Maxillary distraction osteogenesis in Pfeiffer's syndrome: urgent ocular protection by gradual midfacial skeletal advancement

Distraction osteogenesis is increasingly recognised as a potentially useful technique to achieve the co-ordinated augmentation of craniofacial skeletal and soft tissue. A case is presented where bilateral maxillary distraction was successfully used to advance the midface in the treatment of recurrent ocular dislocation, in a 10-month-old boy with Pfeiffer's syndrome.     

Mandibular distraction osteogenesis: effects on articulation and velopharyngeal function

Cytokines can stimulate immune effector cells present within the oral mucosa and epidermis to respond to vaccination or to combat cancer. However, intravenous cytokine delivery is often inefficient and frequently accompanied by systemic toxicity. The goal of this study was to evaluate dogs as a large animal model for gene therapy of cancer because they develop spontaneous oral and epidermal tumors. In this report, we demonstrate that particle-mediated gene transfer of beta-galactosidase, luciferase, interleukin-2, interleukin-6, and granulocyte-macrophage colony stimulating factor (GM-CSF) complementary DNA (cDNA) into the oral mucosa and epidermis of healthy dogs resulted in effective, localized, transgenic protein expression. Additionally, the epidermal sites transfected with GM-CSF developed a profound inflammatory reaction characterized by neutrophilic infiltration. Clinical pathology analyses were unremarkable. These results demonstrate that in vivo particle-mediated gene transfer of canine oral mucosa and epidermis with cytokine cDNA can result in production of biologically active transgenic cytokines with minimal toxicity. These findings have applications to cancer immunotherapy using a gene gun approach.     

Callus distraction: a new method? A historical review of limb lengthening

The technique of callus distraction can be traced back to the work of Codivilla at the beginning of the century. Subsequent to Codivilla, various crude methods of limb lengthening were used but resulted in high complication rates. Not until the work of Putti and Abbott in the 1920s and their painstaking operative technique did the results become verifiable. During the 1930s, various modifications were introduced and the apparatus was simplified. However, because of an increasing tendency to apply this technique to unsuitable cases, it fell into disrepute. After World War II, Anderson, Allan, and Ilizarov developed better equipment, allowing for a better understanding of the biologic principles of callus distraction. In the 1980s, this method was adopted for treatment of major bone defects and shortening of limbs.     

Distraction osteogenesis for lengthening of the hard palate: Part II. Histological study of the hard and soft palate after distraction

To correct velopharyngeal incompetence, a new treatment concept was proposed in Distraction Osteogenesis for Lengthening of the Hard Palate: Part I (using lengthening of the hard and soft palate by distraction osteogenesis). Cephalometry and computed tomography showed successful elongation of the posterior hard palate with gradual calcification. Here the sequential use of fluorochrome markers (oxytetracycline, xylenol orange, DCAF [2,4-bis-N-N'-dicarboxymethyl aminomethyl fluorescein], and alizarin complexone) during the distraction and retention period is reported together with the histologic investigations using light and laser scan microscopy without prior demineralization. The experimental gap showed de novo osteogenesis in all dogs. The new bone was always in continuity with the original anterior and posterior palatal bone margins. It either bridged the experimental gap fully or left a small central zone of fibrous tissue, in which eventual ossification occurred. Several distinct zones could be distinguished: A small central zone was found with parallel strains of collagen fibers, oriented longitudinally in the direction of the distraction. Next to this zone a layer of undifferentiated mesenchymal precursor cells was seen in direct contact to newly formed bone. The next zone was coarse woven bone, showing a transition to mature lamellar bone through remodeling. No evidence of endochondral bone formation was found, i.e., all dogs showed exclusively intramembranous bone formation. The soft tissues showed no signs of alteration: in particular, there was no necrosis or scar formation. The soft tissues were not thinned but appeared to have followed the longitudinal displacement. In conclusion, gradual distraction osteogenesis of the hard palate could be a possible method for lengthening the palate to treat velopharyngeal incompetence.     

Mandibular implant-retained overdenture: finite element analysis of two anchorage systems

Human arm movements towards visual targets are remarkably reproducible in several tasks and conditions. Various authors have reported that trajectories of unconstrained point-to-point movements are slightly curved, smooth and have bell-shaped velocity profiles. The hand paths of such movements show small - but significant - curvatures throughout the workspace. The cause of these curvatures is still obscure. Traditionally this curvature is explained as the result of an optimisation process or is ascribed to mechanical or dynamic properties of the effector system. Recently, however, it has been suggested that these curvatures are due at least partly, to the visual misperception of straight lines. To evaluate the latter hypothesis, we compared unconstrained, self-paced point-to-point movements that subjects made with their right and left hand. We assume that the visual misperception may depend on the position in the workspace, subject, etc. but not on the hand used to make the movement. Therefore we argue that if curvature is caused by a visual misperception of straight lines, curvatures should be the same for movements made with the left and right hand. Our experiments cast strong doubt on the hypothesis that curvatures are the result of a visual distortion, because curvatures of the left hand trajectories, mirrored in the mid-sagittal plane, are found to be accurately described by trajectories of the right hand. Estimates of the effect of visual distortion on movement curvature show that, if present, this effect is very small compared with other sources that contribute to movement curvature. We found that curvatures depend strongly on the subject and on the direction and distance of the movement. Curvatures do not seem to be caused purely by the dynamic properties of the arm, since curvatures do not change significantly with increasing movement velocity. Therefore, we conclude that curvatures reflect an inherent property of the control of multi-joint arm movements.     

Rat mandibular distraction osteogenesis: Part I. Histologic and radiographic analysis

The application of distraction osteogenesis to craniofacial surgery has altered the approach and treatment of congenital and acquired craniofacial defects. Although the histologic and ultrastructural changes associated with distraction osteogenesis have been described extensively, relatively little is known about the molecular regulation of this process. The elucidation of the molecular mechanisms of distraction osteogenesis has important clinical implications because it may facilitate the use of recombinant proteins or gene therapy to accelerate bone regeneration. Molecular analysis of distraction osteogenesis has been hindered by the use of large animal models in which only limited genetic information is available. In this study, a rat model of mandibular distraction osteogenesis is described. This report includes a pilot study (n = 50) to develop an appropriate distraction device and to determine the optimal placement of the osteotomy. The study subsequently included 80 animals, 35 of which were distracted at a rate of 0.25 mm per day for 6 days (1.5 mm total) and 35 that were distracted at a rate of 0.25 mm twice per day (3.0 mm total). These animals were killed at various time points (after latency and during the distraction and consolidation periods) and displayed histologic and radiographic findings of membranous bone distraction osteogenesis that were consistent with those in large ,animal and clinical models. In addition, five animals each were acutely lengthened 1.5 mm and 3.0 mm and demonstrated a fibrous nonunion. Furthermore, the utility of this model is demonstrated in the analysis of the molecular mechanisms of distraction osteogenesis by applying the polymerase chain reaction to total cellular RNA isolated from normal and distracted rat mandibles. In conclusion, it is believed that the rat model of distraction osteogenesis has significant advantages over traditional models, including decreased costs and facilitation of molecular analysis.     

Mandibular onlay grafting using prefabricated bone grafts with primary implant placement: an experimental study in minipigs

The aim of this experimental study was to evaluate the use of prefabricated autogenous bone grafts as onlay grafts to the mandible. Excess bone of 10 x 12 x 40 mm was produced inside blocks of pyrolyzed bovine bone under a polylactic membrane coverage on the outside of the mandible in 15 adult G?ttingen minipigs. After 5 months, this bone was harvested and transferred to the premolar region of the mandibular body in 10 animals. Onlay grafts of mandibular bone were used as controls for the transplanted prefabricated grafts. All grafts were fixed by primary placement of one titanium implant each. Five animals served as ungrafted controls. Evaluation was performed after 3 months and 5 months, respectively. Two animals were lost to evaluation, and one scaffold became infected. Eleven of the remaining 12 scaffolds showed sufficient bone ingrowth for grafting. Three months after transplantation, bone volume of the prefabricated grafts was almost completely preserved, with only minimal resorption in the superficial pores of the scaffolds, while the control grafts exhibited partial resorption. The titanium implants, which had been placed at the time of only grafting, exhibited direct bone-implant contact. Five months after grafting, all titanium implants showed complete osseointegration, with direct bone-implant contact. The grafted bone exhibited a significant increase in bone density by appositional bone formation. The control grafts were nearly completely resorbed at that time.     

Active and passive distraction using a head-mounted display helmet: Effects on cold pressor pain in children.

Objective: The current study tested the effectiveness of interactive versus passive distraction that was delivered via a virtual reality type head-mounted display helmet for children experiencing cold pressor pain. Design: Forty children, aged 5 to 13 years, underwent 1 or 2 baseline cold pressor trials followed by interactive distraction and passive distraction trials in counterbalanced order. Main Outcome Measures: Pain threshold and pain tolerance. Results: Children who experienced either passive or interactive distraction demonstrated significant improvements in both pain tolerance and pain threshold relative to their baseline scores. In contrast, children who underwent a second cold pressor trial without distraction showed no significant improvements in pain tolerance or threshold. Conclusion: Although both distraction conditions were effective, the interactive distraction condition was significantly more effective. Implications for the treatment of children's distress during painful medical procedures are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frontofacial osteotomies, advancement, and remodeling by distraction: an extended application of the technique

The purpose of this clinical report is to present the distraction technique for advancement of the frontofacial skeleton as a unit. Our 14-year-old patient was diagnosed with Carpenter's syndrome and kleblattsch?del deformity at birth. At other centers the patient underwent corrective surgeries, including repeated fronto-orbital advancement in an attempt to correct the residual deformity. This has resulted in bony malunion and recurrent deformity, and it has left the patient with no available donor sites for harvesting of bone graft. The patient had class III malocclusion, severe midfacial and frontal deficiency, and relative turricephaly. We performed frontofacial osteotomies and placement of the distraction devices. Distraction of 20 mm was accomplished, correcting the exophthalmos and midface retrusion and producing class I dental occlusion. We conclude that distraction is an optional surgical method that can be applied in selected cases for advancement of the entire frontofacial skeleton.     

Selectivity in distraction by irrelevant featural singletons: Evidence for two forms of attentional capture.

Four experiments addressed the degree of top-down control over attentional capture in visual search for featural singletons. In a modified spatial cuing paradigm, the spatial relationship and featural similarity of target and distractor singletons were systematically varied. Contrary to previous studies, all 4 experiments showed that when searching for a singleton target, an irrelevant featural singleton captures spatial attention only when defined by the same feature value as the target. Experiments 2, 3, and 4 provided a potential explanation for the discrepancy with previous studies by showing that irrelevant singletons can produce distraction effects that are dissociable from shifts of spatial attention. The results suggest the existence of 2 distinct forms of attentional capture. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quantitating dialysis using two dialysate samples: a simple, practical and accurate approach for evaluating urea kinetics

AIM: Factors which influence the accuracy of the field application during daily irradiation routine are not well known. The aim of this prospective analysis was to determine the significance of these factors on the occurrence of field misadjustments in irradiation without immobilization and to evaluate their clinical relevance. PATIENTS AND METHODS: Fifty-three patients received external cobalt-60 beam irradiation without fixation. Once weekly portal images of all treatment fields were carried out. In addition to objective patient data (age, weight, height, general condition, irradiation indication), the psychological situation of the patient during treatment (anxiety, restlessness, pain) and work circumstances of the medical staff during treatment were evaluated once weekly. The distance of clearly visible anatomic structures to the field borders of the portal images were measured and the deviation to the corresponding simulator images was calculated. Patient data were correlated to the number of field misadjustments (deviation larger than 1 cm). RESULTS: Patients whose condition is generally poor and patients being treated palliatively, patients with feeling of anxiety, restlessness or pain during simulation or irradiation and heavy patients (90 kg and more) were more often misadjusted. The number of field misadjustments increased with the stress of the medical staff. CONCLUSIONS: The problem of reproducibility of external beam irradiation without fixation in palliative treatment is of clinical relevance. Effective analgesic therapy and a comfortable and painfree patient set-up reduce misadjustments. In curative treatment, immobilization techniques should be used.     

Rat mandibular distraction osteogenesis: II. Molecular analysis of transforming growth factor beta-1 and osteocalcin gene expression

Distraction osteogenesis is a powerful technique capable of generating viable osseous tissue by the gradual separation of osteotomized bone edges. Although the histologic and ultrastructural changes associated with this process have been extensively delineated, the molecular events governing these changes remain essentially unknown. We have devised a rat model of mandibular distraction osteogenesis that facilitates molecular analysis of this process. Such information has significant clinical implications because it may enable targeted therapeutic manipulations designed to accelerate osseous regeneration. In this study, we have evaluated the expression of transforming growth factor beta-1, a major regulator of osteogenesis during endochondral bone formation and development, and osteocalcin, an abundant noncollagenous extracellular matrix protein implicated in the regulation of mineralization and bone turnover. The right hemimandible of 36 adult male rats was osteotomized, and a customized distraction device was applied. Animals were allowed to recover and, after a 3-day latency period, were distracted at a rate of 0.25 mm twice daily for 6 days followed by a 2- or 4-week consolidation period. Distraction regenerate was harvested after the latency period, days 2, 4, or 6 of distraction, and after 2 or 4 weeks of consolidation and processed for Northern analysis (n = 4 at each time point) and immunohistochemical localization of TGF-beta1 (n = 2 at each time point). Six sham-operated animals (i.e., skin incision without osteotomy) were also killed (immediately postoperatively), and the mandibles were harvested and prepared in a similar fashion. Equal loading and transfer of RNA for Northern analysis was ensured by stripping and probing membranes with a probe against GAPDH (a housekeeping gene). Our results demonstrate that the spatial and temporal patterns of TGF-beta1 mRNA expression and protein production coincide with osteoblast migration, differentiation, and extracellular matrix synthesis. In addition, we demonstrate that TGF-beta1 production may be an important regulator of vasculogenesis during mandibular distraction osteogenesis. Finally, we have shown that osteocalcin gene expression coincides temporally with mineralization during rat mandibular distraction osteogenesis.     

Body composition analysis by DEXA by using dynamically changing samarium filtration

Dual-energy X-ray absorptiometry (DEXA) has a high accuracy for body composition analysis but is influenced by beam hardening and other error sources in the extremes of measurement. To compensate for beam hardening, the Norland XR-36 introduces a dynamically changing samarium filtration system, which depends on the current-absorber thickness. With this system we found a good agreement (r = 0.99) between reference and measured amounts of tissue or fat percentages in a plastic phantom and in smaller (approximately 0.5-4 kg) and larger (approximately 5-20 kg) piles of tissue (ox muscle and lard). Scans of six healthy volunteers covered with combinations of beef and lard (approximately 5-15 kg) showed a good agreement (r = 0.99) between reference and DEXA values of added soft tissue mass and fat percentage. We conclude that the DEXA method (and, in particular, the Norland XR-36 using dynamic filtration) has a high accuracy for body composition analysis. It has a potential for gaining status as a reference method in the future and may presently be used as a supplement to the traditional methods for body composition analysis.     

Brachymetatarsia: congenitally short third and fourth metatarsals treated by distraction lengthening--a case report and literature summary

Brachymetatarsia is an uncommon condition, and when present, it is usually asymptomatic. A case report demonstrating the use of distraction lengthening for symptomatic multiple congenital short metatarsals is presented. A 15-year-old female with congenital short third and fourth metatarsals was treated for painful transfer lesions under the second and fifth metatarsal heads and a secondary hallux valgus deformity. Surgical correction with a chevron osteotomy, soft tissue reconstruction of the second toe, and distraction lengthening of the third and fourth metatarsals was performed. Three years after treatment, the patient has an excellent clinical correction, with no evidence of recurrent transfer lesions. To our knowledge, this is the first report demonstrating the use of distraction lengthening without supplemental bone graft for multiple short metatarsals in a single extremity.     

Reovirus-specific polypeptides: analysis using discontinuous gel electrophoresis

An analysis of reovirus-specific polypeptides in cells infected with temperature-sensitive mutants under permissive and nonpermissive conditions revealed the presence of (i) all the known viral polypeptides and (ii) aberrant migration of the mu 1 and mu 2 polypeptides in four groups of mutants.     

Evaluation for micropotential analysis by signal-averaged ECG using Holter monitoring

The development of signal-averaged electrocardiogram (SAECG) has made possible the examination of ventricular late potentials (LP). Recently, the Holter SAECG system, which uses the tape of Holter monitoring, was produced. In the filtered QRS duration (FQRS), a correlation of R = 0.81 was seen between real time SAE and Holter SAE. Correlation of root mean square voltage of the signals in the last 40 mS of QRS (RMS40) and the duration of low amplitude signals (< 40 microV) in the latter part of the QRS (LAS40) were 0.79 and 0.70, respectively between these two systems. As good correlation was seen among the various indicators on the Holter SAECG and real time SAECG, a comparative study in the evaluation for ventricular tachycardia (VT) was performed on these two SAECG systems. With the Holter SAECG, positive LP were as follows: in myocardial disease with VT, 83.3% were positive LP; in myocardial disease without VT, 7.5% were positive LP; and in the healthy subjects, 0% were positive LP. For assessing VT, either real time SAECG or the Holter SACGE may be considered equally suitable for clinical use. During the treadmill exercise test, myocardial ischemia was investigated by the Holter SAECG system. After exercise, healthy subjects revealed longer FQRS, larger root mean square voltage of the signals in the QRS (RMS Total). While in ischemic heart disease, that had ST depression on the Holter ECG after exercise, decrease in RMS Total was found. For assessing myocardial ischemia, it is believed that Holter SAECG had the possibility of evaluating high frequency component in the entire QRS.(ABSTRACT TRUNCATED AT 250 WORDS)     

Disruption of short-term memory by changing and deviant sounds: Support for a duplex-mechanism account of auditory distraction.

The disruption of short-term memory by to-be-ignored auditory sequences (the changing-state effect) has often been characterized as attentional capture by deviant events (deviation effect). However, the present study demonstrates that changing-state and deviation effects are functionally distinct forms of auditory distraction: The disruption of visual-verbal serial recall by changing-state speech was independent of the effect of a single deviant voice embedded within the speech (Experiment 1); a voice-deviation effect, but not a changing-state effect, was found on a missing-item task (Experiment 2); and a deviant voice repetition within the context of an alternating-voice irrelevant speech sequence disrupted serial recall (Experiment 3). The authors conclude that the changing-state effect is the result of a conflict between 2 seriation processes being applied concurrently to relevant and irrelevant material, whereas the deviation effect reflects a more general attention-capture process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)