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Dodelzon K, Grimm L, Coffey K, Reig B, Mullen L, Dashevsky BZ, Bhole S, Parikh JR. Tips and Tricks for Image-Guided Breast Biopsies: Technical Factors for Success. JOURNAL OF BREAST IMAGING 2024; 6:658-667. [PMID: 39313444 PMCID: PMC11875097 DOI: 10.1093/jbi/wbae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Indexed: 09/25/2024]
Abstract
Image-guided biopsy is an integral step in the diagnosis and management of suspicious image-detected breast or axillary lesions, allowing for accurate diagnosis and, if indicated, treatment planning. Tissue sampling can be performed under guidance of a full spectrum of breast imaging modalities, including stereotactic, tomosynthesis, sonographic, and MRI, each with its own set of advantages and limitations. Procedural planning, which includes consideration of technical, patient, and lesion factors, is vital for diagnostic accuracy and limitation of complications. The purpose of this paper is to review and provide guidance for breast imaging radiologists in selecting the best procedural approach for the individual patient to ensure accurate diagnosis and optimal patient outcomes. Common patient and lesion factors that may affect successful sampling and contribute to postbiopsy complications are reviewed and include obesity, limited patient mobility, patient motion, patients prone to vasovagal reactions, history of anticoagulation, and lesion location, such as proximity to vital structures or breast implant.
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Affiliation(s)
- Katerina Dodelzon
- Weill Cornell Medicine at NewYork-Presbyterian, Department of Radiology, New York, New York, USA
| | - Lars Grimm
- Duke University Medical Center, Department of Radiology, Durham, North Carolina, USA
| | - Kristen Coffey
- Weill Cornell Medicine at NewYork-Presbyterian, Department of Radiology, New York, New York, USA
| | - Beatriu Reig
- New York University Grossman School of Medicine, Department of Radiology New York, NY, USA
| | - Lisa Mullen
- Johns Hopkins Medicine, Department of Radiology, Baltimore, MD, USA
| | - Brittany Z Dashevsky
- Stanford University School of Medicine, Department of Radiology, Stanford, CA, USA
| | - Sonya Bhole
- Northwestern University, Feinberg School of Medicine, Department of Radiology Chicago IL, USA
| | - Jay R. Parikh
- The University of Texas MD Anderson Cancer Center, Department of Radiology Houston, TX USA
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El-bakoury E, Abd El Maksoud WM, Sultan MH, Elwany YN, Bawahab MA, Ahmed YS, Mehanna AA. Ultrasound-guided percutaneous insertion of small vascular surgical clips versus dedicated breast mammoclips as markers for breast cancer prior to neo-adjuvant therapy: a prospective randomized controlled trial. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022; 53:262. [DOI: 10.1186/s43055-022-00922-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/30/2022] [Indexed: 09/02/2023] Open
Abstract
Abstract
Aim
To investigate the feasibility of applying small vascular surgical clips as tissue markers for breast cancer in patients scheduled for neoadjuvant chemotherapy (NAC) in comparison with the dedicated breast clips with assessment of their different complications.
Patients and methods
This prospective randomized controlled trial included 160 female patients with breast cancer whose neoadjuvant chemotherapy was required for their management. Patients were randomly allocated into 2 groups; group I for patients who were subjected to the insertion of the small vascular surgical clips, and Group II for patients who were subjected to the insertion of the dedicated breast clips (UltraClips®). Assessment of the feasibility of the application of the vascular surgical clips and detection of the complications of the vascular surgical clips compared to the UltraClip® commercial clips were the endpoints of this study.
Results
Vascular surgical clips application had significantly longer duration than the duration of application of the UltraClips® (9.10 ± 2.67 min, and 5.44 ± 1.09 min respectively, P < 0.001). The application of vascular surgical clips was feasible in all patients. There were more incidences of non-deployment (6 patients) and mal-deployment (4 patients) in group I, compared to one patient and 2 patients in group II, respectively. All patients of non-deployment and mal-deployment in both groups had reapplication of other clips successfully. There were no significant differences between the two groups regarding incidence of complications.
Conclusions
The spinal needle/surgical vascular clip technique seems to be a cheap and effective alternative to the dedicated commercial mammoclips when required, with convenient results and minimal complications.
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Kim YJ, Kim DH, Choi H, Ryu DH, Yun HY. Delayed duodenal stump fistula after laparoscopic distal gastrectomy with Billroth-II reconstruction for early gastric cancer: A case report. Medicine (Baltimore) 2022; 101:e29732. [PMID: 35801737 PMCID: PMC9259114 DOI: 10.1097/md.0000000000029732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Duodenal stump fistula (DSF) is one of the most serious complications of gastrectomy. The mean time to diagnosis of DSF is approximately 9 days after operation. Our report describes an extremely rare case of delayed DSF 144 days after a laparoscopic distal gastrectomy. A 58-year-old man with drug-induced liver cirrhosis (Child-Pugh class A) underwent laparoscopic distal gastrectomy with Billroth-II reconstruction for early gastric cancer. On postoperative day 1, he underwent reoperation because of intra-abdominal bleeding. Ongoing bleeding was observed in the stapler line of the duodenal stump and was controlled using metallic surgical clips. The patient was discharged on postoperative day 14, without complications. After 144 days following the first operation, he visited the emergency room with right flank pain and high fever. Computed tomography revealed free air and abscess near the duodenal stump site. Emergency laparotomy, abscess unlooping, and drain insertion were performed. After surgery, bile was drained by intra-abdominal drainage, and fistulography showed a duodenal fistula. The patient was discharged 55 days after his third surgery. This is an extremely rare case of DSF, which may be caused by the metallic surgical clips used for hemostasis of the duodenal stump stapler line. We believe that the use of metallic surgical clips for hemostasis of the duodenal stump after Billroth-II reconstruction should be avoided.
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Affiliation(s)
- Yeo Jin Kim
- Department of Surgery, Chungbuk National University Hospital, Chungcheongbuk-do, Republic of Korea
- Department of Surgery, Chungbuk National University College of Medicine, Chungcheongbuk-do, Republic of Korea
| | - Dae Hoon Kim
- Department of Surgery, Chungbuk National University Hospital, Chungcheongbuk-do, Republic of Korea
- Department of Surgery, Chungbuk National University College of Medicine, Chungcheongbuk-do, Republic of Korea
- *Correspondence: Dae Hoon Kim, Department of Surgery, Chungbuk National University College of Medicine, 1, Chungdae-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28644, Republic of Korea (e-mail: )
| | - Hanlim Choi
- Department of Surgery, Chungbuk National University Hospital, Chungcheongbuk-do, Republic of Korea
- Department of Surgery, Chungbuk National University College of Medicine, Chungcheongbuk-do, Republic of Korea
| | - Dong Hee Ryu
- Department of Surgery, Chungbuk National University Hospital, Chungcheongbuk-do, Republic of Korea
- Department of Surgery, Chungbuk National University College of Medicine, Chungcheongbuk-do, Republic of Korea
| | - Hyo Yung Yun
- Department of Surgery, Chungbuk National University Hospital, Chungcheongbuk-do, Republic of Korea
- Department of Surgery, Chungbuk National University College of Medicine, Chungcheongbuk-do, Republic of Korea
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Contact Dermatitis in the Surgical Patient: A Focus on Wound Closure Materials. Dermatitis 2022; 34:191-200. [PMID: 35481860 DOI: 10.1097/der.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Irritant and allergic contact dermatitis from wound closure materials can occur in patients after surgical procedures. The resulting inflammation from contact dermatitis can compromise wound healing, mimic surgical site infections, and result in wound dehiscence. Components of wound closure material, such as antibiotic coatings, dyes, sterilizing compounds, or the material itself, have been implicated as contact allergens. This article provides the latest overview of the components of 3 major forms of wound closure materials-sutures, staples, and tissue adhesives-associated with contact dermatitis, discusses their cross-reactivity, and provides diagnostic and treatment guidelines.
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Ji X, Wei M, Wang L, Li J, Gao D, Geng C. Application of ultrasound-guided placement of markers for locating axillary lymph nodes of breast cancer. Gland Surg 2021; 10:3067-3074. [PMID: 34926222 PMCID: PMC8637064 DOI: 10.21037/gs-21-598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/29/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND With the continuous improvement of pathological complete response (pCR) rate after neoadjuvant therapy (NAT), it is necessary to locate the tumor bed and axillary lymph nodes (ALNs) for subsequent surgery. Therefore, breast tissue markers emerge. This study aims to evaluate the feasibility and accuracy of ultrasound (US)-guided placement of markers for locating ALNs of breast cancer. METHODS A total of 285 patients who received US-guided placement of markers for locating ALNs in our hospital were selected. Among these patients, 87 patients were in the early breast cancer (EBC) group with negative ALNs and 198 ones were in the NAT group with positive ALNs. Data including the basic information of patients, position and size of ALN, process of US-guided marker placement, placement success rate, complications, detection rate of marker by imaging, and shift rate were recorded. RESULTS All patients were successfully undergone US-guided marker placement. And the average operation time was 2 minutes with no adverse reactions. All the patients underwent surgery successfully. US, computer tomography (CT) and magnetic resonance imaging (MRI) were used to detect the marker. The detection rate of markers by US and CT/MRI were 100% (87/87) in EBC group, and 98.5% (195/198) and 100% (198/198) by US and CT/MRI, respectively, in NAT group. The postoperative marker shift rate was 2.1% (6/285), including 3.4% (3/87) marker shift rate in EBC group and 1.5% (3/198) in NAT group, with no statistically significant difference between them. CONCLUSIONS US-guided marker placement in ALNs of breast cancer is simple and safe, with firm positioning and low shift rate, which is convenient for clinical promotion.
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Affiliation(s)
- Xiaohui Ji
- Department of Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mengying Wei
- Department of Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liuyuan Wang
- Department of Breast Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Juanjuan Li
- Department of Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dongxia Gao
- Department of Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Cuizhi Geng
- Department of Breast Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Benefits and Biosafety of Use of 3D-Printing Technology for Titanium Biomedical Implants: A Pilot Study in the Rabbit Model. Int J Mol Sci 2021; 22:ijms22168480. [PMID: 34445182 PMCID: PMC8395183 DOI: 10.3390/ijms22168480] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Titanium has been used in osteosynthesis for decades and its compatibility and safety is unquestioned. Studies have shown that there is release and collection of titanium in the organ systems with little note of toxicity. The gold standard is considered to be titanium osteosynthesis plate produced by milling methods. The use of customized titanium plates produced with 3D printing, specifically direct metal laser sintering, have found increasing use in recent years. It is unknown how much titanium is released in these printed titanium implants, which is known to be potentially porous, depending on the heat settings of the printer. We hypothesize that the amount of titanium released in printed titanium implants may be potentially more or equal compared to the gold standard, which is the implant produced by milling. METHODS We studied the biosafety of this technology and its products by measuring serum and organ titanium levels after implantation of 3D-printed versus traditionally fabrication titanium plates and screws in a pilot study using the rabbit model. A total of nine rabbits were used, with three each in the control, milled and printed titanium group. The animals were euthanized after six months. Serum and organs of the reticuloendothelial system were harvested, digested and assayed for titanium levels. RESULTS Organ and serum titanium levels were significantly higher in rabbit subjects implanted with titanium implants (milled and printed) compared to the control group. However, there was no significant difference in organ and serum titanium levels of subjects implanted with milled and traditionally fabricated titanium implants. CONCLUSIONS The biosafety of use of 3D-printed titanium implants and traditionally fabricated titanium implants are comparable. With this in mind, 3D-printed custom implants can not only replace, but will very possibly surpass traditionally fabricated titanium implants in the mode and extent of use.
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Guergan S, Hoopmann U, Roehm C, Boeer B, Fugunt R, Helms G, Seller A, Marx M, Oberlechner E, Hartkopf A, Preibsch H, Brucker S, Wallwiener D, Hahn M, Gruber IV. Evaluation of sonographic detectability of different markers within an in vitro simulation model of the axilla. Arch Gynecol Obstet 2021; 304:839-848. [PMID: 34142225 PMCID: PMC8325667 DOI: 10.1007/s00404-021-06085-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Clip-marking of axillary lymph nodes with initial biopsy-confirmed metastasis is required for targeted axillary dissection (TAD), which includes sentinel lymph node dissection (SLND) and selective localization and removal of the clipped targeted lymph node. There have been several studies which examined the feasibility of TAD in routine clinical use. In this context, the optimal clip visualisation was noted as one of the crucial limiting factors. We, therefore, evaluated the sonographic detectability of 10 different commercially available markers within an in vitro model simulating the anatomical composition of the axilla. METHODS In this standardised model consisting of porcine fat with 30 mm thickness, the visibility of a total of ten markers was analysed in all 3 planes (parallel, diagonal, orthograde) with wire guidance and then classified into either "visibility good", "visibility moderate" or "visibility poor" with regard to the alignment of the transducer. Additionally, "real-life conditions" were simulated, in which the markers were searched without any wires guidance. RESULTS It was observed that, while not all markers are detectable in fatty tissue, markers with spherical shape (non-embedded Inconel or Nitinol) or rectangular-shaped Titanium markers with embedded material have a clear advantage. 3D-shaped markers can always be detected in all three axes, which is of particular importance in the axilla with its pyramid shape and fatty tissue. CONCLUSION The shape and the embedding of the material play a crucial role for visibility and efficacy of the marker, as reliable marking of suspicious and pathological axillary lymph nodes is essential for TAD.
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Affiliation(s)
- Selin Guergan
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Uta Hoopmann
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Carmen Roehm
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Bettina Boeer
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Regina Fugunt
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Gisela Helms
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Anna Seller
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Mario Marx
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany.,Department of Plastic, Reconstructive and Breast Surgery, Elblandklinikum Radebeul, Radebeul, Germany
| | - Ernst Oberlechner
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Andreas Hartkopf
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Heike Preibsch
- Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Sara Brucker
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Diethelm Wallwiener
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Markus Hahn
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Ines Verena Gruber
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany.
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Immunological Aspects of Dental Implant Rejection. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7279509. [PMID: 33376734 PMCID: PMC7744195 DOI: 10.1155/2020/7279509] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/29/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
Nowadays, dental implants are a prominent therapeutic approach among dentists for replacing missing teeth. Failure in dental implants is a severe challenge recently. The factors which lead to dental implant failure are known. These factors can be categorized into different groups. In this article, we discussed the immunological aspects of implant failure as one of these groups. Cytokines and immune cells have extensive and various functions in peri-implantitis. The equilibrium between pro and anti-inflammatory cytokines and cells, which involve in this orchestra, has a crucial role in implant prognosis. In conclusion, immune cells, especially macrophages and dendritic cells, almost increased in the patients with implant failure. Also, proinflammatory cytokines were proposed as diagnostic factors according to their higher levels in dental implant rejection.
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Smith S, Taylor CR, Kanevsky E, Povoski SP, Hawley JR. Long-term safety and efficacy of breast biopsy markers in clinical practice. Expert Rev Med Devices 2020; 18:121-128. [PMID: 33233969 DOI: 10.1080/17434440.2020.1852928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective: Percutaneous breast and axillary core biopsy followed by marker placement are integral parts of a breast imager's practice benefiting both patients and clinicians. Marker placement is the standard to facilitate future care. The purpose of this study is to characterize the safety and performance of MammoMARK, CorMARK, and HydroMARK biopsy markers by evaluating device-related adverse events, device deficiencies, and long-term safety.Methods: A retrospective review of three radiology practices identified patients who underwent image-guided breast or axillary biopsies followed by marker placement between 1 January 2012 and 1 January 2017. Medical records were reviewed with adverse events related to marker placement and use recorded.Results: 768 markers were placed with three (0.4%) events recorded. Two device deficiencies and one non-serious adverse event occurred in three patients. Device deficiency events involved user errors deploying the markers, one to inability to locate the marker on post-biopsy imaging, and the second to misplacement relative to biopsy target. One non-serious adverse event involved inability to locate/retain the marker in a surgically resected specimen. No serious adverse events were reported.Conclusion: Placement of breast biopsy markers is safe with minimal associated risks. Issues related to device malfunction, durability, reliability, safety, or performance were not reported.
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Affiliation(s)
- Sharon Smith
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Clayton R Taylor
- Department of Radiology, Division of Women's and Breast Imaging, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Stephen P Povoski
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jeffrey R Hawley
- Department of Radiology, Division of Women's and Breast Imaging, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Ge S, Beh JCY, Chee D, Goh L. Entanglement of biopsy needle with pre‐existing breast marker clip—An unusual complication during ultrasound‐guided breast rebiopsy. Breast J 2020; 26:1876-1878. [DOI: 10.1111/tbj.13820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 11/28/2022]
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Park C, Chevalier F, Möbus V, Hoedl P, Engelmann K, Falk S, Leithner D, Kaltenbach B, Vogl TJ, Müller-Schimpfle M. Subsequent Marking under Ultrasound Guidance of Vacuum-Assisted Breast Biopsy Areas after Receipt of Histology: A Feasibility Study of a New Technique. Breast Care (Basel) 2020; 15:628-634. [PMID: 33447237 DOI: 10.1159/000506069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/21/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of this study was to evaluate the feasibility and the accuracy of a secondary, metachronous ultrasound (US)-guided marking of the stereotactic vacuum-assisted breast biopsy (ST-VABB) area. Materials and Methods The institutional ethics committee approved the study. The retrospective study included 98 patients. In ST-VABB of 45 women, no tissue markers were deployed at the biopsy site, even if no residual calcifications remained. After histology proved the necessity for a subsequent operation, the biopsy site was marked under US guidance using a coil marker. All interventions were technically successful. No complications occurred. Mammography was done to visualize the coil deployment. The distances from the center of the lesion and the biopsy cavity to the coil location were measured in both planes to evaluate the accuracy of the marking procedure. Results In 24 of the 46 cases, the whole lesion was biopsied without residual elements. The mean time between ST-VABB and sonographic marking of the lesion was 9.7 days (median 6.5). The biopsy cavity could be detected in 40 (87%) cases and thus marked exactly. The mean time of US-guided marking was 12.5 min. The mean distance between the coil and the target lesion was 0.6 ± 1.5 cm in the craniocaudal (cc) view and 0.5 ± 1.5 cm in the mediolateral (ml) view for all markings. The mean delta value from the distance nipple-original lesion and from the distance nipple-coil was 0.85 ± 1.2 cm (median 0.5) in the cc view and 0.88 ± 1.2 cm (median 0.6) in the ml view for all cases. Clip migration was not observed. Conclusion Our study demonstrates the feasibility and the technical success of secondary metachronous coil marking of the biopsy site under US guidance after receipt of histology. This approach seems to be a cost-effective alternative to the standard procedure of the primary coil marking especially in all completely removed lesions. It may offer advantages for allergic patients.
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Affiliation(s)
- Clara Park
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Frauke Chevalier
- Department of Radiology, Municipal Clinics Frankfurt/Main-Hoechst, Frankfurt am Main, Germany
| | - Volker Möbus
- Department of Gynaecology, Municipal Clinics Frankfurt/Main-Hoechst, Frankfurt am Main, Germany
| | - Petra Hoedl
- Department of Pathology, Municipal Clinics Frankfurt/Main-Hoechst, Frankfurt am Main, Germany
| | | | - Stephan Falk
- OptiPath, Pathology Associates, Frankfurt am Main, Germany
| | - Doris Leithner
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Benjamin Kaltenbach
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Markus Müller-Schimpfle
- Department of Radiology, Municipal Clinics Frankfurt/Main-Hoechst, Frankfurt am Main, Germany
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Amano H, Miyake K, Hinoki A, Yokota K, Kinoshita F, Nakazawa A, Tanaka Y, Seto Y, Uchida H. Novel zinc alloys for biodegradable surgical staples. World J Clin Cases 2020; 8:504-516. [PMID: 32110659 PMCID: PMC7031837 DOI: 10.12998/wjcc.v8.i3.504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/14/2019] [Accepted: 12/21/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The development of biodegradable surgical staples is desirable as non-biodegradable Ti alloy staples reside in the human body long after wound healing, which can cause allergic/foreign-body reactions, adhesion, or other adverse effects. In order to develop a biodegradable alloy suitable for the fabrication of surgical staples, we hypothesized that Zn, a known biodegradable metal, could be alloyed with various elements to improve the mechanical properties while retaining biodegradability and biocompatibility. Considering their biocompatibility, Mg, Ca, Mn, and Cu were selected as candidate alloying elements, alongside Ti, the main material of clinically available surgical staples. AIM To investigate the in vitro mechanical properties and degradation behavior and in vivo safety and feasibility of biodegradable Zn alloy staples. METHODS Tensile and bending tests were conducted to evaluate the mechanical properties of binary Zn alloys with 0.1-6 wt.% Mg, Ca, Mn, Cu, or Ti. Based on the results, three promising Zn alloy compositions were devised for staple applications (wt.%): Zn-1.0Cu-0.2Mn-0.1Ti (Zn alloy 1), Zn-1.0Mn-0.1Ti (Zn alloy 2), and Zn-1.0Cu-0.1Ti (Zn alloy 3). Immersion tests were performed at 37 °C for 4 wk using fed-state simulated intestinal fluid (FeSSIF) and Hank's balanced salt solution (HBSS). The corrosion rate was estimated from the weight loss of staples during immersion. Nine rabbits were subjected to gastric resection using each Zn alloy staple, and a clinically available Ti staple was used for another group of nine rabbits. Three in each group were sacrificed at 1, 4, and 12 wk post-operation. RESULTS Additions of ≤1 wt.% Mn or Cu and 0.1 wt.% Ti improved the yield strength without excessive deterioration of elongation or bendability. Immersion tests revealed no gas evolution or staple fracture in any of the Zn alloy staples. The corrosion rates of Zn alloy staples 1, 2, and 3 were 0.02 mm/year in HBSS and 0.12, 0.11, and 0.13 mm/year, respectively, in FeSSIF. These degradation times are sufficient for wound healing. The degradation rate is notably increased under low pH conditions. Scanning electron microscopy and energy dispersive spectrometry surface analyses of the staples after immersion indicated that the component elements eluted as ions in FeSSIF, whereas corrosion products were produced in HBSS, inhibiting Zn dissolution. In the animal study, none of the Zn alloy staples caused technical failure, and all rabbits survived without complications. Histopathological analysis revealed no severe inflammatory reaction around the Zn alloy staples. CONCLUSION Staples made of Zn-1.0Cu-0.2Mn-0.1Ti, Zn-1.0Mn-0.1Ti, and Zn-1.0Cu-0.1Ti exhibit acceptable in vitro mechanical properties, proper degradation behavior, and in vivo safety and feasibility. They are promising candidates for biodegradable staples.
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Affiliation(s)
- Hizuru Amano
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Koichi Miyake
- Mitsui Mining and Smelting Co., Ltd., Tokyo 141-0032, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Fumie Kinoshita
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya 466-8560, Japan
| | - Atsuko Nakazawa
- Department of Clinical Research, Saitama Children’s Medical Center, Saitama 330-8777, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Yasuhiro Seto
- Mitsui Mining and Smelting Co., Ltd., Tokyo 141-0032, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
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Banys-Paluchowski M, Gruber IV, Hartkopf A, Paluchowski P, Krawczyk N, Marx M, Brucker S, Hahn M. Axillary ultrasound for prediction of response to neoadjuvant therapy in the context of surgical strategies to axillary dissection in primary breast cancer: a systematic review of the current literature. Arch Gynecol Obstet 2020; 301:341-353. [PMID: 31897672 DOI: 10.1007/s00404-019-05428-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Data on the optimal treatment strategy for patients undergoing neoadjuvant therapy (NAT) who initially presented with metastatic nodes and convert to node-negative disease (cN+ → ycN0) are limited. Since NAT leads to axillary downstaging in 20-60% of patients, the question arises whether these patients might be offered less-invasive procedures than axillary dissection, such as sentinel node biopsy or targeted removal of lymph nodes marked before therapy. METHODS We performed a systematic review of clinical studies on the use of axillary ultrasound for prediction of response to NAT and ultrasound-guided marking of metastatic nodes for targeted axillary dissection. RESULTS The sensitivity of ultrasound for prediction of residual node metastasis was higher than that of clinical examination and MRI/PET in most studies; specificity ranged in large trials from 37 to 92%. The diagnostic performance of ultrasound after NAT seems to be associated with tumor subtype: the positive predictive value was highest in luminal, the negative in triple-negative tumors. Several trials evaluated the usefulness of ultrasound for targeted axillary dissection. Before NAT, nodes were most commonly marked using ultrasound-guided clip placement, followed by ultrasound-guided placement of a radioactive seed. After chemotherapy, the clip was detected on ultrasound in 72-83% of patients; a comparison of sonographic visibility of different clips is lacking. Detection rate after radioactive seed placement was ca. 97%. CONCLUSION In conclusion, ultrasound improves prediction of axillary response to treatment in comparison to physical examination and serves as a reliable guiding tool for marking of target lymph nodes before the start of treatment. High quality and standardization of the examination is crucial for selection of patients for less-invasive surgery.
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Affiliation(s)
| | - Ines Verena Gruber
- Department for Women's Health, University of Tübingen, Tübingen, Germany
| | - Andreas Hartkopf
- Department for Women's Health, University of Tübingen, Tübingen, Germany
| | - Peter Paluchowski
- Department of Gynecology and Obstetrics, Regio Klinikum Pinneberg, Pinneberg, Germany
| | - Natalia Krawczyk
- Department of Obstetrics and Gynecology, University of Düsseldorf, Düsseldorf, Germany
| | - Mario Marx
- Department for Women's Health, University of Tübingen, Tübingen, Germany.,Department of Plastic, Reconstructive and Breast Surgery, Elblandklinikum Radebeul, Radebeul, Germany
| | - Sara Brucker
- Department for Women's Health, University of Tübingen, Tübingen, Germany
| | - Markus Hahn
- Department for Women's Health, University of Tübingen, Tübingen, Germany
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Amano H, Hanada K, Hinoki A, Tainaka T, Shirota C, Sumida W, Yokota K, Murase N, Oshima K, Chiba K, Tanaka Y, Uchida H. Biodegradable Surgical Staple Composed of Magnesium Alloy. Sci Rep 2019; 9:14671. [PMID: 31604974 PMCID: PMC6789124 DOI: 10.1038/s41598-019-51123-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 09/25/2019] [Indexed: 11/09/2022] Open
Abstract
Currently, surgical staples are composed of non-biodegradable titanium (Ti) that can cause allergic reactions and interfere with imaging. This paper proposes a novel biodegradable magnesium (Mg) alloy staple and discusses analyses conducted to evaluate its safety and feasibility. Specifically, finite element analysis revealed that the proposed staple has a suitable stress distribution while stapling and maintaining closure. Further, an immersion test using artificial intestinal juice produced satisfactory biodegradable behavior, mechanical durability, and biocompatibility in vitro. Hydrogen resulting from rapid corrosion of Mg was observed in small quantities only in the first week of immersion, and most staples maintained their shapes until at least the fourth week. Further, the tensile force was maintained for more than a week and was reduced to approximately one-half by the fourth week. In addition, the Mg concentration of the intestinal artificial juice was at a low cytotoxic level. In porcine intestinal anastomoses, the Mg alloy staples caused neither technical failure nor such complications as anastomotic leakage, hematoma, or adhesion. No necrosis or serious inflammation reaction was histopathologically recognized. Thus, the proposed Mg alloy staple offers a promising alternative to Ti alloy staples.
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Affiliation(s)
- Hizuru Amano
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Kotaro Hanada
- Advanced Manufacturing Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Ibaraki, 305-8564, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Naruhiko Murase
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Kazuo Oshima
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Kosuke Chiba
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
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Wegner U, Rainford S. Adverse reaction regarding titanium-based marker clip: case report of a potential complication. Int Med Case Rep J 2019; 12:291-295. [PMID: 31695515 PMCID: PMC6718166 DOI: 10.2147/imcrj.s222484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/15/2019] [Indexed: 11/23/2022] Open
Abstract
Adverse reaction to titanium-based breast marker clip is a very uncommon complication in medicine. We report a 65-year-old female patient who was referred with left breast lumpiness to the assessment clinic. Breast radiology with interesting sequelae following titanium clip insertion, in combination with literature review, will be discussed. The patient had a history of adverse skin reactions to base metals. However, no allergy specifically to titanium was reported. Imaging findings with regard to the symptomatic breast were nonspecific; thus, multiple core biopsies were taken, and titanium clip was inserted. Subsequent histological examination showed benign changes. However, 7 weeks later, the marked area became very tender and the same patient re-presented to the clinic, requesting removal of the metallic component. Following multidisciplinary meetings and discussions, the person underwent ultrasound-guided vacuum biopsy and the clip was removed. The symptoms completely resolved after the successful procedure, and histological examination revealed lymphocytic infiltration of the tissues. Reactions to titanium-based marker clips are rare and only limited records have been found in the literature. More cases need to be reported in order to establish the full significance of such adverse sequelae. It is recommended that medical history with regard to allergies, prior titanium clip insertions, should be discussed.
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Affiliation(s)
- Urszula Wegner
- Department of Breast Imaging, Kettering General Hospital, Kettering, UK
| | - Sarah Rainford
- Department of Breast Imaging, Kettering General Hospital, Kettering, UK
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16
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Reprint of: Breast tissue markers: Why? What's out there? How do I choose? Clin Imaging 2019; 55:196-212. [DOI: 10.1016/j.clinimag.2019.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/20/2018] [Accepted: 07/04/2018] [Indexed: 11/21/2022]
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Novel Biocompatible and Biodegradable PCL-PLA/ Iron Oxide NPs Marker Clip Composite for Breast Cancer Biopsy. Polymers (Basel) 2018; 10:polym10121307. [PMID: 30961232 PMCID: PMC6401809 DOI: 10.3390/polym10121307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 12/20/2022] Open
Abstract
Strength and biocompatibility of composite materials (using a polymer matrix) are used in medicine for various devices such as prostheses and marker clips (biomarkers). Marker clips indicate the site of a lesion in the body, specifically for breast cancer diagnosis or treatment. In general, marker clips are made of steel or titanium, but lately, materials containing biodegradable polymers had been proposed. Our hypothesis is that a copolymer of polylactic acid and poly(ε-caprolactone) (PLA-PCL) could be used as marker clip material. After evaluating different polymer rates performance, metallic nanoparticles (NPs) were included to enhance the stability of the best copolymer and a marker clip prototype was proposed. Characterization of nanoparticles was made by dynamic light scattering (DLS), X-ray diffraction (XRD) and magnetic measurements. Mechanical, thermal and radiopacity properties were evaluated for composites formulation. In vitro, radiopaque experiments showed that BM-2 composite had the best performance. In vivo experiments showed that, after five months, the marker clip prototype maintained its shape, visibility and contrast properties. In consequence, a novel formulation of composite (PLA-PCL/metallic nanoparticles) is suitable for further studies as an alternative material for marker clips for breast cancer lesions.
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Breast tissue markers: Why? What's out there? How do I choose? Clin Imaging 2018; 52:123-136. [DOI: 10.1016/j.clinimag.2018.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/20/2018] [Accepted: 07/04/2018] [Indexed: 11/17/2022]
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Mombelli A, Hashim D, Cionca N. What is the impact of titanium particles and biocorrosion on implant survival and complications? A critical review. Clin Oral Implants Res 2018; 29 Suppl 18:37-53. [DOI: 10.1111/clr.13305] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Andrea Mombelli
- Division of Periodontology; University Clinics of Dental Medicine; University of Geneva; Geneva Switzerland
| | - Dena Hashim
- Division of Periodontology; University Clinics of Dental Medicine; University of Geneva; Geneva Switzerland
| | - Norbert Cionca
- Division of Periodontology; University Clinics of Dental Medicine; University of Geneva; Geneva Switzerland
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20
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Hofmann SC, Plett M, Jansen S, Thomas P, Thölken KFM. Titanium hypersensitivity causing painful intra-abdominal oedema after staple-fixed inguinal hernia repair. Contact Dermatitis 2018. [PMID: 29521457 DOI: 10.1111/cod.12985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Silke C Hofmann
- Centre for Dermatology, Allergy and Dermatosurgery, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
| | - Maria Plett
- Centre for Dermatology, Allergy and Dermatosurgery, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
| | - Stefan Jansen
- Centre for Visceral Surgery, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
| | - Peter Thomas
- Department of Dermatology and Allergy, Ludwig-Maximilians-University, Munich, Germany
| | - Karisa F M Thölken
- Centre for Dermatology, Allergy and Dermatosurgery, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
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21
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Marking clips for tumour-bed localization as a cause of chronic sinus formation and pain after breast conservation surgery for cancer: A case series of 4 patients. J Plast Reconstr Aesthet Surg 2016; 69:1302-4. [PMID: 27430604 DOI: 10.1016/j.bjps.2016.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/24/2016] [Accepted: 07/03/2016] [Indexed: 11/22/2022]
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Fage SW, Muris J, Jakobsen SS, Thyssen JP. Titanium: a review on exposure, release, penetration, allergy, epidemiology, and clinical reactivity. Contact Dermatitis 2016; 74:323-45. [PMID: 27027398 DOI: 10.1111/cod.12565] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 11/29/2022]
Abstract
Exposure to titanium (Ti) from implants and from personal care products as nanoparticles (NPs) is common. This article reviews exposure sources, ion release, skin penetration, allergenic effects, and diagnostic possibilities. We conclude that human exposure to Ti mainly derives from dental and medical implants, personal care products, and foods. Despite being considered to be highly biocompatible relative to other metals, Ti is released in the presence of biological fluids and tissue, especially under certain circumstances, which seem to be more likely with regard to dental implants. Although most of the studies reviewed have important limitations, Ti seems not to penetrate a competent skin barrier, either as pure Ti, alloy, or as Ti oxide NPs. However, there are some indications of Ti penetration through the oral mucosa. We conclude that patch testing with the available Ti preparations for detection of type IV hypersensitivity is currently inadequate for Ti. Although several other methods for contact allergy detection have been suggested, including lymphocyte stimulation tests, none has yet been generally accepted, and the diagnosis of Ti allergy is therefore still based primarily on clinical evaluation. Reports on clinical allergy and adverse events have rarely been published. Whether this is because of unawareness of possible adverse reactions to this specific metal, difficulties in detection methods, or the metal actually being relatively safe to use, is still unresolved.
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Affiliation(s)
- Simon W Fage
- Department of Dermato-Venereology, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Joris Muris
- Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - Stig S Jakobsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Jacob P Thyssen
- National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
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23
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24
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Nihon-Yanagi Y, Ishiwatari T, Otsuka Y, Okubo Y, Tochigi N, Wakayama M, Nemoto T, Watanabe M, Kaneko H, Sumino Y, Shibuya K. A case of postoperative hepatic granuloma presumptively caused by surgical staples/clipping materials. Diagn Pathol 2015; 10:90. [PMID: 26156756 PMCID: PMC4495706 DOI: 10.1186/s13000-015-0291-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 05/05/2015] [Indexed: 01/18/2023] Open
Abstract
A 66-year-old man with postsigmoidectomy status for colon cancer received laparoscopic partial hepatectomy due to a hepatic mass with employing titanium clips were for a vascular clamp. Histological examination showed liver metastasis from sigmoid colon cancer. Twenty-nine months after the partial hepatectomy, a mass developed on the stump at the hepatic resection. Laparoscopic left lateral segmentectomy was conducted under suspicion of cancer recurrence and an automatic titanium stapling device was used. The macroscopically cut surface of the liver showed a grey-white solid nodule measuring 23 x 20 mm and involving metal clips. The nodule was consistent with granuloma microscopically. Twenty-three months after the segmentectomy, a mass reappeared on the hepatic radial margin and an open left lateral hepatic lobectomy was performed because of its growth tendency. Histopathological examination revealed granuloma similar to the previous instance. Since these nodules formed a granulomatous lesion surrounding metal staples/clips and evidence of caseous necrosis was lacking, granuloma due to surgical staples/clips was suspected. Sporadic case reports of postoperative pulmonary granuloma at the staple line have been published previously, but there are no articles detailing a case involving hepatic granuloma. We present our case as the first report of postoperative staple-line hepatic granuloma.
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Affiliation(s)
- Yasuhiro Nihon-Yanagi
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan.
| | - Takao Ishiwatari
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan.
| | - Yuichiro Otsuka
- Department of General and Gastroenterological Surgery, Toho University School of Medicine, 6-11-1 Omori-Nishi,, 143-8541, Ota-Ku, Tokyo, Japan.
| | - Yoichiro Okubo
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan.
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan.
| | - Megumi Wakayama
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan.
| | - Tetsuo Nemoto
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan.
| | - Manabu Watanabe
- Division of Gastroenterology and Hepatology; Department of Internal Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan.
| | - Hironori Kaneko
- Department of General and Gastroenterological Surgery, Toho University School of Medicine, 6-11-1 Omori-Nishi,, 143-8541, Ota-Ku, Tokyo, Japan.
| | - Yasukiyo Sumino
- Division of Gastroenterology and Hepatology; Department of Internal Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan.
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, 143-8541, Ota-Ku, Tokyo, Japan.
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Youn I, Choi SH, Kook SH, Choi YJ, Park CH, Park YL, Kim DH. Ultrasonography-guided surgical clip placement for tumor localization in patients undergoing neoadjuvant chemotherapy for breast cancer. J Breast Cancer 2015; 18:44-9. [PMID: 25834610 PMCID: PMC4381122 DOI: 10.4048/jbc.2015.18.1.44] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/27/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose We investigated the feasibility of using surgical clips as markers for tumor localization and their effect on the imaging evaluation of treatment responses after neoadjuvant chemotherapy (NAC). Methods A total of 16 breast cancers confirmed by needle biopsy in 15 patients were included in this study from October 2012 to June 2014. Under ultrasonography (US)-guidance, the surgical clips were placed prior to NAC. Additional mammography, breast US, and breast magnetic resonance examinations were performed within 10 days before surgery. The time period from marker insertion to operation date was documented. Images acquired via the three modalities were evalu-ated for the following parameters: location of clip, clip migration (>1 cm), the presence of complications from clip placement, and the effect of clips on the assessment of treatment. Results The mean time period was 128.6±34.4 days (median, 132.0 days) from the date of clip insertion to the date of surgery. The mean number of inserted clips was 2.3±0.7 (median, 2.0). Clip migration was not visualized by imaging in any patient, and there were no complications reported. Surgical clips did not negatively affect the assessment of treatment responses to NAC. Conclusion Surgical clips may replace commercial tissue markers for tumor localization in breast cancer patients undergoing NAC without migration. Surgical clips are well tolerated and safe for the patient, easily visualized on imaging, do not interfere with treatment response, and are cost-effective.
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Affiliation(s)
- Inyoung Youn
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seon Hyeong Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin Ho Kook
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Heun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Lai Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hoon Kim
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Osman RB, Swain MV. A Critical Review of Dental Implant Materials with an Emphasis on Titanium versus Zirconia. MATERIALS 2015; 8:932-958. [PMID: 28787980 PMCID: PMC5455450 DOI: 10.3390/ma8030932] [Citation(s) in RCA: 230] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/20/2015] [Accepted: 02/12/2015] [Indexed: 01/21/2023]
Abstract
The goal of the current publication is to provide a comprehensive literature review on the topic of dental implant materials. The following paper focuses on conventional titanium implants and more recently introduced and increasingly popular zirconia implants. Major subtopics include the material science and the clinical considerations involving both implant materials and the influence of their physical properties on the treatment outcome. Titanium remains the gold standard for the fabrication of oral implants, even though sensitivity does occur, though its clinical relevance is not yet clear. Zirconia implants may prove to be promising in the future; however, further in vitro and well-designed in vivo clinical studies are needed before such a recommendation can be made. Special considerations and technical experience are needed when dealing with zirconia implants to minimize the incidence of mechanical failure.
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Affiliation(s)
- Reham B Osman
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centrum of Dentistry Amsterdam (ACTA), 1081 LA Amsterdam, The Netherlands.
- Department of Removable Prosthodontics, Cairo University, Giza 11553, Egypt.
| | - Michael V Swain
- Biomaterials Laboratory, Sydney Dental Hospital, the University of Sydney, Surry Hills, NSW 2010, Australia.
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Abstract
Titanium has gained immense popularity and has successfully established itself as the material of choice for dental implants. In both medical and dental fields, titanium and its alloys have demonstrated success as biomedical devices. Owing to its high resistance to corrosion in a physiological environment and the excellent biocompatibility that gives it a passive, stable oxide film, titanium is considered the material of choice for intraosseous use. There are certain studies which show titanium as an allergen but the resources to diagnose titanium sensivity are very limited. Attention is needed towards the development of new and precise method for early diagnosis of titanium allergy and also to find out the alternative biomaterial which can be used in place of titanium. A review of available articles from the Medline and PubMed database was done to find literature available regarding titanium allergy, its diagnosis and new alternative material for titanium.
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Affiliation(s)
- Manish Goutam
- Department of Prosthodontics and Implantology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Chandu Giriyapura
- Department of Prosthodontics and Implantology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Sunil Kumar Mishra
- Department of Prosthodontics and Implantology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Siddharth Gupta
- Department of Prosthodontics and Implantology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
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SAITO M, KARAKIDA T, YAMAMOTO R, NAGANO T, YAMAKOSHI Y, HAYAKAWA T, OIDA S, GOMI K. Differentiation potential of osteoblast from cultured C2C12 cells on zirconia disk. Dent Mater J 2014; 33:275-83. [DOI: 10.4012/dmj.2013-321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Idiopathic granulomatous mastitis (IGM) is a rare condition of unknown etiology with nonspecific findings. We present an unusual case of IGM manifesting after breast biopsy in a 42-year-old Turkish woman. IGM should be considered in the differential diagnosis when mastitis, carcinoma, and systemic diseases have been excluded and especially in the setting of a postbiopsy infection that is not responsive to antibiotic therapy.
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A plea for the biopsy marker: how, why and why not clipping after breast biopsy? Breast Cancer Res Treat 2011; 132:881-93. [DOI: 10.1007/s10549-011-1847-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 10/19/2011] [Indexed: 10/16/2022]
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Lésion eczématiforme chronique du sein après mise en place d’un clip chirurgical. ACTA ACUST UNITED AC 2011; 40:174-7. [DOI: 10.1016/j.jgyn.2010.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 07/15/2010] [Accepted: 07/28/2010] [Indexed: 11/19/2022]
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Yamazoe M. Study of corrosion of combinations of titanium/Ti-6Al-4V implants and dental alloys. Dent Mater J 2010; 29:542-53. [PMID: 20823622 DOI: 10.4012/dmj.2010-005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Metal ions released in 1% lactic acid solution from combinations of titanium fixtures with superstructures made of dental precious metal alloys (dental alloys) and titanium and differences based on the fixing method were investigated. In combinations of titanium with dental alloys, the level of Ti release was influenced by micro-structure of titanium: it was lower when the grain size was smaller. In titanium-titanium combinations, differences in the micro-structure of metal also markedly influenced the dissolution: the level of release increased when the micro-structure of titanium was different. The Ti and V release levels were higher in combination with titanium alloy and titanium than with titanium alloy and dental alloys. Regarding the superstructure-fixture fixing method, the level of Ti release was significantly lower in cement than in direct fixation.
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Affiliation(s)
- Masatoshi Yamazoe
- Division of Biomaterials, Department of Hard Tissue Research, Graduate School of Oral Medicine, Matsumoto Dental University, 1780 Gobara Hirooka Shiojiri, Nagano 399-0781, Japan.
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Kohal RJ, Baechle M, Han JS, Hueren D, Huebner U, Butz F. In vitro reaction of human osteoblasts on alumina-toughened zirconia. Clin Oral Implants Res 2009; 20:1265-71. [PMID: 19681970 DOI: 10.1111/j.1600-0501.2009.01735.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Alumina toughening enhances the mechanical properties of zirconia ceramics but the biocompatibility of this material has rarely been addressed. In this study, we examined the osteoblast response to alumina-toughened zirconia (ATZ) with different surface topographies. MATERIAL AND METHODS Human osteoblasts isolated from maxillary biopsies of four patients were cultured and seeded onto disks of the following substrates: ATZ with a machined surface, airborne-particle abraded ATZ, airborne-particle abraded and acid etched ATZ. Airborne-particle abraded and acid etched titanium (SLA) and polystyrene disks served as a reference control. The surface topography of the various substrates was characterized by profilometry (R(a), R(p-v)) and scanning electron microscopy (SEM). Cell proliferation, cell-covered surface area, alkaline phophatase (ALP) and osteocalcin production were determined. The cell morphology was analyzed on SEM images. RESULTS The surface roughness of ATZ was increased by airborne-particle abrasion, but with the R(a) and R(p-v) values showing significantly lower values compared with SLA titanium (Mann-Whitney U-test P<0.05). The proliferation assay revealed no statistically significant differences between the ATZ substrates, SLA titanium and polystyrene (Kruskal-Wallis test, P>0.05). All substrates were densely covered by osteoblasts. ALP and osteocalcin production was similar on the examined surfaces. Cell morphology analysis revealed flat-spread osteoblasts with cellular extensions on all substrates. CONCLUSIONS These results indicate that ATZ may be a viable substrate for the growth and differentiation of human osteoblasts. Surface modification of ATZ by airborne-particle abrasion alone or in combination with acid etching seems not to interfere with the growth and differentiation of the osteoblasts.
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Affiliation(s)
- Ralf J Kohal
- Department of Prosthodontics, School of Dentistry, University Hospital Freiburg, Freiburg, Germany
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Egusa H, Ko N, Shimazu T, Yatani H. Suspected association of an allergic reaction with titanium dental implants: a clinical report. J Prosthet Dent 2009; 100:344-7. [PMID: 18992567 DOI: 10.1016/s0022-3913(08)60233-4] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent reports have questioned whether metal sensitivity may occur after exposure to titanium. This clinical report demonstrates the emergence of facial eczema in association with a titanium dental implant placed for a mandibular overdenture supported by 2 implants. Complete remission was achieved by the removal of the titanium material. This clinical report raises the possibility that in rare circumstances, for some patients, the use of titanium dental implants may induce an allergic reaction.
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Affiliation(s)
- Hiroshi Egusa
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
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Sicilia A, Cuesta S, Coma G, Arregui I, Guisasola C, Ruiz E, Maestro A. Titanium allergy in dental implant patients: a clinical study on 1500 consecutive patients. Clin Oral Implants Res 2009; 19:823-35. [PMID: 18705814 DOI: 10.1111/j.1600-0501.2008.01544.x] [Citation(s) in RCA: 265] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In dentistry, allergic reactions to Ti implants have not been studied, nor considered by professionals. Placing permanent metal dental implants in allergic patients can provoke type IV or I reactions. Several symptoms have been described, from skin rashes and implant failure, to non-specific immune suppression. OBJECTIVE Our objective was to evaluate the presence of titanium allergy by the anamnesis and examination of patients, together with the selective use of cutaneous and epicutaneous testing, in patients treated with or intending to receive dental implants of such material. MATERIAL AND METHODS Thirty-five subjects out of 1500 implant patients treated and/or examined (2002-2004) were selected for Ti allergy analysis. Sixteen presented allergic symptoms after implant placement or unexplained implant failures [allergy compatible response group (ACRG)], while 19 had a history of other allergies, or were heavily Ti exposed during implant surgeries or had explained implant failures [predisposing factors group (PFG)]. Thirty-five controls were randomly selected (CG) in the Allergy Centre. Cutaneous and epicutaneous tests were carried out. RESULTS Nine out of the 1500 patients displayed positive (+) reactions to Ti allergy tests (0.6%): eight in the ACRG (50%), one in the PFG (5.3%)(P=0.009) and zero in the control group. Five positives were unexplained implant failures (five out of eight). CONCLUSIONS Ti allergy can be detected in dental implant patients, even though its estimated prevalence is low (0.6%). A significantly higher risk of positive allergic reaction was found in patients showing post-op allergy compatible response (ACRG), in which cases allergy tests could be recommended.
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Stynes G, Kiroff GK, Morrison WAJ, Kirkland MA. Tissue compatibility of biomaterials: benefits and problems of skin biointegration. ANZ J Surg 2008; 78:654-9. [PMID: 18796021 DOI: 10.1111/j.1445-2197.2008.04609.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The integration of biomaterials with skin is necessary to enable infection-free access to vasculature and body cavities. Also, integrating plastics and metals with skin increases options for the reconstruction of surgical and traumatic defects and enables the permanent implantation of robotic and electronic devices. Until now, attempts to integrate biomaterials with skin permanently have failed because of epidermal marsupialization and infection. This article reviews the general properties required of biomaterials to optimize integration with body tissues, the modifications that increase biocompatibility, focusing particularly on surface functionalization and the specific requirements for biomaterial integration into skin. Critical pathophysiological processes relating to biocompatibility are discussed with particular emphasis on the skin-biomaterial interface. Future directions are speculated on, in particular, the specific utility of subatmospheric pressure dressings in facilitating tissue integration into biomaterials.
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Affiliation(s)
- Gil Stynes
- Barwon Biomedical Research, Department of Clinical and Biomedical Sciences, The Geelong Hospital, Geelong, Australia.
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Vamanu CI, Høl PJ, Allouni ZE, Elsayed S, Gjerdet NR. Formation of potential titanium antigens based on protein binding to titanium dioxide nanoparticles. Int J Nanomedicine 2008; 3:69-74. [PMID: 18488417 PMCID: PMC2526361 DOI: 10.2147/ijn.s1796] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Degradation products of titanium implants include free ions, organo-metallic complexes, and particles, ranging from nano to macro sizes. The biological effects, especially of nanoparticles, is yet unknown. The main objective of this study was to develop Ti-protein antigens in physiological solutions that can be used in testing of cellular responses. For this purpose, 0.1% TiO2 nanoparticles less than 100 nm were mixed with human serum albumin (HSA), 0.1% and 1%, in cell culture medium (DMEM, pH 7.2). The Ti concentrations in the resulting solutions were analyzed by inductively coupled plasma mass spectrometry. The stability of the nanoparticles in suspension was analyzed by UV-vis spectrophotometer and Dynamic Light Scattering. The concentration of Ti in suspension was dependent on the presence and concentration of HSA. Albumin prevented high aggregation rate of TiO2 nanoparticles in cell culture medium. It is shown that nano TiO2-protein stable aggregates can be produced under physiological conditions at high concentrations, and are candidates for use in cellular tests.
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Affiliation(s)
- Carmen Irina Vamanu
- Department of Oral Sciences, Faculty of Dentistry, University of Bergen, Bergen, Norway.
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Bächle M, Butz F, Hübner U, Bakalinis E, Kohal RJ. Behavior of CAL72 osteoblast-like cells cultured on zirconia ceramics with different surface topographies. Clin Oral Implants Res 2007; 18:53-9. [PMID: 17224024 DOI: 10.1111/j.1600-0501.2006.01292.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Because of its inherent strength, biocompatibility, and tooth-like color, zirconia ceramics have the potential to become an alternative to titanium as dental implant material. This study aimed at investigating the osteoblastic response to yttrium-stabilized tetragonal zirconia polycrystal (Y-TZP) with different surface topographies. METHODS CAL72 osteoblast-like cells were cultured on machined (TZP-m), airborne particle abraded (TZP-s), and airborne particle abraded and acid-etched Y-TZP (TZP-sa) surfaces. Polystyrene and airborne particle abraded with large grit and acid-etched (SLA) titanium served as a reference control. The surface topography was examined by scanning electron microscopy (SEM) and profilometry. At culture days 3, 6, and 12, cell proliferation, at day 12 cell morphology, and cell-covered surface area were determined. RESULTS The surface roughness of Y-TZP was increased by airborne particle abrasion and additionally by acid etching. No statistically significant differences were found between average roughness (R(a)) and maximum peak-to-valley height (R(p-v)) values of airborne particle abraded and acid-etched Y-TZP and SLA titanium. Whereas the cell proliferation assay revealed statistically significant greater values at day 3 for surface-treated Y-TZP and polystyrene cultures as compared with machined Y-TZP, no differences between the Y-TZP groups, SLA titanium, and polystyrene were observed at culture days 6 and 12. CONCLUSIONS Cell morphology and cell-covered surface area were not affected by the type of substrate. The results suggest that roughened Y-TZP is an appropriate substrate for the proliferation and spreading of osteoblastic cells.
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Affiliation(s)
- Maria Bächle
- Department of Prosthodontics, School of Dentistry, University Hospital Freiburg, Freiburg, Germany.
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Flatebø RS, Johannessen AC, Grønningsaeter AG, Bøe OE, Gjerdet NR, Grung B, Leknes KN. Host Response to Titanium Dental Implant Placement Evaluated in a Human Oral Model. J Periodontol 2006; 77:1201-10. [PMID: 16805683 DOI: 10.1902/jop.2006.050406] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recent reports have questioned if metal sensitivity may arise from exposure to titanium. The objective of this study was to histologically evaluate non-perforated mucosa covering submerged maxillary titanium implants with regard to induced tissue reactions. METHODS Thirteen patients, 21 to 69 years of age, without previous implants were included. After initial examination, the bone crest areas destined for dental implant placement were exposed, and threaded external hex dental implants were inserted. Prior to wound closure, a full mucosal tissue slice was biopsied from the edge of the mucoperiosteal flap (baseline). The patients were monitored monthly for 6 months. At the abutment connection, biopsies were taken by a 6-mm punch, altogether yielding 26 specimens. Tissue reactions were analyzed by coded histometric analysis at four defined areas at increasing distance from the oral epithelium, including ratios of inflammatory cells (IC)/epithelial cells, IC/fibroblasts, and number of dense particles. RESULTS The stained sections portrayed gingival tissue with intact oral epithelium and connective tissue with variable accumulation of IC. Experimental biopsies demonstrated mineralized areas and dense particles of different sizes. Analysis of variance revealed a higher IC/fibroblast ratio for level 3 at baseline compared to level 3 at 6 months (P<0.01). Furthermore, a significant decrease in IC/fibroblast ratio was observed between levels 2 and 3 and 2 and 4 at 6 months (P<0.001). The connective tissue level facing the cover screw contained the highest number of dense particles (P<0.01). CONCLUSIONS Tissue sensitivity reactions to titanium implants were not disclosed. All 6-month biopsies contained dense particles that were most likely metals.
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Affiliation(s)
- Rigmor S Flatebø
- Department of Oral Sciences - Periodontology, Faculty of Dentistry, University of Bergen, Bergen, and Department of Oral and Maxillofacial Surgery, Stavanger University Hospital, Stavanger, Norway
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Zaffe D, Bertoldi C, Consolo U. Accumulation of aluminium in lamellar bone after implantation of titanium plates, Ti-6Al-4V screws, hydroxyapatite granules. Biomaterials 2004; 25:3837-44. [PMID: 15020159 DOI: 10.1016/j.biomaterials.2003.10.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2003] [Accepted: 10/07/2003] [Indexed: 11/16/2022]
Abstract
Titanium plates, Ti6Al4V screws and surrounding tissues, and biopsies of hydroxyapatite (Osprovit) grafts of maxillary sinus lifting were investigated to evaluate the release and accumulation of ions. Optical microscopy, SEM and X-ray microanalysis were carried out to evaluate the plates and screws removed from patients presenting inflammation and biopsies. Ions release from metallic appliances or leaching from granules towards soft tissues was observed. An accumulation of aluminium but not titanium was found in soft tissues. A peculiar accumulation of aluminium in the dense lamella of newly formed bone was recorded. The results seem to indicate that biological perturbations may be related to aluminium release from the tested biomaterials. The aluminium content of these biomaterials, its diffusion and accumulation are discussed. Further studies on ion release from biomaterials and aluminium fate in skeletal tissues are suggested.
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Affiliation(s)
- Davide Zaffe
- Department of Anatomy, Section of Human Anatomy, University of Modena and Reggio Emilia, Via del Pozzo 71, Policlinico, 41100 Modena, MO, Italy.
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Zaffe D, Bertoldi C, Consolo U. Element release from titanium devices used in oral and maxillofacial surgery. Biomaterials 2003; 24:1093-9. [PMID: 12504532 DOI: 10.1016/s0142-9612(02)00424-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Optical microscopy, scanning electron microscopy and X-ray microanalysis (EDS system) were used on c.p. titanium devices (21 grids and 10 plates) removed from 28 patients without signs of inflammation 6-24 months after surgery. Plates, grids and surrounding tissue were investigated to evaluate the titanium release and accumulation. Titanium was only present in the interfacial bone, probably due to fretting, and in all fibrous tissue surrounding the devices. Titanium content followed a decreasing gradient extending from the device surface and was not detected at a distance greater than 1mm. High titanium levels were found in blood cells in the connective tissue. In conclusion, titanium release from the devices stops only after bone is laid down on the titanium surfaces. Titanium release does not seem to interfere with the osteogenic process but perhaps may interact with it.
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Affiliation(s)
- Davide Zaffe
- Department of Anatomy and Histology, Section of Human Anatomy, University of Modena and, Reggio Emilia, Italy.
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Kokubo M, Mitsumori M, Yamamoto C, Fujishiro S, Mise K, Kodama H, Nagata Y, Hiraoka M. Impact of boost irradiation with surgically placed radiopaque clips on local control in breast-conserving therapy. Breast Cancer 2002; 8:222-8. [PMID: 11668244 DOI: 10.1007/bf02967512] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether boost irradiation relying on radiopaque clips placed surgically around the resected margin of breast cancer contributes to increasing the local control rate in patients with close or positive margins in breast-conserving therapy (BCT). METHODS Among 837 patients with breast cancer who underwent BCT between November 1987 and December 1998, 181 patients with close or positive surgical margins received boost irradiation following conventional tangential whole breast irradiation. Since 1994, four radiopaque clips were surgically placed around the resected margin of the breast cancer in 155 patients treated with wide excision. The four clips were clearly and accurately identified with a CT-simulator (CT-S). The boost irradiation field was automatically determined with a safety margin of 3 cm according to one-to-one correspondence of radiopaque clips to pathologically close or positive surgical margins. In the remaining 26 patients treated before 1994, the boost irradiation field was determined according to the skin tattoo of the primary tumor. RESULTS The median follow-up period of the 155 patients receiving the radiopaque clips was 42 months (range: 19 to 78), and that of the 26 patients without the clips was 87 months. Local recurrence was observed in two of the 155 patients who underwent boost irradiation using the radiopaque clips 39 and 54 months after the surgery, while 4 of the 26 patients developed local recurrence 14, 23, 51, and 76 months after BCT. In three of the four patients without the clips developing local recurrences, local recurrences were observed at the margin of the boost irradiation field. The 5-year local recurrence-free survival rate of patients who received boost irradiation with the radiopaque clips was 97%, and that of patients without the clips was 88%. The difference of local recurrence-free survival rates between the patients with and without the clips was significant (p<0.05). CONCLUSION Surgically placed radiopaque clips appear to be useful for determining adequate boost field in the BCT using the CT-S and help increase the local control rate.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/mortality
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Contrast Media
- Disease-Free Survival
- Female
- Humans
- Japan
- Mastectomy, Segmental/methods
- Mastectomy, Segmental/mortality
- Middle Aged
- Radiotherapy, Adjuvant
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- M Kokubo
- Department of Therapeutic Radiology and Oncology, Graduate School of Medicine, Kyoto University, Japan
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