[Tourniquet ischemia. Experimental studies and clinical data].
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Biomedical subjects
Publications and source records attributed to A Salamon.
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Authors review clinical appearance of perilunate dislocations and perilunate fracture dislocations dealing with diagnostic and therapeutic questions. Their own material over a period of 6 years consists of 12 perilunate dislocation cases in 11 patients. Problems of early and delayed management, conservative or operative treatment are discussed. Based on follow up investigation, subjective and objective late results are described.
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Wounds caused in the dorsal musculature of guinea pigs were sutured with various types of threads and the histological reactions caused by the latter were studied. Light and electron microscopic methods revealed that the best resorption can be achieved with Dexon threads. This synthetic thread is resorbed in 14 to 16 weeks causing only a minimal histological reaction and without cicatrization in its vicinity. Around threads which are not absorbed a connective tissue capsule is formed; this one is thin in the case of Ethilon and Chrom cat gut and somewhat more marked when Rixo or Supramid threads are used. The histological reaction is the most intense around the traditional linen thread which leads to cicatrization. In the resorption of Dexon a decisive role is attributed to the giant cells of the foreign body while in the case of non-absorbable synthetics and linen threads the fibre forming roles of the histiocytes, mastocytes and fibroblasts dominate.
In dog experiments homologous tendon grafts preserved in beta-propiolactone have been examined by means of light-polarisation microscope and electronmicroscope. The histologic data showed that grafts preserved by beta-propiolactone were completely reorganised within 8 weeks after the transplantation similarly to autologous grafts. This process takes place with very little initial inflammatory reaction, followed by fibroblast reaction. The original collagen fibrous framework is decomposed and new tendon is formed by new collagen fibres on this frame. Cicatrisation was not encountered and graft function was excellent. Functional results in 5 patients were investigated 2 years after replacement of the flexor tendons of the hand and were found to be good in 4 cases, satisfactory in 1 case. The results of animal experiments and the excellent experience with preliminary clinical application of the method suggest that homologous tendon grafts preserved in beta-propiolactone may be used for replacement of injured human flexor tendons of the hand.
In the contracting palmar aponeurosis of patients suffering from Dupuytren's disease myofibroblasts are revealed by electron microscopical examination. These cells display abnormal foldings of the nucleus, microfilaments resembling the myofilaments in smooth muscle cells, rough endoplasmic reticulum occupying circumscribed portions of the cytoplasm, free ribosomes, well-developed Golgi apparatus, numerous mitochondria, occasionally lipid droplets, cilia-like formations, hemidesmosomes and maculae adherens (desmosomes) between the cells and formation of basement membrane. According to literary data, the myofibroblasts contain actin and have contractile properties. These myofibroblasts are supposed to contribute to the development of Dupuytren's contracture. The process is finally stabilized by the disappearance of myofibroblasts and by the simultaneous development of compact collagenous fibre bundles secernated by classical fibroblasts.
The involved palmar aponeurosis of 30 patients in different stages of Dupuytren's disease was removed and examined by light and electron microscopy. The specimens were obtained by Z-plasty and limited fasciectomy. The light microscopic slides of the early stages of the disease showed areas rich in cells and surrounded by a network of collagen fibres. In the late phase of the lesion mature scar tissue was observed. By electron microscopy fibroblast-like cells--so-called myofibroblasts were seen in the early stages of the lesion. These cells possess, in addition to nuclear deformations, the following ultrastructural cytoplasmic characteristics: microfibrils occasionally forming small dense bodies, prominent rough endoplasmic reticulum and Golgi complex, many mitochondria and free ribosomes. The cell surface if partly covered by a "basement membrane". The myofibroblasts attach to each other frequently through hemidesmosomes or desmosomes. According to data in the literature, the microfilaments within the cytoplasm contain actin, consequently these cells have the property of contraction. In our opinion--in accordance with some other authors--the myofibroblasts might play an important role in the pathogenesis of Dupuytren's contracture.
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The survey literary data on the mechanism, symptoms and treatment of vertical talus neck fractures associated to subtalar dislocations, they present five cases in their practice. Reducement of the fracture dislocation, fixation by Kirschner wire was accomplished and a plaster cast was applied, for twelve weeks as an average. Avascular necrosis of the bone did not occur. The authors lay emphasis on the importance of early careful reducement and immobilization.
The authors survey data in the medical literature on Kiel type heterolog conserved bones and report their own experiences. Forty-nine cases altogether, the authors grafted bone manufactured by the Braun firm, in seven patients; a Kiel type bone conserved by the method of the authors in forty-two patients; The grafts were used mostly in patients with solitaer bone cysts, in a smaller number in patients with bone cavities following impression fractures, pseudarthrosis and arthrodesis. Their results were excellent, minor complications occured in only four cases. Finally some up-to-date problems of bone grafting, regeneration are discussed in this paper.
Autologous and homologous cutis grafts have been used for the repair of experimental defect of the tendon of the m. ext. carpi ulnaris in adult dogs. Newly formed tendon tissue was found on the frame of the cutis graft about 8 weeks after the implantation. The structure of the newly formed tendon was investigated by light and polarization microscopy up to 8 weeks postoperatively.
Collagen synthesis has been studied in preserved autologous and homologous tendon grafts, applied in dogs. The stages of collagen morphogenesis observed in the synthetizing fibroblasts appearing in the decomposing original structure of the transplants as well as in the extracellular ground substance are described. The results suggest that autologous tendon grafts and homologous ones preserved by irradiation, stored in cold physiological saline and beta-propiolactone, are rebuilt within eight weeks; meanwhile the original collagenous fibre structure is decomposed. When other preserving procedures such as deep-freezing or gamma irradiation are applied recomposition of the graft is retarded or fails to occur; the result is a cicatrizing adhesion.
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