Thesis (doctoral)--Freie Universität Berlin, 1979.

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Objectifs : Il n’existe pas de valve de remplacement idéale à l’heure actuelle. L’utilisation du péricarde autologue pour confectionner une valve de remplacement dans le même temps opératoire est une alternative intéressante. Le but de cette étude est de mettre au point une nouvelle méthode de préparation des tissus utilisant un gel polysaccahridique et de standardiser les techniques de préparation, de fabrication et d’implantation de la néo-valve péricardique. Méthodes : Au total 18 moutons ont été opérés pour un remplacement valvulaire aortique par autogreffe péricardique traitée par gel de polymère ou glutaraldéhyde dans les conditions physiologiques d’une chirurgie à coeur ouvert sous circulation extra-corporelle. La néo-valve a été implantée au niveau de l’anneau valvulaire natif par 3 hémi-surjets au Prolène 5/0 avec l’utilisation d’instruments dédiés conçus grâce à l’étude ex-vivo. Les moutons survivants sont sacrifiés à un an pour une évaluation histologique de l’implant tissulaire péricardique.Résultats : Le temps moyen de confection de l’autogreffe péricardique est de 15.68 +/- 4.84 mn, pour un temps de CEC moyen de 136.17 +/- 27.46 mn. Le temps de clampage aortique moyen est de 85.61 +/- 12.21mn. Le gradient moyen trans-valvulaire est de 4,1 mmHg. Les valves prétraitées au glutaraldéhyde sont plus massivement calcifiées que celles traitées par le gel de polymère.Conclusion : L’utilisation du péricarde autologue dans la reconstruction valvulaire aortique est une alternative intéressante surtout chez l’enfant et sur les petits anneaux. L’utilisation d’instruments dédiés permet de rendre la fabrication et l’implantation de la néo-valve plus simple et plus reproductible avec des temps de CEC et de clampage raisonnables. Le gel de polymère donne de meilleurs résultats histologiques que le glutaraldéhyde. / Objective: Ideal prosthetic heart valve is not available. The use of the patient own pericardium for construction heart valve prosthesis is an interesting alternative and has several potential advantages. The aim of our study is to set up a new method for pericardium preparation with polysaccharide hydrogel and standardize the valve treatment processing and implantation.Méthods: Eighteen sheep underwent aortic valve replacement with autologous pericardium valve traited with polymeric gel or glutaraldéhyde using cardio-pulmonary bypass. The pericardial prosthesis was implanted with a proximal running 5/0 Prolène sutures placed along the aortic annulus and utilization of specially designed instruments. Survival sheep were euthanized after 12 months for histologic evaluation of the pericardial valvular implant.Results: Cardiopulmonary bypass and cross-clamp mean time was 136.17 +/- 27.46 mn and 85.61 +/- 12.21mn respectively. The prosthesis mean time construction was 15.68 +/- 4.84 mn. The mean transvalvular gradient after implantation was 4,1mmHg. The autologous pericardial valves treated with glutaraldehyde tended to show more extensive calcification than pericardial valves treated with polymeric gel.Conclusion: Truly stenless aortic valve replacement using autologous pericardium is feasible with cross clamping time acceptable and technically reliable with the use of specially designed instruments. The use of polymeric gel for treatment of autologous pericardial valve is less aggressive than glutaraldéhyde.

The object of this study was to compare growth factor and cytokine profiles in canine autologous conditioned serum (ACS) to canine plasma. Blood collected from 16 medium to large breed dogs was used to produce ACS (Orthokine® vet irap 10 syringes) and citrated plasma (control). Canine-specific ELISA assays were run per manufacturers’ instructions for interleukin (IL)-10, IL-4, tumor necrosis factor (TNF)-α, insulin-like growth factor (IGF)-1, fibroblast growth factor (FGF)-2, transforming growth factor (TGF)-β1, IL-1β, and interleukin-1 receptor antagonist (IL-1ra). Serum, in addition to plasma and ACS, was collected from an additional 6 dogs for TNF-α, IL-1β, and IL-1ra analysis (total of 22 dogs). Data were analyzed for differences in cytokine concentrations between ACS, plasma, and serum using the Wilcoxon signed-rank test with significance set at P<.05.There was a large variability in growth factor and cytokine concentrations between individual dogs in both plasma and ACS. There were no significant differences in IL-10, TNF-α, IGF-1, FGF-2, and TGF-β1 concentrations between ACS, plasma, or serum. ACS concentrations of IL-1β (median, range; 46.3 pg/mL, 0-828.8) and IL-4 (0.0 pg/mL, 0-244.1) were significantly increased compared to plasma (36.6 pg/mL, 0-657.1 and 0.0 pg/mL, 0-0, respectively). IL-1ra concentrations in ACS (median, range; 3458.9 pg/mL, 1,243.1-12,089.0) were significantly higher than plasma (692.3 pg/mL, 422.5- 1,475.6), as was the IL-1ra:IL-1β ratio (39.9 and 7.2, respectively). / Master of Science

A dissertation submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, in fulfilment of requirements for the degree of Master of Medicine (Surgery) Johannesburg 1993. / During the period June 1985-December 1989, 77 patients were accumulated for the autotransfusion trial, 21 of which were control patients. These patients were managed at three institutions namely Hillbrow (64), Coronation (1) and Shongwe (12) Hospitals. Of these 77 patients, 65 were involved in penetrating or blunt injuries, and 12 were ruptured ectopic pregnancies. The ages of all patients ranged from 16 yrs to 65 yrs. The patients were divided into four groups: 1 banked blood only (controls), 21 2 autotransfused blood only, 27 3 combined banked and autotransfusion, 17 4 ruptured ectopic pregnancies, 12. Investigated were the effects of autotransfused or banked blood volumes on the following parameters: 1 White cell counts: admission and post-transfusion day 1 2 Platelet counts: post-transfusion days :1. and 2 3 Haemoglobin: admission and post-transfusiondays 1 and 2 4 prothrombin indeex: post-trancfusidoanys 1, 2, and 3 5 Partial thromboplast times: post-transfusion days 1 and 2 6 Fibrinogen Degradation products: post-transfusion day 1 7 Haptoglobin levels: post-transfusion day 1 8 Haemopexin levels: post-transfusion day 1 9 Fibrinogen levels: post-transfusion days 1 and 2 Four salvage techniques were utilised. Complications were analysed for each transfusion group. Autotransfusion of salvaged blood from haemotihoxaces and haemoperitoneums is safe, efficaoious, and cost effective, provided that certain guidelines are followed.

Background. Relapsed acute promyleocytic leukemia (APL) is treated with re-induction chemotherapy, commonly arsenic trioxide, and stem cell transplantation (SCT). The effect of arsenic trioxide on autologous peripheral blood stem cell collection is unknown. Procedure. Five pediatric patients with relapsed APL had PML-RARA negative peripheral blood stem cells mobilized (four after arsenic trioxide) and underwent autologous SCT after cyclophosphamide (60 mg/kg x 2) and total body irradiation (TBI-fractionated 1,200 cGy) conditioning. Results. All five patients remain in molecular remission a median of 20 months post-transplant. Conclusion. Autologous SCT performed during molecular remission is a treatment option for pediatric patients with relapsed APL and may provide durable leukemia-free survival without the complications of allogeneic transplantation.

Rapidly progressive diffuse systemic sclerosis (dSSc) is a life-threatening condition characterized by increased mortality with few effective therapies, typically only helpful in stabilizing disease. Autologous hematopoietic stem cell transplantation (AHSCT) is the only treatment that has demonstrated improved survival. Despite promising results from three randomized controlled trials (RCTs), best practice use of AHSCT in the real-world setting is not well established. The primary objective of this thesis was to summarize the clinical efficacy, limitations and utilization of AHSCT in the management of rapidly progressive dSSc. Specifically, we conducted (1) a systematic review to describe the efficacy of AHSCT in dSSc as well as practice variation in patient selection and treatment regimens; and (2) a multicenter retrospective cohort study to compare outcomes for subjects who received AHSCT in France compared to those who received conventional care in Canada. There was important variability in the criteria for patient selection and treatment protocols. While AHSCT is associated with improved overall survival, skin fibrosis and lung function, further studies are needed to understand its potential for expanded eligibility and effects on other disease manifestations.

No description available.

In our aging population, arthritis is becoming an increasingly common problem. Pain, loss of joint function and other negative affects make arthritis a major health problem. The most common form of arthritis, osteoarthritis, is caused by the "wear and tear" of articular cartilage on the surface of bones in synovial joints. It is a chronic problem that is slowed with different types of therapies, including pharmaceutical, nutritional and surgical, but to date the wearing down of the cartilage cannot be stopped or reversed. Normal, mature, articular cartilage does not spontaneously repair itself after an injury. In light of this, several surgical techniques are being developed to repair degenerate and/or osteoarthritic cartilage. One such approach uses Autologous Chondrocyte Implantation (ACI). Dr. Mats Brittberg, and associates at Goteborg University in Sweden began using this cartilage repair procedure in 1987. Other techniques attempt to stimulate the subchondral bone to generate cartilage, such as Abrasion Arthroplasty. Still others use tissue grafts to attempt to repair lesions in cartilage. The surface biomechanics of these repaired tissues have not yet been studied. How well does the repaired cartilage resist wear? How long will it last? How does the repaired cartilage compare to "normal" cartilage in terms of wear-resistance? It is the goal of this research to gain initial knowledge to help answer these questions. Dr. Brittberg has provided 17 sample of cartilage, from 9 Swedish patients, including repaired and normal pairs using the aforementioned repair techniques and others, as well as a degenerate and normal cartilage pair. The intention of this paper is to report the findings of experiments performed using these samples, and compare the wear-resistance of repaired and degenerate cartilage to that of normal cartilage. Wear and friction tests were carried out on 2 mm diameter specimens using a biotribology device and a new, modified technique developed specifically for these small samples. The cartilage samples were mounted, using specially designed adapters, in our biotribology device for oscillating contact against polished stainless steel disks at a constant applied normal load, oscillating frequency, and test time. A buffered saline solution was used as the lubricant. Cartilage wear was determined from hydroxyproline analysis of the test fluid and washings from the wear test. Thin layers of transferred cartilage-like films to the stainless steel disks were also analyzed. Also, friction data was recorded throughout the tests. The results of these experiments show that: 1) For the two pairs of ACI repaired cartilage, the repaired cartilage gave substantially less wear than that of normal cartilage. 2) For all other repair techniques tested, the repaired cartilage produced more wear than normal cartilage. 3) The single osteoarthritic cartilage tested produced similar wear to that of normal cartilage. This is surprising since the current thought is osteoarthritic cartilage is more susceptible to wear. 4) The hydroxyproline concentration, by weight, of cartilage increases after the wear test. 5) Friction levels were in the boundary lubrication regime, and had no correlation with the amount of wear. To our knowledge, this research represents the first controlled "in vitro" study of an important unknown in cartilage repair, i.e., the wear-resistance of the repaired cartilage. It shows that ACI produces a cartilage with very good wear-resistance, better than that of other repair techniques, and possibly better than normal, healthy cartilage. ACI and its applications to the treatment of degenerate and osteoarthritic joints are promising, and studies will continue to investigate this and other types of cartilage repair. / Master of Science

A cirurgia de reconstrução de mama é uma ferramenta cirúrgica de importância ímpar para reparar os defeitos e assimetrias causadas pelos vários tipos de tratamentos cirúrgicos do Câncer de mama. Várias técnicas e táticas têm sido demosntradas e aplicadas nos últimos anos. Muitos são os estágios em que se encontram os pacientes e vários são os esquemas de abordagem terapêutica para diferentes estágios e tipos histológicos que se apresentam. Tratamentos quimioterápicos pré ou pós-operatório, tratamento radioterápico no pós-operatório quase imediato, mastectomias preventivas, setores amplos em diferentes quadrantes, quadrantectomias, todos estes são vários aspectos de tratamento de uma mesma patologia, porém com estágios e características histológicas e moleculares diferenciadas. Como alternativa cirúrgica para reconstrução de mama em câncer de mama, nos casos em que está indicada a quadrantectomia e/ou setor de mama, independentemente da localização na mama, é que propusemos uma técnica de uso de enxerto autólogo da mama contralateral para manter a forma e a simetria mamária associada a técnicas cirúrgicas de mamoplastias. Objetivo: O objetivo do presente estudo foi avaliar o uso de enxerto de mama contralateral associada a outras técnicas de cirurgia mamária já descritas por outros autores e acompanhar o resultado quanto à estética e simetria mamária no pós-operatório imediato e após o tratamento radioterápico. Comparar os resultados com as mamas do pré-operatório e avaliar a simetria e a estética no pós-operatório. Métodos: Foram incluídos neste estudo 42 pacientes com diferentes tratamentos, porém todas com indicação cirúrgica semelhantes: setor de mama ou quadrantectomia, seguidos de radioterapia. Todos os casos foram fotografados no pré-operatório e mais de 3 meses pós-tratamento radioterápico. Foi utilizada uma escala contínua para avaliar o grau de simetria mamária no pós-operatório de mais de 3 meses de radioterapia. A escalala de medição se baseou numa régua milimétrica de 0 a 10 cm. Foi solicitado a quatro especialistas na área para colocar uma marca na escala com relação à simetria e ao aspecto estético das mamas. As notas de cada paciente foram avaliadas estatisticamente. Resultados: Os resultados foram estatisticamente significativos para a avaliação estética e para a simetria mamária pós-cirurgia e radioterapia. Conclusão: Cocluímos que o enxerto autólogo de mama contralateral em cirurgia de reconstrução de mama é um procedimento que, quando utilizado com outras técnicas, traz um resultado estético e simétrico adequado, desta forma mostrando mais uma alternativa para cirurgia de reconstrução mamária. / Background: The Breast Reconstruction surgery is a surgical tool of unparalleled importance to repair the defects and asymmetries caused by various types of surgical breast cancer treatment. Various techniques and tactics has been demonstrated and applied in recent years. Many patients are at different stages of the disease and several are the sorts of therapeutic approaches for different stages and histologic types that feature. Neo adjuvant chemotherapy treatments or postoperative chemotherapy, radiotherapy in almost immediately after surgery, preventive mastectomies, removing large breast tissue in different quadrants, quadrantectomies. All these are various aspects of treatment of the same disease however to different stages and histological and molecular characteristics. As a surgical alternative to breast reconstruction in breast cancer, where it is indicated quadrantectomy and or wide resection of breast tissue in the same quadrant, regardless of location in the breast that I proposed a technique contralateral breast grafiting replacement to keep shape and breast symmetry. Objetive: The aim of this study was to evaluate the contralateral breast graft associated with other breast surgery techniques already described by other authors, and follow the aesthetic result in the immediate postoperative period and after three months of radiotherapy. Compare the results with those of preoperative breast, and evaluate the symmetry postoperatively and proper aesthetic result. Methods: The study included 42 patients. Each case with different proposals for treatment, but all with similar surgical indication, wide resection of the breast or quadrantectomy, followed by radiotherapy. All cases were photographed in their preoperative, “pre radiotherapy” and three months post radiotherapy. A continuous scale was used to assess the degree of mammary symmetry in these patients in the post operative period of three months after radiotherapy. The measurement was based on a rule millimeter scale from 0 to 10 cm. We were asked to four experts in the field to put a mark on the scale with respect to symmetry and aesthetic appearance of the breasts. The scores of each patient were evaluated statistically. Results: The results were statistically significant for the aesthetic evaluation of the breasts and also for evaluation of the symmetry of the breasts after surgery and radiotherapy. Conclusion: We concluded that autologous graft contralateral breast in breast reconstruction surgery is a procedure that when used with other techniques, brings an aesthetic and suitable symmetrical result thus showing an alternative to breast reconstruction surgery.