Comparative Analysis of Using Bone Graft, Hydroxyapatite Coralline (Biocoral®) and Porous Polyethylene (Medpor®) Implants for Cranioplasty in a Rat Model of Cranial Bone Defect.

AIM: To compare the efficacy of bone graft, hydroxyapatite coralline (Biocoral®), and porous polyethylene (Medpor®) implants for cranioplasty in a rat model of cranial bone defects. MATERIAL AND METHODS: Two parietal bone defects were created in each of 16 male Sprague-Dawley rats. One was repaired with a bone graft using bone removed from the contralateral defect, and the other was filled with either Medpor® or Biocoral® (each n=8, with the repair on the left in four and the right in the other four). The rats were sacrificed at either 4 or 8 weeks, and implant stability, volumetric changes, and histological parameters were compared between the three materials. RESULTS: At 8 weeks, scores for bone formation (p=0.003), healing of the defects (p=0.008), and material resorption (p=0.010) were higher for the bone grafts than for Biocoral® and Medpor®, whereas the fibrosis scores were significantly higher for Medpor® and Biocoral® than for the bone grafts (p=0.004). The other parameters were similar between the three materials at 8 weeks, except for significantly higher inflammatory cell infiltration with Medpor® than with Biocoral® and bone grafts (p=0.005). CONCLUSION: Implant stability scores were similar for the three implant materials. However, there was better bone formation and healing of the defects with bone grafts, a lower risk of resorption and greater fibrosis induction with Medpor® and Biocoral®, and less volumetric reduction with Medpor®.

The role of adenovirus 36 as a risk factor in obesity: the first clinical study made in the fatty tissues of adults in Turkey.

Obesity which developes due to multifactorial reasons, was associated recently with human Adenovirus-36 (Ad-36). The aim of this study was to investigate the prevalence of Ad-36 antibodies in obese adults and also to investigate the DNA of Ad-36 in their adipose tissue. In this cross-sectional and case-control based study, 49 obese adults, with BMI ≥ 30 kg/m(2), and 49 non-obese adults, with BMI ≤ 25 kg/m(2), applied for esthetic purposes and were included in this study as patient and control groups, respectively. Adipose tissue samples, obtained by the lipoaspiration method, were studied by single-step PCR and nested-PCR methods. Simultaneously, the presence of Ad-36 antibodies and serum leptin and adiponectin levels were assessed by serum neutralization assay (SNA) and ELISA, respectively. Serum samples which didn't cause a cytopathic effect at ≥ 1:8 were accepted as positive. Ad-36 antibody was detected in 6 (12.2%) of 49 patients by SNA and was statistically significant (p < 0.05). Ad-36 DNA was not detected in any of the adipose tissue samples of the patient or control groups. Mean BMI and leptin levels were higher in the Ad-36-positive group, while adiponectin levels were found to be lower in the Ad-36-positive group. Although no statistically significant difference was found in cholesterol and triglyceride levels between the two groups (p > 0.05), lower mean serum cholesterol and triglyceride levels were found in the Ad-36-positive patients. In conclusion, we couldn't detect Ad-36 DNA in adipose tissue; however, we detected significantly higher Ad-36 antibody levels in the obese group compared to the non-obese group, according to the both univariant and multivariant analyses, suggesting that Ad-36 may play a role in obesity. There is a need for new and extended serial, particularly cohort and human-based, studies in order to have a clear understanding of the Ad-36-obesity relationship.

Free pre-expanded lateral circumflex femoral artery perforator flap for extensive resurfacing and reconstruction of the hand.

Resurfacing and reconstruction of extensive scars, severe contractures and deformities of the hand are still challenging cases for plastic surgeons. Treatments usually necessitate thin, pliable and broad flaps. Additionally, minimising the donor-site morbidity is an indisputable requisite. The pre-expanded perforator flap technique has been shown to provide extensive, thin and pliable skin with increased vascularity while reducing the donor-site morbidity. Utilisation of free pre-expanded lateral circumflex femoral artery perforator flap in an aesthetic and functional reconstruction of severe post-burn hand deformity is demonstrated. The successful functional and aesthetic outcome that was achieved in the early postoperative period and which still persists after 23 months of follow-up indicates that our technique could be preferably used in the extensive coverage of the hand.

Does partial expander deflation exacerbate the adverse effects of radiotherapy in two-stage breast reconstruction?

BACKGROUND: The optimum protocol for expander volume adjustment with respect to the timing and application of radiotherapy remains controversial. METHODS: Eighteen New Zealand rabbits were divided into three groups. Metallic port integrated anatomic breast expanders of 250 cc were implanted on the back of each animal and controlled expansion was performed. Group I underwent radiotherapy with full expanders while in Group II, expanders were partially deflated immediately prior to radiotherapy. Control group did not receive radiotherapy.The changes in blood flow at different volume adjustments were investigated in Group II by laser Doppler flowmetry. Variations in the histopathologic properties of the irradiated tissues including the skin, capsule and the pocket floor, were compared in the biopsy specimens taken from different locations in each group. RESULTS: A significant increase in skin blood flow was detected in Group II with partial expander deflation. Overall, histopathologic exam revealed aggravated findings of chronic radiodermatitis (epidermal atrophy, dermal inflammation and fibrosis, neovascularisation and vascular changes as well as increased capsule thickness) especially around the lower expander pole, in Group II. CONCLUSIONS: Expander deflation immediately prior to radiotherapy, may augment the adverse effects, especially in the lower expander pole, possibly via enhanced radiosensitization due to a relative increase in the blood flow and tissue oxygenation.

Ultrasonographically determined pedicled breast reduction in severe gigantomastia.

BACKGROUND: The free nipple breast reduction method has certain disadvantages, such as nipple hyposensitivity, loss of lactation, and loss of projection. To eliminate these risks, the authors describe a patient-based breast reduction technique in which the major supplier vessels of the nipple-areola complex were determined by color Doppler ultrasonography. Pedicles containing these vessels were designed for reductions. METHODS: Sixteen severe gigantomastia patients with a mean age of 41 years (range, 23 to 60 years) were included in the study. Major nipple-areola complex perforators were determined with 13- to 5-MHz linear probe Doppler ultrasonography before surgery. Pedicles were designed according to the vessel locations, and reductions were performed with superomedial-, superolateral-, or mediolateral-based designs. RESULTS: Different combinations of internal mammary and lateral thoracic artery perforator-based reductions were achieved. None of the patients had areola necrosis. Mean reduction weight was 1795 g (range, 1320 to 2280) per breast. CONCLUSIONS: Instead of using standard markings for severe gigantomastia patients, custom-made and sonographically determined pedicles were used. This technique can be considered as a "guide" for the surgeon during very large breast reductions.

Effect of injection of botulinum toxin on lateral pterygoid muscle used together with the arthroscopy in patients with anterior disk displacement of the temporomandibular joint.

OBJECTIVES: In this study, we aimed to study the effects of an additional lateral pterygoid muscle (LPM), botulinum toxin-A (BTX-A) injection on arthroscopic lysis, lavage and posterior band coagulations. Subjective and objective measures have been documented. PATIENTS AND METHODS: Fourty-three subjects (6 females, 37 males; mean age 35 years; range 15 to 48 years) with 52 joints were enrolled in the study. Patients were divided into two groups. The first group was treated with arthroscopic lysis, lavage and posterior band coagulation. The second group received an injection of 20 U of BTX-A to the LPM in addition to the former treatment. Patients were assessed statistically in the 1st week, and in the 1st, 3rd and 6th months postoperatively with the measures of lateral deviations, protrusions and visual analogue scale (VAS) values using Student-t test. RESULTS: Group 1 and group 2 showed significant results within themselves with the exception of the 3rd month values of right deviations in group 1. When groups were compared with each other; significant results were observed in left deviation values only in the 3rd month, protrusion in the 1st month, and most importantly VAS values starting from the 1st month. CONCLUSION: Botulinum toxin-A injection to the LPM mostly improved subjective measures starting from the 1st month. Other objective measures like protrusions, and deviations were not found to be affected generally. These findings suggest the improvement of symptoms with BTX-A injections in additon to the standard arthroscopy. However, diminishing effect of BTX-A and lack of information on the exact mechanism of action of toxin on temporomandibular joint necessitate further studies on this topic.

Molecular correlates of temporomandibular joint disease.

OBJECTIVE: The relation between disease severity and the known mediators of pain, inflammation, and tissue damage-prostaglandin E 2 (PGE 2 ), leukotriene B 4 (LTB 4 ), malondialdehyde (MDA), nitric oxide (NO), and myeloperoxidase (MPO)-was examined in the synovial fluid of patients with internal derangement (ID) of the temporomandibular joint (TMJ). STUDY DESIGN: Thirty-two patients with ID were classified according to Wilkes by clinical and radiological examinations, and TMJ synovial fluid samples were obtained by arthrocentesis. PGE 2 and LTB 4 levels were measured by ELISA kits, MDA levels were determined by a fluorometric method, myeloperoxidase activity was determined by an end-point method, and NO levels were measured by Griess reaction. RESULTS: The earliest significant increase was observed in NO levels (stage II) and this elevation persisted in the subsequent stages. The first significant elevation in PGE 2 and LTB 4 levels and MPO activity were observed in stage III. Both PGE 2 and LTB 4 levels were increased in stage III and were correlated with each at this stage and in the subsequent stage. Significant increases in MDA levels were observed only in stage IV. At stage IV there was correlation between MDA and PGE 2 , MDA and LTB 4 , and MDA and MPO. The relation between PGE 2 and MDA was the most powerful one. CONCLUSION: Results of this cross-sectional study point out the relation between disease severity and levels of some molecular mediators in synovial fluid of TMJ. Longitudinal studies are needed to explore the role of these molecular mediators in the progression of ID.

The effect of short- versus long-term administration of alpha tocopherol on the survival of random flaps in experimental diabetes mellitus.

The effects of short- versus long-term alpha tocopherol administration on oxidative stress and survival of dorsal random flaps were studied in diabetic rats. Seven groups, with 20 rats in each, were constructed: (1) control, (2) noncontrolled diabetes, (3) noncontrolled diabetes+short-term alpha tocopherol, (4) noncontrolled diabetes+long-term alpha tocopherol, (5) insulin treatment, (6) insulin+short-term alpha tocopherol, and (7) insulin+long-term alpha tocopherol. After 3 months of diabetes, dorsal McFarlane flaps were raised. Flap viability and free-radical measurements with histopathological examination were investigated. Mean flap survival in Groups I to VII were 84.0+/-2.2%, 55.0+/-2.4%, 57.0+/-2.5%, 57.8+/-3.7%, 64.1+/-4.1%, 70.0+/-4.9%, and 77.0+/-6.6%, respectively. Free-radical concentration, as assessed with luminol- and lucigenin-enhanced chemiluminiscence, was inversely correlated with flap survival. The results for viability and free-radical concentrations were significant between Groups 1, 2, 5, 6, and 7. Random flaps in diabetic animals showed significantly greater necrosis compared with controls. Among the diabetic animals, group receiving combination of insulin and long-term alpha tocopherol treatment had the greatest flap viability and least tissue free-radical concentration. Histopathological studies showed a hyalinization of arterioles in diabetics with long-term alpha tocopherol treatment protecting the vessel wall. In conclusion, random flaps in experimental diabetes mellitus show greater tissue oxidative stress and necrosis, which is only partially corrected with insulin treatment. Long-term antioxidant supplementation as an adjunct to insulin further lowers the oxidative stress, protects vessel structure and function, and therefore increases flap survival.

Ptosis caused by pachydermoperiostosis.

A 39-year-old man with pachydermoperiostosis is presented. He had enlarged, thickened upper eyelids that made it difficult for him to open his eyes. Eyelid correction was performed by resecting the excessive skin and orbicularis muscle in a fusiform shape and shortening the levator aponeurosis by plication. A wedge resection of the lateral third of the upper lid shortened the horizontal width and also changed the unpleasant fan shape to a better shape, with a natural curvature of the lid. The authors also performed a 5-mm transconjunctival tarsectomy. Visual impairment was corrected with a satisfactory aesthetic outcome.