Comminuted intraarticular fractures of the distal humeral condyles. Surgical vs. nonsurgical treatment.

Forty-two comminuted intraarticular fractures of the humeral condyles treated between 1975 and 1981 were analyzed in order to compare the results of operative versus nonoperative management. Twenty-nine patients were treated by open reduction and internal fixation; the remainder were treated by nonoperative techniques. Functional results were evaluated by the method of Bickel and Perry. Of the patients treated by open reduction and internal fixation, 76% had an excellent or good result. Of the nonsurgically-treated patients, only eight percent had a satisfactory result. Anatomic restoration by open reduction and rigid internal fixation in conjunction with early motion was associated with satisfactory results. The preferred surgical exposure was a posterior "U" incision with extraarticular olecranon osteotomy. This provided good visualization and facilitated anatomic restoration in these complex fractures.

Aggressiveness of SJL/J lymphomas correlates with absence of H-2Ds antigens.

SJL/J lymphomas emerged as H-2Ds-negative variants upon transplantation of their respective H-2Ds-positive spontaneous tumors. Of nine spontaneous SJL/J lymphomas examined, only two contained detectable numbers of H-2Ds-negative tumor cells. Of seven successfully transplanted tumors, however, four emerged as predominantly H-2Ds-negative tumors by their second transplantation. Long term SJL/J lymphoma lines, RCS 5 and SJL/SJL, were also found to be H-2Ds-negative. The expression of H-2Ks and I-As were maintained on all tumor lines examined. H-2Ds-negative tumor cells were consistent stimulators of syngeneic lymphoproliferation, whereas tumors maintaining H-2Ds expression varied in their stimulatory capacity. Transplantation times required to achieve morbidity in syngeneic mice correlated with tumor cell expression of H-2Ds. Tumors maintaining H-2Ds expression were less aggressive and required 57 to 150 days to produce morbidity compared with highly aggressive H-2Ds-negative tumors that required only 7 to 10 days at one-quarter of the cell dose (10(7) cells). Growth curve analysis based on spleen weights (corrected for body weight) indicated that three types of SJL/J lymphomas could be identified based on their expression of H-2Ds and ability to stimulate syngeneic lymphoproliferation: 1) indolent, nonstimulatory H-2Ds-positive tumors; 2) indolent, stimulatory H-2Ds-positive tumors; and 3) highly aggressive, stimulatory H-2Ds-negative tumors.

A morphologic overview of the porcine bioprosthetic valve--before and after its degeneration.

Patients with valvular heart disease have had their diseased, natural heart valves replaced with the porcine aortic bioprosthetic valve (Hancock type) at Henry Ford Hospital since 1971. This commercially available valvular bioprosthesis is characterized by 1) loss of endothelium from both surfaces of the leaflets, 2) modification in the organization of the fibrous connective tissue of the leaflet, and 3) a reduction in the macromolecular complexes (proteoglycan) of the extracellular matrix. Subendothelial components are therefore exposed to the circulating blood. This bioprosthetic heart valve undergoes degeneration after it is inserted into patients for various lengths of time. Prominent features of the degenerated porcine bioprosthetic valve include 1) penetration of plasma proteins into the interior of the leaflet, 2) adhesion of various types of leukocytes (mononuclear cells and granulocytes) to the surfaces of the leaflets, 3) deposition of single platelets, platelet aggregates and microthrombi onto the leaflet's surface, 4) destruction of collagen fibers, and 5) pathologic deposition of calcium salts. The mechanisms responsible for the degeneration of the porcine aortic bioprosthetic valve are incompletely understood at this time.

Oestrus, time of ovulation, ovulation rate and conception rate in progestagen-treated ewes given Gn-RH, Gn-TH analogues and gonadotrophins.

The influence of Gn-RH, hCG and a PMSG-hCG mixture (PG600) on the time of ovulation, ovulation rate and on the occurrence of oestrus in ewes treated with progestagen-impregnated sponges for 12 days examined. The effects of Gn-RH analogues on plasma LH, oestrus, ovulation and conception rate were also investigated. Six separate experiments were carried out. When 50 micrograms Gn-RH were given 24 h after sponge removal ovulation occurred in 44--46% of ewes within 24 h and in all ewes by 34 h. Gn-RH was a more potent ovulation synchronizer than hCG. Both hCG and PG600 reduced the incidence of overt oestrus. Gn-RH also had this effect in ewes treated during February and May but not in August and September. Gn-RH analogues given 2 days before sponge removal significantly increased ovulation rate. The display of oestrus was not affected in ewes treated 2 days before sponge removal but was suppressed in 43-69% of ewes treated with an analogue at the time of sponge removal. Ovulation occurred in 50-62% of ewes within 30-35 h of injection of Gn-RH analogues, regardless of the time of their administration. The release of LH in response to one analogue was not influenced by the presence of the progestagen-impregnated sponge in the vagina. When given a Gn-RH analogue 2 days before sponge removal or at the time of sponge removal 63 and 62% of mated ewes became pregnant compared with 70% of control ewes.

Effect of gold sodium thiomalate on murine lymphocyte functions.

The in vitro effects of gold sodium thiomalate (GTM) on various murine splenic lymphocytic functions were tested. The presence of GTM in cultures of splenic cells suppressed anti-hapten responses to both thymus-independent and thymus-dependent antigens. GTM also suppressed the in vitro generation of cytotoxic effector cells as well as the mitogenic response to both T cell and B cell mitogens. This suppression could not be reversed by the addition of irradiated spleen cells. Spleen cells exposed to GTM for 4 hr prior to culture also exhibited similarly suppressed functions, although their functional capacity could be fully restored by the addition of irradiated spleen cells. These results show that GTM inhibits both humoral and cellular immune mechanisms and appears to act primarily at the accessory (macrophage) cell level, with perhaps a secondary effect on T lymphocytes.

Total hip replacement in patients with rheumatoid arthritis.

In this prospective study, 50 patients with a confirmed diagnosis of rheumatoid arthritis had total hip replacement. Preoperatively and at regular intervals postoperatively, all patients had evaluation of pain, ambulation, and range of motion according to the scale of d'Aubigne and Postel. Follow-up ranged from three to seven years, with the average being longer than four years. All patients demonstrated significant improvement in these parameters. Specific problems of the rheumatoid patient are discussed in detail.

Evidence for separate subpopulations of B cells responding to T-independent and T-dependent immunogens.

BALB/c spleen cell cultures were double-challenged with optimal doses of TNP-T independent and TNP-T-dependent immunogens. The anti-hapten response was additive or synergistic in double challenged cultures compared to the response in cultures challenged with either immunogen alone. A high, suppressive dose of either immunogen did not prevent the response to an optimal dose of the second immunogen in the same culture. Spleen cell cultures were also double challenged with combinations of two T-dependent or two T-independent immunogens. Addition or synergy in the anti-hapten response only occurred when the double challenge consisted of a mixutre of T-dependent and T-independent immunogens. These results are consistent with the proposed B1B2 classification of B cell subpopulations.

A clinical evaluation of aspirin prophylaxis of thromboembolic disease after total hip arthroplasty.

Prophylaxis of thromboembolic disease using aspirin was studied prospectively in 340 patients undergoing total hip replacement, excluding those with prior thromboembolic disease. Clinical criteria were used to diagnose thrombophlebitis, while clinical criteria, roentgenography, blood-gas determinations, electrocardiography, and pulmonary vascular scanning were used to diagnose pulmonary emboli. Five patients had signs of symptoms of pulmonary emboli, all confirmed by pulmonary vascular scan. No fatal pulmonary emboli occurred. Twenty-six patients had thrombophlebitis. Without simultaneous control group, a reduction in postoperative thromboembolic disease in these patients receiving aspirin was not proved. However, the observed low incidence of clinically evident thromboembolic manifestations suggests that aspirin may be a simple and useful prophylactic agent in these patients.

A modified solid ankle brace for the treatment of arthritides.

A modified solid ankle short leg brace is presented for use in patients with ankle joint and hind foot arthritides. Thirty-five patients were followed up for an average of 2 1/2 years. Thirty patients had marked relief of pain; three, moderate relief; and two, no relief. Thirty-two patients had improved cosmesis of their gait patterns.

Effect of frequent ejaculation on semen characteristics in rams.

Sixteen Suffolk rams were ejaculated repeatedly for a period of eight hours during the month of November. Ejaculates were examined for semen characteristics. Volume density and number of sperm per ejaculate declined significantly in successive ejaculates. Motility and percentage abnormal sperm were not affected by frequent collection. It is concluded that the number of sperm per ejaculate, after the eighth ejaculate, could fall below that required for fertilisation to occur, particularly in progestagen treated ewes.

In vitro immunogenicity of trinitrophenylated bacteriophage T4. I. Lack of helper cell cooperation.

A primary immune response was obtained in vitro to trinitrophenylated bacteriophate T4 (TNP-T4) by using normal BALB/c spleen cells challenged in vitro. The primary response was limited to anti-TNP; we failed to find evidence of a primary anti-T4 response in spleen cell cultures challenged with either TNP-T4 or native T4. In vivo priming with the carrier T4 failed to enhance the subsequent in vitro response to TNP-T4 although such priming sometimes caused suppression of the anti-hapten response. The addition of excess free carrier to spleen cell cultures challenged with TNP-T4 failed to suppress the anti-tnp response. Spleen cells treated with anti-theta plus complement were unaffected in their ability to respond to TNP-T4. We conclude that TNP-T4 should be classified among the thymus independent antigens.