Predictive value of magnetic resonance imaging diffusion parameters using artificial intelligence in low-and intermediate-risk prostate cancer patients treated with stereotactic ablative radiotherapy: A pilot study.

INTRODUCTION: To investigate the predictive value of the pre-treatment diffusion parameters of diffusion-weighted magnetic resonance imaging (DW-MRI) using artificial intelligence (AI) for prostate-specific antigen (PSA) response in patients with low- and intermediate-risk prostate cancer (PCa) treated with stereotactic ablative radiotherapy (SABR). METHODS: Retrospective evaluation was performed for 30 patients using pre-treatment multi-parametric MR image datasets between 2017 and 2021. MR-based mean- and minimum apparent diffusion coefficients (ADCmean, ADCmin) were calculated for the intraprostatic dominant lesion. Therapeutic response was assessed using PSA levels. Predictive performance was assessed by the receiver operating characteristic (ROC) analysis. Statistics performed with a significance level of p ≤ 0.05. RESULTS: No biochemical relapse was detected after a median follow-up of twenty-three months (range: 3-50), with a median PSA of 0.01 ng/ml (range: 0.006-2.8) at the last examination. Significant differences were observed between the pre-treatment ADCmean, ADCmin parameters, and the group averages of patients with low and high 1-year-PSA measurements (p < 0.0001, p < 0.0001). In prediction, the random forest (RF) model outperformed the decision tree (DT) and support vector machine (SVM) models by yielding area under the curves (AUC), with 0.722, 0.685, and 0.5, respectively. CONCLUSION: Our findings suggest that pre-treatment MR diffusion data may predict therapeutic response using the novel approach of machine learning in PCa patients treated with SABR. IMPLICATIONS FOR PRACTICE: Clinicians shall measure and implement the evaluation of the suggested parameters (ADCmin, ADCmean) to provide the most accurate therapy for the patient.

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support.

BACKGROUND: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. STUDY DESIGN: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. RESULTS: Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0-76.0), median injury severity score was 34.0 (IQR, 27.0-43.0), and the median duration of ECMO support was 11 days (IQR, 7.5-20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). CONCLUSIONS: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

Some Nitrogen Rich Energetic Material Synthesis by Nucleophilic Substitution Reaction from Polynitro Aromatic Compounds.

Three new nitrogen-rich energetic compounds, N-(5-chloro-2,4-dinitrophenyl)hydrazine (1), N-(5-chloro-2,4-dinitrophenyl)guanidine (2) and N-(5-chloro-2,4-dinitrophenyl)-4-aminopyrazole (3) prepared by the nucleophilic substitution reaction of 1,3-dichloro-4,6-dinitrobenzene with hydrazine, guanidinium carbonate and 4-aminopyrazole. The compounds were characterized by 1H NMR, 13C NMR, IR and mass spectroscopy. Only compound 2 could be prepared in a suitable crystal and molecular model was determined by X-ray analysis. Compounds were investigated by TG and DSC. Thermal degradation and thermokinetic behavior were investigated by Ozawa-Flynn-Wall and Kissinger-Akahira-Sunose techniques. Compounds were observed to be prone to exothermical thermal decomposition. HOMO and LUMO levels, theoretical formation enthalpy and electrostatic maps were calculated by Gaussian09. The detonation velocity and pressure were calculated by Kamlet-Jacobs equation. The compounds were assayed for antimicrobial properties.

Emergent valve replacement after circular mapping catheter entrapment in mitral valve apparatus.

We present the case of a 47-year-old male patient with a history of symptomatic paroxysmal atrial fibrillation who failed guideline-directed medical treatment and cardioversion. Electrical mapping was attempted and complicated with catheter entrapping in the mitral valve (MV) apparatus, and multiple attempts for retrieval were unsuccessful and caused severe valvular dysfunction. Emergent valve replacement was required secondary to the extensive disruption of the valvular apparatus and posterior annulus. Mapping catheter entrapment in the valvular apparatus is an uncommon complication, but when it occurs, there is a high risk of injury to the MV apparatus during retrieval. To avoid extensive MV damage, operators should use minimal force during standard manoeuvres to extract the catheter. If gentle retrieval manoeuvres fail, surgical exploration and open retrieval may prevent MV damage. Early surgical consultation and exploration could result in open catheter retrieval or MV repair versus MV replacement.

Axillary Access TAVR: Entrapment of a Transcatheter Aortic Valve in the Innominate Artery With Aortic Dissection.

Non-femoral transcatheter aortic valve replacement (TAVR) is indicated when peripheral vascular disease is diagnosed. We describe the "double-stick" technique via the axillary artery. During the procedure, the pigtail coiled around the TAVR system. While retracting the TAVR sheath, the seam along system split dislodging the valve from the balloon. The valve was entrapped in the innominate artery, and an aortic dissection required surgery. With the double-stick technique, friction and resistance between the pigtail and delivery system must be avoided. Pre-procedural planning and early identification is paramount. Smaller and more seamless delivery systems may reduce risk for dissection and entrapment.

Total Artificial Heart Salvage of a Heterotopic Heart Transplant Patient.

Rescuing heterotopic heart transplantation (HHT) patients remains a challenge in the field. When a 41-year-old patient was transferred to our service, we chose a novel approach that is reported herein. The HHT had been performed over 20 years ago, and in 2016, because of complications, the patient was listed for transplant with a 1A status. For the first time, the SynCardia 50cc total artificial heart (TAH) (SynCardia Systems, LLC, Tucson, AZ) was used in an HHT patient. Investigators attained approval to use the SynCardia 50cc investigational device, as this was an emergent case with few options. The donor heart from the HHT was left in place, alongside the TAH. By leaving the donor heart from the HHT, the need for long and tedious extensive dissection around the right lung was eliminated; thereby reducing the potential risk of lung parenchymal injury, massive bleeding, and complex air leaks. The procedure was successful, and the patient underwent a successful orthotopic heart transplantation six months after being placed on TAH.

Left Ventricular Rupture After Impella® Placement During High-Risk Percutaneous Coronary Intervention.

Ventricular perforation is a rare complication during a high-risk percutaneous coronary intervention (PCI) when supported by Impella® (Abiomed). However, instrumentation of the left ventricle several days after transmural infarct potentially increases susceptibility for perforation. While a patient is on Impella support, physicians should review ventriculograms carefully to detect perforation and should consider the presence of a decompressed ventricle, the absence of normal systolic pressure and the movement of contrast from the ventricle into the aorta bypassing the left ventricular ejection. Immediate removal of the Impella if a perforation occurs must be avoided. Retrieving the device would risk a catastrophic bleed, while alternative repair techniques are available. Here, we describe a patient with a left ventricle perforation that occurred during a high-risk PCI supported by an Impella device. ANNOTATED SUMMARY: The repair of a left ventricle perforation during high-risk PCI in a patient who had an unrecognized left ventricular perforation is described. Physicians are encouraged to carefully review ventriculograms to identify the subtle changes that can indicate a perforation. Further, immediate removal of the temporary LVAD should be avoided to minimize the risk of catastrophic bleeds.

Left Ventricular Assist Device Outflow Graft Obstruction: A Case Series.

Dysfunction of different components within continuous-flow (CF) left ventricular assist device (LVAD) systems may cause adverse cardiovascular and end-organ sequelae. Outflow graft obstruction is a recognized type of LVAD component dysfunction. Ten patients were admitted and treated for LVAD outflow graft obstruction. Two of these patients subsequently developed recurrent outflow graft obstruction requiring reintervention; however, each reoccurrence was at a different site than the original obstruction. Thus, a total of 12 cases of obstruction were analyzed. The most common reasons for hospital admission were low flow LVAD alarms or decompensated heart failure. Presentation with outflow graft obstruction occurred an average of 3.0 years after LVAD implantation. Patients underwent echocardiographic evaluation at the time of admission. Left ventricular assist device component dysfunction was suspected based on echocardiographic findings, and follow-up contrast studies were used to establish the specific diagnosis of outflow graft stenosis. The majority of stenotic lesions (10/12) were treated percutaneously with balloon angioplasty and stenting with balloon-expandable endovascular prostheses. Postintervention, all patients had significant improvement in LVAD flow rates.

New Approach in Assessing Core Muscle Endurance Using Ratings of Perceived Exertion.

George, JD, Tolley, JR, Vehrs, PR, Reece, JD, Akay, MF, and Cambridge, EDJ. New approach in assessing core muscle endurance using ratings of perceived exertion. J Strength Cond Res 32(4): 1081-1088, 2018-This study sought to develop regression models to estimate maximal endurance time using data from 4 core muscle endurance tests. Eighty healthy university students (age: 22.7 ± 1.9 years) performed the plank, right side-bridge, left side-bridge, and back extension tests in a random order. Participants were instructed to hold each static position for a maximal endurance time, while maintaining proper form, and then rest for 5 minutes between tests. A test administrator recorded participants' ratings of perceived exertion (RPE; a modified 10-point scale) every 5 seconds. Based on regression analysis, the elapsed time to reach an RPE of 8 (RPE8) exhibited statistical significance (p < 0.0001) and the highest accuracy as compared with lower RPE values. The following univariate regression models were generated to estimate maximal endurance time across the 4 tests: plank (r = 0.94; standard error of estimate [SEE] = 17.6 seconds; n = 77) = 23.9 + (1.110 × RPE8); right side-bridge (r = 0.92; SEE = 11.4 seconds; n = 80) = 18.5 + (1.022 × RPE8); left side-bridge (r = 0.93; SEE = 10.8 seconds; n = 80) = 16.8 + (1.062 × RPE8); and back extension (r = 0.93; SEE = 14.2 seconds; n = 79) = 21.5 + (1.027 × RPE8). These results suggest that submaximal protocols based on elapsed time to reach RPE8 provide strength and conditioning professionals relatively accurate univariate regression equation estimates of maximal core muscle endurance time and offer a viable submaximal alternative to maximal capacity testing when time efficiency, participant safety, or certain educational objectives may be a priority.

Alterations in dysadherin expression and F-actin reorganization: a possible mechanism of hypericin-mediated photodynamic therapy in colon adenocarcinoma cells.

Dysadherin is a recently found anti-adhesion molecule, therefore detection and down regulation of its expression is promising in cancer treatment. The up-regulation of dysadherin contributes to colon cancer recurrence and metastasis. Dysadherin also has connections with cytoskeletal proteins and it can cause alterations in the organisation of filamentous actin (F-actin) in metastatic cancers. In this study, hypericin (HYP)-mediated photodynamic therapy (PDT) was performed in two different grade colon adenocarcinoma cell lines HT-29 (Grade I) and Caco-2 (Grade II). Cells were treated with 0.04, 0.08 or 0.15 µM HYP concentrations and irradiated with (4 J/cm(2)) fluorescent lamps. The effects of HYP was examined 16 and 24 h after the activation. We investigated for the first time the effect of HYP-mediated PDT on the expression of dysadherin and F-actin organisation. According to the results, HYP mediated PDT caused a decrease in gene expression and immunofluorescence staining of dysadherin and an increase in actin stress fibers and actin aggregates in HT-29 and Caco-2 cell lines. Besides, cytotoxicity, number of floating cells and apoptotic index changed depending on the cell type, HYP concentration and incubation time. We have demonstrated for the first time that dysadherin and F-actin could be target molecules for HYP-mediated PDT in HT-29 and Caco-2 colon cancer cell lines.

Coronary artery bypass grafting vs percutaneous coronary intervention and long-term mortality and morbidity in multivessel disease: meta-analysis of randomized clinical trials of the arterial grafting and stenting era.

IMPORTANCE: Recent trials of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) for multivessel disease were not designed to detect a difference in mortality and therefore were underpowered for this outcome. Consequently, the comparative effects of these 2 revascularization methods on long-term mortality are still unclear. In the absence of solid evidence for mortality difference, PCI is oftentimes preferred over CABG in these patients, given its less invasive nature. OBJECTIVES: To determine the comparative effects of CABG vs PCI on long-term mortality and morbidity by performing a meta-analysis of all randomized clinical trials of the current era that compared the 2 treatment techniques in patients with multivessel disease. DATA SOURCES: A systematic literature search was conducted for all randomized clinical trials directly comparing CABG with PCI. STUDY SELECTION: To reflect current practice, we included randomized trials with 1 or more arterial grafts used in at least 90%, and 1 or more stents used in at least 70% of the cases that reported outcomes in patients with multivessel disease. DATA EXTRACTION: Numbers of events at the longest possible follow-up and sample sizes were extracted. DATA SYNTHESIS: A total of 6 randomized trials enrolling a total of 6055 patients were included, with a weighted average follow-up of 4.1 years. There was a significant reduction in total mortality with CABG compared with PCI (I2 = 0%; risk ratio [RR], 0.73 [95% CI, 0.62-0.86]) (P < .001). There were also significant reductions in myocardial infarction (I2 = 8.02%; RR, 0.58 [95% CI, 0.48-0.72]) (P < .001) and repeat revascularization (I2 = 75.6%; RR, 0.29 [95% CI, 0.21-0.41]) (P < .001) with CABG. There was a trend toward excess strokes with CABG (I2 = 24.9%; RR, 1.36 [95% CI, 0.99-1.86]), but this was not statistically significant (P = .06). For reduction in total mortality, there was no heterogeneity between trials that were limited to and not limited to patients with diabetes or whether stents were drug eluting or not. Owing to lack of individual patient-level data, additional subgroup analyses could not be performed. CONCLUSIONS AND RELEVANCE: In patients with multivessel coronary disease, compared with PCI, CABG leads to an unequivocal reduction in long-term mortality and myocardial infarctions and to reductions in repeat revascularizations, regardless of whether patients are diabetic or not. These findings have implications for management of such patients.

Holter ECG assessment of the effects of three different local anesthetic solutions on cardiovascular system in the sedated dental patients with coronary artery disease.

OBJECTIVE: The purpose of the study is to compare the effects of lidocaine alone, epinephrine-combined lidocaine and prilocaine with octapressin on the cardiovascular system during minor oral surgery of sedated cardiac dental patients under local anesthesia. METHODS: Connected to a Holter electrocardiogram (ECG) monitor for a total of 5 hours starting 1 hour before the procedure, twenty patients with high risk of coronary artery disease were included in the prospective cohort study. All the patients had three operations at 3 different appointments with at least one-week intervals and each operation was performed under local anesthesia achieved by 3.6 mL of 3% prilocaine with octapressin, 3.6 mL of 2% lidocaine with 1:80.000 epinephrine and 3.6 mL of 2% lidocaine without a vasoconstrictor. Data of the Holter ECG device assessed at the end of every hour and evaluated statistically. Repeated measures ANOVA, Friedman test, and Wilcoxon signed ranks test were used to perform statistical analysis. RESULTS: Heart-rate showed significant differences between lidocaine with epinephrine and pure lidocaine in an hour following the injection (p<0.05 for all). Cardiac rhythm showed significant differences between prilocaine with octapressin and pure lidocaine at the second hour after its administration (p<0.05 for all). There were no significant differences between 3 local anesthetics in terms of ST segment deviation. CONCLUSION: In minor oral operation on the sedated patients with cardiac disease, the use of 3.6 mL or a less amount of local anesthetic injection containing epinephrine appears to be a predictable and safe method.

Toxicity of food contaminant furan on liver and kidney of growing male rats.

Furan is a chemical used in some industrial products and occurs naturally in heat-treated foods. We aimed to investigate the effects of orally administered furan on liver and kidney in growing Wistar male rats for 90 days. In this respect, biochemical, morphological, histopathological, and histomorphometrical examinations were performed. Three- to 4-week aged rats were divided into five groups of eight animals each; control, oil control; 2, 4, 8 mg/kg/day furan treatment groups. At the end of the experiment, antioxidant enzyme activities and serum AST, ALT, HDL, Urea, etc. levels were analyzed. Malondialdehyde (MDA) levels, superoxide dismutase (SOD), catalase (CAT), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were also measured in liver homogenates. Also, liver and kidney were examined morphologically and histopathologically under light microscopy. According to the results of biochemical analysis, ALT, ALP, and LDL levels in treatment groups were significantly different compared with control groups. While LDL levels in treatment groups increased significantly, ALT and ALP levels decreased significantly. No significant changes were observed in liver MDA levels, superoxide dismutase and catalase activities in treatment groups. While IL-6 levels did not change in treatment groups, furan caused dose-dependent increases in liver TNF-α level of rats. In treatment groups, absolute and relative liver weights changed significantly, however, no significant changes were observed in kidney and relative kidney weights. Hyperemic blood vessels in the liver and congestion, edema, fibrosis, and tubular damage in the kidney of rats treated with furan were observed histopathologically. According to histomorphometric examinations, glomeruli diameters and glomerular volume decreased in the kidneys of rats in treatment groups.

Pathological and biochemical effects of therapeutic and supratherapeutic doses of celecoxib in Wistar albino male rats.

Celecoxib is intended for acute pain, menstrual cramps, pain, and inflammation of osteoarthritis and rheumatoid arthritis. The aim of this study was to evaluate the effects of celecoxib (10 and 50 mg/kg/day) treatment on rats orally for 28 days. We examined effects on some biochemical parameters and kidney and liver tissues of celecoxib-treated Wistar albino male rats. At the end of the study, hepatic and renal function tests were performed and liver and kidney of rats were microscopically examined to detect systemic toxicity of celecoxib. Celecoxib-treated rats had statistically significant decreases of cholesterol, total bilirubin, total protein, urea, globulin, blood urea nitrogen, phosphorus, and calcium. Serum gamma glutamyl transferase levels increased in 10- and 50-mg/kg/day celecoxib-treated rats. Histological examinations showed mononuclear cell infiltration, hyperplasia, and cellular degeneration in liver and tubular damage and mononuclear cell infiltration in kidney. We suggest that high doses of celecoxib may cause changes in liver and kidney histopathology, liver function, and in some biochemical parameters.

The effects of maternal exposure to food additive E341 (tricalcium phosphate) on foetal development of rats.

E341 (tricalcium phosphate) (TCP) is commonly used as a food additive and also as a nutritional supplement. To evaluate the possible developmental effects, female Wistar rats were treated with E341 (TCP) by oral gavage during pregnancy. There were three groups of each containing five rats. Rats in Groups I-III were fed with standard diet, oil and E341 (TCP) 175mg/kg body weight during gestation days (GD 0-20) respectively. We assessed foetal body lengths and weights and also made morphometric examination of placenta and umbilical cord. The placental weights of E341 (TCP) group (Group III) were found to be decreased statistically. According to skeletal stainings of foetuses, lengths of left ulna (28.3%), right femur (29.8%), left femur (34.9%) and diameter of the skull of y-axis were significantly decreased (12.3%) in E341 (TCP) treatment groups. There was an increase in trans-umbilical diameter in treatment group (14%). This is the first study in which developmental effects of E341 (TCP) have ever evaluated. The results suggest that prenatal development of rats during gestation is sensitive to E341 (TCP) exposure.

Effects of transmandibular symphyseal distraction on teeth, bone, and temporomandibular joint.

PURPOSE: The aim of this clinical study was to investigate the clinical effects and long-term results of the transmandibular symphyseal distraction technique for the correction of mandibular transverse deficiencies. This was achieved by assessing the dental, skeletal, and temporomandibular joint changes in the sagittal, vertical, and axial planes using cephalograms, dental casts, and computed tomography (CT). PATIENTS AND METHODS: Seven patients with mandibular transverse deficiencies (3 females and 4 males), aged 14.3 to 22.5 years (mean 16.2), were treated with a bone-borne transmandibular distractor. Lateral and posteroanterior cephalometric films, CT scans of both temporomandibular joints, and dental casts were obtained preoperatively, at the end of the distraction period, and at the end of 3 years (clinical follow-up period). The clinical findings were assessed according to the morphologic and functional success criteria established by the Steering Group of European Collaboration on Cranial Facial Anomalies for patients with developmental dentofacial anomalies undergoing craniofacial distraction osteogenesis. The statistical analysis of cephalometric films and dental cast measurements was done using the paired t test. The mean postoperative examination period was 40 months (range 36 to 48). RESULTS: The desired amount of distraction was achieved in all patients (mean 6.48 mm). The intraoperative and postoperative complications encountered included damage to the central incisors during vertical osteotomy (1 patient), wound dehiscence after a latent period (3 patients), mild temporomandibular joint pain during the distraction period (3 patients), and chronic gingivitis around the activation rods (7 patients). The success criteria for craniofacial distraction osteogenesis were fulfilled at the end of the 3-year follow-up period. Model analysis showed that the maximal amount of expansion was achieved at the premolar region (first premolar 5.79 mm, second premolar 5.07 mm). Frontal (posteroanterior) cephalograms taken at the end of the distraction period revealed significant increases in the bicondylar (0.35 mm), bigonion (3.43 mm), biantegonion (2.29 mm), and intermolar (4.0 mm) widths, and the ramal angle had decreased significantly (-1.64 degrees). The increase in the transverse measurements was greater at the dentoalveolar level than at the base of the mandible. Lateral cephalograms showed that transmandibular symphyseal distraction produced significant increases in the incisor mandibular plane angle (2.79 degrees) and mandibular body length (1.72 mm). The effect of the procedure on the condyle was 2.5 degrees to 3 degrees of distolateral rotation as calculated using the CT scans. Dental crowding was resolved rapidly by the movement of the teeth into the distraction regenerate. CONCLUSIONS: The clinical and radiologic results of the present study have shown that a transmandibular distractor is a clinically effective bone-borne distractor for the correction of mandibular transverse deficiencies and anterior crowding. The follow-up cephalograms and CT scans showed the transverse skeletal stability of the distraction procedure and no permanent temporomandibular dysfunction. However, additional multicenter studies with more patients are necessary to precisely evaluate the long-term postdistraction changes on the skeleton, teeth, and temporomandibular joint.

Effects of imatinib mesylate on renin-angiotensin system (RAS) activity during the clinical course of chronic myeloid leukaemia.

The renin-angiotensin system (RAS) is involved in cell growth, proliferation and differentiation in bone marrow in an autocrine-paracrine manner, and it modulates normal and neoplastic haematopoietic cell proliferation. This study aimed to assess expressions of the RAS components, renin, angiotensinogen and angiotensin-converting enzyme (ACE), during imatinib mesylate treatment of patients with chronic myeloid leukaemia (CML). Expressions of RAS components were studied in patients with CML at the time of diagnosis (n = 83) and at 3, 6 and 12 months after diagnosis (n = 35) by quantitative real-time polymerase chain reaction. De novo CML patients had increased ACE, angiotensinogen and renin mRNA levels and these expression levels decreased following administration of imatinib. The RAS activities were significantly different among Sokal risk groups of CML, highlighting the altered biological activity of RAS in neoplastic disorders. The results of this study confirm that haematopoietic RAS affects neoplastic cell production, which may be altered via administration of tyrosine kinase inhibitors such as imatinib mesylate.

Investigating the interaction between oncogene and tumor suppressor protein.

It is known that cancer develops when cells in a part of the body begin to grow out of control. Because cancer cells continue to grow and divide with no order, they never differentiate into the specific tissue, and thus, they are functionally different from normal cells. However, there are some genes that help to prevent cells' malignant behavior, and therefore, are referred to as tumor suppressor genes. Here, we have investigated the structural and functional relationships of p53, oncogene and interleukin 2 (IL2) proteins using the resonant recognition model (RRM), a physico-mathematical approach based on digital signal processing methods. In addition, using the RRM concepts, we have designed the peptide analoges that would exhibit tumor-suppression-like activity and be used in anticancer vaccine development.

Transpalatal distraction using bone-borne distractor: clinical observations and dental and skeletal changes.

PURPOSE: The aim of this clinical study was to analyze the outcome, complications, and long-term results of transpalatal distraction for the correction of maxillary transverse deficiency (MTD) and assess skeletal and dental changes in the sagittal, vertical, and transverse planes through cephalograms and dental casts. PATIENTS AND METHODS: Ten adult patients with MTD were treated with a Transpalatal Distractor (Surgi-Tec, Bruges, Belgium). Lateral and posteroanterior cephalometric films and dental casts were taken before surgery and at the end of the consolidation period. The statistical analysis of cephalometric film and dental cast measurements was undertaken with paired t tests. RESULTS: The intraoperative and postoperative problems encountered were damage to the central incisive teeth as a result of vertical osteotomy, wound dehiscence after the latent period, pain during the distraction period, and loosening of the distractor and buccal displacement of the left alveolar segment during the consolidation period. Model analysis showed that the greatest amount of transverse increase was in the premolar region (7.07 mm for first premolar and 7.10 mm for second premolar). Frontal cephalometric analysis indicated that transverse distances increased more at the alveolar level (7.75 mm) than in the maxillary base (5.25 mm) and nasal region (4.3 mm). The asymmetries between the left and right sides in both dental and skeletal expansions were statistically nonsignificant. The changes in the Sella-nasion-point A, Sella-nasion-point B, Sella-nasion and gonion-gnasion angles were statistically significant. CONCLUSIONS: According to the results of this study, transpalatal distraction was found to be a clinically effective technique for palatal expansion in adult patients with MTD. However, treatment planning and regular clinical follow-up visits are necessary for long-term clinical success.

Results and complications of alveolar distraction osteogenesis to enhance vertical bone height.

OBJECTIVE: The aim of this retrospective study was to analyze the outcome and complications of alveolar distraction osteogenesis for the correction of vertically deficient ridges by using intraosseous and extraosseous distractors. STUDY DESIGN: Seven patients with severely atrophic alveolar crests were treated by distraction osteogenesis in 5 alveolar ridge deficiencies by intraosseous distractors and in 2 alveolar ridge deficiencies by extraosseous distractors. The bone deficiencies were secondary to atrophy after periodontal disease, tooth extraction, or trauma. Three months after consolidation of the distracted segments, implants were placed in the distracted areas. The average follow-up period after prosthetic loading was 50 months. RESULTS: The mean alveolar height achieved was 7.8 mm (range, 4-9 mm). The intraoperative and postoperative problems encountered were lack of device activation (n = 1), lingual displacement of the distracted segment (n = 1), paresthesia of the lower lip (n = 4), and dehiscence and plate exposure (n = 2). Most of these complications were considered to be minor complications and were solved without any problems. CONCLUSION: It was concluded that alveolar distraction osteogenesis seems to be an effective technique to treat vertical alveolar ridge deficiencies, but adequate treatment planning is necessary for success. The complications related to this technique can be solved with simple treatments.