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The clinical practice of anesthesia has undergone many advances in the past few years, making this the perfect time for a new state-of-the-art anesthesia textbook for practitioners and trainees. The goal of this book is to provide a modern, clinically focused textbook giving rapid access to comprehensive, succinct knowledge from experts in the field. All clinical topics of relevance to anesthesiology are organized into 29 sections consisting of more than 180 chapters. The print version contains 166 chapters that cover all of the essential clinical topics, while an additional 17 chapters on subjects of interest to the more advanced practitioner can be freely accessed at www.cambridge.org/vacanti. Newer techniques such as ultrasound nerve blocks, robotic surgery and transesophageal echocardiography are included, and numerous illustrations and tables assist the reader in rapidly assimilating key information. This authoritative text is edited by distinguished Harvard Medical School faculty, with contributors from many of the leading academic anesthesiology departments in the United States and an introduction from Dr S. R. Mallampati. This book is your essential companion when preparing for board review and recertification exams and in your daily clinical practice.
The three most important components of tissue engineering are biomaterials, cellular biology, and vascular supply. Biomaterials are needed to control the delivery of new cells into the body. In the absence of biomaterials, cells that are injected into a vein, a cavity, or tissue tend to disperse, so a sufficiently high density of cells to perform the intended function—replacement or repair of a damaged structure—is never achieved.1 A porous delivery system is needed that confines the cells to the desired location and promotes their nourishment until blood vessels grow in and new tissue is formed. Biomaterials such as plastics can provide such a porous delivery system.
The ability to create bone from periosteum and biodegradable polymer may have significant utility in reconstructive orthopedic and plastic surgery. Polyglycolic acid (PGA) serves as a biodegradable matrix which can be configured to a desirable shape and structure. This study was conducted to generate new bone tissue from periosteum and PGA polymer and to compare the tissue to the bone tissue generated from periosteal cells seeded onto PGA polymer. Bovine periosteum, harvested from fresh calf limbs, was placed either directly onto PGA polymer (1 cm2) or onto tissue culture dishes for periosteal cell isolation. In Medium 199 media with antibiotics and ascorbic acid, the periosteum/PGA construct was cultured for one week, then implanted into the dorsal subcutaneous space of nude mice. Periosteal cells, cultured from pieces of periosteum for two weeks, were isolated into cell suspension and seeded (˜l-3× 107 cells) onto PGA polymer (1 cm2); after one week in culture, the periosteal cell-seeded polymer was implanted into the subcutaneous space of athymic mice. Specimens, harvested at 4, 8, and 14 week intervals, were evaluated grossly and histologically. The periosteum/PGA constructs showed an organized cartilage matrix with early evidence of bone formation at 4 weeks, a mixture of bone and cartilage at 8 weeks, and a complete bone matrix at 14 weeks. Constructs created from periosteal cells seeded onto polymer showed presence of disorganized cartilage at 4 and 8 weeks, and a mixture of bone and cartilage at 14 weeks. Periosteum placed directly onto polymer will form an organized cartilage and bone matrix earlier than constructs formed from periosteal cell-seeded polymer. This data suggests that PGA is an effective scaffold for periosteal cell attachment and migration to produce bone which may offer new approaches to reconstructive surgery.
This report concerns the tissue-engineered growth of new cartilage in the shape of a human ear. Using synthetic biodegradable polyesters, a porous, three dimensional device in the shape of a human ear was fabricated. The polymer matrices were seeded with living chondrocytes isolated from a freshly sacrificed calf shoulder and implanted subcutaneously on the dorsum of athymic rats. This resulted in the formation of new cartilage in the shape of a human ear of approximately the same dimensions as the original implants. Histological analysis revealed the presence of mature cartilage in all specimens.
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