Comparison between the European Randomized Study for Screening of Prostate Cancer (ERSPC) and Prostate Biopsy Collaborative Group (PBCG) risk calculators: Prediction of clinically significant Prostate Cancer risk in a cohort of patients from Argentina.

OBJECTIVE: To compare the performance of the risk calculators of the European Randomized Study for Screening of Prostate Cancer (ERSPC) and the Prostate Biopsy Collaborative Group (PBCG) in predicting the risk of presenting clinically significant prostate cancer. MATERIAL AND METHODS: Retrospectively, patients who underwent prostate biopsy at Sanatorio Allende Cerro, Ciudad de Córdoba, Argentina, were identified from January 2018 to December 2021. The probability of having prostate cancer was calculated with the two calculators separately and then the results were compared to establish which of the two performed better. For this, areas under the curve (AUC) were analyzed. RESULTS: 250 patients were included, 140 (56%) presented prostate cancer, of which 92 (65.71%) had clinically significant prostate cancer (Gleason score ≥7). The patients who presented cancer were older, had a higher prostate-specific antigen (PSA) value, and had a smaller prostate size. The AUC to predict the probability of having clinically significant prostate cancer was 0.79 and 0.73 for PBCG-RC and ERSPC-RC respectively (P=0.0084). CONCLUSION: In this cohort of patients, both prostate cancer risk calculators performed well in predicting clinically significant prostate cancer risk, although the PBCG-RC showed better accuracy.

Probiotics diminish the post-operatory pain following mandibular third molar extraction: a randomised double-blind controlled trial (pilot study).

The aim of this study was to investigate the effect of a probiotic in preventing infections after third molar surgery. Thirty-eight patients were consecutively enrolled to a double-blind randomised placebo-controlled trial. Patients were asked to take one tablet two times a day containing a mixture of Levilactobacillus brevis CECT7480 (KABP-052) and Lactoplantibacillus plantarum CECT7481 (KABP-051) or placebo for the first post-intervention week. The primary outcome was the postoperative infection rate. Secondary outcomes included swelling, eating difficulties and postoperative pain recorded by the patient using a visual analogue scale (VAS) during the first postoperative week. No statistically significant difference in the infection rate between the groups was found; with only three cases of infections reported (one in the probiotic group and two in the placebo group) on the first week. Compared to placebo, treatment with the probiotic showed a significantly higher reduction in pain and eating difficulties scores at 5, 6 and 7 days post-surgery. Swelling values were not significantly different between the groups at any time point. The findings of this pilot study justify a larger study to clarify the possible role of these bacterial strains on the post-operative pain management following third molar surgery.

[Social reimbursement-the Spanish-German ENT Society's (SDGHNO) Latin America project]. / Soziale Rückvergütung ­ das Projekt "Lateinamerika" der Spanisch-Deutschen HNO-Gesellschaft (SDGHNO).

Nowadays, social projects are usually oriented in such a way that after a given period of time, they can either support themselves independently or even allow a pecuniary reimbursement. In the latter case, experts speak of a profit-oriented reimbursement. On the other hand, there is so-called social reimbursement, which in contrast to the abovementioned form is not profit oriented, but, for example, considers its task fulfilled by the fact of successful knowledge transfer. The Spanish-German Society for ENT Medicine and Head and Neck Surgery (SDGHNO) launched the Latin America project in 2001 under the patronage of the then President Prof. Dr. Wolfgang Draf (Fulda). The goal of the SDGHNO was and is to create a professional as well as cultural platform for Spanish- and German-speaking ENT doctors. This platform can and should be used for professional purposes, e.g., for knowledge transfer. Since the beginning of its existence, the Latin America project has thus brought numerous scientific events into being and created specific contacts which have lasted until today or have even been continued and further developed. Particularly successful examples are Chile, Colombia, and Peru. This is a vivid example of social reimbursement, because the participating German-speaking members/speakers carried out their tasks on an entirely voluntary basis. Thus, the SDGHNO did not bear any travel, catering, or accommodation costs. The activities of the SDGHNO within the framework of the Latin America project are explained.

Effect of preoperative oral pravastatin reload in systemic inflammatory response and myocardial damage after coronary artery bypass grafting. A pilot double-blind placebo-controlled study.

AIM: Statins exert pleiotropic effects that result in cardioprotective and antiinflammatory properties. There is a lack of information about the effect of preoperative reloading statin administration in surgical coronary patients regarding myocardial protection, systemic inflammatory response (SIR) attenuation and nitric oxide (NO) metabolism. METHODS: Thirty consecutive dyslipidemic patients under chronic treatment with statins were randomized to orally receive pravastatin 80 mg (N.=10), 40 mg (N.=10) or placebo (N.=10) two hours before anesthetic induction for non-emergent on-pump coronary artery bypass grafting (CABG) procedures. Perioperative peripheral venous and intraoperative CS blood samples were collected for determination of drug-related adverse effects, NO metabolism and both myocardial damage and SIR biomarkers. RESULTS: Pravastatin reloading resulted in a significant and dose-related intense attenuation of SIR, but no differences in cardiac damage biomarker levels were demonstrated. NO release and inducible nitric oxide synthase expression was significantly reduced in both treatment groups. Highest pravastatin doses significantly increased systemic creatine phosphokinase (CPK) concentration compared with intermediate doses but no other adverse effects were observed. CONCLUSION: Oral pravastatin reloading before non-emergent CABG significantly attenuates postoperative SIR and systemic NO/iNOS concentrations with no effect in perioperative myocardial damage. Highest pravastatin doses increase CPK levels and must be avoided in susceptible patients.

Setting up equine embryo gender determination by preimplantation genetic diagnosis in a commercial embryo transfer program.

Preimplantation genetic diagnosis (PGD) allows identifying genetic traits in early embryos. Because in some equine breeds, like Polo Argentino, females are preferred to males for competition, PGD can be used to determine the gender of the embryo before transfer and thus allow the production of only female pregnancies. This procedure could have a great impact on commercial embryo production programs. The present study was conducted to adapt gender selection by PGD to a large-scale equine embryo transfer program. To achieve this, we studied (i) the effect on pregnancy rates of holding biopsied embryos for 7 to 10 hours in holding medium at 32 °C before transfer, (ii) the effect on pregnancy rates of using embryos of different sizes for biopsy, and (iii) the efficiency of amplification by heating biopsies before polymerase chain reaction. Equine embryos were classified by size (≤300, 300-1000, and >1000 µm), biopsied, and transferred 1 to 2 or 7 to 10 hours after flushing. Some of the biopsy samples obtained were incubated for 10 minutes at 95 °C and the rest remained untreated. Pregnancy rates were recorded at 25 days of gestation; fetal gender was determined using ultrasonography and compared with PGD results. Holding biopsied embryos for 7 to 10 hours before transfer produced pregnancy rates similar to those for biopsied embryos transferred within 2 hours (63% and 57%, respectively). These results did not differ from pregnancy rates of nonbiopsied embryos undergoing the same holding times (50% for 7-10 hours and 63% for 1-2 hours). Pregnancy rates for biopsied and nonbiopsied embryos did not differ between size groups or between biopsied and nonbiopsied embryos within the same size group (P > 0.05). Incubating biopsy samples for 10 minutes at 95 °C before polymerase chain reaction significantly increased the diagnosis rate (78.5% vs. 45.5% for treated and nontreated biopsy samples respectively). Gender determination using incubated biopsy samples matched the results obtained using ultrasonography in all pregnancies assessed (11/11, 100%); untreated biopsy samples were correctly diagnosed in 36 of 41 assessed pregnancies (87.8%), although the difference between treated and untreated biopsy samples was not significant. Our results demonstrated that biopsied embryos can remain in holding medium before being transferred, until gender diagnosis by PGD is complete (7-10 hours), without affecting pregnancy rates. This simplifies the management of an embryo transfer program willing to incorporate PGD for gender selection, by transferring only embryos of the desired sex. Embryo biopsy can be performed in a clinical setting on embryos of different sizes, without affecting their viability. Additionally, we showed that pretreating biopsy samples with a short incubation at 95 °C improved the overall efficiency of embryo sex determination.

Estudio epidemiológico de la incidencia de caries del órgano dentario 46 como primer diente afectado en la dentición permanente / Epidemiologic study of the incidence of tooth decay body 46 as first tooth concerned in the permanent dentition

El primer molar permanente es un órgano dental muy importante en la dentición ya que tiene un papel importante en la oclusión y en la función masticatoria; los primeros molares inferiores son los más susceptibles debido a su anatomía y morfología, ser los primeros en hacer erupción, el factor gravedad que hace que los alimentos no se queden en los primeros molares superiores y si en los inferiores y la causa que sea más en el derecho que en el izquierdo es la forma como se realiza el cepillado. El estudio se realizó en la Clínica de Odontopediatría de la Facultad de Estomatología de la U.A.S.L.P., la muestra fue de 500 pacientes (55.20% Femenino y 44.80% Másculino) edades de los pacientes de 6 a 18 años, el órgano dentario más afectado es el primer molar permanente inferior derecho 46 (68.40%) observado clínicamente y con el cuestionamiento directo o indirecto, también nos mostro que el cepillado se realiza dos veces al día (37%)

The first permanent molar is a very important dental organ in the teething has an important role in the occlusion and masticatory function; the first lower molars are the most susceptible due to their anatomy and morphology, to be first to erupt, the factor gravity that causes that the foods do not remain in first superiors molars and if in the lowers and the cause that is more in the right than in the left one is the form as brushing one is realized. The study carried out in the Clinic of Odontopediatry of the Facultad de Estomatología of U.A.S.L.P., the sample was of 500 patients (55.20% Feminine and 44.80% Másculine) ages of the patients of 6 to 18 years, the most affected dental organ is the first one to molar permanent lower right 46 (68.40%) noted Clínically and with the direct or indirect, questioning also we showed brushing is done twice a day (37%)

Eficacia del cepillo de esponja vegetal (Luffa cylindrica. L Roem) en la remoción de placa supragingival. Paraguay, 2010 / Effectiveness of the loofa (Luffa cylindrica. L Roem) brush in the supragingival plaque removal. Paraguay, 2010

Una de las causas principales de las dolencias bucales es la placa dental. Para el control de la misma, el cepillo con esponja vegetal (Luffa cylindrica. L Roem) podría convertirse en un auxiliar alternativo económico. El objetivo de este estudio fue determinar la eficacia del cepillo de esponja vegetal frente al cepillo convencional en la remoción de placa supragingival. Ensayo clínico, aleatorizado y simple ciego para el evaluador. Fueron incluidos en el estudio 95 estudiantes de Odontología de las Universidades del Pacífico Privada, Nacional de Asunción, Central del Paraguay y Autónoma de Asunción sin patología bucal evidente, con más de 20% de placa dental en el examen inicial. La presencia de placa gingival basal fue evaluada con el índice de O' Leary tras seis horas mínimas sin cepillado ni uso de colutorios, a continuación se procedió al cepillado con los métodos asignados volviéndose a evaluar la presencia de placa supragingival. No se observó diferencia significativa en el porcentaje promedio de placa por la técnica Luffa en comparación con la técnica convencional después del cepillado (60% ±19 vs 62% ± 21 valor de p = 0,53, prueba t de student. El cepillo con esponja vegetal (Luffa cylindrica. L Roem) es una alternativa económica para la reducción de la placa supragingival.

One of the main causes of oral diseases is dental plaque. The loofah (Luffa cylindrica. L Roem) brush could become an economics alternative auxiliary to control dental plaque. The objective of this study was to determine the effectiveness of the loofa brush against the conventional toothbrush in the supragingival plaque removal. This was a randomized clinical trial, single blinded for the evaluator. Ninety five odontology students from the governmental National University of Asuncion and the private Pacifico and Autonoma de Asunción universities were included in the study. They did not have any obvious oral pathology and had more than 20% of dental plaque in the initial examination. The presence of basal gingival plaque was evaluated with the O’ Leary index after a minimum of six hours without brushing and using mouthwash. Then, they brushed their teeth with the method assigned and the presence of supragingival plaque was reevaluated. There was no significant difference in the mean percentages of plaque by the Luffa plaque technique compared with the conventional technique after brushing (60% ± 19 vs 62% ± 19 vs 62 ±, p value=0.53, Student’s t test). The loofa brush (Loofah cylindrica, L. Roem) is an economical alternative for the reduction of the supragingival plaque.

Microscopic pulmonary embolisation of an indwelling central venous catheter with granulomatous inflammatory response.

Indwelling catheters can disintegrate into tiny fragments and embolise. Once the fragments are detected radiographically, they can be removed using vascular intervention techniques. Rarely, indwelling catheters dwindle into inextricable pieces that embolise into minute pulmonary vessels and lymphatics, causing granulomatous changes microscopically. The present study reports a 54-yr-old female who had received several indwelling central lines during several abdominal surgeries over a 5-yr period. The patient developed a noncaseating granulomatous skin lesion followed by exertional dyspnoea a few months later. Chest radiographs and computed tomography showed diffuse interstitial infiltrates. Open lung biopsy showed two types of granulomas: 1) peri-lymphangitic and peri-bronchiolar non-necrotising granulomas consistent with sarcoidosis; and 2) distinct foreign body granulomas. In some of the foreign body granulomas, confocal Raman spectroscopy identified the presence of bisphenol-A-polycarbonate, a polymer commonly used in biomedical devices. The patient improved following treatment with prednisone followed by methotrexate. The present case illustrates an interesting combination of two causes of granulomatous disease, the importance of examining all biopsy specimens from sarcoidosis patients for foreign particles and the rare occurrence of microscopic embolisation of catheter fragments to the lung with foreign-body giant cell reaction to them.

Health effects of natural dust: role of trace elements and compounds.

This article reviews the health effects of trace elements carried in natural dusts of geologic or geochemical origin. The sources of these dusts are diverse, including volcanoes, dust storms, long-range transport of desert dust, and displacement through natural processes such as landslides and earthquakes. The primary focus is dust exposures affecting communities rather than occupational groups (which have been comprehensively explored in other publications). The principal elements and compounds reviewed are trace metals (including As, Hg, Cd, and Fe), radioactive elements, fluoride, silicates, natural asbestiform compounds, and alkali salts. The pathways by which such agents affect human populations are explored, including carriage through water, air, soil, and the food chain. The mechanisms of biotoxicity and the acute and chronic consequences on health associated with these elements are described. The discussion explores problems inferring risk and disease causation from natural dust exposures using standard epidemiological indicators, particularly for chronic outcomes, and will argue for the importance of the ecological perspective in assessing pathogenesis. The authors stress the global scale of the problem, which remains underevaluated and underreported in terms of health implications.

[Recurrent polychondritis: apropos of a case]. / Policondritis recidivante: a propósito de un caso.

We present a case of relapsing polychondritis which presented as hypoacusis and showed several peculiarities. The initial diagnosis was serous otitis. After a more careful study we found certain details which made us suspect a relapsing polychondritis. The diagnosis was confirmed by a biopsy of the nasal cartilage and a detailed systemic study was performed. As distinctive characteristics we found a mixed hypoacusis, in which the sensorineural component was partially recovered following corticoid treatment.

Temporospatial expression of HSP72 and c-JUN, and DNA fragmentation in goat hippocampus after global cerebral ischemia.

The role of gene induction (expression of HSP72 and c-JUN proteins) and delayed ischemic cell death (in situ labeling of DNA fragmentation) have been investigated in the goat hippocampus after transient global cerebral ischemia. The animals were subjected to 20-min ischemia (bilateral occlusion of the external carotid arteries plus bilateral jugular vein compression) and allowed to reperfuse for 2 h, and then 1, 3, and 7 days. Histological signs of cell loss were not found in the hippocampus at 2 h, 1 day, or 3 days of reperfusion. However, such an ischemic insult produced extensive, selective, and delayed degeneration in the hippocampus, as 68% of the neurons in CA1 had died at 7 days, but cell loss was not detected in CA3 and dentate gyrus fields. Concomitantly, a high percentage of TUNEL-positive CA1 neurons (60+/-9%, mean +/- SEM) was seen at 7 days, but not at the earlier time points. Mild induction of HSP72 was detected in the goat hippocampus after ischemia. The maximum percentage of HSP72-positive neurons (10-15%) was shown at 3 days of reperfusion and was concentrated mainly in the CA3 field, subiculum, and hilus, rather than in the CA1 field, whereas HSP72 expression was hardly detected at 7 days. At this later time point, scattered induction of nuclear c-JUN was found in a few neurons. The results show that: 1) postischemic delayed neuronal death selectively affects the CA1 field in the goat hippocampus, a phenomenon which seems to take longer to develop than in previously reported rodent models; and 2) postischemic expression of c-JUN does not appear to be related to cell death or survival, while the inability of most CA1 neurons to express HSP72 could contribute to neuronal death.

Generation of sequence-specific, high affinity anti-DNA antibodies.

By taking advantage of the extreme stability of a protein-DNA complex, we have obtained two highly specific monoclonal antibodies against a predetermined palindromic DNA sequence corresponding to the binding site of the E2 transcriptional regulator of the human papillomavirus (HPV-16). The purified univalent antibody fragments bind to a double-stranded DNA oligonucleotide corresponding to the E2 binding site in solution with dissociation constants in the low and subnanomolar range. This affinity matches that of the natural DNA binding domain and is severalfold higher than the affinity of a homologous bovine E2 C-terminal domain (BPV-1) for the same DNA. These antibodies discriminate effectively among a number of double- and single-stranded synthetic DNAs with factors ranging from 125- to 20,000-fold the dissociation constant of the specific DNA sequence used in the immunogenic protein-DNA complex. Moreover, they are capable of fine specificity tuning, since they both bind less tightly to another HPV-16 E2 binding site, differing in only 1 base pair in a noncontact flexible region. Beyond the relevance of obtaining a specific anti-DNA response, these results provide a first glance at how DNA as an antigen is recognized specifically by an antibody. The accuracy of the spectroscopic method used for the binding analysis suggests that a detailed mechanistic analysis is attainable.

Hemochromatosis (HFE) gene sequence analysis of formalin-fixed, paraffin-embedded liver biopsy specimens.

BACKGROUND: Hereditary hemochromatosis (HH) is a common disease predominantly characterized by mutations of the HFE gene. METHODS AND RESULTS: We investigated the utility of HFE gene sequence analysis in the diagnosis of HH in 61 prospectively accrued formalin-fixed, paraffin-embedded liver biopsy specimens with clinical or histologic features suggestive of HH. Mutations in codons 63 or 282 of the HFE gene were identified by direct sequencing; in 21 of these samples, quantitative hepatic iron testing was also performed. Changes characteristic of HH were present in 16 (26%) of the cases, and 54% of the cases showed HFE gene mutations. The most common alteration was homozygous mutation of codon 282 (11 cases, 18%), followed by the combined 63 + 282 heterozygous mutation (3 cases, 5%). Two cases (3%) showed biallelic mutation of codon 63. The other 28 cases (46%) showed no sequence abnormalities. Weak iron staining did not exclude HH; intense staining did not reliably predict HH. CONCLUSION: When HH is clinically and/or histologically suspected, HFE gene sequencing of formalin-fixed, paraffin-embedded liver biopsy specimens is a rapid and cost-effective approach to genotypic diagnosis of HH.

Irradiation-induced up-regulation of Fas in esophageal squamous cell carcinoma is not accompanied by Fas ligand-mediated apoptosis.

BACKGROUND AND OBJECTIVES: Fas (APO-1) induces apoptosis after binding Fas ligand (FasL). Evidence suggests that tumors may use this interaction to evade the host immune response. Fas/FasL expression has not been reported in esophageal cancer. We hypothesized that Fas expression would render esophageal cancer cells susceptible to Fas ligation and that irradiation of the cells would increase Fas expression. METHODS: Two human esophageal squamous cell carcinoma lines, KYSE 150, which has a wild-type (wt) p53 gene, and 410 (mutated p53), were irradiated. Reverse-transcriptase polymerase chain reaction was used to detect Fas and FasL expression. Fas protein was quantitated by enzyme-linked immunosorbent assay and its presence further confirmed by Western analysis. FasL was detected by Western analysis. Cells were treated with Fas monoclonal antibody (maximum 0.05 microg/ml)+/-cycloheximide, and viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Cells were also transduced with FasL cDNA and then quantified. RESULTS: Both lines expressed Fas and FasL, but only the KYSE 150 cell line displayed an increase in Fas following irradiation. No alteration in cell growth was detected for Fas antibody- or FasL-transduced groups versus controls. CONCLUSIONS: We have demonstrated Fas and FasL expression in esophageal tumor lines. We have also shown that Fas levels are significantly increased in response to irradiation in a wt p53 line. However, cells were resistant to treatment with Fas antibody or following transduction with FasL, suggesting that these tumor cells may use Fas/FasL expression to evade the host immune response.

Calcium and increase excitability promote tolerance against anoxia in hippocampal slices.

We have previously demonstrated that anoxic preconditioning (APC) protects against a subsequent otherwise 'lethal' anoxic insult in hippocampal slices. Tested here are two hypotheses: (a) APC requires calcium to improve electrical recovery in hippocampal slices; and (b) mild excitation promotes preconditioning neuroprotection. Control hippocampal slices were given a single 'test' anoxic insult followed by reoxygenation. Experimental slices were preconditioned by three short anoxic insults of 1 min separated by 10 min of reoxygenation. At 30 min after the third 'conditioning' insult, slices underwent a 'test' anoxic insult [1 min of anoxic depolarization (AD)], and then slices were reoxygenated. Evoked potentials (EPs) were recorded throughout the experiment. In other slices, APC was emulated by inducing spreading depression (as determined by a negative DC shift) with KCL or by inducing increased neuronal excitability with the excitatory agent 8-cyclopentyl-1, 3-dipropylxanthine (DPCPX) (an adenosine A1 receptor blocker). 'Test' anoxic insults lasted 2 min of AD in these groups. To determine the role of calcium during APC, extracellular CaCl2 was decreased to 0.5 mM but only during the APC episodes ('test' anoxia, 1 min of AD). EP amplitudes recovered significantly better after anoxia in preconditioned slices, and in KCl- and DPCPX-treated slices (147.2+/-33.3, n=8, **p<0.01, 71.7+/-13.5, n=7, **p<0.01, and 117.8+/-37.3, n=5, ***p<0.001, respectively) compared to controls. Decreases in extracellular CaCl2 during APC blocked the recovery of EPs after 'test' anoxia (80.6+/-23.0, n=8). These data confirm that increases in excitability can emulate APC. These data also demonstrate that calcium influx during preconditioning is required for the induction of tolerance during APC.

Randomized placebo-controlled trial of 2,3-dimercaptosuccinic acid in therapy of chronic arsenicosis due to drinking arsenic-contaminated subsoil water.

INTRODUCTION: Chronic arsenic toxicity producing various clinical manifestations is currently epidemic in West Bengal, India, Bangladesh, and other regions of the world. Animal studies have indicated that 2,3-dimercaptosuccinic acid can be used as an oral chelating agent. A prospective, double-blind, randomized controlled trial was carried out to evaluate the efficacy and safety of 2,3-dimercaptosuccinic acid for chronic arsenicosis due to drinking arsenic-contaminated (> or = 50 micrograms/L) subsoil water in West Bengal. METHOD: Twenty-one consecutive patients with chronic arsenicosis were individually randomized (random number; assignment made by individual not evaluating patients) into 2 groups: 11 patients (10 male, age 25.5 +/- 8 years) received 2,3-dimercaptosuccinic acid 1400 mg/d (1000 mg/m2) in the first week and 1050 mg/d (750 mg/m2) during the next 2 weeks with a repeat course 3 weeks later. The other 10 patients (all male, age 32.2 +/- 9.7 years) were given placebo capsules for the same schedule. The clinical features were evaluated by an objective scoring system before and after treatment. Routine investigations including liver function tests, arsenic concentrations in urine, hair, and nails, and skin biopsy evaluations were also completed. RESULTS: Though there was improvement in the clinical score of 2,3-dimercaptosuccinic acid-treated patients, similar improvement was observed in the placebo-treated group. There were no statistical differences in the clinical scores between the 2 groups at the beginning and at the end of treatment. Similarly, no differences were found for the other investigated parameters. CONCLUSION: Under the conditions of this study, 2,3-dimercaptosuccinic acid was not effective in producing any clinical or biochemical benefit or any histopathological improvement of skin lesions in patients with chronic arsenicosis.

Two decades of cervical esophagostomy: indications and outcomes.

Diverting cervical esophagostomy is a surgical procedure generally reserved for extremely ill patients as a life-saving maneuver. However, it is also a procedure that is infrequently performed, such that most centers have limited experience with the operation. To investigate the indications and outcomes of cervical esophagostomy, we reviewed the use of this operation at UCLA Medical Center over the last 20 years as employed for esophageal leaks. Eighteen patients underwent this procedure for the following indications: leak with malignant tracheoesophageal fistula (11%), anastomotic leak (44%), endoscopic injury (18%), gunshot wound (5.5%), operative injury (11%), corrosive ingestion (11%), and spontaneous rupture (5.5%). Overall mortality directly attributable to sepsis was 33 per cent. Of the surviving patients, 67 per cent later underwent reconstruction. Seventy-two per cent of patients had end esophagostomies, and the remainder had loop diversions. The primary indication for operation in these patients was persistent sepsis after initial surgical management of esophageal spillage into the mediastinum or neck. This series suggests that cervical esophagostomy, when applied to the appropriate patient population, can decrease mortality and allow subsequent alimentary reconstruction.

Characterization of the cortical laser-doppler flow and hippocampal degenerative patterns after global cerebral ischaemia in the goat.

Large-animal models offer several advantages in the study of cerebral ischaemia: easier control of physiological variables, easier neuropathological evaluation, etc. In the present study we have taken advantage of the unique cerebrovascular anatomy of the goat to reproduce a model of reversible, incomplete, global cerebral ischaemia in a large-sized animal species, in which the effects of successive manoeuvres to stop and re-start cerebral blood flow can be recorded continuously. Early cortical laser-Doppler flow response (up to 2 h) and delayed neuronal degeneration (7 days) in the hippocampal CA1 subfield have been analysed in goats undergoing 5, 10 or 20 min of transient, global cerebral ischaemia. Bilateral occlusion of the external carotid artery plus compression of jugular veins reduced cortical laser-Doppler flow to 11 +/- 8% of preischaemic values (P<0.01), flattened the electrocorticogram, and increased mean arterial blood pressure by 17 +/- 23% (P<0.01) and intracranial pressure by 161 +/- 136% (P<0.01). A rather heterogeneous response was obtained during reperfusion: 14 out of 31 goats showed the "classical" pattern consisting of hyperaemia followed by delayed hypoperfusion. The remaining goats showed neither hyperaemia (11 goats) nor delayed hypoperfusion (6 goats). The duration of the ischaemic insult did not correlate with the magnitude of hyperaemia or delayed hypoperfusion, but influenced neurodegeneration: while no loss of hippocampal CA1 neurons was observed at 7 days after 5 or 10 min ischaemia, a 68% cell loss was observed in the 20-min ischaemia group. Our goat model has thus proven to be very suitable for the induction of global cerebral ischaemia in a large-animal species without extensive surgery. It allows reproducible reductions of cerebral blood flow, long-term recovery, low mortality rate, and high incidence of neuronal damage. The results reported here support the view that delayed hypoperfusion is not an important determinant of neuronal injury.

Pathological and biophysical findings associated with silicone breast implants: a study of capsular tissues from 86 cases.

Breast implant capsular tissues from 86 cases were studied to characterize the relationship between capsular findings and the type of implant used. Tissues were examined by light microscopy, immunohistochemistry, scanning electron microscopy/energy dispersive x-ray analysis and Fourier transform infrared, and Raman microspectroscopy. Capsular pathology was influenced by the structure and composition of the implant. A pseudoepithelium at the inner capsular surface (synovial metaplasia) was noted with silicone gel-filled, saline-filled, and polyurethane-coated implants, and disproportionatelywith textured surface implants. Immunohistochemical studies of pseudoepithelium supported a macrophage/histiocyte cellular origin. Talc was identified intracellularly within macrophages in 42 cases. Capsular calcification was strongly associated with the presence of implant stabilization patch material. Infrared spectra were used to identify silicone, talc, Dacron, and two different types of polyurethane in capsular tissues. Micropapillary structures identified at the pseudoepithelial surface have, to the authors' knowledge, not been previously described.