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Membrane-guided bone regeneration. Segmental radius defects studied in the rabbit.

We tested the principle of guided tissue regeneration (GTR) for healing segmental long-bone defects. 7 mm (3 animals) or 10 mm (5 animals) long segmental defects were created in the diaphyses of both radii in 8 rabbits. The defect on one side was covered with a barrier membrane of expanded polytetrafluoroethylene membrane shaped as a tube, while the contralateral side with no membrane served as the control. Healing was followed with radiographs obtained repeatedly during a 13- (n 3) or 27- (n 5) week period. Thereafter, the animals were killed and ground sections of the defect sites were prepared for histologic examination. Radiographically, the control sites showed some early subperiosteal callus formation and nonunion of the defects after 6 weeks. The bone ends were rounded off and sealed with cortical bone. No major changes were noted after 6 weeks. At the test sites, subperiosteal bone formation at the bone ends was first observed radiographically at 2 weeks. At 9 weeks, a thin cortical bone bridged the defect along the inner surface of the membrane. Histologically, an interrupted line of thin, cortical bone was observed along the inner surface of the barrier membrane. Fatty bone marrow occupied the central and largest volume of the defect. We conclude that it seems possible to use the principle of GTR to accomplish bone union of segmental long-bone defects.

Animals↗

Bone regeneration at rabbit skull defects treated with transforming growth factor-beta1 incorporated into hydrogels with different levels of biodegradability.

OBJECT: Skull bone regeneration induced by transforming growth factor-beta1 (TGFbeta1)-containing gelatin hydrogels (TGFbeta1-hydrogels) was investigated using a rabbit skull defect model. Different strengths of TGFbeta1 were examined and compared: different TGFbeta1 doses in gelatin hydrogels with a fixed water content, different water contents in gelatin hydrogels with a fixed TGFbeta1 dose, and TGFbeta1 in solution form. In addition, regenerated skull bone was observed over long time periods after treatment. METHODS: Soft x-ray, dual energy x-ray absorptometry, and histological studies were performed to assess the time course of bone regeneration at a 6-mm-diameter skull defect in rabbits after treatment with TGFbeta1-hydrogels or other agents. The influence of TGFbeta1 dose and hydrogel water content on skull bone regeneration by TGFbeta1-hydrogels was evaluated. Gelatin hydrogels with a water content of 95 wt% that incorporated at least 0.1 microg of TGFbeta1 induced significant bone regeneration at the rabbit skull defect site 6 weeks after treatment, whereas TGFbeta1 in solution form was ineffective, regardless of dose. The in vivo degradability of the hydrogels, which varied according to water content, played an important role in skull bone regeneration induced by TGFbeta1 -hydrogels. In our hydrogel system, TGFbeta1 is released from hydrogels as a result of hydrogel degradation. When the hydrogel degrades too quickly, it does not retain TGFbeta1 or prevent ingrowth of soft tissues at the skull defect site and does not induce bone regeneration at the skull defect. It is likely that hydrogel that degrades too slowly physically impedes formation of new bone at the skull defect. Following treatment with 0.1-microg TGFbeta1-hydrogel (95 wt%), newly formed bone remained at the defect site without being resorbed 6 and 12 months later. The histological structure of the newly formed bone was similar to that of normal skull bone. Overgrowth of regenerated bone and tissue reaction were not observed after treatment with TGFbeta1 -hydrogels. CONCLUSIONS: A TGFbeta1-hydrogel with appropriate biodegradability will function not only as a release matrix for the TGFbeta1, but also as a space provider for bone regeneration. The TGFbeta1-hydrogel is a promising surgical tool for skull defect repair and skull base reconstruction.

Absorptiometry, Photon↗

Therapeutic effect of umbilical cord serum eyedrops for persistent corneal epithelial defect.

PURPOSE: To evaluate the therapeutic effect of umbilical cord serum in the treatment of persistent epithelial defect of the cornea. METHODS: Fourteen eyes of 14 patients with persistent epithelial defect that had persisted for at least 2 weeks despite conventional treatment were treated with 20% umbilical cord serum eyedrops six times a day. The images of the epithelial defects were captured using a camera attached to a slit lamp biomicroscope and the areas of the epithelial defects were calculated. Treatment was considered effective for epithelial defect healing within 2 weeks, partially effective for healing within 2 to 4 weeks, and ineffective for healing requiring either more than 1 month or additional measures. RESULTS: Mean duration of epithelial defect before treatment was 7.2 +/- 6.3 weeks, and mean area was 7.86 +/- 7.32 mm2. Umbilical cord serum therapy was effective in 6 eyes (42.9%), partially effective in 6 (42.9%), and ineffective in 2 (14.2%). Nevertheless, the epithelial defects in both the ineffective eyes were eventually healed within 8 weeks. Mean healing time in effective or partially effective cases was 2.75 +/- 1.06 weeks. CONCLUSIONS: The use of umbilical cord serum eyedrops for the treatment of persistent epithelial defect is effective.

Adult↗

Stimulation of fracture healing in a canine ulna full-defect model by low-intensity pulsed ultrasound.

Because no report has been issued on the healing effects of low-intensity pulsed ultrasound on moderate to large fracture gaps, we performed an experimental study using a canine ulna full-defect model. Ten mongrel male dogs were divided into two groups: a small defect group and large defect group. The defects were made on the middle one third of both ulnae and one side only was randomly selected for ultrasound sonication, at 1 MHz, 200 microsecond bursting sine wave in 50 mW/cm2 spacial average and temporal average. Sonication was started on the day after surgery and applied for 15 minutes once a day for six days a week. In the small defect group, the means of the radiologic scores, as described by Lane and Sandhu, were 0.6, 4.4, and 8.4 in the control side and 1.8, 6.0, and 10.4 in the treatment side one, three, and five months after the operation, respectively (p=0.0372). In the large defect model, the corresponding means were 2.2, 3.4, and 6.0 in the control side and 3.3, 5.4, and 9.2 in the treatment side (p= 0.009). Low-intensity pulsed ultrasound enhanced new bone formation in small and large full-defects and decreased the incidence of nonunion in the large defect model.

Animals↗

Embryonic stem cells form articular cartilage, not teratomas, in osteochondral defects of rat joints.

Embryonic stem (ES) cells are considered to be a potential tool for repairing articular cartilage defects, but so far it has been impossible to cause these cells to differentiate into chondrocytes exclusively, either in vivo or in vitro. To explore a potential new cell source of cell transplantation for articular cartilage defects, we transplanted ES cells into articular cartilage defects in immunosuppressed rats. ES cells (AB2.2 or CCE cells) were transplanted into articular cartilage defects in the patellar groove of immunosuppressed rats treated with cyclosporine. The cells were histologically observed until 8 weeks after transplantation. To determine whether the repair tissue in the defect in the AB2.2-transplanted group was derived from the transplanted cells, the neomycin-resistant gene, which had been transfected into AB2.2 cells but does not exist in rat cells, was used for detection. The cells produced cartilage, resulting in repair of the defects from 4 weeks until 8 weeks after the transplantation without forming any teratomas. The neomycin-resistant gene was detected in every sample, demonstrating that the repair tissue in the AB2.2-transplanted group was derived from the transplanted AB2.2 cells. The environment of osteochondral defects is chondrogenic for ES cells. ES cells may thus be a potential tool for repairing articular cartilage defects.

Animals↗

"Defective" mutations of hepatitis D viruses in chronic hepatitis D patients.

AIM: To verify whether "defective" mutations existed in hepatitis D virus (HDV). METHODS: Hepatitis delta antigen (HDAg)-coding sequences were amplified using Pfu DNA polymerases with proof-reading activities from sera of five patients with chronic hepatitis D. Multiple colonies were sequenced for each patient. Pfu analyzed a total of 270 HDV clones. Three representative defective HDV clones were constructed in expression plasmids and transfected into a human hepatoma cell line. Cellular proteins were extracted and analyzed by Western blot. RESULTS: Four of five cases (80%) showed defective HDV genomes in their sera. The percentage of defective genomes was 3.7% (10/270). The majority (90%) of the defective mutations were insertions or deletions that resulted in frameshift and abnormal stop translation of the HDAg. The predicted mutated HDAg ranged from 45 amino acids to >214 amino acids in length. Various domains of HDAg associated with viral replication or packaging were affected in different HDV isolates. Western blot analysis showed defected HDAg in predicted positions. CONCLUSION: "Defective" viruses do exist in chronic HDV infected patients, but represented as minor strains. The clinical significance of the "defected" HDV needs further study to evaluate.

Amino Acid Sequence↗

Management of corneal epithelial defects following laser in situ keratomileusis.

PURPOSE: To determine the main principles of postoperative management in patients with epithelial defects following LASIK. METHODS: Patients with myopia and myopic astigmatism (N=2,972; refraction from -1.25 to -15.50 D) were treated with the Nidek EC-5000 excimer laser, using the Chiron Vision HT-230 Hansatome microkeratome. We observed 95 cases with intraoperative epithelial damage among 5,896 operations (1.6%) . Patients received traditional topical medical treatment (Tobramycin 0.3%, five times a day; Lacrisifi, six to eight times a day). In eyes with an epithelial defect less then 3 mm, no additional medical care was needed. In eyes with epithelial defects more then 3 mm, soft therapeutic contact lenses were used until total re-epithelialization occurred. RESULTS: Total re-epithelialization was observed the day following surgery in patients with small defects (less then 3 mm). Visual acuity achieved preoperative level 4 to 7 days after surgery. Total re-epithelialization in patients with soft contact lenses occurred 1 to 3 days after LASIK. On the next day examination, Solcoseryl 20% eye gel was added to topical therapy for corneal healing. In these patients visual acuity achieved preoperative level 10 to 14 days after surgery. In three eyes with large epithelial defects (4 to 5 mm), irregular astigmatism (one eye; 0.02%) or against-the-rule astigmatism (two eyes; 0.03%) occurred. Patients complained of blurred and double vision. Transepithelial phototherapeutic keratectomy was performed after 3 months for epithelial smoothing, with good visual results. CONCLUSION: Management of epithelial defects following LASIK can be concentrated on avoiding epithelial hyperplasia. Epithelial defects less than 3 mm do not appear to produce epithelial hyperplasia. Irregular astigmatism induced by LASIK can result in reduced best spectacle-corrected visual acuity. A common cause of irregular astigmatism is corneal epithelial remodeling and corneal thickening secondary to corneal epithelial defects created at the time of the LASIK procedure.

Astigmatism↗

Triptans and the incidence of epithelial defects during laser in situ keratomileusis.

PURPOSE: To investigate whether the incidence of epithelial defects during laser in situ keratomileusis (LASIK) was different in patients who were taking sumatriptan (Imitrex, Glaxo Smith Kline, Pittsburgh, Pa) for migraine headaches than in those who were not. METHODS: A retrospective chart review was performed on 54 eyes of 28 patients who had been identified as taking sumatriptan and had undergone LASIK at Minnesota Eye Consultants between 1999 and 2001. These patients were compared with 54 gender- and age-matched control eyes operated on with the same microkeratome at the same location during the same period of time. The incidence of epithelial defects during LASIK was compared between the two groups. RESULTS: In the sumatriptan group, 11.1% (6 of 54) of eyes developed epithelial defects as compared to 9.3% (5 of 54) of eyes in the non-triptan group (P=.75, chi square). More recent sumatriptan exposure did not increase the incidence of epithelial defect (P=.47). In patients in whom sumatriptan was stopped >1 month prior to LASIK, 6.3% (1 of 16 eyes) had epithelial defects; in patients in whom sumatriptan was stopped <1 month prior to LASIK, 14.3% (4 of 28 eyes) developed epithelial defects; and 9.3% (5 of 54 eyes) of patients in whom no triptans had ever been used had epithelial defects (P=.70). CONCLUSIONS: There is no correlation between the use of sumatriptan for relief of migraine headaches and the generation of epithelial defects during LASIK. There appears to be no reason to stop triptans before proceeding with LASIK.

Adult↗

Guided bone regeneration with beta-tricalcium phosphate and poly L-lactide-co-glycolide-co-epsilon-caprolactone membrane in partial defects of canine humerus.

This study was performed to evaluate the effect of betatricalcium phosphate and poly L-lactide-co-glycolide-coepsilon- caprolactone (TCP/PLGC) membrane in the repair of partial bone defects in canine proximal humerus. Three adult mixed-breed dogs were used during the experimental period. The length of the defect was quarter of the full length of humerus, and width of the defect was quarter of middle diameter of the lateral aspect of humerus. The humeri of each dog were divided into treatment (TCP/ PLGC) and control groups. The defect was covered with TCP/PLGC membrane in treatment group. To evaluate regeneration of the bone, computerized tomography (CT) and histopathologic examination were performed. The radiopaque lines were appeared at the original defect sites in TCP/PLGC group but below the original site in control at 4th week. Radiopacity and thickness of the defect sites, and radiopaque lines were more increased at 8th week than those of 4th week. Histopathologic findings revealed fibrous connective tissue migration into the defect and the migration inhibited the structure of new cortex to be placed in the original level in control whereas new cortex growth was found in the level of original line in TCP/ PLGC group. However, the new cortical bone in the TCP/ PLGC group was thinner and less organized than the adjacent intact cortex, and the amount of new cancellous bones were also scanty. The result suggested that TCP/ PLGC membrane is a good guided bone regeneration material to restore the original morphology of humerus in partial defect.

Absorbable Implants↗

Birth defects in the infants of aboriginal and non-aboriginal mothers with diabetes in Western Australia.

OBJECTIVE: Because of the high prevalence of non-insulin-dependent diabetes in Australian Aborigines, and a suggestion that the prevalence of birth defects was high in the infants of Aboriginal mothers with gestational diabetes, this study was undertaken to determine the prevalence of birth defects in infants of Aboriginal and non-Aboriginal mothers with insulin-dependent, non-insulin-dependent, and gestational diabetes mellitus. DESIGN: A retrospective cohort study of all births to diabetic and non-diabetic mothers in Western Australia, 1980-1984. MAIN OUTCOME MEASURE: Birth defects diagnosed at any time up to the age of six years. RESULTS: Compared with infants of non-diabetic, non-Aboriginal mothers, the prevalence ratio for birth defects in infants of non-Aboriginal insulin-dependent mothers was 2.08 (95% confidence interval, 1.2-3.7), and for infants of mothers with non-insulin-dependent diabetes the ratio was 3.64 (95% CI, 1.5-8.6). The corresponding ratios for infants of Aboriginal mothers were 4.85 (95% CI, 0.8-28.2) and 3.64 (95% CI, 1.3-10.4). For birth defects in infants of gestational diabetic mothers, the prevalence ratio was 1.07 (95% CI, 0.6-1.9) for the non-Aboriginal group and 3.65 (95% CI, 2.3-6.0) for the Aboriginal group. Diabetes could have accounted for 0.14% of birth defects in infants of non-Aboriginal mothers and for 4.62% in infants of Aboriginal mothers. CONCLUSIONS: The excess of birth defects in infants of Aboriginal women with gestational diabetes may be due to non-insulin-dependent diabetes that predates the pregnancy but is only diagnosed during pregnancy. For Aboriginal infants, maternal diabetes may be the single most common known cause of birth defects that is amenable to change.

Cohort Studies↗

[A case of congenital skull defect complicated with arachnoid cyst].

A 3-month-old boy was referred to our hospital with left temporal bone defect and bulging skin. The skull defect had been recognized since birth. There was no family history of any congenital anomaly and his physical development was normal for his age. His bulged left temporal region was covered by normal skin and a skull defect measuring 2 x 2 cm in size was palpated at the center. CT scan revealed skull defect at the pterion accompanied with widening of the middle cranial fossa. Arachnoid cyst of the middle cranial fossa was also suspected. The skull defect gradually enlarged and especially on crying the left temporal skin bulging became more marked. The bone edge of the defect was thin and was deflected outward. The operation was planned and performed at the age of 11 months. After excision and fenestration of the arachnoid cyst, duraplasty and cranioplasty were performed using split-thickness calvarial bone graft. Splitting the frontal calvarial bone suitable for the defect, the outer table was returned to the donor site, and the inner table was fixed into the defect. Follow-up CT one year after surgery revealed a satisfactory cosmetic result and no bone resorption. Split calvarium cranioplasty is considered to be even more useful in an infant.

Arachnoid Cysts↗

Evidence for a primary defect of lipoamide dehydrogenase in Friedreich's ataxia.

There is now a great deal of evidence to link genetic defects of pyruvate metabolism to brain disease. Experimental evidence is reviewed in Chapter 12, and clinical evidence has been reviewed above. Severe lesions of components of the pyruvate dehydrogenase complex are associated with severe generalized brain disease, and milder defects with inherited ataxias. Nearly half of one series of our ataxic patients had deficient activity of pyruvate dehydrogenase, and 40% of another series have deficient activity of the lipoamide dehydrogenase component. This last group corresponds to 60% of the patients with Friedreich's ataxia and its clinical variants at UCLA. There is an association between defective activity of lipoamide dehydrogenase and disease, and the data suggest there is a structural mutation of the gene for the enzyme. Preliminary studies suggest that obligate heterozygotes as a group have enzyme activities between those for controls and those for patients. Moreover, the obligate heterozygotes from families in which there are kinetic defects of lipoamide dehydrogenase also appear to have kinetic abnormalities of the enzyme. The ataxic patients with reduced lipoamide dehydrogenase activity currently fall into two clinical groups. One is ragged-red ataxia, and the other is a disorder that is a subgroup of the classic Friedreich's ataxia syndrome. Studies need to be undertaken on a larger group of patients, with more diverse inherited ataxias, to test the present clinical associations of the enzyme defect. A dietary treatment derived from a knowledge of the presumed defect has modified the ataxia that is associated with defects of pyruvate decarboxylase, but the diet has not yet been tested with defects of lipoamide dehydrogenase.

Ataxia↗

[Limb reduction defects in Asturias (1986-1997): prevalence and clinical presentation].

AIM: To determine the prevalence and clinical presentation of limb reduction defects in Asturias (Spain). PATIENTS AND METHODS: Among the 92300 newborns, stillbirths and induced abortions for congenital defects surveyed by the Registry of Congenital Defects in Asturias (population-based registry) during 1986-1997, we studied the children with limb reduction defects. Frequency is expressed as total prevalence per 10000 births. RESULTS: Seventy-three children with limb reduction defects were identified, with a total prevalence of 8 per 10000 births (CI 6.2-9.8): upper limbs were affected in 65.7%, lower limbs in 23.3% and both upper and lower limbs were affected in 11%. Transverse terminal defects were present in 49.3%, and were intercalary in 16.4%, preaxial longitudinal in 8.2%, postaxial longitudinal in 9.6%, split hand/foot in 9.6% and multiple in 6.8%. Limb deficiencies were found in 52%; of these, 48% were associated with other congenital defects. Four had chromosomal anomalies and 20 were syndromes. 31% had low birth weight for their gestational age. Alcohol exposure during pregnancy was recorded in three mothers. CONCLUSIONS: A detailed study of limb reduction defects could lead to a better understanding of clinical presentation and to an etio-pathogenic diagnosis to control risk factors.

Congenital Abnormalities↗

Strut-autografting with and without osteogenic protein-1 : a preliminary study of a canine femoral head defect model.

BACKGROUND: Osteonecrosis of the femoral head frequently leads to collapse of the articular cartilage and to disabling osteoarthritis, which ultimately may necessitate joint arthroplasty. One treatment method that has had moderate success is the so-called trapdoor approach, which involves excavation of diseased (necrotic) bone followed by bone-grafting. Augmentation of this procedure with various growth and differentiation factors may improve the outcome. We developed a canine model that mimics the clinical situation with trapdoor bone-grafting. The objective of this study was to evaluate the effect of the addition of osteogenic protein-1 on healing following the trapdoor procedure with strut-autografting. METHODS: Thirty-four skeletally mature dogs were used in the experiment. After capsulotomy, a trapdoor was created in the anterolateral surface of the femoral head and a 2-cm-diameter subchondral area of bone was removed. In the phase-I experiments, seven dogs had no treatment of the defect (Group I) and nine dogs were treated with strut-grafting (Group II). In phase II, the procedure was modified by collapsing the trapdoor into the created defect intraoperatively in eighteen dogs, which were divided into three equal groups: six untreated defects were left collapsed (Group III), six were treated with bone graft (Group IV), and six were treated with bone graft augmented with osteogenic protein-1 (Group V). RESULTS: Three of the seven femoral heads in Group I (untreated defect) and one of the nine heads in Group II (grafting without collapsing of the trapdoor) had evidence of cartilage collapse. Inspection of sagittal slices and radiographs revealed an unfilled residual defect in all Group-I heads, whereas all Group-II heads were well healed. The mean normalized stiffness value was significantly larger in Group II than it was in Group I. On visual inspection, depression was noted in all of the femoral heads in Group III (untreated defect; trapdoor left collapsed). In both Group IV and Group V (grafting without and with osteogenic protein-1), the trapdoor cartilage appeared to be essentially normal. Groups IV and V had more radiographic healing than did Group III. The defects in Group V (grafting with osteogenic protein-1) healed faster radiographically than did those in Group IV (grafting without osteogenic protein-1). CONCLUSIONS: Moderate-to-excellent healing was seen both radiographically and biomechanically by four months in the groups treated with grafting, with and without osteogenic protein-1, whereas untreated defects did not heal. CLINICAL RELEVANCE: Symptomatic osteonecrosis of the femoral head is a clinical challenge. The animal model in the current study is a useful tool for the evaluation of methods to treat osteonecrosis of the femoral head. Studies investigating additional time-periods between implantation of osteogenic protein-1 and assessment of results as well as different doses of osteogenic protein-1 are warranted.

Analysis of Variance↗

[Investigation on the positions and relevant factors of wedge-shaped defects in the elderly].

OBJECTIVE: To investigate the position and relevant factors of wedge-shaped defects in elderly. METHODS: 462 elderly were examined. RESULTS: The occurrence rate of wedge-shaped defects was 99.1%, all had at least labial or buccal defects, with premolars the most frequent. However, 15.2% of them had lingual defects, most frequently in molars. No significant association were found between wedge-shaped defect position and tooth brushing or erosion factors in the group. In tooth with defect, the occlusal surface wear was more severe, the denture abutment teeth were more in number, and the functional mobility was increased; in teeth with lingual defect, these phenomena were more obvious. CONCLUSION: The wedgeshaped defects, besides tooth brushing and erosion factors, occlusal force and its accumulation plays a role as well, lingual lesions are more related to traumatic occlusal force.

Aged↗

[Changes of blood circulation of the extremity with tibia shaft defects treated with external fixation].

OBJECTIVE: To study external skeletal fixation for long tubular bony defect by end to end compression with lengthening (EECL) and segmental bone transport by lengthening (STBL). METHODS: About 20% - 30% of the original length was resected from the middle shaft of the tibia in 10 goats of 1 - 2 years of age. The bony defect ends were shortened step by step with the sulcated half-ring external fixator. Changes of the blood flow of the distant extremity were measured with pulse-dopplar monitor, reference blood flow, and angiograph. RESULTS: The blood flow of the distant extremity was not affected when bony defect was less than 15% of the original length. Blood circulation disorder would appear in the distant extremity when bony defect ranged from 15% to 20% of the original length. The distant extremity would necrose because of obstruction of blood circulation when bony defect was more than 20% of the original length. CONCLUSIONS: EECL can be recommended if bony defect is less than 15% of the original length. SBTL might be the only feasible way if bony defect is more than 20% of the original length. If bony defect is within 15% and 20%, EECL should be applied with great care while watching the extremity circulation with pulse-Dopplar monitor.

Animals↗

[Primary reconstruction of lateral oro-mandibular defects using titanium plates (Thorp) and revascularized non-osseous flaps: a personal experience].

Reconstruction of a particular defect is an highly complex problem, that is reflected in the number and variety of techniques proposed. This is particularly true for reconstruction of mandibular segment defects usually together with the need to repair oro-pharnygeal soft tissues defects of various size. The high rate of successes that can be obtained today using microvascular reconstruction techniques explains the reason why bone free flaps have progressively become the "gold standard" used as benchmark for all other forms of primary mandibular reconstruction. However, for selected patients (elderly patients or individuals in poor general health; the presence of lateral oro-mandibular defects or soft tissue defects significantly exceeding the bone defect) the association of non-osseous microvascular free flaps (such as forearm skin flaps or miocutaneous free flaps of the abdominal rectus muscle) with a titanium mandibular reconstruction plate (THORP) can prove a valid alternative. Indeed, in these cases reconstruction of choice would be the association of two free flaps, one osseous and the other non osseous. The use of THORP-type mandibular reconstruction plates in repairing lateral defects increases the overall risk of complications related to the reconstruction technique which is already hindered by the risks associated with the use of microvascular free flaps. The present work starts with a retrospective evaluation of 5 years series of primary mandibular reconstruction for lateral oro-mandibular defects following oncological surgery. The role of THORP-type titanium mandibular plates, used in combination with non-osseous free flaps in the treatment of selected patients, is then described and discussed.

Aged↗

[Abdominal wall defects from 1961 to 2000--incidence, prenatal diagnosis and prevalence by maternal age].

OBJECTIVE: Presentation of defects of the abdominal wall--omphalocele and gastroschisis--in the Czech Republic during 1961 to 2000. Analysis of the prevalence of these defects in different groups by maternal age. DESIGN: Retrospective demographic epidemiological study. SETTING: Institute for the Care of Mother and Child, Prague. METHOD: Data from the nationwide registration of congenital defects were used which are kept in the Institute for Health Information and Statistics of the CR and data on the prenatal diagnosis from different departments of medical genetics. Epidemiological analysis of the incidence of defects of the abdominal wall--omphalocele and gastroschisis, diagnosed pre- and postnatally in the Czech Republic in 1961-2000. For the mathematical and statistical analysis of the prevalence of these defects by maternal age the method of calculation of the 95% confidence interval of probability was used. RESULTS: In the Czech Republic during the period of 1961-2000 a total of 2293 cases of abdominal wall defects were registered. From this total number of notified defects 1915 cases were diagnosed after delivery, prenatal diagnosis was made in 378 cases and pregnancy was therefore terminated prematurely. From the total number of abdominal wall defects there were 1450 cases of omphalocele (incl. 136 prenatally diagnosed cases) and 843 cases of gastroschisis (incl. 242 cases diagnosed prenatally). CONCLUSION: The authors found a significant decrease in the incidence in the neonatal population of the Czech Republic due to the advances of prenatal diagnosis in the recent decade. As regards omphalocele there is a significantly higher risk in women older than 39 years, in the case of gastroschisis there is a higher risk for women under 18 years and women above 39 years.

Adolescent↗