[Beyond the trenches, two German pioneers of plastic surgery]

Cosmetic and reconstructive surgery has existed in many forms since antiquity, but it was the impulse given by the Great War that gave birth to plastic and cosmetic surgery as we know it today. After the Great War, the names of the most famous pioneers of the allies' side are Sir Harold Gillies, Mac Indoe and also Hippolyte Morestin; however, the surgeons of the enemy axis, beyond the trenches, faced the same constraints with their own war casualties. We present the destinies of two great pioneers of plastic surgery within the beautiful German Bismarckian period: Professor Erich Lexer, and "non-professor" Jakob Joseph.

[Dujarrier scandal: Yesterday and today]

From the municipal archives of the "dujarrier-geoffre" procès in 1929, we analyse an evolution in jurisprudence. Nowadays, the judgment would have to be more merciful to the surgeon (finally condemned) or to the victim who lost her left leg and her "maison de couture"? We review the birth of "medical responsibility" at the "belle époque" in France. Finally with the help of the "sou medical" archives, we show the evolution of plastic surgeons' sinistrality since 1993 (no data before).

Antenatal IL-1-dependent inflammation persists postnatally and causes retinal and sub-retinal vasculopathy in progeny

Antenatal inflammation as seen with chorioamnionitis is harmful to foetal/neonatal organ development including to eyes. Although the major pro-inflammatory cytokine IL-1β participates in retinopathy induced by hyperoxia (a predisposing factor to retinopathy of prematurity), the specific role of antenatal IL-1β associated with preterm birth (PTB) in retinal vasculopathy (independent of hyperoxia) is unknown. Using a murine model of PTB induced with IL-1β injection in utero, we studied consequent retinal and choroidal vascular development; in this process we evaluated the efficacy of IL-1R antagonists. Eyes of foetuses exposed only to IL-1β displayed high levels of pro-inflammatory genes, and a persistent postnatal infiltration of inflammatory cells. This prolonged inflammatory response was associated with: (1) a marked delay in retinal vessel growth; (2) long-lasting thinning of the choroid; and (3) long-term morphological and functional alterations of the retina. Antenatal administration of IL-1R antagonists - 101.10 (a modulator of IL-1R) more so than Kineret (competitive IL-1R antagonist) - prevented all deleterious effects of inflammation. This study unveils a key role for IL-1β, a major mediator of chorioamnionitis, in causing sustained ocular inflammation and perinatal vascular eye injury, and highlights the efficacy of antenatal 101.10 to suppress deleterious inflammation.

The measurement of photoneutron dose in the vicinity of clinical linear accelerators

In Brazil, the replacement of rather old cobalt and cesium teletherapy machines with high-energy (E > 10 MV) medical linear accelerators (linacs) started in the year 2000, as part of an effort by the Ministry of Health to update radiotherapy installations. Since then, the contamination of undesirable neutrons in the therapeutic beam generated by these high-energy photons has become an issue of concern when considering patient and occupational doses. The walls of the treatment room are shielded to attenuate the primary and secondary X-ray fluence, and this shielding is generally considered adequate also to attenuate neutrons. However, these neutrons are scattered through the treatment room maze and might result in a radiological problem at the door entrance, an area of high occupancy by the workers of a radiotherapy facility. This paper presents and discusses the results of ambient dose equivalent measurements of neutron using bubble detectors. The measurements were made at different points inside the treatment rooms, including the isocentre and the maze. Several radiation oncology centres, which are users of Varian Clinac or Siemens machines, have agreed to allow measurements to be taken at their facilities. The measured values were compared with the results obtained through the semi-empirical Kersey method of neutron dose equivalent calculation at maze entrances, with reported values provided by the manufacturers as well as values published in the literature. It was found that the measured values were below the dose limits adopted by the Brazilian Regulatory Agency (CNEN), requiring no additional shielding in any of the points measured.

Neutron scattering in concrete and wood: Part II--Oblique incidence

The knowledge of neutron reflection coefficients is of practical interest when projecting the shielding of radiotherapy rooms, since it is known that about 75% of the neutrons at the maze entrance of these rooms are scattered neutrons. In a previous paper, the energy spectra of photoneutrons were calculated, when reflected by ordinary, high-density concrete and wood barriers, using the MCNP5 code, considering normal incidence and neutron incident energies varying between 0.1 and 10 MeV. It was found that the mean energy of the reflected neutrons does not depend on the reflection angle and that these mean energies are lower in wood and barytes concrete, compared with ordinary concrete. In the present work, the simulation of neutron reflection coefficients were completed, considering the case when these particles do not collide frontally with the barriers, which constitute the radiotherapy room walls. Some simulations were also made to evaluate how neutron equivalent doses at the position of the room door is affected when the maze walls are lined with neutron absorbing materials, such as wood itself or borated polyethylene. Finally, capture gamma rays dose at the entrance of rooms with different maze lengths were also simulated. The results were discussed in the light of the albedo concepts presented in the literature and some of these results were confronted with others, finding good agreement between them.

Malignant melanoma of soft parts. A "non plastic surgeon's land"?

Malignant melanoma of soft parts (MMSP) (or "clear cell sarcoma") is a very rare tumour that shows up without primitive skin involvement (except in subcutaneous prolongations of deep tumours), mostly predominant in the extremities of young adults. Eight files of MMSP were studied retrospectively. The mean patient is a male of 35 years old affected in an extremity (four upper, three lower and one gluteal), according to classical descriptions. The importance of radical surgery in these cases has been extensively established. Confronted with these cases, the plastic surgeon must be aware of the specifics of this rare entity to ensure its proper inclusion in his clinical suspicion. Just in case.

A comparison of 0.5% ropivacaine and 1% mepivacaine for sciatic nerve block in the popliteal fossa

BACKGROUND

The purpose of this study was to compare anesthetic efficacy and postoperative analgesia of 0.5% ropivacaine and 1% mepivacaine for sciatic nerve block in the popliteal fossa (popliteal block).

METHODS

A prospective, double-blind study was carried out in 58 adult patients scheduled for outpatient foot or ankle surgery. They were randomized to receive popliteal block with 40 ml of either 0.5% ropivacaine (group R) or 1% mepivacaine (group M). An atraumatic, Teflon-coated needle connected to a neurostimulator was used to make a single puncture using a posterior approach. The times to onset of sensory and motor block, and the need for intraoperative sedation were recorded. Before discharge, patients were asked to document the time to first analgesic use, time to return of full sensation in the foot, and their evaluation of the technique.

RESULTS

Onset time (mean+/-standard deviation, 95% confidence interval) of both sensory block (6.5+/-5.1 min, 4.47-8.49, in group R and 6.2+/-3.7 min, 4.83-7.69, in group M) and motor block (6.6+/-4.4 min, 4.81-8.23, in group R and 7.9+/-4.1 min, 6.29-9.53, in group M) was similar in both groups. Postoperative analgesia lasted longer in group R (15.2+/-5.1 h, 13.25-17.21) than in group M (5.7+/-1.8 h, 5.01-6.41; P<0.001). Duration of sensory block was longer in group R (20.7+/-6.2 h, 18.51-23.01) than in group M (6.5+/-1.7 h, 5.86-7.16; P<0.001). Acceptance of the anesthetic procedure was similar in both groups.

CONCLUSION

In this study we demonstrated that both 0.5% ropivacaine and 1% mepivacaine for popliteal block produced rapid, effective and safe anesthesia but postoperative analgesia was more long-lasting with ropivacaine.

Expression of prolactin gene and secretion of prolactin by rat retinal capillary endothelial cells

PURPOSE

Prolactin fragments inhibit blood vessel formation, whereas anti-prolactin antibodies induce angiogenesis in the cornea. Endothelial cells from brain capillaries and the umbilical vein produce prolactin, and this study was undertaken to determine whether retinal capillary endothelial cells could be a source for prolactin in the eye.

METHODS

Primary cultures of rat retinal endothelial cells were investigated for the expression of prolactin mRNA by reverse transcription-polymerase chain reaction (RT-PCR) and Southern blot analysis and by in situ hybridization. The prolactin protein was analyzed by immunocytochemistry, enzyme-linked immunoabsorbent assay, Western blot analysis, and the Nb2-cell bioassay. The effect of prolactin and the 16-kDa prolactin fragment on retinal endothelial cell proliferation was investigated, and the expression of the cloned prolactin receptor was analyzed by RT-PCR and Southern blot analysis.

RESULTS

Retinal endothelial cells expressed prolactin mRNA and full-length 23-kDa prolactin. Prolactin was observed in the cytoplasm of cells and in their conditioned medium at levels 300 times those described in endothelial cells from other vessels and species. Exogenous 16-kDa prolactin inhibited rat retinal endothelial cell proliferation, whereas 23-kDa prolactin was inactive. No evidence was obtained for the expression of the cloned prolactin receptor in these cells, but the prolactin receptor was amplified in whole rat retina.

CONCLUSIONS

Endothelial cells from the microcirculation of rat retina produce and release prolactin. That the cloned prolactin receptor was not expressed in these cells argues against direct autocrine effects of prolactin. Possible paracrine effects are suggested by the expression of the prolactin receptor in retinal tissue.

Liver function testing in a working population: three strategies to reduce false-positive results

A very high rate of mildly abnormal results on a liver panel of five serum chemistries was observed when these tests were performed on a group of asymptomatic, normal workers. These results often led to lengthy delays in hiring, which benefited neither worker nor employer. Three strategies which markedly reduce the number of false-positive examinations with little or no reduction in test sensitivity are available.

Allergy to laboratory animals in health care personnel

Lab animal allergy is a frequent affliction of health care and research personnel whose work involves contact with lab animals. It affects up to 30% of those who are exposed directly and even some workers exposed indirectly, often unwittingly. The consequences of LAA may be severe, including disabling asthma and loss or attenuation of a career. Although recognized for many years, the working-out of the fine details about animals antigens, extracts, and diagnosis and treatment regimens is still far from finished. Not one prospective study longer than one year has been reported, although at least three are underway. It is hoped that information from these studies will contribute to the knowledge about the true incidence of LAA, exposure dose-response, and sensitivity, specificity, and positive predictive value of possible contributory factors such as atopy. The consesus of opinion is that, until the full significance of possible predictive factors is known, judgments concerning employment based on these factors should be avoided. Finally, there is a great need for increased emphasis on the development and objective evaluation of preventive measures.

Occupational allergy to laboratory animals: an epidemiologic study

A cross-sectional study has been carried out at The National Institutes of Health to examine the prevalence of laboratory animal allergy (LAA) in a population exposed to animals, and to compare the prevalence of general allergy in the exposed v a control group. A group of 289 workers with light-to-moderate exposure to animals, 260 with heavy exposure, and 242 control subjects were interviewed. A slightly greater prevalence of general allergy was found among those working with laboratory animals (39%), than in the control group (33.9%), but the difference was not statistically significant. The prevalence of LAA in the total exposed group was 23.9%. A history of atopic problems and history of allergy to domestic animals correlated significantly with LAA, as did the number of species of animals handled and the average number of hours per week exposed to laboratory animals, with evidence of dose-response relationships.

The National Institutes of Health animal handlers medical surveillance program

The medical surveillance program for animal caretakers, technicians, and other personnel having contact with animals at the National Institutes of Health is described. The program classifies workers according to the groups of animals with which they work. It includes preplacement physical examinations, preventive immunizations, testing, and monitoring of health status. This program helps to protect the workers' health from diseases acquired from animals and to prevent ill employees from adversely affecting the health of the animals with which they work.