Percutaneous autologous bone marrow-derived mesenchymal stromal cell implantation is safe for reconstruction of human lower limb long bone atrophic nonunion

Objective: Nonunion is defined as a minimum of a 9-month period of time since an injury with no visibly progressive signs of healing for 3 months. Recent studies show that application of mesenchymal stromal cells [MSCs] in the laboratory setting is effective for bone regeneration. Animal studies have shown that MSCs can be used to treat nonunions. For the first time in an Iranian population, the present study investigated the safety of MSC implantation to treat human lower limb long bone nonunion

Materials and Methods: It is a prospective clinical trial for evaluating the safety of using autologus bone marrow derived mesenchymal stromal cells for treating nonunion. Orthopedic surgeons evaluated 12 patients with lower limb long bone nonunion for participation in this study. From these, 5 complied with the eligibility criteria and received MSCs. Under fluoroscopic guidance, patients received a one-time implantation of 20-50x106 MSCs into the nonunion site. All patients were followed by anterior-posterior and lateral X-rays from the affected limb, in addition to hematological, biochemical, and serological laboratory tests obtained before and 1, 3, 6, and 12 months after the implantation. Possible adverse effects that included local or systemic, serious or non-serious, and related or unrelated effects were recorded during this time period

Results: From a safety perspective, all patients tolerated the MSCs implantation during the 12 months of the trial. Three patients had evidence of bony union based on the after implantation X- rays

Conclusion: The results have suggested that implantation of bone marrow-derived MSCs is a safe treatment for nonunion. A double-blind, controlled clinical trial is required to assess the efficacy of this treatment

Incidence of tonsillectomy complications [a 10-year study of 4042 cases]

Background: According to the prevalence of tonsillectomy, this study was performed to evaluate the complications in patients that had referred between the years 1989 and 1998

Materials and Methods: This was an observational retrospective study performed on 4042 patients who underwent tonsillectomy during 10 years. [From those, 2708 cases underwent surgery in one center and the remaining 1324 cases underwent tonsillectomy in another center by otolaryngologists]. Records of the patients in both groups were surveyed in regard to complications

Results: A total number of 113 [2.79%] patients had complications. Complications were mostly seen in the age group of 5-9 years. The most common complication was bleeding which occurred in 59 patients [1.46%]. Other complications in order of prevalence were clot formation or hematoma in the tonsillar fossa, tongue and soft palate edema, airway obstruction, hoarseness, persistent vomiting, infection of the parapharyngeal space, dental complications, remaining of a broken needle in tonsillar fossa, and death

Conclusion: According to the high prevalence of tonsillectomy in our country and high rate of bleeding and its related risks which may even lead to death and also the role of skill and attention of the surgeon and anesthesiologist during surgery and postoperative care in recovery room and in the ward, it is recommended for the surgeon to consider all of the related cares and perform surgery after acquiring the necessary skill with the help of an expert anesthesiologist to minimize the complications