Morphological and functional studies on submucosal islet transplants in normal and diabetic hamsters

The long-term outcome of human islet allotransplantation is poor, and it remains to be seen if the Edmonton Protocol will make a positive impact upon the extension of posttransplant islet function. Hence, establishing an implantation site capable of sustaining islet allografts for a prolonged duration needs to be explored. In this study we investigated the submucosal space of the duodenum in Syrian golden hamsters. Following transplantation of more than 800 islets into streptozotocin (STZ)-induced diabetic hamsters, basal nonfasted blood glucose levels decreased from 403 +/- 14 to 143 +/- 10 mg/dl within 5 weeks posttransplantation. In these animals, in vivo islet function, as determined by intravenous glucose tolerance test (IVGTT), was similar to nondiabetic controls (K values: 1.16 +/- 0.12 vs. 0.95 +/- 0.06, respectively) and was significantly greater than diabetic controls (K value: 0.47 +/- 0.07). Islets transplanted into the submucosal space become richly vascularized within 2 weeks, and there is minimal host inflammatory infiltrate. The beta-cells of the graft remain well granulated with insulin for at least 129 days. We conclude that the submucosal space is an effective engraftment site for islets that warrants further development in a large-animal model.     

Hyponatraemia associated with psychotropic medications. A review of the literature and spontaneous reports

Psychotropic medication-induced hyponatraemia is an uncommon but important clinical problem with potential serious consequences if not recognised and treated early. Several risk factors have been associated with the development of hyponatraemia. This article reviews reported cases of hyponatraemia associated with the use of psychotropic medications and evaluates possible risk factors and causes. The data were sourced by a search of Medline for reports of hyponatraemia associated with the use of psychotropic medication between January 1966 and December 2000 and a search of US Food and Drug Administration (FDA) spontaneous reporting system database between January 1966 and December 1999. All the reports were included in this review. In the case reports the following data were assessed: age, gender, daily dosage, days to onset, days to recovery, medical condition, concurrent medications. Several risk factors were identified: advanced age, female gender, use of other medications, medical comorbidity. The risk of hyponatraemia was found to be higher during the first 2 weeks of treatment. Administration of the dosage of the drug was not found to be related to the development of hyponatraemia. Hyponatraemia can cause confusion, agitation and lethargy. Any change in the course of illness should alert the physician to the possibility of hyponatraemia.     

Assessment of a new immunocytochemical technique in HbF-cell counting by a novel objective evaluation method

A recently developed immunocytochemical technique in HbF-cell counting was assessed by an objective evaluation method. The basic principle of this method is the preparation of aliquots with predetermined HbF-cell (target) values. These aliquots serve as control samples to standardize the HbF-cell measurements by the new immunocytochemical technique, which uses the StreptABComplex/AP staining procedure (SAP) and visualization under white light. Immunofluorescence optical counts (IF) were performed in parallel with the new technique. A trend of inaccuracy was observed in low target values for both methods. As the level of target values increased, deviations became insignificant (relative accuracy < 8%) with SAP having slightly better results. Linear regression data of the estimated %HbF-cell rates by the two methods versus the target values were very satisfactory for both methods with SAP being slightly better. SAP seems to provide an accurate and reliable alternative for HbF-cell estimation comparable with the classical IF optical count.     

Quality of life in social anxiety disorder compared with panic disorder and the general population

OBJECTIVE: Quality of life in a treatment-seeking cohort of patients with social anxiety disorder was compared with that of patients with panic disorder who were matched for age, comorbid illnesses, and gender and with population-based norms. METHODS: The study participants were 33 patients with social anxiety disorder and 33 patients with panic disorder who had participated in clinical trials and who had completed the Medical Outcomes Study Short-Form-36 (SF-36) as part of a baseline evaluation. The patients did not have significant comorbid psychiatric disorders. Paired t tests were used to compare baseline scores on subscales of the SF-36 between the two cohorts. One-sample t tests were used to compare scores on subscales of the SF-36 with expectation scores based on 2,474 persons from the general population. RESULTS: Compared with the general population, the patients with social anxiety disorder had significantly greater impairment as measured by the SF-36 social functioning and mental health subscales. Subscale scores also indicated poorer emotional role functioning, but the difference was not significant. However, they were significantly less impaired than the patients with panic disorder in terms of physical functioning, physical role, and mental health. CONCLUSIONS: Patients with social anxiety disorder who do not have significant comorbid depression or anxiety are substantially impaired in quality of life, but to a lesser extent than patients with panic disorder, who suffer from both mental and physical impairments in quality of life.     

Comparison of sputum induction with bronchoalveolar lavage cell differential counts in patients with sarcoidosis

BACKGROUND AND AIM: Induced sputum (IS) has been proposed as a useful non-invasive method mainly for the assessment of airway diseases. The aim of this study was to evaluate IS cellular composition and T-lymphocyte subpopulations and to compare them with those of bronchoalveolar lavage fluid (BALF) in patients with sarcoidosis. METHODS: We studied prospectively 20 patients (12 female, 8 male) of median age 46 yr (range 25-65) with sarcoidosis and 10 normal subjects (5 female, 5 male) of median age 39 yr (range 26-60). IS was performed with hypertonic saline solution using an ultrasonic nebulizer (De Vilbis 2000). BALF was performed by conventional procedure using fiberoptic bronchoscopy. May-Giemsa-Grunewald stained preps were differentially counted and T-lymphocyte subsets were analyzed by flow activated cell sorter (FACS). RESULTS: The percentage of macrophages was significantly lower in IS than in BALF (p < 0.0001), the percentage of neutrophils was significantly lower in BALF than in IS (p < 0.0001), while there was no difference in the percentage of lymphocytes (p = 0.693) and eosinophils (p = 0.25) in IS vs BALF in patients with sarcoidosis. A significant correlation was found between BALF and IS lymphocyte counts (r = 0.61, p = 0.004), macrophages (r = 0.51, p = 0.02), and CD4+/CD8+ ratio (r = 0.700, p = 0.001). CONCLUSIONS: These results suggest that the inflammation in sarcoidosis could be effectively and non-invasively determined by the analysis of cell differential counts and T-lymphocyte subsets in IS. Further studies are needed to explore the role of IS vs BALF in the follow-up of these patients.     

Role of surface roughness of titanium versus hydroxyapatite on human bone marrow cells response

This study was designed to assess human bone marrow cell response and particularly cell adhesion, proliferation, and differentiation, when cultured in vitro on titanium alloy and hydroxyapatite with different values of surface roughness. A further aim was to compare the cell response on the two materials, currently used in spinal surgery. Cell adhesion was determined after 0.5, 2, 4, and 18 hours of incubation; proliferation after 8, 11, 14, and 16 days of culture; and differentiation was evaluated with the expression of alkaline phosphatase activity after 8 and 16 days of culture. This study showed that bone marrow cells grew faster on titanium alloy than on hydroxyapatite, although fewer cells attached to titanium, compared to those attached to hydroxyapatite. No statistically significant difference was observed as the expression of alkaline phosphatase activity on hydroxyapatite and titanium alloy of the same roughness. Cell adhesion, proliferation, and differentiation are dependent on surface roughness of the biomaterial, and all three increased as the roughness of titanium alloy increased. Conclusively, surface roughness of titanium and hydroxyapatite significantly influences bone marrow cell response, and therefore these biomaterials should be used with rough outer surface, if a significant cell response on them is desired. These advantages of titanium and hydroxyapatite theoretically seem to be of particular importance in the following situations: long fusions, lumbosacral fusion, revision surgery with poor bone bank, neuropathic scoliosis associated with few bone graft reserves, and adult patients with severe osteoporosis.     

Comparative strength measurements of five different fixation systems applied on an in vitro model of femoral midshaft osteotomy

. Oblique midshaft fractures of long bones can be stabilized using either plates and screws, lag screws, wires, cerclages, or a combination of these methods. Fractures at the distal tip of a well-fixed femoral prosthesis are difficult to stabilize with plates and screws because of the underlying intramedullary stem, polymethylmetacrylate (PMMA) cement, and thin periprosthetic femoral cortex. In this study we compared in vitro the mechanical performance of five different osteosynthesis techniques applied on an oak femoral model obliquely oscillated to mimic a short oblique fracture: (a) Double stainless steel wiring; (b) two 4.5 mm lag screws; (c) combination of one 4.5 mm cortical screw and one stainless steel wire; (d) one titanium compression cerclage Gundolf (CCG) combined with one 4.5 mm screw; and (e) double CCG. The five fixation constructs were subjected to a noncyclic destructive axial compression and torsional loading. The highest torque stiffness proved to be the double CCG and the double screw constructs, followed by and combination of CCG-screw and double screw constructs. The mode of failure in torque was a longitudinal crack close to the screw tip and loosening of the CCG and wire. The double screw, double CCG, and screw-CCG constructs provided the highest stiffness in axial compressive forces. The mode of failure in compression was loosening of the CCG and wire and bending of the screw. This comparative study showed that double CCG can theoretically replace the conventional methods of "minimal" osteosynthesis in the midshaft of long bones, and thus shows promise in the treatment of difficult short-oblique type femoral fracture at the distal tip of a well-fixed femoral prosthesis. The advantages of using the CCG is simplicity of technique, biocompatibility of titanium, no interference in modern imaging techniques, and avoidance of stripping of muscles and degloving of bone surfaces, as often happens in platting. Résumé. Etude comparative de la robustesse de cinq systèmes d'ostéosynthèse diaphysaire appliqués à un modèle in vitro d'ostéotomie fémorale. Les fractures diaphysaires obliques peuvent être stabilisées grace à des systèmes vis plaques, vis décalées, fils métalliques ou cerclages, ou encore grace à une combinaison de ces différents systèmes. Les fractures diaphysaires survenant au niveau de l'extrémité distale d'une tige fémorale bien fixée sont difficile à stabiliser par le biais de plaques vissées, en raison de la présence de la tige fémorale, du ciment, et du fin cortex fémoral périprothétique. Nous avons comparé dans cette étude le comportement mécanique "in vitro" de cinq techniques d'ostéosynthèse diaphysaires appliquées à un modèle fémoral en bois de chêne, coupé en son milieu par un plan oblique simulant une fracture courte oblique. Les cinq systèmes testés sont: (a) double ligature inox; (b) 2 vis décalées 4,5 mm; (c) combinaison d'une vis corticale de 4,5 mm et d'une ligature inox (d) un cerclage titane CCG (cerclage de compression de Gundolf) combiné à une vis de 4,5 mm; (e) un double cerclage CCG. Les cinq montages d'ostéosynthèse sont soumis à des chargements non-cycliques jusqu'à rupture, en compression, et en Torsion. La rigidité en Torsion la plus élevée est mesurée pour le double CCG et les deux vis décalées. Les modes de ruptures observés en torsion sont une brèche longitudinale près de l'extrémité des vis, et un desserrage des cerclages et ligatures. Les deux vis, le double CCG et la combinaison Vis-CCG sont les plus rigides en compression. Les modes de rupture observés en compression sont un desserrage des CCG et des ligatures, et un pliage des vis. Cette étude comparative montre que le CCG peut remplacer en théorie les méthodes conventionnelles d'ostéosynthèse diaphysaires "A minima", et est à ce titre très prometteur dans le cadre de fractures diaphysaires courtes obliques en extrémité de tiges fémorales bien fixées.