Retrospective case review of capsular contracture after two-stage breast reconstruction: is colonization of the tissue expander pocket associated with subsequent implant capsular contracture?

Periprosthetic capsular contracture is a common problem associated with implant-based breast reconstruction. The purpose of this study was to determine if bacterial colonization of the tissue expander contributes to contracture of the permanent implant. Medical records were reviewed for 86 patients (124 tissue expanders) between 1997 and 2001 in 1 institution. Three specimens taken from the expander were cultured. The overall incidence of colonization was 42.7%; 49.4% (38.8-60.0) of immediate and 28.2% (14.1-42.3) of delayed expanders had at least 1 positive culture site (P = 0.043). The most common organisms were Propionibacterium acnes (57.6%), Staphylococcus epidermidis (31.0%), and Peptostreptococcus (5.8%). Statistical analysis revealed no significant difference between colonization of the expander and capsular contracture of the permanent prosthesis (P = 0.59). 45.8% (25.9-65.8) of breasts irradiated preoperatively developed contracture versus 14% (7.2-20.8) with no irradiation (P = 0.0013). These results suggest that colonization of the expander occurs frequently, irradiation predisposes to contracture, and colonization did not contribute to secondary implant contracture in this study population.     

The evaluation of change in pain intensity: a comparison of the P4 and single-item numeric pain rating scales

STUDY DESIGN: Prospective observation study. OBJECTIVES: To compare the test-retest reliability and longitudinal validity (sensitivity to change) of 2 single-item numeric pain rating scales (NPRSs) with a 4-item pain intensity measure (P4). BACKGROUND: Pain is a frequent outcome measure for patients seen in physical therapy; however, the error associated with efficient pain measures, such as the single-item NPRS, is greater than for self-report measures of functional status. Initial evaluation of the P4 suggests that it is more reliable and sensitive to change than the NPRS. METHODS AND MEASURES: Two single-item NPRSs and the P4 were administered on 3 occasions--initial visit (n = 220), within 72 hours of baseline (n = 213), and 12 days following baseline assessment (n = 183)--to patients with musculoskeletal problems receiving physical therapy. Reliability was assessed using a type 2,1 intraclass correlation coefficient. Longitudinal validity was assessed by correlating the measures' change scores with a retrospective rating of change that included patients' and clinicians' perspectives. RESULTS: The test-retest reliability and longitudinal validity of the P4 were significantly greater (P1<.05) than both single-item NPRSs. Minimal detectable change of the P4 at the 90% confidence level was estimated to be a change of 22% of the scale range (9 points) compared to 27.3% (3 points) and 31.8% (3.5 points) for the 2-day NPRS and 24-hour NPRS, respectively. CONCLUSIONS: The findings of this study suggest the P4 is more adept at assessing change in pain intensity than popular versions of single-item NPRSs.     

Interstitial quinacrine activates a distinctive immune response effective for tumor immunotherapy

BACKGROUND: Interstitial immunotherapy consists of the local injection of immune cells or molecules with cytotoxic properties to destroy neoplastic cells. Intratumor injection of quinacrine induces intense recruitment of activated immune cells that leads to necrosis and elimination of experimental malignant neoplasms; this effect seems to be mediated by immune molecules. METHODS: We measured the tissue content of activated immune cells and various cytokines at different times during the first 8 days after a single interstitial injection of 150 mg quinacrine in rats. RESULTS: A large cell infiltrate by macrophages, CD4(+), CD8(+), and natural killer cells was evident a few hours after quinacrine injection. In comparison with controls, tissue contents of 4 cytokines had a marked increase: macrophage chemoattractant protein-1 increased 115-fold; interleukin-6, 9-fold; RANTES (regulated on activation, normal T cell expressed and secreted), 13-fold; and macrophage inflammatory protein-2, 10-fold. Other cytokines, like interleukins 1beta, 2, 4, 10, interferon-gamma, tumor necrosis factor-alpha, complement 3, and C reactive protein did not increase significantly, indicating that the endogenous local response to quinacrine follows a singular pathway of immune activation. CONCLUSIONS: Interstitial quinacrine is a strong activator of innate immunity and is not mediated by the usual mechanisms of immune recognition. It constitutes an original approach for regional immunotherapy of neoplasms that is not mediated solely by induction of local, cytotoxic chemical necrosis.     

Possible role of substance P in the ischemia-reperfusion injury in the isolated rabbit lung

The origin of the endothelial damage leading to the ischemia-reperfusion injury after lung transplantation has not been elucidated. We postulated that neurotransmitters released during the preservation of the donor lung might explain this vascular derangement. Thus, in isolated rabbit lungs preserved over 24 hours, we evaluated the release of acetylcholine (ACh) and substance P (SP), the activity of their major degrading enzymes, acetylcholinesterase (AChE) and neutral endopeptidase (NEP), and changes in the capillary permeability. Both neurotransmitters showed the highest release rate in the first 15 minutes, followed by a sharp exponential decrement at 1, 6, 12 and 24 hours. AChE and NEP activities showed no variation at these time intervals. Basal capillary permeability significantly increased (P<0.01) after 24 hours preservation with saline. This increased permeability was avoided (P<0.01) by the SP fragment 4-11 (an SP receptors antagonist), but not by atropine. These results suggest for the first time a pathogenic role of SP in the ischemia-reperfusion injury, and thus the potential usefulness of SP antagonists as additives in the lung preservation solutions should be explored.     

Open Minimally Invasive Parathyroid Surgery

Outpatient minimally invasive parathyroidectomy (MIP) employs (1) preoperative parathyroid localization with high quality sestamibi scans, (2) cervical block anesthesia, (3) limited exploration, and (4) the rapid intraoperative parathyroid hormone assay to confirm an adequate resection. The technical aspects of this procedure are described, and the results obtained in 255 patients who underwent MIP are compared with those of 401 patients who underwent conventional bilateral cervical exploration under general anesthesia. MIP and standard exploration were indistinguishable with regard to high cure and low complication rates. MIP, however, was superior with regard to operating time, length of hospital stay, patient comfort, and costs.This article was presented at the International Association of Endocrine Surgeons meeting in Uppsala, Sweden, June 13–17, 2004.     

The Dutch Heart Health community intervention 'Hartslag Limburg': results of an effect study at individual level

'Hartslag Limburg' (Dutch for Heartbeat Limburg), a regional cardiovascular diseases (CVD) prevention program, integrates a community strategy and a high-risk strategy to reduce CVD risk behaviors. The present paper focuses on the effects of the community intervention on fat intake and physical activity. The project was based on community organization principles and health education theories and methods. In order to implement the intervention, nine local Health Committees were set up, each organizing activities that facilitate and encourage people to adopt a healthier lifestyle. A pre-test-post-test control group design with two post-tests was used to evaluate the intervention. At baseline, representative random cohort research samples were selected in the Maastricht region and in a control region. Data on fat intake and physical activity, and on the psychosocial determinants of these behaviors, were gathered by means of mail surveys. The present study indicates that the intervention had a significant effect on fat reduction, especially among respondents aged 相似文献   

Staging the menopausal transition: Data from the TREMIN Research Program on Women’s Health

The present study was conducted to test the assumptions of a staging system of reproductive aging that was proposed at the Stages of Reproductive Aging Workshop (STRAW) in 2001. Using longitudinal data provided by 100 women over a period of 3-12 years, we asked whether midlife women move in a uniform progression from pre- to peri- to postmenopause, as refuted by earlier studies but proposed by the STRAW model, or whether they differ from this assumed pattern. Participants were recruited from the TREMIN Research Program on Women's Health, the oldest ongoing study of menstruation and women's health in the world. Eligibility criteria included reaching menopause during the course of the study and not using exogenous hormones. Participants provided annual self-reports of menopausal stage based on observations of their menstrual cycles ("regular," "changing," and "menopausal"). Findings revealed a lack of uniformity as women progressed toward menopause. From 8 to over 20 different perimenopausal stage patterns were observed, depending on the analysis. While the most common pattern was to progress from regular to changing to menopause, some women experienced menstrual bleeding after a year or more of amenorrhea, others flip-flopped between stages, and still others skipped directly from regular bleeding to menopause. We conclude that there is considerable variation in women's movement across menopausal status categories and urge researchers to accommodate such findings in their model building.     

Work organization, area labor-market characteristics, and depression among U.S. nursing home workers: a cross-classified multilevel analysis

Associations between forms of work organization that follow globalization and depression were examined in U.S. nursing home assistants. A cross-sectional study of 539 nurse assistants in 49 nursing homes in three states in 2000 assessed nursing home ownership type, managerial style, wage policy, nurse assistants' emotional stresses, and area labor-market characteristics (county income inequality, median household income, and social capital) in relation to the prevalence of depression among the nurse assistants. A cross-classified multilevel analysis was used. For-profit ownership, emotional strain, managerial pressure, and lack of seniority pay increases were associated with depression. Labor-market characteristics were not associated with depression once work organization was taken into account. The deregulation of the nursing home industry that accompanies globalization is likely to adversely affect the mental health of nursing home assistants.