Strabismus in hydrocephalus patients.

PURPOSE: To evaluate the characteristics and outcomes of strabismus in patients with hydrocephalus. METHODS: A retrospective chart review of patients with strabismus and hydrocephalus is performed in the Department of Pediatric Ophthalmology between 2012 and 2018. RESULTS: Seventeen patients between the ages of 6 months and 13 years met the criteria of strabismus and hydrocephalus. Although all had developmental delay, five patients out of 17 were premature (lower than 36 weeks of gestation). All patients had ventriculoperitoneal shunt placement for congenital hydrocephalus. Three patients had exotropia, whereas 14 had esotropia. Glasses were prescribed to 13 patients: hyperopic correction in 12 and myopic correction in one patient. Surgical correction with bimedial recession was performed in five patients. Four of them achieved successful ocular alignment. CONCLUSIONS: Children with hydrocephalus most likely have esotropia. Although good ocular alignment is achieved with surgical correction in some patients, some patients may benefit from glasses.

Changes in dimension of neurovascular canals in the mandible and maxilla: A radiographic finding in patients diagnosed with MRONJ.

BACKGROUND: The aim of this retrospective study was to compare the morphological features of neurovascular canals and foramina of patients with medication-related osteonecrosis of the jaws (MRONJ) and healthy individuals by using cone beam computed tomography (CBCT). MATERIAL AND METHODS: The CBCT images of 58 patients under bisphosphonate therapy diagnosed with MRONJ and age gender- matched controls were retrospectively evaluated. The diameter of mandibular and nasopalatine canal and mandibular, mental and lingual foramina were measured on several sections of CBCT. The value of mental index (MI) and panoramic mandibular index (PMI) were also assessed. RESULTS: The mean value of diametric measurements for all neurovascular canals and foramina in MRONJ patients were narrower than controls. Left mandibular foramen was the most affected area (p<0.001). There were significantly difference in all measurements of mental foramen, lingual foramen and mandibular incisive canal between two groups (p<0.05). PMI of MRONJ subjects were also significantly differences in both sides (p<0.05). CONCLUSION: In MRONJ patient, neurovascular canals and foramina are affected due to the alterations in bone remodeling. Therefore, the diametric measurement of neurovascular canals and assessment of MI and PMI on CBCT, is a potentially useful method for detection of early changes associated with bisphosphonate therapy and for predict areas where new necrosis may occur.

Classification of alveolar bone destruction patterns on maxillary molars by using cone-beam computed tomography.

OBJECTIVE: The defective diagnosis of alveolar structures is one of most serious handicaps when assessing available periodontal treatment options for the prevention of tooth loss. The aim of this research was to classify alveolar bone defects in the maxillary molar region which is a challenging area for dental implant applications. To our knowledge, this is the first study of periodontal bone defect prevalence by using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: In this study, the remaining alveolar bone patterns of 669 maxillary molars of 243 patients with periodontal bone loss were investigated on four aspects and the furcation areas of teeth, and then they were classified into six main groups. Combined periodontal-endodontic lesions (CPELs) were also reported in another category. RESULTS: Following exclusion of 39 (5.8%) teeth with CPEL, the most common group was horizontal bone defects (71.4%) and the least seen group was three-walled vertical bone defects (1.9%) in all alveolar bone sides of teeth. Osseous crater was found at the rate of 6.7% on interdental alveolar bone. Dehiscence and fenestration were detected at rates of 2.7% and 3.3%, respectively. In the assessment of furcation areas, there was no furcation involvement in 61.4% of all teeth and the rate of Grade-II involvements was 26.2%. CONCLUSIONS: The most appropriate treatment option may be decided through accurate imaging of periodontal defect morphology. CBCT can provide comprehensive information about the remaining alveolar bone structures. In this way, the need for dental implant can be prevented in many cases and be replaced with a more conservative approach on the maxillary molar region.

A limited and useful approach to determine proximal periodontal health.

Previous researchers have shown that there exists an interaction between gingival blood flow and gingival health. The purpose of this study was to compare the papillary blood flow at sites treated by a bridge with the blood flow at untreated sites. Twenty persons with resin-bonded fixed partial dentures were included in the study. The contralateral natural teeth of the site symmetrical to that of the restorations were used as controls. Blood flow was measured from the middle point of the papillae from both test and control sites by Laser Doppler Flowmetry (LDF). The plaque index, papillary bleeding index and probing depth measurements were recorded. There was a statistically significant difference between the test and control sites in papillary blood flow measurements and clinical indices (p < 0.05). Moreover there was statistical significance between gingival blood flow measurements and papillary bleeding index in the experimental group (p < 0.05). In short, there exists an important relationship between resin-bonded fixed partial dentures and papillary blood flow. Although there were no correlations between LDF values and clinical parameters, it can be emphasized, within the limits of the study, that LDF readings have limited diagnostic value, at least when it comes to clinical performance of fixed prosthesis.

A computed tomography-based morphometric study of the styloid process.

BACKGROUND: The styloid process (SP) refers to a cylindrical piece projecting from the inferior of the temporal bone, situated anterior to the stylomastoid foramen. It is an anatomic formation close to major vessels and nerves, and its excessive elongation results in pathologies leading to anatomical disorders, such as Eagle's syndrome. Several studies have been conducted on SP in relation to its close proximity to vessels and nerves, but there is no study that reveals its distance to important anatomical formations, such as the internal auditory meatus (IAM), carotid canal (CC), cochlea, tegmen tympani (TT) and tragus. In the current study, we aimed to investigate the incidence of Eagle's syndrome based on morphometric measurements of SP. MATERIALS AND METHODS: The patient files archived in the Radiology Department of Adiyaman University Training and Research Hospital were retrospectively examined. The study was carried out on the data of patients for whom specialist radiologists found no pathology findings on the computed tomography images. A total of 77 individuals (36 females and 41 males) aged 22 to 54 years were included in the study. The length of SP and its distances to IAM, cochlea, CC, TT and tragus were obtained using computed tomography radiological measurements. RESULTS: When the individual measurements performed on computed tomography images were evaluated in men and women, no significant difference was found concerning the distance between SP and various anatomic structures in close proximity to SP (p > 0.05). However, there was a statistically significant difference between the genders in length of the right SP (p = 0.003) and left SP (p = 0.006). CONCLUSIONS: This anthropometric study revealed the standard morphometric measurements of SP. We believe that the data obtained will help clinicians to identify and diagnose pathologies more easily.

Vaginectomy and laparoscopically assisted vaginal hysterectomy as adjunctive surgery for female-to-male transsexual reassignment: preliminary report.

OBJECTIVE: Reassignment surgery of the female-to-male transsexual is a rarely performed surgical procedure that should involve a gynecologist's consultation and expertise. This study examines the experience with this type of surgery at Baskent University Hospital, Ankara, Turkey, from the gynecologists' point of view. STUDY DESIGN: Eight patients underwent laparoscopically assisted vaginal hysterectomy, bilateral salpingo-oophorectomy and total vaginectomy, followed by phallic construction. Patients were followed up for 9 to 30 months post-surgery. RESULTS: The average operative time for total vaginectomy and laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy was 2 h and 20 min. The estimated average blood loss was 250 ml. Other than one bladder perforation, which was repaired immediately and healed uneventfully, we encountered no operative or postoperative complications linked to the gynecologic surgery. CONCLUSION: Laparoscopy seems to be useful in female-to-male transsexual surgery in allowing the preservation of structures vital for phallic construction, such as inferior epigastric vessels and the rectus abdominis muscle. The application of vaginectomy awaits justification through long-term follow-up studies of transsexuals who have undergone colpocleisis.

Orbicularis oculi myocutaneous flap in reconstruction of postburn lower eyelid ectropion.

The management of postburn lower eyelid ectropion is difficult, since the contraction of the skin graft may give rise to secondary deformities especially around the lateral 1/3 of the lower eyelid. In this paper, the results of reconstruction in lower eyelid ectropion with a laterally based orbicularis oculi myocutaneous flap from the upper eyelid in 7 young patients are presented. Satisfactory function and cosmesis were obtained in the evaluation of the patients up to 40 months follow-up. The method proved versatile as the donor scar was well-hidden in the supratarsal fold and the temporally based myocutaneous flap provided additional support to the lower eyelid by exerting an upward pull against the gravity. It is concluded that usage of this flap in postburn ectropion cases is worthwhile to avoid any recurrences. reserved.

A modified technique to correct the cleft lip nasal deformity.

Repositioning the collapsed alar cartilage, lengthening the columella and correct repositioning of the alar base of the cleft side are the main components of the cleft lip nostril repair. The rotation-advancement lip procedure was performed in all primary cases, and to some extent for necessary revision in secondary cases. For elevating and supporting the displaced alar cartilage "Skoog's mattress key stitch" was used. The columella was lengthened with a c-flap. In the secondary cases the c-flap was kept long and wide enough, so that its de-epithelialized distal part was used to augment the depression of the cleft side alar base. In all primary cases, a lateral mucosal L-flap was inserted into the intercartilaginous incision. 17 primary and 15 secondary cases were repaired using this technique. Follow-up of the patients from one to four years demonstrated no interference with nasal growth in primary cases and no recurrence of the deformity in any case. Three secondary cases required additional minor corrections.

The trauma of suction-assisted lipectomy cannula on flap circulation in rats.

The effect of suction-assisted lipectomy on cutaneous blood vessels of inguinal skin flaps was studied and compared in 191 rats. Different types of cannula tips were used; the number of passes was standardized. In one experiment, following suctioning, 3 X 2 cm groin island flaps based on inferior epigastric pedicles were raised and then reattached. Fluorescein dye study and microangiography were performed to evaluate flap viability. Flap survival was determined clinically and by histologic examination on the fifth postoperative day. Three-sided inguinal random-pattern flaps were raised in a second experiment and reattached following suctioning. On the fifth postoperative day, surviving flap areas were measured using standard photographs and an imaging computer and were compared with controls. Results showed that cannula passes accompanied by vacuum are harmful to vessels, while those unaccompanied by vacuum are not. The greater the number of suctioning passes, the more trauma there is to vessels and the greater is the likelihood of flap necrosis. Conical and spatula tips were more harmful to vessels than spherical, cobra, keel cobra, or Fournier tips. These results support the conclusion that suction-assisted lipectomy enhances the possibility of skin necrosis by traumatizing the vascular pedicle of a flap, especially when it is used as an adjunct to flap elevation.

Ultraviolet-A induced delayed wound contraction and decreased collagen content in healing wounds and implant capsules.

Chronic exposure to ultraviolet-A radiation causes changes in the biochemistry of dermal connective tissue. To investigate its effects on wound healing, we irradiated Sprague-Dawley rats for 4 months using a black ray ultraviolet-A radiation source (560 J/cm2). Full thickness skin wounds of 2 cm in diameter were then created on the back of each animal and silicone cubes were implanted subcutaneously into the irradiated area of the back. Wound contraction in the irradiated animals (n = 28) was significantly slower than that of the controls (n = 29) (p < 0.001). Postoperatively, the hydroxyproline content of the contracted wounds and the implant capsules was assessed at 6 and 12 weeks, respectively. In the irradiated animals, it was found to be significantly less than that of the controls (p < 0.001). A delay in wound contraction and a decrease in hydroxyproline content of healing wounds and implant capsules, reflecting an alteration in collagen metabolism, are two effects of prolonged intermittent ultraviolet-A radiation pretreatment.

Microvascular ear replantation with no vein anastomosis.

In replantation of a totally amputated ear, the artery only was repaired with no vein repair. Venous stasis was successfully prevented by daily skin punctures during the first 4 days postoperatively. The elastic cartilage framework with no internally circulating blood constitutes the major percentage of the auricle mass. Thus the metabolic demand of the ear is relatively small, according to its small caliber nutrient vessels. Although the successful result in this single case report means neither a consistent procedure nor uniformly safe choice of treatment, the potential use of the single-artery repair with no accompanying vein anastomosis in ear replantations, we believe, deserves to be considered.

Nerve regeneration in a bony bed: vascularized versus nonvascularized nerve grafts.

In a rabbit model, regeneration of the intratemporal facial nerve was studied as vascularized and nonvascularized nerve grafts. Fifteen New Zealand white rabbits weighing 4 to 4.5 kg were used. A 1-cm gap was created in the intratemporal facial nerve. In the vascularized nerve graft group (group 1), the facial nerve was repaired with a vascularized median nerve graft (n = 6), while in the nonvascularized nerve graft group (group 2), the median nerve was used as a nonvascularized graft (n = 6). In group 3, the facial nerve gap was left unrepaired (n = 3). At 3 months postoperatively, electrophysiologic testing, morphologic nerve study, and morphometric muscle analysis were performed. Although the mean numerical values of axonal counting, nerve conduction, and morphometric muscle study results were slightly better in the vascularized nerve graft group, the differences between the two grafted groups were not statistically significant (p > 0.05). Morphometric nerve analysis, i.e., axon diameter and myelin sheath thickness, showed significant differences in nerve regeneration between the two groups (p < 0.05). These results suggest that a bony bed is not optimal for neovascularization of a nerve graft. We conclude that vascularized nerve grafts are superior to nonvascularized nerve grafts when nerve regeneration occurs in a bony recipient bed. This might be of clinical importance in the repair of facial nerve lesions within the temporal bone.

Augmentation of random-flap survival by implantation of vascularized fascia allografts and temporary immunosuppression: implications for flap fabrication.

The purpose of this study was to explore the possible use of an allogeneic vascular source for flap fabrication. Epigastric fascia with its superficial epigastric vessel pedicle was harvested from the donor rat and microsurgically revascularized in the recipient rat across a major histocompatibility barrier. ACI rats (Rtl-a) served as donors, and Lewis rats (Rtl-1) served as recipients. The recipient rat was immunosuppressed with a daily dose of 2 mg/kg cyclosporin A plus 5 mg/kg prednisone for 4 weeks. Three experiments were performed for skin, muscle, and bone studies. In experiment 1 (20 Lewis rats), placement of the allotransplanted fascia underneath the epigastric skin significantly improved the survival of a random epigastric skin flap raised 3 weeks later (7.35 +/- 0.65 cm2 versus 6.09 +/- 0.90 cm2, p < 0.05). Immunosuppression was discontinued 10 days after flap elevation with no observable additional skin necrosis. In experiment 2 (13 Lewis rats) and experiment 3 (14 Lewis rats), segments of isogeneic muscle and bone were grafted successfully on the allotransplanted fascia, respectively. The survival of these grafts was confirmed by metabolic bone activity, bone labeling, microangiography, and histologic studies and further confirmed 2 weeks after cessation of immunosuppression. An allotransplanted fascia as a vascular source proved in this model its capability to improve the survival of a random skin flap and to accept a free bone or muscle graft with temporary immunosuppression. These findings hold promise for possible use of an allogeneic vascular source in flap fabrication.

Osteocutaneous flap prefabrication based on the principle of vascular induction: an experimental and clinical study.

Conventional osteomyocutaneous flaps do not always meet the requirements of a composite defect. A prefabricated composite flap may then be indicated to custom create the flap as dictated by the complex geometry of the defect. The usual method to prefabricate an osteocutaneous flap is to harvest a nonvascularized bone graft and place it into a vascular territory of a soft tissue, such as skin, muscle, or omentum, before its transfer. The basic problem with this method is that the bone graft repair is dependent on the vascular carrier; the bone needs to be revascularized and regenerate. The bone graft may not be adequately perfused at all, even long after the transfer of the prefabricated flap. This study was designed to prefabricate an osteocutaneous flap where simply the bone nourishes the soft tissues, in contrast to the conventional technique in which the soft tissue supplies a bone graft. This technique is based on the principle of vascular induction, where a pedicled bone flap acts as the vascular carrier to neovascularize a skin segment before its transfer. Using a total of 40 New Zealand White rabbits, two groups were constructed as the experimental and control groups. In the experimental group, a pedicled scapular bone flap was induced to neovascularize the dorsal trunk skin by anchoring the bone flap to the partially elevated skin flap with sutures in the first stage. After a period of 4 weeks, the prefabricated composite flaps (n = 25) were harvested as island flaps pedicled on the axillary vessels. In the control group, nonvascularized scapular bone graft was implanted under the dorsal trunk skin with sutures; after 4 weeks, island composite flaps (n = 15) were harvested pedicled on the cutaneous branch of the thoracodorsal vessels. In both groups, viability of the bony and cutaneous components was evaluated by means of direct observation, bone scintigraphy, measurement of bone metabolic activity, microangiography, dye injection study, and histology. Results demonstrated that by direct observation on day 7, the skin island of all of the flaps in the experimental group was totally viable, like the standard axial-pattern flap in the control group. Bone scintigraphy revealed a normal to increased pattern of radionuclide uptake in the experimental group, whereas the bone graft in the control group showed a decreased to normal pattern of radioactivity uptake. The biodistribution studies revealed that the mean radionuclide uptake (percent injected dose of 99mTc methylene diphosphonate/gram tissue) was greater for the experimental group (0.49+/-0.17) than for the control group (0.29+/-0.15). The difference was statistically significant (p<0.01). By microangiography, the cutaneous component of the prefabricated flap of the experimental group was observed to be diffusely neovascularized. Histology demonstrated that although the bone was highly vascular and cellular in the experimental group, examination of the bone grafts in the control group revealed necrotic marrow, empty lacunae, and necrotic cellular debris. Circulation to the bone in the experimental group was also demonstrated by India ink injection studies, which revealed staining within the blood vessels in the bone marrow. Based on this experimental study, a clinical technique was developed in which a pedicled split-inner cortex iliac crest bone flap is elevated and implanted under the medial groin skin in the first stage. After a neovascularization period of 4 weeks, prefabricated composite flap is harvested based on the deep circumflex iliac vessels and transferred to the defect. Using this clinical technique, two cases are presented in which the composite bone and soft-tissue defects were reconstructed with the prefabricated iliac osteomyocutaneous flap. This technique offers the following advantages over the traditional method of osteocutaneous flap prefabrication. Rich vascularity of the bony component of the flap is preserved following transfer (i.e. (ABSTRACT

Evaluation of initial attachment of human gingival fibroblast cells to biodegradable membranes in vitro by light and scanning electron microscopy.

Guided tissue regeneration procedures using resorbable membranes have become accepted therapy for treating periodontal defects. Resorbable collagen and synthetic polylactide and polyglycolide copolymer membranes have been found to support regeneration and preclude the need for surgical removal. This study was undertaken to assess and compare the initial attachment of human gingival fibroblast cells to four collagen-based membranes (fascia lata, fascia temporalis, dura mater, and Type I bovine collagen) and a synthetic polylactic acid-based membrane (resolut). Human gingival fibroblasts were grown from explants of normal tissue obtained during surgical reduction of retromolar tissues. Membrane specimens were placed in separate culture wells and incubated with fibroblasts for one hour. The number of adherent cells was evaluated by light microscopy using an ocular grid system and detailed examination was performed by scanning electron microscopy. The results of evaluation by light microscopy indicated that initial cell attachment was significantly less in the polylactic acid-based membrane group than in the collagen-based membrane groups (P < 0.01). However, no significant differences were found among the collagen membrane groups in terms of fibroblast attachment (P > 0.01). Scanning electron microscopy examination of fibroblasts cultured directly on barrier membranes indicated that the collagen-based membranes appeared to facilitate cell attachment, whereas the polylactic acid-based membrane exhibited a morphology that was not conducive to attachment of human gingival fibroblasts. Based on these limited in vitro results, it appears that collagen-based membranes offer greater potential than polylactic acid-based membranes for guided tissue regeneration at surgical sites.

Macrodactyly: report of eight cases of a rare anomaly.

Macrodactyly or megalodactyly is a rare anomaly of the extremities. Neural factors are involved in the etiology. Presented here are eight cases which comprise five macrodactylous toes and three fingers. The mean age at first referral was 6.8 years. Six patients underwent resection of the proximal phalanges together with bulk reduction of the soft tissue mass. Only soft tissue reduction was performed in the remaining two patients. Skin necrosis was observed in two cases, one of which necessitated amputation at the proximal interphalangeal joint level. The functional outcome was evaluated as poor with limited range of motion and stiffness in the joints. As far as functional results are concerned, macrodactylous toes had a better prognosis than that of fingers. It was concluded that none of the available methods as yet gives ideal functional and cosmetic results in macrodactyly.

Effect of enzymes on strawberry volatiles during storage, at different ripeness level, in different cultivars, and during eating.

UNLABELLED: Strawberry samples with enzyme activity and without enzyme activity (stannous chloride added) were measured for real-time formation of lipoxygenase (LOX) derived aroma compounds after 5 min pureeing using selected ion flow tube-mass spectrometry (SIFT-MS). The concentration of (Z)-3-hexenal and (E)-2-hexenal increased immediately after blending and gradually decreased over time, while hexanal concentration increased for at least 5 min in ground strawberries. The formation of hexanal was slower than the formation of (Z)-3-hexenal and (E)-2-hexenal in the headspace of pureed strawberries. The concentration of LOX aldehydes and esters significantly increased during refrigerated storage. Damaging strawberries increased the concentration of LOX aldehydes but did not significantly affect the concentration of esters. The concentrations of many of the esters were strongly correlated to their corresponded acids and/or aldehydes. The concentration of LOX-generated aldehydes decreased during ripening, while fruity esters increased. Different varieties had different aroma profiles and esters were the greatest percentage of the volatiles. The aroma release of some of the LOX-derived aldehydes in the mouthspace in whole strawberries compared to chopped strawberries showed that these volatiles are formed in the mouth during chewing. The persistence of LOX-derived compounds was higher than esters after swallowing. The mouthspace after and before swallowing persistence ratio of esters decreased as the chain length of the acid part of the ester compounds increased in whole strawberries. PRACTICAL APPLICATION: The storage studies showed that the concentrations of fruity and fresh volatiles increased during ripening and storage while damaging only increases the fresh volatiles. The nose, mouth, and headspace information can be used in the flavor industry to improve the formula of natural strawberry flavor by considering human perception during eating.