Ligament replacement in experiments on animals.
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Biomedical subjects
Publications and source records attributed to D H Jenkins.
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The results of sixty-five surgical corrections of secondary spinal deformities in spina bifida children are reported. Twenty-three patients had kyphectomies, and thirty-nine patients had anterior and posterior spinal fusions for scoliosis. There were three deaths. Patients in both groups showed functional improvement, though the effects on respiratory function were minimal. Patients with scoliosis should have their surgery before the curve reaches 100 degrees. Correction in these patients may have to be carried out very early if there is rapid curve progression. Kyphectomy ideally should be carried out between the ages of ten and fourteen years when bone size and quality are suitable for fixation.
The families of 11 children who had been operated for the correction of kyphosis and scoliosis not less than 12 months previously were visited. The anxieties and expectations of patients and parents were investigated and the results compared with a similar investigation in the schools of the children.
The results of an assessment of carbon fibre for biological use are given, with particular reference to the clinical use of the material in the treatment of equine tendon injury. Biocompatability of the fibres is assessed using fibroblast cell cultures and replacement of normal tendon with carbon fibre prostheses in experimental animals. The rationale and technique for using this material in clinical cases of tendon injury in the racehorse are described. Results are given from 62 implant operations in a limited series of 40 horses.
Ventral hernia was induced surgically in sheep and either left unrepaired (5 animals), repaired with plastic mesh (20 animals) or with carbon fibre (20 animals). In unrepaired animals the hernia persisted. Three hernias recurred in the group repaired with plastic mesh, 2 as a consequence of sepsis. All the hernias repaired with carbon fibre remained sound over periods varying from 8 months to 2 years. There was a gradual invasion of the carbon fibres by collagenous tissue and thus a transition from one to the other of the stress of maintaining the abdominal wall intact.
The role of flexible carbon-fibre implants as substitutes for injured tendons and ligaments was investigated. These implants were simple to perform and were well tolerated by the patient. Repairs using carbon-fibres in 60 patients were successful, particularly in the almost insoluble problem of posterior cruciate laxity. The results in this report show that carbon-fibre implants have few disadvantages and have a future use in reconstructive procedures.
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A method of internal fixation of the disrupted symphysis publis is discribed which uses readily available AO plates and tools. Patients can be mobilized at 3 days and discharged within 2 weeks. This method of treatment represents a considerable saving in nursing time and a great improvement for the patient, who is usually free from pain after 1 week.
Two studies (one in Holstein calves and one in Holstein cows) were conducted to determine potential toxicity and residue levels following oral ingestion of polybrominated biphenyls (PBB). The material was FireMaster FF-1. Administration was by gelatin capsules. Doses in calves were 0.1, 1.0, 10, or 100 mg/kg body weight, while doses in cows were equivalent to 0.01, 0.1, 1.0, or 10 ppm in the diet. The calves were sacrificed after 2, 4, 6, or 12 weeks. The cows were fed 158 or 228 days, and were then in a recovery period for 182 or 112 days. In the calf study, signs of toxicity were observed only in animals fed 100 mg/kg-day. Administration of 10 mg/kg-day or less for up to 12 weeks caused no overt signs of toxicity. Histologic studies were conducted upon selected organs and tissues taken at time of sacrifice. The only treatment-induced lesions among animals fed 0.1 mg/kg-day were minimal lesions in the kidney and skin in the one calf fed at this level for 12 weeks. Treatment-induced lesions were present in the kidneys, skin, and/or liver from some animals fed levels of 1.0 mg/kg-day and above. The relative severity of these lesions was related to the level and length of exposure. Treatment-associated changes were observed in the testes of all males in this study. The hypospermatogenesis observed was consistent with the age of the animals due to prepuberal development of the testes. No clinical signs of toxicity or histologic changes attributed to PBB were observed in the cows. Two cows were pregnant at the initiation of the study and give birth to normal, healthy calves during the study. These calves grew normally and appeared healthy when sacrificed at about 6 months of age. Residue levels were quantitated as the hexabromobiphenyl isomer (BP-6) which is the major isomer present in the PBB mixture. Tissue residue levels in calves increased with dose and duration of administration of PBB with highest levels being found in the fat. At 100 mg/kg the levels in fat were about 6000 to 6300 ppm after 6 to 12 weeks. Residue levels of BP-6 in milk and fat of the cows also increased with dose and duration of administration. Maximum levels in milk were about 1/3 the levels in the diet. In general, the levels plateaued after about 4 to 6 weeks and did not go appreciably higher even though administration of the FireMaster FF-1 was continued. Maximum levels in fat were on the order of approximately 4.5 times the levels in the diet, except at the lowest dose level. Residues decreased in milk after administration of PBB was discontinued, but detectable levels were still present 6 months later. Residues were found in the calves born of treated cows indicating passage of the PBBs through the placental barrier and/or ingestion through the milk.
Carbon fibre appears to induce the formation of tendon in both animals and humans. Experiments have been conducted in sheep in which new anterior cruciate ligaments have been induced in response to the implantation of filamentous carbon fibre. Long-term studies indicate that the carbon fibre slowly breaks up at the site of implantation and later begins to appear in the regional lymph nodes.
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Experiments have been performed on rabbits and sheep which demonstrate that pure carbon, in a flexible and filamentous form of great strength, can be used successfully to induce the formation of new tendons. A concept fundamentally different from that underlying the use of other artificial tendon replacements is involved, in which rapidly developing tendon-like tissue is induced to form around the implant. This gradually takes over the function of the implant. The early results in rabbits and the late results in sheep suggest that filamentous carbon may have a place in the replacement of the calcaneal tendon and the collateral ligaments of the knee.
The case is reported of an elderly man with asymptomatic cervical spondylosis who sustained a minor hyperextension injury of the cervical spine when the brakes of a car were applied suddenly to avoid a collision. Within six hours marked swelling of the neck and severe dyspnoea developed, and a lateral radiograph showed the pharyngeal shadow displaced far forwards and a crack fracture of an anterior osteophyte. Tracheostomy and evacuation of a massive prevertebral haematoma were performed, with immediate relief. The case draws attention to the possibility of this serious complication of a "whiplash" type of injury.
The accuracy and postoperative morbidity of cannulation of the cystic duct in routine operative cholangiography were compared with those of needle puncture of the common bile duct. The results are comparable and a case is made for the simpler procedure of needle puncture of the common duct.
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