A case of disintegrated Strattice™ 4 years after immediate breast reconstruction.

Acellular dermal matrices (ADMs) are used frequently in immediate breast reconstruction (IBR). In general, the porcine-derived ADM Strattice™ has been reported with good outcomes and low complication rates. Nonetheless, we report here a case of a 42-year-old, otherwise healthy woman with a history of uncomplicated bilateral prophylactic nipple-sparing mastectomies and subpectoral IBRs performed using Strattice™ and Mentor® CPG™, who was referred to the Department of Plastic Surgery 4 years after this surgery due to changed appearance of her breast implants. Both CPG implants were found intact and there were no signs of infection but, surprisingly, the Strattice™ had completely disintegrated on both sides. Examinations did not show any malignancies, and at 1-year clinical follow-up, the patient had no signs of relapse. Thus, we suggest that the Strattice™ had disintegrated as a late aseptic foreign body reaction and emphasise the importance of surgeons being aware of this late and rare complication.

Partial salvage of avulsed tissue after dog bite.

Injuries to the nose can be severe from both a functional and cosmetic perspective. After suffering a dog bite to the central part of the face, an 18-year old woman underwent replantation of the avulsed tissue with the help of microsurgical arterial anastomosis. A venous anastomosis was impossible and venous congestion was treated with leech therapy. Subsequent skin necrosis occurred after a few days and the replantation was revised, revealing healthy tissue immediately below. The defect was covered with a full-thickness skin graft. At follow-up review eight months later, the functional and cosmetic result was satisfactory. To our knowledge, this is one of few cases where an injury of this severity healed with a cosmetically acceptable result.

Campylobacter jejuni peritonitis and bacteremia in a patient undergoing continuous ambulatory peritoneal dialysis.

Gram-negative pathogen-induced continuous ambulatory peritoneal dialysis- (CAPD) related peritonitis is increasing, especially that caused by enteric pathogens. We describe a 54-year-old Taiwanese man with a case of Campylobacter jejuni-mediated CAPD-related peritonitis and bacteremia. Positive Campylobacter jejuni dialysate and blood cultures confirmed the diagnosis of CAPD-mediated systemic infection. We initially administered intraperitoneal ceftazidime, amikacin and oral azithromycin, but the patient did not recover. We then administered i.v. ciprofloxacin and replaced the hemodialysis (HD). The patient recovered and was discharged with maintenance HD. Treatment of Campylobacter jejuni-mediated CAPD peritonitis is a challenge in areas with high antibiotic resistance.

Influence of home monitoring on compliance with a reduced sodium intake diet.

To test the utility of a qualitative chloride titrator strip in facilitating compliance with a reduced sodium intake diet, we enrolled 32 patients into a randomized crossover trial comprising two study periods of four weeks each. The study periods were begun after the patients had undergone extensive instruction in the diet and the use of the strip. A high degree of correlation between the patient's and the laboratory's interpretation of the strip result was identified in 29 of the subjects. Ability to use the strip was not related to level of education. A total of 12 patients achieved compliance with the diet when using the strips. Of these, nine were able to achieve compliance without the strips. Ten patients (30%) had significantly lower sodium intake when using the strips than when they did not use them. We conclude that the use of the chloride titrator strip can be mastered by most patients and, in conjunction with dietary counseling, can facilitate compliance with a reduced sodium intake diet.

Blood pressure response to dietary sodium restriction in normotensive adults.

Sixteen healthy, normotensive husband-wife pairs participated in a study to investigate the effect of reduction of dietary sodium intake (goal less than or equal to 60 mEq/day) on blood pressure. Sodium excretion decreased from a control average of 152.7 +/- 10.1 (SE) mEq/day to 69.5 +/- 4.5 mEq/day (p less than 0.001). Results indicated significant decreases in both systolic (p less than 0.001) and diastolic (p less than 0.001) blood pressure after a period of sodium restriction. In the entire group, there was no significant change in potassium excretion (58.4 +/- 3.2 vs 54.6 +/- 3.5 mEq/day) or body weight (76.0 +/- 2.8 vs 75.3 +/- 2.7 kg). Although there was variability in the blood pressure response, the decrease in blood pressure was significantly correlated with the magnitude of sodium restriction (r = 0.36, p less than 0.03). These results indicate that the blood pressure response to sodium restriction may not be limited to individuals with hypertension and that the response is heterogeneous in normotensive subjects.

The resolution of status and ideological conflicts in a community mental health setting.

During the past two decades, both the theory and practice of mental health work in the United States have been influenced significantly by the emergence of a community mental health movement. The proponents of this movement have urged conceptual and organizational reforms which would make psychiatric services more accessible and valuable to a broad range of society's population. Two of the most important of the suggested reforms represent significant challenges to the "medical model" which has long characterized American mental health practice. These mandates are: (1) to restructure traditionally stratified professional role relationships in more democratic ways, and (2) to replace traditional intrapsychic diagnostic and treatment models with more socially oriented ones. This paper examines the impact of these two proposed reforms upon the work of a group of traditionally trained mental health professionals who sought to implement the ideas of community mental health practice. It focuses, in particular, upon the status and ideological conflicts engendered by these new goals and on the factors that affect their resolution.