Fitness for work after preserved bone transplantation.

The fitness for work in patients after preserved bone transplantation was analyzed. The analysis was based on clinical control of 1014 patients two years or more post surgery. It was found that 73% of all patients recovered fully their working ability. Important factors for working ability in such treatment are: age, diagnosis and localization of process, presumed role of transplant and duration of illness before operation.

Modification of collagen film by certain chemical agents.

Morphological changes and the content of free carboxyl groups in bovine collagen (type I) film under the influence of trypsin, hydrochloric acid (HCl) and ethylenediaminetetraacetic acid (EDTA) were studied. Incubation with trypsin and HCl was found to cause some delamination of the film and the appearance of some low-density spots. Incubation with EDTA did not cause any morphological changes. A high concentration of free carboxyl groups (10-fold higher than in control) was seen after incubation with trypsin.

Preserved bone in clinical transplantation.

Results of treatment by preserved bone transplantation in 552 patients are presented. Analysis is based on the activity of the Central Tissue Bank in Warsaw. Radiation-sterilization of lyophilized bone allografts is a routine method used in this bank. After long term observation of patients, the importance of age and diagnosis for clinical results of bone transplantation are discussed.

In vitro culture of human epithelial cells on a modified xenogenic collagen support.

Human epithelial cells (HeLa, HaCaT, NHK) were cultured in vitro on chemically modified collagen membranes. Adhesion to the support was measured by estimation of the percentage of adhering 51Cr-labeled cells. Proliferation was estimated with the XTT test. Morphological observations of cells growing on HCl-treated collagen were performed using histological and electron microscopic techniques. HCl and trypsin-modified xenogenic collagen was found to be a good support for human cells in vitro. EDTA-incubated collagen enhanced neither adhesion nor proliferation. The best adhesion and proliferation were found on HCl-treated collagen, depending, however, on the kind of cells.

The quality of heart valve tissue for homograft transplantation.

BACKGROUND AND AIM OF THE STUDY: The results of heart valve replacement surgery may be improved by refining surgical techniques and/or developing new heart valve transplants. The aim of this study was to examine the effect of age on the presence of cholesterol clefts and lipid deposits in the cusp base and sinus wall of aortic homografts. METHODS: Seventy-one valves were obtained at autopsy from donors (aged 15- 40 years) with no history of illness or evidence of serious illness. Trauma was the predominant cause of death among patients. The valves were examined using an osmium-vaporization technique. RESULTS: Osmiophilic deposits were detected in the cusp base in 28 cases (42%), and in the sinus wall in 49 cases (69%). Cholesterol crystals in the cusp base were found in 16 cases (24%), and sinus wall cholesterol clefts in 26 cases (38%). The model-predicted probability of cusp base lipid deposits existing was 76% in 40-year-old donors, 36% in 30-years-olds, and 11% in 20-year-olds; the probability of cusp base cholesterol clefts existing was 45%, 21% and 8% in these age groups, respectively. The influences of immunological reactions, biochemical changes (centers of calcification) and acceleration of atherosclerotic processes are discussed. CONCLUSION: The microscopic study of heart valves demonstrated the presence of lipid deposits in subjects of an unexpectedly young age. Among our study material, 58% of valves obtained from donors aged 11-40 years were unsuitable for transplantation. Our results confirmed the need for macroscopic inspection of heart valves before their being transplanted.

Analysis of hyaluronidase diffusion for histochemical purposes.

Observations on hyaluronidase difussion from natural and artificial objects to precipitated medium are described. The conclusions from this investigation are: (1) hyaluronidase diffusing from biological objects in a precipitated medium is an active enzyme. (2) hyaluronidase diffusion may be utilized for localization of the enzyme. (3) certain parameters of the reaction hyaluronidase--hyaluronic acid may be measured with the use of the notion "diffusion radius".

Long-term follow up after transplantation of frozen and radiation sterilized bone grafts.

The application of frozen and radiation sterilized allogenic bone grafts for reconstructions in orthopaedic operations is described. Analysis of results of treatment of 1125 patients was performed. It was found that use of preserved bone allows to reduce the extend and duration of surgery. Nearly total substitution of grafts may be seen in 3 to 8 months after surgery.

Bone banking for transplantation in orthopaedic reconstructions.

Results of orthopaedic reconstructions in 1014 patients with the use of preserved allogenic bone grafts are presented. The method of grafts preservation seems to be of significance in surgical applications; deep-freezing is more favorable in more comparison with lyophilization. The result of treatment after bone transplantation is dependent on numerous biological and clinical variables.

Application of frozen and radiation-sterilised bone allografts for treatment of bone cysts.

Between 1981 and 1998 frozen and radiation sterilized bone allografts were transplanted into 1376 patients at the Institute of Traumatology, Orthopaedic and Neurosurgery of the Military School of Medicine in Warsaw. Of these 179 (13%) required treatment due to benign tumours. Incidence of solitary cysts was highest (127 cases, 71%), mainly occurring in children (84%). During surgery bone cysts were excised and filled by bone grafts. Results were evaluated several years after surgery (2-10 yrs) using x-rays and clinical examination. Rebuilding of allografts was one of the most important prognostic factors. Within the period of observation time 83% of transplanted allografts were rebuilt and substituted by own patients bone.

Frozen and radiation-sterilized bone allografts in the treatment of post-traumatic malformation of bones.

Post-traumatical malformations of bone are often reconstructed with the use of preserved bone allografts. At the Institute of Traumatology, Orthopaedics and Neurosurgery 495 patients were treated with use of preserved (frozen and radiation-sterilized) bone allografts, following trauma, between 1981 and 1995. Non union of bone and osteomyelitis were main reasons for allotransplantation of bone. Remodelling of bone allografts has been observed during 2-8 years after surgery. Substitution of allografts and good result of treatment were found in 80% of all cases. In paper the analysis of results of treatment is presented.

Fusion of spine in children scoliosis with frozen & radiation--sterilized bone allograft.

102 children have been treated at the Institute of Traumatology, Orthopaedics & Neurosurgery a result of scoliosis. In all of these multi-step treatment has been applied. Initially a telescopic rod was implanted into the spine. Allografts were introduced around the rod hook, after 6 or 8 months, when angle of scoliosis increased, the rod was exchanged for a longer one. The final step was performed when conditions permitted and the scoliosis was markedly corrected and the fusion of the spine with the solid allograft was accomplished. The result of treatment was evaluated 1 to 7 years after surgery. Bone allografts were rebuilt within 6 month. Correction of scoliosis of 50% to 70% was achieved in all cases.

Human osteoblast in contact with various biomaterials in vitro.

OBJECTIVES: The aim of the study was to investigate changes in osteoblast number and viability in contact with biomaterials and to compare both tests. METHODS: Human primary culture osteoblasts were seeded on the polished surfaces of hydroxyapatite, alumina, titanium and surgical steel. After 4, 9, 14, 24 and 48h cultures were subjected to XTT viability assay. Subsequently Hoechst staining of nuclei was performed. Number of cells on each sample was counted. RESULTS: There were no differences in cell viability measured by means of XTT assay between osteoblasts cultured on hydroxyapatite and alumina during 48 hours of experiment. However on titanium as well as on surgical steel cell viability was significantly lower than on bioceramics. The lowest viability was noticed on surgical steel. Cell number on titanium was significantly higher than on steel. There were no differences between cell numbers on hydroxyapatite and alumina as well as between investigated bioceramics and metals. Nucleus number and the results of viability assay were compared. There was no correlation found between number and viability of cells. CONCLUSION: the results of a single test may not provide sufficient information on the interaction between cells and implant. Application of a battery of tests is necessary in material biocompatibility investigation in vitro.

Allogenic preserved costal cartilage in reconstructive surgery.

Allogenic, preserved cartilage is often used for reconstruction of face. This study was undertaken to analyze the effects of cartilage transplantation. In analyzed group of 437 patients after cartilage transplantation, 42.2% were operated because of posttraumatical changes, 29.0% because of congenital malformations. In 16.7% nonspecific inflammations were the cause of reconstructive operations. Malformations were mainly localised in nose 59%, ear concha 16.5% and mandible 10.9%. Human costal cartilage, preserved in 0.9% NaCl and radiation-sterilized was used for reconstruction. 24-190 months after surgery (in several clinical units) patients were examined and results were collected in special questionnaire by the team who performed surgery. The results of treatment were compared with age, diagnosis and localisation of changes. It was found that very good result of treatment was achieved in 33.5% of patients, in 41.8% result was satisfactory. In 19.9% of operated patients result of treatment was unsatisfactory. Correlation of some clinical and biological characteristics with the result of treatment is discussed.

Preserved tissue allografts in reconstructive surgery.

Results of treatment with three various kinds of allografts: lyophilized bone, deep frozen bone and cartilage preserved in physiological solution, all of them radiation-sterilized are presented. We believe that this presentation may be helpful in estimating the tissue bank's allografts and in establishing indications and contraindications in the application of allografts in surgery.The 'indices of coincidence' were compared in a group of 1014 patients after bone (lyophilized and radiation-sterilized) transplantation. It seems that such a variable as 'rebuilding of graft' may be of prognostic value in analysing the results of treatment in this group.The application of frozen and radiation-sterilized allogenic bone grafts for reconstructions is also described. An analysis of the results of treatment in 1125 patients reveals that the use of preserved bone reduces the extent and duration of surgery. Almost total substitution of grafts may be seen in 3-8 months after surgery.Allogenic, preserved cartilage is often used in facial reconstructions of face. Human costal cartilage, preserved in 0.9% NaCl and radiation-sterilized, was used for reconstruction. The patients were examined 24-190 months after surgery (in several clinical units) and results were collected in a special questionnaire by the team that performed surgery. In an analysed group of 437 patients after cartilage transplantation, 42.2% were operated because of posttraumatical changes, 29.0% because of congenital malformations and in 16.7% non-specific inflammations were the cause of reconstructive operations. Malformations were located mainly in the nose (59%), the ear concha (16.5%) and 10.9% were mandible.The results of treatment were compared with ages of patients, diagnosis and the locations of the changes. Very good results were achieved in 33.5% of the patients, and satisfactory in 41.8% of the patients. However, in 19.9% of the patients the result of treatment was unsatisfactory. Correlation between some clinical and biological characteristics and the result of treatment is under discussion.

[Difficulties in the diagnosis of epilepsy in children]. / Trudnosci diagnostyczne w rozpoznawaniu padaczki u dzieci.

On the basis of an analysis of 3 cases it was shown that the occurrence of seizure-like symptoms with abnormal EEG and history data suggesting possible damage to the central nervous system are not always sufficient for an unequivocal diagnosis of epilepsy and for beginning of long-term antiepileptic treatment which is not without adverse effects on the developing organism of a child. For establishing of correct diagnosis and avoiding of too hasty introduction of anticonvulsant treatment not only careful history and family data and pathological EEG tracings should be considered, but the seizure-like symptoms and results of laboratory investigations should be carefully analysed. On many cases, especially in younger children, the diagnosis should be established in hospital.

[Catamnestic studies of children with epilepsy]. / Badanie katamnestyczne dzieci chorych na padaczke.

Late results of epilepsy treatment in 150 children hospitalized in the Department of Psychiatry, Institute of Paediatrics, Medical Academy in Warsaw and followed-up in the outpatient clinic of this Department are described. The criteria of selection of the cases for analysis were age of 10 years, at least, and disease duration at least 4 years. It was found that in 72% of cases the seizures had been completely controlled (absent for at least 2 years). In 28% the seizures continued despite systematic treatment. The analysis showed that persistence of seizures was caused, among other factors, by the degree and extent of the organic damage to the central nervous system confirmed in neurological and psychological examination and electroencephalographic investigations, the type of seizures, mainly seizures of salaam type and partial seizures with complex signs, recurring status epilepticus, and coexistence of various types of seizures in a child. Interseizure psychic disturbances were more frequently observed in children in whom the seizures could not have been controlled completely.

[Mental disorders in children with epilepsy]. / Zaburzenia psychiczne u dzieci chorych na padaczke.

In a group of 80 epileptic children aged 10-11-12 years in 75% of cases psychic changes were found, including disturbances of intellectual abilities of the oligophrenic-dementive type, and personality disorders. The cause of these disturbances was organic brain damage due mainly to pathological events in pregnancy and labour, and to mechanical craniocerebral trauma in early childhood. Other causes included: duration, type and frequency of seizures and longstanding pharmacological polytherapy not considering the interaction of drugs. The coexistent neurotic symptoms in 60% out of 80 studied children were caused by abnormal family situation and situation in school which had undoubtedly an effect on the prognosis and course of epilepsy in children.

[Evaluation of the mental state of children with early-childhood onset of epilepsy treated between 1977 and 1981 (preliminary report)]. / Ocena stanu psychicznego dzieci z padaczka wczesnodziecieca leczonych w latach 1977-1981 (doniesienie wstepne).

From a group of 248 cases of epilepsy observed in the last five years 69 (28%) children, 32 boys and 37 girls, were isolated (aged from several months to 14 years) in whom the first epileptic seizures appeared at the age of 3 years or less. The subgroups were subjected to detailed psychiatric-psychological analysis for establishing whether epilepsy beginning in the life period of the most intense developmental processes may have any decisive influence on the psychic development and social adaptation of the child. It was found that children with epilepsy beginning at the age below 3 years require not only a careful differential diagnosis but even more a comprehensive therapeutic management, which should include, besides systematic administration of drugs and periodic EEG control also a continuous psychological and psychiatric supervision and care which would ensure a possibly optimal development of mental skills and social adaptation in the family and outside it.

[Psychosocial problems of epileptic children and their families]. / Psychospoleczne problemy dzieci chorych na padaczke i ich rodzin.

Families of 156 children and adolescents in the age from 10 to 18 years were studied. Epilepsy was diagnosed in 118 patients; control group consisted of 38 subjects with cognitive and emotional dysfunction due to minimal-brain damage. Author used the standardized interview of parents and ill child. All children underwent psychiatric and neurologic examination. The laboratory tests which confirmed the diagnosis of epilepsy or the organic background of mental disturbances in control group without epilepsy, as well as psychological tests were done. On the basis of these investigations it was found that epilepsy in children had the influence on child's and its family functioning. Such influence was more pronounced among children who fail to remain seizure-free after therapy, and in whom seizures were accompanied by chronic mental disorders. The vicious circle mechanism was found in several cases. The child's disorder caused negative reaction of family members, which in turn unfavourably influenced child's functioning and behaviour. According to the author these statements are of great importance for psycho-sociotherapy.

[A follow-up study of adolescents after suicide attempts]. / Badania katamnestyczne mlodziezy dorastajacej podejmujacej próby samobójcze.

Young persons who in the past attempted suicide show the following characteristics: 1. they unwillingly make contact with an agency which they had consulted or had been treated due to their suicide attempt, 2. often maintain suicidal thoughts (11 of 37), 3. they have a higher estimation of their psychosocial situation then an objective assessment would indicate, 4. their psychosocial functioning does not improve with time.