The impact of aging and atherosclerotic risk factors on transthoracic coronary flow reserve in subjects with normal coronary angiography

Age may affect coronary flow reserve (CFR) especially in subjects with atherosclerotic risk factors (ARFs). The aim of this prospective, multicenter, observational study was to determine the effects of aging on CFR in patients with normal epicardial coronary arteries and ARFs. Three-hundred-thirty-five subjects (mean age = 61 years) with at least one ARF but normal coronary angiography underwent high-dose dipyridamole stress-echo with Doppler evaluation of left anterior descending artery. CFR was calculated as the ratio between hyperemic and resting coronary diastolic peak velocities. Patients were divided in age quartiles. CFR was progressively reduced with aging (1st quartile: 3.01 ± 0.69, 4th quartile: 2.39 ± 0.49, p < 0.001). This was mainly due to a gradual increase of resting velocities (1st quartile = 26.3 ± 6.1 cm/s, 4th quartile = 30.2 ± 6.4 cm/s, p < 0.001) while the reduction of hyperemic velocities remained unaffected (1st quartile = 77.7 ± 18.9 cm/s, 4th quartile = 70.9 ± 18.4 cm/s, NS). When age quartiles and ARFs were entered into a regression model, third and fourth age quartile (p < 0.0005 and p < 0.0001 respectively), left ventricular mass index (p < 0.0001), diastolic blood pressure (p < 0.001), total cholesterol (p < 0.002), fasting blood glucose (p < 0.01) and male gender (p < 0.05) were independent determinants of CFR in the whole population. Aging reduces coronary flow reserve in patients with angiographically normal coronary arteries due to a gradual increase of resting coronary flow velocity. CFR is also affected by atherosclerotic risk factors and left ventricular hypertrophy.

Morphological analysis of the maxillary arch and hard palate in edentulous maxilla of South Indian dry skulls

PURPOSE

The purpose of this study is to demonstrate the role of aging\edentulousness on the maxillary arch, the size of the alveolar process, the shape and thickness of the hard palate in the South Indian dry skulls to customize more appropriate treatment of elderly edentulous patients.

METHODS

One hundred dry skulls were divided into dentate and edentulous groups and were subgrouped into male and female. They were subjected to various morphological and morphometrical analyses.

RESULTS

The data have revealed a more significant reduction in the depth and width (p < 0.001) of the arch corresponding to the reduction in the size and thickness of the alveolar process (p < 0.001) in the edentulous skull. Further, a significant reduction in the size and thickness (p < 0.001) of the hard palate was observed in the edentulous skull. The data clearly indicate the effect of tooth loss in the horizontal regression of the maxilla. Furthermore, it may enhance the bone resorption that can ultimately result in the marked reduction of the width and depth of the alveolar arch concomitant with the alteration of the hard palate. These changes may subsequently alter the facial appearance in the elderly population.

CONCLUSION

The observed data from specific group of population may provide relevant data for their comparative analysis between different populations for a better understanding of their regional differences with respect to environmental and social influence. Moreover, the data can provide a better idea to evaluate a promising treatment strategy in prosthodontics and orthodontics in South India.

Evaluation of enamel pearls by cone-beam computed tomography (CBCT)

OBJECTIVE

The aim of this study was to evaluate the frequency of enamel pearls according to population, sex and tooth groups on Cone-Beam Computed Tomography (CBCT) or Dental Volumetric Tomography (DVT) scans of patients, retrospectively.

STUDY DESIGN

In this study, 15185 teeth belonging to 768 patients, 430 female and 338 male, was performed cross-sectional examination by CBCT. The volumetric Computed Tomography used in the study is Newton FP based on flat-panel. The data were analyzed with Pearson chi-squared test.

RESULTS

Enamel pearls were detected in 36 subjects (4.69%). Of these enamel pearls, 19 were detected in male and 17 were in male. There was no statistically a significant association between prevalence of enamel pearls and sex. All of enamel pearls were detected in molar teeth, for prevalence 0.83%.

CONCLUSION

All of enamel pearls are found upper and lower molar teeth, especially the most commonly in maxillary second and third molars.

Factors influencing the incidence of maxillofacial fractures

PURPOSE

Maxillofacial injuries occur in a significant proportion of trauma patients. Trauma causes considerable economic expense due to procedural costs, the time a patient is off work, and the associated loss of income. For these reasons, it is an important health and economic issue. The aim of this study is to discuss the factors that may influence the incidence of maxillofacial fractures. As it is necessary to determine trends to help guide the development of new methods of injury prevention, preventative measures are also discussed.

METHODS

An electronic search was undertaken in March 2011, including articles published between 1980 and 2011 with the terms "facial fractures" and "maxillofacial fractures" in the title. The texts of epidemiological studies were reviewed in order to identify factors that may influence the incidence of maxillofacial fractures.

RESULTS

From the selected articles, ten factors were identified: age, gender, geographic region and cultural aspects, socioeconomic status, temporal and climatic influence, use of alcohol and drugs, compliance with road traffic legislation, domestic violence, osteoporosis, and etiology of the maxillofacial trauma.

CONCLUSIONS

Care of injured patients should include not only management of the acute phase, but also combine preventive programs and interventional programs aimed at reducing the incidence of maxillofacial fractures. Therefore, there is a need to ensure strict compliance of traffic rules and regulations, implement improvement in automotive safety devices, organize prevention programs to minimize assaults, implement school education in alcohol abuse and handling potentially hostile situations (especially for men), improve protection during sporting activities, and legislate wearing of protective headgear in workers. Preventive strategies remain the cheapest way to reduce direct and indirect costs of the sequelae of trauma. Societal attitudes and behaviors must be modified before a significant reduction in the incidence of maxillofacial fractures will be seen.

Life-threatening cervical spine collapse as a result of postradiation osteonecrosis-case report and review of the literature

BACKGROUND

Mandibular osteoradionecrosis (ORN) is a well-known complication of head and neck radiotherapy; however, ORN of the cervical spine is rarely reported.

METHODS

Herein, we present a patient with a history of tonsillar carcinoma treated with chemoradiation who developed acute, severe progressive neck pain due to cervical spine collapse as a result of ORN. We also discuss diagnosis and treatment of cervical ORN based on a review of the literature.

RESULTS

The patient was successfully treated with antibiotics and surgical debridement and fixation.

CONCLUSION

Delayed diagnosis of cervical ORN can result in marked disability and pain due to spinal cord compression, as well as serious deformity and instability requiring surgical intervention, and even death. It is important for otolaryngologists who treat head and neck malignancies to be aware of this potential complication so that patients may be diagnosed as early as possible and treated with conservative measures.

1,454 mandibular fractures: a 3-year study in a hospital in Belo Horizonte, Brazil

OBJECTIVE

To analyze the mandibular fractures which presented over a 3-year period at an emergency hospital in Belo Horizonte, Brazil.

METHODS

The data collected included age, sex, aetiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture, and treatment. The analysis involved descriptive statistics and the Pearson's chi-square, Bonferroni, Kolmogorov-Smirnov, Kruskal-Wallis and Mann-Whiney tests, and analysis of variance.

RESULTS

There were 1,454 mandibular fractures in 1,023 patients. Males of 20-29 years of age sustained the majority of fractures. Traffic accidents were the major causes of trauma, followed by violence and falls. A high incidence of fractures in women due to violence was observed. The condyle region was found to be the most common fracture site in the mandible. A surgical approach was performed in most cases. There were more accidents causing mandibular fractures on the weekends.

CONCLUSION

The individuals with mandibular fractures due to "traffic accidents" were younger than those due to "violence" and "falls". There was a significant statistical association between age and aetiology as well as between sex and aetiology of mandibular fractures.

On the use of smart stents for monitoring in-stent restenosis

In angioplasty with stent placement, re-narrowing of the artery within the stent site may occur due to the body's natural response to "heal" the stented area. This re-narrowing, also known as "in-stent restenosis", usually occurs within 6 months after surgery. To monitor and diagnose in-stent restenosis, passive telemonitoring using smart stents has been already proposed. In this paper, we present a feasibility study and advocate the use of an alternative method, namely active telemonitoring, which uses an integrated circuit embedded on the smart stent. Electromagnetic simulations and in-vitro measurements are presented to find the suitable range of frequency to wirelessly transfer power to the active device embedded on the smart stent. Furthermore, the range of induced power levels are simulated and experimentally verified.

[Epidemiological profile of emergency care for dental and oral injuries in Brazil, 2006-2007]

Injuries resulting from accidents and violence occupy a key place in the current epidemiological scenario. The head and face are one of the main sites of lesions from external causes, especially dental and oral injuries. This article aims to present the epidemiological profile of emergency care for dental and oral lesions from external causes. The study used data from the Surveillance System for Violence and Accidents (VIVA) for the years 2006 and 2007. There were a total of 106,075 emergency visits involving external causes, of which 939 (~1%) presented dental and oral lesions. There were a majority or large proportions of males (65.5%), children < 10 years (44.3%), black individuals (66%), and individuals with low schooling (45.9%). High proportions of the injuries occurred at home (48.3%) or on public byways (30%). Frequent characteristics were cuts or puncture wounds (63.3%) and lesions resulting from falls (43%), traffic accidents (19.9%), and physical assault (13%).

Eagle's syndrome in an orthodontic patient

This purpose of this article was to report the clinical case of a patient with Eagle's syndrome. She was referred to the orthodontic clinic by her general clinician, with the complaint of temporomandibular dysfunction. The orthodontic records showed a styloid process elongation accompanied by calcification and fracture on the right side. Eagle's syndrome was diagnosed, and the patient was referred to a buccomaxillofacial surgeon for surgical correction.

[Radiation-related caries: etiology and possible preventive strategies. What should the radiotherapist know?]

BACKGROUND

After radiation treatment of head-and-neck cancer, the impairment of patient's quality of life still remains an issue. After completion of the treatment course, a substantial number of patients develop so-called radiation caries. In addition, almost 50% of all cases of infectious osteoradionecrosis (iORN) of the jaws are directly associated with radiation caries. This review addresses our current knowledge on the etiology and pathogenesis of radiation caries including possible preventive strategies.

MATERIALS AND METHODS

A PubMed search using the terms "radiation caries" ("radiation related caries", "radiation related damage to dentition") and "radiogenic caries" ("postradiation caries", "dental complications and radiotherapy") was performed. The analysis of its content focused on the etiology, the pathogenesis, and the available knowledge on prophylaxis as well as treatment of radiation caries.

RESULTS

For this review, 60 publications were selected. As main causal factors for radiogenic caries, either indirect impairment, resulting from alterations in the oral environment (e.g., radiation-induced xerostomia) or direct radiation-induced damage in teeth hard tissues are discussed. Radiation caries remains a lifelong threat and, therefore, requires permanent prevention programs.

CONCLUSION

To enable optimal medical care of the patients during the time course of radiotherapy as well as afterwards, close interdisciplinary cooperation between radiotherapists, oral surgeons, otorhinolaryngologists, and dentists is absolutely essential.

Comparison of coronary microcirculation in female nurses after day-time versus night-time shifts

Nightshift work, which is known to cause mental stress and disrupt normal biological diurnal rhythms, leads to endothelial dysfunction resulting in increased risk for cardiovascular disease. This study aimed to investigate the acute effect of night-shift work on coronary microcirculation through assessment of coronary flow reserve (CFR) by transthoracic Doppler echocardiography. This study consisted of 36 women nurses who underwent transthoracic Doppler echocardiographic examinations after working a nightshift and on a regular day without previous nightshift work. Flow velocity in the distal portion of the left anterior descending coronary artery was measured at baseline and during adenosine infusion. CFR was calculated as the ratio of hyperemic to basal mean diastolic flow velocity. CFR after night work was lower than that on a regular workday (3.8 ± 0.6 vs 4.1 ± 0.6, p <0.001). Degree of decreases in CFR after night work was correlated to Framingham risk score (r = 0.35, p = 0.036). In conclusion, this study demonstrated that coronary microcirculation was impaired after nightshift work in women nurses.

Endothelial-mediated coronary flow reserve and its relation to mitral annular tissue Doppler velocities in offspring of hypertensive parents

BACKGROUND

Although coronary flow reserve (CFR) is reduced in hypertensive patients, data regarding the endothelial response of coronary vasomotion and its relation to left ventricular (LV) function in their offspring is limited.

OBJECTIVE

To investigate the endothelial response of coronary flow, using cold pressor test (CPT), in offspring of hypertensive parents and its impact on LV diastolic function.

SUBJECTS AND METHODS

The study population consisted of 32 healthy young offspring (mean age 23.5 ± 7.1 years) of hypertensive parents and 26 aged matched volunteers (healthy offspring of normotensive parents) as controls. Coronary blood flow velocities were recorded in all subjects at rest and after CPT; a stimulus that can be considered totally endothelium-dependent. CFR was calculated as the ratio of hyperemic-to-resting diastolic peak velocities. Doppler echocardiographic assessment was performed using both conventional and tissue Doppler assessment.

RESULTS

Coronary diastolic peak velocities at rest was comparable between the two groups (27.1 ± 6.2 vs 26.4 ± 5.8; P > 0.05); but the velocities were significantly lower after CPT in offspring of hypertensive parents (P < 0.02), with highly significant lower CFR (P < 0.0001). Conventional echo-Doppler variables were comparable in both groups, whereas tissue Doppler assessment demonstrated significant LV diastolic dysfunction among offspring of hypertensive parents. The CPT-CFR was significantly correlated to tissue Doppler diastolic dysfunction in this group (For Em, Am and Em/Am, r was 0.65, 0.59 and 0.61, respectively, and P < 0.001).

CONCLUSION

Offspring of hypertensive parents have coronary endothelial dysfunction that appears in response to physiological stimuli (CPT). The coronary endothelial dysfunction is associated with latent LV diastolic dysfunction.

A review of the mandibular and maxillary nerve supplies and their clinical relevance

Mandibular and maxillary nerve supplies are described in most anatomy textbooks. Nevertheless, several anatomical variations can be found and some of them are clinically relevant. Several studies have described the anatomical variations of the branching pattern of the trigeminal nerve in great detail. The aim of this review is to collect data from the literature and gives a detailed description of the innervation of the mandible and maxilla. We carried out a search of studies published in PubMed up to 2011, including clinical, anatomical and radiological studies. This paper gives an overview of the main anatomical variations of the maxillary and mandibular nerve supplies, describing the anatomical variations that should be considered by the clinicians to understand pathological situations better and to avoid complications associated with anaesthesia and surgical procedures.

Resting coronary flow velocity in the functional evaluation of coronary artery stenosis: study on sequential use of computed tomography angiography and transthoracic Doppler echocardiography

AIMS

Accelerated flow at the site of flow-limiting stenosis can be detected by transthoracic Doppler echocardiography (TTDE). We studied feasibility and accuracy of sequential coronary computed tomography angiography (CTA) and TTDE in detection of haemodynamically significant coronary artery disease (CAD).

METHODS AND RESULTS

We prospectively enrolled 107 patients with intermediate (30-70%) pre-test likelihood of CAD. All patients underwent CTA using a 64-slice scanner. Using TTDE, the ratio of maximal diastolic flow velocity to pre-stenotic flow velocity (M/P ratio) was measured in the coronary segments with stenosis in CTA. In all patients, the results were compared with invasive coronary angiography, including measurement of fractional flow reserve when appropriate. All analyses were done blinded. TTDE was feasible in 276 of 285 evaluated coronary segments. Significant coronary stenoses were associated with a higher M/P ratio than non-significant stenoses (3.59 ± 1.82 vs. 1.28 ± 0.60, P < 0.001). The optimal M/P ratio for detection of significant stenosis was 2.2 (area under receiver operating characteristic curve 0.92, P < 0.001). Compared with the strategy of CTA alone, sequential CTA and focused TTDE had a better positive predictive value (PPV; 61 vs. 78%) and diagnostic accuracy (93 vs. 96%, P = 0.006) without impairment of the negative predictive value (97 vs. 97%).

CONCLUSION

Sequential use of CTA and TTDE is feasible for combined anatomic and functional evaluation of coronary stenoses. Compared with coronary CTA alone, addition of TTDE improved PPV for detection of significant CAD.

Feasibility of treating irradiated bone with intramedullary delivered autologous mesenchymal stem cells

Background. We aimed to explore (i) the short-term retention of intramedullary implanted mesenchymal stem cells BMSCs and (ii) their impact on the bone blood flow and metabolism in a rat model of hindlimb irradiation. Methods. Three months after 30 Gy irradiation, fourteen animals were referred into 2 groups: a sham-operated group (n = 6) and a treated group (n = 8) in which ¹¹¹In-labelled BMSCs (2 × 10⁶ cells) were injected in irradiated tibias. Bone blood flow and metabolism were assessed by serial ^99mTc-HDP scintigraphy and 1-wk cell retention by recordings of ^99mTc/¹¹¹In activities. Results. The amount of intramedullary implanted BMSCs was of 70% at 2 H, 40% at 48 H, and 38% at 168 H. Bone blood flow and bone metabolism were significantly increased during the first week after cell transplantation, but these effects were found to reduce at 2-mo followup. Conclusion. Short-term cell retention produced concomitant enhancement in irradiated bone blood flow and metabolism.

Measurement of the midpalatal suture width

OBJECTIVE

To conduct a pilot study to investigate the potentiality to determine the midpalatal sutural width radiographically with a flat-panel volume computed tomography (fpVCT) in a porcine model.

MATERIALS AND METHODS

Bone samples from the midpalatal suture of five young (16 weeks) and five old (200 weeks) sus scrofa domestica were gathered. The midpalatal suture width was measured via fpVCT and compared to respective histological preparations. Results with P < .05 were considered significant.

RESULTS

The data obtained by fpVCT and by histomorphometric analysis reveal a highly significant age dependency of the measured suture width (both P < .0001), with lower suture width values in older subjects compared to the younger group. The averaged suture widths measured in the fpVCT images shows a distinctively higher mean compared to the histomorphometric data with high statistical significance (P < .0001). The evaluated difference between both methods was almost constant.

CONCLUSION

fpVCT is a powerful tool for determining midpalatal sutural width.

Coronary Flow Reserve of the Non-Ischemia Related Coronary Artery During Dobutamine Stress Echocardiography

Background

Incorporation of analysis of coronary velocities in stress studies adds diagnostic value to both clinical variables and dobutamine echocardiography. Micorcirculatory abnormalities may precede obstructive corornary disease. Therefore the aim of this study was to assess Doppler derived coronary velocity and flow of the left anterior descending coronary artery (LAD) during dobutamine stress echocardiography (DSE) in patients without LAD-related ischemia.

Methods

Sixty nine patients with chest pain underwent DSE studies to evaluate myocardial ischemia. All had trans-thoracic Doppler interrogation of the distal LAD before and just after termination of the DSE. Coronary velocity reserves (CFR) were calculated as the ratios of post-DSE/baseline diastolic velocities. Volumetric flow in the distal LAD was calculated from the diameter of LAD color jet and velocity integral. Volumetric flow reserve was calculated as the ratio of post-DSE baseline LAD flows.

Results

At rest all subjects had left ventricular wall motion score index (WMSI) = 1, while in 28, wall motion abnormality appeared in non-LAD territory with WMSI = 1.17 ± 0.08. Peak diastolic velocity after DSE increased form 28.5 ± 13.6 to 52.4 ± 23.7 cm/sec, P = 9.5 × 10^-11, and velocity-CFR was 2.08 ± 0.7. Diastolic LAD flow increased from 36.5 ± 23.8 to 75.75 ± 48.7 mL/min, P = 1.21 × 10^-7 and volumetric-CFR was 2.6 ± 2.8. Peak diastolic velocity-CFR in patients without LV wall motion abnormality was 2.4 ± 0.7 while in those with motion abnormality 1.77 ± 0.56, P = 0.00008. Flow-derived LAD-CFR was 3.3 ± 3.7 in those without compared to 1.88 ± 0.57 in patients with wall motion abnormality, P < 0.05.

Conclusion

LAD velocity and flow reserves are reduced in patients with remote myocardial ischemia, which may indicate early atherosclerotic involvement.

Metaanalysis of maxillofacial trauma in the northern districts of kerala: one year prospective study

PURPOSE

There is an increased incidence of maxillofacial trauma all over the world. A study was conducted to find out the epidemiological characteristics of maxillofacial trauma in Northern districts of Kerala.

METHODS

All the trauma patients who attended the Department of Oral and Maxillofacial Surgery, Government Dental College, Calicut, Kerala during the period of 2006-2007 was included in the study. The incidence, prevalence, age and sex distribution, seasonal and daily variations and aetiology of maxillofacial trauma were studied. The pattern and demographic distribution of fractures of maxillofacial skeleton also were studied.

RESULTS

This study indicates a significant increase in the incidence of maxillofacial trauma in the region. There was a male predominance and the highest incidence was in the age group of 20-40 years. Road traffic accident was the most common aetiological factor causing maxillofacial trauma. More than 30% of trauma cases suffered fracture of maxillofacial skeleton. There was an increased incidence of midface fracture when compared to mandibular fractures in the study. Most common site of mandibular fracture was in the parasymphysis region and in the midface was the zygomatic complex region.

CONCLUSION

The increased incidence of maxillofacial trauma following road traffic accidents noted in this study reveals the need for formulating preventive measures in the state of Kerala. Increasing facilities for the management of maxillofacial trauma at local hospitals and medical colleges is mandatory. Training of the paramedical personnel, health workers and also the public regarding first aid and primary trauma care is also necessary.

Angiographically borderline left main coronary artery lesions: correlation of transthoracic doppler echocardiography and intravascular ultrasound: a pilot study

Background

the clinical decision making could be difficult in patients with borderline lesions (visually assessed stenosis severity of 30 to 50%) of the left main coronary artery (LM). The aim of the study was to evaluate the relationship between transthoracic Doppler (TTDE) peak diastolic flow velocity (PDV) and intravascular ultrasound (IVUS) measurements in the assessment of angiographically borderline LM lesions.

Methods

27 patients (mean age 64 ± 8 years, 21 males) with borderline LM stenosis referred for IVUS examination were included in the study. We performed standard IVUS with minimal lumen area (MLA) and plaque burden (PB) measurement and routine quantitative coronary angiography (QCA) with diameter stenosis (%DS) and area stenosis (%AS) assessment in all. During TTDE, resting PDV was measured in the LM.

Results

interpretable Doppler signal could be obtained in 24 patients (88% feasibility); therefore these patients entered the final analysis. MLA was 7.1 ± 2.7 mm². TTDE measured PDV correlated significantly with IVUS-derived MLA (r = -0.46, p < 0.05) and plaque burden (r = 0.51, p < 0.05). Using a velocity cut-off of 112 cm/sec TTDE showed a 92% sensitivity and 62% specificity to identify IVUS-significant (MLA < 6 mm²) LM stenosis.

Conclusion

In angiographically borderline LM disease, resting PDV from transthoracic echocardiography is increased in presence of increased plaque burden by IVUS. TTDE evaluation might be a useful adjunct to other invasive and non-invasive methods in the assessment of borderline LM lesions. Further, large scale studies are needed to establish the exact cut-off value of PDV for routine clinical application.

Paradental (mandibular inflammatory buccal) cyst

The paradental cyst is commonly misinterpreted when associated with atypical clinical and radiographic characteristics, in turn causing diagnostic problems. For this reason, the study of the differential diagnosis of this lesion has become extremely important. In addition, the correlation of clinical, histologic, and radiographic findings are also of great value in obtaining accurate diagnoses. The minor variations in the clinical appearance of paradental cysts make it feasible to consider the two main groups of cysts separately: those associated with 1st and 2nd permanent molars of the mandible and those associated with the 3rd mandibular molar. Moreover, this distinction in localization may well dictate the necessary treatment. Bearing in mind the minor clinical variations, the present article aims to discuss the differential diagnosis of this lesion and its different possible treatments by presenting a case report to illustrate the findings.

Minimally invasive endoscopic osteosynthesis for frontozygomatic fracture: a new approach

Miniplate fixation on the lateral face of the orbital rim using existing endoscopic methods for frontozygomatic fracture still has some disadvantages, such as cosmetic disturbance from the lateral brow incision for the trocar, and abnormal palpability of the miniplate. We applied a new method of endoscopic osteosynthesis by access through temporal incisions alone and miniplate fixation on the lateral temporal face of the frontozygoma. Postoperative courses were uneventful in all four cases treated, and we achieved cosmetic improvement (minimizing incision and scars) as well as decreased palpability of the miniplate.

Imaging of the Head and Neck following Radiation Treatment

Squamous cell carcinoma of the head and neck occurs in approximately 40,000 patients annually in the United States and is often treated with radiation therapy. Radiological studies are obtained following treatment for head and neck malignancies to assess for recurrent tumor, posttreatment changes, and associated complications. Radiation treatment creates a difficult clinical picture for oncologists, head and neck surgeons, neuroradiologists, and neuropathologists. As post-treatment imaging studies are often discussed at radiology/pathology working conferences, knowledge of the imaging appearance of radiation-associated changes in the head and neck and the terminology used by neuroradiologists may not only aid in interpretation of the pathologic specimen, but also assist in communications with neuroradiologists and referring clinicians.

Osteodistraction of the maxilla in transverse deficiency in adults: analysis of the literature and clinical case

Osteogenic distraction is a bone regeneration and reconstruction technique. Razdolsky et al. (2001) [1] have defined it as "the process of creating new bone by stretching". Disjunction entails separating two anatomical structures at their junction system and, therefore, at a suture. Usually, it involves separating two semi-maxillae in the transverse dimension by means of an osteotomy. Transverse maxillary distraction appears to offer an alternative of choice to orthognathic surgery alone, which is frequently prone to relapse (Betts et al., 2004) [2]. The greatest benefit of osteogenic distraction lies in its greater potential for expansion and concurrent growth of the soft tissues. Among other things, this technique increases arch length, thus precluding tooth extractions in cases of maxillary crowding, and appears to provide more stable results than conventional surgical intermaxillary disjunction.

A mandibular body fracture related to mouth-opening training in a dialysis patient

A mandibular body fracture related to mouth-opening training in a dialysis patient is reported. A 61-year-old male patient had noticed pain in the right mandibular body and difficulty in mouth opening a week previously. The patient had been performing mouth-opening training for a couple of weeks. The right lower face was slightly swollen with tenderness at the right lower border of the mandible. Hypoesthesia of the right lower lip was also observed. A bone step was palpable on the alveolar ridge of the right mandible, but mobility was not marked. The mandible was atrophic in the body region with only four anterior teeth left. Panoramic X-ray examination revealed a moderately displaced fracture in the right molar region of the mandible. The patient had no severe pain or difficulty in eating using a partial denture. The patient had received dialysis for 17 years and had also been treated by warfarin and aspirin. The patient was followed up under restricted mouth opening. Osteosynthesis with bone remodeling was confirmed after 6 months by X-ray examination. No complication requiring further treatment occurred during the follow-up period. In this patient, a medically compromised condition under long-term dialysis is considered a predisposing factor, which made the atrophic mandible more susceptible to the stress related to mouth-opening training.

Coronary flow reserve, strain and strain rate imaging during pharmacological stress before and after percutaneous coronary intervention: comparison and correlation

INTRODUCTION

Coronary flow reserve (CFR) could apply reliable information about the coronary circulation, and strain (S) and strain rate imaging (SRI) are able to quantify the left ventricular myocardial performance. The aim of this study was to assess myocardial performance in relation to the function of the coronary circulation before and after successful percutaneous coronary intervention (PCI) of the left anterior descending artery.

MATERIAL AND METHOD

Fourteen patients (10 men, 4 women, mean age 53.2 ± 11.4 years) with severe left anterior descending stenosis who had a successful selective PCI were recruited into this study. CFR and myocardial deformity indices (S and SR) were recorded before and after percutaneous intervention, both at rest and during stress echo test.

RESULTS

CFR, S, and SR increased after intervention significantly. There was significant correlation between CFR ratio and poststress systolic strain (SS) ratio and early diastolic strain rate (ESR) ratio (P < 0.05 and r > 0.6). Also CFR improvement had significant relationship with changes of poststress Systolic SR and poststress Systolic S (P < 0.05 and r > 0.6). Based on regression analysis the amount of change in CFR was independently associated with change in SS during stress and systolic SR.

CONCLUSION

PCI improves CFR (a marker of coronary perfusion), strain, and strain rate (markers of regional cardiac wall deformation). The independent association between CFR improvement and poststress systolic strain and strain rate means that SRI parameters can independently predict CFR changes after PCI.