hyperthermique intraperitoneale (CHIP), paraissent ameliorer son pronostic. Methodes : Vingt-deux patients atteints de mesotheliome peritoneal ont ete traites par l’association chirurgie de cytoreduction et CHIP entre 1989 et 2006 au Centre Hospitalier Lyon Sud. Une analyse retrospective de la survie en fonction de facteurs pronostiques, cliniques, et histologiques a ete realisee. Resultats : Vingt-deux patients atteints de mesotheliome peritoneal ont ete inclus : 16 formes epitheliales, 3 formes biphasiques, 3 formes multikystiques. Seize patients presentaient une carcinose de stade 3 ou 4 selon la classification de Gilly. Une chirurgie optimale de cytoreduction (resection macroscopiquement complete ou nodules tumoraux residuels Conclusion : L’association chirurgie de cytoreduction et CHIP permet d’envisager des survies prolongees chez les patients presentant un mesotheliome peritoneal malin, dont la prise en charge doit se faire au sein d’un centre specialise.

Rationale and Objectives Pulmonary vascular control mechanisms are complex and likely to differ between species. We wish to quantify regional perfusion and the effects of gravity using computed tomography. Materials and Methods Sequential density measurements following the administration of a bolus of iodinated contrast medium were acquired from four healthy human subjects and four dogs. Results In humans, perfusion (Q) was linear throughout most of the range of vertical height, with an overall gradient of −2.6% cm−1. However, when perfusion was normalized to “tissue” density (blood plus tissue: sQt), maximum perfusion occurred around the mid-range of vertical height, being 9% (range 1–22%) greater than either the dorsal or ventral extreme. Within discrete transverse axial sections, concentric zones of perfusion centered on blood vessels were demonstrated. The relationship between sQt and vertical height in dogs was distinctly linear, with a gradient of −7.2% cm−1. In dogs, the median gradient of Q was −13.6% cm−1 (range −9.7 to −17.1%). Conclusions Differences in regional pulmonary perfusion, particularly the vertical gradient observed in humans and dogs, may in part reflect anatomic differences between the symmetric dichotomous branching structure of the human pulmonary vasculature and the more asymmetrical structure found in dogs.

Objective: To determine how memory-encoding tasks elicit functional perfusion change in subjects with amnestic mild cognitive impairment (aMCI). Methods: Twelve subjects with aMCI and 14 age-matched cognitively normal (CN) subjects were recruited for this study. Arterial spin-labeling perfusion MRI (ASL-MRI) was employed to measure regional cerebral blood flow (CBF) during both control and encoding task conditions. Results: Experimental results demonstrated that hypoperfusion occurred in the right precuneus and cuneus in the aMCI group, and not the CN group, during the control state. During the memory-task performance, the difference in these regional hypoperfusion areas extended to the posterior cingulate. These regional perfusion rates correlated with the Mini-Mental State Examination and the Rey Auditory Verbal Learning Test scores. In addition, a CBF percentage increase (22.7%) occurred in the right parahippocampus region during the memory-encoding task performance in the CN group, with approximately no change in the aMCI group. Conclusion: Subjects with amnestic mild cognitive impairment had significant regional cerebral hypoperfusion and lacked the dynamic capability to modulate their regional cerebral blood flow responses to the challenge of the functional tasks.

The PET tracer (82)Rb is commonly used to evaluate regional perfusion defects for the diagnosis of coronary artery disease. There is limited information on the quantification of myocardial blood flow and flow reserve with this tracer. The goal of this study was to investigate the use of a one-compartment model of (82)Rb kinetics for the quantification of myocardial blood flow.Fourteen healthy volunteers underwent rest and dipyridamole stress imaging with both (13)N-ammonia and (82)Rb within a 2-week interval. Myocardial blood flow was estimated from the time-activity curves measured with (13)N-ammonia using a standard two-compartment model. The uptake parameter of the one-compartment model was estimated from the time-activity curves measured with (82)Rb. To describe the relationship between myocardial blood flow and the uptake parameter, a nonlinear extraction function was fitted to the data. This function was then used to convert estimates of the uptake parameter to flow estimates. The extraction function was validated with an independent data set obtained from 13 subjects with documented evidence of coronary artery disease (CAD).The one-compartment model described (82)Rb kinetics very well (median R-square = 0.98). The flow estimates obtained with (82)Rb were well correlated with those obtained with (13)N-ammonia (r = 0.85), and the best-fit line did not differ significantly from the identity line. Data obtained from the subjects with CAD confirmed the validity of the estimated extraction function.It is possible to obtain accurate estimates of myocardial blood flow and flow reserve with a one-compartment model of (82)Rb kinetics and a nonlinear extraction function.

Regional perfusion imaging (RPI) based on pulsed arterial spin labeling and angulated inversion slabs has been recently proposed. The technique allows mapping of individual brain perfusion territories of the major feeding arteries and could become a valuable clinical tool for evaluation of patients with cerebrovascular diseases. Here we propose a new labeling scheme for RPI where lateral and posterior circulations are labeled simultaneously. Two scans instead of three are sufficient to obtain the same perfusion territories as in the original approach, allowing for a 33% reduction in the total RPI protocol time. Moreover, the position of the inversion slabs with respect to vascular anatomy facilitates the planning and allows potentially better labeling efficiency. The new approach was tested on seven healthy volunteers and compared to the original labeling scheme. The results showed that the same perfusion territories and regional CBF values can be obtained.

Much has been learned in the past decade about osteomyelitis. The inhibitory mechanisms of the "biofilm slime" layer that is formed by bacterial extracapsular exopolysaccharides and binds to bone, joints, and implants are now better understood than in the past. The surface colonization of bacteria that occurs within these biofilms is a biologic phenomenon that is somewhat unique to orthopedic infections. This survival strategy of bacteria is effective, and it is important for veterinarians who treat osteomyelitis to be aware of current diagnostic and therapeutic treatment modalities. The practitioner should be aware of the most common bacteria associated with osteomyelitis and the traditional treatments that are still used. Current therapeutic treatment modalities, such as antibiotic- impregnated polymethylmethacrylate, antibiotic-impregnated plaster of Paris, and regional perfusion, have become routine, however, and have been responsible for improving the prevention and outcome of osteomyelitis in the horse. It is the intent of this article to make equine veterinarians aware of current information as well as the future treatments of osteomyelitis.

Resume Introduction Le carcinome neuroendocrine cutane primitif ou tumeur de Merkel est une tumeur rare. Sa taille est parfois importante du fait de frequents retards au diagnostic. Le traitement habituel associe une exerese chirurgicale large et une radiotherapie complementaire. Observation Une femme de 69 ans consultait pour une volumineuse tumeur de Merkel de la jambe droite. L’imagerie par resonance magnetique montrait une tumeur envahissant les plans profonds et des lesions satellites. Il n’y avait pas de metastase ganglionnaire regionale ou viscerale. Afin d’eviter une amputation, une chimiotherapie locoregionale extracorporelle de type membre perfuse isole avec du melphalan etait delivree et permettait d’obtenir une remission complete en quelques mois. Cette remission complete persistait 5 ans et demi apres le traitement avec des sequelles moderees : une sclerose cutanee, une hyperpigmentation et une discrete raideur de la cheville. Discussion .A notre connaissance, seuls cinq cas de tumeur de Merkel traites par chimiotherapie de type membre perfuse isole ont ete rapportes dans la litterature : quatre cas de recidives locales et une tumeur primitive avec adenopathie regionale. Un seul de ces malades etait toujours en remission complete 18 mois apres le traitement. La chimiotherapie de type membre perfuse isole peut avoir une indication dans le traitement des tumeurs de Merkel evoluees d’un membre sans atteinte osseuse et sans metastase ganglionnaire regionale.

Pulsed arterial spin labeling (ASL) techniques have been theoretically and experimentally validated for cerebral blood flow (CBF) quantification. In this study ASL-FAIRER was used to measure regional pulmonary blood flow (rPBF) in seven healthy subjects. Two general ASL strategies were investigated: 1) a single-subtraction approach using one tag-control pair acquisition at an inversion time (TI) matched to the RR-interval, and 2) a multiple-subtraction approach using tag-control pairs acquired at various TIs. The mean rPBF averaged 1.70 +/- 0.38 ml/min/ml when measured with the multiple-subtraction approach, and was approximately 2% less when measured with the single-subtraction method (1.66 +/- 0.24 ml/min/ml). Assuming an average lung density of 0.33 g/ml, this translates into a regional perfusion of approximately 5.5 ml/g/min, which is comparable to other measures of pulmonary perfusion. As with other ASL applications, a key problem with quantitative interpretation of the results is the physical gap between the tagging region and imaged slice. Because of the high pulsatility of PBF, ASL acquisition and data analysis differ significantly between the lung and the brain. The advantages and drawbacks of the single- vs. multiple-subtraction approaches are considered within a theoretical framework tailored to PBF.

Purpose To assess the accuracy of a model-based approach for registration of myocardial dynamic contrast-enhanced (DCE)-MRI corrupted by respiratory motion. Materials and Methods Ten patients were scanned for myocardial perfusion on 3T or 1.5T scanners, and short- and long-axis slices were acquired. Interframe registration was done using an iterative model-based method in conjunction with a mean square difference metric. The method was tested by comparing the absolute motion before and after registration, as determined from manually registered images. Regional flow indices of myocardium calculated from the manually registered data were compared with those obtained with the model-based registration technique. Results The mean absolute motion of the heart for the short-axis data sets over all the time frames decreased from 5.3 ± 5.2 mm (3.3 ± 3.1 pixels) to 0.8 ± 1.3 mm (0.5 ± 0.7 pixels) in the vertical direction, and from 3.0 ± 3.7 mm (1.7 ± 2.1 pixels) to 0.9 ± 1.2 mm (0.5 ± 0.7 pixels) in the horizontal direction. A mean absolute improvement of 77% over all the data sets was observed in the estimation of the regional perfusion flow indices of the tissue as compared to those obtained from manual registration. Similar results were obtained with two-chamber-view long-axis data sets. Conclusion The model-based registration method for DCE cardiac data is comparable to manual registration and offers a unique registration method that reduces errors in the quantification of myocardial perfusion parameters as compared to those obtained from manual registration. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc.

The behaviour of the heart has always elicited interest and particularly the study of its myocardium, as 5-10% of the blood pumped by the heart is passed through the coronary arteries to the myocardium itself. An in-depth investigation of the myocardium behaviour is useful. The present work aims to investigate how myocardium perfusion is influenced by myocardial stress and diseased states, and in general by LV pumping abnormalities. LV myocardial perfusion can then serve as a possible index of the capacity of the LV to respond to its work demand, and thus of the risk of heart failure. The poroelastic analysis of the myocardium based on finite element method (FEM) for regional perfusion through a rectangular element with various physiological ranges of loading conditions was studied.

Wound management in equine patients can be very challenging. Bacterial infection of traumatic wounds or surgical incisions compromises healing and further complicates wound management. This paper focuses on recent advances in the management of severely infected wounds, with particular attention paid to selection of antimicrobial agents and to methods for optimizing delivery and efficacy of antimicrobial drugs at the site of infection.

We have developed a new quantitative single-photon-emission computed tomography (SPECT) method that uses113mIn-labeled albumin macroaggregates and Technegas (99mTc) to estimate the distributions of regional ventilation and perfusion for the whole lung. The multiple inert-gas elimination technique (MIGET) and whole lung respiratory gas exchange were used as physiological evaluations of the SPECT method. Regional ventilation and perfusion were estimated by SPECT in nine healthy volunteers during awake, spontaneous breathing. Radiotracers were administered with subjects sitting upright, and SPECT images were acquired with subjects supine. Whole lung gas exchange of MIGET gases and arterial Po2and Pco2gases was predicted from estimates of regional ventilation and perfusion. We found a good agreement between measured and SPECT-predicted exchange of MIGET and respiratory gases. Correlations ( r2) between SPECT-predicted and measured inert-gas excretions and retentions were 0.99. The method offers a new tool for measuring regional ventilation and perfusion in humans.

BACKGROUND: This study was conducted to assess the best available evidence for the use of isolated limb perfusion. METHODS: Following the principles of Evidence-Based Medicine, we reviewed the best available evidence for isolated limb perfusion (ILP) for melanoma and soft tissue sarcoma (STS) of the limb. RESULTS: Adjuvant ILP with melphalan (M-ILP) to wide local excision cannot be recommended for patients with primary melanoma with a limited regional benefit and no increase in overall survival (level 1b evidence). Prophylactic M-ILP next to the excision of recurrent melanoma has resulted in a nonsignificant decrease in recurrence rate (33% to 50%), with a significantly longer recurrence-free interval (10 to 17 months), but no survival benefit (level 2b evidence). Therapeutic M-ILP, with or without tumor-necrosis factor alpha and interferon gamma (T(I)M-ILP), seems indicated in unresectable melanoma (level 3 to 4 evidence). In unresectable STS of the limbs, limb salvage can be obtained in 57% to 86% of patients with neoadjuvant T(I)M-ILP (level 3 evidence). A comparison of level 3 to 4 studies on ILP and other neoadjuvant treatment modalities for unresectable STS shows that ILP results in the highest limb salvage rate with the lowest complication rate. CONCLUSIONS: Based on level 3 to 4 evidence, ILP is indicated in unresectable locoregional (recurrent) melanoma and unresectable STS of the limbs. Level 1 and 2b evidence does show an effect of prophylactic ILP on micrometastatic disease in locoregional (recurrent) melanoma of the limb. ILP seems the most effective limb sparing, neoadjuvant treatment modality when compared with other neoadjuvant treatment options for unresectable STS of the limb (level 3 to 4 evidence), although randomized studies are lacking

A 2-week-old Morgan filly examined because of lameness of 5 days' duration was found, on the basis of clinical and radiographic findings, to have septic physitis of the distal end of the radius. The foal was treated by means of intraosseous regional perfusion with penicillin and amikacin and systemic administration of antimicrobials. Intraosseous regional perfusion was performed 3 times. The foal was anesthetized for the first episode of intraosseous regional perfusion, but was only sedated for the subsequent 2 episodes. Antimicrobials were administered systemically for 22 days. Foals with septic physitis are typically considered to have a guarded to poor prognosis for recovery; however, this treatment regimen resulted in relatively fast and uncomplicated resolution of the infection in this foal.