陶对陶全髋关节置换在Crowe Ⅳ型髋关节发育不良中的疗效观察

目的 :观察陶瓷对陶瓷全髋关节置换术(THA)在CroweⅣ型髋关节发育不良(DDH)中的临床应用效果。方法:回顾性分析2008年4月至2015年12月由同一名高年资医生应用第3代或第4代陶瓷对陶瓷界面对CroweⅣ型DDH行THA患者111例(137髋),单侧85例,双侧26例,年龄18~68(38.88±10.83)岁,随访时间12~96(41.16±21.50)个月。术前及术后随访均拍摄X线片进行观察,并采用Harris评分对临床效果进行评价。观察术后Harris评分的改善,陶瓷碎裂、异响以及脱位等并发症的发生率。结果:Harris评分由术前56.54±15.67提高至术后88.30±6.86(P=0.017)。未发现假体周围明显骨溶解,无陶瓷碎裂发生。3髋分别因感染、股骨柄松动、下肢不等长翻修;3髋脱位。77例患者记录步态及髋关节活动度,其中69例患者髋关节屈曲可达120°以上。结论 :在CroweⅣ型DDH行THA中应用陶瓷对陶瓷界面可达到较好的临床效果。     

人工全髋关节置换治疗成人髋关节发育不良

目的探讨成人髋关节发育不良(DDH)行人工全髋关节置换(THA)的手术方法及早期疗效。方法对21例成人DDH继发骨关节炎患者(22髋)行生物型THA。髋关节脱位按Crowe分型:Ⅰ型15髋,Ⅱ型和Ⅲ型共6髋,Ⅳ型1髋。髋臼重建方式中采用真臼加深内移15髋,结构性植骨4髋,旋转中心上移3髋。1髋CroweⅣ型行转子下短缩截骨。结果患者均获得随访,时间6~24个月。无假体周围感染、假体不稳及松动。X线片显示结构性植骨无塌陷,转子下截骨部位愈合良好。髋关节功能Harris评分:术前30~53(38.6±5.6)分,术后76~94(84.2±6.8)分。结论 THA治疗成人DDH早期疗效满意,与普通THA相比,DDH的THA技术要求高,操作较复杂。     

CroweⅡ/Ⅲ型髋关节发育不良继发重度骨关节炎髋臼解剖旋转中心重建方法及效果

目的探讨在全髋关节置换术治疗CroweⅡ/Ⅲ型髋关节发育不良(DDH)继发重度骨关节炎(OA)中准确去除髋臼骨赘及重建人工髋臼解剖旋转中心的方法与效果。方法回顾性分析2011年6月至2013年6月,上海交通大学第九人民医院骨科应用人工全髋关节置换术治疗的31例(36髋)CroweⅡ/Ⅲ型DDH继发重度OA炎患者。病例纳入标准:CroweⅡ/Ⅲ型成人DDH继发终末期OA(TonnisⅣ型),髋关节疼痛影响正常生活方式或工作;排除标准:患侧髋关节有感染史、骨折史及手术史,下肢有感觉障碍及肌力异常。CroweⅡ型25髋,CroweⅢ型11髋。术前应用平片、CT等影像学方法评估髋臼形态及髋臼缘骨赘部位与骨赘量,术中以坐骨结节作为真实髋臼后壁高度的参考标志,准确切除髋臼后缘增生骨赘,以卵圆窝为参考标志确定真臼位置及深度重建臼杯,最后以臼杯前缘为标志切除髋臼前缘残留骨赘。所有患者均应用生物型臼杯,臼杯直径为44~52 mm。术前、术后对术侧髋关节进行Harris髋关节评分(HHS),术后测量假体旋转中心的垂直与水平距离及外展角。SPSS 13.0统计学软件包处理数据,计量资料应用t检验,以P0.05为差异有统计学意义。结果所有患者均未发生血管、神经损伤及髋臼骨折,旋转中心垂直距离、水平距离分别为(22.5±3.2)mm及(29.4±2.6)mm,与解剖旋转中心符合率为86.11%,外展角为(44.3±3.2)°。随访期间未发生髋关节脱位、假体松动、感染等并发症。Harris髋关节评分(HHS)由术前(38±9)分(25~55分)升至术后末次随访(94±3)分(89~100分),差异有统计学意义(t=35.95,P0.05)。结论CroweⅡ/Ⅲ型DDH继发重度OA的髋臼形态发生明显改变,术前应用CT充分评估髋臼形态,术中准确切除骨赘,以卵圆窝为参考标志重建髋臼旋转中心接近解剖旋转中心,可达到满意的临床效果。     

肢体延长后行全髋关节置换治疗CroweⅣ型髋关节发育不良

目的 探讨骨外固定延长器肢体延长后采用全髋关节置换(total hip arthroplasty,THA)治疗年轻CroweⅣ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)继发骨关节炎的方法与疗效.方法 回顾性分析2007年10月至2012年1月,治疗12例单侧CroweⅣ型DDH继发骨关节炎患者资料,男2例,女10例;年龄18～35岁,平均25.7岁.采取分次手术的方法,初次手术行软组织松解及安装髂股外固定延长器,术后每天延长3～5 mm,待纠正肢体短缩,即股骨头下移至真臼水平后再行THA.THA术中采用生物型假体结合自体股骨头移植重建髋臼.所有手术均无需短缩股骨.结果 初次手术时间(35.2±3.6) min,术后住院时间(13.3±1.6)d.再次手术时间(77.3±12.4) min,术后住院时间(9.2±2.5)d.12例患者均获得随访,随访时间9～48个月,平均(13.6±3.2)个月,肢体不等长由术前(5.6±1.5) cm恢复到术后(0.5±0.2)cm;Harris评分由术前(45.7±2.6)分提高到术后(92.3±3.3)分.12例患者末次随访均获得良好的髋、膝关节功能.术后无一例出现钉道感染、牵引针无菌性松动、髋关节感染、假体松动脱位及深静脉血栓形成等并发症.3例在肢体延长过程中出现小腿一过性神经麻痹,经调整牵引速度后缓解,5例在THA术后出现小腿皮肤麻木,均未行治疗而在术后6周缓解.结论 针对年轻的CroweⅣ型DDH继发骨关节炎患者,可先通过髂股牵引恢复肢体长度,而后再行THA.这种逐步延长的方式既可避免神经损伤,又可显著改善患肢功能,并发症少.     

全髋关节置换术治疗Crowe Ⅳ型髋关节发育不良患者及围手术期并发症分析

目的:探讨人工全髋关节置换术治疗Crowe Ⅳ型成人髋关节发育不良的疗效及围手术期并发症。方法:2000年3月至2010年3月,对19例(23髋)Crowe Ⅳ型成人髋关节发育不良患者进行人工全髋关节置换术,其中男5例,女14例;年龄41～72岁,平均61.3岁。髋臼侧采用小臼杯结合髋臼内陷技术安置臼杯假体,股骨侧采用粗隆下短缩截骨放置股骨假体。采用Harris评分评价术后髋关节功能。结果:所有患者获随访,时间1～8年,平均4.2年,术后X线片显示髋臼假体均位于真臼内,无髋臼假体松动。股骨侧截骨处均骨性愈合。Harris评分由术前平均(34.0±6.9)分提高至末次随访的(85.0±7.5)分。发生围手术期并发症11例,包括股骨劈裂骨折3例,神经并发症3例,截骨延迟愈合2例,术后脱位3例。结论:采用小臼杯、假体内陷技术、股骨短缩截骨对Crowe Ⅳ型DDH患者行全髋关节置换可以重建关节功能,恢复下肢长度,早期疗效满意,但并发症发生率高。后期疗效有待进一步观察。     

S-ROM假体全髋关节置换治疗Crowe Ⅳ型髋关节发育不良

目的:探讨S-ROM假体全髋关节置换术治疗CroweⅣ型髋关节发育不良的方法并评价其疗效。方法:2000年10月至2011年10月,应用全髋关节置换术治疗CroweⅣ型髋关节发育不良患者30例36髋,其中6例双侧,24例单侧。采用S-ROM假体结合股骨转子下横断截骨短缩行人工关节置换术,髋臼侧均采用生物型假体,假体在真臼水平或接近于真臼水平植入。对临床结果采用改良Harris评分进行评价,术前及术后随访时均拍X线片进行观察。结果:30例中早期死亡l例(双髋),失访2例(2髋),余27例32髋获得随访,时间7～84个月,平均48个月。2髋分别于术后12、18个月随访时仍可见骨折线,下肢行走无异常,术后未发生感染或神经损伤等严重并发症。改良Harris评分由术前平均41.7±3.7改善至术后89.1±2.9。无假体松动或位置不当需要翻修的病例。影像学复查显示关节假体在位,金属臼杯、股骨假体与宿主骨嵌合良好,无明显松动。所有施行臼侧植骨及股骨截骨的患者植骨及截骨处均骨性愈合,无假体松动,活动度无明显受限,患髋无痛,Trendelenburg征阴性,均无须使用行走辅助工具。结论:对CroweⅣ型髋关节发育不良患者行全髋关节置换术时,良好的真臼暴露、加深髋臼、股骨短缩、斜行截骨及使用S-ROM组配式股骨柄假体假体能提高全髋关节置换术的治疗效果。     

非截骨全髋关节置换术治疗单侧CroweⅣ型髋关节发育不良

目的探讨非截骨全髋关节置换术(THA)治疗单侧CroweⅣ型髋关节发育不良(DDH)的临床疗效。方法应用非截骨THA治疗15例单侧CroweⅣ型DDH患者。术中髋臼均置于原真臼位置,通过有限软组织松解,未行股骨短缩截骨。术后对患者满意度、Harris髋关节评分、双下肢不等长等情况进行评估。结果患者均获得随访,时间3~48个月。随访期间无髋关节脱位、假体感染、假体松动发生。Harris髋关节评分由术前25~39(32.8±4.2)分提高至术后85~93(90.3±2.3)分,差异有统计学意义(P0.05)。末次随访按Harris髋关节评分评估疗效:优12例,良3例。14例患者满意度高。术后随时间延长双下肢相对长度差逐渐缩小,末次随访时双下肢相对长度差为0~10(5.3±3.9)mm。1例有术后坐骨神经牵拉损伤,于术后3个月逐渐恢复。结论非截骨THA治疗单侧CroweⅣ型DDH手术效果满意,该方法相对于转子下截骨可能更简单,远期疗效尚待进一步观察。     

CroweⅣ型髋关节发育不良全髋关节置换术前计算机辅助设计

目的 探索采用计算机辅助技术,对接受全髋关节置换(total hip arthroplasty,THA)的CroweⅣ型髋关节发育不良患者进行术前评估,确定髋臼大小、骨缺损程度,并在此基础上辅助手术设计、假体选择及骨缺损修复.方法 2011年3月至10月,共10例(13髋)CroweⅣ型高位脱位髋关节发育不良患者接受THA治疗.患者均为女性;年龄32～74岁,平均42岁.所有患者术前行髋关节三维CT扫描,然后将扫描数据输入Superlmage软件重建骨盆及髋臼.重建后在不同角度精确评估真臼位置,测量真臼大小及前后柱厚度,评估骨缺损程度;将髋臼试模、骨缺损修复材料(钽金属垫块)按1:1大小扫描输入计算机系统,进行术前模拟安放,确定髋臼假体大小、安放位置;髋臼假体安放后评估遗留的骨缺损,确定骨缺损修复材料,进行骨缺损修复模拟测试.结果 9例(12髋)术中实际安放髋臼假体型号与术前计算机辅助设计一致,1例(1髋)假体型号较术前设计大一号.所有患者髋臼安放位置与术前计划一致,均安放于真臼.髋臼骨缺损修复按术前设计:4髋因髋臼顶部骨缺损明显(臼顶部骨性覆盖＜70％),采用钽金属垫块修复骨缺损,以增强髋臼的稳定性;7髋采用Harris法自体股骨头植骨修复骨缺损;2髋髋臼杯植入后臼顶覆盖可,术中未植骨.结论 对CroweⅣ型髋关节发育不良者行计算机辅助下THA术前设计,有助于术前精确评估真臼发育情况、大小及髋臼骨缺损,提高手术治疗精确性.     

全髋关节置换术治疗成人髋关节发育不良的疗效分析

目的探讨全髋关节置换(total hip arthroplasty,THA)治疗成人发育性髋关节发育不良(developmental dysplasia of the hip,DDH)伴骨性关节炎的临床疗效。方法采用THA治疗成人DDH病人28例30髋,其中CroweⅠ型4髋,CroweⅡ型10髋,CroweⅢ型8髋,CroweⅣ型8髋,手术采用改良后外侧入路,术中行髋周软组织松解,恢复真臼重建,达到延长肢体长度目的。随访6～60个月,平均33个月。术前及术后随访采用Harris评分系统(包括疼痛、功能等)评价。结果术前Harris评分23～57分,平均(42. 37±2. 51)分,术后评分79～95分,平均(88. 13±3. 27)分,较术前明显提高(P 0. 05)。患者疼痛明显缓解,活动及功能满意,且假体位置均较好,无松动等不良情况。结论 THA是治疗成人DDH的有效方法,可缓解疼痛及改善功能。     

Crowe Ⅳ型髋关节发育不良的全髋关节置换术

目的 探讨全髋关节置换术治疗成人Crowe Ⅳ型髋关节发育不良(developmental dyspla-sia of the hip,DDH)的方法并评价其疗效.方法 1997年10月至2009年1月,应用全髋关节置换术治疗Crowe Ⅳ型DDH患者15例20髋,其中5例双侧、10例单侧.18髋采用Secur-Fit股骨假体,2髋采用Corail股骨假体.转子下斜行截骨6髋,髋臼底磨穿5髋,均行股骨头植骨.结果 15例中早期死亡1例(双髋),失访2例(2髋),余12例16髋获得平均44.2个月(5～92个月)随访.术后发生出血性休克1例,脂肪栓塞1例,术后脱位2例,股骨上端骨裂2例.转子下斜行截骨6髋中,1髋失随访,2髋分别于术后18和23个月随访时仍可见骨折线,下肢行走无异常,其余3髋骨愈合.髋臼底植骨5髋,除1髋失访外,其余均获得愈合.术后X线片显示髋臼假体均位于真臼内,完全骨性覆盖,无髋臼假体松动.术后双下肢长度差平均1.1 cm(0～2.2 cm).末次随访Harris评分由术前平均(24.7±5.7)分(15～32分)提高至末次随访(85.6±5.6)分(80～94分),差异有统计学意义.结论 对Crowe Ⅳ型DDH患者行全髋关节置换术时,良好的真臼暴露、加深髋臼、股骨短缩、斜行截骨及使用Secur-Fit假体能提高全髋关节置换术的治疗效果.     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

Prolongation of lung xenograft survival in rats with a short course of deoxyspergualin and cyclosporin A

The efficacy of 15-deoxyspergualin (DSG), cyclosporin A (CyA), and splenectomy-alone or in combination-in prologing the survival of concordant lung xenotransplants was studied in the hamster-to-rat model. In the untreated group, rejection occurred within 3 days, with an elevation of lymphocytotoxic antibody titers. The rejected lung revealed that ED1+cells were more prevalent than MRC OX8+cells in the perivascular infiltrates. In the DSG group, the antibody response was suppressed and median survival increased to 7.5 days. The rejected lungs demonstrated a highly significant depression in ED1+cellular infiltration and a moderate MRC OX8+cellular infiltration. When maintenance CyA was combined with a short course of DSG, survival dramatically increased to beyond 100 days. There were no deposits of IgM, IgG, or C3 or of any cell infiltrate in the grafts of two animals sacrificed 107 and 119 days post-transplantation. We conclude that initial treatment with DSG combined with continuous CyA can suppress acute rejection in the hamster-to-rat lung xenograft model, resulting in longterm graft survival.     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

Synergistic effect of donor-specific blood transfusion and a short course of deoxyspergualin in rat kidney transplantation

Deoxyspergualin (DSG), an analogue of spergualin produced by B. laterosporus, has a strong immunosuppressive effect in various transplantation models. We have investigated the mechanism of donor-specific prolongation of survival time in rat kidney grafting by donor-specific blood transfusion (DST) and a short course of DSG. Lewis (LEW) kidney allografts were transplanted into fully allogeneic BN rats. Fresh, whole LEW blood 1.0 ml, was injected i.v. into BN rats 2 days prior to transplantation. Then, DSG, 6 mg/kg per day, was administered by i.m. injection on days 0, 1, and 2 after transplantation. The recipients were divided into five groups: group 1 (n=6) no treatment: group 2 (n=6) DST only; group 3 (n=7) DSG only; group 4 (n=7) DST and DSG; and group 5 (n=6), third party (ACI rats) blood transfusion and DSG. Lymphocytes (cervical lymph nodes) and serum were harvested from BN recipients on day 7 postgrafting. For suppressor cell assays, lymphocytes from BN recipients in each group were added as a third cell to the mixed lymphocyte reaction (MLC) between nontransplanted BN lymphocytes (responder) and LEW or other third party (PVGC, ACI, WKA rats) lymphocytes (stimulator). Antidonor lymphocytotoxic antibody (ADLA) was checked by microcytotoxicity assays. Median survival times (MST) for each group were: group 1, 10 days; group 1, 10 days; group 3, 13 days; group 4, 75 days; and group 5, 13 days. Remarkable prolongation of MST was only noted in group 4. In the suppressor cell assay, group 4 showed significant suppression (40%; P<0.05); the other groups did not show any suppression. This suppressive activity in group 4 was effective only during the MLC between BN and LEW, not during the MLC of third party-BN combinations. Thus, suppressor cells from DST/DSG-treated BN recipients appear to be donor-specific. In the microcytotoxicity assay, the only group that showed any ADLA was group 2, which was not treated with DSG. These results clearly show that both induction of donor-specific suppressor cells and inhibition of ADLA production are associated with the remarkable donor-specific prolongation of kidney allograft survival in DST/DSG-treated recipients.