Arta Medica Vol. 61, No 4, 2016 ediție specială

Collagen / chitosan hybrid sponge as a scaffold for cell culture

Fri, 01 Jan 2016 00:00:00 GMT

Collagen / chitosan hybrid sponge as a scaffold for cell culture Cobzac, Vitalie; Jian, Mariana; Madan, Vadim; Croitor, Gheorghe; Nacu, Viorel The aim of this study is to obtain a three-dimensional collagen type I/chitosan scaffold for seeding the cells cultured in vitro, and promotion of cell adhesion and proliferation. Materials and methods used to obtain a collagen I/chitosan hybrid scaffold were bovine tendons that after mincing have been processed with 0,05M Na2 HPO4 solution for 4 days, followed by enzymatic digestion with pepsin 100 mg per 1gr. of tendon, EDTA and acetic acid for 24 hours at 4°C. Then collagen was purified by precipitation with 1.8 M NaCl, followed by acetic acid dissolution and dialysis in bags with 12000 Da pore size by a large volume of 0.02 M Na2HPO4 solution, until pH of collagen solution become neutral or weak base, then it was frozen at -60 °C and allowed to thaw at room temperature. Collagen is separated from the remaining liquid by centrifugation at 1000 g for 10 min. The obtained collagen is dissolved with acetic acid to a concentration of 1%, then freeze-dried (EVD-12; Unicryo MCL-60). Obtained sponge was treated with 0.25% chitosan solution for 24 hours, then washed with distilled water on a vibrator, frequently changing the water. After that the collagen/chitosan sponge is freeze-dried and cross-linked at room temperature in a vapor chamber with 12.5% glutaraldehyde (SERVA) for 24 hours. Results: Pore size in native collagen sponge vary between 50 and 200μ, but in the case of hybrid collagen/chitosan sponge, pore size vary between 30 and 100μ. Conclusion. The obtaining method of a hybrid collagen/chitosan scaffold for cell seeding is effective. The sponge size and microscopic structure allow its utilisation in filling tissue defects and tissue engineering. Laboratory of Tissue Engineering and Cells Cultures, State University of Medicine and Pharmacy “Nicolae Testemițanu”, Republic of Moldova, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016

Intraoperative prevention and treatment of periprosthetic infection after total hip or knee replacement

Fri, 01 Jan 2016 00:00:00 GMT

Intraoperative prevention and treatment of periprosthetic infection after total hip or knee replacement Vasilchishin, Y.M.; Vasyuk, V.L.; Vasiuk, S.V. Steady increase in primary total hip replacement and total knee replacement in Ukraine and worldwide inevitably leads to corresponding increase in absolute incidence of their complications, including periprosthetic infection (PPI). Its frequency has been reported lately from 0.5% to 3.0%. In absolute numbers it means hundreds and thousands of patients per year. Patients with surgical site infection are 60% more likely to stay in an intensive care unit, 5 times more likely to readmit to the hospital, and have a double mortality rate compared to patients without surgical site infection. PPI does not only negate the effect of the surgery, but often puts the limb or even the patient’s survival at risk. This necessitates constant search of new or improved ways to prevent and to treat PPI. The intraoperative measures for prophylaxis of infection after total hip or knee replacement were substantiated, namely the effect of laminar clean air in the operating room. Introducing laminar clean air caused a decrease in total microbial count of the air by 60 times, and a decrease in particular matter > 0.3 μm (PM0.3) count by 7289 times (p<0.001), which was associated with a shortening of mean postoperative hospital stay from 11.10±4.01 to 8.64±2.84, a decrease in percentage of patients who spent over 14 days in hospital after surgery from 7.3% to 2.2%, and a decrease in infection rate after total hip or knee replacement from 3.3% to 1.1%. Improved technique of two stage exchange arthroplasty of the hip using the designed antibiotic impregnated cement spacers made intraoperatively with the designed metallic molds was used in 49 patients with periprosthetic infection after total hip replacement. Infection eradication and good functional results were achieved in 89.5%. Mean Harris Hip Score at follow up was 87.18±6.44. Improved technique of two stage knee revision using the designed articulating antibiotic impregnated cement spacers was used in 20 patients with infected total knee replacement. Infection control and good functional results were achieved in 84.2%. At follow up, mean Knee Injury and Osteoarthritis Outcome Score was 67.9±6.2, mean Knee Society Score was 72.8±2.7. Bukovinian State Medical University, Chernivtsy, Ukraine, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016

Asociated injuries of the peripheral nerves of the foreartm and management of surgical treatment

Fri, 01 Jan 2016 00:00:00 GMT

Asociated injuries of the peripheral nerves of the foreartm and management of surgical treatment Vacarciuc, Ion Introduction. Repair of a peripheral nerve has considerable functional consequences for the individual, due to sensory and motor loss, as well as the pain and discomfort from cold intolerance. Material and methods Our experience refere to the period 1998-2016 years based on the treatment of 104 patients with associated nerve injuries. Patients were aged between 16 and 65 year, 83 were male and 21 female; in 87 cases the nerve lesions were associated with flexor tendons injuries and in 42 cases with a variety of fractures. Nerve injuries consisted in multiple lesions of the proper digital nerves - 16 cases, lesions of the common digital nerves at palm level - 19 cases, lesions of the median or ulnar nerves in the forearm - 50 cases, combined injuries of median and ulnar nerves were found in 19 cases. Primary surgical approach included anatomical restoration of skeletal and tendinous elements. In 54 the nerve reconstruction was also performed, utilizing epyperineurorraphy in 61 cases and the epyneurorraphy in 7 cases, neurolizis in 29 cases. In 7 cases with irreparable radial nerve palsy we used with successful transfers of muscle tendon. Results and discussion There still are discussions about the optimal posttraumatic delay for nerve reconstruction, but one condition must be clear: injuries of the nerves in the harul require - especially if the motor component is involved - an as early as possible surgical approach. As above mentioned, we performed primary neurorraphy in 54 cases. Results were considered good in 18 cases, satisfactory in 31 and poor in 5 cases. Microscopic techniques utilizing atraumatic materials combined with an active postoperative recuperatory management allowed us to obtain favorable results in associated injuries of the hand. In 24 cases the lesions were associated with fractures of the humerus bone, in 4 cases - with fractures of the radial bone. The open lesion of the nerve was present în 6 cases, in 2 of which was lesioned the median nerve, in 1 – was lesioned the median, ulnar and radial nerves. In 7 cases with irreparable radial nerve palsy we used with successful transfers of muscle tendon. The long term results were followed for 7 pacients. Good results were registered in 4 cases, satisfactory 3 cases. State University of Medicine and Pharmacy ”Nicolae Testemițanu”, Republic of Moldova, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016

Treatment of chronic coccydynia

Fri, 01 Jan 2016 00:00:00 GMT

Treatment of chronic coccydynia Tagadiuc, Anatolie Coccydynia is a rare but painful disorder characterized by axial coccygeal pain which is typically exacerbated by pressure. 35 patients with chronic coccydynia were included into the study. Among them 30 females and 5 males; mean age 39 years – range 12 to 58 years. The mean symptom duration was 3 months (range 1 to 6 months). Twenty-one patients had a history of trauma and the rest were considered idiopathic. No patient with trauma addressed at the time of the incident. The results of our study allowed to establish that the conservative treatment is the treatments of choice for patients with coccydynia despise etiology, radiographic data and intensity of clinical symptoms. Successful results can be obtained and maintained with no less then two courses of conservative treatment. For patients unresponsive to conservative treatment, coccygectomy is a successful method of treatment. Clinical Hospital of Traumatology and Orthopedics, Chișinău, Republic of Moldova, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016