[Current Perceptions of Lipofilling on the Basis of the New Guideline on "Autologous Fat Grafting"]. / Aktuelle Erkenntnisse zur Eigenfett Transplantation anhand der neuen Leitlinie "Autologe Fetttransplantation".

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.

Vessel calibre and haemoglobin effects on pulse oximetry.

Despite its success as a clinical monitoring tool, pulse oximetry may be improved with respect to the need for empirical calibration and the reports of biases in readings associated with peripheral vasoconstriction and haemoglobin concentration. To effect this improvement, this work aims to improve the understanding of the photoplethysmography signal-as used by pulse oximeters-and investigates the effect of vessel calibre and haemoglobin concentration on pulse oximetry. The digital temperature and the transmission of a wide spectrum of light through the fingers of 57 people with known haemoglobin concentrations were measured and simulations of the transmission of that spectrum of light through finger models were performed. Ratios of pulsatile attenuations of light as used in pulse oximetry were dependent upon peripheral temperature and on blood haemoglobin concentration. In addition, both the simulation and in vivo results showed that the pulsatile attenuation of light through fingers was approximately proportional to the absorption coefficients of blood, only when the absorption coefficients were small. These findings were explained in terms of discrete blood vessels acting as barriers to light transmission through tissue. Due to the influence of discrete blood vessels on light transmission, pulse oximeter outputs tend to be dependent upon haemoglobin concentration and on the calibre of pulsing blood vessels-which are affected by vasoconstriction/vasodilation. The effects of discrete blood vessels may account for part of the difference between the Beer-Lambert pulse oximetry model and empirical calibration.

Evaluation of a soft-handling computerized pneumatic tube specimen delivery system. Effects on analytical results and turnaround time.

A computerized pneumatic tube specimen delivery system with system-wide air cushion soft handling features was evaluated. There were no significant differences in values (largely normal) for components of a standard chemical profile or complete blood count in specimens delivered from the outpatient center or neonatal intensive care unit by pneumatic tube compared to couriers. The pneumatic tube system also did not affect values for pO2, pCO2, and pH over a wide range (pO2, 25 to 438 mmHg) in specimens sent from the operating room during cardiac surgery. The pneumatic tube system decreased the median turnaround time for potassium and hemoglobin results on specimens from the emergency department by 25%. The system evaluated is a rapid, efficient mechanism for sending specimens to the clinical laboratory that produces no significant effects on analytical results and has the ability to decrease turnaround time.

Implementing TQM.

Total quality management (TQM) is an organized, systematic approach to problem solving and continuous improvement. American corporations have found that TQM is an excellent way to improve competitiveness, lower operating costs, and improve productivity. Increasing numbers of laboratories are investigating the benefits of TQM. For this month's column, we asked our respondents: What steps has your laboratory taken to implement TQM?

Mass spawning in tropical reef corals.

Synchronous multispecific spawning by a total of 32 coral species occurred a few nights after late spring full moons in 1981 and 1982 at three locations on the Great Barrier Reef, Australia. The data invalidate the generalization that most corals have internally fertilized, brooded planula larvae. In every species observed, gametes were released; external fertilization and development then followed. The developmental rates of externally fertilized eggs and longevities of planulae indicate that planulae may be dispersed between reefs.

The weather and deaths from pneumonia.

Changes in the weather are highly significantly correlated with changes in death rate from pneumonia but the association is not a simple one. Two apparently separate periods of weather change are negatively correlated with pneumonia. Both are centred around a time approximately a week before death but one is associated with periods of changed weather of about a week's duration and the other with long-term, probably seasonal, change. Both are almost certainly related to the onset or acquisition of the disease. In addition there is an immediate positive correlation of high humidity and temperature with deaths. This occurs at a time when the patients have had the disease for a week or more and points to the need to avoid these conditions when nursing patients with pneumonia. All three associations are more marked in the elderly and all three operate at all temperatures and humidities met with in Britain. Control of the microenvironment of the elderly is necessary throughout the temperature range.

Relationship of air temperature to various chemical, haematological, and haemostatic variables.

Results for biochemical and haematological variables have been correlated with data on atmospheric temperature in order to identify possible mechanisms through which low environmental temperature may increase mortality from myocardial infarction and cerebrovascular disease. With the exception of cholesterol, there were no associations in the case of several clinical chemistry variables, or of haemoglobin and related indices. With varying degrees of consistency among the sex and age groups studied, temperature was positively correlated with factor VII, antithrombin III, and cholesterol, and negatively correlated with fibrinolytic activity. The correlations were all low but may offer some clues to mechanisms whereby air temperature influences ischaemic heart and cerebrovascular disease mortality.

Environment, temperature and death rates.

Analysis of recorded monthly deaths in England and Wales shows a close association of death rates with external temperature in most diseases other than the cancers. Analysis of daily deaths in England and Wales and in New York shows the following relationships between temperature and deaths from myocardial infarction, strokes and pneumonia. Between -10 degrees and +20 degrees C mimimum temperature there is a nearly linear fall in deaths as the temperature rises. Above 20 degrees C deaths rise steeply as the temperature rises and below -10 degrees C rise steeply as temperature falls. These associations of deaths with temperature are much stronger in the elderly than in younger subjects. Detailed analysis of the daily deaths in England and Wales from myocardial infarction, strokes and pneumonia show that short-term (1--2 days) temperature changes have little effect on death rates but medium-term (7--10 days) and longer-term (three or more weeks) changes associated with very significant changes in death rates. The three diseases vary in the time relations between temperature change and change in death rates. In all three there is an interval between the change in temperature and death and this is shortest in the case of myocardial infarction (1--2 days before death), longest in the case of pneumonia (about a week before death) and intermediate in the case of strokes (about 3--4 days before death). At low temperatures death rates increase as the duration of temperature change increases, while at high temperatures (but below +20 degrees C) death rates decrease as the period of temperature change is longer. The implications of these findings are discussed and it is postulated that there is probably causal relationship between temperature change and deaths from a wide variety of diseases. A proximal link in the chain is probably a failure of autonomic control of body temperature in the elderly leading to a change in body temperature and some humoral change which in turn leads to death. It is not appropriate to concentrate on hypothermia as the relationship between temperature and death is seen at all temperatures.

Evaluation of vocal pitch in male transsexuals.

A 49-year-old male-to-female transsexual was administered voice therapy following surgery. Tape recordings were made of her speech prior to and each week during therapy. Selected sentences from these reocrdings were analyzed. Results indicate that changes in both fundamental frequency and perceptual judgments of femininity were statistically significant and supportive to the client. The voice of the client was still discernible from that of a female speaker, although less so than before therapy. It is suggested that a composite treatment program combined with laryngeal modification through surgical intervention may be necessary.

Relationships of temperature with death rates from all causes and from certain respiratory and arteriosclerotic diseases in different age groups.

Changes of temperature of short duration (2-10 days) and of longer duration (15 and more days) are associated with inverse changes in death rates in both respiratory infections (pneumonia and bronchitis) and in vascular diseases (myocardial infarction and cerebral vascular accidents). These relationships are less or absent in younger subjects and marked in the elderly. The temperature on the day of death is less relevant to the death rate than that on earlier days and the particular days which are most relevant differ in the different conditions. In the case of myocardial infarcts the temperature 1 to 2 days before death is the most relevant, in strokes 3 to 4 days before death and in the respiratory infections more than 5 days before death is the most relevant.

Seasonal and short-term relationships of temperature with deaths from myocardial and cerebral infarction.

In subjects over 60, changes in temperature lasting two or more days are associated with highly significant changes in death rates from myocardial infarction and cerbral vascular accidents. In both cases, the lower the temperature the higher the death rate and vice versa. Moreover the temperatures one to four days prior to the clinical onset of infarction are more relevant than that on the day of onset, a fact which may have a bearing on prophylaxis. In the case of strokes, a high temperature on the day of onset is also associated with an increase in deaths on that day. The relevance of these findings to possible mechanisms and prophylaxis is discussed.