Emil Kohan

The effect of age on osteogenic, adipogenic and proliferative potential of female adipose-derived stem cells.

Human adipose tissue is an ideal source of autologous cells that is both plentiful and easily obtainable in large quantities through the simple surgical procedure of liposuction. The stromal vascular fraction of adipose tissue contains a stem cell population, adipose‐derived stem cells (ASCs), capable of adipogenic, osteogenic, myogenic and chondrogenic differentiation. These cells have already been recognized to possess great therapeutic potential in tissue engineering and regeneration. In this study, we sought to determine the effect of donor age on the growth kinetics and differentiation potential of ASCs. For this, ASCs were isolated from liposuctioned adipose tissue obtained from female patients in the age range 20–58 years. Population doubling time was calculated over 2 weeks and differentiation potential was determined by assaying for adipogenesis and osteogenesis. ASCs obtained from older donors appeared to have a slower rate of proliferation, but this relationship was not significant. While adipogenic potential was unrelated to donor age, a distinct relationship between donor age and osteogenic potential was observed. The aetiology of this age‐dependent change in osteogenic potential was not due to any changes in the number of precursors with osteogenic capacity in the adipose sample. These findings have important implications for emerging cell‐based therapeutic strategies, such as tissue engineering, in addition to treatment of various metabolic bone disorders including osteoporosis. Copyright

Economic advantages to a distraction decision tree model for management of neonatal upper airway obstruction.

Background: Neonatal upper airway obstruction demands urgent attention. Tracheostomy can prove to be lifesaving but has morbidities. Recently, the authors found reduced morbidity/mortality when using a distraction decision tree model compared with conventional “case-by-case” management. In this current study, the authors assess the long-term costs of (1) a decision tree model versus conventional treatment and (2) tracheostomy versus distraction osteogenesis. Methods: An inpatient cost-matrix analysis study on neonates with upper airway obstruction and micrognathia was performed (n = 149). In Part I, conventionally treated neonates managed on a case-by-case basis received home monitoring or a tracheostomy. Decision tree model–managed newborns had specialist consultations and diagnostic testing to determine whether home monitoring, tracheostomy, or distraction osteogenesis would be implemented. In Part II, tracheostomy treatment was compared directly to distraction osteogenesis. Results: In Part I (conventional versus decision tree model), taking into account the costs of the distraction, tracheostomy, hospital stay, diagnostic studies, physician fees, and emergency department visits, the total per patient treatment cost was 1.5 greater in the conventional treatment group (

“Strategic sequences” in adipose-derived stem cell nerve regeneration

332,673) compared with the decision tree model (

Sagittal synostotic twins: reverse pi procedure for scaphocephaly correction gives superior result compared to endoscopic repair followed by helmet therapy.

225,998) (p < 0.05). In Part II (tracheostomy versus distraction osteogenesis), the total per-patient treatment cost in the tracheostomy group was two times greater than in the distraction group (

Reconstruction of the irradiated orbit with autogenous fat grafting for improved ocular implant.

382,246 versus

The relationship between preoperative cervical alignment and postoperative spinal cord drift after decompressive laminectomy and arthrodesis for cervical spondylotic myelopathy

193,128) (p < 0.05). Conclusions: In treating newborns with micrognathia and upper airway obstruction, a decision tree model with mandibular distraction decreases long-term health care costs compared with conventional treatment. Furthermore, when comparing distraction to tracheostomy, similar decreases in long-term health care costs occurred.

Total upper and lower eyelid reconstruction using an expanded forehead flap.

Peripheral nerve injuries (PNI) are a major source of morbidity worldwide. The development of cellular regenerative therapies has the potential to improve outcomes of nerve injuries. However, an ideal therapy has yet to be found. The purpose of this study is to examine the current literature key points of regenerative techniques using human adipose‐derived stem cells (hADSCs) for nerve regeneration and derive a comprehensive approach to hADSC therapy for PNI.

Correction of hydrocephalic macrocephaly with total cranial vault remodeling and molding helmet therapy.

A unique situation of twins with similar sagittal synostosis pathology who underwent different surgical corrective procedures allowed us an opportunity to compare an endoscopic technique to the more traditional technique of a modified cranial vault remodeling (CVR). At 4 months of age, 1 twin underwent an endoscopic-assisted extended strip craniectomy with postoperative helmet therapy for 12 months, and the other underwent a reverse pi CVR procedure. Cephalic index, the Whitaker Aesthetic score, and developmental tests were used for comparison during a 6-year follow-up. The modified CVR had a superior outcome compared to the endoscopic procedure with regard to cephalic index measurements (CVR = 77; endoscopic = 63; P < 0.05) and the Whitaker score (CVR = 1 or no revisions necessary; endoscopic = 2.3 or minor to major bony work required for correction). Patients had similar intelligence quotient test scores; however, the endoscopic patient had lower scores in both preschool tests and global evaluations compared with the normal scores of the CVR patient. The modified CVR procedure was superior to the endoscopic procedure, at least in these twins with sagittal synostosis.

Duodenal Bulb Mucosa with Hypertrophic Gastric Oxyntic Heterotopia in Patients with Zollinger Ellison Syndrome

Background: Soft-tissue augmentation of irradiated sites has posed numerous challenges to craniofacial reconstructive surgeons. Irradiated and enucleated orbits are challenging, especially when attempting to prime the orbit for a future prosthesis. The authors document a series of successful autologous fat injections in irradiated orbits of patients with primary tumors of the orbit, using the Coleman fat grafting technique. Methods: Six patients underwent serial autologous fat grafting after irradiation to the orbit and enucleation. The amount of fat transferred to the periorbita was measured. For measuring fat retention, the authors used surface area analysis of the images and three-dimensional photography. Outcomes were measured by physicians and patients on a scale of 0 to 4. Also, fat retention in these irradiated patients was compared with that of nonirradiated patients who had malar fat injections for cosmetic purposes. Results: Patients had a mean of three fat injection procedures with a mean of 24 cc per injection. After serial fat grafting, four of the six patients were successfully fitted for orbital prostheses. Outcomes measured by physicians and patients were a mean of 3.1 and 3.3, respectively. Retention in the postoperative period was initially similar between the nonirradiated orbit (81 percent retention) and the irradiated orbit (78 percent retention) but differed at long-term follow-up (72 percent versus 38 percent). Conclusion: Autologous fat grafting may be used for improved ocular implantation to the irradiated enucleated orbit.

Long-term effects of breast aging in patients undergoing explantation: analysis of breast aesthetics from before augmentation to after explantation.

BACKGROUND Cervical spondylotic myelopathy represents a debilitating disorder, often resulting in significant neurological impairment over time. Cervical laminectomy has enjoyed a successful track record in the surgical management of these patients. Little is understood regarding the significance of postdecompressive migration of the spinal cord in relation to patient outcome. METHODS Preoperative and postoperative cervical spine MRIs of 28 patients who underwent cervical laminectomy and fusion for the treatment of CSM were reviewed. Radiographic parameters including preoperative cervical alignment, LDI, space available at the level cepahlad/caudad to the decompression, percent spinal cord expansion at the radiographically most compressed level, and spinal cord drift to the midpoint of the spinal cord were measured and subsequently analyzed for statistical correlation. The recovery rate based on the mJOA score was calculated for each patient and analyzed for correlation with spinal cord drift. RESULTS The Cobb angle C2-7, cervical spinal angle, and CCI represented tightly correlated measures of cervical alignment. The preoperative cervical alignment did not statistically correlate with postoperative spinal cord drift. No statistical correlation was revealed between postdecompressive spinal cord drift and recovery rate. CONCLUSIONS Preoperative cervical alignment does not statistically correlate with postoperative spinal cord drift in patients undergoing multisegmental decompressive laminectomy and fusion for CSM. The observation of significant posterior shifting of the spinal cord in the context of straight or kyphotic preoperative alignment suggests that posterior decompression and arthrodesis represent a viable option in the surgical management of patients with CSM with nonlordotic preoperative alignment.