Bone Edges Research Articles

Triple square extended osteotomies for treatment of scaphocephaly (Renier's "H" technique modification).

Scaphocephaly is the most common single suture craniosynostosis. Surgical technique has evolved from simple strip craniectomy over π-procedures and vertex craniectomies to extensive cranial remodeling which is preferred procedure nowadays. The purpose of this paper is to present our modification of Renier's standard "H" technique and its preliminary results in detail. Eleven patients with scaphocephaly were surgically treated from January 2011 until January 2014. Only children with isolated sagittal synostosis were included in the study. Our modified Renier's technique reduces the possibility of lesion of superior sagittal sinus, dividing parietal bone in three bone fragments, thus achieving shortening of the scull in AP diameter without detaching the bone from the superior sagittal sinus. The possibility for potential secondary stenosis is minimized using extended V-shaped osteotomies with rounding of the bone edges, as well as making wide neocoronal and neolambdoid sutures. Cosmetic results were estimated as very pleasing immediately after surgery by both the parents and the surgeons in all cases. The majority of patients presented in our study were categorized as Sloan Class 1. Improvement or normalization of the cranial index was accomplished in all patients. No revision surgeries were required during the follow-up. Triple square extended osteotomies technique is a fast, simple, and efficient surgical option for children with sagittal synostosis and can be safely applied in the first months of life in children even under weight of 6kilos. Preliminary results are encouraging and deserve a longer follow-up and comparative surgical analysis to verify its usefulness in the future.

Copper accumulation in the sequestrum of medication-related osteonecrosis of the jaw

Bisphosphonates (BPs) have been widely, efficiently, and safely used for the treatment of various bone-related diseases such as osteoporosis. However, concerns about jaw osteonecrosis associated with oral treatment (medication-related osteonecrosis of the jaw [MRONJ]) have been increasing. Although many risk factors for MRONJ have been elucidated, its precise etiology and methods of prevention remain unknown. In this study, we have applied various elemental analysis methods for MRONJ specimens (e.g., X-ray fluorescence with synchrotron radiation [SR-XRF], particle-induced X-ray emission [PIXE], X-ray absorption fine structure [XAFS]) in order to reveal the accumulation and chemical state of trace bone minerals. In four MRONJ sequestra, the characteristic localization of copper (Cu) was observed by SR-XRF. Using micro-PIXE analysis, Cu looked to be localized near the edge of the trabecular bone. The chemical state of the accumulated Cu was estimated using XAFS and the possibility of a Cu–BP complex formation was assumed. Thus, in this study we argue for the feasibility of the trace element analysis to evaluate the potential pathophysiological mechanism of MRONJ.

Skeletal callus formation is a nerve-independent regenerative response to limb amputation in mice and Xenopus.

To clarify the mechanism of limb regeneration that differs between mammals (non‐regenerative) and amphibians (regenerative), responses to limb amputation and the accessory limb inducible surgery (accessory limb model, ALM) were compared between mice and Xenopus, focusing on the events leading to blastema formation. In both animals, cartilaginous calluses were formed around the cut edge of bones after limb amputation. They not only are morphologically similar but show other similarities, such as growth driven by undifferentiated cell proliferation and macrophage‐dependent and nerve‐independent induction. It appears that amputation callus formation is a common nerve‐independent regenerative response in mice and Xenopus. In contrast, the ALM revealed that the wound epithelium (WE) in Xenopus was innervated by many regenerating axons when a severed nerve ending was placed underneath it, whereas only a few axons were found within the WE in mice. Since nerves are involved in induction of the regeneration‐permissive WE in amphibians, whether or not nerves can interact with the WE might be one of the key processes separating successful nerve‐dependent blastema formation in Xenopus and failure in mice.

Real-time assessment of bone structure positions via ultrasound imaging

Computer-assisted orthopedic surgery allows clinicians to have better results and decreases the number of early prosthetic replacements. Nevertheless, the patient follow-up from pre-operative diagnosis to post-operative control cannot be assessed in a constant referential. In this paper, a real-time algorithm that extracts bone edges from images and, then, derives bony landmarks from these edges is proposed. Indeed, we assess in real-time the bone structure positions via ultrasound imaging to create a useful referential for pre-operative, intra-operative and post-operative measurements. To assist the clinician while acquiring bony anatomical landmarks, the extraction of the bone---soft tissue interface and bony landmarks from ultrasound images is done automatically. The experimentations were performed on a database of images from healthy volunteers, and the obtained results showed the efficiency and the stability of the performance of the proposed method.

Discrepancies in measuring acetabular coverage: revisiting the anterior and lateral center edge angles.

The lateral center edge angle (LCEA) and the anterior center edge angle (ACEA) are commonly used to assess acetabular coverage of the femoral head. There are two distinct methods found in the literature to obtain these angles, specifically, measuring to the most lateral bone edge versus the sclerotic lateral sourcil edge. A difference between these two methods may contribute to inconsistent estimates of acetabular coverage, and potentially lead to clinical misdiagnosis and treatment mismanagement. The objectives of this study were to quantify the difference between bone edge and sourcil edge measurements and to determine how the difference influences the classification of acetabular coverage in adult patients with suspected hip pathomorphology. Two observers completed the measurements independently using preoperative anteroposterior and false profile radiographs. Bland–Altman plots and paired t-tests were used to compare measurement methods. Bone and sourcil measurements of the LCEA and ACEA were significantly different (both P < 0.001). On average, the bone LCEA was 4° (95% limits of agreement = −2° to 10°) greater than the sourcil LCEA. The bone ACEA was, on average, 10° (95% limit of agreement = −2° to 22°) greater than the sourcil ACEA. The differences often led to different clinical classifications for the same hip. With a statistically and clinically significant difference in the quantification of acetabular coverage using bone edge versus sourcil edge methods for measuring the LCEA and ACEA in adult patients, it should be mandatory to clearly identify which method was used in each study.

Finite element analysis of stress distributions in mono- and bi-cortical dental implants.

The finite element analysis (FEA) of the stress distribution in the mono- and bicortically fixed implants subjected to 3-axial loading was performed and verified experimentally on a model mandible to evaluate the benefits of each type of fixation from the viewpoint of the compressive stress reduction in the cortical part of atrophied mandible. The analysis revealed that the highest compressive stresses in the cortical bone are generated at the edge of the cortical bone where the highest torque from the implant is acting. The most effective way to reduce the maximum level of compressive stresses in the cortical bone and in the implant is the recession of the implant thread slightly below the surface of the cortical bone. Shortening of the intraosseal length of the implant and/or thinning of the upper cortical bone result in a substantial increase of the maximum compressive stresses. The comparison of FEA and model experiments suggests that bicortical fixation is the most efficient in the fresh implants and the advantage of bicortical fixation compared to monocortical fixation decreases with time due to osteointegration, possibly as a result of gradual suppression of sliding between the bone and implant during loading.

BCL11B expression in intramembranous osteogenesis during murine craniofacial suture development

Sutures, where neighboring craniofacial bones are separated by undifferentiated mesenchyme, are major growth sites during craniofacial development. Pathologic fusion of bones within sutures occurs in a wide variety of craniosynostosis conditions and can result in dysmorphic craniofacial growth and secondary neurologic deficits. Our knowledge of the genes involved in suture formation is poor. Here we describe the novel expression pattern of the BCL11B transcription factor protein during murine embryonic craniofacial bone formation. We examined BCL11B protein expression at E14.5, E16.5, and E18.5 in 14 major craniofacial sutures of C57BL/6J mice. We found BCL11B expression to be associated with all intramembranous craniofacial bones examined. The most striking aspects of BCL11B expression were its high levels in suture mesenchyme and increasingly complementary expression with RUNX2 in differentiating osteoblasts during development. BCL11B was also expressed in mesenchyme at the non-sutural edges of intramembranous bones. No expression was seen in osteoblasts involved in endochondral ossification of the cartilaginous cranial base. BCL11B is expressed to potentially regulate the transition of mesenchymal differentiation and suture formation within craniofacial intramembranous bone.

Fibulin-1 is required for bone formation and Bmp-2-mediated induction of Osterix

The extracellular matrix protein Fibulin-1 (Fbln1) has been shown to be involved in numerous processes including cardiovascular and lung development. Here we have examined the role of Fbln1 in bone formation. Alizarin red staining of skulls from Fbln1-deficient mice showed reduced mineralization of both membranous and endochondral bones. MicroCT (μCT) analysis of the calvarial bones (i.e., frontal, parietal and interparietal bones collectively) indicated that bone volume in Fbln1 nulls at neonatal stage P0 were reduced by 22% (p=0.015). Similarly, Fbln1 null frontal bones showed a 16% (p=0.035) decrease in bone volume, with a reduction in the interfrontal bone, and a discontinuity in the leading edge of the frontal bone. To determine whether Fbln1 played a role in osteoblast differentiation during bone formation, qPCR was used to measure the effects of Fbln1 deficiency on the expression of Osterix (Osx), a transcription factor essential for osteoblast differentiation. This analysis demonstrated that Osx mRNA was significantly reduced in Fbln1-deficient calvarial bones at developmental stages E16.5 (p=0.049) and E17.5 (p=0.022). Furthermore, the ability of Bmp-2 to induce Osx expression was significantly diminished in Fbln1-deficient mouse embryo fibroblasts. Together, these findings indicate that Fbln1 is a new positive modulator of the formation of membranous bone and endochondral bone in the skull, acting as a positive regulator of Bmp signaling.

The effect of nutritional rickets on bone mineral density.

Nutritional rickets is caused by impaired mineralization of growing bone. The effect of nutritional rickets on areal bone mineral density (aBMD) has not been established. Our objective was to determine if aBMD is lower in children with active rickets than in healthy control children. We expected that the reduction in aBMD would vary between the radial and ulnar metaphyses near the growth plates and the proximal diaphyses. Case-control study. Primary care outpatient department of a teaching hospital in Jos, Nigeria. Nigerian children with radiographically-confirmed rickets were compared with a reference group of control children without rickets from the same community. Forearm bone density measurements were performed in all children with pDXA. Age, sex, and height-adjusted bone density parameters were compared between children with rickets and control subjects. A total of 264 children with active rickets (ages 13-120 months) and 660 control children (ages 11-123 months) were included. In multivariate analyses controlling for height, age, and gender, rickets was associated with a 4% greater bone area and 7% lower aBMD of the radial and ulnar metaphyses compared with controls (P < .001). The effects of rickets on the diaphyses of the radius and ulna were more pronounced with an 11% greater bone area, 21% lower aBMD, and 24% lower bone mineral apparent density than controls (P < .001). In children with rickets, aBMD values were unrelated to dairy product intake or serum calcium, phosphorus, alkaline phosphatase, or 25-hydroxyvitamin D. Metaphyseal aBMD was positively associated with radiographic severity score, attributed to bone edge detection artifact by densitometry in active rickets. Rickets results in increased bone area and reduced aBMD, which are more pronounced in the diaphyseal than in the metaphyseal regions of the radius and ulna, consistent with secondary hyperparathyroidism, generalized osteoid expansion and impaired mineralization.

Influence of MRI-based bone outline definition errors on external radiotherapy dose calculation accuracy in heterogeneous pseudo-CT images of prostate cancer patients

Background. This work evaluates influences of susceptibility-induced bone outline shift and perturbations, and bone segmentation errors on external radiotherapy dose calculation accuracy in magnetic resonance imaging (MRI)-based pseudo-computed tomography (CT) images of the male pelvis.Material and methods. T1/T2*-weighted fast gradient echo, T1-weighted spin echo and T2-weighted fast spin echo images were used in bone detection investigation. Bone edge location and bone diameter in MRI were evaluated by comparing those in the images with actual physical measurements of fresh deer bones positioned in a gelatine phantom. Dose calculation accuracy in pseudo-CT images was investigated for 15 prostate cancer patients. Bone outlines in T1/T2*-weighted images were contoured and additional segmentation errors were simulated by expanding and contracting the bone contours with 1 mm spacing. Heterogeneous pseudo-CT images were constructed by adopting a technique transforming the MRI intensity values into Hounsfield units with separate conversion models within and outside of bone segment.Results. Bone edges and diameter in the phantom were illustrated correctly within a 1 mm-pixel size in MRI. Each 1 mm-sized systematic error in bone segment resulted in roughly 0.4% change to the prostate dose level in the pseudo-CT images. The prostate average (range) dose levels in pseudo-CT images with additional systematic bone segmentation errors of −2 mm, 0 mm and 2 mm were 0.5% (−0.5–1.4%), −0.2% (−1.0–0.7%), and −0.9% (−1.8–0.0%) compared to those in CT images, respectively, in volumetric modulated arc therapy treatment plans calculated by Monte Carlo algorithm.Conclusions. Susceptibility-induced bone outline shift and perturbations do not result in substantial uncertainty for MRI-based dose calculation. Dose consistency of 2% can be achieved reliably for the prostate if heterogeneous pseudo-CT images are constructed with ≤± 2 mm systematic error in bone segment.

Evaluation of results of maxillary sinus lifting surgeries using Resorbable synthetic hydroxyapatite

AIM: This study aims to evaluate the results of 10 cases of maxillary sinus lifting using synthetic resorbable hydroxyapatite (osteogen ®) as a filling material. MATERIAL AND METHODS: The surgeries were performed in patients who presented bone resorption in this region. The results were compared radiographically six months after the surgery through initial and final radiographs analysis. RESULTS: The vertical bone height gain was on average 1200.4%, when compared to the initial bone edge. CONCLUSION: The formation of bone tissue in that region had made possible future prosthetic rehabilitation.

Resorption of Autogenous Bone Graft in Cranioplasty: Resorption and Reintegration Failure.

ObjectiveRe-implantation of autologous skull bone has been known to be difficult because of its propensity for resorption. Moreover, the structural characteristics of the area of the defect cannot tolerate physiologic loading, which is an important factor for graft healing. This paper describes our experiences and results with cranioplasty following decompressive craniectomy using autologous bone flaps.MethodsIn an institutional review, the authors identified 18 patients (11 male and 7 female) in whom autologous cranioplasty was performed after decompressive craniectomy from January 2008 to December 2011. We examined the age, reasons for craniectomy, size of the skull defect, presence of bony resorption, and postoperative complications.ResultsPostoperative bone resorption occurred in eight cases (44.4%). Among them, two experienced symptomatic breakdown of the autologous bone graft that required a second operation to reconstruct the skull contour using porous polyethylene implant (Medpor®). The incidence of bone resorption was more common in the pediatric group and in those with large cranial defects (>120 cm2). No significant correlation was found with sex, reasons for craniectomy, and cryopreservation period.ConclusionThe use of autologous bone flap for reconstruction of a skull defect after decompressive craniectomy is a quick and cost-effective method. But, the resorption rate was greater in children and in patients with large skull defects. As a result, we suggest compressive force of the tightened scalp, young age, large skull defect, the gap between bone flap and bone edge and heat sterilization of autologous bone as risk factors for bone resorption.

Towards Multiple 3D Bone Surface Identification and Reconstruction Using Few 2D X-Ray Images for Intraoperative Applications

This article discusses a possible method to use a small number, e.g. 5, of conventional 2D X-ray images to reconstruct multiple 3D bone surfaces intraoperatively. Each bone's edge contours in X-ray images are automatically identified. Sparse 3D landmark points of each bone are automatically reconstructed by pairing the 2D X-ray images. The reconstructed landmark point distribution on a surface is approximately optimal covering main characteristics of the surface. A statistical shape model, dense point distribution model (DPDM), is then used to fit the reconstructed optimal landmarks vertices to reconstruct a full surface of each bone separately. The reconstructed surfaces can then be visualised and manipulated by surgeons or used by surgical robotic systems.

Technical considerations and outcome assessment in retrogasserian balloon compression for treatment of trigeminal neuralgia. Series of 901 patients.

Background:The aim of our study was to describe the retrogasserian balloon compression (RGBC) procedure with some personal tricks and to assess the long-term results.Methods:Between 1985 and 2012, 901 patients, suffering from refractory trigeminal neuralgia (TN), underwent RGBC procedure in our department. Concerning the surgical technique, the introducer was in close contact with the posterior extremity of the horizontal plate of the palatine bone and had the direction of the bisector of the angle clivus-superior edge of the petrous bone on an X-rays sagittal view. No metallic material was inserted intracranially. The balloon was inflated with 0.7 cc of contrast medium for 6 min.Results:At 1 month follow up, appreciable pain relief was obtained in 835 patients (92.7%). At 1 year, results were excellent in 605 patients (67.1%), satisfactory in 109 patients (12.1%), poor in 57 patients (6.3%), fair in 66 patients (7.3%), whereas recurrences were observed in the remaining 64 patients (7.2%). At mean follow up of 16,5 years, 559 (62%) patients remained pain free. Twenty six patients (2,8%) continued to experience severe pain. Recurrences occurred in two hundred and fifty patients (27,8%). Fifty two of them were operated on a third time and 22 underwent four procedures.Conclusion:RGBC is an appropriate and effective procedure for treatment of refractory TN, ensuring a long lasting pain relief predicted on three factors: pear shape of the balloon, its volume, and duration as mentioned earlier.

Study of Jugular Foramen – A Case Report

The jugular foramen at the base of the skull varies in shape and size the foramen lies at the petrous part of temporal bone and behind by the occipital bone. It's irregular in shape. Usually the right foramen is larger than the left. The variation in the foramen is observed in different racial group and sexes. The shape and size of foramen is inversely related to size of sigmoid sinus. Petrosal portion contains the inferior petrosal sinus. Sigmoid portion receives the sigmoid sinus. Intrajugular portion contains cranial nerves IX, X and XI. AIM: To analyze the length and width of jugular foramen. To determine the side dominance of the foramen. MATERIALS AND METHODS: A total of 32 jugular foramen in dry adult skulls from Department of Anatomy, CHRI were used for the present study. Sagittal and transverse diameters were measured using digital vernier caliper. OBSERVATIONS: The overall dimensions of Jugular foramen were recorded on both sides. The mean transverse diameter (width) on the right and the left side were 11.779mm and 10.901mm respectively. The mean sagittal diameter (length) on the right and left side were 10.141mm and 09.025mm. In 62.5% of cases the right foramen was larger , in 37.5% of cases left foramen was larger than the right. Dome was found bilaterally in 50% of cases, The unilateral presence of dome was equally distributed to both sides. Jugular process was found bilaterally in 18.75%, right side 31.25% and left side in 18.75% of cases. The process was absent in 31.25% cases. Complete Septation of the foramen was found in 12.5% on right side, 6.25% on left side. Partial Septation was seen in 87.5% on right side, in 93.74% on left side. CONCLUSION: In comparison with the previous studies, the width of the Jugular foramen is slightly higher where as the length is slightly lower. There is an increase in the occurrence of bony partition compared to the previous study. Dimension, dome and Septation were significantly higher on right side than on left. Jugular foramen serves as an important land mark during surgeries of posterior cranial fossa. I. Introduction In anatomical, a foramen is considered as opening. Foraminae transmits nerves, arteries, veins, or other structures to connect one part of the body with another part. The human skull has numerous foramina through which cranial nerves, & vessels and other structure pass. The skull bones contain foraminae that include the frontal, ethmoid, sphenoid, maxilla, palatine, temporal and occipital. There are 21 foramina present in all of the major bones of the skull. Jugular foramen is a passage or fissure between the petrous part of the temporal bone and the jugular process of the occipital bone, sometimes divided into two by the intrajugular processes. Jugular fossa contains the junction of the largest sigmoid sinus and internal jugular vein. Inferior petrosal sinus, glossopharyngeal nerve, vagus nerve, accessory nerve, meningeal branches of the ascending pharyngeal and occipital arteries are the structures passing through this foramen. The jugular foramen is a complex bony canal, which transmits vessels and nerves from the posterior cranial fossa through the base of the skull into the carotid space. According to Quain's Elements of Anatomy, the jugular foramen is described as being divided into three compartments. The anterior part is sometimes completely separated by a bony spicule (Intrajugular process).According to Cunningham's, the edge of the occipital bone forms a jugular notch and the petrous part of temporal bone is excavated to from a jugular fossa, which accommodates the superior bulb of jugular vein. According to Gray's anatomy lower border of jugular foramen are smooth and upper border sharp and notched. The margins of notch extend and divided in to three compartments. The larger size of right jugular foramen accounts to the superior sagittal sinus draining into the right transverse sinus. But there is a very wide variation in the anatomy of the intracranial venous sinuses which accounts for variation in size and shape of jugular foramina. Complete division of the foramen by a bony septum is comparatively rare. In some cases the foramen was found to be divided into three compartments. Incomplete bony Septation, which in life is probably completed by cartilage. In syndrome of the jugular foramen (Vernet's syndrome), there is paralysis of the 9th, 10 th and 11th cranial nerves. These, along with paralysis of the 12th cranial nerve (Villaret's syndrome), occur with a retropharyngeal lesion of the posterior cranial fossa. Patients

Congenital Dehiscence in the Posterior Semicircular Canal

Posterior semicircular canal dehiscence (PSCD) may be of congenital origin. PSCD is characterized by the lack of bone coverage, which results in its lumen being exposed to the meninges of the posterior cranial fossa or to the gulf of the jugular vein. It has an incidence of 0.2%. Its presence has been associated with several well-defined entities, although a congenital origin has not been proven. We have analyzed, from a macroscopic, microscopic, and radiologic (computed tomography) viewpoint, the right temporal bone of a 32-week-old human fetus that presented a defect in the bone coverage located in the rear. The macroscopic study showed a solution of continuity in the posterior semicircular canal, with elliptic morphology and smooth edges. This defect was 3.4 mm long with a width that varied between 0.67 mm in its apical portion and 1.42 in the basal portion. The radiologic study (computed tomography) showed the absence of bone coverage of the posterior semicircular canal, which was open to the intracranial space in the posterior fossa. Its histologic study showed good bone coverage of this canal at the expense of compact bone tissue. However, at the medial end, there is a lack of bone coverage, resulting in the lumen of the canal being open to the intracranial space. The bone edges of the defect did not present any osteoclast activity. The lack of bone coverage (dehiscence) of the posterior semicircular canal in a 32-week-old fetus suggests a congenital component of bony dehiscences of this canal. Even so, this single finding does not conclusively prove the congenital component, and the dehiscence is a finding that can be part of and not by itself a syndrome.

C‐reactive protein and leucocyte counts drop faster using the HeartShield® device in patients with DSWI

Right ventricular heart rupture is a devastating complication associated with negative pressure wound therapy (NPWT) in cardiac surgery. The use of a rigid barrier disc (HeartShield™) has been suggested to offer protection against this lethal complication by preventing the heart from being drawn up by the negative pressure and damaged by the sharp sternum bone edges. Seven patients treated with conventional NPWT and seven patients treated with NPWT with a protective barrier disc (HeartShield) were compared with regard to bacterial clearance and infection parameters including C-reactive protein levels and leucocyte counts. C-reactive protein levels and leucocyte counts dropped faster and bacterial clearance occurred earlier in the HeartShield® group compared with the conventional NPWT group. Negative biopsy cultures were shown after 3·1 ± 0·4 NPWT dressing changes in the HeartShield group, and after 5·4 ± 0·6 NPWT dressing changes in the conventional NPWT group (P < 0·001). All patients were followed up with clinical check-up after 3 months. None of the patients in the HeartShield group had any signs of reinfection such as deep sternal wound infection (DSWI) or sternal fistulas, whereas in the conventional NPWT group, two patients had signs of sternal fistulas that demanded hospitalisation. HeartShield hinders the right ventricle to come into contact with the sharp sternal edges during NPWT and thereby protects from heart damage. This study shows that using HeartShield is beneficial in treating patients with DSWI. Improved wound healing by HeartShield may be a result of the efficient drainage of wound effluents from the thoracic cavity.

1845 COMPARISON OF PELVIC ANATOMY AFTER CHILDBIRTH AND MENOPAUSE TO BEFORE CHILDBIRTH USING PELVIC MRI. AND NALYSIS OF PREDICTORS OF CYSTOCELE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology (II)1 Apr 20131845 COMPARISON OF PELVIC ANATOMY AFTER CHILDBIRTH AND MENOPAUSE TO BEFORE CHILDBIRTH USING PELVIC MRI. AND NALYSIS OF PREDICTORS OF CYSTOCELE Mitsuharu Iwasaki, Nobuhiro Haga, Junya Hata, Yuuichi Satoh, Kouji Sagawa, Norio Takahashi, and Yoshiyuki Kojima Mitsuharu IwasakiMitsuharu Iwasaki Fukushima, Japan More articles by this author , Nobuhiro HagaNobuhiro Haga Fukushima, Japan More articles by this author , Junya HataJunya Hata Fukushima, Japan More articles by this author , Yuuichi SatohYuuichi Satoh Fukushima, Japan More articles by this author , Kouji SagawaKouji Sagawa Fukushima, Japan More articles by this author , Norio TakahashiNorio Takahashi Fukushima, Japan More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima Fukushima, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2264AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We measured various parameters representing the levator ani muscle and pelvic morphology from MRI images of Japanese female pelvis to clarify the changes due to aging and childbirth. Finally we analyzed statistically relevance to occurrence of cystocele and its grade. METHODS As levator ani muscle parameters, we measured levator ani muscle volume and the levator hiatus longitudinal and transverse diameter from MRI. As pelvic morphology parameters, we measured the distance between the ischium, pubic arch angle, the distance of obstetrical conjugate, and the distance between lower edge of the pubic bone and coccyx from MRI. Using these data, we compared the differences between the three groups, postmenopausal parous women with cystocele:GROUP1 (n= 29), postmenopausal parous women without cystocele:GROUP2 (n=26), and young nulliparous women:GROUP3 (n= 26). Furthermore, in addition to the Body Mass Index we analyzed the predictors of occurrence of cystocele and its grade. RESULTS Volume decrease of levator ani muscle and the increase in levator hiatus longitudinal and transverse diameter thought to be due to childbirth and aging was observed. It was thought the levator ani muscle volume reduction and increased levator hiatus transverse diameter were the risk factor for cystocele occurrence and its grade. Pelvic morphology and Body Mass Index, was not involved in the cystocele occurrence and its grade. CONCLUSIONS In Japanese women, it was found that the levator ani muscle volume reduction and increased levator hiatus transverse diameter were the risk factor for cystocele occurrence and its grade. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e757-e758 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitsuharu Iwasaki Fukushima, Japan More articles by this author Nobuhiro Haga Fukushima, Japan More articles by this author Junya Hata Fukushima, Japan More articles by this author Yuuichi Satoh Fukushima, Japan More articles by this author Kouji Sagawa Fukushima, Japan More articles by this author Norio Takahashi Fukushima, Japan More articles by this author Yoshiyuki Kojima Fukushima, Japan More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Zygomatic Distraction Osteogenesis for Correction of Midfacial Support After Hemimaxillectomy: Experience and Technical Considerations

The maxilla is the functional and esthetic keystone of the midface, and large maxillary defects remain a challenge for reconstructive surgery. Different regional and microvascularized flaps have been used to restore the hemimaxilla. Distraction osteogenesis offers an alternative to complex flaps, with less donor-site morbidity. This method is also preferable as a secondary reconstruction in cases of serious bone defects where other flaps have failed. Four patients with maxillary defects after oncologic ablation presented at a mean follow-up period of 36 months (standard deviation, 18 mo). In these patients, transport distraction osteogenesis of the zygoma was used to restore the bony support of the low maxilla. After a latency period of 15 days, distraction began at a rate of 0.5 mm/day. A 2-step distraction, by changing the direction of the zygomatic device, was carried out in 3 cases. After a consolidation period of 4 to 6 months for each distraction, the devices were removed and the bone edges were joined together with an autogenous bone graft (anterior iliac crest and calvaria). A good quality of bone was observed in the distracted gap, which allowed for postoperative dental implant placement and prosthetic rehabilitation. In patients with large maxillary defects in which the remaining bone is insufficient and in patients in whom other reconstructive methods have failed, zygomatic distraction is an excellent option to restore the low projection of the maxilla. Bone transport was found to be a stable reconstructive method that allowed for the restoration of function and esthetics in oncologic patients.

A new method of segmentation of compact-appearing, transitional and trabecular compartments and quantification of cortical porosity from high resolution peripheral quantitative computed tomographic images

A transitional or cortico-trabecular junctional zone exists at any location composed of both cortical and trabecular bones such as the metaphyses of tubular bones and short bones like the femoral neck. The transitional zone comprises the inner cortex adjacent to the medullary canal and trabeculae abutting against the cortex contiguous with the endocortical surface. This is a site of vigorous remodeling. Intracortical remodeling cavitates the inner cortex expanding this transitional zone at the price of compact-appearing cortex so that it contains porosity, cortical fragments that resemble trabeculae, and trabeculae abutting the eroding cortex. The porosity of the transitional zone is an important source of bone loss. It reduces bone strength exponentially and is a quantifiable `fingerprint' of structural deterioration.A new automated method of segmentation of bone from background and bone into its compact-appearing cortex, transitional zone, and trabecular compartment is described, with a new approach to quantification of cortical porosity. Segmentation is achieved by automatically selecting attenuation profile curves perpendicular to the periosteal surface. Local bone edges are identified as the beginning and the end of the rising and falling S-shaped portions of the curve enabling the delineation of the compartments. Analyzing ~3600 consecutive overlapping profiles around the perimeter of each cross-sectional slice segments the compartments.Porosity is quantified as the average void volume fraction of all voxels within each compartment. To assess accuracy at the distal radius and tibia, μCT images of cadaveric specimens imaged at 19μm voxel size served as the gold standard. To assess accuracy at the proximal femur, scanning electron microscopy (SEM) images of specimens collected at 2.5μm resolution served as the gold standard.Agreement between HRpQCT and the gold standards for segmentation and quantification of porosity at the distal radius and tibia ranged from R2=0.87 to 0.99, and for the proximal femur ranged from 0.93 to 0.99. The precision error in vivo for segmentation and quantification of porosity in HRpQCT images at the distal radius, given by the root mean square error of the coefficient of variation, ranged from 0.54% for porosity of the transitional zone to 3.98% for area of the compact-appearing cortex.Segmentation of the transitional zone minimizes errors in apportioning cortical fragments and cortical porosity to the medullary compartment and so is likely to allow accurate assessment of fracture risk and the morphological effects of growth, aging, diseases and therapies.