Late capsular hematoma after breast reconstruction with polyurethane-covered implants

We report two patients who developed late hematomas after breast reconstruction with polyurethane-covered implants. Although the cause of these hematomas is not absolutely clear, they are believed to have been caused by the intense, highly vascular inflammatory response that polyurethane coating is known to elicit. The development of late hematoma has not been previously stressed in the literature as a late complication of polyurethane-covered breast implants.     

Synthetic implants in the reconstruction of the ossicular chain

OBJECTIVE: To determine whether there is a relationship between overexpression of c-met oncoprotein and stage of human gastric mucosal lesions, and its significance. METHOD: Immunohistochemical staining was used in 157 cases of endoscopic biopsies with c-met monoclonal antibody, S-19, which was raised against the human c-met gene product. RESULTS: overexpresion of c-met oncoprotein was detected in 3/30 cases (10%) of superficial gastritis, 4/33 cases (12.1%) of chronic atrophic gastritis, 10/31 cases (32.3%) of intestinal mataplasia, 10/30 cases (33.3%) of dysplasia, and 10/30 cases (33.3%) of gastric carcinoma. The positive staining rate was higher in intestinal mataplasia (54.8%), dysplasia (56.7%), carcinoma (53.3%) than in two kinds of simple chronic gastritis (P < 0.05). The positive staining was obviously located in luminal membrane of mucosal cells. The positive cells were mainly situated in proliferative cell zone of gastric glands. Moreover, the weak staining only in this zone was shown in two of the three normal mucosa. CONCLUSIONS: The overexpression of c-met may be involved in proliferation of gastric mucosa. It is possible that persistent overexpression of c-met oncoprotein is associated with the malignant transformation of gastric mucosal cells.     

The reconstruction and dose-rate calculation of radium needle implants

A comprehensive computer program has been developed for carrying out the various tasks associated with radium needle implants. Data input for the program are obtained by digitizing an orthogonal pair of radiographs with an analogue tracing system. Corresponding needles in the two radiographs are automatically located, and the implant may be rotated to any desired position in three dimensional space, at the same time presenting a view of the rotation on a storage oscilloscope. Automatic determination of the mean plane of a planar implant is possible, and the dose-rate distribution may be calculated in any specified plane. A Paterson--Parker exposure rate calculation may be performed with a biological dose and treatment time correction incorporated. The program is written in Fortran and runs on a small interactive computer system.     

Immunodiffusion and immunohistochemical investigations on the reactivity of oxide ceramic middle-ear implants

Oxide ceramic materials (partial and total ossicular replacement prostheses) have been implants of preference for the reconstruction of the ossicular chain because of their excellent biocompatibility. The reaction on the surface of the implants takes place at three biodynamic levels according to the model of Stern's bilayer. We investigated the adsorption of proteins, which is determined by the cellular reaction and degradation to the surface using radial immunodiffusion and immunohistochemical methods. First, ceramic implants of aluminum oxide, hydroxyapatite, glass ceramic and zirconium oxide have individual actual (i.e. biological) surfaces. With a perthometer and the contact-free laser Focodyn method we determined each actual (i.e. biological) surface of the various ceramic implants mentioned above. Using radial immunodiffusion, the adsorption of albumin, glycoprotein, plasminogen, fibronectin, IgA, IgG and IgM shows characteristic rates of adsorption to the respective ceramic surfaces in correlating to the actual surface. A cross-check with fluorescent antibodies confirmed the protein adsorption. The individual surface adsorption of the proteins remains characteristic and is the basis for the recording of cellular reactions after implantation.     

Carbon-fiber implants for knee ligament reconstruction. 10-year results

The retrospective results of carbon prostheses for knee ligament reconstruction in 120 patients, as established by questionnaire, are reported at 10 +/- 2 years follow-up. Eighty patients could also be reviewed clinically. Some 60% of the patients showed good subjective function at reduced activity level. Complications were seen in 72.5% of the patients with rupture of the carbon prosthesis and in 68% of those with synovitis. X-ray showed osteoarthritis in up to 59% of the patients. Carbon prostheses for collateral ligament reconstruction (85% medial, 5.8% lateral) were successful in 75% of cases. Activity and time seem to be less responsible for failure of the carbon prostheses than the features of growing in. Destruction of the knee joint over time is due to reactive synovitis and catabolic enzyme reaction and correlates with joint effusion and pain. If these problems appear, (arthroscopic) resection of the synovia is indicated to interrupt the circulus vitiosus.     

Dental prosthetic reconstruction of osseointegrated implants placed in irradiated bone

Deficiency of the sixth component of human complement (C6) has been reported in a number of families from the western Cape, South Africa. Meningococcal disease is endemic in the Cape and almost all pedigrees of total C6 deficiency (C6Q0) have been ascertained because of recurrent disease. We have sequenced the expressed exons of the C6 gene from selected cases and have found three molecular defects leading to total deficiency: 879delG, which is the common defect in the Cape and hitherto unreported, and 1195delC and 1936delG, which have been previously reported in African-Americans. We also show that the 879delG and 1195delC defects are associated with characteristic C6/C7 region DNA marker haplotypes, although small variations were observed. The 1936delG defect was observed only once in the Cape, but its associated haplotype could be deduced. The data from the haplotypes indicate that these three molecular defects account for the defects in all the 38 unrelated C6Q0 individuals we have studied from the Cape. We have also observed the 879delG defect in two Dutch C6-deficient kindreds, but the 879delG defect in the Cape probably did not come from The Netherlands.     

Functional alveolar ridge reconstruction with prefabricated iliac crest free flap and osseointegrated implants after hemimaxillectomy

We achieved functional alveolar ridge reconstruction after hemimaxillectomy using a prefabricated iliac crest flap. The iliac crest was vascularized secondarily by a long rectus abdominis muscle flap with its inferior epigastric vessels intact to obtain an ideal anatomic location between the maxillary defect and microvascular anastomosis site. The iliac crest was tightly resurfaced with a split-thickness skin graft as well. After a bony surgical delay, the prefabricated iliac crest flap was microsurgically transferred to the face. Three osseointegrated implants were placed in the prefabricated iliac crest, and a dental prosthesis was worn with immobilization and stability. Our procedure enabled recovery of a satisfactory facial appearance and excellent masticatory function.     

Full mouth reconstruction. Utilizing fiber-reinforced framework and Ceromer restorations in combination with pressed ceramic technology

The final results of this case were pleasing to the patient and the dentist (Fig. 5). The missing teeth had been replaced, function had been restored, the anterior crowding had been eliminated (Fig. 6), and the bioesthetic symmetry and harmony had been restored (Fig. 7). The patient reported a dramatic increase in self confidence with her peers. (Fig. 8) Special thanks to Michael Milner for the excellent Laboratory work provided for this case.     

Placement of endosteal implants combined with chin bone onlay graft for dental reconstruction in patients with grafted alveolar clefts

CONTEXT: Physical activity and fitness are believed to reduce premature mortality, but whether genetic factors modify this effect is not known. OBJECTIVE: To investigate leisure physical activity and mortality with respect to familial aggregation of health habits during childhood and factors that may enable some individuals to achieve higher levels of fitness. DESIGN: Prospective twin cohort study. SETTING: Finland. SUBJECTS: In 1975, at baseline, 7925 healthy men and 7977 healthy women of the Finnish Twin Cohort aged 25 to 64 years who responded to a questionnaire on physical activity habits and known predictors of mortality. Those who reported exercising at least 6 times per month with an intensity corresponding to at least vigorous walking for a mean duration of 30 minutes were classified as conditioning exercisers, those who reported no leisure physical activity were classified as sedentary, and other subjects were classified as occasional exercisers. MAIN OUTCOME MEASURES: All-cause mortality and discordant deaths among same-sex twin pairs from 1977 through 1994. RESULTS: Among the entire cohort, 1253 subjects died. The hazard ratio for death adjusted for age and sex was 0.71 (95% confidence interval [CI], 0.62-0.81) in occasional exercisers and 0.57 (95% CI, 0.45-0.74) in conditioning exercisers, compared with those who were sedentary (Pfor trend <.001). Among the twin pairs who were healthy at baseline and discordant for death (n=434), the odds ratio for death was 0.66 (95% CI, 0.46-0.94) in occasional exercisers and 0.44 (95% CI, 0.23-0.83) in conditioning exercisers compared with those who were sedentary (P for trend, .005). The beneficial effect of physical activity remained after controlling for other predictors of mortality. CONCLUSION: Leisure-time physical activity is associated with reduced mortality, even after genetic and other familial factors are taken into account.     

Primary insertion of osseointegrated dental implants into fibula osteoseptocutaneous free flap for mandible reconstruction

Twelve patients with segmental mandibular defects were reconstructed with fibula osteoseptocutaneous flaps and simultaneous placement of osseointegrated implants. Decision to perform this procedure was based on the facts that all patients had benign diseases, did not require postoperative radiotherapy, were in good general and oral conditions, and were psychologically motivated. A total of 34 fixtures was inserted in the first stage. Eight patients underwent second stage surgery, which consisted of connection of the implant abutments to the fixtures and the use of palatal mucosal grafts around the implants. Final dental prostheses were fixed 1 month later in seven patients, at this time. All flaps survived after surgery, and no implant failure was observed after a mean follow-up period of 25 months. Only one fixture was not used during the subsequent stage and was left as a sleeper. Fixed dental prostheses were used in five patients and removable overlay prostheses in the other two. Chewing function was recovered between 4 and 6 weeks after the start using the definitive dental prosthesis. In contrast to previous results, we conclude that excellent results can be achieved when this combined procedure is used in carefully selected patients. In addition, it is confirmed that the fibula osteoseptocutaneous flap is a versatile, reliable composite tissue that facilitates primary placement of osseointegrated dental implants during mandible reconstruction, thus allowing full oral rehabilitation in a shorter period of time.     

Educating a patient with dental implants

A functional dentition can be restored for edentulous and partially edentulous patients through the placement of dental implants. Dental assistants have a significant role in the education of implant patients so that meticulous oral self-care can be accomplished. Only through the combined team efforts of the dental office staff and patients themselves will the continued success of dental implantology be insured.     

Use of demineralized bone implants in orbital and craniofacial reconstruction and a review of the literature

A retrospective study and review of the literature was performed on the use of demineralized bone implants for the correction of orbital and craniofacial defects. Demineralized bone implants heal by endochondral osteogenesis, inducing a transformation of local cells, as well as by osteoconduction, similar to autogenous grafts. They induce the chemotaxis and transformation of mesenchymal cells into chondroblasts, followed by ossification. They also act as a scaffold, with bone resorption taking place simultaneous with bone formation. This study reviewed 21 patients and 31 orbits, in which demineralized bone was used for orbitocranial reconstruction for congenital deformities (nine patients), after surgery for orbital fractures (seven patients: four floor, three roof), and orbital tumors (five patients). The surgical technique is described, and the results are discussed. The follow-up period averaged 15 months (6 months to 33 months). The overall resorption rate of the demineralized bone implants was estimated based on follow-up radiologic studies (facial films, computed tomography scans, and magnetic resonance imaging scans), as well as clinical examinations. All patients had a satisfactory to excellent result. The demineralized bone and Grafton (Osteotech, Shrewsbury, NJ, U.S.A.) was obtained from the Musculoskeletal Transplant Foundation of Holmdel, New Jersey, and it was all processed and reconstituted in a standard manner with Alloprep System. Surgical complications were cerebrospinal fluid leaks (one patient) with infection, transient chemosis, enophthalmos, and hypophthalmos. There were no complications related to demineralized bone alone. Properly prepared demineralized bone is a safe material for orbital reconstruction that eliminates the need for a second operative site to harvest a bone graft.     

Observation on women with breast implants

The controversy over silicone breast implants continues. This review considers evidence on both sides of the issue. Clinical observations suggests consistent chronic fatigue, muscle pain, joint pain, lymphadenopathy, peripheral neuritis and bladder dysfunction syndrome. Epidemiologic studies of defined connective tissue diseases do not show an association, but some studies show a statistical increase in prevalence of symptoms. The author believes symptomatic women should consider having the breast implants removed and not replaced.     

Evolution of the local calcium content around irradiated beta-tricalcium phosphate ceramic implants: in vivo study in the rabbit

To evaluate whether dissolved calcium from tricalcium phosphate implants contributes to osseous wound healing in bone defects, the authors used nuclear radioactivated materials. Six months after irradiation, the calcium was still radioactive. Samples of the material were prepared and placed in rabbit condyles for 1, 3 and 9 months. Over time the condyles were retrieved and treated for histology or radiocounting. Measurements of the radioactivity of the slices and histomorphometry of the implants and surrounding tissues were performed. The authors observed that the radioactivity decreased regularly. Connective tissue had penetrated the pores and totally invaded the implants, first at the periphery of the implants, then inside the pores. Comparison of the results of radioactivity and histomorphometry suggest that part of the calcium from the implants was re-used specifically in the new osseous tissue.     

Biomechanical and histologic alteration of facial recipient bone after reconstruction with autogenous bone grafts and alloplastic implants: a 1-year study

Potential alteration of the underlying recipient bone resulting from a graft or implant has significant clinical relevance. The present study was designed to evaluate the biomechanical and histologic alteration of facial recipient bone with autogenous bone graft and alloplastic implants over a 1-year period. The bilateral arches of 15 rabbits were randomized between four groups: (1) control (n = 6), subperiosteal exposure of the zygomatic arch was made; (2) onlay (n = 12), bone graft was placed as an onlay to the zygomatic arch; (3) inlay (n = 6), bone graft was placed as an inlay within the zygomatic arch; (4) implant (n = 6), a stainless steel plate was placed as an onlay to the zygomatic arch. Animals were killed 1 year after grafting. In the onlay groups, all steel implants and half of the onlay bone grafts (n = 6) were separated from the zygomatic arch; the remaining onlay bone grafts (n = 6) were left on the zygomatic arch. Three-point breaking strength was measured through the center of the graft/implant site on the zygomatic arch, followed by histologic evaluation and histometric assessment of residual bone density. The findings demonstrated no difference in the breaking strength per unit bone area between the control zygomatic arch group and the onlay group in which the bone graft was left in place. Breaking strength of the zygomatic arch in the former two groups was significantly greater than that in either group in which the onlay bone graft or implant had been removed, and was also greater than the breaking strength in that group in which inlay bone had been placed (p < 0.05). Histologic assessment showed full-thickness conversion in architecture of the zygomatic arch from compact to woven bone beneath onlays of either autogenous bone graft or steel implant; histometric assessment demonstrated an accompanying decrease in bone density in the latter groups relative to the control zygoma (p < 0.05). We conclude that onlay autogenous bone graft and alloplastic implants to the facial skeleton induce transformation of both graft and recipient bone from compact to woven architecture, accompanied by a reduction in bone density. The biomechanical strength of recipient facial bone is significantly weakened if an onlay bone graft or implant is removed. Weakening occurs per unit area of remaining bone, and is therefore independent of any thinning that may occur within the recipient bone because of graft/implant placement. These findings may impact upon decisions to augment stress-bearing regions of the facial skeleton with bone graft or implants, particularly if the graft/implant may eventually require removal.     

Orbital lymphosarcoma associated with reticuloendotheliosis virus in a peafowl

Escherichia coli biotin carboxylase was affinity labeled with adenosine diphosphopyridoxal to identify its ATP binding site. Lysyl endopeptidase digestion of the modified protein, followed by high performance liquid chromatography separation and amino acid sequencing allowed to identify lysine-238 to be the site of modification. Site-directed mutagenesis of this residue into alanine, arginine or glutamine resulted in mutants with much decreased activity. Lysine-238 seems to interact with the gamma-phosphate group of ATP but is not involved in catalysis.     

Neurologic disease among women with breast implants

US angiography, enhanced with intraarterial CO2 microbubbles imaging, documented 40 nodules of hepatocellular carcinoma (HCC) lesser than 20 mm in diameter in 34 patients, which were convinced histopathologically. As to the imaging acuity of arterial vascularity in nodules, US angiography was compared with DSA and US color angio. The detection of arterial vascularity was possible in 34 (85.0%) of 40 nodules by US angiography, 26 (65.0%) by DSA, and 28 (70.0 %) by US color angio. US angiography was available for detection of HCC, particularly with small HCC lesser than 20 mm in size.     

Health risks for women with breast implants

Women who have undergone implantation of a breast prosthesis have been exposed to a variety of health risks, many of which were unknown to them at the time of surgery. Recognition of health hazards has prompted the Food and Drug Administration to restrict implantation of these devices while study of safety and efficacy are undertaken. Capsule contracture, or the contraction of the fibrous tissue surrounding the prosthesis, is the most frequently occurring complication. Exposure to an implant does not appear to heighten the risk for breast cancer, but the opacity of a prosthesis substantially reduces the diagnostic capability of mammography. Silicone, used in the manufacture of implants, is linked to immunologic changes that result in connective tissue disorders. Most often this condition is scleroderma. Damaging effects from toluenediamine, a disintegration product of the polyurethane coating, have been reported. Whether the concentration of this chemical reaches toxic levels in women with prostheses remains to be clarified by current investigations.