Piece Of Bone Research Articles

Classification and Management of Failed Fixation of the Volar Marginal Fragment in Distal Radius Fractures.

Greater understanding of specific fracture patterns following distal radius fractures has arisen with the advent of volar plating. The volar marginal fragment (VMF) is a small peripheral piece of bone which is critical to carpal stability. Failure to achieve good fixation of the VMF can result in volar subluxation of the carpus and distal radioulnar joint instability. Due to its small, distal nature, this fragment can be easily missed and difficult to fix. Loss of reduction of the VMF following operative fixation presents specific challenges and surgical considerations dictated by patient characteristics and timing. Our goal of this review is to present a classification system for these failed VMFs which can help guide surgical treatment as well as expected outcomes.

Treatment of Bone Marrow Cancer Based on Model Predictive Control

Bone marrow is a spongy tissue that contains stem cells that are found inside some bones, including the hip and femur. Bone marrow cancer is a type of cancer that is caused by stem cells that make up the blood cells in the bone marrow. Sometimes these cells grow too fast or abnormally, which is called bone marrow cancer. Bone tissue cells are mainly composed of osteoblasts and osteoclasts. Osteoblast cells constantly build new bone throughout the life of each bone, and other cells called osteoclasts constantly absorb pieces of bone, so the bone is constantly being renewed. In this paper, mathematical models of tumors, the effect of the body on the drug, and the drug on the body are introduced, and then the appropriate dose of the drug to reduce tumor density is calculated using the model predictive control (MPC) algorithm. To obtain an adaptive MPC strategy, the extended least squares (ELS) method developed to learn the parameters of the tumor growth model is used. Finally, the simulation in MATLAB, assuming the model is correct, shows that the tumor is gone, and the bone mass improves over a period of time. The results demonstrate that the proposed method is effective for the treatment of bone marrow cancer.

Innovation Technology on Catfish Fillet By-Product as Raw Materials for Food Industry

Kampar Regency is one of the national catfish cultivation development clusters, and there are many catfish processing industries, especially fish fillet processing. The processing of catfish fillets always left by-products in the form of small pieces of meat, skin, bones, and abdominal fat, which amounts to around 50% – 60%. The by- products are mostly disposed to the environment around the industry, causing pungent odor pollution, as the byproducts contain protein, fat, minerals and crude enzymes which are suitable habitat for the growth of spoilage microbes. Therefore, it is very possible for these by-products to be processed further in order to obtain new products in the form of industrial raw materials that have economic added value. The objectives of this research are (1) Optimizing the utilization of by-products from fish fillet processing starch into raw materials for food industry that have economic value; and (2) understanding the characteristics of organoleptic quality and the proximate composition of the food industry raw materials produced. The research method used is an experimental method, namely experiments on processing by-products into raw materials for the food industry in the form of fish meal, fish oil and bone meal. The results showed that the number of by-products produced from processing the catfish fillets was arround 60% with, consisted of head, tailbone and fins by 37%, small pieces of meat 5%, viscera 10% and abdominal fat 8%. Furthermore, that raw materials having organoleptic quality and proximate composition that meet the SNI standards.

Forensic investigation of a hunting incident of Indian porcupine (Hystrix indica) in Uttarakhand: A study to help rein in biodiversity loss

Across the world, hunting is one of the main causes of the decline in populations of wild vertebrates. This activity has serious effects not only on the specific, target populations but also on the dynamics and structures of other animal populations. Often the only evidence available for successful prosecution of poachers is in the form of small pieces of skin, bone, and meat. In such cases, forensic investigations can irrefutably establish the identity of the species involved in the illegal hunting by using genetic technologies. This articles describes an investigative study in a suspected wildlife hunting incident in which molecular biology techniques were employed to identify the species involved. Using fragments of cytochrome b (Cyt b) and 12S ribosomal RNA (12S rRNA) mitochondrial markers, the samples were confirmed to be from an IUCN Red List species, the Indian porcupine (Hystrix indica).This is the first genetic record of an Indian porcupine from the Uttarakhand population. The genetic analysis in this study was suitable for diagnosing the species and concluding a criminal investigation. Molecular forensic techniques can, therefore, provide an important tool that enables local law enforcement agencies to apprehend poachers. Meanwhile the present study represents a small step in reducing the hunting of porcupine in Uttarakhand as well as other adjoining states, with the aim of conserving biodiversity.

Different Cleaning Techniques for Removal of Iron stain from Archaeological Bone Artifacts: A Review

Archaeological bone artifacts are found in different locations in Egypt, and they represent multiple values that should be preserved from different deterioration factors. Iron contamination is considered one of the most aspects of deterioration for bones extracted from excavation areas. This study aims to make an integrated study for the first time on the formation of iron rust stain on archaeological bones, explain the aspects and mechanism of its deterioration, explain traditional and advanced techniques of cleaning used for stain removal, and presents the analysis and investigations used to explain the deterioration or evaluate the materials and methods used in this process. The nature and formation of iron stain and its effect on archaeological bone components were explained. The cleaning techniques (mechanical, chemical, laser, and plasma) for removing it were discussed. Some analyses and investigations [such as different types of microscopes, X-ray fluorescence, Atomic absorption, Fourier Transform Infrared (FTIR) spectroscopy, etc.] that can be used in this process were mentioned. The results confirmed that iron is present within sediments can lead to the breakdown of collagen. It can cause an increase in the porosity of bone artifacts. Hydroxyapatite can undergo alterations such as ionic exchange, cationic exchange, and substitution of phosphate with carbonate. All cleaning techniques have many advantages and some disadvantages. The choice of method for cleaning of iron rust stain depends on the condition and size of the bone piece, and on the thickness and nature of the iron stain.

Organotypic in vitro block culture model to investigate tissue-implant interface. An experimental study on pig mandible

In vitro studies of implant-tissue attachment are primarily based on two-dimensional cell culture models, which fail to replicate the three-dimensional native human oral mucosal tissue completely. Thus, the present study aimed to describe a novel tissue culture model using pig mandibular block including alveolar bone and gingival soft tissues to evaluate the tissue attachment to titanium implant provided with hydrothermally induced TiO2 coating. Tissue attachment on TiO2 coated and non-coated implants were compared. Ti-6Al-4V alloy posts were used to function as implants that were inserted in five pig mandibles. Implants were delivered with two different surface treatments, non-coated (NC) titanium and hydrothermal induced TiO2 coated surfaces (HT). The tissue-implant specimens were cultured at an air/liquid interface for 7 and 14 days. The tissue-implant interface was analyzed by histological and immunohistochemical stainings. The microscopic evaluation suggests that pig tissue explants established soft and hard tissue attachment to both implant surfaces. The epithelial cells appeared to attach to the coated implant. The epithelium adjacent to the implant abutment starts to change its phenotype during the early days of the healing process. New bone formation was seen within small pieces of bone in close contact with the coated implant. In conclusion, this in vitro model maintains the viability of pig tissue and allows histologically and immunohistochemically evaluate the tissue-implant interface. HT-induced TiO2 coating seems to have a favorable tissue response. Moreover, this organotypic tissue culture model is applicable for further studies with quantitative parameters to evaluate adhesion molecules present at the implant-tissue interface.

Entrapment of the Brachial Artery Following Supracondylar Fracture Reduction: A Case Report

Background: Supracondylar fractures of the humerus are common elbow fractures in children. Supracondylar fractures have two subtypes: flexion, which makes up less than 2% of all such fractures, and extension, which makes up more than 98% of supracondylar fracture of the humerus. Supracondylar fractures of the humerus can develop vascular and neurological complications, either following the fracture itself due to the detached pieces of bone or after reduction or K-wire fixation therapy. The most common complication is damage to the brachial artery. Case Presentation: Our patient is a healthy 7-year-old right dominant boy who sustained a Gartland type III fracture following a fall and was admitted to the Emergency Ward. At first, a weak pulse was detected in the distal part of the right upper extremity. After the reduction using 2 K-wires, the distal pulse of the limb became undetectable. Vascular examination revealed that the adventitia of the brachial artery was trapped between the condyle parts. The artery was then released, and the distal pulse returned. Conclusions: This case shows that although entrapment and pulling of the adventitia of the brachial artery between the condyles of the humerus following a supracondylar fracture is a rare occurrence, it can happen in this type of fracture. After reduction using K-wires percutaneously, a neurovascular examination in all cases of supracondylar fractures is necessary. In supracondylar fractures with pink pulseless limbs, immediate arterial exploration can achieve a markedly better outcome than simply monitoring.

Tinbl:bein fra middelalderens Lund

A small piece of a tubular sheepbone (length: 6,5 cm, diameter: 2 cm) was found in 1961 during an archaeological excavation of the medieval town of Lund. The artefact is contextually dated to the second half of the eleventh century. The bone piece is provided with finely carved teeth and carries an inscription in runes. The identification of each rune character is uncomplicated. The inscription says: tinbl:bein. The second sequence bein represents the noun Rune Danish bæin, Old Danish bēn ‘bone’ in all probability with reference to the piece itself and it is plausible that the inscription forms a compound designating the utensil in question, but which utensil? The difficult task is to interpret tinbl? The first suggestion by the late runologist, Erik Moltke, related the runes to the noun Rune Danish tæinn, Old Danish tēn ‘spindle’ and alternatively, to the noun and verb Old Danish twinnæ ‘a twine/to twine’ suggesting the artefact being a utensil for twining threads together, i.e. a twining-bone. Erik Moltkes suggestions seem neither linguistically nor technically convincing. The bone piece was a unique find in 1961, but now a number of similar archaeological artefacts seem to constitute a whole group. In this article, I suggest that the sequence tinbl reflects the noun Old English timple known as a loan word in post-medieval Nordic languages. The present day English form is temple and the present day Danish form is tempel and the word designates an implement used in weaving. Consequently, the runic object must be a temple-bone (Old Danish *timpelbēn) an end-piece of a primitive medieval temple.

The surface-dwelling from layer I of Mira site: Main features and interpretations

Situated in Dnieper valley, in the central part of continental Ukraine, the site of Mira yields two well-preserved Palaeolithic occupation levels, possessing features of true living floors. The uppermost layer I, presenting remains of autumn-winter seasonal occupation, is dated to between 32,000 and 31,000cal BP. Layer I contains EUP assemblage combining the technological and morphological features of local Middle and Upper Palaeolithic. Layer I includes many various objects, like pits, postholes, hearths, bone and ashes accumulations etc. Remains of sub-circular surface-dwelling construction with an area of about 14.5 m2 were recognised in the uppermost layer due to numerous postholes and specific characteristics of the living floor. Micro-stratigraphic and spatial features recognise two distinct construction elements, namely the external irregular spherical contour and the inscribed slightly asymmetrical rectangular contour. An entrance, associated with four ashy lenses of likely smoke hearths, was recognised oriented east-wards toward a current river channel. This outer, close to the entrance, zone of construction contains numerous flints, in particular, flint tools, thousands tiny debris and waste-flakes of tool resharpening and reshaping, as well as bone ornaments and ornamented bone pieces, and also a fragment of a human molar. On the contrary, the practically free lithics though containing plenty of burned organic material, the back part of the construction, likely separated from the outer zone by a special partition, was seemingly served as a sleeping zone. It is possible to conclude about the recovery of remains of permanent carcass surface cylindrical dwelling that found analogies in ethnographical records. Keeping in mind the age and geographical position, we deal with the earliest instance of complicate surface-dwelling construction currently known in the steppe area of the East European plain.

Single-Cell Analysis of Mesenchymal Stem Cells Reveals Their Molecular and Functional Heterogeneity in Myeloma

IntroductionBone marrow (BM) mesenchymal stem cells (MSCs) are rare but heterogeneous cell populations, and both MSCs and their lineages mediate BM niches, hematopoiesis, and myeloma (MM) growth.The aim of the study was to assess variation in gene expression of unexpanded single MSCs generated from the same source, and study the heterogeneous effect on MM cell growth of MSCs lines generated from single MSCs or normal MSCs primed by MM cells. We also studied changes in MSCs during MM progression and identified MSC factors that mediate MM growth.MethodsCells collected from bone pieces following enzymatic digestion were cultured for 2-4 days. The adherent cells were trypsinized, replated to separate MSCs from macrophages and allowed to adhere overnight. Cells were then trypsinized and single MSCs were sorted into 96-well plates. Validation of single cell sorting and viability was assessed microscopically by staining for CFSE.Single MSCs were generated from two normal samples and two MM patients. Sorted single cells were subjected to qRT-PCR using primers of 34 genes implicated in MSC biology (e.g. CD73), cell cycle (e.g. KI67, CDKN2A), differentiation (e.g. RUNX2, PPARG, CYR61), transcription (e.g. FOXC1), and specific MSC genes we identified to be top overexpressed (e.g. POSTN) or underexpressed (e.g. IGFBP2, LEPR) in bone biopsy samples from high-risk MM patients. Also included were CD45 and CD34 to exclude hematopoietic cells, and GAPDH and ACTB as housekeeping genes. After excluding CD45+ cells and cells with low expression of housekeeping genes a total of 111 and 104 single MSCs from normal and MM subjects, respectively, were analyzed. Single MSCs expressed typical MSC markers such as CD73, CD90, FN1 and FAP.For generating MSC lines from the same source, single MSCs from each source were subjected to long-term culture supplemented with CM from whole BM and MSC cultures.For preparing primed MSCs, normal MSCs generated by standard method were cultured alones (unprimed MSCs) or cocultured with MM cells for 5 days (primed MSCs).The cultured and co-cultured cells were trypsinized, replated for 40 min followed by serial washing that attain >95% purified adherent MSCs. Primed and unprimed MSCs were subjected to gene expression profiling (GEP) and their CM used for proteomics and growth assays.ResultsSingle MSCs from the same source (i.e. normal and MM bones) heterogeneously expressed genes related to cell cycle, differentiation, and extracellular matrix. MM single MSCs had lower expression of markers of proliferation (e.g. KI67, p<0.005) and differentiation (e.g. RUNX2, p<0.03), and higher expression of the senescence marker CDKN2A (p<0.001).To further capture MSC heterogeneity, MSCs lines were generated from single MSCs and tested for their ability to support MM cells. Growth of individual MSCs varied in culture, most had a limited proliferation rate, and few were capable of generating MSC lines. MSC lines generated from the same source (4-10 lines from normal or MM subjects) had variable effects on growth of MM cells in co-cultures, or when their CM used on MM cell grown alone (p<0.0008 between lowest to highest growth stimulating lines).CM from primed MSCs stimulated the growth of primary MM cells compared to CM from unprimed MSCs in short-term culture (n=10, p<0.007) or 10-days co-couture with normal MSCs (n=6, p<0.002).Primed MM cells had reduced expression and secretion of factors related to the IGF1 pathways including IGFBP2, IGFBP3 and IGF2, whereas IGF1 was not impacted. Recombinant IGF1 promoted growth of BM-dependent MM cells in serum-free conditions, an effect that was significantly blocked by recombinant IGFBP2 (p<0.0003).IGFBP2 expression by GEP was lower in biopsy samples from MM patients (n=531) than normal subjects (n=68), lower in samples from high-risk than low-risk patients, and lower in focal lesion than random BM biopsies from the same patients (n=77). Immunohistochemistry showed high IGFBP2 protein expression by BM mesenchymal cells, particularly, small adipocytes, and changes in the proportion of IGFBP2+ cells correlated with the reduced gene expression in MM patients' biopsies, and with disease stage.ConclusionsThese findings suggest that MSCs from normal subjects and MM patients are heterogeneous population of cells, are deregulated as part of MM disease progression, and that production of factors such as IGFBP2 by these cells impacts bioavailability of IGF1. DisclosuresDavies:Bristol-Myers: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Morgan:Takeda: Consultancy, Honoraria; Celgene: Consultancy, Honoraria, Research Funding; Bristol Myers: Consultancy, Honoraria.

Post-traumatic cerebrospinal fluid rhinorrhea and Transcranial approach surgical outcomes.

Objective: To assess the outcomes of the transcranial approach in traumatic cerebrospinal fluid rhinorrhea. Study Design: Descriptive study. Setting: J.P.M.C, Karachi. Period: 15-1-2017 to 17-7- 2019. Material &amp; Method: Total of 57 patient were included. Including criteria were patient with a history of trauma, fall, assault, and delayed onset, however, patients presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhea, brain abscess, brain space-occupying lesion, skull base surgery operated elsewhere were excluded. fasia lata, Pericranial flaps were used for the surgical repair. Data were analyzed on SPSS version 22.0. Result: Patients gone through the surgical approach having intradural repair in all patients, 25 (43.85%) patients with fasia lata graft while pericranium in 32 (56.1%) and the defect was filled with small bone pieces. In 38(66.6%) unilateral sub frontal approach was done while in 19 patients (33.3 %%) bicoronal craniotomy was carried out. All patient had dura defected, 37 patients (64.9%) had a fractured cribriform plate, 9 (15%) patient had fovea ethmoidal fracture. 30(52.63%) had right side leak, 20 had left side leak (35%), 7(12.28%) had bilateral from both nasals leakage. No reoperation was done. 93% procedure showed successfully. Conclusions: This method is effective with the low rate of morbidity in patients, it can be preferred for traumatic cerebrospinal fluid (CSF) leaks with the injuries associated with the brain, recurrent leak cases with a success rate of &gt; 93%

Evaluating bacterial contamination of free bone fragments falling to the ground and the effectiveness of antiseptic solutions.

This study aims to determine the contamination incidence rate of bone fragments that have been dropped on the floor of the operating theatre, as well as how effective antimicrobial solutions are at decontaminating them. Bone fragments obtained after 30 total knee arthroplasties were used in the study. Inert pieces of bone emerging after the bone cuts during total knee arthroplasty were divided into 1 × 1cm fragments. The bone fragments were first left in free fall on the floor of the operating theatre and then were kept in a number of antimicrobial solutions for 15s. Subsequently, they were microbiologically and histopathologically examined. A swab culture was also taken from the floor of the operating theatre. It was determined that 63.3% of osteochondral fragments in the non-intervened group were contaminated. Growth was likewise detected in all swab cultures. Microorganisms growing in the swab culture and the non-intervened group were similar and mostly Staphylococcus epidermidis and Klebsiella pneumoniae. When the growth rates of the 10% povidone-iodine and 4% chlorhexidine gluconate groups were compared with the growth rate of the non-intervened group, a statistical difference was found. No difference was determined between the growth rates of the sodium hypochlorite and the non-intervened groups. The histopathological analysis revealed no statistical difference between the groups in terms of bone marrow, vascular structure, fat tissue, and osteoblastic activity results in the osteochondral fragments CONCLUSION: Bone tissues dropped from a sterile area on the floor of the operating theatre are highly contaminated. An effective decontamination without bone cell toxicity was achieved using povidone-iodine. Although chlorhexidine gluconate solution had an effective decontamination effect compared to the non-intervened group, it was not 100% effective. Sodium hypochlorite solution was not effective in the decontamination of grafts under our working conditions.

The Element of Paaw in Marsupials and the Ear Region of Philander opossum (Linnaeus, 1758) (Didelphimorphia, Didelphidae)

A small piece of cartilage or bone, the element of Paaw, occurs in the tendon of the stapedius muscle in some extant marsupial and placental mammals. It has been nearly a century since the last comprehensive treatment of the distribution of the element of Paaw in mammals. The current report updates knowledge on this structure by synthesizing the subsequent literature and providing new observations of extant marsupials from the collections of the Section of Mammals, Carnegie Museum of Natural History, and two online resources for CT scanned data: DigiMorph.org and MorphoSource.org. We found an element of Paaw in some representatives of all seven extant marsupial orders: Didelphimorphia, Microbiotheria, Notoryctemorphia, Peramelemorphia, Paucituberculata, Dasyuromorphia, and Diprotodontia. In the first four orders, the element is substantial, longer than the long axis of the fenestra vestiuli (oval window), which holds the stapedial footplate; it is smaller than the long axis of the fenestra vestibuli in Paucituberculata and we do not have measures to report for the last two orders. In most marsupials examined, the element of Paaw contacts the petrosal behind the oval window, suggesting it functions as a sesamoid bone, increasing the lever arm of the stapedius muscle. Although there is some variability in the presence of the bone both between and within individual museum specimens, we interpret this as the result of preparation techniques rather than true variation.To place the element of Paaw in its anatomical context, we describe in detail the ear region and middle-ear auditory apparatus of the gray four-eyed opossum, Philander opossum (Linnaeus, 1758), a didelphid from Central and South America, based on a CT scanned specimen from Carnegie Museum of Natural History. It has an ossified element of Paaw with a volume greater than the stapes. Comparisons are made with petrosals of Didelphis marsupialisLinnaeus, 1758, and Monodelphis domestica (Wagner, 1842), also based on CT scanned specimens.

Botulism in dogs: A clinical case study

Botulism is a rare and fatal disease of humans and animals caused by the bacterium Clostridium botulinum that produces the botulinum toxin responsible for flaccid paralysis. The present case study discusses about the clinical signs, diagnostic evaluation and therapeutic outcome of carrion associated botulism in dogs. A total of eight dogs were presented with signs of dysphagia, regurgitation, incoordination in gait and recumbency in some cases after feeding with poultry abattoir waste. Radiographic findings revealed megaesophagus with ingested bone pieces in stomach of five dogs. Based on the clinical signs, anamnestic data, and radiographic findings the cases were tentatively diagnosed as carrion botulism and was successfully managed.

Evaluation of Cortical Bone Microdamage and Primary Stability of Orthodontic Miniscrew Using a Human Bone Analogue.

Orthodontic miniscrews have gained popularity; however, they have some drawbacks, including screw loosening that results from bone resorption caused by excess microdamage created during screw insertion. Pilot hole preparation through the cortical bone is considered beneficial to avoid such microdamage, while an overly large pilot hole impairs primary stability. Hence, we used a human bone analogue to evaluate the microdamage and primary stability to estimate the optimal pilot hole size that would minimize the screw loosening risk. Ti6Al4V orthodontic miniscrews and 1.0-mm-thick synthetic cortical bone pieces were prepared. Various compressive loads were applied in indentation tests to test pieces’ surfaces, and the microdamaged areas were confirmed as stress-whitening zones. Screw insertion tests were performed in which a miniscrew was inserted into the test pieces’ pilot hole with a diameter of 0.7–1.2 mm in 0.1-mm intervals, and the stress-whitening area was measured. The insertion and removal torque were also measured to evaluate primary stability. The stress-whitening areas of the 1.0–1.2 mm pilot hole diameter groups were significantly smaller than those of the other groups (p < 0.05), whereas the 0.9 and 1.0 mm pilot hole diameter groups showed higher primary stability than other groups. In conclusion, the bone analogue could be utilized to evaluate microdamage in cortical bones and the primary stability of miniscrews.

Micro-Raman spectroscopy of Shang oracle bone inscriptions

Oracle bone inscriptions (OBI) refers to graphs engraved on scapulae and turtle shells as part of divination practice in Shang dynasty (ca. 1600–1050 BCE). Hundreds of thousands of oracle bones have been unearthed at Anyang, Henan, the last capital of Shang dynasty, during the last century. OBI represents not only the earliest known Chinese writing but also the oldest extant documents about Shang history. Here we employed a non-invasive micro-Raman spectroscopy to investigate the composition of pigments found in the grooves of OBI graphs on 48 pieces of shells and bones. Among the 86 graphs we analyzed, 37 contained cinnabar, 7 contained hematite, 3 contained both cinnabar and hematite, and 1 contained goethite. Another 37 graphs contained carbon black, and 1 contained graphite. The sensitivity of micro-Raman allows us to identify OBI coloration even if the color has faded and not visible. Thus, micro-Raman analysis would allow us to restore the original coloration pattern of OBI graphs as the Shang diviner applied three thousand years ago. The extensive use of red and black coloration for OBI is consistent with the dichotomy nature of the positive and negative charge as imposed by the diviners. The restoration of original coloration will be essential for relating the coloration with other divination parameters such as crack numerals, crack notations, and the content of OBI inscriptions. Such correlation will help us to understand the function of coloration and its role in Shang divination.

Foreign body (bone piece) perforating into anterior abdominal wall presenting as rectus sheath abscess

Foreign body (bone piece) perforating into anterior abdominal wall presenting as rectus sheath abscess

Artificial expansion of the narrow pelvis

Frank, director of the obstetric institute in Cologne, performed in 1894 on a patient who, due to a narrow pelvis, underwent symphysiotomy and who could hardly walk due to nonunion of the pubic articulation, a secondary operation, and he refreshed the articular surfaces of the joint and inserted a piece of bone taken between them them together with a skin flap from the right horizontal branch of the pubic bone.

Diagnostic Performance and Radiation Dose of the EOS System to Image Enchondromatosis: A Phantom Study

Background: Radiation doses and capability of EOS, conventional radiography (CR), and computed tomography (CT) to detect and measure enchondromas in a dedicated five-year-old anthropomorphic phantom were compared. Methods: To simulate enchondromas, minced pieces of chicken bone and cartilage were packed in conventional kitchen plastic foil to create ovoidal/rounded masses and randomly hung on the phantom. The phantom was imaged five times with CR, CT, and EOS, each time changing the number and position of inserts. All images were reviewed by a senior radiologist and a radiology resident. Results: EOS and CR detected all inserts in 4/5 cases (80%), while in one case 1/17 inserts was not seen. Excellent agreement of EOS with CR (88% reproducibility; bias = 14 mm; repeatability coefficient (CoR) 2.9; 95% CI from −2.8 to 3.1 mm; p = 0.5) and CT (81% reproducibility; bias = 15 mm; CoR 5.2; 95% CI from −5.5 to 5.2 mm; p = 0.7) was found. EOS showed 71% interobserver reproducibility (CoR 7.2; bias = 0.6 mm; 95% CI from −6.6 to 7.8 mm; p = 0.25). The EOS-Fast radiation dose was also significantly lower than the median radiation dose of CR (644.7 (599.4–651.97) mGy•cm2, p = 0.004). Conclusions: Low-dose EOS has the same capability as CR to detect and measure enchondroma-like inserts on a phantom and may be considered to monitor patients with multiple enchondromas.

Aggressive resection of craniopharyngioma achieved by drilling the tuberculum sellae/planum sphenoidale using a frontal basal interhemispheric approach: A review of 55 cases

ObjectiveThe frontal basal interhemispheric approach (FBIA) is preferable for resection of craniopharyngioma (CP), achieving desirable total resection rates in early reports of lesions located in the suprasellar region to the third ventricle. For tumours that have created a larger obstruction of the tuberculum sellae and planum sphenoidale, aggressive resection in the intrasellar region and medial wall of the cavernous sinus is not feasible compared to improving tumour visualization by drilling the tuberculum sellae and planum sphenoidale. In a report of drilling the sellar tuberculum and sphenoid planum, drilling allowed the direct visualization of tumours invading the intrasellar region and medial wall of the cavernous sinus. Reconstructing the opening of the sellar-sphenoid cavity is achieved by microsuturing a piece of the pericranium/dura around the dural edge of the defective dura of the open sphenoid sinus and sellar cavity to prevent cerebrospinal fluid (CSF) leakage. Patients and methodsThe FBIA with drilling of the tuberculum sellae and planum sphenoidale was performed to remove the tumours that invaded the intrasellar region and cavernous sinus in 55 patients from January 2014 to October 2019 at our institution. The pre- and postoperative pituitary hormone levels and vision were evaluated as effective standards after surgery and compared using paired t-tests. The different rates of CSF leakage between the packing and microsuture groups were compared by χ2 test, p < 0.05. ResultsIn all patients with a mean 37-month follow-up (range, 3–2 months), 43 (78.2%) patients returned to their normal life or school independently, 7 (12.7%) patients were able to perform normal activities with minor complaints or effort, and 4 (7.3%) patients could care for themselves or only required occasional assistance. One (1.8%) death occurred, attributed to CSF leak-related meningitis at 5 months after surgery. Postoperative CSF leakage occurred in eight (19.0%) of 42 patients with packed bone wax or pieces of muscle to the sphenoid sinus. Of 13 patients with a piece of the periosteum/dura microsutured around the defective dura of the sellar region and open sphenoid sinus, one (7.7%) of 13 patients experienced CSF leakage in the perioperative period. With statistical analysis, there was a potential risk for postoperative CSF leakage in the bone wax and muscle piece in the open sphenoid sinus, whereas microsuture manoeuvres were effective for avoiding the risk of postoperative CSF leakage (χ2 = 8.865, p < 0.005). The microsutures closed the open sphenoid sinus such that it was water-tight. Postoperative visual acuity and the visual field were not affected by the increased intrasellar exposure or the open sphenoid sinus achieved by drilling the tuberculum sellae and planum sphenoidale. ConclusionTuberculum sellae/planum sphenoidale drilling via FBIA is feasible to enhance the direct visualization of CP resection, which expands the intrasellar region with a direct resection of recurrent tumours in the sellar cavity and adhering to the medial wall of the cavernous sinus. The potential risk of a CSF leakage seemed to be mitigated when using water-tight microsutures on a piece of the pericranium/dura around the edge of the defective dura in the sellar region and the open sphenoid sinus cavity.