Injection of embryonic stem cells into scarred rabbit vocal folds enhances healing and improves viscoelasticity: short-term results.

OBJECTIVES: Scarring caused by trauma, postcancer treatment, or inflammation in the vocal folds is associated with stiffness of the lamina propria and results in severe voice problems. Currently there is no effective treatment. Human embryonic stem cells (hESC) have been recognized as providing a potential resource for cell transplantations, but in the undifferentiated state, they are generally not considered for therapeutic use due to risk of inadvertent development. This study assesses the functional potential of hESC to prevent or diminish scarring and improve viscoelasticity following grafting into scarred rabbit vocal folds. STUDY DESIGN: hESC were injected into 22 scarred vocal folds of New Zealand rabbits. After 1 month, the vocal folds were dissected and analyzed for persistence of hESC by fluorescence in situ hybridization using a human specific probe, and for differentiation by evaluation in hematoxylin-eosin-stained tissues. Parallel-plate rheometry was used to evaluate the functional effects, i.e., viscoelastic properties, after treatment with hESC. RESULTS: The results revealed significantly improved viscoelasticity in the hESC-treated vs. non-treated vocal folds. An average of 5.1% engraftment of human cells was found 1 month after hESC injection. In the hESC-injected folds, development compatible with cartilage, muscle and epithelia in close proximity or inter-mixed with the appropriate native rabbit tissue was detected in combination with less scarring and improved viscoelasticity. CONCLUSIONS: The histology and location of the surviving hESC-derived cells strongly indicate that the functional improvement was caused by the injected cells, which were regenerating scarred tissue. The findings point toward a strong impact from the host microenvironment, resulting in a regional specific in vivo hESC differentiation and regeneration of three types of tissue in scarred vocal folds of adult rabbits.

Modes of failure of a threaded acetabular cup : a radiographic study with EBRA of 42 revised cups.

A radiographic study of a singular type of threaded cup, revised due to aseptic loosening, was performed with Einzel-Bild-Roentgen-Analyse (EBRA) to detect eventual risk factors and patterns of loosening. Fifty-three cups of 50 patients were revised. Forty-two cups could be measured with EBRA. No cup had obvious osteolysis, 33 cups demonstrated early migration, and all cups had migrated at the time of revision. Twenty-eight of the cups had a change of inclination and 21 of anteversion, respectively. The mean migration was 1.9 mm in the medial and 7.9 mm in the cranial direction; the mean wear rate was 0.2 mm/year. Cups with early migration had a higher migration rate. All male patients had early migration; medially placed cups had less migration than the other cups. Wear was not significantly affected by the migration of the implant. No cup had a complete radiolucent line, and the only radiographic sign for loosening was the change of position of the cup. Medial placement showed less migration in case of loosening. Regular radiographic follow-up is recommended for the examined implant, and the cup should not be used in the future.

High tibial osteotomy: does navigation improve results?

Between January 2003 and March 2006, the authors performed 67 open-wedge high tibial osteotomies (HTO) for treatment of genu varum and osteoarthritis. Through comparison of two groups, the study sought to answer whether computed tomography (CT)-free navigation is feasible for HTO and will provide a more accurate correction angle without giving rise to additional complications. The results showed a significantly higher accuracy in achieving the proper leg axis correction (P< .016) when HTO was performed with navigation. Navigation in HTO, which allows intraoperative calculation of the leg axis, seems to be a reliable and safe procedure. Knowing that clinical results of HTO in varus deformity of the leg axis are closely connected to correct postoperative valgus alignment and avoiding overcorrection and undercorrection, the study lead to the conclusion that the use of navigation will contribute to better clinical outcomes.

Preoperative marking of musculoskeletal tumors guided by magnetic resonance imaging.

BACKGROUND: The purpose of this study was to evaluate a new stereotactic method for preoperative coil-marking of musculoskeletal tumors with use of interventional magnetic resonance imaging. METHODS: Nine patients with a soft-tissue or bone-marrow tumor were referred to our department for preoperative marking of the extent of the lesion. In one patient, two lesions were marked. Guidance for the punctures and the delivery of the coils was provided by an open low-field magnetic resonance imaging system with horizontal access. After imaging of the extent of the lesion, magnetic resonance imaging-compatible titanium coils were placed with use of nearly real-time or step-by-step magnetic resonance imaging control. The coils were placed up to seventy-two hours before the surgery. The inclusion of the tumor borders within the area of the excision was examined with cross-sectional histological analysis of surgical specimens. RESULTS: The tumor-marking intervention was successfully performed with the guidance of magnetic resonance imaging only in all patients. Preoperatively, nineteen coils were used to mark the ten lesions in the nine patients. All of the coils were easily located with intraoperative fluoroscopy. No coil migrated between the time of the percutaneous marking and the surgery. Histological examination of the resection borders revealed no residual tumor cells. No complications were observed, and, after a mean of twenty-three months of follow-up, no tumor had recurred. CONCLUSIONS: Preoperative coil-marking guided by magnetic resonance imaging for exact delineation of a musculoskeletal tumor is technically feasible and can readily demonstrate the full extent of the tumor. Use of magnetic resonance fluoroscopy reduces the time needed for the intervention. We recommend the coil-marking technique.