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At our Medical Center, our reconstructive service has actively sought referrals of acute and chronic infections by declaring an interest in undertaking the integrated management and reconstruction of these cases. The practices of the two senior surgeons were reviewed for three academic years (1992 to 1995). Cases of surgical infection were analyzed as to site, ablative procedures, and reconstructive procedures. In total, 139 patients with 147 infections were identified. Sites of infection included head and neck (9.5 percent), trunk and pelvis (39.5 percent), upper extremity (22 percent), and lower extremity (29 percent). One-hundred thirty-one ablative procedures were done on this group, as were 126 reconstructive procedures, including 17 fasciocutaneous flaps, 26 pedicled muscle flaps, and 28 microsurgical flaps. With a mean follow-up of 14 months, 92 percent of these patients had resolution of infection. The 8 percent failure group included recurrences, amputation, and death. This series demonstrates that a plastic surgery service can attract a diverse population of surgical infections and manage them successfully with ablation and a wide variety of reconstructive procedures. The coordination of ablation and reconstruction may be optimally performed by the plastic surgeon.

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Aspects of interpersonal, personality, and cognitive models of depression were tested in a college sample. The perceptions and actual interpersonal behaviors of dependent and self-critical women and their romantic partners were assessed during a conflict-resolution task. Dependent women were characterized by positive biases in the perception of lovingness expressed within the relationship. The partners of dependent women, however, experienced a decrease in positive affect and a trend toward increasing hostility during the conflict-resolution task. Self-critical women were objectively rated as less loving and more hostile, and their partners were also rated as less loving. Self-critics also exhibited negative biases in self-perceptions of submissiveness. The results are interpreted within a comprehensive framework integrating various elements of interpersonal, personality, and cognitive models of depression.

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Lipomas of the breast are usually small, benign neoplasms which can be treated by simple excision. Diagnosis of these masses, however, can be difficult because of the normal fatty composition of the breast. A number of radiological manoeuvres have been described for diagnosing deep lipomas in the breast, yet the clinical and radiographic identification of these masses remains challenging. We present a case of giant lipoma of the breast which was not appreciated on initial clinical and radiographic evaluation, and which was later found to comprise most of the mass of the breast. Following resection, the deformed breast was reconstructed using folded dermoglandular flaps from the areas expanded by the lipoma with excellent results. This case is an excellent illustration of the difficulties associated with diagnosis of these tumours and the reconstructive options available following excision.

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Lemierre's syndrome is characterized by pharyngeal infections in young healthy adults with secondary septic thrombophlebitis and multiple metastatic infections. In the preantibiotic era, Lemierre's syndrome was common and lethal. With the advent of antibiotics, Lemierre's syndrome has become such a rare entity that the diagnosis is often delayed or missed. With prompt recognition, appropriate antibiotic therapy, and surgical drainage of metastatic abscesses, the majority of patients can be cured. A case of Lemierre's syndrome in a 22-year-old previously healthy man treated on a plastic surgery service is presented. Surgeons who can be consulted for deep space infections should be aware of this disease so that the diagnosis and treatment can be initiated promptly to prevent patients from succumbing to this life-threatening but curable disease.

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Craniosynostosis following ventricular shunting procedures for hydrocephalus has become a recognized complication of shunting procedures. Secondary synostosis results from a decrease in intracranial volume leading to collapse of the cranial vault. Since this represents a distinct etiopathogenesis different from that typically involved, the surgical approach should be altered. Eight patients with secondary scaphocephaly underwent surgical reconstruction. The clinical data and radiographic studies were reviewed for these patients. The surgical approach consisted of sagittal or parasagittal strip craniectomies, lateral osteotomies with bone-flap expansion, occipital and frontal remodeling as needed, and the application of rigid fixation to maintain contour and prevent recurrent collapse of the cranial vault. Patient follow-up ranged from 3 to 37 months. Five of these patients were premature infants, an association not previously recognized in the literature. Satisfactory results were obtained in all patients. Keeping the craniectomy sites parent and achieving a more normal cranial contour through cranial remodeling have provided good results in this population.

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Plastic surgery has a rich history in the development of the field of transplantation. Many prominent plastic surgeons, while undertaking experimental as well as clinical efforts, pioneered and assisted in the establishment of journals and societies devoted exclusively to the field of transplantation. Much of this work was initiated during World War II, a time when transplantation was viewed with suspicion by both scientists and clinicians. While work in this area has undergone a quiescence among members of our specialty, advances in microsurgery and immunology have rekindled interest among plastic surgeons.

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In an effort to further define the immunologic mechanisms leading to acute composite-tissue allograft rejection, the migratory patterns of donor leukocytes were evaluated. Using a rat model, 52 orthotopic vascularized hindlimb transplants were performed in strains representing major histocompatibility mismatches. In order to evaluate the effect of allogeneic skin on limb rejection, all donor skin was removed in a second group of allografts. Recipient lymphoid organs were examined during the week following transplantation for antigen-presenting cells using a donor-specific class II monoclonal antibody. Donor leukocytes, with dendritic cell morphology, were identified in recipient spleen and lymph nodes draining the allograft. Significantly higher numbers of donor leukocytes were present during postoperative days 1 through 4 for both groups. Association of these important passenger leukocytes with host T-lymphocytes may represent the site of initiation of the immune response.

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This study was undertaken in an initial effort to characterize the immunology of extremity transplantation by examining the pattern and kinetics of leukocyte migration from rat limb transplants. Migration of donor leukocytes was evaluated by examining recipient lymphoid tissues with a donor-specific, anti-major histocompatibility complex, class I monoclonal antibody. Double-antibody, two-color labeling was used to localize donor cells to specific regions within these tissues. Donor leukocytes, with dendritic cell morphology, were found in the T-cell-rich areas of lymph nodes draining the allograft and spleen. The donor cells were present on postoperative days 1 through 3 but were not present on days 5 to 7. Donor leukocytes were not present in distant lymph nodes or liver. These findings indicate a migration of leukocytes, most likely the highly immunogenic dendritic cell, from rat limb transplants to the draining lymphoid tissues. Migration occurs shortly after transplantation and may lead to the sensitization of alloreactive T-cells.

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The reaction of the spleen cell migration inhibition in the presence of monospecific antisera against mouse G, A and M immunoglobulins was used to detect cytophilic antibodies on the surface of mouse granulocytes. The oral administration of ACR live vaccine from suppressor revertant Salmonella typhimurium Rev. 8 protected the mice against infection induced by virulent species of mouse. Salmonella typhimurium. The immunized mice showed an increase in cytophilic IgG on the surface of neutrophile granulocytes.

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The work of was aimed at the morphological study of the harmlessness and protective activity of the live salmonella vaccine prepared form the suppressor S. typhimurium revertant intended for the prophylaxis and treatment of carrier state after the sustained food poisoning. It was shown to model experiments on mice that oral immunization caused no development of pathological changes, and at the same time prevented the appearance of the disease in infection of the animals by the virulent strain--S. typhimurium No. 415 in a dose of 100 LD50. A marked immunomorphological reaction developed in the small intestine and the lymphoid organs.

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The authors aimed at the experimental confirmation of avirulent properties of suppressor revertants of streptomycin-dependent salmonella mutants and also at the study of their immunogenicity. Stability of the loss of virulence by the suppressor revertants was established by studying the virulence of the subcultures isolated from them, differing by the genotype. Repeated passage of suppressor revertants of S. typhimurium Rev8, S. enteritidis Rev5, S. pullorum Rev through the biological objects highly sensitive to salmonella infection failed to lead to elevation of the virulence of the cultures under study. Live salmonella vaccines prepared from the suppressor revertants proved to be highly immunogenic in single oral and parenteral immunization of albino mice and chicks. Analogous immunization with killed vaccines was much less effective, streptomycin-dependent vaccines occupying the intermediate position.

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The authors present experimental data on the study of the living enteral vaccine against the typhoid infection from the Vi-negative strain of salmonella with a double-dependence by streptomycin and purine, and from the Vi-positive strain -- citrobacter 5396/38. The method of immunoelectrophoretic analysis showed an indenticity of the O- and H-antigens of the doubledependent mutant with the O- and H-antigens of the typhoid strains of bacteria (Ty2-4446 and 5501). A sufficiently marked immunological reaction was revealed in the tests of antibody formation and in the study of the preventive activity of the sera of the immunized rabbits. The efficacy of the enteral immunization with the associated vaccine consisting of a doubledependent mutant of typhoid bacilli and the citrobacter strain in the doses tested (a 6-fold immunization) was demonstrated in experiments on albino mice. Association in one preparation of the cultures under study did not lead to any changes in the immunogenic properties of these strains. The cells of the mutant strain administered per os gave a positive culture (from the mouse organism) only in the course of the first 24 hours, in difference from the citrobacter strain which gave a positive culture in the course of 14 days.

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Virulent and avirulent cells resistant to streptomycin were revealed in the population of avirulent streptomycin-resistant mutant (obtained from the supressor revertant str-d S. enteritidis mutant) in seeding on a medium with streptomycin. Transduction analysis of the isolated avirulent and virulent strains demonstrated that mutation in the gene-suppressor su-str+ led to the loss of virulence. In connection with the presence in the genom of suppressor revertants of the streptomycin-dependent mutants two mutations (su-su+ and str-d), which irrespective of one another led to the loss of virulence, a conclusion was drawn on the stability of avirulent properties of such strains and on future prospects for their use in the capacity of living vaccines.

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