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Intraoperative and postoperative subtrochanteric fracture of the femur associated with removal of the Zickel nail.

Twelve patients, whose ages ranged from twenty-one to sixty-eight years (mean, 32.6 years) and in whom a Zickel nail had been used to treat an acute traumatic subtrochanteric fracture of the femur, had fourteen subtrochanteric refractures that were associated with removal of the nail. The refracture was always different from the original fracture in type and site (being located an average of 4.3 centimeters distal to the lesser trochanter). Five of the refractures were recognized intraoperatively at the time of removal of the nail. Because of this potential complication, we believe that the Zickel nail should not be used in the treatment of subtrochanteric fractures of the femur in young patients.

Adult↗

Purification and characterization of granulocytic progenitor cells (CFU-C) from human peripheral blood using immunologic surface markers.

The concentration of committed granulocytic progenitor cells (CFU-C) in functionally unique subpopulations of human peripheral blood mononuclear cells has been determined by the in vitro methyl-cellulose assay. Using immunoabsorbent column chromatography and rosette-depletion techniques, we have demonstrated that CFU-C, although not present in either purified T or B lymphocyte populations, are highly concentrated in the "null" cell population, which lacks sheep erythrocyte receptors and surface immunoglobulin. Further fractionation of this null subset has demonstrated that CFU-C do not bear complement receptors, but require the presence of peripheral blood mononuclear cell feeder layers for maximum proliferation.

Bone Marrow Cells↗

Rupture of the distal insertion of the biceps brachii tendon.

Rupture of the distal insertion of the biceps brachii tendon is a rare injury. There has been no unanimity in the literature concerning the best method of repair. Between March 1981 and July 1984, 14 ruptures (12 acute and two late) were repaired using a modification of the Boyd-Anderson technique. Cybex testing of the elbow flexion by applying an eccentric load demonstrated that strength and endurance in the repaired dominant arm were roughly equal to the noninjured, nondominant arm, but that strength and endurance of the repaired nondominant arm were only 64% and 50%, respectively, of the noninjured dominant arm. Surgical repair is a safe procedure that yields consistently good results.

Adult↗

Nontraumatic ghost cell glaucoma--a case report.

Ghost cell glaucoma (GCG) has recently been described following vitrectomy, cataract extraction, and penetrating or blunt trauma. We describe the occurrence of GCG in a phakic eye with no prior ocular trauma or surgery following vitreous hemorrhage from diabetic retinopathy. We postulate the occurrence of a spontaneous rupture of the anterior hyaloid face which allowed passage of ghost cells into the anterior chamber. A therapeutic vitrectomy was complicated by intraoperative vitreous hemorrhage. Two weeks postvitrectomy, GCG recurred and was successfully controlled by irrigation through an anterior chamber approach. This is the procedure of choice in GCG following vitrectomy and may eliminate the need for a second vitrectomy.

Adult↗

Further dissection of the functional heterogeneity within the OKT4+ and OKT8+ human T cell subsets.

Previous studies have suggested functional heterogeneity within the OKT4+ and the OKT8+ populations. For example, after activation the OKT4+ population contains not only helper cells but also cells capable of suppressing B cell differentiation. Previous studies also indicate that the reciprocal T cell population, OKT8+, does not provide helper activity but contains cytotoxic effector cells and radiosensitive cells important in the suppression of B cell differentiation. Using a new differentiation antigen, OKT17, which recognizes a surface antigen present on the majority of resting normal peripheral T lymphocytes but is present only on a subset of OKT4+ cells after activation, evidence was obtained that two functionally mature subsets can be distinguished within the OKT4+ population itself: OKT4+17+ radiosensitive suppressor cells and OKT4+17- radiosensitive helper cells. Recently, another monoclonal antibody, OKT20, has been described which is present on a small percentage of resting lymphocytes but is expressed in varying proportions on activated T cells. Functional analysis of normal resting human T lymphocytes demonstrated that the OKT20-depleted T cell subset was able to generate cytotoxic cells and to suppress antibody production to the same extent as did OKT8+ cells. On the other hand, when unselected T lymphocytes were cultured for six days in a mixed lymphocyte reaction and then depleted of OKT20 reactive cells, the cytotoxic effector T cells were eliminated. In contrast, OKT20-depleted T cells after identical activation were still able to suppress antibody production. These data provide evidence that following activation of OKT8+ cells, the OKT20 differentiation antigen becomes selectively expressed on cytotoxic effectors but not on suppressor cells.

Antibodies, Monoclonal↗

Functional subsets of human monocytes defined by monoclonal antibodies: a distinct subset of monocytes contains the cells capable of inducing the autologous mixed lymphocyte culture.

The induction of most immune responses requires the close cooperation between T cells and antigen-presenting cells (APC), presumably of monocyte/macrophage (M phi) lineage. To characterize human APC further, we used two monoclonal antibodies, OKM1 and OKM5, to isolate and identify M phi subsets. OKM1 has been described and recognizes cell surface antigens on most M phi and granulocytes. OKM5 recognizes cell surface determinants present on the majority of human M phi but does not recognize other hematopoietic cell types. A small subset of peripheral blood M phi is OKM1-OKM5+. Human peripheral blood E- cells were separated into OKM1+ and OKM1- subsets by a rosetting technique utilizing anti-Ig-coated red cells. The capacity to present self antigens in the autologous mixed lymphocyte culture (AMLC) resided predominantly within the E-OKM1- subset, even if surface membrane Ig-positive cells were eliminated. Similar experiments showed that the ability to stimulate in AMLC was contained in the E-OKM5+ population and in fact resided primarily within the E-OKM1-OKM5+ subset. All of these subsets were able to trigger allogeneic T cells to proliferate. The capacity of these APC subsets to present soluble antigens (mumps, tetanus toxoid) was also examined. The data demonstrated that although the majority of these APC are E-OKM1+, E-OKM1-OKM5+ cells can also present foreign antigen. Taken together, these data suggest OKM1 and OKM5 can be used to isolate two functionally distinct human M phi subsets. One subset (E-OKM1+) is capable of presenting soluble antigens but shows minimal ability to trigger AMLC. The other subset (E-OKM1-OKM5+) can also present soluble antigens but is the predominant subset that can trigger AMLC.

Animals↗