The surgical treatment of spinal deformities in the Department of Orthopaedic Surgery, University Medical School of Pécs, Hungary: history and development.

Since its foundation in 1966, a great deal of attention has been paid to the treatment of spinal deformities, especially idiopathic scoliosis, in the Department of Orthopaedic Surgery, Medical School of University, Pécs. The authors compared the results of three different surgical methods (modified Hibbs, Harrington, Cotrel-Dubousset) on 171 patients between 1966 and 1992. The average follow-up period was between 2 and 13.2 years. In cases in which the modified Hibbs procedure was used we achieved a 26% correction, in the Harrington cases we achieved a 43.9% correction, and the loss of correction was 100% after the Hibbs operation and 18% after the Harrington operation in the follow-up period. In cases of Cotrel-Dubousset Instrumentation we achieved about 70% correction, but the follow-up period was too short (2 years) to evaluate the loss of correction in these cases.

Changes of expression of endogenous sugar receptors by polymorphonuclear leukocytes after prolonged anaesthesia and surgery.

Anaesthesia and surgery are known to depress granulocyte function in the early postoperative period, leading to deterioration of the immune defence against infection. Carbohydrate-lectin interactions may play an important role in the activities of phagocytic cells in that they facilitate initial host defence in the event of microbial antigenic challenge. A panel of biotinylated (neo)glycoproteins (chemically glycosilated carrier proteins) was used to detect endogenous carbohydrate-binding receptors /lectins/, on peripheral blood polymorphonuclear leukocytes of patients undergoing prolonged anaesthesia for replantation surgery. Four hours after induction of anaesthesia, a progressive decline of expression of endogenous sugar receptors on granulocytes was detected using the labelled (neo)glycoproteins lactose-BSA, N-acetyl-D-glucosamine-BSA, D-mannose-BSA, sialic-acid-BSA and D-xylose-BSA. Concomitant changes in peripheral white blood cell counts and the lack of depression in the absence of general anaesthetic agents suggested the existence of a possible relationship between reduced expression of (neo)glycoprotein receptors to impaired granulocyte function and anaesthetic-induced immunodepression.

Spatial differences of endogenous lectin expression within the cellular organization of the human heart: a glycohistochemical, immunohistochemical, and glycobiochemical study.

Protein-carbohydrate recognition may be involved in an array of molecular interactions on the cellular and subcellular levels. To gain insight into the role of proteins in this type of interaction, surgically removed specimens of human endomyocardial tissue were processed for histochemical and biochemical analysis. The inherent capacity of these sections to bind individual sugar moieties, which are constituents of the carbohydrate part of cellular glycoconjugates, was assessed using a panel of biotinylated neoglycoproteins according to a standardized procedure. Together with appropriate controls, it primarily allowed localization of endogenous lectins. Differences in lectin expression were observed between layers of endocardial tissue, myocardial cell constituents, connective-tissue elements, and vascular structures. The endocardium proved to be positive with beta-galactoside-bearing probes; with neoglycoproteins carrying beta-xylosides, alpha-fucosides, and galactose-6-phosphate moieties; and with probes containing a carboxyl group within the carbohydrate structure, namely sialic acid and glucuronic acid. In contrast, only fucose-and maltose-specific receptors were apparent in the elastic layers of the endocardium. Aside from ascertaining the specificity of the protein-carbohydrate interaction by controls, i.e., lack of binding of the probe in the presence of the unlabelled neoglycoprotein and lack of binding of the labelled sugar-free carrier protein, respective sugar receptors were isolated from heart extracts by using histochemically effective carbohydrates as immobilized affinity ligand. Moreover, affinity chromatography using immobilized lactose as affinity ligand as well as the use of polyclonal antibodies against the predominant beta-galactoside-specific lectin of heart demonstrated that the lactose-specific neoglycoprotein binding was due to this lectin. Remarkably, the labelled endogenous lectin, preferred to plant lectins for detecting ligands of the endogenous lectin, localized ligands in tissue parts where the lectin itself was detected glycohistochemically as well as immunohistologically. This demonstration of receptor-ligand presence in the same system is a further step toward functional assignment of the recorded protein-carbohydrate interaction. Overall, the observed patterns of lectin expression may serve as a guideline to elucidate the precise physiological relevance of lectins and to analyze pathological conditions comparatively.

Reduced expression of mannose-specific receptors on murine peripheral blood polymorphonuclear leukocytes following prolonged anaesthesia with different inhalation agents.

Inhalation anaesthetic agents are known to depress phagocytic functions such as mobilization, attachment, chemotactic motility, engulfment and intracellular killing. Mannose-specific sugar receptors on the surface of leukocytes are involved in a series of phagocytosis-related activities. To investigate the effect of anaesthesia on the expression of this type of sugar receptor, mice were anaesthetized with halothane, enflurane and isoflurane. The presence of mannose-binding receptors on peripheral blood polymorphonuclear leukocytes was examined glycocytochemically using the biotinylated neoglycoprotein mannosylated bovine serum albumin. Prolonged administration of inhalation anaesthetic agents, especially halothane, markedly depressed expression of mannose-specific receptors. This reduction may possibly contribute to postoperative immunodepression, resulting from the impaired cellular interaction which is involved in the phagocytic function of granulocytes.

Detection and mapping of endogenous receptors for carrier-immobilized constituents of glycoconjugates (lectins) by labelled (neo)glycoproteins and by affinity chromatography in human adult mesencephalon, pons, medulla oblongata and cerebellum.

Different carrier-immobilized carbohydrate moieties were employed as tools to detect respective binding sites glycohistochemically and glycobiochemically. Besides ascertaining their presence the pattern of endogenous sugar receptors (lectins) in different regions of the human central nervous system was mapped to reveal any non-uniform expression. A strong and specific staining with biotinylated neoglycoproteins, exposing different sugar moieties as ligands, indicated the presence of sugar receptors in the nuclei, neuronal pathways and accessory structures such as ependyma cells, plexus chorioideus, intra- and extracerebral vessels and leptomeninges localized in the mesencephalon, in the pons, in the medulla oblongata and in the cerebellum. Significant differences were seen for various neuroanatomical regions like nerve cells in the basal and central regions of the nuclei pontis in the glycohistochemically detected level of expression of endogenous sugar receptors (lectins). The used approach with carbohydrate constituents of cellular glycoconjugates as ligands in search of specific receptors complemented studies on the localization of glycoconjugates with sugar-specific tools like plant lectins. Exemplary glycobiochemical investigations on the medulla oblongata and cerebellum were performed to investigate the molecular nature of sugar receptors detected glycohistochemically. Despite notable overall similarities, carbohydrate-binding proteins of differing molecular weight can be isolated from these two regions of the central nervous system, namely in the case of receptors with specificity to beta-galactoside termini, to N-acetyl-D-galactosamine and N-acetyl-D-glucosamine and to D-xylose. These combined glycohistochemical and glycobiochemical results serve as a guideline for exploring the physiological relevance of the detected regional differences.

Contralateral haemothorax: a late complication of subclavian vein cannulation.

Contralateral haemothorax developed as a late complication of subclavian vein cannulation following gradual erosion of the wall of the superior vena cava by the tip of the catheter. The use of a relatively rigid catheter and a left-sided approach may have contributed to this rare, but potentially fatal complication.

Impaired metabolic activity of phagocytic cells after anaesthesia and surgery.

Peripheral blood leucocytes and their phagocytosis-associated metabolic activity were studied in 65 patients after elective surgery representing similar degrees of surgical trauma. Halothane (group A) or neurolept (group B) anaesthesia were given to 50 patients. Fifteen patients had extradural blockade only (group C). Leucocytosis was observed immediately after surgery in group B: patients in groups A and C responded more slowly. The higher 2nd-day values were followed by a decrease in leucocyte numbers on the 5th day. Although patients in groups A and B showed immediate decreases in nitroblue tetrazolium reduction, recovery was noted only in group B on the 5th day after operation. It is postulated that leucocytes with damaged membranes and receptors are probably lacking in the necessary functional integrity to fight invading microorganisms.

Double labelled T suppressor lymphocytes in the thymus of a patient with myasthenia gravis: morphological and immunological characteristics.

Double labelled lymphocytes were prevalent in the thymus of a 32-year-old woman with myasthenia gravis. The simultaneous presence of both E and C3b surface receptors was demonstrated. Focal paranuclear acid phosphatase activity of the cells supported their T cell origin. Histological analysis revealed a hyperplastic thymus with germinal centres in one lobe and an unusual transition to "thymoma-like" diffuse sheets of thymocytes and large thymic epithelial cells in the other lobe. Immunological studies of isolated cells from the "thymoma-like" region revealed a high percentage of E rosettes (96%), EAC rosettes (87%) and IgG-EA rosettes (60%). The large number of "active" rosettes (94%) indicated high avidity of receptors for sheep red blood cells. The postoperative accumulation of acid phosphatase positive T cells with C3b surface receptors in the peripheral blood was striking. These characteristics suggest that this cell population represents an activated T subset (TG) with a certain degree of immaturity similar to a particular stage of foetal T cell development (prothymocytes).

Clinical studies on the mucolytic effect of mesna.

Eighty intensive care patients requiring mucolytic therapy because of pulmonary mucus retention after chest (28 cases) or thoracic (52 cases) surgery were given the drug mesna by three different methods: bronchial lavage with a mixture of mesna (5% to 10%) and lidocaine (1%) in 15 to 20 ml, 10 to 20 times a day (10 cases); instillation into the bronchial tree of 15 to 20 ml of a 5% to 10% mesna solution three to five times a day (20 cases); continuous aerosolization of four to five ampules of mesna per 24 hours with a Bennett nebulizer (50 cases). The duration of mesna therapy ranged from 2 to 21 days. The drug was found to be highly effective in all three methods; rapid fluidization of bronchial secretions was observed and aspiration of the latter was considerably facilitated. Tolerance was excellent and there were no side effects, even in cases with bronchial asthma. A particularly good effect was seen on blood-contaminated mucus. Samples of aspirated mucus were investigated by the electron spin resonance (ESR) technique to obtain structural information about the effects of mesna as compared with N-acetylcysteine. Mucolytics decrease with ESR signal, and the rate of reduction is supposed to measure the rupture of disulphide bridges and, consequently, the degree of mucus fluidization. The rate of decrease of the ESR signals is much higher after mesna.

Bilateral testicular tumours.

After discussing the frequency of bilateral testicular tumours, attention is drawn to their rising incidence. In the 10 year period 1967 to 1976, three patients with bilateral testicular tumour were treated at the Department of Urology of the University Medical School of Pécs. Two had successively appearing bilateral seminoma and embryonal carcinoma, in the third patient simultaneously a malignant lymphoma appeared. As regards the question whether bilateral testicular tumours are two independent primary tumours or one is a metastastatic growth, presence of two primary tumours is assumed. The special features of therapy and prognosis are discussed.

Oxygen therapy and massive pulmonary haemorrhage in newborn infants.

A significant rise in the frequency of neonatal pulmonary haemorrhage was observed in the year when intensive oxygen therapy by CPAP and IPPV ventilation was started. To clarify the role of oxygen therapy the neonatal deaths occurring in two periods of different oxygen treatment were analysed and compared in respect of all clinical features which may be involved in the pathogenesis of pulmonary haemorrhage. In conclusion it is suggested that the local effect of oxygen is probably an additional but significant pathogenetic factor in the condition.