Differential effect on cell-mediated immunity in human volunteers after intake of different lactobacilli.

Probiotics are live microorganisms which have beneficial effects on the host when ingested in adequate amounts. Probiotic bacteria may stimulate immune effector functions in a strain-specific manner. In this blind placebo-controlled trial, we investigated the effects on the immune system following daily intake of six different strains of lactobacilli or the Gram-negative bacterium Pseudomonas lundensis for 2 or 5 weeks. Blood lymphocyte subsets were quantified by fluorescence activated cell sorter and the expression of activation and memory markers was determined. The bacterial strains were also examined for their capacity to adhere to human intestinal cells and to be phagocytosed by human peripheral blood mononuclear cells. Intake of Lactobacillus plantarum strain 299v increased the expression of the activation marker CD25 (P = 0·01) on CD8(+) T cells and the memory cell marker CD45RO on CD4(+) T cells (P = 0·03), whereas intake of L. paracasei tended to expand the natural killer T (NK T) cell population (P = 0·06). The phagocytic activity of granulocytes was increased following intake of L. plantarum 299v, L. plantarum HEAL, L. paracasei or L. fermentum. In contrast, ingestion of L. rhamnosus decreased the expression of CD25 and CD45RO significantly within the CD4(+) cell population. The observed immune effects after in-vivo administration of the probiotic bacteria could not be predicted by either their adherence capacity or the in-vitro-induced cytokine production. The stimulation of CD8(+) T cells and NK T cells suggests that intake of probiotic bacteria may enhance the immune defence against, e.g. viral infections or tumours.

Limited gene flow may enhance adaptation to local optima in isolated populations of the Roesel's bush cricket (Metrioptera roeselii).

Variation in morphological traits along latitudinal gradients often manifests as size clines. In insects, both positive and negative correlations are seen, and the mechanism behind the response is unclear. We studied variation in seven morphological traits of Roesel's bush cricket, Metrioptera roeselii, sampled from seven latitude-matched-pair populations that were either geographically isolated from or connected to the species continuous distribution range. The aim was to examine whether morphological traits differed between isolated and continuous populations, and whether latitudinal variation was apparent. The data were used to indicate whether variation in trait means originates from plastic responses to the environment or genetic adaptation to local conditions. To evaluate the influence of gene flow on trait means, we analysed the genetic variation in seven microsatellites. Data showed that individuals from isolated populations display a positive relationship between latitude and body size, whereas individuals from continuous populations show little or no such relationship. The combined morphological and genetic data suggest that the isolated populations have adapted to local optima, while gene flow between continuous populations appears to counteract this process.

Bone scintigraphy in evaluating the viability of composite bone grafts revascularized by microvascular anastomoses, conventional autogenous bone grafts, and free non-revascularized periosteal grafts.

We studied the value of bone scintigraphy in the assessment of anastomotic patency and bone-cell viability in free bone grafts revascularized by microvascular anastomoses in twenty-seven dogs. The dogs were divided into three different groups, and scintigraphy was carried out using technetium-labeled methylene diphosphonate in composite bone grafts revascularized by microvascular anastomoses, conventional autogenous bone grafts, and periosteal grafts placed in different recipient beds. The viability of the grafts was evaluated by histological examination and fluorescence microscopy after triple labeling with oxytetracycline on the first postoperative day, alizarin complexone on the fourth postoperative day, and DCAF on the eleventh postoperative day. A positive scintiscan within the first week following surgery indicated patent microvascular anastomoses, and histological study and fluorescence microscopy confirmed that bone throughout the graft was viable. A positive scintiscan one week after surgery or later does not necessarily indicate microvascular patency or bone-cell survival, because new bone formed by creeping substitution on the surface of a dead bone graft can result in this finding.

Microvascular free bone transfer with revascularization of the medullary and periosteal circulation or the periosteal circulation alone. A comparative experimental study.

UNLABELLED: Two different types of vascularized rib grafts presently are used in clinical practice and as experimental models for investigations on free microvascular bone transfer: the posterior rib graft, including both medullary and periosteal blood supply to the bone; and the posterolateral segmental rib graft, supplied by periosteal vessels alone, Complete survival of bone after successful revascularization of the posterior type of graft is well established, but this graft has the disadvantage of a complicated dorsal dissection which has limited its clinical use. Instead, many microsurgeons have utilized the posterolateral rib segment, which is easy and safe to excise although its viability and adequate microcirculation have not yet been confirmed. In nine large dogs, we compared the viability and vascularity of bone after transfer of the two types of bone grafts by histological methods, fluorochrome bone-labeling, microangiography, and technetium scintigraphy. The grafts were transferred to the subcutaneous fat tissue in the groin, where blood supply was reconstituted by microvascular anastomoses to local donor vessels. The results suggest that a bone transplant with revascularization of periosteal only established a collateral circulation to medullary vessels, and that there is no difference in viability of the two kinds of grafts. CLINICAL RELEVANCE: The technique of transferring whole bone segments by microvascular anastomoses of their vascular pedicles has been employed clinically either by preserving the periosteal blood supply alone or by preserving the medullary and the periosteal blood supply. This study demonstrates that the preservation of the periosteal blood supply alone can result in complete bone-graft survival even when the graft is placed in a poorly vascularized tissue bed.

Survival of Lactobacillus plantarum DSM 9843 (299v), and effect on the short-chain fatty acid content of faeces after ingestion of a rose-hip drink with fermented oats.

In a controlled and randomised double-blind study, 26 healthy adult volunteers consumed, for 21 d, 400 ml of a rose-hip drink containing oats (0.7 g/100ml) fermented with Lactobacillus plantarum DSM 9843 (RHL; containing 5 x 10(7) cfu ml(-1)), and 22 volunteers in a second group the same amount of a pure rose-hip drink (RH). Significant increases in the total faecal concentration of carboxylic acids (P < 0.05 after 1 week and P < 0.01 after 3 weeks of intake), acetic acid (P < 0.01 after 3 weeks of intake) and propionic acid (P < 0.01 after 3 weeks of intake and P < 0.05 eight days after intake ceased) were recorded in the RHL group, indicating increased fermentation in the colon. In both groups a significant increase was obtained in the concentration of faecal lactic acid (P < 0.001 after 1 and 3 weeks of intake). No changes were seen in the concentration of faecal butyrate. The numbers of faecal bifidobacteria and lactobacilli increased significantly in both groups after 3 weeks of intake. Sulphite-reducing clostridia rapidly decreased in the group receiving the product with Lb. plantarum DSM 9843 after 1 week of intake, and then also in the pure rose-hip group after 3 weeks of intake. No changes were seen in the numbers of total anaerobes, gram-negative anaerobes or total aerobes during administration. Lb. plantarum DSM 9843 was recovered in faeces from all volunteers in the RHL group. Median amounts were 7.0 (5.0-8.8) log10 cfu g(-1) after one week of intake, and 6.7 (5.0-8.9) log10 cfu g(-1) after 3 weeks, respectively. The strain was still recovered from faeces of five volunteers 8 d after administration ceased (> 4.8 log10 cfu g(-1)). During the period of intake the volunteers in the RHL group experienced a significant increase in stool volume, a significant decrease in flatulence and slightly softer stools. Volunteers in the RH group experienced a slight but significant decrease in stool volume.

Microvenous grafts to arterial defects. The use of mechanical or suture anastomoses.

A mechanical microvascular anastomotic device, the Unilink system, was compared with sutures in terms of patency, anastomotic time, and histologic changes when a microvenous graft is placed in an arterial defect. Twenty rabbits underwent grafting of a 1.0-cm defect in both carotid arteries with a 1.5-cm reversed femoral vein graft. Anastomoses were performed with the Unilink system on one side and sutures on the other. Animals were killed at 2 weeks (10 animals) and 16 weeks (10 animals) with the vein grafts being assessed with clinical patency tests and then fixated for histologic evaluation. All 20 grafts (100%) interposed with the Unilink system were fully patent while 17 (85%) of the 20 grafts interposed with sutures were fully patent. The grafting procedure with the Unilink anastomoses averaged 12.5 minutes while the sutured anastomoses averaged 41.9 minutes. No differences in the histologic appearance of the vein grafts were noted between the two types of anastomoses. All grafts showed endothelialization at 2 weeks with intimal hyperplasia or "arterialization" being a constant finding.

Capsular contracture around saline-filled fine textured and smooth mammary implants: a prospective 7.5-year follow-up.

In a previous prospective randomized clinical study comparing in the same patient textured and smooth saline-filled mammary implants (Biocell) with large pore size (300 to 600 microm), we saw no difference in capsular contracture. This study was undertaken in a similar way to compare capsular contracture around smooth and textured saline-filled prostheses with pores of small size. During a period of 7.5 years, the breast hardness was followed up, and at the end of the study patient satisfaction was evaluated. Twenty healthy women with a mean age of 30 years were operated on for breast augmentation. Two surgeons performed all operations in a standardized way. Each patient received subglandularly a Siltex textured saline-filled prosthesis with a pore size of 30 to 70 microm in one breast, and a smooth saline-filled prosthesis in the other. The hardness of the breasts was evaluated after 0.5, 1, and 7.5 years using Baker grading and applanation tonometry. Eighteen patients completed 1-year and 7.5-year follow-up. Two breasts with smooth prostheses were contracted after 6 months (Baker III or IV). After 1 year, four patients with smooth prostheses and one with a textured prosthesis had capsular contracture (p = 0.34). Seven and one-half years after surgery, six patents with smooth and four with textured implants had contracture (p = 0.66). On two patients with smooth prostheses and one patient with a textured prosthesis, the capsule around the implant hardened between 6 and 12 months. Between 1 year and 7.5 years, three breasts with smooth and textured implants contracted and one with a textured implant softened.The patients reported on a Visual Analogue Scale (1 to 10) the impact of the augmentation on their quality of life to be 9 +/- 1. Four patients preferred the breast with the smooth prosthesis, three preferred the breast with the textured prosthesis, and the others found both breasts equal. This study showed no significant difference of contracture with smooth versus fine textured implants. The majority of the patients preferred the smooth implants. The patients reported that the breast augmentation had had an extremely high impact on their quality of life.

Mechanical anastomosis of small arteries and veins with the unilink apparatus: a histologic and scanning electron microscopic study.

A new method for mechanical anastomosis of small vessels--the Unilink device--has been tested in 23 rabbits. A total of 81 arterial and venous anastomoses were performed. One of the arterial anastomoses were thrombotized, while the remaining 80 anastomoses were fully patent at 2 or 16 weeks. The repair process at the anastomotic site was very rapid both in arteries and veins. The endothelialization was complete at 2 weeks, but a marked atrophy of the media was noted in the arterial anastomoses. The same phenomenon was observed in the venous anastomosis, but to a much lesser degree. Thrombus formation was extremely rare, and the atrophy of the media did not seem to affect the patency rate. The experiment has confirmed that the Unilink method provides a very safe, fast, and simple way to perform microvascular anastomoses.

Capsular contracture with textured versus smooth saline-filled implants for breast augmentation: a prospective clinical study.

Texturization of silicone-filled breast implants has been shown to reduce the incidence of capsular contracture. A double-blind clinical study was undertaken to compare this incidence in saline-filled implants with textured or with smooth surfaces. Twenty-one women underwent mammary augmentation with a textured implant in one breast and a smooth implant in the other. The implants were placed subglandularly. All operations were performed by the same surgeon and all follow-up examinations by another. Breast hardness was evaluated 6 months postoperatively with applanation tonometry, using Baker's grading, and after 12 months, now also with a questionnaire concerning the patient's evaluation. Capsular contracture (Baker 3) had occurred in 33 percent of the breasts at the end of the study, and was bilateral in five cases. The incidence of contracture and the patients' views on the results did not differ between textured and smooth prostheses or between right and left breasts. Five patients requested reoperation, two of them because of breast hardness. Texturization of saline-filled implants thus did not reduce the incidence of capsular contracture.

The effect of prolonged ischemia time on osteocyte and osteoblast survival in composite bone grafts revascularized by microvascular anastomoses.

Twenty-six adult mongrel dogs were used to investigate the effect of prolonged ischemia on osteocyte and osteoblast survival in composite bone grafts revascularized by microvascular anastomoses. The bone grafts were stored in chilled (+5 degrees C) Collins-Terasaki solution, and ischemia time varied from 90 minutes to 48 hours. With histologic techniques and fluorochrome bone labeling it was shown that the bone marrow, the osteocytes, and the osteoblasts could completely survive up to 25 hours of ischemia. Although bone grafting techniques are employed routinely in many orthopedic and plastic surgical procedures, our knowledge is incomplete concerning the ischemic period tolerated by osteocytes and osteoblasts in these grafts. This information is essential when bone transfer on microvascular pedicles is employed, since 3 to 6 hours of ischemia time may be necessary in these operations. The present experiment has shown that osteocytes and osteoblasts can survive a rather long ischemic period if the medullary nutrient blood supply is later reconstituted. This fact adds validity to the technique of free vascularized bone grafts in reconstructive surgery.

Microvascular anastomoses in irradiated vessels: a comparison between the Unilink system and sutures.

A new mechanical device (the Unilink system) was compared to conventional suture anastomoses in irradiated microvessels. Twenty rabbits received a single radiation dose of 20 Gy from a 7-MeV electron source through an anterior neck field. One and 6 months following irradiation, the carotid arteries and facial veins were divided and anastomosed on one side with the Unilink system and on the other side with suture technique. At sacrifice 4 weeks postoperatively, all vessels were evaluated for patency and histologic changes associated with radiation and anastomotic trauma. Histology disclosed severe radiation changes. Also, intimal hyperplasia was consistently found at the anastomotic sites in the arteries, while it was totally absent in the venous anastomoses. Occlusive thrombosis was found in two arteries, one anastomosed with the Unilink system and one sutured. Two other arteries, one from each group, had subtotal occlusions at the anastomotic site. No occlusions occurred in any of the venous anastomoses. The overall patency in this study was 97.5 percent, with no difference between the two techniques.

Fat cylinder transplantation: an experimental comparative study of three different kinds of fat transplants.

In an experimental comparative study, fat cylinders harvested with a new instrument were compared with excised fat and aspirated fat. In 12 New Zealand White rabbits, fat grafts of about 1 ml were transplanted from the fat pad between the shoulders to the scalp and rear side of the ears by three different fat harvesting techniques. After 6 months, the change in the weight of each of the 36 specimens was measured. All specimens were freeze-cut after fixation and stained with Sudan IV, a fat-specific stain. They were examined under a light microscope and evaluated by computer-assisted image analysis. There was no statistical difference in the percentage change in weight between the excised fat and the fat cylinder groups (2 and 1 percent, respectively). For aspirated fat, however, the difference was significant (-59 percent). There also were significantly more surviving mature adipocytes in the fat cylinder group than in the aspirated fat group. We conclude that fat cylinders harvested with the new instrument are as good grafting material as excised fat, while aspirated fat in this study was clearly inferior for grafting.

Free vascularized bone grafts: factors affecting their survival and ability to heal to recipient bone defects.

Composite bone grafts revascularized by microvascular anastomoses with respect to bone cell survival, vessel architecture, and the grafts' ability to participate in healing toward a recipient bone were investigated in 21 adult mongrel dogs. Bone grafts with an intact medullary and periosteal supply were compared with bone grafts with only periosteal bone supply intact. It was demonstrated that bone grafts with both medullary and periosteal blood supplies survived completely but were partially resorbed with time. Periosteally supplied bone grafts demonstrated less resorption but showed, in some grafts, bone marrow necrosis and partial loss of osteocytes. The osteoblasts survived equally well in both groups. No difference in the ability to participate in healing to a recipient bone defect could be demonstrated, although microangiograms revealed significant differences in the medullary microvasculature and at the host-graft junctions in these two types of grafts. The question of whether to preserve the medullary blood supply when transferring whole bone segments by microvascular anastomoses is significant with respect to possible donor-site selection. This study has shown that bone grafts with an intact medullary and/or periosteal blood supply will survive transplantation and participate in healing to a recipient defect equally well.

Preoperative antibiotics and capsular contracture in augmentation mammaplasty.

The main drawback with augmentation mammaplasty using implants is capsular contracture. The cause of this complication is still unknown. Silicone particles, hematoma, and bacterial contamination are some of the etiologic factors discussed. In this randomized, double-blind study on 76 breast-augmented women, 50 percent of the patients had preoperative prophylaxis with benzylpenicillin and dicloxacillin. Bacteria samples were taken intraoperatively. The number of negative cultures increased significantly with antibiotic prophylaxis. In four follow-ups during the first postoperative year, the rate of contractures was evaluated by subjective and objective methods. The results showed no statistically significant difference between the placebo and the antibiotic group with respect to the incidence of capsular contracture.

Climate and environment change in patients with chronic airway obstruction.

Psychological, clinical, and pulmonary physiological measurements were studied in ten patients with weather-sensitive chronic airway obstruction during one month in Gothenburg, Sweden, and immediately after for one month in the Canary Islands, a change to a drier and warmer climate. All patients improved according to psychological tests and claimed to be better. Objective measurements including peak expiratory flow rate, airway conductance, static lung volumes, and elastic lung recoil showed improvement in eight of ten patients, a change that we believe is due to the effect of climate.

Constant compression caliper for objective measurement of breast capsular contracture.

The main problem with silicone implants in augmentation mammaplasty and breast reconstruction is the development of capsular contracture. The universal method for evaluating the degree of firmness of the breast is the subjective palpation technique and the classification according to Baker. Many objective methods using calipers for measurements of compression, different devices for indentation and discs for applanation tonometry have been described, but none of these have been widely accepted. In this paper a new measuring instrument is presented based on the principle of a constant compression force between two caliper jaws applied to the breast. The inverse value of the compressibility of the breast is read on a scale on the device. This objective method correlates acceptably with the palpation technique according to the Breast Augmentation Classification (BAC) (12), which is a modification of Baker's classification (1978), except for the first follow-up.

Long term evaluation of the unilink anastomotic system. A study with light and scanning electron microscopy.

The long term effects of the Unilink mechanical microvascular anastomosis in terms of anastomotic patency and histological changes in the vessel wall were evaluated in 10 rabbits. Both carotid arteries and facial veins were divided and reanastomosed with the Unilink device. At death two years later all 40 anastomoses were fully patent, with histological changes similar to those described previously after 16 weeks, that is, normal endothelial lining, but almost total atrophy of the media at the anastomotic site. The thinning of the vessel wall at the anastomosis caused neither occlusions nor aneurysms during the observation period.

Reconstruction of soft tissue defects including the Achilles tendon with free neurovascular tensor fascia lata flap and fascia lata. Case report.

The combined loss of the Achilles tendon and the overlying soft tissue in the young ambulant patient with expectations of a normal life is a challenge. These patients need not only skin coverage but also dynamic, functioning repair. Two cases of major defects after tumour resection are presented. In each case the tendon was reconstructed using the remaining gastrocnemius aponeurosis reinforced with fascia lata. This was covered by a free tensor fascia lata (TFL) flap. In one of the cases the flap was transferred as a neurovascular free flap.

The "bottle brush": a new concept for uncemented anchorage of bone implants. Preliminary mechanical and biomechanical studies.

We present a new concept for bone of implants, the "bottle brush". It may be suitable for joint prostheses, dental or percutaneous implants, or other devices fixed into bone. Mechanical pullout studies in artificial brass cavities of different sizes and shapes and implantation studies in 20 rabbits, have been successfully carried out. Further experimental and clinical studies are in progress.

Clinical experience with the Unilink/3M Precise microvascular anastomotic device.

The Unilink/3M Precise anastomotic device for microvascular anastomoses has been evaluated in 38 critical anastomoses in 26 selected patients. The microvascular anastomosis was usually completed within three minutes by a single surgeon. There was only one failure, when an arterial anastomosis clotted because of a technical error. In all patients tissue survival was dependent on patent mechanical anastomoses (critical anastomoses) and the follow-up period was more than three years.