Soft tissue sarcoma of the anterior abdominal wall: review of reconstruction techniques.

Tumors of the abdominal wall excised with inadequately wide margins have a high local recurrence rate. The surgeon's fear of iatrogenic defects of the abdominal wall should not outweigh the need for wide resection margins to prevent tumor recurrence when excising primary and secondary malignancies. Appropriate monobloc excision of abdominal wall malignancies can be satisfactorily accomplished through a wide array of modalities. The authors describe successful abdominal wall reconstruction with the use of polypropylene mesh after excision of a recurrent soft tissue sarcoma. They review various methods of abdominal wall reconstruction to assist the surgeon in choosing the appropriate reconstruction technique.

HDL-cholesterol: exercise formula. Results of long-term (6-year) strenuous swimming exercise in a middle-aged male with paraplegia.

Paraplegic individuals are at increased risk for developing heart disease because of low HDL-cholesterol levels. Exercise has been identified as an important factor in raising the HDL-cholesterol level. This case study documents the effects of long-term (6-year) strenuous exercise (2940 kcal/wk) on lipid markers in a 41-year-old white male with paraplegia. An additional 21 mg of HDL-cholesterol (84% increase) were observed in a paraplegic individual who swam 2100 kcal/week for 6 years. Througout this study, serial blood samples were analyzed for total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides. An initial low HDL-cholesterol of 25 mg/dl was measured in the subject. This case study continued for 72 months to determine the long-term effects on various blood lipid fractions of swimming an additional 2.5 hours/week. HDL-cholesterol slowly increased over the duration of the study. After 12 months of swimming the HDL fraction had increased from 25 mg/dl to 31 mg/dl. After 24 months and at the end of 72 months of swimming, the HDL fraction had risen to 43 mg/dl and 46 mg/dl, respectively. The estimated long-term energy cost for each additional 1 mg/dl of HDL-cholesterol above the pre-exercise HDL value was 100 kcal/week in this subject. Long-term strenuous swimming exercise has been successfully incorporated into the lifestyle of a paraplegic individual. Significant reduction in known coronary risk factors followed a marked increase in the HDL-cholesterol level.

Recognition of a second serogroup of Legionella longbeachae.

A strain of Legionella longbeachae (Tucker 1) that was isolated from the postmortem lung tissue of a pneumonia patient was serologically distinct from four other strains of L. longbeachae. The recognition of a second serogroup of L. longbeachae represents the first reported instance of serogroup diversity within a species of Legionella other than L. pneumophila. The disease caused by the Tucker 1 strain does not seem to be readily distinguishable from that of pneumonia caused by other legionellae.