Biomedical subjects
J Viljanto
Publications and source records attributed to J Viljanto.
Macrophages in trauma-induced myositis ossificans.
The basic cellular mechanisms of different forms of myositis ossificans are poorly known. In the current experiment the nature of the early (24-168 h) inflammatory cell reaction preceding trauma-induced myositis ossificans was studied. New bone formation was induced in the vastus intermedius region of the rabbit quadriceps muscle by means of immobilization and daily passive mobilization. Before the start of treatment, a cell harvesting device (viscose cellulose sponge in a silastic tube) was implanted in the region of interest. The opposite intermedius muscle and a standardized surgical skin wound served as the control sites. The results showed a significantly prolonged invasion of macrophages into the ossifying intermedius muscle as compared with the control intermedius muscle. It is hypothesized that microinjury and subsequent muscle necrosis cause the invasion of macrophages, and these cells respond to the conditions of the traumatized muscle under passive mobilization by releasing osteogenic growth factors.
Effect of haematocrit on wound healing in children.
The effects of mild or moderate normovolaemic anaemia on wound healing (WH) continue to be debatable. The results of animal experiments and clinical experience are somewhat controversial. In this study, sixty-six boys, aged from 5 to 15, mean 10.1 years, were routinely operated on for a unilateral inguinal hernia, after which their WH was studied by the Cellstic device. Based on differential count of wound cells and their mutual transformed cell to cell ratios it was found that the optimum level of haematocrit (Hct) for WH was 37-39% with haemoglobin (Hb) values of 12.0-12.4 g/100 ml. Hct values under and over these limits began to retard WH significantly (p less than 0.02) without any visual signs of delay in WH. Both values are below the age adjusted means but just above the lower limits of normal. It is thus allowed, for the majority of healthy children with normal blood values, a mild decrease of Hct during the operation without any harmful effect on WH.
Ultrastructural characteristics of cells in human wound collected by Cellstic device.
The differentiating human wound cells and intercellular matrix was studied by electron microscopy. The cells were collected with a special wound drain containing a piece of cellulose sponge. Although fibroblastic cells could be detected as early as 20 hr after operation, the main cell population consisted of inflammatory cells. The fibroblastic cells were classified into three types according to the stage of ultrastructural differentiation. Some cells of different types were in close contact by membrane apposition to each other and to the sponge material. However, no specialized junctions were seen. Organized collagen fibers were not seen during the observation period despite the well developed organelles for protein synthesis in the fibroblastic cells. The close contacts of normal cells with the sponge pore walls indicated good compatibility with human tissue and safe use for clinical experiments in routine operations.
Signs of capillary formation in the early phase of wound healing in children.
Small silicone rubber tubes containing a standard size viscose cellulose sponge (Cellstic) were implanted in wounds of 23 children at the end of routine surgery. The Cellstics were drawn out of the wounds 1-4 days after implantation. Single cells and cell aggregates, called cell aggregation centers (CAC), were washed out of the Cellstic sponges by the retrograde injection technique, centrifuged, studied histologically and histochemically for cytochrome oxidase activity. Small leukocytic CACs and solitary cells, also including some macrophages and a few endothelial cells, were observed on the first postoperative day. On the second postoperative day and thereafter 2-4 endothelial cells were attached to each other surrounding a lumen. These capillary segment-looking formations (CSF) resembled capillary segments and they were seen both inside and outside the (now larger) CACs. Outside the CACs solitary endothelial cells occasionally exhibited ring-like formations. High cytochrome oxidase activity was observed especially in many CSFs but the solitary and the ring-shaped endothelial cells, in- and outside the CACs, also showed intense oxidative metabolism.
Two successful thoracotomies in an infant of very low birth weight.
A female infant with a birth weight of 750 g underwent successful thoracotomy twice, at an age of 5 days for persisting pneumo-pleural air leakage and at an age of 3 weeks for patent ductus arteriosus causing heart failure.
Effect of intrauterine thymectomy on granulation tissue formation. An experimental study.
Intrauterine thymectomy was successfully performed on 9 guinea pig foetuses at the gestational age of 36-48 days. This resulted in a significant suppression of the phytohemagglutinin (PHA) response of the whole blood lymphocytes at the age of 3 mth. The in utero-thymectomized guinea pigs and their littermate non-thymectomized controls were operated on by making 4 symmetrical dorsal skin incisions and by subcutaneously implanting 8 standardized pieces of viscose cellulose sponge. On the 1st, 3rd, 5th and 10th days the tensile strength of the wounds was determined and the implants were analysed histologically and enzymehistochemically. At the time of incipient fibroplasia on the 5th post-operative day, the tensile strength of the wounds, the number of fibroblasts and the activities of aminopeptidase and succinate dehydrogenase were clearly less in the guinea pigs which had been thymectomized in utero. These findings indicate that adequate thymic function was necessary for normal fibroblast proliferation, since intrauterine thymectomy led to a temporary delay in the beginning of the fibroblastic phase in wound healing.
Anastomotic leakage in oesophageal atresia. Diagnostic and therapeutic considerations.
Oesophageal anastomotic leakage complicates 5-38% of operations performed for congenital atresia, and continues with prematurity and concomitant anomalies to be a cause of a fatal outcome. After a short review of the diagnostic and therapeutic possibilities of this complication the authors present their own series of 37 consecutive oesophageal atresia and/or oesophagotracheal fistula. Seven of these had anastomotic leakage within 2 to 8 days after operation. Three of them had been primarily operated on through a retropleural approach. The remaining four had had a transpleural approach and were all treated with an immediate rethoracotomy and resuture of the disruption with good primary results. A few cases reported earlier and the authors' present experience support the view that rethoracotomy and resuture of the disruption in transpleurally operated patients provides a method which allows early debridement of the pleural cavity and pulmonary reexpansion, accelerates secondary anastomotic healing and shortens the period needed for pleural drainage and intravenous nutrition.
Fibronectin in early phases of wound healing in children.
Fibronectin, an adhesive glycoprotein, was demonstrated with the Cellstic device in healing wounds of 13 children after routine surgery. An indirect immunofluorescent method was adapted to cytological and histological specimens made from the Cellstic sponges 1 to 92 hours after operation. As early as one hour after Cellstic implantation some bright fluorescent spots could be seen in the cytological specimens, although cell morphology still fully resembled to that of peripheral blood. The intensity of the fibronectin fluorescence increased rapidly until the maximum was reached 24-48 hours after surgery. Thereafter the fluorescence gradually decreased to the level of the first hours. Rapid appearance of fibronectin, its abundance on the second day and gradual diminution upon the activation of type I collagen synthesis indicate its role as a biological guide for localization of cellular activity in wound repair.
Ectopia cordis.
Ectopia cordis is a rare congenital anomaly with an unknown incidence. The heart lies totally or partially outside the thoracic cage. Sternal cleft without cardiac protrusion outside the thorax is not included. The condition is often associated with various cardiac and extracardiac anomalies. During the period 1968-1978 three cases of thoracic total ectopia cordis were encountered. Surgical correction was unsuccessful. This has been the outcome in all but one case of thoracic forms of total ectopia cordis reported earlier in the literature.
Disinfection of surgical wounds without inhibition of normal wound healing.
The goal of disinfection of surgical wounds is to destroy as large a number as possible of the microbes that have made their way into the surgical wounds during the time of surgery, without disturbing the normal wound-healing process. It is not a substitute for preoperative disinfection of the skin or aseptic technique, but makes it possible to further decrease the rate of infection in slightly or moderately contaminated wounds. This was shown with a series of 294 pediatric surgical patients, 283 of whom had undergone appendectomy. A 5% povidone-iodine solution, especially in combination with excipients, was too strong, whereas a 1% povidone-iodine solution without excipients applied to the surgical wound was safe from the standpoint of wound healing, and decresed the number of wound infections in those patients with appendicitis in whom neither peritonitis nor periappendicular abscess had yet developed.
Cell aggregation centers--initial strength elements in human wound healing.
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Regeneration of subcutaneous connective tissue in children. II. A histochemical study with application of the CELLSTIC device.
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Burn injuries in Finland.
In the present investigation the burn injuries in Finland are estimated for a non-selected burns population. Annually 0.4% of the population seek medical care for burn injuries. The incidence of burns cases requiring hospital admission is 35/10(5) inhabitants/year. After initial treatment in the emergency ward, approximately 10% of burned adults and up to 25% of burned children are hospitalized. Of all burns cases requiring hospitalization, 55% are children under 15, 40% are adults of working age and only 5% are over 65 years of age. Men comprise two-thirds of the patients. The estimated bed capacity according to data collected is 20 per one million inhabitants (16 in the case of a continuous 100% load): 12 for adults and 8 for children. Of all the fatalities from burns, approximately 70% of deaths occur immediately from injury. The overall hospital mortality of burned adults is 5%, and 1% in children. The most typical burned child is a toddler with a burn covering less than 5% of the skin surface. The average burned adult in hospital is a man of 42 with 12% burn of total skin surface (3% of third degree) and who is discharged after 17 days of hospitalization.
Local hyperalimentation of experimental granulation tissue.
The effect of local hyperalimentation on developing granulation tissue was studied in rats. Cylindrical hollow viscose cellulose sponge implants were used subcutaneously as an inductive matrix fro the growth of granulation tissue. In the first, control group the implants were kept untouched while the second, "sham" group was treated daily by withdrawing 1 ml of wound fluid from the central dead space of the implant and then injecting the fluid back. In the third, hyperalimentation group the aspirated wound fluid was substituted with a corresponding volume of sterile, nonpyrogenic solution containing a mixture of amino acids (Le-7402 A) and glucose, electrolytes and vitamins (Le-7402 B). Within the first week of tissue growth daily application of these nutritional substances caused a changeover of local tissue from predominantly anaerobic towards more oxidative metabolism. Measurement of nucleic acid and hydroxyproline contents indicated enhanced accumulation of cells and collagen in tissues receiving local hyperalimentation. The results combined with earlier data from our laboratory strongly suggest that several types of wounds, especially those containing a marked dead space or large regenerative area, exist in chronic lack of oxygen and other nutrients. Therefore, the healing process in these wounds can be stimulated, to a certain extent, by exposure to increased oxygen tension and/or by local hyperalimentation.
Local hyperalimentation of open wounds.
After débridement of necrotized and devitalized tissue in deep burns and large traumatic soft tissue defects, the raw surfaces were covered with separate sheets of viscose cellulose sponge (VCS), each moistened by continuous slow infusion of one of the following solutions: (a) 0-9 per cent NaCl; (b) 10 per cent glucose; (c) Rheomacrodex (dextrane hydrolysate in 0-9 per cent NaCl); (d) 7 per cent Levamin (a mixture of essential amino acids and glycin in 5 per cent sorbitol; (e) a combination of two solutions containing amino acids (Le-7402 A) and glucose, electrolytes and vitamins (Le-7402 B). The cellulose sponges were removed or changed 3-7 days later. Macroscopically, histologically and enzyme histochemically, the most active granulation tissue formation was found under the VCS moistened with amino acid solutions, especially when accompanied by glucose and vitamin supplementation. The results strongly suggest that local cellular hyperalimentation of open raw wound surfaces is possible, permitting a new kind of nutritional support in these patients.
Wound healing in children as assessed by the CELLSTIC method.
Assessment of the quality and speed of wound healing in man has been rather difficult until the present time. By the use of CEELSTIC, a tissue-sensitive test drain composed of a standardized piece of viscose cellulose sponge inside a thin Silastic tube, cells existing between wound edges can be analyzed by histologic, cytologic, and enzyme histochemical means. The 166 pediatric surgical patients studied showed that wound healing is an age-dependent process reflected by the increased time needed for cellular transformation and maximal activation of hexokinase and isocitrate dehydrogenase with increasing age.