Biofilm formation on voice prostheses: influence of dairy products in vitro

Laryngectomized patients use silicone rubber voice prostheses to regain their speech, however, the lifetime of these devices is limited due to biofilm formation. Following anecdotal evidence, the influence of various dairy products on biofilm formation on voice prostheses was studied, using the artificial throat-model. Biofilms were grown on Groningen and Provox2 voice prostheses by inoculating two artificial throats with the total microflora isolated from an explanted Groningen voice prosthesis. After 3 days, one throat was perfused three times daily with 650 ml dairy product; the other was perfused with phosphate buffered saline, used as a control. After 12 days the microflora on each voice prosthesis was determined. Perfusion of the artificial throat with buttermilk three times daily for 9 days reduced the amount of bacteria and yeasts in the biofilm on Groningen voice prostheses to 3% and 15% of the control, respectively. These effects were not observed with a pasteurized conservable buttermilk product. Yakult fermented milk drink, Mona mild yoghurt, Mona vifit yoghurt, semi-skimmed milk and low-fat yoghurt reduced the amount of bacteria by various degrees, ranging from 12% (Yakult) to 88% (Mona mild) of the control, but these products did not inhibit, and sometimes even stimulated, yeast growth. A combination of buttermilk and Yakult did not show a synergistic effect, as expected. Effects for the Provox2 voice prosthesis were less pronounced. These in vitro experiments in the artificial throat demonstrated that the formation of the biofilm on voice prostheses can be lessened by the daily use of certain dairy products, of which buttermilk had the strongest inhibitory effect, followed by Yakult.

The effect of buttermilk consumption on biofilm formation on silicone rubber voice prostheses in an artificial throat

Biofilm formation on indwelling silicone rubber voice prostheses in laryngectomized patients is still the main reason for dysfunction of the valve, leading to frequent replacements. Within patient support groups in The Netherlands, laryngectomees have suggested that the consumption of buttermilk prolongs the life-time of indwelling silicone rubber voice prostheses. The aim of the present study was to compare biofilm formation on Groningen button voice prostheses in a so-called artificial throat. Ten prostheses were placed in a simulated control group and ten other prostheses in a group with a simulated consumption of 700 ml buttermilk three times a day. Biofilms were allowed to grow on the prostheses by inoculating two artificial throats with the total cultivable microflora (bacteria and yeasts) isolated from an explanted Groningen button voice prosthesis. After 3 days, one artificial throat was perfused three times daily with phosphate buffer (control group) for 8 days, while the other artificial throat was perfused with buttermilk. Prostheses removed from the artificial throat in the control group were covered with a thick biofilm. Scanning electron microscopy showed microcolonies growing into the silicone rubber, similar to the ingrowth observed on explanted Groningen buttons. The simulated consumption of buttermilk in the other artificial throat almost fully prevented the formation of a biofilm on the prostheses during the experimental period. These in vitro experiments in the artificial throat demonstrate that the deterioration of voice prostheses can be lessened by the daily intake of buttermilk through its inhibitory effects on biofilm formation.

In vitro and in vivo microbial adhesion and growth on argon plasma-treated silicone rubber voice prostheses

Patients who undergo a total laryngectomy usually receive a silicone rubber voice prosthesis for voice rehabilitation. Unfortunately, biofilm formation on the esophageal side of voice prostheses limits their lifetime to 3-4 mon on average. The effects of repeated argon plasma treatment of medical grade, hydrophobic silicone rubber on in vitro adhesion and growth of bacteria and yeasts isolated from voice prostheses, as well as in vivo biofilm formation are presented here. In vitro experiments demonstrated that initial microbial adhesion over a 4 h time span to plasma-treated, hydrophilized, silicone rubber was generally less than on original, hydrophobic silicone rubber, both in the absence and presence of a salivary conditioning film on the biomaterial. Growth studies over a time period of 14 d at 37 degrees C in a modified Robbins device, showed that fewer Candida cells adhered on plasma-treated, hydrophilized silicone rubber as compared to on original, hydrophobic silicone rubber. For the in vivo evaluation of biofilm formation on plasma-treated silicone rubber voice prostheses, seven laryngectomized patients received a partly hydrophilized "Groningen Button" voice prosthesis for a planned evaluation period of 4 wk. After removal of the voice prostheses, the border between the hydrophilized and the original, hydrophobic side of the prostheses was clearly visible. However, biofilm formation was, unexpectedly, less on the original, hydrophobic sides, although the microbial compositions of the biofilms on both sides were not significantly different. Summarizing, this study demonstrates that in vitro microbial adhesion and growth on silicone rubber can be reduced by plasma treatment, but in vivo biofilm formation on silicone rubber voice prostheses is oppositely enhanced by hydrophilizing the silicone rubber surface. Nevertheless, from the results of this study the important conclusion can be drawn that in vivo biofilm formation on voice prostheses is controlled by the hydrophobicity of the biomaterials surface used.

Progesterone receptors in arachnoid cysts. An immunocytochemical study in 2 cases

We report 2 cases of arachnoid cysts, one with a retrocerebellar and the other with a left temporal localization, in which immunohistochemical studies had been conducted. The results of the immunohistochemistry on the presence of carcino-embryonic antigen (CEA) and glial fibrillary acidic protein (GFAP), and of the scanning- and transmission electron microscopy revealed the cyst lining to be identical to subdural neurothelium. Progesterone receptors were found in the nuclei of cells lining the cyst, which also suggests the similarity of the cyst lining to arachnoid granulations and meningiomas as derivatives of subdural neurothelium, which also possess progesterone receptors.

Biological alterations of rat podocytes cultured under basolateral hydrostatic pressure

In vivo, glomerular visceral epithelial cells (GVEC), or podocytes, are morphologically highly differentiated cells which are in close contact with adjacent cells by complex interdigitating foot processes. In vitro, the dedifferentiated appearance of podocytes hampers investigations on podocyte structure and function. Cultured podocytes resemble simple epithelium in several ways with apical tight junctions and absence of foot processes. The morphological resemblances between GVEC early in embryonic development, in proteinuric diseases and in cultured cells are striking, but the mechanisms involved in these (de)differentiation processes are poorly understood. A common feature of GVEC in these various states of dedifferentiation is their altered exposure to or even total lack of hydrostatic pressure, suggesting that this may be one of the parameters involved in GVEC differentiation. In this study we investigated whether basolateral hydrostatic pressure could affect GVEC biology in vitro. We therefore exposed cultured GVEC grown on porous supports to basolateral hydrostatic pressure and investigated morphology with scanning and transmission electron microscopy, expression of specific podocyte markers and their biological responses to a model stimulus, the cytokine IFN-gamma. Morphologically, monolayers of pressurized GVEC contained large regions of whirl-like, raised cell formations. Individual cells in these formations had a rounded morphology and pore-like indentations between adjacent cells were observed. Cell-cell contacts were often found more basally and intercellular spaces were widened. Moreover, protein expression of pressurized monolayers was altered, as demonstrated by regions of cells with decreased keratin expression. Finally, upon exposure to the model stimulus IFN-gamma, the pressurized as compared to the control GVEC demonstrated a 3-fold increased expression of MHC class II and a strongly decreased sensitivity to the toxic effects of IFN-gamma. In conclusion, we found several indications that hydrostatic pressure can affect podocyte biology in vitro and similar mechanisms may account for podocyte biology in vivo. The strikingly altered morphology and biology of pressurized GVEC suggest that this culture system can be quite relevant for future studies with cultured GVEC.

Biodeterioration of medical-grade silicone rubber used for voice prostheses: a SEM study

Silicone voice prostheses used for rehabilitation of speech after total laryngectomy are inserted in an non-sterile habitat. Deposits on explanted Groningen Button voice prostheses revealed a biofilm, due to heavy colonization of the silicone surface by bacteria and yeasts. Furthermore, it was demonstrated by scanning electron microscopy on sectioned explants that the silicone material was deteriorated by filamentous and vegetative yeast cells. The different explants showed a variety of sharp-edged, discrete yeast colonies. The yeasts grew just under the silicone surface and up to 700 microns into the silicone material. Finally, nine different types of defects in the silicone material created by the yeasts are described. This deterioration of the silicone by yeasts seems to be the main reason for the failure and the frequent replacement of the prostheses. The mechanisms of silicone deterioration are still hypothetical.

Healing of microvenous PTFE prostheses implanted into the rat femoral vein

44 PTFE prostheses (Gore-Tex; ID 1 mm) were implanted into rats' femoral veins by means of the sleeve anastomotic technique and were evaluated at regular intervals from 1 h up till 24 weeks after implantation by means of light and electron microscopy to study in detail their healing process. All prostheses, except one at 1 week and one at 24 weeks after implantation, were patent at the time of removal. Upon implantation, the luminal surface of the prostheses became covered with a thin clot layer. From 1 week onwards, endothelial cells originating from the anastomotic sides grew in across the anastomoses. In addition, small capillary-like orifices were present at the anastomotic sites, from which endothelial cells also seemed to originate. At 2 weeks, in several areas in the mid-region of the prostheses, the fronts of regenerating endothelial cells had reached each other, and about 80% of the luminal surface was covered by endothelium and at 3 weeks, the prostheses were completely covered by an endothelial layer. These results demonstrate that PTFE microvenous prostheses heal exclusively by means of rapid ingrowth of endothelial cells originating from both sides at the anastomoses.

Autologous vein supported with a biodegradable prosthesis for arterial grafting

To evaluate the potential of a supporting, compliant, biodegradable prosthesis to function as a temporary protective scaffold for autologous vein grafts in the arterial circulation, we implanted vein grafts into the carotid arteries of rabbits, either with (composite grafts) or without (control grafts) such a supporting prosthesis, and evaluated them up to 6 weeks. The control vein grafts showed edema and severe medial disruption with infiltration of polymorphonuclear cells on day 1. Over the study, irregular fibrocyte formation resulted in the formation of a fibrotic vein wall. In contrast, the composite vein grafts showed preservation of smooth muscle cell layers and elastic laminae with a minor inflammatory response. Regular proliferation of fibroblasts, which in some areas were circularly oriented, was observed. We conclude that a supporting, compliant, biodegradable prosthesis can function as a protective scaffold for vein grafts in the arterial circulation, thus reducing damage to the vein graft wall and allowing gradual arterialization.

Mersilene (polyester), a new suture for penetrating keratoplasty

Mersilene (polyester monofilament) seems to be suitable for penetrating keratoplasty because it is strong, shows no degradation by ultraviolet light, is insoluble, so that it can be left in situ, and offers the possibility of regulating postoperative astigmatism by suture adjustment. In 12 patients penetrating keratoplasty was performed with the combined interrupted/running suturing technique, using eight interrupted nylon 10-0 sutures and one running Mersilene 11-0 suture. The results were compared with those of 25 patients in whom eight interrupted nylon 10-0 sutures and one running nylon 11-0 suture were used. Six months after penetrating keratoplasty, no differences could be found between the two groups in keratometric astigmatism, visual acuity or slitlamp findings. In three patients postoperative adjustment of the running Mersilene suture reduced astigmatism by 50, 90 and 100% respectively. In an animal study the behaviour of Mersilene in the cornea was evaluated by slitlamp examination, histology and electron-microscopy. The tissue response to Mersilene was minimal. Considering the resemblance to nylon in clinical findings, minimal tissue response, lack of biodegradation and possibility of regulating postoperative astigmatism by suture adjustment, Mersilene seems to be a suitable material for penetrating keratoplasty.

Experimental microvenous reconstructions with Gore-Tex polytetrafluoroethylene prosthesis implanted by means of the sleeve anastomotic technique

Polytetrafluoroethylene (PTFE) prostheses (Gore-Tex; ID, 1 mm; length, 5-7 mm; wall thickness, 0.2 mm; fibril length, 30 microns, n = 28) were implanted into the rat femoral vein by means of the sleeve anastomotic technique to enhance the patency rate. In the control group, PTFE prostheses (n = 8) were implanted by means of the end-to-end technique. In the experimental group patency and healing of the PTFE prostheses were evaluated at 1 day (n = 4), 1 week (n = 6), 3 weeks (n = 6), 6 weeks (n = 6), and 12 weeks (n = 6) after implantation by means of macroscopic inspection and routine light and scanning electron microscopy. All prostheses, except one at 1 week after implantation, were patent at the time of removal. All of the microvenous prostheses were completely covered by an endothelial layer at 3, 6, and 12 weeks after implantation. Occasionally some smooth muscle-like cells could be found underneath this endothelial layer, but stenosis was never observed at the anastomotic sites. Only scarce tissue ingrowth was observed in the wall of the PTFE prostheses. In the control group, all prostheses, except one prosthesis after 3 weeks, were found to be occluded. An occlusive mural thrombus was found firmly attached at the anastomoses at 1 day, and an organized thrombus at 3 weeks after implantation. The patent prosthesis demonstrated complete endothelial healing. These results demonstrate the importance of the sleeve anastomotic technique and the potential of PTFE prostheses as a microvenous conduit when implanted by means of the sleeve anastomotic technique in experimental reconstructive microvascular procedures.

Vacuum cell seeding: a new method for the fast application of an evenly distributed cell layer on porous vascular grafts

The study was to develop a method to induce rapid endothelial coverage of vascular prostheses by cell seeding. The method uses vacuum pressure and is therefore called vacuum cell seeding. A special seeding device was constructed, in which grafts of different length and/or inner diameter could be positioned. Microporosity of the grafts was a prerequisite for this method. Two types of commercially available microporous grafts were tested. The ePTFE graft routinely used clinically needed pretreatment to enable the method, whilst a polyurethane-based graft could be seeded as received. Vacuum cell seeding applied cells from a suspension in culture medium within 10 min in an evenly distributed cell layer on to the luminal graft surface. The adhering cells immediately started flattening, thereby completely covering the luminal surface. It was concluded that the vacuum cell seeding method rapidly introduced a confluent layer of seeded cells on porous vascular grafts in a simple way, which in the clinical setting could easily be performed on the operating table.

Morphology of donor lens-capsule material studied by SEM

The lens capsule of a 70-year-old male donor with a cataractous lens was carefully prepared for SEM by first washing the capsule with buffer solution to remove lens-fibres and subsequently attaching it to silicon rubber. During the fixation and drying stages of the preparation procedure the capsule stayed attached to the rubber substratum. In the equatorial zone germinating cells were found with knob-shaped microvilli, closely connected to lens-fibres. Large units of pathological capsule epithelial cells were found, only slightly inter connected by a few pseudopodia. In addition, single pathological epithelial cells with pseudopodia, arranged on top of the cell in a rosette-like configuration, were found at certain locations. Both types are probably related to the original lens-cataract.

Secondary cataract material collected with a glass cannula. A SEM study

Secondary cataract material from three patients, collected with a glass cannula approx. 18, 24 and 30 months respectively after operation, was prepared for SEM examination. For the soft samples this was done by filtration through a millipore filter followed by fixation and drying. The more solid material was suspended in a fixation solution, followed by centrifuging, suspension in 70% ethanol and drying on a specimen-holder. The short residence samples (18 months) showed mainly erythrocytes, some (inflammatory) cells and degenerated lens-fibre material. Most of the more solid material, which was collected more than 20 months after operation, showed fragments of (regenerated) capsule epithelium and pieces of solid lens-fibre material with fragments of capsule epithelium attached.

Keratoconus morphology and cell dystrophy: a SEM study

The SEM-pictures represent a keratoconus in a 59-year-old patient with a Descemet rupture, which had led to a so-called Kammerwassereinbruch, where the failure of the endothelial structure has become manifest in the epithelium. In the Descemet-rupture the onset of stromal pathology is observable, while outside the rupture severe degradation of endothelial cells is seen. This is manifested as cell-membrane perforation, loss of cell contents and oedema formation in general. On the epithelial side the pathology is expressed as cell-membrane degradation and the presence of very irregularly shaped, sometimes swollen and in other cases shrunken, epithelial cells, in particular in the areas of the surface depressions. The topographical correspondence of these pathological phenomena on the endothelial and the epithelial sides is stressed.

Kinetics of cell spreading on protein precoated substrata: a study of interfacial aspects

In this paper, interfacial aspects of spreading and adhesion of human skin fibroblasts on solid substrata after protein precoating have been studied. Three solid substrata were used with different surface free energy (gamma s): Tissue Culture Polystyrene (TCPS) with gamma s = 70 erg.cm-2, Polyvinylfluoride (PVF) with gamma s = 56 erg.cm-2 and Fluoroethylenepropylene (FEP) copolymer with gamma s = 18 erg.cm-2. The substrata were precoated with fetal calf serum, bovine fibronectin or bovine serum albumin. Cell spreading was evaluated by means of light microscopy and scanning electron microscopy (SEM). Adhesion sites were studied by transmission electron microscopy (TEM). In general, spreading was lowest on FEP and highest on TCPS. Although protein precoating markedly increased cell spreading, the relative order in which the cells spread on the protein precoated substrata remained identical to that on the bare substrata. Analysis of the kinetics of spreading demonstrated that spreading was fastest on the high-energy substratum and slowest on the low-energy substratum. In the presence of all three types of protein precoating, the average distance between a cell and a substratum after spreading was smaller (20-50 nm) than without a coating (greater than 100 nm).

Soemmering's ring, an aspect of secondary cataract: a morphological description by SEM

A Soemmering's ring attached to a patient's I.O.L. was removed and processed for SEM-examination. The enveloping structure of the Soemmering's ring was clearly of capsular origin, adherent along a single line and forming an envelope around the inner material. The envelope had a membranous character. The contents of the ring varied from the outside to the centre. Close to the capsule envelope a more or less amorphous material was found. Most of the contents of the ring was made up of lens-fibre material. Sometimes clear lens fibres were visible with densely packed lens-fibre proteins, sometimes with clusters of recrystallized proteins, rod-shaped or spherical, surrounded by what appeared to be amorphous material. The recrystallized and the amorphous lens-fibre material are similar to material found in cataractous lenses.

Some aspects of cataract morphology: a SEM-study

Two lenses from patients of very advanced age with senile cataracts were processed for SEM, fractured equatorially, sputtered with Au and examined by SEM. In the cross-fracture various areas could be observed. Although the overall structure of the lens-fibres appeared to be intact, higher magnifications showed that the len-fibre material had changed into a brittle structure, with either a granular appearance or a fibrillar character. At other places clearly recrystallization of lens-fibre proteins had taken place, with the formation of finger-like substructures, sometimes organized into plate-like structures or running parallel to each other in a kind of undulating pattern. Between the various areas of chemically changed lens-fibre material certain 'canal-like' areas were found with cellular structures, the so-called 'waterclefts' or 'Wasserspalten'. Structures which, together with the chemical change in the lens proteins, account for the dramatic change in light dispersion.