The skeletal framework of human kidney and renal cell carcinoma

Summary The three dimensional architecture of the connective tissue framework of normal human kidney and three renal cell carcinomas was studied. A sodium hydroxide maceration technique was used to remove the cellular elements thus exposing the underlying connective tissue structures. The collagen fibrillar network was visualized using the scanning electron micriscope. In normal kidney the fibres were fine, and smooth, and corresponded to the shapes of the original parenchymal constituents. The fibres of the kidney tumours were coarse in nature and irregularly distributed. The technique provides a rapid method for studying connective tissue fibres in normal and diseased tissue. The three dimensional architecture thus exposed enhances our knowledge of tumour stroma.     

Reactions of thigh tissues of sheep to blunt trauma

Severe damage to the deep musculature of the thigh was caused by standardized crushing injuries applied to muscle overlying the femora of anesthetized sheep. The injuries caused an acute inflammatory response, with the formation of granulation tissue and, later, extensive scarring. Periosteal bone formed in all cases, in some instances resulting in a spike of bone that protruded into the overlying soft tissue. Heterotopic bone formed in 16.6% of the legs of sheep within three weeks to three months after trauma by intramembranous ossification within scar tissue replacing muscle tissue.     

基于Micro-CT的三维打印组织工程骨建模技术

目的建立符合组织工程要求支架材料的空间构型,建立支架材料CAD的微观建模。方法以Micro-CT所得的DICOM文件作为三维建模的输入文件,通过对生物骨骼组织构造研究,对DICOM格式的CT数据按灰度进行筛选,结合大量断面数据得到骨结构轮廓,进行微观仿生骨组织建模,得到骨骼微观结构的STL文件。结果建立基于通过Micro-CT所得的DICOM文件,可建立的骨骼微观结构的STL文件。结论Micro-CT所得仿生三维模型对三维打印组织工程骨建模技术有重要意义。     

Free vascularized tissue transfer for limb salvage in peripheral vascular disease

In patients with tissue necrosis, higher limb salvage rates can be accomplished with free tissue transfers performed by a vascular and plastic surgeon team. We treated 10 patients with severe ischemic soft tissue defects in their legs with radical debridement and free tissue transfer alone (two patients) or after revascularization (eight patients). Arteriography was performed to plan revascularization to evaluate bypass results, and to identify appropriate recipient vessels for free tissue transfer. Soft tissue defects treated with free tissue transfer included nonhealing amputation sites in five patients and proximal skin and muscle necrosis in the remaining patients, one of which resulted in an exposed in-situ graft in one leg. One patient underwent a distal bypass specifically to provide arterial inflow for free tissue transfer, whereas seven other patients received free tissue transfers following bypass due to persistently nonhealing wounds. The remaining two patients had diabetes mellitus with necrosis near a major joint with nonhealing amputation sites. Free tissue transfers were taken from the latissimus dorsi in six patients, and from the gracilis, rectus abdominis, rectus femoris, and scapula flaps in other patients. Recipient vessels for free tissue transfers were the external iliac artery (one patient), saphenous vein bypass grafts (two patients), popliteal artery (one patient), posterior tibial (three patients), and dorsalis pedis vessels (three patients). Eight of the 10 flaps were viable at follow-up (four months-six years), with a mean follow-up of 20 months. One patient underwent above-knee amputation 15 months after operation and one underwent below-knee amputation three years later due to central flap necrosis. The remainder achieved functional limb salvage allowing patients to resume ambulation. Vascular surgeons should consider free tissue transfer in patients with nonhealing soft tissue defects following optimal revascularization to further extend our ability to salvage the threatened limb.Presented at the Annual Meeting of the Peripheral Vascular Surgery Society, New York, New York, June 17, 1989.     

New principles in classifying vascularized tissue complexes used in plastic and reconstructive surgery

Based on their personal experience of transplantation of 152 free and 367 non-free++ blood-supplied tissue complexes the authors propose to divide them into three main groups in relation to their specific formation and transplantation: mono-, poly- and megacomplexes of tissue (flaps). Distinctions of these three groups of tissue complexes, their general properties as well as indications for their application are discussed.     

自体脾组织移植后病理学变化的实验研究

目的　研究自体脾组织移植后不同时相点病理形态学变化规律。　方法　健康Wistar大鼠 5 6只 ,雌雄不限 ,体重 10 0～ 12 0 g ,随机分为 7组 ,每组 8只中又设脾切除自体组织大网膜内脾移植组 5只 ,假手术组 3只 ,分别于术后 7、14、3 0、60、90、12 0、180d取脾组织 ,光镜、透射电镜观察。　结果　移植脾组织之重量在术后 7d最轻 ,为 0 .0 72 g ,其后逐渐增加 ,180d时为 0 .5 11g ,各时相点之间有明显差异 (P <0 .0 5 )。病理检查提示移植脾组织经历急性期、缓解期、修复期三个病理时期 ,逐步恢复并接近正常的组织结构。　结论　自体脾组织大网膜内移植术是简便有效的脾移植方法。自体移植脾组织再生过程可分为 :急性期、缓解期与修复期     

三种常用皮瓣修复指端软组织缺损疗效比较

目的 探讨手部常用的三种小型皮瓣修复指端软组织缺损的临床疗效.方法 根据损伤的程度、性质、指别以及患者的意愿,选用了三种术式对90例指端软组织缺损进行修复.结果 90例手部小型皮瓣全部成活,皮瓣质地良好,外形及功能满意.两点辨别觉（2PD）检测：术后随访6,12,18个月时,三组间动态两点辨别觉（M2PD）及静态两点辨别觉（S2PD）比较,其差异均无统计学意义（P＞0.05）.结论 三种皮瓣是修复指端软组织缺损的理想皮瓣,且成活率高,感觉功能恢复良好.     

Combined medialis pedis and medial plantar fasciocutaneous flaps based on the medial plantar pedicle for reconstruction of complex soft tissue defects in the hand

The reconstruction of complex soft tissue defects in hands remains a difficult challenge in reconstructive surgery. In this report, we introduce a combined medialis pedis and medial plantar fasciocutaneous flaps supplied by the lateral and medial branches of the medial plantar artery, which allows a one-stage reconstruction of multiple soft tissue defects in hand. Three combined medialis pedis and medial plantar fasciocutaneous flaps were transferred for repair of the soft tissue defects including palmar and dorsal areas of hand, thumb pulp, and the dorsum of index finger in three patients. All three flaps survived uneventfully with coverage matching the texture and color of the recipients. The donor sites healed without complication. The experience from these cases proves that the combined medialis pedis and medial plantar fasciocutaneous flaps based on the medial plantar pedicle would be a valuable alternative for the reconstruction of complex soft tissue defects in the hand.     

The mechanism of joint capsule thermal modification in an in-vitro sheep model

The purpose of this study was to understand the mechanism responsible for joint capsule shrinkage after nonablative laser application in an in-vitro sheep model. Femoropatellar joint capsular tissue specimens harvested from 20 adult sheep were treated with one of three power settings of a holmium:yttrium-aluminum-garnet laser or served as a control. Laser treatment significantly shortened the tissue and decreased tissue stiffness in all three laser groups, whereas failure strength was not altered significantly by laser treatment. Transmission electron microscopic examination showed swollen collagen fibrils and loss of membrane integrity of fibroblasts. A thermometric study revealed nonablative laser energy caused tissue temperature to rise in the range of 64 degrees C to 100 degrees C. Electrophoresis after trypsin digestion of the tissue revealed significant loss of distinct alpha bands of Type I collagen in laser treated samples, whereas alpha bands were present in laser treated tissue without trypsin digestion. The results of this study support the concept that the primary mechanism responsible for the effect of nonablative laser energy is thermal denaturation of collagen in joint capsular tissue associated with unwinding of the triple helical structure of the collagen molecule.     

Tissue expansion: A simple technique for complex traumatic soft tissue defects

Post-traumatic soft tissue loss results in significant functional and esthetic morbidity. Reconstruction is often limited by shortage of soft tissues. Esthetic and functional restorations are possible by generation of well-matched autogenous sensate tissue by tissue expansion. Fifteen (nine females and six males) cases of large and complex soft tissue defects after trauma, age ranging from 7 to 43 years of age, were managed by tissue expansion over a period of 22 months. Indications were post-burn scars of the face (five), post-burn alopecia (three), avulsion injury scalp (one), massive abdominal wall defect (one), post-crush injury ankylosis of the right elbow (one), and post-burn contracture of the neck (three). Tissue expansion was well tolerated by all patients. Major complications seen were accidental implant deflation (6.6%) and partial implant exposure (6.6%). Minor complications were seen in 20% of the cases. Tissue expansion is slow and staged but a simple and safe reconstructive technique for managing large post-traumatic soft tissue loss with excellent results.     

Effects of various caloric intakes on nitrogen metabolism of the body, the muscles and the viscera during total parenteral nutrition with aminoacidic solution enriched with branched-chain amino acids

Nitrogen metabolism was studied in ten injured/septic patients by means of a two compartment model, differentiating muscle from non muscle (central) tissue. During fasting muscle tissue loses a consistent amount of aminoacids which is retained in part by central tissue, giving rise to a positive nitrogen balance, whilst three methyl histidine and body nitrogen output are elevated. Total parenteral nutrition (glucose 15 kcal kg-1 day-1, nitrogen 0.30 g kg-1 die-1) improved body nitrogen balance and three methyl histidine excretion, but did not affect significantly either muscle or central nitrogen balance. Increasing caloric support to 30 kcal kg-1 day-1 did not showed any further effect on body nitrogen balance and three methyl histidine, while it improved significantly vs basal muscle nitrogen balance, but did not affect central nitrogen balance.     

Response to methotrexate in fibrosing alveolitis associated with connective tissue disease.

Methotrexate by intermittent intramuscular injection was used to treat three patients with fibrosing alveolitis complicating connective tissue diseases. All three patients had improvement of symptoms, two had radiological improvement, and one had significant improvement of pulmonary function. Two patients whose pulmonary symptoms, function, and chest radiographs had deteriorated on penicillamine improved when treated with methotrexate. Methotrexate may be a useful treatment for fibrosing alveolitis complicating connective tissue diseases.     

正常人的软组织张力测定

目的 :探讨正常人的软组织张力测定和生物力学特点。方法 :本组 30名健康成年人 ,男 19例 ,女 11例 ,年龄 10～ 5 6岁 ,平均 35岁 ,选取合谷、肩井、三阴交三穴进行垂直于皮肤平面测出 1、2、3、4、6……毫米张力计刻度位移所对应的张力数值。结果 :据所测数值绘出三个部位曲线 ,三处软组织服从大致相同的力学曲线 ,即大体分为皮肤段、皮下组织段、肌内段、深层组织段。结论 :软组织是一种非线性粘弹性材料 ,三处软组织综合刚度合谷穴 <肩井穴 <三阴交穴 ,皮肤刚度小于肌肉的刚度。     

Perioperative fluid management: comparison of high, medium and low fluid volume on tissue oxygen pressure in the small bowel and colon

BACKGROUND AND OBJECTIVE: Insufficient blood flow and oxygenation in the intestinal tract is associated with increased incidence of postoperative complications after bowel surgery. High fluid volume administration may prevent occult regional hypoperfusion and intestinal tissue hypoxia. We tested the hypothesis that high intraoperative fluid volume administration increases intestinal wall tissue oxygen pressure during laparotomy. METHODS: In all, 27 pigs were anaesthetized, ventilated and randomly assigned to one of the three treatment groups (n = 9 in each) receiving low (3 mL kg-1 h-1), medium (7 mL kg-1 h-1) or high (20 mL kg-1 h-1) fluid volume treatment with lactated Ringer's solution. All animals received 30% and 100% inspired oxygen in random order. Cardiac index was measured with thermodilution and tissue oxygen pressure with a micro-oximetry system in the jejunum and colon wall and subcutaneous tissue. RESULTS: Groups receiving low and medium fluid volume treatment had similar systemic haemodynamics. The high fluid volume group had significantly higher mean arterial pressure, cardiac index and subcutaneous tissue oxygenation. Tissue oxygen pressures in the jejunum and colon were comparable in all three groups. CONCLUSIONS: The three different fluid volume regimens tested did not affect tissue oxygen pressure in the jejunum and colon, suggesting efficient autoregulation of intestinal blood flow in healthy subjects undergoing uncomplicated abdominal surgery.     

拆分一个第二足趾重建单指或多指多关节复合组织缺损

目的 探讨对一指或多指的多关节毁损并伴有皮肤、肌腱、甲床等缺损的多处及复合组织缺损的重建与再造方法.方法 从2007年8月至2010年8月,共收治单指或多指多关节复合组织缺损8例20指,均应用第二足趾的跖趾关节、近、远侧指间关节及其皮肤、肌腱、甲床等为供体,按受区所需进行分配并解剖、游离及拆分,然后分别移植到手指各缺损部位,进行血管、神经、肌腱等吻合,用一个足趾的不同组织修复一指或多指多部位、多组织的缺损.结果 重建的20指术后均顺利成活,接近原手指外观及功能,足部供区外观及功能影响较小.随访3个月～3年,按手外科学会再造指功能评定试用标准评定:结果优16指,良3指,可1指.结论 根据受区所需,拆分第二趾,对一指多处或多个手指进行再造与重建,效果满意,是一种修复一指多处或多指多处包括关节在内的复合组织同时缺损的理想方法.     

Ciprofloxacin concentration in human prostatic tissue following 3 days' administration]

The penetration of Ciprofloxacin (CPFX) into the prostatic tissue and the serum was examined. Forty-four patients with benign prostatic hypertrophy treated with transurethral resection of the prostate were entered in this study. CPFX was administered orally in a dose of 200 mg three times daily for three days preoperatively. The blood samples were taken simultaneously at the time of the tissue sampling. The patients were divided into groups 1 and 2. In group 1 (16 patients), the tissue sampling was done about 17 hours after the final drug administration. The mean concentration of CPFX was 0.61 +/- 0.40 microgram/g in the prostatic tissue and 0.27 +/- 0.19 micrograms/ml in the serum. In group 2 (28 patients), tissue sampling was done 5.5 hours after the final drug administration. The mean concentration of CPFX was 1.32 +/- 0.64 micrograms g in the prostatic tissue and 0.65 +/- 0.31 microgram/ml in the serum.     

Finite-element modeling of trabecular bone: Comparison with mechanical testing and determination of tissue modulus

We combined three techniques—mechanical testing, three-dimensional imaging, and finite-element modeling—to distinguish between the contributions of architecture and tissue modulus to mechanical function in human trabecular bone. The objectives of this study were 2-fold. The first was to assess the accuracy of micromechanical modeling of trabecular bone using high-contrast x-ray images of the trabecular architecture. The second was to combine finite-element calculations with mechanical testing to infer an average tissue modulus for the specimen. Specimens from five human L1 vertebrae were mechanically tested along the three anatomic axes. The specimens were then imaged by synchrotron x-ray tomography, and the elastic moduli of each specimen were calculated from the tomographic image by finite-element modeling. We found that 23-μm tomographic images resolved sufficient structural detail such that the calculated anisotropy in the elastic modulus was within the uncertainties of the experimental measurements in all cases. The tissue modulus of each specimen was then estimated by comparing the calculated mean stiffness of the specimen, averaged over the three anatomical directions, with the experimental measurement. The absolute values of the experimental elastic constants could be fitted, again within the uncertainties of the experimental measure-ments, by a single tissue modulus of 6.6 GPa, which was the average tissue modulus of the five specimens. These observations suggest that a combination of mechanical testing, three-dimensional imaging, and finite-element modeling might enable the physiological variations in tissue moduli to be determined as a function of age and gender.     

A tissue engineering approach to meniscus regeneration in a sheep model

OBJECTIVE: Regeneration of the meniscal tissue occurs to a limited extent, and the loss of meniscal tissue leads to osteoarthritis. A new biomaterial consisting of hyaluronic acid and polycaprolactone was used as a meniscus substitute in sheep to evaluate the properties of the implant material with regard to size, biomechanical stability, tissue ingrowth, and integration. METHODS: Eight sheep (right stifle joints) were treated with three total and three partial meniscus replacements while two meniscectomies served as empty controls. The animals were euthanized after 6 weeks. The specimens were assessed by gross inspection and histology, and compared with the nonoperated left joints. RESULTS: The surgical technique was found to be feasible. The implants remained in position, did not tear, and showed excellent tissue ingrowth to the capsule. Tissue integration was also observed between the original meniscus and the implant. However, graft compression and extrusion occurred. The histological investigation revealed tissue formation, cellular infiltration and vascularization. Cartilage degeneration was more severe in the operated joints. CONCLUSION: The present study shows promising results concerning the qualities of this biomaterial with regard to implantation technique, stability and tissue ingrowth.     

Determining weight‐bearing tissue condition using peak reactive hyperemia response trend and ultrasonographic features: Implications for pressure ulcer prevention

Frequent repositioning is important to prevent pressure ulcer (PU) development, by relieving pressure and recovering damages on skin areas induced by repetitive loading. Although repositioning is the gold standard to prevent PU, there is currently no strategy for determining tissue condition under preventive approaches. In this study, the peak reactive hyperemia (RH) trends and ultrasonographic (US) features are compared with the tissue condition under histopathological examination to determine the potential use of these features in determining the tissue condition noninvasively. Twenty‐one male Sprague–Dawley rats (seven per group), with body weight of 385–485 g, were categorized into three groups and subjected to different recovery times, each with three repetitive loading cycles at skin tissues above of right trochanter area. The first, second, and third groups were subjected to short (3 minutes), moderate (10 minutes), and prolonged (40 minutes) recovery, respectively, while applying fixed loading time and pressure (10 minutes and 50 mmHg, respectively), to provide different degree of recovery and tissue conditions (tissue damage and tissue recovery). Peak RH was measured in the three cycles to determine RH trend (increasing, decreasing, and inconsistent). All rat tissues were evaluated using ultrasound at pre‐ and post‐experiment and rated by two raters to categorize the severity of tissue changes (no, mild, moderate, and severe). The tissue condition was also evaluated using histopathological examination to distinguish between normal and abnormal tissues. Most of the samples with increasing RH trend is related to abnormal tissue (71%); while inconsistent RH trends is more related to normal tissue (82%). There is no relationship between the tissue conditions evaluated under ultrasonographic and histopathological examination. Peak RH trend over repetitive loading may serve as a new feature for determining the tissue condition that leading to pressure ulcer.     

拆分一个第二足趾重建单指或多指多关节复合组织缺损

目的 探讨对一指或多指的多关节毁损并伴有皮肤、肌腱、甲床等缺损的多处及复合组织缺损的重建与再造方法.方法 从2007年8月至2010年8月,共收治单指或多指多关节复合组织缺损8例20指,均应用第二足趾的跖趾关节、近、远侧指间关节及其皮肤、肌腱、甲床等为供体,按受区所需进行分配并解剖、游离及拆分,然后分别移植到手指各缺损部位,进行血管、神经、肌腱等吻合,用一个足趾的不同组织修复一指或多指多部位、多组织的缺损.结果 重建的20指术后均顺利成活,接近原手指外观及功能,足部供区外观及功能影响较小.随访3个月～3年,按手外科学会再造指功能评定试用标准评定:结果优16指,良3指,可1指.结论 根据受区所需,拆分第二趾,对一指多处或多个手指进行再造与重建,效果满意,是一种修复一指多处或多指多处包括关节在内的复合组织同时缺损的理想方法.