Comparison of the stability of bioabsorbable and titanium osteosynthesis materials for rigid internal fixation in orthognathic surgery. A prospective randomized controlled study in 101 patients with 192 osteotomies.

The purpose of this study was to evaluate the stability of rigid internal fixation in orthognathic surgery with either bioabsorbable or titanium osteosynthesis. Orthognathic surgery was performed on 101 patients. Bilateral sagittal ramus osteotomy was performed on 55 patients using bioabsorbable osteosynthesis in 26 and titanium osteosynthesis in 29 patients. Le Fort I osteotomy was performed on 28 patients with bioabsorbable and titanium osteosynthesis in 17 and 11 patients, respectively. Bimaxillary osteotomies were performed on 18 patients (8 were fixated with bioabsorbable and 10 with titanium osteosynthesis). Poly-70L/30DL-lactide copolymer (PLDLA) consisting of 70% L-lactide and 30% DL-lactide was used as the bioabsorbable osteosynthesis material. These plates and screws were compared with corresponding titanium materials. Statistically a clear relapse tendency was seen in skeletal measurements in all patient groups but without clinical importance. Radiological follow-up time was at least 18.3 months and clinical follow-up time at least 6.3 years. The materials used did not cause any adverse reaction except in three cases, one in the bioabsorbable group and two in the titanium group where fistula in connection with the osteosynthesis material was noted resulting in removal of the materials.

Differences in retinal neovascular tissue and vitreous humour in patients with type 1 and type 2 diabetes.

AIMS: The aim of the study was to evaluate the histopathology of neovascular tufts and vitreous samples collected from patients with diabetes. METHODS: Vitreous samples and neovascular tufts were collected from patients with type 1 (n = 13) and (n = 17) type 2 diabetes with proliferative retinopathy, and from controls with a macular hole (n = 5). Neovessels were analysed using immunohistochemistry and vitreous samples with an enzyme-linked immunosorbent assay (ELISA). The main outcome measure was to examine differences in the levels of growth factors in patients with type 1 and type 2 diabetes with proliferative retinopathy. RESULTS: Vascular endothelial growth factor (VEGF)-A was most strongly present in the samples from patients with type 1 diabetes. In type 2 diabetes, VEGF-D was more abundantly present than in type 1 diabetes. Angiopoietin (ANG)-2 was also abundantly present. Macrophages and nuclear factor kappa B (NFkappaB) were found, indicating the presence of an inflammatory process in the neovascular tissues. CONCLUSIONS: VEGF-A and ANG-2 are equally important in the neovascular process in both type 1 and type 2 diabetes. VEGF-D is abundantly present in type 2 diabetes. In order to achieve better control of diabetic retinopathy, it might be beneficial to develop treatments that prevent the actions of ANG-2 and VEGF-D.

Clinical features and a follow-up study in a family with X-linked progressive cone-rod dystrophy.

PURPOSE: To study a large family with X-linked progressive cone-rod dystrophy. METHODS: There were 128 members in the family. Of these, 45 had an ophthalmological examination and 3 gave their permission to use the results of their recent ophthalmological examination. In addition to the usual eye examination, visual fields, colour vision, dark adaptation and electroretinogram (ERG) were examined. RESULTS: Ten affected men aged 6 to 81 years were found in the family. The visual acuities varied from counting fingers (cf) 10 cm to 0.5 in the right eye (RE) and from cf 30 cm to 0.4 in the left eye (LE). The refraction was myopic in all affected members, varying from -1.5 to -24.0 D (RE) and from -2.0 to -20.25 D (LE). In visual functions, central scotomas and concentric constriction in the visual fields, red or red-green defects in colour vision, abnormal cone and rod dark adaptation and affected cone response in ERG were found. The 6 obligate carriers were aged 17 to 77 years. Their visual acuities varied from 0.05 (strabismic amblyopia) to 1.25(RE) and from 0.7 to 1.25 (LE), and refraction from +/-0 to +6.0 D (RE) and from -0.5 to +5.0 D (LE). Their visual fields and colour vision were normal. The non-affected men were aged 13 to 55 years, their visual acuity was normal in both eyes, and refraction varied from -5.0 to +1.5 D (RE) and from -5.5 to +1.75 (LE). The result of the eye examination was normal except in colour vision: two men were congenitally deuteranomalous. The women who were not obligate carriers were aged 10 to 77 years, their visual acuity was from 0.3 to 1.6 in both eyes, and refraction from -5.5 to +4.75 (RE) and from -5.25 to +4.0 (LE). Two women had one amblyopic eye. Otherwise the eye examination was normal. CONCLUSIONS: The clinical diagnosis of X-linked cone dystrophy 1 (COD1) is based on progressive loss of visual acuity, moderate or high myopia, red colour vision defect and affected cone response or cone and rod response in ERG. The future identification of the COD1 gene will confirm the diagnosis of the disease and help in genetic counseling of the family.

Mitotic activity of keratinocytes in nifedipine- and immunosuppressive medication-induced gingival overgrowth.

BACKGROUND: The purpose of the study was to compare mitotic activity in the basal cell layer of normal human gingiva and in nifedipine- and immunosuppressive medication-induced gingival overgrowth. METHODS: Gingival samples were collected from 19 generally healthy individuals, 12 nifedipine-medicated cardiac patients, and 22 immunosuppression-medicated (azathioprine, prednisolone, and cyclosporin A) organ transplant recipients. The transplant recipients were divided into those not taking nifedipine and those taking nifedipine. Cryostat sections were stained with monoclonal antibody for Ki-67, using an avidin-biotin-enzyme complex method. The mitotic activities of epithelial cells were determined as percentages of Ki-67 labeled cells in relation to total numbers of epithelial cells in the basal layer of oral, oral sulcular, and sulcular epithelium. RESULTS: Mitotic activities were significantly higher in all 3 medication groups in the oral epithelium (P < or =0.003), and in the immunosuppression group in the sulcular epithelium (P= 0.032) than in the controls. In the oral sulcular epithelium, mitotic activity was fairly similar in all medication groups. In the nifedipine group a significant negative correlation was found between duration of nifedipine medication and the percentage of Ki-67 labeled cells in the oral epithelium (P= 0.025). CONCLUSIONS: The results suggest that the increased epithelial thickness observed in nifedipine- and cyclosporin A-induced gingival overgrowth is associated with increased mitotic activity, especially in the oral epithelium.

Density of CD1a-labeled Langerhans' cells in normal human gingiva and in nifedipine- and immunosuppressive medication-induced gingival overgrowth.

BACKGROUND: The purpose of this study was to compare the distribution of Langerhans' cells in normal human gingiva and in nifedipine- and immunosuppressive medication-induced gingival overgrowth by means of an immunohistochemical study. METHODS: Gingival samples were collected from 11 nifedipine-medicated cardiac patients, 22 triple-medicated (azathioprine, prednisolone, and cyclosporin A) renal transplant recipients, and 28 generally healthy individuals. Patients were grouped into the immunosuppression group, the combined immunosuppression and nifedipine group, the nifedipine group, and the generally healthy control group. Five microm-thick cryostat sections were stained with monoclonal antibody (mAb) for CD1a using an avidin-biotin-enzyme complex (ABC) method. Numbers of CD1a-labeled cells/mm2 were determined in 6 areas: oral epithelium, oral sulcular epithelium, sulcular epithelium, middle connective tissue, connective tissue beneath the oral epithelium, and connective tissue beneath the sulcular epithelium. Significances of differences between the groups were tested by means of the Kruskall-Wallis test, and significances of differences between pairs of results by the Mann-Whitney U-test and the t test. RESULTS: Numbers of CD1a-labeled cells were significantly lower in the medicated groups than in controls in all 3 epithelial areas (P <0.0001) and in the connective tissue beneath the sulcular epithelium (P <0.0021). There were significantly fewer CD1a-labeled cells in the sulcular epithelium in the nifedipine group than in the other medication groups. CONCLUSIONS: The reduced numbers of CD1a-labeled cells found in nifedipine-induced gingival overgrowth were similar to the reduced numbers of CD1a-labeled cells in gingival overgrowth associated with immunosuppressive medication.