Three-Dimensional Assessment of Temporomandibular Joint Morphology and Facial Asymmetry in Individuals with Different Vertical Skeletal Growth Patterns.

The aim of the current study was to investigate, by means of Cone-Beam Computed Tomography (CBCT), condyle−fossa relationship, temporomandibular joint (TMJ) morphology and facial asymmetry in subjects with different vertical skeletal growth patterns. CBCT of 56 patients (112 TMJs) were categorized into three groups according to the mandibular plane angle (MP): Hypodivergent (MP ≤ 23°), Normodivergent (23° < MP < 30°), and Hyperdivergent (MP ≥ 30°). TMJ spaces, width and depth of the condyle and thickness of the fossa were measured. Horizontal and vertical measurements were used to assess facial asymmetry. One-way Analysis of Variance (ANOVA) and post-hoc Turkey tests were computed for the between-groups comparison. Statistical significance was set at p < 0.05. Larger anterior joint space and smaller condylar dimensions (medio-lateral diameter and medio-lateral thickness) were observed in the hyperdivergent group compared to the normodivergent and hypodivergent groups. Right condylar distances to midsagittal plane were significantly larger than left distances in all the three groups. A vertical pattern of growth in healthy individuals seems to be associated with condylar position and dimension, while facial asymmetry values do not differ among different vertical groups.

Screening of Chronic Kidney Disease in Adults: A 10 years' Experience in North Indian City on World Kidney Day.

Chronic kidney disease (CKD) is a complex disease that is asymptomatic in its early stages. Its delayed recognition may predispose patients to adverse outcomes. Early detection and management of kidney disease through screening programs is widely recommended. In the present study, we conducted a screening program at a hospital set up on World Kidney Day for 10 years to detect patients with CKD. The current study constituted 1324 apparently healthy adults, aged >18 years. Information on age, sex, height, weight, history of diabetes mellitus (DM) and hypertension (HTN), and familial history of kidney disease was recorded. Systolic and diastolic blood pressure, random blood sugar; urinalysis, and serum creatinine (Cr) levels were measured. The study outcome was the presence of CKD. Binary logistic regression analysis was applied to find the predictors of CKD. The median age of the study subjects was 40 years. CKD was found in 35.6% of subjects. Age, DM, HTN, and abnormal Cr levels were associated with increasing risk of CKD. The main objective of the present study was to identify the extent of risk relative to the co-factors of CKD and thereby target those who are potentially modifiable, like DM, to intervene at the earliest possible stage to treat the current disease condition and prevent the future health impairment.

Fresh Autologous Pericardium to Reconstruct the Pulmonary Valve at the Annulus When Tetralogy of Fallot Requires a Transannular Patch at Midterm.

Tetralogy of Fallot often requires reconstruction of the right ventricular outflow tract with a transannular patch (TAP), but this renders the pulmonary valve incompetent and eventually leads to right ventricular dysfunction. We retrospectively evaluated the efficacy of a reconstructed pulmonary valve and annulus in 70 patients who underwent, from December 2006 through December 2010, complete correction of tetralogy of Fallot. We divided the 70 patients into 2 groups in accordance with whether they required (n=50) or did not require (n=20) a TAP. We used autologous untreated pericardium to fashion the TAP and to create both an annulus of the correct size and a competent pulmonary valve with native leaflets. We evaluated the efficiency of this procedure both functionally and anatomically. The median age of the patients was 11 years (range, 2-38 yr). There were 56 males, with no significant difference in sexual distribution between groups. The clinical follow-up was 88% for 57.5 months, and the echocardiographic follow-up was 80% for 36 months. There was no significant difference in outflow gradient or in the occurrence of pulmonary insufficiency between the TAP group (none, 31; mild, 12; moderate, 6; and severe, 1) and the No-TAP group (none, 16; moderate, 2; and severe, 2) (P=0.59). Nor was there any thickening or calcification in the constructed valves. We conclude that pulmonary valves constructed of untreated autologous pericardium performed as well as native valves after total tetralogy of Fallot correction at midterm.

Exposures of lateral and inferior cardiac surface for coronary anastomosis during minimally invasive coronary artery bypass grafting.

Exposure of the lateral and inferior surface of the heart during off-pump coronary artery bypass grafting is associated with some degree of cardiac instability during recovery with completion of grafting. Exposure of lateral and posterior surfaces by currently available equipment is difficult in minimally invasive coronary artery bypass grafting (MICABG) owing to limited exposure. We describe an effective variation of often-used technique of pericardial stitch in exposure of cardiac surfaces during MICABG. This technique was used in 24 patients undergoing multivessel MICABG. Deep pericardial sutures were used to manipulate the exposure of cardiac surfaces. Left anterior descending artery was grafted in all 24 cases. Obtuse marginal artery was grafted in 20 cases and posterior descending artery in 12 cases. Average grafts were 2.3 per patient. There was no conversion to median sternotomy. Use of deep pericardial suture is simple technique for exposure of lateral and inferior surface during multivessel MICABG. This offers adequate exposure and operating space for easy maneuverability.

Early and mid-term results of minimally invasive coronary artery bypass grafting.

INTRODUCTION: Minimally invasive coronary artery bypass grafting (MICABG) is a less invasive method of performing surgical revascularization. This technique coupled with use of off pump technique of surgical revascularization makes it truly less invasive. This method is highly effective even in high-risk patients. Results of this procedure are comparable to standard off pump technique and are better than percutaneous coronary intervention utilizing drug-eluting stent. We present an early and mid-term result of the use of this technique. METHOD: We enrolled 33 patients for analysis operated between 2008 and 2012. Operation was performed utilizing off-pump technique of coronary artery bypass grafting through a minimal invasive incision. Left internal mammary artery graft was done for single vessel disease and radial artery was utilized for other grafts if required. Median follow up of 2.5 years (6 months-4 years) is available. RESULTS: Median age was 58.5 years (41-77) and all were male. Single vessel disease was present in 7, double vessel in 14 and triple vessel disease in 12 patients. All the patients had normal left ventricular size and function. There was no operative and 30-day mortality. Conversion to median sternotomy to complete the operation was done in 6.6% (2 out of 33 patients). One patient had acute myocardial infarction and there were no deaths during follow up. CONCLUSION: MICABG is a safe and effective method of revascularization in low risk candidates for coronary artery bypass grafting.

Effect of mitral valve replacement on reduction of left atrial size.

INTRODUCTION: asymptomatic left atrial enlargement is not uncommon in rheumatic mitral valve disease. We studied the change in size of the left atrium after mitral valve replacement. PATIENTS AND METHODS: between January and December 2005, 116 patients underwent isolated mitral valve replacement. Two groups were identified based on left atrial size: group 1 < 60 mm (n = 79) and group 2 > 60 mm (n = 37). The patients were followed up for 40.4 ± 19.3 months Clinical assessment, preoperative and last postoperative echocardiograms were considered for analysis. RESULTS: the left atrium decreased by 5.84 mm ± 10.5 in group 1 compared to 20.9 mm ± 10.64 in group 2 (p = 0.0001). This correlated with preoperative mitral valve area (p = 0.009), preoperative mitral regurgitation (p = 0.000), and preoperative atrial fibrillation (p = 0.022). Linear regression analysis revealed atrial fibrillation (p = 0.001, b1 = 6.006), a high grade of mitral regurgitation (p = 0.001, b1 = -3.812), and larger size of the left atrium (p = 0.000, b1 = -0.701) predicted a greater reduction of left atrial size during follow-up. Left atrial size decreased by 28 mm in patients with a preoperative left atrium >60 mm (75% sensitivity and 100% specificity). CONCLUSION: the asymptomatic left atrium reduces in size considerably after mitral valve replacement, and the decrease is greater in patients with a left atrium >60 mm in size.