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PURPOSE: Delineation of brain tissue that is at risk but not yet infarcted (penumbra) continues to be a major challenge for stroke imaging. Metabolic characterization of the penumbra might be able to be achieved using blood-oxygen-level-dependent (BOLD) imaging. MATERIALS AND METHODS: We analyzed MRI data from 20 patients within the first 6 hours after stroke onset and after 5-8 days. Among other sequences, the MRI protocol consisted of diffusion-weighted (DWI/ADC = apparent diffusion coefficient) and quantitative T2 and T2* imaging (qT2, qT2*). BOLD images (T2') were calculated using 1/T2' = 1/qT2* - 1/qT2. BOLD lesions were rated by two blinded observers. RESULTS: Based on the primary blinded reading of the BOLD images, the lesion side was rated correctly by observers 1 and 2 in 80/50 % of the cases, incorrectly in 5/40 % of the cases, and rated as not visible in 15/10 % of the cases. After unblinding the observers, the visibility was rated in 45/45 % of the cases as good, in 35/40 % of the cases as reasonable, and in 20/15 % of the cases as insufficient for diagnostic purposes. The sensitivity for subsequent infarct growth was 0.88 (95 % confidence interval, CI 0.47 to 0.99), the specificity was 0.33 (95 % CI 0.07 to 0.70), the positive predictive value (PPV) was 0.54 (95 % CI 0.25 to 0.81), and the negative predictive value (NPV) was 0.75 (95 % CI 0.19 to 0.99). The odds ratio for subsequent infarct growth was 3.5 (95 % CI 0.20 to 115.53). CONCLUSION: Hypo-intense lesions in BOLD imaging were visible and exceeded the lesion in diffusion-weighted imaging in most of the stroke patients. The encouraging results justify further testing of the hypothesis that BOLD lesions, when larger than DWI lesions, are associated with infarct growth from initial DWI to final infarct.

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A growth factor-based strategy recently has been shown to induce the intrinsic repair of partial-thickness articular cartilage lesions, thereby obviating the need for transplanting cells or tissue. It was the purpose of the current study to ascertain whether this principle could be applied to full-thickness articular cartilage defects created in adult rabbits and mature miniature pigs. The transforming growth factor-beta1 contained within the authors' chondrogenic matrix-complex proved to be potent in its osteogenic capacity when liberated into the bone compartment of such lesions, inducing the rapid upgrowth of osseous tissue and vascular buds into the cartilage compartment. This is an unwanted response that must be prevented. A cell and blood vessel-excluding membrane (Millipore in rabbits and Goretex in miniature pigs) was inserted at the interface between cartilage and bone compartments, both of which were filled at the appropriate juncture with the chondrogenic matrix-complex. These structural barriers were effective in obstructing the up-growth of blood vessels into the cartilage compartment and in preventing the osteogenic tissue differentiation attributable to the presence of a vasculature.

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OBJECTIVE: Because articular cartilage has limited ability to repair itself, treatment of (osteo)chondral lesions remains a clinical challenge. We aimed to evaluate how well a tissue-engineered cartilage-like implant, derived from chondrocytes cultured in a novel patented, scaffold-free bioreactor system, would perform in minipig knees with chondral, superficial osteochondral, and full-thickness articular defects. DESIGN: For in vitro implant preparation, we used full-thickness porcine articular cartilage and digested chondrocytes. Bioreactors were seeded with 20x10(6) cells and incubated for 3 weeks. Subsequent to culture, tissue cartilage-like implants were divided for assessment of viability, formaldehyde-fixed and processed by standard histological methods. Some samples were also prepared for electron microscopy (TEM). Proteoglycans and collagens were identified and quantified by SDS-PAGE gels. For in vivo studies in adult minipigs, medial parapatellar arthrotomy was performed unilaterally. Three types of defects were created mechanically in the patellar groove of the femoral condyle. Tissue-engineered cartilage-like implants were placed using press-fit fixation, without supplementary fixation devices. Control defects were not grafted. Animals could bear full weight with an unlimited range of motion. At 4 and 24 weeks postsurgery, explanted knees were assessed using the modified ICRS classification for cartilage repair. RESULTS: After 3-4 weeks of bioreactor incubation, cultured chondrocytes developed a 700-microm- to 1-mm-thick cartilage-like tissue. Cell density was similar to that of fetal cartilage, and cells stained strongly for Alcian blue and safranin O. The percentage of viable cells remained nearly constant (approximately 90%). Collagen content was similar to that of articular cartilage, as shown by SDS-PAGE. At explantation, the gross morphological appearance of grafted defects appeared like normal cartilage, whereas controls showed irregular fibrous tissue covering the defect. Improved histologic appearance was maintained for 6 months postoperatively. Although defects were not always perfectly level upon implantation at explanation the implant level matched native cartilage levels with no tissue hypertrophy. Once in place, implants remodelled to tissues with decreased cell density and a columnar organization. CONCLUSIONS: Repair of cartilage defects with a tissue-engineered implant yielded a consistent gross cartilage repair with a matrix predominantly composed of type II collagen up to 6 months after implantation. This initial result holds promise for the use of this unique bioreactor/tissue-engineered implant in humans.

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The technique of radio-radial monobloc-fixation with the small AO external fixator device has been applied to 17 consecutive Colles' fractures. The fracture types were mainly A3 and C2, according to the AO classification. We found this technique to be easy and quick in application and stable in fixation. Direct, precise and atraumatic reduction can be achieved by using the distal pins as joy-sticks. Furthermore, disimpaction of the fracture to regain length is possible without bone grafting. Normal carpal mobility and load transfer is preserved during fracture healing and the injured hand can be used in daily life with certain restrictions. To prevent pin-track infections, early mobilization of the wrist should be avoided. We recommend this technique in the treatment of comminuted AO-type A3 fractures of the distal radius and in certain type C2 cases.

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The rate of longitudinal bone growth is regulated primarily by modulations in the activity of epiphyseal plate hypertrophic chondrocytes, these being manifested as changes in cell and matrix volume. It was the purpose of this study to ascertain whether the cytoplasmic organelles representing the cellular production apparatus, i.e. rough endoplasmic reticulum, Golgi apparatus and mitochondria, contribute to these changes by modulating their rate of activity or by increasing/decreasing the surface area and/or volume of their membranes. Using rats at different stages of growth, the surface areas and volumes of the three organellar systems were quantified in epiphyseal plate chondrocytes at the onset and termination of hypertrophy by ultrastructural stereology. Matrix synthesis during the same span was assessed by monitoring the production of its principal components, namely, fibrillar collagen (ultrastructural morphometry) and glycosaminoglycans (quantitative (35)S-autoradiography). Each organelle adapts to increases (21- to 35-day-old rats) and decreases (35- to 80-day-old rats) in growth rate by its own individual combination of the two alternative mechanisms, but modulations in the level of activity predominate over alterations in the surface area or volume of their membranes. These findings point to the danger of relying solely on data gleaned from a quantitative ultrastructural analysis of organellar parameters and emphasise the necessity of conducting functional assays in parallel, as performed here.

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100 consecutive patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. We report our results and the management of choledocholithiasis. In two cases the laparoscopic procedure had to be converted into open cholecystectomy due to bleeding. There were no complications postoperatively. The results show that laparoscopic cholecystectomy is a safe procedure with real benefits. The main advantages are greater comfort for the patient, better cosmetic results, shortening of hospital stay and earlier return to full activity. We feel that, with a proper indication, laparoscopic removal of the gallbladder will establish itself as the procedure of choice in stone disease.

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72 patients with isthmic spondylolisthesis have been analyzed prospectively with respect to their clinical presentation, radiological and intraoperative findings, operative techniques and surgical results. Excellent, good and satisfactory results have been obtained in 59 (82%), 10 (14%) and 3 patients (4%), respectively, by use of microsurgical techniques in combination with Louis-plate-fixation in Grade I and double arthrodesis/Cotrel-Dubousset-instrumentation in Grade II spondylolisthesis.

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In a case of hairy cell leukemia the evidence of tartrate-resistant isoenzyme 5 of phosphatase (TRISP 5) developed to findings important for the diagnosis. The evidence was achieved by means of disc electrophoresis by separating the cell lysate of white blood cells. The percentage of TRISP 5 in the total activity of acid phosphatase in leukocytes amounted to 17.6%. In cytochemical respect the evidence of TRISP 5 proved to be negative. The classification of these findings and their differential-diagnostic significance are discussed.

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