Tricortical Calcaneal Bone Graft and Management of the Donor Site

The clinical outcomes of 19 patients requiring autogenous grafts for foot surgery were followed up until healing at the donor site occurred. In all cases, tricortical bone was extracted from the calcaneus for use at another pedal site. The first cohort of 9 patients had the calcaneal deficit replaced with allogenic cubes. The second cohort received no tissue replacement. Patients were reviewed postoperatively with a questionnaire and clinical examination to evaluate the outcome of the operations. Radiographic outcomes were observed at the donor and recipient sites in both groups until healing was confirmed as bridging trabeculation. Incorporation of the graft at the donor site was also reviewed. Clinical outcomes, namely pain, local sensory function, and return to footwear, were satisfactory in all patients and were not significantly different between groups. One patient from each group sustained a heel fracture. The donated autogenous grafts at the recipient sites were all incorporated uneventfully at 6 months. In the first cohort, allogenic graft incorporation in the calcaneus was complete in only 2 patients at the 12-month stage. The remaining 7 cases showed reduction of the deficit by new bone formation arising from the calcaneus. Donor sites with allogenic bone replacement healed at a median of 18 months (interquartile range, 18-18 months). In the group without replacement, healing occurred at a median of 6 months (interquartile range, 6-12 months), a highly statistically significant difference (P < .001). In the second cohort without allogenic graft replacement, radiographic filling at the donor site was complete within a 12-month period. Tricortical bone can be successfully harvested from the calcaneus, but there may an associated risk of heel fracture. The role of replacement allogenic bone in assisting healing at the donor site is unclear.     

Double sodium and potassium sulphates revealed by microprobe analysis in dried cervical mucus: a mid-cycle crystallographic index

The use of physical techniques such as scanning electron microscopyand microprobe analysis permits the analysis of valuable detailsof the structure of dried samples of mid-cycle cervical mucusduring the period of maximum ferning. From a crystallographicpoint of view, particular attention was paid to the location,morphology and chemical composition of anisotropic organic sulphatemicrostructures. As distinct from the isotropic sodium chloridepattern described by Papanicolaou, these appear in a narrowperiod of time corresponding to the middle of the period ofmaximum ferning. Anisotropic microstructures were revealed tobe tiny isolated crystals or polycrystalline aggregates composedof double salts of potassium and sodium. The potassium/sodiumcation ratio, equal to 3/1, was constant in the best specimens.Using a simple polarizing microscope, the detection of anisotropicmicrostructures may be useful to determine the period of maximumfertility more accurately. In addition, experiments have beencarried out in order to determine the relative importance ofsulphate anisotropic structures as compared with the whole crystallizedsurface and to investigate precisely their transience afterthey appear.     

卟啉类衍生物的合成

卟啉类衍生物的合成已有七十余年的历史,其合成方法有以吡咯为原料的全合成,也有以易得的天然产物,如血红素等为原料进行半合成。自报道血卟啉衍生物(hematoporphyrin derivatives简称HpD)与激光结合用于诊治癌症以后,有关卟啉类的化学和临床研究,也迅速开展起来。1982年报道了单乙酰血卟啉、双乙酰血卟啉和乙酰氧乙基乙烯次卟啉在动物体内有对肿瘤的光敏活性,而纯血卟啉、原卟啉和羟乙基乙烯次卟啉却无效。为     

Spontaneous splenic hemorrhage in a patient with Wegener's granulomatosis

We report the occurrence of spontaneous splenic hemorrhage in a patient with Wegener's granulomatosis. Pulmonary infiltrates, hemoptysis, and crescentic glomerulonephritis were accompanied by a progressive splenic enlargement with minimal abdominal symptoms. Magnetic resonance imaging was particularly helpful. The spleen was removed by minimally invasive endoscopic surgery. Subcapsular hemorrhage had occurred because of splenic vasculitis. Postoperatively, a remission was achieved by a combination of high-dose corticosteroids and cyclophosphamide.     

The classification and diagnostic algorithm for primary lymphatic dysplasia: an update from 2010 to include molecular findings

Historically, primary lymphoedema was classified into just three categories depending on the age of onset of swelling; congenital, praecox and tarda. Developments in clinical phenotyping and identification of the genetic cause of some of these conditions have demonstrated that primary lymphoedema is highly heterogenous. In 2010, we introduced a new classification and diagnostic pathway as a clinical and research tool. This algorithm has been used to delineate specific primary lymphoedema phenotypes, facilitating the discovery of new causative genes. This article reviews the latest molecular findings and provides an updated version of the classification and diagnostic pathway based on this new knowledge.