Use of a permanent tissue expander for breast reconstruction

The use of tissue expansion in breast reconstruction is a recognized alternative surgical approach. The second generation of tissue-expanding prostheses is the permanent reverse double-lumen expander. In a series of 100 breast reconstructions using a permanent tissue expander, the clinical benefits of producing a moderate degree of mound ptosis along with observed reduction in pain during expansion are discussed. Additional advantages to the use of the device are the cost savings realized, elimination of a second procedure and a second anesthetic exposure, and a high degree of patient acceptance and satisfaction. This study includes breast reconstruction following mastectomies for malignant and premalignant disease, as demonstrated in 75 delayed and 25 immediate reconstructions, with the longest follow-up being 3 years. Complications of infection (3 percent), significant capsular contracture (4 percent), and implant failure (3 percent) are the most frequent and major complications observed yet. In no instance was breast reconstruction rendered unachievable in the face of these complications. The demonstrated results achieved with permanent tissue-expanding prosthesis, complemented by the obvious benefits and a low rate of significant complications, endorse this method as a viable alternative approach in reconstructive breast surgery.     

Continuous arteriovenous hemodialysis: an alternative therapy for acute renal failure associated with critical illness.

Critically ill patients often cannot tolerate conventional hemodialysis because of hemodynamic instability. Continuous arteriovenous hemofiltration provides control of fluid and electrolyte balance but is inefficient in the management of azotemia. Continuous arteriovenous hemodialysis (CAVHD) combines dialysis with hemofiltration. We performed 15 CAVHD treatments of 2 or more days'' duration in 12 critically ill patients aged 23 to 85 (mean 64.4) years who had acute oliguric renal failure as a component of multiple organ system failure and who were unsuitable for conventional hemodialysis. The total treatment time was 106 days. The serum creatinine and urea levels were controlled in all the patients during CAVHD. The ultrafiltrate losses were sufficient to allow appropriate nutrition and fluid administration and still maintain a negative fluid balance. Renal function returned in five patients (42%), of whom four survived to be discharged home. CAVHD is an effective means of managing acute oliguric renal failure in critically ill patients.     

Age-related changes of the somatotrophs of the domestic fowl Gallus gallus

Summary The ultrastructure of the somatotrophs of the caudal pituitary of the domestic fowl was studied quantitatively. Two age groups of male chickens were compared: 4–6 weeks and 24–30 weeks post-hatching. With age, somatotrophs decreased from about 40% to about 30% of the pituitary cell population. Their volume density decreased similarly. Mean volume of a somatotroph was the same in young and adult animals. Because the granule volume density of the somatotrophs was unchanged, but the somatotroph volume density of the gland declined, the granule volume density of the caudal pituitary gland dropped in parallel with that of the somatotrophs. Thus the volume of the gland comprised of somatotroph granules fell about 32%: from 6.57% to 4.45%. This lowered pool of stored hormone may be linked to the lowered circulating levels of growth hormone found in older animals by other investigators.The granule volume density of the somatotrophs was unchanged but the numerical density approximately doubled; thus the mean granule size decreased by 47% with age. The relationship of the size reduction of the granules to the lowered plasma growth hormone levels is not understood at present.Supported in part by Hatch and State funds from the New Jersey State Agricultural Experimental Station and NSF grants PCM 8,0227,27 and PCM 8,302197.     

猫脑干上涎核节前神经元电活动的观察

在麻醉的32只猫记录了电刺激颌下腺神经支引起的上涎核平均场电位和单位放电。逆行电刺激颌下腺神经支引起的上涎核平均场电位分布在同侧脑干背面闩部头端5.5—8mm处,与过去的组织学结果大致符合。用微电极在上涎核记录了68个对刺激颌下腺神经支有反应的单位,其中33个单位作了碰撞试验。有9个单位符合逆向反应标准,它们是真正的颌下腺节前神经元,逆行反应的潜伏期为14.4±2.5ms,其轴突传导速度为2.9±0.1m/s。其他不符合逆向反应标准的单位,对刺激颌下腺神经支仍能发生反应,估计多为中间神经元。在一部分单位观察了电刺激舌神经或味觉刺激舌引起的反应。根据这些观察对上涎核内存在复杂神经元回路的可能性作了讨论。     

Objectively Measured Physical Activity in European Adults: Cross-Sectional Findings from the Food4Me Study

Background

Comparisons of objectively measured physical activity (PA) between residents of European countries measured concurrently with the same protocol are lacking. We aimed to compare PA between the seven European countries involved in the Food4Me Study, using accelerometer data collected remotely via the Internet.

Methods

Of the 1607 participants recruited, 1287 (539 men and 748 women) provided at least 3 weekdays and 2 weekend days of valid accelerometer data (TracmorD) at baseline and were included in the present analyses.

Results

Men were significantly more active than women (physical activity level = 1.74 vs. 1.70, p < 0.001). Time spent in light PA and moderate PA differed significantly between countries but only for women. Adherence to the World Health Organization recommendation to accumulate at least 150 min of moderate-equivalent PA weekly was similar between countries for men (range: 54–65%) but differed significantly between countries for women (range: 26–49%). Prevalence estimates decreased substantially for men and women in all seven countries when PA guidelines were defined as achieving 30 min of moderate and vigorous PA per day.

Conclusions

We were able to obtain valid accelerometer data in real time via the Internet from 80% of participants. Although our estimates are higher compared with data from Sweden, Norway, Portugal and the US, there is room for improvement in PA for all countries involved in the Food4Me Study.