Purpose: Palatal fracture and mandible fracture result in instability of dental arch. Because they divide the maxillary and mandibular alveolus sagittally and / or transversely and comminute the dentition, they permit rotation of dental alveolar segments and significantly increase the potential for fracture malalignment, complicating fracture treatment. Previous treatment of palatal fracture consisted of palatal splint application and rigid palatal vault stabilization. This procedure result in patient's oral discomfort and removal of palate and screw. Mandible fracture often results in malocclusion due to widening of posterior aspect of dental arch. So we introduce more simple method using intermolar traction wiring, which can protect the widening of dental arch and rotation of dental alveolar segment. Methods: Arch bar and intermolar traction wiring with wire 1 - 0, or 2 - 0 was applied. After exposure of fracture line, neutrooclusion was maintained with intermaxillary fixation. And then open reduction & internal fixation on maxillary fracture line, commonly maxillary buttress, alveolar ridge, pyriform aperture except palatal vault or mandibular fracture line. After 1 week, intermolar traction wiring was removed. We checked occlusion and postoperative radiologic finding. Results: From June of 2007 to October of 2007, 10 patient, who have maxillary fracture with palatal fracture and mandible fracture, underwent open reduction & internal fixation with intermolar traction wiring. All have satisfactory occlusion and there were no complication, like gingiva disease, mouth opening impairment and nonunion. Conclusion: The intermolar traction wiring accompany open reduction and internal fixation can be alternative method for restoration of dental arch in facial bone fracture.
Purpose: To report the clinical results and efficacies of one stage reverse lateral supramalleolar adipofascial flap for soft tissue reconstruction of the foot and ankle joint. Material and Methods: We performed 5 cases of one stage reverse lateral supramalleolar adipofascial flap from Jan 2005 to Sept 2005. All patients were males and mean age was 50(36~59) years old. The causes of soft tissue defects were 1 diabetic foot, 2 crushing injuries of the foot, 1 open fracture of the calcaneus, and 1 chronic osteomyelitis of the medial cuneiform bone. Average size of the flap was 3.6(3~4)${\times}$4.6(4~6) cm. All flaps were harvested as adipofascial flap and were performed with the split-thickness skin grafts (STSG) above the flaps simultaneously. Results: All flap survived completely and good taking of STSG on the flap was achieved in all cases. There were no venous congestion and marginal necrosis of the flap. In diabetic foot case, wound was healed at 4 weeks after surgery due to wound infection. There was no contracture on the grafted sites. Ankle and toe motion were not restricted at last follow up. All patients did not have difficulty in wearing shoes. Conclusion: The reverse lateral supramalleolar adipofascial flap and STSG offers a valuable option for repair of exposure of the tendon and bone around the ankle and foot. Also one stage procedure with STSG can give more advantages than second stage with FTSG, such as good and fast take-up, early ambulation and physical therapy, and good functional result.
The pathway and time course of fucose-containing glycoprotein synthesis and intracellular translocation in osteoclasts of the mice maxillary alveolar bone were investigated by electron microscopic radioautography. Male Balb-C mice weighing 17gm were anesthetized with Nembutal and injected via the external jugular vein with 2.5 mCi of $L-[6-^{3}H]-fucose$ (specific activity 16.8 mCi/mmol) in 0.1 ml of sterile saline solution. At 5, 10, 20, 35 minutes and 8 hours after administration of the $^{3}H-fucose$, animals were killed by intracardiac perfusion of 30ml of 2% glutaraldehyde in a modified Tyroid solution, pH 7.4. The maxillae were then removed and further fixed in Karnovsky fixative for an additional 3-4 hours. After rinsing in 0.1M cacodylate buffer for 10 minutes, the maxillae were demineralized for 2 weeks at $4^{\circ}C$ in ethylene diamine tetra acetate containing 2% glutaraldehyde. The first interdental areas were mesiodistally sectioned into slices of 1mm thickness and postfixed in osmium tetroxide. Tissues were then dehydrated and embedded in Poly Bed. To prepare electron microscopic radioautography, the dipping method of Kopriwa (1973) was employed. Thin sections were coated with a crystalline monolayer of ILford $L_4$ photographic emulsion. After exposure for 4 months at $4^{\circ}C$, the sections were developed Kodak Microdol-X and Phenidon (for compact grains), fixed in 30% sodium thiosulfate, stained with uranyl acetate and lead citrate and examined in the electron microscope (JEOL 1200 EX). At 5, 10 and 20 minutes after injection, $^{3}H-fucose$ was concentrated in Golgi cisternae of the osteoblasts. By 35 minutes the labels were observed over small vesicles in the suprannclear area of osteoclasts. At 8 hours, numerous silver grains were located on the ruffled border and cell membrane of osteoclasts. These results indicate that fucose molecules are added in the Golgi apparatus and small vesicles appear to be responsible for translocation of the glycoproteins to the marginal portion of osteoblasts. The glycoproteins are distributed on the osteoclast cell surface and especially over the ruffled border.
Journal of International Society for Simulation Surgery
/
제1권2호
/
pp.99-102
/
2014
The skull defect can be made after the trauma, oncologic problems or neurosurgery. The skull reconstruction has been the challenging issue in craniofacial fields for a long time. So far the skull reconstruction with autogenous bone would be the standard. Although the autogenous bone would be the ideal one for skull reconstruction, donor site morbidity would be the inevitable problem in many cases. Meanwhile various types of allogenic and alloplastic materials have been also used. However, skull reconstruction with many alloplastic material have produced no less complications including infection, exposure, and delayed wound healing. Because the 3D printing technique evolved so fast that 3D printed titanium implant were possible recently. The aim of this trial is to try to restore the original skull anatomy as possible using the 3D printed titanium implant, based on the mirrored three dimensional CT images based on the computer simulation. Preoperative computed tomography (CT) data were processed for the patient and a rapid prototyping (RP) model was produced. At the same time, the uninjured side was mirrored and superimposed onto the traumatized side, to create a mirror-image of the RP model. And we fabricated Titanium implant to reconstruct three-dimensional orbital structure in advance, using the 3D printer. This prefabricated Titanium-implant was then inserted onto the defected skull and fixed. Three dimensional printing technique of titanium material based on the computer simulation turned out to be very successful in this patient. Individualized approach for each patient could be an ideal way to manage the traumatic patients in near future.
A 10-day-old, Holstein calf with facial mass of 10 cm in diameter at the forehead region referred to Veterinary Medical Teaching Hospital in Chungnam National University. The mass was soft and fluctuating swelling. It had normal skin and hair hanging forward from frontal region and was thought to contain cerebrospinal fluid. On the skull radiography, cauliflower like-irregular marginated, soft tissue opacity mass was identified craniodorsal to the frontal bone. The mass appeared as a cyst filled with anechoic fluid on ultrasonography. Soft tissue structures considered brain tissues were observed in the deep area of the mass. On the computed tomography, a large skull defect of left side frontal bone was found, and heterogeneous materials were exposed through the defect but exposure of cerebral meninges and brain tissue were not confirmative. On magnetic resonance imaging, herniated left brain parenchyma showed heterogenous T2 and T1 hyperinsensity. In the intracranium, T2 hyperinstense and T1 hypointense fluid was identified on the left side, instead of left cerebral parenchyma. Also leftward shift of right hemisphere and midline structure, including thalamus and midbrain, were observed. The definitive diagnosis was confirmed as a meningoencephalocele based on computed tomography and magnetic resonance imaging. The calf was euthanized and necropsy was performed. On necropsy, both hemisphere were developed unequally with different size. One side hemisphere was grown in the outside through 10 cm hole on the median plane.
Purpose: The basic vascular anatomy and versatility of the anterolateral thigh flap was reported firstly by Song in 1984 and then by Zhang who introduced the reverse flow pattern of this flap. In this case, the authors reviewed various articles and their experiences with the distally based anterolateral thigh flap and applied it for coverage of bone-exposed wound occurred at the distal of the disarticulated knee stump. We consequently reported the reliability and resourcefulness of this flap in the difficult and limited situation. Methods: A 67-year-old-man who had suffered from arteriosclerotic obliterans inevitably underwent the disarticulation at knee joint due to clinical deterioration. He presented to our clinic with soft tissue necrosis and bone exposure at the stump. We debrided the wound and conducted the distally based anterolateral thigh island flap by transecting proximal portion of descending branch of the lateral circumflex femoral artery and the $14{\times}10cm$ sized flap was transferred to cover the defect. The pedicle measured 14 cm in length with pivot point 7 cm above the patella. Results: The postoperative course was mainly uneventful except early venous congestion for 4 days and subsequent partial skin loss. The wound was healed by secondary intension and no other sequelae had been observed during follow-up period of 12 months. Conclusion: Despite the presence of various reconstructive choices, the distally based anterolateral thigh island flap can be designed to repair soft tissue defects around the knee region, providing its reliable blood supply and long pedicle length, especially in the challenging cases.
The purpose of this study is to evaluate the distribution of stress in the root end resected teeth. The finite element method was used to compare stresses along the root and retrograde filling material in seven two-dimensional models of mandibular 2nd premolar. Each model was endodontic treatment and gold crown' restoration. Each model divided with amagam core restoration or gold casting post restoration. Thus each model divided with shape of root end resection, depth of retropreparation and exposure length of root in the bony cavity. The seven models were classified as in the table 1 below. A load of 500N was applied $45^{\circ}$ diagonally on the lingual slope of the buccal cusp. These mode were analyzed with two dimensional finite element methods. The results of this study were as follows : 1. The maximum tensile stress along the inner canal wall was shown on the model 7. 2. When the model 1 was compared with the model 5, the maximum tensile stress along the inner canal wall showed the model 1. 3. Less equivalent stress was shown on the model 6 and more equivalent stress was shown on the model 4. 4. More shear stress was shown on the retrograde filling material of the model 7. 5. The models with increased length of exposed root in the bony cavity demonstrated a gradual increase to the tensile stress in X direction which occurred approximately a boundary between the bone and exposed root in' the bony cavity. 6. The model which had a case of matching the apex of post and a boundary between the bone and exposed root in the bony cavity demonstrated more increase tensile stress in X direction than other models.
In order to reduce the radiation exposure dose of the patient and to obtain accurate diagnosis results, the quality control of the diagnostic radiation generator must be conducted periodically In particular, bone density test equipment could be influenced by many factors, and it is far more important because inaccurate measurement would eventually affect the result value. However, the cross-correction phantom of DXA equipment is poorly penetrated due to lack of awareness of the industry and the high cost. Therefore, this study developed a BMD phantom using a 3D printer and Korean BMD phantom with low cost by cross analyzing Korean BMD value from The Korean National Health and Nutrition Examination Survey and evaluated it. The L1, L2, and L3 BMD values of phantoms produced with the 3D printer were measured to be $0.887{\pm}0.006g/cm^2$, $0.927{\pm}0.006g/cm^2$, and $0.960{\pm}0.005g/cm^2$, at 215 mm height and $0.882{\pm}0.011g/cm^2$, $0.914{\pm}0.005g/cm^2$, $0.933{\pm}0.008g/cm^2$ at 155 mm height displaying statistically significant relevance. The result suggests that a proper quality control and cross calibration of DXA device be possible and expected to be an essential data for various medical phantom manufacture development using 3D printer.
To determine the relationships between soybean food intake, dietary isoflavone intake, and osteoporosis incidence, questionnaire surveys, bone mineral density measurements, and dietary surveys by food record were performed with 19 postmenopausal women ($57.6{\pm}7.3$ yrs of age) in Daejeon city. The subjects were divided into two groups: an 'osteoporosis group' (OG, n=10) and a 'normal group' (NG, n=9). Mean age, height, and body weight were similar between the two groups but BMI was higher in OG than in NG. Mean age at menarche was not different between the two groups. However, mean number of childbirths was greater in OG than in NG and mean total period of lactation was shorter in OG. Mean exercise time per week was similar between the two groups, and mean time of sunlight exposure tended to be shorter in OG. Mean daily intake of calcium was lower in OG whereas sodium intake was higher in OG. Mean daily intakes of total soybean food (OG: $203.8{\pm}84.6\;g/d$, NG: $285.0{\pm}146.3\;g/d$) and total dietary isoflavone (OG: $29.1{\pm}14.3\;mg/d$, NG: $38.3{\pm}23.1\;mg/d$) were not different between the two groups. However, greater intakes of soybean food and dietary isoflavone were associated with higher bone mineral density, respectively. The above results indicate that osteoporosis incidence tends to be influenced by BMI, maternal factors, dietary nutrient intakes, soybean food intakes, and dietary isoflavone intakes in postmenopausal women; although no significant differences in soybean food and dietary isoflavone intake were found between the two groups. This tendency implies that greater intakes of soybean food and dietary isoflavone lead to lower incidence of osteoporosis in postmenopausal women.
Upon sensing of microbial infections or endogenous danger signals in macrophages, inflammasome signaling plays a significant role in triggering inflammatory responses via producing interleukin (IL)-$1{\beta}$. Recent studies revealed that active caspase-1, a product of the inflammasome complex, causes maturation of inactive pro-IL-$1{\beta}$ into the active form. However, the underlying mechanism by which this leaderless cytokine is secreted into the extracellular space remains to be elucidated. In this study, we demonstrated that prolonged lipopolysaccharide (LPS) treatment to macrophages could trigger the unexpected maturation and extracellular release of IL-$1{\beta}$ through a nucleotide-binding oligomerization domain-like receptor family, pyrin domain-containing 3 (NLRP3)-independent manner. Short-term treatment (less than 6 h) of LPS induced robust production of the IL-$1{\beta}$ precursor form inside cells but did not promote the maturation and secretion of IL-$1{\beta}$ in bone marrow-derived macrophages or peritoneal macrophages. Instead, prolonged LPS treatment (more than 12 h) led to a significant release of matured IL-$1{\beta}$ with no robust indication of caspase-1 activation. Intriguingly, this LPS-triggered secretion of IL-$1{\beta}$ was also observed in NLRP3-deficient macrophages. In addition, this unexpected IL-$1{\beta}$ release was only partially impaired by a caspase-1 and NLRP3 inflammasome inhibitor. Collectively, our results propose that prolonged exposure to LPS is able to drive the maturation and secretion of IL-$1{\beta}$ in an NLRP3 inflammasome-independent manner.
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