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Biermann N, Eschenbacher E, Brébant V, Heine N, Brix E, Prantl L, Anker AM. Patient characteristics may affect the lymphatic staining ability of Indocyanine green and Patent blue during lymphaticovenous anastomosis. Clin Hemorheol Microcirc 2024; 86:153-158. [PMID: 37718792 DOI: 10.3233/ch-238112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND The use of dyes like Indocyanine green (ICG) and Patent blue facilitates the identification of lymphatic vessels during lymphaticovenous anastomosis (LVA) surgery. However, some patients experience "staining failure". In these cases, no stained lymphatic vessels can be detected, making supermicrosurgical LVA even more complex. OBJECTIVE This study aims to investigate patient-related factors that may interfere with lymphatic vessel staining during LVA. METHODS A retrospective study was conducted on 30 patient charts, focusing on patient characteristics and the staining quality of ICG and Patent blue dye. Statistical analyses were performed to identify correlations between variables. RESULTS Significant correlations were found between higher age and secondary lymphedema, longer duration of lymphedema in male patients until surgery and reoccurring cellulitis and Patent blue staining. Notably, recurrent infections to the lymphatic system resulted in inferior staining ability during LVA surgery. CONCLUSIONS Due to staining failure the detection of functional lymphatic vessels remains challenging in LVA surgery. A more extensive preoperative workup is recommended for patients with recurrent cellulitis to optimize surgical feasibility and procedure quality in LVA treatment for lymphedema.
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Affiliation(s)
- Niklas Biermann
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Elisabeth Eschenbacher
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Vanessa Brébant
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Norbert Heine
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Eva Brix
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Alexandra M Anker
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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Heine N, Brebant V, Seitz S, Eigenberger A, Prantl L, Tessmann V. Lightweight implants in breast reconstruction. Clin Hemorheol Microcirc 2023:CH239101. [PMID: 36970892 DOI: 10.3233/ch-239101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Since the first use of silicone implants by Cronin in 1962, there have been several attempts to introduce alternative filling materials for breast implants on the market. A promising new development are lightweight implants, whose filler material is one third lighter than conventional silicone gel. While these implants have been used primarily for aesthetic augmentation, a benefit could be expected particularly in post-mastectomy reconstruction. MATERIALS AND METHODS Since 2019, 92 operations using lightweight implants have been performed at our clinic, 61 of them for breast reconstruction after mastectomy. These have been compared to 92 breast reconstructions using conventional silicone implants. RESULTS The average volume of the lightweight implants was 30% higher than of the conventional implants (452 ml resp. 347 ml), whereas the implant weight was comparable in both groups (317 g resp. 347 g). Grade 3-4 capsular fibrosis was seen in 6 cases in both groups; revision was required 9 times (lightweight implants) and 7 times (conventional silicone implants) during the follow-up period. DISCUSSION To our knowledge, this is the first study to investigate the use of lightweight implants in breast reconstruction. With exception of the filler material, the implants used in the two groups were comparable in shape and surface. The inserted lightweight implants had a greater volume but nearly the same weight as the conventional implants and were used in patients with a higher body mass index. Thus, lightweight implants were preferred in patients whose reconstruction required a larger implant volume. CONCLUSION Lightweight implants are a new alternative for breast reconstruction especially in case that larger implant volume is demanded. The increased complication rate has to be verified in further studies.
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Affiliation(s)
- N Heine
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef, Regensburg, Germany
| | - V Brebant
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef, Regensburg, Germany
| | - S Seitz
- Department of Obstetrics and Gynecology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
| | - A Eigenberger
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef, Regensburg, Germany
- Medical Device Lab, Regensburg Center of Biomedical Engineering (RCBE), Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - L Prantl
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef, Regensburg, Germany
| | - V Tessmann
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef, Regensburg, Germany
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Brebant V, Lemonnier L, Georgieva M, Anker A, Heine N, Seitz S, Frank K, Prantl L, Eigenberger A. Comparison of analog and digitally evaluated volume of the female breast in reconstructive breast surgery. Validation of a noninvasive measurement method with 3D camera1. Clin Hemorheol Microcirc 2023; 85:277-287. [PMID: 36502309 DOI: 10.3233/ch-229101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Reconstructive surgery is established as a standard treatment option after mastectomy due to cancer. It is crucial to patients to achieve a natural and symmetric looking breast through reconstruction. Anthropometric measurements are used to assess the objective symmetry of the breast, which are prone to errors and difficult to reproduce. OBJECTIVE The aim of this work is to validate breast volumetry using three-dimensional surface imaging. METHODS We compared preoperatively analog and digitally evaluated volume of the breast with our gold standard, direct water displacement measurement of the mastectomy specimen. We examined 34 breast specimens in total. RESULTS Each measurement method (Breast Sculptor, VAM, Breast-V) for breast volume/mass determination demonstrates acceptable agreement ranges when compared with resected volumes and masses. The strongest volumetry instrument is Breast Sculptor (digital), the weakest is Breast-V (analog). CONCLUSIONS 3D surface imaging is a quick, effective, and convenient method to evaluate breast shape and volume. The accuracy, reproducibility, and reliability of 3D surface imaging were comparable with MRI in our study.This takes us a step closer to the long-term goal of establishing robust instruments to plan breast reconstructive surgery, achieve better surgical results, and contribute to quality assurance in breast surgery.
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Affiliation(s)
- V Brebant
- University Medical Center Regensburg. Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, Regensburg, Germany
| | - L Lemonnier
- University Medical Center Regensburg. Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, Regensburg, Germany
| | - M Georgieva
- University Medical Center Regensburg, Department of Radiology, Regensburg, Germany
| | - A Anker
- University Medical Center Regensburg. Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, Regensburg, Germany
| | - N Heine
- University Medical Center Regensburg. Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, Regensburg, Germany
| | - S Seitz
- University Medical Center Regensburg, Department of Gynecology and Obstetrics, Caritas Hospital St. Josef, Regensburg, Germany
| | - K Frank
- Division of Hand-, Plastic- and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - L Prantl
- University Medical Center Regensburg. Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, Regensburg, Germany
| | - A Eigenberger
- University Medical Center Regensburg. Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, Regensburg, Germany
- Medical Device Lab, Regensburg Center of Biomedical Engineering (RCBE), Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
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Heine N, Eigenberger A, Brebant V, Hoesl V, Brix E, Prantl L, Kempa S. Comparison of skin sensitivity following breast reconstruction with three different techniques: Autologous fat grafting, DIEP flap and expander/implant1. Clin Hemorheol Microcirc 2021; 80:389-397. [PMID: 34806600 DOI: 10.3233/ch-219203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Autologous fat grafting (AFG) has been established over the past two decades as an additive technique during and after breast reconstruction. Complete reconstruction of the breast mound with AFG alone represents an exceptional technique that has been published mostly in case reports or in studies with limited cases.The purpose of this study is to investigate the influence of three different techniques for breast reconstruction on the recovery of skin sensitivity at the reconstructed breast. METHODS The study included 30 patients after mastectomy following breast cancer. Three groups were examined: A) breast reconstruction by autologous fat grafting (AFG), B) breast reconstruction by deep inferior epigastric artery perforator flap (DIEP) and C) breast reconstruction by expander/implant (TE).Biometric data were compared; sensitivity tests were performed using Semmes-Weinstein monofilaments.The non-operated, healthy contralateral breasts of the patients were used as a reference. RESULTS While the traditional reconstruction techniques by microsurgical anastomosed perforator flap or expander/implant showed a strongly decreased or completely missing sensitivity of the skin, the tests after reconstruction by AFG represented high values of sensory recovery, which came close to the reference group of non-operated breasts. CONCLUSION To our knowledge, this is the first study to compare skin sensitivity after AFG-based reconstruction to established techniques for breast reconstruction. We could demonstrate in a limited group of patients, that breast reconstruction by autologous fat grafting can achieve higher values of skin sensitivity compared to traditional techniques.
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Affiliation(s)
- N Heine
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg andCaritas Hospital St. Josef, Regensburg, Germany
| | - A Eigenberger
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg andCaritas Hospital St. Josef, Regensburg, Germany.,Faculty of Mechanical Engineering, OstbayerischeTechnische Hochschule Regensburg (OTH Regensburg), Germany
| | - V Brebant
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg andCaritas Hospital St. Josef, Regensburg, Germany
| | | | - E Brix
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg andCaritas Hospital St. Josef, Regensburg, Germany
| | - L Prantl
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg andCaritas Hospital St. Josef, Regensburg, Germany
| | - S Kempa
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg andCaritas Hospital St. Josef, Regensburg, Germany
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Kempa S, Brix E, Heine N, Hösl V, Strauss C, Eigenberger A, Brébant V, Seitz S, Prantl L. Autologous fat grafting for breast reconstruction after breast cancer: a 12-year experience. Arch Gynecol Obstet 2021; 305:921-927. [PMID: 34532758 PMCID: PMC8967754 DOI: 10.1007/s00404-021-06241-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
Purpose The aim of our study was to examine the surgical outcome and complications (efficiency) as well as the incidence of locoregional recurrence and distant metastases (oncological safety) in patients who underwent autologous fat grafting (AFG) of the breast following breast cancer surgery. Methods In our monocentric cohort study, retrospective and prospective data were collected from all consecutive patients who underwent AFG after breast cancer between 2008 and 2020; a total of 93 patients met the inclusion criteria. Results Our long-term results showed no increase in tumor recurrence and distant metastases in the studied collective when compared to the available literature. We observed 1 local recurrence (1.1%), 2 distant metastases (2.2%), and 1 tumor-related death (1.1%). There was a high degree of patient satisfaction; 67.12% of patients reported adequate satisfaction with autologous fat grafting. Conclusion Currently, to our knowledge, this is the study with the longest follow-up time (mean 6.7 years after AFG and 11.5 years after tumor resection). The results of our clinical study will contribute to improve evidence in the broad field of AFG, adipose stem cell and tumor research. Consistent with our study, the literature review shows a clear tendency of clinical trial results with a low incidence rate of tumor recurrence and metastasis following the use of AFG. AFG seems to be a safe procedure also after breast cancer treatment.
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Affiliation(s)
- Sally Kempa
- Department of Plastic, Aesthetic and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93053, Regensburg, Germany
| | - Eva Brix
- Department of Plastic, Aesthetic and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93053, Regensburg, Germany
| | - Norbert Heine
- Department of Plastic, Aesthetic and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93053, Regensburg, Germany
| | - Vanessa Hösl
- Department of Plastic, Aesthetic and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93053, Regensburg, Germany
| | - Catharina Strauss
- Department of Plastic, Aesthetic and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93053, Regensburg, Germany
| | - Andreas Eigenberger
- Department of Plastic, Aesthetic and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93053, Regensburg, Germany
| | - Vanessa Brébant
- Department of Plastic, Aesthetic and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93053, Regensburg, Germany
| | - Stephan Seitz
- Department of Obstetrics and Gynecology, Caritas Hospital St. Josef, University of Regensburg, D-93053, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Aesthetic and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93053, Regensburg, Germany.
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Brebant V, Heine N, Lamby P, Heidekrueger PI, Forte A, Prantl L, Aung T. Augmented reality of indocyanine green fluorescence in simplified lymphovenous anastomosis in lymphatic surgery. Clin Hemorheol Microcirc 2019; 73:125-133. [DOI: 10.3233/ch-199220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- V. Brebant
- University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - N. Heine
- University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - P. Lamby
- University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - PI Heidekrueger
- University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - A.J. Forte
- Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - L. Prantl
- University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - T. Aung
- University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
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Werner-Klein M, Grujovic A, Obradovic M, Hoffmann M, Lu X, Kirsch S, Treitschke S, Köstler C, Weidele K, Irlbeck C, Botteron C, Werno C, Polzer B, Guzvic M, Buchholz S, Rümmele P, Heine N, Rose-John S, Klein CA. Abstract LB-312: Interleukin 6 transsignaling is a candidate mechanism to drive progression of human DCCs during periods of clinical latency. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-lb-312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
While thousands of breast cancer cells disseminate and home to bone marrow (BM) until primary surgery, usually less than a handful will succeed in establishing manifest metastases months to years later. Signals and mechanisms determining failure or success of disseminated cancer cells (DCCs) are largely unknown and there is no in vivo model available to study the spontaneous progression and genomic evolution from early bone marrow infiltration to manifestation of bone metastasis, as spontaneous or transgenic mouse models do not generate bone metastases. We therefore profiled DCCs from BM of breast cancer patients long before manifestation of metastasis by RNAseq to identify signals supporting survival or outgrowth of DCCs and identified IL6/PTEN/PI3K signaling as candidate pathway for DCC activation. Since early DCCs often display close-to-normal genomes we used mammary epithelial cells ex vivo isolated from reduction mammoplasties and immortalized pre-malignant breast cancer cell lines as model for functional testing in vitro. Using specific activators and inhibitors of IL6 signaling revealed that IL6 trans, but not classical signaling, regulates stemness of mammary epithelial cells. Moreover, knock-down of PTEN revealed that PI3K/PTEN pathway activation renders cells independent of IL6 trans-signaling. Interestingly, gp130 expression, a pre-requisite for IL6 trans-signaling was found to be down-regulated by bone marrow stromal and endosteal, but not vascular niche cells, and as a consequence the number of cells with stem-like ability was significantly reduced. Consistent with a bottleneck function of microenvironmental DCC control, we found PIK3CA mutations highly associated with late-stage metastatic DCCs and CTCs while generally absent in early DCCs. Our data suggest that the initial steps of metastasis formation depend on microenvironmental signals and are not cancer cell-autonomous.
Citation Format: Melanie Werner-Klein, Ana Grujovic, Milan Obradovic, Martin Hoffmann, Xin Lu, Stefan Kirsch, Steffi Treitschke, Cäcilia Köstler, Kathrin Weidele, Christoph Irlbeck, Catherine Botteron, Christian Werno, Bernhard Polzer, Miodrag Guzvic, Stefan Buchholz, Petra Rümmele, Norbert Heine, Stefan Rose-John, Christoph A. Klein. Interleukin 6 transsignaling is a candidate mechanism to drive progression of human DCCs during periods of clinical latency [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-312.
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Affiliation(s)
- Melanie Werner-Klein
- 1Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany
| | - Ana Grujovic
- 1Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany
| | - Milan Obradovic
- 1Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany
| | - Martin Hoffmann
- 2Fraunhofer Institute for Toxicology and Experimental Medicine, Division of Personalized Tumour Therapy, Regensburg, Germany
| | - Xin Lu
- 2Fraunhofer Institute for Toxicology and Experimental Medicine, Division of Personalized Tumour Therapy, Regensburg, Germany
| | - Stefan Kirsch
- 2Fraunhofer Institute for Toxicology and Experimental Medicine, Division of Personalized Tumour Therapy, Regensburg, Germany
| | - Steffi Treitschke
- 2Fraunhofer Institute for Toxicology and Experimental Medicine, Division of Personalized Tumour Therapy, Regensburg, Germany
| | - Cäcilia Köstler
- 2Fraunhofer Institute for Toxicology and Experimental Medicine, Division of Personalized Tumour Therapy, Regensburg, Germany
| | - Kathrin Weidele
- 2Fraunhofer Institute for Toxicology and Experimental Medicine, Division of Personalized Tumour Therapy, Regensburg, Germany
| | - Christoph Irlbeck
- 1Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany
| | - Catherine Botteron
- 2Fraunhofer Institute for Toxicology and Experimental Medicine, Division of Personalized Tumour Therapy, Regensburg, Germany
| | - Christian Werno
- 2Fraunhofer Institute for Toxicology and Experimental Medicine, Division of Personalized Tumour Therapy, Regensburg, Germany
| | - Bernhard Polzer
- 2Fraunhofer Institute for Toxicology and Experimental Medicine, Division of Personalized Tumour Therapy, Regensburg, Germany
| | - Miodrag Guzvic
- 1Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany
| | - Stefan Buchholz
- 3University Medical Center Regensburg, Clinic of Gynecology and Obstetrics, Regensburg, Germany
| | - Petra Rümmele
- 4Institute of Pathology, University Hospital, Friedrich-Alexander-University, Erlangen, Germany
| | - Norbert Heine
- 5Center of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Rose-John
- 6Institute of Biochemistry, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - Christoph A. Klein
- 1Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany
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Anker A, Prantl L, Strauss C, Brébant V, Heine N, Lamby P, Geis S, Schenkhoff F, Pawlik M, Klein S. Vasopressor support vs. liberal fluid administration in deep inferior epigastric perforator (DIEP) free flap breast reconstruction – a randomized controlled trial. Clin Hemorheol Microcirc 2018; 69:37-44. [DOI: 10.3233/ch-189129] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A.M. Anker
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L. Prantl
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C. Strauss
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - V. Brébant
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - N. Heine
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - P. Lamby
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S. Geis
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - F. Schenkhoff
- Department of Anaesthesiology, Caritas Hospital St. Josef, Regensburg, Germany
| | - M. Pawlik
- Department of Anaesthesiology, Caritas Hospital St. Josef, Regensburg, Germany
| | - S.M. Klein
- Center for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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Heine N, Koch C, Brebant V, Kehrer A, Anker A, Prantl L. Breast sensitivity after mastectomy and autologous reconstruction. Clin Hemorheol Microcirc 2017; 67:459-465. [DOI: 10.3233/ch-179227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Norbert Heine
- Center of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - Christoph Koch
- Center of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - Vanessa Brebant
- Center of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - Andreas Kehrer
- Center of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - Alexandra Anker
- Center of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - Lukas Prantl
- Center of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Germany
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Prantl L, Rennekampff HO, Giunta RE, Harder Y, von Heimburg D, Heine N, Herold C, Kneser U, Lampert F, Machens HG, Mirastschijski U, Müller D, Pallua N, Schantz T, Schönborn A, Ueberreiter K, Witzel CH, Bull G, Rezek D, Sattler G, Vogt PM, Horch RE. [Current Perceptions of Lipofilling on the Basis of the New Guideline on "Autologous Fat Grafting"]. HANDCHIR MIKROCHIR P 2016; 48:330-336. [PMID: 27832668 DOI: 10.1055/s-0042-117635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Introduction: Autologous fat transfer has recently become an increasingly popular surgical procedure and comprises harvesting, processing and transplantation of adipose tissue, as well as professional follow-up care. This method, as a surgical procedure, can be utilised for trauma-, disease- or age-related soft tissue volume deficits and soft tissue augmentation. As usage is increasing, but the variables of fat harvest, specific indications and fashion of fat transfer are poorly defined, there is a great demand for development of a guideline in the field of reconstructive and aesthetic surgery. Methods: All relevant points were discussed within the scope of a consensus conference including a nominal group process of all societies involved in the procedure and ratified with a strong consensus (>95%). Literature from the standard medical databases over the last 10 years was retrieved, studied and specific guidelines were concluded. Results: Consensus was achieved among all professionals involved on the following points: 1. definition 2. indication/contraindication, 3. preoperative measures 4. donor sites 5. techniques of processing 6. transplantation 7. follow-up care 8. storage 9. efficacy 10. documentation 11. evaluation of patient safety. Conclusion: Definite indications and professional expertise are paramount for autologous fat tissue transfer. Successful transfers are based on the use of correct methods as well as specific instruments and materials. Autologous adipose tissue transplantation is considered to be a safe procedure in reconstructive and aesthetic surgery, due to the low rate of postoperative complications and sequelae.
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Affiliation(s)
- L Prantl
- Abteilung für Plastische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg
| | - H O Rennekampff
- Klinik für Orthopädie, Unfall-, Hand- und Wiederherstellungschirurgie, Plastische und Ästhetische Chirurgie sowie Verbrennungschirurgie, Leverkusen
| | - R E Giunta
- Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, Klinikum der Ludwig-Maximilians Universität (LMU) München, München
| | - Y Harder
- Ente Ospedaliero Cantonale Cirurgia Plastica, ricostruttiva ed estetica Viganello, Lugano
| | | | - N Heine
- Klinik für Plastische und Ästhetische, Hand- und Wiederherstellungschirurgie, Caritas Krankenhaus St. Josef, Regensburg
| | - C Herold
- Klinik für Plastische und Ästhetische Chirurgie im Sana Klinikum HamelnPyrmont, Oldenburg
| | - U Kneser
- Klinik für Hand-, Plastische- und Rekonstruktive Chirurgie - Schwerbrandverletztenzentrum, BG-Unfallklinik Ludwigshafen, Ludwigshafen am Rhein
| | - F Lampert
- Klinik für Plastische- und Handchirurgie, Universitätsklinikum Freiburg, Freiburg
| | - H G Machens
- Klinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar der Technischen Universität München, München
| | - U Mirastschijski
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Klinikum Bremen Mitte, Bremen
| | - D Müller
- Haut- und Laserzentrum an der Oper, München
| | - N Pallua
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Uniklinik RWTH Aachen, Aachen
| | - T Schantz
- Klinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar der Technischen Universität München, München
| | - A Schönborn
- Klinik für Plastische und Ästhetische Chirurgie, St. Josefs-Krankenhaus Potsdam-Sanssouci, Potsdam
| | | | - C H Witzel
- Plastische Chirurgie, Charité - Universitätsmedizin Berlin, Berlin
| | - G Bull
- Marienhospital Düsseldorf, Düsseldorf
| | | | | | - P M Vogt
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschriurgie, Med. Hochschule Hannover, Hannover
| | - R E Horch
- Plastische- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Erlangen
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Klein S, Prantl L, Geis S, Eisenmann-Klein M, Dolderer J, Felthaus O, Loibl M, Heine N. Pressure monitoring during lipofilling procedures. Clin Hemorheol Microcirc 2014; 58:9-17. [DOI: 10.3233/ch-141872] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S.M. Klein
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L. Prantl
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S. Geis
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M. Eisenmann-Klein
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - J. Dolderer
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - O. Felthaus
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M. Loibl
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - N. Heine
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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Heine N, Prantl L, Eisenmann-Klein M. Extracorporeal shock wave treatment of capsular fibrosis after mammary augmentation – Preliminary results. J COSMET LASER THER 2013; 15:330-3. [DOI: 10.3109/14764172.2012.738915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Besides the established techniques of pediculed and free tissue transplantations for breast reconstruction, adipose tissue engineering and structural fat grafting are being applied as options for regenerative therapy. While the initial euphoria about the foreseeable realisation of cell-matrix entities of sufficient size, functionality and long-term volume stability for use in humans has diminished somewhat, fat grafting as experienced a renaissance in recent years. One of the decisive factors for the engraftment of the tissue graft generated though tissue engineering is the formation of an adequate vascular network. Improvements of the matrix, which ideally should mimic natural tissue, such as the use of adipose-derived stem cells (ASCs) that can contribute both to adipogenesis and neoangiogenesis represent promising new approaches. In autologous fat grafting, the mixing of adipocytes and cells of the stromal-vascular fraction (SVF) in order to generate the principle of an inductive microenvironment has already been applied successfully in clinical routine. On the basis of the experimental data that demonstrate an interaction of the adipocytes, ASCs and other progenitor cells with breast cancer cells and the insufficient clinical data regarding oncological safety, this procedure should only be used critically. A concluding evaluation will only be possible after long-term clinical studies have provided good results.
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Affiliation(s)
- L Prantl
- Center of Plastic and Aesthetic, Hand and Reconstructive Surgery, University of Regensburg.
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Abstract
BACKGROUND During the past 15 years, reduction mammoplasty with a short vertical scar has become increasingly common in the world of plastic surgery. Still, the indication for this technique often is limited to smaller reduction weights, so that the inverted T-scar techniques have yet to be regarded as the gold standard for excessive breast hypertrophy. METHODS In the authors' department, their own modification of vertical scar reduction mammoplasty, based on the techniques of C. Lassus, G. Maillard, and M. Lejour, has been performed since 1990. During the past 10 years, the authors have used it for all breast sizes. To investigate the safety and the results for patients with very large breast volumes (gigantomasty involving at least > or =1,000 g of excised tissue per one side), this study retrospectively evaluated 25 women with a mean age of 43.1 +/- 11.2 years who underwent surgery from January 2002 to June 2003. A protocol was used to record patient satisfaction and complaints and to quantify the final result objectively. RESULTS The average resection weight for the 25 women was 1,227 +/- 300 g (maximum, 2,300 g) on the right side and 1,218 +/- 343 g (maximum, 2,100 g) on the left side. The sternal notch-to-nipple distance was reduced from 37.1 +/- 4 cm to 23.4 +/- 2.1 cm on the right side and from 37.4 +/- 3.5 cm to 24 +/- 2 cm on the left side. The brassiere size was reduced by about three cup sizes on the average. During an average follow-up period of 2 years (n = 15), patient satisfaction was high, with good acceptance of the breast shape and a low rate of major complications (12%). CONCLUSION The results suggest that the authors' modified vertical scar technique can be used successfully for all dimensions of reduction mammoplasty regardless of breast weight.
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Affiliation(s)
- N Heine
- Department of Plastic Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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15
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Schreml S, Heine N, Eisenmann-Klein M, Prantl L. Bacterial colonization is of major relevance for high-grade capsular contracture after augmentation mammaplasty. Ann Plast Surg 2007; 59:126-30. [PMID: 17667403 DOI: 10.1097/01.sap.0000252714.72161.4a] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many studies indicate that subclinical bacterial colonization plays a pivotal role in capsular contracture. Nevertheless, it has not been clarified whether bacterial stimuli are only associated with high-grade (Baker III/IV) or low-grade (Baker I/II) capsular contractures. The study included 45 female patients suffering from unilateral capsular fibrosis following augmentation mammaplasty with silicone implants (smooth: n = 28; textured: n = 17). In total, there were 16 (35.6%) bacterially contaminated swabs. No significant difference could be detected between colonization rates of smooth (52.9%) and textured (25.0%) implants (z = 1.575, P = 0.115). Interestingly, no colonization was detected for Baker I/II contractures, but the colonization rate for Baker III/IV contractures amounted to 66.7%, showing a highly significant difference between the 2 groups (z = 4.351, P < 0.001). Our study shows significant differences in bacterial contamination rates between high-grade and low-grade capsular contractures. One might speculate that bacterial stimuli accelerate the process of inflammation and fibrosis in patients who tend to develop capsular fibrosis.
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Affiliation(s)
- Stephan Schreml
- Department of Plastic Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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Kerl S, Heine N, Eisenmann-Klei M, Ortmann O. Algorithmus für rekonstruktive Verfahren in der onkoplastischen Mammachirurgie nach Mastektomie. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Prantl L, Schreml S, Heine N, Eisenmann-Klein M, Angele P. Surgical Treatment of Chronic Phantom Limb Sensation and Limb Pain after Lower Limb Amputation. Plast Reconstr Surg 2006; 118:1562-1572. [PMID: 17102729 DOI: 10.1097/01.prs.0000233048.15879.0e] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Therapy for phantom sensation and phantom limb pain following amputation is still difficult, because pathophysiologic mechanisms have not been clarified. This report illustrates a simple and useful surgical intervention. The authors propose that changes at the peripheral nerve site can influence the central feeling of phantom sensation and pain. METHODS Fifteen patients (mean age, 56 years) with lower limb amputation were included in the study. In all patients, the sciatic nerve was split at a point approximately 3 cm proximal to the popliteal fossa, and the two parts were reconnected in a sling fashion using an epiperineurial technique under microscopic vision. The nerves were covered with a fibrin patch and anesthetics were applied by means of a local pain catheter. Frequency, duration, intensity, and quality of phantom pain were compared preoperatively and 1 week, 3 months, 6 months, and 1 year postoperatively. RESULTS Fourteen of 15 patients defined the procedure as very helpful. Average, maximum, and minimum pain intensity were significantly reduced 1 week, 3 months, 6 months, and 1 year postoperatively (p < 0.001). Pain intensity scores decreased significantly over the long term after surgical intervention (median visual analogue scale score: preoperatively, 7; 1 year postoperatively, 4) (p < 0.001). The duration of pain attack shortened from approximately 120 minutes to 5 to 10 minutes. CONCLUSIONS This study shows that accurate treatment of the peripheral nerve can help to successfully reduce phantom limb pain. The authors feel encouraged to perform future investigations to test their operative method in a prospective, randomized, matched control study including electrophysiologic tests for more objective pain assessment.
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Affiliation(s)
- Lukas Prantl
- Regensburg, Germany From the Institute of Plastic Surgery and Department of Trauma and Reconstructive Surgery, University Hospital Regensburg
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Prantl L, Pöppl N, Horvat N, Heine N, Eisenmann-Klein M. Serologic and histologic findings in patients with capsular contracture after breast augmentation with smooth silicone gel implants: is serum hyaluronan a potential predictor? Aesthetic Plast Surg 2005; 29:510-8. [PMID: 16328636 DOI: 10.1007/s00266-005-5049-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In this study, breast implant capsular tissues and blood samples from 25 cases were studied to characterize the relationship between capsular findings and serum analysis. The serum fibrosis indexes hyaluronan and the aminoterminal propeptide of procollagen type III (PIIINP) are fairly well correlated in several other studies with the inflammation grade and fibrosis in patients with progressive fibrotic disorders such as liver cirrhosis. METHODS The study enrolled 25 female patients (average age, 40 +/- 12 years) with capsular contracture after bilateral cosmetic breast augmentation using smooth silicone gel implants (Mentor). The implants were placed in a submuscular position through an incision in the inframammary fold. The implant removals were prompted by development of capsular fibrosis (Baker grades 1-4). Samples of capsular tissue were obtained from all the patients for standard histologic and immunohistochemical analyses. Blood samples were drawn from all the patients immediately before surgery. Sera from 20 healthy female patients (average age, 34 +/- 9 years) who had undergone plastic surgery for reduction mammaplasty were used as controls. RESULTS Histology. Capsular tissue was significantly thicker in patients with grades 3 and 4 contracture than in women with grade 2 contracture according the classification by Baker. There was a moderate (n = 15) or severe (n = 10) chronic inflammatory reaction in the capsules around the implants. Fibroblasts and macrophages represented the major cell population found in the fibrous capsules. In addition, activated CD4+ cells were detected. An inner layer with synovia-like metaplasia and multinucleated giant cells was found. Fibroblast-like cells formed the most common cell type in the capsules, along with macrophages, scattered polymorphonuclear leukocytes, lymphocytes, plasma cells, and mast cells. Serum analysis. There was a significantly higher level (p < 0.05) of hyaluronan serum concentration in patients with capsular contracture (26 +/- 14 microg/l) than in control subjects (12 +/- 6 microg/l). There was a positive correlation between the grade of capsular contracture (Baker 1-4) and the hyaluronan serum concentration (Baker 1-2: 15 +/- 3 microg/l; Baker 3-4: 35 +/- 12 microg/l) (r2 = 0.73; p < 0.05). CONCLUSION : In this study, serum hyaluronan levels were significantly elevated in patients with constrictive fibrosis after breast augmentation, and there was a positive correlation with the stage of capsular contracture. Serum hyaluronan concentration may help in defining patients at risk for capsular fibrosis. If treatment with new drugs can be started as a preventive measure, it may be possible to reduce the rate of patients who require surgical intervention.
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Affiliation(s)
- L Prantl
- Department of Plastic Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, G-93042, Germany.
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Abstract
A case of isolated unilateral temporalis muscle hypertrophy of unknown cause is presented. It had been treated surgically 10 years previously. The histologic workup showed normal muscle tissue. A year before, the patient had reported a slowly enlarging mass in the right temporal region next to the eye. The recurrence of temporalis muscle hypertrophy was idiopathic. It was managed using a combination of surgical treatment and botulinum toxin A injection.
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Affiliation(s)
- L Prantl
- Institute of Plastic Surgery, Caritas Hospital St. Josef/University of Regensburg, Landshuterstrasse 65 D-93053, Regensburg, Germany
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Ritter K, Fudickar A, Heine N, Thomssen R. Autoantibodies with a protective function: polyreactive antibodies against alkaline phosphatase in bacterial infections. Med Microbiol Immunol 1997; 186:109-13. [PMID: 9403838 DOI: 10.1007/s004300050052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In patients with acute bacterial infections antibodies directed against a particular bacterial antigen were detected. The molecular mass of this bacterial antigen was 50 kDa as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. By comparison of the NH2-terminal amino acid sequence, the 50-kDa antigen was identified as alkaline phosphatase (AP). Affinity-purified antibodies from patient's sera directed against the bacterial AP (anti-alpha) were also shown to react with human and animal AP, which have different structures. Anti-alpha are IgG subtype 3 immunoglobulins, and their light chains are of the kappa type. Upon isoelectric focussing, the anti-alpha formed a scalariform pattern with five to seven bands in the pH range 7-9. The anti-alpha have an opsonic activity and cause a five- to eightfold increase of phagocytosis of gram-positive and gram-negative bacteria. According to their polyreactivity, their sudden rise early in infection, their oligoclonality, as well as their opsonizing properties, they are assumed to be permanently available natural antibodies that take part in early defence mechanisms.
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Affiliation(s)
- K Ritter
- Institute of Medical Microbiology, RWTH Aachen, Germany
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