[The effect of human placental suspension on rat sciatic nerve healing]. / Siçan siyatik sinir iyilesmesinde insan plasenta süspansiyonunun etkisi.

OBJECTIVES: We investigated the effect of human placental suspension (HPS) on rat sciatic nerve regeneration. METHODS: Eight adult female Sprague-Dawley rats weighing between 250 and 300 g were randomly divided into control and study groups equal in number. Both sciatic nerves were explored under anesthesia, transsected and then immediately repaired. At the end of the operation, and on the second and fifth days, HPS and saline were administered to the operation zone in the test and control groups, respectively. For functional examination, electromyographic activity was measured in posterior extremities of all rats preoperatively and at the end of eight weeks. The rats were then sacrificed to obtain transections from the repaired area and its distal region for histologic examination and the number of myelin-sheathed axons was estimated in both regions. RESULTS: Electromyographic study showed delayed latency and decreased amplitude following operation in both groups, being less severe in the study group without reaching a significant difference from the control group (p>0.05). The most notable histopathologic finding was increased endoneural collagen in the control group and regenerative axonal growth in the HPS group. The number of axons was greater in the distal region in both groups. In both regions, the number of myelin-sheathed axons was greater in the HPS group, but this difference was significant only for the number of axons in the repair zone (p=0.001). CONCLUSION: Our data suggest that HPS may exert a favorable effect on peripheral nerve regeneration.

Successful treatment of high congenital dislocated hips in older children by open reduction, pelvic and femoral osteotomy with external fixator stabilization (average 8.2 years of age).

A new technique using a hinged external fixator to stabilize an open reduction with pelvic and femoral osteotomies has been developed for treating high-dislocated hips in older children with developmental dislocated hip (DDH). This technique was performed in 11 patients (12 hips) at a mean age of 8.2 years. At follow up, radiographic results showed no redislocation/subluxation and clinical results demonstrated 11 hips as excellent/good and only one hip as poor from persistent stiffness. In conclusion, this new technique produces acceptable results in the treatment of older children with high dislocation of the hip from DDH.

The mechanical or electrical induction of medullary angiogenesis: will it improve sternal wound healing?

We induced angiogenesis in the tibial medulla and cortex of rabbits by electrical and mechanical stimulation, with the aim of future application to ischemic disease. Sixteen New Zealand rabbits were divided into 4 groups: in Group 1, a K wire was inserted into the medullary channel; in Group 2 a hole was drilled into the tibia; in Group 3, electrical stimulation was applied to the medullary channel; and in Group 4 (the control group), nothing was done. The interventions were applied during a 21-day period, after which all animals were evaluated scintigraphically and histopathologically. All 3 interventional groups were significantly superior to the control group in regard to medullary and cortical vascularity: the P values were 0.021 in all comparisons to control. However, the most fibrotic changes in the medulla occurred in the group that had been treated with electricity (P = 0.008). Slight fibrotic changes occurred in the hole group (P = 0.040), and none occurred in the K-wire group. In sum, all 3 interventions are capable of inducing medullary angiogenesis, but electricity is inferior in regard to fibrotic change. We believe that this present study can establish a baseline for further work that explores clinical applications to problematic ischemic conditions, including delayed sternal wound healing after cardiac surgery.

Effect of end-to-side repair of proximal nerve stumps of transected peripheral nerves on the development of neuroma (experimental study).

OBJECTIVE: Neuroma is a psychologically and physically disabling problematic condition without any current standard therapy. For that reason, we investigated whether end-to-side anastomosis of the proximal end of the transected nerve into the adjacent nerve will prevent the development of neuroma in different types of nerve injuries. STUDY DESIGN: In this study, hind legs of 18 Sprague-Dawley female rats were used. Six groups were formed. In group I, peroneal nerves were transected and its proximal end was attached end-to-side through the epineural window to the adjacent tibial nerve. In group II, contrary to group I, an epineural window was created in the tibial nerve and the same number of sutures were employed. In group III, tibial nerve was transected proximal to the end-to-side repair site, whereas in group IV, distal segment of the nerve was cut, and an end-to-end repair procedure was repeated. In group V, unlike group I, an approximately 1-cm segment was resected and removed distal (from tibial nerve) to the end-to-side repair site. In group VI, an epineural window was created in the tibial nerve and the same number of sutures were used, and also a 1-cm distal nerve segment was resected. The rats were followed for 2 months, and then all of the groups were evaluated histopathologically, and weights of the posterior muscle groups of hind legs were evaluated. FINDINGS AND CONCLUSIONS: No neuroma formation was observed in the proximal stumps of peroneal nerve segments in end-to-side repair sites in groups I, III, IV, and V, and proximal stumps of the tibial nerve in group V. In group VI, neuroma formation was observed in the proximal end of the tibial nerve. When weights of the posterior muscle groups of hind legs in groups I and II were comparatively assessed, statistically significant difference was not detected. In conclusion, based on histological data obtained for proximal nerve ends and segments distal to the end-to-side repair sites, we think that end to side neurorrhaphy of the proximal end of the damaged nerve to adjacent nerve will prevent the development of neuroma without injuring the intact nerve segment.

The comparison of femoral curves and curves of contemporary intramedullary nails.

UNLABELLED: The aim of this study was to evaluate both the cortical and the medullary anterior bowing of the femur, and to compare these measurements with current intramedullary nails to assess the adequacy of their design. METHODS: Lateral digital radiographic views of left femurs of 104 normal subjects (18-68 years old) were obtained. Radii of cortical and medullary curvatures of femurs were calculated using these images. The values obtained were compared to the radius of curvatures of ten different intramedullary nails. RESULTS: Medullary bowing was between 114 and 1,389 mm (mean: 722 mm, SD: 230 mm) and the cortical bowing was between 109 and 1,666 mm (mean: 770 mm, SD: 267 mm). For males, these values were 114-1,389 mm (mean: 722 mm, SD: 230 mm) and 109-1,666 mm (mean: 770 mm, SD: 267 mm), respectively. For females, they were 114-1,389 mm (mean: 722 mm, SD: 230 mm) and 109-1,666 mm (mean: 770 mm, SD: 267 mm), respectively. The differences between genders were not significant. Cortical and medullar bowing was strongly correlated with age (r=-0.269, p<0.006 and r=-0.234, p<0.017, respectively). These significances were produced by females only. Radii of curvatures of intramedullary nails ranged between 150 and 300 cm and were higher than the mean cortical (77 cm) and medullary (72.2 cm) bowings. CONCLUSION: The difference between the curves of femur and the contemporary femoral nails implicates the inadequacy of the design of such nails for the Caucasian race living in Anatolia. Therefore, such nails should be revised accordingly to prevent the above-mentioned complications.

Effect of caffeic acid phenethyl ester on cartilage in experimental osteoarthritis.

Activation of nuclear factor kappa B (NF-kappaBeta) in synovial cells is seen in RA and OA patients. Caffeic acid phenethyl ester (CAPE) is a specific and potent inhibitor of NF-kappaBeta. We aimed to determine the in vivo effects of intra-articular injections of CAPE on cartilage in an experimental rabbit osteoarthritis (OA) model. Two groups of six New Zealand white rabbits underwent unilateral anterior cruciate ligament transection (ACLT). Four weeks after ACLT, the test group was injected with 150 micro g/kg CAPE in 0.5% ethanol once daily for 2 weeks and the control group was injected the same amount of 0.5% ethanol intra-articularly. All rabbits were killed 2 weeks after the last injection, and cartilage tissue was evaluated morphologically. A histological score totaling 7 points was determined for each knee. The CAPE group showed significantly decreased cartilage destruction and reduced loss of matrix proteoglycans. The histological score for cartilage tissue was significantly better in the CAPE group than in the control group (3.0+/-0.25 vs 5.3+/-0.55, P=0.005). This study suggests that intra-articular injection of CAPE may protect cartilage against the development of experimentally induced OA.