Quality of life, patient satisfaction and cosmetic outcome after breast reconstruction using DIEP flap or expandable breast implant.

In a cross-sectional postal survey, we compared patient-reported outcomes in patients undergoing breast reconstruction with the deep inferior epigastric perforator (DIEP) flap or an expandable breast implant (EBI). We included 34 consecutive patients who had breast reconstruction with DIEP flap and 30 patients with EBI. Outcomes were assessed using the Short Form 36 (SF-36) quality of life questionnaire, two study-specific patient satisfaction questionnaires and a visual analogue scale (VAS) on cosmetic result. There were no significant differences in SF-36 subscale scores between the two groups. On the study-specific questionnaire, more patients in the DIEP group were satisfied with the appearance of their breast (P<0.0005) and reported an improved social relationship (P=0.02), and fewer patients were sad about their body image (P=0.01) after reconstruction than in the EBI group. On the other study-specific items, satisfaction was similar in the two groups. On all five VAS items, DIEP patients reported better cosmetic results than EBI patients. We conclude that patient satisfaction and cosmetic outcome were better after breast reconstruction with the DIEP flap compared with EBI, while there was no difference in health-related quality of life.

Tachykinins mediate changes in ion transport in porcine jejunum through release of prostaglandins and neurotransmitters.

In the present study, we investigated the mediators involved in substance P (SP) and neurokinin A (NKA) induced ion transport. Stripped preparations of porcine jejunal tissue were mounted in Ussing-chambers and short-circuited. The cyclo-oxygenase inhibitor, piroxicam (10 microM) and the neuronal conduction blocker, tetrodotoxin (TTX) (0.1 microM) both significantly decreased the SP (0.1 microM) (66% and 36%, respectively) and NKA (1 microM) (64% and 31%, respectively) induced increase in short-circuit current (SCC). Pretreatment with both piroxicam and TTX totally abolished the SP and NKA response. SP (0.1 microM) caused a significant release of prostaglandin E2 (PGE2), whereas the release of PGE2 induced by NKA was not significant. Experiments were performed to clarify if vasoactive intestinal polypeptide (VIP) was mediating SP or NKA responses. VIP caused a TTX-insensitive and a concentration-dependent increase in SCC. Two VIP antagonists did not change the response to VIP (10 nM and 0.1 microM). Thus, these antagonists could not be used to further elucidate the role of VIP. We were unable to measure a significant release of VIP after SP or NKA treatment. These results indicate, that SP and NKA regulate ion transport in porcine jejunum, entirely through the release of prostaglandins and enteric neurotransmitters.

The effect of alpha-trinositol on cholera toxin-induced fluid accumulation in pig (Sus scrofa domesticus) jejunum in vivo.

The effect of alpha-trinositol (D-myo-inositol-1,2,6-trisphosphate) on cholera toxin-induced fluid accumulation (i.e., net fluid secretion) was studied in the pig jejunum in vivo. Cholera toxin caused a dose-dependent fluid accumulation in control experiments. Intravenous injection of alpha-trinositol produced a reduction of the response to cholera toxin with a significant maximal inhibition of 36%. However, in high concentrations of alpha-trinositol this inhibition was absent.

Synaptic communication between external and internal submucosal plexus neurones in the jejunum of the newborn pig?

Intracellular recordings were made from neurones in the internal submucosal plexus (ISP) of porcine small intestine and synaptic inputs were investigated by focal stimulation of nerve fiber tracts. Nicotinic fast excitatory potentials (e.p.s.p.s) were recorded in all neurones, but slow e.p.s.p.s and slow inhibitory potentials (i.p.s.p.s) were rarely seen. Membrane potential changes similar to those occurring during the slow e.p.s.p. and slow i.p.s.p. could be evoked by exogenous application of neurotransmitters, even in neurones failing to display a nerve-mediated response. We suggest that the predominant source of the slow synaptic inputs to the ISP may be the neurones of the external submucosal plexus (ESP). The failure to record slow e.p.s.p.s and i.p.s.p.s could be a consequence of the anatomical arrangement of the submucosal plexuses whereby interconnecting strands between the ISP and ESP are inaccessible to the focal stimulation.

The effect of alpha-trinositol on cholera toxin-induced hypersecretion and morphological changes in pig jejunum.

alpha-Trinositol (D-myo-inositol 1,2,6-trisphosphate, PP56) is a novel antiinflammatory drug. This study elucidates the effect of intravenous alpha-trinositol on basal and acute fluid transport and morphological changes following cholera toxin administration in pig jejunum in vivo. Using isolated jejunal tied-off loops, the fluid hypersecretory (accumulation) effect of different doses of cholera toxin was studied in pigs treated intravenously with saline added different doses (0, 4, 8, 16 and 32 mg x kg-1 x hr-1) of alpha-trinositol. Levels of alpha-trinositol, as well as stereomicroscopical, light microscopical and scanning electron microscopical morphological studies were performed. Cholera toxin evoked a dose-dependent fluid hypersecretion. Treatment with alpha-trinositol caused a dose-dependent inhibition of the cholera toxin-induced fluid hypersecretion and did not affect basal fluid absorption. The 16 mg x kg-1 x hr-1 alpha-trinositol dose gave a maximal inhibition of 36%. Morphological studies showed only minor changes following 6 hr of exposure to 20 micrograms x loop-1 cholera toxin. These changes consisted of dilation of the villus capillaries, an increase of apical membrane blebbing and a reduction of the intercellular space. Treatment with 16 mg x kg-1 x hr-1 alpha-trinositol alone did not induce any morphological changes, and did not alter the morphological changes induced by cholera toxin, which caused fluid hypersecretion and only minor acute morphological changes. In conclusion, alpha-trinositol treatment reduced cholera toxin-induced fluid hypersecretion without altering basal fluid absorption, basal morphology, or cholera toxin-induced morphological changes in pig jejunum in vivo.