Standard Frontal View Research Articles

Panoramic colonoscopy in colorectal cancer screening - a randomized controlled trial.

IntroductionColonoscopy is considered the gold standard for colorectal cancer screening. Panoramic colonoscopy offers better visualization to decrease the adenoma miss rate.AimTo assess the influence of 330° panoramic view colonoscopy on adenoma and polyp detection rate, cecal intubation time, and examiner’s comfort.Material and methodsThe study enrolled 421 patients aged 18–80 years who were eligible for colonoscopy screening. Patients with prior abdominal surgery, inflammatory bowel disease or after colorectal resections were excluded from the study. Patients were randomized to either standard frontal view (SFV) (Olympus Evis Exera III 190 CF-HQ190L) or the panoramic view colonoscopy (PVC) (FUSE CDVL slim c38). The study was approved by the local bioethics committee and registered at ClinicalTrial.gov (NCT02929381).ResultsThere were 214 patients examined with SFV and 207 with PVC. The mean age of patients was 64 ±12.26 years. The two groups were comparable. The median cecal intubation time was 234 s with SFV vs. 311 s with PVC (p < 0.001). There were no significant differences in CIR or withdrawal time. PVC made it possible to discover more diverticula in the ascending colon (p = 0.009). PDR with SFV was 34.6% and 40.1% with PVC (p = 0.242). A higher number of polyps was found in the transverse colon in the PVC group (p = 0.006). ADR and advanced ADR (aADR) in both groups were similar (26.4% vs. 27.1% and 14, 2% vs. 13.9%).ConclusionsColonoscopy with wide-angle endoscopes lasts longer and allows for the detection of more polyps and diverticula without affecting ADR and aADR. Our study did not reveal the superiority of wide-angle colonoscopy in colorectal cancer screening

Success, safety, and usefulness of right colon retroflexion for the detection of additional colonic lesions not visualized with standard frontal view.

Missed adenomas are the main concern for endoscopists. Right colon retroflexion (RCR) seems to increase the adenoma detection rate (ADR), but important variation in success and usefulness of this maneuver has been reported in the literature AIMS: Primary objective: to assess additional adenoma detection rate (AADR) detected during the RCR attempt. Secondary objectives: to assess success rates of RCR, variables associated with it, and safety of RCR. This is a prospective, unicentric, non-randomized study. Consecutive colonoscopies done by six endoscopists (3 of them with < 3years of experience and 3 with > 3years) from March to May 2017 were included. Olympus colonoscopes were used (CF-H190, CF-H180) Demographic, clinical, and endoscopic variables were collected. 463 colonoscopies were included. RCR success rate was 93.1% (431/463 colonoscopies). Forty additional lesions were visualized during RCR in 34/463 colonoscopies (7.3%). Additional adenomas were detected in 31/463 colonoscopies (6.7%; OR 0.07). low-grade dysplasia adenomas in 29/40 (72.5%) lesions; 3/40 (7.5%), adenomas with high-grade dysplasia; and 7/40 (17.5%) sessile serrated lesions. Additional adenoma detection contributed to modify the colonoscopy surveillance interval in 25 patients (5.4% of the cohort). Variables associated with RCR success in multivariate analysis were no previous abdominal surgery, length of colonoscope insertion in cecum < 80cm, and use of Olympus 190 series colonoscopes. No differences between endoscopists' experience were found. RCR was a safe maneuver, with no adverse events in our study. RCR is a feasible and safe maneuver that can increase ADR, so its routine inclusion in colonoscopy practice should be considered.

The impact of full-spectrum endoscopy on pathological lesion detection in different regions of the colon: a randomised, controlled trial

IntroductionColonoscopy is crucial for detecting and localising pathological lesions within the colon. Colonoscopy quality is defined by the caecal intubation rate, withdrawal time, adenoma detection rate, and polyp detection rate. The newly introduced full-spectrum endoscope (FUSE®) provides a 330° field of view, allowing endoscopists to observe more colonic anatomy. It is intended to increase detection of pathological lesions, especially those situated behind the haustral folds of the bowel. This diagnostic modality should increase the adenoma detection rate (ADR), especially in the right hemicolon. The aim of this study was to explore the efficacy of FUSE for detecting pathologic lesions in different colonic regions.Material and methodsThe study enrolled 408 patients who were randomised to either a standard frontal view (SFV) or the novel full-spectrum colonoscopy. Analysis was performed among three broad regions of the colon: right, transverse, and left colon, according to the Boston Bowel Preparation Scale.ResultsFUSE yielded a higher diverticula detection rate (DDR) in the right and middle colon (DDR-R (p < 0.05), DDR-T (p < 0.05), DDR-L (p = 0.862)). ADR (p = 0.761), advanced ADR (aADR) (p = 0.950), and DDR (p = 0.967) in respective regions of the colon were similar between the groups; however, the total number of adenomas detected with FUSE was higher in the right and middle regions of the colon compared with those detected by SFV (p < 0.05).ConclusionsFull-spectrum colonoscopy allows for effective recognition of pathological lesions in the right and middle regions of the colon. Although full-spectrum colonoscopy did not statistically affect ADR, the absolute number of adenomas detected was higher compared with classical endoscopy.

Effect of Preoperative Nasal Retainer on Nasal Growth in Patients with Bilateral Incomplete Cleft Lip: A 3-Year Follow-Up Study.

BackgroundThe purpose of this study was to evaluate changes in nasal growth after the implementation of a preoperative nasal retainer in patients with bilateral incomplete cleft lip. MethodsTwenty-six infants with bilateral incomplete cleft lip and cleft palate were included in the study. A preoperative nasal retainer was applied in 5 patients from the time of birth to 2.6–3.5 months before primary cheiloplasty. Twenty-one patients who were treated without a preoperative nasal retainer were placed in the control group. Standard frontal, basal, and lateral view photographs were taken 3 weeks before cheiloplasty, immediately after cheiloplasty, and at the 1- and 3-year postoperative follow-up visits. The columella and nasal growth ratio and nasolabial angle were indirectly measured using photographic anthropometry. ResultsThe ratio of columella length to nasal tip protrusion significantly increased after the implementation of a preoperative nasal retainer compared to the control group for up to 3 years postoperatively (P<0.01 for all time points). The ratios of nasal width to facial width, nasal width to intercanthal distance, columellar width to nasal width, and the nasolabial angle, for the two groups were not significantly different at any time point. ConclusionsImplementation of a preoperative nasal retainer provided significant advantages for achieving columellar elongation for up to 3 years postoperatively. It is a simple, reasonable option for correcting nostril shape, preventing deformities, and guiding development of facial structures.

Physical capacity of girls with mild and moderate idiopathic scoliosis: influence of the size, length and number of curvatures (Czaprowski et al.)

Dear Editor, We read with much interest the article entitled ‘Physical capacity of girls with mild and moderate idiopathic scoliosis: influence of the size, length and number of curvatures’ by Czaprowski et al. [1]. We appreciate the authors and editor for publishing this interesting article. The exclusion of other underlying causes of scoliosis is predominantly carried out before arriving at a definitive diagnosis for AIS. The clinical examination and standard radiography are so far considered as the mainstay in facilitating the diagnosis of scoliosis. However, Kim et al. [2] described the pitfalls (50 diurnal variation, difficulty in patient position for accurate frontal view, intra and inter observer variation) of cobb angle measurement using a two-dimensional radiographic image of a 3d deformity, and moreover, El-Sayyad [3] had recently emphasized on prior objective clinical examination of a patient (leg length, pelvic and extremity symmetry, Adam forward-bending test and previous spinal surgery) to exclude the other potential causes. Czaprowski et al. [1] used standard frontal view radiograph along and bunnel inclinometer to include and exclude the research subjects. However, we feel to validate and strengthen the subject recruitment; reasonable, valid benchmark procedures like clinical examination [3], real-time ultrasound, and AUSCAN [4] could have been carried out. Czaprowski et al. [1] did not clearly define the length of the scoliotic curvature that was determined in their study. In their study, Czaprowski et al. [1] stated that the average number of vertebrae forming scoliosis was 9.4 which in turn do not define the length of scoliotic curvature. One may presume that the current study had determined the length of the scoliotic curve by adding the number of vertebrae caught between the upper and lower tilted vertebrae within the curve. However, with the 36 double-curve subjects presenting with large right thoracic and left curvature, the mere counting of vertebrae between the double curve was arbitrary. Czaprowski et al. [1] did not provide any clinical rationale or research evidence for grouping of subjects by below or equal and above average scoliotic length. Furthermore, scoliosis is a three-dimensional deformity. The current study’s description on length of curvature measurement was not evidence based measurement; thereby, the reliability of these measurements is questionable. We feel that some essential information about the actual testing procedures like the type of warm up exercise, position of ergometer seat height (example knee slightly bent), handle bar height, fatigue reported by test subjects (if any) and duration of rest between during the two 5 min submaximal effort may be beneficial. Moreover, Koumbarilis [5] stated that the exercise intolerance in mild scoliosis is attributed to physical deconditioning rather than primary ventilator limitations. Possible displacement and compression of the heart due to thoracic deformity might not permit the stroke volume to increase during exercise, therefore adding a limitation to cardiovascular exercise. The authors of the present study did not state any possible rationale for the insignificant value of maximum oxygen intake and output during the PWC 170 in girls with mild scoliosis (up to 25o).

Evaluation and selecting indications for the treatment of improving facial morphology by masseteric injection of botulinum toxin type A

Few reports exist on effective methods of evaluating the effects and selecting indications for the treatment of improving facial morphology by masseteric injection of botulinum toxin type A. The method for selecting indicative factors, as determined by the change of masseteric area volume at a standard frontal view when tightly clenching teeth, was used in this study. Patients with varying masseteric area volume were randomly enrolled. Bilateral masseteric muscles were treated with multi-point percutaneous intramuscular injections of botulinum toxin type A, 30-50 u for each side. Changes in facial appearance and satisfaction of patients were observed and standard frontal view photographs were taken pre-treatment and 2-3 months post-treatment. Following this, the anterior facial height(FH), bizygomatic facial width (FWz) and intergonial width (FWg) were measured from the photographs. The indices of FH/FWz and FWg/FWz were calculated and analysed. The results showed that the volume of masseteric area was reduced and the facial morphology was improved at 2-4 weeks post-injection, with maximum reduction at 2-3 months post-injection. All of the 32 patients were satisfied with the clinical effects. The pre-treatment and post-treatment values of FH/FWz were 0.8309±0.0423 and 0.8331±0.0382, respectively, and FWg/FWz values were 0.8281±0.0209 and 0.7925±0.0206 (P<0.01), respectively. In conclusion, the appropriateness of masseteric injection of botulinum toxin type A for improving facial morphology can be determined by the changes in masseteric area volume at a standard frontal view of tightly clenched teeth. In addition, the facial index of FWg/FWz can be used to evaluate the treatment.

Three-Dimensional Photography and Its Application to Facial Plastic Surgery

Photography is integral to the practice of facial plastic surgery. We describe a new 3-D photographysystem,the3dMDfaceSystem(3dMD,Atlanta,Ga),whichprovidesahighresolution 3-D image that can be viewed from any angle; has the ability to accurately measure surface distance, area, and volume; and performs profile adjustments that can be viewed in 3 dimensions. We describe specific applications of this system to facial plastic surgery, namely, to that of the aging face.

Measurement of Polyethylene Wear in Metal-Backed Acetabular Cups

A new technique, the 3-dimensional technique, has been developed. Using a digitzer, points taken from anteroposterior and lateral radiographs are input into a personal computer. A 3-dimensional solid model of the prosthesis is created using custom software. Tilt and anteversion of the acetabular cup are measured, and the model is rotated to a standard frontal view, allowing measurement of femoral head displacement from the center of the acetabular cup. Comparing serial radiographs of the same patient gives the direction and distance of femoral head displacement over time, and this value is used to calculate the minimum volume of polyethylene debris generated. The 3-dimensional technique has been validated by construction of a precision acrylic phantom, and milling of a metal-backed acetabular cup to simulate polyethylene wear. Three-dimensional measurement of femoral head displacement using this technique has an accuracy of +/- 0.15 mm, and volume calculations are within 8% of the true amount of polyethylene removed from the cup. The 3-dimensional technique gives previously unavailable information, and can be used for clinical evaluation of polyethylene wear and evaluation of new prosthetic designs and bearing surfaces.

Quantified comparison of frontal sinus patterns by means of computed tomography

The observation of frontal sinus patterning is a well-established technique of personal identification in forensic anthropology. Variations in size, shape, symmetry, border outline, and the presence and number of septa and cells are compared using antemortem and postmortem radiographs. Traditionally, a standard frontal view is utilized. Computed tomography produces contiguous radiographic images of the cranium at predetermined increments. Multiple comparisons of the sinus configuration can therefore be made at different levels. The use of different ‘window’ settings (attenuation coefficient ranges) for the production of CT scans is discussed. A scoring system is described for the precise and quantified comparison of frontal sinuses in antemortem to postmortem CT scans. The application of these procedures to actual cases is described.

The use of Computed Tomography (CT) Scans in the Comparison of Frontal Sinus Configurations

The observation of frontal sinus patterning is a well-established technique of personal identification in forensic anthropology and odontology. Variations in size, shape, symmetry, border outline, and the presence and number of septa and cells are compared using antemortem and postmortem radiographs. Traditionally, a standard frontal view is utilized.Computed tomography produces contiguous radiographic images of the cranium at predetermined increments. Multiple comparisons of the sinus configuration can therefore be made at different levels. A technique is presented for the production of postmortem CT scans which allows precise comparison to preexisting antemortem scans. A scoring System is described for the comparison of frontal sinuses in antemortem to postmortem CT scans. Its application to a case is discussed.

The radiological assessment of disease of the profunda femoris artery.

In two series with a total of 135 patients with symptoms due to occlusive vascular disease of the lower limbs, 39 per cent of the 209 limbs studied showed narrowing of the origin of the profunda artery. In 68 per cent of the narrowed arteries the abnormality was seen only on oblique or lateral radiographs. When the superficial femoral artery is occluded, the profunda femoris artery is the main artery supplying the lower limb, and narrowing of this vessel may be of considerable functional importance. Localized narrowing of the origin of the profunda artery is common but is often unrecognized because the artery is not adequately demonstrated by standard frontal view arteriography. Adequate arteriography is a necessary preliminary to reconstructive surgery of the profunda femoris artery.