Osseointegration of hydroxyapatite coatings doped with silver nanoparticles: scanning electron microscopy studies on a rabbit model.

BACKGROUND: Modern joint arthroplasties rely on osseointegration of metal components through bone ingrowth into hydroxyapatite (HA) layers. However, such surfaces are prone to colonisation by bacteria and formation of biofilms. Application of silver nanoparticles (SNs) to hydroxyapatite coatings could reduce the risk of infection; however, little is known about how this would affect the process of bone ingrowth. This study examined osseointegration of conventional and SN doped HA coatings in a rabbit model. MATERIALS AND METHODS: In this study, 12 cylindrical implants coated with conven- tional and SN doped HA were implanted into New Zealand white rabbit femora, with each animal receiving both types of implants. After 12 weeks, rabbits were sacrificed, their femora were harvested and implants removed during pull-out testing. Retrieved samples were dehydrated, sputter coated and observed using a scanning electron microscope (SEM) to verify bony ingrowth and retention of SNs. RESULTS: The percentage of implant in direct contact with bone was measured in cross-sections of implants. The SEM analysis demonstrated that osseointegration of the SN doped coatings was similar to the conventional HA samples. A similar morphology of newly formed trabecular bone was observed in both implants, with silver doped HA-coated implants retaining multiple nanoparticles in areas which were not overgrown by bone. Analysis of the bone-implant contact area revealed comparable results for both types of coatings. These finding indicated that SN doped HA coatings are characterised by good osseointegrative properties. CONCLUSIONS: Since SNs were found in areas not covered by mineralised bone, it is assumed that the antimicrobial properties of the modified coating may be retained for 12 weeks after implantation. Additional studies are required to fine--tune the composition of HA coatings with SNs, to ensure optimal osseointegrative and antimicrobial properties.

Early development of the facial nerve in human embryos at stages 13-15.

Study was made on 16 human embryos at developmental stages 13-15 (fifth week). The facial nerve was traced on serial sections made in three planes (sagittal, frontal and horizontal) and stained with routine histological methods and impregnated with silver. In embryos at stage 13 the facial ganglion forms a complex structure with the vestibulocochlear ganglion. It is of fusiform shape in contact with epipharyngeal placode and is located anteriorly and ventrally to the vestibulocochlear ganglion. In embryos at stage 14 the facial ganglion separates from the vestibular and cochlear ganglia and the chorda tympani as the first branch appears. During stage 15 the main trunk of the facial nerve elongates and the greater petrosal nerve originates at the level of the facial ganglion and above the origin of the chorda tympani.

The use of a novel method of endovenous steam ablation in treatment of great saphenous vein insufficiency: own experiences.

OBJECTIVE: Endovascular procedures are gaining more and more popularity as treatment of great saphenous vein (GSV) incompetence. The purpose of the present study was to assess the efficacy of steam GSV ablation. METHODS: Steam ablation using the steam vein sclerosis system (CERMA, France) was performed in 20 patients with GSV incompetence. The efficacy of the procedure was evaluated using ultrasound and the following parameters were assessed: changes in lumen diameter, GSV wall thickness, reflux and presence/absence of blood flow. RESULTS: The GSV steam ablation resulted in the obliteration of the vein lumen in all patients - reflux or blood flow were not observed in any subject. A significant decrease of GSV lumen diameter and an increase of GSV wall thickness were also observed in all subjects following the procedure. No postoperative complications were noted. The steam ablation technique was also positively assessed by the patients. CONCLUSIONS: Steam ablation is an endovascular surgical technique, which can become popular and widely used due to its efficacy and safety. It is also easy to use and patient-friendly. The research on its use should be continued.

Ossification of the vertebral column in human foetuses: histological and computed tomography studies.

There is no agreement in the literature as to the time of the onset and progress of the vertebral column ossification. The aim of the present study was to determine the precise sequence of ossification of the neural arches and vertebral centra.Histological and radiographic studies were performed on 27 human foetuses aged from 9 to 21 weeks. It was found that the ossification of vertebrae commences in foetuses aged 10 and 11 weeks. Ossification centres appear first for neuralarches in the cervical and upper thoracic vertebrae and by the end of 11th week they are present in all thoracic and lumbar neural arches. In the vertebral centrain foetus of 10 weeks ossification was found in the lower 7 thoracic and first lumbar vertebrae. By the end of 11th week ossification is present in the lower 4 cervical, all thoracic, all lumbar and 4 sacral vertebral centra. The study indicates that ossification of the neural arches proceeds in the craniocaudal direction,whereas in the vertebral centra it progresses from the lower thoracic vertebrae into both directions. Different shapes of ossification centres were also described.

Consolidation of first-line therapy with busulphan and melphalan, and autologous stem cell rescue in children with Ewing's sarcoma.

According to the published report on current practice of hematopoietic SCT in Europe, high-dose therapy (HDT) with autologous stem cell support is a standard of care in paediatric patients with high risk (HR) or relapsed Ewing's sarcoma (ES). Randomized trials, however, have not confirmed the value of this procedure yet. In this retrospective analysis we intended to evaluate the role of HDT as a consolidation therapy in first remission of ES. A total of 102 patients were included in the analysis and divided according to the following risk factors: metastatic disease at presentation, feasibility of surgery and histological response after induction. Forty-one patients were classified as standard risk (SR) patients, while the remaining 61 children, with at least one risk factor, were classified as HR patients. HR group patients were non-randomized and qualified according to the decision of the local clinician to give a conventional consolidation (CC) or to perform high-dose chemotherapy and radiotherapy in selected patients. Twenty-six children were given CC while 35 patients were treated with HDT. The HDT consisted of oral BU 4 mg/kg p.o. in divided doses daily for 4 days (total dose 16 mg/kg) followed by melphalan 140 mg/m(2) i.v. on day -2. Probability of relapse-free survival (RFS) in median observation time was significantly worse in HR patients who were given CC therapy as compared with children with HR features receiving high-dose chemotherapy (0.27 vs 0.66 (P = 0.008); OS 0.31 vs 0.71 (P = 0.007), respectively). Patients from the SR group had a probability of RFS of 0.72 and OS of 0.75, and the difference between SR and HR patients after HDT was NS (P = 0.37). Our observation confirms that the consolidation of the first-line treatment with BU and melphalan improves the outcome in ES patients with HR features.

The removal of post-sclerotherapy pigmentation following sclerotherapy alone or in combination with crossectomy.

BACKGROUND: Sclerotherapy is a widely used method for the obliteration of blood vessels. Hyperpigmentation is a frequent complication that results from haemosiderin (FeO) accumulation. Hyperpigmentation and changes in the skin can be observed with ultrasound. OBJECTIVE: The aim of this study was to evaluate the efficacy of hyperpigmentation elimination using an intense pulse light generator (IPL) equipped with radio waves (RF) under ultrasonography (US) control. METHODS: Twenty-one women with permanent hyperpigmentation (after sclerotherapy or crossectomy combined with sclerotherapy) underwent a hyperpigmentation eliminating therapy with the use of IPL + RF and were monitored by using US. The thicknesses of the dermis and the subcutaneous tissue as well as the echogenicities of each layer were assessed. RESULTS: As a result of the therapy, a complete regression of hyperpigmentation was achieved in 90.48% of the women, and in 9.52% of the women, the therapy led to a reduction in hyperpigmentation but did not cause its complete disappearance. An increase in dermal echogenicity and a decrease in subcutaneous tissue echogenicity were observed, but there was no change in their thicknesses. After the therapy, the ultrasound images of areas of previous hyperpigmentation corresponded with images that were characteristic of healthy skin. CONCLUSION: IPL + RF therapy is effective for eliminating permanent skin hyperpigmentation after sclerotherapy. US is also useful in this therapeutic method.

The effectiveness of anticellulite treatment using tripolar radiofrequency monitored by classic and high-frequency ultrasound.

BACKGROUND: Cellulite affects nearly 85% of the female population. Given the size of the phenomenon, we are continuously looking for effective ways to reduce cellulite. Reliable monitoring of anticellulite treatment remains a problem. OBJECTIVE: The main aim of the study was to evaluate the effectiveness of anticellulite treatment carried out using radiofrequency (RF), which was monitored by classical and high-frequency ultrasound. METHODS: Twenty-eight women underwent anticellulite treatment using RF, 17 women were in the placebo group. The therapy was monitored by classical and high-frequency ultrasound. The examinations evaluated the thickness of the epidermal echo, dermis thickness, dermis echogenicity, the length of the subcutaneous tissue bands growing into the dermis, the presence or absence of oedema, the thickness of subcutaneous tissue as well as thigh circumference and the stage of cellulite (according to the Nürnberger-Müller scale). RESULTS: Cellulite was reduced in 89.286% of the women who underwent RF treatment. After the therapy, the following observations were made: a decrease in the thickness of the dermis and subcutaneous tissue, an increase in echogenicity reflecting on the increase in the number of collagen fibres, decreased subcutaneous tissue growing into bands in the dermis, and the reduction of oedema. In the placebo group, no statistically significant changes of the above parameters were observed. CONCLUSION: Radiofrequency enables cellulite reduction. A crucial aspect is proper monitoring of the progress of such therapy, which ultrasound allows.

Splenic arteriovenous fistula--late complications of splenectomy.

This is a case report of a 30-year-old female patient with a splenic arteriovenous fistula of rare, atypical clinical course. The patient was admitted to the hospital due to strong abdominal pains and fever. 13 years earlier, the patient underwent splenectomy due to post-traumatic rupture of the spleen. On imaging examinations prior to surgery (ultrasonography, CT), a splenic arteriovenous fistula was diagnosed. The patient was operated on due to increasing abdominal pain. The fistula was closed by splenic artery and splenic vein banding during the course of laparotomy. This case report will be discussed based on literature review.

Differentiation of the nuclear groups in the posterior horn of the human embryonic spinal cord.

The formation of nuclear groups in the posterior horns of the human embryonic spinal cord was traced in serial sections of embryos of developmental stages 13 to 23 (32 to 56 postovulatory days). The following observations, new for the human, are presented: 1. The differentiation of the neural tube into 3 zones (germinal, mantle and marginal) is detected in the middle of the 5(th) week. 2. The primordia of the posterior horns are marked at stage 14 (33 days). 3. In the middle of the 7(th) week the nucleus proprius and substantia gelatinosa are discerned. 4. Differentiation of the nuclei within the posterior horns proceeds in the ventrodorsal and rostrocaudal gradients.

Early development of the human palate in stages 16 and 17.

A study was performed on 12 human embryos at developmental stages 16 and 17 (6(th) week). In the investigated embryos the primary palate is formed from medial nasal, lateral nasal, and maxillary processes. The medial and lateral nasal processes merge and form the nasal fin at stage 16. This fin regresses and at stage 17 and persists as the oronasal membrane. The primordia of the secondary palate appear at stage 17.

Formation of the vertebral arches of the cervical, thoracic and lumbar vertebrae in early human foetuses.

Fusion of the neural arches was studied in 6 serially sectioned human foetuses aged 9 and 10 weeks. In foetuses of 9 weeks, the completion of arches was observed in the cervical, upper thoracic, and middle thoracic regions of the vertebral column. During the 10th week of development, fusion of neural processes progresses in the lower thoracic and upper three lumbar vertebrae.

Clinical utility of biochemical bone turnover markers in children and adolescents with osteosarcoma.

PURPOSE: Biochemical markers of bone turnover reflecting the intensity of all bone remodeling processes in skeleton are important for fast and non-invasive assessment of bone formation and resorption processes. They can be used in terms of both physiological and pathological states. The aim of this study was to investigate if bone metabolism markers can be clinically useful for monitoring of treatment in children and adolescents with osteosarcoma. MATERIAL/METHODS: The study consisted of 55 patients (median age 15 years) with osteosarcoma and 60 healthy age matched counterparts. Serum bone turnover markers (bone alkaline phosphatase - BALP, osteocalcin - OC and C-terminal telopeptide of type I collagen - CTX) were analyzed by immunoenzymatic methods in patients at time of diagnosis, during treatment and after therapy. RESULTS: We observed that before treatment the concentration of OC in patients with osteosarcoma was significantly lower (p<0.05) compared to that obtained in healthy children, however, BALP and CTX were at a similar level. During chemotherapy the values of bone formation and resorption markers significantly decreased by about 20-30%. After therapy we observed different concentrations of all bone turnover markers in patients with favorable and unfavorable prognosis. Median values of OC and BALP were over twofold higher in patients with progression as compared to patients with remission of disease (p<0.01 and p<0.001, respectively). Patients with poor prognosis had also higher serum concentration of bone resorption marker in comparison to patients with remission (p<0.01). CONCLUSIONS: Presented results suggest that bone turnover markers identify changes in bone metabolism in patients with osteosarcoma during anticancer therapy. These markers due to the non-invasive methods and their specificity might be useful in monitoring of clinical treatment of osteosarcoma patients.

White communicating rami in human embryos at the end of the fifth week.

White communicating rami were traced in 8 human embryos of developmental stages 14 and 15 (aged 33 and 36 postovulatory days, respectively). In embryos at stage 14 the white communicating rami were found in the spinal nerves T1 to T9. In embryos at stage 15 the white communicating rami were present at the spinal cord levels T1 to L3.

The first appearance of sympathetic ganglia in human embryos at stage 13.

The primordia of the sympathetic trunk ganglia were traced on serial sections of 10 embryos at stage 13 (32 postovulatory days). It was found that in all embryos, these primordia were present in the thoracic level T4 to T9 and they appeared as scattered aggregates of cells lying dorsally and laterally to the dorsal aortae.

Differentiation of the facio-vestibulocochlear ganglionic complex in human embryos of developmental stages 13-15.

A study was made on 18 embryos of developmental stages 13-15 (5(th) week). Serial sections made in horizontal, frontal, and sagittal planes were stained with routine histological methods and some of them were treated with silver. In embryos of stage 13, the otic vesicle is at the rhombomere 5, and close to the vesicle is the facial-vestibulocochlear ganglionic complex in which the geniculate, vestibular, and cochlear ganglion may be discerned. These ganglia are well demarcated in embryos of stage 14. In the last investigated stage (15(th)) the nerve fibres of the ganglia reach the common afferent tract.

Limb-salvage reconstruction with MUTARS hemipelvic endoprosthesis: a prospective multicenter study.

BACKGROUND: Limb-sparing surgery with hemipelvic megaprosthetic replacement is often limited by the high rate of associated complications. The aim of this evaluation was to assess clinical and oncological findings with respect to type, treatment and outcome of post-operative complications. METHODS: First results of 40 patients treated with individual MUTARS hemipelvic endoprostheses were evaluated in a prospective multicenter study. RESULTS: The mean follow-up period of the 27 male and 13 female patients was 24 months (range 1-61). The diagnosis was, in 29 cases, a primary bone or soft tissue sarcoma, in 11 patients, a metastasis. Clinical evaluation showed a mean Enneking score of 50% (range 10-70%). The oncological outcome revealed 25 patients (62.5%) alive with no evidence of disease. Seventeen of them had a primary tumour, eight a metastatic malignancy. Seven patients (17.5%) had died of their disease and eight (20%) were still alive but had developed a metastases and/or had had a recurrence of the primary tumour. The one- and two-year overall survival rate of the patients was 89% (+/- 0.10) and 81% (+/- 0.19), respectively. Post-operative complications occurred in 75% of the patients, predominantly wound-related disorders. The rate of implant revision was 22.5% with three septic and six aseptic cases of implant loosening. The estimated three-year-survival rate of the implant was 61.4% [CI95%: 0.36;0.87]. CONCLUSIONS: Periacetabular endoprosthetic replacement showed an acceptable functional and oncological outcome but had a high complication rate owing, predominantly, to infection. The indication for hemipelvic prosthesis in patients with a metastatic disease must be considered seriously.

Innervation of the human cervical and thoracic vertebrae at eight postovulatory weeks.

The nerves to the cervical and thoracic vertebrae were traced in 10 serially sectioned human embryos. It was found that the vertebral bodies receive nerve fibres from the trunks of the spinal nerves, anterior branches and meningeal branches of the spinal nerves, and from the sympathetic trunks. Slender twigs from the trunk of the spinal nerve arise close to the spinal ganglion and terminate in the posterior and lateral surfaces of the vertebrae. Fibres from the anterior branches of the spinal nerves terminate in the lateral and anterior surfaces of the vertebrae. Thin rami from the sympathetic trunk reach the anterior surface of the vertebrae.

The thickness of the ventral midline of the spinal cord in human embryos during the fifth week.

The thickness of the ventral midline of the spinal cord was determined in 9 human embryos aged five weeks (developmental stages 13-15). This part of the spinal cord consists of floor plate, mantle and marginal layers. The floor plate ependymal cells form pseudostratified columnar epithelium. The thickness of the investigated structure varied from 20 to 50 micrometers at different levels of the spinal cord.

Early trabeculation and closure of the interventricular foramen in staged human embryos.

Internal differentiation of the ventricles was studied in staged serially sectioned human embryos of developmental stages 13-19 (postovulatory days 32-46). At stage 13 the trabeculation of both ventricles was advanced and the muscular part of the interventricular septum well marked. Dorsal and ventral endocardial cushions were fused and the atrioventricular canal was divided into two parts. In embryos at stage 18 the membranous interventricular septum was developing and the interventricular foramen was obliterated. At stage 19 the membranous part of the interventricular septum was becoming more cellular in structure.

Skeletal units of the human embryonic mandible.

The development of the mandible was traced on serial sections of 20 human embryos aged 5-8 weeks (developmental stages 13-23). Special consideration was given to the differentiation of skeletal units proposed by Sperber. The first skeletal units, namely the mandibular body, the alveolar unit and the condylar unit, may be distinguished in the 7(th) week. The primordia of all units are identified by the end of the embryonic period (8 weeks).