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1.
Clin Exp Dent Res ; 8(1): 197-208, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34689427

RESUMO

OBJECTIVES: In recent years, many studies have reported that the presurgical nasoalveolar molding method improves the nose morphology; however, the reason for its effectiveness after surgery has never been understood. We evaluated the effect of nasoalveolar molding by comparing it with a passive orthopedic method without a nasal stent and focusing on the nostril morphology after primary cheiloplasty using various measurement methods. We then analyzed the essential factors. MATERIALS AND METHODS: The patients involved were 31 infants with unilateral complete cleft lip and palate treated with primary cheiloplasty at the University of Tsukuba Hospital from 2004 to 2011. Of the 31 infants, 16 received nasoalveolar molding treatment and 15 received passive orthopedic treatment as controls. Photographic facial measurements were performed for all patients immediately and 7 months after primary cheiloplasty. The esthetics of the nostrils were assessed according to the left-right nostril symmetry, as measured by the Hausdorff distance, area ratio, perimeter ratio, and aspect a/u (the aspect ratio of the affected side)/(the aspect ratio of the unaffected side) ratio. In addition, the inclination of the nasal ridge was assessed using anthropometric measurements (Grc-Grn∠midline and midline∠columellar axis). RESULTS: The area ratio, perimeter ratio, and Grc-Grn∠midline were significantly greater in the nasoalveolar molding group immediately after surgery (p = 0.00062, 0.016, and 0.048, respectively) than in the control group. However, the Hausdorff distance and aspect a/u ratio were more favorable (p = 0.0018 and 0.0039, respectively) in the nasoalveolar molding group after 7 months. CONCLUSIONS: The results of our study suggested that using nasoalveolar molding as a presurgical orthopedic treatment could improve the shape of the nasal cartilage with surgeon's corrections.


Assuntos
Fenda Labial , Fissura Palatina , Rinoplastia , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Moldagem Nasoalveolar , Recidiva , Rinoplastia/métodos
2.
Ann Plast Surg ; 78(3): 311-314, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27404473

RESUMO

BACKGROUND: Conventional surgery of toe syndactyly is accomplished using a zig-zag incision and full thickness or split thickness skin grafting. However, this method has an aesthetic problem with a prominent scar on the dorsal side of the foot. The aim of the article was to investigate the efficacy of a cosmetically conscious operation for syndactylies performed using a single technique. METHODS: A retrospective analysis was performed involving 66 patients with 88 syndactylic toes who presented to the department of plastic and reconstructive surgery at 1 of 3 major institutions during a 16-year period (1998-2014). Syndactylies were classified according to the affected interdigital spaces (IDSs). All cases were treated using the same method: linear skin incisions to divide the digits, triangular flaps on the dorsal and plantar sides of the foot, and preserved subcutaneous vascular network skin grafts from the medial inframalleolar region. RESULTS: The most frequent type of toe syndactyly was IDS-2 (union of the second/third toes), which accounted for 59.1% (39/66) of the cases. The rates of familial anomalies were significantly different between bilateral IDS-2 (4/13) and unilateral IDS-2 (0/24) (P < 0.05, Fisher exact test). There were no severe postoperative complications, including scar contracture or keloid formation. All patients obtained sufficiently deep IDSs, and none required repeat surgery. CONCLUSIONS: A straight incision minimizes the scar observed from the visible side, and preserved subcutaneous vascular network skin grafts prevent postoperative contracture of linear scar.


Assuntos
Transplante de Pele/métodos , Sindactilia/cirurgia , Dedos do Pé/anormalidades , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Dedos do Pé/irrigação sanguínea , Dedos do Pé/cirurgia , Resultado do Tratamento
3.
Plast Reconstr Surg Glob Open ; 2(11): e256, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25506539

RESUMO

SUMMARY: The Nuss procedure is a prevalent minimally invasive surgery for pectus excavatum. Although the Nuss procedure has the advantage of leaving less obtrusive scars, the standard technique requires at least 3 skin incisions to insert several instruments. We experienced 7 cases of the modified Nuss procedure using a single incision during a 7-year period. To facilitate passing of the bar, a traction guide was created according to our unique method. There was no need for a bar stabilizer, and no severe intraoperative complications occurred. All patients exhibited satisfactory short-term results; however, 1 patient suffered from bar rotation and required repeat surgery for fixation. Two patients underwent bar removal via the same single incision without any difficulties.

4.
Ann Plast Surg ; 71(2): 170-5, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23123612

RESUMO

We assessed the postoperative nasal form and symmetry after presurgical use of a Hotz plate (HP) in patients with unilateral complete cleft lip and palate (UCLP). The subjects were 28 infants with UCLP who underwent cheiloplasty. Of these subjects, 14 underwent presurgical orthopedic treatment using the HP (HP group) and 14 underwent the same treatment without the HP (non-HP group). Photographic records were obtained 1 and 6 months after cheiloplasty, and the results of anthropometric analysis were compared between the 2 groups. The nasal inclination and the ratio of the width of the nasal base to the total width of the nose were significantly improved in the HP group compared with the non-HP group at both postoperative time points. Thus, presurgical use of the HP significantly improved the nasal asymmetry and deformity in UCLP patients after primary cheiloplasty and nasal repair.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Nariz/anormalidades , Procedimentos Ortopédicos/métodos , Aparelhos Ortopédicos , Procedimentos de Cirurgia Plástica , Terapia Combinada , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Nariz/cirurgia , Procedimentos Ortopédicos/instrumentação , Fotografação , Rinoplastia , Resultado do Tratamento
5.
J Craniofac Surg ; 23(6): 1596-601, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23147280

RESUMO

We evaluated the effects of presurgical nasoalveolar molding (NAM) with an orthopedic appliance and compared them with a passive orthopedic method (Hotz plate, HP), focusing on the naris morphology and width of the alveolar and palate cleft gap. The subjects were 28 unilateral complete cleft lip and palate patients treated with primary cheiloplasty at Tsukuba University Hospital from 2004 to 2011. Thirteen patients were treated preoperatively with NAM (NAM group), and 15 with HP (HP group). The surgical outcome was assessed according to left-right naris symmetry, as measured by the area ratio, perimeter ratio, aspect a/u ratio (aspect ratio of the affected side/aspect ratio of the unaffected side), and Hausdorff distance. In addition, the alveolar and palate cleft width was measured at the times of orthopedic plate setting and primary cheiloplasty. The aspect ratio was significantly smaller in the NAM group than in the HP group before the operation. In both groups, the aspect ratio, perimeter ratio, and Hausdorff distance were significantly smaller after the operation than before. The width of the alveolar and palate cleft gap was significantly narrowed in the NAM group, and the cleft gap at the initiation of NAM correlated significantly with the Hausdorff distance after cheiloplasty. We found that NAM improved the form of the naris after primary cheiloplasty and decreased the palate cleft gap more effectively than HP and that the width of the palate cleft gap was correlated with the surgical outcome of the naris.


Assuntos
Processo Alveolar/anormalidades , Fenda Labial/terapia , Fissura Palatina/terapia , Nariz/anormalidades , Procedimentos Ortopédicos/instrumentação , Processo Alveolar/cirurgia , Estudos de Casos e Controles , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Nariz/cirurgia , Cuidados Pré-Operatórios , Resultado do Tratamento
6.
Artigo em Inglês | MEDLINE | ID: mdl-22906581

RESUMO

OBJECTIVE: To evaluate surgery results, we established a novel method to digitize nasal morphology with the use of Hausdorff distance and analyzed nose morphology after cheiloplasty. STUDY DESIGN: We evaluated the naris after primary cheiloplasty of 30 unilateral cleft lip and palate patients. Similarity between left and right sides was assessed by visual evaluation, area ratio, perimeter ratio, aspect a/u ratio, and Hausdorff distance. The postoperative naris morphology was also compared between 15 patients treated with a Hotz plate before surgery and 15 not treated. RESULTS: Significant correlation with visual evaluation was found for Hausdorff distance. For the groups with and without Hotz plate treatment, the visual evaluation was higher and Hausdorff distance significantly lower in the treated group. CONCLUSIONS: The morphologic measurement obtained using the Hausdorff distance was the closest to visual evaluation, and assessment using Hausdorff distance suggested that using a Hotz plate helps retain the symmetry of the nares after cheiloplasty.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Procedimentos Ortopédicos/métodos , Humanos
7.
J Card Surg ; 27(3): 390-2, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22621721

RESUMO

Pentalogy of Cantrell is a rare congenital anomaly characterized by a combination of severe defects in the middle of the chest and abdomen including intracardiac defects. Survival rate after cardiac surgery is extremely low. We present a successful staged complete repair of an omphalocele, a ventricular septal defect and a sternal defect in a case of pentalogy of Cantrell.


Assuntos
Ectopia Cordis/cirurgia , Comunicação Interventricular/cirurgia , Hérnia Umbilical/cirurgia , Pentalogia de Cantrell/cirurgia , Esterno/cirurgia , Pré-Escolar , Ectopia Cordis/diagnóstico , Comunicação Interventricular/diagnóstico por imagem , Hérnia Umbilical/diagnóstico , Humanos , Lactente , Recém-Nascido , Masculino , Pentalogia de Cantrell/diagnóstico , Esterno/anormalidades , Ultrassonografia
10.
J Hum Genet ; 55(4): 252-4, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20224596

RESUMO

Mutations in the fused in sarcoma (FUS, also known as translated in liposarcoma) gene have been recently discovered to be associated with familial amyotrophic lateral sclerosis (FALS) in African, European and American populations. In a Japanese family with FALS, we found the R521C FUS mutation, which has been reported to be found in various ethnic backgrounds. The family history revealed 23 patients with FALS among 46 family members, suggesting a 100% penetrance rate. They developed muscle weakness at an average age of 35.3 years, followed by dysarthria, dysphagia, spasticity and muscle atrophy. The average age of death was 37.2 years. Neuropathological examination of the index case revealed remarkable atrophy of the brainstem tegmentum characterized by cytoplasmic basophilic inclusion bodies in the neurons of the brainstem. We screened 40 FALS families in Japan and found 4 mutations (S513P, K510E, R514S, H517P) in exon 14 and 15 of FUS. Even in Asian races, FALS with FUS mutations may have the common characteristics of early onset, rapid progress and high penetrance rate, although in patients with the S513P mutation it was late-onset. Degeneration in multiple systems and cytoplasmic basophilic inclusion bodies were found in the autopsied cases.


Assuntos
Esclerose Lateral Amiotrófica/genética , Mutação de Sentido Incorreto , Proteína FUS de Ligação a RNA/genética , Idade de Início , Esclerose Lateral Amiotrófica/epidemiologia , Esclerose Lateral Amiotrófica/patologia , Povo Asiático/genética , Análise Mutacional de DNA , Progressão da Doença , Éxons/genética , Saúde da Família , Feminino , Humanos , Corpos de Inclusão/patologia , Japão , Masculino , Linhagem
11.
J Neurol Sci ; 276(1-2): 88-94, 2009 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-18930252

RESUMO

The purpose of this study was to evaluate the clinical and pathological features in patients with progressive-type familial amyloidotic polyneuropathy (FAP) using autopsy and biopsy specimens. A proband is a 33-year-old man with FAP type I who developed motor, sensory and autonomic impairments with neuropathy, heart failure, and anorexia. Genetic findings of transthyretin (TTR) revealed G to A transition in codon 54 causing a rare mutation of TTR Lys54. He died of pneumonia and severe cardiac failure 4 years after onset. Autopsy showed heavy amyloid deposition in the heart, peripheral nerves, thyroid, skin, fat tissue, prostate and testis, moderate in the sympathetic nerve trunk, vagal nerve, celiac plexus, pelvic plexus, bladder, gastrointestinal tract, tongue, pancreas, lung, pituitary, blood vessel, gall bladder, adrenals and muscles, and free in the central nervous system, liver, kidney and spleen. Sural nerve biopsy in a sibling confirmed TTR amyloidosis immunohistochemically. Electronmicroscopic findings of amyloid fibrils were similar to that of FAP Met30. Immunoelectronmicroscopic findings indicated the relationship between amyloid fibrils or non-fibrillar structure and collagen fibers. The distribution of amyloid deposition, heavy in the heart and lacking in the kidney, is a characteristic feature and reflected severity of FAP with TTR Lys54.


Assuntos
Neuropatias Amiloides Familiares , Lisina/genética , Mutação/genética , Pré-Albumina/genética , 3-Iodobenzilguanidina/metabolismo , Adulto , Neuropatias Amiloides Familiares/diagnóstico por imagem , Neuropatias Amiloides Familiares/genética , Neuropatias Amiloides Familiares/patologia , Neuropatias Amiloides Familiares/fisiopatologia , Autopsia/métodos , Progressão da Doença , Feminino , Teste de Tolerância a Glucose , Humanos , Masculino , Imagem de Perfusão do Miocárdio/métodos , Nervos Periféricos/metabolismo , Nervos Periféricos/patologia , Nervo Sural/metabolismo , Nervo Sural/patologia , Nervo Sural/ultraestrutura
12.
Ophthalmic Plast Reconstr Surg ; 22(4): 299-301, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16855506

RESUMO

Conjunctival squamous cell carcinoma developed in a 51-year-old man 40 years after he had enucleation of his left eye because of an explosion injury. He had worn several ocular prostheses for more than 40 years. Recently he had noticed an increasing sanguineous conjunctival discharge, a foreign body sensation, and swelling of his left lower eyelid. Incisional biopsies of an underlying conjunctival mass revealed squamous cell carcinoma. His work history did not involve exposure to radiation, chemicals, or the sun. The authors concluded that squamous cell carcinoma in this case was caused by chronic irritation as the result of long-standing use of a poorly fitting ocular prosthesis.


Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias da Túnica Conjuntiva/patologia , Enucleação Ocular , Traumatismos por Explosões/cirurgia , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/cirurgia , Neoplasias da Túnica Conjuntiva/etiologia , Neoplasias da Túnica Conjuntiva/cirurgia , Explosões , Traumatismos Oculares/cirurgia , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Implantes Orbitários/efeitos adversos , Fatores de Tempo
13.
J Plast Reconstr Aesthet Surg ; 59(7): 752-8, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16782573

RESUMO

Lateral ray polydactyly is the most common anomaly of the foot. However, when both the fifth and sixth toes are markedly shorter than a normal toe, reconstruction of a normal-length fifth toe has not been performed, because the toe rarely serves a functional purpose. The authors devised a new method whereby the fifth toe could be lengthened using the excess toe as a composite flap. Fifteen patients (15 toes) underwent our procedures and were evaluated in this study. The stepladder island flap is used. The decision as to which toe to use as the flap was made preoperatively based on nail size, and its morphologic and radiographic conditions. Stepladder incision lines were designed on the dorsal and plantar sides of the duplication. Care was taken to preserve the neurovascular bundle with the subcutaneous pedicle and osteotomies were made at the middle phalanx of the flap and the distal or middle phalanx of the recipient in almost all cases. The elevated composite toe flap was advanced and the bone was fixed rigidly for 1-2 months after the operation. During our follow-up periods, the reconstructed toes grew normally, and good aesthetic results had been achieved apart from the bulkiness of the reconstructed toes. There was no deficiency in circulation or function for walking, running, or shoe-fitting in this series.


Assuntos
Polidactilia/cirurgia , Dedos do Pé/anormalidades , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Polidactilia/patologia , Complicações Pós-Operatórias , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Dedos do Pé/patologia , Dedos do Pé/cirurgia , Resultado do Tratamento
14.
Auris Nasus Larynx ; 31(3): 287-92, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15364366

RESUMO

We report a 75-year-old male with anaplastic carcinoma in an extrathyroid area. Thyroid remained unchanged. The patient is alive without incident of tumor recurrence at 3.5 years after total resection and at 5 years after initial symptom. The tumor developed between the sternocleidomastoid muscle and common carotid artery, and was completely separated from the thyroid. The tumor location was consistent with a branchial cyst. The tumor consisted of two parts; an upper solid tumor and a deep cystic tumor. The former showed anaplastic carcinoma with osteoclast-like giant cells. The latter was consistent with thyroid papillary carcinoma. The center was intermingled with these two carcinomas. Anaplastic carcinoma cells were positive for vimentin and papillary carcinoma cells were positive for keratin, thyroglobulin, and thyroid transcription factor-1. These results remain insufficient to find any conclusions concerning the tumor nature; either ectopic thyroid carcinoma arising from a branchial cyst or occult thyroid carcinoma metastasis. This is rare case in which thyroid anaplastic carcinoma transformed from papillary carcinoma in an extrathyroid area.


Assuntos
Carcinoma Papilar/patologia , Carcinoma/patologia , Transformação Celular Neoplásica/patologia , Neoplasias da Glândula Tireoide/patologia , Idoso , Branquioma/patologia , Carcinoma/química , Carcinoma/diagnóstico por imagem , Carcinoma/cirurgia , Carcinoma Papilar/química , Carcinoma Papilar/cirurgia , Diagnóstico Diferencial , Humanos , Queratinas/análise , Masculino , Proteínas Nucleares/análise , Osteoclastos/patologia , Tireoglobulina/análise , Neoplasias da Glândula Tireoide/química , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Fator Nuclear 1 de Tireoide , Tomografia Computadorizada por Raios X , Fatores de Transcrição/análise , Vimentina/análise
15.
J Spinal Disord Tech ; 15(1): 88-90, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11891462

RESUMO

Intramedullary tuberculoma with syringomyelia is rare. We treated a woman with back pain and weakness of the left leg that had slowly progressed for more than 30 years. Radiologic evaluation demonstrated a crescent-shaped calcification at the level of the C6 vertebra, and syringomyelia from C7 to T9. Laminectomy and syringosubdural shunt placement were performed, and a tuberculoma was removed. Back pain resolved after the operation, and mobility was facilitated. We recommend surgery for intrathecal tuberculoma with syringomyelia even when the course has been prolonged with no active tuberculous lesion.


Assuntos
Neoplasias da Medula Espinal/diagnóstico , Siringomielia/diagnóstico , Tuberculoma/diagnóstico , Vértebras Cervicais/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias da Medula Espinal/complicações , Siringomielia/etiologia , Tuberculoma/complicações
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