Bony healing of large cranial and mandibular defects protected from soft-tissue interposition: A comparative study of spontaneous bone regeneration, osteoconduction, and cancellous autografting in dogs

The purpose of this study was to compare spontaneous bone regeneration, osteoconduction, and bone autografting in critical size calvarial and mandibular defects (defects which do not heal spontaneously during the lifetime of the animal) that were protected from soft-tissue interposition. Eighteen adult mongrel dogs underwent osteotomies to create a unilateral 30-mm segmental defect in the midbody of the edentulated right mandible and bilateral 15-mm x 20-mm full-thickness window defects in the parietal bones. The defects were either left empty, implanted with coralline hydroxyapatite (HA) blocks, or autografted with iliac cancellous bone. All defects were protected with a macroporous titanium mesh and the segmental mandibular defects were additionally stabilized by internal plate fixation. Specimens were retrieved after 2 and 4 months and three undecalcified longitudinal central sections including the osteotomy interfaces were prepared from each specimen for histometry and histology. Sections were analyzed for volume fractions of bone, soft tissue, and implant using scanning electron microscopy, backscatter electron imaging and histometric computer software. In the mandibular model, the empty defects exhibited the greatest amount of bone formation after 4 months (47.3 percent), which was greater than the amount of bone in the autografted group (34.8 percent) and significantly greater than the amount of bone within the hydroxyapatite implants (19.0 percent, p < 0.05). In the cranial defects, the autografted specimens demonstrated the greatest volume fraction of bone after 4 months (27.3 percent), which was significantly greater than within both the empty defects (18.2 percent, p < 0.05) and the hydroxyapatite implants (18.2 percent, p < 0.05). New bone formation in the mandibular defects united the cut ends at 4 months regardless of treatment and originated predominantly from the periosteum which remained present only along the alveolar border after surgical closure. In the calvarial defects, periosteum was not preserved and bone regenerated centripetally, originating from the diplo? without any evidence of dural osteogenesis. Bone bridging was incomplete in the empty cranial defects at 4 months. In both the mandibular and cranial specimens, new bone at 2 months was a mixture of woven and parallel fibered bone. At 4 months, the new bone had remodeled almost entirely into mature Haversian bone. This study demonstrated a remarkable ability of defect protection with a macroporous protective sheet to facilitate bone regeneration in critical size mandibular and cranial bone defects. When active osteogenic periosteum was present, as in our mandibular model, we concluded that defect protection alone was sufficient to allow for healing even of critical size defects. When periosteum was absent as in our cranial defects, the limited spontaneous bone formation benefited from the added contributions of cancellous grafting and osteoconductive implants, both of which promoted bone bridging across the defects. We suggest that in the future a resorbable macroporous protective sheet would be advantageous in comparison to a titanium mesh to facilitate bone regeneration by preventing soft-tissue prolapse and allowing the migration of mesenchymal cells and the proliferation of blood vessels from the adjacent soft tissues into the bone defect. Finally, this study identified the need to differentiate critical size defects into those with and without defect protection and periosteum.     

The impact of liposuction on body fat

Routine liposuction has very low perioperative complication rates and is thus considered to be innocuous. Some authors have even proposed that large-volume liposuction could be therapeutic. However, because subcutaneous adipose tissue has nutritional and thermodynamic metabolic functions proportional to the absolute amount and the distribution of fat, it is possible that removal of subcutaneous adipose tissue might be detrimental. We measured the amount of fat removed by large-volume (>1000 cc) liposuction and expressed the results in terms of absolute and relative changes in total body fat and in visceral adipose tissue (nonsubcutaneous adipose tissue) in 63 normal weight to mildly obese women (n = 51) and men (n = 12). Aspiration of 1.5 +/- 0.7 kg (mean +/- SD) of lipid in women removed 9.2 +/- 3.2 percent of body fat or 10.5 percent of subcutaneous adipose tissue corresponding to a 12-percent increase in the ratio of visceral to subcutaneous adipose tissue. One third of the women (n = 17) had a mean increase of 16 percent (range 13 to 21 percent) in the proportion of visceral fat. In the 12 men, aspiration of 1.7 +/- 0.6 kg of lipid removed 9.8 +/- 2.9 percent of body fat or 12.7 +/- 3.6 percent of subcutaneous adipose tissue, resulting in a 14-percent increase in the ratio of visceral to subcutaneous fat. The correlation between aspirate and body mass index was 0.57 (p < 0.001). Although large-volume subcutaneous liposuction removed relatively little body fat, it led to significant increases in the proportion of visceral adipose tissue. Because the proportion of visceral adipose tissue is a risk factor for metabolic complications of obesity, the metabolic effects of large-volume liposuction need to be evaluated.     

Expression of the 27,000 mol. wt heat shock protein following kainic acid-induced status epilepticus in the rat

Western analysis and immunohistochemistry were used to determine the time-course and the distribution of the 27,000 mol. wt heat shock protein, Hsp27, in rat brain following systemic administration of kainic acid. No Hsp27 immunoreactivity was detected in naive control animals or in rats that failed to develop status epilepticus. Hsp27 immunoreactivity was detected as early as 12 h in the parietal cortex, piriform cortex and the hippocampus of rats that developed status epilepticus. The number of cells expressing Hsp27 and the intensity of Hsp27 immunoreactivity were increased 24 h after kainic acid administration. Hsp27 immunoreactivity was still observed seven days post-kainic acid injection. The morphology of the Hsp27-positive cells and double immunofluorescence against Hsp27 and glial fibrillary acidic protein revealed that Hsp27-positive cells were astrocytes. In addition, the distribution of Hsp27 suggested that astrocytic Hsp27 was dependent on excitation-induced metabolic stress rather than the direct effect of kainic acid on astrocytes.     

The effect of finishing and polishing on surface roughness of a processed resilient denture liner

A raised ridge on a Molloplast-B sample was removed using one of three burs, four stones, or a coarse sandpaper disc. Samples were polished using pumice alone, tin oxide alone, or both agents. A flat, unfinished sample served as a control. The average surface roughness was measured after reductions and subsequent polishings. The length of time required for initial reduction was recorded. Average surface roughness measurements ranged from 16.0 to 1.4 microns, with the control measuring 0.66 micron. Without polishing, burs produced rougher surfaces than stones and required longer times for reduction. Bur samples also remained rougher than stone samples after pumicing. No significant differences were found between treatments or controls after the use of either a combination of pumice and tin oxide or tin oxide alone.     

Chondrosarcoma metastatic to the eye

Diagnostic endoscopic retrograde cholangiopancreatography (ERCP) is a remarkably safe procedure in experienced hands. A series of complications directly related to both the manipulation and cannulation of the ampulla of Vater, as well as consequent to medication and cardiorespiratory events, has been described. Herein we report a case of severe barotrauma complication of diagnostic endoscopic cholangiography.     

Performance and metabolic responses of young dairy calves fed diets supplemented with chromium tripicolinate

Forty-two Holstein calves were used to study performance and metabolic responses when milk replacer and then postweaning starter were supplemented with 1 ppm of Cr as Cr-tripicolinate. From birth through 8 wk of age, supplemental Cr tended to improve the growth performance of bull calves but not of heifer calves. Starter intake and feed efficiency were not affected by supplemental Cr. From 1 to 5 wk of age, plasma cortisol concentrations sampled just prior to feeding decreased, and concentrations of insulin-like growth factor-I increased. All calves appeared to become less sensitive to insulin as they aged. From 1 to 5 wk of age, plasma glucose and insulin concentrations gradually diverged for all calves; glucose concentrations decreased, and insulin concentrations increased. In addition, glucose clearance rate, measured by i.v. glucose tolerance tests, was more rapid when calves were 2 wk of age than when calves were 8 wk of age. The glucose clearance rate was greater in heifer calves than in bull calves but was not affected by supplemental Cr. Entry of plasma glucose following an i.v. propionate load was also greater in heifer calves than in bull calves but was not affected by supplemental Cr. Plasma nonesterified fatty acids were lower in calves fed milk replacer or starter supplemented with Cr than in control calves, although this effect diminished as calves aged. This finding was considered to be indirect evidence of enhanced insulin sensitivity in calves fed milk replacer or starter supplemented with Cr. Overall, data suggested that supplemental Cr-tripicolinate had minor effects on the metabolism and growth performance of conventionally managed dairy calves. The most notable effects occurred during the initial few weeks of life.     

Elimination of susceptibility distortions and reduction of diffusion attenuation in NMR microscopy by line-narrowed 2DFT

NMR imaging at high field strengths is adversely affected by magnetic susceptibility variations within the specimen. This is especially true in NMR microscopy. We present results using a line-narrowed imaging sequence which overcomes the image distortions associated with the frequency encoded readout method. Signal attenuation due to diffusion in static magnetic field gradients is also reduced.     

Correlation of very late activation integrin and CD44 expression with extrarenal invasion and metastasis of renal cell carcinomas

Cell adhesion molecules mediate cell-cell and cell-matrix interactions, and they are thought to play an important role in tumor invasion and metastasis. Altered expression of integrins and CD44 in renal cell carcinoma has been recently demonstrated, but an association with invasive or metastatic behavior has not been reported. We examined very late activation (VLA) integrin and CD44 expression in 37 renal cell carcinomas and correlated adhesion molecule expression with multiple histological and clinical parameters. Most tumors exhibited positive staining for VLA3 (81%). Approximately one third of the tumors stained positively for VLA6 and CD44, and fewer (27%) were positive for VLA2. Only a few tumors were positive for VLA4 (8%) and VLA5 (14%). Most of the tumors exhibiting positive staining showed a combination of membranous and cytoplasmic staining patterns. Low-grade tumors positive for VLA6 showed a tendency for basilar staining of the tumor cells, whereas high-grade tumors exhibited diffuse cytoplasmic staining. All tumors exhibiting weak or strong positive staining for VLA4 or VLA5 showed extrarenal invasion or were known to have developed metastases at the time of nephrectomy. All tumors strongly positive for VLA2 or CD44 showed invasion beyond the renal capsule or metastases. In contrast to a previous study, no association was observed between positive staining and tumor grade. Nor were tumor size, architectural pattern, cell type, or DNA ploidy found to be associated with particular staining patterns. Although many of the invasive tumors showed no difference in VLA integrin or CD44 expression compared with tumors confined to the kidney, increased expression in some of them suggests that these cell adhesion molecules may contribute to the invasive or metastatic phenotype.