Secondary breast reconstruction with deepithelialized free flaps from the lower abdomen for intractable capsular contracture and maintenance of breast volume

Although surgical techniques and the quality of mammary prostheses have been improved significantly in recent years, capsular contracture attendant on prosthetic mammary reconstruction remains a major flaw. Although rarely, some patients are confronted with recurrent and intractable capsular contractures with resultant breast deformity, even after multiple attempts at capsulectomies and implant exchange. Patients with recurrent capsular contracture often do not want replacement with a new prosthesis, but desire the maintenance of their breast volume with a safe alternative. In an attempt to maintain breast volume and to improve the aesthetic appearance, secondary breast reconstruction using bilateral deepithelialized free flaps from the lower abdomen was performed in a series of seven patients. Three bilateral muscle-sparing TRAM flaps, two bilateral DIEP flaps, one bilateral SIEA flap, one unilateral SIEA flap, and one unilateral DIEP flap (a total number of 14 flaps) were used following implant removal, total capsulectomy, and prophylactic subcutaneous mastectomy. The early postoperative course was uneventful, and all flaps survived completely with no complications. There were no donor-site problems, except in one patient (case 5), who had partial skin necrosis of the abdominal flap. The long-term results (mean follow-up: 4.8 years) demonstrated an aesthetically satisfactory appearance of the breasts, with no major donor-site problems. Several advantages, as well as drawbacks, are highlighted with this technique.     

Laryngeal dysplasia: aetiology and molecular biology

Laryngeal premalignancy is a common clinical concern. While tobacco has long been established as the principal identifiable aetiological factor, the last two decades have seen publications investigating a potential role for gastroesophageal reflux, gastrectomy and human papilloma virus. Furthermore, there have been major advances in our understanding of the molecular biology of cancer and premalignancy. Accompanying this increased understanding, significant efforts have been made to correlate the expression of molecular markers with the clinical course of premalignant laryngeal lesions. This review summarizes current knowledge of the aetiological factors and molecular biology of laryngeal premalignancy. All aetiological factors, including molecular markers, are discussed separately and their possible role in the clinical course of these lesions is discussed.     

Effects of maturation on parameters used for pass/fail criteria in neonatal hearing screening programmes using evoked otoacoustic emissions

We aimed to investigate the incidence of false alarms that occurred with the pass/fail criteria used in a published series of neonatal hearing screening programmes, as a function of age. We analysed the database of 19137 normally hearing babies (38274 ears) tested in the Wessex Universal Neonatal Hearing Screening Project. Otoacoustic emissions were recorded prior to discharge from maternity units, using IL088 equipment. We assessed the pass/fail rate using the Wessex criteria and 10 other pass/fail criteria published in the literature. Using Pearson's correlation coefficient, a statistically significant correlation between signal-to-noise ratio at each of the frequency bands 1, 2, 3, 4 and 5 kHz and babies' age in hours at the 0.01 level was identified. The correlation was also significant (0.01 level) between age and frequency reproducibility in each of the bands at 1, 2, 3, 4 and 5 kHz as well as the whole reproducibility. The number of false alarms reduced significantly after the first 24 h of life with all the criteria examined. We conclude that in the first hours after birth due to insufficient maturation of the otoacoustic emission, there is a high rate of false alarms. This increase in the false alarm rate, whilst dependent on the criteria used, occurs with all criteria. This leads to the consideration of whether the establishment of age-dependent pass/fail criteria could reduce the false alarm rate and the subsequent strain on diagnostic centres.     

Preferential diaphragmatic weakness during sustained Pseudomonas aeruginosa lung infection

Infection with Pseudomonas aeruginosa plays a major role in the pulmonary inflammation and injury associated with cystic fibrosis. Lung inflammation may also lead to more widespread systemic effects on other organs. We tested the following hypotheses: (1) ongoing P. aeruginosa lung infection produces diaphragmatic and limb muscle weakness and (2) such muscle dysfunction is directly correlated with the level of pulmonary inflammation. Chronic bronchopulmonary infection with mucoid P. aeruginosa was induced in C57BL/6 mice. At Day 2 after infection, diaphragmatic force was decreased (37%) only in mice infected with a high dose of 1 x 10(6) cfu, whereas by Day 7 after infection, diaphragmatic force was similarly reduced (36%) even at a fivefold lower inoculating dose. No significant correlations were found between diaphragmatic weakness and pulmonary inflammation, as assessed by the number of neutrophils, macrophages, and lymphocytes in bronchoalveolar lavage fluid. Moreover, in marked contrast to the diaphragm, no effects of P. aeruginosa infection on contractile function were observed in prototypical slow- and fast-twitch hindlimb muscles. We conclude that sustained lung infection with P. aeruginosa induces preferential weakness of the diaphragm, which is not directly correlated with the degree of pulmonary inflammation induced under these conditions.     

Effective Wound Closure With a New Two-Component Wound Closure Device (Prineo™) in Excisional Body-Contouring Surgery: Experience in Over 200 Procedures

Background  

In excisional body-contouring surgery the surgeon is often confronted with time-consuming closure of long wounds. Recently, a new combination of a self-adhering mesh together with a liquid 2-octyl cyanoacrylate adhesive (Prineo™; Ethicon, Inc., Somerville, NJ, USA) has been introduced to replace intracutaneous running suture.     

Custom-made tissue expanders in reconstructive surgery for challenging skin defects

Background

Tissue expansion is a simple yet versatile surgical technique. Skin defects come in a variety of shapes and dimensions, and in specific reconstructive situations, the catalogued tissue expanders may be of limited suitability producing expanded skin that is not readily compatible with the defect leading to additional scarring and unsatisfactory results. In patients with specific requirements, we have successfully used specially designed tissue expanders to facilitate the reconstruction with reduced morbidity. The aim of the study was to present our experience, indications and outcome of custom-made tissue expanders in resurfacing defects in areas with limited tissue availability.

Methods

Thirty-two textured custom-made tissue expanders were used in 16 patients for skin defects. Indications included eight traumas and eight congenital defects. Custom-made tissue expanders with specified locations for the valves were used in combination with advancement of skin to suit specific reconstructive requirements and minimize scarring.

Results

Custom-made tissue expanders are ideal in certain circumstances to improve the quality of skin reconstruction with reduced morbidity. Skin necrosis was seen in one smoking patient.

Conclusions

In specific reconstructive situations where catalogued tissue expanders are not suitable, custom-made tissue expanders are preferable to optimize results of skin reconstruction with minimal added cost. Level of Evidence: Level IV, therapeutic study.     

Local nasal immunotherapy and bronchial hyperreactivity in seasonal allergic rhinitis: an observational pilot study.

The clinical efficacy of local nasal immunotherapy (LNIT) in patients with allergic rhinitis is amply documented. The aim of the study was to determine the effect on bronchial hyperresponsiveness (BHR) assessed at baseline and after 3 years of LNIT or pharmacological treatment alone. Forty-three randomized patients with allergic oculorhinitis were enrolled (26 positive to Graminaceae and 17 to Parietaria judaica pollens). All patients were asked whether they were willing to follow a 3-year treatment course involving preseasonal LNIT with a powder extract of Graminaceae or Parietaria pollens. Twenty-four patients (16 allergic to Graminaceae and eight to Parietaria) selected LNIT and the other 19 opted for symptomatic pharmacological treatment only. The latter was considered the control group. On the basis of positive or negative bronchial hyperresponsiveness and the LNIT, four subgroups were established and followed in open conditions, during which a record was kept of symptom scores, drug use, spirometry and methacholine test findings. After 3 years, patients treated with LNIT had a significant reduction of symptoms and drug intake. In the controls, symptoms worsened, thus requiring more drugs to control them. Bronchial hyperresponsiveness significantly improved in hyperreactive patients receiving LN7IT 10 of whom were no longer hyperreactive and one at a higher threshold. Among controls, bronchial hyperresponsiveness did not change, with the exception of three nonreactive patients who became hyperreactive, one of them with asthma. These findings confirm the efficacy of LNIT in allergic rhinitis suggesting that it might have systemic activity interfering with bronchial hyperresponsiveness and hence the onset of bronchial asthma.     

Hepatoprotective effect of tempol on oxidative toxic stress in STZ-induced diabetic rats

Tempol is a synthetic antioxidant. Since many studies revealed the protective effect of antioxidants on liver, current study was performed to assess the hepatoprotective effects of tempol on streptozotocin induced diabetic rats. Blood glucose, oxidative toxic stress (OTS) biomarkers and liver enzymes were measured. Findings showed that tempol significantly decreased serum levels of glucose in tempol treated group. Also treatment with tempol significantly reduced AST and ALT compared to diabetic control group (p?相似文献   

Genetic study of the PAH locus in the Iranian population: familial gene mutations and minihaplotypes

Phenylketonuria (PKU), one of the most common inborn errors of amino acid metabolism, is caused by mutations in the phenylalanine hydroxylase (PAH) gene (PAH). PKU has wide allelic heterogeneity, and over 600 different disease-causing mutations in PAH have been detected to date. Up to now, there have been no reports on the minihaplotype (VNTR/STR) analysis of PAH locus in the Iranian population. The aims of the present study were to determine PAH mutations and minihaplotypes in Iranian families with PAH deficiency and to investigate the correlation between them. A total of 81 Iranian families with PAH deficiency were examined using PCR-sequencing of all 13 PAH exons and their flanking intron regions to identify sequence variations. Fragment analysis of the PAH minihaplotypes was performed by capillary electrophoresis for 59 families. In our study, 33 different mutations were found accounting for 95% of the total mutant alleles. The majority of these mutations (72%) were distributed across exons 7, 11, 2 and their flanking intronic regions. Mutation c.1066-11G > A was the most common with a frequency of 20.37%. The less frequent mutations, p.Arg261Gln (8%), p.Arg243Ter (7.4%), p.Leu48Ser (7.4%), p.Lys363Asnfs*37 (6.79%), c.969 + 5G > A (6.17%), p.Pro281Leu (5.56), c.168 + 5G > C (5.56), and p.Arg261Ter (4.94) together comprised about 52% of all mutant alleles. In this study, a total of seventeen PAH gene minihaplotypes were detected, six of which associated exclusively with particular mutations. Our findings indicate a broad PAH mutation spectrum in the Iranian population, which is consistent with previous studies reporting a wide range of PAH mutations, most likely due to ethnic heterogeneity. High prevalence of c.1066-11G > A mutation linked to minihaplotype 7/250 among both Iranian and Mediterranean populations is indicative of historical and geographical links between them. Also, strong association between particular mutations and minihaplotypes could be useful for prenatal diagnosis (PND) and preimplantation genetic diagnosis (PGD) in affected families.