Helminth and ectoparasitic faunas of the Harris's hawk, Parabuteo unicinctus (Accipitriformes: Accipitridae), in Chile: new data on host-parasite associations for Neotropical raptors / Helmintos e ectoparasitas do gavião-asa-de-telha (Accipitriformes: Parabuteo unicinctus) no Chile: novas associações parasita-hospedeiro para os rapinantes neotropicais

Abstract Birds of prey harbor a wide spectrum of various parasites, mostly with a heteroxenous life cycle. However, most reports on their parasites come from Europe. Although the Harris's hawk (Parabuteo unicinctus) is a widespread species in America, parasitological surveys on this hawk are mostly focused on coprological findings and ectoparasites, with poor attention paid to helminths. The aim of this study was to gather new and additional data on host-parasite associations for the Harris's hawk. Twenty-nine birds from central and southern Chile were necropsied. Further, nine birds from a rehabilitation center and 22 museum specimens were inspected for ectoparasites. Sixty-eight percent of birds hosted at least one parasite species. Four lice species, one mite species and eight helminth species (five nematodes, two platyhelminthes and one acanthocephalan) were recorded. Parasitic lice Colpocephalum nanum and Nosopon chanabense, and a nematode Cyathostoma (Hovorkonema) americana were recorded for the first time in raptors from the Neotropics. A feather mite, Pseudalloptinus sp., nematodes, Physaloptera alata and Microtetrameres sp., and a trematode Neodiplostomim travassosi, were recorded for the first time in Chile. The presence of diverse heteroxenous helminths reported here in the Harris's hawk could be explained by the generalist diet of this raptor.

Resumo As aves de rapina representam uma fonte importante de parasitas heteroxenos. Porém, a maioria dos relatos são da Europa. O gavião-asa-de-telha (Parabuteo unicinctus) é uma espécie amplamente distribuída no continente Americano, porém estudos parasitológicos nessas aves têm documentado achados coprológicos e ectoparasitas, com poucos relatos sobre endoparasitas como helmintos. Por essa razão, o objetivo deste estudo foi descrever novas associações parasita-hospedeiro para o gavião-asa-de-telha e rapinantes neotropicais. Vinte nove aves provenientes do centro e sul do Chile foram submetidas à necropsia. Por outro lado, nove aves de um centro de reabilitação e 22 espécimes de museu foram inspecionados em busca de ectoparasitas. Do total de aves, 68,3% foram identificadas como portadoras de pelo menos uma espécie de parasita. Quatro espécies de piolhos, um ácaro e oito helmintos (cinco nematoides, dois platelmintos e um acantocéfalo) foram registrados. Os piolhos Colpocephalum nanum, Nosopon chanabense e o nematóide Cyathostoma (Hovorkonema) americana são reportados pela primeira vez em rapinantes neotropicais. Colpocephalum nanum, N. chanabense, Pseudalloptinus sp., Physaloptera alata, Microtetrameres sp., C. (H.) americana e Neodiplostomim travassosi, são reportados pela primeira vez no Chile. A diversidade de helmintos heteróxenos, identificados neste trabalho, poderia ser explicada devido à dieta geralista do gavião-asa-de-telha.

Percepção de enfermeiros acerca do processo de titulação hospital amigo da criança / Percepción de enfermeros sobre el proceso de titulación hospi-tal amigo del niño / Nurses' perception about the titling process of hospital amigo da criança

RESUMO Objetivo: descrever a perceção dos enfermeiros acerca do processo de implantação da titulação de Hospital Amigo da Criança de um hospital escola do Sul do Brasil. Método: pesquisa com abordagem qualitativa descritiva e exploratória. A coleta de dados foi realizada por meio de entrevista semiestruturada com 14 enfermeiros que trabalham na Unidade Materno-infantil do Hospital Escola da Universidade Federal de Pelotas e os dados foram analisados segundo a proposta Operativa de Minayo. Resultados: os enfermeiros se sentem corresponsáveis, mesmo não participando de algumas fases do processo. Enfatizam que o processo é dificil, existe fragilidade no engajamento da equipe multidisciplinar, bem como no incentivo institucional. Destacaram que o incentivo ao aleitamento materno, o contato pele a pele, amamentação na 1ª hora de vida e o alojamento conjunto são as ações que potencializam o processo, contrapondo com o uso de bico/chupeta e o número de partos cesáreos realizados na instituição. Conclusão: a maioria dos enfermeiros declara-se participativa e atuante na busca pelo título de Hospital Amigo da Criança, mesmo não participando de todas as fases do processo e das atividades propostas. Os resultados apresentados poderão fornecer subsídios aos gestores e profissionais de saúde na construção de ações para garantir que mais hospitais alcancem a titulação e IHAC.

RESUMEN Objetivo: describir la percepción de los enfermeros sobre el proceso de implantación de la titulación de Hospital Amigo del Niño (IHAN) de un hospital escuela del Sur de Brasil. Método: investigación con abordaje cualitativo descriptivo y exploratorio. La recolección de datos fue realizada por medio de entrevista semiestructurada con 14 enfermeros que trabajan en una Unidad Materno-infantil del Hospital Escuela de la Universidad Federal de Pelotas y los datos fueron analizados según la propuesta Operativa de Minayo. Resultados: los enfermeros se sienten corresponsables, aunque no participen de algunas fases del proceso. Señalan que el proceso es difícil, existe fragilidad en el compromiso del equipo multidisciplinario, así como en el fomento institucional. Destacaron que el estímulo a la lactancia materna, el contacto piel a piel, lactancia en la 1ª hora de vida y el alojamiento conjunto son las acciones que potencian el proceso, contraponiendo con el uso de boquilla/chupete y el número de partos cesáreos realizados en la institución. Conclusión: la mayoría de los enfermeros se declara participativa y actuante en la búsqueda del título de Hospital Amigo del Niño, aunque no participen en todas las fases del proceso y de las actividades propuestas. Los resultados presentados podrán proporcionar colaboraciones a los gestores y profesionales de salud en la construcción de acciones para garantizar que más hospitales logren la titulación e IHAN

ABSTRACT Objective: to describe the nurses' perception about the implementation of the titling process of Hospital Amigo da Criança of a Teaching Hospital in southern Brazil. Method: it is a research with a descriptive and exploratory qualitative approach. The data collection was carried out through semi-structured interviews with 14 nurses who work in the Maternal-Infant Unit of the Teaching Hospital of the Federal University of Pelotas and the data were analyzed according to Minayo's Operative proposal. Results: the nurses feel co-responsible, even not participating in some phases of the process, they emphasize that the process is difficult, there is weakness in the engagement of the multidisciplinary team, as well as in institutional encouragement. They highlighted that encouraging breastfeeding, skin-to-skin contact, breastfeeding in the 1st hour of life and rooming-in are the actions that enhance the process, relying on the use of a nipple/pacifier and the number of cesarean deliveries performed in the institution. Conclusion: most nurses declare them selves participative and active in the search for the title of Hospital Amigo da Criança, even though they do not participate in all phases of the process and proposed activities. The results presented may provide subsidies to managers and health professionals in the construction of actions to ensure that more hospitals reach the title and "IHAC".

Comparison between infrared and hot-blade beak trimming methods in white and brown pullets: performance, organ and bone development / [Comparativo entre debicagem infravermelha e por lâmina-quente em linhagens de frangas leves e semi-pesadas: desempenho, desenvolvimento ósseo e de órgãos]

The purpose of this study was to evaluate infrared beak trimming versus hot-blade beak trimming on performance, organ and bone development of laying pullets, using 240 birds, at 0-16 weeks of age, from two strains (white layer - Hy-Line W36 and brown layer - Hy-Line Brown). Infrared debeaking was performed on the first day of life in the hatchery, whereas hot-blade beak trimming was performed at eight days of age. Zootechnical performance at 6, 9, 12 and 15 weeks of age was analyzed. At the end of the trial, one Bird per experimental unit was euthanized for liver, gizzard, proventriculus, heart and small intestine relative weight evaluation. Both tibiotarsus were collected to measure bone breaking resistance, bone mineral content and bone densitometry. There was higher body weight and feed intake in both bird strains submitted to infrared beak trimming. Additionally, hot-blade white layers presented lower body development and feed intake. The debeaking methods did not influence relative organ weights or tibiotarsus parameters evaluated. We conclude that the infrared beak trimming method promotes better pullet body development than the conventional hot-blade method, improving feed intake, without compromising organ and bone development, being a more adequate debeaking method to be used in layer production.(AU)

Para avaliar a debicagem infravermelha versus a debicagem pelo método da lâmina quente no desempenho, no desenvolvimento de órgãos e na qualidade óssea de poedeiras em recria, foram utilizadas 240 aves, entre zero e 16 semanas de idade, em duas linhagens (branca - Hy-Line W36 e vermelha - Hy-Line Brown). A debicagem por infravermelho foi realizada no primeiro dia de vida no incubatório, enquanto a debicagem com lâmina quente foi realizada aos oito dias de idade. Analisou-se o desempenho zootécnico na sexta, nona, 12ª e 15ª semanas de idade. No final do estudo, uma ave por unidade experimental foi eutanasiada para avaliação do peso relativo do fígado, da moela, do proventrículo, do coração e do intestino delgado, e ossos do tibiotarso foram coletados para avaliação da resistência à ruptura, do conteúdo mineral e da densitometria óssea. Houve maior peso corporal e consumo alimentar nas aves pertencentes às duas linhagens quando submetidas à debicagem por infravermelho, sem haver influência sobre o peso relativo dos órgãos e a qualidade óssea. Conclui-se que o método de debicagem por radiação infravermelha promove melhor desenvolvimento corporal das frangas em relação à debicagem por lâmina quente, melhorando consumo de ração, sem comprometer o desenvolvimento de órgãos e ossos, sendo mais adequada para utilização na avicultura de postura comercial.(AU)

Comparative anatomy of blue-and-yellow macaw (Ara ararauna) and toco toucan (Ramphastos toco) beaks using macroscopic analysis and computerized tomography / Anatomía comparada de los picos de guacamayo azul y amarillo (Ara ararauna) y de tucán toco (Ramphastos toco) mediante análisis macroscópico y tomografía computarizada

SUMMARY: Clinically, avian medicine still finds it very difficult to treat wild patients due to the lack of reliable information about their anatomy and physiological parameters that make comparative analyzes possible. Considering that computed tomography (CT) is one of the most viable alternatives in radiography of the head, we describe the comparative anatomy of the beak in the Ara ararauna and the Ramphastos toco through this imaging modality and macroscopy analysis, providing additional information about their conformation and topography for clinical exams. Adult specimens of each were dissected after the CT and beaks were removed for macroscopic analyses. The macroscopic and tomographic findings for both species confirm the similarities in beak morphology and the dietary peculiarities of each.The CT scan proved to be a useful tool to visualize internal structures of the skull through a detailed virtopsy of regions that are difficult to access by the usual necropsy with a scalpel.

RESUMEN: Debido a la escasa información de la anatomía y de los parámetros fisiológicos que hacen posible los análisis comparativos en la medicina aviar, clínicamente resulta muy difícil el tratamiento de estos animales. Considerando que la tomografía computarizada es una buena alternativa, estudiamos la anatomía comparativa del pico en Ara ararauna y Toco Toucan utilizando imágenes y un análisis de macroscopía. Estos métodos proporcionaron información adicional referente a su conformación y topografía para el trabajo clínico. Después de analizar la tomografía se disecaron las muestras de especímenes adultos y se retiraron los picos para un análisis macroscópico. Los hallazgos macroscópicos y tomográficos para ambas especies corroboraron la relación morfológica entre los picos y las peculiaridades dietéticas de cada uno. Se demostró además, que la tomografía computarizada es una herramienta útil para visualizar las estructuras internas del cráneo de las aves, a través de una virtopsia detallada en áreas de difícil acceso durante una necropsia habitual.

Presiones y pico flujo tosido en la asistencia mecánica de la tos / Pressures used and peak cough flow during mechanical cough assistance

Introducción: En las personas con enfermedad neuromuscular, la incapacidad para toser y para generar flujos espiratorios adecuados constituye el principal limitante para mantener una adecuada salud del sistema respiratorio. La asistencia mecánica de la tos es un dispositivo que genera presión positiva y negativa en la vía aérea y simula una tos normal. Se realizó una revisión bibliográfica. Se incluyeron 9 estudios, con un total de 235 sujetos adultos con enfermedad neuromuscular. Objetivos: Describir los valores de presiones de insuflación y exsuflación utilizados y su relación con los valores de pico flujo tosido. Desarrollo: El 28 por ciento era de género femenino y las edades estaban comprendidas entre 14 a 77 años. Las presiones utilizadas variaron entre los estudios, con valores que iban desde +15/ -15 cm H2O a los +40/ -40 cm H2O. Con respecto a los valores de pico flujo tosido, 7 estudios observaron incrementos estadísticamente significativos al aplicar la terapéutica. En estos estudios, para obtener un flujo espiratorio superior a 160 L/min se requirieron presiones de al menos -30/+30 cm H2O. Conclusiones: Se requieren futuras investigaciones que permitan el desarrollo de un consenso respecto a aplicación de la asistencia mecánica de la tos en sujetos con enfermedad neuromuscular, así como establecer criterios de selección de las presiones de insuflación y exsuflación a programar durante la terapéutica(AU)

Introduction: In people with neuromuscular disease, the inability to cough and generate adequate expiratory flows is the main limitation to maintain adequate health of the respiratory system. The mechanical assistance of the cough is a device that generates positive and negative pressure in the airway, simulating a normal cough. 9 studies were included, with a total of 235 adult subjects with neuromuscular disease. Objectives: Describe the values ​​of insufflation and exsufflation pressures used and to describe their relationship with peak cough flow values. Development: 28 percent were female and the ages between 14 and 77 years old. The pressures used varied between the different studies, with values ​​ranging from + 15 / -15 cm H2O to + 40 / -40 cm H2O. According to the peak cough flow values, seven studies observed statistically significant increases when applying the therapy. In these studies, to obtain an expiratory flow greater than 160 L / min, at least -30 / + 30 cm H2O were required. Conclusions: Future research is required to allow the development of a consensus regarding the application of mechanical cough assistance in subjects with neuromuscular disease, as well as establishing selection criteria for insufflation and exsufflation pressures to be programmed during therapy(AU)

Método estadístico matemático para identificar el estado de la COVID-19 con relación al pico epidémico / Statistical and mathematical method to monitor COVID-19 status in relation to the peak of the epidemic

RESUMEN Introducción: Varios modelos han intentado pronosticar y evaluar el estado actual de la pandemia que ha generado el coronavirus SARVS-CoV2, siendo la evaluación la base fundamental para la toma de decisiones. Por ello, la importancia de identificar el estado de la COVID-19 en un lapso seleccionado es un proceso de gestión de información muy importante, el cual puede realizarse a través de métodos estadísticos y matemáticos con el fin de tomar decisiones para controlar la epidemia. Objetivo: Proponer un método estadístico matemático para identificar el estado de la COVID-19 con relación al pico epidémico en lapsos escogidos. Método: Se utilizaron métodos teóricos entre los que destacan el análisis, la síntesis y la abstracción, y otros de carácter puramente matemáticos. Resultados: Como resultado de la aplicación práctica del método se generan gráficos que ofrecen información válida y confiable para un eficaz proceso de toma de decisiones. Conclusiones: Esta propuesta muestra robustez teórica y eficacia práctica que, aunque se elabora teniendo en cuenta los datos de Cuba, es extrapolable a cualquier otro país, e incluso a provincias y municipios.

ABSTRACT Introduction: Several models have tried to predict and evaluate the current status of the pandemic that the new coronavirus, labeled SARVS-CoV2, has caused. This evaluation would be the basis for decision making. Therefore, the importance of monitoring the COVID-19 status in a selected period of time is very important for the process of information management, which can be done through statistical and mathematical methods in order to make big decisions to control the epidemic. Objective: To propose a mathematical and statistical method to monitor COVID-19 status in contrast to the peak of the epidemic in a selected period of time. Method: Several theoretical methods were used, specially: analysis, synthesis, abstract; and other purely mathematical methods. Results: As a result of the practical application of the methods used, valid and reliable information was generated in charts, supporting an effective process of decision making. Conclusions: This proposal shows the robustness of its theoretical aspects and a practical effectiveness that, even if elaborated to submit Cuban-generated national data, it could be used in other countries, and even in a provincial or municipal level.

Alternaria yunnanensis sp. nov., a New Alternaria Species Causing Foliage Spot of Rubber Tree in China

A new species of Alternaria causing leaf spots on the rubber tree (Hevea brasiliensis) in Yunnan, China, was isolated, examined, and illustrated. Morphologically, it belongs to the section Porri of Alternaria, which produces relatively large conidia and a simple or branched, filamentous long beak. It is, however, characterized by conidiophores gradually enlarging near the apex into a clavate conidiogenous cell and long ellipsoid to obclavate, smooth-walled conidia with a long filamentous beak. Molecular phylogenetic analyses based on ITS rDNA, GAPDH, and TEF1-alpha sequences demonstrate that the phytopathogen falls in the clade of the section Porri, being most closely related to A. sidae, A. sennae, A. deseriticola, A. cyamopsidis, A. rostellata, A. nitrimali, A. crassa, and A. thunbergiae.

Radiologic Analysis of Distal Radius Fracture Accompanying Spontaneous Extensor Pollicis Longus Rupture

PURPOSE: The spontaneous extensor pollicis longus (EPL) tendon rupture is a well-documented complication of non-displaced or minimally displaced distal radius fracture. Authors analyzed the radiographs of patients treated for closed EPL rupture after distal radius fracture. MATERIALS AND METHODS: Twenty-eight patients (21 females, 7 males; average age of 58 years) with tendon transfer for spontaneous rupture of EPL after distal radius fracture were included. Wrist radiographs were taken at the first visit with EPL rupture. On the lateral view, posterior cortical displacement, distance from highest point in Lister's tubercle to fracture line, and height of the Lister's tubercle were measured. The distance from the lunate facet to the fracture line was measured on anteroposterior view. Radiologic change at the time of EPL rupture around the Lister's tubercle was evaluated by comparing it with the contra lateral wrist radiograph. Radial beak fracture pattern was also identified. RESULTS: The interval between the injury and the spontaneous EPL rupture varied from 2 to 20 weeks, with an average of 6.7 weeks. There were 25 cases of non-displacement, 3 cases of mean 2.0 mm cortical displacement. The average distance from the lunate facet to the fracture line was 9.1 mm (3-12.1 mm), from the highest point in Lister's tubercle to the fracture line was 3.0 mm toward proximal radius (1.7-4.9 mm). The average height of the Lister's tubercle was 3.4 mm in the injured wrist and 3.1 mm in the opposite wrist. Radial beak fracture pattern was shown at 11 cases. CONCLUSION: All cases presented no or minimal displaced fracture, and the fracture line was in the vicinity of the Lister's tubercle. Those kinds of fractures can highlight the possibility of spontaneous EPL rupture, depites its rarity.

Variación en el tamaño de los huevos en garzas (Aves: Ardeidae) que anidan en la ciénaga de Birama, Cuba / Egg size variation in egrets and herons (Aves: Ardeidae) nesting in Birama’s swamp, Cuba

Intraclutch egg size variation in birds depends on many ecological factors and on the evolutive history of each species. In wading birds, a trend to smaller eggs with laying order has been described, but comparative reports are scarce. In this study, egg size variation patterns were described for nine Egrets and Heron species nesting in Birama’ Swamp, Cuba. The patterns were described using external dimensions of 3 142 eggs from 1 875 nests of Butorides virescens, Bubulcus ibis, Ardea alba, Nycticorax nycticorax, Nyctanassa violacea and four Egretta species, taken in the field between 1998 and 2006. Results showed that eggs were 4.9-10% of adult weight and had volume variation coefficients between 6-9%. There were no general and consistent interspecies relationship between clutch size and egg sizes. Average volumes tend to get smaller with laying order, but it is not statistically detectable in Butorides and Bubulcus. Last egg was between 0.2% and 15% smaller than the first, showing an inverse relationship with it. Intraclutch asymmetry is light in E. thula and fluctuating around null in Bubulcus. Size only predicted laying or hatching order for the last egg, in nests with more than two eggs, with 72.4% of confidence.

Las variaciones intranidada de la talla de los huevos de las aves responden a numerosos factores ecológicos y de la historia evolutiva de las especies. En las zancudas aunque se ha descrito una disminución de la talla con el orden de puesta, los trabajos comparativos entre especies son escasos. En este trabajo se describen los patrones de variación del tamaño de los huevos de nueve especies de garzas (Aves: Ardeidae) nidificantes en la ciénaga de Birama, Cuba. Los patrones se describen a partir de las dimensiones de 3 142 huevos, pertenecientes a 1 875 nidos de Butorides virescens, Bubulcus ibis, Ardea alba, Nycticorax nycticorax, Nyctanassa violacea y cuatro especies de Egretta, tomados en la ciénaga de Birama, Cuba, entre 1998 y 2006. Los huevos representaron entre el 4.9-10% del peso adulto y tuvieron un coeficiente de variación del volumen entre el 6-9%. No existió una relación general consistente entre especies entre el tamaño de puesta y las dimensiones de los huevos. El volumen promedio del huevo tiende a disminuir con el orden de puesta, pero no es estadísticamente detectable en Butorides y Bubulcus. El último huevo fue entre un 0.2 y un 15% menor que el primero, disminuyendo su volumen relativo con la talla del primer huevo. La asimetría intranidada es menos marcada en E. thula y prácticamente fluctuante alrededor de cero en Bubulcus. En general, la talla del huevo solo puede predecir el orden de puesta para el último huevo en nidadas mayores de dos con un 72.4% de confianza.

Use of an Ultrasonic Osteotome for Direct Removal of Beak-Type Ossification of Posterior Longitudinal Ligament in the Thoracic Spine

Direct removal of beak-type ossification of posterior longitudinal ligament at thoracic spine (T-OPLL) is a challenging surgical technique due to the potential risk of neural injury. Slipping off the cutting surface of a high-speed drill may result in entrapment in neural structures, leading to serious complications. Removal of T-OPLL with an ultrasonic osteotome, utilizing back and forth micro-motion of a blade rather than rotatory-motion of drill, may reduce such complications. We have applied the ultrasonic osteotome for posterior circumferential decompression of T-OPLL for three consecutive patients with beak-type OPLL and have described the surgical techniques and patient outcomes. The preoperative chief complaint was gait disturbance in all patients. Japanese orthopedic association scores (JOA) was used for functional assessment. Scores measured 2/11, 5/11, 2/11, and 4/11 for each patient. The ventral T-OPLL mass was exposed after posterior midline approach, laminotomy and transeversectomy. The T-OPLL mass was directly removed with an ultrasonic osteotome and instrumented segmental fixation was performed. The surgeries were uneventful. Detailed surgical techniques were presented. Gait disturbance was improved in all patients. Dural tear occurred in one patient without squeal. Postoperative JOA was 6/11, 10/11, 8/11, and 8/11 (recovery rate; 44%, 83%, 67%, and 43%) respectively at 18, 18, 10, and 1 months postoperative. T-OPLL was completely removed in all patients as confirmed with computed tomography scan. We hope that surgical difficulties in direct removal of T-OPLL might be reduced by utilizing ultrasonic osteotome.

Reconstruction of Postburn Sideburn and Frontal Hairline Alopecia by Various Tailored Scalp Flaps Transfer

PURPOSE: Reconstruction of sideburn and frontal hairline alopecia after burn injuries is one of the challenging tasks in reconstructive surgery. We report on the successful experiences to reconstruct the sideburn and frontal hairline alopecia with various scalp flaps such as Beak scalp flap, scalp rotation flap, scalp transposition flap and scalp expansion operation. METHODS: We experienced the patients who had postburn scalp alopecia after severe facial burn injuries. Among them we selected 8 patients of postburn sideburn and frontal hairline loss and reconstructed with variable scalp flaps. The types of scalp flaps for reconstruction were the Beak scalp flap which is made of the extended postauricular scalp flap combined with the central scalp rotation flap, scalp rotational flap, scalp transposition flap, and scalp expansion operations. We studied the indication of the transferred various scalp flaps for each case considering the size and shape of hair loss lesion, complications, problems of donor site, appearance of reconstructed frontal hairline and sideburns through follow survey. The follow-up periods were 3 months to 2 years. RESULTS: We experienced 8 patients of postburn sideburn and frontal hairline alopecia. Patients' age ranged from 13 to 16 years. male to female ratio was 2:6. Reconstruction methods were 1 case of Beak scalp flap, 1 case of scalp rotation flap, 1 case of scalp transposition flap and 5 cases of scalp expansions. All transferred scalp flaps were completely survived. As complications, 1 case hematoma, 1 case partial edge extrusion of expander, 1 case of persistent headache in scalp expansion operation were noted. There were no remarkable problems in scalp donor site. After 3 months to 2 years follow up, satisfactory results were obtained in all patients. Illustrated Case: The 31-years-old female patient had loss of right frontal hairline, sideburn caused by flame burn. With aid of 3D computerized graphic design, the extended posterior auricular scalp flap with the central frontal scalp rotation flap, which is called as the Beak scalp flap, is a newly designed scalp flap for correction of her frontal hairline and sideburn alopecia. The size of the central frontal scalp rotation flap was 12x11 cm, and the size of the extended postauricular scalp flap was 7x1.5 cm. This flap is elevated simultaneously and could cover the sideburn and frontal hairline alopecia in a single procedure. At postoperatively, the transferred the Beak scalp flap was survived completely. The 9 months follow-up after operation, well reconstructed her right sideburn and frontal hairline was shown. CONCLUSION: For reconstruction of postburn sideburn and frontal hairline alopecia, the scalp flaps transfer should be precisely design in accordance with size, location of hair loss, direction of hair, and also it is emphasized to minimize postoperative scalp donor scars. We had successful reconstruction of postburn sideburn and frontal hairline alopecia by the Beak scalp flap, as a newly designed the composite scalp flap, which is made of the extended postauricular scalp flap combined with the central frontal scalp rotation flap, this flap can be used for reconstruction of loss of sideburn and frontal hairline in a single stage procedure. And also we have used scalp rotation flap, scalp transposition flap, and scalp expansion operations for this purpose. We present these method's reliability and validity.

Extended Draf IIb Procedures in the Treatment of Frontal Sinus Pathology

OBJECTIVES: Draf IIb approach provides wide, unilateral access to the frontal sinus. This approach can be extended without destruction of the contralateral frontal sinus drainage pathway, performed during Draf III (modified Lothrop) procedure. There is limited data in the literature regarding the use of modified Draf IIb procedures. METHODS: Patients treated with extended Draf IIb procedures in a single center were retrospectively assessed. RESULTS: Ten patients were identified, including 2 cases of osteoma, 1 inverted papilloma, 1 carcinoma, 5 mucoceles, and 1 chronic rhinosinusitis patient. Six patients had undergone prior surgery, including external procedures in 3 cases. Modifications of Draf IIb were classified as the following: removal of the anterosuperior nasal septum adjacent to the nasal beak, removal of the intersinus septum, and a combination of the above-mentioned methods (upper nasal septum and intersinus septum removal). There were 3 patients operated on with type 1 modification, one patient with type 2 modification, and 6 patients with type 3 modification. There were no perioperative complications. CONCLUSION: In selected cases, extended Draf IIb procedures are safe and effective in the treatment of frontal sinus disease.

A Measurement of the Frontal Sinus Ostium Using the Sagittal Images of Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic management of frontal sinus disease remains a difficult task. In order to minimize the risk of intracranial complication, easily identifiable landmarks and measurements should be required. This study aims to identify standard distances from the columella to the anterior and posterior borders of the frontal sinus ostium in Korean men and women. SUBJECTS AND METHOD: We obtained the sagittal images taken from 30 men and 30 women. Measurements from the columella to the nasofrontal beak (NFB) and anterior skull base (ASB) were made. Also, the angle between the lines of the columella to the ASB and hard palate was measured. RESULTS: The mean distance from the columella to the NFB was 55.3+/-3.9 mm in men and 52.1+/-4.7 mm in women (p0.05). CONCLUSION: This study suggests sinus surgeons to stay a distance from the columella of less than 57.6 mm in men and 54.3 mm in women to minimize skull base injury.

Bisphosphonate Related Atypical Femoral Fracture / 대한고관절학회지

PURPOSE: We attempted to determine the differences in frequency, as well as clinical, radiologic characteristics of atypical femoral fracture between groups of patients who have taken bisphosphonate and those who have not by conduct of a retrospective analysis of patients with low energy subtrochanteric and shaft fractures of the femur. MATERIALS AND METHODS: We conducted a retrospective study of 44 cases of 41 female patients over 60 years old who underwent surgery due to femoral shaft/subtrochanteric fractures from August 2001 to October 2011. The patients were divided into two groups: Group A, 22 cases in 19 patients with a history of bisphosphonate treatment; Group B, 22 cases in 22 patients without a history of bisphosphonate treatment as a control group. We assessed the duration of bisphosphonate treatment, presence of prodromal symptoms, and radiological results, and compared age, BMD results, union period, and nonunion rate between the two groups. RESULTS: Mean medication period was 56.8 months(12-132 months) and prodromal symptoms were observed in one case. Lateral cortical thickening and transverse fracture with a medial cortical bone beak were observed in all patients of Group A, and contralateral cortical hypertrophy of the femur was noted in 15 patients(17 cases) (77.3%). Mean age was 73.2 years in Group A and 78.2 years in Group B, which showed significant difference (P=0.021), while no difference was observed in BMD, union period, and nonunion rate. CONCLUSION: An atypical femoral fracture can occur in the subtrochanteric or shaft of the femur. The typical radiological characteristics of this fracture are lateral cortical thickening and transverse fracture with a medial cortical bone beak and contralateral abnormality of cortical bone. Findings of this study suggest that medical practitioners should be careful of atypical fractures with osteoporosis patients who use prolonged bisphosphonate.

Atypical Subtrochanteric Femur Fracture in Patient with Metastatic Breast Cancer Treated with Zoledronic Acid / 한국유방암학회지

Several case series have suggested an association exists between atypical femoral subtrochanteric fractures and long-term use of bisphosphonates. It is thought that prolonged use of bisphosphonates may lead to adynamic, fragile bone. The radiologic features of atypical fractures include diffuse cortical thickening, transverse fracture, and beaking at the lateral subtrochanteric area. Atypical subtrochanteric femur fractures have been reported after use of alendronate, but there have been rare reports of atypical femur fractures occurring after administration of zoledronic acid. A 56-year-old female with metastatic breast cancer treated with zoledronic acid presented with pain in the right hip. X-rays showed a right subtrochanteric fracture, and she underwent operation. Four months later after having undergone an operation, the patient struggled with walking and X-ray showed delayed union of the fracture site.

Patrones de crecimiento postnatal en ocho especies de garzas (Ciconiiformes: Ardeidae)

Postnatal growth patterns in eight species of herons and egrets (Ciconiiformes: Ardeidae). Avian postnatal growth has received considerable attention and its ecological implications have been deeply analyzed. In this current paper, I describe the patterns of culmen and tarsus growth, as well as of weight gain patterns in eight species of herons and egrets (Aves: Ardeidae) found in the Birama Swamp in Eastern Cuba. Between 1998 and 2006, 714 nestlings of the following species were measured every two days: Butorides virescens, Bubulcus ibis, Egretta thula, E. tricolor, E. caerulea, E. rufescens, Ardea alba and Nycticorax nycticorax. Logistic and Gompertz equations were adjusted to data using non-lineal regression models with adult values as the asymptote. For each species, the following were determined and recorded: growth rate, age at inflexion, instantaneous growth rates at each age interval, and time taken to reach 90% of adult size. Reported hatchling sizes were similar in other localities, with a variation coefficient ranging between 10-19%. At hatch, each species exhibited differing sizes relative to adult values. In all cases, Gompertz equations were best fitted to explain more variance and lesser residuals. Rates of weight change and tarsus growth were alometrically related to the log of adult weight. Two main growth processes were identified: a physical extension in dimensions of each measure ment reflecting inter-specific morphometric differences, and a lineal increase of the growth period from Green Heron to Great Egret. The Black-crowned Night Heron, Cattle Egret and Reddish Egret exhibited some unique measurement characteristics in comparison to the remaining members of the family. All results support the hypothesis that hypermorphosis, as the main evolutionary process in the microevolution of Ardeidae, is caused by a delayed final moment of growth. Rev. Biol. Trop. 59 (2): 771-787. Epub 2011 June 01.

El crecimiento en aves forma parte de las estrategias reproductivas y su implicación ecológica ha sido profundamente debatida. En este trabajo se describe el crecimiento del pico, peso y tarso de ocho garzas (Aves: Ardeidae) en la ciénaga de Birama, Cuba. Para ello, entre 1998-2006, se midieron en días alternos un total de 714 pichones de Butorides virescens, Bubulcus ibis, Egretta thula, E. tricolor, E. caerulea, E. rufescens, Ardea alba y Nycticorax nycticorax, durante sus dos primeras semanas de vida. Se hicieron ajustes a las curvas Logística y de Gompertz y se usó regresiones no lineales y valores adultos como asíntotas, además se determinaron las variables que describenel crecimiento. El tamaño de los pichones al eclosionar fue similar al encontrado en otras localidades, con CV entre 10-19% y diferencias relativas al tamaño adulto. Las ecuaciones de Gompertz tuvieron menos residuos en todos los casos. Entonces, se identificaron dos procesos fundamentales de extensión en el crecimiento de cada estructura: uno físico y otro de duración, entre B. virescens y E. alba. Nycticorax, B. ibis y E. rufescens mostraron variaciones que los diferenciaron del resto. Los resultados apoyan la hipótesis de la microevolución de Ardeidae por hipermorfosis, por un retardo en el momento final del crecimiento.

Pyknodysostosis: report of a rare case with review of literature

Pyknodysostosis is a rare autosomal recessive disorder characterized by the post natal onset of short limbs, short stature, and generalized hyperostosis along with acro-osteolysis with sclerosis of the terminal phalanges, a feature that is considered essentially pathognomonic. Other features include persistence of fontanelles, delayed closure of sutures, wormian bones, absence of frontal sinuses, and obtuse mandibular gonial angle with relative mandibular prognathism. We report a case of 17-year-old girl who presented with a chief complaint of retention of deciduous teeth. General physical examination demonstrated short stature, frontal and parietal bossing, depressed nasal bridge, beaked nose, hypoplastic midface, wrinkled skin over the finger tips, and nail abnormalities. Radiographs showed multiple impacted permanent and supernumerary teeth, hypoplastic paranasal sinuses with acro-osteolysis of terminal phalanges, and open fontanelles, and sutures along with wormian bones in the lambdoidal region.

Pneumatization Pattern of the Frontal Recess: Relationship of the Anterior-to-Posterior Length of Frontal Isthmus and/or Frontal Recess with the Volume of Agger Nasi Cell

OBJECTIVES: We analyzed the pneumatization pattern of the frontal recess (FR) in a Korean population. We also determined the correlation between the volume of the agger nasi cell (ANC) and the anterior-to-posterior (A-P) length of the frontal isthmus (FI) and FR. METHODS: Multiplanar paranasal sinus computed tomography (CT) images from 105 patients who underwent endoscopic sinus surgery were reviewed. The prevalence of frontal recess cells (FRCs), thickness of the frontal beak (FB), volume of the ANC, A-P length of the FI, and FR were evaluated. RESULTS: The ANC was identified in 96% of the patients and frontal cells (FCs) in 32% (FC type 1, 24.2%; type 2, 4.2%; type 3, 3.1%; and type 4, 0%). The prevalences of frontal bullar, suprabullar, supraorbital ethmoidal, and interfrontal sinus septal cells were 10%, 7.8%, 3.6%, and 6.8%, respectively. The A-P lengths of the FR and FI were 10.1+/-3.1 and 8.4+/-2.9 mm, respectively. The thickness of the FB was 7.8+/-1.8 mm and the volume of the ANC averaged 394.1+/-240.5 mm3. The thickness of the FB did not correlate with the volume of the ANC. In contrast, the A-P length of the FI and FR were positively correlated with the volume of the ANC. CONCLUSION: ANCs and FCs were found in 96% and 32% of the cases in this series. FC type 4 was not seen. What appeared to be FC4 on conventional CT was identified as FBC from reconstructed parasagittal images. A large ANC increased the A-P length of the FI and FR, regardless of the thickness of the FB.

A Case of Diffuse Cerebral Cortical Dysplasia and Partial Agenesis of Corpus Callosum in Seckel Syndrome

Seckel syndrome is a rare autosomal recessive disorder characterized by low birth weight, short but proportionate stature, microcephaly, moderate to severe mental retardation and typical facial features mimicking bird including receding forehead and chin, a prominent beaked nose and large eyes. A number of CNS anomalies have been reported in literature that are mental retardation, seizures, pachygyria, arachnoid cysts, large basal ganglia, agenesis of corpus callosum, hypoplasia of cerebellar vermis and cerebral aneurysms. Our patient had seizures, microcephaly, mental retardation and CNS anomalies, including diffuse cerebral dysgenesis, pachygyria and partial agenesis of corpus callosum. We report a case of Seckel syndrome with CNS anomalies and a follow up visit at 5 years later