Intraneural perineurioma involving the median nerve.

Intraneural perineurioma is a rare clinical entity, which tends to affect major nerve trunks in the upper extremities. On light microscopy, numerous pseudo-onion-bulb structures having a central clear area are surrounded by concentric layers of eosinophilic elongate cells having spindled nuclei. Immunohistochemistry of concentric cells stains positive for epithelial membrane antigen but negative for S100 protein. Because of the small number of cases, no consensus has been made on proper treatment of this entity. Although none of the patients who have had excision of tumor with nerve grafting have had sensory nerve recovery, we believe each patient should be individualized until more data are available regarding this tumor.

The effects of alloplastic implant onlays on bone in the rabbit mandible.

The relative importance of the factors that contribute to the bone erosion seen underlying alloplastic implants remains unknown. This study was designed to examine the effects of different alloplastic onlays on the mandible in a rabbit animal model. Three alloplastic materials (soft solid silicone, methyl methacrylate, and porous polyethylene) were examined to determine the importance of implant composition in bone resorption. Thin (1.5-mm) and thick (6-mm) onlays were used to determine the relative importance of implant thickness. Fluorescent markers were administered at different time intervals to evaluate the patterns of new bone formation. A total of 96 implants placed on the mandibles of 16 animals were examined grossly, histologically, and under fluorescent microscopy after 12 and 24 weeks. The frequency and degree of bone erosion were related both to the type of alloplast and to the thickness of the implant. Silicone implants were associated with the greatest amount of bone resorption (p < 0.01). Thicker silicone implants were associated with a greater degree of thinning (p < 0.05). Bone resorption beneath the implants was documented by the presence of osteoclasts actively eroding bone and by changes in the normal patterns of the fluorescent markers. Both the thin methyl methacrylate and the thin porous polyethylene implants had a low incidence of bone thinning. The thick methyl methacrylate implants caused more erosion than the thin implants of the same material, although this was less than the silicone groups. Increasing the thickness of porous polyethylene implants did not adversely affect the underlying bone.(ABSTRACT TRUNCATED AT 250 WORDS)

The physiologic basis for nonconventional vascular perfusion.

It is traditionally thought that the exchange of oxygen occurs only at the capillary level, with both arterial inflow and venous outflow required. However, as early as 1970, studies have indicated that significant arteriolar and venular diffusion of O2 and CO2 occurs. The precapillary and postcapillary diffusion of oxygen and carbon dioxide and their potential regulation via the Bohr effect are key elements in understanding the success of nonconventional vascular perfusion (arterialized venous, total arterial, total venous), where the capillary circulation is bypassed. In retrograde "reverse-flow" island flaps, there is an anterograde blood flow through the capillary bed, with nonconventionally reversed flow within the arterial and venous systems, respectively. The reversal of venous flow is best explained as a combination of valvular insufficiency and the existence of vein-vein bypass channels via the venae comitantes.

Comparison of various delivery systems for demineralized bone matrix in a rat cranial defect model.

Demineralized bone matrix (DBM) has been successfully used as a substitute for bone grafting. Autogenous bone grafts may cause site morbidity and undergo significant resorption. DBM may overcome these problems, but it has no mechanical stability until bone formation has occurred. We tested various alloplastic implants (i.e., Surgicel, polydioxanone [PDS], porous polyethylene [Medpor], and Gelfoam) in combination with DBM and compared it with DBM alone in a 9 x 9 mm rat cranial defect model. Histological and biomechanical measurements were performed at postoperative month 2. Among the study groups, Gelfoam/DBM inhibited bone formation to varying degrees and was the only group that displayed an inflammatory response. Mechanical pushout tests using a servohydraulic testing frame were conducted. The Medpor/DBM implant displayed the strongest support at 2 months; maximum load was 95% of intact skull. Surgicel/DBM and DBM alone were comparable; maximum load was 66% of intact skull. Gelfoam/DBM and PDS/DBM displayed the weakest support (48% of intact skull). We conclude that, after 2 months of implantation, alloplastic/DBM composites provide osseous structural integration. Gelfoam/DBM is not an effective delivery system for DBM in our model.