Sue Ann Thompson

Suitability of the Iliac Crest as a Site for Harvest of Autogenous Bone Grafts

Many donor sites have been advocated for obtaining cancellous bone to be used for grafting alveolar defects. Recently, some authors have suggested that the iliac crest site produced an unacceptably high degree of postoperative morbidity. Because of this morbidity, the use of other donor areas, e.g., rib, cranium, and mandible, are advocated. The iliac crest donor site for alveolar bone grafting has been common practice in our institution for years under the assumption that little or no postoperative morbidity occurred. To investigate and document the accuracy of our assumption, the charts of the most recent 50 consecutive patients receiving alveolar bone grafts, all of which used the iliac crest as a donor site, were reviewed. Postoperative pain, numbness, infection, paralysis, or long-term disability were catalogued from the charts. In addition, a questionnaire was sent to the parents and patients requesting their perceptions of these parameters. In the cases reviewed, the average length of skin incision was 4.2 cm. The average quantity of bone harvested was 4.1 cc. The usual hospitalization time was 2-3 days. No patients experienced serious or long-term complications at the surgical donor site. Immediate postoperative complications among the 50 patients studied were limited to one hematoma, one stitch abscess, one case of swelling with pain, one erythema, and one 4-day fever accompanied by slight serosanguineous drainage. Information from the questionnaire suggests that most patients returned to full activity within 4-6 weeks. No patient reported any long-term pain or disability.(ABSTRACT TRUNCATED AT 250 WORDS)

Localization of immunoreactive prolactin in ependyma and circumventricular organs of rat brain

SummaryImmunoreactive prolactin (IMP) has been localized in the male rat brain using the soluble peroxidase-anti-peroxidase (PAP) technique. In normal untreated animals, reaction product was seen in choroid plexus (CP) and in ependymal cells of the ventricular lining with heaviest concentrations of positively staining cells in the 3rd ventricle near the subcommisural organ (SCO), in the lateral ventricles near the subfornical organ (SFO), and in the 4th ventricle near the area postrema (AP). IMP was also present in numerous ependymal cells resembling tanycytes in the cerebral aqueduct, central canal of the spinal cord at the level of the AP, the organum vasculosum of the lamina terminalis (OVLT) and the floor of the infundibular recess. Immunoreactive cells resembling neurons were localized within the substance of the AP, SCO, and OVLT. IMP was also present in fibers of the zona externa of the median eminence and infundibular stalk; a few cells of the pars tuberalis contained reaction product. Hypophysectomized rats and bromocriptine-treated rats exhibited a similar staining pattern except that bromocriptine treatment eliminated IMP from most CP cells. Hypophysectomy, bromocriptine or estrogen treatment enhanced staining for IMP in cells of the pars tuberalis; estrogen treatment or hypophysectomy produced an increase in the number and distribution of immunoreactive cells as well as increased density of reaction product in cells of the medial habenular nucleus. The functional relevance of prolactin in these locations in the brain, the possible routes of transport of prolactin from the pituitary gland to the central nervous system, and the strong suggestion of extra-pituitary sites of synthesis of a prolactin-like hormone are discussed.

Effect of Immunological Differences on Rat Aortic Valve Allograft Calcification

Calcification may be a cause of allograft valve degeneration. To determine whether immunological differences between donor and recipient affect the degree of calcification that occurs, adult Lewis rats received aortic valve allografts transplanted heterotopically into the abdominal aorta. All valves were transplanted immediately after harvest. The valves were not exposed to antibiotics or albumin before insertion. Valve donors were of the Lewis (syngeneic), F344 (weakly allogeneic, RT1 compatible, non‐RT1 incompatible), LBN F1 (moderately allogeneic, one haaplotype identical, one haplotype incompatible at the RT1 and non‐RT1 loci), and Brown Norway (strongly allogeneic, RT1 and non‐RT1 incompatible) strains. Valves were harvested 3–12 weeks following transplantation. Scanning electron microscopy and energy dispersion x‐ray microanalysis were performed on one leaflet of each valve to evaluate calcium content. Calcium content expressed in counts (mean ± standard error) according to donor strain were: Lewis, 1642 ± 233; F344, 4853 ± 1412; LBN F1, 4714 ± 823; and Brown Norway, 4358 ± 835. Significant differences (p < 0.05) existed between valves from Lewis donors and those from each other strain. No differences among the other strains were statistically significant. It is concluded that syngeneic valve allografts calcify less than allogeneic grafts. However, the degree of allogenicity did not influence the magnitude of calcification.

Immunogenicity, Antigenicity, and Endothelial Viability of Aortic Valves Preserved at 4°C in a Nutrient Medium

Abstract In patients undergoing aortic valve replacement, allograft valves stored at 4°C in a nutrient medium have been associated with excellent immediate and long‐term results. The effects of this method of prolonged storage on the antigenic, immunological, and cellular characteristics of these grafts are incompletely understood. This study was designed to study these phenomena in rat aortic valves subjected to antibiotic sterilization and stored for up to 3 weeks in RPMI containing 10% fetal calf serum. Selected valves from Brown Norway rats were implanted heterotopically into the abdominal aorta of Lewis rats. Other valves were studied prior to transplantation. Antigenicity was determined by immunocytochemical staining using monoclonal mouse antibodies directed at Class I and Class II rat antigens. Immunogenicity was determined by duration of second‐set skin graft survival following heterotopic aortic valve implant. Endothelial cell viability was determined by flow cytometric analysis of endothelial cells harvested from aortic valve allografts by collagenase digestion. Only fresh valves and valves stored for 1 day were positive for Class I antigens; no valves were positive for Class II antigens. Duration of skin graft survival was prolonged with greater duration of storage, but grafts remained immunogenic after 21 days of storage. Endothelial cell viability declined from 95% in the fresh valves to 64% after 21 days of storage. With prolonged duration of allograft valve storage at 4°C, there is an attenuation of antigenicity, immunogenicity, and endothelial cell viability. Loss of endothelial cells may contribute to the changes in immunological responses to the valve allografts. The expression of antigens on the endothelial surface is not a reliable predictor of immunological response.

Oral commissure burns in children.

&NA; Electrical burns of the mouth are relatively common in young children. Early intervention to prevent complications remains controversial. A chart review was conducted of 24 patients with oral commissure burns who were treated at the University of Iowa from 1975 to 1988. All of these patients were treated conservatively without splinting or early surgery. Only one patient underwent oral splinting before receiving care at the University of Iowa Hospitals and Clinics. While under our care, no patients suffered significant hemorrhage at eschar separation. Commissuroplasty and/or reconstructive lip surgery were performed at various times after the burn injury was healed and the functional or aesthetic impairment was established. Long‐term follow‐up was from 5 to 17 years, allowing for longitudinal evaluation of the postburn scars and their influence on facial growth. Our review revealed that (1) younger children with more severe burns have a less favorable outcome; (2) no hemorrhage was observed immediately after the burn or at eschar separation; and (3) conservative surgical treatment after scar maturation—and in some cases following steroid injections— resulted in a successful functional and esthetic outcome. (Plast. Reconstr. Surg. 97: 738, 1996.)

Complication outcomes based on preoperative admission and length of stay for primary palatoplasty and cleft lip/palate revision in children aged 1 to 6 years.

With increasing focus on outcome studies, there is continued need for data about whether same-day admission and reduced hospital stay have adverse effects on surgical treatment, including that for cleft lip and palate. In this study, medical records were inspected for all cleft lip and palate patients, aged 1 to 6 years, who had primary palatoplasty or cleft lip/palate revision in this treatment center between 1978 and 1992 (N = 329). Length of stay for 251 (96.5%) of the 260 subjects admitted the day before surgery was from 4 to 7 days; 9 remained in the hospital longer than 8 days. Length of stay for 67 (97.1%) of 69 patients admitted the day of surgery was from 2 to 3 days; 2 were in the hospital for 7 days, and none for 8 or more days. Thirty-seven instances of surgical complications were reported for the 260 patients admitted the day before surgery (14.2%). Twelve complications (17.4%) were recorded for the 69 patients admitted the day of surgery. There was no significant difference in the number of complications between the two groups of patients (Fishers exact test, p = 0.5682). There was no significant difference in the types of complications observed between the two groups (Fishers exact test). Surgery was performed at age 1 year for 61 of the 69 patients admitted on the day of surgery (88.4%). The mean age of this group was significantly younger than that of patients operated on earlier than 1989 and admitted on the day before surgery (Wilcoxons test, p = .0001, Z = 4.48). The results of this study show that there is no statistical difference in the number and type of complications observed regardless of whether the patients were admitted to the hospital the day before or the day of surgery.

GLUCOSE TRANSPORTER 3 (GLUT3) PROTEIN IS PRESENT IN HUMAN MYOCARDIUM

Glucose and fructose enter mammalian cells via facilitated diffusion, a process regulated by five glucose transporter isoforms (GLUT1-5) at the plasma membrane. The tissue-specific pattern of GLUT isoform expression likely reflects differing needs for glucose transport by various tissues. Myocytes must respond expeditiously to increased metabolic demand. A basal isoform, GLUT1, and the insulin-regulatable glucose transporter, GLUT4, have been demonstrated in human myocytes. GLUT3 has a high affinity for glucose, but its presence in human myocardium has not been clearly established. The purpose of this study was to determine whether GLUT3 protein is present in human cardiac myocytes. We examined rapidly frozen myocardial tissue from the explanted heart of seven patients undergoing cardiac transplantation, from the heart of a young, previously healthy male organ donor, from the heart of a 67-year-old woman without known cardiac disease who had a fatal stroke, and from the heart of six human fetuses. GLUT3 protein was detected by immunoblots and localized by light and electron microscopy immunohistochemistry. The presence of GLUT3 protein was verified in myocardial tissue by both immunoblots and immunohistochemistry. Light and electron microscopy confirmed that GLUT3 was in cardiac myocytes. GLUT3 was also demonstrated as a 48 kDa protein in fetal myocardium, which was present at 10 weeks, increased at 15 weeks, then decreased at 20 weeks of gestation. GLUT3 is present in human adult and fetal myocardium. Human myocardial GLUT3 regulation and its role in myocardial glucose uptake remain to be elucidated.

In utero cleft palate repair in the ovine model.

Cleft lip and palate defects assume many forms from mild to severe, but all may be associated with abnormal craniofacial development. Even the most expert and sophisticated methods of surgical repair are followed by scar contraction and fibrosis, which result in skeletal defects, dental abnormalities, cosmetic disfigurement, and speech impairment. Recent clinical and experimental observations that fetal cutaneous wounds heal without scarring are of great potential interest in the management of cleft lip and palate. The objective of this study was to investigate the effect of prenatal repair of iatrogenically produced cleft palate on scar formation in the fetal lamb model. Ten ewes were operated on ranging in gestation from 70 to 133 days. Fifteen lambs were studied (nine cleft palates produced and repaired in utero; one cleft produced in utero and not repaired, four normal, unoperated palates; and one cleft palate produced and repaired 1 week postnatally). The lambs were delivered normally at 145 to 147 days gestation and maintained with the ewe until 1 month of age. The lambs were euthanized, and the surgical area of the palates studied grossly and histologically. Animals operated at 112 days or later in gestation exhibited scars both clinically and histologically. The animals that had cleft palate produced and repaired at 70 days gestation did not have a visible palatal scar at 1 month of age. Histologically, there was evidence of minimal scarring without disruption of normal architecture. Studies are underway to determine the impact of reduced scarring on craniofacial growth after palatal repair during mid gestation in the ovine model.

Differential effects of prolactin on rat dorsolateral prostate and R3327 prostatic tumor sublines.

Many investigators have reported effects of the pituitary hormone, prolactin, on the physiology and biochemistry of the rat prostate gland, particularly the lateral or dorsolateral lobe. The Dunning R3327H is a transplantable rat prostatic adenocarcinoma derived from a spontaneous tumor of the Copenhagen rat dorsolateral prostate. This study describes and compares morphological and physiological effects of prolactin on rat dorsolateral prostate and two sublines of the Dunning tumor. Ectopic pituitary grafts were used to induce chronic hyperprolactinemia in castrated rats receiving androgen supplement to provide a relatively controlled hormonal environment in which the effects of prolactin were maximally and consistently observed. Gravimetric and biochemical analyses, as well as ultrastructural study, provided evidence of prolactins stimulatory effect on dorsolateral prostate growth and secretory activity. Hyperprolactinemia stimulated the growth of the well-differentiated, androgen-dependent R3327/3219 tumor subline with an increase in weight, volume and the total content of DNA, protein and zinc. There were no changes in tumor morphology. In contrast, the anaplastic androgen-independent R3327/150 tumor subline did not respond to graft-induced hyperprolactinemia. This differential response of the two R3327 tumor sublines attests to the complexity of prolactins effects on prostatic tissue and to the extent of the deterioration of endocrine control that often accompanies tumor progression. Prolactin binding in the R3327 sublines was studied using immunohistochemical staining and radioligand assay, but produced complex results which raise questions about the discrepancy between hormone binding and biological action of prolactin in prostatic tissues.

Effect of storage at 4°C in a nutrient medium on antigenic properties of rat aortic valve allografts

The effects of prolonged storage at 4 degrees C in nutrient medium on the antigenic properties of aortic valve allografts are unknown. Lewis rats received heterotopic aortic valve allografts from Brown Norway donors. Valves were transplanted immediately after harvest (fresh), or after antibiotic sterilization and storage in a nutrient medium at 4 degrees C for 3, 7, 14, or 21 days. Additional rats underwent sham laparotomy (sham). All recipient rats received Brown Norway skin grafts 3 weeks after valve transplant or sham procedure. Time to skin graft rejection for all groups was as follows: fresh (n = 10), 4.5 +/- 0.9 days; sham (n = 10), 7.1 +/- 0.3 days; 3-day (n = 10), 4.9 +/- 0.3 days; 7-day (n = 10), 5.2 +/- 0.4 days; 14-day (n = 10), 6.1 +/- 0.7 days; and 21-day (n = 10), 6.0 +/- 0.6 days. Significant differences existed between the sham group and each of the transplanted groups. No significant differences existed between the fresh group and either the 3-day or 7-day groups. The difference between the fresh group and the 14-day group approached significance (0.05 less than p less than 0.10), and the difference between the fresh and 21-day groups was significant (p less than 0.05). Additional valves not used for transplantation were studied with scanning electron microscopy. The valves preserved in nutrient medium exhibited a progressive loss of endothelium as compared with fresh valves. Storage of aortic valve allografts in a nutrient medium at 4 degrees C is associated with a progressive attenuation of antigenic response.(ABSTRACT TRUNCATED AT 250 WORDS)