Zur frage der transplantation von massiven diaphysen-halbgelenk-alloknochenkomplexen

Zusammenfassung Dieser Bericht beschreibt die Entwicklung auf dem Gebiet der Transplantation von massiven Diaphysen-Halbgelenk-Alloknochenkomplexen.Am Beispiel eines Kranken mit sekundärem, differenziertem Osteochondrosarkom der proximalen Metaphyse der linken Tibia wird eine gliederhaltende, radikale Operation, und zwar eine Einpolknochen-resektion mit Diaphysen- und Halbgelenkersatz, illustriert. Nach der radikalen Entfernung des Tumors weit im gesunden Gewebe wird der fehlende Diaphysen-und Gelenkanteil durch ein massives Transplantat aus entsprechendem Alloknochenkomplex ersetzt. Somit ist durch eine Arthroplastik die Wiederherstellung des Kniegelenks und Erhaltung seiner Funktion erzielt worden. Der Autor weist auf die Grundlagen der Indikation und der operativen Technik hin. Das wichtigste Kriterium für die Indikation bezüglich der Knochengeschwülste ist die Zulässigkeit des Verfahrens aus onkologischer Sicht. Von besonderer Bedeutung ist die Wahl des Transplantates in bezug auf Größe, Konservierung und immunologische Verwandtschaft unter Berücksichtigung der Kriterien der AB0-, D-, HL-A-Systeme.Für die operative Technik sind von besonderer Bedeutung: die stabile Osteosynthese zwischen Transplantat und Empfängerknochen auf möglichst breiter Anschlußfläche, die Entfernung der Spongiosaanteile des Transplantates, das Anlegen von Autospongiosa zwischen und um die Anschlußstelle der Fragmente, die Kapsel- und Bändernaht, die gute Weichteildeckung, das Benutzen der Redondrainage. Zum Erhalt der Gelenkfunktion ist die funktionelle Frühbewegung von entscheidender Bedeutung.

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Notes on the transplantation of a massive shaft-and-half-joint compound allograft

Summary In a concise introduction the possibilities of using a massive shaft-and-half-joint compound graft is discussed.This report is about a patient with differentiated secondary osteochondrosarcoma in the proximal metaphysis of the left tibia, subjected to a sparing the limb radical intervention-monopolar resection of the proximal tibial half. The lacking shaft and half-joint are reconstructed through the transplantation of a massive shaft-metaepiphyseal allograft. Thus arthroplasty is also accomplished with preservation of the knee joint function. The main points of the indications and operative technique of the method are outlined. The problem of feasibility of the procedure from oncological viewpoint emerges as an essential aspect of the indications in bone tumours. Selection of the graft by its size and immunological relations with the recipient, estimated on the basis of the criteria of the AB0, D, HL-A systems, is also of no less importance.In terms of the operative technique, special attention is called to: stable internal fixation between graft and host bone, securing the maximum possible contact area between them, removal of the spongy bone from the medullary canal and condyles, interposition of cancellous autografts between and around the fragments in the osteosynthesis zone, suture of the articular capsule and ligaments, adequate soft tissue resurfacing and utilization of Redon-drainage. To retain joint function early functional exercise therapy proves to be of utmost importance.

     

Osteoplastische Behandlung der Osteomyelitis

Zusammenfassung Nach kurzer Einführung folgt die Begriffsbestimmung der osteoplastischen Behandlung der Osteomyelitis, bei der die Knochentransplantation nicht nur Knochenersatz leistet, sondern darüber hinaus ein wesentlicher Faktor der Heilung des osteomyelitischen Prozesses ist. Der Autor geht auf die Fragen der Indikationen, Eigenschaften des Knochenlagers, Wesen, Struktur und Konservierungsart des Transplantates, immunologische Probleme, Anwendungsmethoden, Dynamik des Umbaues des Transplantates und Ergebnisse ein. Er schlägt eine Skala für eine Qualifizierung des Empfängerlagers vor. Der Autor hat die osteoplastische Behandlung der Osteomyelitis im breiten Rahmen der verschiedenen Anwendungsmethoden entwickelt. Es wird zur Analyse und Diskussion ein Krankengut von 602 Fällen vorgeführt. Das Krankengut ist nach Kriterien, Alter, Lokalisation, Morphologie, Infektion und Operationsverfahren untersucht. Weiterhin ist die Charakteristik des Transplantates, Entnahmestellen und seine Konservierungsart aufgezeigt. Der Autor hat die Ausfüllung der Defekte an der Entnahmestelle des Autotransplantates (Spongiosa, Span) durch Allospongiosa eingeführt.Bei Ausfüllungen von 285 Entnahmestellen hat er keinerlei Komplikationen beobachtet.Die Beurteilung der Ergebnisse werden im Zusammenhang mit den Komplikationen bzw. Erkrankungen des Transplantates analysiert. Andererseits werden die Ergebnisse und die Komplikationen im Zusammenhang mit dem Alter, dem Wesen und der Struktur des Transplantates sowie in Beziehung zum Operationsverfahren beurteilt. Gesondert sind die Reoperationen aufgestellt. Es haben sich bei 436 Kranken mit hämatogener Osteomyelitis 58 und bei 166 Kranken mit traumatischer eitriger Ostitis 34 Reoperationen als notwendig erwiesen. Die Heilungsquote nach der osteoplastischen Behandlung ist für die hämatogene Osteomyelitis 86%, für die traumatische Ostitis 79%. Einschließlich der Reoperationen steigt die Heilungsquote auf entsprechend 97% und 98%.Der Autor führt eine neue Stadienskala für den Umbau des Transplantates ein, die 6 Stadien enthält und die den Verhältnissen bei der Osteomyelitis entspricht.

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Osteoplastic treatment of the osteomyelitis

Summary After a short introduction, a definition of the nature of the osteoplastic treatment is given, in which the bone grafting assures not only a bonesubstitution, but it is the motive factor for the treatment of the osteomyelitis.The author gives a discussion on the problems of indications, properties of the bone-bed, structure and methods of conservation of the graft, the immunological problems, methods of application, the dynamics of the graft's reorganization and the results. He proposes a scale for the properties of the bed-recipient. Osteoplastic treatment of the osteomyelitis is developed by the author in a large plan of different surgical-operative methods. A clinical material of 602 patients is included for analysis and discussion. Criteria for the clinical material are as follows: age, localization, morphology, infection and method of conservation are given. The author starts using allografting to replace the donor's damage, when the auto-bone is taken. There are any complications after 285 such substitutions. The results are analysed in connection with the complications, typical of the bone grafting add of the diseases of the grafts respectively. On other hand the results are analysed in connection with the age of the patient, nature and structure of the graft and the type of operation. The reoperations are analysed separately. In 436 patients with haematogenic osteomyelitis the reoperations are 58, and in 166 patients with traumatic purulent ostitis they are 34. With the osteoplastic treatment of the haematogenic osteomyelitis the curability is 86 per cent, and in the traumatic purulent ostitis is 79 per cent. After the reoperations these percentages ware corrected to 97 for the haematogenic osteomyelitis and 98 per cent for the traumatic purulent ostitis, respectively. The author introduces a new scale for the stages of reorganization of the graft, including 6 stages with good correspondation to the conditions of the osteomyelitis.

     

Novel Mutations in the DYNC1H1 Tail Domain Refine the Genetic and Clinical Spectrum of Dyneinopathies

The heavy chain 1 of cytoplasmic dynein (DYNC1H1) is responsible for movement of the motor complex along microtubules and recruitment of dynein components. Mutations in DYNC1H1 are associated with spinal muscular atrophy (SMA), hereditary motor and sensory neuropathy (HMSN), cortical malformations, or a combination of these. Combining linkage analysis and whole‐exome sequencing, we identified a novel dominant defect in the DYNC1H1 tail domain (c.1792C>T, p.Arg598Cys) causing axonal HMSN. Mutation analysis of the tail region in 355 patients identified a de novo mutation (c.791G>T, p.Arg264Leu) in an isolated SMA patient. Her phenotype was more severe than previously described, characterized by multiple congenital contractures and delayed motor milestones, without brain malformations. The mutations in DYNC1H1 increase the interaction with its adaptor BICD2. This relates to previous studies on BICD2 mutations causing a highly similar phenotype. Our findings broaden the genetic heterogeneity and refine the clinical spectrum of DYNC1H1, and have implications for molecular diagnostics of motor neuron diseases.     

Number and function of circulating human antigen presenting cells regulated by sleep

STUDY OBJECTIVES: There is evidence that sleep facilitates the adaptive immune response to infectious agents and, thereby, supports immunologic memory. The effect might be attained by sleep-induced changes in the number and function of dendritic cells (DCs), which play a key role in the initiation of the immune response. This study aimed to dissociate effects of sleep and circadian rhythm on circulating numbers of DC precursors, ie, CD14+CD16- and CD14(dim)CD16+ monocytes, myeloid dendritic cell precursors (pre-mDC), and plasmacytoid dendritic cells (PDC) and on 2 key cytokines produced by these cells, ie, interleukin (IL)-12 and interferon (IFN)-alpha. DESIGN: In a within-subject cross-over design, human subjects were examined on 2 occasions, ie, during a normal sleep-wake cycle and during 24 hours of wakefulness. Blood was sampled every 1.5 hours during nighttime and every 3 hours during daytime. SETTING: Experiments took place under controlled laboratory conditions. PARTICIPANTS: Twenty-seven healthy men aged between 18 and 30 years. MEASUREMENTS AND RESULTS: Compared with wakefulness, sleep was associated with a striking increase in the number of pre-mDC producing IL-12, which is a main inducer of Th1 responses. In addition, sleep slightly decreased PDC and also T cell counts but did not affect IFN-alpha production by PDC. Sleep, however, substantially decreased numbers of CD14(dim)CD16+ monocytes, probably reflecting increased margination of the cells upon a sleep-related drop in catecholamine release. CONCLUSIONS: Our data identify pre-mDC producing IL-12 as a basic target of sleep that is most closely related to mature APC function and whereby sleep can effectively enhance adaptive immune responses.     

RANDOM SYSTEMS OF HARD PARTICLES:MODELS AND STATISTICS

1　Ｉｎｔｒｏｄｕｃｔｉｏｎ　　Ｉｎｍａｎｙｓｉｔｕａｔｉｏｎｓ ,ｅｎｇｉｎｅｅｒｓａｎｄｓｃｉｅｎｔｉｓｔｓａｒｅｃｏｎ ｆｒｏｎｔｅｄｗｉｔｈｉｒｒｅｇｕｌａｒｓｐａｔｉａｌｓｔｒｕｃｔｕｒｅｓｗｈｉｃｈｃａｎｂｅｉｎ ｔｅｒｐｒｅｔｅｄａｎｄｍｏｄｅｌ     

Minor and major complications of arthroscopic synovectomy of the knee joint performed by rheumatologist

The aim of the study was to analyze the type and incidence of major and minor complications resulting from arthroscopy with arthroscopic synovectomy of the knee joint performed by rheumatologist in different rheumatological diseases. METHODS: In a prospective study the incidence of complications in arthroscopic subtotal synovectomy with subsequent tidal flow lavage was analyzed in 201 rheumatic patients. The arthroscopic synovectomies were performed by one team of rheumatologists in the operation room of the University Clinic of Rheumatology in the town of Plovdiv for a period of 8-9 years. RESULTS: The major complications related to the arthroscopic synovectomy included septic arthritis (0.5%) and rupture of the joint capsule with edema of the thigh and leg (1.5%). The minor postarthroscopic complications were infection of the operative skin incision (2.0%), hemarthrosis (3.5%), severe postoperative pain (1.5%) and gout relapse (0.5%). Complete recovery was achieved after complications were treated and the result of the synovectomy was not compromised. CONCLUSION: Arthroscopic synovectomy of the knee joint performed by rheumatologist in in-patients involves low risk of complications among which minor operative and postoperative ones are prevalent. These do not compromise near and late results of the arthroscopic synovectomy.     

Conditionally replicating mycobacteriophages: A system for transposon delivery to Mycobacterium tuberculosis

Transposon mutagenesis provides a direct selection for mutants and is an extremely powerful technique to analyze genetic functions in a variety of prokaryotes. Transposon mutagenesis of Mycobacterium tuberculosis has been limited in part because of the inefficiency of the delivery systems. This report describes the development of conditionally replicating shuttle phasmids from the mycobacteriophages D29 and TM4 that enable efficient delivery of transposons into both fast- and slow-growing mycobacteria. These shuttle phasmids consist of an Escherichia coli cosmid vector containing either a mini-Tn10(kan) or Tn5367 inserted into a nonessential region of the phage genome. Thermosensitive mutations were created in the mycobacteriophage genome that allow replication at 30°C but not at 37°C (TM4) or 38.5°C (D29). Infection of mycobacteria at the nonpermissive temperature results in highly efficient transposon delivery to the entire population of mycobacterial cells. Transposition of mini-Tn10(kan) occurred in a site-specific fashion in M. smegmatis whereas Tn5367 transposed apparently randomly in M. phlei, Bacille Calmette–Guérin (BCG), and M. tuberculosis. Sequence analysis of the M. tuberculosis and BCG chromosomal regions adjacent to Tn5367 insertions, in combination with M. tuberculosis genomic sequence and physical map data, indicates that the transpositions have occurred randomly in diverse genes in every quadrant of the genome. Using this system, it has been readily possible to generate libraries containing thousands of independent mutants of M. phlei, BCG, and M. tuberculosis.