Bone mineral density in adolescent girls with anorexia nervosa--a cross-sectional study.

UNLABELLED: The total body and lumbar spine bone mineral density (BMD) were measured in order to determine the prevalence and possible risk factors of decreased BMD in anorexia nervosa (AN). SUBJECTS: Sixty-one in-patient girls with DSM III-R AN: age 14.7+/-2.16 years; duration of AN 12.9+/-15.1 months; percentage of ideal body weight 70+/-8.7%; body mass index score -1.62+/-0.79. METHOD: Total body (in 61 patients) and lumbar spine BMD (in 43 patients), content of lean and fat tissue mass were measured by DXA during the first month of treatment. RESULTS: Low total body BMD was found in 23.7% and low lumbar spine BMD in 36.6% of patients. There was a negative correlation between BMD and age, age of menarche, degree of undernourishment, duration of AN and amenorrhea. A step-wise linear regression analysis revealed that age of menarche was the most important factor related to BMD in this group.

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.

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.

Bone mineral content and bone mineral density in adolescent girls with anorexia nervosa--a longitudinal study.

OBJECTIVE: Total body and lumbar spine bone mineral density (BMD-TB, BMD-L) and total body bone mineral content (BMC-TB) were measured to establish the course of bone demineralization in anorexia nervosa and the clinical factors influencing BMC-TB and BMD changes during treatment. METHOD: Forty-two girls with DSM III-R anorexia nervosa, age 14.7+/-2.4 years. BMC-TB, BMD-TB and BMD-L were measured in approximately 7-month intervals for 27.8+/-4.1 months using DXA. RESULTS: Despite nutritional improvement, there was an initial decrease of BMD-L, and no change in BMC-TB and BMD-TB. an increase in BMC-TB and BMD was observed after approx. 21 months from the beginning of the study. CONCLUSION: The improvement in BMC-TB and BMD was related to changes in nutritional status and was significantly marked in younger patients, with earlier anorexia onset and before menarche.

[Features of autism, autistic traits, autism: retrospective analysis of clinical symptoms in children treated in the Pediatric Psychiatric Clinic]. / Cechy autyzmu, rysy autystyczne, autyzm: analiza retrospektywna objawów klinicznych u dzieci leczonych w Klinice Psychiatrii Dzieciecej.

All currently accepted definitions of autism include three main criteria which have to be met for a diagnosis to be made. These are: disturbance of reciprocal social interaction, disturbance of communication and restriction of normal variation in behaviour and interests. The criteria used in the ICD-10 include all these domains. On the other hand, the number of mentally handicapping conditions and brain damage syndromes show the same triad of symptoms. Many of patients actually fulfill all currently accepted criteria for autism, but, for some reason do not receive the diagnosis. We analysed retrospectively the clinical picture of all children hospitalised in Department of Child Psychiatry in the last 10 years before the introduction of ICD-10 in Poland (1986-1996) and diagnosed as having autism, autistic traits or features. The group consist of 19 children (0.8% of all children hospitalised in that time). 4 of them had been diagnosed as having autism, 4 as having features of autism and 11 as having autistic traits. Additional diagnoses were: organic brain damage in 2 children, carnitine deficiency and cerebral palsy in 1 child and minimal brain dysfunction in 3 cases. Despite of the diagnosis all children met current ICD-10 criteria for autism or atypical autism, according to age of onset. There were no significant differences in constellation of symptoms included in ICD-10 between groups divided according to the past diagnosis.

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.

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.

Interaction between tissues and implantable materials.

Interaction between tissues and implantable materials is a factor of critical importance in biocompatibility studies. Bioactivity of implants is expected when the resorption or controlled integration of the implant with surrounding tissues is required. On the contrary, biomaterial inertness is suitable in the case of most load-bearing implants. Both desired and undesired consequences of partial implant biodegradation are discussed on the base of the authors' experimental work done on alumina and carbon-fiber-reinforced carbon composites (CFRC). Two examples of investigations of the interaction between bioceramics (CFRC, alumina, hydroxyapatite, and tricalcium phosphate) and cells in culture are shown as an alternative to the methods based on experimental implantation. The future of research on biomaterial-tissue interaction is discussed with respect to the developments in tissue engineering.

Interaction between carbon composites and bone after intrabone implantation.

Candidate carbon fiber reinforced carbon (CFRC) porous implant materials were evaluated for tissue compatibility in a rat model. Six different CFRCs of constant pore size (about 30 microm) were fabricated that had 9, 12, and 17% porosity with 2-nm3 matrix crystallites and 6, 12, and 20% at 25 nm3. They were implanted as femoral transverse diaphyseal pins that were 1.5 mm in diameter. At 5 and 45 weeks, implant and bone histologic specimens were evaluated histologically and by a scanning electron microscope and an electron microprobe. Also, regional lymph nodes and spleens were examined. By 45 weeks, direct implant-bone contact was observed over most of the interface in most specimens. At the implant surface, there was partial replacement of CFRC with host tissue. However, the microprobe showed that the implant-bone interface was chemically abrupt with no cross-diffusion of ionic species. Besides the surface effects, there was partial filling of the implant pores with tissue, including bone organized de novo deep within. This was observed histologically and confirmed by microprobe. Lymph nodes and spleens were histologically normal, and no carbon particles were found. None of the results were influenced by porosity or matrix crystallite size over the ranges studied. In summary, these porous CFRCs are partially degraded when in contact with bone and appear substantially tissue compatible. They may be useful as scaffolds for regrowth of bone.

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.

[Schizophrenia, schizophrenia-like disorders and delusional disorders in patients with anorexia nervosa: literature review and report of 3 cases]. / Schizofrenia, zaburzenia typu schizofrenii i urojeniowe u pacjentów z rozpoznaniem jadlowstretu psychicznego--przeglad pismiennictwa, prezentacja 3 przypadków.

The authors present the review of literature concerning schizophrenia, schizophrenia type and delusional disorders in patients with a lifetime diagnosis of anorexia nervosa (AN). The authors describe also 3 patients (2 cases of paranoid schizophrenia and 1 case of catatonic syndrome). The clinical features in all patients are discussed. In 1 patient the catatonic symptoms occurred within the context of AN, (perhaps due to metabolic disturbances) and in 2 other cases the psychotic features occurred after recovery from AN. The authors discuss the occurrence of psychotic features in AN, and the possible function of starvation and metabolic disturbances in their aetiology.

[Follow-up study of adolescents with anorexia nervosa]. / Odlegle wyniki leczenia dorastajacych chorych na jadlowstret psychiczny.

Analysis of the results of treatment of 132 patients hospitalized because of anorexia nervosa is presented. Average time of observation after hospitalization was 7,9/12 years. Mean age when the disease started was 13,7/12 years, when the analysis was performed--22 years. Catamnestic data were received directly from patients--46, from family members--25, from health service--3.18 sent answers by post, 40 neither contacted us nor answered to questionnaire. Analysis was founded on Morgan, Russel criteria, modified by Ratnasuriya. It showed that good results of treatment were received in 76% of all analyzed patients, in 11% they were intermediate, and poor in 12%. Two persons (2%) died. The social functioning of patients was found to be the best. More than half of the examined group had depressive and/or anxiety disorders. These disorders are significant in all the patients who remain chronically ill.

Fixation of carbon fibre-reinforced carbon composite implanted into bone.

The push-out test of three types of biomaterials: carbon fibre-reinforced carbon (CFRC), hydroxyapatite (HA), and surgical steel (SS) implanted into rabbits' femurs was carried out. Hydroxyapatite was used as a positive control (good fixation expected in bone) and surgical steel was a negative one (potentially no fixation in bone). Regeneration of bone in contact with all implants was found three months after implantation. The shear strength between CFRC implants and bone was lower than with the HA implants and higher than the shear strength between the surgical steel and bone. Compressive strength of CFRC implants removed after the observation period was significantly lower than the compressive strength of non-implanted samples. It is concluded that the mechanical bonding between the CFRC implants and host tissues exists 3 months after intrabone implantation and is accompanied by a decrease of the strength of implants.

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.