Effects in post-menopausal women of transdermal estrogen associated with progestin upon the removal from the plasma of a microemulsion that resembles low-density lipoprotein (LDL)

Objective: To evaluate the effects of transdermal estradiol and medroxyprogesterone acetate (MPA) treatment on the removal from the plasma of a cholesterol-rich microemulsion (LDE) that roughly resembles low-density lipoprotein (LDL) structure and that binds to LDL receptors. Methods: Ten healthy post-menopausal women were studied before and after 3-month treatment with transdermal estradiol in the following dosages administered every 3.5 days: 25, 50, 50, 100, 100, 50, 50 and 25 μg. From the 15th to the 21st day and from the 22nd to the 28th day of estrogen treatment, respectively, 10 and 5 mg q.d. MPA per oral were associated to the transdermal estrogen. The emulsion labeled with ¹⁴C-cholesteryl oleate was injected after 12 h fasting and its fractional catabolic rate (FCR) was calculated from the plasma decaying curves of the isotope. Results: Treatment reduced LDL-cholesterol levels by 8% only (149.0 ± 36.0 mg/dl, 138.0 ± 27.0 mg/dl; P = 0.046), but the FCR of LDE expressed in medians (25%; 75%) increased from 0.0054 (0.003; 0.052) h⁻¹ to 0.021 (0.009; 0.10) h⁻¹, P = 0.002. Conclusion: The association used in this study so as to mimic the increasing–decreasing pattern of the hormonal ovarian production reduced modestly LDL-cholesterol levels but pronouncedly increased the lipoprotein removal as tested by LDE FCR.     

Breast reconstruction with polyurethane implants: preliminary report

Today, immediate breast reconstruction is widely accepted in breast cancer surgery. There are many reconstruction procedures that combine cancer indications with patient's expectations. Improved techniques in the use of textured or polyurethane-coated implants and tissue expanders, associated with increasingly more conservative mastectomy procedures, may result in better cosmetic outcomes and less complications, even in patients that require postoperative radiotherapy. From June 2002 to December 2008, 166 unilateral breast reconstructions were performed immediately using definite prosthesis with polyurethane-coated (6) or textured (24) implants, or later, after implant of 136 tissue expanders, using polyurethane-coated (113) or textured (23) implants. Eighty-six two-stage breast reconstructions were irradiated where later 63 polyurethane-coated implants and 23 textured implants have been inserted. Results were analysed evaluating complications associated with temporary expanders and with the two definite implants, with or without RT, respectively. Excluding capsular contracture, total complication rate was 14.7% with expanders, 5.0% with polyurethane implants and 12.8% with textured implants. In this study, severe capsular contracture was reported in 21.7% of cases with textured prosthesis and in 6.3% of cases with polyurethane implants in patients receiving RT. This difference was statistically significant. As of today, no case of clinically noticeable capsular contracture was seen in non-irradiated patients receiving breast reconstruction with polyurethane-coated implants. These results allow us to establish RT, which is not a severe contraindication to breast reconstruction with implants. Polyurethane implants have provided encouraging results either in terms of lower complication rate and likelihood of capsular contracture.     

Characterization of yellow-pigmented enterococci from severe human infections.

Four strains of yellow-pigmented enterococci that resembled the species Enterococcus casseliflavus were isolated from patients who had undergone surgical treatment. They were substantially homologous in terms of biochemical properties, antibiotic susceptibilities, and plasmid DNA profiles. Yellow-pigmented enterococci could be another potentially important cause of nosocomial infection in surgical units.