Degree Of Protrusion Research Articles

Narrowing of Lumbar Spinal Canal Predicts Chronic Low Back Pain More Accurately than Intervertebral Disc Degeneration: A Magnetic Resonance Imaging Study in Young Finnish Male Conscripts

The objective of this magnetic resonance imaging study was to evaluate the role of degenerative changes, developmental spinal stenosis, and compression of spinal nerve roots in chronic low back (CLBP) and radicular pain in Finnish conscripts. The degree of degeneration, protrusion, and herniation of the intervertebral discs and stenosis of the nerve root canals was evaluated, and the midsagittal diameter and cross-sectional area of the lumbar vertebrae canal were measured in 108 conscripts with CLBP and 90 asymptomatic controls. The midsagittal diameters at L1-L4 levels were significantly smaller in the patients with CLBP than in the controls. Moreover, degeneration of the L4/5 disc and protrusion or herniation of the L5/S1 disc and stenosis of the nerve root canals at level L5/S1 were more frequent among the CLBP patients. Multifactorial analysis of the magnetic resonance imaging findings provided a total explanatory rate of only 33%. Narrowing of the vertebral canal in the anteroposterior direction was more likely to produce CLBP and radiating pain than intervertebral disc degeneration or narrowing of the intervertebral nerve root canals.

Question Mark Ear Deformity and a Modified Surgical Correction Method

The authors present another type of correction for a relatively rare congenital ear deformity aptly named by Cosman et al. [1,2], the ‘‘question mark ear.’’ The authors appropriately describe the defect as a deficiency of tissue at the junction of the ear lobe and helical rim and adjacent scapha (root of the helix), resulting in a partial cleft associated with varying degrees of protrusion of the ear itself. In the single case described, the authors used a technique of elevating a posterior subcutaneous skin flap based laterally over a free graft of cartilage from the underlying concha to restore helical rim continuity. With this technique, the flap is rolled up to cover the grafted cartilage, and the skin flap donor site is closed, as depicted in their illustration. Unlike some other methods using either a Z plasty or multiple interdigitating flaps, the authors 1 technique results in surgical scars on only the posterior surface of the ear, which is commendable

Extreme Eye Projection in the Male Weevil Exechesops leucopis (Coleoptera: Anthribidae): Its Effect on Intrasexual Behavioral Interferences

Fungus weevils, Exechesops leucopis (Anthribidae), are sexually dimorphic in the degree of eye protrusion and antenna elongation. I examined the allometric relationships of eye span, eyestalk length, antenna length, elytra width, and wing length against body size (pronotum width), and their effects on the outcome of male-male combat in the laboratory. Male eye span, eyestalk length, and antenna length indicated positive allometry, while elytra width showed isometry, and wing length showed negative allometry. In male-male combat, males with a larger eye span, antenna length, and body size defeated those with smaller attributes. However, when males fought experimentally males of similar body size, only eye span affected the outcome of combat, independent of body size and antenna length. In the female-female contests, the prior residency was an important determinant of victory the other than any morphological traits.

Correlation Between Neurological Deficit and Spinal Canal Compromise in 198 Patients with Thoracolumbar and Lumbar Fractures

Review the correlation between loss of spinal canal diameter and neurological deficits in patients with thoracolumbar and lumbar burst fractures. To try to establish a correlation between neurological deficits and the degree of narrowing of the spinal canal. The correlation between the degree of protrusion of the bone fragments into the spinal canal and the incidence of neurological deficits in thoracolumbar and lumbar burst fractures has not been well established, raising a lot of controversies in the literature. Manual measurements of axial-computed tomography scan films using a millimetric ruler were made from the spinal canal of 198 patients admitted to the hospital with thoracolumbar and lumbar burst fractures, from 1989 to 2000. The probability of neurological deficit in a patient with 25, 50, and 75% narrowing of the thoracolumbar spinal canal was found to be 12, 41, and 78%, and in the lumbar spinal canal it was 8, 30, and 68%, respectively. The narrowing of the spinal canal proved to be a predictive factor in establishing early neurological deficits in thoracolumbar and lumbar burst fractures, showing a positive correlation between narrowing of the spinal canal and the severity of the incomplete neurological deficit by the Frankel classification. Patients with complete spinal cord injuries (Frankel A) did not show this correlation.

Tongue–jaw kinematic correlates of /s/ spectra

Frequencies of spectral peaks for fricatives are determined by the size of the resonating cavity anterior to the place of articulatory constriction in the upper vocal tract. For /s/, this cavity size may be altered through anterior–posterior (a–p) movements of the tongue blade forming the constriction, changes of jaw height, and degree of lip protrusion. With respect to intensity, modeling studies suggest that intensity of fricative spectral peaks may be related to degree of articulatory constriction. These spectral–kinematic relationships have been little studied in natural speech. This study used data from the University of Wisconsin X-Ray Microbeam Database to examine the relationship between spectral peaks and movements of the tongue and jaw in the /s/ productions of one normal speaker. Results showed no relationship between a–p tongue position and frequency of spectral peaks. However, a significant inverse correlation related peak between frequency and jaw opening. Thus, for this speaker jaw height appeared a more important determinant of spectral variability for /s/ than tongue position. Additional results showed a significant relationship between peak intensity and distance of the tongue blade from the palate. These natural speech data will be discussed with respect to models and theories of fricative production.

EVALUATION OF PULMONARY FLOW BY DOPPLER ECHOCARDIOGRAPHY AND SCINTIGRAPHY AFTER PERCUTANEOUS CLOSURE OF PATENT DUCTUS ARTERIOSUS

Background: Most patients who submitted to percutaneous closure of a patent ductus arteriosus (PCPDA), show some degree of protrusion of the occlusive device into the left pulmonary artery (LPA). The purpose of this study is to assess the prevalence of coil protrusion, and whether it causes significant obstruction. Methods: A study group (SG) of 70 patients was submitted to PCPDA with Gianturco coils (mean age: 8.6 years). Doppler Echocardiographic studies were performed, with a mean time follow‐up of 55 months. Coil and LPA were assessed by suprasternal, short‐axis, and high left parasternal views. LPA diameter was indexed to body surface area. A Doppler Index was calculated by the differences of the velocities from each pulmonary artery in relation to the pulmonary trunk, expressed in percentage (VD index). Pulmonary scintigraphy was performed using intravenous injection of 99 Tcm labeled macroaggregated albumin to evaluate lung perfusion. The diameters and disturbances in flow velocities by Doppler echocardiography of the pulmonary arteries were compared with lung perfusion by pulmonary scintigraphy. The same measurements were performed in a control group (CG) of 22 patients (normal or with minimal heart defects). VD Index values of the SG were compared with pulmonary scintigraphy values of the CG to establish normal and abnormal values. Mean time interval between the two studies was 81 days. Results: In 66 patients (95%), the coil protruded into the LPA. Mean LPA diameter was 13mm (SG and CG). Mean VD Index was 22% in the SG and 1.7% in the CG. A cut‐off value of 50% for the VD Index was determined (ROC curve), with 100% sensibility and 98% of specificity. In 8 patients (11%) the VD Index was > 50%, with abnormal left pulmonary perfusion (LPP) in 7 patients. A significant correlation between the VD Index and LPP was demonstrated (R2= 65.19). To estimate the LPP by Doppler a regression equation was obtained: LPP = 47.8 − 0.09 × VD Index. The LPA diameter was compared between patients with VD Index > 50%, < 50%, and CG, with no statistically significant difference (p = 0.6). Conclusion: Protrusion of the coil to LPA was frequently found. LPA diameters did not correlate with flow disturbances and reduced LPP. Patients showing blood flow acceleration >50% at the left pulmonary artery by Doppler have significantly lower values of lung perfusion.

Efficiency of a pendulum appliance for molar distalization related to second and third molar eruption stage

A modified pendulum appliance, including a distal screw and special preactivated pendulum springs (built-in straightening activation and toe-in bending), was used for bilateral maxillary molar distalization in 36 adolescent patients in various stages of the molar dentition. The patients were divided into 3 groups (PG 1-3) according to the stage of eruption of their second and third molars. In PG 1 (18 patients), eruption of the second molars had either not yet taken place or was not complete. In PG 2 (15 patients), the second molars had already developed as far as the occlusal plane, with the third molars at the budding stage. In PG 3 (3 patients), germectomy of the wisdom teeth had been carried out, and the first and second molars on both sides had completely erupted. Analysis of cephalograms to identify any changes in the sagittal plane showed that, in the direction of distalization, a tooth bud acts on the mesial neighboring tooth like a fulcrum, and that tipping of the first molars in patients in whom the second molar was still at the budding stage was thus greater. In patients whose second molars had erupted completely, the degree of tipping was greater again when a third molar bud was located in the direction of movement. After previously completed germectomy of the wisdom teeth, almost exclusively bodily distalization of both molars is possible, even without bands being applied to the second molars. However, if the first and second molars are distalized simultaneously with a pendulum appliance, the duration of therapy will be longer, greater forces will have to be applied, and more anchorage will be lost. Statistical analysis of the results of dental-angular measurements showed significant differences in the degree of molar tipping and reciprocal incisor protrusion. The degree of distal tipping of first molars was less in patients with erupted second molars (PG 2 and PG 3) than in those whose second molars were not yet erupted (PG 1). For instance, the measured angles were 0.9° ± 3.43° (to the palatal plane) and 0.8° ± 3.4° (to the anterior cranium floor) in PG 2, and −0.33° ± 0.58° and 0.67° ± 2.08°, respectively, in PG 3, contrasting with respective values of 5.89° ± 3.74° and 5.36° ± 3.49° in PG 1. Tipping of erupted second molars was much more marked in PG 2 (7.92° ± 5.83° to the palatal plane and 7.55° ± 5.28° to the anterior cranium floor), but much less pronounced in PG 3 (2° ± 1.73° to the palatal plane and 2° ± 2° to the anterior cranium floor) than the corresponding movement of the second budding-stage molars in PG 1 (4.06° ± 2.15° and 3.97° ± 2.27°, respectively). The degree of incisor protrusion occurring reciprocally with molar distalization was much less in these patients (measured angles of 3.28° ± 1.97° and 2.89° ± 2.17° to the palatal plane and anterior cranium floor, respectively) than in the patients presenting different stages of the dentition (angles of 5.5° ± 3.33° and 6.03° ± 4.29°, respectively, in PG 2, and angles of 5.5° ± 3.28° and 6.67° ± 3.09°, respectively, in PG 3). Moreover, measurement of dental casts in the horizontal plane showed not only the targeted mesiobuccal rotation of both maxillary molars, but also a vestibular drift of the unbanded second molars.

Intravesical Prostatic Protrusion Predicts the Outcome of a Trial Without Catheter Following Acute Urine Retention

We prospectively evaluated a simple, noninvasive method to predict the outcome of a voiding trial following acute urine retention (ARU) based on intravesical prostatic protrusion (IPP) using transabdominal ultrasound. Males older than 50 years presenting with an initial episode of ARU were included in the study. Patients with prostatic cancer, urinary tract infection, bilateral hydronephrosis or neurological disease were excluded. The duration of catheterization, residual urine volume, serum prostate specific antigen and prostate volume were recorded. The patient bladder was filled with 200 ml normal saline via a catheter in situ. IPP was measured in the mid sagittal section using transabdominal ultrasound. The degree of protrusion was classified as grades 1--5 mm or less, 2--greater than 5 to 10 mm and 3--greater than 10 mm. Uroflowmetry and post-void residual urine were recorded after catheter removal. The voiding trial was judged to be unsuccessful if the patient failed to reestablish satisfactory micturition, with post-void residual urine greater than 100 ml and maximum urine flow less than 10 ml per second. A total of 100 patients were included in the study. The failure rate of the voiding trial based on grades 1 to 3 IPP were 36% (13 of 36 cases), 58% (11 of 19) and 67% (30 of 45). This rate was significant (chi-square test for trend 0.007). IPP is a useful predictor for evaluating the success of a voiding trial following ARU. Patients with a grade 1 prostate may benefit from a trial without a catheter. However, patients with a grade 3 prostate are less likely to do so and would require a more definitive surgical procedure.

Combined therapy with pendulum and lingual arch appliances in the early mixed dentition.

In 20 patients with arch length deficiency and anterior crowding, pendulum and lingual arch appliances were inserted simultaneously in the upper and in the lower arch respectively to gain space. The patients were divided into two groups according to their dental eruption stage: ten children (six boys, four girls; mean age: 9 years, 6 months) were in the early mixed dentition, while an adolescent comparison group of the same size (three boys, seven girls; mean age: 12 years, 3 months) were in the permanent dentition at the beginning of treatment. The main purpose of the study was to investigate whether simultaneous therapy with pendulum and lingual arch appliances is to be recommended, i.e. whether this therapy should take place as interceptive treatment in the early mixed dentition or only in the permanent dentition in adolescence. Parameters were the extent and quality of dentoalveolar effects and the side effects (mesial movement of the incisors, protrusion of the incisors, tipping of molars). The treatment course was documented by means of study casts and lateral cephalograms. Assessment of the diagnostic records yielded the following findings: In the early treatment group the maxillary molars were distalized by the pendulum appliance by a mean distance of 4.0 +/- 1.46 mm, resulting in distal tipping by 6.1 +/- 2.18 degrees. The incisors were moved reciprocally by 1.08 +/- 1.06 mm to anterior and protruded by 7.65 +/- 4.84 degrees. In the comparison group molar distalization and molar tipping were less pronounced (2.86 +/- 1.54 mm/4.25 +/- 3.78 degrees ), while mesial movement of the incisors was comparably high at 1.62 +/- 0.99 mm. At only 3.8 +/- 2.9 degrees, incisor protrusion was significantly less pronounced than in the early treatment group (p = 0.045). The proportion of molar distalization in the total movement was higher in patients in the early mixed dentition: 79.83 +/- 15.38% vs 60.71 +/- 26.64%. During the early therapy with the lingual arch appliance in the lower arch, the molars were uprighted to the distal by 2.4 +/- 0.97 degrees and the incisors were tipped to labial by 5.0 +/- 1.83 degrees. In the adolescent control group, molar uprighting was less pronounced and the degree of incisor protrusion was significantly lower (2.75 +/- 1.11 degrees, p = 0.004). With the appropriate indication, the combined therapy with the two compliance-independent appliances described can be recommended for gaining sagittal arch length in the early mixed dentition.

The role of cine flow MRI in children with Chiari I malformation.

Since the introduction of MRI, the incidence of Chiari I malformations (cerebellar tonsils ectopia) has increased. The clinical significance of this finding remains questionable in some instances. Recently, cine flow MRI has added to the understanding of the dynamics of cerebrospinal fluid at the craniocervical junction and to the pathophysiology of the Chiari I malformation. The present study attempts to analyze the role of cine flow MRI in Chiari I malformations. Between January 1990 and December 2000, 24 patients were identified who met the following inclusion criteria: patients diagnosed with Chiari I malformation who had had an MRI of the brain including the craniocervical junction, clinical follow-up for at least six months, and cine flow studies had to have been performed pre- and postoperatively. The cine flow studies were repeated during follow-up if the patients were not surgical candidates. Patients harboring intracranial space occupying lesions or lumboperitoneal shunts were excluded. Sixteen of the 24 selected patients underwent 18 operations and 8 were followed conservatively. There was a wide variation in clinical presentations. Twelve patients had cerebellar tonsils protruding more than 5 mm below the foramen magnum, and in 12 patients the descent of the cerebellar tonsils was less than 5 mm. Despite this difference in the degree of protrusion, there was no significant difference in clinical presentation. The cisterna magna was small or absent in 20 patients with sluggish cine flow posteriorly, 19 of whom were symptomatic, in contrast to 1 symptomatic patient who had satisfactory cine flow. All patients with Chiari I malformation and an associated cervical syrinx had absent cine flow at the craniovertebral junction, and this finding was statistically significant. There was a good correlation between the clinical presentation and cine flow preoperatively, and between clinical improvement and cine flow postoperatively. Patients with Chiari I malformation, cervical syrinx, and absent cine flow preoperatively improved after suboccipital decompression and duroplasty. Patients with Chiari I malformations without syrinx and absent cine flow underwent suboccipital bony decompression alone and had satisfactory outcomes.

MRI changes of cervical spine in asymptomatic and symptomatic young adults

Several work-related, psychosocial and individual factors have been verified as being related to neck and shoulder pain, but the role of pathology visualized by magnetic resonance imaging (MRI) remains unclear. In this study, the relationship between neck and shoulder pain and cervical high-field MRI findings was investigated in a sample of persons in a longitudinal survey. The study aimed to determine whether subjects with persistent or recurrent neck and shoulder pain were more likely to have abnormal MRI findings of cervical spine than those without neck and shoulder pain. A random sample of 826 high-school students was investigated initially when the students were 17-19 years, and again when they had reached 24-26 years of age. Eighty-seven percent participated in the first survey in 1989, of whom 76% took part in the second survey, in 1996. The validated Nordic Musculoskeletal Questionnaire was used to collect data about neck and shoulder symptoms. Two groups were chosen for the MRI study: the first group ( n=15) consisted of the participants who had reported no neck and shoulder symptoms in either of the inquiries, while the second group ( n=16) comprised those who were suffering from neck and shoulder symptoms once a week or more often at the time of both surveys. The degrees of disc degeneration, anular tear, disc herniation and protrusion were assessed by two radiologists. The differences between the two study groups were evaluated. The study found that abnormal MRI findings were common in both study groups. Disc herniation was the only MRI finding that was significantly associated with neck pain. These findings indicate that pathophysiological changes of cervical spine verified on MRI seem to explain only part of the occurrence of neck and shoulder pain in young adults.

Evaluation of Shoulder Function Before and After Removal of Humeral Interlocking Nail

Purpose : We evaluated the shoulder function according to the degree of protrusion or sinking of proximal ends of humeral interlocking nails. Materials and Methods : On 12 patients who were treated using humeral antegrade intramedullary nailing, the shoulder function has been evaluated with the Constant’s shoulder function score and the shoulder score index of the research of American Shoulder and Elbow Surgeons, before removal of nails and one year after that. The degree of protrusion or sinking of the proximal ends of nails was measured on shoulder AP X-ray films. Patients with shoulder dysfunction or neurovascular injuries were excluded from this study. Results : Protrusion of the proximal end of the nail caused rotator cuff irritation and impingement and shoulder dysfunction. In the case of sinking of the proximal end of the nail, the shoulder function status was decreased with the sinking degree of the proximal end of it after nail removal. Conclusion : We thought that an accurate preoperative measurement of the nail length is needed and sinking the proximal end of nail minimally, simultaneously avoiding the protrusion, is important for the restoration of shoulder function after nail removal.

Macular Diseases—Application of Automated Static Perimetry and Optical Coherence Tomography

The usefulness of automated static perimetry and optical coherence tomography in the management of macular diseases has been described. Scotomata in eyes with central serous chorioretinopathy could be evaluated with central 10-degree automated static perimetry. The degree of visual field defects in eyes with the disease varied greatly with mean deviation of −10 dB or less in as many as 10% of the subjects. Although retinitis pigmentosa is a diffuse retinal dystrophy, eyes with a moderately advanced stage of retinitis pigmentosa should be managed as a macular disease, because the functioning retina is confined within the vascular arcade. The progressive nature in this stage of the disease could be demonstrated with a central 10-degree automated static perimetry measured once or twice a year and the use of univariate linear regression of mean deviation, in half of the patients with a mean follow-up period of 5 years. Functional recovery in eyes with exudative age-related macular degeneration after laser surgery or submacular surgery could be evaluated with central 10-degree automated static perimetry. Eyes with increased mean deviation in spite of reduced visual acuity after therapeutic intervention should also be evaluated. Macular function could also be evaluated using a color test. A newly developed color saturation discrimination test was applied to patients with age-related macular degeneration, retinitis pigmentosa, and cone dystrophy. The degree of dyschromatopsia was less in eyes with age-related macular degeneration than in those with retinitis pigmentosa or cone dystrophy with the same level of acuity loss. The highly protrusive nature of the orange-red nodule in eyes with idiopathic polypoidal choroidal vasculopathy was demonstrated with dimensional measurement with OCT. The degree of protrusion was greater than in eyes with serous pigment epithelial detachment, which suggests that the polypoidal lesion is covered with rigid tissues including Bruch's membrane. Parafoveal retinal sensitivity obtained with automated static perimetry was studied in correlation with retinal thickness measured using OCT in eyes with branch retinal vein occlusion showing macular edema without macular non-perfusion or massive retinal hemorrhages. The increased retinal thickness due to macular edema is closely correlated with retinal sensitivity both at the fovea and in the parafoveal area. Eighty-nine phakic eyes of 46 patients with retinitis pigmentosa patients were studied to detect cystoid macular edema using OCT. Cystoid lesions were observed in the macula in 12 eyes in 6 (13%) of 46 patients. Some eyes with OCT-proven cystoid macular edema did not show dye pooling in the fluorescein angiogram. The width of the total area of cystoid lesions was positively correlated with best-corrected visual acuity but the thickness of the neurosensory retina at the center of the fovea was not. OCT findings of successfully repaired macular holes were categorized into 3 groups. Eyes with U-type showed a normal foveal contour and a dark layer corresponding to the outer segment of photoreceptors. Eyes with V-type showed a notch in the surface of repaired neurosensory retina without a dark layer on the retinal pigment epithelium. Those with W-type showed a defect of the neurosensory retina, where the retinal pigment epithelium was exposed. The visual results were excellent in eyes with U-type, but poor in those with W-type.

Orthodontic side-effects of mandibular advancement devices during treatment of snoring and sleep apnoea.

The aims of this study were to investigate possible orthodontic side-effects following the use of mandibular advancement devices (MAD) in adults with snoring and sleep apnoea. A second objective was to analyse the effect of the appliance design. Seventy-five patients treated with MAD and 17 reference patients were studied at follow-up after 2.5 +/- 0.5 years. In the test group, 47 patients were provided with soft elastomeric devices, while the remaining 28 patients received hard acrylic devices. The treatment induced a change in overjet of -0.4 +/- 0.8 mm (mean +/- SD) and a change in overbite of -0.4 +/- 0.7 mm (mean +/- SD). These changes were larger than those found in the reference group (P < 0.01). The odds ratio (OR) for the largest quartile of reduction in overjet was 3.8 in patients using hard acrylic devices compared with those using soft elastomeric devices (P < 0.05). A large reduction in overjet in patients using the hard acrylic devices was unrelated to the degree of mandibular protrusion by the device. The OR for a large reduction in overjet in patients using the soft elastomeric devices with a protrusion of 6 mm or above was 6.8 compared with smaller mandibular protrusions (P < 0.05). The results indicate that the orthodontic side-effects are small during the treatment of adult subjects with MAD for snoring and sleep apnoea, especially in patients using soft elastomeric devices with mandibular protrusions of less than 6 mm. The follow-up of patients treated with MAD is recommended, as individual patients may experience marked orthodontic side-effects.

Repair of bilateral clefts of lip, alveolus and palate Part 1: A refined method for the lip-adhesion in bilateral cleft lip and palate patients

The protruding premaxilla represents the most severe problem in the surgical closure of a bilateral cleft lip, alveolus and palate (BCLP). In principle there are two methods to overcome this obstacle: (1) preliminary lip adhesion and (2) presurgical repositioning with intraoral devices. According to the various degrees of premaxillary protrusion, sometimes adhesion alone is sufficient, if the surgical technique is unlikely to break down. In this paper a refined adhesion method is presented, withstanding traction to the wound margins and concomitantly enables lip and nose repairs in a single second operation. For patients with severe premaxillary protrusion, presurgical use of a Latham appliance achieves conditions for safe lip adhesion as above. Both treatment methods are outlined.

Exophthalmometric values in a normal Indian population

PURPOSE . The purpose of this study was to establish a set of exophthalmometric values in a normal Indian population and to compute a regression equation for calculating these values. METHODS . Twenty-five-hundred clinically normal Indians of both sexes in the age group of 3–80 years, who did not have local or systemic disease likely to affect orbital or ocular structures, were enrolled in this study. Hertel's exophthalmometer was used to measure the degree of protrusion of the eyes. Statistical methods were used to calculate the mean values in the right and left eye in either sex and to compute a regression equation for calculating the exophthalmometric values. RESULTS . The range of exophthalmometric values in a normal Indian population aged 3–80 years was 7–19 mm for males and 7–21 mm for females. The exophthalmometric values were higher in the first decade, decreased in the second decade, and increased again in the third decade. They then remained stable for the next three to four decades. The peak was reached in the seventh decade in males and in the sixth decade in females. The lowest values in both sexes were attained in the eighth decade. The regression equations for the calculation of the exophthalmometric values are: In males for the right eye: Exophthalmometric value = 12.43 + 0.25 × age; In males for the left eye: Exophthalmometric value = 12.30 + 0.029 × age; In females for the right eye: Exophthalmometric value = 13.30 - 0.003 × age; In females for the left eye: Exophthalmometric value = 13.17 - 0.0003 × age. CONCLUSIONS . The trend of the normal exophthalmometric values for Indian subjects, by and large, was found to be similar to that quoted for other races. A knowledge of the normal values for this population subgroup can help clinicians in the early diagnosis and follow-up of patients with endocrine diseases, orbital tumors, craniofacial trauma and deformities and severe myopia.

Iodide-to-cation charge-transfer bands as a novel probe for evaluation of actual acceptor strengths of cations in zeolites and cation-dependent pore volume change.

Iodide-to-cation charge-transfer (ITC-CT) bands have been measured for the first time in zeolites X and Y exchanged with a series of alkali metal ions and the results show that the ITC-CT band progressively red shifts with increasing the size and the number of site III cations in the supercage, which indicates that the actual acceptor strength of the cation toward iodide increases with increasing the degree of protrusion of the cation into supercages and the number of cations, and overall, with decrease in supercage volume.

Graves' ophthalmopathy: eye muscle involvement in patients with diplopia.

Diplopia identifies patients with eye muscle involvement in Graves' ophthalmopathy (GO). To identify clinical parameters that could eliminate the need for magnetic resonance imaging (MRI) to assess the activity of inflammation in the eye muscles of GO patients with diplopia. In 43 patients with GO with recently developed diplopia, orbital ultrasound and MRI were performed. Muscle diameters and MRI T2 relaxation times were measured, and the amount of orbital connective tissue was calculated from MRI scans and compared with ultrasound readings, diplopia grades, degree of protrusion, ocular pressure, tear production, antibody levels and hormonal parameters of thyroid function. No correlation was found between diameters of 233 extraocular muscles measured by MRI and by ultrasound. For each of the four muscles, there was a diameter above which ultrasound was always unreliable. MRI data were used in further analysis. Of the muscles examined, the inferior rectuses were the most frequently enlarged - at least one, in 93% of cases. Medial, lateral and superior rectuses were enlarged in 59%, 37% and 34% of the orbits respectively. The pattern of muscle involvement of the two orbits tended to be symmetric (r=0.49, P=0.003), particularly for the medial rectuses (r=0.90, P=0.000). Proptosis correlated with the sum of the muscle diameters for a given eye (right eye: r=0.54, P=0.003; left eye: r=0.57, P=0.001), but it failed to correlate with the amount of orbital connective tissue. In 53% of the patients, normal T2 relaxation times were found in all eight muscles. There was only a weak correlation between muscle thickness and T2 relaxation time (r=0.49, P=0.003), indicating that muscle enlargement alone is not a sign of disease activity. The severity of diplopia was independent of T2 relaxation time. The amount of orbital connective tissue showed a negative correlation with the greatest T2 relaxation time for a given eye (r= -0.52, P=0.004); this suggests that disease types exist that have predominant muscle involvement and predominant connective tissue expansion. No correlation between connective tissue expansion and proptosis, diplopia grade, muscle thickness or disease duration was found - that is, connective tissue expansion is not a major factor in diplopia. Both muscle and connective tissue findings were independent of thyroid function. Ultrasound and MRI eye muscle diameter readings do not correlate, because of the inherent inaccuracy of orbital ultrasound. Muscle enlargement alone does not mean oedematous swelling and active disease. Neither ultrasound, nor any combination of 11 clinical and laboratory parameters provided the degree of information on muscles and connective tissue that was obtainable by MRI. In unclear cases of recently developed diplopia, before orbital decompression surgery, in the case of treatment failure or if, for any other reason, imaging is needed in GO, MRI is the method of choice.

Eruption guidance appliance effects in the treatment of Class II, Division 1 malocclusions

The objective of this research was to cephalometrically evaluate the possible effects of the Eruption Guidance Appliance on the craniofacial complex in a sample of 30 patients, over a treatment period of 26 months. The experimental sample consisted of 30 patients (13 females and 17 males), 27 of which presented with a Class II, Division 1 malocclusion and 3 with a Class I malocclusion. The mean initial chronologic age was 9 years; the treatment period lasted 26 months. A control group was used for comparison and consisted of 30 subjects (13 females and 17 males) of similar ages and spanned a similar observation period. Twenty-six subjects of this control group had Class II, Division 1 malocclusions, and 4 had Class I malocclusions. Lateral cephalometric headplates were obtained for the experimental group initially and after 26 months of treatment. The subjects in the control group were randomly selected from a serial growth study sample from the Orthodontic Department at Bauru Dental School, University of São Paulo, for whom cephalometric headplates were obtained annually from 4 to 18 years of age. Comparative statistics were used to assess possible differences between the experimental and control groups during the 26-month period of observation. Results demonstrated statistically significant increases in mandibular growth, degree of mandibular protrusion, lower anterior and total anterior face height, mesial migration of the lower molars, and mandibular posterior dentoalveolar height. There was also lingual tipping and retrusion of the upper incisors, linear protrusion of the lower incisors, improvement in the maxillomandibular relationship and in molar relationship, as well as a significant decrease in the overjet and overbite and an inhibition of the vertical development of the upper incisors. The study demonstrated no significant changes in maxillary growth during the evaluation period. It was concluded from these results that the effects of the Eruption Guidance Appliance during this time period were mostly dentoalveolar, with a smaller, but significant, skeletal effect. (Am J Orthod Dentofacial Orthop 2000;117:119-29)

In search of the ideal female umbilicus.

The umbilicus is essential to the aesthetic appearance of the abdomen. However, little research exists on what characterizes an aesthetically pleasing umbilicus. Often, the plastic surgeon is called on to reconstruct the umbilicus. Although a variety of reconstructive methods are available, no real standards define the appearance of an aesthetically pleasing umbilicus. To ascertain the characteristics of an aesthetically pleasing umbilicus, a photographic analysis was undertaken using 147 female participants between the ages of 18 and 62 years. Each subject's age, height, and weight were recorded. Photographs of each participant's umbilicus were then taken from 30 cm and 50 cm away. The photographs were reviewed by the authors, and each umbilicus was categorized on the basis of size, shape, hooding, or protrusion. The photographs were then reviewed by a panel and given a score between 1 and 10 to rate attractiveness. Using linear regression analysis, the effects of body mass index, shape, hooding, and umbilical protrusion on attractiveness were assessed. The T- or vertically shaped umbilicus with superior hooding consistently scored the highest in aesthetic appeal, whereas the presence of any degree of protrusion and a horizontal orientation or distorted shape detracted from the score. Those with a large umbilicus tended to score consistently lower than those with a smaller configuration. A desirable goal in umbilical reconstruction is, thus, to create a small T or vertically oriented umbilicus with the addition of a superior hood or shelf.