Clinical Outcomes in Breast Reconstruction Patients Using a Sterile Acellular Dermal Matrix Allograft.

BACKGROUND: Human acellular dermal matrices (ADMs) have enabled successful breast reconstructions while decreasing muscle donor morbidity and pain for the patient. However, some literature reports indicate an increase in complications, especially infection. The decellularization and terminal sterilization properties of DermACELL (D-ADM), a human ADM, may reduce the rate of complications in augmented breast reconstruction while still maintaining successful outcomes. In the study presented here, we evaluate the quality and safety of outcomes with the use of D-ADM during tissue expander breast reconstruction. METHODS: A retrospective chart review was conducted of patients who underwent breast reconstruction with the use of D-ADM, at a single-military hospital-based practice, resulting in a population of 38 subjects and 58 breasts who had breast reconstruction augmented with D-ADM. RESULTS: Fifty-six breasts (96.6%) in thirty-six patients demonstrated successful outcomes with a median 27 weeks' time to complete healing. Post-reconstruction radiation and chemotherapy were applied to 24.1 and 25.9% of reconstructions, respectively. Complications rates were minimal with rates of 1.7% for surgical site infection and 1.7% for red breast syndrome. CONCLUSION: The low complication rates combined with the high success and patient satisfaction rates observed for D-ADM support the use of this ADM in breast reconstruction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Intrahepatic Cholestasis of Pregnancy (ICP) in U.S. Latinas and Chileans: Clinical features, Ancestry Analysis, and Admixture Mapping.

In the Americas, women with Indigenous American ancestry are at increased risk of intrahepatic cholestasis of pregnancy (ICP), relative to women of other ethnicities. We hypothesized that ancestry-related genetic factors contribute to this increased risk. We collected clinical and laboratory data, and performed biochemical assays on samples from U.S. Latinas and Chilean women, with and without ICP. The study sample included 198 women with ICP (90 from California, U.S., and 108 from Chile) and 174 pregnant control women (69 from California, U.S., and 105 from Chile). SNP genotyping was performed using Affymetrix arrays. We compared overall genetic ancestry between cases and controls, and used a genome-wide admixture mapping approach to screen for ICP susceptibility loci. We identified commonalities and differences in features of ICP between the 2 countries and determined that cases had a greater proportion of Indigenous American ancestry than did controls (p = 0.034). We performed admixture mapping, taking country of origin into account, and identified one locus for which Native American ancestry was associated with increased risk of ICP at a genome-wide level of significance (P = 3.1 x 10(-5), Pcorrected = 0.035). This locus has an odds ratio of 4.48 (95% CI: 2.21-9.06) for 2 versus zero Indigenous American chromosomes. This locus lies on chromosome 2, with a 10 Mb 95% confidence interval which does not contain any previously identified hereditary 'cholestasis genes.' Our results indicate that genetic factors contribute to the risk of developing ICP in the Americas, and support the utility of clinical and genetic studies of ethnically mixed populations for increasing our understanding of ICP.

Poland's breast reconstruction with decellularized human dermal allograft.

The eponym of Poland's syndrome is given to a condition described by Sir Alfred Poland in 1941. The condition is characterized by a myriad of anomalies of the chest wall with multiple theories of its etiology. Usually, the patient that presents to the reconstructive breast surgeon is a female with some degree of abnormal development of her affected ipsilateral breast. Numerous options of breast reconstruction have been described in the literature for patients with Poland's breast anomalies. These include the use of autologous tissue, prosthetic material, or a combination of both. The use of dermal allograft for breast reconstruction in breast cancer has become extremely helpful and prevalent. Currently, the use of dermal allograft with the aid of the pectoralis major muscle is one of the most common techniques for breast reconstruction. However, with the absence of the pectoralis major muscle as is in the case of Poland's syndrome the utility of this technique is unknown. In this article the author describes the case of a patient with severe breast hypoplasia secondary to Poland's syndrome and the successful use of decellularized human dermal allograft only and a tissue expander, followed by postoperative adjustable mammary prosthesis.

Effects of hyperbaric oxygen on the replanted extremity subjected to prolonged warm ischaemia.

In this investigation, the influence of hyperbaric oxygen (HBO) therapy on the survival of a replanted extremity subjected to prolonged warm ischaemia is evaluated. Among the relative contraindications to replantation are prolonged warm ischaemia time, since an obstruction to blood reflow ('no-reflow phenomenon') may occur in amputated parts that are subjected to more than 6h of warm ischaemia. Twenty-three rat hindlimbs were amputated and subjected to 4h of normothermic ischaemia. The average weight of the animals was 500 gm, and re-plantation of the hindlimb was performed by bone fixation followed by microvascular anastomosis of the femoral vessels. Limb re-vascularisation was confirmed at the end of all procedures by the milk test, clinical assessment and pulse oximetry recordings (>90%). Eleven animals served as a control group and no further therapy was instituted, whereas 12 animals served as the study (replantation) group and were subjected to HBO therapy for 3 days postoperatively. The therapy was conducted in a large animal chamber for 90 min at 2.5 ata. Limb survival was assessed by capillary refill upon compression, skin turgor assessment and colour. Confirmation of clinical findings was conducted with daily pulse oximetry readings of >90%. Animals were followed up for 7 days at which point all animals were euthanized or were euthanized earlier if a non-viable limb was present. Two of the 11 limbs in the control group survived following re-plantation, whereas eight of the 12 limbs in the experimental HBO group survived at least 7 days following replantation. This difference was statistically significant (p=0.0361) using chi-square analysis and Fisher's exact test. Although re-plantation of an amputated extremity after prolonged warm ischaemia is considered a relative contraindication due to the possibility of poor outcomes, our results indicate that the window for replantation may be increased if adjunctive HBO therapy is employed in the postoperative period.

Aluminosis: a propósito de 2 casos / Aluminosis: apropos of 2 cases

Se presentan 2 pacientes de un grupo de 6 trabajadores que tenían en común haber laborado en la actividad de metalización (recubrimiento de superficies metálicas con aluminio pulverizado con una antorcha), los cuales durante 8 años, como promedio, compartieron largas jornadas. Se describe la forma de inicio de la enfermedad y su evolución, muy grave y rápida en el primer caso, y algo más solapada en el segundo, pues ambos fallecieron. Se detallan además las condiciones de trabajo y de las adecuaciones que sobre éstas se realizan antes y después de diagnosticados los casos. Resultado del análisis conjunto de los exámenes realizados a los trabajadores, así como su historia ocupacional, antecedentes personales y familiares, se concluye que se trató de 2 casos afectados por aluminosis

Valores de aldolasa, glucosa-6-fosfatasa y lactato dehidrogenasa en trabajadores expuestos a plaguicidas / Values of aldolase, glucose-6-phosphatase and lactate dehydrogenase in workers expose

Se realizó el estudio en 62 operadores y ayudantes de fumigación de diferentes Empresas de Cultivos Varios de la Provincia La Habana, expuestos a distintos tipos de plaguicidas durante 1 a 20 años, y como control en 37 trabajadores no expuestos a plaguicidas. Se les realizó exámenes clínicos y análisis de laboratorio clínico. Se determinaron las enzimas aldolasa, lactato dehidrogenasa y glucosa-6-fosfatasa en suero. No se encontraron diferencias significativas en los valores de lactato dehidrogenasa y glucosa-6-fosfatasa entre la muestra y el control. Los valores de aldolasa de la muestra fueron: 4.02 ñ 2,48 mUI y en el grupo control fueron de 6,85 ñ 2,54 mUI, los cuales fueron significativos para p<0,05

Estudio cardiorrespiratorio en mancheteros de alta productividad: comparación con un grupo control / Cardiorespiratory study in cane cutters with high productivity: comparison with a control group

Se compara la capacidad vital y los datos electrocardiográficos y radiológicos que expresan el grosor de la pared de los ventrículos de un grupo de macheteros de alta productividad, con un grupo control de trabajadores de una fundición, donde se encuentra que en el grupo de macheteros de alta productividad hay modificaciones del aparato cardiovascular semejantes a las que se producen en los atletas, sin acompañarse de modificaciones significativas de la capacidad vital, lo que se considera en relación con que la actividad que realizan no implica ejercicios que mejoran la ventilación y que el ejercicio fuera del trabajo no lo practican de forma sistemática e integramente

Exposición mercurial femenina en clínicas estomatológicas de Ciudad de La Habana / Female mercury exposition in dental clinics in Havana City

Se estudió una muestra de mujeres trabajadoras de salones de operatoria de clínicas estomatológicas de Ciudad de La Habana, con el objetivo de determinar la magnitud actual de su exposición al mercurio y la repercusión sobre los principales indicadores de salud. El estudio comprendió la valoración de la exposición ambiental e individual de cada trabajadora, así como la evaluación clínica, bioquímica y psicológica de sus principales indicadores de salud, tomando como referencia un grupo de mujeres sanas sin exposición mercurial conocida. En la investigación se determinó que la exposición mercurial femenina en las clínicas dentales de Ciudad de La Habana no es preocupante, aunque el riesgo subsiste y es necesario mantener el control sistemático correspondiente. Se observó además, que las diferencias entre la muestra y el control no eran significativas en cuanto a los principales indicadores clínicos y bioquímicos. No obstante, en la muestra aparecieron algunas alteraciones psicológicas que sugieren cierta afectación subclínica debido a la exposición mercurial, sin descartar totalmente la posibilidad de influencia de otros factores psicosociales