The use of artificial nerve conduit containing viable Schwann cells is one of the most promising strategies to repair the peripheral nerve injury. To fabricate an effective nerve conduit whose microstructure and internal environment are more favorable in the nerve regeneration than existing ones, a new three-dimensional Schwann cell culture technique using Matrigel(R) and dorsal root ganglion (DRG) was developed. Nerve conduit of three-dimensionally arranged Schwann cells was fabricated using direct seeding of freshly harvested DRG into a Matrigel(R) filled silicone tube (I.D. 1.98 mm, 14 mm length) and in vitro rafting culture for 2 weeks. The nerve regeneration efficacy of three-dimensionally cultured Schwann cell conduit (3D conduit group, n=6) was assessed using SD rat sciatic nerve defect of 10 mm, and compared with that of silicone conduit filled with Matrigel(R) and Schwann cells prepared from the conventional plain culture method (2D conduit group, n=6). After 12 weeks, sciatic function was evaluated with sciatic function index (SFI) and gait analysis, and histomorphology of nerve conduit and the innervated tissues of sciatic nerve were examined using image analyzer and electromicroscopic methods. The SFI and ankle stance angle (ASA) in the functional evaluation were -60.1+/-13.9, 37.9 degrees +/-5.4 degrees in 3D conduit group (n=5) and -87.0 +/-12.9, 32.2 degrees +/-4.8 degrees in 2D conduit group (n=4), respectively. And the myelinated axon was 44.91%+/-0.13% in 3D conduit group and 13.05%+/-1.95% in 2D conduit group to the sham group. In the TEM study, 3D conduit group showed more abundant myelinated nerve fibers with well organized and thickened extracellular collagen than 2D conduit group, and gastrocnemius muscle and biceps femoris tendon in 3D conduit group were less atrophied and showed decreased fibrosis with less fatty infiltration than 2D conduit group. In conclusion, new three-dimensional Schwann cell culture technique was established, and nerve conduit fabricated using this technique showed much improved nerve regeneration capacity than the silicone tube filled with Matrigel(R) and Schwann cells prepared from the conventional plain culture method.
Animals ; Ankle ; Axons ; Cell Culture Techniques ; Collagen ; Diagnosis-Related Groups ; Fibrosis ; Gait ; Ganglia, Spinal ; Muscle, Skeletal ; Myelin Sheath ; Nerve Fibers, Myelinated ; Nerve Regeneration ; Peripheral Nerve Injuries ; Peripheral Nerves* ; Rats ; Regeneration* ; Schwann Cells ; Sciatic Nerve ; Silicones ; Tendons

Styela clava, called non-native tunicate or sea squirt, is habitat which include bays and harbors in Korea and several sites in the sea faced world. We fabricate cellulose membrane nerve conduit (CMNC) from this native sea squirt skin, and evaluate the capacity of promoting peripheral nerve regeneration in the rat sciatic nerve defect model. After processing the pure cellulose membrane from the sea squirt skin as we already published before, CMNC was designed as a non-tubular sheet with 14 mm length and 4 mm width. Total eleven male Spraque-Dawley rats (12 weeks, weighing 250 to 300g) were divided into sham group (n=2), silicone tube grafted control group (n=3) and experimental group (n=6). Each CMNC grafted nerve was evaluated after 4, 8 and 12 weeks in the experimental group, and after 12 weeks, sciatic function was evaluated with sciatic function index (SFI) and gait analysis, and histomorphology of nerve conduit and the innervated tissues of sciatic nerve were all examined using image analyzer and electromicroscopic methods in the all groups. The regenerated axon and nerve sheath were found only in the inner surface of the CMNC after 4 weeks and became more thicker after 8 and 12 weeks. In the TEM study, CMNC grafted group showed more abundant organized myelinated nerve fibers with thickened extracellular matrix than silicone conduit grafted group after 12 weeks. The sciatic function index (SFI) and ankle stance angle (ASA) in the functional evaluation were -47.2+/-3.9, 35.5.+/-4.9.in CMNC grafted group (n=2) and -80.4+/-7.4, 29.2.+/-5.3.in silicone conduit grafted group (n=3), respectively. And the myelinated axon was 41.59% in CMNC group and 9.51% in silicone conduit group to the sham group. The development of a bioactive CMNC to replace autogenous nerve grafts offers a potential and available approach to improved peripheral nerve regeneration. As we already published before, small peptide fragment derived from the basement membrane matrix proteins of squirt skin, which is a kind of anchoring protein composed of glycocalyx, induced the effective axonal regeneration with rapid growth of Schwann cells beneath the inner surface of CMNC. So the possibilities of clinical application as a peripheral nerve regeneration will be able to be suggested.
Animals ; Ankle ; Axons ; Basement Membrane ; Bays ; Cellulose* ; Ecosystem ; Extracellular Matrix ; Gait ; Glycocalyx ; Humans ; Korea ; Male ; Membranes* ; Myelin Sheath ; Nerve Fibers, Myelinated ; Peripheral Nerves* ; Rats ; Regeneration* ; Schwann Cells ; Sciatic Nerve ; Silicones ; Skin ; Transplants ; Urochordata

Measurement of regional cerebral blood flow with single photon emission computed tomography(SPECT) was performed using 99mTc-HMPAO in 16 patients with traumatic subdural hygroma, and we investigated the relationships between the results and the initial clinical findings and clinical outcomes on 4-month after injury. In patients with complex subdural hygroma, improvement of perfusion on follow up SPECT was correlated with the clinical outcome. But in patients with simple subdural hygroma, the clinical outcomes were good regardless of cerebral perfusion on initial SPECT and cerebral hypoperfusion was improved on follow up SPECT in all patients. These results suggested that associated parenchymal injury, initial perfusion of the frontal cortex, and improvement of perfusion on follow up SPECT were good indicators of clinical outcome. In conclusion, HMPAO-SPECT can be helpful in predicting the prognosis and assessing the effect of surgical treatment in patients with traumatic subdural hygroma.
Follow-Up Studies ; Humans ; Perfusion ; Prognosis ; Subdural Effusion* ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon*

OBJECTIVES: Mandibular angle reduction or reduction genioplasty is a routine well-known facial contouring surgery that reduces the width of the lower face resulting in an oval shaped face. During the intraoral resection of the mandibular angle or chin using an oscillating saw, unexpected peripheral nerve damage including inferior alveolar nerve (IAN) damage could occur. This study analyzed cases of damaged IANs during facial contouring surgery, and asked what the basic standard of care in these medical litigation-involved cases should be. MATERIALS AND METHODS: We retrospectively reviewed a total of 28 patients with IAN damage after mandibular contouring from August 2008 to July 2015. Most of the patients did not have an antipathy to medical staff because they wanted their faces to be ovoid shaped. We summarized three representative cases according to each patient's perceptions and different operation procedures under the approvement by the Institutional Review Board of Seoul National University. RESULTS: Most of the patients did not want to receive any further operations not due to fear of an operation but because of the changes in their facial appearance. Thus, their fear may be due to a desire for a better perfect outcome, and to avoid unsolicited patient complaints related litigation. CONCLUSION: This article analyzed representative IAN cutting cases that occurred during mandibular contouring esthetic surgery and evaluated a questionnaire on the standard of care for the desired patient outcomes and the specialized surgeon's position with respect to legal liability.
Chin ; Ethics Committees, Research ; Genioplasty ; Humans ; Jurisprudence ; Liability, Legal* ; Mandibular Nerve* ; Medical Staff ; Peripheral Nerves ; Retrospective Studies ; Seoul ; Standard of Care ; Surgery, Plastic

OBJECTIVES: Mandibular angle reduction or reduction genioplasty is a routine well-known facial contouring surgery that reduces the width of the lower face resulting in an oval shaped face. During the intraoral resection of the mandibular angle or chin using an oscillating saw, unexpected peripheral nerve damage including inferior alveolar nerve (IAN) damage could occur. This study analyzed cases of damaged IANs during facial contouring surgery, and asked what the basic standard of care in these medical litigation-involved cases should be. MATERIALS AND METHODS: We retrospectively reviewed a total of 28 patients with IAN damage after mandibular contouring from August 2008 to July 2015. Most of the patients did not have an antipathy to medical staff because they wanted their faces to be ovoid shaped. We summarized three representative cases according to each patient's perceptions and different operation procedures under the approvement by the Institutional Review Board of Seoul National University. RESULTS: Most of the patients did not want to receive any further operations not due to fear of an operation but because of the changes in their facial appearance. Thus, their fear may be due to a desire for a better perfect outcome, and to avoid unsolicited patient complaints related litigation. CONCLUSION: This article analyzed representative IAN cutting cases that occurred during mandibular contouring esthetic surgery and evaluated a questionnaire on the standard of care for the desired patient outcomes and the specialized surgeon's position with respect to legal liability.
Chin ; Ethics Committees, Research ; Genioplasty ; Humans ; Jurisprudence ; Liability, Legal* ; Mandibular Nerve* ; Medical Staff ; Peripheral Nerves ; Retrospective Studies ; Seoul ; Standard of Care ; Surgery, Plastic

Nineteen patients with benign pancreatic disease were managed with surgical treatment in Pusan Medical Center during three years from September 1993 to September 1995 and the results were reviewed retrospectively. The results were as follows; 1) This report includes five cases of severe(hemorrhagic in one case and necrotizing in four cases) acute pancreatitis,eight cases of pancreatic inury,three cases of pancreatic pseudocyst and three cases of chronic pancreatitis. 2)The most common etiology of benign pancreatic disease, excluding pancreatic injury, was alcohol ingestion. 3)Five cases of severe acute pancreatitis were represented with more than 4 of Ranson's prognostic factors and the surgical methods refered were external drainage with debridment or necrosectomy. All were effectively managed surgically except one case of death which had more than 6 of Ranson's prognostic factors. 4)The etiology of pancreatic injury was blunt abdominal trauma in seven cases and surgical complications in one case. The sites of injury were head in three cases,body in three cases and tail in one case. The operative methods used were drainage(all cases),distal pancreatectomy(3 cases),triple ostomy(1 case) and pancreaticoduodenectomy(1 case). 5)The sites of pancreatic pseudocysts were the body in two cases, head in one case. The operative method used was as follows; excision in one case, external drainage in one case and cystojejunostomy in one case. 6)Three cases of the chronic pancreatitis were diagnosed by intraoperative findings. 7)In conclusion, the most reliable treatment for benign pancreatic disease is early surgical intervention, in order to reduce the mortality rate and complications induced by pancreatic inflammation.
Busan ; Drainage ; Eating ; Head ; Humans ; Inflammation ; Mortality ; Pancreatic Diseases* ; Pancreatic Pseudocyst ; Pancreatitis ; Pancreatitis, Chronic ; Retrospective Studies

Suppression of cellular immunity is the host responses to surgical stress. When the body is exposed to surgical stress, decreased immunocyte function is one of the surgical stress-induced biologic responses. In all patients exposed to the surgical stress, peripheral blood lymphocyte numbers and function were suppressed until at least 2 weeks postoperatively. This immunosuppression was mainly due to a decrease of helper-inducer T cells, cytotoxic T cells, natural killer cells, and an increase of suppressor T cells. The blood levels of interleukin-6(IL-6) cytokine increase in response to surgical stress and cause an increase of so-called acute phase reactants, including C-reactive protein(CRP). In the previously damaged patients group, expected to early stress expose, immunosuppression was more developed than other normal groups. Cellular immunosuppression by surgical stress was mainly due to an increase of lymphocyte subsets that depress cellular immunity coupled with a decrease of the subsets that promote it. Overproduction of CRP in response to surgical stress may play an important role in the development of immunosuppression.
Acute-Phase Proteins ; Humans ; Immunity, Cellular ; Immunosuppression ; Interleukin-6 ; Killer Cells, Natural ; Lymphocyte Count ; Lymphocyte Subsets ; T-Lymphocytes

Schwann cell, one of important components of peripheral nervous system, interact with neurons to mutually support the growth and replication of embryonal nerves and to maintain the different functions of adult nerves. The Ara-C, known as an antimitotic agent, have been used to have high effectiveness in eliminating fibroblasts during Schwann cell culture period. This enrichment effect is also known to be cummulative with each successive pulse of Ara-C applied and is due to a progressive loss of fibroblasts. But the cytotoxicity by Ara-C is also cummulative and noticeable over the period. To determine the most effective application time and interval of Ara-C in the Schwann cell culture, we observed the Schwann cell purity and density with the Ara-C treatment in plain and three-dimensional culture from dorsal root ganglion of new born rat. By culturing dispersed dorsal root ganglia, we can repeatedly generate homogenous Schwann cells, and cellular morphology and cell count with mean percentages were evaluated in the plain culture dishes and in the immunostainings of S-100 and GFAP in the three-dimensional culture. The Ara-C treated cultures showed a higher Schwann cell percentage (31.0%+/-8.09% in P4 group to 65.5%+/-24.08% in P2 group), compared with that obtained in the abscence of Ara-C (17.6%+/-6.03%) in the plain culture after 2 weeks. And in the three-dimensional culture, S-100 positive cells increased to 56.22%+/-0.67% and GFAP positive cells to 66.46%+/-1.83% in G2 group (p<0.05), higher yield than other groups with Ara-C application. Therefore, we concluded that the Ara-C treatment is effective for the proliferation of Schwann cells contrast to the fibroblasts in vitro culture, and the first application after 24 hours from cell harvesting and subsequent 2 pulse treatment (P2 group in plain culture and G2 group in three-dimensional culture) was more effective than other application protocols.
Adult ; Animals ; Cell Count ; Cell Culture Techniques ; Cytarabine* ; Fibroblasts ; Ganglia, Spinal* ; Humans ; Neurons ; Peripheral Nervous System ; Rats* ; Schwann Cells ; Spinal Nerve Roots*

No abstract available.
CD4 Lymphocyte Count* ; Humans ; Oral Manifestations*

Chronic recurrent multifocal osteomyelitis (CRMO) is one of the most severe form of chronic non-bacterial osteomyelitis (CNO), which could result in bone and related tissue damage. This autoinflammatory bone disorder (ABD) is very difficult for its clinical diagnosis because of no diagnostic criteria or biomarkers. CRMO in the jaw must be suspected in the differential diagnosis of chronic and recurrent bone pain in the jaw, and a bone biopsy should be considered in chronic and relapsing bone pain with swelling that is unresponsive to treatment. The early diagnosis of CRMO in the jaw will prevent unnecessary and prolonged antibiotic usage or unnecessary surgical intervention. The updated researches for the identification of genetic and molecular alterations in CNO/CRMO should be studied more for its correct pathophysiological causes and proper treatment guidelines. Although our trial consisted of reporting items from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), there are very few articles of randomized controlled trials. This article was summarized based on the author's diverse clinical experiences. This paper reviews the clinical presentation of CNO/CRMO with its own pathogenesis, epidemiology, recent research studies, and general medications. Treatment and monitoring of the jaw are essential for the clear diagnosis and management of CNO/CRMO patients in the field of dentistry and maxillofacial surgery.
Biomarkers ; Biopsy ; Dentistry ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Epidemiology ; Humans ; Jaw ; Osteomyelitis ; Surgery, Oral