These proteins were estimated in the serum of eight patients after surgery. Both proteins rise markedly in the serum, the a., acid glycoprotein reaching peak concentration in two to three days, and falling again equally rapidly, the orosomucoid rising more slowly to reach a peak after four to seven days, and returning to normal values in 10 to 14 days. Estimations of serum levels in 24 patients with a variety of diseases show that the two proteins can vary independently; values as high as eight times normal were found for orosomucoid in Crohn's disease. In patients with proteinuria, orosomucoid is preferentially excreted in the urine. The losses of a1 acid glycoprotein are, however, anomalous, being proportionately less than those of albumin, relative to the serum levels.The significance of these preliminary findings is discussed.

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round blue‐staining bodies in the cytoplasm of neutrophil leucocytes were reported by Döhle in 1911. He observed these inclusion bodies (now known as Döhle bodies) in scarlet fever, but similar structures have been noted on numerous occasions since, in association with various different diseases including diphtheria (Kolmer, 1912), typhus (MacEwen, 1914), tuberculosis (Bachman and Lucke, 1918) and in patients with burns (Weiner and Topley, 1955). May (1909) noticed persistent inclusion bodies in the neutrophils of a healthy person, in association with giant platelets. It was not until 1945 that this association was shown in some cases to be familial, when Hegglin (1945) reported a family with Döhle bodies in their neutrophils and chronic thrombocytopenia. More recently, Petz, Smith and Nelson (1960), Wassmuth, De Groote, Hamilton and Sheets (1961), Oski, Naiman, Allen and Diamond (1962) and Buchanan, Pearce and Wetherley‐Mein (1964) have reported families with the May‐Hegglin anomaly. We have been unable to find any report of Döhle bodies associated with transient thrombocytopenia. Most reports of transient Döhle bodies have referred to their presence in certain specific conditions. Random observations in this department suggested that they occurred more frequently, and were found in a wider range of conditions, than might be supposed from a study of the literature. A moderate thrombocytopenia was also noted on several occasions to be associated with the presence of transient Döhle bodies. The results of a formal investigation into the incidence and nature of these structures, as well as their association with thrombocytopenia, is reported here.

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Background: Autologous free tissue transfer is a common method of breast reconstruction in the United States, but it involves many care teams and can incur a large cost on an institution. The consistency and efficiency of performing these procedures can be improved with a method called the 4 disciplines of execution (4DX). Methods: Patients that underwent autologous breast reconstruction between 2015 and 2020 were included. Midway through the collection period, several preoperative and intraoperative interventions were implemented using the 4DX. Then, 2 cohorts of patients were analyzed for differences in operative times, length of stay (LOS), and major complications. Results: Thirty-two total patients were included. The median operative time before interventions were implemented was 828 minutes, and the median operative time after interventions was 619 minutes ( P < 0.05). The median LOS in days before interventions was 5 days, and the median LOS after interventions was 3 days ( P < 0.05). There were no statistically significant differences in complications before or after the interventions. Conclusions: The 4DX successfully improved consistency and efficiency in the process of performing autologous breast reconstruction at our institution, as evidenced by a faster median operative time and shorter patient LOS in the hospital.