Transforming Growth Factor-ß3 Therapy Delays Postoperative Reossification and Improves Craniofacial Growth in Craniosynostotic Rabbits.

Postoperative reossification is a common clinical correlate following surgery. It has been suggested that an underexpression of transforming growth factor-ß3 (TGF-ß3) may be related to craniosynostosis and postoperative reossification. Adding TGF-ß3 may delay reossification and improve postoperative growth. The present study was designed to test this hypothesis. Thirty 10-day-old New Zealand white rabbits with hereditary coronal suture synostosis were divided into three groups: (1) suturectomy controls (n = 14), (2) suturectomy treated with bovine serum albumin (n = 8), and (3) suturectomy treated with TGF-ß3 protein (n = 8). At 10 days of age, a 3-mm × 15-mm coronal suturectomy was performed, and serial three-dimensional (3D) computed tomography (CT) scans and cephalographs were taken at 10, 25, 42, and 84 days of age. Calvaria were harvested at 84 days of age for histomorphometric analysis. Mean differences were analyzed using a group by age analysis of variance. Analysis of the 3D CT scan data revealed that sites treated with TGF-ß3 had significantly (P < .05) greater defect areas and significantly (P < .05) greater intracranial volumes through 84 days of age compared with controls. Histomorphometry showed that sites treated with TGF-ß3 had patent suturectomy sites and significantly (P < .001) less new bone in the suturectomy site compared with controls. Serial radiograph data revealed significant (P < .05) differences in craniofacial growth from 25 to 84 days in TGF-ß3-treated rabbits compared with controls. Data show that TGF-ß3 administration delayed reossification and improved craniofacial growth in this rabbit model. These findings also suggest that this molecular-based therapy may have potential clinical use.

Survivorship and long-term outcome of a consecutive series of 200 Scandinavian Total Ankle Replacement (STAR) implants.

AIMS: We report the long-term clinical and radiological outcomes of a consecutive series of 200 total ankle arthroplasties (TAAs, 184 patients) at a single centre using the Scandinavian Total Ankle Replacement (STAR) implants. PATIENTS AND METHODS: Between November 1993 and February 2000, 200 consecutive STAR prostheses were implanted in 184 patients by a single surgeon. Demographic and clinical data were collected prospectively and the last available status was recorded for further survival analysis. All surviving patients underwent regular clinical and radiological review. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scoring system. The principal endpoint of the study was failure of the implant requiring revision of one or all of the components. Kaplan-Meier survival curves were generated with 95% confidence intervals and the rate of failure calculated for each year. RESULTS: A total of 84 patients (87 ankles) were alive by the end of this study. Of the surviving 84 patients (87 ankles; rheumatoid arthritis (RA), n = 40; OA, n = 47), 45 were women and 39 were men, with a mean age of 54 years (18 to 72 years) at the time of surgery. A total of 32 implants failed (16%), requiring revision surgery. The mean time to revision was 80 months (2 to 257). The implant survival at 15.8 years, using revision as an endpoint, was 76.16% (95% confidence interval (CI) 64.41 to 87.91). We found a steady but low decrease in survival over the study period. The mean AOFAS score improved from 28 (10 to 52) preoperatively to 61 (20 to 90) at long-term follow-up. CONCLUSION: STAR prostheses in the United Kingdom have now been largely superseded by newer design TAAs, potentially with improved characteristics and surgical techniques. The long-term survivorship for the STAR prosthesis can provide a benchmark for these later designs of ankle arthroplasty.

A strategy for reducing blood-transfusion requirements in elective orthopaedic surgery. Audit of an algorithm for arthroplasty of the lower limb.

We prospectively audited 79 patients undergoing primary knee or hip arthroplasty (38 knees, 41 hips) and found that 66% (58% of knees, 73% of hips) had at least one unit of blood transfused postoperatively, with a mean transfusion requirement of 13 units per patient (1.1 for knees, 0 to 6; 1.5 for hips, 0 to 4). We then established a new protocol for postoperative blood transfusion. This requires the calculation of the maximum allowable blood loss (MABL) that each individual patient can safely lose based upon their weight and preoperative haematocrit. The total blood loss up to this volume is replaced with colloid. When a patient's total blood loss reaches their MABL their haematocrit is measured at the bedside using the Microspin system (Bayer plc, Newbury, UK). If their haematocrit is low (< 0.30 for men, < 0.27 for women), blood is transfused. As a safety net all patients have their haemoglobin formally checked on days 1, 2, and 3 after surgery and have a transfusion if the haemoglobin levels are less than 8.5 g/dl. We conducted a further audit of 82 patients (35 knees, 47 hips) after the introduction of this protocol. Under the new protocol only 24% of patients required blood (11% of knees, 34% of hips) with a mean transfusion requirement of 0.56 units per patient (0.26 for knees, 0 to 4; 0.79 for hips, 0 to 4). The use of clinical audit and the introduction of strict guidelines for transfusion can change transfusion practice and result in improved patient care. Our transfusion protocol is a simple and effective method of keeping transfusion to a minimum and is particularly useful in departments which do not have the facility to use autologous blood or reinfusion drains for relective orthopaedic surgery.

[Extended small bowel resection with right hemicolectomy after massive superior mesenteric artery embolism, management in early postoperative period]. / Rozlegla resekcja jelita cienkiego polaczona z prawostronnym wycieciem okreznicy w przebiegu zatoru tetnicy krezkowej górnej, postepowanie we wczesnym okresie pooperacyjnym.

Intensive care management in recent postoperative period in nine patients with superior mesenteric artery embolism was provided. In all patients during surgical treatment an extensive resection of small bowel and right colectomy were performed. On the basis of physiopathological mechanisms of occlusional bowel ischemia and septic shock development the appropriate therapeutic procedure during pre and postoperative period was submitted. The authors suggest usefulness of the antibiotic prophylaxis in patients with high risk of measenteric embolism in order to decrease the dynamics of septic complications in the cases with bowel necrosis.

Total ankle replacement: the results of 100 mobility total ankle replacements.

We describe the early results of a prospective study of 100 total ankle replacements (96 patients) at a single centre using the Mobility Total Ankle Replacement. At final review, six patients had died and five ankles (5%) had been revised, two by fusion and three by exchange of components. All remaining patients were reviewed at a minimum of three years. The mean follow-up was 43 months (4 to 63). The three-year survival was 97% (95% confidence interval (CI) 91 to 99). The four-year survival was 93.6% (95% CI 84.7 to 97.4). The portion of bony interface that was visible on plain radiograph was divided into 15 zones and a radiolucent line or osteolytic cavity was seen in one zone in 14 ankles. It was not seen in more than one zone. In five ankles it was > 10 mm in width. This study suggests that the early outcome of ankle replacement is comparable to that of other total joint replacements.

Nearest-neighbor detection of atoms in a 1D optical lattice by fluorescence imaging.

We overcome the diffraction limit in fluorescence imaging of neutral atoms in a sparsely filled one-dimensional optical lattice. At a periodicity of 433 nm, we reliably infer the separation of two atoms down to nearest neighbors. We observe light induced losses of atoms occupying the same lattice site, while for atoms in adjacent lattice sites, no losses due to light induced interactions occur. Our method points towards characterization of correlated quantum states in optical lattice systems with filling factors of up to one atom per lattice site.

[Antibacterial treatment in patients after extended bowel resection with ileo-cecal valve removal--personal experience]. / Leczenie przeciwbakteryjne chorych po rozleglych resekcjach jelita cienkiego polaczonych z usunieciem mechanizmu zastawkowego kretniczo-katniczego--doswiadczenia wlasne.

Small bowel infection in patients that underwent extensional bowel resection is one of causal mechanisms of massive diarrhoea in postoperative period. The aim of this study was to investigate clinical importance of ciprofloxacin efficacy in treatment of massive diarrhoea in patients after extensional bowel resection with removing of ileo-coecal valve (EBR + ICVR). From group of 21 patients that underwent EBR + ICVR the postoperative period survived only 11. In 9 cases massive diarrhoea and sepsis was observed. Routinely applied three-drugs antibacterial therapy based on penicillin or first-generation cephalosporin, aminoglycoside and metronidazole was efficient in 18% of patients only. The ciprofloxacin was used as a second-shot therapy in patients which did not realt on routine three-drugs antibacterial management. In all cases the clinical efficacy was observed as recessing of diarrhoea and septic symptoms. On the basis of our experience we suggest that in patients with massive diarrhea due to ascending contamination of small bowel after extensive resection with removal of ileo-coecal valve, ciprofloxacine is the treatment of choice.

Sacroiliac joint fusion for chronic pain: a simple technique avoiding the use of metalwork.

A previously undescribed method for posterior fusion of the sacroiliac joint (SIJ) utilizing the Cloward instrumentation is presented, suitable for cases with chronic pain and intact ligamental structures of the SIJ. The advantages of the method in comparison with other described options include minimal disturbance of the periarticular structures, avoidance of introduction of metalwork and preservation of the iliac crest contour. This technique has been used in five cases with follow-up longer than 2 years (mean 29 months, range 25-41 months). In all cases there was resolution of their painful symtomatology.