Comparison of conventional orthognathic surgery and "surgery-first" protocol: a new weapon against time.

The aim of this literature review article is to evaluate the new surgical technique "Surgery-First" and compare it with the conventional orthognathic surgery in terms of treatment length, patient satisfaction and post-surgical stability. The goal is to compare the pro and cons of the two techniques and to determine which technique can offer more efficient results.

Isolated episode of exercise-related ventricular fibrillation in a healthy athlete.

A 19-year-old man had a documented ventricular fibrillation during a football match. He was a top-level athlete, and after successful resuscitation, he was extensively studied. Electrolytic disturbances, long QT syndrome and nervous mechanisms were all ruled out. Right and left ventriculography, coronary angiograms, electrophysiologic study and endomyocardial biopsy all proved normal. A beta-blocker was empirically given in the absence of any reliable test to guide therapy more scientifically.

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional reentrant tachycardia. Comparison with patients with ventricular pre-excitation and with normal subjects.

The aim of our work was to evaluate the inducibility of atrial fibrillation in a group of patients with atrioventricular junctional reentrant tachycardia and to compare it with that of patients with a Kent-type ventricular pre-excitation (Wolff-Parkinson-White syndrome) and a control group. One hundred and twenty-five subjects were separated into groups. Group 1 comprised 49 Wolff-Parkinson-White patients, with a mean age of 26.4, range 10-66 years; group 2, 51 patients with atrioventricular junctional reentrant tachycardia inducible by transoesophageal atrial stimulation and/or clinically documented, with a mean age of 43.4, range 16-78 years; group 3, 25 control subjects with a mean age of 26.4, range 13-76 years. Each subject underwent atrial transoesophageal stimulation with the following protocol: programmed atrial stimulation with 1 and 2 stimuli during atrial pacing of 100.min-1 and 150.min-1; atrial stimulation for 10 s at a rate of 200-300-400-500-600.min-1 with intervals of 10 s between stimulations, five successive 'ramp-up' atrial stimulations for 9 s with the rate increasing from 100 to 800.min-1 with intervals of 10 s between stimulations. The end point was the completion of the protocol or induction of sustained atrial fibrillation (> 1 min). The chi-square test was used for statistical analysis. Our results showed that in group 1 atrial fibrillation was induced in 27/49 patients (55.1%); this was sustained in 13/49 (26.5%) and non-sustained in 14/49 (28.5%); in group 2, atrial fibrillation was induced in 22/51 patients (43.0%); it was sustained in 7/51 (13.7%) and non-sustained in 15/51 (29.4%); in group 3, sustained atrial fibrillation was not induced in any subject and in only one subject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant, while group 2 vs group 3 and group 1 vs group 3 were significant (P < 0.003 and P < 0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerability in comparison to the control subjects and a similar vulnerability to group 1 patients. It is possible that the greater atrial vulnerability in the patients of group 2 was due to the double nodal pathway.