Plasma rich in growth factors (PRGF) for the promotion of bone cell proliferation and tissue regeneration

Objectives

Over the past few years, studies about growth factors have been increasingly developed and the knowledge of their role in stimulating cell proliferation and differentiation used for therapeutic purposes. This study aims to compare a platelets concentrate, the plasma rich in growth factors (PRGF) to a control, consisting of cellulose membranes, to evaluate in vitro the cellular adhesion and migration of human osteoblasts (hOb) and understand if the use of platelets concentrates could be an advantage in view of bone tissue regeneration.

Study design

Twenty-seven human donors provided 27 blood samples used to make 54 samples: 27 for PRGF and 27 for the control group. PRGFs and controls were incubated for 48 h in sterility in 1 ml of culture with 10⁵ hOb and hOb in the scaffolds were then quantified.

Results

In PRGF samples, hObs were more numerous than in controls. (T?=?6.6964, p?<?0.0001).

Conclusions

Human osteoblasts are driven to colonize PRGFs with a greater efficacy than negative controls, probably due to the presence of chemokines and growth factors in PRGFs.

     

Role of CT in the diagnosis of jejunal–ileal perforations

Purpose

The purpose of this study was to evaluate the computed tomography (CT) signs of free and covered small-bowel perforations and the potential of CT in recognising the aetiology.

Materials and methods

Thirty-five patients with surgically proven small-bowel perforation were retrospectively evaluated. Fundamental signs (extraluminal air, solution of continuity) and secondary signs (thickening of the mesentery, free or perilesional fluid, wall thickening) were considered.

Results

CT alterations were found in 31/35 (88.6 %) patients: extraluminal air (30/35, 85.7 %), solution of continuity (11/35, 31.4 %), intra-abdominal fluid (27/35, 77.1 %), thickening of the mesentery (20/35, 57.1 %), and wall thickening (14/35, 40 %). In 25/35 cases (71.4 %) pneumoperitoneum was detected, associated with secondary signs (23/25, 82 %), confirmed as free perforations at surgery. In 5/35 patients (14.2 %), peri-intestinal air bubbles and secondary signs were evident, while in 1/35 cases (2.8 %) only secondary signs were seen, namely covered perforations. In 4/35 patients (11.4 %) with a covered perforation, the CT scan was negative. The nature of the perforations was completely recognisable in 26/31 cases (83.9 %), partially identifiable in 4/31 (12.9 %), not evident in 1/31 (3.2 %).

Conclusion

CT investigation is essential in the recognition of a small-bowel perforation and in the definition of its nature.     

Selektive, lumbale, mediolaterale und laterale (lateroforaminale) Wurzeldekompression bei lateraler Wirbelkanalstenose

Zusammenfassung Operationsziel Dekompression einer lumbalen Nervenwurzel (meist L5) vom Hiatus duralis bis lateral des Foramen intervertebrale und bis zum lateralen Kompartiment ohne Zerstörung des Gelenks. Indikationen Knöcherne Kompression einer lumbalen Nervenwurzel im Recessus lateralis, Foramen intervertebrale und intervertebralen Kompartiment. Kontraindikationen Bei korrekter Diagnose gibt es keine Kontraindikationen. Erschwerend kann die extraforaminale Dekompression der fünften Lendenwurzel sein, besonders im Fall der degenerativen ventralen Verschiebung des fünften Lendenwirbels. Operationstechnik Medianer Zugang zum Spinalkanal und zum intervertebralen Kompartiment. Freilegung und Dekompression der Wurzel im Spinalkanal und im Recessus lateralis bis zur Umbiegungsstelle in das Foramen intervertebrale. Mikrotechnische Exploration des intervertebralen Kompartiments, Dekompression der Wurzel, Erweiterung des Foramen intervertebrale. Ergebnisse 88 von 94 Patienten, die von 1991 bis Ende 1994 operiert worden waren, wurden 1995, acht bis 54 Monate (durchschnittlich 28 Monate) nach der Operation, erneut untersucht. 96 Wurzeln waren dekomprimiert worden, am häufigsten die Wurzel L5. Eine doppelseitige Operation war nie notwendig gewesen. 73 Patienten werteten die Operation in Bezug auf ihre radikulären Beschwerden als Erfolg, zehn als nützlich; bei vier Patienten ergab sich keine signifikante Erleichterung. In einem Fall lag eine irreversible Fußheberparese mit Deafferenzierungsbeschwerden im Dermatom L4 vor. Bei sechs Patienten, wovon vier mit dem Gesamtergebnis der Behandlung zufrieden waren, zeigte sich eine leichte Verschlechterung der Kreuzschmerzen. Summary Objectives To eliminate radicular symptoms by decompression of a lumbar nerve root (usually L5) from its dural exit to the intervertebral foramen up to the lateral compartment without damaging the facet joint. Indications Bony decompression of a lumbar nerve root at the lateral recess, in the intervertebral foramen, and in the intervertebral compartment. The mediolateral and lateral decompression is indicated in deformation of the spinal canal caused by wear. It is usually found at the concave side of a degenerative scoliosis. Contraindications There exists no contraindication on the condition that the diagnosis is correct. An extraforaminal decompression on the fifth lumbar nerve root can be more difficult, particularly in instances of an anterior degenerative displacement of the fifth lumbar vertebra. An alternative to this selective decompression could be a rather disadvantageous removal of the facet joint. Surgical Technique Medical approach to the spinal canal and the intervertebral compartment. Exposure and decompression of the root in the spinal canal and at the lateral recess up to the point where the nerve root curves laterally into the intervertebral foramen. Microscopic exploration of the intervertebral compartment, decompression of the root and enlargement of the intervertebral foramen. Results Follow-up (average of 28 months) of 88 patients out of 94 operated between 1991 and end of 1994. Six patients of advanced age had died in the meantime. Decompression of 96 roots, most often at the level of L5. Bilateral surgery was never required for any of the patients. Successful relief of radicular symptoms was reported by 73 patients, 10 patients judged the operation as beneficial, and 4 did not experience any improvement. One patient suffered from an irreversible drop foot accompanied by symptoms of deafferentation at the L4 dermatome. A slight deterioration of the low back pain was reported by 6 patients - 4 of whom were satisfied with the overall result.     

Doppler Ultrasound Could Predict Varices Progression and Rebleeding After Portal Hypertension Surgery: Lessons from 146 EGDS and 10?Years of Follow-Up

Background  

Surgical treatment of variceal hemorrhagic complications for patients with schistosomal portal hypertension in our group comprised an esophagogastric devascularization procedure with splenectomy (EGDS). There are two different kinds of postoperative follow-up: prophylactic or on-demand endoscopic program of varices eradication. This program implies risks and costs and only proves necessary in 6–29% of cases. This study was designed to assess portal vein Doppler ultrasound data in these patients, and to verify correlations with progression in the number and size of varices, as well as the appearance of red spots and rebleeding during the postoperative period after EGDS.     

Selective lumbar neuroforaminal decompression in lateral spinal stenosis

Objectives  

To eliminate radicular symptoms by decompression of a lumbar nerve root (usually L5) from its dural exit to the intervertebral foramen up to the lateral compartment without damaging the facet joint.     

Results of dipyridamole plus atropine echo stress test for the diagnosis of coronary artery disease

Sensitivity of dipyridamole stress echocardiography (DIP-E) has been reported to be less than ideal in particular subsets of patients such as those with less severe extent of coronary artery disease (CAD). To verify if sensitivity could be improved, ATRO (1 mg in 2 minutes) was added at the end of a negative high-dose (0.84 mg/kg over 10 minutes) DIP-E in 61 consecutive patients (58 men, aged 53±7 years) evaluated for chest pain (33%) or for detection of residual ischemia after acute myocardial infarction (AMI) or previous MI (67%). DIP-E was positive in 28/61 (46%) and negative in 33/61 (54%) patients. Additional echo positivity was obtained in 18/33 (54%) patients after ATRO. Coronary arteriography was normal in 6 patients (10%); 1-vessel CAD was diagnosed in 28 (46%), 2-vessel CAD in 16 (26%) and 3-vessel CAD in 11 (18%) cases. The sensitivity for CAD diagnosis was 49% (27/55) for DIP-E and 84% (46/55) for DIP-E + ATRO (p<0.001). Specificity was 83% and 80%, respectively. Diagnostic accuracy increased from 52% to 83% (p<0.001). The better diagnostic accuracy of DIP-E was mainly related to the significant increase in sensitivity of the combined test in patients with 1-vessel CAD (from 46% to 75%) (p<0.005). At quantitative coronary evaluation, compared to patients with positive DIP-E + ATRO or negative DIP-E + ATRO test, patients with positive DIP-E had a higher mean % diameter stenosis: 80±13% vs 72±24% and 65±36%, respectively. Peak heart rate was significantly higher after the addition of ATRO vs basal and DIP alone in patients with a positive DIP-E + ATRO test. The addition of ATRO to DIP increases diagnostic accuracy of DIP-E particularly in patients with less severe extent of CAD; ATRO may be considered as a useful routine procedure for increasing diagnostic value of DIP-E test.