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Absence of tumor necrosis factor-alpha in suction blister fluids and stratum corneum from patients with psoriasis.

Tumor necrosis factor (TNF)-alpha is a cytokine with multiple biological properties, particularly proinflammatory, apart from the induction of tumor necrosis. In order to elucidate the role of TNF-alpha in the pathogenesis of psoriasis, we have carried out bioassay and enzyme-linked immunosorbent assay for TNF-alpha in suction blister fluids and horny tissue extracts from psoriatic skin. Although bioassay showed some activities in the suction blister fluids and horny tissue extracts, there were no significant differences between the levels of activities from normal and psoriatic skin. They were at the background level and pretreatment of the samples with anti-TNF-alpha antiserum failed to abrogate the activities. ELISA confirmed the absence of TNF-alpha. Therefore, the present study could not verify that TNF-alpha plays a major role in the pathogenesis of psoriasis.

Adolescent↗

Villous damage induced by suction biopsy and by acute ethanol intake in normal human small intestine.

Previous studies by us indicated that ethanol in concentrations of 2.0-4.8% produced subepithelial blebs in the jejunum of the hamster. In the rat, due to rupture of the blebs, there was denudation of the villus tip epithelium. There are nos similar data on humans. Ethanol, in quantities equivalent to 4.8-6.4 ounces of 80 proof whiskey (diluted to 20% w/v), was infused into stomachs of 20 normal human volunteers. Subjects were divided into groups (Gr) according to the amount or type of alcohol given, and site of biopsies (SB). Gr 1:60 g ethanol, SB = jejunum. Gr 2:45 g ethanol, SB = jejunum. Gr 3:45 g ethanol, SB = duodenum. Gr 4:45 g ethanol as 4.8 oz 80 proof whiskey, SB = duodenum. To compare the morphology in the absence and presence of ethanol, biopsies were obtained from each volunteer before ethanol administration (control period), immediately after peak ethanol concentration in the duodenum or jejunum (ethanol period), and when intraluminal ethanol concentration fell towards zero (recovery period). The mean peak intraluminal ethanol concentrations in the four groups varied between 5.69% and 9.37% (w/v). Ethanol-induced damage was evaluated using strict preset criteria. Coded slides were evaluated by two observers. Suction biopsy damaged 18% of the villi even in biopsies obtained during the control period. Ethanol produced a statistically significant increase in the number of damaged villi (mean of all groups 45%, range: 32% in Gr 2 to 62% in Gr 3). During the recovery period the number of damaged villi fell to that seen in control period biopsies. Ethanol, in quantities equivalent to those ingested during moderate drinking, may produce transient damage to the upper small intestine of man. Conversely, ethanol may simply increase the susceptibility of the mucosa to the unavoidable trauma of suction biopsy. However, the histological and ultrastructural changes were similar to those induced by ethanol in small laboratory animals.

Adolescent↗

Influence of suction-assisted lipectomy on coagulation.

Suction-assisted lipectomy is the most commonly performed surgical aesthetic procedure in North America today. The procedure is not without significant morbidity, as death as well as serious nonfatal complications have been reported. Thromboembolic disease as a complicating factor of various types of surgical procedures and trauma has been well documented in the literature. Stasis, injury, and hypercoagulation--the limbs of Virchow's triad--contribute to predisposition for morbidity. The effects of stasis and injury are experienced with most operative procedures. We questioned whether suction-assisted lipectomy, in the appropriately selected and managed patient, would demonstrate a predisposition toward a hypercoagulable state and subsequent thromboembolic disease. In our group of ten female patients who underwent large-volume liposuction, a carefully selected assay of hematological factors demonstrated alterations consistent with a controlled response to tissue injury, but did not demonstrate a predisposition to a hypercoagulable state or subsequent increased risk of thromboembolic sequelae.

Adult↗

Suction-assisted lipectomy of the upper arm: a four-cannula technique.

A new technique for suction-assisted lipectomy of the upper arm is described. It uses four separate cannulas of varying lengths, all with an internal diameter of only 3.0 mm. Only a single incision is required. The benefits include the elimination of the complication of excessive fat suctioned from the middle of the arm, reduced scarring, and reduced surgical time. The patient recovers quickly with less bruising and more comfort. Results are pleasing with virtually no complications.

Arm↗

Suction lipectomy: an excellent adjutant to improve the results of breast reconstruction with RAM flaps.

It has been said about breast reconstruction with implants that a patient should not expect more than a mound that will fill out her brassiere or bathing suit. Autogenous tissue breast reconstruction has changed this. One of the great advantages of autogenous reconstruction over implants is that the breast remains soft, supple, and warm, improving with time as the scars begin to fade and becoming more natural and pendulous. Furthermore, since the new breast is made of fat, we can change its size, enhance its shape, and sculpture it with a suction lipectomy cannula to make it look practically identical to the opposite. We look upon breast reconstruction with rectus abdominis myocutaneous (RAM) flaps as a torsoplasty because of the improvements to the two areas involved: the reconstructed breast and the resulting abdominal lipectomy. This torsoplasty is done in two stages: One is the actual transfer of the rectus abdominis flap in which the skin and fat involved is designed to try to give an aesthetic dermolipectomy but without compromising the vascularity of the flap. Three or four months later, we perform the second-stage torsoplasty where the suction-assisted lipectomy plays a fundamental role and which is the subject of this article.

Abdominal Muscles↗

Pharmacokinetics and suction blister fluid penetration of a semisynthetic injectable streptogramin RP 59500 (RP 57669/ RP 54476).

RP 59500 is a new semisynthetic injectable streptogramin with excellent activity against most gram-positive bacteria. In order to assess its potential for the treatment of tissue infections, the pharmacokinetics and penetration into suction blister fluid were studied in a pilot phase I study in six male volunteers following a single infusion of 12 mg/kg over 1 h. Plasma and suction blister fluid concentrations were determined by microbiological assay. The mean peak concentration in plasma was 8.65 mg/l at the end of infusion. The mean plasma elimination half-life was 1.48 h. The mean peak concentration in interstitial fluid was 2.41 mg/l and was reached after 1 h in two volunteers and after 2 h in the other four. The mean percentage penetration for the interval 0-6 h was 82.5%. RP 59500 was still detectable in interstitial fluid at 6 h at a mean concentration of 0.92 +/- 0.25 mg/l. The data of this pilot study demonstrate good penetration of RP 59500 into non-inflammatory interstitial fluid.

Adult↗

Power-assisted lipoplasty versus traditional suction-assisted lipoplasty: comparative evaluation and analysis of output.

Power-Assisted lipoplasty (PAL) is a new method introduced to simplify and standardize surgical results of traditional suction-assisted lipoplasty (SAL). Comparative studies already have demonstrated PAL to be a handy, atraumatic, time- and fatigue-sparing technique. The authors performed a pilot study to compare the output capacity of PAL and SAL in 15 healthy female patients. The general and the specific per area outputs over 1 min from symmetrical areas were assessed. The results confirmed the efficiency of PAL (17.41% increase in average specific area output, as compared to SAL) and the distribution of fat in major "fat storage" areas such as the abdomen and the anterior thigh. Specific per area output indicated a higher suction capacity for PAL in all areas except the inner thigh. The efficiency of PAL seemed to be less influenced than that SAL by fat distribution.

Adipose Tissue↗

Endometrial suction biopsy: appraisal of a new instrument.

With the use of a completely self-contained, pre-evacuated, and disposable suction apparatus, endometrial suction biopsy was performed in 250 patients presenting with abnormal uterine bleeding or for an infertility evaluation. The instrument's components and performance features are described, as well as the distribution of tissue diagnoses. Biopsy provided tissue sufficient for diagnosis in 90 per cent of cases where tissue was obtained. In the postmenopausal subgroup, hyperplastic transformation was seen in 28/71 (39 per cent) women, and occult adenocarcinoma was diagnosed in another nine (12 per cent). Over-all instrument performance was very good.

Adolescent↗

Histopathologic evaluation of uteri curetted by flexible suction cannula.

A prospective study was undertaken to evaluate the use of the flexible plastic cannula for obtaining endometrial specimens for diagnostic purposes. Suction curettage was performed immediately prehysterectomy, the specimens evaluated, and then compared to similar specimens obtained by a metal curette. Another group of patients had suction curettage performed as an office procedure 24 to 72 hours before hysterectomy. The results of our study confirm the adequacy of this method for obtaining endometrial samples.

Adult↗

Suction lesions of the frontal cerebral cortex in the rat induce asymmetrical behavioral and catecholaminergic responses.

Suction lesions of the right frontal cerebral cortex in rats induce a period of spontaneous hyperactivity. The hyperactivity, as measured by an increase in running wheel activity begins about one week post-operatively and continues throughout the remainder of a 30-day observation period. The increased activity is accompanied by a bilateral decrease in norepinephrine concentrations in both the ipsilateral and contralateral cortex and locus coeruleus. Identical lesions of the left frontal cerebral cortex produce neither the hyperactivity nor a decrease in norepinephrine concentrations. These experiments have reproduced many of the behavioral and biochemical asymmetries seen after middle cerebral artery ligation; however, suction lesions are both simpler to produce and histologically less variable in their effects.

Animals↗

Cause of closed suction drainage tube obstruction and its prevention using a tube coated on the inside with a silicone gel drug delivery system.

In experimental and clinical studies we showed that obstruction of closed suction drainage tubes is often caused by clots. To prevent this we describe a tube coated on the inside with a silicone gel drug delivery system, which releases anticoagulant drugs. It prevents coagulation and liquefies blood clots present in the tube. This device should thus find application as a tube for continuous suction drainage systems.

Anticoagulants↗

Colonization of Yankauer suction catheters with pathogenic organisms.

Oral suction devices may be fomites for nosocomial infections. This study was designed to evaluate the rate of contamination of Yankauer suction catheters. Among the 20 catheters tested, 16 (80%) yielded cultures for pathogens. Seven (35%) were colonized with multiple pathogens. Among the organisms encountered included methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE). These devices should be handled and stored with appropriate care.

Bacteria↗

Preventing febrile complications of suction curettage abortion.

To identify risk factors for febrile complications after suction curettage abortion, we analyzed the data of 26,332 women who underwent suction curettage abortion at five participating centers in the Joint Program for the Study of Abortion, Part III, from 1975 to 1978. We defined febrile morbidity as an oral temperature of greater than or equal to 38 degrees C for 2 days or longer. The febrile morbidity rate was 0.34 per 100 abortions. We performed a multivariate analysis using a linear logistic regression model. Prophylactic antibiotics proved to be the most protective factor, reducing the rate of febrile complications to about one third that of women who received no prophylactic antibiotics (relative risk 0.36; 95% confidence interval 0.18 to 0.70). Patients who had had one or more previous births also had a significantly lower risk of febrile morbidity (relative risk 0.54; 95% confidence interval 0.33 to 0.88). Other factors did not significantly affect the febrile complication rate.

Abortion, Induced↗

Micropipette suction for measuring piconewton forces of adhesion and tether formation from neutrophil membranes.

A new method for measuring piconewton-scale forces that employs micropipette suction is presented here. Spherical cells or beads are used directly as force transducers, and forces as small as 10-20 pN can be imposed. When the transducer is stationary in the pipette, the force is simply the product of the suction pressure and the cross-sectional area of the pipette minus a small correction for the narrow gap that exists between the transducer and the pipette wall. When the transducer is moving along the pipette, the force on it is corrected by a factor that is proportional to the ratio of its velocity relative to its drag-free velocity. With this technique, the minimum force required to form a membrane tether from neutrophils is determined (45 pN), and the length of the microvilli on the surface of neutrophils is inferred. The strength of this technique is in its simplicity and its ability to measure forces between cells without requiring a separate theory or a calibration against an external standard and without requiring the use of a solid surface.

Biophysical Phenomena↗

Evolution with age of the acetylcholinesterase activity in rectal suction biopsy in Hirschsprung's disease.

The acetylcholinesterase (AChE) activity in Hirschsprung's disease was analyzed for histochemical patterns according to age. Its evolutional nature was also assessed. Two hundred thirty children (0 to 16 years of age) with acute or chronic obstipation were submitted to rectal suction biopsy for AChE histochemical staining. One hundred nineteen of them showed abnormal AChE activity. Retrospective analysis of those cases permitted us to establish three histochemical patterns: Pattern I, thick nerve trunks present only in the submucosa and, characteristically, absence of AChE activity in the lamina propria. This pattern was predominant in newborn up to 3 months of age and was designated the newborn pattern. Pattern II, thin nerve fibers in the muscularis mucosae and submucosa with a clear infiltration in the lamina propria. This pattern was mainly seen in children older than 1 year of age and was called classical pattern. Pattern III, an intermediate pattern showing morphologic characteristics of the two previous patterns with predominance of one or another, according to the age. A prospective study was also made in 15 children with Hirschsprung's disease who were submitted to suction rectal biopsies at different ages. In this study, a clear evolutional character of the AChE activity was observed from the newborn pattern to the intermediate and finally to the classical pattern.

Acetylcholinesterase↗

Measures to prevent cervical injury during suction curettage abortion.

Cervical injury is one of the most frequent complications of suction curettage abortion, yet little is known about its risk factors or prevention. In 15 438 suction curettage abortions carried out at less than or equal to 12 weeks' gestation in hospitals in the USA from 1975 to 1978 the incidence of cervical injury requiring suturing was 1.03 per 100 abortions. Among factors potentially within the physician's control, use of laminaria rather than rigid dilators for dilatation had a strong protective effect (relative risk 0.19), whereas performance of the abortion by a resident rather than an attending physician (relative risk 2.0) and use of general rather than local anaesthesia (relative risk 2.6) had detrimental effects on rates of cervical injury. Among other factors, a previous abortion had a protective effect (relative risk 0.46), whereas patient age less than or equal to 17 years had a detrimental effect (relative risk 1.9). Use of laminaria, performance of the abortion by an attending physician, and local anaesthesia together yield a 27-fold protective effect.

Abortion, Induced↗

Comparison of hand-held, suction, and automated trephines on experimental corneal wound size.

Three trephines were tested to determine their uniformity in creating a circular opening during penetrating keratoplasty. Twenty-one globes (seven per instrument) were trephined with a hand-held, suction or automated trephine. The mean astigmatism was greatest with the hand-held device (mean 0.73 cm) and least with the automated trephine (mean 0.50 cm). The automated and the suction trephines (mean astigmatism 0.51 cm) may result in reduced corneal astigmatism during penetrating keratoplasty.

Astigmatism↗

A prospective, randomized study of closed-suction drainage after laparoscopic-assisted vaginal hysterectomy.

STUDY OBJECTIVE: To estimate whether closed-suction drainage of the pelvis after laparoscopic-assisted vaginal hysterectomy reduces the risk of postoperative morbidity. DESIGN: Prospective, randomized study (Canadian Task Force classification 1). SETTING: Teaching medical center. PATIENTS: Three hundred twenty-four women. INTERVENTION: Laparoscopic-assisted vaginal hysterectomy. MEASUREMENTS AND MAIN RESULTS: The 160 women in group 1 had closed-suction (Jackson-Pratt) drains inserted into the peritoneal cavity and cul-de-sac, whereas the 164 in group 2 had no drains. Postoperative time to flatulence, hemoglobin, analgesic requirements, duration of hospital stay, rehospitalization, complications, febrile morbidity, and infection were studied. No statistically significant differences were seen between groups in demographics, outcome measures, postoperative infectious morbidity, or complications. The small power value may mean that no true differences existed for most tests. A statistically significant difference in analgesic requirement was found, with more oral analgesics taken by women in group 2. CONCLUSION: Prophylactic surgical drainage may not be necessary to prevent postoperative morbidity after laparoscopic-assisted vaginal hysterectomy when prophylactic and postoperative antibiotics are given. A drain still has its role in gynecologic laparoscopy in selected women, such as in those with persistent ooze from raw surfaces, bowel injury, or frank pus in the abdomen.

Adult↗