Surgical treatment of breast cancer in previously augmented patients

The incidence of breast cancer is increasing each year. Concomitantly, cosmetic breast augmentation has become the second most often performed cosmetic surgical procedure. As the augmented patient population ages, an increasing number of breast cancer cases among previously augmented women can be anticipated. The surgical treatment of these patients is controversial, with several questions remaining unanswered. Is breast conservation therapy feasible in this patient population and can these patients retain their implants? A retrospective review of all breast cancer patients with a history of previous augmentation mammaplasty who were treated at the Revlon/UCLA Breast Center between 1991 and 2001 was performed. During the study period, 58 patients were treated. Thirty patients (52 percent) were treated with a modified radical mastectomy with implant removal. Twenty-eight patients (48 percent) underwent breast conservation therapy, which consisted of lumpectomy, axillary lymph node dissection, and radiotherapy. Twenty-two of the patients who underwent breast conservation therapy initially retained their implants. Eleven of those 22 patients (50 percent) ultimately required completion mastectomies with implant removal because of implant complications (two patients), local recurrences (five patients), or the inability to obtain negative margins (four patients). Nine additional patients experienced complications resulting from their implants, including contracture, erosion, pain, and rupture. The data illustrate that breast conservation therapy with maintenance of the implant is not ideal for the majority of augmented patients. Breast conservation therapy with explantation and mastopexy might be appropriate for rare patients with large volumes of native breast tissue. Mastectomy with immediate reconstruction might be a more suitable choice for these patients.     

Endocrine events during the periestrous period and the subsequent estrous cycle in ewes after estrus synchronization

The aim of the present study was to investigate the endocrinology of the periestrus period and that of the subsequent estrous cycle in ewes synchronized during the breeding season. Animals were treated for 14 days with either MAP intravaginal sponges or subcutaneous progesterone implants, followed by administration of 500 IU PMSG at the time of withdrawal. The time to estrus occurrence following progestagen withdrawal differed significantly between groups (45.3+/-2.7h for the MAP and 21.5+/-1.2h for the implant group, P<0.001). Estradiol levels around estrus did not differ between groups, but a significant difference was detected for the interval from peak estradiol to estrus, with a shorter interval for the implant group (26.7+/-0.7 and 2.7+/-0.9h, P<0.001). Progesterone implants shortened the interval from removal to LH surge, compared to the MAP group (31.2+/-4.4 and 56.5+/-3.6h, respectively, P<0.05). An earlier response was also observed for the interval from estradiol peak to LH peak in the implant group (12.1+/-3.3 and 37+/-2h, respectively, P<0.005), but no difference was observed for the interval from estrus to LH surge. Progesterone levels, particularly during the Days 6 to 10 of the subsequent estrous cycle were significantly higher (P<0.05) in the implant group. It is concluded that the kind of progesterone treatment may affect the time of estrus and the LH peak as well as the progesterone levels of the subsequent cycle.     

Improvement of femoral bone-cement adhesion in cemented revision hip arthroplasty by application of an amphiphilic bonder in a dynamic femur expulsion testing in vitro ]

Cemented femoral stems have shown decreased longevity compared to cementless implants in hip revision arthroplasty. The aim of this study was to evaluate the effect of an amphiphilic bonder on bone cement stability in a biomechanical femur expulsion test. A simplified hip simulator test setup with idealised femur stem specimens was carried out. The stems were implanted into bovine femurs (group 1: no bonder, n=10; group 2: bonder including glutaraldehyde, n=10; group 3: bonder without glutaraldehyde, n=10). A dynamic loading (maximum load: 800 N; minimum load: 100 N; frequency: 3 Hz; 105 cycles) was performed. Subsequently, the stem specimens were expulsed axially out of their implant beds and maximum load at failure was recorded. The static controls showed a mean maximum load to failure of 4123 N in group 1, 8357.5 N in group 2 and 5830.8 N in group 3. After dynamic loading, the specimens of group 2 reached the highest load to failure (8191.5 N), followed by group 3 (5649.5 N) and group 1 (3462 N), respectively. In group 2, we observed nine periprosthetic fractures at a load of 8400 N without signs of interface loosening. Application of an amphiphilic bonder led to a significant improvement of bonding stability, especially when glutaraldehyde was added to the bonder. This technique might offer an increased longevity of cemented femur revision stems in total hip replacement.     

Effects of tempol on renal angiotensinogen production in Dahl salt-sensitive rats

We have recently reported that Dahl salt-sensitive rats (DS) on high salt diet (HS) have an inappropriate augmentation of intrarenal angiotensinogen. Recent studies also reported that the augmented superoxide anion formation plays important roles in this animal model of hypertension. This study was performed to address the hypothesis that an inappropriate augmentation of intrarenal angiotensinogen by HS is caused by the augmented reactive oxygen species. Male DS (200-220 g) were maintained on low salt diet LS (N = 7) or HS (N = 27) for 4 weeks. The HS group was subdivided into three subgroups to receive null (N = 12), superoxide dismutase mimetic, tempol (3 mmol/l, N = 8), or vasodilator, hydralazine (0.5 mmol/l, N = 7) in drinking water during the period. Systolic BP was significantly increased in the DS+HS group compared to the DS+LS group (184+/-7 mmHg vs. 107+/-5 at 4-week). Tempol or hydralazine treatment equivalently attenuated the hypertension (128+/-3 and 127+/-5 at 4-week, respectively). Urinary excretion of thiobarbituric acid reactive substances at 4-week was significantly increased in the DS+HS group compared to the DS+LS group (0.66+/-0.05 micromol/day vs. 0.14+/-0.01). Tempol treatment prevented this effect (0.24+/-0.04) but hydralazine treatment only partially prevented the effect (0.40+/-0.03). Kidney angiotensinogen levels, measured by Western blot analysis, were significantly increased in the DS+HS group compared to the DS+LS group (32+/-5 densitometric units vs. 21+/-1). Tempol (14+/-3) but not hydralazine (32+/-5) treatment prevented the intrarenal angiotensinogen augmentation. The evidence suggests that the enhanced intrarenal angiotensinogen in DS challenged with HS is associated with the augmented reactive oxygen species.     

Modulation of bone ingrowth of rabbit femur titanium implants by in vivo axial micromechanical loading.

Titanium implants commonly used in orthopedics and dentistry integrate into host bone by a complex and coordinated process. Despite increasingly well illustrated molecular healing processes, mechanical modulation of implant bone ingrowth is poorly understood. The objective of the present study was to determine whether micromechanical forces applied axially to titanium implants modulate bone ingrowth surrounding intraosseous titanium implants. We hypothesized that small doses of micromechanical forces delivered daily to the bone-implant interface enhance implant bone ingrowth. Small titanium implants were placed transcortically in the lateral aspect of the proximal femur in 15 New Zealand White rabbits under general anesthesia and allowed to integrate with the surrounding bone for 6 wk. Micromechanical forces at 200 mN and 1 Hz were delivered axially to the right femur implants for 10 min/day over 12 consecutive days, whereas the left femur implants served as controls. The average bone volume 1 mm from mechanically loaded implants (n = 15) was 73 +/- 12%, which was significantly greater than the average bone volume (52 +/- 21%) of the contralateral controls (n = 15) (P < 0.01). The average number of osteoblast-like cells per endocortical bone surface was 55 +/- 8 cells/mm(2) for mechanically loaded implants, which was significantly greater than the contralateral controls (35 +/- 6 cells/mm(2)) (P < 0.01). Dynamic histomorphometry showed a significant increase in mineral apposition rate and bone-formation rate of mechanically stressed implants (3.8 +/- 1.2 microm/day and 2.4 +/- 1.0 microm(3).microm(-2).day(-1), respectively) than contralateral controls (2.2 +/- 0.92 microm/day and 1.2 +/- 0.60 microm(3).microm(-2).day(-1), respectively; P < 0.01). Collectively, these data suggest that micromechanical forces delivered axially on intraosseous titanium implants may have anabolic effects on implant bone ingrowth.     

The infected or exposed breast implant: management and treatment strategies

Among the potential complications associated with the use of breast implants are the risks of periprosthetic infection and device extrusion. There is little published information about the effective management of these situations. Conservative recommendations include antibiotic therapy and removal of the implant until resolution of the infection or until the wound has healed. A retrospective review identified patients with periprosthetic infection or threatened or actual device exposure treated by the senior author. Twenty-four patients encompassing 26 affected prostheses were available for review and were classified into seven groups based on initial presentation as follows: group 1, mild infection (n = 8); group 2, severe infection (n = 4); group 3, threatened exposure without infection (n = 3); group 4, threatened exposure with mild infection (n = 3); group 5, threatened exposure with severe infection (n = 1); group 6, actual exposure without clinical infection (n = 5); and group 7, actual exposure with infection (n = 2). To salvage the prosthesis in these patients, various treatment strategies were utilized. All patients with a suspected infection or device exposure were started immediately on appropriate antibiotic therapy (oral antibiotics for mild infections and parenteral antibiotics for severe infections). Salvage methods included one or more of the following: antibiotic therapy, débridement, curettage, pulse lavage, capsulectomy, device exchange, primary closure, and/or flap coverage. Twenty (76.9 percent) of 26 threatened implants with infection or threatened or actual prosthesis exposure were salvaged after aggressive intervention. The presence of severe infection adversely affected the salvage rate in this series. A statistically significant difference exists among those patients without infection or with mild infection only (groups 1, 3, 4, and 6); successful salvage was achieved in 18 (94.7 percent) of 19 patients, whereas only two of seven of those implants with severe infection (groups 2, 5, and 7) were salvaged (p = 0.0017). Ten (90.9 percent) of 11 devices with threatened or actual exposure, not complicated by severe infection (groups 3, 4, and 6), were salvaged. Several treatment strategies were developed for periprosthetic infection and for threatened or actual implant exposure. Patients with infection were placed on oral or intravenous antibiotics; those who responded completely required no further treatment. For persistent mild infection or threatened or actual exposure, operative intervention was required, including some or all of the following steps: implant removal, pocket curettage, partial or total capsulectomy, débridement, site change, placement of a new implant, and/or flap coverage; the menu of options varied with the precise circumstances. No immediate salvage was attempted in five cases, due to either severe infection, nonresponding infection with gross purulence, marginal tissues, or lack of options for healthy tissue coverage. Based on the authors' experience, salvage attempts for periprosthetic infection and prosthesis exposure may be successful, except in cases of overwhelming infection or deficient soft-tissue coverage. Although an attempt at implant salvage may be offered to a patient, device removal and delayed reinsertion will always remain a more conservative and predictable option.     

Stability of dental implants in microvascular osseous transplants

Microvascular iliac crest and scapula transplants have been used in reconstruction of the lower jaw following tumor surgery. It has only been with the insertion of dental implants that a satisfactory prosthetic rehabilitation of the patient has been achieved. For this study, a follow-up of 38 patients with lower jaw tumors was carried out. The patients had been treated with partial resection of the lower jaw and neck dissection with microvascular iliac crest transplants (n = 20) or microvascular scapula transplants (n = 18); this was followed with dental implants (n = 143) in the region of the transplants or the local lower jaw. One hundred thirty-nine of the 143 dental implants were loaded by prosthetic superstructures. In all patients, the implant situation was evaluated on average 2 years 5 months after implantation. Periotest values, periimplant probing depths, and contact bleeding were registered, and the extent of periimplant bone loss was defined radiographically. The clinical situation in the region of the implant was compared for both types of implants and also with the nonresected lower jaw. The average Periotest values were within the normal range for all groups. In one scapula implant, however, a better average of Periotesting, -3.3, was found compared with implants of the iliac crest with Periotest values of -0.7. A measurement of -2.1 was found for the local lower jaw, similar to that of scapula implants. Pathologic probing depths were found for all three compared groups. The radiographically determined vertical loss of bone was the same for all three groups, on average 1 mm at 27 months postoperatively. The highest incidence of sulcus bleeding was found in the scapula implant group. Thus, it can be stated that the scapula transplants provide a similar transplant site to local lower jaw bone, whereas implants in iliac crest transplants show lesser bony stability. Periimplant soft-tissue conditions are worse for both types of transplants compared with local tissue of the lower jaw.     

Failure of the LH-releasing hormone agonist, deslorelin, to prevent development of a persistent follicle in heifers synchronized with norgestomet

The use of exogenous progestagens for estrus synchronization in cattle can result in a persistent dominant follicle which is associated with reduced fertility. We examined whether the LHRH agonist, deslorelin, would prevent the formation of a persistent follicle in heifers synchronized with norgestomet. The estrous cycles of heifers were synchronized with cloprostenol, and on Day 7 of the ensuing cycle the heifers received one of the following treatments for 10 d: Group C (n = 5), untreated control; Group N (n = 6), injection of a luteolytic dose of cloprostenol on Days 7 and 8 and implant of norgestomet from Day 7 to Day 17 (i.e. typical 10-day norgestomet implant period); Group D (n = 6), injection of cloprostenol on Days 7 and 8 and implants of deslorelin from Day 7 to Day 17; Group ND (n = 6), injections of cloprostenol and both norgestomet and deslorelin implants as above. Follicle growth was monitored using ultrasonography. Group-N heifers showed continued follicle growth and had larger follicles on Day 17 of the cycle than Group-C heifers (16.8 +/- 1.6 and 10.4 +/- 1.6 mm). Follicle growth for Group-D and ND heifers was similar and variable, and seemed to depend on follicle status at the initiation of treatment. Heifers with follicles of 5 to 10 mm (n = 9) in diameter either showed no follicle growth (2 9 ) or developed large follicles (7 9 ), while heifers with follicles approximately 12 mm (n = 3) in diameter showed follicle atresia with no further significant growth. On Day 17, size of the largest follicle was similar for Group-ND (14.3 +/- 2.9) and Group-D (16.8 +/- 1.6) heifers. Heifers in Group N showed estrous behavior 1.8 +/- 0.2 d after treatment, whereas heifers in Groups D and ND did not show estrus for 2 to 4 wk. The results show that combined treatment with progestagen and an LHRH agonist does not consistently prevent the development of a persistent dominant follicle and that return to estrus can be delayed after treatment with an LHRH agonist.     

Reproductive responses of early postpartum dairy cattle to continuous treatment with a GnRH agonist (deslorelin) for 28 days to delay the resumption of ovulation

An experiment was conducted to investigate the potential of chronic delivery of a potent GnRH agonist (deslorelin) via subcutaneous implants to delay the resumption of ovulatory cycles in postpartum dairy cattle. Cows received either a single deslorelin implant (n=40; DES) within 7 days of calving or were untreated (n=24; CON). Blood samples were collected thrice weekly during the period the implants were in place. Plasma concentrations of progesterone (P4) and 17beta-oestradiol (E2) were measured along with selected serum metabolites. Implants were removed after 28 days and cattle monitored daily for behavioral oestrus. Serial weekly blood samples were collected to detect the occurrence of ovulation. Cows were artificially inseminated as they were detected in oestrus from 30 days after implant removal. Pregnancy status was subsequently determined by manual palpation of uterine contents at strategic intervals.Insertion of implants induced ovulation in 3/40 cows as determined by a rise in progesterone 7 days later. Deslorelin implants delayed the onset of ovulatory cycles compared with untreated herdmates (mean 43.4+/-4.2 versus 57.3+/-1.6 days postpartum; P<0.001). A noticeable delay of at least 12 days was observed between implant removal and the first animals ovulating. Mean plasma E2 concentrations during the period the implants were in place were similar for DES and CON cows that experienced a prolonged spontaneous postpartum anoestrus (low P4 >60 days), although both groups had concentrations only 20% of CON cows that had ovulated prior to 30 days postpartum.The patterns of recovery following implant removal were highly variable. A number of DES cows showed a low and transient rise in plasma progesterone around 21 days after implant removal. Some cows displayed oestrus but did not appear to form a fully functional corpus luteum with this phenomenon being more prevalent among DES cows (7 of 37 versus 1 of 21; P<0.05). Overall, significantly more DES cows were detected in oestrus without ovulating compared to CON cows. Final pregnancy rates did not differ between DES and CON groups. The mean time to conception for DES cows was longer (21.2+/-5.6 versus 41.1+/-7.4 days, CON versus DES; P<0.01). This difference was not present if the time from first ovulation to conception was compared (50.5+/-5.3 versus 43.5+/-9.3 days, CON versus DES; P>0.05). Deslorelin implants provided a reliable method of inducing anoestrus when treatment was initiated prior to 3 days postpartum. A variable pattern of recovery was observed which delayed conception but did not ultimately reduce the final proportion pregnant at the completion of mating. The study demonstrates the potential of GnRH agonists to control postpartum reproductive function to manipulate the fertility of dairy cows.     

Population dynamics in bioaugmented membrane bioreactor for treatment of bromoamine acid wastewater

The performances and microbial population changes in laboratory-scale membrane bioreactor (MBR) augmented with Sphingomonas xenophaga QYY were investigated in the present study. It was demonstrated that after 30 days acclimation, the non-augmented MBR system were able to degrade bromoamine acid (BAA) well. However, the efficiency of the system decreased with BAA concentration increasing. While the augmented MBR showed higher capability, in which the color and COD removal were more than 90% and 50%, respectively. By ribosomal intergenic spacer analysis (RISA), it was found that BAA-utilizing populations gradually increased to become the dominant species in the non-augmented MBR. However, the augmented MBR possessed relatively stable treatment abilities, in which the introduced strain QYY could be persistent and co-exist well with the indigenous populations.     

Effect of intravaginal implants of melatonin on the onset of ovarian activity in adult and prepubertal ewes

Melatonin was administered intravaginally in Silastic tubing to adult and prepubertal ewes. In Exp. 1, ewe lambs (born early March) were given intravaginal melatonin implants at a mean age (+/- s.e.m.) of 7.5 +/- 0.1 weeks (Group E, N = 10) or 19.4 +/- 0.2 weeks (Group L, N = 10). The third group (Group C, N = 10) received empty implants. In Exp. 2 mature ewes were given implants on 13 May (Group E, N = 10) or 18 July (Group L, N = 10) or received empty implants (Group C, N = 10) on one of these two dates. Blood samples were taken twice weekly for progesterone assay. In Exp. 1 the mean age (+/- s.e.m.) at puberty (progesterone greater than 2 nmol/l for two consecutive samples) was 35.4 +/- 0.8 weeks. Puberty was advanced by 5.2 weeks in Group L lambs, occurring at a mean age of 30.2 +/- 0.7 weeks (P less than 0.001). In Group E lambs the timing of puberty was unaltered, occurring at a mean age of 34.8 +/- 0.6 weeks. Mature ewes in Group L (Exp. 2) showed increased incidence of ovarian activity (9/10 ewes cycling by 26 September) compared with the control ewes (1/10) (P less than 0.001), but there was no effect in Group E ewes (3/10). The results demonstrate that continuous melatonin administration to adult and prepubertal ewes can mimic the effect of short days in terms of the reproductive response, and that the present and previous exposure to melatonin is critical in determining the response.     

Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications

A retrospective review was performed of one surgeon's experience with 40 consecutive patients who had undergone two-stage saline-filled implant breast reconstruction and radiation during the period from 1990 through 1997. A randomly selected group of 40 other two-stage saline-filled implant breast reconstructions from the same surgeon and time period served as controls. This review was undertaken because of the absence of specific information on the outcome of staged saline implant reconstructions in the radiated breast. Previously published reports on silicone gel implants and radiation have been contradictory. At the same time, the criteria for the use of radiation in the treatment of breast cancer have been expanded and the numbers of reconstruction patients who have been radiated are increasing dramatically. For example, in a 1985 report on immediate breast reconstruction, only 1 of 185 patients over a 6-year period underwent adjuvant radiation therapy, whereas in this review, there were 40 radiated breasts with saline-filled implants, 19 of which received adjuvant radiation therapy during their expansion. The study parameters included patient age, breast cup size, implant size, length of follow-up, number of procedures, coincident flap operations, Baker classification, complications, opposite breast procedures, pathologic stage, indications for and details about the radiation, and outcomes. The use of radiation in this review of reconstructed breasts can logically be divided into four groups: previous lumpectomy and radiation (n = 7), mastectomy and radiation before reconstruction (n = 9), mastectomy and adjuvant radiation during reconstruction/expansion (n = 19), and radiation after reconstruction (n = 5). The largest and most rapidly growing group of patients is of those receiving postmastectomy adjuvant radiation therapy. A total of 47.5 percent (19 of 40) of radiated breasts with saline implants ultimately needed the addition of, or replacement by, a flap. Ten percent of a control group with nonradiated saline implant reconstructions also had flaps, none as replacements. Fifty percent or more of both the radiated and control groups had contralateral surgery. Complications were far more common in the radiated group; for example, there were 32.5 percent capsular contractures compared with none in the control group. The control nonradiated implant-only group and the flap plus implant radiated group did well cosmetically. The radiated implant-only group was judged the worst. The increasing use of radiation after mastectomy has important implications for breast reconstruction. The possibility for radiation should be thoroughly investigated and anticipated preoperatively before immediate breast reconstruction. Patients with invasive disease, particularly with large tumors or palpable axillary lymph nodes, are especially likely to be encouraged to undergo postmastectomy radiation therapy. The indications for adjuvant radiation therapy have included four or more positive axillary lymph nodes, tumors 4 cm (or more) in diameter, and tumors at or near the margin of resection. More recently, some centers are recommending adjuvant radiation therapy for patients with as few as one positive lymph node or even in situ carcinoma close to the resection margin. The use of latissimus dorsi flaps after radiation has proven to be an excellent solution to postradiation tissue contracture, which can occur during breast expander reconstruction. The use of the latissimus flap electively with skin-sparing mastectomy preradiation is probably unwise, unless postmastectomy radiation is unlikely. Skin-sparing mastectomy with a latissimus flap thus should be preserved for patients unlikely to undergo adjuvant radiation therapy. Purely autologous reconstruction such as a TRAM flap is another option for these patients, either before or after radiation therapy.     

In vitro secretion of prostaglandins from endometrium of postpartum beef cows expected to have short or normal luteal phases

The objective of this study was to characterize endometrial secretion (in vitro) of prostaglandin F (PGF), 15-keto-13,14-dihydro-prostaglandin F2 alpha (PGFM), prostaglandin E2 (PGE2), and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) on Day 5 following the first postpartum estrus of cows anticipated to have a short compared to a normal estrous cycle. Twenty-seven beef cows were randomly assigned into four groups. The Short Cycle (n = 6; control) and Short Cycle/Explant (n = 8; endometrial explants) groups had their calves weaned at 30-32 days postpartum. The Normal Cycle (n = 5, control) and Normal Cycle/Explant (n = 8; endometrial explants) groups received norgestomet (progestin) implants for 9 days beginning 21-23 days postpartum, and calves were weaned at implant insertion. Estrous cycle length (mean +/- SE; p less than 0.01) for the Short Cycle group was 11.5 +/- 1.9 days compared to 18.8 +/- 0.6 days for the Normal Cycle group. On Day 5 following the first postpartum estrus, cows in the Short Cycle/Explant and Normal Cycle/Explant groups were hysterectomized, and endometrial explants were incubated in Earle's Balanced Salt solution/Medium 199 for 90 min with or without arachidonic acid (AA) in the presence of three levels of oxytocin. Mean concentrations of PGF and PGFM were combined to obtain a value for total PGF. Concentrations of total PGF, PGE2 (from explants without AA treatment), and 6-keto-PGF1 alpha in medium of the Short Cycle/Explant group were higher (p less than 0.01) than in medium of the Normal Cycle/Explant group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of Roman chair exercise training on the development of lumbar extension strength

The purpose of this study was to determine the effect of 45 degrees Roman chair exercise training on the development of lumbar extension strength. Fifteen healthy volunteers (9 women, 6 men) were recruited from a university setting and were randomly assigned to 1 of 2 groups. One group (n = 9) performed progressive resistance back extension exercise on a 45 degrees Roman chair once weekly for 12 weeks. Training consisted of one set of 8-20 dynamic repetitions to volitional exhaustion using hand-held metal plates for additional resistance. The other group did not train (control, n = 6). Peak isometric lumbar extension torque was measured on a lumbar extension dynamometer before and after the 12-week program. Following training, peak isometric lumbar extension torque did not increase for the Roman chair group (before: 224.0 +/- 134.1 N x m; after: 240.3 +/- 137.4 N x m; p > 0.05) compared with the control group (before: 175.6 +/- 68.9 N x m; after: 178.2 +/- 69.9 N x m; p > 0.05), despite an increase in dynamic exercise load.     

Influence of transmucosal height in abutments of single and multiple implant-supported prostheses: a non-linear three-dimensional finite element analysis

The aim of this study was to analyze the influence of three different transmucosal heights of the abutments in single and multiple implant-supported prostheses through the finite element method. External hexagon implants, MicroUnit, and EsthetiCone abutments were scanned and placed in an edentulous maxillary model obtained from a tomography database. The simulations were divided into two groups: (1) one implant with 3.75 × 10 mm placed in the upper central incisor, simulating a single implant-supported fixed prosthesis with an EsthetiCone abutment; and (2) two implants with 3.75 × 10 mm placed in the upper lateral incisors with MicroUnit abutments, simulating a multiple implant-supported prosthesis. Subsequently, each group was subdivided into three models according to the transmucosal height (1, 2, and 3 mm). A static oblique load at an angle of 45 degrees to the long axis of the implant in palatal-buccal direction of 150 and 75 N was applied for multiple and single implant-supported prosthesis, respectively. The implants and abutments were assessed according to the equivalent Von Mises stress analyses while the bone and ceramics were analyzed through maximum and minimum principal stresses. The total deformation values increased in all models, while the transmucosal height was augmented. The transmucosal height of the abutments influences the stress values at the bone, ceramics, implants, and abutments of both the single and multiple implant-supported prostheses, with the transmucosal height of 1 mm showing the lowest stress values.     

Improvement of reproductive performance in crossbred zebu anestrous primiparous cows by treatment with norgestomet implants or 96 h calf removal

The aim of the present study was to compare the effect of norgestomet implants (NI) and calf removal (CR) for 96 h on estrus induction and first service fertility in crossbred zebu primiparous anestrous cows after 120 days postpartum. A total of 152 cows in a tropical environment were allotted to three experimental groups: CR for 96 h (n = 51), NI for 9 days plus 500 IU of PMSG at implant removal (n = 51) and a control group (CG) without treatment (n = 50). Estrous rate (%) and mean interval to first estrus (days) were 50.9 and 26.3+/-6.8; 60.7 and 13.8+/-6.8; 16.0% and 61.8+/-5.9 days for groups CR, NI and CG, respectively. CR and NI were statistically similar, however, both groups were different (P < 0.01) when compared with CG. Calving interval to first service and to conception were: CR: 151.2+/-8.4 and 157.8+/-21.4; NI: 145.2+/-8.5 and 150.9+/-21.3; CG: 186.8+/-7.3 and 201.0+/-18.5. A difference (P < 0.01) was found in both intervals when comparing the CR and NI with CG, with longer intervals for cows in the CG group. First service conception rates were 61.5, 67.7 and 62.5% for groups CR, NI and CG, respectively, and were not different (P > 0.05). These results demonstrate the efficacy of NI + PMSG or temporary CR for 96 h in inducing a fertile estrus and shortening the interval to estrus and to conception in primiparous crossbred anestrous zebu cows in the tropics.     

Comparative study of antioxidant enzymes in tissues surrounding implant in rabbits

There is a possible role of reactive oxygen species (SROS) in the complication of implants although there is presently little information. The aim of this study was to investigate the alterations in lipid peroxidation (LP) and antioxidant enzyme activities in tissues surrounding implants in rabbits. Thirty New Zealand albino male rabbits were used. They were randomly divided into five groups. The first group (I) was used as control. Groups II, III, IV and V were implanted with stainless steel, ceramic, titanium and polyethylene, respectively. One month after the administration of implant, the tissues surrounding the implant were carefully removed for antioxidant enzyme analysis. Glucose-6-phosphate dehydrogenase (G6PD), glutathione reductase (GR), superoxide dismutases (SOD), glutathione peroxidase (GPx), catalase (CAT) in tissues surrounding the implants in the groups II, III and IV were significantly (p<0.05-p<0.001) lower than in the control group although glutathione S-transferase (GST) activities and LP values were increased. CAT activity and LP level did not decrease in group V. In conclusion, these data demonstrate that there is an increase in lipid peroxidation in the tissues surrounding ceramic and titanium implants of animals whereas there is a decrease in antioxidant enzymes. Oxidative stress plays a very important role in the complications of ceramic and titanium implants. The polyethylene implant seems to be the best of the four implant materials tested.     

Synchronization of estrus and fertility in goats with norgestomet ear implants

Estrus was synchronized in 64 dairy goats in July with norgestomet ear implants. Half the does received ear implants that contained 6 mg norgestomet and the remaining does received implants that contained 3 mg. Implants were left in place for 11 days. Each doe received i.m. injections of 400 IU PMSG and 50 mug cloprostenol 24 hours prior to implant removal. Twenty-eight of 32 does (87.5%) that received 6 mg or 3 mg norgestomet exhibited onset of estrus within 24 hours of implant removal. All does had exhibited onset of standing estrus by 43 hours after implant removal. Does were hand-mated to fertile bucks twice daily while in standing estrus. There were no differences between does implanted with 6 mg or 3 mg in fertility to the induced estrus (74.2% vs 75% kidding), mean length of gestation (151.0 +/- 3.2 vs 151.6 +/- 2.0 days), mean number of kids per doe (2.1 +/- 0.8 vs 2.3 +/- 0.7) or in mean kid weights (3.10 +/- 0.80 vs 3.06 +/- 0.86 kg) (6 mg vs 3 mg, respectively). It was concluded that ear implants that contained 3 mg of norgestomet were equally as effective as implants that contained 6 mg for synchronization of estrus in dairy goats.     

Rate and incidence of capsular contracture: a comparison of smooth and textured silicone double-lumen breast prostheses

Capsular contracture results in dissatisfaction and deformity among the 2 million women who have had silicone implants. The literature describes contracture rates as high as 74 percent. I present a comparison of rates and incidences of contracture in patients augmented with smooth and textured double-lumen silicone implants. A total of 165 "smooth" and 63 "textured" implant patients were included in this study, which spans 12 years, 1978-1990. All patients underwent bilateral aesthetic augmentation performed by the same surgeon. Of the 165 smooth implant patients, 74 (44.8 percent) experienced contractures requiring treatment. Of the 63 textured implant patients, 3 (4.8 percent) previous contracture patients experienced sudden fibrosis within 3 months. All others remained soft. It appears that deeply textured silicone surfaces delay or decrease the rate and incidence of clinical capsular contracture, at least for 2 years.     

Removal of deslorelin (Ovuplant) implant 48 h after administration results in normal interovulatory intervals in mares

Deslorelin implants, approved for use in inducing ovulation in mares, have been associated with prolonged interovulatory intervals in some mares. Administration of prostaglandins in the diestrous period, following a deslorelin-induced ovulation, has been reported to increase the incidence of delayed ovulations. The goals of the present study were: (1) to determine the percentage of mares given deslorelin that experience delayed ovulations with or without subsequent prostaglandin treatment, and (2) to determine if removal of the implant 48 h after administration would effect the interval to subsequent ovulation. We considered interovulatory intervals to be prolonged if they were greater than the mean +/- 2 standard deviation (S.D.) of the control group in study 1 and the hCG group in study 2. In study 1, we retrospectively reviewed reproduction records for 278 mares. We either allowed the mare to ovulate spontaneously or induced ovulation using deslorelin acetate implants or hCG. We administered prostaglandin intramuscularly, 5-9 days after ovulation in selected mares in each group. A higher percentage of mares which were induced to ovulate with deslorelin and given prostaglandins had a prolonged interovulatory interval (23.5%; n = 16), as compared to deslorelin-treated mares that did not receive prostaglandins (11.1%; n = 5). In study 2, we induced ovulation in mares with hCG (n = 47), a subcutaneous deslorelin implant via an implanting device provided by the manufacturer (n = 28), or a deslorelin implant via an incision in the neck (n = 43) and we removed the implant 48 h after administration. We administered prostaglandin to all mares 5-9 days after ovulation. In study 2, mares from which the implant was removed had a normal ovulation rate and none had a prolonged interval to ovulation. Administration of prostaglandin after deslorelin treatment was associated with a longer interval from luteolysis to ovulation than that found in mares not treated with deslorelin. Prostaglandin administration during diestrus may have exacerbated the increased interval to ovulation in deslorelin-treated mares. We hypothesize that prolonged secretion of deslorelin from the implant was responsible for the extended interovulatory intervals.