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Sample records for bone allograft dfdba

  1. Clinical application of radiation sterilized demineralized freeze dried bone allograft (DFDBA) and DFDBA combined with bovine periosteum membrane in periodontal defects

    International Nuclear Information System (INIS)

    Tantin R Dwijartini; Paramita Pandansari; Basril Abbas; Nazly Hilmy

    2008-01-01

    Full text: The objective of this report is to evaluate the effects of Radiation Sterilized Demineralized Freeze Dried Bone Allograft (DFDBA) and DFDBA combined with Bovine Periosteum Membrane (BPM) as well as BPM only in some cases of Periodontal Defects. BPM was used as a guided tissue regeneration. This study was carried out to 26 patients as follows : 10 cases for periodontal pocket using only DFDBA and DFDBA combined with BPM for 16 cases which consist of 10 cases of post extraction socket, 5 cases of gingival recession and one case of maxillary bone defect. DFDBA and periosteum membrane used were produced by BATAN Research Tissue Bank. Flap operation was done for all of the treatments, and followed by filling with DFDBA and/or DFDBA combined with periosteum membrane or BPM only. Evaluations were done up to 6 months. Parameters observed were the improvement of bone level, clinical attachment level, pocket depth and gingival margin location as well as increasing the thickness of maxillary bone. All of those evaluations were done by clinical observation and x-ray examination. Results obtained show that the improvement of clinical attachment level, reduces the pocket depth and increases bone density happened in all cases observed. It was also shows that BPM can be used as a guided tissue regeneration. No rejection could be observed in all of those cases. This study clearly indicated that DFDBA had an inductive effect on the formation of new bone and connective tissue. It can be concluded that DFDBA and Bovine Periosteum Membrane are promising to be used in treatment of the case of Periodontal Defects. (Author)

  2. ALVEOLAR BONE REGENERATION AFTER DEMINERALIZED FREEZE DRIED BONE ALOGRAFT (DFDBA BONE GRAFTING

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    Sri Oktawati

    2006-04-01

    Full Text Available Periodontal treatment by conventional way will result in healing repair, which easily cause recurrence. Modification of treatment should be done to get an effective result, that is the regeneration of alveolar bone and to reduce inflammation. The objective of this study is to determine the alveolar bone regeneration after using DFDBA (Demineralized Freeze Dried Bone Allograft. Quasi experimental designs with pre and post test method was used in this study. From 13 patients, 26 defects got conventional or regenerative treatment. The indicator of alveolar bone regenaration in bone height in radiographic appearance and level of osteocalsin in gingival crevicular fluid (GCF were checked before and after the treatment, then the changes that occurred were analyzed. The result of the research showed that alveolar bone regeneration only occurred to the group of regenerative treatment using DFDBA. The conclusion is the effective periodontal tissue regeneration occurred at regenerative treatment by using DFDBA, and the osteocalsin in GCF can be used as indicator of bone growth.

  3. Osteoinductive and Osteopromotive Variability among Different Demineralized Bone Allografts.

    Science.gov (United States)

    Wei, Lingfei; Miron, Richard J; Shi, Bin; Zhang, Yufeng

    2015-06-01

    The purpose of this investigation was to compare the osteoinductive and osteopromotive potential of two widely used demineralized freeze-dried bone allografts (DFDBA) (Osteotech® DFDBA and LifeNet® DFDBA). Twenty-seven male Wistar rats (mean body weight 200 g) were treated with either DFDBA from Osteotech and LifeNet or control for femoral and intramuscular defects and assigned to histological analysis at 2, 4, and 8 weeks postimplantation. Hematoxylin and eosin (H&E), Safranin-O, tartrate-resistant acid phosphatase (TRAP), and osteopontin (OPN) staining were performed. Quantitative analysis of mineralized new bone to total volume (BV/TV) was assessed by micro-computed tomography. Both allografts demonstrated osteoinductive potential at 2 weeks as assessed by intramuscular bone formation. LifeNet DFDBA displayed continual new bone formation at 4 and 8 weeks, whereas Osteotech particles were fully resorbed by 4 weeks postimplantation. Femur defects demonstrated significantly greater BV/TV at 4 and 8 weeks with higher expression of OPN staining around LifeNet DFDBA particles. TRAP-positive cells were visible in and around both allograft materials. The results from the present study indicate that variability among allografts exists. In the present, LifeNet DFDBA supported more new bone formation. Further larger animal models or clinical trials are required to validate these findings. © 2013 Wiley Periodicals, Inc.

  4. Osteoinductive potential of a novel biphasic calcium phosphate bone graft in comparison with autographs, xenografts, and DFDBA.

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    Miron, Richard J; Sculean, Anton; Shuang, Yang; Bosshardt, Dieter D; Gruber, Reinhard; Buser, Daniel; Chandad, Fatiha; Zhang, Yufeng

    2016-06-01

    Since the original description of osteoinduction in the early 20th century, the study and development of innovative biomaterials has emerged. Recently, novel synthetic bone grafts have been reported with potential to form ectopic bone in vivo. However, their full characterization in comparison with other leading bone grafts has not been investigated. The aim of this study was to determine the osteoinductive potential of bone grafts by comparing autogenous bone grafts, demineralized freeze-dried bone allografts (DFDBA), a commonly utilized natural bone mineral (NBM) from bovine origin (Bio-Oss), and a newly developed biphasic calcium phosphate (BCP). Grafts were compared in vitro for their ability to stimulate bone marrow stromal cell (BMSC) migration, proliferation, and differentiation as assessed by quantitative real-time PCR for genes coding for bone markers including Runx2, collagen I, and osteocalcin. Furthermore, bone grafts were implanted in the calf muscle of 12 beagle dogs to determine their potential to form ectopic bone in vivo. The in vitro results demonstrate that both autografts and DFDBA show potential for cell recruitment, whereas only autografts and BCP demonstrated the ability to differentiate BMSCs toward the osteoblast lineage. The in vivo ectopic bone model demonstrated that while NBM particles were not osteoinductive and autogenous bone grafts were resorbed quickly in vivo, ectopic bone formation was reported in DFDBA and in synthetic BCP grafts. The modifications in nanotopography and chemical composition of the newly developed BCP bone grafts significantly promoted ectopic bone formation confirming their osteoinductive potential. In conclusion, the results from this study provide evidence that synthetic bone grafts not only serve as a three-dimensional scaffold but are also able to promote osteoinduction. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Bone allografting in children

    Science.gov (United States)

    Sadovoy, M. A.; Kirilova, I. A.; Podorognaya, V. T.; Matsuk, S. A.; Novoselov, V. P.; Moskalev, A. V.; Bondarenko, A. V.; Afanasev, L. M.; Gubina, E. V.

    2017-09-01

    A total of 522 patients with benign and intermediate bone tumors of various locations, aged 1 to 15 years, were operated in the period from 1996 to 2016. To diagnose skeleton tumors, we used clinical observation, X-ray, and, if indicated, tomography and tumor site biopsy. In the extensive bone resection, we performed bone reconstruction with the replacement of a defect with an allograft (bone strips, deproteinized and spongy grafts), sometimes in the combination with bone autografting. After segmental resection, the defects were filled with bone strips in the form of matchstick grafts; the allografts were received from the Laboratory for Tissue Preparation and Preservation of the Novosibirsk Research Institute of Traumatology and Orthopedics. According to the X-ray data, a complete reorganization of bone grafts occurred within 1.5 to 3 years. The long-term result was assessed as good.

  6. Periodontal Regeneration Of 1-, 2-, and 3-Walled Intrabony Defects Using Accell Connexus (registered trademark) Versus Demineralized Freeze-Dried Bone Allograft: A Randomized Parallel Arm Clinical Control Trial

    Science.gov (United States)

    2015-06-01

    dissimilar individuals of the same species (American Academy of Periodontology Glossary of Periodontal Terms 2001). They can be osteoconductive or...procedures in humans for almost 30 years. (Bowers, 1989). Now a product distributed by Keystone Dental, Accell Connexus®, is a new bone allograft...particulate DFDBA (Company information, Keystone Dental). The bone graft is then sterilized in the same manner as particulate DFDBA which has been

  7. Socket preservation using demineralized freezed dried bone allograft with and without plasma rich in growth factor: A canine study

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    Ahmad Mogharehabed

    2014-01-01

    Full Text Available Background: The accelerating effect of plasma rich in growth factors (PRGFs in the healing of extraction sockets has been demonstrated by some studies. The aim of the present study was to histologically and histomorphometrically evaluate whether bone formation would increase by the combined use of PRGF and demineralized freeze-dried bone allograft (DFDBA. Materials and Methods: In four female dogs, the distal root of the second, third and fourth lower premolars were extracted bilaterally and the mesial roots were preserved. The extraction sockets were randomly divided into DFDBA + PRGF, DFDBA + saline or control groups. Two dogs were sacrificed after 2 weeks and two dogs were sacrificed after 6 weeks. The extraction sockets were evaluated from both histological and histomorphometrical aspects. The data were analyzed by Mann-Whitney followed by Kruskal-Wallis tests using the Statistical Package for the Social Sciences version 20 (SPSS Inc., Chicago, IL, USA. Significant levels were set at 0.05. Results: The least decrease in socket height was observed in the DFDBA + PRGF group (0.73 ± 0.42 mm. The least decrease in the coronal portion was observed in the DFDBA + PRGF group (1.38 ± 1.35 mm². The least decrease in the middle surface was observed in the DFDBA group (0.61 ± 0.80 mm². The least decrease in the apical portion was observed in the DFDBA group (0.34 ± 0.39 mm². Conclusion: The present study showed better socket preservation subsequent to the application of DFDBA and PRGF combination in comparison with the two other groups. However, the difference was not statistically significant.

  8. A randomized controlled evaluation of alveolar ridge preservation following tooth extraction using deproteinized bovine bone mineral and demineralized freeze-dried bone allograft.

    Science.gov (United States)

    Sadeghi, Rokhsareh; Babaei, Maryam; Miremadi, S Asghar; Abbas, Fatemeh Mashadi

    2016-01-01

    Alveolar ridge preservation could be performed immediately following tooth extraction to limit dimensional changes of alveolar process due to bone resorption. The aim of this study was to compare the clinical and histologic outcomes of socket preservation using two different graft materials; deproteinized bovine bone mineral (DBBM) and demineralized freeze-dried bone allograft (DFDBA) with absorbable collagen membrane. Twenty extraction sockets in 20 patients were randomly divided into 2 treatment groups: 10 sockets were augmented with DBBM and collagen membrane whereas 10 sockets were filled with DFDBA and covered by collagen membrane. Primary closure was achieved over extraction sockets by flap advancement. Horizontal and vertical ridge dimensional changes were assessed at baseline and after 4-6 months at the time of implant placement. For histological and histomorphometrical analysis, bone samples were harvested from the augmented sites with trephine during implant surgery. All data were analyzed using SPSS version 18 (α=0.05). Clinical measurements revealed that average horizontal reduction was 2.3 ± 0.64 mm for DFDBA and 2.26 ± 0.51 mm for DBBM. Mean vertical ridge resorption at buccal side was 1.29 ± 0.68 mm for DFDBA and 1.1 ± 0.17 mm for DBBM. Moreover, mean vertical ridge reduction at lingual site was 0.41 ± 0.38 mm and 0.35 ± 0.34 mm for DFDBA and DBBM, respectively. No significant differences were seen between two groups in any of those clinical parameters. Histologic analysis showed statistically significant more new bone deposition for DFDBA compared to DBBM (34.49 ± 3.19 vs. 18.76 ± 3.54) (P alveolar ridge preservation after tooth extraction, but there was more new bone formation and less residual graft particles in DFDBA group than in DBBM group.

  9. Allograft in bone tumour surgery

    International Nuclear Information System (INIS)

    Sengupta, S.

    1999-01-01

    In the last twenty years, there has been a vast improvement in the prognosis of primary malignant tumours of bone. This is due to many factors including early detection, staging and classification of tumours as a result of better staining and imaging techniques, better surgical technology, e.g. endoprosthesis and most importantly adjuvant treatment with cytotoxic drugs. As a result of long term survival, amputation of limb has more or less been replaced by limb salvage surgery. This procedure consists of two parts. Primary objective is of course complete removal of the tumour by adequate soft tissue cover and secondarily by reconstruction of the locomotor system, If possible with retention of the function of the limb. These procedures include endo-prosthetic replacement or arthroplasty and arthrodesis using autologus grafts, allograft or combination. With the development of bone banks and assured safety of preserved bones, reconstructive limb salvage surgery using massive allograft is gradually replacing prosthetic implants. The advantages include replacement of articular surfaces, incorporation of the graft to the host bone, attachment of bone tissue and increased probably permanent survival. Allograft can be used for intercalary replacement, osteo-articular arthroplasty arthrodesis or filling large cavities. Inherent complication of massive allograft are disease transmission, infection, delayed and non-union, pathological fractures, mechanical failure and joint destruction. Several limb salvage procedures using allografts have been carried out in our institution with one failure due to infection. Paucity of available allograft has restricted more such procedures to be carried out

  10. Biomechanical properties of bone allografts

    International Nuclear Information System (INIS)

    Pelker, R.R.; Friedlaender, G.E.; Markham, T.C.

    1983-01-01

    The biomechanical properties of allograft bone can be altered by the methods chosen for its preservation and storage. These effects are minimal with deep-freezing or low-level radiation. Freeze-drying, however, markedly diminishes the torsional and bending strength of bone allografts but does not deleteriously affect the compressive or tensile strength. Irradiation of bone with more than 3.0 megarad or irradiation combined with freeze-drying appears to cause a significant reduction in breaking strength. These factors should be considered when choosing freeze-dried or irradiated allogeneic bone that will be subjected to significant loads following implantation

  11. A comparative evaluation of extraction socket preservation with demineralized freeze-dried bone allograft alone and along with platelet-rich fibrin: A clinical and radiographic study

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    Dhaval J Thakkar

    2016-01-01

    Full Text Available Aims: To investigate clinically and radiographically, the bone fill in extraction sockets using demineralized freeze-dried bone allograft alone and along with platelet-rich fibrin (PRF. Materials and Methods: A randomized controlled clinical trial was carried out on 36 nonrestorable single-rooted teeth sites. Sites were randomized into demineralized freeze-dried bone allograft (DFDBA combined with PRF - test and DFDBA - control groups using a coin toss method. After the placement of graft material, collagen membrane was used to cover it. The clinical parameters recorded were ridge width and ridge height. All the parameters were recorded at baseline and at 90 and 180 days. Statistical Analysis Used: Independent t-test and paired t-test. Results: In both groups, there is significant reduction in loss of ridge width and ridge height from baseline to 90 days (P < 0.001, baseline to 180 days (P < 0.001, and 90-180 days (P < 0.001. However, when both the groups were compared the test group favored in the reduction of ridge width while there was no statistical difference in reduction of ridge height among at different intervals. Conclusions: Although DFDBA is considered as an ideal graft material, PRF can be used as an adjunctive with DFDBA for socket preservation.

  12. A comparative evaluation of freeze dried bone allograft and decalcified freeze dried bone allograft in the treatment of intrabony defects: A clinical and radiographic study

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    Rajat Gothi

    2015-01-01

    Full Text Available Background: Ideal graft material for regenerative procedures is autogenous bone graft but the major disadvantage with this graft is the need for a secondary surgical site to procure donor material and the frequent lack of intraoral donor site to obtain sufficient quantities of autogenous bone for multiple or deep osseous defects. Hence, to overcome these disadvantages, bone allografts were developed as an alternative source of graft material. Materials and Methods: In 10 patients with chronic periodontitis, 20 bilateral infrabony defects were treated with freeze dried bone allograft (FDBA-Group A and decalcified freeze dried bone allograft (DFDBA-Group B. Clinical and radiographic parameters were assessed preoperatively and at 3 months and 6 months postoperatively. Data thus obtained was subjected to statistical analysis. Results: Significant improvement in the reduction in probing depth and relative attachment level (RAL from the baseline to 3 months to baseline to 6 months in group A and group B, which was statistically significant but no statistically significant reduction was seen between 3 months and 6 months. On inter-group comparison, no significant differences were observed at all-time points. In adjunct to the probing depth and RAL, the radiographic area of the defect showed a similar trend in intra-group comparison and no significant difference was seen on inter-group comparison at all-time points. Conclusions: Within the limitations of the current study, it can be concluded that DFDBA did not show any improvement in the clinical and radiographic parameters in the treatment of the intrabony defects as compared to FDBA.

  13. Mandibular reconstruction using bone allografts

    International Nuclear Information System (INIS)

    Chang Joon Yim

    1999-01-01

    Further understanding of bone healing mechanisms, bone physiology and bone biology, transplantation immunology, and development of Tissue Banking procedures has enabled oral and maxillofacial surgeons to reconstruct even the most difficult bony defects successfully with the preserved allogeneic bone implant. Although it had been known that bone allografts were clinically effective, its application has not been widespread until the reports of Inclan (I 942), Hyatt and Butler (I 950), and Wilson (I 95 1). Tissue Banking provides the surgeon with a readily available, relatively inexpensive, and relatively safe selection of allogeneic bone for clinical use. Now autogenous bone and allogeneic bone implants present a wide variety of surgical options to surgeons, whether used separately or in combination. The surgeons are able to make judicious and fruitful choices, only with a thorough knowledge of the above-mentioned biological principles and skillful techniques. Many kinds of bone grafting techniques have been tried for reconstructing defective osseous tissues of the oral and maxillofacial region, though they have varying degrees of success. The osseous defects which require grafting include those of various size, shape, position, or amount. Unlike autogenous grafts, whose function is to provide osteogenic cells, allografts are purely passive, offering only a matrix for the inductive phase of bone healing. The condition of the recipient bed is of primary importance, because the host must produce all of the essential elements for the bone allograft to become incorporated. Depending on the processing methods of the allogeneic bone, the bone graft materials have different qualities, different healing potentials and different indications. Proper selection of grafts and surgical techniques requires an understanding of graft immunology and the mechanisms of graft healing. The surgeons should know about the biological principles to raise the clinical success rate

  14. Evaluation of bioactive glass and demineralized freeze dried bone allograft in the treatment of periodontal intraosseous defects: A comparative clinico-radiographic study

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    Kishore Kumar Katuri

    2013-01-01

    Full Text Available Aim: The purpose of this study was to evaluate the efficacy of demineralized freeze dried bone allograft (DFDBA and bioactive glass by clinically and radiographically in periodontal intrabony defects for a period of 12 months. Materials and Methods: Ten systemically healthy patients diagnosed with chronic periodontitis, with radiographic evidence of at least a pair of contralateral vertical osseous defects were included in this study. Defect on one-side is treated with DFDBA and the other side with bioactive glass. Clinical and radiographic measurements were made at baseline 6 month and 12 month after the surgery. Results: Compared to baseline, the 12 month results indicated that both treatment modalities resulted in significant changes in all clinical parameters (gingival index, probing depth, clinical attachment level (CAL and radiographic parameters (bone fill; P < 0.001FNx01. However, sites treated with DFDBA exhibited statistically significantly more changes compared to the bioactive glass in probing depth reduction (2.5 ± 0.1 mm vs. 1.8 ± 0.1 mm CAL gain 2.4 ± 0.1 mm versus 1.7 ± 0.2 mm; ( P < 0.001FNx01. At 12 months, sites treated with bioactive glass exhibited 56.99% bone fill and 64.76% bone fill for DFDBA sites, which is statistically significant ( P < 0.05FNx01. Conclusion: After 12 months, there was a significant difference between the two materials with sites grafted with DFDBA showing better reduction in probing pocket depth, gain in CAL and a greater percentage of bone fill when compared to that of bioactive glass.

  15. Comparative evaluation of platelet-rich fibrin with demineralized freeze-dried bone allograft in periodontal infrabony defects: A randomized controlled clinical study

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    Monali Shah

    2015-01-01

    Full Text Available Introduction: Several bone graft materials have been used in the treatment of infrabony defects. Demineralized freeze-dried bone allograft (DFDBA has been histologically proven to be the material of choice for regeneration. However, platelet-rich fibrin (PRF has been said to have several properties that aid in healing and regeneration. Hence, this study focuses on the regenerative capacity of PRF when compared with DFDBA. Materials and Methods: A total of 40 sites with intrabony defects were selected and were assigned to the test group (open flap debridement [OFD] and PRF, n = 20 and the control group (OFD + DFDBA, n = 20. At the test sites, two PRF plugs were placed in the intrabony defect after debridement of the site and flap was sutured in place. The parameters measured were probing depth (PD, relative attachment level (RAL, and gingival marginal level (GML. These parameters were measured just before surgery (baseline and at 6 months postsurgery. The changes in PD, RAL, and GML were analyzed at baseline and postsurgically after 6 months in each group with paired t-test and between the two groups with unpaired t-test. Results: The mean reduction in PD after 6 months in the test PRF group is 3.67 ± 1.48 mm where in control DFDBA group is 3.70 ± 1.78 mm. Gain in RAL in the test PRF group is 2.97 ± 1.42 mm where in control DFDBA group, it is 2.97 ± 1.54 mm. Gingival margin migrated apically in the test PRF group by 0.43 ± 1.31 mm where in control DFDBA group by 0.72 ± 2.3 mm. It was seen that the differences in terms of PD (P = 0.96, RAL (P = 1.00 and GML (P = 0.62 were not significant. Conclusion: Platelet-rich fibrin has shown significant results after 6 months, which is comparable to DFDBA for periodontal regeneration in terms of clinical parameters. Hence, it can be used in the treatment of intrabony defects.

  16. Structural bone allograft fractures in oncological procedures.

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    Garcia-Coiradas, Javier; Garcia-Maroto, Roberto; Cebrian, Juan Luis; Lopez-Duran, Luis

    2015-11-01

    We report our experience analysing the risk of fracture amongst allografts in limb-preserving surgery for bone tumours. We retrospectively reviewed our experience with bone allograft and its major complications when used for limb -preserving operations for bone tumours. Forty-one structural allografts were performed in 39 patients between 1992 and 2012. Minimum follow-up was 20 months. Massive allografts have a high complication rate. Excluding infection and nonunion, five acute fractures were found. All fractures occurred after the graft-host junction was united. Local factors-such as graft preservation, weight bearing, fixation to the host or systemic factors such as adjuvant treatments (chemotherapy or radiotherapy)-influence fracture rate. In our study, four patients achieved consolidation with internal fixation and autologous iliac-crest graft, whilst only one required graft exchange. There is no general consensus as to when to treat fractures using open reduction and internal fixation or by exchanging the allograft. Higher fracture rate in relation to systemic treatment was found. Massive structural allograft reconstruction still has a place in limb-preserving surgery, with an acceptable fracture rate and a durable solution.

  17. Histologic evaluation of bone healing capacity following application of inorganic bovine bone and a new allograft material in rabbit calvaria.

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    Mojgan Paknejad

    2015-02-01

    Full Text Available Considering the importance of bone augmentation prior to implant placement in order to obtain adequate bone quality and quantity, many studies have been conducted to evaluate different techniques and materials regarding new bone formation. In this study, we investigated the bone healing capacity of two different materials deproteinized bovine bone mineral (DBBM with the trade name of Bio-Oss and demineralized freeze-dried bone allograft (DFDBA with the trade name of DynaGraft.This randomized blinded prospective study was conducted on twelve New Zealand white rabbits. Three cranial defects with an equal diameter were created on their calvarium. Subsequently, they were distributed into three groups: 1. The control group without any treatment; 2. The Bio-Oss group; 3. The DynaGraft group. After 30 days, the animals were sacrificed for histologic and histomorphometric analysis.Substantial new bone formation was observed in both groups. DynaGraft: 56/1 % ± 15/1 and Bio-Oss: 53/55 % ± 13/5 compared to the control group: 28/6 % ± 11/2. All groups showed slight inflammation and a small amount of residual biomaterial was observed.Considerable new bone formation was demonstrated in both DynaGraft and Bio-Oss groups in comparison with the control group. Both materials are considered biocompatible regarding the negligible foreign body reaction.

  18. Magnetic resonance imaging of massive bone allografts with histologic correlation

    International Nuclear Information System (INIS)

    Hoeffner, E.G.; Soulen, R.L.; Ryan, J.R.; Qureshi, F.

    1996-01-01

    The objective of this study was to better understand the MRI appearance of massive bone allografts. The MRI findings of three massive bone allografts imaged in vivo were correlated with the histologic findings following removal of the allografts. A fourth allograft, never implanted, was imaged and evaluated histologically. Allografts were placed for the treatment of primary or recurrent osteosarcoma. The in-vivo allografts have a heterogeneous appearance on MRI which we attribute to the revascularization process. Fibrovascular connective tissue grows into the graft in a patchy, focal fashion, down the medullary canal from the graft-host junction and adjacent to the periosteum. The marrow spaces are initially devoid of normal cellular elements and occupied by fat and gelatinous material. This normal postoperative appearance of massive bone allografts must not be interpreted as recurrent neoplasm or infection in the allograft. Recognition of these complications rests on features outside the marrow. (orig./MG)

  19. Arthroscopic meniscal allograft transplantation without bone plugs.

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    Alentorn-Geli, Eduard; Seijas Vázquez, Roberto; García Balletbó, Montserrat; Álvarez Díaz, Pedro; Steinbacher, Gilbert; Cuscó Segarra, Xavier; Rius Vilarrubia, Marta; Cugat Bertomeu, Ramón

    2011-02-01

    Partial or total meniscectomy are common procedures performed at Orthopedic Surgery departments. Despite providing a great relief of pain, it has been related to early onset knee osteoarthritis. Meniscal allograft transplantation has been proposed as an alternative to meniscectomy. The purposes of this study were to describe an arthroscopic meniscal allograft transplantation without bone plugs technique and to report the preliminary results. All meniscal allograft transplantations performed between 2001 and 2006 were approached for eligibility, and a total of 35 patients (involving 37 menisci) were finally engaged in the study. Patients were excluded if they had ipsilateral knee ligament reconstruction or cartilage repair surgery before meniscal transplantation or other knee surgeries after the meniscal transplantation. Scores on Lysholm, Subjective IKDC Form, and Visual Analogue Scale (VAS) scale for pain were obtained at a mean follow-up of 38.6 months and compared to pre-operative data. Data on chondral lesions were obtained during the arthroscopic procedure and through imaging (radiographs and MRI) studies pre-operatively. Two graft failures out of 59 transplants (3.4%) were found. Daily life accidents were responsible for all graft failures. Significant improvements for Lysholm, Subjective IKDC Form, and VAS for pain scores following the meniscal allograft transplantation were found (P lesion, there was no significant interactions for Lysholm (n.s.), Subjective IKDC Form (n.s.), and VAS for pain scores (n.s.). This study demonstrated that an arthroscopic meniscal allograft transplantation without bone plugs improved knee function and symptoms after a total meniscectomy. Improvements were observed independently of the degree of chondral lesion.

  20. A comparision of two types of decalcified freeze-dried bone allograft in treatment of dehiscence defects around implants in dogs

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    Ahmad Moghareh Abed

    2011-01-01

    Full Text Available Background: Decalcified freeze-dried bone allograft (DFDBA may have the potential to enhance bone formation around dental implants. Our aim in this study was the evaluation and comparison of two types of DFDBA in treatment of dehiscence defects around Euroteknika® implants in dogs. Methods : In this prospective clinical trial animal study, all mandibular premolars of three Iranian dogs were extracted. After 3 months of healing, fifteen SLA type Euroteknika® dental implants (Natea with 4.1mm diameter and 10mm length were placed in osteotomy sites with dehiscence defects of 5mm length, 4 mm width, and 3mm depth. Guided bone regeneration (GBR procedures were performed using Cenobone and collagen membrane for six implants, the other six implants received Dembone and collagen membrane and the final three implants received only collagen membrane. All implants were submerged. After 4 months of healing, implants were uncovered and stability (Implant Stability Quotient of all implants was measured. Then, block biopsies of each implant site were taken and processed for ground sectioning and histomorphometric analysis. The data was analyzed by ANOVA and Pearson tests. P value less than 0.05 was considered to be significant. Results: All implants osseointegrated after 4 months. The mean values of bone to implant contact for histomorphometric measurements of Cenobone, Denobone, and control groups were 77.36 ± 9.96%, 78.91 ± 11.9% and 71.56 ± 5.61% respectively, with no significant differences among the various treatment groups. The correlation of Implant Stability Quotient and histomorphometric techniques was 0.692. Conclusion: In treating of dehiscence defects with GBR technique in this study, adding DFDBA did not significantly enhance the percentages of bone-to-implant contact measurements; and Implant Stability Quotient Resonance Frequency Analysis appeared to be a precise technique.

  1. Bone Allografts: What Is the Risk of Disease Transmission with Bone Allografts?

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    ... freezing in liquid nitrogen, freeze-drying, demineralization, and vacuum sealing) render DFDBA and FDBA grafts safe for ... Media Listen Watch YouTube About CDC Employment Newsroom Training/Education Funding CDC's Organization Mission and Vision Using ...

  2. Determination of orthodontic tooth movement and tissue reaction following demineralized freeze-dried bone allograft grafting intervention

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    Massoud Seifi

    2012-01-01

    Full Text Available Background: Socket preservation after tooth extraction is one of the indications of bone grafting to enhance preorthodontic condition. The aim of this study is to determine the effects of socket preservation on the immediate tooth movement, alveolar ridge height preservation and orthodontic root resorption. Materials and Methods: In a split-mouth technique, twelve sites in three dogs were investigated as an experimental study. Crushed demineralized freeze-dried bone allograft (DFDBA (CenoBone® was used as the graft material. The defects were made by the extraction of 3 rd premolar. On one side of each jaw, the defects were preserved by DFDBA and defects of the other side left opened as the control group. Simultaneously the teeth adjacent to the defects were pulled together by a NiTi coil spring. After eight weeks, the amount of (OTM, alveolar height, and root resorption were measured. Analysis of variance was used for purpose of comparison. Results: There was a slight increase in OTM at grafted sites as they were compared to the control sites (P<0.05. Also a significant bone resorption in control site and successful socket preservation in experimental site were observed. Reduction of root resorption at the augmented site was significant compared to the normal healing site (P<0.05. Conclusion: Using socket preservation, tooth movement can be immediately started without waiting for the healing of the recipient site. This can provide some advantages like enhanced rate of OTM, its approved effects on ridge preservation that reduces the chance of dehiscence and the reduction of root resorption.

  3. Determination of orthodontic tooth movement and tissue reaction following demineralized freeze-dried bone allograft grafting intervention.

    Science.gov (United States)

    Seifi, Massoud; Ghoraishian, Seyed Ahmad

    2012-03-01

    Socket preservation after tooth extraction is one of the indications of bone grafting to enhance preorthodontic condition. The aim of this study is to determine the effects of socket preservation on the immediate tooth movement, alveolar ridge height preservation and orthodontic root resorption. In a split-mouth technique, twelve sites in three dogs were investigated as an experimental study. Crushed demineralized freeze-dried bone allograft (DFDBA) (CenoBone(®)) was used as the graft material. The defects were made by the extraction of 3(rd) premolar. On one side of each jaw, the defects were preserved by DFDBA and defects of the other side left opened as the control group. Simultaneously the teeth adjacent to the defects were pulled together by a NiTi coil spring. After eight weeks, the amount of (OTM), alveolar height, and root resorption were measured. Analysis of variance was used for purpose of comparison. There was a slight increase in OTM at grafted sites as they were compared to the control sites (P<0.05). Also a significant bone resorption in control site and successful socket preservation in experimental site were observed. Reduction of root resorption at the augmented site was significant compared to the normal healing site (P<0.05). Using socket preservation, tooth movement can be immediately started without waiting for the healing of the recipient site. This can provide some advantages like enhanced rate of OTM, its approved effects on ridge preservation that reduces the chance of dehiscence and the reduction of root resorption.

  4. Combining bisphosphonates with allograft bone for implant fixation

    NARCIS (Netherlands)

    Mathijssen, N.M.C.; Buma, P.; Hannink, G.J.

    2014-01-01

    The aim of this review was to discuss the current state of research of combining bisphosphonates with allograft bone for implant fixation. The allograft bone can only be reached by the bisphosphonate once it has been revascularized. However, this can be circumvented by local administration of

  5. Complications of massive allograft reconstruction for bone tumors

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    Abolhasan Borjian

    2006-11-01

    Full Text Available BACKGROUND: Since the evolution of multi-drug chemotherapy and radiotherapy and new sophisticated surgical techniques, limb salvage and reconstruction, rather than amputation, has become the preferred treatment for patients with bone tumors. One option is allograft replacement. Although allograft has several advantages, it is not without complications. This study was performed to observe these complications in a group of patients treated with allograft replacement for bone tumor resection. The purpose was to gain an overview of the factors predisposing to these complications to minimize their occurrence. METHODS: This retrospective study was performed on patients with benign aggressive and malignant bone tumors undergoing limb reconstruction with allograft between 1997 and 2005 in Al-Zahra and Kashani Hospitals in Isfahan, Iran. Data was collected from patient files, clinical notes, radiographs and a recent physical examination. Complications including local recurrence, fracture of allograft, fixation failure, nonunion, infection, skin necrosis and neurological damage were recorded. RESULTS: Sixty patients including 39 males and 21 females were studied. The mean age of patients was 23 ± 11.7 years. The mean follow-up interval was 28.1 ± 12.4 months (mean ± SD. Complications were allograft fracture in 20%, local recurrence in 16%, fixation failure in 11%, nonunion in 6%, infection in 6%, skin necrosis in 6%, and peroneal nerve palsy in 1% of cases. Most local recurrences (60% were those with a mal-performed biopsy. Most allograft fractures occurred when a short plate was used. CONCLUSIONS: Allograft replacement for bone tumors remains a valid option. To avoid complications, biopsy should be done by a trained surgeon in bone oncology. A long plate is recommended for fixation. Sterility and graft processing must be optimal. Autogenous bone graft must be added at host-allograft junction. KEY WORDS: Bone tumors, bone allograft, limb

  6. Percutaneous fusion of lumbar facet with bone allograft

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    Félix Dolorit Verdecia

    2015-03-01

    Full Text Available OBJECTIVE: To assess the evolution of the cases treated with percutaneous facet fusion with bone allograft in lumbar facet disease. METHOD: Between 2010 and 2014, 100 patients (59 women and 41 men diagnosed with lumbar facet disease underwent surgery. RESULTS: The lumbar facet fusion with bone allograft shows good clinical results, is performed on an outpatient basis, and presents minimal complications and rapid incorporation of the patient to the activities of daily living. CONCLUSIONS: The lumbar facet fusion with bone allograft appears to be an effective treatment for lumbar facet disease.

  7. The safety of bone allografts used in dentistry: a review.

    Science.gov (United States)

    Holtzclaw, Dan; Toscano, Nicholas; Eisenlohr, Lisa; Callan, Don

    2008-09-01

    Recent media reports concerning "stolen body parts" have shaken the public's trust in the safety of and the use of ethical practices involving human allografts. The authors provide a comprehensive review of the safety aspects of human bone allografts. The authors reviewed U.S. government regulations, industry standards, independent industry association guidelines, company guidelines and scientific articles related to the use of human bone allografts in the practice of dentistry published in the English language. The use of human bone allografts in the practice of dentistry involves the steps of procurement, processing, use and tracking. Rigorous donor screening and aseptic proprietary processing programs have rendered the use of human bone allografts safe and effective as a treatment option. When purchasing human bone allografts for the practice of dentistry, one should choose products accredited by the American Association of Tissue Banks for meeting uniformly high safety and quality control measures. Knowledge of human bone allograft procurement, processing, use and tracking procedures may allow dental clinicians to better educate their patients and address concerns about this valuable treatment option.

  8. Clinical and biometrical evaluation of socket preservation using demineralized freeze-dried bone allograft with and without the palatal connective tissue as a biologic membrane.

    Science.gov (United States)

    Moghaddas, Hamid; Amjadi, Mohammad Reza; Naghsh, Narges

    2012-11-01

    Alveolar ridge preservation following tooth extraction has the ability to maintain the ridge dimensions and allow the implant placement in an ideal position fulfilling both functional and aesthetic results. The aim of this study was to evaluate the efficacy of the palatal connective tissue as a biological membrane for socket preservation with demineralized freeze-dried bone allograft (DFDBA). Twelve extraction sites were treated with DFDBA with (case group) and without (control group) using autogenous palatal connective tissue membrane before placement of implants. Alveolar width and height, amount of keratinized tissue, and gingival level were measured at pre-determined points using a surgical stent at two times, the time of socket preservation surgery. In both groups a decrease in all socket dimensions was found. The average decrease in socket width, height, keratinized tissue, and gingival level in case group was 1.16, 0.72, 3.58, and 1.27 mm, and in control group was 2.08, 0.86, 4.52, and 1.58 mm respectively. Statistical analysis showed that decrease in socket width (P = 0.012), keratinized tissue (P ≤ 0.001), and gingival level (P = 0.031) in case group was significantly lower than that of the control group. Results showed no meaningful difference in socket height changes when compared with case and control groups (P = 0.148). Under the limits of this study, connective tissue membrane could preserve socket width, amount of keratinized tissue, and the gingival level more effectively than DFDBA alone.

  9. Porous allograft bone scaffolds: doping with strontium.

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    Yantao Zhao

    Full Text Available Strontium (Sr can promote the process of bone formation. To improve bioactivity, porous allograft bone scaffolds (ABS were doped with Sr and the mechanical strength and bioactivity of the scaffolds were evaluated. Sr-doped ABS were prepared using the ion exchange method. The density and distribution of Sr in bone scaffolds were investigated by inductively coupled plasma optical emission spectrometry (ICP-OES, X-ray photoelectron spectroscopy (XPS, and energy-dispersive X-ray spectroscopy (EDS. Controlled release of strontium ions was measured and mechanical strength was evaluated by a compressive strength test. The bioactivity of Sr-doped ABS was investigated by a simulated body fluid (SBF assay, cytotoxicity testing, and an in vivo implantation experiment. The Sr molar concentration [Sr/(Sr+Ca] in ABS surpassed 5% and Sr was distributed nearly evenly. XPS analyses suggest that Sr combined with oxygen and carbonate radicals. Released Sr ions were detected in the immersion solution at higher concentration than calcium ions until day 30. The compressive strength of the Sr-doped ABS did not change significantly. The bioactivity of Sr-doped material, as measured by the in vitro SBF immersion method, was superior to that of the Sr-free freeze-dried bone and the Sr-doped material did not show cytotoxicity compared with Sr-free culture medium. The rate of bone mineral deposition for Sr-doped ABS was faster than that of the control at 4 weeks (3.28 ± 0.23 µm/day vs. 2.60 ± 0.20 µm/day; p<0.05. Sr can be evenly doped into porous ABS at relevant concentrations to create highly active bone substitutes.

  10. Surgical revascularization induces angiogenesis in orthotopic bone allograft

    NARCIS (Netherlands)

    Willems, Wouter F.; Kremer, Thomas; Friedrich, Patricia; Bishop, Allen T.

    2012-01-01

    Remodeling of structural bone allografts relies on adequate revascularization, which can theoretically be induced by surgical revascularization. We developed a new orthotopic animal model to determine the technical feasibility of axial arteriovenous bundle implantation and resultant angiogenesis. We

  11. Three-Dimensional Virtual Bone Bank System Workflow for Structural Bone Allograft Selection: A Technical Report

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    Lucas Eduardo Ritacco

    2013-01-01

    Full Text Available Structural bone allograft has been used in bone defect reconstruction during the last fifty years with acceptable results. However, allograft selection methods were based on 2-dimensional templates using X-rays. Thanks to preoperative planning platforms, three-dimensional (3D CT-derived bone models were used to define size and shape comparison between host and donor. The purpose of this study was to describe the workflow of this virtual technique in order to explain how to choose the best allograft using a virtual bone bank system. We measured all bones in a 3D virtual environment determining the best match. The use of a virtual bone bank system has allowed optimizing the allograft selection in a bone bank, providing more information to the surgeons before surgery. In conclusion, 3D preoperative planning in a virtual environment for allograft selection is an important and helpful tool in order to achieve a good match between host and donor.

  12. BONE ALLOGRAFTING IN REVISION KNEE ARTHROPLASTY: HISTOLOGICAL CHARACTERISTICS OF STRUCTURAL ALLOGRAFTS 54 MONTHS FOLLOW UP

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    T. A. Kuliaba

    2016-01-01

    Full Text Available Compensation of large bone defects by AORI third type classification is the most difficult problem the audit knee arthroplasty. In this situation, the surgeon have to choose between three possibilities: to use metal cones/sleeves, and, in cases with severely damaged metaepiphysis, to use structural allografts or oncological megaimplants. No doubt, it is interesting to follow the processes that are taking place with massive structural allografts implanted into the human body long time ago. This article presents the case study of the rheumatoid arthritis patient’s treatment with a severe lesion of the knee joint, subjected to repeated revision surgeries, last two of which are made with the use of massive structural allograft of femur. Morphological study of a massive distal femur allograft in 54 months after surgery showed that superficial ingrowth of connective tissue and blood vessels happens on the allograft’s border with its partial restructuring of the bone tissue at the border with the recipient bone. However, the most of allograft remains unchanged even after 54 months after surgery.

  13. Three-dimensional virtual bone bank system for selecting massive bone allograft in orthopaedic oncology.

    Science.gov (United States)

    Wu, Zhigang; Fu, Jun; Wang, Zhen; Li, Xiangdong; Li, Jing; Pei, Yanjun; Pei, Guoxian; Li, Dan; Guo, Zheng; Fan, Hongbin

    2015-06-01

    Although structural bone allografts have been used for years to treat large defects caused by tumour or trauma, selecting the most appropriate allograft is still challenging. The objectives of this study were to: (1) describe the establishment of a visual bone bank system and workflow of allograft selection, and (2) show mid-term follow-up results of patients after allograft implantation. Allografts were scanned and stored in Digital Imaging and Communications in Medicine (DICOM) files. Then, image segmentation was conducted and 3D model reconstructed to establish a visual bone bank system. Based on the volume registration method, allografts were selected after a careful matching process. From November 2010 to June 2013, with the help of the Computer-assisted Orthopaedic Surgery (CAOS) navigation system, the allografts were implanted in 14 patients to fill defects after tumour resection. By combining the virtual bone bank and CAOS, selection time was reduced and matching accuracy was increased. After 27.5 months of follow-up, the mean Musculoskeletal Tumor Society (MSTS) 93 functional score was 25.7 ± 1.1 points. Except for two patients with pulmonary metastases, 12 patents were alive without evidence of disease at the time this report was written. The virtual bone bank system was helpful for allograft selection, tumour excision and bone reconstruction, thereby improving the safety and effectiveness of limb-salvage surgery.

  14. Comparison of bone regeneration using three demineralized freeze-dried bone allografts: A histological and histomorphometric study in rabbit calvaria

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    Parichehr Behfarnia

    2012-01-01

    Conclusion: Both test and control groups resulted in successful new bone formation. No difference was noted in bone formation and remained particles between three commercial bone allografts. Further studies in this issue may be needed.

  15. [Reconstruction of periprosthetic fractures of hip with cortical bone plates allografts].

    Science.gov (United States)

    Zhou, Zong-ke; Pei, Fu-xing; Tu, Chong-qi; Yang, Jing; Shen, Bin; Liu, Lei; Fatou, Camara-yagouba

    2004-12-22

    To observe clinical results for reconstruction of periprosthetic fractures of hip with cortical bone plates allografts by deep-freezing and ethylene oxide treatment. Seven patients with periprosthetic fractures of hip underwent cortical bone plates allografts by deep-freezing at -70 degrees C after being treatment of 48 degrees C ethylene oxide. And evaluate clinical outcome by examining T lymphocytes, Harris scores, X-rays photograph, and bone scintigraphy. There were not activity of immune rejection and infection in all patients. Harris scores of patients increased 21, 32, 40, 40 scores at 3, 6, 12, 24 months after surgery. T-lymphocytes, antibody and immunocomplex in blood was normal postoperation. X-ray film indicated that fracture was healed at 3 months and there was partially bone conjunction between allograft strut and host bone. There was incorporation of 85% allograft strut to host bone, and 15% allograft strut was partially absorbed at 12 months after surgery. The size of femur of host was added 3 mm to 5 mm, averaged 4.3 mm at 12 months postoperation. Density of 80% allograft plates was as same as host bone after remodeling and the absorbtion of 10% allograft plates stopped at 24 months after surgery. There was thick of nuclein in the area of allograft cortical bone plates by bone scintigraphy examination at 3 months postoperation, and the thick of nuclein was stronger at 6, and 12 months after surgery. Allograft cortical bone plates by deep frozen at -70 degrees C after being treatment of 48 degrees C ethylene oxide is suitable for mechanical fixation and biological bone transplantation, and it can increase bone reservation, augment strength of femur once the allograft strut incorporates to host bone, and avoid removing metal implant in second operation when being applied into reconstruction femoral fracture in joint replacement.

  16. Cross-correlative 3D micro-structural investigation of human bone processed into bone allografts

    Energy Technology Data Exchange (ETDEWEB)

    Singh, Atul Kumar [Centre for Research in Nanotechnology & Science, Indian Institute of Technology Bombay, Mumbai 400076 (India); Gajiwala, Astrid Lobo [Tissue Bank, Tata Memorial Hospital, Parel, Mumbai 400012 (India); Rai, Ratan Kumar [Centre of Biomedical Research, SGPGIMS Campus, Lucknow 226014 (India); Khan, Mohd Parvez [Division of Endocrinology, Center for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI) CSIR-Central Drug Research Institute, Lucknow 226031 (India); Singh, Chandan [Centre of Biomedical Research, SGPGIMS Campus, Lucknow 226014 (India); Barbhuyan, Tarun [Division of Endocrinology, Center for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI) CSIR-Central Drug Research Institute, Lucknow 226031 (India); Vijayalakshmi, S. [Centre for Research in Nanotechnology & Science, Indian Institute of Technology Bombay, Mumbai 400076 (India); Chattopadhyay, Naibedya [Division of Endocrinology, Center for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI) CSIR-Central Drug Research Institute, Lucknow 226031 (India); Sinha, Neeraj, E-mail: neerajcbmr@gmail.com [Centre of Biomedical Research, SGPGIMS Campus, Lucknow 226014 (India); Kumar, Ashutosh, E-mail: ashutoshk@iitb.ac.in [Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai 400076 (India); Bellare, Jayesh R., E-mail: jb@iitb.ac.in [Centre for Research in Nanotechnology & Science, Indian Institute of Technology Bombay, Mumbai 400076 (India); Department of Chemical Engineering, Indian Institute of Technology Bombay, Mumbai 400076 (India)

    2016-05-01

    Bone allografts (BA) are a cost-effective and sustainable alternative in orthopedic practice as they provide a permanent solution for preserving skeletal architecture and function. Such BA however, must be processed to be disease free and immunologically safe as well as biologically and clinically useful. Here, we have demonstrated a processing protocol for bone allografts and investigated the micro-structural properties of bone collected from osteoporotic and normal human donor samples. In order to characterize BA at different microscopic levels, a combination of techniques such as Solid State Nuclear Magnetic Resonance (ssNMR), Scanning Electron Microscope (SEM), micro-computed tomography (μCT) and Thermal Gravimetric Analysis (TGA) were used for delineating the ultra-structural property of bone. ssNMR revealed the extent of water, collagen fine structure and crystalline order in the bone. These were greatly perturbed in the bone taken from osteoporotic bone donor. Among the processing methods analyzed, pasteurization at 60 °C and radiation treatment appeared to substantially alter the bone integrity. SEM study showed a reduction in Ca/P ratio and non-uniform distribution of elements in osteoporotic bones. μ-CT and MIMICS® (Materialize Interactive Medical Image Control System) demonstrated that pasteurization and radiation treatment affects the BA morphology and cause a shift in the HU unit. However, the combination of all these processes restored all-important parameters that are critical for BA integrity and sustainability. Cross-correlation between the various probes we used quantitatively demonstrated differences in morphological and micro-structural properties between BA taken from normal and osteoporotic human donor. Such details could also be instrumental in designing an appropriate bone scaffold. For the best restoration of bone microstructure and to be used as a biomaterial allograft, a step-wise processing method is recommended that preserves all

  17. Primary arthroplasty in healed osteoarticular allograft in patients with history of primary femoral bone tumors.

    Science.gov (United States)

    Verbeek, Bianca M; Kaiser, Courtney L; Paulino Pereira, Nuno Rui; Hornicek, Francis J; Raskin, Kevin A; Schwab, Joseph H; LozanoCalderón, Santiago A

    2017-12-01

    Roughly 25-35% of patients who are treated with osteoarticular allograft for primary bone sarcomas or aggressive benign bone tumors require surgery in the long-term due to degenerative changes of the articular surface of the allograft. There are three established methods of reconstruction for this complication; a total hip arthroplasty (THA) or total knee arthroplasty (TKA) in the retained osteoarticular allograft, a proximal or distal endoprosthesis after removal of the allograft, and an allograft-prosthesis composite (APC). The aims of this study are 1) to determine the rate of complication and failure of THA/TKA in healed femoral allograft; 2) to compare the methods of revision for allograft degeneration; and 3) to compare the use of arthroplasty in healed allograft to that of arthroplasty in native bone. We included all patients with primary bone sarcomas and locally aggressive primary benign bone tumors treated between 1984 and 2014 with an osteoarticular allograft followed by any subsequent arthroplasty technique as described above. Complications and reasons for failure are described following the classification of Henderson et al. Failure was defined as any complication leading to removal of the initial treatment construct. Failure rates of these groups were compared to primary arthroplasty in a live host bone (Control Group). Complications happened in 25 (61.0%) of the patients with a THA/TKA in the retained allograft, of these, 24 (58.5%) experienced failure, the most common being structural failure/type III (14, 58.3%). Thirteen patients (81.3%) with an endoprosthesis after removal of the allograft experienced complications, all of whom failed. The most common failure modes were aseptic loosening/type II (4, 30.8%) and infection/type IV (5, 38.5%). Complications in patients with an APC were experienced by 12 (85.7%) patients, 11 (78.6%) of whom failed. The most common failure mode was infection/type IV (4, 36.4%). Significantly (p < 0.001) fewer

  18. Augmentation of bone healing in delayed and atrophic nonunion of fractures of long bones by partially decalcified bone allograft (decal bone

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    Anuj Jain

    2015-01-01

    Conclusion: The partially decalcified bone allograft is an effective modality for augmentation of bone healing without complication associated with autograft like donor site morbidity, increased blood loss and increase in the surgical time.

  19. Bone marrow-derived T lymphocytes responsible for allograft rejection

    International Nuclear Information System (INIS)

    Senjanovic, M.; Marusic, M.

    1984-01-01

    Lethally irradiated mice reconstituted with syngeneic bone marrow cells were grafted with allogeneic skin grafts 6-7 weeks after irradiation and reconstitution. Mice with intact thymuses rejected the grafts whereas the mice thymectomized before irradiation and reconstitution did not. Thymectomized irradiated mice (TIR mice) reconstituted with bone marrow cells from donors immune to the allografts rejected the grafts. Bone marrow cells from immunized donors, pretreated with Thy 1.2 antibody and C', did not confer immunity to TIR recipients. To determine the number of T lymphocytes necessary for the transfer of immunity by bone marrow cells from immunized donors, thymectomized irradiated mice were reconstituted with nonimmune bone marrow cells treated with Thy 1.2 antibody and C' and with various numbers of splenic T lymphocytes from nonimmune and immune donors. Allogeneic skin graft rejection was obtained with 10(6) nonimmune or 10(4) immune T cells. The effect of immune T cells was specific: i.e., immune T cells accelerated only rejection of the relevant skin grafts whereas against a third-party skin grafts acted as normal T lymphocytes

  20. [Bone defects in revision knee arthroplasty: filling with bone allograft plus platelet-derived growth factors].

    Science.gov (United States)

    Macule-Beneyto, Francisco; Segur-Vilalta, Josep; Vilchez-Cavazos, Felix; Esteban-Navarro, Pedro; Vidal-Sicart, Sergi; Acosta-Olivo, Carlos

    2014-01-01

    One of the most challenging aspects of a revision knee arthroplasty is the management of bone loss. The OBJECTIVE of the study is to show the capability to augment bone mineral density in areas with bone loss with platelet-derived growth factors. Randomized, prospective, blinded study in patients who underwent a total knee replacement revision with tibial-damaged metaphyseal bone were randomly allocated to have a revision total knee arthroplasty and to fill the bone defects with lyophilized bone allograft mixed with platelet growth factors (experimental group, n= 9) or with lyophilized bone allograft alone (control group, n= 7). To evaluate bone mineral density between groups, dual-energy X-ray absorptiometry (DEXA) was performed preoperatively, at 1 month, 6 months and 1 year after surgery. The study was comprised of a total of 16 patients. We found no significant differences observed during the follow-up between groups in mineral bone density. Use of platelet-derived growth factors does not improve bone mineral density in patients with revision knee arthroplasty.

  1. Processing of gamma irradiated bone allografts for treatment of injuries in a nuclear scenario

    International Nuclear Information System (INIS)

    Singh, Durgeshwer; Singh, Antaryami; Singh, Rita; Shah, Om

    2014-01-01

    Bone allografts fill an important void in the surgical practice of orthopaedic surgery, and their use to replace and reconstruct musculoskeletal structures following injury or disease has gained increasing acceptance by orthopaedic surgeons. Serious mechanical injuries in a nuclear scenario involving compression, displacement and missile hit will lead to high incidence of various kinds of bone fractures, spinal injuries and joint injuries apart from lethality, lung damage and eardrum rupture. Bone allografts can be employed for repairing fracture defects, filling in destroyed regions of bone, management of open fractures and joint injuries. Autologous bone grafts, though ideal, have the drawback of secondary surgery for autograft retrieval, complications of infection and donor site morbidity. Bone allografts eliminate additional incision necessary for acquiring an autograft and consequently reduce operating time, blood loss as well as hospital and medical costs. However, disease transmission and bacterial infection in bone allograft transplantation is of significant concern. Sterilization by gamma irradiation is a definitive method for eliminating microorganisms and can prevent life-threatening allograft associated infections. The present study was carried out with the aim of bioburden assessment, radiation sterilization and clinical evaluation of bone allografts processed from femoral heads obtained from living donors. Femoral heads were obtained during surgery at Department of Orthopaedic Surgery, SN Medical College, Jodhpur and processed as freeze-dried bone allografts. Bioburden of bone allografts was found to be in the range of 2.26 to 3.59 log CFU/g. Verification dose for different batches of processing was 7.24±1.27 kGy. Radiological data of processed gamma irradiated bone grafts used in clinical cases of trauma surgery was recorded and has shown successful graft incorporation in allogenic recipients. (author)

  2. Osteoinductive effect of bone bank allografts on human osteoblasts in culture.

    Science.gov (United States)

    de la Piedra, Concepción; Vicario, Carlos; de Acuña, Lucrecia Rodríguez; García-Moreno, Carmen; Traba, Maria Luisa; Arlandis, Santiago; Marco, Fernando; López-Durán, Luis

    2008-02-01

    Incorporation of a human bone allograft requires osteoclast activity and growth of recipient osteoblasts. The aim of this work was to study the effects produced by autoclavated and -80 degrees C frozen bone allografts on osteoblast proliferation and synthesis of interleukin 6 (IL6), activator of bone resorption, aminoterminal propeptide of procollagen I (PINP), marker of bone matrix formation, and osteoprotegerin (OPG), inhibitor of osteoclast activity and differentiation. Allografts were obtained from human femoral heads. Human osteoblasts were cultured in the presence (problem group) or in the absence (control group) of allografts during 15 days. Allografts produced a decrease in osteoblast proliferation in the first week of the experiment, and an increase in IL6 mRNA, both at 3 h and 2 days, and an increase in the IL6 released to the culture medium the second day of the experiment. We found a decrease in OPG released to the culture on the 2nd and fourth days. These results suggest an increase in bone resorption and a decrease in bone formation in the first week of the experiment. In the second week, allografts produced an increase in osteoblast proliferation and PINP release to the culture medium, indicating an increase in bone formation; an increase in OPG released to the culture medium, which would indicate a decrease in bone resorption; and a decrease in IL6, indicating a decrease in bone resorption stimulation. These results demonstrate that autoclavated and -80 degrees C frozen bone allografts produce in bone environment changes that regulate their own incorporation to the recipient bone.

  3. Periosteal augmentation of allograft bone and its effect on implant fixation - an experimental study on 12 dogs()

    DEFF Research Database (Denmark)

    Barckman, Jeppe; Baas, Jorgen; Sørensen, Mette

    2013-01-01

    Periosteum provides essential cellular and biological components necessary for fracture healing and bone repair. We hypothesized that augmenting allograft bone by adding fragmented autologous periosteum would improve fixation of grafted implants.......Periosteum provides essential cellular and biological components necessary for fracture healing and bone repair. We hypothesized that augmenting allograft bone by adding fragmented autologous periosteum would improve fixation of grafted implants....

  4. Osteogenic protein-1 increases the fixation of implants grafted with morcellised bone allograft and ProOsteon bone substitute: an experimental study in dogs

    DEFF Research Database (Denmark)

    Jensen, T B; Overgaard, S; Lind, M

    2007-01-01

    Impacted bone allograft is often used in revision joint replacement. Hydroxyapatite granules have been suggested as a substitute or to enhance morcellised bone allograft. We hypothesised that adding osteogenic protein-1 to a composite of bone allograft and non-resorbable hydroxyapatite granules...... (ProOsteon) would improve the incorporation of bone and implant fixation. We also compared the response to using ProOsteon alone against bone allograft used in isolation. We implanted two non-weight-bearing hydroxyapatite-coated implants into each proximal humerus of six dogs, with each implant...... surrounded by a concentric 3 mm gap. These gaps were randomly allocated to four different procedures in each dog: 1) bone allograft used on its own; 2) ProOsteon used on its own; 3) allograft and ProOsteon used together; or 4) allograft and ProOsteon with the addition of osteogenic protein-1. After three...

  5. The effect of gamma irradiation on the osteoinductivity of demineralized human bone allograft.

    Directory of Open Access Journals (Sweden)

    Babak Arjmand

    2014-03-01

    Full Text Available The gamma irradiation has been used for end sterilization of allograft bones and its effects with a 25 kGy dosage on the osteoinductive properties of demineralized bone allograft powder was studied. This work carried out using an experimental method in an animal model. In this study the demineralized bone allograft powder which had been sterilized and prepared with gamma irradiation in a 25 kGy dosage in 18 hours, was used as a study group and the demineralized bone allograft powder which had been prepared aseptically was used as the reference group. 30 mg of bone powder from each group were implanted into right and left paravertebral muscles of eighteen rats, separately. After four weeks, the implanted samples were harvested with a 0.5 cm border and then the osteoinductivity of implants in two groups were compared with histopathologic studies. In 94.4% of the reference samples a new bone formation was observed. In the study group, this difference was observed only in 27.7% of samples (P<0.002. It appears that using gamma irradiation may lead to a reduction in osteoinduction properties of demineralized bone allograft powder.

  6. The Use of Structural Allograft in Primary and Revision Knee Arthroplasty with Bone Loss

    Directory of Open Access Journals (Sweden)

    Raul A. Kuchinad

    2011-01-01

    Full Text Available Bone loss around the knee in the setting of total knee arthroplasty remains a difficult and challenging problem for orthopaedic surgeons. There are a number of options for dealing with smaller and contained bone loss; however, massive segmental bone loss has fewer options. Small, contained defects can be treated with cement, morselized autograft/allograft or metal augments. Segmental bone loss cannot be dealt with through simple addition of cement, morselized autograft/allograft, or metal augments. For younger or higher demand patients, the use of allograft is a good option as it provides a durable construct with high rates of union while restoring bone stock for future revisions. Older patients, or those who are low demand, may be better candidates for a tumour prosthesis, which provides immediate ability to weight bear and mobilize.

  7. Freeze dried bone allografts in dental and maxillofacial reconstructive surgery - experience in Malaysia

    International Nuclear Information System (INIS)

    Abd Rani Samsudin; Meor Zaidi Meor Kamal

    1999-01-01

    The utilisation of vascularised and free bone autografts remain the goal standard in maxillofacial reconstructive surgery in Malaysia, but the use of freeze dried bone allograft is still widely practiced in many centres with variable results. This study evaluate the effectiveness and clinical efficacy of using radiation sterilised freeze dried bone allografts in oral and maxillofacial reconstructive surgery. The bone grafts were prepared at the Malaysian National Tissue Bank. Seventy eight patients who had undergone oral and Maxillofacial surgical procedures with reconstruction using bone allografts were included in this study. 50 patients were male and 28 patients were female and their age ranged from 14 to 75 years. Forty two patients underwent enucleation of benign cystic lesions in the jaws, 15 patients underwent repair of orbital floor fractures, 6 patients of jaw fractures with partial loss of bone while 8 patients underwent augmentation of depressed cheek bone. Another 4 patients had partial resection of the mandible because of cancer and 3 patients had facial osteotomies. A follow up period of 12 months up to 4 years was carried out. The patients were assessed both clinically and radiologically throughout their follow up visits. Clinical assessment showed no evidence of rejection of the implanted freeze dried allografts. Bone allografts implanted as inlay grafts demonstrated a better clinical performance than onlay grafts and the poorest results were obtained following bridging bony defects in the jaws. Radiation sterilised freeze dried bone allografts produced at the Malaysian National Tissue Bank are bio-compatible, functional, and provide predictable results when applied to selected areas of the facial skeleton

  8. Arthroscopic Meniscal Allograft Transplantation With Soft-Tissue Fixation Through Bone Tunnels.

    Science.gov (United States)

    Spalding, Tim; Parkinson, Ben; Smith, Nick A; Verdonk, Peter

    2015-10-01

    Meniscal allograft transplantation improves clinical outcomes for patients with symptomatic meniscus-deficient knees. We describe an established arthroscopic technique for meniscal allograft transplantation without the need for bone fixation of the meniscal horns. After preparation of the meniscal bed, the meniscus is parachuted into the knee through a silicone cannula and the meniscal horns are fixed with sutures through bone tunnels. The body of the meniscus is then fixed with a combination of all-inside and inside-out sutures. This technique is reliable and reproducible and has clinical outcomes comparable with those of bone plug fixation techniques.

  9. Increased Risk of Revision After Anterior Cruciate Ligament Reconstruction With Bone-Patellar Tendon-Bone Allografts Compared With Autografts.

    Science.gov (United States)

    Maletis, Gregory B; Chen, Jason; Inacio, Maria C S; Love, Rebecca M; Funahashi, Tadashi T

    2017-05-01

    The use of allograft tissue for anterior cruciate ligament reconstruction (ACLR) remains controversial. To compare the risk of aseptic revision between bone-patellar tendon-bone (BPTB) autografts and BPTB allografts. Cohort study; Level of evidence, 2. A retrospective cohort study of prospectively collected data was conducted using the Kaiser Permanente ACLR Registry. A cohort of patients who underwent primary unilateral ACLR with BPTB autografts and BPTB allografts was identified. Aseptic revision was the endpoint. The type of graft and allograft processing method (nonprocessed, <1.8-Mrad, and ≥1.8-Mrad irradiation) were the exposures of interest evaluated. Age (≤21 and ≥22 years) was evaluated as an effect modifier. Analyses were adjusted for age, sex, and race. Kaplan-Meier curves and Cox proportional hazards models were employed. Hazard ratios (HRs) and 95% CIs are provided. The BPTB cohort consisted of 5586 patients: 3783 (67.7%) were male, 2359 (42.2%) were white, 1029 (18.4%) had allografts (nonprocessed: 155; <1.8 Mrad: 525; ≥1.8 Mrad: 288), and 4557 (81.6%) had autografts. The median age was 34.9 years (interquartile range [IQR], 25.4-44.0) for allograft cases and 22.0 years (IQR, 17.6-30.0) for autograft cases. The estimated cumulative revision rate at 2 years was 4.1% (95% CI, 2.9%-5.9%) for allografts and 1.7% (95% CI, 1.3%-2.2%) for autografts. BPTB allografts had a significantly higher adjusted risk of revision than BPTB autografts (HR, 4.54; 95% CI, 3.03-6.79; P < .001). This higher risk of revision was consistent with all allograft processing methods when compared with autografts and was also consistently higher in patients with allografts regardless of age. When BPTB allograft tissue was used for ACLR, an overall 4.54 times adjusted higher risk of revision was observed compared with surgery performed with a BPTB autograft. Whether the tissue was irradiated with either high- or low-dose radiation, chemically processed, or not processed at

  10. Bone transplantation and tissue engineering, part III: allografts, bone grafting and bone banking in the twentieth century.

    Science.gov (United States)

    Hernigou, Philippe

    2015-03-01

    During the 20th century, allograft implantation waned in popularity as a clinical activity. Reports appeared in the literature describing several small series of patients in whom bone was obtained from amputation specimens or recently deceased individuals. The concept of bone banking became a reality during and after World War II when the National Naval Tissue Bank was established in Bethesda and a number of small banks sprang up in hospitals throughout the world. Small fragments, either of cortical or medullary bone, from these banks were used heterotopically to augment spinal fusions, to implant into cyst cavities, or to serve as a scaffolding for repair of non- or delayed union of fractures of the long bones.

  11. Laboratory methods used for testing the effect of radiation sterilization and preservation procedures on bone allografts

    International Nuclear Information System (INIS)

    Dziedzic-Goclawska, A.

    1999-01-01

    Sterilization of tissue allografts with ionizing radiation introduced in the mid of 1950s is more and more frequently used in tissue banking practice. The dose of 25 kGy is currently recommended and commonly used by many tissue banks in the world with the exception of the Central Tissue Bank in Warsaw where the dose of 33 kGy + 10 % has been routinely used since 1963, and from 1997 the dose of 35 kGy + 10 % has been introduced. To study the effect of radiation-sterilization on bone allografts the interdisciplinary investigations have been undertaken and several techniques have been implemented in our tissue bank. The electron paramagnetic resonance (EPR) spectroscopy has been applied to investigate the amount, origin and stability of free radicals and other paramagnetic entities induced in radiation-sterilized bone allografts. This technique has been also utilized for quantitative evaluation of remodeling process of radiation-sterilized bone allografts and for estimation of the absorbed dose of ionizing radiation using bone tissue as a dosimeter. A model of heterotopically induced osteogenesis after transplantation of devitalized bone matrix into the muscle (described by Urist in 1965) is very useful in tissue banking practice. It allows one to determine the contribution the graft itself makes to osteogenesis. This model is routinely used in our tissue bank to evaluate the effect of various sterilization and preservation procedures on osteoinductive properties of bone allografts. The solubility in vitro of collagen - a carrier for bone morphogenetic proteins (BMPS) and a major constituent of bone and the other connective tissue grafts, has been studied by measuring the amount of extracted neutral, acid and total soluble collagen from bone grafts preserved by different methods at irradiated at vanous experimental conditions. A positive correlation between collagen solubility in vitro and the rate of graft resorption in vivo has been observed. The high doses of

  12. A robust method to coat allograft bone with a drug-releasing polymer shell - biomed 2010.

    Science.gov (United States)

    Davidoff, Sherry N; Call, Brent P; Hogrebe, Paul C; Grainger, David W; Brooks, Amanda E

    2010-01-01

    Bone allograft material used for osseous void filling and structural support in skeletal reconstructive surgeries can also be used in combination as a drug carrier. Previous coating methods to load drugs, such as antibiotics and anti-inflammatories, provided an initial burst release, which may not be optimal for combating persistent local implant-associated bacterial infections. Theoretical drug release kinetics can be optimized not only with a clinically relevant drug-to-polymer ratio but also with a robust, effective rate-limiting release coating method. Three coating methods were evaluated in which degradable polycaprolactone (PCL) polymer retains and controls the release of antibiotic tobramycin from commercial, clinically common allograft bone fragments. Methods are based on a common dip-coating of the allograft fragment, with each coating method distinguished by subsequent drying and processing steps. Using a combination of classic polymer coating techniques, dipping and rapid drying, a method has been developed to apply the drug-releasing polymer coating while concurrently maintaining the high surface area, cancellous pore allograft structure. This provides increased local drug loading and controlled release over the clinically relevant six-to-eight week time period. This method offers potential for industrial scale-up as multiple cancellous allograft fragments can be processed batch-wise. Multiple drugs and combination therapies can also be applied in laminate coating designs.

  13. No effect of platelet-rich plasma with frozen or processed bone allograft around noncemented implants

    DEFF Research Database (Denmark)

    Jensen, T B; Rahbek, O; Overgaard, S

    2005-01-01

    by isolating the buffy coat from autologous blood samples. Bone allograft was used fresh-frozen or processed by defatting, freeze drying, and irradiation. Cylindrical hydroxyapatite-coated titanium implants were inserted bilaterally in the femoral condyles of eight dogs. Each implant was surrounded by a 2.5-mm...

  14. Experience of using allograft transplantation to reconstruct bone defect at Dr. Soetomo Hospital, Surabaya, Indonesia

    International Nuclear Information System (INIS)

    Ferdiansyah Abdurrahman

    1999-01-01

    To evaluate the result of allograft transplantation to reconstruct bone defect. The study was case series. All of the cases have been evaluated clinically and radiologically. All of the operations were carried out at Dr. Soetomo Hospital as the referral hospital. Twenty one patients with bone defect were caused by tumour (11 patients), injury (7 patients) infection (1 patient), and congenitial anomaly (2 patients). Out of 21 patients, 15 (78.8%) were already radiologically united, and out of 21 patients 14 (73.7%) patients showed an excellent and good limb function, whereas 5 (26.3%) patients showed a fair and poor result respectively. Allograft transplantation gave a good result to reconstruct bone defect

  15. Sandwich allografts for long-bone nonunions in patients with osteogenesis imperfecta: a retrospective study.

    Science.gov (United States)

    Puvanesarajah, Varun; Shapiro, Jay R; Sponseller, Paul D

    2015-02-18

    Patients with osteogenesis imperfecta often develop nonunions, as internal fixation has limited applicability in this condition. We report the outcomes of a modified "sandwich technique" in the treatment of long-bone nonunions in patients with osteogenesis imperfecta; this technique brings circumferential stabilization and normal collagen to the nonunion site. From May 2003 through February 2012, twelve patients (eight females, four males; median age, 39.0 years; range, eleven to seventy-eight years) who had osteogenesis imperfecta (Sillence type I [three], type III [eight], and type IV [one]) and a combined total of thirteen nonunions (two humeral, two radial, three femoral, four tibial, and two ulnar; median duration, 15.0 months; range, six to 204 months) were treated at our institution with compressed sandwich allograft cortical struts. The struts were fashioned to be wide enough to allow for increased osteoconductive surface area and to approximate a hemicylindrical shape. Treatment history and demographics data were acquired through retrospective chart review. Follow-up radiographs were analyzed by two attending orthopaedic surgeons to determine radiographic findings. The median follow-up time was 4.6 years (range, 2.1 to 10.3 years). All thirteen nonunions, including one requiring a second graft procedure, healed with abundant, smooth allograft incorporation, resulting in an initial healing rate of 92% because of a refracture in one patient. This patient's nonunion ultimately healed with additional allograft struts and a new intramedullary rod. One patient required removal of prominent screws. The final follow-up examinations revealed no pain or refracture at the original nonunion site. All patients regained their prefracture level of function. Sandwich allograft struts constitute a durable, safe method for the stabilization and healing of persistent long-bone nonunions in patients with osteogenesis imperfecta. All patients showed incorporation of the

  16. Increased Release Time of Antibiotics from Bone Allografts through a Novel Biodegradable Coating

    Directory of Open Access Journals (Sweden)

    István Hornyák

    2014-01-01

    Full Text Available The use of bone allografts is contraindicated in septic revision surgery due to the high risk of graft reinfection. Antibiotic release from the graft may solve the problem and these combinations can theoretically be used for prevention or even therapy of infection. The present study investigated whether amoxicillin, ciprofloxacin, and vancomycin alone or in combination with chitosan or alginate are suitable for short-term or long-term bone coating. Human bone allografts were prepared from femoral head and lyophilized. Antibiotic coating was achieved by incubating the grafts in antibiotic solution and freeze-drying again. Two biopolymers chitosan and alginate were used for creating sustained-release implantable coatings and the drug release profile was characterized in vitro by spectrophotometry. Using lyophilization with or without chitosan only resulted in short-term release that lasted up to 48 hours. Alginate coating enabled a sustained release that lasted for 8 days with amoxicillin, 28 days with ciprofloxacin coating, and 50 days with vancomycin coating. Using only implantable biodegradable allograft and polymers, a sustained release of antibiotics was achieved with ciprofloxacin and vancomycin for several weeks. Since the calculated daily release of the antibiotic was lower than the recommended IV dose, the calcium alginate coated bone graft can support endoprosthesis revision surgery.

  17. Effects of trypsinization and mineralization on intrasynovial tendon allograft healing to bone.

    Science.gov (United States)

    Qu, Jin; van Alphen, Nick A; Thoreson, Andrew R; Chen, Qingshan; An, Kai-Nan; Amadio, Peter C; Schmid, Thomas M; Zhao, Chunfeng

    2015-04-01

    The purpose of the current study was to develop a novel technology to enhance tendon-to-bone interface healing by trypsinizing and mineralizing (TM) an intrasynovial tendon allograft in a rabbit bone tunnel model. Eight rabbit flexor digitorum profundus (FDP) tendons were used to optimize the trypsinization process. An additional 24 FDP tendons were stratified into control and TM groups; in each group, 4 tendons were used for in vitro evaluation of TM and 8 were transplanted into proximal tibial bone tunnels in rabbits. The samples were evaluated histologically and with mechanical testing at postoperative week 8. Maximum failure strength and linear stiffness were not significantly different between the control and TM tendons. A thin fibrous band of scar tissue formed at the graft-to-bone interface in the control group. However, only the TM group showed obvious new bone formation inside the tendon graft and a visible fibrocartilage layer at the bone tunnel entrance. This study is the first to explore effects of TM on the intrasynovial allograft healing to a bone tunnel. TM showed beneficial effects on chondrogenesis, osteogenesis, and integration of the intrasynovial tendon graft, but mechanical strength was the same as the control tendons in this short-term in vivo study. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  18. Evaluation of Clinical Results and Complications of Structural Allograft Reconstruction after Bone Tumor Surgery

    Directory of Open Access Journals (Sweden)

    Mohammad Gharedaghi

    2016-07-01

    Full Text Available Background: Massive bone allograft is an option in cases of limb preservation and reconstruction after massive benign and malignant bone tumor resection. The purpose of this study was to analyze the outcome of these procedures at Imam Reza Hospital, Mashhad University of Medical Sciences. Methods: In this study, 113 cases have been presented. Eleven cases were excluded (patients has a traumatic defect or they passed away before the completion of the study’s two-year follow up period. Each patient completed a questionnaire, went through a physical examination and, if indicated, X-ray information was collected. The patients were divided into three groups: chemotherapy, chemotherapy plus radiation therapy, and no-adjuvant-therapy. Results: Fifty-four cases were male and the mean age was 24.5±5.39. The number of cases and indications for surgery were: 33 cases of aggressive benign tumors or low grade malignant bone tumors (large bone defects including 16 germ cell tumors, eight aneurysmal bone cysts, five low grade osteosarcomas, and four chondrosarcomas. Another 69 cases were high-grade malignant bone tumors including 42 osteosarcomas, 21 Ewing’s sarcoma, and six other high grade osteosarcomas. Patients were divided into three groups: the first group received no adjuvant therapy, the second group received chemotherapy, and the third group received chemotherapy plus radiotherapy. The location of tumors were as follows: eight cases in the pelvic bone, 12 in the proximal femur, 18 in the femoral shaft, 36 in the distal femur, 12 in the proximal tibia, and 16 in the humeral bone. The 12 cases of proximal femoral defects were reconstructed by allograft composite prosthesis, 18 diaphyseal defects with intercalary allograft, and 36 distal femoral defects were reconstructed using osteoarticular allograft. The rate of deep infection was 7:8% (eight patients and in this regard, we found a significant difference among the three groups, such that most

  19. Comparative study and histomorphometric analysis of bone allografts lyophilized and sterilized by autoclaving, gamma irradiation and ethylene oxide in rats

    Directory of Open Access Journals (Sweden)

    Otavio Machado de Almeida

    2013-01-01

    Full Text Available PURPOSE: To compare three sterilization methods (autoclave, gamma irradiation and ethylene oxide over non demineralized lyophilized bone allografts. METHODS: Bone allografts were implanted on paravertebral muscles of 21 rats. After 30 days animals were sacrificed and grafts underwent comparative analysis regarding histomorphometric and macroscopic parameters. RESULTS: Allografts that underwent the three sterilization methods presents similar weight gain, cortical thickness similar to control group, and less fibrosis than the control group. Grafts that underwent sterilization in autoclave presented less presence of multinucleated giant cells, although not statistically significant. There was also no statistically significant difference regarding mineralization on the three groups. CONCLUSION: The three sterilization methods cause similar effects on bone allografts regarding macroscopic and histomorphometric parameters.

  20. Effects of particle size and porosity on in vivo remodeling of settable allograft bone/polymer composites.

    Science.gov (United States)

    Prieto, Edna M; Talley, Anne D; Gould, Nicholas R; Zienkiewicz, Katarzyna J; Drapeau, Susan J; Kalpakci, Kerem N; Guelcher, Scott A

    2015-11-01

    Established clinical approaches to treat bone voids include the implantation of autograft or allograft bone, ceramics, and other bone void fillers (BVFs). Composites prepared from lysine-derived polyurethanes and allograft bone can be injected as a reactive liquid and set to yield BVFs with mechanical strength comparable to trabecular bone. In this study, we investigated the effects of porosity, allograft particle size, and matrix mineralization on remodeling of injectable and settable allograft/polymer composites in a rabbit femoral condyle plug defect model. Both low viscosity and high viscosity grafts incorporating small (<105 μm) particles only partially healed at 12 weeks, and the addition of 10% demineralized bone matrix did not enhance healing. In contrast, composite grafts with large (105-500 μm) allograft particles healed at 12 weeks postimplantation, as evidenced by radial μCT and histomorphometric analysis. This study highlights particle size and surface connectivity as influential parameters regulating the remodeling of composite bone scaffolds. © 2015 Wiley Periodicals, Inc.

  1. Freeze-dried bone allografts sterilized with gamma radiation and the clinical use in harelip

    International Nuclear Information System (INIS)

    Luna Z, D.; Reyes F, M. L.; Diaz M, I.; Cruz A, L. C.; Vazquez R, M. A.

    2010-10-01

    Bone for transplant is part of the musculoskeletal tissue join with fascia lat, tendon, ligament and cartilage. Bone is formed by cells (osteocytes, osteoblasts and osteoclasts) and extracellular matrix formed mainly by collagen and hydroxyapatite, which gives strength and elasticity to the bone. The bone function in the body is to move, support, organs protection, production of blood cells and store minerals. The musculoskeletal tissue is processed in specialized tissue banks using gamma radiation of cobalt-60 for sterilization at 25 kGy doses at very low temperature or at room temperature, getting tissues with high quality for clinical applications in injured patients. The process of the bone for transplants varies depend on the size and the surgeon likes, nevertheless in general the large ones are preserved at low temperature (-80 C), meanwhile the short ones are freeze-dried preserved. The musculoskeletal diseases represent the most common physical incapacity, which affect million of people around the world. Due to the human body has 206 bones, during a bone injury each bone can be replaced or repaired with several devices, in general the surgeon goes to a specialized tissue banks, to get the bone, due to the high bone quantity on the body and the number of bone injuries and diseases, the bone is the most transplanted around the world only behind the blood. The bone can be processed in several sizes and shapes, one of these is bone powder from allograft, which is used over all for bone filling, this can be take advantage for cleft lip and palate defects, which is a birth defect, this can affect the way the child's face looks, it can also lead to problems with eating, talking and ear infections. The description of the bone powder process is presented and the clinical use of this powder in several pediatric patients for cleft lip and palate defects is described. (Author)

  2. Freeze-dried bone allografts sterilized with gamma radiation and the clinical use in harelip

    Energy Technology Data Exchange (ETDEWEB)

    Luna Z, D.; Reyes F, M. L. [ININ, Carretera Mexico-Toluca s/n, Ocoyoacac 52750, Estado de Mexico (Mexico); Diaz M, I.; Cruz A, L. C. [Centro Estatal de Trasplantes del Estado de Mexico, Pablo Sidar No. 602, Col. Universidad, Toluca 50130, Estado de Mexico (Mexico); Vazquez R, M. A., E-mail: daniel.luna@inin.gob.m [Centro de Especialidades Odontologicas, Instituto Materno Infantil del Estado de Mexico, Paseo Colon esquina Felipe Angeles s/n, Col. Villa Hogar, Toluca 50170, Estado de Mexico (Mexico)

    2010-10-15

    Bone for transplant is part of the musculoskeletal tissue join with fascia lat, tendon, ligament and cartilage. Bone is formed by cells (osteocytes, osteoblasts and osteoclasts) and extracellular matrix formed mainly by collagen and hydroxyapatite, which gives strength and elasticity to the bone. The bone function in the body is to move, support, organs protection, production of blood cells and store minerals. The musculoskeletal tissue is processed in specialized tissue banks using gamma radiation of cobalt-60 for sterilization at 25 kGy doses at very low temperature or at room temperature, getting tissues with high quality for clinical applications in injured patients. The process of the bone for transplants varies depend on the size and the surgeon likes, nevertheless in general the large ones are preserved at low temperature (-80 C), meanwhile the short ones are freeze-dried preserved. The musculoskeletal diseases represent the most common physical incapacity, which affect million of people around the world. Due to the human body has 206 bones, during a bone injury each bone can be replaced or repaired with several devices, in general the surgeon goes to a specialized tissue banks, to get the bone, due to the high bone quantity on the body and the number of bone injuries and diseases, the bone is the most transplanted around the world only behind the blood. The bone can be processed in several sizes and shapes, one of these is bone powder from allograft, which is used over all for bone filling, this can be take advantage for cleft lip and palate defects, which is a birth defect, this can affect the way the child's face looks, it can also lead to problems with eating, talking and ear infections. The description of the bone powder process is presented and the clinical use of this powder in several pediatric patients for cleft lip and palate defects is described. (Author)

  3. Effect of ethylene oxide sterilization on the osteoinductivity of demineralized allograft bone powder

    International Nuclear Information System (INIS)

    Hamid Reza Aghayan; Babak Arjmand; Mehdi Golestani; Farokh Tirgari

    2008-01-01

    Full text: Ethylene oxide has been widely used for secondary sterilization of bone allograft to reduce the risk of infection and associated complications. In this study we investigate the effects of ethylene oxide gas sterilization on the osteoinductivity of demineralized bone Powder. Eighteen rats received two separate implants consisting of 30 mg aseptically prepared and 30 mg ethylene oxide-sterilized demineralized bone powder. The demineralized bone powder from each group was placed into two separate muscle pouch created in the paravertebral muscles of each rat. After 4 weeks each implantation site was removed with 0.5 cm normal tissue around the implant. Histological examination was done to determine the presence or absence of osteoinduction. All except one of eighteen aseptically prepared demineralized bone powder sites histologically contained new bone elements (94.4%) and fourteen (77.7%) of ethylene oxide sterilized demineralized bone powder sites showed evidence of new bone elements (p>0.05). There is no significant difference in osteoblast formation in two groups. We concluded that ethylene oxide sterilization in 42 degree C did not significantly reduce the osteoinductivity of demineralized bone powder. So ethylene oxide can be considered as a suitable but not perfect method for secondary sterilization of demineralized bone powder. (Author)

  4. Management of fenestration using bone allograft in conjunction with platelet-rich fibrin

    Directory of Open Access Journals (Sweden)

    Anuradha Bhatsange

    2017-01-01

    Full Text Available Fenestration and dehiscence are said to be anatomical variations of cortical bone and not true pathological entities. They represent window-like defects covered by periosteum and overlying gingiva with or without the intact marginal bone. The etiology of such defects is still unclear, though many hypotheses such as occlusal traumatism, trauma, and variation in root bone angulation have been put forward. Diagnosis of such defects is challenging clinically, and they cannot be appreciated in conventional radiographs. In many instances, they are accidentally discovered during periodontal and oral surgical procedures. These defects, if not treated, can affect prognosis and complicate healing of the affected teeth. Treatment of such cortical bony defects is challenging and involves the use of potential regenerative materials to aid in regeneration. This case report describes the successful management of such a defect, discovered through exploratory flap approach, using PRF in conjunction with bone allograft.

  5. Surgical guides (patient-specific instruments) for pediatric tibial bone sarcoma resection and allograft reconstruction.

    Science.gov (United States)

    Bellanova, Laura; Paul, Laurent; Docquier, Pierre-Louis

    2013-01-01

    To achieve local control of malignant pediatric bone tumors and to provide satisfactory oncological results, adequate resection margins are mandatory. The local recurrence rate is directly related to inappropriate excision margins. The present study describes a method for decreasing the resection margin width and ensuring that the margins are adequate. This method was developed in the tibia, which is a common site for the most frequent primary bone sarcomas in children. Magnetic resonance imaging (MRI) and computerized tomography (CT) were used for preoperative planning to define the cutting planes for the tumors: each tumor was segmented on MRI, and the volume of the tumor was coregistered with CT. After preoperative planning, a surgical guide (patient-specific instrument) that was fitted to a unique position on the tibia was manufactured by rapid prototyping. A second instrument was manufactured to adjust the bone allograft to fit the resection gap accurately. Pathologic evaluation of the resected specimens showed tumor-free resection margins in all four cases. The technologies described in this paper may improve the surgical accuracy and patient safety in surgical oncology. In addition, these techniques may decrease operating time and allow for reconstruction with a well-matched allograft to obtain stable osteosynthesis.

  6. Surgical Guides (Patient-Specific Instruments for Pediatric Tibial Bone Sarcoma Resection and Allograft Reconstruction

    Directory of Open Access Journals (Sweden)

    Laura Bellanova

    2013-01-01

    Full Text Available To achieve local control of malignant pediatric bone tumors and to provide satisfactory oncological results, adequate resection margins are mandatory. The local recurrence rate is directly related to inappropriate excision margins. The present study describes a method for decreasing the resection margin width and ensuring that the margins are adequate. This method was developed in the tibia, which is a common site for the most frequent primary bone sarcomas in children. Magnetic resonance imaging (MRI and computerized tomography (CT were used for preoperative planning to define the cutting planes for the tumors: each tumor was segmented on MRI, and the volume of the tumor was coregistered with CT. After preoperative planning, a surgical guide (patient-specific instrument that was fitted to a unique position on the tibia was manufactured by rapid prototyping. A second instrument was manufactured to adjust the bone allograft to fit the resection gap accurately. Pathologic evaluation of the resected specimens showed tumor-free resection margins in all four cases. The technologies described in this paper may improve the surgical accuracy and patient safety in surgical oncology. In addition, these techniques may decrease operating time and allow for reconstruction with a well-matched allograft to obtain stable osteosynthesis.

  7. UVB pretreatment of rat bone marrow allografts. Prevention of GVHD and induction of allochimerism and donor-specific unresponsiveness

    International Nuclear Information System (INIS)

    Chabot, J.A.; Pepino, P.; Wasfie, T.; Stegall, M.D.; Marboe, C.; Hardy, M.A.

    1990-01-01

    Ultraviolet B irradiation has been used to pretreat blood and islets to prevent subsequent graft rejection. In this study the optimal dose of UVB irradiation of bone marrow was determined in syngeneic recipients and was subsequently applied to in-vitro treatment of bone marrow allografts. UVB pretreatment of donor bone marrow inoculum led to complete prevention of GVHD in allogeneic rat recipients without major marrow or other toxicity. Long-standing recipients of allogeneic UVB-BM became stable adult chimeras. The recipients of allogeneic BM were populated by donor-type peripheral blood lymphocytes and did not reject host or donor-type heart grafts. The BM allograft recipients were immunocompetent as measured by their ability to normally reject third-party cardiac allografts. We suggest that the prevention of GVHD and induction of stable chimerism in adult recipients of allogeneic UVB-BM may be mediated by suppressor mechanisms

  8. Reconstruction of Chest Wall by Cryopreserved Sternal Allograft after Resection of Aneurysmal Bone Cyst of Sternum

    Directory of Open Access Journals (Sweden)

    Kambiz Sheikhy

    2017-01-01

    Full Text Available A 20-year-old female was referred to our hospital due to deformity and bulging in anterior aspect of chest wall in sternal area. Chest X-ray and CT scan confirmed a large mass with destruction of sternum. Pathologic diagnosis after incisional biopsy was compatible with aneurysmal bone cyst. We resected sternum completely and reconstructed large anterior defect by a cryopreserved sternal allograft. In follow-up of patient there was no unstability of chest wall with good cosmetic result.

  9. Benefits of mineralized bone cortical allograft for immediate implant placement in extraction sites: an in vivo study in dogs.

    Science.gov (United States)

    Orti, Valérie; Bousquet, Philippe; Tramini, Paul; Gaitan, Cesar; Mertens, Brenda; Cuisinier, Frédéric

    2016-10-01

    The aim of the present study was to evaluate the effectiveness of using a mineralized bone cortical allograft (MBCA), with or without a resorbable collagenous membrane derived from bovine pericardium, on alveolar bone remodeling after immediate implant placement in a dog model. Six mongrel dogs were included. The test and control sites were randomly selected. Four biradicular premolars were extracted from the mandible. In control sites, implants without an allograft or membrane were placed immediately in the fresh extraction sockets. In the test sites, an MBCA was placed to fill the gap between the bone socket wall and implant, with or without a resorbable collagenous membrane. Specimens were collected after 1 and 3 months. The amount of residual particles and new bone quality were evaluated by histomorphometry. Few residual graft particles were observed to be closely embedded in the new bone without any contact with the implant surface. The allograft combined with a resorbable collagen membrane limited the resorption of the buccal wall in height and width. The histological quality of the new bone was equivalent to that of the original bone. The MBCA improved the quality of new bone formation, with few residual particles observed at 3 months. The preliminary results of this animal study indicate a real benefit in obtaining new bone as well as in enhancing osseointegration due to the high resorbability of cortical allograft particles, in comparison to the results of xenografts or other biomaterials (mineralized or demineralized cancellous allografts) that have been presented in the literature. Furthermore, the use of an MBCA combined with a collagen membrane in extraction and immediate implant placement limited the extent of post-extraction resorption.

  10. Contemporary guided bone regeneration therapy for unaesthetic anterior peri-implantitis case

    Directory of Open Access Journals (Sweden)

    Benso Sulijaya

    2016-12-01

    Full Text Available Background: Dental implant is one of an alternative solutions reconstruction therapy for missing teeth. Complication of dental implant could occurs and leading to implant failure. In order to restore the complication, surgical treatment with guided bone regeneration (GBR is indicated. The potential use of bone substitutes is widely known to be able to regenerate the bone surrounding the implant and maintain bone volume. Purpose: The study aimed to demonstrate the effectiveness of implant-bone fully coverage by using sandwich technique of biphasic calcium phosphate (BCP and demineralized freeze-dried bone allografts (DFDBA bone substitutes combined with collagen resorbable membrane. Case: A 24-year-old male came with diagnosis of peri-implantitis on implant #11. Clinical finding indicated that implant thread was exposed on the labial aspect. Case management: After initial therapy including oral hygiene improvement performed, an operator did a contemporary GBR to correct the defect. Bone graft materials used were 40% β-tri calcium phosphate (β-TCP-60% hydroxyapatite (HA on the outer layer and DFDBA on the inner layer of the defect. Resorbable collagen membrane was used to cover the graft. Conclusion: GBR with sandwich technique could serve as one of the treatment choices for correcting an exposed anterior implant that would enhance the successful aesthetic outcome.

  11. Enhancement by dimethyl myleran of donor type chimerism in murine recipients of bone marrow allografts

    Energy Technology Data Exchange (ETDEWEB)

    Lapidot, T.; Terenzi, A.; Singer, T.S.; Salomon, O.; Reisner, Y. (Weizmann Institute of Science, Rehovot (Israel))

    1989-05-15

    A major problem in using murine models for studies of bone marrow allograft rejection in leukemia patients is the narrow margin in which graft rejection can be analyzed. In mice irradiated with greater than 9 Gy total body irradiation (TBI) rejection is minimal, whereas after administration of 8 Gy TBI, which spares a significant number of clonable T cells, a substantial frequency of host stem cells can also be detected. In current murine models, unlike in humans, bone marrow allograft rejection is generally associated with full autologous hematopoietic reconstitution. In the present study, we investigated the effect of the myeloablative drug dimethyl myleran (DMM) on chimerism status following transplantation of T cell-depleted allogenic bone marrow (using C57BL/6 donors and C3H/HeJ recipients, conditioned with 8 Gy TBI). Donor type chimerism 1 to 2 months post-transplant of 1 to 3 x 10(6) bone marrow cells was markedly enhanced by using DMM one day after TBI and prior to transplantation. Conditioning with cyclophosphamide instead of DMM, in combination with 8 Gy TBI, did not enhance engraftment of donor type cells. Artificial reconstitution of T cells, after conditioning with TBI plus DMM, by adding mature thymocytes, or presensitization with irradiated donor type spleen cells 1 week before TBI and DMM, led to strong graft rejection and consequently to severe anemia. The anti-donor responses in these models were proportional to the number of added T cells and to the number of cells used for presensitization, and they could be neutralized by increasing the bone marrow inoculum.

  12. Enhancement by dimethyl myleran of donor type chimerism in murine recipients of bone marrow allografts

    International Nuclear Information System (INIS)

    Lapidot, T.; Terenzi, A.; Singer, T.S.; Salomon, O.; Reisner, Y.

    1989-01-01

    A major problem in using murine models for studies of bone marrow allograft rejection in leukemia patients is the narrow margin in which graft rejection can be analyzed. In mice irradiated with greater than 9 Gy total body irradiation (TBI) rejection is minimal, whereas after administration of 8 Gy TBI, which spares a significant number of clonable T cells, a substantial frequency of host stem cells can also be detected. In current murine models, unlike in humans, bone marrow allograft rejection is generally associated with full autologous hematopoietic reconstitution. In the present study, we investigated the effect of the myeloablative drug dimethyl myleran (DMM) on chimerism status following transplantation of T cell-depleted allogenic bone marrow (using C57BL/6 donors and C3H/HeJ recipients, conditioned with 8 Gy TBI). Donor type chimerism 1 to 2 months post-transplant of 1 to 3 x 10(6) bone marrow cells was markedly enhanced by using DMM one day after TBI and prior to transplantation. Conditioning with cyclophosphamide instead of DMM, in combination with 8 Gy TBI, did not enhance engraftment of donor type cells. Artificial reconstitution of T cells, after conditioning with TBI plus DMM, by adding mature thymocytes, or presensitization with irradiated donor type spleen cells 1 week before TBI and DMM, led to strong graft rejection and consequently to severe anemia. The anti-donor responses in these models were proportional to the number of added T cells and to the number of cells used for presensitization, and they could be neutralized by increasing the bone marrow inoculum

  13. Repopulation of Intrasynovial Flexor Tendon Allograft with Bone Marrow Stromal Cells: An Ex Vivo Model

    Science.gov (United States)

    Amadio, Peter C.; Thoreson, Andrew R.; An, Kai-Nan

    2014-01-01

    Purpose: Delayed healing is a common problem whenever tendon allografts are used for tendon or ligament reconstruction. Repopulating the allograft with host cells may accelerate tendon regeneration, but cell penetration into the allograft tendon is limited. Processing the tendon surface with slits that guide cells into the allograft substrate may improve healing. The purpose of this study was to describe a surface modification of allograft tendon that includes slits to aid cell repopulation and lubrication to enhance tendon gliding. Methods: Canine flexor digitorum profundus tendons were used for this study. Cyclic gliding resistance was measured over 1000 cycles. Tensile stiffness was assessed for normal tendon, tendon decellularized with trypsin and Triton X-100 (decellularized group), tendon decellularized and perforated with multiple slits (MS group) and tendon decellularized, perforated with slits and treated with a carbodiimide-derivatized hyaluronic acid and gelatin (cd-HA-gelatin) surface modification (MS-SM group). To assess tendon repopulation, bone marrow stromal cells (BMSCs) were used in the decellularized and MS groups. DNA concentration and histology were evaluated and compared to normal tendons and nonseeded decellularized tendons. Results: The gliding resistance of the decellularized and MS groups was significantly higher compared with the normal group. There was no significant difference in gliding resistance between the decellularized and MS group. Gliding resistance of the normal group and MS-SM group was not significantly different. The Young's modulus was not significantly different among the four groups. The DNA concentration in the MS group was significantly lower than in normal tendons, but significantly higher than in decellularized tendons, with or without BMSCs. Viable BMSCs were found in the slits after 2 weeks in tissue culture. Conclusions: Tendon slits can successfully harbor BMSCs without compromising their survival and without

  14. Pullout strength of bone-patellar tendon-bone allograft bone plugs: a comparison of cadaver tibia and rigid polyurethane foam.

    Science.gov (United States)

    Barber, F Alan

    2013-09-01

    To compare the load-to-failure pullout strength of bone-patellar tendon-bone (BPTB) allografts in human cadaver tibias and rigid polyurethane foam blocks. Twenty BPTB allografts were trimmed creating 25 mm × 10 mm × 10 mm tibial plugs. Ten-millimeter tunnels were drilled in 10 human cadaver tibias and 10 rigid polyurethane foam blocks. The BPTB anterior cruciate ligament allografts were inserted into these tunnels and secured with metal interference screws, with placement of 10 of each type in each material. After preloading (10 N), cyclic loading (500 cycles, 10 to 150 N at 200 mm/min) and load-to-failure testing (200 mm/min) were performed. The endpoints were ultimate failure load, cyclic loading elongation, and failure mode. No difference in ultimate failure load existed between grafts inserted into rigid polyurethane foam blocks (705 N) and those in cadaver tibias (669 N) (P = .69). The mean rigid polyurethane foam block elongation (0.211 mm) was less than that in tibial bone (0.470 mm) (P = .038), with a smaller standard deviation (0.07 mm for foam) than tibial bone (0.34 mm). All BPTB grafts successfully completed 500 cycles. The rigid polyurethane foam block showed less variation in test results than human cadaver tibias. Rigid polyurethane foam blocks provide an acceptable substitute for human cadaver bone tibia for biomechanical testing of BPTB allografts and offer near-equivalent results. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  15. The Use of Cryopreserved Human Skin Allograft for the Treatment of Wounds With Exposed Muscle, Tendon, and Bone.

    Science.gov (United States)

    Wilson, Thomas C; Wilson, Jessica A; Crim, Brandon; Lowery, Nicholas J

    2016-04-01

    Wounds with exposed bone or tendon continue to be a challenge for wound care physicians, and there is little research pertaining to the treatment of these particular wounds with allograft skin. The purpose of this study was to evaluate the effectiveness and safety of a biologically active cryopreserved human skin allograft for treating wounds with exposed bone and/or tendon in the lower extremities. Fifteen patients with 15 wounds at a single hospital-based wound care center were included in the study. Eleven wounds had exposed bone, 1 wound had exposed ten- don, and 3 wounds had exposed bone and tendon. Standard treatment principles with adjunctive cadaveric allograft application were performed on all wounds in the study. In this study 14/15 (93.3%) of the wounds healed completely. The mean duration of days until coverage of the bone and/or tendon with granulation tissue was 36.14 (5.16 weeks) (range 5-117 days). Mean duration to complete healing of the wound was 133 days (19 weeks) (range 53-311 days). The mean number of grafts applied was 2. There were no adverse events directly related to the graft. Zero major amputations and 1 minor amputation occurred. This study found biologically active cryopreserved human skin allografts to be safe and effective in treating difficult wounds with exposed bone and/or tendon. To the authors' knowledge, this is the largest study to date focused on the utilization of allograft skin as an adjunct therapy for lower extremity wounds with exposed tendon and/or bone.

  16. Quality control and quality standards for the production of bone allografts in China

    International Nuclear Information System (INIS)

    Sun Shiquan; Li Youchen

    1999-01-01

    There is a rapid progress of tissue banking especially Bone Banking in China, In order to strengthen the control on medical devices, Ministry of Public Health (MPH) issued the 'Regulation on Supervision of Critical Medical Devices, MPH Decree No. 54' in 1997. The SPTB was requested to submit new application for the approval of production and providing of tissue allografts. The needed documents are clinical reports, package insert, quality standards of product, Quality System Regulation (QSR) and audit report. Quality System Regulation document adopted the GMP standard for medical devices of FDA, US (21 CFR 620-1997). SPTB will amend the existed Quality Manual to suit the requirement of QSR. Referring to the AATB Standards, SPTB established 'Technical Standards' for Tissue Banking and was approved by the local government, which will be the supplement of the submitted QSR document. Considering the need of market control, MPH requested to submit a 'Quality Standard of Product' and the method of inspection. SPTB has completed such standards for final inspection of bone products, which includes the test for residual water, microbiology, bone species, colour and structure. In addition, the Tissue Bank has completed standards for in process inspection, which includes residual blood, radiation sterilization, initial bioburden, package leakage and biomechanics. In-process inspection is important for the control of non-conforming final products to assure the safety and efficacy of bone grafts. Methods of in process inspection and final inspection are described and discussed in this paper

  17. Prolonging survival in vascularized bone allograft transplantation: developing specific immune unresponsiveness

    International Nuclear Information System (INIS)

    Paskert, J.P.; Yaremchuk, M.J.; Randolph, M.A.; Weiland, A.J.

    1987-01-01

    Vascularized bone allografts (VBAs) could be useful adjuncts to the clinical reconstructive surgeon's arsenal. These grafts are known experimentally to be subject to host rejection. One way to control the rejection problem would be to develop specific immune unresponsiveness via host conditioning. Using a proven reliable model in inbred rats for studying heterotopic VBA transplantation, recipient animals were conditioned preoperatively with third-party unrelated blood, donor-specific blood (DSB) alone and with cyclosporine, and ultraviolet irradiated donor-specific blood. The combination of DSB plus cyclosporine delayed rejection of grafts across a strong histocompatibility barrier for three to four weeks. However, rejection was delayed across a weak histocompatibility barrier for five to six weeks using this same host pretreatment. The implications are that specific immunosuppression, although possible, is difficult to achieve in VBA transplantation, and that such techniques will rely on tissue-matching to minimize the genetic disparity between graft and host

  18. Teriparatide attenuates scarring around murine cranial bone allograft via modulation of angiogenesis.

    Science.gov (United States)

    Cohn Yakubovich, Doron; Eliav, Uzi; Yalon, Eran; Schary, Yeshai; Sheyn, Dmitriy; Cook-Wiens, Galen; Sun, Shuting; McKenna, Charles E; Lev, Shaya; Binshtok, Alexander M; Pelled, Gadi; Navon, Gil; Gazit, Dan; Gazit, Zulma

    2017-04-01

    Nearly all bone fractures in humans can deteriorate into a non-union fracture, often due to formation of fibrotic tissue. Cranial allogeneic bone grafts present a striking example: although seemingly attractive for craniofacial reconstructions, they often fail due to fibrosis at the host-graft junction, which physically prevents the desired bridging of bone between the host and graft and revitalization of the latter. In the present study we show that intermittent treatment with recombinant parathyroid hormone-analogue (teriparatide) modulates neovascularization feeding in the graft surroundings, consequently reducing fibrosis and scar tissue formation and facilitates osteogenesis. Longitudinal inspection of the vascular tree feeding the allograft has revealed that teriparatide induces formation of small-diameter vessels in the 1st week after surgery; by the 2nd week, abundant formation of small-diameter blood vessels was detected in untreated control animals, but far less in teriparatide-treated mice, although in total, more blood capillaries were detected in the animals that were given teriparatide. By that time point we observed expression of the profibrogenic mediator TGF-β in untreated animals, but negligible expression in the teriparatide-treated mice. To evaluate the formation of scar tissue, we utilized a magnetization transfer contrast MRI protocol to differentiate osteoid tissue from scar tissue, based on the characterization of collagen fibers. Using this method we found that significantly more bone matrix was formed in animals given teriparatide than in control animals. Altogether, our findings show how teriparatide diminishes scarring, ultimately leading to superior bone graft integration. Copyright © 2017. Published by Elsevier Inc.

  19. Histologic healing following tooth extraction with ridge preservation using mineralized versus combined mineralized-demineralized freeze-dried bone allograft: a randomized controlled clinical trial.

    Science.gov (United States)

    Borg, Tyler D; Mealey, Brian L

    2015-03-01

    Mineralized and demineralized freeze-dried bone allografts (FDBAs) are used in alveolar ridge (AR) preservation; however, each material has advantages and disadvantages. Combinations of allografts aimed at capitalizing on the advantages each offers are available. To date, there is no evidence to indicate if a combination allograft is superior in this application. The primary objective of this study is to histologically evaluate and compare healing of non-molar extraction sites grafted with either mineralized FDBA or a 70:30 mineralized:demineralized FDBA combination allograft in AR preservation. The secondary objective is to compare dimensional changes in ridge height and width after grafting with these two materials. Forty-two patients randomized into two equal groups received ridge preservation with either 100% mineralized FDBA (active control group) or the combination 70% mineralized: 30% demineralized allograft (test group). Sites were allowed to heal for 18 to 20 weeks, at which time core biopsies were obtained and dental implants were placed. AR dimensions were evaluated at the time of extraction and at implant placement, including change in ridge width and change in buccal and lingual ridge height. Histomorphometric analysis was performed to determine percentage of vital bone, residual graft, and connective tissue/other non-bone components. There was no significant difference between groups in AR dimensional changes. Combination allograft produced increased vital bone percentage (36.16%) compared to the FDBA group (24.69%; P = 0.0116). The combination allograft also had a significantly lower mean percentage of residual graft particles (18.24%) compared to FDBA (27.04%; P = 0.0350). This study provides the first histologic evidence showing greater new bone formation with a combination mineralized/demineralized allograft compared to 100% mineralized FDBA in AR preservation in humans. Combination allograft results in increased vital bone formation while

  20. Early detection of femoral head avascular necrosis by bone SPECT compared to MRI in renal allograft recipients

    International Nuclear Information System (INIS)

    Kang, Do Young; Yang, Seoung Oh; Lee, Hee Kyung; Han, Duck Jong; Shin, Myung Jin

    1997-01-01

    The prevalence of avascular necrosis (AVN) of femoral head in patients who receive immunosuppresive agents after renal transplantation is reported to be 4-29%. Among patients who develop AVN after renal transplantation, 80% become symptomatic within 2 years after transplantation. As the number of renal transplantation has been increased recently, early detection of femoral head AVN is very important because early surgical core decompression of femoral head can prevent collapse of the head. MRI is known to be very sensitive to diagnose femoral head AVN. However in three cases we report here, bone SPECT showed early changes of femoral head AVN, whereas MRI showed no specific abnormality. Case 1. A 53-year-old female received an allograft kidney transplantation in 1994. Preoperative bone scan was normal. She complained of both hip pain on Mar. 18 1997. Bone SPECT showed cold defect in both femoral heads but MRI showed no abnormality. After 3 months, bone SPECT and MRI showed AVN of both femoral heads. She underwent bilateral total hip replacement arthroplasty. AVN of femoral heads was confirmed by microscopic examination. Case 2. A 38-year-old female received an allograft kidney transplantation in Feb. 27 1997. Preoperative bone scan was normal. She ran a fever and creatinine was elevated from 1.2 to 2.8 mg/dL. She took high dose methylprednisolone therapy for acute reanl rejection. After two days, she complained pain in both hip joints and knee joints. Bone SPECT showed cold defects in both femoral heads but MRI showed no abnormality. A follow-up bone SPECT and MRI 20 days later revealed AVN of both femoral heads. Case 3. A 50-year-old male received an allograft kidney transplantation on Jul. 12 1995. Preoperative bone scan was normal. He complained of right hip pain on Jul, 26 1995. His bone SPECT showed cold defects in both femoral heads while MRI showed only minimal hip joint effusion. He also complained of left hip pain on Oct. 2 1995. He was admitted on Mar 17

  1. Early detection of femoral head avascular necrosis by bone SPECT compared to MRI in renal allograft recipients

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Do Young; Yang, Seoung Oh; Lee, Hee Kyung; Han, Duck Jong; Shin, Myung Jin [Asan Mecical Center, Seoul (Korea, Republic of)

    1997-07-01

    The prevalence of avascular necrosis (AVN) of femoral head in patients who receive immunosuppresive agents after renal transplantation is reported to be 4-29%. Among patients who develop AVN after renal transplantation, 80% become symptomatic within 2 years after transplantation. As the number of renal transplantation has been increased recently, early detection of femoral head AVN is very important because early surgical core decompression of femoral head can prevent collapse of the head. MRI is known to be very sensitive to diagnose femoral head AVN. However in three cases we report here, bone SPECT showed early changes of femoral head AVN, whereas MRI showed no specific abnormality. Case 1. A 53-year-old female received an allograft kidney transplantation in 1994. Preoperative bone scan was normal. She complained of both hip pain on Mar. 18 1997. Bone SPECT showed cold defect in both femoral heads but MRI showed no abnormality. After 3 months, bone SPECT and MRI showed AVN of both femoral heads. She underwent bilateral total hip replacement arthroplasty. AVN of femoral heads was confirmed by microscopic examination. Case 2. A 38-year-old female received an allograft kidney transplantation in Feb. 27 1997. Preoperative bone scan was normal. She ran a fever and creatinine was elevated from 1.2 to 2.8 mg/dL. She took high dose methylprednisolone therapy for acute reanl rejection. After two days, she complained pain in both hip joints and knee joints. Bone SPECT showed cold defects in both femoral heads but MRI showed no abnormality. A follow-up bone SPECT and MRI 20 days later revealed AVN of both femoral heads. Case 3. A 50-year-old male received an allograft kidney transplantation on Jul. 12 1995. Preoperative bone scan was normal. He complained of right hip pain on Jul, 26 1995. His bone SPECT showed cold defects in both femoral heads while MRI showed only minimal hip joint effusion. He also complained of left hip pain on Oct. 2 1995. He was admitted on Mar 17

  2. Histologic and tomographic findings of bone block allografts in a 4 years follow-up: a case series

    Energy Technology Data Exchange (ETDEWEB)

    Deluiz, Daniel; Pires, Fabio Ramoa; Tinoco, Justine Monnerat; Tinoco, Eduardo Muniz Barretto [Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ (Brazil); Oliveira, Luciano Santos, E-mail: d.deluiz@implanto-puc.org [Pontificia Universidade Catolica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ (Brazil); Fletcher, Paul [Department of Periodontology, Columbia University College of Dental Medicine, New York, NY (United States)

    2016-11-15

    The aim of this paper is to report histologic and tomographic findings of fresh frozen bone block allografts bearing dental implants in functional occlusion in a long-term follow-up. Four patients with implants functionally loaded for 4 years on augmented ridges requiring additional mucogingival surgery or implant placement were included in this case series. Cone-beam tomography scans were compared volumetrically between the baseline (first implant placement) and current images. Biopsies of the grafts were retrieved and sent to histological analysis. Volumetric reduction of the grafts varied from 2.1 to 7.7%. Histological evaluation demonstrated well-incorporated grafts with different degrees of remodeling. While data presented in this report are from a small sample size and do not allow definitive conclusions, the biopsies of the grafted sites were very similar to the host's native bone. Remodeling of the cortical portion of the allografts seems to take longer than the cancellous portion. The presence of unincorporated graft remains did not impair the implant success or the health of the surrounding tissues. This is the first time histologic and tomographic long term data of bone allograft have been made available in dentistry. (author)

  3. Age-related new bone formation following the use of cancellous bone-block allografts for reconstruction of atrophic alveolar ridges.

    Science.gov (United States)

    Nissan, Joseph; Kolerman, Roni; Chaushu, Liat; Vered, Marilena; Naishlos, Sarit; Chaushu, Gavriel

    2018-02-01

    An age-related decrease in the number of osteogenic progenitor cells may compromise bone augmentation. Histomorphometrical assessment of age-related new bone formation, following atrophic alveolar ridge reconstruction, using cancellous bone-block allografts. Ninety-three consecutive patients (58 females and 35 males) were referred for implant-supported restoration of 122 severe atrophic alveolar ridges. Alveolar ridge deficiency locations were classified as anterior maxilla (n = 58), posterior maxilla (n= 32), and posterior mandible (n = 32). A bony deficiency of at least 3 mm horizontally and up to 3 mm vertically according to computerized tomography (CT) in the posterior mandible and anterior maxilla, served as inclusion criteria. In the posterior maxilla, a residual alveolar ridge up to 4 mm vertically according to CT served as inclusion criteria. Augmentation was performed by the use of cancellous bone-block allografts. Bone biopsies (9-month posterior maxilla, 4 months anterior maxilla and posterior mandible) of young (≤40 years) versus older (>40 years) patients were histomorphometrically evaluated. In the posterior maxilla, no statistically significant histomorphometric differences were noted. While at the anterior maxilla and posterior mandible, statistically significant more newly formed bone was found in young versus older individuals, respectively (38.6% vs 19.8%, P = 0.04 and 69% vs 31%, P = .05). New bone formation following residual alveolar ridge bone grafting is age-related. Longer bone consolidation and healing time may be recommended for older individuals. © 2017 Wiley Periodicals, Inc.

  4. Microarchitecture of the Augmented Bone Following Sinus Elevation with an Albumin Impregnated Demineralized Freeze-Dried Bone Allograft (BoneAlbumin versus Anorganic Bovine Bone Mineral: A Randomized Prospective Clinical, Histomorphometric, and Micro-Computed Tomography Study

    Directory of Open Access Journals (Sweden)

    Kivovics Márton

    2018-01-01

    Full Text Available Serum albumin has been identified as an endogenous protein that is integral to early bone regeneration. We hypothesized that albumin addition to allografts may result in better bone remodeling than what can be achieved with anorganic xenografts. Sinus elevations were performed at 32 sites of 18 patients with the lateral window technique. Sites either received filling with an anorganic bovine bone mineral (ABBM, BioOss, Geistlich, CH or albumin impregnated allograft (BoneAlbumin, OrthoSera, AT. After 6-months patients received dental implants and 16 bone core biopsy samples were obtained from the ABBM filled, and 16 from the BoneAlbumin augmented sites. The biopsies were examined by histomorphometry and µCT. Percentage of the residual graft in the BoneAlbumin group was 0–12.7%, median 5.4% vs. ABBM 6.3–35.9%, median 16.9%, p < 0.05. Results of the µCT analysis showed that the microarchitecture of the augmented bone in the BoneAlbumin group resembles that of the native maxilla in morphometric parameters Trabecular Pattern Factor and Connectivity. Our data show that while ABBM successfully integrates into the newly formed bone tissue as persisting particles, BoneAlbumin is underway towards complete remodeling with new bone closely resembling that of the intact maxilla.

  5. Enhancing pedicle screw fixation in the lumbar spine using allograft bone plug interference fixation.

    Science.gov (United States)

    Chrea, Bopha; Malempati, Harsha; Campbell, Jeffrey R; Khan, Sonja; Ching, Randal P; Lee, Michael J

    2014-05-01

    A within-subjects controlled laboratory study. To examine a biological alternative to cement augmentation for pedicle screw fixation comparing bilateral axial pullout tests of augmented and nonaugmented (controls) pedicle screws. Fixation in the osteoporotic spine remains a difficult challenge with failure by loosening or backout. Pedicle screw augmentation has been attempted using polymethylmethacrylate and bioabsorbable calcium cements; however, the potential for extravasation and embolization of cement are becoming increasingly concerning and merit the search for alternative methods to improve screw-anchoring strength. Twenty-four (24) fresh human lumbar vertebrae were tested to compare the pullout strength of augmented and nonaugmented pedicle screws. Two different augmentation strategies were employed using allograft bone plugs (ABPs) and evaluated using 12 specimens per group. Bone mineral density of each specimen was obtained using dual-energy x-ray absorptiometry. The augmented versus nonaugmented pedicle was randomized for each vertebra, and bilateral testing enabled paired statistical analyses. Axial pullout tests were performed using an materials testing system servohydraulic test system, and peak force, failure displacement, and stiffness was obtained for each test and correlated with bone mineral density. Augmentation using 6-mm-diameter ABPs with 6.25-mm-diameter pedicle screws resulted in statistically weaker average pullout strength (775±455 N) than the nonaugmented controls (1233±826 N). When using smaller (5 mm diameter) AGPs with the same diameter screws, there was no statistical difference between average pullout strength for the augmented pedicle screws (1772±652 N) and the nonaugmented screws (1780±575 N). Preliminary study of pedicle screw augmentation using cannulated ABPs showed no improvement of fixation with pedicles in the spine. This was even true in osteoporotic specimens, where augmentation would seem to be of considerable benefit.

  6. The use of bone block allografts in sinus augmentation, followed by delayed implant placement: A case series

    Directory of Open Access Journals (Sweden)

    Eurico D Aloja

    2013-01-01

    Full Text Available Purpose: This article reports the clinical outcomes observed in a large number of patients receiving block bone allograft used for sinus augmentation and delayed implant placement. Patients and Methods: In total, 28 patients (13 males with a mean age of 49.8 ± 10.1 years (range: 33-67 years were included in this case series. All selected patients suffered from severe alveolar ridge atrophy in the posterior maxilla and required bone augmentation procedures, followed by implant placement after 6 months. All patients were followed for 18 months after the grafting, with scheduled monthly visits and/or more frequent visits if required. The survival rates for both the bone blocks and placed implants were then evaluated. Results: A total of 42 blocks and 90 implants were placed. Only one bone graft and 5 implants failed; the survival rate was 97.2% and 95.5% for the bone grafts and implants, respectively. The graft failed due to the onset of post-surgical infectious sinusitis, while in some patients′ implants showed absence of osteointegration at the end of the healing phase. Of note, all failed implants were observed in heavy smokers; in all other patients, blocks and implants were successful. Conclusions: This preliminary case series suggests that the grafting of bone allograft followed by delayed implant placement may be a promising strategy for sinus augmentation. More extended and larger follow-up studies are needed to confirm this preliminary data.

  7. No red cell alloimmunization or change of clinical outcome after using fresh frozen cancellous allograft bone for acetabular reconstruction in revision hip arthroplasty: a follow up study

    Directory of Open Access Journals (Sweden)

    Mittag Falk

    2012-09-01

    Full Text Available Abstract Background Possible immunization to blood group or other antigens and subsequent inhibition of remodeling or incorporation after use of untreated human bone allograft was described previously. This study presents the immunological, clinical and radiological results of 30 patients with acetabular revisions using fresh frozen non-irradiated bone allograft. Methods AB0-incompatible (donor-recipient bone transplantation was performed in 22 cases, Rh(D incompatible transplantation in 6 cases. The mean follow up of 23 months included measuring Harris hip score and radiological examination with evaluation of remodeling of the bone graft, implant migration and heterotopic ossification. In addition, all patients were screened for alloimmunization to Rh blood group antigens. Results Compared to the whole study group, there were no differences in clinical or radiological measurements for the groups with AB0- or Rh(D-incompatible bone transplantation. The mean Harris Hip Score was 80.6. X-rays confirmed total remodeling of all allografts with no acetabular loosening. At follow up, blood tests revealed no alloimmunization to Rh blood group donor antigens. Conclusions The use of fresh frozen non-irradiated bone allograft in acetabular revision is a reliable supplement to reconstruction. The risk of alloimmunization to donor-blood group antigens after AB0- or Rh-incompatible allograft transplantation with a negative long-term influence on bone-remodeling or the clinical outcome is negligible.

  8. Remodeling of cortical bone allografts mediated by adherent rAAV-RANKL and VEGF gene therapy

    DEFF Research Database (Denmark)

    Ito, Hiromu; Koefoed, Mette; Tiyapatanaputi, Prarop

    2005-01-01

    Structural allograft healing is limited because of a lack of vascularization and remodeling. To study this we developed a mouse model that recapitulates the clinical aspects of live autograft and processed allograft healing. Gene expression analyses showed that there is a substantial decrease in ...

  9. Safety and effectiveness of bone allografts in anterior cervical discectomy and fusion surgery.

    Science.gov (United States)

    Miller, Larry E; Block, Jon E

    2011-11-15

    Systematic review. The primary aim of this review was to evaluate clinical and radiographic outcomes in studies of anterior cervical discectomy and fusion (ACDF) using allograft versus ACDF with autograft, ACDF with cage devices, and cervical disc arthroplasty for the treatment of symptomatic cervical disc disease. ACDF remains the standard of care for patients with cervical radiculopathy who are unresponsive to conservative medical care. However, no known study has compared patient outcomes after ACDF with allograft, ACDF with autograft, ACDF with cage, and disc arthroplasty. After applying strict inclusion criteria, 21 comparisons from 20 studies formed the basis for this review. Patient outcomes included neck and arm pain, neck disability index (NDI), physical component summary (PCS), and mental component summary (MCS) scores from the SF-36, radiographic fusion rate, and select adverse events (e.g., wound infection, dysphagia, and adjacent segment degeneration). The four treatment groups included ACDF with allograft (allograft, n = 1341), ACDF with autograft (autograft, n = 568), ACDF with cage (cage, n = 87), and cervical disc arthroplasty (arthroplasty, n = 603). Neck pain was reduced similarly by 63% to 69% in all groups. Comparable improvements were realized in arm pain after ACDF with allograft (75%) or arthroplasty (73%) that were greater than other treatment groups (62-68%). There was notable improvement in neck disability (61-65%) with allograft and arthroplasty after treatment. PCS scores improved with allograft (42%) and arthroplasty (44%). MCS scores improved modestly (16-21%) with allograft and arthroplasty. Fusion rates were 91% for allograft and autograft and 97% for cage. Adverse events were uncommon in all groups. ACDF with allograft, ACDF with autograft, ACDF with cage, and cervical disc arthroplasty show similar improvements in pain, function, and quality of life with correspondingly low adverse event rates. All ACDF procedures result in high

  10. Revision Anterior Cruciate Ligament Reconstruction: Results of a Single-stage Approach Using Allograft Dowel Bone Grafting for Femoral Defects.

    Science.gov (United States)

    Werner, Brian C; Gilmore, Carl J; Hamann, Joshua C; Gaskin, Cree M; Carroll, John J; Hart, Joseph M; Miller, Mark D

    2016-08-01

    The purpose of this study was to present results of single-stage revision anterior cruciate ligament (ACL) reconstruction using an allograft bone dowel for isolated femoral bony deficiency. Sixteen patients underwent single-stage revision ACL reconstruction using an allograft bone dowel for isolated femoral bony deficiency between 2007 and 2012. Twelve patients (75%) completed study visits, which included CT scans as well as completion of validated outcomes measures. The average KT-1000 side-to-side difference was 1.0 mm ± 2.9 mm. The average International Knee Documentation Committee score was 70.2 ± 17.8, the Tegner score was 4.8 ± 2.8, and the visual analog scale pain score was 2.8 ± 2.4. An analysis of CT scans showed that all 12 dowels had excellent (>75%) incorporation. A single-stage approach for revision ACL reconstruction using allograft dowels for isolated femoral bony deficiency yields objective and subjective outcomes comparable to those reported in the literature for two-stage and other single-stage techniques, with good incorporation of the dowels. Retrospective case series, level IV.

  11. Alveolar Ridge Preservation After Tooth Extraction with DFDBA and Platelet Concentrates: A Radiographic Retrospective Study.

    Science.gov (United States)

    Baniasadi, Behrang; Evrard, Laurence

    2017-01-01

    The purpose of this study was to evaluate vertical alveolar bone loss 3 months after tooth extraction when a technique of ridge preservation was applied using a particulate demineralized freeze-dried bone allograft 300 - 500 µm associated with platelet concentrates (platelet-rich-fibrin) in the form of gel and membranes. A retrospective radiological clinical study was conducted on 56 patients for whom 95 extractions had been performed immediately followed by alveolar filling. Among the patients, 17 were smokers and 16 were provided with an immediate removable temporary prosthesis after extractions. Vertical bone loss was measured radiologically by panoramic X-ray before extractions and by a computed tomography scan 3 months after, at the level of mid-buccal bone wall, by two independent observers. For statistical analysis, Student's t-test was performed to compare the mean bone loss between mono- and pluri-radicular teeth and to compare the mean bone loss between tobacco users versus non users and finally to compare the mean bone loss between individuals that had provisional removable prosthesis and those that had not. Three months after tooth extraction, the mean of vertical loss of the mid-buccal bone wall was 0.72 (SD 0.71) mm (5.53% SD 5.19). No significant difference between bone loss at mono-radicular and pluri-radicular teeth (P = 0.982) was observed. There was no significant correlation between tobacco habits and bone loss (P = 0.2), nor between provisional removable prosthesis and bone loss (P = 0.786). These results indicate a good potential for the technique using Demineralized Freeze-Dried Bone Allograft 300 - 500 µm and platelet concentrates in alveolar bone preservation.

  12. A biomechanical assessment of superior shoulder translation after reconstruction of anterior glenoid bone defects: The Latarjet procedure versus allograft reconstruction.

    Science.gov (United States)

    Degen, Ryan M; Giles, Joshua W; Boons, Harm W; Litchfield, Robert B; Johnson, James A; Athwal, George S

    2013-01-01

    The coracoacromial ligament (CAL) is an important restraint to superior shoulder translation. The effect of CAL release on superior stability following the Latarjet is unknown; therefore, our purpose was to compare the effect of two Latarjet techniques and allograft reconstruction on superior instability. Eight cadaveric specimens were tested on a simulator. Superior translation was monitored following an axial force in various glenohumeral rotations (neutral, internal, and external) with and without muscle loading. Three intact CAL states were tested (intact specimen, 30% glenoid bone defect, and allograft reconstruction) and two CAL deficient states (classic Latarjet (classicLAT) and congruent-arc Latarjet (congruentLAT)). In neutral without muscle loading, a significant increase in superior translation occurred with the classicLAT as compared to 30% defect (P = 0.046) and allograft conditions (P = 0.041). With muscle loading, the classicLAT (P = 0.005, 0.002) and the congruentLAT (P = 0.018, 0.021) had significantly greater superior translation compared to intact and allograft, respectively. In internal rotation, only loaded tests produced significant results; specifically, classicLAT increased translation compared to all intact CAL states (P 0.05) and no differences (P = 1.0) were found between classicLAT and congruentLAT. In most simulations, CAL release with the Latarjet lead to increased superior humeral translation. The choice of technique for glenoid bone loss reconstruction has implications on the magnitude of superior humeral translation. This previously unknown effect requires further study to determine its clinical and kinematic outcomes.

  13. Assay method for polymer-controlled antibiotic release from allograft bone to target orthopaedic infections - biomed 2010.

    Science.gov (United States)

    Sevy, Justin O; Slawson, Matthew H; Grainger, David W; Brooks, Amanda E

    2010-01-01

    To mitigate and circumvent orthopaedic-associated infection, systematic oral and parenteral antibiotic therapy is often used; however, efficacy is limited due to dosing, systemic side-effects, patient compliance, effective delivery, treatment length, and resistant bacteria. A more effective method may be sustained local drug delivery of antibiotics at the wound site, using delivery vehicles that control release rates. In the case of bone for example, this could be clinically familiar bone graft. Unfortunately, without a rate-control strategy, local antibiotic delivery from allograft displays a prominent burst release: a large amount of drug payload is released as a bolus within 72 hours and depleted. Although his offers effective immediate killing, persitor bacteria remain an infection risk. Notably, drug resistance is a problem at reduced antibiotic levels. To allow better local dosing modulation, a degradable polycaprolactone (PCL) polymer allograft coating is used to modulate local delivery of the antibiotic, tobramycin. This polymer/antibiotic hybrid coats the porous structure of the cancellous bone graft, providing a substantial drug reservoir and allowing controlled release of antibiotic over extended time. PCL/tobramycin-coated bone fragments of different PCL molecular weights and variable drug loads are assayed in vitro for drug release. Tobramycin concentration is determined based on derivatization of its 5 primary amine groups with a fluorescent reagent, phthaldialdehyde (OPA). Tobramycin concentrations in release media can be calculated based on a standard curve with a reasonable accuracy and dynamic range.

  14. Comparison of the capacity of enamel matrix derivative gel and enamel matrix derivative in liquid formulation to adsorb to bone grafting materials.

    Science.gov (United States)

    Miron, Richard J; Bosshardt, Dieter D; Buser, Daniel; Zhang, Yufeng; Tugulu, Stefano; Gemperli, Anja; Dard, Michel; Caluseru, Oana M; Chandad, Fatiha; Sculean, Anton

    2015-04-01

    The use of an enamel matrix derivative (EMD) has been shown to enhance periodontal regeneration (e.g., formation of root cementum, periodontal ligament, and alveolar bone). However, in certain clinical situations, the use of EMD alone may not be sufficient to prevent flap collapse or provide sufficient stability of the blood clot. Data from clinical and preclinical studies have demonstrated controversial results after application of EMD combined with different types of bone grafting materials in periodontal regenerative procedures. The aim of the present study is to investigate the adsorption properties of enamel matrix proteins to bone grafts after surface coating with either EMD (as a liquid formulation) or EMD (as a gel formulation). Three different types of grafting materials, including a natural bone mineral (NBM), demineralized freeze-dried bone allograft (DFDBA), or a calcium phosphate (CaP), were coated with either EMD liquid or EMD gel. Samples were analyzed by scanning electron microscopy or transmission electron microscopy (TEM) using an immunostaining assay with gold-conjugated anti-EMD antibody. Total protein adsorption to bone grafting material was quantified using an enzyme-linked immunosorbent assay (ELISA) kit for amelogenin. The adsorption of amelogenin to the surface of grafting material varied substantially based on the carrier system used. EMD gel adsorbed less protein to the surface of grafting particles, which easily dissociated from the graft surface after phosphate-buffered saline rinsing. Analyses by TEM revealed that adsorption of amelogenin proteins were significantly farther from the grafting material surface, likely a result of the thick polyglycolic acid gel carrier. ELISA protein quantification assay demonstrated that the combination of EMD liquid + NBM and EMD liquid + DFDBA adsorbed higher amounts of amelogenin than all other treatment modalities. Furthermore, amelogenin proteins delivered by EMD liquid were able to penetrate the

  15. The use of allograft bone during the course of femoral reconstruction in hip revision arthroplasty

    International Nuclear Information System (INIS)

    David, A.; Morgan, F.; Imran Ilyas

    1999-01-01

    We have studied 61 patients who underwent femoral revision surgery requiring allograft reconstruction of the skeleton between 1987 and 1995. The group had a mean age of 68 years with a mean follow-up of 5.1 years. The preoperative Harris hip score was increased from 30 points to a postoperative score of 69 points. A rerevision rate of 20% was noted. Segmental anomalies were classified according to the American Academy of Orthopaedic Surgeons system. Subgroups were analysed according to the classification and relative indications for the use of impaction allografting, corticocancellous strut grafting, anatomic specific allografts and calcar allografts were devised. This paper details the results of those subgroups and outlines pitfalls and problems associated with complex surgery of this type

  16. In vitro comparison of the efficacy of TGF-β1 and PDGF-BB in combination with freeze-dried bone allografts for induction of osteogenic differentiation in MG-63 osteoblast-like cells.

    Science.gov (United States)

    Vahabi, Surena; Torshabi, Maryam; Esmaeil Nejad, Azadeh

    2016-12-01

    Predictable regeneration of alveolar bone defects has always been a challenge in implant dentistry. Bone allografts are widely used bone substitutes with controversial osteoinductive activity. This in vitro study aimed to assess the osteogenic potential of some commercially available freeze-dried bone allografts supplemented with human recombinant platelet-derived growth factor-BB and transforming growth factor beta-1. Cell viability, mineralization, and osteogenic gene expression of MG-63 osteoblast-like cells were compared among the allograft alone, allograft/platelet-derived growth factor-BB, allograft/transforming growth factor beta-1, and allograft/platelet-derived growth factor-BB/transforming growth factor beta-1 groups. The methyl thiazol tetrazolium assay, real-time quantitative reverse transcription polymerase chain reaction and alizarin red staining were performed, respectively, for assessment of cell viability, differentiation, and mineralization at 24-72 h post treatment. The allograft with greater cytotoxic effect on MG-63 cells caused the lowest differentiation among the groups. In comparison with allograft alone, allograft/transforming growth factor beta-1, and allograft/transforming growth factor beta-1/platelet-derived growth factor-BB caused significant upregulation of bone sialoprotein and osteocalcin osteogenic mid-late marker genes, and resulted in significantly higher amounts of calcified nodules especially in mineralized non-cytotoxic allograft group. Supplementation of platelet-derived growth factor-BB alone in 5 ng/mL concentration had no significant effect on differentiation or mineralization markers. According to the results, transforming growth factor beta-1 acts synergistically with bone allografts to enhance the osteogenic differentiation potential. Therefore, this combination may be useful for rapid transformation of undifferentiated cells into bone-forming cells for bone regeneration. However, platelet-derived growth factor

  17. Dental Implant Placement with Simultaneous Anterior Maxillary Reconstruction with Block and Particulate Fresh Frozen Allograft Bone: A Case Report with 24-Month Follow-Up Data

    Directory of Open Access Journals (Sweden)

    J. S. Vieira

    2017-01-01

    Full Text Available Fresh frozen allograft bone is routinely used in orthopedic surgery for the reconstruction of large bone defects, and its use in oral and maxillofacial surgery is increasing. The purpose of this case was to demonstrate the installation of dental implants and the use of fresh frozen bone for reconstruction of anterior maxilla in the same surgery. This case report presents the insertion of dental implants followed immediately by a placement of fresh frozen allograft in block and particle for a reconstruction of atrophic anterior maxillary in the same surgery. Ten months subsequent to this procedure, provisional fixed prosthesis was installed on the implants. Four months later (postoperative month 14, the final fixed prosthesis was installed and the clinical success was observed. The insertion of dental implants followed immediately by a placement of fresh frozen allograft is a safe and efficient process that results in the successful return of dental function and aesthetic rehabilitation for the patient.

  18. The effect of radiation-sterilization conditions and preservation procedures on physico-chemical and biological properties of bone allografts

    International Nuclear Information System (INIS)

    Goclawska, A.D.; Kaminski, A.; Wasilewska, M.

    1999-01-01

    Radiation-sterilization of connective tissue allografts (bone including) with a dose of 35 kGy is routinely used in the Central Tissue Bank in Warsaw since 1963. This method of sterilization offers many advantages: good penetration ability, relatively low temperature rise, and possibility of sterilization of grafts in closed beforehand vials, which protects against secondary contamination. It should be kept in mind, however that high doses of ionizing radiation (in the range of 20-35 kGy) used for sterilization evoke many chemical and physical changes which may influence biological properties of grafts. These changes have been studied using various methodological approaches. Using electron paramagnetic resonance (EPR) spectrometry it has been found that in radiation-sterilized bone two types of paramagnetic entities are generated: i/ coliagen radicals which are unstable and disappear completely in the presence of air oxygen, ii/ very stable at room temperature paramagnetic defects (centers) localized in the crystalline lattice of bone mineral. These stable paramagnetic defects have been treated as a new kind of markers and used for: a/ quantitative evaluation of remodeling process of radiation-sterilized bone allografts preserved by lyophilization or deep freezing; b/ estimation of the dose of ionizing radiation absorbed by living organism in the case of accidental exposure (skeleton serving as a dosimeter) and for control of radiation-sterilization process. The effect of radiation-sterilization and preservation procedures on bone allografts was studied using a model of heterotopically induced osteogenesis and measuring the solubility of bone collagen in vitro. It has been observed that lyophilized bone allografts irradiated at room temp. with doses of 35 and 50 kGy, respectively, were very quickly resorbed in vivo and did not induce osteogenesis, while lyophilized as well as deep-frozen matrices irradiated at -7OoC were slowly resorbed and induced de novo bone fon

  19. Mouse NK cell-mediated rejection of bone marrow allografts exhibits patterns consistent with Ly49 subset licensing.

    Science.gov (United States)

    Sun, Kai; Alvarez, Maite; Ames, Erik; Barao, Isabel; Chen, Mingyi; Longo, Dan L; Redelman, Doug; Murphy, William J

    2012-02-09

    Natural killer (NK) cells can mediate the rejection of bone marrow allografts and exist as subsets based on expression of inhibitory/activating receptors that can bind MHC. In vitro data have shown that NK subsets bearing Ly49 receptors for self-MHC class I have intrinsically higher effector function, supporting the hypothesis that NK cells undergo a host MHC-dependent functional education. These subsets also play a role in bone marrow cell (BMC) allograft rejection. Thus far, little in vivo evidence for this preferential licensing across mouse strains with different MHC haplotypes has been shown. We assessed the intrinsic response potential of the different Ly49(+) subsets in BMC rejection by using β2-microglobulin deficient (β2m(-/-)) mice as donors. Using congenic and allogeneic mice as recipients and depleting the different Ly49 subsets, we found that NK subsets bearing Ly49s, which bind "self-MHC" were found to be the dominant subset responsible for β2m(-/-) BMC rejection. This provides in vivo evidence for host MHC class I-dependent functional education. Interestingly, all H2(d) strain mice regardless of background were able to resist significantly greater amounts of β2m(-/-), but not wild-type BMC than H2(b) mice, providing evidence that the rheostat hypothesis regarding Ly49 affinities for MHC and NK-cell function impacts BMC rejection capability.

  20. Long bone nonunions treated with autologous concentrated bone marrow-derived cells combined with dried bone allograft.

    Science.gov (United States)

    Scaglione, M; Fabbri, L; Dell'Omo, D; Gambini, F; Guido, G

    2014-08-01

    Nowadays the treatment of long bone nonunion continues to be one of the most complex and debated topics due to the large number of failures. For several years, in the relevant literature three factors have been considered essential in the healing process: growth factors and hormones, osteoprogenitor cells (mesenchymal stem cells), and extracellular matrix. The mechanical stability of the fracture site is considered the fourth element of the "Diamond concept theory." The aim of our study was to evaluate the validity of biological adjuvants of mechanical synthesis allowing a faster healing process of nonunions. We dealt with 19 patients with long bone nonunion. All patients have been treated with concentrated mesenchymal stem cells without bone autologous transplant. We used the Extracell BMC-marrow aspirate protocol of Regen Lab. The radiographic parameters taken into account for the diagnosis of successful healing were the presence of a bridge callus, obliteration of the fracture line and bone cortical continuity. Clinically, the pain was investigated with VAS score (visual analogue scale), where zero means no pain and 10 the worst possible pain. Radiographic investigation shows complete healing in 78.9 % (15 cases) with an average time to healing of 6.5 months (minimum healing time 80 days) corresponding also in complete remission of clinical symptoms. The use of growth factors and autologous mesenchymal stem cells through the enforcement of system for tissue regeneration is a valid and innovative biotechnology technique for the treatment long bone nonunions.

  1. Socket preservation using freeze-dried bone allograft with and without plasma rich in growth factors in dogs

    Directory of Open Access Journals (Sweden)

    Mohammad Hasan Samandari

    2016-01-01

    Full Text Available Background: Plasma rich in growth factors (PRGF and freeze-dried bone allograft (FDBA are shown to promote bone healing. This study was aimed to histologically and histomorphometrically investigate the effect of combined use of PRGF and FDBA on bone formation, and compare it to FDBA alone and control group. Materials and Methods: The distal roots of the lower premolars were extracted bilaterally in four female dogs. Sockets were randomly divided into FDBA + PRGF, FDBA, and control groups. Two dogs were sacrificed after 2 weeks and two dogs were sacrificed after 4 weeks. Sockets were assessed histologically and histomorphometrically. Data were analyzed by Kruskal-Wallis test followed by Mann-Whitney U-tests utilizing the SPSS software version 20. P < 0.05 was considered statistically significant. Results: While the difference in density of fibrous tissue in three groups was not statistically significant (P = 0.343, the bone density in grafted groups was significantly higher than the control group (P = 0.021. The least decrease in all socket dimensions was observed in the FDBA group. However, these differences were only significant in coronal portion at week 4. Regarding socket dimensions and bone density, the difference between FDBA and FDBA+PRGF groups was not significant in middle and apical portions. Conclusion: The superiority of PRGF+FDBA overFDBA in socket preservation cannot be concluded from this experiment.

  2. Hemicortical resection and inlay allograft reconstruction for primary bone tumors: a retrospective evaluation in the Netherlands and review of the literature

    NARCIS (Netherlands)

    Bus, M.P.; Bramer, J.A.; Schaap, G.R.; Schreuder, H.W.B.; Jutte, P.C.; Geest, I.C.M. van der; Sande, M.A. van de; Dijkstra, P.D.

    2015-01-01

    BACKGROUND: Selected primary tumors of the long bones can be adequately treated with hemicortical resection, allowing for optimal function without compromising the oncological outcome. Allografts can be used to reconstruct the defect. As there is a lack of studies of larger populations with

  3. Hemicortical Resection and Inlay Allograft Reconstruction for Primary Bone Tumors A Retrospective Evaluation in the Netherlands and Review of the Literature

    NARCIS (Netherlands)

    Bus, M. P. A.; Bramer, J. A. M.; Schaap, G. R.; Schreuder, H. W. B.; Jutte, P. C.; van der Geest, I. C. M.; van de Sande, M. A. J.; Dijkstra, P. D. S.

    2015-01-01

    Background: Selected primary tumors of the long bones can be adequately treated with hemicortical resection, allowing for optimal function without compromising the oncological outcome. Allografts can be used to reconstruct the defect. As there is a lack of studies of larger populations with

  4. Comparative Alveolar Ridge Preservation Using Allogenous Tooth Graft versus Free-dried Bone Allograft: A Randomized, Controlled, Prospective, Clinical Pilot Study.

    Science.gov (United States)

    Joshi, Chaitanya Pradeep; D'Lima, Cynthia Bernardo; Samat, Urmila Chandrashekhar; Karde, Prerna Ashok; Patil, Agraja Ganpat; Dani, Nitin Hemchandra

    2017-01-01

    For the first time in India, allografts from human extracted teeth were prepared. A randomized, prospective, clinicoradiographical, histological study was conducted to evaluate their efficacy in comparison with freeze-dried bone allograft (FDBA) in alveolar ridge preservation. Graft preparation: with written consent, teeth were collected from three donors (full mouth extraction cases). Once donors' serums were tested negative for HIV, HBV, HCV, and Venereal disease research laboratory (VDRL), mineralized whole tooth allograft (WTA) and dentin allograft (DA) were prepared using the standard protocol of Tissue Bank at Tata Memorial Hospital, Mumbai, India. In this randomized controlled trial, 15 patients undergoing extraction of at least four teeth were selected. In each patient after atraumatic extractions, one socket was grafted with WTA, second with DA, third with FDBA, and fourth was left ungrafted (control site). All the sites were covered with chorion membrane. To estimate three-dimensional alveolar crest changes, cone beam computed tomography scans were taken immediately after grafting and 4 months postoperatively. Bone biopsies using 3 mm trephine bur were obtained from four patients at the time of implant placement and evaluated histologically. Clinically uneventful healing was observed at all sites. Compared to other sites, WTA and DA consistently showed superior results demonstrating least reduction in alveolar crest height and width which was statistically significant ( P < 0.05). Between WTA and DA sites, there was no statistically significant difference. Histological analysis also confirmed more new bone formation at WTA and DA sites. Rather than disposing extracted human teeth as a biomedical waste (common practice), they can be collected from suitable systemically healthy donors. With the help of tissue bank, they can be processed into an allograft, serving as an excellent alternative to conventional allografts.

  5. Analysis of new bone, cartilage, and fibrosis tissue in healing murine allografts using whole slide imaging and a new automated histomorphometric algorithm

    OpenAIRE

    Zhang, Longze; Chang, Martin; Beck, Christopher A; Schwarz, Edward M; Boyce, Brendan F

    2016-01-01

    Histomorphometric analysis of histologic sections of normal and diseased bone samples, such as healing allografts and fractures, is widely used in bone research. However, the utility of traditional semi-automated methods is limited because they are labor-intensive and can have high interobserver variability depending upon the parameters being assessed, and primary data cannot be re-analyzed automatically. Automated histomorphometry has long been recognized as a solution for these issues, and ...

  6. Immunogenicity of Freeze-Dried and Deep-Frozen Bone Allografts

    Science.gov (United States)

    1976-01-01

    cultures. JournalI of Bacteriolotly and Viral Ii~iiiinology, 1971, 64, 243-254. (17) Strong. D.M., 1loody,71, rdtuc, ¶0.Ahmied, A. and Seli.K.W...it was, however, lower than that observed with fresh allografts. S/N 0102- LF- 014- 6601 UNCLASS[ FIED SErURITY CLASIFICATIoN OF THIS PAnF(’,-n rImr. F.. d)

  7. A clinical and histomorphometric study of calcium sulfate compared with freeze-dried bone allograft for alveolar ridge preservation.

    Science.gov (United States)

    Toloue, Samira M; Chesnoiu-Matei, Ioana; Blanchard, Steven B

    2012-07-01

    Many materials have been found to be effective in ridge preservation. The purpose of this study is to determine whether calcium sulfate (CS) is as effective as freeze-dried bone allograft (FDBA) in preserving postextraction ridge dimensions and to evaluate the amount of new bone formation and graft clearance through histologic analysis. Thirty-one extraction sites were selected. Postextraction clinical measurements were made, and sites were divided randomly into the test group (CS) or the control group (FDBA). After graft placement, all individuals received the same postoperative treatment and instructions. Participants were recalled after 3 months, measurements were made, and sites were re-entered. Bone samples were harvested and analyzed with histologic methodology for new bone formation and remaining residual graft. Thirteen test and 15 control sites were evaluated. There was no significant change in vertical ridge height before or after surgery within the test and control groups (P = 0.57, P = 0.68, respectively). There was a significant decrease in bucco-lingual ridge width for both groups (P = 0.0003, P = 0.0075, respectively), but the difference between groups was not significant (P = 0.11). Histologic analysis revealed an average of 32% new bone formation with 2.5% graft remaining for the test group and 16.7% new bone formation with 21% graft remaining for the control. Results indicate that CS is as effective as FDBA in preserving postextraction ridge dimensions in non-molar extraction sites. There is greater clearance of CS with more new bone formation after ≈3 months compared with FDBA in these sites. This paper received the Maynard K. Hine Award for Excellence in Dental Research presented by the Indiana Section of the American Association for Dental Research and supported by Procter & Gamble.

  8. Bone Cysts After Osteochondral Allograft Repair of Cartilage Defects in Goats Suggest Abnormal Interaction Between Subchondral Bone and Overlying Synovial Joint Tissues

    Science.gov (United States)

    Pallante-Kichura, Andrea L.; Cory, Esther; Bugbee, William D.; Sah, Robert L.

    2013-01-01

    The efficacy of osteochondral allografts (OCA) may be affected by osseous support of the articular cartilage, and thus affected by bone healing and remodeling in the OCA and surrounding host. Bone cysts, and their communication pathways, may be present in various locations after OCA insertion and reflect distinct pathogenic mechanisms. Previously, we analyzed the effect of OCA storage (FRESH, 4°C/14d, 4°C/28d, FROZEN) on cartilage quality in fifteen adult goats after 12 months in vivo. The objectives of this study were to further analyze OCA and contralateral non-operated (Non-Op) CONTROLS from the medial femoral condyle to (1) determine the effect of OCA storage on local subchondral (ScB) and trabecular (TB) bone structure, (2) characterize the location and structure of bone cysts and channels, and (3) assess the relationship between cartilage and bone properties. (1) Overall bone structure after OCA was altered compared to Non-Op, with OCA samples displaying bone cysts, ScB channels, and ScB roughening. ScB BV/TV in FROZEN OCA was lower than Non-Op and other OCA. TB BV/TV in FRESH, 4°C/14d, and 4°C/28d OCA did not vary compared to Non-Op, but BS/TV was lower. (2) OCA contained “basal” cysts, localized to deeper regions, some “subchondral” cysts, localized near the bone-cartilage interface, and some ScB channels. TB surrounding basal cysts exhibited higher BV/TV than Non-Op. (3) Basal cysts occurred (a) in isolation, (b) with subchondral cysts and ScB channels, (c) with ScB channels, or (d) with subchondral cysts, ScB channels, and ScB erosion. Deterioration of cartilage gross morphology was strongly associated with abnormal μCT bone structure. Evidence of cartilage-bone communication following OCA repair may favor fluid intrusion as a mechanism for subchondral cyst formation, while bone resorption at the graft-host interface without affecting overall bone and cartilage structure may favor bony contusion mechanism for basal cyst formation. These

  9. Resident Arterial Cells and Circulating Bone Marrow-Derived Cells both Contribute to Intimal Hyperplasia in a Rat Allograft Carotid Transplantation Model

    Directory of Open Access Journals (Sweden)

    Yi He

    2017-07-01

    Full Text Available Background/Aims: Neointimal formation following vascular injury remains a major mechanism of restenosis, whereas the precise sources of neointimal cells are still uncertain. We tested the hypothesis that both injured arterial cells and non-arterial cells contribute to intimal hyperplasia. Methods: Following allograft transplantation of the balloon-injured carotid common artery (n = 3-6, the cellular composition of the transplant grafts and the origins of neointimal cells were measured by immunohistochemistry and immunofluorescence staining. Results: Smooth muscle actin (SMA-positive and CD68-positive cells were clearly observed 14 days later in the neointima after allograft transplantation of the balloon-injured carotid common artery, where re-endothelialization was not yet complete. Green fluorescent protein (GFP and wild-type (WT allograft transplantation revealed that the majority of the neointima cells were apparently from the recipient (≈85% versus the donor (≈15%. Both monocyte chemotactic protein-1 (MCP-1/CCR2 and stromal cell-derived factor-1 (SDF-1/CXCR4 signaling were involved in intimal hyperplasia, with bone marrow-derived cells also playing a role. Conclusion: These data support the hypothesis that intimal hyperplasia could develop in our novel rat allograft transplantation model of arterial injury, where neointima is attributable not only to local arterial cells but also non-arterial cells including the bone marrow.

  10. Comparison of lyophilization, and freezing in honey as techniques to preserve cortical bone allografts used to repair experimental femoral defects in domestic adult cats

    Directory of Open Access Journals (Sweden)

    M.P. Ferreira

    2012-04-01

    Full Text Available Cats with orthopedic conditions are a prominent part of the clinical work of veterinary. Conditions such as comminuted fractures, bone tumors and non-unions are often difficult to repair and may require the use of bone grafts for treatment. This study evaluated cortical bone allografts preserved in honey, frozen or lyophilized for correcting long bone defects created in the diaphysis of the right femur of domestic cats (n=24. In the control group (n=6, the defect was repaired using autogenous cortical bone graft. In the remaining animals (n=6/group, the defect was repaired with cortical bone allografts preserved in honey, frozen or lyophilized. Success of graft incorporation and length of time for consolidation were assessed through clinical, radiographic and histological evaluations performed up to 180 days. In the control, frozen, honey and lyophylized groups, respectively, success of graft incorporation was 91.6%, 83.3%, 75%, and 25%, with corresponding mean length of time for consolidation of 83.1, 78, 105 and 120 days. Incorporation percentage in the lyophilized group was significantly lower than in the frozen and control groups. In conclusion, bone grafts preserved in honey or frozen were effective for repairing cortical defects in the femurs of cats as compared to autogenous cortical bone grafts.

  11. Comparative Effectiveness of Bone Grafting Using Xenograft Freeze-Dried Cortical Bovine, Allograft Freeze-Dried Cortical New Zealand White Rabbit, Xenograft Hydroxyapatite Bovine, and Xenograft Demineralized Bone Matrix Bovine in Bone Defect of Femoral Diaphysis of White Rabbit: Experimental Study In Vivo

    Directory of Open Access Journals (Sweden)

    Ferdiansyah Mahyudin

    2017-01-01

    Full Text Available Autogenous bone graft is gold standard in treating bone defects, but it might have difficulty in corporation and rejection reaction. This study is to compare the effectiveness among freeze-dried xenograft, freeze-dried allograft, hydroxyapatite xenograft, and demineralized bone matrix xenograft as bone graft to fill bone defect in femoral diaphysis of white rabbit. Thirty male New Zealand white rabbits were distributed into five groups. Bone defect was filled correspondingly with xenograft freeze-dried cortical bovine, allograft freeze-dried cortical New Zealand white rabbit, xenograft hydroxyapatite bovine, and xenograft demineralized bone matrix bovine. No graft was used in control group. VEGF, osteoblast, and woven bone were higher in allograft freeze-dried cortical New Zealand white rabbit (mean 5.6625 (p<0.05 and xenograft demineralized bone matrix bovine (mean 5.2475 (p<0.05 with calcification of woven bone was already seen in week 2 in the latter group. There was a decrease of woven bone (mean 4.685 (p<0.05 fibrous tissue (mean 41.07 (p<0.05 in xenograft demineralized bone matrix bovine. The Immunoglobulin-G was elevated in control and all study groups but not significantly (p=0.07855. Bone healing process in xenograft demineralized bone matrix bovine is more effective than in xenograft hydroxyapatite bovine, allograft freeze-dried New Zealand white rabbit, xenograft freeze-dried cortical bovine, and control.

  12. Prospective Clinical and Radiographic Study of Alveolar Ridge Preservation Combining Freeze-Dried Bone Allograft With Two Xenogeneic Collagen Matrices.

    Science.gov (United States)

    Parashis, Andreas O; Hawley, Charles E; Stark, Paul C; Ganguly, Rumpa; Hanley, James B; Steffensen, Bjorn

    2016-04-01

    Tooth extractions are followed by significant dimensional changes in the alveolar crest that may preclude implant placement. This randomized, controlled, prospective compares the preservation of soft and hard tissue dimensional changes after alveolar ridge preservation (ARP) using two membranes consisting of collagen matrix (CM) or extracellular matrix (ECM) as barriers over freeze-dried bone allograft (FDBA). Standardized clinical and radiographic measurements of soft and hard tissues were recorded by means of a stent before and 4 months after ARP. The surgery entailed sulcular incisions with minimal flap elevation and repositioning without advancement. Of 11 patients in the CM group and 12 in the ECM group who completed the study, gingival thickness (GT) increased from 0.1 to 0.2 mm for both groups along with a 0.5-mm decrease in the width of keratinized tissue after healing. Reductions in ridge width were most pronounced on the coronal aspect, 1.8 mm for CM and 2.0 mm for ECM, whereas vertical reduction was most pronounced on the buccal aspect, 0.7 to 1.0 mm. Differences between groups were not statistically significant. However, significant correlation for changes in GT (P = 0.001) and crestal bone width (P = 0.002) with preoperative buccal plate thickness (BPT) was observed. Both xenogeneic collagen matrices combined with FDBA were effective in maintaining soft tissues and minimizing ridge resorption in all dimensions after ARP. BPT was an important determinant for amount of change in crestal GT and ridge width.

  13. The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut.

    Science.gov (United States)

    Rollo, G; Tartaglia, N; Falzarano, G; Pichierri, P; Stasi, A; Medici, A; Meccariello, L

    2017-12-01

    Subtrochanteric fractures have a bimodal age distribution. They usually require open reduction and internal fixation. Closed reduction and intramedullary nail fixation rate are increased for this type of fracture. As a result, the hardware breakage and non-union rate is high among such patients. Our purpose is to evaluate the outcomes of the role of blade plate and bone strut allograft in the management of subtrochanteric non-union by femoral nailing. We reported a group of 22 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail with medial femoral allograft bone and lateral blade plate and wire (PS) s; and a group of 13 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail treated with lateral blade plate and screws (CG). The chosen criteria to evaluate the two group during the clinical and radiological follow-up were the quality of life, measured by The Short Form (12) Health Survey (SF-12), the hip function and quality of life related to it, measured by the Harris Hip Score (HHS), bone healing, measured by Radiographic Union Score (RUS) by XR and CT at 1 year after the surgery, and postoperative complications. The evaluation endpoint was set at 12 months. The Bone healing measured by RUS occurred and also the full recovery before the first trauma measured by SF-12 and HHS are better in PS group. We only had three unimportant complications in PS while four breakage hardware in CG. We conclude that in complicated non-unions, the use of blade plate and bone strut allograft has a definite positive role in the management of such cases.

  14. EXPERIMENTAL ESTIMATION OF THE DEMINERALIZED BONE ALLOGRAFTS MADE BY TECHNOLOGY OF CITO

    Directory of Open Access Journals (Sweden)

    Yu. B. Yurasova

    2010-01-01

    Full Text Available Research is devoted an experimental estimation of osteoinductive properties of demineralized bone implants (DBA made on technology CITO with use of lyophilization and radiating sterilization by stream of fast electrons. As experimental animals, white rats on ectopic osteogenesis model for a period of 40 days and rabbits to which DBA implanted into defect of the jaw with terms of experiment 10, 20, 30, 60 and 90 days have been chosen. Results of morphological researches testified to absence of toxicity, presence of high indicators of biointegration and osteoinductance studied DBA. The offered technology of processing of a bone tissue allows to keep biological activity of tissues and to receive biological materials with the expressed plastic properties. Obtained among other data were the bases for the decision of use of these materials in clinic of different bone pathologies.

  15. Novel in Vitro Modification of Bone for an Allograft with Improved Toughness Osteoconductivity

    Science.gov (United States)

    2014-04-01

    measure of strong bone. We have demonstrated thus far ALT-711 has weak but measurable positive effects on the osteogenic expression of stem cells on...Woong Kim, PhD: University of Auckland , New Zealand, Post-doc fellow, 2012 – present. RT-PCR analysis, sample procurement and preparation, fluorescence

  16. Clinical trial and in-vitro study comparing the efficacy of treating bony lesions with allografts versus synthetic or highly-processed xenogeneic bone grafts

    DEFF Research Database (Denmark)

    Kubosch, Eva Johanna; Bernstein, Anke; Wolf, Laura

    2016-01-01

    BACKGROUND: Our study aim was to compare allogeneic cancellous bone (ACB) and synthetic or highly-processed xenogeneic bone substitutes (SBS) in the treatment of skeletal defects in orthopedic surgery. METHODS: 232 patients treated for bony lesions with ACB (n = 116) or SBS (n = 116) within a 10......-year time period were included in this case-control study. Furthermore, both materials were seeded with human osteoblasts (hOB, n = 10) and analyzed by histology, for viability (AlamarBlue®) and protein expression activity (Luminex®). RESULTS: The complication rate was 14.2 %, proportion of defects....... Histological examination revealed similar bone structures, whereas cell remnants were apparent only in the allografts. Both materials were biocompatible in-vitro, and seeded with human osteoblasts. The cells remained vital over the 3-week culture period and produced microscopically typical bone matrix. We...

  17. Properties of the "Orgamax" osteoplastic material made of a demineralized allograft bone

    Science.gov (United States)

    Podorognaya, V. T.; Kirilova, I. A.; Sharkeev, Yu. P.; Uvarkin, P. V.; Zhelezny, P. A.; Zheleznaya, A. P.; Akimova, S. E.; Novoselov, V. P.; Tupikova, L. N.

    2016-08-01

    We investigated properties of the "Orgamax" osteoplastic material, which was produced from a demineralized bone, in the treatment of extensive caries, in particular chronic pulpitis of the permanent teeth with unformed roots in children. The "Orgamax" osteoplastic material consists of demineralized bone chips, a collagen additive, and antibiotics. The surface morphology of the "Orgamax" osteoplastic material is macroporous, with the maximum pore size of 250 µm, whereas the surface morphology of the major component of "Orgamax", demineralized bone chips, is microporous, with a pore size of 10-20 µm. Material "Orgamax" is used in the treatment of complicated caries, particularly chronic pulpitis of permanent teeth with unformed roots in children. "Orgamax" filling a formed cavity exhibits antimicrobial properties, eliminates inflammation in the dental pulp, and, due to its osteoconductive and osteoinductive properties, undergoes gradual resorption, stimulates regeneration, and provides replacement of the defect with newly formed tissue. The dental pulp viability is completely restored, which ensures the complete formation of tooth roots with root apex closure in the long-term period.

  18. Proximal femoral allografts for reconstruction of bone stock in revision arthroplasty of the hip. A nine to fifteen-year follow-up.

    Science.gov (United States)

    Blackley, H R; Davis, A M; Hutchison, C R; Gross, A E

    2001-03-01

    Revision of a femoral component in a patient who has severe bone loss is a complex problem that is likely to increase with the increasing numbers of patients who have multiple revision hip arthroplasties. A valuable option in such a situation is use of a long-stem prosthesis that is cemented to a proximal femoral allograft but not to the host bone. Between April 1984 and December 1989, sixty-three total hip arthroplasties in sixty consecutive patients were revised with a proximal femoral allograft-prosthesis construct. The average length of the allograft was 15 cm. The average age of the patients at the time of the revision was 62.5 years. All patients had undergone at least one previous total hip arthroplasty, and an average of 3.8 previous total hip arthroplasties had been performed in the series. Each patient was assigned a modified Harris hip score. Radiographs were examined for trochanteric union, allograft-host union, endosteal and periosteal resorption, component loosening, and fracture. At an average of eleven years (range, nine years and four months to fifteen years) after the revision, forty-five patients were alive, fourteen patients had died, and one patient had been lost to follow-up. The patients who had died or had been lost to follow-up had had a total of fifteen allografts (24%) and had been followed for an average of five years and seven months (range, two years and four months to eight years). The average preoperative Harris hip score for the sixty-three hips was 30 points (range, 6 to 65 points). At the latest follow-up evaluation, the average score for the hips with the original graft in situ was 71 points (range, 47 to 95 points). Five hips failed because of infection, and four of them were successfully revised. Three hips failed because of aseptic loosening, at an average of ten years and three months; two were successfully revised, and the third was awaiting revision at the time of writing. An additional operation was performed in three hips

  19. Osteoconduction of impacted porous titanium particles with a calcium-phosphate coating is comparable to osteoconduction of impacted allograft bone particles: in vivo study in a nonloaded goat model.

    Science.gov (United States)

    Walschot, Lucas H B; Aquarius, René; Schreurs, Barend W; Verdonschot, Nico; Buma, Pieter

    2012-08-01

    Impaction grafting restores bone defects in hip arthroplasty. Defects are reconstructed with bone particles (BoP) as substitute materials with adequate mechanical and biological properties are not yet available. Ceramic particles (CeP) have mechanical drawbacks as opposed to porous titanium particles (TiP). In this in vivo study, bone ingrowth and bone volume in coated and noncoated TiP were compared to porous biphasic calcium-phospate CeP and allograft BoP. Coatings consisted of silicated calcium-phosphate and carbonated apatite. Materials were implanted in goats and impacted in cylindrical defects (diameter 8 mm) in the cancellous bone of the femur. On the basis of fluorochrome labeling and histology, bone ingrowth distance was measured at 4, 8, and 12 weeks. Cross-sectional bone area was measured at 12 weeks. TiP created a coherent matrix of entangled particles. CeP pulverized and were noncoherent. Bone ingrowth in TiP improved significantly by the coatings to levels comparable to BoP and CeP. Cross-sectional bone area was smaller in CeP and TiP compared to BoP. The osteoconductive properties of impacted TiP with a calcium-phosphate coating are comparable to impacted allograft bone and impacted biphasic ceramics. A more realistic loaded in vivo study should prove that coated TiP is an attractive alternative to allograft bone. Copyright © 2012 Wiley Periodicals, Inc.

  20. Role of allografts in spinal surgery

    International Nuclear Information System (INIS)

    Aziz Nather

    1999-01-01

    With development of more tissue banks in the region and internationally, allografts are increasingly being used in orthopaedic surgery including spinal surgery. Two groups of patients will particularly benefit from the use of allografts. The first group is young children in whom iliac crest is cartilaginous and cannot provide sufficient quantity of autografts. The second is the elderly where bones from iliac crest are porotic and fatty. Allografts are used to fulfill two distinct functions in Spinal Surgery. One is to act as a buttress for anterior spinal surgery using cortical allografts. The other is to enhance fusion for posterior spinal surgery. Up to December 1997, 71 transplantations have been performed using allografts from NUH Tissue Bank. Anterior Spinal Surgery has been performed in 15 cases. The indications are mainly Trauma-Burst Fractures and Spinal Secondaries to the Spine. All cases are in thoracic and thoracolumbar region. Allografts used are deep frozen and freeze-dried cortical allografts. Femur is used for thoraco-lumbar region and humerus for upper thoracic region. Instrumentation used ranged from anterior devices (Canada, DCP, Synergy etc) to posterior devices (ISOLA). Deep frozen allografts and more recently freeze-dried allografts are preferred especially for osteoporotic spines. Cortical allografts are packed with autografts from ribs in the medullary canal. Allograft-autograft composites are always used to ensure better incorporation. Postero-lateral fusion has been performed for 56 cases. The indications include congenital and idiopathic scoliosis, degenerative stenosis, degenerative spondylolisthesis, spondylolytic spondylolisthesis, fracture-dislocation, osteoporotic burst fracture, spinal secondaries with cord compression and traumatic spondylolisthesis. Deep frozen bone allografts are used in combination with patient's own autografts from spinous processes to provide a 50% mix. Instrumentation used include Hartshill, Steffee, Isola

  1. Importance of B cells to development of regulatory T cells and prolongation of tissue allograft survival in recipients receiving autologous bone marrow transplantation.

    Science.gov (United States)

    Gorczynski, Reginald M; Farrokhi, Kaveh; Gorczynski, Christopher; Sadozai, Hassan; Zhu, Fang; Khatri, Ismat

    2018-01-16

    We previously showed that congenic bone marrow transplantation (BMTx) post myeloablation augmented tissue allograft survival in association with increased regulatory T (Treg) cells of both host and bone marrow donor origin. Regulatory B (Breg) cells can also modulate T-cell immunity and B cells may be implicated in the development of Treg cells. Accordingly, we explored the effect of B-cell depletion in vivo on augmented graft survival post BMTx. C57BL/6 mice received BALB/c skin allografts followed 7 days later by myeloablation using cyclophosphamide and busulphan. Mice then received T-cell-depleted bone marrow from CD45.1 congenic donors, and ongoing immunosuppression with rapamycin (to day 28 after BMTx). Control mice received cyclophosphamide and busulphan followed by rapamycin, but not congenic bone marrow. At different times post BMTx, mice received B-cell-depleting antibody treatment, and the effect on both skin graft survival, and induction of Treg cells was assessed. BMTx resulted in significantly prolonged skin graft survival versus control mice, in association with attenuated donor-specific alloreactivity relative to controls, increased splenic Treg cells and significantly diminished anti-donor IgG. In mice receiving infusion of B-depleting antibodies for 12 days from day 15 post BMTx, both graft survival and Treg cell activity were diminished, particularly for functional Treg cells of donor origin. Adoptive transfer of Breg cells from mice harvested at 15 days post BMTx prolonged survival in naive transplanted mice and increased Treg cell levels. Thus, autologous BMTx augmentation of graft survival is dependent in part upon a population of Breg cells that can modulate the function of donor-derived Treg cells. © 2018 John Wiley & Sons Ltd.

  2. [Effects of reconstruction with unicondylar osteoarticular allografts with or without prosthesis for bone tumors around knee joint].

    Science.gov (United States)

    Xue, Y S; Fu, J; Guo, Z; Wang, Z; Pei, Y J; Dang, L L; Fan, H B

    2017-04-01

    Objective: To investigate the survival rate, function outcomes, and complications after using unicondylar osteoarticular allografts with or without prosthesis to reconstruct the knee joint for tumors located in distal femoral or proximal tibial uni-condyle. Methods: Twenty-two patients who underwent unicondylar osteoarticular allografts with or without prosthesis composite reconstructions from January 2007 to December 2015 in Department of Orthopaedic Surgery of Xi Jing Hospital, the Fourth Military Medical University were retrospectively reviewed. There were 14 males and 8 females and the mean age was 35 years(8-65 years). There were 12 malignent tumors and 10 aggressive benign tumors. The tumors were located in distal femur in 14 cases and proximal tibia in 8 cases. After tumor excision, the distal femur was reconstructed with unicondylar osteoallograft-prosthesis composite, and proximal tibial plate was reconstructed with unicondylar osteoarticular allograft with the help of computer-assisted navigation system. Function and radiograph were documented according to the Musculoskeletal Tumor Society (MSTS) functional scoring system and the International Society of Limb Salvage (ISOLS) radiographic scoring system. The median follow-up time was 60 months (5-116 months). Results: At the latest follow-up, 2 patients had amputation owing to local recurrence in 12 malignant tumors. Three patients had pulmonary metastasis and 1 patient died another 2 alive with disease. Kaplan-Meier analysis indicated that the disease-free survival rate was 73%. There was no recurrence and metastasis in 10 patients with giant cell tumor. The average MSTS score was 26 points and the radiographic score was 78%-94%(average 90%). The complications included superficial infection in 1 patient and screw broken in 1 patient. There was no broken or collapse allograft in all composite reconstruction patients but 6 cases in allograft reconstruction. Conclusions: Unicondylar osteoarticular allografts

  3. A retrospective study of iliac crest bone grafting techniques with allograft reconstruction: do patients even know which iliac crest was harvested? Clinical article.

    Science.gov (United States)

    Pirris, Stephen M; Nottmeier, Eric W; Kimes, Sherri; O'Brien, Michael; Rahmathulla, Gazanfar

    2014-10-01

    Considerable biological research has been performed to aid bone healing in conjunction with lumbar fusion surgery. Iliac crest autograft is often considered the gold standard because it has the vital properties of being osteoconductive, osteoinductive, and osteogenic. However, graft site pain has been widely reported as the most common donor site morbidity. Autograft site pain has led many companies to develop an abundance of bone graft extenders, which have limited proof of efficacy. During the surgical consent process, many patients ask surgeons to avoid harvesting autograft because of the reported pain complications. The authors sought to study postoperative graft site pain by simply asking patients whether they knew which iliac crest was grafted when a single skin incision was made for the fusion operation. Twenty-five patients underwent iliac crest autografting with allograft reconstruction during instrumented lumbar fusion surgery. In all patients the autograft was harvested through the same skin incision but with a separate fascial incision. At various points postoperatively, the patients were asked if they could tell which iliac crest had been harvested, and if so, how much pain did it cause (10-point Numeric Rating Scale). Most patients (64%) could not correctly determine which iliac crest had been harvested. Of the 9 patients who correctly identified the side of the autograft, 7 were only able to guess. The 2 patients who confidently identified the side of grafting had no pain at rest and mild pain with activity. One patient who incorrectly guessed the side of autografting did have significant sacroiliac joint degenerative pain bilaterally. Results of this study indicate the inability of patients to clearly define their graft site after iliac crest autograft harvest with allograft reconstruction of the bony defect unless they have a separate skin incision. This simple, easily reproducible pilot study can be expanded into a larger, multiinstitutional

  4. Treatment of Severe Bone Defects During Revision Total Knee Arthroplasty with Structural Allografts and Porous Metal Cones

    DEFF Research Database (Denmark)

    Beckmann, Nicholas A; Mueller, Sebastian; Gondan, Matthias

    2015-01-01

    Aseptic loosening and focal osteolysis are the most common reasons for knee arthroplasty failure. The best treatment remains unclear. We reviewed the literature on the treatment of revision knee arthroplasty using bony structural allografts (476 cases) and porous metal cones (223 cases......) to determine if a difference in the revision failure rates was discernable. The failure rates were compared using a logistic regression model with adjustment for discrepancies in FU time and number of grafts used (femoral, tibial, or both). In this analysis, the porous implant shows a significantly decreased...

  5. Histologic Evaluation of Wound Healing After Ridge Preservation With Cortical, Cancellous, and Combined Cortico-Cancellous Freeze-Dried Bone Allograft: A Randomized Controlled Clinical Trial.

    Science.gov (United States)

    Demetter, Randy S; Calahan, Blaine G; Mealey, Brian L

    2017-09-01

    Cortical and cancellous mineralized freeze-dried bone allografts (FDBA) are available for use in alveolar ridge preservation after tooth extraction. There are currently no data regarding use of a combination 50%/50% cortico-cancellous FDBA compared with a 100% cortical or 100% cancellous FDBA in ridge preservation. The primary objective of this study is to dimensionally and histologically evaluate healing after ridge preservation in non-molar sites using 50%/50% cortico-cancellous FDBA versus 100% cortical and 100% cancellous FDBA. Sixty-six patients requiring extraction of a non-molar tooth were enrolled and randomized into three groups to receive ridge preservation with the following: 1) 100% cortical FDBA; 2) 100% cancellous FDBA; or 3) 50%/50% cortico-cancellous FDBA. After 18 to 20 weeks of healing, a biopsy was harvested, and an implant was placed. The alveolar ridge was measured pre- and postoperatively to evaluate change in ridge height and width. Percentages of vital bone, residual graft, and connective tissue (CT)/other were determined via histomorphometric analysis. Histomorphometric analysis revealed no significant differences among groups regarding percentage of vital bone or CT/other. The 100% cortical FDBA group had significantly greater residual graft material (P = 0.04). Dimensional analysis revealed no significant between-group differences in any parameter measured. To the best knowledge of the authors, this study offers the first histologic evidence demonstrating no significant difference in vital bone formation or dimensional changes among 50%/50% cortico-cancellous FDBA, 100% cortical FDBA, and 100% cancellous FDBA when used in ridge preservation of non-molar tooth sites.

  6. Controlling Arteriogenesis and Mast Cells Are Central to Bioengineering Solutions for Critical Bone Defect Repair Using Allografts

    Directory of Open Access Journals (Sweden)

    Ben Antebi

    2016-01-01

    Full Text Available Although most fractures heal, critical defects in bone fail due to aberrant differentiation of mesenchymal stem cells towards fibrosis rather than osteogenesis. While conventional bioengineering solutions to this problem have focused on enhancing angiogenesis, which is required for bone formation, recent studies have shown that fibrotic non-unions are associated with arteriogenesis in the center of the defect and accumulation of mast cells around large blood vessels. Recently, recombinant parathyroid hormone (rPTH; teriparatide; Forteo therapy have shown to have anti-fibrotic effects on non-unions and critical bone defects due to inhibition of arteriogenesis and mast cell numbers within the healing bone. As this new direction holds great promise towards a solution for significant clinical hurdles in craniofacial reconstruction and limb salvage procedures, this work reviews the current state of the field, and provides insights as to how teriparatide therapy could be used as an adjuvant for healing critical defects in bone. Finally, as teriparatide therapy is contraindicated in the setting of cancer, which constitutes a large subset of these patients, we describe early findings of adjuvant therapies that may present future promise by directly inhibiting arteriogenesis and mast cell accumulation at the defect site.

  7. The effects of hydroxyapatite coating and bone allograft on fixation of loaded experimental primary and revision implants

    DEFF Research Database (Denmark)

    Søballe, Kjeld; Mouzin, Olivier R G; Kidder, Louis A

    2003-01-01

    We used our established experimental model of revision joint replacement to examine the roles of hydroxyapatite coating and bone graft in improving the fixation of revision implants. The revision protocol uses the Søballe micromotion device in a preliminary 8-week period of implant instability...

  8. Clinical Evaluation of Decellularized Nerve Allograft with Autologous Bone Marrow Stem Cells to Improve Peripheral Nerve Repair and Functional Outcomes

    Science.gov (United States)

    2016-07-01

    followed for 18 months post -surgery. Secondary outcomes will be examined to evaluate the efficacy of the co-treatment for nerve repair compared to...transplantation of in vitro differentiated bone-marrow stromal cells. Eur J Neurosci . 2001 Dec;14(11):1771-6. 20. Djouad F, Jackson WM, Bobick BE, Janjanin S...enrollment. Goals/Milestones Yr 1 Goals  Start Up, Hire PM, Identify Staff, Project Planning, Organization, Doc Prep  SRC/IRB /HRPO (SRC 10/16 IRB

  9. The use of osteochondral allograft with bone marrow-derived mesenchymal cells and hinge joint distraction in the treatment of post-collapse stage of osteonecrosis of the femoral head.

    Science.gov (United States)

    Gagala, J; Tarczynska, M; Gaweda, K; Matuszewski, L

    2014-09-01

    Osteonecrosis of the femoral head is an entity which occurs mainly in young and active patients aged between 20 and 50. The success of hip joint preserving treatments ranges from 15% to 50% depending on the stage and amount of osteonecrotic lesion. Total hip replacement is indicated in late post-collapse hips but it has unsatisfactory survival because of the wear and osteolysis in young and active patients. Osteochondral allografts have been reported in the treatment of large articular lesions with defects in underlying bone in knee, talus and shoulder. By combining osteoconductive properties of osteochondral allograft with osteogenic abilities of bone marrow-derived mesenchymal cells it has a potential to be an alternative to an autologous graft. The adjunct of hinged joint distraction should minimize stresses in subchondral bone to promote creeping substitution and prevent femoral head collapse. Unlike current treatment modalities, it would provide both structural support and allow bony and articular substitution. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Reconstruction of an atrophied posterior mandible with the inlay technique and allograft block versus allograft particulate: a case report.

    Science.gov (United States)

    Checchi, Vittorio; Mazzoni, Annalisa; Breschi, Lorenzo; Felice, Pietro

    2015-01-01

    This case report describes the bilateral reconstruction of a severely atrophic posterior mandible in a 30-year-old woman using allograft block versus particulate grafting in the inlay technique. Three months later, four dental implants were placed and bone core biopsy specimens were taken for histologic evaluation. During implant placement, the grafted sites were stable with good clinical osseointegration. The histologic analysis showed the presence of compact bone revealing areas of demarcation between grafted bone, newly formed bone, and bone-regenerated areas. Allografts might serve as an alternative to autogenous and heterologous grafting in posterior mandible augmentation using the inlay technique.

  11. Rejection Study of Cancelous Allograft in Emergency Orthopaedic Operation

    International Nuclear Information System (INIS)

    Manjas, Menkher; Hilmy Nazly

    2002-01-01

    The fast development of national and international tissue bank, increased the use of bone allografts in orthopaedic surgery including emergency open reduction and internal fixation at fresh bone fractures. The aim of this work is to evaluate rejection and usefulness of cancelous bone allografts which have been used in emergency orthopaedic operation. Dwing February until June 2000 two group of 20 patients each, were studied. after preferring emergency open reduction and internal fixation. The first group was treated with cancelous allograft transplantation at the site of the fracture, but the second group did not get any graft. Radiation sterilized allograft were used at this study. Parameters observed were local reaction of wound operation, local rejection and callus formation. The results show that there is no rejection of cancelous bone allograft detected from local and systemic reaction of wound operation. After three week, operation there was no significant different number of callus formation can be detected by conventional radiology examination but after 6 weeks there was a significant increasing in number of callus formation in the group of cancelous allograft transplantation (P < 0.05)

  12. Allograft Reconstruction for the Treatment of Musculoskeletal Tumors of the Upper Extremity

    Directory of Open Access Journals (Sweden)

    Luis A. Aponte-Tinao

    2013-01-01

    Full Text Available In comparison with the lower extremity, there is relatively paucity literature reporting survival and clinical results of allograft reconstructions after excision of a bone tumor of the upper extremity. We analyze the survival of allograft reconstructions in the upper extremity and analyze the final functional score according to anatomical site and type of reconstruction. A consecutive series of 70 allograft reconstruction in the upper limb with a mean followup of 5 years was analyzed, 38 osteoarticular allografts, 24 allograft-prosthetic composites, and 8 intercalary allografts. Kaplan-Meier survival analysis of the allografts was performed, with implant revision for any cause and amputation used as the end points. The function evaluation was performed using MSTS functional score. Sixteen patients (23% had revision surgery for 5 factures, 2 infections, 5 allograft resorptions, and 2 local recurrences. Allograft survival at five years was 79% and 69% at ten years. In the group of patients treated with an osteoarticular allograft the articular surface survival was 90% at five years and 54% at ten years. The limb salvage rate was 98% at five and 10 years. We conclude that articular deterioration and fracture were the most frequent mode of failure in proximal humeral osteoarticular reconstructions and allograft resorption in elbow reconstructions. The best functional score was observed in the intercalary humeral allograft.

  13. Knee extensor mechanism allograft reconstruction following chronic disruption.

    Science.gov (United States)

    Murgier, J; Boisrenoult, P; Pujol, N; Beranger, J S; Tardy, N; Steltzlen, C; Beaufils, P

    2015-11-01

    The management of chronic extensor mechanism disruption can be complex. One of the options is allograft reconstruction. The goal of this study was to present the surgical procedure and provide preliminary results with this technique. The allograft uses the whole extensor mechanism (anterior tibial tubercle, patellar ligament, patella, quadriceps tendon). The native patella can be completely removed if the quality of the bone is poor, otherwise a bone groovecan be created to receive the allograft. The allograft is tightly tensioned with the knee in full extension. This surgical technique was performed 5 times with a minimum follow-up of 1 year. Active extension was recovered in all cases. The mean postoperative KOOS was 55.5 the IKS function score was 68.5 and the IKS knee score was 83. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Magnetic resonance imaging features of allografts

    International Nuclear Information System (INIS)

    Kattapuram, S.V.; Rosol, M.S.; Rosenthal, D.I.; Palmer, W.E.; Mankin, H.J.

    1999-01-01

    enhancement observed on MRI during the first few months to 2 years following surgery represents vascular ingrowth and early skeletal repair. The zone of periosteal enhancement could also include the new bone laid on the surface of the allograft through which the soft tissues bind to the cortex. The exact reason for the inhomogeneity in the marrow signal, and the diffuse, inhomogeneous marrow enhancement is not clear. This may represent saponified and/or necrotic marrow fat interspersed with the fibrovascular tissue. The features noted here should provide radiologists with useful information regarding imaging characteristics they can expect to see in other allograft replacement patients. (orig.)

  15. Ridge preservation with or without an osteoinductive allograft: a clinical, radiographic, micro-computed tomography, and histologic study evaluating dimensional changes and new bone formation of the alveolar ridge.

    Science.gov (United States)

    Brownfield, Lauren A; Weltman, Robin L

    2012-05-01

    The aim of this randomized, controlled clinical trial is to determine whether ridge preservation using an osteoinductive allograft (test) would prevent ridge resorption and promote bone maturation compared to extraction alone (control). Seventeen patients (20 total sites), in need of a non-molar extraction and delayed implant placement were randomly selected to receive either ridge preservation or extraction alone. A cone-beam computed tomography was completed with a radiographic stent in place before extraction and 10 to 12 weeks postoperatively for dimensional and buccal plate analyses. Bone cores were taken for micro-computed tomography (microCT) and histologic analyses. Resorption of the alveolar ridge occurred at all sites with no statistically significant differences found between test and control sites. A significant correlation was found between the initial buccal plate thickness and the loss of vertical ridge height. microCT and histologic analyses found a mean new bone volume of 44.9% with microCT and 37.4% with histology in test sites and 39% and 35.5%, respectively, in control sites. The residual graft volume was 2.4% with microCT and 4.5% with histology. Test and control sites lost similar amounts of alveolar ridge, with the loss of buccolingual width occurring predominantly at the expense of the buccal bone. A thicker buccal plate was associated with less ridge loss in the vertical dimension. The percentage of new bone was not statistically significant between either the test or control sites, using either microCT or histologic analyses.

  16. Total femoral allograft with simultaneous revision total hip and knee arthroplasty: 18 year follow-up

    Directory of Open Access Journals (Sweden)

    Ryan N. Harris, DO

    2015-09-01

    Full Text Available Massive allograft can be a useful option in revision total joint arthroplasty for treatment of significant bone loss. In rare cases, revision hip and knee arthroplasty procedures can be performed simultaneously using massive allograft-prosthetic composites. We present an 18 year follow up of a patient who received a simultaneous revision hip and knee total femoral allograft and discuss recent literature as it relates to this case.

  17. Biological effects of rAAV-caAlk2 coating on structural allograft healing

    DEFF Research Database (Denmark)

    Koefoed, Mette; Ito, Hiromu; Gromov, Kirill

    2005-01-01

    Structural bone allografts often fracture due to their lack of osteogenic and remodeling potential. To overcome these limitations, we utilized allografts coated with recombinant adeno-associated virus (rAAV) that mediate in vivo gene transfer. Using beta-galactosidase as a reporter gene, we show...

  18. Kidney allograft survival in dogs treated with total lymphoid irradiation

    International Nuclear Information System (INIS)

    Howard, R.J.; Sutherland, D.E.R.; Lum, C.T.; Lewis, W.I.; Kim, T.H.; Slavin, S.; Najarian, J.S.

    1981-01-01

    Total lymphoid irradiation (TLI) is immunosuppressive and, in rodents, can induce a state where transplantation of allogenic bone marrow results in chimerism and permanent acceptance of organ allografts from the donor strain. Twelve splenectomized dogs were treated with TLI (150 rads per fraction, total dose 1950 to 3000 rads) before bilateral nephrectomy and renal allotransplantation. Eight dogs received bone marrow from the kidney donor. In 13 untreated control dogs renal allografts functioned for a mean +- (SE) of 4.7 +- 0.3 days. In the four TLI treated dogs who did not receive bone marrow the renal allografts functioned for 15 to 76 days (two dogs died with functioning grafts). In the eight TLI treated dogs who received donor bone marrow, two died immediately after transplantation, two rejected at 3 and 13 days, one died at 13 days with a functioning graft, and two have had the grafts function for longer than 500 days. Chimerism was not detected in the one dog tested. The response of peripheral blood lymphocytes to stimulation with phytohemaglutinin and in mixed lymphocyte culture was suppressed for at least one month after TLI. The results confirm the immunosuppressive effect of TLI. The absence of kidney rejection in two recipients of donor bone marrow show the potential of this approach to induce long-term immunologic unresponsiveness as to an organ allograft, but the outcome is unpredictable and further experiments are needed to define the optimal conditions for administration of TLI and bone marrow to the recipients

  19. Head-on Allograft Transplantation: A Unique Case Report Where a Large Piece of Femoral Bone was Extruded from One Patient's Body and Impaled Another Patient's Tibia.

    Science.gov (United States)

    Rossman, Stephen R; Shaath, M Kareem; Graf, Kenneth W

    2017-01-01

    Open femoral fractures are relatively uncommon occurrences, with few reports addressing their management. They are caused by high-energy mechanisms, and bone loss is a possible, but infrequent occurrence. We present a case in which two friends, 20- and 21-year-old males, were involved in a motorcycle collision. A large piece of bone was ejected from one patient's femur as a bony projectile and impaled the other patient's tibia, resulting in an open tibial plateau fracture. This is the first case in the English literature, to the best of our knowledge, in which a piece of bone was ejected from one patient, causing a fracture in another. Two males, in their mid-twenties, were involved in a head-on motorcycle collision. Both patients sustained open fractures to their lower extremities. A large piece of bone was ejected from one patient's femur and impaled the other patient's tibia, causing an open tibial plateau fracture. The patient who provided the bony projectile underwent retrograde intramedullary nail fixation. The segmental piece of bone was not replanted, and he went on to heal without negative sequelae at 2-year follow-up. To the best of our knowledge, this is the first case documented in the English literature in which an ejected piece of bone from one person caused a fracture in another fracture. Management of extruded bone segments should be considered on a case-by-case basis.

  20. Use of Cortical Strut Allograft After Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty.

    Science.gov (United States)

    Lim, Chin Tat; Amanatullah, Derek F; Huddleston, James I; Hwang, Katherine L; Maloney, William J; Goodman, Stuart B

    2017-05-01

    Cortical strut allografts restore bone stock and improve postoperative clinical scores after revision total hip arthroplasty (THA). However, use of a cortical strut allograft is implicated in delayed healing of an extended trochanteric osteotomy (ETO). To date, there are no reports directly comparing ETO with or without cortical strut allografts. We reviewed prospectively gathered data on 50 revision THAs performed from 2004-2014 using an ETO. We compared the demographic, radiological, and clinical outcome of patients with (16 hips) and without (34 hips) cortical strut allograft after an ETO. There were no significant differences in Western Ontario McMaster Universities Osteoarthritis Index or Harris Hip Score between the ETOs with and without a cortical strut allograft. Fifteen of the ETOs (94%) with a cortical strut allograft and 31 of the ETOs (91%) without a cortical strut allograft were in situ at final follow-up (P = 1.000). A higher proportion hips with cortical strut allograft (100%, 16 patients) had preoperative Paprosky grade bone loss more than IIIA compared to those without allograft (29%, 10 patients) (P revision THA with ETO does not reduce the rate of union, radiological or clinical outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Ankle bipolar fresh osteochondral allograft survivorship and integration: transplanted tissue genetic typing and phenotypic characteristics.

    Science.gov (United States)

    Neri, Simona; Vannini, Francesca; Desando, Giovanna; Grigolo, Brunella; Ruffilli, Alberto; Buda, Roberto; Facchini, Andrea; Giannini, Sandro

    2013-10-16

    Fresh osteochondral allografts represent a treatment option for early ankle posttraumatic arthritis. Transplanted cartilage survivorship, integration, and colonization by recipient cells have not been fully investigated. The aim of this study was to evaluate the ability of recipient cells to colonize the allograft cartilage and to assess allograft cell phenotype. Seventeen ankle allograft samples were studied. Retrieved allograft cartilage DNA from fifteen cases was compared with recipient and donor constitutional DNA by genotyping. In addition, gene expression was evaluated on six allograft cartilage samples by means of real-time reverse transcription-polymerase chain reaction. Histology and immunohistochemistry were performed to support molecular observations. Of fifteen genotyped allografts, ten completely matched to the host, three matched to the donor, and two showed a mixed profile. Gene expression analysis showed that grafted cartilage expressed cartilage-specific markers. The rare persistence of donor cells and the prevailing presence of host DNA in retrieved ankle allografts suggest the ingrowth of recipient cells into the allograft cartilage, presumably migrating from the subchondral bone, in accordance with morphological findings. The expression of chondrogenic markers in some of the samples argues for the acquisition of a chondrocyte-like phenotype by these cells. To our knowledge, this is the first report describing the colonization of ankle allograft cartilage by host cells showing the acquisition of a chondrocyte-like phenotype.

  2. Allograft tolerance in pigs after fractionated lymphoid irradiation. II. Kidney graft after conventional total lymphoid irradiation and bone marrow cell grafting

    International Nuclear Information System (INIS)

    Fradelizi, D.; Mahouy, G.; de Riberolles, C.; Lecompte, Y.; Alhomme, P.; Douard, M.C.; Chotin, G.; Martelli, H.; Daburon, F.; Vaiman, M.

    1981-01-01

    Experiments with pigs have been performed in order to establish bone marrow chimerism and kidney graft tolerance between SLA genotyped semi-incompatible animals. Recipients were conditioned by means of conventional fractionated total lymphoid irradiation (TLI) delivered by a vertical cobalt source. The principal lymphoid regions of the pig, including thymus and spleen, were submitted to irradiation. Two protocols were tested: A = 250 cGy four times a week x 13 times (TLI) (two animals) and B = 350 cGy three times a week x 8 times (TLI) (four animals). Bone marrow cells were injected 24 h after the last irradiation. One day later, bilateral nephrectomy and the graft of one kidney from the bone marrow cell donor were performed simultaneously. Results convinced us that application of the TLI protocol to humans is not yet practicable and that further experimental work is needed

  3. Allograft Pancreatectomy: Indications and Outcomes.

    Science.gov (United States)

    Nagai, S; Powelson, J A; Taber, T E; Goble, M L; Mangus, R S; Fridell, J A

    2015-09-01

    This study evaluated the indications, surgical techniques, and outcomes of allograft pancreatectomy based on a single center experience. Between 2003 and 2013, 47 patients developed pancreas allograft failure, excluding mortality with a functioning pancreas allograft. Early graft loss (within 14 days) occurred in 16, and late graft loss in 31. All patients with early graft loss eventually required allograft pancreatectomy. Nineteen of 31 patients (61%) with late graft loss underwent allograft pancreatectomy. The main indication for early allograft pancreatectomy included vascular thrombosis with or without severe pancreatitis, whereas one recipient required urgent allograft pancreatectomy for gastrointestinal hemorrhage secondary to an arterioenteric fistula. In cases of late allograft pancreatectomy, graft failure with clinical symptoms such as abdominal discomfort, pain, and nausea were the main indications (13/19 [68%]), simultaneous retransplantation without clinical symptoms in 3 (16%), and vascular catastrophes including pseudoaneurysm and enteric arterial fistula in 3 (16%). Postoperative morbidity included one case each of pulmonary embolism leading to mortality, formation of pseudoaneurysm requiring placement of covered stent, and postoperative bleeding requiring relaparotomy eventually leading to femoro-femoral bypass surgery 2 years after allograftectomy. Allograft pancreatectomy can be performed safely, does not preclude subsequent retransplantation, and may be lifesaving in certain instances. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  4. Comparative evaluation of decalcified freeze dried bone allograft with and without local doxycycline in non-contained human periodontal infrabony defects

    Directory of Open Access Journals (Sweden)

    Ashish Agarwal

    2013-01-01

    Full Text Available Background: Doxycycline has been advocated as useful adjuncts in periodontal therapy not only due to their antimicrobial actions, but also to their recently recognized anti-collagenolytic, anti-inflammatory, osteoclast inhibitory and fibroblast stimulating property. The purpose of the present cohort study was to evaluate the regenerative outcomes of bone graft with or without local doxycycline in non-contained infrabony periodontal defects. Materials and Methods: 16 one or two wall infrabony defects, in 11 patients suffering from moderate to severe chronic periodontitis, aged 35-60 years, were randomly divided for bone graft, alone (control and with doxycycline (test for the study. At baseline, after 3 months and after 6 months of post-operative period, pocket probing depth (PPD, clinical attachment level (CAL, radiological bone fill (RBF and alveolar height reduction were recorded. Analysis of variance and Newman-Keuls post-hoc test were used or statistical analysis. A two-tailed probability (P value P < 0.05 was considered to be statistically significant. Results: For the control group PPD reduction 2.00 ± 0.18 mm, CAL gain 1.38 ± 0.17 mm, RBF 0.63 ± 0.27 mm (18.0% was observed while in the test group PPD reduction 2.00 ± 0.38 mm, CAL gain 1.25 ± 0.31 mm, RBF 0.75 ± 0.31 mm (20.7% was evaluated. While alveolar height reduction for the control group and test group was 13% and 12.5% respectively. Conclusion: The study confirmed no added benefits of local doxycycline, as compared with bone graft alone, for regeneration of non-contained human periodontal infrabony defects.

  5. Quadriceps tendon allografts as an alternative to Achilles tendon allografts: a biomechanical comparison.

    Science.gov (United States)

    Mabe, Isaac; Hunter, Shawn

    2014-12-01

    Quadriceps tendon with a patellar bone block may be a viable alternative to Achilles tendon for anterior cruciate ligament reconstruction (ACL-R) if it is, at a minimum, a biomechanically equivalent graft. The objective of this study was to directly compare the biomechanical properties of quadriceps tendon and Achilles tendon allografts. Quadriceps and Achilles tendon pairs from nine research-consented donors were tested. All specimens were processed to reduce bioburden and terminally sterilized by gamma irradiation. Specimens were subjected to a three phase uniaxial tension test performed in a custom environmental chamber to maintain the specimens at a physiologic temperature (37 ± 2 °C) and misted with a 0.9 % NaCl solution. There were no statistical differences in seven of eight structural and mechanical between the two tendon types. Quadriceps tendons exhibited a significantly higher displacement at maximum load and significantly lower stiffness than Achilles tendons. The results of this study indicated a biomechanical equivalence of aseptically processed, terminally sterilized quadriceps tendon grafts with bone block to Achilles tendon grafts with bone block. The significantly higher displacement at maximum load, and lower stiffness observed for quadriceps tendons may be related to the failure mode. Achilles tendons had a higher bone avulsion rate than quadriceps tendons (86 % compared to 12 %, respectively). This was likely due to observed differences in bone block density between the two tendon types. This research supports the use of quadriceps tendon allografts in lieu of Achilles tendon allografts for ACL-R.

  6. Balancing the Rates of New Bone Formation and Polymer Degradation Enhances Healing of Weight-Bearing Allograft/Polyurethane Composites in Rabbit Femoral Defects

    Science.gov (United States)

    2014-10-03

    for 24 h in PBS, and then tested using an Instron DynaMight 8841 machine equipped with a 1.7 N$m torque cell. The potted ends were gripped using the...kg intramuscularly (IM) followed by ketamine at 40 mg/kg IM. Bilateral defects of *6 mm diam- eter by 11 mm in depth were drilled in the lateral...Epub 1983/01/01. 49. Ashman, R.B., Corin, J.D., and Turner, C.H. Elastic proper ties of cancellous bone: measurement by an ultrasonic technique. J

  7. A comparative evaluation of freeze-dried bone allograft with and without bioabsorbable guided tissue regeneration membrane Healiguide® in the treatment of Grade II furcation defects: A clinical study

    Directory of Open Access Journals (Sweden)

    Deept Jain

    2015-01-01

    Full Text Available Background: Furcation defects represent one of the most demanding therapeutic challenges for periodontal therapy. Various treatment modalities have been tried with different success rates. The present study was undertaken to evaluate the efficacy of freeze-dried bone allograft (FDBA with and without bioabsorbable guided tissue regeneration (GTR membrane Healiguide® in the treatment of Grade II furcation defects. Materials and Methods: Ten patients with bilateral Grade II furcation defects were selected for the study. After phase I therapy, subjects were divided into two arms and treated in a split-mouth design. Ten defects were treated with FDBA alone in the control arm. Ten defects were treated with FDBA in conjunction with bioabsorbable GTR membrane Healiguide® in test arm. Clinical parameters like plaque index, gingival index, vertical probing depth, horizontal probing depth, and relative attachment level (RAL were assessed at baseline, 3 months, and 6 months postoperatively. Results: At 6 months, clinical improvement was seen in both the arms with mean pocket depth reduction of 1.2 ± 1.032 mm and 1.7 ± 0.948 mm and mean horizontal probing depth reduction being 2.1 ± 1.969 mm and 1.6 ± 1.264 mm in control and test arm, respectively. Both surgical procedures resulted in a statistically significant reduction in vertical and horizontal probing depths. Conclusion: Both the arms demonstrated a significant improvement in the probing depth, horizontal furcation depth, and RAL at 6 months postsurgery in the treatment of Grade II furcation defects. However, on the intergroup comparison, there was no statistically significant difference in the results achieved between two arms.

  8. A comparison of busulphan versus total body irradiation combined with cyclophosphamide as conditioning for autograft or allograft bone marrow transplantation in patients with acute leukaemia

    Energy Technology Data Exchange (ETDEWEB)

    Ringden, O. [Huddinge Hospital, Stockholm (Sweden). Dept. of Clinical Immunology; Labopin, M.; Gorin, N.C. [Hopital Saint-Antoine, Paris (France). Centre International Greffes de Moelle; Tura, S. [Orsola University Hospital, Bologna (Italy); Arcese, W. [University `La Sapienza`, Rome (Italy). Haematology; Iriondo, A. [Hospital National, Santander (Spain); Zittoun, R. [Hotel-Dieu, Paris (France). Service d`Hematologie; Sierra, J. [Hospital Clinic, Barcelona (Spain)

    1996-06-01

    We retrospectively compared the outcome in patients in the EBMT database transplanted for acute leukaemia from January 1987 to January 1994 who received busulphan and cyclophosphamide (BU/CY) as a pretransplant regimen versus those who received cyclophosphamide and total-body irradiation (CY-TBI). The patients were matched for type of transplant (autologous bone marrow transplantation (ABMT) versus allogenic (BMT)), diagnosis (acute lymphoblast leukaemia (ALL) ora cute myeloid leukaemia (AML)), status (early first complete remission, CR-1) versus intermediate (second or later remission, first relapse), age, FAB classification for AML, prevention of graft-versus-host disease and year of transplantation. BU/CY and CY/TBI as pretransplant regimens gave similar results in all situations, except ABMT for ALL intermediate stages with more than 2 years from diagnosis to transplantation, where a lower RI and a higher LFS were associated with CY/TBI. (author).

  9. Radionuclide diagnosis of allograft rejection

    International Nuclear Information System (INIS)

    George, E.A.

    1982-01-01

    Interaction with one or more anatomical and physiopathological characteristics of the rejecting renal allograft is suggested by those radioagents utilized specifically for the diagnosis of allograft rejection. Rejection, the most common cause of declining allograft function, is frequently mimicked clinically or masked by other immediate or long term post transplant complications. Understanding of the anatomical pathological features and kinetics of rejection and their modification by immunosuppressive maintenance and therapy are important for the proper clinical utilization of these radioagents. Furthermore, in selecting these radionuclides, one has to consider the comparative availability, preparatory and procedural simplicity, acquisition and display techniques and the possibility of timely report. The clinical utilities of radiofibrinogen, /sup 99m/Tc sulfur colloid and 67 Ga in the diagnosis of allograft rejection have been evaluated to a variable extent in the past. The potential usefulness of the recently developed preparations of 111 In labeled autologous leukocytes and platelets are presently under investigation

  10. Allografts versus Equine Xenografts in Calcaneal Fracture Repair.

    Science.gov (United States)

    Sonmez, Mehmet Mesut; Armagan, Raffi; Ugurlar, Meric; Eren, Tugrul

    Displaced intra-articular calcaneal fractures are difficult to treat. We determined the functional results and complications of using allografts or equine xenografts in treating these fractures. We reviewed patients seen at our center from May 2011 to December 2014 with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and an additional bone allograft or equine xenograft. A minimum of 1 year after surgery, a history of infection and functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society clinical rating system. Changes in the Gissane angle (GA) and Böhler angle were assessed from radiographs. Of the 91 eligible patients, 15 were lost to follow-up, leaving a sample of 76 patients (42 males): 45 received allografts (19 for type III and 26 for type IV fractures) and 31 received xenografts (20 for type III and 11 for type IV fractures). The mean age was about 40 years in both groups. After ≥1 year of follow-up, the proportion of patients in the American Orthopaedic Foot and Ankle Society scoring categories did not differ significantly between the 2 groups (mean ankle score, 86.5 in the allograft group and 85.1 in the xenograft group), and the American Orthopaedic Foot and Ankle Society functional outcomes were good or excellent in 69% and 68%, respectively (p = .986). The groups did not differ in the incidence of superficial or deep infection (p = 1.000). The Böhler angles were significantly decreased in the xenograft group. Xenografts might be preferred for repairing intra-articular calcaneal fractures because they can perform as well as allografts, avoid donor site morbidities, and are more available and less expensive than allografts. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Donation FAQs (Bone and Tissue Allografts)

    Science.gov (United States)

    ... South Dakota State University team in Brookings, South Dakota. Kevin was fatally injured in a skateboarding accident shortly before the beginning of his junior year. Although Kevin’s accident was tragic, he answered the prayers of many people who were, at the same time, waiting for ...

  12. Bone autografts and allografts in dogs

    International Nuclear Information System (INIS)

    Fitch, R.; Kerwin, S.; Sinibaldi, K.R.; Newman-Gage, H.

    1997-01-01

    Three patients (1 dog, 2 horses) are described where myelography was complicated, purportedly by injection of contrast medium into the meninges superficial to the subarachnoid space, Contrast medium injected in this location in a cadaver tended to accumulate dorsally within the vertebral canal, deep to the dura mater but superficial to the subarachnoid space, The ventral margin of the pooled contrast medium had a wavy or undulating margin and the dorsal margin was smooth, pooled contrast medium was believed to be sequestered within the structurally weakdural border cell layer between the dura mater and arachnoid membrane, or the so-called subdural space

  13. Distal Radius Allograft Reconstruction Utilizing a Step-Cut Technique After En Bloc Tumor Resection.

    Science.gov (United States)

    Luchetti, Timothy J; Wysocki, Robert W; Cohen, Mark S

    2018-01-01

    En bloc resection of the distal radius is a common treatment for advanced and recurrent giant cell tumors and less commonly for sarcoma. Various reconstructive options exist, including ulnar transposition, osteoarticular autograft and allograft, and allograft arthrodesis. We present a technique of reconstruction using a distal radius bulk allograft with a step-cut to allow for precise restoration of proper length and to promote bony union. Preoperative templating is performed with affected and contralateral radiographs to assess the size of the expected bony defect, location of the step-cut, and the optimal size of the distal radius allograft required. A standard dorsal approach to the distal radius is utilized, and the tumor is resected. A proximal row carpectomy is performed, and the plate/allograft construct is applied to the remaining host bone. Iliac crest bone graft is harvested and introduced at the graft-bone interface and radiocarpal arthrodesis sites. We have previously reported outstanding union rates with the step-cut technique compared with a standard transverse cut. The technique described provides reproducible union and stabilization of the wrist and forearm with adequate function following en bloc resection of the distal radius for tumor.

  14. Emphysema in the renal allograft

    Energy Technology Data Exchange (ETDEWEB)

    Potter, J.L.; Sullivan, B.M.; Fluornoy, J.G.; Gerza, C.

    1985-04-01

    Two diabetic patients in whom emphysematous pyelonephritis developed after renal transplantation are described. Clinical recognition of this unusual and serious infection is masked by the effects of immunosuppression. Abdominal radiographic, ultrasound, and computed tomography findings are discussed. The clinical presentation includes urinary tract infection, sepsis, and acute tubular malfunction of the allograft in insulin-dependent diabetics.

  15. Soaking morselized allograft in bisphosphonate can impair implant fixation

    DEFF Research Database (Denmark)

    Jakobsen, Thomas; Baas, Jørgen; Bechtold, Joan E

    2007-01-01

    The use of impacted, morselized allograft is a well-established way to provide initial stability of revision joint replacements. We investigated whether rinsing morselized allograft in bisphosphonate and subsequently impacting it around experimental titanium-coated implants would further facilitate...... bisphosphonate (alendronate, 2 mg/mL) or saline (control). Unbound alendronate was not rinsed away. During the first surgery, one pair of implants (alendronate and control) was inserted into one humerus. Eight weeks later, a second pair of implants was inserted into the contralateral humerus. The first pair....... Furthermore, the alendronate treatment blocked formation of new bone and inhibited resorption of the graft material. Although limited by the specific dose of alendronate used and the omission of rinsing away excess bisphosphonate, this study warrants caution and calls for further experimental research before...

  16. Comparison of allografts and xenografts used for alveolar ridge preservation. A clinical and histomorphometric RCT in humans.

    Science.gov (United States)

    Serrano Méndez, Carlos Alberto; Lang, Niklaus Peter; Caneva, Martina; Ramírez Lemus, Gloria; Mora Solano, Gerardo; Botticelli, Daniele

    2017-08-01

    Several types of bone grafts are used in ridge preservation procedures. To compare the healing of allografts and xenografts applied for alveolar ridge preservation. Twenty volunteers in need of extraction of a single-rooted tooth prior to implant installation were randomized into two groups. One group received a deproteinized cancellous bovine bone xenograft embedded in a 10% collagen matrix and the other a demineralized freeze-dried cortical bone allograft. A collagen membrane was used to cover the grafts, flaps were sutured. At baseline and 6 months later, clinical measurements including vertical and horizontal bone dimensions were taken. Histomorphometric analysis was performed. Both groups showed shrinkage of bone dimensions. At mesial, center and distal sites, the vertical changes in dimension were -0.6, 0.5, and -0.1 mm for the allograft and -1.1, -0.4, and -0.9 mm for the xenograft. The horizontal changes in dimensions were -1.4 mm for the allograft and -2.6 mm for the xenograft. New bone and residual graft material were 25.5 ± 10.1% and 33.8 ± 9.4% at the allograft and 35.3 ± 16.8% and 22.2 ± 13.4% at the xenograft sites. None of the differences was statistically significant. Both grafting materials are suitable for the preservation of the alveolar ridge. © 2017 Wiley Periodicals, Inc.

  17. Can fresh osteochondral allografts restore function in juveniles with osteochondritis dissecans of the knee?

    Science.gov (United States)

    Lyon, Roger; Nissen, Carl; Liu, Xue Cheng; Curtin, Brian

    2013-04-01

    Failure of initial treatment for juvenile osteochondritis dissecans (OCD) may require further surgical intervention, including microfracture, autograft chondrocyte implantation, osteochondral autografting, and fresh osteochondral allografting. Although allografts and autografts will restore function in most adults, it is unclear whether fresh osteochondral allograft transplantations similarly restore function in skeletally immature patients who failed conventional treatment. Therefore, we determined function in (1) daily activity; (2) sports participation; and (3) healing (by imaging) in children with juvenile OCD who failed conventional therapy and underwent fresh osteochondral allograft transplantation. We retrospectively reviewed 11 children with OCD of the knee treated with a fresh stored osteochondral allograft between 2004 and 2009 (six males and five females). The average age of the children at the time of their allograft surgery was 15.2 years (range, 13-20 years). The clinical assessments included physical examination, radiography, MRI, and a modified Merle D'Aubigné-Postel score. The size of the allograft was an average of 5.11 cm(2). The minimum followup was 12 months (average, 24 months; range, 12-41 months). All patients had returned to activities of daily living without difficulties at 6 months and returned to full sports activities between 9 and 12 months after surgery. The modified Merle D'Aubigné-Postel score improved from an average of 12.7 preoperatively to 16.3 at 24 months postoperatively. Followup radiographs at 2 years showed full graft incorporation and no demarcation between the host and graft bone. Our observations suggested fresh osteochondral allografts restored short-term function in patients with juvenile OCD who failed standard treatments. Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

  18. Posterior atlantoaxial fusion with a screw-rod system: Allograft versus iliac crest autograft.

    Science.gov (United States)

    Huang, Da-Geng; Zhang, Xin-Liang; Hao, Ding-Jun; Yu, Cheng-Cheng; Mi, Bai-Bing; Yuan, Qi-Ling; He, Bao-Rong; Liu, Tuan-Jiang; Guo, Hua; Wang, Xiao-Dong

    2017-11-01

    To compare the effectiveness of allograft and iliac crest autograft in atlantoaxial fusion. Between January 2012 and December 2012, 41 consecutive patients underwent posterior atlantoaxial fusion with a screw-rod fixation system in our spine center. The choice to use allograft or iliac crest autograft was made by the patient himself or herself after being informed about the advantages and disadvantages of both methods. In the allograft group, we used mixed material of morcellized demineralized freeze-dried bone allograft and local autograft for posterior atlantoaxial fusion. In the autograft group, we used the morcellized iliac crest autograft for fusion. Patients underwent regular follow up including CT scans and dynamic radiographs 6 months postoperatively and every 6 months thereafter until study completion or confirmation of fusion. Twenty-four patients underwent posterior atlantoaxial fusion with allograft, and 17 underwent fusion with autograft. All patients were followed up for at least 24 months. At the final follow-up visit, only two (8.3%) patients in the allograft group had confirmed posterior bony fusion on CT imaging while 15 (88.2%) patients in the autograft group had confirmed posterior bony fusion. None of the 41 patients had movement on the dynamic radiographs. Allograft is not reliable for posterior atlantoaxial fusion even with the rigid internal fixation of modern constructs. Autograft remains the first choice for atlantoaxial fusion despite the donor-site morbidity. The assessment of fusion based on a lack of movement on dynamic radiographs is not reliable. The confirmation of fusion should be based on the presence of bridging bone on CT imaging. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Efficacy of cortico/cancellous composite allograft in treatment of cervical spondylosis.

    Science.gov (United States)

    Park, Jung-Ho; Bae, Yoon-Kwang; Suh, Seung-Woo; Yang, Jae-Hyuk; Hong, Jae-Young

    2017-08-01

    This was a prospective comparative study.The aim of this study was to compare the clinical and radiologic outcomes of patients treated with cortico/cancellous composite allograft or autoiliac bone graft in anterior cervical discectomy and fusion.Several methods have been developed to fuse the cervical spine for treatment of cervical spondylosis. Cortico/cancellous composite allograft might be another alternative.A total of 46 patients who underwent surgery for treatment of cervical spondylosis were evaluated between September 2010 and January 2015. The duration of operation, blood loss, perioperative complications, neck disability index (NDI), visual analogue scale (VAS), and fusion rates were compared between the 2 groups.There were no significant differences in clinical or radiologic outcomes between the patients treated with cortico/cancellous composite allograft and those treated with autoiliac bone graft. The 2 groups showed similar improvements in clinical symptoms and fusion rates. Although not statistically significant, the subsidence rate was lower in the cortico/cancellous composite group.Cortico/cancellous composite allograft is an effective alternative to conventional allograft or autograft in anterior cervical discectomy and fusion.

  20. Comparing autograft, allograft, and tricalcium phosphate ceramic in a goat instrumented posterolateral fusion model

    NARCIS (Netherlands)

    Delawi, D.; Kruyt, M.C.; Yuan, Huipin; Vincken, K.L.; de Bruijn, Joost Dick; Oner, F.C.; Dhert, W.J.A.

    2013-01-01

    The most common application of bone grafts is spinal fusion surgery, in which the use of iliac crest autograft is the gold standard. Harvesting of autograft, however, requires an extra surgical procedure, which is associated with additional morbidity. Allograft is the well-known alternative, but it

  1. Renal allograft rupture: US diagnosis

    International Nuclear Information System (INIS)

    Maklad, N.F.

    1987-01-01

    The US appearances in seven pathologically and/or surgically proved cases of renal allograft rupture are presented. These include a triangular or amorphous echogenic area in the cortex and medulla in a polar location, an echogenic band or wavy, branching anechoic lines in the hyperechoic region, a subcapsular hematoma, and an extrarenal hematoma in direct continuity with the echogenic area. Duplex Doppler examination in renal allograft rupture shows marked reduction of absence of the diastolic component of the velocity waveform in the arcuate and interlobar arteries, with reduction in amplitude of the systolic wave form. Correlation of the US appearances with gross and microscopic pathologic findings indicates that the echogenic area is due to an intrarenal hematoma, while the echogenic band represents the cortical laceration with adherent blood clots. The US-duplex Doppler examination should be the primary diagnostic modality in this life-threatening condition

  2. Leiomyoma in a Renal Allograft

    Directory of Open Access Journals (Sweden)

    Yan Jun Li

    2016-01-01

    Full Text Available Leiomyomas are smooth muscle tumours that are rarely found in the kidney. There is one report of a leiomyoma in a kidney transplant in a paediatric recipient. Here, we report an adult renal transplant recipient who developed an Epstein-Barr virus-positive leiomyoma in his allograft 15 years after transplantation. The patient was converted to everolimus for posttransplant immunosuppression management and there was no sign of progression over a year.

  3. Femoral head allograft disinfection system using moderate heat

    International Nuclear Information System (INIS)

    Knaepler, H.; Von Garrel, T.

    1999-01-01

    The employment of a reliable thermal viral inactivation process, which minimally manipulates tissues, for surgically retrieved femoral head allografts addresses the increased concerns with virus transmissibility while minimizing the loss of biological properties. The newest European and German surgical bone banking guidelines have incorporated the use of independently validated then-nal viral inactivation methods in place of repeat serological testing of donor. Our investigations have shown that heat treatment at 80 degree C for a minimum of 10 minutes provides safe, good quality cancellous bone allografts and increases the cost-effectiveness and simplicity of managing a hospital frozen femoral head bone bank. Human femoral head centers were contaminated with different vegetative bacterial and viral suspensions. A core temperature of 80 degree C for 10 minutes was sufficient to fully inactivate 3 x 106 ml Staphylococcus aureus and Streptococcus faecalis, and >5 loglo steps of cytomeglia (herpes group), polio (enterovirus), and yellow fever (arbovirus) viruses. A one hour treatment in a water bath set at 80 degree sufficient to fully inactivate E. coli, proteus vulgaris, and Pseudomonas aerog. vegetative suspensions; 20 minutes was sufficient to fully inactivate the D antigen (rhesus factor) but had no effect on A or B antigens. Several biomechanical and biological properties of bone following a one hour treatment in a water bath set at 80 degree C were investigated. Employing compression and tension tests, 80 degree C treated human and porcine cancellous bone blocks showed reductions in properties ranging from 8-19% compared to untreated control groups. Osteointegration at 3 months following treatment of explanted and then reimplanted autograft rat diaphyseal segment was 15% less than untreated controls. Subsequently, a thermal disinfection system for femoral heads from living donors (Lobator Marburg Bone Bank System, Telos GmbH, Hungen, Germany) was developed. A

  4. Femoral revision with impaction allografting and an uncemented femoral component

    DEFF Research Database (Denmark)

    Nickelsen, T N; Erenbjerg, M; Retpen, J B

    2008-01-01

    A technique for uncemented revision of the femoral component which combines impaction allografting and the use of a long-stemmed proximally coated titanium prostheses (Bimetric, Biomet Inc.) is described. The results after a mean follow-up of 112 months are reported. From 1991 to 1995 femoral...... implants 88% had no pain, 10% had slight pain and only 2% had severe pain. Thirty-eight patients had radiographic signs of remodelling of the graft and/or cortical repair. In cases with a successful outcome, the results have been encouraging in relation to clinical performance, regeneration of bone...

  5. Osteoconduction of impacted porous titanium particles with a calcium-phosphate coating is comparable to osteoconduction of impacted allograft bone particles: In vivo study in a nonloaded goat model

    NARCIS (Netherlands)

    Walschot, L.H.B.; Aquarius, R.; Schreurs, B.W.; Verdonschot, Nicolaas Jacobus Joseph; Buma, P.

    2012-01-01

    Aims: Impaction grafting restores bone defects in hip arthroplasty. Defects are reconstructed with bone particles (BoP) as substitute materials with adequate mechanical and biological properties are not yet available. Ceramic particles (CeP) have mechanical drawbacks as opposed to porous titanium

  6. Osteoconduction of impacted porous titanium particles with a calcium-phosphate coating is comparable to osteoconduction of impacted allograft bone particles: in vivo study in a nonloaded goat model.

    NARCIS (Netherlands)

    Walschot, L.H.B.; Aquarius, R.J.; Schreurs, B.W.; Verdonschot, N.J.; Buma, P.

    2012-01-01

    AIMS: Impaction grafting restores bone defects in hip arthroplasty. Defects are reconstructed with bone particles (BoP) as substitute materials with adequate mechanical and biological properties are not yet available. Ceramic particles (CeP) have mechanical drawbacks as opposed to porous titanium

  7. Irradiated large segment allografts in limb saving surgery for extremity tumor - Philippine experience

    International Nuclear Information System (INIS)

    Wang, E.H.M.; Agcaoili, N.; Turqueza, M.S.

    1999-01-01

    Limb saving surgery has only recently become an option in the Phillipines. This has given a better comprehension of oncologic principles and from the refinement of bone-reconstruction procedures. Foremost among the latter is the use of large segment bone allografts. Large-segment allografts (LSA) are available from the Tissue and Bone Bank of the University of the Philippines (UP). After harvest, these bones are processed at the Bank, radiation-sterilized at the Philippine Nuclear Research Institute, and then stored in a -80 degree C deep freezer. We present our 4-year experience (Jan 93 - Dec 96) with LSA for limb saving surgery in musculoskeletal tumors. All patients included had: (1) malignant or aggressive extremity tumors; (2) surgery performed by the UP - Musculoskeletal Tumor Unit (UP-MUST Unit); (3) reconstructions utilizing irradiated large-segment allografts from the UP Tissue and Bone Bank; and (4) follow-up of at least one year or until death. Tumors included osteosarcoma (6) giant cell tumors (11), and metastatic lesions (3). Age ranged from 16-64 years old; 13 males and 7 females. Bones involved were the femur (12) tibia (5) and humerus (3). Average defect length was 15 cm and surgeries performed were intercalary replacement (5), resection arthrodesis (11), hemicondylar allograft (3), and allograft-prosthesis-composite (1). Follow-up ranged was from 17- 60 months or until death. Fifteen (1 5) were alive with NED (no evidence of disease), 3 were dead (2 of disease 1 of other causes), and 2 were AWED (alive with evidence of disease). Functional evaluation using the criteria of the International Society of Limb Salvage (ISOLS) was performed on 18 patients. This averaged 27.5 out of 30 points (92%) for 15 patients. Many having returned to their previous work and recreation. The 3 failures were due to infections in 2 cases (both of whom opted for amputations but who have not been fit with prostheses), and a fracture (secondary to a fall) in one case. Limb

  8. Radiation sterilization of skin allograft

    Science.gov (United States)

    Kairiyama, E.; Horak, C.; Spinosa, M.; Pachado, J.; Schwint, O.

    2009-07-01

    In the treatment of burns or accidental loss of skin, cadaveric skin allografts provide an alternative to temporarily cover a wounded area. The skin bank facility is indispensable for burn care. The first human skin bank was established in Argentina in 1989; later, 3 more banks were established. A careful donor selection is carried out according to the national regulation in order to prevent transmissible diseases. As cadaveric human skin is naturally highly contaminated, a final sterilization is necessary to reach a sterility assurance level (SAL) of 10 -6. The sterilization dose for 106 batches of processed human skin was determined on the basis of the Code of Practice for the Radiation Sterilization of Tissue Allografts: Requirements for Validation and Routine Control (2004) and ISO 11137-2 (2006). They ranged from 17.6 to 33.4 kGy for bioburdens of >10-162.700 CFU/100 cm 2. The presence of Gram negative bacteria was checked for each produced batch. From the analysis of the experimental results, it was observed that the bioburden range was very wide and consequently the estimated sterilization doses too. If this is the case, the determination of a tissue-specific dose per production batch is necessary to achieve a specified requirement of SAL. Otherwise if the dose of 25 kGy is preselected, a standardized method for substantiation of this dose should be done to confirm the radiation sterilization process.

  9. Radiation sterilization of skin allograft

    International Nuclear Information System (INIS)

    Kairiyama, E.; Horak, C.; Spinosa, M.; Pachado, J.; Schwint, O.

    2009-01-01

    In the treatment of burns or accidental loss of skin, cadaveric skin allografts provide an alternative to temporarily cover a wounded area. The skin bank facility is indispensable for burn care. The first human skin bank was established in Argentina in 1989; later, 3 more banks were established. A careful donor selection is carried out according to the national regulation in order to prevent transmissible diseases. As cadaveric human skin is naturally highly contaminated, a final sterilization is necessary to reach a sterility assurance level (SAL) of 10 -6 . The sterilization dose for 106 batches of processed human skin was determined on the basis of the Code of Practice for the Radiation Sterilization of Tissue Allografts: Requirements for Validation and Routine Control (2004) and ISO 11137-2 (2006). They ranged from 17.6 to 33.4 kGy for bioburdens of >10-162.700 CFU/100 cm 2 . The presence of Gram negative bacteria was checked for each produced batch. From the analysis of the experimental results, it was observed that the bioburden range was very wide and consequently the estimated sterilization doses too. If this is the case, the determination of a tissue-specific dose per production batch is necessary to achieve a specified requirement of SAL. Otherwise if the dose of 25 kGy is preselected, a standardized method for substantiation of this dose should be done to confirm the radiation sterilization process.

  10. MORPHOLOGY OF ISCHEMIC INJURY OF LIVER ALLOGRAFT

    Directory of Open Access Journals (Sweden)

    L. V. Shkalova

    2010-01-01

    Full Text Available The literature data in modern transplantology concerning morphology of ischemic injury of liver allograft are analyzed in the article. Questions of pathogenesis of liver allograft ischemic injury, histological features that indicate the possibility of donor liver transplantation are discussed in detail, as well as the role of steatosis and its reverse is highlighted. We tried to systematize the morphological changes depending on severity of ischemic injury; also we focused on the questions of persistency of the ischemic injury in the liver allograft

  11. Optimized total body irradiation for induction of renal allograft tolerance through mixed chimerism in cynomolgus monkeys

    Energy Technology Data Exchange (ETDEWEB)

    Kimikawa, Masaaki; Kawai, Tatsuo; Ota, Kazuo [Tokyo Women`s Medical Coll. (Japan)

    1996-12-01

    We previously demonstrated that a nonmyeloablative preparative regimen can induce mixed chimerism and renal allograft tolerance between MHC-disparate non-human primates. The basic regimen includes anti-thymocyte globulin (ATG), total body irradiation (TBI, 300 cGy), thymic irradiation (TI, 700 cGy), splenectomy, donor bone marrow (DBM) infusion, and posttransplant cyclosporine therapy (CYA, discontinued after 4 weeks). To evaluate the importance and to minimize the toxicity of irradiation, kidney allografts were transplanted with various manipulations of the irradiation protocol. Monkeys treated with the basic protocol without TBI and TI did not develop chimerism or long-term allograft survival. In monkeys treated with the full protocol, all six monkeys treated with two fractionated dose of 150 cGy developed chimerism and five monkeys appeared tolerant. In contrast, only two of the four monkeys treated with fractionated doses of 125 cGy developed chimerism and only one monkey survived long term. The degree of lymphocyte depletion in all recipients was proportional to the TBI dose. The fractionated TBI regimen of 150 cGy appears to be the most consistently effective regimen for establishing donor bone marrow cell engraftment and allograft tolerance. (author)

  12. Masquelet's Technique for Management of Long Bone Defects ...

    African Journals Online (AJOL)

    Bone defect, of whatever cause, is clinically challenging to treat. Defects of up to 4.0 cm can be successfully treated with cancellous bone grafting. Large defects require more complex alternatives like, bone transport, vascularized bone grafting, allografts or fibular pro-tibia grafting. There are advantages and disadvantages ...

  13. Allograft for maxillary sinus floor augmentation: a retrospective study of 90 cases.

    Science.gov (United States)

    Guerrero, Jaime S; Al-Jandan, Badr A

    2012-04-01

    The aim of this study is to demonstrate the clinical applicability and efficacy of an allograft for maxillary sinus augmentations in patients requiring placement of dental implants. Sixty consecutive patients underwent a total of 90 sinus augmentations. Twenty-nine were women and 31 men, with a mean age of 54 years. Twenty-six patients received a bilateral procedure and 34 unilateral. All cases were treated with the lateral wall technique. Allograft consisted of demineralized freeze-dried blocks in 6 cases, particulate in 82 cases, and a combination of both in 2 cases. In 30 patients, it was combined with platelet-rich plasma. A total of 84 implants were inserted. Bone samples of grafted areas were obtained in two patients for histological examination. Seventy-three implants were clinically successful at the reentry time. Eleven implants in seven patients were removed between 15 days and 6 months after their placement. Seven of these implants were replaced and received prostheses as well, for an overall postloading success rate of 95.2%. Follow-up for all patients after final restoration was between 12 and 96 months. Specimen's histological evaluation revealed bone formation and evidence of inflammatory infiltrate. Based on the findings of this study, it can be suggested that the use of the demineralized freeze-dried bone allograft from the Banco de Huesos y Tejidos Fundación Cosme y Damian for sinus augmentation is effective and constitutes a feasible therapeutic alternative for implant placement.

  14. A 3- to 18-Year Follow-Up of Revision Total Hip Arthroplasty With Impacted Bone Allografts and Cemented Lubinus SP II Stem. Clinical, Radiographic, and Survivorship Analysis With Comparison to the Literature.

    Science.gov (United States)

    Stigbrand, Hampus; Ullmark, Gösta

    2017-09-01

    We present the first medium- to long-term follow-up of revision total hip arthroplasty using impaction bone grafting (IBG) combined with the matte and collared Lubinus SP II stem for cases of severe osteolysis and stem loosening. Sixty-nine femoral revisions were identified for 67 patients consecutively operated with revision femoral arthroplasty using IBG and a cemented Lubinus SP II stem. The mean age was 69 years (standard deviation, 9.9). We retrospectively analyzed 68 cases (1 was lost to follow-up). At the time of the revision surgery, all had substantial femoral bone loss. Fifteen of the revisions were performed due to deep infection. The patients were analyzed by clinical score and radiography. At follow-up, 4 femoral components (6%) had been rerevised or assessed as failure. Of these 4, 3 were assessed as mechanical failure, and 1 for dislocation; none was for infection. Three cups (4%) had been revised for dislocation; 1 of these also had a stem exchange. Three cases (4%) had been reoperated for a periprosthetic fracture in distal femur without stem exchange. Radiologic results were excellent and the clinical Merle d'Aubignè-Postel score had improved from a mean of 12.2 preoperatively to 17.5 at follow-up. IBG combined with the Lubinus SP II stem is safe and results in a low rate of periprosthetic fractures and dislocations. The medium- to long-term clinical result was excellent, with regeneration of living bone in the femur. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Bone marrow-derived immature dendritic cells prime in vivo alloreactive T cells for interleukin-4-dependent rejection of major histocompatibility complex class II antigen-disparate cardiac allograft

    OpenAIRE

    Buonocore, Sofia; Flamand, Véronique; Goldman, Michel; Braun, Michel Y

    2003-01-01

    BACKGROUND: Dendritic cells (DC) at the immature state express low levels of major histocompatibility complex and costimulatory molecules and are poor stimulators of primary T-cell response in vitro. Injection of immature bone marrow-derived DC, however, was shown to prime in vivo alloreactive CD4 T lymphocytes toward type 2 cytokine-producing cells in the absence of CD8 T-cell activation. METHODS: We undertook the present study to determine whether Th2-immunization by immature DC could lead ...

  16. [Attitude towards organ and tissue donation in Europe : Prerequisite for osteochondral allograft treatment].

    Science.gov (United States)

    Schmidt, S; Schulte, A; Schwarz, S; Hofmann, N; Tietz, S; Boergel, M; Sixt, S U

    2017-11-01

    The biggest obstacle to overcome for routine treatment of various pathologies with fresh osteochondral allograft is the availability of tissue for transplantation. Large fresh osteochondral allografts are usually harvested from organ donors, but in contrast to organs, tissues can be procured after cardiac arrest. Medical staff as well the general public are much less aware of the possibilities and requirements of tissue donation compared to organ donation. This review aims to highlight the current situation of organ and tissue donation in Europe and to raise this much needed awareness. For this research, PubMed database was scanned using the terms "tissue/organ donation", "bone donation/transplantation", "cartilage transplantation/allografts" and "osteochrondral allografts". Relatives of potential donors are often not approached because physicians and nurses do not feel sufficiently prepared for this task and, thus, are reluctant to address this topic. Different options could alleviate the pressure medical staff is feeling. Furthermore, there are different factors influencing consent that can be addressed to increase donation rates. Currently, a lot of potential concerning musculoskeletal tissue grafts remains unused. Most importantly, families should be encouraged to speak about their potenzial will to donate and educational programs should be established to increase trust in organ and tissue donation and the allocation system and to increase knowledge about the importance of transplantation medicine. But joined efforts of different parts of the medical systems and different organizations involved in tissue transplantation should improve the situation for patients waiting for much needed transplants.

  17. Comparison of glenohumeral contact pressures and contact areas after glenoid reconstruction with latarjet or distal tibial osteochondral allografts.

    Science.gov (United States)

    Bhatia, Sanjeev; Van Thiel, Geoffrey S; Gupta, Deepti; Ghodadra, Neil; Cole, Brian J; Bach, Bernard R; Shewman, Elizabeth; Wang, Vincent M; Romeo, Anthony A; Verma, Nikhil N; Provencher, Matthew T

    2013-08-01

    Glenoid reconstruction with distal tibial allografts offers the theoretical advantage over Latarjet reconstruction of improved joint congruity and a cartilaginous articulation for the humeral head. Hypothesis/ To investigate changes in the magnitude and location of glenohumeral contact areas, contact pressures, and peak forces after (1) the creation of a 30% anterior glenoid defect and subsequent glenoid bone augmentation with (2) a flush Latarjet coracoid graft or (3) a distal tibial osteochondral allograft. It was hypothesized that the distal tibial bone graft would best normalize glenohumeral contact areas, contact pressures, and peak forces. Controlled laboratory study. Eight cadaveric shoulder specimens were dissected free of all soft tissues and randomly tested in 3 static positions of humeral abduction with a 440-N compressive load: 30°, 60°, and 60° of abduction with 90° of external rotation (ABER). Glenohumeral contact area, contact pressure, and peak force were determined sequentially using a digital pressure mapping system for (1) the intact glenoid, (2) the glenoid with a 30% anterior bone defect, and (3) the glenoid after reconstruction with a distal tibial allograft or a Latarjet bone block. Glenoid reconstruction with distal tibial allografts resulted in significantly higher glenohumeral contact areas than reconstruction with Latarjet bone blocks in 60° of abduction (4.87 vs. 3.93 cm2, respectively; P Latarjet reconstruction in the ABER position (2.39 vs. 2.61 N, respectively; P Latarjet reconstruction also followed this same pattern, but differences in contact areas and peak forces between the defect model and Latarjet reconstruction in the ABER position were not statistically significant (P > .05). Reconstruction of anterior glenoid bone defects with a distal tibial allograft may allow for improved joint congruity and lower peak forces within the glenohumeral joint than Latarjet reconstruction at 60° of abduction and the ABER position

  18. Urinary calprotectin and posttransplant renal allograft injury

    DEFF Research Database (Denmark)

    Tepel, Martin; Borst, Christoffer; Bistrup, Claus

    2014-01-01

    regression showed that higher urinary calprotectin concentrations and older donor age predicted lower eGFR four weeks, 6 months, and 12 months after transplantation. CONCLUSIONS: Urinary calprotectin is an early, noninvasive predictor of immediate renal allograft injury after kidney transplantation.......OBJECTIVE: Current methods do not predict the acute renal allograft injury immediately after kidney transplantation. We evaluated the diagnostic performance of urinary calprotectin for predicting immediate posttransplant allograft injury. METHODS: In a multicenter, prospective-cohort study of 144...... incipient renal transplant recipients, we postoperatively measured urinary calprotectin using an enzyme-linked immunosorbent assay and estimated glomerular filtration rate (eGFR) after 4 weeks, 6 months, and 12 months. RESULTS: We observed a significant inverse association of urinary calprotectin...

  19. Bone grafting options in children.

    Science.gov (United States)

    Betz, Randal R; Lavelle, William F; Samdani, Amer F

    2010-08-01

    Retrospective review of the literature. To review the current literature as well as recent trends in bone grafting techniques available for children. The currently accepted gold standard in bone grafting for adolescent idiopathic scoliosis (AIS) is autogenous iliac crest. Due to questions concerning complications such as donor site pain, other options have been explored, including various allograft sources, demineralized bone matrix, and bone morphogenetic protein. A review of the current medical literature was completed and additional case examples are presented. A review of the literature reveals that up to 31% of patients have persistent pain at 2 years post surgery when autogenous iliac crest bone graft is harvested. Allograft supplementation of local autograft has been demonstrated in the literature to be as effective as autogenous iliac crest bone grafting in contributing to a successful posterior spinal fusion in patients with AIS. Modern demineralized bone matrix formulations have been found in both animal models as well as in a recent retrospective clinical review to contribute to a successful posterior spinal fusion in AIS. Bone morphogenetic protein has been shown to contribute to a successful posterior spinal fusion in complex pediatric spinal deformity patients. At 2 years follow-up, patients who underwent a posterior instrumented spinal fusion that was not augmented with any bone graft appear to have successful spinal fusions. Although autogenous iliac bone graft remains the benchmark to which bone grafting materials are compared, other options including the placement of no bone graft at all provides similar fusion rates in patients with AIS.

  20. Bone Metabolism after Total Hip Revision Surgery with Impacted Grafting: Evaluation using H215O and [18F]fluoride PET; A Pilot Study

    NARCIS (Netherlands)

    Temmerman, Olivier; Raijmakers, Pieter; Heyligers, Ide; Comans, Emile; Lubberink, Mark; Teule, Gerrit; Lammertsma, Adriaan

    2008-01-01

    Purpose: To evaluate bone blood flow and bone formation in patients after total hip revision surgery with impacted bone grafting using H2 15O and [18F]fluoride positron emission tomography (PET). Procedures: To asses bone blood flow and bone metabolism in bone allograft after impaction grafting,

  1. Bone grafting: An overview

    Directory of Open Access Journals (Sweden)

    D. O. Joshi

    2010-08-01

    Full Text Available Bone grafting is the process by which bone is transferred from a source (donor to site (recipient. Due to trauma from accidents by speedy vehicles, falling down from height or gunshot injury particularly in human being, acquired or developmental diseases like rickets, congenital defects like abnormal bone development, wearing out because of age and overuse; lead to bone loss and to replace the loss we need the bone grafting. Osteogenesis, osteoinduction, osteoconduction, mechanical supports are the four basic mechanisms of bone graft. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. An ideal bone graft material is biologically inert, source of osteogenic, act as a mechanical support, readily available, easily adaptable in terms of size, shape, length and replaced by the host bone. Except blood, bone is grafted with greater frequency. Bone graft indicated for variety of orthopedic abnormalities, comminuted fractures, delayed unions, non-unions, arthrodesis and osteomyelitis. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. By adopting different procedure of graft preservation its antigenicity can be minimized. The concept of bone banking for obtaining bone grafts and implants is very useful for clinical application. Absolute stability require for successful incorporation. Ideal bone graft must possess osteogenic, osteoinductive and osteocon-ductive properties. Cancellous bone graft is superior to cortical bone graft. Usually autologous cancellous bone graft are used as fresh grafts where as allografts are employed as an alloimplant. None of the available type of bone grafts possesses all these properties therefore, a single type of graft cannot be recomm-ended for all types of orthopedic abnormalities. Bone grafts and implants can be selected as per clinical problems, the equipments available and preference of

  2. Effect of VEGF-A165 addition on the integration of a cortical allograft in a tibial segmental defect in rabbits.

    Science.gov (United States)

    Ruiz-Ibán, Miguel Angel; Gonzalez-Lizán, Fausto; Diaz-Heredia, Jorge; Elías-Martin, Maria Elena; Correa Gorospe, Carlos

    2015-05-01

    Long-bone segmental defects caused by infection, fracture, or tumour are a challenge for orthopaedic surgeons. Structural allografts are sometimes used in their treatment but their poor biological characteristics are a liability. The objective of this study was to determine whether the addition of recombinant vascular endothelial growth factor-A (VEGF) to a structural allograft improved its integration into a rabbit tibial segmental defect in a non-union model. Tibial segmental defects were filled with heat sterilized allogenic tubular tibiae sections and then stabilized with a screw plate. In the VEGF treatment group (n = 6 tibiae), 2 μg of VEGF added to a 50 μl matrigel solution was inserted into the allograft cavity. In the control group (n = 6 tibiae), only matrigel was added. After 12 weeks, macroscopic and microscopic analysis, radiographs, and computerized micro-tomography (micro-CT) were performed. If allograft consolidation was present, a torsional resistance analysis was performed. Addition of VEGF to the allograft decreased the rate of osteosynthesis failure compared with the control group (1/6 vs. 5/6, p = 0.08), increased trabecular continuity evaluated by micro-CT in the bone-allograft interphases (8/12 vs. 2/12, p = 0.036) and histological trabecular continuity (7/12 vs. 0/12, p = 0.0046). Full consolidation was observed in three tibiae of the VEGF group and one in the control group (differences not significant); however, torsional resistance showed no significant differences (n.s.). Addition of VEGF to a structural allograph inserted into a rabbit tibial segmental defect increased allograft integration rate. Further research in this direction might help clinicians in dealing with large bone defects.

  3. Experimental studies on glycerol preserved vascular allografts

    NARCIS (Netherlands)

    Fahner, P.J.

    2014-01-01

    Autologous vein is the conduit of choice in patients with critical peripheral arterial disease who need a vascular reconstruction. However, autologous vein could be of inferior quality or used in prior surgery. Vascular allograft transplantation is an attractive alternative to prosthetic grafts in

  4. Renal Allograft in a Professional Boxer

    Directory of Open Access Journals (Sweden)

    Einollahi Behzad

    2008-01-01

    Full Text Available Significant health benefits result from regular physical activity for kidney transplant recipients. Nevertheless, some adverse effects also have been shown to be associated with highly intensive exercises. We report a kidney transplant professional boxer whose kidney allograft has remained in good health, despite his violent sport activities.

  5. A case of primary renal allograft dysfunction due to myeloma cast nephropathy

    Directory of Open Access Journals (Sweden)

    Umesh Lingaraj

    2015-01-01

    Full Text Available We report a rare case of primary renal allograft dysfunction due to myeloma cast nephropathy in a patient with no overt clinical features of multiple myeloma preceding his transplantation. A 45-year-old man on hemodialysis for six months for end-stage kidney disease due to presumed chronic glomerulonephritis developed immediate graft dysfunction post-transplantation. The graft biopsy was diagnostic of myeloma cast nephropathy. Other criteria for lambda light chain multiple myeloma were fulfilled with immunofixation electrophoresis and bone marrow biopsy. He was treated with plasmapheresis, bortezomib and high-dose dexamethasone. However, the patient succumbed to septicemia on the 37 th post-operative day. This is probably the first report of primary renal allograft dysfunction due to myeloma cast nephropathy diagnosed within the first week posttransplanation in a patient with unrecognized multiple myeloma.

  6. Teriparatide Therapy Enhances Devitalized Femoral Allograft Osseointegration and Biomechanics in a Murine Model

    Science.gov (United States)

    Reynolds, David G.; Takahata, Masahiko; Lerner, Amy L.; O’Keefe, Regis J.; Schwarz, Edward M.; Awad, Hani A.

    2010-01-01

    Despite the remarkable healing potential of long bone fractures, traumatic injuries that result in critical defects require challenging reconstructive limb sparing surgery. While devitalized allografts are the gold standard for these procedures, they are prone to failure due to their limited osseointegration with the host. Thus, the quest for adjuvants to enhance allograft healing remains a priority for this unmet clinical need. To address this, we investigated the effects of daily systemic injections of 40 µg/kg teriparatide (recombinant human parathyroid hormone) on the healing of devitalized allografts used to reconstruct critical femoral defects (4 mm) in C57Bl/6 mice. The femurs were evaluated at 4 and 6 weeks using micro CT, histology, and torsion testing. Our findings demonstrated that teriparatide induced prolonged cartilage formation at the graft-host junction at 4 weeks, which led to enhanced trabeculated bone callus formation and remarkable graft-host integration at 6-weeks. Moreover, we observed a significant 2-fold increase in normalized callus volume (1.04 ± 0.3 vs. 0.54 ± 0.14 mm3/mm; pTeriparatide treatment significantly increased the torsional rigidity (585±408 versus 1175±311 N.mm2) and yield torque (6.8±5.5 versus 10.5±4.2 N.mm) compared to controls. Interestingly, the Union Ratio correlated significantly with the yield torque and torsional rigidity (R2=0.59 and R2=0.77, pteriparatide as an adjuvant therapy for allograft repair in a mouse model of massive femoral defect reconstruction, and warrant further investigation in a larger animal model at longer time intervals to justify future clinical trials for PTH therapy in limb sparing reconstructive procedures. PMID:20950720

  7. Outcomes and complication rates of different bone grafting modalities in long bone fracture nonunions: a retrospective cohort study in 182 patients.

    Science.gov (United States)

    Flierl, Michael A; Smith, Wade R; Mauffrey, Cyril; Irgit, Kaan; Williams, Allison E; Ross, Erin; Peacher, Gabrielle; Hak, David J; Stahel, Philip F

    2013-09-09

    Novel bone substitutes have challenged the notion of autologous bone grafting as the 'gold standard' for the surgical treatment of fracture nonunions. The present study was designed to test the hypothesis that autologous bone grafting is equivalent to other bone grafting modalities in the management of fracture nonunions of the long bones. A retrospective review of patients with fracture nonunions included in two prospective databases was performed at two US level 1 trauma centers from January 1, 1998 (center 1) or January 1, 2004 (center 2), respectively, until December 31, 2010 (n = 574). Of these, 182 patients required adjunctive bone grafting and were stratified into the following cohorts: autograft (n = 105), allograft (n = 38), allograft and autograft combined (n = 16), and recombinant human bone morphogenetic protein-2 (rhBMP-2) with or without adjunctive bone grafting (n = 23). The primary outcome parameter was time to union. Secondary outcome parameters consisted of complication rates and the rate of revision procedures and revision bone grafting. The autograft cohort had a statistically significant shorter time to union (198 ± 172-225 days) compared to allograft (416 ± 290-543 days) and exhibited a trend towards earlier union when compared to allograft/autograft combined (389 ± 159-619 days) or rhBMP-2 (217 ± 158-277 days). Furthermore, the autograft cohort had the lowest rate of surgical revisions (17%) and revision bone grafting (9%), compared to allograft (47% and 32%), allograft/autograft combined (25% and 31%), or rhBMP-2 (27% and 17%). The overall new-onset postoperative infection rate was significantly lower in the autograft group (12.4%), compared to the allograft cohort (26.3%) (P grafting appears to represent the bone grafting modality of choice with regard to safety and efficiency in the surgical management of long bone fracture nonunions.

  8. Papillary renal cell carcinoma in allograft kidney

    International Nuclear Information System (INIS)

    Roy, Catherine; El Ghali, Sofiane; Buy, Xavier; Gangi, Afshin; Lindner, Veronique

    2005-01-01

    Papillary renal cell carcinoma is a subgroup of malignant renal epithelial neoplasms. Its occurrence in allograft transplanted kidney has not been debated in the literature. We report two pathologically proven cases and discuss the clinical hypothesis for such neoplasms and the aspect on MR images. The paramagnetic effect of the iron associated with an absence of signal coming from calcifications is a plausible explanation for this unusual hypointense appearance on T2-weighted sequence. (orig.)

  9. Late de novo minimal change disease in a renal allograft

    International Nuclear Information System (INIS)

    Madhan, Krishan K.; Camp, Cynric R. E. Temple

    2009-01-01

    Among the causes of the nephrotic syndrome in renal allografts, minimal change disease is a rarity with only few cases described in the medical literature. Most cases described have occurred early in the post-transplant course. There is no established treatment for the condition but prognosis is favorable. We describe a case of minimal change disease that developed 8 years after a successful transplantation of a renal allograft in a middle-aged woman. The nephrotic syndrome was accompanied by deterioration of allograft function. Treatment with mycophenolate mofetil was successful in inducing remission and stabilizing allograft function. (author)

  10. Bone graft materials in fixation of orthopaedic implants in sheep

    DEFF Research Database (Denmark)

    Babiker, Hassan

    2013-01-01

    Bone graft is widely used within orthopaedic surgery especially in revision joint arthroplasty and spine fusion. The early implant fixation in the revision situation of loose joint prostheses is important for the long-term survival. Bone autograft has been considered as gold standard in many...... orthopaedic procedures, whereas allograft is the gold standard by replacement of extensive bone loss. However, the use of autograft is associated with donor site morbidity, especially chronic pain. In addition, the limited supply is a significant clinical challenge. Limitations in the use of allograft include...... skeletal bones. The osteoconductive properties of the composite might be improved by adding bone marrow aspirate (BMA), which can be harvested during surgery. Other alternatives to bone graft are demineralised bone matrix (DBM) and human cancellous bone (CB). DBM is prepared by acid extraction of human...

  11. Tenosynovial Giant Cell Tumor in the Midfoot Treated With Femoral Head Allograft Reconstruction.

    Science.gov (United States)

    Fuchs, Daniel J; Switaj, Paul J; Peabody, Terrance D; Kadakia, Anish R

    Tenosynovial giant cell tumor (also known as giant cell tumor of tendon sheath or pigmented villonodular synovitis) is a rare soft tissue tumor that arises from the tenosynovium of a tendon sheath or the synovium of a diarthrodial joint. This disease process occurs infrequently in the foot and ankle but can result in significant bone erosion and destructive changes of affected joints. These cases are challenging to treat, because the tumor most commonly presents in young, active patients and can be associated with extensive bone loss. We review a case of tenosynovial giant cell tumor of tendon sheath of the midfoot, which was treated with mass resection, structural femoral head allograft bone grafting, and internal fixation with dorsal plating. The patient had achieved successful bony fusion and acceptable functional outcomes at the final follow-up visit 40 months postoperatively. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  12. The effects of bone marrow aspirate, bone graft, and collagen composites on fixation of titanium implants

    DEFF Research Database (Denmark)

    Babiker, Hassan; Ding, Ming; Sandri, Monica

    2012-01-01

    Replacement of extensive local bone loss especially in revision joint arthroplasty and spine fusion is a significant clinical challenge. Allograft and autograft have been considered as gold standards for bone replacement. However, there are several disadvantages such as donor site pain, bacterial...... on the early fixation of bone implants in this sheep model. © 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2012....

  13. The biomechanical behavior on the interface of tumor arthrosis/allograft prosthetic composite by finite element analysis

    Science.gov (United States)

    Chen, H. Z.; Jiang, W.; Zou, W.; Luo, J. M.; Chen, J. Y.; Tu, C. Q.; Xing, B. B.; Gu, Z. W.; Zhang, X. D.

    2008-11-01

    The biomechanical behavior of the uniting interface between the allograft bone and the autogenetic bone plays an important role in the treatment of the proximal femur massive defects with artificial tumor arthrosis/allograft prosthetic composite (TAAPC). According to the CT data of a patient, a 3D medical treatment model of TAAPC was established. Under the loads of 1.5 and 2.5 times standard body weight (70 kg), the mechanical behavior of the treatment model was analyzed by finite element analysis (FEA) for three typical healing periods. The results show that there are significant differences in the stress values and distribution in different healing periods. With healing of osteotomy, the hardness of the tissue of the uniting interface increases, the stress in uniting area was increased greatly and the stress concentration decreased. After cured the stress almost reached the level of normal bone. In the initial stage of healing, the healing training is not encouraged because there is an obvious risk of fracture of prosthesis and bone cement. In addition, porous hydroxyapatite (HA) ceramic used as bone tissue scaffold for this case, not only facilitates the generation of new bone, but also can avoid this risk caused by the non-uniting interface.

  14. Composite Biomaterial as a Carrier for Bone-Active Substances for Metaphyseal Tibial Bone Defect Reconstruction in Rats

    DEFF Research Database (Denmark)

    Horstmann, Peter Frederik; Raina, Deepak Bushan; Isaksson, Hanna

    2017-01-01

    /hydroxyapatite biomaterial (GBM) could serve as a carrier for local delivery of bone morphogenic protein-2 (BMP-2) and zoledronic acid (ZA) in a tibia defect model in rats. Empty and allograft-filled defects were used as controls. A 3 × 4-mm metaphyseal bone defect was created in the proximal tibia, and the rats were...

  15. Patient And Allograft Survival After Transplantation With A Living ...

    African Journals Online (AJOL)

    Departments of Human Anatomy & Surgery, University of Nairobi. BACICGROUND: Late allograft loss remains a key area of concern. This study was aimed at determining the patient and renal allograft outcome and identifying the factors responsible for survival following transplantation with a living-related donor kidney at.

  16. Allograft Arthrodesis of the Knee in High-grade Osteosarcoma

    Directory of Open Access Journals (Sweden)

    Teng-Le Huang

    2005-09-01

    Conclusion: Due to the high rate of complications in this study, we conclude that allograft arthrodesis should be left as a salvage or “back-up” reconstructive procedure after resection of osteosarcoma around the knee, unless there are special indications for this procedure. We found allograft fracture to be the most common complication.

  17. Surgical techniques and radiological findings of meniscus allograft transplantation.

    Science.gov (United States)

    Lee, Hoseok; Lee, Sang Yub; Na, Young Gon; Kim, Sung Kwan; Yi, Jae Hyuck; Lim, Jae Kwang; Lee, So Mi

    2016-08-01

    Meniscus allograft transplantation has been performed over the past 25 years to relieve knee pain and improve knee function in patients with an irreparable meniscus injury. The efficacy and safety of meniscus allograft transplantation have been established in numerous experimental and clinical researches. However, there is a lack of reviews to aid radiologists who are routinely interpreting images and evaluating the outcome of the procedures, and also meniscus allograft transplantation is not widely performed in most hospitals. This review focuses on the indications of the procedure, the different surgical techniques used for meniscus allograft transplantation according to the involvement of the lateral and medial meniscus, and the associated procedures. The postoperative radiological findings and surgical complications of the meniscus allograft transplantation are also described in detail. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Chemical sterilization of allograft dermal tissues.

    Science.gov (United States)

    Phipps, Abigail; Vaynshteyn, Edward; Kowalski, John B; Ngo, Manh-Dan; Merritt, Karen; Osborne, Joel; Chnari, Evangelia

    2017-12-01

    Common terminal sterilization methods are known to alter the natural structure and properties of soft tissues. One approach to providing safe grafts with preserved biological properties is the combination of a validated chemical sterilization process followed by an aseptic packaging process. This combination of processes is an accepted method for production of sterile healthcare products as described in ANSI/AAMI ST67:2011. This article describes the validation of the peracetic acid and ethanol-based (PAAE) chemical sterilization process for allograft dermal tissues at the Musculoskeletal Transplant Foundation (MTF, Edison, NJ). The sterilization capability of the PAAE solution used during routine production of aseptically processed dermal tissue forms was determined based on requirements of relevant ISO standards, ISO 14161:2009 and ISO 14937:2009. The resistance of spores of Bacillus subtilis, Clostridium sporogenes, Mycobacterium terrae, Pseudomonas aeruginosa, Enterococcus faecium, and Staphylococcus aureus to the chemical sterilization process employed by MTF was determined. Using a worst-case scenario testing strategy, the D value was calculated for the most resistant microorganism, Bacillus. The 12D time parameter determined the minimum time required to achieve a SAL of 10 -6 . Microbiological performance qualification demonstrated a complete kill of 10 6 spores at just a quarter of the full cycle time. The validation demonstrated that the PAAE sterilization process is robust, achieves sterilization of allograft dermal tissue to a SAL 10 -6 , and that in combination with aseptic processing secures the microbiological safety of allograft dermal tissue while avoiding structural and biochemical tissue damage previously observed with other sterilization methods such as ionizing irradiation.

  19. A review: HIV inactivation in allografts

    International Nuclear Information System (INIS)

    Astrid Lobo Gajiwala

    1999-01-01

    This review focuses on the use of 70% ethanol as a virucidal agent with particular reference to human immunodeficiency virus (HIV). The transmission of this virus through allografts is of particular to tissue banks since the screening for HIV antibody of potential donors of tissues does not eliminate the risk of HIV transmission. Seronegetive donors who were in the 'window' period i.e. the time between infection and seroconversion, have been known to transmit HIV. It is suggested that exposure to 70% ethanol be included as a routine step in the banking of tissues whether fresh frozen or freeze-dried

  20. Meniscal allograft transplantation: a meta-analysis

    Directory of Open Access Journals (Sweden)

    De Bruycker Manolito

    2017-01-01

    Full Text Available Purpose: This meta-analysis evaluates the mid- to long-term survival outcome of MAT (meniscal allograft transplantation. Potential prognosticators, with particular focus on chondral status and age of the patient at the time of transplantation, were also analysed. Study design: Meta-analysis. Methods: An online database search was performed using following search string: “meniscal allograft transplantation” and “outcome”. A total of 65 articles were analysed for a total of 3157 performed MAT with a mean follow-up of 5.4 years. Subjective and clinical data was analysed. Results: The subjective and objective results of 2977 patients (3157 allografts were analysed; 70% were male, 30% were female. Thirty-eight percent received an isolated MAT. All other patients underwent at least one concomitant procedure. Lysholm, Knee injury and Osteoarthritis Outcome (KOOS, International Knee Documentation Committee (IKDC and Visual Analogue Scale (VAS scores were analysed. All scores showed a good patient satisfaction at long-term follow-up. The mean overall survival rate was 80.9%. Complication rates were comparable to standard meniscal repair surgery. There was a degenerative evolution in osteoarthritis with at least one grade in 1760 radiographically analysed patients. Concomitant procedures seem to have no effect on the outcome. Age at transplantation is a negative prognosticator. The body mass index (BMI of the patient shows a slightly negative correlation with the outcome of MAT. Conclusions: MAT is a viable solution for the younger patient with chronic pain in the meniscectomised knee joint. The complications are not severe and comparable to meniscal repair. The overall failure rate at final follow-up is acceptable and the allograft heals well in most cases, but MAT cannot be seen as a definitive solution for post-meniscectomy pain. The correct approach to the chronic painful total meniscectomised knee joint thus requires consideration of all

  1. Cortical Strut Allograft Support of Modular Femoral Junctions During Revision Total Hip Arthroplasty.

    Science.gov (United States)

    Lim, Chin Tat; Amanatullah, Derek F; Huddleston, James I; Hwang, Katherine L; Maloney, William J; Goodman, Stuart B

    2017-05-01

    There is risk of junction failure when using modular femoral stems for revision total hip arthroplasty (THA), especially with loss of bone stock in the proximal femur. Using a cortical strut allograft may provide additional support of a modular femoral construct in revision THA. We reviewed prospectively gathered clinical and radiographic data for 28 revision THAs performed from 2004 to 2014 using cementless modular femoral components with cortical strut allograft applied to supplement proximal femoral bone loss: 5 (18%) were fluted taper designs and 23 (82%) were porous cylindrical designs All the patients had a Paprosky grade IIIA or greater femoral defect. The mean follow-up was 5.4 ± 3.9 years. The Harris Hip Scores improved from 26 ± 10 points preoperatively to 71 ± 10 points at final follow-up (P hips) of all revision or conversion THAs were in place at final follow-up. Three (11%) patients underwent reoperations, 2 for infection and 1 for periprosthetic fracture. There was no statistical significant change in femoral component alignment (P = .161) at final follow-up. Mean subsidence was 1.8 ± 1.3 mm at final follow-up. Femoral diameter increased from initial postoperative imaging to final follow-up imaging by a mean of 9.1 ± 5.1 mm (P hips (96%) achieved union between the cortical strut allograft and the host femur. The use of a modular femoral stem in a compromised femur with a supplementary cortical strut allgraft is safe and provides satisfactory clinical and radiological outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Pasteurized autograft-prosthesis composite for proximal femoral reconstruction: an alternative to allograft composite.

    Science.gov (United States)

    Eid, Ahmed Shawky; Jeon, Dae-Geun; Song, Won Seok; Lee, Soo-Yong; Cho, Wan Hyeong

    2011-06-01

    Allograft-prosthesis composite (APC) for proximal femur reconstruction have shown favorable longevity and functional outcome compared to endoprosthesis, owing to restoration of bone stock, load-sharing property, and biological attachment of abductors and iliopsoas tendons. This study examined whether a pasteurized-prosthesis composite (PPC) is comparable to APC regarding implant survival, functional outcome, and complication rates. We retrospectively reviewed 18 patients with proximal femur malignancy that underwent reconstruction with a cemented pasteurized autograft-prosthesis composite between 1993 and 2008. We evaluated implant survival (Kaplan-Meier), functional outcome (MSTS score), complications and secondary operations. The estimated survival rate of the 18 composites was 86% at 5 and 10 years. Within a mean follow-up of 93 months (median 113, range 14-163) two composites (11%) were removed due to un-resolving infection. The mean MSTS functional score of surviving 16 composites was 80% (range 70-95). Non-union and stem loosening in host bone were identified in a single patient, while infection developed in two patients. THA conversion occurred in three composites due to secondary osteoarthritis in two, and subluxation in one case. Two of the six cases, with greater trochanter (GT) reconstruction, showed GT avulsion. No autograft was fractured. Pasteurized autograft-prosthesis composite (PPC) of the proximal femur has comparable survival rate, functional outcome, and complication rates to allograft-prosthesis composite (APC), thereby offering an alternative reconstructive option for proximal femoral reconstruction.

  3. The prevalence of osteopenia in pediatric renal allograft recipients varies with the method of analysis.

    Science.gov (United States)

    Saland, J M; Goode, M L; Haas, D L; Romano, T A; Seikaly, M G

    2001-09-01

    Pediatric renal allograft recipients often suffer from osteopenia and the potential for increased fractures. Although modern densitometers are widely available, their use in children is complicated by lack of optimal interpretive criteria. We reviewed dual energy X-ray absorptiometry (DEXA) studies in 33 patients with functional renal allografts 4.4 +/- 3.6 years after transplantation. We interpreted our data using three previously described methods of assigning bone mineral density (BMD) Z scores. BMD was directly related to age, height, weight, body surface area, and pubertal status (p < 0.001). Using gender-mixed reference data matched by chronological age, the mean BMD Z score was -0.9 +/- 1.3 vs. 0.4 +/- 1.4 when matched by height-age (p < 0.001). Height-age adjustment particularly increased the BMD Z score of pubertal adolescents. In a subset of 22 patients, gender-matched reference data led to different results from the gender-mixed reference population (mean BMD Z score 0.0 +/- 1.7 vs. -0.8 +/- 1.4, p < 0.001). The perceived prevalence of osteopenia among pediatric kidney transplant recipients differs using analysis based on chronological age, height-age, or gender-matched reference data. Further studies are necessary to determine the clinical significance of measured bone density in this population.

  4. Adefovir nephrotoxicity in a renal allograft recipient

    Directory of Open Access Journals (Sweden)

    N George

    2015-01-01

    Full Text Available Adefovir dipivoxil, an oral prodrug of adefovir, is used in the treatment of lamivudine-resistant hepatitis B virus (HBV infection. Nephrotoxicity manifesting as proximal renal tubular dysfunction and acute tubular necrosis (ATN were commonly reported in the past, when higher doses were used for the treatment of human immunodeficiency virus infection. However, nephrotoxicity is rare at lower doses that are currently recommended for the treatment of HBV infection. A 31-year-old female was detected to be hepatitis B surface antigen positive months after a kidney transplant. The patient was initiated on lamivudine, but developed resistance after 1 year of treatment, at which time low-dose adefovir was added. The patient developed renal allograft dysfunction after 10 months of starting adefovir. Serum creatinine increased from 1.1 mg/dl to 1.9 mg/dl, along with progressively increasing sub-nephrotic proteinuria. Renal allograft biopsy revealed features of ATN. After discontinuation of adefovir, proteinuria resolved and renal dysfunction improved slowly over the next 2 years. Adefovir-induced nephrotoxicity, although uncommon at lower doses, needs to be considered in the differential diagnosis of renal dysfunction and sub-nephrotic proteinuria occurring in patients receiving adefovir for prolonged periods.

  5. Crevicular fluid levels of interleukin-8, interleukin-17 and soluble intercellular adhesion molecule-1 after regenerative periodontal therapy.

    Science.gov (United States)

    Erdemir, Ebru Olgun; Hendek, Meltem Karsiyaka; Keceli, H Gencay; Apan, Teoman Z

    2015-01-01

    The aim of this study is to evaluate the influence of regenerative periodontal therapy on clinical parameters and interleukin-8 (IL-8), IL-17 and soluble intercellular adhesion molecule-1 (sICAM-1) levels in gingival crevicular fluid (GCF) of subjects with chronic periodontitis (CP). Fifteen patients received demineralized freeze-dried bone allograft (DFDBA) surgically to the site of infrabony defect. Clinical periodontal indices were recorded, and GCF samples were collected at baseline and at the 6(th) and the 9(th) month after the surgery. Except plaque index, all clinical parameters improved following surgery (P periodontal healing after demineralized freeze-dried bone grafting.

  6. Anterior Cervical Discectomy with Instrumented Allograft Fusion: Lordosis Restoration and Comparison of Functional Outcomes among Patients of Different Age Groups.

    Science.gov (United States)

    Muzević, Dario; Splavski, Bruno; Boop, Frederick A; Arnautović, Kenan I

    2018-01-01

    To investigate clinical parameters of anterior cervical discectomy and fusion (ACDF) treatment and outcomes using osseous allografts in different age groups, study the postoperative results of restoration of lordosis, and evaluate the utility of bone allografts for ACDF, including graft subsidence. We reviewed data from 154 patients with clinical symptoms and radiologic signs of disc herniation and/or cervical spondylosis. Decompression was achieved through discectomy, osteophyte ablation, endplate drilling, and foraminotomy. Fusion was achieved with allografts, demineralized bone matrix, and cervical plates/screws. The relationships between preoperative and postoperative cervical spine configuration (ie, Benzel's criteria), pain intensity, and neurologic status were analyzed. The mean patient age was 51 years, and the median duration of symptoms was 6 months. The mean age differed significantly between the patients with diabetes and those without diabetes. The mean body mass index (BMI) was 30.36. Fifty-two patients had disc herniation, and 102 had spondylosis. Surgery was performed on a total of 313 levels. The median duration of follow-up was 24 months. Marked improvements in postoperative spine configuration or preservation of lordosis were recorded. Overall, 122 patients were neurologically intact, and 32 patients experienced residual postsurgery neurologic deficits (minor, n = 22; moderate, n = 9; severe, n = 1). Postoperative pain intensity and neurologic status were significantly improved. Outcomes were excellent in 66 patients, good in 61, fair in 24, and poor in 3 (no mortality). No significant differences in patient age, smoking habits, diabetes, or BMI were seen among outcomes, or between patients with soft disc herniation or spondylosis. Osseous allografting can excellently restore cervical lordosis regardless of age and is an excellent graft choice for ACDF. Patients of advanced age with comorbidities should not be denied surgery. Copyright © 2017

  7. Free vascularized fibula grafts for salvage of failed oncologic long bone reconstruction and pathologic fractures.

    Science.gov (United States)

    Friedrich, Jeffrey B; Moran, Stephen L; Bishop, Allen T; Shin, Alexander Y

    2009-01-01

    Vascularized bone grafts, particularly the free fibula transfer, have incited revolutionary changes in the field of skeletal reconstruction. In no place has this been more evident than in oncologic reconstruction. The free vascularized fibula graft has been used to good effect for primary long-bone reconstruction, long-bone allograft complication salvage, and pathologic fracture salvage of the long bones. Although many of these procedures often entail significant complications, limb salvage has been made possible in a majority of patients using transfers of free vascularized fibula grafts. The purpose of this review is to critically evaluate the technique of onlay free vascularized fibula grafts for salvage of allograft complications and pathologic fractures of the long bones. This will be accomplished by reviewing the problem of allograft complications and pathologic fractures, the current treatment modalities available, the outcomes of these treatments, and future directions of treatment for this particular problem.

  8. Are the current chronic allograft nephropathy grading systems sufficient to predict renal allograft survival?

    Directory of Open Access Journals (Sweden)

    G.T. Moscoso-Solorzano

    2008-10-01

    Full Text Available A major problem in renal transplantation is identifying a grading system that can predict long-term graft survival. The present study determined the extent to which the two existing grading systems (Banff 97 and chronic allograft damage index, CADI correlate with each other and with graft loss. A total of 161 transplant patient biopsies with chronic allograft nephropathy (CAN were studied. The samples were coded and evaluated blindly by two pathologists using the two grading systems. Logistic regression analyses were used to evaluate the best predictor index for renal allograft loss. Patients with higher Banff 97 and CADI scores had higher rates of graft loss. Moreover, these measures also correlated with worse renal function and higher proteinuria levels at the time of CAN diagnosis. Logistic regression analyses showed that the use of angiotensin-converting enzyme inhibitor (ACEI, hepatitis C virus (HCV, tubular atrophy, and the use of mycophenolate mofetil (MMF were associated with graft loss in the CADI, while the use of ACEI, HCV, moderate interstitial fibrosis and tubular atrophy and the use of MMF were associated in the Banff 97 index. Although Banff 97 and CADI analyze different parameters in different renal compartments, only some isolated parameters correlated with graft loss. This suggests that we need to review the CAN grading systems in order to devise a system that includes all parameters able to predict long-term graft survival, including chronic glomerulopathy, glomerular sclerosis, vascular changes, and severity of chronic interstitial fibrosis and tubular atrophy.

  9. Are the current chronic allograft nephropathy grading systems sufficient to predict renal allograft survival?

    Directory of Open Access Journals (Sweden)

    G.T. Moscoso-Solorzano

    Full Text Available A major problem in renal transplantation is identifying a grading system that can predict long-term graft survival. The present study determined the extent to which the two existing grading systems (Banff 97 and chronic allograft damage index, CADI correlate with each other and with graft loss. A total of 161 transplant patient biopsies with chronic allograft nephropathy (CAN were studied. The samples were coded and evaluated blindly by two pathologists using the two grading systems. Logistic regression analyses were used to evaluate the best predictor index for renal allograft loss. Patients with higher Banff 97 and CADI scores had higher rates of graft loss. Moreover, these measures also correlated with worse renal function and higher proteinuria levels at the time of CAN diagnosis. Logistic regression analyses showed that the use of angiotensin-converting enzyme inhibitor (ACEI, hepatitis C virus (HCV, tubular atrophy, and the use of mycophenolate mofetil (MMF were associated with graft loss in the CADI, while the use of ACEI, HCV, moderate interstitial fibrosis and tubular atrophy and the use of MMF were associated in the Banff 97 index. Although Banff 97 and CADI analyze different parameters in different renal compartments, only some isolated parameters correlated with graft loss. This suggests that we need to review the CAN grading systems in order to devise a system that includes all parameters able to predict long-term graft survival, including chronic glomerulopathy, glomerular sclerosis, vascular changes, and severity of chronic interstitial fibrosis and tubular atrophy.

  10. Cardiac allograft immune activation: current perspectives

    Directory of Open Access Journals (Sweden)

    Chang D

    2014-12-01

    Full Text Available David Chang, Jon Kobashigawa Cedars-Sinai Heart Institute, Los Angeles, CA, USA Abstract: Heart transplant remains the most durable option for end-stage heart disease. Cardiac allograft immune activation and heart transplant rejection remain among the main complications limiting graft and recipient survival. Mediators of the immune system can cause different forms of rejection post-heart transplant. Types of heart transplant rejection include hyperacute rejection, cellular rejection, antibody-mediated rejection, and chronic rejection. In this review, we will summarize the innate and adaptive immune responses which influence the post-heart transplant recipient. Different forms of rejection and their clinical presentation, detection, and immune monitoring will be discussed. Treatment of heart transplant rejection will be examined. We will discuss potential treatment strategies for preventing rejection post-transplant in immunologically high-risk patients with antibody sensitization. Keywords: heart transplant, innate immunity, adaptive immunity, rejection, immunosuppression

  11. Bipolar fresh osteochondral allograft of the ankle.

    Science.gov (United States)

    Giannini, Sandro; Buda, Roberto; Grigolo, Brunella; Bevoni, Roberto; Di Caprio, Francesco; Ruffilli, Alberto; Cavallo, Marco; Desando, Giovanna; Vannini, Francesca

    2010-01-01

    Severe post-traumatic ankle arthritis poses a reconstructive challenge in the young and active patient. Bipolar fresh osteochondral allograft (BFOA) may represent an intriguing alternative to arthrodesis and prosthetic replacement. The aim of this study was to describe a lateral trans-malleolar technique for BFOA, and to evaluate the results in a case series. From 2004 to 2006, 32 patients, mean age of 36.8 +/- 8.4 years, affected by ankle arthritis underwent BFOA with a mean followup of 31.2 months. The graft was prepared by specifically designed jigs, including the talus and the tibia with the medial malleolus. The host surfaces were prepared by the same jigs through a lateral approach. The graft was placed and fixed with twist-off screws. Patients were evaluated clinically and radiographically at 2, 4, and 6 month after operation, and at a minimum 24 months followup. A biopsy of the grafted areas was obtained from 7 patients at 1-year followup for histological and immunohistochemical examination. Preoperative AOFAS score was 33.1 +/- 10.9 and postoperatively 69.5 +/- 19.4 (p < 0.0005). Six failures occurred. Cartilage harvests showed hyaline-like histology with a normal collagen component but low proteoglycan presence and a disorganized structure. Samples were positive for MMP-1, MMP-13 and Capsase-3. The use of BFOA represents an intriguing alternative to arthrodesis or arthroplasty. We believe precise allograft sizing, stable fitting and fixation and delayed weightbearing were key factors for a successful outcome. Further research regarding the immunological behavior of transplanted cartilage is needed.

  12. Deceased donor skin allograft banking: Response and utilization

    Directory of Open Access Journals (Sweden)

    Gore Madhuri

    2010-10-01

    Full Text Available Background: In the absence of xenograft and biosynthetic skin substitutes, deceased donor skin allografts is a feasible option for saving life of patient with extensive burn injury in our country. Aims: The first deceased donor skin allograft bank in India became functional at Lokmanya Tilak Municipal (LTM medical college and hospital on 24 th April 2000. The response of Indian society to this new concept of skin donation after death and the pattern of utilization of banked allografts from 2000 to 2010 has been presented in this study. Settings and Design: This allograft skin bank was established by the department of surgery. The departments of surgery and microbiology share the responsibility of smooth functioning of the bank. Materials and Methods: The response in terms of number of donations and the profile of donors was analyzed from records. Pattern and outcome of allograft utilization was studied from specially designed forms. Results: During these ten years, 262 deceased donor skin allograft donations were received. The response showed significant improvement after counselling was extended to the community. Majority of the donors were above 70 years of age and procurement was done at home for most. Skin allografts from 249 donors were used for 165 patients in ten years. The outcome was encouraging with seven deaths in 151 recipients with burn injuries. Conclusions: Our experience shows that the Indian society is ready to accept the concept of skin donation after death. Use of skin allografts is life saving for large burns. We need to prepare guidelines for the establishment of more skin banks in the country.

  13. Osteochondral and Meniscal Allograft Transplantation in the Football (Soccer) Player

    OpenAIRE

    G?rtz, Simon; Williams, Riley J.; Gersoff, Wayne K.; Bugbee, William D.

    2012-01-01

    Knee injuries are common in football, frequently involving damage to the meniscus and articular cartilage. These injuries can cause significant disability, result in loss of playing time, and predispose players to osteoarthritis. Osteochondral allografting is an increasingly popular treatment option for osteoarticular lesions in athletes. Osteochondral allografts provide mature, orthotopic hyaline cartilage on an osseous scaffold that serves as an attachment vehicle, which is rapidly replaced...

  14. Comparison of the regenerative potential of an allograft used alone and that in conjunction with an immunosuppressive drug in the treatment of human periodontal infrabony defects: A clinical and radiological study

    Directory of Open Access Journals (Sweden)

    Dhawan Shivani

    2010-01-01

    Full Text Available Background: Experimentation confirmed the conclusion that bone allografts, like other tissue and organ allografts, are immunogenic. These immune responses cause resorption of allograft, thus lowering the bone formation capacity of the graft. An attempt has been made in this study to prevent immune reactions and achieve enhanced regeneration of allograft-demineralized freeze-dried bone matrix by incorporating it with an immunosuppressive drug Cyclosporine-A (CsA in the treatment of human periodontal infrabony defects. Materials and Methods: Fifteen patients showing clinical evidence of almost bilateral infrabony defects requiring bone grafting procedures were selected. In each patient, the infrabony defect of one side of the arch was designated as Group A (control site and the infrabony defect of the contralateral side of the same arch was designated as Group B (test site. Results: On comparative evaluation of the two groups (by Student t-test, the mean values of reduction in probing depth (P=0.81 NS and gain in clinical attachment level (P=1.00 NS of Group B were found to be greater than that of Group-A, but the differences were statistically non-significant. The mean linear bone fill (P=0.010 FNx08 of Group B was also detected to be higher than that of Group A, and the difference was found to be statistically significant. Conclusion: Increase in linear bone fill in Group B signifies the role of CsA in augmenting the regenerative potential of allograft by eliminating immune reactions.

  15. Preservation and sterilization methods of the meniscal allografts: literature review.

    Science.gov (United States)

    Mickiewicz, Patrycja; Binkowski, Marcin; Bursig, Henryk; Wróbel, Zygmunt

    2014-09-01

    Nowadays, there are four types of meniscal allografts known: fresh, cryopreserved, deep-frozen and lyophilized ones but only two of them are widely used in clinical practice. Use of different types of meniscal allografts still remains controversial due to preparation method, their biomechanical properties as well as cost which is connected with processing and storage. The main aim of this review is to present the current status of knowledge concerning meniscal allograft preservation and sterilization, especially the advantages and disadvantages of each method. Authors wanted to show a broad spectrum of methods used and conceptions presented by other authors. The second aim is to gather available information about meniscal preservation and sterilization methods in one paper. Deep-frozen and cryopreserved meniscal allografts are the most frequently used ones in the clinical practice. The use of fresh grafts stays controversial but also has many followers. Lyophilized grafts in turn are not applied at present due to some serious drawbacks including reduction of tensile strength, poor rehydration, graft shrinkage and post-transplantation joint effusion as well as increased risk of meniscal size reduction. An application of sterilizing agents make the meniscal allograft free from the bacteria and viruses, but also it may cause serious structure changes. Therefore, choosing just one ideal method of meniscal allograft preservation and sterilization is complicated and should be based on broad knowledge and experience of surgeon performing the transplantation.

  16. Clinical and functional outcomes of tibial intercalary allograft reconstructions

    Directory of Open Access Journals (Sweden)

    Lucas López Millán

    2012-12-01

    Full Text Available Background The purpose of this study was to evaluate the survival, the complications and the functional outcome of intercalary tibial allografts reconstructions following tumor resections. Methods Intercalary tibia segmental allografts were implanted in 26 consecutive patients after segmental resections. Average follow-up was 6 years. Allograft survival was determined with the Kaplan-Meier method. Function was evaluated with the Musculoskeletal Tumor Society scoring system (MSTS. Results The rate of survival was 84% (CI 95%: 90%- 70% at 5 years and 79% at 10 years (CI 95%: 95%-63%. Allografts were removed in 5 patients (3 due to infections and 2 due to local recurrences. Two patients showed diaphyseal nonunion and 3 had an incomplete fracture, but it was not necessary to remove the allografts. Average MSTS functional score was 29 points (range 27 to 30. Conclusions Despite the incidence of complications, this analysis showed an acceptable survival with excellent functional scores. The use of intercalary allograft clearly has a place in the reconstruction of a segmental defect created by the resection of a tumor in the diaphyseal and/or metaphyseal portion of the tibia.

  17. Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion

    Science.gov (United States)

    Liao, Jen-Chung; Chen, Wen-Jer; Chen, Lih-Huei

    2007-01-01

    From July 2004 to June 2005, 19 patients with 25 discs underwent anterior cervical discectomy and interbody fusion (ACDF) in which polyetheretherketone (PEEK) cages were filled with freeze-dried cancellous allograft bone. This kind of bone graft was made from femoral condyle that was harvested during total knee arthroplasty. Patient age at surgery was 52.9 (28–68) years. All patients were followed up at least 1 year. We measured the height of the disc and segmental sagittal angulation by pre-operative and post-operative radiographs. CT scan of the cervical spine at 1 year was used to evaluate fusion rates. Odom's criteria were used to assess the clinical outcome. All interbody disc spaces achieved successful union at 1-year follow-up. The use of a PEEK cage was found to increase the height of the disc immediately after surgery (5.0 mm pre-operatively, 7.3 mm immediately post-operatively). The final disc height was 6.2 mm, and the collapse of the disc height was 1.1 mm. The segmental lordosis also increased after surgery (2.0° pre-operatively, 6.6° immediately post-operatively), but the mean loss of lordosis correction was 3.3° at final follow-up. Seventy-four percent of patients (14/19) exhibited excellent/good clinical outcomes. Analysis of the results indicated the cancellous allograft bone-filled PEEK cage used in ACDF is a good choice for patients with cervical disc disease, and avoids the complications of harvesting iliac autograft. PMID:17639386

  18. Clinical uses of radiosterilized freeze-dried human bone: its application in buccomaxillary surgery

    International Nuclear Information System (INIS)

    Wolfsohn, B.; Taramasso, F.; Godoy, J.; Wodowoz, O.; Saldias, M.; Silva, W.; Machin, D.; Sanchez, G.; Alvarez, I.

    2008-01-01

    Full text: The objective of this paper is to evaluate the uses of different human bone tissue allografts in bucomaxillary surgery between 2005 and 2007. Presentation of our experience using single freeze dried bone allografts and associated to bovine collagen membranes (commercial registered). Twenty patients were treated with cortical struts, cancellous chips, morsellized and morsellized demineralized bone. All the grafts were processed at the INDT multi tissue bank from cardiac arrest and brain death cadaveric donors. All the tissues were radiosterilized by Gamma radiation. Bone allografts were used: 1) to optimize bone support increasing maxillar or mandible bone before implant surgery. 2) in dehiscences and fissures during the implant surgery. 3) to stimulate bone regeneration in alveolar cavity, post-apicectomies, and cystectomies as well as for bone defects. The patients were periodically evaluated using standardized protocols. All the cases were successful showing clinic and radiologically osseointegration after 6 and 12 months. Results were evaluated considering surgical technique and patients bucomaxillary rehabilitation. Clinical uses of bone allografts confirm in our experience, as scientific literature outcomes shows, are useful in patients that refuses autografts ablation. (Author)

  19. Ridge preservation comparing socket allograft alone to socket allograft plus facial overlay xenograft: a clinical and histologic study in humans.

    Science.gov (United States)

    Poulias, Evmenios; Greenwell, Henry; Hill, Margaret; Morton, Dean; Vidal, Ricardo; Shumway, Brian; Peterson, Thomas L

    2013-11-01

    Previous studies of ridge preservation showed a loss of ≈18% or 1.5 mm of crestal ridge width in spite of treatment. The primary aim of this randomized, controlled, masked clinical trial is to compare a socket graft to the same treatment plus a buccal overlay graft, both with a polylactide membrane, to determine if loss of ridge width can be prevented by use of an overlay graft. Twelve patients who served as positive controls received an intrasocket mineralized cancellous allograft (socket group), and 12 patients received the same socket graft procedure plus buccal overlay cancellous xenograft (overlay group). Horizontal ridge dimensions were measured with a digital caliper, and vertical ridge changes were measured from a stent. Before implant placement, at 4 months, a trephine core was obtained for histologic analysis. The mean horizontal ridge width at the crest for the socket group decreased from 8.7 ± 1.0 to 7.1 ± 1.5 mm for a mean loss of 1.6 ± 0.8 mm (P overlay group decreased from 8.4 ± 1.4 to 8.1 ± 1.4 mm for a mean loss of 0.3 ± 0.9 mm (P >0.05). The overlay group was significantly different from the socket group (P overlay group had 40% ± 16% (P >0.05). The overlay treatment significantly prevented loss of ridge width and preserved or augmented the buccal contour. The socket and overlay groups healed with a high percentage of vital bone.

  20. Differentiation of bone marrow cells with irradiated bone in vitro

    International Nuclear Information System (INIS)

    Toshiyuki Tominaga; Moritoshi Itoman; Izumi, T.; Wakita, R.; Uchino, M.

    1999-01-01

    Disease transmission or infection is an important issue in bone allograft, and irradiation is used for sterilization of graft bones. One of the advantages of bone allograft over biomaterials is that graft bones have osteoinductive factors such as growth factors. Irradiation is reported to decrease the osteoinductive activity in vivo. We investigated the osteoinductive activity of irradiated bone by alkaline phosphatase (ALP) activity in rat bone marrow cell culture. Bones (tibias and femurs of 12-week-old Wistar rats) were cleaned of adhering soft tissue, and the marrow was removed by washing. The bones were defatted, lyophilized, and cut into uniform 70 mg fragments. Then the Bone fragments were irradiated at either 10, 20, 25, 30, 40, or 50 kGy at JAERI. Bone marrow cells were isolated from tibias and femurs of 4-week-old Wistar rats. Cells were plated in tissue culture flask. When primary cultures reached confluence, cells were passaged (4 x 103 cell / cm2) to 6 wells plates. The culture medium consisted of minimum essential medium, 10% fetal bovine serum, ascorbic acid, and antibiotics. At confluence, a cell culture insert was set in the well, and an irradiated bone fragment was placed in it. Then, medium was supplemented with 10 mM ?-glycerophosphate and 1 x 10-8 M dexamethasone. Culture wells were stained by naphthol AS-MX phosphate, N,N-dimethyl formamide, Red violet LB salt on day 0, 7, 14. The density of ALP staining was analyzed by a personal computer. Without bones, ALP staining increased by 50% on day 7 and by 100% on day 14, compared with that on day 0. The other side, with bones irradiated at 30 kGy or lower, ALP staining increased by 150% on day 7, and by 180% on day 14, compared with that on day 0. In the groups of irradiated bones of 40 kGy or higher, the increase in ALP staining was less prominent compared with the groups of irradiated bones of 30 kGy or lower. In the groups of 0-30 kGy irradiation, ALP staining increased in the early period

  1. Human decellularized bone scaffolds from aged donors show improved osteoinductive capacity compared to young donor bone.

    Directory of Open Access Journals (Sweden)

    Christopher A Smith

    Full Text Available To improve the safe use of allograft bone, decellularization techniques may be utilized to produce acellular scaffolds. Such scaffolds should retain their innate biological and biomechanical capacity and support mesenchymal stem cell (MSC osteogenic differentiation. However, as allograft bone is derived from a wide age-range, this study aimed to determine whether donor age impacts on the ability an osteoinductive, acellular scaffold produced from human bone to promote the osteogenic differentiation of bone marrow MSCs (BM-MSC. BM-MSCs from young and old donors were seeded on acellular bone cubes from young and old donors undergoing osteoarthritis related hip surgery. All combinations resulted in increased osteogenic gene expression, and alkaline phosphatase (ALP enzyme activity, however BM-MSCs cultured on old donor bone displayed the largest increases. BM-MSCs cultured in old donor bone conditioned media also displayed higher osteogenic gene expression and ALP activity than those exposed to young donor bone conditioned media. ELISA and Luminex analysis of conditioned media demonstrated similar levels of bioactive factors between age groups; however, IGF binding protein 1 (IGFBP1 concentration was significantly higher in young donor samples. Additionally, structural analysis of old donor bone indicated an increased porosity compared to young donor bone. These results demonstrate the ability of a decellularized scaffold produced from young and old donors to support osteogenic differentiation of cells from young and old donors. Significantly, the older donor bone produced greater osteogenic differentiation which may be related to reduced IGFBP1 bioavailability and increased porosity, potentially explaining the excellent clinical results seen with the use of allograft from aged donors.

  2. Acetabular Reconstruction with the Burch-Schneider Antiprotrusio Cage and Bulk Allografts: Minimum 10-Year Follow-Up Results

    Directory of Open Access Journals (Sweden)

    Dario Regis

    2014-01-01

    Full Text Available Reconstruction of severe pelvic bone loss is a challenging problem in hip revision surgery. Between January 1992 and December 2000, 97 hips with periprosthetic osteolysis underwent acetabular revision using bulk allografts and the Burch-Schneider antiprotrusio cage (APC. Twenty-nine patients (32 implants died for unrelated causes without additional surgery. Sixty-five hips were available for clinical and radiographic assessment at an average follow-up of 14.6 years (range, 10.0 to 18.9 years. There were 16 male and 49 female patients, aged from 29 to 83 (median, 60 years, with Paprosky IIIA (27 cases and IIIB (38 cases acetabular bone defects. Nine cages required rerevision because of infection (3, aseptic loosening (5, and flange breakage (1. The average Harris hip score improved from 33.1 points preoperatively to 75.6 points at follow-up (P<0.001. Radiographically, graft incorporation and cage stability were detected in 48 and 52 hips, respectively. The cumulative survival rates at 18.9 years with removal for any reason or X-ray migration of the cage and aseptic or radiographic loosening as the end points were 80.0% and 84.6%, respectively. The use of the Burch-Schneider APC and massive allografts is an effective technique for the reconstructive treatment of extensive acetabular bone loss with long-lasting survival.

  3. A Two-Step Model of Acute CD4 T-Cell Mediated Cardiac Allograft Rejection1

    OpenAIRE

    Grazia, Todd J.; Pietra, Biagio A.; Johnson, Zachary A.; Kelly, Brian P.; Plenter, Robert J.; Gill, Ronald G.

    2004-01-01

    CD4 T cells are both necessary and sufficient to mediate acute cardiac allograft rejection in mice. This process requires “direct” engagement of donor MHC class II molecules. That is, acute rejection by CD4+ T cells requires target MHC class II expression by the donor and not by the host. However, it is unclear whether CD4+ T cell rejection requires MHC class II expression on donor hemopoietic cells, nonhemopoietic cells, or both. To address this issue, bone marrow transplantation in mice was...

  4. Evaluasi Pemberian Bahan Allograft dan Alloplast pada Penderita Periodontitis Agresif Menyeluruh dengan Genotipe Positif Alel 2 (+3954 Interleukin-1 Beta

    Directory of Open Access Journals (Sweden)

    Andrena Andrena

    2013-06-01

    Full Text Available Generalized aggressive periodontitis is a disease or a disorder of periodontium that occurs in people below 30 years old. These patients usually have several immune response disorders, such as defects in chemotaxis, phagocytic of neturophils and monocytes, and genetic defect. Clinically, there are generalized losses of tissue attachment with extensive, rapid and progressive alveolar bone resorption. In order to repair bone destruction, treatment that produce bone regeneration is needed, i.e. full thickness flap with bone grafting. In these cases, allograft and alloplast bone grafts were used. Allograft is derived from subjects within the same species but different individuals, whereas alloplast is foreign body embedded into the tissue (e.g. hydroxylapatite. In this report, pocket depth, papillae bleeding index (PBI, and clinical attachment were evaluated. Six month after surgery and bone grafting, there were + 4 mm decrease of pocket depths, bleeding on probing index and 3-4 mm increase of clinical attachment. Unstimulated wholes saliva were also collected for DNA isolation. The IL-1beta(+3954 genotypes were performed by Polymerase chain reaction, digested with TagI restriction enzyme and separated by gel electrophoresis. Results showed both patients bearing allele 2 homozygous of IL-1B+3954 genotype. This genotype has been identified as the one of immunogenetic factor that could affect the severity of periodontal disease. Successful treatment depends on the adequacy of oral hygiene. Patients were advised to maintain optimal oral hygiene and to do periodic check every 2-3 months.DOI: 10.14693/jdi.v15i2.70

  5. The use of a bioresorbable nano-crystalline hydroxyapatite paste in acetabular bone impaction grafting.

    NARCIS (Netherlands)

    Arts, J.J.C.; Verdonschot, N.J.J.; Schreurs, B.W.; Buma, P.

    2006-01-01

    Calcium phosphates such as TCP-HA granules are considered promising bone graft substitutes. In the future, they may completely replace allograft bone for impaction grafting procedures. Mechanically, acetabular reconstructions with TCP-HA granules show high stability, however this is partly caused by

  6. Assessment of activated porous granules on implant fixation and early bone formation in sheep

    Directory of Open Access Journals (Sweden)

    Ming Ding

    2016-04-01

    Conclusion: In conclusion, despite nice bone formation and implant fixation in all groups, bioreactor activated graft material did not convincingly induce early implant fixation similar to allograft, and neither bioreactor nor by adding BMA credited additional benefit for bone formation in this model.

  7. Biomimetic coatings for bone tissue engineering of critical-sized defects

    NARCIS (Netherlands)

    Liu, Y.; Wu, G.; de Groot, K.

    2010-01-01

    The repair of critical-sized bone defects is still challenging in the fields of implantology, maxillofacial surgery and orthopaedics. Current therapies such as autografts and allografts are associated with various limitations. Cytokine-based bone tissue engineering has been attracting increasing

  8. Mannan binding lectin : a two-faced regulator of renal allograft injury?

    NARCIS (Netherlands)

    Damman, Jeffrey; Seelen, Marc A.

    Complement activation plays an important role in the pathogenesis of renal allograft injury after kidney transplantation. There are three known pathways of complement activation, namely, classical, alternative, and lectin pathways. In renal allograft injury, contradictory results were reported about

  9. Comparison of Clinical Outcome of Autograft and Allograft Reconstruction for Anterior Cruciate Ligament Tears

    Directory of Open Access Journals (Sweden)

    Yu-Hua Jia

    2015-01-01

    Conclusions: In the repair of ACL tears, allograft reconstruction is as effective as the autograft reconstruction, but the allograft can lead to more tunnel widening evidently in the tibial tunnel, particularly.

  10. The role of CD8+ T cells during allograft rejection

    Directory of Open Access Journals (Sweden)

    V. Bueno

    2002-11-01

    Full Text Available Organ transplantation can be considered as replacement therapy for patients with end-stage organ failure. The percent of one-year allograft survival has increased due, among other factors, to a better understanding of the rejection process and new immunosuppressive drugs. Immunosuppressive therapy used in transplantation prevents activation and proliferation of alloreactive T lymphocytes, although not fully preventing chronic rejection. Recognition by recipient T cells of alloantigens expressed by donor tissues initiates immune destruction of allogeneic transplants. However, there is controversy concerning the relative contribution of CD4+ and CD8+ T cells to allograft rejection. Some animal models indicate that there is an absolute requirement for CD4+ T cells in allogeneic rejection, whereas in others CD4-depleted mice reject certain types of allografts. Moreover, there is evidence that CD8+ T cells are more resistant to immunotherapy and tolerance induction protocols. An intense focal infiltration of mainly CD8+CTLA4+ T lymphocytes during kidney rejection has been described in patients. This suggests that CD8+ T cells could escape from immunosuppression and participate in the rejection process. Our group is primarily interested in the immune mechanisms involved in allograft rejection. Thus, we believe that a better understanding of the role of CD8+ T cells in allograft rejection could indicate new targets for immunotherapy in transplantation. Therefore, the objective of the present review was to focus on the role of the CD8+ T cell population in the rejection of allogeneic tissue.

  11. Significant prolongation of segmental pancreatic allograft survival in two species

    Energy Technology Data Exchange (ETDEWEB)

    Du Toit, D.F.; Heydenrych, J.J.

    1988-06-01

    A study was conducted to assess the suppression of segmental pancreatic allograft rejection by cyclosporine (CSA) alone in baboons and dogs, and subtotal marrow irradiation (TL1) alone and TL 1 in combination with CSA in baboons. Total pancreatectomy in the dog and primate provided a reliable diabetic model, induced an absolute deficiency of insulin and was uniformly lethal if not treated. Continuous administration of CSA in baboons resulted in modest allograft survival. As in baboons, dogs receiving CSA 25 mg/kg/d rendered moderate graft prolongation but a dose of 40 mg/kg/d resulted in significant graft survival (greater than 100 days) in 5 of 8 allograft recipients. Irradiation alone resulted in minimal baboon pancreatic allograft survival of 20 baboons receiving TL1 1,000 rad and CSA, 3 had graft survival greater than of 100 days. Of 15 baboons receiving TL1 800 rad and CSA, 6 had graft survival of greater than 100 days. In conclusion, CSA administration in dogs and TL1 in combination with CSA in baboons resulted in highly significant segmental pancreatic allograft survival.

  12. Significant prolongation of segmental pancreatic allograft survival in two species

    International Nuclear Information System (INIS)

    Du Toit, D.F.; Heydenrych, J.J.

    1988-01-01

    A study was conducted to assess the suppression of segmental pancreatic allograft rejection by cyclosporine (CSA) alone in baboons and dogs, and subtotal marrow irradiation (TL1) alone and TL 1 in combination with CSA in baboons. Total pancreatectomy in the dog and primate provided a reliable diabetic model, induced an absolute deficiency of insulin and was uniformly lethal if not treated. Continuous administration of CSA in baboons resulted in modest allograft survival. As in baboons, dogs receiving CSA 25 mg/kg/d rendered moderate graft prolongation but a dose of 40 mg/kg/d resulted in significant graft survival (greater than 100 days) in 5 of 8 allograft recipients. Irradiation alone resulted in minimal baboon pancreatic allograft survival of 20 baboons receiving TL1 1,000 rad and CSA, 3 had graft survival greater than of 100 days. Of 15 baboons receiving TL1 800 rad and CSA, 6 had graft survival of greater than 100 days. In conclusion, CSA administration in dogs and TL1 in combination with CSA in baboons resulted in highly significant segmental pancreatic allograft survival

  13. Immunomodulation to Optimize Vascularized Composite Allograft Integration in Limb Loss Therapy

    Science.gov (United States)

    2015-10-01

    to   lower  the  risk  and  improve  the  benefits  of   patients  after   limb  reconstruction  through  transplantation.  The  study  provides  a  new...reconstruction  of  skin,   muscle ,  tendon,  bone,  nerve,  and   vessels  as  a  functional  unit  ( limb )  in  individuals  who  suffered   limb  loss.  The...2 AWARD  NUMBER:        W81XWH-­12-­2-­0058   TITLE:      Immunomodulation to Optimize Vascularized Composite Allograft Integration in Limb Loss

  14. Bone tumor

    Science.gov (United States)

    Tumor - bone; Bone cancer; Primary bone tumor; Secondary bone tumor; Bone tumor - benign ... The cause of bone tumors is unknown. They often occur in areas of the bone that grow rapidly. Possible causes include: Genetic defects ...

  15. Bone Grafting: Sourcing, Timing, Strategies, and Alternatives.

    Science.gov (United States)

    Egol, Kenneth A; Nauth, Aaron; Lee, Mark; Pape, Hans-Christoph; Watson, J Tracy; Borrelli, Joseph

    2015-12-01

    Acute fractures, nonunions, and nonunions with bone defects or osteomyelitis often need bone graft to facilitate union. There are several factors to consider when it is determined that a bone graft is needed. These factors include the source of the bone graft (autograft vs. allograft), proper timing for placement of the bone graft, strategies to avoid further complications (particularly in the setting of osteomyelitis), and with the development of a variety of bone graft substitutes, whether alternatives to autograft are available and appropriate for the task at hand. Autograft bone has commonly been referred to as the "gold standard" of bone grafts, against which the efficacy of other grafts has been measured. The best timing for when to place a bone graft or substitute is also somewhat controversial, particularly after an open fracture or a potentially contaminated bed. The treatment of infected nonunions, particularly those that require a graft to facilitate healing, can be quite challenging. Typically, the infection is completely eradicated before placement of a bone graft, but achieving a sterile bed and the timing of a bone graft require strategic thinking and planning. This review outlines the benefits of autografts, the most suitable sites for harvesting bone grafts, the timing of bone graft procedures, the potential risks and benefits of grafting in the face of infection, and the currently available bone graft extenders.

  16. Bone loss following knee arthroplasty: potential treatment options.

    Science.gov (United States)

    Vasso, Michele; Beaufils, Philippe; Cerciello, Simone; Schiavone Panni, Alfredo

    2014-04-01

    The management of bone loss is a crucial aspect of the revision knee arthroplasty. Bone loss can hinder the correct positioning and alignment of the prosthetic components, and can prevent the achievement of a stable bone-implant interface. There is still controversy regarding the optimal management of knee periprosthetic bone loss, especially in large defects for which structural grafts, metal or tantalum augments, tantalum cones, porous metaphyseal sleeves, and special prostheses have been advocated. The aim of this review was to analyze all possible causes of bone loss and the most advanced strategies for managing bony deficiency within the knee joint reconstruction. Most significant and recent papers about the management of bone defects during revision knee arthroplasty were carefully analyzed and reviewed to report the most common causes of bone loss and the most effective strategies to manage them. Modular metal and tantalum augmentation showed to provide more stable and durable knee revisions compared to allografts, limited by complications such as graft failure, fracture and resorption. Moreover, modular augmentation may considerably shorten operative times with a potential decrease of complications, above all infection which has been frequently associated to the use of allografts. Modular augmentation may significantly reduce the need for allografting, whose complications appear to limit the long-term success of knee revisions.

  17. Nebulized Pentamidine-Induced Acute Renal Allograft Dysfunction

    Directory of Open Access Journals (Sweden)

    Siddhesh Prabhavalkar

    2013-01-01

    Full Text Available Acute kidney injury (AKI is a recognised complication of intravenous pentamidine therapy. A direct nephrotoxic effect leading to acute tubular necrosis has been postulated. We report a case of severe renal allograft dysfunction due to nebulised pentamidine. The patient presented with repeated episodes of AKI without obvious cause and acute tubular necrosis only on renal histology. Nebulised pentamidine was used monthly as prophylaxis for Pneumocystis jirovecii pneumonia, and administration preceded the creatinine rise on each occasion. Graft function stabilised following discontinuation of the drug. This is the first report of nebulized pentamidine-induced reversible nephrotoxicity in a kidney allograft. This diagnosis should be considered in a case of unexplained acute renal allograft dysfunction.

  18. Immunomodulatory Strategies Directed Towards Tolerance of Vascularized Composite Allografts

    Science.gov (United States)

    Michel, Sebastian G.; Villani, Vincenzo; Muraglia, Glenn M. La; Torabi, Radbeh; Leonard, David A.; Randolph, Mark A.; Colvin, Robert B.; Yamada, Kazuhiko; Madsen, Joren C.; Cetrulo, Curtis L.; Sachs, David H.

    2015-01-01

    Background Achieving tolerance of vascularized composite allografts (VCAs) would improve the risk-to-benefit ratio in patients who undergo this life-enhancing, though not life-saving, transplant. Kidney co-transplantation along with a short course of high-dose immunosuppression enables tolerance of heart allografts across a full MHC mismatch. In this study, we investigated whether tolerance of VCA across full MHC disparities could be achieved in animals already tolerant of heart and kidney allografts. Methods Miniature swine that were tolerant of heart and/or kidney allografts long-term underwent transplantation of myocutaneous VCA across the same MHC barrier. Prior to VCA transplant, Group 1 (n=3) underwent Class I-mismatched kidney transplantation; Group 2 (n=3) underwent two sequential Class I-mismatched kidney transplantations; Group 3 (n=2) underwent haploidentical MHC-mismatched heart/kidney transplantation; and Group 4 (n=2) underwent full MHC-mismatched heart/kidney transplantation. Results All three animals in Group 1 and two of three animals in Group 2 showed skin rejection ≤85 days; one animal in Group 2 showed prolonged skin survival >200 days. Animals in Groups 3 and 4 showed skin rejection ≤30 days and regained in vitro evidence of donor responsiveness. Conclusion This is the first pre-clinical study in which hearts, kidneys, and VCAs have been transplanted into the same recipient. Despite VCA rejection, tolerance of heart and kidney allografts was maintained. These results suggest that regulatory tolerance of skin is possible but not generally achieved by the same level of immunomodulation that is capable of inducing tolerance of heart and kidney allografts. Achieving tolerance of skin may require additional immunomodulatory therapies. PMID:25757218

  19. Alveolar Ridge Preservation Using Allografts and Dense Polytetrafluoroethylene Membranes With Open Membrane Technique in Unhealthy Extraction Socket.

    Science.gov (United States)

    Cheon, Gi-Beom; Kang, Kyung Lhi; Yoo, Mi-Kyung; Yu, Jeoung-A; Lee, Dong-Woon

    2017-08-01

    We evaluated the effectiveness of the open membrane technique using a high-density polytetrafluoroethylene (dPTFE) membrane with freeze-dried bone allografts in damaged sockets for alveolar ridge preservation (ARP). This retrospective study included 26 sites from 20 patients who had received ARP for the placement of dental implants. ARP was conducted using dPTFE membrane with allografts on the day of extraction without primary closure. When the membrane was removed after 4 weeks, the newly formed reddish tissue at the grafted site was checked (first outcome, clinical evaluation). Four months after membrane removal, a core biopsy was performed from the center of the grafted site before implant placement (second outcome, histomorphometric evaluation). Radiographic measurements of alveolar bone changes between implant prosthesis delivery and the 1-year follow-up were obtained (third outcome, radiographic evaluation). A total of 23 sites from 18 patients had no complications during the follow-up period. Three sites from two patients were excluded because of early membrane removal. Newly formed reddish tissue was found at 15 sites, and partially formed tissue was found at 8 sites. Although we were unable to harvest bone core from all sites, histomorphometric analysis in 11 patients indicated that the mean area of new bone was 28.48% ± 6.60%, that of the remaining graft particle was 27.68% ± 9.18%, and that of fibrous tissue was 43.84% ± 6.98%. The mean loss of marginal bone was 0.13 ± 0.06 mm at the mesial area and 0.15 ± 0.06 mm at the distal area, as assessed using radiographic evaluations. The results of this nonrandomized study suggest that this technique may be an appropriate procedure for ARP. Further studies with a control group and more subjectives can be designed based on this study.

  20. Early kidney allograft loss - is there scope for improvement?

    Science.gov (United States)

    Ferrari, Paolo

    2018-02-17

    Increased longevity matching using Kidney Donor Profile Index (KDPI) to optimize long-term kidney allograft survival has been central to the effort of appropriate allocation of deceased donor kidneys. The data by Helenterä and co-workers in this issue, who looked at predictors of early allograft loss, should prompt an analysis of whether predictors of short-term graft survival can improve KDPI-based decisions when considering whether to accept or decline a deceased donor kidney offer. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  1. Mechanical properties of human bone-tendon-bone grafts preserved by different methods and radiation sterilised

    International Nuclear Information System (INIS)

    Kaminski, A.; Gut, G.

    2008-01-01

    Full text: Patellar tendon auto and allografts are commonly used in orthopaedic surgery for reconstruction of the anterior crucial ligaments (ACL). Autografts are mainly used for primary reconstruction, while allografts are useful for revision surgery. To avoid the risk of infection diseases transmission allografts should be radiation-sterilised. As radiation-sterilisation is supposed to decrease the mechanical strength of tendon tissue, it is important to establish methods of allografts preservation and sterilisation resulting in their best quality and safety. Therefore, the purpose of the study was to compare the tensile strength of the central one third of human patellar tendon (as used for ACL reconstruction), preserved by different methods (deep fresh freezing, lyophilisation) and subsequently radiation-sterilised with doses of 0 (control), 25, 50 or 100 kGy. Bone-tendon-bone grafts were prepared from cadaveric human patella tendon with both patellar and tibial attachments. BTB grafts were preserved by deep freezing, glicerolisation or lyophilisation and radiation-sterilised with doses of 0 (control), 25, 50 or 100 kGy. To estimate mechanical properties all samples were subjected to tensile tests to failure using Instron system. Before these tests all lyophilised grafts were rehydrated. We found decrease of tensile strength of irradiated grafts compared to non-irradiated controls. Obtained results of the mechanical testing of studied grafts indicate their potential usefulness for clinical applications.(Author)

  2. Effect of Bisphosphonate Pretreatment on Fresh Osteochondral Allografts: Analysis of In Vitro Graft Structure and In Vivo Osseous Incorporation.

    Science.gov (United States)

    Moore, Drew D; Baker, Kevin C; Baker, Erin A; Fleischer, Mackenzie M; Newton, Michael D; Barreras, Nicholas; Vaupel, Zachary M; Fortin, Paul T

    2018-03-23

    Fresh allograft transplantation of osteochondral defects restores functional articular cartilage and subchondral bone; however, rapid loss of chondrocyte viability during storage and osteoclast-mediated bone resorption at the graft-host interface after transplantation negatively impact outcomes. The authors present a pilot study evaluating the in vitro and in vivo impact of augmenting storage media with bisphosphonates. Forty cylindrical osteochondral cores were harvested from femoral condyles of human cadaveric specimens and immersed in either standard storage media or storage media supplemented with nitrogenated or non-nitrogenated bisphosphonates. Maintenance of graft structure and chondrocyte viability were assessed at 3 time points. A miniature swine trochlear defect model was used to evaluate the influence of bisphosphonate-augmented storage media on in vivo incorporation of fresh osteochondral tissue, which was quantified via μCT and decalcified histology. In the in vitro study, Safranin-O/Fast Green staining showed that both low- and high-dose nitrogenated-treated grafts retained chondrocyte viability and cartilage matrix for up to 43 days of storage. Allografts stored in nitrogenated-augmented storage media showed both μCT and histologic evidence of enhanced in vivo bony and cartilaginous incorporation in the miniature swine trochlear defect model. Several preclinical studies have shown the potential for enhanced storage of fresh osteochondral allografts via additions of relatively common drugs and biomolecules. This study showed that supplementing standard storage media with nitrogenated bisphosphonates may improve maintenance of chondrocyte viability and graft structure during cold storage as well as enhance in vivo osseous and cartilaginous incorporation of the graft. [Orthopedics: 201x; xx(x):xx-xx.]. Copyright 2018, SLACK Incorporated.

  3. Diagnostic value of plasma and bronchoalveolar lavage samples in acute lung allograft rejection: differential cytology.

    Science.gov (United States)

    Speck, Nicole E; Schuurmans, Macé M; Murer, Christian; Benden, Christian; Huber, Lars C

    2016-06-21

    Diagnosis of acute lung allograft rejection is currently based on transbronchial lung biopsies. Additional methods to detect acute allograft dysfunction derived from plasma and bronchoalveolar lavage samples might facilitate diagnosis and ultimately improve allograft survival. This review article gives an overview of the cell profiles of bronchoalveolar lavage and plasma samples during acute lung allograft rejection. The value of these cells and changes within the pattern of differential cytology to support the diagnosis of acute lung allograft rejection is discussed. Current findings on the topic are highlighted and trends for future research are identified.

  4. Production of irradiated bone derivatives for odontology and traumatology

    International Nuclear Information System (INIS)

    Martin, Hugo R.; Murature, D.A.

    2004-01-01

    In 2003, the National Atomic Energy Commission (CNEA), the Industrial Human Tissue Processing Plant of the Cordoba University and the Cordoba Science Agency analyzed the joint installation and operation of a Gamma Radiosterilization Module for the production of sterile human bone tissues as allografts for odontology and traumatology. The irradiation procedures were developed at the CNEA's Ezeiza Atomic Center. The irradiated bone tissues are being used in odontology with an excellent clinical behaviour. (author)

  5. HLA-DR overexpression in tubules of renal allografts during early and late renal allograft injuries.

    Science.gov (United States)

    Wen, Jiqiu; Zhang, Mingchao; Chen, Jinsong; Zeng, Caihong; Cheng, Dongrui; Liu, Zhi-Hong

    2013-12-01

    We sought to discover which types of injuries were related to human leukocyte antigen DR expression in acute rejection and late chronic injury in renal allografts. Ninety-two recipients were separated into the early acute rejection group, the late monocyte infiltration group, and the late chronic injury group. Ten subjects with acute cellular rejection received a repeat biopsy. All samples were stained with CD4, CD8, CD20, CD68, and human leukocyte antigen DR by immunochemical staining. Levels of these markers were compared among the subgroups of each group. Human leukocyte antigen DR expression was greater in the early C4d-negative acute rejection group than it was in the early C4d-positive acute rejection group. Human leukocyte antigen DR expression was greater during acute rejection than that was on a repeat biopsy. Human leukocyte antigen DR expression was accord with the infiltration of monocyte infiltration in the acute cellular rejection group. Human leukocyte antigen DR expression was greater during late acute rejection than it was in BK virus nephropathy, which was not in accord with monocyte infiltration. Human leukocyte antigen DR expression was greater during chronic rejection than it was in IgAN, BK virus nephropathy, and TA/IF groups, and even in tubular atrophy. Human leukocyte antigen DR expression in renal tubular cells was associated with early acute cellular rejection and was in accord with monocyte infiltration. Human leukocyte antigen DR expression in renal tubular cells during the late phase (especially in tubular atrophy) was a marker of chronic rejection, but was not in accord with monocyte infiltration in renal allografts.

  6. An osteophyte in the tibial plateau is a risk factor for allograft extrusion after meniscus allograft transplantation.

    Science.gov (United States)

    Jeon, Byeongsam; Kim, Jong-Min; Kim, Jong-Min; Lee, Chang-Rack; Kim, Kyung-Ah; Bin, Seong-Il

    2015-05-01

    Osteophytes can be observed on the tibial plateau during meniscus allograft transplantation (MAT). However, no studies to date have evaluated the effect of these osteophytes on meniscus allograft extrusion. Osteophyte excision in the tibial plateau could reduce extrusion of the transplanted meniscus and improve short-term clinical outcomes with meniscus allograft transplantation. Cohort study; Level of evidence, 3. Between October 2004 and July 2012, a total of 323 patients underwent MAT at a single institution. Of these, 88 patients had a peripheral osteophyte in their tibial plateau, and they were enrolled in the study retrospectively. The mean age of the patients was 35.3 years (range, 15-56 years); there were 57 male and 31 female patients. Forty-four patients underwent osteophyte excision concomitantly with MAT and 44 patients underwent MAT only. The 2 groups showed no difference in terms of age, body mass index, time after meniscectomy, and preoperative knee scores. A medial meniscus allograft was transplanted in 13 cases (15%) and a lateral meniscus in 75 (85%). The absolute extrusion and relative percentage of extrusion were measured to evaluate allograft extrusion 12 months after MAT. The modified Lysholm scoring system and the Hospital for Special Surgery score at 2 years after MAT were used to evaluate clinical outcomes. The mean absolute extrusions at 1 year postoperatively in the excision and nonexcision groups were 3.5±1.5 and 5.5±1.6 mm, respectively. The mean relative percentages of extrusion were 34.1%±15.9% and 54.7%±20.7%, respectively. The rates of allograft extrusion (>3 mm) were 28 of 44 (63.6%) and 41 of 44 (93.2%) in the excision and nonexcision groups, respectively. The intergroup differences in absolute extrusion, relative percentage of extrusion, and rate of allograft extrusion were statistically significant (P<.001 for all 3 parameters). There were no significant differences in the clinical outcomes (modified Lysholm or Hospital of

  7. Management of resistant distal femur non-unions with allograft strut and autografts combined with osteosynthesis in a series of 22 patients.

    Science.gov (United States)

    Kanakeshwar, Raja Bhaskara; Jayaramaraju, Dheenadhayalan; Agraharam, Devendra; Rajasekaran, Shanmuganathan

    2017-08-01

    Challenges to the surgeon in managing cases of resistant non-union of the distal femur include poor bone stock, disuse osteopenia and joint contractures. Procedures varying from simple bone grafting to megaprosthesis revision have been described. We successfully managed such cases using our technique of combining cortical allograft struts to augment the defect in the femoral condyle coupled with autogenous iliac crest bone grafting and locking plate osteosynthesis. Between April 2012 and May 2014, 22 patients who presented with resistant nonunions of the distal femur following initial surgery were managed using this technique. Cortical allograft struts were taken from the tissue bank of our institution. All patients were followed up post operatively and their time to union was noted. Functional outcome was calculated using LEFS (Lower extremity functional score). The average follow up of all our patients was 24 months. All patients went on to achieve complete bony union. The average union time was 6.2 months (5 to 8 months). One patient who was a diabetic had superficial infection post operatively which was treated successfully with IV antibiotics. Average knee flexion was 110 degrees (80 to 130 degrees). The mean LEFS score was 72 (59 to 79). Combing a locking plate fixation with the bone grafting technique of using an allograft strut to support the metaphyseal medial bone defect and autografts gives a good union and a good functional outcome in the management of resistant non-unions of the distal femur by enhancing the biology and providing a good structural support to the distal femur. © 2017 Elsevier Ltd. All rights reserved.

  8. Development of national capability in the production of high quality radiation sterilized allografts for safe clinical usage

    International Nuclear Information System (INIS)

    Norimah Yusof; Selamat Sainuddin Nadir; Noor Azlan Muhammad Ajali; Asnah Hassan; Salahbiah Abd Majid; Nor Shamsuria Omar

    1995-01-01

    Tissue banking is a new concept recently introduced in Malaysia despite the long history of the utilization of human tissue in surgery. The lack of local capability, unclear religious status and ethical problem were among many reasons for the delay in establishing a tissue bank. Through an extensive coordinated research programme by the International Atomic Energy Agency (IAEA) and with full support from local governments, a number of tissue banks throughout the Asia Pacific region has been formed. In Malaysia, two tissue banks have been established, at the Science University of Malaysia (USM), Kubang Kerian and Malaysian Institute for Nuclear Technology Research (MINT), Bangi respectively. The MINT tissue bank started processing human bones and amniotic membrane routinely since 1993 as the result of R and D in improving and validating the processing procedures and ssetting up of quality system. Radiation sterilized allografts produced by MINT have been used clinically in treating burned patients and in orothopaedic surgery. The future outlook of MINT tissue bank will be in establishing itself as a biomaterial centre to continue providing high quality allografts and consultancy in tissue banking while venturing into more challenging R and D arena including skin and bone culture and development of new materials using indigenous sources through nuclear technology

  9. Allogeneic bone marrow grafts in genotyped swine

    International Nuclear Information System (INIS)

    Vaiman, M.

    1974-01-01

    The proof of a major histocompatibility complex (MHC) called SL-A enabled to promote bone marrow allografts. A study of the response to that kind of graft in irradiated pig states a number of interesting points. Bone marrow allografting complies with the rule of tissular compatibility with the major histocompatibility complex. The taking of SL-A incompatible bone marrow allografts could not be achieved under the experimental conditions. In spite of the high doses of radiation, 950 to 1050 rads, higher than 1.5 LD 100%, recipients were capable of rejecting their grafts, regularly. SL-A identify ensured 100%, initial achievement. However, animals developed regular fatal disease within a fairly short time. This development could by no means, be ascribed to the sole sequealae of radiation sickness since autografted animals at equal or even higher doses, showed none of the symptome. Assumption of a chronic graft-vs-host reactions, induced by the minor histocompatible systems, was put foreward, but should be confirmed histopathologically [fr

  10. Could Uric acid have a Pathogenic Role in Chronic Allograft ...

    African Journals Online (AJOL)

    Introduction: Chronic allograft dysfunction (CAD) is the primary cause of chronic graft failure after kidney transplantation. The pathogenesis of CAD involves both antigen-dependent and antigen-independent mechanisms. Serum uric acid could have a role in both mechanisms. Review: Hyperuricemia in subjects with renal ...

  11. Glutathione depletion in epithelial lining fluid of lung allograft patients.

    Science.gov (United States)

    Baz, M A; Tapson, V F; Roggli, V L; Van Trigt, P; Piantadosi, C A

    1996-02-01

    The lower respiratory tract is protected against reactive oxygen species (ROS) by a complex antioxidant system. In the epithelial lining fluid (ELF), glutathione (L-alpha-glutamyl-L-cysteinylglycine, GSH) is essential for adequate protection of pneumocytes from potential toxicity mediated by extracellular hydrogen peroxide (H2O2). We assessed the concentration of total GSH in bronchoalveolar lavage fluid (BALF) in lung allograft patients in the absence and presence of acute rejection. Bronchoalveolar lavage (BAL) and biopsies were performed concurrently on 36 occasions in 17 patients who had undergone lung transplantation. BALF samples were divided into two groups on the basis of presence or absence of acute lung rejection on transbronchial biopsy. Seven BALF samples were obtained from control subjects for comparison. The BALF data demonstrated significantly lymphocyte recruitment and evidence of lung injury during acute rejection episodes. Transplant allografts without rejection showed significant depletion of total GSH in the ELF as compared with that of normal volunteers (94.0 +/- 9.7 microM versus 302.6 +/- 40.8 microM, p < 0.01). Transplant allografts with acute rejection had a slightly higher GSH concentration in their ELF (179.8 +/- 34.7), but this was still lower than control values. The deficiency of total GSH in the alveolar fluid may predispose lung allografts to extracellular H2O2-mediated toxicity.

  12. Left versus right deceased donor renal allograft outcome.

    LENUS (Irish Health Repository)

    Phelan, Paul J

    2009-12-01

    It has been suggested that the left kidney is easier to transplant than the right kidney because of the longer length of the left renal vein, facilitating the formation of the venous anastomosis. There are conflicting reports of differing renal allograft outcomes based on the side of donor kidney transplanted (left or right).We sought to determine the effect of side of donor kidney on early and late allograft outcome in our renal transplant population. We performed a retrospective analysis of transplanted left-right deceased donor kidney pairs in Ireland between January 1, 1998 and December 31, 2008. We used a time to death-censored graft failure approach for long-term allograft survival and also examined serum creatinine at different time points post-transplantation. All outcomes were included from day of transplant onwards. A total of 646 transplants were performed from 323 donors. The incidence of delayed graft function was 16.1% in both groups and there was no significant difference in acute rejection episodes or serum creatinine from 1 month to 8 years post-transplantation.There were 47 death-censored allograft failures in the left-sided group compared to 57 in the right-sided group (P = 0.24). These observations show no difference in renal transplant outcome between the recipients of left- and right-sided deceased donor kidneys.

  13. Noninvasive diagnosis of allograft vascular disease after heart transplantation

    Directory of Open Access Journals (Sweden)

    Fernando Bacal

    2001-01-01

    Full Text Available OBJECTIVE: To determine the predictive values of noninvasive tests for the detection of allograft vascular disease. METHODS: We studied 39 patients with mean ages of 48±13 years and a follow-up period of 86±13 months. The diagnosis of allograft vascular disease was made by cine-coronary arteriography, and it was considered as positive if lesions existed that caused > or = 50% obstruction of the lumen. Patients underwent 24h Holter monitoring, thallium scintigraphy, a treadmill stress test, and dobutamine stress echocardiography. Sensitivity, specificity, and positive and negative predictive values were determined in percentages for each method, as compared with the cine-coronary arteriography results. RESULTS: Allograft vascular disease was found in 15 (38% patients. The Holter test showed 15.4% sensitivity, 95.5% specificity. For the treadmill stress test, sensitivity was 10%, specificity was 100%. When thallium scintigraphy was used, sensitivity was 40%, specificity 95.8%. On echocardiography with dobutamine, we found a 63.6% sensitivity, 91.3% specificity. When the dobutamine echocardiogram was associated with scintigraphy, sensitivity was 71.4%, specificity was 87%. CONCLUSION: In this group of patients, the combination of two noninvasive methods (dobutamine echocardiography and thallium scintigraphy may be a good alternative for the detection of allograft vascular disease in asymptomatic patients with normal ventricular function.

  14. Chronic Renal Allograft Dysfunction: Risk Factors, Immunology and ...

    African Journals Online (AJOL)

    Introduction: Kidney transplantation is the treatment of choice for patients with end-stage renal disease. Despite great progress in surgical aspects and immunosupression therapy, long-term graft survival has not been consistent. Chronic allograft dysfunction (CAD) remains a major cause of late grafts failure. Review: CAD is ...

  15. Live Skin Allograft in the Management of Severe Burns

    African Journals Online (AJOL)

    skin substitutes to promote wound healing, reduce pain, and prevent ... into the healing wound as happens with allografts and xenografts (2). ... burns included open flames in two and hot water, hot tea and petrol in one patient each. Both children and one adult had the mothers as skin donors (Figure 1), while two adults had ...

  16. Effects of Acute Cytomegalovirus Infection on Rat Islet Allograft Survival

    NARCIS (Netherlands)

    Smelt, M. J.; Faas, M. M.; Melgert, B. N.; de Vos, P.; de Haan, Bart; de Haan, Aalzen

    2011-01-01

    Transplantation of pancreatic islets is a promising therapy for the treatment of type 1 diabetes mellitus. However, long-term islet graft survival rates are still unsatisfactory low. In this study we investigated the role of cytomegalovirus (CMV) in islet allograft failure. STZ-diabetic rats

  17. Tuberculosis in a renal allograft recipient presenting with intussusception.

    Science.gov (United States)

    Mohapatra, A; Basu, G; Sen, I; Asirvatham, R; Michael, J S; Pulimood, A B; John, G T

    2012-01-01

    Extra-pulmonary tuberculosis (TB) is more common in renal allograft recipients and may present with dissemination or an atypical features. We report a renal allograft recipient with intestinal TB presenting 3 years after transplantation with persistent fever, weight loss, diarrhea, abdominal pain and mass in the abdomen with intestinal obstruction. He was diagnosed to be having an ileocolic intussusception which on resection showed a granulomatous inflammation with presence of acid-fast bacilli (AFB) typical of Mycobacterium tuberculosis. In addition, AFB was detected in the tracheal aspirate, indicating dissemination. He received anti-TB therapy (ATT) from the fourth postoperative day. However, he developed a probable immune reconstitution inflammatory syndrome (IRIS) with multiorgan failure and died on 11(th) postoperative day. This is the first report of intestinal TB presenting as intussusception in a renal allograft recipient. The development of IRIS after starting ATT is rare in renal allograft recipients. This report highlights the need for a high index of suspicion for diagnosing TB early among renal transplant recipients and the therapeutic dilemma with overwhelming infection and development of IRIS upon reduction of immunosuppression and starting ATT.

  18. Veto cell suppression mechanisms in the prevention of allograft rejection

    DEFF Research Database (Denmark)

    Jacobsen, I M; Claesson, Mogens Helweg

    1998-01-01

    on the surface of the veto-active cell. Data from a large number of experimental and clinical studies strongly indicate that veto-active cells function in vivo and are capable of preventing allograft rejection. Thus, donor-cell-mediated veto activity is the most likely explanation for the well-known graft...

  19. Long-term allograft survival after kidney transplantation.

    Science.gov (United States)

    Gómez, E Gómez; Hernández, J P Campos; López, F J Márquez; Garcia, J Ruiz; Montemayor, V Garcia; Curado, F Anglada; Vallejo, M Leva; López, J C Regueiro; Cabello, M D Navarro; Aljama, P; Tapia, M J Requena

    2013-01-01

    Technical and medical advances over the past few years have produced an important increase in the functionality of renal allografts. The aim of this study was to identify the factors associated with allograft survival 15 years after transplantation in our series. A retrospective study of kidney transplantations was carried out at Reina Sofia Hospital in Cordoba from February 1979 to December 1997, with follow-up through June 2012. A subanalysis of the series was undertaken, and Kaplan-Meier analysis and Cox proportional hazards model regression used to achieve the main objective of the study. A total of 487 renal allografts with a mean follow-up of 114 months were studied, of which 37% (n = 180) survived for >15 years. Of the 180 patients, the main causes of graft failure were chronic allograft nephropathy in 29 (66%) and patient death in 13 (29.5%). Multivariate analysis identified the number of HLA mismatches (hazard ratio [HR] 1.25, 95% CI 1.01-1.56), panel reactive antibodies (HR 2.61, 95% CI 1.28-5.26), and delayed graft function (HR 11.25, 95% CI 1.33-95.28) as being significantly associated with graft loss after 15 years. The high immunologic risk of the patients was independently associated with graft loss. Delayed graft function was the most important factor in the speed of graft failure beyond 15 years. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Apoptotic tubular cell death during acute renal allograft rejection

    NARCIS (Netherlands)

    Wever, P. C.; Aten, J.; Rentenaar, R. J.; Hack, C. E.; Koopman, G.; Weening, J. J.; ten Berge, I. J.

    1998-01-01

    Tubular cells are important targets during acute renal allograft rejection and induction of apoptosis might be a mechanism of tubular cell destruction. Susceptibility to induction of apoptosis is regulated by the homologous Bcl-2 and Bax proteins. Expression of Bcl-2 and Bax is regulated by p53,

  1. Urine Proteomics to Detect Biomarkers for Chronic Allograft Dysfunction

    Science.gov (United States)

    Quintana, Luís F.; Solé-Gonzalez, Amanda; Kalko, Susana G.; Bañon-Maneus, Elisenda; Solé, Manel; Diekmann, Fritz; Gutierrez-Dalmau, Alex; Abian, Joaquin; Campistol, Josep M.

    2009-01-01

    Despite optimal immunosuppressive therapy, more than 50% of kidney transplants fail because of chronic allograft dysfunction. A noninvasive means to diagnose chronic allograft dysfunction may allow earlier interventions that could improve graft half-life. In this proof-of-concept study, we used mass spectrometry to analyze differences in the urinary polypeptide patterns of 32 patients with chronic allograft dysfunction (14 with pure interstitial fibrosis and tubular atrophy and 18 with chronic active antibody-mediated rejection) and 18 control subjects (eight stable recipients and 10 healthy control subjects). Unsupervised hierarchical clustering showed good segregation of samples in groups corresponding mainly to the four biomedical conditions. Moreover, the composition of the proteome of the pure interstitial fibrosis and tubular atrophy group differed from that of the chronic active antibody-mediated rejection group, and an independent validation set confirmed these results. The 14 protein ions that best discriminated between these two groups correctly identified 100% of the patients with pure interstitial fibrosis and tubular atrophy and 100% of the patients with chronic active antibody-mediated rejection. In summary, this study establishes a pattern for two histologic lesions associated with distinct graft outcomes and constitutes a first step to designing a specific, noninvasive diagnostic tool for chronic allograft dysfunction. PMID:19056874

  2. Primary Nonfunction of Renal Allograft Secondary to Acute Oxalate Nephropathy

    Directory of Open Access Journals (Sweden)

    Ravi Parasuraman

    2011-01-01

    Full Text Available Primary nonfunction (PNF accounts for 0.6 to 8% of renal allograft failure, and the focus on causes of PNF has changed from rejection to other causes. Calcium oxalate (CaOx deposition is common in early allograft biopsies, and it contributes in moderate intensity to higher incidence of acute tubular necrosis and poor graft survival. A-49-year old male with ESRD secondary to polycystic kidney disease underwent extended criteria donor kidney transplantation. Posttransplant, patient developed delayed graft function (DGF, and the biopsy showed moderately intense CaOx deposition that persisted on subsequent biopsies for 16 weeks, eventually resulting in PNF. The serum oxalate level was 3 times more than normal at 85 μmol/L (normal <27 μmol/L. Allograft nephrectomy showed massive aggregates of CaOx crystal deposition in renal collecting system. In conclusion, acute oxalate nephropathy should be considered in the differential diagnosis of DGF since optimal management could change the outcome of the allograft.

  3. A histomorphometric and micro-computed tomography study of bone regeneration in the maxillary sinus comparing biphasic calcium phosphate and deproteinized cancellous bovine bone in a human split-mouth model

    NARCIS (Netherlands)

    de Lange, G.L.; Overman, J.R.; Farre-Guasch, E.; Korstjens, C.M.; Hartman, B.; Langenbach, G.E.J.; van Duin, M.A.; Klein-Nulend, J.

    2014-01-01

    Objective The gain of mineralized bone was compared between deproteinized bovine bone allograft (DBA) and biphasic calcium phosphate (BCP) for dental implant placement. Study Design Five patients with atrophic maxillae underwent bilateral sinus elevation with DBA (Bio-Oss) and BCP (Straumann

  4. Polymer-controlled release of tobramycin from bone graft void filler.

    Science.gov (United States)

    Brooks, Amanda E; Brooks, Benjamin D; Davidoff, Sherry N; Hogrebe, Paul C; Fisher, Mark A; Grainger, David W

    2013-12-01

    Despite clinical, material, and pharmaceutical advances, infection remains a major obstacle in total joint revision surgery. Successful solutions must extend beyond bulk biomaterial and device modifications, integrating locally delivered pharmaceuticals and physiological cues at the implant site, or within large bone defects with prominent avascular spaces. One approach involves coating clinically familiar allograft bone with an antibiotic-releasing rate-controlling polymer membrane for use as a matrix for local drug release in bone. The kinetics of drug release from this system can be tailored via alterations in the substrate or the polymeric coating. Drug-loaded polycaprolactone coating releases bioactive tobramycin from both cadaveric-sourced cancellous allograft fragments and synthetic hybrid coralline ceramic bone graft fragments with similar kinetics over a clinically relevant 6-week timeframe. However, micron-sized allograft particulate provides extended bioactive tobramycin release. Addition of porogen polyethylene glycol to the polymer coating formulation changes tobramycin release kinetics without significant impact on released antibiotic bioactivity. Incorporation of oil-microencapsulated tobramycin into the polymer coating did not significantly modify tobramycin release kinetics. In addition to releasing inhibitory concentrations of tobramycin, antibiotic-loaded allograft bone provides recognized beneficial osteoconductive potential, attractive for decreasing orthopedic surgical infections with improved filling of dead space and new bone formation.

  5. Cell-Free DNA and Active Rejection in Kidney Allografts.

    Science.gov (United States)

    Bloom, Roy D; Bromberg, Jonathan S; Poggio, Emilio D; Bunnapradist, Suphamai; Langone, Anthony J; Sood, Puneet; Matas, Arthur J; Mehta, Shikha; Mannon, Roslyn B; Sharfuddin, Asif; Fischbach, Bernard; Narayanan, Mohanram; Jordan, Stanley C; Cohen, David; Weir, Matthew R; Hiller, David; Prasad, Preethi; Woodward, Robert N; Grskovic, Marica; Sninsky, John J; Yee, James P; Brennan, Daniel C

    2017-07-01

    Histologic analysis of the allograft biopsy specimen is the standard method used to differentiate rejection from other injury in kidney transplants. Donor-derived cell-free DNA (dd-cfDNA) is a noninvasive test of allograft injury that may enable more frequent, quantitative, and safer assessment of allograft rejection and injury status. To investigate this possibility, we prospectively collected blood specimens at scheduled intervals and at the time of clinically indicated biopsies. In 102 kidney recipients, we measured plasma levels of dd-cfDNA and correlated the levels with allograft rejection status ascertained by histology in 107 biopsy specimens. The dd-cfDNA level discriminated between biopsy specimens showing any rejection (T cell-mediated rejection or antibody-mediated rejection [ABMR]) and controls (no rejection histologically), P rejection at a cutoff of 1.0% dd-cfDNA were 61% and 84%, respectively. The AUC for discriminating ABMR from samples without ABMR was 0.87 (95% CI, 0.75 to 0.97). Positive and negative predictive values for ABMR at a cutoff of 1.0% dd-cfDNA were 44% and 96%, respectively. Median dd-cfDNA was 2.9% (ABMR), 1.2% (T cell-mediated types ≥IB), 0.2% (T cell-mediated type IA), and 0.3% in controls ( P =0.05 for T cell-mediated rejection types ≥IB versus controls). Thus, dd-cfDNA may be used to assess allograft rejection and injury; dd-cfDNA levels rejection (T cell-mediated type ≥IB or ABMR) and levels >1% indicate a probability of active rejection. Copyright © 2017 by the American Society of Nephrology.

  6. Glomerular damage as a predictor of renal allograft loss

    Directory of Open Access Journals (Sweden)

    G. Moscoso-Solorzano

    2010-06-01

    Full Text Available Interstitial fibrosis and tubular atrophy (IF/TA are the most common cause of renal graft failure. Chronic transplant glomerulopathy (CTG is present in approximately 1.5-3.0% of all renal grafts. We retrospectively studied the contribution of CTG and recurrent post-transplant glomerulopathies (RGN to graft loss. We analyzed 123 patients with chronic renal allograft dysfunction and divided them into three groups: CTG (N = 37, RGN (N = 21, and IF/TA (N = 65. Demographic data were analyzed and the variables related to graft function identified by statistical methods. CTG had a significantly lower allograft survival than IF/TA. In a multivariate analysis, protective factors for allograft outcomes were: use of angiotensin-converting enzyme inhibitor (ACEI; hazard ratio (HR = 0.12, P = 0.001, mycophenolate mofetil (MMF; HR = 0.17, P = 0.026, hepatitis C virus (HR = 7.29, P = 0.003, delayed graft function (HR = 5.32, P = 0.016, serum creatinine ≥1.5 mg/dL at the 1st year post-transplant (HR = 0.20, P = 0.011, and proteinuria ≥0.5 g/24 h at the 1st year post-transplant (HR = 0.14, P = 0.004. The presence of glomerular damage is a risk factor for allograft loss (HR = 4.55, P = 0.015. The presence of some degree of chronic glomerular damage in addition to the diagnosis of IF/TA was the most important risk factor associated with allograft loss since it could indicate chronic active antibody-mediated rejection. ACEI and MMF were associated with better outcomes, indicating that they might improve graft survival.

  7. Transplantation tolerance in primates following total lymphoid irradiation and allogeneic bone marrow injection. II. Renal allographs

    International Nuclear Information System (INIS)

    Myburgh, J.A.; Smit, J.A.; Hill, R.R.H.; Browde, S.

    1980-01-01

    A modified regimen of fractionated total lymphoid irradiation and allogeneic bone marrow (BM) injection in chacma baboons produced transplantation tolerance for allografted kidneys from the BM donors, and substantial chimerism without evidence of graft-versus-host disease. Increasing the dose of nucleated BM cells injected 4-fold over that used in liver transplantation resulted consistently in normal graft function in the early weeks after transplantation. Bone marrow injection and challenge with renal allografts could be delayed for at least 3 weeks after completion of irradiation. If it can be shown that this period can be extended even further, the protocols will be relevant to the circumstances of clinical cadaveric renal transplantation

  8. Survival, recurrence, and function after epiphyseal preservation and allograft reconstruction in osteosarcoma of the knee.

    Science.gov (United States)

    Aponte-Tinao, Luis; Ayerza, Miguel A; Muscolo, D Luis; Farfalli, Germán L

    2015-05-01

    Bone tumor resections for limb salvage have become the standard treatment. Recently, intercalary tumor resection with epiphyseal sparing has been used as an alternative in patients with osteosarcoma. The procedure maintains normal joint function and obviates some complications associated with osteoarticular allografts or endoprostheses; however, long-term studies analyzing oncologic outcomes are scarce, and to our knowledge, the concern that a higher local recurrence rate may be an issue has not been addressed. We wanted to assess (1) the overall survival in patients treated with this surgical technique; (2) the percentage of local recurrence and limb survival, specifically the incidence of recurrence in the remaining epiphysis; (3) the frequency of orthopaedic complications, and, (4) the functional outcomes in patients who have undergone intercalary tumor resection. We analyzed all 35 patients with osteosarcomas about the knee (distal femur and proximal tibia) treated at our center between 1991 and 2008 who had resection preserving the epiphysis and reconstruction with intercalary allografts. Minimum followup was 5 years, unless death occurred earlier (mean, 9 years; range, 1-16 years), and no patients were lost to followup. During the study period, our indications for this approach included patients without metastases, with clinical and imaging response to neoadjuvant chemotherapy, that a residual epiphysis of at least 1 cm thickness could be available after a surgical margin width in bone of 10 mm was planned, and 16% of patients (35 of 223) meeting these indications were treated using this approach. Using a chart review, we ascertained overall survival of patients, oncologic complications such as local recurrence and tumor progression, limb survival, and orthopaedic complications including infection, fracture, and nonunion. Survival rates were estimated using the Kaplan-Meier method. Patient function was evaluated using the Musculoskeletal Tumor Society (MSTS

  9. Cost comparison of femoral head banking versus bone substitutes.

    Science.gov (United States)

    Leung, Hon-Bong; Fok, Margaret Woon-Man; Chow, Lorraine Chi-Yan; Yen, Chi-Hung

    2010-04-01

    To compare the costs of femoral head banking versus bone substitutes. Records of femoral head banking from 1998 to 2008 were reviewed. The cost of allogenic cancellous bone graft was calculated by estimating the direct expenditure of femoral head procurement, screening tests, and storage, and then divided by the amount of bone harvested. 326 females and 141 males (mean age, 80.3 years) donated 470 femoral heads. Each transplantable femoral head costs US$978. Each gram of transplantable allogenic bone graft costs US$86, compared with US$9 to 26 per gram for commercially available bone substitutes. Compared with bone substitutes, femoral head banking in Hong Kong was less economical. Unless allografts yield superior outcomes, harvesting femoral heads for general usage (such as filling bone voids for fresh fractures) is not justified from a financial perspective, especially in banks dedicated to procuring bone from femoral heads only.

  10. Osteogenic protein 1 device increases bone formation and bone graft resorption around cementless implants

    DEFF Research Database (Denmark)

    Jensen, Thomas B; Overgaard, Søren; Lind, Martin

    2002-01-01

    In each femoral condyle of 8 Labrador dogs, a non weight-bearing hydroxyapatite-coated implant was inserted surrounded by a 3 mm gap. Each gap was filled with bone allograft or ProOsteon with or without OP-1 delivered in a bovine collagen type I carrier (OP-1 device). 300 microg OP-1 was used...... in the 0.75 cc gap surrounding the implant. After 3 weeks, the OP-1 device enhanced implant fixation by 800% (p...

  11. Biomaterial scaffolds for treating osteoporotic bone

    Science.gov (United States)

    Sterling, Julie A.

    2014-01-01

    Healing fractures resulting from osteoporosis or cancer remains a significant clinical challenge. In these populations, healing is often impaired not only due to age and disease, but also by other therapeutic interventions such as radiation, steroids, and chemotherapy. Despite substantial improvements in the treatment of osteoporosis over the few decades, osteoporotic fractures are still a major clinical challenge in the elderly population due to impaired healing. Similar fractures with impaired healing are also prevalent in cancer patients, especially those with tumor growing in bone. Treatment options for cancer patients are further complicated by the fact that bone anabolic therapies are contraindicated in patients with tumors. Therefore, many patients undergo surgery to repair the fracture, and bone grafts are often used to stabilize orthopaedic implants and provide a scaffold for ingrowth of new bone. Both synthetic and naturally occurring biomaterials have been investigated as bone grafts for repair of osteoporotic fractures, including calcium phosphate bone cements, resorbable polymers, and allograft or autograft bone. In order to re-establish normal bone repair, bone grafts have been augmented with anabolic agents, such as mesenchymal stem cells (MSC) or recombinant human bone morphogenetic protein-2 (rhBMP2). These developing approaches to bone grafting are anticipated to improve the clinical management of osteoporotic and cancer-induced fractures. PMID:24458428

  12. Treatment of Severely Resorbed Maxilla Due to Peri-Implantitis by Guided Bone Regeneration Using a Customized Allogenic Bone Block: A Case Report

    Directory of Open Access Journals (Sweden)

    Oliver Blume

    2017-10-01

    Full Text Available The objective of this case report is to introduce a customized CAD/CAM freeze-dried bone allograft (FDBA block for its use in Guided Bone Regeneration (GBR procedures for severely deficient maxillary bones. Additionally, a special newly developed remote incision technique is presented to avoid wound dehiscence. The results show optimal integration behavior of the FDBA block after six months and the formation of new vital bone. Thus, the results of the present case report confirm the use of the customized CAD/CAM bone block for augmentation of complex defects in the maxillary aesthetic zone as a successful treatment concept.

  13. Journey of bone graft materials in periodontal therapy: A chronological review

    Directory of Open Access Journals (Sweden)

    Jitendra Kumar

    2016-01-01

    Full Text Available Bone, the basic building block of the healthy periodontium, is affected in most of the periodontal diseases and can be managed either by mechanically recontouring it or by grafting techniques, which encourages regeneration where it has been lost. Bone replacement grafts are widely used to promote bone formation and periodontal regeneration. Bone grafting, placing bone or bone substitutes into defects created by the disease process, acts like a scaffold upon which the body generates its own, new bone. A wide range of bone grafting materials, including bone grafts and bone graft substitutes, have been applied and evaluated clinically, including autografts, allografts, xenografts, and alloplasts. This review provides an overview of the clinical application, biologic function, and advantages and disadvantages of various types of bone graft materials used in periodontal therapy till date with emphasis on recent advances in this field.

  14. Remodeling Tulang Alveolar untuk Reimplantasi dan Transplantasi Gigi Anterior pada Kehilangan Tulang Hebat Paska Trauma

    Directory of Open Access Journals (Sweden)

    Heru Maksmara

    2011-06-01

    Full Text Available Latar Belakang. Remodeling tulang alveolar berguna untuk memperbaiki kehilangan struktur jaringan pendukung gigi yang hebat pada reimplantasi dan transplantasi gigi anterior, supaya gigi anterior yang terlepas dari soketnya paska trauma dapat di implantasi. Bahan cangkok tulang untuk remodeling tulang alveolar yang digunakan berjenis demineralized freeze-dried bone allograft (DFDBA. Tujuan Penulisan Laporan Kasus. Melaporkan keberhasilan menanam gigi tetap ditempatnya dengan teknik remodeling tulang dengan penambahan DFDBA agar struktur jaringan pendukung gigi yang hilang kembali normal. Penatalaksanaan. Pasien paska trauma, dalam keadaan tidak sadar selama 7 hari di ruang rawat intensif dan dirawat selama 7 hari di bangsal. Pasien mengalami trauma dan kehilangan tulang penyangga gigi yang hebat, pada gigi anterior bawah. Tiga gigi anterior mengalami kegoyahan 4° dan dua gigi hilang. Hilangnya dua gigi mengakibatkan area edentulous besar, sehingga perlu di lakukan transplantasi satu gigi. Untuk memperkecil edentulous dilakukan penambahan lebar mahkota gigi menggunakan composite light curing. Setelah pencabutan gigi, semua gigi yang akan di implant dilakukan perawatan saluran akar gigi dan disterilkan. Flap operasi dilakukan untuk menata serpihan tulang dan menilai besarnya trauma, daerah luka dibersihkan dengan lIarutan salin. Splinting semua gigi yang akan di implant menggunakan arch bar dan kawat. Penambahan bahan cangkok tulang DFDBA pada daerah operasi. Menjahit daerah operasi ke korona gigi dan ditutup pack. Setelah 6 bulan operasi dua gigi tidak men gal ami kegoyahan, dua gigi lain mengalami kegoyahan 2°, 12 bulan tiga gigi tidak mengalami kegoyahan dan hanya satu gigi transplantasi yang mengalami kegoyahan 1°. Re-entry operasi dilakukan untuk remodeling tulang bertambah baik. Setelah 6 bulan paska re-entry operasi, gigi yang di transplantasi tidak mengalami kegoyahan. Sehingga splint dapat dilepas. Kesimpulan. Remodeling tulang pada

  15. Bone Diseases

    Science.gov (United States)

    ... avoid smoking and drinking too much alcohol. Bone diseases can make bones easy to break. Different kinds ... break Osteogenesis imperfecta makes your bones brittle Paget's disease of bone makes them weak Bones can also ...

  16. The Kidney-Vascular-Bone Axis in the Chronic Kidney Disease-Mineral Bone Disorder.

    Science.gov (United States)

    Seifert, Michael E; Hruska, Keith A

    2016-03-01

    The last 25 years have been characterized by dramatic improvements in short-term patient and allograft survival after kidney transplantation. Long-term patient and allograft survival remains limited by cardiovascular disease and chronic allograft injury, among other factors. Cardiovascular disease remains a significant contributor to mortality in native chronic kidney disease as well as cardiovascular mortality in chronic kidney disease more than doubles that of the general population. The chronic kidney disease (CKD)-mineral bone disorder (MBD) is a syndrome recently coined to embody the biochemical, skeletal, and cardiovascular pathophysiology that results from disrupting the complex systems biology between the kidney, skeleton, and cardiovascular system in native and transplant kidney disease. The CKD-MBD is a unique kidney disease-specific syndrome containing novel cardiovascular risk factors, with an impact reaching far beyond traditional notions of renal osteodystrophy and hyperparathyroidism. This overview reviews current knowledge of the pathophysiology of the CKD-MBD, including emerging concepts surrounding the importance of circulating pathogenic factors released from the injured kidney that directly cause cardiovascular disease in native and transplant chronic kidney disease, with potential application to mechanisms of chronic allograft injury and vasculopathy.

  17. Efficacy of prophylactic irradiation in altering renal allograft survival

    International Nuclear Information System (INIS)

    Faber, R.; Johnson, H.K.; Braren, H.V.; Richie, R.E.

    1974-01-01

    Renal allograft rejection is a complex phenomenon involving both cell-mediated and humoral antibody responses. Most transplant programs have used a combination of therapeutic modalites to combat the immune system in an attempt to prolong both allograft and patient survival. Corticosteroids (methylprednisolone (Solu-Medrol) and prednisone and azathioprine (Imuran) are widely accepted as immunosuppressive drugs; however, both are non-specific and have the disadvantage of compromising the recipients' defense mechanisms. Nevertheless, these drugs have proved to be essential to the success of renal transplantation and they are routinely used while the efficacy of other modalities continues to be evaluated. We could find no reports of a prospective study to evaluate the efficacy of prophylactic irradiation in the complex therapeutic situation of renal transplantation with the only variable being the administration of local graft irradiation. The purpose of this study was to evaluate prophylactic graft irradiation for its effectiveness in preventing graft rejection in conjunction with Imuran and corticosteroids

  18. Guided bone regeneration using demineralized allogenic bone matrix with calcium sulfate: case series.

    Science.gov (United States)

    Kim, Young-Kyun; Lee, Ji-Young; Kim, Su-Gwan; Lim, Seung-Chul

    2013-05-01

    The purpose of this case series was to evaluate the effect of guided bone regeneration using demineralized allogenic bone matrix with calcium sulfate. Guided bone regeneration using Demineralized Allogenic Bone Matrix with Calcium Sulfate (AlloMatrix™, Wright. USA) was performed at the time of implant placement from February 2010 to April 2010. At the time of the second surgery, clinical evaluation of bone healing and histologic evaluation were performed. The study included 10 patients, and 23 implants were placed. The extent of bony defects around implants was determined by measuring the horizontal and vertical bone defects using a periodontal probe from the mesial, distal, buccal, and lingual sides and calculating the mean and standard deviation of these measurements. Wedge-shaped tissue samples were obtained from 3 patients and histologic examination was performed. In clinical evaluation, it was observed that horizontal bone defects were completely healed with new bones, and in the vertical bone defect area, 15.1% of the original defect area remained. In 3 patients, histological tests were performed, and 16.7-41.7% new bone formation was confirmed. Bone graft materials slowly underwent resorption over time. AlloMatrix™ is an allograft material that can be readily manipulated. It does not require the use of barrier membranes, and good bone regeneration can be achieved with time.

  19. Biodegradable hybrid tissue engineering scaffolds for reconstruction of large bone defects

    Science.gov (United States)

    Barati, Danial

    Complex skeletal injuries and large bone fractures are still a significant clinical problem in US. Approximately 1.5 million Americans (veterans, their families, and civilians) every year suffer from bone loss due to traumatic skeletal injuries, infection, and resection of primary tumors that require extensive grafting to bridge the gap. The US bone graft market is over $2.2 billion a year. Due to insufficient mechanical stability, lack of vascularity, and inadequate resorption of the graft, patients with traumatic large skeletal injuries undergo multiple costly operations followed by extensive recovery steps to maintain proper bone alignment and length. Current strategies for repairing damaged or diseased bones include autologous or allograft bone transplantations. However, limited availability of autografts and risk of disease transmission associated with allografts have necessitated the search for the development of new bone graft options and strategies. The overall goal of this project is to develop a much-needed bone-mimetic engineered graft as a substitute for current strategies providing required bone grafts for reconstruction of large bone defects. This project will use the structure of natural cortical bone as a guide to produce an engineered bone graft with balanced strength, osteogenesis, vascularization, and resorption. The outcome of this project will be a biodegradable hybrid scaffold system (similar to natural cortical bone) including a mechanically strong scaffold allowing for mechanical stability of the load-bearing defect site and a soft and highly porous structure such as a hydrogel phase which will allow for efficient cell and growth factor delivery into the defect implantation site, cell niche establishment and promotion of mineralization. Successful completion of this project will transform bone graft technology for regeneration of complex bone defects from a frozen or freeze-dried allograft to a safe, infection-free, mechanically

  20. X-ray microtomography-based measurements of meniscal allografts.

    Science.gov (United States)

    Mickiewicz, P; Binkowski, M; Bursig, H; Wróbel, Z

    2015-05-01

    X-ray microcomputed tomography (XMT) is a technique widely used to image hard and soft tissues. Meniscal allografts as collagen structures can be imaged and analyzed using XMT. The aim of this study was to present an XMT scanning protocol that can be used to obtain the 3D geometry of menisci. It was further applied to compare two methods of meniscal allograft measurement: traditional (based on manual measurement) and novel (based on digital measurement of 3D models of menisci obtained with use of XMT scanner). The XMT-based menisci measurement is a reliable method for assessing the geometry of a meniscal allograft by measuring the basic meniscal dimensions known from traditional protocol. Thirteen dissected menisci were measured according the same principles traditionally applied in a tissue bank. Next, the same specimens were scanned by a laboratory scanner in the XMT Lab. The images were processed to obtain a 3D mesh. 3D models of allograft geometry were then measured using a novel protocol enhanced by computer software. Then, both measurements were compared using statistical tests. The results showed significant differences (P<0.05) between the lengths of the medial and lateral menisci measured in the tissue bank and the XMT Lab. Also, medial meniscal widths were significantly different (P<0.05). Differences in meniscal lengths may result from difficulties in dissected meniscus measurements in tissue banks, and may be related to the elastic structure of the dissected meniscus. Errors may also be caused by the lack of highlighted landmarks on the meniscal surface in this study. The XMT may be a good technique for assessing meniscal dimensions without actually touching the specimen. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  1. Pancreas Allograft Transplantation in Dogs with Experimental Diabetes Mellitus

    OpenAIRE

    Mendívil Zapata, Rolando; Garmendia, Fausto; Yerén, Cecilia; Torres, William

    2014-01-01

    OBJETIVE : To evaluate the efficacy of pancreatic allograft transplantation (TAP ) in dogs with diabetes mellitus ( DME ) induced by alloxan . METHODS : 63 mongrel dogs were used , of which 33 for the very best experimental conditions , the other 30 were divided into 3 groups of 10 each : a) controls, were only produced DME b ) receptors with DME, the who underwent TAP and c) pancreas donors . RESULTS : The glycemic control was complete in 50% of recipients and partial in 30% , giving an over...

  2. Late Acute Rejection Occuring in Liver Allograft Recipients

    Directory of Open Access Journals (Sweden)

    Eric M Yoshida

    1996-01-01

    Full Text Available To study the effect of immunosuppressive reduction on the incidence and consequence of late acute rejection (LAR in liver allograft recipients, mean daily prednisone dose, mean cyclosporine A (CsA trough and nadir levels were retrospectively reviewed for the nearest 12-week period preceding six episodes of LAR in five liver allograft recipients (group 1. Results were compared with those from a cohort of 12 liver allograft recipients who did not develop LAR (group 2. LAR was defined as acute rejection occurring more than 365 days post-transplantation. Median follow-up for both groups was similar (504 days, range 367 to 1050, versus 511 days, range 365 to 666, not significant. Mean trough CsA levels were lower in patients with LAR compared with those without (224±66 ng/mL versus 233±49 ng/mL but the difference was not statistically significant. In contrast, mean daily prednisone dose (2.5±1.6 mg/ day versus 6.5±2.9 mg/day, P=0.007 and CsA nadir values (129±60 ng/mL versus 186±40 ng/mL, P=0.03 were significantly lower in patients who developed LAR compared with those who did not. Five of six episodes (83% of LAR occurred in patients receiving less than 5 mg/day of prednisone, versus a single LAR episode in only one of 12 patients (8% receiving prednisone 5 mg/day or more (P=0.004. In all but one instance, LAR responded to pulse methylprednisolone without discernible affect on long term graft function. The authors conclude that liver allograft recipients remain vulnerable to acute rejection beyond the first post-transplant year; and reduction of immunosuppressive therapy, particularly prednisone, below a critical, albeit low dose, threshold increases the risk of LAR.

  3. Acute Hepatic Allograft Rejection in Pediatric Recipients: Independent Factors

    OpenAIRE

    Dehghani, S. M.; Shahramian, I.; Afshari, M.; Bahmanyar, M.; Ataollahi, M.; Sargazi, A.

    2017-01-01

    Background: Acute cellular rejection (ACR) has a reversible effect on graft and its survival. Objective: To evaluate the relation between ACR and clinical factors in recipients of liver transplant allografts. Methods: 47 consecutive liver recipients were retrospectively studied. Their data were extracted from records and analyzed. Results: 38 (81%) of the 47 recipients experienced ACR during a 24-month follow-up. The rate of rejection was associated with none of the studied factors—recipient’...

  4. Thioredoxin priming prolongs lung allograft survival by promoting immune tolerance.

    Science.gov (United States)

    Hu, Hanbo; Zhu, Xiaoyan; Joshi, Sunil; Lu, Li; Xia, Chang-Qing; Patel, Jawaharlal M

    2015-01-01

    Tolerance to allograft antigen is the major challenge and final goal of transplant medicine. Our previous study demonstrated that thioredoxin-1 (Trx) priming of donor lung significantly protected allogeneic lung graft. To determine whether Trx priming of donor lung inhibits allograft rejection, extends allograft survival and induces immune tolerance, orthotopic left lung transplantation was performed from Lewis to Sprague-Dawley rats without immunosuppression. Donor lungs were primed with Trx at 4°C for 4 hr prior to transplantation. After up to 37 days post-transplantation, allograft lung morphology, recipient T cell and humoral alloantigen-specific immune responses were examined. We found that Trx-primed lungs exhibited much reduced acute rejection and associated lung injuries resulting in loss of graft functional area at 5-37 days post-transplant in contrast to the control groups. CD4+ T cells from the recipients with Trx-primed grafts responded to the stimulation of dendritic cells (DCs) of donor origin, in contrast to DCs from the third party, with significantly reduced proliferation. Consistent with above findings, we observed that CD4+Foxp3+ regulatory T cells in spleen cells from the recipients with Trx-primed grafts were significantly increased compared to controls, and CD4+ T cells from the recipients with Trx-primed grafts produced much higher levels of immunosuppressive cytokine, IL-10 when stimulated with allogeneic donor DCs. In addition, humoral immune tolerance was also induced as there was no significant increase levels of serum antibodies against donor antigens in Trx-lung recipients when re-challenged with allogeneic donor antigens. Our results demonstrate that one-time Trx-priming of donor lung grafts prior to transplantation significantly prolongs the survival of the grafts through inducing or promoting cellular and humoral alloantigen-specific immune tolerance, which might be associated with the induction of immunosuppressive regulatory T

  5. Thioredoxin priming prolongs lung allograft survival by promoting immune tolerance.

    Directory of Open Access Journals (Sweden)

    Hanbo Hu

    Full Text Available Tolerance to allograft antigen is the major challenge and final goal of transplant medicine. Our previous study demonstrated that thioredoxin-1 (Trx priming of donor lung significantly protected allogeneic lung graft. To determine whether Trx priming of donor lung inhibits allograft rejection, extends allograft survival and induces immune tolerance, orthotopic left lung transplantation was performed from Lewis to Sprague-Dawley rats without immunosuppression. Donor lungs were primed with Trx at 4°C for 4 hr prior to transplantation. After up to 37 days post-transplantation, allograft lung morphology, recipient T cell and humoral alloantigen-specific immune responses were examined. We found that Trx-primed lungs exhibited much reduced acute rejection and associated lung injuries resulting in loss of graft functional area at 5-37 days post-transplant in contrast to the control groups. CD4+ T cells from the recipients with Trx-primed grafts responded to the stimulation of dendritic cells (DCs of donor origin, in contrast to DCs from the third party, with significantly reduced proliferation. Consistent with above findings, we observed that CD4+Foxp3+ regulatory T cells in spleen cells from the recipients with Trx-primed grafts were significantly increased compared to controls, and CD4+ T cells from the recipients with Trx-primed grafts produced much higher levels of immunosuppressive cytokine, IL-10 when stimulated with allogeneic donor DCs. In addition, humoral immune tolerance was also induced as there was no significant increase levels of serum antibodies against donor antigens in Trx-lung recipients when re-challenged with allogeneic donor antigens. Our results demonstrate that one-time Trx-priming of donor lung grafts prior to transplantation significantly prolongs the survival of the grafts through inducing or promoting cellular and humoral alloantigen-specific immune tolerance, which might be associated with the induction of

  6. Proteinuria after kidney transplantation, relationship to allograft histology and survival.

    Science.gov (United States)

    Amer, H; Fidler, M E; Myslak, M; Morales, P; Kremers, W K; Larson, T S; Stegall, M D; Cosio, F G

    2007-12-01

    Proteinuria is associated with reduced kidney allograft survival. Herein we assessed the association between proteinuria, graft histology and survival. The cohort included 613 kidney allograft recipients who had proteinuria (measured) and surveillance biopsies at 1-year posttransplant. Proteinuria >150 mg/day was detected in 276 patients (45%) and in 182 of these, proteinuria was below 500. In >84% of patients even low levels of proteinuria were associated with albuminuria. Proteinuria was associated with the presence of graft glomerular pathology and the use of sirolimus. Eighty percent of patients with proteinuria >1500 mg/day had glomerular pathology on biopsy. However, lower levels of proteinuria were not associated with specific pathologies at 1 year. Compared to no sirolimus, sirolimus use was associated with higher prevalence of proteinuria (40% vs. 76%, p Proteinuria was associated with reduced graft survival (HR = 1.40, p = 0.001) independent of other risk factors including, glomerular pathology, graft function, recipient age and acute rejection. The predominant pathology in lost allografts (n = 57) was glomerular, particularly in patients with 1-year proteinuria >500. Thus, proteinuria, usually at low levels (proteinuria relate to poor graft survival. Proteinuria and glomerular pathology relate independently to survival.

  7. Multidetector computed tomography findings of spontaneous renal allograft ruptures

    Energy Technology Data Exchange (ETDEWEB)

    Basaran, C. [Department of Radiology, Baskent University Faculty of Medicine, Ankara (Turkey)], E-mail: ceylab@baskent-ank.edu.tr; Donmez, F.Y.; Tarhan, N.C.; Coskun, M. [Department of Radiology, Baskent University Faculty of Medicine, Ankara (Turkey); Haberal, M. [Department of General Surgery, Baskent University Faculty of Medicine, Ankara (Turkey)

    2009-05-15

    Aim: To describe the characteristics of spontaneous renal allograft rupture using multidetector computed tomography (MDCT). Method: Five patients with spontaneous renal allograft rupture, as confirmed by pathologic examination, were referred to our institution between 1985 and 2008. The clinical records and preoperative MDCT findings of the patients were studied retrospectively. Results: Clinical and/or histological findings were consistent with acute rejection in all cases. Using MDCT, disruption of the capsular integrity and parenchymal rupture was seen in four patients. Four of the five patients showed decreased enhancement and swollen grafts. Perirenal (n = 4), subcapsular (n = 1), and intraparenchymal (n = 1) haematomas were also seen. In the patient with an intraparenchymal haematoma there was no disruption of capsular integrity, but capsular irregularities were seen near the haematoma. Conclusion: MDCT is a useful investigative tool for the evaluation of suspected spontaneous renal allograft rupture. As well as a swollen graft, disruption of the capsule, parenchyma, and/or haematoma should prompt the radiologist to consider this diagnosis.

  8. Prolongation of segmental and pancreaticoduodenal allografts in the primate with total-lymphoid irradiation and cyclosporine

    Energy Technology Data Exchange (ETDEWEB)

    Du Toit, D.F.; Heydenrych, J.J.; Smit, B.; Louw, G.; Zuurmond, T.; Els, D.; Du Toit, L.B.; Weideman, A.; Davids, H.; van der Merwe, E.

    1987-09-01

    The prolongation of segmental and pancreaticoduodenal allografts (PDA) by total lymphoid irradiation (TLI) and in combination with cyclosporine (CsA) was assessed in a well established total pancreatectomy, diabetic, primate transplantation model. Pancreatic transplantation was performed in 119 pancreatectomized baboons (Papio ursinus). Of a total of 109 allografts performed, 71 were segmental allografts (open duct drainage) and 38 PDA. Of 119 graft recipients, 10 received segmental pancreatic autografts. TLI and CsA administered separately to segmental allograft recipients resulted in modest allograft survival and indefinite graft survival was not observed. 8 of 17 (47%) segmental allograft recipients that received TLI and CsA had graft survival beyond 100 days, indicating highly significant pancreatic allograft survival. All long-term segmental allograft recipients were rendered normoglycemic (plasma glucose less than 8 mmol/L) by this immunosuppressive regimen. In contrast, poor results were observed in PDA recipients treated with TLI and CsA. Mean survival in 18 treated PDA recipients was 23.8 days, 8 survived longer than 20 days (44.4%), and 1 greater than 100 days (5.5%). Despite treatment, early rejection of the duodenum in PDA recipients frequently resulted in necrosis and perforation and contributed to a high morbidity and mortality. This study indicates that, in contrast to the significant prolongation of segmental allografts by TLI and CsA, poor immunosuppression was achieved by this regimen in PDA recipients and was associated with a high morbidity and mortality caused by early rejection of the duodenum.

  9. Prolongation of segmental and pancreaticoduodenal allografts in the primate with total-lymphoid irradiation and cyclosporine

    International Nuclear Information System (INIS)

    Du Toit, D.F.; Heydenrych, J.J.; Smit, B.

    1987-01-01

    The prolongation of segmental and pancreaticoduodenal allografts (PDA) by total lymphoid irradiation (TLI) and in combination with cyclosporine (CsA) was assessed in a well established total pancreatectomy, diabetic, primate transplantation model. Pancreatic transplantation was performed in 119 pancreatectomized baboons (Papio ursinus). Of a total of 109 allografts performed, 71 were segmental allografts (open duct drainage) and 38 PDA. Of 119 graft recipients, 10 received segmental pancreatic autografts. TLI and CsA administered separately to segmental allograft recipients resulted in modest allograft survival and indefinite graft survival was not observed. 8 of 17 (47%) segmental allograft recipients that received TLI and CsA had graft survival beyond 100 days, indicating highly significant pancreatic allograft survival. All long-term segmental allograft recipients were rendered normoglycemic (plasma glucose less than 8 mmol/L) by this immunosuppressive regimen. In contrast, poor results were observed in PDA recipients treated with TLI and CsA. Mean survival in 18 treated PDA recipients was 23.8 days, 8 survived longer than 20 days (44.4%), and 1 greater than 100 days (5.5%). Despite treatment, early rejection of the duodenum in PDA recipients frequently resulted in necrosis and perforation and contributed to a high morbidity and mortality. This study indicates that, in contrast to the significant prolongation of segmental allografts by TLI and CsA, poor immunosuppression was achieved by this regimen in PDA recipients and was associated with a high morbidity and mortality caused by early rejection of the duodenum

  10. Quantification of renal allograft perfusion using arterial spin labeling MRI: initial results.

    Science.gov (United States)

    Lanzman, Rotem S; Wittsack, Hans-Jörg; Martirosian, Petros; Zgoura, Panagiota; Bilk, Philip; Kröpil, Patric; Schick, Fritz; Voiculescu, Adina; Blondin, Dirk

    2010-06-01

    To quantify renal allograft perfusion in recipients with stable allograft function and acute decrease in allograft function using nonenhanced flow-sensitive alternating inversion recovery (FAIR)-TrueFISP arterial spin labeling (ASL) MR imaging. Following approval of the local ethics committee, 20 renal allograft recipients were included in this study. ASL perfusion measurement and an anatomical T2-weighted single-shot fast spin-echo (HASTE) sequence were performed on a 1.5-T scanner (Magnetom Avanto, Siemens, Erlangen, Germany). T2-weighted MR urography was performed in patients with suspected ureteral obstruction. Patients were assigned to three groups: group a, 6 patients with stable allograft function over the previous 4 months; group b, 7 patients with good allograft function who underwent transplantation during the previous 3 weeks; group c, 7 allograft recipients with an acute deterioration of renal function. Mean cortical perfusion values were 304.8 +/- 34.4, 296.5 +/- 44.1, and 181.9 +/- 53.4 mg/100 ml/min for groups a, b and c, respectively. Reduction in cortical perfusion in group c was statistically significant. Our results indicate that ASL is a promising technique for nonenhanced quantification of cortical perfusion of renal allografts. Further studies are required to determine the clinical value of ASL for monitoring renal allograft recipients.

  11. The use of osteo-articular allografts for reconstruction after resection of the distal radius for tumour.

    Science.gov (United States)

    Scoccianti, G; Campanacci, D A; Beltrami, G; Caldora, P; Capanna, R

    2010-12-01

    Several techniques have been described to reconstruct a mobile wrist joint after resection of the distal radius for tumour. We reviewed our experience of using an osteo-articular allograft to do this in 17 patients with a mean follow-up of 58.9 months (28 to 119). The mean range of movement at the wrist was 56° flexion, 58° extension, 84° supination and 80° pronation. The mean ISOLS-MSTS score was 86% (63% to 97%) and the mean patient-rated wrist evaluation score was 16.5 (3 to 34). There was no local recurrence or distant metastases. The procedure failed in one patient with a fracture of the graft and an arthrodesis was finally required. Union was achieved at the host-graft interface in all except two cases. No patient reported more than modest non-disabling pain and six reported no pain at all. Radiographs showed early degenerative changes at the radiocarpal joint in every patient. A functional pain-free wrist can be restored with an osteo-articular allograft after resection of the distal radius for bone tumour, thereby avoiding the donor site morbidity associated with an autograft. These results may deteriorate with time.

  12. 3D perfusion bioreactor-activated porous granules on implant fixation and early bone formation in sheep

    DEFF Research Database (Denmark)

    Ding, Ming; Snoek Henriksen, Susan; Martinetti, Roberta

    2017-01-01

    Early fixation of total joint arthroplasties is crucial for ensuring implant survival. An alternative bone graft material in revision surgery is needed to replace the current gold standard, allograft, seeing that the latter is associated with several disadvantages. The incubation...... of such a construct in a perfusion bioreactor has been shown to produce viable bone graft materials. This study aimed at producing larger amounts of viable bone graft material (hydroxyapatite 70% and β-tricalcium-phosphate 30%) in a novel perfusion bioreactor. The abilities of the bioreactor-activated graft material...... allograft, granules, granules with bone marrow aspirate or bioreactor-activated graft material. Following an observation time of 6 weeks, early implant fixation and bone formation were assessed by micro-CT scanning, mechanical testing, and histomorphometry. Bone formations were seen in all groups, while...

  13. Does PEEK/HA Enhance Bone Formation Compared With PEEK in a Sheep Cervical Fusion Model?

    Science.gov (United States)

    Walsh, William R; Pelletier, Matthew H; Bertollo, Nicky; Christou, Chris; Tan, Chris

    2016-11-01

    Polyetheretherketone (PEEK) has a wide range of clinical applications but does not directly bond to bone. Bulk incorporation of osteoconductive materials including hydroxyapatite (HA) into the PEEK matrix is a potential solution to address the formation of a fibrous tissue layer between PEEK and bone and has not been tested. Using in vivo ovine animal models, we asked: (1) Does PEEK-HA improve cortical and cancellous bone ongrowth compared with PEEK? (2) Does PEEK-HA improve bone ongrowth and fusion outcome in a more challenging functional ovine cervical fusion model? The in vivo responses of PEEK-HA Enhanced and PEEK-OPTIMA ® Natural were evaluated for bone ongrowth in the form of dowels implanted in the cancellous and cortical bone of adult sheep and examined at 4 and 12 weeks as well as interbody cervical fusion at 6, 12, and 26 weeks. The bone-implant interface was evaluated with radiographic and histologic endpoints for a qualitative assessment of direct bone contact of an intervening fibrous tissue later. Gamma-irradiated cortical allograft cages were evaluated as well. Incorporating HA into the PEEK matrix resulted in more direct bone apposition as opposed to the fibrous tissue interface with PEEK alone in the bone ongrowth as well as interbody cervical fusions. No adverse reactions were found at the implant-bone interface for either material. Radiography and histology revealed resorption and fracture of the allograft devices in vivo. Incorporating HA into PEEK provides a more favorable environment than PEEK alone for bone ongrowth. Cervical fusion was improved with PEEK-HA compared with PEEK alone as well as allograft bone interbody devices. Improving the bone-implant interface with a PEEK device by incorporating HA may improve interbody fusion results and requires further clinical studies.

  14. Non-Invasive Monitoring of Temporal and Spatial Blood Flow during Bone Graft Healing Using Diffuse Correlation Spectroscopy

    Science.gov (United States)

    Han, Songfeng; Hoffman, Michael D.; Proctor, Ashley R.; Vella, Joseph B.; Mannoh, Emmanuel A.; Barber, Nathaniel E.; Kim, Hyun Jin; Jung, Ki Won; Benoit, Danielle S. W.; Choe, Regine

    2015-01-01

    Vascular infiltration and associated alterations in microvascular blood flow are critical for complete bone graft healing. Therefore, real-time, longitudinal measurement of blood flow has the potential to successfully predict graft healing outcomes. Herein, we non-invasively measure longitudinal blood flow changes in bone autografts and allografts using diffuse correlation spectroscopy in a murine femoral segmental defect model. Blood flow was measured at several positions proximal and distal to the graft site before implantation and every week post-implantation for a total of 9 weeks (autograft n = 7 and allograft n = 10). Measurements of the ipsilateral leg with the graft were compared with those of the intact contralateral control leg. Both autografts and allografts exhibited an initial increase in blood flow followed by a gradual return to baseline levels. Blood flow elevation lasted up to 2 weeks in autografts, but this duration varied from 2 to 6 weeks in allografts depending on the spatial location of the measurement. Intact contralateral control leg blood flow remained at baseline levels throughout the 9 weeks in the autograft group; however, in the allograft group, blood flow followed a similar trend to the graft leg. Blood flow difference between the graft and contralateral legs (ΔrBF), a parameter defined to estimate graft-specific changes, was elevated at 1–2 weeks for the autograft group, and at 2–4 weeks for the allograft group at the proximal and the central locations. However, distal to the graft, the allograft group exhibited significantly greater ΔrBF than the autograft group at 3 weeks post-surgery (p flow supports established trends of delayed healing in allografts versus autografts. PMID:26625352

  15. Delaying Shoulder Motion and Strengthening and Increasing Achilles Allograft Thickness for Glenoid Resurfacing Did Not Improve the Outcome for a 30-Year-Old Patient with Postarthroscopic Glenohumeral Chondrolysis

    Directory of Open Access Journals (Sweden)

    John G. Skedros

    2014-01-01

    Full Text Available Although interposition soft-tissue (biologic resurfacing of the glenoid with humeral hemiarthroplasty has been considered an option for end-stage glenohumeral arthritis, the results of this procedure are highly unsatisfactory in patients less than 40 years old. Achilles tendon allograft is popular for glenoid resurfacing because it can be made robust by folding it. But one reason that the procedure might fail in younger patients is that the graft is not initially thick enough for the young active patient. Most authors report folding the graft only once to achieve two-layer thickness. We report the case of a 30-year-old male who had postarthroscopic glenohumeral chondrolysis that was treated with Achilles tendon allograft resurfacing of the glenoid and humeral hemiarthroplasty. An important aspect of our case is that the tendon was folded so that it was 50–100% thicker than most allograft constructs reported previously. We also used additional measures to enhance allograft resiliency and bone incorporation: (1 multiple nonresorbable sutures to attach the adjacent graft layers, (2 additional resorbable suture anchors and nonresorbable sutures in order to more robustly secure the graft to the glenoid, and (3 delaying postoperative motion and strengthening. However, despite these additional measures, our patient did not have an improved outcome.

  16. Acetabular reconstruction with bone impaction grafting and a cemented cup: 20 years' experience.

    NARCIS (Netherlands)

    Schreurs, B.W.; Slooff, T.J.J.H.; Gardeniers, J.W.M.; Buma, P.

    2001-01-01

    Acetabular bone stock loss compromises the outcome in primary and revision total hip arthroplasty. In 1979, a biologic method was introduced with tightly impacted cancellous allografts in combination with a cemented polyethylene cup for acetabular reconstruction. With this technique, it is possible

  17. Graft-derived anti-HPA-2b production after allogeneic bone-marrow transplantation

    DEFF Research Database (Denmark)

    Taaning, E; Jacobsen, N; Morling, N

    1994-01-01

    We report on a male who received a bone-marrow allograft from his HLA identical sister for acute myelogenous leukaemia. After transplantation, the patient suffered from refractoriness to the transfusions of HLA-matched platelets and a strong platelet-specific antibody, anti-HPA-2b, of IgG1 subcla...

  18. Review of Mechanical, Processing, and Immunologic Factors Associated With Outcomes of Fresh Osteochondral Allograft Transplantation of the Talus.

    Science.gov (United States)

    Okeagu, Chikezie N; Baker, Erin A; Barreras, Nicholas A; Vaupel, Zachary M; Fortin, Paul T; Baker, Kevin C

    2017-07-01

    Osteochondral lesions of the talus (OLTs) are an increasingly implicated cause of ankle pain and instability. Several treatment methods exist with varying clinical outcomes. Due in part to successful osteochondral allografting (OCA) in other joints, such as the knee and shoulder, OCA has gained popularity as a treatment option, especially in the setting of large lesions. The clinical outcomes of talar OCA have been inconsistent relative to the positive results observed in other joints. Current literature regarding OCA failure focuses mainly on 3 factors: the effect of graft storage conditions on chondrocyte viability, graft/lesion size, and operative technique. Several preclinical studies have demonstrated the ability for bone and cartilage tissue to invoke an immune response, and a limited number of clinical studies have suggested that this response may have the potential to influence outcomes after transplantation. Further research is warranted to investigate the role of immunological mechanisms as an etiology of OCA failure. Level V, expert opinion.

  19. Bone regeneration: current concepts and future directions

    Directory of Open Access Journals (Sweden)

    McGonagle Dennis

    2011-05-01

    Full Text Available Abstract Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. However, there are complex clinical conditions in which bone regeneration is required in large quantity, such as for skeletal reconstruction of large bone defects created by trauma, infection, tumour resection and skeletal abnormalities, or cases in which the regenerative process is compromised, including avascular necrosis, atrophic non-unions and osteoporosis. Currently, there is a plethora of different strategies to augment the impaired or 'insufficient' bone-regeneration process, including the 'gold standard' autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. Improved 'local' strategies in terms of tissue engineering and gene therapy, or even 'systemic' enhancement of bone repair, are under intense investigation, in an effort to overcome the limitations of the current methods, to produce bone-graft substitutes with biomechanical properties that are as identical to normal bone as possible, to accelerate the overall regeneration process, or even to address systemic conditions, such as skeletal disorders and osteoporosis.

  20. Late sarcoma development after curettage and bone grafting of benign bone tumors

    International Nuclear Information System (INIS)

    Picci, Piero; Sieberova, Gabriela; Alberghini, Marco; Balladelli, Alba; Vanel, Daniel; Hogendoorn, Pancras C.W.; Mercuri, Mario

    2011-01-01

    Background and aim: Rarely sarcomas develop in previous benign lesions, after a long term disease free interval. We report the experience on these rare cases observed at a single Institution. Patients and methods: 12 cases curetted and grafted, without radiotherapy developed sarcomas, between 1970 and 2005, 6.5-28 years from curettage (median 18, average 19). Age ranged from 13 to 55 years (median 30, average 32) at first diagnosis; tumors were located in the extremities (9 GCT, benign fibrous histiocytoma, ABC, and solitary bone cyst). Radiographic and clinic documentation, for the benign and malignant lesions, were available. Histology was available for 7 benign and all malignant lesions. Results: To fill cavities, autogenous bone was used in 4 cases, allograft in 2, allograft and tricalcium-phosphate/hydroxyapatite in 1, autogenous/allograft in 1, heterogenous in 1. For 3 cases the origin was not reported. Secondary sarcomas, all high grade, were 8 osteosarcoma, 3 malignant fibrous histiocytoma, and 1 fibrosarcoma. Conclusions: Recurrences with progression from benign tumors are possible, but the very long intervals here reported suggest a different cancerogenesis for these sarcomas. This condition is extremely rare accounting for only 0.26% of all malignant bone sarcomas treated in the years 1970-2005 and represents only 8.76% of all secondary bone sarcomas treated in the same years. This incidence is the same as that of sarcomas arising on fibrous dysplasia, and is lower than those arising on bone infarcts or on Paget's disease. This possible event must be considered during follow-up of benign lesions.

  1. Lateral meniscus allograft transplantation: clinical and anatomic outcomes after arthroscopic implantation with tibial tunnels versus open implantation without tunnels.

    Science.gov (United States)

    Faivre, B; Boisrenoult, P; Lonjon, G; Pujol, N; Beaufils, P

    2014-05-01

    Meniscus allograft transplantation (MAT) is used to treat patients with knee pain after total or subtotal meniscectomy. The graft can be inserted during open or arthroscopic surgery. The objectives are anatomic horn positioning and strong fixation to the bone and capsule of an appropriately sized graft. Arthroscopic MAT with trans-tibial bone fixation ensures better mid-term functional outcomes and limits allograft extrusion. We conducted a retrospective single-centre study of 23 consecutive patients who underwent MAT between 2001 and 2010. Among them, 11 had open surgery and anchoring of the horns without tunnels and 12 had arthroscopically-assisted surgery with bony fixation of the horns through trans-tibial tunnels. The two groups were comparable at baseline. Mean follow-up was 66.1 months. Post-operative outcomes were assessed using the IKDC score and KOOS, standard radiographs of both knees, and either magnetic resonance imaging or computed arthrotomography. We measured joint space narrowing, meniscal extrusion in the sagittal and coronal planes; and the degree of cartilage coverage by the graft using an index developed for this study. The overall failure rate was 17.4% (4/23, two cases each of complete and partial graft removal). Joint space narrowing increased by 28% versus the pre-operative value (P=0.009). IKDC and KOOS values were not significantly different between the two groups. Absolute meniscus extrusion was greater in the arthroscopy group (4mm vs. 3mm, P=0.03). Osteoarthritis of the transplanted compartment is unavoidable. Open surgery is associated with less meniscal extrusion. The clinical outcomes are independent from the technique used. Other factors require investigation, including graft rehabilitation, quality peripheral suturing, and intermeniscal ligament reconstruction. IV, retrospective study. Copyright © 2014. Published by Elsevier Masson SAS.

  2. The renal arterial resistive index and stage of chronic kidney disease in patients with renal allograft

    DEFF Research Database (Denmark)

    Winther, Stine O; Thiesson, Helle C; Poulsen, Lene N

    2012-01-01

    The study investigated the optimal threshold value of renal arterial resistive index as assessed by Doppler ultrasonography determining chronic kidney disease stage 4 or higher in patients with renal allograft.......The study investigated the optimal threshold value of renal arterial resistive index as assessed by Doppler ultrasonography determining chronic kidney disease stage 4 or higher in patients with renal allograft....

  3. Scapular allograft reconstruction after total scapulectomy: surgical technique and functional results

    NARCIS (Netherlands)

    Capanna, R.; Totti, F.; Geest, I.C.M. van der; Muller, D.A.

    2015-01-01

    HYPOTHESIS: Scapular allograft reconstruction after total scapulectomy preserving the rotator cuff muscles is an oncologically safe procedure and results in good functional outcome with a low complication rate. METHODS: The data of 6 patients who underwent scapular allograft reconstruction after a

  4. The effect of radiation sterilization on human transplantable bone

    International Nuclear Information System (INIS)

    Triantafyllou, N.; Karatzas, P.

    1974-11-01

    In order to study the effect of radiation sterilization on human transplantable bones, work was carried out on human and bovine bone tissue samples. Factors causing possible alterations in the mechanical structures of the preserved bone allografts were considered to be deep freezing (-35degC), lyophylization, irradiation, or a combination of lyophylization and irradiation. The latter could be shown to lower the mechanical strength of the bone. Crystal lattice of the bone did not show any alterations in x-ray diffraction pattern, following freeze drying and/or irradiation with doses up to 10 Mrad of gamma radiation. Deterioration in mechanical properties is probably due to damage to the organic phase of the bone matrix

  5. Treatment of infrabony defects with platelet-rich fibrin along with bone graft: Case report

    Directory of Open Access Journals (Sweden)

    Surekha Y Bhedasgaonkar

    2015-01-01

    Full Text Available Although periodontitis is an infectious disease of periodontal tissues, changes that occur in the bone are crucial, because destruction of bone is responsible for tooth loss. Although horizontal bone loss is most common, vertical bone loss is more amenable to regenerative periodontal therapy. Recently, importance has been given to use of platelet-rich fibrin (PRF for predictably obtaining periodontal regeneration. PRF is a concentrated suspension of growth factors found in platelets. These growth factors moderate the wound healing and promote tissue regeneration. This article includes case reports of two patients who showed infrabony defects that were treated with combining PRF with allograft. This case report tried to compare the clinical and radiographical outcome obtained by combination of PRF and allograft.

  6. Distal Femur Allograft Prosthetic Composite Reconstruction for Short Proximal Femur Segments following Tumor Resection

    Directory of Open Access Journals (Sweden)

    Bryan S. Moon

    2013-01-01

    Full Text Available Short metaphyseal segments remaining after distal femoral tumor resection pose a unique challenge. Limb sparing options include a short stemmed modular prosthesis, total endoprosthetic replacement, cross-pin fixation to a custom implant, and allograft prosthetic composite reconstruction (APC. A series of patients with APC reconstruction were evaluated to determine functional and radiologic outcome and complication rates. Twelve patients were retrospectively identified who had a distal femoral APC reconstruction between 1994 and 2007 to salvage an extremity with a segment of remaining bone that was less than 20 centimeters in length. Seventeen APC reconstructions were performed in twelve patients. Eight were primary procedures and nine were revision procedures. Average f/u was 89 months. Twelve APC reconstructions (71% united and five (29% were persistent nonunions. At most recent followup 10 patients (83% had a healed APC which allowed WBAT. One pt (8% had an amputation and one pt (8% died prior to union. Average time to union was 19 months. Four pts (33% or five APC reconstructions (29% required further surgery to obtain a united reconstruction. Although Distal Femoral APC reconstruction has a high complication rate, a stable reconstruction was obtained in 83% of patients.

  7. Clinical utility of labeled cells for detection of allograft rejection and myocardial infarction

    International Nuclear Information System (INIS)

    Fawwaz, R.A.

    1984-01-01

    The choice of a specific radiolabeled blood component for use in detection of allograft rejection depends on several factors including the immunosuppressive agents used, the type of organ allografted, and particularly the length of time the allograft resides in the host and the duration of rejection. To date, only the use of 111In-labeled platelets in renal allograft recipients immunosuppressed with azathioprine and corticosteroids has shown clinical promise in the detection of early allograft rejection. Radiolabeled blood components are unlikely to play a significant role in detection of myocardial infarction. The use of these agents for monitoring therapeutic interventions or as indicators of prognosis in patients with myocardial infarction continues to be investigated

  8. A single administration of LFA-1 antibody confers prolonged allograft survival.

    Science.gov (United States)

    Talento, A; Nguyen, M; Blake, T; Sirotina, A; Fioravanti, C; Burkholder, D; Gibson, R; Sigal, N H; Springer, M S; Koo, G C

    1993-02-01

    C57BL/6 (B6) thyroid gland transplanted to the left kidney capsule of an allogeneic (BALB/c) host was typically rejected in 14 days. A single administration of 500 micrograms of an antibody to the adhesion molecule, leucocyte function-associated antigen (LFA-1, CD11a), prevented all thyroid allograft rejection for at least 70 days. Fifty percent of the treated recipients retained intact allografts for 470 days. However, the same treatment with anti-CD11a could not protect a sensitized BALB/c mouse from rejecting a second B6 thyroid allograft. Production of donor-specific alloantibodies elicited by allograft rejection was also inhibited in this system. In this transplant model, the Ab therapy is more efficacious than that of FK506, administered daily for 14 days at 15 mg/kg. These results demonstrate the remarkable effect of an anti-LFA-1 antibody in promotion of allograft survival.

  9. Building better bone: The weaving of biologic and engineering strategies for managing bone loss.

    Science.gov (United States)

    Schwartz, Andrew M; Schenker, Mara L; Ahn, Jaimo; Willett, Nick J

    2017-09-01

    Segmental bone loss remains a challenging clinical problem for orthopaedic trauma surgeons. In addition to the missing bone itself, the local tissues (soft tissue, vascular) are often highly traumatized as well, resulting in a less than ideal environment for bone regeneration. As a result, attempts at limb salvage become a highly expensive endeavor, often requiring multiple operations and necessitating the use of every available strategy (autograft, allograft, bone graft substitution, Masquelet, bone transport, etc.) to achieve bony union. A cost-sensitive, functionally appropriate, and volumetrically adequate engineered substitute would be practice-changing for orthopaedic trauma surgeons and these patients with difficult clinical problems. In tissue engineering and bone regeneration fields, numerous research efforts continue to make progress toward new therapeutic interventions for segmental bone loss, including novel biomaterial development as well as cell-based strategies. Despite an ever-evolving literature base of these new therapeutic and engineered options, there remains a disconnect with the clinical practice, with very few translating into clinical use. A symposium entitled "Building better bone: The weaving of biologic and engineering strategies for managing bone loss," was presented at the 2016 Orthopaedic Research Society Conference to further explore this engineering-clinical disconnect, by surveying basic, translational, and clinical researchers along with orthopaedic surgeons and proposing ideas for pushing the bar forward in the field of segmental bone loss. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1855-1864, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  10. The effects of a novel-reinforced bone substitute and Colloss®E on bone defect healing in sheep

    DEFF Research Database (Denmark)

    Ding, Ming; Røjskjaer, Jesper; Cheng, Liming

    2012-01-01

    Hydroxyappatite-β-tricalciumphosphate (HA/β-TCP) was reinforced with poly(D,L)-lactic acid (PDLLA) to overcome its weak mechanical properties. Two substitutes with porosities of 77% and 81% HA/β-TCP reinforced with 12 wt % PDLLA were tested in compression. The effects of allograft, substitute (HA......, the sheep were sacrificed. Implants with surrounding bone were harvested and sectioned into two parts: one for microcomputed tomography scanning and push-out test, and one for histomorphometry. The 77% HA/β-TCP reinforced with PDLLA had similar mechanical properties to human cancellous bone...... and was significantly stronger than the HA/β-TCP without PDLLA. Microarchitecture of gap mass was significantly changed after implantation for all groups. Allograft had stronger shear mechanical properties than the other three groups, whereas there were no significant differences between the other three groups...

  11. Management of chronic allograft dysfunction by switch over to rapamycin.

    Science.gov (United States)

    Sundaram, Varun; Abraham, Georgi; Fathima, Nusrath; Sundaram, Vivek; Reddy, Yogesh N V; Mathew, Milly; Sathiah, Vijaiaboobbathi

    2010-01-01

    The aim of this study was to evaluate the efficacy of conversion from calcineurin inhibitors (CNI)-based to a rapamycin-based immunosuppressive regimen in renal transplant recipients who had allograft dysfunction, in a South Indian population. We analyzed the results of 75 (19.5%) of the 398 renal transplants performed over a five-year period from 2002 to 2007, who were converted from a CNI-based immunosuppression to rapamycin including patients with chronic allograft dysfunction, chronic allograft injury and malignancy. The data analyzed included serial rapamycin levels, serum creatinine, eGFR by nankivel formula, lipid profile, hemoglobin and serum potassium levels. Statistical analysis was performed using student's t test and the Kaplan Meir survival curve was used to predict probability of survival among patients on rapamycin. The mean age of the study patients was 39.6 + or - 12.2 yrs and there was a male predominance (74.6%). Diabetic nephropathy was the predominant cause (36%) of end-stage renal disease (ESRD). Statistical analysis revealed a significant improvement in GFR of 14.6 mL/min and decrease in potassium by 0.7 mmol/L after initiation of rapamycin. There were no significant differences in terms of lipid profile, platelet count, hemoglobin and urine albumin levels. Rapamycin was discontinued in one patient due to hypokalemic nephropathy and in another patient due to delayed wound healing. To our knowledge, this is the first study to provide information on the conversion from a CNI to rapamycin-based immunosuppression in a cohort of Indian renal transplant recipients. In conclusion, the findings of our study confirm that rapamycin-based immunosuppressive regimen improves renal function and graft survival with minimal side effects, in comparison to CNI-based immunosuppression.

  12. Management of chronic allograft dysfunction by switch over to rapamycin

    Directory of Open Access Journals (Sweden)

    Sundaram Varun

    2010-01-01

    Full Text Available The aim of this study was to evaluate the efficacy of conversion from Calcineurin Inhibitors (CNI-based to a rapamycin-based immunosuppressive regimen in renal transplant reci-pients who had allograft dysfunction, in a South Indian population. We analyzed the results of 75 (19.5% of the 398 renal transplants performed over a five-year period from 2002 to 2007, who were converted from a CNI-based immunosuppression to rapamycin including patients with chronic allograft dysfunction, chronic allograft injury and malignancy. The data analyzed included serial rapamycin levels, serum creatinine, eGFR by nankivel formula, lipid profile, hemoglobin and serum potassium levels. Statistical analysis was performed using student′s t test and the Kaplan Meir survival curve was used to predict probability of survival among patients on rapamycin. The mean age of the study patients was 39.6 ± 12.2 yrs and there was a male predominance (74.6%. Diabetic nephropathy was the predominant cause (36% of end-stage renal disease (ESRD. Statistical analysis revealed a significant improvement in GFR of 14.6 mL/min and decrease in potassium by 0.7 mmol/L after initiation of rapamycin. There were no significant differences in terms of lipid profile, platelet count, hemoglobin and urine albumin levels. Rapamycin was discontinued in one patient due to hypokalemic nephropathy and in another patient due to delayed wound healing. To our knowledge, this is the first study to provide information on the conversion from a CNI to rapamycin-based immunosuppression in a cohort of Indian renal transplant recipients. In conclusion, the findings of our study confirm that rapamycin-based immunosuppressive regimen improves renal function and graft survival with mini-mal side effects, in comparison to CNI-based immunosuppression.

  13. Ankle and shoulder joint reconstruction using soft tissue allografts

    International Nuclear Information System (INIS)

    Nather, A.; Singh, G.

    2008-01-01

    Full text: Lateral Collateral Ligament Insufficiency is a common complication of injury to the ankle joint. This needs reconstruction of the torn ligament as the joint instability gives rise to frequent giving way at the ankle joint. It can be reconstructed using autologous peroneus brevis tendon. The authors prefer to reconstruct using deep frozen (-80 degree C) non-gamma irradiated tibialis anterior or tibialis posterior tendon allograft procured by NUH Tissue Bank. The graft must be at least between 18-22 cm long. The procedure employed is a first stage Brostrom Procedure repairing the anterior talo-fibula ligament using Mitek sutures. In the second stage the Calcaneofibular ligament is reconstructed using a figure of eight tendon reconstruction via drill holes in the fibular above and the calcaneum below. Twelve cases have been reconstructed this way with good results. When injury is sustained to the Acromia-clavicular (AC) Joint, for type 3 to 5 AC Joint Dislocation and in manual labourers, reconstruction is needed. The author's preferred method is a 2 stage procedure using deep frozen (-80 degree C), non gamma-irradiated fascia lata allografts procured by NUH Tissue Bank. In the first stage the dislocated AC Joint is reduced and held in position by transfixation using 2 baby Steinmann Pins and repair of torn corac clavicular ligaments. The second stage consisted of reconstruction with rolled-up fascia lata figure of eight allograft tendon between the clavicle and the coracoid process. The 2 pins are removed after 6 weeks and the shoulder mobilised. 10 cases have been done with good results. Two cases showed mild subluxation of the AC joint due to slight loss of the reduction performed during the operation. (Author)

  14. Knowledge on Bone Banking among Participants in an Orthopaedic Conference: A Preliminary Survey.

    Science.gov (United States)

    Mohd, S; Yusof, N; Ramalingam, S; Ng, W M; Mansor, A

    2017-07-01

    Despite increasing use of bone graft in Malaysia, there was still lack of data to quantify knowledge level on bone banking among orthopaedic community who are involved in transplantation related work. Therefore, a survey on awareness in tissue banking specifically bone banking, usage and choice of bone grafts was conducted. From 80 respondents, 82.5% were aware about tissue banking however only 12.5% knew of the existence of tissue banks in Malaysia. Femoral head was the bone allograft most often used as a substitute to autograft. Only 34.8% respondents preferred irradiated bone grafts whilst 46.9% preferred nonirradiated, indicating the need to educate the importance of radiation for sterilising tissues. Exhibition was the most preferred medium for awareness programme to disseminate information about bone banking in the orthopaedic community. The professional awareness is necessary to increase the knowledge on the use of bone graft, hence to increase bone transplantation for musculoskeletal surgeries in the country.

  15. Donor and procurement related issues in vascularized composite allograft transplantation.

    Science.gov (United States)

    McDiarmid, Sue V

    2013-12-01

    To understand the unique requirements of vascularized composite allograft (VCA) donation and procurement practices and the integral role of the established nationwide organ procurement organizations in organ procurement. The recent issuance of a Final Rule (July 2013) by the United States Secretary of Health that redefines VCAs as organs rather than tissues, opens up the potential to formalize policies and procedures, under the auspices of the Organ Procurement and Transplantation Network, that can improve VCA donation, procurement practices, develop allocation algorithms and provide transparent oversight. Improved VCA donation rates, procurement procedures and broader sharing nationwide of VCA donors will have important implications in advancing the emerging field of VCA transplantation.

  16. Cellular Therapy to Obtain Rapid Endochondral Bone Formation

    Science.gov (United States)

    2010-02-01

    surgery, and both autografts and allografts have been commonly used in spinal fusion, revision total hip arthroplasty , maxillofacial reconstruction...idiopathic scoliosis. Spine (Phila Pa 1976) 2003 Apr 15;28(8):793-798. 2. Goldberg VM. Selection of bone grafts for revision total hip arthroplasty ...grafting4. This number does not include the millions of total joint arthroplasties , spinal arthrodeses, maxillofacial surgeries and implant

  17. Effect of gamma irradiation sterilization on the osteoinductive capacity of demineralized bone powder

    International Nuclear Information System (INIS)

    Babak Arjmand; Hamid Reza Aghayan; Mehdi Golestani; Farid Azmoudeh Ardalan

    2008-01-01

    Full text: Gamma irradiation is a well known method for secondary sterilization of bone allograft before clinical use to reduce the risk of infections and complications. The current study evaluated the effect of gamma irradiation on the osteoinductive capability of human demineralized bone powder using a rat model. Twenty rats received two separate implants consisting of 30 mg aseptically-harvested and 30 mg gamma irradiated demineralized bone powder. The implants from each group were placed into two separate muscle pouch in the paravertebral muscles of each rat. All 20 rats were euthanized after 4 weeks and each implantation site was removed with 0.5 cm normal tissue around the implant. Histological examination was done to determine the presence or absence of new bone, cartilage and bone marrow element. All except one of 20 aseptically-harvested demineralized bone powder sites histologically contained new bone elements (95%) and six (30%) of 20 gamma irradiated demineralized bone powder sites showed evidence of new bone elements. There was significant difference between two groups (p<0.05). The results of this study indicate that gamma irradiation reduces osteoinductive properties of demineralized bone powder. But because of its availability and low cost it is widely used for secondary sterilization of bone allografts. (Author)

  18. Establishment of donor Chimerism Using Allogeneic Bone Marrow with AMP Cell Co-infusion

    Science.gov (United States)

    2017-09-01

    AWARD NUMBER: W81XWH-15-1-0234 TITLE: Establishment of donor Chimerism Using Allogeneic Bone Marrow with AMP Cell Co-infusion PRINCIPAL...14/2017 4. TITLE AND SUBTITLE Establishment of donor Chimerism Using Allogeneic Bone Marrow with AMP Cell Co-infusion 5a. CONTRACT NUMBER 5b. GRANT...tolerance induction of all types of allografts. In this study, we investigate whether co-infusion of amnion- derived multipotent progenitor ( AMP ) cells

  19. High Hydrostatic Pressure for Disinfection of Bone Grafts and Biomaterials: An Experimental Study

    OpenAIRE

    Gollwitzer, Hans; Mittelmeier, Wolfram; Brendle, Monika; Weber, Patrick; Miethke, Thomas; Hofmann, Gunther O; Gerdesmeyer, Ludger; Schauwecker, Johannes; Diehl, Peter

    2009-01-01

    Background: Autoclaving, heat, irradiation or chemical detergents are used to disinfect autografts, allografts and biomaterials for tissue reconstruction. These methods are often associated with deterioration of mechanical, physical, and biological properties of the bone grafts and synthetic implants. High hydrostatic pressure has been proposed as a novel method preserving biomechanical and biological properties of bone, tendon and cartilage. This is the first study to assess the inactivation...

  20. Bone transplantation in limb saving surgeries: Philippine experience

    International Nuclear Information System (INIS)

    Wang, Edward H.M.

    1998-01-01

    Until the turn of the decade, Filipino patients afflicted with malignant and aggressive extremity tumors were almost uniformly treated with mutilating amputations. Limb saving surgery only recently became an option locally - this resulting not only from a better comprehension of surgical oncologic principles but also from the development and refinement of reconstructive procedures following such surgeries. Foremost among the latter is the use of long bone transplants, otherwise known as large segment bone allografts. Large segment allografts are available from the Tissue and Bone Bank of the University of the Philippines- the only bank of its kind in the country. All allografts are harvested from appropriate donors (both cadaveric and live), processed at the bank, radiation-sterilized at the Philippine Nuclear Research Institute (PNRI), and finally brought back to and stored in a -80 degrees centigrade deep freezer at the Bank. This paper presents our 4-year experience with large-segment allografts for extensive defects of limbs salvage surgery in musculoskeletal tumors. All patients included in this presentation had : (1) malignant or aggressive extremity tumors; (2) surgery performed by the University of the Philippines-Musculoskeletal Tumor Unit (UP-MuST Unit); (3) follow-up at least one year or until death; and (4) available pre-and post-operative radiographs for review. Over a period of 4 years (January 1993-January 1997), 63 patients with malignant or aggressive extremity tumors (who formerly would have been amputated) underwent limb salvage surgery by the UP-MuST Unit. Twenty (20) of these patients had reconstructions utilizing irradiated large-segment allografts and fulfilled the above criteria for inclusion in this review. Limb saving surgery for Filipino patients with musculoskeletal tumors continues to be a challenge because of both tumor size and the size of the defect requiring reconstruction. Large-segment allografts from the UP-Tissue and Bone Bank

  1. Advances in Osteobiologic Materials for Bone Substitutes.

    Science.gov (United States)

    Hasan, Anwarul; Byambaa, Batzaya; Morshed, Mahboob; Cheikh, Mohammad Ibrahim; Shakoor, Rana Abdul; Mustafy, Tanvir; Marei, Hany

    2018-04-27

    A significant challenge in the current orthopedics is the development of suitable osteobiologic materials that can replace the conventional allografts, autografts and xenografts, and thereby serve as implant materials as bone substitutes for bone repair or remodeling. The complex biology behind the nano-microstructure of bones and their repair mechanisms, which involve various types of chemical and biomechanical signaling amongst different cells, has set strong requirements for biomaterials to be used in bone tissue engineering. This review presents an overview of various types of osteobiologic materials to facilitate the formation of the functional bone tissue and healing of the bone, covering metallic, ceramic, polymeric and cell-based graft substitutes, as well as some biomolecular strategies including stem cells, extracellular matrices, growth factors and gene therapies. Advantages and disadvantages of each type, particularly from the perspective of osteoinductive and osteoconductive capabilities, are discussed. Although the numerous challenges of bone regeneration in tissue engineering and regenerative medicine are yet to be entirely addressed, further advancements in osteobiologic materials will pave the way towards engineering fully functional bone replacement grafts. This article is protected by copyright. All rights reserved.

  2. Experimental study of tissue-engineered cartilage allograft with RNAi chondrocytes in vivo

    Directory of Open Access Journals (Sweden)

    Wang ZH

    2014-05-01

    Full Text Available Zhenghui Wang,1 Xiaoli Li,2 Xi-Jing He,3 Xianghong Zhang,1 Zhuangqun Yang,4 Min Xu,1 Baojun Wu,1 Junbo Tu,5 Huanan Luo,1 Jing Yan11Department of Otolaryngology – Head and Neck Surgery, 2Department of Dermatology, 3Department of Orthopedics, The Second Hospital, Xi’an Jiaotong University, 4Department of Plastic and Burns Surgery, The First Hospital, Xi’an Jiaotong University, 5Department of Oral and Maxillofacial Plastic Surgery, The Stomatological Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of ChinaPurpose: To determine the effects of RNA interference (RNAi on chondrocyte proliferation, function, and immunological rejection after allogenic tissue-engineered cartilage transplantation within bone matrix gelatin scaffolds.Methods: Seven million rat normal and RNAi chondrocytes were harvested and separately composited with fibrin glue to make the cell suspension, and then transplanted subcutaneously into the back of Sprague Dawley rats after being cultured for 10 days in vitro. Untransplanted animals served as the control group. The allograft and immunological response were examined at 1, 2, 4, 8, and 12 months postoperatively with hematoxylin and eosin histochemical staining, immunohistochemical staining (aggrecan, type II collagen, class I and II major histocompatibility complex, and flow cytometry for peripheral blood cluster of differentiation 4+ (CD4+ and CD8+ T-cells.Results: There was no infection or death in the rats except one, which died in the first week. Compared to the control group, the RNAi group had fewer eukomonocytes infiltrated, which were only distributed around the graft. The ratio of CD4+/CD8+ T-cells in the RNAi group was significantly lower than the normal one (P<0.05. There were many more positively stained chondrocytes and positively stained areas around the cells in the RNAi group, which were not found in the control group.Conclusion: The aggrecanase-1 and aggrecanase-2 RNAi for chondrocytes

  3. Radiation sterilisation of tissue allografts for transplant surgery

    International Nuclear Information System (INIS)

    Phillips, G.O.

    1994-01-01

    The application of ionising radiation to sterilise biological tissues is an extension of their use for the sterilisation of other medical products and pharmaceuticals. This paper describes the effects of radiation on biological tissues, both at the macro- and molecular level. Changes in mechanical and other physical properties can accompany irradiation. These are shown to be due to the glycosamino-glycan component (hyaluronic acid), rather than to the collagen fibrils. Fast reaction methods are used to identify the mechanism of the radiation degradation processes. Methods by which tissues can be protected from these undesirable effects are discussed. The application of radiation sterilisation to human tissues used in transplant surgery is described, and the practical methods of processing given. Such radiation sterilised allografts now have wide application, with more than 500,000 used each year. The IAEA programme in this field has extended the application to 13 countries of the Asia and Pacific Region. Such Tissue Banks are also established with the support of IAEA in Africa and South America. The allografts can now be produced in developing countries in a readily available form, at low cost, and reduce the need for costly imported alternatives. (author). 45 refs., 19 figs., 3 tabs

  4. T-cell exhaustion in allograft rejection and tolerance.

    Science.gov (United States)

    Thorp, Edward B; Stehlik, Christian; Ansari, M Javeed

    2015-02-01

    The role of T-cell exhaustion in the failure of clearance of viral infections and tumors is well established. There are several ongoing trials to reverse T-cell exhaustion for treatment of chronic viral infections and tumors. The mechanisms leading to T-cell exhaustion and its role in transplantation, however, are only beginning to be appreciated and are the focus of the present review. Exhausted T cells exhibit a distinct molecular profile reflecting combinatorial mechanisms involving the interaction of multiple transcription factors important in control of cell metabolism, acquisition of effector function and memory capacity. Change of microenvironmental cues and limiting leukocyte recruitment can modulate T-cell exhaustion. Impaired leukocyte recruitment induces T-cell exhaustion and prevents allograft rejection. Preventing or reversing T-cell exhaustion may lead to prevention of transplant tolerance or triggering of rejection; therefore, caution should be exercised in the use of agents blocking inhibitory receptors for the treatment of chronic viral infections or tumors in transplant recipients. Further definition of the role of T-cell exhaustion in clinical transplantation and an understanding of the mechanisms of induction of T-cell exhaustion are needed to develop strategies for preventing allograft rejection and induction of tolerance.

  5. Autoantibodies to vimentin cause accelerated rejection of cardiac allografts.

    Science.gov (United States)

    Mahesh, Balakrishnan; Leong, Hon-Sing; McCormack, Ann; Sarathchandra, Padmini; Holder, Angela; Rose, Marlene L

    2007-04-01

    Autoimmune responses to vimentin occur after solid organ transplantation, but their pathogenic effects are unclear. The aim of these studies was to investigate the effects of vimentin preimmunization on allogeneic and isografted hearts in a murine transplant model. Immunization of C57BL/6 mice with murine vimentin in complete Freund's adjuvant resulted in anti-vimentin antibodies and vimentin-reactive Th-1 cells. Transplantation of 129/sv hearts into vimentin-immunized C57BL/6 recipients resulted in accelerated rejection (8.4 +/- 1.5 days; n = 18), compared with hen egg lysozyme-immunized C57BL/6 (13.3 +/- 2.2 days; n = 10; P rejection, shown by the fact that vimentin-immunized B-cell-deficient IgH6 mice did not show accelerated rejection of 129/sv allografts, but rejection was restored by adoptive transfer of serum containing anti-vimentin antibodies. Eluates from donor hearts placed in vimentin/complete Freund's adjuvant recipients contained anti-vimentin antibodies, shown by Western blotting. Confocal imaging of rejected hearts de-monstrated presence of vimentin and C3d on apoptosed leukocytes, endothelial cells, and platelet/leukocyte conjugates. These results demonstrate that autoantibodies to vimentin, in conjunction with the alloimmune response, have a pathogenic role in allograft rejection.

  6. Renal allograft loss in the first post-operative month: causes and consequences.

    LENUS (Irish Health Repository)

    Phelan, Paul J

    2013-01-15

    Early transplant failure is a devastating outcome after kidney transplantation. We report the causes and consequences of deceased donor renal transplant failure in the first 30 d at our center between January 1990 and December 2009. Controls were adult deceased donor transplant patients in the same period with an allograft that functioned >30 d. The incidence of early graft failure in our series of 2381 consecutive deceased donor transplants was 4.6% (n = 109). The causes of failure were allograft thrombosis (n = 48; 44%), acute rejection (n = 19; 17.4%), death with a functioning allograft (n = 17; 15.6%), primary non-function (n = 14;12.8%), and other causes (n = 11; 10.1%). Mean time to allograft failure was 7.3 d. There has been a decreased incidence of all-cause early failure from 7% in 1990 to <1% in 2009. Patients who developed early failure had longer cold ischemia times when compared with patients with allografts lasting >30 d (p < 0.001). Early allograft failure was strongly associated with reduced patient survival (p < 0.001). In conclusion, early renal allograft failure is associated with a survival disadvantage, but has thankfully become less common in recent years.

  7. Treatment options for renal cell carcinoma in renal allografts: a case series from a single institution.

    Science.gov (United States)

    Swords, Darden C; Al-Geizawi, Samer M; Farney, Alan C; Rogers, Jeffrey; Burkart, John M; Assimos, Dean G; Stratta, Robert J

    2013-01-01

    Renal cell carcinoma (RCC) is more common in renal transplant and dialysis patients than the general population. However, RCC in transplanted kidneys is rare, and treatment has previously consisted of nephrectomy with a return to dialysis. There has been recent interest in nephron-sparing procedures as a treatment option for RCC in allograft kidneys in an effort to retain allograft function. Four patients with RCC in allograft kidneys were treated with nephrectomy, partial nephrectomy, or radiofrequency ablation. All of the patients are without evidence of recurrence of RCC after treatment. We found nephron-sparing procedures to be reasonable initial options in managing incidental RCCs diagnosed in functioning allografts to maintain an improved quality of life and avoid immediate dialysis compared with radical nephrectomy of a functioning allograft. However, in non-functioning renal allografts, radical nephrectomy may allow for a higher chance of cure without the loss of transplant function. Consequently, radical nephrectomy should be utilized whenever the allograft is non-functioning and the patient's surgical risk is not prohibitive. © 2013 John Wiley & Sons A/S.

  8. Utility of an allograft tendon for scoliosis correction via the costo-transverse foreman.

    Science.gov (United States)

    Sun, Dong; McCarthy, Michael; Dooley, Adam C; Ramakrishnaiah, Raghu H; Shelton, R Shane; McLaren, Sandra G; Skinner, Robert A; Suva, Larry J; McCarthy, Richard E

    2017-01-01

    Current convex tethering techniques for treatment of scoliosis have centered on anterior convex staples or polypropylene tethers. We hypothesized that an allograft tendon tether inserted via the costo-transverse foramen would correct an established spinal deformity. In the pilot study, six 8-week-old pigs underwent allograft tendon tethering via the costo-transverse foreman or sham to test the strength of the transplanted tendon to retard spine growth. After 4 months, spinal deformity in three planes was induced in all animals with allograft tendons. In the treatment study, the allograft tendon tether was used to treat established scoliosis in 11 8-week-old pigs (spinal deformity > 50°). Once the deformity was observed (4 months) animals were assigned to either no treatment group or allograft tendon tether group and progression assessed by monthly radiographs. At final follow-up, coronal Cobb angle and maximum vertebral axial rotation of the treatment group was significantly smaller than the non-treatment group, whereas sagittal kyphosis of the treatment group was significantly larger than the non-treatment group. In sum, a significant correction was achieved using a unilateral allograft tendon spinal tether, suggesting that an allograft tendon tethering approach may represent a novel fusion-less procedure to correct idiopathic scoliosis. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:183-192, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  9. Electrocardiographic Characteristics of Potential Organ Donors and Associations with Cardiac Allograft Utilization

    Science.gov (United States)

    Khush, Kiran K.; Menza, Rebecca; Nguyen, John; Goldstein, Benjamin A.; Zaroff, Jonathan G.; Drew, Barbara J.

    2012-01-01

    Background Current regulations require that all cardiac allograft offers for transplantation must include an interpreted 12-lead electrocardiogram (ECG). However, little is known about the expected ECG findings in potential organ donors, or the clinical significance of any identified abnormalities in terms of cardiac allograft function and suitability for transplantation. Methods and Results A single experienced reviewer interpreted the first ECG obtained after brainstem herniation in 980 potential organ donors managed by the California Transplant Donor Network from 2002-2007. ECG abnormalities were summarized, and associations between specific ECG findings and cardiac allograft utilization for transplantation were studied. ECG abnormalities were present in 51% of all cases reviewed. The most common abnormalities included voltage criteria for left ventricular hypertrophy (LVH), prolongation of the corrected QT interval (QTc), and repolarization changes (ST/T wave abnormalities). Fifty seven percent of potential cardiac allografts in this cohort were accepted for transplantation. LVH on ECG was a strong predictor of allograft non-utilization. No significant associations were seen between QTc prolongation, repolarization changes and allograft utilization for transplantation, after adjusting for donor clinical variables and echocardiographic findings. Conclusions We have performed the first comprehensive study of ECG findings in potential donors for cardiac transplantation. Many of the common ECG abnormalities seen in organ donors may result from the heightened state of sympathetic activation that occurs after brainstem herniation, and are not associated with allograft utilization for transplantation. PMID:22615333

  10. Cost effectiveness of meniscal allograft for torn discoid lateral meniscus in young women.

    Science.gov (United States)

    Ramme, Austin J; Strauss, Eric J; Jazrawi, Laith; Gold, Heather T

    2016-09-01

    A discoid meniscus is more prone to tears than a normal meniscus. Patients with a torn discoid lateral meniscus are at increased risk for early onset osteoarthritis requiring total knee arthroplasty (TKA). Optimal management for this condition is controversial given the up-front cost difference between the two treatment options: the more expensive meniscal allograft transplantation compared with standard partial meniscectomy. We hypothesize that meniscal allograft transplantation following excision of a torn discoid lateral meniscus is more cost-effective compared with partial meniscectomy alone because allografts will extend the time to TKA. A decision analytic Markov model was created to compare the cost effectiveness of two treatments for symptomatic, torn discoid lateral meniscus: meniscal allograft and partial meniscectomy. Probability estimates and event rates were derived from the scientific literature, and costs and benefits were discounted by 3%. One-way sensitivity analyses were performed to test model robustness. Over 25 years, the partial meniscectomy strategy cost $10,430, whereas meniscal allograft cost on average $4040 more, at $14,470. Partial meniscectomy postponed TKA an average of 12.5 years, compared with 17.30 years for meniscal allograft, an increase of 4.8 years. Allograft cost $842 per-year-gained in time to TKA. Meniscal allografts have been shown to reduce pain and improve function in patients with discoid lateral meniscus tears. Though more costly, meniscal allografts may be more effective than partial meniscectomy in delaying TKA in this model. Additional future long term clinical studies will provide more insight into optimal surgical options.

  11. Biologic and clinical aspects of integration of different bone substitutes in oral surgery: a literature review.

    Science.gov (United States)

    Zizzari, Vincenzo Luca; Zara, Susi; Tetè, Giulia; Vinci, Raffaele; Gherlone, Enrico; Cataldi, Amelia

    2016-10-01

    Many bone substitutes have been proposed for bone regeneration, and researchers have focused on the interactions occurring between grafts and host tissue, as the biologic response of host tissue is related to the origin of the biomaterial. Bone substitutes used in oral and maxillofacial surgery could be categorized according to their biologic origin and source as autologous bone graft when obtained from the same individual receiving the graft; homologous bone graft, or allograft, when harvested from an individual other than the one receiving the graft; animal-derived heterologous bone graft, or xenograft, when derived from a species other than human; and alloplastic graft, made of bone substitute of synthetic origin. The aim of this review is to describe the most commonly used bone substitutes, according to their origin, and to focus on the biologic events that ultimately lead to the integration of a biomaterial with the host tissue. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. [Custom-made artificial bones fabricated by an inkjet printing technology].

    Science.gov (United States)

    Igawa, Kazuyo; Chung, Ung-il; Tei, Yuichi

    2008-12-01

    Although current treatment modalities for bone defects include autograft, allograft, and artificial bone substitutes, they have problems concerning invasiveness, safety, and performance, respectively, calling for development of innovative artificial bones with better handling and mechanical strength, better control of external and internal structures, and better biodegradability and osteo-inductive ability. We propose to fabricate novel high performance artificial bones using 3D inkjet printer based on the image data of bone deformity. Shape precisely fitting to the deformity, internal structure facilitating cell invasion, and good biodegradability are achieved. Bioactive substances can be incorporated by printing in combination with drug delivery system to induce bone regeneration at desired locations. These osteo-inductive artificial bones will help efficiently treat various types of bone deformity in a less invasive and safe manner.

  13. Chondroblastoma of the Knee Treated with Resection and Osteochondral Allograft Reconstruction

    Directory of Open Access Journals (Sweden)

    Judd Fitzgerald

    2014-01-01

    Full Text Available Case. This case report describes the operative management of 16-year-old male with a symptomatic chondroblastoma of the distal femur with breach of the chondral surface. Following appropriate imaging and core needle biopsy, the diagnosis was confirmed histologically. The patient then underwent intralesional curettage and osteochondral allograft reconstruction of the defect. At one-year follow-up the patient was pain-free and has obtained excellent range of motion. There is radiographic evidence of allograft incorporation and no evidence of local recurrence. Conclusion. Osteochondral allograft reconstruction is an effective option following marginal resection and curettage of chondroblastoma involving the chondral surface of the distal femur.

  14. Quality control in tissue banking--ensuring the safety of allograft tissues.

    Science.gov (United States)

    Humphries, Linda K; Mansavage, Vicki L

    2006-09-01

    DESPITE FEDERAL REGULATIONS for tissue-banking practices, inadequate quality control led to the largest allograft tissue recall in history in October 2005. THE RECALL INCLUDED all allograft tissues obtained from 761 donors and distributed by five tissue banks. Many of these tissues already had been implanted and were unrecoverable. THIS ARTICLE DESCRIBES the many tissue-banking industry variables, including donor selection and testing and tissue recovery, processing, and preservation. QUESTIONS THAT HEALTH CARE providers can ask to determine which tissue banks' quality control measures best ensure the safety of the allografts they provide also are included.

  15. Impaired renal allograft function is associated with increased arterial stiffness in renal transplant recipients

    DEFF Research Database (Denmark)

    Kneifel, M; Scholze, A; Burkert, A

    2006-01-01

    It is important whether impairment of renal allograft function may deteriorate arterial stiffness in renal transplant recipients. In a cross-sectional study, arterial vascular characteristics were non-invasively determined in 48 patients with renal allograft using applanation tonometry and digital...... photoplethysmography. Mean age was 51 +/- 2 years (mean +/- SEM), and studies were performed 17 +/- 1 months after transplantation. The stage of chronic kidney disease was based on the glomerular filtration rate. We observed a significant association between the stage of chronic kidney disease and arterial stiffness...... of large arteries S1 and small arteries S2 in renal transplant recipients (each p renal allograft (p

  16. Reliability of a semi-automated 3D-CT measuring method for tunnel diameters after anterior cruciate ligament reconstruction: A comparison between soft-tissue single-bundle allograft vs. autograft.

    Science.gov (United States)

    Robbrecht, Cedric; Claes, Steven; Cromheecke, Michiel; Mahieu, Peter; Kakavelakis, Kyriakos; Victor, Jan; Bellemans, Johan; Verdonk, Peter

    2014-10-01

    Post-operative widening of tibial and/or femoral bone tunnels is a common observation after ACL reconstruction, especially with soft-tissue grafts. There are no studies comparing tunnel widening in hamstring autografts versus tibialis anterior allografts. The goal of this study was to observe the difference in tunnel widening after the use of allograft vs. autograft for ACL reconstruction, by measuring it with a novel 3-D computed tomography based method. Thirty-five ACL-deficient subjects were included, underwent anatomic single-bundle ACL reconstruction and were evaluated at one year after surgery with the use of 3-D CT imaging. Three independent observers semi-automatically delineated femoral and tibial tunnel outlines, after which a best-fit cylinder was derived and the tunnel diameter was determined. Finally, intra- and inter-observer reliability of this novel measurement protocol was defined. In femoral tunnels, the intra-observer ICC was 0.973 (95% CI: 0.922-0.991) and the inter-observer ICC was 0.992 (95% CI: 0.982-0.996). In tibial tunnels, the intra-observer ICC was 0.955 (95% CI: 0.875-0.985). The combined inter-observer ICC was 0.970 (95% CI: 0.987-0.917). Tunnel widening was significantly higher in allografts compared to autografts, in the tibial tunnels (p=0.013) as well as in the femoral tunnels (p=0.007). To our knowledge, this novel, semi-automated 3D-computed tomography image processing method has shown to yield highly reproducible results for the measurement of bone tunnel diameter and area. This series showed a significantly higher amount of tunnel widening observed in the allograft group at one-year follow-up. Level II, Prospective comparative study. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. High dose teriparatide (rPTH1-34 therapy increases callus volume and enhances radiographic healing at 8-weeks in a massive canine femoral allograft model.

    Directory of Open Access Journals (Sweden)

    Kohei Nishitani

    Full Text Available Small animal studies have demonstrated significant high-dose recombinant parathyroid hormone1-34 (rPTH1-34 effects on intercalary allograft healing. Towards a human adjuvant therapy to decrease non-unions, we evaluated rPTH1-34 safety and efficacy in a clinically relevant canine femoral allograft model. Adult female mongrel hounds (n = 20 received a 5cm mid-diaphyseal osteotomy reconstructed with a plated allograft, and were randomized to: 1 Placebo (n = 5; daily saline, 2 Continuous rPTH1-34 (n = 7; 5 μg/kg/day s.c. from day 1-55 post-op, or 3 Delayed rPTH1-34 (n = 8; 5 μg/kg/day s.c. from day 14-28 post-op. Safety was assessed by physical behavior and blood calcium monitoring. Cone beam CT (CB-CT was performed on days 14, 28 and 56 post-op to assess 2D cortical healing, 3D bone volume, and Union Ratio. Biomechanical testing and dynamic histomorphometry were also performed. The high drug dose was poorly tolerated, as most dogs receiving rPTH1-34 had to be given intravenous saline, and one dog died from hypercalcemia. Continuous rPTH1-34 significantly increased 2D healing and callus volumes at 4-weeks versus Placebo, and sustained the significant increase in cortical union at 8-week (p<0.05. These rPTH1-34 effects were confirmed by histomorphometry, revealing significant increases in mineral apposition rates (MAR on host bone and graft-host junctions (p<0.05. Delayed rPTH1-34 significantly increased callus volume and MAR at 8 weeks (p<0.05. Although no biomechanical differences were observed, as expected for early healing, the results demonstrated that 2D RUST scoring significantly correlated with torsional biomechanics (p<0.01. In conclusion, 8-weeks of intermittent high-dose rPTH1-34 treatment significantly increases callus formation and accelerates bony union of intercalary massive allografts in a clinically relevant canine model, but with serious side-effects from hypercalcemia.

  18. Bone Cancer

    Science.gov (United States)

    Cancer that starts in a bone is uncommon. Cancer that has spread to the bone from another ... more common. There are three types of bone cancer: Osteosarcoma - occurs most often between ages 10 and ...

  19. Bone Grafts in Jaw Cysts- Hydroxyapatite & Allogenic Bone – A Comparative Study

    Directory of Open Access Journals (Sweden)

    Showkat Mamun

    2009-11-01

    Full Text Available Background: Auto bone is the gold standard in bone grafting. However, the morbidity and additional surgical time associated with its collection, as well as the limited supply, have stimulated the search for substitutes. Allograft is more limited than autograft because it yields more variable clinical results. Composite synthetic grafts offer an alternative because Hydroxyapatite is chemically identical to the inorganic matrix of living bones and it can be processed synthetically. The intent was to evaluate these two graft materials for clinical use and to provide an insight on the different grafting strategies to enhance bone formation. Objective: To find out the bone healing process and the prognostic value for the patient using hydroxyapatite alloplastic material and allogenic bone graft. Method: Total 28 patients were included in the study after the clinical and radiological evaluation where 14 cases were treated with allogenic-bone graft and rest 14 cases were treated with hydroxyapatite alloplastic material after enucleation of the cystic lesion in random manner. The integration of hydroxyapatite and allogenic bone was assessed with postoperative lesion diameter, trabecular pattern, histopathological and scintigraphic examination of the successful graft cases. Statistical analysis was carried out by ‘unpaired T test' and ‘Chi square' test. Result: The radiological, histopathological and scintigraphical outcome of the patients treated with hydroxyaptite granule bone graft were clinically and statistically superior in comparison with those who were treated with allogenic bone graft. Conclusion: This safe and osteoconductive hydroxyapatite appears suitable for filling bone defects and bone cavities, showing less resorption and a rapid osseous integration. Key words: Hydroxyapatite; allogenic bone; scintigraphy; radiology; histopathology.DOI: 10.3329/bsmmuj.v2i1.3707 BSMMU J 2009; 2(1: 25-30

  20. Allogenic bone rods with freeze drying and gamma rays irradiation for treatment of fracture

    International Nuclear Information System (INIS)

    Zhou Zhenbin

    1999-01-01

    Opened reduction and internal fixation are the usual treatment of fracture, but both methods need a second operation for removal implants. The benefits of the bone rods are that they can avoid the removement of internal fixation and will be absorbed spontaneously. The bone rods are made of allogeneic compact bones with freeze-drying and gamma rays irradiation supplied by Shanxi Provincial Tissue Bank. The purpose of this study is to evaluate allograft reaction, the stability of the internal fixation, osteoinduction in the treatment of fracture using allogeneic bone rods with freeze drying and gamma rays irradiation. From May 1997 to May 1998, fourteen cases (male 12, female 2) of treatment were reviewed. The mean age was 37.3 (21-5 1). There were 3 medial malleolus fractures, 7 tibia and fibula fractures, 1 ulna and radius fracture, 1 lateral condyle of humerus fracture. The clinical results were satisfactory. Because the strength of the bone rods are weaker than that of screws, the bone rods are only indicated in the fixation of cancellous bones fracture and unloaded bone fracture. It can be used as a supplementary fixation of loaded bone. It is not indicated for fixation of comminuted fracture. More than two bone rods may be used in the fixation of fracture in order to get stability of the fracture and decrease stress between rods which will prevent the break of the bone rods. Allogeneic bone rods with freeze-drying and gamma rays irradiation can be used as implants of non-immunogenicity. There are no allograft reactions in all cases (including fever, leukocytosis, exudation or swelling in the wound). Although plenty of experimental studies have showed that freeze drying with gamma rays irradiation (below 50 KGy) would not destroy BMP of bone allograft, but there is no osteoinduction in our cases. The healing of a fracture and bridging external callus are similar as other operations. This new technique may have the following advantages compare with the screws: 1

  1. Acute Hepatic Allograft Rejection in Pediatric Recipients: Effective Factors.

    Science.gov (United States)

    Dehghani, S M; Shahramian, I; Afshari, M; Bahmanyar, M; Ataollahi, M; Sargazi, A

    2018-01-01

    Acute cellular rejection (ACR), a reversible process, can affect the graft survival. To evaluate the relation between ACR and clinical factors in recipients of allograft liver transplantation. 47 recipients of liver were consecutively enrolled in a retrospective study. Their information were retrieved from their medical records and analyzed. Of the 47 recipients, 38 (81%) experienced acute rejection during 24 months of the transplantation. None of the studied factors for occurring transplant rejection, i.e ., blood groups, sex, age, familial history of disease, receiving drugs and blood products, type of donor, Child score, and Child class, was not found to be significant. During a limited follow-up period, we did not find any association between ACR and suspected risk factors.

  2. Amniotic membrane allografts: development and clinical utility in ophthalmology

    Directory of Open Access Journals (Sweden)

    Rizzuti A

    2014-12-01

    Full Text Available Allison Rizzuti,1,2 Adam Goldenberg,1 Douglas R Lazzaro1,2 1SUNY Downstate Medical Center, 2Kings County Hospital Center, Brooklyn, NY, USA Abstract: Amniotic membrane, the innermost layer of the placenta, is a tissue that promotes epithelialization, while decreasing inflammation, neovascularization, and scarring. It is used in the surgical management of a wide variety of ophthalmic conditions where it functions as a graft or patch in ocular surface reconstruction. The development of new preservation techniques, as well as a sutureless amniotic membrane, has allowed for easier, in-office placement, without the disadvantages of an operating room procedure. The purpose of this review is to describe the historical development of amniotic membrane in ophthalmology and to describe its current clinical applications, particularly focusing on recent advances. Keywords: ocular surface, cornea, stem cells, prokera, allograft, patch, transplantation

  3. 100 second renal allografts from a single transplantation institution.

    Science.gov (United States)

    Ascher, N L; Ahrenholz, D H; Simmons, R L; Najarian, J S

    1979-01-01

    Between January 1, 1968 and March 1977, 100 of 131 patients who lost their first transplant at the University of Minnesota received a second renal allograft. Overall patient survival in the retransplanted group was 10% less than that in the dialysis group. The best results (graft function and patient survival were seen in young patients, nondiabetics, patients who received two sequential living related groups, and in those whose first graft was lost secondary to chronic rejection. The poorest results were seen in older patients (greater than 40 years), diabetics, and patients with acute rejection during the initial graft. Shared donor antigens do not affect graft outcome. These findings, although not the product of a randomized prospective study, may be useful in advising patients of the relative risks of retransplantation or hemodialysis.

  4. Characterization of ionizing radiation effects on human skin allografts

    International Nuclear Information System (INIS)

    Bourroul, Selma Cecilia

    2004-01-01

    The skin has a fundamental role in the viability of the human body. In the cases of extensive wounds, allograft skin provides an alternative to cover temporarily the damaged areas. After donor screening and preservation in glycerol (above 85%), the skin can be stored in the Skin Banks. The glycerol at this concentration has a bacteriostatic effect after certain time of preservation. On the other hand, skin sterilization by ionizing radiation may reduces the quarantine period for transplantation in patients and its safety is considered excellent. The objectives of this work were to establish procedures using two sources of ionizing radiation for sterilization of human skin allograft, and to evaluate the skin after gamma and electron beam irradiation. The analysis of stress-strain intended to verify possible effects of the radiation on the structure of preserved grafts. Skin samples were submitted to doses of 25 kGy and 50 kGy in an irradiator of 60 Co and in an electron beam accelerator. Morphology and ultra-structure studies were also accomplished. The samples irradiated with a dose of 25 kGy seemed to maintain the bio mechanic characteristics. The gamma irradiated samples with a dose of 50 kGy and submitted to an electron beam at doses of 25 kGy and 50 kGy presented significant differences in the values of the elasticity modulus, in relation to the control. The analysis of the ultramicrographies revealed modifications in the structure and alterations in the pattern of collagen fibrils periodicity of the irradiated samples. (author)

  5. Survivorship After Meniscal Allograft Transplantation According to Articular Cartilage Status.

    Science.gov (United States)

    Lee, Bum-Sik; Bin, Seong-Il; Kim, Jong-Min; Kim, Won-Kyeong; Choi, Jun Weon

    2017-04-01

    Clinical outcomes after meniscal allograft transplantation (MAT) in arthritic knees are unclear, and objective estimates of graft survival according to the articular cartilage status have not been performed. MAT should provide clinical benefits in knees with high-grade cartilage damage, but their graft survivorship should be inferior to that in knees with low-grade chondral degeneration after MAT. Cohort study; Level of evidence, 3. The records of 222 consecutive patients who underwent primary MAT were reviewed to compare clinical outcomes and graft survivorship. The patients were grouped according to the degree and location of articular cartilage degeneration: low-grade chondral lesions (International Cartilage Repair Society [ICRS] grade ≤2) on both the femoral and tibial sides (ideal indication), high-grade lesions (ICRS grade 3 or 4) on either the femoral or tibial side (relative indication), and high-grade lesions on both sides (salvage indication). Kaplan-Meier survival analysis with the log-rank test was performed to compare the clinical survival rates and graft survival rates between the groups. A Lysholm score of meniscal tear or meniscectomy of greater than one-third of the allograft, objectively evaluated by magnetic resonance imaging (MRI) and second-look arthroscopic surgery. The mean (±SD) Lysholm score significantly improved from 63.1 ± 15.1 preoperatively to 85.1 ± 14.3 at the latest follow-up of a mean 44.6 ± 19.7 months ( P lesions. However, better graft survival can be expected when articular cartilage is intact or if chondral damage is limited to a unipolar lesion. MAT should be considered before the progression of chondral damage to a bipolar lesion for better graft survivorship and should be performed cautiously in arthritic knees.

  6. Intramyocardial impedance measurements for diagnosis of acute cardiac allograft rejection.

    Science.gov (United States)

    Pfitzmann, R; Müller, J; Grauhan, O; Hetzer, R

    2000-08-01

    Measurements of intramyocardial impedance at high frequencies can indicate alterations in cell membranes and intracellular spaces during acute cardiac allograft rejection. Fifteen beagle dogs underwent heterotopic heart transplantation and were immunosuppressed with cyclosporine and methyl prednisolone (MP). Impedance was determined twice daily by means of four screw-in electrodes in the right and left ventricle. Transmyocardial biopsies and the intramyocardial electrogram (IMEG) were performed as reference methods. A total of 23 rejection episodes were induced. When acute rejection was recognized histologically and through IMEG readings, the animals were treated with a bolus of 125 mg of methyl prednisolone over 5 consecutive days. Treatment of rejection was controlled by biopsy and IMEG. All hearts showed a uniform decrease in impedance of about 28.3%+/-5.5% immediately after transplantation, which subsequently reached a stable plateau after 7 to 8 days. Impedance values then remained unchanged as long as rejection was absent. Biopsy findings of grades 1A to 1B (ISHLT) were accompanied by a statistically significant increase in impedance of 12.2%+/-2.5%; of grades 2 to 3A of 19.2%+/-3.2% and of grades 3B to 4 of 27.0%+/-2.9%. Sensitivity was 96%, specificity 91%. Successful treatment of rejection led to a decrease of impedance to the initial levels. The amount of increase in impedance of high frequencies is a method to stratify acute cardiac allograft rejection into grades like histologically grading. The effectiveness of rejection treatment can also be monitored through impedance measurement. The method is also applicable for telemetric rejection monitoring by means of an implantable device.

  7. Optimising femoral-head osteochondral allograft transplantation in a preclinical model

    Directory of Open Access Journals (Sweden)

    Brett D. Crist

    2016-04-01

    Conclusion: These data provide initial translational and clinical evidence for large osteochondral allografts as a potential option for functional resurfacing of full-thickness cartilage defects of the femoral head.

  8. RNA-seq analysis of clinical-grade osteochondral allografts reveals activation of early response genes

    NARCIS (Netherlands)

    Lin, Yang; Lewallen, Eric A.; Camilleri, Emily T.; Bonin, Carolina A.; Jones, Dakota L.; Dudakovic, Amel; Galeano-Garces, Catalina; Wang, Wei; Karperien, Marcel J.; Larson, Annalise N.; Dahm, Diane L.; Stuart, Michael J.; Levy, Bruce A.; Smith, Jay; Ryssman, Daniel B.; Westendorf, Jennifer J.; Im, Hee-Jeong; van Wijnen, Andre J.; Riester, Scott M.; Krych, Aaron J.

    2016-01-01

    Preservation of osteochondral allografts used for transplantation is critical to ensure favorable outcomes for patients after surgical treatment of cartilage defects. To study the biological effects of protocols currently used for cartilage storage, we investigated differences in gene expression

  9. Identification of β2-microglobulin as a urinary biomarker for chronic allograft nephropathy using proteomic methods.

    LENUS (Irish Health Repository)

    Johnston, Olwyn

    2011-08-01

    Chronic allograft nephropathy (CAN) remains the leading cause of renal graft loss after the first year following renal transplantation. This study aimed to identify novel urinary proteomic profiles, which could distinguish and predict CAN in susceptible individuals.

  10. Identification of a peripheral blood transcriptional biomarker panel associated with operational renal allograft tolerance

    NARCIS (Netherlands)

    Brouard, Sophie; Mansfield, Elaine; Braud, Christophe; Li, Li; Giral, Magali; Hsieh, Szu-Chuan; Baeten, Dominique; Zhang, Meixia; Ashton-Chess, Joanna; Braudeau, Cecile; Hsieh, Frank; Dupont, Alexandre; Pallier, Annaik; Moreau, Anne; Louis, Stephanie; Ruiz, Catherine; Salvatierra, Oscar; Soulillou, Jean-Paul; Sarwal, Minnie

    2007-01-01

    Long-term allograft survival generally requires lifelong immunosuppression (IS). Rarely, recipients display spontaneous "operational tolerance" with stable graft function in the absence of IS. The lack of biological markers of this phenomenon precludes identification of potentially tolerant patients

  11. Donor dopamine treatment limits pulmonary oedema and inflammation in lung allografts subjected to prolonged hypothermia

    NARCIS (Netherlands)

    Hanusch, Christine; Nowak, Kai; Toerlitz, Patrizia; Gill, Ishar S.; Song, Hui; Rafat, Neysan; Brinkkoetter, Paul T.; Leuvenink, Henri G.; Van Ackern, Klaus C.; Yard, Benito A.; Beck, Grietje C.

    2008-01-01

    Background. Endothelial barrier dysfunction severely compromises organ function after reperfusion. Because dopamine pretreatment improves hypothermia mediated barrier dysfunction, we tested the hypothesis that dopamine treatment of lung allografts positively affects tissue damage associated with

  12. Targeted inhibition of renal Rho kinase reduces macrophage infiltration and lymphangiogenesis in acute renal allograft rejection

    NARCIS (Netherlands)

    Poosti, Fariba; Yazdani, Saleh; Dolman, M. Emmy M.; Kok, Robbert Jan; Chen, Cheng; Ding, Guohua; Lacombe, Marie; Prakash, Jai; van den Born, Jacob; Hillebrands, Jan-Luuk; van Goor, Harry; de Borst, Martin H.

    2012-01-01

    The Rho kinase pathway plays an important role in epithelial dedifferentiation and inflammatory cell infiltration. Recent studies suggest that inflammation promotes lymphangiogenesis, which has been associated with renal allograft rejection. We investigated whether targeted inhibition of the Rho

  13. Circulating endothelial progenitor cell numbers are not associated with donor organ age or allograft vasculopathy in cardiac transplant recipients.

    Science.gov (United States)

    Thomas, H E; Parry, G; Dark, J H; Arthur, H M; Keavney, B D

    2009-02-01

    Increasing age is associated with reduced numbers of circulating endothelial progenitor cells (EPCs). It is unclear whether this relates to depletion or impairment of bone marrow progenitors, or to deficient mobilization signals from aging tissues. In cardiac transplant patients, one previous study has reported an association between circulating EPCs and the risk of cardiac allograft vasculopathy (CAV). We investigated whether increased donor heart age, a strong risk factor for CAV, was associated with reduced circulating EPC numbers in a group of cardiac transplant recipients matched for factors which influence EPC numbers, but with maximally discordant donor heart ages. We identified 32 patient pairs, matched for factors known to influence EPC numbers, but who had discordant donor heart ages by at least 20 years. EPCs were quantified using flow cytometry for absolute counts of cells expressing all the combinations of CD45, CD34, CD133 and the kinase domain receptor (KDR). There were no significant differences in the numbers of circulating EPCs between patients with old or young donor heart age. There was no association between the presence of CAV and circulating EPC numbers. We suggest that the increased susceptibility to CAV of older donor hearts is not mediated via circulating EPCs. Our results are consistent with the theory that the normal age-related decline in EPC numbers relates to bone marrow aging rather than failure of target tissues to induce EPC mobilization.

  14. Effect of cold nerve allograft preservation on antigen presentation and rejection

    Science.gov (United States)

    Ray, Wilson Z.; Kale, Santosh S.; Kasukurthi, Rahul; Papp, Esther M.; Johnson, Philip J.; Santosa, Katherine B.; Yan, Ying; Hunter, Daniel A.; Mackinnon, Susan E.; Tung, Thomas H.

    2010-01-01

    Object Nerve allotransplantation provides a temporary scaffold for host nerve regeneration and allows for the reconstruction of significant segmental nerve injuries. The need for systemic the current clinical utilization of nerve allografts, although this need is reduced by the practice of cold nerve allograft preservation. Activation of T cells in response to alloantigen presentation occurs in the context of donor antigen presenting cells (direct pathway) or host antigen-presenting cells (indirect pathway). The relative role of each pathway in eliciting an alloimmune response and its potential for rejection of the nerve allograft model has not previously been investigated. The objective of this investigation was to study the effect of progressive periods of cold nerve allograft preservation on antigen presentation and the alloimmune response. Methods The authors used wild type C57Bl/6 (B6), BALB/c, and major histocompatibility Class II–deficient (MHC−/−) C57Bl/6 mice as both nerve allograft recipients and donors. A nonvascularized nerve allograft was used to reconstruct a 1-cm sciatic nerve gap. Progressive cold preservation of donor nerve allografts was used. Quantitative assessment was made after 3 weeks using nerve histomorphometry. Results The donor-recipient combination lacking a functional direct pathway (BALB/c host with MHC−/− graft) rejected nerve allografts as vigorously as wild-type animals. Without an intact indirect pathway (MHC−/− host with BALB/c graft), axonal regeneration was improved (p < 0.052). One week of cold allograft preservation did not improve regeneration to any significant degree in any of the donor-recipient preservation did improve regeneration significantly (p < 0.05) for all combinations compared with wild-type animals without pretreatment. However, only in the presence of an intact indirect pathway (no direct pathway) did 4 weeks of cold preservation improve regeneration significantly compared with 1 week and no

  15. Risk factors of aseptic bone resorption: a study after autologous bone flap reinsertion due to decompressive craniotomy.

    Science.gov (United States)

    Dünisch, Pedro; Walter, Jan; Sakr, Yasser; Kalff, Rolf; Waschke, Albrecht; Ewald, Christian

    2013-05-01

    In patients who have undergone decompressive craniectomy, autologous bone flap reinsertion becomes necessary whenever the cerebral situation has consolidated. However, aseptic necrosis of the bone flap remains a concern. The aim of this study was to report possible perioperative complications in patients undergoing autologous bone flap reinsertion and to identify the risk factors that may predispose the bone flap to necrosis. All patients admitted to the authors' neurosurgical department between September 1994 and June 2011 and who received their own cryoconserved bone flap after decompressive craniectomy were studied. The grade of the bone flap necrosis was classified into 2 types. Type II bone necrosis was characterized by aseptic resorption with circumscribed or complete lysis of tabula interna and externa requiring surgical revision. To define predisposing factors, a multivariate analysis was performed using bone necrosis as the dependent variable. Among the 372 patients (mean age 48.6 years, 57.4% males) who received 414 bone flaps during the observation period, 134 (36.0%) had a diffuse traumatic brain injury, 69 (18.5%) had subarachnoid hemorrhage, 58 (15.6%) had cerebral infarction, 56 (15.1%) had extraaxial bleeding, 43 (11.6%) had intracerebral bleeding, and 12 (3.2%) had a neoplasm. Surgical relevant Type II bone flap necrosis occurred in 85 patients (22.8%) and 91 bone flaps, after a median time of 15 months (interquartile range [IQR], 10-33 months). In a multivariate analysis with Type II necrosis as the dependent variable, bone flap fragmentation with 2 (OR 3.35, 95% CI 1.59-7.01, p bone flap necrosis. In patients undergoing bone flap reinsertion after craniotomy, aseptic bone necrosis is an underestimated problem during long-term follow-up. Especially in younger patients with an expected good neurological recovery and a fragmented bone flap, an initial allograft should be considered because of an increased risk for aseptic bone flap necrosis.

  16. Perfused nonfunctioning renal allograft: Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Mohamed Zahran

    2018-01-01

    Full Text Available We report a case of very early postoperative iatrogenic dissection of common iliac artery (CIA, external iliac artery (EIA causing acute ischemia of the right lower limb, and impairing the perfusion of a renal allograft. This was managed successfully by graft nephrectomy and interposition polytetrafluoroethylene grafting of the CIA and EIA with re-implantation of the kidney allograft and restoration of its perfusion and function, together with restoration of the lower limb circulation.

  17. Pilot Study of Renal Diffusion Tensor Imaging as a Correlate to Histopathology in Pediatric Renal Allografts.

    Science.gov (United States)

    Li, Yi; Lee, Marsha M; Worters, Pauline W; MacKenzie, John D; Laszik, Zoltan; Courtier, Jesse L

    2017-06-01

    Fractional anisotropy (FA) is a measure of molecular motion obtained from diffusion tensor imaging (DTI). The objective of this study was to assess the use of FA as a noninvasive correlate of renal allograft histopathology. Sixteen pediatric renal allograft recipients were imaged using DTI in a prospective study, between October 2014 and January 2016, before a same-day renal allograft biopsy. The Kendall tau correlation coefficient was used to assess the relationship between cortical and medullary FA values and several clinically important Banff renal allograft histopathology scores. The Mann-Whitney U test was also used to compare cortical and medullary FA values in the region of biopsy in patients whose biopsy results did and in those whose biopsy results did not change clinical management. Medullary FA values had direct inverse correlation with several histopathology scores: tubulitis (designated "t" score in Banff pathologic classification, p < 0.04), interstitial inflammation (i score, p < 0.005), tubular atrophy (ct score, p < 0.002), and interstitial fibrosis (ci score, p < 0.007). Cortical FA values inversely correlated with peritubular capillaritis (ptc score, p < 0.02). Neither medullary nor cortical FA values correlated with glomerulitis (g score). At a b value of 800 s/mm 2 , medullary FA values of pediatric renal allograft recipients whose renal biopsies prompted a change in clinical management (mean ± SD at a b value of 800 s/mm 2 = 0.262 ± 0.07; n = 9) were statistically different compared with the group whose biopsy results did not change clinical management (mean ± SD at a b value of 800 s/mm 2 = 0.333 ± 0.06; n = 7) (p < 0.006). FA is a noninvasive correlate of several important renal allograft histopathology scores and a potential noninvasive method of assessing renal allograft health in pediatric allograft recipients.

  18. Antibody-mediated rejection of single class I MHC-disparate cardiac allografts.

    Science.gov (United States)

    Hattori, Y; Bucy, R P; Kubota, Y; Baldwin, W M; Fairchild, R L

    2012-08-01

    Murine CCR5(-/-) recipients produce high titers of antibody to complete MHC-mismatched heart and renal allografts. To study mechanisms of class I MHC antibody-mediated allograft injury, we tested the rejection of heart allografts transgenically expressing a single class I MHC disparity in wild-type C57BL/6 (H-2(b)) and B6.CCR5(-/-) recipients. Donor-specific antibody titers in CCR5(-/-) recipients were 30-fold higher than in wild-type recipients. B6.K(d) allografts survived longer than 60 days in wild-type recipients whereas CCR5(-/-) recipients rejected all allografts within 14 days. Rejection was accompanied by infiltration of CD8 T cells, neutrophils and macrophages, and C4d deposition in the graft capillaries. B6.K(d) allografts were rejected by CD8(-/-)/CCR5(-/-), but not μMT(-/-)/CCR5(-/-), recipients indicating the need for antibody but not CD8 T cells. Grafts recovered at day 10 from CCR5(-/-) and CD8(-/-)/CCR5(-/-) recipients and from RAG-1(-/-) allograft recipients injected with anti-K(d) antibodies expressed high levels of perforin, myeloperoxidase and CCL5 mRNA. These studies indicate that the continual production of antidonor class I MHC antibody can mediate allograft rejection, that donor-reactive CD8 T cells synergize with the antibody to contribute to rejection, and that expression of three biomarkers during rejection can occur in the absence of this CD8 T cell activity. © Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.

  19. Increased circulating follicular helper T cells with decreased programmed death-1 in chronic renal allograft rejection

    OpenAIRE

    Shi, Jian; Luo, Fengbao; Shi, Qianqian; Xu, Xianlin; He, Xiaozhou; Xia, Ying

    2015-01-01

    Background Chronic antibody-mediated rejection is a major issue that affects long-term renal allograft survival. Since follicular helper T (Tfh) cells promote the development of antigen-specific B cells in alloimmune responses, we investigated the potential roles of Tfh cells, B cells and their alloimmune-regulating molecules in the pathogenesis of chronic renal allograft rejection in this study. Methods The frequency of Tfh, B cells and the levels of their alloimmune-regulating molecules inc...

  20. Effects of cryopreservation on the immunogenicity of porcine arterial allografts in early stages of transplant vasculopathy.

    Science.gov (United States)

    Solanes, Núria; Rigol, Montserrat; Khabiri, Ebrahim; Castellà, Manuel; Ramírez, José; Roqué, Mercè; Agustí, Elba; Roig, Eulàlia; Pérez-Villa, Fèlix; Segalés, Joaquim; Pomar, José Luís; Engel, Pablo; Massaguer, Anna; Martorell, Jaume; Rodríguez, Jose Antonio; Sanz, Ginés; Heras, Magda

    2005-10-01

    The number of revascularization procedures including coronary and lower extremity bypass, have increased greatly in the last decade. It suggests a growing need for vascular grafts. Cryopreserved allografts could represent a viable alternative but their immunologic reactivity remains controversial. 71 pigs (40 recipients and 31 donors) were used. Two femoral grafts per recipient animal were implanted for 3, 7, and 30 days. Types of grafts: fresh autograft as a control graft (n=19), fresh allograft (n=31) and cryopreserved allograft (n=30). Histological and immunohistochemical studies were performed. Fresh allografts compared to autografts showed intimal inflammatory infiltration at 3 days (328 vs. 0 macrophages/mm2; P<0.05) and 7 days (962 vs. 139 T lymphocytes/mm2; P<0.05) post-transplantation. At 30 days, there was a loss of endothelial cells, presence of luminal thrombus and aneurismal lesions (total area=15.8 vs. 8.4 mm2; P<0.05). Cryopreservation did not reduce these lesions nor modify endothelial nitric oxide synthase (eNOS) expression nor modify the number of animals that developed anti-SLA antibodies. Moreover, at 7 days, cryopreserved allografts compared to fresh allografts showed a higher expression of P-selectin (5 out of 5 vs. 1 out of 5; P<0.05) and, at 30 days, a greater inflammatory reactivity (2692 vs. 1107 T lymphocytes/mm2 in media; P<0.05) with a trend towards a higher presence of multinucleated giant cells than in the fresh ones. The cryopreservation method used maintained immunogenicity of allografts and increased the inflammatory reactivity found in fresh allografts up to 30 days of vascular transplantation.

  1. Low Bone Density

    Science.gov (United States)

    ... Bone Density Exam/Testing › Low Bone Density Low Bone Density Low bone density is when your bone ... to people with normal bone density. Detecting Low Bone Density A bone density test will determine whether ...

  2. In vivo performance of combinations of autograft, demineralized bone matrix, and tricalcium phosphate in a rabbit femoral defect model

    International Nuclear Information System (INIS)

    Kim, Jinku; McBride, Sean; Hollinger, Jeffrey O; Dean, David D; Sylvia, Victor L; Doll, Bruce A

    2014-01-01

    Large bone defects may be treated with autologous or allogeneic bone preparations. Each treatment has advantages and disadvantages; therefore, a clinically viable option for treating large (e.g., gap) bone defects may be a combination of the two. In the present study, bone repair was determined with combinations of autografts, allografts, and synthetic bone grafts using an established rabbit femoral defect model. Bilateral unicortical femoral defects were surgically prepared and treated with combinatorial bone grafts according to one of seven treatment groups. Recipient sites were retrieved at six weeks. Cellular/tissue responses and new bone formation were assessed by histology and histomorphometry. Histological analysis images indicated neither evidence of inflammatory, immune responses, tissue necrosis, nor osteolysis. Data suggested co-integration of implanted agents with host and newly formed bone. Finally, the histomorphometric data suggested that the tricalcium phosphate-based synthetic bone graft substitute allowed new bone formation that was similar to the allograft (i.e., demineralized bone matrix, DBM). (paper)

  3. A Modified Technique for Occipitocervical Fusion Using Compressed Iliac Crest Allograft Results in a High Rate of Fusion in the Pediatric Population.

    Science.gov (United States)

    Iyer, Rajiv R; Tuite, Gerald F; Meoded, Avner; Carey, Carolyn C; Rodriguez, Luis F

    2017-11-01

    In children, high rates of occipitocervical (OC) fusion have been demonstrated with the use of rigid instrumentation in combination with harvested autograft, with or without bone morphogenetic protein (BMP). Historically, the use of allograft materials demonstrated inferior OC fusion outcomes compared with autograft. However, autograft harvest harbors an increased risk of patient morbidity, and the use of BMP is costly and controversial in children. Thus, there remains a need for safer, less costly, yet efficacious techniques for OC fusion in the pediatric population. We retrospectively reviewed the charts of patients younger than 21 years of age who underwent OC fusion with structural allograft placement at our institution from 2010 to 2015. Data collected included age, sex, follow-up duration, fusion outcomes, and postoperative complications. A total of 19 patients (8 female and 11 male) underwent OC fusion with our surgical technique. Mean age was 8.5 ± 4.3 years. Radiographic follow up data were available for 18 of 19 patients. One patient was lost to clinical follow up but had radiographic confirmation of fusion. Thus, 18 of 18 (100%) of patients with radiographic follow-up achieved successful arthrodesis as determined by computed tomography. Median duration to documented fusion was 4.5 months. Clinical follow-up was available for 17 of 19 patients and was on average 18.8 ± 13.5 months. One patient required reoperation for graft fracture 8 months after radiographic confirmation of successful fusion. There were no vertebral artery injuries or other postoperative complications. We demonstrate a modified technique for OC fusion in children with unique structural allograft shaping and affixation, leading to excellent fusion outcomes at follow up. This technique obviates the need for autograft harvest or BMP, and may decrease postoperative morbidity. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. [Clinical-radiological evaluation of the impaction allografting and cemented rod technique in revision knee surgery].

    Science.gov (United States)

    Mateo-Negreira, J; López-Cuello, P; Pipa-Muñiz, I; Rodríguez García, N; Murcia-Mazón, A; Suárez-Suárez, M A

    2016-01-01

    Long term clinical and radiological evaluation of results, survival, and peri- operative and post-operative complications of the patients who have been operated on for revision total hip arthroplasty using the impaction allografting and cemented rod technique. An observational, analytical, prospective and non-random study was conducted on 26 patients who underwent revision total hip arthroplasty in our Hospital (1997-98). They were clinically and radiologically assessed, and a survival analysis of the implant was performed. Statistically significant differences were identified in the pre- and post-operative values, according to Harris and Merle D́Aubigne scores. The femoral components survival was considered as an endpoint of the revision replacement, which was 84% at a mean of 13 years. There were 9 intraoperative complications (6 were fractures) and they significantly affected the length of hospital stay. No post-operative complications were observed in 70% of the patients. None of the analysed variables had any influence on the radiological subsidence of the femoral component. Several techniques aim to solve the bone stock deficiency in revision total hip arthroplasty, but only impaction grafting attempts to recover it. The Ling's technique shows an improvement over the Merle D́Aubigne and Harris scores, in the medium-long term. The intraoperative complications are mainly an increase in the length of hospital stay and the number of days needed to be able to sit down. Ling's technique is a good option to consider in young patients where it is foreseeable that there is a new revision surgery in the future. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

  5. Increased circulating follicular helper T cells with decreased programmed death-1 in chronic renal allograft rejection.

    Science.gov (United States)

    Shi, Jian; Luo, Fengbao; Shi, Qianqian; Xu, Xianlin; He, Xiaozhou; Xia, Ying

    2015-11-03

    Chronic antibody-mediated rejection is a major issue that affects long-term renal allograft survival. Since follicular helper T (Tfh) cells promote the development of antigen-specific B cells in alloimmune responses, we investigated the potential roles of Tfh cells, B cells and their alloimmune-regulating molecules in the pathogenesis of chronic renal allograft rejection in this study. The frequency of Tfh, B cells and the levels of their alloimmune-regulating molecules including chemokine receptor type 5 (CXCR5), inducible T cell co-stimulator (ICOS), programmed death-1 (PD-1), ICOSL, PDL-1 and interleukin-21 (IL-21), of peripheral blood were comparatively measured in 42 primary renal allograft recipients within 1-3 years after transplantation. Among them, 24 patients had definite chronic rejection, while other 18 patients had normal renal function. Tfh-cell ratio was significantly increased with PD-1 down-regulation in the patients with chronic renal allograft rejection, while B cells and the alloimmune-regulating molecules studied did not show any appreciable change in parallel. The patients with chronic renal allograft rejection have a characteristic increase in circulating Tfh cells with a decrease in PD-1 expression. These pathological changes may be a therapeutic target for the treatment of chronic renal allograft rejection and can be useful as a clinical index for monitoring conditions of renal transplant.

  6. Relationship between CGRP level and acute reject reaction in cardiac allograft recipient in rats

    International Nuclear Information System (INIS)

    Li Lusheng; Zhao Xin; Song Guangmin; Yang Xixiu; Song Huimin

    2001-01-01

    Objective: To investigate the relationship between the calcitonin gene related peptide (CGRP) and acute reject reaction in the cardiac allograft in rat. Methods: There were 28 wistar rats with inbreeding line as donors and SD rats as recipients. Cervical heart allograft model was used. Blood was sampled from the third day after grafting to terminal reject reaction when the acceptors were killed. 32 rats without allograft were regarded as the normal controls. Results: The mean survival time of the experimental group was 7.21±2.36 days. Volume of the allografts was greatly increased with hyperemia and edema. CGRP level in the plasma of experimental rats was 180.18±69.77 ng/L, while the level of control rats was 277.41 ± 79.02 ng/L. The deference was statistically significant (P<0.05). Conclusion: In the acute reject reaction, CGRP level is greatly decreased in the plasma of cardiac allograft recipients. Further studies are therefore needed to investigate the application of CGRP measurement in the prevention and treatment of rejection reaction of cardiac allograft

  7. An alternative technique for anterior chest wall reconstruction: the sternal allograft transplantation.

    Science.gov (United States)

    Dell'Amore, Andrea; Cassanelli, Nicola; Dolci, Giampiero; Stella, Franco

    2012-12-01

    Sternal resection is indicated for a variety of pathological conditions, mainly neoplastic or related to sternotomy complications. Resection of the sternum generally leaves a large chest-wall defect, and reconstruction is thus the most difficult part of the operation. Correct stabilization of the anterior chest wall is very important to avoid secondary complications and respiratory failure. In the last few years, different technical solutions have been used to reconstruct the sternum. We describe our technique using a sternal allograft to reconstruct the anterior chest wall after partial or complete sternal resection. Between June 2010 and February 2012, four patients underwent sternectomy followed by anterior chest wall reconstruction using sternal allograft. The sternal allograft was harvested from a multitissue donor following Italian legislation for tissue donation. Three patients had neoplastic involvement of the sternum, and one had a complete sternal defect as a complication of a cardiac operation. We had no operative mortality. Three patients underwent partial sternal transplantation, and one underwent total sternal replacement. We had no postoperative respiratory insufficiency, infections or mechanical failure of the reconstructions. The respiratory function was preserved in all patients. The follow-up period was free from complications related to the sternal allograft implantation. The technique of sternal allograft transplantation is simple, reproducible and provides excellent functional and cosmetic results. Further studies including a larger number of patients are needed to understand the biology of the allograft and the long-term results of this technique.

  8. Injury to Allografts: innate immune pathways to acute and chronic rejection

    International Nuclear Information System (INIS)

    Land, W. G.

    2005-01-01

    An emerging body of evidence suggests that innate immunity, as the first line of host defense against invading pathogens or their components [pathogen-associated molecular patterns, (PAMPs)], plays also a critical role in acute and chronic allograft rejection. Injury to the donor organ induces an inflammatory milieu in the allograft, which appears to be the initial key event for activation of the innate immune system. Injury-induced generation of putative endogenous molecular ligand, in terms of damaged/danger-associated molecular patterns (DAMPs) such as heat shock proteins, are recognized by Toll-like receptors (TLRs), a family of pattern recognition receptors on cells of innate immunity. Acute allograft injury (e.g. oxidative stress during donor brain-death condition, post-ischemic reperfusion injury in the recipient) includes DAMPs which may interact with, and activate, innate TLR-bearing dendritic cells (DCs) which, in turn, via direct allo-recognition through donor-derived DCs and indirect allo-recogntion through recipient-derived DCs, initiate the recipient's adaptive alloimmune response leading to acute allograft rejection. Chronic injurious events in the allograft (e.g. hypertension, hyperlipidemia, CMV infection, administration of cell-toxic drugs [calcineurin-inhibitors]) induce the generation of D AMPs , which may interact with and activate innate TLR-bearing vascular cells (endothelial cells, smooth muscle cells) which, in turn, contribute to the development of atherosclerosis of donor organ vessels (alloatherosclerosis), thus promoting chronic allograft rejection. (author)

  9. Effects of Recombinant Human Bone Morphogenetic Protein-2 on Vertical Bone Augmentation in a Canine Model.

    Science.gov (United States)

    Hsu, Yung-Ting; Al-Hezaimi, Khalid; Galindo-Moreno, Pablo; O'Valle, Francisco; Al-Rasheed, Abdulaziz; Wang, Hom-Lay

    2017-09-01

    Vertical bone augmentation (VBA) remains unpredictable and challenging for most clinicians. This study aims to compare hard tissue outcomes of VBA, with and without recombinant human bone morphogenetic protein (rhBMP)-2, under space-making titanium mesh in a canine model. Eleven male beagle dogs were used in the study. Experimental ridge defects were created to form atrophic ridges. VBA was performed via guided bone regeneration using titanium mesh and allografts. In experimental hemimandibles, rhBMP-2/absorbable collagen sponge was well mixed with allografts prior to procedures, whereas a control buffer was applied within controls. Dogs were euthanized after a 4-month healing period. Clinical and radiographic examinations were performed to assess ridge dimensional changes. In addition, specimens were used for microcomputed tomography (micro-CT) assessment and histologic analysis. Membrane exposure was found on five of 11 (45.5%) rhBMP-2-treated sites, whereas it was found on nine of 11 (81.8%) non-rhBMP-2-treated sites. Within 4 months of healing, rhBMP-2-treated sites showed better radiographic bone density, greater defect fill, and significantly more bone gain in ridge height (P 0.05). Under light microscope, predominant lamellar patterns were found in the specimen obtained from rhBMP-2 sites. With inherent limitations of the canine model and the concern of such a demanding surgical technique, current findings suggest that the presence of rhBMP-2 in a composite graft allows an increase of vertical gain, with formation of ectopic bone over the titanium mesh in comparison with non-rhBMP-2 sites.

  10. Lyophilized allografts without pre-treatment with glutaraldehyde are more suitable than cryopreserved allografts for pulmonary artery reconstruction

    Directory of Open Access Journals (Sweden)

    J.R. Olmos-Zúãiga

    2016-01-01

    Full Text Available Various methods are available for preservation of vascular grafts for pulmonary artery (PA replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA grafts and cryopreserved (CryoPA grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP in group III increased significantly at the end of the study compared with baseline (P=0.02 and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA. Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising.

  11. Lyophilized allografts without pre-treatment with glutaraldehyde are more suitable than cryopreserved allografts for pulmonary artery reconstruction.

    Science.gov (United States)

    Olmos-Zúñiga, J R; Jasso-Victoria, R; Díaz-Martínez, N E; Gaxiola-Gaxiola, M O; Sotres-Vega, A; Heras-Romero, Y; Baltazares-Lipp, M; Baltazares-Lipp, M E; Santillán-Doherty, P; Hernández-Jiménez, C

    2016-02-01

    Various methods are available for preservation of vascular grafts for pulmonary artery (PA) replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA) grafts and cryopreserved (CryoPA) grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP) in group III increased significantly at the end of the study compared with baseline (P=0.02) and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA)] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA). Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising.

  12. Lyophilized allografts without pre-treatment with glutaraldehyde are more suitable than cryopreserved allografts for pulmonary artery reconstruction

    International Nuclear Information System (INIS)

    Olmos-Zúãiga, J.R.; Jasso-Victoria, R.; Díaz-Martínez, N.E.; Gaxiola-Gaxiola, M.O.; Sotres-Vega, A.; Heras-Romero, Y.; Baltazares-Lipp, M.; Baltazares-Lipp, M.E.; Santillán-Doherty, P.; Hernández-Jiménez, C.

    2015-01-01

    Various methods are available for preservation of vascular grafts for pulmonary artery (PA) replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA) grafts and cryopreserved (CryoPA) grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP) in group III increased significantly at the end of the study compared with baseline (P=0.02) and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA)] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA). Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising

  13. Lyophilized allografts without pre-treatment with glutaraldehyde are more suitable than cryopreserved allografts for pulmonary artery reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Olmos-Zúãiga, J.R.; Jasso-Victoria, R. [Department of Experimental Surgery, National Institute of Respiratory Diseases ' Ismael Cosío Villegas' , Mexico City (Mexico); Díaz-Martínez, N.E. [Medical and Pharmaceutical Biotechnology, Center for Research and Assistance in Technology and Design of the State of Jalisco, Guadalajara, Jalisco (Mexico); Gaxiola-Gaxiola, M.O. [Laboratory of Morphology, National Institute of Respiratory Diseases ' Ismael Cosío Villegas' , Mexico City (Mexico); Sotres-Vega, A.; Heras-Romero, Y.; Baltazares-Lipp, M. [Department of Experimental Surgery, National Institute of Respiratory Diseases ' Ismael Cosío Villegas' , Mexico City (Mexico); Baltazares-Lipp, M.E. [Hemodynamics and Echocardiography Service, National Institute of Respiratory Diseases ' Ismael Cosío Villegas' , Mexico City (Mexico); Santillán-Doherty, P. [Medical Administration, National Institute of Respiratory Diseases ' Ismael Cosío Villegas' , Mexico City (Mexico); Hernández-Jiménez, C. [Department of Experimental Surgery, National Institute of Respiratory Diseases ' Ismael Cosío Villegas' , Mexico City (Mexico)

    2015-12-04

    Various methods are available for preservation of vascular grafts for pulmonary artery (PA) replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA) grafts and cryopreserved (CryoPA) grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP) in group III increased significantly at the end of the study compared with baseline (P=0.02) and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA)] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA). Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising.

  14. Alveolar ridge sockets preservation with bone grafting--review.

    Science.gov (United States)

    Allegrini, Sergio; Koening, Bruno; Allegrini, Marcia Rivellino Facci; Yoshimoto, Marcelo; Gedrange, Tomasz; Fanghaenel, Jochen; Lipski, Mariusz

    2008-01-01

    Alveolar bone seems to play a key role in providing support to the teeth, which are anchored to the bone by desmodontal fibers. The progressive alveolar bone resorption process occurs due to a loss of anatomic, biologic and mechanical factors. Mechanical stimulation of alveolar bone during mastication is crucial in keeping the teeth and underlying bone healthy. Tooth extraction leads to typical bone deficiency of ridge width and height of alveolar crest and reduces the possibility of placing screw titanium implants. When tooth extraction is necessary, trauma should be minimized during the procedure and bone preservation should receive careful attention. The literature has shown that early bone loss can be significantly reduced by socket grafting. The process of socket grafting requires an understanding of wound healing and an appreciation of the biological properties of the products available for socket grafting. Augmentative measures may, thus, be required to guarantee optimal prosthetic replacement of the lost tissue. Success or failure of augmentation procedures is dependent on revascularization and remodelling of the grafted bone into a vital, load bearing bone. In contrast to a visible three-dimensional change, the concept of remodelling refers to the internal turnover of bone, which is a coupled process where osteoclastic resorption and osteoblastic formation are more or less balanced. To restore alveolar bone loss and support efficient placement of dental implants, many different bone substitute such as autografts, allografts, xenografts, synthetic biomaterials and osteoactive agents have been proposed. In order to avoid harvesting an autograft, and thereby eliminating additional surgical procedures and risks, bone grafting materials and substitutes are alternative filler materials to be used for ridge augmentation. To present a literature review about biomaterials applicable in alveolar ridge sockets preservation to future implants insertion. The

  15. Permeability study of cancellous bone and its idealised structures.

    Science.gov (United States)

    Syahrom, Ardiyansyah; Abdul Kadir, Mohammed Rafiq; Harun, Muhamad Nor; Öchsner, Andreas

    2015-01-01

    Artificial bone is a suitable alternative to autografts and allografts, however their use is still limited. Though there were numerous reports on their structural properties, permeability studies of artificial bones were comparably scarce. This study focused on the development of idealised, structured models of artificial cancellous bone and compared their permeability values with bone surface area and porosity. Cancellous bones from fresh bovine femur were extracted and cleaned following an established protocol. The samples were scanned using micro-computed tomography (μCT) and three-dimensional models of the cancellous bones were reconstructed for morphology study. Seven idealised and structured cancellous bone models were then developed and fabricated via rapid prototyping technique. A test-rig was developed and permeability tests were performed on the artificial and real cancellous bones. The results showed a linear correlation between the permeability and the porosity as well as the bone surface area. The plate-like idealised structure showed a similar value of permeability to the real cancellous bones. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

  16. Rapid prototyping technology and its application in bone tissue engineering.

    Science.gov (United States)

    Yuan, Bo; Zhou, Sheng-Yuan; Chen, Xiong-Sheng

    Bone defects arising from a variety of reasons cannot be treated effectively without bone tissue reconstruction. Autografts and allografts have been used in clinical application for some time, but they have disadvantages. With the inherent drawback in the precision and reproducibility of conventional scaffold fabrication techniques, the results of bone surgery may not be ideal. This is despite the introduction of bone tissue engineering which provides a powerful approach for bone repair. Rapid prototyping technologies have emerged as an alternative and have been widely used in bone tissue engineering, enhancing bone tissue regeneration in terms of mechanical strength, pore geometry, and bioactive factors, and overcoming some of the disadvantages of conventional technologies. This review focuses on the basic principles and characteristics of various fabrication technologies, such as stereolithography, selective laser sintering, and fused deposition modeling, and reviews the application of rapid prototyping techniques to scaffolds for bone tissue engineering. In the near future, the use of scaffolds for bone tissue engineering prepared by rapid prototyping technology might be an effective therapeutic strategy for bone defects.

  17. Bioreactor activated graft material for early implant fixation in bone

    DEFF Research Database (Denmark)

    Snoek Henriksen, Susan; Ding, Ming; Overgaard, Søren

    2011-01-01

    Introduction The combined incubation of a composite scaffold with bone marrow stromal cells in a perfusion bioreactor could make up a novel hybrid graft material with optimal properties for early fixation of implant to bone. The aim of this study was to create a bioreactor activated graft (BAG...... in each sheep. The concentric gap (2 mm) surrounding the implant was filled with 1) BAG (autogenous), 2) granules, 3) granules+bone marrow aspirate (BMA, autologous) or 4) allograft. The sheep were euthanized after 6 weeks. Distal femurs were removed and implant-bone samples were divided in two parts...... calculated to assess implant fixation. Results were assessed by One-way ANOVA. P-values less than 0.05 were considered significant. Results One sheep in group 1 had to be euthanized after 4 weeks (excluded). One implant in each group was loosened and could not undergo push-out test (excluded). Group 1...

  18. Inhibition of chemokine-glycosaminoglycan interactions in donor tissue reduces mouse allograft vasculopathy and transplant rejection.

    Directory of Open Access Journals (Sweden)

    Erbin Dai

    2010-05-01

    Full Text Available Binding of chemokines to glycosaminoglycans (GAGs is classically described as initiating inflammatory cell migration and creating tissue chemokine gradients that direct local leukocyte chemotaxis into damaged or transplanted tissues. While chemokine-receptor binding has been extensively studied during allograft transplantation, effects of glycosaminoglycan (GAG interactions with chemokines on transplant longevity are less well known. Here we examine the impact of interrupting chemokine-GAG interactions and chemokine-receptor interactions, both locally and systemically, on vascular disease in allografts.Analysis of GAG or CC chemokine receptor 2 (CCR2 deficiency were coupled with the infusion of viral chemokine modulating proteins (CMPs in mouse aortic allograft transplants (n = 239 mice. Inflammatory cell invasion and neointimal hyperplasia were significantly reduced in N-deacetylase-N-sulfotransferase-1 (Ndst1(f/fTekCre(+ heparan sulfate (GAG-deficient (Ndst1(-/-, p<0.044 and CCR2-deficient (Ccr2(-/-, p<0.04 donor transplants. Donor tissue GAG or CCR2 deficiency markedly reduced inflammation and vasculopathy, whereas recipient deficiencies did not. Treatment with three CMPs was also investigated; Poxviral M-T1 blocks CC chemokine receptor binding, M-T7 blocks C, CC, and CXC GAG binding, and herpesviral M3 binds receptor and GAG binding for all classes. M-T7 reduced intimal hyperplasia in wild type (WT (Ccr2(+/+, p< or =0.003 and Ccr2(-/-, pallografts, but not in Ndst1(-/- aortic allografts (p = 0.933. M-T1 and M3 inhibited WT (Ccr2(+/+ and Ndst1(+/+, p< or =0.006 allograft vasculopathy, but did not block vasculopathy in Ccr2(-/- (p = 0.61. M-T7 treatment alone, even without immunosuppressive drugs, also significantly prolonged survival of renal allograft transplants (p< or =0.001.Interruption of chemokine-GAG interactions, even in the absence of chemokine-receptor blockade, is a highly effective approach to reduction of

  19. Scabies in a bilateral hand allograft recipient: An additional mimicker of acute skin rejection in vascularized composite allotransplantation.

    Science.gov (United States)

    Kanitakis, Jean; Morelon, Emmanuel

    2017-06-01

    Vascularized composite tissue allografts include skin, which frequently undergoes, in the early post-graft period, acute rejections. The diagnosis of acute rejection may be difficult as it can be mimicked by several dermatoses. We present a bilateral hand allograft recipient who developed, 16.5 years post-graft, cutaneous lesions raising suspicion about rejection. Physical examination and skin biopsy were diagnostic of scabies. This ectoparasitosis should be added in the list of dermatoses that can mimic allograft rejection in vascular composite allografts. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Novel in Vitro Modification of Bone for an Allograft with Improved Toughness Osteoconductivity

    Science.gov (United States)

    2015-06-01

    Anticonvulsant - Disease/conditions - Osteogenesis imperfecta, Cushing’s syndrome, Syphilis Task 2. Optimize AGE-breaker (ALT-711) treatments (36...stage, the optimum concentration and duration of AGE-breaker solutions was determined for the next steps (Milestone 1). Figure 11: The amount of

  1. Biocompatibility and Chemical Reaction Kinetics of Injectable, Settable Polyurethane/Allograft Bone Biocomposites

    Science.gov (United States)

    2012-08-05

    content for all liquid compo- nents was determined by Karl Fischer (KF) titration with a 798MPT Titrino with a 10 ml burette (Metrohm). Briefly, 0.5...increase their strength, control expansion of the material by absorbing excess moisture from the wound bed, and provide an osteoconductive matrix to... determined by nuclear magnetic resonance (NMR), and the cytotoxicity was assessed by live/dead staining. Finally, the ability of the biocomposites to

  2. Quality system and audit of human skin allografts

    International Nuclear Information System (INIS)

    Van Baare, J.

    1999-01-01

    Allograft skin has long been recognised as an important resource in the management of bum wounds. The important issue in skin banking is fust to guarantee safety of human cadaveric donor skin. Second, the quality of the allografts should be assured. The Euro Skin Bank, established in 1976, is located in The Netherlands. Not only in The Netherlands, but in many other (European) countries no specific regulation exists for tissue banking. With respect to skin banking in The Netherlands the Euro Skin Bank requested the government what regulations should be applied on their activities. It was stated in 1994 that human allografl skin should be regarded as a phan-naceutical drug, a magistral preparation. The Euro Skin Bank should therefore be subjected to the guidelines given for the Good Laboraton, Practices and Good Manufacturing Practices to process allogmft skin. Nevertheless, it was in the opinion of the Euro Skin Bank that regulating human tissue as a pharmaceutical drug was not sufficient e.g. no specific regulations for serologic testing of the tissue donor is given, which should be one of the most important issues in tissue banking. Recently the government has published new legislation for tissue banks in The Netherlands: on July I st, 1998, a new legislation was enforced concerning organ and tissue donation and on November I st, 1998, quality requirements for organ and tissue banks are published. The European Community discussed the possibility to bring all animal and human tissues under the Medical Device Directive (MDD). Soon it was proposed not to incorporate viable hw-nan tissue into the MDD. Last year all human tissue was excluded from the MDD. Lack of European regulations has been resulted in national laws, e.g. in The Netherlands, Germany and France. Possibly there might be a more significant role for the European Association of Tissue Banks in the near future for European legislation on tissue banking. In order to have a standard quality system wmch is

  3. Bone marrow aspiration

    Science.gov (United States)

    Iliac crest tap; Sternal tap; Leukemia - bone marrow aspiration; Aplastic anemia - bone marrow aspiration; Myelodysplastic syndrome - bone marrow aspiration; Thrombocytopenia - bone marrow aspiration; Myelofibrosis - bone marrow aspiration

  4. Neurotoxin from Naja naja atra venom inhibits skin allograft rejection in rats.

    Science.gov (United States)

    Xu, Yin-Li; Kou, Jian-Qun; Wang, Shu-Zhi; Chen, Cao-Xin; Qin, Zheng-Hong

    2015-09-01

    Recent studies reported that Naja naja atra venom (NNAV) regulated immune function and had a therapeutic effect on adjunctive arthritis and nephropathy. We hypothesized that NNAV and its active component, neurotoxin (NTX), might inhibit skin allograft rejection. Skin allografts were used to induce immune rejection in rats. In addition, mixed lymphocyte culture (MLC) was used to mimic immune rejection reaction in vitro. Both NNAV and NTX were orally given starting from 5days prior to skin allograft surgery. The results showed that oral administration of NNAV or NTX prolonged the survival of skin allografts and inhibited inflammatory response. The production of Th1 cytokines (IFN-γ, IL-2) was also suppressed. NTX inhibited T-cell proliferation and CD4(+) T cell division induced by skin allografts. NTX also showed immunosuppressive activity in mixed lymphocyte culture. Atropine alone inhibited Con A-induced proliferation of T cells and potentiated NTX' s inhibitory effects on T cells, while pilocarpine only slightly enhanced Con A-induced T cell proliferation and partially reversed the inhibitory effect of NTX. On the other hand, neither nicotine nor mecamylamine had an influence on NTX's inhibitory effects on Con A-induced T cell proliferation in vitro. NTX inhibited T cell proliferation by arresting the cell cycle at the G0/G1 phase. The present study revealed that NNAV and NTX suppressed skin allograft rejection by inhibiting T cell-mediated immune responses. These findings suggest both NNAV and NTX as potential immunosuppressants for preventing the immune response to skin allografts. Copyright © 2015. Published by Elsevier B.V.

  5. The protective effect of meniscus allograft transplantation on articular cartilage: a systematic review of animal studies.

    Science.gov (United States)

    Rongen, J J; Hannink, G; van Tienen, T G; van Luijk, J; Hooijmans, C R

    2015-08-01

    Despite widespread reporting on clinical results, the effect of meniscus allograft transplantation on the development of osteoarthritis is still unclear. The aim of this study was to systematically review all studies on the effect of meniscus allograft transplantation on articular cartilage in animals. Pubmed and Embase were searched for original articles concerning the effect of meniscus allograft transplantation on articular cartilage compared with both its positive (meniscectomy) and negative (either sham or non-operated) control in healthy animals. Outcome measures related to assessment of damage to articular cartilage were divided in five principal outcome categories. Standardized mean differences (SMD) were calculated and pooled to obtain an overall SMD and 95% confidence interval. 17 articles were identified, representing 14 original animal cohorts with an average timing of data collection of 24 weeks [range 4 weeks; 30 months]. Compared to a negative control, meniscus allograft transplantation caused gross macroscopic (1.45 [0.95; 1.95]), histological (3.43 [2.25; 4.61]) damage to articular cartilage, and osteoarthritic changes on radiographs (3.12 [1.42; 4.82]). Moreover, results on histomorphometrics and cartilage biomechanics are supportive of this detrimental effect on cartilage. On the other hand, meniscus allograft transplantation caused significantly less gross macroscopic (-1.19 [-1.84; -0.54]) and histological (-1.70 [-2.67; -0.74]) damage to articular cartilage when compared to meniscectomy. However, there was no difference in osteoarthritic changes on plain radiographs (0.04 [-0.48; 0.57]), and results on histomorphometrics and biomechanics did neither show a difference in effect between meniscus allograft transplantation and meniscectomy. In conclusion, although meniscus allograft transplantation does not protect articular cartilage from damage, it reduces the extent of it when compared with meniscectomy. Copyright © 2015 Osteoarthritis

  6. From skin allograft coverage to allograft-micrograft sandwich method: A retrospective review of severe burn patients who received conjunctive application of cultured epithelial autografts.

    Science.gov (United States)

    Chua, Alvin Wen Choong; Khoo, Yik Cheong; Truong, Thi Thu Ha; Woo, Evan; Tan, Bien Keem; Chong, Si Jack

    2018-02-20

    A 12-year retrospective review of severe burn patients who received cultured epithelial autografts (CEA) at the Singapore General Hospital Burns Centre from January 2005 to December 2016 was carried out. During this period, two different surgical modalities were employed to manage these burn injuries. In the earlier period, following early excision of the burn wounds, exposed surfaces were covered with a combination of split thickness skin autografts (STSG) and allografts. Surfaces covered with skin allografts were subsequently debrided of the allo-epidermis in about 3 weeks later, exposing the allodermis with granulating tissues for grafting of CEA; a technique known as the Cuono's method. In the later period, allograft-autologous micrograft sandwich technique was used to graft on the early excised burns with subsequent CEA grafting. The former and latter groups represented by STSG/C (n=10) and M/CEA (n=14) respectively, were compared in terms of clinical profiles, outcomes, allograft/CEA usage and total graft cost. No significant differences were found based on mean age and presence of inhalation burns between the two treatment methods However, percentage total body surface area (TBSA) and Revised Baux Score were significantly higher (pmicrografts which seemed to improve stabilization of the wound bed resulting in less operating procedures and improving CEA take. To conclude, the M/CEA method introduced was able to treat more severe burn patients at lower graft costs without compromising critical clinical outcomes significantly. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

  7. Improving efficiency of a regional stand alone bone bank.

    Science.gov (United States)

    Warnock, Jonathan M; Rowan, Clare H; Davidson, Helen; Millar, Ciara; McAlinden, M Gavan

    2016-03-01

    The introduction of a stand-alone Bone Bank in our Regional Orthopaedic Hospital has improved the availability of femoral head allograft. Benninger et al. (Bone Joint J 96-B:1307-1311, 2014), demonstrated their institutions bank to be cost effective despite a 30 % discard rate for harvested allograft. We sought to audit our own discard rates and subsequent cost-effectiveness of our bone bank. Donor recruitment. Before approaching a potential donor, our establishment's nurse specialists review their clinical notes and biochemical laboratory results, available on a regional Electronic Care Records. They view femoral head architecture on radiographs against set criteria, Patient Archive and Communication system (SECTRA, Sweden). In total 1383 femoral heads were harvested, 247 were discarded giving an overall rate of 17.9 %. The most common reasons for discard of harvested graft was a positive microbiology/bacteriology result, n = 96 (38.9 %). After a rise in discard rates in 2007, we have steadily reduced our discard rates since 2006/2007 (28.2 %), 2008/2009 (17 %), 2010/2011 (14.8 %), and finally to 10.3 % in 2012/2013. In the current financial year, our cost to harvest, test, store and release a femoral head is £ 610. With a structured donor recruitment process and unique pre-operative radiographic analysis we have successfully reduced our discard rates bi-annually making our bone bank increasingly cost-effective.

  8. Bone regenerative medicine: classic options, novel strategies, and future directions

    Science.gov (United States)

    2014-01-01

    This review analyzes the literature of bone grafts and introduces tissue engineering as a strategy in this field of orthopedic surgery. We evaluated articles concerning bone grafts; analyzed characteristics, advantages, and limitations of the grafts; and provided explanations about bone-tissue engineering technologies. Many bone grafting materials are available to enhance bone healing and regeneration, from bone autografts to graft substitutes; they can be used alone or in combination. Autografts are the gold standard for this purpose, since they provide osteogenic cells, osteoinductive growth factors, and an osteoconductive scaffold, all essential for new bone growth. Autografts carry the limitations of morbidity at the harvesting site and limited availability. Allografts and xenografts carry the risk of disease transmission and rejection. Tissue engineering is a new and developing option that had been introduced to reduce limitations of bone grafts and improve the healing processes of the bone fractures and defects. The combined use of scaffolds, healing promoting factors, together with gene therapy, and, more recently, three-dimensional printing of tissue-engineered constructs may open new insights in the near future. PMID:24628910

  9. Effect of blood transfusions on canine renal allograft survival

    International Nuclear Information System (INIS)

    Van Der Linden, C.J.; Buurman, W.A.; Vegt, P.A.; Greep, J.M.; Jeekel, J.

    1982-01-01

    In this study significantly prolonged canine renal allograft survival has been demonstrated after transfusion of 100 ml of third-party whole blood given peroperatively. Peroperative transfusions of third-party leukocyte-free blood or pure lymphocyte cell suspensions did not influence graft survival. Futhermore, no improvement in graft survival has been found after a peroperative transfuson of irradiated whole blood (2500 rad). These data suggest that delayed graft rejection after blood transfusions can only be expected after the administration of whole blood. The role of competent lymphocytes in whole blood is questionable, since a transfusion of irradiated whole blood in combination with nonirradiated lymphocytes did not lead to prolonged graft survival. Immunosuppression of the recipient directly after transfusion seems to be essential to induce the beneficial effect of blood transfusions. This has been demonstrated for a transfusion of whole blood 14 days before transplantation. A single transfusion of 100 ml of whole blood 14 days before transplantation could effectively prolong graft survival if immunosuppression with azathioprine and prednisone was started on the day of transfusion. No improvement in graft survival has been found with such a transfusion if preoperative immunosuppression has been omitted

  10. Effect of blood transfusions on canine renal allograft survival

    International Nuclear Information System (INIS)

    van der Linden, C.J.; Buurman, W.A.; Vegt, P.A.; Greep, J.M.; Jeekel, J.

    1982-01-01

    In this study significantly prolonged canine renal allograft survival has been demonstrated after transfusion of 100 ml of third-party whole blood given peroperatively. Peroperative transfusions of third-party leukocyte-free blood or pure lymphocyte cell suspensions did not influence graft survival. Furthermore, no improvement in graft survival has been found after a peroperative transfusion of irradiated whole blood (2500 rad). These data suggest that delayed graft rejection after blood transfusions can only be expected after the administration of whole blood. The role of competent lymphocytes in whole blood is questionable, since a transfusion or irradiated whole blood in combination with nonirradiated lymphocytes did not lead to prolonged graft survival. Immunosuppression of the recipient directly after transfusion seems to be essential to induce the beneficial effect of blood transfusions. This has been demonstrated for a transfusion of whole blood 14 days before transplantation. A single transfusion of 100 ml of whole blood 14 days before transplantation could effectively prolong graft survival if immunosuppression with azathioprine and prednisone was started on the day of transfusion. No improvement in graft survival has been found with such a transfusion if preoperative immunosuppression has been omitted

  11. The effect of donor gender on renal allograft survival.

    Science.gov (United States)

    Neugarten, J; Srinivas, T; Tellis, V; Silbiger, S; Greenstein, S

    1996-02-01

    Donor gender plays a role in the outcome of renal transplantation, but the mechanisms responsible for this effect are unclear. In this study, actuarial graft survival in 1049 recipients transplanted at Montefiore Medical Center between 1979 and 1994 was examined. It was found that donor gender had no influence on graft survival in recipients treated with precyclosporine immunosuppressive agents. In contrast, graft survival time was greater in cyclosporine-treated recipients of male donor kidneys compared with female kidneys (p demand results in hyperfiltration-mediated glomerular injury and that this is responsible for reduced survival time of female allografts. Any hypothesis purporting to explain gender-related differences in graft survival time must take into account this study's observations that the donor-gender effect was observed only in cyclosporine-treated recipients, was not seen in African-American donors, appeared soon after renal transplantation, and did not increase progressively with time. These observations are most consistent with the hypothesis that gender-related differences in graft survival time may reflect differences in susceptibility to cyclosporine nephrotoxicity or differences in the therapeutic response to cyclosporine.

  12. Impact of obesity on development of chronic renal allograft dysfunction

    International Nuclear Information System (INIS)

    Jahromi, Alireza Hamidian; Jalali, Ghanbar Ali Raiss; Roozbeh, Jamshid

    2009-01-01

    Obesity in nontransplant patients has been associated with hypertension, hyperlipidemia, diabetes, and proteinuria. To determine whether renal transplant recipients with an elevated BMI have worse long term graft survival, we prospectively studied 92 patients transplanted between April 1999 and July 2000. Weight (Wt) and height of the patients were recorded prior to transplantation and two weeks, one, two and three years post transplantation. Blood urea nitrogen (BUN), creatinine (Cr) and blood pressure were checked monthly, while triglyceride, cholesterol, high density lipoprotein (HDL), and low density lipoprotein (LDL) were obtained 3 monthly for 3 years post transplantation. Graft dysfunction was defined as serum Cr > 1.8 mg/dL. While BMI and Wt of the patients before transplantation did not show any significant correlation with chronic renal allograft dysfunction (CRAD), patients with higher Wt and BMI two weeks after transplantation showed an increased risk of developing CRAD during the three year post transplant independent of other risk factors (P< 0.05). Patients with greater Wt loss in the first two weeks post transplantation showed a decreased risk of developing CRAD in the following 3 years (P< 0.001). Our study suggests that high Wt and BMI are significantly associated with worse graft survival 3 years post renal transplantation. (author)

  13. Restrictive allograft syndrome after lung transplantation: new radiological insights

    Energy Technology Data Exchange (ETDEWEB)

    Dubbeldam, Adriana; Barthels, Caroline; Coolen, Johan; Verschakelen, Johny A.; Wever, Walter de [University Hospitals Leuven, Department of Radiology, Leuven (Belgium); Verleden, Stijn E.; Vos, Robin; Verleden, Geert M. [University Hospitals Leuven, Department of Pneumology, Leuven (Belgium)

    2017-07-15

    To describe the CT changes in patients with restrictive allograft syndrome (RAS) after lung transplantation, before and after clinical diagnosis. This retrospective study included 22 patients with clinical diagnosis of RAS. Diagnosis was based on a combination of forced expiratory volume (FEV1) decline (≥20 %) and total lung capacity (TLC) decline (≥10 %). All available CT scans after transplantation were analyzed for the appearance and evolution of lung abnormalities. In 14 patients, non-regressing nodules and reticulations predominantly affecting the upper lobes developed an average of 13.9 months prior to the diagnosis of RAS. Median graft survival after onset of non-regressing abnormalities was 33.5 months, with most patients in follow-up (9/14). In eight patients, a sudden appearance of diffuse consolidations mainly affecting both upper and lower lobes was seen an average of 2.8 months prior to the diagnosis of RAS. Median graft survival was 6.4 months after first onset of non-regressing abnormalities, with graft loss in most patients (6/8). RAS has been previously described as a homogenous group. However, our study shows two different groups of RAS-patients: one with slow progression and one with fast progression. The two groups show different onset and progression patterns of CT abnormalities. (orig.)

  14. Long term results of total lymphoid irradiation in the treatment of cardiac allograft rejection

    International Nuclear Information System (INIS)

    Wolden, Suzanne L.; Tate, David J.; Hunt, Sharon A.; Strober, Samuel; Hoppe, Richard T.

    1996-01-01

    Purpose: To evaluate the short and long term effects of total lymphoid irradiation (TLI) in the treatment of allograft rejection in cardiac transplant patients. Materials and Methods: From 1986 to 1995, 48 courses of TLI were delivered to 47 patients who had received cardiac transplants at Stanford University. In 38 cases, TLI was administered for chronic, intractable allograft rejection despite conventional anti-rejection therapy, including corticosteroids, azathioprine, cyclosporine, OKT3, DHPG, RATG, and methotrexate. Ten patients received TLI prophylactically, beginning radiation between 5 and 16 days after heart transplantation. The prescribed radiation dose was 800 cGy given in 80 cGy fractions twice weekly to all major lymph node regions using mantle and inverted Y fields. Patients continued to receive all medications except azathioprine which was held during TLI to prevent severe marrow suppression. All patients were closely monitored for episodes of rejection, infection, prednisone requirements, blood counts, and complications of treatment. Post-irradiation follow up ranged from 6 months to 9.1 years with a mean of 3.1 years. Results: The actual mean dose of radiation was 730 cGy delivered over a mean of 39 calendar days. Fifty six percent of patients required treatment delay or abbreviation because of thrombocytopenia, leukopenia, infection, or unrelated problems. In patients treated for intractable rejection, the frequency of rejection dropped from 0.46 episodes/patient/month before radiation to 0.14 episodes/patient/month during TLI (p 3 during TLI (p = 0.01) and remained low at 167.6 cells/mm 3 2-4 months after treatment (p = 0.05). CD8+ lymphocytes also decreased during treatment from 233.2 to 65.8 cells/mm 3 (p = 0.003) but rose significantly above normal to 381.3 cells/mm 3 2-4 months after TLI (p 0.05). Thus, the ratio of helper/suppresser T-cells was chronically decreased. Infection rates were not significantly different before, during or after

  15. Assessment of early renal allograft dysfunction with blood oxygenation level-dependent MRI and diffusion-weighted imaging

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Yoon [Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Chan Kyo, E-mail: chankyokim@skku.edu [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Park, Byung Kwan [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Sung Ju; Lee, Sanghoon [Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Huh, Wooseong [Department of Nephrology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2014-12-15

    Highlights: • R2* and ADC in renal allografts are moderately correlated with eGFR. • R2* and ADC are lower in early allograft dysfunction than normal allograft function. • No significant difference between AR and ATN was found in both R2* and ADC. - Abstract: Purpose: To investigate blood oxygenation level-dependent (BOLD) MRI and diffusion-weighted imaging (DWI) at 3 T for assessment of early renal allograft dysfunction. Materials and methods: 34 patients with a renal allograft (early dysfunction, 24; normal, 10) were prospectively enrolled. BOLD MRI and DWI were performed at 3 T. R2* and apparent diffusion coefficient (ADC) values were measured in cortex and medulla of the allografts. Correlation between R2* or ADC values and estimated glomerular filtration rate (eGFR) was investigated. R2* or ADC values were compared among acute rejection (AR), acute tubular necrosis (ATN) and normal function. Results: In all renal allografts, cortical or medullary R2* and ADC values were moderately correlated with eGFR (P < 0.05). Early dysfunction group showed lower R2* and ADC values than normal function group (P < 0.05). AR or ATN had lower R2* values than normal allografts (P < 0.05), and ARs had lower cortical ADC values than normal allografts (P < 0.05). No significant difference of R2* or ADC values was found between AR and ATN (P > 0.05). Conclusion: BOLD MRI and DWI at 3 T may demonstrate early functional state of renal allografts, but may be limited in characterizing a cause of early renal allograft dysfunction. Further studies are needed.

  16. Proteinuria as a Noninvasive Marker for Renal Allograft Histology and Failure: An Observational Cohort Study

    Science.gov (United States)

    Lerut, Evelyne; Emonds, Marie-Paule; Herelixka, Albert; Evenepoel, Pieter; Claes, Kathleen; Bammens, Bert; Sprangers, Ben; Meijers, Björn; Jochmans, Ina; Monbaliu, Diethard; Pirenne, Jacques; Kuypers, Dirk R.J.

    2016-01-01

    Proteinuria is routinely measured to assess renal allograft status, but the diagnostic and prognostic values of this measurement for renal transplant pathology and outcome remain unclear. We included 1518 renal allograft recipients in this prospective, observational cohort study. All renal allograft biopsy samples with concomitant data on 24-hour proteinuria were included in the analyses (n=2274). Patients were followed for ≥7 years post-transplantation. Compared with proteinuria failure were 1.14 (95% confidence interval [95% CI], 0.81 to 1.60; P=0.50), for proteinuria 0.3–1.0 g/24 h, 2.17 (95% CI, 1.49 to 3.18; P3.0 g/24 h, independent of GFR and allograft histology. The predictive performance of proteinuria for graft failure was lower at 3 months after transplant (area under the receiver-operating characteristic curve [AUC] 0.64, P3 months after transplant (AUC 0.73, P1.0 g/24 h. These data support current clinical guidelines to routinely measure proteinuria after transplant, but illustrate the need for more sensitive biomarkers of allograft injury and prognosis. PMID:26152270

  17. Geographic inequities in liver allograft supply and demand: does it affect patient outcomes?

    Science.gov (United States)

    Rana, Abbas; Kaplan, Bruce; Riaz, Irbaz B; Porubsky, Marian; Habib, Shahid; Rilo, Horacio; Gruessner, Angelika C; Gruessner, Rainer W G

    2015-03-01

    Significant geographic inequities mar the distribution of liver allografts for transplantation. We analyzed the effect of geographic inequities on patient outcomes. During our study period (January 1 through December 31, 2010), 11,244 adult candidates were listed for liver transplantation: 5,285 adult liver allografts became available, and 5,471 adult recipients underwent transplantation. We obtained population data from the 2010 United States Census. To determine the effect of regional supply and demand disparities on patient outcomes, we performed linear regression and multivariate Cox regression analyses. Our proposed disparity metric, the ratio of listed candidates to liver allografts available varied from 1.3 (region 11) to 3.4 (region 1). When that ratio was used as the explanatory variable, the R(2) values for outcome measures were as follows: 1-year waitlist mortality, 0.23 and 1-year posttransplant survival, 0.27. According to our multivariate analysis, the ratio of listed candidates to liver allografts available had a significant effect on waitlist survival (hazards ratio, 1.21; 95% confidence interval, 1.04-1.40) but was not a significant risk factor for posttransplant survival. We found significant differences in liver allograft supply and demand--but these differences had only a modest effect on patient outcomes. Redistricting and allocation-sharing schemes should seek to equalize regional supply and demand rather than attempting to equalize patient outcomes.

  18. Diffusion tensor imaging and tractography for assessment of renal allograft dysfunction - initial results

    Energy Technology Data Exchange (ETDEWEB)

    Hueper, Katja; Gutberlet, M.; Rodt, T.; Wacker, F.; Galanski, M.; Hartung, D. [Institute for Diagnostic and Interventional Radiology, Hannover Medical School - Germany, Hannover (Germany); Gwinner, W. [Clinic for Nephrology, Hannover Medical School - Germany, Hannover (Germany); Lehner, F. [Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School - Germany, Hannover (Germany)

    2011-11-15

    To evaluate MR diffusion tensor imaging (DTI) as non-invasive diagnostic tool for detection of acute and chronic allograft dysfunction and changes of organ microstructure. 15 kidney transplanted patients with allograft dysfunction and 14 healthy volunteers were examined using a fat-saturated echo-planar DTI-sequence at 1.5 T (6 diffusion directions, b = 0, 600 s/mm{sup 2}). Mean apparent diffusion coefficient (ADC) and mean fractional anisotropy (FA) were calculated separately for the cortex and for the medulla and compared between healthy and transplanted kidneys. Furthermore, the correlation between diffusion parameters and estimated GFR was determined. The ADC in the cortex and in the medulla were lower in transplanted than in healthy kidneys (p < 0.01). Differences were more distinct for FA, especially in the renal medulla, with a significant reduction in allografts (p < 0.001). Furthermore, in transplanted patients a correlation between mean FA in the medulla and estimated GFR was observed (r = 0.72, p < 0.01). Tractography visualized changes in renal microstructure in patients with impaired allograft function. Changes in allograft function and microstructure can be detected and quantified using DTI. However, to prove the value of DTI for standard clinical application especially correlation of imaging findings and biopsy results is necessary. (orig.)

  19. Bone grafting in surgery about the foot and ankle: indications and techniques.

    Science.gov (United States)

    Fitzgibbons, Timothy C; Hawks, Michael A; McMullen, Scott T; Inda, David J

    2011-02-01

    Bone grafting is a common procedure in foot and ankle surgery. Historically, autogenous bone graft has most often been harvested from the ipsilateral iliac crest. However, other sites offer similar volumes of cancellous bone and are associated with fewer complications. The ipsilateral proximal tibia, distal tibia, and calcaneus provide adequate amounts of bone graft material for most arthrodesis procedures about the foot and ankle. Emerging techniques have enabled the development of a seemingly unlimited supply of alternative bone graft materials with osteoconductive properties. The osteoprogenitor cells in bone marrow aspirates can be concentrated by use of selective retention systems. These aspirate-matrix composites may be combined with allograft preparations, resulting in a product that promotes osteoconduction, osteoinduction, and osteogenesis with limited morbidity.

  20. Bone Grafts, Substitutes, and Augments in Benign Orthopaedic Conditions Current Concepts.

    Science.gov (United States)

    Blank, Alan; Riesgo, Aldo; Gitelis, Steven; Rapp, Timothy

    2017-04-01

    Musculoskeletal tumors are relatively rare diagnoses made by orthopaedic surgeons. While approximately 2,500 primary bone sarcomas are diagnosed annually in the USA, the number of benign orthopaedic tumors encountered annually is far more difficult to quantify. Some studies have documented between 3% and 10% of the general population having benign bony lesions. Many of these conditions can be simply observed, while others will require surgical intervention. Surgical treatments for benign conditions range from a one-step curettage to extensive resection and reconstruction. With treatment of larger lesions, significant bony defects may need to be addressed surgically. Treatment options have evolved over time with the use of various bone graft and bone void fillers, including methyl methacrylate cement, autograft, allograft bone chips, struts and osteoarticular segments, synthetic bone graft substitutes, and metal augments. This review provides an overview of the present status of bone graft, substitutes, and augment options for the orthopaedic surgeon treating benign musculoskeletal conditions.

  1. Double-chamber rotating bioreactor for dynamic perfusion cell seeding of large-segment tracheal allografts: comparison to conventional static methods.

    Science.gov (United States)

    Haykal, Siba; Salna, Michael; Zhou, Yingzhe; Marcus, Paula; Fatehi, Mostafa; Frost, Geoff; Machuca, Tiago; Hofer, Stefan O P; Waddell, Thomas K

    2014-08-01

    Tracheal transplantation with a long-segment recellularized tracheal allograft has previously been performed without the need for immunosuppressive therapy. Recipients' mesenchymal stromal cells (MSC) and tracheal epithelial cells (TEC) were harvested, cultured, expanded, and seeded on a donor trachea within a bioreactor. Prior techniques used for cellular seeding have involved only static-seeding methods. Here, we describe a novel bioreactor for recellularization of long-segment tracheae. Tracheae were recellularized with epithelial cells on the luminal surface and bone marrow-derived MSC on the external surface. We used dynamic perfusion seeding for both cell types and demonstrate an increase in both cellular counts and homogeneity scores compared with traditional methods. Despite these improvements, orthotopic transplantation of these scaffolds revealed no labeled cells at postoperative day 3 and lack of re-epithelialization within the first 2 weeks. The animals in this study had postoperative respiratory distress and tracheal collapse that was incompatible with life.

  2. Local Tacrolimus (FK506) Delivery for Prevention of Acute Rejection in the Nonhuman Primate Delayed Mixed Chimerism Vascularized Composite Allograft Tolerance Induction Protocol

    Science.gov (United States)

    2016-10-01

    Chimerism Vascularized Composite Allograft Tolerance Induction Protocol PRINCIPAL INVESTIGATORS: Dr. Curtis L. Cetrulo CONTRACTING ORGANIZATION...Tacrolimus (FK506) Delivery for Prevention of Acute Rejection in the Nonhuman Primate Delayed Mixed Chimerism Vascularized Composite Allograft Tolerance...tacrolimus, FK506, vascularized composite allografts, immune rejection, preclinical, transplant, nonhuman primate model, degradable polymer, tyrosine

  3. Evaluation of Posterolateral Lumbar Fusion in Sheep Using Mineral Scaffolds Seeded with Cultured Bone Marrow Cells

    Science.gov (United States)

    Cuenca-López, María D.; Andrades, José A.; Gómez, Santiago; Zamora-Navas, Plácido; Guerado, Enrique; Rubio, Nuria; Blanco, Jerónimo; Becerra, José

    2014-01-01

    The objective of this study is to investigate the efficacy of hybrid constructs in comparison to bone grafts (autograft and allograft) for posterolateral lumbar fusion (PLF) in sheep, instrumented with transpedicular screws and bars. Hybrid constructs using cultured bone marrow (BM) mesenchymal stem cells (MSCs) have shown promising results in several bone healing models. In particular, hybrid constructs made by calcium phosphate-enriched cells have had similar fusion rates to bone autografts in posterolateral lumbar fusion in sheep. In our study, four experimental spinal fusions in two animal groups were compared in sheep: autograft and allograft (reference group), hydroxyapatite scaffold, and hydroxyapatite scaffold seeded with cultured and osteoinduced bone marrow MSCs (hybrid construct). During the last three days of culture, dexamethasone (dex) and beta-glycerophosphate (β-GP) were added to potentiate osteoinduction. The two experimental situations of each group were tested in the same spinal segment (L4–L5). Spinal fusion and bone formation were studied by clinical observation, X-ray, computed tomography (CT), histology, and histomorphometry. Lumbar fusion rates assessed by CT scan and histology were higher for autograft and allograft (70%) than for mineral scaffold alone (22%) and hybrid constructs (35%). The quantity of new bone formation was also higher for the reference group, quite similar in both (autograft and allograft). Although the hybrid scaffold group had a better fusion rate than the non-hybrid scaffold group, the histological analysis revealed no significant differences between them in terms of quantity of bone formation. The histology results suggested that mineral scaffolds were partly resorbed in an early phase, and included in callus tissues. Far from the callus area the hydroxyapatite alone did not generate bone around it, but the hybrid scaffold did. In nude mice, labeled cells were induced to differentiate in vivo and monitored by

  4. Evaluation of Posterolateral Lumbar Fusion in Sheep Using Mineral Scaffolds Seeded with Cultured Bone Marrow Cells

    Directory of Open Access Journals (Sweden)

    María D. Cuenca-López

    2014-12-01

    Full Text Available The objective of this study is to investigate the efficacy of hybrid constructs in comparison to bone grafts (autograft and allograft for posterolateral lumbar fusion (PLF in sheep, instrumented with transpedicular screws and bars. Hybrid constructs using cultured bone marrow (BM mesenchymal stem cells (MSCs have shown promising results in several bone healing models. In particular, hybrid constructs made by calcium phosphate-enriched cells have had similar fusion rates to bone autografts in posterolateral lumbar fusion in sheep. In our study, four experimental spinal fusions in two animal groups were compared in sheep: autograft and allograft (reference group, hydroxyapatite scaffold, and hydroxyapatite scaffold seeded with cultured and osteoinduced bone marrow MSCs (hybrid construct. During the last three days of culture, dexamethasone (dex and beta-glycerophosphate (β-GP were added to potentiate osteoinduction. The two experimental situations of each group were tested in the same spinal segment (L4–L5. Spinal fusion and bone formation were studied by clinical observation, X-ray, computed tomography (CT, histology, and histomorphometry. Lumbar fusion rates assessed by CT scan and histology were higher for autograft and allograft (70% than for mineral scaffold alone (22% and hybrid constructs (35%. The quantity of new bone formation was also higher for the reference group, quite similar in both (autograft and allograft. Although the hybrid scaffold group had a better fusion rate than the non-hybrid scaffold group, the histological analysis revealed no significant differences between them in terms of quantity of bone formation. The histology results suggested that mineral scaffolds were partly resorbed in an early phase, and included in callus tissues. Far from the callus area the hydroxyapatite alone did not generate bone around it, but the hybrid scaffold did. In nude mice, labeled cells were induced to differentiate in vivo and monitored

  5. Macrophage response in experimental third-degree skin burns treated with allograft. Histological and immunohistochemical study.

    Science.gov (United States)

    Popescu, Florina Carmen; Mogoşanu, G D; Busuioc, Cristina Jana; Pârvănescu, H; Lascăr, I; Mogoantă, L

    2012-01-01

    Macrophages are some of the innate immune cells with a central role in inflammatory and immune responses. Studies in the last 20 years have shown that these cells have a particular influence in the reparative processes also. Our aim in this study was to evaluate the macrophage response in third-degree skin burns treated with allograft in an experimental model. Macrophages were specifically highlighted by immunohistochemical staining with anti-CD68 antibody. In the first evolutive part of the reparatory process, macrophages rapidly increased both numerically and as a relative area with about 300%, and then decreased progressively along with the granulation tissue maturation. Macrophage overall response curve was similar in animals treated with allograft and in the control group (untreated), which leads us to believe that the allograft does not induce a more ample immune response that could be regarded as pathological.

  6. Total lymphoid irradiation assessed for possible enhancement of immunosuppression in hyperimmunized dogs receiving renal allografts

    International Nuclear Information System (INIS)

    Sonoda, Kazuhiko; Rapaport, F.T.

    1992-01-01

    With performed antibodies to human leukocyte antigens (HLA) appearing in an increasing number of patients today, hyperimmunization constitutes a major problem in clinical transplantation. In adult beagle dogs hyperimmunized with skin allografts and buffy coat injection, we performed renal allograft transplantation to assess the efficacy of total lymphoid irradiation (TLI) employed as a preoperative measure in combination with cyclosporine (CyA) and methyl-prednisolone (MPL) in effecting immunosuppression. The mean survival period were 6.5 days in dogs withheld preliminary treatment, 9.0 days in the dogs receiving CyA and MPL, 26.7 days in those administered one-stage TLI, and 68 days (terminated by euthanasia) of the dogs given two-stage TLI. TLI administered two stages is considered an effective method of enhancing immunosuppression sufficiently to enable the attenuation of adverse reaction to renal allograft in hyperimmunized recipients. (author)

  7. The Impact of Ventricular Assist Device Prior to Transplantation on Morphological Parameters in Cardiac Allografts

    DEFF Research Database (Denmark)

    Wassilew, Katharina

    2017-01-01

    Due to the shortage of donor organs, mechanical circulatory support systems (MCS) are now widely used as a treatment option to bridge the failing heart to transplantation. There are limited data, suggesting that prolonged use of ventricular assist device (VAD) therapy may result in cardiac...... of the level of macrophages on the degree of IF in right ventricular endomyocardial biopsies (EMBs) of cardiac allografts. Methods: We evaluated all consecutive EMBs of cardiac allografts from 254 patients taken between 01/2011 and 12/2012.With regard to pre-transplant MCS treatment, patients were divided....... The Cochran-Mantel-Haenzsel test was applied to assess significance of the differences in interactions between groups. To evaluate the impact of bridge- to- transplant mechanical circulatory support on development on transplant vasculopathy in cardiac allografts, the intramyocardial terminal arterial network...

  8. Heart Allograft Tolerance Induced and Maintained by Vascularized Hind-Limb Transplant in Rats

    Directory of Open Access Journals (Sweden)

    Quan Liu

    2013-01-01

    Full Text Available Organ/tissue transplantation has become an effective therapy for end-stage diseases. However, immunosuppression after transplantation may cause severe side effects. Donor-specific transplant tolerance was proposed to solve this problem. In this study, we report a novel method for inducing and maintaining heart allograft tolerance rats. First, we induced indefinite vascularized hind-limb allograft survival with a short-term antilymphocyte serum + Cyclosporine A treatment. Peripheral blood chimerism disappeared 6-7 weeks after immunosuppression was withdrawn. Then the recipients accepted secondary donor-strain skin and heart transplantation 200 days following vascularized hind-limb transplantation without any immunosuppression, but rejected third party skin allografts, a status of donor-specific tolerance. The ELISPOT results suggested a mechanism of clone deletion. These findings open new perspectives for the role of vascularized hind-limb transplant in the induction and maintenance of organ transplantation tolerance.

  9. Antibody-engineered nanoparticles selectively inhibit mesenchymal cells isolated from patients with chronic lung allograft dysfunction.

    Science.gov (United States)

    Cova, Emanuela; Colombo, Miriam; Inghilleri, Simona; Morosini, Monica; Miserere, Simona; Peñaranda-Avila, Jesus; Santini, Benedetta; Piloni, Davide; Magni, Sara; Gramatica, Furio; Prosperi, Davide; Meloni, Federica

    2015-01-01

    Chronic lung allograft dysfunction represents the main cause of death after lung transplantation, and so far there is no effective therapy. Mesenchymal cells (MCs) are primarily responsible for fibrous obliteration of small airways typical of chronic lung allograft dysfunction. Here, we engineered gold nanoparticles containing a drug in the hydrophobic section to inhibit MCs, and exposing on the outer hydrophilic surface a monoclonal antibody targeting a MC-specific marker (half-chain gold nanoparticles with everolimus). Half-chain gold nanoparticles with everolimus have been synthesized and incubated with MCs to evaluate the effect on proliferation and apoptosis. Drug-loaded gold nanoparticles coated with the specific antibody were able to inhibit proliferation and induce apoptosis without stimulating an inflammatory response, as assessed by in vitro experiments. These findings demonstrate the effectiveness of our nanoparticles in inhibiting MCs and open new perspectives for a local treatment of chronic lung allograft dysfunction.

  10. Cellular basis for accumulation of In-111-labeled leukocytes and platelets in rejecting cardiac allografts: concise communication

    International Nuclear Information System (INIS)

    Wang, T.S.T.; Oluwole, S.; Fawwaz, R.A.; Wolff, M.; Kuromoto, N.; Satake, K.; Hardy, M.A.; Alderson, P.O.

    1982-01-01

    Biodistribution and imaging studies in rats showed that In-111-labeled leukocytes and platelets accumulate progressively with time after transplantation in cardiac allografts undergoing rejection, but do not accumulate in normal syngeneic heart grafts. Maximum heart allograft-to-blood ratios of 9:1 were obtained, and allograft-to-native heart ratios of 17:1. Microscopic studies of the rejecting cardiac allografts showed that histologic findings paralleled the cellular changes predicted by the radionuclide studies. Intravenously administered Ga-67 citrate and Tc-99m sulfur colloid failed to show significant accumulation in rejecting grafts. The findings suggest that cellular rejection, rather than nonspecific inflammatory changes, is the primary basis for accumulation of In-111 leukocytes and platelets in rejecting cardiac allografts

  11. Cellular basis for accumulation of 111In-labeled leukocytes and platelets in rejecting cardiac allografts: concise communication

    International Nuclear Information System (INIS)

    Wang, T.S.; Oluwole, S.; Fawwaz, R.A.; Wolff, M.; Kuromoto, N.; Satake, K.; Hardy, M.A.; Alderson, P.O.

    1982-01-01

    Biodistribution and imaging studies in rats showed that 111 In-labeled leukocytes and platelets accumulate progressively with time after transplantation in cardiac allografts undergoing rejection, but do not accumulate in normal syngeneic heart grafts. Maximum heart allograft-to-blood ratios of 9:1 were obtained, and allograft-to-native heart ratios of 17:1. Microscopic studies of the rejecting cardiac allografts showed that histologic findings paralleled the cellular changes predicted by the radionuclide studies. Intravenously administered 67 Ga citrate and /sup 99m/Tc sulfur colloid failed to show significant accumulation in rejecting grafts. The findings suggest that cellular rejection, rather than nonspecific inflammatory changes, is the primary basis for accumulation of 111 In leukocytes and platelets in rejecting cardiac allografts

  12. Implante ósseo cortical alógeno conservado em mel na reconstrução de falha óssea diafisária em fêmur de cães: avaliação clínica e radiográfica Honey preserved cortical allografts in the repair of diaphyseal femoral defect in dogs: clinical and radiographic evaluation

    Directory of Open Access Journals (Sweden)

    Marcelo Meller Alievi

    2007-04-01

    Full Text Available Foi realizada falha segmentar de 5cm na região diafisária do fêmur de 14 cães adultos, sendo utilizado implante ósseo cortical alógeno conservado em mel para a sua reconstrução. O implante foi estabilizado no leito receptor por meio de uma placa de compressão dinâmica e oito parafusos corticais. Foram realizadas avaliações clínicas e radiográficas periódicas por até 360 dias. A porcentagem de incorporação das interfaces foi de 79,2%, e o tempo médio necessário para a incorporação foi de 67,1 dias, variando entre 45 e 90 dias. Não foi verificada diferença significativa entre o tempo de incorporação das interfaces proximal e distal. As principais complicações foram não-união, fratura e reabsorção intensa do implante. Apesar das complicações, é possível concluir que o implante ósseo cortical alógeno conservado em mel é opção viável para a reconstrução óssea.Fourteen adult mongrel dogs were used to evaluate the honey preserved cortical allografts in the repair of diaphyseal femoral defect. The allografts were inserted into a 5cm segmental defect created in the mid-diaphysis of the right femur in each dog. The bones were stabilized with a dynamic compression plate and eight bone screws. Healing was followed clinically and femora were evaluated radiographically, periodically. Nineteen (79.2% of the twenty-four host-graft interfaces were radiographically incorporated. Average time to allograft incorporation was 67.1 days (range 45 days to 90 days. There was no statistical difference in the allograft incorporation time between proximal and distal host-graft interfaces. Complications observed were nonunion, allograft fracture, and allograft resorption. The conclusion is that despite the complications, honey preserved cortical allografts are a viable option to bone reconstruction.

  13. Detection and measurement of tubulitis in renal allograft rejection

    Science.gov (United States)

    Hiller, John B.; Chen, Qi; Jin, Jesse S.; Wang, Yung; Yong, James L. C.

    1997-04-01

    Tubulitis is one of the most reliable signs of acute renal allograft rejection. It occurs when mononuclear cells are localized between the lining tubular epithelial cells with or without disruption of the tubular basement membrane. It has been found that tubulitis takes place predominantly in the regions of the distal convoluted tubules and the cortical collecting system. The image processing tasks are to find the tubule boundaries and to find the relative location of the lymphocytes and epithelial cells and tubule boundaries. The requirement for accuracy applies to determining the relative locations of the lymphocytes and the tubule boundaries. This paper will show how the different sizes and grey values of the lymphocytes and epithelial cells simplify their identification and location. Difficulties in finding the tubule boundaries image processing will be illustrated. It will be shown how proximate location of epithelial cells and the tubule boundary leads to distortion in determination of the calculated boundary. However, in tubulitis the lymphocytes and the tubule boundaries are proximate.In these cases the tubule boundary is adequately resolved and the image processing is satisfactory to determining relativity in location. An adaptive non-linear anisotropic diffusion process is presented for image filtering and segmentation. Multi-layer analysis is used to extract lymphocytes and tubulitis from images. This paper will discuss grading of tissue using the Banff system. The ability to use computer to use computer processing will be argued as obviating problems of reproducability of values for this classification. This paper will also feature discussion of alternative approaches to image processing and provide an assessment of their capability for improving the identification of the tubule boundaries.

  14. Renal Allograft Outcome After Simultaneous Heart and Kidney Transplantation.

    Science.gov (United States)

    Grupper, Avishay; Grupper, Ayelet; Daly, Richard C; Pereira, Naveen L; Hathcock, Matthew A; Kremers, Walter K; Cosio, Fernando G; Edwards, Brooks S; Kushwaha, Sudhir S

    2017-08-01

    Chronic kidney disease frequently accompanies end-stage heart failure and may result in consideration of simultaneous heart and kidney transplantation (SHKT). In recent years, there has been a significant increase in SHKT. This single-center cohort consisted of 35 patients who underwent SHKT during 1996 to 2015. The aim of this study was to review factors that may predict better long-term outcome after SKHT. Thirteen patients (37%) had delayed graft function (DGF) after transplant (defined as the need for dialysis during the first 7 days after transplant), which was significantly associated with mechanical circulatory support device therapy and high right ventricular systolic pressure before transplant. Most of the recipients had glomerular filtration rate (GFR) ≥50 ml/min/1.73 m 2 at 1 and 3 years after transplant (21 of 26 [81%] and 20 of 21 [95%], respectively). Higher donor age was associated with reduced 1-year GFR (p = 0.017), and higher recipient pretransplant body mass index was associated with reduced 3-year GFR (p = 0.008). There was a significant association between DGF and reduced median GFR at 1 and 3 years after transplant (p transplant were 97%, 91%, and 86% respectively. In conclusions, our data support good outcomes after SHKT. Mechanical circulatory support device therapy and pulmonary hypertension before transplant are associated with DGF, which is a risk factor for poor long-term renal allograft function. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. B-cell-mediated strategies to fight chronic allograft rejection

    Directory of Open Access Journals (Sweden)

    Ali H Dalloul

    2013-12-01

    allograft rejection.

  16. Asymptomatic Pulmonary Allograft Kaposi Sarcoma: A Case Report.

    Science.gov (United States)

    Nannini, Nazarena; Rebusso, Alessandro; Lunardi, Francesca; Loy, Monica; Calabrese, Francesca; Battistella, Lucia; Schiavon, Marco; Rea, Federico; Calabrese, Fiorella

    2017-08-01

    Solid-organ transplant recipients are at high risk of developing malignancies. A greater risk of Kaposi sarcoma has been reported in lung recipients in our country, particularly in those from Southern Italy, probably due to the high prevalence of Human herpes virus 8 infection. Kaposi sarcoma affecting only the lung allograft is extremely rare. We describe a case of a lung recipient who developed Kaposi sarcoma only in the graft, 22 months after transplant. The patient, a 65-year-old man from Southern Italy, underwent bilateral lung transplant for idiopathic pulmonary fibrosis in January 2009. He developed mild/moderate acute cellular rejection (≥A2) in 4 of 6 scheduled transbronchial biopsies thus was treated with increased immunosuppressive therapy, shifting from cyclosporine to tacrolimus and mycophenolate mofetil. In July 2010, a high-resolution computed tomography scan showed small bilateral lung nodules, despite a generally good condition. After 2 months, his condition worsened with a severe weight loss. A positron emission tomography scan showed mild metabolic activity in the lesions with no other localizations. In October 2010, a lung biopsy was performed, with results showing typical histologic and immunohistochemical features of Kaposi sarcoma. Molecular tissue evaluations and serologic analyses were positive for Human herpes virus 8. The patient's immunosuppressive therapy was suspended, and he started liposomal doxorubicin treatment; however, after the first cycle, he developed severe respiratory dysfunction. The patient died 27 months after lung transplant for neoplasm. Our report highlights the importance of considering Kaposi sarcoma in the differential diagnosis for lung nodules in lung transplant recipients, even in the absence of any initial specific symptom or cutaneous lesion.

  17. T2' imaging of native kidneys and renal allografts. A feasibility study

    International Nuclear Information System (INIS)

    Mathys, C.; Blondin, D.; Wittsack, H.J.; Miese, F.R.; Rybacki, K.; Walther, C.; Holstein, A.; Lanzman, R.S.

    2011-01-01

    Purpose: To evaluate the feasibility of T2' mapping in native kidneys and renal allografts. Materials and Methods: Following approval of the local ethics committee, 24 renal allograft recipients and 10 control subjects (healthy volunteers) were included in this study. Multi-echo T2 and T2 * imaging was performed on a 1.5 Tesla scanner. Allograft recipients were assigned to two groups: group (a), 8 patients with good (glomerular filtration rate of more than 40 ml/min) allograft function and no evidence of transplant rejection, transplant renal artery stenosis or ureteral obstruction; group (b), 16 patients with deterioration of renal graft function (glomerular filtration rate (GFR) of 40 ml/min or less). Two different imaging protocols were tested. Results: The mean T2' relaxation parameters were 108.33 msec ± 13.34, 100.00 msec ± 18.89 and 124.57 msec ± 6.51 for groups (a), (b) and for control subjects, respectively. The reduction of T2' values in patient group (b) was not statistically significant. However, significant correlations could be demonstrated between T2' values and the glomerular filtration rate (GFR) of renal allograft function. The reproducibility was tested and the coefficients of variation of T2' values in the cortex of transplanted kidneys were 11.1 % within subjects and 11.3 % between subjects. Conclusion: Our results indicate that T2' imaging is a promising non-enhanced technique, which seems to reveal information on transplant function. Further studies are required to determine the clinical value of T2' mapping for monitoring renal allograft recipients. (orig.)

  18. T2' imaging of native kidneys and renal allografts. A feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Mathys, C.; Blondin, D.; Wittsack, H.J.; Miese, F.R.; Rybacki, K.; Walther, C.; Holstein, A.; Lanzman, R.S. [Universitaetsklinikum Duesseldorf (Germany). Inst. fuer Radiologie

    2011-02-15

    Purpose: To evaluate the feasibility of T2' mapping in native kidneys and renal allografts. Materials and Methods: Following approval of the local ethics committee, 24 renal allograft recipients and 10 control subjects (healthy volunteers) were included in this study. Multi-echo T2 and T2{sup *} imaging was performed on a 1.5 Tesla scanner. Allograft recipients were assigned to two groups: group (a), 8 patients with good (glomerular filtration rate of more than 40 ml/min) allograft function and no evidence of transplant rejection, transplant renal artery stenosis or ureteral obstruction; group (b), 16 patients with deterioration of renal graft function (glomerular filtration rate (GFR) of 40 ml/min or less). Two different imaging protocols were tested. Results: The mean T2' relaxation parameters were 108.33 msec {+-} 13.34, 100.00 msec {+-} 18.89 and 124.57 msec {+-} 6.51 for groups (a), (b) and for control subjects, respectively. The reduction of T2' values in patient group (b) was not statistically significant. However, significant correlations could be demonstrated between T2' values and the glomerular filtration rate (GFR) of renal allograft function. The reproducibility was tested and the coefficients of variation of T2' values in the cortex of transplanted kidneys were 11.1 % within subjects and 11.3 % between subjects. Conclusion: Our results indicate that T2' imaging is a promising non-enhanced technique, which seems to reveal information on transplant function. Further studies are required to determine the clinical value of T2' mapping for monitoring renal allograft recipients. (orig.)

  19. Pretransplant serum BAFF levels are associated with pretransplant HLA immunization and renal allograft survival.

    Science.gov (United States)

    Friebus-Kardash, Justa; Wilde, Benjamin; Keles, Deniz; Heinold, Andreas; Kribben, Andreas; Witzke, Oliver; Heinemann, Falko Markus; Eisenberger, Ute

    2018-04-01

    The essential function of B cell-activating factor (BAFF) is regulating the survival and differentiation of B cells. The link between pretransplant BAFF levels and pretransplant alloimmunization and its value to predict subsequent acute antibody-mediated rejection (AMR) and outcome after renal transplantation is not fully understood. Objective of our retrospective single-center study was to determine, by ELISA analysis of pretransplant serum BAFF levels in 249 patients undergoing renal transplantation, association between preformed anti-human leukocyte antigen (HLA) antibodies, occurrence of acute antibody mediated rejection (AMR) and renal allograft survival. Pretransplant serum BAFF levels were significantly higher in presensitized recipients with anti-HLA antibodies (3262±2796pg/ml) than in recipients without occurrence of anti-HLA antibodies (2252±1425pg/ml; pBAFF levels correlated with cumulative MFI values of anti-HLA antibodies (r=0.2966, p=0.0025). Patients with high pretransplant BAFF levels (≥2137pg/ml) experienced significantly lower allograft survival rates compared to low pretransplant BAFF levels (80% vs. 91%; p=0.01). Coexistence of high pretransplant BAFF levels and posttransplant AMR was associated with the worst allograft survival rates (56%). Relative risk (RR) for allograft loss was associated with high serum BAFF levels (RR 2.3; p=0.02), presence of anti-HLA antibodies (RR 2.5; p=0.007) or anti-HLA -donor-specific antibodies (DSAs) (RR 2.6; p=0.003) before transplant and AMR post transplant (RR 2.5; p=0.007). AMR was the strongest independent risk factor for allograft failure (RR 2.6; p=0.03). Elevated pretransplant serum BAFF levels negatively affect renal allograft survival and represent a risk factor for allosensitization and subsequent AMR. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Cardiac retransplantation is an efficacious therapy for primary cardiac allograft failure

    Directory of Open Access Journals (Sweden)

    Acker Michael A

    2008-05-01

    Full Text Available Abstract Background Although orthotopic heart transplantation has been an effective treatment for end-stage heart failure, the incidence of allograft failure has increased, necessitating treatment options. Cardiac retransplantation remains the only viable long-term solution for end-stage cardiac allograft failure. Given the limited number of available donor hearts, the long term results of this treatment option need to be evaluated. Methods 709 heart transplants were performed over a 20 year period at our institution. Repeat cardiac transplantation was performed in 15 patients (2.1%. A retrospective analysis was performed to determine the efficacy of cardiac retransplantation. Variables investigated included: 1 yr and 5 yr survival, length of hospitalization, post-operative complications, allograft failure, recipient and donor demographics, renal function, allograft ischemic time, UNOS listing status, blood group, allograft rejection, and hemodynamic function. Results Etiology of primary graft failure included transplant arteriopathy (n = 10, acute rejection (n = 3, hyperacute rejection (n = 1, and a post-transplant diagnosis of metastatic melanoma in the donor (n = 1. Mean age at retransplantation was 45.5 ± 9.7 years. 1 and 5 year survival for retransplantation were 86.6% and 71.4% respectively, as compared to 90.9% and 79.1% for primary transplantation. Mean ejection fraction was 67.3 ± 12.2% at a mean follow-up of 32.6 ± 18.5 mos post-retransplant; follow-up biopsy demonstrated either ISHLT grade 1A or 0 rejection (77.5 ± 95.7 mos post-transplant. Conclusion Cardiac retransplantation is an efficacious treatment strategy for cardiac allograft failure.

  1. Impaired elastin deposition in Fstl1-/- lung allograft under the renal capsule.

    Directory of Open Access Journals (Sweden)

    Yan Geng

    Full Text Available Lung alveolar development in late gestation is a process important to postnatal survival. Follistatin-like 1 (Fstl1 is a matricellular protein of the Bmp antagonist class, which is involved in the differentiation/maturation of alveolar epithelial cells during saccular stage of lung development. This study investigates the role of Fstl1 on elastin deposition in mesenchyme and subsequent secondary septation in the late gestation stage of terminal saccular formation. To this aim, we modified the renal capsule allograft model for lung organ culture by grafting diced E15.5 distal lung underneath the renal capsule of syngeneic host and cultured up to 7 days. The saccular development of the diced lung allografts, as indicated by the morphology, epithelial and vascular developments, occurred in a manner similar to that in utero. Fstl1 deficiency caused atelectatic phenotype companied by impaired epithelial differentiation in D3 Fstl1(-/- lung allografts, which is similar to that of E18.5 Fstl1(-/- lungs, supporting the role of Fstl1 during saccular stage. Inhibition of Bmp signaling by intraperitoneal injection of dorsomorphin in the host mice rescued the pulmonary atelectasis of D3 Fstl1(-/- allografts. Furthermore, a marked reduction in elastin expression and deposition was observed in walls of air sacs of E18.5 Fstl1(-/- lungs and at the tips of the developing alveolar septae of D7 Fstl1(-/- allografts. Thus, in addition to its role on alveolar epithelium, Fstl1 is crucial for elastin expression and deposition in mesenchyme during lung alveologenesis. Our data demonstrates that the modified renal capsule allograft model for lung organ culture is a robust and efficient technique to increase our understanding of saccular stage of lung development.

  2. Comparison of allograft and polyetheretherketone (PEEK) cage subsidence rates in anterior cervical discectomy and fusion (ACDF).

    Science.gov (United States)

    Yson, Sharon C; Sembrano, Jonathan N; Santos, Edward Rainier G

    2017-04-01

    Structural allografts and PEEK cages are commonly used interbody fusion devices in ACDF. The subsidence rates of these two spacers have not yet been directly compared. The primary aim of this study was to compare the subsidence rate of allograft and PEEK cage in ACDF. The secondary aim was to determine if the presence of subsidence affects the clinical outcome. We reviewed 67 cases (117 levels) of ACDF with either structural allograft or PEEK cages. There were 85 levels (48 cases) with PEEK and 32 levels (19 cases) with allograft spacers. Anterior and posterior disc heights at each operative level were measured at immediate and 6months post-op. Subsidence was defined as a decrease in anterior or posterior disc heights >2mm. NDI of the subsidence (SG) and non-subsidence group (NSG) were recorded. Chi-square test was used to analyze subsidence rates. T-test was used to analyze clinical outcomes (α=0.05). There was no statistically significant difference between subsidence rates of the PEEK (29%; 25/85) and allograft group (28%; 9/32) (p=0.69). Overall mean subsidence was 2.3±1.7mm anteriorly and 2.6±1.2mm posteriorly. Mean NDI improvement was 11.7 (from 47.1 to 35.4; average follow-up: 12mos) for the SG and 14.0 (from 45.8 to 31.8; average follow-up: 13mos) for the NSG (p=0.74). Subsidence rate does not seem to be affected by the use of either PEEK or allograft as spacers in ACDF. Furthermore, subsidence alone does not seem to be predictive of clinical outcomes of ACDF. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Longterm renal allograft survival after sequential liver-kidney transplantation from a single living donor.

    Science.gov (United States)

    Kitajima, Kumiko; Ogawa, Yuichi; Miki, Katsuyuki; Kai, Kotaro; Sannomiya, Akihito; Iwadoh, Kazuhiro; Murakami, Toru; Koyama, Ichiro; Nakajima, Ichiro; Fuchinoue, Shohei

    2017-03-01

    Combined liver-kidney transplantation (CLKT) is well established as a definitive therapy with the potential to provide complete recovery for certain liver-kidney diseases, although the results might be contingent on the cause of transplantation. The purposes of the present study were to review the longterm outcome of renal allografts in CLKT patients from single living donors and to investigate the beneficial factors, compared with solitary renal transplantation. Thirteen patients underwent sequential liver transplantation (LT) and kidney transplantation (KT) from single living donors. The indications for KT were oxaluria (n = 7), autosomal recessive polycystic disease (n = 3), and others (n = 3). The same immunosuppressive regimen used after LT was also used after KT. KT was performed between 1.7 and 47.0 months after the LT. The overall patient survival rate was 92.3% at 10 years. In 12 of the 13 surviving patients, the renal allografts were found to be functioning in 11 patients after a mean follow-up period of 103.6 months. The death-censored renal allograft survival rate at 10 years was 100%, which was better than that of KT alone (84.9%) in Japan. Immunological protection conferred by the preceding liver allograft may have contributed to the longterm outcomes of the renal allografts. In addition, the donation of double organs from a single living and related donor may have a favorable impact on the graft survival rate. In the future, investigations of factors affecting the longterm outcome of renal allografts, including details of the involvement of de novo donor-specific antibody, will be needed. Liver Transplantation 23 315-323 2017 AASLD. © 2016 by the American Association for the Study of Liver Diseases.

  4. Percutaneous Method of Management of Simple Bone Cyst

    Directory of Open Access Journals (Sweden)

    O. P. Lakhwani

    2013-01-01

    Full Text Available Introduction. Simple bone cyst or unicameral bone cysts are benign osteolytic lesions seen in metadiaphysis of long bones in growing children. Various treatment modalities with variable outcomes have been described in the literature. The case report illustrates the surgical technique of minimally invasive method of treatment. Case Study. A 14-year-old boy was diagnosed as active simple bone cyst proximal humerus with pathological fracture. The patient was treated by minimally invasive percutaneous curettage with titanium elastic nail (TENS and allogenic bone grafting mixed with bone marrow under image intensifier guidance. Results. Pathological fracture was healed and allograft filled in the cavity was well taken up. The patient achieved full range of motion with successful outcome. Conclusion. Minimally invasive percutaneous method using elastic intramedullary nail gives benefit of curettage cyst decompression and stabilization of fracture. Allogenic bone graft fills the cavity and healing of lesion by osteointegration. This method may be considered with advantage of minimally invasive technique in treatment of benign cystic lesions of bone, and the level of evidence was therapeutic level V.

  5. Successful treatment of verruca vulgaris with Thuja occidentalis in a renal allograft recipient

    Directory of Open Access Journals (Sweden)

    R Joseph

    2013-01-01

    Full Text Available Human papillomavirus-driven verruca vulgaris infection is common in solid organ transplant recipients and increases the risk for squamous cell carcinoma. The available treatment modalities have limited response. We report a renal allograft recipient who presented with multiple warts not responding to cryotherapy and radiosurgery with one turning malignant, needing amputation of the finger. An extract from Thuja occidentalis (White cedar tree cured the resistant warts on the other fingers, leaving only superficial scars and without affecting allograft function. We have reviewed the pharmacological and clinical properties of T. occidentalis.

  6. Long term follow up of pinna reconstruction by costal cartilagenous allograft

    International Nuclear Information System (INIS)

    Chanida Kanchanalarp; Yongyudh Vajaradul

    1999-01-01

    During 1990 to 1998,15 patients underwent pinna reconstruction using costal cartilagenous allografts,10 males, 5 females aged between 13 to 37 years old. The costal cartilages were implanted beneath the post auricular skin. Three months later, the composite cartilage-skin graft was elevated and the other free skin graft was used to reconstruct the pinna. Thirteen out of 15 patients had satisfactory cosmetic and function as usual. Only one cartilagenous graft had necrosis and the other one had infected necrosis after accidental trauma two weeks postoperatively. In conclusion costal cartilagenous allograft is an alternative pinna reconstruction with a good long-term result

  7. Correlation between nuclear perfusion parameters and duplex US indices in the diagnosis of renal allograft rejection

    International Nuclear Information System (INIS)

    Kim, E.E.; Maklad, N.F.; Pjura, G.A.; Lowry, P.A.

    1986-01-01

    Fifty nuclear perfusion and duplex US studies in 30 patients who had received renal allografts were prospectively analyzed to evaluate their respective measures of blood flow as indicators of rejection. The nuclear study (Tc-99m DTPA) generated three parameters, and a real-time, pulsed Doppler sector scanner generated resistance and pulsatility indices. In nine cases with a greater than 70% resistance index and 1.4 pulsatility index on US, the US findings correlated well with changes in nuclear perfusion parameters, indication rejection. The authors conclude that the combination of decreasing nuclear perfusion parameters and positive US indices may obviate the need for biopsy in the diagnosis of allograft rejection

  8. Does allograft failure impact school attendance in children? A NAPRTCS study.

    Science.gov (United States)

    Chen, Ashton; Martz, Karen; Rao, Panduranga

    2012-04-01

    Studies show that adult dialysis patients with allograft failure have increased mortality and morbidity on dialysis compared to transplant naïve patients. We previously showed comparable mortality risk in pediatric dialysis patients after allograft failure compared to transplant naïve patients; the impact on morbidity is less clear. Specifically, the effect of allograft failure on school attendance in pediatric patients has not previously been studied. Using the North American Pediatric Renal Trials and Collaborative Studies database, we compared school attendance between transplant naïve and allograft failure patients from 1 January 1992 to 31 December 2007. School attendance was compared between the two groups at 6 and 12 months after dialysis initiation using a chi-square test. Factors which can potentially impact on school attendance data were evaluated using a multivariate logistic regression analysis. There were 2783 patients who had a follow-up at least 6 months after dialysis initiation and were capable of attending school during the study period. Patients were categorized by transplant history: previous allograft failure (n=576) and transplant naïve (n=2207). At 6 months, full-time school attendance was 67.2% in the allograft failure group and 72.3% in the transplant naïve group (P=0.0164). At 12 months, attendance was 68.6% in the allograft failure group and 72.5% in the transplant naïve group (P=0.103). After covariate adjustment, transplant failure did not impact school attendance at either 6 or 12 months follow-up [hazard ratio (HR) 1.12, confidence interval (CI) 0.91-1.39; HR 0.99, CI 0.78-1.27, respectively]. Children with failed allografts who return to dialysis have comparable school attendance compared to their transplant naïve dialysis counterparts. These results suggest that transplant failure is not an adverse prognostic factor for quality of life as measured by full-time school attendance.

  9. Blockade of Vascular Adhesion Protein-1 Inhibits Lymphocyte Infiltration in Rat Liver Allograft Rejection

    OpenAIRE

    Martelius, Timi; Salaspuro, Ville; Salmi, Marko; Krogerus, Leena; Höckerstedt, Krister; Jalkanen, Sirpa; Lautenschlager, Irmeli

    2004-01-01

    Vascular adhesion protein-1 (VAP-1) has been shown to mediate lymphocyte adhesion to endothelia at sites of inflammation, but its functional role in vivo has not been tested in any rodent model. Here we report the effects of VAP-1 blockade on rat liver allograft rejection. BN recipients of PVG liver allografts (known to develop acute rejection by day 7) were treated with 2 mg/kg anti-VAP-1 (a new anti-rat VAP-1 mAb 174–5) or isotype-matched irrelevant antibody (NS1) every other day (n = 6/gro...

  10. Trimethoprim-sulfamethoxazole induced acute interstitial nephritis in renal allografts; clinical course and outcome.

    LENUS (Irish Health Repository)

    Garvey, J P

    2009-11-01

    Acute interstitial nephritis (AIN) secondary to trimethoprim-sulfamethoxazole (TMP-SMX) is well documented as a cause of acute renal failure in native kidneys. TMP-SMX is the standard prophylactic agent against pneumocystis carinii (PCP) used in the early post-transplant period, however, it has to date only been indirectly associated with AIN in renal allografts. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: We describe eleven renal transplant patients with acute allograft dysfunction in whom a transplant biopsy demonstrated primary histopathologic features of allergic AIN, all of whom were receiving TMP-SMX in addition to other medications known to cause AIN.

  11. Meniscal allograft transplantation. Part 1: systematic review of graft biology, graft shrinkage, graft extrusion, graft sizing, and graft fixation.

    Science.gov (United States)

    Samitier, Gonzalo; Alentorn-Geli, Eduard; Taylor, Dean C; Rill, Brian; Lock, Terrence; Moutzouros, Vasilius; Kolowich, Patricia

    2015-01-01

    To provide a systematic review of the literature regarding five topics in meniscal allograft transplantation: graft biology, shrinkage, extrusion, sizing, and fixation. A systematic literature search was conducted using the PubMed (MEDLINE), ScienceDirect, and EBSCO-CINAHL databases. Articles were classified only in one topic, but information contained could be reported into other topics. Information was classified according to type of study (animal, in vitro human, and in vivo human) and level of evidence (for in vivo human studies). Sixty-two studies were finally included: 30 biology, 3 graft shrinkage, 11 graft extrusion, 17 graft size, and 6 graft fixation (some studies were categorized in more than one topic). These studies corresponded to 22 animal studies, 22 in vitro human studies, and 23 in vivo human studies (7 level II, 10 level III, and 6 level IV). The principal conclusions were as follows: (a) Donor cells decrease after MAT and grafts are repopulated with host cells form synovium; (b) graft preservation alters collagen network (deep freezing) and causes cell apoptosis with loss of viable cells (cryopreservation); (c) graft shrinkage occurs mainly in lyophilized and gamma-irradiated grafts (less with cryopreservation); (d) graft extrusion is common but has no clinical/functional implications; (e) overall, MRI is not superior to plain radiograph for graft sizing; (f) graft width size matching is more important than length size matching; (g) height appears to be the most important factor influencing meniscal size; (h) bone fixation better restores contact mechanics than suture fixation, but there are no differences for pullout strength or functional results; and (i) suture fixation has more risk of graft extrusion compared to bone fixation. Systematic review of level II-IV studies, Level IV.

  12. Long-term results of total lymphoid irradiation in the treatment of cardiac allograft rejection

    International Nuclear Information System (INIS)

    Wolden, Suzanne L.; Tate, David J.; Hunt, Sharon A.; Strober, Samuel; Hoppe, Richard T.

    1997-01-01

    Purpose: To evaluate the short and long-term effects of total lymphoid irradiation (TLI) in the treatment of cardiac transplant rejection. Methods and Materials: Between 1986 and 1995, 48 courses of TLI were delivered to 47 cardiac transplant patients. In 37 patients, TLI was administered for intractable allograft rejection despite conventional therapy while 10 patients received TLI prophylactically. The prescribed radiation dose was 8 Gy in 0.8 Gy fractions twice weekly to mantle and inverted-Y plus spleen fields. Postirradiation follow-up ranged from 6 months to 9.1 years, with a mean of 3.1 years. Results: The actual mean dose was 7.3 Gy delivered over a mean of 39 days. Fifty-six percent of patients required treatment delay or abbreviation because of thrombocytopenia, leukopenia, infection, or unrelated problems. In patients treated for intractable rejection, rejection rates dropped from 0.46 to 0.14 and to 0.06 episodes/patient/month before, during, and after TLI (p < 0.0001). Rejection rates continued to drop throughout follow-up. Prednisone requirements decreased from 0.41 mg/kg before treatment to 0.21 mg/kg afterward (p < 0.0001). The ratio of helper to cytotoxic-suppressor T-cells decreased during TLI from 1.33 to 0.89, and remained low at 0.44, 2-4 months after treatment. Infection rates were not increased and two patients developed malignancy. Rejection rates were high during prophylactic treatment and this protocol was abandoned. Three-year actuarial survival after irradiation was 60% for patients with intractable rejection and 70% for the prophylactic cohort. Conclusion: TLI is an effective treatment for control of intractable cardiac rejection. Episodes of rejection and steroid dosage requirements are decreased for up to 9.1 years. A possible mechanism of action is long term alteration in T-lymphocyte subsets. Patients experience transient bone marrow suppression but no increase in infection or bleeding. Long-term complications of TLI are not

  13. Treatment of a Developmental Groove and Supernumerary Root Using Guided Tissue Regeneration Technique

    Directory of Open Access Journals (Sweden)

    Zahra Alizadeh Tabari

    2016-01-01

    Full Text Available Introduction. The radicular groove is a developmental groove which is usually found on the palatal or lateral aspects of the maxillary incisor teeth. The present case is a maxillary lateral incisor with a small second root and a deep radicular groove. The developmental groove caused a combined periodontal-endodontic lesion. Methods. Case was managed using a combined treatment procedure involving nonsurgical root canal therapy and surgical periodontal treatment. After completion of root canal treatment, guided tissue regeneration (GTR was carried out using decalcified freeze dried bone allograft (DFDBA and a bioabsorbable collagenous membrane. Tooth also was splinted for two months. Results. After 12 months the tooth was asymptomatic. The periapical radiolucency disappeared and probing depth did not exceed 3 mm. Conclusion. Combined treatment procedure involving nonsurgical root canal therapy and surgical periodontal regenerative treatment can be a predictable technique in treating combined endodontic-periodontal lesions caused by radicular groove.

  14. Femoral revision with impaction allografting and an uncemented femoral component

    DEFF Research Database (Denmark)

    Nickelsen, T N; Erenbjerg, M; Retpen, J B

    2008-01-01

    implants 88% had no pain, 10% had slight pain and only 2% had severe pain. Thirty-eight patients had radiographic signs of remodelling of the graft and/or cortical repair. In cases with a successful outcome, the results have been encouraging in relation to clinical performance, regeneration of bone...

  15. Management of metaphyseal bone loss in revision knee arthroplasty.

    Science.gov (United States)

    Mancuso, Francesco; Beltrame, Arianna; Colombo, Elia; Miani, Enrick; Bassini, Fabrizio

    2017-06-07

    Revision total knee arthroplasty (TKA) is usually made more complex by the presence of bone defects, which may be caused by periprosthethic infection, polyethylene wear, implant loosening or fractures. The main aim of the present work is to review the available literature to understand the current options to manage with the bone loss during knee revisions. Available English literature for bone defects in revision TKAs has been evaluated looking at treatment options and their results in terms of clinical and radiological outcomes and failure rates. Anderson Orthopaedic Research Institute (AORI) classification is the most frequently used because it helps in the choice of the most suitable treatment. Several options are available in the management of metaphyseal bone loss in revision knee arthroplasty. For small and contained defects (AORI type 1) cement with or without screws and auto- or allograft morcellized bone are available. In uncontained but mild defects (AORI type 2A) metal augments should be use while large and uncontained defects (AORI type 2B and 3) are best addressed with structural allograft or metal filling devices (cones and sleeves). Stemmed components, either cemented or cementless, are recommended to reduce the strain at the interface implant-host. The treatment of bone defects in revision TKAs has evolved during the last years providing different options with good results at a short/medium term follow up. With the increasing revision burden, further scientific evidence is requested to identify the best approach for each patient. Long-term clinical outcome as well as implant survival after revision TKA are still sub-optimal and depend upon many factors including cause for revision, surgical approach, type of implants used and various patient factors.

  16. Substitutes of structural and non-structural autologous bone grafts in hindfoot arthrodeses and osteotomies: a systematic review.

    Science.gov (United States)

    Müller, Marc Andreas; Frank, Alexander; Briel, Matthias; Valderrabano, Victor; Vavken, Patrick; Entezari, Vahid; Mehrkens, Arne

    2013-02-07

    Structural and non-structural substitutes of autologous bone grafts are frequently used in hindfoot arthrodeses and osteotomies. However, their efficacy is unclear.The primary goal of this systematic review was to compare autologous bone grafts with structural and non-structural substitutes regarding the odds of union in hindfoot arthrodeses and osteotomies. The Medline and EMBASE and Cochrane databases were searched for relevant randomized and non-randomized prospective studies as well as retrospective comparative chart reviews. 10 studies which comprised 928 hindfoot arthrodeses and osteotomies met the inclusion criteria for this systematic review. The quality of the retrieved studies was low due to small samples sizes and confounding variables. The pooled random effect odds for union were 12.8 (95% CI 12.7 to 12.9) for structural allografts, 5.7 (95% CI 5.5 to 6.0) for cortical autologous grafts, 7.3 (95% CI 6.0 to 8.6) for cancellous allografts and 6.0 (95% CI 5.7 to 6.4) for cancellous autologous grafts. In individual studies, the odds of union in hindfoot arthrodeses achieved with cancellous autologous grafts was similar to those achieved with demineralised bone matrix or platelet derived growth factor augmented ceramic granules. Our results suggest an equivalent incorporation of structural allografts as compared to autologous grafts in hindfoot arthrodeses and osteotomies. There is a need for prospective randomized trials to further clarify the role of substitutes of autologous bone grafts in hindfoot surgery.

  17. Allogeneic versus autologous derived cell sources for use in engineered bone-ligament-bone grafts in sheep anterior cruciate ligament repair.

    Science.gov (United States)

    Mahalingam, Vasudevan D; Behbahani-Nejad, Nilofar; Horine, Storm V; Olsen, Tyler J; Smietana, Michael J; Wojtys, Edward M; Wellik, Deneen M; Arruda, Ellen M; Larkin, Lisa M

    2015-03-01

    The use of autografts versus allografts for anterior cruciate ligament (ACL) reconstruction is controversial. The current popular options for ACL reconstruction are patellar tendon or hamstring autografts, yet advances in allograft technologies have made allogeneic grafts a favorable option for repair tissue. Despite this, the mismatched biomechanical properties and risk of osteoarthritis resulting from the current graft technologies have prompted the investigation of new tissue sources for ACL reconstruction. Previous work by our lab has demonstrated that tissue-engineered bone-ligament-bone (BLB) constructs generated from an allogeneic cell source develop structural and functional properties similar to those of native ACL and vascular and neural structures that exceed those of autologous patellar tendon grafts. In this study, we investigated the effectiveness of our tissue-engineered ligament constructs fabricated from autologous versus allogeneic cell sources. Our preliminary results demonstrate that 6 months postimplantation, our tissue-engineered auto- and allogeneic BLB grafts show similar histological and mechanical outcomes indicating that the autologous grafts are a viable option for ACL reconstruction. These data indicate that our tissue-engineered autologous ligament graft could be used in clinical situations where immune rejection and disease transmission may preclude allograft use.

  18. The treatment of peripheral nerve injuries using irradiated allografts and temporary host immunosuppression (in a rat model)

    International Nuclear Information System (INIS)

    Easterling, K.J.; Trumble, T.E.

    1990-01-01

    Irradiation of allografts prior to transplantation and host immunosuppression with cyclosporin-A were studied separately and in combination as means of lessening the rejection of transplanted peripheral nerve tissue. Lewis and Brown Norway rats were used in the animal model, as they differ at both major and minor histocompatibility loci. Sciatic nerve grafts (2.5 cm) were used and the animals were followed for 16 weeks after nerve grafting. The outcome was studied by functional measurements (sensory testing, gait analysis, joint flexion contracture, and muscle weight), as well as by measurements of biochemical and histologic parameters (hydroxyproline concentration and axon counts, respectively). Sensory testing was not reliable because of crossover innervation by the saphenous nerve. Evaluation by standard gait-testing techniques was found to be unsatisfactory. However, the allografted animals receiving cyclosporin-A had significantly smaller flexion contractures, compared to the allografted animals without immunosuppression (17 degrees +/- 12 degrees vs. 44 degrees +/- 13 degrees and 51 degrees +/- 13 degrees, p less than 0.005). Allografted animals receiving short-term cyclosporin-A had contractures that were not significantly different from those seen in isografted control animals (17 degrees +/- 12 degrees vs. 22 degrees +/- 15 degrees, NS). Muscle hydroxyproline concentration analysis revealed a lower hydroxyproline concentration among the allografted groups that received irradiated allografts, compared to groups receiving nonirradiated allogeneic grafts. The studies of muscle hydroxyproline concentration and muscle weight both showed substantial reinnervation, even in allografted animals without pretreatment of the grafts or immunosuppression of the recipient animal

  19. The treatment of peripheral nerve injuries using irradiated allografts and temporary host immunosuppression (in a rat model)

    Energy Technology Data Exchange (ETDEWEB)

    Easterling, K.J.; Trumble, T.E. (Yale Univ. School of Medicine, New Haven, CT (USA))

    1990-10-01

    Irradiation of allografts prior to transplantation and host immunosuppression with cyclosporin-A were studied separately and in combination as means of lessening the rejection of transplanted peripheral nerve tissue. Lewis and Brown Norway rats were used in the animal model, as they differ at both major and minor histocompatibility loci. Sciatic nerve grafts (2.5 cm) were used and the animals were followed for 16 weeks after nerve grafting. The outcome was studied by functional measurements (sensory testing, gait analysis, joint flexion contracture, and muscle weight), as well as by measurements of biochemical and histologic parameters (hydroxyproline concentration and axon counts, respectively). Sensory testing was not reliable because of crossover innervation by the saphenous nerve. Evaluation by standard gait-testing techniques was found to be unsatisfactory. However, the allografted animals receiving cyclosporin-A had significantly smaller flexion contractures, compared to the allografted animals without immunosuppression (17 degrees +/- 12 degrees vs. 44 degrees +/- 13 degrees and 51 degrees +/- 13 degrees, p less than 0.005). Allografted animals receiving short-term cyclosporin-A had contractures that were not significantly different from those seen in isografted control animals (17 degrees +/- 12 degrees vs. 22 degrees +/- 15 degrees, NS). Muscle hydroxyproline concentration analysis revealed a lower hydroxyproline concentration among the allografted groups that received irradiated allografts, compared to groups receiving nonirradiated allogeneic grafts. The studies of muscle hydroxyproline concentration and muscle weight both showed substantial reinnervation, even in allografted animals without pretreatment of the grafts or immunosuppression of the recipient animal.

  20. Successful treatment of early allograft dysfunction with cinacalcet in a patient with nephrocalcinosis caused by severe hyperparathyroidism: a case report.

    Science.gov (United States)

    Cheunsuchon, Boonyarit; Sritippayawan, Suchai

    2017-04-08

    Hyperparathyroidism is common in patients undergoing kidney transplantation. Occasionally, this condition can cause early allograft dysfunction by inducing calcium phosphate deposition in the allograft, which results in nephrocalcinosis. Although nephrocalcinosis occurs occasionally in kidney allografts, it has only rarely been reported in the literature. Here, we present the case of a 58-year-old Thai woman with severe hyperparathyroidism who received a living-related kidney transplant from her 35-year-old son. Our patient developed allograft dysfunction on day 2 post-transplantation despite good functioning graft on day 1. Allograft biopsy showed extensive calcium phosphate deposition in distal tubules. She was treated with cinacalcet (a calcimimetic agent) and aluminum hydroxide. Allograft function was restored to normal within 1 week after transplantation with greatly reduced intact parathyroid hormone level. Hyperparathyroidism in early functioning allograft causes elevated calcium and phosphate concentration in distal tubules resulting in nephrocalcinosis. The massive calcium phosphate precipitation obstructs tubular lumens, which leads to acute tubular dysfunction. Treatment of nephrocalcinosis with cinacalcet is safe and may improve this condition by increasing serum phosphate and reducing serum calcium and intact parathyroid hormone.

  1. Time-dependent changes in B-type natriuretic peptide after heart transplantation: correlation with allograft rejection and function.

    Science.gov (United States)

    Bader, Feras M; Rogers, R Kevin; Kfoury, Abdallah G; Gilbert, Edward M; Horne, Ben D; Stehlik, Josef; Renlund, Dale G

    2009-01-01

    Endomyocardial biopsy is the gold standard to diagnose cardiac allograft rejection, although a noninvasive modality such as brain natriuretic peptide (BNP) is attractive. The authors examined the correlation of BNP levels with rejection patterns and allograft function in cardiac allograft recipients followed up to 8 years. One hundred forty-four consecutive patients underwent endomyocardial biopsy, right heart catheterization, and blood sampling. BNP levels decreased during the first 6 months after transplant but then reached a plateau. Time-dependent correlations were made between BNP levels and allograft rejection, left ventricular ejection fraction, pulmonary capillary wedge pressure, right atrial pressure, and serum creatinine. BNP levels were not different between patients with any rejection pattern and no rejection prior to or after 6 months following transplant. BNP levels did not correlate with ejection fraction, pulmonary capillary wedge pressure, right atrial pressure, or creatinine in the first 6 months after transplant. Statistically significant correlations existed between BNP and these parameters after 6 months following transplant. In cardiac transplant recipients, BNP levels decrease in the first 6 months following transplant and then reach a plateau regardless of the presence, type, or severity of allograft rejection. BNP levels do predict allograft rejection but correlate with allograft function after 6 months following transplant.

  2. Clinical, Histological, and Molecular Markers Associated With Allograft Loss in Transplant Glomerulopathy Patients.

    Science.gov (United States)

    Kamal, Layla; Broin, Pilib Ó; Bao, Yi; Ajaimy, Maria; Lubetzky, Michelle; Gupta, Anjali; de Boccardo, Graciela; Pullman, James; Golden, Aaron; Akalin, Enver

    2015-09-01

    We aimed to investigate the clinical, histopathological, and molecular factors associated with allograft loss in transplant glomerulopathy (TGP) patients. Of the 525 patients who underwent clinically indicated kidney biopsies, 52 (10%) had diagnosis of TGP. Gene expression profiles of 28 TGP and 11 normal transplant kidney biopsy samples were analyzed by Affymetrix HuGene 1.0 ST expression arrays. Over a median follow up of 23 months (1-46 months) after the diagnosis of TGP by biopsy, 17 patients (32%) lost their allografts at a median of 16 months (1-44 months). There was no difference between the 2 groups in terms of any demographic variables, serum creatinine, panel reactive antibody levels, donor-specific antibody frequency, or mean fluorescence intensity values. Patients who lost their allograft had a significantly higher median spot protein to creatinine ratio 2.81 (1.20-6.00) compared to no graft loss patients 1.16 (0.15-2.53), (P TGP patients with allograft loss.

  3. Bioengineering Thymus Organoids to Restore Thymic Function and Induce Donor-Specific Immune Tolerance to Allografts

    Science.gov (United States)

    Fan, Yong; Tajima, Asako; Goh, Saik Kia; Geng, Xuehui; Gualtierotti, Giulio; Grupillo, Maria; Coppola, Antonina; Bertera, Suzanne; Rudert, William A; Banerjee, Ipsita; Bottino, Rita; Trucco, Massimo

    2015-01-01

    One of the major obstacles in organ transplantation is to establish immune tolerance of allografts. Although immunosuppressive drugs can prevent graft rejection to a certain degree, their efficacies are limited, transient, and associated with severe side effects. Induction of thymic central tolerance to allografts remains challenging, largely because of the difficulty of maintaining donor thymic epithelial cells in vitro to allow successful bioengineering. Here, the authors show that three-dimensional scaffolds generated from decellularized mouse thymus can support thymic epithelial cell survival in culture and maintain their unique molecular properties. When transplanted into athymic nude mice, the bioengineered thymus organoids effectively promoted homing of lymphocyte progenitors and supported thymopoiesis. Nude mice transplanted with thymus organoids promptly rejected skin allografts and were able to mount antigen-specific humoral responses against ovalbumin on immunization. Notably, tolerance to skin allografts was achieved by transplanting thymus organoids constructed with either thymic epithelial cells coexpressing both syngeneic and allogenic major histocompatibility complexes, or mixtures of donor and recipient thymic epithelial cells. Our results demonstrate the technical feasibility of restoring thymic function with bioengineered thymus organoids and highlight the clinical implications of this thymus reconstruction technique in organ transplantation and regenerative medicine. PMID:25903472

  4. Comparison of nutritional status in hemodialysis patients with and without failed renal allografts.

    Science.gov (United States)

    Yelken, B M; Gorgulu, N; Caliskan, Y; Yazici, H; Turkmen, A; Yildiz, A; Sever, M S

    2010-01-01

    The survival of patients returning to hemodialysis (HD) following kidney transplant failure is unfavorable. However, the factors responsible for this poor outcome are largely unknown; chronic inflammation due to failed allograft and malnutrition may contribute to morbidity and mortality. We aimed to compare the nutritional status and its relation with inflammation in patients on HD with and without previous kidney transplantation. Forty-three patients with failed renal allografts (27 males; mean age 36±9 yr) and 40 never transplanted HD patients (24 males; mean age 39±9 yr) were included in the study. Body weight, triceps (TSF), biceps (BSF), subscapular (SSSF), and suprailiac skinfold thicknesses (SISF); mid-arm, mid-arm muscle, hip and waist circumferences; as well as body mass indices (BMIs) were determined as anthropometric parameters. Moreover, biochemical markers of nutritional status, including serum cholesterol and albumin as well as high-sensitive C-reactive protein (hs-CRP), as a marker of inflammation, were measured. Associations among these variables were analyzed. There were no significant differences considering age, gender or duration of renal replacement therapy between the two groups. The TSF (pfailed renal allografts were significantly lower than those of the never transplanted HD patients. Waist circumference was significantly lower as well (p=0.028). Patients with failed transplants were characterized by lower serum albumin (pfailed allografts may induce chronic inflammation in chronic HD patients which may result in a worse nutritional status. © 2009 John Wiley & Sons A/S.

  5. Partial trapeziectomy and interposition of fascia lata allograft in the operative treatment of thumb base osteoarthritis

    NARCIS (Netherlands)

    Spaans, Anne J.; Weijns, Marieke E.; Braakenburg, Assa; Van Minnen, Leo Paul; Mink Van Der Molen, Aebele B.

    2016-01-01

    Aim: The purpose of this retrospective cohort study was to evaluate the results of fascia lata allograft interposition after partial trapeziectomy in patients with symptomatic first carpometacarpal joint osteoarthritis. Methods and results: Twenty-one patients (22 thumbs) with Eaton-Glickel stage II

  6. The predictive value of renal vascular resistance for late renal allograft loss

    NARCIS (Netherlands)

    de Vries, APJ; van Son, WJ; van der Heide, JJH; Ploeg, RJ; Navis, G; de Jong, PE; Gans, ROB; Bakker, SJL; Gansevoort, RT

    The renal artery resistance index (RI), assessed by Doppler ultrasonography, was recently identified as a new risk marker for late renal allograft loss. This finding requires confirmation since RI in that study was not measured at predetermined time points and ultrasonography is operator-dependent.

  7. The predictive value of renal vascular resistance for late renal allograft loss

    NARCIS (Netherlands)

    de Vries, A. P. J.; van Son, W. J.; Homan van der Heide, J. J.; Ploeg, R. J.; Navis, G.; de Jong, P. E.; Gans, R. O. B.; Bakker, S. J. L.; Gansevoort, R. T.

    2006-01-01

    The renal artery resistance index (RI), assessed by Doppler ultrasonography, was recently identified as a new risk marker for late renal allograft loss. This finding requires confirmation since RI in that study was not measured at predetermined time points and ultrasonography is operator-dependent.

  8. Sensitivity of scintigraphy with 111In-lymphocytes for detection of cardiac allograft rejection

    International Nuclear Information System (INIS)

    Eisenberg, S.B.; Eisen, H.J.; Sobel, B.E.; Bergmann, S.R.; Bolman, R.M. III

    1988-01-01

    We recently demonstrated the feasibility of noninvasive detection of cardiac allograft rejection after administration of indium-111-labeled lymphocytes. To determine the sensitivity and specificity of the technique, as well as its value for delineating the severity of rejection, we studied 16 dogs with heterotopic thoracic cardiac allografts. Five animals were evaluated while exposed to immunosuppressive agents. Animals were scanned sequentially after administration of 100-400 microCi of indium-111-labeled autologous lymphocytes. Myocardial lymphocyte infiltration was expressed as the indium excess (IE), defined as the ratio of indium activity of the transplant or native heart compared with that in blood. Scintigraphic results were compared with characteristics of simultaneously obtained endomyocardial biopsies. Among 17 biopsy documented episodes of rejection, 16 were detected scintigraphically. Among 18 biopsies with no evidence of rejection, scintigraphy was uniformly negative. Thus, the sensitivity and specificity of scintigraphy were 94 and 100%, respectively. Biopsies graded as showing no rejection were associated with an IE of 0.3 +/- 0.5 (+/- SD); those graded as mild, 2.8 +/- 1.7; those as moderate, 10.7 +/- 7.2; and those graded as indicative of severe rejection, 14.2 +/- 4.5. Thus, scintigraphy with indium-111-labeled lymphocytes sensitively and specifically detects cardiac allograft rejection and delineates the intensity of the rejection process. It should be useful clinically for assessing potential allograft rejection noninvasively

  9. PD-L1 Deficiency within Islets Reduces Allograft Survival in Mice.

    Directory of Open Access Journals (Sweden)

    Dongxia Ma

    Full Text Available Islet transplantation may potentially cure type 1 diabetes mellitus (T1DM. However, immune rejection, especially that induced by the alloreactive T-cell response, remains a restraining factor for the long-term survival of grafted islets. Programmed death ligand-1 (PD-L1 is a negative costimulatory molecule. PD-L1 deficiency within the donor heart accelerates allograft rejection. Here, we investigate whether PD-L1 deficiency in donor islets reduces allograft survival time.Glucose Stimulation Assays were performed to evaluate whether PD-L1 deficiency has detrimental effects on islet function. Islets isolated from PDL1-deficient mice or wild- type (WT mice (C57BL/6j were implanted beneath the renal capsule of streptozotocin (STZ-induced diabetic BALB/c mice. Blood glucose levels and graft survival time after transplantation were monitored. Moreover, we analyzed the residual islets, infiltrating immune cells and alloreactive cells from the recipients.PD-L1 deficiency within islets does not affect islet function. However, islet PD-L1 deficiency increased allograft rejection and was associated with enhanced inflammatory cell infiltration and recipient T-cell alloreactivity.This is the first report to demonstrate that PD-L1 deficiency accelerated islet allograft rejection and regulated recipient alloimmune responses.

  10. One-stage human acellular nerve allograft reconstruction for digital nerve defects

    Directory of Open Access Journals (Sweden)

    Xue-yuan Li

    2015-01-01

    Full Text Available Human acellular nerve allografts have a wide range of donor origin and can effectively avoid nerve injury in the donor area. Very little is known about one-stage reconstruction of digital nerve defects. The present study observed the feasibility and effectiveness of human acellular nerve allograft in the reconstruction of < 5-cm digital nerve defects within 6 hours after injury. A total of 15 cases of nerve injury, combined with nerve defects in 18 digits from the Department of Emergency were enrolled in this study. After debridement, digital nerves were reconstructed using human acellular nerve allografts. The patients were followed up for 6-24 months after reconstruction. Mackinnon-Dellon static two-point discrimination results showed excellent and good rates of 89%. Semmes-Weinstein monofilament test demonstrated that light touch was normal, with an obvious improvement rate of 78%. These findings confirmed that human acellular nerve allograft for one-stage reconstruction of digital nerve defect after hand injury is feasible, which provides a novel trend for peripheral nerve reconstruction.

  11. A new in vitro approach to determine acquired tolerance in long-term kidney allograft recipients

    International Nuclear Information System (INIS)

    Reinsmoen, N.L.; Kaufman, D.; Matas, A.; Sutherland, D.E.; Najarian, J.S.; Bach, F.H.

    1990-01-01

    Previous studies indicate some kidney allograft recipients treated with total lymphoid irradiation, cyclosporine, or conventional immunosuppressive therapy demonstrate specific proliferative unresponsiveness in mixed lymphocyte culture (MLC) to donor cells at various times posttransplant. To investigate possible donor-specific hyporeactivity, we have studied 3 patients treated with TLI whose grafts have survived longer than 10 years; 2 patients given the same immunosuppressive protocol but without TLI whose grafts have survived longer than 10 years; and 27 CsA-treated living-related donor and cadaver-allograft recipients 1 year posttransplant. We confirmed previous observations of hyporeactivity of some patients' cells to stimulation by donor cells. In addition, we identified hyporeactivity to stimulation by homozygous typing cells (HTCs) defining the HLA-Dw specificities of the donor cells for all 3 of the 3 TLI patients, 1 of the 2 non-TLI patients, and 9 of the 27 patients 1 year posttransplant. The LRD recipients with donor-specific hyporeactivity as defined by the HTC analysis demonstrated fewer rejection episodes (25% vs. 57%) and lower mean creatinine levels (1.18 vs 1.78 mg/dL) than patients without donor-specific hyporeactivity. These studies demonstrate the feasibility of monitoring the immune status of allograft recipients posttransplant by means of HTC analysis, eliminating the need for pretransplant specimens. This approach provides a possible means to assess which patients may have acquired donor-specific hyporeactivity to their kidney allograft and thus may require less immunosuppression

  12. Rejection of stable cultured allografts by active or passive (adoptive) immunization.

    OpenAIRE

    Vesole, D H; Dart, G A; Talmage, D W

    1982-01-01

    Injection of live lymphoid cells of donor strain or immune cells of recipient strain resulted in rejection of previously stable cultured mouse thyroid allografts. The results are interpreted to indicate that a cultured graft is relatively ineffective in activating recipient lymphocytes but is capable of maintaining them in an activated state and serving as a target for them once they are activated.

  13. Tissue Augmentation with Allograft Adipose Matrix For the Diabetic Foot in Remission

    Directory of Open Access Journals (Sweden)

    Tala B. Shahin, BS

    2017-10-01

    Conclusion:. The results from this preliminary experience suggest that allograft adipose matrix delivered to the high risk diabetic foot may have promise in reducing tissue stress over pre- and postulcerative lesions. This may ultimately assist the clinician in extending ulcer-free days for patients in diabetic foot remission.

  14. Stress Altered Stem Cells with Decellularized Allograft to Improve Rate of Nerve Regeneration

    Science.gov (United States)

    2015-12-01

    of the cellular elements normally present in peripheral nerve . 2. KEYWORDS: peripheral nerve repair , nerve injury , decellularized nerve ... nerve regeneration. The slow rate of nerve re generation in limbs results in poor prognosis for patients suffering from severe injuries , leading to...allograft, neural regeneration, stem cells, stress altered cells, peripheral nerve injury model, nerve graft 3 This comprehensive final report summarizes

  15. CT perfusion technique for assessment of early kidney allograft dysfunction: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Helck, A.; Notohamiprodjo, M.; Schoen, F.; Nikolaou, K.; Clevert, D.A.; Reiser, M.; Becker, C. [Ludwig-Maximilians-University of Munich, Department of Clinical Radiology, University Hospitals Grosshadern, Munich (Germany); Wessely, M.; Schoenermarck, U.; Fischereder, M. [Ludwig-Maximilians-University of Munich, Department of Internal Medicine IV, Nephrology, University Hospitals Grosshadern, Munich (Germany); Klotz, E. [Siemens Healthcare, Computed Tomography, Forchheim (Germany)

    2013-09-15

    To assess the benefit of quantitative computed tomography (CT) perfusion for differentiating acute tubular necrosis (ATN) and acute rejection (AR) in kidney allografts. Twenty-two patients with acute kidney allograft dysfunction caused by either AR (n = 6) or ATN (n = 16) were retrospectively included in the study. All patients initially underwent a multiphase CT angiography (CTA) protocol (12 phases, one phase every 3.5 s) covering the whole graft to exclude acute postoperative complications. Multiphase CT dataset and dedicated software were used to calculate renal blood flow. Renal biopsy or clinical course of disease served as the standard of reference. Mean effective radiation dose and mean amount of contrast media were calculated. Renal blood flow values were significantly lower (P = 0.001) in allografts undergoing AR (48.3 {+-} 21 ml/100 ml/min) compared with those with ATN (77.5 {+-} 21 ml/100 ml/min). No significant difference (P = 0.71) was observed regarding creatinine level with 5.65 {+-} 3.1 mg/dl in AR and 5.3 {+-} 1.9 mg/dl in ATN. The mean effective radiation dose of the CT perfusion protocol was 13.6 {+-} 5.2 mSv; the mean amount of contrast media applied was 34.5 {+-} 5.1 ml. All examinations were performed without complications. CT perfusion of kidney allografts may help to differentiate between ATN and rejection. (orig.)

  16. Selective lymphoid irradiation: III. Prolongation of cardiac xenografts and allografts in presensitized rats

    International Nuclear Information System (INIS)

    Hardy, M.A.; Oluwole, S.; Fawwaz, R.; Satake, K.; Nowygrod, R.; Reemtsma, K.

    1982-01-01

    Selective lymphoid irradiation (SLI) with palladium-109-hematoporphyrin (Pd-H) combined with antilymphocyte globulin (ALG) induces either donor-specific permanent rat heart allograft acceptance or significant allograft prolongation depending on the degree of donor-recipient matching. The purpose of this study was to determine if SLI combined with ALG can affect ACI heart allograft survival in Lewis recipients presensitized to ACI, and of hamster heart xenografts of Lewis rats. SLI combined with ALG delays allograft and xenograft rejection in the presence of induced or preformed antidonor antibodies, and converts primarily a humoral rejection into a cellular rejection by mechanisms as yet uncertain. Such peritransplant treatment had significant effect on the levels of antidonor complement-dependent cytotoxic antibody titers but did not correlate directly with graft survival. Histological analysis of rejected hearts in all groups demonstrated primarily a humoral hyperacute rejection in control animals and in recipients treated with ALG alone, while peritransplant treatment with Pd-H and ALG resulted not only in prolonged graft survival but histologically, primarily a cellular rejection of the graft

  17. Osteochondral allograft transplantation in the ankle: a review of current practice

    Directory of Open Access Journals (Sweden)

    Fuchs DJ

    2015-08-01

    Full Text Available Daniel J Fuchs, Anish R Kadakia Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Northwestern University, Chicago, IL, USA Abstract: Osteochondral allograft transplantation is a technique that was first developed to treat cartilage pathology in the knee. Over the past 15 years, this technology has been translated to the treatment of osteochondral lesions and end-stage arthritis of the ankle. For osteochondral lesions of the talus or the tibia, a fresh osteochondral allograft transplant can be fashioned to match a specific defect and is useful for large, cystic or uncontained lesions. For a young patient with end-stage arthritis, bipolar fresh osteochondral allograft transplantation is a treatment alternative to ankle arthrodesis. Evidence for these operations is limited and consists primarily of case series, which have reported variable rates of success and in some cases high rates of complications and reoperations. Nevertheless, these techniques continue to evolve and should be considered as options for patients with certain conditions that are particularly challenging to treat. Keywords: osteochondral, osteochondritis, allograft, lesion, talus, graft

  18. Comparative immunohistologic studies in an adoptive transfer model of acute rat cardiac allograft rejection

    International Nuclear Information System (INIS)

    Forbes, R.D.; Lowry, R.P.; Gomersall, M.; Blackburn, J.

    1985-01-01

    It has been shown that fulminant acute rejection of rat cardiac allografts across a full haplotype disparity may occur as a direct result of adoptive transfer of sensitized W3/25+ MRC OX8- SIg- T helper/DTH syngeneic spleen cells to sublethally irradiated recipients. In order to establish the immunohistologic parameters of this form of rejection, allografts and recipient lymphoid tissue were analyzed using a panel of monoclonal antibodies of known cellular distribution. These data were compared with those obtained following reconstitution of irradiated allograft recipients with unseparated sensitized spleen cells, with unreconstituted irradiated donor recipient pairs, with unmodified first-set rejection, and with induced myocardial infarction of syngeneic heart grafts transplanted to normal and to sublethally irradiated recipients. Rejecting cardiac allografts transplanted to all reconstituted irradiated recipients were characterized by extensive infiltration with MRC OX8+ (T cytotoxic-suppressor, natural killer) cells even when this subset was virtually excluded from the reconstituting inocula. A similar proportional accumulation of MRC OX8+ cells observed at the infarct margins of syngeneic heart grafts transplanted to irradiated unreconstituted recipients greatly exceeded that present in normal nonirradiated controls. These data provide evidence that under conditions of heavy recipient irradiation, MRC OX8+ cells may be sequestered within heart grafts in response to nonspecific injury unrelated to the rejection process

  19. Induction of allogeneic unresponsiveness by supralethal irradiation and bone marrow reconstitution. [Dogs

    Energy Technology Data Exchange (ETDEWEB)

    Rapaport, F.T.; Bachvaroff, R.J.; Akiyama, N.; Sato, T.

    1980-09-01

    Supralethally irradiated dogs were reconstituted wth their own stored bone marrow and were challenged at various time intervals with a kidney allograft. The data suggest that transplanted bone marrow cells may participate directly in the events leading to allogenic unresponsiveness. The time interval between marrow cell replacement and kidney allotransplantation required for optimal results suggest that at least one cycle of cell turnover by the replaced stem cells is needed in order to produce unresponsiveness. Host irradiation and reconstitution with stored autologous marrow may be useful in the treatment of certain forms of cancer.

  20. Clinical outcome of narrow diameter implants inserted into allografts

    Directory of Open Access Journals (Sweden)

    Maurizio Franco

    2009-08-01

    Full Text Available OBJECTIVE: Narrow diameter implants (NDI (i.e. diameter <3.75 mm are a potential solution for specific clinical situations, such as reduced interradicular bone, thin alveolar crest and replacement of teeth with small cervical diameter. NDI have been available in clinical practice since the 1990s, but only few studies have analyzed their clinical outcome and no study have investigated NDI inserted in fresh-frozen bone (FFB grafts. Thus, a retrospective study on a series of NDI placed in homologue FFB was designed to evaluate their clinical outcome. MATERIAL AND METHODS: In the period between December 2003 and December 2006, 36 patients (22 females and 14 males, mean age 53 years with FFB grafts were selected and 94 different NDI were inserted. The mean follow-up was 25 months. To evaluate the effect of several host-, surgery-, and implant-related factors, marginal bone loss (MBL was considered an indicator of success rate (SCR. The Kaplan Meier algorithm and Cox regression were used. RESULTS: Only 5 out of 94 implants were lost (i.e. survival rate - SVR 95.7% and no differences were detected among the studied variables. On the contrary, the Cox regression showed that the graft site (i.e. maxilla reduced MBL. CONCLUSIONS: NDI inserted in FFB have a high SVR and SCR similar to those reported in previous studies on regular and NDI inserted in non-grafted jaws. Homologue FFB is a valuable material in the insertion of NDI.

  1. Histological and immunohistochemical study of cutaneous angiogenesis process in experimental third-degree skin burns treated with allograft.

    Science.gov (United States)

    Busuioc, Cristina Jana; Popescu, Florina Carmen; Mogoşanu, G D; Pârvănescu, H; Streba, Liliana; Mogoantă, L

    2012-01-01

    Skin burns are a rather high incidence lesions which, depending on their depth and extension, can severely affect not only the skin but the entire organism. Third-degree skin burns extended on over 20% of the body surface often require skin graft. Skin allograft is a therapeutic alternative when autograft cannot be used. We investigated the allograft influence on the angiogenesis process in third-degree skin burns, using an experimental model. We noticed that the allograft induces a stronger inflammatory reaction associated with intense angiogenesis process by about 10-15% compared to control group.

  2. Outcomes of Latarjet Versus Distal Tibia Allograft for Anterior Shoulder Instability Repair: A Matched Cohort Analysis.

    Science.gov (United States)

    Frank, Rachel M; Romeo, Anthony A; Richardson, Catherine; Sumner, Shelby; Verma, Nikhil N; Cole, Brian J; Nicholson, Gregory P; Provencher, Matthew T

    2018-04-01

    Anterior glenoid reconstruction with fresh distal tibia allograft (DTA) has been described for management of recurrent shoulder instability, with encouraging early outcomes; however, no comparative data with the Latarjet procedure are available. The purpose of this study was to compare the clinical outcomes between patients undergoing DTA and a matched cohort of patients undergoing Latarjet. Cohort study; Level of evidence, 3. A review was conducted of prospectively collected data for patients with a minimum 15% anterior glenoid bone loss who underwent shoulder stabilization via either the DTA or Latarjet procedure and had a minimum follow-up of 2 years. Consecutive patients undergoing DTA were matched in a 1-to-1 format to patients undergoing Latarjet by age, body mass index, history of contact sports, and number of previous shoulder operations. Patients were evaluated pre- and postoperatively with a physical examination and the following outcome assessments: Simple Shoulder Test, visual analog scale, American Shoulder and Elbow Surgeons, Western Ontario Shoulder Instability Index, and Single Assessment Numeric Evaluation. Complications, reoperations, and episodes of recurrent instability were analyzed. Statistical analysis was performed with Student t tests, with P Latarjet, 50 DTA) with a mean ± SD age of 25.6 ± 6.1 years were analyzed at 45 ± 20 months (range, 24-111) after surgery. Thirty-two patients (64%) in each group underwent prior ipsilateral shoulder surgery (range, 1-3). Patients undergoing DTA had significantly greater glenoid bone loss defects when compared with patients undergoing Latarjet (28.6% ± 7.4% vs 22.4% ± 10.3%, P = .001). Patients in both groups experienced significant improvements in all outcome scores after surgery ( P Latarjet and DTA groups: visual analog scale (0.67 ± 0.97 vs 1.83 ± 2.31), American Shoulder and Elbow Surgeons (91.06 ± 8.78 vs 89.74 ± 12.66), Western Ontario Shoulder Instability Index (74.30 ± 21.84 vs 89

  3. Influence of socioeconomic status on allograft and patient survival following kidney transplantation.

    Science.gov (United States)

    Ward, Frank L; O'Kelly, Patrick; Donohue, Fionnuala; ÓhAiseadha, Coilin; Haase, Trutz; Pratschke, Jonathan; deFreitas, Declan G; Johnson, Howard; Conlon, Peter J; O'Seaghdha, Conall M

    2015-06-01

    Whether socioeconomic status confers worse outcomes after kidney transplantation is unknown. Its influence on allograft and patient survival following kidney transplantation in Ireland was examined. A retrospective, observational cohort study of adult deceased-donor first kidney transplant recipients from 1990 to 2009 was performed. Those with a valid Irish postal address were assigned a socioeconomic status score based on the Pobal Hasse-Pratschke deprivation index and compared in quartiles. Cox proportional hazards models and Kaplan-Meier survival analysis were used to investigate any significant association of socioeconomic status with patient and allograft outcomes. A total of 1944 eligible kidney transplant recipients were identified. The median follow-up time was 8.2 years (interquartile range 4.4-13.3 years). Socioeconomic status was not associated with uncensored or death-censored allograft survival (hazard ratio (HR) 1.0, 95% confidence interval (CI) 0.99-1.00, P = 0.33 and HR 1.0, 95% CI 0.99-1.00, P = 0.37, respectively). Patient survival was not associated with socioeconomic status quartile (HR 1.0, 95% CI 0.93-1.08, P = 0.88). There was no significant difference among quartiles for uncensored or death-censored allograft survival at 5 and 10 years. There was no socioeconomic disparity in allograft or patient outcomes following kidney transplantation, which may be partly attributable to the Irish healthcare model. This may give further impetus to calls in other jurisdictions for universal healthcare and medication coverage for kidney transplant recipients. © 2015 Asian Pacific Society of Nephrology.

  4. Diagnostic significance of semiquantitative and quantitative parameters of Tc99m-Ethylenedicystine renal allograft scintigraphy.

    Science.gov (United States)

    Barai, Sukanta; Kumar, Rakesh; Mehta, Sada Nand; Dinda, Amit Kumar; Yadav, Rajiv; Bandopadhayaya, Guru Pada; Tarun, Singhal; Malhotra, Arun

    2003-01-01

    No objective parameters for renal allograft evaluation have yet been described for Tc99m-Ethylenedicystine. This study evaluates the diagnostic significance of different quantitative and semi-quantitative parameters of renal allograft scintigraphy using Tc99m-Ethylenedicystine. A total of 72 renal dynamic scintigraphic studies were performed within 2-weeks of renal transplantation in 42 patients. The graft perfusion, kidney/aorta ratio, washout index and retention index were derived from all studies. All these parameters were evaluated for their ability to distinguish between a normal graft, a graft with acute rejection (AR), and a graft with acute tubular necrosis (ATN). Histopathological verification of diagnosis was obtained in all cases. Studies were subdivided into 3 groups according to histopathological findings: acute rejection (n = 42), normal (n = 18) and acute tubular necrosis (n = 12). Normal allografts were visualized with in 2.66 +/- 0.59 seconds of visualization of abdominal aorta. The K/A ratio, wash out index and retention index was 15.22 +/- 6.86, 1.67 +/- 0.45, and 5.48 +/- 0.98 respectively. Allografts with ATN were visualized with in 3.36 +/- 0.80 seconds of visualization of abdominal aorta. The K/A ratio, wash out index and retention index was 12.73 +/- 6.74, 0.60 +/- 0.14, and 9.18 +/- 1.48 respectively. In AR, allografts were visualized 15.18 +/- 9.48 seconds after visualization of abdominal aorta. The K/A ratio, wash out index and retention index was 7.07 +/- 2.15, 0.63 +/- 0.11, and 2.26 +/- 1.28 respectively. Retention index can separate all the three condition of normal, acute rejection and acute tubular necrosis from each other. Retention index of or = 7 is suggestive of acute tubular necrosis. However, perfusion, K/A ratio and washout index can not segregate all the three groups.

  5. Effect of 34 kinds of traditional Japanese herbal medicines on prolongation of cardiac allograft survival.

    Science.gov (United States)

    Jin, X; Uchiyama, M; Zhang, Q; Harada, T; Otsuka, K; Shimokawa, T; Niimi, M

    2014-05-01

    Herbal medicines have been used for over 3,000 years in Asian as alternative therapy for their variety effects and have recently become popular in Europe and the United States. In the last 30 years, Japanese herbal medicines were widely used for treatment of diseases after been recognized officially by Japanese government. In this study, we investigated the effect of 34 kinds of traditional Japanese herbal medicines on alloimmune responses in a murine model of cardiac allograft transplantation. CBA mice (H2(k)) underwent transplantation of a C57BL/6 (H2(b)) heart and received oral administration of 2 g/kg/d of the 34 kinds of herbal medicines from the day of transplantation until 7 days afterward. Naïve CBA mice rejected B6 cardiac grafts acutely (median survival time [MST], 7 days). CBA transplant recipients given 2 g/kg/d of Sairei-to (TJ-114) and Tokishakuyaku-san (TJ-23) had prolonged C57BL/6 allograft survival indefinitely (both MSTs > 100 days). Moreover, CBA transplant recipients given Seisinrensiin (TJ-111), Tokishigyakukagoshuyushokyoto (TJ-38), Rikkunshito (TJ-43), Maobushisaishinto (TJ-127), Ninjin-yoei-to (TJ-108), Ryokan-kyomi-shinge-nin-to (TJ-119), Inchingorei-san (TJ-117), Hochuekkito (TJ-41), Kihi-to (TJ-65), and Sinbu-to (TJ-30) had also prolonged C57BL/6 allograft survival significantly (MSTs of 28, 22, 16, 14, 14, 13, 12, 9.5, 9 and 9 days, respectively). However, none of other 22 kinds of herbal medicines could prolong the allograft survival. Furthermore, oral administration of 2 g/kg/d of Daikenchuto (TJ-100) induced sudden death (within 1 minute) in CBA mice. In conclusion, 12 kinds of Japanese herbal medicines prolonged allograft survival and one showed toxic effect in mice. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Broken bone

    Science.gov (United States)

    ... Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Broken bone URL of this page: //medlineplus.gov/ency/ ... following steps to reduce your risk of a broken bone: Wear protective ... pads. Create a safe home for young children. Place a gate at stairways ...

  7. Preservation of posterior mandibular extraction site with allogeneic demineralized, freeze-dried bone matrix and calcium sulphate graft binder before eventual implant placement: a case series.

    Science.gov (United States)

    Almasri, Mazen; Camarda, Aldo-Joseph; Ciaburro, Hugo; Chouikh, Fairouz; Dorismond, Sarah-Jane

    2012-01-01

    This case series reports short- and long-term healing, before and after placement of an implant, in posterior mandibular extraction sites grafted with demineralized, freeze-dried bone matrix (DFDBM) allograft mixed with calcium sulphate graft binder. Three patients who underwent surgical extraction of a posterior mandibular molar experienced partial loss of the buccal bone plate at the extraction site. Alveolar bone reconstruction with a DFDBM allograft mixed with calcium sulphate graft binder was performed immediately. The graft was covered with a biodegradable regenerative membrane. For each of the 3 patients, the implant and healing abutment were placed after 6, 9 and 12 months, respectively, followed by crown placement 3, 5 and 5 months later, respectively. The implants were periodically re-evaluated, both clinically and radiographically, between 10 and 39 months after final insertion of the crown. An implant stability device was used to evaluate the long-term biological and functional stability of the implants. Upon exposure and implant placement, the grafted alveolar ridge in all patients presented appropriately sized, dense and well-vascularized bone, wide enough to receive the planned wide-platform implant. The long-term interface stability quotient ranged from 87 to 90. Posterior mandibular extraction sites with compromised buccal alveolar bone may be effectively managed by immediate alveolar augmentation using a mixture of DFDBM allograft and calcium sulphate graft binder. This approach provides ideal alveolar form and consistency for eventual placement of the implant.

  8. Metabolic syndrome is associated with impaired long-term renal allograft function; not all component criteria contribute equally

    NARCIS (Netherlands)

    de Vries, APJ; Bakker, SJL; van Son, WJ; van der Heide, JJH; Ploeg, RJ; The, HT; de Jong, PE; Gans, ROB

    2004-01-01

    Chronic renal transplant dysfunction (CRTD) remains a leading cause of renal allograft loss. Evidence suggests that immunological and ischemic insults are mainly associated with CRTD occurring within the first year after transplantation, whereas nonimmunological insults are predominantly associated

  9. Role of Magnetic Resonance Elastography as a Noninvasive Measurement Tool of Fibrosis in a Renal Allograft: A Case Report.

    Science.gov (United States)

    Kim, J K; Yuen, D A; Leung, G; Jothy, S; Zaltzman, J; Ramesh Prasad, G V; Prabhudesai, V; Mnatzakanian, G; Kirpalani, A

    2017-09-01

    A major reason for poor long-term kidney transplant outcomes is the development of chronic allograft injury, characterized by interstitial fibrosis and tubular atrophy. Currently, an invasive biopsy that samples only report the use of magnetic resonance elastography (MRE) to quantify tissue stiffness as a noninvasive and whole-kidney measurement tool of allograft fibrosis in a kidney transplant patient at 2 time points. The MRE whole-kidney stiffness values reflected the changes in fibrosis of the kidney allograft as assessed by histologic examination. To our knowledge, this technique is the first observation of change over time in MRE-derived whole-kidney stiffness in an allograft that is consistent with changes in histology-derived fibrosis scores in a single patient. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Bone Replacement Materials and Techniques Used for Achieving Vertical Alveolar Bone Augmentation

    Directory of Open Access Journals (Sweden)

    Zeeshan Sheikh

    2015-05-01

    Full Text Available Alveolar bone augmentation in vertical dimension remains the holy grail of periodontal tissue engineering. Successful dental implant placement for restoration of edentulous sites depends on the quality and quantity of alveolar bone available in all spatial dimensions. There are several surgical techniques used alone or in combination with natural or synthetic graft materials to achieve vertical alveolar bone augmentation. While continuously improving surgical techniques combined with the use of auto- or allografts provide the most predictable clinical outcomes, their success often depends on the status of recipient tissues. The morbidity associated with donor sites for auto-grafts makes these techniques less appealing to both patients and clinicians. New developments in material sciences offer a range of synthetic replacements for natural grafts to address the shortcoming of a second surgical site and relatively high resorption rates. This narrative review focuses on existing techniques, natural tissues and synthetic biomaterials commonly used to achieve vertical bone height gain in order to successfully restore edentulous ridges with implant-supported prostheses.

  11. A novel technique for impaction bone grafting in acetabular reconstruction of revision total hip arthroplasty using an ex vivo compaction device

    International Nuclear Information System (INIS)

    Akiyama, Haruhiko; Takemoto, Mitsuru; Morishima, Takkan

    2011-01-01

    Impaction bone grafting allows restoration of the acetabular bone stock in revision hip arthroplasty. The success of this technique depends largely on achieving adequate initial stability of the component. To obtain well-compacted, well-graded allograft aggregates, we developed an ex vivo compaction device to apply it in revision total hip arthroplasty on the acetabular side, and characterized mechanical properties and putative osteoconductivity of allograft aggregates. Morselized allograft bone chips were compacted ex vivo using the creep technique and subsequent impaction technique to form the bone aggregates. Impaction allograft reconstruction of the acetabulum using an ex vivo compaction device was performed on eight hips. The mechanical properties and three-dimensional micro-CT-based structural characteristics of the bone aggregates were investigated. In clinical practice, this technique offered good reproducibility in reconstructing the cavity and the segmental defects of the acetabulum, with no migration and no loosening of the component. In vitro analysis showed that the aggregates generated from 25 g fresh-frozen bone chips gained compression stiffness of 13.5-15.4 MPa under uniaxial consolidation strain. The recoil of the aggregates after compaction was 2.6-3.9%. The compression stiffness and the recoil did not differ significantly from those measured using a variety of proportions of large- and small-sized bone chips. Micro-CT-based structural analysis revealed average pore sizes of 268-299 μm and average throat diameter of pores in the bone aggregates of more than 100 μm. These sizes are desirable for osteoconduction, although large interconnected pores of more than 500 μm were detectable in association with the proportion of large-sized bone chips. Cement penetration into the aggregates was related to the proportion of large-sized bone chips. This study introduces the value of an ex vivo compaction device in bone graft compaction in clinical

  12. Sleep influences the immune response and the rejection process alters sleep pattern: Evidence from a skin allograft model in mice.

    Science.gov (United States)

    Ruiz, Francieli Silva; Andersen, Monica Levy; Guindalini, Camila; Araujo, Leandro Pires; Lopes, José Daniel; Tufik, Sergio

    2017-03-01

    Sleep generally regulates immune functions in a supportive manner and can affect parameters that are directly involved in the rejection process. The first objective was to assess whether sleep deprivation (SD) or sleep restriction (SR) affects the allograft rejection process in mice. The second objective was to investigate whether the rejection process itself modulates the sleep pattern of allografted mice. Adult BALB/c and C57BL/6J male mice were used as the donors and recipients, respectively, except for the syngeneic group (ISOTX), which received skin from mice of the same strain (C57BL/6J). The recipients were randomly assigned to either one of two control groups - TX (allogenic) or ISOTX (syngeneic) - which underwent stereotaxic surgery to enable sleep recording prior to the allograft but were not sleep deprived; one of two paradoxical sleep deprived groups - SDTX and TXSD - which underwent 72h of continuous SD either before or after the allograft respectively, and one of two sleep restricted groups - SRTX and TXSR - which underwent 21h of SD and 3h of sleep for 15days either before or after the allograft respectively. The skin allograft was inspected daily to determine the survival time, expected as 8.0±0.4days in this transplant model under no treatment. The sleep pattern was controlled throughout the rejection process in the SD and SR groups. Draining lymph nodes