Taswell, Howard F.

Summary Modular, porous-coated, titanium segmental endoprostheses were implanted bilaterally in the femoral diaphysis of 7 adult mixed-breed dogs. Autogenous bone graft in particle form was placed around the implant and bone. In 1 limb, homologous fibrin adhesive was mixed with the graft in situ before soft tissue closure. The contralateral limb was grafted in identical manner, but without fibrin adhesive, and served as a control. Radiography was performed immediately after surgery and 1, 2, 3, 4, 6, 8, 10, and 12 weeks later to assess callus area and bone remodeling. At 12 weeks, dogs were euthanatized and bone/implant fixation strength was tested under torsion and compared with values for 6 in vitro controls. Histomorphometric and microradiographic analyses of transverse sections of the distal portion of the implanted femurs were performed. Radiographic callus area was significantly (P < 0.05) smaller in the femurs grafted with fibrin adhesive, compared with the contralateral control. New bone formation (21.4 ± 1.8% vs 19.2 ± 2.4%), unlabeled bone (64.8 ± 3.0% vs 67.9 ± 4.2%), porosity (13.9 ± 0.7% vs 12.9 ± 0.8%), and bone ingrowth into the porous coating (10.3 ± 0.9% vs 10.0 ± 1.2%) were not significantly different between fibrin- and nonfibrin-grafted implants, respectively. There were no significant differences in torsional strength of implant fixation between the fibrin- and nonfibrin-grafted femurs or between the in vivo implanted femurs and the in vitro controls. These data indicate that fibrin adhesive may have been advantageous in maintaining apposition of bone graft adjacent to the endoprosthesis, but it probably did not have an enhancing effect on extracortical bone bridging or ingrowth over a porous-coated segmental bone replacement endoprosthesis.

Abstract A 58-yr-old woman is described in whom light and electron microscopic studies of bone marrow revealed the typical features of type I dyserythropoietic anemia. This form of anemia may be first diagnosed late in life, and caution should be exerted to avoid its confusion with preleukemia or erythroleukemia.

Patients with severe, inoperable cholestasis and intractable pruritus not responding to conventional medical therapy might benefit from a depletion of their bile acid pool by sorbent perfusion since accumulated bile acids are possibly responsible for their itching. In vitro, USP-charcoal-coated glass beads removed bile acids from human plasma far better than any other sorbent tested. In order to demonstrate the safety and efficacy of charcoal plasmaperfusion in vivo, five dogs underwent plasmapheresis one week following cholecystectomy and bile duct ligation, and 2.2 ± 0.2 (x̄ ± SD) times their plasma volume was passed over a column containing 400 ml of charcoal-coated glass beads prior to reinfusion. During the procedure the plasma bile acid concentration was reduced by 40.2 ± 4.0% and the bilirubin level by 48.2 ± 3.3%. The columns, whose capacity was far from being saturated, retained 1.3 ± 0.4 times the pre-perfusion plasma pool of bile acids (1.1 ± 0.2 for bilirubin) suggesting that substantial amounts of bile acids and bilirubin were mobilized from tissue stores. The procedure was well tolerated by the animals and might have promising clinical applications.