下颌骨偏斜畸形颏孔区锥形束CT观察分析

目的    应用锥形束CT（CBCT）观察、测量下颌骨偏斜畸形患者颏孔区牙槽骨形态,为正颌外科手术中颏成形术提供参考,减少神经、血管损伤等并发症的发生。方法    选取2014年3月至2015年10月大连市口腔医院收治的下颌骨偏斜畸形成人患者84例,进行CBCT扫描,用InVivo5软件对下颌骨进行三维重建,定位标记点,观察、测量和分析下颌骨颏孔位置及颏管形态,用SPSS17.0软件包对测量结果进行分析。结果    颏孔大部分位于下颌第二前磨牙下方（39.29%）,位于第一前磨牙下方（11.90%）者最少。各测量值在偏斜侧和偏斜对侧的差异无统计学意义,除颏管角度外,性别差异较显著,均为男性大于女性。结论    下颌骨偏斜畸形患者颏孔位置较正常人有一定差异,男女性之间也有所不同,CBCT影像可清晰显示颏管的三维结构、走向以及与邻近结构的关系,可以有效减少或避免手术并发症。     

Patent foramen ovale diagnosis: The importance of provocative maneuvers

Patent foramen ovale (PFO) is a frequent congenital anomaly, but massive right‐to‐left shunt (RTLS) is normally prevented by higher pressures in left heart chambers. However, mechanical ventilation with positive end‐expiratory pressure (PEEP) can significantly increase right atrial pressure, accentuating the RTLS, mainly after major cardiothoracic surgery. We report a patient admitted to the intensive care unit after cardiac surgery. Pre‐ and intraoperative transesophageal echocardiography only described an aneurysmal interatrial septum with no shunt. However, high‐PEEP ventilation induced a paradoxical response with life‐threatening hypoxemia, triggering further echocardiographic evaluation, revealing massive RTLS across a stretch PFO. Provocative maneuvers (Valsalva/PEEP) significantly increase echocardiographic sensitivity, unmasking silent PFO. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45 :58–61, 2017     

Morphological characteristics of external auditory canal in congenital aural stenosis patients

ObjectiveTo investigate characteristics of congenital aural stenosis (CAS) patients' external auditory canal (EAC) (position, length, orientation, etc.) and compare them with normal EAC.

3D打印导航板在椎间孔镜下腰椎髓核摘除术中的临床应用

目的:探讨3D技术打印导航板在椎间孔镜下腰椎髓核摘除术中应用的可行性及效果。方法:回顾性分析2016年1月～2017年1月在我院采用椎间孔镜下腰椎髄核摘除术治疗单节段腰椎间盘突出症60例患者,采用随机数字表法分为观察组和对照组,每组各30例。观察组采用3D打印导板辅助穿刺下椎间孔镜下腰椎髓核摘除术,对照组采用单纯椎间孔镜下腰椎髓核摘除术,并对两组的穿刺次数、X线透视次数、手术时间、术后并发症进行对比。两组在术前及术后1d、1周、1个月行腰痛VAS评分(0～100分),术前、术后3个月随访时行Oswestry功能障碍指数(Oswestry dysfunction index,ODI)及改良Macnab疗效评定。结果:患者穿刺次数、X线透视次数、手术时间观察组为(1.17±0.37、2.33±0.75、40.47±7.55min)均低于对照组(5.00±2.15、10.63±3.77、63.67±16.63min),差异有统计学意义(P0.01)。术后1d腿痛VAS评分观察组(19.67±8.99)低于对照组(32.00±9.21),差异有统计学意义(P0.05);术后1周及1个月腿痛VAS评分观察组(13.17±10.94、10.50±13.47)、对照组(16.00±11.62、11.50±13.65),差异无统计学意义(P0.05);术后3个月ODI评分观察组(13.20±9.86)%低于对照组(15.73±10.74)%,差异无统计学意义(P0.05);术后改良Macnab疗效评定优良率试验组(90.0%)与对照组(86.7%),差异无统计学意义(P0.05)。对照组并发症:神经损伤2例、腰大肌血肿1例、减压不彻底1例,观察组并发症:减压不彻底1例,差异有统计学意义(P0.05)。结论:3D技术打印的导板辅助椎间孔镜下腰椎髓核摘除术,可降低穿刺次数、减少X线透视次数、手术时间。     

Paradoxical Cerebral Embolism as Initial Manifestation of Chronic Thromboembolic Pulmonary Hypertension: A Case Report

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by chronic thrombi in the pulmonary arteries, causing pulmonary hypertension and right heart failure. Early and accurate diagnosis are essential for successful treatment but are often difficult because clinical signs and symptoms can be nonspecific and risk factors, such as history of venous thromboembolism, may not always be present. Here, we report a case involving a 76-year-old woman who demonstrated paradoxical cerebral embolism as the initial manifestation of CTEPH. She developed right hemiplegia without dyspnea or edema. Brain magnetic resonance imaging revealed multiple fresh infarctions, while transesophageal echocardiography revealed a patent foramen ovale. Based on these findings, she was diagnosed as having paradoxical cerebral embolism. During the search for the embolic source, right heart catheterization showed significant pulmonary hypertension and pulmonary angiography revealed chronic thrombi in the peripheral pulmonary arteries, consistent with a diagnosis of CTEPH. To our knowledge, this is the first case of CTEPH to be diagnosed with the onset of paradoxical cerebral embolism. Because CTEPH is the only potentially curable form of pulmonary hypertension, clinicians should consider paradoxical cerebral embolism as a possible initial manifestation of CTEPH.     

Distance from file tip to the major apical foramen in relation to the numeric meter reading on the display of three different electronic apex locators

Aim  To establish and compare the relationship between the distance from the file tip to the apical foramen and the numeric meter reading on the display of three different electronic apex locators (EALs).
Methodology  A total of 12 extracted intact, straight, single-rooted human teeth with complete roots were used. The actual root canal length (AL) was determined after access preparation. For the electronic measurements with each EAL, silicon stops were fixed with auto-polymerizing resin to size 15 K-files at AL and 0.5, 1, 2, 3, 4 mm short of AL. The data was analysed by two-way anova and Tukey's honestly significant difference (HSD) test for multiple comparisons amongst EALs. Additionally, one-way anova and Tukey's HSD test were carried out for multiple comparisons amongst the measurements of each EAL.
Results  There was a statistically significant difference amongst all EALs in indicating the position of file tips in relation to the major foramen ( P  < 0.05). The correlation between the meter reading and the position of the file tip from the apical foramen was statistically significant in the three EALs. There were significant differences amongst the measurements at distances from 0 to 2 mm in Justy III. In Dentaport, significant differences were found from 0 to 1 mm. However, the E-Magic Finder showed significant differences from 0 to 0.5 mm.
Conclusions  Justy III was more capable of displaying the intracanal position of the file tip from the major foramen in mm whilst advancing through the root canal during electronic measurements than the Dentaport and E-Magic Finder Deluxe.     

Diagnostic approach to fetal microcephaly

Microcephaly in utero is conventionally defined as a fetal head circumference (HC) 3SD below the mean for gestational age according to Jeanty et al.’s reference range. Prediction of microcephaly at birth (micB) based on conventional prenatal biometry is associated with a high percentage of false positive diagnoses and as a result, in countries in which it is an option, termination of pregnancy may be offered in cases that would have culminated in birth of a normocephalic child. A false negative diagnosis is rarer, but may lead to the birth of a symptomatic microcephalic child.In this review we present the results of our recent studies aimed at improvement of accurate prenatal detection of microcephaly including: (1), application of two new reference ranges for fetal HC in cases with a prenatal diagnosis of microcephaly based on the conventional reference; (2) assessment whether integration of additional parameters (stricter fetal HC cut-offs, small-for-gestational age (SGA), decreased HC/abdominal circumference and HC/femur length ratios, presence of associated malformations and family history) can improve prediction; (3), estimation of the difference between Z-scores of prenatal HC and the corresponding occipitofrontal circumference (OFC) at birth in order to propose an adjustment for better prediction of the actual OFC deviation at birth; (4), assessment whether micB diagnosis can be improved by accurate detection of false positive Fmic cases whose small HC is due to an acrocephalic-like head deformation by applying a new reference range of a vertical measurement of the fetal head: foramen magnum-to-cranium distance (FCD).The conventional and new reference ranges for fetal HC, all result in considerable over-diagnosis of fetal microcephaly (ranging from 43% to 33%). The use of the new references does not significantly improve micB prediction compared with the conventional one, whilst integrating additional parameters results in a better positive predictive value (PPV), but an increase in false negatives. The degree of Fmic severity is significantly over-estimated compared to the corresponding micB. The difference between the postnatal OFC deviation from the mean and the prenatal HC ranges from ?0.74 SD to ?1.95 SD for various fetal HC references. Application of the reference range for vertical cranial dimensions enables exclusion of fetuses with a small HC associated with a vertical cranial deformity without missing those with actual micB. Combining the fetal HC with the developed FCD criteria raised the PPV of micB to 78%.

Morphometric study of jugular foramen in adult South Indian skulls

IntroductionThe jugular foramen lies between the occipital bone and the petrosal portion of the temporal bone. It allows the passage of important nervous and vascular vein and inferior petrosal sinus. Glomic tumors, schwannomas, metastatic lesions and infiltrating inflammatory processes are associated with this foramen, which can account for injuries of related structures. Morphometric study of this foramen will serve as guide for imaging and operative procedures in the jugular foramen region.Material and methodsOne hundred and sixteen dry adult skulls of unknown sex of south Indian origin were utilized for this study. Following dimensions of the foramen were measured with the help of a digital vernier caliper: i) Maximum dimension along the long axis; ii) Maximum dimension perpendicular to the long axis; iii) Maximum height of dome of jugular fossa and iv) Distance of stylomastoid foramen from lateral margin of jugular foramen. The minimum distance of stylomastoid foramen from the lateral margin of the foramen was also measured.ObservationsThe findings of the present study bring forth some important facts as follows: On an average, all the dimensions measured were more on the right side. The jugular fossa showed great variability ranging from total absence of fossa to deep excavation anterolaterally forming a large fossa with the well-defined roof.ConclusionThese observations call for further studies on variability of jugular fossa and its possible implications. The distance of the stylomastoid foramen from the jugular foramen will serve as guide for operating surgeons using infratemporal approach during skull base surgeries.