Sample records for rib cartilage grafts

  1. Modified technique to increase nostril cross-sectional area after using rib and septal cartilage graft over alar nasal cartilages. (United States)

    Wulkan, Marcelo; Sá, Alvaro Julio de Andrade; Alonso, Nivaldo


    Describe a modified technique to increase nostril cross-sectional area using rib and septal cartilage graft over alar nasal cartilages. A modified surgical technique was used to obtain, carve and insert cartilage grafts over alar nasal cartilages. This study used standardized pictures and measured 90 cadaveric nostril cross-sectional area using Autocad(®); 30 were taken before any procedure and 60 were taken after grafts over lateral crura (30 using costal cartilage and 30 using septal cartilage). Statistical analysis were assessed using a model for repeated measures and ANOVA (Analysis of Variance) for the variable "area". There's statistical evidence that rib cartilage graft is more effective than septal cartilage graft. The mean area after the insertion of septal cartilage graft is smaller than the mean area under rib graft treatment (no confidence interval for mean difference contains the zero value and all P-values are below the significance level of 5%). The technique presented is applicable to increase nostril cross section area in cadavers. This modified technique revealed to enhance more nostril cross section area with costal cartilage graft over lateral crura rather than by septal graft.

  2. Aesthetic auricular reconstruction with autologous rib cartilage grafts in adult microtia patients. (United States)

    Han, So-Eun; Lim, So-Young; Pyon, Jai-Kyung; Bang, Sa-ik; Mun, Goo-Hyun; Oh, Kap Sung


    Cartilage calcification is an important factor in aesthetic auricular reconstruction using autologous rib cartilage grafts in adults, a technique that involves difficult manipulation and unexpected absorption. As a result, artificial implants or prosthetics are considered for auricular reconstruction in adult patients despite the limitations of artificial material. In this article, we present our experience with auricular reconstruction using autologous rib cartilage grafts in adult microtia patients with reliable aesthetic results and minimal complications. A retrospective chart review was performed for 84 microtia patients ranging in age from 21 to 56 (average: 29.9) years who underwent auricular reconstruction using autologous rib cartilage grafts from March 2001 to March 2013. To validate our acceptable reconstructive results, two independent observers performed postoperative photographic evaluation of two groups (adults and children) using non-inferiority tests in addition to patient questionnaires. The mean operation time for rib cartilage grafts was 3 h and 53 min, and the follow-up time for all patients ranged from 6 months to 8 years. Surgery-related complications occurred in only three cases. On objective photographic evaluation, the adult group was not inferior to the child group in auricular shape, location, or symmetry. The subjective patient satisfaction evaluation reported a high satisfaction rate. As this study shows, aesthetic auricular reconstruction using rib cartilage grafts in adult microtia patients is possible even in cases with advanced cartilage calcification. Modification of the fabricating framework, well-preserved flap vascularity, and complete understanding of physiological aspects of rib cartilage are essential for aesthetic auricular reconstruction. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  3. Rib cartilage graft for posttraumatic or degenerative arthritis at wrist level: 10-year results. (United States)

    Obert, Laurent; Lepage, Daniel; Ferrier, Maxime; Tropet, Yves


    Background Posttraumatic arthritides of the radiocarpal joint, secondary to scaphoid nonunion advanced collapse (SNAC), scapholunate advanced collapse (SLAC), or Kienböck disease or in cases of intraarticularmalunion of the distal radius, are classically solved by some type of arthrodesis procedure. Osteochondral grafting provides a possible motion-sparing option that can diminish pain in the active patient. Description of Technique A chondrocostal graft harvested from the ninth rib was inserted and fixed with a plate in place of the articular defect in cases of a malunited intra-articular distal radius fracture (7 cases) or to replace the proximal pole of the scaphoid in cases of SNAC or SLAC (18 cases). In Kienböck disease, the graft was inserted as a free cartilage spacer (4 cases). Results Harvesting the graft from the ninth rib had minimal morbidity without pleural injury in the reported series. Graft union was achieved in all cases of fixation. No graft resorption or necrosis were observed on X-ray and magnetic resonance imaging (MRI) evaluation at the longest follow-up of 10 years. Histological analysis performed at the time of plate removal showed the vitality of the graft. Two thirds of the patients had excellent or good results using the Green and O'Brien score. Conclusions Reconstruction of a partially destroyed articular surface using a costal graft is reliable and provides an alternative option for resurfacing the articular surface with viable cartilage.

  4. Nose and Midface Augmentation by Rib Cartilage Grafts: Methods and Outcome in 32 Cases

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    Adham Farouk


    Full Text Available Recession of the midface is a relatively common condition that can have a negative impact on facial and nasal aesthetic appearance, and it poses a challenge to plastic surgeons. In cases with generalized maxillary retrusion and/or malocclusion, bone advancement surgery is required, but in localized cases, mostly seen in cleft lip patients, the quest is for an ideal material and a proper technique that would be used to augment the receding area. Throughout a period of seven years, thirty-two patients with nose and midface retrusion were managed by a construct of rib cartilage grafts designed to compensate the deficiency at the maxillary, piriform, and premaxillary areas. Results were satisfactory for most patients in terms of improved fullness of malar area, improved nasal tip projection and rotation, and improvement of upper lip. The presented technique of rib cartilage grafting is a safe and effective method for nose and midface augmentation.

  5. Harvesting split thickness costal cartilage graft

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    Sunil Gaba


    Full Text Available Aim: There are few complications associated with harvesting of full thickness coastal cartilage grafts i.e., pneumothorax (0.9%, contour deformities and prolonged post-operative pain. To address these issues, authors devised special scalpel to harvest split-thickness costal cartilage grafts. Materials and Methods: Standard inframammary incision was used for harvesting rib. Incision was made directly over the desired rib. Specially designed scalpel was used to cut through the rib cartilage to the half of the thickness. The study was conducted in two parts – cadaveric and clinical. Results: There was significantly less pain and no pneumothorax in the patients in whom the split thickness graft was harvested. Wounds healed without any complication. Discussion: Thus, newly devised angulated scalpel used in the current study, showed the potential to supply the reconstructive surgeon with split thickness rib graft without risk of complications such as pneumothorax or warping contour deformities and post-operative pain.

  6. [Autologous rib cartilage harvesting: operative procedure and postoperative pain reduction]. (United States)

    Rasp, G; Staudenmaier, R; Ledderose, H; Kastenbauer, E


    In reconstructive surgery there is a growing demand for cartilage grafts. For small amounts of autologous tissue, cartilage from the nasal septum or ear concha is a sufficient and reliable tissue, but in cases of extensive defects or higher mechanical load autologous rib cartilage is a commonly used transplant. Nevertheless, a serious donor-site morbidity, especially postoperative pain, has to be taken into consideration. We present a modified technique for harvesting rib cartilage with a consecutive local pain therapy. In contrast to the commonly used incision through all layers of tissue the described technique follows the anatomical structures of skin tension-lines, the fascial and muscle fibers and tissue sliding-planes. Starting with a transversal skin incisions 1.5 cm above the costal arch, longitudinal splitting of the rectus abdominis fascia and muscle, the rib cartilage of the ribs 6 to 8 can be exposed. Grafts in the size of at least 3 to 8 cm can be harvested under preservation of the perichondrium. This technique causes a high degree of stability and good function of the abdominal wall. POSTOPERATIVE PAIN THERAPY: After harvesting rib cartilage most patients complain about extensive postoperative pain. For adequate treatment the local application of a long-lasting anesthetic substance close to the intercostal nerves is helpful. The introduction of a peridural catheter opens the feasibility of continuously applying a local anesthetic for 3 to 4 days directly into the donor-site. This procedure reduces the need for general anesthetics dramatically and prevents further complications. This modified technique for harvesting rib cartilage diminishes the donor-site morbidity by reducing the risk of pneumothorax, hernias and functional deficits. Moreover, the local pain therapy assures postoperative wellness and mobility.

  7. Nasal reconstruction with articulated irradiated rib cartilage

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    Murakami, C.S.; Cook, T.A.; Guida, R.A. (Univ. of Washington School of Medicine, Seattle (USA))


    Nasal structural reconstruction is a formidable task in cases where there is loss of support to both the nasal dorsum and tip. A multitude of surgical approaches and materials have been used for the correction of the saddle-nose deformity with varying degrees of success. Articulated irradiated rib cartilage inserted through an external rhinoplasty approach was used to reconstruct nasal deformities in 18 patients over a 6-year period. Simultaneous use of a midline forehead flap to reconstruct the overlying soft tissue was required in four cases. Follow-up ranged from 1 to 6 years (mean, 2.8 years). Results were rewarding in most cases with marked improvement in nasal support and airway. Revision and/or replacement secondary to trauma or warping of the graft was required in four cases. None of the patients exhibited infection, extrusion, or noticeable resorption. A description of the surgical technique, review of all the cases, and recommendation for continued use of this graft material are discussed.

  8. Modified technique to increase nostril cross-sectional area after using rib and septal cartilage graft over alar nasal cartilages Técnica modificada para aumentar a área seccional externa da narina após o uso de enxerto cartilaginoso de costela e septo sob as cartilagens alares nasais

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    Marcelo Wulkan


    Full Text Available PURPOSE: Describe a modified technique to increase nostril cross-sectional area using rib and septal cartilage graft over alar nasal cartilages. METHODS: A modified surgical technique was used to obtain, carve and insert cartilage grafts over alar nasal cartilages. This study used standardized pictures and measured 90 cadaveric nostril cross-sectional area using Autocad®; 30 were taken before any procedure and 60 were taken after grafts over lateral crura (30 using costal cartilage and 30 using septal cartilage. Statistical analysis were assessed using a model for repeated measures and ANOVA (Analysis of Variance for the variable "area". RESULTS: There's statistical evidence that rib cartilage graft is more effective than septal cartilage graft. The mean area after the insertion of septal cartilage graft is smaller than the mean area under rib graft treatment (no confidence interval for mean difference contains the zero value and all P-values are below the significance level of 5%. CONCLUSIONS: The technique presented is applicable to increase nostril cross section area in cadavers. This modified technique revealed to enhance more nostril cross section area with costal cartilage graft over lateral crura rather than by septal graft.OBJETIVO: Descrever uma técnica modificada para se aumentar a área seccional externa da narina com cartilagem septal e costal acima das cartilagens alares nasais. MÉTODOS: Utilizou-se uma técnica cirúrgica modificada para obter, esculpir e inserir enxertos de cartilagem sobre as cartilagens alares. Realizou-se fotos padronizadas e mensuração de 90 áreas seccionais externas de narina em cadáveres com Autocad®; 30 antes sem procedimento; 60 após a inclusão de enxertos sob a cruz lateral (30 usando cartilagem costal e 30 usando cartilagem septal. A análise estatística foi feita com um modelo de medidas repetidas e ANOVA para a variável "área" RESULTADOS: Existe evidência estatística de que o enxerto de


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    Raghavendra D.R.


    Full Text Available Costal cartilages are flattened bars of hyaline cartilages. All ribs except the last two, join with the sternum through their respective costal cartilages directly or indirectly. During dissection for 1st MBBS students in the Department of Anatomy, JJMMC, Davangere, variation was found in a male cadaver aged 45 –50 years. Multiple ossified costal cartilages for 1st rib were present on left side. There were 3 costal cartilages connecting 1st rib to manubrium. There were two small intercostal spaces between them. The lower two small costal cartilages fused together to form a common segment which in turn fused with large upper costal cartilage. The large upper costal cartilage forms costochondral joint with 1st rib. All costal cartilages showed features of calcification. The present variation of multiple ossified costal cartilages are due to bifurcation of costal cartilage. It may cause musculoskeletal pain, intercostal nerve entrapment or vascular compression. Awareness of these anomalies are important for radiologists for diagnostic purpose and for surgeons for performing various clinical and surgical procedures.

  10. Onlay Rib Bone Graft in Elevation of Reconstructed Auricle: 17 Years of Experience

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    Taehoon Kim


    Full Text Available BackgroundA cartilage wedge block and covering flap are standard procedures for firm elevation of the ear in microtia correction. However, using costal cartilage for elevation of the reconstructed auricle can be insufficient, and the fixed cartilage wedge block may be absorbed or may slip out. Furthermore, elevating covering flaps is time-consuming and uses up fascia, a potential source of reconstruction material. Therefore, we propose an innovative method using autologous onlay rib bone graft for auricular elevation of microtia.MethodsFrom February 1995 to August 2012, 77 patients received a first stage operation with a rib cartilage framework graft. In the second stage operation, a small full thickness of rib bone was harvested through the previous donor scar. The bihalved rib bone was inserted into the subperiosteal pocket beneath the cartilage framework.ResultsThe follow-up time ranged from 1 month to 17 years, with a mean of 3 years. All of the patients sustained the elevation of their ears very well during the follow-up period. Donor site problems, except for hypertrophic scars, were not observed. Surgery-related complications, specifically skin necrosis, infection, or hematoma, occurred in 4 cases.ConclusionsOnlay rib bone graft used to elevate the reconstructed auricle is a more anatomically appropriate material than cartilage, due to the bone-to-bone contact between the bone graft and the temporal bone. Postoperative minor correction of the elevation degree is straightforward and the skin graft survives better. Therefore, reconstructed auricle elevation using onlay rib bone graft is a useful and valuable method.

  11. Long-term use and follow-up of autologous and homologous cartilage graft in rhinoplasty

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    Ghasemali Khorasani


    Full Text Available Background: Cartilage grafting is used in rhinoplasty and reconstructive surgeries. Autologous rib and nasal septum cartilage (auto graft is the preferred source of graft material in rhinoplasty, however, homologous cartilage (allograft has been extensively used to correct the nasal framework in nasal deformities. Autologous cartilage graft usage is restricted with complication of operation and limiting availability of tissue for extensive deformities. Alternatively, preserved costal cartilage allograft represents a readily available and easily contoured material. The current study was a formal systematic review of complications associated with autologous versus homologous cartilage grafting in rhinoplasty patients. Methods: In this cohort retrospective study, a total of 124 patients undergone primary or revision rhinoplasty using homologous or autologus grafts with postoperative follow-up ranging from 6 to 60 months were studied. The types of grafts and complications related to the grafts were evaluated. This included evaluation for warping, infection, resorption, mobility and fracture. Results: The total complications related to the cartilage grafts were 7 cases, which included 1 warped in auto graft group, three cases of graft displacement (two in allograft group and one in auto graft group and three fractures in allograft group. No infection and resorption was recorded. Complication rate (confidence interval 0.95 in autologous and homologous group were 1.25(0.4-3.88 and 2.08(0.78-5.55 in 1000 months follow up. There was no statistically significant difference between autologous and homologous group complications. Onset of complication in autologous and homologous group were 51.23(49.27-53.19 and 58.7(54.51-62.91 month respectively (P=0.81. Conclusion: The allograft cartilage has the advantage of avoiding donor-site scar. Moreover, it provides the same benefits as autologous costal cartilage with comparable complication rate. Therefore, it

  12. [Relationship between PMI and ATR-FTIR Spectral Changes in Swine Costal Cartilages and Ribs]. (United States)

    Yao, Yao; Wang, Qi; Jing, Xiao-li; Li, Bing; Zhang, Yin-ming; Wang, Zhi-jun; Li, Cheng-zhi; Lin, Han-cheng; Zhang, Ji; Huang, Ping; Wang, Zhen-yuan


    To analyze postmortem chemical changes in Landrace costal cartilages and ribs using attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy, and to provide a novel technique for estimation of postmortem interval (PMI). The swines were sacrificed by hemorrhage and their costal cartilages and ribs were kept in 20 degrees C. The chemical analysis of the costal cartilages and ribs were performed using ATR-FTIR every 72 h. The correlation between the certain spectral parameters and PMI was also analyzed. The time-dependent changes of costal cartilages were more significant than ribs. There were no obvious changes for the main absorbance bands position, and some absorbance band ratios showed time-dependent changes and significant correlations with the PMI. ATR-FTIR has the ability to analyze postmortem chemical changes of the swine costal cartilages and ribs, and it can be a new method to estimate PMI based on spectroscopy.

  13. Rib Cartilage Assessment Relative to the Healthy Ear in Young Children with Microtia Guiding Operative Timing. (United States)

    Kang, Shen-Song; Guo, Ying; Zhang, Dong-Yi; Jiang, Du-Yin


    The optimal age at which to initiate for auricular reconstruction is controversial. Rib cartilage growth is closely related to age and determines the feasibility and outcomes of auricular reconstruction. We developed a method to guide the timing of auricular reconstruction in children with microtia ranging in age from 5 to 10 years. Rib cartilage and the healthy ear were assessed using low-dose multi-slice computed tomography. The lengths of the eighth rib cartilage and the helix of the healthy ear (from the helical crus to the joint of the helix and the earlobe) were measured. Surgery was performed when the two lengths were approximately equal. The preoperative eighth rib measurements significantly correlated with the intraoperative measurements (P rib growth was not linear. In 76 (62.8%) of 121 patients, the eighth rib length was approximately equal to the helix length in the healthy ear; satisfactory outcomes were achieved in these patients. In 18 (14.9%) patients, the eighth rib was slightly shorter than the helix, helix fabrication was accomplished by adjusting the length of the helical crus of stent, and satisfactory outcomes were also achieved. Acceptable outcomes were achieved in 17 (14.0%) patients in whom helix fabrication was accomplished by cartilage splicing. In 9 (7.4%) patients with insufficient rib cartilage length, the operation was delayed. In one (0.8%) patient with insufficient rib cartilage length, which left no cartilage for helix splicing, the result was unsatisfactory. Eighth rib cartilage growth is variable. Rib cartilage assessment relative to the healthy ear can guide auricular reconstruction and personalize treatment in young patients with microtia.

  14. Rib Cartilage Assessment Relative to the Healthy Ear in Young Children with Microtia Guiding Operative Timing

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    Shen-Song Kang; Ying Guo; Dong-Yi Zhang; Du-Yin Jiang


    Background:The optimal age at which to initiate for auricular reconstruction is controversial.Rib cartilage growth is closely related to age and determines the feasibility and outcomes of auricular reconstruction.We developed a method to guide the timing of auricular reconstruction in children with microtia ranging in age from 5 to 10 years.Methods:Rib cartilage and the healthy ear were assessed using low-dose multi-slice computed tomography.The lengths of the eighth rib cartilage and the helix of the healthy ear (from the helical crus to the joint of the helix and the earlobe) were measured.Surgery was performed when the two lengths were approximately equal.Results:The preoperative eighth rib measurements significantly correlated with the intraoperative measurements (P < 0.05).From 5 to 10 years of age,eighth rib growth was not linear.In 76 (62.8%) of 121 patients,the eighth rib length was approximately equal to the helix length in the healthy ear;satisfactory outcomes were achieved in these patients.In 18 (14.9%) patients,the eighth rib was slightly shorter than the helix,helix fabrication was accomplished by adjusting the length of the helical crus of stent,and satisfactory outcomes were also achieved.Acceptable outcomes were achieved in 17 (14.0%) patients in whom helix fabrication was accomplished by cartilage splicing.In 9 (7.4%) patients with insufficient rib cartilage length,the operation was delayed.In one (0.8%) patient with insufficient rib cartilage length,which left no cartilage for helix splicing,the result was unsatisfactory.Conclusions:Eighth rib cartilage growth is variable.Rib cartilage assessment relative to the healthy ear can guide auricular reconstruction and personalize treatment in young patients with microtia.

  15. Quantitative geometric analysis of rib, costal cartilage and sternum from childhood to teenagehood. (United States)

    Sandoz, Baptiste; Badina, Alina; Laporte, Sébastien; Lambot, Karene; Mitton, David; Skalli, Wafa


    Better understanding of the effects of growth on children's bones and cartilage is necessary for clinical and biomechanical purposes. The aim of this study is to define the 3D geometry of children's rib cages: including sternum, ribs and costal cartilage. Three-dimensional reconstructions of 960 ribs, 518 costal cartilages and 113 sternebrae were performed on thoracic CT scans of 48 children, aged 4 months to 15 years. The geometry of the sternum was detailed and nine parameters were used to describe the ribs and rib cages. A "costal index" was defined as the ratio between cartilage length and whole rib length to evaluate the cartilage ratio for each rib level. For all children, the costal index decreased from rib level 1 to 3 and increased from level 3 to 7. For all levels, the cartilage accounted for 45-60 % of the rib length, and was longer for the first years of life. The mean costal index decreased by 21 % for subjects over 3-year old compared to those under three (p < 10(-4)). The volume of the sternebrae was found to be highly age dependent. Such data could be useful to define the standard geometry of the pediatric thorax and help to detect clinical abnormalities.

  16. Management of chest deformity caused by microtia reconstruction: Comparison of autogenous diced cartilage versus cadaver cartilage graft partial filling techniques. (United States)

    Go, Ju Young; Kang, Bo Young; Hwang, Jin Hee; Oh, Kap Sung


    Efforts to prevent chest wall deformity after costal cartilage graft are ongoing. In this study, we introduce a new method to prevent donor site deformation using irradiated cadaver cartilage (ICC) and compare this method to the autogenous diced cartilage (ADC) technique. Forty-two pediatric patients comprised the ADC group (n = 24) and the ICC group (n = 18). After harvesting costal cartilage, the empty perichondrial space was filled with autologous diced cartilage in the ADC group and cadaver cartilage in the ICC group. Digital photographs and rib cartilage three-dimensional computed tomography (CT) data were analyzed to compare the preventive effect of donor site deformity. We compared the pre- and postoperative costal cartilage volumes using 3D-CT and graded the volumes (grade I: 0%-25%, grade II: 25%-50%, grade III: 50%-75%, and grade IV: 75%-100%). The average follow-up period was 20 and 24 months in the ADC and ICC groups, respectively. Grade IV maintenance of previous costal cartilage volume was evident postoperatively in 22% of patients in the ADC group and 82% of patients in the ICC group. Intercostal space narrowing and chest wall depression were less in the ICC group. There were no complications or severe resorption of cadaver cartilage. ICC support transected costal ring and prevented stability loss by acting as a spacer. The ICC technique is more effective in preventing intercostal space narrowing and chest wall depression than the ADC technique. Samsung Medical Center Institution Review Board, Unique protocol ID: 2009-10-006-008. This study is also registered on PRS ( Record 2009-10-006). Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Transplantation of rib cartilage reshaped with 1.56 μm laser radiation in rabbits (United States)

    Sobol, E.; Baum, O.; Alexandrovskaya, Yu.; Shekhter, A.; Selezneva, L.; Svistuskin, V.


    As cartilage is an ideal natural material for transplantation, its use in the ENT surgery is limited by a difficulty to get proper shape of cartilage implants. Aim of the work is to make ring-shaped cartilage implants, to check their stability after laser reshaping and to perform transplantation into rabbits in vivo. We experimented with costal cartilages of 1-2 mm in thickness obtained from 3rd and 4rd ribs of a rabbit. 1.56 μm laser (Arcuo Medical Inc.) was used for cartilage reshaping. The laser settings were established taking into account anisotropy of cartilage structure for different orientation of the implants. The reshaped cartilage implants were surgically sewn to rib cartilages of the other rabbits. The rabbits were slaughtered in 3.5-4 months after surgery. The results have shown that (1) all reshaped implants kept circular form, and (2) the implants were adhered to the native rabbit cartilage sites (3) pronounced signs of regeneration in the intermediate zones were observed. The prospects of the cartilage implants use in larynx stenosis surgery are discussed.

  18. [Clinical analysis on characteristics of rib cartilage calcification in congenital microtia patients]. (United States)

    Fengfeng, Guo; Xiaobo, Yu; Bo, Pan; Lin, Lin; Haiyue, Jiang


    To explore the incidence, degree, and pattern of rib cartilage calcification in congenital microtia patients, in order to provide reference for harvesting the rib cartilage, sculpturing cartilage framework. From Jun. 2013 to Nov. 2014, 383 patients (age range, 6-45 years) underwent CT scans of the chest. 11 patients with bony diseases or traumatic history were excluded. The remaining 372 patients were divided by age into four groups as 6-15, 16-25, 26-35, 36-45 years old. Twenty patients (10 male and 10 female) were selected by the order of patient identification number in each age group, thus selecting a total of 80 patients (40 male and 40 female). Retrospective study of CT scans of the chest in 80 patients and the incidence, degree, and pattern of cartilage calcification of the sixth to eighth ribs were noted. A chi-square test is conducted to test whether there are significant difference between the variables through the SPSS 19.0 software. Overall, 40.4% (194/480) cartilage was calcified; female patients (47.50%, 114/240) showed higher frequency of calcification than male patients (33.33%, 80/240, P = 0. 025). Calcification rates of all age groups are 1.7% (2/120), 46.7% (56/ 120), 49.2% (59/120), 64.2% (77/120). Calcification rate of 6-15 years group is lowest in all groups (P 0.05). Calcification rates of the sixth and sevent rib cartilage were higher than those of the eighth rib cartilage in all age groups except 6-15 years group, who had a similar rate of all three ribs. Calcification rate of all three rib cartilage was significantly increased with age. Calcification rates of the amle's rib cartilage and the female's in all age groups are 3.3% (2/60) and 0.0% (0/60) (6-15 years): 33.3% (20/60) and 60.0% (36/60) (16-25 years): 40.0% (24/60) and 58.3% (35/60) (26-35 years), 56.7% (34/60) and 71.2% (43/60) (36-45 years). In 6-15 years group calcification rates of male and female had a similar rate, while female's rates were higher than male's rates in other

  19. Techniques for diced cartilage with deep temporalis fascia graft. (United States)

    Calvert, Jay; Kwon, Edwin


    Diced cartilage with deep temporalis fascia (DC-F) graft has become a popular technique for reconstruction of the nasal dorsum. Cartilage can be obtained from the septum, ear, or costal cartilage when employing the DC-F technique. The complications seen with DC-F grafts tend to occur early in the surgeon's implementation of this technique. Management of the complications varies depending on the severity of the problem. This article gives an overview of both the technique and the complications commonly encountered.

  20. Fascia versus cartilage graft in type I tympanoplasty: audiological outcome. (United States)

    Kim, Joo Yeon; Oh, Jung Ho; Lee, Hwan Ho


    Various materials such as fascia, perichondrium, and cartilage have been used for reconstruction of the tympanic membrane in middle ear surgery. Because of its stiffness, cartilage is resistant to resorption and retraction. However, cartilage grafts result in increased acoustic impedance, the main limitation to their use. The aim of this study was to compare the hearing results after cartilage tympanoplasty versus fascia tympanoplasty. This study included 114 patients without postoperative tympanic membrane perforation who underwent tympanoplasty type I between 2007 and 2010, 31 with fascia and 83 with cartilage. Preoperative and 1 year postoperative air-bone gap (ABG) and postoperative gain in ABG at frequencies of 0.5, 1, 2, and 3 kHz were assessed. Both groups were statically similar in terms of the severity of middle ear pathology and the preoperative hearing levels. Overall, postoperative successful hearing results showed 77.4% of the fascia group and 77.1% of the cartilage group. Mean postoperative gains in ABG were 9.70 dB for the fascia group and 9.78 dB for the cartilage group. These results demonstrate that hearing after cartilage tympanoplasty is comparable to that after fascia tympanoplasty. Although cartilage is the ideal grafting material in problematic cases, it may be used in less severe cases, such as in type I tympanoplasty, without fear of impairing hearing.

  1. Simple Correction of Alar Retraction by Conchal Cartilage Extension Grafts

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    Yong Jun Jang


    Full Text Available BackgroundAlar retraction is a challenging condition in rhinoplasty marked by exaggerated nostril exposure and awkwardness. Although various methods for correcting alar retraction have been introduced, none is without drawbacks. Herein, we report a simple procedure that is both effective and safe for correcting alar retraction using only conchal cartilage grafting.MethodsBetween August 2007 and August 2009, 18 patients underwent conchal cartilage extension grafting to correct alar retraction. Conchal cartilage extension grafts were fixed to the caudal margins of the lateral crura and covered with vestibular skin advancement flaps. Preoperative and postoperative photographs were reviewed and analyzed. Patient satisfaction was surveyed and categorized into 4 groups (very satisfied, satisfied, moderate, or unsatisfied.ResultsAccording to the survey, 8 patients were very satisfied, 9 were satisfied, and 1 considered the outcome moderate, resulting in satisfaction for most patients. The average distance from the alar rim to the long axis of the nostril was reduced by 1.4 mm (3.6 to 2.2 mm. There were no complications, except in 2 cases with palpable cartilage step-off that resolved without any aesthetic problems.ConclusionsConchal cartilage alar extension graft is a simple, effective method of correcting alar retraction that can be combined with aesthetic rhinoplasty conveniently, utilizing conchal cartilage, which is the most similar cartilage to alar cartilage, and requiring a lesser volume of cartilage harvest compared to previously devised methods. However, the current procedure lacks efficacy for severe alar retraction and a longer follow-up period may be required to substantiate the enduring efficacy of the current procedure.

  2. Simple Correction of Alar Retraction by Conchal Cartilage Extension Grafts. (United States)

    Jang, Yong Jun; Kim, Sung Min; Lew, Dae Hyun; Song, Seung Yong


    Alar retraction is a challenging condition in rhinoplasty marked by exaggerated nostril exposure and awkwardness. Although various methods for correcting alar retraction have been introduced, none is without drawbacks. Herein, we report a simple procedure that is both effective and safe for correcting alar retraction using only conchal cartilage grafting. Between August 2007 and August 2009, 18 patients underwent conchal cartilage extension grafting to correct alar retraction. Conchal cartilage extension grafts were fixed to the caudal margins of the lateral crura and covered with vestibular skin advancement flaps. Preoperative and postoperative photographs were reviewed and analyzed. Patient satisfaction was surveyed and categorized into 4 groups (very satisfied, satisfied, moderate, or unsatisfied). According to the survey, 8 patients were very satisfied, 9 were satisfied, and 1 considered the outcome moderate, resulting in satisfaction for most patients. The average distance from the alar rim to the long axis of the nostril was reduced by 1.4 mm (3.6 to 2.2 mm). There were no complications, except in 2 cases with palpable cartilage step-off that resolved without any aesthetic problems. Conchal cartilage alar extension graft is a simple, effective method of correcting alar retraction that can be combined with aesthetic rhinoplasty conveniently, utilizing conchal cartilage, which is the most similar cartilage to alar cartilage, and requiring a lesser volume of cartilage harvest compared to previously devised methods. However, the current procedure lacks efficacy for severe alar retraction and a longer follow-up period may be required to substantiate the enduring efficacy of the current procedure.

  3. Reconstruction of large iliac crest defects after graft harvest using autogenous rib graft: a prospective controlled study. (United States)

    Bapat, Mihir R; Chaudhary, Kshitij; Garg, Hitesh; Laheri, Vinod


    Prospective controlled study analyzing the donor site morbidity after reconstruction of full thickness iliac crest defects, using autologous rib grafts. To compare the pain and cosmetic outcomes of patients with iliac crest reconstruction with those who have had no reconstruction of the iliac crest. Chronic donor site pain and poor cosmesis have been the major deterrents in using iliac crest for long-segment spinal reconstructions. Iliac crest reconstruction with rib has been reported but most studies are uncontrolled and retrospective. Patients with iliac defects rib graft harvested during the anterolateral approach to spine. Rib graft of the appropriate contour was impacted into the notches created in the iliac crest defect. The control group comprised 16 patients without reconstruction of the iliac crest. The pain, cosmesis, and functional disability were assessed on the basis of visual analog scores and a predesigned questionnaire. Judet iliac views were used to assess the incorporation of the rib graft. Evaluation was performed at 1.5, 3, 6, and 12 months, respectively. Intensity and incidence of pain was significantly lower in the reconstructed group. Cosmetic outcome was also significantly better in this group. Patients in control group had significant complications related to the tenting of skin over the defect such as bursitis and skin necrosis. Radiologic incorporation was documented in 95% of patients with 1 patient having resorption of the rib graft. Rib graft reconstruction provides a cheap and effective alternative for iliac crest reconstruction. Patients undergoing thoracotomy or thoraco-phrenico-lumbotomy for spinal reconstruction, the unutilized rib graft should be used to reconstruct the iliac defect. Reduced donor site morbidity and better cosmesis are the major benefits of reconstruction.

  4. Post-ablative reconstruction of the medial canthus and medial orbital wall using conchal cartilage graft with three illustrative cases. (United States)

    Dagregorio, G; Darsonval, V


    When the medial third of the upper or lower eyelid has to be reconstructed after full-thickness tumour excision, we usually use Hübner tarsomarginal grafts, but when medial canthal lesions spread to the medial orbital wall without invading the orbital margin, conchal graft becomes our first surgical option. Previously reported solutions to this difficult problem are few and concern more directly medial orbital wall fractures. We found no article dealing specifically with the use of conchal graft in post-ablative reconstruction of the medial orbital wall. Nevertheless the concha presents great advantages over bone grafting or rib cartilage, because it is more flexible and malleable. And it is less prone to extrusion or infection as may be allografts implants. It is a very effective way to repair medial orbital defects, but graft reorientation must be perfect to match exactly the medial orbital wall concavity.

  5. In Situ Splitting of a Rib Bone Graft for Reconstruction of Orbital Floor and Medial Wall. (United States)

    Uemura, Tetsuji; Yanai, Tetsu; Yasuta, Masato; Harada, Yoshimi; Morikawa, Aya; Watanabe, Hidetaka; Kurokawa, Masato


    In situ splitting of rib bone graft was conducted in 22 patients for the repair of orbital fracture with no other complicating fractures. A bone graft was harvested from the sixth or seventh rib in the right side. The repair of the orbital floor and medial wall was successful in all the cases. Ten patients had bone grafting to the orbital floor, eight had it done onto medial wall, and 4 onto both floor and wall after reduction. The mean length of in situ rib bone graft was 40.9 mm (range, 20-70 mm), the mean width of these was 14.9 mm (range, 8-20 mm). The bone grafting was done by one leaf for 15 cases and two leafs for 7 cases in size of defects. The technique of in situ splitting of a rib bone graft for the repair of the orbital floor and medial wall is a simple and safe procedure, easily taking out the in situ splitting of a rib, and less pain in donor site. It has proved to be an optimal choice in craniofacial reconstruction, especially the defects of orbital floor and medial wall.

  6. Morphological characteristics of the life cycle of resting cartilage cells in mouse rib investigated in intrasplenic isografts. (United States)

    Ishizeki, K; Kuroda, N; Nawa, T


    Resting cartilages taken from 2-day-old mouse ribs were transplanted into spleens in order to carry out morphological investigations of the life cycles of their chondrocytes. The explants were isografted for periods of up to 60 days and examined at light and electron microscopic levels, using von Kossa's reaction or osmium-potassium ferrocyanide (OPF) fixation. By day 3 after transplantation, resting cartilage containing immature chondrocytes was well adapted to splenic tissue and by 7 days after transplantation these chondrocytes had changed into early hypertrophic chondrocytes containing large vacuoles, glycogen aggregates and abundant secretory organelles. It was also demonstrated by von Kossa's reaction that the initial calcification occurred in the territorial matrix during this period. In spite of the hypertrophic chondrocytes in the central zone being surrounded by an extensively calcified matrix during days 14-21 after transplantation, these cells had well-preserved organized organelles, except that Golgi-associated elements and endoplasmic reticulum revealed a tendency toward degenerative changes. With increased duration of the grafting period, from 30-60 days, the calcification zone progressed gradually, and the number of hypertrophic chondrocytes embedded in the calcified matrix decreased considerably. By day 60, degenerating hypertrophic chondrocytes of two types were distinguished:flattened cells containing large vacuoles, poorly developed Golgi apparatuses, and rough endoplasmic reticulum; and shrunken dark cells displaying terminal hypertrophy. During the present study, we observed no vascular invasion into the calcified matrix, or appearance of bone-related cells, and the morphological changes from the resting chondrocytes to cellular hypertrophy accompanied by the formation of a calcified matrix were observed at day 60. These findings indicate that resting cartilage cells of the mouse have the capacity for terminal differentiation when transplanted

  7. Preparation and placement of cartilage island graft in tympanoplasty

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    Veysel Yurttas


    Full Text Available Introduction: Cartilage graft tympanoplasty has a better success rate in the treatment of chronic otitis media if regularly prepared and placed. Objective: To prepare cartilage island material and evaluate its effect on the success rate of tympanoplasty. Methods: The medical records of 87 patients (48 males and 39 females; mean age, 27.3 ±11.2 years; range, 14–43 years with chronic otitis media without cholesteatoma who underwent intact canal-wall-up tympanoplasty and revision surgery between December of 2007 and October of 2011 were retrospectively evaluated. Surgery was performed under general anesthesia via a retroauricular approach. Results: The overall success rate of this technique was 93% in terms of perforation closure. No graft lateralization or displacement into the middle ear occurred. The overall average preoperative air bone gap was 37.27 ± 12.35 dB, and the postoperative air bone gap was 27.58 ± 9.84 dB. The mean postoperative follow-up period was 15.3 months (range: 7–21 months. Conclusion: If cartilage graft is properly prepared and placed, cartilage graft tympanoplasty appears to provide better success rates and hearing results.

  8. Additional circular intercostal space created by bifurcation of the left 3rd rib and its costal cartilage: a case report. (United States)

    Kumar, Naveen; Guru, Anitha; Patil, Jyothsna; Ravindra, Swamy; Badagabettu, Satheesha Nayak


    In the thorax there are normally 11 pairs of intercostal spaces: the spaces between adjacent ribs. The intercostal spaces contain intercostal muscles, intercostal nerves and vessels. During a routine dissection for undergraduate medical students, we observed a variation involving the left 3rd rib and 3rd costal cartilage in the cadaver of a man of Indian ethnicity aged about 65 years. The left 3rd rib and its costal cartilage were bifurcated at their costochondral junction enclosing a small circular additional intercostal space. Muscle tissue covered by deep fascia was present in this circular intercostal space. The muscle in the circular intercostal space received its nerve supply from a branch of the 2nd intercostal nerve. Knowledge of such variations is helpful to surgeons operating on the anterior thoracic wall involving ribs and intercostal spaces. Knowing the possibility of the presence of an additional space between normal intercostal spaces can guide a surgeon through to a successful surgery.

  9. Magnetic resonance imaging of hyaline cartilage regeneration in neocartilage graft implantation. (United States)

    Tan, C F; Ng, K K; Ng, S H; Cheung, Y C


    The purpose of this study was to investigate the regenerative potential of hyaline cartilage in a neocartilage graft implant with the aid of MR cartilage imaging using a rabbit model. Surgical osteochondral defects were created in the femoral condyles of 30 mature New Zealand rabbits. The findings of neocartilage in autologous cartilage grafts packed into osteochondral defects were compared with control group of no implant to the osteochondral defect. The outcome of the implantations was correlated with histologic and MR cartilage imaging findings over a 3-month interval. Neocartilage grafts packed into osteochondral defects showed regeneration of hyaline cartilage at the outer layer of the implant using MR cartilage imaging. Fibrosis of fibrocartilage developed at the outer layer of the autologous cartilage graft together with an inflammatory reaction within the osteochondral defect. This animal study provides evidence of the regenerative ability of hyaline cartilage in neocartilage transplants to repair articular cartilage.

  10. Comparison of cartilage graft and fascia in type 1 tympanoplasty: systematic review and meta-analysis. (United States)

    Yang, Tao; Wu, Xuewen; Peng, Xiaofei; Zhang, Yanni; Xie, Shaobing; Sun, Hong


    Tympanoplasty using cartilage grafts has a better graft take rate than that using temporalis fascia grafts. There are no significant differences between cartilage grafts and temporalis fascia grafts for hearing outcomes. Contrary to the sliced cartilage sub-group, full-thickness cartilage grafts generate better hearing outcomes than temporalis fascia grafts. Tympanic membrane perforation can cause middle ear relapsing infection and lead to hearing damage. Various techniques have been applied in order to reconstruct the tympanic membrane. Recently, cartilage grafts and temporalis fascia grafts have been widely used for tympanic membrane closure. A systemic review and meta-analysis was carried out based on published retrospective trials that investigated the efficacy of cartilage grafts and temporalis fascia grafts in type 1 tympanoplasty. Both graft take rates and mean AIR-BONE-GAP gains were analyzed. Cochrane Library, PubMed, and Embase were systematically searched. After a scientific investigation, we extracted the relevant data following our selection criteria. Odds ratio (OR) of graft take rates and mean difference (MD) of AIR-BONE-GAP gains were calculated within 95% confidence intervals. Eight eligible articles with 915 patients were reviewed. The pooled OR for graft take rate was 3.11 (95% CI =1.94-5.00; p = 0.43) and the difference between the two groups was significant, which means that the cartilage grafts group got a better graft take rate than the temporalis fascia grafts group. The pooled MD for mean AIR-BONE-GAP gain was 1.92 (95% CI = -0.12-3.95; p fascia grafts group. On the contrary, the pooled MD of sliced cartilage grafts sub-group was 0.12 (95% CI = -0.44-0.69; p = 0.61) and there was no significant difference between the sliced cartilage grafts and temporalis fascia group.

  11. Reconstruction of ulnar defect with vascularized rib graft: A case report. (United States)

    Spiker, Andrea M; Humbyrd, Casey J; Osgood, Greg M; Yang, Stephen C; Deune, E Gene


    This case report describes the reconstruction of a segmental ulnar defect using a vascularized rib graft. A 27-year-old man was injured during military service by an improvised explosive device, resulting in bilateral through-the-knee amputations, left hand deformity, and a segmental left ulnar defect. After unsuccessful ulnar reconstruction with nonvascularized autologous bone and allograft bone substitutes, he presented to our institution. We removed the residual allograft fragments from the ulnar defect, harvested a vascularized left sixth rib with the intercostal artery and vein, secured the construct with internal hardware, and performed microanastomoses of the intercostal artery and vein to the posterior interosseous artery and vein. Postoperatively, he had a hematoma at the vascularized graft recipient site caused by anticoagulation therapy for his chronic deep vein thrombosis. Despite this, the rib graft successfully incorporated on the basis of radiographic and clinical examinations at 27 months. He had no pain and good function of the arm. The results of this case suggest that a vascularized rib graft for forearm reconstruction may be a viable option with minimal donor site morbidity. © 2015 Wiley Periodicals, Inc. Microsurgery 37:160-164, 2017.

  12. Semiquantitative correction of posttraumatic enophthalmos with sliced cartilage grafts. (United States)

    Matsuo, K; Hirose, T; Furuta, S; Hayashi, M; Watanabe, T


    A simple surgical technique for correcting posttraumatic enophthalmos is described. The steps are as follows: (1) a plaster mold is obtained of the patient's face, (2) wax is added to the enophthalmic eye of the plaster mold until it becomes symmetrical, (3) the quantity of wax is measured, and (4) the same amount of sliced costal cartilage is implanted beneath the periosteum of the extended orbital wall behind the vertical axis of the globe. Using this technique, we have successfully treated six patients with traumatic orbital floor defects without complication. This approach is useful for decreasing the orbital volume using a semiquantitative procedure to estimate the amount of graft material required. In this respect, costal cartilage demonstrates a marked advantage, with stability and cosmetic appearance verified over 12 months of follow-up.

  13. Impact Insertion of Osteochondral Grafts: Interference Fit and Central Graft Reduction Affect Biomechanics and Cartilage Damage. (United States)

    Su, Alvin W; Chen, Yunchan; Wailes, Dustin H; Wong, Van W; Cai, Shengqiang; Chen, Albert C; Bugbee, William D; Sah, Robert L


    An osteochondral graft (OCG) is an effective treatment for articular cartilage and osteochondral defects. Impact of an OCG during insertion into the osteochondral recipient site (OCR) can cause chondrocyte death and matrix damage. The aim of the present study was to analyze the effects of graft-host interference fit and a modified OCG geometry on OCG insertion biomechanics and cartilage damage. The effects of interference fit (radius of OCG - radius of OCR), loose (0.00mm), moderate (0.05mm), tight (0.10mm), and of a tight fit with OCG geometry modification (central region of decreased radius) were analyzed for OCG cylinders and OCR blocks from adult bovine knee joints with an instrumented drop tower apparatus. An increasingly tight OCG-OCR interference fit led to increased taps for insertion, peak axial force, graft cartilage axial compression, cumulative and total energy delivery to cartilage, lower time of peak axial force, lesser graft advancement during each tap, higher total crack length in the cartilage surface, and lower chondrocyte viability. The modified OCG, with reduction of diameter in the central area, altered the biomechanical insertion variables and biological consequences to be similar to those of the moderate interference fit scenario. Micro-computed tomography confirmed structural interference between the OCR bone and both the proximal and distal bone segments of the OCGs, with the central regions being slightly separated for the modified OCGs. These results clarify OCG insertion biomechanics and mechanobiology, and introduce a simple modification of OCGs that facilitates insertion with reduced energy while maintaining a structural interference fit. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  14. Rib cage pain (United States)

    ... pain or discomfort in the area of the ribs. Considerations With a broken rib, the pain is worse when bending and twisting ... any of the following: Bruised, cracked, or fractured rib Inflammation of cartilage near the breastbone ( costochondritis ) Osteoporosis ...

  15. Additional circular intercostal space created by bifurcation of the left 3rd rib and its costal cartilage: a case report

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    Kumar Naveen


    Full Text Available Abstract Introduction In the thorax there are normally 11 pairs of intercostal spaces: the spaces between adjacent ribs. The intercostal spaces contain intercostal muscles, intercostal nerves and vessels. Case presentation During a routine dissection for undergraduate medical students, we observed a variation involving the left 3rd rib and 3rd costal cartilage in the cadaver of a man of Indian ethnicity aged about 65 years. The left 3rd rib and its costal cartilage were bifurcated at their costochondral junction enclosing a small circular additional intercostal space. Muscle tissue covered by deep fascia was present in this circular intercostal space. The muscle in the circular intercostal space received its nerve supply from a branch of the 2nd intercostal nerve. Conclusions Knowledge of such variations is helpful to surgeons operating on the anterior thoracic wall involving ribs and intercostal spaces. Knowing the possibility of the presence of an additional space between normal intercostal spaces can guide a surgeon through to a successful surgery.

  16. Diced Cartilage Grafts Wrapped in Rectus Abdominis Fascia for Nasal Dorsum Augmentation. (United States)

    Cerkes, Nazim; Basaran, Karaca


    Dorsum augmentation is one of the most delicate components of rhinoplasty. Although various solid grafts have been used in the past for this purpose, diced cartilage grafts wrapped in fascia have become popular in recent decades. In this study, the authors analyze and discuss the results of using diced cartilage grafts wrapped in rectus abdominis muscle fascia for dorsal augmentation. Nasal dorsum augmentation using the diced cartilage wrapped in rectus abdominis fascia technique was performed on 109 patients between 2008 and 2014. Six patients were primary cases, 69 patients were secondary, and 18 were tertiary. Sixteen patients had previously undergone more than three operations. In all patients, the rectus abdominis fascia was harvested with the described technique and wrapped around the diced cartilages obtained from the costal cartilage. The average follow-up period was 19.6 months (range, 6 to 47 months). Satisfactory results were obtained with acceptable complications and revision rates. Three patients underwent reoperation because of overcorrection. Insufficient augmentation was seen in five patients. In four patients, infection developed after postoperative day 5. One patient complained of a hypertrophic scar on the donor site. None of the patients showed any symptoms indicating an abdominal hernia. Techniques using diced cartilage grafts wrapped in fascia have now become the gold standard for dorsal augmentations. When it is considered that secondary cases requiring dorsal augmentation are usually those also needing costal cartilage grafts, rectus abdominis fascia becomes a useful carrier for diced cartilages, which is in the same donor area. Therapeutic, IV.

  17. Nanoassemblies of Tissue-Reactive, Polyoxazoline Graft-Copolymers Restore the Lubrication Properties of Degraded Cartilage. (United States)

    Morgese, Giulia; Cavalli, Emma; Müller, Mischa; Zenobi-Wong, Marcy; Benetti, Edmondo M


    Osteoarthritis leads to an alteration in the composition of the synovial fluid, which is associated with an increase in friction and the progressive and irreversible destruction of the articular cartilage. In order to tackle this degenerative disease, there has been a growing interest in the medical field to establish effective, long-term treatments to restore cartilage lubrication after damage. Here we develop a series of graft-copolymers capable of assembling selectively on the degraded cartilage, resurfacing it, and restoring the lubricating properties of the native tissue. These comprise a polyglutamic acid backbone (PGA) coupled to brush-forming, poly-2-methyl-2-oxazoline (PMOXA) side chains, which provide biopassivity and lubricity to the surface, and to aldehyde-bearing tissue-reactive groups, for the anchoring on the degenerated cartilage via Schiff bases. Optimization of the graft-copolymer architecture (i.e., density and length of side chains and amount of tissue-reactive functions) allowed a uniform passivation of the degraded cartilage surface. Graft-copolymer-treated cartilage showed very low coefficients of friction within synovial fluid, reestablishing and in some cases improving the lubricating properties of the natural cartilage. Due to these distinctive properties and their high biocompatibility and stability under physiological conditions, cartilage-reactive graft-copolymers emerge as promising injectable formulations to slow down the progression of cartilage degradation, which characterizes the early stages of osteoarthritis.

  18. Postoperative pain control by preventive intercostal nerve block under direct vision followed by catheter-based infusion of local analgesics in rib cartilage harvest for auricular reconstruction in children with microtia: A randomized controlled trial. (United States)

    Woo, Kyong-Je; Kang, Bo Young; Min, Jeong Jin; Park, Jin-Woo; Kim, Ara; Oh, Kap Sung


    Children with microtia complain of severe postoperative pain during early postoperative days after rib cartilage harvest for auricular reconstruction. The purpose of this study was to evaluate the effects of preventive donor site wound analgesia by intercostal nerve block (ICNB) and catheter-based infusion of local analgesics on postoperative pain after rib cartilage graft for auricular reconstruction in children with microtia. In this prospective randomized study, 66 children underwent postoperative pain control using either preventive ICNB followed by catheter-based infusion (33 patients, study group) or intravenous (IV) analgesia alone (33 patients, control group). ICNB was performed under direct vision by the surgeon by injecting 0.5% bupivacaine into each of the three intercostal spaces before perichondrial dissection. Catheters were placed in three subchondral spaces before wound closure, and 0.5% bupivacaine was infused every 12 h for 48 h postoperatively. Pain degrees were recorded every 4 h during the first 48 postoperative hours using a visual analogue scale. The study group showed significantly lower mean pain scores of the chest at rest (3.7 vs. 5.1, p = 0.001), the chest during coughing (4.3 vs. 5.8, p = 0.006), and the ear (3.0 vs. 4.1, p = 0.001) than the control group. The amount of use of rescue IV ketorolac was smaller in the study group (p = 0.026) than in the control group. No side effects related to the intervention were noted. Preventive ICNB followed by catheter-based infusion is effective and safe in postoperative pain relief in rib cartilage graft for auricular reconstruction. (The clinical trial registration number: WHO ICTRP, (KCT0001668)). Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  19. Levator lengthening technique using cartilage or fascia graft for paralytic lagophthalmos in facial paralysis. (United States)

    Hayashi, Ayato; Yoshizawa, Hidekazu; Natori, Yuhei; Senda, Daiki; Tanaka, Rica; Mizuno, Hiroshi


    Lid loading using gold weights has been commonly used to treat paralytic lagophthalmos (PL); however, the procedure has a relatively high complication rate and the availability of these plates varies among social circumstances. We used a levator lengthening (LL) technique, which originally elongated the levator aponeurosis by inserting a fascia graft between the edge of the levator aponeurosis and the tarsal plate. However, because this procedure tends to result in a wide residual lagophthalmos, we changed the graft material from fascia to conchal cartilage. In this study, we describe in detail our experience with LL using the cartilage graft. LL was performed in 18 patients with PL. Fascia grafts were used in seven patients and cartilage grafts in 11. Static reconstructions of the lower eyelid and eyebrow were also performed in most patients. Efficacy was evaluated from patient reports of ocular symptoms and by measuring the palpebral fissure width at opening and closing for both eyes. All patients experienced improved ophthalmological symptoms, which were more apparent in cartilage cases. The average palpebral fissure at eyelid closure was 1.8 mm in cartilage cases and 4.0 mm in fascia cases. In cases where an eyebrow lift was concurrently performed, the residual lagophthalmos became wider in fascia grafting but remained acceptable in cartilage grafting. LL is a simple and useful procedure for treating PL with higher efficacy when a cartilage graft is used. However, the level of the upper eyelid can be easily adjusted by changing the fixation position of the cartilage. Additional experience is required to obtain more consistent outcomes. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. Alternative surgical treatment of paralytic lagophthalmos using autogenic cartilage grafts and canthopexy. (United States)

    Friedhofer, Henri; Coltro, Pedro Soler; Vassiliadis, Aneta Hionia; Nigro, Marcelus Vinícius; Saito, Fábio Lopes; Moura, Tatiana; Faria, José Carlos; Ferreira, Marcus Castro


    This study aims to analyze the use of autogenic auricular cartilage grafts as weight for the upper eyelid in conjunction with lateral canthopexy for patients with mild paralytic lagophthalmos. This procedure was also accompanied by elevation of the lower eyelid using the cartilage graft for moderate cases. We conducted a retrospective study including case series of 30 patients with paralytic lagophthalmos from 1997 to 2010. For mild cases, cartilage from the auricular scapha was placed in pretarsal space of the upper eyelid and cartilage from the concha was inserted in preaponeurotic space and then sutured to the levator aponeurosis in conjunction with lateral canthopexy. For moderate cases, lower eyelid was also elevated by suturing cartilage graft to tarsum and resting it by the inferior orbital rim. All patients had some degree of keratopathy before the intervention. After treatment, they presented with evident clinical improvement, reduction of eye symptoms, and resolution of keratopathy. During the mean postoperative follow-up of 37.3 months, none of the patients presented with cartilage graft exposition, reabsorption, visibility, infection, or warping. Complete eye closure was achieved in 24 (80%) patients, whereas the remaining 6 (20%) patients had residual asymptomatic lagophthalmos. The intervention using autogenic auricular cartilage grafts explained in this study was only effective for the treatment of mild and moderate cases of paralytic lagophthalmos. This outpatient surgery is associated with low morbidity and achievement of functional and aesthetic improvement.

  1. Precision carving of costal cartilage graft for contour fill in aesthetic and reconstructive rhinoplasty

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    Uday Bhat


    Full Text Available Background: Autogenous costal cartilage is a good option for large volume requirements in rhinoplasty, when septal or conchal cartilages do not suffice. Reluctance to use costal cartilage is due to apprehension of warping. However, warping can be avoided if we follow the principle of balanced section as advocated by Gibson and Davis. "Warping" can also be utilized to change the curvature of the graft. Materials and Methods: We have used 69 costal cartilage grafts as a solid piece for contour fill in rhinoplasty in 31 patients over the last 10 years. Principle of balanced section as advocated by Gibson and Davis was adhered to while carving the grafts, however some grafts were allowed to warp to get different sizes and shapes. Results: All the procedures were uneventful. Aesthetic appearance of all patients was satisfactory and acceptable to all the patients. In two cases, the dorsal graft minimally shifted to one side, but remained straight. In one patient, there was late appearance of distortion. Conclusion: The mode of cartilage warping is predictable and it can be used to advantage. Apprehension to use costal cartilage graft is unjustified, as with precision carving a desired shape can be obtained.

  2. Vascular-pedicled costal cartilage graft for the treatment of subglottic and upper tracheal stenosis. (United States)

    Hashizume, K; Kanamori, Y; Sugiyama, M; Tomonaga, T; Nakanishi, H


    Free costal cartilage graft for the treatment of subglottic and tracheal stenosis is widely used, but postoperative granulation formation is a problem. To reduce the risk of granulation formation after free costal graft, a new operation of costal cartilage graft with vascular pedicle was introduced. A vascular pedicled fifth costal cartilage graft is prepared using internal thoracic artery and vein and intercostal artery and vein as a vascular pedicle. The prepared graft is brought to the upper trachea. The anterior wall of cricoid is split, and the costal cartilage graft is implanted to the split part and tracheostomy. Extubation on the next day is possible if the general condition of the patient permits. In 3 cases of subglottic or upper tracheal stenosis, this operation was performed. All the patients had tracheostomy made during early infancy. The postoperative course was uneventful, and all the patients were extubated soon after the operation. No granulation tissue was observed by postoperative bronchoscopic examinations. Costal cartilage graft with vascular pedicle is a safe and useful new operation for the treatment of subglottic and upper tracheal stenosis. There also is a possibility of using this procedure for the treatment of long segment tracheal stenosis.

  3. Comparison of temporal muscle fascia and cartilage grafts in pediatric tympanoplasties. (United States)

    Demirci, Sule; Tuzuner, Arzu; Karadas, Hatice; Acıkgoz, Cemile; Caylan, Refik; Samim, Ethem Erdal


    To compare anatomic and functional outcomes of the different graft materials used in pediatric tympanoplasty. The patients younger than 18 years of age and who had tympanoplasty between 2010 and 2012 were included in the study. Temporal muscle fascia or cartilage was used as the graft material. The age, gender, the side of the operated ear, the operation technique, pre- and postoperative audiological results, and the status of the graft were noted. An intact graft and an air-bone gap (ABG) ≤ 20 were regarded as surgical success in the postoperative period. Audiograms obtained before surgery and 1 year after surgery were used for the comparison. Sixty pediatric cases were included in the study. Fascia graft was used as the graft material in 35 of them, and cartilage was used in 25 patients. The graft success rate was 82.9% in the fascia group while it was 92% in the cartilage group. In the fascia group preoperative ABG was 28.2 ± 10.1 dB, postoperative ABG was 15.1 ± 10.2dB, and postoperative gain was 13.1 ± 9.6 dB. In the cartilage group, preoperative ABG was 28.9 ± 10.2dB, and postoperative ABG was 16.8 ± 10.3 dB with a postoperative gain of 12.1 ± 6.8 dB. The differences between the fascia and the cartilage groups were not statistically significant either for hearing gain or graft success rate. Cartilage and fascia grafts yield similar results for hearing gain and graft success rate in pediatric tympanoplasty. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Comparison of temporalis fascia muscle and full-thickness cartilage grafts in type 1 pediatric tympanoplasties. (United States)

    Yegin, Yakup; Çelik, Mustafa; Koç, Arzu Karaman; Küfeciler, Levent; Elbistanlı, Mustafa Suphi; Kayhan, Fatma Tülin

    Various graft materials have been used to close tympanic membrane perforations. In the literature, there are few studies in pediatric populations comparing different graft materials. To our knowledge, there is no reported study that measured the thickness of the tragal cartilage in pediatric tympanoplasties. The tragal cartilage is not of uniform thickness in every patient. To compare anatomical and functional outcomes of temporalis fascia muscle and full-thickness tragal cartilage in type 1 pediatric tympanoplasties. In total, 78 patients (38 males, 40 females; average age 10.02±1.98 years; range, 7-18 years) who underwent type 1 tympanoplasties in our clinic were included. Demographics, anatomical, and functional outcomes were collected. Temporalis fascia muscle and tragal cartilage were used as graft materials. Tragal cartilage was used without thinning, and the thickness of tragal cartilage was measured using a micrometer. Anatomical and functional outcomes of cartilage and fascia were compared. Audiometric results comparing the cartilage and fascia groups were conducted at 6 months, and we continued to follow the patients to 1 year after surgery. An intact graft and an air-bone gap≤20dB were regarded as a surgical success. Results with a p-valuefascia group. In the fascia group, the preoperative air-bone gap was 33.68±11.44 dB and postoperative air-bone gap was 24.25±12.68dB. In the cartilage group, the preoperative air-bone gap was 35.68±12.94dB and postoperative air-bone gap was 26.11±12.87dB. The anatomical success rate in the cartilage group was significantly better than that for the fascia group (pfascia and cartilage groups (p>0.05). The average thickness of tragal cartilage in the pediatric population was 0.693±0.094mm in males and 0.687±0.058 mm in females. Our data suggest that the anatomical success rate for a cartilage tympanoplasty was higher than for a fascia tympanoplasty. Functional results with cartilage were not different than with

  5. Sublabial Autologous Ear Cartilage Grafting for Increasing the Nasolabial Angle

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    Rajko Toncic


    Full Text Available BackgroundThe loss of nasal tip support is caused by many factors and eventually results in the collapse and eventual dropping of the nasal tip. This reduces the nasolabial (NL angle and negatively affects respiratory functions and one's appearance.MethodsThe aim of this retrospective study, which was conducted on 52 patients, was to present and popularize a simple and effective method for the reconstruction of a weakened columella by inserting an autologous ear cartilage graft using a sublabial approach.ResultsOf all the patients, three patients experienced transplant rejection. The period of follow-up observation was one to five years (mean, 27 months. The results were objectively evaluated by measuring the NL angle in standardized photos before and after the procedure at different time intervals over the follow-up period. We observed a significant increase of the NL angle (mean, 20°, and found these results to be durable over the long term. Of the 52 patients included in this study observed patients, three were dissatisfied (due to immediate infection and shifting of the strut, 28 were satisfied, and 21 were very satisfied.ConclusionsThe surgical method described here is simple and can be learned quickly. It has very good results with few complications, and is our method of choice for complex and serious cases seen in everyday rhinosurgical practice.

  6. Fascia compared to one-piece composite cartilage-perichondrium grafting for tympanoplasty

    NARCIS (Netherlands)

    Lyons, Sarah A.; Su, Tanly; Vissers, Linda E T; Peters, Jeroen P M; Smit, Adriana L; Grolman, Wilko


    OBJECTIVE: To evaluate the effectiveness of type 1 tympanoplasty with one-piece composite cartilage-perichondrium (CCP) grafts compared to temporalis fascia (TF) grafts for tympanic membrane (TM) closure and hearing improvement in adult patients with a subtotal TM perforation and chronic otitis medi

  7. Healing and hearing results of temporalis fascia graft Vs cartilage graft (Full thickness and half thickness in type I tympanoplasty

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    Sanjana V Nemade


    Full Text Available Background- Although temporalis fascia is the commonly used graft material for tympanic membrane reconstruction, cartilage–perichondrium graft is the material of choice for the reconstruction of the atelectatic tympanic membrane, recurrent perforations, subtotal and total perforations. Stiffness of cartilage graft is always the concern for the audiological outcome of the surgery. In our study, we used temporalis fascia and the cartilage graft of different thickness and have done the honest efforts to find out the ideal graft that will form a perfect balance between the stability and the acoustic sensitivity of the tympanic membrane. Materials and methods: 90 patients were included who underwent type one tympanoplasty between July 2003 to January 2006. 30 cases were included in Group A in which temporalis fascia was used. 30 cases were included in Group B in which full thickness tragal cartilage (1mm was used and 30 cases were included in Group C in which partial thickness (0.5 mm tragal cartilage was used. Results: Graft take was accomplished in 86 patients (95.5%. The average Air-Bone gap closure achieved in Group A was 27.4 dB; in Group B was 17.5dB while in Group C it was26.8 dB. Conclusion- Cartilage of 0.5 mm thickness maintains a perfect balance between sufficient stability and adequate acoustic sensitivity. If the stability of the reconstructed membrane is a higher priority, like in chronic eustachian tube blockage, full thickness tragal cartilage can be used, although it entails some sacrifice of acoustic quality.

  8. Catheter-based donor site analgesia after rib grafting: a prospective, randomized, double-blinded clinical trial comparing ropivacaine and bupivacaine. (United States)

    Anantanarayanan, Parameswaran; Raja, Dharmesh Kumar; Kumar, J Naveen; Sneha, P; Christabel, Amelia; Manikandhan, Ramanathan; Elavazhagan, Namasivayam


    Although ribs provide the best source of cartilage for reconstruction, its harvesting is associated with significant postoperative pain and sometimes incapacitating functional deficit. The lack of studies in the maxillofacial literature on regional analgesia for rib harvests stimulated this study design. This study compared ropivacaine with bupivacaine in providing postoperative analgesia after rib harvest. Patients who needed rib grafting for maxillofacial reconstructive procedures were enrolled in this prospective, randomized, double-blinded clinical trial. Patients were randomly allocated to 1 of 2 groups with different modalities of anesthesia against a control group. A catheter was embedded in the rib donor site in all patients. Patients in group A received 0.75% ropivacaine, those in group B received 0.5% bupivacaine, and those in croup C patients received normal saline and served as the controls. The outcome variables were the subjective and objective pain scores, the duration of action, and the efficacy of the drugs after rib harvest. Dependent variables were the need for a rescue analgesic by the patient and the duration of hospital stay. The subjective intensity of pain at rest was calculated using the visual analog scale. The objective pain scores at function were evaluated by comparing preoperative with postoperative values of incentive spirometry, breath-holding test, maximal chest expansion, and match-blowing test. The t test and paired samples test were used to the analyze data, and a P value less than .05 was considered significant. Forty-two patients were enrolled in this study. Patients in groups A and B showed significant pain relief compared with group C. Patients in group A showed significantly less pain at rest (2.8±0.894) compared with those in group B (3.7±0.875; Ppain at function (3.8±0.894) compared with those in group B (4.7±0.923; Prib harvesting provides excellent postoperative comfort, with ropivacaine providing an earlier return

  9. Estimation of eighth costal cartilage in surgical timing of microtia reconstruction. (United States)

    Moon, Il Yung; Oh, Kap Sung; Lim, So Young; Pyon, Jai-Kyong; Mun, Goo-Hyun; Bang, Sa-Ik


    There is controversy over the optimal timing of microtia reconstruction. The eighth costal cartilage, which is used to shape the helix framework, can be one of the key factors determining surgical timing of microtia reconstruction. Nevertheless, it is difficult to predict the length of the eighth costal cartilage preoperatively. The aim of the present study was to suggest clinical predictors of the length of the eighth cartilage by assessing the correlation between the actual length of the eighth cartilage and preoperative measurements of the cartilage length using three-dimensional rib-cage computed tomography (3D rib-cage CT). A retrospective analysis was performed on a total of 97 patients who underwent preoperative 3D rib-cage CT and auricular reconstruction using a rib cartilage graft between January 2010 and February 2013. The length of the eighth costal cartilage on 3D rib-cage CT was measured preoperatively, and the length of the harvested eighth rib cartilage was measured intraoperatively. We analyzed the association between the preoperative and intraoperative measured length of the eighth rib, with patient age, height, weight, and body mass index. Preoperative measurement using 3D rib-cage CT showed a high correlation with actual cartilage length. Height and weight correlated more strongly with length than with age. This study describes the usefulness of 3D rib-cage CT for preoperative measurement of the length of the eighth costal cartilage. The measurement of the eighth rib cartilage on 3D rib-cage CT could be a useful aid for reconstructive surgeons in planning microtia reconstruction.

  10. [Reconstruction after extended partial laryngeal and hypopharyngeal resections. A new method with rib cartilage, chondrosynthesis and free radial transplants]. (United States)

    Siegert, R; Witte, J; Jurk, V; Kunisch, M; Katzbach, R; Remmert, S


    Partial pharyngectomy combined with subtotal laryngectomy results in permanent tracheostomy and long lasting swallowing difficulties in many cases. Based on our prior experimental and clinical studies on laryngeal chondrosynthesis the objectives of this project were to develop a method for reconstruction of up to two thirds of the larynx and one pyriform sinus. The resected laryngeal framework is reconstructed with autogenous rib cartilage and stabilized with plates and screws. In addition a piece of cartilage is used as a buttress for apposition by the remaining mobile vocal cord. A free radial forearm flap covers the reconstructed framework and forms the sulcus of the pyriform sinus. Up to now 7 patients have been operated with this technique. The follow up was 35 months on average. None of the patients has a clinically relevant aspiration. All patients have a well understandable voice and one of them--a teacher--could even resume his speech profession. In selected patients these techniques enable functional rehabilitation of swallowing, breathing and speech even after extended partial pharyngolaryngectomy.

  11. Increases in discontinuous rib cartilage and fused carpal bone in rat fetuses exposed to the teratogens, busulfan, acetazolamide, vitamin A, and ketoconazole. (United States)

    Dodo, T; Uchida, K; Hirose, T; Fukuta, T; Kojima, C; Shiraishi, I; Kato, E; Horiba, T; Mineshima, H; Okuda, Y; Maeda, M; Katsutani, N; Hirano, K; Aoki, T


    Skeletal changes induced by treatment of pregnant rats with four potent teratogens, busulfan, acetazolamide, vitamin A palmitate, and ketoconazole, were evaluated using Alizarin Red S and Alcian Blue double-staining to investigate the relationship between drug-induced skeletal malformations and cartilaginous changes in the fetuses. Pregnant rats (N = 8/group) were treated once or twice between gestation days (GDs) 10 to 13 with busulfan at doses of 3, 10, or 30 mg/kg; acetazolamide at 200, 400, or 800 mg/kg; vitamin A palmitate at 100,000, 300,000, or 1,000,000 IU/kg; or ketoconazole at doses of 10, 30, or 100 mg/kg. Uterine evaluations and fetal external and skeletal examinations were conducted on GD 20. Marked skeletal abnormalities in ribs and hand/forelimb bones such as absent/ short/bent ribs, fused rib cartilage, absent/fused forepaw phalanx, and misshapen carpal bones were induced at the mid- and high-doses of busulfan and acetazolamide and at the high-dose of vitamin A palmitate and ketoconazole. Increased incidences of discontinuous rib cartilage (DRC) and fused carpal bone (FCB) were observed from the low- or mid-dose in the busulfan and acetazolamide groups, and incidences of FCB were increased from the mid-dose in the vitamin A palmitate and ketoconazole groups. Therefore, DRC and FCB were detected at lower doses than those at which ribs and hand/forelimb malformations were observed in the four potent teratogens.

  12. Perichondrium/cartilage composite graft for repairing large tympanic membrane perforations and hearing improvement

    Institute of Scientific and Technical Information of China (English)

    CHEN Xiao-wei; YANG Hua; GAO Ru-zhen; YU Rong; GAO Zhi-qiang


    Background The main risk factors for postoperative failure in tympanoplasties are large perforations that are difficult to repair, annular perforations, and a tympanic membrane (TM) with extensive granular myringitis that require middle ear exploration and mastoidectomy. The aim of this study was to investigate a novel technique of perichondrium/cartilage composite graft for repairing the large TM perforation in the patient of otitis media.Methods Retrospective chart reviews were conducted for 102 patients with large tympanic membrane perforations, who had undergone tympanoplasty from August 2005 to August 2008. Tympanoplasty or tympanomastoidectomy using a perichondrium/cartilage composite graft was analyzed. The tragal or conchal perichondrium/cartilage was used to replace the tympanic membrane in patients.Results Patients aged from 13 to 67 years were followed up in average for 24 months (10-36 months). Seventy-four ears (72.61%) were used the tragal perichondrium/cartilage as graft material and 27 ears (27.39%) were used the conchal perichondrium/cartilage. Graft take was successful in all patients. Postoperative complications such as wound infection, hematoma, or sensorineural hearing loss were not identified. Nine patients (8.82%) had the partial ossicular replacement prosthesis, 14 patients (13.72%) using the autologous curved incus and 79 patients (77.45%) without prosthesis. Successful closure occurred in 92% of the ears. A total of 85.8% patients achieved a postoperative hearing improvement.Conclusions The graft underlay tympanoplasty using perichonddum/cartilage composite is effective for the majority of patients with large perforation. The hearing was improved even if the mastoidectomy was required in the patients with otitis media with extensive granulation.

  13. Unilateral cleft nasal deformity correction using conchal cartilage lily flower graft. (United States)

    Hwang, Kun; Kim, Han Joon; Paik, Moo Hyun


    We present a conchal cartilage lily flower graft for correcting depressed and laterally displaced alar cartilage for correction of unilateral cleft nasal deformity.After making a V incision at the base of the columellar and then marginal incisions, the alar cartilages were exposed. A fusiform-shaped cartilage larger than 2.5 cm in length and 1 cm in width was obtained. The midline long axis was scored with a No. 15 knife, and the lateral one third was split. Two-thirds length portions were folded in half, and they became straightened in the shape of a stalk of a lily flower. Two symmetrical one-third length portions were fanned out bilaterally in the shape of the leaf of a lily flower. The stalk portion was positioned in a pocket between the medial crura, and the 2 leaf portions were placed on the dome of the alar cartilages. The marked points of the cleft side and contralateral side were secured with sutures. The V incision at the base of the columellar and the marginal incisions were closed with a V-Y shape. In this technique, the 2 leaf portions were placed on the dome of the alar cartilages and sutured; therefore, the suture holds the dome of the cleft side to the contralateral side without peaking.Thirteen patients (6 male and 7 female subjects; age range, 13-30 years) were operated. Among them, 6 patients were very satisfied, and 5 patients were satisfied with the results. Two patients felt they were improved.We think the conchal cartilage lily flower graft might be a good method for correction of depressed and laterally displaced alar cartilage in unilateral cleft nasal deformity.

  14. The effects of femoral graft placement on cartilage thickness after anterior cruciate ligament reconstruction. (United States)

    Okafor, Eziamaka C; Utturkar, Gangadhar M; Widmyer, Margaret R; Abebe, Ermias S; Collins, Amber T; Taylor, Dean C; Spritzer, Charles E; Moorman, C T; Garrett, William E; DeFrate, Louis E


    Altered joint motion has been thought to be a contributing factor in the long-term development of osteoarthritis after ACL reconstruction. While many studies have quantified knee kinematics after ACL injury and reconstruction, there is limited in vivo data characterizing the effects of altered knee motion on cartilage thickness distributions. Thus, the objective of this study was to compare cartilage thickness distributions in two groups of patients with ACL reconstruction: one group in which subjects received a non-anatomic reconstruction that resulted in abnormal joint motion and another group in which subjects received an anatomically placed graft that more closely restored normal knee motion. Ten patients with anatomic graft placement (mean follow-up: 20 months) and 12 patients with non-anatomic graft placement (mean follow-up: 18 months) were scanned using high-resolution MR imaging. These images were used to generate 3D mesh models of both knees of each patient. The operative and contralateral knee models were registered to each other and a grid sampling system was used to make site-specific comparisons of cartilage thickness. Patients in the non-anatomic graft placement group demonstrated a significant decrease in cartilage thickness along the medial intercondylar notch in the operative knee relative to the intact knee (8%). In the anatomic graft placement group, no significant changes were observed. These findings suggest that restoring normal knee motion after ACL injury may help to slow the progression of degeneration. Therefore, graft placement may have important implications on the development of osteoarthritis after ACL reconstruction.

  15. Minimizing Superficial Thermal Injury Using Bilateral Cryogen Spray Cooling During Laser Reshaping of Composite Cartilage Grafts (United States)

    Chang, Cheng-Jen; Cheng, Sally M.H.; Chiu, Lynn L.; Wong, Brian J.F.; Ting, Keen


    Composite cartilage grafts were excised from New Zealand rabbit ears. Flat composite grafts (of cartilage and overlying skin graft on both surfaces) were obtained from each ear and cut into a rectangle measuring 50 mm by 25 mm (x by y) with an average thickness of approximately 1.3 mm (z), skin included. Specimens were manually deformed with a jig and maintained in this new position during laser illumination. The composite cartilage grafts were illuminated on the concave surface with an Nd:YAG laser (1,064 nm, 3 mm spot) at 10 W, 20 W, 30 W, 40 W, 50 W. Cryogen spray cooling (CSC) was applied to both exterior (convex) and interior (concave) surfaces of the tissue to reduce thermal injury to the grafts. CSC was delivered: (1) in controlled applications (cryogen released when surface reached 40°C, and (2) receiving only laser at above wattage, no CSC [representing the control group]. The specimens were maintained in a deformation for 15 minutes after illumination and serially examined for 14 days. The control group with no CSC caused injury to all specimens, ranging from minor to full thickness epidermal thermal injury. Although most levels of laser and CSC yielded a high degree of reshaping over an acute time period, after 14 days specimens exposed to 30 W, 40 W, 50 W retained shape better than those treated at 10 W and 20 W. The specimens exposed to 50 W with controlled CSC retained its new shape to the highest degree over all others, and thermal injury was minimal. In conclusion, combinations of laser and CSC parameters were effective and practical for the reshaping of composite cartilage grafts. Lasers Surg. PMID:18727025

  16. Evaluation of Autogenous Engineered Septal Cartilage Grafts in Rabbits: A Minimally Invasive Preclinical Model

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    Anton Kushnaryov


    Full Text Available Objectives. (1 Evaluate safety of autogenous engineered septal neocartilage grafts and (2 compare properties of implanted grafts versus controls. Study Design. Prospective, basic science. Setting. Research laboratory. Methods. Constructs were fabricated from septal cartilage and then cultured in vitro or implanted on the nasal dorsum as autogenous grafts for 30 or 60 days. Rabbits were monitored for local and systemic complications. Histological, biochemical, and biomechanical properties of constructs were evaluated. Results. No serious complications were observed. Implanted constructs contained more DNA (P<0.01 and less sGAG perDNA (P<0.05 when compared with in vitro controls. Confined compressive aggregate moduli were also higher in implanted constructs (P<0.05 and increased with longer in vivo incubation time (P<0.01. Implanted constructs displayed resorption rates of 20–45 percent. Calcium deposition in implanted constructs was observe. Conclusion. Autogenous engineered septal cartilage grafts were well tolerated. As seen in experiments with athymic mice, implanted constructs accumulated more DNA and less sGAG when compared with in vitro controls. Confined compressive aggregate moduli were higher in implanted constructs. Implanted constructs displayed resorption rates similar to previously published studies using autogenous implants of native cartilage.

  17. Assessment of the 18-month permanence of onlay tip cartilage grafts following rhinoplasty. (United States)

    Persichetti, Paolo; Simone, Pierfranco; Carusi, Carlo


    Augmentation rhinoplasty requires addition of materials of various natures to reshape the nasal pyramid. Onlay tip grafts are single or multilayered grafts placed horizontally over the alar domes. The aim of the present study was to assess the 18-month permanence of onlay septal cartilage grafts. Twenty-eight patients underwent rhinoplasty with onlay tip cartilage graft, between June 2008 and November 2008 at the Campus Bio-Medico University in Rome, Italy. They were reviewed and photographed 6 months and 18 months postoperatively. Comparison of 6-month and 18-month postoperative pictures was performed with Adobe Photoshop CS. Measurements on pictures were taken with AutoCAD. Comparison of photographs showed no visible difference in nasal tip projection. Comparison of the measurements of tip projection showed a mean reduction of 0.06 mm (0.19%). Considerable stability of nasal tip projection after rhinoplasty with onlay tip grafts was observed postoperatively. Comparison of standardised digital photographs is a valid procedure to assess contour alterations of various anatomical structures after plastic surgery.

  18. Recurrence rate of repaired hard palate oronasal fistula with conchal cartilage graft (United States)

    Abdali, Hosein; Hadilou, Mansour; Feizi, Awat; Omranifard, Mahmood; Ardakani, Mehdi Rasti; Emami, Abolhasan


    Background: After cleft palate repair, oronasal fistula (ONF) formation is one of the considerable and troublesome complications. Conchal cartilage graft is one option that can be used in recurrent fistula correction. The aim of the current study is investigating the recurrence rate of the hard palate ONF or ONF at the junction of hard and soft palate after utilizing conchal cartilage graft and comparing this rate with other methods. Materials and Methods: In this observational prospective study, 29 patients suffering from ONF with small, medium and large sizes who were referring to Alzahra university hospital, Isfahan, Iran and Fateme Zahra university hospital, Tehran, Iran between November 2011 and November 2012 were enrolled. All patients had midline cleft palate, 29.6% of them had cleft lip too that was repaired previously. All patients were followed-up for 2 years (every 2 months) after repair. Results: The mean (range) age of studied samples was 10.7 (2-23) years. 16 patients (55.7%) were female, and reminders were male. During 2 years followup, we detected recurrence of ONF in 6 patients (20.68%) and the success rate was 79.32%. The recurrence rate, after applying the current approach, among who experienced the several times of recurrence was significantly higher than among those who experienced first time of recurrence (33.3% vs. 7.1%; P 0.1). Conclusion: Using of conchal cartilage graft for recurrent ONF with ≤1 cm was safe and efficacious, in ONF >1 cm conchal cartilage graft can be used as a primary method and if recurrence occurred chooses other complex procedure. PMID:25538779

  19. Recurrence rate of repaired hard palate oronasal fistula with conchal cartilage graft

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    Hosein Abdali


    Full Text Available Background: After cleft palate repair, oronasal fistula (ONF formation is one of the considerable and troublesome complications. Conchal cartilage graft is one option that can be used in recurrent fistula correction. The aim of the current study is investigating the recurrence rate of the hard palate ONF or ONF at the junction of hard and soft palate after utilizing conchal cartilage graft and comparing this rate with other methods. Materials and Methods: In this observational prospective study, 29 patients suffering from ONF with small, medium and large sizes who were referring to Alzahra university hospital, Isfahan, Iran and Fateme Zahra university hospital, Tehran, Iran between November 2011 and November 2012 were enrolled. All patients had midline cleft palate, 29.6% of them had cleft lip too that was repaired previously. All patients were followed-up for 2 years (every 2 months after repair. Results: The mean (range age of studied samples was 10.7 (2-23 years. 16 patients (55.7% were female, and reminders were male. During 2 years followup, we detected recurrence of ONF in 6 patients (20.68% and the success rate was 79.32%. The recurrence rate, after applying the current approach, among who experienced the several times of recurrence was significantly higher than among those who experienced first time of recurrence (33.3% vs. 7.1%; P 0.1. Conclusion: Using of conchal cartilage graft for recurrent ONF with ≤1 cm was safe and efficacious, in ONF >1 cm conchal cartilage graft can be used as a primary method and if recurrence occurred chooses other complex procedure.

  20. Titanium plating system with autologous rib graft sternoplasty in the treatment of thoracic inlet compression

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    Matthew Alexander


    Full Text Available Narrowing of the thoracic inlet leading to airway compression is a rare and challenging condition in the pediatric population. Reports in the literature have described this variant related to multiple conditions including double crush phenomenon following repair of pectus excavatum, anterior spinal displacement, and straight back syndrome. Underlying genetic conditions such as Marfan's Syndrome and Hurler's Syndrome have also been reported to contribute to clinically significant airway compression independent of dynamic tracheal collapse such as tracheomalacia. The borders of the thoracic inlet are anatomically bound by the body of the first thoracic vertebrae (T1 posteriorly, the posterior surface of the manubrium anteriorly, and the medial aspects of the first ribs on either side laterally. Relief of tracheal compression in this location is complicated by the rigidity of the boney thoracic inlet and limited space for lifting procedures such as anterior aortopexy. Several operative approaches to treat this condition have been described including manubrial/sternal resection, first rib resection, and reconstruction of the thoracic inlet. Described here are three patients where successful reconstruction of the thoracic inlet was achieved using autologous rib graft sternoplasty and a titanium sternal plating system to widen the thoracic inlet and eliminate external compression on the trachea.

  1. Reconstruction of a Large Anterior Ear Defect after Mohs Micrographic Surgery with a Cartilage Graft and Postauricular Revolving Door Flap

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    Stephanie Nemir


    Full Text Available A novel postauricular revolving door island flap and cartilage graft combination was employed to correct a large defect on the anterior ear of an 84-year-old man who underwent Mohs micrographic surgery for an antihelical squamous cell carcinoma. The defect measured 4.6 × 2.4 cm and spanned the antihelix, scapha, a small portion of the helix, and a large segment of underlying cartilage, with loss of structural integrity and anterior folding of the ear. The repair involved harvesting 1.5 cm2 of exposed cartilage from the scaphoid fossa and then sculpting and suturing it to the remnant of the antihelical cartilage in order to recreate the antihelical crura. The skin of the posterior auricle was then incised just below the helical rim and folded anteriorly to cover the cartilage graft. The flap remained attached by a central subcutaneous pedicle, and an island designed using the full-thickness defect as a stencil template was pulled through the cartilage window anteriorly to resurface the anterior ear. This case demonstrates the use of the revolving door flap for coverage of large central ear defects with loss of cartilaginous support and illustrates how cartilage grafts may be used in combination with the flap to improve ear contour after resection.

  2. The effect of adipose-derived stem cells on the survival of diced cartilage graft in rabbits

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    Mohammad reza Ebadi


    Full Text Available Backgrounds and Aims: The use of diced cartilage grafts in rhinoplasty in recent years, have been considered by most plastic surgeons. However, long-term resorption usually occurs. The aim of this study was to Examine the effects of adipose-derived stem cells on the viability of diced cartilage grafts. Materials and Methods: In this study, 10 New Zealand White male rabbits, weighing 2000-2500 g, approximately 12 to 16 weeks of age were used.Stem cells was harvested from inguinal adipose tissue of each rabbits. Grafts placed subcutaneously along the dorsal midline. Stem cells were injected in one side and the other side was control. The cartilage weights were recorded both before implantation and after explantation. Evaluation of living chondrocytes was conducted 12 weeks after implantation. Results: The mean difference of cartilage weights was varied between two groups (intervention and control sides; So that the average was significantly higher in stem cell side than that in the control side (p=0.021. The average number of live chondrocytes was significantly higher in the intervention side than the control side (p<0.001. Conclusions: These findings suggest that adipose-derived stem cells can maintain the viability of diced cartilage, although the exact mechanism remains to be defined. Because adipose-derived stem cells are autologous and easy to harvest, they may be useful for improving the long-term outcomes of diced cartilage grafting.

  3. Autologous Cricoid Cartilage as a Graft for Airway Reconstruction in an Emergent Technique - A Case Report

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    Farzad Izadi


    Full Text Available Introduction: Laryngotracheal stenosis can be caused after traumatic injuries to the neck from the subglottic larynx to the trachea. Patients with laryngotracheal stenosis often need a tracheotomy and occasionally may become tracheotomy dependent. Different procedures have been described for the management of these lesions. Management options include techniques of endoscopic dilation, laser resection, laryngo-fissure, and an innovative array of plastic reconstructions with or without the use of stents.   Case Report:This paper presents airway reconstruction in a young patient with severe subglottic stenosis due to a blunt trauma to the neck, who was treated using particles of an autologous fractured cricoid cartilage as the source for airway augmentation. An incision was made in the anterior midline of the cricoid lamina and deepened through the scar tissue to the posterior cricoid lamina. Then two lateral incisions (right & left were made in the cricoid lamina and fractured cartilage particles and the scar tissue were removed via these two lateral incisions. The mucosal lining at the right and left of the midline incision, after debulking, were sutured to a lateral position. Thereafter three cartilage particles were used to reconstruct the anterior cricoid lamina and augment the lumen.   Conclusion:  It is worth to mention that an autologus cartilage graft can be used for certain cases with traumatic airway stenosis. Further follow up and more patients are needed to approve this method of reconstructive surgery in emergent situations.

  4. Autologous Cricoid Cartilage as a Graft for Airway Reconstruction in an Emergent Technique - A Case Report (United States)

    Izadi, Farzad; Vaghardoost, Reza; Derakhshandeh, Vita; Sobouti, Behnam; Ghavami, Yaser


    Introduction: Laryngotracheal stenosis can be caused after traumatic injuries to the neck from the subglottic larynx to the trachea. Patients with laryngotracheal stenosis often need a tracheotomy and occasionally may become tracheotomy dependent. Different procedures have been described for the management of these lesions. Management options include techniques of endoscopic dilation, laser resection, laryngo-fissure, and an innovative array of plastic reconstructions with or without the use of stents. Case Report: This paper presents airway reconstruction in a young patient with severe subglottic stenosis due to a blunt trauma to the neck, who was treated using particles of an autologous fractured cricoid cartilage as the source for airway augmentation. An incision was made in the anterior midline of the cricoid lamina and deepened through the scar tissue to the posterior cricoid lamina. Then two lateral incisions (right & left) were made in the cricoid lamina and fractured cartilage particles and the scar tissue were removed via these two lateral incisions. The mucosal lining at the right and left of the midline incision, after debulking, were sutured to a lateral position. Thereafter three cartilage particles were used to reconstruct the anterior cricoid lamina and augment the lumen. Conclusion: It is worth to mention that an autologus cartilage graft can be used for certain cases with traumatic airway stenosis. Further follow up and more patients are needed to approve this method of reconstructive surgery in emergent situations. PMID:27280104

  5. Cartilage Tympanoplasty: Is it more effective than temporalis fascia grafting for tympanoplasty?

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    Shyamakant Prasad


    Full Text Available Chronic suppurative otitis media is a disease which is a major cause of morbidity in our country. A large proportion of these patients have safe (mucosal chronic suppurative otitis media. It leads to otorrhoea and deafness which hampers productivity of many individuals. Otolaryngologist play an important role in its correction and amelioration by con-servative or operative procedures. One such procedure is tympanoplasty. AIMS AND OBJECTIVES 1. To evaluate improvement in hearing following tympanoplasty using temporalis fascia graft and cartilage island graft at 8 weeks after surgery. 2. Graft status after tympanoplasty using temporalis fascia graft and cartilage island graft. 3. Assess other complications after surgery in both groups. This study was conducted in the Department of Otorhinolaryngology and Head and Neck Sur-gery, ST. STEPHEN’S HOSPITAL, DELHI between November 2010 to November 2012. INCLUSION CRITERIA 1. Includes patient in the age group of 20-40 years, having good general physical condition. 2. No evidence of active infection in nose, throat or paranasal sinuses, central perforation of pars tensa of the tympanic membrane with dry ear for a minimum period of 3 weeks be-fore the day of operation. 3. Patients having good eustachian tube function with good cochlear reserve. Exclusion criteria: 1. Patients having blocked eustachian tube, with polyp, granulations or cholesteatoma 2. Failed myringoplasty in the same ear 3. Otogenic intra cranial complications in the past 4. Evidence of otitis externa or otomycosis 5. Per operative ossicular discontinuity, fixed foot plate 6. Patients with evidence of focal sepsis

  6. Application of acellular dermal matrix and expandedflapin half auricular reconstructionwithrib cartilage grafts%脱细胞真皮及扩张皮瓣在肋软骨移植半耳缺损再造中的应用

    Institute of Scientific and Technical Information of China (English)

    董海江; 王喜梅; 万程; 李想; 张琼阁


    BACKGROUND:Traumatic auricle defectsin upper 1/2 or lower 1/2,seriously involve theauricular cartilage and skin blood vessels. The autogenic rib cartilage graft and acelular dermal matrix have good histocompatibility, and expanded flapis a kind of thin and achromatic tissue for skin defect repair. OBJECTIVE:To explore theapplication ofacelular dermal matrix and expanded flap in half auricular reconstruction,and to find out the fine carving and anastomosis of autogenic rib cartilage graftas wel as its similarities with the ear and clinical significance. METHODS:Eight cases of half auricular defects were treated with expanded flap, autogenic rib cartilage graft, fine anastomosisofautogenic rib cartilage graft and residual earfor half auricular reconstruction,during which theacelular dermal matrixwas usedto promote residual ear docking and skul auricle angle formation. The reconstructionwasperformed in three stages:first,anexpander(volume, 80mL)wassubcutaneously implanted attheretro-auricular area;second, the auricular defects were reconstructed with fine rib cartilage graft, acelular dermal matrix and auriculoplasty;finaly, acelular dermal matrixwas usedto promote residual ear docking. Thenthehalf auricular reconstructionwas evaluatedby objective measurement and subjective rating. RESULTS AND CONCLUSION:Half auricular reconstruction was successful in al the eight caseswithout obvious complications, and the cartilage grafts were in good condition.During thefolow-up,thereconstructed auriclewasshapedwel andformed a good involution withtheresidualauricle. In addition, the flange was smooth withoutobviouscolor difference and edema, and its position, size and shape were consistent with those of thecontralateralone. Afterthefolow-up of 6 months, objective indicators showed that the affected side had no significant differencefromthe contralateralone(P> 0.05). In conclusion,theacelular dermal matrixcanobviously decrease the complications of the cartilage grafts

  7. Release of transgenic progranulin from a living hyaline cartilage graft model: An in vitro evaluation on anti-inflammation. (United States)

    Lau, Ting Ting; Zhang, Feng; Tang, Wei; Wang, Dong-An


    Osteoarthritis (OA) is a prevalent condition that compromises and even jeopardizes the life quality of millions of people. Common symptoms in OA includes joint stiffness and soreness, and they are often associated with inflammations to various extend. Due to the avascular and aneural nature of articular hyaline cartilage, it has limited self-repair capabilities; especially under inflammatory conditions, damages inflicted on cartilage are often irreversible. Hence, treatment approaches focus on anti-inflammation or articular cartilage replacement. In this study, an engineered, dual-functional living hyaline cartilage graft (LhCG), capable of releasing transgenic anti-inflammatory cytokine-progranulin (PGRN) is developed and envisioned to simultaneously fulfil both requirements. The therapeutic functionality of PGRN releasing LhCG is evaluated by co-culturing the constructs with tumor necrosis factor-alpha (TNFα) secreting THP-1 cells to simulate the inflammatory condition in arthritis. Non-transgenic LhCG constructs and non-coculture sample groups were set up as controls. Gene expression and ECM composition changes across samples were assessed to understand the effects of PGRN as well as inflammatory environment on the cartilage graft. Collectively, the results in this study suggest that in situ release of transgenic recombinant PGRN protects LhCG from induced inflammation in vitro; contrastively, in the absence of PGRN, cartilage grafts are at risk of being degraded and mineralized under exposure to TNFα signaling. This shows that cartilage graft itself can be at risk of degradation or calcification when implanted in arthritic microenvironment. Hence, the inflammatory microenvironment has to be considered in cartilage replacement therapy to increase chances of successful joint mobility restoration. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2968-2977, 2016. © 2016 Wiley Periodicals, Inc.

  8. A retrospective analysis of two independent prospective cartilage repair studies : autogenous perichondrial grafting versus subchondral drilling 10 years post-surgery

    NARCIS (Netherlands)

    Bouwmeester, PSJM; Homminga, GN; Bulstra, SK; Geesink, RGT; Kuijer, Roelof

    Background: Experimental data indicate that perichondrial grafting to restore articular cartilage defects will result in repair with hyaline-like cartilage, In contrast, debridement and drilling results in repair with fibro-cartilage. In this retrospective study the long-term clinical results of

  9. Anteroposterior cricoid split interposition costal cartilage grafts for laryngotracheal stenosis in children

    Institute of Scientific and Technical Information of China (English)

    RUAN Yan-yan; CHEN Wen-xian; CUI Peng-cheng; GAO Peng-fei


    Objective: To investigate the effects of anteroposterior cricoid spliting interposition costal grafting for moderate and severe laryngotracheal stenosis in children. Methods: From 1995 to 2005, 87 children (aged 1.2 to 14 years) with moderate and severe glottic and subglottic stenosis were retrospectively studied. They were operated with cricoid spliting laryngotracheal reconstruction in our hospital. All of 87 patients were tracheostomy-dependent before surgery. Results: Eighty-five patients (95%) were successfully decannnulated and got an effective phonation. The follow-up time was more than 5 years. The effect of operation was satisfactory and the growth and development of children was normal. Conclusion: Anteroposterior cricoid split interposition costal cartilage graft is a safe and effective treatment method formoderate and severe glottic and subglottic stenosis in children.

  10. Use of genetically modified muscle and fat grafts to repair defects in bone and cartilage

    Directory of Open Access Journals (Sweden)

    CH Evans


    Full Text Available We report a novel technology for the rapid healing of large osseous and chondral defects, based upon the genetic modification of autologous skeletal muscle and fat grafts. These tissues were selected because they not only possess mesenchymal progenitor cells and scaffolding properties, but also can be biopsied, genetically modified and returned to the patient in a single operative session. First generation adenovirus vector carrying cDNA encoding human bone morphogenetic protein-2 (Ad.BMP-2 was used for gene transfer to biopsies of muscle and fat. To assess bone healing, the genetically modified (“gene activated” tissues were implanted into 5mm-long critical size, mid-diaphyseal, stabilized defects in the femora of Fischer rats. Unlike control defects, those receiving gene-activated muscle underwent rapid healing, with evidence of radiologic bridging as early as 10 days after implantation and restoration of full mechanical strength by 8 weeks. Histologic analysis suggests that the grafts rapidly differentiated into cartilage, followed by efficient endochondral ossification. Fluorescence in situ hybridization detection of Y-chromosomes following the transfer of male donor muscle into female rats demonstrated that at least some of the osteoblasts of the healed bone were derived from donor muscle. Gene activated fat also healed critical sized defects, but less quickly than muscle and with more variability. Anti-adenovirus antibodies were not detected. Pilot studies in a rabbit osteochondral defect model demonstrated the promise of this technology for healing cartilage defects. Further development of these methods should provide ways to heal bone and cartilage more expeditiously, and at lower cost, than is presently possible.

  11. Comparison of results of graft uptake using tragal cartilage perichondrium composite graft versus temporalis fascia in patients undergoing surgery for chronic otitis media - squamous type. (United States)

    Khalilullah, S; Shah, Shankar P; Yadav, D; Shrivastav, R P; Bhattarai, H


    To assess, analyze and compare the results of graft uptake using Tragal Cartilage-Perichondrium Composite (TCPC) graft with Temporalis Fascia (TF) graft in patients who undergoing surgery for chronic otitis media - squamous type. Patients aged 13 years and above with diagnosis of chronic otitis media - squamous type undergoing modified radical mastoidectomy, either primary or revision surgery with grafting of tympanic membrane (TM) and patients undergoing excision of postero-superior retraction pocket (PSRP) were included in this study. Patients were divided in two groups: Group A-patients undergoing TCPC graft and Group B -patients undergoing TF graft. Graft uptake results were assessed between 8-12 weeks of surgery. In both Groups there were 30 patients each. In Group A successful graft uptake was seen in 27 patients (90 %) and failure of graft uptake was seen in 3 patients(10 %). In Group B successful graft uptake was seen in 28 patients (93.3 %) and failure in 2 patients (6.67 %).Out of the total 60 patients, 11 patients had PSRP. All 6 patients with PSRP in Group A had successful graft uptake and no retraction. Among the 5 patients with PSRP in Group B all patients had sucessful graft uptake, however, in 2 patients retraction of the tympanic membrane was seen similar to the preoperative findings. There was no statistical difference (p = 0.433) between the use of temporalis fascia or tragal cartilage perichondrium in patients undergoing surgery for chronic otitis media - squamous type.

  12. Modifications in Autogenous Rib Cartilage Reconstruction of Microtia%改良法肋软骨全耳廓再造术

    Institute of Scientific and Technical Information of China (English)

    李意源; 张如鸿; 张群; 许志成; 许枫; 李大涛; 孙楠; 汪诚


    Objective To introduce the modifications in autogenous rib cartilage reconstruction of microtia, so as to present more natural and stable morphology of the reconstructed ear. Methods From 2009, 234 cases of microtia were received modified total ear reconstruction by autogenous costal cartilage. Modifications of the two-staged surgery were as follows: Decreasing the needed rib cartilage into 6~8 in donor site;Different cartilage framework in different patient;Designing a U shape cartilage block to support the complex of tragus and antitragus; The negative suction management in the second stage surgery;Using specific bone cement in the second stage surgery for ear elevation. Results All the patients were followed up for more than 6 months, most reconstructed ears were satisfiable in symmetry and stability of the three dimensional morphology and the cranio-auricular angle. Skin color and texture were favorable as well. The most common complication was reduction of the projection angle of the constructed ear caused by hypertrophic scars and severe scar contractures. Conclusion These modifications in autogenous rib cartilage reconstruction of microtia are effective and practical. So far the results of ear reconstruction are satisfactory but not in complete control.%目的:对二期法的肋软骨全耳廓再造术进行改进,以增强再造耳结构的自然性及稳定性。方法自2009起,对234例小耳畸形患者行全耳廓再造,并对肋软骨全耳廓再造法进行了系列改良,措施包括:①供区仅切取第6~8肋软骨;②根据肋软骨厚度不同,采取个性化雕刻;③耳屏对耳屏复合体下方以U型软骨块支撑;④Ⅰ期术后,对耳舟和耳甲腔进行负压管理;⑤Ⅱ期手术时使用特定形状的骨水泥支架进行支撑。结果术后患者均随访6个月以上,在耳廓的位置及三维形态、耳廓皮肤色泽、与健侧耳的对称性等方面多能达到满意效果,再造耳结构及颅

  13. Comparison of postoperative pain relief by intercostal block between pre-rib harvest and post-rib harvest groups. (United States)

    Bashir, Muhammad Mustehsan; Shahzad, Muhammad Ateeq; Yousaf, Muhammad Nadeem; Khan, Bilal Ahmad; Khan, Farid Ahmad


    To compare intercostal nerve block before and after rib harvest in terms of mean postoperative pain score and mean postoperative tramadol usage. Randomized controlled trial. Department of Plastic Surgery, Mayo Hospital, KEMU, Lahore, from January 2011 to July 2012. Patients (n = 120) of either gender with ASA class-I and II requiring autogenous costal cartilage graft were inducted. Patients having history of local anaesthetic hypersensitivity and age 60 years were excluded. Subjects were randomly assigned to pre-rib harvest (group-1) and post-rib harvest (group-2). Local anaesthetic mixture was prepared by adding 10 milliliters 2% lidocaine to 10 milliliters 0.5% bupivacaine to obtain a total 20 ml solution. Group-1 received local anaesthetic infiltration along the proposed incision lines and intercostals block before the rib harvest. Group-2 received the infiltration and block after rib harvest. Postoperative consumption of tramadol and pain scores were measured at 6 and 12 hours postoperatively using VAS. Mean age was 31.43 ± 10.78 years. The mean pain scores at 6 hours postoperatively were 1.033 ± 0.609 and 2.4667 ± 0.812 in pre-rib harvest and post-rib harvest groups respectively (p Intercostal block administered before rib harvest as preemptive strategy result in decreased postoperative pain scores and narcotic use.

  14. Bifid rib: A rare anomaly

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    Mythili Krishnan Rathinasabapathi


    Full Text Available A case of the bifid rib was found during routine bone study. The distal part of the osseous rib bifurcated into two divisions with an angle of 60°. Both divisions had their own costal cartilage. Bifid rib is a congenital abnormality of the rib cage and usually asymptomatic, often discovered incidentally on chest X-ray. Effects of this neuroskeletal anomaly can include respiratory difficulties and neurological limitations.

  15. Cartilage graft or fascia in tympanoplasty in patients with low middle ear risk index (anatomical and audological results). (United States)

    Callioglu, Elif Ersoy; Ceylan, B Tijen; Kuran, Gokhan; Demirci, Sule; Tulaci, Kamil Gokce; Caylan, Refik


    The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients with low middle ear risk index (MERI). In this retrospective study, 63 patients that underwent type 1 tympanoplasty with chondroperichondrial island graft between July 2009 and November 2010 were compared with 45 patients in whom temporal muscle fascia was used. Patients in both groups had low MERI values varying between 1 and 3. Five and nine patients underwent masteidectomy in cartilage and fascia group, respectively. Mean duration of follow-up was 11.9 ± 3.7 (5-17) months. Mean value was calculated at pre-operative and post-operative hearing threshold 0.5, 1, 2, 4 kHz, and air bone gap (ABG) gain was compared in both cartilage and fascia groups. when pre-operative and post-operative ABG gain were compared, significant decrease was seen in ABG levels (p fascia group. In both groups, age, sex, and the addition of mastoidectomy procedure had no significant effect on ABG gain and success. Cartilage is a graft material that may be preferred without concern about the effects on hearing results, especially, in patients with low MERI values. The addition of mastoidectomy had no impact on the outcome of operation and audiological results. However, further studies with larger case series may be carried out to further clarify the issue.


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    Umut Tuncel


    Conclusion: As a result, we can say that spongostan wrapped diced cartilages graft seems to be a cheap, safe and effective method for obtaining a nice nasal dorsal contouring as well as for correcting and preventing of dorsal irregularities in rhinoplasty. [J Contemp Med 2013; 3(1.000: 12-16

  17. A preclinical evaluation of an autologous living hyaline-like cartilaginous graft for articular cartilage repair: a pilot study. (United States)

    Peck, Yvonne; He, Pengfei; Chilla, Geetha Soujanya V N; Poh, Chueh Loo; Wang, Dong-An


    In this pilot study, an autologous synthetic scaffold-free construct with hyaline quality, termed living hyaline cartilaginous graft (LhCG), was applied for treating cartilage lesions. Implantation of autologous LhCG was done at load-bearing regions of the knees in skeletally mature mini-pigs for 6 months. Over the course of this study, significant radiographical improvement in LhCG treated sites was observed via magnetic resonance imaging. Furthermore, macroscopic repair was effected by LhCG at endpoint. Microscopic inspection revealed that LhCG engraftment restored cartilage thickness, promoted integration with surrounding native cartilage, produced abundant cartilage-specific matrix molecules, and re-established an intact superficial tangential zone. Importantly, the repair efficacy of LhCG was quantitatively shown to be comparable to native, unaffected cartilage in terms of biochemical composition and biomechanical properties. There were no complications related to the donor site of cartilage biopsy. Collectively, these results imply that LhCG engraftment may be a viable approach for articular cartilage repair.

  18. Maxillonasal dysplasia (Binder′s syndrome and its treatment with costal cartilage graft: A follow-up study

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    Bhatt Yogesh


    Full Text Available Maxillonasal dysplasia or Binder′s syndrome is an uncommon congenital condition characterized by a retruded mid-face with an extremely flat nose. We report here six patients with maxillonasal dysplasia whose noses were corrected with onlay costal cartilage grafts using a combined oral vestibular and external rhinoplasty approach for nasal dorsal augmentation, columellar lengthening, and premaxillary augmentation. The cartilage graft was dipped in a solution of 100 ml 0.9% NaCl and one vial (80mg gentamicin for 30 min to prevent warping. L struts made for nasal augmentation, columellar lengthening, and premaxillary augmentation were fixed to one another by slots made in the graft. This technique has been used in children, adults, and for secondary cases with promising results. All patients were of class I dental occlusion. The nasal and premaxillary augmentation which was monitored by serial photography was found to be stable over a follow-up period of three years

  19. The effect of adipose-derived stem cells on the increased survival of crushed cartilage graft in rabbits

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    Mohammad Reza Ebadi


    Full Text Available Background: In recent years the use of diced cartilage grafts in reconstructive surgery particulary rhinoplasty have been considered by most plastic surgeons. However, long-term resorption usually occurs. Stem cells are a powerful tool for reconstructive surgery to rebuild and maintain tissue with reduced complications. Since the adipose tissue-derived stem cells (ADSCs can rebuild a wide variety of tissues such as skin, fat, bone and cartilage are used, this is a very good chance for cosmetic surgery. The aim of this study was to examine the effects of adipose-derived stem cells on the viability of diced cartilage grafts. Methods: This interventional study was performed on May 2014 in animal laboratory of Hazrat Fatima Hospital on 10 New Zealand white male rabbits, weighing 2000-2500 grams, approximately 12 to 16 weeks of age. Stem cells was harvested from inguinal adipose tissue of each rabbits. After completely removing the skin and perichondrium, cartilage became divided into two equal pieces using a scalpel. Then place the ear amputation was restored by nylon 4 zero. After weighing cartilages, on either side of the center line on the back of each rabbits, left and right, subcutaneous pocket created equal weight and each piece of cartilage was placed in an envelope. Stem cells were injected in one side and the other side was control. The cartilage weights were recorded both before implantation and after explantation. Evaluation of living chondrocytes was conducted 12 weeks after implantation. Results: The mean difference of cartilage weights was varied between two groups (intervention and control sides, So that the average was significantly higher in stem cell side than that in the control side (P= 0.021. The average number of live chondrocytes was significantly higher in the intervention side than the control side (P< 0.001. Conclusion: Despite the unclear mechanism, these results suggest that adipose-derived stem cells can maintain the

  20. 多层螺旋CT骨三维重建在肋骨及肋软骨骨折的诊断价值%The Diagnostic Value of Multi-slice Spiral CT 3D Bone Reconstruction on Rib and Rib Cartilage Fractures

    Institute of Scientific and Technical Information of China (English)

    苏杨; 刘静; 王江玥


    Objective To explore the application value of multi-slice spiral CT (MSCT) three-dimensional (3D) bone reconstruction on the diagnosis of rib and rib cartilage fractures.Methods Forty-three cases of patients with chest injury were treated as the study objects. All of them underwent multi-slice spiral CT scanning. Volume rendering (VR), maximum intensity projection (MIP) and multi planar reconstruction (MPR) were used for 3D reconstruction of ribs and rib cartilage. Compared with routine CT scan, the diagnostic advantages of MSCT 3D reconstruction were analyzed.Results Forty-three cases had rib fractures, a total of 122 ribs. Single fractures accounted for 30.23% and multiple fractures accounted for 69.77%; The axillary segment of rib fracture was common, accounting for 95.65%, 15 cases had rib cartilage fractures, a total of 23, 24 cases were detected with complications by MSCT. The accuracy rate of MSCT 3D reconstruction in the diagnosis of rib and rib cartilage fractures (98.36%, 95.65%) were significantly higher than those of CT scan (72.95%, 13.04%) (P<0.05).Conclusion The accuracy of MSCT in the diagnosis of rib and cartilage fractures is high. It can be used as an ideal imaging method for the diagnosis of the disease.%目的:探讨多层螺旋CT(multi-slice spiral computed tomography, MSCT)骨三维重建在诊断肋骨及肋软骨骨折中的应用价值。方法选取43例胸部外伤患者为研究对象,均行多层螺旋CT扫描,运用容积重建(volume rendering, VR)、最大密度投影(maximum intensity projection, MIP)、多平面重建(multi planar reconstruction, MPR)三维重建肋骨及肋软骨,并与常规CT平扫对比,分析MSCT三维重建的诊断优势。结果43例肋骨骨折,共122根;其中单发骨折占30.23%,多发骨折占69.77%;肋骨骨折腋段较为常见,占95.65%;15例肋软骨骨折,共23根;MSCT检出24例外伤后并发症。MSCT三维重建技术诊断肋骨及肋软骨骨折的准确率为98

  1. Progress in Using Free Autogenous Periosteal Grafts to Repair Articular Cartilage Defects%自体游离骨膜移植修复关节软骨缺损的研究进展

    Institute of Scientific and Technical Information of China (English)



    The cambium layer of Periosteum contains undifferentiated mesenchymal cells, which have the duality into cartilage and into bone. The low tension hypoxia of articular cavity is good for the process, that periosteal becoming to cartilage, but free autologous periosteal graft to repairing articular cartilage defects is still in the exploratory stage, this article is a brief overview on the status quo of autogenous free periosteal graft repairing articular cartilage defects.

  2. Medpor as Framework for Auricle Reconstruction in Patients With Calcified Rib Cartilage%MEDPOR在肋软骨已钙化患者耳廓再造术中的应用

    Institute of Scientific and Technical Information of China (English)

    宋春琼; 敖健飞


    目的:探讨对于肋软骨已发生钙化的先天性小耳或后天性耳缺损患者,以MEDPOR作为再造耳廓支架的可行性。方法手术分为2期,1期是在残耳后埋置皮肤软组织扩张器,扩张皮瓣或瘢痕瓣。2期是以扩张皮瓣、耳后乳突区皮下筋膜瓣、残耳、MEDPOR支架、中厚皮片移植行耳廓再造术。自2009年1月---2014年1月,以此种方法行耳廓再造术34例,男性23例,女性11例,年龄32岁-61岁,均为单侧耳廓再造。结果34例耳均顺利完成二期耳廓再造手术。术后随访时间,最短2年,最长5年7个月,形态令人满意,支架无外露发生。结论对于肋软骨已发生钙化的先天性小耳或后天性耳缺损患者,MEDPOR支架是较为适合的再造耳廓支架材料。%Objective To investigate the possibility of utility of Medpor framework in ear reconstruction when fac-ing rib cartilage calcification in patients with congenital or acquired microtia. Methods Ear reconstruction was completed in two stages. In the first stage, an expander was implanted behind the remnant ear. The skin or scar flap was formed after a period of expansion. In the second stage, the expanded flap, the fascia flap in the mastoid area, the remnant ear, a Me-dorpor framework and split-thickness skin graft were utilized to reconstruct the ear. From January 2009 to January 2014, 34 patients (23 males, 11 females, aged 32 to 61 years) underwent unilateral ear reconstruction in this manner. Results All the 34 patients successfully completed the two-stage ear reconstruction. The follow-up period ranged from 2 years to 5 years and 7 months. The reconstructed ears were satisfactory to patients. No Medpor framework was exposed or extruded. Conclusion Medpor framework is suitable material in ear reconstruction when the desired rib cartilage is calcified in pa-tients with congenital or acquired microtia.

  3. 扩张耳后皮瓣联合自体肋软骨移植矫正耳甲腔型小耳畸形%Expanded post-auricular skin flap combined with autologous rib cartilage framework for correction of concha-type microtia

    Institute of Scientific and Technical Information of China (English)

    于晓波; 蒋海越; 潘博; 赵延勇; 林琳


    Objective To explore the clinical effect of the method by using an expanded postauricular skin flap combined with autologous rib cartilage framework for correction of concha-type microtia.Methods The operation were performed in three stages.The expander was implanted under post-auricular skin at the first stage and expanded skin flap was formed.At the second stage,the expander was taken out and the expanded skin flap was transferred with autologous rib cartilage framework and skin graft for correction of microtia.At the third stage,the reconstructed ear was revised and new concha was formed.Results From August 2008 to August 2011,108 cases with 113 concha-type microtia were corrected by this method.All patients healed primarily and were followed up for 6 months to 3 years.The reconstructed ears had a good appearance and position,and were symmetric to ear on the healthy sides.Conclusions Using expanded post-auricular skin flap combined with autologous rib cartilage framework is a reliable method for concha-type microtia.%目的 探讨应用耳后扩张皮瓣联合自体肋软骨支架移植矫正先天性耳甲腔型小耳畸形的临床效果.方法 手术分3期:一期制备耳后扩张皮瓣,二期扩张器取出、扩张皮瓣转移、自体肋软骨支架移植、中厚皮片移植术,三期再造耳修整,耳甲腔成形术.结果 2008年8月至2011年8月,应用上述方法修复先天性耳甲腔型小耳畸形108例113只耳,术后患者伤口均一期愈合,均获随访6个月至3年,平均12个月.患者术后再造耳廓形态良好,外耳解剖结构清晰,颅耳角位置、大小、形态与健侧基本一致.结论 扩张耳后皮瓣法联合肋软骨支架移植是修复耳甲腔型小耳畸形的一种较理想可靠的方法.

  4. Use of Interim Scaffolding and Neotissue Development to Produce a Scaffold-Free Living Hyaline Cartilage Graft. (United States)

    Lau, Ting Ting; Leong, Wenyan; Peck, Yvonne; Su, Kai; Wang, Dong-An


    The fabrication of three-dimensional (3D) constructs relies heavily on the use of biomaterial-based scaffolds. These are required as mechanical supports as well as to translate two-dimensional cultures to 3D cultures for clinical applications. Regardless of the choice of scaffold, timely degradation of scaffolds is difficult to achieve and undegraded scaffold material can lead to interference in further tissue development or morphogenesis. In cartilage tissue engineering, hydrogel is the highly preferred scaffold material as it shares many similar characteristics with native cartilaginous matrix. Hence, we employed gelatin microspheres as porogens to create a microcavitary alginate hydrogel as an interim scaffold to facilitate initial chondrocyte 3D culture and to establish a final scaffold-free living hyaline cartilaginous graft (LhCG) for cartilage tissue engineering.

  5. Preliminary clinical research with rib cartilages anomalies in patients with microtia%小耳畸形患者肋软骨发育异常的临床初步研究

    Institute of Scientific and Technical Information of China (English)

    杨美蓉; 潘博; 蒋海越; 陈威威; 李青松; 张晔; 李川


    目的 探讨小耳畸形患者肋软骨发育异常的特点及构成比.方法 对2014年11月至2015年9月行外耳再造术的230例小耳畸形患者,常规进行术前胸部CT扫描和三维重建,回顾性分析其肋软骨异常的特点及构成比.应用x2检验和Spearman分析小耳畸形和肋软骨发育异常的关系.结果 230例小耳畸形患者中合并肋软骨发育异常75例(32.6%),其中肋软骨数量异常4例(1.7%),结构异常16例(7.0%),连接异常63例(27.4%),同时合并2种类型的肋软骨异常8例(3.5%).肋软骨连接异常主要表现为第8肋软骨直接与胸骨连接(22.6%),其次为第7肋软骨未连接至胸骨(4.3%).Ⅰ、Ⅱ、Ⅲ度小耳畸形患者肋软骨发育异常的构成比分别为11.5%(3/26)、32.8 %(58/177)、51.9% (14/27).肋软骨发育异常在Ⅲ度小耳畸形中的构成比高于Ⅱ度患者,在Ⅱ度小耳畸形中的构成比高于Ⅰ度患者(P =0.007).结论 肋软骨发育异常在小耳畸形患者中构成比较高,且构成比与小耳畸形的严重程度相关,耳廓发育程度越差者伴发肋软骨发育异常的几率越大.%Objective To investigate the characteristics and constituent ratio of rib cartilages anomalies in patients with microtia.Methods We conducted a retrospective study of the clinical and imaging data of 230 consecutive patients with microtia from November 2014 to September 2015 in Plastic Surgery Hospital.Pearson x2 test and Spearman analysis were used to analyze the relationship between microtia and rib cartilages anomalies.Results A total of 75 cases (32.6%) were documented with rib cartilages anomalies,including 4 cases (1.7%) with numerical variations,16 cases (7.0%) with structural changes,63 cases (27.4%) with abnormal articulations and 8 cases with two types of anomalies.Abnormal attachment to the sternum of the eighth rib cartilages was observed frequently (18.7%),whereas 10 cases (4.7%) with the seventh rib cartilages


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    Full Text Available Temporalis fascia has long been regarded as the ideal graft material for tympanic membrane repair. However it often does not seem to withstand negative middle ear pressure in the post-operative period. Tragal cartilage with perichondrium would appear to be a better graft material with good hearing outcome. It can be obtained easily with cosmetically acceptable incision. In the present study, we have compared the graft properties of Temporalis fascia versus Tragal cartilage perichondrium with respect to healing, hearing and rate of postoperative retraction or re-perforation. 132 patients of chronic otitis media with pure conductive hearing loss were posted for tympanoplasty. Temporalis fascia graft was used in 71 patients and cartilage perichondrium (composite graft was used in 61 patients. Post-operative healing, hearing and rate of retraction or re-perforation were compared for both the graft materials. All the patients were followed up for 2 years. Patients where temporalis fascia graft was used, 60 (84.5% showed a good neotympanum, 7(9.85% had re-perforation and 5(7.04% had retraction pockets. Patients where tragal cartilage perichondrium was used, 60(98.36% showed a healed tympanic membrane and only 1(1.63% had re-perforation. None of the patients showed retraction pocket or cholestetoma. Postoperative hearing was accessed 6 months after surgery. Patients with temporalis fascia graft showed an air bone gap of less than 10 dB in 49 (82% patients and more than 10 dB in 11(18% patients. Air bone gap closure with tragal cartilage perichondrium was less than 10 dB in 45(78% patients and more than 10 dB in 13 patients (122%. Tragal cartilage perichondrium (<0.5 mm seems to be an ideal graft material for tympanic membrane in terms of postoperative healing and acoustic properties. It can easily withstand negative middle ear pressure which may have contributed to the development of otitis media and significantly affect healing outcomes in

  7. Bifid ribs observed in the third and the fourth ribs. (United States)

    Osawa, T; Sasaki, T; Matsumoto, Y; Tsukamoto, A; Onodera, M; Nara, E; Chen, J K; Fujimura, A; Nozaka, Y


    Three cases of bifid ribs were found in two cadavers during routine dissections at the Iwate Medical University School of Dentistry. All of the cases were found in the third or the fourth rib. The distal parts of the osseous rib bifurcated with an angle of 60 degrees and both of the branches had their own costal cartilage. The costal cartilage fused again to form the trunk which was connected to the sternum. The space between the two branches was filled with presumably normal intercostal muscles. Blood supply was maintained by a small branch from the interthoracic artery to the upper branches. However, the intercostal nerves did not branch toward the upper branch but only ran along the lower margins of the lower branches of the bifid ribs.

  8. Viability of porcine nasal septal cartilage grafts following Nd:YAG (n=1.32μm) laser radiation (United States)

    Chao, Kenneth K. H.; Wong, Brian J.; Kim, Hong K.; Milner, Thomas E.; Sung, Chung-Ho; Sobol, Emil N.; Nelson, J. Stuart


    Mechanically deformed morphologic cartilage grafts undergo a temperature dependent phase transformation during sustained laser irradiation that results in reshaping of the specimen. While thermal, optical, and mechanical properties of cartilage undergoing laser heating have been previously investigated, the viability of these irradiated grafts has yet to be examined closely until now. In this study, chondrocyte viability following laser irradiation was determined by measuring the incorporation of radiolabelled sulfate (Na 35SO4-2) into proteoglycan (PTG) macromolecules. Proteoglycans are highly sulfated and are the principal molecular constituents of cartilage matrix. Their synthesis directly reflects chondrocyte viability. By measuring the scintillation counts of 35SO4-2 uptake and normalizing the value by the total protein content of each specimen we can determine the level of PTG synthesis rates following laser reshaping. Regional baseline PTG synthesis rates as a function of location was determined by dividing each specimen into six regions. All regions except the most cephalic are demonstrated similar PTG synthesis rates. The most cephalic region exhibited a significantly greater PTG synthesis rates. In order to establish a positive control for this study, specimens were immersed in boiling saline water for approximately 40 minutes. The boiled specimens demonstrated a fivefold increase in normalized radioisotope uptake and suggest that the non-specific uptake of radioactive Na35SO4-2 is caused by structural alterations in the collagen matrix caused by extensive thermal exposure. To avoid this thermal artifact, another positive control was established using nitric oxide was to induce apoptosis of the chondrocytes, resulting in significantly lower PTG synthesis compared to untreated tissue. Cartilage specimens (25 X 10 X 2 mm) were irradiated with light emitted from an Nd:YAG laser (25 W/cm2, (lambda) equals 1.32 micrometer) while radiometric surface temperature

  9. Ultrasonography and Radiography Evaluation of the Cartilage Graft in Repair of Experimentally Induced Radial Bone Defect in Rabbit

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    Foad Sadi


    Full Text Available We would like to thank to the Faculty of Specialized Veterinary Sciences research council. Science and Research Branch of Islamic Azad University, Punak Tehran for approval and financial support to finish this project. Problems statement: The purpose of this research was to determine the biological effect of cartilage graft as a bone defect filler and osteogenetic stimulation to speed up bone healing too. Approach: Sixteen adult male New Zealand white rabbits having body weight ranged from 3.0-3.5 Kg. Under general anesthesia, a segmental full thickness bone defect of 10 mm in length was created in the middle of the right radial shaft in all rabbits. They were divided into two groups of 6 rabbits each. Group I was considered as control and the fractured site was fixed using finger bone plate with 4 screws, whereas the ear cartilage of 1×1 cm graft was used to fill the gap after fracture fixation in Group II. Rabbits in two groups were subdivided into 2 subgroups of 1 and 2 months duration with 4 rabbits in each. Radiography and two dimensional and color Doppler sonography were done before and after creating defects and on 15, 30 and 60 days to evaluate local reaction as far as new blood vessels network and callus formation are concerned. Results: On the radiographs during the whole process, bone repair in Group I was not as perfect as those in Group II samples and trace of internal callus filled the gap incompletely in 60 days in Group I, whereas in Group II internal callus almost was formed on 30 days and in addition intercortical callus was seen supporting to cover and filled the gap completely in this group. Sonographic findings confirmed the protrusion of newly formed blood vascular network in 30 days in Group I and from 15 days in Group II and remarkably increased till end of observation period. Conclusion: Cartilage graft is suitable alternative bone filler and radiography and sonography are reliable techniques to trace local reaction at

  10. The slipping rib syndrome in children. (United States)

    Saltzman, D A; Schmitz, M L; Smith, S D; Wagner, C W; Jackson, R J; Harp, S


    The slipping rib syndrome is an infrequent cause of thoracic and upper abdominal pain and is thought to arise from the inadequacy or rupture of the interchondral fibrous attachments of the anterior ribs. This disruption allows the costal cartilage tips to sublux, impinging on the intercostal nerves. Children with this entity are seldom described in the literature. We present a retrospective review of 12 children and young adults with slipping rib syndrome and a systematic approach for evaluation and treatment.

  11. Shear loading of costal cartilage

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    Subit, Damien


    A series of tests were performed on a single post-mortem human subject at various length scales. First, tabletop tests were performed. Next, the ribs and intercostal muscles were tested with the view to characterize the load transfer between the ribs. Finally, the costal cartilage was tested under shear loading, as it plays an important in the transfer of the load between the ribs and the sternum. This paper reports the results of dynamic shear loading tests performed on three samples of costal cartilage harvested from a single post-mortem human subject, as well as the quantification of the effective Young's modulus estimated from the amount of cartilage calcification.


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    Dhana Lakshmi


    Full Text Available Ribs are twelve pairs of elastic arches which articulate with vertebral column posteriorly and sternum anteriorly forming much of thoracic skeleton which protects the vital organs. Variations of ribs are being reported and this case report is of multiple bifid ribs observed in a male cadaver. Bifidity occurred in right 2nd, 4th ribs and in left 3rd rib. Dimensions of the foramina were measured and its way of fusion with sternum through costal cartilages were observed. Multiple bifid ribs are a rare anomaly with the incidence of 0.15% to 3.4%. Bifid rib can be a feature of Gorlin - Goltz syndrome. Its clinical importance to physicians, surgeons and radiologists were emphasized.

  13. Comparative Study of New Autologous Material, Bone-Cartilage Composite Graft (BCCG), for Ossiculoplasty with Polycel(®) and Titanium. (United States)

    Kong, Ji Sun; Jeong, Chang Yeong; Shim, Myung Joo; Kim, Woo Jin; Yeo, Sang Won; Park, Shi Nae


    Ossiculoplasty is a surgical procedure that recreates sound transmission of the middle ear in conductive hearing loss. Various materials have been used for ossicular reconstruction, but the most ideal material for ossiculoplasty remains controversial. The purpose of this study is to introduce a novel method of autologous ossiculoplasty, bone-cartilage composite graft (BCCG), and to compare its surgical results with different types of ossiculoplastic prostheses. A retrospective study was performed in a tertiary referral center. Data of 275 patients who received ossiculoplasty using the three different materials of BCCG, Polycel(®) , and titanium were analyzed according to type of ossiculoplasty: partial or total ossicular replacement prosthesis (PORP or TORP). Hearing results, complication rates, and clinical parameters including age, sex, past history, preoperative diagnosis, and surgery type were compared among different groups. Ossiculoplasty with BCCG showed satisfactory hearing outcomes and the lowest complication rate among the three different materials. In particular, its extrusion rate was 0%. We propose that the BCCG technique is a useful alternative method for ossiculoplasty, with proper patient selection. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  14. The effects of dynamic compression on the development of cartilage grafts engineered using bone marrow and infrapatellar fat pad derived stem cells. (United States)

    Luo, Lu; Thorpe, Stephen D; Buckley, Conor T; Kelly, Daniel J


    Bioreactors that subject cell seeded scaffolds or hydrogels to biophysical stimulation have been used to improve the functionality of tissue engineered cartilage and to explore how such constructs might respond to the application of joint specific mechanical loading. Whether a particular cell type responds appropriately to physiological levels of biophysical stimulation could be considered a key determinant of its suitability for cartilage tissue engineering applications. The objective of this study was to determine the effects of dynamic compression on chondrogenesis of stem cells isolated from different tissue sources. Porcine bone marrow (BM) and infrapatellar fat pad (FP) derived stem cells were encapsulated in agarose hydrogels and cultured in a chondrogenic medium in free swelling (FS) conditions for 21 d, after which samples were subjected to dynamic compression (DC) of 10% strain (1 Hz, 1 h d(-1)) for a further 21 d. Both BM derived stem cells (BMSCs) and FP derived stem cells (FPSCs) were capable of generating cartilaginous tissues with near native levels of sulfated glycosaminoglycan (sGAG) content, although the spatial development of the engineered grafts strongly depended on the stem cell source. The mechanical properties of cartilage grafts generated from both stem cell sources also approached that observed in skeletally immature animals. Depending on the stem cell source and the donor, the application of DC either enhanced or had no significant effect on the functional development of cartilaginous grafts engineered using either BMSCs or FPSCs. BMSC seeded constructs subjected to DC stained less intensely for collagen type I. Furthermore, histological and micro-computed tomography analysis showed mineral deposition within BMSC seeded constructs was suppressed by the application of DC. Therefore, while the application of DC in vitro may only lead to modest improvements in the mechanical functionality of cartilaginous grafts, it may play an important

  15. Slipping rib syndrome in childhood. (United States)

    Mooney, D P; Shorter, N A


    Slipping rib syndrome is an unusual cause of lower chest and upper abdominal pain in children not mentioned in major pediatric surgical texts. The syndrome occurs when the medial fibrous attachments of the eighth, ninth, or tenth ribs are inadequate or ruptured, allowing their cartilage tip to slip superiorly and impinge on the intervening intercostal nerve. This may cause a variety of somatic and visceral complaints. Although the diagnosis may be made based on history and physical examination, lack of recognition of this disorder frequently leads to extensive diagnostic evaluations before definitive therapy. The authors report on four children who have this disorder.

  16. MRI monitoring of autologous hyaline cartilage grafts in the knee joint: a follow-up study over 12 months; MRT-Monitoring autologer Chondrozytentransplantate im Kniegelenk: Eine Verlaufsstudie ueber 12 Monate

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    Mueller-Horvat, C.; Schick, F.; Claussen, C.D.; Groenewaeller, E. [Abt. fuer Radiologische Diagnostik, Eberhard-Karls-Univ. Tuebingen (Germany)


    Purpose: To evaluate the suitability of different MR sequences for monitoring the stage of maturation of hyaline cartilage grafts in the knee joint and the early detection of complications like hypertrophy. In addition, it was analyzed whether indirect MR arthrography can indicate debonding of the graft. Materials and Methods: MRI examinations were performed in 19 patients, aged 17-43 years, with autologous transplantation of a hyaline cartilage tissue graft after knee trauma. Examination dates were prior to transplantation to localize the defect, and 6 weeks, 3, 6 and 12 months after transplantation to control morphology and maturation of the autologous graft. Standard T2- and protondensity-weighted turbo spin echo (TSE) sequences and T1-weighted spin echo (SE) sequences were used, as well as gradient echo (GRE) sequences with and without magnetization transfer (MT) prepulses. In some cases, indirect MR arthrography was performed. Results: Cartilage defect and the hyaline cartilage graft could be detected in all 19 patients. Hypertrophy of the graft could be found early in 3 patients and debonding in 1 patient. For depicting the graft a short time after surgery. T2-weighted TSE-sequences showed the best results. Six and 12 months after transplantation, spoiled 3D-GRE-sequences like FLASH3D (fast low angle shot) showed reduced artifacts due to magnetic residues from the surgery. Difference images from GRE-sequences with and without MT pulse provided high contrast between cartilage and surrounding tissue. The quantification of the MT effect showed an assimilation of the graft to the original cartilage within 12 months. Indirect MR arthrography showed subchondral contrast medium even 12 months after transplantation in 3 patients. (orig.)

  17. Ribbing disease

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    Mukkada Philson


    Full Text Available Ribbing disease is a rare sclerosing dysplasia that involves long tubular bones, especially the tibia and femur. It occurs after puberty and is reported to be more common in women. In this article we describe how Ribbing disease can be differentiated from diseases like Engelmann-Camurati disease, van Buchem disease, Erdheim-Chester disease, osteoid osteoma, chronic osteomyelitis, stress fracture, etc.

  18. The button graft technique for perforations affecting less than 25% of the tympanic membrane: a non-randomised comparison of a new modification to cartilage tympanoplasty with underlay and overlay grafts. (United States)

    Abdelghany, A M


    To evaluate a new composite cartilage-perichondrium graft (button graft) for repair of small-sized tympanic membrane perforations and to compare its success rate with that of the underlay and overlay techniques with temporal fascia or tragal perichondrium. Prospective, sequential allocation of surgical technique study. Tertiary care university hospital. One hundred 95 patients aged 14-42 years with central, uncomplicated tympanic membrane perforations with completely visualised margins affecting less than 25% of the tympanic membrane, distributed in three groups: 1 (underlay), 2 (overlay) and 3 (button graft). Patients were allocated in sequence to: 1 underlay graft, 2 overlay graft and 3 cartilage tympanoplasty with button graft technique. Patients were operated on under local anaesthesia. Postoperative status of the tympanic membrane, hearing improvement, duration of surgery and incidence of complications at 12 months postoperative. Group 1 (underlay) had 66 patients; group 2 (overlay), 65; and group 3 (cartilage), 66. Success was defined as the complete closure of the tympanic membrane one year after the operation. The success rates were 98.5% (65 of 66), 97% (63 of 65) and 98.5% (65 of 66) cases, and the mean air-bone gap gains were 10.18 (±5.4) dB, 8.5 (+6.5) dB and 9.1 (+5.1) dB for groups 1, 2 and 3, respectively. No bone conduction threshold or speech discrimination score worsening was noted. The mean durations of the operative procedure were 35 ± 8.4 (range 22,63), 42 ± 6.8 (range 33,75) and 23 ± 6.3 (range 15,41) min for groups 1, 2 and 3, respectively (P = 0.02). Tympanic membrane retraction occurred in three cases in underlay group 1, and tympanic membrane cholesteatoma pearls occurred in two cases in overlay group 2. The button graft technique is an effective and fast alternative for the repair of small tympanic membrane perforations if complete visualisation of the margin is possible. The shorter time taken with the button grafts is mainly due to

  19. Talocalcaneal Joint Middle Facet Coalition Resection With Interposition of a Juvenile Hyaline Cartilage Graft. (United States)

    Tower, Dyane E; Wood, Ryan W; Vaardahl, Michael D


    Talocalcaneal joint middle facet coalition is the most common tarsal coalition, occurring in ≤2% of the population. Fewer than 50% of involved feet obtain lasting relief of symptoms after nonoperative treatment, and surgical intervention is commonly used to relieve symptoms, increase the range of motion, improve function, reconstruct concomitant pes planovalgus, and prevent future arthrosis from occurring at the surrounding joints. Several approaches to surgical intervention are available for patients with middle facet coalitions, ranging from resection to hindfoot arthrodesis. We present a series of 4 cases, in 3 adolescent patients, of talocalcaneal joint middle facet coalition resection with interposition of a particulate juvenile hyaline cartilaginous allograft (DeNovo(®) NT Natural Tissue Graft, Zimmer, Inc., Warsaw, IN). With a mean follow-up period of 42.8 ± 2.9 (range 41 to 47) months, the 3 adolescent patients in the present series were doing well with improved subtalar joint motion and decreased pain, and 1 foot showed no bony regrowth on a follow-up computed tomography scan. The use of a particulate juvenile hyaline cartilaginous allograft as interposition material after talocalcaneal middle facet coalition resection combined with adjunct procedures to address concomitant pes planovalgus resulted in good short-term outcomes in 4 feet in 3 adolescent patients. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Survivorship Analysis of Eighty Revised Hip Arthroplasties With the Impaction Grafting Technique Using Whole Femoral Head Allografts With the Articular Cartilage. (United States)

    Fadulelmola, Ahmed; Drampalos, Efstathios; Hodgkinson, John; Hemmady, Mukesh


    Acetabular impaction bone grafting aims to restore anatomy in hip revision surgery. This is an effective but expensive and time-consuming technique. Usually, the articular cartilage is removed from the femoral head allograft. We aimed to reproduce the same results retaining the cartilage of the allograft. Eighty acetabular revisions using impacted morselized bone graft retaining the articular cartilage and a cemented cup were studied retrospectively. Six were lost during follow-up. The mean follow-up was 6.5 years (range 1-13). Clinical and radiological assessment was made using the Oxford Hip Score, Hodgkinson's criteria for socket loosening, and the Gie classification for evaluation of allograft incorporation. Sixty-three sockets (85.1%) were considered radiologically stable (type 0, 1, and 2 demarcations), 8 (10.8%) were radiologically loose (type 3), and 3 (4.1%) presented with migration. Fifty-one (68.9%) cases showed good trabecular remodeling (grade 3), 20 (27%) showed trabecular incorporation (grade 2), and 3 (4.1%) showed poor allograft incorporation. Mean preoperative hip score was 43 and postoperative score was 28. Six (8.1%) cases presented heterotopic ossification around the revised implants, 2 patients (2.7%) had periprosthetic fractures, and 4 (5.4%) had dislocations. The Kaplan-Meier survivorship at a mean of 6.5 years with revision of the cup for any reason was 95.9% (95% confidence interval 5.6-7.5). The mid-term results of our technique are promising. Particularly when the supply of fresh-frozen allografts and surgical time is limited, using whole femoral head with articular cartilage is both safe and effective. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Rib Fractures (United States)

    ... Commentary Recent News Scientists Working on Solar-Powered Prosthetic Limbs Exercise a Great Prescription to Help Older Hearts Bavencio Approved for Rare Skin Cancer Older Mothers May Raise Better-Behaved Kids, Study ... or a collapsed lung (pneumothorax—see Traumatic Pneumothorax ). An injury that fractures the lower ribs sometimes also damages the liver (see Liver ...

  2. Cartilage storage at 4 °C with regular culture medium replacement benefits chondrocyte viability of osteochondral grafts in vitro. (United States)

    Qi, Jianhong; Hu, Zunjie; Song, Hongqiang; Chen, Bin; Xie, Di; Zhou, Lu; Zhang, Yanming


    Maintenance of articular cartilage allografts in culture media is a common method of tissue storage; however, the technical parameters of graft storage remain controversial. In this study, we examined the optimal temperature and culture medium exchange rate for the storage of osteochondral allografts in vitro. Cylindrical osteochondral grafts (n = 120), harvested from the talar joint surface of ten Boer goats, were randomly classified into four groups and stored under the following conditions: Group A1 was maintained at 4 °C in culture medium that was refreshed every 2 days; Group A2 was maintained at 4 °C in the same culture medium, without refreshing; Group B1, was maintained at 37 °C in culture medium that was refreshed every 2 days; Group B2, was maintained at 37 °C in the same culture medium, without refreshing. Chondrocyte viability in the grafts was determined by ethidium bromide/fluorescein diacetate staining on days 7, 21, and 35. Proteoglycan content was measured by Safranin-O staining. Group A1 exhibited the highest chondrocyte survival rates of 90.88 %, 88.31 % and 78.69 % on days 7, 21, and 35, respectively. Safranin O staining revealed no significant differences between groups on days 21 and 35. These results suggest that storage of osteochondral grafts at 4 °C with regular culture medium replacement should be highly suitable for clinical application.

  3. Rib overgrowth may be a contributing factor for pectus excavatum: Evaluation of prepubertal patients younger than 10years old. (United States)

    Park, Chul Hwan; Kim, Tae Hoon; Haam, Seok Jin; Lee, Sungsoo


    We compared the costal cartilage and rib length between prepubertal patients with symmetric pectus excavatum and age- and sex-matched controls without anterior chest wall depression to evaluate if rib overgrowth is a contributing factor for pectus excavatum The sample included 18 prepubertal patients ribs and costal cartilage were measured using three-dimensional volume-rendered computed tomography and curved multiplanar reformatting techniques. The rib and costal cartilage lengths, total combined rib and costal cartilage length, and costal index ([length of cartilage/length of rib]×100 [%]) at the fourth to sixth levels were compared between the groups. The rib lengths in the patient group were significantly longer than in the control group for the 6th right rib and 4th, 5th, and 6th left ribs. The costal cartilage lengths and costal indices were not different between two groups. In patients with symmetric pectus excavatum aged ribs were longer than those of controls, suggesting that abnormal rib overgrowth may be a contributing factor responsible for pectus excavatum rather than cartilage overgrowth. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. The junction between hyaline cartilage and engineered cartilage in rabbits. (United States)

    Komura, Makoto; Komura, Hiroko; Otani, Yushi; Kanamori, Yutaka; Iwanaka, Tadashi; Hoshi, Kazuto; Tsuyoshi, Takato; Tabata, Yasuhiko


    Tracheoplasty using costal cartilage grafts to enlarge the tracheal lumen was performed to treat congenital tracheal stenosis. Fibrotic granulomatous tissue was observed at the edge of grafted costal cartilage. We investigated the junction between the native hyaline cartilage and the engineered cartilage plates that were generated by auricular chondrocytes for fabricating the airway. Controlled, prospecive study. In group 1, costal cartilage from New Zealand white rabbits was collected and implanted into a space created in the cervical trachea. In group 2, chondrocytes from auricular cartilages were seeded on absorbable scaffolds. These constructs were implanted in the subcutaneous space. Engineered cartilage plates were then implanted into the trachea after 3 weeks of implantation of the constructs. The grafts in group 1 and 2 were retrieved after 4 weeks. In group 1, histological studies of the junction between the native hyaline cartilage and the implanted costal cartilage demonstrated chondrogenic tissue in four anastomoses sides out of the 10 examined. In group 2, the junction between the native trachea and the engineered cartilage showed neocartilage tissue in nine anastomoses sides out of 10. Engineered cartilage may be beneficial for engineered airways, based on the findings of the junction between the native and engineered grafts. Copyright © 2012 The American Laryngological, Rhinological and Otological Society, Inc.

  5. Costal cartilage fractures and disruptions in a rugby football player. (United States)

    Lopez, Victor; Ma, Richard; Li, Xinning; Steele, John; Allen, Answorth A


    Costal cartilage fracture of the rib cage, or costochondral, is a rare sporting injury. For contact athletes, the instability of the rib cage may lead to potential serious complications, similar to rib fractures or thorax disruption. Most authors recommend initial conservative treatment with surgery reserved for only recalcitrant cases. We report a case of an amateur American male rugby football player who sustained a costal cartilage fracture and disruption involving the anterior left fifth and sixth rib costal cartilages. The case highlights the difficulty in establishing the diagnosis based on clinical examination and standard radiographs alone. Computed tomography was used to assist in diagnosing this destabilizing injury to the rib cage. Costal cartilage fractures and disruptions in athletes are rarely reported in the literature and can have serious implications for the athlete's ability to return to play if the rib cage is destabilized.

  6. Microtia reconstruction: autologous rib and alloplast techniques. (United States)

    Cabin, Jonathan A; Bassiri-Tehrani, Michael; Sclafani, Anthony P; Romo, Thomas


    Microtia represents a spectrum of maldevelopment of the external ear. Reconstructive techniques may utilize an autogenous rib cartilage framework and require 2-4 stages; alternatively, an alloplastic framework can be used and typically requires 1-2 stages. Successful reconstruction of microtia with either technique can provide a significant quality of life improvement, and both techniques are described in this article.

  7. Ear reconstruction using autologous rib cartilage ear framework by multi-layer spliced sculpture in microtia patients%自体肋软骨多层拼接雕刻耳支架在小耳畸形耳廓成形术中的应用

    Institute of Scientific and Technical Information of China (English)

    万睿; 任军; 庞星原; 林亮; 邓裴; 汪文娟


    Objective To explore ear reconstruction using autologous rib cartilage ear framework by multi-layer spliced sculpture in microtia patients.Methods From Feb 2010 to May 2011,29 microtia patients were subjected to ear reconstruction using autologous rib cartilage ear framwork by four-layer spliced sculpture.Results In one operation 29 patients achieved 2 cm transverse height of reconstructed ears which were basically coincidence with the normal side.Patents and their families were all satisfied with the results.Follow-up of 3-12 months showed that only 1 case reconstructed-ear height was significantly lower transverse process.Owing to sleeping position,the patient did not protect the reconstructed ear,leading to frequent reconstructed-ear pressure.Conclusions The method of multi-layer spliced sculpture autologous rib cartilage ear reconstruction has good clinical effect.It can make reconstructed ear reach nomal transverse height and avoid the third rib cartilage transplant operation to continue increasing the transvers height.%目的 探索利用自体肋软骨多层拼接雕刻耳支架进行小耳畸形耳廓成形术的临床效果.方法 自2010年2月至2011年5月,对29例单侧小耳畸形患者进行自体肋软骨4层拼接雕刻耳支架耳廓成形术.结果 29例形成的外耳横突高度均一次性达到2 cm,基本与对侧外耳横突高度一致,患者及其家属均满意.随访3~12个月,仅1例再造外耳横突高度明显降低,经寻问患者,因睡觉姿势未注意保护患侧再造外耳,导致形成的外耳经常受压所致.结论 自体肋软骨多层拼接雕刻耳支架耳廓形成术临床效果好,可以使成形的外耳横实达到正常高度,从而避免在Ⅲ期手术时再次肋软骨移植以增加横突高度.

  8. A comparative study of outcome of ossiculoplasty using cartilage graft, bone and different alloplasts in chronic otitis media

    Directory of Open Access Journals (Sweden)

    Sougata Mahanty


    Full Text Available Objective: The objective was to determine which material, among autologous cartilage, autologous incus and partial ossicular replacement prosthesis (PORP, gives better postoperative hearing result in ossiculoplasty. Study Design: Nonrandomized prospective cohort (longitudinal study. Settings: Tertiary referral center. Materials and Methods: Patients were selected from outpatients department with the clinical diagnosis of chronic suppurative otitis media with cholesteatoma or granulation tissue. Patients underwent necessary preoperative investigations including pure tone audiometry (PTA. Total 67 patients were selected for this study, among them 12 patients did not fit the selection criteria and 5 patients lost during follow-up. Hence, total 50 patients were taken in the study group. Intervention: Ossiculoplasty with cartilage, incus and PORP after modified radical mastoidectomy. Main Outcome Measure: Hearing results were measured by PTA-air bone gap (PTA-ABG after 6 months of operation. Results: Selecting the criteria <20 dB ABG as success when stapes superstructure is present, cartilage has 60% success rate, incus has 73.68%, and PORP has 56.25% success. Extrusion rate of different prosthesis shows, PORP has 25%, cartilage has 20% extrusion. Incus has the lowest (5.26% extrusion rate. Conclusion: Among the ossiculoplasty materials, autologous incus gives best postoperative hearing gain and lowest extrusion rate.

  9. [Reconstruction of the external ear in children. Contribution of the clay model cartilage sculpture]. (United States)

    Disant, F; Truy, E; Kauffmann, I; Morgon, A


    The use of rib cartilage graft in ear reconstruction gives good cosmetic results after the age of 8. However three main conditions must be taken into account: 1) a perfect framework sculpture; 2) good quality of the skin in order to provide a soft tissue free of scars and able to drape the framework in all the details of the sculpture; 3) a soft but useful succion system allowing a good coaptation between the framework and the skin without vascular damage. Most of the surgical failures are due to skin scars which compromise the elasticity of the cutaneous pocket. The authors recommend to wait until the age of 8 before any surgery in order to keep the skin intact and to let the ribs grow. The problem of hearing can be treated as secondary.

  10. Fine-tuning Cartilage Tissue Engineering by Applying Principles from Embryonic Development

    NARCIS (Netherlands)

    C.A. Hellingman (Catharine)


    textabstractCartilage has a very poor capacity for regeneration in vivo. In head and neck surgery cartilage defects are usually reconstructed with autologous cartilage from for instance the external ear or the ribs. Cartilage tissue engineering may be a promising alternative to supply tissue for

  11. Rib-muscle pedicle flap for the repair of congenital tracheal stenosis. (United States)

    Willner, A; Velez, F J


    Congenital tracheal stenosis (CTS) is an uncommon congenital anomaly that presents early in life with symptoms of biphasic stridor. Most cases require surgical correction. Techniques have included dilation, resection of the involved segment, and tracheoplasty. Today pericardium and costal cartilage are the most frequently used materials for tracheoplasty, but patients still often encounter problems with the graft, with the procedure, or with late complications. This preliminary study was undertaken to determine the feasibility of a rib-intercostal muscle pedicle flap for the treatment of CTS. Tracheoplasties were performed on seven 3.5- to 5.5-kg piglets with a pedicled segment of the right fourth rib via a lateral thoracotomy incision. The method was found to be technically feasible, and pedicles of greater than 2.5 cm were easily developed. The repair provided good structural support and an airtight seal at high ventilator pressures. Histologic examination after 2 weeks showed the flap to be incorporating into the native trachea and to be without degenerative changes. This "vital" composite flap has several real and theoretic advantages over current methods of repair and may prove to be valuable in the treatment of CTS. The clinical application of this myo-osseous pedicle graft in the treatment of patients with stenoses not amenable to surgical resection and primary anastomosis should be explored.

  12. Análisis histológico de los injertos de cartílago autológos envueltos en fascia Histologic analisis of autologous cartilage graft wrapping with fascia

    Directory of Open Access Journals (Sweden)

    N.E. Cedeño Lamus


    Full Text Available Los injertos de cartílago son ampliamente utilizados en Cirugía Plástica; sin embargo, existe un riesgo potencial de reabsorción que puede comprometer los logros obtenidos. Algunos autores presentan resultados exitosos utilizando injertos de cartílago envueltos en fascia. El propósito del trabajo es aportar evidencia científica en relación a las posibles ventajas de los mismos. Realizamos un estudio descriptivo, prospectivo, experimental y comparativo de 20 ratas blancas Sprague-Dawley, desde mayo a octubre del 2007. Las unidades de muestra fueron los cortes histológicos obtenidos del cartílagos tras ser implantados durante 8 semanas. Trabajamos con 2 grupos: grupo estudio, de 10 ratas con cartílago autológo envuelto en fascia y grupo control, de 10 ratas con cartílago sólo. Se realizó examen histológico e inmunohistoquímico determinando viabilidad, reacción inflamatoria, necrosis, reabsorción y capacidad de regeneración. Los injertos de cartílago autólogo envueltos en fascia resultaron menos fiables que los injertos de cartílago solos, mostrando una mayor reabsorción (80% frente a 60%, menor capacidad de regeneración (50% frente a 80%, mayor respuesta inflamatoria (80% frente a 30%, menor viabilidad (16% frente a 38% y con necrosis (30%. El análisis estadístico no mostró diferencia significativa. En conclusión, la envoltura en fascia del injerto de cartílago autólogo no aumentó su viabilidad, ni disminuyó su reabsorción, en animales de experimentación.Cartilage grafts are widely used in Plastic Surgery; however, there is a potential risk of reasorption that may affect the results obtained. Some authors report successful achievements using cartilage grafts wrapped in fascia. The purpose of this paper is to provide scientific evidence regarding the potential benefits of cartilage grafts wrapped with fascia. A descriptive, prospective, experimental and comparative study of some 20 white Sprague-Dawley rats was

  13. A Study of the Morbidity Involved in Whole Rib Harvesting and In Situ Splitting Rib Harvesting Surgery. (United States)

    Zhang, Lu; Sun, Xiao-Ming; Jin, Rong; Shi, Yao-Ming; Sun, Bao-Shan; Zhang, Ying; Zhang, Yu-Guang


    Although there have been several reports that detail the in situ rib splitting harvesting surgical procedure, there are limited published studies evaluating this procedure and the traditional whole rib harvesting approach. In this study, the authors conducted a retrospective controlled study on the complications related to the 2 rib harvesting approaches. From March 2012 to May 2014, 24 patients were treated with rib grating, of whom 9 patients received conventional rib harvesting surgery and 15 patients received in situ splitting harvesting surgery. In all patients, a 3-dimensional computed tomography study of the chest was performed 7 days postoperatively. Postoperative complications were assessed and postoperative pain was assessed using a visual analog scale after the first 24, 48, and 72 hours after the surgery. The complication rate for in situ splitting rib harvesting was 6.67% versus 44.44% for patients treated with whole rib grafting surgery. After 48 and 72 hours, the visual analog scale scores in patients treated with in situ splitting rib grafts were significantly lower than the patients treated with traditional surgery. The in situ splitting approach for obtaining a rib results in a clinically significant reduction in complications compared with the traditional approach.

  14. A transduced living hyaline cartilage graft releasing transgenic stromal cell-derived factor-1 inducing endogenous stem cell homing in vivo. (United States)

    Zhang, Feng; Leong, Wenyan; Su, Kai; Fang, Yu; Wang, Dong-An


    Stromal cell-derived factor-1 (SDF-1), also known as a homing factor, is a potent chemokine that activates and directs mobilization, migration, and retention of certain cell species via systemic circulation. The responding homing cells largely consist of activated stem cells, so that, in case of tissue lesions, such SDF-1-induced cell migration may execute recruitment of endogenous stem cells to perform autoreparation and compensatory regeneration in situ. In this study, a recombinant adenoviral vector carrying SDF-1 transgene was constructed and applied to transduce a novel scaffold-free living hyaline cartilage graft (SDF-t-LhCG). As an engineered transgenic living tissue, SDF-t-LhCG is capable of continuously producing and releasing SDF-1 in vitro and in vivo. The in vitro trials were examined with ELISA, while the in vivo trials were subsequently performed via a subcutaneous implantation of SDF-t-LhCG in a nude mouse model, followed by series of biochemical and biological analyses. The results indicate that transgenic SDF-1 enhanced the presence of this chemokine in mouse's circulation system; in consequence, SDF-1-induced activation and recruitment of endogenous stem cells were also augmented in both peripheral blood and SDF-t-LhCG implant per se. These results were obtained via flow cytometry analyses on mouse blood samples and implanted SDF-t-LhCG samples, indicating an upregulation of the CXCR4(+)(SDF-1 receptor) cell population, accompanied by upregulation of the CD34(+), CD44(+), and Sca-1(+) cell populations as well as a downregulation of the CD11b(+) cell population. With the supply of SDF-1-recruited endogenous stem cells, enhanced chondrogenesis was observed in SDF-t-LhCG implants in situ.

  15. Hyaline cartilage degenerates after autologous osteochondral transplantation. (United States)

    Tibesku, C O; Szuwart, T; Kleffner, T O; Schlegel, P M; Jahn, U R; Van Aken, H; Fuchs, S


    Autologous osteochondral grafting is a well-established clinical procedure to treat focal cartilage defects in patients, although basic research on this topic remains sparse. The aim of the current study was to evaluate (1) histological changes of transplanted hyaline cartilage of osteochondral grafts and (2) the tissue that connects the transplanted cartilage with the adjacent cartilage in a sheep model. Both knee joints of four sheep were opened surgically and osteochondral grafts were harvested and simultaneously transplanted to the contralateral femoral condyle. The animals were sacrificed after three months and the received knee joints were evaluated histologically. Histological evaluation showed a complete ingrowth of the osseous part of the osteochondral grafts. A healing or ingrowth at the level of the cartilage could not be observed. Histological evaluation of the transplanted grafts according to Mankin revealed significantly more and more severe signs of degeneration than the adjacent cartilage, such as cloning of chondrocytes and irregularities of the articular surface. We found no connecting tissue between the transplanted and the adjacent cartilage and histological signs of degeneration of the transplanted hyaline cartilage. In the light of these findings, long-term results of autologous osteochondral grafts in human beings have to be followed critically.

  16. Evaluation and analysis of graft hypertrophy by means of arthroscopy, biochemical MRI and osteochondral biopsies in a patient following autologous chondrocyte implantation for treatment of a full-thickness-cartilage defect of the knee. (United States)

    Niemeyer, Philipp; Uhl, Markus; Salzmann, Gian M; Morscheid, Yannik P; Südkamp, Norbert P; Madry, Henning


    Graft hypertrophy represents a characteristic complication following autologous chondrocyte implantation (ACI) for treatment of cartilage defects. Although some epidemiological data suggest that incidence is associated with first-generation ACI using autologous chondrocyte implantation, it has also been reported in other technical modifications of ACI using different biomaterials. Nevertheless, it has not been described in autologous, non-periosteum, implant-free associated ACI. In addition, little is known about histological and T2-relaxation appearance of graft hypertrophy. The present case report provides a rare case of extensive graft hypertrophy following ACI using an autologous spheres technique with clinical progression over time. Detailed clinical, MR tomographic and histological evaluation has been performed, which demonstrates a high quality of repair tissue within the hypertrophic as well as non-hypertrophic transplanted areas of the repair tissue. No expression of collagen type X (a sign of chondrocyte hypertrophy), only slight changes of the subchondral bone and a nearly normal cell-matrix ratio suggest that tissue within the hypertrophic area does not significantly differ from intact and high-quality repair tissue and therefore seems not to cause graft hypertrophy. This is in contrast to the assumption that histological hypertrophy might cause or contribute to an overwhelming growth of the repair tissue within the transplantation site. Data presented in this manuscript might contribute to further explain the etiology of graft hypertrophy following ACI.

  17. Atraumatic First Rib Fracture

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    Koray Aydogdu


    Full Text Available Rib fractures are usually seen after a trauma, while atraumatic spontaneous rib fractures are quite rare. A first rib fracture identified in our 17 years old female patient who had not a history of trauma except lifting a heavy weight was examined in details in terms of the potential complications and followed-up for a long time. We presented our experience on this case with atraumatic first rib fracture that has different views for the etiology in light of the literature.

  18. Bone grafting: An overview

    Directory of Open Access Journals (Sweden)

    D. O. Joshi


    Full Text Available Bone grafting is the process by which bone is transferred from a source (donor to site (recipient. Due to trauma from accidents by speedy vehicles, falling down from height or gunshot injury particularly in human being, acquired or developmental diseases like rickets, congenital defects like abnormal bone development, wearing out because of age and overuse; lead to bone loss and to replace the loss we need the bone grafting. Osteogenesis, osteoinduction, osteoconduction, mechanical supports are the four basic mechanisms of bone graft. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. An ideal bone graft material is biologically inert, source of osteogenic, act as a mechanical support, readily available, easily adaptable in terms of size, shape, length and replaced by the host bone. Except blood, bone is grafted with greater frequency. Bone graft indicated for variety of orthopedic abnormalities, comminuted fractures, delayed unions, non-unions, arthrodesis and osteomyelitis. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. By adopting different procedure of graft preservation its antigenicity can be minimized. The concept of bone banking for obtaining bone grafts and implants is very useful for clinical application. Absolute stability require for successful incorporation. Ideal bone graft must possess osteogenic, osteoinductive and osteocon-ductive properties. Cancellous bone graft is superior to cortical bone graft. Usually autologous cancellous bone graft are used as fresh grafts where as allografts are employed as an alloimplant. None of the available type of bone grafts possesses all these properties therefore, a single type of graft cannot be recomm-ended for all types of orthopedic abnormalities. Bone grafts and implants can be selected as per clinical problems, the equipments available and preference of

  19. Engineering Cartilage (United States)

    ... Research Matters NIH Research Matters March 3, 2014 Engineering Cartilage Artistic rendering of human stem cells on ... situations has been a major goal in tissue engineering. Cartilage contains water, collagen, proteoglycans, and chondrocytes. Collagens ...

  20. The importance of costal cartilage framework stabilization in microtia reconstruction: anthropometric comparison based on 216 cases. (United States)

    Xu, Zhicheng; Zhang, Ruhong; Zhang, Qun; Xu, Feng; Li, Datao


    This study explored anthropometric changes in the reconstructed auricle and the contralateral normal ear in a series of 216 microtia patients using different stabilization methods. Our main personal modifications concerning the preparation of the framework were the following: 1. The individualized framework grafting was based on patients with different ages and different degrees of the strength and thickness of the rib cartilage. 2. The framework was stabilized as a "C" shape by using a piece of cartilage or suture to reinforce the two end points of the "C". In group A (the thickness of cartilage was more than 5 mm), a block of residual cartilage fixed by wire was added between the tragus and the base frame of the inferior crus by the modified method but was not applied in the original method. In group B (the thickness of cartilage was less than 5 mm), a 4-0 braided suture was used to reinforce the two structures but was not used in the original method. No significant differences were found in the height or width measurements of the cartilage framework and the contralateral normal side in either group at the time of implantation. At the follow-up, the height and width measurements were obviously increased in both groups operated on by the original method compared with the initial implanted or contralateral normal measurements. There were no significant differences in the height or width measurements by the modified method in either group. The authors' techniques produced acceptable results and generated some useful parameters for the growth study of the reconstructed auricle and the contralateral normal ear. The modifications in framework stabilization allow a harmonious outline of the reconstructed auricle to be attained, which is almost symmetrical to the contralateral normal auricle.

  1. 自体耳软骨移植在鼻尖成形术中的临床应用分析%Clinical application analysis of auto-ear cartilage graft on the nasorostral region

    Institute of Scientific and Technical Information of China (English)

    沈正宇; 朱善智


    目的:介绍自体耳软骨移植在鼻尖部美容术中的应用体会.方法:针对外鼻短小,鼻尖低平、肥大圆钝,以及部分假体隆鼻术后效果不佳的病例,在隆鼻时切除鼻翼软骨外侧脚上外侧部,并水平褥式缝合,将内侧脚也行缝合,以缩小鼻小柱宽度及延长鼻小柱;切取自体耳软骨,用以抬高及延长鼻尖.结果:本组25例患者,均随访3~6个月,鼻尖外形、颜色均满意,无假体在鼻尖部和切口处穿孔.供区耳廓外形无改变.结论:自体耳软骨移植鼻成形术其方法较好,效果明显,值得在临床上推广应用.%Objective To introduce the application of auto-ear cartilage grafting in beauty culture on the nasorostral region. Methods Augmentation rhinopiasty was performed on patients with a short nose with a low,flat,blunt break point,or unsatisfactory postoperative result of previous nasal surgery,At the same time the upper lateral part of the nasal ala cartilage was cut to reduce the width and lengthen the nasal columella.and autogenous ear cartilage was grafted to raise and extend the break point. Results Twenty-five cases in this group had been followed up for 3~6months,and the appearance.colour of the nose were satisfactory and no penetration of prosthesis was found in the nasorotral region and incision .In addition,the appearance of the pinna in the donor site had no change. Conclusion Augmentation rhinopiasty with an autogenous ear cartilage graft is good method to improve the nasal deserves more widespread use.

  2. Limited integrative repair capacity of native cartilage autografts within cartilage defects in a sheep model. (United States)

    Gelse, Kolja; Riedel, Dominic; Pachowsky, Milena; Hennig, Friedrich F; Trattnig, Siegfried; Welsch, Götz H


    The purpose of this study was to investigate integration and cellular outgrowth of native cartilage autografts transplanted into articular cartilage defects. Native cartilage autografts were applied into chondral defects in the femoral condyle of adult sheep. Within the defects, the calcified cartilage layer was either left intact or perforated to induce bone marrow stimulation. Empty defects served as controls. The joints were analyzed after 6 and 26 weeks by macroscopic and histological analysis using the ICRS II Score and Modified O'Driscoll Scores. Non-treated defects did not show any endogenous regenerative response and bone marrow stimulation induced fibrous repair tissue. Transplanted native cartilage grafts only insufficiently integrated with the defect borders. Cell death and loss of proteoglycans were present at the margins of the grafts at 6 weeks, which was only partially restored at 26 weeks. Significant cellular outgrowth from the grafts or defect borders could not be observed. Bonding of the grafts could be improved by additional bone marrow stimulation providing ingrowing cells that formed a fibrous interface predominantly composed of type I collagen. Transplanted native cartilage grafts remain as inert structures within cartilage defects and fail to induce integrative cartilage repair which rather demands additional cells provided by additional bone marrow stimulation. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  3. Sternoplasty and rib distraction in neonatal Jeune syndrome.

    LENUS (Irish Health Repository)

    Conroy, Eimear


    A 12-week-old boy with Jeune syndrome (asphyxiating thoracic dystrophy) was referred to the orthopaedic unit with progressive respiratory failure, recurrent respiratory tract infections, and recurrent admissions to the intensive care unit for ventilatory support. His chest x-ray revealed a small and narrow thoracic cage with short broad ribs and abnormal costal cartilages. His chest expansion was impaired by the short, horizontally positioned ribs resulting in alveolar hypoventilation. Without surgical intervention to expand his thoracic cage, he would die of respiratory failure.

  4. Dorsal Augmentation with Septal Cartilage


    Murrell, George L.


    Deficiency of nasal dorsal projection may be inherent or acquired. Repair is most commonly performed with an onlay graft. When nasal septal cartilage is available, it is the author's preferred source for graft material. It is important to realize that dorsal augmentation is an operation performed for aesthetic not functional reasons. As such, patients understandably scrutinize their postoperative result, and attention to detail in all aspects of the surgery is critical in achieving a favorabl...

  5. Spontaneous rib fractures. (United States)

    Katrancioglu, Ozgur; Akkas, Yucel; Arslan, Sulhattin; Sahin, Ekber


    Other than trauma, rib fracture can occur spontaneously due to a severe cough or sneeze. In this study, patients with spontaneous rib fractures were analyzed according to age, sex, underlying pathology, treatment, and complications. Twelve patients who presented between February 2009 and February 2011 with spontaneous rib fracture were reviewed retrospectively. The patients' data were evaluated according to anamnesis, physical examination, and chest radiographs. The ages of the patients ranged from 34 to 77 years (mean 55.91 ± 12.20 years), and 7 (58.4%) were male. All patients had severe cough and chest pain. The fractures were most frequently between 4th and 9th ribs; multiple rib fractures were detected in 5 (41.7%) patients. Eight (66.7%) patients had chronic obstructive pulmonary disease, 2 (16.7%) had bronchial asthma, and 2 (16.7%) had osteoporosis. Bone densitometry revealed a high risk of bone fracture in all patients. Patients with chronic obstructive pulmonary disease or bronchial asthma had been treated with high-dose steroids for over a year. Spontaneous rib fracture due to severe cough may occur in patients with osteoporosis, chronic obstructive pulmonary disease, or bronchial asthma, receiving long-term steroid therapy. If these patients have severe chest pain, chest radiography should be performed to check for bone lesions. © The Author(s) 2015.

  6. Tissue engineering strategies to study cartilage development, degeneration and regeneration. (United States)

    Bhattacharjee, Maumita; Coburn, Jeannine; Centola, Matteo; Murab, Sumit; Barbero, Andrea; Kaplan, David L; Martin, Ivan; Ghosh, Sourabh


    Cartilage tissue engineering has primarily focused on the generation of grafts to repair cartilage defects due to traumatic injury and disease. However engineered cartilage tissues have also a strong scientific value as advanced 3D culture models. Here we first describe key aspects of embryonic chondrogenesis and possible cell sources/culture systems for in vitro cartilage generation. We then review how a tissue engineering approach has been and could be further exploited to investigate different aspects of cartilage development and degeneration. The generated knowledge is expected to inform new cartilage regeneration strategies, beyond a classical tissue engineering paradigm.

  7. Multislice computed tomography of the first rib: a useful technique for bone age assessment. (United States)

    Moskovitch, Guillaume; Dedouit, Fabrice; Braga, José; Rougé, Daniel; Rousseau, Hervé; Telmon, Norbert


    Macroscopic study of the first rib has been described by Kunos et al. as an efficient method of age estimation. We retrospectively reviewed a test sample of 160 first right ribs obtained from multislice computed tomography (MSCT) clinical investigations of living individuals aged 15-30 years old. Based on the descriptions of Kunos et al., we analyzed the morphological appearance of the sternal end of the first rib on two- and three-dimensional MSCT reconstructions and defined changes in appearance in stages (from 2 to 5). We also studied the calcification and ossification of the costal cartilage as an independent feature. By statistical analysis (ANOVA), we determined for each gender the correlation between the estimated stage of the costal face, the appearance of the costal cartilage, and the documented age of the subjects. We demonstrated that MSCT of the first rib appears to be an efficient noninvasive modality for bone age estimation.

  8. Estudo experimental comparativo entre o butil-2-cianoacrilato, a mistura gelatina-resorcina-formaldeído e sutura na estabilização de enxertos de cartilagem em coelhos Comparison of butyl-2-cyanocrylate, gelatin-resorcin-formaldehyde (GRF compound and suture in stabilization of cartilage grafts in rabbits

    Directory of Open Access Journals (Sweden)

    Heloisa Juliana Zabeu Rossi Costa


    Full Text Available Os enxertos de cartilagem constituem-se em boa opção técnica para aprimoramento das rinoplastias. Procura-se um material para sua fixação que seja de simples manuseio, e que provoque mínima reação tecidual. OBJETIVO: Comparar o uso do butil-2-cianoacrilato, mistura gelatina-resorcina-formaldeído (GRF e sutura na estabilização de enxertos de cartilagem em coelhos. FORMA DE ESTUDO: Experimental. MATERIAL E MÉTODO: Utilizaram-se 15 coelhos adultos da raça Nova Zelândia machos, de cujas orelhas foram ressecados 6 enxertos de cartilagem, fixados no periósteo da calvária e unidos dois a dois com sutura, GRF e cianoacrilato. Após 2, 6 e 12 semanas, grupos de 5 coelhos foram sacrificados e realizou-se avaliação da distância de deslocamento do enxerto e análise histológica do processo inflamatório tecidual e da adesão/deformidade das cartilagens. RESULTADOS: Houve deslocamento menor nas fixadas com GRF do que com cianoacrilato e sutura. O processo inflamatório foi maior nos animais de 2 semanas, decaindo até restar pequeno grau de fibrose em 12 semanas, de modo semelhante nas 3 fixações. Não houve descolamento nem deformidade em nenhuma dupla de cartilagens fixada com sutura e o maior número de cartilagens descoladas e deformadas se deu com o cianoacrilato. O número de cartilagens deformadas foi diretamente proporcional ao número de descoladas. Os dados foram significativos estatisticamente (pCartilage grafting is an interesting option for rinoplasties refinements. AIM: to compare butyl-2-cyanocrylate, compound gelatin-resorcin-formaldeyide (GRF and suture control to determine the efficacy of these tissue glue preparations in securing grafted cartilage. STUDY DESIGN: Experimental. METHODS: Fifteen male adult New Zealand rabbits were submitted to a surgical procedure to harvest 6 auricular cartilage grafts from each animal. 2 of these grafts in each animal were glued together with butyl-2-cyanocrylate, 2 with compound

  9. EFICACIA TERAPÉUTICA DE LA TIMPANOPLASTIA VÍA TRASCANAL CON INJERTO DE CARTÍLAGO Y PERICONDRIO Therapeutic efficacy of tympanoplasty with cartilage and perichondrium graft by transcanal way

    Directory of Open Access Journals (Sweden)

    Manuel Tomás Pérez Arana


    Full Text Available Antecedentes . La timpanoplastia es un procedimiento muy utilizado en el tratamiento quirúrgico de las perforaciones timpánicas que presenta variaciones en sus técnicas e injertos, por lo cual es importante evaluar los resultados de eficacia de la técnica quirúrgica empleada. Objetivo . Conocer las características clínicas y la eficacia terapéutica en los pacientes sometidos a timpanoplastia tipo I con injerto de cartílago y pericondrio por vía transcanal y técnica medial-lateral. Material y métodos . Estudio retrospectivo de una serie de casos, con aplicación de un formulario para recolección de datos de la historia clínica y analizados con Epi - Info 6.04. Resultados . Se incluyeron 67 pacientes de los cuales, en 50 pacientes hubo integración total del injerto (74.6% y en 17 (25,4% no hubo integración. En 41 pacientes (61.2% hubo mejoría subjetiva de la audición y en 26 (38.8% no la hubo. Conclusión . La timpanoplastia tipo I en nuestro medio, con injerto de cartílago y pericondrio muestra un buen porcentaje de eficacia en el cierre de las perforaciones timpánicas junto con una mejoría subjetiva de la audición .Background . Tympanoplasty is a frecuent surgery made with different techniques and grafts. It‘s important to know results of every method to evaluate efficacy. Objective . To know clinic characteristics and therapeutic efficacy outcome in patients who underwent tympanoplasty type I with cartilage and perichondrium graft by transcanal way and lateral middle. Materials and methods . Retrospective case series using form application of information harvest of the clinical history analized with Epi -info 6.04. Results . The study included 67 patients; in 50 patients there was total integration of the graft (74.6%, in 17 (25.4% there wasn't integration. In 41 patients (61.2% there was a subjective improvement of the audition and in 26 (38.8% there wasn't . Conclusions . The results of tympanoplasty tipe I in our

  10. Nonspecific otalgia: Indication for cartilage tympanoplasty

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    Rauf Ahmad


    Full Text Available Introduction: Myringoplasty and tympanoplasty are commonly performed otologic surgical procedures. The aim of this study was to analyze the influence of nonspecific otalgia on the successful autologous conchal cartilage and temporalis fascia graft take up in type-1 tympanoplasty. Materials and Methods: A total of 250 adult patients who met the inclusion criteria were enrolled for this study. Patients were placed in two groups (otalgia and nonotalgia group depending upon the history of otalgia. Patients in both groups were operated (type-1 tympanoplasty using randomly either temporalis fascia or conchal cartilage as the graft material. Follow-up of patients was done after 3 weeks, 6 weeks, and 3 months of surgery to check the status of graft take up. Result: Our study shows that patients in otalgia group in which autologous temporalis fascia was used as the graft material, the majority of patients had graft necrosis by 3 months after surgery (9.6% success only. Whereas patients of the same group in which autologous conchal cartilage was used as the graft material, successful graft take up was in 93.5% patients after 3 months of surgery. Our study shows that there was not much difference in using autologous temporalis fascia or autologous conchal cartilage on successful graft take up in nonotolgia group of patients, with success rate of 97.89% and 97.84%, respectively.

  11. Improved cartilage integration and interfacial strength after enzymatic treatment in a cartilage transplantation model

    NARCIS (Netherlands)

    J. van de Breevaart Bravenboer; C.D. in der Maur; L. Feenstra (Louw); J.A.N. Verhaar (Jan); H.H. Weinans (Harrie); G.J.V.M. van Osch (Gerjo); P.K. Bos (Koen)


    textabstractThe objective of the present study was to investigate whether treatment of articular cartilage with hyaluronidase and collagenase enhances histological and mechanical integration of a cartilage graft into a defect. Discs of 3 mm diameter were taken from 8-mm diameter bo

  12. Outcomes after operative management of symptomatic rib nonunion. (United States)

    Gauger, Erich M; Hill, Brian W; Lafferty, Paul M; Cole, Peter A


    To report the outcomes of rib reconstruction after painful nonunion. Retrospective case series. Level I trauma center. Between November 2007 and May 2013, 10 patients who presented with 16 rib nonunions and disabling pain were treated with reconstruction of their nonunited rib fractures. Rib nonunion reconstruction predominately with iliac crest bone graft and a tension band plate with a locked precontoured plating system for ribs. Demographic data, mechanism of injury, and number of rib nonunions were recorded. Operative procedure, length of follow-up, complications, Short Form Survey 36, and a patient questionnaire were also captured and documented. Eight of the 10 patients sustained their original fractures from a fall. Outcomes were available for the 10 patients at a mean follow-up of up of 18.6 months (range, 3-46 months). All 16 ribs went on to union with a mean time from reconstruction to union of 14.7 weeks (range, 12-24 weeks). At final follow-up, the mean mental and physical component Short Form Survey 36 scores were 54.4 and 43.5, respectively. Eight of the 10 patients were able to return to work and/or previous activities without limitations. Complications included 1 wound infection that resolved after irrigation and debridement with adjunctive antibiotics. One symptomatic implant was removed. Ten patients with 16 symptomatic rib nonunions were reconstructed using autologous bone graft and implant/mesh fixation manifesting in successful union with improved patient function and a low rate of complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  13. Elastic cartilage reconstruction by transplantation of cultured hyaline cartilage-derived chondrocytes. (United States)

    Mizuno, M; Takebe, T; Kobayashi, S; Kimura, S; Masutani, M; Lee, S; Jo, Y H; Lee, J I; Taniguchi, H


    Current surgical intervention of craniofacial defects caused by injuries or abnormalities uses reconstructive materials, such as autologous cartilage grafts. Transplantation of autologous tissues, however, places a significant invasiveness on patients, and many efforts have been made for establishing an alternative graft. Recently, we and others have shown the potential use of reconstructed elastic cartilage from ear-derived chondrocytes or progenitors with the unique elastic properties. Here, we examined the differentiation potential of canine joint cartilage-derived chondrocytes into elastic cartilage for expanding the cell sources, such as hyaline cartilage. Articular chondrocytes are isolated from canine joint, cultivated, and compared regarding characteristic differences with auricular chondrocytes, including proliferation rates, gene expression, extracellular matrix production, and cartilage reconstruction capability after transplantation. Canine articular chondrocytes proliferated less robustly than auricular chondrocytes, but there was no significant difference in the amount of sulfated glycosaminoglycan produced from redifferentiated chondrocytes. Furthermore, in vitro expanded and redifferentiated articular chondrocytes have been shown to reconstruct elastic cartilage on transplantation that has histologic characteristics distinct from hyaline cartilage. Taken together, cultured hyaline cartilage-derived chondrocytes are a possible cell source for elastic cartilage reconstruction. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Z Moinfar


    Full Text Available Short rib polydactyly syndrome (SRPS is a very rare congenital anomaly that is classified into four subtypes. It is an autosomal recessive inherited disease. We report a case of this syndrome without a previous family history of congenital defects.

  15. Left Rib Pain - Football

    National Research Council Canada - National Science Library

    Ireland, M; Zimmerman, E


    .... His ribs healed uneventfully, on requestioning him, family history is significant in that patient's father had polycystic kidney disease and died of cancer. He has two brothers who were checked for polycystic kidney disease. All immediate family members tested negative for polycystic kidney disease.

  16. Injerto columelar extendido angulado. Método para prevenir la rotación cefálica y lateral de los injertos de cartílago en la punta nasal Angulated extended collumelar graft. A method to prevent the cephalic and lateral rotation of the cartilage graft in the nasal tip

    Directory of Open Access Journals (Sweden)

    Y. Castro Govea


    Full Text Available El paciente mestizo generalmente posee una nariz pequeña, de base ancha, con fosas nasales redondas y dorso convexo. Los cartílagos alares son débiles, delgados y cortos, proporcionando un soporte estructural deficiente y pobre definición de la punta nasal. Los injertos de cartílago de la punta nasal se usan frecuentemente para corregir esta condición; sin embargo un problema común es la rotación cefálica, caudal y lateral de estos cartílagos. Empleamos un injerto columelar extendido angulado (ICEA para proporcionar elongación y soporte columelar; la extensión angulada nos brinda a su vez un mejor control y predicción de la posición de los injertos de la punta nasal al prevenir su desplazamiento cefálico y lateral. El protocolo quirúrgico empleado incluyó historia clínica completa, desarrollo de un plan quirúrgico mediante análisis de la deformidad y fotografías pre y postoperatorias para el control de los pacientes a medio y largo plazo. Tratamos 95 pacientes usando este procedimiento; 75 con rinoplastia abierta y 20 con técnica cerrada. El rango del periodo de seguimiento fue de 6 meses a 4 años. Los resultados obtenidos fueron satisfactorios, mostrando mejor control y predicción de la forma de la punta nasal. En conclusión, creemos que el injerto columelar extendido angulado proporciona un mejor control de la proyección y angularidad de los injertos colocados en la punta nasal.The mestizo patient usually has a small nose, with wide base, round nostrils and convex dorsum. The alar cartilages are weak, thin and short, providing a deficient structural support and poor definition of the nasal tip. Cartilage graft in the nasal tip are very often used to correct this condition, but a commun problem of this procedure is the cephalic or lateral rotation of these grafts. We used an angulated extended collumalar graft to give collumelar support and elongation. The angulated extension of the graft provides a better control and

  17. Tumors of the ribs: experience with 47 cases. (United States)

    Andrianopoulos, E G; Lautidis, G; Kormas, P; Karameris, A; Lahanis, S; Papachristos, I; Kaselouris, C; Argyropoulos, A


    To emphasise the existing difficulties in differentiating benign from malignant rib tumours, and especially the problems that a clinical doctor encounters when dealing with a hyperplastic rib. Forty-seven patients with rib tumour underwent surgery in a period of 12 years (1984-1996). In 40 cases (85%), the lesion was benign and in seven (15%) was malignant. Twenty-one benign tumours originated from cartilage and bone, seven were inflammatory, six originated from the bone marrow, and minor percentages (2.5-5%) had vascular, neurogenous, degenerative or miscellaneous origin. Three of the malignant tumours were primary chondrosarcomas and two were metastatic from kidney. The rest were metastatic from stomach (adeno-Ca), and skin (melanoma). The mean age in the benign group was 25.2 years and in the primary malignant group was 20.7 years. Related symptoms were pain (47%) and swelling (42.5%). One-third (32%) of the patients were asymptomatic and the lesion was accidentally found during routine chest radiography. All patients were treated surgically with wide excision of the tumour and the diagnosis was established histologically. Resection was complete and curative in all cases without recurrence. Since the likelihood of malignancy cannot be excluded, all rib tumours should be considered malignant until proven otherwise. Therefore, prompt intervention is necessary and wide and radical initial excision of the involved rib is advocated.

  18. Cough-induced rib fractures. (United States)

    Sano, Atsushi; Tashiro, Ken; Fukuda, Tsutomu


    Occasionally, patients who complain of chest pain after the onset of coughing are diagnosed with rib fractures. We investigated the characteristics of cough-induced rib fractures. Between April 2008 and December 2013, 17 patients were referred to our hospital with chest pain after the onset of coughing. Rib radiography was performed, focusing on the location of the chest pain. When the patient had other signs and symptoms such as fever or persistent cough, computed tomography of the chest was carried out. We analyzed the data retrospectively. Rib fractures were found in 14 of the 17 patients. The age of the patients ranged from 14 to 86 years (median 39.5 years). Ten patients were female and 4 were male. Three patients had chronic lung disease. There was a single rib fracture in 9 patients, and 5 had two or more fractures. The middle and lower ribs were the most commonly involved; the 10th rib was fractured most frequently. Cough-induced rib fractures occur in every age group regardless of the presence or absence of underlying disease. Since rib fractures often occur in the lower and middle ribs, rib radiography is useful for diagnosis. © The Author(s) 2015.

  19. Nineth Rib Syndrome after 10(th) Rib Resection. (United States)

    Yu, Hyun Jeong; Jeong, Yu Sub; Lee, Dong Hoon; Yim, Kyoung Hoon


    The 12(th) rib syndrome is a disease that causes pain between the upper abdomen and the lower chest. It is assumed that the impinging on the nerves between the ribs causes pain in the lower chest, upper abdomen, and flank. A 74-year-old female patient visited a pain clinic complaining of pain in her back, and left chest wall at a 7 on the 0-10 Numeric Rating scale (NRS). She had a lateral fixation at T12-L2, 6 years earlier. After the operation, she had multiple osteoporotic compression fractures. When the spine was bent, the patient complained about a sharp pain in the left mid-axillary line and radiating pain toward the abdomen. On physical examination, the 10(th) rib was not felt, and an image of the rib-cage confirmed that the left 10(th) rib was severed. When applying pressure from the legs to the 9(th) rib of the patient, pain was reproduced. Therefore, the patient was diagnosed with 9(th) rib syndrome, and ultrasound-guided 9(th) and 10(th) intercostal nerve blocks were performed around the tips of the severed 10(th) rib. In addition, local anesthetics with triamcinolone were administered into the muscles beneath the 9(th) rib at the point of the greatest tenderness. The patient's pain was reduced to NRS 2 point. In this case, it is suspected that the patient had a partial resection of the left 10(th) rib in the past, and subsequent compression fractures at T8 and T9 led to the deformation of the rib cage, causing the tip of the remaining 10(th) rib to impinge on the 9(th) intercostal nerves, causing pain.

  20. The effect of calcification on the structural mechanics of the costal cartilage. (United States)

    Forman, Jason L; Kent, Richard W


    The costal cartilage often undergoes progressive calcification with age. This study sought to investigate the effects of calcification on the structural mechanics of whole costal cartilage segments. Models were developed for five costal cartilage specimens, including representations of the cartilage, the perichondrium, calcification, and segments of the rib and sternum. The material properties of the cartilage were determined through indentation testing; the properties of the perichondrium were determined through optimisation against structural experiments. The calcified regions were then expanded or shrunk to develop five different sensitivity analysis models for each. Increasing the relative volume of calcification from 0% to 24% of the cartilage volume increased the stiffness of the costal cartilage segments by a factor of 2.3-3.8. These results suggest that calcification may have a substantial effect on the stiffness of the costal cartilage which should be considered when modelling the chest, especially if age is a factor.

  1. Shark cartilage (United States)

    ... sarcoma, that is more common in people with HIV infection. Shark cartilage is also used for arthritis, psoriasis, ... Neovastat) by mouth seems to increase survival in patients with advanced kidney cancer (renal cell carcinoma). This product has FDA “Orphan Drug ...

  2. Rib-sparing internal mammary vessel harvest for microvascular breast reconstruction in 100 consecutive cases. (United States)

    Sacks, Justin M; Chang, David W


    Using the internal mammary vessels as recipient vessels in free-flap autologous breast reconstruction has become a common practice. However, these vessels are typically accessed by removing a costochondral segment. The purpose of this study was to describe the authors' rib-sparing technique for accessing the internal mammary vessels that is efficient and reliable and limits chest wall morbidity. The authors analyzed 100 consecutive free-tissue transfers for breast reconstruction in which the internal mammary vessels were accessed using a rib-sparing technique. The data were obtained from a prospectively maintained database and medical records. Of the 100 free-flap reconstructions, 47 used deep inferior epigastric perforator flaps, 45 used muscle-sparing transverse rectus abdominis myocutaneous flaps, six used superficial inferior epigastric artery flaps, and two used superior gluteal artery perforator flaps. No rib cartilage was removed in 66, but a segment of rib cartilage was removed in 34 procedures to optimize the exposure and facilitate anastomosis. After the initial learning curve, however, the internal mammary vessels were used in approximately 90 percent of cases without removal of any rib cartilage. The third intercostal space was used to access the internal mammary vessels two-thirds of the time, and the second intercostal space was used one-third of the time. There were no incidences of complications or morbidity associated with the rib-sparing approach to internal mammary vessel harvest. For most patients, the rib-sparing technique is an efficient and safe approach for exposing the internal mammary vasculature for microvascular breast reconstruction while minimizing chest wall morbidity.

  3. Which cartilage is regenerated, hyaline cartilage or fibrocartilage? Non-invasive ultrasonic evaluation of tissue-engineered cartilage. (United States)

    Hattori, K; Takakura, Y; Ohgushi, H; Habata, T; Uematsu, K; Takenaka, M; Ikeuchi, K


    To investigate ultrasonic evaluation methods for detecting whether the repair tissue is hyaline cartilage or fibrocartilage in new cartilage regeneration therapy. We examined four experimental rabbit models: a spontaneous repair model (group S), a large cartilage defect model (group L), a periosteal graft model (group P) and a tissue-engineered cartilage regeneration model (group T). From the resulting ultrasonic evaluation, we used %MM (the maximum magnitude of the measurement area divided by that of the intact cartilage) as a quantitative index of cartilage regeneration. The results of the ultrasonic evaluation were compared with the histological findings and histological score. The %MM values were 61.1 +/- 16.5% in group S, 29.8 +/- 15.1% in group L, 36.3 +/- 18.3% in group P and 76.5 +/- 18.7% in group T. The results showed a strong similarity to the histological scoring. The ultrasonic examination showed that all the hyaline-like cartilage in groups S and T had a high %MM (more than 60%). Therefore, we could define the borderline between the two types of regenerated cartilage by the %MM.

  4. Rib metastases from a non-tonsillar squamous cell carcinoma in a dog. (United States)

    Clarke, B S; Mannion, P A; White, R A S


    Metastatic spread to the ribs in a 15-year-old, male, neutered, Irish setter is reported occurring secondary to an oral squamous cell carcinoma (SCC). The dog presented with a history of a rapidly growing SCC of the right upper incisive region, which was confirmed by histopathology as a SCC. Thoracic radiographs showed bony lesions associated with the body of the right third rib, and the fifth and seventh costal cartilages. A rostral partial maxillectomy was performed as palliative treatment for the oral mass and a core biopsy of the lesion on the third rib was performed. The rib lesion was identified histopathologically as a metastatic SCC. A review of the literature of oropharyngeal SCC and the metastatic potential of non-tonsillar SCC is presented, in particular metastatic bone disease. This case report suggests possible implications of metastatic bone disease for treatment and prognosis for future cases of non-tonsillar SCC.

  5. Chondroblastoma of rib : case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Hun; Kim, Kyung Rae; Ryu, Sang Wan [Kwangju Hospital, Kwangju (Korea, Republic of)


    Chondroblastoma is an uncommon, benign, cartilaginous neoplasm originating in an epiphysis or apophysis of a long tubular bone. The rib is an unusual site for chondroblastoma. The authors describe a case of chondroblastoma of the rib and present a brief review of the literature.

  6. Human conchal cartilage and temporal fascia: an evidence-based roadmap from rhinoplasty to an in vivo study and beyond. (United States)

    Cimpean, Anca Maria; Crăiniceanu, Zorin; Mihailovici, Dorina; Bratu, Tiberiu; Raica, Marius


    Conchal cartilage or cartilage/ temporal fascia composite grafting (DC-F) used for rhinoplasty is applied by plastic surgeons for reconstructive purposes. Previous studies on experimental models such as mice or rabbits have elucidated on the late events following grafting, with tissue specimens being harvested two months after implantation. Early microscopic and molecular events following DC-F grafting are completely unknown. We designed a chick embryo chorioallantoic membrane model for human grafts study, regarding the dynamic observation of graft survival and its mutual interrelation with the chick embryo chorioallantoic membrane microenvironment. The DC-F graft preserved its cartilage component in a normal state compared to cartilage graft-only because of protective factors provided by temporal fascia. Its strong adherence to the cartilage, lack of angiogenic factors and high content of collagen IV-derived fragments with anti-angiogenic effects make the temporal fascia a good protective tissue to prevent implanted cartilage degeneration. The cartilage graft produced high inflammation, stromal fibrosis and activated angiogenic cascade through VEGF-mediated pathways followed by cartilage degeneration. Also, high content of podoplanin from conchal cartilage chondrocytes exerted a major role in inflammation accompanying cartilage graft. The presently employed experimental model allowed us to characterize the early histological and molecular events triggered by temporal fascia, cartilage or composite graft DC-F implanted on chick embryo chorioallantoic membrane. Our microscopic and molecular observations may help explain some post-surgical complications generated after using cartilage alone as biomaterial for nasal augmentation, supporting the use of DC-F composite graft, with the aim to reduce unwanted post-surgical events. Copyright © 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  7. Riboflavin synthesis genes ribE, ribB, ribH, ribA reside in the lux operon of Photobacterium leiognathi. (United States)

    Lin, J W; Chao, Y F; Weng, S F


    Nucleotide sequence of the riboflavin synthesis genes ribE, ribB, ribH, ribA (GenBank Accession No. AF364106) resided in the lux operon of Photobacterium leiognathi PL741 has been determined, and the amino acid sequences of riboflavin synthetase (RibE), DHBP synthetase (RibB), lumazine synthetase (RibH), GTP cyclohydrolase II (RibA) encoded by the riboflavin synthesis genes are deduced. Nucleotide sequence reveals that the ribE gene encodes the riboflavin synthetase responsible for converting lumazine to riboflavin, the ribB gene encodes the DHBP synthetase responsible for 3,4-dihydroxyl-2-butanone 4-phosphate synthesis, the ribH gene encodes the lumazine synthetase responsible for lumazine synthesis, and the ribA gene encodes the GTP cyclohydrolase II responsible for lumazine synthesis. Functional analysis illustrates that the specific segments lay behind the ribH and ribA genes might form potential loops Omega(oT) and Omega(TI)--Omega(TII); Omega(oT) is functioned as mRNA stability loop or/and for subregulation by alternative modulation, and Omega(TI)--Omega(TII) could be the transcriptional terminator of the lux operon. The gene order of the ribE, ribB, ribH, ribA genes resided in the lux operon and linked to the lum operon is luxE-luxG-ribE-ribB-ribH-ribA-ter--> (R&R: regulatory region; ter: transcriptional terminator), whereas the R&R is the regulatory region for the lum and the lux operons, and ter and ter* are the transcriptional terminators for the lux and lum operons.

  8. Poland syndrome with absent ribs


    Rupam Kumar Ta; Kaushik Saha; Arnab Saha; Santanu Ghosh; Mrinmoy Mitra


    Poland syndrome is a rare congenital disorder characterized by ipsilateral absence of pectoralis major muscle. This syndrome is associated with various anomalies such as ipsilateral syndactyly, brachidactyly, dextrocardia, herniation of lung, underdevelopment of upper ribs, aplasia or hypoplasia of breast, etc. Only few cases had been reported with absent ribs in Poland syndrome. We report a rare case of Poland syndrome presented to us with mal-development of his right hemithorax and weakness...

  9. Poland syndrome with absent ribs

    Directory of Open Access Journals (Sweden)

    Rupam Kumar Ta


    Full Text Available Poland syndrome is a rare congenital disorder characterized by ipsilateral absence of pectoralis major muscle. This syndrome is associated with various anomalies such as ipsilateral syndactyly, brachidactyly, dextrocardia, herniation of lung, underdevelopment of upper ribs, aplasia or hypoplasia of breast, etc. Only few cases had been reported with absent ribs in Poland syndrome. We report a rare case of Poland syndrome presented to us with mal-development of his right hemithorax and weakness of right hand.

  10. Cartilage oligomeric matrix protein enhances the vascularization of acellular nerves

    Directory of Open Access Journals (Sweden)

    Wei-ling Cui


    Full Text Available Vascularization of acellular nerves has been shown to contribute to nerve bridging. In this study, we used a 10-mm sciatic nerve defect model in rats to determine whether cartilage oligomeric matrix protein enhances the vascularization of injured acellular nerves. The rat nerve defects were treated with acellular nerve grafting (control group alone or acellular nerve grafting combined with intraperitoneal injection of cartilage oligomeric matrix protein (experimental group. As shown through two-dimensional imaging, the vessels began to invade into the acellular nerve graft from both anastomotic ends at day 7 post-operation, and gradually covered the entire graft at day 21. The vascular density, vascular area, and the velocity of revascularization in the experimental group were all higher than those in the control group. These results indicate that cartilage oligomeric matrix protein enhances the vascularization of acellular nerves.

  11. Cartilage oligomeric matrix protein enhances the vascularization of acellular nerves

    Institute of Scientific and Technical Information of China (English)

    Wei-ling Cui; Long-hai Qiu; Jia-yan Lian; Jia-chun Li; Jun Hu; Xiao-lin Liu


    Vascularization of acellular nerves has been shown to contribute to nerve bridging. In this study, we used a 10-mm sciatic nerve defect model in rats to determine whether cartilage oligomeric matrix protein enhances the vascularization of injured acellular nerves. The rat nerve defects were treated with acellular nerve grafting (control group) alone or acellular nerve grafting combined with intraperitoneal injection of cartilage oligomeric matrix protein (experimental group). As shown through two-dimensional imaging, the vessels began to invade into the acellular nerve graft from both anastomotic ends at day 7 post-operation, and gradually covered the entire graft at day 21. The vascular density, vascular area, and the velocity of revascularization in the experimental group were all higher than those in the control group. These results indicate that cartilage oligomeric matrix protein enhances the vascularization of acellular nerves.

  12. Detection of rib fractures in minor chest injuries: a comparison between ultrasonography and radiography performed on the same day

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Yong Soo; Back, Chang Hee; Lee, Kyung Rae; Shin, Yun Hack; Whang, Yeong Seop; Jeong, Ku Young [Yeosu Baek Hospital, Yeosu (Korea, Republic of); Chung, Soo Hyun [NamWon Medical Center, NamWon (Korea, Republic of); Whang, Cheol Mog [Konyang University Hospital, Daejeon (Korea, Republic of)


    We wished to compare the ability of ultrasonography and radiography performed on the same day to detect rib fractures in minor chest injuries. Two hundred and fifteen patients with minor chest injuries were selected. Radiography and ultrasonography were performed on the same day with these patients. Chest wall pain was the only presenting symptom. Two radiologists performed ultrasonography. Fractures were identified by a disruption of the anterior margin of the rib and costal cartilage. The incidence and location of fractures and complications revealed by radiography and ultrasonography were compared. Radiographs revealed the presence of 70 rib fractures in 50 (23%) of 215 patients and ultrasonography revealed the presence of 203 rib fractures in 133 (62%) of 215 patients. Ultrasonography uniquely identified 133 rib fractures in 83 patients. Ultrasonography identified a 2.9 fold increase in the number of fractures in a 2.6 fold number of subjects as compared to radiography. Of the 203 sonographically detected fractures, 201 were located in the rib, one was located at the costochondral junction, and one in the costal cartilage. There were no complications seen by either radiography or ultrasonography. Ultrasonography reveals more fractures than those that may be overlooked on radiography for minor chest injuries.


    Directory of Open Access Journals (Sweden)

    Naveen Kumar


    Full Text Available OBJECTIVE: To compare the graft acceptance rates and auditory outcomes of endoscopic cartilage tympanoplasty operations with those of endoscopic primary tympanoplasty using temporalis fascia in a homogenous group of patients . MATERIAL AND METHODS : This prospective study was conducted on 64 patients between the ages of 15 to 50 years. All patients had a central tympanic membrane perforation without infection in middle ear or upper respiratory tract. RESULTS : Anatomical results in terms of graft uptake and intact tympanic membrane over a period of 2 years showed good results both in 26(92.85% cases in cartilage group and in 33(91.66% cases in temporalis fascia group. The average post - operative Air bone gap in endoscopic fascia tympanoplasty group was 14.61db and 15.65db in endoscopic cartilage tympanoplasty group . CONCLUSION: Endoscopic tympanoplasty is a minimally invasive, sutureless procedure with better patient compliance. Tympanoplasty with cartilage graft has a high degree of graft take up. Tympanoplasty with cartilage provides better results in terms of integrity and intactness of the graft and less percentage of postoperative discharge from the operated ear.

  14. Rib plating of acute and sub-acute non-union rib fractures in an adult with cystic fibrosis: a case report. (United States)

    Dean, Nathan C; Van Boerum, Don H; Liou, Theodore G


    Rib fractures associated with osteoporosis have been reported to occur ten times more frequently in adults with cystic fibrosis. Fractures cause chest pain, and interfere with cough and sputum clearance leading to worsened lung function and acute exacerbations which are the two main contributors to early mortality in cystic fibrosis. Usual treatment involves analgesics and time for healing; however considerable pain and disability result due to constant re-injury from chronic repetitive cough. Recently, surgical plating of rib fractures has become commonplace in treating acute, traumatic chest injuries. We describe here successful surgical plating in a White cystic fibrosis patient with multiple, non-traumatic rib fractures. A-37-year old White male with cystic fibrosis was readmitted to Intermountain Medical Center for a pulmonary exacerbation. He had developed localized rib pain while coughing 2 months earlier, with worsening just prior to hospital admission in conjunction with a "pop" in the same location while bending over. A chest computerized tomography scan at admission demonstrated an acute 5th rib fracture and chronic non-united 6th and 7th right rib fractures. An epidural catheter was placed both for analgesia and to make secretion clearance possible in preparation for the surgery performed 2 days later. Under general anesthesia, he had open reduction and internal fixation of the right 5th, 6th and 7th rib fractures with a Synthes Matrix rib set. After several days of increased oxygen requirements, fever, fluid retention, and borderline vital signs, he stabilized. Numerical pain rating scores from his ribs were lower post-operatively and he was able to tolerate chest physical therapy and vigorous coughing. In our case report, rib plating with bone grafting improved rib pain and allowed healing of the fractures and recovery, although the immediate post-op period required close attention and care. We believe repair may be of benefit in selected cystic

  15. Imaging of articular cartilage

    Directory of Open Access Journals (Sweden)

    Bhawan K Paunipagar


    Full Text Available We tried to review the role of magnetic resonance imaging (MRI in understanding microscopic and morphologic structure of the articular cartilage. The optimal protocols and available spin-echo sequences in present day practice are reviewed in context of common pathologies of articular cartilage. The future trends of articular cartilage imaging have been discussed with their appropriateness. In diarthrodial joints of the body, articular cartilage is functionally very important. It is frequently exposed to trauma, degeneration, and repetitive wear and tear. MRI has played a vital role in evaluation of articular cartilage. With the availability of advanced repair surgeries for cartilage lesions, there has been an increased demand for improved cartilage imaging techniques. Recent advances in imaging strategies for native and postoperative articular cartilage open up an entirely new approach in management of cartilage-related pathologies.

  16. Influence of ribs on train aerodynamic performances

    Institute of Scientific and Technical Information of China (English)

    MIAO Xiu-juan; GAO Guang-jun


    The influence of ribs on the train aerodynamic performance was computed using detached eddy simulation (DES), and the transient iteration was solved by the dual-time step lower-upper symmetric Gauss-Seidel (LU-SGS) method. The results show that the ribs installed on the roof have a great effect on the train aerodynamic performance. Compared with trains without ribs, the lift force coefficient of the train with convex ribs changes from negative to positive, while the side force coefficient increases by 110% and 88%, respectively. Due to the combined effect of the lift force and side force, the overturning moment of the train with convex ribs and cutting ribs increases by 140% and 106%, respectively. There is larger negative pressure on the roof of the train without ribs than that with ribs. The ribs on the train would disturb the flow structure and contribute to the air separation, so the separation starts from the roof, while there is no air separation on the roof of the train without ribs. The ribs can also slow down the flow speed above the roof and make the air easily sucked back to the train surface. The vortices at the leeward side of the train without ribs are small and messy compared with those of the train with convex or cutting ribs.

  17. Cartilage Integration: Evaluation of the reasons for failure of integration during cartilage repair. A review

    Directory of Open Access Journals (Sweden)

    IM Khan


    Full Text Available Articular cartilage is a challenging tissue to reconstruct or replace principally because of its avascular nature; large chondral lesions in the tissue do not spontaneously heal. Where lesions do penetrate the bony subchondral plate, formation of hematomas and the migration of mesenchymal stem cells provide an inferior and transient fibrocartilagenous replacement for hyaline cartilage. To circumvent the poor intrinsic reparative response of articular cartilage several surgical techniques based on tissue transplantation have emerged. One characteristic shared by intrinsic reparative processes and the new surgical therapies is an apparent lack of lateral integration of repair or graft tissue with the host cartilage that can lead to poor prognosis. Many factors have been cited as impeding cartilage:cartilage integration including; chondrocyte cell death, chondrocyte dedifferentiation, the nature of the collagenous and proteoglycan networks that constitute the extracellular matrix, the type of biomaterial scaffold employed in repair and the origin of the cells used to repopulate the defect or lesion. This review addresses the principal intrinsic and extrinsic factors that impede integration and describe how manipulation of these factors using a host of strategies can positively influence cartilage integration.

  18. Cryptococcal osteomyelitis in the ribs

    Directory of Open Access Journals (Sweden)

    Sethi Somika


    Full Text Available Isolated cryptococcal osteomyelitis, in an immunocompetent, is rare and only a few cases have been reported in literature. We present the case of a 30-year-old man presented with pain on the left side of chest with fever and gradually increasing swelling in left lateral lower aspect of chest. Investigation revealed a lytic lesion in the anterior end of left 6 th rib with normal CD4 count. He was tested negative for HIV antigen. Excision of the sixth rib, morphologically revealed cryptococcal osteomyelitis and the patient was given anti-fungal treatment for six months.

  19. Cervical Rib causing Thrombosis of Subclavian Atery

    Directory of Open Access Journals (Sweden)

    P Sharma


    Full Text Available We describe here an unusual case of thrombosis of left subclavian artery in a patient with cervical rib. The patient presented with features of ischaemia of left upper limb. X-ray chest revealed bilateral cervical ribs, longer on the left side. Color Doppler studies showed echogenic thrombus within the left subclavian artery. Angiography revealed complete occlusion of left subclavian artery. Embolectomy was done. She was planned for excision of rib. KEYWORDS: cervical rib, thrombosis of subclavian artery.

  20. To Resect or Not to Resect: The Effects of Rib-Sparing Harvest of the Internal Mammary Vessels in Microsurgical Breast Reconstruction. (United States)

    Wilson, Stelios; Weichman, Katie; Broer, P Niclas; Ahn, Christina Y; Allen, Robert J; Saadeh, Pierre B; Karp, Nolan S; Choi, Mihye; Levine, Jamie P; Thanik, Vishal D


    The internal mammary vessels are the most commonly used recipients for microsurgical breast reconstructions. Often, the costal cartilage is sacrificed to obtain improved vessel exposure. In an effort to reduce adverse effects associated with traditional rib sacrifice, recent studies have described less-invasive, rib-sparing strategies. After obtaining institutional review board's approval, a retrospective review of all patients undergoing microsurgical breast reconstruction at a single institution between November 2007 and December 2013 was conducted. Patients were divided into two cohorts for comparison: rib-sacrificing and rib-sparing internal mammary vessel harvests. A total of 547 reconstructions (344 patients) met inclusion criteria for this study. A total of 64.9% (n = 355) underwent rib-sacrificing internal mammary vessel harvest. Cohorts were similar in baseline patient characteristics, indications for surgery, and cancer therapies. However, patients undergoing rib-sparing reconstructions had significantly shorter operative times (440 vs. 476 minutes; p rib-sparing techniques had greater incidence of fat necrosis requiring excision (12.5 vs. 2.8%; p rib-sacrificing patients. Rib-sparing harvest of internal mammary vessels is a feasible technique in microsurgical breast reconstruction. However, given the significant increase in fat necrosis requiring surgical excision, the trend toward increased postoperative complications, and no significant difference in postoperative revision rates, the purported benefits of this technique may fail to outweigh the possible risks. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  1. Abdominal mass hiding rib osteomyelitis. (United States)

    Raffaeli, Genny; Borzani, Irene; Pinzani, Raffaella; Giannitto, Caterina; Principi, Nicola; Esposito, Susanna


    Rib osteomyelitis is a rare entity, occurring in approximately 1 % or less of all cases of haematogenous osteomyelitis. Given its rarity and clinical heterogeneity, the diagnosis of rib osteomyelitis can be challenging and requires a high index of suspicion. We present a case of acute osteomyelitis of the rib due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA), which occurred in an otherwise healthy 3-month-old infant and mimicked an epigastric hernia at first. An otherwise healthy 3-month-old female infant was sent by her primary care paediatrician to the paediatric emergency department for possible incarcerated epigastric hernia because for 2 days, she had suffered from mild to moderate fever, irritability, poor feeding, and tender epigastric swelling. Ultrasonographic imaging excluded epigastric hernia, and transthoracic echocardiography ruled out endocarditis. However, clinical assessment combined with laboratory criteria classified the child into the high-risk group for having severe bacterial infection. Consequently, awaiting the definitive diagnosis, she was immediately treated with a broad-spectrum regimen of intravenous antibiotic therapy based on vancomycin (40 mg/kg/die in 3 doses) and meropenem (100 mg/kg/die in 3 doses). Three days after admission, the blood culture result was positive for methicillin-resistant Staphylococcus aureus, and vancomycin remained as antibiotic therapy. On day 3, a second swelling appeared at the level of the seventh left rib, 2 cm-wide, non-erythematous, mildly painful. Ultrasonography of the left chest wall on this occasion showed an image consistent with an acute osteomyelitis of the anterior osteo-chondral region of the 7th rib and associated adjacent periosteal and soft tissue collection and magnetic resonance imaging confirmed the osteomyelitis of the anterior middle-distal part of the 7th left rib, near the costochondral junction. Vancomycin was continued up to a total of 6 weeks of therapy

  2. Sacral rib: an uncommon congenital anomaly. (United States)

    Miyakoshi, Naohisa; Kobayashi, Akira; Hongo, Michio; Shimada, Yoichi


    Sacral rib represents an uncommon pathology in which rib-like structures arise from the sacrum. Supernumerary ribs may occur at any level of the spine, but supernumerary ribs in the sacrococcygeal area are extremely rare. To present the case of a patient with sacral rib and to discuss this entity with reference to the literature. A case report and literature review. A 17-year-old girl presented with low back pain and discomfort in bilateral gluteal regions. Radiographs and computed tomography (CT) of the pelvis showed a smooth-surfaced, rod-like bony structure attaching to the sacrum on the left side. The appearance was consistent with sacral rib. The sacrum was hypoplastic and deviated to the right. Magnetic resonance imaging (MRI) showed insertion of the gluteus maximus (GM) onto the coccyx only on the right side. The sacral rib existed beneath the left GM muscle and received a partial insertion from the left GM muscle. No ligamentous continuation between the sacral rib and coccyx was observed. Conservative treatment relieved symptoms, so no surgical intervention was performed. Sacral rib is a rare congenital anomaly for which surgical intervention is usually unnecessary. However, appropriate workups with CT and/or MRI should be considered for women, because sacral rib may cause complications during childbirth. In the literature, sacral/coccygeal rib is sometimes called "pelvic rib." However, sacral/coccygeal rib should be distinguished from pelvic rib, because pelvic rib originating from the ilium is considered to represent a different entity. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Rhinoplasty: congenital deficiencies of the alar cartilage. (United States)

    Kosins, Aaron M; Daniel, Rollin K; Sajjadian, Ali; Helms, Jill


    Congenital deficiencies of the alar cartilages are rare and often visible at birth but can occasionally present later. The authors review the anatomical development and discuss the incidence and treatment of congenital defects within the alar cartilages seen in rhinoplasty cases. The charts of 869 consecutive patients who underwent open rhinoplasty were retrospectively reviewed, and 8 cases of congenital defects of the alar cartilage within the middle crura were identified. Intraoperative photographs were taken of the alar deformities, and each patient underwent surgical correction. To simplify analysis, a classification of the defects was developed. A division was a cleft in the continuity of the alar cartilage with the 2 ends separate. A gap was a true absence of cartilage ranging from 1 to 4 mm, which can be accurately assessed in unilateral cases. A segmental loss was a defect greater than 4 mm. The 8 cases of deformity could be classified as 4 divisions, 3 gaps, and 1 segmental loss. None of the patients had a history of prior nasal trauma or nasal surgery. Six patients were women and 2 patients were men. In all cases, adequate projection and stability were achieved with a columellar strut. Asymmetry was minimized through concealer or tip grafts. There were no complications. Surgeons performing rhinoplasty surgery will encounter and should be prepared to deal with unexpected congenital defects of the alar cartilage. These defects within the middle crura will require stabilization with a columellar strut and, often, coverage with a concealer tip graft. We speculate that the cause of these defects is a disruption of the hedgehog signals that may arrest the condensation or block the differentiation of the underlying neural crest cells.

  4. IGRT/ART phantom with programmable independent rib cage and tumor motion

    Energy Technology Data Exchange (ETDEWEB)

    Haas, Olivier C. L., E-mail: [Control Theory and Applications Centre, Coventry University, Coventry CV1 2TL (United Kingdom); Mills, John A.; Land, Imke; Mulholl, Pete; Menary, Paul; Crichton, Robert; Wilson, Adrian; Sage, John [Department of Clinical Physics and Bioengineering, University Hospital, Coventry CV2 2DX (United Kingdom); Anna, Morenc [University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, LE1 5WW (United Kingdom); Depuydt, Tom [Radiotherapy, Medical Physics Group, University Hospital UZ Brussel, Laarbeeklaan 101 - 1090 Brussels (Belgium)


    Purpose: This paper describes the design and experimental evaluation of the Methods and Advanced Equipment for Simulation and Treatment in Radiation Oncology (MAESTRO) thorax phantom, a new anthropomorphic moving ribcage combined with a 3D tumor positioning system to move target inserts within static lungs. Methods: The new rib cage design is described and its motion is evaluated using Vicon Nexus, a commercial 3D motion tracking system. CT studies at inhale and exhale position are used to study the effect of rib motion and tissue equivalence. Results: The 3D target positioning system and the rib cage have millimetre accuracy. Each axis of motion can reproduce given trajectories from files or individually programmed sinusoidal motion in terms of amplitude, period, and phase shift. The maximum rib motion ranges from 7 to 20 mm SI and from 0.3 to 3.7 mm AP with LR motion less than 1 mm. The repeatability between cycles is within 0.16 mm root mean square error. The agreement between CT electron and mass density for skin, ribcage, spine hard and inner bone as well as cartilage is within 3%. Conclusions: The MAESTRO phantom is a useful research tool that produces programmable 3D rib motions which can be synchronized with 3D internal target motion. The easily accessible static lungs enable the use of a wide range of inserts or can be filled with lung tissue equivalent and deformed using the target motion system.

  5. The effect of diode laser treatment for hair removal of post-auricular reconstruction with autologous costal cartilage grafts and delaying postauricular skin flap%半导体激光治疗耳后延迟皮瓣加自体肋软骨立体支架法耳再造术后耳廓多毛疗效观察

    Institute of Scientific and Technical Information of China (English)

    吴子涵; 李高峰; 谭军; 丁卫; 张帆


    目的:观察半导体激光对耳后延迟皮瓣加自体肋软骨立体支架法耳再造术后耳廓多毛的治疗效果。方法:使用美国科医人(Lumenis)公司Lightsheer 800 nm半导体激光进行治疗。耳后延迟皮瓣加自体肋软骨立体支架法耳再造术III期手术后1~3个月开始行激光脱毛治疗。结果:19例患者通过1~7次的脱毛治疗,均取得了良好的效果,治疗期间无严重的不良反应。结论:Lightsheer 800 nm半导体激光对耳后延迟皮瓣加自体肋软骨立体支架法耳再造术后耳廓多毛的治疗效果良好,使再造耳的形态更美观。%Objective To observe the effect of diode laser treatment for hair removal of post-auricular reconstruction with autologous costal cartilage grafts and delaying postauricular skin flap. Methods To use Lightsheer,800nm diode laser to perform the treatment.Hair removal treatment was performed after the third phase operation of auricular reconstruction with autologous costal cartilage grafts and delaying postauricular skin flap. Results All of 19 patients got good result after hair removal treatment after 1 to 7 times.No serious complications occur during treatment. Conclusion Lightsheer,800nm diode laser is a safe and effective treatment of hair removal after auricular reconstruction with autologous costal cartilage grafts and delaying postauricular skin flap. That makes the shape of reconstructive ear preferable.

  6. Technique and results of cartilage shield tympanoplasty

    Directory of Open Access Journals (Sweden)

    Sohil I Vadiya


    Full Text Available Aim: Use of cartilage for repair of tympanic membrane is recommended by many otologists. The current study aims at evaluating results of cartilage shield tympanoplasty in terms of graft take up and hearing outcomes. Material and Methods: In the current study, cartilage shield tympanoplasty(CST is used in ears with high risk perforations of the tympanic membrane. A total of 40 ears were selected where type I CST was done in 30 ears and type III CST was done in 10 ears. Results: An average of 37.08 dB air bone gap(ABG was present in pre operative time and an average of 19.15 dB of ABG was observed at 6 months after the surgery with hearing gain of 17.28 dB on average was observed. Graft take up rate of 97.5% was observed. The technique is modified to make it easier and to minimize chances of lateralization of graft. Conclusion: The hearing results of this technique are comparable to other methods of tympanic membrane repair.

  7. Rib Fracture Diagnosis in the Panscan Era. (United States)

    Murphy, Charles E; Raja, Ali S; Baumann, Brigitte M; Medak, Anthony J; Langdorf, Mark I; Nishijima, Daniel K; Hendey, Gregory W; Mower, William R; Rodriguez, Robert M


    With increased use of chest computed tomography (CT) in trauma evaluation, traditional teachings in regard to rib fracture morbidity and mortality may no longer be accurate. We seek to determine rates of rib fracture observed on chest CT only; admission and mortality of patients with isolated rib fractures, rib fractures observed on CT only, and first or second rib fractures; and first or second rib fracture-associated great vessel injury. We conducted a planned secondary analysis of 2 prospectively enrolled cohorts of the National Emergency X-Radiography Utilization Study chest studies, which evaluated patients with blunt trauma who were older than 14 years and received chest imaging in the emergency department. We defined rib fractures and other thoracic injuries according to CT reports and followed patients through their hospital course to determine outcomes. Of 8,661 patients who had both chest radiograph and chest CT, 2,071 (23.9%) had rib fractures, and rib fractures were observed on chest CT only in 1,368 cases (66.1%). Rib fracture patients had higher admission rates (88.7% versus 45.8%; mean difference 42.9%; 95% confidence interval [CI] 41.4% to 44.4%) and mortality (5.6% versus 2.7%; mean difference 2.9%; 95% CI 1.8% to 4.0%) than patients without rib fracture. The mortality of patients with rib fracture observed on chest CT only was not statistically significantly different from that of patients with fractures also observed on chest radiograph (4.8% versus 5.7%; mean difference -0.9%; 95% CI -3.1% to 1.1%). Patients with first or second rib fractures had significantly higher mortality (7.4% versus 4.1%; mean difference 3.3%; 95% CI 0.2% to 7.1%) and prevalence of concomitant great vessel injury (2.8% versus 0.6%; mean difference 2.2%; 95% CI 0.6% to 4.9%) than patients with fractures of ribs 3 to 12, and the odds ratio of great vessel injury with first or second rib fracture was 4.4 (95% CI 1.8 to 10.4). Under trauma imaging protocols that commonly

  8. [Subcutaneous autograft with newly synthesized cartilage using ethisorb polymer in rabbits]. (United States)

    Capitán Guarnizo, A; Viviente Rodríguez, E; Osete Albaladejo, J M; Torregrosa Carrasquer, C; Díaz Manzano, J A; Pérez-Mateos Cachá, J A; Sprekelsen Gassó, C


    We perform a subcutaneous autograft, in animals with preserved immunity (24 rabbits), of cartilage taken from the auricle, treated with tissue engineering thecnics and embeded in a reabsorbable polimer (Ethisorb) that acts as base. We observed a good quality cartilage with the expression of collagen type II and without graft rejection phenomenon.

  9. Anatomical and computed tomography study of the eighth costochondral junction: topography for costochondral graft harvesting. (United States)

    Lepage, D; Tatu, L; Loisel, F; Rey, P B; Obert, L; Parratte, B


    Costochondral grafts have long been used in maxillofacial reconstruction, but have been little used in trauma and orthopedic cases. This surgical technique requires that a graft be harvested from the thorax in the area of the eighth rib. Pleuropulmonary complications are very rare. Although the harvesting technique is simple, it needs to be demystified. This study was performed to define anatomical relationships in the eighth costochondral junction and identify topographical and anatomical landmarks that will make it easier to harvest this structure. This was a two-part study. First, an anatomical study was carried out on human cadaver thoraxes to define topographical landmarks and study the anatomical surroundings of the eighth costochondral junction. Second, an imaging study was performed using a database of existing patient computed tomography (CT) scans of the chest and abdomen to confirm the topographical landmarks defined in the first part of the study. The spine was used as a reference for both studies. The location of the eighth costochondral junction was defined relative to the spinal processes along with its location on the lower rib cage hemiperimeter in the transverse plane starting at the corresponding spinous process. The eighth costochondral junction was in line with the spinal process of the twelfth thoracic vertebra in the vast majority of cases and located at two-thirds of the lower rib cage hemiperimeter from the posterior median sulcus, regardless of the patient's chest shape, age and gender. This junction was always located under a single muscle (external oblique) and protected by a thick perichondrium layer, which separates it from the intercostal pedicles, endothoracic fascia and parietal pleura. This two-part study has identified reliable landmarks for harvesting of an osteochondral graft at the eighth costochondral junction and, by describing its anatomical surroundings, helps take the mystery out of its harvesting. These landmarks were

  10. Repairing articular cartilage defects with tissue-engineering cartilage in rabbits

    Institute of Scientific and Technical Information of China (English)

    SONG Hong-xing; LI Fo-bao; SHEN Hui-liang; LIAO Wei-ming; LIU Miao; WANG Min; CAO Jun-ling


    Objective: To investigate the effect of cancellous bone matrix gelatin (BMG) engineered with allogeneic chondrocytes in repairing articular cartilage defects in rabbits.Methods: Chondrocytes were seeded onto three-dimensional cancellous BMG and cultured in vitro for 12 days to prepare BMG-chondrocyte complexes. Under anesthesia with 2.5% pentobarbital sodium (1 ml/kg body weight), articular cartilage defects were made on the right knee joints of 38 healthy New Zealand white rabbits (regardless of sex, aged 4-5 months and weighing 2.5-3 kg) and the defects were then treated with 2.5 % trypsin.Then BMG-chondrocyte complex (Group A, n=18 ),BMG ( Group B, n=10), and nothing ( Group C, n=10)were implanted into the cartilage defects, respectively. The repairing effects were assessed by macroscopic, histologic,transmission electron microscopic (TEM) observation,immunohistochemical examination and in situ hybridization detection, respectively, at 2, 4, 8, 12 and 24 weeks after operation.Results: Cancellous BMG was degraded within 8 weeks after operation. In Group A, lymphocyte infiltration was observed around the graft. At 24 weeks after operation, the cartilage defects were repaired by cartilage tissues and the articular cartilage and subchondral bone were soundly healed. Proteoglycan and type Ⅱ collagen were detected in the matrix of the repaired tissues by Safranin-O staining and immunohistochemical staining,respectively. In situ hybridization proved gene expression of type Ⅱ collagen in the cytoplasm of chondrocytes in the repaired tissues. TEM observation showed that chondrocytes and cartilage matrix in repaired tissues were almost same as those in the normal articular cartilage. In Group B, the defects were repaired by cartilage-fibrous tissues. In Group C, the defects were repaired only by fibrous tissues.Conclusions : Cancellous BMG can be regarded as the natural cell scaffolds for cartilage tissue engineering.Articular cartilage defects can be repaired by

  11. Rib forming tool for tubing (United States)

    Rowley, James P.; Lewandowski, Edward F.; Groh, Edward F.


    Three cylindrical rollers are rotatably mounted equidistant from the center of a hollow tool head on radii spaced apart. Each roller has a thin flange; the three flanges lie in a single plane to form an internal circumferential rib in a rotating tubular workpiece. The tool head has two complementary parts with two rollers in one part of the head and one roller in the other part; the two parts are joined by a hinge. A second hinge, located so the rollers are between the two hinges, connects one of the parts to a tool bar mounted in a lathe tool holder. The axes of rotation of both hinges and all three rollers are parallel. A hole exposing equal portions of the three roller flanges is located in the center of the tool head. The two hinges permit the tool head to be opened and rotated slightly downward, taking the roller flanges out of the path of the workpiece which is supported on both ends and rotated by the lathe. The parts of the tool head are then closed on the workpiece so that the flanges are applied to the workpiece and form the rib. The tool is then relocated for forming of the next rib.

  12. The Application of Polysaccharide Biocomposites to Repair Cartilage Defects

    Directory of Open Access Journals (Sweden)

    Feng Zhao


    Full Text Available Owing to own nature of articular cartilage, it almost has no self-healing ability once damaged. Despite lots of restore technologies having been raised in the past decades, no repair technology has smoothly substituted for damaged cartilage using regenerated cartilage tissue. The approach of tissue engineering opens a door to successfully repairing articular cartilage defects. For instance, grafting of isolated chondrocytes has huge clinical potential for restoration of cartilage tissue and cure of chondral injury. In this paper, SD rats are used as subjects in the experiments, and they are classified into three groups: natural repair (group A, hyaluronic acid repair (group B, and polysaccharide biocomposites repair (hyaluronic acid hydrogel containing chondrocytes, group C. Through the observation of effects of repairing articular cartilage defects, we concluded that cartilage repair effect of polysaccharide biocomposites was the best at every time point, and then the second best was hyaluronic acid repair; both of them were better than natural repair. Polysaccharide biocomposites have good biodegradability and high histocompatibility and promote chondrocytes survival, reproduction, and spliting. Moreover, polysaccharide biocomposites could not only provide the porous network structure but also carry chondrocytes. Consequently hyaluronic acid-based polysaccharide biocomposites are considered to be an ideal biological material for repairing articular cartilage.

  13. Conserving Cartilage In Microtia Repair: The Modular Component Assembly Approach To Rebuilding A Human Ear (United States)

    Gandy, Jessica R.; Lemieux, Bryan; Foulad, Allen; Wong, Brian J.F.


    Objectives Current methods of microtia repair include carving an auricular framework from the costal synchondrosis. This requires considerable skill and may create a substantial donor site defect. Here, we present a modular component assembly (MCA) approach that minimizes the procedural difficulty and reduces the amount of cartilage to a single rib. Study Design Ex vivo study and survey Methods A single porcine rib was sectioned into multiple slices using a cartilage guillotine, cut into components outlined by 3D-printed templates, and assembled into an auricular scaffold. Electromechanical reshaping (EMR) was used to bend cartilage slices for creation of the helical rim. Chondrocyte viability was confirmed using confocal imaging. Ten surgeons reviewed the scaffold constructed with the MCA approach to evaluate aesthetics, relative stability, and clinical feasibility. Results An auricular framework with projection and curvature was fashioned from one rib. Surgeons found the MCA scaffold to meet minimal aesthetic and anatomic acceptability. When embedded under a covering, the region of the helix and anti-helix of the scaffold scored significantly higher on the assessment survey than that of an embedded alloplast implant (t-value=0.01). Otherwise, no difference was found between the embedded MCA and alloplast implants (t-value >0.05). EMR treated cartilage was found to be viable. Conclusion This study demonstrates that one rib can be used to create an aesthetic and durable framework for microtia repair. Precise assembly and the ability to obtain thin, uniform slices of cartilage were essential. This cartilage-sparing MCA approach may be an alternative to classic techniques. PMID:26720326


    Directory of Open Access Journals (Sweden)



    Full Text Available INTRODUCTION: A variety of organic and inorganic materials is used as grafts in Ossiculoplasty and reconstruction of the outer attic wall and posterior wall of External Auditory Meatus. Tragal cartilage, Conchal cartilage and septal cartilages are frequently used as auto grafts during Tympanoplasty surgery for reconstruction of Ossicular chain. Cartilage grafts used for Ossicular replacement should be thick, sturdy, easily sculpted and without much elasticity. If the graft has elastic nature it tends to reduce the conduction of sound vibrations. Auricular cartilage is accessible through the same post aural incision used for the mastoid surgery. If the auricular cartilage is palpated for the thickness, one would find that the thickest part is the isthmus. It is felt below and posterior to the inter tragal sulcus. The present study is to measure the thickness of the isthmus part of the auricle cartilage. It also includes study of histology of the cartilage of isthmus to observe the stacks of cells present between the two layers of the perichondrium. MATERIALS AND METHODS: The cartilage of isthmus from 36 cadavers is dissected to measure its thickness and for histology study. Cartilage of isthmus from 36 patients undergoing Modified Radical Mastoidectomy is measured for their thickness and histology is studied. A sterile steel calipers is used to measure the thickness of the cartilage, after exposing the cartilage from posterior aspect during surgery. The tips of the calipers are kept touching the perichondrium on both sides. Thin histology sections are taken after embedding the cartilage in paraffin moulds. Hematoxyline and Eosin stain is used to study the histology. The thickest portion of the cartilage is sculpted to be used as a strut in Type III Tympanoplasty. OBSERVATIONS: The thickness of the cartilage varied from 2.1 to 3mm. The number of stacks of chondrocytes varied from 5 to 7. The physical nature of the cartilage is sturdy and easily

  15. Expansion of the Rib Head: A Novel Computed Tomographic Feature of Supernumerary Intrathoracic Ribs. (United States)

    Kabakus, Ismail Mikdat; Atceken, Zeynep; Ariyurek, Orhan Macit


    Intrathoracic ribs are very rare congenital anomalies. Approximately 50 cases have been reported in the literature till date. They are usually present on the right side, between the third and eighth ribs without sex predominance. They may originate from a vertebral body or the proximal or distal part of a rib. In most cases, they are asymptomatic, but they may be associated with developmental abnormalities of ribs and vertebrae. The diagnosis is important to prevent further investigation or intervention. Here we present two rare cases with supernumerary intrathoracic rib and describe a novel sign, namely expansion of the rib head. To the best of our knowledge, this is the shortest supernumerary intrathoracic rib, reported in the literature, on the left side originating from the head of the second rib, which could have been misdiagnosed as osteochondroma due to its atypical features.

  16. Plastic bowing of the ribs in children

    Energy Technology Data Exchange (ETDEWEB)

    Caro, P.A.; Borden, S. IV


    Four cases of plastic bowing of the ribs are presented. In three patients with Werdnig-Hoffman disease, plastic curvatures were associated with chronic pneumonia and atelectasis. We postulate that intrapulmonary retractive forces can deform ribs thinned by muscular atrophy. In turn, thoracic collapse can perpetuate lobar and segmental atelectasis. In one case of osteogenesis imperfecta without pneumonia, we believe normal muscle forces bent ribs weakened by deficiency of normal cortical architecture.

  17. Vascular Canals in Permanent Hyaline Cartilage: Development, Corrosion of Nonmineralized Cartilage Matrix, and Removal of Matrix Degradation Products. (United States)

    Gabner, Simone; Häusler, Gabriele; Böck, Peter


    Core areas in voluminous pieces of permanent cartilage are metabolically supplied via vascular canals (VCs). We studied cartilage corrosion and removal of matrix degradation products during the development of VCs in nose and rib cartilage of piglets. Conventional staining methods were used for glycosaminoglycans, immunohistochemistry was performed to demonstrate collagens types I and II, laminin, Ki-67, von Willebrand factor, VEGF, macrophage marker MAC387, S-100 protein, MMPs -2,-9,-13,-14, and their inhibitors TIMP1 and TIMP2. VCs derived from connective tissue buds that bulged into cartilage matrix ("perichondrial papillae", PPs). Matrix was corroded at the tips of PPs or resulting VCs. Connective tissue stromata in PPs and VCs comprised an axial afferent blood vessel, peripherally located wide capillaries, fibroblasts, newly synthesized matrix, and residues of corroded cartilage matrix (collagen type II, acidic proteoglycans). Multinucleated chondroclasts were absent, and monocytes/macrophages were not seen outside the blood vessels. Vanishing acidity characterized areas of extracellular matrix degradation ("preresorptive layers"), from where the dismantled matrix components diffused out. Leached-out material stained in an identical manner to intact cartilage matrix. It was detected in the stroma and inside capillaries and associated downstream veins. We conclude that the delicate VCs are excavated by endothelial sprouts and fibroblasts, whilst chondroclasts are specialized to remove high volumes of mineralized cartilage. VCs leading into permanent cartilage can be formed by corrosion or inclusion, but most VCs comprise segments that have developed in either of these ways. Anat Rec, 300:1067-1082, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  18. Endoscopy-Assisted Single-Incision Technique to Harvest the Conchal Cartilage and Temporal Fascia Simultaneously by Using Phaco Slit Knife. (United States)

    Ugurlu, Alper Mete; Ersozlu, Tolga; Basat, Salih Onur; Ceran, Fatih


    Conchal cartilage and temporal fascia grafts are useful materials for secondary rhinoplasty cases. Generally, surgeons require to access autologous grafts fast and effortlessly. Harvesting 2 different types of graft, such as cartilage and fascia, however, are associated with limitations, such as additional surgery time, extra incisions, and postoperative additional distortions at the graft-host interface. The authors evolved a modified single incision that would harvest conchal cartilage and temporal fascia simultaneously by using 4 mm endoscope and 3 mm angled phaco slit knife.

  19. Sub-alar batten grafts as treatment for nasal valve incompetence; description of technique and functional evaluation.

    NARCIS (Netherlands)

    Andre, R.F.; D'Souza, A.R.; Kunst, H.P.M.; Vuyk, H.D.


    OBJECTIVE: To describe and evaluate the functional results of a surgical technique for treating nasal valve incompetence, in which a cartilage graft called a sub-alar batten graft is placed along the undersurface of the lateral crus of the lower lateral cartilage. METHODS: The functional outcomes of

  20. Cavernous Hemangioma of the Rib: A Rare Diagnosis

    Directory of Open Access Journals (Sweden)

    Stavros Gourgiotis


    Full Text Available Hemangioma of the rib is an uncommon benign vascular tumour. A case of rib hemangioma in a 29-year-old woman is presented. Chest roentgenogram and computed tomography revealed a mass along the inner surface of the 7th left rib with bone destruction. She underwent resection of the 7th rib. The pathologic diagnosis was cavernous hemangioma. Hemangiomas of the rib are rare tumours but should be kept in mind in the differential diagnosis of rib tumours.

  1. Scoliosis secondary to an unusual rib lesion.

    LENUS (Irish Health Repository)

    Burke, N G


    Tumours of the chest wall are uncommon and are usually malignant. A bone haemangioma is a rare benign vascular neoplasm, which more commonly occurs in middle-aged patients. We present the case of a scoliosis caused by a rib haemangioma in an adolescent male. Other causes of scoliosis secondary to rib lesions are discussed.

  2. Clinical advantages of cartilage palisades over temporalis fascia in type I tympanoplasty. (United States)

    Vashishth, Ashish; Mathur, Neeraj Narayan; Choudhary, Santosha Ram; Bhardwaj, Abhishek


    To compare the post-operative outcomes in using temporalis fascia and full thickness broad cartilage palisades as graft in type I tympanoplasty. This study, conducted at a tertiary referral institute, included 90 consecutive patients with mucosal type chronic otitis media requiring type I tympanoplasty with a 60/30 distribution of cases with fascia and cartilage palisades, respectively. The fascia group consisted of primary cases in adults and excluded revision cases, near-total or total perforations and pediatric cases. The cartilage group included pediatric, revision cases and near-total or total perforations. The fascia group utilized the underlay technique for grafting, whereas the cartilage group used tragal full thickness broad cartilage palisades with perichondrium attached on one side placed in an underlay or over-underlay manner. Post-operative graft take-up and hearing outcomes were evaluated after 6 months and 1 year with subjective assessment and pure tone audiometry. The graft take-up rate was 83.3% in the fascia group and 90% in the cartilage palisade group. The mean pure tone air-bone gaps pre- and post-operatively in the fascia group were 30.43 ± 5.75 dB and 17.5 ± 6.94 dB, respectively, whereas for the cartilage group, these values were 29 ± 6.21 dB and 7.33 ± 3.88 dB, respectively. Cartilage grafting with full thickness palisades is more effective than fascia as graft material, particularly in "difficult" tympanoplasties fraught with higher failure rates otherwise. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. Development and characterization of decellularized human nasoseptal cartilage matrix for use in tissue engineering. (United States)

    Graham, M Elise; Gratzer, Paul F; Bezuhly, Michael; Hong, Paul


    Reconstruction of cartilage defects in the head and neck can require harvesting of autologous cartilage grafts, which can be associated with donor site morbidity. To overcome this limitation, tissue-engineering approaches may be used to generate cartilage grafts. The objective of this study was to decellularize and characterize human nasoseptal cartilage with the aim of generating a biological scaffold for cartilage tissue engineering. Laboratory study using nasoseptal cartilage. Remnant human nasoseptal cartilage specimens were collected and subjected to a novel decellularization treatment. The decellularization process involved several cycles of enzymatic detergent treatments. For characterization, decellularized and fresh (control) specimens underwent histological, biochemical, and mechanical analyses. Scanning electron microscopy and biocompatibility assay were also performed. The decellularization process had minimal effect on glycosaminoglycan content of the cartilage extracellular matrix. Deoxyribonucleic acid (DNA) analysis revealed the near-complete removal of genomic DNA from decellularized tissues. The effectiveness of the decellularization process was also confirmed on histological and scanning electron microscopic analyses. Mechanical testing results showed that the structural integrity of the decellularized tissue was maintained, and biocompatibility was confirmed. Overall, the current decellularization treatment resulted in significant reduction of genetic/cellular material with preservation of the underlying extracellular matrix structure. This decellularized material may serve as a potential scaffold for cartilage tissue engineering. N/A. Laryngoscope, 126:2226-2231, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  4. The Effect of Rib Shape on Stiffness. (United States)

    Holcombe, Sven A; Wang, Stewart C; Grotberg, James B


    This study investigates the isolated effect of rib shape on the mechanical characteristics of ribs subjected to multiple forms of loading. It aims to measure the variation in stiffness due to shape that is seen throughout the population and, in particular, provide a tool for researchers to better understand the influence of shape on resulting stiffness. A previously published six-parameter shape model of the central axis of human ribs was used. It has been shown to accurately model the overall rib path using intrinsic geometric properties such as size, aspect ratio, and skewness, through shapes based on logarithmic spirals with high curvature continuity. In this study the model was fitted to 19,500 ribs from 989 adult female and male CT scans having demographic distributions matching the US adult population. Mechanical loading was simulated through a simplified finite element model aimed at isolating rib shape from other factors influencing mechanical response. Four loading scenarios were used representing idealized free and constrained loading conditions in axial (body-anterior) and lateral directions. Characteristic rib stiffness and maximum stress location were tracked as simulation output measures. Regression models of rib stiffness found that all shape model parameters added information when predicting stiffness under each loading condition, with their linear combination able to account for 95% of the population stiffness variation due to shape in midlevel ribs for free axial loading, and 92%-98% in other conditions. Full regression models including interactive terms explained up to 99% of population variability. Results allow researchers to better evaluate the differences in stiffness results that are obtained from physical testing by providing a framework with which to explain variation due to rib shape.

  5. MRI of the cartilage

    Energy Technology Data Exchange (ETDEWEB)

    Imhof, H.; Noebauer-Huhmann, I.-M.; Krestan, C.; Gahleitner, A.; Marlovits, S.; Trattnig, S. [Department of Osteology, Universitaetklinik fuer Radiodiagnostik, AKH-Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria); Sulzbacher, I. [Universitaetsklinik fuer Pathologie Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria)


    With the introduction of fat-suppressed gradient-echo and fast spin-echo (FSE) sequences in clinical routine MR visualization of the hyaline articular cartilage is routinely possible in the larger joints. While 3D gradient-echo with fat suppression allows exact depiction of the thickness and surface of cartilage, FSE outlines the normal and abnormal internal structures of the hyaline cartilage; therefore, both sequences seem to be necessary in a standard MRI protocol for cartilage visualization. In diagnostically ambiguous cases, in which important therapeutic decisions are required, direct MR arthrography is the established imaging standard as an add-on procedure. Despite the social impact and prevalence, until recent years there was a paucity of knowledge about the pathogenesis of cartilage damage. With the introduction of high-resolution MRI with powerful surface coils and fat-suppression techniques, visualization of the articular cartilage is now routinely possible in many joints. After a short summary of the anatomy and physiology of the hyaline cartilage, the different MR imaging methods are discussed and recommended standards are suggested. (orig.)

  6. Design of a rib impactor equipment (United States)

    Torres, C. R.; García, G.; Aguilar, L. A.; Martínez, L.


    The human ribs must be analyzed as long and as curved bones, due to their physiology. For the development of an experimental equipment that simulate the application of loads, over the rib in the moment of a frontal collision in an automobile with seat belt, it was applied a methodology that constituted in the identification of needs and the variables which led the design of 3D model, from this it was used the technique of fused deposition modeling for the development of the equipment pieces. The supports that hold the rib ends were design with two and three degrees of freedom that allows the simulation of rib movement with the spine and the breastbone in the breathing. For the simulation of the seat belt, it was determined to applied two loads over the front part of the rib from the sagittal and lateral plane respectively, for this it was made a displacement through a lineal actuator with a speed of 4mm/s. The outcomes shown a design of an equipment able to obtain the load parameters required to generate fractures in rib specimens. The equipment may be used for the study of specimens with nearby geometries to the rib taken as a reference.

  7. [Surgical treatment of cervical rib syndrome]. (United States)

    Sultanov, D D; Usmanov, N U; Kurbanov, N R; Abdulloev, N K


    The authors report herein the results of examination and surgical management of fifty-one patients presenting with cervical ribs. Of these, there were 33 women. Compression of the neurovascular bundle (NVB) was found to be caused by a supplementary cervical rib in twenty-three patients while in the remaining 28 patients by a rudimentary cervical rib. Twenty-two patients were found to have clinical manifestations of Raynaud's syndrome. The presence of abnormal cervical ribs was determined roentgenologically. All the patients with rudimentary cervical ribs and twelve of the 23 patients with supplementary cervical ribs were diagnosed as having bilateral abnormalities. Haemodynamics was studied by Doppler ultrasonography revealing blood flow impairments in upper-limb arteries in Edson's test in patients with supplementary cervical ribs and Raynaud's syndrome. In rudimentary cervical rib - only in the development of Raynaud's syndrome. The nervous function was studied by means of electroneuromyography (ENMG). All the patients were diagnosed as having a significant decrease in both motor and sensitive nervous conductivity of the radial and median nerves. All patients were operated on under endotracheal anaesthesia. Decompression operations were carried out in fifty-one patients, with selective thoracocervical sympathectomy performed in twelve. For treating rudimentary cervical rib, we worked out a combined method of an operative intervention. Analysing the obtained surgical outcomes showed the following: forty-four patients (86.3%) endured the operation with no complications. Intraoperative complications were noted to occur in 5.9% of patients and complications in the immediate postoperative period were observed to develop in 7.8% of patients. All the encountered complications turned out transient, easily amendable to treatment, and did not influence the final outcome of the operation. In the remote period up to 5 years positive results remained in 90.2% of the patients.

  8. Comparison of tympanoplasty results with use of perichondrium- cartilage and temporalis facia

    Directory of Open Access Journals (Sweden)

    Seyed Basir Hashemi


    Full Text Available Introduction: The use of cartilage in reconstruction of the tympanic membrane has been established especially in cases such as tubal dysfunction and adhesive processes. Cartilage offers the advantage of higher mechanical stability compared with membranous materials but may alter the acoustic transfer characteristics of the graft. The purpose of this study was to investigate the hearing results after thin cartilage – perichondrium tympanoplasty, versus temporalis facia tympanoplasty. Materials and Methods: In this clinical trial, tympanic membrane reconstruction was operated with thin perichondrium-cartilage slices in one group of patients and temporalis facia in another group. Post operation Speech reception threshold (SRT and graft take rate were compared statistically between two groups. Results: After one-year follow up, the graft take rate was 98% in the temporalis fascia group and 96.8% in the cartilage perichondrium group. The mean improvement of SRT was 17.9db for cartilage-perichondrium group and 21.6db for temporalis fascia group. The difference was not statistically significant. Conclusion: Considering the results of this study, cartilage-perichondrium tympanoplasty offers the possibility of a rigorous tympanic membrane (TM reconstruction with no statistically significant differences in post operative hearing results.

  9. Rib Fracture Fixation: Indications and Outcomes. (United States)

    Senekjian, Lara; Nirula, Raminder


    Rib fractures are a frequently identified injury in the trauma population. Not only are multiple rib fractures painful, but they are associated with an increased risk of adverse outcomes. Pneumonia in particular can be devastating, especially to an elderly patient, but other complications such as prolonged ventilation and increased intensive care and hospital durations of stay have a negative impact on the patient. Computed tomography scan is the best modality to diagnosis rib fractures but the treatment of fractures is still evolving. Currently patient care involves a multidisciplinary approach that includes pain control, aggressive pulmonary therapy, and possibly surgical fixation. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Bilateral same-day endoscopic transcanal cartilage tympanoplasty: initial results. (United States)

    Daneshi, Ahmad; Jahandideh, Hesam; Daneshvar, Ali; Safdarian, Mahdi

    Same-day closure of bilateral tympanic membrane perforations is a quick and more comfortable procedure for the patients. However, conventional bilateral same-day tympanoplasty or myringoplasty has been rarely performed because of the theoretical risk of postoperative complications. To evaluate the advantages and outcomes of bilateral simultaneous endoscopic cartilage tympanoplasty in patients with bilateral tympanic membrane perforations. From February 2012 to March 2013, patients with bilateral dry tympanic membrane perforations who had some degree of hearing loss corresponding to the size and location of the perforation entered the study. There was no suspicion to disrupted ossicular chain, mastoid involvement or other middle or inner ear pathology. Endoscopic transcanal cartilage tympanoplasty was done using the underlay (medial) technique. The graft was harvested from cymba cartilage in just one ear with preservation of perichondrium in one side. A 1.5cm×1.5cm cartilage seemed to be enough for tympanoplasty in both sides. Nine patients (4 males and 5 females) with the mean age of 37.9 years underwent bilateral transcanal cartilage tympanoplasty in a same-day surgery. The mean duration of follow up was 15.8 months. There were detected no complications including hearing loss, otorrhea and wound complication with no retraction pocket or displaced graft during follow-up period. The grafts take rate was 94.44% (only one case of unilateral incomplete closure). The mean of air-bone gap overall improved from 13.88dB preoperatively to 9.16dB postoperatively (p<0.05). Bilateral endoscopic transcanal cartilage tympanoplasty can be considered as a safe minimally invasive procedure that can be performed in a same-day surgery. It reduces the costs and operation time and is practical with a low rate of postoperative complications. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights

  11. Optimizing rib width to height and rib spacing to deck plate thickness ratios in orthotropic decks

    Directory of Open Access Journals (Sweden)

    Abdullah Fettahoglu


    Full Text Available Orthotropic decks are composed of deck plate, ribs, and cross-beams and are frequently used in industry to span long distances, due to their light structures and load carrying capacities. Trapezoidal ribs are broadly preferred as longitudinal stiffeners in design of orthotropic decks. They supply the required stiffness to the orthotropic deck in traffic direction. Trapezoidal ribs are chosen in industrial applications because of their high torsional and buckling rigidity, less material and welding needs. Rib width, height, spacing, thickness of deck plate are important parameters for designing of orthotropic decks. In the scope of this study, rib width to height and rib spacing to deck plate thickness ratios are assessed by means of the stresses developed under different ratios of these parameters. For this purpose a FE-model of orthotropic bridge is generated, which encompasses the entire bridge geometry and conforms to recommendations given in Eurocode 3 Part 2. Afterwards necessary FE-analyses are performed to reveal the stresses developed under different rib width to height and rib spacing to deck plate thickness ratios. Based on the results obtained in this study, recommendations regarding these ratios are provided for orthotropic steel decks occupying trapezoidal ribs.

  12. Ribbed vaults of late Gothic in Sardinia

    Directory of Open Access Journals (Sweden)

    Paola Casu


    Full Text Available The late Gothic construction practice, settled in the Spanish Mediterranean area, is based on predetermined geometric rules and is shown in religious buildings with ribbed vaults. The proportion between the sides of the area to cover, tracing plan of the ribs as a succession of corner bisectors, stereotomy problems and volumetric aspects, are just some of the elements that can describe the complex construction of a ribbed vault. The aim of this paper is to analyze the dimensional information of the late gothic ribbed vaults of Sardinia, in order to define the geometric and proportional rules for a correct drawing, establishing a standard procedure for the collection of measures and the construction of the 3D model of vaults.

  13. Nasal bone grafts from the removed hump used as overlay grafts to camouflage concave lateral crura. (United States)

    Kubilay, Utku; Erdogdu, Suleyman; Sezen, Ozan Seymen


    Alar cartilage consists of a medial crus, middle crus and lateral crus. The lateral crus is an important aesthetic and functional structure of the nose. A 32-year-old male patient with concave lateral crura was operated by the authors. An open rhinoplasty with a dorsal approach to the septum is preferred. The nasal bones harvested from the hump, which is an autogenous graft trimmed and sutured on both concave lateral crura as an overlay camouflage grafts. Satisfactory result was achieved.

  14. Supersonic Wing Optimization Using SpaRibs (United States)

    Locatelli, David; Mulani, Sameer B.; Liu, Qiang; Tamijani, Ali Y.; Kapania, Rakesh K.


    This research investigates the advantages of using curvilinear spars and ribs, termed SpaRibs, to design a supersonic aircraft wing-box in comparison to the use of classic design concepts that employ straight spars and ribs. The objective is to achieve a more efficient load-bearing mechanism and to passively control the deformation of the structure under the flight loads. Moreover, the use of SpaRibs broadens the design space and allows for natural frequencies and natural mode shape tailoring. The SpaRibs concept is implemented in a new optimization MATLAB-based framework referred to as EBF3SSWingOpt. This optimization scheme performs both the sizing and the shaping of the internal structural elements, connecting the optimizer with the analysis software. The shape of the SpaRibs is parametrically defined using the so called Linked Shape method. Each set of SpaRibs is placed in a one by one square domain of the natural space. The set of curves is subsequently transformed in the physical space for creating the wing structure geometry layout. The shape of each curve of each set is unique; however, mathematical relations link the curvature in an effort to reduce the number of design variables. The internal structure of a High Speed Commercial Transport aircraft concept developed by Boeing is optimized subjected to stress, subsonic flutter and supersonic flutter constraints. The results show that the use of the SpaRibs allows for the reduction of the aircraft's primary structure weight without violating the constraints. A weight reduction of about 15 percent is observed.

  15. Reports on various anomalies of the ribs

    Energy Technology Data Exchange (ETDEWEB)

    Brinkmann, G.; Brix, F.


    Three patients are presented who were suffering from different anomalies of the ribs: There was one each plus and minus variant and a female patient with Gorlin-Goltz syndrome (basal cell nevus syndrome) demonstrating several changes in the ribs as an expression of a genetically determined segmentation disturbance. These presentations are followed by a detailed discussion on the types and causes of such anomalies.

  16. Effect of Aspect Ratio, Channel Orientation, Rib Pitch-to-Height Ratio, and Number of Ribbed Walls on Pressure Drop Characteristics in a Rotating Channel with Detached Ribs

    Directory of Open Access Journals (Sweden)

    K. Arun


    Full Text Available The present work involves experimental investigation of the effects of aspect ratio, channel orientation angle, rib pitch-to-height ratio (P/e, and number of ribbed walls on friction factor in orthogonally rotating channel with detached ribs. The ribs are separated from the base wall to provide a small region of flow between the base wall and the ribs. Experiments have been conducted at Reynolds number ranging from 10000–17000 with rotation numbers varying from 0–0.38. Pitch-to-rib height ratios (P/e of 5 and 10 at constant rib height-to-hydraulic diameter ratio (e/D of 0.1 and a clearance ratio (C/e of 0.38 are considered. The rib angle of attack with respect to mainstream flow is 90∘. The channel orientation at which the ribbed wall becomes trailing surface (pressure side on which the Coriolis force acts is considered as the 0∘ orientation angle. For one-wall ribbed case, channel is oriented from 0∘ to 180∘ about its axis in steps of 30∘ to change the orientation angle. For two-wall ribbed case, the orientation angle is changed from 0∘ to 90∘ in steps of 30∘. Friction factors for the detached ribbed channels are compared with the corresponding attached ribbed channel. It is found that in one-wall detached ribbed channel, increase in the friction factor ratio with the orientation angle is lower for rectangular channel compared to that of square channel for both the pitch-to-rib height ratios of 5 and 10 at a given Reynolds number and rotation number. Friction factor ratios of two-wall detached ribbed rectangular channel are comparable with corresponding two-wall detached ribbed square channel both under stationary and rotating conditions.

  17. Sliding alar cartilage (SAC) flap: a new technique for nasal tip surgery. (United States)

    Ozmen, Selahattin; Eryilmaz, Tolga; Sencan, Ayse; Cukurluoglu, Onur; Uygur, Safak; Ayhan, Suhan; Atabay, Kenan


    Congenital anatomic deformities or acquired weakness of the lateral crura of the lower lateral cartilages after rhinoplasty could cause alar rim deformities. As lower lateral cartilages are the structural cornerstone of the ala and tip support, deformities and weakness of the alar cartilages might lead to both functional and esthetic problems. In this article, we are introducing sliding alar cartilage flap as a new technique to reshape and support nasal tip. One hundred sixty consecutive patients between 18 and 55 years of age (mean age: 27.51) were included in the study between January 2007 and May 2008. Of the total number of patients 60 were male and 100 of them were female. None of the patients had rhinoplasty procedure including lower lateral cartilage excision previously. Sliding alar cartilage technique was used in an open rhinoplasty approach to shape the nasal tip in all patients. This technique necessitates about 2 to 3 minutes for suturing and undermining the alar cartilages. The follow-up period was between 4 and 18 months. In no patients any revision related to the sliding alar cartilage technique was required. Revision was applied in 3 patients due to thick nasal tip skin and in one patient due to unpleasant columellar scar. In this article, we are presenting the "sliding alar cartilage flap" as a new technique for creating natural looking nasal tip. This technique shapes and supports nasal tip by spontaneous sliding of the cephalic portion of the lower lateral cartilage beneath the caudal alar cartilage, with minimal manipulation, without any cartilage resection, or cartilage grafting.

  18. The effect of age and demographics on rib shape. (United States)

    Holcombe, Sven A; Wang, Stewart C; Grotberg, James B


    Elderly populations have a higher risk of rib fractures and other associated thoracic injuries than younger adults, and the changes in body morphology that occur with age are a potential cause of this increased risk. Rib centroidal path geometry for 20 627 ribs was extracted from computed tomography (CT) scans of 1042 live adult subjects, then fitted to a six-parameter mathematical model that accurately characterizes rib size and shape, and a three-parameter model of rib orientation within the body. Multivariable regression characterized the independent effect of age, height, weight, and sex on the rib shape and orientation across the adult population, and statistically significant effects were seen from all demographic factors (P rib end-to-end separation and rib aspect ratio are seen to increase with age, producing elongated and flatter overall rib shapes in elderly populations, with age alone explaining up to 20% of population variability in the aspect ratio of mid-level ribs. Age was not strongly associated with overall rib arc length, indicating that age effects were related to shape change rather than overall bone length. The rib shape effect was found to be more strongly and directly associated with age than previously documented age-related changes in rib angulation. Other demographic results showed height and sex being most strongly associated with rib size, and weight most strongly associated with rib pump-handle angle. Results from the study provide a statistical model for building rib shapes typical of any given demographic by age, height, weight, and sex, and can be used to help build population-specific computational models of the thoracic rib cage. Furthermore, results also quantify normal population ranges for rib shape parameters which can be used to improve the assessment and treatment of rib skeletal deformity and disease. © 2017 Anatomical Society.

  19. Reconstruction of iliac crest with rib to prevent donor site complications: A prospective study of 26 cases

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    Dave B


    Full Text Available Background: The tricortical bone graft from the iliac crest are used to reconstruct the post corpectomy spinal defects. The donor iliac area defect is large and may give rise to pain at donor site, instability of pelvis, fracture of ilium, donor site muscle herniation or abdominal content herniation. Rib removed during thoracotomy was used by us to reconstruct the iliac crest defect. Materials and Methods: Twenty-six patients who underwent thoracotomy for dorsal spine corpectomy or curettage for various spinal pathologies from June 2002 to May 2004 were included in the study. After adequate decompression the spine was reconstructed by tricortical bone graft from iliac crest and reconstruction of the iliac crest was done with the rib removed for exposure during thoracotomy. Results: The mean follow up was 15 months. All patients had good graft incorporation which was evaluated on the basis of local tenderness and radiographs. One patient had graft displacement. Conclusion: The reconstruction of iliac crest by rib is a simple and effective procedure to prevent donor site complications.

  20. Cartilage repair and joint preservation: medical and surgical treatment options. (United States)

    Madry, Henning; Grün, Ulrich Wolfgang; Knutsen, Gunnar


    Articular cartilage defects are most often caused by trauma and osteoarthritis and less commonly by metabolic disorders of the subchondral bone, such as osteonecrosis and osteochondritis dissecans. Such defects do not heal spontaneously in adults and can lead to secondary osteoarthritis. Medications are indicated for symptomatic relief. Slow-acting drugs in osteoarthritis (SADOA), such as glucosamine and chondroitin, are thought to prevent cartilage degeneration. Reconstructive surgical treatment strategies aim to form a repair tissue or to unload compartments of the joint with articular cartilage damage. In this article, we selectively review the pertinent literature, focusing on original publications of the past 5 years and older standard texts. Particular attention is paid to guidelines and clinical studies with a high level of evidence, along with review articles, clinical trials, and book chapters. There have been only a few randomized trials of medical versus surgical treatments. Pharmacological therapies are now available that are intended to treat the cartilage defect per se, rather than the associated symptoms, yet none of them has yet been shown to slow or reverse the progression of cartilage destruction. Surgical débridement of cartilage does not prevent the progression of osteoarthritis and is thus not recommended as the sole treatment. Marrow-stimulating procedures and osteochondral grafts are indicated for small focal articular cartilage defects, while autologous chondrocyte implantationis mainly indicated for larger cartilage defects. These surgical reconstructive techniques play a lesser role in the treatment of osteoarthritis. Osteotomy near the knee joint is indicated for axial realignment when unilateral osteoarthritis of the knee causes axis deviation. Surgical reconstructive techniques can improve joint function and thereby postpone the need for replacement of the articular surface with an artificial joint.

  1. Turbulent flow in a ribbed channel: Flow structures in the vicinity of a rib

    DEFF Research Database (Denmark)

    Wang, Lei; Salewski, Mirko; Sundén, Bengt


    PIV measurements are performed in a channel with periodic ribs on one wall. The emphasis of this study is to investigate the flow structures in the vicinity of a rib in terms of mean velocities, Reynolds stresses, probability density functions (PDF), and two-point correlations. The PDF distribution...... of u′ is bimodal in the separated shear layer downstream of the rib. The maximum Reynolds shear stresses occur at the leading edge of the rib. Based on quadrant analysis, it is found that ejection motions make a dominant contribution to the Reynolds shear stress in this region. Moreover, topology......-based visualization is applied to the separation bubble upstream of the rib. Salient critical points and limit cycles are extracted, which gives clues to the physical processes occurring in the flow....

  2. Anti-cartilage antibody. (United States)

    Greenbury, C L; Skingle, J


    Antibody to cartilage has been demonstrated by indirect immunofluorescence on rat trachea in the serum of about 3% of 1126 patients with rheumatoid arthritis. Titres ranged from 1:20 to 1:640. The antibody was not found in 284 patients with primary or secondary osteoarthritis or in 1825 blood donors, nor, with the exception of two weak reactors, in 1314 paraplegic patients. In most cases the antibody appears to be specific for native type II collagen. Using this as an antigen in a haemagglutination test 94% of anti-cartilage sera were positive, whereas among 100 rheumatoid control sera there were only three weak positives. More than 80% of patients with antibody had some erosion of articular cartilage, but there was no correlation with age, sex, duration of disease, nor any recognisable clinical event or change.

  3. Remoção da cartilagem articular associada ou não a implante homógeno ou enxerto autógeno de osso esponjoso em cães submetidos à artrodese atlantoaxial Joint cartilage removal associated or not to homologous implant or autologous cancellous bone graft in dogs submitted to atlantoaxial arthrodesis

    Directory of Open Access Journals (Sweden)

    Rafael Festugatto


    Full Text Available O objetivo deste estudo foi avaliar o grau de fusão articular e formação óssea na articulação atlantoaxial de cães submetidos à artrodese após a remoção da cartilagem articular associada ou não ao implante homógeno ou enxerto autógeno de osso esponjoso. Foram utilizados 12 cães, adultos, distribuídos aleatoriamente em três grupos iguais. Grupo I (GI: realizada apenas a remoção da cartilagem articular e imobilização articular com pinos e resina acrílica. Grupo II (GII: feita a remoção da cartilagem articular e imobilização da articulação, seguida da colocação e modelagem do implante ósseo esponjoso homógeno entre as superfícies articulares. Grupo III (GIII: foi realizado o mesmo procedimento do GII, mais o enxerto ósseo esponjoso autógeno no local determinado. Realizaram-se exames radiográficos em todos os animais aos 30, 60 e 90 dias de pós-operatório (PO. Aos 90 dias de PO foi feita a eutanásia para o emprego do teste de palpação manual, avaliação tomográfica e histopatológica. Para análise estatística da associação entre o grau de fusão articular, aplicou-se o Teste Qui-quadrado de independência. Os resultados dos testes foram avaliados pela significância exata e considerados significantes a 5% (PThe aim of this study was to evaluate the degree of joint fusion and bone formation in dogs undergoing atlantoaxial arthrodesis after removal of articular cartilage associated or not to implant homogenous or autogenous cancellous bone. Twelve dogs, weighing between 8 and 12kg were randomly divided into three groups. Group I (GI performed only the removal of joint cartilage and joint immobilization with acrylic resin and pins. Group II (GII: after removel of joint cartilage and articular immobilization was performed modeling and placement of homogenous cancellous bone at the given location. The volume of homograft placed in the joint was measured using a precision balance and all animals received the

  4. Principles of cartilage repair

    CERN Document Server

    Erggelet, Christoph; Mandelbaum, Bert R


    Cartilage defects affect patients of all age groups. Surgeons, teamdoctors, general practitioners and physiotherapists alike are expected to provide adequate care. Only individual treatment plans combining a well balanced choice of various options will be successful. Background knowledge, operative and non-operative therapies are described in concise chapters: Articular cartilage biology - Diagnostics - Surgical techniques - Symptomatic and alternative medications - Physiotherapy. Diagnostic findings and surgical procedures are generously illustrated by aquarelles and colour photographs. Recommendations for additional reading, description of important clinical scoring systems and a listing of analytic tools are added for further information.

  5. Isolated rib fractures in geriatric patients

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    Elmistekawy Elsayed


    Full Text Available Introduction: The goal of this study was to investigate the short-term outcomes in patients older than 60 years with isolated rib fractures and admitted to emergency hospital. Materials and Methods: This study included patients who were 60 years old or more and sustained blunt chest injury and had isolated rib fractures. The following data were obtained from the medical records: age, gender, number of fracture ribs, side of fracture ribs, mechanism and nature of injury, preexisting medical conditions, complications, admission to intensive care unit (ICU, need for mechanical ventilation, length of ICU and hospital stay and mortality. Results: For the study, 39 patients who were 60 years old or more and admitted to the hospital because of isolated rib fractures were enrolled. There were 28 males (71.7% and 11 females (28.3% with mean age of (66.84 ± 4.7 years. No correlation was found between comorbidities and hospital outcomes except in those who were diabetic (P-value = 0.005 and those with chronic lung disease (P-value = 0.006. Pulmonary complications were the most frequent complications encountered in those patients. Pulmonary complications were: lung contusion in 8 patients (20.5% and pulmonary infection in 6 patients (15.8%. Conclusion: Elderly patients sustaining blunt chest trauma had significant morbidity and potential for mortality.

  6. Role of Autologous Versus Homologous Cartilage in Ossicular Reconstruction: A Comparative Study. (United States)

    Sharma, Karan; Gururani, Pratibha; Arora, Archana; Singh, Gagandeep


    Ossicular discontinuity is the most common cause of conductive hearing loss. The use of ossicular graft material in ossicular chain reconstruction significantly improves the result in hearing. This study was conducted to compare and analyze the outcome of ossicular reconstruction using autologous conchal cartilage and homologous septal cartilage in terms of hearing results and graft uptake rates. Study design Randomized clinical trial. Study included 100 patients visiting the ENT department of government medical college. Patients between 16 and 50 years of age with history of chronic ear discharge and minimum air bone gap of 20 dB were included in the study. The patients underwent detailed ENT examination, audiological and radiological assessment of temporal bone and those patients with evidence of ossicular erosion were subjected to ossiculoplasty with autologous conchal cartilage (group I) and homologous septal cartilage (group II) randomly. The patients were followed up after 3 and 6 months to analyze functional and anatomical results. Out of 50 patients from group I who underwent autologous cartilage ossicular reconstruction 35 patients (70 %) showed significant improvement in hearing as assessed by pure tone audiogram after 6 months as compared to 34 patients (68 %) with homologous cartilage reconstruction. Complications and extrusion rates were almost similar in both the groups. Hearing results in both the groups are almost comparable but the homologous preserved cartilage being readily available is an equally good option for ossicular reconstruction.

  7. Comparative study of sliced tragal cartilage and temporalis fascia in type I tympanoplasty. (United States)

    Khan, M M; Parab, S R


    To compare anatomical and audiological results using sliced tragal cartilage and temporalis fascia in type I tympanoplasty. A retrospective review was undertaken of primary tympanoplasties using sliced tragal cartilage and temporalis fascia from May 2005 to January 2008. In total, 223 ears were operated on using sliced tragal cartilage graft and 167 using temporalis fascia. Statistical analysis of the outcome data was performed. At the two-year and four-year follow ups, successful closure of the tympanic membrane was achieved in 98.20 per cent and 97.75 per cent, respectively, of the cartilage group compared with 87.42 per cent and 82.63 per cent, respectively, of the temporalis fascia group. At the four-year follow up, the average air-bone gap was 7.10 ± 3.01 dB in the cartilage group and 8.05 ± 3.22 dB in the temporalis fascia group. The overall success rate for primary cartilage tympanoplasty is higher when using sliced cartilage than with temporalis fascia grafting.

  8. Rib for blended wing-body aircraft (United States)

    Hawley, Arthur V. (Inventor)


    Structural ribs for providing structural support for a structure, such as the pressure cabin of a blended-wing body aircraft. In a first embodiment, the ribs are generally Y-shaped, being comprised of a vertical web and a pair of inclined webs attached to the vertical web to extend upwardly and outwardly from the vertical web in different directions, with only the upper edges of the inclined webs being attached to a structural element. In a second embodiment, the ribs are generally trident-shaped, whereby the vertical web extends upwardly beyond the intersection of the inclined webs with the vertical web, with the upper edge of the vertical web as well as the upper edges of the inclined webs being attached to the same structural element.

  9. Chondroblastoma of rib in situs inversus

    Directory of Open Access Journals (Sweden)

    Purwa R Patil


    Full Text Available Chondroblastoma is a rare benign cartilaginous tumour accounting for approximately 1% of all bone tumours. It commonly arises from epiphysis of a long bone, particularly the humerus, tibia and femur. Rib is an extremely rare site for this tumour with a few cases reported in the literature. It is commonly seen in children and adults between the ages of 10 - 20 years. Although roentgenographic findings are quite common characteristic of this tumour, it can sometimes be misdiagnosed as giant cell tumour, osteogenic sarcoma and myeloma on histopathology. We report a 26-year-old male patient with situs inversus and chondroblastoma of rib. To the best of our knowledge, this is the first case of chondroblastoma of the rib in a patient of situs inversus. Segmental resection is the treatment of choice. It usually behaves in a benign fashion, but few cases have shown local recurrences and distant metastasis; hence, follow-up of the patient is essential.

  10. Cartilage differentiation in cephalopod molluscs. (United States)

    Cole, Alison G; Hall, Brian K


    Amongst the various metazoan lineages that possess cartilage, tissues most closely resembling vertebrate hyaline cartilage in histological section are those of cephalopod molluscs. Although elements of the adult skeleton have been described, the development of these cartilages has not. Using serial histology of sequential developmental stages of the European cuttlefish, Sepia officinalis, we investigate these skeletal elements and offer the first description of the formation of any cellular invertebrate cartilage. Our data reveal that cuttlefish cartilage most often differentiates from uncondensed mesenchymal cells near the end of embryonic development, but that the earliest-forming cartilages differentiate from a cellular condensation which goes through a protocartilage stage in a manner typical of vertebrate primary cartilage formation. We further investigate the distribution and degree of differentiation of cartilages at the time of hatching in an additional four cephalopod species. We find that the timing of cartilage development varies between elements within a single species, as well as between species. We identify a tendency towards cartilage differentiation from uncondensed connective tissue in elements that form at the end of embryogenesis or after hatching. These data suggest a form of metaplasia from connective tissue is the ancestral mode of cartilage formation in this lineage.


    Directory of Open Access Journals (Sweden)

    Ariana Barlič


    Surveys show that the most frequently used surgical methods are mosaicplasty and bonemarrow stimulation with microfracturing. The efficacy of the autologous chondrocyte implantationmethod should be superior to microfracturing on a long run. Especially when(regeneration of the hyaline cartilage instead of fibrous tissue (fibrocartilage is concerned.However, it has not been scientifically proved yet

  12. Articulations of the ribs: a pictorial review. (United States)

    Sutro, C J; Sutro, W H


    The joints of the ribs are true articulations and may be involved by local or general affections of the skeleton. Scoliosis, kyphosis, infections, arthritis (local or general types) may result in fibrosis, abnormal configuration, or ankylosis of the joints in question. In certain types of fractures of the dorsal vertebrae, disruption of the contiguous rib articulations may result in fibrosis or bony depositions and secondarily aid in local stabilization of the fracture. Narrowing of the intercostal spaces, as noted in kyphosis, scoliosis, and arthritis of the dorsal region, does not seem to be routinely associated with clinical findings of intercostal neuralgia.

  13. Rib fractures and their association With solid organ injury: higher rib fractures have greater significance for solid organ injury screening. (United States)

    Rostas, Jack W; Lively, Timothy B; Brevard, Sidney B; Simmons, Jon D; Frotan, Mohammad A; Gonzalez, Richard P


    The purpose of this study was to identify patients with rib injuries who were at risk for solid organ injury. A retrospective chart review was performed of all blunt trauma patients with rib fractures during the period from July 2007 to July 2012. Data were analyzed for association of rib fractures and solid organ injury. In all, 1,103 rib fracture patients were identified; 142 patients had liver injuries with 109 (77%) associated right rib fractures. Right-sided rib fractures with highest sensitivity for liver injury were middle rib segment (5 to 8) and lower segment (9 to 12) with liver injury sensitivities of 68% and 43%, respectively (P rib fractures. Left middle segment rib fractures and lower segment rib fractures had sensitivities of 80% and 63% for splenic injury, respectively (P Rib fractures higher in the thoracic cage have significant association with solid organ injury. Using rib fractures from middle plus lower segments as indication for abdominal screening will significantly improve rib fracture sensitivity for identification of solid organ injury. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. CCN family member 2/connective tissue growth factor (CCN2/CTGF has anti-aging effects that protect articular cartilage from age-related degenerative changes.

    Directory of Open Access Journals (Sweden)

    Shinsuke Itoh

    Full Text Available To examine the role of connective tissue growth factor CCN2/CTGF (CCN2 in the maintenance of the articular cartilaginous phenotype, we analyzed knee joints from aging transgenic mice (TG overexpressing CCN2 driven by the Col2a1 promoter. Knee joints from 3-, 14-, 40-, and 60-day-old and 5-, 12-, 18-, 21-, and 24-month-old littermates were analyzed. Ccn2-LacZ transgene expression in articular cartilage was followed by X-gal staining until 5 months of age. Overexpression of CCN2 protein was confirmed through all ages in TG articular cartilage and in growth plates. Radiographic analysis of knee joints showed a narrowing joint space and other features of osteoarthritis in 50% of WT, but not in any of the TG mice. Transgenic articular cartilage showed enhanced toluidine blue and safranin-O staining as well as chondrocyte proliferation but reduced staining for type X and I collagen and MMP-13 as compared with those parameters for WT cartilage. Staining for aggrecan neoepitope, a marker of aggrecan degradation in WT articular cartilage, increased at 5 and 12 months, but disappeared at 24 months due to loss of cartilage; whereas it was reduced in TG articular cartilage after 12 months. Expression of cartilage genes and MMPs under cyclic tension stress (CTS was measured by using primary cultures of chondrocytes obtained from wild-type (WT rib cartilage and TG or WT epiphyseal cartilage. CTS applied to primary cultures of mock-transfected rib chondrocytes from WT cartilage and WT epiphyseal cartilage induced expression of Col1a1, ColXa1, Mmp-13, and Mmp-9 mRNAs; however, their levels were not affected in CCN2-overexpressing chondrocytes and TG epiphyseal cartilage. In conclusion, cartilage-specific overexpression of CCN2 during the developmental and growth periods reduced age-related changes in articular cartilage. Thus CCN2 may play a role as an anti-aging factor by stabilizing articular cartilage.

  15. Contribution of somitic cells to the avian ribs

    National Research Council Canada - National Science Library

    Evans, Darrell J.R


    ... been termed the distal rib. Intercostal spaces lie between adjacent ribs cranially and caudally and are spanned by intercostal muscles, which are involved, in part, in the process of ventilation. The question of where the thoracic ribs originate, embryologically, has been the focus of debate for some time. Controversy has existed since at l...

  16. Mechanical Action of the Intercostal Muscles on the Ribs (United States)

    de Troyer, Andre; Kelly, Suzanne; Zin, Walter A.


    The external and internal interosseous intercostal muscles were separately stimulated at end-expiratory lung volume in anesthetized dogs. These muscles were all found to elevate the ribs into which they insert. By attaching weights to the ribs, it was determined that the nonlinear compliance of the ribs was responsible for this phenomenon.

  17. Comparison of a microsliced modified chondroperichondrium shield graft and a temporalis fascia graft in primary type I tympanoplasty: A prospective randomized controlled trial. (United States)

    Bhattacharya, Shambhu Nath; Pal, Sudipta; Saha, Somnath; Gure, Prasanta Kumar; Roy, Anupam


    We conducted a prospective, randomized, controlled trial to compare outcomes in type I tympanoplasty patients who received an autologous microsliced modified cartilage perichondrium shield graft (cartilage group) and those who received an autologous temporalis muscle fascia graft (fascia group). Our three outcomes measures were (1) anatomic success rates at 3 months, (2) hearing results at 6 months, and (3) rates of morphologic success (i.e., the absence of reperforation, retraction, and graft displacement) at 2 years among those in each group who had an intact graft at 3 months. Of 56 patients who were initially enrolled and who underwent one of these type I tympanoplasty procedures, 51 completed the study-28 in the cartilage group and 23 in the fascia group. The former was made up of 11 males and 17 females, aged 15 to 48 years (mean: 27.4), and the latter included 9 males and 14 females, aged 15 to 52 years (mean: 31.7). The overall graft take rate at 3 months with respect to perforation closure (anatomic success) was 93.3% in the cartilage group and 91.7% in the fascia group, which was not a statistically significant difference. The mean hearing gain at 6 months was 11.7 ± 7.6 dB in the cartilage group and 12.6 ± 6.0 dB in the fascia group-again, not statistically significant. At 2 years, morphologic success rates were 92.3 and 81.0%, respectively-again, not statistically significant. We conclude that autologous microsliced modified cartilage perichondrium shield graft tympanoplasty is as effective as conventional temporalis fascia tympanoplasty in terms of graft take rates and functional results. Indeed, medium-term outcomes (2-yr follow-up) revealed that sustainable morphologic success was actually better with the cartilage technique than with the fascia technique because it was associated with fewer revision surgeries.


    Directory of Open Access Journals (Sweden)

    Chandra Sekharam Naidu


    Full Text Available We here with present a case of osteochondroma of the (L 8 th rib, in a child 8 years of, one year duration. He presented with pain and swelling which are gradually increasing. After thorough investigation we have excised the tumor and sent for histopathological examination

  19. Advances in cartilage tissue engineering : in vitro

    NARCIS (Netherlands)

    E.W. Mandl (Erik)


    textabstractWithin the body three subtypes of cartilage can be distinguished: hyaline cartilage, elastic cartilage and fibrocartilage. Hyaline cartilage is the predominant subtype and is mainly located in articular joints and in less extent in the nasal septum and cricoid. Elastic cartilage can be

  20. Embryonic origin and fate of chondroid tissue and secondary cartilages in the avian skull


    Lengelé, Benoît; Schowing, J.; Dhem, Antoine


    BACKGROUND: Chondroid tissue is an intermediate calcified tissue, mainly involved in desmocranial morphogenesis. Often associated with secondary cartilages, it remained of unprecise embryonic origin. METHODS: The latter was studied by performing isotopic isochronic grafts of quail encephalon onto 30 chick embryos. The so-obtained chimeras were sacrificed at the 9th, 12th, and 14th day of incubation. The contribution of graft- and host-derived cells to the histogenesis of chondroid tissue,...

  1. Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures. (United States)

    Chapman, Brandon C; Overbey, Douglas M; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T; French, Andrew; Johnson, Jeffrey L; Burlew, Clay C; Barnett, Carlton; Moore, Ernest E; Pieracci, Fredric M


    Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student's t-test and chi-square analysis were used for comparison. We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest. The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.

  2. Mechanical and biochemical mapping of human auricular cartilage for reliable assessment of tissue-engineered constructs. (United States)

    Nimeskern, Luc; Pleumeekers, Mieke M; Pawson, Duncan J; Koevoet, Wendy L M; Lehtoviita, Iina; Soyka, Michael B; Röösli, Christof; Holzmann, David; van Osch, Gerjo J V M; Müller, Ralph; Stok, Kathryn S


    It is key for successful auricular (AUR) cartilage tissue-engineering (TE) to ensure that the engineered cartilage mimics the mechanics of the native tissue. This study provides a spatial map of the mechanical and biochemical properties of human auricular cartilage, thus establishing a benchmark for the evaluation of functional competency in AUR cartilage TE. Stress-relaxation indentation (instantaneous modulus, Ein; maximum stress, σmax; equilibrium modulus, Eeq; relaxation half-life time, t1/2; thickness, h) and biochemical parameters (content of DNA; sulfated-glycosaminoglycan, sGAG; hydroxyproline, HYP; elastin, ELN) of fresh human AUR cartilage were evaluated. Samples were categorized into age groups and according to their harvesting region in the human auricle (for AUR cartilage only). AUR cartilage displayed significantly lower Ein, σmax, Eeq, sGAG content; and significantly higher t1/2, and DNA content than NAS cartilage. Large amounts of ELN were measured in AUR cartilage (>15% ELN content per sample wet mass). No effect of gender was observed for either auricular or nasoseptal samples. For auricular samples, significant differences between age groups for h, sGAG and HYP, and significant regional variations for Ein, σmax, Eeq, t1/2, h, DNA and sGAG were measured. However, only low correlations between mechanical and biochemical parameters were seen (Rbiochemical map of human auricular cartilage. Regional variations in mechanical and biochemical properties were demonstrated in the auricle. This finding highlights the importance of focusing future research on efforts to produce cartilage grafts with spatially tunable mechanics. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. No breakpoint for mortality in pediatric rib fractures. (United States)

    Rosenberg, Graeme; Bryant, Alex K; Davis, Kimberly A; Schuster, Kevin M


    Rib fracture number correlates with mortality in adult trauma patients, sharply rising above six fractured ribs. Because of the pliability of younger ribs, pediatric ribs are believed to require more energy to fracture. We hypothesized this will result in a different rib fracture-associated pediatric mortality rate. We queried the National Trauma Data Bank (American College of Surgeons, Chicago, Illinois) for patients younger than 21 years with and without rib fractures (2002-2009), abstracting the number of rib fractures, diagnoses, procedures, and outcomes. Univariable and multivariable analyses were performed with logistic regression to adjust for age and concomitant injury. We identified 729,240 pediatric patients, 19,442 with rib fractures. Mortality doubled from 1.79% without rib fracture to 5.81% for one rib fracture and then nearly linearly increased to 8.23% for seven fractures unlike the pattern in adults. This pattern persisted irrespective of the age group evaluated. Ventilator days also increased with increasing number of rib fractures. Adjusted odds of mortality increased up to six rib fractures for all age groups. Penetrating injury, concomitant injury, and hemothorax all predicted mortality on multivariable analysis. More than two rib fractures also predicted chest tube placement (odds ratio [OR], thoracostomy 11.89 (11.37-12.44), thoracotomy 5.89 (5.17-6.84), thoracoscopy (6.28-12.03), laparotomy 2.68 (2.49-2.89). Mortality increased nearly linearly for increasing numbers of pediatric rib fractures without an inflection. Odds of mortality increases with each additional rib fractured in all pediatric age groups. Prognostic and epidemiologic study, level III.


    Directory of Open Access Journals (Sweden)

    Biram Singh


    Full Text Available OBJECTIVE This study was conducted to find out the ideal graft between septal cartilage and cortical mastoid bone in Farrior’s type 3 tympanoplasty in cholesteatoma patients in terms of hearing improvement, graft status and recurrence rate of the disease after canal wall down mastoidectomy. METHODS This randomized controlled trial was conducted in a tertiary care centre and the procedure and data collections were carried out for one and a half calendar year with effect from September 2007 and each case was followed up for 6 months. The data were entered and calculated statistically using SPSS16 for windows. RESULTS The study shows significant hearing improvement in both the groups. The tympanoplasty type 3 with cortical mastoid bone had air bone gap less than 20dB in 40% of patients. In septal cartilage, tympanoplasty group air bone gap less than 20dB was observed in 36.4%. Retraction of graft developed in 1(2.4% out of 20 patients among cortical mastoid bone tympanoplasty group. Among 22 patients of septal cartilage tympanoplasty type 3, 2(4.8% patients had cartilage resorption and 3(7.1% had graft displacement. Of the total 42 patients, 2(4.8% developed recurrence of the disease. CONCLUSION Cholesteatoma management is controversial. Canal wall down mastoidectomy can reduce the recurrence of disease. The cortical mastoid bone and septal cartilage grafts can provide hearing improvement after tympanoplasty type 3. There is no significant difference in hearing improvement between the two grafts.

  5. Lubrication of Articular Cartilage. (United States)

    Jahn, Sabrina; Seror, Jasmine; Klein, Jacob


    The major synovial joints such as hips and knees are uniquely efficient tribological systems, able to articulate over a wide range of shear rates with a friction coefficient between the sliding cartilage surfaces as low as 0.001 up to pressures of more than 100 atm. No human-made material can match this. The means by which such surfaces maintain their very low friction has been intensively studied for decades and has been attributed to fluid-film and boundary lubrication. Here, we focus especially on the latter: the reduction of friction by molecular layers at the sliding cartilage surfaces. In particular, we discuss such lubrication in the light of very recent advances in our understanding of boundary effects in aqueous media based on the paradigms of hydration lubrication and of the synergism between different molecular components of the synovial joints (namely hyaluronan, lubricin, and phospholipids) in enabling this lubrication.

  6. Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment. (United States)

    Talbot, Brett S; Gange, Christopher P; Chaturvedi, Apeksha; Klionsky, Nina; Hobbs, Susan K; Chaturvedi, Abhishek


    The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not only identify the presence of rib injuries but also alert the clinician about organ-specific injury, specific traumatic patterns, and acute rib trauma complications that require emergent attention. Rib injuries can be separated into specific morphologic fracture patterns that include stress, buckle, nondisplaced, displaced, segmental, and pathologic fractures. Specific attention is also required for flail chest and for fractures due to pediatric nonaccidental trauma. Rib fractures are associated with significant morbidity and mortality, both of which increase as the number of fractured ribs increases. Key complications associated with rib fracture include pain, hemothorax, pneumothorax, extrapleural hematoma, pulmonary contusion, pulmonary laceration, acute vascular injury, and abdominal solid-organ injury. Congenital anomalies, including supernumerary or accessory ribs, vestigial anterior ribs, bifid ribs, and synostoses, are common and should not be confused with traumatic pathologic conditions. Nontraumatic mimics of traumatic rib injury, with or without fracture, include metastatic disease, primary osseous neoplasms (osteosarcoma, chondrosarcoma, Ewing sarcoma, Langerhans cell histiocytosis, and osteochondroma), fibrous dysplasia, and Paget disease. Principles of management include supportive and procedural methods of alleviating pain, treating complications, and stabilizing posttraumatic deformity. By recognizing and accurately reporting the imaging findings, the radiologist will add value to the care of patients with thoracic trauma. Online supplemental material is available for this article. (©)RSNA, 2017.

  7. Rib fractures in infants due to cardiopulmonary resuscitation efforts. (United States)

    Dolinak, David


    Although it is widely known that adults may sustain fractures of the anterior and/or lateral aspects of the ribs due to cardiopulmonary resuscitation (CPR) efforts, relatively little is written about the generation of CPR-related rib fractures in the infant age range. In a series of 70 consecutive autopsies in infants ranging in age from 2 weeks to 8 months, with no history or indications of injury, the parietal pleura of the thoracic cage was stripped and the ribs carefully examined for fracture. Subtle fractures of the anterolateral aspects of the ribs were discovered in 8 (11%) of the 70 cases. In 7 of the 8 cases, multiple ribs were fractured (ranging up to 10 rib fractures), and in 5 of these cases, the rib fractures were bilateral. All of the rib fractures were subtle, had little if any associated blood extravasation, and would have been easily missed had the parietal pleura not been stripped. These anterolateral rib fractures in infants are the likely correlate of anterolateral rib fractures that are not uncommonly seen in the adult population, resulting from resuscitation efforts. The rib fractures are subtle and may not be identified unless the parietal pleura is stripped.

  8. The contribution of rib fractures to chronic pain and disability. (United States)

    Gordy, Stephanie; Fabricant, Loic; Ham, Bruce; Mullins, Richard; Mayberry, John


    The contribution of rib fractures to chronic pain and disability is not well described. Two hundred three patients with rib fractures were followed for 6 months. Chronic pain was assessed using the McGill Pain Questionnaire Pain Rating Index and Present Pain Intensity (PPI) scales. Disability was defined as a decrease in work or functional status. The prevalence of chronic pain was 22% and disability was 53%. Acute PPI predicted chronic pain. Associated injuries, bilateral rib fractures, injury severity score, and number of rib fractures were not predictive of chronic pain. No acute injury characteristics were predictive of disability. Among 89 patients with isolated rib fractures, the prevalence of chronic pain was 28% and of disability was 40%. No injury characteristics predicted chronic pain. Bilateral rib fractures and acute PPI predicted disability. The contribution of rib fractures to chronic pain and disability is significant but unpredictable with conventional injury descriptors. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Scaffolding Biomaterials for Cartilage Regeneration

    Directory of Open Access Journals (Sweden)

    Zhen Cao


    Full Text Available Completely repairing of damaged cartilage is a difficult procedure. In recent years, the use of tissue engineering approach in which scaffolds play a vital role to regenerate cartilage has become a new research field. Investigating the advances in biological cartilage scaffolds has been regarded as the main research direction and has great significance for the construction of artificial cartilage. Native biological materials and synthetic polymeric materials have their advantages and disadvantages. The disadvantages can be overcome through either physical modification or biochemical modification. Additionally, developing composite materials, biomimetic materials, and nanomaterials can make scaffolds acquire better biocompatibility and mechanical adaptability.

  10. Computational study on effects of rib height and thickness on heat transfer enhancement in a rib roughened square channel

    Indian Academy of Sciences (India)



    A computational study was carried out for the heat transfer augmentation in a three-dimensional square channel fitted with different types of ribs. The standard k–e model and its two variants (RNG and realizable) were used for turbulence modeling. The predictions were compared with available experimental andcomputational results. Three rib configurations were used in the present study: 90° continuous attached ribs, 60° V-shaped broken attached thick and thin ribs. It was observed that the maximum heat transfer occurs at the normalized rib spacing (p/e) = 10 in the case of 90° attached ribs. The effects of the blockage ratio and rib thickness were investigated for 60° V-shaped broken ribs with Re = 10,000–30,000 and p/e = 10. It was observed that the average Nusselt number decreases with an increase in the Reynolds number for almost all configurations studied in the present study. For the 60° V-shaped broken ribs, increasing the blockage ratio had an adverse effect on the heat transfer. It was also observed that thin ribs perform better than thick ribs.

  11. Bone graft (United States)

    ... around the area. The bone graft can be held in place with pins, plates, or screws. Why ... Orthopaedic Surgery, San Francosco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the ...

  12. Streamlined bioreactor-based production of human cartilage tissues. (United States)

    Tonnarelli, B; Santoro, R; Adelaide Asnaghi, M; Wendt, D


    Engineered tissue grafts have been manufactured using methods based predominantly on traditional labour-intensive manual benchtop techniques. These methods impart significant regulatory and economic challenges, hindering the successful translation of engineered tissue products to the clinic. Alternatively, bioreactor-based production systems have the potential to overcome such limitations. In this work, we present an innovative manufacturing approach to engineer cartilage tissue within a single bioreactor system, starting from freshly isolated human primary chondrocytes, through the generation of cartilaginous tissue grafts. The limited number of primary chondrocytes that can be isolated from a small clinically-sized cartilage biopsy could be seeded and extensively expanded directly within a 3D scaffold in our perfusion bioreactor (5.4 ± 0.9 doublings in 2 weeks), bypassing conventional 2D expansion in flasks. Chondrocytes expanded in 3D scaffolds better maintained a chondrogenic phenotype than chondrocytes expanded on plastic flasks (collagen type II mRNA, 18-fold; Sox-9, 11-fold). After this "3D expansion" phase, bioreactor culture conditions were changed to subsequently support chondrogenic differentiation for two weeks. Engineered tissues based on 3D-expanded chondrocytes were more cartilaginous than tissues generated from chondrocytes previously expanded in flasks. We then demonstrated that this streamlined bioreactor-based process could be adapted to effectively generate up-scaled cartilage grafts in a size with clinical relevance (50 mm diameter). Streamlined and robust tissue engineering processes, as the one described here, may be key for the future manufacturing of grafts for clinical applications, as they facilitate the establishment of compact and closed bioreactor-based production systems, with minimal automation requirements, lower operating costs, and increased compliance to regulatory guidelines.

  13. Distraction Osteogenesis of Multiple Ribs for the Treatment of Acquired Thoracic Dystrophy. (United States)

    Piper, Merisa L; Delrosario, Lawrence; Hoffman, William Y


    Acquired thoracic dystrophy is a complication associated with early open repair of pectus excavatum resulting from extensive cartilage resection. The condition can cause serious functional and physiologic impairments, including cardiac compression and restrictive pulmonary function. We describe a 17-year-old boy with acquired thoracic dystrophy after Ravitch repair of pectus excavatum during infancy, whom we treated with distraction osteogenesis. The patient had a marked deformity of the chest wall and general hypoplasia of the central portion of the ribcage, with resultant symptomatic dyspnea on exertion and reduced pulmonary function. After osteotomies and distraction osteogenesis of bilateral ribs 4-8 using customized distraction devices, he had improved thoracic contour, resolution of dyspnea, and decreased restrictive pulmonary symptoms. This case suggests that distraction osteogenesis, already used extensively in craniomaxillofacial and orthopedic surgery, may be a novel method for management of this condition.

  14. Chondromyxoid fibroma of the second rib. (United States)

    Long, Kristin L; Absher, Kimberly J; Draus, John M


    Chondromyxoid fibromas are benign tumors which are found most frequently in the metaphyses of long bones. They comprise less than 1% of primary bone neoplasms and display a hypermetabolic appearance on PET imaging. Oftentimes, they are misdiagnosed as chondrosarcomas and are excised due to concern for malignancy. We present a case of a condromyxoid fibroma originating from the second rib of a 15-year-old girl.

  15. Osteoradionecrosis of the Ribs following Breast Radiotherapy

    Directory of Open Access Journals (Sweden)

    Luke Nicholls


    Full Text Available Introduction: Osteoradionecrosis (ORN of the chest wall is a rare complication after whole-breast radiotherapy (RT. Herein, we report a case of ORN involving the underlying ribs following adjuvant whole-breast RT using standard fractionation and conduct a review of the literature. Case Report: A previously well 43-year-old female with right-sided, early-stage, node-negative breast cancer was treated with breast-conserving surgery. She subsequently underwent adjuvant whole-breast RT receiving 50 Gy in 25 fractions over 5 weeks using standard tangential photon fields with 6 MV photons followed by an electron boost of 10 Gy in 5 fractions according to International Commission on Radiation Units (ICRU requirements. Eleven months after RT, the patient developed right lateral chest wall pain, with magnetic resonance imaging (MRI demonstrating two fractures involving the underlying right fifth and sixth ribs associated with fatty marrow changes in the second to sixth ribs, thus raising the possibility of ORN. Treatments including hyperbaric oxygen, pentoxifylline and vitamin E were used with symptomatic improvements. There was demonstrable resolution on follow-up MRI at 2.5 years. Conclusion: The incidence of ORN utilising modern RT techniques and standard fractionation is rare. Numerous treatments are available, with variable response rates. Emerging evidence of predictive gene profiling to estimate the risk of radiation sensitivity may assist in individualising preventative strategies to mitigate the risk of ORN.

  16. [The anatomical structure similarity research on auricular cartilage and nasal alar cartilage]. (United States)

    Chen, Changyong; Fan, Fei; Li, Wenzhi; Li, Binbin; You, Jianjun; Wang, Huan


    There are many scaffold materials of repairing nasal alar cartilage defects. Auricuiar cartilage was used extensively in terms of its abundant tissues, good elasticity, little donor-site malformation, good plasticity etc. The authors dissected auricular cartilage and nasal alar cartilage, measured cartilage's morphous data and found some similar territories with nasal alar cartilage in the structure of auricular cartilage. An anatomical study was performed using 10 adult cadavers acquired through Plastic Surgery Hospital, Peking Union Medical College, Beijing, China. Seven male and three female cadav-ers were included in the study. Harvest 20 auricular cartilage specimens and 20 nasal alar cartilage specimens. Then, Computed Tomography Scan on the auricular cartilage and nasal alar cartilage were performed. The datas were imported into mimics and three-dimensional reconstructions of the auricular cartilage and nasal alar cartilage were carried on. Parts of the auricular cartilage, such as conchal fossa, tragus, intertragic notch, and cymba of auricular concha, curs of helix and curs of helix, triangular fossa, are ana-tomically similar to nasal alar cartilage. This study reports the anatomy of auricular cartilage and nasal alar cartilage, found some territories in the auricular cartilage, such as conchal fossa, tragus, intertragic notch, and cymba of auricular concha, curs of helix and curs of helix, triangular fossa, are anatomically similar to nasal alar cartilage. This research provides the anatomical basis that auricular cartilage was used to repair the nasal cartilage defect.

  17. PIV Measurements of Turbulent Flow in a Channel with Solid or Perforated Ribs

    DEFF Research Database (Denmark)

    Wang, Lei; Salewski, Mirko; Sundén, Bengt


    Particle image velocimetry measurements are performed in a channel with periodic ribs on one wall. We investigate the flow around two different rib configurations: solid and perforated ribs with a slit. The ribs obstruct the channel by 20% of its height and are arranged 10 rib heights apart....... For the perforated ribs, the slit height is 20% of the rib height, and the open-area ratio is 16%. We discuss the flow in terms of mean velocity, streamlines, vorticity, turbulence intensity, and Reynolds shear stress. We find that the recirculation bubbles after the perforated ribs are significantly smaller than...... those after the solid ribs. The reattachment length after perforated ribs is smaller by about 45% compared with the solid ribs. In addition, the Reynolds shear stresses around the perforated ribs are significantly smaller than in the solid rib case, leading to a reduction of the pressure loss...

  18. 13C NMR relaxation studies on cartilage and cartilage components. (United States)

    Naji, L; Kaufmann, J; Huster, D; Schiller, J; Arnold, K


    We have investigated the molecular motions of polysaccharides of bovine nasal and pig articular cartilage by measuring the 13C NMR relaxation times (T1 and T2). Both types of cartilage differ significantly towards their collagen/glycosaminoglycan ratio, leading to different NMR spectra. As chondroitin sulfate is the main constituent of cartilage, aqueous solutions of related poly- and monosaccharides (N-acetylglucosamine and glucuronic acid) were also investigated. Although there are only slight differences in T1 relaxation of the mono- and the polysaccharides, T2 decreases about one order of magnitude, when glucuronic acid or N-acetylglucosamine and chondroitin sulfate are compared. It is concluded that the ring carbons are motion-restricted primarily by the embedment in the rigid pyranose structure and, thus, additional limitations of mobility do not more show a major effect. Significant differences were observed between bovine nasal and pig articular cartilage, resulting in a considerable line-broadening and a lower signal to noise ratio in the spectra of pig articular cartilage. This is most likely caused by the higher collagen content of articular cartilage in comparison to the polysaccharide-rich bovine nasal cartilage.

  19. Juvenile first rib fracture caused by morning stretching. (United States)

    Lee, Seung-Joon; Yie, Kilsoo; Chon, Sung Bin


    First rib fractures are very rare, being primarily associated with external blunt trauma. Related conditions, such as sudden contraction of the neck muscle, stress fractures, and fatigue fractures, have been reported sporadically. These fractures are mostly related to repetitive or explosive physical training. However, anatomical relationships and related injury mechanisms may cause first rib fractures without repetitive sports activity. To present a case of juvenile first rib fracture caused by morning stretching without sports activity. CASE  We present a rare case report of juvenile atraumatic first rib fracture. Physicians should be aware that even morning stretching with yawning can cause a first rib fracture in children. Awareness is important for early recognition, and proper management is critical for a pain-free return to normal life. An understanding of the mechanism of atraumatic first rib fracture is important. Copyright © 2012. Published by Elsevier Inc.

  20. The Place of Ultrasonography in the Evaluation of Rib Fractures

    Directory of Open Access Journals (Sweden)

    Fulya Bakılan


    Full Text Available Objective: The aim of this study was to investigate whether ultrasonography is superior to chest x-ray in detecting rib fractures in patients with minor blunt chest trauma and chest pain. Materials and Methods: Ultrasonography findings of 32 patients with minor blunt chest trauma showing no evidence of a rib fracture on anteroposterior chest x-rays, were documented. Presence of cortical discontinuities, acoustic shadows, reverberation artifacts, and hematoma by ultrasonography was proposed as the diagnostic criteria for detecting the rib fracture. Results: Rib fracture was detected in 20 patients (62.5% according to ultrasonography results. A mildly displaced fracture was detected in 7 patients (35%, hematoma was detected in 3 patients (15% and multiple fractures (in 5th, 6th, 7th, and 8th ribs were detected in 1 patient (5%. Conclusion: The results of our study showed that ultrasonography is superior to chest x-ray, in detecting rib fractures.

  1. The sound transmission of finite ribbed plates using a variational

    DEFF Research Database (Denmark)

    Brunskog, Jonas


    Many lightweight structures consist of plates being stiffened by ribs. The rib stiffeners can significantly change the vibration field and the radiation behavior of the structure. These type of structures has thus often been studied in the past. However, there is a lack of simplified expressions...... for the sound transmission of these structures. Therefore, simplified expressions for the sound transmission of finite single leaf ribbed plates are derived, using a variational technique based on integral equations of the fluid loaded plate....

  2. Slipping Rib Syndrome as Persistent Abdominal and Chest Pain. (United States)

    Bolaños-Vergaray, Juan Javier; de la Gala García, Francisco; Obaya Rebollar, Juan Carlos; Bové Alvarez, Maria


    Slipping rib syndrome is an overlooked cause of persistent abdominal or chest pain. The etiology of this syndrome is not well understood, but the characteristic pain is from hypermobility of the false ribs. Although it is a diagnosis of exclusion, misdiagnosis may lead to an excessive workup. A simple clinical examination via the hooking maneuver is the most significant feature of its diagnosis. We describe the case of a 41-year-old woman with slipping rib syndrome.

  3. A Short-term Comparison Between Result of Palisade Cartilage Tympanoplasty and Temporalis Fascia Technique

    Directory of Open Access Journals (Sweden)

    Mahmood Shishegar


    Full Text Available Introduction: The use of cartilage as a grafting material has been advocated in cases where there is a high risk of graft failure, such as subtotal perforations, adhesive processes, and residual defects after primary tympanoplasties. The purpose of this study was to compare the graft acceptance rates and auditory outcomes of cartilage tympanoplasty operations using a palisade technique with those of primary tympanoplasty using temporalis fascia in a homogenous group of patients. Study Design: Prospective study.  Materials and Methods:The study population included 54 patients who were operated on in two groups (palisade technique & temporalis fascia technique with each group containing 27 patients. Patients with pure subtotal perforations (perforation of >50% of the whole tympanic membrane [TM] area, an intact ossicular chain, at least a one month dry period, and normal middle ear mucosa were included in the study. Grafts acceptance rates and pre- and post-operative audiograms were compared. The follow-up time was six months.  Results: Graft acceptance was achieved in all patients (100% in the palisade cartilage tympanoplasty group and in 25 patients (92.5% in the temporalis fascia group. This difference was not statistically significant (P= 0.15. Comparison of the increases in mean speech reception threshold, air–bone gap, and pure-tone average scores between both techniques showed no significant changes.    Conclusion: Our experience with the palisade cartilage technique demonstrates that subtotal or total perforation at high risk for graft failure can be treated efficiently, and that a durable and resistant reconstruction of the TM with reasonable auditory function can be achieved.  

  4. A short-term evaluation between the result of palisade cartilage tympanoplasty and temporalis fascia technique

    Directory of Open Access Journals (Sweden)

    Irfan Ul Shamas


    Full Text Available Introduction: The use of cartilage as a grafting material has been advocated in cases where there is a high risk of graft failure, such as subtotal perforations, adhesive processes, and residual defects after primary tympanoplasties. The purpose of this study was to compare the graft acceptance rates and auditory outcomes of cartilage tympanoplasty operations using a palisade technique with those of primary tympanoplasty using temporalis fascia in a homogenous group of patients. Study Design: Prospective study. Materials and Methods: The study population included 54 patients who were operated on in two groups (palisade technique and temporalis fascia technique with each group containing 27 patients. Patients with pure subtotal perforations (perforation of >50% of the whole tympanic membrane [TM] area, an intact ossicular chain, at least 1 month dry period, and normal middle ear mucosa were included in the study. Grafts acceptance rates and pre and postoperative audiograms were compared. The follow-up time was 6 months. Results: Graft acceptance was achieved in all patients (100% in the palisade cartilage tympanoplasty group and in 25 patients (92.5% in the temporalis fascia group. This difference was not statistically significant (P = 0.15. Comparison of the increases in mean speech reception threshold, air-bone gap, and pure-tone average scores between both techniques showed no significant changes. Conclusion: Our experience with the palisade cartilage technique demonstrates that subtotal or total perforation at high risk for graft failure can be treated efficiently, and that a durable and resistant reconstruction of the TM with reasonable auditory function can be achieved.

  5. Detection and labeling ribs on expiration chest radiographs (United States)

    Park, Mira; Jin, Jesse S.; Wilson, Laurence S.


    Typically, inspiration is preferred when xraying the lungs. The x-ray technologist will ask a patient to be still and to take a deep breath and to hold it. This not only reduces the possibility of a blurred image but also enhances the quality of the image since air-filled lungs are easier to see on x-ray film. However, inspiration causes low density in the inner part of lung field. That means that ribs in the inner part of lung field have lower density than the other parts nearer to the border of the lung field. That is why edge detection algorithms often fail to detect ribs. Therefore to make rib edges clear we try to produce an expiration lung field using a 'hemi-elliptical cavity.' Based on the expiration lung field, we extract the rib edges using canny edge detector and a new connectivity method, called '4 way with 10-neighbors connectivity' to detect clavicle and rib edge candidates. Once the edge candidates are formed, our system selects the best candidates using knowledge-based constraints such as a gradient, length and location. The edges can be paired and labeled as superior rib edge and inferior rib edge. Then the system uses the clavicle, which is obtained in a same method for the rib edge detection, as a landmark to label all detected ribs.

  6. Quantitative Measurement Method for Possible Rib Fractures in Chest Radiographs (United States)

    Kim, Jaeil; Kim, Sungjun; Kim, Young Jae


    Objectives This paper proposes a measurement method to quantify the abnormal characteristics of the broken parts of ribs using local texture and shape features in chest radiographs. Methods Our measurement method comprises two steps: a measurement area assignment and sampling step using a spline curve and sampling lines orthogonal to the spline curve, and a fracture-ness measurement step with three measures, asymmetry and gray-level co-occurrence matrix based measures (contrast and homogeneity). They were designed to quantify the regional shape and texture features of ribs along the centerline. The discriminating ability of our method was evaluated through region of interest (ROI) analysis and rib fracture classification test using support vector machine. Results The statistically significant difference was found between the measured values from fracture and normal ROIs; asymmetry (p rib fracture classifier, trained with the measured values in ROI analysis, detected every rib fracture from chest radiographs used for ROI analysis, but it also classified some unbroken parts of ribs as abnormal parts (8 to 17 line sets; length of each line set, 2.998 ± 2.652 mm; length of centerlines, 131.067 ± 29.460 mm). Conclusions Our measurement method, which includes a flexible measurement technique for the curved shape of ribs and the proposed shape and texture measures, could discriminate the suspicious regions of ribs for possible rib fractures in chest radiographs. PMID:24175118

  7. Stress injury of the rib in a swimmer

    Energy Technology Data Exchange (ETDEWEB)

    Heincelman, Carrie [University of Cincinnati Medical Center, Department of Orthopaedic Surgery, Cincinnati, OH (United States); Brown, Seth; England, Eric; Mehta, Kaushal; Wissman, Robert D. [University of Cincinnati Medical Center, Department of Radiology, Cincinnati, OH (United States)


    Rib stress injuries are uncommonly reported but have been documented among athletes, most notably rowers. There have only been two prior case reports of rib stress injuries in swimmers, both of which were young females. Magnetic resonance (MR) imaging was either not obtained or the imaging characteristics were incompletely described. We present a case of an isolated third rib stress injury in a collegiate male swimmer diagnosed via MR imaging. We briefly discuss the possible etiologies for rib stress injuries, their MR appearance, as well as their treatment. (orig.)

  8. Case report 467: Cystic chondroblastoma left 4th rib

    Energy Technology Data Exchange (ETDEWEB)

    Sundaram, M.; McGuire, M.H.; Naunheim, K.; Schajowicz, F.


    A case of chondroblastoma in an 18-year-old female arising from a rib near the costotransverse articulation (presumably from the epiphysis of the articular process) has been described. The destructive pattern noted in the rib, associated with a large soft tissue mass, favored a malignant lesion rather than a benign one. Histologically, this tumor had large cystic and hemorrhagic components, consistent with the diagnosis of a cystic chondroblastoma of a rib. Curiously, this patient, like two others with chondroblastoma in a rib was asymptomatic, and attention to the abnormality was drawn from a routine chest radiography. The patient remains disease-free one and a half-years following surgery.

  9. Tensorial electrokinetics in articular cartilage. (United States)

    Reynaud, Boris; Quinn, Thomas M


    Electrokinetic phenomena contribute to biomechanical functions of articular cartilage and underlie promising methods for early detection of osteoarthritic lesions. Although some transport properties, such as hydraulic permeability, are known to become anisotropic with compression, the direction-dependence of cartilage electrokinetic properties remains unknown. Electroosmosis experiments were therefore performed on adult bovine articular cartilage samples, whereby fluid flows were driven by electric currents in directions parallel and perpendicular to the articular surface of statically compressed explants. Magnitudes of electrokinetic coefficients decreased slightly with compression (from approximately -7.5 microL/As in the range of 0-20% compression to -6.0 microL/As in the 35-50% range) consistent with predictions of microstructure-based models of cartilage material properties. However, no significant dependence on direction of the electrokinetic coupling coefficient was detected, even for conditions where the hydraulic permeability tensor is known to be anisotropic. This contrast may also be interpreted using microstructure-based models, and provides insights into structure-function relationships in cartilage extracellular matrix and physical mediators of cell responses to tissue compression. Findings support the use of relatively simple isotropic modeling approaches for electrokinetic phenomena in cartilage and related materials, and indicate that measurement of electrokinetic properties may provide particularly robust means for clinical evaluation of cartilage matrix integrity.

  10. Biotribology :articular cartilage friction, wear, and lubrication


    Schroeder, Matthew O


    This study developed, explored, and refined techniques for the in vitro study of cartilage-on-cartilage friction, deformation, and wear. Preliminary results of in vitro cartilage-on- cartilage experiments with emphasis on wear and biochemistry are presented. Cartilage-bone specimens were obtained from the stifle joints of steers from a separate controlled study. The load, sliding speed, and traverse of the lower specimens were held constant as lubricant and test length were varied. Lubric...

  11. Brief report: reconstruction of joint hyaline cartilage by autologous progenitor cells derived from ear elastic cartilage. (United States)

    Mizuno, Mitsuru; Kobayashi, Shinji; Takebe, Takanori; Kan, Hiroomi; Yabuki, Yuichiro; Matsuzaki, Takahisa; Yoshikawa, Hiroshi Y; Nakabayashi, Seiichiro; Ik, Lee Jeong; Maegawa, Jiro; Taniguchi, Hideki


    In healthy joints, hyaline cartilage covering the joint surfaces of bones provides cushioning due to its unique mechanical properties. However, because of its limited regenerative capacity, age- and sports-related injuries to this tissue may lead to degenerative arthropathies, prompting researchers to investigate a variety of cell sources. We recently succeeded in isolating human cartilage progenitor cells from ear elastic cartilage. Human cartilage progenitor cells have high chondrogenic and proliferative potential to form elastic cartilage with long-term tissue maintenance. However, it is unknown whether ear-derived cartilage progenitor cells can be used to reconstruct hyaline cartilage, which has different mechanical and histological properties from elastic cartilage. In our efforts to develop foundational technologies for joint hyaline cartilage repair and reconstruction, we conducted this study to obtain an answer to this question. We created an experimental canine model of knee joint cartilage damage, transplanted ear-derived autologous cartilage progenitor cells. The reconstructed cartilage was rich in proteoglycans and showed unique histological characteristics similar to joint hyaline cartilage. In addition, mechanical properties of the reconstructed tissues were higher than those of ear cartilage and equal to those of joint hyaline cartilage. This study suggested that joint hyaline cartilage was reconstructed from ear-derived cartilage progenitor cells. It also demonstrated that ear-derived cartilage progenitor cells, which can be harvested by a minimally invasive method, would be useful for reconstructing joint hyaline cartilage in patients with degenerative arthropathies.

  12. Evolution of Autologous Chondrocyte Repair and Comparison to Other Cartilage Repair Techniques

    Directory of Open Access Journals (Sweden)

    Ashvin K. Dewan


    Full Text Available Articular cartilage defects have been addressed using microfracture, abrasion chondroplasty, or osteochondral grafting, but these strategies do not generate tissue that adequately recapitulates native cartilage. During the past 25 years, promising new strategies using assorted scaffolds and cell sources to induce chondrocyte expansion have emerged. We reviewed the evolution of autologous chondrocyte implantation and compared it to other cartilage repair techniques. Methods. We searched PubMed from 1949 to 2014 for the keywords “autologous chondrocyte implantation” (ACI and “cartilage repair” in clinical trials, meta-analyses, and review articles. We analyzed these articles, their bibliographies, our experience, and cartilage regeneration textbooks. Results. Microfracture, abrasion chondroplasty, osteochondral grafting, ACI, and autologous matrix-induced chondrogenesis are distinguishable by cell source (including chondrocytes and stem cells and associated scaffolds (natural or synthetic, hydrogels or membranes. ACI seems to be as good as, if not better than, microfracture for repairing large chondral defects in a young patient’s knee as evaluated by multiple clinical indices and the quality of regenerated tissue. Conclusion. Although there is not enough evidence to determine the best repair technique, ACI is the most established cell-based treatment for full-thickness chondral defects in young patients.

  13. Versatility of three-dimensional total alar cartilage dissection in aesthetic rhinoplasty. (United States)

    Yun, In Sik; Rah, Dong Kyun; Kim, Sung Min


    In many cases, Asians' noses are shorter; their nasal tips have a bulbous shape and typically lack the projection. To correct these problems, we completely dissected the alar cartilage in a three-dimensional manner by which the alar cartilage could be repositioned. Thus, no external force was exerted to the alar cartilage. For approximately 4 years, a total of 502 patients were treated with this surgical method. Using the open rhinoplasty, the alar cartilage was dissected in such a manner that it should be completely isolated from the skin, nasal mucosa, and upper lateral cartilage in 3 layers. Thereafter, using various nasal tip plasty techniques, the alar cartilage was reshaped and then repositioned. Patients were followed up for a mean period of 18 months. Then, the degree of subjective satisfaction of patients was analyzed with the use of 4-point visual analog scale scores. On the assessment of the degree of subjective satisfaction of patients, of a total of 502 patients, 87% responded as "very satisfactory" or "satisfactory." Through an analysis of the photographs taken before and after surgery, in patients with a short nose, the current surgical procedure was effective in extending the length of nose without the septal extension graft. The nasolabial angle was ideally expressed. Through meticulous cartilage manipulation, the tip projection improved and a bulbous shape of the nasal tip was resolved. In an aesthetic rhinoplasty for Asians, if plastic surgery of the nasal tip should be performed using a three-dimensional dissection of the alar cartilage, it would be helpful for surgeons to effectively and freely manipulate the alar cartilage according to their plans.

  14. Interchondral subluxation or "clicking rib syndrome". (United States)

    Abrahams, P


    A case history of the interchondral subluxation syndrome is presented, the anatomy as related to the symptoms discussed and the literature of this so-called "clicking-rib syndrome" reviewed. Unfortunately, this syndrome is not widely recognized but it is hoped that this article will bring it to the attention of those most likely to encounter it-the primary-care physician-and so save numerous unnecessary investigations and consultations. Once one is aware of its existence, the condition is easily diagnosed by careful history and examination alone.

  15. Binding and lubrication of biomimetic boundary lubricants on articular cartilage. (United States)

    Samaroo, Kirk J; Tan, Mingchee; Putnam, David; Bonassar, Lawrence J


    The glycoprotein, lubricin, is the primary boundary lubricant of articular cartilage and has been shown to prevent cartilage damage after joint injury. In this study, a library of eight bottle-brush copolymers were synthesized to mimic the structure and function of lubricin. Polyethylene glycol (PEG) grafted onto a polyacrylic acid (pAA) core mimicked the hydrophilic mucin-like domain of lubricin, and a thiol terminus anchored the polymers to cartilage surfaces much like lubricin's C-terminus. These copolymers, abbreviated as pAA-g-PEG, rapidly bound to cartilage surfaces with binding time constants ranging from 20 to 39 min, and affected lubrication under boundary mode conditions with coefficients of friction ranging from 0.140 ± 0.024 to 0.248 ± 0.030. Binding and lubrication were highly correlated (r(2)  = 0.89-0.99), showing that boundary lubrication in this case strongly depends on the binding of the lubricant to the surface. Along with time-dependent and dose-dependent behavior, lubrication and binding of the lubricin-mimetics also depended on copolymer structural parameters including pAA backbone length, PEG side chain length, and PEG:AA brush density. Polymers with larger backbone sizes, brush sizes, or brush densities took longer to bind (p lubricate and protect cartilage in vivo. In copolymers with shorter pAA backbones, increasing hydrodynamic size inhibited lubrication (p lubricating efficacy as recombinant lubricins and as such have potential for in vivo treatment of post-traumatic osteoarthritis. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:548-557, 2017.

  16. Comparison of ultrasonography and radiography in diagnosis of rib fractures. (United States)

    Pishbin, Elham; Ahmadi, Koorosh; Foogardi, Molood; Salehi, Maryam; Seilanian Toosi, Farrokh; Rahimi-Movaghar, Vafa


    Rib fractures are the most common skeletal thoracic injuries resulting from blunt chest trauma. Half of the rib fractures are not detected upon a precise physical evaluation and radiographs. Recently ultrasonography (USG) has been investigated to detect rib fractures. But based on literature the usefulness of USG varies widely. This study was conducted to investigate the role of USG in the detection of possible rib fractures in comparison with radiography. In this cross-sectional study, consecutive patients with minor blunt chest trauma and suspected rib fractures presenting in Imam Reza Hospital located in Mashhad-Iran, between April 2013 and October 2013 were assessed by USG and radiography. The radiography was performed in a posteroanterior (PA) chest projection and oblique rib view centered over the area of trauma. The time duration spent in taking USG and radiography were recorded. The prevalence and location of fractures revealed by USG and radiography were compared. Sixty-one suspected patients were assessed. The male to female ratio was 2.4:1 (43 men and 18 women) with a mean ± SD age of (44.3 ± 19.7) years. There were totally 59 rib fractures in 38 (62.3%) patients based on radiography and USG, while 23 (37.7%) patients had no diagnostic evidence of rib lesions. USG revealed 58 rib fractures in 33 (54.1%) of 61 suspected patients and radiographs revealed 32 rib fractures in 20 (32.8%) of 61 patients. A total of 58 (98.3%) rib fractures were detected by USG, whereas oblique rib view and PA chest radiography showed 27 (45.8%) and 24 (40.7%) rib fractures, respectively. The average duration of USG was (12 ± 3) min (range 7-17 min), whereas the duration of radiography was (27 ± 6) min (range 15-37 min). The kappa coefficient showed a low level of agreement between both USG and PA chest radiography (kappa coefficient = 0.28), and between USG and oblique rib view (kappa coefficient = 0.32). USG discloses more fractures than radiography in

  17. Computed tomography measurement of rib cage morphometry in emphysema.

    Directory of Open Access Journals (Sweden)

    Nicola Sverzellati

    Full Text Available BACKGROUND: Factors determining the shape of the human rib cage are not completely understood. We aimed to quantify the contribution of anthropometric and COPD-related changes to rib cage variability in adult cigarette smokers. METHODS: Rib cage diameters and areas (calculated from the inner surface of the rib cage in 816 smokers with or without COPD, were evaluated at three anatomical levels using computed tomography (CT. CTs were analyzed with software, which allows quantification of total emphysema (emphysema%. The relationship between rib cage measurements and anthropometric factors, lung function indices, and %emphysema were tested using linear regression models. RESULTS: A model that included gender, age, BMI, emphysema%, forced expiratory volume in one second (FEV1%, and forced vital capacity (FVC% fit best with the rib cage measurements (R(2 = 64% for the rib cage area variation at the lower anatomical level. Gender had the biggest impact on rib cage diameter and area (105.3 cm(2; 95% CI: 111.7 to 98.8 for male lower area. Emphysema% was responsible for an increase in size of upper and middle CT areas (up to 5.4 cm(2; 95% CI: 3.0 to 7.8 for an emphysema increase of 5%. Lower rib cage areas decreased as FVC% decreased (5.1 cm(2; 95% CI: 2.5 to 7.6 for 10 percentage points of FVC variation. CONCLUSIONS: This study demonstrates that simple CT measurements can predict rib cage morphometric variability and also highlight relationships between rib cage morphometry and emphysema.

  18. Computed Tomography Measurement of Rib Cage Morphometry in Emphysema (United States)

    Sverzellati, Nicola; Colombi, Davide; Randi, Giorgia; Pavarani, Antonio; Silva, Mario; Walsh, Simon L.; Pistolesi, Massimo; Alfieri, Veronica; Chetta, Alfredo; Vaccarezza, Mauro; Vitale, Marco; Pastorino, Ugo


    Background Factors determining the shape of the human rib cage are not completely understood. We aimed to quantify the contribution of anthropometric and COPD-related changes to rib cage variability in adult cigarette smokers. Methods Rib cage diameters and areas (calculated from the inner surface of the rib cage) in 816 smokers with or without COPD, were evaluated at three anatomical levels using computed tomography (CT). CTs were analyzed with software, which allows quantification of total emphysema (emphysema%). The relationship between rib cage measurements and anthropometric factors, lung function indices, and %emphysema were tested using linear regression models. Results A model that included gender, age, BMI, emphysema%, forced expiratory volume in one second (FEV1)%, and forced vital capacity (FVC)% fit best with the rib cage measurements (R2 = 64% for the rib cage area variation at the lower anatomical level). Gender had the biggest impact on rib cage diameter and area (105.3 cm2; 95% CI: 111.7 to 98.8 for male lower area). Emphysema% was responsible for an increase in size of upper and middle CT areas (up to 5.4 cm2; 95% CI: 3.0 to 7.8 for an emphysema increase of 5%). Lower rib cage areas decreased as FVC% decreased (5.1 cm2; 95% CI: 2.5 to 7.6 for 10 percentage points of FVC variation). Conclusions This study demonstrates that simple CT measurements can predict rib cage morphometric variability and also highlight relationships between rib cage morphometry and emphysema. PMID:23935872

  19. Rib-sparing and internal mammary artery-preserving microsurgical breast reconstruction with the free DIEP flap. (United States)

    Kim, Hyungsuk; Lim, So-Young; Pyon, Jai-Kyong; Bang, Sa-Ik; Oh, Kap Sung; Lee, Jeong Eon; Nam, Seok Jin; Mun, Goo-Hyun


    Using an internal mammary artery as the recipient vessel in a free flap autologous breast reconstruction is common practice, but this vessel is often sacrificed for end-to-end anastomosis and is typically assessed by removing a costal cartilage segment. The authors studied the reliability of the end-to-side arterial anastomosis using a rib-sparing approach by comparing it with end-to-end anastomosis. The authors analyzed 100 consecutive medical records of patients who underwent autologous breast reconstruction with a free deep inferior epigastric artery perforator flap in which the internal mammary vessels were assessed using a rib-sparing technique. The study compared the complications between the two groups of end-to-side arterial anastomosis (50 cases) and end-to-end arterial anastomosis (50 cases). Exposure of the internal mammary artery using a rib-sparing technique was performed successfully in all 100 flaps. The second and third intercostal spaces were used in 46 and 54 cases, respectively. The mean width of the used intercostal space was 18.3 ± 2.4 mm in the end-to-side group and 18.3 ± 2.9 mm in the end-to-end group (p = 0.923). All flaps survived without partial or total necrosis. One case of venous insufficiency that required exploration occurred in the end-to-side group; the flap was totally saved with venous revision. There was no significant statistical difference between the end-to-side and end-to-end groups in all other variables, including mean flap ischemic time (p = 0.431) and fat necrosis (p = 0.339). The rib-sparing and internal mammary artery-preserving free deep inferior epigastric artery perforator flap transfer is an efficient and safe technique for microsurgical breast reconstruction.

  20. The Outcome of Shield Graft Tympanoplasty: A Single Center Descriptive Study at KAMC

    Directory of Open Access Journals (Sweden)

    Mohamed Sa’ad Eldin Aly


    Full Text Available Cartilage has proven to be a favorable graft material to close tympanic membrane perforations. Objective: In this study we describe our experience with cartilage shield graft tympanoplasty in reconstruction of tympanic membrane perforations. Study Design: A retrospective review was done on 42 patients. The male to female ratio was 19:23 and the age range 11-72 years. Cases varied between Chronic Otitis Media with Dry Perforation and Ossicular Discontinuity and were treated with cartilage shield graft tympanoplasty type I or III, respectively. The corresponding author performed all operations over a period of 2 years at the department of Otolaryngology Head and Neck Surgery at King Abdullah Medical City, Makkah, Saudi Arabia. Methods: Patient and disease information were collected retrospectively and analyzed. Results: Graft take was achieved in 42 patients (100%. No statistically significant association between the postoperative pure tone average – air bone gap results and age, sex, or type of tympanoplasty was observed (p>0.05. The overall mean preoperative pure tone average – air bone gap was 27.0±10.5 dB, and it decreased to 14.9±7.0 dB 3 months postoperatively. A statistically significant improvement was observed (p<0.001. Conclusion: Excellent graft take results were achieved and hearing outcomes were satisfactory. Therefore, shield cartilage graft is a valid alternative in all tympanoplasty procedures.

  1. SC Cyclotron and RIB Facilities in Kolkata

    CERN Document Server

    Sinha, Bikash; Chakrabarti, Alok


    The superconducting cyclotron under construction at this Centre has bending limit (K-bend) of 520 and focusing limit (K-foc) of 160. It is being constructed, primarily, for nuclear physics experiments with heavy ion beams at intermediate energies. The 100-ton main magnet is currently in the commissioning phase with the main coil already at 4.2K temperature. Magnetic field measurements will be carried out over the next several months. All other systems of the cyclotron are in an advanced stage of fabrication or development. We plan to start assembly of the complete cyclotron around the end of 2005. In the phase-I of the project one beam line has been provided. Construction of three more beam lines and various experimental facilities for nuclear physics as well as irradiation experiments has also been funded and the work is well on its way. An ISOL type Radioactive Ion Beam (RIB) facility is being built with the existing K=130 room temperature cyclotron, VEC, as the primary beam source. In-beam RIB production a...

  2. Quality of life after major trauma with multiple rib fractures. (United States)

    Marasco, Silvana; Lee, Geraldine; Summerhayes, Robyn; Fitzgerald, Mark; Bailey, Michael


    Rib fractures are a common injury presenting to major trauma centres and community hospitals. Aside from the acute impact of rib fracture injury, longer-term morbidity of pain, disability and deformity have been described. Despite this, the mainstay of management for the vast majority of rib fracture injuries remains supportive only with analgesia and where required respiratory support. This study aimed to document the long-term quality of life in a cohort of major trauma patients with rib fracture injury over 24 months. Retrospective review (July 2006-July 2011) of 397 major trauma patients admitted to The Alfred Hospital with rib fractures and not treated with operative rib fixation. The main outcome measures were quality of life over 24 months post injury assessed using the Glasgow Outcome Scale Extended and SF12 health assessment forms and a pain questionnaire. Assessment over 24 months of major trauma patients with multiple rib fractures demonstrated significantly lower quality of life compared with published Australian norms at all time points measured. Return to work rates were poor with only 71% of those who were working prior to their accident, returning to any work. This study demonstrates a significant reduction in quality of life for rib fracture patients requiring admission to hospital, which does not return to the level of Australian norms for at least two years. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  3. Surgical Management of Rib Fractures: Strategies and Literature Review. (United States)

    de Jong, M B; Kokke, M C; Hietbrink, F; Leenen, L P H


    Rib fractures can cause significant problems in trauma patients, often resulting in pain and difficulty with respiration. To prevent pulmonary complications and decrease the morbidity and mortality rates of patients with rib fractures, currently there is a trend to provide surgical management of patients with flail chest. However, the indications for rib fracture fixation require further specification. Past and current strategies are described according to a review of the medical literature. A systematic review was performed including current indications for rib fracture fixation. MEDLINE (2000-2013) was searched, as well as Embase (2000-2013) and Cochrane Databases, using the keywords rib, fracture, fixation, plate, repair, and surgery. Three retrospective studies were found that described different techniques for rib fracture fixation. The results demonstrated a reduced number of ventilation days, decreased long-term morbidity and pain, and satisfactory rehabilitation after surgical treatment. In addition to flail chest, age, Injury Severity Score, and the number of rib fractures were important predictive factors for morbidity and mortality. Surgical rib fracture fixation might be indicated in a broader range of cases than is currently performed. Prospective randomized trials are needed for further confirmation. © The Finnish Surgical Society 2014.

  4. Rib enlargement in premature infants with bronchopulmonary dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Hye Kyung; Han, Kim Bokyung; Chang, Yun Sil; Choo, In Wook [Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul (Korea, Republic of); Kim, Kyeong Ah [Anyang General Hospital, Anyang (Korea, Republic of)


    The purpose of this study is to describe the rib changes seen in patients with brochopulmonary dysplasia (BPD). Serial chest radiographs of nine premature infants with BPD who showed diffuse rib enlargement were reviewed for hyperinflation, which was compared with the observed degree of rib enlargement. Vibrator chest physiotherapy was performed in all cases, and five infants underwent conventional ventilation plus high frequency oscillatory ventilation therapy. Their calcium level was normal whereas alkaline phosphatase and phosphate levels were high. In all infants except one, liver enzyme levels were normal. For the treatment of patent ductus arteriosus, infection, and BPD, medications including indomethacin, antibiotics, and dexamethasone were administered. Vitamin D was given to all patients with total parenteral nutrition. Rib enlargement was found to be severe (n=3D4), moderate (n=3D3), or mild (n=3D2) with undulating margins or posterior tapering (n=3D2). Hyperinflation was noted in eight patients, in seven of whom it was moderate to severe. Among these seven, rib enlargement was severe (n=3D2), moderate (n=3D3), or mild (n=3D2). In one infant with mild hyperinflation, rib enlargement was severe. Bilateral irregular infiltrates and atelectases were noted in all patients. In BPD patients, rib enlargement may be seen. In order to differentiate this process from systemic bone disease or bony dysplasia, an awareness of the rib changes occurring in patients with BPD may be important. (author)

  5. Effect of rib-cage structure on acoustic chest impedance

    DEFF Research Database (Denmark)

    Zimmermann, Niels Henrik; Møller, Henrik; Hansen, John


    even weak sounds originating from e.g. the heart. The acoustic impedance is influenced by the structure of the ribcage; hence the acoustic impedance will change depending on if the coupler has been placed on a top of a rib or between the ribs (the intercostal). The impedance of the chest is measured...

  6. Chondral Rib Fractures in Professional American Football: Two Cases and Current Practice Patterns Among NFL Team Physicians. (United States)

    McAdams, Timothy R; Deimel, Jay F; Ferguson, Jeff; Beamer, Brandon S; Beaulieu, Christopher F


    Although a recognized and discussed injury, chondral rib fractures in professional American football have not been previously reported in the literature. There currently exists no consensus on how to identify and treat these injuries or the expected return to play for the athlete. To present 2 cases of chondral rib injuries in the National Football League (NFL) and discuss the current practice patterns for management of these injuries among the NFL team physicians. Case series; Level of evidence, 4. Two cases of NFL players with chondral rib injuries are presented. A survey regarding work-up and treatment of these injuries was completed by team physicians at the 2014 NFL Combine. Our experience in identifying and treating these injuries is presented in conjunction with a survey of NFL team physicians' experiences. Two cases of rib chondral injuries were diagnosed by computed tomography (CT) and treated with rest and protective splinting. Return to play was 2 to 4 weeks. NFL Combine survey results show that NFL team physicians see a mean of 4 costal cartilage injuries per 5-year period, or approximately 1 case per year per team. Seventy percent of team physicians use CT scanning and 43% use magnetic resonance imaging for diagnosis of these injuries. An anesthetic block is used acutely in 57% and only electively in subsequent games by 39%. A high index of suspicion is necessary to diagnose chondral rib injuries in American football. CT scan is most commonly used to confirm diagnosis. Return to play can take up to 2 to 4 weeks with a protective device, although anesthetic blocks can be used to potentially expedite return. Chondral rib injuries are common among NFL football players, while there is no literature to support proper diagnosis and treatment of these injuries or expected duration of recovery. These injuries are likely common in other contact sports and levels of competition as well. Our series combined with NFL team physician survey results can aid team

  7. Stent graft placement for dysfunctional arteriovenous grafts

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Gyeong Sik [Dept. of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young; Ahn, Moon Sang [Chungnam National University Hospital, Daejeon (Korea, Republic of)


    This study aimed to evaluate the usefulness and outcomes of stent graft use in dysfunctional arteriovenous grafts. Eleven patients who underwent stent graft placement for a dysfunctional hemodialysis graft were included in this retrospective study. Expanded polytetrafluoroethylene covered stent grafts were placed at the venous anastomosis site in case of pseudoaneurysm, venous laceration, elastic recoil or residual restenosis despite the repeated angioplasty. The patency of the arteriovenous graft was evaluated using Kaplan-Meier analysis. Primary and secondary mean patency was 363 days and 741 days. Primary patency at 3, 6, and 12 months was 82%, 73%, and 32%, respectively. Secondary patency at the 3, 6, 12, 24, and 36 months was improved to 91%, 82%, 82%, 50%, and 25%, respectively. Fractures of the stent graft were observed in 2 patients, but had no effect on the patency. Stent graft placement in dysfunctional arteriovenous graft is useful and effective in prolonging graft patency.

  8. Effect of rib-cage structure on acoustic chest impedance

    DEFF Research Database (Denmark)

    Zimmermann, Niels Henrik; Møller, Henrik; Hansen, John


    even weak sounds originating from e.g. the heart. The acoustic impedance is influenced by the structure of the ribcage; hence the acoustic impedance will change depending on if the coupler has been placed on a top of a rib or between the ribs (the intercostal). The impedance of the chest is measured...... in the frequency range from 40 Hz to 5 kHz using an acoustic impedance tube made specifically for the purpose. The measurements are carried out in a grid pattern on the surface of the chest. The grid is aligned according to the ribs; hence the measurements are either on a top of the ribs or between the ribs...

  9. Painful rib hump: a new clinical sign for detecting intraspinal rib displacement in scoliosis due to neurofibromatosis

    Directory of Open Access Journals (Sweden)

    Katsalouli Marina


    Full Text Available Abstract Background Spinal cord compression and associate neurological impairment is rare in patients with scoliosis and neurofibromatosis. Common reasons are vertebral subluxation, dislocation, angulation and tumorous lesions around the spinal canal. Only twelve cases of intraspinal rib dislocation have been reported in the literature. The aim of this report is to present a case of rib penetration through neural foramen at the apex of a scoliotic curve in neurofibromatosis and to introduce a new clinical sign for its detection. Methods A 13-year-old girl was evaluated for progressive left thoracic kyphoscoliotic curve due to a type I neurofibromatosis. Clinical examination revealed multiple large thoracic and abdominal "cafe-au-lait" spots, neurological impairment of the lower limbs and the presence of a thoracic gibbous that was painful to pressure at the level of the left eighth rib (Painful Rib Hump. CT-scan showed detachment and translocation of the cephalic end of the left eighth rib into the adjacent enlarged neural foramen. The M.R.I. examination of the spine showed neither cord abnormality nor neurogenic tumor. Results The patient underwent resection of the intraspinal mobile eighth rib head and posterior spinal instrumentation and was neurologically fully recovered six months postoperatively. Conclusion Spine surgeons should be aware of intraspinal rib displacement in scoliotic curves in neurofibromatosis. Painful rib hump is a valuable diagnostic tool for this rare clinical entity.

  10. [Reconstruction of auricular framework using autologous perichondrial grafts. An experimental study]. (United States)

    Qi, F Z


    An experimental study was performed in 13 adult dogs to find out whether the cartilage forming capacity of the costal perichondrium could be utilized in reconstruction of the auricular framework. Silastic ear-shaped frameworks, which were wrapped by free costal perichondrial grafts, were transferred to the subcutaneous space on both side of the thorax. The animals were sacrificed at 2 months, 3 months, and 4 months postoperatively. After 6 weeks, the reconstructed auricular cartilage framework collapsed and the silicone framework was rejected. In groups of 2, 3 and 4 months, collapse of the cartilage framework occurred when the silicone tube was removed in 7 day. There was certain elasticity, but the auricular framework had only little resistance to pressure. How to improve new cartilage production would be the key point of further study. Histologically, it was shown that mature hyalin cartilage was generated in 2 months postoperatively.

  11. Biomechanical and biochemical characterization of porcine tracheal cartilage. (United States)

    Hoffman, Benjamin; Martin, Matthew; Brown, Bryan N; Bonassar, Lawrence J; Cheetham, Jonathan


    The trachea is essential to respiratory function and is a mechanically and biochemically complex composite tissue. Tissue-engineering approaches to treat tracheal diseases require detailed knowledge of the native mechanical and biochemical properties of the trachea. Although the porcine trachea represents an excellent preclinical model, relevant mechanical and biochemical composition are incompletely characterized. Experimental. The mechanical and biochemical properties of 12 intact porcine tracheas were determined to characterize their compliance, as well as the aggregate modulus, bidirectional elastic modulus, hydraulic permeability, and biochemical characteristics of individual cartilage rings. Data demonstrate the glycosaminoglycan content of tracheal rings was (mean ± standard deviation) 190 ± 49 μg/mg. Hydroxyproline content was 8.2 ± 3.2 μg/mg, and DNA content was 1.3 ± 0.27 μg/mg, a four-fold difference between circumferential elastic modulus (5.6 ± 2.0 megapascal [MPa]) and longitudinal composite elastic modulus (1.1 ± 0.7 MPa, P biochemical and mechanical properties of porcine tracheal cartilage, which is considered an excellent candidate for xenogenic tracheal graft and a source for tissue-engineered tracheal reconstruction. The range of parameters characterized in this study agrees with those reported for hyaline cartilage of the airway in other species. These characteristics can be used as quantitative benchmarks for tissue-engineering approaches to treat tracheal disease. NA. Laryngoscope, 126:E325-E331, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  12. The heterozygous disproportionate micromelia (dmm) mouse: morphological changes in fetal cartilage precede postnatal dwarfism and compared with lethal homozygotes can explain the mild phenotype. (United States)

    Seegmiller, Robert E; Bomsta, Brandon D; Bridgewater, Laura C; Niederhauser, Cindy M; Montaño, Carolina; Sudweeks, Sterling; Eyre, David R; Fernandes, Russell J


    The disproportionate micromelia (Dmm) mouse has a mutation in the C-propeptide coding region of the Col2a1 gene that causes lethal dwarfism when homozygous (Dmm/Dmm) but causes only mild dwarfism observable approximately 1-week postpartum when heterozygous (Dmm/+). The purpose of this study was 2-fold: first, to analyze and quantify morphological changes that precede the expression of mild dwarfism in Dmm/+ animals, and second, to compare morphological alterations between Dmm/+ and Dmm/Dmm fetal cartilage that may correlate with the marked skeletal differences between mild and lethal dwarfism. Light and electron transmission microscopy were used to visualize structure of chondrocytes and extracellular matrix (ECM) of fetal rib cartilage. Both Dmm/+ and Dmm/Dmm fetal rib cartilage had significantly larger chondrocytes, greater cell density, and less ECM per unit area than +/+ littermates. Quantitative RT-PCR showed a decrease in aggrecan mRNA in Dmm/+ vs +/+ cartilage. Furthermore, the cytoplasm of chondrocytes in Dmm/+ and Dmm/Dmm cartilage was occupied by significantly more distended rough endoplasmic reticulum (RER) compared with wild-type chondrocytes. Fibril diameters and packing densities of +/+ and Dmm/+ cartilage were similar, but Dmm/Dmm cartilage showed thinner, sparsely distributed fibrils. These findings support the prevailing hypothesis that a C-propeptide mutation could interrupt the normal assembly and secretion of Type II procollagen trimers, resulting in a buildup of proalpha1(II) chains in the RER and a reduced rate of matrix synthesis. Thus, intracellular entrapment of proalpha1(II) seems to be primarily responsible for the dominant-negative effect of the Dmm mutation in the expression of dwarfism.

  13. Single crystalline silicon solar cells with rib structure (United States)

    Yoshiba, Shuhei; Hirai, Masakazu; Abe, Yusuke; Konagai, Makoto; Ichikawa, Yukimi


    To improve the conversion efficiency of Si solar cells, we have developed a thin Si wafer-based solar cell that uses a rib structure. The open-circuit voltage of a solar cell is known to increase with deceasing wafer thickness if the cell is adequately passivated. However, it is not easy to handle very thin wafers because they are brittle and are subject to warpage. We fabricated a lattice-shaped rib structure on the rear side of a thin Si wafer to improve the wafer's strength. A silicon nitride film was deposited on the Si wafer surface and patterned to form a mask to fabricate the lattice-shaped rib, and the wafer was then etched using KOH to reduce the thickness of the active area, except for the rib region. Using this structure in a Si heterojunction cell, we demonstrated that a high open-circuit voltage (VOC) could be obtained by thinning the wafer without sacrificing its strength. A wafer with thickness of 30 μm was prepared easily using this structure. We then fabricated Si heterojunction solar cells using these rib wafers, and measured their implied VOC as a function of wafer thickness. The measured values were compared with device simulation results, and we found that the measured VOC agrees well with the simulated results. To optimize the rib and cell design, we also performed device simulations using various wafer thicknesses and rib dimensions.

  14. What Accounts for Rib Fractures in Older Adults?

    Directory of Open Access Journals (Sweden)

    Lisa-Ann Wuermser


    Full Text Available To address the epidemiology of rib fractures, an age- and sex-stratified random sample of 699 Rochester, Minnesota, adults age 21–93 years was followed in a long-term prospective study. Bone mineral density (BMD was assessed at baseline, and fractures were ascertained by periodic interview and medical record review. During 8560 person-years of followup (median, 13.9 years, 56 subjects experienced 67 rib fracture episodes. Risk factors for falling predicted rib fractures as well as BMD, but both were strongly age-related. After age-adjustment, BMD was associated with rib fractures in women but not men. Importantly, rib fractures attributed to severe trauma were associated with BMD in older individuals of both sexes. Self-reported heavy alcohol use doubled fracture risk but did not achieve significance due to limited statistical power. Bone density, along with heavy alcohol use and other risk factors for falling, contributes to the risk of rib fractures, but no one factor predominates. Older women with rib fractures, regardless of cause, should be considered for an osteoporosis evaluation, and strategies to prevent falling should be considered in both sexes.

  15. Single crystalline silicon solar cells with rib structure

    Directory of Open Access Journals (Sweden)

    Shuhei Yoshiba


    Full Text Available To improve the conversion efficiency of Si solar cells, we have developed a thin Si wafer-based solar cell that uses a rib structure. The open-circuit voltage of a solar cell is known to increase with deceasing wafer thickness if the cell is adequately passivated. However, it is not easy to handle very thin wafers because they are brittle and are subject to warpage. We fabricated a lattice-shaped rib structure on the rear side of a thin Si wafer to improve the wafer’s strength. A silicon nitride film was deposited on the Si wafer surface and patterned to form a mask to fabricate the lattice-shaped rib, and the wafer was then etched using KOH to reduce the thickness of the active area, except for the rib region. Using this structure in a Si heterojunction cell, we demonstrated that a high open-circuit voltage (VOC could be obtained by thinning the wafer without sacrificing its strength. A wafer with thickness of 30 μm was prepared easily using this structure. We then fabricated Si heterojunction solar cells using these rib wafers, and measured their implied VOC as a function of wafer thickness. The measured values were compared with device simulation results, and we found that the measured VOC agrees well with the simulated results. To optimize the rib and cell design, we also performed device simulations using various wafer thicknesses and rib dimensions.

  16. Transcriptomic signatures in cartilage ageing (United States)


    Introduction Age is an important factor in the development of osteoarthritis. Microarray studies provide insight into cartilage aging but do not reveal the full transcriptomic phenotype of chondrocytes such as small noncoding RNAs, pseudogenes, and microRNAs. RNA-Seq is a powerful technique for the interrogation of large numbers of transcripts including nonprotein coding RNAs. The aim of the study was to characterise molecular mechanisms associated with age-related changes in gene signatures. Methods RNA for gene expression analysis using RNA-Seq and real-time PCR analysis was isolated from macroscopically normal cartilage of the metacarpophalangeal joints of eight horses; four young donors (4 years old) and four old donors (>15 years old). RNA sequence libraries were prepared following ribosomal RNA depletion and sequencing was undertaken using the Illumina HiSeq 2000 platform. Differentially expressed genes were defined using Benjamini-Hochberg false discovery rate correction with a generalised linear model likelihood ratio test (P ageing cartilage. Conclusion There was an age-related dysregulation of matrix, anabolic and catabolic cartilage factors. This study has increased our knowledge of transcriptional networks in cartilage ageing by providing a global view of the transcriptome. PMID:23971731

  17. The rib cage stabilizes the human thoracic spine: An in vitro study using stepwise reduction of rib cage structures. (United States)

    Liebsch, Christian; Graf, Nicolas; Appelt, Konrad; Wilke, Hans-Joachim


    The stabilizing effect of the rib cage on the human thoracic spine is still not sufficiently analyzed. For a better understanding of this effect as well as the calibration and validation of numerical models of the thoracic spine, experimental biomechanics data is required. This study aimed to determine (1) the stabilizing effect of the single rib cage structures on the human thoracic spine as well as the effect of the rib cage on (2) the flexibility of the single motion segments and (3) coupled motion behavior of the thoracic spine. Six human thoracic spine specimens including the entire rib cage were loaded quasi-statically with pure moments of ± 2 Nm in flexion/extension (FE), lateral bending (LB), and axial rotation (AR) using a custom-built spine tester. Motion analysis was performed using an optical motion tracking system during load application to determine range of motion (ROM) and neutral zone (NZ). Specimens were tested (1) in intact condition, (2) after removal of the intercostal muscles, (3) after median sternotomy, after removal of (4) the anterior rib cage up to the rib stumps, (5) the right sixth to eighth rib head, and (6) all rib heads. Significant (p rib cage (FE: + 21.1%, LB: + 10.9%, AR: + 72.5%), and all rib heads (AR: + 5.8%) relative to its previous condition. Compared to the intact condition, ROM and NZ increased significantly after removing the anterior part of the rib cage (FE: + 52.2%, + 45.6%; LB: + 42.0%, + 54.0%; AR: + 94.4%, + 187.8%). Median sternotomy (FE: + 11.9%, AR: + 21.9%) and partial costovertebral release (AR: + 11.7%) significantly increased the ROM relative to its previous condition. Removing the entire rib cage increased both monosegmental and coupled motion ROM, but did not alter the qualitative motion behavior. The rib cage has a strong effect on thoracic spine rigidity, especially in axial rotation by a factor of more than two, and should therefore be considered in clinical scenarios, in vitro, and in silico.

  18. Prolonged in vitro precultivation alleviates post-implantation inflammation and promotes stable subcutaneous cartilage formation in a goat model. (United States)

    Liu, Yi; Li, Dan; Yin, Zongqi; Luo, Xusong; Liu, Wei; Zhang, Wenjie; Zhang, Zhiyong; Cao, Yilin; Liu, Yu; Zhou, Guangdong


    Synthetic biodegradable scaffolds such as polylactic acid coated polyglycolic acid (PLA-PGA) are especially suitable for engineering shaped cartilage such as auricle, but they induce a serious inflammatory reaction particularly in the immunologically aggressive subcutaneous site, leading to resorption of the engineered autologous cartilage. Our previous study in a rabbit model has demonstrated 2 weeks of in vitro precultivation could significantly alleviate the post-implantation inflammation induced by PLA-PGA engineered cartilaginous grafts, but reproduction of this result failed in a preclinical goat model. The aims of the current study were to investigate whether prolonged in vitro precultivation could form a mature cartilaginous graft to resist the acute host response and promote stable subcutaneous cartilage formation in a preclinical goat model. Goat chondrocytes were seeded onto PLA-PGA scaffolds, in vitro precultivated for 2, 4, 8, and 12 weeks, and then implanted subcutaneously in autologous goats for 1 and 8 weeks. The in vitro engineered cartilage (vitro-EC) was examined histologically (hematoxylin and eosin, safranin-O, collagen II). The 1 week explants were examined histologically and stained for CD3, CD68, collagen I, and apoptosis. The 8 week explants were evaluated by histology, wet weight, volume, glycosaminoglycan (GAG) quantification and Young's modulus. With prolonged in vitro time, the quality of vitro-EC improved and the amount of scaffold residue decreased; more pronounced cartilage formation with fewer immune cells (CD3 and CD68 positive), apoptotic cells, and less collagen I expression were observed in explants that had been in vitro precultivated for a longer period. The subcutaneously regenerated neocartilage became more mature after prolonged implantation. These results suggested that prolonged in vitro precultivation allowed formation of a mature cartilaginous graft to resist the acute host response and promoted stable subcutaneous

  19. The anatomical and histological features of the area between the upper and lower lateral nasal cartilages: a pilot study

    Directory of Open Access Journals (Sweden)

    Fatih Yazar


    Full Text Available Objective: Nasal alar retraction deformities occasionally require both soft tissue release and large cartilage grafts. The structure between the upper lateral cartilage and the lateral crus of the lower lateral cartilage has been described as fibrous tissue, intercartilaginous ligament, ligament-like arrangement or connective tissue. Despite its importance, no anatomical and histological examination has been conducted on this structure. Therefore, the present study aimed to identify the area between the upper and lower lateral cartilages by histological examination. Methods: Eleven hemi-facial human cadaver dissections were performed. Initially, the gross dissection of all specimens was conducted. The cutaneous-subcutaneous division of the skin was elevated and was removed. The upper and lower lateral cartilages were removed en bloc together with the area among these cartilages from six specimens and were divided from its midline. The obtained twelve specimens were fixed in formalin, processed and embedded in paraffin. 4 μm sections were obtained. Other five specimens were examined to outline under a stereomicroscope. This approach allowed free access to the structure extending from the area between the upper and lower lateral cartilages to the skin. The full-thickness biopsy was taken from the structure extending from the area between the upper and lower lateral cartilages to the skin. All specimens were fixed in formalin, processed and embedded in paraffin. 4 μm sections were obtained and prepared for microscopic examination. All the sections were stained with hematoxylin & eosin, Mowry’s colloidal iron, Verhoff’s elastic stain, and Masson’s trichrome stain for histological examination. The contents were determined. Results: A single dense longitudinal collagenous bundle between the cartilages and a structure extending from the area between the cartilages to the skin were found. Conclusion: The knowledge of this area in terms of

  20. Non-diffuseness of vibration fields in ribbed plates

    DEFF Research Database (Denmark)

    Brunskog, Jonas; Chung, Hyuck


    This paper presents numerical simulations of structural intensity in a rib-reinforced plate, investigating the diffuseness. Many prediction models of building and structural acoustics, such as statistical energy analysis or energy flow methods, assume the vibrational wave fields to be diffuse....... However, the diffuseness assumption is not always valid. One such example is a rib-reinforced plate typically found in a lightweight floor with wooden joists. Other examples can be found in aircraft and ship structures. The structural intensity of a ribbed plate is computed at low to mid frequencies using...

  1. Nuclear Physics with RIB's: How it all started (United States)

    Tanihata, Isao


    Neutron halos were discovered through measurements of interaction cross sections and fragmentation cross sections of nuclei near the neutron drip line. Such measurements became possible with the use of radioactive ion beams (RIBs) produced though projectile fragmentations of high-energy heavy-ion collisions. RIBs were invented 30 years ago at the Bevalac facility in Berkeley. In this article, I describe how they were invented and how neutron halos were discovered. What happened at that time was a series of small serendipities guiding us to the present prosperous field of RIB science.

  2. Uses of Various Grafting Techniques in External Approach Rhinoplasty: An Overview. (United States)

    Khan, Nazir A; Rehman, Ayaz; Yadav, Rajshri


    The surgeons performing rhinoplasty found Graft selection the greatest challenge. To avoid an immune response the preferred choice thus far for nasal reconstruction would be autograft compared to allograft due to its lower rate of rejection. We have evaluated 30 patients who underwent open rhinoplasty and We used conchal and septal cartilaginous grafts in various forms by the open approach to correct various nasal deformities compared our experience regarding the operative technique, graft availability, indications, and limitations. No bony graft material or synthetic materials were used. Preoperative extensive evaluation of the patient was done in order to determine the type of deformity and the type of graft to be used in order to correct the deformity. Preoperative and postoperative photographs were taken in four basic views: frontal, lateral, lateral-oblique and basal in order to assess the results of the surgery. The study was done on 30 patients (20 male and 10 females) using the external rhinoplasty approach using the septal and conchal cartilages in different forms. Autologous septal cartilage was used in most of the patients (25 out of 30) and conchal cartilage was used in 5 patients. Multiple grafting techniques were used in some patients. Three patients had traumatic etiology. Columellar strut graft along with TIG technique was used in 16 patients, spreader graft was used in 8 patients, and septal extension graft was used in 5 patient and shield graft in 1 patient. Septorhinoplasty continues to evolve through various new techniques and modifications with the main goal to improve functional nasal airway and to restore cosmetic harmony to the face. Optimum result is very much dependent on the surgeon's attention to functional, aesthetic, and reconstructive principles and graft selection.

  3. Vascular thoracic outlet syndrome. Longer posterior rib stump causes poor outcome

    NARCIS (Netherlands)

    Geven, Leontien I.; Smit, Andries J.; Ebels, Tjark


    Objective: To assess the role of the relative length of the posterior rib stump in outcome after transaxittary first rib resection for thoracic outlet syndrome. Methods: All patients with a transaxittary first rib resection between January 1990 and February 2004 were selected. Relative rib stump len

  4. 20 CFR 225.22 - Employee RIB PIA used in survivor annuities. (United States)


    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Employee RIB PIA used in survivor annuities... Amount of the Residual Lump-Sum Payable § 225.22 Employee RIB PIA used in survivor annuities. The Employee Retirement Insurance Benefit PIA (Employee RIB PIA) is used to compute the employee RIB amount...

  5. Transcriptomic profiling of cartilage ageing

    Directory of Open Access Journals (Sweden)

    Mandy Jayne Peffers


    Full Text Available The musculoskeletal system is severely affected by the ageing process, with many tissues undergoing changes that lead to loss of function and frailty. Articular cartilage is susceptible to age related diseases, such as osteoarthritis. Applying RNA-Seq to young and old equine cartilage, we identified an over-representation of genes with reduced expression relating to extracellular matrix, degradative proteases, matrix synthetic enzymes, cytokines and growth factors in cartilage from older donors. Here we describe the contents and quality controls in detail for the gene expression and related results published by Peffers and colleagues in Arthritis Research and Therapy 2013 associated with the data uploaded to ArrayExpress (E-MTAB-1386.

  6. Cartilage and bone cells do not participate in skeletal regeneration in Ambystoma mexicanum limbs. (United States)

    McCusker, Catherine D; Diaz-Castillo, Carlos; Sosnik, Julian; Q Phan, Anne; Gardiner, David M


    The Mexican Axolotl is one of the few tetrapod species that is capable of regenerating complete skeletal elements in injured adult limbs. Whether the skeleton (bone and cartilage) plays a role in the patterning and contribution to the skeletal regenerate is currently unresolved. We tested the induction of pattern formation, the effect on cell proliferation, and contributions of skeletal tissues (cartilage, bone, and periosteum) to the regenerating axolotl limb. We found that bone tissue grafts from transgenic donors expressing GFP fail to induce pattern formation and do not contribute to the newly regenerated skeleton. Periosteum tissue grafts, on the other hand, have both of these activities. These observations reveal that skeletal tissue does not contribute to the regeneration of skeletal elements; rather, these structures are patterned by and derived from cells of non-skeletal connective tissue origin.


    NARCIS (Netherlands)

    Levett, Peter Andrew


    For millions of people, damaged cartilage is a major source of pain and disability. As those people often discover upon seeking medical treatment, once damaged, cartilage is very difficult to repair. Finding better clinical therapies for damaged cartilage has generated a huge amount of research inte

  8. Biomaterial and Cell Based Cartilage Repair

    NARCIS (Netherlands)

    Zhao, X


    Injuries to human native cartilage tissue are particularly troublesome because cartilage has little ability to heal or regenerate itself. The reconstruction, repair, and regeneration of cartilage tissue continue to be one of the greatest clinical challenges, especially in orthopaedic and plastic sur

  9. Biomaterial and Cell Based Cartilage Repair

    NARCIS (Netherlands)

    Zhao, X


    Injuries to human native cartilage tissue are particularly troublesome because cartilage has little ability to heal or regenerate itself. The reconstruction, repair, and regeneration of cartilage tissue continue to be one of the greatest clinical challenges, especially in orthopaedic and plastic

  10. Limitations and sources of bias in clinical knee cartilage research. (United States)

    Worthen, Jamie; Waterman, Brian R; Davidson, Philip A; Lubowitz, James H


    The purpose of this study was to systematically review the limitations and biases inherent to surgical trials on the management of knee chondral defects. A literature search of PubMed/Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, and the Cochrane Central Register of Controlled Trials was conducted in September 2010 and updated in August 2011 to identify all English-language, Level I evidence, prospective, randomized controlled trials published from 1996 to present. The keyword search included the following: "autologous chondrocyte," "cartilage graft," "cartilage repair," "chondroplasty," "microfracture," "mosaicplasty," and/or "osteochondral." Nonoperative studies, nonhuman studies, ex vivo studies, non-knee studies, and/or studies with follow-up of less than 1 year were excluded. A systematic review was performed on all included studies, and limitations and/or biases were identified and quantitated. Of 15,311 citations, 33 abstracts were reviewed and 11 prospective, randomized controlled trials were included. We identified 9 major limitations (subject age, subject prior surgery, subject duration of symptoms, lesion location, lesion size, lesion number, procedure selection, procedure standardization, and limited histologic analysis) and 7 common biases (selection, performance, transfer, nonresponder, detection, publication, and study design). Level I therapeutic studies investigating the surgical management of human knee cartilage defects have substantial identified biases and limitations. This review has limitations because other classifications of bias or limitation exist. Optimal management of cartilage defects is controversial, and future rigorous research methods could minimize common biases through strict study design and patient selection criteria, larger patient enrollment, more extended follow-up, and standardization of clinical treatment pathways. Level I, systematic review of Level I studies. Copyright © 2012

  11. Biological, biochemical and biomechanical characterisation of articular cartilage from the porcine, bovine and ovine hip and knee. (United States)

    Fermor, H L; McLure, S W D; Taylor, S D; Russell, S L; Williams, S; Fisher, J; Ingham, E


    This study aimed to determine the optimal starting material for the development of an acellular osteochondral graft. Osteochondral tissues from three different species were characterised; pig (6 months), cow (18 months) and two ages of sheep (8-12 months and >4 year old). Tissues from the acetabulum and femoral head of the hip, and the groove, medial and lateral condyles and tibial plateau of the knee were assessed. Histological analysis of each tissue allowed for qualification of cartilage histoarchitecture, glycosaminoglycan (GAG) distribution, assessment of cellularity and cartilage thickness. Collagen and GAG content were quantified and cartilage water content was defined. Following biomechanical testing, the percentage deformation, permeability and equilibrium elastic modulus was determined. Results showed that porcine cartilage had the highest concentration of sulphated proteoglycans and that the condyles and groove of the knee showed higher GAG content than other joint areas. Cartilage from younger tissues (porcine and young ovine) had higher cell content and was thicker, reflecting the effects of age on cartilage structure. Cartilage from older sheep had a much higher elastic modulus and was less permeable than other species.


    Directory of Open Access Journals (Sweden)

    Vivek V


    Full Text Available ABSTRACT : OBJECTIVES : To Compare Different Tissues Used for Tympanic Membrane grafting. DESIGN : A Prospective , double blind , randomized study. MATERIAL AND METHOD : The study was conducted on 75 patie nts with 80 ear disease having Safe or Tubo - tympanic type of Chronic suppurative Otitis media. Type - 1 Tympanoplasty was done using various graft materials. RESULTS : The result shows that Graft success rate was maximum with Fascia Lata graft (95% followed by Tragal Perichondrium (90%. For Temporalis Fascia and Tragal Cartilage grafts , success rate was same i.e. 85%. They achieve comparable and excellent graft take - up of 88.75%. They also achieve comparable and good hearing restoration. CONCLUSION : It was c oncluded that various autograft materials for Tympanoplasty achieved comparable and ex cellent graft take - up and comparable and good hearing restoration. The Graft success rate and mean hearing improvement (A - B gap closure for different graft materials sho ws similar success rate and hearing improvement respectively KEYWORDS : Tympanoplasty . Chronic suppurative otitis media (CSOM . Temporalis Fascia . Tragal Perichondrium . Tragal Cartilage . Fascia Lata . Hearing impairment

  13. A new grafting technique for tympanoplasty: tympanoplasty with a boomerang-shaped chondroperichondrial graft (TwBSCPG). (United States)

    Dündar, Rıza; Soy, Fatih Kemal; Kulduk, Erkan; Muluk, Nuray Bayar; Cingi, Cemal


    The aim of this study was to introduce a new grafting technique in tympanoplasty that involves use of a boomerang-shaped chondroperichondrial graft (BSCPG). The anatomical and functional results were evaluated. A new tympanoplasty with boomerang-shaped chondroperichondrial graft (TwBSCPG) technique was used in 99 chronic otitis media patients with central or marginal perforation of the tympanic membrane and a normal middle ear mucosa. All 99 patients received chondroperichondrial cartilage grafts with a boomerang-shaped cartilage island left at the anterior and inferior parts. Postoperative follow-ups were conducted at months 1, 6, and 12. Preoperative and postoperative audiological examinations were performed and air-bone gaps were calculated according to the pure-tone averages (PTAs) of the patients. In the preoperative period, most (83.8%) air-bone gaps were ≥ 16 dB; after operating using the TwBSCPG technique, the air-bone gaps decreased to 0-10 dB in most patients (77.8%). In the TwBSCPG patients, the mean preoperative air-bone gap was 22.02 ± 6.74 dB SPL. Postoperatively, the mean postoperative air-bone gap was 8.70 ± 5.74 dB SPL. The TwBSCPG technique therefore decreased the postoperative air-bone gap compared to that preoperatively (p = 0.000, z = -8.645). At the 1-month follow-up, there were six graft perforations and one graft retraction. At the 6-month follow-up, there were nine graft perforations and three graft retractions. At 12 months, there were seven graft perforations and four graft retractions. During the first year after the boomerang tympanoplasty surgery, graft lateralization was not detected in any patient. Retractions were grade 1 according to the Sade classification and were localized to the postero-superior quadrant of the tympanic membrane. The TwBSCPG technique has benefits with respect to postoperative anatomical and audiological results. It prevents perforation of the tympanic membrane at the anterior quadrant and avoids graft

  14. Temporalis muscle fascia and cartilage palisade technique of type 1 tympanoplasty: A comparison

    Directory of Open Access Journals (Sweden)

    Kumar Subhanshu


    Full Text Available Background: Chronic suppurative otitis media is one of the common causes of deafness in india and occupies a considerable amount of clinic and operating time of otolaryngologists. Materials and Methods: This was a prospective study containing 50 patients, which was further divided into two groups of 25 patient each. One group was cartilage palisade technique group and other was temporalis fascia technique group (TFT group. Detailed history and examination along with pure tone audiometry was performed. Pre- and postoperative hearing results and graft uptake were compared. All surgeries were performed through the post aural approach. Cartilage was harvested from cymba concha and fascia from temporalis muscle. Results: Hearing improved significantly when either of the technique was used. Though this was slightly better, but stastically insignificant in TFT. there was no significant difference in the graft uptake rates, but it was better in cases of Eustachian tube dysfunction when cartilage palisades were used. Conclusion: There was no statistically significant difference in results in terms of success and auditory function but cartilage palisade technique gave better results in specific conditions like Eustachian tube dysfunction.

  15. Macrophage phagocytosis alters the MRI signal of ferumoxytol-labeled mesenchymal stromal cells in cartilage defects (United States)

    Nejadnik, Hossein; Lenkov, Olga; Gassert, Florian; Fretwell, Deborah; Lam, Isaac; Daldrup-Link, Heike E.


    Human mesenchymal stem cells (hMSCs) are a promising tool for cartilage regeneration in arthritic joints. hMSC labeling with iron oxide nanoparticles enables non-invasive in vivo monitoring of transplanted cells in cartilage defects with MR imaging. Since graft failure leads to macrophage phagocytosis of apoptotic cells, we evaluated in vitro and in vivo whether nanoparticle-labeled hMSCs show distinct MR signal characteristics before and after phagocytosis by macrophages. We found that apoptotic nanoparticle-labeled hMSCs were phagocytosed by macrophages while viable nanoparticle-labeled hMSCs were not. Serial MRI scans of hMSC transplants in arthritic joints of recipient rats showed that the iron signal of apoptotic, nanoparticle-labeled hMSCs engulfed by macrophages disappeared faster compared to viable hMSCs. This corresponded to poor cartilage repair outcomes of the apoptotic hMSC transplants. Therefore, rapid decline of iron MRI signal at the transplant site can indicate cell death and predict incomplete defect repair weeks later. Currently, hMSC graft failure can be only diagnosed by lack of cartilage defect repair several months after cell transplantation. The described imaging signs can diagnose hMSC transplant failure more readily, which could enable timely re-interventions and avoid unnecessary follow up studies of lost transplants.

  16. Effect of rib angle on local heat/mass transfer distribution in a two-pass rib-roughened channel (United States)

    Chandra, P. R.; Han, J. C.; Lau, S. C.


    The naphthalene sublimation technique is used to investigate the heat transfer characteristics of turbulent air flow in a two-pass channel. A test section that resembles the internal cooling passages of gas turbine airfoils is employed. The local Sherwood numbers on the ribbed walls were found to be 1.5-6.5 times those for a fully developed flow in a smooth square duct. Depending on the rib angle-of-attack and the Reynolds number, the average ribbed-wall Sherwood numbers were 2.5-3.5 times higher than the fully developed values.

  17. Operative Fixation of Rib Fractures Indications, Techniques, and Outcomes. (United States)

    Galos, David; Taylor, Benjamin; McLaurin, Toni


    Rib fractures are extremely common injuries and vary in there severity from single nondisplaced fractures to multiple segmental fractures resulting in flail chest and respiratory compromise. Historically, rib fractures have been treated conservatively with pain control and respiratory therapy. However this method may not be the best treatment modality in all situations. Operative fixation of select rib fractures has been increasing in popularity especially in patients with flail chest and respiratory compromise. Newer techniques use muscle sparing approaches and precontoured locking plate technology to obtain stable fixation and allow improved respiration. Current reports shows that rib fracture fixation offers the benefits of improved respiratory mechanics and improved pain control in the severe chest wall injury with resultant improvement in patient outcomes by decreasing time on the ventilator, time in the intensive care unit, and overall hospital length of stay.

  18. Application of the rainfall infiltration breakthrough (RIB) model for ...

    African Journals Online (AJOL)

    Application of the rainfall infiltration breakthrough (RIB) model for groundwater ... Correlation analysis between rainfall and observed WLF data at daily scale and ... data are more realistic than those for daily data, when using long time series.

  19. Application of the rainfall infiltration breakthrough (RIB) model for ...

    African Journals Online (AJOL)


    May 23, 2012 ... Scenarios using the data from Oudebosch with different rainfall and groundwater abstraction inputs ... A manual entitled 'Preparation of a manual on Quantitative ..... The definition of the symbols used in the RIB programme.

  20. Innovation on RC Waffle and Ribbed Slab Analysis Models

    Directory of Open Access Journals (Sweden)

    P. Hájek


    Full Text Available Waffle and ribbed reinforced concrete slabs are widely used in building constructions in view of the flexibility design and structural efficiency. The wide range of reinforced concrete and composite waffle and ribbed slabs has been theoretically analysed and tested from the point of view of structural behaviour within the research performed in the last years. The results of the experimental investigation, supported by theoretical conclusions, have confirmed significantly better structural properties of the composite waffle slabs (composed from RC and ceramic fillers than the assumptions usually considered in common analysis models. New analysis equivalent models for structural analysis RC and composite waffle and ribbed structures have been developed and compared with the test results. In the paper are presented some generalized conclusions as a basis for the formulation of principles of an optimized design of RC waffle and ribbed slab structures.

  1. Rib gap anomaly in partial or mosaic trisomy 8

    Energy Technology Data Exchange (ETDEWEB)

    Kozlowski, K.; Collis, J.; Suter, M.; Sillence, D.


    Gaps in the first ribs were observed in two children, one with partial and the other with mosaic trisomy for chromosome 8. The sign may be considered in conjunction with other features as a relative indication for chromosomal studies.

  2. Lower thoracic rib stress fractures in baseball pitchers. (United States)

    Gerrie, Brayden J; Harris, Joshua D; Lintner, David M; McCulloch, Patrick C


    Stress fractures of the first rib on the dominant throwing side are well-described in baseball pitchers; however, lower thoracic rib fractures are not commonly recognized. While common in other sports such as rowing, there is scant literature on these injuries in baseball. Intercostal muscle strains are commonly diagnosed in baseball pitchers and have a nearly identical presentation but also a highly variable healing time. The diagnosis of a rib stress fracture can predict a more protracted recovery. This case series presents two collegiate baseball pitchers on one team during the same season who were originally diagnosed with intercostal muscle strains, which following magnetic resonance imaging (MRI) were found to have actually sustained lower thoracic rib stress fractures. The first sustained a stress fracture of the posterior aspect of the right 8th rib on the dominant arm side, while the second presented with a left-sided 10th rib stress fracture on the nondominant arm side. In both cases, MRI was used to visualize the fractures as plain radiographs are insensitive and commonly negative early in patient presentation. Patients were treated with activity modification, and symptomatic management for 4-6 weeks with a graduated return to throwing and competition by 8-10 weeks. The repetitive high stresses incurred by pitching may cause either dominant or nondominant rib stress fractures and this should be included in the differential diagnosis of thoracic injuries in throwers. It is especially important that athletic trainers and team physicians consider this diagnosis, as rib fractures may have a protracted course and delayed return to play. Additionally, using the appropriate imaging techniques to establish an accurate diagnosis can help inform return-to-play decisions, which have important practical applications in baseball, such as roster management and eligibility.

  3. Membranized semiconductor rib waveguides for acousto-optic modulation enhancement

    DEFF Research Database (Denmark)

    Barretto, Elaine Cristina Saraiva; Hvam, Jørn Märcher


    Membranized rib waveguides are proposed as an efficient way to increase acousto-optic modulation by up to four orders of magnitude compared to the traditional structures, opening up possibilities of constructing more compact and power-saving devices.......Membranized rib waveguides are proposed as an efficient way to increase acousto-optic modulation by up to four orders of magnitude compared to the traditional structures, opening up possibilities of constructing more compact and power-saving devices....

  4. Solitary plasmacytoma of the rib: A rare case

    Directory of Open Access Journals (Sweden)

    Rikki Singal


    Full Text Available Localized solitary plasmacytoma of the bone is a rare disease and is characterized by only one or two isolated bone lesions with no evidence of disease dissemination. We report a case of solitary plasmacytoma of the rib in a 43-year-old female. The patient underwent complete en-bloc resection of the chest wall including rib, muscle, and parietal pleura. Patient is asymptomatic without any recurrence after two and half years of follow up.

  5. Rib fractures in coronary bypass patients: radionuclide detection. (United States)

    Greenwald, L V; Baisden, C E; Symbas, P N


    Sternal retraction can cause the first rib to be fractured posteriorly, injuring the brachial plexus. The authors conducted bone scans of 24 consecutive open-heart surgery patients and found an unexpectedly high number of rib fractures which in all but one case had not been seen on the chest radiograph. Bone scans are recommended whenever there is unexplained non-incisional pain in a patient who has undergone sternal retraction.

  6. Post-accelerator LINAC design for the VECC RIB project

    Indian Academy of Sciences (India)

    Arup Bandyopadhyay


    Variable Energy Cyclotron Centre (VECC) is presently developing an ISOL post-acclerator type of RIB facility. The scheme utilises the existing = 130 room temperature variable energy cyclotron machine as the primary accelerator for the production of RIBs and radio frequency quadrupole (RFQ) and LINAC modules for the post-acceleration. The design aspects of these postaccelerator LINAC modules will be discussed in this paper.

  7. Rib Fracture Protocol Advancing the Care of the Elderly Patient. (United States)

    Leininger, Susan

    This article discusses unique factors associated with rib fractures in the elderly patient population and explains the process used in one facility to develop a revised protocol for the management of elderly patients with a rib fracture. The goals were to eliminate gaps in early trauma care management and employ a care routine that would improve outcomes for this vulnerable group of patients with fracture.

  8. An analysis of 214 cases of rib fractures

    Directory of Open Access Journals (Sweden)

    Sule Karadayi


    Full Text Available INTRODUCTION: Rib fractures are the most common type of injury associated with trauma to the thorax. In this study, we investigated whether morbidity and mortality rates increased in correlation with the number of fractured ribs. MATERIALS AND METHODS: Data from 214 patients with rib fractures who applied or were referred to our clinic between January 2007 and December 2008 were retrospectively evaluated. The patients were allocated into three groups according to the number of fractures: 1 patients with an isolated rib fracture (RF1 (n = 50, 23.4%, 2 patients with two rib fractures (RF2 (n = 53, 24.8%, and 3 patients with more than two rib fractures (RF3 (n = 111, 51.9%. The patients were evaluated and compared according to the number of rib fractures, mean age, associated chest injuries (hemothorax, pneumothorax, and/or pulmonary contusion, and co-existing injuries to other systems. FINDINGS: The mean age of the patients was 51.5 years. The distribution of associated chest injuries was 30% in group RF1, 24.6% in group RF2, and 75.6% in group RF3 (p<0.05. Co-existing injuries to other systems were 24% in group RF1, 23.2% in group RF2, and 52.6% in group RF3 (p<0.05. Two patients (4% in group RF1, 2 patients (3.8% in group RF2, and 5 patients (4.5% in group RF3 (total n = 9; 4.2% died. CONCLUSION: Patients with any number of rib fractures should be carefully screened for co-existing injuries in other body systems and hospitalized to receive proper treatment.

  9. Occult rib fractures and brachial plexus injury following median sternotomy for open-heart operations. (United States)

    Baisden, C E; Greenwald, L V; Symbas, P N


    The incidence and the sites of rib fractures during open-heart operations through a median sternotomy incision were studied in 36 consecutive patients divided into two groups. In Group 1 (24 patients), a conventional Ankeney retractor was used to expose the heart, and in Group 2 (12 patients), a similar retractor was used but with its uppermost pair of blades removed. Thorough physical examinations and preoperative and postoperative chest roentgenograms were obtained, and postoperative bone scans were done in all patients. No rib fractures were detected on the routine chest roentgenograms in patients in either group. Bone scans, however, showed 44 rib fractures (15 of the first rib, 13 of the second rib, 4 of the third rib, 6 of the fourth rib, 3 of the fifth rib, and 3 of the sixth rib) in 16 patients in Group 1. Six patients in Group 2 had 9 rib fractures (2 of the first rib, 4 of the second rib, and 1 each of the third, fifth, and sixth ribs). None of the patients in Group 2 had brachial plexus injury and neither of the first rib fractures in this group were located posteriorly, whereas 3 patients in Group 1 had both brachial plexus injury and posterior first rib fractures.

  10. Delivering multiple independent RIB simultaneously: Technical and operational challenges

    Energy Technology Data Exchange (ETDEWEB)

    Morton, A.C.


    ISAC is an ISOL-type facility at which RIB are produced by direct reactions of 480 MeV protons from TRIUMFs main cyclotron on thick targets. Like other ISOL-type facilities, ISAC is limited to the production and delivery of a single RIB at any given time. ARIEL, the Advanced Rare-IsotopE Laboratory, will provide for the production and delivery of, ultimately, two additional RIB, the first produced by photofission on actinide targets using electrons from a new superconducting electron linac and the second by direct and indirect reactions with protons from TRIUMFs main cyclotron. This will allow for the simultaneous delivery of three independent RIB to experimental areas at ARIEL and ISAC. The shift from single-user to multi-user operation will introduce significant technical and operational challenges that RIB facilities have not yet had to address. Almost all aspects of facility operation will become more complex as the first RIB from ARIEL targets become available.

  11. VTT's micron-scale silicon rib+strip waveguide platform (United States)

    Aalto, Timo; Harjanne, Mikko; Cherchi, Matteo


    Silicon rib waveguides enable single-mode (SM) operation even with the combination of multi-micron core dimensions and high refractive index contrast. In such large waveguides the optical mode field is almost completely confined inside the Si core, which leads to small propagation losses and small polarization dependency. The unique SM condition of the rib waveguide also enables the use of an ultra-wide wavelength range, for example from 1.2 to <1.7 μm, without sacrificing either SM operation or low propagation loss. This makes micron-scale Si waveguides particularly well-suited for spectroscopy and extensive wavelength division multiplexing. However, rib waveguides require large bending radii, which lead to large circuit sizes. There are two solutions for this. So-called Euler bends in Si strip waveguides enable low-loss bends down to 1 μm bending radius with less than 0.1 dB/90° loss for both polarizations. Another alternative is a total-internal reflection mirror that can have loss as low as 0.1 dB for both polarizations in either strip or rib waveguides. The excitation of higher order modes in large strip waveguides is avoided by using adiabatic rib-strip converters and low-loss components. With rib and strip waveguides it is possible to reach a unique combination of low loss, extremely small footprint, small polarization dependency, ultra-wide bandwidth and tolerance to high optical powers.

  12. Strategies for Stratified Cartilage Bioprinting

    NARCIS (Netherlands)

    Schuurman, W.


    Multiple materials, cells and growth factors can be combined into one construct by the use of a state–of-the-art bioprinter. This technique may in the future make the fabrication of complete tissues or organs possible. In this thesis the feasibility of the bioprinting of cartilage and the difference

  13. Postnatal development of articular cartilage

    NARCIS (Netherlands)

    Turnhout, van M.C.


    Articular cartilage (AC) is the thin layer of tissue that covers the ends of the bones in the synovial joints in mammals. Functional adult AC has depth-dependent mechanical properties that are not yet present at birth. These depth-dependent mechanical properties in adult life are the result of a

  14. Postnatal development of articular cartilage

    NARCIS (Netherlands)

    Turnhout, van M.C.


    Articular cartilage (AC) is the thin layer of tissue that covers the ends of the bones in the synovial joints in mammals. Functional adult AC has depth-dependent mechanical properties that are not yet present at birth. These depth-dependent mechanical properties in adult life are the result of a dep

  15. Polymers in Cartilage Defect Repair of the Knee: Current Status and Future Prospects

    Directory of Open Access Journals (Sweden)

    Ralph M. Jeuken


    Full Text Available Cartilage defects in the knee are often seen in young and active patients. There is a need for effective joint preserving treatments in patients suffering from cartilage defects, as untreated defects often lead to osteoarthritis. Within the last two decades, tissue engineering based techniques using a wide variety of polymers, cell sources, and signaling molecules have been evaluated. We start this review with basic background information on cartilage structure, its intrinsic repair, and an overview of the cartilage repair treatments from a historical perspective. Next, we thoroughly discuss polymer construct components and their current use in commercially available constructs. Finally, we provide an in-depth discussion about construct considerations such as degradation rates, cell sources, mechanical properties, joint homeostasis, and non-degradable/hybrid resurfacing techniques. As future prospects in cartilage repair, we foresee developments in three areas: first, further optimization of degradable scaffolds towards more biomimetic grafts and improved joint environment. Second, we predict that patient-specific non-degradable resurfacing implants will become increasingly applied and will provide a feasible treatment for older patients or failed regenerative treatments. Third, we foresee an increase of interest in hybrid construct, which combines degradable with non-degradable materials.

  16. Ontogeny of 3D rib curvature and its importance for the understanding of human thorax development. (United States)

    García-Martínez, Daniel; Recheis, Wolfgang; Bastir, Markus


    Sagittal and axial rib orientation relative to the spine are two factors that modify rib cage morphology during ontogeny. Some studies suggest that these factors do not operate in the same way at the upper (ribs 1-5) and lower thorax (ribs 6-10) during postnatal growth, but it is unknown if the ontogenetic thoracic changes are produced by morphological changes of the ribs (intrinsic rib factors) or by external factors related to costal joints (extrinsic rib factors). To clarify these questions, we applied 3D geometric morphometrics of landmarks and sliding semilandmarks (N = 20/rib) to 280 individual ribs (1-10) of Homo sapiens comprising the entire human ontogeny and growth simulations were carried out. PCA shows that intrinsic rib factors (rib torsion and axial rib curvature) are ontogenetic factors of variability that contribute to configuring the adult thorax shape. Moreover, growth simulations and regression slopes suggest that the upper thorax unit is comprised by ribs 1-7 and the lower unit at least by ribs 8-10. These results suggest anatomical constraints for ontogenetic rib variation, since ribs 1-7 (true ribs) are directly linked to the sternum. Moreover, these results are supported by functional anatomy because pulmonary kinematics would influence the upper unit and diaphragmatic kinematics would influence the lower one. Our findings are relevant not only to understanding how changes at individual ribs contribute to the adult thorax morphology, but also to the development and evolution of the modern human rib cage. © 2015 Wiley Periodicals, Inc.

  17. Potential Benefits of Rib Fracture Fixation in Patients with Flail Chest and Multiple Non-flail Rib Fractures. (United States)

    Qiu, Meiguang; Shi, Zhanjun; Xiao, Jun; Zhang, Xuming; Ling, Shishui; Ling, Hao


    The purpose of this study is to evaluate the potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures versus conventional treatment modalities. A retrospective reviewed study compared 86 cases which received surgical treatment between June 2009 and May 2013 to 76 cases which received conservative treatment between January 2006 and May 2009. The patients were divided into the flail chest (n = 38) and multiple non-flail rib fracture groups (n = 124). In the flail chest group, the mechanical ventilation time, ICU monitoring time, tracheostomies, thoracic deformity, and impaired pulmonary function and return to full-time employment were compared. In the multiple non-flail rib fracture group, fracture healing, visual analog scale (VAS) pain score, inpatient length of stay, atelectatic, pulmonary complications, and normal activity-returning time were compared. Patients in the flail chest operative fixation group had significantly shorter ICU stay, decreased ventilator requirements, fewer tracheostomies, less thoracic deformity and impaired pulmonary function, and more returned to full-time employment. Patients in the multiple non-flail rib fracture operative fixation had shorter hospital stay, less pain, earlier return to normal activity, more fracture healing, less atelectasis, and fewer pulmonary infections. This study demonstrates the potential benefits of surgical stabilization of flail chest and multiple non-flail rib fractures with plate fixation. When compared with conventional conservative management, operatively managed patients demonstrated improved clinical outcomes.

  18. Cartilage-selective genes identified in genome-scale analysis of non-cartilage and cartilage gene expression

    Directory of Open Access Journals (Sweden)

    Cohn Zachary A


    Full Text Available Abstract Background Cartilage plays a fundamental role in the development of the human skeleton. Early in embryogenesis, mesenchymal cells condense and differentiate into chondrocytes to shape the early skeleton. Subsequently, the cartilage anlagen differentiate to form the growth plates, which are responsible for linear bone growth, and the articular chondrocytes, which facilitate joint function. However, despite the multiplicity of roles of cartilage during human fetal life, surprisingly little is known about its transcriptome. To address this, a whole genome microarray expression profile was generated using RNA isolated from 18–22 week human distal femur fetal cartilage and compared with a database of control normal human tissues aggregated at UCLA, termed Celsius. Results 161 cartilage-selective genes were identified, defined as genes significantly expressed in cartilage with low expression and little variation across a panel of 34 non-cartilage tissues. Among these 161 genes were cartilage-specific genes such as cartilage collagen genes and 25 genes which have been associated with skeletal phenotypes in humans and/or mice. Many of the other cartilage-selective genes do not have established roles in cartilage or are novel, unannotated genes. Quantitative RT-PCR confirmed the unique pattern of gene expression observed by microarray analysis. Conclusion Defining the gene expression pattern for cartilage has identified new genes that may contribute to human skeletogenesis as well as provided further candidate genes for skeletal dysplasias. The data suggest that fetal cartilage is a complex and transcriptionally active tissue and demonstrate that the set of genes selectively expressed in the tissue has been greatly underestimated.

  19. Experimental investigation of impingement heat transfer from a round rib-roughened surface (United States)

    Isman, Mustafa Kemal; Can, Muhiddin


    An experimental investigation on impingement heat transfer from a rib-roughened surface is performed. Single, double, and triple rib configurations are tested. The rib is also located at three different positions for a single rib case. The Reynolds number is varied from 10,000 to 50,000 whereas the dimensionless jet-to-surface distance (z/D) is kept constant as 8. Results show that, the Nusselt number decreases just before a rib. After the rib, however, the Nusselt number decreases by a larger amount. Since ribs cause a reincreasing in the Nusselt number after the stagnation point and since the stagnation point Nusselt number is not affected by ribs, they can be used to enhance heat transfer especially for spot cooling applications. It is also obtained that using ribs is more useful for low speed impinging jets, when heat transfer from the whole surface is considered.

  20. Evaluating Loading Deflection of Distraction Osteogenic Rib in a Rabbit Model. (United States)

    Shen, Weimin; Tang, Chenlu; Yang, Junyi; Kong, Liangliang; Zhang, Xiaoying


    The treatment of patients with partially atrophic rib and rib defects requires an ideal arc of the rib that has adequate bone length and width. To design and assemble a distraction device with a strain gauge, we need to establish an animal model for testing it during rib distraction osteogenesis. Osteotomies were performed at the same position in the fifth rib in 8 rabbits. Customized distraction devices attached to strain gauges were used to distract the ribs. After a month of distraction and consolidation, loading deflection gauges were used, and specimens were examined histologically to record bone formation. Distraction osteogenesis was carried out successfully in all rabbits when the device used to distract the rib up to 4 cm. The device can be used for strain testing during rib distraction osteogenesis performed in a rabbit model. There was no significant difference in the loading deflection gauges of the bone between osteogenic and contralateral ribs. This animal model of costal distraction osteogenesis is successful.

  1. Totally Endoscopic (VATS) First Rib Resection for Thoracic Outlet Syndrome. (United States)

    George, Robert S; Milton, Richard; Chaudhuri, Nilanjan; Kefaloyannis, Emmanuel; Papagiannopoulos, Kostas


    Thoracic outlet syndrome (TOS) causes neurologic symptoms in 95% of cases and vascular symptoms in 5% of cases. Surgical resection is curative. Endoscopic-assisted transaxillary first rib resection has been previously reported. In this study we report a totally endoscopic video-assisted thoracoscopic surgery (VATS) approach using tailored endoscopic instruments. Ten patients (8 women; average age, 32.3 ± 5.6 years) with TOS underwent VATS first rib resection following failure of symptom improvement with physiotherapy. Symptoms were: unilateral neurogenic (n = = 7), bilateral neurogenic (n = = 2), and bilateral arterial compression (n = = 1). Three standard VATS ports were utilized. The parietal pleura and periosteum overlying the first rib were stripped avoiding injury to the neurovascular bundle. The rib was transected with an endoscopic rib cutter and resected completely in a piecemeal fashion using endoscopic bone nibblers. All periosteal remnants were trimmed releasing the neurovascular bundle completely. Patients were discharged within 72 hours following surgery. One patient had the contralateral side treated 18 months later and another patient is awaiting the second surgery. At follow-up, 9 patients had complete resolution of their main symptoms. One patient with neurogenic TOS developed mild functional and sensational loss of the non-dominant hand that improved within 8 months with physiotherapy. VATS first rib resection for TOS provides, unlike the classic approaches, a superior, magnified, and well-illuminated view of the thoracic inlet. It allows good posterior trimming of the first rib, release of brachial plexus, and an aesthetically pleasing result, especially in female patients. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Prolonged pain and disability are common after rib fractures. (United States)

    Fabricant, Loic; Ham, Bruce; Mullins, Richard; Mayberry, John


    The contribution of rib fractures to prolonged pain and disability may be underappreciated and undertreated. Clinicians are traditionally taught that the pain and disability of rib fractures resolves in 6 to 8 weeks. This study was a prospective observation of 203 patients with rib fractures at a level 1 trauma center. Chest wall pain was evaluated by the McGill Pain Questionnaire (MPQ) pain rating index (PRI) and present pain intensity (PPI). Prolonged pain was defined as a PRI of 8 or more at 2 months after injury. Prolonged disability was defined as a decrease in 1 or more levels of work or functional status at 2 months after injury. Predictors of prolonged pain and disability were determined by multivariate analysis. One hundred forty-five male patients and 58 female patients with a mean injury severity score (ISS) of 20 (range, 1 to 59) had a mean of 5.4 rib fractures (range, 1 to 29). Forty-four (22%) patients had bilateral fractures, 15 (7%) had flail chest, and 92 (45%) had associated injury. One hundred eighty-seven patients were followed 2 months or more. One hundred ten (59%) patients had prolonged chest wall pain and 142 (76%) had prolonged disability. Among 111 patients with isolated rib fractures, 67 (64%) had prolonged chest wall pain and 69 (66%) had prolonged disability. MPQ PPI was predictive of prolonged pain (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.4 to 2.5), and prolonged disability (OR, 2.2; 95% CI, 1.5 to 3.4). The presence of significant associated injuries was predictive of prolonged disability (OR, 5.9; 95% CI, 1.4 to 29). Prolonged chest wall pain is common, and the contribution of rib fractures to disability is greater than traditionally expected. Further investigation into more effective therapies that prevent prolonged pain and disability after rib fractures is needed. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Evaluation of Rib Fractures on a Single-in-plane Image Reformation of the Rib Cage in CT Examinations. (United States)

    Dankerl, Peter; Seuss, Hannes; Ellmann, Stephan; Cavallaro, Alexander; Uder, Michael; Hammon, Matthias


    This study aimed to evaluate the diagnostic performance of using a reformatted single-in-plane image reformation of the rib cage for the detection of rib fractures in computed tomography (CT) examinations, employing different levels of radiological experience. We retrospectively evaluated 10 consecutive patients with and 10 patients without rib fractures, whose CT scans were reformatted to a single-in-plane image reformation of the rib cage. Eight readers (two radiologists, two residents in radiology, and four interns) independently evaluated the images for the presence of rib fractures using a reformatted single-in-plane image and a multi-planar image reformation. The time limit was 30 seconds for each read. A consensus of two radiologist readings was considered as the reference standard. Diagnostic performance (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) was assessed and evaluated per rib and per location (anterior, lateral, posterior). To determine the time limit, we prospectively analyzed the average time it took radiologists to assess the rib cage, in a bone window setting, in 50 routine CT examinations. McNemar test was used to compare the diagnostic performances. Single image reformation was successful in all 20 patients. The sensitivity, specificity, PPV, and NPV for the detection of rib fractures using the conventional multi-planar read were 77.5%, 99.2%, 89.9%, and 98.0% for radiologists; 46.3%, 99.7%, 92.5%, and 95.3% for residents; and 29.4%, 99.4%, 82.5%, and 93.9% for interns, respectively. Sensitivity, PPV, and NPV increased across all three groups of experience, using the reformatted single-in-plane image of the rib cage (radiologists: 85.0%, 98.6%, and 98.7%; residents: 80.0%, 92.8%, and 98.2%; interns: 66.9%, 89.9%, and 97.1%), whereas specificity did not change significantly (99.9%, 99.4%, and 99.3%). The diagnostic performance of the interns and residents was significantly better when

  4. Analysis of the current rib support practices and techniques in U.S. coal mines. (United States)

    Mohamed, Khaled M; Murphy, Michael M; Lawson, Heather E; Klemetti, Ted


    Design of rib support systems in U.S. coal mines is based primarily on local practices and experience. A better understanding of current rib support practices in U.S. coal mines is crucial for developing a sound engineering rib support design tool. The objective of this paper is to analyze the current practices of rib control in U.S. coal mines. Twenty underground coal mines were studied representing various coal basins, coal seams, geology, loading conditions, and rib control strategies. The key findings are: (1) any rib design guideline or tool should take into account external rib support as well as internal bolting; (2) rib bolts on their own cannot contain rib spall, especially in soft ribs subjected to significant load-external rib control devices such as mesh are required in such cases to contain rib sloughing; (3) the majority of the studied mines follow the overburden depth and entry height thresholds recommended by the Program Information Bulletin 11-29 issued by the Mine Safety and Health Administration; (4) potential rib instability occurred when certain geological features prevailed-these include draw slate and/or bone coal near the rib/roof line, claystone partings, and soft coal bench overlain by rock strata; (5) 47% of the studied rib spall was classified as blocky-this could indicate a high potential of rib hazards; and (6) rib injury rates of the studied mines for the last three years emphasize the need for more rib control management for mines operating at overburden depths between 152.4 m and 304.8 m.

  5. Analysis of the current rib support practices and techniques in U.S. coal mines

    Institute of Scientific and Technical Information of China (English)

    Mohamed Khaled M.; Murphy Michael M.; Lawson Heather E.; Klemetti Ted


    Design of rib support systems in U.S. coal mines is based primarily on local practices and experience. A better understanding of current rib support practices in U.S. coal mines is crucial for developing a sound engineering rib support design tool. The objective of this paper is to analyze the current practices of rib control in U.S. coal mines. Twenty underground coal mines were studied representing various coal basins, coal seams, geology, loading conditions, and rib control strategies. The key findings are:(1) any rib design guideline or tool should take into account external rib support as well as internal bolting;(2) rib bolts on their own cannot contain rib spall, especially in soft ribs subjected to significant load—external rib control devices such as mesh are required in such cases to contain rib sloughing;(3) the majority of the studied mines follow the overburden depth and entry height thresholds recommended by the Program Information Bulletin 11-29 issued by the Mine Safety and Health Administration;(4) potential rib insta-bility occurred when certain geological features prevailed—these include draw slate and/or bone coal near the rib/roof line, claystone partings, and soft coal bench overlain by rock strata;(5) 47%of the stud-ied rib spall was classified as blocky—this could indicate a high potential of rib hazards;and (6) rib injury rates of the studied mines for the last three years emphasize the need for more rib control management for mines operating at overburden depths between 152.4 m and 304.8 m.

  6. Muscle: Bone ratios in beef rib sections. (United States)

    Dolezal, H G; Murphey, C E; Smith, G C; Carpenter, Z L; McCartor, M


    Thirty-eight steers and thirty heifers (14 to 17 months of age, from F(1) Hereford × Brahman cows bred to Angus or Hereford bulls), were either forage-fed for 123 days on millet-bermudagrass pasture or grain-fed for 90 days on a high-concentrate diet and were then commercially slaughtered. Warm carcass weights ranged from 167·8 kg to 324·3 kg. At 24 h post mortem, Texas Agricultural Experiment Station personnel (1) assigned scores or took measurements on each carcass for all factors used in yield grading and quality grading, (2) measured the length of hind leg (HL) and carcass length (CL) and (3) assigned a score for carcass muscling (MS) and, as appropriate, made an adjusted longissimus muscle area (ALA) evaluation. The 9th-10th-11th rib section from one side of each carcass was physically separated into longissimus muscle, fat, 'other soft tissue' and bone and ether extract determinations of the longissimus muscle and 'other soft tissue' components were made and used to adjust the yields of each of these components to a fat-free basis. Muscle to bone ratios ranged from 2·38 to 4·37. With both age and carcass weight held constant, diet, breed and sex explained only 35·8% of the variation in muscle to bone ratio. The best simple correlation with muscle to bone ratio was ALA/CL (r = ·59). Other measures significantly correlated with muscle to bone ratio included ALA (r = 0·55), MS (r = 0·50) and carcass weight (r = 0·49). Multiple regression analyses identified a three-variable subset comprised of ALA, carcass weight and CL which was related (P carcass measures useful for predicting muscle to bone ratio.

  7. Fabrication of Barrier Ribs for PDP by Capillary Infiltration Process and Their Sintering Behavior

    Institute of Scientific and Technical Information of China (English)

    Tae Jung Tang; Hak Nynu Choi; Chan Hyoung Kang; Yong Seog Kim


    Closed-cell type barrier ribs such as meander, honeycomb, SDR, and waffle types were produced using capillary molding process. Sintering of the ribs revealed that the ribs with asymmetric geometry such as meander and SDR type became distorted severely by the sintering process, but the ribs with symmetric geometry such as honeycomb and waffle type maintained their green state morphology. After sintering, the ribs were coated with green phosphor using osmosis coating process and its luminance characteristics were evaluated. The results indicated that the luminance and its efficiency is improved by using closed-cell type ribs with the new phosphor forming technology.

  8. Flank pseudohernia following posterior rib fracture: a case report. (United States)

    Butensky, Adam M; Gruss, Leah P; Gleit, Zachary L


    A pseudohernia is an abdominal wall bulge that may be mistaken for a hernia but that lacks the disruption of the abdominal wall that characterizes a hernia. Thus, the natural history and treatment of this condition differ from those of a hernia. This is the first report of a pseudohernia due to cough-associated rib fracture. A case of pseudohernia due to fractures of the 10(th) and 11(th) ribs in a 68-year-old white woman is presented. The patient suffered from a major coughing episode 1 year prior to her presentation, after which she noted a progressively enlarging bulge in her left flank. Computed tomography demonstrated a bulge in the abdominal wall containing bowel and spleen but with all muscle and fascial layers intact; in addition, lateral 10(th) rib and posterior 11(th) rib fractures were noted. As there was no defect in muscle or fascia, we diagnosed a pseudohernia, likely due to a denervation injury from the fractured ribs. Symptomatic treatment was recommended, including wearing a corset and referral to a pain management clinic. Symptomatic treatment is thought to be the mainstay of therapy for pseudohernias, as surgical intervention is unlikely to be of benefit.

  9. Differentiating the Causes of Spontaneous Rib Fracture After Breast Cancer. (United States)

    Harris, Susan R


    Spontaneous rib fracture after treatment for primary breast cancer is not uncommon. Although metastatic disease accounts for about 30% of spontaneous rib fractures and should constitute the first line of diagnostic investigation, other possible contributors include primary osteoporosis or secondary osteoporosis resulting from cancer treatments. Chemotherapy-induced menopause, aromatase inhibitors, radiation therapy, and long-term bisphosphonate use can all contribute to bone fragility, including spontaneous rib fractures in the latter 3. Drawing on recent breast cancer practice guidelines as well as population-based studies of fracture risk for women with a history of breast cancer and systematic reviews, this Perspective will provide an update on recent developments in understanding how to differentiate the possible reasons for non-traumatic rib fracture in women treated for breast cancer. In addition to describing the various possible causes of spontaneous rib fracture, the recommended medical and imaging procedures for differentiating among the potential causes will be presented. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Thoracic epidural steroid injection for rib fracture pain. (United States)

    Rauchwerger, Jacob J; Candido, Kenneth D; Deer, Timothy R; Frogel, Jonathan K; Iadevaio, Robert; Kirschen, Neil B


    Treatment for rib fracture pain can be broadly divided into pharmacologic approaches with oral and/or parenteral medication and interventional approaches utilizing neuraxial analgesia or peripheral nerve blocks to provide pain relief. Both approaches attempt to control nociceptive and neuropathic pain secondary to osseous injury and nerve insult, respectively. Success of treatment is ultimately measured by the ability of the selected modality to decrease pain, chest splinting, and to prevent sequelae of injury, such as pneumonia. Typically, opioids and NSAIDs are the drugs of first choice for acute pain because of ease of administration, immediate onset of action, and rapid titration to effect. In contrast, neuropathic pain medications have a slower onset of action and are more difficult to titrate to therapeutic effect. Interventional approaches include interpleural catheters, intercostal nerve blocks, paravertebral nerve blocks, and thoracic and lumbar epidural catheters. Each intervention has its own inherent advantages, disadvantages, and success rates. Rib fracture pain management practice is founded on the thoracic surgical and anesthesiology literature. Articles addressing rib fracture pain are relatively scarce in the pain medicine literature. As life expectancy increases, and as healthcare system modifications are implemented, pain medicine physicians may be consulted to treat increasing number of patients suffering rib fracture pain and may need to resort to novel therapeutic measures because of financial constraints imposed by those changes. Here we present the first published case series of thoracic epidural steroid injections used for management of rib fracture pain. © 2012 The Authors Pain Practice © 2012 World Institute of Pain.

  11. [Rib cage ostheosynthesis. Literature review and case reports]. (United States)

    Jiménez-Quijano, Andrés; Varón-Cotés, Juan Carlos; García-Herreros-Hellal, Luis Gerardo; Espinosa-Moya, Beatriz; Rivero-Rapalino, Oscar; Salazar-Marulanda, Michelle


    Fractures of the chest wall include sternum and rib fractures. Traditionally they are managed conservatively due to the anatomy of the rib cage that allows most of them to remain stable and to form a callus that unites the fractured segments. In spite of this management, some patients present with chronic pain or instability of the wall which makes them require some type of fixation. The present article performs a literature review based on 4 cases. The first case was a 61 year-old man with blunt chest trauma, with a great deformity of the chest wall associated with subcutaneous emphysema, and pneumothorax. The second case was a 51 year-old man with blunt chest trauma, initially managed at another institution, who despite treatment, had persistent pain and dyspnoea. The third case was a 30 year-old man that suffered a motor vehicle accident, with resulting pain and crepitation of the rib cage and with diagnostic images showing multiple rib fractures. The last case is a 62 year-old man that fell down the stairs, with blunt chest trauma with high intensity pain, dyspnoea and basal ipsilateral hypoventilation. Rib fracture fixation offers a good alternative in selected patients to decrease associated morbidity, leading to a patient's fast return to his or her working life. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  12. Botulinum toxin treatment for slipping rib syndrome: a case report. (United States)

    Pirali, Caterina; Santus, Gianna; Faletti, Sofia; De Grandis, Domenico


    Slipping rib syndrome (SRS) is a musculoskeletal cause of severe and recurrent thoracic or abdominal pain. The etiology of SRS is unknown, it seems to arise from costal hypermobility with a tendency of one of the ribs (usually from 8th to 10th but also 11th and 12th have been described) to slip under the superior adjacent rib. Its prevalence is underestimated because SRS is mainly a clinical diagnosis, frequently missed. The critical aspect of the diagnosis is knowledge of the condition itself, which, when lacking, often results in the patient being referred to many different specialists and exposed to unnecessary and costly investigations. The management of the condition includes conservative techniques such as manipulation, localized anesthetic, and steroid or anesthetic nerve block. However, where conservative therapy fails, surgical treatment, with excision of the rib, may be performed. In this paper we describe the case of a patient with persistent and debilitating flank pain who, after many investigations, was diagnosed with SRS. The usual conservative treatment failed, after which we treated the patient with injections of incobotulinumtoxin A into muscles inserting on the inferior side of the rib cage (quadratus lumborum muscle, muscle transversus abdomini, abdominal external oblique muscle, and recto abdomini) achieving a complete relief from pain. To our knowledge botulinum toxin has never been proposed before for the treatment of SRS. We believe that it should be considered as a therapeutic option, especially where other medical treatments have failed or as an intermediate step before surgical intervention.

  13. Emerging from the rib: resolving the turtle controversies. (United States)

    Rice, Ritva; Riccio, Paul; Gilbert, Scott F; Cebra-Thomas, Judith


    Two of the major controversies in the present study of turtle shell development involve the mechanism by which the carapacial ridge initiates shell formation and the mechanism by which each rib forms the costal bones adjacent to it. This paper claims that both sides of each debate might be correct-but within the species examined. Mechanism is more properly "mechanisms," and there is more than one single way to initiate carapace formation and to form the costal bones. In the initiation of the shell, the rib precursors may be kept dorsal by either "axial displacement" (in the hard-shell turtles) or "axial arrest" (in the soft-shell turtle Pelodiscus), or by a combination of these. The former process would deflect the rib into the dorsal dermis and allow it to continue its growth there, while the latter process would truncate rib growth. In both instances, though, the result is to keep the ribs from extending into the ventral body wall. Our recent work has shown that the properties of the carapacial ridge, a key evolutionary innovation of turtles, differ greatly between these two groups. Similarly, the mechanism of costal bone formation may differ between soft-shell and hard-shell turtles, in that the hard-shell species may have both periosteal flattening as well as dermal bone induction, while the soft-shelled turtles may have only the first of these processes. © 2015 Wiley Periodicals, Inc.

  14. Mechanobiology and Cartilage Tissue Engineering

    Institute of Scientific and Technical Information of China (English)

    Céline; HUSELSTEIN; Natalia; de; ISLA; Sylvaine; MULLER; Jean-Franois; STOLTZ


    1 IntroductionThe cartilage is a hydrated connective tissue in joints that withstands and distributes mechanical forces. Chondrocytes utilize mechanical signals to maintain tissue homeostasis. They regulate their metabolic activity through complex biological and biophysical interactions with the extracellular matrix (ECM). Although some of the mechanisms of mechanotransduction are known today, there are certainly many others left unrevealed. Different topics of chondrocytes mechanobiology have led to the de...

  15. Resident mesenchymal progenitors of articular cartilage. (United States)

    Candela, Maria Elena; Yasuhara, Rika; Iwamoto, Masahiro; Enomoto-Iwamoto, Motomi


    Articular cartilage has poor capacity of self-renewal and repair. Insufficient number and activity of resident mesenchymal (connective tissue) progenitors is likely one of the underlying reasons. Chondroprogenitors reside not only in the superficial zone of articular cartilage but also in other zones of articular cartilage and in the neighboring tissues, including perichondrium (groove of Ranvier), synovium and fat pad. These cells may respond to injury and contribute to articular cartilage healing. In addition, marrow stromal cells can migrate through subchondral bone when articular cartilage is damaged. We should develop drugs and methods that correctly stimulate resident progenitors for improvement of repair and inhibition of degenerative changes in articular cartilage. Copyright © 2014. Published by Elsevier B.V.

  16. Diode laser (980nm) cartilage reshaping (United States)

    El Kharbotly, A.; El Tayeb, T.; Mostafa, Y.; Hesham, I.


    Loss of facial or ear cartilage due to trauma or surgery is a major challenge to the otolaryngologists and plastic surgeons as the complicated geometric contours are difficult to be animated. Diode laser (980 nm) has been proven effective in reshaping and maintaining the new geometric shape achieved by laser. This study focused on determining the optimum laser parameters needed for cartilage reshaping with a controlled water cooling system. Harvested animal cartilages were angulated with different degrees and irradiated with different diode laser powers (980nm, 4x8mm spot size). The cartilage specimens were maintained in a deformation angle for two hours after irradiation then released for another two hours. They were serially measured and photographed. High-power Diode laser irradiation with water cooling is a cheep and effective method for reshaping the cartilage needed for reconstruction of difficult situations in otorhinolaryngologic surgery. Key words: cartilage,diode laser (980nm), reshaping.

  17. Harnessing Biomechanics to Develop Cartilage Regeneration Strategies


    Athanasiou, KA; Responte, DJ; Brown, WE; Hu, JC


    Copyright © 2015 by ASME. As this review was prepared specifically for the American Society of Mechanical Engineers H.R. Lissner Medal, it primarily discusses work toward cartilage regeneration performed in Dr. Kyriacos A. Athanasiou's laboratory over the past 25 years. The prevalence and severity of degeneration of articular cartilage, a tissue whose main function is largely biomechanical, have motivated the development of cartilage tissue engineering approaches informed by biomechanics. Thi...

  18. Incidental imaging findings of congenital rib abnormalities - a case series and review of developmental concepts. (United States)

    Aignătoaei, Anda Maria; Moldoveanu, Cristina Elena; Căruntu, Irina Draga; Giușcă, Simona Eliza; Partene Vicoleanu, Simona; Nedelcu, Alin Horațiu


    Congenital rib abnormalities are found in approximately 2% of the general population. Usually, they occur in isolation, when they are rarely symptomatic, but they can also associate with other malformations. We reviewed imaging examinations performed over a period of two years (2014-2015), enabling us to identify isolated rib abnormalities in six adult patients. The case series consisted in three cases with bilateral cervical ribs and one case each with bifid rib, costal fusion and rib pseudarthrosis. In all patients, the costal anomalies were discovered incidentally. All rib malformations were detected at thoracic radiography, except for the rib pseudarthrosis, which was identified at CT scan. Differential diagnosis was made between cervical ribs and abnormalities of the C7 transverse process and of the first rib, while the other costal malformations were distinguished from tumoral, traumatic or inflammatory lesions of the chest wall, lung and pleura. Considering the existing knowledge on rib development, we suggest a classification of the most common types of rib malformations in three categories: (I) results of homeotic transformation, referring to numerical aberrations; (II) segmentation errors, including costal fusion and bridging; (III) anomalies of resegmentation, resulting in bifid ribs. It is important that radiologists are familiarized with the imaging features of rib abnormalities, since these anomalies can be misinterpreted as lesions with different implications. We aim that the developmental classification proposed in this paper can contribute to a better understanding of this pathology.

  19. Improving the Odds: Intercostal Metal Coils Mark Area to Resect in Rib Lesions. (United States)

    Riggs, Kyle W; Zeltsman, David; Gu, Bo; Sung, Chris C; Lobko, Igor

    Precise localization of a rib lesion for its resection remains a challenge because of multiple factors including nonpalpable pathology, unfavorable body habitus, inaccurate clinical examination, and unreliable rib count on physical examination, unfavorable lesion location within a rib (its posterior aspect), and resection of sclerotic lesions with grossly intact rib cortex. We describe a novel rib localization technique that eliminates potential mistakes and avoids resection of an inappropriate rib. Our method of rib localization includes placement of metallic coils by interventional radiologists under computed tomography guidance where two coils are deployed within the intercostal spaces, one superior and one inferior to the rib lesion. Intraoperative use of fluoroscopy results in precise localization of rib lesions even in cases where the pathology is not grossly apparent. We implemented this approach in 2014 and have since performed it in five patients for both lytic and sclerotic lesions. Placement of markers superficial to the intercostal spaces resulted in their displacement in one case. Successfully, we removed the correct ribs in each patient without technical difficulties or complications. Our series demonstrates a novel strategy for a highly accurate and relatively easy way to identify the exact portion of the rib for surgical resection. Intercostal space positioning of the coil markers superior and inferior to the lesion prevents their dislodgement during patient transport and positioning on the operating room table, which improves rib identification accuracy and reliability. When combined with intraoperative fluoroscopy, it will greatly eliminate resection of incorrect ribs.

  20. Numerical investigations of rib fracture failure models in different dynamic loading conditions. (United States)

    Wang, Fang; Yang, Jikuang; Miller, Karol; Li, Guibing; Joldes, Grand R; Doyle, Barry; Wittek, Adam


    Rib fracture is one of the most common thoracic injuries in vehicle traffic accidents that can result in fatalities associated with seriously injured internal organs. A failure model is critical when modelling rib fracture to predict such injuries. Different rib failure models have been proposed in prediction of thorax injuries. However, the biofidelity of the fracture failure models when varying the loading conditions and the effects of a rib fracture failure model on prediction of thoracic injuries have been studied only to a limited extent. Therefore, this study aimed to investigate the effects of three rib failure models on prediction of thoracic injuries using a previously validated finite element model of the human thorax. The performance and biofidelity of each rib failure model were first evaluated by modelling rib responses to different loading conditions in two experimental configurations: (1) the three-point bending on the specimen taken from rib and (2) the anterior-posterior dynamic loading to an entire bony part of the rib. Furthermore, the simulation of the rib failure behaviour in the frontal impact to an entire thorax was conducted at varying velocities and the effects of the failure models were analysed with respect to the severity of rib cage damages. Simulation results demonstrated that the responses of the thorax model are similar to the general trends of the rib fracture responses reported in the experimental literature. However, they also indicated that the accuracy of the rib fracture prediction using a given failure model varies for different loading conditions.

  1. Can Glucosamine Supplements Protect My Knee Cartilage from Osteoarthritis? (United States)

    ... Can glucosamine supplements protect my knee cartilage from osteoarthritis? Answers from Brent A. Bauer, M.D. Study results on this question have ... build cartilage. The most common type of arthritis, osteoarthritis wears away the slick cartilage that covers the ...

  2. Optical properties of nasal septum cartilage (United States)

    Bagratashvili, Nodar V.; Sviridov, Alexander P.; Sobol, Emil N.; Kitai, Moishe S.


    Optical parameters (scattering coefficient s, absorption coefficient k and scattering anisotropy coefficient g) of hyaline cartilage were studied for the first time. Optical properties of human and pig nasal septum cartilage, and of bovine ear cartilage were examined using a spectrophotometer with an integrating sphere, and an Optical Multi-Channel Analyser. We measured total transmission Tt, total reflection Rt, and on-axis transmission Ta for light propagating through cartilage sample, over the visible spectral range (14000 - 28000 cm-1). It is shown that transmission and reflection spectra of human, pig and bovine cartilage are rather similar. It allows us to conclude that the pig cartilage can be used for in-vivo studies instead of human cartilage. The data obtained were treated by means of the one-dimensional diffusion approximation solution of the optical transport equation. We have found scattering coefficient s, absorption coefficient k and scattering anisotropy coefficient g by the iterative comparison of measured and calculated Tt, Rt and Ta values for human and pig cartilage. We found, in particular, that for 500 nm irradiation s equals 37,6 plus or minus 3.5 cm-1, g equals 0,56 plus or minus 0.05, k approximately equals 0,5 plus or minus 0.3 cm-1. The above data were used in Monte Carlo simulation for spatial intensity profile of light scattered by a cartilage sample. The computed profile was very similar to the profile measured using an Optical Multi-Channel Analyzer (OMA).

  3. The effect of graft strength on knee laxity and graft in-situ forces after posterior cruciate ligament reconstruction.

    Directory of Open Access Journals (Sweden)

    Yu-Shu Lai

    Full Text Available Surgical reconstruction is generally recommended for posterior cruciate ligament (PCL injuries; however, the use of grafts is still a controversial problem. In this study, a three-dimensional finite element model of the human tibiofemoral joint with articular cartilage layers, menisci, and four main ligaments was constructed to investigate the effects of graft strengths on knee kinematics and in-situ forces of PCL grafts. Nine different graft strengths with stiffness ranging from 0% (PCL rupture to 200%, in increments of 25%, of an intact PCL's strength were used to simulate the PCL reconstruction. A 100 N posterior tibial drawer load was applied to the knee joint at full extension. Results revealed that the maximum posterior translation of the PCL rupture model (0% stiffness was 6.77 mm in the medial compartment, which resulted in tibial internal rotation of about 3.01°. After PCL reconstruction with any graft strength, the laxity of the medial tibial compartment was noticeably improved. Tibial translation and rotation were similar to the intact knee after PCL reconstruction with graft strengths ranging from 75% to 125% of an intact PCL. When the graft's strength surpassed 150%, the medial tibia moved forward and external tibial rotation greatly increased. The in-situ forces generated in the PCL grafts ranged from 13.15 N to 75.82 N, depending on the stiffness. In conclusion, the strength of PCL grafts have has a noticeable effect on anterior-posterior translation of the medial tibial compartment and its in-situ force. Similar kinematic response may happen in the models when the PCL graft's strength lies between 75% and 125% of an intact PCL.

  4. Epidural analgesia in patients with traumatic rib fractures

    DEFF Research Database (Denmark)

    Duch, P; Møller, M H


    BACKGROUND: Traumatic rib fractures are a common condition associated with considerable morbidity and mortality. Observational studies have suggested improved outcome in patients receiving continuous epidural analgesia (CEA). The aim of the present systematic review of randomised controlled trials...... (RCTs) was to assess the benefit and harm of CEA compared with other analgesic interventions in patients with traumatic rib fractures. METHODS: We performed a systematic review with meta-analysis and trial sequential analysis (TSA). Eligible trials were RCTs comparing CEA with other analgesic...... interventions in patients with traumatic rib fractures. Cumulative relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were estimated, and risk of systematic and random errors was assessed. The predefined primary outcome measures were mortality, pneumonia and duration...

  5. Shape Optimization of Inclined Ribs as Heat Transfer Augmentation Device

    Institute of Scientific and Technical Information of China (English)

    Kwang-Yong Kim; Hong-Min Kim


    This work presents numerical optimization techniques for the design of a rectangular channel with inclined ribs to enhance turbulent heat transfer.The response surface method with Reynolds-averaged Navier-Stokes analysis is used for optimization.Shear stress transport turbulence model is used as a turbulence closure.Computational results for local heat transfer rate show a reasonable agreement with the experimental data.Width-to-rib height ratio and attack angle of the rib are chosen as design variables.The objective function is defined as a linear combination of heat-transfer and friction-loss related terms with the weighting factor.Full-factorial experimental design method is used to determine the data points.Optimum shapes of the channel have been obtained in a range of the weighting factor.

  6. 小儿脊柱侧弯并发剃刀背畸形的矫治%Treatment of rib prominence scoliosis in children

    Institute of Scientific and Technical Information of China (English)

    孙琳; 于凤章; 潘少川; 张学军; 李承鑫; 马军; 赵华


    目的 矫正脊柱侧弯患儿的肋骨剃刀背畸形。方法 在实行后路脊柱侧弯矫形及脊柱融合术时,采用凸侧多节短段肋骨切除术同时矫治剃刀背及术后佩带矫形石膏或支具背心,更为有利。结果 1997年9月至1999年6月共有49例脊柱侧弯患儿施行剃刀背矫形术,未发生气胸、胸膜破裂等并发症,有3例患儿遗有残余剃刀背,其余患儿矫形效果均满意。结论 多节短段肋骨切除术是一种简便有效、安全的方法。在矫形剃刀背的同时,还可提供脊柱融合的植骨材料,免去髂骨取骨。%Objective In order to correct the rib prominence scoliosis inchildren .Methods From 1997 to 1999, 49 children with congenital scoliosis(27), idiopathic scoliosis(15), neurofibromatosis with scoliosis(6) and Marfan's syndrome with scoliosis(1) were treated. Rib resection was performed during the posterior spinal fusion on scoliosis, the spinal orthosis was applied postoperatively. Results No pneumothorax was happened postoperatively . All cases got satisfactory cosmetic appearance except 3 had residual rib prominence. Conclusions Multiple short segment costectomy is a safe and effective technique for the rib deformity in children with scoliosis. The resected ribs could provide the bone grafting for spinal fusion.

  7. Blunt chest trauma: is there a place for rib stabilization? (United States)


    Rib fractures are a common and highly morbid finding in patients with blunt chest trauma. Over the past decade, a renewed interest in (and instrumentation for) rib fixation in this cohort has occurred. Stabilization of the chest wall in this setting, particularly when a flail segment is present, is associated with significant reductions in the rates of respiratory failure, pneumonia, ICU stay, and mortality. Thoracic surgeons should remain actively involved in this evolving area of our specialty to further optimize patient outcomes. PMID:28446987

  8. Subclavian artery stenosis caused by a prominent first rib

    Directory of Open Access Journals (Sweden)

    Isabelle Claus


    Full Text Available Thoracic outlet syndrome is a mechanical space problem in which the brachial plexus and/or subclavian vessels are compressed. Arterial compression is least common and almost always associated with a bony anomaly. We present a case of a 49-year-old woman with a prominent first rib which caused a subclavian artery stenosis. There are many options for subclavian artery repair through open surgery. In high-risk patients, minimal invasive techniques are favorable. To date, few case reports exist on an endovascular artery repair combined with open first rib resection. While long-term follow-up will be necessary, our preliminary results seem promising.

  9. Acute rib fracture diagnosis in an infant by US: a matter of child protection

    Energy Technology Data Exchange (ETDEWEB)

    Kelloff, Jennifer; Spivey, Maria [Washington University School of Medicine, Department of Pediatrics, Section on Child Abuse and Neglect, St. Louis Children' s Hospital, One Children' s Place, Box 8116, St. Louis, MO (United States); Hulett, Rebecca [Washington University School of Medicine, Department of Radiology, St. Louis Children' s Hospital, St. Louis, MO (United States)


    Rib fractures in infants and children are highly specific for inflicted injury in the absence of a major accidental injury or underlying bone disorder. We present a 9-week-old infant diagnosed with an acute rib fracture by US at the site where physicians palpated chest wall crepitus when no rib fractures had been visualized on the skeletal survey, including oblique views of the ribs. Based on the US diagnosis of the acute rib fracture the infant was taken into protective custody. Follow-up skeletal survey 2 weeks later revealed healing fractures of the left 6th and 7th posterolateral ribs and right 7th, 8th and 9th anterolateral ribs. We were unable to locate previous reports describing the diagnosis of rib fractures in infants by US. (orig.)

  10. Cartilage repair: surgical techniques and tissue engineering using polysaccharide- and collagen-based biomaterials. (United States)

    Galois, L; Freyria, A M; Grossin, L; Hubert, P; Mainard, D; Herbage, D; Stoltz, J F; Netter, P; Dellacherie, E; Payan, E


    Lesions of articular cartilage have a large variety of causes among which traumatic damage, osteoarthritis and osteochondritis dissecans are the most frequent. Replacement of articular defects in joints has assumed greater importance in recent years. This interest results in large part because cartilage defects cannot adequately heal themselves. Many techniques have been suggested over the last 30 years, but none allows the regeneration of the damaged cartilage, i.e. its replacement by a strictly identical tissue. In the first generation of techniques, relief of pain was the main concern, which could be provided by techniques in which cartilage was replaced by fibrocartilage. Disappointing results led investigators to focus on more appropriate bioregenerative approaches using transplantation of autologous cells into the lesion. Unfortunately, none of these approaches has provided a perfect final solution to the problem. The latest generation of techniques, currently in the developmental or preclinical stages, involve biomaterials for the repair of chondral or osteochondral lesions. Many of these scaffolds are designed to be seeded with chondrocytes or progenitor cells. Among natural and synthetic polymers, collagen- and polysaccharide-based biomaterials have been extensively used. For both these supports, studies have shown that chondrocytes maintain their phenotype when cultured in three dimensions. In both types of culture, a glycosaminoglycan-rich deposit is formed on the surface and in the inner region of the cultured cartilage, and type II collagen synthesis is also observed. Dynamic conditions can also improve the composition of such three-dimensional constructs. Many improvements are still required, however, in a number of key aspects that so far have received only scant attention. These aspects include: adhesion/integration of the graft with the adjacent native cartilage, cell-seeding with genetically-modified cell populations, biomaterials that can be

  11. Articular Cartilage Changes in Maturing Athletes (United States)

    Luria, Ayala; Chu, Constance R.


    Context: Articular cartilage has a unique functional architecture capable of providing a lifetime of pain-free joint motion. This tissue, however, undergoes substantial age-related physiologic, mechanical, biochemical, and functional changes that reduce its ability to overcome the effects of mechanical stress and injury. Many factors affect joint function in the maturing athlete—from chondrocyte survival and metabolism to structural composition and genetic/epigenetic factors governing cartilage and synovium. An evaluation of age-related changes for joint homeostasis and risk for osteoarthritis is important to the development of new strategies to rejuvenate aging joints. Objective: This review summarizes the current literature on the biochemical, cellular, and physiologic changes occurring in aging articular cartilage. Data Sources: PubMed (1969-2013) and published books in sports health, cartilage biology, and aging. Study Selection: Keywords included aging, athlete, articular cartilage, epigenetics, and functional performance with age. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: To be included, research questions addressed the effect of age-related changes on performance, articular cartilage biology, molecular mechanism, and morphology. Results: The mature athlete faces challenges in maintaining cartilage health and joint function due to age-related changes to articular cartilage biology, morphology, and physiology. These changes include chondrocyte loss and a decline in metabolic response, alterations to matrix and synovial tissue composition, and dysregulation of reparative responses. Conclusion: Although physical decline has been regarded as a normal part of aging, many individuals maintain overall fitness and enjoy targeted improvement to their athletic capacity throughout life. Healthy articular cartilage and joints are needed to maintain athletic performance and general activities. Genetic and potentially reversible

  12. Bone grafts in dentistry

    Directory of Open Access Journals (Sweden)

    Prasanna Kumar


    Full Text Available Bone grafts are used as a filler and scaffold to facilitate bone formation and promote wound healing. These grafts are bioresorbable and have no antigen-antibody reaction. These bone grafts act as a mineral reservoir which induces new bone formation.

  13. Microbiological Safety of Commercial Prime Rib Preparation Methods: Thermal Inactivation of Salmonella in Mechanically Tenderized Rib Eye. (United States)

    Calle, Alexandra; Porto-Fett, Anna C S; Shoyer, Bradley A; Luchansky, John B; Thippareddi, Harshavardhan


    Boneless beef rib eye roasts were surface inoculated on the fat side with ca. 5.7 log CFU/g of a five-strain cocktail of Salmonella for subsequent searing, cooking, and warm holding using preparation methods practiced by restaurants surveyed in a medium-size Midwestern city. A portion of the inoculated roasts was then passed once through a mechanical blade tenderizer. For both intact and nonintact roasts, searing for 15 min at 260°C resulted in reductions in Salmonella populations of ca. 0.3 to 1.3 log CFU/g. For intact (nontenderized) rib eye roasts, cooking to internal temperatures of 37.8 or 48.9°C resulted in additional reductions of ca. 3.4 log CFU/g. For tenderized (nonintact) rib eye roasts, cooking to internal temperatures of 37.8 or 48.9°C resulted in additional reductions of ca. 3.1 or 3.4 log CFU/g, respectively. Pathogen populations remained relatively unchanged for intact roasts cooked to 37.8 or 48.9°C and for nonintact roasts cooked to 48.9°C when held at 60.0°C for up to 8 h. In contrast, pathogen populations increased ca. 2.0 log CFU/g in nonintact rib eye cooked to 37.8°C when held at 60.0°C for 8 h. Thus, cooking at low temperatures and extended holding at relatively low temperatures as evaluated herein may pose a food safety risk to consumers in terms of inadequate lethality and/or subsequent outgrowth of Salmonella, especially if nonintact rib eye is used in the preparation of prime rib, if on occasion appreciable populations of Salmonella are present in or on the meat, and/or if the meat is not cooked adequately throughout.

  14. Risk of metastasis among rib abnormalities on bone scans in breast cancer patients (United States)

    Li, Qin; Chen, Zhiqiang; Zhao, Yansheng; Li, Xiuqing; Pan, Hong; Xia, Tiansong; Chen, Lin; Xu, Zhaoqiang; Zhou, Wenbin; Liu, Xiaoan


    Bone scan abnormalities, especially rib lesions, are often confusing for physicians due to a high number of false-positive lesions. This study investigated risk factors that are associated with bone metastasis in 613 breast cancer patients with bone scan abnormalities. Significantly increased rates of bone metastasis were observed in patients with multiple lesions, large tumor sizes, and lymph node involvement. In addition, patients with concurrent lesions of rib and other sites exhibited a significant higher rate of metastatic disease compared to those with other site lesions (P = 0.009). In the subset of 324 patients with rib abnormalities, the rate of metastasis was extremely low in patients with pure rib lesions (1.2%; 95% CI: 0.1%–4.1%). Concurrent lesions of rib and other sites were more likely to be rib metastasis compared to pure rib lesions (P rib lesions and lesions located on bilateral ribs were more likely to be rib metastasis (P rib abnormalities could be recommended for follow-up only. However, if concurrent lesions of rib and other sites were detected on bone scans, additional radiological examinations should be performed to patients. PMID:25939860

  15. Comparison of Computed Tomography and Chest Radiography in the Detection of Rib Fractures in Abused Infants (United States)

    Wootton-Gorges, Sandra L.; Stein-Wexler, Rebecca; Walton, John W.; Rosas, Angela J.; Coulter, Kevin P.; Rogers, Kristen K.


    Purpose: Chest radiographs (CXR) are the standard method for evaluating rib fractures in abused infants. Computed tomography (CT) is a sensitive method to detect rib fractures. The purpose of this study was to compare CT and CXR in the evaluation of rib fractures in abused infants. Methods: This retrospective study included all 12 abused infants…

  16. Anatomical study of nasal cartilage in buffalo (Bubalus bubulus

    Directory of Open Access Journals (Sweden)

    Mahdi Yeganehzad


    Full Text Available This study used ten heads of adult buffalo taken from slaughterhouse. After transferring the samples to the anatomy hall, a split was carefully created on skin of muzzle and the skin was slowly separated from muscles and hypodermal connective tissue. Place of connection of cartilages to bone, cartilages to each other and shape of the cartilages were specified. In buffalo, nose apex has two nostrils fixed by bone and cartilage. After identifying and separating the cartilages, it was found that nasal cartilages in buffalo consisted of: 1 septum nasal located between two nostrils and reinforces it from inside. 2 dorso-lateral nasal cartilage constituting dorsal and lateral parts of the nostril. 3 ventro-lateral nasal cartilage constituting ventral and lateral parts of the nostril. 4 lateral accessory cartilage constituting lateral and ventral parts of the nostril. 5 medial accessory nasal cartilage located at Alar fold and connected to ventro-lateral nasal cartilage.

  17. Strategies for Zonal Cartilage Repair using Hydrogels

    NARCIS (Netherlands)

    Klein, Travis J.; Rizzi, Simone C.; Reichert, Johannes C.; Georgi, Nicole; Malda, Jos; Schuurman, Wouter; Crawford, Ross W.; Hutmacher, Dietmar W.


    Articular cartilage is a highly hydrated tissue with depth-dependent cellular and matrix properties that provide low-friction load bearing in joints. However, the structure and function are frequently lost and there is insufficient repair response to regenerate high-quality cartilage. Several hydrog

  18. Magnetic Resonance Imaging of Cartilage Repair (United States)

    Trattnig, Siegfried; Winalski, Carl S.; Marlovits, Stephan; Jurvelin, Jukka S.; Welsch, Goetz H.; Potter, Hollis G.


    Articular cartilage lesions are a common pathology of the knee joint, and many patients may benefit from cartilage repair surgeries that offer the chance to avoid the development of osteoarthritis or delay its progression. Cartilage repair surgery, no matter the technique, requires a noninvasive, standardized, and high-quality longitudinal method to assess the structure of the repair tissue. This goal is best fulfilled by magnetic resonance imaging (MRI). The present article provides an overview of the current state of the art of MRI of cartilage repair. In the first 2 sections, preclinical and clinical MRI of cartilage repair tissue are described with a focus on morphological depiction of cartilage and the use of functional (biochemical) MR methodologies for the visualization of the ultrastructure of cartilage repair. In the third section, a short overview is provided on the regulatory issues of the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) regarding MR follow-up studies of patients after cartilage repair surgeries. PMID:26069565

  19. Melanoma of the ear: results of a cartilage-sparing approach to resection. (United States)

    McCarty, Melissa A; Lentsch, Eric J; Cerrati, Eric W; Stadelmann, Wayne K


    Melanoma of the ear is often treated by composite resection of the skin and cartilage and, occasionally, by total auriculectomy. This review analyzes the oncologic, functional, and esthetic results of cartilage-sparing wide local excision for melanoma of the ear. This retrospective study reviewed patients with ear melanoma treated between 1997 and 2002. All patients were treated with cartilage-sparing wide local excision, and ears were reconstructed with skin grafts and/or local flaps. The majority of patients were men (16/18 patients) who ranged in age from 42 to 82 years. The most common sites of occurrence were the helical rim (7/18 patients) and the earlobe (6/18 patients). The average depth of invasion was 2.02 mm (range 0.4-6.0 mm). Sentinel lymph node biopsy was performed in 13 cases, of which only one was positive. The local control rate was 100 %, overall survival was 72 % (13/18 patients), and disease-specific survival was 89 % (16/18 patients). Average follow-up was 30.5 months (range 1-61). The rates for local control, overall survival, and disease-specific survival were excellent. These data indicate that for the majority of ear melanomas, cartilage-sparing wide local excision is an acceptable means of treatment.

  20. Tissue engineering for articular cartilage repair – the state of the art

    Directory of Open Access Journals (Sweden)

    B Johnstone


    Full Text Available Articular cartilage exhibits little capacity for intrinsic repair, and thus even minor injuries or lesions may lead to progressive damage and osteoarthritic joint degeneration, resulting in significant pain and disability. While there have been numerous attempts to develop tissue-engineered grafts or patches to repair focal chondral and osteochondral defects, there remain significant challenges in the clinical application of cell-based therapies for cartilage repair. This paper reviews the current state of cartilage tissue engineering with respect to different cell sources and their potential genetic modification, biomaterial scaffolds and growth factors, as well as preclinical testing in various animal models. This is not intended as a systematic review, rather an opinion of where the field is moving in light of current literature. While significant advances have been made in recent years, the complexity of this problem suggests that a multidisciplinary approach – combining a clinical perspective with expertise in cell biology, biomechanics, biomaterials science and high-throughput analysis will likely be necessary to address the challenge of developing functional cartilage replacements. With this approach we are more likely to realise the clinical goal of treating both focal defects and even large-scale osteoarthritic degenerative changes in the joint.

  1. Image-Guided Techniques Improve the Short-Term Outcome of Autologous Osteochondral Cartilage Repair Surgeries (United States)

    Devlin, Steven M.; Hurtig, Mark B.; Waldman, Stephen D.; Rudan, John F.; Bardana, Davide D.; Stewart, A. James


    Objective: Autologous osteochondral cartilage repair is a valuable reconstruction option for cartilage defects, but the accuracy to harvest and deliver osteochondral grafts remains problematic. We investigated whether image-guided methods (optically guided and template guided) can improve the outcome of these procedures. Design: Fifteen sheep were operated to create traumatic chondral injuries in each knee. After 4 months, the chondral defect in one knee was repaired using (a) conventional approach, (b) optically guided method, or (c) template-guided method. For both image-guided groups, harvest and delivery sites were preoperatively planned using custom-made software. During optically guided surgery, instrument position and orientation were tracked and superimposed onto the surgical plan. For the template-guided group, plastic templates were manufactured to allow an exact fit between template and the joint anatomy. Cylindrical holes within the template guided surgical tools according to the plan. Three months postsurgery, both knees were harvested and computed tomography scans were used to compare the reconstructed versus the native pre-injury joint surfaces. For each repaired defect, macroscopic (International Cartilage Repair Society [ICRS]) and histological repair (ICRS II) scores were assessed. Results: Three months after repair surgery, both image-guided surgical approaches resulted in significantly better histology scores compared with the conventional approach (improvement by 55%, P < 0.02). Interestingly, there were no significant differences found in cartilage surface reconstruction and macroscopic scores between the image-guided and the conventional surgeries. PMID:26069658

  2. A dual flow bioreactor with controlled mechanical stimulation for cartilage tissue engineering. (United States)

    Spitters, Tim W G M; Leijten, Jeroen C H; Deus, Filipe D; Costa, Ines B F; van Apeldoorn, Aart A; van Blitterswijk, Clemens A; Karperien, Marcel


    In cartilage, tissue engineering bioreactors can create a controlled environment to study chondrocyte behavior under mechanical stimulation or produce chondrogenic grafts of clinically relevant size. Here we present a novel bioreactor that combines mechanical stimulation with a two compartment system through which nutrients can be supplied solely by diffusion from opposite sides of a tissue-engineered construct. This design is based on the hypothesis that creating gradients of nutrients, growth factors, and growth factor antagonists can aid in the generation of zonal tissue-engineered cartilage. Computational modeling predicted that the design facilitates the creation of a biologically relevant glucose gradient. This was confirmed by quantitative glucose measurements in cartilage explants. In this system, it is not only possible to create gradients of nutrients, but also of anabolic or catabolic factors. Therefore, the bioreactor design allows control over nutrient supply and mechanical stimulation useful for in vitro generation of cartilage constructs that can be used for the resurfacing of articulated joints or as a model for studying osteoarthritis disease progression.

  3. Tissue engineering for articular cartilage repair--the state of the art. (United States)

    Johnstone, Brian; Alini, Mauro; Cucchiarini, Magali; Dodge, George R; Eglin, David; Guilak, Farshid; Madry, Henning; Mata, Alvaro; Mauck, Robert L; Semino, Carlos E; Stoddart, Martin J


    Articular cartilage exhibits little capacity for intrinsic repair, and thus even minor injuries or lesions may lead to progressive damage and osteoarthritic joint degeneration, resulting in significant pain and disability. While there have been numerous attempts to develop tissue-engineered grafts or patches to repair focal chondral and osteochondral defects, there remain significant challenges in the clinical application of cell-based therapies for cartilage repair. This paper reviews the current state of cartilage tissue engineering with respect to different cell sources and their potential genetic modification, biomaterial scaffolds and growth factors, as well as preclinical testing in various animal models. This is not intended as a systematic review, rather an opinion of where the field is moving in light of current literature. While significant advances have been made in recent years, the complexity of this problem suggests that a multidisciplinary approach - combining a clinical perspective with expertise in cell biology, biomechanics, biomaterials science and high-throughput analysis will likely be necessary to address the challenge of developing functional cartilage replacements. With this approach we are more likely to realise the clinical goal of treating both focal defects and even large-scale osteoarthritic degenerative changes in the joint.

  4. The Articulated Alar Rim Graft: Reengineering the Conventional Alar Rim Graft for Improved Contour and Support. (United States)

    Ballin, Annelyse C; Kim, Haena; Chance, Elizabeth; Davis, Richard E


    Surgical refinement of the wide nasal tip is challenging. Achieving an attractive, slender, and functional tip complex without destabilizing the lower nasal sidewall or deforming the contracture-prone alar rim is a formidable task. Excisional refinement techniques that rely upon incremental weakening of wide lower lateral cartilages (LLC) often destabilize the tip complex and distort tip contour. Initial destabilization of the LLC is usually further exacerbated by "shrink-wrap" contracture, which often leads to progressive cephalic retraction of the alar margin. The result is a misshapen tip complex accentuated by a conspicuous and highly objectionable nostril deformity that is often very difficult to treat. The "articulated" alar rim graft (AARG) is a modification of the conventional rim graft that improves treatment of secondary alar rim deformities, including postsurgical alar retraction (PSAR). Unlike the conventional alar rim graft, the AARG is sutured to the underlying tip complex to provide direct stationary support to the alar margin, thereby enhancing graft efficacy. When used in conjunction with a well-designed septal extension graft (SEG) to stabilize the central tip complex, lateral crural tensioning (LCT) to tighten the lower nasal sidewalls and minimize soft-tissue laxity, and lysis of scar adhesions to unfurl the retracted and scarred nasal lining, the AARG can eliminate PSAR in a majority of patients. The AARG is also highly effective for prophylaxis against alar retraction and in the treatment of most other contour abnormalities involving the alar margin. Moreover, the AARG requires comparatively little graft material, and complications are rare. We present a retrospective series of 47 consecutive patients treated with the triad of AARG, SEG, and LCT for prophylaxis and/or treatment of alar rim deformities. Outcomes were favorable in nearly all patients, and no complications were observed. We conclude the AARG is a simple and effective method for

  5. Olecranon bone graft: revisited. (United States)

    Mersa, Berkan; Ozcelik, Ismail Bulent; Kabakas, Fatih; Sacak, Bulent; Aydin, Atakan


    Autogenous bone grafts are frequently in use in the field of reconstructive upper extremity surgery. Cancellous bone grafts are applied to traumatic osseous defects, nonunions, defects after the resection of benign bone tumors, arthrodesis, and osteotomy procedures. Cancellous bone grafts do not only have benefits such as rapid revascularization, but they also have mechanical advantages. Despite the proximity to the primary surgical field, cancellous olecranon grafts have not gained the popularity they deserve in the field of reconstructive hand surgery. In this study, the properties, advantages, and technical details of harvesting cancellous olecranon grafts are discussed.

  6. Alkali suppression for pure Radioactive Ion Beam (RIB) production

    CERN Document Server

    E. Bouquerel, R. Catherall, M. Eller, J. Lettry, S. Marzari, T. Stora and the ISOLDE

    The ISOLDE facility at CERN has constantly developed new ion beams with betterpurity and improved yields over the last decades. Chemical selectivity for the productionof pure RIBs can be achieved by condensation of less volatile species in the transferline between the target and the ion source and by selective ionisation schemes such asthat provided by Resonance Ionization Laser Ion Source (RILIS)...

  7. Lidocaine patches reduce pain in trauma patients with rib fractures. (United States)

    Zink, Karen A; Mayberry, John C; Peck, Ellen G; Schreiber, Martin A


    Rib fracture pain is notoriously difficult to manage. The lidocaine patch is effective in other pain scenarios with an excellent safety profile. This study assesses the efficacy of lidocaine patches for treating rib fracture pain. A prospectively gathered cohort of patients with rib fracture was retrospectively analyzed for use of lidocaine patches. Patients treated with lidocaine patches were matched to control subjects treated without patches. Subjective pain reports and narcotic use before and after patch placement, or equivalent time points for control subjects, were gathered from the chart. All patients underwent long-term follow-up, including a McGill Pain Questionnaire (MPQ). Twenty-nine patients with lidocaine patches (LP) and 29 matched control subjects (C) were analyzed. During the 24 hours before patch placement, pain scores and narcotic use were similar (LP 5.3, C 4.6, P = 0.19 and LP 51, C 32 mg morphine, P = 0.17). In the 24 hours after patch placement, LP patients had a greater decrease in pain scores (LP 1.2, C 0.0, P = 0.01) with no change in narcotic use (LP -8.4, C 0.5-mg change in morphine, P = 0.25). At 60 days, LP patients had a lower MPQ pain score (LP 7.7, C 12.2, P rib fracture pain. Lidocaine patches resulted in a sustained reduction in pain, outlasting the duration of therapy.

  8. Snapping scapular syndrome secondary to rib intramedullary fixation device

    Directory of Open Access Journals (Sweden)

    Ezequiel E. Zaidenberg


    Conclusion: Surgeons should pay attention to any protrusion of intramedullary rib implants, especially in the evaluation of routine X-rays following surgical treatment. We should be aware of the possibility of this rare cause of snapping scapula syndrome to avoid delayed diagnosis and consider removing the implant will resolve the pain.

  9. Embryonic remnants of intercentra and cervical ribs in turtles

    Directory of Open Access Journals (Sweden)

    Ingmar Werneburg


    A broad sample of extant turtles possesses a series of paired bones in the neck that are situated between the cervical vertebrae. These paired bones were originally proposed to be cervical rib remnants, but have more recently been interpreted as vestiges of intercentra. Here, we document, for the first time, the neck development of a pleurodire turtle, Emydura subglobosa, and identify blastematous structures, which partially recapitulate the ribs and intercentra of the plesiomorphic tetrapod condition. We identify blastematous “bridges” between intercentra and the corresponding ribs, which we homologize with the vestiges visible in extant turtles and with the remnant parapophyseal articulation processes of the intercentra of some stem taxa. Only the unpaired, median part of the intercentrum of the atlas is retained in adult turtles, but intercentra are recapitulated along the entire vertebral column during development; they are embedded in the cervical myosepta and serve as attachment sites for neck musculature. We also identify two rib rudiments in the occipital region, which may indicate that at least two vertebrae are integrated into the cranium of turtles in particular, and of amniotes in general.

  10. Rib fracture in a horse during an endurance race. (United States)

    Trigo, Pablo; Muñoz, Ana; Castejón, Francisco; Riber, Cristina; Hassel, Diana M


    We describe a fatal case, in which a horse suffered a fall and as a consequence, rib fractures. Diagnosis was made postmortem and the horse died without showing clear signs of respiratory dysfunction. The retrospective reports of injuries can be important to reduce these traumatic events and to avoid fatalities.

  11. Nuclear Physics Programs for the Future RIBs Facility in Korea

    Institute of Scientific and Technical Information of China (English)

    Moon Chang-Bum


    We present nuclear physics programs based on the planned experiments using rare isotope beams (RIBs) for the future Korean Rare Isotope Beams Accelerator facility(KRIA). This ambitious facility has both an Isotope Separation On Line (ISOL) and fragmentation capability for producing RIBs and accelerating beams of wide range mass of nuclides with energies of a few to hundreds MeV per nucleon. Low energy RIBs at Elab = 5 to 20 MeV per nucleon are for the study of nuclear structure and nuclear astrophysics toward and beyond the drip lines while higher energy RIBs produced by in-flight fragmentation with the reaccelerated ions from the ISOL enable to explore the neutron drip lines in intermediate mass regions. The planned programs have goals for investigating internal structures of the exotic nuclei toward and beyond the nucleon drip lines by addressing the following issues: how the shell structure evolves in areas of extreme proton to neutron imbalance; whether the isospin symmetry maintains in isobaric mirror nuclei at and beyond the drip lines; how two-proton radioactivity affects abundances of the elements;what the role of the continuum states including resonant states above proton-decay threshold in exotic nuclei is in astrophysical nuclear reaction processes, and how the nuclear reaction rates triggered by unbound proton-rich nuclei make an effect on rapid proton capture processes in a very hot stellar plasma.

  12. Single-transverse-mode Ti:sapphire rib waveguide laser

    NARCIS (Netherlands)

    Grivas, C.; Shepherd, D.P.; May-Smith, T.C.; Eason, R.W.; Pollnau, M.


    Laser operation of Ti:sapphire rib waveguides fabricated using photolithography and ion beam etching in pulsed laser deposited layers is reported. Polarized laser emission was observed at 792.5 nm with an absorbed pump power threshold of 265 mW, which is more than a factor of 2 lower in comparison t

  13. A bond model for ribbed bars based on concrete confinement

    NARCIS (Netherlands)

    Den Uijl, J.A.; Bigaj, A.J.


    A new bond model for ribbed bars embedded in concrete has been developed. The model is based on the confining capacity of the concrete surrounding the bar. This confinement capacity is evaluated with the help of a thick-wailed-cylinder model, with which the relation between the radial displacement

  14. Challenges in engineering osteochondral tissue grafts with hierarchical structures Ivana Gadjanski, Gordana Vunjak Novakovic (United States)

    Gadjanski, Ivana; Vunjak-Novakovic, Gordana


    Introduction A major hurdle in treating osteochondral (OC) defects are the different healing abilities of two types of tissues involved - articular cartilage and subchondral bone. Biomimetic approaches to OC-construct-engineering, based on recapitulation of biological principles of tissue development and regeneration, have potential for providing new treatments and advancing fundamental studies of OC tissue repair. Areas covered This review on state of the art in hierarchical OC tissue graft engineering is focused on tissue engineering approaches designed to recapitulate the native milieu of cartilage and bone development. These biomimetic systems are discussed with relevance to bioreactor cultivation of clinically sized, anatomically shaped human cartilage/bone constructs with physiologic stratification and mechanical properties. The utility of engineered OC tissue constructs is evaluated for their use as grafts in regenerative medicine, and as high-fidelity models in biological research. Expert opinion A major challenge in engineering OC tissues is to generate a functionally integrated stratified cartilage-bone structure starting from one single population of mesenchymal cells, while incorporating perfusable vasculature into the bone, and in bone-cartilage interface. To this end, new generations of advanced scaffolds and bioreactors, implementation of mechanical loading regimens, and harnessing of inflammatory responses of the host will likely drive the further progress. PMID:26195329

  15. Comparison of Modified Cartilage Shield Tympanoplasty with Tympanoplasty Using Temporalis Fascia Only: Retrospective Analysis of 142 Cases

    Directory of Open Access Journals (Sweden)

    Sohil Vadiya


    Full Text Available The current study compares outcomes of modified cartilage shield tympanoplasty (CST with temporalis fascia tympanoplasty in type I procedures in Indian patients. Graft uptake rates are better with the CST technique and hearing results are almost equivalent with both techniques except at 8000 Hz where improvement in hearing was found better with the use of temporalis fascia alone. The CST technique used in the study is unique.

  16. Shanidar 3 Neandertal rib puncture wound and paleolithic weaponry. (United States)

    Churchill, Steven E; Franciscus, Robert G; McKean-Peraza, Hilary A; Daniel, Julie A; Warren, Brittany R


    Since its discovery and initial description in the 1960s, the penetrating lesion to the left ninth rib of the Shanidar 3 Neandertal has been a focus for discussion about interpersonal violence and weapon technology in the Middle Paleolithic. Recent experimental studies using lithic points on animal targets suggest that aspects of weapon system dynamics can be inferred from the form of the bony lesions they produce. Thus, to better understand the circumstances surrounding the traumatic injury suffered by Shanidar 3, we conducted controlled stabbing experiments with replicas of Mousterian and Levallois points directed against the thoraces of pig carcasses. Stabs were conducted under both high and low kinetic energy conditions, in an effort to replicate the usual impact forces associated with thrusting spear vs. long-range projectile weapon systems, respectively. Analysis of the lesions produced in the pig ribs, along with examination of goat ribs subjected primarily to high kinetic energy stabs from an independent experiment, revealed consistent differences in damage patterns between the two conditions. In the case of Shanidar 3, the lack of major involvement of more than one rib, the lack of fracturing of the affected and adjacent ribs, and the lack of bony defects associated with the lesion (such as wastage, hinging, and radiating fracture lines) suggests that the weapon that wounded him was carrying relatively low kinetic energy. While accidental injury or attack with a thrusting spear or knife cannot absolutely be ruled out, the position, angulation, and morphology of the lesion is most consistent with injury by a low-mass, low-kinetic energy projectile weapon. Given the potential temporal overlap of Shanidar 3 with early modern humans in western Asia, and the possibility that the latter were armed with projectile weapon systems, this case carries more than simple paleoforensic interest.

  17. Rib Fractures: To Fix or Not to Fix? An Evidence-Based Algorithm. (United States)

    Bemelman, Michael; de Kruijf, M W; van Baal, Mark; Leenen, Luke


    Rib fractures are a common injury resulting from blunt chest trauma. The most important complications associated with rib fractures include death, pneumonia, and the need for mechanical ventilation. The development of new osteosynthesis materials has stimulated increased interest in the surgical treatment of rib fractures. Surgical stabilisation, however, is not needed for every patient with rib fractures or for every patient with flail chest. This paper presents an easy-to-use evidence-based algorithm, developed by the authors, for the treatment of patients with flail chest and isolated rib fractures.

  18. Fixation of a human rib by an intramedullary telescoping splint anchored by bone cement. (United States)

    Liovic, Petar; Šutalo, Ilija D; Marasco, Silvana F


    A novel concept for rib fixation is presented that involves the use of a bioresorbable polymer intramedullary telescoping splint. Bone cement is used to anchor each end of the splint inside the medullary canal on each side of the fracture site. In this manner, rib fixation is achieved without fixation device protrusion from the rib, making the splint completely intramedullary. Finite element analysis is used to demonstrate that such a splint/cement composite can preserve rib fixation subjected to cough-intensity force loadings. Computational fluid dynamics and porcine rib experiments were used to study the anchor formation process required to complete the fixation.

  19. Securing aesthetic outcomes for composite grafts to alar margin and columellar defects: A long term experience. (United States)

    Ahuja, Rajeev B; Gupta, Rajat; Chatterjee, Pallab; Shrivastava, Prabhat


    Composite grafts for nasal reconstruction have been around for over a century but the opinion on its virtues and failings keeps vacillating with a huge difference on the safe size of the graft for transfer. Alar margin and columellar defects are more distinct than dorsal nasal defects in greater difficulty in ensuring a good aesthetic outcome. We report our series of 19 consecutive patients in whom a composite graft was used to reconstruct a defect of alar margin (8 patients), alar base (7 patients) or columella (4 patients). Patient ages ranged from 3-35 years with 5 males and 14 females. The grafts to alar margin and base ranged 0.6-1 cm in width, while grafts to columella were 0.7-1.2 cm. The maximum dimension of the graft in this series was 0.9 mm x 10 mm. Composite grafts were sculpted to be two layered (skin + cartilage), three layered wedges (skin + cartilage + skin) or their combination (two layered in a portion and three layered in another portion). All grafts were cooled in postoperative period for three days by applying an indigenous ice pack of surgical glove. The follow up ranged from 3-9 months with an average of 4.5 months. All of our 19 composite grafts survived completely but they all shrank by a small percentage of their bulk. Eleven patients rated the outcome between 90-95% improvement. We noticed that composite grafts tended to show varied pigmentation in our patients, akin to split skin grafts. In our opinion, most critical to graft survival is its size and the ratio of the marginal raw area to the graft bulk. We recommend that graft width should not exceed 1 cm to ensure complete survival even though larger sized grafts have been reported to survive. We recommend cooling of the graft and justify it on the analogy of 'warm ischemia time' for a replantation, especially in warmer climes like ours in India. We have outlined several considerations in the technique, with an analysis of differing opinions that should facilitate a surgeon in making an

  20. Ribbed bedforms on palaeo-ice stream beds resemble regular patterns of basal shear stress ('traction ribs') inferred from modern ice streams (United States)

    Stokes, Chris R.; Margold, Martin; Creyts, Timothy


    Rapidly-flowing ice streams are an important mechanism through which ice sheets lose mass, and much work has focussed on elucidating the processes that increase or decrease their velocity. Recent work using standard inverse methods has inferred previously-unrecognised regular patterns of high basal shear stress ('sticky spots' >200 kPa) beneath a number of ice streams in Antarctica and Greenland, termed 'traction ribs'. They appear at a scale intermediate between smaller ribbed moraines and much larger mega-ribs observed on palaeo-ice sheet beds, but it is unclear whether they have a topographic expression at the bed. Here, we report observations of rib-like bedforms from Digital Elevation Models (DEMs) along palaeo-ice stream beds in western Canada that resemble both the pattern and dimensions of traction ribs. Their identification suggests that traction ribs may have a topographic expression that lies between, and partly overlaps with, ribbed moraines and much larger mega-ribs. These intermediate-sized bedforms support the notion of a ribbed bedform continuum. Their formation remains conjectural, but our observations from palaeo-ice streams, coupled with those from modern ice masses, suggest they are consistent with wave-like instabilities occurring in the coupled flow of ice and till and modulated by subglacial meltwater drainage. Their form and pattern may also involve glaciotectonism of subglacial sediments.

  1. Autosomal dominant precocious osteoarthropathy due to a mutation of the cartilage oligomeric matrix protein (COMP) gene: further expansion of the phenotypic variations of COMP defects

    Energy Technology Data Exchange (ETDEWEB)

    Kawaji, Hiroyuki [Department of Orthopaedic Surgery, Sanyudo Hospital, 6-1-219 Chuou, Yonezawa, Yamagata 992-0045 (Japan); Nishimura, Gen [Department of Radiology, Nasu Chuou Hospital, Tochigi (Japan); Watanabe, Sobei; Sasaki, Akira; Sano, Tokuhisa [Department of Orthopaedic Surgery, Tohoku Kohsei-Nenkin Hospital, Miyagi (Japan); Mabuchi, Akihiko; Ikeda, Toshiyuki; Ikegawa, Shiro [Laboratory for Bone and Joint Diseases, SNP Research Center, Tokyo (Japan); Ohashi, Hirofumi [Division of Medical Genetics, Saitama Children' s Medical Center, Saitama (Japan)


    We report on a Japanese family of four generations with an autosomal dominant precocious osteoarthropathy. The cardinal clinical manifestations of affected individuals were painful weight-bearing large joints, which started in late childhood or adolescence. The radiological hallmarks included coxa plana, mild epiphyseal dysplasia of the knee, and round talar domes with tibiotalar slant in childhood, which evolved into degenerative joint diseases in adulthood. The disease phenotype was cosegregated with a mutation of the cartilage oligomeric matrix protein (COMP) gene in the family members, who underwent molecular evaluation. COMP mutations have been reported in a mild form of multiple epiphyseal dysplasia (MED), Ribbing type, as well as allied disorders with more severe manifestations, such as MED Fairbank type and pseudoachondroplasia. Unlike previously reported cases with the Ribbing type, the present patients did not have short stature or brachydactyly. This report expands further the phenotypic variations of COMP defects. (orig.)

  2. Knee cartilage extraction and bone-cartilage interface analysis from 3D MRI data sets (United States)

    Tamez-Pena, Jose G.; Barbu-McInnis, Monica; Totterman, Saara


    This works presents a robust methodology for the analysis of the knee joint cartilage and the knee bone-cartilage interface from fused MRI sets. The proposed approach starts by fusing a set of two 3D MR images the knee. Although the proposed method is not pulse sequence dependent, the first sequence should be programmed to achieve good contrast between bone and cartilage. The recommended second pulse sequence is one that maximizes the contrast between cartilage and surrounding soft tissues. Once both pulse sequences are fused, the proposed bone-cartilage analysis is done in four major steps. First, an unsupervised segmentation algorithm is used to extract the femur, the tibia, and the patella. Second, a knowledge based feature extraction algorithm is used to extract the femoral, tibia and patellar cartilages. Third, a trained user corrects cartilage miss-classifications done by the automated extracted cartilage. Finally, the final segmentation is the revisited using an unsupervised MAP voxel relaxation algorithm. This final segmentation has the property that includes the extracted bone tissue as well as all the cartilage tissue. This is an improvement over previous approaches where only the cartilage was segmented. Furthermore, this approach yields very reproducible segmentation results in a set of scan-rescan experiments. When these segmentations were coupled with a partial volume compensated surface extraction algorithm the volume, area, thickness measurements shows precisions around 2.6%

  3. Hyaline cartilage cells outperform mandibular condylar cartilage cells in a TMJ fibrocartilage tissue engineering application. (United States)

    Wang, L; Lazebnik, M; Detamore, M S


    To compare temporomandibular joint (TMJ) condylar cartilage cells in vitro to hyaline cartilage cells cultured in a three-dimensional (3D) environment for tissue engineering of mandibular condylar cartilage. Mandibular condylar cartilage and hyaline cartilage cells were harvested from pigs and cultured for 6 weeks in polyglycolic acid (PGA) scaffolds. Both types of cells were treated with glucosamine sulfate (0.4 mM), insulin-like growth factor-I (IGF-I) (100 ng/ml) and their combination. At weeks 0 and 6, cell number, glycosaminoglycan (GAG) and collagen content were determined, types I and II collagen were visualized by immunohistochemistry and GAGs were visualized by histology. Hyaline cartilage cells produced from half an order to a full order of magnitude more GAGs and collagen than mandibular condylar cartilage cells in 3D culture. IGF-I was a highly effective signal for biosynthesis with hyaline cartilage cells, while glucosamine sulfate decreased cell proliferation and biosynthesis with both types of cells. In vitro culture of TMJ condylar cartilage cells produced a fibrous tissue with predominantly type I collagen, while hyaline cartilage cells formed a fibrocartilage-like tissue with types I and II collagen. The combination of IGF and glucosamine had a synergistic effect on maintaining the phenotype of TMJ condylar cells to generate both types I and II collagen. Given the superior biosynthetic activity by hyaline cartilage cells and the practical surgical limitations of harvesting cells from the TMJ of a patient requiring TMJ reconstruction, cartilage cells from elsewhere in the body may be a potentially better alternative to cells harvested from the TMJ for TMJ tissue engineering. This finding may also apply to other fibrocartilages such as the intervertebral disc and knee meniscus in applications where a mature cartilage cell source is desired.

  4. Cartilage T2 assessment: differentiation of normal hyaline cartilage and reparative tissue after arthroscopic cartilage repair in equine subjects. (United States)

    White, Lawrence M; Sussman, Marshall S; Hurtig, Mark; Probyn, Linda; Tomlinson, George; Kandel, Rita


    To prospectively assess T2 mapping characteristics of normal articular cartilage and of cartilage at sites of arthroscopic repair, including comparison with histologic results and collagen organization assessed at polarized light microscopy (PLM). Study protocol was compliant with the Canadian Council on Animal Care Guidelines and approved by the institutional animal care committee. Arthroscopic osteochondral autograft transplantation (OAT) and microfracture arthroplasty (MFx) were performed in knees of 10 equine subjects (seven female, three male; age range, 3-5 years). A site of arthroscopically normal cartilage was documented in each joint as a control site. Joints were harvested at 12 (n = 5) and 24 (n = 5) weeks postoperatively and were imaged at 1.5-T magnetic resonance (MR) with a 10-echo sagittal fast spin-echo acquisition. T2 maps of each site (21 OAT harvest, 10 MFx, 12 OAT plug, and 10 control sites) were calculated with linear least-squares curve fitting. Cartilage T2 maps were qualitatively graded as "organized" (normal transition of low-to-high T2 signal from deep to superficial cartilage zones) or "disorganized." Quantitative mean T2 values were calculated for deep, middle, and superficial cartilage at each location. Results were compared with histologic and PLM assessments by using kappa analysis. T2 maps were qualitatively graded as organized at 20 of 53 sites and as disorganized at 33 sites. Perfect agreement was seen between organized T2 and histologic findings of hyaline cartilage and between disorganized T2 and histologic findings of fibrous reparative tissue (kappa = 1.0). Strong agreement was seen between organized T2 and normal PLM findings and between disorganized T2 and abnormal PLM findings (kappa = .92). Quantitative assessment of the deep, middle, and superficial cartilage, respectively, showed mean T2 values of 53.3, 58.6, and 54.9 msec at reparative fibrous tissue sites and 40.7, 53.6, and 61.6 msec at hyaline cartilage sites. A

  5. First rib metamorphosis: its possible utility for human age-at-death estimation. (United States)

    Kunos, C A; Simpson, S W; Russell, K F; Hershkovitz, I


    Human first ribs demonstrate predictable, sequential changes in shape, size, and texture with increasing age, and thus, can be used as an indicator of age at death. Metamorphosis of the first rib's head, tubercle, and costal face was documented in a cross-sectional sample of preadult and adult first ribs of known age at death from the Hamann-Todd skeletal collection (Cleveland Museum of Natural History, Cleveland, Ohio). Blind tests of the usefulness of the first rib as an age indicator were conducted, including tabulation of intraobserver and interobserver inaccuracies and biases. First rib age estimates show inaccuracies and biases by decade comparable to those generated by other aging techniques. Indeed, the first rib method is useful as an isolated age indicator. When used in conjunction with other age indicators, the first rib improves the quality of summary age assessments.

  6. Heat Transfer Augmentation in Developing Flow Through a Ribbed Square Duct

    Institute of Scientific and Technical Information of China (English)

    Khan R K; Ali M.A.T; Akhanda M.A.R


    An experimental study is conducted to investigate the heat transfer augmentation in developing turbulent flow through a ribbed square duct. The duct is made of 16mm thick bakelite sheet. The bottom surface of the ribbed wall having rib pitch to height ratio of 10 is heated by passing a c current to the heater placed under it. The uniform heating is controlled using a digital temperature controller and a variac. The results of ribbed duct are compared with the results of a smooth duct under the same experimental conditions. It is observed that the heat transfer augmentation in ribbed duct is better than that of the smooth duct. At Re=5.0 × 104 , the mean temperature of air flowing through the ribbed duct increases by 2.45 percent over the smooth duct, whereas in the ribbed duct Nusselt number increases by 15.14 percent than that of the smooth duct with a 6 percent increase in pressure drop.

  7. A cartilage-inspired lubrication system. (United States)

    Greene, George W; Olszewska, Anna; Osterberg, Monika; Zhu, Haijin; Horn, Roger


    Articular cartilage is an example of a highly efficacious water-based, natural lubrication system that is optimized to provide low friction and wear protection at both low and high loads and sliding velocities. One of the secrets of cartilage's superior tribology comes from a unique, multimodal lubrication strategy consisting of both a fluid pressurization mediated lubrication mechanism and a boundary lubrication mechanism supported by surface bound macromolecules. Using a reconstituted network of highly interconnected cellulose fibers and simple modification through the immobilization of polyelectrolytes, we have recreated many of the mechanical and chemical properties of cartilage and the cartilage lubrication system to produce a purely synthetic material system that exhibits some of the same lubrication mechanisms, time dependent friction response, and high wear resistance as natural cartilage tissue. Friction and wear studies demonstrate how the properties of the cellulose fiber network can be used to control and optimize the lubrication and wear resistance of the material surfaces and highlight what key features of cartilage should be duplicated in order to produce a cartilage-mimetic lubrication system.

  8. Regulatory Challenges for Cartilage Repair Technologies. (United States)

    McGowan, Kevin B; Stiegman, Glenn


    In the United States, few Food and Drug Administration (FDA)-approved options exist for the treatment of focal cartilage and osteochondral lesions. Developers of products for cartilage repair face many challenges to obtain marketing approval from the FDA. The objective of this review is to discuss the necessary steps for FDA application and approval for a new cartilage repair product. FDA Guidance Documents, FDA Panel Meetings, scientific organization recommendations, and were reviewed to demonstrate the current thinking of FDA and the scientific community on the regulatory process for cartilage repair therapies. Cartilage repair therapies can receive market approval from FDA as medical devices, drugs, or biologics, and the specific classification of product can affect the nonclinical, clinical, and regulatory strategy to bring the product to market. Recent FDA guidance gives an outline of the required elements to bring a cartilage repair product to market, although these standards are often very general. As a result, companies have to carefully craft their study patient population, comparator group, and clinical endpoint to best showcase their product's attributes. In addition, regulatory strategy and manufacturing process validation need to be considered early in the clinical study process to allow for timely product approval following the completion of clinical study. Although the path to regulatory approval for a cartilage repair therapy is challenging and time-consuming, proper clinical trial planning and attention to the details can eventually save companies time and money by bringing a product to the market in the most expeditious process possible.

  9. NMR Studies of Cartilage Dynamics, Diffusion, Degradation (United States)

    Huster, Daniel; Schiller, Jurgen; Naji, Lama; Kaufmann Jorn; Arnold, Klaus

    An increasing number of people is suffering from rheumatic diseases, and, therefore, methods of early diagnosis of joint degeneration are urgently required. For their establishment, however, an improved knowledge about the molecular organisation of cartilage would be helpful. Cartilage consists of three main components: Water, collagen and chondroitin sulfate (CS) that is (together with further polysaccharides and proteins) a major constituent of the proteoglycans of cartilage. 1H and 13C MAS (magic-angle spinning) NMR (nuclear magnetic resonance) opened new perspectives for the study of the macromolecular components in cartilage. We have primarily studied the mobilities of CS and collagen in bovine nasal and pig articular cartilage (that differ significantly in their collagen/polysaccharide content) by measuring 13C NMR relaxation times as well as the corresponding 13C CP (cross polarisation) MAS NMR spectra. These data clearly indicate that the mobility of cartilage macromolecules is broadly distributed from almost completely rigid (collagen) to highly mobile (polysaccharides), which lends cartilage its mechanical strength and shock-absorbing properties.

  10. Clinical and Radiologic Predictive Factors of Rib Fractures in Outpatients With Chest Pain. (United States)

    Zhang, Liang; McMahon, Colm J; Shah, Samir; Wu, Jim S; Eisenberg, Ronald L; Kung, Justin W


    To identify the clinical and radiologic predictive factors of rib fractures in stable adult outpatients presenting with chest pain and to determine the utility of dedicated rib radiographs in this population of patients. Following Institutional Review Board approval, we performed a retrospective review of 339 consecutive cases in which a frontal chest radiograph and dedicated rib series had been obtained for chest pain in the outpatient setting. The frontal chest radiograph and dedicated rib series were sequentially reviewed in consensus by two fellowship-trained musculoskeletal radiologists blinded to the initial report. The consensus interpretation of the dedicated rib series was used as the gold standard. Multiple variable logistic regression analysis assessed clinical and radiological factors associated with rib fractures. Fisher exact test was used to assess differences in medical treatment between the 2 groups. Of the 339 patients, 53 (15.6%) had at least 1 rib fracture. Only 20 of the 53 (37.7%) patients' fractures could be identified on the frontal chest radiograph. The frontal chest radiograph had a sensitivity of 38% and specificity of 100% when using the rib series as the reference standard. No pneumothorax, new mediastinal widening or pulmonary contusion was identified. Multiple variable logistic regression analysis of clinical factors associated with the presence of rib fractures revealed a significant association of trauma history (odds ratio 5.7 [p rib fractures in this population demonstrated a significant association of pleural effusion with rib fractures (odds ratio 18.9 [p rib fractures received narcotic analgesia in 47.2% of the cases, significantly more than those without rib fractures (21.3%, p rib fractures have a higher association with a history of minor trauma and age ≥40 in the adult population. Radiographic findings associated with rib fractures include pleural effusion. The frontal chest radiograph alone has low sensitivity in

  11. Does intraarticular inflammation predict biomechanical cartilage properties? (United States)

    Waldstein, Wenzel; Perino, Giorgio; Jawetz, Shari T; Gilbert, Susannah L; Boettner, Friedrich


    Intact cartilage in the lateral compartment is an important requirement for medial unicompartmental knee arthroplasty (UKA). Progression of cartilage degeneration in the lateral compartment is a common failure mode of medial UKA. Little is known about factors that influence the mechanical properties of lateral compartment cartilage. The purposes of this study were to answer the following questions: (1) Does the synovial fluid white blood cell count predict the biomechanical properties of macroscopically intact cartilage of the distal lateral femur? (2) Is there a correlation between MRI grading of synovitis and the biomechanical properties of macroscopically intact cartilage? (3) Is there a correlation between the histopathologic assessment of the synovium and the biomechanical properties of macroscopically intact cartilage? The study included 84 patients (100 knees) undergoing primary TKA for varus osteoarthritis between May 2010 and January 2012. All patients underwent preoperative MRI to assess the degree of synovitis. During surgery, the cartilage of the distal lateral femur was assessed macroscopically using the Outerbridge grading scale. In knees with an Outerbridge grade of 0 or 1, osteochondral plugs were harvested from the distal lateral femur for biomechanical and histologic assessment. The synovial fluid was collected to determine the white blood cell count. Synovial tissue was taken for histologic evaluation of the degree of synovitis. The mean aggregate modulus and the mean dynamic modulus were significantly greater in knees with 150 or less white blood cells/mL synovial fluid compared with knees with greater than 150 white blood cells/mL synovial fluid. There was no correlation among MRI synovitis grades, histopathologic synovitis grades, and biomechanical cartilage properties. The study suggests that lateral compartment cartilage in patients with elevated synovial fluid white blood cell counts has a reduced ability to withstand compressive loads

  12. Morbidity, mortality, associated injuries, and management of traumatic rib fractures. (United States)

    Lin, Frank Cheau-Feng; Li, Ruei-Yun; Tung, Yung-Wei; Jeng, Kee-Ching; Tsai, Stella Chin-Shaw


    Thoracic trauma is responsible for approximately 25% of trauma deaths, and rib fractures are present in as many as 40-80% of patients, and intensive care and/or ventilator support are frequently required for these patients. To identify their risk factors would improve treatment strategies for these patients. Between March 2005 and December 2013, consecutive patients with blunt thoracic trauma, who were admitted to the Department of Thoracic Surgery at Tungs' Taichung Metro Harbor Hospital (Taichung, Taiwan), were reviewed in this retrospective cohort study with the approval of the Institutional Review Board. The duration of hospital stay, ventilator support, injury severity score (ISS), type of injury, associated injuries, treatments, and mortality were analyzed statistically. A total of 1621 thoracic trauma patients were included in this study, with a male majority and an age range of 18-95 years (mean age, 51.2 years). Approximately 11.7% of these patients had an ISS ≥ 16 and a mortality rate of 6.9%. Among them, 78.5% had rib fractures; 31.8%, traumatic hemothorax; 15.6%, pneumothorax; 9.6%, hemopneumothorax; and 4.6%, lung contusion. The most common associated injury was extremity fracture, followed by head injury and clavicle fracture. Surgery on the extremities (20.6% of patients) and chest tube placement (22.7% of patients) were the most common treatments. The number of rib fractures was associated with prolonged hospital and intensive care unit (ICU) stays (≥7 days), an ISS ≥ 16, and pulmonary complications of hemothorax, pneumothorax, and hemopneumothorax, but not with mechanical ventilator use. Furthermore, old age was significantly associated with rib fractures in patients with thoracic trauma. The severity of traumatic rib fractures was identified in this study. Therefore, a trauma team needs better preparation to provide effective treatment strategies when encountering thoracic trauma patients, especially patients who are older and have rib

  13. Small female rib cage fracture in frontal sled tests. (United States)

    Shaw, Greg; Lessley, David; Ash, Joseph; Poplin, Jerry; McMurry, Tim; Sochor, Mark; Crandall, Jeff


    The 2 objectives of this study are to (1) examine the rib and sternal fractures sustained by small stature elderly females in simulated frontal crashes and (2) determine how the findings are characterized by prior knowledge and field data. A test series was conducted to evaluate the response of 5 elderly (average age 76 years) female postmortem human subjects (PMHS), similar in mass and size to a 5th percentile female, in 30 km/h frontal sled tests. The subjects were restrained on a rigid planar seat by bilateral rigid knee bolsters, pelvic blocks, and a custom force-limited 3-point shoulder and lap belt. Posttest subject injury assessment included identifying rib cage fractures by means of a radiologist read of a posttest computed tomography (CT) and an autopsy. The data from a motion capture camera system were processed to provide chest deflection, defined as the movement of the sternum relative to the spine at the level of T8.  A complementary field data investigation involved querying the NASS-CDS database over the years 1997-2012. The targeted cases involved belted front seat small female passenger vehicle occupants over 40 years old who were injured in 25 to 35 km/h delta-V frontal crashes (11 to 1 o'clock). Peak upper shoulder belt tension averaged 1,970 N (SD = 140 N) in the sled tests. For all subjects, the peak x-axis deflection was recorded at the sternum with an average of -44.5 mm or 25% of chest depth. The thoracic injury severity based on the number and distribution of rib fractures yielded 4 subjects coded as Abbreviated Injury Scale (AIS) 3 (serious) and one as AIS 5 (critical). The NASS-CDS field data investigation of small females identified 205 occupants who met the search criteria. Rib fractures were reported for 2.7% of the female occupants. The small elderly test subjects sustained a higher number of rib cage fractures than expected in what was intended to be a minimally injurious frontal crash test condition. Neither field studies nor

  14. 13 ribs as a predictor of long gap esophageal atresia: myth or reality? Analysis of associated findings of esophageal atresia and abnormal rib count. (United States)

    Durell, Jonathan; Dagash, Haitham; Eradi, Bala; Rajimwale, Ashok; Nour, Shawqui; Patwardhan, Nitin


    The presence of 13 pairs of ribs on pre-operative chest x-ray has been postulated to be an indicator for long gap esophageal atresia (EA). This study sought to determine the validity of this theory and identify associated pathological conditions in patients with EA and abnormal rib count. Babies with EA from January 2005 - December 2012 were retrospectively analyzed. Information was gathered from neonatal health records and operation notes. Chest x-rays were reviewed to determine rib count. Long gap EA was defined as failure to achieve primary esophageal anastomosis. Statistical analysis performed with Fisher's exact test. Seventy-six patients were identified. Eight patients had long gap EA, with none of these patients having 13 pairs of ribs. Paradoxically, 10 patients with esophageal atresia +/- trachea-esophageal atresia (EA +/- TEF) and supernumerary ribs underwent primary repair. Nine patients had 11 pairs of ribs, of which 2 had pure EA and a long gap. Using Fisher's exact test to compare the groups of supernumary ribs and non-supernumary ribs there is a p value of 0.587. VACTERL association was identified in 40% of those with supernumerary ribs. Various associated syndromes and concomitant abnormalities were identified. We found no association between 13 pairs of ribs and long gap in esophageal atresia. Those with 13 pairs of ribs were more likely to have associated anomalies, although this was not statistically significant. Our cohort of patients was found to have a range of pathology related to genetic syndromes, further atresias, and malformations, which is well known to be associated with children born with EA +/- TEF. Prognosis study - level IV. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Reappraisal of mesenchymal chondrosarcoma: novel morphologic observations of the hyaline cartilage and endochondral ossification and beta-catenin, Sox9, and osteocalcin immunostaining of 22 cases. (United States)

    Fanburg-Smith, Julie C; Auerbach, Aaron; Marwaha, Jayson S; Wang, Zengfeng; Rushing, Elisabeth J


    Mesenchymal chondrosarcoma, a rare malignant round cell and hyaline cartilage tumor, is most commonly intraosseous but can occur in extraskeletal sites. We intensively observed the morphology and applied Sox9 (master regulator of chondrogenesis), beta-catenin (involved in bone formation, thought to inhibit chondrogenesis in a Sox9-dependent manner), and osteocalcin (a marker for osteoblastic phenotype) to 22 central nervous system and musculoskeletal mesenchymal chondrosarcoma. Cases of mesenchymal chondrosarcoma were retrieved and reviewed from our files. Immunohistochemistry and follow-up were obtained on mesenchymal chondrosarcoma and tumor controls. Twenty-two mesenchymal chondrosarcomas included 5 central nervous system (all female; mean age, 30.2; mean size, 7.8 cm; in frontal lobe [n = 4] and spinal cord [n = 1]) and 17 musculoskeletal (female-male ratio, 11:6; mean age, 31.1; mean size, 6.2 cm; 3 each of humerus and vertebrae; 2 each of pelvis, rib, tibia, neck soft tissue; one each of femur, unspecified bone, and elbow soft tissue). The hyaline cartilage in most tumors revealed a consistent linear progression of chondrocyte morphology, from resting to proliferating to hypertrophic chondrocytes. Sixty-seven percent of cases demonstrated cell death and acquired osteoblastic phenotype, cells positive for osteocalcin at the site of endochondral ossification. Small round cells of mesenchymal chondrosarcoma were negative for osteocalcin. SOX9 was positive in both components of 21 of 22 cases of mesenchymal chondrosarcoma. beta-Catenin highlighted rare nuclei at the interface between round cells and hyaline cartilage in 35% cases. Control skull and central nervous system cases were compared, including chondrosarcomas and small cell osteosarcoma, the latter positive for osteocalcin in small cells. Mesenchymal chondrosarcoma demonstrates centrally located hyaline cartilage with a linear progression of chondrocytes from resting to proliferative to hypertrophic

  16. First and second order stereology of hyaline cartilage: Application on mice femoral cartilage. (United States)

    Noorafshan, Ali; Niazi, Behnam; Mohamadpour, Masoomeh; Hoseini, Leila; Hoseini, Najmeh; Owji, Ali Akbar; Rafati, Ali; Sadeghi, Yasaman; Karbalay-Doust, Saied


    Stereological techniques could be considered in research on cartilage to obtain quantitative data. The present study aimed to explain application of the first- and second-order stereological methods on articular cartilage of mice and the methods applied on the mice exposed to cadmium (Cd). The distal femoral articular cartilage of BALB/c mice (control and Cd-treated) was removed. Then, volume and surface area of the cartilage and number of chondrocytes were estimated using Cavalieri and optical dissector techniques on isotropic uniform random sections. Pair-correlation function [g(r)] and cross-correlation function were calculated to express the spatial arrangement of chondrocytes-chondrocytes and chondrocytes-matrix (chondrocyte clustering/dispersing), respectively. The mean±standard deviation of the cartilage volume, surface area, and thickness were 1.4±0.1mm(3), 26.2±5.4mm(2), and 52.8±6.7μm, respectively. Besides, the mean number of chondrocytes was 680±200 (×10(3)). The cartilage volume, cartilage surface area, and number of chondrocytes were respectively reduced by 25%, 27%, and 27% in the Cd-treated mice in comparison to the control animals (pcartilage components carried potential advantages for investigating the cartilage in different joint conditions. Chondrocyte clustering/dispersing and cellularity can be evaluated in cartilage assessment in normal or abnormal situations. Copyright © 2016 Elsevier GmbH. All rights reserved.

  17. Nonepiphyseal Giant Cell Tumor of the Rib: A Case Report

    Directory of Open Access Journals (Sweden)

    Hippocrates Moschouris


    Full Text Available A case of a 32-year-old female patient with a giant cell tumor originating in the middle part of the left 10th rib is presented. On X-rays and CT, the tumor caused a well-defined osteolysis with nonsclerotic borders. On MRI, it exhibited intermediate signal intensity on T1 sequences and central high signal and peripheral intermediate signal on T2 sequences. On contrast-enhanced MR images both central and peripheral-periosteal enhancement was noted. Thanks to its small size ( cm, the lesion was easily resected en bloc with a part of the affected rib. The patient is free of recurrence for 3 years after the operation.

  18. Tip Graft and Columellar Strut Using Dorsal Osseocartilaginous Hump

    Directory of Open Access Journals (Sweden)

    Mehdi Bakhshaee


    Full Text Available Background: Although, different grafts are used for nasal tipplasty in cases with under projected or ill defined tip, the selectionof a graft material, which provides sufficient amount oftissue with least donor site morbidity and low recipient sitecomplication is challenging. The objectives of the presentstudy were to examine the usefulness of cartilaginous dorsumas a proper material for tip graft, and to introduce the cartilaginousdorsum as an acceptable material for columellar strut.Methods: Fifty six (18 males and 38 females patients wereoperated for augmentation tip plasty and hump reduction from2004 to 2008. The tailored cartilaginous or ostecartilaginousdorsum was used as a tip graft or columellar strut in 35 and 21cases, respectively. The cartilaginous framework was exposedusing open or close rhinoplasty approach in 41 and 15 cases,respectively. The patients were followed for 12- 36 months.Cosmetic outcomes and patients' satisfaction were obtainedusing qualitative measures.Results: The percentage of patients with very improved, improved,unchanged or unacceptable aesthetic outcome were39.29%, 50%, 3.57% and 7.14%, respectively. Moreover, thepercentages of very satisfied, satisfied, indifferent and unsatisfiedpatients were 66%, 18%, 9%, and 7%, respectively.Conclusion: The procedure provides a well-defined nasal tipwith no evidence of bifidity, angularity, or cartilage graft visibilityand displacement. The use of dorsal osteocartilaginousgraft offers outstanding advantages including ease of harvest,mould, fix, and low resorption.

  19. Effectiveness of surgical rib fixation on prolonged mechanical ventilation in patients with traumatic rib fractures: A propensity score-matched analysis. (United States)

    Wada, Tomoki; Yasunaga, Hideo; Inokuchi, Ryota; Matsui, Hiroki; Matsubara, Takehiro; Ueda, Yoshihiro; Gunshin, Masataka; Ishii, Takeshi; Doi, Kent; Kitsuta, Yoichi; Nakajima, Susumu; Fushimi, Kiyohide; Yahagi, Naoki


    We investigated whether surgical rib fixation improved outcomes in patients with traumatic rib fractures. This was a retrospective study using a Japanese administrative claim and discharge database. We included patients with traumatic rib fractures admitted to hospitals where surgical rib fixation was available from July 1 2010, to March 31, 2013. We detected patients who underwent surgical rib fixation within 10 days of hospital admission (surgical group) and those who did not (control group). The main outcome was prolonged mechanical ventilation, defined as that performed for 5 or more days, or death within 28 days. One-to-four propensity score matching was performed between the 2 groups with adjustment for possible confounders. Among 4577 eligible patients, 90 (2.0%) underwent the surgical rib fixation. After the matching, we obtained 84 and 336 patients in the surgical and control groups, respectively. Logistic regression analyses showed that the surgical group was significantly less likely to receive prolonged mechanical ventilation or die within 28 days than the control group (22.6% vs 33.3%; odds ratio, 0.59; 95% confidence interval, 0.36-0.96; P=.034). Surgical rib fixation within 10 days of hospital admission may improve outcomes in patients with traumatic rib fractures. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Case report: clinical and postmortem findings in four cows with rib fracture. (United States)

    Braun, Ueli; Warislohner, Sonja; Hetzel, Udo; Nuss, Karl


    Published reports of rib fractures in adult cattle are limited to the occurrence of chronic rib swellings caused by calluses, which are unremarkable from a clinical standpoint, whereas studies identifying clinical signs of rib fractures were not found in a literature search. This report describes the clinical and postmortem findings in four cows with rib fractures. The 13th rib was fractured in three cows and the 11th rib in the remaining cow; three fractures were on the right and one on the left side. Clinical and postmortem findings varied considerably, and percussion of the rib cage elicited a pain response in only one cow. One cow had generalised peritonitis because of perforation of the rumen by the fractured rib. One cow was recumbent because of pain and became a downer cow, and two other cows had bronchopneumonia, which was a sequel to osteomyelitis of the fracture site in one. In the absence of a history of trauma, the diagnosis of rib fracture based on clinical signs alone is difficult. Although rib fractures undoubtedly are very painful, the four cases described in this report suggest that they are difficult to diagnose in cattle because associated clinical signs are nonspecific.

  1. Heat transfer and friction factors in the ribbed square convergent and divergent channels (United States)

    Lee, M. S.; Ahn, S. W.


    Heat transfer and friction factors are reported for the measurements of turbulent flows in the convergent and divergent square channels with one-sided ribbed wall as well as two opposite in-line ribbed walls. The study covers three different hydraulic diameter ratios between inlet and exit at the test section such as Dho/Dhi = 0.75, 1.0, and 1.33 and Reynolds numbers in the range of 25,000-79,000. The channels, composing of ten isolated copper sections in the length of test section of 1 m, have the hydraulic diameter of 87.5 mm for the straight channel (Dho/Dhi = 1.0); the rib height-to-hydraulic diameter is 0.114; the rib pitch-to-height ratio equals 10. On the contrary to public opinion that the friction factor depends on the portion of the ribbed area, the total friction factor in the two opposite ribbed walls are lower than in the one-sided ribbed wall in the divergent channel of Dho/Dhi = 1.33 because the total pressure, summing positive dynamic and negative static pressures, is acted. The results show that the two opposite ribbed divergent channel of Dho/Dhi = 1.33 provides the best heat transfer enhancement and the two opposite ribbed convergent channel of Dho/Dhi = 0.75 provides the worst friction factor enhancement, and the ribbed divergent channels are generally recommended.

  2. A history of the understanding of cartilage. (United States)

    Benedek, T G


    To review the historic development of the understanding of articular cartilage from the earliest comment in the fourth century BCE until about 2000. The history up to 1900 is told chronologically, divided into (1) recognition of the tissue, (2) structure, and (3) chemistry. The twentieth century is sketched with a timeline of discoveries that at the time were important and a bibliography of journal review articles. By 1900 the avascular, aneural state and fibrillar composition have been accepted. The nutrition of articular cartilage remained in dispute. The composition of the binding substance and its relation to collagen remained unknown. Research in the first half of the twentieth century continued to be impeded by lack of technology. The advent of electron microscopy, isotopic tracer technics and enzymology rapidly accelerated the understanding of hyaline cartilage beginning in the 1950s. The history of research on hyaline cartilage illustrates the dependence of scientific progress on technologic innovation.

  3. The minor collagens in articular cartilage

    DEFF Research Database (Denmark)

    Luo, Yunyun


    Articular cartilage is a connective tissue consisting of a specialized extracellular matrix (ECM) that dominates the bulk of its wet and dry weight. Type II collagen and aggrecan are the main ECM proteins in cartilage. However, little attention has been paid to less abundant molecular components......, especially minor collagens, including type IV, VI, IX, X, XI, XII, XIII, and XIV, etc. Although accounting for only a small fraction of the mature matrix, these minor collagens not only play essential structural roles in the mechanical properties, organization, and shape of articular cartilage, but also...... fulfil specific biological functions. Genetic studies of these minor collagens have revealed that they are associated with multiple connective tissue diseases, especially degenerative joint disease. The progressive destruction of cartilage involves the degradation of matrix constituents including...

  4. Meniscal allograft transplantation. Part 1: systematic review of graft biology, graft shrinkage, graft extrusion, graft sizing, and graft fixation. (United States)

    Samitier, Gonzalo; Alentorn-Geli, Eduard; Taylor, Dean C; Rill, Brian; Lock, Terrence; Moutzouros, Vasilius; Kolowich, Patricia


    To provide a systematic review of the literature regarding five topics in meniscal allograft transplantation: graft biology, shrinkage, extrusion, sizing, and fixation. A systematic literature search was conducted using the PubMed (MEDLINE), ScienceDirect, and EBSCO-CINAHL databases. Articles were classified only in one topic, but information contained could be reported into other topics. Information was classified according to type of study (animal, in vitro human, and in vivo human) and level of evidence (for in vivo human studies). Sixty-two studies were finally included: 30 biology, 3 graft shrinkage, 11 graft extrusion, 17 graft size, and 6 graft fixation (some studies were categorized in more than one topic). These studies corresponded to 22 animal studies, 22 in vitro human studies, and 23 in vivo human studies (7 level II, 10 level III, and 6 level IV). The principal conclusions were as follows: (a) Donor cells decrease after MAT and grafts are repopulated with host cells form synovium; (b) graft preservation alters collagen network (deep freezing) and causes cell apoptosis with loss of viable cells (cryopreservation); (c) graft shrinkage occurs mainly in lyophilized and gamma-irradiated grafts (less with cryopreservation); (d) graft extrusion is common but has no clinical/functional implications; (e) overall, MRI is not superior to plain radiograph for graft sizing; (f) graft width size matching is more important than length size matching; (g) height appears to be the most important factor influencing meniscal size; (h) bone fixation better restores contact mechanics than suture fixation, but there are no differences for pullout strength or functional results; and (i) suture fixation has more risk of graft extrusion compared to bone fixation. Systematic review of level II-IV studies, Level IV.

  5. Cytokeratin - positive rib osteosarcoma metastasizing to the small intestine

    Directory of Open Access Journals (Sweden)

    Hiroko Kuwabara


    Full Text Available Osteosarcoma (OS is a malignant tumor in which osteoid or bone is produced directly by tumor cells. Some OS cells are positive for cytokeratin (CK and epithelial membrane antigen by immunohistochemistry (IHC and this may lead to a misdiagnosis of metastatic carcinoma, particularly when the tumor location is unusual. On the other hand, gastrointestinal metastasis of OS is rare. We present the case of a 67-year-old Japanese man with a small intestinal intussusception due to metastasis of a CK-positive rib OS. The tumor cells were positive for CK, osteopontin and osteonectin by IHC and a diagnosis of a CK-positive chest wall OS metastasizing to the small intestine was considered. Osteoid or bone formation was histologically absent and therefore chest wall OS had to be differentially diagnosed from metastatic carcinoma of unknown origin. A postmortem histological analysis confirmed a rib OS. Awareness of CK-positive OS is important for making a correct diagnosis and for disease management and an immunohistochemical analysis of the tumor for expression of osteopontin and osteonectin may be used to support the diagnosis. In addition, this case shows that rib OS can metastasize to the gastrointestinal tract, albeit rarely, which may induce an intestinal intussusception.

  6. Respiratory pattern changes produced by intercostal muscle/rib vibration. (United States)

    Bolser, D C; Lindsey, B G; Shannon, R


    Large-amplitude vibration of the intercostal muscles/ribs has an inhibitory effect on inspiratory motor output. This effect has been attributed, in part, to the stimulation of intercostal muscle tendon organs. Intercostal muscle/rib vibration can also produce a decrease or increase in respiratory frequency. Studies were conducted 1) to determine whether, in addition to intercostal tendon organs, costovertebral joint mechanoreceptors (CVJR's) contribute to the inspiratory inhibitory effect of intercostal muscle/rib vibration (IMV) and 2) to explain the different respiratory frequency responses to IMV previously reported. Phrenic (C5) activity was monitored in paralyzed thoracotomized, artificially ventilated cats. Vibration (125 Hz) at amplitudes greater than 1,200 micron of one T6 intercostal space in decerebrated vagotomized rats reduced phrenic activity. This response was still present but weaker in some animals after denervation of the T6 intercostal muscles. Subsequent denervation of the T6 CVJR's by dorsal root sections eliminated this effect. Respiratory frequency decreased during simultaneous vibration (greater than 1,200 micron) of the T5 and T7 intercostal spaces in vagotomized cats. Respiratory frequency increased during IMV of two intercostal spaces (greater than 1,300 micron) in vagal intact cats. The use of different anesthetics (pentobarbital, allobarbital) did not alter these results. We conclude that CVJR's may contribute to the inhibitory effect of IMV on medullary inspiratory activity. The presence or absence of pulmonary vagal afferents can account for the different respiratory frequency responses to IMV, and different anesthetics did not influence these results.

  7. The effect of spacer ribs on Ledinegg type flow instabilities

    Energy Technology Data Exchange (ETDEWEB)

    Coutts, D.A.


    An experimental program has been completed which evaluated the effect of a flow obstruction in a heated channel on the onset of flow instability (OBI). The test channel was rectangular (80 {times} 3 mm), heated on one surface, and equipped with view ports. Tests were conducted in a flow controlled mode at heat fluxes of 370 kW/M{sup 2}, and 610 kW/m{sup 2}. Direct comparisons were made between the demand curve minimum for the unobstructed channel and a channel equipped with a 2.07 mm wide rib that was parallel to the flow and in contact with the heated surface. Data at OFI is presented in the nondimensional terms Of Q{sub ratio} (ratio of heat flux applied to heat flux required to achieve saturated liquid conditions at the exit), and the local Stanton number at the channel exit for each channel arrangement. The Q{sub ratio} and Stanton number values for the unobstructed channel and the rib equipped channel are then compared to produce an estimate of the rib effect.

  8. DiGeorge syndrome with vertebral and rib dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Puno-Cocuzza, C.; David, K.; Kogekar, N. [Brooklyn Hospital Center, NY (United States)


    DiGeorge syndrome results from defect in the development of the third and fourth pharyngeal pouches, and is characterized by conotruncal heart defects, aplasia or hypoplasia of thymus and parathyroid glands resulting in immune deficiency and hypocalcemia. Other associated abnormalities include renal, thyroid and diaphragmatic defects, oral clefting, etc. Etiologically, it is heterogeneous, with a microdeletion of 22q11 present in over 80% of cases. Our patient was born following a pregnancy complicated by insulin dependent gestational diabetes. There was truncus arteriosus type 2, absense of thymic shadow on CXR with severe deficiency of T cell function, and persistent hypocalcemia with low parathormone. Right kidney was absent. Dysplastic ribs including fused and bifid ribs were noted. Hypoplastic vertebrae and hemivertebrae were present through thoracic and lumbar regions. Chromosome analysis was normal, and metaphase FISH analysis with probe N25 representing locus D22S75 did not show any deletion of 22q11.2. The skeletal findings similar to these have not been previously reported in association with DiGeorge syndrome to our knowledge. Vertebral and rib abnormalities are known to occur with pregestational maternal diabetes. Maternal diabetes has also been suggested to be a possible etiology in a very small proportion of DiGeorge syndrome cases. It is possible that these findings occured together on account of gestational maternal diabetes in our case.

  9. LDA - Measurements of Transitional Flows Induced by a Square Rib

    Energy Technology Data Exchange (ETDEWEB)

    Becker, S.; Durst, F.; Stoots, Carl Marcel; Condie, Keith Glenn; McEligot, Donald Marinus


    New fundamental measurements are presented for the transition process in flat plate boundary layers downstream of two-dimensional square ribs. By use of laser Doppler anemometry (LDA) and a large Matched-Index-of-Refraction (MIR) flow system, data for wall-normal fluctuations and Reynolds stresses were obtained in the near wall region to y+<0.1 in addition to the usual mean streamwise velocity component and its fluctuation. By varying velocity and rib height, the experiment investigated the following range of conditions: k+ = 5.5 to 21, 0.3rib. For "large" elements, evolution of turbulent statistics of the viscous layer for a turbulent boundary layer (y+<~30) was rapid even in flows where the mean velocity profile still showed laminar behavior.

  10. Materials science: Like cartilage, but simpler

    DEFF Research Database (Denmark)

    Skov, Anne Ladegaard


    The properties of articular cartilage, which lines bones in joints, depend partlyon repulsion between components of the material. A new synthetic gel that mimics this feature has rare, direction-dependent properties.......The properties of articular cartilage, which lines bones in joints, depend partlyon repulsion between components of the material. A new synthetic gel that mimics this feature has rare, direction-dependent properties....

  11. The structure and function of cartilage proteoglycans

    Directory of Open Access Journals (Sweden)

    P J Roughley


    Full Text Available Cartilage contains a variety of proteoglycans that are essential for its normal function. These include aggrecan, decorin, biglycan, fibromodulin and lumican. Each proteoglycan serves several functions that are determined by both its core protein and its glycosaminoglycan chains. This review discusses the structure/function relationships of the cartilage proteoglycans, and the manner in which perturbations in proteoglycan structure or abundance can adversely affect tissue function.

  12. Cartilage proteoglycans inhibit fibronectin-mediated adhesion (United States)

    Rich, A. M.; Pearlstein, E.; Weissmann, G.; Hoffstein, S. T.


    Normal tissues and organs show, on histological examination, a pattern of cellular and acellular zones that is characteristic and unique for each organ or tissue. This pattern is maintained in health but is sometimes destroyed by disease. For example, in mobile joints, the articular surfaces consist of relatively acellular hyaline cartilage, and the joint space is enclosed by a capsule of loose connective tissue with a lining of fibroblasts and macrophages. In the normal joint these cells are confined to the synovial lining and the articular surface remains acellular. In in vitro culture, macrophages and their precursor monocytes are very adhesive, and fibroblasts can migrate and overgrow surfaces such as collagen or plastic used for tissue culture. The fibroblasts adhere to collagen by means of fibronectin, which they synthesize and secrete1. Because the collagen of cartilage is capable of binding serum fibronectin2 and fibronectin is present in cartilage during its development3, these cells should, in theory, slowly migrate from the synovial lining to the articular surface. It is their absence from the articular cartilage in normal circumstances, and then presence in such pathological states as rheumatoid arthritis, that is striking. We therefore set out to determine whether a component of cartilage could prevent fibroblast adherence in a defined adhesion assay. As normal cartilage is composed of 50% proteoglycans and 50% collagen by dry weight4, we tested the possibility that the proteoglycans in cartilage inhibit fibroblast adhesion to collagen. We present here evidence that fibroblast spreading and adhesion to collagenous substrates is inhibited by cartilage proteoglycans.

  13. Precision of hyaline cartilage thickness measurements

    Energy Technology Data Exchange (ETDEWEB)

    Jonsson, K.; Buckwalter, K.; Helvie, M.; Niklason, L.; Martel, W. (Univ. of Michigan Hospitals, Ann Arbor, MI (United States). Dept. of Radiology)


    Measurement of cartilage thickness in vivo is an important indicator of the status of a joint as the various degenerative and inflammatory arthritides directly affect the condition of the cartilage. In order to assess the precision of thickness measurements of hyaline articular cartilage, we undertook a pilot study using MR imaging, plain radiography, and ultrasonography (US). We measured the cartilage of the hip and knee joints in 10 persons (4 healthy volunteers and 6 patients). The joints in each patient were examined on two separate occasions using each modality. In the hips a swell as the knee joints, the most precise measuring method was plain film radiography. For radiographs of the knees obtained in the standing position, the coefficient of variation was 6.5%; in the hips this figure was 6.34%. US of the knees and MR imaging of the hips were the second best modalities in the measurement of cartilage thickness. In addition, MR imaging enabled the most complete visualization of the joint cartilage. (orig.).

  14. Mutations in IFT-A satellite core component genes IFT43 and IFT121 produce short rib polydactyly syndrome with distinctive campomelia. (United States)

    Duran, Ivan; Taylor, S Paige; Zhang, Wenjuan; Martin, Jorge; Qureshi, Faisal; Jacques, Suzanne M; Wallerstein, Robert; Lachman, Ralph S; Nickerson, Deborah A; Bamshad, Michael; Cohn, Daniel H; Krakow, Deborah


    Skeletal ciliopathies comprise a spectrum of ciliary malfunction disorders that have a profound effect on the skeleton. Most common among these disorders is short rib polydactyly syndrome (SRPS), a recessively inherited perinatal lethal condition characterized by a long narrow chest, markedly shortened long bones, polydactyly and, often, multi-organ system involvement. SRPS shows extensive locus heterogeneity with mutations in genes encoding proteins that participate in cilia formation and/or function. Herein we describe mutations in IFT43, a satellite member of the retrograde IFT-A complex, that produce a form of SRPS with unusual bending of the ribs and appendicular bones. These newly described IFT43 mutations disrupted cilia formation, produced abnormalities in cartilage growth plate architecture thus contributing to altered endochondral ossification. We further show that the IFT43 SRPS phenotype is similar to SRPS resulting from mutations in the gene encoding IFT121 (WDR35), a direct interactor with IFT43. This study defines a new IFT43-associated phenotype, identifying an additional locus for SRPS. The data demonstrate that IFT43 is essential for ciliogenesis and that the mutations disrupted the orderly proliferation and differentiation of growth plate chondrocytes, resulting in a severe effect on endochondral ossification and mineralization. Phenotypic similarities with SRPS cases resulting from mutations in the gene encoding the IFT43 direct interacting protein IFT121 suggests that similar mechanisms may be disrupted by defects in these two IFT-A satellite interactors.

  15. Scaffold-based Drug Delivery for Cartilage Tissue Regeneration. (United States)

    Shalumon, K T; Chen, Jyh-Ping


    Regenerative engineering is an advanced field comprising the collective benefit of biodegradable polymers with cells and tissue inducing factors. Current method of replacing the defective organ is through transplantation, but is limited due to immune rejection and availability. As a solution, new polymeric biomaterial-based three-dimensional (3D) scaffolds in combination with cells and inducing factors were aroused to fulfil the existing demands. These scaffolds apply material science, biomedical technology and translational medicine to develop functional tissue engineering constructs. Presence of small molecules and growth factors guides the cell phenotypes to specific organ development. The 3D scaffold thus could also be favorably used as carriers for various types of drugs and genes, with the release profile fine-tuned by modulation of the scaffold's morphology, porosity, and composition. An increasing trend was observed in recent years toward the combination of scaffolds and growth factors to fabricate a bioactive system, which not only provide a biomimetic biodegradable physical support for tissue growth but also explores biological signals to modulate tissue regeneration. In this review, along with general aspects of tissue engineering, we also discuss the importance of various scaffold architectures like nanofibers, hydrogels, beads, meshes, microspheres etc. in combination with specific drugs, growth factors and small molecules for cartilage regeneration. Growth factors may be incorporated into scaffolds by direct blending, physical adsorption, drop casting, surface grafting, covalent bonding, chemical immobilization, coaxial electrospinning, microparticle incorporation etc. This offers new possibilities for the development of biomimetic scaffolds that are endowed with a hierarchical architecture and sophisticated release kinetics of the growth factors. This review portrait the fundamentals of tissue engineering with emphasis on the role of inducing factors

  16. Determining the critical size of a rabbit rib segmental bone defect model. (United States)

    Liu, Fengzhen; Chen, Kun; Hou, Lei; Li, Keyi; Wang, Dawei; Zhang, Bin; Wang, Xiumei


    In order to establish and standardize the rabbit rib segmental bone defect model, it is of vital importance to determine rabbit rib critical size defect (CSD). According to the general time needed for spontaneous long-bone regeneration, three-month observation period was set to determine the CSD. The rabbit rib segmental bone defects with different sizes from 1 to 5 cm with or without periosteum were performed in the eighth rib of 4-month-old male New Zealand rabbits and underwent X-ray examinations at the 4th, 8th and 12th weeks postoperatively. The gross and histological examinations at postoperative week 12 were evaluated, which showed that the critical sizes in the rabbit rib models with and without periosteum were 5 and 2 cm, respectively. This study provides prerequisite data for establishing rabbit rib CSD model and evaluating bone materials using this model.

  17. A proposed scheme for classifying pediatric rib head fractures using case examples. (United States)

    Pinto, Deborrah C; Love, Jennifer C; Derrick, Sharon M; Wiersema, Jason M; Donaruma-Kwoh, Marcella; Greeley, Christopher S


    Pediatric rib head fractures are typically described as "posterior" or "costovertebral," terms lacking specificity. To resolve this issue, a scheme was developed to describe the location of rib head fractures observed in a pediatric forensic population. The scheme uses three anatomical landmarks, terminus (tip), tubercle, and costovertebral articular surface to divide the rib head into two subregions, costovertebral and costotransverse. Examples of five cases of infants with rib head fractures are presented using this scheme. Forty-eight rib head fractures were observed in these infants with the following frequencies: 56% (three infants) at the terminus; 21% (three infants) in the costovertebral subregion; 21% (one infant) at the costovertebral articular facet; and 2% (one infant) in the costotransverse subregion. Due to the small number of cases assessed, statistical analyses could not be performed; however, the data demonstrate the variation in distribution of pediatric rib head fractures. © 2014 American Academy of Forensic Sciences.

  18. [Hydatid disease of the first rib treated surgically by the Roos approach]. (United States)

    Marghli, A; Smati, B; Abdelmalek, M; Attia, S; Djilani, H; Kilani, T


    Hydatid disease is a parasitic infection due to Echinococcus granulosus. Since involvement of the ribs and in particular the first rib is rare, diagnosis and treatment in these locations can pose special problems. The purpose of this report is to describe the case of a 27-year-old man in whom an apical left opacity was discovered by chance. Clinical examination was normal. Thoracic ultrasound demonstrated multilocular cyst in the left apical region of the thorax. Thoracic computed tomography (CT) demonstrated a hydatid cyst originating from the first rib. The patient was operated using the technique known as the Roos approach. The procedure consisted of cystectomy with resection of the first rib. The multiloculated appearance of the lesion and erosion at the first rib was consistent with hydatid cyst. The Roos approach is the technique of choice for the treatment of the first rib.

  19. Cartilage repair surgery: outcome evaluation by using noninvasive cartilage biomarkers based on quantitative MRI techniques? (United States)

    Jungmann, Pia M; Baum, Thomas; Bauer, Jan S; Karampinos, Dimitrios C; Erdle, Benjamin; Link, Thomas M; Li, Xiaojuan; Trattnig, Siegfried; Rummeny, Ernst J; Woertler, Klaus; Welsch, Goetz H


    New quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as outcome measures after cartilage repair. To review the current literature on the use of quantitative MRI biomarkers for evaluation of cartilage repair at the knee and ankle. Using PubMed literature research, studies on biochemical, quantitative MR imaging of cartilage repair were identified and reviewed. Quantitative MR biomarkers detect early degeneration of articular cartilage, mainly represented by an increasing water content, collagen disruption, and proteoglycan loss. Recently, feasibility of biochemical MR imaging of cartilage repair tissue and surrounding cartilage was demonstrated. Ultrastructural properties of the tissue after different repair procedures resulted in differences in imaging characteristics. T2 mapping, T1rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), and diffusion weighted imaging (DWI) are applicable on most clinical 1.5 T and 3 T MR scanners. Currently, a standard of reference is difficult to define and knowledge is limited concerning correlation of clinical and MR findings. The lack of histological correlations complicates the identification of the exact tissue composition. A multimodal approach combining several quantitative MRI techniques in addition to morphological and clinical evaluation might be promising. Further investigations are required to demonstrate the potential for outcome evaluation after cartilage repair.

  20. Cartilage Repair Surgery: Outcome Evaluation by Using Noninvasive Cartilage Biomarkers Based on Quantitative MRI Techniques?

    Directory of Open Access Journals (Sweden)

    Pia M. Jungmann


    Full Text Available Background. New quantitative magnetic resonance imaging (MRI techniques are increasingly applied as outcome measures after cartilage repair. Objective. To review the current literature on the use of quantitative MRI biomarkers for evaluation of cartilage repair at the knee and ankle. Methods. Using PubMed literature research, studies on biochemical, quantitative MR imaging of cartilage repair were identified and reviewed. Results. Quantitative MR biomarkers detect early degeneration of articular cartilage, mainly represented by an increasing water content, collagen disruption, and proteoglycan loss. Recently, feasibility of biochemical MR imaging of cartilage repair tissue and surrounding cartilage was demonstrated. Ultrastructural properties of the tissue after different repair procedures resulted in differences in imaging characteristics. T2 mapping, T1rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC, and diffusion weighted imaging (DWI are applicable on most clinical 1.5 T and 3 T MR scanners. Currently, a standard of reference is difficult to define and knowledge is limited concerning correlation of clinical and MR findings. The lack of histological correlations complicates the identification of the exact tissue composition. Conclusions. A multimodal approach combining several quantitative MRI techniques in addition to morphological and clinical evaluation might be promising. Further investigations are required to demonstrate the potential for outcome evaluation after cartilage repair.

  1. Effect of Channel Orientation and Rib Pitch-to-Height Ratio on Pressure Drop in a Rotating Square Channel with Ribs on Two Opposite Surfaces

    Directory of Open Access Journals (Sweden)

    Prabhu S. V.


    Full Text Available The effect of channel orientation and rib pitch-to-height ratio on the pressure drop distribution in a rib-roughened channel is an important issue in turbine blade cooling. The present investigation is a study of the overall pressure drop distribution in a square cross-sectioned channel, with rib turbulators, rotating about an axis normal to the free stream. The ribs are configured in a symmetric arrangement on two opposite surfaces with a rib angle of 90 ∘ to the mainstream flow. The study has been conducted for three Reynolds numbers, namely, 13 000, 17 000, and 22 000 with the rotation number varying from 0– 0.38 . Experiments have been carried out for various rib pitch-to-height ratios ( P/e with a constant rib height-to-hydraulic diameter ratio ( e/D of 0.1 . The test section in which the ribs are placed on the leading and trailing surfaces is considered as the base case ( orientation angle= 0 ∘ , Coriolis force vector normal to the ribbed surfaces. The channel is turned about its axis in steps of 15 ∘ to vary the orientation angle from 0 ∘ to 90 ∘ . The overall pressure drop does not change considerably under conditions of rotation for the base case. However, for the other cases tested, it is observed that the overall pressure drop increases with an increase in the rotation number for a given orientation angle and also increases with an increase in the orientation angle for a given rotation number. This change is attributed to the variation in the separation zone downstream of the ribs due to the presence of the Coriolis force—local pressure drop data is presented which supports this idea. At an orientation angle of 90 ∘ (ribs on the top and bottom surfaces, Coriolis force vector normal to the smooth surfaces, the overall pressure drop is observed to be maximum during rotation. The overall pressure drop for a case with a rib pitch-to-height ratio of 5 on both surfaces is found to be the highest

  2. Association of Ipsilateral Rib Fractures With Displacement of Midshaft Clavicle Fractures. (United States)

    Stahl, Daniel; Ellington, Matthew; Brennan, Kindyle; Brennan, Michael


    To determine whether the presence of ipsilateral rib fractures affects the rate of a clavicle fracture being unstable (>100% displacement). A retrospective review from 2002-2013 performed at a single level 1 trauma center evaluated 243 midshaft clavicle fractures. Single Level 1 trauma center. These fractures were subdivided into those with ipsilateral rib fractures (CIR; n = 149) and those without ipsilateral rib fractures (CnIR; n = 94). The amount of displacement was measured on the initial injury radiograph and subsequent follow-up radiographs. Fractures were classified into either 100% displacement, based on anteroposterior radiographs. Ipsilateral rib fractures were recorded based on which number rib was fractured and the total number of fractured ribs. One hundred sixteen (78%) of the CIR group and 51 (54%) of the CnIR group were found to have >100% displacement at follow-up (P = 0.0047). Seventy-two percent of the CIR group demonstrated progression from 100% displacement of the fracture compared with only 54% of the CnIR group (P 100% was 4.08 (P = 0.000194) when ribs 1-4 were fractured and not significant for rib fractures 5-8 or 9-12. The presence of concomitant ipsilateral rib fractures significantly increases the rate of midshaft clavicle fractures being >100% displaced. In addition, a fracture involving the upper one-third of the ribs significantly increases the rate of the clavicle fracture being >100% displaced on early follow-up. Clavicle fractures with associated ipsilateral rib fractures tend to demonstrate an increased amount of displacement on follow-up radiographs compared with those without ipsilateral rib fractures. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

  3. XROMM analysis of rib kinematics during lung ventilation in the green iguana, Iguana iguana. (United States)

    Brainerd, Elizabeth L; Moritz, Sabine; Ritter, Dale A


    The three-dimensional rotations of ribs during breathing are typically described as bucket-handle rotation about a dorsoventrally oriented axis, pump-handle rotation about a mediolateral axis, and caliper rotation about a rostrocaudal axis. In amniotes with double-headed ribs, rib motion is constrained primarily to one degree-of-freedom (DOF) rotation about an axis connecting the two rib articulations. However, in Squamata, the ribs are single headed and the hemispherical costovertebral joints permit rotations with three DOF. In this study, we used X-ray reconstruction of moving morphology (XROMM ) to quantify rib rotation during deep breathing in four green iguanas. We found that rib rotation was strongly dominated by bucket-handle rotation, thus exhibiting nearly hinge-like motion, despite the potential for more complex motions. The vertebral and sternal segments of each rib did not deform measurably during breathing, but they did move relative to each other at a thin, cartilaginous intracostal joint. While standing still and breathing deeply, four individual iguanas showed variability in their rib postures, with two breathing around a highly inflated posture, and two breathing around a posture with the ribs folded halfway back. Bucket-handle rotations showed clear rostrocaudal gradients, with rotation increasing from the third cervical to the first or second dorsal rib, and then decreasing again caudally, a pattern that is consistent with the intercostal muscles in the rostral intercostal spaces being the primary drivers of inspiration. The constrained, primarily bucket-handle rotations observed here during breathing do not help to explain the evolution of permissive, hemispherical costovertebral joints in squamates from the more constrained, double-headed rib articulations of other amniotes. © 2016. Published by The Company of Biologists Ltd.

  4. A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures

    Directory of Open Access Journals (Sweden)

    Gultekin Gulbahar


    Full Text Available First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity.

  5. Oblique septal crossbar graft for anterior septal angle reconstruction. (United States)

    Aziz, Zeeshan S; Brenner, Michael J; Putman, Harrison C


    Nasal septal deformity is a central feature of the crooked nose, contributing to functional and aesthetic problems. Straightening of the septum often requires resection, scoring, or incision of the septum--maneuvers that inevitably weaken the cartilaginous dorsal and caudal L-shaped struts, which together are known as the L-strut. Compromise of this L-strut predisposes to septal buckling, recurrent deviation, and saddle nose deformity. We describe our experience with the oblique septal crossbar, a structural graft that allows biomechanically sound anterior septal angle reconstruction during septorhinoplasty. The technique improves dorsal septal support and facilitates correction of the crooked nose. The open septorhinoplasty approach and swinging door maneuver are followed by placement of a diagonally oriented crossbar graft, obtained from cartilage or the perpendicular plate. The approach allows consistent midline correction and buttressing of the nasal dorsum, with no complications to date.

  6. [Use of the calvarium for bone grafting in cranio-maxillo-facial surgery]. (United States)

    Raulo, Y; Baruch, J


    Bone grafts's traditional donor sites in cranio-maxillo-facial surgery have been for many years and are still in some occasions the ribs, iliac crest and tibia. Bone grafts taken from the calvaria have been used by some surgeons in the past but its wide acceptance was only achieved after Paul Tessier had reported his own experience. The calvaria is composed of inner and outer tables that encloses a layer of cancellous bone called the diploe. A high degree of variability exist with respect to skull thickness. Nevertheless parietal bones is the preferable site for the harvesting of the graft. The embryonic origin of the cranium should be responsible for greater survival of the graft. Membranous bone would maintain its volume to a greater extent than endochondral bone when autografted in the cranio-facial region. However this remains controversial. Two techniques can be used for the harvesting of a calvarial bone grafts. A split thickness calvarial graft involves removal of the outer table while leaving the inner layer in place. Its main disadvantage is the relatively thinness of the bone transferred. A full thickness segment of skull involves the cranium cavity be entered. A half of the graft can be split along the diploe space and returned to fill the donor site. The other half is used for reconstruction. It is a more complicated procedure. Cranial grafts have been used in the following cases. Correction of contour defect of the forehead and zygomatic bones, orbital floor reconstruction, restoration of the nasal bridge, bone grafting of the maxilla and mandibule. The advantages are the following: the donor and recipient sites are in adjacent surgical fields, the donor site scar is hidden in the scalp, morbidity associated with removing the graft is almost inexistent. (ABSTRACT TRUNCATED AT 250 WORDS)

  7. Reconstruction of mandibular defects using nonvascularized autogenous bone graft in Nigerians

    Directory of Open Access Journals (Sweden)

    Kizito Chioma Ndukwe


    Full Text Available Objectives: The aim of this study is to evaluate the success rate and complications of mandibular reconstruction with nonvascularized bone graft in Ile-Ife, Nigeria. Patients and Methods: A total of 25 patients who underwent reconstruction of mandibular discontinuity defects between January 2003 and February 2012, at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife constituted the study sample. Relevant information was retrieved from the patients′ records. This information include patients′ demographics (age and sex as well as the type of mandibular defect, cause of the defect, type of mandibular resection done, source of the bone graft used, and the method of graft immobilization. Morbidity associated with the graft procedures were assessed by retrieving information on graft failures, length of hospital stay following surgery, rehabilitation device used and associated graft donor and recipient site complications. Result: There were 12 males and 13 females with a male:female ratio was 1:1.1. The age of the patients ranged from 13 to 73 years with a mean age for males 32.7 ± standard deviation (SD 12.9 and for females 35.0 ± SD 17.1. Jaw defect was caused by resection for tumours and other jaw pathologies in 92% of cases. Complete symphyseal involvement defect was the most common defect recorded 11 (44%. Reconstruction with nonvascularized rib graft accounted for 68% of cases while iliac crest graft was used in 32% of the patients. Successful take of the grafts was recorded in 22 patients while three cases failed. Wound dehiscence (two patients and postoperative wound infection (eight patients were the most common complications recorded. Conclusion: The use of nonvascularized graft is still relevant in the reconstruction of large mandibular defects caused by surgical ablation of benign conditions in Nigerians. Precise surgical planning and execution, extended antibiotic therapy, and meticulous postoperative care

  8. Correction of internal nasal valve stenosis: a single surgeon comparison of butterfly versus traditional spreader grafts. (United States)

    Stacey, D Heath; Cook, Ted A; Marcus, Benjamin C


    Nasal obstruction due to internal nasal valve (INV) collapse is relatively common. This article evaluates 2 different methods repairing the INV.Our subject population is a single-surgeon group of 82 patients who underwent a septorhinoplasty for nasal airway obstruction. Patients received either a spreader graft or butterfly graft. There are 30 patients who received spreader grafts and 52 patients who received a butterfly graft. All patients had a minimum of 3 months follow-up. All patients were evaluated with standardized questionnaire. Participants were asked to evaluate improvement in their nasal airway on an analog scale of 1 to 5. Participants were also asked to comment on changes in pre and postoperative snoring and sleep habits. Lastly, participants were queried regarding the ear cartilage harvest and if this bothered them.Patients undergoing both procedures demonstrated an overall improvement in their nasal breathing. Significant differences in improvement were observed for patients in the categories of postoperative snoring, sleep, and continuous positive airway pressure use. Patients were not bothered by the ear cartilage harvest.In select patients, the butterfly graft is a useful solution for INV collapse correction.

  9. The number of displaced rib fractures is more predictive for complications in chest trauma patients. (United States)

    Chien, Chih-Ying; Chen, Yu-Hsien; Han, Shih-Tsung; Blaney, Gerald N; Huang, Ting-Shuo; Chen, Kuan-Fu


    Traumatic rib fractures can cause chest complications that need further treatment and hospitalization. We hypothesized that an increase in the number of displaced rib fractures will be accompanied by an increase in chest complications. We retrospectively reviewed the trauma registry between January 2013 and May 2015 in a teaching hospital in northeastern Taiwan. Patients admitted with chest trauma and rib fractures without concomitant severe brain, splenic, pelvic or liver injuries were included. The demographic data, such as gender, age, the index of coexistence disease, alcohol consumption, trauma mechanisms were analyzed as potential predictors of pulmonary complications. Pulmonary complications were defined as pneumothorax, hemothorax, flail chest, pulmonary contusion, and pneumonia. In the 29 months of the study period, a total of 3151 trauma patients were admitted to our hospital. Among them, 174 patients were enrolled for final analysis. The most common trauma mechanism was road traffic accidents (58.6%), mainly motorbike accidents (n = 70, 40.2%). Three or more displaced rib fractures had higher specificity for predicting complications, compared to three or more total rib fractures (95.5% vs 59.1%). Adjusting the severity of chest trauma using TTSS and Ribscore by multivariable logistic regression analysis, we found that three or more rib fractures or any displaced rib fracture was the most significant predictor for developing pulmonary complication (aOR: 5.49 95% CI: 1.82-16.55). Furthermore, there were 18/57 (31.6%) patients with fewer than three ribs fractures developed pulmonary complications. In these 18 patients, only five patients had delayed onset complications and four of them had at least one displaced rib fracture. In this retrospective cohort study, we found that the number of displaced or total rib fractures, bilateral rib fractures, and rib fractures in more than two areas were associated with the more chest complications. Furthermore

  10. Cutoff-mesa isolated rib optical waveguide for III-V heterostructure photonic integrated circuits

    Energy Technology Data Exchange (ETDEWEB)

    Vawter, Gregory A. (Albuquerque, NM); Smith, Robert E. (Albuquerque, NM)


    A cutoff mesa rib waveguide provides single-mode performance regardless of any deep etches that might be used for electrical isolation between integrated electrooptic devices. Utilizing a principle of a cutoff slab waveguide with an asymmetrical refractive index profile, single mode operation is achievable with a wide range of rib widths and does not require demanding etch depth tolerances. This new waveguide design eliminates reflection effects, or self-interference, commonly seen when conventional rib waveguides are combined with deep isolation etches and thereby reduces high order mode propagation and crosstalk compared to the conventional rib waveguides.

  11. Cutoff-mesa isolated rib optical waveguide for III-V heterostructure photonic integrated circuits (United States)

    Vawter, G.A.; Smith, R.E.


    A cutoff mesa rib waveguide provides single-mode performance regardless of any deep etches that might be used for electrical isolation between integrated electrooptic devices. Utilizing a principle of a cutoff slab waveguide with an asymmetrical refractive index profile, single mode operation is achievable with a wide range of rib widths and does not require demanding etch depth tolerances. This new waveguide design eliminates reflection effects, or self-interference, commonly seen when conventional rib waveguides are combined with deep isolation etches and thereby reduces high order mode propagation and crosstalk compared to the conventional rib waveguides. 7 figs.

  12. Plasmacytoma presenting as missing rib on chest film: a case report and review of the literature. (United States)

    Caffery, Terrell; Foy, Matthew


    A 33-year-old man presented to the emergency department (ED) with chief complaint of chest pain, persisting for approximately one year. Chest X-ray revealed he was missing the right posterior fifth rib. Physical examination showed no surgical scars, and he reported no history of chest trauma. A CT of his chest demonstrated a mass involving the posterior aspect of the right fifth rib, and subsequent biopsy revealed plasma cells. Laboratory results indicated the tumor was a solitary plasmacytoma of the rib. He was referred to oncology and treated with radiation therapy. This case report illustrates an unusual presentation of a solitary plasmacytoma of the rib.

  13. Rib fractures: comparison of associated injuries between pediatric and adult population. (United States)

    Kessel, Boris; Dagan, Jasmin; Swaid, Forat; Ashkenazi, Itamar; Olsha, Oded; Peleg, Kobi; Givon, Adi; Alfici, Ricardo


    Rib fractures are considered a marker of exposure to significant traumatic energy. In children, because of high elasticity of the chest wall, higher energy levels are necessary for ribs to fracture. The purpose of this study was to analyze patterns of associated injuries in children as compared with adults, all of whom presented with rib fractures. A retrospective cohort study involving blunt trauma patients with rib fractures registered in the National Trauma Registry was conducted. Of 6,995 trauma victims who were found to suffer from rib fractures, 328 were children and 6,627 were adults. Isolated rib fractures without associated injuries occurred in 19 children (5.8%) and 731 adults (11%). More adults had 4 or more fractured ribs compared with children (P brain injuries (P = .003), hemothorax/pneumothorax (P = .006), spleen, and liver injury (P injuries in children was significantly higher than in adults suffering from rib fractures. In spite of a higher Injury Severity Score and incidence of associated injuries, mortality rate was similar. Mortality of rib fracture patients was mostly affected by the presence of extrathoracic injuries. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Rib fractures after chest physiotherapy for bronchiolitis or pneumonia in infants

    Energy Technology Data Exchange (ETDEWEB)

    Chalumeau, Martin [Service de Pneumologie et d' Allergologie Pediatriques, Hopital Necker-Enfants Malades, Paris (France); Service de Pediatrie, Hopital Saint-Vincent-de-Paul, Paris (France); Foix-l' Helias, Laurence; Scheinmann, Pierre; Zuani, Pierre [Service de Pneumologie et d' Allergologie Pediatriques, Hopital Necker-Enfants Malades, Paris (France); Gendrel, Dominique [Service de Pediatrie, Hopital Saint-Vincent-de-Paul, Paris (France); Ducou-le-Pointe, Hubert [Service de Radiologie, Hopital d' Enfants Armand-Trousseau, Avenue du Docteur Arnold Netter, 75571 Paris Cedex 12 (France)


    Heading AbstractBackground. The reported causes of rib fractures in infants are: child abuse, accidental injury, cardiopulmonary resuscitation, bone fragility, birth trauma and severe cough.Objective. To report chest physiotherapy (CPT) as a new cause of rib fractures in five infants.Materials and methods. We retrospectively identified all infants with rib fractures after CPT for bronchiolitis or pneumonia over a 4-year period in two paediatric and one paediatric radiology units in three university hospitals in Paris.Results. Five boys were identified. Their median age was 3 months. None had any other potential cause of rib fractures. The indication for CPT was bronchiolitis in four cases and pneumonia in one. The median number of rib fractures was four (range 1-5). Fractures were located between the 3rd and 8th ribs; they were lateral in four patients and posterior in one; they were unilateral in four patients and bilateral in one. Evolution was favourable in all cases. The prevalence of rib fractures after CPT during the study period was estimated at 1 in 1,000 infants hospitalised for bronchiolitis or pneumonia.Conclusions. CPT should be considered a potential, but very rare cause of rib fractures in infants. It can be of clinical relevance when rib fractures are the only feature suggestive of child abuse. (orig.)

  15. Enhanced cartilage repair in 'healer' mice-New leads in the search for better clinical options for cartilage repair. (United States)

    Fitzgerald, Jamie


    Adult articular cartilage has a poor capacity to undergo intrinsic repair. Current strategies for the repair of large cartilage defects are generally unsatisfactory because the restored cartilage does not have the same resistance to biomechanical loading as authentic articular cartilage and degrades over time. Recently, an exciting new research direction, focused on intrinsic cartilage regeneration rather than fibrous repair by external means, has emerged. This review explores the new findings in this rapidly moving field as they relate to the clinical goal of restoration of structurally robust, stable and non-fibrous articular cartilage following injury.

  16. Clinical Analysis for the Correlation of Intra-abdominal Organ Injury in the Patients with Rib Fracture (United States)


    Background Although it is rare for the fracture itself to become a life threatening injury in patients suffering from rib fracture, the lives of these patients are occasionally threatened by other associated injuries. Especially, early discovery of patients with rib fracture and intra-abdominal organ injury is extremely important to the prognosis. This study analyzed the link between rib fracture and intra-abdominal injury to achieve improved treatment. Materials and Methods Among trauma patients that had visited the hospital emergency room from January 2007 to December 2009, a retrospective study was conducted on 453 patients suffering from rib fracture due to blunt trauma. Rib fracture was classified according to location (left, right, and bilateral), and according to level (upper rib fracture [1-2nd rib], middle rib fracture [3-8th rib], and lower rib fracture [9-12th rib]). The researched data was statistically compared and analyzed to investigate the correlation between the location, level, and number of rib fracture and intra-abdominal organ injury. Results Motor vehicle injury was found to be the most common mechanism of injury with 208 cases (46%). Associated injuries accompanied with rib fracture were generated in 276 cases (61%). Intra-abdominal organ injury was discovered in 97 cases (21%). Liver injury was the most common intra-abdominal injury associated with rib fracture with 39 cases (40%), followed by spleen injury, with 23 cases (23%). Intra-abdominal injury according to level of rib fracture was presented as upper rib fracture in 11 cases (11%), middle rib fracture in 31 cases (32%), and lower rib fracture in 55 cases (57%), thus verifying that intra-abdominal injuries were commonly accompanied in lower rib fractures (p=0.03). In particular, significant increase of intra-abdominal injury was presented in fractures below the 8th rib (p=0.03). The number of intra-abdominal injuries requiring emergency operations was significantly higher in patients

  17. Comparison of cartilage with temporalis fascia tympanoplasty: A meta-analysis of comparative studies. (United States)

    Jalali, Mir Mohammad; Motasaddi, Masoud; Kouhi, Ali; Dabiri, Sasan; Soleimani, Robabeh


    To systematically review the results of type 1 tympanoplasty with temporalis fascia (TF) versus cartilage in patients with chronic otitis media (COM) for graft integration and hearing improvement. The English language literature (until June 1, 2016) was searched, using Medline (via PubMed), Scopus, ProQuest, Ovid, Cochrane database, and Google Scholar. A comprehensive review of the literature was performed. Prospective and retrospective studies enrolling patients with COM were included. Relevance and validity of selected articles were evaluated. Heterogeneity was assessed using I(2) statistics. For dichotomous variables, absolute rate differences, and number needed to treat (NNT) were calculated. For continuous variables, standard mean differences were calculated. A total of 11 prospective and 26 retrospective studies involving 3,606 patients were included. In general, the overall graft integration rates of cartilage and fascia tympanoplasty were 92% and 82%, respectively (NNT = 11.1, P fascia tympanoplasty provided similar improvements in the hearing outcome postoperatively. Large prospective trials are necessary to collect high-quality data. NA. Laryngoscope, 127:2139-2148, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  18. Human stem cells and articular cartilage regeneration. (United States)

    Inui, Atsuyuki; Iwakura, Takashi; Reddi, A Hari


    The regeneration of articular cartilage damaged due to trauma and posttraumatic osteoarthritis is an unmet medical need. Current approaches to regeneration and tissue engineering of articular cartilage include the use of chondrocytes, stem cells, scaffolds and signals, including morphogens and growth factors. Stem cells, as a source of cells for articular cartilage regeneration, are a critical factor for articular cartilage regeneration. This is because articular cartilage tissue has a low cell turnover and does not heal spontaneously. Adult stem cells have been isolated from various tissues, such as bone marrow, adipose, synovial tissue, muscle and periosteum. Signals of the transforming growth factor beta superfamily play critical roles in chondrogenesis. However, adult stem cells derived from various tissues tend to differ in their chondrogenic potential. Pluripotent stem cells have unlimited proliferative capacity compared to adult stem cells. Chondrogenesis from embryonic stem (ES) cells has been studied for more than a decade. However, establishment of ES cells requires embryos and leads to ethical issues for clinical applications. Induced pluripotent stem (iPS) cells are generated by cellular reprogramming of adult cells by transcription factors. Although iPS cells have chondrogenic potential, optimization, generation and differentiation toward articular chondrocytes are currently under intense investigation.

  19. Thermogravimetry of irradiated human costal cartilage

    Energy Technology Data Exchange (ETDEWEB)

    Martinho Junior, Antonio C.; Machado, Luci D.B.; Dias, Djalma B.; Mathor, Monica B. [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)]. E-mail:;;;; Herson, Marisa R. [Universidade de Sao Paulo, SP (Brazil). Hospital das Clinicas. Banco de Tecidos do Instituto Central]. E-mail:; Meumann, Nilton F.; Pasqualucci, Carlos Augusto G. [Universidade de Sao Paulo, SP (Brazil). Faculdade de Medicina. Servico de Verificacao de Obitos]. E-mail:


    Costal cartilage has been sterilized with gamma radiation using {sup 60}Co sources at two different doses, 25 kGy and 50 kGy, for storage in tissue banks. Samples of costal cartilage were deep-freezing as method of preservation. Thermogravimetry (Shimadzu TGA-50) was used to verify the water release of costal cartilage before and after irradiation. The TG tests were carried out at heating rate of 10 deg C/min from room temperature to 600 deg C under a flow rate of 50 mL/min of compressed air. Samples of costal cartilage were divided in 2 parts. One part of them was kept as reference material; the other part was irradiated. This procedure assures better homogeneity of the sample and reproducibility of the experimental results. The obtained data have shown that the TG curves have the same pattern, independently of the sample. Non-irradiated samples showed great variability of thermogravimetric curves among different donors and for the same donor. Further experimental work is being carried out on human cartilage preserved in glycerol in high concentration (> 98%) to compare with those deep freezing. (author)

  20. Human Stem Cells and Articular Cartilage Regeneration

    Directory of Open Access Journals (Sweden)

    A. Hari Reddi


    Full Text Available  The regeneration of articular cartilage damaged due to trauma and posttraumatic osteoarthritis is an unmet medical need. Current approaches to regeneration and tissue engineering of articular cartilage include the use of chondrocytes, stem cells, scaffolds and signals, including morphogens and growth factors. Stem cells, as a source of cells for articular cartilage regeneration, are a critical factor for articular cartilage regeneration. This is because articular cartilage tissue has a low cell turnover and does not heal spontaneously. Adult stem cells have been isolated from various tissues, such as bone marrow, adipose, synovial tissue, muscle and periosteum. Signals of the transforming growth factor beta superfamily play critical roles in chondrogenesis. However, adult stem cells derived from various tissues tend to differ in their chondrogenic potential. Pluripotent stem cells have unlimited proliferative capacity compared to adult stem cells. Chondrogenesis from embryonic stem (ES cells has been studied for more than a decade. However, establishment of ES cells requires embryos and leads to ethical issues for clinical applications. Induced pluripotent stem (iPS cells are generated by cellular reprogramming of adult cells by transcription factors. Although iPS cells have chondrogenic potential, optimization, generation and differentiation toward articular chondrocytes are currently under intense investigation.

  1. Primary lymphoma of bone originating in a rib. (United States)

    Nishiyama, N; Nakatani, S; Inoue, K; Katoh, T; Kinoshita, H


    Malignant lymphoma originating in the bone is rare and is now recognized as being an independent clinicopathologic entity known as primary lymphoma of bone. A 60-year-old man complaining of right chest and back pain consulted our hospital for further examination. Chest X-ray and computed tomogram revealed osteolysis and a surrounding soft tissue mass in the sixth right rib. An ultrasonically-guided needle biopsy of the tumor was performed, and histologic examination indicated the dense proliferation of similar-sized atypical cells with nucleoli and an irregular nuclear border. A diagnosis of diffuse, medium-sized non-Hodgkin's lymphoma, B-cell type was made. En block resection of the tumor and chest wall was performed. Macroscopically, the tumor measured 7.5 x 4.8 x 3.0 cm in diameter, and the histologic findings were similar to those of the preoperative needle biopsy. Unfortunately, postoperative treatment with radiation therapy and chemotherapy was ultimately unsuccessful, and a local recurrence and metastatic lesions appeared in the stomach and para-aortic abdominal lymph nodes 7 months after the first symptom appeared. The patient died 3 months later. Surgery was chosen as the initial therapy as it was considered that a rib resection would not result in serious respiratory compromise and the complete resection of the tumor would be superior to radiation therapy for local control. Some authors have reported that the surgical resection of a primary lymphoma of the bone originating in a rib can yield a good prognosis. However, it is a systemic disease and a more effective therapeutic strategy should be developed.

  2. Orthotopic Autologous Chondrocyte Grafting as a Method of Treatment of Growth Plate Damage in Rabbits. (United States)

    Tomaszewski, Ryszard; Wiktor, Łukasz; Gap, Artur


    With the continuous advances in the therapy of joint cartilage injury, some of those classification systems are also being used for evaluating the quality of regenerating cartilage. Histo lo gi cal assessment of joint cartilage is a very important component in the staging of osteoarthritis and tracing therapeutic outcomes. We performed a histological assessment of regenerating growth plate in a group of New Zealand white rabbits as a component of autologous chondrocyte therapy for growth plate damage. We studied a group of 14 five-week-old in-bred white rabbits. We used a tre phine needle to harvest growth plate from the medial fourth of tibial width. The mean duration of the procedure was 25 minutes (range: 12-37 minutes). We conducted a total of 25 growth plate harvesting procedures. In 21 cases, we placed a drainage tube at the site of the defect for 22 days. After removing the tube, we introduced a cartilago-fibrinous construct containing cultured autologous chondrocytes into 14 defects, while 4 defects were left intact. Three growth plates represented non-intervention controls. Our analysis showed satisfactory graft morphology and integration; absence of inflammatory res ponse and fair restitution of growth plate architecture. 1. Growth plate damage can lead to the development of an angular deformity as a result of im paired longitudinal bone growth; 2. Autologous chondrocyte grafting is a good method of treatment for growth plate damage; 3. A weakness of autologous chondrocyte grafting is the relatively long time of chondrocyte culturing.

  3. Repair of osteochondral defects in rabbits with ectopically produced cartilage

    NARCIS (Netherlands)

    Emans, PJ; Hulsbosch, M; Wetzels, GMR; Bulstra, SK; Kuijer, R


    Cartilage has poor regenerative capacity. Donor site morbidity and interference with joint homeostasis should be considered when applying the autologous chondrocyte transplantation technique. The use of ectopically produced cartilage, derived from periosteum, might be a novel method to heal

  4. Cold plate with combined inclined impingement and ribbed channels

    Energy Technology Data Exchange (ETDEWEB)

    Parida, Pritish R.


    Heat transfer devices and methods for making the same that include a first enclosure having at least one inlet port; a second enclosure having a bottom plate and one or more dividing walls to establish channels, at least one internal surface of each channel having rib structures to create turbulence in a fluid flow; and a jet plate connecting the first enclosure and the second enclosure having impinging jets that convey fluid from the first enclosure to the channels, said impinging jets being set at an angular deviation from normal to cause local acceleration of fluid and to increase a local heat transfer rate.

  5. Bilateral First Rib Stress Fractures in a Basketball Player

    Directory of Open Access Journals (Sweden)

    Abidin (Radyoloji Kilincer


    Full Text Available I read the article published by Aydogdu et al with a great interest. I congratulate them for this successfully written case report. Additionally, I want to focus an important point about the case they presented is that the diagnosis in that case is likely stress fracture. It is understood from the text and title that they avoided to make a diagnosis of stress fracture in the case, despite of history of lifting heavy weights for three days. And also I decided to mention through this article to an example of our case with bilateral first rib old fractures.

  6. Golfer's fracture of the ribs

    Energy Technology Data Exchange (ETDEWEB)

    Lim, J. H. [Seoul District Armed Forces General Hospital, Seoul (Korea, Republic of)


    Golfer's fracture is stress fracture of the posterior portion of left 3, 4, 5, 6 or 7th ribs of golfer's, usually beginners,and it is considered due to exposure to unaccustomed severe exercise of this fascinating sport. Healing is usually uneventful, but possible complication may occur, because symptom is mild and golfers continue the exercise with physical therapy such as massage. Author report 4 cases of golfer's fracture, including 1 case complicated by platelike at electasis of lung.

  7. Three-year clinical outcome after chondrocyte transplantation using a hyaluronan matrix for cartilage repair

    Energy Technology Data Exchange (ETDEWEB)

    Nehrer, S. [Department of Orthopedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)]. E-mail:; Domayer, S. [Department of Orthopedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Dorotka, R. [Department of Orthopedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Schatz, K. [Department of Orthopedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Bindreiter, U. [Department of Orthopedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Kotz, R. [Department of Orthopedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)


    Repair of articular cartilage represents a significant clinical problem and although various new techniques - including the use of autologous chondrocytes - have been developed within the last century the clinical efficacy of these procedures is still discussed controversially. Although autologous chondrocyte transplantation (ACT) has been widely used with success, it has several inherent limitations, including its invasive nature and problems related to the use of the periosteal flap. To overcome these problems autologous chondrocytes transplantation combined with the use of biodegradable scaffolds has received wide attention. Among these, a hyaluronan-based scaffold has been found useful for inducing hyaline cartilage regeneration. In the present study, we have investigated the mid-term efficacy and safety of Hyalograft[reg] C grafts in a group of 36 patients undergoing surgery for chronic cartilage lesions of the knee. Clinical Outcome was assessed prospectively before and at 12, 24, and 36 months after surgery. No major adverse events have been reported during the 3-year follow-up. Significant improvements of the evaluated scores were observed (P < 0.02) at 1 year and a continued increase of clinical performance was evident at 2 and 3 years follow-up. Patients under 30 years of age with single lesions showed statistically significant improvements at all follow-up visits compared to those over 30 with multiple defects (P < 0.01). Hyalograft[reg] C compares favorably with classic ACT and is particularly indicated in younger patients with single lesions. The graft can be implanted through a miniarthrotomy and needs no additional fixation with sutures except optional fibrin gluing at the defect borders. These results suggest that Hyalograft[reg] C is a valid alternative to ACT.

  8. Skin graft - slideshow (United States)

    ... ency/presentations/100100.htm Skin graft - series—Normal anatomy To use the sharing features on this page, ... 2017 Updated by: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason ...

  9. Experimental and Numerical Study on Heat Transfer Enhancement of a Rectangular Channel with Discontinuous Crossed Ribs and Grooves

    Institute of Scientific and Technical Information of China (English)

    唐新宜; 朱冬生


    Experimental and numerical investigations have been conducted to study turbulent flow of water and heat transfer characteristics in a rectangular channel with discontinuous crossed ribs and grooves.The tests investigated the overall heat transfer performance and friction factor in ribbed and ribbed-grooved channels with rib angle of 30°.The experimental results show that the overall thermo-hydraulic performance for ribbed-grooved channel is increased by 10%-13.6% when compared to ribbed channel.The investigation on the effects of different rib angles and rib pitches on heat transfer characteristics and friction factor in ribbed-grooved channel was carried out using Fluent with SST(shear-stress transport) k-ω turbulence model.The numerical results indicate that the case for rib angle of 45° shows the best overall thermo-hydraulic performance,about 18%-36% higher than the case for rib angle of 0°.In addition,the flow patterns and local heat transfer characteristics for ribbed and ribbed-grooved channels based on the numerical simulation were also analyzed to reveal the mechanism of heat transfer enhancement.

  10. Development of artificial articular cartilage

    Indian Academy of Sciences (India)

    Biswajit Bera


    The present study describes the development of artificial articular cartilage on the basis of mimicking structural gel properties and mechanical gel properties of natural articular cartilage. It is synthesized from PVA/Si nanocomposite containing 20% Tetra ethoxy silane (TEOS) by sol–gel method. Mechanical strength of Poly(vinyl alcohol), PVA is improved up to 35 MPa. Manufacturing method is adopted considering colloidal stability of nano silica particle in PVA sol at specific pH = 1. An adhesive is also prepared from PVA/Si nanocomposite containing 40% TEOS for firm attachment of artificial articular cartilage on underlying bone with high bond strength.

  11. Tissue engineering of cartilages using biomatrices

    DEFF Research Database (Denmark)

    Melrose, J.; Chuang, C.; Whitelock, J.


    Tissue engineering is an exciting new cross-disciplinary methodology which applies the principles of engineering and structure-function relationships between normal and pathological tissues to develop biological substitute to restore, maintain or improve tissue function. Tissue engineering...... therefore involves a melange of approaches encompassing developmental biology, tissue mechanics, medicine, cell differentiation and survival biology, mechanostransduction and nano-fabrication technology. The central tissue of interest in this review is cartilage. Traumatic injuries, congenital abnormalities...... and age-related degenerative diseases can all lead to cartilage loss; however, the low cell density and very limited self-renewal capacity of cartilage necessitate the development of effective therapeutic repair strategies for this tissue. The ontogeny of the chondrocyte, which is the cell that provides...

  12. Articular Cartilage Repair Using Marrow Stimulation Augmented with a Viable Chondral Allograft: 9-Month Postoperative Histological Evaluation

    Directory of Open Access Journals (Sweden)

    James K. Hoffman


    Full Text Available Marrow stimulation is frequently employed to treat focal chondral defects of the knee. However, marrow stimulation typically results in fibrocartilage repair tissue rather than healthy hyaline cartilage, which, over time, predisposes the repair to failure. Recently, a cryopreserved viable chondral allograft was developed to augment marrow stimulation. The chondral allograft is comprised of native viable chondrocytes, chondrogenic growth factors, and extracellular matrix proteins within the superficial, transitional, and radial zones of hyaline cartilage. Therefore, host mesenchymal stem cells that infiltrate the graft from the underlying bone marrow following marrow stimulation are provided with the optimal microenvironment to undergo chondrogenesis. The present report describes treatment of a trochlear defect with marrow stimulation augmented with this novel chondral allograft, along with nine month postoperative histological results. At nine months, the patient demonstrated complete resolution of pain and improvement in function, and the repair tissue consisted of 85% hyaline cartilage. For comparison, a biopsy obtained from a patient 8.2 months after treatment with marrow stimulation alone contained only 5% hyaline cartilage. These outcomes suggest that augmenting marrow stimulation with the viable chondral allograft can eliminate pain and improve outcomes, compared with marrow stimulation alone.

  13. Joint homeostasis in tissue engineering for cartilage repair

    NARCIS (Netherlands)

    Saris, D.B.F.


    Traumatic joint damage, articular cartilage and the research into methods of restoring the articulation are not new topics of interest. For centuries, clinicians have recognized the importance of cartilage damage and sought ways of learning about the normal form and function of hyaline cartilage as

  14. Preparation of Articular Cartilage Specimens for Scanning Electron Microscopy. (United States)

    Stupina, T A


    We developed and adapted a technology for preparation of articular cartilage specimens for scanning electron microscopy. The method includes prefixation processing, fixation, washing, and dehydration of articular cartilage specimens with subsequent treatment in camphene and air-drying. The technological result consists in prevention of deformation of the articular cartilage structures. The method is simpler and cheaper than the known technologies.

  15. Spectrocolorimetric evaluation of repaired articular cartilage after a microfracture

    Directory of Open Access Journals (Sweden)

    Dohi Yoshihiro


    Full Text Available Abstract Background In clinical practice, surgeons differentiate color changes in repaired cartilage compared with surrounding intact cartilage, but cannot quantify these color changes. Objective assessments are required. A spectrocolorimeter was used to evaluate whether intact and repaired cartilage can be quantified. Findings We investigated the use of a spectrocolorimeter and the application of two color models (L* a* b* colorimetric system and spectral reflectance distribution to describe and quantify articular cartilage. In this study, we measured the colors of intact and repaired cartilage after a microfracture. Histologically, the repaired cartilage was a mixture of fibrocartilage and hyaline cartilage. In the L* a* b* colorimetric system, the L* and a* values recovered to close to the values of intact cartilage, whereas the b* value decreased over time after the operation. Regarding the spectral reflectance distribution at 12 weeks after the operation, the repaired cartilage had a higher spectral reflectance ratio than intact cartilage between wavelengths of 400 to 470 nm. Conclusion This study reports the first results regarding the relationship between spectrocolorimetric evaluation and the histological findings of repair cartilage after a microfracture. Our findings demonstrate the ability of spectrocolorimetric measurement to judge the repair cartilage after treatment on the basis of objective data such as the L*, a* and b* values and the SRP as a coincidence index of the spectral reflectance curve.

  16. Semi-automatic knee cartilage segmentation (United States)

    Dam, Erik B.; Folkesson, Jenny; Pettersen, Paola C.; Christiansen, Claus


    Osteo-Arthritis (OA) is a very common age-related cause of pain and reduced range of motion. A central effect of OA is wear-down of the articular cartilage that otherwise ensures smooth joint motion. Quantification of the cartilage breakdown is central in monitoring disease progression and therefore cartilage segmentation is required. Recent advances allow automatic cartilage segmentation with high accuracy in most cases. However, the automatic methods still fail in some problematic cases. For clinical studies, even if a few failing cases will be averaged out in the overall results, this reduces the mean accuracy and precision and thereby necessitates larger/longer studies. Since the severe OA cases are often most problematic for the automatic methods, there is even a risk that the quantification will introduce a bias in the results. Therefore, interactive inspection and correction of these problematic cases is desirable. For diagnosis on individuals, this is even more crucial since the diagnosis will otherwise simply fail. We introduce and evaluate a semi-automatic cartilage segmentation method combining an automatic pre-segmentation with an interactive step that allows inspection and correction. The automatic step consists of voxel classification based on supervised learning. The interactive step combines a watershed transformation of the original scan with the posterior probability map from the classification step at sub-voxel precision. We evaluate the method for the task of segmenting the tibial cartilage sheet from low-field magnetic resonance imaging (MRI) of knees. The evaluation shows that the combined method allows accurate and highly reproducible correction of the segmentation of even the worst cases in approximately ten minutes of interaction.

  17. [Chondrocyte mecanobiology. Application in cartilage tissue engineering]. (United States)

    Stoltz, Jean François; Netter, Patrick; Huselstein, Céline; de Isla, Natalia; Wei Yang, Jing; Muller, Sylvaine


    Cartilage is a hydrated connective tissue that withstands and distributes mechanical forces within joints. Chondrocytes utilize mechanical signals to maintain cartilaginous tissue homeostasis. They regulate their metabolic activity through complex biological and biophysical interactions with the extracellular matrix (ECM). Some mechanotransduction mechanisms are known, while many others no doubt remain to be discovered. Various aspects of chondrocyte mechanobiology have been applied to tissue engineering, with the creation of replacement tissue in vitro from bioresorbable or non-bioresorbable scaffolds and harvested cells. The tissues are maintained in a near-physiologic mechanical and biochemical environment. This paper is an overview of both chondrocyte mechanobiology and cartilage tissue engineering

  18. Body weight independently affects articular cartilage catabolism. (United States)

    Denning, W Matt; Winward, Jason G; Pardo, Michael Becker; Hopkins, J Ty; Seeley, Matthew K


    Although obesity is associated with osteoarthritis, it is unclear whether body weight (BW) independently affects articular cartilage catabolism (i.e., independent from physiological factors that also accompany obesity). The primary purpose of this study was to evaluate the independent effect of BW on articular cartilage catabolism associated with walking. A secondary purpose was to determine how decreased BW influenced cardiovascular response due to walking. Twelve able-bodied subjects walked for 30 minutes on a lower-body positive pressure treadmill during three sessions: control (unadjusted BW), +40%BW, and -40%BW. Serum cartilage oligomeric matrix protein (COMP) was measured immediately before (baseline) and after, and 15 and 30 minutes after the walk. Heart rate (HR) and rate of perceived exertion (RPE) were measured every three minutes during the walk. Relative to baseline, average serum COMP concentration was 13% and 5% greater immediately after and 15 minutes after the walk. Immediately after the walk, serum COMP concentration was 14% greater for the +40%BW session than for the -40%BW session. HR and RPE were greater for the +40%BW session than for the other two sessions, but did not differ between the control and -40%BW sessions. BW independently influences acute articular cartilage catabolism and cardiovascular response due to walking: as BW increases, so does acute articular cartilage catabolism and cardiovascular response. These results indicate that lower-body positive pressure walking may benefit certain individuals by reducing acute articular cartilage catabolism, due to walking, while maintaining cardiovascular response. Key pointsWalking for 30 minutes with adjustments in body weight (normal body weight, +40% and -40% body weight) significantly influences articular cartilage catabolism, measured via serum COMP concentration.Compared to baseline levels, walking with +40% body weight and normal body weight both elicited significant increases in

  19. The RIB production target for the SPES project (United States)

    Monetti, Alberto; Andrighetto, Alberto; Petrovich, Carlo; Manzolaro, Mattia; Corradetti, Stefano; Scarpa, Daniele; Rossetto, Francesco; Martinez Dominguez, Fernando; Vasquez, Jesus; Rossignoli, Massimo; Calderolla, Michele; Silingardi, Roberto; Mozzi, Aldo; Borgna, Francesca; Vivian, Gianluca; Boratto, Enrico; Ballan, Michele; Prete, Gianfranco; Meneghetti, Giovanni


    Facilities making use of the Isotope Separator On-Line (ISOL) method for the production of Radioactive Ion Beams (RIB) attract interest because they can be used for nuclear structure and reaction studies, astrophysics research and interdisciplinary applications. The ISOL technique is based on the fast release of the nuclear reaction products from the chosen target material together with their ionization into short-lived nuclei beams. Within this context, the SPES (Selective Production of Exotic Species) facility is now under construction in Italy at INFN-LNL (Istituto Nazionale di Fisica Nucleare — Laboratori Nazionali di Legnaro). The SPES facility will produce RIBs mainly from n-rich isotopes obtained by a 40 MeV cyclotron proton beam (200 μA) directly impinging on a uranium carbide multi-foil fission target. The aim of this work is to describe and update, from a comprehensive point of view, the most important results obtained by the analysis of the on-line behavior of the SPES production target assembly. In particular an improved target configuration has been studied by comparing different codes and physics models: the thermal analyses and the isotope production are re-evaluated. Then some consequent radioprotection aspects, which are essential for the installation and operation of the facility, are presented.

  20. The RIB production target for the SPES project

    Energy Technology Data Exchange (ETDEWEB)

    Monetti, Alberto [viale dell' Universita 2, Laboratori Nazionali di Legnaro, Legnaro (Italy); University of Padua, Department of Industrial Engineering (DII), Padova (Italy); Andrighetto, Alberto; Manzolaro, Mattia; Corradetti, Stefano; Scarpa, Daniele; Rossetto, Francesco; Vasquez, Jesus; Rossignoli, Massimo; Calderolla, Michele; Silingardi, Roberto; Mozzi, Aldo; Vivian, Gianluca; Boratto, Enrico; Ballan, Michele; Prete, Gianfranco [viale dell' Universita 2, Laboratori Nazionali di Legnaro, Legnaro (Italy); Petrovich, Carlo [ENEA, Bologna (Italy); Martinez Dominguez, Fernando [viale dell' Universita 2, Laboratori Nazionali di Legnaro, Legnaro (Italy); ESS Bilbao, Instituto de Fusion Nuclear, Madrid (Spain); Borgna, Francesca [viale dell' Universita 2, Laboratori Nazionali di Legnaro, Legnaro (Italy); University of Padua, Department of Pharmaceutical and Pharmacological Sciences, Padova (Italy); Meneghetti, Giovanni [University of Padua, Department of Industrial Engineering (DII), Padova (Italy)


    Facilities making use of the Isotope Separator On-Line (ISOL) method for the production of Radioactive Ion Beams (RIB) attract interest because they can be used for nuclear structure and reaction studies, astrophysics research and interdisciplinary applications. The ISOL technique is based on the fast release of the nuclear reaction products from the chosen target material together with their ionization into short-lived nuclei beams. Within this context, the SPES (Selective Production of Exotic Species) facility is now under construction in Italy at INFN-LNL (Istituto Nazionale di Fisica Nucleare - Laboratori Nazionali di Legnaro). The SPES facility will produce RIBs mainly from n-rich isotopes obtained by a 40 MeV cyclotron proton beam (200 μA) directly impinging on a uranium carbide multi-foil fission target. The aim of this work is to describe and update, from a comprehensive point of view, the most important results obtained by the analysis of the on-line behavior of the SPES production target assembly. In particular an improved target configuration has been studied by comparing different codes and physics models: the thermal analyses and the isotope production are re-evaluated. Then some consequent radioprotection aspects, which are essential for the installation and operation of the facility, are presented. (orig.)

  1. Cryptococcal rib osteomyelitis as primary and only symptom of idiopathic CD4 penia

    DEFF Research Database (Denmark)

    Legarth, Rebecca A; Christensen, Merete; Calum, Henrik


    A 59-year old man with idiopathic CD4 lymphopenia presented with extensive disseminated Cryptococcus neoformans infection including a large rib cryptoccocoma, vertebral spondylitis and pleural empyema. Complete resection of the affected part of the rib was necessary after failure of initial...

  2. Surgical Treatment of Snapping Scapula Syndrome Due to Malunion of Rib Fractures. (United States)

    Ten Duis, Kaj; IJpma, Frank F A


    This report describes a case of snapping scapula syndrome (SSS) caused by malunited rib fractures. Abrasion of the deformed ribs was performed with good results. SSS as a cause of shoulder pain after thoracic trauma has to be considered and can be treated by a surgical abrasion technique. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Primary Osteoblastic Osteosarcoma of the Rib in an Adult: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jung Ah; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Ryoo, In Seon [Dept. of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Hyo Ah; Chung, Jin Haeng [Dept. of Patholgy, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Oh, Joo Han [Dept. of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)


    We report the CT and magnetic resonance (MR) imaging appearances in an adult case of primary osteoblastic osteosarcoma of the rib. Osteosarcoma of the rib presents a diagnostic challenge because of the rarity of the lesion, especially with plain radiographs. The tumor should be suspected if CT and MR images demonstrate mineralization, suggestive of an osteoid matrix.

  4. Sternum Length and Rib Cage Dimensions Compared with Bodily Proportions in Adults with Cystic Fibrosis

    Directory of Open Access Journals (Sweden)

    Louis-Philippe Laurin


    Full Text Available BACKGROUND: A greater structural expansion of the rib cage in females compared with males has been described in cystic fibrosis (CF patients; however, conflicting data exist as to whether an elongation of the bony ribs and sternum contributes to this expansion.

  5. The use of nylon cable ties to repair rib fractures in neonatal foals. (United States)

    Downs, Chris; Rodgerson, Dwayne


    Commercially available nylon cable ties were used as a method of internal fixation for displaced rib fractures in 8 equine neonates. The procedure was effective, well-tolerated, rapid, and inexpensive. The use of nylon cable ties as internal fixation for displaced rib fractures in foals is an effective surgical procedure.

  6. Synostosis of first and second thoracic ribs: Anatomical and radiological assessment

    Directory of Open Access Journals (Sweden)

    Gupta V


    Full Text Available An unusual specimen showing synostosis of left sided first and second ribs was encountered during scanning of bones in anatomy department. The ribs were partially fused in the region of their neck and tubercles, and displayed an osseous tunnel. The tunnel measured 1.2 cm in length and was directed anterolaterally. The shaft of first rib imperceptibly blended with that of the second and resulted in obliteration of first intercostal space. The maximum width of this conjoint shaft was 3.6 cm. Superior surface of the rib specimen was marked by a large muscular impression for scalenus medius muscle. The groove for subclavian artery on the superior surface of first rib was prominent. The anterior end of the second rib and a portion of its shaft were separated from the anterior end of first rib by a V-shaped notch. The radiograph of the specimen confirmed the presence of a tunnel between the fused portions of neck and tubercle. Such skeletal abnormalities may be associated with segmentation defects of bony tissues and variations in the disposition of neurovascular structures, thus rendering them vulnerable to compression at the thoracic outlet. The fused ribs affect the chest wall expansion and may result in respiratory complications. Precise knowledge and awareness of such anomalies is important for clinicians, especially for thoracic surgeons and radiologists.

  7. Osteomyelitis of sternum and rib after breast prosthesis implantation: A rare or underestimated infection? (United States)

    Seng, Piseth; Alliez, Antoine; Honnorat, Estelle; Menard, Amelie; Casanova, Dominique; Stein, Andreas


    Sternum and rib osteomyelitis complicated from breast implant infection is rare. We report a case of early sternum and rib osteomyelitis occurred during breast implant infection managed in an inter-regional referral center for bone/joint infections in the south of France. PMID:26793446

  8. Osteomyelitis of sternum and rib after breast prosthesis implantation: A rare or underestimated infection?

    Directory of Open Access Journals (Sweden)

    Piseth Seng


    Full Text Available Sternum and rib osteomyelitis complicated from breast implant infection is rare. We report a case of early sternum and rib osteomyelitis occurred during breast implant infection managed in an inter-regional referral center for bone/joint infections in the south of France.


    Directory of Open Access Journals (Sweden)

    Hiroyuki Fujioka


    Full Text Available A 17-year-old boy, who played a weight lifting in high school, sustained stress fracture of the first rib without any causes. We successfully treated first rib stress fracture with limitation of using the upper extremity and with using low-intensity pulsed ultrasound

  10. Transduction of anti-cell death protein FNK suppresses graft degeneration after autologous cylindrical osteochondral transplantation. (United States)

    Nakachi, Noriki; Asoh, Sadamitsu; Watanabe, Nobuyoshi; Mori, Takashi; Matsushita, Takashi; Takai, Shinro; Ohta, Shigeo


    This study shows that artificial super antiapoptotic FNK protein fused with a protein transduction domain (PTD-FNK) maintains the quality of osteochondral transplant by preventing chondrocyte death. Cylindrical osteochondral grafts were obtained from enhanced green fluorescent protein (EGFP)-expressing transgenic rats, in which living chondrocytes express green fluorescence, and submerged into medium containing PTD-FNK, followed by transplantation into cartilage defects of wild-type rats by impact insertion simulating autologous transplantation. The tissues were histologically evaluated by hematoxylin-eosin and Safranin-O staining. At 1 week, chondrocyte alignment was normal in the PTD-FNK treatment group, whereas all grafts without PTD-FNK treatment showed mixed cluster cell distribution. At 4 weeks, all grafts with PTD-FNK treatment showed almost normal matrix, whereas two grafts without PTD-FNK treatment showed fibrocartilage. Notably, all grafts with PTD-FNK retained high intensity of Safranin-O staining, but all grafts without PTD-FNK largely lost Safranin-O staining. PTD-FNK significantly suppressed a decrease in the survival rate and the density of EGFP-positive cells at 1 and 2 weeks, and this tendency continued at 4 weeks. The results of terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP)-nick end-labeling staining showed that PTD-FNK inhibited cell death, indicating that PTD-FNK protects chondrocyte death and suppresses graft degeneration.

  11. Overexpression of hsa-miR-148a promotes cartilage production and inhibits cartilage degradation by osteoarthritic chondrocytes

    NARCIS (Netherlands)

    Vonk, Lucienne A.; Kragten, Angela H.M.; Dhert, Wouter J.; Saris, Daniël B.F.; Creemers, Laura B.


    Objective Hsa-miR-148a expression is decreased in OA cartilage, but its functional role in cartilage has never been studied. Therefore, our aim was to investigate the effects of overexpressing hsa-miR-148a on cartilage metabolism of OA chondrocytes. Design OA chondrocytes were transfected with a

  12. Overexpression of hsa-miR-148a promotes cartilage production and inhibits cartilage degradation by osteoarthritic chondrocytes

    NARCIS (Netherlands)

    Vonk, L A; Kragten, A H M; Dhert, W J A|info:eu-repo/dai/nl/10261847X; Saris, D B F; Creemers, L B

    OBJECTIVE: Hsa-miR-148a expression is decreased in Osteoarthritis (OA) cartilage, but its functional role in cartilage has never been studied. Therefore, our aim was to investigate the effects of overexpressing hsa-miR-148a on cartilage metabolism of OA chondrocytes. DESIGN: OA chondrocytes were

  13. Late-onset chest wall abscess due to a biodegradable rib pin infection after lung transplantation. (United States)

    Goda, Yasufumi; Chen-Yoshikawa, Toyofumi F; Kusunose, Masaaki; Hamaji, Masatsugu; Motoyama, Hideki; Hijiya, Kyoko; Aoyama, Akihiro; Date, Hiroshi


    A 55-year-old man with end-stage emphysema underwent a right single-lung transplantation through a posterolateral thoracotomy. The fifth rib was divided and fused back using a biodegradable pin made of polylactide acid and hydroxyapatite. Two weeks postoperatively, he suffered from central vein catheter-related sepsis due to methicillin-sensitive Staphylococcus aureus. After being successfully treated for sepsis, he was discharged. However, 3 months later, computed tomography revealed multiple loculated abscesses in the chest wall and the right pleural space. Reoperative thoracotomy revealed abscesses mainly located around the fifth rib, where the pin was inserted. Both cultures of the abscess and the fifth rib were positive for methicillin-sensitive S. aureus, which suggested that the rib pin was the cause of the secondary infection. This case suggests the rib pins, even if they are biodegradable, could have a risk of infections side effect especially for the immunosuppressed patients.

  14. Control of Separating Flow Behind a Step by Means of Slotted Ribs (United States)

    D'yachenko, A. Yu.; Zhdanov, V. L.; Smul'skii, Ya. I.; Terekhov, V. I.


    One of the promising and simplest methods of passively controlling separating flow behind a backward-facing step with the aid of slotted ribs is considered. The size and number of slots were varied in wide ranges in experiments so that the relative area of the slots amounted to R = Fs/Fr = 0-1. The influence of the longitudinal vortices induced by the teeth in a rib on the distribution of pressure and heat transfer rate in the recirculation region in the case of varying the sizes of slots in a rib, the spacing between them, and the position of the rib relative to the backwardfacing step has been studied. The effectiveness of using slotted ribs for reducing the length and intensity of the region of reverse flow behind the step is shown.

  15. Lateral Thoracic Osteoplastic Rib-Sparing Technique Used for Lateral Spine Surgery: Technical Note. (United States)

    Moisi, Marc; Fisahn, Christian; Tubbs, R Shane; Page, Jeni; Rice, Richard; Paulson, David; Kazemi, Noojan; Hanscom, David; Oskouian, Rod J


    Of patients who have undergone lateral approaches to the thoracic spine, surgical site postoperative pain appears to be greater among those who have undergone transection and removal of a rib segment than those who have not. Therefore, techniques that conserve anatomical position and minimize tissue disruption would theoretically result in less pain and a quicker recovery. Herein, we describe a rib-sparing osteoplastic technique used when rib segments need to be displaced in order to create an unobscured corridor to the operative target. Our approach minimizes soft tissue disruption and restores the anatomical function of the rib. Based on our experience, these patients report less pain, mobilize earlier, and are discharged sooner than those who have had rib segments sacrificed as part of a lateral approach to the spine.

  16. Recognition of a rare intrathoracic rib with computed tomography: a case report. (United States)

    Abdollahifar, Mohammad-Amin; Abdi, Shabnam; Bayat, Mohammad; Masteri Farahani, Reza; Abbaszadeh, Hojjat-Allah


    One of the uncommon congenital variations is intrathoracic rib which a normal, a bifid, or an accessory rib lies within the thoracic cavity that is founded accidentally. Clinically, in most cases they are without symptoms; however, it may cause intrathoracic problems therefore it is important for radiologists and physicians to identify to prevent of excessive intervention and treatment during imaging diagnostic techniques of thoracic problems. In this report, we provide the case of a rare presentation of an intrathoracic rib in a 3-year-old boy arising from the inferior portion of a second rib based on findings from computed tomography. To our knowledge, this is only the second reported case of this type of intrathoracic rib that demonstrated with computed tomography.

  17. Early intravenous ibuprofen decreases narcotic requirement and length of stay after traumatic rib fracture. (United States)

    Bayouth, Lilly; Safcsak, Karen; Cheatham, Michael L; Smith, Chadwick P; Birrer, Kara L; Promes, John T


    Pain control after traumatic rib fracture is essential to avoid respiratory complications and prolonged hospitalization. Narcotics are commonly used, but adjunctive medications such as nonsteroidal anti-inflammatory drugs may be beneficial. Twenty-one patients with traumatic rib fractures treated with both narcotics and intravenous ibuprofen (IVIb) (Treatment) were retrospectively compared with 21 age- and rib fracture-matched patients who received narcotics alone (Control). Pain medication requirements over the first 7 hospital days were evaluated. Mean daily IVIb dose