Successful treatment of refractory tibial nonunion using calcium sulphate and bone marrow stromal cell implantation.

Successful healing of a nine-year tibial nonunion resistant to six previous surgical procedures was achieved by tissue engineering. We used autologous bone marrow stromal cells (BMSCs) expanded to 5 x 10(6) cells after three weeks' tissue culture. Calcium sulphate (CaSO4) in pellet form was combined with these cells at operation. The nonunion was clinically and radiologically healed two months after implantation. This is the description of on healing of a long-standing tibial nonunion by tissue engineering. The successful combination of BMSCs and CaSO4 has not to our knowledge been reported in a clinical setting.

Early results of autologous chondrocyte implantation in the talus.

Autologous chondrocyte implantation (ACI) has been used most commonly as a treatment for cartilage defects in the knee and there are few studies of its use in other joints. We describe ten patients with an osteochondral lesion of the talus who underwent ACI using cartilage taken from the knee and were prospectively reviewed with a mean follow-up of 23 months. In nine patients the satisfaction score was 'pleased' or 'extremely pleased', which was sustained at four years. The mean Mazur ankle score increased by 23 points at a mean follow-up of 23 months. The Lysholm knee score returned to the pre-operative level at one year in three patients, with the remaining seven showing a reduction of 15% at 12 months, suggesting donor-site morbidity. Nine patients underwent arthroscopic examination at one year and all were shown to have filled defects and stable cartilage. Biopsies taken from graft sites showed mostly fibrocartilage with some hyaline cartilage. The short-term results of ACI for osteochondral lesions of the talus are good despite some morbidity at the donor site.

Serum from patients anesthetized with opiates less effective in the support of chondrocyte growth in vitro.

Risk of viral and/or prion disease transmission associated with the use of fetal bovine serum in clinical cell culture has led to the increasing use of autologous human serum in tissue engineering. A relatively large volume of blood is needed and so, to decrease patient discomfort, we have investigated the feasibility of taking blood when the patient is anesthetized. Two serum samples were prepared from each of 22 patients: (1). from the awake patient (PRE) and (2). from the patient 5 min after induction of general anesthesia (PER). The sera were compared for their ability to support the in vitro proliferation of primary human chondrocytes, determined by cell counting. The effects of anesthetic agents on the PER/PRE cell number ratio were established by analysis of variance and stepwise multilinear regression analysis. The PER sample supported higher growth in 2 of 22 patients, equivalent growth in another 11, and significantly lower growth in the remaining 8. Only the opiate analgesics (fentanyl [Sublimaze], alfentanyl [Rapifen], and diamorphine) had a significant and inhibitory effect on chondrocyte proliferation. It is suggested that opiate analgesics be avoided when blood is taken to support the in vitro growth of human cells.

Detection of white blood cell populations in the ejaculates of fertile men.

Using a now established, reliable technique for detecting white blood cells in human semen, we have examined the ejaculates of a fertile group of men. We have also highlighted the need for strict recruitment criteria to be established to enable accurate comparisons to be drawn between different patient groups and results from different laboratories.

Granulomatous angitis of the central nervous system. Case report and review.

The nineteenth case report of granulomatous angiitis of the central nervous system is described in a 47-year-old patient, who survived 2 years with his disease. Problems with establishing the diagnosis are discussed. No single group of clinical symptoms or laboratory data exist for making a positive diagnosis during life, although a combination of certain nonspecific factors such as mental change, spinal fluid protein elevation and pleocytosis should be present before the diagnosis of granulomatous angiitis is entertained. Special blood tests and immunological studies and contrast procedures, as well as cortical biopsy have been of little value in establishing the diagnosis; instead, a leptomeningeal biopsy may be the procedure of choice. This patient, as well as the others given a trial of steroid treatment, demonstrated some obvious detectable clinical improvement. All patients treated with steroids have survived longer than any untreated patient suggesting that these drugs may be of some benefit.

Qualitative identification of alloys by energy-dispersive X-ray spectroscopy.

Energy dispersive X-ray spectroscopy can be used to identify alloy types quickly and, in many cases, to distinguish between alloy systems within a certain alloy type. Characteristic X-rays of major components in an alloy are produced through excitation by an isotopic source. Ratios of the X-ray intensities of a pair of elements are plotted vs. ratios of the theoretical weight fractions of these elements. This provides a unique data point which is a function of the composition of the particular alloy system. In some cases, characteristic X-rays of minor constituents are used for total identification.

The in vitro growth of human chondrocytes.

Autologous chondrocyte implantation (ACI) for the treatment of articular cartilage defects has been described by other workers, however, relatively few details of the in vitro growth of the cells have been published. Here we describe the release of cells from adult human articular cartilage and their growth characteristics in vitro.Cultures were successfully established from 29 of 30 biopsies taken from patients aged 20-72 year. No significant relationship was found between donor age and initial cell yield following cartilage digest, however, the time to primary confluence increased in direct proportion to age. Thereafter the kinetics of cell proliferation was independent of donor age.The proportion of apoptotic or necrotic cells in the cartilage digest was low and increased with time in culture only in those cells which remained non-adherent. Conversely, entry into cell cycle was restricted to those cells which had become adherent.These results illustrate that previously reported techniques for isolating and culturing chondrocytes are reproducible, that adherent chondrocytes have considerable proliferative potential, and that concern about cell growth and viability need not, in itself, limit the clinical application of ACI to younger patients.

Properties of blast cells in 'control' cultures of human blood lymphocytes. Preliminary note.

Ficoll-Hypaque separated normal human peripheral blood lymphocytes undergo appreciable blastogenesis in RPMI 1640-pooled human serum or - autologous plasma. During the 1st week, granulated blasts with peroixdase activity and ultrastructural properties of granulocytes precursors appear. These cells, which appear to be relateed to CFC (colony-forming cells), contribute to the mitotic population in these unstimulated "control" cultures prior to 6 days.

The annual cost of psoriasis.

BACKGROUND: The need for comparative cost figures for psoriasis therapy has become increasingly important. OBJECTIVE: Our purpose was to compare the yearly costs of various psoriasis treatments. METHODS: Ten patients were selected for each treatment modality and the average total cost per year, per patient was evaluated. RESULTS: All treatments evaluated were cheaper than inpatient therapy, with Goeckerman treatment in the day-care setting the most expensive and hydroxyurea the cheapest. Cyclosporine, which was used for comparison, was at least twice as expensive as all the other treatments except for Goeckerman treatment in the day-care setting, compared with which it was about 70% more expensive. CONCLUSION: No single treatment appears to be universally superior to others. In considering specific treatment for psoriasis, cost analyses, including appropriate laboratory and other specialized evaluations, must be taken into account. With use of these data, practitioners and health care organizations may be better able to select appropriate therapy.

Seminal white blood cells in men with urethral tract infection. A monoclonal antibody study.

Monoclonal antibodies were used to detect seminal leucocytes in 19 men with urethritis. A wide range in the number and type of leucocytes between individuals was documented (median 2.06 x 10(6)/ml, range 0.6-29.89 x 10(6)/ml); 22% of the men had less than 1 x 10(6) leucocytes/ml. The results suggest that the threshold of greater than or equal to 1 x 10(6)/ml proposed by the World Health Organisation to indicate genital tract infection is unsuitable for men with urethritis.

Antisperm antibodies are more prevalent in men with low sperm motility.

Fifty-six men with low sperm motility (less than or equal to 40% of sperm with forward progression) who attended our infertility clinic were tested for antisperm antibodies (IgG and IgA) using the indirect immunobead test. Nineteen (34%) of these men were found to be positive (greater than 10% binding). This was significantly higher (P less than 0.01) than the incidence (5%) of antibodies in men who attended our infertility clinic with high sperm motility (greater than 40% of sperm with forward progression). It is concluded that significantly more men with low sperm motility have antisperm antibodies. The functional significance of these antibodies warrants further investigation.

Antisperm antibodies and lymphocyte subsets in semen--not a simple relationship.

The significance of white blood cells in the ejaculate remains a matter of controversy. Several authors have suggested that such cells are important in the modulation of an antisperm antibody response, i.e. a predominance of suppressor/cytotoxic to helper/inducer T cells may prevent the development of antisperm antibodies. In order to examine this relationship further we have documented the white blood cell types, with emphasis on the T-lymphocyte populations, in the ejaculates of men from infertile couples with and without antisperm antibodies; the latter group was divided further into two groups--vasovasostomized men and idiopathic men. All seven of the men without antisperm antibodies had a predominance of suppressor/cytotoxic T cells to helper/inducer T cells in the ejaculate. However, only in some of the men with antibodies was there a predominance of T-helper/inducer cells. It is clear that the relationship between antisperm antibodies and seminal leucocytes is therefore not as straightforward as has been proposed.

Seminal peroxidase positive cells are not an adequate indicator of asymptomatic urethral genital infection.

The relationship between asymptomatic urethral infection and seminal white blood cells, as detected using the peroxidase enzyme system, was examined. Eighty-four semen donors were tested. Twenty-four (29%) were diagnosed as having an active urethral genital infection. There was no statistical relationship between the total number of concentrations of peroxidase-positive cells and a urethral genital infection. Further studies should concentrate on the subtypes of seminal leucocytes and their surface receptors using monoclonal antibodies.

The hypo-osmotic swelling test and the sperm mucus penetration test in determining fertilization of the human oocyte.

The usefulness of the hypo-osmotic swelling (HOS) test and the sperm mucus penetration (SMP) test as sperm function tests for in-vitro fertilization was analysed in 56 couples. Using logistic regression analysis only the SMP test was independently related to fertilization (P = 0.004), no false negative results were obtained, i.e. no fertilization if sperm from the ejaculate failed to penetrate mucus. The HOS test was of no predictive value. The results justify a further examination of the SMP test in other IVF centres.