Needle Point Research Articles

Blepharoplasty for double eyelid by the inner-external double consecutive sewing method

目的 探索一种双重睑成形术的新方法.方法 用自行研制并已获国家专利的J形针尖有孔的双重睑缝合针和内外双重连续缝合法,对42例(84眼)符合入选条件的志愿者进行了上述手术,随访10年以上.结果 每眼手术时间2～5 min.全部获得了较满意持久的双重睑,无感染或其他明显的并发症.结论 本缝合针和手术方法属于完全自主创新的产品和眼睑成形技术,安全、快速,成形效果美观而持久。

Long-term Skeletal Muscle Protection After Gene Transfer in a Mouse Model of LGMD-2D

Limb girdle muscular dystrophy (LGMD) describes a group of inherited diseases resulting from mutations in genes encoding proteins involved in maintaining skeletal muscle membrane stability. LGMD type-2D is caused by mutations in alpha-sarcoglycan (sgca). Here we describe muscle-specific gene delivery of the human sgca gene into dystrophic muscle using an adeno-associated virus 1 (AAV1) capsid and creatine kinase promoter. Delivery of this construct to adult sgca(-/-) mice resulted in localization of the sarcoglycan complex to the sarcolemma and a reduction in muscle fiber damage. Sgca expression prevented disease progression as observed in vivo by T(2)-weighted magnetic resonance imaging (MRI) and confirmed in vitro by decreased Evan's blue dye accumulation. The ability of recombinant AAV-mediated gene delivery to restore normal muscle mechanical properties in sgca(-/-) mice was verified by in vitro force mechanics on isolated extensor digitorum longus (EDL) muscles, with a decrease in passive resistance to stretch as compared with untreated controls. In summary, AAV/AAV-sgca gene transfer provides long-term muscle protection from LGMD and can be non-invasively evaluated using magnetic resonance imaging.

The Short‐Term Effects of Acupuncture on Myofascial Pain Patients After Clenching

Short-term pain reduction from acupuncture in chronic myofascial pain subjects was evaluated using an 11-point (0 to 10) numeric rating scale, visual analog scale (VAS), and pain rating of mechanical pressure on the masseter muscle. A single-blind, randomized, controlled, clinical trial with an independent observer was performed. Fifteen chronic myofascial pain subjects over the age of 18 were randomly assigned into groups: nine subjects received real acupuncture; six subjects received sham acupuncture. Each subject clenched his/her teeth for 2 minutes. Acupuncture or sham acupuncture was administered at the Hegu Large Intestine 4 acupoint. Sham acupuncture was conducted by lightly pricking the skin with a shortened, blunted acupuncture needle through a foam pad, without penetrating the skin. The foam pad visually conceals the needle's point of the entry, so that the subject cannot discern which technique is being used. The subjects rated their general pain on a numeric rating scale. A mechanical pain stimulus was applied with an algometer and the subject rated his/her pain on a VAS. Statistical analysis was performed using the repeated measures anova, paired t-tests, and Fisher's exact test as appropriate. There was a statistically significant difference in pain tolerance with acupuncture (P = 0.027). There was statistically significant reduction in face pain (P = 0.003), neck pain (P = 0.011), and headache (P = 0.015) with perception of real acupuncture. Pain tolerance in the masticatory muscles increased significantly more with acupuncture than sham acupuncture.

Fending Off Idolatry: Ceremonial Law in Mendelssohn's Jerusalem

Did any Jew prior to [the Western Orthodoxy and the liberalism of the reformers of the nineteenth century] really think—without having the question put to him—that he was keeping the Law, and the Law him, only because God imposed it upon Israel at Sinai? Actually faced by the question, he might have thought of such an answer; and the philosophers to whom the question has been put because they were supposedly ‘professional’ thinkers, have always been fond of giving this very reply. From Mendelssohn on, our entire people has subjected itself to the torture of this embarrassing questioning; the Jewishness of every individual has squirmed on the needle point of a “why” [und als von Mendelssohn ab unser ganzes Volk sich der Folter all dieser wahrhaft peinlichen Fragen unterzog und das Judesein jedes Einzelnen nun auf der Nadelspitze eines Warum tanzte, da mochte es an der Zeit sein]. Certainly, it was high time for an architect to come and convert this foundation into a wall behind which the people, pressed with questions, could seek shelter. But for those living without questions, this reason for keeping the Law was only one among others and probably not the most cogent. No doubt the Torah, both written and oral was given Moses on Sinai but was it not created before the creation of the world? Written against a background of shining fire in letters of somber flame? And was not the world created for its sake? And did not Adam’s son Seth found the first House of Study for the teaching of the Torah? And did not the patriarchs keep the Law for half a millennium before Sinai?”1

Fibrin Sealant Reduces Pain after Tonsillectomy: Prospective Randomized Study

Postsurgical pain in adults following tonsillectomy with fibrin sealant or electrocoagulation was assessed by surface electromyography (sEMG), a dysphagia severity rating scale (DSRS), and a visual analog scale (VAS) pain For group 1 (n = 40), hemostasis was achieved by fibrin sealant spraying to the tonsillar fossae. For group 2 (n = 40), hemostasis was achieved by bipolar or needle point electrocautery. The timing of single swallowing and continuous drinking and the mean electrical activity of the masseter, infrahyoid, and submental-submandibular muscles were compared with a normative database during 30 days and with DSRS and VAS scores. Electrical activity of the masseter and infrahyoid muscles was significantly higher in both groups in comparison with the normative database (p < .05 to p < .005), whereas timing was less affected. The combined sEMG, DSRS, and VAS assessment showed that tonsillectomy ended with sealant causes less pain than electrocoagulation (p < .05). The DSRS score data were in strong positive correlation with the sEMG records, whereas the VAS pain score was less informative. The combined sEMG and pain score data indicate that the electrocautery hemostatic technique is more painful and traumatic than the sealant technique. Surface electromyography of swallowing is a simple, reliable evaluation method for postsurgical odynophagia complaints and might be used as an objective tool for pain assessment.

1180: Interventional procedures on breast disease

One of the most important applications of breast ultrasound is to guide interventional procedures. During this presentation, we will discuss applications, indications, patient preparation, equipment selection, advantages and disadvantages and suggestions that will lead to the most successful results in the use of this procedure using this freehand technique. The main objective of this lecture is to analyse the use in a diagnostic, therapeutic and presurgical stage of the following procedures: fine-needle aspiration; large core biopsy; directional vacuum-assisted biopsy; presurgical localization in nonpalpable lesions. There are two principal approaches for freehand sonographically-guided procedures. One way would be to introduce the needle from the short end of the transducer which will give a clear view of both the needle tip and shaft. The other way would be to introduce the needle from the long axis of the transducer face, having the lesion visualized at its midpoint, with the disadvantage that only the needle point and not the shaft will be seen on screen. There are three fundamental aspects to bear in mind in interventionism: the guidance of the needle into the lesion, the procedure of obtaining the material itself and the cytopathologist’s experience. The main indications for obtaining material in solid lesions with the assistance of Ultrasound are: in tumours suspicious of malignancy, in order to confirm the diagnosis and investigate hormonal receptors and plan the most adequate therapy to apply; in images which do not concur with either the clinical evaluation or mammography results and are suspicious of malignancy; When there is more than one mass where the possibility for multifocal or multicentric malignant disease exists, in order to plan the treatment to follow; in any solid mass of any type, detected in the course of pregnancy or lactation. According to my experience, fine-needle aspiration proves successful with a sensibility of 91%, a specificity of 99.6% and a PPV of 95.8%, being 35% of the total of the lesions evaluated palpable and 65% of them nonpalpable. Core biopsies are made with activated guns using a 14-gauge needle, five passes being necessary in order to obtain enough material from the different areas of the lesion. The advantage of core-biopsy is the possibility to obtain more representative material for the histological evaluation making its accuracy to the final results a 100%. The directional vacuum-assisted biopsy is used in solid lesions bigger than 10 mm, taking only one penetration of the device to obtain several samples of material more representative in volume. For presurgical localization, we use carbon particles or hook-wire as markers, this procedure being successful in 100% of the cases. Conclusion: the importance of all the methods explained above is their role in lesions that are either nonconclusive, those which show doubtful images, in an early diagnosis and in order to avoid unnecessary surgical procedures. The sonographer plays a most important role in the diagnosis of nonpalpable lesions.

Closure of Colonic Perforation with a Novel Endoscopic Suturing Device

Background: Endoscopic suturing devices have been reported for the treatment of gastroesophageal reflux disease, animal models of bleeding ulcers, large upper gastrointestinal tract perforations, fistulae closure and most recently a small series of anastomotic reductions in bariatric patients as well as transgastric surgery with variable results. Technical intricacy, size of the devices and superficial plication of the stitches remain a major reasons for suboptimal results. Aim: Assess the feasibility and accuracy of a new investigational endoscopic suturing device in the closure of colonic perforations in a porcine model. Methods: Acute studies were conducted under general anesthesia. Two live pigs underwent colon cleansing with tap water enemas followed by standard flexible sigmoidoscopy using a front viewing endoscope (GIF-100). An artificial transmural perforation of 2.5 cm to 3 cm in length was created at approximately 50 cm from the anal verge. Colonic decompression was immediately noticed after the perforation was performed. Suturing was accomplished by using a semiflexible hollow 19-gage needle preloaded with a metallic “T-Tag” fastener that incorporates a pre attached monofilament suture (Ethicon Endo-Surgery, Inc.). The needle point is withdrawn into a protective sheath before insertion into the working channel of the endoscope. The loaded system is passed through the working channel of the endoscope and once visible, the needle is exposed from the protective sheath in order to obtain serosal penetration. Once two tissue tags have been placed, both free ends of the suture are locked together by using a knotting element (passed in the working channel) with a built in cutting device to obtain tissue apposition. A total of two perforations were made in each animal. Observations: All four perforations were successfully sutured, three with adequate tissue apposition and excellent bowel distention with air insufflation. The number of stitches applied were three (one perforation), two (two perforations) and one (one perforation). None had significant bleeding. Conclusion: The new endoscopic suturing prototype is a technically simple and accurate transmural device that mimics hand-placed surgical sutures. Further development and testing is ongoing.

Nanomanipulation of sections of human tongue squamous cell carcinoma by atomic force microscopy

To investigate the appropriate nanomanipulation of slides of human tongue squamous cell carcinoma tissue and cultured cells by atomic force microscopy (AFM), and develop methods to improve the resolution and contrast of AFM images. Human tongue squamous carcinoma cells of the line Tca8113 were cultured. Cell masses were isolated and collected, and sectioned. Then the white lead and silvery white sections were transferred on mica slides, dried. Eighty slides were used and divided into 2 groups to be immersed into hydrogen dioxide of the concentrations 20% and 30% for 0, 5, 10, 15, 20, 25, 30, and 40 min respectively. Samples of human tongue squamous carcinoma were collected from 15 cases. Every sample was divided into 2 halves. Half of every sample underwent routine paraffin preparation of slide and adhered onto glass, dissolving of paraffin with dimethylbenzene for 0, 10, 15, 30, 45, or 60 min; and half of the sample underwent routine preparation of slides for electron microscopy, the white lead and silvery white sections were transferred on mica slides, dried. The slides were observed by contact mode AFM in air. In the ultrathin sections the metastructure of the cell such as the cell membrane, nuclear membrane and nucleolus could be distinct from each other clearly. The profile of the cell and the nucleus inside could be revealed by AFM after the paraffin sections were treated in dimethylbenzene for 15-30 min. AFM manipulation could be achieved within nanometer range by precise modulation of scanning force, area, angle and so on. The appropriate needle point should contain elastic coefficient > 5.0 N/m. The force exerted on the needle point should be within the range 50-300 nN. After location the scanning direction should be within the range of 20 nm-1 microm. A series of modified techniques of preparing and treating AFM samples, such as adhering the sections onto mica slide, dissolving of epoxy resin by hydrogen dioxide and removal of paraffin by dimethylbenzene, were developed, thus realizing high resolving power AFM imaging, especially for nuclear membrane, and nucleolus, and providing a base of AFM location, dissection, isolation and obtainment at nanometer scale.

Astral Caption (after an etching by Howardena Pindell, Cassiopeia, Andromeda [2003

Astral Caption:(After an etching by Howardena Pindell, Cassiopeia, Andromeda [2003]) Brent Hayes Edwards (bio) I write to snatch the light away the way the stars bleed white from the rims of their sockets, the faint afterflash of how many dark paths of departure I write to intuit what trifles or looms beyond my vision, as a map is always a fanciful concatenation of what can't be known at once: Laventille, Ouagadougou, Takoradi, Newark, Belém. The map is many maps: capped turrets and cannonballs, spent, a charged symposium of gametes; bird tracks at dusk on a beach of volcanic sand; an archive of confused attack, index and cipher, sluice and retreat; a graveyard of chain links (uncoupled, tossed without ceremony) and hoes (dropped after digging); a blueprint of chutes and spires; glow worms trapped in tar. The stars migrate in tides of disarray. A constellation is a pack of incandescents traversing the plain. It is only susceptible to capture in the faint incisions it left as it came undone. [End Page 32] I write to ask the copper what it saw: a needle point slicing beeswax, it whispers, goose down on my skin . . . An astrologer is a humble tailor, stitching the closest fit for a body that died thousands of years ago. How does the night share its secrets? Taunting, indirection, the fugitive's black craft: The stars have left us. I write to constellate a leaving in a script only acid can read. Ink irrigates the furrows. And what gets hung? A window on the wall, a scribbled deposit of wounds. Brent Hayes Edwards Brent Hayes Edwards is an associate professor in the English Department at Rutgers University in New Brunswick. He is the author of The Practice of Diaspora (Harvard University Press, 2003) and co-editor of Uptown Conversation: The New Jazz Studies (Columbia University Press, 2004). He is an associate editor of Callaloo. Copyright © 2006 Charles H. Rowell

Paternity of the Doughty technique

Correspondence in the July edition of Anaesthesia[1, 2] prompts me to comment on my recollection of the ‘Doughty’ technique that I used and taught at Kingston Hospital over 20 years ago. The basic principle was to separate the very firm force needed to drive the point of the Tuohy needle into the epidural space from the very delicate pressure applied to the plunger of the syringe to signal its entry. Figure 1 shows the syringe attached to the Tuohy needle. Strong opposing pressure is exerted between the two hands: the needle point is moved steadily towards the epidural space by the cautious but controlled relaxation of the fingers and thumb of the left hand. The syringe contains about 10 ml of fluid. The metacarpal head of the right index finger exerts minimal pressure on the end of the plunger. Loss of resistance to injection is readily perceived by the epiduralist but may be quite imperceptible to the bystander. Reflux of injected fluid is minimal. The ‘Doughty’ technique as demonstrated by Dr Doughty. From 1974 until my retirement in 1980 I used to run a one-to-one fortnight's intensive epidural course at Kingston Hospital. Both anaesthetists and obstetricians were welcomed and each participant was expected to remain ‘on-call’ for the whole time. I tried to avoid too much talking in the labour ward in the presence of mothers urgently in need of pain relief. Most of the teaching was done in my office. The first tutorial dealt with handling the syringe, Tuohy needle and epidural catheter (Fig. 1). Then came the subject of inadvertent dural puncture, with an admission of the 10 occasions on which I had been the culprit. I had a home movie showing myself as the performer plus a set of 30 slides showing the process in detail. I had a sizeable collection of slides derived from the many public lectures I had given including a paper on ‘The impossible epidural’. Shortly before my retirement, prepacked disposable epidural sets became commercially available. I did not use them because the syringes provided did not readily match my technique. Our own equipment was scrupulously cleaned and serviced on the labour wards by trained domestic staff. So much for history, but from what I have said you will not be surprised if I emphatically reject claims of paternity regarding the ‘son-of-Doughty’ techniques described by Yentis and Barnes. I fully endorse Professor Felicity Reynolds' interpretation of my technique – not surprising as she had attended the course at Kingston in the late 1970s.

Procedural Distress in Children With Cancer

To examine the relationship among different indicators of pain and distress, including self-report, behavioral observations, and physiological parameters, in children with cancer undergoing invasive procedures. Forty-eight children between the ages of 3.1 and 17.7 years were evaluated while undergoing lumbar punctures. Self-report measures assessed anxiety, pain, self-efficacy, expectations of coping strategies, and coping self-efficacy. Parents reported on their own and their child's levels of anxiety, and physicians estimated their own level of stress and technical difficulty in completing the procedure. Behavioral observations were made prior to, during, and after the procedure. Physiological parameters included heart rate, cardiac vagal tone, and salivary cortisol. At the discretion of attending physicians, 32 children received deep sedation, 9 received light sedation, and 7 received cognitive-behavioral strategies with topical anesthetic as interventions to manage procedural distress. There was a high degree of consistency within self-report, behavioral, and physiological parameters, but correlations between measures in different modalities were low. There were floor effects for most behavioral and self-report measures of distress. Cortisol showed marked changes preprocedure to postprocedure, demonstrating high levels of physiological response despite lack of apparent or perceived discomfort. Heart rate was significantly lower in the group using cognitive-behavioral techniques, especially at the point of needle insertion. Self-report measures, behavioral indicators, and physiological changes are not interchangeable outcomes. Treatment strategies were effective for minimizing subjective and behavioral distress, but not necessarily for physiological reactions. Future research should focus on individual differences in these responses, and treatment outcome studies aimed at reducing distress must be clear about the specific goals of intervention.

The need for epidural wings

The recent correspondence by Yentis and Barnes [1] and Reynolds [2] has highlighted developments in the ‘Doughty’ technique. Looking at the illustrations it would appear that Yentis and Barnes favour the addition of wings to the epidural needle, although, as Reynolds points out, this was not part of Doughty's original technique. So why have epidural needle wings now become popular? In 1948, Macintosh first described the addition of wings to spinal needles [3]. This modification permitted lumbar puncture without the need to touch the needle point or shaft. Over the following decade, wings found their way onto epidural needles [4]. For advocates of the hanging drop technique, which is now rarely performed, wings provided greater control during needle advancement through the ligamentum flavum. A similar advantage could be suggested when using intermittent advancement with an air-filled syringe. These claims may have some validity when dealing with a more elderly population, such as that encountered in orthopaedic surgery, where ligaments are heavily calcified. However, this is not so in obstetrics and, as saline is the most widely used technique for locating the epidural space [5], the need for wings is questionable. Indeed, they may actually encourage needle advancement with both hands, rather than solely through the plunger of the syringe. Consequently, needle control is reduced and the risk of dural puncture increased. Some manufacturers include separate wings in their packs and these may be connected to the needle if required. Others, however, provide preattached wings, some of which cannot be removed. During a recent discussion with one leading manufacturer, I was disappointed to hear that they at least have no plans to produce a wingless epidural needle. Hopefully, this lack of flexibility will not be adopted by other companies. So should obstetric anaesthetists use wings simply because they are provided in the pack? Some may have no choice if their supplier does not produce a wingless needle. For those who do, we should consider whether wings confer any advantage to the user, which in the obstetric population is far from certain.

Diagnostic lumbar puncture. Comparative study between 22–gauge pencil point and sharp bevel needle

Post–lumbar puncture headache is a frequent clinical problem. Needle design is expected to reduce post–puncture headache. In this study, we compared two different lumbar puncture needle designs in diagnostic lumbar puncture and analysed post–dural puncture headache (PDPH) and social and economical harm associated with the diagnostic lumbar puncture procedure. This prospective, controlled study consisted of 80 consecutive adult patients requiring elective diagnostic lumbar puncture due to various neurological symptoms. Lumbar puncture was completed either with Spinocan® 22 G sharp bevel needle or Whitacre® 22G pencil point needle. Patients were asked about previous headache symptoms and pain provoked by puncture. One week after the lumbar puncture all patients were interviewed by telephone and occurrence and type of headache, headache intensity, medication and frequency of impairment in activities of daily living were asked. Need for epidural blood patch was also recorded. Thirty–three of 78 (42%) patients experienced headache after diagnostic lumbar puncture and in 26 (33%) the headache could be classified as PDPH. There were no statistically significant differences between needle types in the frequency of common headache, PDPH, puncture pain intensity, need for epidural blood patch or sick leave. Also, there were no other complications except local back pain or headache. In this study, the needle design did not affect the frequency of PDPH. Also, PDPH was common, occurring in 33% cases and caused a considerable amount of disturbance in daily activities. Seeking help for this condition was insufficient and only part of these PDPH patients were treated with epidural blood patch.

Pain Reduction by Fibrin Sealant in Older Children and Adult Tonsillectomy

Because tonsillectomy is a painful procedure in adults, this study was performed to see whether the addition of fibrin sealant (Tisseel) to the tonsillar fossa at the completion of tonsillectomy would reduce pain in adults and allow them to return to work sooner. Forty adult patients over the age of 12 were entered into a prospective randomized study to see whether the addition of fibrin sealant (Tisseel) to the tonsillar fossa at the completion of tonsillectomy for recurrent tonsillitis would reduce the time the patient needed to take narcotic analgesics after surgery. Fifteen adults had a traditional complete tonsillectomy by means of a needle point Bovie and served as a control group. Twenty-five (adults had the same procedure with the addition of Tisseel to see how long they required narcotic analgesics postoperatively and when they were able to resume normal activities. The control group took narcotics for an average of 10.3 days, whereas the addition of Tisseel reduced the time to 8.16 days (P = .0058). This significant reduction of time allowed adults to return to work and other activities sooner. Because the time required to return to work is often of paramount interest to patients having surgery, Tisseel should be considered a safe addition to older children and adult tonsillectomy in patients who are not allergic to bovine products because it will allow an earlier return to normal activities.

Failed spinal anaesthesia after intrathecal chemotherapy

Failed spinal anaesthesia after intrathecal chemotherapy

Endoscopic mandibular condylectomy and reconstruction: early clinical results

Purpose The purpose of this study was to evaluate early outcomes in patients who underwent endoscopic condylectomy and costochondral graft reconstruction (CCG) of the ramus/condyle unit (RCU). Patients and methods A retrospective evaluation of 10 consecutive patients who underwent endoscopic condylectomy and CCG (n = 17 sides) for the treatment of idiopathic condylar resorption (n = 7), degenerative joint disease (n = 1), and malunion of a fractured condyle (n = 2) was completed. Patients were included who had 1) adequate documentation after endoscopic condylectomy and CCG reconstruction and 2) a minimum of 6-months follow-up. Patients with inadequate documentation or follow-up were excluded. The surgical technique included a 1.5-cm incision inferior to the mandibular angle. Blunt dissection was carried to the masseter muscle, which was incised using needle point electrocautery. An optical cavity was created for insertion of a Hopkins (Karl Storz, Culver City, CA) endoscope. The resection and reconstruction were carried out with endoscopic instrumentation. Preoperative (T0), postoperative (T1), and follow-up (T2) clinical examinations, lateral cephalograms, and panoramic radiographs were used to evaluate the outcomes. Results In all 10 cases, condylectomy and CCG reconstruction (n = 17 sides) were successfully performed using the endoscopic approach. The mean follow-up period was 17 months (range, 8 to 38 months). All submandibular scars were aesthetically satisfactory, and there were no facial, inferior alveolar, or lingual nerve injuries. No other intraoperative or postoperative complications occurred. Postoperative RCU length, mandibular position, and correction of the occlusion were documented using lateral cephalometric and panoramic radiographs. Conclusion The results of this study indicate that endoscopic condylectomy and CCG reconstruction produce satisfactory clinical outcomes without significant morbidity. Long-term follow-up studies are in progress.

OH radicals generated by DC corona discharge for improving the pulsed discharge desulfuration efficiency.

Positive DC corona discharge is formed with needle-plate electrode configuration, in which the water vapor is ejected though the needle points. The purpose is to increase the numbers of the water-based radicals, ionize the water molecule and improve the desulfuration efficiency of pulsed corona reactor. The water ions were determined by four stages molecular beam mass spectrometer and diagnose the water-based radicals by emission spectrograph. A conclusion on formation of ions and radicals with DC corona discharges can be drawn.

Drying Enhancement of Rough Rice by an Electric Field

Corona discharge produced by a multiple point-to-plate high-voltage electric field (HVEF) was used to investigate the enhancement of rough rice drying and its effect on rice fissuring and germination. The HVEF consisted of a 16 needle point cathode with a direct current power supply, and a grounded stainless steel plate anode. The drying rate of the treated rough rice was notably greater than that of the control, and the drying rate was described by an exponential model. There was a good agreement between the predicted and experimental results (coefficient of determination R 2=0·98). The electric field treatment significantly enhanced drying but had no effect on rice fissuring at a lower temperature. The average drying rate of the treated rice increased 2·83, 1·59 and 1·63 times at 25, 40 and 50°C, respectively, compared to the corresponding control. The drying rate also increased with increasing electric field strength. The electric field treatment did not have significant effects on the percentage of kernels having heavy fissures or the germination rate of rough rice (probability P>0·05). The total number of fissured kernels in the treated sample was increased compared to the control.

Indication for intraoral vertical ramus osteotomy (IVRO): a follow-up report

tomy and placement of costochondral grafts (n 14 sides) using endoscopic technique. The diagnoses were idiopathic condylar resorption (n 6), malunion of a fractured condyle (n 1), and degenerative joint disease (n 1). Inclusion criteria included condylar pathology requiring condylectomy and reconstruction; adequate preand postoperative documentation; and at least 6 months follow-up. Patients excluded had less than 6 months postoperative follow-up, and/or inadequate radiographs or clinical documentation. A 1.5-cm incision was made directly below the mandibular angle. The dissection was continued bluntly to the masseter muscle, which was incised using a needle point electrocautery. Then, with endoscopic elevators, an optical cavity was created for insertion of a Hopkins endoscope and visualization of the ramus/condyle unit (RCU). Anatomic landmarks were identified and the operation carried out with specially designed endoscopic equipment. Preoperative (T0), postoperative (T1), and follow-up (T2) clinical examinations, lateral cephalograms, and panoramic radiographs were used to evaluate the outcomes. Results: In all 8 cases condylectomy and CCG reconstruction (n 14 sides) was successfully performed using the endoscopic approach. The mean follow-up period was 17 months (range 8 to 38 months). Mean operating time was 52 minutes per side (range 25 to 75 minutes) and the average length of stay for all patients was 2 days (2 to 4 days). No intraoperative or long-term postoperative complications were encountered in any of the patients. One patient experienced transient marginal mandibular nerve weakness post-operatively that resolved within 2 weeks. Panoramic radiographs documented postoperative RCU position and lateral cephalograms documented mandibular position and closure of the anterior open bite. Measurements made from lateral cephalograms at T0 revealed that all 8 patients presented with a Class II malocclusion, mean RCU length was 4.6 cm, and mean openbite and overjet were 2.3 mm and 8 mm, respectively. At T1 all patients demonstrated Class I occlusion; a mean RCU length of 5.6 cm; overbite of 1.0 mm; and overjet of 2 mm. At T2 all patients maintained a Class I occlusion; mean RCU height was 5.4 cm; overbite was 1.8 mm; and overjet was 2.7 mm. Conclusion: The results of this case series indicate that endoscopic condylectomy and CCG is feasible with minimal morbidity and short-term stability comparable to standard techniques.

Desempenho e características de carcaça de novilhos de origem leiteira, alimentados com diferentes níveis de concentrado e de cama de frango

Foram confinados 24 bezerros mestiços holandeses machos não-castrados com peso médio inicial de 75 kg e final de 215 kg, com o objetivo de avaliar consumo, ganho de peso, conversão alimentar, rendimento de carcaça e dos cortes básicos e composição física da carcaça. Os animais foram alimentados com capim-elefante de 30 a 45 dias de idade, concentrado à base de farelo de soja, fubá de milho, farinha de carne e mistura mineral e cama de frango, constituindo-se os tratamentos: 1 = 50% volumoso e 50% concentrado, 2 = 50% volumoso, 35% de concentrado e 15% de cama de frango, 3 = 25% de volumoso e 75% concentrado e 4 = 25% de volumoso, 52,5% de concentrado e 22,5% de cama de frango, na base da matéria seca. O delineamento experimental foi em blocos casualisados, com seis blocos e quatro tratamentos. Não houve efeito de tratamento para consumo de matéria seca (CMS), em kg/dia. O consumo de fibra em detergente neutro (CFDN) foi menor para o tratamento 3 e o consumo de proteína bruta (CPB) maior para o tratamento 4. As conversões alimentares de MS, PB e FDN foram melhores, o ganho de peso médio diário (GMD) e o peso de carcaça quente e fria dos animais do tratamento 3 (75% de concentrado) foram superiores aos dos demais tratamentos. A proporção de cama de frango de 22,5% na matéria seca da ração total diminuiu o GMD em ração contendo 75% de concentrado, mas não foi observado o mesmo comportamento para a proporção de 15%. Os rendimentos de carcaça quente e fria, os rendimentos de acém, ponta de agulha, alcatra, coxão, dianteiro, traseiro especial e traseiro total, o comprimento de carcaça, a área de olho de lombo, a composição física de carcaça e a relação músculo/osso não foram influenciados pelos tratamentos. Os animais do tratamento 3 apresentaram maior espessura de gordura e, conseqüentemente, o menor valor absoluto de quebra no rendimento de carcaça pelo resfriamento.