The distribution of extracellular matrix vesicles in healing of rat tibial bone three days after intramedullary injury

Summary The distribution of extracellular matrix vesicles on the third day of bone healing was studied by morphometric analysis of transmission electron micrographs. Detection and grouping of the vesicles was performed according to type, diameter, and distance from the calcified front. The different types were selected as follows: vesicles with electron-lucent contents (empty), vesicles with amorphous electron-opaque contents (amorphic), vesicles containing crystalline depositions (crystal), and vesicles containing crystalline structures with ruptured membranes (rupture). The majority of vesicles were between 0.07 µm and 0.12 m in diameter and were located at less than 3 m from the calcified front. The distribution of the empty, amorphic, crystal, and rupture vesicles was 23.2%, 74%, 2.5%, and 0.3% respectively. Their sequence of arrangement according to diameter was as follows: empty, amorphic, crystal, and rupture, the empty vesicles constituting the smallest and the rupture the largest type. Distances from the calcified front were similar for the empty, amorphic, and crystal vesicles, while the rupture type was located nearest to the front. The present observations support the widely acknowledged hypothesis on the role of extracellular matrix vesicles in mineralization. It is thought that the secretion of empty vesicles from the cell is followed by intravscular accumulation of amorphous Ca and Pi to form a hydroxyapatite crystal that, in turn, ruptures the vesicle's membrane. The maturation process is accompanied by an increase of the vesicular diameter and its approximation to the calcifying front.     

Cranioplasty of an extremely large cranial defect caused by transitional meningioma with a knitted polypropylen-polyester prothesis “Codubix”

Summary The authors report a case of transitional cell meningioma of the convexity which destroyed a large portion of the calvarium and invaded subcutaneous tissue. The tumour was totally removed and a large cranial defect/430 cm² in size/ was filled with a polypropyleno-polyester knitted prothesis Codubix with an excellent result.The problems of chronioplastic closure of such an unusually large skull defect and the advantages of the use of the material Codubix are discussed.     

242. Korrelation klinischer und biochemischer Befunde mit dem Schweregrad einer bakteriellen Peritonitis

Zusammenfassung Anhand von Verlaufsdaten 66 chirurgischer Patienten mit einer bakteriologisch gesicherten Peritonitis sollten harte und weiche Kriterien zur Beurteilung des Schweregrades differenziert werden. Untersuchungskriterien: 1) regionale Ausbreitung, 2) Entwicklung eines Organod. Systemversagens, 3) Leukocytose/Thrombopenie, Körpertemperatur, 4) die Plasmamediatoren Endotoxin/Prostaglandin F₂ (PGF₂), 5) Anamnesedauer (Erstsymptom bis OP), 6) Anzahl erforderlicher Reoperationen und 7) Lebensalter. Zuzuordnende Schweregrade: Grad 1: überlebt, Grad 2: mit Komplikationen überlebt, Grad 3: nicht überlebt. Danach erweisen sich als harte Kriterien: 1) Lokalisation, 2) Anamnesedauer, 3) Leukocytose, 4) Endotoxin > 100 Eu/ml, PGF₂ > 500 pg/ml, 5) Körpertemperatur 38,5°C.     

82. Fragen der chirurgischen Weiterbildung: Gegenwärtiger Stand

Zusammenfassung Weiterbildung — die Einführung eines approbierten Arztes in ein anerkanntes Fachgebiet — ist im Begriff und System von Ausbildung (des Studenten) und lebenslanger Fortbildung (des fertigen Arztes) zu unterscheiden. Sie schafft das Fundament, auf dem sich Wissen und Können der Angehörigen einer Disziplin aufbauen, und setzt damit Wertmaßstäbe im eigenen Land und über die Grenzen hinaus. Weiterbildungsordnung (WO) und als Richtlinien bezeichnete Ausführungsbestimmungen regeln den Ablauf der Weiterbildung (W). Neu ist im wesentlichen die Verlängerung der Weiterbildungszeit von 5 auf 6 Jahre, die Einführung von Teilgebieten (in der Chirurgie Teilgebiet Kinder-Chirurgie und Teilgebiet Unfall-Chirurgie) mit dem Ziel, abgerundeten Subspezialitäten im Rahmen des Gesamt-Fachgebiets eine Autonomie zu geben, sowie ein umfangreicher Operations-Katalog. Die WO ist damit richtungweisend für die weitere Entwicklung des Fachgebietes und begründet erhebliche Anforderungen sowohl an den Facharzt-Aspiranten als auch an den Erfahrenen, der die W leitet. Die Einführung eines Befähigungsnachweises als einer in der ausschließlichen Kompetenz der ärztlichen Selbstverwaltung gelegenen Abschlußkontrolle wird befürwortet.

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Summary Postgraduate medical education in an approved specialty by definition and set-up differs from both undergraduate medical education and the life-long continuing medical education after completion of training. Postgraduate education in medicine is the basis for the knowledge and proficiency of a specialist and sets standards at home and abroad. Postgraduate education is laid down in principle in the Weiterbildungsordnung and regulated by the Richtlinien. Major innovations are a prolongation of training from 5 to 6 years, the introduction of subspecialties (pediatric surgery, traumatology), in order to give these established groups autonomy within the field of surgery and finally a sizable list of operations to be performed. The new Weiterbildungsordnung will guide the future development of surgery and imposes demands both on those in training and those responsible for it. An examination as "proof of competence"' is recommended, but should remain within the competence of the medical profession.

     

Cytotoxic effect of diphtheria toxin used alone or in combination with other agents on human renal cell carcinoma cell lines

Treatment of renal cell carcinoma (RCC) by conventional chemotherapy and immunotherapy has resulted in minimal remissions. Alternative forms of therapy are therefore being sought. The present study investigated the sensitivity of RCC cell lines to several toxins used alone and in combination with other agents. RCC lines were relatively sensitive to the direct cytotoxic effect of diphtheria toxin (DTX), Pseudomonas aeruginosa exotosin A (PEA) and ricin. Furthermore, DTX in combination with tumor necrosis factor- (TNF-) resulted in synergistic cytotoxic activity. The mechanism of synergy was examined. A possible mechanism of resistance to TNF- in tumor cells is the expression of TNF- mRNA or protein. R11 cells did not constitutively express mRNA for TNF-, however, treatment of R11 cells with TNF- induced the expression of TNF- mRNA. When DTX was used in combination with TNF-, the level of TNF- mRNA induced by TNF- was markedly reduced. These studies suggest that DTX in combination with TNF- can overcome the resistance of RCC lines and that the marked downregulation of TNF- mRNA by DTX may play a role in the enhanced cytotoxicity seen with the combination of DTX and TNF-. Furthermore, the combination treatment might also potentiate the antitumor host responses. The implications of these findings in clinical therapy are discussed.     

Demonstration of the 5-flap technique

Summary Demonstration of the 5-flap technique which is double opposed Z-plasty and Y – V advancement is presented. A 4×4 gauze serves to demonstrate this technique.The authors dedicate this paper to the dear memory of their teacher, the late Prof. Zvi Neuman, who passed away untimely on March 22, 1977     

31. Über das Problem,Appendicitis" in unserem 10jährigen Krankengut

Zusammenfassung An der dritten chirurgischen Klinik der Semmelweis Universität Budapest haben wir von 1976 bis 1985 862 Patienten wegen Verdacht auf akute Appendicitis operiert. Bei 111 Patienten konnte ein Beweis einer Entzündung weder makroskopisch noch histologisch nachgewiesen werden. Diese Patienten wurden unter der Diagnose chronische Appendicitis geführt, die Letalität betrug 0,8%. Bei den 751 wegen akuter Appendicitis operierten Fällen betrug die Letalität 0,5%. Bei den Patienten, die wegen chronischer Appendicitis operiert wurden und bei denen der Eingriff als sogenannte prophylaktische Appendektomie gilt, waren die Komplikationen sowie die Letalität größer, als in der wegen akuter Appendicitis operierten Gruppe. Deshalb werden die aus prophylaktischen Gründen durchgeführten Appendektomien bei uns nicht befürwortet.     

“Pregnancy zone” protein in sera from patients with prostatic cancer treated with oestrogens

Summary The pregnancy zone protein is a human a₂-serum globulin previously found in pregnant women and women taking oral contraceptive drugs. The occurrence of this protein in sera from 22 out of 34 patients with prostatic cancer treated with oestrogen was demonstrated by an immunological technique. Immunological identity was found between this steroid-inducible protein and that in sera from pregnant women and women taking contraceptive drugs. This protein was not detected in 27 patients with prostatic cancer not treated with oestrogens. Oral diethylstilboestrol appeared to induce the pregnancy zone protein more often than injections of polyoestradiol phosphate.     

Effects of thiopental on cardiac energy metabolisms in postischemic reperfusion in rat

In experiments on isolated rat heart lung preparation, the effects of thiopental on myocardial metabolisms in postischemic reperfusion were evaluated with intramyocardial high energy phosphates, lactate, pyruvate and glycogen. The release of CPK in the perfusate blood was also measured at the end of reperfusion. After 10min perfusion, hearts were made globally ischemic for 8min and reperfused for 12min. Large dose of thiopental (100µg/ml) reduced the energy charge and glycogen content. Reperfusion with an anesthetic dose of thiopental (10µg/ml) resulted in an exacerbation of the CPK release. Protection by thiopental during ischemia was not observed and its high dose may be harmful.(Kashimoto S et al.: Effects of thiopental on cardiac energy metabolisms in postischemic reperfusion in rat. J Anesth 1: 77–81, 1987)     

The role of TGF-β in patterning and growth of the mammary ductal tree

Evidence that transforming growth factor beta (TGF-)⁴ influences pattern formation in the developing mammary gland and negatively regulates ductal growth is reviewed. In the mouse, overexpression of TGF- transgenes during puberty reduces the rate of growth of the ductal tree and simplifies the pattern of arborization, while expression during pregnancy also interferes with lactation. Expression studies in the normal mouse gland indicate that TGF- is synthesized in the mammary epithelium, with the three isoforms showing somewhat different spatial and temporal distributions. Exogenous TGF- applied directly to the glandin situ inhibits epithelial cell division within hours, and strongly stimulates extracellular matrix synthesis over a longer time course. Normal human breast cells as well as certain breast cancer cell lines also secrete TGF- and are themselves inhibited by it, suggesting an autoregulatory feedback circuit, that in some cases appears to be modulated by estradiol. Taken together, the evidence suggests a model in which growth and patterning of the mammary ductal tree are regulated, at least in part, by TGF- operating through an autocrine feedback mechanism and by paracrine circuits associated with epithelial-stromal interactions.     

Comparison of adrenoceptor subtype expression in porcine and human bladder and prostate

We have quantified and characterized ₁-, ₂-and -adrenoceptor subtypes in porcine bladder detrusor and bladder neck, human bladder detrusor, and porcine and human prostate. ₁-, ₂- and -adrenoceptor were identified in radioligand binding studies using [³H]prazosin, [³H]RX 821002 and [¹²⁵I]iodocyanopindolol, respectively, as the radioligands. In porcine male and female detrusor and bladder neck and male prostate, adrenoceptors were detected in the order of abundance > _{2 1} (not detectable), with no major differences between the sexes or between detrusor and bladder neck. In human detrusor and prostate the order of abundance was > _{2 1} (not detectable) and ₁ > ₂. respectively. The ₂-adrenoceptors in all tissues were homogeneously of the _2A-subtype as evidenced by competition binding studies with yohimbine, prazosin, ARC 239 and oxymetazoline. The -adrenoceptors represented a mixed population with a dominance of the ₂-subtype in all tissues as demonstrated by competition binding with ICI 118,551 and CGP 20,712A. We conclude that pigs may be a suitable model for studies of detrusor function with respect to adrenoceptor expression. They may be less suitable for studies of bladder neck or prostate function.     

Spontaneous spinal epidural hematomas: is the role of dural arteriovenous malformations underestimated?

Two recent observations of spinal epidural hematomas (SEH) are presented: one of them was associated with iatrogenic coagulopathy, the other, apparently spontaneous, required reoperation for early recurrence and was finally attributed to ruptured epidural arteriovenous malformation missed during the first procedure. Both patients underwent complete recovery. Although modern neuroimaging provides quick, noninvasive, and sensitive assessment of spinal epidural bleeding, we believe that preoperative spinal angiography is indicated in spontaneous SEH with subacute clinical course. Demonstration of underlying vascular anomaly would allow better surgical planning, complete obliteration of abnormal vessels, and prevention of recurrences. Essential epidemiological, pathogenetical, and clinical aspects of SEH are reviewed.     

62. Durch mikroskopische Diagnostik mögliche und vermeidbare Fehler bei der lungenchirurgischen Indikationsstellung

Zusammenfassung Bronchusexcisionen aus kleinzelligen Carcinomen sind sehr vulnerabel und können leicht derart deformiert werden, daß sie kaum oder auch gar nicht von einer chronisch-entzündlichen Zelleninfiltration zu unterscheiden sind, woraus sich schwerwiegende Folgen ergeben können.Eine epitheolidzellig-granulomatöue Adenitis mediastinaler Lymphknoten kann eine spezifische Entzündung sein, es kann aber auch eine tuberculoide Reaktion im Abflußgebiet eines Carcinoms vorliegen. Durch diese Diagnose ist also das Vorhandensein eines Bronchialcarcinoms nicht ausgeschlossen.Die cytologische Diagnose orverdächtige Zellen ist so vage, daß sie als solche, d. h. ohne eindeutige klinische Befunde, niemals zu therapeutischen Konsequenzen führen sollte.Die cytologische Diagnose len einer malignen Geschwulst ist recht verläßlich und das Risiko einer darauf beruhenden chirurgischen Indikationsstellung ist nur gering. In 264 histologisch einwandfrei verifizierten Fällen (davon 254 Lungencarcinome) war diese Diagnose nur in 3,8% er Fälle falsch.

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Summary Biopsies of small-cells carcinomas of the bronchus are highly vulnerable and are easily deformed, so that they become indistinguishable from chronic inflammatory cell infiltrates, with serious consequences.Epitheloid-cellular granulomatous mediastinal adenitis may represent either a specific inflammation or a tuberculoid reaction in the catchment area of a carcinoma, so that this diagnosis does not exclude the presence of bronchial carcinoma.A cytological diagnosis of query malignant cells so vague that without definite clinical signs it should never produce therapeutic consequences.A cytological diagnosis of ls from a malignant tumor reliable, and indications for surgery based on it carry little risk. In 264 cases of unobjectionable histological identification (254 of these were pulmonary carcinoma) the diagnosis was mistaken in no more than 3.8%Epitheloid-cellular granulomatous mediastinal adenitis may represent either & specific inflammation or a tuberculoid reaction in the catchment area of a carcinoma, so that this diagnosis does not exclude the presence of bronchial carcinoma.A cytological diagnosis of query malignant cells is so vague that without definite clinical signs it should never produce therapeutic consequences.a cytological diagnosis of cells from a malignant tumor is reliable, and indications for surgery based on it carry little risk. In 264 cases of unobjectable histological identification (254 of these were pulmonary carcinoma) the diagnosis was mistake in no more than 3.8%.

     

Reconstruction of bony defects using the Ilizarov “bone transport” technique

Summary Ilizarov's method of percutaneous transosseous osteosynthesis allows management of complex skeletal deformities using elastic external fixation, atraumatic corticotomy and gradual adaptations between bony fragments. One particular application, useful in the reconstruction of bony defects, is the lift or bone transport technique, in which in fact internal lengthening is carried out. Using some of their first cases as illustrations, the authors describe the technique and its potential problems.     

Transforming growth factor-beta localization during mouse prostate morphogenesis and in prostatic growth abnormalities

Summary Growth and morphogenesis of the prostate involves mesenchymal-epithelial interactions. Transforming growth factor-beta 1 (TGF-1) is one growth factor that may play a role in these paracrine interactions. We have localized TGF-1 by molecular and immunohistochemical analysis in the developing mouse prostate. Accumulations of TGF-1 protein were localized in the mesenchyme surrounding ductules in fetal and neonatal prostate. Previous studies in the mouse prostate reconstitution (MPR) model system have localized accumulations of TGF-1 to regions of oncogene-induced abnormalities. In surgically excised adult human prostate tissues, localized accumulations of TGF-1 are associated with prostate cancer and benign prostatic hyperplasia (BPH). Intracellular TGF-1 was more often associated with stromal cells in BPH and with neoplastic epithelial cells in prostate cancer. The production and accumulation of TGF-1 appears to involve interactions between mesenchymal and epithelial cells. Further experimental studies may clarify the relationships between TGF-1 and abnormal prostatic growth.     

Penetration of cefazolin,ceftriaxone, cefoperazone,and ceftazidime into human gallbladder tissue and bile

Forty patients underwent elective cholecystectomy following administration of a single intravenous dose of cefazolin, ceftriaxone, cefoperazone, or ceftazidime. Mean gallbladder bile concentrations of cefoperazone (398.8 g/ml and ceftriaxone (153.4 g/ml) were significantly higher than those of cefazolin (12.3 g/ml) and ceftazidime (3.08 g/ml) (p<0.008). Mean gallbladder tissue levels of cefazolin (30.1 g/g), ceftriaxone (50.5 g/g), and cefoperazone (91.0 g/g) exceeded that of ceftazidime (7.25 g/g) (p<0.001). When adjusted for known in vitro activity against biliary pathogens, these data suggest that cefoperazone and ceftriaxone are superior to ceftazidime and cefazolin for prophylaxis in elective biliary surgery.

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Resumen Las nuevas cefalosporinas de tercera generación poseen actividad contra una variedad de bacterias, incluso la mayoría de los patógenos biliares comunes. Hemos realizado un estudio prospectivo sobre el grado de penetración de la cefazolina, la ceftriaxona, la cefoperazona, y la ceftazidima en el tejido y la bilis de la vesícula biliar en pacientes sometidos a colecistectomía electiva.Cuarenta pacientes recibieron una dosis única de la cefalosporina dentro de la hora anterior a la colecistectomía. Las concentraciones medias en la bilis de la vesícula biliar fueron significativamente mayores para la cefoperazona (398.8g/ml) y la ceftriaxona (153.4g/ml) que para la cefazolina (12.3g/ml) y la ceftazidima (3.08g/ml) (p<0.008). Los niveles medios en el tejido de la vesícula biliar fueron superiores para la cefalozina (30.1g/g), la ceftriaxona (50.5g/g), y la cefoperazona (91.0g/g que para la ceftazidima (7.25g/g) (p<0.001). Al ajustar estos datos contra valores conocidos de actividad in vitro contra patógenos biliares, aparece que la cefoperazona y la ceftriaxona son superiores a la ceftazidima y la cefazolina en cuanto a profilaxis en cirugía biliar electiva.

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Résumé Quarante patients ont été cholécystectomisés après administration intraveineuse d'une dose unique de céfazoline, de ceftriaxone, de céfapérazone ou de ceftazidine. La concentration moyenne de la bile vésiculaire en céfopérazone (398.8g/ml) et en ceftriaxone (153.4g/ml) était significativement plus élevée que la concentration en céfazoline (12.3g/ml) et en ceftazidine (3.08g/ml) (p<0.008). Les concentrations tissulaires vésiculaires moyennes de céfazoline (30.1g/g), de ceftriaxone (50.5g/g), et de céfopérazone (91.0g/g) étaient plus importantes que la concentration de ceftazidine (7.25g/g) (p<0.001). Lorsque ces antibiotiques sont sensibles in vitro contre des germes pathogènes, nos résultats suggèrent que le céfopérazone et la ceftriaxone sont meilleurs que la ceftazidine et la céfazoline dans la prophylaxie antibiotique de la chirurgie biliaire élective.

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Presented at the Société Internationale de Chirurgie in Sydney, Australia, September, 1987.     

Standardization of Ischemic Hepatic Failure in Pigs as a Model for Bioartificial Liver Assessment

Purpose. A standard protocol of ischemic liver failure in pigs was examined to establish a system for assessing the efficacy of a bioartificial liver, based on clinical practice. Methods. The portal blood flow was extracorporeally bypassed into the cervical jugular vein, using a centrifugal blood pump. The portal vein and hepatic artery were then ligated. Results. The maintenance protocol was established as follows: (1) the concentration of the inhaled anesthetic was decreased by 0.2% when the systolic blood pressure was 100mmHg; (2) the volume of an infusion containing 5% glucose was increased to 10ml/kg per hour when central venous pressure was 5mmHg; (3) 20ml of 50% glucose was injected intravenously when the blood glucose was 50mg/dl; (4) 2000 units of heparin was injected intravenously when the activated clotting time was 150s; (5) sodium bicarbonate was given when the blood pH was 7.3; (6) tidal volume was increased by 1ml/kg when the pCO₂ was 80mmHg; (7) oxygen was increased by 25% when the pO₂ was 100mmHg. No vasopressors were used in the experiment. Conclusion. Our protocol reduced the operating time and minimized the risk of data deviation that can arise from variations in operating techniques and individual animal conditions. This experimental model is also easy to use as a bridge to transplantation.     

Computer assisted quantification of vasospasm on angiograms

Summary We describe a new computer-based, automated method for the assessment of in vivo cerebral vasospasm. Arterial diameter measurements were performed on post-processed digital substraction angiographic images, using pixel as the unit. Vasospasm which was difficult to detect by visual inspection could be measured by the stenosis quantification program. A computer-assisted method such as we describe might decrease the risk of subjective errors.     

Human interface technology

Summary Human interface technology is a new science which must be understood by all surgeons in order to cope with the ever-increasing complexity of surgical practice. This science is the understanding of how humans comprehend, interact, and use the world around them. The increasing use of robotics, computers, and virtual reality depend upon this technology to create a user-friendly environment to be able to assimilate the massive amount of data and images and to naturally interact with machines and computers. Through careful implementation, more complex systems will become easier to use and enhance the surgeon—the technology must adapt to the surgeon, not the reverse.The opinions or assertions contained herein are the private views of the author and are not to be construed as official, or as reflecting the views of the Department of the Army of the Department of Defense.     

Local application of basic fibroblast growth factor into the bone increases bone mass at the applied site in rabbits

The effect of basic fibroblast growth factor (bFGF) applied locally into the bone under physiological conditions was investigated. An aqueous solution containing Og (vehicle), 100 g or 400 g recombinant human bFGF was percutaneously applied through a needle into the right ilium in rabbit, and the ilia were harvested 4 weeks after the application. Compared with vehicle-treated animals, bone mineral density measured by dual-energy X-ray increased in the 400 g bFGF group. The width of trabeculae in the bFGF-treated groups was greater than in the vehicle group. These results showed that bFGF applied locally into the bone under physiological conditions affected bone formation, and suggested that such an application might have potential for increasing bone.