Socket regeneration after immediate loading implants with tissue and bone graft: 1-year clinical follow-up

Evaluation of ridge alteration after 1 year follow up after immediate loading implant placement. Methods: Ten patients were included in the study, in whom the ridge volume, height, and thickness were evaluated from region of interest (ROI) of tomographic images of the operated areas (test group) and compared to the opposite tooth (control group). Results: After one year, there was no implant loss and all patients were satisfied with the treatment. In the test group there was a statistically significant increase in ridge height (2.89±1.05 mm) when compared to the control group. No significant difference in relation to ridge volume and thickness was observed. In the intragroup evaluation, a significant gain in ridge height (2.65±3.08 mm) was observed when compared to baseline. Conclusion: The placement of an immediate implant, temporary crown, and tissue regeneration in sockets with buccal defects promotes the regeneration of the buccal wall while preventing the reduction of bone volume and thickness

Cambios Dimensionales en Técnicas de Preservación Alveolar Bartee y Bio-Col con Xenoinjerto Inteross®

RESUMEN: La preservación de las dimensiones y contorno del reborde alveolar posterior a una extracción es de suma importancia para evitar problemas subsecuentes para la colocación de un implante dental. El objetivo de este estudio fue comparar los cambios dimensionales mediante el análisis en tomografía computarizada de haz cónico (CBCT) en sitios pre y post preservados con técnica Bartee y Bio-Col con xenoinjerto a los 6 meses de cicatrización. En un paciente de 62 años, se realizaron 6 preservaciones alveolares en órganos dentarios uniradiculares, con diagnóstico periodontal sin esperanza, grupo A la técnica de preservación alveolar Bartee (n= 3) y grupo B la técnica de preservación alveolar Bio-Col (n= 3). Se utilizó xenoinjerto (InterOss ® Anorganic Cancellous Bone Graft Granules 0,25- 1mm Sigma graft) en ambos grupos. En el grupo A se colocó injerto óseo en la totalidad del alveolo asistido por una membrana no reabsorbible de politetrafluoroetile no denso (Cytoplast ™ Regentex TXT-200 singles, Osteogenics Biomedical Inc, Lubbock, Texas). En el grupo B se colocó el injerto óseo en 3⁄4 del alveolo y el último 1⁄4 del alveolo fue ocupado por apósito de colágeno reabsorbible (CollaPlug ® Zimmer biomet). Se registraron mediciones obtenidas mediante CBCT inicial previa a la realización de preservaciones alveolares y se tomó una segunda CBCT a los 6 meses de cicatrización obteniendo la medición en sentido vertical y horizontal, coincidiendo en el plano de corte. Se observó mediante el análisis dimensional en grupo A y Grupo B obteniendo en sentido vertical un 13,58 % y 20,76 % de reabsorción y en sentido horizontal 13,45 % y 15,72 % respectivamente a los 6 meses de cicatrización, utilizando xenoinjerto por lo que no existe diferencia estadísticamente significativa en cuanto a los cambios dimensionales entre ambas técnicas p>0,05. La preservación alveolar proporciona una estabilidad dimensional contrarrestando el proceso de reabsorción fisiológica, siendo una opción predecible.

ABSTRACT: Preserving the dimensions and contour of the alveolar ridge after the dental extraction, it´s of utmost importance to avoidsubsequent problems for the placement of a dental implant. The objective of this study was compare the dimensional changes through the analysis in Cone-beam computed tomography (CBCT), in pre and post sites preserved with the Bartee and Bio-Col technique with xenograft at 6 months of healing. In a 62-year-old patient, 6 alveolar preservations were performed in uniradicular dental organs, with a hopeless periodontal diagnosis, group A the Bartee alveolar ridge preservation technique (n = 3) and group B the Bio-Col alveolar ridge preservation technique (n = 3). Xenograft (InterOss ® Anorganic Cancellous Bone Graft Granules 0.25-1mm Sigma graft) was used in both groups. In the group A a bone graft was placed in the entire socket, assisted by a dense non-absorbable polytetrafluoroethylene membrane (Cytoplast ™ Regentex TXT-200 singles, Osteogenics Biomedical Inc, Lubbock, Texas). In the group B the bone graft was placed in 3⁄4 of the socket and the last 1⁄4 of the socket was occupied by an absorbable collagen dressing (CollaPlug ® Zimmer biomet). Measurements obtained by initial CBCT before recording alveolar ridge preservations were recorded, and the second CBCT was taken 6 months after healing obtaining the measurement vertically and horizontally, coinciding in the section plane. It was observed through dimensional analysis in group A and Group B, obtaining 13.58% and 20.76% of reabsorption vertically and 13.45% and 15.72% respectively at 6 months of healing, using xenograft, so there is no statistical difference significant in terms of dimensional changes between both techniques p> 0.05. Alveolar ridge preservation provides dimensional stability by counteracting the physiological resorption process, being a predictable option.

Establishment and identification of cell lines from type O blood Korean native pigs and their efficiency in supporting embryonic development via somatic cell nuclear transfer

Due to their similarities with humans in anatomy, physiology, and genetics miniature pigs are becoming an attractive model for biomedical research. We aim to establish and evaluate blood type O cells derived from Korean native pig (KNP), a typical miniature pig breed in Korea. Ten cell lines derived from 8 KNP piglets and one adult female KNP (kidney and ear tissues) were established. To confirm the presence of blood type O, genomic DNA, fucosyltransferase (FUT) expression, and immunofluorescence staining were examined. Additionally, fluorescence-activated cell sorting and somatic cell nuclear transfer were performed to investigate the normality of the cell lines and to evaluate their effectiveness in embryo development. We found no significant bands corresponding to specific blood group A, and no increase in FUT expression in cell lines derived from piglets No. 1, No. 4, No. 5, No. 8, and the adult female KNP; moreover, they showed normal levels of expression of α 1,3-galactosyltransferase and cytidine monophosphate-N-acetylneuraminic acid hydroxylase. There was no significant difference in embryo development between skin and kidney fibroblasts derived from the blood type O KNPs. In conclusion, we successfully established blood type O KNP cell lines, which may serve as a useful model in xenotransplantation research.

Application of meshed acellular allogeneic dermal matrix and split thickness autogenous skin graft for the treatment of pediatric claw hand / 中华整形外科杂志

Objective@#To explore the methods and the clinical effect of composite skin graft with meshed acellular allogeneic dermal matrix(allo-ADM)and split thickness autogenous skin graft for pediatric claw hand.@*Methods@#From January 2013 to March 2016, acellular allogeneic dermis matrix(allo-ADM)with split thickness autogenous skin graft was applied for 13 cases(20 hands) of burned pediatric claw hands. The size of the wounds ranged from 6cmx6cm to 10cmx17cm, located in the back of the proximal phalanx and hand. The scar was totally excised and hands′deformities were corrected, with allo-ADM and split thickness autogenous skin graft to cover the wounds. Kirschner wire and plaster fixation, graft gauze bag pile were released 2 weeks after surgery, following by wearing a brace and elastic glove for rehabilitative therapy.@*Results@#2 weeks after transplantation the composite skin survival rate was 70%-100%; 10 cases(17 hands) were followed up for 10 months to2 years. The skin graft survival rate was 70% in 2 cases(3 hands), who underwent secondary operation to correct deformity. The composite skin graft survival rate was above 90% in 8 cases(14 hands). Long term follow-up results showed that composite skin graft had satisfactory elasticity and color. According to the active range assessment of joint movement (TAM method), the results were excellent (TAM% equals to 100%) in 4 hands, good (TAM% was greater than 75%) in 11 hands and acceptable (TAM% was equal to 50%) in 2 hands.@*Conclusions@#Composite transplantation of acellular allogeneic dermis matrix with spit thick autogenous skin graft can effectively improve the appearance and function of children′s claw hand, while avoiding the scar formation due to the harvest of full thickness skin.

Anticalcification Treatment of Glutaraldehyde-fixed Bovine Pericardium with Amino Acids (The Effect of Ethanol, Glutamic Acid and Homocysteic Acid Treatment) / 대한흉부외과학회지

BACKGROUND: Glutaraldehyde-fixed heterografts are prone to calcification after long-term implantation in human, and this is one of the limiting factors for the longevity of the heterografts used in cardiovascular surgery. The aim of the study was to evaluate the anticalcification effect of an ethanol and amino acids treatment on glutaraldehyde- fixed bovine pericardium. MATERIAL AND METHOD: Bovine pericardial tissues were divided into 5 groups. Group 1 consisted of tissues fixed with glutaraldehyde, group 2 consisted of commercially available bovine pericardial valve tissues (Carpentier-Edwards PERIMOUNT), group 3 consisted of glutaraldehyde-fixed tissues treated with ethanol, group 4 consisted of glutaraldehyde-fixed tissues treated with ethanol and L-glutamic acid, and group 5 consisted of glutaraldehyde-fixed tissues treated with ethanol and homocysteic acid. The tissue microstructure was examined by light and electron microscopy. Tissue samples of each group were implanted into rat subcutaneous tissue for 3~4 months and the calcium contents were measured after harvest. RESULT: The collagen fibers appeared to be well preserved in all the groups. The calcium contents of groups 2, 3, 4 and 5 (13.46+/-11.74, 0.33+/-0.02, 0.39+/-0.08 and 0.42+/-0.06micro/mg, respectively) were all significantly lower than that of group 1 (149.97+/-28.25micro/mg) (p <0.05). The calcium contents of groups 3, 4 and 5 were all significantly lower than that of group 2 (p <0.05). CONCLUSION: Treatment with ethanol alone or in combination with amino acids (L-glutamic acid or homocysteic acid) strongly prevented the calcification of glutaraldehyde-fixed bovine pericardium.

Development of Porcine Pericardial Heterograft for Clinical Application(Microscopic Analysis of Various Fixation Methods) / 대한흉부외과학회지

BACKGROUND: Various experimental trials for the development of bioprosthetic devices are actively underway, secondary to the limited supply of autologous and homograft tissue to treat cardiac diseases. In this study, porcine bioprostheses that were treated with glutaraldehyde (GA), ethanol, or sodium dodecylsulfate (SDS) were examined with light microscopy and transmission electron microscopy for mechanical and physical imperfections before implantation. MATERIAL AND METHOD: 1) Porcine pericardium, aortic valve, and pulmonary valve were examined using light microscopy and JEM-100CX II transmission electron microscopy, then compared with human pericardium and commercially produced heterografts. 2) Sections from six treated groups (GA-Ethanol, Ethanol-GA, SDS only, SDS-GA, Ethanol-SDS-GA and SDS-Ethanol-GA) were observed using the same methods. RESULT: 1) Porcine pericardium was composed of a serosal layer, fibrosa, and epicardial connective tissue. Treatment with GA, ethanol, or SDS had little influence on the collagen skeleton of porcine pericardium, except in the case of SDS pre-treatment. There was no alteration in the collagen skeleton of the porcine pericardium compared to commercially produced heterografts. 2) Porcine aortic valve was composed of lamina fibrosa, lamina spongiosa, and lamina ventricularis. Treatment with GA, ethanol, or SDS had little influence on these three layers and the collagen skeleton of porcine aortic valve, except in the case of SDS pre-treatment. There were no alterations in the three layers or the collagen skeleton of porcine aortic valve compared to commercially produced heterografts. CONCLUSION: There was little physical and mechanical damage incurred in porcine bioprosthesis structures during various glutaraldehyde fixation processes combined with anti-calcification or decellularization treatments. However, SDS treatment preceding GA fixation changed the collagen fibers into a slightly condensed form, which degraded during transmission electron micrograph. The optimal methods and conditions for sodium dodecylsulfate (SDS) treatment need to be modified.

Development of Porcine Pericardial Heterograft for Clinical Application(Tensile Strength-thickness) / 대한흉부외과학회지

BACKGROUND: Bioprosthetic devices for treating cardiovascular diseases and defects may provide alternatives to autologous and homograft tissue. We evaluated the mechanical and physical conditions of a porcine pericardial bioprosthesis treated with Glutaraldehyde (GA), Ethanol, or Sodium dodecylsulfate (SDS) before implantation. MATERIAL AND METHOD: 1) Thirty square-shaped pieces of porcine pericardium were fixed in 0.625%, 1.5% or 3% GA solution. 2) The tensile strength and thickness of these and other bioprosthesis, including fresh porcine pericardium, fresh human pericardium, and commercially produced heterografts, were measured. 3) The tensile strength and thickness of the six treated groups (GA-Ethanol, Ethanol-GA, SDS only, SDS-GA, Ethanol-SDS-GA and SDS-Ethanol-GA) were measured. RESULT: 1) Porcine pericardium fixed in 0.625% GA the thinnest and had the lowest tensile strength, with thickness and tensile strength increasing with the concentration of GA solution. The relationship between tensile strength and thickness of porcine pericardium increased at thicknesses greater than 0.1 mm (correlation-coefficient 0.514, 0<0.001). 2) There were no differences in tensile strength or thickness between commercially-produced heterografts. 3) Treatment of GA, ethanol, or SDS minimally influenced thickness and tensile strength of porcine pericardium, except for SDS alone. CONCLUSION: Porcine pericardial bioprosthesis greater than 0.1 mm thick provide better handling and advantageous tensile strength. GA fixation did not cause physical or mechanical damage during anticalcification or decellularization treatment, but combining SDS-ethanol pre-treatment and GA fixation provided the best tensile strength and thickness.

Mitigation of Calcification of Heterograft Tissue / 대한흉부외과학회지

BACKGROUND: With the development of cardiac surgical technique, we need more prosthetic materials for repairing the intra- and extracardiac defects. Although bovine pericardial bioprosthesis treated with glutaraldehyde (GA) solution is one of the most popular materials, it has a drawback of later calcific degeneration. The purpose of this study is to investigate the effectiveness of several materials and methods in reducing the calcific degeneration of bovine pericardium. MATERIAL AND METHOD: Forty square-shaped pieces of bovine pericardia were fixed in 0.625% GA solution with 4 g/L MgCl2.6H2O as a control group (group 1). Other 40 pieces pre-treated with 1% SDS (group 2) and 40 pieces post-treated with 8% glutamate (group 3) and 2% chitosan (group 4) were also fixed in the same GA solution. Other 40 pieces pre-treated with 1% SDS and post-treated with 8% glutamate and 40 pieces post-treated with 2% chitosan were also fixed in the same GA solution (group 5, 6). The pericardial pieces were implanted into the belly of 40 Fisher 344 rats subdermally and were extracted 1 month, 2 months, 3 months, and 6 months after the implantation. With an atomic absorption spectrophotometry, we measured the calcium amount deposited and examined the tissue with microscope. RESULT: The calcium deposition in 1 month was less in group 2, 5, 6 than that in group 1 (p<0.05). It was most prominent in group 5 (p<0.01). This finding continued in 2 month. In 3 month, the calcium deposition was less in group 3 and 4 as well as group 2, 5, and 6 than in group 1. In 6 month, the calcium deposition in group 2, 3, 4, 5, and 6 was less than that in group 1 and the difference was more than that of 1, 2, and 6 month. The microscopic calcium deposition was also less in group 2 and 5. Calcium deposition developed in the whole layer of pericardium, beginning with the surrounding the collagen fiber and progressing inwardly. CONCLUSION: Pre-treatment with SDS, post-treatment with glutamate or chitosan, and SDS pre-treatment and post-treatment with glutamate or chitosan were effective in reducing the calcium deposition in bovine pericardium. Moreover, the combined method of SDS pre-treatment and glutamate post-treatment was more effective than other methods.

Outcome of Different Grafted Bone in Lumbar Posterolateral Fusion / 대한척추외과학회지

OBJECTIVES: Using a retrospective analysis on the fusion rate and the postoperative improvement in symptoms, this study evaluated the clinical feasibility of a bone graft in lumbar fusion surgery in the following cases: (1) Group I: local autograft, (2) Group II: local autograft and iliac crest autograft, and (3) Group III: local autograft and customized heterograft. MATERIALS AND METHODS: Among the patients who had undergone a decompression and lumbar posterolateral fusion for various lumbar diseases, between January 1997 and December 1999, 178, in who 2 year follow-up observations had been possible, were selected for this study. The patients were allocated to 1 of 3 groups, Group I (47 patients), Group II (57 patients) and Group III (74 patients). For each group, the mean patient ages were 58.3, 49 and 62.4 years old, respectively, with male to female ratios of 24:23, 23:24 and 36:38. Postoperative radiographs were taken at 2 weeks, 3 months and 1 year, and further follow-up observations were conducted at 1-year intervals. The bone fusions was determined, along with the fusion rates, based on Lenke's criteria, and the post-operative clinical outcomes were evaluated as excellent, good, normal and poor, using Kim's method. A statistical analysis was performed with Chi-square tests. RESULTS: From the follow-up observations for over a year, the radiographic evaluations showed that the fusion rates of Groups I and II, over B: 86.6 and over B: 88.9%, were superior to the over B: 80.1% of Group III, but with no statistical significance. For the clinical outcomes, the 78.1 88% over good results were superior to the 69.4% of Group III, which also showed statistical significance. CONCLUSIONS: The selective use of customized heterograft was assumed to be effective in an insufficient autogenous bone or a difficult autogenous bone collection even though it causes significantly lower improvement in the symptoms.

Treatment of Enchondromas of the Hand with Heterograft Bone / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness of treatments for enchondromas of the hand with heterograft bone substitute instead of bone autograft. MATERIALS AND METHODS: We reviewed the radiographs of 15 patients that were followed for a minimum of 6 months. From January 1995 to May, 2000, fifteen patients that were treated with heterograft bone and could be followed-up for at least 6 months were retrospectively studied. Clinical, radiological and histological results were evaluated. RESULTS: Clinically excellent in 5, good in 10. Radiologic result was 12 in Group 1, 3 in Group 2, the average consolidation duration was 8 months (5-11 months). The typical histologic findings of enchondroma by intraoperative specimens were hyaline cartilage, myxoid degeneration, calcification, and enchondral ossification. Grafted heterograft bone was incorporated via physiologic remodelling without significant problems. No signigicant complications occurred. CONCLUSION: We believe that heterograft bone is a good treatment option for enchondromas of the hand, given the disadvantages of bone autografts or allografts.

The Results of Spinous Process-splitting Laminoplasty Using Heterograft Spinous Process Spacer / 대한정형외과학회잡지

PURPOSE: To assess the effectiveness and safety of heterograft spacer (Lubboc) as a substitute for autograft in cervical laminoplasty. MATERIALS AND METHODS: 21 patients with cervical myelopathy were treated by spinous process splitting laminoplasty using heterograft intraspinous spacers. The clinical and the radiographic evaluations were checked pre- and postoperatively. RESULTS: The average JOA score was increased from 8.7 preoperatively to 12.9 at the final follow-up with a average recovery rate of 60.6%. Preoperative spinal canal diameter, 14.7 +/- 1.4 mm were improved to 20.1 +/- 1.8 mm postoperatively and canal to body ratio, 0.75 +/- 0.10 to 1.02 +/- 0.11 in average. The intraspinous spacer, heterograft demonstrated fragmentation and partial resorption mainly at the level of C3, 4, 5 from postoperative 2 months, but showed no clinical deterioration in spite of radiographic changes of heterograft. CONCLUSION: We think that heterograft spacer is one of the safe and effective substitutes for autograft in maintaining the improved postoperative radiographic indeces.

Prevention of calcification in bovine pericardial bioprosthesis cyxretreatment with surfactants / 대한흉부외과학회지

BACKGROUND: Bovine pericardial bioprosthesis treated with glutaraldehyde (GA) is one of the most popular prosthetic materials, but late calcific degeneration after implantation is a problem that remains unsolved. For the purpose of mitigating the calcific degeneration, we added MgCl2 into the 0.625% GA solution to compete with calcium for binding to the free aldehyde from GA and pretreated with the surfactants like sodium dodecyl sulfate (SDS) and Triton X-100 before GA fixation for preventing the phospholipid infiltration into the pericardial tissue, the first step of the calcific degeneration. MATERIAL AND METHOD: 40 square-shaped pieces of bovine pericardia were fixed in 0.625% GA solution with 4g/L MgCl2 6H2O as a control group (group 1). 40 pieces pretreated with 1% SDS were also fixed in the same GA solution (group 2) and other 40 pieces pretreated with 1% Triton X-100 were prepared with the same method (group 3). After 1 month of fixation these were implanted into the belly of 40 Sprague-Dawley subdermally and extracted 1 month, 2 months, 3 months and 6 months after implantation. With atomic absorption spectrophotometry we measured the deposited calcium amount. RESULT: 1 month after implantation we could not find any differences between the three groups, but by the 2nd month calcium deposition was 0.921+/-0.121 mg/g in group 1, 0.481+/-0.037 mg/g in group 2 and 1.369+/-0.200 mg/g in group 3. By the 3rd month it was 0.786+/-0.080 mg/g in group 1, 0.584+/-0.054 mg/g in group 2 and 1.139+/-0.188 mg/g in group 3, and on the 6th month 1.623+/-0.601 mg/g in group 1,0.501+/-0.043 mg/g in group 2 and 1.625+/-0.382 mg/g in group 3, with statistical significance in group 2 (p<0.05). CONCLUSION: Pretreatment with SDS showed meaningful calcium mitigation effects on subcutaneously implanted bovine pericardium in the rat models but the neutral type surfactant, Triton X-100, had no positive mitigation effect in this experiment.

Calcium Mitigation in the Bovine Pericardial Tissue in the Rat Subcutaneous Implantation model-MgCl2 Effect / 대한흉부외과학회지

Bovine pericardial bioprosthesis treated with glutaraldehyde is one of the most popular prosthetic materials, but late calcific degeneration must be solved. According to the alleged hypothesis of this calcification mechanism the free aldehyde groups on the surface of the tissue treated with glutaraldehyde bind to the circulating free calcium and induce mineralization. For mitigating the calcific degeneration, I added MgCl2 into the 0.625% glutaraldehyde solution to compete with calcium for binding to free aldehyde from the glutaraldehyde. I prepared 60 pieces of square shaped bovine pericardia and fixed in the 0.625% glutaraldehyde solution as control group (group 1), and the other 60 pieces in the same glutaraldehyde solution with 4g/L MgCl2 6H2O as the other group (group 2). After fixation for 1 month these were implanted into the bellies of 60 Sprague-Dawley rats subdermally and extracted on 1 month, 2 months, 3 months and 6 months later. With atomic absorption spectophotometry I measured the deposited calcium amount with the following results; 1 month and 2 months after implantation I could not find any differences between two groups, but in the 3rd month calcium was 1.738 mg/g in group 1 and 0.786 mg/g in group 2 and in the 6th month calcium had risen to 3.102 mg/g in group 1 and 1.623 mg/g in group 2, which has statistical significance (p<0.05). This means magnesium shows meaningful calcium mitigation effects on subcutaneously implanted bovine pericardium in the rat models.

Experimental Study of Heterograft Method on the Healing Process of Long Bone Defect in Rabbits / 대한정형외과학회잡지

Bone grafts are used in the repair of segmental bone loss caused by severe trauma, bone tumors and infection, and to enhance bone healing in ununited fractures. Autograft is the most frequently used and the most effective method, but because of inadquate supply and additional operative morbidity, allograft or heterograft could be used. Heterograft has been shown to be poorly tolerated by the host and ineffective in providing an osteogenic system. The objective of this study is to observe healing process of a segmental defect of long bone following to heterograft, and to compare the difference of histologic process between autograft and hetero graft. Twenty-four white rabbits weighing 1,000 to 2,000 grams were used for the experiment. A segment measuring three times the diameter of the ulna shaft (1.5 to 2cm) of rabbit was resected with its periosteum. Twenty-four white rabbit were divided into three groups (control, autograft, heterograft group) according to graft methods, each group comprising of eight rabbits. The animals were sacrificed at 2, 4, 8 and 12 weeks after the experimental procedures and were periodically evaluated by radiographs and histology. The obtained results were as follows: 1. The results of the radiological evaluation showed that no ungrafted ulnar defects (control group) healed. In the heterograft group, partial union was observed from 8 weeks and complete union was obtained on 12 weeks. In the autograft group, partial union was observed on 2 weeks and complete union was obtained on 4 weeks. 2. The results from histological examination showed that the ungrafted ulnae did not heal across the defect but some immature trabeculae were founded on the edges of the defect. In the heterograft group, immature trabeculae were appeared from 4 weeks and defects were substituted with mature trabeculae on 12 weeks. In autograft group, defects were substituted with immature trabeculae on 2 weeks and with mature trabeculae on 4 weeks. As seen in the results of the experiment, union could be obtained with the heterograft, but needed more long time than autograft. Though the autograft is the most effective graft method in bone defect or non-union, above results suggest the heterograft as the alternative method in the treatment of large bone defect, in a multioperated patient, or in the children or the elderly, combined with autograft or alone.

Enxerto valvulado extracardíaco no estabelecimento da continuidade entre o ventrículo direito e as artérias pulmonares: técnicas e resultados de sua aplicaçäo na correçäo do tronco arterioso comum / Valved Extracardiac Conduits for Establishment of Right Ventricle-Pulmonary Artery Continuity. Technique and Results in Truncus Arteriosus Communis

Objetivo - Avaliar os resultados dos enxertos valvulados extracardíacos, empregados no estabelecimento da continuidade entre o ventrículo direito e as artérias pulmonares em pacientes portadores de tronco arterioso comum. Métodos - Quinze pacientes portadores de tronco arterioso comum foram submetidos a cirurgia corretiva com a utilização de enxerto valvulado extracardíaco no estabelecimento da continuidade entre o ventrículo direito e as artérias pulmonares no período de janeiro de 1981 a janeiro de 1991. A idade média foi de 2 anos e 9 meses e o peso médio de 9,6 kg. Oito pacientes eram do sexo feminino e sete do masculino. O diagnóstico foi estabelecido através de estudo hemodinâmico e/ou ecocardiográfico e a indicação cirúrgica baseada na presença de insuficiência cardíaca e na prevenção da progressão de doença vascular pulmonar obstrutiva. Os enxertos foram confeccionados com a inserção de válvula biológica de pericárdio bovino em prótese tubular de "woven dacron", com diâmetro variando de12a22mm. Resultados - A mortalidade hospitalar foi de 33% tendo como causa principal a síndrome de baixo débito. Complicações pós-operatórias, de gravidade variável, ocorreram em 80% dos pacientes, incluindo os óbitos hospitalares. Na evolução tardia, quatro pacientes foram submetidos a reintervenções por complicação estenótica do enxerto valvulado, em média 5 anos e 2 meses após o implante. A mortalidade tardia foi de 30%, correspondendo a uma sobrevivência atuarial de 66,6% no 1° ano, 53,3% no 3° ano e 46,2% em 5 e 10 anos. Conclusão - Embora os enxertos valvulados extracardíacos tenham melhorado substancialmente a sobrevida dos pacientes portadores de tronco arterioso comum. As complicações estenóticas tardias impedem que os mesmos constituam uma solução definitiva para o problema original, motivando o constante desenvolvimento de técnicas de anastomose direta ventrícularterial.

Purpose - To evaluate the results of valved extracardiac conduits for establishment of right ventricle pulmonary artery continuity in patients with truncus arteriosus communis. Methods - between January 1981 - January 1991, 15 patients with persistent truncus arteriosus communis underwent surgical repair with valved extracardiac conduits for establishment of right ventricle-pulomonary artery continuity. Mean age was 2 years 9 months and mean weight 9.6 kg. Eight patients were females and seven males. The diagnosis was established by hemodynamics and/or echocardiographic studies and surgical indication was based in presence of cardiac insuficience and prevention of pulmonary vasculardisease. Valved conduits were performed with insertion of pericardial xenograft in woven dacron prosthesis. Diameters ranged between 12 to 22 mm. Results - The in-hospital mortality was 33% and the low output syndrome was the main cause. Post-operative complications, with variable gravity, occurred in 80% of the patients. Reoperation occurred in four patients during the long term follow-up due to stenotic complications of the valved conduit, mean 5 years 2 months after implant. Late mortality was 30%, with correspondent actuarial life table of 66,6% in 1st year, 53,3%, 3rd and 46,2% in 5 and 10 years. Conclusion - Although the valved extracardiac conduits have significantly improved the survival of patients with truncus arteriosus communis, late stenotic complications were high determining continuous development of direct ventricle-arterial anasthomosis techniques

A Clinical Study of Benign Bone Tumors Treated by Partly Deproteinised Xenograft(Kiel Bone) / 대한정형외과학회잡지

The use of lyophilised bone from calves as a heterograft was introduced by Maatz and Bauermeister in 1957 as an alternative to autografts and freeze-dried homografts which were then in general use. The Kiel bone was known to possess no antigenecity and serial radiographs revealed that it is incorporated into the recipient site by a process of creeping substitution from surrounding bone. In patients with benign bone tumors, the surgical dead space was filled with Kiel bone graft in the departments of orthopedic surgery, Pusan national university hospital. The results were followed up for more than 14 months, and were evaluated by the palin film findings. The results were as follows : l. Of the 22 cases, satisfactory result was obtained in 18 cases(81,8%). 2. The mean lesion size(diameter of lesion/diameter of bone)of success cases was 61.6%, and the mean lesion size of failed cases was 82.8%. 3. The duration from the Kiel bone graft to the evidence of new bone formation and remodelling was 10.5 months on an average with a range of 7months to 15months, and the duratin from the Kiel bone graft to the complete resorption of the Kiel bone was 45.7 months on an average with a range of 29 months to 66 months. 4. The causes of the failed cases were thought to be incomplete removal of the lesion, decreased vascularity due to repeated surgery, large size of the lesion, and the potentiality of tumor, 5. It was difficult to evaluate success rate according to underlying disease because the number of the cases was not large enough, but giant cell tumor showed high recurrence rate.

INFLUENCE ON NERVE REGENERATION IN THE USE OF HETEROGRAFT TREATED BY CON A / 解剖学报

The effect of concanavalin A (Con A) on nerve regeneration in heterograft was done in the present study. A segment about 5mm long was removed from the right sciatic nerve of adult rats. A 8mm of the heterograft nerve segment from the tibial nerve of the rabbit and pretreated by Con A was transplanted into the gap of the severed rat nerve. Regenerating nerve fibers were found from the proximal part of the sciatic nerve into the graft, and also from the graft into the distal part of the sciatic nerve at the 4th,8th and 12th week after transplantation. Regenerating nerve fibers existed separately or clustered into fascicles in the graft,as well as in the distal part of sciatic nerve. Some unmyeli-nated nerve fibers were scattered among the regenerating myelinated fibers. The gastrocnemius muscle was AChE-positive at 8th and 12th week after transplantation. In silver-combined AChE staining section, the regenerating nerve fibers could be seen connecting with the motor endplates. There were regenerating free nerve endings and nerve fascicles in the dermis and epidermis at 8th and 12th week after transplantation. The present study showed that the pretreatment of Con A had benefit to that the regenerating nerve fibers to pass through the heterograft and reinnervated to the targetes.ADepartment of Anatomy,Jiangxi Medical College,Nanchang 330006,China