Accuracy of two different voxel sizes for presurgical evaluation of mandibular osteotomy.

The aim of this study was to compare the accuracy of two different voxel resolutions for the preoperative assessment of mandibular osteotomies. The study was conducted on 37 dry adult human mandibles. To obtain measurement standardization, heated gutta-percha cones were placed on the dry mandibles to mark 20 anatomical points. These cones were used for all measurement groups. Cone beam computerized tomography (CBCT) scans of the mandibles were made using 0.200mm3 and 0.400mm3 voxel sizes (Planmeca Promex-3D Helsinki, Finland). The results obtained from these two groups were compared with physical measurements obtained using a digital calliper, in order to analyze their predictive value. In the study, one voxel size did not have supremacy over the other in terms of accuracy. For mandibular osteotomies, 0.400mm3 voxel size can be preferred because of lower radiation dose.

The evaluation of serum N-terminal prohormone brain-type natriuretic peptide, troponin-I, and high-sensitivity C-reactive protein levels in children with congenital heart disease.

Although advanced diagnostic and treatment methods are available, congenital heart disease (CHD) holds an important place among the causes of death within the first year of age. Therefore, several prognostic factors are needed for diagnosis and monitoring of these patients. In this study, which includes 66 CHD patients and 38 healthy control children, serum cardiac troponin-I (cTnI), high-sensitivity C-reactive protein (Hs-CRP), and N-terminal prohormone brain-type natriuretic peptide (NT-proBNP) levels were analyzed for their prognostics values. The patient groups were categorized and then evaluated as cyanotic (n = 16), acyanotic (n = 50), symptomatic (n = 23), asymptomatic (n = 43), and isolated ventricular septal defect (VSD)-isolated atrial septal defect (ASD) groups. Cyanotic group was statistically compared with acyanotic group, symptomatic group with asymptomatic group, and VSD group with ASD group. Between the cyanotic, acyanotic, and control groups; between symptomatic and asymptomatic groups; and between the VSD and ASD groups, significant difference was not showed for age (p > 0.05). NT-proBNP was found to be significantly higher in the cyanotic group than acyanotic and control group, in the symptomatic group than asymptomatic group; and in the patient group than healthy control group (p < 0.05). Between the groups of VSD and ASD, significant difference was not showed (p > 0.05). The same comparison results for TnI and Hs-CRP were not significant (p > 0.05). TnI and Hs-CRP were only found significantly higher in the patient group than healthy control group (p < 0.05). Eventually, we think that NT-proBNP, Hs-CRP, and TnI might be used for clinical management and estimation of outcome of these disorders in the future and these also might be able to modify existing strategies, but much more studies are needed.

False positive 18F-FDG PET scan in adrenal oncocytoma.

18F-FDG whole-body positron emulsion tomography (18F-FDG PET) has become an established imaging modality for a variety of cancers. Today, 18F-FDG PET is utilized to differentiate benign from malignant non-functioning adrenal masses. In this report, a 25-year-old woman presented with a 2-month history of left flank pain. Abdominal CT revealed a left 6.5 x 4.5 cm adrenal mass with regular margins and focal calcification. To make a differential diagnosis, 18F-FDG PET was performed. Preoperative laboratory studies showed that the mass was non-functioning. A left adrenalectomy was performed through a left subcostal incision. The final pathologic evaluation revealed adrenal oncocytoma. We present the disassociation between preoperative 18F-FDG PET and pathologic findings of a benign adrenocortical oncocytoma.

Parallel implementation of the accelerated BEM approach for EMSI of the human brain.

Boundary element method (BEM) is one of the numerical methods which is commonly used to solve the forward problem (FP) of electro-magnetic source imaging with realistic head geometries. Application of BEM generates large systems of linear equations with dense matrices. Generation and solution of these matrix equations are time and memory consuming. This study presents a relatively cheap and effective solution for parallel implementation of the BEM to reduce the processing times to clinically acceptable values. This is achieved using a parallel cluster of personal computers on a local area network. We used eight workstations and implemented a parallel version of the accelerated BEM approach that distributes the computation and the BEM matrix efficiently to the processors. The performance of the solver is evaluated in terms of the CPU operations and memory usage for different number of processors. Once the transfer matrix is computed, for a 12,294 node mesh, a single FP solution takes 676 ms on a single processor and 72 ms on eight processors. It was observed that workstation clusters are cost effective tools for solving the complex BEM models in a clinically acceptable time.

131I labeling of tamoxifen and biodistribution studies in rats.

Tamoxifen [TAM ([Z]-2-[4-(1,2-diphenyl-1-di-butenyl)-phenoxy]-N,N-dimethylethanamine)] has been used as an antiestrogen drug for treatment and prevention of human breast cancer. Tamoxifen was labeled with 131I using iodogen as an oxidizing agent. Mass spectroscopy of the cold standard showed that the labeling occurs in ortho position to the phenyl ether position of TAM as expected. Quality control, radiochemical yield and stability were established using the radioelectrophoresis method. The radiolabeled compound maintained its stability throughout working period of 24 h. Scintigraphic imaging was performed and tissue distribution was determined in Albino Wistar rats. According to biodistribution and imaging experiments the radiolabeled compound presented estrogen receptor (ER) specificity and it was uptaken by endometrium as well as breast tissue.

Is there an impact of postoperative urethral and periurethral anatomical features in post-radical retropubic prostatectomy incontinence?

OBJECTIVES: To determine the anatomical changes in urethral and periurethral tissues after radical retropubic prostatectomy (RRP) by magnetic resonance imaging (MRI) and correlate these changes to continence. MATERIALS AND METHODS: 14 patients with grade 2-5 incontinence and 16 continent (grade 1) patients who had undergone non-nerve-sparing RRP for clinically localized prostatic carcinoma were evaluated. The sphincteric urethral length, transverse and craniocaudal diameters of both levator ani muscles and the volume of periurethral fibrosis were determined by abdominopelvic MRI. Continent (group 1) and incontinent (group 2) groups were compared in terms of sphincteric urethral length, transverse and craniocaudal diameters of levator ani muscles, volume of periurethral fibrosis, prostate volume, age and pathological stage. RESULTS: Among all the evaluated parameters, a statistically significant correlation was found only between the volume of periurethral fibrosis and the number of postoperative operations for urethral strictures in the incontinent group (p = 0.013, r = 0.859). CONCLUSIONS: Our results suggest that the postoperative sphincteric urethral length is not the sole factor in regaining continence after RRP as mentioned in the literature.

[Annuloplasty reduces the mitral leaflets mobility]. / L'annuloplastie réduit la mobilité des deux feuillets mitraux.

The posterior mitral leaflet is usually motionless following mitral valve repair. The aim of this study was to assess (1) the geometric changes of the left ventricular base following prosthetic ring annuloplasty and (2) their impact on the anterior mitral leaflet (AML) mobility. Thirty five patients operated upon for mitral valve repair underwent an intraoperative transesophageal echographic study before and after annuloplasty. A posterior leaflet resection was achieved in 29 cases and ring annuloplasty alone in 6 cases. No repair technique was performed on the AML. Four parameters were assessed: the anteroposterior mitral annulus diameter, the aortomitral angle, the opening and closure angles of the AML. Annuloplasty resulted in a drastic reduction of the mitral annulus from 36.8 +/- 5.6 mm to 20.9 +/- 3.8 mm (systole, long axis view) (p < 0.0001). The aortomitral angle decreased following annuloplasty from 115.1 +/- 8.3 to 108.0 +/- 9.60 (systole, long axis view) (p < 0.0001). No difference was observed between systolic and diastolic measurments concerning the mitral annulus or the aortomitral angle. The opening angle of the AML remained unchanged whereas the closure angle increased from 17.8 +/- 6.10 to 26.6 +/- 6.70 (long axis view) (p = 0.0001) resulting in a displacement of the coaptation point towards the apex. Consequently, the excursion of the anterior leaflet throughout the cardiac cycle decreased following annuloplasty from 43 +/- 130 to 32.5 +/- 11 (long axis view) (p < 0.0001).

[Widening plasty of the anterior cusp in rheumatic mitral insufficiency]. / Plastie d'élargissement de la valve antérieure dans l'insuffisance mitrale rhumatismale.

UNLABELLED: The mechanism of insufficiency in rheumatic valve disease includes 1. annulus dilatation and 2. restricted leaflet motion. Aiming at improving the treatment of restriction, augmentation of the anterior mitral leaflet (AML) was achieved with a piece of autologous pericardium. METHODS: between January 1995 and December 1999, out of 274 patients refered for rheumatic mitral disease, 143 patients underwent a repair (52%), 81% of them had pure regurgitation with no stenosis. Ring annuloplasty was performed in all cases. Two techniques used for treating the restrictive componant of the regurgitation were compared in two consecutive cohort of patients: no AML augmentation (n=62) and AML augmentation (n=81). Mean age was 42 + 3 years and all preoperative variables were comparable except for the incidence of redo patients who all underwent AML extension. RESULTS: in hospital mortality was 0.7% (n=1 with AML extension) and there was one early reoperation for a pericardial patch dehiscence. After a mean follow-up of 3.2 years, there was one sudden death (no AML extension). The reoperation rate was lower with (2.5%) than without (12.9%) AML augmentation (p<0.05). Echographic study showed a lower incidence of recurrency of mitral insufficiency when AML augmentation had been performed (grade 2: 9% and grade 3: 3%) as compared to no AML augmentation (grade 2: 35% and grade 3: 14%) (p<0.05). The mitral orifice area was larger (AML augmentation: 2.2 + 0.3 cm2 vs no AML augmentation: 1.8 + 0.4 cm2). CONCLUSION: ring annuloplasty alone failed to correct rheumatic mitral insufficiency in all cases. AML augmentation improved the quality of the repair and decreased the risk of reoperation.

Homologous transplantation of the mitral valve: a review.

Numerous experimental studies were conducted on homologous transplantation of the mitral valve either for mitral or tricuspid valve replacement in the early '60s. The first mitral homograft in humans was performed in 1965 by Senning. Since that time, there has been a limited number of implants mainly because of technical difficulties related to the insertion of the papillary muscles. Based on principles established for mitral valve repair, a reproducible method of homograft replacement of the mitral valve was described. Following validation in animals, the technique was applied in a series of 104 patients undergoing partial or complete mitral valve replacement. Significant improvements concerned: selection of indications and contraindications, staged approach according to the extent of the lesions leading either to partial or total replacement, systematic use of prosthetic ring annuloplasty, understanding of papillary muscle anatomy allowing a rationale for a reliable attachment method. In hospital mortality was 3.8%. At 8 years, the incidences of patients free from cardiac death and from all death were 90.6% and 82% respectively. Freedom from any cardiac event (death or reoperation) was 72% at 7 years. Similarly to the aortic homograft, mitral homograft durability was decreased in younger patients. Partial homograft replacementoffered satisfactory results particularly in the case of endocarditis and enhanced the possibilities of valve repair. The limitations of the technique are: the technical difficulty which does not permit a completely standardized operation, the risk of early valve dysfunction related to valve mismatch and the risk of late deterioration mainly leading to stenosis. Homologous transplantation of the mitral valve was also applied for tricuspid valve replacement in the case of infective endocarditis or for replacement of a degenerated bioprosthesis. Satisfactory results have been reported. However due to the lack of anatomical landmarks, the implantation procedure has remained technically challenging. Thus until further progress demonstrates a clear superiority of the mitral homograft, bioprosthesis remains the gold standard for replacing the mitral or the tricuspid valve with a biological substitute.

[An exceptional etiology of left ventricular aneurysm: type AA amyloidosis]. / Une cause exceptionnelle d'anévrisme du ventricule gauche: l'amylose de type AA.

Left ventricular aneurysms most often occur in the course of myocardial infarction. In rare cases they can be detected when the coronary network is devoid of any lesions. The aetiology is therefore multiple and dependent on the context. One aetiology seems less exceptional and concerns idiopathic aneurysms encountered in the African population, where the role of a "debilitating condition" such as tuberculosis has been evoked. We report the case history of a young patient from Zaire with a left ventricular aneurysm discovered in association with ganglionic tuberculosis complicated by AA amyloidosis. Histological analysis allowed the aetiological diagnosis to be established. Aneurysmal dilatation of the left ventricle was reported in the presence of amyloid deposits at the intra-myocardial arteriole level, whereas the context suggested a tubercular role. In spite of the difficulty of establishing a precise aetiological diagnosis, there seems to exist a consensus for surgical management.

[Primary pericardial sarcoma]. / Sarcome primitif du péricarde.

We present the case of a 50 years old male revealed by a recurrent pericardial effusion. The diagnosis of malignancy was confirmed by direct biopsy. The treatment consisted in surgical excision and chemotherapy. The patient was asymptomatic 17 months after surgery.

Homograft replacement of the mitral valve in young recipients: mid-term results.

OBJECTIVE: Mitral homograft (MH) can represent an interesting alternative for valve replacement in the young. However, concerns have been expressed about the durability of valve allografts in children. We report our experience with MH replacement in young patients. METHODS: From 1993 to 1997, 13 young patients aged 3-25 years (mean 15+/-6 years) underwent total mitral valve (MV) replacement with a cryopreserved homograft (CH). All but one had previously undergone one or more cardiac operations. The indications were rheumatic disease (6), acute and subacute endocarditis (2), congenital heart disease (4), and systemic lupus endocarditis (1). RESULTS: No in hospital deaths are reported. Discharge echocardiogram showed a well-functioning MH in all but one patient. One patient was lost to follow-up. Follow-up ranged from 0.7 to 6.6 years (4.1+/-2.2). On follow-up two patients were doing well. Two patients died without reoperation and both had MV stenosis. Seven patients (54%) required reoperation: mean delay 4.17 years (0.7-7). In all cases, thickening, shrinking and calcification of the allograft were present. None of these seven had contributive histopathologic changes. One patient presenting recurrent MV insufficiency will require a reoperation. CONCLUSION: MV homograft is a safe and reproducible technique, but does not provide durable results and should not be used in young patients.

[The best of valvular heart disease in 2002]. / L'essentiel de 2002 des valvulopathies.

For AS, besides a very thorough update by Carabello on their management, new experimental work confirms that the pathophysiology of the condition is closer to atherosclerotic and inflammatory processes than pure degeneration. Moreover this year brings a batch of long term post-operative results, one of which is an important series relating to 2194 bioprostheses followed up for 15 years. The choice of valvular substitute between 60 and 70 years old is the subject for several studies. A series of 259 re-operations for bioprosthesis deterioration allows quantification of the operative risk to which those with this substitute are subjected in case of degeneration. Finally, the strategy to adopt in a patient with an indication for aortocoronary bypass but also with a not-tight AS is discussed (abstention, decalcification, or "preventive" valvular replacement?). For aortic insufficiency (AI) some new results for the Ross operation have been published and the first publications reporting on the attempts of experimental positioning of bioprostheses via the percutaneous route in animals are appearing. As for mitral valvulopathies, MI has carved a privileged place. Much work this year relates amongst other things to functional MI in dilated cardiomyopathies with dilatation of the ring, to the natural history of mitral valvular prolapse detailed in an important series of 833 patients, and to the evolutive risk of atrial fibrillation (AF) with MI and its treatment during plasty or mitral valvular replacement procedures. Anticoagulant treatment for mechanical prostheses is the subject of much work drawn from a large German prospective study (GELIA) confirming the general tendency for alleviation of intensity in aortic especially but also mitral valvulopathies, stressing the advantages of autocontrol. Finally, the Valvulopathy Working Group of the European Society of Cardiology publishes its recommendations for asymptomatic valvulopathies, recalling the echographic criteria of dilatation and left ventricular function to be retained for operative indications, emphasising furthermore the significance of the stress test in the follow up of asymptomatic AS.

A four-dimensional study of the aortic root dynamics.

OBJECTIVE: Although aortic root expansion has been well studied, its deformation and physiologic relevance remain controversial. Three-dimensional (3-D) sonomicrometry (200Hz) has made time-related 4-D study possible. METHODS: Fifteen sonomicrometric crystals were implanted into the aortic root of eight sheep at each base (three), commissures (three), sinuses of Valsalva (three), sinotubular junction (three), and ascending aorta (three). In this acute, open-chest model, the aortic root geometric deformations were time related to left ventricular and aortic pressures. RESULTS: During the cardiac cycle, aortic root volume increased by mean+/-1 standard error of the mean (SEM) 33.7+/-2.7%, with 36.7+/-3.3% occurring prior to ejection. Expansion started during isovolumic contraction at the base and commissures followed (after a delay) by the sinotubular junction. At the same time, ascending aorta area decreased (-2.6+/-0.4%). During the first third of ejection, the aortic root reached maximal expansion followed by a slow, then late rapid decrease in volume until mid-diastole. During end-diastole, the aortic root volume re-expanded by 11.3+/-2.4%, but with different dynamics at each area level. Although the base and commissural areas re-expanded, the sinotubular junction and ascending aorta areas kept decreasing. At end-diastole, the aortic root had a truncated cone shape (base area>commissures area by 51.6+/-2.0%). During systole, the root became more cylindrical (base area>commissures area by 39.2+/-2.5%) because most of the significant changes occurred at commissural level (63.7+/-3.6%). CONCLUSION: Aortic root expansion follows a precise chronology during systole and becomes more cylindrical - probably to maximize ejection. These findings might stimulate a more physiologic approach to aortic valve and aortic root surgical procedures.

Aortic and pulmonary root: are their dynamics similar?

OBJECTIVES: The long-term behavior of the pulmonary autograft in the aortic position (Ross procedure) remains uncertain. Using three-dimensional (3D) sonomicrometry (200 Hz) we compared the dynamics of the aortic and pulmonary roots. METHODS: Twenty-four crystals were implanted in each aortic (eight sheep) and pulmonary roots (six sheep) at: base (3 x 2), commissures (3 x 2), sinotubular junction (3 x 2), ascending aorta (3) and pulmonary trunk (3). Under stable hemodynamic conditions, geometric changes were time-related to left ventricular pressure (LV) and aortic pressure. RESULTS: The expansion of the aortic root is twice that of the pulmonary root. During the cardiac cycle, the aortic root volume increased by 37.7 +/- 2.7% (mean +/- SEM) versus 20.9 +/- 1.0% for the pulmonary root. Both were cone-shaped at end diastole. Because expansion at commissures was twice that of the base, both roots became more cylindrical during ejection. Although both roots started to expand prior to ejection and reached maximal expansion during the first third of ejection, the commissural and sinotubular junction dynamics were different in each root. While in the aortic root, expansion at commissural and sinotubular junction levels was significantly different (63.7 +/- 3.6% versus 37.0 +/- 2.1%), in the pulmonary root, they were similar (29.0 +/- 1.3% versus 27.7 +/- 1.4%). Expansion of the three sinuses was also different (P<0.001). In the aortic root: the right expanded more than the left and more than the non-coronary sinus. In the pulmonary root: the right sinus expanded more than the anterior more than the left. CONCLUSIONS: Dynamic differences might explain the global pulmonary root dilatation when subjected to systemic pressure, particularly at the level of the sinotubular junction which might result in the autograft failure. Differences in the asymmetrical expansion of the aortic and pulmonary roots should be considered for the implantation of the pulmonary autograft in the most physiological position.

Chronic hemolytic anemia associated with glucose 6-phosphate dehydrogenase (Guadalajara)1 159 C --> T (387 Arg --> Cys) deficiency associated with Gilbert syndrome in a Turkish patient.

The case of an 8-year-old male child with severe kernicterus sequelae is presented in this paper. The child's hemoglobin value varied between 6.0 and 10.8 g/dL and his reticulocyte count ranged between 3.4 and 46.0% during the steady-state condition and hyperhemolytic crisis, respectively. A chronic hemolytic type of red cell G6PD deficiency was diagnosed. DNA studies indicate that the mutation was G6PD Guadalajara 1159 C --> T (387 Arg --> Cys) that is situated at the NADP binding site. Additionally, extra nucleotides of (TA) in the A(TA)n TAA motif of the promoter region of the uridine diphosphate-glucuronosyltransferase gene (UGT-1 A) were found to be homozygous in the patient. The coexistence of Gilbert syndrome with a chronic type of G6PD deficiency was suggested as a cause of neonatal hyperbilirubinemia leading to kernicterus.

[Blunt force rupture of the thoracic aorta and diaphragm: an unusual association]. / Rupture de l'isthme aortique et de la coupole diaphragmatique droite: une association inhabituelle.

The aim of this study was to report two cases of rupture of the right hemidiaphragm with intra-thoracic liver hernia, associated with a traumatic aortic disruption. These two lesions followed traffic accidents, and were both treated separately. Both patients had a long-term favourable progression. Association of these two lesions is particularly rare: fewer than 50 cases have been previously described in an extensive review of the literature. CT-scan seems to be particularly efficient in diagnosis, even if less efficient than other more specific explorations. The order of surgical management is guided by the physical examination, and especially by abdominal emergency.

[Partial tricuspid homograft: a new technique for tricuspid valve repair. Report of a case]. / Homogreffe tricuspide partielle: une nouvelle technique de réparation de la valve tricuspide. A propos d'un cas.

The authors report the case of a drug abuser treated successfully for fungal tricuspid endocarditis complicated by massive pulmonary embolism. Partial valvular replacement with a segment of a tricuspid homograft associated with disobliteration of a pulmonary artery was performed. Peroperative transoesophageal echocardiography showed satisfactory tricuspid valve function. The postoperative course was uneventful. After 5 months' follow-up, the patient was asymptomatic and in good general condition. Control echocardiography showed a stable operative result.

Molecular analysis of turkish beta-thalassemia heterozygotes with normal Hb A2 levels.

Four parents of three unrelated families who are obligatory beta-thalassemia heterozygotes and two parents with Hb Knossos are presented. In these subjects, although the red blood cell counts and red cell indices were compatible with beta-thalassemia trait, the Hb A2 values were between 1.9-2.9% of the total hemoglobin. Examination of the delta-globin gene by Southern blot, restriction endonuclease analysis, and by direct sequencing of amplified DNA revealed the presence of the (delta0) -7.2 kb Corfu type deletion, the (delta+) codon 27 (G-->T) and (delta0) IVS-I-2 (T-->C) mutations in trans or in cis with a severe beta-thalassemia allele, and the (delta0) codon 59 (-A) deletion in cis with the betaKnossos allele.