Plagiocephaly after Neonatal Developmental Dysplasia of the Hip at School Age.

Developmental dysplasia of the hip (DDH) may require early abduction treatment with infants sleeping on their back for the first few months of life. As sleeping on back is known to cause deformational plagiocephaly, we assessed school age children treated for dislocation or subluxation of the hip-joint in infancy. Plagiocephaly was analyzed by using cephalic index (CI) and oblique cranial length ratio (OCLR) as anthropometric measurements from 2D digital vertex view photographs. Six of the 58 (10.3%) DDH children and only one of the 62 (1.6%) control children had plagiocephaly (p = 0.041). Furthermore, cross bite was found in 14 (24.1%) of the DDH children and in 7 (10.3%) of the control children. Developmental dysplasia of the hip in infancy was associated with cranial asymmetries and malocclusions at school age. Preventive measures should be implemented.

Childhood intelligence and early tooth wear patterns.

OBJECTIVE: The aim of this study is to explore the relationships between early dental wear patterns and preschool IQ (Intelligence Quotient, by Stanford-Binet) of the child to illuminate the historic relationship of mental queries and bruxism. METHODS: The dental study participants were 864 Euro-American preschool and school children whose IQs were tested for school maturity purposes at the age of 4 years, followed by dental data in a cross-sectional manner at the mean age of 7.8 years. Worn dentitions were classified as "symmetric" or "right-" and "left-sided," based on the faceting of the teeth. RESULTS: In general, the relationships of tooth wear and intelligence were scarce, reflecting social background factors. Statistically significant results between asymmetric wear and gender groups suggest that direction of jaw function has a role in the regulation of processes responsible for individual mental performance in childhood. DISCUSSION: Increased left-side tooth wear and early advantage in the intelligence test in girls is intriguing due to the fact that they reach maturity earlier than boys in verbal articulation, controlled in most cases by the limited area on the left side of the brain.

Occlusal asymmetries in children with congenital hip dislocation.

Developmental dysplasia of the hip (DDH) has been associated with other congenital postural deformities and associated with asymmetric features in the body. The aim of this study was to examine the associations between developmental DDH and malocclusions in preschool and school children. The subjects were 60 children (40 girls and 20 boys) born during 1997-2001 in Northern Ostrobothnia Hospital District and having developmental DDH and treated by Von Rosen method. The control group consisted of 71 Finnish children (46 girls and 25 boys) matched by age and gender. Children participated the cross-sectional study at the age of 5-10 years; the mean age of the DDH children was 8.0 (SD 1.4) and controls 7.9 (SD 1.4) years. Dental examinations, intra-oral photographs, and clinical examination including growth measurements were carried out. The DDH children had significantly more lateral crossbites than controls (30/9.9 per cent; P < 0.003). Overall, 77.8 per cent of cases were unilateral crossbites and found more on the right side (50 per cent) compared to the left side (22.2 per cent). Girls had more crossbite compared to boys (77.8/22.2 per cent; odds ratio 2.53). Children with congenital hip dislocation are more predisposed to the asymmetric growth of occlusion and the development of crossbite. The genetic and environmental factors including intrauterine conditions in addition to the splint therapy may be possible influencing factors. This study will give additional information of the development of occlusal asymmetries and the multifactorial nature of the aetiology of lateral malocclusions.

Validation of a new method for automated determination of bone age in Japanese children.

BoneXpert, an automated method for analysis of hand radiographs of children, has recently been developed and validated in European children. It determines Tanner-Whitehouse (TW) and Greulich Pyle (GP) bone ages (BA). The purpose of this work is to validate BoneXpert BA in Japanese children and determine the following two properties of the method: (1) The accuracy of the BA, i.e. the standard deviation from an experienced Japanese TW BA rater. (2) The precision of the BA, i.e. BoneXpert's ability to yield the same BA value on a repeated radiograph. The data consist of two studies: 185 radiographs of 22 normal children followed longitudinally from approximately 7 years to full maturity, and 284 radiographs of 22 patients with growth hormone deficiency treated with growth hormone and gonadotropin-releasing hormone analogue followed from an age of 4-11 years to almost full maturity. All radiographs were rated manually according to the TW-Japan system. BoneXpert processed all images, and the accuracy (SD) of TW-Japan BA was 0.72 years (95% CI 0.68-0.76). The precision error (SD) on a single determination of GP BA was 0.17 years (95% CI 0.15-0.19). It is concluded that BoneXpert performs as well in Japanese children as it does in Caucasian children. This study accomplishes a calibration of BoneXpert to the TW-Japan standard, which performs well for the entire BA range from 4 years up to full maturity.

Urinary trypsin inhibitor improves viability of the liver in brain-dead rats.

BACKGROUND/AIMS: The present study examined the effect of urinary trypsin inhibitor (UTI) on liver injury in hypotensive brain-dead rats. METHODS: Brain death was induced by inflating a balloon catheter placed in the epidural space. UTI (100,000 units/kg/hour) was intravenously administered from 30 min until 6 hours after the induction of brain death. Systemic hemodynamics and hepatic tissue flow (HTF) were measured, and blood samples and hepatic tissue specimens for morphological examinations were obtained during the experiments. RESULTS: The induction of brain death caused a 30% decrease in both mean arterial pressure and HTF, and an increase in the serum transaminase level in comparison with sham-operated rats. Brain death also increased the serum concentration of cytokine-induced neutrophil chemoattractant (CINC) (4.4-fold), as well as the number of CINC-positive cells (4.4-fold) and sequestered neutrophils in the sinusoids (3.1-fold). Post-treatment of brain-dead rats with UTI restored the HTF and reduced serum transaminase level. UTI decreased plasma CINC level and the number of neutrophils and CINC-positive cells in the sinusoids. CONCLUSIONS: The results suggest that treatment with UTI after the establishment of brain death improved the viability of the liver in hypotensive brain-dead rats by inhibiting CINC production.

Effects of growth hormone on craniofacial growth.

OBJECTIVE: This study determined the effects of growth hormone (GH) therapy on craniofacial growth in idiopathic growth hormone deficiency (GHD). MATERIALS AND METHODS: Fifty-seven patients (33 boys and 24 girls; age range 4.5 to 16.7 years) with GHD were investigated and categorized into three groups according to the duration of GH therapy: the untreated group, the short-term therapy group, and the long-term therapy group. Their lateral cephalometric radiographs were studied, and craniofacial measurements were assessed by age and sex by using matched standard deviation scores. RESULTS: In the untreated group, the anterior cranial base, total facial height, maxillary length, mandibular total length, mandibular body length, and ramus height were smaller than the standard values. In comparison with the untreated group, the long-term therapy group had a significantly larger upper facial height (P < .05), maxillary length (P < .01), and ramus height (P < .01) measurements. CONCLUSIONS: Children who received long-term GH replacement therapy showed increased growth of the craniofacial skeleton, especially the maxilla and ramus. These findings suggest that GH accelerates craniofacial development, which improves occlusion and the facial profile.

Linear and angular filipino cephalometric norms according to age and sex.

OBJECTIVE: To quantify relevant cephalometric parameters for Filipinos according to age and sex. MATERIALS AND METHODS: A total of 157 Filipino subjects (78 males, 79 females) who fulfilled specific criteria were selected from elementary, high school, and college students affiliated with Manila Central University. They were divided into comparison groups (GI, GII, GIII, and GIV) on the basis of chronological age and sex. Lateral cephalograms were taken for all subjects, and the mean and standard deviation for each parameter was recorded and compared among groups. RESULTS: The male group had a longer anterior cranial base (S-N), total facial height (N-Me), longer lower anterior facial height (N-ANS), longer ramus height (Cd-Go), longer lower posterior dentoalveolar height (Mo-Mi'), and total mandibular length (Gn-Cd) than the female group. All these linear measurements were statistically significantly different between males and females in GI, GIII, and GIV. On the other hand, SNB angle showed significant differences (P = .0271) in GIV only. In the lower third of the face, significant opposite tendencies were found in GIV. The female group showed a clockwise rotation, whereas the male counterpart had a counterclockwise rotation of the mandibular plane. The denture pattern of both groups was characterized by a proclination of both lower incisor (Ii to MP) and upper incisor (Is to SN). CONCLUSIONS: Convexity due to dentoalveolar protrusion is the naturally occurring facial profile for Filipinos. The adult females showed steeper mandibular and occlusal plane angles than the male samples.

Evaluation of the usefulness of tumor budding on the prediction of metastasis to the lung and liver after curative excision of colorectal cancer.

BACKGROUND/AIMS: We evaluated the usefulness of tumor budding, defined as the morphology of infiltration by small clusters of undifferentiated adenocarcinoma into the invasive front of the lesion, for the prediction of metastasis to the lung and liver after curative excision of colorectal cancer. METHODOLOGY: The subjects were 491 patients with a single colorectal cancer lesion, in whom follow-up observation was performed for more than 5 years, consisting of 278 patients without recurrence, 155 patients with the first metastasis to the liver alone, and 58 patients with the first metastasis to the lung alone. The invasive front was histologically re-examined using sections with the largest diameter of the primary colorectal cancer lesion, and the tumor budding was classified into 3 grades based on the morphology of infiltration. The usefulness of this factor for the prediction of metastasis to the lung and liver was examined by multivariate analysis together with conventional clinicopathological factors such as age, sex, tumor location, tumor size, histological type, tumor depth, invasion of lymph ducts, venous invasion, and metastasis to lymph nodes. RESULTS: Comparisons of the no-recurrence and lung metastasis groups by multivariate analysis indicated that moderate to severe tumor budding (odds ratio=0.1291, P<0.0001) and positive metastasis to lymph nodes (odds ratio=0.1142, P<0.0001) were extracted as the independent prediction factors of metastasis to the lung. Comparisons of the no-recurrence and liver metastasis groups indicated that infiltration over the proper muscular tunics (odds ratio=0.0284, P<0.0001) and positive metastasis to lymph nodes (odds ratio=0.3289, P=0.0002) were extracted as the independent prediction factors of metastasis to the liver. CONCLUSIONS: Tumor budding in the invasive front of the lesion was considered to be a simple and useful pathohistological factor for the prediction of metastasis to the lung in patients with colorectal cancer after curative excision. It was suggested that this factor is important for the prediction of metastasis to the lung after surgery and for the planning of treatment methods.

Relationship between the direction of mandibular growth and masseter muscle conduction velocity.

INTRODUCTION: The purpose of this study was to investigate the relationship between muscle conduction velocity (MCV) of the masseter muscle and the direction of mandibular growth. METHODS: Longitudinal cephalometric X-rays taken at the prepubertal and postpubertal periods of 16 Japanese girls were analyzed. MCV was calculated from the delay in myoelectric signals obtained by using multiple surface electrode arrays placed along the fibers of the left masseter muscle in the postpubertal period. The direction of mandibular growth was evaluated by superimposition of the lateral cephalometric X-rays at the prepubertal and postpubertal periods. The relationship between MCV and the direction of mandibular growth was analyzed statistically. RESULTS: MCV was significantly correlated with the vertical facial height at the postpubertal period and the direction of mandibular condyle growth. CONCLUSIONS: If the relationship between prepubertal and postpubertal of MCV is clarified, it might be possible to predict the direction of mandibular growth and the vertical facial proportions at the postpubertal period from MCV of the masseter muscle at the prepubertal period.

Impacted mandibular second molar with extruded maxillary second molar: a case report.

AIM: To present a method for correction of an extruded maxillary second molar. METHODS: A female patient, 16 years of age, presented with an impacted mandibular second molar and an extruded opposing maxillary second molar. After placement of appliances in the maxilla, an elastic was hooked between the distal end of the extended lingual arch and the lingual button of the maxillary second molar. RESULTS: After sufficient intrusion of the maxillary second molar was achieved, the conventional method for traction of an impacted mandibular second molar was used. Neither root resorption nor undesirable periodontal problems were observed. CONCLUSION: The approach used in the present case is simple and efficient for both traction and retention of a maxillary molar.

Asymmetry of the sphenoid bone and its suitability as a reference for analyzing craniofacial asymmetry.

The purposes of this study were to evaluate the asymmetry of the sphenoid bone and to determine its suitability as a reference for analyzing asymmetry of the skull. Thirty-seven dry skulls from India were divided into group A (n = 18), with a right-left length discrepancy of less than 2 mm for both the external acoustic meatus-frontozygomatic suture and external acoustic meatus-subspinale, and group B (n = 19), with a right-left length discrepancy of more than 2 mm for either of these 2 parameters. The skulls were then examined with regard to the percentage of asymmetry of the sphenoid bone, the angles between the cranial base and the facial axis, and the distance between reference surfaces of the sphenoid bone and facial landmarks by 3-dimensional measurement system. The following results were obtained: 1. Asymmetry of the sphenoid bone, while slight, was found in both groups. There were no significant differences between the 2 groups. 2. The cranial base and the facial axis did not form a right angle in group A, and there were no significant differences between the 2 groups. 3. The distances between reference surfaces of the sphenoid bone and the lower landmarks of the facial bone were greater than those of the upper landmarks. 4. The external acoustic meatus was the most suitable reference for analysis of craniofacial asymmetry.

Predicting mandibular growth potential with cervical vertebral bone age.

This study assessed the possibility of using cervical vertebral bone age determined from cephalometric radiographs to predict mandibular growth potential. The subjects were 2 groups of 20 Japanese girls and young women: one group to derive a formula for predicting mandibular growth potential, the other to compare predicted values with actual values. Each group included subjects in the initial stage of the pubertal growth period and the final stage of growth in early adulthood. A formula for predicting mandibular growth potential that included cervical vertebral bone age and the actual growth of the mandible (condylion-gnathion) was determined with regression analysis. Cervical vertebral bone age, bone age on hand-wrist radiographs, and chronological age were inserted into the formula, and actual values and values predicted with these parameters of the formula for mandibular growth potential were compared. The formula found mandibular growth potential (in millimeters) = -2.76 x cervical vertebral bone age + 38.68. The average error between the value predicted by cervical vertebral bone age and the actual value (1.79 mm) was significantly less (P <.001) than that between the actual value and the value predicted by chronological age (3.48 mm) and approximately the same as that between the actual value and the value predicted by bone age (2.09 mm). The formula derived from this study might be useful for treating orthodontic patients in the growth stage.

Unerupted maxillary central and lateral incisors and canine with crossbite and asymmetry.

This case report describes the treatment of a patient with unerupted maxillary right central incisor, lateral incisor, and canine in a Class III malocclusion with asymmetry of the lower face. Sequential traction of the 3 unerupted teeth with a light force system was used in the treatment. The results remained stable during the 4-year retention period.

Cervical vertebral bone age in girls.

The purpose of this study was to establish cervical vertebral bone age as a new index for objectively evaluating skeletal maturation on cephalometric radiographs. Using cephalometric radiographs of 176 girls (ages 7.0-14.9 years), we measured cervical vertebral bodies and determined a regression formula to obtain cervical vertebral bone age. Next, using cephalometric and hand-wrist radiographs of another 66 girls (ages 8.0-13.9 years), we determined the correlation between cervical vertebral bone age and bone age using the Tanner-Whitehouse 2 method. The following results were obtained: (1) a regression formula was determined to obtain cervical vertebral bone age based on ratios of measurements in the third and fourth cervical vertebral bodies; (2) the correlation coefficient for the relationship between cervical vertebral bone age and bone age (0.869) was significantly (P <.05) higher than that for the relationship between cervical vertebral bone age and chronological age (0.705); and (3) the difference (absolute value) between the cervical vertebral bone age and bone age (0.75 years) was significantly (P <.001) smaller than that between cervical vertebral bone age and chronological age (1.17 years). These results suggest that cervical vertebral bone age reflects skeletal maturity because it approximates bone age, which is considered to be the most reliable method for evaluating skeletal maturation. Using cervical vertebral bone age, it might be possible to evaluate maturity in a detailed and objective manner on cephalometric radiographs.

Factors contributing to long graft survival in non-heart-beating cadaveric renal transplantation in Japan: a single-center study at Kitasato University.

A total of 107 cadaveric kidneys from non-heart-beating donors (NHBDs) have been transplanted between 1974 and 2000 at Kitasato University Hospital, Sagamihara, Japan. The patient survival of the 107 recipients of cadaveric renal transplants at 1, 5 and 10 yr was 0.857, 0.770 and 0.746, respectively. The 50% graft survival was 3.8 yr. The 5 and 10-yr graft survival was 0.457 and 0.337, respectively. Twenty of the 107 recipients of non-heart-beating cadaveric renal transplantation had graft survival longer than 10 yr. Of these 20 patients, 14 survivors still maintain functioning renal grafts and two died with functioning graft, although the remaining four reverted to dialysis because of chronic rejection and nephropathy. The average graft survival of these 20 patients at the time of study was 13.3 yr and the longest was 21.4 yr. The average serum creatinine level at 10 yr after transplantation was 1.63 mg/dL, almost identical to that at 5 yr post-transplant. The donors aged on average 40.2 yr; 13 were male and seven were female. The youngest donor was 9-yr-old and the oldest was 66. The graft survival was significantly better in the group with donor age younger than 55 yr (Log-rank: p=0.007). The average weight of the renal graft was not different between the long and shorter graft survival groups. The average warm ischemic time and total ischemic time were 9.7 and 539.7 min, respectively. The duration of post-transplant acute tubular necrosis averaged 9.2 days. These parameters tended to be shorter than those in recipients with graft survival >10 yr, but with no statistical significance. The mean numbers of acute rejection (AR) episode within 3 months after transplantation were 0.25 +/- 0.66 and 0.92 +/- 0.90 (p=0.020) in long survival and shorter survival groups, respectively. Long survivors had a significantly lower incidence of AR. Two of 20 cases received conventional immunosuppression with prednisolone, azathioprine and mizoribin, and 18 had prednisolone and calcineurin inhibitor (CNI). Kaplan-Meier analysis showed a significant contribution of CNI to graft survival (p=0.036). However, the graft survival reduction rate after 1 yr post-transplant did not differ between conventional and CNI immunosuppression. These data suggest that renal grafts retrieved with proper organ procurement procedures from NHBDs may survive long-term and help to overcome donor shortage.

Effects of cortisol administration on hepatic circulation during brain death in rabbits.

BACKGROUND: Hemodynamic instability and endocrinologic alterations during brain death contribute to dysfunction of donor organs. The present study was conducted to examine the effect of cortisol administration on hepatic circulation in brain-dead hypotensive donors. METHODS: Brain death was created by inflating a balloon catheter inserted into the epidural space in rabbits. In another set of experiments, non-brain-dead rabbits were bilaterally adrenalectomized. At 1 hour of equilibration after brain death or adrenalectomy, cortisol at a dose of either 0.05 or 5 mg/kg/hr was given intravenously for 5 hours. RESULTS: The induction of brain death resulted in a significant decrease in mean arterial pressure (MAP), whereas MAP after adrenalectomy was maintained. Both brain death and adrenalectomy caused an approximately 40% decrease in the portal vein blood flow (PVF) and hepatic tissue blood flow (HTF) and a significant increase in serum hyaluronic acid (HA) level as well as alanine aminotransferase (ALT) level. These changes were associated with a substantial decrease in serum cortisol level. Transmission electron microscopic examination showed swollen Kupffer cells with phagocytosis. Cortisol supplement after brain death or adrenalectomy significantly increased PVF and HTF to prevalues without affecting MAP. Both dosing rates of cortisol also significantly decreased serum HA and ALT levels and attenuated Kupffer cell activation. CONCLUSIONS: These results suggest that cortisol administration exhibits beneficial effects on hepatic circulation in hemodynamically unstable brain-dead animals.