Double Barrel Research Articles

Free Revascularized Fibula Graft for Reconstruction of Mandibular Continuity Defects

Mandibular reconstruction represents a challenge to the oral and maxillofacial surgeon and has been revolutionized by the modern microvascular techniques Objective: To evaluate the usefulness of the free vascularized fibula graft for reconstruction of discontinuity defects of Mandible after resections of benign aggressive odontogenic tumours. The results of 7 vascularized free fibula graft without a skin paddle that were used for mandibular reconstruction is presented. The "double barrel" technique was used in 1 case. The donor site was closed directly in all cases. All procedures were performed by the same surgical team in oral and Maxillofacial Surgery department of BSMMU and Health & Hope Hospital from January, 2006 to December 2011. A total of patients (3 males, 4 females) were treated. All flaps except 1 were viable. Success rate was 85.71% .The average length of the fibula graft was 10.96 cm, and the number of osteotomies ranged from 0 to 3. There were no long-term functional complications in the lower leg. The fibula flap provides a successful bone graft for mandibular restoration with an acceptably low complication rate. DOI: http://dx.doi.org/10.3329/bmj.v41i1.18782 Bangladesh Medical Journal 2012 Vol. 41 No. 1; 45-49

Detection of Single Crystal Facets of Pt Ultramicroelectrode: Application of Ohmic Microscopy

Analyses of spatially-resolved ohmic microscopy measurements,1,2,3 using a polycrystalline Pt disk electrode embedded in an insulating surface were found to yield quantitative agreement between theory and experiment. Our efforts are currently being focused toward assessing the spatial resolution of this technique by employing facetted Pt single crystal facets grown on ultra-small platinum electrodes. The ohmic response, which represents a direct measure of the current flowing through a small area of the electrode, has confirmed the presence of individual facets on the Pt single crystal bead with clear Pt (111) and (100) orientation. EXPERIMENTAL The facetted Pt single crystal microelectrode (ca. 150 μm in diameter) used for these measurements was grown following the method reported by Komanicky and Fawcett.4 Double barrel capillaries were pulled to a diameter of ca. 5µm for each barrel, and filled with an aqueous 0.1 M H2SO4 solution. Microreference (μ-ref) Ag/AgCl electrodes were made by inserting two Ag wires coated with a layer of AgCl (0.125 mm in diameter) formed by dipping the wire in a saturated KCl aqueous solution for at least 12 h. The μ-ref Ag/AgCl electrodes and Pt UME were mounted on individual holders connected in turn to individual micromanipulators. Once the tips of μ-ref electrodes were placed in close vicinity of a Pt single crystal facet, cyclic voltammetric curves were recorded using a potentiostat (Autolab, PGSTAT302N, Nova 1.6, Metrohm). The time response of the potential difference between the two μ-ref electrodes, denoted as, Δφsol, amplified 100 times (Ina131, Texas instrument), was recorded on a digital multimeter (Keithley 3706 System Switch/Multimeter) using the Labview platform. RESULTS AND DISCUSSIONShown in Figure 1 (upper panel) is the cyclic voltammogram of the facetted Pt single crystal in 0.1M H2SO4 recorded at a scan rate ν = 10V/s displaying a hydrogen adsorption|desorption region characteristic of polycrystalline Pt in this electrolyte. Close inspection of the voltammogram at more positive potentials revealed the presence of two small peaks centered at about 0.45 V vs RHE which are unique to the (111) surface. Significant differences were observed in the Δφsol vs E curves recorded simultaneously (see black curve in lower panel, Fig. 1) where the features associated with the (111) face can be clearly discerned based on a comparison with the voltammogram of a genuine Pt(111) electrode (see red curve in lower panel, Fig1).. Similar conclusions could be drawn from data collected with the μ-ref electrodes placed in the center of the Pt(100) facet. In that case, however, the Δφsol vs E curves displayed in addition to a peak unique to Pt(100), a prominent feature associated with Pt(100) steps. Efforts are now underway to solve Laplace’s equation for this type of facetted electrode to gain insight into the actual spatial resolution of ohmic microscopy in its present state of development and in particular the effect of neighboring regions on the recorded signal. Acknowledgements This work was supported by a Grant from NSF. Reference C. A. Cartier, D. Kumsa, Z. Feng, H. Zhu, D. A. Scherson, Anal.Chem. 84 (2012), 7080Y. Chen , A. Belianinov, D. A. Scherson, J. phy. Chem. C, 112 (2008), 8754M. Ignatowitz, E. Oesterschulze, Applied physics letters, 101 (2012), 251601V. Komanicky, W. Ronald Fawcett, J. Electroanal. Chemistry, 556 (2003) 109J.M. Feliu, J.M. Orts, R Gómez, A. Aldaz, J. Clavilier J. Electroanal. Chem 372(1994),265

A double barrel for perfect results

A double barrel for perfect results

Successful outside-the-stent stenting for an occluded primary stented superficial femoral artery

A 61-year-old man with in-stent occlusion of the superficial femoral artery (SFA) underwent the endovascular therapy using a subintimal technique. The wire was intentionally advanced into the subintimal space next to the occluded stent in the SFA, and a stent was implanted in a double barrel fashion outside of the in-stent occlusion site. The procedure was performed without any complications and with the successful angiographic and intravascular ultrasound imaging results. At 1-year follow-up, the patient still had no leg complaints and the stent was still shown as patent. The procedure might be a useful technique when the recanalization was proved impossible after several attempts to recanalize the primary occluded stent in the SFA.

Double barrel fibula flap with dental rehabilitation for mandibular reconstruction

Purpose: The vascularized free fibula flap (VFFF) has become the popular reconstruction method after mandibular resection due to advantages of enough bone graft length and accepting dental implants. However, using a single fibula bone may have height discrepancy between the native mandible and grafted fibula which results in subsequent difficulty in wearing conventional dentures or osseintegrated implants. Several options could be used to resolve this problem such as delayed onlay bone graft, iliac bone reconstruction, fibula distraction and double barrel fibula flap graft. This article describes our experience in reconstruction of segmental mandible defect with double barrel fibula flap and denture rehabilitation.

Use of the ‘double barrel’ free vascularized fibula in mandibular reconstruction

Use of the ‘double barrel’ free vascularized fibula in mandibular reconstruction

Double barrel vascularized fibula graft in mandibular reconstruction: a 10-year experience with an algorithm

Double barrel vascularized fibula graft in mandibular reconstruction: a 10-year experience with an algorithm

The NYU Experience With Free Fibula Reconstruction of the Mandible Utilizing Virtual Surgical Planning

Statement of the Problem: The use of free osseous flaps has become the gold standard for reconstruction of complex mandibular defects. Popularized by Hidalgo in 1989, the free fibula transfer has become the operation of choice for these indications. While this operation has become routine; contouring of the flap using wedge osteotomies, as well as its inset remain operator dependent and imprecise. At our institution we have attempted to make this process more uniform and reproducible through the use of virtual planning and pre-fabricated cutting jigs. We have previously reported our experience on computer-aided design and manufacturing; however the purpose of this study was to review our series of free fibula mandibular reconstructions using these adjunctive technologies. Methods: Prior to surgery all patients underwent CT scanning of the face and bilateral lower extremities. These images were then transmitted to an outside vendor. In consultation with both the ablative and reconstructive teams, a surgical plan was devised and performed virtually, cutting jigs for both creation of themandibular defect and for fibular osteotomies were fabricated, and a stereolithicmodel that allows for precise pre-surgical bendingof a reconstructionplatewas created. The rest of the surgical procedure was performed in standard fashion. Following IRB approval, all cases between 2009 and 2012were identified and retrospectively reviewed. In addition to patient demographics, the charts were reviewed for surgical indications, microvascular anastomoses, use of a skin paddle, use of a ‘‘double barrel’’, timing of dental implant placement (immediate versus delayed), and timing of dental prosthetic rehabilitation (immediate versus delayed). Methods of Data Analysis: This was a retrospective chart review from 2009 to the present. Fifty-four reconstructionswere identified ashavingundergonepresurgical virtual planning and subsequent surgery formandibular reconstruction with microvascular free fibula transfer. Patient demographics and case variables were analyzed. Results: Fifty-four reconstructions were performed in 52 patients. Patients were evenly divided between a private, university affiliated medical center and a large county hospital. The most common indications were ma-

OP031: Double barrel vascularized fibula graft in mandibular reconstruction: A 10-year experience with an algorithm

This retrospective study aims to report an algorithm to assist surgeons in selecting different modes of the double barrel vascularized fibula graft for mandibular reconstruction. Forty-five patients who underwent reconstruction of mandibular defects with different modes of the double barrel vascularized fibula graft were reviewed. Our algorithm for deciding on any one of the different modes for different mandibular defects is influenced by the factors including history of radiotherapy, the length of mandibular body defect, and the need to preserve the inferior mandibular border. Postoperative functional outcomes included diet type and speech, and aesthetic results gained at post-operative 2 years. Patients with implant-borne prosthetic teeth underwent assessment of their masticatory function. There were four modes of mandibular reconstruction according to our algorithm, which included double barrel vascularized fibula graft ( n = 21), partial double barrel fibula graft ( n = 11), condylar prosthesis in combination with partial/double barrel fibula graft ( n = 11), and double barrel fibula onlay graft ( n = 2). Flap survival in all patients was 97.78%. Good occlusion, bony unions and wound closures were observed in 44 patients. Eleven patients received dental implantation in the transplanted fibula at post-operative 9–18th months. One patient wore removal partial dentures. For 11 patients with implant-borne prosthetic teeth, the average postoperative ipsilateral occlusal force was 41.5 ± 17.7% of the contralateral force. Good functional and aesthetic results were achieved in 38 patients with more than 2 years follow-up, including regular diet, normal speech and excellent or good appearance, especially for patients with dental rehabilitation. Good aesthetic and functional results can be achieved after dental rehabilitation by following our algorithm when choosing the different modes of double barrel vascularized fibula graft for mandibular reconstruction.

OP032: What can fibula flap do in jaw reconstruction?

Part A 3-D model simulation and reconstruction of composite total maxillectomy defects with fibula osteomyocutaneous flap flow-through from radial forearm flap 3-Dimensional model simulation technique and free fibula osteomyocutaneous flap flow-through from radial forearm flap were used to reconstruct a total maxillectomy defect for a 21-years-old female patient. Preoperatively, the 3-dimensional simulated resin models of skeleton and fibula were used to design. In surgery, a 22-cm length free fibula was divided into four segments to make skeletal framework as surgical planning with a radial forearm flap flow-through for the free fibula flap with the skin paddle to repair the palatal and nasal region. Free fibula and radial forearm flap were alive, and the patient was satisfied with the results both aesthetically and functionally due to dental rehabilitation which was carried out 6 months postoperatively. This preliminarily clinical study and case demonstrated the fibula osteomyocutaneous flap is an ideal donor site in total maxillectomy defect reconstruction; the flow-through forearm radial flap not only serves as the vascular bridge to midface reconstruction, but also provides sufficient soft tissue cover for the intra-oral defect. Part B Double barrel fibula free flap with second-staged dental implants for mandibular reconstruction. The aim of this study was to evaluate the method for segmental mandibular reconstruction using double-barrel fibular flap with second-staged dental implant-supported prosthetic rehabilitation. 5 patients (2 gingival carcinomas, 2 ameloblastomas and 1 keratocyst) had undergone segmental mandibulectomy with 6–9 cm defect length. After tumor resection, double barrel fibula osteomyocutaneous flaps were used to reconstruct the mandible. All the flaps were alive with no complications post-operatively. Follow-up at 6 months showed good osteo-integration in panoramic radiograph and esthetic facial appearance. The patients underwent second-stage implants 8 months after fibula transplantation and implant-supported prosthesis was installed 1–2 months later to complete teeth rehabilitation.

Ileal duplication cyst associated with segmental ileal stenosis and neonatal perforation

A prenatally diagnosed terminal ileal duplication cyst associated with prenatal segmental mesenteric vascular thrombosis, ileal stenosis and proximal ileal perforation presenting in the neonatal period with bilious vomiting secondary to obstruction and perforation proximal to the segmental ileal stenosis in the proximal ileum has been reported. Plain X-ray, ultrasound scans and contrast studies were helpful in diagnosis. She underwent exploratory laparotomy, resection of terminal ileal duplication cyst with end-to-end anastomosis, resection of perforated stenotic proximal ileal segment with double barrel ileostomy formation uneventfully. She had staged closure of ileostomy and recovered well.

Characterizing the buckling behavior of cylindrical hollow and hybrid specimens by experimental upsetting tests

In the research of the compound forging of steel-aluminum parts mostly the upsetting test is used. In this paper the factors influencing the buckling behavior during the upsetting of mono hollow cylinders and hybrid steel-aluminum specimens are examined and characterized by two parameters. The buckle ratio is used as a measurement for the uniformity of the part geometry in radial direction and the buckle distance provides information about the part geometry in axial direction. The results gained by the upsetting of hollow cylinders show that the reproducibility depends on the wall thickness of the hollow steel cylinder. Above a forming temperature of T = 750 °C a transformation from mode II (double barrel profile) to mode I (single barrel profile) occurs. Furthermore, it could be shown, that the strain rate has no influence on the buckling behavior in both the upsetting of hollow cylinders as well as the upsetting of hybrid specimens. The results gained by the upsetting of hybrid steel aluminum specimens show that with increasing forming temperature the hybrid specimens with a wall thickness of the steel casing of s = 1 mm form more homogeneously in radial direction. In addition the scatter of the results decreases with increasing forming temperature.

The development of cerebral amyloid angiopathy in cerebral vessels. A review with illustrations based upon own investigated post mortem cases

The process of β-amyloid accumulation in cerebral vessels is presented. Cerebral amyloid angiopathy (CAA) was confirmed during an autopsy. It was diagnosed according to the Boston criteria. Cerebral amyloid angiopathy can involve all kinds of cerebral vessels (cortical and leptomeningeal arterioles, capillaries and veins). The development of CAA is a progressive process. β-amyloid appears first in the tunica media, surrounding smooth muscle cells, and in the adventitia. β-amyloid is progressively accumulated, causing a gradual loss of smooth muscle cells in the vessel wall and finally replacing them. Then, the detachment and delamination of the outer part of the tunica media results in the "double barrel" appearance, fibrinoid necrosis, and microaneurysm formation. Microbleeding with perivascular deposition of erythrocytes and blood breakdown products can also occur. β-amyloid can also be deposited in the surrounding of the affected vessels of the brain parenchyma, known as "dysphoric CAA". Ultrastructurally, when deposits of amyloid fibers were localized in or outside the arteriolar wall, the degenerating vascular smooth muscle cells were observed. In the Institute of Psychiatry and Neurology the study was carried out in a group of 48 patients who died due to intracerebral hemorrhage caused by sporadic CAA.

1P265 ダブルバレルカーボンプローブを用いた組織モデルからのmRNA回収と定量評価(21A. ゲノム生物学:ゲノム解析,ポスター,日本生物物理学会年会第51回(2013年度))

1P265 ダブルバレルカーボンプローブを用いた組織モデルからのmRNA回収と定量評価(21A. ゲノム生物学:ゲノム解析,ポスター,日本生物物理学会年会第51回(2013年度))

Managing the Iliac-caval Confluence in Iliac Vein Stenting.

Iliac vein stenoses are often located right at the junction with vena cava and may actually involve the vena cava itself in about 10% of cases. Iliac vein stent extension into the inferior vena cava is required in both instances to avoid local migration and recurrence. This raises concerns regarding jailing the contralateral iliac vein flow and poses problems with simultaneous or sequential contralateral stenting, which is necessary in about 20% of cases. ‘Double barrel’, fenestration, or end-to-side techniques in bilateral stenting have technical obstacles that may prevent successful stenting or lead to poor outcome.

Research for Automatic Forecasting System of Weighting Rainfall Recorder

In order to solve the problem of siphon rainfall recorder’s hard to control automaticly and the measurement error when siphoning, we research the Automatic forecasting system based on double barrel double siphon rainfall recorder and ARM processing terminal. By using double barrel double siphon structure and weighing cell, we eliminate the rainfall error caused by siphon loss, and achieve the automatic collection of rainfall data.

Intestinal tuberculosis complicated with perforation during anti-tuberculous treatment in a 13-year-old girl with defective mitogen-induced IL-12 production

Interleukin-12 (IL-12) is a cytokine which is secreted by activated phagocytes and dendritic cells and promotes cell-mediated immunity to intracellular pathogens, by inducing type 1 helper T cell (TH1) responses and interferon- γ (IFN- γ) production. Defects in the IL-12 may cause selective susceptibility to intracellular pathogens, such as mycobacteria. We herein report on a 13-year-old girl with defective mitogen-induced IL-12 production, who developed intestinal tuberculosis with wide dissemination involving the lung and urinary tract. She improved gradually, but developed terminal ileal perforation approximately 6.1 months following initiation of anti-tuberculous treatment. The paradoxical response phenomenon was suspected. The girl subsequently underwent surgical resection of the affected bowel segment with a temporary double barrel stoma, and ileocolonic anastomosis was performed after the completion of the anti-tuberculous therapy. The patient remained well, with no evidence of recurrent tuberculosis in the past 5 years. This case illustrates the possibility of underlying primary immunodeficiency in a patient with disseminated tuberculosis; delayed tuberculous intestinal perforation can develop during chemotherapy for tuberculosis.

A case of esophageal complication in epidermolysis bulhosa simplex

It is well known the involvement of the gastrointestinal tract in Epidermolysis Bulhosa (EB) and its consequences on both nutrition and growth. We present a case of a young girl with EB diagnosed soon after birth, admitted to our emergency room with food impactation. The endoscopy revealed a double barrel esophagus. No medical or surgical therapy was started and after 2 months of enteric feeding, spontaneous resolution was observed at endoscopy. Skin biopsy was compatible with EB Simplex. According to the literature EB Simplex is the subtype the least associated with GI tract involvement, presenting with dysphagia in only 2% of the patients, and with the lowest cumulative risk of esophageal stricturing. ConclusionWe present an unusual case of EB simplex involvement of the esophagus with spontaneous resolution of a false lumen, with clinical improvement of the patient.

Efficacy of Acacia senegal for Stoma Care in Children with Colostomy

The creation of a stoma on the abdomen and the need for appliance on the peristomal skin make this region vulnerable to inflammatory skin disorders. In this study, we introduce a novel protection with Acacia senegal and compare the protective effects of this barrier with zinc sulfate ointment. To examine the effect of protective interventions, a prospective, controlled, clinical study was conducted. Participants were all infants consecutively admitted to the pediatric surgery unit of the study hospitals for elective surgery of colostomy creation. After laparotomy and double barrel colostomy creation, patients were randomly assigned to use one barrier (gum acacia or zinc sulfate ointment) for 4 weeks. In this study, a total of 60 infants (30 as case and 30 as control) were evaluated. Results showed that there was a statistically significant difference in peristomal skin inflammation rate in groups; infants who had Acacia senegal barrier showed lower and less sever inflammation rates (p=0.05). Compared with zinc oxide, we found a lower rate of dermatitis in the Acacia group.

Investigation of the Benefits of Application of Earthquake Action on the Design of Double Layer Barrel Vaults

Space structures are generally light and rich in redundancy. These two characteristics caused this assumption for a while that these structures are aseismic. However, some events like Kobe 1995 earthquake, Japan, showed that although the space structures are safer than ordinary structures, but are not aseismic. A lot of research based on the seismic behavior of the space structures are carried out since then [1, 2, 3 and 4], however few of the is lead to practical results. Sadeghi in 2004 have established some formula for assessing the equivalent static earthquake action on the double layer barrel vaults. In the current work, those formulae are considered in the design of six double layer barrel vaults with different rise to span ratios and support conditions. Then the seismic behavior of these double layer barrel vaults are compared with corresponding barrel vaults which are designed without considering the seismic actions. To do this, the finite element package of ANSYS is utilized. The results show that these formulae are practically useful and versatile and application of them on the barrel vaults improves the structures' seismic safety significantly.