La maladie de Grisel: spontaneous atlantoaxial subluxation.

OBJECTIVE: "La maladie de Grisel" (Grisel's syndrome) is a spontaneously occurring atlantoaxial subluxation with torticollis. We present a case of atlantoaxial subluxation occurring in a 20-year period of pharyngoplasty surgery. The occurrence of a "spontaneous" atlantoaxial subluxation after oral cavity or pharynx operations is rare. Because some neck pain and stiffness are commonly seen after these kinds of operations, we would like to draw attention to this unusual complication. Symptoms associated with a torticollis after an operation in the oral cavity or pharynx requires additional investigation to exclude this rare complication. A review of the available literature concerning etiology and treatment of la maladie de Grisel is presented.

Fluorescence labeling to study platelet and leucocyte deposition onto vascular grafts in vitro.

Platelets and leucocytes are important participants in the response of the body to small diameter vascular grafts implanted into the arterial circulation. A sensitive and quick method for measuring platelet and leucocyte deposition contributes to material evaluation. With a newly developed fluorescence labeling method we examined the deposition of platelets and leucocytes onto vascular grafts in vitro. Human platelets and leucocytes were isolated and labeled with the fluorescence label Europium trichloride (EuCl3). After reconstitution of the labeled cells in plasma their functionality appeared intact and competitive with unlabeled cells. Eu-labeled platelets or leucocytes were then incubated with expanded polytetrafluoroethylene (ePTFE), Dacron and polyurethane (PU) vascular grafts in autologous plasma. Beta-thromboglobin and thromboxane release from platelets and beta-glucuronidase release from leucocytes during the incubation experiments were measured. Platelets and leucocytes deposited significantly less onto ePTFE compared to Dacron and polyurethane (P < 0.01). Our results are in accordance with results of in vivo studies using radio-active labeling to study platelet and leucocyte deposition. However, a new finding was that this reduced cell deposition may in part be due to possible toxic effects of ePTFE, shown by increased haemolysis and beta-thromboglobin release.

The effect of surgical wounding on tumour development.

For more than a century, a role for wound healing in the outgrowth of tumours has been implied based on observations in both experimental and clinical studies. Wound healing can be divided into stages of inflammatory, proliferative, repair and remodelling processes. Through proper regulation of activation of epithelial, endothelial and inflammatory cells, platelets and fibroblasts, and the production of growth factors, wounds heal and the various cell types resume their normal function. In tumour growth, similar processes of cell activation and growth factor production are observed. These processes are, however, differently regulated leading to ongoing cellular activation. In recent years, growth factors such as EGF, TGF-alpha and TGF-beta, bFGF, IGF I and II, and PDGF have been identified to play a role in the different stages of wound healing. In addition, some of these factors have now been identified as also being involved in the outgrowth of tumours. In this review, cell types involved in wound healing and tumour growth, as well as the growth factors and cytokines they produce and the role of the extracellular matrix, extensively present in both conditions, are being discussed. A better understanding of the time interval during which the sequelae of events in wound healing occur in relation to the time interval of tumour recurrence may be the basis for defining new therapeutic strategies that can interfere with tumour outgrowth without affecting wound healing processes. These new therapeutic approaches may be of importance especially after surgery or other invasive (diagnostic) procedures in cancer patients.

Influence of luminal pore size on the patency rate and endothelialization of polymeric microvenous prostheses.

In microvenous prosthetic surgery a continuous search for better patency rates is necessary to enable a clinical application. In this search for better patencies, modifications in the wall structure are being made. Directions found in the literature suggest that pore size plays an important role in achieving better patencies. Thus far, no study has been conducted to evaluate the influence of pore size on the patency rate of polyurethane microvenous prostheses. Since polyurethane is known to yield good patency rates, we conducted this study in which we compared different luminal pore sizes with regard to patency. Pore size varied from 0.6 to 20 microns in microvenous polyurethane-based prostheses (length 5-6 mm, internal diameter 1 mm). The results showed a favorable patency rate in the pore sizes larger than 5.0 microns (patency 75%) when compared to pore sizes smaller than 2.0 microns (patency 50%). This study demonstrates that microvenous polyurethane-based prostheses with a luminal pore size larger than 5.0 microns may yield better patency rates than prostheses with a luminal pore size smaller than 5.0 microns. Further studies are currently being performed to elucidate the very reasons for this effect.