Fresh frozen bone in oral and maxillofacial surgery

Abstract The aim of the current study was to review the use of fresh frozen bone (FFB) in oral and maxillofacial surgery. We performed a review of the articles published in the literature between 1976 and May 2014 analyzing three medical databases (PubMed, Cochrane Library, and Embase) and using specific search terms. Literature analysis on FFB applications in oral and maxillofacial surgery revealed 47 articles between 1976 and May 2014. There are 46 clinical articles and one review. Clinical articles are represented by 22 case reports and case series and 24 retrospective studies. Classifying the scientific production by year of publication, it is evident that especially during the last 6 years there was an increase of FFB graft use in oral and maxillofacial approaches. The literature analysis on FFB's use shows that its application in oral and maxillofacial surgery began slowly in 1992 with Perrott and since 2006 it had a real development. The recent significant increase emphasizes the importance of FFB for bone regeneration in oral and maxillofacial surgery. This review found consistent evidence of FFB's use increase in oral and maxillofacial surgery suggesting a valid instrument for bone regeneration. To date, risks connected to the infections' transmission and to the immunogenic potential are extremely low and could be considered practically absent. So, this is an important alternative in the preimplant reconstructive surgery

De geneeskunst in de Lage Landen tijdens de Gouden Eeuw

Die Geschichte der Medizin lässt sich bis in die Antike zurückverfolgen. Aus unterschiedlichen biologischen philosophischen Ansichten entwickelten sich die ersten medizinischen Theorien. Hippokrates von Kos (460-377 v. Chr.) und Galenus van Pergamum (130-200 v. Chr.) haben durch ihre Arbeit nachfolgende Epochen beeinflusst. Das empirische Forschung von Hippokrates und die Humoralpathologie von Galen waren richtungsweisend während des gesamten Mittelalters und überlebten sogar teilweise bis ins achtzehnte und neunzehnte Jahrhundert, manche sogar bleiben bis in die moderne Zeit erhalten. Nach Christus waren es die Geistlichen, die die Schulen in Europa leiteten. Nicht nur weil in den Klöstern Bücher gesammelt und kopiert wurden, sondern auch weil damals Bücher für den normalen Menschen einfach zu teuer waren. Während des Mittelalters war so die Kirche ein starker beeinflussender Faktor - wissenschaftliche Forschung in die “falsche Richtung” wurde verhindert. Eine Änderung fand erst im sechzehnten Jahrhundert mit der Entwicklung von moderner anatomischer Forschung durch Andreas Vesalius (1514-1564) statt. Die Gründung von Hochschulen war für die Entwicklung der Medizin ein wichtiger Schritt. Hierdurch verschob sich das Zentrum der medizinischen Wissenschaft von Griechenland nach Italien und Spanien. Erst in dem sechzehnten und siebzehnten Jahrhundert, durch die Gründung von Universitäten in den niederen Landen - insbesondere in Leiden in 1579 - wurden die niederen Lande ein Zentrum der Wissenschaften in Europa. Durch die Entdeckung des Blutkreislaufs durch William Harvey (1578-1657) konnten viele falsche Theorien falsifiziert werden und die Metamorphose von den “piskijkers” zu echten Wissenschaftern begann. Stück für Stück widersprach man der Galenischen Lehre und durch Herman Boerhaave (1668-1738) wurde die Niederlande das Zentrum der medizinisch-wissenschaftlichen Forschung in Europa. Die medizinische Lehre von Boerhaave mit seiner klinischen Erziehung der Studenten verbreitete sich durch ganz Europa und sogar bis nach Japan. Nach seinem Tod waren es seine Lehrlinge, die die Geschichte der Medizin weiter bestimmt haben. So gründeten Gerhard van Swieten (1700-1772), Anton de Haen (1704-1776) en Jan Ingen-Hausz (1730-1799) die Wiener medizinische Schule. Ab diesem Zeitpunkt wanderte das Zentrum der Medizin nach Zentral-Europa und später auch zu Amerika’s Westküste. Die Geschichte und die Entstehung von medizinisch wissenschaftlicher Forschung kann man auch mit Hilfe von Eponymenlisten darstellen. 4503 Namen von Ärzten spiegeln den échten Aufschwung der Medizin während der letzten fünf Jahrhunderte wieder. Drei Texte aus der Zeit der Hochburg der Medizin der niederen Lande wurden analysiert und mit dem heutigen Stand der Dinge verglichen: Johannes Coninck, Cirurgia of Hantgewerck int lichame der menschen (ed. Willy L. Braekman). Omirel UFSAL, Brussel 1985. Joan Baptista van Helmont, Dageraed, ofte nieuwe opkomst der geneeskonst. Uitgeverij W.N. Schors, Amsterdam 1978 Herman Boerhaave, Kortbondige spreuken wegens de ziektens (ed. G.A. Lindeboom, facsimile van uitgave Amsterdam 1741). Stafleu, Alphen aan den Rijn 1979 Es gibt einen großen Unterschied was Arzneimittel damals und heute betrifft, weil die Entwicklung in diesem Fachbereich zum größten Teil erst im zwanzigsten Jahrhundert geschah. Jedoch, was Wunden und Frakturen betrifft, änderte sich der Stand des Wissens nur wenig. Das Erkennen von tödlichen Verletzungen war bereits damals akkurat. Bei Fieber unterscheiden sich jedoch bereits die fundamentalen Definitionen - heutzutage gilt es nur als Symptom. In Boerhaave’s Zeit war dies eine alleinstehende Krankheit, beeinflusst durch das Unverständnis der Abläufe im Inneren des menschlichen Körpers. Van Helmont’s Kapitel über die Pest spiegelt die Gründe für den Aberglauben als unterliegende Ursache zum Verständnis von unerklärbaren Krankheiten wieder. Hier zeigt sich der Fortschritt der modernen Zeit - heutzutage ist ein Antibiotikum ausreichend um diese Krankheit zu heilen. Der Begriff Krebs - an und für sich als Erkrankung des modernen Zeitalters bezeichnet, in dem die Menschen immer älter werden - kam bei Boerhaave bereits vor. Die chirurgische Therapie war aber in ihren Grundsätzen bereits mit der modernen übereinstimmend. Zusammenfassend kann man sagen, dass die Erkenntnisse der modernen Wissenschaften ohne der Vorreiterrolle in der Zeit von sechzehntem bis achtzehntem Jahrhundert in den niederen Landen nicht möglich gewesen wären

Structural and molecular characteristics of axons in the long head of the biceps tendon

The innervation of the long head of the biceps tendon (LHBT) is not sufficiently documented. This is a drawback since pathologies of the LHBT are a major source of shoulder pain. Thus, the study aimed to characterize structurally and molecularly nervous elements of the LHBT. The proximal part of 11 LHBTs was harvested intraoperatively. There were 8 female and 3 male specimens. Age ranged from 66 to 86 years. For structural analyses, nervous elements were viewed in the transmission electron microscope. For molecular characterization, we used general neuronal markers including antibodies against neurofilament and protein gene product 9.5 (PGP9.5) as well as specific neuronal markers including antibodies against myelin basic protein (MBP), calcitonin gene-related product (CGRP), substance P (SP), tyrosine hydroxylase (TH), and growth-associated protein 43 (GAP43). Anti-neurofilament and anti-PGP9.5 visualized the overall innervation. Anti-MBP visualized myelination, anti-CGRP and anti-SP nociceptive fibers, anti-TH sympathetic nerve fibers, and anti-GAP43 nerve fibers during development and regeneration. Immunolabeled sections were analyzed in the confocal laser scanning microscope. We show that the LHBT contains unmyelinated as well as myelinated nerve fibers which group in nerve fascicles and follow blood vessels. Manny myelinated and unmyelinated axons exhibit molecular features of nociceptive nerve fibers. Another subpopulation of unmyelinated axons exhibits molecular characteristics of sympathetic nerve fibers. Unmyelinated sympathetic fibers and unmyelinated nociceptive fibers express proteins that are found during development and regeneration. Present findings support the hypothesis that ingrowth of nociceptive fibers are the source of chronic tendon pain

PENGARUH DOSIS PUPUK KOMPOS DAN NPK TERHADAP PERTUMBUHAN DAN HASIL BAWANG MERAH (ALLIUM ASCOLANICUM L.) VARIETAS BREBES

Penelitian ini bertujuan untuk mengetahui pengaruh kompos dan NPK pupuk terhadap pertumbuhan dan produksi tanaman bawang Brebes dan interaksi antara kedua faktor. Percobaan ini menggunakan Faktorial Rancangan Acak Pola. Faktor-faktor yang mempengaruhi dosis diuji kompos terdiri dari 4 tingkatan, yaitu: kontrol, 10, 20 dan 30 faktor ton / ha dan NPK dosis pupuk yang terdiri dari 4 tingkatan, yaitu: kontrol, 100, 200 dan 300 kg / ha, sehingga bahwa ada 16kombinasi perlakuan dengan 3 ulangan dan 48 unit percobaan, setiap unit terdiri dari 5 tanaman sampel percobaan.Hasil penelitian menunjukkan bahwa dosis kompos cenderung lebih baik pada dosis pengobatan 30 ton / ha untuk pertumbuhan dan hasil bawang. Sementara itu, NPK dosis pupuk untuk pertumbuhan dan hasil tanaman bawang merah cenderung lebih baik pada dosis pengobatan 200 kg NPK / ha. Tidak ada interaksi yang nyata antara perlakuan dosis pupuk NPK untuk kompos dengan semua variabel yang diamati pada pertumbuhan dan hasil bawang.Kata kunci: bawang, kompos, NPKBanda Ace

The anastomotic network around the anterior superior alveolar nerve: an anatomical and radiological study

Innervation of superior teeth is supplied by the posterior (PSAN), anterior (ASAN) and sometimes by middle superior alveolar nerve (MSAN). PSAN arises from the maxillary nerve and passes through the posterolateral maxillary wall towards the posterior teeth. ASAN arises from the anterior portion of the infraorbital nerve and courses within the infraorbital canal passing nearby the piriform aperture and premaxilla. When present, MSAN arises from the posterior portion of the infraorbital nerve and runs along the lateral maxillary wall. However, an additional nasopalatine or sublabial injection is frequently required to obtain a complete anesthesia of the maxillary teeth due to rich anastomotic network (1-2). With the aim to better describe the complexity of the superior alveolar nerve network, fifty-seven high-definition sinonasal cone-beam CT (CBCT) were analyzed. PSAN, ASAN and MSAN were detected by specific bony landmarks/canals and nervous anastomoses were accurately evaluated. In addition, medial anastomotic branches from the palatal and/or nasal nervous plexi were also considered. PSAN and ASAN were identified in 100% of cases whereas MSAN in 19.6% of cases. Anastomotic branch versus ASAN was identified in all cases from MSAN and in 60.3% from PSAN. Medial anastomotic branch was detected in 62.0% of cases from the nasal plexus and in 6.2% from the palatal plexus: the former passed through a bony defect in the floor of the piriform aperture or at the base of the nasal septum; the latter passed through a tiny canal in the interface between maxilla and premaxilla. These data confirm that maxillary teeth innervation, especially for incisor teeth, could be provided not only by alveolar nerves but also from palatal and nasal plexi via small branches running within maxillary bony canals. These results support the need of additional anesthetic injection to obtain adequate anesthesia of the maxillary teeth; moreover, the role of CBCT in the identification of the nervous pattern was underlined

Combined presence of ophthalmic artery origin from anterior cerebral artery and meningolacrimal artery

In this study we describe a case of an ophthalmic artery (OphA) originating from the pre-communicating segment of the anterior cerebral artery (A1), associated with the presence of a meningolacrimal artery (MLA). The OphA has an anomalous origin in 1-3% of cases and rarely arises from A1, however, the combination of these anatomical variations is unique. Anomalous origins of the OphA are also correlated with a higher incidence of ICA aneurysm (1). Macroscopic and endonasal endoscopic dissections of a cadaver head, which formerly underwent a cone-beam CT scan, were performed. Bilateral samples of the ICA walls were collected and processed for standard hematoxylin-eosin staining and immunofluorescence analysis. The MLA was found on the right side by CT scan and its entrance in the superior orbital fissure was confirmed during head dissection. Hence, performing the endoscopic approach on the same side, the anomalous OphA, originating from the inferior surface of A1 segment and entering the optic canal above the optic nerve, was discovered. This arterial pattern could be explained by the embryological development of the orbital vascular system and it is referred to persistent ventral OphA (2). The histomorphological examination of ICA walls showed a significantly decreased thickness of the tunica media and adventitia on the right side compared to the left one. In addition, fluores- cence microscopy showed that type I and type III collagen were significantly lower in the tunicae media and adventitia of the right side. Since aneurysms of the ICA are related with a low content of collagen in the arterial wall, our results are consistent with current literature

Quantitative Anatomic Comparison of Endoscopic Transnasal and Microsurgical Transcranial Approaches to the Anterior Cranial Fossa

BACKGROUND: Several microsurgical transcranial approaches (MTAs) and endoscopic transnasal approaches (EEAs) to the anterior cranial fossa (ACF) have been described. OBJECTIVE: To provide a preclinical, quantitative, anatomic, comparative analysis of surgical approaches to the ACF. METHODS: Five alcohol-fixed specimens underwent high-resolution computed tomography. The following approaches were performed on each specimen: EEAs (transcribriform, transtuberculum, and transplanum), anterior MTAs (transfrontal sinus interhemispheric, frontobasal interhemispheric, and subfrontal with unilateral and bilateral frontal craniotomy), and anterolateral MTAs (supraorbital, minipterional, pterional, and frontotemporal orbitozygomatic approach). An optic neuronavigation system and dedicated software (ApproachViewer, part of GTx-Eyes II-UHN) were used to quantify the working volume of each approach and extrapolate the exposure of different ACF regions. Mixed linear models with random intercepts were used for statistical analyses. RESULTS: EEAs offer a large and direct route to the midline region of ACF, whose most anterior structures (ie, crista galli, cribriform plate, and ethmoidal roof) are also well exposed by anterior MTAs, whereas deeper ones (ie, planum sphenoidale and tuberculum sellae) are also well exposed by anterolateral MTAs. The orbital roof region is exposed by both anterolateral and lateral MTAs. The posterolateral region (ie, sphenoid wing and optic canal) is well exposed by anterolateral MTAs. CONCLUSION: Anterior and anterolateral MTAs play a pivotal role in the exposure of most anterior and posterolateral ACF regions, respectively, whereas midline regions are well exposed by EEAs. Furthermore, certain anterolateral approaches may be most useful when involvement of the optic canal and nerves involvement are suspected

The psychostimulant (±)-cis-4,4'-dimethylaminorex (4,4'-DMAR) interacts with human plasmalemmal and vesicular monoamine transporters

(±)-cis-4,4'-Dimethylaminorex (4,4'-DMAR) is a new psychoactive substance (NPS) that has been associated with 31 fatalities and other adverse events in Europe between June 2013 and February 2014. We used in vitro uptake inhibition and transporter release assays to determine the effects of 4,4'-DMAR on human high-affinity transporters for dopamine (DAT), norepinephrine (NET) and serotonin (SERT). In addition, we assessed its binding affinities to monoamine receptors and transporters. Furthermore, we investigated the interaction of 4,4'-DMAR with the vesicular monoamine transporter 2 (VMAT2) in rat phaeochromocytoma (PC12) cells and synaptic vesicles prepared from human striatum. 4,4'-DMAR inhibited uptake mediated by human DAT, NET or SERT, respectively in the low micromolar range (IC; 50; values < 2 μM). Release assays identified 4,4'-DMAR as a substrate type releaser, capable of inducing transporter-mediated reverse transport via DAT, NET and SERT. Furthermore, 4,4'-DMAR inhibited both the rat and human isoforms of VMAT2 at a potency similar to 3,4-methylenedioxymethylamphetamine (MDMA). This study identified 4,4'-DMAR as a potent non-selective monoamine releasing agent. In contrast to the known effects of aminorex and 4-methylaminorex, 4,4'-DMAR exerts profound effects on human SERT. The latter finding is consistent with the idea that fatalities associated with its abuse may be linked to monoaminergic toxicity including serotonin syndrome. The activity at VMAT2 suggests that chronic abuse of 4,4'-DMAR may result in long-term neurotoxicity

Changes of the Intercondylar Notch and their impact on the morphology of the cruciate ligaments : a retrospective study

Einleitung. Da das vordere Kreuzband (ACL) nicht nur gegen das Dach, sondern auch gegen die laterale Wand der Fossa intercondylaris (IN) gedru&#776;ckt wird, könnten Informationen zu Veränderungen im Laufe des Lebens und im Fortschreiten der Arthrose wichtig sein zur Vorhersage von Risiken von VKB-Ruptur und Degeneration. Daher war das Ziel dieser Studie die Evaluation des Einflusses von Altern (Teil 1) und Arthrose (Teil 2) auf die Morphologie der IN. Zusätzlich wurde der Einfluss von Arthrose auf die Kreuzbänder und die meniskofemoralen Bänder untersucht. Material und Methoden. Bilddaten stammten von der Univ. Klinik fu&#776;r Radiologie und Nuklearmedizin der Medizinischen Universität Wien (Teil 1) sowie von der Osteoarthritis Initiative (Teil 2). In coronalen und axialen Bildern wurden die knöchernen Strukturen vermessen. Auf Höhe des Sulcus popliteus und auf Höhe des Gelenkspalts wurden die Femurcondylen, die Breite der IN (NW) und die Breite des distalen Femurs vermessen. Der Notch Width Index wurde berechnet (NWI). Auf Ganzbein-Röntgenbildern wurde die Beinachse vermessen. Die Morphologie von ACL, hinterem Kreuzband (PCL) und den meniskofemoralen Bändern wurde beurteilt. Resultate. Die Morphologie der IN wird direkt vom Altern und von der Entwicklung von Arthrose beeinflusst. Drei Formen der IN (A-Form, Inverse-U-Form, &#937;-Form) wurden definiert um diese Veränderungen zu charakterisieren. Insbesondere die &#937;-Form ist direkt verantwortlich fu&#776;r Rupturen des ACL. Veränderungen der IN beeinflussen auch signifikant die Morphologie der anderen ligamentösen Strukturen. Schlussfolgerung. Um die enge Korrelation der knöchernen und ligamentösen Strukturen zu betonen, wurde der Begriff des interkondylären Raums eingefu&#776;hrt. Das ist kein statischer Bereich, sondern unterliegt immerwährenden Veränderungen im Laufe des Lebens. Auf Höhe des Gelenkspalts sollte ein NWI <0.17 und ein NW < 14mm als IN Stenose interpretiert werden und ist somit ein Risikofaktor fu&#776;r Kreuzbandrupturen. Messungen in Kombination mit der Beurteilung der Form im Sinne einer semiquantitativen Evaluation könnten die Risikoeinschätzung fu&#776;r Ligament-Pathologien verbessern.Introduction. As the anterior cruciate ligament (ACL) is not only impinged against the roof but also against the lateral wall of the intercondylar notch (IN), information of changes during life and especially the progression of osteoarthritis could be relevant in predicting the risk for ACL-rupture and -degeneration. Therefore the purpose of this study is to evaluate the influence ageing (part 1) and of osteoarthritis (part 2) on notch morphology. Additionally the influence of osteoarthritis on the cruciate ligaments as well as on the meniscofemoral ligaments was investigated. Material and Methods. Image data was retrieved from the radiologic department of the Medical University of Vienna (part 1) and from the osteoarthritis initiative (part 2). In coronal and axial images osseous structures were measured. At the level of the popliteal sulcus and on the level of the joint line, the width of the lateral and medial femoral condyle, the notch width (NW) as well as the total width of the distal femur were measured. The notch width index (NWI) was calculated. On whole-leg radiographs the leg alignment was measured. The morphology of the ACL, the posterior cruciate ligament (PCL) and the meniscofemoral ligaments were assessed. Results. The morphology of the IN is directly influenced by ageing and by the development of osteoarthritis. Three types of shapes (A-shape, Inverse-U-shape, &#937;-shape) were defined to characterize these changes. Especially the &#937;-shape is directly correlated with rupture of the ACL. Changes to the IN also significantly influence the morphology of the other ligamentous structures. Conclusion. To reflect the intimate correlation of the osseous structures and the ligaments of the IN, the term intercondylar space was created. It is not a static area but undergoes continuous changes throughout life. At the level of the joint line a NWI <0.17 and a NW < 14mm should be interpreted as notch stenosis and are definite risk factors for ACL rupture. Measurements combined with the evaluation of the shape of the IN could improve risk estimation for ligament pathologies through semiquantitative assessment.submitted by Mag. Dr. Lena HirtlerZusammenfassung in deutscher SpracheAbweichender Titel laut Übersetzung der Verfasserin/des VerfassersMedizinische Universität Wien, Dissertation, 2016OeBB(VLID)192334

Ectopic tendons of the pectoralis minor muscle as cause for shoulder pain and motion inhibition-Explaining clinically important variabilities through phylogenesis.

OjectiveClinical consequences of ectopic tendons of the pectoralis minor muscle (PMM) for shoulder pain and range-of-motion limitation have been demonstrated. For better understanding the existence of such ectopic tendons, a phylogenetic hypothesis is proposed.MethodsForty-five shoulders of anatomical specimens were dissected and examined. Insertions areas of PMM were measured and occurring aberrant tendons were identified. Their relationship with the coracohumeral ligament (CHL) described and samples of the ligament were collected and histologically stained.ResultsThe prevalence of PMM variations was 37.84%. Shoulders with variations showed a statistically significant smaller coracopectoral distance (pConclusionsThe presented results prompted the conclusion that the CHL may be in fact the remnant of the pectoralis minor tendon (PMT), which migrated from the humerus to the coracoid process through the process of phylogenetic evolution. Variations of PMTs are significantly more common than in previous studies. Imaging techniques appear to be insufficiently sensitive for reliably detecting ectopic tendons. Especially in patients experiencing shoulder pain and stiffness in whom the commoner pathologies have been ruled out the possibility of ectopic PMT should be kept in mind and ruled out