Treatment of keloids and hypertrophic scars using topical and intralesional mitomycin C.

BACKGROUND: Keloids develop due to the overgrowth of fibrous tissue. Currently, there is no gold standard treatment for keloids and hypertrophic scars (HTS). Their propensity for local invasion and recurrence has prompted many investigations on antineoplastic agents. OBJECTIVES: To investigate the efficacy of topical and intralesional mitomycin C for the treatment of keloids and HTS. METHODS: Nine patients with clinically diagnosed keloids and HTS were treated using topical mitomycin C (1 mg/mL) for 3 min after shaving excision. The Vancouver Scars Scale, patient satisfaction, and adverse effects were checked after 6 months. The keloids and HTS were photographed at each monthly visit. Intralesional mitomycin C (1 mg/mL) was administered to study the effect on the regression of keloids in 2 patients. RESULTS: Application of mitomycin C to the base of shave-removed keloids and HTS showed good results. Six out of 9 patients were very satisfied with the outcome of treatment; none were disappointed. The results of intralesional mitomycin C treatment were disappointing. Both cases worsened, with increased ulceration after treatment. CONCLUSIONS: Topical application of mitomycin C following shaving excision was safe and effective for the treatment of keloids and HTS. However, intralesional mitomycin C therapy aggravated both lesions.

Epidemiological investigation of outbreaks of fowl adenovirus infection in commercial chickens in Korea.

In total, 39 clinical cases of fowl adenoviruses (FAdV) infection in chickens (28 broiler, 7 native, and 4 layer chickens) between 2007 and 2010 in Korea were investigated. The FAdV types 4, 8b, and 11 comprised 18, 9, and 12 clinical cases, respectively. All FAdV type 4 cases showed clinical hydropericardium (HPS) lesions as well as inclusion body hepatitis (IBH), whereas all FAdV types 8b and 11 cases exhibited IBH lesions without HPS. All 3 types were detected in broiler (9-30 d old) and layer chickens (23-112 d old), whereas most native chickens (14-65 d old) were affected only by FAdV type 4. Infectious bursal disease virus and chicken infectious anemia virus were complications in 51.3% of FAdV cases, with mortalities of 55% to <0.1%. Chicken infectious anemia virus was detected in all native chicken cases. These results indicate that preventive measures against FAdV infection and immunosuppressive diseases on poultry farms should be implemented.

Effects of homologous and heterologous neuraminidase vaccines in chickens against H5N1 highly pathogenic avian influenza.

The 2004 Asian H5N1 epizootic outbreak indicates the urgent need for vaccines against highly pathogenic avian influenza (HPAI) virus. The manufacture of inactivated whole-virus vaccines from HPAI viruses by traditional methods is not feasible for safety reasons as well as technical issues. The low pathogenic avian influenza A/wild bird feces/CSM2/02 (H5N3) virus was used as a heterologous neuraminidase vaccine, and HPAI A/CK/Korea/ES/03 (H5N1) virus was used as a homologous neuraminidase vaccine. Protection efficacy of both vaccines was evaluated by clinical signs, mortality rates, and virus shedding from oropharynx and cloaca of vaccinated chickens after challenge with HPAI A/CK/Korea/ES/03 (H5N1) virus. One dose of 128 hemagglutinin (HA) homologous H5N1 vaccine induced 100% protection in mortality and prevented viral shedding completely after lethal dose virus challenge, whereas one dose of 64 HA unit of heterologous H5N3 vaccine only induced 50% protection in mortality, and it did not prevent viral shedding. However, two doses at a 3-wk interval of 64 HA unit of heterologous H5N3 vaccine as well as one dose of 1024 HA unit of heterologous H5N3 vaccine induced 100% survival rate and could prevent viral shedding completely. Furthermore, we could differentiate the sera of infected birds from those of vaccinated birds by indirect immunofluorescent antibody test. These results suggest that heterologous neuraminidase H5N3 vaccine could be a useful tool for the control of H5N1 HPAI epidemic in poultry.

Doppler flow velocity mapping in an in vitro model of the normal pulmonary artery.

Pulsed Doppler pulmonary artery velocity measurements are useful in evaluating a number of cardiac conditions including pulmonary hypertension, pulmonary stenosis and insufficiency, intracardiac shunts and other congenital abnormalities. However, variations in sample location relative to the arterial wall and valve have been thought to affect pulmonary artery velocity and acceleration measurements clinically. Therefore, pulsed Doppler and color flow mapping were performed in a pulsatile flow apparatus connected to a glass or Plexiglas model of the main pulmonary artery and its bifurcation, which contained a Hancock 29 mm pericardial tissue valve (5.35 cm2 orifice). Doppler sample volumes were placed at four sites: 1) at the pulmonary valve leaflet tips, centrally; 2) 2 cm distal to the leaflet tips, centrally; 3) 2 cm distal but laterally near the pulmonary artery wall; and 4) at the pulmonary artery bifurcation, centrally. Doppler peak flow velocity and acceleration time were measured. There was no difference between sites 1 and 2 in peak flow velocity or acceleration time. At site 3, peak flow velocity and acceleration time were both less than at site 1 (mean +/- SD, 85 +/- 44 versus 105 +/- 39 cm/s, p less than 0.005, and 162 +/- 65 versus 188 +/- 46 ms, p less than 0.03, respectively). Moreover, the pulmonary artery velocity contour at site 3 exhibited increased spectral dispersion and notching and increased variance on the color spectrum. At site 4, peak flow velocity was less than at site 1 (85 +/- 31 versus 105 +/- 39 cm/s, p less than 0.005), whereas pulmonary artery acceleration time was not significantly different. In this model, Doppler pulmonary artery flow velocity was best recorded within 2 cm of the valve and in the center of the vessel. Similar studies should be performed in the human pulmonary artery to standardize the recording technique and sample sites for Doppler measurements of velocity and acceleration.

Review of hydrodynamic principles for the cardiologist: applications to the study of blood flow and jets by imaging techniques.

An understanding of the basic concepts of the physics of blood flow is of vital importance to the cardiologist as he or she attempts to utilize new blood flow imaging modalities, such as Doppler ultrasound and nuclear magnetic resonance imaging. Concepts such as the Bernoulli equation and its limitations, the continuity equation and volume flow calculations and the theory of free and confined jets have applications in cardiac blood flow-related problems. For example, mitral regurgitant flow may be treated with the free jet theory. Aortic stenosis results in confined jet flow. It is important that the cardiologist understand the basic principles behind these hydrodynamic concepts so that he or she can use them in appropriate applications. The limitations of the simplification of complex hydrodynamic relations that are used clinically need to be clearly understood so that these simplified principles are not used improperly or used to draw oversimplified conclusions.

Factors influencing the structure and shape of stenotic and regurgitant jets: an in vitro investigation using Doppler color flow mapping and optical flow visualization.

To evaluate factors influencing the structure and shape of stenotic and regurgitant jets, Doppler color flow mapping and optical flow visualization studies were performed with use of a syringe model with a constant rate of ejection to simulate jets of valvular regurgitation and a pulsatile flow model of the right heart chambers to simulate jets of mild, moderate and severe valvular pulmonary stenosis. Ink-(0 to 40%) glycerol-water jets (viscosity 1 to 3.5 centiPoise) were produced by injecting the fluid at a constant rate into a 10 gallon rectangular reservoir of the same still fluid through 1.4 and 3.4 mm needles. The Doppler color flow scanners imaged the laminar jet length within 3 mm of actual jet length (2 to 6 cm) and the jet width within 2 to 3 mm of the actual jet width. Jet flows with Reynolds numbers ranging from 230 to 1,200 injected into still fluid yielded jet length/width ratios that decreased with increasing Reynolds numbers and leveled off to a length/width ratio of 5-6:1 at a Reynolds number near 600. When the fluid reservoir was swirled to better mimic the effect of flow entering the same cardiac chamber from a second source, the jets showed diminution of the jet length/width ratio and a clearly defined zone of turbulence. Studies of the pulsatile flow model were performed at cardiac outputs of 1 to 6 liters/min for the normal and each stenotic valve. Mild stenosis had an orifice area of 2.8 cm2, moderate stenosis an area of 1.0 cm2 and severe stenosis an area of 0.5 cm2. Laminar jet length represented the length of the total jet, which had a symmetric width and was measured from the valve opening to a region where the jet exhibited a spray effect. Laminar jet lengths (0.2 to 1.1 cm) were imaged by Doppler color flow mapping and optical visualization only in the moderate and severely stenotic valves and only at flows less than or equal to 3 liters/min (mean Reynolds numbers less than or equal to 3,470). Beyond this flow rate the jets exhibited a spray effect. Laminar jet length/width ratio approached unity with an increased amount of valvular stenosis and higher flow volumes (cardiac output). Proximal aliasing was present in each valve studied. the length of aliasing (0 to 3.2 cm) proximal to the valve was longer with increased flow rates and increased amounts of stenosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Spatial velocity distribution and acceleration in serial subvalve tunnel and valvular obstructions: an in vitro study using Doppler color flow mapping.

To evaluate the spatial distribution of flow velocities, turbulence and spatial acceleration in serial tunnel-valve obstruction, Doppler color flow mapping was performed in a pulsatile flow model with a tunnel obstruction (1.0 or 1.5 cm2) inserted at 2, 20 and 40 mm proximal to a mildly stenotic bioprosthetic valve studied at flow rates of 1, 2.7 and 4.9 liters/min. Measured pressure gradients were consistently higher across the tunnel (mean +/- SD 32.7 +/- 26.5 mm Hg) than across the tunnel plus valve (28.8 +/- 26.9 mm Hg, p less than 0.01). Doppler color flow map images were analyzed using a Sony RGB video-digitizing computer, providing numerical velocity assignments for the blue, red and green (variance) pixel components to allow the flow maps to be constructed into digital velocity maps and pseudo three-dimensional velocity maps. The maximal velocity stream extended distal to the tunnel (2 to 19 mm), and the length of this extension correlated well with the pressure gradient measured across the tunnel (r = 0.89), with a rapidly decelerating and turbulent spray area seen immediately distal to the valve. Pressure gradient calculated from the maximal velocity derived from the color flow map, which could only be estimated from the velocity maps for the 1.5 cm2 tunnel, correlated well with the gradient measured across the tunnel (18.0 +/- 14.1 versus 19.2 +/- 14.5 mm Hg, respectively, r = 0.98). Acceleration was seen proximal to both tunnels.(ABSTRACT TRUNCATED AT 250 WORDS)

Highly pathogenic avian influenza in magpies (Pica pica sericea) in South Korea.

Highly pathogenic avian influenza (HPAI) is an extremely infectious, systemic viral disease of birds that produces high mortality and morbidity. HPAI was diagnosed in the three dead magpies (Pica pica sericea) submitted to the National Veterinary Research and Quarantine Service. At necropsy, the prominent lesions were multifocal or coalescing necrosis of the pancreas with enlargement of the livers and spleens. Microscopically, there were severely necrotizing pancreatitis and lymphocytic meningoencephalitis. Influenza viral antigen was also detected in areas closely associated with histologic lesions. Avian influenza virus was isolated from cecal tonsils and feces of the magpies. The isolated virus was identified as a highly pathogenic H5N1, with hemagglutinin proteolytic cleavage site deduced amino acid sequence of QREKRKKR/GLFGAIAG. To determine the pathogenicity of the isolate, eight 6-wk-old specific-pathogen-free chickens were inoculated intravenously with the virus, and all birds died within 24 hr after inoculation. This is the first report of HPAI in magpies.

Doppler echocardiographic study of porcine bioprosthetic heart valves in the aortic valve position in patients without evidence of cardiac dysfunction.

To study the natural history of the hemodynamic performance of bioprosthetic heart valves, Doppler echocardiograms were recorded in a group of clinically stable patients at 2 and 5 years after replacement of native aortic valves with bioprosthetic valves. Eighteen patients completed a 2-year and 26 patients a 5-year follow-up examination. The effective orifice areas of identical models of bioprosthetic valves (Hancock II) were determined in vitro in a left-sided heart pulse duplicator system. In vivo Doppler-derived effective orifice areas were compared with the in vitro measurements for the same valve size. At both the 2- and 5-year follow-up examinations, the Doppler-derived effective orifice area was significantly less than the in vitro area (p less than 0.0001 at each interval). Ten of 16 valves evaluated serially decreased greater than 0.20 cm2 in the Doppler-derived effective orifice area between studies. The mean decrease in effective orifice area in valves evaluated serially was 0.25 +/- 0.29 cm2 (p less than 0.005). The peak transaortic gradient increased from 21 +/- 6 to 27 +/- 8 mm Hg (p less than 0.01). The mean transaortic gradient increased from 12 +/- 4 to 15 +/- 7 mm Hg (p less than 0.05). It is concluded that serial Doppler echocardiographic studies demonstrate a deterioration in the hemodynamic performance of bioprosthetic valves over time in patients with no symptoms or signs of valvular dysfunction and that Doppler echocardiography may be useful for identifying subclinical bioprosthetic valvular dysfunction.

In vitro velocity and turbulence measurements in the vicinity of three new mechanical aortic heart valve prostheses: Björk-Shiley Monostrut, Omni-Carbon, and Duromedics.

The in vitro velocity and turbulent shear stress fields created by three new mechanical valve designs (size 27 mm) were studied in the aortic position under pulsatile flow conditions. The following valves were studied: Björk-Shiley Monostrut tilting disc, Omni-Carbon tilting disc, and Duromedics bileaflet. All three valve designs created low pressure gradients with effective orifice areas in the range of 3.10 to 3.90 cm2. Both tilting disc designs created major and minor orifice jets, which were asymmetric in size. The peak velocities of the major and minor orifice jets were, however, of the same magnitude (200 cm/sec). The Omni-Carbon valve created a more even flow distribution through the minor orifice compared with the Björk-Shiley design. Regions of stagnation/flow separation were observed immediately adjacent (ie, distal) to the minor orifice strut and the pivot guards of the Björk-Shiley and Omni-Carbon valve designs, respectively. The Duromedics valve created relatively centralized flow. However, a major portion of the flow occurred through the two lateral orifices. Regions of flow separation/stagnation were observed adjacent to the valve sewing ring in the area of the valve pivot (hinge) mechanism. All three valve designs did create elevated turbulent shear stresses, with peak values in the range of 1000 to 2000 dynes/cm2 and mean values in the range of 100 to 1000 dynes/cm2. Such elevated shear stresses could cause sublethal and/or lethal damage to cellular blood elements. In an overall analysis, these new-generation low-profile mechanical valves are hemodynamically comparable to the Medtronic Hall and St. Jude Medical mechanical valves and are superior to the older-generation mechanical valves. However, it is unlikely that these valve designs will eliminate the problems of thrombosis, thromboembolic complications, and hemolysis.

Reconstruction of the right ventricular outflow tract with a bovine jugular vein graft fixed with a naturally occurring crosslinking agent (genipin) in a canine model.

OBJECTIVE: This study was designed to evaluate a newly developed biologic valved conduit fixed with genipin used to reconstruct the right ventricular outflow tract in a canine model. METHODS: Fresh bovine jugular veins with a retained native valve procured from a slaughterhouse were used as raw materials to fabricate the valved conduits. A naturally occurring crosslinking agent, genipin, was used to fix the procured jugular veins. The glutaraldehyde-fixed counterpart was used as a control. A canine model was used in the study. RESULTS: Echocardiography revealed that the motion of the valvular leaflets in both the glutaraldehyde- and genipin-fixed conduits was satisfactory. The transvalvular pressure gradients of both studied groups were minimal. No endothelium-like cells were observed on the luminal surface of the conduit and the valvular leaflet for the glutaraldehyde-fixed group throughout the entire course of the study. In contrast, endothelium-like cells were observed on the entire surface of the genipin-fixed valved conduit retrieved at 6 months postoperatively in all the cases studied. There was no evidence of luminal fibrous peel in any the valved conduits studied. Degradation of valvular leaflet in one of the glutaraldehyde-fixed conduits was observed. In this particular case, thrombus formation was also observed on the surface of the valvular leaflet. On the other hand, no apparent degradation or thrombus formation was observed on the surfaces of the genipin-fixed valvular leaflet and conduit. A significantly more severe inflammatory reaction was observed for the glutaraldehyde-fixed conduit than for its genipin-fixed counterpart throughout the entire course of the study. The calcium contents of the samples before implantation and those retrieved at distinct implantation duration were minimal for both the glutaraldehyde- and genipin-fixed tissues. CONCLUSION: Although further studies are necessary, the genipin-fixed valved conduit appears to have great potential in helping mitigate the complications observed in the commercially available conduits.

Heparinization on pericardial substitutes can reduce adhesion and epicardial inflammation in the dog.

OBJECTIVE: Primary concerns about currently available pericardial substitutes include adhesion and epicardial reaction. The purpose of this study is to evaluate host reaction to pericardial substitutes with and without incorporating slow heparin release. METHODS: To avoid biologic variation among these pericardial patches, we made a composite of six membranes. The composite membrane consisted of epoxy-fixed patches with (1) or without (2) ionically bound heparin, a glutaraldehyde-fixed patch with (3) or without (4) ionically bound heparin, an expanded polytetrafluoroethylene patch (5), and a polyester polymeric patch (6). Ten recipient dogs weighing from 12 to 19 kg (mean 13.6 kg) were used to assess the composite membranes as pericardial substitutes. The implanted composite membranes were retrieved 1 week (one dog), 2 weeks (one dog), 4 weeks (one dog), 8 weeks (one dog), and 12 weeks (six dogs) after implantation. RESULTS: Overall, the synthetic patches had a more notable inflammatory reaction than the biologic patches with or without ionically bound heparin. The heparin-bound patches caused significantly less inflammation than their nonheparinized counterparts. The heparinized porcine patches cross-linked with different compounds were found to have less fibrous formation than the nonheparinized patches and the synthetic patches. CONCLUSIONS: Heparinized pericardial substitutes may cause less adhesion and inflammatory reaction than nonheparinized material.

In vitro hemodynamic characteristics of tissue bioprostheses in the aortic position.

The in vitro hemodynamic characteristics of a variety of old and new generation porcine and bovine pericardial bioprostheses were investigated in the aortic position under pulsatile flow conditions. The following valves were studied: Carpentier-Edwards porcine (Models 2625 and 2650), Carpentier-Edwards pericardial, Hancock porcine (Models 242, 250, and 410), Hancock pericardial, and Ionescu-Shiley (standard and low-profile) bioprostheses. The pressure drop results indicated that the old design valves had performance indices in the range of 0.30 to 0.42, whereas the new low-pressure fixed designs have performance indices of 0.50 to 0.70. Flow visualization and velocity and turbulent shear stress measurements, conducted with a two-dimensional laser Doppler anemometer system, indicated that all tissue valve designs created jet-type flow fields. The intensity of the jets and turbulence levels were less severe with the new designs. The old designs created higher peak jet velocities and higher levels of turbulent shear stresses. On the whole, pericardial bioprostheses have better in vitro hemodynamic characteristics than porcine bioprostheses. These observations should have applications regarding the clinical choice of bioprosthetic valves and have implications regarding further improvements in the preparation and design of bioprosthetic valves.

Physical properties of a porcine internal thoracic artery fixed with an epoxy compound.

This study aimed to investigate the physical properties of a porcine internal thoracic artery fixed with an epoxy compound. Fresh and glutaraldehyde-fixed porcine arteries were used as controls. Both the epoxy-fixed and glutaraldehyde-fixed porcine arteries showed significant increases in fixation index and denaturation temperature as compared to the fresh one. Additionally, the resistance of porcine arteries against bacterial collagenase in vitro degradation increased significantly after cross-linking with the epoxy compound of glutaraldehyde. The reduction of the tensile strength of the epoxy-fixed artery after bacterial collagenase degradation was more severe than in its glutaraldehyde-fixed counterpart. Generally, with increasing pH, temperature or fixative concentration, the fixation indices and denaturation temperatures of the epoxy-fixed porcine arteries increased. The results obtained in this study may be used to optimize the fixation process for developing a small-diameter biological vascular graft fixed by an epoxy compound.

Cross-linking characteristics of biological tissues fixed with monofunctional or multifunctional epoxy compounds.

The cross-linking characteristics of biological tissues fixed by various epoxy compounds with different chemical structures (i.e. number of epoxide functional groups and backbone length) were investigated. Generally speaking, the tissues fixed with monofunctional fixatives were more pliable than those fixed with multifunctional fixatives. The fixation indices of the fixed tissues did not seem to be affected by the chemical structures of the fixatives. However, the number of functional groups and backbone length of the fixatives did play an important role in influencing the denaturation temperatures of the fixed tissues. In general, the denaturation temperatures of the multifunctional fixed tissues were higher than those of the monofunctional fixed tissues. Among the monofunctional fixed tissues, it was found that increasing the backbone length of the fixative decreased the denaturation temperature of the fixed tissue. This effect was present until the backbone length of the fixative became large enough.

In vitro surface characterization of a biological patch fixed with a naturally occurring crosslinking agent.

The study was designed to characterize the surface properties (including water contact angle, surface tension, protein adsorption, platelet adhesion, and cellular compatibility) of a biological patch fixed with genipin, a naturally occurring crosslinking agent. Fresh and glutaraldehyde-fixed counterparts were used as controls. It was found that both glutaraldehyde and genipin are effective crosslinking agents for biological tissue fixation. Fixation of biological tissue with glutaraldehyde or genipin significantly increased its hydrophilicity and surface tension and reduced its mol ratio of adsorbed fibrinogen to adsorbed albumin as well as the amount of adhered platelet. There were no significant differences in hydrophilicity, surface tension, the mole ratio of adsorbed fibrinogen to adsorbed albumin, and the amount of platelet adhesion between the glutaraldehyde- and genipin-fixed tissues. However, the cellular compatibilities of fresh and the genipin-fixed tissues were significantly superior to the glutaraldehyde-fixed tissue.

Mechanical properties of a porcine aortic valve fixed with a naturally occurring crosslinking agent.

The study investigates the mechanical properties of porcine aortic valve leaflets fixed with a naturally occurring crosslinking agent, genipin, at distinct pressure heads. Fresh and the glutaraldehyde-fixed counterparts were used as controls. Subsequent to fixation, the changes in leaflet collagen crimps and its surface morphology were investigated by light microscopy and scanning electron microscopy (SEM). Also, the crosslinking characteristics of each studied group were determined by measuring its fixation index and denaturation temperature. In the mechanical testing, tissue strips made from each studied group were examined in both the circumferential and radial directions. Histological and SEM comparisons between fresh porcine aortic valve leaflet and those fixed at medium or high pressure revealed that the following changes may occur: elimination of the natural collagen crimping, and extensive loss of the endothelial layer. The denaturation temperatures of the glutaraldehyde-fixed leaflets were significantly greater than the genipin-fixed leaflets; however, their fixation indices were comparable. Generally, fixation pressure did not affect the crosslinking characteristics of the genipin- and glutaraldehyde-fixed leaflets. It was found that fixation of porcine aortic valves in genipin or glutaraldehyde did not alter the mechanical anisotropy observed in fresh valve leaflets. This indicated that the intramolecular and intermolecular crosslinks introduced into the collagen fibrils during fixation is of secondary importance to the presence of structural and mechanical anisotropy in fresh leaflet. Tissue fixation in genipin or glutaraldehyde may produce distinct crosslinking structures. However, the difference in crosslinking structure between the genipin- and glutaraldehyde-fixed leaflets did not seem to cause any significant discrepancies in their mechanical properties when compared at the same fixation pressure. Nevertheless, regardless of the crosslinking agent used, changes in mechanical properties and ruptured patterns were observed when the valve leaflets were fixed at distinct pressures.

Effects of heparin immobilization on the surface characteristics of a biological tissue fixed with a naturally occurring crosslinking agent (genipin): an in vitro study.

Heparinized biomaterials have been used to manufacture blood-contacting prostheses. The present study was intended to characterize the surface properties of a genipin-fixed biological tissue immobilized with heparin using the methods of ionic binding (the /h-i tissue) or covalent binding via multi-point attachment (the /h-m tissue) or end-point attachment (the /h-e tissue). The surface characteristics of test tissues evaluated were water contact angle, surface tension, protein adsorption, platelet adhesion, and cellular compatibility. Nonheparinized and the glutaraldehyde-fixed counterparts were used as controls. It was found that immobilization of heparin on the glutaraldehyde- and genipin-fixed tissues increased their hydrophilicity and surface tension and suppressed their mole ratio of adsorbed fibrinogen to adsorbed albumin and the amount of platelets adhered. Among the heparinized tissues, the /h-m tissue was more hydrophobic and had a higher mole ratio of adsorbed fibrinogen to adsorbed albumin and a greater amount of platelets adhered than the /h-i and /h-e tissues. In general, the surface characteristics of the /h-i tissue were comparable to the /h-e tissue. However, it is known that the ionically immobilized heparin may be displaced from the surface by an ion-exchange mechanism when exposed to blood. There were no significant differences in hydrophilicity, surface tension, the mole ratio of adsorbed fibrinogen to adsorbed albumin, and the amount of platelet adhesion between the glutaraldehyde- and genipin-fixed tissues in comparison with their respective counterparts. However, the cellular compatibility of the genipin-fixed tissues with or without heparinization was significantly superior to its glutaraldehyde-fixed counterparts.

Evaluation of an epoxy-fixed biological patch with ionically bound heparin as a pericardial substitute.

In an attempt to develop an improved pericardial substitute, we undertook the development of an epoxy-fixed biological patch with ionically bound heparin. The study was to evaluate the cross-linking characteristics of this newly developed biological patch using its glutaraldehyde-fixed counterpart as a control. In addition, the feasibility of using this newly developed biological patch as a pericardial substitute was assessed in a canine model. In the study, it was observed that the epoxy-fixed biological patch appeared more similar to the native pericardium in colour and was more pliable than its glutaraldehyde-fixed counterpart. Also, both the epoxy- and glutaraldehyde-fixed biological patches had significant increases in fixation index and denaturation temperature as compared to the fresh one (p < 0.05). In the canine study, the epoxy-fixed biological patch with ionically bound heparin was found to have significantly less adhesion formation than those currently used clinically (p < 0.05).

Giant-cell tumor of bone: analysis of two hundred and eight cases in Chinese patients.

Giant-cell tumor of bone seems to occur more frequently in Chinese people than in those residing in Western countries. The estimated incidence is about 20 per cent of all primary tumors of bone. Of 208 surgically treated and pathologically proved giant-cell tumors, 194 were benign. We excluded patients with primary or secondary amputation unrelated to recurrence and those followed for less than two years or lost to follow-up. Of the remaining 111 patients who were followed for more than two years, twenty-nine had a recurrence, giving a recurrence rate of 26.1 per cent. The rate of recurrence was highest following curettage and bone-grafting (41.2 per cent) and was much lower in patients who were treated by resection and fusion (7.1 per cent). Since resection of this tumor with reconstructive procedures, either by massive homogenous bone-grafting or artificial joint replacement, is complicated and might cripple the patient if it fails, we propose excision and curettage with bone-grafting as the most suitable method of treatment in the majority of patients with giant-cell tumor of bone.