[Importance of bone grafting in open tibial fractures (Gustilo III)]. / Importance de l'apport osseux dans les fractures ouvertes (Gustilo III) de jambe.

The authors report a retrospective study of 6 cases treated over the period 1988-1993.The closure of the wound was achieved by means of 3 free flaps (2 provided bone and skin in a single flap and the third was a latissimus dorsi muscle flap) and 3 pedicular flaps.The fixation of the fracture was performed by an external fixator in all cases. In one third of the cases a secondary nailing was performed to obtain consolidation. A bone graft was needed in 2/3 of the cases (2 bone free flaps, 1 bone allograft, 1 cancellous autograft).

Trimetazidine reverses deleterious effects of ischemia-reperfusion in the isolated perfused pig kidney model.

BACKGROUND: Delayed graft function has remained an important complication after renal transplantation. METHODS: The purpose of this study was to evaluate Euro-Collins (EC) plus trimetazidine (TMZ) in comparison with standard EC solution after 24- or 48-hour cold storage. The normothermic isolated perfused pig kidney technique combined with proton nuclear magnetic spectroscopy was used. RESULTS: The study verified that TMZ plus EC had a beneficial preservation effect over EC in terms of better perfusate flow rate at both 24 and 48 h (p < 0.01 and p < 0.001, respectively). In addition, TMZ also was beneficial in terms of increased glomerular filtration rate, better proximal tubular functions, and less tubular injury markers. Lipid peroxidation, evaluated by malondialdehyde renal tissue levels, was decreased in kidney homogenates preserved with TMZ, particularly after 48-hour cold storage. Citrate excretion which reflects a better intracellular pH regulation was detected in urine from kidneys preserved with TMZ. Histological data paralleled findings of the above when comparing cellular injury factors such as vacuolization, necrosis, tubular structure, and interstitial edema. CONCLUSION: These results indicate that, under the conditions of our experiments, the addition of TMZ to EC solution increased the preservation quality of kidneys particularly after prolonged cold ischemia.

Lipid peroxidation after cold storage and normothermic reperfusion: the effect of trimetazidine.

Ischemia reperfusion injury is still a leading cause of early graft dysfunction after transplantation. Trimetazidine (TMZ) has been postulated to be protective against renal damage from oxygen free radicals. The aim of this study was to assess the effect TMZ during cold storage (CS) and normothermic reperfusion in an isolated perfused pig kidney model. Three groups were studied: control group, immediately perfused (G0), 48 h CS in Euro-Collins solution (G1), and 48 h CS in Euro-Collins solution plus TMZ (G2). Glomerular filtration rate (GFR) and fractional sodium reabsorption (FRNa+) were calculated during reperfusion from urine and perfusate samples. Lipid peroxidation was determined by the renal tissue level of Schiff bases (SB) and malondialdehyde (MDA) after reperfusion. A histological evaluation was performed after reperfusion. Renal function was significantly improved and lipid peroxidation reduced after preservation in Euro-Collins solution plus TMZ. Functional data were closely related to histological damage. In conclusion, TMZ is a useful protective agent against renal damage induced by CS.