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It is now used against cancer of The backbone of chitin is a six-member carbon ring that female reproductive organs cheap 200MDI beconase aq visa allergy shots skin reactions, brain tumors buy beconase aq no prescription allergy forecast for san antonio, and other cancers purchase beconase aq with a mastercard allergy testing boulder. This A form of the metal platinum called cisplatin stops can- structure is very similar to that of cellulose. Newer groups of chitin is known as acetamide, whereas cellulose has treatments that are biological or based on proteins or genetic material and can target specific cells are also being developed. Monoclonal antibodies are genetically engineered copies of Chitin is a noteworthy biological feature because it is proteins used by the immune system to fight disease. Rituximab was the first moncoclonal antibody approved for In contrast, most polymers are man-made and are comprised use in cancer, and more are under development. The purpose of chitin is to provide support for the Interferons serve to alert the body’s immune system of an organism. The degree of support depends on the amount and impending attack, thus causing the production of other pro- the thickness of chitin that is present. Interferons are being studied for rooms, chitin confers stability and rigidity, yet allows some treating a number of cancers, including a form of skin cancer flexibility. This allows the mushrooms to stand and still be called multiple myeloma. A third group of drugs are called flexible enough to sway without snapping. Although many new- the peptidoglycan supportive layer that is a feature of Gram- borns develop only mild pneumonia, because the lungs of a positive and Gram-negative bacteria. The think peptidoglycan newborn are fragile, especially in pre-term babies, any infec- layer in Gram-positive bacteria provides a rigid and robust sup- tion of lung tissue is serious and can be life-threatening. The peptidoglycan layer in Gram-negative bacteria that is Specific antibiotics are used to fight chlamydial pneu- only one molecule thick does not provide the same degree of monias. Other mechanical elements of the Gram- to combat Chlamydia pneumoniae and Chlamydia trachoma- negative cell wall are necessary to shore up the structure. Tetracycline is usually effective against Chlamydia In the ocean, where many creatures contain chitin, sea- psittaci. The bacteria are able to See also Bacteria and bacterial infection; Transmission of break down the polymer and use the sugar molecules as meta- pathogens bolic fuel. See also Fungi CHLORAMPHENICOL • see ANTIBIOTICS Chlamydial pneumoniaCHLAMYDIAL PNEUMONIA CChlorinationHLORINATION Chlamydial pneumonia is a pneumonia cause by one of sev- Chlorination refers to a chemical process that is used primarily eral forms of Chlamydial bacteria. The three major forms of to disinfect drinking water and spills of microorganisms. The Chlamydia responsible for pneumonia are Chlamydia pneu- active agent in chlorination is the element chlorine, or a deriv- moniae, Chlamydia psittaci, and Chlamydia trachomatis. Chlorination is a In reaction to infection, infected lung tissue may swift and economical means of destroying many, but not all, become obstructed with secretions. As part of a generalized microorganisms that are a health-threat in fluid such as drink- swelling or inflammation of the lungs, the fluid or pus secre- ing water. Blockage of the alveoli results in a of its ability to kill bacteria and other disease-causing organ- decreased oxygenation of the blood and deprivation of oxygen isms at relatively low concentrations and with little risk to to tissues. Much of the Chlamydia pneumoniae (in older literature known as killing effect in bacteria is due to the binding of chlorine to “Taiwan acute respiratory agent”) usually produces a condi- tion known as “walking pneumonia,” a milder form of pneu- reactive groups within the membrane(s) of the bacteria. As well, chlorine inhibits various bio- tating and dangerous to at risk groups that include the elderly, chemical reactions in the bacterium. In contrast to the rapid young children, or to individuals already weakened by another action of chlorine, other water disinfection methods, such as illness. Chlamydia pneumoniae spreads easily and the high the use of ozone or ultraviolet light, require minutes of expo- transmission rate means that many individuals within a popu- sure to a microorganism to kill the organism. In many water treatment facilities, chlorine gas is Species of chlamydiae can be directly detected follow- pumped directly into water until it reaches a concentration that ing cultivation in embryonated egg cultures and immunofluo- is determined to kill microorganisms, while at the same time rescence staining or via polymerase chain reaction (PCR). The exact con- Chlamydiae can also be detected via specific serologic tests. Chlamydia psittaci is an avian bacteria that is transmit- For example, surface waters contain more organic material that ted by human contact with infected birds, feathers from acts to absorb the added chlorine. Thus, more chlorine needs to infected birds, or droppings from infected birds. The specific be added to this water than to water emerging from deep under- pneumonia (psittacosis) may be severe and last for several ground. The pneumonia is generally more dangerous than the rine that is effective is determined by monitoring the water for form caused by Chlamydia pneumoniae. Both methods of chlorination are so inexpensive that tis infections are especially dangerous during pregnancy nearly every public water purification system in the world has because the newborn may come in contact with the bacteria in adopted one or the other as its primary means of destroying the vaginal canal and aspirate the bacteria into its lung tissue disease-causing organisms. With carbon dioxide, water, and the help of Giardia form dormant structures called cysts that are resistant specialized enzymes, the light energy absorbed creates chem- to chlorination. The prevalence of these protozoans in world- ical energy in a form the cell can use to carry on its processes. Thus, the effec- In addition to chlorophyll, there are other pigments tiveness of chlorination may be compromised in some water known as accessory pigments that are able to absorb light systems. As well, adherent bacterial populations of bacteria where the chlorophyll is unable to. Carotenoids, like B- such as Escherichia coli that form in distribution pipelines are carotenoid, are also located in the thylakoid membrane. A third concern with chlorination is the reaction between algae, bacteria, and diatoms, coloring them varying shades of chlorine and methane gas, which produces one or more chlo- red, orange, blue, and violet. The best known are trichloromethane (chloroform) and tetrachloromethane (carbon tetrachloride). See also Autotrophic bacteria; Blue-green algae These chlorinated hydrocarbons have been shown to have adverse health effects in humans when ingested in sufficient quantity for a long time. CChlorophytaHLOROPHYTA Furthermore, from an engineering point of view, excess chlorine can be corrosive to pipelines. In older water treatment Chlorophyta are microorganisms that are grouped in the king- systems in the United States, for example, the deterioration of dom called Protista. The microbes are plant-like, in that they the water distribution pipelines is a significant problem to are able to manufacture energy from sunlight. Terrestrial habitats include tree CChlorophyllHLOROPHYLL trunks, moist rocks, snowbanks, and creatures including turtles, sloths and mollusks. There are some 8,000 species of chloro- Chlorophyll is a green pigment contained in the foliage of phytes, ranging in size from microscopic to visibly large. The first class, responsible for absorbing sunlight required for the production of which contains the greatest number of organisms, is called sugar molecules, and ultimately of all biochemicals, in the plant. A notable example of an organism from this Chlorophyll is found in the thylakoid sacs of the chloro- class is Chlorella, which is economically important as a dietary plast. The chloroplast is a specialized part of the cell that func- supplement. Another member of the class is Volvox, a spherical tions as an organelle. Once the appropriate wavelengths of organized community containing upwards of 60,000 cells. In this class have existed since prehistoric times, as evidenced by photosynthesis, the chloroplast absorbs light energy, and con- verts it into the chemical energy of simple sugars.
At that time generic beconase aq 200MDI mastercard allergy treatment chiropractic, tests for these agents were not as sophis- the need for the trait (the antibiotic of interest is not present in ticated and as definitive as they are now order discount beconase aq online allergy testing logan utah. Hence beconase aq 200MDI low cost allergy quorn symptoms, contamination prevention escaped detection sickened thousands of people. Blood sup- procedures have tended to focus on those aspects of contami- plies in Canada and elsewhere are now safeguarded from con- nation that are both relevant and likely to occur. As an example of the measures currently in place, the Food products are also prone to contamination. The con- United States has three agencies that are concerned with the tamination can originate in the breeding environment. These are the Department of example, poultry that are grown in crowded conditions are Agriculture, Environmental Protection Agency, and the Food reservoirs of bacterial contamination, particularly with and Drug Administration. Over half of all poultry entering pro- ulatory legislation that addresses the contamination of various cessing plants are contaminated with this bacterium. Quality control measures, which monitor critical phases Analysis and Critical Point Program (HACPP); Laboratory of the process from raw material to finished product, are help- techniques in microbiology ful in pinpointing and eliminating sources of contamination. An example is Corynebacterium jeikeium, whose infec- food handlers is a key factor. In the United States, estimates tion can be taxing to treat as the organism is resistant to are the one in five food-borne disease outbreaks is caused by numerous antibiotics. Over the past two decades, the numbers the handling of foods by personnel whose hands are contami- of such infections have been rising. Coryneform bacteria can stain positive in the Gram In the nineteenth century, similar hygiene problems cre- stain protocol. The contamination acteristic feature is their tendency to arrange themselves in a of open wounds, incisions and entry routes of catheters killed V-like pattern or lined up, much like logs stacked one against the majority of surgical patients. This, and their inconsistent Gram See also Blood borne infections; Hazard Analysis and Critical stain reaction, can make identification of the microorganism Point Program (HAACP); History of public health; tedious. More rigorous biochemical and molecular biological Transmission of pathogens tools of identification are being used by organizations such as the Centers for Disease Control (CDC) to establish a definitive classification scheme for Coryneform bacteria. For example, CORYNEFORM BACTERIA CDC groups JK and D-2 in the genus Corynebacterium are Coryneform bacteria now recognized as important human disease-causing microor- Coryneform bacteria are normal residents of the skin. Conversely, these rigorous techniques have resulted can also cause opportunistic infections. These are infections in the removal of some species of bacteria from the genus. In fact, before Coryneform bacteria were known to 136 WORLD OF MICROBIOLOGY AND IMMUNOLOGY Coulter counter be comprised of several species, the bacteria were referred to In 1993, Costerton left Calgary to take up the post of as diphtheroids. Diphtheria is apparent as an inflammation and Director of the Center for Biofilm Engineering at Montana bleeding of the throat and as a generalized toxic poisoning of State University, Bozeman. Since then, he and his colleagues the body, due to the release of a powerful toxin by the bacte- have used techniques such as confocal microscopy to probe ria. The toxin spreads throughout the body via the bloodstream intact biofilms without disrupting them. These studies have and has a particular affinity for tissues such as the heart, nerve revealed the complex nature of biofilm structure and the coor- endings and the adrenal glands. Diphtheria is treatable with dinated nature of the interaction between the bacterial popula- antibiotics. As well, Costerton discovered the Other species of the genus Corynebacterium cause mas- so-called bioelectric effect, in which an application of current titis in cows (an infection and inflammation of the udder), makes a biofilm much more susceptible to antibiotic killing. Rhodococcus equi, which inhabits soil, of strategies to combat chronic infections, such as the is an important pathogen of young horses. Another human Pseudomonas aeruginosa lung infections that occur, and can pathogen is It is also a normal resident on skin surfaces, and ultimately kill those afflicted with cystic fibrosis. For these and other pioneering contributions to biofilm research, Costerton has received many awards. These include See also Gram staining the Sir Frederick Haultain Prize for outstanding achievement in the physical sciences (1986), the Isaak Walton Killam Memorial Prize for Scientific Achievement in Canada (1990), CCosterton, John WilliamOSTERTON, JOHN WILLIAM (1934- ) and a Fellowship in the American Association for the Canadian microbiologist Advancement of Science (1997). William (Bill) Costerton is a Canadian microbiologist who is actively involved internationally in promoting the multi- has pioneered the recognition of bacterial biofilms as the dom- disciplinary structure of the Center’s research and education inant mode of growth of bacteria, and who first demonstrated curriculum. See also Antibiotic resistance, tests for; Bacterial adaptation; Costerton was born in Vernon, British Columbia. CCoulter counterOULTER COUNTER Robert Murray at the University of Western Ontario in London, A Coulter counter is a device that is used to measure the num- Ontario, where he received a Ph. Following post- ber of cells in a certain volume of a sample suspension. The doctoral training at Cambridge University, Costerton moved to counter achieves this enumeration by monitoring the decrease MacDonald College of McGill University, in the Canadian in electrical conductivity that occurs when the cells pass province of Quebec, where he became first a Professional through a small opening in the device. While originally devel- Associate in 1966 then an Assistant Professor in 1968. In 1970 oped for use with blood cells, the Coulter counter has found he moved to the University of Calgary as an Associate great use in a diverse number of disciplines, including micro- Professor. From 1985 to 1992, he held positions at Calgary as the AOS- biology, where it is used to determine the total number of bac- TRA Research Professor followed by the National Sciences teria in samples. Because the device operates on the physical blockage of These two appointments freed him from teaching to concen- electrical conductivity by particles in a sample, the Coulter trate on his burgeoning research into bacterial biofilms. Research on biofilms has occupied Costerton since his An indication of the total number of bacteria (alive, dormant, move to Calgary. The number of living bacteria can, the existence of biofilms and when on to show that biofilms however, usually be easily determined using another volume are the dominant mode of growth for bacteria. Coulter conceived and constructed the first counter in the Research over a decade demonstrated the importance of this basement of his home in Chicago in the early 1950s. Then as exopolysaccharide in enabling the bacteria to survive doses of now, the device relies on a vacuum pump that draws a solution antibacterial agents, including antibiotics that readily killed or suspension through an electrically charged tube that has a bacteria grown in conventional lab cultures. As particles pass through the hole was so convincing that an initially skeptical scientific com- the electrical field is interrupted. The pattern of the interrup- munity became convinced of the importance and widespread tion can be related to the number of particles and even to par- nature of biofilms. There is a predilection towards acquiring the tend to aggregate together in a suspension. This may be clump of bacteria passing through the orifice of the counter because of a closer contact with animals such as cats by this age could be counted as a single bacterium. This would produce an group, or because of lack of administration of smallpox vaccine. Treatment for cowpox tends to be ensuring that the The Coulter counter has been used for many applica- patient is as comfortable as possible while waiting for the tions, both biological and nonbiological. Sometimes, a physician may wish device was reconfigured to incorporate a laser beam. This to drain the pus from the skin sores to prevent the spread of the allowed the use of fluorescent labeled monoclonal antibodies infection further over the surface of the skin. The use of this treatment needs to be evaluated carefully, as there See also Bacterial growth and division; Laboratory techniques can be side effects such as kidney damage. Antibodies to the in microbiology vaccinia virus may also be injected into a patient, as these antibodies also confer protection against cowpox.
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These are relatively long and only a few are face hooks into the membrane(s) beconase aq 200MDI line allergy symptoms in adults, where they are held by two present on a bacterium order beconase aq in india allergy symptoms on tongue. The basal bodies act as bush- and serve as a portal for the movement of genetic material ings quality beconase aq 200MDI allergy shots nosebleeds, allowing flagellar tube to turn clockwise and counter- (specifically the circularly organized material called a plas- clockwise. By spinning around from this membrane anchor, mid) from one bacterium to the other. The genetic spread of flagella act as propellers to move a bacterium forward, or in a antibiotic resistance occurs using pili. These runs and tumbles enable a bac- See also Anti-adhesion methods; Bacteria and bacterial infec- terium to move toward an attractant or away from a repellant. The tactic process is highly orchestrated, with sensory BACTERIAL ARTIFICIAL CHROMOSOME proteins detecting the signal molecule and conveying the sig- nal into flagellar action. In contrast, an Olympic Bacterial artificial chromosomes (BACs) involve a cloning sprinter can propel himself at just over five body lengths per system that is derived from a particular plasmid found in the second. Depending upon the type of bacteria, flagella are char- bacterium Escherichia coli. The use of the BAC allows large acteristically arranged singly at only one end of the cell pieces of deoxyribonucleic acid (DNA) from bacterial or non- (monotrichous), singly at both ends of the cell (amphitrich- bacterial sources to be expressed in Escherichia coli. Repeated ous), in a tuft at one or a few sites (lophotrichous), or all over expression of the foreign DNA produces many copies in the the bacterial surface (peritrichous). BACs proved useful in the sequencing BACTERIAL FOSSILIZATION • see FOSSILIZATION of the human genome. OF BACTERIA The BAC is based on a plasmid in Escherichia coli that is termed the F (for fertility) plasmid. The F plasmid (or F fac- tor) contains information that makes possible the process called BACTERIAL GENETICS • see MICROBIAL GENETICS conjugation. In conjugation, two Escherichia coli bacteria can physically connect and an exchange of DNA can occur. A BAC contains the conjugation promoting genetic infor- BACTERIAL GROWTH AND DIVISION Bacterial growth and division mation as well as stretch of DNA that is destined for incorpora- tion into the bacterium. The sequences are referred to as sequence tag tion on agar in a liquid growth medium, in natural settings, connectors. In the laboratory, where growth conditions of Using a BAC, large stretches of DNA can be incorpo- temperature, light intensity, and nutrients can be made ideal rated into the bacterial genome and subsequently replicated for the bacteria, measurements of the number of living bacte- along with the bacterial DNA. In molecular biology terminol- ria typically reveals four stages, or phases, of growth, with ogy, pieces of DNA that contain hundreds of thousands of respect to time. Initially, the number of bacteria in the popula- nucleotides (the building blocks of DNA) can be inserted into tion is low. Often the bacteria are also adapting to the envi- a bacterium at one time. Depending sections of the foreign DNA, the amount of DNA that can be on the health of the bacteria, the lag phase may be short or analyzed can be very large. The latter occurs if the bacteria are damaged or have just BACs were developed in 1992. The primary reason for this popu- After the lag phase, the numbers of living bacteria rap- larity is the stability of the inserted DNA in the bacterial idly increases. Because the inserted DNA remains in the bacterial the population keeps doubling in number at the same rate. This genome during repeated cycles of replication, the information is called the log or logarithmic phase of culture growth, and is is not lost. As well, the BAC can be sequenced using the nor- the time when the bacteria are growing and dividing at their mal tools of molecular biology. For Escherichia coli, for example, the rate The most dramatic recent example of the power of of growth and division of a single bacterium (also called the BACs is their use by The Institute for Genomic Research generation time) during the log phase is 15 to 20 minutes. In (TIGR) in the technique of shotgun cloning that was employed the log phase, most of the bacteria in a population are growing in the sequence determination of the human genome. The resulting “library” could be expressed in ever in the closed conditions of a flask of growth medium. Subsequently, Nutrients begin to become depleted, the amount of oxygen these sequences could be reconstructed to produce the orderly becomes reduced, and the pH changes, and toxic waste prod- sequence of the actual genome. This approach proved to be ucts of metabolic activity begin to accumulate. The bacteria less expensive and quicker than the method known as directed respond to these changes in a variety of ways to do with their sequencing, where a genome was sequenced in a linear fash- structure and activity of genes. This plateau period is called the sta- human genome that have been expressed in Escherichia coli tionary phase. Here, the number of bacteria growing and by the use of BACs is now close to one million. In addition to dividing is equaled by the number of bacteria that are dying. The number of living bacteria declines sharply over With the realization of the sequence of the human time in what is called the death or decline phase. Indeed, BAC also exhibit these growth phases in different regions of a cloning kits are now available commercially for what is colony. For example, the bacteria buried in the oldest part of termed genomic profiling. Culturing of bacteria is possible such that fresh growth medium can be added at rate equal to the rate at which cul- BACTERIAL EPIDEMICS • see EPIDEMICS, BACTERIAL ture is removed. The rate at which the bacteria grow is 49 Bacterial growth and division WORLD OF MICROBIOLOGY AND IMMUNOLOGY Freeze fracture electron micrograph showing dividing Streptococcus bacteria. The division plane between the daughter cells is evident in some bacteria. The obvious events of growth and division that are Bacteria can be tailored to grow relatively slow or fast and, apparent from measurement of the numbers of living bacteria if the set-up is carefully maintained, can be maintained for a are the manifestation of a number of molecular events. Such sources include simple normal helical configuration and replicates. Nitrogen is the genetic material migrate to either end of the bacterium. Sulphur and phosphorus are also needed for the man- cisely at the middle of the bacterium. Other elements, such as as a ring from the inner surface of the membrane. When the potassium, calcium, magnesium, iron, manganese, cobalt and septum is complete, an inner wall has been formed, which zinc are necessary for the functioning of enzymes and other divides the parent bacterium into two so-called daughter bacte- processes. Bacterial division is initiated by as-yet unidentified sen- Depending on the species, bacteria exhibit a usually limited sors of either the volume or the length of the bacterium. The range in temperatures in which they can growth and repro- sensors trigger a series of events, including the formation of duce. In septum formation are number of proteins are peratures from 20°–50° C (68°–122° F). Outside this range recruited to the site where septal formation will begin. The Z-ring is analogous to a drawstring, and is likely sure, light and moisture.
Particularly beconase aq 200MDI allergy medicine for infants, it has advantages in that opera- tion time is reduced purchase beconase aq overnight allergy medicine brands names, rehabilitation as well as the surgical technique is easier order beconase aq with visa allergy medicine zyrtec dosage, addi- tional procedures such as bone graft can be combined, and a stage IV patient can be treated with acceptable results. Therefore, it is recommended particularly for young patients with stage 2 or 3 and some selected patients with stage 4. Rosenberg AG, Kull L, Galante JO (1994) Primary total hip arthroplasty using noncemented porous coated femoral components in patients with osteonecrosis of the femoral head. Coventry MB, Beckenbaugh RD, Nolan DR, Ilstrup DM (1974) 2012 total hip arthro- plasties: a study of postoperative course and early complications. Krackow KA, Mont MA, Maar DC (1993) Limited femoral endoprosthesis for avascular necrosis of the femoral head. Saito S, Saito M, Nishina T, Ohzono K, Ono K (1989) Long-term results of total hip arthroplasty for osteonecrosis of the femoral head: a comparison with osteoarthritis. Fairbank AC, Bhatia D, Jinnah RH, Hungerford DS (1995) Long-term results of core decompression for ischaemic necrosis of the femoral head. Rosenwasser MP, Gartino JP, Kiernan HA, Michelsen CB (1994) Long term follow-up of through debridement and cancellous bone grafting of the femoral head for avascu- lar necrosis. Fuchs B, Knothe U, Hertel R, Ganz R (2003) Femoral osteotomy and iliac graft vascu- larization for femoral head osteonecrosis. Bonfiglio M, Bardenstein MB (1958) Treatment by bone grafting of aseptic necrosis of the femoral head and nonunion of the femoral neck (Phemister technique). Buckley PD, Gearen PF, Petty RW (1991) Structural bone grafting for early atraumatic avascular necrosis of the femoral head. Ohzono K, Saito M, Takaoka K, et al (1991) Natural history of nontraumatic avascular necrosis of the femoral head. Sugioka Y (1978) Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. Sugioka Y (1984) Transtrochanteric rotational osteotomy in the treatment of idio- pathic and steroid induced femoral head necrosis, Perthes disease, slipped capital femoral epiphysis, and osteoarthritis of the hip: indications and results. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. Koo KH, Kim R, Ko GH, Song HR, Jeong ST, Cho SH (1995) Preventing collapse in early-stage osteonecrosis of the femoral head: a randomized clinical trial of core decompression. Lafforgue P, Dahan E, Chagnnaud C, Schiano A, Kasbarian M, Acquaviva PC (1993) Early-stage avascular necrosis of the femoral head: MR imaging for prognosis in 31 cases with at least 2 years of follow-up. Judet H, Judet J, Gilbert A (1981) Vascular microsurgery in osthopaedics. Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA (1995) Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting: a long-term follow-up study of one hundred and three hips. Wagner H, Zeiler G (1980) Idiopathic avascular necrosis of the femoral head. Results of intertrochanteric osteotomy and resurfacing (author’s transl). Maistrelli G, Fusco U, Avai A, Bombelli R (1988) Osteonecrosis of the hip treated by intertrochanteric osteotomy: a four to 15 year follow-up. Ganz R, Buechler U (1983) Overview of attempts to revitalize the dead head in aseptic necrosis of the femoral head: osteotomy and revascularization. Dean MT, Cabenela ME (1993) Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head. J Bone Joint Surg 75B:597–602 Vascularized Iliac Bone Graft Using Deep Circumflex Iliac Vessels for Idiopathic Osteonecrosis of the Femoral Head Kunihiko Tokunaga, Muroto Sofue, Youichirou Dohmae, Kenji Watanabe, Masaki Ishizaka, Yutaka Ohkawa, Toshio Iga, and Naoto Endo Summary. This study aimed to analyze the clinical and radiologic findings of 59 hips from 46 patients who underwent vascularized iliac bone graft (VIBG) using the deep circumflex iliac artery and vein for idiopathic osteonecrosis of the femoral head (ION). More than half of the femoral heads collapsed even though they did not show preoperative collapse. In males, preoperative collapse of the femoral head, bone graft with total curettage of the osteonecrotic lesion, and bilateral VIBG reduced JOA scores. For patients over 30 years old, preoperative collapse, bone graft with total curettage of the osteonecrotic lesion, and abuse of alcohol reduced survival rate after VIBG when the endpoint was set as collapse of the femoral head. These data suggest that young patients suffering from early-stage ION without collapse of the femoral head should be indicated to undergo VIBG. However, VIBG is only a time-saving surgery to postpone performing total arthroplasty or hemiarthroplasty for patients with early-stage ION because VIBG cannot always improve hip function and femoral head deformity. Idiopathic osteonecrosis, Femoral head, Vascularized iliac bone graft, Collapse, Time-saving surgery Introduction Since 1982, vascularized iliac bone graft (VIBG) has been performed using the deep circumflex iliac vessels in patients suffering from idiopathic osteonecrosis of the femoral head (ION) [1,2]. The concepts of our VIBG method are based on the aim to Division of Orthopedic Surgery, Department of Regenerative Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan 125 126 K. VIBG is indicated for IONs of types B, C-1, and C-2 according to a system devised by the Japanese Investigation Committee for ION. Because other bone- and cartilage-preserving surgeries for the treatment of ION were also available, including transtrochanteric varus osteotomy and transtrochan- teric anterior rotational osteotomy, our VIBG was often indicated for IONs with a relatively wide necrotic area. We initially carried out VIBG for advanced cases with severe femoral head collapse such as stage 3-B or 4 according to the system devised by the Japanese Investigation Committee for ION. The objectives of this study were (1) to analyze radiologic and clinical findings of our VIBG method, (2) to inves- tigate factors affecting radiologic and clinical results, and (3) to determine the indica- tion of VIBG for patients with ION. Patients and Methods We performed VIBG using the deep circumflex iliac artery and vein using the Smith- Petersen approach (Fig. For initial cases, the entire necrotic lesion was curetted, and bone chips were harvested from the ilium and packed with the pedicular bone graft (“old method”). The more-recent method included curettage of the region where the pedicular bone was grafted (“current method”). We analyzed 59 hips from 46 patients (18 women and 28 men) with ION who underwent VIBG from 1982 to 2001. Average follow-up period was 9 years, and average patient age at surgery was 34 years. To assign grades to each type of ION, a system devised by the Japanese Investigation Committee for ION was used, as follows. Types A and B corresponded to cases with a necrotic area less than two-thirds of the weight-bearing surface of the acetabulum. Type C-1 corresponded to cases with a necrotic area greater than two-thirds of the weight- bearing surface of the acetabulum, but the lateral edge never exceeded the most lateral edge of the acetabulum. Type C-2 corresponded to cases with a necrotic area greater than two-thirds of the weight-bearing surface of the acetabulum and a lateral edge exceeding the most lateral edge of the acetabulum. To grade the stage of each ION, a system devised by the Japanese Investigation Committee for ION was also used, as follows. Stage 1 corresponded to a preadiographic stage that was detectable only by one scintigram, magnetic resonance imaging (MRI), or core biopsy.
