Influence of chemical allograft preservation procedures on the human immunodeficiency virus.

Since chemically preserved allogenic transplants have an established place in reconstructive procedures, the possibility of transferring the human immunodeficiency virus (HIV) with these transplants has been intensively discussed. In this study the authors obtained brain and spleen samples from six HIV-infected cadavers and preserved them with Merthiolate, Cialit, and formaldehyde. After preservation, the tissues were examined for proviral HIV-1 DNA (gag, pol, env) using the polymerase chain reaction. Proviral sequences were clearly demonstrated after the preservation procedure. The results of this study indicate that HIV remains in tissues that have been treated with Merthiolate, formaldehyde, or Cialit. Further investigations are necessary to determine if the virus is in an inactivated or activated form. It can be concluded that, because of the possible transmission of HIV by chemically preserved homografts, serologic screening of donors should be mandatory.

A comparative electron microscopic study of chemical techniques for preservation of auditory ossicles as homografts.

The ultrastructure of preserved ossicles at different shelf lives was compared. Homograft ossicles were harvested and preserved in 70% alcohol, 1:5000 Cialit (sodium-2-ethyl-mercuri-mercapto-benzoxazole-5-carboxylate), and buffered 4% formaldehyde at pH 7. The ultrastructure of each ossicle was studied by both scanning and transmission electron microscopy and was compared to that of fresh controls placed in 0.9 N saline solution. The results indicated clearly the superiority of 70% alcohol as a long-term preservative and 1:5000 Cialit as a short-term preservative.

Toxic keratopathy due to the accidental use of chlorhexidine, cetrimide and cialit.

Due to economical reasons some ophthalmologists are using an irrigating solution made by the hospital pharmacy instead of the commercially available solutions. These irrigating solutions come in bottles which are identical to the ones used for other solutions. During the last three years bottles were accidentally mixed up five times. Consequently, bottles containing solutions such as chlorhexidine, cetrimide, chlorhexidine/centrimide and cialit solutions were used during cataract surgery. This resulted in immediate corneal edema which, in its turn resulted in a bullous keratopathy. Four patients underwent a penetrating keratoplasty. In one patient the cornea was covered with a conjunctival flap. Light microscopy of the corneas included epithelial edema, loss of keratocytes, and a disrupted and sometimes absent endothelial cell layer.

[Comparative study of the effect of different chemical procedures on the antigenicity of allogenic transplants of the human trachea]. / Estudio comparativo del efecto de distintos procedimientos químicos sobre la antigenicidad de trasplantes alógenos de tráquea humana.

Replacement of long tracheal segments poses some unsolved problems, specially the undisponibility of an adequated substitution material. This study deals with some of the immunological aspects of the transplantation and preservation of human tracheal grafts. Since immunological rejection occurs in the first place as a consequence of incompatibility for class II antigens (HLA-DR, -DP and -DQ), their presence and distribution was studied using monoclonal antibodies and the immunoperoxidase method. Class II expressing cells were recognized in the mucosa and the mixed glandular tissue. Furthermore we investigated the influence of different preservation methods on the antigenicity of tracheal allografts. The results showed a total destruction of these antigens. We can conclude that chemically preserved human tracheal allografts are immunologically suitable for reconstructive surgery of the trachea.

A comparison of class II antigenicity of human tracheal allografts stored in cialit and in merthiolate.

This report deals with some of the immunological aspects of the transplantation and preservation of human tracheal grafts. The immunological behavior of the transplanted graft depends largely on the interaction of the preservatives with the tissue proteins. Using monoclonal antibodies and the immunoperoxidase staining technique we have investigated the effect of Merthiolate, Cialit, formaldehyde/Merthiolate, and formaldehyde/Cialit preservation techniques on monomorphic determinants of class II transplantation antigens in human tracheal allografts. Unpreserved grafts were found to express class II antigens. These antigens were totally destroyed after 7 days in formaldehyde and 42 days in Cialit and Merthiolate. Preservation in Cialit and Merthiolate showed a gradual disintegration of the histological structures. In contrast, buffered formaldehyde did not appear to alter the histological structure of the tracheal graft. Irrespective of the mode of preservation, the cartilaginous tissue appeared to persist virtually unaffected. No essential differences were observed between the immunological staining of tracheal grafts preserved in Cialit and Merthiolate.

[Are cialit-preserved ossicles as middle ear implants still bacteriologically defensible? Their replacement by pre-formed implants fashioned from teeth]. / Sind Cialit-konservierte Ossikel als Mittelohrimplantate bakteriologisch noch vertretbar? Ihr Ersatz durch vorgefertigte Implantate aus Zähnen.

Recent studies have demonstrated a limited bactericidal activity of Cialit in the preservation of otologic transplants. The authors therefore performed several tests following routine treatment of the grafts. First, the contamination of allogenic ossicles was studied; afterwards, the bactericidal activity of Cialit was tested against standardized germs and clinical isolates. At the highly toxic concentration of 1:2000, Cialit is bactericidal. For clinical purposes, however, the less toxic solution of 1:5000 is generally used, which is not sufficiently safe against certain resistant clinical isolates. The fact that the activity of Cialit depends on its concentration explains the controversial findings in the literature. Furthermore, it is doubtful whether a weaker solution would prevent transmission of an HIV or hepatitis infection. Therefore, the authors recommend the autoclaving of otologic allografts. This also has forensic reasons; for example if the serologic status of the donor is unknown. As ossicles become brittle under this procedure, the authors now use sculptured parts of teeth, in which the hydroxyl-apatite is much more compact. The preformed prostheses can be autoclaved without problem. More than 150 reconstructions have proved the acceptance of this cheap implant material. Furthermore, forensic problems with ossicles from corpses do not arise.

Progressive fatal dementia (Creutzfeldt-Jakob disease) in a patient who received homograft tissue for tympanic membrane closure.

We report the case history of a 54-year-old man who developed a fatal neurological disorder 4 years after a successful tympanoplasty with homograft pericardium. The final diagnosis of this case was Creutzfeldt-Jakob disease. This infectious spongiform encephalopathy is probably caused by a slow virus that can be transmitted by transplantation materials. The possible accidental transmission of Creutzfeldt-Jacob disease by the use of homograft materials in otologic surgery is discussed.

Microwave treatment of xenogeneic cartilage transplants.

Human rib cartilage was irradiated with microwaves according to six different methods and transplanted into rabbits. Untreated rib cartilage preserved in Cialit served as a control. After 12 and 40 wk of implantation, the microscopic appearance of these xenogeneic cartilage transplants was given a score in comparison with the transplants preserved in Cialit. The microwave treatment of the cartilage appeared to improve the results. The Cialit-preserved transplants showed progressive resorption by macrophages with central necrosis and fragmentation, which was not present in the microwave-treated grafts. Microwaves seem to stabilize the cartilage matrix and enhance the diffusion of fixatives. Irradiation in ethanol as an immersion fluid appeared to be the best method. The results of transplantation can benefit from the use of microwaves in the preservation of the cartilage. It is argued that, in addition, microwave irradiation might be used for inactivation of human immunodeficiency virus in human cartilage used for transplantation.

Influence of the mode of preparation on the distortion and consistency of homologous costal cartilage implants.

Nasal implants of autologous costal cartilage have an undesirable tendency to distortion. This tendency may be reduced by the process of devitalization, which occurs in the preparation of homologous costal cartilage for storage in a tissue bank. An in vitro study has been undertaken, utilizing five common methods of cartilage preparation (cialit, ethyl alcohol, formalin, glutaraldehyde and irradiation) to determine whether there is any significant variation in the degree of distortion which occurred and any variation in cartilage consistency. We conclude that all of the methods evaluated would produce banked homologous costal cartilage with an equally low incidence of distortion but implants are less readily carved from cartilage stored in cialit.

[Lateral ligament replacement of the ankle joint--cialit graft or tendon graft? A comparative clinical study from the Balgrist Orthopedic University Hospital, Zürich]. / Lateraler Bandersatz am Sprunggelenk--Cialithautplastik oder Sehnenplastik? Eine vergleichende klinische Studie aus der Orthopädischen Universitätsklinik Balgrist, Zürich.

Of a total of 268 patients who were operated because of ankle instability, 125 who were treated with cialit skin graft and 101 who received a peroneal tendon graft were interrogated. 36 were clinically and radiologically examined. Apart from some very minor disturbances, neither during the period immediately after surgery nor later, were the subjective or objective results significantly different. This observation demands that no surgical technique should be employed that could interfere with the function of proprioceptive or constraining structures.

Cialit preserved cartilage: failure to guarantee sterility.

Homograft cartilage preserved in Cialit solution became contaminated with Pseudomonas fluorescens, making it unsuitable for reconstructive surgery. Cialit solution has no virucidal activity, and the risk of viral infections such as AIDS and hepatitis is a further reason not to use it as a storage solution for cartilage.

'Cialit' as a tissue preservative: a microbiological assessment.

We describe bacterial contamination of a 'Cialit'-preserved cartilage bank which continued after a variety of changes to the harvesting and preservation protocols during a 3-year prospective study. Our results emphasize the importance of adequate tissue bank microbiological screening. Alternative methods of tissue preservation should be considered.

[Transmissibility of HIV infections via allogeneic transplants]. / Zur Ubertragbarketi von HIV-Infektionen durch allogene Transplantate.

HIV-infections can be transferred by blood and blood products, semen or organ transplants. For this reason, the WHO recommended a screening of all donors of blood, semen, tissues and organs. Those who belong to high-risk groups should be excluded from donations. If this recommendation should be also applied to cialit preserved auditory aussicles, this would probably mean the end of allogeneic transplantations of middle-ear surgery which are being performed daily. Therefore, we carried out experimental examinations with HIV-infected auditory aussicles in cialit. According to our results, it can be assumed that a virus-destruction takes place via a cialit-treatment. The same applies to solvent-dried fascia as to auditory aussicles which have been preserved in the same way. Consequently, there is no objection to further application of these allogeneic transplants in respect to HIV-infections.

The use of sodium sulfide to separate mercury from tissues preserved in Cialit and Merthiolate solutions.

The purpose of the present experiment was to look at the dissolution time in physiological sodium chloride (0.9% NaCl) and sodium sulfide (Na2S) of any mercury (Hg) contained in human auditory ossicles and cartilage after preservation in Cialit and Merthiolate. Both homograft tissues produced almost identical graph complexes. Under static conditions 10 micrograms Hg could be found in NaCl after 15 min, whereas there was complete demercurization after 3 min in Na2S. The dissolution time in NaCl subjected to constant stirring was about 10 min and was less than 1 min in Na2S. For the rapid elimination of Hg from auditory ossicles stored in preservatives containing Hg, our studies show that the use of a flowing solvent is advisable. Further, the extraction of Hg is quicker in sodium sulfide than in an isotonic solution of sodium chloride.

Preservation of otologic homografts.

Techniques for preservation of homografts for replacement of tympanic membranes, ossicles, closure of the oval window, and canalplasty remain controversial. Review of 300 articles reveals no evidence opposing the harvesting of grafts from living patients or cadavers, or the prolonged storage of these materials in antibacterial solutions. It appears to be important to store the grafting material long enough to reduce antigenicity. Numerous techniques and materials are being used with success. Additional research on antigens, histologic fate of grafts, long-term success, and complications is essential to determine ideal grafting materials, preservatives, and techniques.

[The surgical treatment of large eventrations using skin homografts preserved in cialit]. / Le traitement chirurgical des grandes éventrations par l'homogreffe de peau conservée au cialit.

52 persons who had been operated upon for large eventration by means of Cialit dermatoplasty were re-examined after an interval of 2 to 12 years. After a description of the operating technique, the immediate and then the long-term results are analysed. The quantity of mercury in the blood and the urine of 7 patients never shows an increase that reaches the critical threshold. The figures obtained go down to reference values found in the case of non-exposed persons after 9 months in the blood and 4 months in the urine. A fresh intervention in the case of 3 patients has permitted a histological examination of the cicatrix after Cialit skin transplantation. Analysis confirms the excellent tolerance of the material and its integration with the tissues of the recipient. The interest of this technique in an infected environment is to be emphasized.

[Preservation and application possibilities of allogenic (homologous) transplants in the ear, nose and throat region]. / Konservierung und Anwendungsmöglichkeiten allogener (homologer) Transplantate im Hals-Nasen-Ohrenbereich.

Of the allogenic transplants used in head and neck surgery, auditory ossicle transplants, allogenic cartilage transplants and fascia transplants have yielded good results in many cases. Recent reports describe the successful use of allogenic tracheal tissue. Auditory ossicles are most commonly preserved in cialite solution, while cartilage transplants are best preserved in merthiolate solution.