Mandibular retrusion, temporomandibular joint derangement, and orthognathic surgery planning.

One-hundred consecutive orthognathic surgery candidates with mandibular retrusion were selected for retrospective analysis. Patients had undergone imaging studies that included magnetic resonance imaging (MRI) of both temporomandibular joints to assess the presence or absence, stage, and activity of suspected internal derangement(s). Patients were divided into stable and unstable deformity groups based on the presence or absence of change in their facial contour and/or occlusal disturbances in the 24 months prior to evaluation. Each of the 58 unstable and 30 of 42 stable patients were found to have internal derangements of at least one temporomandibular joint. The degree of joint degeneration directly paralleled the severity of retrognathia in most cases. We concluded that temporomandibular joint internal derangement is common in cases of mandibular retrusion and leads to the facial morphology in a high percentage of patients. Preoperative temporomandibular joint imaging with MRI is recommended prior to orthognathic surgical correction of retrognathic deformities.     

Maxillary hypoplasia secondary to midfacial trauma in childhood

Three normal children who suffered midfacial trauma and developed midfacial retrusion that would require Le Fort III advancements for correction of the deformity are described. The common denominator in these three cases seems to be an injury to the medial facial structure including the nasal septum. It is concluded that midfacial fractures in childhood may be a cause of subsequent midfacial hypoplasia.     

Blindness as a complication of Le Fort I osteotomy for maxillary distraction

High Le Fort I osteotomy and maxillary distraction has become an accepted method for the treatment of maxillary retrusion in children and teenagers with cleft lip and palate or craniofacial anomalies. This procedure effectively corrects the dentofacial deformity in these patients. No major surgical morbidity has been reported. During the past 4 years, 94 cleft patients with maxillary hypoplasia received Le Fort I osteotomy and distraction osteogenesis at the authors' center. Two of them developed blindness after this operation. The first case was a girl with bilateral cleft lip and palate with median facial dysplasia. She received high Le Fort I osteotomy at age 12 years 4 months to correct maxillary retrusion. Right eye swelling and ecchymosis was found after surgery. The patient complained of vision loss in that eye 2 days later. Computed tomography showed subarachnoid hemorrhage and skull base hematoma. There were no atypical fractures in the orbit, pterygoid plates, sphenoid bone, and skull base. Angiogram revealed left ophthalmic and basilar artery aneurysm. The second case was a 12-year-old boy with left cleft lip and palate. He received Le Fort I osteotomy to correct maxillary retrusion. During surgery, abnormal pupil dilatation was found after the osteotomy and down-fracture of maxilla. Emergent computed tomography found no hemorrhage or atypical fractures. Examination revealed complete left optic neuropathy and partial right abducens nerve palsy with mydriasis. Magnetic resonance imaging, magnetic resonance angiography, and repeated computed tomography revealed no sign of orbital injury, vascular problem, or abnormal fractures. The cause of blindness was unknown. In both cases, a steroid was used. Maxillary distraction was continued. Recovery of meaningful visual sense did not occur after 3 and 2 years' follow-up, respectively. A review of the literature revealed five other patients who suffered from visual loss after Le Fort I osteotomy. Inadvertent skull base fractures were identified in two cases, but a cause for the blindness was not known in the others. Induced hypotension and indirect trauma may be responsible for the optic nerve injury. In none of the cases was meaningful visual sense recovered, although high-dose steroids were given. In conclusion, a total of seven cases developed blindness after Le Fort I osteotomy. Once blindness develops, the prognosis is poor. High Le Fort I osteotomy should be performed with extreme care, and perhaps the informed consent should include visual loss as a complication of the procedure.     

Rotation advancement of the midface by distraction osteogenesis

A wide variety of disease processes produce alteration of midfacial skeletal growth, resulting in moderate-to-severe midface deficiency presenting as retrusion associated with Angle's class III malocclusion. Le Fort III osteotomies with advancement can provide an excellent tool for correction of this deformity. Recently, the corrective procedure of choice for advancement of midfacial segments has been distraction osteogenesis after osteotomy. Straight linear advancement is the most common choice for corrective movement of the midfacial segment, whether accomplished through acute surgical advancement or through the progressive distraction technique. Unfortunately, linear advancement can produce abnormal configurations, both at the nasal root and lateral orbits, regardless of the technique used. Enophthalmos, caused by orbital enlargement, may limit the advancement necessary to achieve class I occlusion.The authors have extended the utility of the Le Fort III procedure and have improved the final outcome by creating a controlled rotation advancement of the midfacial segment using distraction. The application of an existing internal distraction device is modified to control the movement of the midfacial segment in a rotation advancement path. Included in the series were 10 patients with severe midface retrusion secondary to multiple congenital syndromes, along with cleft lip and palate. The ages of the patients ranged from 6 to 14 years. An internal distraction system was used in all cases. Application of the distractor was substantially modified to simplify both fixation and removal and to produce controlled rotation advancement. The team orthodontist determined the final occlusal relationship. Percutaneous distractor drive rods were removed 4 to 6 weeks after active distraction to increase patient comfort. The distractors and all associated hardware were removed after 12 to 16 weeks of consolidation; follow-up periods ranged from 1 to 3 years.By using the modified distractor application to produce rotation advancement, the contour abnormalities at the nasal root and lateral orbit and the enophthalmos produced by linear advancement were eliminated. Significant improvement in facial contour and class I occlusion was obtained in all cases. Complications consisted of near exposure of the device in one patient. Stability has been excellent, with no relapse reported by the orthodontist.Rotational advancement of facial segments by distraction allows successful early intervention in patients with significant midface retrusion. The abnormal nasal root and lateral orbital configurations produced by direct linear advancement are avoided, and a stable and normalized facial configuration is produced.     

Pitfalls of nonstandardized photography in facial plastic surgery patients

The authors tested the hypothesis that certain maneuvers (neck flexion/extension and head protrusion/retrusion) alter the appearance of the submental area, jawline, and melolabial groove. They used a questionnaire survey of 20 na?ve judges who assessed a standardized photograph album of three subjects. The subjects' faces (frontal and lateral views) were photographed in neutral, neck flexion/extension, and head protrusion/retrusion positions. High Kendall coefficients of correlation were observed in 10 of 12 questions evaluating an improvement in jawline definition with neck extension or head protrusion, as well as in 11 of 12 questions assessing decreased submental soft tissue. All questions relating to the melolabial groove had a correlation coefficient of less than 0.70. Small changes in patient positioning during photodocumentation for facial plastic surgical procedures can cause dramatic changes in the appearance of certain parameters. Standardizing patient positioning for preoperative and postoperative photographs is imperative.     

Analysis of fronto-orbital advancement for Apert, Crouzon, Pfeiffer, and Saethre-Chotzen syndromes

The purposes of this study were (1) to document outcome after primary fronto-orbital advancement for the four major eponymous craniosynostotic syndromes (Apert, Crouzon, Pfeiffer, and Saethre-Chotzen) and (2) to identify factors that might influence need for primary and secondary fronto-orbital advancement or foreheadplasty. Also tested was the hypothesis that coincident sagittal synostosis could modulate brachycephaly and affect whether a primary or secondary frontal operation was necessary. Data were collected on age and indications for initial operation, type of primary and secondary frontal procedures, and concomitant sagittal synostosis. Patients initially managed by subcranial Le Fort III were included in the study group but excluded from analysis of fronto-orbital advancement. Patients treated by monobloc advancement or Le Fort III osteotomies with frontal grafting or Anderl modification were assessed as having had primary fronto-orbital advancement. Minimum time to follow-up was 5 years. A total of 126 patients met inclusion criteria. Lateral photographs were examined to assess preoperative and postoperative sagittal position of supraorbital rims-to-globes. Frontal re-advancement was indicated if the corneal apex was anterior to the supraorbital rim. Foreheadplasty was indicated for unacceptable frontal contour and normal supraorbital rim-to-globe relationship. Primary correction for frontal retrusion was not required in 4 percent of Apert (1 of 25), 16 percent of Crouzon (7 of 44), 6 percent of Pfeiffer (2 of 31), and 19 percent of Saethre-Chotzen (5 of 26) patients. Of those infants who had a primary fronto-orbital advancement, reoperation for either supraorbital retrusion or frontal deformity was necessary in all 16 Apert patients and in 5 of 19 Crouzon (26 percent), 10 of 26 Pfeiffer (38 percent), and 13 of 20 Saethre-Chotzen (65 percent) patients (p < 0.001). Age at initial fronto-orbital advancement did not influence reoperative rate. No correlation was found between concomitant sagittal synostosis and necessity for primary or secondary frontal correction (p = 0.22). In summary, phenotypic diagnosis was determinant for outcome as defined by need for secondary fronto-orbital advancement, foreheadplasty, or both. Apert patients had the highest incidence of reoperation for frontal retrusion or forehead contour. Crouzon and Saethre-Chotzen patients were most likely to express a minor phenotype and not require fronto-orbital correction. Coincident sagittal synostosis did not influence frontal projection, as reflected in need for either primary or secondary frontal advancement.     

Speech results after bilateral osteotomy surgery for cleft palate: a review of 413 patients

Patients records of those who had received the bilateral osteotomy surgical procedure for cleft palate were studied. There were 413 records available for review. Patients evaluated by a speech/language pathologist numbered 226. The other 137 patients were evaluated either by a school speech/language pathologist or by the plastic surgeon. An additional 50 records could not be used. Patients were 18 to 24 months through 35 years of age. The results revealed that 81.5 percent of the patients demonstrated normal or near normal resonance quality. Two additional positive aspects of the procedure are that the risk of postpuberty maxillary retrusion is reduced, and palatal length is increased. It is, however, a disadvantage that considerable training and experience are essential in order that the surgeon can successfully use the osteotomy. Based on a review of the literature and findings of this study, it appears that the speech results for bilateral osteotomy palate closure are comparable with and in some cases better than the results reported on smaller populations.     

An apparatus and a method for measuring the relationship of triceps surae torques to tibio-tarsal angles in man.

1. The apparatus and method described give the relationship of triceps surae torque to the absolute tibio-tarsal angle. Data of the anatomy of the foot and the axis of the ankle are taken into consideration. They make complementary measurements necessary, which in certain cases enable the angle recorded by the apparatus to be corrected so as to obtain the true angle. 2. The reliability of the apparatus and the technique of linkage of subject to apparatus are judged by examination of the torque-angle plots obtained by passive stretching of the triceps in 7 subjects for whom correction is monor. Good reliability was observed during the session and from one session to another. The plot is exponential. The merits of the method of correcting angles are illustrated in three subjects with the same protocol: when plots are not corrected, they are more dispersed during the session and no longer exponential. These results justify the considerable correction of the angle that we propose in the study of isometric contractions.     

Study of the functional status of a synthetic apparatus of blood lymphocytes under the action of weak low-frequency magnetic fields

The functional state of the synthetic apparatus of animal blood lymphocytes under weak low-frequency magnetic fields was studied. The changes in blood cell synthetic activity and leukocyte formula, a signal index of general nonspecific adaptation reactions, were shown. In the majority of cases examined, the variable magnetic fields increase the functional activity of the lymphocyte synthetic apparatus, improve the type of adaptation reaction, and enhance the level of immune resistance of the organism.     

中国五味子属植物叶表皮研究

用浓硫酸－铬酸离析法,在光学显微镜下观察了中国五味子属植物１４种,１亚种,２变种,共２４个样品成熟叶的叶表皮细胞及气孔器特征,结果表明：五味子属植物叶片的上、下表皮细胞呈多边形或不规则形,垂周壁式样为平直,菜或浅汉浪;少数种类上表皮有气孔器或分泌细胞,所有的种类下表皮具气孔器和分泌细胞;气孔器类型以平列型为主,并伴有侧列型,极少数出现不规则型,气孔极区呈稍角质和厚或棒形角质加厚,稀Ｔ形角质加厚,叶     

FURTHER STUDIES ON CELL DIVISION WITHOUT MITOTIC APPARATUS IN SEA URCHIN EGGS

A large quantity of paraffin oil, sucrose solution, or sea water was injected into the eggs of the heart urchin Clypeaster japonicus shortly before the onset of the first cleavage. The injected oil became spherical, pushing the mitotic apparatus aside. The sucrose solution mixed with the protoplasm and caused disintegration of the mitotic apparatus, and the sea water formed a vacuole at the center of the cell. In all these cases, cleavage may take place almost normally in spite of the absence of the mitotic apparatus or its displacement within the cell. In some eggs, furrowing may take place when more than fifty per cent of the endoplasm has been replaced with sea water before onset of cleavage.     

产后康复治疗仪使用时机对促进子宫收缩及刺激泌乳的效果观察

目的观察产后康复治疗仪时机对促进产后子宫收缩及刺激泌乳的效果。方法将146例初产妇按住院单双号分为观察组和对照组各73例,观察组产妇在胎儿前肩娩出后即采用产后康复治疗仪对双侧乳房及"气海"穴、"关元"穴进行电刺激,对照组在处理完第三产程后采用产后康复治疗仪对双侧乳房及"气海"穴、"关元"穴进行电刺激,两组产妇低频电刺激强度均以产妇能够耐受为度,观察两组产妇产后1、2h的出血量及产后2h泌乳量情况。结果两组产妇产后1、2h的出血量及产后2h泌乳量比较,差异具有统计学意义(P0.05)。结论在胎儿前肩娩出后即采用产后康复治疗仪对双侧乳房及"气海"穴、"关元"穴进行电刺激,可有效促进子宫收缩,减少产后出血,促进乳汁分泌,有利于产妇恢复及促进母乳喂养。     

The effect of drying on the content of nucleic acids and mutational changes in microorganisms

The literary and own experimental data on the genetic apparatus changes in microorganisms after drying are reviewed. In the survived drying cells the total content of nucleic acids decreases, some amount of mainly high-molecule ribonucleic acid decomposes. The RNA isolation into the suspended medium is also observed in connection with the destructive processes in the cytoplasmic membrane and the decomposition of some intracellular structures. The dehydration of microbial cells violates the normal processes of DNA replication, and sometimes it leads to the conformational changes in molecule structure. In some cases the damage in the genetic apparatus causes the mutation changes of microorganisms. This should be taken into account in experiments where lyophilized cultures are used.     

Immuno-electron microscopy of formation,degradation and exocytosis of the ovulation neurohormone in Lymnaea stagnalis

Summary The cerebral caudodorsal cells (CDC) of the pulmonate snail Lymnaea stagnalis are involved in the control of egg laying and associated behaviour by releasing various peptides. One of these is the ovulation hormone (CDCH). The cellular dynamics of this peptide have been studied using an antiserum raised to a synthetic portion of CDCH comprising the 20–36 amino acid sequence. With the secondary antibody-immunogold technique, specific immunoreactivity was found in all CDC. Rough endoplasmic reticulum and Golgi apparatus showed very little reactivity as did secretory granules that were in the process of being budded off from the Golgi apparatus. However, secretory granules that were being discharged from the Golgi apparatus, were strongly reactive. Secretory granules within lysosomal structures revealed various degrees of immunoreactivity, indicating their graded breakdown. Large electrondense granules, formed by the Golgi apparatus and thought to be involved in intracellular degradation of secretory material, were only slightly reactive. In the axon terminals secretory granules released their contents into the haemolymph by the process of exocytosis. The exteriorized contents were in most cases clearly immunopositive.The possibility has been discussed that CDCH is cleaved from its polypeptide precursor within secretory granules during granule discharge from the Golgi apparatus; subsequently, the mature secretory granules would be transported towards the neurohaemal axon terminals where they release CDCH into the haemolymph. Superfluous secretory material would be degraded by the lysosomal system including the large electron-dense granules.     

A micro-chamber for continuous microscopic monitoring of anaerobic bacteria

A recently developed apparatus is described that allows continuous microscopic monitoring of bacteria grown in anaerobic conditions. Four species of Bacteroides were tested using this equipment and normal and reproducible growth rates were obtained in all cases.     

A micro-chamber for continuous microscopic monitoring of anaerobic bacteria

A recently developed apparatus is described that allows continuous microscopic monitoring of bacteria grown in anaerobic conditions. Four species of Bacteroides were tested using this equipment and normal and reproducible growth rates were obtained in all cases.     

The Terry Biopsy Needle

Six illustrative cases are reported to demonstrate the versatility of the Terry biopsy needle as a useful instrument for obtaining satisfactory biopsy specimens from the liver and from other tissues as well. The apparatus and method of use are described and illustrated.     

The use of the polymerase chain reaction in the diagnosis of pulmonary tuberculosis

The data on the use of the polymerase chain reaction (PCR) with primers INS1 and INS2 for the diagnosis of pulmonary tuberculosis are presented. All stages of PCR are described: from the treatment of biological material to the conditions necessary for carrying PCR and the registration of the results. Simultaneously with this reaction, PCR in a Cobas Amplicor apparatus was carried out and Mycobacterium tuberculosis culture was grown in a liquid medium in an MB/BacT apparatus. The study revealed that the method of PCR in pure M. tuberculosis culture made it possible to detect even the DNA of those cells which formed no colonies on L?wenstein--Jensen medium. The detection of M. tuberculosis in clinical samples (sputum, pleural exudate) taken from 31 patients with different pulmonary pathology showed that in 87.1% of cases diagnostics with the use of PCR carried out in a Cobas Amplicor apparatus and with primers INS1 and INS2 yielded similar results. In patients with pulmonary tuberculosis the results of PCR were positive, while the results of the analysis made with use of an MB/BacT apparatus were negative. The proposed primers INS1 and INS2, the conditions of amplification and detection make up the test system for the detection of mycobacteria of the tuberculosis complex.     

Early detection of voice diseases via a web-based system

Voice is the result of the coordination of the whole pneumophonoarticulatory apparatus. The analysis of the voice allows the identification of the diseases of the vocal apparatus and currently is carried out from an expert doctor through methods based on the auditory analysis. The paper presents a web-based system for the acquisition and automatic analysis of vocal signals. Vocal signals are submitted by the users through a simple web-interface and are analyzed in real-time by using state-of-the art signal processing techniques, providing first-level information on possible voice alterations. The system offers different analysis functions to the doctors that may analyze suspected cases in detail. The system is currently being tested in the otorhinolaryngologist setting to carry out mass prevention via screening at a regional scale.     

The analysis of nanogram levels of free amino acids by reverse-phase high-pressure liquid chromatography.

A simple method and apparatus are described for the efficient recovery of proteins from sodium dodecyl sulfate-polyacrylamide gel systems after electrophoretic resolution. This procedure provides for high yields of proteins which are free of sodium dodecyl sulfate and in certain cases, exhibit significant levels of biological activity.