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.

'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.

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.

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.

Histologic fate of tympanic membrane and ossicle homografts.

1. The biologic behavior and usefulness of homologous incus grafts preserved in Cialit compare favorably with that of ossicular autografts. 2. Reconstruction of the transplanted incus correlates with the period of its immersion in preservative: the briefer the period of exposure to fixative, the more rapidly resorption and substitution occur. The longer the preservation time, the slower the rate of incus transplant reconstruction. 3. The preserved heterograft bone chip is unsuitable, since it disintegrates completely irrespective of the duration of its preservation. 4. The configuration of all bone chips is extensively altered after implantation. Autograft and homograft bone chips are both poorly tolerated. Chemical fixation does not alter this reaction. Fragments are shortened, softened, and rounded off. Heterologous bone chips are completely resorbed.

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.

[Surgical reconstruction of the trachea by a tracheal homograft preserved in cialit]. / Reconstruction chirurgicale de la trachée par homogreffe de trachée conservée dans du cialit.

1. Direct transplantation of tracheal homograft is not possible so far. 2. Tracheal wall can be preserved for homostatic transplant by Cialit-solution. 3. Cialit-preserved tracheal homografts must be implanted into the recipient's subcutis prior to use them as tracheal substitute. 4. This procedure is suitable also in human reconstructive surgery of the trachea for some "real difficult cases".

[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.

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.

[Determination of mercury-content of tissues preserved in cialit (author's transl)]. / Bestimmung des Quecksilbergehalts von in Cialit konservierten Geweben

The mercury-tissue-concentrations of implants (structures of the middle ear, bones, cartilage, dura) after preservation in solutions of cialit are mostly independent on preservation conditions, low and seem to be physiological. A positive correlation exists between the weight of the implant and the mercury-tissue concentrations. An enrichment with mercury-ions cannot be stated. The statements do not concern the mercury which is bound on cialit in the implant.

Cialit preserved homograft cartilage in nasal augmentation: a long-term review.

Costal cartilage was harvested from cadavers less than 55 years old, stored in Cialit at a temperature of 4 degrees C and kept in a "cartilage bank" for no longer than one year. The cadaver cartilage was used largely for nasal augmentation and this paper describes the results of 67 cartilage homograft implants in patients who have been followed up for 1-8 years. These suggest that Cialit preserved cartilage homograft should be the first choice of material in nasal augmentation.

[Experimental EMG-anatomopathological study of rabbits treated with Cialit grafts for the repair of sciatic nerve loss of substance]. / Studio sperimentale EMG-anatomo-patologico nel coniglio sottoposto ad innesto Cialit per colmare una perdita di sostanza del nervo sciatico.

The sciatic nerves of 10 rabbits of the New Zealand strain were cut and isolated in the latero-posterior region of the thigh under general anesthesia. Immediate homograft technique was used in animals. The maximal motor conduction velocity of the sciatic nerve was measured in all the animals before the cutting of the nerve. Long-term EMG and anatomo-pathological controls were carried out. The results obtained are discussed. Further research will be continued by applying new techniques and new EMG parameters as well as more sophisticated anatomo-pathological techniques.

[Incus, controlled deepfrozen or in cialit conserved, after allogenetic implantation. An animal-experimental study with comparing histology (author's transl)]. / Der kontrolliert tiefgefrorene und der in Cialit konservierte Amboss nach allogenetischer Implantation. Eine tierexperimentelle Studie mit vergleichender Histologie.

The histological reactions to the implantation of allogenetic incus after conservation in Cialit or after controlled deepfreezing are described. After 5 months the incusses of both conservation technics show the same good tendency of revitalisation. Therefore the controlled deep-freezing technic does not offer an advantage compared to the Cialit conservation method at least for the present state of knowledge.

[The cialit-conserved trachea homograft (author's transl)]. / Das Cialit-konservierte Tracheatransplantat.

After all techniques for reconstruction of tracheal segments with trachea-homografts, known from the literature, have failed to show satisfactory functional results, we have carried out further experiments concerning this subject. Our main interest was focused on the following topics: 1. the regeneration pattern of the respiratory epithelium in the trachea, 2. possibilities of the conservation of trachea-transplants, 3. the behaviour of the receptor area against trachea homografts. We found, that in correspondence with clinical observations, even large circumferencial defected epithelial areas in the mucous layer of the trachea have been regenerated in a form of new mucous membrane which showed no morphological difference from normal structure. Segments of trachea can be preserved in Cialit solution. Prefixation in formaldehydsaline fixative improves the preservation of the tissue structure. Homografts obtained in the above described technique could almost always be made to heal, either directly in the trachea or in the subcutaneous tissue of the recipient-animals. The behaviour of the cartilage and the epithelium is demonstrated by histological methods as well as by scanning electronmicroscopy.

Use of chemically preserved tendon allografts in hand surgery.

The origin of the use of tendons preserved in Cialit is reviewed and the results of a series of thirty-seven flexor tendon grafts which were performed by this method are discussed.

Results of animal experiments on the transplantability of Cialit preserved human fascia.

Results of animal experiments on the transplantability of Cialit preserved fascia are presented. Preserved human fascia was grafted to the area of the forehead of 11 rabbits. Specimens were taken for examination between the 10th and 50th day. The fascia healed normally and was revascularised. Based on the results of these experiments, the method of preserving connective tissue (fascia) in Cialit also appears to be suitable for clinical use in the maxillo-facial region in reconstructive surgery, e.g., in facial palsy.

[Experimental heterograft tracheal transplants in animals. III. Light microscopic, scanning and electron microscopic findings (author's transl)]. / Ergebnisse heterologer Trachealtransplantationen im Tierexperiment. III. Licht-, raster- und transmissionselektronenmikroskopische Langzeitbefunde.

In seven three-month old piglets, tracheal defects were created experimentally and Cialit-fixed human tracheal transplants were grafted at the site of the defect. The implants did well in five of the animals, and no signs of respiratory insufficiency (such as stridor, dyspnea or cyanosis) were found. 230-273 days after the transplantation, the animals were sacrificed and the tracheas removed. The transplants were then examined macroscopically and by light, scanning and transmission electron microscopy. Two questions arose: 1) What was the fate of the epithelium of the tracheal graft? It was then found that the host tracheal epithelium surrounding the graft resurfaces the graft. However, a series of morphological changes occur and are described in detail. 2) What happens to the grafted tracheal cartilage? It was found that the cartilage was replaced by thick connective tissue and scar. From the results of these studies, two conclusions could be drawn. 1) The repair of tracheal defects by means of Cialit-fixed human tracheal grafts is limited in those cases in which the newly formed connective tissue is not able to stabilize the tracheal tube. 2) The size of the heterologous tracheal transplant is limited to 6-7 cm2 in animal experiments.