We hypothesized that tissue hyperoxia would enhance and hypoxia inhibit neovascularization in a wound model. Therefore, we used female Swiss-Webster mice to examine the influence of differential oxygen treatment on angiogenesis. One milliliter plugs of Matrigel, a mixture of matrix proteins that supports but does not itself elicit angiogenesis, were injected subcutaneously into the mice. Matrigel was used without additive or with added vascular endothelial growth factor (VEGF) or anti-VEGF antibody. Animals were maintained in hypoxic, normoxic, or one of four hyperoxic environments: hypoxia -- 13 percent oxygen at 1 atmosphere absolute (ATA); normoxia -- 21 percent oxygen at 1 ATA; hyperoxia -- (groups a-d) 100 percent oxygen for 90 minutes twice daily at the following pressures: Group a, 1 ATA; Group b, 2 ATA; Group c, 2.5 ATA; Group d, 3.0 ATA. Subcutaneous oxygen tension was measured in all groups. The Matrigel was removed 7 days after implantation. Sections were graded microscopically for the extent of neovascularization. Angiogenesis was significantly greater in all hyperoxic groups and significantly less in the hypoxic group compared with room air-exposed controls. Anti-VEGF antibody abrogated the angiogenic effect of both VEGF and increased oxygen tension. We conclude that angiogenesis is proportional to ambient pO(2) over a wide range. This confirms the clinical impression that angiogenesis requires oxygen. Intermittent oxygen exposure can satisfy the need for oxygen in ischemic tissue.

Scarring is considered a major medical problem that leads to cosmetic and functional sequelae. Scar tissue is clinically distinguished from normal skin by an aberrant color, rough surface texture, increased thickness (hypertrophy), occurrence of contraction, and firmness. Marked histologic differences are the change in dermal architecture and the presence of cells such as the myofibroblast. Many assessment tools are available for analysis of pathologic conditions of the skin; however, there is no general agreement as to the most appropriate tools for evaluation of scar tissue. This review critically discusses currently available objective measurement tools, subjective assessment tools, and potential devices that may be available in the future for scar assessment.

The authors' findings at Temple University Hospital may help to alert health care providers to take necessary steps to control the spread of methicillin-resistant S. aureus in the community and in the inpatient setting. Cultures should be carefully followed and infections should be treated with appropriate antibiotics.

The applicability of simple methods to measure the size of pathological skin lesions for management and research has been poorly studied to date. The interobserver reliability and accuracy (validity) was established for planimetry by photography and planimetry by tracing on a transparent sheet in this study. Drawings of 25, 50, and 75 cm(2) were created on 3 locations with increasing curvature (back, thigh, and forearm) in 20 healthy volunteers. Three investigators evaluated the drawings by both planimetry techniques. Both techniques showed a good reliability (r >or= 0.82, intraclass correlation) for 25 cm(2) areas. Planimetry by photography was more reliable than planimetry by tracings for the 50 -and 75-cm(2) areas and was more accurate than planimetry by tracing for all areas except for the area with the greatest curvature, the forearm. The study permits the conclusion that planimetry by photography is more suitable for surface area measurements than planimetry by tracing except for extremely curved body parts, where it is likely that effects of distortion supervene.

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uxtahepatic inferior vena cava (IVC) injuries are a continuing surgical challenge and a source high morbidity and mortality (50 -100%). 1-17 Surgical techniques have ranged from direct repair 1,3,4,18 -28 to lobar resection 29 to tamponade with packs, omentum, or both. 30 -35 Additional maneuvers used for the management of these caval injuries have been atriocaval shunting 18,21,23,36 -38 and deep hypothermic circulatory arrest. 39 However, despite these techniques, the survival rate remains low. This article presents a patient with a juxtahepatic vena cava penetrating injury managed by a novel approach of interventional endovascular isolation followed by primary repair. This method was found to be safe, simple, and effective. CASE REPORTA 24-year-old old African American man sustained a gunshot wound to the right flank. He was initially alert, with a Glasgow Coma Scale of 15, but was hypotensive (86/60 mm Hg) and tachycardic (128 beats per minute). A chest radiograph showed a right hemothorax. Through a 36-Fr chest tube placed in the right chest, 100 mL of blood was initially obtained. Simultaneously, two 8-Fr introducers were placed, one in the left femoral vein and another in the left subclavian vein, through which crystalloid fluid was administered. A positive focused abdominal sonography for trauma showed free peritoneal blood. The patient was intubated and brought emergently to the operating room.Exploratory laparotomy showed massive hemoperitoneum, a complex through and through right hepatic lobe wound, and a grade 2 splenic laceration. There was ongoing hemorrhage from behind the liver despite a Pringle maneuver. A Kocher maneuver was performed. A 1.5-cm hole was seen in the right posterolateral IVC 1 cm inferior to the bare area of the liver. The proximity of the tear to the lower edge of the liver prevented adequate vascular control. Direct digital pressure was used to control the hemorrhage and allow further resuscitation.Intraoperative consultation with vascular surgery was requested, and a decision made to proceed with balloon tamponade for proximal and distal control. Percutaneous access for distal control was through a left groin introducer previously placed in the trauma bay for resuscitation. Under fluoroscopic guidance, a guidewire was passed without difficulty though this introducer to the IVC and palpated in the vena cava to confirm appropriate positioning. A 27-mm occlusion balloon catheter (Boston Scientific, Natick, MA) was passed over the guidewire and positioned just inferior to the injury. A right internal jugular catheter was placed, and through this, another 27-mm balloon catheter was passed to the IVC just superior the injury site for proximal control.Finger tamponade of the IVC injury was continued for hemorrhage control. This also confirmed correct balloon catheter positioning above and below the injury. The balloons were inflated with contrast agent and provided excellent hemostasis (Fig. 1).The laceration was exposed and repaired with pledgeted sutures of 4-0 polytetrafluoroeth...

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