Development and global validation of a 1-week-old piglet head finite element model for impact simulations / 中华创伤杂志(英文版)

PURPOSE@#Child head injury under impact scenarios (e.g. falls, vehicle crashes, etc.) is an important topic in the field of injury biomechanics. The head of piglet was commonly used as the surrogate to investigate the biomechanical response and mechanisms of pediatric head injuries because of the similar cellular structures and material properties. However, up to date, piglet head models with accurate geometry and material properties, which have been validated by impact experiments, are seldom. We aim to develop such a model for future research.@*METHODS@#In this study, first, the detailed anatomical structures of the piglet head, including the skull, suture, brain, pia mater, dura mater, cerebrospinal fluid, scalp and soft tissue, were constructed based on CT scans. Then, a structured butterfly method was adopted to mesh the complex geometries of the piglet head to generate high-quality elements and each component was assigned corresponding constitutive material models. Finally, the guided drop tower tests were conducted and the force-time histories were ectracted to validate the piglet head finite element model.@*RESULTS@#Simulations were conducted on the developed finite element model under impact conditions and the simulation results were compared with the experimental data from the guided drop tower tests and the published literature. The average peak force and duration of the guide drop tower test were similar to that of the simulation, with an error below 10%. The inaccuracy was below 20%. The average peak force and duration reported in the literature were comparable to those of the simulation, with the exception of the duration for an impact energy of 11 J. The results showed that the model was capable to capture the response of the pig head.@*CONCLUSION@#This study can provide an effective tool for investigating child head injury mechanisms and protection strategies under impact loading conditions.

Avaliação da eficácia do sistema rigeneracon no tratamento de lesões de calvária em ratos / [Evaluation of the efficacy of the rigeneracon system in the treatment of calvary injuries in rats]

Defeitos ósseos constituem um problema de saúde global. O sistema Rigenera permite a extração de microenxertos ricos em células-tronco mesenquimais (CTMs). Objetivou-se avaliar o processo de regeneração óssea por enxertos obtidos pelo sistema Rigenera em defeitos críticos na calvária de ratos. Foram utilizados 18 ratos Wistar, machos, pesando 285±29g, distribuídos em três grupos (n=6), sendo cada animal controle de si mesmo, denominados G15-Controle e G15-Tratado (15 dias); G30-Controle e G30-Tratado (30 dias) e G60-Controle e G60-Tratado (60 dias). Foram realizadas duas lesões de 5mm de diâmetro em cada antímero da calvária. Nos grupos tratados, foram utilizados microenxertos autólogos de cartilagem xifoide, obtidos pelo sistema Rigenera. O defeito contralateral serviu como controle em todos os animais. Os animais foram eutanasiados aos 15, 30 e 60 dias após a cirurgia, e as amostras foram processadas para a histoquímica. Nos grupos controle, não foram observados sinais de regeneração óssea, enquanto nos grupos tratamento foram verificadas áreas de formação óssea e tecido mesenquimal ativado. O sistema Rigenera foi eficiente na obtenção de microenxertos autólogos, para terapia celular em defeito crítico de calvária de ratos. Com o aprimoramento do protocolo, o sistema Rigenera poderá ser amplamente utilizado no tratamento de lesões ósseas.(AU)

Bone defects are a global health problem. The Rigenera system allows the extraction of micro grafts rich in mesenchymal stem cells (MSCs). The objective of this study was to evaluate the bone regeneration process by grafts obtained by the Rigenera system in defects in the rats calvarian. Eighteen male Wistar rats were used, weighing 285 ± 29g, distributed in three groups (n = 6), where each animal was treatment and control, called G15-Control and G15-Treated (15 days); G30-Control and G30-Treated (30 days) and G60-Control and G60-Treated (60 days). Two 5mm diameter lesions were performed on each calvaria side. In the treated groups, autologous micrograft from xiphoid cartilage, obtained by the Rigenera system, were used. The other defect served as a control in all animals. The animals were euthanized at 15, 30 and 60 days after the surgery and the samples were processed for histochemistry. In the control groups, no signs of bone regeneration were observed, while in the treatment groups, areas of bone formation and activated mesenchymal tissue were verified. The Rigenera system was efficient in obtaining autologous micrograft for cell therapy in a critical calvaria defect in rats. Rigenera system can be widely used in the treatment of bone injuries.(AU)

Estrategias para el empleo optimizado de la neuroimagenología en pacientes con traumatismo encéfalo craneano: puesta al día / Strategies for the optimized use of neuroimaging in patients with head trauma cranial: update

INTRODUCTION: Introduction of current neuroimaging technologies has been essential for the agile and effective diagnosis of cranial brain injuries. However, for various reasons there is a tendency to indiscriminate use. A review of the topic was made aimed at providing an update on the recommended strategies for the optimized use of these technologies. Material and method: A review of the topic of the last five years was made, using the Medline / Pubmed and SciELO platforms of complete articles, in English and Spanish. We also included relevant articles, published in previous years, located in previous bibliographic reviews carried out by the authors. CONCLUSIONS: Routine study with CT scan in all patients with head trauma is not cost effective, should be used in patients with Glasgow less than 15 points or in those with Glasgow of 15 points and risk factors of intracranial injury. Its use as a form of neuromonitoring is similarly useful, but on a selective basis. Magnetic Resonance Imaging is especially useful in the mediate or late periods of cranial trauma, in patients with clinical tomographic incongruences, very useful to establish prognosis in diffuse traumas and intracranial complications. Neurosonology is a useful tool for therapeutic decision.

The effect of graft application and allopurinol treatment on calvarial bone defect in rats

Abstract Purpose: To investigate the effects of allopurinol administration on osteoinductive reaction and bone development with graft material. Methods: Thirty-six Wistar albino rats were divided into 3 groups. In the control group, calvarial bone defect was only created without any treatment. In the Defect + Graft group, allograft treatment was performed by forming 8 mm calvarial bone defect. In the Defect + Graft + Allopurinol group, alloplastic bone graft was placed in the calvarial bone defect and then, allopurinol (50 mg/kg/day) treatment was intraperitoneally applied for 28 days. Results: Histopathological examination revealed inflammation, congestion in the vessels, and an increase in osteoclast cells in the defect area. We also observed that new osteocyte cells, increase in connective tissue fibers, and new bone trabeculae. Osteopontin expression was positive in osteoblast cells and lacunated osteocyte cells were located in the periphery of the new bone trabeculae. Osteopontin expression was also positive in osteoblasts and osteocytes cells of new bone trabeculae in the graft site. Conclusion: It has been shown that allopurinol treatment in rat calvaria defects may induce osteoblastic activity, matrix development, mature bone cell formation and new bone formation when used with autogenous grafts.

Effects of vacuum sealing drainage on the treatment of cranial bone-exposed wounds in rabbits

This study was designed to assess the efficacy of vacuum sealing drainage (VSD) on skull exposure wounds in rabbits and to investigate the underlying mechanism of the process. Full-thickness excisional circular wounds 2×2 cm with or without periosteum involvement were created in 88 New Zealand white rabbits (mean body weight: 3.0±0.65 kg). Animals were randomly divided into 4 groups: periosteum-intact wounds treated with traditional dressing (p+control), periosteum-intact wounds treated with VSD (p+VSD), periosteum-lacking wounds treated with traditional dressing (p-control) and periosteum-lacking wounds treated with VSD (p-VSD). The wounds treated with traditional dressing were covered with Vaseline gauze, while VSD treatment was accompanied with continuous -120 mmHg pressure. Finally, wound tissues were harvested for analysis of hydroxyproline content and histologic detection. VSD hastened the wound healing process significantly (P<0.05) compared to the corresponding control groups. VSD alleviated the inflammation reaction, accelerated re-epithelialization and facilitated the organization of collagen fibers into neat rows. During the wound healing process, the hydroxyproline content increased overtime [i.e., postoperative days (POD) 7, POD 10 and POD 15] in all four groups, and it peaked in the p+VSD group. VSD also promoted angiogenesis via increasing number and quality of collagen. We concluded that VSD can promote healing in bone-exposed wounds via increasing hydroxyproline content and vessel density, reducing inflammatory responses and generating ordered collagen arrangement.

Simvastatin and biphasic calcium phosphate affects bone formation in critical-sized rat calvarial defects

ABSTRACT PURPOSE: To investigate the effects of locally applied simvastatin plus biphasic calcium phosphate (BoneCeramic(r)) or collagen sponge on bone formation in critical-sized bone defects. METHODS: Thirty defects of 5mm in diameter were created bilaterally with a trephine bur in the calvariae of fifteen Wistar rats. The defects were divided into five groups: group 1 - control, no treatment; group 2 (BoneCeramic(r)); group 3 (BoneCeramic(r) + 0.1mg simvastatin); group 4 (collagen sponge); and group 5 (collagen sponge + 0.1mg simvastatin). After eight weeks the animals were euthanized and their calvariae were histologically processed. Hematoxylin and eosin-stained sections were subjected to histological and histomorphometrical analyses. The area of newly formed bone was calculated and compared between groups. RESULTS: The greater amount of a bone-like tissue was formed around the carrier in group 3 (BoneCeramic(r) + 0.1mg simvastatin) followed by group 2 (BoneCeramic(r)), and almost no bone was formed in the other groups. Group 3 was significantly different compared to group 2, and both groups were significantly different compared to the other groups. CONCLUSION: Simvastatin combined with BoneCeramic(r) induced significantly greater amounts of newly formed bone and has great potential for the healing of bone defects.

Investigation of various events occurring in the brain tissue after calvarial defects in rats / Investigación de las alteraciones ocurridas en el tejido cerebral posterior a la creación de defectos en la calvaria de ratas

Bone damage and accidents, traumas can alter people's normal life, and damage the soft tissues. In this study, we aimed to investigate in calvarial defects in rats depending on the severity of cerebral contusion injury occurring in the temporal region. The rats were randomly divided into two groups: group 1 (control group), critical size cranial model with no treatment (n= 10); group 2 (14-day synthetic graft group given 7th day DEXA), critical size cranial model treated with Dexamethasone (0.05 mg/kg intramuscular injection) +Synthetic graft (n= 10) One calvarium defect of 7 mm was made in the parietal bone of each animal under general anesthesia. Calvarial defect results in dilatation of blood vessels, hemorrhage and deterioration was observed in glial fibrillary structures. Additionally, the increase in vascular endothelial growth factor expression showed a positive reaction with glial fibrillary acid protein astrocytes extensions. Apoptotic glial cells stained positive with Bcl-2. Calvarial defects caused by mild brain injury, to be induced by inflammatory cytokines, interrupting glial fibrillary degeneration by affecting the blood brain barrier is thought to promote apoptotic changes.

Daños óseos, accidentes y traumas pueden alterar la vida normal de las personas y dañar los tejidos blandos. Este estudio tuvo como objetivo investigar los defectos de calota en ratas en función de la gravedad de la lesión cerebral que ocurre en una contusión de la región temporal. Las ratas fueron divididas aleatoriamente en dos grupos: al grupo 1 (control), se le realizó un modelo de defecto craneal de tamaño crítico sin tratamiento (n= 10) y al grupo 2, se le realizó un modelo de defecto craneal de tamaño crítico que fue tratado con dexametasona (0,05 mg/kg vía i.m.) + injerto sintético (n= 10) (14 d con injerto sintético y el día 7 se le administró dexametasona). El modelo generó un defecto de 7 mm en el hueso parietal en cada animal, bajo anestesia general. Los defectos craneales produjeron dilatación de los vasos sanguíneos, hemorragias y deterioro en las estructuras gliales fibrilares. Además, el aumento de la expresión del factor de crecimiento vascular endotelial mostró una reacción con las positiva con la proteína ácida fibrilar de la glía el las extensiones de los astrocitos. Las células gliales apoptóticas se tiñeron positivas con Bcl-2. Los defectos de calota causan una lesión cerebral leve, inducidas por citoquinas inflamatorias, las que interrumpen la degeneración glial fibrilar al afectar la barrera hematoencefálica, induciendo cambios apoptóticos.

The biopolymer sugarcane as filling material of critical defects in rats

PURPOSE: To evaluate the effects of particulate (granule-shaped) SCB on bone repair relating it to its biocompatibility and bone neoformation. METHODS: Thirty Wistar rats were submitted to a one 7-mm-diameter defect and divided equally into three experimental groups, with two different postoperative times of evaluation, 90 and 120 days. Each calvaria defect was filled up with clot (control group), particulated autogenous bone or granulated SCB. Five animals of each group were assessed at 90 and 120 days after surgery. In these two periods, histological and histometric analysis were obtained. RESULTS: The clot group showed a bone resorption trend while the autogenous bone group a bone repair trend. However in the SCB group, the critical defect filled up only with fibrous connective tissue and presented none bone neoformation. CONCLUSION : The sugarcane biopolymer when used in critical size defects was a biocompatible material and proved to be a good material to fill bone cavities, keeping them as uniform areas filled with soft tissue and avoiding the tissue shrinkage.

Reconstrução facial forense: comparação entre tabelas de espessuras de tecidos moles faciais / P

As Ciências Forenses empregam a técnica de Reconstrução Facial buscando aumentar as possibilidades de reconhecimento humano. Após análise antropológica, a face é esculpida sobre o crânio esqueletizado e divulgada na mídia. Existem várias metodologias para a modelagem do rosto e das características da face, bem como vários dados de espessuras de tecidos moles que auxiliam no contorno facial. Com o intuito de investigar se existe uma metodologia que favoreça mais reconhecimentos e que permita uma maior semelhança com o indivíduo, este trabalho buscou comparar reconstruções faciais manuais feitas com duas abordagens para o preenchimento dos tecidos moles (métodos Americano e de Manchester) e para a predição dos olhos, nariz, boca e orelhas. Também buscou comparar reconstruções realizadas com quatro tabelas de espessuras de tecidos moles, desenvolvidas para brasileiros por estudos prévios, observando a possibilidade de unir esses dados para auxiliar na reconstrução. Um quarto objetivo foi averiguar se existe influência do sexo e do conhecimento anatômico ou forense na frequência de reconhecimentos. O estudo foi dividido em duas fases. Na primeira, duas reconstruções foram realizadas para dois indivíduos alvos (um homem e uma mulher) com os métodos Americano e de Manchester, aplicando dois guias para olhos, nariz, boca e orelhas. As reconstruções foram avaliadas por quarenta indivíduos (homens e mulheres, divididos em 4 grupos - alunos de graduação em Odontologia que não passaram pela disciplina de Odontologia Legal, alunos

de graduação em Odontologia que passaram pela disciplina, especialistas em Odontologia Legal e indivíduos que não possuíam conhecimento de anatomia humana) por meio dos testes de reconhecimento e semelhança. Para o alvo feminino, as frequências de reconhecimentos foram 20% e 10% para os métodos Americano e de Manchester, respectivamente; para o alvo masculino, as frequências foram 35% e 17,5%. Em relação à semelhança, as medianas foram menores que 3 (em uma escala de 1 a 5); entretanto, foi verificada uma exceção para a escultura feita com o método Americano para o alvo masculino, a qual apresentou mediana 3. Na segunda fase, reconstruções faciais para quatro alvos (dois homens e duas mulheres) foram obtidas com o método Americano, considerando as quatro tabelas de espessuras de tecidos moles para brasileiros. Dezesseis reconstruções foram avaliadas por cento e vinte indivíduos, também pelos testes de reconhecimento e semelhança. Assim como na fase I, foram considerados o sexo e o grupo dos avaliadores. Para o alvo 1, as proporções de acertos são significativamente maiores para reconstruções feitas com as tabelas de cadáveres (44% e 38%) em relação às com os dados de exames de imagem. Para o alvo 4, as proporções de acertos com os dados de cadáveres (Tedeschi-Oliveira et al.) e com os de ressonância magnética foram significativamente maiores comparados às reconstruções com dados de tomografias computadorizadas. Em relação à semelhança, somente o alvo 1 mostrou diferenças significativas de frequências de semelhança leve entre reconstruções. Além disso, não houve influência nem do sexo, nem do conhecimento de anatomia nas frequências de reconhecimentos corretos. Espera-se que a tabela proposta possa ser empregada para a população brasileira.

Forensic Sciences employ Forensic Facial Reconstruction technique to increase possibilities in human recognition. After anthropological analysis, the face can be created on the skeletonized skull and published in the media. There are several methodologies for facial modeling and facial features as well as multiple soft tissue thicknesses data that aid in facial contour. In order to investigate whether a methodology allows more recognition and greater resemblance to a person, this study aimed to compare manual facial reconstructions made with two approaches of filling facial soft tissue (American and Manchester methods) and two approaches to predict the eyes, nose, mouth and ears. This study also intended to compare facial reconstructions carried out with four Brazilian soft tissue thicknesses data, that were developed by previous studies considering the possibily of merging these data for Forensic Reconstruction purpose. A fourth aim was to determine whether sex and anatomical or Forensic knowledge of assessor can influence in frequency of recognition. This study was divided into two phases. In the first phase, two reconstructions were performed for two targets (one male and one female) with American and Manchester methods and applying two guides for eyes, nose, mouth and ears. The reconstructions were evaluated by forty assessors (both sex, divided into four groups - undergraduated students in dentistry who did not study Forensic Dentistry,

undergraduated students in dentistry who have gone through the subject of Forensic Dentistry, experts in Forensic Dentistry and individuals who did not have knowlegde of human anatomy) through the recognition and resemblance tests. For female target, frequencies of recognitions were 20% and 10% for American and Manchester methods, respectively; for male target, frequencies were 35% and 17.5%, with significant differences between the proportions of correct responses. Regarding resemblance rates, medians were less than 3 (on a scale from 1 to 5); however, it was found an exception for the sculpture made with the American method for male target, which had median 3. Thus, American method was used for the reconstructions of phase II. In this second phase, facial reconstructions for four targets (two male and two female) were obtained with the American method, considering the four Brazilian soft tissue thicknesses data. Sixteen facial reconstructions were evaluated by a hundred and...

Effect of collagen sponge and fibrin glue on bone repair

ABSTRACT The ability of hemostatic agents to promote bone repair has been investigated using in vitro and in vivo models but, up to now, the results are inconclusive. Objective In this context, the aim of this study was to compare the potential of bone repair of collagen sponge with fibrin glue in a rat calvarial defect model. Material and Methods Defects of 5 mm in diameter were created in rat calvariae and treated with either collagen sponge or fibrin glue; untreated defects were used as control. At 4 and 8 weeks, histological analysis and micro-CT-based histomorphometry were carried out and data were compared by two-way ANOVA followed by Student-Newman-Keuls test when appropriated (p≤0.05). Results Three-dimensional reconstructions showed increased bone formation in defects treated with either collagen sponge or fibrin glue compared with untreated defects, which was confirmed by the histological analysis. Morphometric parameters indicated the progression of bone formation from 4 to 8 weeks. Additionally, fibrin glue displayed slightly higher bone formation rate when compared with collagen sponge. Conclusion Our results have shown the benefits of using collagen sponge and fibrin glue to promote new bone formation in rat calvarial bone defects, the latter being discreetly more advantageous.

Avaliação de diferentes protocolos de aplicação do laser de baixa intensidade associado ou não ao osso bovino inorgânico (Bio-Oss®) na cicatrização de defeitos ósseos criados cirurgicamente em calvárias de ratos: estudo histológico e histométrico / Evaluation of different protocols of low-level laser (LLL) application combined or not with inorganic bovine bone (Bio-Oss®) in the healing of surgically created bone defects in rat calvaria: histological and histometric study

O propósito deste estudo foi avaliar diferentes protocolos de aplicação do laser de baixa intensidade (LBI) associados ou não ao osso bovino inorgânico (Bio-Oss®) na cicatrização de defeitos ósseos de tamanho crítico (DTC) em calvárias de ratos. Foram utilizados 90 ratos machos adultos (Rattus norvegicus, albinus, Wistar). Um defeito de tamanho crítico (DTC) de 5 mm de diâmetro foi criado cirurgicamente na calvária de cada animal. Os animais foram divididos igualmente (n=10) e aleatoriamente em 9 gruposexperimentais: 1) grupo C (controle), 2) grupo LBI (4J) (laser de baixa intensidade GaAlAs, 730 nm, 100 mW, 4J, 140 J/cm2), 3) Grupo LBI (6J) (laser de baixa intensidade GaAlAs, 730 nm, 100 mW, 6J, 210 J/cm2), 4) Grupo BO (osso bovino inorgânico), 5) Grupo BO + LBI (4J) (osso bovino inorgânico + laser de baixa intensidade 4J), 6) Grupo BO + LBI (6J) (osso bovino inorgânico + laser de baixa intensidade 6J), 7) Grupo OA (osso autógeno), 8) Grupo OA + LBI (4J) (osso autógeno + laser de baixa intensidade 4J), 9) Grupo OA + LBI (6J) (osso autógeno + laser de baixa intensidade 6J). Os animais foram submetidos à eutanásia aos 30 dias pós-operatórios. Foram avaliadas a área de osso neoformado (AON), extensão linear de osso (ELO) e área de partículas remanescentes (APR). Os dados foram submetidos ao teste paramétrico ANOVA, seguido pelo teste de Tukey (p<0,05). O grupo BO+LBI (6J) demonstrou maior média (48,57 ± 28,22%) de AON e o grupo C a menor média (9,96 ± 4,49%) de AON. Os grupos LBI (6J), OA+LBI (6J) e BO+LBI (6J) demonstraram diferenças estatisticamente significativas de AON em relação ao grupo C. Em relação a ELO, apenas os grupos BO e BO+LBI (4J) não demonstraram diferenças estatisticamente significativas quando comparados ao grupo C, e a maior diferença entre as médias de ELO foram nas comparações do grupo LBI (6J) (76,55 ± 15,54%) com o grupo C (16,00 ± 9,86%. Maior APR foi observada nos grupos em que BO não foi irradiado pelo LBI. Porém, quando...

The purpose of this study was to evaluate different protocols of low-level laser (LLL) application combined or not with inorganic bovine bone (Bio-Oss®) in the healing process of bone defects of critical size (CSD) in rat calvaria. 90 male adult rats (Rattusnorvegicus, albinus, Wistar) were used. A critical size defect (CSD) of 5 mm in diameter was surgically created in the calvaria of each rat. The rats were then divided equally (n=10) and randomly into 9 experimental groups: 1) Group C (control) 2) Group LBI (4J) (low-level laser - GaAlAs, 730 nm, 100 mW, 4J, 140 J/cm2), 3) Group LBI (6) (low- level laser - GaAlAs, 730 nm, 100 mW, 6J, 210 J/cm2), 4) Group BO (inorganic bovine bone), 5) Group BO + LBI (4J) (inorganic bovine bone + low-level laser 4J), 6) Group BO LBI (6J) (inorganic bovine bone + low-level laser 6J), 7) Group OA (autogenous bone), 8) Group OA + LBI (4J) (autogenous bone + low-level laser 4J), 9 Group OA + LBI (6J) (autogenous bone + low-level laser 6J). The rats utilized were euthanized 30 days post-operation. The areas of new bone formation (ANB), linear extension bone (LEB), and areas of remaining particles (ARP) were evaluated. The data underwent the parametric ANOVA test, followed by the Tukey test (p<0,05). Group BO+LBI (6J) presented the greatest average (48,57 ± 28,22%) of ANB and Group C presented the lowest average (9,96 ± 4,49%) of ANB. The groups LBI (6J), OA+LBI (6J), and BO+LBI (6J) presented statistically significant differences of ANB in comparison to Group C. Regarding the LEB, only the groups BO and BO+LBI (4J) did not present differences statistically significant in comparison to Group C. The largest difference between the averages of LEB were in the comparison of Group LBI (6J) (76,55 ± 15,54%) with Group C (16,00 ± 9,86%). The largest ARP was observed in the groups where the inorganic bovine bone was not irradiated by the LLL. However, when comparing Group BO+LBI (6J) to Group OA+LBI (4J) and...

Avaliação da cicatrização de defeitos ósseos criados cirurgicamente em calvárias de ratos tratados com regeneração óssea guiada e enxertos de origem bovina associados ou não ao laser de baixa intensidade: estudo histológico e histométrico / Evaluation of the bone healing in critical-size calvarial defects in rats treated with guided bone regeneration and inorganic bovine bone associated or not with low level laser: histological and histometric study

O propósito deste estudo foi avaliar histologicamente o papel do laser de baixa intensidade (LB) no processo de cicatrização óssea de defeitos de tamanho crítico em calvárias de ratos tratados com osso bovino (BO) associados a regeneração óssea guiada (ROG). Foram utilizados 80 ratos machos adultos (Rattus norvegicus, albinus, Wistar), pesando entre 250 e 300 g. Um defeito ósseo de tamanho crítico (DTC) com 5 mm de diâmetro foi criado na calvária de cada animal. Os animais foram divididos aleatoriamente em 8 grupos de tratamento (n=10), sendo: 1) Grupo C (controle), 2) Grupo LB - laser de baixa intensidade (laser de baixa intensidade - GaAlAs, 730nm, 100mW, 6J, 210J/cm2), 3) Grupo BO (osso bovino), 4) Grupo ROG (membrana colágena), 5) Grupo BO/ROG (osso bovino/membrana colágena), 6) Grupo BO/LB (osso bovino/laser de baixa intensidade), 7) Grupo ROG/LB (membrana colágena/laser de baixa intensidade), 8) Grupo BO/ROG/LB (osso bovino/laser de baixa intensidade/membrana colágena). Após 30 dias, os animais foram submetidos à eutanásia. As variáveis avaliadas foram: área de osso neoformado (AON), extensão linear de osso (ELO) e área de partículas remanescentes (APR). Foi utilizado o teste paramétrico ANOVA, seguido pelo teste de Tukey. Todos os grupos apresentaram maiores médias de AON em relação ao grupo C, exceto os grupos BO, BO/ROG e BO/ROG/LB. Todos os grupos apresentaram médias de ELO estatisticamente diferente do grupo C, exceto o BO. O grupo BO/ROG/LB não apresentou maiores médias de AON e ELO que o Grupo BO/ROG, entretanto mostrou maior formação óssea na região da membrana quando utilizado o LB em associação ao BO/ROG na análise histológica. Maior APR foi observada nos grupos em que BO não foi irradiado pelo LB. Entretanto, não ocorreu diferença estatisticamente significativa entre APR nos grupos BO e BO/ROG, BO/LB e BO/ROG/LB, BO/ROG e BO/ROG/LB. O LB não levou a maior formação óssea histométrica quando associado ao BO/ROG, apesar de...

The purpose of this study was to evaluate histologically the low level laser (LB) on bone healing in critical-size calvarial defects (CSD) in rats treated with inorganic bovine bone (BO) and guided bone regeneration (GBR). Were used 80 male adult rats (Rattus norvegicus albinus Wistar) weighing 250 to 300 g. A bone defect of critical size (DTC) with 5 mm in diameter was created in the calvaria of each animal. The animals were randomly divided into 8 treatment groups (n = 10), 1) Group C (control), 2) Group LB - low level laser (low level laser - GaAlAs, 730nm, 100mW, 6J, 210J / cm2 ), 3) Group BO (bovine bone), 4) Group ROG (collagen membrane), 5) Group BO / ROG (bovine bone / collagen membrane), 6) Group BO/ LB (bovine bone / low level laser), 7) Group ROG / LB (collagen membrane / low level laser), 8) Group BO / LB / ROG (bovine bone /low level laser / collagen membrane). After 30 days, the animals were euthanized. The variables analyzed were newly formed bone area (AON), linear extension of bone (ELO) and area of remnant particles (APR). The parametric test ANOVA followed by Tukey's test was used. All groups have the highest mean AON compared to C group except the group BO, BO/ROG and BO / ROG / LB. All groups showed mean of ELO statistically different from group C, except the BO. The Group BO/ROG/LB did not show higher ELO and AON than Group BO/ROG, however showed increased bone formation in the membrane area when used LB with BO/ROG in the histological analysis. Higher APR was observed in the groups where BO is not irradiated by LB. However, there was no significant difference between APR in BO BO and BO/ROG groups, BO/LB and BO/ROG/LB groups. The LB has not provide greater histometric bone formation when combined with BO / ROG, despite promote greater bone formation in the histological analysis...

Avaliação de diferentes protocolos de aplicação do laser de baixa intensidade associado ou não ao osso bovino inorgânico (Bio-Oss®) na cicatrização de defeitos ósseos criados cirurgicamente em calvárias de ratos: estudo histológico e histométrico / Evaluation of different protocols of low-level laser (LLL) application combined or not with inorganic bovine bone (Bio-Oss®) in the healing of surgically created bone defects in rat calvaria: histological and histometric study

O propósito deste estudo foi avaliar diferentes protocolos de aplicação do laser de baixa intensidade (LBI) associados ou não ao osso bovino inorgânico (Bio-Oss®) na cicatrização de defeitos ósseos de tamanho crítico (DTC) em calvárias de ratos. Foram utilizados 90 ratos machos adultos (Rattus norvegicus, albinus, Wistar). Um defeito de tamanho crítico (DTC) de 5 mm de diâmetro foi criado cirurgicamente na calvária de cada animal. Os animais foram divididos igualmente (n=10) e aleatoriamente em 9 gruposexperimentais: 1) grupo C (controle), 2) grupo LBI (4J) (laser de baixa intensidade GaAlAs, 730 nm, 100 mW, 4J, 140 J/cm2), 3) Grupo LBI (6J) (laser de baixa intensidade GaAlAs, 730 nm, 100 mW, 6J, 210 J/cm2), 4) Grupo BO (osso bovino inorgânico), 5) Grupo BO + LBI (4J) (osso bovino inorgânico + laser de baixa intensidade 4J), 6) Grupo BO + LBI (6J) (osso bovino inorgânico + laser de baixa intensidade 6J), 7) Grupo OA (osso autógeno), 8) Grupo OA + LBI (4J) (osso autógeno + laser de baixa intensidade 4J), 9) Grupo OA + LBI (6J) (osso autógeno + laser de baixa intensidade 6J). Os animais foram submetidos à eutanásia aos 30 dias pós-operatórios. Foram avaliadas a área de osso neoformado (AON), extensão linear de osso (ELO) e área de partículas remanescentes (APR). Os dados foram submetidos ao teste paramétrico ANOVA, seguido pelo teste de Tukey (p<0,05). O grupo BO+LBI (6J) demonstrou maior média (48,57 ± 28,22%) de AON e o grupo C a menor média (9,96 ± 4,49%) de AON. Os grupos LBI (6J), OA+LBI (6J) e BO+LBI (6J) demonstraram diferenças estatisticamente significativas de AON em relação ao grupo C. Em relação a ELO, apenas os grupos BO e BO+LBI (4J) não demonstraram diferenças estatisticamente significativas quando comparados ao grupo C, e a maior diferença entre as médias de ELO foram nas comparações do grupo LBI (6J) (76,55 ± 15,54%) com o grupo C (16,00 ± 9,86%. Maior APR foi observada nos grupos em que BO não foi irradiado pelo LBI. Porém, quando...

The purpose of this study was to evaluate different protocols of low-level laser (LLL) application combined or not with inorganic bovine bone (Bio-Oss®) in the healing process of bone defects of critical size (CSD) in rat calvaria. 90 male adult rats (Rattusnorvegicus, albinus, Wistar) were used. A critical size defect (CSD) of 5 mm in diameter was surgically created in the calvaria of each rat. The rats were then divided equally (n=10) and randomly into 9 experimental groups: 1) Group C (control) 2) Group LBI (4J) (low-level laser - GaAlAs, 730 nm, 100 mW, 4J, 140 J/cm2), 3) Group LBI (6) (low- level laser - GaAlAs, 730 nm, 100 mW, 6J, 210 J/cm2), 4) Group BO (inorganic bovine bone), 5) Group BO + LBI (4J) (inorganic bovine bone + low-level laser 4J), 6) Group BO LBI (6J) (inorganic bovine bone + low-level laser 6J), 7) Group OA (autogenous bone), 8) Group OA + LBI (4J) (autogenous bone + low-level laser 4J), 9 Group OA + LBI (6J) (autogenous bone + low-level laser 6J). The rats utilized were euthanized 30 days post-operation. The areas of new bone formation (ANB), linear extension bone (LEB), and areas of remaining particles (ARP) were evaluated. The data underwent the parametric ANOVA test, followed by the Tukey test (p<0,05). Group BO+LBI (6J) presented the greatest average (48,57 ± 28,22%) of ANB and Group C presented the lowest average (9,96 ± 4,49%) of ANB. The groups LBI (6J), OA+LBI (6J), and BO+LBI (6J) presented statistically significant differences of ANB in comparison to Group C. Regarding the LEB, only the groups BO and BO+LBI (4J) did not present differences statistically significant in comparison to Group C. The largest difference between the averages of LEB were in the comparison of Group LBI (6J) (76,55 ± 15,54%) with Group C (16,00 ± 9,86%). The largest ARP was observed in the groups where the inorganic bovine bone was not irradiated by the LLL. However, when comparing Group BO+LBI (6J) to Group OA+LBI (4J) and...

Manejo de las deformaciones craneales secuelares: craneoplastia con implantes individualizados a partir de modelos esteriolitográficos / Management of the secondary cranial deformity: customized cranioplasty implants form stereolithographic models

La deformación craneal secuelar es una alteración secundaria a una craniectomía descompresiva para el manejo de la hipertensión intracraneal no controlada por otras medidas terapéuticas, es de decir de evolución maligna. Este procedimiento, es efectivo en reducir la presión intracraneal en la injuria encefálica traumática severa, accidente vascular encefálico, hemorragia subaracnoidea, infecciones del Sistema Nervioso Central, etc. Posteriormente, se reconstruye la bóveda craneal mediante la craneoplastía para la protección del tejido neural, evitar la hipotensión endocraneana y mejorar la función cerebral el aspecto estético del paciente. El hueso autólogo de la craniectomía es el material ideal para la cranioplastía subsecuente. Sin embargo, debido a la destrucción provocada por el traumatismo, por reabsorción ósea o por infección, entre otras causas, puede ser imposible utilizarlo. En dichas situaciones se debe recurrir a la reconstrucción con otros materiales para obtener un buen resultado cosmético y protección cerebral. Se presenta la craneoplastía secundaria con implantes individualizados en poli metilmetacrilato (PMMA) confeccionados a partir de modelos esteriolitográficos o prototipos en una serie de pacientes. Se realizó el análisis de los resultados obtenidos...

Secondary cranial defects or deformities are changes likely to decompressive craniectomy for the management of intractable intracra-nial hypertension by others therapeutics means. This procedure is effective in reducing intracranial pressure in severe traumatic brain injury, stroke, subarachnoid hemorrhage and infection. Subsequently, is necessary a cranioplasty to reconstruct the cranial vault for the protection of neural tissue, improving brain function and the aesthetic aspect of the patient. The autologous bone from the craniectomy is the ideal material for subsequent cranioplasty. However, due to the destruction caused by trauma, infection or bone resorption among other reasons, it may be impossible to use it. In such situations, the reconstruction should be done with other materials in order to obtain a good cosmetic result and cerebral protection. Secondary cranioplasty with poly methyl methacrylate (PMMA) individualized implant made from stereolithographic models in a series of patients is presented. Analyses of the results have been done...

Three years with a knife stuck in the brain / Três anos com uma faca cravada no encéfalo

Cranial stabbing injuries penetrating the brain are not commonly encountered. The cases in which the knife is retained constitute a challenge to the neurosurgeon. When a long-term permanence occurs, the reaction to the presence of the foreign body causes adherence to the nervous tissue and a higher risk is expected from the removal. The procedure should be performed with meticulous dissection and minimal oscillation of the blade thus avoiding damage to the adjacent structures. We report a case of a man who remained three years with a knife blade deeply lodged in the brain. After obtaining informed consent, the blade was removed; there were no postoperative complications. To our knowledge, this is the first case in which, after years of permanence, a knife blade was removed from the brain through a craniotomy.

Lesões cranianas por arma branca com penetração do encéfalo não são comuns. Os casos em que a faca encontra-se retida constituem um desafio para o neurocirurgião. Quando ocorre uma longa permanência, a reação à presença do corpo estranho causa aderência ao tecido nervoso e um maior risco é previsto para a remoção. O procedimento deve ser realizado com dissecção meticulosa e mínima oscilação da lâmina, evitando, assim, lesão das estruturas adjacentes. Apresentamos o caso de um indivíduo que permaneceu três anos com a lâmina de uma faca alojada profundamente no encéfalo. Após obtermos consentimento informado, a lâmina foi removida; não houve complicações pós-operatórias. Até onde sabemos, este é o primeiro caso em que, após anos de permanência, a lâmina de uma faca foi removida do encéfalo por meio de uma craniotomia.

Osteocalcin Immunohistochemical Expression During Repair of Critical-Sized Bone Defects Treated with Subcutaneous Adipose Tissue in Rat and Rabbit Animal Model

The aim of this study was to evaluate the osteocalcin immunoexpression during the bone repair treated with subcutaneous adipose tissue in rats and rabbits. Fourteen rats and 14 rabbits were used in the study. A critical-sized calvarial defect was created in each animal. The animals were divided into 4 experimental groups: RC (rat control), RbC (rabbit control), RAT (rat adipose tissue), RbAT (rabbit adipose tissue). In the groups RC and RbC the defect was filled with a blood clot. In groups RAT and RbAT, the defect was filled with macerated subcutaneous adipose tissue. The euthanasia was performed at 30 days (RC and RAT) and 40 days (RbC and RbAT). Histological analysis and immunohistochemical analysis of osteocalcin protein expression were performed. Data were submitted to descriptive statistical analysis (mode). Osteocalcin immunoexpression was detected in the experimental models. Notwithstanding, RbAT showed higher positivity, especially in the adipocytes, than the group RAT group. In groups RC and RbC, the surgical wound was filled by collagen fibers. In Group RAT, the defect was composed by collagen fibers and adipocytes in the reparative sites. Similarly, in RbAT, the defect also was partially filled by collagen fibers and presence of adipocytes dispersed among the fibers. Additionally, chronic inflammatory process and areas of bone matrix deposition were observed. It may be concluded that in both animal models the adipose tissue demonstrated low osteogenic capacity. However, the rabbit animal model exhibited a more evident osteocalcin immunoexpression and a greater amount of newly formed bone matrix.

Este estudo avaliou a imunoexpressão da osteocalcina no reparo ósseo de defeitos críticos tratados com tecido adiposo subcutâneo em rato e coelho. Foram utilizados 14 ratos e 14 coelhos. Um defeito crítico foi realizado na calvária de cada animal. Os animais foram divididos em 4 grupos experimentais: CR (controle rato), CC (controle coelho), TAR (tecido adiposo do rato), TAC (tecido adiposo do coelho). Nos grupos CR e CC, o defeito foi preenchido com coágulo. Nos grupos TAR e TAC, o defeito foi preenchido com tecido adiposo subcutâneo macerado. A eutanásia dos grupos CR e TAR ocorreu com 30 dias e dos grupos CC e TAC com 40 dias. Foram realizadas análise histológica e imunoistoquímica com a proteína osteocalcina. Os dados foram submetidos à análise estatística descritiva (moda). Nos modelos experimentais foi observada a imunoexpressão de osteocalcina. Contudo, o TAC apresentou maior imunoexpressão entre os adipócitos quando comparado ao TAR. Nos grupos CR e CC a ferida cirúrgica foi preenchida por fibras colágenas. No grupo TAR foi observado o preenchimento por fibras colágenas e presença de adipócitos no interior deste tecido. No grupo TAC o defeito foi preenchido parcialmente por fibras colágenas, com presença de adipócitos dispersos entre as fibras. Além disso, foi observado processo inflamatório crônico e sinais de neoformação óssea. Conclui-se que em ambos os modelos animais o enxerto de tecido adiposo apresentou baixa capacidade osteogênica. Contudo, o modelo animal coelho apresentou uma imunoexpressão da osteocalcina mais evidente e maior quantidade de matriz óssea neoformada.

A rare case of penetrating cranial trauma by knife with direct lesion to the anterior cerebral artery

Las lesiones penetrantes en el cráneo por lo general se asocian con alta mortalidad. Ellos pueden ser el resultado de numerosos eventos, la mayoría de ellos están causados por un trauma de alta energía. La perforación de un cráneo por los objetos de baja energía cinética es inusual en la práctica neuroquirúrgica. Un alto porcentaje de los casos con lesiones penetrantes craneales se asocian con lesiones vasculares, lo que requiere el estudio de la vascularización intracraneal para una conducta médica adecuada. Presentamos un caso de una paciente de 32 años de edad que sufrió un trauma penetrante en el cráneo con un cuchillo a través de los huesos del cráneo, con lesión directa a la arteria cerebral anterior, e incluimos una breve revisión de la literatura sobre el tema.

The penetrating injuries of the skull are usually associated with high mortality. They may be the result of numerous events, the majority of them being caused by high energy trauma. Penetrating brain injury by objects of low kinetic energy is unusual in the neurosurgical practice. A high percentage of the cases with penetrating injuries is associated with cranial vascular lesions, requiring study of the intracranial vasculature for proper management. We report on a case of a 32-year-old patient who suffered a head-penetrating trauma by a knife through the bones of the skull, with direct injury to the anterior cerebral artery, including a brief review of the literature on the theme.

Analysis of cranio-cerebral injuries by blunt force.

Despite current advances in public education and in automobile safety requirements, cranio-cerebral injuries continues to be a major cause of morbidity and mortality and accounts for significant portion of health care costs today. Trauma respects neither geography nor body systems. Consequently head injury occurs every 15 seconds and a patient dies from a head injury every 12 minutes, a day doesn’t pass that an emergency department physician is not confronted with a head injured patient. The present work is based on the observation and study made on 117 cases collected. These cases include 39 cases who died before being admitted to any hospital and were sent directly by the police to postmortem, Mysore Medical College, Mysore, and 78 cases that died in the hospital under medical care. Clinical data are available for 78 cases that died in the hospital after undergoing some treatment. An attempt is made in these cases to correlate clinical findings with the autopsy findings.

Presentación clínica y tomográfica de pacientes con displasia fibrosa craneofacial en la Clínica José A. Rivas / Clinical and radiological presentation in patients with fi brous dysplasia craniofacial in José A. Rivas clinic

Objetivo: describir las manifestaciones clínicas y radiológicas de los pacientes con diagnóstico de displasia fi brosa craneofacial en el Servicio de Rinología y Base de Cráneo de la Clínica José A. Rivas, entre enero del 2009 y enero del 2012. Diseño: estudio tipo serie de casos con análisis prospectivo Métodos: se incluyeron diez pacientes entre los ocho y 36 años con diagnóstico de displasia fi brosa craneofacial, en los que se tuvieron en cuenta variables demográfi cas, manifestaciones clínicas, presentación tomográfi ca, y se revisó el tipo de tratamiento realizado, al igual que la recidiva de la enfermedad. Resultados: se encontró que la manifestación preponderante ocurría en el sexo masculino (60%), con una media de 17 años, y la condición clínica común fue la asimetría facial (ocho pacientes). Además, el seno etmoidal fue el que evidenció mayor compromiso (60% de los casos); dos pacientes registraron lesión de la base del cráneo, uno de ellos reportó ceguera y compromiso del nervio óptico. En la tomografía, el tipo 2, con compromiso de más de dos senos paranasales, fue el que se halló con más frecuencia, y la variedad mixta, con respecto al tipo de lesión, tuvo mayor porcentaje que la de vidrio esmerilado, la homogénea y la quística. Al 90% de los pacientes se les sometió a tratamiento quirúrgico ciento por ciento endoscópico, y se detectó un 20% de recidivas.

Objective: To describe the clinical and radiological diagnosis of patients with craniofacial fibrous dysplasia in the Service of Rhinology and Skull Base Clinic José A. Rivas, between January 2009 and January 2012. Design: case series with prospective analysis. Methods: Ten patients between eight and 36 years diagnosed with craniofacial fibrous dysplasia, which took into account demographic, clinical, tomographic presentation, and revised the type of treatment, as well as recurrence of disease. Results: We found that the predominant manifestation occurred in males (60%), with a mean of 17 years, and the common clinical condition was facial asymmetry (eight patients). In addition, the ethmoid sinus was evident that greater commitment (60% of cases), two patients reported injury skull base, one of them reported blindness and optic nerve involvement. On CT, type 2, with involvement of more than two sinuses, was the one most frequently found, and the mixed variety, with respect to the type of injury, had the highest percentage of frosted glass, the homogeneous the cystic. 90% of patients underwent surgical treatment hundred percent endoscopic and detected 20% of recurrences. Conclusions: There are few studies in Colombia about craniofacial fibrous dysplasia. For this reason, we present statistics about the pathology own study, proposing a new tomographic classification as a basis for future research.