PURPOSE: As well as patient survival, the restoration of postoperative function such as ambulation is important in limb salvage operations for treatment of malignant bone tumors involving the proximal femur. The authors analyzed clinical outcomes of limb salvage operations using tumor prostheses for metastatic or primary malignant bone tumors in the proximal femur. MATERIALS AND METHODS: From February 2005 to January 2014, 20 cases (19 patients) with malignant bone tumor involving the proximal femur with pain or complicated pathologic fracture were treated with segmental resection and limb salvage operations with tumor prostheses. Mean age was 63.1 years (range 35-86). Fourteen patients were male and six ones were female. The mean follow-up period was 20 months (1-94 months). There were 15 cases of metastatic bone tumor, 4 cases of osteosarcoma, and 1 case of multiple myeloma. The primary tumors of the metastatic bone tumors included 4 lung cancers, 3 hepatocellular carcinomas, and 3 renal cell carcinomas. Other primary tumors were breast cancer, thyroid cancer, colon cancer, prostate cancer, and malignant spindle cell tumor, each in 1 case. Modular tumor prostheses were used in all cases; (Kotz's(R) Modular Tumor prosthesis (Howmedica, Rutherford, New Jersey) in 3 cases, MUTARS(R) proximal femur system (Implantcast, Munster, Germany) in 17 cases). Perioperative pain was assessed with Visual Analogue Scales (VAS). Postoperative functional outcome was assessed with Musculoskeletal Tumor Society (MSTS) grading system. RESULTS: Out of 20 cases (19 patients), 11 cases (10 patients) survived at the last follow-up. Average postoperative survival of the 9 deceased patients was 10.1 months (1-38 months). VAS score improved from pre-operative average of 8.40 (5-10) to 1.35 (0-3) after operation. Average postoperative MSTS function score was 19.65 (65.50%, 7-28). The associated complications were 2 local recurrences, 3 hematomas, 3 infections, 2 scrotal swellings, and 1 dislocation. There was no case of periprosthetic fracture or loosening. CONCLUSION: Limb salvage operation with tumor prosthesis is an appropriate treatment for early pain reduction and functional restoration in malignant bone tumors in the proximal femur with pain an/or complicated pathologic fractures.
Breast Neoplasms ; Carcinoma, Hepatocellular ; Carcinoma, Renal Cell ; Colonic Neoplasms ; Dislocations ; Female ; Femur* ; Follow-Up Studies ; Fractures, Spontaneous ; Hematoma ; Humans ; Limb Salvage* ; Lung Neoplasms ; Male ; Multiple Myeloma ; Osteosarcoma ; Periprosthetic Fractures ; Prostatic Neoplasms ; Prostheses and Implants* ; Recurrence ; Thyroid Neoplasms ; Walking ; Weights and Measures

PURPOSE: The aim of this study was to evaluate the effect of Er:YAG laser on microstructure and roughness of TiO2 blasting implant surface. MATERIALS AND METHODS: Ten TiO2 blasting implant were used in this experiment. One implant was control group, and nine TiO2 blasting implant surfaces were irradiated with Er:YAG laser under 100 mJ/pulse, 140 mJ/pulse, and 180 mJ/pulse condition for 1 min, 1.5 min, and 2 min respectively. Optical interferometer and scanning electron microscopy was utilized to measure roughness and microstructure of specimens. RESULTS: The surface roughness was decreased after Er:YAG laser irradiation in all groups, but there was no significant difference. 100 mJ/pulse and 140 mJ/pulse group did not alter the TiO2 blasting implant surface in SEM study while 180 mJ/pulse group altered the TiO2 blasting implant surface. Implant surfaces showed melting, microfracture and smooth surface in 180 mJ/pulse group. CONCLUSION: Detoxification of implant surface using Er:YAG laser must be irradiated with proper energy output and irradiation time to prevent implant surface alteration.
Freezing ; Microscopy, Electron, Scanning

A malignant granular cell tumor (MGCT) occurred in the left shoulder of a 62-year-old man. The patient underwent wide marginal excision followed by chemotherapy and radiotherapy. A metastatic tumor was identified in the axillary lymph node 22 months after the excision of the shoulder mass. The primary tumor was a poorly circumscribed mass measuring 5 5 4 cm. On cut section, it was a solid mass with yellowish tan color. Histologically, both primary and metastatic tumor consisted of polygonal cells with abundant granular cytoplasm and a vesicular nucleus with a prominent nucleolus. Two to three mitotic figures per ten high power fields at 200 were counted. Tumor cells were weakly stained with periodic acid-Schiff (PAS) preparation both before and after diastase digestion, and were positive for S-100 protein, neuron-specific enolase (NSE), and vimentin. By electron microscopy, the cytoplasm was filled with numerous autophagolysosomes containing myelin figures, mitochondria, and fragmented rough endoplasmic reticula. Basal laminae and angulated bodies were also noted. These findings suggest schwannian differentiation of this tumor.
Amylases ; Basement Membrane ; Cytoplasm ; Digestion ; Drug Therapy ; Granular Cell Tumor* ; Humans ; Immunohistochemistry ; Lymph Nodes ; Microscopy, Electron ; Middle Aged ; Mitochondria ; Myelin Sheath ; Phosphopyruvate Hydratase ; Radiotherapy ; S100 Proteins ; Shoulder* ; Triacetoneamine-N-Oxyl ; Vimentin

No Abstract Available.
Humans*

PURPOSE: This study aimed to find out whether there are relationships among anatomic characteristics of inferior oblique muscle insertion, corneal diameter, axial length and inferior oblique recession landmark. METHODS: Thirty-one Korean cadaver orbits were dissected to expose the full length of extraocular muscles and sclera, and then we measured the length from the recession landmark of inferior oblique to the lateral edge of insertion of inferior rectus and to the inferior edge of insertion of lateral rectus. RESULTS: The mean of angles between the inferior oblique muscle insertion and lateral rectus direction is 27.9+/-9.0degrees and the range is from 15 degrees to 50 degrees . There is a statistically significant correlation between cord length of 8 mm recession landmark of inferior oblique and angles of inferior oblique insertion with lateral rectus direction. We divided the shapes of inferior oblique insertion into straight and convexed curves. Twelve insertions are straight and thirteen insertions are curved. There is no statistically significant correlation between shape of inferior oblique insertion and cord length from recession landmark. In corneal diameter and axial length, we found correlations with cord length of 8 mm and 10 mm recession landmark of inferior oblique. CONCLUSIONS: We conclud that there are some correlations among anatomic characteristics, axial length and corneal diameter with recession landmark of inferior oblique.
Cadaver ; Muscles ; Orbit ; Sclera

The purpose of this study was to evaluate exophytically vertical bone formation in residual ridge of the beagle dog by the concept of guided bone regeneration with a titanium reinforced e-PTFE membrane combined with irradiated cancellous human bone. Twelve male beagle dogs(mean age 1.5 years and mean weight 12kg) were used for this study. The alveolar ridges after extraction of all mandibular premolars were surgically and horizontally removed. At 8 weeks after extractions, full-thickness flap was reflected and cortical bone was removed with round bur and copious irrigation. Rectangular parallelepiped(10mm in length, 5mm in width, and 4mm in height) bended with titanium-reinforced e-PTFE(TR e-PTFE) membrane was placed on the decorticated alveolar ridge, fixed with metal pins and covered with full-thickness flap and assigned as a control group. Test groups were treated with TR e-PTFE membrane filled with irradiated cancellous human bone. Of twelve beagle dogs, four control dogs and four test dogs without membrane exposure to oral cavity were sacrificed at 8 and 16 weeks respectively. The surgical sites were dissected out, fixed in 4% buffered formaldehyde, dyed using a Villanueva staining technique, and processed for embedding in plastic resin. The cutting and grinding methods were routinely processed for histologic and histomophometric analyis of exophytic bone formation as well as statistical analysis. The results of this study were as follows: 1. Exophytic bone formation in the both of experimental groups was increased respectively after surgery from 23.40% at 8 weeks to 46.26% at 16 weeks in the control groups, from 40.23% at 8 weeks to 47.11% at 16 weeks in the test groups(p<0.05). 2. At 8 weeks after surgery, exophytic bone formation was made 40.23% in the test groups and 33.40% in the control groups. Exophytic bone formation was significantly made in the test group more than in the control group. At 16 weeks after surgery, exophytic bone formation was made 44.11% in the test groups and 46.26% in the control groups. Exophytic bone formation was made in the test groups more than in the control groups, but there was no statistically significant differences. 3. The membrane was fixed with metal pins to closely contact it to the bone surface. So, collapse and deviation of the membrane could be prevented and in growth of connective tissue also could be blocked from the periphery of the membrane. On the basis of these findings, we suggest that intraoral experimental model for exophytic bone formation may be effective to evaluate the effect of bone graft material. And it indicates that combined use of membrane and ICB graft material is more effective than use of membrane only for exophytic bone formation.
Alveolar Process ; Animals ; Bicuspid ; Bone Regeneration ; Connective Tissue ; Dogs* ; Formaldehyde ; Humans* ; Male ; Membranes ; Models, Theoretical ; Mouth ; Osteogenesis* ; Plastics ; Titanium ; Transplants

PURPOSE: In this study, the effect of micro-macroporous biphasic calcium phosphate(MBCP) incorporated with inorganic polyphosphate for bone regeneration in the calvaria of rabbit was evaluated. MATERIALS AND METHODS: The procedure of guided bone regeneration was performed with titanium reinforced expanded polytetrafluoroethylene(TR-ePTFE) membrane. Four animal groups were compared : 1) TR-ePTFE membrane for negative control group, 2) TR-ePTFE membrane filled with MBCP for positive control group, 3) TR-ePTFE membrane filled with MBCP soaked in 4% inorganic polyphosphate for experimental group I, and 4) TR-ePTFE membrane filled with MBCP soaked in 8% inorganic polyphosphate for experimental group II. RESULTS: 1. Negative control group showed the highest new bone formation at 16 weeks. 2. Positive control group showed the smallest new bone formation compared to other groups. 3. 8% inorganic polyphosphate induced more volume of bone formation, otherwise experimental group II did not show significant difference compared to negative control group. CONCLUSION: These results suggest that inorganic polyphosphate has a promoting effect on bone regeneration, possibly by enhancing osteoconductivity of the carrier and by increasing osteoinductivity of the defected alveolar bone tissue.
Animals ; Bone and Bones ; Bone Regeneration ; Calcium ; Hydroxyapatites ; Membranes ; Osteogenesis ; Skull ; Titanium

PURPOSE: The present study was performed to evaluate the effect of erbium-doped: yttrium, aluminium and garnet (Er:YAG) laser irradiation on sand-blasted, large grit, acid-etched (SLA) implant surface microstructure according to varying energy levels and application times of the laser. METHODS: The implant surface was irradiated by the Er:YAG laser under combined conditions of 100, 140, or 180 mJ/pulse and an application time of 1 minute, 1.5 minutes, or 2 minutes. Scanning electron microscopy (SEM) was used to examine the surface roughness of the specimens. RESULTS: All experimental conditions of Er:YAG laser irradiation, except the power setting of 100 mJ/pulse for 1 minute and 1.5 minutes, led to an alteration in the implant surface. SEM evaluation showed a decrease in the surface roughness of the implants. However, the difference was not statistically significant. Alterations of implant surfaces included meltdown and flattening. More extensive alterations were present with increasing laser energy and application time. CONCLUSIONS: To ensure no damage to their surfaces, it is recommended that SLA implants be irradiated with an Er:YAG laser below 100 mJ/pulse and 1.5 minutes for detoxifying the implant surfaces.
Dental Implants ; Dietary Sucrose ; Microscopy, Electron, Scanning ; Yttrium

This study was performed to evaluate the effect of inorganic polyphosphate on bone formation in the calvaria of rabbit in the procedure of guided bone regeneration with bovine cancellous bone graft and titanium reinforced expanded polytetrafluoroethylene(TR-ePTFE) membrane. The rabbits were divided into four groups. Control group I used only TR-ePTFE membrane, control group II used TR-ePTFE membrane and deproteinized bovine bone mineral soaked in saline, experimental group III and IV used TR-ePTFE membrane and deproteinized bovine bone mineral soaked in 1% or 2% inorganic polyphosphate respectively. After decortication in the calvaria, GBR procedure was performed on 12 rabbits with titanium reinforced ePTFE membrane filled with deproteinized bovine bone mineral soaked in saline or inorganic polyphosphate. The animals were sacrificed at 2 weeks, 4 weeks, and 8 weeks after the surgery. Decalcified and non-decalcified specimens were processed for histologic and immunohistochemistric analysis. 1. Titanium reinforced ePTFE(TR-ePTFE) membrane showed good spacemaking and cell occlusiveness capability, but it showed poor wound stabilization. 2. The deproteinized bovine bone mineral did not promote bone regeneration, but it acted as a space filler. 3. There was no complete resorption of the deproteinized bovine bone mineral within 8 weeks. 4. 1% inorganic polyphosphate did not promote bone formation, but 2% inorganic poly- phosphate promoted bone formation. Within the above results, 2% inorganic polyphosphate could be used effectively for bone regeneration.
Animals ; Bone Regeneration* ; Membranes ; Osteogenesis ; Rabbits ; Skull ; Titanium ; Transplants ; Wounds and Injuries

PURPOSE: The aim of this case report is to present a case of incomplete bone formation after sinus augmentation. METHODS: A patient having alveolar bone resorption of the maxillary posterior edentulous region and advanced pneumatization of the maxillary sinus was treated with sinus elevation using deproteinized bovine bone in the Department of Periodontology, Kyung Hee University School of Dentistry and re-evaluated with computed tomography (CT) follow-up. RESULTS: Even though there were no significant findings or abnormal radiolucency on the panoramic radiograph, incomplete bone formation in the central portion of the augmented sinus was found fortuitously in the CT scan. The CT scan revealed peri-implant radiolucency in the apical portion of the implant placed in the augmented maxillary sinus. Nevertheless, the dental implants placed in the grafted sinus still functioned well at over 15 months follow-up. CONCLUSIONS: The result of this case suggests that patients who received maxillary sinus augmentation may experience incomplete bone formation. It is possible that 1) osteoconductive graft material with poor osteogenic potential, 2) overpacking of graft material that restricts the blood supply, and 3) bone microbial contamination may cause the appearance of incomplete bone formation after sinus augmentation. Further studies are needed to elucidate the mechanism of this unexpected result and care must be taken to prevent it.
Bone Resorption ; Dental Implants ; Dentistry ; Durapatite ; Follow-Up Studies ; Humans ; Maxillary Sinus ; Osteogenesis ; Transplants