Jacques Gruwez

Intrinsic problems with the external fixation device of Hoffmann-Vidal-Adrey: a critical evaluation of 117 patients with complex tibial shaft fractures

In the 1978-1986 period, 117 patients with 119 fresh and complex fractures of the lower leg were secured primarily with a Hoffmann-Vidal-Adrey external fixation device. Ninety-five fractures could be followed until bony consolidation. In 12 fractures (12.7%) a pseudarthrosis developed, and a deep infection in four (4.2%). The external fixation device was attached for an average time of 25.0 weeks. Pin loosening was seen in seven patients (7.3%), minor pin-tract infection in nine (9.4%), and major pin-tract infection in three patients (3.1%). Fourteen fractures needed a secondary internal fixation; in 17 other fractures a secondary transplantation of cancellous bone autografts without internal fixation was carried out. After healing of the soft tissues, the tibial fracture can be regarded as a closed one and other therapeutic procedures to accelerate bony consolidation should be taken into account. The advantages and disadvantages of a second internal stabilization should be evaluated for every fracture with bone healing problems. The alteration from external to internal fixation makes an early removal of the external fixator possible and prevents in this way the intrinsic problems combined with this fixation type such as delayed union, nonunion, pin loosening, or pin-tract infection.

Prolongation of allogeneic heart graft survival in the rat after implantation on portal vein.

In rats, heart allografts with venous drainage via the portal vein were performed and compared with similar grafts draining into the inferior vena cava. A new technique was developed using the complete thoracic descending aorta and ligation of all its branches. The descending thoracic aorta was anastomosed to the recipients abdominal aorta below the left renal vein. The pulmonary artery was implanted on the portal vein in an end to side fashion. In two rat strain combinations the allograft survival time was significantly prolonged when compared to that of the control grafts with pulmonary-caval anastomosis. The presumed mechanism for this prolonged graft survival might be the sequestration or degradation of transplantation antigens in the liver during their first passage through this organ. In this way only a small amount of antigen reaches the systemic circulation.

The effects of cryopreservation on membrane integrity, membrane transport, and protein synthesis in rat hepatocytes

The cryopreservation of hepatocytes is of particular interest as a step in the possible treatment of some inborn disorders of metabolism. This study examines the metabolic damage that occurs as a result of the freeze-thaw procedures and during subsequent incubation periods of isolated rat hepatocytes. Even for freshly prepared hepatocytes, the presence of 1.8 M of Me2SO during incubation led to a rapid decline in viability. Optimal recovery after cryopreservation was obtained when incubation was started after the progressive removal of Me2SO. A buffer medium characterized by an intracellular electrolyte composition (Euro-Collins) proved particularly beneficial to the membrane integrity, probably by protecting the (Na+,K+)ATPase pump activity. The interpretation of viability using the trypan blue exclusion test was generally confirmed by the metabolic analysis of protein synthesizing activity and membrane transport function which are regarded as more rigorous tests of functional viability. The incorporation of L-[U-14C]isoleucine into the proteins of fresh hepatocytes during the first hour of incubation progressively leveled off over the next 2 hr. The cryopreserved hepatocytes showed a similar pattern although at a lower level of activity. Even after 3 hr of preincubation, the subsequent addition of labeled isoleucine still indicated a residual protein synthesizing activity. The active transport of alpha-amino[1-14C]isobutyric acid through the cell membranes reached a peak value after 60 min of incubation of fresh hepatocytes, and after 40 min of incubation of cryopreserved cells, followed by a steep decline as expression of rapid membrane deterioration. Again, the membrane transport pattern for the cryopreserved samples occurred at a lower level of activity. After preincubation of fresh and cryopreserved hepatocytes for 180 min, subsequent addition of labeled alpha-aminoisobutyric acid did not show any further significant metabolic activity. Initially the amino acid availability appeared to control protein synthesizing activity while, as membrane transport became seriously damaged, incorporation leveled off with only a low metabolic activity remaining. Although cryopreserved hepatocytes were susceptible to faster deterioration during subsequent incubation, considerable metabolic activity was retained. However, fresh and cryopreserved hepatocytes expressed metabolic functions at significantly different activities. Moreover, the differences between fresh and cryopreserved cells varied with the particular cellular function being examined.

Scanning electron microscopic study of microvascular anastomoses on irradiated vessels: Long‐term effect of irradiation

A study was performed to determine the effect of preoperative irradiation on microvascular arterial anastomoses. The study focused on microthrombi and epithelial regeneration. Using scanning electron microscopy (SEM), a clear difference was seen comparing nonirradiated to irradiated vessels. No difference was found between short‐ and long‐term effects of irradiation.

Internal stabilization after external fixation of fractures of the shaft of the tibia: sense or nonsense?

A series of 95 patients with fresh fractures of the shaft of the tibia, treated primarily with a Vidal-Adrey transfixation frame, was studied retrospectively. Only 20 fractures (21.0 per cent) attained clinical and radiological consolidation within 4 months after injury. Pseudoarthrosis was seen in 12 patients (12.9 per cent). The external fixator was attached for an average time of 25.0 weeks. Pin loosening was seen in seven patients (7.3 per cent), minor pin track infection in nine (9.4 per cent) and major pin track infection in three (3.1 per cent). In 31 patients (32.6 per cent) a second operative procedure was necessary to accelerate fracture healing. In 17 patients an autologous bone graft was carried out with the external fixator in place. Internal stabilization was performed after removal of the external fixator frame in 14 cases, at an average time of 9.4 months after injury. In difficult fractures we feel that change from external to internal fixation should be performed earlier; it makes early removal of the fixator pins possible and prevents the problems associated with prolonged use of fixator frames. The internal fixation, eventually combined with a transplantation of cancellous autografts, creates a mechanical and biological stimulus for bone consolidation. Functional recovery may also be improved because of a shorter healing time.

Does the Musculus Cricopharyngeus Play a Role in the Genesis of Zenker’s Diverticulum? Enzyme Histochemical and Contractility Properties

Different etiological mechanisms have been proposed to explain the genesis of a pharyngoesophageal diverticulum. Mostly these theories postulate disordered function between pharyngeal contraction and cricopharyngeal relaxation [1]. Best known is the theory of the premature cricopharyngeal closure before the bolus can be propelled [4]. All these theories are based on manometric studies [4, 5, 7–12]. But very little is known about the morphological aspects of the cricopharyngeus [2, 3] and to our knowledge no studies on its contractile properties have been published. In order to evaluate the role of the cricopharyngeal muscle during swallowing in normal patients and patients with a Zenker’s diverticulum, the contractile properties of this striated muscle were studied, in an attempt to correlate the contractile properties with the morphological changes between both groups found at histological and enzyme-histochemical examination.

Immunological and clinical observations in diabetic kidney graft recipients pretreated with total-lymphoid irradiation

In a feasibility study, twenty patients with end-stage diabetic nephropathy were treated with fractionated total-lymphoid irradiation (TLI, mean dose 25 Gy), before transplantation of a first cadaveric kidney. During radiotherapy, only one patient had a serious side effect (bone marrow depression). After transplantation four patients died (one of a myocardial infarction, one of ketoacidosis, and two of infections occurring during treatment of rejection crises). One graft was lost because of chronic rejection. The other 15 patients have a functioning graft (mean follow-up 24 months) and receive low-dose prednisone alone (<10 mg/day, n=ll) or in conjunction with cyclosporine (n=4) as maintenance immunosuppressive therapy. A favorable clinical outcome after TLI (no, or only one, steroid-sensitive rejection crisis) was significantly correlated with (1) a high pre-TLI helper/suppressor lymphocyte ratio, (2) a short interval between TLI and the time of transplantation, and (3) the occurrence of functional suppressor cells early after TLI. The most striking immunological changes provoked by TLI consisted of a long-term depression of the mixed lymphocyte reaction and of the phytohemagglutinin, and Concanavalin A or pokeweed-mitogen-induced blastogenesis. A rapid and complete recovery of the natural killer cell activity was observed after TLI. A permanent inversion of the OKT4+ (T helper/inducer) over OKT8+ (T suppressor/cytotoxic) lymphocyte ratio was provoked by a decrease of the OTK4+ subpopulation, together with a supranormal recovery of the OKT8+ lymphocytes. A majority of the latter lymphocytes did also express the Leu 7 and the Leu 15 phenotype.

The use of laparotomy in the treatment of recent diaphragmatic rupture due to blunt trauma

The choice of approach is still one of the most controversial points in the surgical treatment of recent rupture of the diaphragm. Most authors agree, however, about the use of thoracotomy in the late cases with strangulation. From 1970 to 1982 inclusive, 40 patients were operated on within a week of closed rupture of the diaphragm. The following data appear from these operations: 1. In 29 patients (73 per cent) one or more subdiaphragmatic organs needed repair. Only 4 patients (10 per cent) required operation for a thoracic lesion. 2. The hernia was easily repaired in the 34 cases treated by laparotomy only. For this reason when confronted by a recent diaphragmatic rupture, we almost always use an abdominal incision knowing that it, can easily be extended into the chest if this becomes necessary for the treatment of an injury there. In our experience, this policy needed to be changed in only a very few special cases.

Primary leiomyosarcoma of the diaphragm

Primary leiomyosarcoma of the diaphragm is extremely rare and only five cases have so far been reported. In the early stages clinical signs are scarce and diagnosis is difficult. The advent of MR-imaging has helped in detecting the origin of a diaphragmatic tumour and its relationship to the adjacent tissues. The highly malignant character of this tumour accounts for the poor prognosis even when radical surgery is performed.

Importance of HLA-DR matching in polytransfused cadaveric kidney transplant recipients. A prospective one-center study

Since August 1978 prospective HLA-DR typing has been performed in 157 donor-recipient pairs. All recipients received pretransplant blood transfusions. This study shows that HLA-DR matching can significantly improve the survival of cadaveric kidney allografts, even in polytransfused recipients. Patients receiving kidneys with no HLA-DR incompatibilities have a one-year graft survival of 97%, versus 86% for recipients with 1 HLA-DR incompatibility and 73% for recipients with 2 HLA-DR incompatibilities. The cumulative dose of corticosteroids during the first year after transplantation is significantly lower in patients with no DR-incompatibilities. HLA-A and B matching have no additional effect on graft survival.