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[Status quo of plastic surgery education in Austria].

Quality is essentially based on excellent training. Therefore, all medical disciplines in Austria, including the Plastic Surgery, have to orientate on EU-standards including efforts to adapt the surgical training. To gain an overall impression of the present training situation in Austria, an anonymous questionnaire was sent to all the 25 trainees in Plastic Surgery in summer 1995. Eight centres were involved throughout the country. The questions covered quality of training, reference departments, rotation in training, and postgraduate studies, 52% of the questionnaires were sent back. The conclusions resulting from the questionnaires are the following: unrestricted passing of plastic surgery know-how, provision of reference departments, implementation of rotation for training, carrying out of all operations listed in the EU-catalogue, regular postgraduate training. Only in this way excellently trained plastic surgeons with a strong self confidence can be a convincing counterpole to other fields of surgery which increasingly lay claim to Plastic Surgery terrain.

Austria↗

What do plastic surgeons do?

The image of plastic surgery as portrayed by the media is of concern to all plastic surgeons. In order to assess knowledge about the specialty, a questionnaire was devised and given to five groups of participants: general practitioners, medical students, nurses, plastic surgical out-patient attendees, and the general public. The results revealed that general practitioners, nurses and medical students in the Cambridge area are, on the whole, knowledgeable about the role of plastic surgery. However, the general public are not so well educated and 23.7% of them could not think of five conditions treated by plastic surgeons, and felt that burns and cosmetic problems were the commonest conditions dealt with. Improved liaison with general practitioners, other specialties and more teaching of undergraduates, coupled with more effective promotion of the skills on offer might permit better use to be made of the specialty.

Health Knowledge, Attitudes, Practice↗

Mechanisms of deafferentation-induced plasticity in human motor cortex.

Deafferentation induces rapid plastic changes in the cerebral cortex, probably via unmasking of pre-existent connections. Several mechanisms may contribute, such as changes in neuronal membrane excitability, removal of local inhibition, or various forms of short- or long-term synaptic plasticity. To understand further the mechanisms involved in cortical plasticity, we tested the effects of CNS-active drugs in a plasticity model, in which forearm ischemic nerve block (INB) was combined with low-frequency repetitive transcranial magnetic stimulation (rTMS) of the deafferented human motor cortex. rTMS was used to upregulate the plastic changes caused by INB. We studied six healthy subjects. In two control sessions without drug application, INB plus rTMS increased the motor-evoked potential (MEP) size and decreased intracortical inhibition (ICI) measured with single- and paired-pulse TMS in the biceps brachii muscle proximal to INB. A single oral dose of the benzodiazepine lorazepam (2 mg) or the voltage-gated Na+ and Ca2+ channel blocker lamotrigine (300 mg) abolished these changes. The NMDA receptor blocker dextromethorphan (150 mg) suppressed the reduction in ICI but not the increase in MEP size. With sleep deprivation, used to eliminate sedation as a major factor of these drug effects, INB plus rTMS induced changes similar to that seen in the control sessions. The findings suggest that (1) the INB plus rTMS-induced increase in MEP size involves rapid removal of GABA-related cortical inhibition and short-term changes in synaptic efficacy dependent on Na+ or Ca2+ channels and that (2) the long-lasting (>60 min) reduction in ICI is related to long-term potentiation-like mechanisms given its duration and the involvement of NMDA receptor activation.

Adult↗

A comparison of metal and plastic cannulae for performing vacuum.

A comparative study was conducted to evaluate the efficacy of a metal or flexible plastic 8 mm cannula for artificial abortion by vacuum aspiration for patients at six to 10 weeks' gestation. Complication rates, amounts of retained tissue (obtained with a curette check), frequencies of cannula obstructions and procedure times were used as criteria for determining the efficacy of the two types of cannulae. Two physicians participated in the study: one was responsible for the preliminary examination and performance of the abortion, and the other physician, who was kept unaware of the type of cannula used, was responsible for patient care after completions of the abortion to the time of the follow-up visit. Paracervical block anesthesia was used in all cases. Differences in complication rates (controlled for gestational age) between groups of subjects aborted with either the metal or flexible plastic cannula were not significantly different (p less than .05). For both patient groups shock was the most frequently reported immediate complication (2.7% in the metal cannula group, 4,7% in the flexible plastic cannula group), and leukorrhea was the most frequently reported complication at the time of follow-up (3.3% metal, 5.3% flexible plastic). Amounts of retained tissue and frequency of cannulae obstruction were similar for both groups. Procedure times were also similar for both groups (means of 5.7 minutes and 5.5 minutes, respectively, for procedures performed with the metal and flexible plastic cannulae).

Abortion, Induced↗

Plasticizers and inhibition of leukocyte function in vitro.

OBJECTIVES: To evaluate the influence of the plasticizer metabolites of di(2-ethylhexyl)phthalate (DEHP), mono(2-ethylhexyl)phthalate (MEHP), 2-ethylhexanol (2-EH), and phthalic acid (PA) on various immune functions of polymorphonuclear blood leukocytes (PMNL) and monocytes (MN). MEHP, 2-EH, and PA are the main hydrolysis products of DEHP. Since DEHP is leached out of the plastic matrix, patients on hemodialysis and continuous ambulatory peritoneal dialysis are exposed to considerable amounts of DEHP and its metabolites. SETTING: Teaching hospital, Department of Nephrology. PARTICIPANTS: Ten healthy volunteers. MEASUREMENTS: After incubation of leukocytes in solutions with different plasticizer concentrations, oxidative respiratory metabolism was determined by luminol-enhanced chemiluminescence (CL) after stimulation with phorbol myristate acetate (PMA). Furthermore, superoxide (O2-) generation was measured by cytochrome c reduction. RESULTS: At pH 5.4, a dose-dependent decrease of luminol-enhanced CL response was found in all assays. For MEHP and PA the level of significance was reached at 10 mg/L and 1 mg/L, respectively. Superoxide generation by PMNL and MN at pH 5.4 was also suppressed by MEHP and PA. At pH 7.4, only a slight suppression of oxidative metabolism at higher concentrations was observed. After incubation of the cells in a solution containing all DEHP metabolites (MEHP, PA, and 2-EH), a significant suppressive effect of CL at pH 5.4 could be observed at final plasticizer concentrations of 0.5 mg/L. CONCLUSIONS: A dose-dependent impairment of leukocyte oxidative metabolism at a low pH could be demonstrated. The suppressive effect was particularly marked after incubation of the cells in solutions containing a mixture of the main plasticizers. At pH 5.4, we observed a slight alteration even at concentrations very close to those that could be found in commercially available peritoneal dialysis fluids. These results might point toward a possible synergistic detrimental effect of the different DEHP metabolites on leukocyte function, with possible clinical relevance.

Adult↗

Evidence for new growth and regeneration of cut axons in developmental plasticity of the rubrospinal tract in the North American opossum.

We have shown previously that rubral axons can grow around a lesion of their spinal pathway in the developing opossum and that a critical period exists for that plasticity (Martin and Xu, Dev Brain Res 39:303, 1988). Since most rubrospinal neurons degenerate after axotomy during the critical period, we have proposed that plasticity results primarily from growth of late arriving axons around the lesion rather than regeneration of cut axons (Xu and Martin, J Comp Neurol 279:368, 1989). In the present study, we used a double-labeling paradigm to test that hypothesis. Four groups of pouch young opossums received bilateral or unilateral injections of Fast Blue (FB) into the caudal thoracic or rostral lumbar cord (T12-L2) at different ages in order to label rubrospinal neurons. Three or 4 days later, the rubrospinal tract was transected unilaterally, four to five segments rostral to the injection(s). If the injection was unilateral, the lesion was made ipsilateral to it. The animals were maintained for about 1 month before a second marker, Diamidino Yellow (DY), was injected, usually bilaterally, between the FB injection(s) and the lesion. The animals were maintained for about 5 days before sacrifice and sections through the red nucleus and spinal cord were examined with a fluorescence microscope. During the critical period for plasticity, only a few rubral neurons contralateral to the lesion were labeled by FB alone, supporting our previous contention that most axotomized neurons degenerate. In contrast, many neurons were labeled by DY alone, indicating that their axons were not present in the caudal cord at the time of the FB injection and that they grew around the lesion during the 1 month survival to incorporate DY. A few double-labeled neurons were also found. One interpretation of such neurons is that they survived axotomy, as evidenced by the presence of FB, and supported axons which grew around the lesion to take up DY. Another interpretation is that they supported late growing axons which incorporated residual FB as well as DY. In order to choose between these alternatives, a similar double-labeling paradigm was carried out, but with removal of FB at the time of the lesion. Since a few neurons were still double labeled, we conclude that regeneration of cut axons also contributed to rubrospinal plasticity. Our results support our previous suggestion that developmental plasticity of the rubrospinal tract results primarily from growth of late arriving axons around the lesion, but they also suggest that regeneration of cut axons occurs.

Amidines↗

Physical and physiological plasticity of hematopoietic stem cells.

Stem cells from a variety of tissues have recently been shown to be capable of differentiating into cells characteristic of a separate tissue, apparently in response to microenvironmental signals. This is hierarchical plasticity. We have shown that both human and murine neurosphere cells with potential for differentiating into neurons, oligodendrocytes, and astrocytes can produce hematopoietic stem cells when engrafted into fetal sheep or murine day 3.5 blastocysts, respectively. We have also demonstrated an alternative form of stem cell plasticity: functional plasticity at different points in cell cycle transit and at different phases of a circadian rhythm. We have shown that long-term engraftment varies reversibly as primitive murine stem cells (lineage-negative rhodamine(low) Hoechst(low)) transit the cell cycle under stimulation by interleukin-3 (IL-3), IL-6, IL-11, and steel factor, with engraftment being defective in late S/early G2. Engraftment also varies markedly with circadian time. Presumptive mechanisms for these phenotypic shifts include alteration in adhesion protein expression with consequent changes in marrow homing. Most recently, we have also demonstrated that stem cell differentiation varies markedly with cell cycle transit. There are other features of the hematopoietic stem cell which suggest that it is a highly plastic cell with the ability to rapidly change its membrane phenotype, while exhibiting extraordinary directed motility. These data suggest that cell cycle and circadian plasticity should be considered additional major features of the hematopoietic stem cell phenotype.

Animals↗

Plasticity in zebrafish hox expression in the hindbrain and cranial neural crest.

The anterior-posterior identities of cells in the hindbrain and cranial neural crest are thought to be determined by their Hox gene expression status, but how and when cells become committed to these identities remain unclear. Here we address this in zebrafish by cell transplantation, to test plasticity in hox expression in single cells. We transplanted cells alone, or in small groups, between hindbrain rhombomeres or between the neural crest primordia of pharyngeal arches. We found that transplanted cells regulated hox expression according to their new environments. The degree of plasticity, however, depended on both the timing and the size of the transplant. At later stages transplanted cells were more likely to be irreversibly committed and maintain their hox expression, demonstrating a progressive loss of responsiveness to the environmental signals that specify segmental identities. Individual transplanted cells also showed greater plasticity than those lying within the center of larger groups, suggesting that a community effect normally maintains hox expression within segments. We also raised experimental embryos to larval stages to analyze transplanted cells after differentiation and found that neural crest cells contributed to pharyngeal cartilages appropriate to the anterior-posterior level of the new cellular environment. Thus, consistent with models implicating hox expression in control of segmental identity, plasticity in hox expression correlates with plasticity in final cell fate.

Animals↗

Effect of cytochalasin D on the adhesion of a neuroblastoma x glioma cell line (NG108-15) to laminin and plastic substrates.

Adhesion of the neuronal cell surface to its underlying substrate plays an important role in neurite outgrowth in vitro. I have investigated the adhesive basis for neurite outgrowth in the presence of cytochalasin D, a disruptor of actin-containing microfilaments, and in the presence of vinblastine, a depolymerizer of microtubules. Scanning electron microscopy shows that cytochalasin D does not alter the branching configuration of filopodia on a laminin substrate, although processes are shorter and tapered distally in the presence of the drug. Using a standard attachment assay for the neuroblastoma x glioma cell line (NG108-15) I show that vinblastine does not influence attachment of NG108-15 cells to either plastic or laminin. Cytochalasin D-treated cells normally attach to high concentrations of a laminin substrate (20 micrograms/ml). However, when cell are seeded on a laminin substrate at lower concentrations (0.001-10 micrograms/ml), or on YIGSR, a fragment of laminin, cytochalasin D increases cell attachment. Cytochalasin D increases attachment in a dose-dependent manner when cells are seeded on plain polystyrene plastic, so that the number of cells attached to plastic in 1 microM cytochalasin D is similar to the number attached to laminin (20 micrograms/ml). Combining low concentrations of cytochalasin D and laminin results in greater attachment than with either agent alone. Mild trypsinization of the cell surface reduces the CD-enhanced attachment to plastic, indicating that a protein on the cell surface may be involved. The effect of cytochalasin D appears to be cell specific since cytochalasin D does not affect the attachment of a fibroblast cell line (NIH 3T3) to laminin and plastic.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Plastic repair of the lateral ligament of the upper ankle joint: methods and results (author's transl)].

A review is given about common techniques for plastic repair of the lateral ligament of the upper ankle joint. Own experiences are presented. Indications for plastic repair age: old injury of the ligaments with clinical symptoms; fresh lesions of the ligament; if the tissues of the articular capsule or of the ligament are completely destroyed or if during surgery a chronic insufficiency of the ligaments becomes evident. Contraindications against plastic repair are: a marked arthrosis of the ankle joint, a permanent valgar displacement of the talus, old age and a high risk for surgery. The results of 13 plastic operations of the lateral ligament could be classified as "very good" in ten cases and as "good" in three cases (evaluation according to Marti). In seven cases a modified technique of Watson-Jones has been used, twice Weber's method and in four cases a direct ligament plastic. Those procedures are favoured which come close to the original anatomy, are easy to perform without destroying functional structures and which do not cause an unnecessary restriction of movement.

Adolescent↗

Torque deformation characteristics of plastic brackets: a comparative study.

AIM: The purpose of this study was to compare the torque deformation characteristics of seven commercially available plastic brackets, both amongst each other and with stainless steel brackets. MATERIAL AND METHODS: Ten brackets each of (1) pure polycarbonate, (2) ceramic reinforced polycarbonate, (3) fiberglass reinforced polycarbonate, (4) ceramic reinforced polycarbonate with metal slot, (5) fiberglass reinforced polycarbonate with metal slot, (6) polyurethane, and (7) polyurethane with metal slot were exposed to torsion in a torquemeter, following an aging process according to ISO 10477. Ten stainless steel brackets served as a control group. Torsion was applied continuously using a material testing machine (Zwick Z2.5, Zwick Materialprüfung, Ulm, Germany). RESULTS: The results showed within the group of plastic brackets that metal slot reinforced brackets were subject to the lowest degree of deformation, followed by the brackets made of pure polyurethane, pure polycarbonate and fiberglass reinforced polycarbonate. The ceramic reinforced polycarbonate brackets showed the highest deformation under torque stress. The plastic deformation of the ceramic reinforced, fiberglass reinforced and pure polycarbonate brackets started even in the recommended torque range of 10-20 Nmm. The additional ceramic and fiberglass in the plastic brackets investigated in this study did not improve the torque stability of the polycarbonate brackets. The pure polyurethane brackets showed no significant difference from the pure polycarbonate brackets at the moment of 15 Nmm which is the optimal torque for a maxillary incisor. CONCLUSION: A comparison with the stainless steel brackets illustrated that plastic brackets are suited for clinical application only if they have a metal slot.

Biomechanical Phenomena↗

Activation of human blood monocytes by adherence to tissue culture plastic surfaces.

Human monocytes, purified by countercurrent centrifugal elutriation, were cultured either in plastic dishes or in Teflon vials to determine if attachment would result in activation. beta-Glucuronidase activity, 5'-nucleotidase activity, plasminogen activator, and superoxide anion generation were measured as markers of monocyte activation. Conditioned media and cell lysates were assayed at 2, 4, 8, and 10 hr and then daily for 6 days. Monocytes cultured in plastic dishes secreted a significantly greater proportion of their beta-glucuronidase into the medium than those cultured in Teflon vials. The activity of 5'-nucleotidase was lower in monocytes cultured in plastic dishes, consistent with greater activation. Cellular plasminogen activator levels and the capacity for superoxide anion generation were enhanced in cells cultured in plastic dishes, relative to monocytes cultured in Teflon vials. These observations indicate that monocyte attachment in plastic surfaces results in their activation, a phenomenon that may influence the nature and interpretation of experimental data derived from cultured adherent monocytes or macrophages.

5'-Nucleotidase↗

A comparison of cervical scrapes for HPV typing by dot-blot hybridization obtained by wood and plastic spatulas.

A cross-over study was designed to determine whether the type of spatula used to collect cervical cells influences the ability of dot-blot hybridization to detect HPV DNA. Fifty-nine patients had a cervical scrape with a wood spatula first and a plastic spatula second: 60 were scraped in the inverse order. The order of sampling did not affect the HPV DNA positivity rate, which was nearly similar for both wood and plastic spatulas (30 and 32%, respectively). Wood spatulas collected more cells and greater than 1 x 10(5) cells more often than plastic spatulas (P = 0.001 and 0.06, respectively). Non-purple (negative) dots were more frequent in samples obtained by wood than by plastic spatulas (P = 0.001). The study showed that cervical cell collection by wood spatulas is preferred as they harvest more cells, thus optimizing the sensitivity of the hybridization method, and the spatulas are also more economical. Although they yielded more non-purple dots, a reduction in these dots by using plastic spatulas did not result in a significantly increased HPV positivity rate.

Cohort Studies↗

Stem cell plasticity: the growing potential of cellular therapy.

The fundamental principle of stem cell biology is that cells with the potential for both self-renewal and terminal differentiation into one or more cell types may be found in a given tissue. The corollary of this principle is that the stem cells give rise to tissues in which they reside, the so-called expected tissues. Many exciting discoveries reported over the last several years challenge this paradigm by showing that there are not only tissue-specific stem cells that differentiate to the expected mature cells, but also that tissue stem cells can differentiate into unexpected cell lineages, suggesting an enormous plasticity of differentiation. Hematopoietic stem cells, which have drawn the most attention, mesenchymal stem cells, and neural stem cells have been the focus of many investigations. However, recent studies directed toward hematopoietic stem cells have disputed the concept of stem cell plasticity, suggesting that experimental artifact or somatic cell fusion may account for reported observations of plasticity. Although the data are mounting, stem cell plasticity, strictly defined, has yet to be rigorously proven. Animal models to meticulously define the biology and potential plasticity of stem cells and pilot clinical trials to begin to explore the biology and therapeutic potential of human stem cells will both be vital to advance the field over the coming years.

Animals↗

Plastic bronchitis: is thoracic duct ligation a real surgical option?

Plastic bronchitis is an unusual clinical scenario of unknown cause and occurs in multiple clinical settings. The disease is characterized by the development of arborizing, thick, tenacious casts of the tracheobronchial tree that results in airway obstruction. Patients with congenital heart disease who have undergone a Fontan operation are at high risk for having this problem develop. Management of this distressing situation is difficult with only palliative options being available, such as repeated bronchoscopies, inhaled heparin, tissue plasminogen activator, inhaled bronchodilators, or azithromycin. The patients with Fontan circuits have a myriad of unique complications develop, such as atrial arrhythmias, recurrent pleural effusions, chylothoraces, protein-losing enteropathy, and plastic bronchitis. High intrathoracic lymphatic pressures with nondemonstrable lympho-bronchial fistulas were believed to be the cause for the development of these recurrent bronchial casts in plastic bronchitis. Faced with recurrent plastic bronchitis resistant to medical management in 2 Fontan patients with normal Fontan pressures on cardiac catheterization, we decided to explore a surgical solution by performing a thoracic duct ligation. This resulted in complete resolution of the formation of casts in both patients, who were discharged home and remain asymptomatic on continued follow-up. Thoracic duct ligation provides a surgical cure for plastic bronchitis by decreasing intrathoracic lymphatic pressure and flow.

Airway Obstruction↗

How tough is bone? Application of elastic-plastic fracture mechanics to bone.

Bone, with a hierarchical structure that spans from the nano-scale to the macro-scale and a composite design composed of nano-sized mineral crystals embedded in an organic matrix, has been shown to have several toughening mechanisms that increases its toughness. These mechanisms can stop, slow, or deflect crack propagation and cause bone to have a moderate amount of apparent plastic deformation before fracture. In addition, bone contains a high volumetric percentage of organics and water that makes it behave nonlinearly before fracture. Many researchers used strength or critical stress intensity factor (fracture toughness) to characterize the mechanical property of bone. However, these parameters do not account for the energy spent in plastic deformation before bone fracture. To accurately describe the mechanical characteristics of bone, we applied elastic-plastic fracture mechanics to study bone's fracture toughness. The J integral, a parameter that estimates both the energies consumed in the elastic and plastic deformations, was used to quantify the total energy spent before bone fracture. Twenty cortical bone specimens were cut from the mid-diaphysis of bovine femurs. Ten of them were prepared to undergo transverse fracture and the other 10 were prepared to undergo longitudinal fracture. The specimens were prepared following the apparatus suggested in ASTM E1820 and tested in distilled water at 37 degrees C. The average J integral of the transverse-fractured specimens was found to be 6.6 kPa m, which is 187% greater than that of longitudinal-fractured specimens (2.3 kPa m). The energy spent in the plastic deformation of the longitudinal-fractured and transverse-fractured bovine specimens was found to be 3.6-4.1 times the energy spent in the elastic deformation. This study shows that the toughness of bone estimated using the J integral is much greater than the toughness measured using the critical stress intensity factor. We suggest that the J integral method is a better technique in estimating the toughness of bone.

Animals↗

A role for retinal brain-derived neurotrophic factor in ocular dominance plasticity.

Visual deprivation is a classical tool to study the plasticity of visual cortical connections. After eyelid closure in young animals (monocular deprivation, MD), visual cortical neurons become dominated by the open eye, a phenomenon known as ocular dominance (OD) plasticity . It is commonly held that the molecular mediators of OD plasticity are cortically derived and that the retina is immune to the effects of MD . Recently, it has been reported that visual deprivation induces neurochemical, structural, and functional changes in the retina , but whether these retinal changes contribute to the effects of MD in the cortex is unknown. Here, we provide evidence that brain-derived neurotrophic factor (BDNF) produced in the retina influences OD plasticity. We found a reduction of BDNF expression in the deprived retina of young rats. We compensated this BDNF imbalance between the two eyes by either injecting exogenous BDNF in the deprived eye or reducing endogenous BDNF expression in the nondeprived eye. Both treatments were effective in counteracting the OD shift induced by MD. Retinal BDNF could also influence OD distribution in normal animals. These results show for the first time that OD plasticity is modulated by BDNF produced in the retina.

Analysis of Variance↗

Relationship between drug dissolution and leaching of plasticizer for pellets coated with an aqueous Eudragit S100:L100 dispersion.

In order to investigate the relationship between drug dissolution and leaching of plasticizer, theophylline pellets coated with 30% (w/w) Eudragit S100:L100 (1:1) plasticized with different levels of triethyl citrate (TEC) were prepared. The influence of storage conditions on the dissolution profile of theophylline and leaching of TEC was determined. Theophylline was found to dissolve completely from pellets coated with Eudragit S100:L100 (1:1) plasticized with 50% TEC at pH 6.0 after 2h. The shape of the pellets was maintained during dissolution testing. Cracks due to the leaching of TEC were observed in the scanning electron micrographs (SEMs) following dissolution testing at pH 6.0. Both the dissolution of theophylline and the leaching of TEC decreased during storage due to further coalescence of the acrylic polymers. The dissolution profiles of theophylline showed a biphasic pattern and the lag times were estimated as the time points at which a second, rapid release of theophylline was initiated. Subsequently, the percent of TEC leached at the lag time was calculated. While the lag time was increased by storage time and humidity, the percent of TEC leached at the lag time was unchanged as a function of storage condition and was dependent on the initial TEC levels in the films. In conclusion, the plasticizer content in the film coating influenced the dissolution profile of theophylline from pellets coated with Eudragit S100:L100 (1:1). A large amount of the TEC was leached from the enteric films before drug release was initiated and a TEC level of approximately 30% in the films, based on the polymer weight, was the critical amount of TEC for initiating drug release during dissolution testing at pH 6.0. While enteric films are more soluble and dissolve faster at higher pH values, the kinetics of plasticizer release was one of the important factors controlling the dissolution of drugs at pH 6.0, at which pH the enteric polymers were insoluble.

Citrates↗