Modified high-level Le Fort I advancement without malar augmentation: assessment of effect on midfacial aesthetics.

The 'beauty arch', an aesthetic feature of the midface, is a double-S-shaped curve that extends downward from the lateral canthus. This retrospective study evaluated whether modified high Le Fort I advancement (combined with impaction or down-grafting) without malar augmentation can approximate a patient's 'ideal' beauty arch (IBA). Pre- and postoperative profile (natural head position) photographs for 36 patients with midfacial hypoplasia were aligned digitally. For each individual, standardized methods were used to identify landmarks and draw the preoperative real beauty arch (RBA), postoperative RBA, and IBA. Distances from a defined landmark to each arch were measured and means were compared. The mean advancement range was 4.2 ± 2.2 mm, and the mean pre- and postoperative RBA distances were significantly different (138.7 ± 24.1 vs 145.0 ± 25.8 pixels, respectively; P = 0.0001). In the impaction and down-grafting subgroups, there was no significant correlation between amount of maxillary movement and the difference between pre- and postoperative RBA distances (P > 0.05 for both). The postoperative RBA was satisfactorily close to the IBA in 35 cases (97.2%); one patient required later augmentation. The findings suggest that modified high Le Fort I advancement surgery without malar augmentation provides satisfactory malar projection for most patients with maxillary hypoplasia.

Renal hydatidosis.

Renal hydatidosis in humans is rare, although it is not uncommon in sheep- and cattle-raising countries. We describe a patient who had renal hydatidosis with hydatidcysturia.

Intrarenal pressure following pyeloplasty or percutaneous surgery.

In a study of 37 patients it was shown that recording the intrapelvic pressure is a safe and reliable means of judging the best time to remove a nephrostomy tube. No post-operative complications were encountered and the procedure has the added advantage of avoiding the use of X-rays.

Comparative study of etofenamate and fentanyl for outpatient extracorporeal shockwave lithotripsy.

OBJECTIVE: This study aimed to compare the clinical efficacy and safety of etofenamate (a non-steroidal anti-inflammatory drug) and fentanyl (an opioid analgesic) for outpatient extracorporeal shock wave lithotripsy (ESWL). MATERIAL AND METHODS: 60 non-premedicated patients underwent ESWL for urinary tract calculus with the Multimed 2000 (ELMED Lithotripsy Co.. Turkey) lithotripter. None of patients had previous experience with ESWL treatment. The patients were divided into two groups. A single dose of 1 g etofenamate was given to the patients intramuscularly 25 min before ESWL in group I (n = 30) and 0.1 mg fentanyl was administered intravenously just before ESWL in group II (n = 30). At the end of the treatment a visual analogue score (VAS) of 0 (no pain) to 10 (greatest pain) was used to evaluate the pain. Blood pressure, heart rate and arterial oxygen tension (PaO2) were measured before and during the ESWL. Groups were compared according to the pain scores, stone size, number of shocks, maximum voltage achieved, duration of ESWL and incidence of side-effects of the administered drug. Data were analysed with the Mann-Whitney U-test. RESULTS: No statistical differences were found between the two groups regarding achieved maximal energy levels, pain scores and number of shock waves given (p < 0.01). Satisfactory stone fragmentation was achieved in both groups. There were no changes in blood pressure or heart rate during the ESWL in either group. PaO2 was not affected in the etofenamate group, whereas a transient desaturation in two patients and giddiness in three patients were recorded in the fentanyl group. CONCLUSIONS: Both etofenamate and fentanyl have clinically sufficient effects on pain, and can be used safely for outpatient ESWL procedures.

An unusual cause of renal colic: hydatiduria.

Hydatid disease of the urinary tract is seen rarely. Hydatiduria may be a finding of renal involvement, but it is a rare cause of renal colic. A case is reported of renal hydatid disease that was diagnosed during the investigation of renal colic. A 38-year-old woman presented with renal colic. She had a history of episodes of renal colic and occasional voiding of grape-like material. No calculus was found in the urinary tract by plain film or ultrasonographic examination. The histopathologic examination of this material revealed daughter cysts that are pathognomonic for hydatid disease. Ultrasound and computed tomography confirmed this diagnosis and right nephrectomy was performed without cyst perforation or any spilling of cyst content. Albendazole, 10 mg/kg per day, was given for 4 weeks (2 weeks preoperatively and 2 weeks postoperatively).

Management of ureterosigmoidal anastomotic stricture by balloon dilatation.

Ureterosigmoidal anastomotic stricture is seen in nearly half of the patients who had ureterosigmoidostomy. Many of these patients are in need of reoperation. Balloon dilatation via percutaneous nephrostomy is an alternative method which avoids reoperation.

Effects of shock waves on the rat foetus.

Controversy exists concerning whether shock wave lithotripsy (SWL) is contraindicated during pregnancy (4, 5). The effects of shock waves on a variety of cells are well documented in both clinical and experimental studies, but their effect on the foetus remains unclear. In this study, we investigated the effects of SWL on the rat foetus. On the 8th, 11th, 14th and 17th days of pregnancy, 100, 250 or 500 shock waves were administered with a Multimed 2001 ELMED Systems Lithotriptor. In ongoing pregnancy, the effects of SWL on the foetus ranged from early mild effects to later moderate effects and fatal effects. There were no viable foetuses in the latest period of pregnancy in rats receiving 500 shocks waves. Histological changes were observed in the brain, lungs and subcutaneous tissue. Fusion and necrosis were found in many dead foetuses. Our study demonstrates that SWL causes foetal damage and death in the late period of pregnancy in rats.