Allograft reconstruction for the treatment of long bone defects: report of 9 cases

From April 1980 to December 1987, we experienced 18 cases of frozen intercalary allografts including 13 cases of bone tumor, 3 cases of congenital pseudoarthrosis of the tibia and 2 cases of traumatic bone defect. Nine cases were followed up for more than 2 years. The average allograft of length was 10.5cm (ranging from 3.5cm to 22cm). All cases had supplemental autografts in combination with intercalary allografts. The average time of radiographic union was 5 months (ranging from 4 months to 8 months) between allograft and autogenous cancellous bone graft, and 11.3 months (ranging from 7 months to 18 months) between allograft and host bone. We use the bone scan for early determination of the fate of allografts. The bone scan usually becomes positive at about 6 months after transplantation. The functional result was 89% "excellent" and "good" according to Henry J. Mankin's grading. One non-union and 3 leg length discrepancies of more than 2cm were encountered. In this study, we found that the deep frozen allograft for the treatment of large bone defects is very encouraging.

The surgical treatment of complete acromioclavicular joint dislocation

Forty-eight patients with complete acromioclavicular (A-C) joint dislocation were treated surgically and followed postoperatively for an average of 26 months. Nineteen patients were treated with simple temporary pinning without ligament reconstruction. Eight of these patients were found, on follow-up x-ray, to have some degree of loss of reduction. All 21 patients treated with Neviaser's operation and all four patients treated with pinning and coracoclavicular (C-C) ligament reconstruction maintained their position on follow-up. One patient treated with arthrodesis of the C-C joint with a wire sustained metallic failure, and another treated with arthrodesis with a screw sustained bone erosion of the clavicle. Although the radiographic results were not necessarily good, 94% (45/48) of patients obtained good or excellent functional results. Reconstruction of either the superior A-C ligament or the C-C ligament, besides temporary fixation of the A-C joint, is recommended for surgical treatment of complete A-C joint dislocation.

One-stage combined operation of congenital dislocation of the hips in older children

From 1977 to 1983, 17 patients with 20 long-standing congenitally dislocated hips were treated with a one-stage combined operation and then followed for more than 3 years by our institution. The growth of the proximal femur after femoral osteotomy was studied. The average neck-shaft angle was 111 degrees immediately after operation, and 128 degrees at follow-up. The outcome was largely independent of either age at operation or bilateral involvement. Our findings revealed 30% good and 50% excellent results in our patients.

Intraosseous hypertension in osteoarthritis of the hip and ischemic necrosis of the femoral head

Intraosseous hypertension is noted both in osteoarthritis of the hip and ischemic necrosis of the femoral head. The mean intraosseous pressure in osteoarthritis cases was 30.0 +/- 4.2 mmHg. The incidence of abnormal intraosseous pressure and positive stress tests was 39% and 26.7%, respectively. In patients with ischemic necrosis of the femoral head, intraosseous pressure was 45.6 +/- 19.4 mmHg, 79% of patients had abnormal intraosseous pressure, and 56.1% had positive stress tests. Intraosseous pressure studies indicated a statistically significant difference between patients with osteoarthritis and those with ischemic necrosis of the femoral head.

One-stage versus two-stage bilateral autophor ceramic total hip arthroplasty

Noncemented autophor ceramic total hip arthroplasty (ACTHA) has been developed in recent years for treatment of advanced hip diseases. Bilateral ACTHAs were routinely performed in two operations at a four- to six-month interval. There have been no reported series of one-stage bilateral ACTHAs. In this retrospective study, the authors compared 20 patients who had bilateral one-stage ACTHAs with 15 patients who had similar bilateral arthroplasties in two stages. The study revealed no significant differences in estimated intraoperative blood loss, postoperative hemovac drainage, total amount of blood transfusion, intra- or postoperative complications, or postoperative functional results in the two groups. There was no difference in achieving prosthesis stability by interface bone growth, in spite of a significant difference in weight-bearing status during the immediate postoperative period. The one-stage bilateral procedure, however, offered advantages over two-stage bilateral procedures, including shorter length of hospital stay (18 days versus 27 days), shorter operative time (148 minutes versus 245 minutes), shorter period of disability (86 days versus 202 days), and reduced economic costs (about 10% less). There was no increase in the risk of morbidity or mortality in the one-stage bilateral group. In selected cases, one-stage bilateral ACTHA would be preferable.

Some cultural conditions that control biosynthesis of lipid and aflatoxin by Aspergillus parasiticus

Synthesis of total lipid and aflatoxin by Aspergillus parasiticus as affected by various concentrations of glucose and nitrogen in a defined medium and by different incubation temperatures was studied. Maximal yields of lipid and aflatoxin were obtained with 30% glucose, whereas mold growth, expressed as dry weight, was maximal when the medium contained 10% glucose. Maximal mold growth occurred when the medium contained 3% (NH(4))(2)SO(4); however, 1% (NH(4))(2)SO(4) favored maximum accumulation of lipid and aflatoxin. Growth of mold and synthesis of lipid and toxin also varied with the incubation temperature. Maximal mold growth occurred at 35 C, whereas most toxin appeared at 25 C. Maximal production of lipid occurred at 25 and 35 C but production was more rapid at 35 C. Essentially all glucose in the medium (5% initially) was utilized in 3 days at 25 and 35 C but not in 7 days at 15 and 45 C. Patterns for formation of lipid and aflatoxin were similar at 15 and 25 C when a complete growth medium was used and at 28 C when the substrate contained various concentrations of glucose or (NH(4))(2)SO(4). They were dissimilar when the mold grew at 35 or 45 C. At these temperatures lipid was produced preferentially and only small amounts of aflatoxin appeared.