Complications of harvesting autogenous bone grafts: a group experience of 20,000 cases.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to P Tessier.
Explore the source record for details and available documents.
Alloplastic bone substitutes can be used to alter facial contour. In contrast, autogenous bone grafts have a successful 80-year history of restoring facial contour as well as the basic functional support of the craniofacial skeleton. The traditional procedures for harvesting and using autogenous bone grafts are not obsolete. During the past 30 years, the techniques have been refined and new sources have been found, such as calvarial grafts. New tools were required and have been designed to make harvesting of grafts easier and faster for the surgeon and safer and less expensive for the patient. Four short articles under the heading of "Techniques and Tools" are presented addressing the harvesting of (1) iliac, (2) costal, (3) tibial, and (4) calvarial grafts. These articles are based on the experience of six surgeons using the same technique and instruments in more than 20,000 autogenous bone grafting procedures. (These figures represent the group experience as of 2001. Since then, one of the junior coauthors has retired, but the remaining five continue to harvest autogenous bone grafts on a regular basis. So, the group experience as of 2004 is in the range of 23,000 procedures). The-senior surgeon's experience of 9500 procedures spans a period of 50 years (from 1946 to 1996). For the other surgeons (10,500 procedures combined), the collection period was 25 years (from 1975 to 2000).
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Sixteen 3-week-old calves were intratracheally inoculated with Mycoplasma bovis. Follow-up consisted of regular bronchoalveolar lavages (BALs) and clinical examinations. Animals were slaughtered from 4 to 21 days after inoculation. Counts were made of the mycoplasmas and other bacteria systematically isolated from the BAL liquids and lung lobes after slaughter. On the 6th day, spectinomycin 20mg/kg was given intramuscularly in three repeated doses at 24h intervals to six randomly chosen calves. All animals had developed a persistent M. bovis infection with a maximum BAL count on the 6th day (start of treatment). Co-occuring Pasteurella multocida infection was found in most animals with a maximum rate on the 14th day. The extent of lung surface lesions varied widely (0-64%) but was greater in the later slaughtered calves. Average counts of M. bovis and P. multocida in the BAL liquids were lower in treated calves than in untreated ones but the difference was not statistically significant. However, M. bovis and P. multocida counts in the lungs of the treated group were significantly lower than in the untreated group (p=0.003 and 0.009, respectively).
Explore the source record for details and available documents.
Over the last decade or so there has been a growing interest in routes of antimicrobial administration other than by the conventional intravenous route for institutionalized patients and for some outpatients. Both oral (PO) and intramuscular (IM) routes of administration are less costly than giving antimicrobial agents by vein (IV). In addition, fewer complications such as catheter-related sepsis and phlebitis are associated with non-IV routes of administration. Furthermore, a reduced-dosage, reduced-volume IM administration of ceftriaxone may provide a tolerable route of administration and equivalent bactericidal activities compared with higher dose IV ceftriaxone. The purpose of this study was to determine the time that the drug concentration remained in excess of the minimum inhibitory concentration (MIC) (T > MIC) and the duration of bactericidal activities of ceftriaxone one gram administered IV, ceftriaxone 250 mg given IM and cefixime 400 mg given orally against clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in adult volunteers. Single doses of each agent were administered and serum concentrations were collected over the standard dosing period of 24 h for all study regimens. Ceftriaxone, regardless of route of administration and dose, resulted in bactericidal activities and T > MIC for 100% of the dosing period for S. pneumoniae, H. influenzae, and M. catarrhalis. Cefixime maintained at least 50% T > MIC and bactericidal activity against both isolates each of H. influenzae and M. catarrhalis. Against both isolates of S. pneumoniae, cefixime achieved T > MIC for at least 50% of the dosing period, but did not maintain bactericidal activity. Reduced dose ceftriaxone given IM seems to be a viable alternative to ceftriaxone IV if the pathogen, susceptibility and infection site are known. Based on T > MIC exceeding 50% of the dosing interval, cefixime would be considered an effective alternative to IV therapy against common respiratory tract pathogens. Clinical studies need to be conducted to confirm these findings.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Studies in our laboratory and others have recently shown that staphylococcal enterotoxin-derived superantigens stimulate proinflammatory cytokine gene expression in vitro. We have therefore investigated the ability of superantigens to induce leukocyte accumulation at extravascular sites in vivo using the subcutaneous air pouch model. Injection of staphylococcal enterotoxin A (SEA) induced a significant accumulation of leukocytes over basal levels in a time- and dose-dependent manner. It was also shown that superantigens are capable of inducing this response in mice depleted of CD4 T cells, as well as in severe combined immune-deficient and nude mice. These observations suggest that superantigens are capable of inducing leukocyte accumulation independently of the presence of T lymphocytes. Experiments were also conducted using mutant SEAs that have a reduced binding affinity for major histocompatibility complex (MHC) Class II molecules, as well as using MHC Class II-deficient mice. The results of these experiments indicated that MHC Class II molecules are not required for the observed effect of superantigens in vivo. Taken together, these results indicate, first, that bacterial superantigens promote inflammation in subcutaneous tissue in vivo and, second, the potential existence of a novel receptor for superantigens that mediates this subcutaneous inflammatory response.
Personal computer (PC)-based computing is now ubiquitous in common consumer applications. Although PCs have equaled or surpassed engineering workstations in basic computing power and economy, there is still strong workstation dependency for imaging applications. This article demonstrates that a complete system, based on a Pentium PC (Intel Corporation, Santa Clara, CA) and readily available and inexpensive software, can be built very economically for effective execution of most of the commonly used three-dimensional imaging operations. For the craniofacial application, the Pentium system offers a twofold speed advantage over a Sparc 20 system using similar three-dimensional processing software. The Pentium system allows interactive fuzzy volume rendering, and manipulation and analysis of complex hard and soft-tissue structures.
Bioimpedance offers a simple non-invasive means of measuring systolic ejection volume and heart rate and thus cardiac output. Four pairs of electrodes are placed on precise locations on the chest and stroke volume is calculated according to the equation developed by Kubicek in 1966 and modified by Sramek in 1980. The aim of this work was to evaluate this method in patients with heart disease. In a series of 50 patients, the coefficient of correlation for cardiac index between impedance values (2.52 +/- 0.71 ml/min/m2) and thermodilution values (2.74 +/- 0.69 ml/min/m2) was 0.63 (p < 0.01). The mean difference was -0.2 l/min/m2 (confidence interval +1 l/min/m2 to -1.4 l/min/m2). There was no statistical correlation in patients with complete left bundle branch block, severe mitral or aortic regurgitation or dilatation of the aorta. In a group of 11 healthy volunteers, there was a good correlation between two measures taken at a 2 day interval (r = 0.95). The coefficient of variation ranged from 1.2 to 7% for ejection volume. Bioimpedance is reproducible and simple, authorizing its use for non-invasive monitoring of cardiac output in a given patient in various clinical situations.
OBJECTIVE: To examine the regulation of the intercellular adhesion molecule 1 (ICAM-1) gene in cultured human synovial fibroblasts in response to tumor necrosis factor alpha (TNF alpha), and investigate its modulation by the synthetic glucocorticoid, dexamethasone. METHODS: Cell surface expression of ICAM-1 was determined by flow cytometry, enzyme immunoassay, and immunoprecipitation. ICAM-1 messenger RNA (mRNA) levels were monitored by Northern blot. ICAM-1 function was determined by measuring the adhesion of monocytes to synovial fibroblasts. RESULTS: ICAM-1 expression on unstimulated cells was weak but was rapidly enhanced in both a time- and dose-dependent manner following exposure to TNF alpha. Treatment of the cells with TNF alpha also resulted in both a time- and dose-dependent increase in steady-state ICAM-1 mRNA levels, as determined by Northern blot. The increased expression of ICAM-1 was inhibited by cycloheximide and actinomycin D. Cultured synovial fibroblasts from patients with rheumatoid and nonrheumatoid arthropathies responded similarly to TNF alpha. Adhesion studies demonstrated that ICAM-1 is involved in the adherence of peripheral blood monocytes to TNF alpha-activated synovial fibroblasts. In addition, dexamethasone inhibited TNF alpha-induced surface expression of ICAM-1, accumulation of ICAM-1 mRNA, and adhesion of monocytes to TNF alpha-activated synovial fibroblasts. CONCLUSION: These combined results provide further evidence of an important role of ICAM-1 in inflammatory synovitis, as well as a potentially novel site of antiinflammatory action of glucocorticoids.