Cytological criteria of endometrial lesions with emphasis on stromal and epithelial cell clusters: result of 8 years of experience with intrauterine sampling.

OBJECTIVE: There are a number of unresolved issues in endometrial cytology. They include the significance of nuclear atypia for the diagnosis of grade1 adenocarcinoma (G1AC) and atypical endometrial hyperplasia (AEH), cytological criteria of endometrial hyperplasia without atypia, and recognition of stromal cell cluster (SC) and its distinction from epithelial cell cluster (EC). METHODS: We examined nuclear atypia, SC and EC in typical cases of five categories: normal endometrium (NEM), simple endometrial hyperplasia without atypia (SEH), complex endometrial hyperplasia without atypia (CEH), G1AC and grade2 adenocarcinoma (G2AC). We classified EC into four types: simple EC (SPEC), large regular EC (LREC), large irregular EC (LIEC) and small irregular EC (SIEC). Based on the results, we developed criteria of endometrial cytology and have evaluated 13 639 cases over 8 years. RESULTS: Nuclear atypia was significantly more frequent in G2AC than in any of the other four categories (P < 0.001). SC was significantly more frequent in NEM and SEH than in the other three categories (P < 0.001). G1AC and G2AC showed significantly higher frequency of LIEC than the other three categories (P < 0.001). CEH exhibited significantly higher frequency of LREC than the four categories (P < 0.001). The sensitivity and the specificity was 88.8% and 99.0% respectively. CONCLUSIONS: We could diagnose G1AC, G2AC and CEH with high accuracy using the established criteria mainly based on SC and EC. We think that the criteria may facilitate an effective screening and an objective interpretation of endometrial samples.

Transplantation of the neonatal suprachiasmatic nuclei into rats with complete bilateral suprachiasmatic lesions.

The suprachiasmatic nuclei (SCN) obtained from neonatal day 1 rats were transplanted into the third ventricle of SCN lesioned rats which had shown circadian arrhythmicity in wheel-running activity for more than 2 months. In 8 out of 16 rats that received SCN transplantation, appearance of circadian rhythms in wheel-running activity was observed between 2 and 9 weeks after transplantation. Histological examination revealed ingrowth of the grafts into the periventricular zone, caudal from the lesioned SCN. These findings suggest that the recovery of circadian rhythmicity was the result of functional reinnervation of the periventricular zone by efferent fibers from the SCN.

Patient and nurse evaluation of patient-controlled analgesia delivery systems for postoperative pain management.

Five different patient-controlled analgesia (PCA) delivery systems were evaluated for the treatment of acute postoperative pain in 423 patients undergoing elective operations at a large tertiary care hospital. The PCA trial was conducted on four different postsurgical wards over a 5-mo period. All five devices were utilized on each ward for a 1-mo period. According to the nurses, the mean time (+/- SD) required to become comfortable using the Pharmacia Deltec CADD-PCA was significantly longer (50 +/- 37 min) than that using the Abbott Lifecare Plus (19 +/- 17 min), Bard PCA I (17 +/- 14 min), IVAC PCA (17 +/- 14 min), or Baxter PCA Infusor (7 +/- 8 min). With respect to ease of documentation by the nursing staff, the Baxter device was superior to the Pharmacia device. Similarly, mechanical problems were less frequent with the Baxter (6%) compared with the Pharmacia device (71%). The patients felt that the nurses were more comfortable using the Baxter device than the Pharmacia device. The patients also found the Baxter device easier to use, especially at night, and the least likely to interfere with ambulation. In conclusion, 80% of the nurses at this teaching center preferred the Baxter PCA Infusor over four widely used electronic PCA devices for the management of acute postoperative pain. The Pharmacia device was felt by the nurses to be less user friendly than the other programmable PCA devices used in this trial. Of the electronic devices we studied, the Bard and IVAC devices were the most cost-effective.

Experimental alveolar ridge augmentation by distraction osteogenesis using a simple device that permits secondary implant placement.

The purpose of this study was to develop an improved technique of alveolar ridge augmentation by distraction osteogenesis using distraction screws, and to investigate tissue reactions to titanium implants at the distraction site. The left mandibular premolars were extracted from 6 adult dogs. After 12 weeks, a box-shaped osteotomy of the alveolar bone was carried out, and distraction devices were placed on the transport and base segments. After a 7-day latency period, the alveolar bone was augmented by 7 mm vertically at a rate of 1.0 mm/day. Just after distraction, these devices were replaced with dental implants for fixation of the transport segment and bone formation of the distraction site. Histologic and radiographic evaluations were made at 8 and 12 weeks after distraction. Vertical augmentation averaged 6.1 mm after 12 weeks of consolidation. It was possible to lengthen the alveolar bone without great difficulty, and good bone formation was recognized in the distraction site. Greater integration between the implant and the distracted bone was observed at 12 weeks after distraction than at 8 weeks. Distraction osteogenesis was successfully applied to alveolar ridge augmentation by this improved technique, and the implants osseointegrated in the augmented ridge.

Mandibular lengthening by intraoral distraction using osseointegrated implants.

Mandibular lengthening by distraction osteogenesis is a new method for use in treating congenital deformities or postsurgical bone defects. However, the use of extraoral transcutaneous pins in the mandible has disadvantages, such as facial scars and facial nerve or inferior alveolar nerve injury. The purpose of this study was to establish a new approach to distraction osteogenesis in the mandible by using osseointegrated implants and an intraoral device. Ten adult canines were used for this experiment. After extraction of the teeth and placement of two titanium implants in the left mandible, connection of the intraoral distraction device to the abutments, and corticotomy in the medial portion between implants were performed. Distraction was done at the rate of 1 mm per day to elongate 10 mm in length. Radiographic and histologic examinations showed that successful mandibular lengthening was achieved. New bone was primarily formed by intramembranous ossification and partial endochondral ossification. Titanium implants placed for anchorage of the device remained stable during the course of mandibular lengthening. Study results suggest that the intraoral device using osseointegrated dental implants can be used as a mechanism for distraction osteogenesis in the mandible.

The fate of developing teeth in mandibular lengthening by distraction: an experimental study.

PURPOSE: The purpose of this study was to observe developing teeth in a lengthened mandible after distraction. MATERIAL: Ten mongrel dogs with deciduous dentitions were used. METHODS: A corticotomy was carefully made around a tooth bud and the external distractor (Orthofix M-100) was connected. After a 5-day latent period, distraction was started at a rate of 0.75 mm per day for 10 consecutive days. Then, the lower jaw was stabilized by an external fixation to allow ossification. While the operation was performed on the left side (Distraction group), the contralateral side was studied for comparison (Control). In addition, a corticotomy, artificial fracture and external fixation were carried out to confirm the influence of the operation (Fracture group). Then macroscopic, radiographic and histological evaluations were carried out. RESULTS: In the Distraction group, the space between the wall of the dental follicle and the crown expanded as distraction began. The end of the calcified root became wider and irregular during the distraction period, and finally, the apex closed. In the Fracture group, the teeth erupted although slight alterations of the root shape were observed in association with the operation period. CONCLUSION: The root became irregular, but the teeth erupted within the distraction area.

Psychological study of cleft palate children with or without cleft lip by kinetic family drawing.

To clarify how cleft palate children with or without cleft lip perceive their family, we applied the Kinetic Family Drawing (KFD) technique to 60 cleft palate children (with or without cleft lip). The children were aged 7-9 years (in the 1-3 grade of elementary school) and attended the Department of Oral Surgery, Nagoya University Hospital, between 1990 and 1997. Controls consisted of 100 normal elementary school children of the same age. Major findings were: (1) Compared with normal children, cleft lip and palate boys and cleft palate only girls drew their self-images significantly more often in region D (lower right) and in region A (upper left), respectively. (2) Cleft palate children with or without cleft lip felt anxiety and fear toward their family, rarely viewing their homes as a restful place; this suggested insecurity. Uniquely dynamic relations were also suggested in their homes. (3) Cleft palate children with or without cleft lip often perceived their father or mother as persons easily acceptable in society. Rather remote psychological distance between parents and cleft palate children with or without cleft lip was suggested.

Maxillary advancement by distraction osteogenesis using osseointegrated implants.

The purpose of this study was to establish a new technique for distraction osteogenesis in the maxilla, using an osseointegrated implant and intraoral device. After extraction of the premolar and molar teeth, four titanium implants were installed in the maxillary alveolar bone. Three months later, the distraction device was connected to the abutments, and osteotomy in the medial portion of maxilla between the implants was performed. Distraction was carried out at the rate of 1 mm per day to obtain a 10-mm elongation, Morphological, radiographic and histological examinations showed that successful maxillary advancement was achieved. New bone was primarily formed by intramembranous ossification and partial endochondral ossification. Titanium implants placed for anchorage of the distraction device remained stable during the course of maxillary advancement. This technique can provide significant advancement of the maxilla with better stability. The treatment system can be applied in any kind of maxillary deformities which need to be corrected surgically by classic osteotomy without bone grafting.

Trifocal distraction osteogenesis for segmental mandibular defect: a technical innovation.

Distraction osteogenesis in the mandible is a promising method, not only for correction of mandibular hypoplasia such as hemifacial microsomia, but also for reconstruction of segmental bone defects in the mandible. The authors report a case in which a mandibular segmental defect, about 60 mm in length, was reconstructed by distraction osteogenesis. The patient was a 45-year-old man who had been treated for an oral floor cancer. After preoperative chemotherapy and irradiation therapy, the mandible had been resected from the second incisor on the right side to the first molar on the left side, and had been reconstructed with a titanium plate and a vascularized rectus-abdominis compound flap. However, an infection developed around the titanium plate and this plate had to be removed. Therefore, trifocal distraction using an original three-dimensional distractor was performed, at the rate of 1 mm per day (0.5 mm in the morning and 0.5 mm in the evening). During the distraction period, the skin flap was pushed out from the bone defect. Although small free bone transplants were needed for complete continuity, the segmental bone defect was almost filled by the regenerated bone with the lengthened gingiva. Radiographic observation showed successful new bone formation in the lengthened area.

Experimental study of mechanical analysis in mandibular lengthening. Application of strain gauge measurement.

In distraction osteogenesis, the assessment of new bone formation and the decision of when to remove the distraction device are very important from clinical viewpoint. The purpose of this study was to measure bone stiffness using a strain gauge during and after mandibular lengthening, and to compare the results with those from radiographic and histological examinations. Twelve adult mongrel dogs served as the experimental subjects. An external distraction device was connected to the mandible, and distraction was started 7 days after operation and continued for 10 consecutive days. The animals underwent strain gauge measurement and radiographic examination of the mandible at the completion of distraction and every 2 weeks until the end of the consolidation period. The animals were then sacrificed at 2, 4, 6, 8, 10, and 12 weeks after completion of the distraction for histologic examinations. There was correlation between the amount of decrease in strain, increase in ratio of radiopacity, and newly formed bone in the distracted area.

Modified osteosynthesis for condylar neck fractures in atrophic mandibles.

A fixation system combining both plate and lag screw osteosynthesis for condylar neck fractures of the mandible is described. The currently available device is adapted in that the lag screw is inserted in the lateral cortical bone of the condylar segment instead of the cancellous bone alone.

Alveolar ridge augmentation by distraction osteogenesis using titanium implants: an experimental study.

The left mandibular premolars were extracted from five adult dogs. After twelve weeks, a box-shaped osteotomy of the alveolar bone was carried out and two 10 mm implants were placed 5 mm into the transport alveolar segment, leaving 5 mm exposed. The alveolar bone was vertically augmented 5 mm by screwing the implants. After distraction, the implants were left to integrate into the bone. Histological and radiographical evaluations showed the lifting of the transport segment and the development of new bone in the distraction area. Although integration of implants within both the transport segment and the regenerated bone was observed, two of the ten implants failed and partial bone resorption of the transport segment was noted.

Segmental mandibular reconstruction by distraction osteogenesis under skin flaps.

In five adult dogs, molars were extracted and skin flaps from the neck prepared for delayed transplantation. Two weeks later, a 25-mm segment of the mandible was excised with surrounding periosteum and gingiva. The mandible was stabilized with a reconstruction plate and the intraoral defect repaired with a pedicled skin flap. A proximal transport segment was created and an external distraction device was applied. After one week, distraction of the transport segment was begun at a rate of 1 mm/day. After distraction was completed, the lengthening appliance was left in place for 12 weeks until the dogs were killed. Radiologic and histologic examination revealed new bone at the distraction site. The intraoral skin flap was pushed out of the defect as distraction progressed. Bony union of the transport segment to the distal stump was not achieved due to intervening soft tissue. These results suggest that it is feasible to bridge a mandibular defect that is covered with a skin flap, with distraction osteogenesis.

Prosthodontic closure of palatal fistula with osseointegrated implants and onlay bone grafts--case report.

A case treated with onlay bone grafting and simultaneous osseointegrated implant insertion is reported. The patient had an oronasal fistula in the center of the premaxillary region due to failed repair of a bilateral cleft palate. Four fixtures were inserted with onlay bone grafting of the maxillary alveolar ridge. Twelve months postsurgery, one fixture was lost as a result of severe bone resorption around the fixture, but three fixtures integrated strongly. We constructed an overdenture stabilized with ball attachments connected to the implants 13 months after the first operation. Speech and masticatory function improved remarkably with closure of the fistula and good fixation of the denture.

Three-dimensional computed tomographic analysis for placement of maxillofacial implants after maxillectomy.

Three-dimensional computed tomography scanning was used to examine six patients who had undergone maxillectomy and who were being considered for endosseous dental implants in the residual maxillary bone. This technique allowed three-dimensional visualization of the precise structures of the deformed maxilla, which facilitated the operation procedure by indicating optimal sites for fixture installation.

Spatial image of school environment in children with cleft lip and/or palate.

To evaluate the adaptability of children with cleft lip and/or palate to school, their mental images of the school environment were investigated in a semantic differential method survey using 23 pairs of adjectives. The following eight places on and off the school grounds were chosen as environmental factors; classroom, gymnasium, school nurse's office, teachers' office, playground, hallway, road leading to school and road leading back home. 50 children with cleft lip and/or palate (ages 10-11 years) were enrolled in this study. These children had a feeling of liberation in the teachers' office and school nurse's office. However, they did not have an established feeling of relaxation or affinity in the classroom, gymnasium, playground, hallway, or on the road to and from school, the very locales that were the main areas of their school activity. This suggested that self-expression and adaptation were difficult for these children.