論文

Oculopharyngodistal myopathy is an extremely rare disease characterised by slowly progressive blepharoptosis, facial and bulbar muscle weakness and distal leg myopathy. We report the case of a 72-year-old woman with severe bilateral blepharoptosis and facial palsy caused by oculopharyngodistal myopathy that was present for more than 29 years. The condition was successfully treated by simple surgical intervention.

Rupture of the Achilles tendon is a very common trauma. Reconstruction of a chronic Achilles tendon defect is challenging for reconstructive surgeons, and several methods have been described. The ideal reconstruction would result in the patients resuming the activity level they were accustomed to before the injury. In our patient, the Achilles tendon was reconstructed using the gracilis muscle flap, and the flap was fixed using a fragment of the tibial bone, yielding satisfactory results. In this report, we describe this procedure employed and provide a description of the case.

Distraction osteogenesis is now a standard procedure for hemifacial microsomia, and various methods have been described. However, it is sometimes difficult to obtain the horizontal occlusal plane and facial symmetry. This brief communication describes and discusses the usefulness of solid model simulation surgery for hemifacial microsomia.

Some case reports described the usage of bone cement mixed with antibiotics. However, there are few studies that referred to experimental research of calcium phosphate cement with antibiotics. Thus, we mixed vancomycin and amikacin with bone cement in various concentrations and examined its characterization and antibacterial activity. As a result, 6.25 wt% over the concentration could not mix with cement. With an increase in the antibiotic content, the hardening time was prolonged and the compressive strength tended to decrease. In consistency, vancomycin mixed cement increased, whereas amikacin mixed cement decreased. The elution of antibiotics showed sustained release. In conclusion, the characteristics of the bone cement changed based on the amount of antibiotics added, and calcium phosphate cement is useful as a drug carrier.

Cranioplasty using custom-made hydroxyapatite (HAP) ceramic implants is a common procedure for the repair of skull defects. The advantages of using HAP are that it is nonmetallic, unlike titanium; biocompatible; and osteoconductive. Furthermore, it can be molded to any complex shape that may be needed. A disadvantage is that titanium screws and plates are in development for its fixation. We developed a technique for implant fixation using bioabsorbable screws and plates, and named this technique RIVET: resorbable immobilization for vacuolar en bloc technique.Before each operation, the implant was customized for the patient in question on the basis of models prepared using computed tomography data. The bioabsorbable plates were attached to the implant by drilling, tapping, and screwing, as shown in the video (http://links.lww.com/ SCS/A43). The interior portion of the screw was then melted to flatten it against the internal surface of the implant, forming a rivet to join the plate and HAP implant.We used this technique for cranial reconstruction in 2 patients, with satisfying and functional results. We did not encounter any complications.In conclusion, the technique described here allows surgeons to fix implants and plates together more rigidly, giving a better result than possible with previous methods.

OBJECTIVE: The aim of the study was to evaluate the volume of the maxillary sinus in patients with cleft alveolus. STUDY DESIGN: This is a retrospective, descriptive study. PATIENTS AND METHODS: The 3-dimensional computed tomographic data of 218 maxillary sinuses of 109 patients with cleft alveolus were compared with those of 100 sinuses of 50 healthy individuals. RESULTS: No significant difference in the maxillary sinus volume was found between the patients with cleft alveolus and the noncleft individuals. In the patients with cleft palate and alveolus, the maxillary sinus volume was significantly larger on the right side, but no significant difference was found between the cleft and noncleft sides. CONCLUSIONS: The volume of the maxillary sinus in the patients with cleft alveolus is not different from that of the noncleft individuals. The information about the maxillary sinus is clinically important in executing such operations as endoscopic sinus surgery.

Catheter insertion for intravenous hyperalimentation is a commonly and widely used clinical technique. When compared with the incidence of complications associated with insertions into the internal jugular vein or the subclavian vein, complications associated with insertions into the femoral vein are less frequent. In this paper, we describe a very rare complication of femoral vein catheter insertionnamely, catheter displacement into the inferior epigastric vein.

In order to construct functional skeletal muscle in vitro for tissue engineering, cell alignment followed by the fusion of skeletal muscle cells, and the construction of basement membrane are needed. Of the various means used to align skeletal muscle cells, the mechanical load method is the most popular. In the present paper, we describe the history of attempts to align skeletal muscle cells in vitro and the construction of basement membrane. We then describe the challenges we faced to achieve skeletal muscle tissue engineering in type I collagen gel by co-culturing various types of cells including skeletal muscle cells, fibroblasts, endothelial cells, and fetal rat anterior horn cells.

Endothelial progenitor cells (EPCs) have been identified in peripheral blood, and have been reported to be incorporated into ischemic regions such as the ischemic hindlimb. In this study, we examined whether or not transplantation of EPCs is useful for salvaging surgical flaps in vivo. At the same time, we quantitatively compared the neovascularization ability of transplanted EPCs and that of mature endothelial cells (ECs). ECs obtained from the aorta of rats by explantation and passaged several times were used in the present study. EPCs were obtained from the blood of rat hearts. The blood samples were separated by density gradient centrifugation. Light-density mononuclear cells (MNCs) were collected and cultured on plastic plates coated with rat plasma vitronectin. Cells attached at day 7 of culture were deemed to be EPCs. Then PBS (control), ECs, or EPCs (3.0 × 105 suspended in 1.0 ml PBS) were injected at the middle of a flap. Seven days after surgery, the survival lengths of the flaps were evaluated. EPC-transplanted groups revealed statistically significant augmentation of survival length compared with the other two groups (p < 0.003). EPC-transplanted groups had significantly more angiographically detectable blood vessels (p < 0.003) and significantly higher capillary density (p < 0.03) than the other two groups. Confocal microscopy revealed that EPCs were incorporated into enhanced neovascularization. These results suggest that transplantation of EPCs may be useful for salvaging surgical flaps, and EPCs are superior to ECs in neovascularization ability.

It is theoretically possible to thin a forearm flap by clarifying the subcutaneous adipofascial structure and vasculature of the forearm, and a thin forearm flap has been developed accordingly based on the anatomy. In our report, we discussed indications for thin flap usage from a point of view which considers reconstruction of skin, bone and mucosal defects. Our first choice for thin forearm flap usage utilizes the two skin paddles and the radial bone for reconstructing whole defects of the nose. With this method, the donor site, if possible, is covered with the VAF flap using the basilic vein and its accompanying arteries after elevating the flap.

Purpose: We examined the expression pattern of bone morphogenetic proteins (BMPs) during mandibular distraction osteogenesis in rabbits and also investigated the mechanism of membranous bone distraction. Materials and Methods: Twenty-three rabbits underwent mandibular distraction (protocol; no latency period, a 1-week distraction at 0.5 mm/d, and a 2-week consolidation period). Samples were collected at 3, 5, and 7 days of distraction and at 1-week and 2-week consolidation. We prepared undecalcified fresh-frozen sections and immunohistochemically evaluated the expression of BMPs 2 through 8. Results: Both endochondral ossification and intramembranous ossification were observed. The expression of BMPs 2, 4, 5, and 6 was observed continuously from the beginning of distraction. BMP-7 was expressed weakly. The expression of BMP-3 was not observed conspicuously during distraction but was strongly expressed at 1- and 2-week consolidation. Conclusion: The expression pattern of BMPs during membranous bone distraction was similar to that during long bone distraction, but it differed from the expression pattern of long bone distraction in that the expression of BMPs was maintained for 2 weeks after the completion of distraction.

In order to construct functional skeletal muscle in vitro for tissue engineering, the micro architecture including microcirculation, neuromuscular junctions, and cell alignment has to be constructed. Thus it has been said that tissue engineered skeletal muscle will not be realized until two or three decades in the future. Skeletal muscle, however, possesses the ability to regenerate partial defects even in adult animals, and this regenerative activity can be a blue print for skeletal muscle tissue engineering. In the present paper, we describe the principle of skeletal muscle regeneration, and then describe the challenges to achieve skeletal muscle tissue engineering.

Fetal cutaneous wound made at a proper developmental stage leaves any scar formation and regenerates normal skin completely. Thus fetal wound healing can be a model of regeneration in mammalian. In this review, various differences between adult and fetal wound healing from molecular, cellular, and morphological aspects are introduced to understand the mechanism of regeneration. Then the transition from fetal to adult type wound healing is discussed in detail.

Fetal skin possesses a regenerative activity until certain developmental stages. However, the origin of cells that regenerate dermis after wounding has not been clarified yet. In the present study we located the origin of cells that reconstruct fetal dermal structure by histological examination and by marking cells in the loose fascia. Next we evaluated the regenerative activity of fetal dermal mesenchymal cells by cotransplanting with fetal epidermal cells onto the skin defect of scid mice. We conclude that fetal dermal mesenchymal cells but not loose fascial cells possess regenerative activity even on the environment in scid mice.