This review demonstrates that prophylactic use of GCCI can have a positive effect on wound healing in a range of orthopaedic surgical procedures and in high-risk patients. GCCI may also have a role to play in the treatment of osteomyelitis.
In a prospective clinical trial, plasma histamine levels were measured in 28 polytrauma patients on day 1, 5 and 14 after trauma. Only those subjects who died were drop-outs. All patients had severe polytrauma with at least 3 body regions involved. The median plasma histamine levels at all three time points were significantly higher than in patients with single trauma of the extremities or before selective orthopaedic surgery but still in the normal range (less than 1 ng/ml). However, all patients with plasma levels above 1 ng/ml on days 1 and 5 died, as did all patients with levels above 0.5 ng/ml on day 1. Thus the elevation of plasma histamine levels, for whatever reason, appears to be a prognostic factor for bad outcome in polytrauma patients.
In our study we examined bone disinfection by ethanol and by irradiation. A 70% aqueous ethanol solution diffused through a 3 mm and a 6 mm slice of human cancellous bone against 2 ml of a HIV-sample (RTA: 300,000 cpm/ml) for 24 hours. In both cases HIV could not be inactivated. Infected T-lymphocyte cultures showed specific morphological cell changes. The Abbott HIV-antigen-EIA proved the treated HIV-samples to be infectious after cultivation in macrophage-cultures. Additional gas chromatography measurements of ethanol diffusion through 3 mm and 6 mm of human cancellous bone supported these observations: a 70% aqueous ethanol solution achieved a concentration of 25.6% (18.0%) in median after 24 hours and a thickness of 3 mm (6 mm). The effect of different doses of irradiation on HIV-samples (RTA:300,000 cpm/ml) was examined. The samples were irradiated with 2, 7, 10, 15 and 25 kGy to determine the appropriate dose for inactivation. Irradiation with 15 kGy caused HIV inactivation since no virus production could be detected in the macrophage culture (Abbott HIV-antigen-EIA). The samples irradiated with 2, 7 and 10 kGy were still infectious.
Cylindrical specimens of trabecular pig bone were tested to uniaxial compressive strain levels of 30% to study the influence of various sterilization techniques and methods of HIV-inactivation on the mechanical properties characterized by compressive modulus, yield point, energy absorption and maximum stress. Heat inactivation at 60 degrees C (Lactated Ringer, 1 h) showed no effect; 80 degrees C (Lactated Ringer, 1 h) resulted in a diminution of the yield point and the maximum stress (p less than 0.005), while energy absorption and compressive modulus were not affected. No reduction in the stability was seen when ethanol was used instead of Lactated Ringer. At a temperature of 100 degrees C, all measured parameters were reduced to approximately 60% compared with the control group. A decrease to 13% to 25% was seen after autoclavation (120 degrees C, 2 bar, 20 min and 134 degrees C, 3 bar, 12 min). Irradiation (60Co) with 3 respectively 10kGy did not impair the stability, whereas a dose of 25 kGy led to a reduction to 61% to 69%. No additional effect was seen when irradiation was followed by storage at -80 degrees C for one week. These effects on bone stability should be considered when choosing a method of bone preparation to obtain HIV-inactivated bone grafts. Autoclavation should be used with caution when stability of the bone graft is essential. In this case, irradiation seems to be a safe method of sterilizing bone grafts ensuring both a high degree of safety and stability.
The use of allogenic bone transplants in surgery has been greatly diminished owing to the risk of transmitting infectious diseases. This risk can be reduced by the use of a thermal disinfection system (Lobator SD-1). This is achieved by increasing the temperature to 80 degrees C, inactivating a number of bacterial and viral agents. In this study the decay of HIV at high temperature in the Lobator SD-1 was researched. In the center of human femoral heads 100 microliters of a highly concentrated suspension of free and cell-bound HIV (10(10)) was exposed to the thermal process at intervals of 5, 10, 20, 30, 40, 50 and 62 min. For the recultivation HUT-78 cells were used through titration of the virus suspension in ten-fold dilutions over ten dilution steps and incubation up to a maximum of 21 days. Evidence of the virus was checked through observing giant cell formations and quantitative determination of p24 antigen using an Elisa test. Linear virus inactivation was found based upon the time the virus was exposed to heat. After a treatment of 40 min in the disinfection system, total virus inactivation was achieved. The normal disinfection process time using Lobator SD-1 is 92 min. A temperature of 80 degrees C is reached after approximately 45 min. The results prove that this system totally inactivates HIV in human femoral heads.
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