Long-term decrease of CD4+CD45RA+ T cells and impaired primary immune response after post-traumatic splenectomy.

Congenital or acquired absence of the spleen and functional hyposplenism are associated with abnormalities of host defence such as an increased susceptibility to infection with encapsulated bacteria. The effects of the lack of the spleen on cell-mediated immunity are largely unknown. In the present study we have investigated peripheral blood lymphocyte subpopulations in healthy adults who had undergone splenectomy because of severe abdominal trauma > 4 years before the study. The results show a significant reduction in the percentage of CD4+ T cells due to a selective and long-term decrease in the percentage of CD4+CD45RA+ lymphocytes, the CD4+ T-cell subset mainly involved in primary immune responses to newly encountered antigens. Levels of the reciprocal CD45RO+CD4+ T-cell subset were comparable between splenectomized and control individuals, as were lymphoproliferative responses and IFN-gamma production to recall antigens. Decreased levels of CD4+CD45RA+ cells were accompanied by an impairment in primary immune responsiveness, as assessed by investigating T-cell proliferation to stimulation with keyhole limpet haemocyanin and by measuring antibody responses following primary immunization with a clinically relevant T-dependent antigen, hepatitis A vaccine, in vivo. These findings suggest a possible role of the spleen in the generation, maintenance and/or differentiation of naive, unprimed T cells or their precursors, which might have a possible functional relevance for primary immune responses following splenectomy.

Immunoscintigraphy of inflammatory processes with a technetium-99m-labeled monoclonal antigranulocyte antibody (MAb BW 250/183).

Antigranulocyte immunoscintigraphy with a technetium-99m- (99mTc) labeled monoclonal antigranulocyte antibody (MAb BW 250/183) was performed in 34 in-patients of the departments of accident surgery and internal medicine in order to prove or exclude inflammatory processes. After labeling with 99mTc, 555 MBq, 99mTc-MAb (0.5 mg antibody) were slowly injected intravenously over a period of 5 min. A whole-body scan was done 4-6 hr postinjection, and planar or SPECT images were performed 6, 18, and 24 hr postinjection. Leukocyte immunoscintigraphy proved inflammatory suppurating processes in 20 cases (true-positive) and excluded them in 11 cases (true-negative). The findings were false-positive in two patients (hematoma without signs of infection, pseudoarthrosis) and false-negative in one patient (encapsulated lung abscess with pleural fibrosis). Anti-idiotypic human anti-mouse antibodies (HAMA) were found only in one out of 20 patients. According to our experiences, immunoscintigraphy with 99mTc-MAb BW 250/183 has a sensitivity of 95%, and is, therefore, well suited for the identification of leukocytic inflammations.

[Fibrin adhesion of cartilage surfaces]. / Die Fibrinklebung von Knorpelflächen.

Basing on encouraging results with the fixation of pure articular cartilage with the fibrin sealant in animal experiments, pure cartilage fragments were replanted in human patients using fibrin sealant. From individual cases biopsies could be taken from macroscopically not well healed areas during arthroscopic examination. The histological results from these cases are presented together with overall clinical experiences. Six weeks after operation one side of the graft showed no union with the subchondral bone and was also separated from the cartilage bed. However, after three and six months, the grafted cartilage had fused with subchondral bone, but pannus-like tissue was covering the surface and filling the cleft at the border to the bed. After one and five years, complete fusion with the subchondral bone and the surrounding cartilage can be demonstrated. There is always covering pannus at the larger observation times. In the majority of the 73 cases treated so far excellent clinical results were obtained, enabling the patients to take up their sporting activities again.

[Healing of chondral fragments]. / Uber die Einheilung replantierter chondraler Fragmente.

Basing on encouraging results with the fixation of pure articular cartilage with the fibrin sealant in animal experiments, pure cartilage fragments were replanted in human patients using fibrin sealant. From individual cases biopsies could be taken from macroscopically not well healed areas during arthroscopic examination. The histological results from these cases are presented together with overall clinical experiences. Six weeks after operation one side of the graft showed no union with the subchondral bone and was also separated from the cartilage bed. However, after three and six months, the grafted cartilage had fused with subchondral bone, but pannus-like tissue was covering the surface and filling the cleft at the border to the bed. After one and five years, complete fusion with the subchondral bone and the surrounding cartilage can be demonstrated. There is always covering pannus at the larger observation times. In the majority of the 48 cases treated so far excellent clinical results were obtained, enabling the patients to take up their sporting activities again.

Divergent patterns of leucocyte locomotion in experimental post-traumatic osteomyelitis.

Leucocyte locomotion (LL) was evaluated in guinea-pigs with experimental post-traumatic osteomyelitis. Surgical procedure (fracture of the right femur), the number of micro-organisms applied to the fractured site and the time sequence of investigations were kept constant. After the right femur of guinea-pigs had been fractured, the animals were divided into three groups: in group I the fractured site remained uninfected, while in groups 2 and 3 the fractured sites were infected with either Escherichia coli (10(5] or with Staphylococcus aureus (10(4]. In a fourth group, guinea-pigs were anaesthesized only, without any further trauma. LL was significantly depressed in all three groups following trauma on postoperative day 5 as compared to pre-operative levels (P less than 0.01), but had remained normal in guinea-pigs which had been anaesthesized only. While LL returned to pre-operative levels and stayed normal in uninfected guinea-pigs and those which had been infected with E. coli, LL levels fell significantly (P less than 0.05) in guinea-pigs which had been infected with Staph. aureus on postoperative day 55 and remained depressed throughout the observation period of 90 days. These findings emphasize that defects in LL are connected with the infectious agent and are not merely secondary to the process in the osseous tissue.

A model of experimental post-traumatic osteomyelitis in guinea pigs.

A model of experimental post-traumatic osteomyelitis is described in which the femur of guinea pigs was fractured and infected with E. coli (10(5)) or Staphylococcus aureus (10(4)). Traumatized uninfected animals served as controls. The animals were further divided within each group by treating the fractured site with an intramedullary wire in one half. Osteomyelitis developed and became chronic in all guinea pigs infected with Staph. aureus, and in nine of 12 infected with E. coli. All animals infected with E. coli treated with an intramedullary wire developed chronic osteomyelitis; only four of seven from E. coli-infected animals with fractures developed this disease. Moreover, Staph. aureus could be recovered from the osseous tissue in the chronic stage of the disease regularly, while E. coli was only present in the early weeks after operation, but not in the chronic stage.

[Posttraumatic osteomyelitis. Mode of infection, significance of metal implants]. / Posttraumatische Osteomyelitis. Infektionsmodus, Bedeutung der Metallimplantation.

Guniea-pigs of the Duncan-Hartley strain were used in a model of posttraumatic osteomyelitis. One femur had been fractured with or without consequent metal implantation and infected subsequently with 10(7) or 10(5) staphylococcus aureus or E. coli. 85% of the animals infected with staph. aureus and 56% infected with E. coli developed osteomyelitis. Healing of infection occurred in 3 cases only and always in the absence of metal implants. All bone infection persisting for more than 3 months were also detectable after 12-18 months. The assessment of opsonising factors revealed a long lasting deficiency in guinea-pigs with metal implants.

Pertrochanteric fractures of the femur. A comparative study of internal fixation with angle nail-plates and flexible condylar nails.

Two methods of internal fixation of pertrochanteric fractures of the femur, angle nail-plates and flexible condylar nails, were compared in a retrospective clinical study, with emphasis on the results and indications as related to the age and physical condition of the patients.

[Acute and chronic experimental posttraumatic osteomyelitis in guinea pigs]. / Die akute und chronische experimentelle posttraumatische Osteomyelitis beim Meerschweinchen.

The model of an experimental posttraumatic osteomyelitis is described. Acute and chronic osteomyelitis was produced by inoculation of 10(5) Staph. aureus or E. coli to fractured femora--stabilised or not--with intramedullar nailing. The results are discussed. The model seems to be useful to further studies on posttraumatic osteomyelitis.

[The posttraumatic osteomyelitis in guinea-pigs (author's transl)]. / Die posttraumatische Osteomyelitis beim Meerschweinchen.

A model of posttraumatic osteomyelitis was developed in 120 Duncan-Hartley guinea-pigs. For this purpose the right femura of all animals were fractured surgically. In 60 guinea-pigs immobilisation of the fractured extremity was omitted, in remaining 60 the medullary space was splinted with intramedullary pin. Each of the two groups was further subdivided in three subgroups, i.s. non infected controls, staphylococcus aureus-infections and escherichia coli-infections. Comparative evaluations were based on ten follow-up studies, nine of which were scheduled for the first three postoperative months and one 12 months after surgery. The overwhelming majority of infected animals developed acute osteomyelitis. This was found to heal within the first three postoperative months in just a few of the animals without intramedullary pinning. In all other animals the condition became chronic and was still demonstrable one year after infection. Follow-up immunological studies were based on bacterial ingestion. An evaluation of opsonic activity against time revealed statistically significant deferences for all groups. Marked depression of opsonic activity within the first 35 postoperative days after intramedullary pinning constituted the most prominent immunological finding.