Validation of new soft tissue software in orthognathic surgery planning.

This study tests computer imaging software (SurgiCase-CMF(®), Materialise) that enables surgeons to perform virtual orthognathic surgical planning using a three dimensional (3D) utility that previews the final shape of hard and soft tissues. It includes a soft tissue simulation module that has created images of soft tissues altered through bimaxillary orthognathic surgery to correct facial deformities. Cephalometric radiographs and CT scans were taken of each patient before and after surgery. The surgical planning system consists of four stages: CT data reconstruction; 3D model generation of facial hard and soft tissue; different virtual surgical planning and simulation modes; and various preoperative previews of the soft tissues. Surgical planning and simulation is based on a 3D CT reconstructed bone model and soft tissue image generation is based on physical algorithms. The software rapidly follows clinical options to generate a series of simulations and soft tissue models; to avoid TMJ functional problems, pre-surgical plans were evaluated by an orthodontist. Comparing simulation results with postoperative CT data, the reliability of the soft tissues preview was >91%. SurgiCase(®) software can provide a realistic, accurate forecast of the patient's facial appearance after surgery.

Pulmonary hypertension as a predictor of postoperative complications and mortality after liver transplantation.

Most transplant centers consider severe pulmonary hypertension (PHT) to be an absolute contraindication for orthotopic liver transplantation (OLT). We retrospectively examined the outcome of 24 patients with PHT (group 1) who underwent OLT compared with 24 matched patients (group 2) without PHT, who also underwent OLT. Based on right cardiac catheterization measurements made after the induction of anesthesia for OLT, PHT was defined as mild or moderate-to-severe if the mean pulmonary arterial pressure exceeded 25 or 35 mm Hg, respectively. The incidence of PHT was 9.8% (24/244); 21/24 PHT patients showed mild and 3/24 moderate PHT. Kaplan-Meier survival analysis did not show a significant difference between the two groups. The incidence of pulmonary infections was significantly greater in group 1 (P < .05). The duration of ventilation and intensive care unit stay was similar in the two groups. Echocardiography detected only the three moderate cases of PHT and not the twenty-one cases of mild PHT. Our analysis suggested that mild PHT was common and did not affect patient outcomes after OLT; moderate or severe PHT was uncommon. The two patients with moderate PHT survived OLT and did not succum to PHT during long-term follow-up.

Deficiency of vitamins E and A in cystic fibrosis is independent of pancreatic function and current enzyme and vitamin supplementation.

UNLABELLED: The aim of this study was to evaluate to what extent serum vitamins A and E cystic fibrosis are affected by the underlying disease, pancreatic sufficiency or insufficiency, meconium ileus, nutritional status, age and treatment (enzyme and vitamin supplementation). Serum vitamin A and E levels were determined by high performance liquid chromatography in 210 cystic fibrosis patients, subdivided according to clinical condition into four subgroups (unsupplemented pancreatic insufficiency, supplemented meconium ileus, pancreatic sufficiency, supplemented pancreatic insufficiency) and compared with 42 control subjects. Vitamin A and E levels were generally lower in cystic fibrosis patients than in controls (P < 0.002 and P < 0.001 respectively). Subjects with pancreatic insufficiency regularly receiving enzyme and vitamin supplementation had significantly lower vitamin A (P < 0.05) and vitamin E (P < 0.01) levels than controls. In subjects with pancreatic sufficiency only vitamin A was significantly lower than in controls (P < 0.01). Vitamin levels were not age-dependent in cystic fibrosis, and no significant correlation with standardized body weight (Z-score) was observed. CONCLUSION: Cystic fibrosis patients show a clear tendency to vitamin A and E deficiency, irrespective of pancreatic function, body weight and standardized supplementation with pancreatic extract and liposoluble vitamins. Since the clinical significance of this deficiency is still not clear, longitudinal studies of cystic fibrosis patients with and without adequate vitamin supplementation are required.

High- versus low-lipase acid-resistant enzyme preparations in cystic fibrosis: a crossover randomized clinical trial.

High-strength pancreatic enzyme preparations have recently come into widespread use in some countries for treatment of pancreatic insufficiency in cystic fibrosis. However, the therapeutic equivalence of these preparations to the standard acid-resistant microsphere preparations, under the same lipase dosage, has not been demonstrated by appropriate clinical trials; they are also considered responsible for severe colonic stricture. In a randomized crossover study, 20 adolescent or adult cystic fibrosis patients were treated in hospital with both low-lipase (A) and high-lipase (B) enteric-coated microsphere preparations. The fat excretion coefficient, evaluated over two 72-h fat balance periods (measured fat intake, 1.43 to 3 g/kg/day according to age), was the main response variable, secondary variables being stool wet and dry weight, fecal nitrogen output, and energy loss. With both preparations, patients were given a daily dose of 1,500-2,000 lipase BP U/g fat ingested, distributed across four meals. The low-strength preparation was divided into three doses during each meal, while the high-strength preparation was taken as a single dose in the middle of each meal. The considerable variability of results did not provide conclusive evidence of equivalence or significant differences between the two preparations in terms of steatorrhea and other variables. However, mean differences between the two treatments and their 95% confidence intervals showed less satisfactory results with the high-lipase preparation. A high-strength preparation is thought to release relatively less enzyme activity in the small intestine, forcing patients to increase their dosage and possibly creating a dangerous enzyme hyperconcentration in the large intestine. For this reason, the occasional occurrence of colonic stricture should be borne in mind, as must the possible scope for division of dosage during each meal.

[Statistical notes and long-term results in 178 patients operated for benign breast diseases]. / Considerazioni statistiche e risultati a distanza in 178 pazienti operati per affezioni benigne della mammella

178 patients of both sexes operated on for benign conditions of the mamilla between 1957 and 1967 were reviewed and the results are reported. The most frequent condition was sclerocystic mastosis, followed by benign cancer and forms with chronic inflammatory aetiology. The most affected sex, obviously, was the female. At follow-up, on average 9 yrs after operation, 19 female patients reported the reappearance of benign neoformations of the mamilla while carcinoma had occurred in a further 7 patients.

[Statistical notes on the age and survival of 178 patients operated for malignant breast tumors]. / Considerazioni statistiche sull'etå e sopravvivenza di 178 pazienti sottoposte ad intervento chirurgico per tumore maligno della mammella

Age and survival data in a series of 178 patients operated for malignant breast tumour during the period 1957-67 are statistically assessed. The mean survival period was 9 yr. Young subjects had a greater chance of survival, while their mortality rate was the lowest after the fifth year.