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The previously presented facial augmentation techniques can be used in conjunction with orthognathic procedures or may be performed as separate procedures. When performed properly, they can enhance facial esthetics and improve patient satisfaction. Alloplastic augmentation, when properly planned and performed, is predictable, stable, and generally accepted by the patient.
INTRODUCTION: Due to a long-term alteration in their chemical composition, resulting in excessive swelling, Miragel scleral buckles are now commonly removed. The aim of this study was to determine the characteristics and the outcome of patients needing Miragel buckling removal. METHODS: Retrospective analysis between 1997 and 1999 of the charts of patients successfully treated for retinal detachment and in whom a Miragelepiscleral buckle was removed after surgery with a minimal follow-up of 6 months after removal. RESULTS: The study group consisted of 24 eyes of 13 women and 11 men. Their mean age at removal was 47.1+/-18.4 years. The removed buckle was encircling in nine cases (37.5%), circumferential (<180 degrees ) in 11 cases (45.8%) and radial in four cases (16.7%). An exposed buckle was observed in two cases (8.3%). Reasons for removal were excessive swelling of the buckle inducing ocular motility disturbance in 23 cases and infection of an extruded buckle in only one case. The mean time between implantation and removal was 91.9+/-28.7 months (range 20-120). One case of scleral perforation during removal and one case of retinal redetachment were observed. Three cases of persistent ocular motility disturbance after removal were also noted. CONCLUSION: Late swelling of the buckle was the main reason for removal. Patients undergoing Miragel buckling removal should be informed of scleral perforation during removal, retinal redetachment and persistence of ocular motility disturbance as possible complications.
BACKGROUND: Long-term complications of extrusion have been reported in patients who received MIRAgel buckles for retinal detachment. All ophthalmologists need to recognize the clinical characteristics of these severe complications, and how the clinical course of complication after the use of MIRAgel buckles differs from that of silicone buckles. METHODS: Case reports and a review of the literature. RESULTS: Severe deterioration of MIRAgel buckles may occur when left in place for 5 years or longer, causing adverse symptoms and occasionally intraocular complications. This deterioration is associated with changes in the microstructural architecture of the hydrogel material in the MIRAgel buckles. CONCLUSION: Long-term follow-up is necessary for patients with MIRAgel buckles, and the buckles should be removed prophylactically when advisable. When severe ocular motility disturbances and/or presence of a tumor-like extraocular mass are observed in patients several years after retinal detachment surgery, the cause may be a swollen MIRAgel buckle.
This study evaluated the performance of a synthetic implant material, Hard Tissue Replacement Polymer, for: (1) ease of handling, (2) compatibility with bone and soft tissue, (3) stability of augmentation over time, and (4) development of untoward effects. HTR (a registered trademark of HTR Sciences, a division of United States Surgical Corporation, Norwalk, CT 06856) was implanted into 34 patients by means of five different surgical procedures. The material was found to be easy to manipulate during surgery. Tissue and bone compatibility, defined as absence of inflammation, was present in 32/34 surgical sites (94%). In extraction sites during the 18-month follow-up, no measurable decrease in bone height or width was seen. One patient with a large periodontal endodontic defect developed a post-operative infection necessitating extraction of the tooth. No induction of bone was seen in response to placement of HTR material.
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After an initial assessment of the experimental approach this experimental project was undertaken to study the regenerative response and incorporation of various implanted materials in calvarial bone defects in rabbits. Four 5-mm full-thickness defects were trephined in the frontal and parietal bones of the rabbits. After removal of the circular bone plugs the defects were used as recipient sites for inlay bone tissue and bone substitutes. In five separate studies the impact of bone regeneration of autogeneic bone grafts or eight bone substitutes were evaluated mainly by contact radiography, light microscopy and morphometry. The observation periods were four and 15 weeks. The main findings were: Autogeneic bone chips offered only minor advantages over controls in the model used and, also, differences in bone regeneration between diversified amounts of bone chips were negligible. In contrast, after bone paste implantation a cellular and mature bone was rapidly produced. Natural bone mineral (Bio-Oss) and synthetic dense hydroxylapatite ceramic proved to be biocompatible and a definite long term bone regeneration around all implants regardless of granulae size or resorbability was observed. Initial bone regeneration in and around the Bio-Oss particles was more extensive. Demineralized bone matrix of membranous and enchondral origins displayed extensive osteoinductive capacity and early bone production significantly exceeded that of control groups. The embryonic origin implied minor effects on the initial regenerative response only. Lyophilized bone allografts of two embryonic origins showed a low osteoinductive potential and a similar fashion of bone regeneration. No marked difference between these groups were displayed. HTR-polymer alone or combined with membraneous mineralized autogeneic bone chips showed a more rapid early bone regeneration than the groups containing lactomer beads, resorbable gel and controls. Also, the HTR-material proved to be a well-tolerated implant material by the recipient tissue bed.
Synthetic bone replacement materials continue to be much discussed in the current periodontal literature. Numerous reports have shown their clinical use in the treatment of intraosseous defects. Periodontal treatment aims also include regeneration of a new functional attachment. Although histologic studies have shown that most of the synthetic bone substitutes can enhance bone formation, they are not able to promote new attachment of periodontal tissues to the root surface previously exposed. Future studies are needed to assess whether these materials could be of use together with growth factors in composite grafts or in conjunction with guided tissue regeneration techniques.
Fifteen patients, men and women aged 18 to 65 years, were treated for periodontitis. Each patient had at least two bilateral intrabony defects; one was designated the experimental site and the other the control site. Both sites were surgically debrided, but one osseous defect received an HTR polymer implant. Patients were followed for 12 months postoperatively. Maximum pocket reduction occurred within 2 months of initial therapy in both experimental and control sites. Initially, pocket reduction was significantly greater in implanted sites than in control sites, but this difference did not occur subsequently. At the end of the 12 months, pocket reduction responses were similar at control and implanted sites.
Presents data on the clinical course and surgical treatment of 26 patients with retroperitoneal tumors and hemangiomas of the pelvis. The diagnosis was confirmed by x-ray, echographic, computer tomographic, and angiographic data on pelvic vessels. To prevent bleedings, embolization of the internal iliac arteries and their branches as far as the 3-4th order was carried out in 9 patients with angiodysplasias and 4 with retroperitoneal pelvic tumors. Endovascular occlusion of the main vessels not only permitted surgery with the minimal blood loss, but was conducive to better visualization of the tissues and made the operation less traumatic.
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Styrene (S) is a widely used aromatic hydrocarbon, responsible for several adverse effects. In humans, the metabolism of S is well characterized: besides the major metabolites (mandelic and phenylglyoxylic acid), a minor metabolic pathway leads to phenylhydroxyethyl mercapturic acids (PHEMAs) [N-acetyl-S-(1-phenyl-2-hydroxyethyl)-L-cysteine (M1) and N-acetyl-S-(2-phenyl-2-hydroxyethyl)-L-cysteine (M2)], that are potentially useful for biomonitoring purposes. A pilot study on a volunteer exposed under controlled conditions to S, with or without ethanol administration, allowed us to characterize the excretion profile of PHEMAs and the ethanol-induced interference on PHEMAs metabolic pathway. We further considered a group of 9 workers exposed to S during the working week to determine the confounding role of chronic exposure. Our results confirm the wide interindividual variability of both the biotransformation rate of S into PHEMAs and of the excretion rate of these metabolites. Moreover, both the above parameters changed during the working week, suggesting the existence of a large intraindividual variability as a consequence of the exposure to S and to other solvents. As a practical rule, the data indicate that it is necessary to collect samples at the beginning of the working week when studies on the correlation between genotype and phenotype are carried out. Finally, the results emphasise the importance of excluding an even extemporary ethanol assumption when practicing a biological monitoring programme based on the determination of urinary PHEMAs.
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Basic fibroblast growth factor (bFGF) was tested for its ability to stimulate angiogenesis in vivo using the rabbit corneal assay. Basic FGF (50-1,000 ng) was incorporated into 10% Hydron, and 50-500 ng of bFGF were incorporated into 10% Elvax. Human serum albumin (HSA) (10 ng) and 50 ng of transforming growth factor-beta (TGF-beta) served as negative and positive controls. Pellets of the polymers containing test compounds were implanted in the rabbit cornea, examined daily, and after 7 days corneal angiogenesis was scored on a graded scale [(-) for no response and +4 for a maximum response]. Histologic analysis of the corneas was performed on days 2 and 7. Basic FGF (50-500 ng) in Hydron failed to stimulate significant angiogenesis, though it did induce angiogenesis accompanied by inflammation at the 1,000-ng dose. Basic FGF in Elvax elicited inflammation-associated +3 to +4 responses at all doses tested. New blood vessels did not form in response to HSA in Hydron or Elvax, while TGF-beta induced +4 angiogenesis accompanied by vigorous inflammation. In vivo release kinetics for bFGF in Hydron and Elvax were compared, and the release of bioactive bFGF from Hydron and Elvax was demonstrated in vitro. These results suggest that the bFGF and Elvax combination incites an inflammatory response which stimulates indirect angiogenesis, while the same concentrations of bFGF delivered in Hydron produced no inflammation or angiogenesis. Although bFGF alone is a potent mitogen for endothelial cells, it does not appear to directly stimulate in vivo angiogenesis.
In this study, two improved pericardial patches were developed and evaluated for their efficacy as pericardial substitutes. The patches are composites consisting of a hydrogel (PHEMA) that coats an underlying mesh (either ETFE or PET). Studies were conducted using subcutaneous implants in rats and pericardial patch implants in greyhound dogs. Adhesions between the substitute and pericardium and the epicardium were minimal. The ETFE composite patch caused an unacceptable epicardial reaction. The PET patch results were encouraging; the epicardium was largely unaffected by the patch.
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The present report reviews the clinical experience of the authors, with a new material in haloplastic grafts; the HTR; with the following purposes: Remain and or increase alveolar ridges. Close-up of congenital clefts.