Tumor Necrosis Factor- and Resorption of Calcium Sulfate Used as a Bone Graft Substitute in Spinal Fusion in Rabbits / 대한정형외과학회잡지

PURPOSE: To investigate the effects of tumor necrosis factor-alpha on calcium sulfate, as a bone graft substitute, in terms of achieving inter-transverse fusion in experimental rabbits. MATERIALS AND METHODS: Twenty adult New Zealand white rabbits were used in our study. 0.4 mg of calcium sulfate was mixed with 0.4 mg of autogenous iliac bone and grafted on the left intertransverse space of L4-5 or L5-6, and then 0.8 mg of autogenous iliac bone was grafted on the right side at the same level. Thus, the experimental rabbits served as their own control. At postoperative 0, 4, 8, 12, and 16 weeks, plain roentgenography was performed to evaluate the bony union. At 16 weeks, all rabbits were sacrificed and histologic evidences of the bony union observed by H and E and trichrome staining. Computed tomography was also used to evaluate the union state. An immuno-histochemical study for TNF-alpha was to investigate the union. RESULTS: Bone graft, mixed with calcium sulfate was resorbed completely radiologically and histologically in 20 rabbits (100%). In contrast, a graft using autogenous cancellous bone showed complete bony union in 15 of 20 rabbits (75%). By immuno-histochemical staining, TNF-alpha was detected at the calcium sulfate mixed autogenous bone graft site. CONCLUSION: Union was not showed at the bone graft site, mixed with calcium sulfate. Therefore, TNF-alpha plays an important role causing subsequent calcium resorption.

Calcium Sulfate as a Graft Substitute for Spinal Fusion / 대한척추외과학회지

STUDY DESIGN: This is a prospective study to determine whether calcium sulfate(CS) used as a bone graft expander could promote spinal fusion as effectively as autogenous bone graft. OBJECTIVES: To investigate the ability of CS to serve as bone graft substitute when combined in a 1:1 ratio with autogenous graft bone(AGB). SUMMARY OF LITERATURE REVIEW: Autogenous bone is considered the most successful bone graft material and is presently gold standard. Many complications, however, have been reported. Thus, numerous biodegradable osteoconductive ceramic bone graft substitute have received attention as alternative to autogenous bone to reduce the complications. The advantage of a biodegradable graft material is its compatibility with the new bone remodeling process required to attain optimum mechanical strength. MATERIALS AND METHODS: Fifteen patients who had undergone posterolateral spinal fusion with instrumentation using CS mixed with AGB were evaluated. The patients received the autogenous iliac crest graft on one side of the spine and an equivalent volume of autogenous iliac crest/ CS combination on the other side. Thus, the patients serve as their own control. The number of segments fused was 45 segments. The implanted sites were assessed for new bone formation and bony fusion by plain radiography and CT. RESULTS: Of 47 segments fused with CS and AGB, 42 segments (89.4%) were completely fused. In contrast, segments fused with AGB alone, 44 segments (93.6%) were fused. One patient showed nonunion at the both side. Two patients had nonunion at the fused segments with CS and ABG. However, the other side showed complete union. 5 patients who underwent removal of hardware had grossly and histologically complete union. There were no complications related to CS. CONCLUSION: Calcium sulfate appeared to have some potential as a bone graft expender rather than a graft substitute when combined 1:1 ratio with ABG, despite fusion rate by CS mixed with AGB ws lower than AGB alone.

A Clinical Analysis of Pancreatic Pseudocysts

BACKGROUND: Pancreatic pseudocysts are localized collections of pancreatic secretions in a cystic structure that lack an epithelial lining and occur as a result of surrounding tissues walling off and containing a pancreatic duct disruption. METHODS: This is paper presents a clinical analysis of 32 cases of pancreatic pseudocysts treated from January 1987 to July 1997 at Pusan Medical Center. RESULTS: The results are summarized briefly as follows: 1) The age and the sex distributions of these patients showed that 19 cases occurred between the 3rd and the 4th decades and the male-to-female ratio was 10.3:1. 2) Pancreatitis was most frequently associated with pancreatic pseudocysts (75%). 3) Common clinical manifestations were abdominal pain (89%), abdominal tenderness (78%), nausea and vomiting (56%), abdominal mass (32%), abdominal distension (31%). 4) Abdominal CT and ultrasound were major diagnostic methods. 5) The location of the peudocysts were the body (41%), head and tail (31%), the tail (22%), and others (6%). 6) The sizes of the pseudocysts were as follows less than 5 cm (5 cases), 5-10 cm (19 cases), above 11 cm (8 cases) in 32 cases. 7) Valuable laboratory data for a pancreatic pseudocyst were blood WBC count (above 10,000/mm in 78%), serum amylase (above 160 unit/L in 62%), urine amylase (above 300 unit/L in 56%), blood glucose (above 110 mg/L in 50%), serum alkaline phosphatase (above 250/L in 44%). 8) The surgical methods in 29 cases were excision (1 case), external drainage (4 cases), cystogastrostomy (7 cases), cystojejunostomy (16 cases), cystoduodenostomy (1 case). 9) Postoperative complications were encountered in 13 cases, and many of the cases involved pulmonary complications and wound infections. CONCLUSIONS: Currently, treatment of patients with pancreatic pseudocysts is based on the clinical setting, the presence or absence of symptoms, the age and size of the pseudocyst, and the presence or absence of complications. In the most common clinical settings, a pseudocyst is discovered after an episode of acute alcoholic pancreatitis.

The Role of Platelet-derived Growth Factor in Regeneration of Pasteurized Osteochondral Graft in Rabbits / 대한정형외과연구학회지

Platelet-derived growth factor(PDGF) is known to accelerate soft tissue fracture and periodontal bone healing, but little information is available for characterizing the healing of articualr cartilage. This study was designed to demonstrate the regeneration potential of pasteurized autogeneous osteochondral graft when PDFG was applied locally in vivo. Eighteen rabbits in two groups were used in the experiment. The free osteochondral fragment(1x1x1 cm) were taken from distal femur. The fragment were pasteurized in 65degrees C for 5 minutes. In experimental group(group II), the fragment were soaked in 0.25 mg/ml of recombinant human PDGF mixed 5 ml normal saline and reimplanted to the resected site, and followed with local administration of 0.25 mg/ml PDGF to knee joint. In control group(group I), the pasteurized fragment were reimplanted in the resected site without any treatments. The histologic characteristics of the transplanted autografts for three rabbits in each group were observed at 3, 5 and 7 weeks postoperatively. The results were as follows; Group II revealed the more favorable regeneration of articular cartilage, less arthritic changes and more mature arrangement of chondrocytes than group I. Even thought the cartilage is avascular and the regeneration capacity of pasteurized cartilage is severely limited, the regeneration of grafted articular cartilage is thought to be accellerated by increased newly formed blood vessels and soft tissues due to the diffusion of PDGF on grafted cartilage, and probably also by differentiation of mesenchymal cells in the initial stage of experiment. The results of this study suggest that local administration of PDGF could be used for the treatment of posttraumatic or degenerative arthritis and various cartilage damages.

Clinical Analysis of Post-Operative Enterocutaneous Fistulas

Despite recent advances in nutritional support, patient monitoring, and surgical intensive care, as well as some improvement in surgical techniques, post-operative fistulas have been regarded as one of the most serious complications in abdominal surgery. The present study was undertaken to evaluate the effectiveness of treatment with total parenteral nutrition (TPN) alone (group A, n=26) or with TPN combined with octreotide, a long-acting analog of somatostatin (group B, n=20) in post-operative enterocutaneous fistulas. In group A, we treated 2 biliary, 10 pancreatic and 14 intestinal cutaneous fistulas with total parenteral nutrition. In group B, we treated 6 biliary, 8 pancreatic and 6 intestinal cutaneous fistulas with octreotide. The results obtained from the analysis are as follows: 1) The spontaneous closure of the fistulas was 69.2% in group A and 75.0% in group B. 2) The mean interval of time to achieve the healing of the fistula was 30.44 days in group A and 14.53 days in group B. 3) The mean interval of time to achieve a fistula output reduction of 50% was 6.44 days in group A and 2.44 days in group B. 4) In patients with low-output fistulas, the spontaneous closure of the fistula was 81.8% in group A and 80.0% in group B. In patients with high-output fistulas, the spontaneous closure of the fistula was 60.0% in group A and 73.3% in group B. 5) In patients with low albumin ( or = 3.0 g/dl), the spontaneous closure of the fistula was 80.0% in group A and 85.7% in group B. 6) In patients with an abdominal abscess, the spontaneous closure of the fistula was 40.0% in group A and 40.0% in group B. In patients without an abdominal abscess, the spontaneous closure of the fistula was 87.5% in group A and 86.7% in group B. 7) As compared with TPN, the spontaneous closure of the fistulas treated with octreotide was increased in the gastroduodenum and the external biliary system, was similar in the small bowel and the pancreas, but was decreased in the colon. We conclude that octreotide is a useful therapeutic complement in the conservative treatment of selected patients with post-operative cutaneous fistulas, especially fistulas in the external biliary system and the gastroduodenum.

Surgical Experiences Involving Benign Pancreatic Diseases

Nineteen patients with benign pancreatic disease were managed with surgical treatment in Pusan Medical Center during three years from September 1993 to September 1995 and the results were reviewed retrospectively. The results were as follows; 1) This report includes five cases of severe(hemorrhagic in one case and necrotizing in four cases) acute pancreatitis,eight cases of pancreatic inury,three cases of pancreatic pseudocyst and three cases of chronic pancreatitis. 2)The most common etiology of benign pancreatic disease, excluding pancreatic injury, was alcohol ingestion. 3)Five cases of severe acute pancreatitis were represented with more than 4 of Ranson's prognostic factors and the surgical methods refered were external drainage with debridment or necrosectomy. All were effectively managed surgically except one case of death which had more than 6 of Ranson's prognostic factors. 4)The etiology of pancreatic injury was blunt abdominal trauma in seven cases and surgical complications in one case. The sites of injury were head in three cases,body in three cases and tail in one case. The operative methods used were drainage(all cases),distal pancreatectomy(3 cases),triple ostomy(1 case) and pancreaticoduodenectomy(1 case). 5)The sites of pancreatic pseudocysts were the body in two cases, head in one case. The operative method used was as follows; excision in one case, external drainage in one case and cystojejunostomy in one case. 6)Three cases of the chronic pancreatitis were diagnosed by intraoperative findings. 7)In conclusion, the most reliable treatment for benign pancreatic disease is early surgical intervention, in order to reduce the mortality rate and complications induced by pancreatic inflammation.

The management of foreign body ingestion in gut

No abstract available.