T cell receptor restriction of diabetogenic autoimmune NOD T cells

Restricted use of T cell receptor (TCR) gene segments is characteristic of several induced autoimmune disease models. TCR sequences have previously been unavailable for pathogenic T cells which react with a defined autoantigen in a spontaneous autoimmune disease. The majority of T cell clones, derived from islets of NOD mice which spontaneously develop type I diabetes, react with insulin peptide B-(9-23). We have sequenced the alpha and beta chains of TCRs from these B-(9-23)-reactive T cell clones. No TCR beta chain restriction was found. In contrast, the clones (10 of 13) used V alpha13 coupled with one of two homologous J alpha segments (J alpha45 or J alpha34 in 8 of 13 clones). Furthermore, 9 of 10 of the V alpha13 segments are a novel NOD sequence that we have tentatively termed V alpha13.3. This dramatic alpha chain restriction, similar to the beta chain restriction of other autoimmune models, provides a target for diagnostics and immunomodulatory therapy.

Peripheral T cell clones from NOD mice specific for GAD65 peptides: lack of islet responsiveness or diabetogenicity

The non-obese diabetic (NOD) mouse develops diabetes as a result of spontaneous T cell mediated destruction of the insulin-producing beta-cells. Tolerization to glutamic acid decarboxylase (GAD65) has been reported to inhibit spontaneous T cell proliferative responses to GAD65 and GAD65 peptides and prevent insulitis and diabetes in NOD mice. To evaluate the role of T cells responsive to GAD65 in induction of diabetes in NOD mice we generated T cell clones from spleen cells of three prediabetic NOD mice using the reported immunodominant human GAD65 peptides nos. 17, 34 and 35, which are spontaneously recognized by NOD spleen cells. The ten T cell clones established from two female and one male NOD mice recognized either the GAD65 peptide no. 35 which has an identical amino acid sequence in mice and humans or recognized the human GAD65 peptide no. 17 which is different in two amino acids from murine GAD65 peptide no. 17. None of the clones exhibited responses to islet cells, and GAD65 peptide no. 17 responsive clones did not cross react with the murine GAD65 peptide no. 17. All clones were CD4 positive and expressed the alpha/beta T cell receptor, but differed in their V beta usage. Analysis of in vitro production of IFN gamma, IL-2 and IL-4 demonstrated a TH1 and TH0 like functional subset of the individual clones. In vivo, neither the autoreactive T cell clones specific for GAD65 peptide no. 35 nor the xenoreactive clones specific for GAD65 peptide no. 17 were able to accelerate diabetes in young NOD mice or transfer diabetes into NODscid mice.

Protection of nonobese diabetic mice from diabetes by intranasal or subcutaneous administration of insulin peptide B-(9-23)

The observation that overt type I diabetes is often preceded by the appearance of insulin autoantibodies and the reports that prophylactic administration of insulin to biobreeding diabetes-prone (BB-DP) rats, nonobese diabetic (NOD) mice, and human subjects results in protection from diabetes suggest that an immune response to insulin is involved in the process of beta cell destruction. We have recently reported that islet-infiltrating cells isolated from NOD mice are enriched for insulin-specific T cells, that insulin-specific T cell clones are capable of adoptive transfer of diabetes, and that epitopes present on residues 9-23 of the B chain appear to be dominant in this spontaneous response. In the experiments described in this report, the epitope specificity of 312 independently isolated insulin-specific T cell clones was determined and B-(9-23) was found to be dominant, with 93% of the clones exhibiting specificity toward this peptide and the remainder to an epitope on residues 7-21 of the A chain. On the basis of these observations, the effect of either subcutaneous or intranasal administration of B-(9-23) on the incidence of diabetes in NOD mice was determined. The results presented here indicate that both subcutaneous and intranasal administration of B-(9-23) resulted in a marked delay in the onset and a decrease in the incidence of diabetes relative to mice given the control peptide, tetanus toxin-(830-843). This protective effect is associated with reduced T-cell proliferative response to B-(9-23) in B-(9-23)-treated mice.

Epitope specificity, cytokine production profile and diabetogenic activity of insulin-specific T cell clones isolated from NOD mice

T cells are known to play an important role in beta cell destruction in the nonobese diabetic (NOD) mouse model of Type I diabetes and islet-specific T cell clones have been demonstrated to be capable of adoptive transfer of diabetes. One important issue involves the identity of beta cell antigens that are recognized by nominally islet cell-specific T cell clones. We have previously reported that insulin-specific T cells are a predominant component of islet-specific T cells isolated from islet infiltrates of pre-diabetic NOD mice. In this report we examine six independently derived insulin-specific T cell clones established from islet infiltrates of pre-diabetic NOD mice in detail. All six clones were found to be specific to a region of the insulin molecule defined by a synthetic peptide encompassing residues 9-23 of the B chain. Despite this restricted specificity, each member of this panel exhibited a distinct receptor specificity defined either by V beta usage or antigen fine specificity. Five clones produced interferon (IFN)-gamma but not interleukin (IL)-4, placing them in the T helper type 1 (TH1)-like category whereas one clone produced both IL-4 and IFN-gamma, a characteristic of TH0 cells. All six clones were capable of either acceleration of diabetes in young NOD mice or adoptive transfer to NODscid mice. Taken together, these results suggest that spontaneously arising insulin-specific T cells participate in beta cell destruction during development of diabetes in NOD mice.

Analysis of the spontaneous T cell response to insulin in NOD mice

Insulin-specific T cells have been found to be present in high frequency among nominally islet-cell-specific T cells in the islet infiltrates that accumulate in NOD mice. In a previous report in which clones obtained from 7- and 12-week-old mice were examined, we identified a 15-residue peptide of the B chain as the dominent epitope for this response. Despite the fact that the response to insulin appears to be directed toward this single peptide, diverse TCR V beta usage was observed. That insulin-specific T cells contribute to beta cell damage is suggested by the fact that all clones tested could mediate beta cell destruction upon adoptive transfer. In the present report we extend this examination of insulin-specific T cells to lines and clones established from mice ranging in age from 4-12 weeks. These clones were found to be very similar to those from 7- and 12-week-old mice. The response was directed to the same peptide and most were found to produce IFN gamma, but none produced IL-4.

Insulin-specific T cells are a predominant component of islet infiltrates in pre-diabetic NOD mice

Numerous investigation have demonstrated that T cells are involved in destruction of beta cells in the NOD mouse, a widely studied model of type I diabetes. In this report we describe a series of islet-specific T cell lines established from islet-infiltrating lymphocytes obtained from individual pre-diabetic NOD mice as well as a large panel of clones derived from these lines. Proliferation assays indicated that these nominally islet-specific lines responded vigorously to porcine insulin. Furthermore, of 40 islet-specific clones derived from lines established from 12-week-old mice, 22 (55%) responded to insulin. A similar analysis of islet-specific clones established from 7-week-old mice indicated that 2 of 14 (14%) were insulin specific. These findings demonstrate that insulin-specific T cells can comprise a major portion of the spontaneously arising T cell response to islets in NOD mice.

[Malignant tumors of the small intestine. Diagnostic problems and differentiated surgical therapy]

The data of 27 patients who suffered from malignant tumors of the small bowel between 1970 and 1992 were retrospectively documented and evaluated. In the mainly elderly patients (5th to 8th decade of life) the tumor was most frequently localized in the ileum (41%), followed by the jejunum (30%) and the duodenum (22%). Adenocarcinoma was the most frequent histological diagnosis. Only 28% of the tumors were limited to the intestinal wall. 40% had metastases, local or to other organs. Due to diagnostic problems only 30% of these tumors were found preoperatively. In 22% of the cases an explorative laparotomy and in 33% an emergency operation because of ileus and/or peritonitis led to the correct diagnosis. Still, in 64% of the patients a R0-resection was possible. Nevertheless, the median period of survival was only 24.8 months. But patients who were R0-resected survived 65 months.

Establishment of islet-specific T-cell lines and clones from islet isografts placed in spontaneously diabetic NOD mice

One impediment to detailed characterization of islet-specific T cells from the NOD mouse model of diabetes is the difficulty encountered in isolation of such cells. This report describes a method that allows routine isolation of relatively large numbers of T cells highly enriched for reactivity toward islet antigens. The method involves renal subcapsular transplantation of spontaneously diabetic NOD mice with NOD islets. These grafts are rapidly destroyed in a tissue-specific manner and this destruction is accompanied by lymphocytic infiltration. Here we demonstrate that the islet graft infiltrates are an excellent source of islet-specific T cells and that islet-specific T-cell lines and clones can be established from these cells. Islet-specific T-cell clones isolated from a T-cell line established from the islet graft infiltrates were capable of adoptive transfer of diabetes to NOD/LtSz-scid recipients.

Regulation of neutrophil interleukin 8 gene expression and protein secretion by LPS, TNF-alpha, and IL-1 beta

Neutrophils are possibly involved in the pathogenesis of various lung diseases through the release of numerous mediators. In the present study, we studied the regulation of IL-8 gene induction and protein secretion in human blood neutrophils. Northern blot analysis revealed that LPS increased IL-8 mRNA levels in neutrophils, with a maximal fivefold increase by 2 h. IL-8 mRNa levels returned to baseline values within 12 h. In contrast, LPS-stimulated monocytes demonstrated a sustained increase of IL-8 mRNA levels for more than 24 h. TNF-alpha, IL-1 beta, and phorbol myristate acetate also increased IL-8 mRNA levels in neutrophils. Immunohistochemical analysis confirmed that IL-8 was localized within stimulated neutrophils. IL-8 secretion by neutrophils and monocytes was quantified using a specific ELISA for IL-8. Resting neutrophils secreted minimal IL-8 activity. However when cells were stimulated with LPS, TNF-alpha, or IL-1B, neutrophils secreted IL-8. IL-8 secretion was most marked during the first 2 h after stimulation and decreased thereafter. In contrast, monocytes maintained a high rate of IL-8 secretion over 12 h. Although a single monocyte secreted 70-fold more IL-8 than did a single neutrophil after 4 h of incubation, the high abundance of neutrophils in peripheral blood made the neutrophil-secreted IL-8 more significant. During the first 2 h, neutrophils secreted approximately 40% of the IL-8 released by monocytes in the same volume of blood. This ratio decreased to 9% after 12 h. Neutrophil-secreted IL-8 may play an autocrine or paracrine role during the initial stage of inflammation.

Producing peak performers--the key to quality patient care

Quality patient care extends only as far as those who deliver such care. To unlock quality service in each employee, the manager must address three combinations that include recruitment, training, and environment.

The documentation dilemma: an integrated solution

Every home healthcare manager must contend with the demands of documentation. One approach to ensure quality and address staff concerns is presented.

Investigations into the analysis of the rate of decay of the compound action potentials recorded from the rat sciatic nerve after death: significance for the prediction of the post-mortem period

There have been a number of papers that have reported the investigations of electrical stimulation of muscle groups in order to determine the post-mortem period. To the authors knowledge, no techniques have been described that analyse the compound action potentials (CAP) of various nerve fibre groups after death. This paper reports the monitoring of both the amplitude and latency changes of the CAP recorded from a stimulated rat sciatic nerve after death. Initial results suggest that the method my be useful in determining the early post-mortem period within 1 or 2 h after death. It may also be of use in measuring nerve conduction delay in various pathological conditions that can affect the neural network; for example diabetes.

Structure of (+/-)-3-benzyloxy-2,3,3a,7a-tetrahydrobenzo[b]thiophen-5 (4H)-one 1,1-dioxide

C15H16O4S, (1), Mr = 292.35, orthorhombic, Pbca, a = 5.9496 (10), b = 11.483 (3), c = 40.262 (7) A, V = 2750.7 (10) A3, Z = 8, Dx = 1.41 g cm-3, mu = 2.340 cm-1, Mo K alpha radiation, lambda = 0.7107 A, F(000) = 1232, T = 198 K, R = 0.0451 for 1703 reflections [Fo greater than or equal to 4 sigma (Fo)]. The two rings are cis-fused with the ring junction torsion angles being -38.2 (3) degrees for C3--C3a--C7a--S1 and -38.4 (4) degrees for C4--C3a--C7a--C7. The thiophene ring assumes the envelope conformation [C3a is 0.590 (3) A from the plane through S1, C2, C3 and C7a] while the cyclohexanone moiety is in the sofa conformation [C3a is 0.530 (3) A from the plane through C4, C5, C6, C7 and C7a].

Structures of two diastereomers of the tetrahydrobenzothiophene moiety of breynolide

(1) (+/-)-3-Triisopropylsiloxy-2,3,3a,7a-tetrahydrobenzo[b]thiophen -5(4H)-one 1,1-dioxide, C17H30O4SSi, Mr = 358.57, triclinic, P1, a = 7.4383 (14), b = 8.1000 (15), c = 16.895 (3) A, alpha = 80.202 (14), beta = 88.800 (15), gamma = 76.231 (14) degrees, V = 974.0 (3) A3, Z = 2, Dx = 1.22 g cm-3, Mo K alpha, lambda = 0.7107 A, mu = 2.339 cm-1, F(000) = 388, T = 298 K, R = 0.0436 for 3086 reflections [F0 greater than or equal to 4 sigma(F0)]. (2) (+/-)-3-tert-Butyldiphenylsiloxy-2,3,3a,7a-tetrahydrobenzo[b]th iophen- 5(4H)-one 1,1-dioxide, C24H28O4SSi, Mr = 440.63, triclinic, P1, a = 9.113 (2), b = 11.020 (2), c = 12.551 (3) A, alpha = 74.01 (2), beta = 70.83 (2), gamma = 88.70 (2) degrees, V = 1141.4 (4) A3, Z = 2, Dx = 1.28 g cm-3, Mo K alpha, lambda = 0.7107 A, mu = 2.125 cm-1, F(000) = 468, T = 298 K, R = 0.0424 for 4262 reflections [F0 greater than or equal to 4 sigma(F0)]. The two rings are cis-fused with the cyclohexenone ring in the sofa conformation and the tetrahydrothiophene ring in the half-chair conformation for both (1) and (2). However, the bulky siloxy groups assume different orientations in the two compounds. In (1), the triisopropylsiloxy group is equatorial and close intramolecular contacts between H2A and H4B [2.29 (3) A], O11 and C4 [2.934 (3) A] and O9 and C7 [2.979 (3) A] are observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Structure of a functionalized tetrahydrobenzothiophene

(+-)-4-(tert-Butyldimethylsiloxy)-3a,4,7,7a-tetrahydrobenzo[b] thiophen -3(2H)-one 1,1-dioxide, C14H24O4SSi, Mr = 316.49, monoclinic, P2(1)/n, a = 7.1431 (7), b = 19.643 (2), c = 12.528 (1) A, beta = 104.810 (8) degrees, V = 1699.4-(3) A3, Z = 4, Dx = 1.24 g cm-3, Mo K alpha radiation, lambda = 0.71073 A, mu = 2.597 cm-1, F(000) = 680, T = 298 K, R = 0.0566 for 2733 reflections [Fo greater than or equal to 4o-(fo)]. The two rings are cisfused with the cyclohexene ring in the half-chair conformation while the thiophene moiety has the envelope conformation. The endocyclic bond angles of the cyclohexene ring are enlarged, especially at the bridgehead C atoms, C3a and C7a, which have angles 116.0 (2) and 116.8 (2)o, respectively. There are several close intramolecular contacts: C3...O11 2.614 (3), O10...O11 3.137 (3), O10...C7 3.073 (4) A. Adjacent molecules related by 1-x, 1-y, 2-z stack so that the carbonyl O and C atoms of one molecule lie directly over the carbonyl C and O atoms of the second molecule. The C...O distance is 3.023 (3) A in this intermolecular interaction.

EEG asymmetries may be affected by cranial and brain parenchymal asymmetries

The plagiocephaly index, an index that reflects an underlying anatomic asymmetry of the brain, was assessed in ten schizophrenic patients and its values were correlated with the lateral distribution of quantitatively evaluated EEG. The correlations between the index and alpha power at F7 were significant, positive for frontal asymmetry (frontal bulging) and negative for occipital flattening. We then studied ten normal subjects in an attempt to illuminate the contribution of several cephalic and cranial variables to the imbalance of alpha-afterdischarges (AD) of VEP recorded at O1-O2. The asymmetry index of AD was computed and correlated with asymmetries of CT-derived measures of occipital bone thickness, occipital lobe width, mastoid area, and sulcal asymmetry (the asymmetry of intraparietal sulcus location from the longitudinal fissure). With the exception of the sulcal variable all measures significantly covaried with alpha AD. These findings caution that it may be important to determine cranial and brain parenchymal asymmetries where brain laterality is pertinent to studies of EEG.

Orientation of the cruciate ligament in the sagittal plane. A method of predicting its length-change with flexion

We have studied the kinematics of the knee in the sagittal plane, using a four-bar linkage as model, and assuming that a "neutral fibre" in each ligament remains isometric throughout flexion. We devised a computer program to calculate the distance separating any pair of points, one on each bone, for various cruciate attachments at various angles of flexion. The parameters for the linkage in four cadaveric knees were obtained by marking the centre of attachment of the cruciate ligaments with tacks and taking lateral radiographs. The movements of the bones were then calculated, in the computer model, for various attachments of "replacement" ligament fibres, the distance between the attachment sites being plotted against the angle of flexion. It was then possible to define zones around the isometric attachment points within which changes in length would be predictable. Our results show that the position of the femoral sites of attachment of both anterior and posterior cruciate replacement was more critical than that of the tibial attachments.

Radical wedge resection for ingrown toenail: long-term results

This paper describes an operation for ingrown toenail that is simple, has a low recurrence rate, leaves patients with an intact, pain-free, cosmetically acceptable nail-bearing toe, and permits the wearing of normal shoes within a short period of time. Among the numerous techniques devised for the treatment of ingrown toenail, no other operation fulfills all of these criteria. It is usual to sacrifice appearance in the hope of cure. During the last 20 years we have adopted a radical wedge resection that has the advantage of resulting in permanent healing and a good-looking toe. After a first series of 67 cases thus treated without a single recurrence, the technique was used in a further series of 339 cases reported here.

The effect of continuous passive motion on anterior cruciate ligament reconstruction stability

This study was undertaken to examine the immediate effect of continuous passive motion (CPM) on anterior cruciate ligament (ACL) reconstruction stability. Cadaver knees were tested with a knee arthrometer with the anterior cruciate intact and then with the anterior cruciate sectioned. One of three anterior cruciate reconstructions was then performed and stability was restored to the knee and it was again tested with the knee arthrometer. Stability was defined as being within 2 mm of the intact measurement. The three operations selected were the Marshall-MacIntosh "over-the-top," (OTT) a patellar bone-patellar tendon-tubercle bone (BTB) graft, and a semitendinosis reconstruction. The specimens were placed on a CPM device in a cooler at 38 degrees F and put through a range of motion of 20 to 70 degrees at 10 cycles per minute for 3 days. A success was less than a 2 mm increase in the post-CPM measurement compared to pre-CPM. All three bone-tendon-bone operations failed. The semitendinosis operation was successful in only three out of eight specimens. The OTT operation was successful in eight out of nine specimens. The possible reasons for success and failure are discussed. Because of the potential problems with failure of an ACL with CPM it is suggested that the particular technique being used for an anterior cruciate reconstruction be tested prior to it being used with CPM clinically.

The diagnosis of meniscus pathology

A study of 281 patients evaluated for a meniscus pathologic condition was performed to assess the accuracy of the clinical diagnosis and arthrogram and delineate the role of arthroscopy. Following the clinical examination, the surgeon stated his level of confidence in his diagnosis, as did the radiologist in his interpretation of the arthrogram. In 134 cases inspected by arthroscopy or arthrotomy, the clinician proved to be correct 74% of the time, and the arthrogram accuracy in evaluating the medial meniscus was 89%; the majority of the errors were false positive diagnoses. In the 82 meniscus tears in which an arthrogram was performed the diagnosis was made in 80 cases, or 98%. The arthrogram accuracy in the lateral compartment was 81%; however, of the 31 lateral meniscus tears in which an arthrogram was performed, a positive diagnosis was yielded by arthrogram in only ten cases. In 34 lateral meniscus tears, a positive clinical diagnosis was made in only 12 cases. Arthroscopy was performed in 117 cases and proved helpful in patient management in 65 cases (55%). Arthroscopy was performed in 25 patients with lateral meniscus tears and a diagnosis of a lateral meniscus tear was made in all cases. The observations suggest that prior to performing an arthrotomy, arthroscopic examination of the knee should be performed routinely in patients suspected of having meniscus tears.

Evaluation of the role of Histamine H1- and H2-receptors in cutaneous inflammation in the guinea-pig produced by histamine and mast cell degranulation

1 The role of histamine H1- and H2-receptors in mediating the cutaneous inflammatory response produced by exogenous histamine and the release of endogenous histamine from mast cells has been investigated by a method which permits simultaneous, quantitative measurement of vasodilatation, vascular permeability and oedema formation. 2 Histamine and the selective H1-receptor agonist, 2-(2-aminoethyl) pyridine, both produced vasodilatation, increased vascular permeability and oedema formation whereas the selective H2-receptor agonist, dimaprit, produced only vasodilatation. 3 Mepyramine and cimetidine both reduced the vasodilatation response to histamine, the combination of antagonists being superior to either antagonist alone. Mepyramine (but not cimetidine) virtually abolished extravascular albumin accumulation and oedema formation. 4 Mepyramine and cimetidine both reduced the vasodilatation response produced by active cutaneous anaphylaxis and compound 48/80. However, mepyramine was less effective in reducing the vascular permeability response to mast cell degranulation than to histamine. 5 In conclusion, the vasodilator response to histamine is mediated by both H1- and H2-receptors; the permeability response to histamine is mediated solely by H1-receptors. A combination of H1- and H2-receptor antagonists appears to be more effective than either antagonist alone in reducing cutaneous inflammatory reactions involving histamine.

Reduction of neglected congenital dislocation of the hip in children over the age of six years

Thirty-two neglected congenital dislocations of the hip in twenty-two children over the age of six years were treated by traction, open reduction and Chiari osteotomy. In five hips, where prolonged traction failed to bring the femoral heads into the vicinity of the acetabulum, a shortening subtrochanteric osteotomy of the femur was performed. The overall results were good and this regime of treatment is recommended.

The fetid foot: lower-extremity infections in patients with diabetes mellitus

Infections of the lower extremities in patients with diabetes mellitus have been attributed to Staphylococcus aureus and other facultatively anaerobic bacteria. However, a review of 30 consecutive diabetics who required surgery for lower-extremity infections revealed that 17 had mixed infections due to both obligate and facultative anaerobes; only six had infections due to S. aureus. Mixed infections often had characteristics of anaerobic suppuration and responded poorly to therapy. Patients with mixed infections required more operations than did those with staphylococcal infections, and their surgical wounds healed more slowly. Seven patients had infections with mixed enteric bacteria (neither anaerobes nor S. aureus), and their response to therapy was intermediate between that of the patients with mixed anaerobic infections and those with staphylococcal infections. Nine additional patients with mixed anaerobic infections were treated with cefoxitin; three required amputations at a level above the ankle, but six patients improved and required only limited surgery that preserved foot function. Bacteroides fragilis was the anaerobe isolated most often. Cefoxitin (less than or equal to 20 micrograms/ml) inhibited all of the anaerobes isolated from the nine patients and 97% of an additional 135 consecutive clinical isolates of B. fragilis; 98% of 54 strains of Bacteroides oralis and all of 34 strains of Bacteroides melaninogenicus were also inhibited. These in vitro results and the results of our clinical study show that cefoxitin is a promising antibiotic for therapy of foot infections due to a mixed flora of anaerobes in diabetics.

Über die Kondensation von Desylbromid mit 4-Alkylthiosemicarbaziden

Aus 2-Brom-1,2-diphenyl-ethan-1-on (Desylbromid) und 4-Alkylthiosemicarbaziden erhält man in ethanolischer Lösung über S-Desal-Verbindungen in Abhängigkeit von den Substituenten 2-Alkylamino-1,3,4-thiadiazine, 3-Amino-thiazolon-(2)-alkylimide bzw. 3-Alkylthiazolon-(2)-hydrazone. Die Konstitution der Verbindungen konnte durch spektroskopische Untersuchungen und unabhängige Synthesen gesichert werden.

Tissue toxicity of antiseptic solutions. A study of rabbit articular and periarticular tissues

The gross, histologic, and biochemical effects of four commercially available antiseptic solutions on rabbit knee articular and periarticular connective tissues were investigated. Rabbit knee joints were injected with 2.0 cc of either Betadine prep solution, Betadine scrub solution, pHisohex or 3% hexachlorophene. The opposite knees were injected with sterile saline. All animals were injected three times at 48-hour intervals and sacrificed 10 days after the last injection. The solutions containing detergents, Betadine scrub, and pHisohex caused severe gross and histologic damage to articular cartilage, synovia, and muscle. The hexachlorophene loss solution caused moderate histologic damage, but caused articular cartilage ground substance. Betadine prep solution caused only minimal gross and histologic damage, without any biochemical evidence of articular cartilage damage. If antiseptic solutions are to be used in irrigating or packing joint injuries, the use of Betadine prep is recommended.

Effect of salicylate therapy on cartilage destruction in experimental pyarthrosis

An experimental rabbit pyarthrosis model was utilized to investigate the effects of sodium salicylate therapy on cartilage destruction. Animals were innoculated with 10(3) organisms of Staphylococcus aureus 502A. The opposite knee was injected with sterile saline. Infection was documented 48 hours post innoculation, procaine penicillin therapy initiated, and the adequacy of therapy evaluated at sacrifice. One half of the animals began salicylate feedings one week prior to injection and this continued until sacrifice at 14 or 49 days. Salicylate levels were 12.5 +/- 6.9 mg %. There was a significant loss of cartilage in both the salicylate treated and untreated animals. The levels of salicylate obtained in this study were not protective to cartilage in a septic joint.

Surgical correction of congenital dislocation of the hip in children aged two to six years

We report on a consecutive series of 68 children, between the ages of two and six years, with 97 neglected dislocated hips. The standard treatment consisted of traction, open reduction and innominate osteotomy. The results were satisfactory in most cases and the number of complications decreased significantly with improved surgical techniques. Additional operations, such as femoral varisation derotation osteotomy or Colonna arthroplasty, were performed only in exceptional cases for the treatment of complications. The treatment of neglected congenital dislocation of the hip after the patient has begun walking is a difficult orthopedic problem and and uniformly good results cannot be expected. Open reduction and innominate osteotomy appear to be the best form of treatment in the age group studied.

Lavage of septic joints in rabbits: effects of chondrolysis

Septic joints were produced in rabbits which were then treated with systemic procaine penicillin. One group of animals also had surgical lavage at four and seven days after bacterial inoculation. In the infected joints there was a significant loss of hexosamine by five days and of collagen by nine days. Lavage delayed the loss of collagen.

Compartmental evaluation of osteoarthritis of the knee. A comparative study of available diagnostic modalities

The distribution and severity of osteoarthritis were investigated in 56 knees by history and physical examination, assessment of knee function, radiography with and without weight-bearing, double-contrast arthrography, and 99mTc-polyphosphate bone imaging. Compartmental involvement (medial, lateral, patellofemoral) was graded independently by 2 or 3 observers for each modality and was correlated with that observed during arthroscopy or direct surgical inspection. The more involved compartments were graded abnormal by all methods. In the less involved compartments, the gamma camera image was most sensitive to pathology, followed by arthrography. The choice of surgical technique and the prognosis depend upon accurate preoperative knowledge of the extent of disease.