Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

There are today several techniques available for cervical fixation - all with inherent limitations and risks. In view of the drawbacks of wiring and screw fixation, which both presuppose good bone quality for stabilization, there is a need for a stable and safe fixation system that can also be used in osteoporotic bone. The objective of the present retrospective study was to assess the usefulness and safety of Cervical Cotrel Dubousset Instrumentation (CCDI), based on sublaminar hooks. The material comprises 60 consecutive patients, 28 men and 32 women, with a mean age of 57.3 years (range 17-84 years), operated on with CCDI. The diagnosis was trauma in 17 patients, rheumatoid arthritis in 16 patients, tumor in 20 patients and miscellaneous diagnoses in 7 patients. The material was dominated by severe pathologies, with neurological impairment in 17 patients (28%). Complications, subjective outcome and Frankel classification of neurological status pre- and postoperatively was documented. The patient outcome evaluation was excellent in 46%, good in 34%, fair in 10%, and poor in 10%. The physician's assessment was similar: 56% excellent, 27% good, 10% fair and 7% poor. Two patients improved by two Frankel grades, 7 by one and 47 patients had the same Frankel grade as preoperatively. Two patients deteriorated by one Frankel grade, one by three grades and one patient by four Frankel grades. Except for a 10% deep wound infection rate, there were few complications, with no evidence of neurological injury from the hooks in the spinal canal. The results of this study show that the cervical CDI system can be safely used for stable cervical fixation without need for external support in severe pathologies of the cervical spine.     

A roentgen stereophotogrammetric study of implant stability and movement of segments in the maxilla of infants with cleft lip and palate.

Three implants (tantalum pins 1.5 x 0.5 mm) were inserted in each lateral segment of the cleft maxilla of ten infants aged three to 33 months. To check the stability of the implants in the bone the distances between the three implants within each segment were measured by means of roentgen stereophotogrammetry (accuracy 0.05 mm) at intervals of 7, 35, 63, 147, and 287 days after initial examination and at varying intervals thereafter (maximal observation time 833 days). No implants were lost and 18 of 60 measured distances were stable (final changes less than 0.2 mm). The three implants were regarded as a rigid-body model which represented the segment in the calculations of motion. In all infants with complete clefts, transverse narrowing occurred immediately after primary closure of the lip, or primary palate repair, while subsequent movement followed individual patterns.     

Hydrolase cytochemistry during follicular atresia in mammals

Activity changes of thiamine pyrophosphatase (TPPase), acid phosphatase (aP), non-specific esterase (nE), acid beta-galactosidase (a beta Gal), beta-glucuronidase (beta-Gluc), and beta-D-N-acetylglucosaminidase (NAG) in follicles during atresia were investigated in the ovaries of mice, rats, Mongolian gerbils, hamsters, guines pigs, rabbits, cats, and pigs. Changes of hydrolase activity were highly enzyme dependent, species-specific and mostly confined to the granulosa. Decrease of TPPase activity and increase of lysosomal enzyme activities during atresia appeared to be true for all mammals. The start of activity changes in the time course of atresia depended on the occurrence of the enzyme in the growing granulosa. Continuous increase of lysosomal enzyme activity appeared in follicles where these enzymes could also be found in the growing granulosa. In contrast, when lysosomal enzyme activity was low or could not be detected in the growing granulosa, increased enzyme activity could only be observed at a time when degenerative processes have already progressed considerably. This distribution pattern suggests that hydrolytic enzymes in the granulosa cells as well as hydrolases of invading macrophages participate in this degenerative process. In some mammals, enzyme activity changes appeared in the cumulus oophorus for the first time in advanced stages of degeneration. In some mammals enzyme activity changes were dependent on the developmental stage of the follicle. This stage dependency argues for an interrelationship between activation of lysosomal enzymes and androgen metabolism.