3D computed tomographic evaluation of the upper airway space of patients undergoing mandibular distraction osteogenesis for micrognathia

Mandibular distraction osteogenesis (MDO) is currently an accepted method of treatment for patients requiring reconstruction of hypoplastic mandibles. To date one of the unsolved problems is how to assess the quantitative increase of mandible length needed to achieve a significant change in the volume of the posterior airway space (PAS) in children with mandibular micrognathia following distraction osteogenesis. The purpose of this study is to present quantitative volumetric evaluation of PAS in young patients having distraction osteogenesis for micrognathia using 3D-CT data sets and compare it with pre-operative situation. In this observational retrospective study, we report our experience in five consecutive patients who underwent MDO in an attempt to relieve severe upper airway obstruction. Each patient was evaluated before treatment (T0) and at the end of distraction procedure (T1) with computer tomography (CT) in axial, coronal, and sagittal planes and three-dimensional CT of the facial bones and upper airway. Using parameters to extract only data within anatomic constraints, a digital set of the edited upper airway volume was obtained. The volume determination was used for volumetric qualification of upper airway. The computed tomographic digital data were used to evaluate the upper airway volumes both pre-distraction and post-distraction. The mean length of distraction was 23 mm. Quantitative assessment of upper airway volume before and after distraction demonstrated increased volumes ranging from 84% to 3,087% with a mean of 536%. In conclusion, our study seems to show that DO can significantly increase the volume of the PAS in patients with upper airway obstruction following micrognathia, by an average of 5 times. Furthermore, the worse is the starting volume, the greater the increase in PAS to equal distraction.

Temporal evolution of hepatic anatomy during gestation and growth in the sheep

In mammals, the liver undergoes a series of spectacular anatomical changes during development, particularly in domestic ruminants. In all domestic mammals, the liver retracts cranially until it reaches its definitive diaphragmatic position; however, in the sheep, it also withdraws from the entire left side of the diaphragm and seems to rotate through 180°. An anatomical study reveals that the hepatic conformation evolves very little during this topographical change. The latter occurs in two phases: an initial phase of marked regression of the left lobe, which starts from the beginning of the foetal period (44th day of gestation), followed by marked regression of the entire liver, which starts between the 90th and 117th days and ends between the 2nd and 3rd month of life. The path of hepatic regression is dictated by the particular layout of the liver's attachments in the sheep. The left triangular ligament, which holds the L lobe to the left in other species, is almost completely absent in the sheep, whilst the right lobe is fixed to the top of the diaphragm. As the liver regresses, the right lobe therefore draws the left lobe with it to the right-hand side. A statistical study shows constant regression of the hepatic surface area during the topographical evolution of the liver, with a particularly marked and sudden reduction between the end of the 4th month and the middle of the 5th month of gestation. It also shows that the regression of the left lobe is consistently greater than that of the right lobe and that the topographical regression of the liver cannot be predicted by measuring the weight of the liver, which behaves independently to the surface area of the liver.

Urinary diversion in infants with primary high-grade vesicoureteric reflux, urinary sepsis and renal function impairment

INTRODUCTION

General consensus on the optimal treatment of septic infants with primary high-grade vesicoureteric reflux (VUR) and renal function impairment has not been reached. Our study aims at evaluating the role of temporary urinary diversion.

MATERIALS AND METHODS

Twenty male infants, affected by sepsis and primary high-grade VUR, underwent urinary diversion in 1996-2001 because of estimated risk of renal function deterioration, due to non-compliance with the antibiotic treatment. Plasmatic creatinine clearance, ultrasonography, micturition cystography and scintigraphy were evaluated.

RESULTS

Creatinine clearance was abnormal in 13 infants on admission, in 10 after urinary diversion and in 6 after second surgery. Renal damage (focal or diffuse) was evident in 16 patients, without modifications after surgery. No patient developed urinary tract infections (UTI). Vesicostomy was done in 12 cases, ureterostomy in 8. Nephrectomy was performed in 3 cases with poor renal function, and ureteroneocystostomy in 17.

CONCLUSIONS

Urinary diversion in septic infants with high-grade VUR can represent an alternative approach to the conservative or surgical treatment in selected patients presenting risk of renal function impairment. This procedure allowed an easy management of UTI without worsening of renal function while waiting for a better anatomical status to perform reconstructive surgery.

Calcium-deficient apatite: a first in vivo study concerning bone ingrowth

Biphasic calcium phosphate (BCP) materials are increasingly used to restore bone loss in surgery. Calcium-deficient apatites (CDA), the precursors of BCP, are closer in structure to biological apatites and can be associated with therapeutic agents to form drug-delivery systems. The purpose of this first in vivo study of CDA was to evaluate the osteoconductive properties of two composites, consisting of 40-80 microm granules carried by a cellulose-derived polymer, used to fill critical size bone defects in rabbit femoral ends. Animals were sacrificed 2 or 3 weeks after implantation. Histomorphometric analysis of scanning electron microscopy implant surface files was performed using gray level threshold that distinguish between bone or materials (white) and noncalcified tissue (black). Quantitative results for new bone formation showed no significant differences between the composites or the implantation periods. However, nearly all of the CDA disappeared early while supporting more extensive bone colonization than biphasic calcium phosphates implanted in the same conditions.

Orthotopic ileal bladder: clinical, urodynamic and metabolic evaluation

Since January 1985, orthotopic ileal bladder substitution after radical cystectomy was performed in 64 male patients. The Camey I procedure was performed in 35 patients (group 1) and the Studer procedure in 29 (group 2). Clinical, metabolic and urodynamic evaluation was performed at regular intervals with a mean follow-up of 27 months for group 1 and 13.6 months for group 2. Patients with a Camey I bladder reconstruction presented smaller capacity and higher intraluminal pressure resulting in shorter voiding intervals and a practically uniform presence of enuresis, as opposed to those reconstructed with the Studer procedure. The incidence of ureteral reflux was also higher in group 1. Metabolic studies in both groups revealed a slight metabolic acidosis which was treated with oral alkalinization. It is concluded that detubularization of the terminal ileum creates a more favorable low-pressure reservoir.

[Sequential hepatic photoscintigraphy with 99mTc HIDA as a method for evaluating alkaline reflux after gastric resection by Quiroli's method and after total gastrectomy by Moricca's method]

The authors have utilized the hepatic sequential photoscintigraphy practiced with 99mTc HIDA to inquiry, into the optics of the alkaline backflow, two patterns of reconstruction after gastric surgery: 1) gastric resection by Quiroli (5 cases inquired); 2) gastrectomy by Moricca (5 cases inquired). The research has demonstrated that the reconstruction by Quiroli is utilizable in order to avoid the backflow and elides the possibility of after meal relaxation of the afferent ansa; the research applied to Moricca's method has shown that does not happen oesophageal backflow at fast and that a least and fleeting backflow happens in the first three minutes from the ingestion of the bole. The authors believe that, though applied to little cases, the practiced method is exact and electively qualified for the study of the surgery modifications of the digestive apparatus over-mesocolico.

[Antihypertensive effect of indapamide]

2.5 mg/day indapamide was administered to 16 hypertensive patients for 30 days. These was a gradual, significant reduction in systolic and diastolic pressure values with no significant changes in plasma and urinary electrolytes. The effect of the drug on ARP and renal performance was also examined. There were no alterations of other metabolic parameters. These data point to a safe and lasting hpotensive action on the part of indapamide.

Combination of renal and adrenal scanning in the diagnosis of renovascular hypertension: case report

Superimposition of an adrenal scan on a renal scan revealed a kidney defect not appreciated on the renal scan alone. The defect proved to be ischemia of the upper pole of the kidney. Resection of the lesion alleviated the patient's hypertension.

[Clinical significance in radioimmunologic determination of triiodothyronine]

158 patients with physiological and pathological triiodothyronine values were studied: 118 normal subjects, 33 hyperthyroid patients and 7 hypo- patients. The results correlate well with the patients' clinical state and with other Authors' data.