Ewald Unger

Mechanical properties of the Schneiderian membrane in vitro

OBJECTIVES Perforation of the Schneiderian membrane (maxillary sinus mucosa) is a common complication of maxillary sinus graft procedures. Membrane perforation increases the chance of postoperative sinusitis and endangers graft as well as implant survival. The aim of the present study was to explore the mechanical properties of the Schneiderian membrane. MATERIAL AND METHODS Three test methods were performed on sinus specimen of 20 fresh human cadavers: one- and two-dimensional membrane elongation as far as perforation, as well as membrane detachment from the adherent bone. RESULTS Perforation of the Schneiderian membrane (mean thickness: 90 mum) occurred at a mean tension of 7.3 N/mm(2). The membrane could be stretched to 132.6% of its original size in one-dimensional elongation, and to 124.7% in two-dimensional elongation. Thicker membranes demonstrated significantly higher load limits (P<0.001). The mean modulus of elasticity accounted 0.058 GPa, the mean adhesion force between sinus membrane and bone surface was 0.05 N/mm. CONCLUSIONS Respecting the mechanical properties of the Schneiderian membrane may help reducing the complication rates and thus patient morbidity in minimally invasive maxillary sinus floor elevation.

Basic design and construction of the Vienna FES implants : existing solutions and prospects for new generations of implants

We can distinguish 3 generations of FES implants for activation of neural structures: 1. RF-powered implants with antenna displacement dependent stimulation amplitude; 2. RF-powered implants with stabilised stimulation amplitude; and 3. battery powered implants. In Vienna an 8-channel version of the second generation type has been applied clinically to mobilisation of paraplegics and phrenic pacing. A 20-channel implant of the second generation type for mobilisation of paraplegics and an 8-channel implant of the third generation type for cardiac assist have been tested in animal studies. A device of completely new design for direct stimulation of denervated muscles is being tested in animal studies. There is a limited choice of technologically suitable biocompatible and bioresistant materials for implants. The physical design has to be anatomically shaped without corners or edges. Electrical conductors carrying direct current (D.C.) have to be placed inside a hermetic metal case. The established sealing materials, silicone rubber and epoxy resin, do not provide hermeticity and should only embed DC-free components. For electrical connections outside the hermetic metal case welding is preferable to soldering; conductive adhesives should be avoided. It is advisable to use a hydrophobic oxide ceramic core for telemetry antenna coils embedded in sealing polymer. Cleaning of all components before sealing in resin is of the utmost importance as well as avoidance of rapid temperature changes during the curing process.

Comparing localized and nonlocalized dynamic 31P magnetic resonance spectroscopy in exercising muscle at 7T

By improving spatial and anatomical specificity, localized spectroscopy can enhance the power and accuracy of the quantitative analysis of cellular metabolism and bioenergetics. Localized and nonlocalized dynamic 31P magnetic resonance spectroscopy using a surface coil was compared during aerobic exercise and recovery of human calf muscle. For localization, a short echo time single‐voxel magnetic resonance spectroscopy sequence with adiabatic refocusing (semi‐LASER) was applied, enabling the quantification of phosphocreatine, inorganic phosphate, and pH value in a single muscle (medial gastrocnemius) in single shots (TR = 6 s). All measurements were performed in a 7 T whole body scanner with a nonmagnetic ergometer. From a series of equal exercise bouts we conclude that: (a) with localization, measured phosphocreatine declines in exercise to a lower value (79 ± 7% cf. 53 ± 10%, P = 0.002), (b) phosphocreatine recovery shows shorter half time (t1/2 = 34 ± 7 s cf. t1/2 = 42 ± 7 s, nonsignificant) and initial postexercise phosphocreatine resynthesis rate is significantly higher (32 ± 5 mM/min cf. 17 ± 4 mM/min, P = 0.001) and (c) in contrast to nonlocalized 31P magnetic resonance spectroscopy, no splitting of the inorganic phosphate peak is observed during exercise or recovery, just an increase in line width during exercise. This confirms the absence of contaminating signals originating from weaker‐exercising muscle, while an observed inorganic phosphate line broadening most probably reflects variations across fibers in a single muscle. Magn Reson Med, 2012.

Semi‐LASER localized dynamic 31P magnetic resonance spectroscopy in exercising muscle at ultra‐high magnetic field

Magnetic resonance spectroscopy (MRS) can benefit from increased signal‐to‐noise ratio (SNR) of high magnetic fields. In this work, the SNR gain of dynamic 31P MRS at 7 T was invested in temporal and spatial resolution. Using conventional slice selective excitation combined with localization by adiabatic selective refocusing (semi‐LASER) with short echo time (TE = 23 ms), phosphocreatine quantification in a 38 mL voxel inside a single exercising muscle becomes possible from single acquisitions, with SNR = 42 ± 4 in resting human medial gastrocnemius. The method was used to quantify the phosphocreatine time course during 5 min of plantar flexion exercise and recovery with a temporal resolution of 6 s (the chosen repetition time for moderate T1 saturation). Quantification of inorganic phosphate and pH required accumulation of consecutively acquired spectra when (resting) Pi concentrations were low. The localization performance was excellent while keeping the chemical shift displacement acceptably small. The SNR and spectral line widths with and without localization were compared between 3 T and 7 T systems in phantoms and in vivo. The results demonstrate that increased sensitivity of ultra‐high field can be used to dynamically acquire metabolic information from a clearly defined region in a single exercising muscle while reaching a temporal resolution previously available with MRS in non‐localizing studies only. The method may improve the interpretation of dynamic muscle MRS data. Magn Reson Med, 2011.

Implantable device for long-term electrical stimulation of denervated muscles in rabbits.

Although denervating injuries produce severe atrophic changes in mammalian skeletal muscle, a degree of functional restoration can be achieved through an intensive regime of electrical stimulation. An implantable stimulator was developed so that the long-term effects of different stimulation protocols could be compared in rabbits. The device, which is powered by two lithium thionyl chloride batteries, is small enough to be implanted in the peritoneal cavity. All stimulation parameters can be specified over a wide range, with a high degree of resolution; in addition, up to 16 periods of training (10–180 min) and rest (1–42 h) can be set in advance. The microcontroller-based device is programmed through a bidirectional radiofrequency link. Settings are entered via a user-friendly computer interface and annotated to create an individual study protocol for each animal. The stimulator has been reliable and stable in use. Proven technology and rigorous quality control has enabled 55 units to be implanted to date, for periods of up to 36 weeks, with only two device failures (at 15 and 29 weeks). Changes in the excitability of denervated skeletal muscles could be followed within individual animals. Chronaxie increased from 3.24±0.54 ms to 15.57±0.85 ms (n=55, p<0.0001) per phase in the 2 weeks following denervation.

A laryngeal pacemaker for inspiration-controlled, direct electrical stimulation of the denervated posterior cricoarytenoid muscle in sheep

SummaryBilateral recurrent nerve palsies were induced in four sheep and unilateral nerve palsy in one sheep. Vocal cord abductions were achieved by direct electrical stimulation of the posterior cricoarytenoid muscles (PCMs). By means of the diaphragmatic myogram, respiratory synchronous activation of the glottis opening musculature was shown possible. In all cases an adequate glottis opening for respiratory function was achieved during a maximum period of stimulation of 5–8 h in each animal. Abductor movements of the vocal cords were documented with video laryngoscopy. Using digital image processing, the areas of the open glottis were measured at rest and during bilateral direct electrical stimulation of the PCMs.

Safe neuromuscular electrical stimulator designed for the elderly.

A stimulator for neuromuscular electrical stimulation (NMES) was designed, especially suiting the requirements of elderly people with reduced cognitive abilities and diminished fine motor skills. The aging of skeletal muscle is characterized by a progressive decline in muscle mass, force, and condition. Muscle training with NMES reduces the degradation process. The discussed system is intended for evoked muscle training of the anterior and posterior thigh. The core of the stimulator is based on a microcontroller with two modular output stages. The system has two charge-balanced biphasic voltage-controlled stimulation channels. Additionally, the evoked myoelectric signal (M-wave) and the myokinematic signal (surface acceleration) are measured. A central controller unit allows using the stimulator as a stand-alone device. To set up the training sequences and to evaluate the compliance data, a personal computer is connected to the stimulator via a universal serial bus. To help elderly people handle the stimulator by themselves, the user interface is kept very simple. For safety reasons, the electrode impedance is monitored during stimulation. A comprehensive compliance management with included measurements of muscle activity and stimulation intensity enables a scientific use of the stimulator in clinical trials.

Pruritometer 2: Portable recording system for the quantification of scratching as objective criterion for the pruritus

Studies to evaluate therapies for itching (pruritus) related diseases often require the quantification of the itch sensation. Like all subjective symptoms the evaluation of itching is difficult and can only be done indirectly. With the Pruritometer 2 a measuring system is introduced that evaluates itching by detecting scratching movements. Based on the Pruritometer 1, that processes the signals of a piezoelectric vibration sensor, fixed on the midfinger of the patients dominant hand, and triggers a simple counter, the Pruritometer 2 allows to store the scratch activity during a 24 hours period. For each adjustable time slice of this time period, the amount of scratches and the scratch intensity are recorded. All data can be transferred to a PC via infrared link for further processing with a standard software package. An additional PC-software allows to set various parameters for optimal scratch detection and to test the patient attached system, also via the infrared link. All electronic components are shockproof encapsulated in a milled housing and are attached to a textile watchstrap that is worn by the patient like a wristwatch.

Thermal effects of a combined irrigation method during implant site drilling. A standardized in vitro study using a bovine rib model

OBJECTIVES The purpose of this study was to evaluate the temperature changes during implant osteotomies with a combined irrigation system as compared to the commonly used external and internal irrigation under standardized conditions. MATERIAL AND METHODS Drilling procedures were performed on VII bovine ribs using a computer-aided surgical system that ensured automated intermittent drilling cycles to simulate clinical conditions. A total of 320 drilling osteotomies were performed with twist (2 mm) and conical implant drills (3.5/4.3/5 mm) at various drilling depths (10/16 mm) and with different saline irrigation (50 ml/min) methods (without/external/internal/combined). Temperature changes were recorded in real time by two custom-built thermoprobes with 14 temperature sensors (7 sensors/thermoprobe) at defined measuring depths. RESULTS The highest temperature increase during osteotomies was observed without any coolant irrigation (median, 8.01°C), followed by commonly used external saline irrigation (median, 2.60°C), combined irrigation (median, 1.51°C) and ultimately with internal saline irrigation (median, 1.48°C). Temperature increase with different drill diameters showed significant differences (P < 0.05) regarding drill depth, confirming drill depth and time of drilling as influencing factors of heat generation. Internal saline irrigation showed a significantly smaller temperature increase (P < 0.05) compared with combined and external irrigation. A combined irrigation procedure appears to be preferable (P < 0.05) to an external irrigation method primarily with higher osteotomy depths. CONCLUSIONS Combined irrigation provides sufficient reduction in temperature changes during drilling, and it may be more beneficial in deeper site osteotomies. Further studies to optimize the effects of a combined irrigation are needed.

A novel standardized bone model for thermal evaluation of bone osteotomies with various irrigation methods

OBJECTIVES Based on a novel standardized bovine specimen, the aim of this study was to investigate thermal effects of different irrigation methods during intermittent and graduated drilling. MATERIAL AND METHODS Temperature changes during implant osteotomies (n = 320) of 10 and 16 mm drilling depths with various irrigation methods were investigated on manufactured uniform bone samples providing homogenous cortical and cancellous areas and analogous thermal conductivity comparable to human bone. Automated sequences were performed with surgical twist drills of 2 mm ∅ and conical drills of 3.5, 4.3 and 5 mm ∅. Real-time recording of temperature increase was done using two custom-built multichannel thermoprobes with 14 temperature sensors at a predefined distance of 1 and 2 mm to the final osteotomy. The effects of drilling depth, drilling diameter and irrigation methods on temperature changes were investigated by a linear mixed model. RESULTS Using this uniform bone specimen, the greatest temperature rise was observed without any coolant supply with 29.87°C, followed by external with 28.47°C and then internal with 25.86°C and combined irrigation with 25.68°C. Significant differences (P ≤ 0.0156) between drill depths of 10 vs. 16 mm could be observed with all irrigation methods evaluated. With each of the irrigation methods, significantly higher temperature changes (P < 0.0001) during osteotomies could be observed between twist drills of 2 mm ∅ and conical drills of 3.5, 4.3 and 5 mm ∅. During 10 and 16 mm drilling osteotomies, external irrigation showed significantly higher temperatures (P < 0.05) for all conical drills compared with internal or combined irrigation, respectively. Significantly lower temperatures (P < 0.05) could be detected with internal or combined irrigation for the use of conical drills with various diameters and drilling depths. CONCLUSIONS This fully standardized bone model provides optimized comparability for the evaluation of bone osteotomies and resulting temperature changes. As regards the efficiency of the various irrigation methods, it could be demonstrated that internal and combined irrigation appears to be more beneficial than external irrigation.