Treatment of Orbital Roof Blow-Up Fracture Using a Superior Blepharoplasty Incision.

In orbital roof blow-up fractures, reduction can be achieved easily using an approach from the anterior cranial fossa but the procedure is highly invasive. In contrast, an orbital approach using a superior blepharoplasty incision is minimally invasive. However, if bone fragments are adhered to the dura mater, there is a risk of dura mater injury when fragments are moved for reduction. In blow-in fractures, reduction is performed by pushing the bone fragments against the anterior cranial fossa. In contrast, the procedure is difficult for blow-up fractures because bone fragments must be pulled out into the orbit through the anterior cranial fossa. Orbital blow-up fractures are often associated with intracranial injuries and frequently treated by an approach from the anterior cranial fossa. There has not yet been a report that discusses whether reduction of bone fragments should be performed in blow-up fracture without intracranial injury. In this report, we describe two cases of orbital roof blow-up fracture that did not require treatment for intracranial injury and that were treated using an orbital approach. The treatment involved only the release of orbital fat entrapped between bone fragments and did not involve reduction. The treatment outcomes were good in both cases.

Identification of specific integrin cross-talk for dermal fibroblast cell adhesion using a mixed peptide-chitosan matrix.

Extracellular matrix molecules are recognized by several integrin subtypes, making identification of cross-talk among different integrin subtypes difficult. Here, we evaluated the cross-talk of integrin subtypes using four different integrin-binding peptides (FIB1; integrin αvß3/α5ß1, A2G10; integrin α6ß1, EF1zz; integrin α2ß1, or 531; integrin α3ß1) derived from extracellular matrix molecules. Various combinations of two different integrin-binding peptides were mixed and conjugated on a chitosan matrix at various molar ratios and were evaluated for cell attachment activity. FIB1/A2G10 (molar ratio 5:5; total 10 nmol/well)-chitosan matrix significantly enhanced cell attachment activity compared with sum of the cell attachment activity on FIB1 (5 nmol/well)-chitosan matrices and A2G10 (5 nmol/well)-chitosan matrices, respectively. However, none of the other peptides showed a significant activity change when they were mixed and conjugated on a chitosan matrix. We investigated the mechanisms of this enhancement. FIB1/A2G10 (8:2 or 6:4)-chitosan matrix increased the cell spreading, phosphorylation of focal adhesion kinase at Y397, and slightly decreased phosphorylation of caveolin-1 at Y14 in fibroblasts compared with FIB1-chitosan and A2G10-chitosan matrices. These results indicate that FIB1/A2G10 (8:2 or 6:4)-chitosan matrix synergistically enhances cell attachment, suggesting that integrins αvß3/α5ß1 and α6ß1 are involved in a cross-talk and synergistically enhance cell attachment. These findings also suggest that the mixed peptide-chitosan matrix system can regulate the ratio of two different peptides and is useful for evaluating cellular functions through receptor-specific cross-talk. Further, FIB1/A2G10 (8:2 or 6:4)-chitosan matrix could be a useful material for tissue engineering.

Treatment of inverted nipple with subareolar abscess: usefulness of high-resolution MRI for preoperative evaluation.

Background. Inverted nipples with subareolar abscesses can recur due to insufficient resection. It is important to provide reliable curative treatment after determination of the extent of resection by preoperative imaging evaluation. Methods. Ten patients were treated for inverted nipples with subareolar abscess. Sonography and high-resolution MRI were used as preoperative imaging modalities. The endpoints of preoperative imaging evaluation were defined as the identification of the abscess site, isolated fistula site, and extent of inflammation. Results. In all patients, sonography confirmed the presence of abscesses but their locations could not be identified. Sonography could not confirm the presence of isolated fistula or inflammation. In contrast, high-resolution MRI not only confirmed the presence of abscesses but also revealed their positional relationships with the nipples. In addition, high-resolution MRI confirmed the presence of isolated fistulas and inflammation as well as revealed their positional relationships with the nipples. In all patients, no recurrence was observed, and satisfactory surgical results were obtained. Conclusion. High-resolution MRI is useful in determination of the extent of resection of subareolar abscess associated with inverted nipple.