Intracardiac transplantation of a mixed population of bone marrow cells improves both regional systolic contractility and diastolic relaxation.

BACKGROUND: Pre-clinical and clinical studies suggest that transplantation of bone marrow-derived stem cells can improve global cardiac function. However, no quantitative assessment of regional systolic contraction and correlation with phenotype has been made. Therefore, we used our model of cryoinfarcted rabbit myocardium for intracardiac transplantation of a mixed population of bone marrow-derived cells and assessed both regional function and myogenic conversion of the cells. METHODS: Nineteen New Zealand white rabbits underwent cryoinjury of the left ventricle. Autologous bone marrow (BM) cells were expanded in vitro. After 2 weeks, either 1 x 10(8) mixed BM-derived progenitor cells (BM group, n = 11) or vehicle (control group, n = 8) were injected into the cryoinjured region. Regional systolic function was measured using micromanometry and sonomicrometry before and 4 weeks after cell injection; cell phenotype was evaluated histologically. RESULTS: All animals in the BM group significantly improved both systolic shortening (0.11 +/- 0.7 vs -0.05 +/- 0.05 mm in the control group, p < 0.05) and regional stroke work when compared with control (9.6 +/- 2.4 vs -1.2 +/- 1.2 mm . mm Hg, p < 0.003). In addition, the BM group had improved global diastolic function, as measured by minimum dP/dt and end-diastolic pressure. On histologic assessment, BM cells differentiated toward a myogenic phenotype. CONCLUSIONS: Transplanting a mixed population of marrow-derived cells that can adopt a myogenic phenotype improves regional contractility and diastolic relaxation after myocardial infarction.     

Arthrodese des unteren Sprunggelenks

Pain in or symptomatic destruction of any number of the joints of the hindfoot can have several causes. As well as primary osteoarthritis, these include secondary arthrotic changes following fractures (especially of the talus and/or calcaneus), muscular and/or tenoligamentous instability (e.g., rupture of the posterior tibialis tendon, poliomyelitis, Charcot-Marie-Tooth disease), spastic and flaccid paresis of the lower leg and foot, late stages of various inflammatory arthritides (rheumatoid arthritis, seronegative spondarthritis, collagenoses), and neuropathic diseases with impaired depth perception (Charcot disease of the foot in diabetes mellitis, for example). As a general policy, only joints that are causing symptoms, are clearly arthritic, or are involved in a fixed foot deformity should be fused, so that as much of the residual hindfoot motion as possible is preserved. This helps to restrict future osteoarthritis in adjacent joints. The use of screws rather than staples seems to increase the fusion rates because this technique allows compression on the fusion.     

Ergebnisse der operativen Behandlung des idiopathischen Klumpfußes unter Verwendung eines dorsomedialen Zugangs mit Weichteilpräparation „à la carte“

ZusammenfassungEinleitung In unserer Klinik wird seit über 30 Jahren die operative Behandlung von Klumpfüßen über einen dorsomedialen Zugang durchgeführt. Postoperativ erfolgt zunächst eine Gipsbehandlung, dann eine konsequente Nachbehandlung mit Orthesen und Winkeleinlagen.Material und Methode Zwischen dem 1. 6. 1986 und dem 31. 12. 2000 wurden 130 primäre Klumpfußweichteiloperationen bei 86 Patienten durchgeführt. 119 (92%) Füße konnten nach durchschnittlich 4,5 Jahren klinisch-radiologisch nachuntersucht werden. Das durchschnittliche Alter bei der Operation betrug 7,6 Monate. Klassifikation nach Dimeglio und Score nach Laaveg und Ponseti dienten zur Beurteilung. Die gemessenen Winkel in den belasteten Röntgenbildern des Fußes a.p. und seitlich prä- und postoperativ wurden verglichen, Komplikationen und Rezidive dokumentiert.Ergebnisse 29 (22,3%) Füße wiesen einen Schweregrad IV nach Dimeglio, 58 (44,6%) Grad III und 43 (33,1%) Grad II auf. Ein Klumpfußrezidiv war bei 9 (7,6%) Fällen zu beobachten. Alle Winkel verbesserten sich signifikant. Bei der Nachuntersuchung wurden durchschnittlich 95,4±9,2 Punkte nach dem Score von Laaveg und Ponseti erzielt.Schlussfolgerung Der von uns verwendete dorsomediale Zugangsweg erlaubt eine ausgezeichnete Klumpfußkorrektur mit geringer Rezidiv- und Komplikationsrate.     

Pretransplant bilateral hand-assisted laparoscopic nephrectomy in adult patients with polycystic kidney disease.

Laparoscopic procedures continue to gain popularity over traditional open procedures for a number of abdominal and pelvic surgeries. With increasing experience, the application of this technique is rising because it provides an alternative, less invasive, approach to various surgical procedures. Herein, we report our experience with adult patients with polycystic kidney disease, requiring bilateral laparoscopic nephrectomy before renal transplantation.     

The vertical midface lift. An improved procedure.

We describe a novel procedure for an anatomically-based face lift to correct vertical vectors in the ageing face. It has the advantage of surgical simplicity, minimal tissue removal and minimal risk. It provides an effective readjustment of cheek volume and correction of periorbital hollowness. Natural facial expression is preserved largely because there is no change in the position of the lateral canthus. The cheek is mobilised subperiosteally through a blepharoplasty incision. A second dissection is made via a short temporal incision, to join the infraorbital dissection. A Hagedorn needle is then inserted through a point inferior to the lateral canthus and in line horizontally with the nasal ala. It is passed to the orbital incision, charged with a loop of suture material, and pulled down again to the cheek incision, from where it is pushed back to the orbit to suspend the cheek. The upper border of orbicularis oculi is fixed firmly to the temporalis aponeurosis at the level of the temporal incision. We now frequently use an Endotine Midface device for fixation. Of the first 150 patients, results were excellent or good in 145. This represents a revival of the subperiosteal mask lift, and abandons the use of endoscopic techniques. In spite of its simplicity, the operation involves subperiosteal dissection as well as delicate eyelid surgery that necessitate plastic surgical skill.