SiO2-CaO-P2O5 (58S) sol gel glass applied onto surgical grade stainless steel by spray technique: morphological characterization by digital image processing

AISI 316L stainless steel is commonly used as a low-cost material for permanent implants. It can be protected for degradation and corrosion by applying a hybrid silica based coating. Also the bioactive response of the implant can only be achieved by functionalizing the coated implant surface. The aim of this work is to synthesize and characterize a sol-gel made glass particles from the system SiO2-CaO-P2O5 with potential as bone inductive material, with and without an aging treatment of the precursor solution. The glass was synthesized by sol-gel technique that, comparing with melt glasses, generates an open net structure that could lead to particle dissolution and apatite deposition for biological purposes. The synthesized glass is dispersed by spray onto AISI 316L protected by a hybrid silica based coating, generating deposits with different size and morphology. To characterize the particles composition, microRaman spectroscopy was applied. It showed that no significant changes were reached after aging or thermal treatment of the deposited particles. Image processing techniques based on Mathematical Morphology were used to analyze morphology and sizes of the deposits obtain with the different sols (aged and no aged). Aproximately 50% of the surface was covered with particles made with a glass aged, and a 25% of covered area was reached with no aged one. When no aged glass particles were deposited, the particle size distribution shows the presence of many big particles with a roundness factor between 0.8 and 1 in a high percentage, meaning that they are spherical due to the presence of solvent and with a more open glass structure in the no aged glass. The Digital Image Processing and Raman spectroscopy tools help to analyze, characterize and quantify the bioactive particles deposited onto coated surgical grade stainless steel in terms of morphology, distribution and composition.

[Hippocrates' heritage from Lyons]

Hippocrates' influence is known in Lyons as soon as the time of the Renaissance, after the discovery of printing. Symphorien Champier and later chiefly Rabelais translated texts of the Cos master and had them edited by the first printers. Hippocrates' influence is moreover evident in Rabelais' work. In the XIXth century, surgeon major Pétrequin published the first book devoted to Hippocrates's surgery. More recently, Professor Pierre Delore has been a convinced supporter of neo-hippocratic medicine of which he developed the chief principles in his works.

[The pioneers of vascular surgery in Lyon: M. Jaboulay, A. Carrel, E. Villard et R. Leriche]

Lyon was, during about 30 years, French vascular surgery birth place just after our century beginning. At first, Mathieu Jaboulay, the last Hôtel-Dieu chief-surgeon, made up a blood vessel anastomosis by means of a circular eversive suturing. Then, Alexis Carrel improved anastomotic bindings and get on the first organic transplantation. At the same time, Eugène Villard took up again his experimental studies and, since 1811, made them complete by way of accurate histological analysis. At last, René Leriche devoted himself to sympathetic nervous system surgery in order to cure arteritis but without foreseeing by-pass prospects in the future.

[The Hôtel-Dieu de Lyon, the most beautiful hospital in the kingdom during the reign of Louis XV]

The Hôtel-Dieu was built between 1741 and 1761 on the banks of the Rhône, composed of a magnificent two-story facade, and the whole crowned by a dome which added to the glory of the city. For this grandiose and costly project, Soufflot was called in. The Hôtel-Dieu became the best hospital in the realm. The healthcare personnel consisted of 130 hospitaller sisters and 50 brothers under the guidance of the chaplains. Eight to ten journeymen surgeons, forefathers of the interns, were spread throughout the wards. The principal surgeon chosen by the rectors became, after 6 years of practice, a fully qualified surgeon, or a 'surgeon gaining mastery', and could then practice freely in the city. In 1755, 1300 patients were hospitalized in the old and new buildings.

[Percy at the battle of Eylau]

The battle of Eylau was the bloodiest of the Napoleonic era: around 40,000 Russian and French victims littered the battlefield. It was icy cold. Percy, in charge of the army's health service, was horrified "at the view of corpses heaped in the snow," and organized first aid for the numerous wounded.

[Gaspard II Bartholin and the vulvovaginal gland]

Born in 1655 in Copenhagen to a renowned family, Gaspard Bartholin had the good fortune during his stay in Paris to meet Joseph Guichard du Verney, a French anatomist who had discovered the glandula vestibuloris major. Back in Copenhagen he was appointed professor of anatomy at the age of 21 described the physiology of the glandula vestibuloris major, later known as Batholin's gland. Ennobled, laden with honours, he was later appointed personal physician to the king of Denmark until his death in 1738.

[An unusual anomaly : cervical spondylolysis in an adult]

A case of spondylolysis with exceptional involvement of the cervical spine is reported. The lesion turned out to be a defect in the pars interarticularis of a cervical vertebra. Such cases generally involve the sixth vertebra. Spondylolysis is asymptomatic more often than not. Positive diagnosis is supported by an analysis of the anatomic structures on radiographs and CT-scans. Differential diagnoses include congenital lesion (articular dysplasia) is always found, there is no argument allowing the assertion that cervical spondylolysis is a congenital condition rather than secondary to stress fractures.

[Brief history of the hospital bed]

Start as simple litter for several patients in the Middle-Age, the hospital's bed had progressively change to the first mechanical beds in the XIX century.

Acetabular anatomy and the relationship with pelvic vascular structures. Implications in hip surgery

Most direct vascular trauma occurring during hip surgery results from injury to pelvic vascular structures which are not visible during the procedures of reaming, drilling holes or the fixation of screws. In this study, 5 pelves of fresh cadavers were injected with a radiopaque mixture and were visualised with a scanner according to 5 predetermined sections. Bone depth of the acetabulum was measured in each section. A calculation was made describing the minimal distance separating the inner cortex from the principal pelvic vessels. After an anatomic dissection of each pelvis, the relationship between the vessels and screws of the fixation cup, implanted identically on the quadranted acetabulum, was observed. The screws placed in the anterior and inferior quadrants and the center of the acetabulum endangered the external iliac v. and a. and the obturator pedicle. The depth of the periacetabular bone was greater in the superior and posterior quadrants. The inferior gluteal, pudendal and superior gluteal aa. were more than ten mm from the posterior wall. Conversely, the external iliac and obturator pedicles came in contact with the osseous surface on which they lay. A projection of the vessels on the acetabulum was made, and the reproducible character of the acetabular-quadrant system was verified. The superior quadrant offers all the characteristics of a vascular safe zone. A knowledge of these anatomic relationships explain vascular trauma in pelvic fractures and helps to prevent vascular injury in hip surgery.

The upper end of the femur: dimensions of the endosteal canal

Based on a prospective study of 30 right or left femurs removed in a continuous series in the anatomy department, a study was made of the dimensions of the endosteal canal of the upper end of the femur. The femora were analysed by means of 12 CT scans below the lesser trochanter. The sections were numbered and the dimensional parameters calculated by computer, using an original plan. The results were subjected to descriptive and correlative analysis. From these dimensional findings it appeared that the anatomy of the upper end of the femur is not random; morphotypic models exist and the laws of a normal model are regulated by a mathematical equation.

Results of passive and active immunization directed against ferric aerobactin in experimental enterobacterial infections in mice and chickens

Production of aerobactin has been reported to be a virulence factor in members of the family Enterobacteriaceae. To investigate the protection afforded by humoral immunity directed towards aerobactin in infectious diseases caused by aerobactin-producing strains, we tested the efficacy of mAbAERO1, a murine monoclonal antibody directed to ferric aerobactin, which, in vitro, was found to impair the growth of aerobactin-dependent strains of Enterobacteriaceae under iron-limited conditions. The mortality of mice experimentally infected with the aerobactin-producing strains Escherichia coli V2019 (LD50 = 3.5 x 10(5) CFU/mice) or Klebsiella pneumoniae Caroli (LD50 = 1.3 CFU/mice) was not reduced when 1 mg of mAbAERO1 was injected intravenously 1 h before or 1 h after bacterial challenge. Nor was mortality reduced after challenge with either E. coli V2019 or K. pneumoniae Caroli, even though the active immunization of mice with purified FeAero (ferric aerobactin) conjugated with thyroglobulin as followed by a rise in systemic anti-FeAero antibodies. Lastly, chicks born of hens immunized with FeAero showed evidence of antibody transmission towards FeAero, but were not protected when challenged with E. coli MT78, an aerobactin-producing strain highly virulent for chickens. Therefore, under the experimental conditions tested, humoral immunity against aerobactin appeared to play only a minor role in protection against infections caused by aerobactin-producing members of the family Enterobacteriaceae. However, other experimental models should be tested to confirm these observations.

Immunological variants of the aerobactin-cloacin DF13 outer membrane protein receptor IutA among enteric bacteria

Mouse monoclonal antibodies (MAbs) were generated against a 76-kDa IutA receptor of pathogenic avian Escherichia coli 15972. Six of the eight IutA-specific MAbs isolated (AB1 to AB6) were shown to be directed toward membrane-exposed conformational epitopes, although they did not interfere with the uptake of ferric aerobactin and cloacin DF13 as assessed by competition experiments with purified ligands. The two remaining IutA MAbs (AB9 and AB10) recognized linear epitopes buried in the IutA molecule. The panel of IutA MAbs was used to characterize IutA variants occurring in strains of E. coli, Klebsiella pneumoniae, Enterobacter spp., and Shigella spp., resulting in the identification of four immunological groups of IutAs. MAb AB9 defined an epitope conserved in all IutA variants. In addition, the panel of IutA MAbs served to identify the presence of IutA in wild-type bacteria grown in the presence of diphenylamine to reduce the expression of O-specific polysaccharide.

Comparison of chemical assay, bioassay, enzyme-linked immunosorbent assay, and dot blot hybridization for detection of aerobactin in members of the family Enterobacteriaceae

In order to determine the best strategy for detection of aerobactin in members of the family Enterobacteriaceae, we compared the results of three phenotypic assays, including a chemical assay, a cross-feeding bioassay, and an enzyme-linked immunosorbent assay (ELISA), with the results of a dot blot hybridization assay using a specific probe for the aerobactin genes. The sensitivity and specificity of the ELISA were better than those of the chemical and cross-feeding assays, but the results of dot blot hybridization were the most reproducible. However, none of the Serratia and Enterobacter cloacae strains which produced aerobactin hybridized with the probe. We concluded that the best strategy for aerobactin detection is a two-step procedure that combines screening by dot blot hybridization with an ELISA for negative strains.

[Morphologic anatomy of the valves of the lower limbs]

This study reports a useful technique, in particular at the magnifications of 16, 25 and 40 fresh cadaver: the great saphenous vein contains approximately 7 to 8 valves with a variable, though small, percentage of atrophic valves; regarding deep veins, study includes that of the ostial valves of the great and small saphenous veins and of the bicuspid valves distributed in the femoro-popliteal and leg veins. Varicose veins, obtained by long stripping of the great saphenous (or, more rarely, of the small saphenous) have been used to study: the number of valves (far less in varicose vein sufferers) and the incidence of atrophic valves; possible changes in the structure of valves (or cusps); intermediate pillars between two cusps; the position of the valve in relation to varicose ectasia and to collaterals; the possibility of actual trabecular modifications in the wall (but, most often, valves are typical). The valves of collaterals are bicuspid in the lumen, but the ostial valve is usually unicuspid. Perforating veins generally have a single cusp exterior to passage through the fascia. This study enables interesting comparisons with recent endoscopic findings (and in particular work from the department of Professor Cloarec).

[Popliteal venous aneurysm and recurrent pulmonary embolism. A case report]

Primary popliteal vein aneurysms are rare, in contrast with veinous dilatation secondary to trauma or complicating an arterio-veinous fistula. The authors report the case of recurrent pulmonary embolism in a 46 year old man with a popliteal vein aneurysm. This veinous malformation usually presents with pulmonary embolism due to migration of blood clot from the thrombosed aneurysmal sack. Ultrasonography and/or venography are diagnostic. Surgical care of the aneurysm should be preferred in young and active patients to partial interruption of the inferior vena cava or anticoagulant therapy alone.

[Emergency vascular access in patients with renal failure. Apropos of 32 implantations of permcath]

Central venous catheters allow for the most rapid hemodialysis procedure with sparing of peripheral blood vessels. 32 flexible, double-lumen "permcath" catheters were implanted to 27 patients over a period spanning 42 months (February 86-August 89). Catheter placement was definitive in 2 cases while another 30 provided previsory intravenous access for plasmapheresis (25 cases), acute renal insufficiency (7 cases), and chronic renal failure (17 cases). The mean utilization time per patient was 10.7 +/- 8.01 (SE) weeks. As respects chronic renal failure, this provided a time-opportunity for prospective maturation of conventional venous routes of access or transplantation. Permcath thrombosis occurred in 6 instances (18.75%), 5 times unremittingly (15.4%). Infection occurred in 6 patients (18.75%), leading to ablation of the permcath only once. Thus, permcath ensures safe, effective access for hemodialysis and enables maturation of a conventional venous cutdown. It may be used directly as a permanent vascular approach in case of limited life expectancy or of an extremely precarious vascular bed.

Microsurgical relations of the roots of the brachial plexus. Practical applications

The brachial plexus roots were studied in 20 cadavers under magnification from their origin (division of the corresponding cervical spinal nerves) until their ending (origin of the corresponding trunks). Regional vascular injections were performed in 10 cases using colored latex. The means of fixation of each plexus root to the spine, as well as the collateral branches, the anastomoses and the vascular connections are described. The authors conclude by the description of a microsurgical posterior approach of C5-C6 and C7 up to their origin, with clinical applications.

[Prognosis of the thyroid carcinomas after surgery (author's transl)]

The authors review 140 cases and show the prime importance of the patient's age and the histological type in the prognosis of the operations of thyroid carcinoma (with the exception of solitary malignant cold nodule). The survival rate is higher with the papillary carcinoma of young patients, even though an extensive development of lymph nodes occurs, whereas metastases are encountered in the evolution of follicular carcinoma with increased risks. The anaplastic carcinoma which occurs mainly in aged people, is the worst of all. The medullary carcinoma is quite different from the others and is almost as malignant as the differentiated and anaplastic carcinomas. Surgery has to be adapted to anatomical lesions and requires the presence of an experienced histopathologist, the extension of the gland excision depending on the histological type and whether the isthmic area has been touched or not; in the same way a microscopic examination of lymph nodes, which are systematically excised, reveals whether a lymph nodes dissection has to be done at the same time. In this way extensive excisions together with their sequels can be avoided when the best prognosis can be forecasted with these lesions.

[Anatomy of the anal canal]

The anal canal marks the transition from the end of the alimentary canal to the exterior. Its prime function is to maintain continence by means of the internal sphincter. 1) Level with the mucous membrane, the pectineal line contains the anal valves, which form the limits of a supravalvular area glossy red in colour and a blue-grey subvalvular area in which is sited the linea alba of Hilton. 2) The sphincteral apparatus includes the internal sphincter which contracts automatically and which ensures tight continence, the longitudinal muscular stratum joining the ampulla of the rectum, and the pubo-rectal tract or levator ani, drawing the head of the rectum forwards. 3) The canal is surrounded by cellular perianal tissues, and, phlebologically speaking, is vascularised by a system which joins the portal current; the position of this system explains the topography of hemorrhoids.

[The parathyroid risk in thyroid surgery (author's transl)]

A parathyroid insufficiency, defined like a functional deficit sufficient to pull down calcemia underneath 75 mg/l and/or give clinical obvious disturbances of neuromuscular hyperexcitability, have been observed on 57 patients (2,7%). The risk as interested bilateral gestures (5,5%) with a maximum for total thyroïdectomies (17,7%), surgery for carcinoma (8,5%) and Basedow's illness (8,3%). Less than half the patients can stop their vitaminocalcical treatment, and before the sixth month. First prevention is respect of the frail glandules and their vascularisation, obliging a particular, precise and bloodness surgery. Finally the autotransplantation of parathyroid gland accidentally pulled off or deteriored seems to constitute an interesting contribution.

[Non-recurrent inferior laryngeal nerve (15 operative cases)]

During surgery on the right thyroid lobe, 15 cases of non-recurrence of the inferior laryngeal nerve were observed, among which two types of equal frequency. Embryologic data explain why this abnormality is always associated with an abnormal origin of the right subclavian artery, directly from the aortic arch. The right subclavian artery generally passes behind the oesophagus in these cases. These 15 cases represent 0,79% of the 1889 cases studied during a short period (1971-1978).

[History of anatomy in Lyon]

1. We know very little concerning the teaching of anatomy during the Middle Ages. Only two authors, who both came to live in Lyon, Lanfranc and Guy de Chauliac, wrote on the subject. On the other hand, the important development of printing in Lyon from the sixteenth century onwards, made it possible to spread the translations of classic works and most of the books on Anatomy of the Renaissance. 2. However, Lyonese Anatomy developed very slowly because hospital training was more often badly organized. The only true supporter of Anatomy has been Marc Antoine Petit, chief surgeon of the Hôtel-Dieu before the French Revolution. 3. Apart from the parallel but only transient teaching of the Royal College of Surgery, one will have to wait for the creation of an official teaching first assumed by "schools" (secondary school and preparatory school) and finally by the Faculty of Medicine created in 1877. The names of Testut and of Latarjet contributed to the reknown of the Faculty of Medicine by their anatomical studies of great value for several generations of students. 4. Recently the Faculty of Medicine has been divided into four "universities". The new buildings are larger. The "gift of corpses" has brought a remedy to the shortage of the last twenty years. Anatomical research can be pursued thanks to micro-anatomy and bio-mechanics while conventional teaching is completed by dissection.