PubMed · 16114427
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H Gerlach. 1966. [Problems in stapes surgery].. https://pubmed.ncbi.nlm.nih.gov/16114427/
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OBJECTIVE: This report highlights the management of infrequently encountered massive occipital encephaloceles with herniation of large amount of apparently functional cortex into the encephalocele sac. MATERIALS AND METHODS: Two children with giant occipital encephaloceles with herniation of significant brain parenchyma into the encephalocele sac were managed with expansile cranioplasty and reconstruction of the calvarial defect with autologus bone graft harvested from the adjacent parietal region. CONCLUSIONS: Giant occipital encephaloceles with significant brain parenchyma in the encephalocele sac can be considered for preservation of the herniated parenchyma and expansile cranioplasty.
Different industrial processes exist to purify allogenic bone, providing safe and cleaned blocks for bone allografting. However, they often make use of chemical reagents that can be aggressive for the bone matrix. Bone samples were processed with several soaking techniques used in industry: NaHCO3, H2O2, NaOH and H2O2+NaOH combined; the consequences on the bone matrix and cytocompoatibility were evaluated on femoral heads from osteoarthritic patients. Alterations of matrix were searched by histochemistry, atomic force microscopy (AFM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Cytocompatibility was evaluated by coculturing human osteoblast-like cells (SaOS-2) on bone slices. Collagen fibers were dramatically altered at the surface of bone treated with H2O2, NaOH (and their association), but not with NaHCO3. A marked reduction in the number of hydroxyapatite crystals was observed on the trabecular surfaces by TEM and morphological changes were evidenced in SEM and AFM. Argyrophilic proteins of the bone matrix were removed by H2O2 and NaOH (and their association), but not by NaHCO3. As a consequence, attachment, spreading, proliferation and alkaline phosphatase activity of SaOS-2 were reduced by H2O2 and NaOH treatments. Strong oxidizing reagents altered matrix integrity by modifying collagenous and non-collagenous proteins. Whether these changes have clinical consequences on the bone bonding and osseointegration in human necessitate further investigations.
Non-union of the long bones may have severe consequences, particularly when combined with other post-traumatic sequelae, such as tendon adhesions, reflex sympathetic dystrophy and infection, among others. In these cases, it is important to treat the delayed union or non-union first or at the same time with the other problems in order to achieve adequate function. Once the normal bony healing process has been slowed or stopped, it is necessary to provide both stability to the fracture site, as well as a biological stimulus for the fibrocartilagenous callus to finish the healing process. Vascularised grafts, such as the free fibula, offer not only structural support, but also promote bone healing. The later is achieved by trabecular bone formation, as well as vascular sprouting from pedicle vessels.