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PubMed2001

[Dental implantation at the maxilla with autologous bone transplantation].

In the Department of Maxillofacial and Oral Surgery of County Hospital of Szentes, different types of bone losses of the maxillary alveolar ridge have been treated since 1 March, 1990. The applied surgical procedures were the following: 1. 394 patients were treated with GBR technique and 567 DenTi implants were inserted for these patients. 2. In 47 cases autogenous bone grafts were harvested from mandibular cortica and 78 DenTi implants were placed. Altogether 14 implants were lost; the success rate was 97.81% in the period between 1 March, 1990 and 31 January, 2001. 3. The severely resorbed maxillary alveolar ridge was replaced by rigid autogenous bone graft harvested from the ilium or from tibia. The bone graft was fixed with implants to the recipient surface. This method was applied in 36 cases from 1 February, 1992 until 31 January, 2001. 147 DenTi implants were inserted and 7 of them were lost. The success rate was 97.28%. Our results have indicated that the dental implants had accelerated the remodelling process of the transplanted autogenous bone and the success rate of the simultaneously performed dental implants were comparable to that of the two stage procedures in which dental implants were inserted several weeks following bone grafting. Based on our long-term favourable clinical experience this technique has been proven to be an excellent method for correcting and replacing the lost maxillary alveolar ridges as well as the circumscribed alveolar bony defects.

Bone Remodeling↗
PubMed1975

Malignant degeneration of a chondromyxoid fibroma in a child.

A 10-year-old boy was treated for a chondromyxoid fibroma of the left femur by curettage, and 2 months later complete healing was demonstrated radiographically. Three years after operation, radiographs revealed replacement of the ilium, ischium and upper femur, and destruction of the left hip by a soft-tissue and bony mass; a left hemipelvectomy was performed for what was shown to be a chondrosarcoma. Follow-up 10 years after the initial operation and 7 years after the hemipelvectomy has confirmed uneventful recovery in this rare case of malignant degeneration of a proven chondromyxoid fibroma of bone.

Adolescent↗
PubMed1996

[Human helminthiasis at the Gauls].

It was possible to realize a salvaging in urgency in a building site into the enclosure of the Hôpital Avicenne in Bobigny (seine-Saint-Denis). Into ditches, traces of a native farm from the second century AC, near miscellaneous objects (pots, hatchets, fibules, pieces) was found twelve skeletons. In the ground, extracted between the wings of ilium of an adult skeleton, with an appropriated technical, it was possible to find eggs of Trichuris trichiura and a lot of eggs of Ascaris lumbrocoides. It proves, the human manure was used very probably in the gaul gardens.

France↗
PubMed2001

Acetabular osteitis in ankylosing spondylitis: does fibrillin figure in its pathogenesis?

In the hip and sacroiliac joints, ankylosing spondylitis attacks the acetabulum over the femoral head and the ilium in preference to the sacrum. Both sites involve inflammation in bone subjacent to fibrocartilage with relative sparing of opposing, hyaline cartilage-surfaced mates. This disease appears to target connective tissues rich in fibrillin-1. A cell-mediated autoimmune response may be involved.

Acetabulum↗
PubMed2001

Surgery for primary bone sarcomas of the pelvis.

Primary bone sarcomas of the pelvis represent the most challenging problem in limb-saving surgery. Chondrosarcoma is the most common type, followed by osteosarcoma and Ewing's sarcoma. The symptoms are often vague, so that the diagnosis is made late, when the tumor has already reached a large size. Nowadays hindquarter amputation is reserved for complex tumors involving the sacrum, the sciatic nerve, the iliac vessels or the bladder. Internal hemipelvectomy should be undertaken whenever possible; the reconstructive techniques are based on the three anatomic regions concerned: ilium, periacetabular area, and pubis. Complications occur in more than 50% of the patients. The 5-year survival rate is about 55%. Special scores, such as the MSTS/ISOLS and the TESS score, should be used to make the various studies comparable.

Bone Neoplasms↗
PubMed1998

[Primitive neuroectodermal tumor of bone and soft tissue].

OBJECTIVE: To study the pathological characteristics of primitive neuroectodermal tumor (PNET) of bone and soft tissue. METHOD: Five patients with bone and soft tissue of PNET (2 men and 3 women) were studied by light microscope and immunohistochemistry. The age of the patients was 18, 18, 43, 14, 32 years and the primary sites of involvement were the ilium (n = 2), axillary fossa (n = 1), condyle of femur (n = 1), and diploe (n = 1). X-ray films showed bone osteolytic destruction, and no periosteal reaction or calcification. Surgery was performed in the patients. RESULT: All patients received combined chemotherapy and 3 received radiotherapy. Three patients died of metastatic tumor of lung 20, 13, and 5 months after invasion. 1 patient metastatic tumor of lung 20 months after invasion, and 1 patient bone extensive metastasis 1.5 months after surgery. CONCLUSION: The treatment of PNET of bone and soft tissue awaits further study.

Adolescent↗
PubMed1998

[Cervical spondylotic myelopathy: early diagnosis and timing of operation].

OBJECTIVES: To study early clinical characteristics and diagnosis of cervical spondylotic myelopathy and to search the timing of surgery. METHOD: Seventy-four cases of early diagnosed cervical spondylotic myelopathy (CSM) were treated with anterior cervical decompression and autologous ilium graft fusion. RESULT: The early stage of CSM was indistinct, and symptoms were mild. Neck pain, abnormality of motion and sensation of limbs, and hand and arm symptoms were shown frequently. Changes in neurological function could found during physical examination. Characteristic changes in imaging were helpful in early diagnosis of the disease. CONCLUSION: Early diagnosis and surgery of CSM are important in improving the therapeutic results.

Adult↗
PubMed1998

[Memorial metal ball for the treatment of avascular necrosis of femoral head].

OBJECTIVE: To introduce a new method for the treatment of avascular necrosis of the femoral head. METHOD: A technique has been developed what the memorial metal ball, and where the graft of the wing of the ilium is harvested with the deep circumflex iliac vascular pedicle and implanted into the avascular area of the femoral head. This procedure has been performed in 28 hips in 22 patients. RESULT: Preoperatively, 8 hips were of Ficat Arlet Stage II and twenty stage III. Postoperatively, eighteen patients were pain free, 3 had mild pain, and 1 had moderate pain. The radiographic appearance improved in 2 cases. No major complications occurred. CONCLUSION: It is one of the better alternatives that can prevent the necrotic femoral head from progressing to collapse and promote revascularization and new bone formation by direct mechanical support. The technique is suitable for the treatment of avascular necrosis of femoral head of stage I to III.

Adult↗
PubMed2000

[The effect of V-shaped nitinol alloy implantation on acetabular dysplasia: an experimental study].

OBJECTIVE: To observe the effect of V-shaped nitinol alloy implantation into the acetabular roof of puppies with acetabular dysplasia on acetabular dysplasia. METHODS: The puppies with acetabular dysplasia were divided randomly into two groups. Osteotomy was begun about 0.5 cm above the acetabulum, using a curved osteotome this cut must proceed between the medial wall of the ilium and medial wall of the acetabulum. The osteotomy does not have to be carried to the triradiate cartilage. When the osteotomy is completed, the superior aspect of the acetabulum can be hinged downward by curved osteotome. The V-shaped nitinol alloy was wedged securely in the osteotomy site. Roentgenogram was made 4 and 12 weeks after operation in all animals. RESULTS: The inclination of the acetabular roof was redirected and the acetabular index was decreased. Microscopic study showed a marked proliferation of cartilaginous cells of the acetabular cartilage. CONCLUSION: The V-shaped nitinol alloy implantation into the acetabular roof can correct the sloping acetabular roof, increase the coverage on the femoral head, and improve the growth of the acetabulum.

Acetabulum↗
PubMed1975

Sacro-iliac joint in renal osteodystrophy: roentgenographic-Pathologic correlation.

A detailed roentgenographic and pathologic study of the sacro-iliac joint in a cadaver with renal osteodystrophy revealed subchondral abnormalities, particularly in the ilium, which consisted of resorption of bone, substitutive fibrosis, and thickening of remaining trabeculae. Overlying articular cartilage degeneration was also apparent. The "pseudo-widening" of the joint space noted in ante and post-mortem radiographs in this patient simulated the findings in early ankylosing spondylitis.

Aged↗
PubMed2002

[Reconstruction of tarsus and metatarsus with free iliac flap--a case report and review of literature].

Procedure and late results of treatment of 17 year old female with severe trauma of right foot by agricultural machine are presented. Defects included soft tissues of the dorsal foot, II-IV metatarsal bones, cuneiform bones and majority of the navicular bone. The patient was first treated in a regional hospital and due to infection an amputation of the lower extremity distal part was considered. In our department an emergency necrectomy was carried out, general and local antibiotics were administered and the wounds were split skin grafted. Complete one stage reconstruction of the soft tissues and bones with free osteocutaneous iliac flap was performed three months later. Deep circumflex iliac vessels were anastomosed end-to-side to the only uninterrupted posterior tibial vessels. Two axial K-wires were used to stabilize vascularized bone graft. A fragment of the ilium 8.5 x 6.0 x 1.5 centimeters of favourable arcuate shape was used to reconstruct longitudinal and transversal arches of the foot. The vascularized bone graft healed three months after the reconstruction. The patient recovered full weight bearing capability after a year. No complications were observed in the donor site in spite of the fact that the patient was pregnant and had a normal uncomplicated delivery.

Adolescent↗
PubMed2002

Spinal tuberculosis: report of an atypical presentation.

A 24-year-old woman was treated by the authors for an atypical form of spinal tuberculosis. The patient had simultaneous involvement of T1, T7, and the right ilium. At the T7 level, the anterior and posterior vertebral elements were involved. These findings closely mimicked spinal malignancies. There was no evidence of pulmonary tuberculosis. A biopsy confirmed tuberculosis and the patient was treated successfully with antituberculosis therapy. It is important to be aware that spinal tuberculosis can mimic spinal malignancy.

Adult↗
PubMed2002

[Decompression and internal fixation in the treatment of thoracolumbar spine and spinal cord injury: report of 166 cases].

OBJECTIVE: To evaluate the therapeutic effect of several internal fixation methods in the surgical treatment of thoracolumbar spine and spinal cord injury (SSI-TL). METHODS: In the 166 SSI-TL cases included in this retrospective analysis, 37 had vertebral body burst fracture, 109 had vertebral body compression fracture (with compression to a degree over 50%),14 had vertebral body fracture and dislocation and 6 had multilevel vertebral fractures or jumping fracture. In view of the spinal cord injury 59 belonged to Frankel grade A, 46 grade B, 42 grade C and 19 grade D. Posterior decompression, reduction and internal fixation were performed in 122 patients and the other 44 underwent anterior decompression, reduction and ilium bone grafting. RESULTS: Follow-up study for 3 to 18 month was conducted in 123 cases, in which RF screws cracking occurred in 4 cases, Harrington upper hook dislocation in 5 cases and Harrington rod cracking in 6, while the rest cases were free of theses incidents. In terms of the function recovery of the spinal cord, 88 cases showed improvement of the spinal cord and cauda equina of 1 to 3 Frankel grades, leaving only 35 lingering in grade A. CONCLUSION: Decompression should be performed at early stages of SSI-TL, and employment of various internal fixation instrument helps maintain and enhance spinal stability, preventing secondary lesion of the spinal cord and promoting the function recovery of the injured spinal cord.

Adolescent↗
PubMed2002

Safe and efficient methods of autologous hematopoietic stem cell transplantation for biomedical research in cynomolgus monkeys.

We have established safe and efficient methods for autologous hematopoietic stem cell (HSC) transplantation in cynomolgus monkeys (Macaca fascicularis) that include regimens of supportive care to ensure survival during hematopoietic reconstitution following otherwise lethal total body irradiation. Eleven young adult cynomolgus monkeys were studied. Bone marrow was aspirated from the ilium and/or tuber ischiae after administration of recombinant human stem cell factor (SCF) and granulocyte colony-stimulating factor (G-CSF). Using the immunomagnetic selection method, CD34+ cells were then isolated (90 to 95% pure) as a fraction containing HSCs. Just prior to transplantation, the animals received myeloablative total body irradiation-500 to 550 cGy daily for two days. The monkeys re-infused with CD34+ cells developed moderate to severe myelosuppression, with some animals requiring intravenous hyperalimentation, antibiotic administration, and blood transfusion. Hematopoiesis was restored in all animals after transplantation. It took 12 days, on average, until the peripheral white blood cell count reached more than 1,000 cells/microl. Up to two years after transplantation, signs of radiation-induced pneumonitis or other radiation-related disorders were not evident at the aforementioned dose of irradiation. This transplantation model will be useful for testing new approaches using HSCs for therapy of many diseases and will offer unique insights into the biology of these cells.

Animals↗
PubMed2002

[Use of bioceramics in the treatment of fractures of the thoraco-lumbar spine].

PURPOSE OF THE STUDY: The primary reduction and stabilization of all types of injury to the thoracolumbar spine is currently performed from the posterior approach by an internal, transpedicular fixator. The exceptions are type A fractures, according to the AO classification, that can primarily be treated from the anterior approach. The aim of the study was to assess the effect of BAS-O bioceramic granules, inserted by transpedicular approach, on the development of post-operative kyphosis of the segments injured. MATERIAL: Between 1997 and 2001 we treated anterior spinal column fractures, using bioceramic granules in combination with an internal fixator, in 53 patients (40 men, 13 women: age 26 to 69 years; average, 42.3 years) at the Department of Orthopedics and Traumatology of the Third Faculty of Medicine and FNKV in Prague. However, only 42 patients (33 men, 9 women; age 28 to 67 years; average, 41.6 years) who had had the metal fixator removed more than six months previously were included in the study. The fixator was removed in the range of 10 to 24 months after the primary operation. The sample was divided into two groups; one with bioceramic material inserted in the body of the damaged vertebra (20 patients) and the other bioceramic granules implanted in both the vertebral body and the intervertebral space (22 patients). METHODS: In all the patients, the standard procedure included transpedicular application of Schanz's screws and an USS FS fixator (Synthes). If necessary, distraction of the segment injured and the correction of lordosis were carried out. Further transpedicular procedures to treat the anterior spinal column were as follows: If the vertebral body was injured without destruction to the intervertebral disc, a bent elevator was inserted through the vertebral foramen and the intervertebral joints were reduced. At the same time, a cavity for application of bioceramic granules was created. These were inserted, using a funnel and a pusher, in the anterior part of the injured body. If the fracture involved a destroyed intervertebral disc, the disc was removed, the vertebral end plate of the adjacent vertebra was perforated and bioceramic granules were inserted in both the vertebral body and intervertebral space. Subsequently, spongeous bone grafts were harvested from the ilium and massively applied to the previously decorticated transverse and articular processes. RESULTS: In the group of patients who had bioceramic granules inserted in only the vertebral body, the kyphotic angle was on average 10.36 degrees after injury and 2.86 degrees after surgery; therefore, a correction by 13.22 degrees was achieved. At 3 and 6 months after surgery, the kyphotic angle was 2.71 degrees and 2.68 degrees, respectively; at 3 and 6 months after fixator removal, it was 0.67 degree in both instances. In the group of patients with bioceramic granules implanted in both the vertebral body and intervertebral space, the kyphotic angle was on average 9.16 degrees after injury and 4.26 degrees after, surgery; therefore, a correction by 13.43 degrees was achieved. At 3 and 6 months after surgery, the kyphotic angle was -4.11 degrees and -4.00 degrees, respectively; at 3 and 6 months after fixator removal, it was 2.38 degrees and 2.44 degrees, respectively. DISCUSSION: Our results revealed differences between the patients who had bioceramic granules inserted in only the vertebral body and those who had them also in the intervertebral space. At 6 months after surgery, the first group showed the loss of correction per two segments to be 3.53 degrees on the average, whereas the second group had a loss of 6.70 degrees, i.e., twice as high. This may be explained by a more serious damage to the intervertebral disc in the latter group. Only small differences between the groups were found in the kyphotic angle at both 6 months after surgery and 3 to 6 months after fixator removal. This implied that, in both groups, the loss of correction occurred in the period up to 3 months after removal of the fixator. CONCLUSIONS: Bioceramic granules provide material for replacement of osseous tissue in the body of the vertebra as well as conditions necessary for bone restructuring. The loss of correction per segment is lower by about half in patients treated with bioceramic granules than in those who received a spongeous bone grafts.

Adult↗
PubMedDate not supplied

Dental implants in reconstructed jaws: patients' evaluation of functional and quality-of-life outcomes.

PURPOSE: To evaluate the quality-of-life aspect of treatment outcome following functional jaw reconstruction and dental implants in the maxilla or mandible. MATERIALS AND METHODS: This cross-sectional study used a questionnaire interview of 28 rehabilitated patients who received autogenous bone grafts from the ilium and endosseous implants (14 maxillary and 14 mandibular cases; 134 implants) for functional jaw reconstruction between 1988 and 1999. A questionnaire was developed to assess the quality-of-life outcome for those patients who had finished their rehabilitation at least 6 months prior to the interview. Responses to the questions were recorded by means of visual analog scales. RESULTS: In general, patients gave positive comments on the restoration of their orofacial appearance and function (mastication and speech). The majority (85.7%) found no problem in various daily social activities, including dining in public. DISCUSSION: The overall level of satisfaction with the treatment outcome and the degree of recommendation of the treatment to others were both favorable (mean scores 8.6 and 8.7 out of 10, respectively). CONCLUSION: Oral rehabilitation using functional jaw reconstruction can reach a satisfactory level of esthetics, function, and psychosocial well being of patients, thus improving their quality of life.

Activities of Daily Living↗
PubMed2003

Treatment of tibial defect and bone nonunion with limb shortening with external fixator and reconstituted bone xenograft.

OBJECTIVE: To explore the effect of external fixator and reconstituted bone xenograft (RBX) in the treatment of tibial bone defect, tibial bone nonunion and congenital pseudarthrosis of the tibia with limb shortening. METHODS: Twenty patients (13 males and 7 females) with tibial bone defect, tibial bone nonunion or congenital pseudarthrosis of the tibia with limb shortening were treated with external fixation. Two kinds of external fixators were used: a half ring sulcated external fixator used in 13 patients and a combined external fixator in 7 patients. Foot-drop was corrected at the same time with external fixation in 4 patients. The shortened length of the tibia was in the range of 2-9 cm, with an average of 4.8 cm. For bone grafting, RBX was used in 12 patients, autogenous ilium was used in 3 patients and autogenous fibula was implanted as a bone plug into the medullary canal in 1 case, and no bone graft was used in 4 patients. RESULTS: All the 20 patients were followed-up for 8 months to 7 years, averaging 51 months. Satisfactory function of the affected extremities was obtained. All the shortened extremities were lengthened to the expected length. For all the lengthening area and the fracture sites, bone union was obtained at the last. The average healing time of 12 patients treated with RBX was 4.8 months. CONCLUSIONS: Both the half ring sulcated external fixator and the combined external fixator have the advantages of small trauma, simple operation, elastic fixation without stress shielding and non-limitation from local soft tissue conditions, and there is satisfactory functional recovery of affected extremities in the treatment of tibial bone defects, tibial bone nonunion and congenital pseudarthrosis of the tibia combined with limb shortening. RBX has good biocompatibility and does not cause immunological rejections. It can also be safely used in treatment of bone nonunion and has reliable effect to promote bone healing.

Adolescent↗
PubMed2003

[POEMS syndrome: imaging of skeletal manifestations, a study of 8 cases].

PURPOSE: To describe the imaging features of POEMS, and to compare our experience of 8 cases to a review of literature. MATERIALS AND METHODS: This retrospective study included 8 patients (6 men, 2 women) with POEMS. Plain radiographs (8 patients), CT (6), MR (2) were performed. RESULTS: Topographic localizations of POEMS were pelvis (7 cases), spine (5), femur (1), humerus (1), rib cage (1). Focal bone lesions, multiple (5 cases) or solitary (3 cases), were sclerotic in 4 cases, mixed lytic-sclerotic (lytic center and sclerotic rim) in 3 cases and one patient had an osteolytic lesion with sclerotic margins associated with many osteosclerotic lesions. Profilerative osseous changes were seen in 4 cases (pelvis, spine, tibia). MR imaging was performed in 2 patients: in one patient MR imaging revealed areas of low signal intensity on spin echo T1- and T2-weighted images in vertebral bodies, the other showed a lesion of low signal intensity on spin echo T1-weighted and high signal intensity on T2-weighted images in the ilium and adjacent soft tissue. CONCLUSION: The imaging features commonly observed in POEMS syndrome are sclerotic and mixed lytic-sclerotic lesions, particularly in the pelvis and spine. Proliferative new bone formation is detected in 50%. MR imaging correlates with ostesclerotic or mixed lytic-sclerotic appearance.

Adult↗