Oviductal plasminogen activator inhibitor-1 (PAI-1): mRNA, protein, and hormonal regulation during the estrous cycle and early pregnancy in the pig.

Recent identification of plasminogen activator inhibitor-1 (PAI-1) in the pig oviduct has prompted an evaluation of its mRNA, protein synthesis, and hormonal regulation during the estrous cycle and early pregnancy, defined as time prior to and after maternal recognition of pregnancy. To examine PAI-1 protein synthesis, oviductal tissue was collected from European Large White and Chinese Meishan gilts on days 0, 2, and 5 of early pregnancy, divided into three functional segments, and cultured. Culture media was collected and de novo synthesized PAI-1 analyzed by 2D-SDS-PAGE, fluorography, and densitometry. To determine hormonal regulation of PAI-1 synthesis and secretion, four groups of ovariectomized (OVX) cross-bred gilts were each treated with one of four steroid regimens (corn oil, estrogen, progesterone, or estrogen + progesterone) and tissue collected for RNA or cultured. Steady-state mRNA levels of PAI-1 were evaluated throughout the estrous cycle in cross-bred gilts. To compare steady-state PAI-1 mRNA levels between cyclic and pregnant cross-bred gilts, tissue was collected on days 0, 2, and 12. Quantitative analysis of steady-state levels of PAI-1 mRNA were analyzed by dot-blot hybridization and densitometry. A greater (P < 0.01) synthesis and secretion of PAI-1 protein was found in the isthmus portion of the oviduct relative to either the ampulla or infundibulum regardless of day of pregnancy or breed. No difference could be detected for PAI-1 protein between breeds. The Large White had a greater (P < 0.05) secretion of PAI-1 on day 2 of early pregnancy relative to other days examined. Whole oviductal tissue from cross-bred gilts was found to have a significantly greater amount of PAI-1 mRNA on days 1 and 2 compared to other days examined, while the isthmus had significantly greater levels of mRNA on days 2 and 12. A significant effect of day and segment was detected for levels of PAI-1 mRNA from cyclic and early pregnant cross-bred gilts. PAI-1 mRNA was found to be significantly greater in the isthmus than other segments, regardless of day of the estrous cycle or pregnancy. An interaction was detected for estrogen and progesterone on PAI-1 mRNA (P < 0.05) and protein (P = 0.09). Estrogen was found to inhibit PAI-1 protein synthesis and also inhibited progesterone-mediated stimulation of PAI-1 mRNA. Our results demonstrate expression of PAI-1 mRNA and protein are highest on day 2 of early pregnancy, which is consistent with its proposed function of protecting the oocyte/embryo from enzymatic degradation and/or extracellular matrix remodeling of both oviduct and early cleavage-stage embryo.

Are more passes better? Safety versus efficacy with the pulsed CO2 laser.

Whether greatly increasing the number of passes with the pulsed CO2 laser compromises safety or enhances effectiveness is unknown. Intuitively speaking, more passes should produce a greater depth of injury with better removal of wrinkles but greater likelihood of scarring. A chamois color has been said to signal laser penetration of the reticular dermis and has been recommended as an end point for safe treatment. Isolated case reports and anecdotal stories suggest that the potential for scarring from deep thermal injury remains significant. With the Coherent Ultrapulse laser at our usual therapeutic settings (300 mj, density of 4 with the Computerized Pattern Generator), the authors treated multiple test panels on in situ breast skin (one to 16 passes) and eyelid skin (one to eight passes) and then compared the panels in the excised skin histologically. The depth of injury did not increase after three passes, and no full-thickness injury was observed even in the thin eyelid skin. After treating severely wrinkled upper lips with up to 11 passes without scarring or other adverse effect, the authors treated a small series of patients with four passes on one side of their lips and 10 passes on the other side. No difference could be detected either at the time or after final healing. The authors believe that injury depth in using the pulsed CO2 laser is automatically limited by progressive dessication of the superficial dermis. The chamois color indicates dessication, not increasing depth. Although more than three or four passes will not produce injury under ordinary circumstances, they do not improve the final result.

The effect of Biocell texturing and povidone-iodine irrigation on capsular contracture around saline-inflatable breast implants.

We performed a prospective, concurrently controlled, and blinded 4-year clinical study on 60 patient volunteers to determine the effects of two independent variables, McGhan's Biocell texturization and Betadine antibacterial irrigation, on the incidence of fibrous capsular contracture around saline-inflatable implants following retromammary augmentation. Each patient was randomly assigned both a textured and a smooth implant and both saline and Betadine irrigation so that each patient served as her own control. The textured devices irrigated with Betadine experienced an overall incidence of contracture of only 4 percent compared with 50 percent for the smooth devices irrigated with saline solution. The Betadine-irrigated devices in general had a lower incidence of contracture than the saline-irrigated devices, and the textured-surface devices in general had a lower incidence of contracture than the smooth devices. Antibacterial irrigation and surface texturization may work in a cumulative manner to reduce the early incidence of capsular contracture.

The effect of Siltex texturing and povidone-iodine irrigation on capsular contracture around saline inflatable breast implants.

A prospective, controlled, and blinded clinical study was performed on 56 patient volunteers to determine the effects of two independent variables--the Siltex textured inflatable implant and povidone-iodine irrigation--on the incidence of fibrous capsular contracture following retromammary augmentation. Each patient was randomly assigned both textured and smooth implants and povidone-iodine and saline irrigation, so that each patient served as her own control. The Siltex devices experienced an incidence of class III-IV contracture of only 2 percent, as compared with an incidence of 40 percent around the smooth devices. Most patients, however, preferred the smooth devices despite the higher contracture incidence because the Siltex device was more easily palpable. Povidone-iodine did not reduce the final incidence of contracture. It appeared to delay the onset of contracture, but not with statistical significance.

Capsular contracture: hard breasts, soft data.

Fibrous capsular contracture is by far the most common cause of unsatisfactory results following augmentation mammaplasty. This article reviews the evidence for its various proposed etiologies, the techniques advocated for its prevention, and the procedures currently available for its correction.

Capsular contracture: a prospective study of the effect of local antibacterial agents.

In a prospective, random, double-blind, and concurrently controlled clinical study of 124 patients having augmentation mammaplasty, using multiple independent subjective judges as well as objective compressibility measurements, the use of a variety of local antibacterials in or around inflatable retromammary prosthetic implants reduced the early postoperative onset of class III to IV capsular contracture by sevenfold (85 percent) and the final incidence by more than half (50 percent) (p less than 0.01). We believe this study provides the most unequivocal evidence to date that the cause of capsular contracture in retromammary augmentation is periprosthetic bacterial contamination. Irrigation with a 5 percent povidone-iodine (50 percent Betadine) solution was as effective as other techniques and is currently our procedure of choice.

The safety and efficacy of breast implants for augmentation mammaplasty.

This review of the efficacy and safety of breast implants was intended to focus on our current body of knowledge about these devices. There are informational gaps, but not all of these can be laid at the door of imperfect studies or failed scientific methods. Certain properties of the implants are still unmeasurable, immunologic investigation is still evolving, the cause of wound contraction is inexplicable here or in the burnscar contracture, and the indications for and results of this surgery necessarily are subjective. Still, there are a number of investigative avenues open to us, and our cumulative experience shows no reluctance on the part of plastic surgeons to initiate further studies.

Capsules, infection, and intraluminal antibiotics.

Staphylococcus epidermidis, a normal cutaneous inhabitant previously shown to be present in 67 percent of nipple secretions, has been cultured from 55 percent of surgical mammary pockets prior to implant insertion and from the interior of 71 percent of fibrous capsules explored at open capsulotomy. Cephalothin and gentamicin placed within the lumen of inflatable breast implants in vitro have been shown to diffuse outward through the silicone shell. The use of intraluminal cephalothin and gentamicin in vivo has significantly reduced our incidence of capsular contracture following both primary mammary augmentation and secondary open capsulotomy. The authors believe that the cause of fibrous capsular contracture may be a low-grade periprosthetic infection, and that the unique permeability characteristics of the silicone shell may permit sustained antimicrobial activity at the surface of the prosthesis.

The second-look technique in face lifts--does it work?

Charts of 120 patients who have undergone face lifts in a single practice have been reviewed for objective evidence of postoperative hematoma formation following traditional or second-look face lift surgery. The respective rates of hematoma formation-21.7 percent, as compared with 7 percent-were found to be significantly different (P less than 0.025) by chi-square analysis, and no extraneous factors can be asserted to explain this difference. The authors therefore conclude that the second-look technique is responsible for reducing postoperative complication from face lift and that it is a worthwhile modification to the traditional procedure.