[Free fibula transplantation with restoration of the blood supply].
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Biomedical subjects
Publications and source records attributed to A J Verbout.
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With the aid of a relatively simple computer system three-dimensional graphic reconstruction models have been prepared. The procedure was applied in anatomy on a fixed embryonic specimen and in radiology on living subjects by using computed tomography scans. The results are useful for embryological research as well as for clinical evaluation.
In 10 children seriously disabled by cerebral palsy, 12 dislocated hips were surgically reduced. The main indications for surgery were impaired perineal care, decreasing sitting balance, and pain. Furthermore, the operations were considered in order to anticipate major problems in the future, such as the wind-swept hip phenomenon and pain in the hip. At follow-up, it appeared that all the children had profited from the surgical procedures.
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Relatively poor spatial resolution has been obtained in magnetic resonance (MR) imaging of the shoulder because the shoulder can only be placed in the periphery of the magnetic field. The authors have devised an anatomically shaped surface coil that enables MR to demonstrate normal shoulder anatomy in different planes with high spatial resolution. In the axial plane, anatomy analogous to that seen on computed tomographic (CT) scans can be demonstrated. Variations in scapular position (produced by patient positioning) may make reproducibility of sagittal and coronal plane images difficult by changing the relationship of the plane to the shoulder anatomy. Oblique planes, for which the angle is chosen from the axial image, have the advantage of easy reproducibility. Obliquely oriented structures and relationships are best seen in oblique plane images and can be evaluated in detail.
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The method of graphic reconstruction using the oblique view technique was applied on the transverse CT scans of the vertebral column. In the scanning procedure the low-dose thin-slice technique was used. The method proved valuable for the construction of three-dimensional models as reliable reproduction of the original. The results are useful for preoperative evaluation of the deformed spine as well as for anatomic research.
The literature on the early embryonic development of the vertebral column in various animal species was analyzed to evaluate so many unrelated or contradictory observations. The recurring problems are described. One of the first was the lack of correspondence between the metameric boundaries of the 'primitive vertebral bodies' arising from the somites and those of the adult vertebral bodies, as presumably shown by their relationship to the vertebral processes and spinal nerves. A century ago, Remak introduced the concept of 'Neugliederung', according to which the ultimate vertebral body boundaries are determined by a shift of a half segment in comparison with the earlier segment boundaries. Another question was about the nature of the structures the primitive segments give rise to (axial skeletal tissue and/or muscular tissue and/or nervous tissue), which led to the fundamental problem which system (skeleton or musculature) retains its segmentation. The observation of what was called the intervertebral fissure led to a far-reaching modification of the 'Neugliederung' concept, making a regrouping of parts of the primitive vertebral bodies both possible and probable. The functional necessity for the alternation of muscle and skeleton primordia was also assumed. Although the difference in rostro-caudal level between the boundaries of the somites and the definitive vertebral bodies, measured for instance in relation to the position of the intersegmental vessels, does not support a resegmentation of the vertebral column, because the somite is not a precursor of the adult vertebra, few authors have rejected this view. Subsequently, the discussion focussed on the problem of a) the animal species in which and b) the time at which the intervertebral fissure occurs, and the relationship of this fissure to the primitive vertebral cavity. Under the influence of comparative embryology, a number of authors concentrated mainly on identifying certain embryonic primordia as homologues of phylogenetic vertebral elements, and also on attempting to determine the recombination by which such elements could form a definitive vertebra. According to these authors, not only the vertebral bodies but also the arches and ribs undergo a 'Neugliederung'. Another variant of the 'Neugliederung' concept envisages a gradual shift of the original boundaries of the somites with respect to the transverse level of the definitive vertebrae with or without migration of cellular material. A critical consideration of the concepts at issue, and notably of the 'Neugliederung' concept, is presented. Certain phenomena held to be pillars of the 'Neugliederung' theory could not be confirmed. The functional interpretation of the resegmentation was also reduced to its proper proportions by the analysis. A development of the axial skeleton without resegmentation is just as conceivable in functional terms as one in which resegmentation occurs. A functionally meaningful relationship between muscles and skeletal elements is possible in both cases...
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Anterior cruciate ligament (ACL) reconstruction surgery still has important problems to overcome, such as "donor site morbidity" and the limited choice of grafts in revision surgery. Tissue engineering of ligaments may provide a solution for these problems. Little is known about the optimal cell source for tissue engineering of ligaments. The aim of this study is to determine the optimal cell source for tissue engineering of the anterior cruciate ligament. Bone marrow stromal cells (BMSCs), ACL, and skin fibroblasts were seeded onto a resorbable suture material [poly(L-lactide/glycolide) multifilaments] at five different seeding densities, and cultured for up to 12 days. All cell types tested attached to the suture material, proliferated, and synthesized extracellular matrix rich in collagen type I. On day 12 the scaffolds seeded with BMSCs showed the highest DNA content (p < 0.01) and the highest collagen production (p < 0.05 for the two highest seeding densities). Scaffolds seeded with ACL fibroblasts showed the lowest DNA content and collagen production. Accordingly, BMSCs appear to be the most suitable cells for further study and development of tissue-engineered ligament.