Annales chirurgiae et gynaecologiae. Supplementum最新文献

The effect of whole body irradiation given either beforehand to the donor or after implantation to the recipient rats on the inductive capacity of decalcified bone grafts was studied. In examining the effect of advance whole body irradiation of the donor animal, the grafts were harvested five days after the irradiation, non-irradiated rats serving as control donors. Error! Reference source not found-irradiation with doses of 800, 950 or 1100 rad was used. The grafts, implanted either alone or in composite form in the muscle pouches of non-irradiated rats of an inbred strain, were removed four weeks after implantation and examined by measuring 45Ca uptake, ash weight and area of radio-opacity in roentgenographs. There were no differences in bone-inductive capacity between the grafts obtained after total body irradiation and the control grafts. In the other part of the study, decalcified bone grafts were implanted in the abdominal muscle pouches of the recipient rats, which were exposed to Error! Reference source not found.-radiation of 800 rad on either the second, 10th or 21st day after implantation. Four weeks after implantation the grafts were removed and examined. No differences in new bone formation were found between the groups subjected to irradiation at different times or between these and the non-irradiated controls. It is concluded that donor whole body irradiation of 800-1100 rad in rat has no significant effect on the properties of new bone developed in allogeneic decalcified bone grafts, neither does recipient 800 rad irradiation administered after implantation affect the bone induction activity.

A prospective series of 104 patients underwent bladder neck incision (44 unilateral and 60 bilateral) for urinary obstruction caused by a small benign prostate enlargement. The preoperative mean peak flow value improved significantly from 11.4 ml/s to 16.2 ml/s. There were no significant differences in peak flow values between the unilateral and bilateral incision groups. Subjective results seemed to be similar but transurethral resection of the prostate was needed more often after unilateral incision than after bilateral incision. Postoperative complications were recorded only in the bilateral incision group. Altogether 62% of the patients reported changes in erection or ejaculation ability. Bladder neck incision seems to be an effective means of treating urinary obstruction but adverse effects on sexual function are common, which should be kept in mind when offering this treatment to sexually active men. It can be regarded as the treatment of choice for older men with infravesical obstruction caused by a small prostate enlargement.

The value of serum acid phosphatase (S-ACP) as a marker of transurethral resection (TUR) syndrome was studied in 105 patients undergoing TURP. In ten patients who developed TUR syndrome the elevation of S-ACP was statistically significantly higher than in the rest of the patients. In seven patients prostatic cancer was diagnosed in the resection chips, but there were no differences in the S-ACP levels during TURP between these patients and the rest of the group. According to the present study, S-ACP seems to be a reliable and cheap marker of TUR syndrome, but the method is slow as compared to ethanol, which restricts its use.

Prostatic stents are a new method in the treatment of urinary outflow obstruction caused by benign prostatic hyperplasia. In this study the usefulness of the PROSTAKATH urospiral was evaluated in a multicenter study for treatment of urinary outflow obstruction. There were 87 males with problems related to urination. Sixty-eight patients had total retention. The mean functioning time of the spiral was nine (1-35) months. The outflow obstruction was cleared in 69 (81%) patients. During follow-up, 33 spirals (39%) were removed; 15 of them within a few days after insertion. Altogether, transurethral resection of the prostate (TURP) was done on 22 patients, and transurethral incision of the prostate (TUIP) on four patients. Chronic urinary tract infection reduced significantly (P < 0.05) the functional time of the spiral; no other factors had influence on this variable. The spiral is a good alternative for treating urinary retention in patients waiting for prostatic surgery. The spiral may also be useful in the treatment of urinary obstruction caused by prostatic cancer. Recurrent vesical neck contracture can be prevented with the spiral. Entirely bedridden and demented patients do not benefit from this form of treatment.

In the future, the clinical application of bone morphogenetic protein (BMP) will be mainly in patients of advanced age. In this study, we examined changes in BMP activity due to aging in recipient rats. The bioassays were carried out with bovine bone matrix-derived BMP obtained by the Bessho's BMP purification method. The purified BMP with the atelopeptide type I collagen was implanted into the calf muscles of 5-, 10-, 20- and 40-week-old Wistar rats. Three weeks later, soft X-ray and light-microscopic examination disclosed new bone formation in each aged recipient rat. Bioassay revealed decreasing ALP activity and Ca content as the recipient rats became older. However, bone induction was detected even in the 40-week-old Wistar rats. These results suggested that the bone inducing activity of BMP decreases proportionately as the recipient ages. Nevertheless, BMP offers considerable possibilities for clinical application in patients of advanced age.

Applying our knowledge of heterotopic osteoinduction by bone morphogenetic protein (BMP) and demineralized bone matrix (DBM), we sought to induce ossification of membrane-isolated latissimus dorsi flaps in the rat. Our aim was to produce an animal model for a versatile "custom-made" bone island flap which could be used as a substitute for bone. Ten latissimus dorsi island flaps in nine Wistar rats, 5-6 weeks of age, were prepared using microsurgical techniques in aseptic conditions. The flaps were isolated from other tissues with silicone, Gortex or OpSite membranes. We applied 3-9 mg partially purified bovine BMP or 0.1 -0.25mg BMP bound covalently to type IV collagen with 15mg DBM inside the flaps. We have five animals with eight implants of BMP and DBM in latissimus muscle pouches as rat bioassay controls. The results were evaluated after a period of three weeks using soft X-ray radiography and histology with hematoxylin-eosin-azure II and Alcian blue stains. Positive radiological results were observed in 10/10 flaps (100%), in controls in 7/8 (87.5%). Positive histological results comprised 8/10 (80%) and in controls 7/8 (87.5%). Two flaps (20%) showed partial necrosis. These did not lower the percentage of either positive histological or radiological findings, but exemplified some of the problems which are faced in this kind of tissue engineering.

Using type IV collagen as carrier, the expression of bovine bone morphogenetic protein (bBMP) activity and the relation of ectopic bone formation to BMP dosage in the reconstitution were investigated in BALB mice. Visible heterotopic bone was induced by GuHCl-extracted bovine BMP at a minimal dose of 0.5 mg within 21 days after the BMP was covalently bound to type IV collagen of weight 5.6 mg. The dose-dependent osteogenetic response of BMP was retained in the BMP/type IV collagen composite. As the BMP dose increased in the reconstitution, the integrated intensity and area of bone and cartilage formation, as quantified by a computerized scanner, were enhanced. Degradation of the collagenous carrier was improved by BMP, and neovascularization of the implant site initiated by type IV collagen was also observed. The covalent binding of BMP to type IV collagen postponed the time-sequence of ectopic bone development induced by BMP alone. The conclusion was that the exaggerated and extended effects of type IV collagen on BMP are mainly due to chemotaxis to progenitor cells, immunogenetically inert, vascular initiation and biodegradability in type IV collagen.

Between 1969 and 1992, 32 patients underwent conservative surgery (partial nephrectomy or enucleation) for renal cell carcinoma (RCC). Elective parenchyma-conserving surgery (n = 10) was done in patients with small, peripheral kidney tumors and a normal contralateral kidney. Cancer in a solitary kidney, bilateral tumors, dysfunctional contralateral kidney or chronic renal failure were imperative indications (n = 22) for conservative surgery. In the elective group the tumors were 15-100 mm (mean 37 mm) in diameter, in the imperative group 5 to 200 mm (mean 41 mm). The follow-up was 0.2-192 months (mean 48.7 months). Nine of 22 (41%) patients in the imperative group have died of RCC. There were no renal cancer related deaths in the elective group. The 5-year cause-specific survival rates for the elective and imperative groups were 100% and 46%, respectively. Two patients in the elective group have died of unrelated causes. Local recurrences developed in three of 22 patients in the imperative group after a mean of 5.4 years; two of them had von Hippel-Lindau disease with bilateral RCC. Conservative surgery seems to be a feasible option in small peripheral kidney tumors.

Contact Nd:YAG laser resection using the sapphire tip is nowadays a well-known method of partial nephrectomy. Our material consists of six patients (seven resections). The indication for the operation was a renal carcinoma in five patients (six resections) and renal changes of von Hippel-Lindau syndrome in one patient. Occlusion of the renal artery insured a good intraoperative haemostasis. This improved the cutting properties of the laser and made it more accurate. Low energy levels could be used. Thus the destruction of the renal parenchyma will be reduced. The mean follow-up time was 15.3 months. No local recurrences or distant metastases have been detected. In our hands the Nd:YAG contact laser combined with renal hypothermia is superior to traditional methods of partial nephrectomy.

The 4 M guanidine hydrochloride (GuHCl)-soluble bone matrix proteins which contained bone morphogenetic protein (BMP) were found capable of inducing ectopic bone and cartilage formation in mammals. This osteogenic capacity was resistant to high temperatures and mild heating actually increased the amount of bone induced, with a maximum occurring at 70 degrees C. The osteogenic potential was preserved after heating at 170 degrees C for 10 min or 140 degrees C for 30 min.