Good Long-term Function Research Articles

Indications for Osteotomy of the Tibia in Children

Summary: Osteotomy for deformity of the legs is a commonly performed operation for which many techniques have been described. Indications for osteotomy, however, are lacking. To assess the amount of angulation compatible with good long-term function and avoidance of osteoarthritis we followed a group of patients with fractured tibias a mean of 29 years from injury. Clinical and radiographic outcomes were unaffected by the amount of angulation or by whether there was varus or valgus angulation. Our data suggest that angular deformities <10-15° are well tolerated long term with respect to development of osteoarthritis.

Forty-eight hours hypothermic perfusion storage of pig and baboon hearts

A system has been developed for the continuous hypothermic perfusion of isolated hearts using a clear fluid perfusate. Myocardial viability has been maintained after periods of storage of up to 48 hr. Pig hearts stored in this way showed almost normal hemodynamic performance on subsequent functional testing. Orthotopic allotransplantation or autotransplantation of baboon hearts stored for 48 hr was followed by good immediate and long-term function. Baboons receiving allotransplants survived until rejection. Three of four of those autotransplanted survived until electively sacrificed at 1, 3, and 12 months; all showed normal hemodynamic function on cardiac catheterization and normal myocardial histology.

Immunological consequence of renal transplantation and immunosuppression. I. Alterations in human natural killer-cell activity.

The role and activity of natural killer (NK) cells following renal transplantation remain unknown. To monitor NK activity, a 51Cr release of K-562 targets in prednisone- and azathioprine-treated patients receiving renal allografts was utilized. In 18 patients in whom NK activity was measured prior to and after transplantation, a significant diminution in NK activity within 3 weeks following transplantation was demonstrated compared to pretransplant values (34.71 vs 12.20%, respectively; P less than 0.001). In 11 subjects who had NK activity assayed at various intervals after transplantation but not prior to allografting, mean NK values were markedly lower (mean, 14.2%) than those of normal volunteers or patients maintained on hemodialysis (P less than 0.001). The latter two control groups demonstrated no difference (P = NS) in mean NK activity (39.46 vs 35.82%, respectively). In 5 of the 29 patients evaluated with good long-term graft function (mean, 2.7 years), restitution of normal NK activity was demonstrated. In two patients with bacterial infections, NK activity increased from 39.29 to 51.7% and from 13.54 to 20.00%. After infection, these values were 35.3% in the former and 3.39% in the latter. Viral infection did not appear to affect NK activity significantly. NK activity was increased in only one of seven patients with documented rejection episodes. In three of such patients, NK activity declined significantly following pulse methylprednisolone therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term results of the Chrisman-Snook operation for reconstruction of the lateral ligaments of the ankle.

The Chrisman-Snook procedure for instability of the lateral ankle ligaments, first described in 1969, reconstructs the anterior talofibular ligament and the calcaneofibular ligament using one-half of the peroneus brevis tendon, routed through tunnels in the fibula and calcaneus. In the present long-term evaluation of the results of this procedure, forty-eight of sixty ankles, in fifty-seven patients, were assessed after a mean follow-up of ten years (range, four to twenty-four years). The results were excellent in thirty-eight ankles, good in seven, fair in two, and poor in one. The two ankles with a fair result were improved but still had some persistent instability, while the ankle with a poor result (no improvement) was in a patient with generalized ligament laxity. All three patients with a fair or poor result had had a severe reinjury to the ankle. Based on the findings in this study, we concluded that this procedure will restore good long-term function in a high percentage of patients who are disabled by ankle instability due to unhealed or neglected tears of the lateral ligaments.

Isolated dislocation of the pisiform: A case report and review of the literature

A case of isolated dislocation of the pisiform is reported. Repositioning by open reduction and temporary internal fixation was performed. However, redislocation of the pisiform occurred. Subsequently, removal of the dislocated pisiform bone resulted in good long-term function.

Esophageal Replacement with Colon in Children: Functional Results and Long-term Growth

Twenty-three children consecutively undergoing colon interposition for esophageal replacement were evaluated with barium swallows, clinical interviews, and questionnaires. Fourteen patients underwent colon interposition because of caustic burns of the esophagus only or of the hypopharynx and esophagus. Nine children had long-segment esophageal atresia or esophageal atresia with tracheoesophageal fistula and are included in our operative group. The mean follow-up was 12.8 years for all patients. Strictures, leaks, and colon ischemia at the proximal anastomosis represent the major morbidity for the operative procedure. Analysis of growth charts reveals that patients who ingest lye tend to remain in the 50th percentile after colon transplant, while patients with esophageal atresia or tracheoesophageal fistula who had been in the 12th percentile preoperatively improved to the 33rd percentile after successful transplantation. Radiographic examinations, functional results, and growth curves demonstrated excellent results in 20 patients. Although the choice of a conduit for esophageal replacement is controversial, the surgeon can expect good long-term function and growth with the use of colon in children.

Circulating immune complexes during various forms of renal allograft rejection episodes.

Previous reports on the nephritogenic and immunological enhancing capacity of posttransplant circulating immune complexes (CICs) are conflicting and have been confined to the study of acute rejection episode (AR). This study was undertaken to assess the nephritogenicity of CICs in patients undergoing accelerated acute rejection (AAR) and chronic rejection (CR) episodes. We also assessed the possible role of CICs as mediators of immunological enhancement by assessing CIC levels in long-term-stable allograft recipients. To asses the nephritiogenic role of CICs, 98 CIC determinations were performed on 49 serum samples from 41 pediatric renal transplant recipients using the C1q solid-phase assay (C1q-SPA) and the Raji cell radioimmunoassay (Raji-RIA). Serum samples from normal subjects served as controls. No recipient undergoing AAR had evidence of CICs by eigher assay. 5 of 21 (23.8%) recipients undergoing CR had positive CIC levels in the Raji-RIA, while 4 of 21 (19%) recipients had positive CICs inthe C1q-SPA. There was no statistically significant correlation of CIC levels with long-term allograft function. In addition, there was no evidence supporting antithymocyte globulin as an immunogen in patients demonstrating posttransplant CICs. In summary, CICs do not appear to be an important mediator of AAR or CR episodes, and CICs were not routinely detected in patients with good long-term allograft function.

Assessment of prognostic factors in patients undergoing surgery for non-rheumatic mitral regurgitation.

Twenty-four patients who had undegone mitral valve surgery for pure non-rheumatic mitral regurgitation were studied non-invasively six months to six years postoperatively. The long-term results of operation were assessed on the basis of clinical history, echocardiography, and treadmill stress testing using a points scoring system. The score so obtained was used to divide the patients into those with a good response to surgery (group 1) and those responding poorly (group 2). The effects on the long-term surgical outcome of several intraoperative and preoperative factors were then analysed both together and separately. A short symptomatic history (less than 1 year), a normal left ventricular end-diastolic volume index (less than or equal to 100 ml per m2), and a large post-ectopic potentiation of KV max (greater than 50 s-1) were found to be favourable prognostic factors when analysed independently. An angiographic ejection fraction less than 0.5 was uniformly associated with a poor outcome, and 71 per cent of patients in atrial fibrillation at the time of operation also responded badly. In those patients with good long-term function, cold potassium cardioplegia was more commonly used than intermittent aortic cross clamping as the means of intraoperative myocardial preservation, though this difference did not reach conventional significance. A standard analysis of variance allowed assessment of length of history, left ventricular end-diastolic volume index, and type of valve prosthesis simultaneously. This indicated that both length of history and left ventricular end-diastolic volume index were highly significant prognostic factors. The use of a Björk-Shiley as opposed to a Starr-Edwards prosthesis also emerged as significantly favouring a good long-term result. The state of the left ventricular myocardium before operation and the type of valve prosthesis used were thus shown to be the prime determinants of surgical outcome in these patients. The optimum time for operation was shown to be within one year of the onset of symptoms, and before the left left ventricular end-diastolic volume index exceeds 100 ml per m2, or the ejection fraction falls to less than 0.5. At such a time, irreversible changes in myocardial function sufficient to negate the beneficial effects of mitral valve surgery have not yet occurred.

Long-term study of the microvascular sleeve anastomosis: an experimental study in the rabbit renal artery.

A long-term study of 5 sleeve anastomoses in rabbit renal arteries was performed. Six months postoperatively angiography, light microscopy and electron microscopy was carried out. Good long-term function of the anastomoses without any stenoses or aneurysm formation was obtained. It was concluded from this study in rabbits that the sleeve technique is suitable for microvascular anastomosis and that good long-term function can be obtained.

Should the Ruptured Renal Allograft Be Removed?

During a 16-month period when 93 renal transplants were performed, eight kidney graft ruptures were detected within 18 days of transplantation, without evidence of venous obstruction. Six grafts were removed at the time of an exploratory operation for rupture and only one showed signs of probable irreversible rejection when examined by microscopy. Two graft ruptures were repaired and one of these grafts has had good long-term function 22 months later. These observations suggest that if bleeding at the site of grafts has had good long-term function 22 months later. These observations suggest that if bleeding at the site of graft rupture can be securely controlled and if the conditions of the patient and of the graft are favorable except for the rupture, it may be possible to save more than one of eight grafts.

Extended preservation of the ischemic canine lung by ventilation with PEEP

To determine the technique most helpful in reducing the severity of pulmonary injury and consequent edema and congestion that follows revascularization, 22 dogs were subjected to left pulmonary hilar occlusion with the lung either in the deflated state or expanded by continuous or intermittent positive pressure. Cyclic ventilation of the ischemic canine left lung with 5 cm PEEP increased the length of survival more than 5-fold when compared to dogs treated by continuous expansion or cyclic ventilation without PEEP. Decreases occurred in isotope uptake on ventilation and perfusion scans and in left lung VO 2 and V m during the first 48 hr after hilar occlusion in all dogs. Uptake returned to near normal values 3 mo later in dogs ventilated with PEEP. Lung expansion by means of cyclic ventilation with PEEP appears to prevent alveolar collapse and thus facilitates oxygenation during periods of ischemia. In contrast to other organs, the lung appears to receive oxygen for the metabolic requirements of its cells from the inspired air as well as from arterial blood flow and thus probably is capable of being preserved for periods of at least 10 hr by ventilation alone. The good long-term pulmonary function in seven of eight dogs ventilated with PEEP during 10 hr of left pulmonary ischemia suggests that this technique may be beneficial in obtaining grafts for lung transplantation.

Cadaveric renal transplantation: long-term survival.

From 1965 to 1968, 55 renal transplants were performed In 49 patients. Twenty-six patients have survived with functioning grafts for longer than three years. This represents a three-year graft survival rate of 47% and a patient survival rate of 53%. Twenty patients have good renal function with serum creatinine levels lower than 1.8 mg/100 ml. Neither oliguria nor rejection episodes early after transplantation precluded the prospects of good long-term renal function. In spite of a variety of complications, 85% of these surviving patients have achieved satisfactory physical, occupational, psychological and sexual rehabilitation.