Breast-feeding after inferior pedicle reduction mammaplasty.

The breast-feeding practices of a series of postpartum women, who had undergone prior reduction mammaplasty by means of an inferior pedicle approach, are reported in this retrospective study. Also identified are the factors that influenced the decision to breast-feed postoperatively. From a patient pool of 544 individuals who elected to have reduction mammaplasty between 1984 and 1994 (age range, 15 to 35 years), 334 could be contacted and interviewed by means of telephone by using a standardized questionnaire. Successful breast-feeding was defined as the ability to feed for a duration equal to or greater than 2 weeks. Seventy-eight patients had children after their breast reduction surgery. Fifteen of the 78 patients (19.2 percent) breast-fed exclusively, 8 (10.3 percent) breast-fed with formula supplementation, 14 (17.9 percent) had an unsuccessful breast-feeding attempt, and 41 (52.6 percent) did not attempt breast-feeding. Of the 41 patients not attempting to breast-feed, 9 patients did so as a direct consequence of discouragement by a health care professional. Further reasons for feeding with supplementation, having an unsuccessful attempt, and not attempting to breast-feed are presented. Of the 78 women who had children postoperatively, a total of 27 were discouraged from breast-feeding by medical professionals with only 8 of the 27 (29.6 percent) subsequently attempting, despite this recommendation. In comparison, 26 patients were encouraged to breast-feed; nineteen (73.1 percent) of them did subsequently attempt breast-feeding. This rate is statistically significant by using a chi2 test with 1 df(p = 0.0016). Postpartum breast engorgement and lactation was experienced by 31 of the 41 patients not attempting to breast-feed. Of these 31 patients, 19 believed that they would have been able to breast-feed due to the extent of breast engorgement and lactation experienced. Given the use of an inferior flap mammaplasty technique and patient encouragement, the possibility for breast-feeding after reduction mammaplasty exists. This prevalence falls near the breast-feeding rate found in the population not having undergone breast surgery, according to an article in the Canadian Journal of Public Health.

The effects of early postoperative radiation on vascularized bone grafts.

The effects of early postoperative radiation were assessed in free nonvascularized and free vascularized rib grafts in the canine model. The mandibles of one-half of the dogs were exposed to a cobalt 60 radiation dose of 4080 cGy over a 4-week period, starting 2 weeks postoperatively. The patency of vascularized grafts was confirmed with bone scintigraphy. Histological studies, including ultraviolet microscopy with trifluorochrome labeling, and histomorphometric analyses were performed. Osteocytes persist within the cortex of the vascularized nonradiated grafts to a much greater extent than in nonvascularized, nonradiated grafts. Cortical osteocytes do not persist in either vascularized or nonvascularized grafts subjected to radiation. New bone formation is significantly retarded in radiated grafts compared with nonradiated grafts. Periosteum and endosteum remained viable in the radiated vascularized grafts, producing both bone union and increased bone turnover, neither of which were evident to any significant extent in nonvascularized grafts. Bone union was achieved in vascularized and non-vascularized nonradiated bone. In the radiated group of dogs, union was only seen in the vascularized bone grafts.

Antibodies reactive with streptococcal peptidoglycan-polysaccharide complexes in rheumatic fever, subacute bacterial endocarditis and tuberculosis.

Serum antibodies reactive with streptococcal peptidoglycan-polysaccharide complexes (PG-PS) have been estimated by enzyme-linked immunosorbent assay in patients with acute rheumatic fever (ARF), tuberculosis (TB) and subacute bacterial endocarditis (SBE) compared with normal age- and sex-matched controls. IgG2 and IgG3 were the predominant subclasses of antibodies in TB and SBE, whereas in ARF IgG1, IgG2 and IgG3 antibodies were detected. IgG4 antibodies were detected only infrequently. Antibodies of the IgG subclasses were detected in a greater proportion of sera when the PG-PS antigen was further purified by extraction with sodium dodecyl sulphate.

The radial forearm flap in head and neck reconstruction.

The radial forearm flap has proven to be a very reliable and versatile technique for reconstructing head and neck defects. It is of particular value where segmental defects in the mandible and intraoral mucosa exist, and in reconstructing defects within radiated tissue. The skin of the flap drapes well over the radial bone to allow denture fitting. The radial bone provides an adequate bony strut to allow essentially normal mandibular function. In a previously radiated bed, the flap (from a non-irradiated area) has the virtue of being highly vascular, thus benefiting wound healing. The lack of bulk in the flap prevents separation at the site of inset as wound healing occurs. It is a one-stage reconstruction, and since the donor site is on the upper extremity, early patient mobilization is possible. The donor defect is cosmetically acceptable, and since it lies against the body in the position of rest, it is not frequently exposed. The osseous portion of the flap in a postmenopausal woman should be approached with caution and patients should be warned of the risk of radius fracture. This flap is capable of providing tissue for reconstruction of the head and neck and should be considered for closure of all major defects, particularly those with bone defects or in defects created postirradiation.

The salvage of infected cardiac pacemaker pockets using a closed irrigation system.

Over a period of 71 months, 19 patients were treated for infected or eroded permanent pacemaker pockets. All cases were treated with local debridement and insertion of a closed irrigation system using a solution of tyloxapol and tobramycin. Successful eradicaiton of the infection, without complete replacement of the pacemaker system, was achieved in all cases.

An idiotypic complementarity between rheumatoid factor and anti-peptidoglycan antibodies?

Groups of BALB/c mice have been repeatedly immunized with sterile affinity-purified human rheumatoid factor (RF) preparations from high-titred seropositive rheumatoid arthritis sera. In all cases, there was an antibody response reactive with Streptococcus pyogenes cell wall peptidoglycan-polysaccharide (PG-PS) polymer in both immunodiffusion and ELISA. This antibody could be absorbed by either excess RF or PG-PS, but not by isolated human non-RF IgG or IgM preparations. Groups of mice similarly immunized with non-RF IgG or IgM produced no significant anti-PG-PS antibody response compared with pre-immune sera. All immunogens lacked detectable PG-PS. Thus, anti-PG-PS antibody may be produced by RF immunization in the absence of PG-PS. This suggests some idiotypic complementarity between RF and anti-PG-PS antibodies.

The degloved hand: immediate complete restoration of skin cover with a contralateral forearm free flap.

This paper describes a method of repair of a serious injury with major skin loss on both the volar and dorsal aspects of the hand and wrist using a free "forearm flap" from the opposite limb. The technique is a one-stage procedure, provides a completely variable amount of skin, the freedom to elevate the repaired hand and the opportunity to revascularise the most distal structures using the vessels incorporated in the flap.

Enhancement (by native type II collagen) of the humoral immune response to native type I collagen in the rat.

Both native type II collagen and rabbit IgG were good immunogens in the rat when emulsified in incomplete Freund's adjuvant but native type I collagen and denatured type II collagen were not. Both native type II collagen and rabbit IgG had an enhancing effect upon the production of antibodies to native type I collagen when rats were immunised with a mixture of native type I collagen and either of these immunogens but denatured type II collagen did not have this effect. These immunogens, however, did not enhance the production of antibodies to ovalbumin when emulsified with it. Although both native type II collagen and rabbit IgG showed this enhancing effect with native type I collagen, only rats immunised with native type II collagen or mixtures containing native type II collagen developed arthritis. Thus, a specific immune response to collagen rather than this enhancing effect appears to be necessary for the induction of arthritis.

IgG subclasses in collagen-induced arthritis in the rat.

Using a solid-phase double-antibody radioimmunoassay IgG antibodies to native bovine type II collagen were measured as total IgG and as subclasses of IgG (IgG1, IgG2a, IgG2b, IgG2c ) in arthritic and non-arthritic Sprague-Dawley rats. Statistically significant differences were observed between arthritic and non-arthritic animals for IgG1, IgG2a, IgG2b and total IgG. The significance of these results and their possible relevance to the human disease are discussed.

1 Alpha 2 alpha 3 alpha collagen is arthritogenic.

Native 1 alpha 2 alpha 3 alpha collagen (500 micrograms per rat) was both immunogenic and arthritogenic in Alderley Park rats (46% developed arthritis) but only immunogenic in Sprague-Dawley rats. Conversely, native type II collagen (500 micrograms per rat) was immunogenic and arthritogenic in both strains (64% arthritic in Alderley Park strain, 57% arthritic in Sprague-Dawley strain). The inflammatory polyarthritis induced by 1 alpha 2 alpha 3 alpha collagen was similar to that produced by native type II collagen in clinical appearance, time of onset, and histology. Antibodies raised to native bovine type II collagen cross-reacted with native 1 alpha 2 alpha 3 alpha collagen and vice versa. Thus the minor collagen component of cartilage, the 1 alpha 2 alpha 3 alpha collagen, as well as the major collagen component, type II collagen, are immunogenic and arthritogenic in the rat, with strain differences.

Localisation of collagen types and fibronectin in cartilage by immunofluorescence.

Collagens type I, II, III, IV, and V and the minor cartilage collagens, 1 alpha 2 alpha 3 alpha, C-PS 1, and C-PS 2, were purified, antibodies raised, and then used in immunofluorescence studies on bovine nasal cartilage (BNC). Punctate localisation was seen with the type II antibody. However, pretreatment of sections with hyaluronidase to remove the proteoglycan resulted in diffuse staining over all the section with this antibody. Antibodies to 1 alpha 2 alpha 3 alpha, C-PS 1, and C-PS 2 collagens gave no staining on untreated BNC sections, but after treatment with hyaluronidase all 3 antibodies showed as a diffuse 'halo' round each chondrocyte lacuna. Anti-type I, anti-type III, and anti-type IV collagen antibodies did not stain untreated or enzyme treated BNC. Type V collagen antibodies gave a bright ring in the pericellular region of the lacunae of hyaluronidase-treated BNC. This was unexpected, as we could not detect type V collagen biochemically in the same cartilage. Anti-fibronectin antibodies stained areas distant from the chondrocytes, these areas being distinct from those stained by 1 alpha 2 alpha 3 alpha and C-PS antibodies, suggesting that fibronectin is not associated with these collagens in BNC. These results suggest that different collagen types may have different locations within the cartilage matrix, that proteoglycans may inhibit antibody association with collagen, and that fibronectin is normally not associated with all types of collagen.

Anomalies of the intrinsic muscles in camptodactyly.

Our observations support the view of Millesi that camptodactyly is due to an imbalance between the flexor and extensor forces acting upon the proximal interphalangeal joint. In 21 consecutive operations the insertion of the lumbrical muscle was abnormal. The muscle inserted into either the superficialis tendon (in three cases), the capsule of the metacarpophalangeal joint (in 15), or the extensor expansion of the adjacent finger (in four). The fourth palmar interosseous muscle was examined in the last 10 patients and was abnormal in five. It was absent in two patients, small in one, and inserted into the extensor expansion of the ring finger in two patients. Therefore, it is suggested that camptodactyly is an intrinsic minus deformity. It follows that treatment should consist of soft tissue release, as necessary, to correct the flexion deformity, followed by a tendon transfer to restore intrinsic action and maintain correction of the deformity.

Inferior flap reduction mammaplasty with pedicled nipple.

A modification of the original inferior flap reduction mammaplasty is presented using a dermal pedicle based on the inferior flap to support the nipple and areola complex. The technique is extremely versatile, and the breast contour is excellent. The nipple shows excellent projection and generally improved sensation over the preoperative state.

Antigenic relationships between the serotypes of Pasteurella haemolytica demonstrable by enzyme-linked immunosorbent assay (ELISA).

Mice and rabbits were immunised with sodium salicylate extracts (SSE) prepared from each of 12 serotypes of Pasteurella haemolytica, and the antisera to each were used in cross-indirect haemagglutination (IHA) tests and cross-enzyme-linked immunosorbent assays (ELISA) to study antigenic relationships between the serotypes. An indirect micro-ELISA demonstrated common antigenic relationships which were not apparent by IHA. Antisera from both species revealed considerable shared antigenicity between all the serotypes. Rabbit antisera presented clearer differences between the A biotypes on one hand and the T biotypes on the other, the T biotypes exhibiting much less cross-relatedness than that shown between the A serotypes.

Vasospasm control by intra-arterial reserpine.

Vascular spasm may complicate both traumatic injuries and disease processes. It may be severe enough that thrombosis and vascular compromise occur, causing tissue necrosis. Transient relief may be obtained by proximal sympathetic blocks, but these are not well tolerated by the patient and require repeated injections. This study shows that a single intra-arterial injection of 1.25 mg of reserpine into the branchial artery of human volunteers with a No. 25 needle produces a prolonged sympathectomy distal to the site of injection, with cutaneous flushing, increased temperature, and increased digital pulse wave recordings. It also eliminates the vasoconstriction normally caused by a cold stimulus. Using this dose, the side effects were minimal. No complications were encountered as a result of the technique. Low-dose intra-arterial reserpine is recommended for the treatment of reversible vascular spasm.

Non-specific resistance of mice to Pasteurella haemolytica.

A technique for challenge infection of mice with Pasteurella haemolytica is described. Mice were challenged intraperitoneally with P haemolytica in gastric mucin, and viable counts were performed 6 h later on liver suspensions. Viable counts of P haemolytica in the livers of unvaccinated control mice had increased 6 h after infection. Mice were injected subcutaneously with a commercial pasteurella vaccine at various time intervals before challenge. In those given vaccine two weeks, one week, 48 h and 1 h before challenge, viable counts of P haemolytica in the liver increased as for control mice. However, if the time interval between administration of vaccine and challenge was 12 or 24h, viable counts of P haemolytica in the liver decreased after challenge. Subcutaneous inoculation with the nonbacterial components of the vaccine 24 h before challenge did not cause such an effect. Inobulation with the vaccine 24h before challenge with Escherichia coli resulted in an increase in the LD50 for that organism, indicating that the effect is probably non-specific.