Evidence for detachment of indigenous bacteria from aquifer sediment in response to arrival of injected bacteria.

Two bacterial strains isolated from the aquifer underlying Oyster, Va., were recently injected into the aquifer and monitored using ferrographic capture, a high-resolution immunomagnetic technique. Injected cells were enumerated on the basis of a vital fluorescence stain, whereas total cell numbers (stained target cells plus unstained target and antigenically similar indigenous bacteria) were identified by cell outlines emanating from fluorophore-conjugated antibodies to the two target strains. The arrival of injected bacteria at the majority of monitored sampling ports was accompanied by simultaneous temporary increases in unstained cell counts that outnumbered the injected bacteria by 2- to 100-fold. The origin and mechanism of appearance of the unstained cells are considered.

Reconstruction with the latissimus dorsi flap after skin-sparing mastectomy.

The latissimus dorsi musculocutaneous island flap was once the standard for breast reconstruction. With the increased use of tissue expanders and the development of the transverse rectus abdominis musculocutaneous flap for autologous tissue breast reconstruction, use of the latissimus dorsi has decreased. To reassess the role of the latissimus dorsi musculocutaneous flap in breast reconstruction, a retrospective review was performed to evaluate women who had skin-sparing mastectomy followed by immediate reconstruction with a latissimus dorsi flap and permanent implants. The postoperative aesthetic results and donor site morbidity, including contour deformity and scarring, were examined. Satisfactory results were obtained in 17 of 18 patients. Complications were noted in 5 patients, and all were minor. Using the latissimus dorsi musculocutaneous flap and a permanent breast prosthesis for immediate reconstruction is successful because it provides sufficient muscular coverage of the implant. In addition, it provides a good aesthetic result using a single-stage procedure. Illustrative cases are presented.

Asphyxial death caused by a laryngeal schwannoma: a case report.

Neurogenic tumours of the larynx are unusual, with approximately 115 cases reported in the literature to date. Most of these lesions are benign, solitary submucosal nodules which present with hoarseness and are amenable to surgical resection. We present a case of a large pedunculated schwannoma arising in the aryepiglottic fold associated with sudden asphyxial death in an otherwise healthy young female.

Soft-tissue coverage of the neural elements after myelomeningocele repair.

We retrospectively reviewed all newborns with a diagnosis of myelomeningocele (MMC) admitted to our hospital between January 1990 and September 1994 to determine methods of soft tissue coverage, complication rates, and results. Sixty-five patients underwent repair of thoracic, lumbar, or sacral MMCs. The average size of defect repaired measured 21.3 cm2 (range, 2-80 cm2). Methods of repair included direct approximation of soft tissues with or without undermining (N = 48), Romberg Limberg flaps (N = 8), gluteus maximus or latissimus dorsi musculocutaneous flaps (N = 5), fascioutaneous flaps (N = 3), and V-gamma advancement (N = 1). A total of 18 complications were recorded (27.7%). There were 5 major complications (7.7%) and 13 minor ones (20.0%). Major complications were defined as midline wound dehiscence overlying the neural elements or wound infection leading to meningitis or ventriculitis. All 5 major and 9 minor complications arose in patients undergoing direct soft-tissue approximation. Additionally, all major complications were recorded in defects > 18 cm2. Based on this series, it appears that MMC defects < 18 cm2 can be closed by direct approximation of soft tissues without significant risk or major wound complication. Larger wounds may be successfully closed in this manner, but the risk of major complication is substantial.

Complications in endoscopic plastic surgery.

Owing to the relatively short time endoscopic-assisted plastic surgery procedures have been done, there are few published reports of complications. The experiences of the faculty from the Endoscopy in Plastic Surgery: A consensus Multidisciplinary Symposium as well as the few published reports in the literature have been reviewed. The complications associated with endoscopic techniques are similar to those with open techniques. It is clear, however, that a subset of complications specific to endoscopic procedures exists. As endoscopic techniques and instrumentation are further developed, and as surgeons move higher up on the "learning curve", these complications should be reduced.

Illness and response among south Indian foragers.

The medical system of Paliyan foragers of south India is described on the basis of ethnographic field study. Observational and interview data on etiological theories, shamanistic diagnostic practices, and measures for prevention and treatment of illness and injury are examined in relation to one another. Paliyans give considerable importance to naturalistic as well as personalistic etiologies. They regard diagnosis of efficient causes as a matter of practicality; case studies illustrate how such causes are diagnosed. Aspects of the system are examined in global and regional comparative perspective.