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Methylmethacrylate metabolism in man. The hydrolysis of methylmethacrylate to methacrylic acid during total hip replacement.

Methylmethacrylate, the monomeric component of the polymethylmethacrylate cement used in orthopedic surgery, has been shown to undergo hydrolysis to methacrylic acid during hip replacement operations. Circulating levels of methacrylic acid were comparable with those of methylmethacrylate. Concentrations of both methylmethacrylate and methacrylic acid normally lay in the range 0--15 micrograms/cc. No correlation could be discerned between changes in the concentrations of methylmethacrylate and methacrylic acid, and changes in blood pressure.

Acetabulum

The effect of methylmethacrylate on chemotaxis of polymorphonuclear leukocytes.

The effect of methylmethacrylate on chemotaxis of polymorphonuclear leukocytes was evaluated by an in vitro method that involved migration of human leukocytes under agarose. Chemotactic factors produced during growth of Staphylococcus epidermidis, Staphylococcus aureus, and Escherichia coli remained chemotactically active in the presence of a methylmethacrylate concentration of 1.25 per cent, which was the highest tested. The methylmethacrylate also did not alter the activity of the chemotactic factor produced by zymosan activation of normal human serum. However, when methylmethacrylate was added to normal human serum prior to zymosan activation, a methylmethacrylate concentration of 0.312 per cent significantly depressed the subsequent zymosan-induced chemotactic activity and concentrations above 0.312 per cent abolished it. When methylmethacrylate was added to the polymorphonuclear leukocyte suspensions, there was significant depression of the migration of cells at a concentration of 0.312 per cent, and at concentrations of 0.625 and 1.25 per cent no leukocyte migration occurred.

Cell Migration Inhibition

Methylmethacrylate is a mutagen for Salmonella typhimurium.

The long-term effects of exposure to monomeric methylmethacrylate have yet to be established. We have measured the toxicity and mutagenicity of methylmethacrylate for Salmonella typhimurium. At levels of thirty-four millimolar, methylmethacrylate exhibited 28 per cent of the mutagenic activity of an equimolar dose of dimethylnitrosamine. Methylmethacrylate alone exhibited toxicity to the bacteria, but when the methylmethacrylate was incubated with a rat-liver enzyme metabolizing system, mutagenesis was induced. These findings suggest that an intermediate metabolite of methylmethacrylate is mutagenic to Salmonella typhimurium.

Adhesives

Effects of monomeric methylmethacrylate on ocular tissues.

Toxic effects of high doses of monomeric methylmethacrylate were demonstrated in rabbit eyes. These effects were not related to surgical manipulation. Monomeric methylmethacrylate caused limbal hyperemia, corneal edema, corneal neovascularization, iris engorgement, anterior chamber inflammation, iris atrophy, and cataract. The doses of monomeric methylmethacrylate needed to produce these lesions were much higher than the amount of monomer available for leaching out of implanted intraocular lenses.

Animals

The effect of methylmethacrylate on the bacterial inhibiting properties of normal human serum.

In vitro evaluation of the effect of known concentrations of methylmethacrylate on the bacterial inhibiting properties of normal human serum has been carried out. In low concentrations, methylmethacrylate was found to abolish almost completely the growth inhibition of Staphylococcus epidermidis by normal human serum. Normal human serum did not have an effect on growth of Staphylococcus aureus. It did inhibit growth of Escherichia coli, but there was no reversal of this effect by methylmethacrylate.

Bacteria

The effect of methylmethacrylate on bacterial phagocytosis and killing by human polymorphonuclear leukocytes.

The phagocytic and bactericidal activities of human polymorphonuclear leukocytes in the presence of methylmethacrylate were determined by in vitro techniques. It was found that methylmethacrylate in concentrations as low as 0.156 per cent significantly decreased the ability of leukocytes to phagocytose and kill strains of Staphylococcus epidermidis, Staphylococcus aureus, and Escherichia coli. The evidence indicates that methylmethacrylate impairs the killing more than the phagocytosis by the leukocytes.

Blood Bactericidal Activity

Cardiovascular effects of total hip placement in man. With observations on the effects of methylmethacrylate on the isolated rabbit heart.

The cardiovascular effects of total hip placement were evaluated in 10 surgical patients, aged 55 to 82, while receiving fluroxene-N2O-O2 anesthesia. The anesthetic regimen caused mild cardiovascular depression. The placement of the acrylic cement into the acetabulum and femoral shaft also induced mild cardiovascular depression, but these changes were not significant at p less than 0.05. In one 67-yr-old woman, there were significant reductions of cardiac output and stroke volume 2 min after the insertion of acrylic into the femoral shaft, despite careful replacement of intravascular loss and careful anesthetic management. Methylmethacrylate (1 X 10(-6) to 1 X 10(-4), v/v) was administered to 24 isolated perfused rabbits hearts. These concentrations of methylmetacrylate are of the same order as measurable blood levels in surgical patients. There was a dose-dependent depression of left ventricular dP/dt correlated with a depression of the spontaneous heart rate. When the bradycardia was prevented by electrically pacing the hearts or the administration of atropine, the depressed dP/dt rose to control levels. Reduction in myocardial temperature and heart rate by means of reduction in perfusate temperature of the isolated hearts reduced the myocardial depressant effect of methylmethacrylate.

Aged

Methylmethacrylate as an adjunct in the internal fixation of pathologic fractures.

The authors evaluated methylmethacrylate as an adjunct to internal fixation of 47 pathologic fractures of long bones (10 of the humerus and 37 of the femur) in 43 patients with metastatic disease. In their experience this method proved to be vastly superior to other methods of internal fixation. All patients were relieved of pain and, if able to walk, could do so almost immediately after fixation of the fracture. In the others comfort was enhanced and nursing greatly facilitated. The surgical technique of internal fixation is described in detail. Correct selection of the metal implant, meticulous attention to the biomechanical considerations and restoration of bone continuity by means of methylmethacrylate are most important if a gratifying result is to be obtained.

Adult

Monomeric methylmethacrylate (MMA) acts on the desheathed myelinated nerve and on the node of Ranvier.

The influence of monomeric methylmethacrylate (MMA) on resting and compound action potential of the isolated desheathed sciatic nerve of the frog (sucrose gap method) was determined. Above 10 mM there was a dose-dependent decrease of the compound action potential and a hyperpolarization of the membrane which was augmented with increasing MMA concentrations (4.1 mV +/- 0.2 S.E.M. after 50 mM MMA). The depolarization in low [Ca2+]0 solutions or with veratrine was reversed by MMA. The homologous ethyl, allyl and n-butyl esters were more effective than MMA, and the isobutyl ester less effective, whereas Na-methacrylate and methacrylamide showed no influence. Voltage clamp experiments on the node of Ranvier indicated that 50 mM MMA led to a decrease of the Na+ and K+ currents.

Action Potentials

[Combination of methylmethacrylate (acrylic cement) and antibiotics. Bacteriologic and mechanical study].

The authors report the results of a study about the association of acrylic cement with antibiotics. Three cements have been tested: Simplex, CMW, Palacos, with 14 different antibiotics. A series of experiments has been carried out in three phases: a macroscopic study of the polymerisation of the mixture; in vitro bacteriological studies; and mechanical studies (trials of resistance to traction, flexion, shock measuring the modulus of elasticity and hardness). In vivo bacteriological testings have been carried out on 10 patients. It has come out from this study that the polymerisation of cement, usually does not destroy antibiotics which remain active and that the mechanical properties of cement are modified in sundry manners. All additions of tested antibiotics modifie mechanical properties by about 25 p. 100 but some additions seem to be preferable. Improvements must still be made and confirmed by this type of research.

Ampicillin

[Apropos of complications following the use of methylmethacrylate. Possible prevention by betamethasone].

The aim of this study was to determine whether the prior injection of betamethasone was capable of preventing blood pressure changes and the fall in arterial pO2 when following the fixation of total hip protheses with methyl metacrylate. It involved 54 patients in whom systolic, diastolic and mean blood pressure (BP), arterial pO2, pCO2 and heart rate were noted at different times: T1, 15 minutes after the beginning of the operation; T2 and T3, one minute and five minutes after application of the cement; T4, at the end of the operation. There was no significant difference between the various measurements at times T1, T2, and T3 as far as blood pressure and heart rate were concerned. By contrast, there was a fall in pO2 at times T2 and T2 in relation to times T1 and T4. This fall was significant (p is less than 0.01) but never theless remained moderate. The possible influence of betamethasone is discussed.

Adult