Henry Tesluk

Hepatic ablation with use of radio-frequency electrocautery in the animal model.

The potential of percutaneous radio-frequency (RF) electrocautery hepatic ablation was evaluated in the animal model. RF hepatic ablation was performed under ultrasound (US) guidance in the liver of 10 swine with use of a specifically designed needle. The needle was placed through the liver capsule, and ablation was performed after isolating the liver at laparotomy. Animals were killed immediately (n = 4), at 1 week (n = 1), 2 weeks (n = 3), or at 5 weeks (n = 2). The US findings were correlated with the pathologic results in the animal livers. RF hepatic ablation was successfully performed in the animal model without complications. Lesions in the animal livers were typically 1 x 2 cm, which initially appeared highly echogenic on US scans. These images corresponded to an area of hepatic necrosis. The lesions became less echogenic shortly after initial treatment but could still be visualized with US at 5 weeks. At histologic study at 5 weeks, the treated livers showed central debris, a larger area of necrotic liver, and a zone of granulation tissue surrounded by a fibrotic capsule. No complications were encountered. RF hepatic ablation shows future promise in treatment of hepatic neoplasms.

Hepatic ablation using bipolar radiofrequency electrocautery.

RATIONALE AND OBJECTIVES Percutaneous methods have been used to treat primary and secondary hepatic neoplasms. In the current study, we evaluated the potential of bipolar radiofrequency (RF) electrocautery to increase in vitro liver tissue destruction when compared with monopolar RF electrocautery. METHODS Two needles (electrodes) were placed into fresh bovine liver tissue for use with bipolar electrocautery. Needle tip exposure was kept constant at 3 cm while other parameters, including treatment time, power (wattage), interneedle distance, and needle tip temperature, were changed. Pathologic and histologic correlation was performed, and tissue necrosis was weighed in grams for individual parameters. RESULTS There was a minimal threshold of approximately 45 degrees C where tissue coagulation occurred. Tissue coagulation increased the longer treatment went on. Increasing temperature, wattage, or both increased tissue coagulation such that necrosis was too rapid and char formation occurred, which prevented further coagulation. For all wattages and temperatures, there was increasing tissue necrosis with increasing needle separation, until a point at which further needle separation produced less tissue necrosis. Optimizing parameters allowed tissue coagulation of greater than 30 g. CONCLUSION Bipolar RF electrocautery shows promise for increasing the tissue coagulation in fresh bovine liver compared with the previously described monopolar technique.

The effects of insulin-like growth factor-1 on critical-size calvarial defects in Sprague-Dawley rats.

In a previous study prepared in 1992, we found that insulin-like growth factor-1 showed promise in hastening intramembranous bone repair in midfacial bone defects. For the present study, we created critical-size calvarial defects in 36 adult male Sprague–Dawley rats. The rats were then divided into two groups and killed at 1, 2, 3, 4, 5, 6, and 8 weeks. Twenty-one rats were administered insulin-like growth factor-1 subcutaneously with a 14-day osmotic infusion pump. An untreated group served as controls. Results were compared using routine histology to examine bone reconstitution of the surgical defects. Within the experimental group, we observed repair commenced at ~ 1 week and the critical-size calvarial bone defects were completely obliterated by 6 weeks; in the control group, even by 8 weeks, the surgical defects remained almost unchanged. In summary, this is further evidence that insulin-like growth factor-1 may have the potential to accelerate repair of intramembranous bone defects.

Reconstruction of Calvarial Defects with Anorganic Bovine Bone Mineral (Bio-Oss) in a Rabbit Model

Reconstructive surgeons have employed various procedures using either autogenous or alloplastic materials to repair cranial defects secondary to trauma, extirpative surgery, or congenital anomalies. Currently, the choice appears to be dependent on the personal choice or background of the operating surgeon. For years, our preference has been to use calvarial bone grafts as our primary source of reconstructive material. Disadvantages include uneven resorption of the bone grafts and limited quantities. For these reasons, bony substitutes present new possibilities for reconstruction of craniomaxillofacial defects. We evaluated Bio-Oss, which is a natural bone mineral derived from a bovine source that is chemically and physically identical to human bone, as a possible replacement material to reconstruct skull defects in a rabbit model.

Effect of Insulin-like Growth Factor-1 on Zygomatic Arch Bone Regeneration: A Preliminary Histological and Histometric Study

A number of physicians have attempted to pharmacologically manipulate the healing of bony fractures with a variety of agents such as growth hormone, thyroxine, chondroitin sulfate, and parathyroid hormone. Thus far, results from these experiments have been inconclusive. Previous research dealing with insulinlike growth factors has centered on cultures of osteoblast-like cells and has demonstrated a stimulatory effect on bone collagen synthesis, which may in fact play a critical role in the process of bone formation itself. The purpose of this investigation was to examine the effects of a genetically engineered growth factor, insulin growth factor type I, on midfacial fracture healing. In 24 adult male Sprague–Dawley rats, a standardized defect was created within the midportion of each zygomatic arch. One-half were treated with insulin growth factor type I administered with an osmotic infusion pump and the other half served as control subjects. At 2, 4, 8, and 12 weeks, animals from each group were killed and specimens of the defect obtained. Data were collected from radiographs and histological studies to compare the extent of bony repair. From this study, it appears that insulin growth factor type I could exert a potentiating effect on the repair of midfacial bone defects.

Comparison of flow cytometry to routinetesticular biopsy in male infertility

We compared DNA flow cytometry to morphologic evaluation of routine testicular biopsies as methods of monitoring spermatogenesis. The study group consisted of 14 azoospermic men and 5 others who underwent testicular surgery unassociated with fertility problems. The findings for both studies were divided into three groups: normal, moderately abnormal, and markedly abnormal. Correlations between the findings from routine biopsy and flow cytometry were good. Of 9 patients having normal testicular morphology, 7 had normal ploidy classes by DNA flow cytometry while 2 had moderately abnormal histograms. Of 5 cases with moderately abnormal morphology, 1 had normal, 1 had moderately abnormal, and 3 had markedly abnormal ploidy distributions. In 5 cases described as Sertoli cell only, all DNA histograms were markedly abnormal, consisting almost exclusively of diploid cells. DNA flow cytometry of testicular biopsies and aspirates has been demonstrated to be a rapid, reproducible, and objective approach in evaluating the infertile male and is a promising method to investigate spermatogenesis in an outpatient clinic in lieu of formal testis biopsy.

Repair of experimental calvarial defects with Bio-Oss particles and collagen sponges in a rabbit model

Various materials have been used for reconstruction of both acquired and congenital calvarial defects. Unfortunately, each has its limitations. Autologous bone grafts have irregular rates of resorption that may require secondary corrective surgery, and individual harvest sites have limited stores that can necessitate additional donor locations. Alloplastic materials have unlimited quantities and volume stability but they may not become incorporated and are associated with a higher incidence of infection. The optimal bone substitute should stimulate new bone formation and permanently supplant the temporary space filler, thereby reconstituting the surgical defect. We evaluated 2 newly available bone substitutes, resorbable natural bone mineral (Bio-Oss particles) and a combination of collagen and natural bone mineral collagen combination (Bio-Oss sponges), to repair calvarial defects in an adult, male, New Zealand white rabbit model. We found that the particulate Bio-Oss material resorbed and then underwent the normal physiological stages of bone remodeling. The collagen and Bio-Oss combination was replaced by new bone ingrowth. These materials may have potential for use in the reconstruction of skull defects.

Use of biodegradable plates and screws in a rabbit model.

During the last decade, rigid internal fixation with miniplates and screws has gained widespread acceptance in the correction of both congenital and acquired craniomaxillofacial deformities. Recent studies have proposed that the currently employed metallic plates and screws may require removal because of potential facial growth restriction in growing children. Others have reported bone resorption under the plate due to stress shielding, infection, extrusion, and palpability in regions where there is minimal tissue coverage. Because these implants are radiopaque, they generate significant artifacts that interfere with radiological studies and with radiation therapy in patients undergoing treatment for malignancies. There is no question that the use of a biodegradable plating system would eliminate each of these potential or real problems, because stability is necessary only for a reasonably short period until the fracture segments have become united.We report the initial phase of a long-term study examining various materials that will be available for fabrication of a biodegradable plate and screw system. We evaluated a commercially developed biodegradable plate and screw system to treat zygomatic arch fractures in a rabbit model. Fractures were surgically created at the midpoint of each zygomatic arch. The experimental animals were then divided into three equal groups. Fractures in the first group were permitted to heal without any form of stabilization. In the second group, segments were secured with standard titanium plates and screws. Biodegradable plates and screws were employed for stabilization in the experimental group. Animals were then killed, and radiographs were obtained at 2, 4, 6, and 8 weeks. Zygomatic complexes were removed en bloc, and routine hematoxylin and eosin slides were obtained for light microscopy. Without fixation, fracture segments became significantly displaced. Findings were almost identical in the two treatment groups. This biodegradable system appears to have promise in the care of patients with maxillofacial trauma of the midface.

Effect of insulin-like growth factor type 1 on critical-size defects in diabetic rats

A number of investigators have reported on the clinically significant relationship between diabetes mellitus and impaired wound healing. Diabetic patients have an increased frequency of infection, delayed scar formation, and poor bony union. Investigations completed in our laboratory have demonstrated that insulin-like growth factor type 1 (IGF-1), a somatomedin C, has shown promise for accelerating bony repair. The purpose of this study was to examine the effects of recombinant IGF-1 on standardized, critical-size calvarial defects in 25 adult, male streptozocin-induced diabetic rats. From our study, it appears that IGF-1 exerts a potentiating effect on the repair of bony defects in diabetes-induced rats.

Cystic dysplasia of testis

A rare developmental disorder, cystic dysplasia of the testis, encountered in a newborn infant, is described. The relationship to renal dysplasia and the recent literature are reviewed.