Surgery In Adulthood Research Articles

Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children.

Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children.

Gynecological surgery in adulthood imparts cognitive and brain changes in rats: A focus on hysterectomy at short-, moderate-, and long-term intervals after surgery

Premenopausal hysterectomy is associated with a greater relative risk of dementia. We previously demonstrated cognitive impairments in adult rats six weeks after hysterectomy with ovarian conservation compared with intact sham-controls and other gynecological surgery variations. Here, we investigated whether hysterectomy-induced cognitive impairments are transient or persistent. Adult rats received sham-control, ovariectomy (Ovx), hysterectomy, or Ovx-hysterectomy surgery. Spatial working memory, reference memory, and anxiety-like behavior were tested either six-weeks post-surgery, in adulthood; seven-months post-surgery, in early middle-age; or twelve-months post-surgery, in late middle-age. Hysterectomy in adulthood yielded spatial working memory deficits at short-, moderate-, and long-term post-surgery intervals. Serum hormone levels did not differ between ovary-intact, but differed from Ovx, groups. Hysterectomy had no significant impact on healthy ovarian follicle or corpora lutea counts for any post-surgery timepoint compared with intact sham-controls. Frontal cortex, dorsal hippocampus, and entorhinal cortex were assessed for activity-dependent markers. In entorhinal cortex, there were alterations in FOSB and ΔFOSB expression during the early middle-age timepoint, and phosphorylated ERK1/2 levels at the adult timepoint. Collectively, results suggest a primary role for the uterus in regulating cognition, and that memory-related neural pathways may be modified following gynecological surgery. This is the first preclinical report of long-term effects of hysterectomy with and without ovarian conservation on cognition, endocrine, ovarian, and brain assessments, initiating a comprehensive framework of gynecological surgery effects. Translationally, findings underscore critical needs to decipher how gynecological surgeries, especially those involving the uterus, impact the brain and its functions, the ovaries, and overall aging from a systems perspective.

Determining the neuronal ensembles underlying sex-specific social impairments following adolescent intermittent ethanol exposure

Binge drinking during adolescence can have behavioral and neurobiological consequences. We have previously found that adolescent intermittent ethanol (AIE) exposure produces sex-specific social alterations indexed via decreases of social investigation and/or social preference in rats. The prelimbic cortex (PrL) regulates social interaction, and alterations within the PrL resulting from AIE may contribute to social alterations. The current study sought to determine whether AIE-induced PrL dysfunction underlies decreases in social interaction evident in adulthood. We first examined social interaction-induced neuronal activation of the PrL and several other regions of interest (ROIs) implicated in social interaction. Adolescent male and female cFos-LacZ rats were exposed to water (control) or ethanol (4 g/kg, 25% v/v) via intragastric gavage every other day between postnatal day (P) 25 and 45 (total 11 exposures). Since cFos-LacZ rats express β-galactosidase (β-gal) as a proxy for Fos, activated cells that express of β-gal can be inactivated by Daun02. In most ROIs, expression of β-gal was elevated in socially tested adult rats relative to home cage controls, regardless of sex. However, decreased social interaction-induced β-gal expression in AIE-exposed rats relative to controls was evident only in the PrL of males. A separate cohort underwent PrL cannulation surgery in adulthood and was subjected to Daun02-induced inactivation. Inactivation of PrL ensembles previously activated by social interaction reduced social investigation in control males, with no changes evident in AIE-exposed males or females. These findings highlight the role of the PrL in male social investigation and suggest an AIE-associated dysfunction of the PrL that may contribute to reduced social investigation following adolescent ethanol exposure.

Discussions About Obstetric Brachial Plexus Injuries

Although patients with obstetric brachial plexus injuries (OBPI) have been recognized and treated for greater than 100 years there is much that is not understood or is mis-understood. I address 6 areas for discussion: the cause of OBPI and whether it matters to nerve surgeons; the value of the Narakas grading; whether surgeons should perform primary nerve surgery, especially in patients with incomplete OBPI; the cause and treatment of shoulder tightness; the cause and treatment of elbow contracture; and whether patients with OBPI need surgery in adulthood.

Indications and timing of revision spine surgery in adults after adolescent surgery for idiopathic scoliosis.

Retrospective case series. To characterize the indications and timing of revision spine surgery in adulthood after adolescent surgery for idiopathic scoliosis. Previous studies have shown that revision usually occurs within 3months or more than 5years after the index operation. It is not clear what the indications for and timeline to revision surgery are in these patients during adulthood. 421 patients with idiopathic scoliosis were seen as adults over a 15-year period. 81 patients who had scoliosis surgery prior to age 18 were identified. This cohort was studied for indications and time from index to revision operation. Their clinical presentation and a description of their revision operation was also documented. Of the 81 patients, 18 (22.2%) had a revision surgery as an adult.Indications for revision in order of prevalence were implant malposition, subjacent segment degeneration and stenosis, pseudoarthrosis, delayed deep wound infection, spondylolisthesis, and symptomatic implants. Revisions were indicated generally within 15years or more than 30years after the initial operation. The timeline for revision spine surgery in idiopathic scoliosis was bimodal, with revisions occurring within 15years or over 30years after the initial operation. Implant malposition and subjacent segment degeneration were the most prevalent indications for adulthood revision. Prognostic-IV.

Surgical outcomes of untreated congenital polysyndactyly of the foot in adult patients

Purpose: Polydactyly of the foot is a common congenital anomaly. The goal of surgery for polydactyly is to increase similarity to the contralateral foot, with a well-aligned arcade of toes that allows patients to wear normal footwear and ambulate painlessly. Foot appearance is especially important in Asian countries where people remove their shoes indoors. This study reviewed the surgical results in patients who underwent surgery for correction of untreated foot polydactyly after the age of 18 years. Methods: We retrospectively analyzed the data of 11 patients who underwent surgery between 2006 and 2019. The forefoot width, angulation difference, and toe length ratios between the affected and unaffected feet were compared before and after the operation. In addition, the purpose of the surgery and postoperative cosmetic satisfaction were collected for each patient.Results: The median age at the time of the operation was 25 years (interquartile range, 22–32 years) and most patients presented with postaxial polydactyly. The primary reasons to undergo surgery were both functional and cosmetic. The forefoot width and angle difference ratios became significantly more similar to the contralateral side postoperatively (p<0.05). No significant difference was found in the toe length ratio. Postoperative Global Aesthetic Improvement Scale scores showed satisfactory results. Conclusion: The main reasons for surgery in adulthood included the diverse consequences of functional and cosmetic aspects of the anomaly. Surgery for patients with untreated polydactyly of the foot can yield satisfactory objective and subjective results regardless of the intervention timing.

Clinical Features and Outcomes in Adults With Childhood Repair of Partial Atrioventricular Septal Defect

BackgroundPartial atrioventricular septal defects (pAVSDs) are mostly repaired in childhood; however, there are limited data describing these patients in adulthood. ObjectivesThe objective of this study was to describe clinical course and associations with outcomes in adults with repaired pAVSDs. MethodsA retrospective review of adults (≥18 years) with pAVSDs repaired in childhood who presented to the Adult Congenital Heart Disease Clinic at our institution was conducted. ResultsOf 121 patients, the median age was 31 years (IQR: 22-43 years) and 71.9% were female. The median number of operations at the time of presentation was 1 (IQR: 1-2). Left atrioventricular valve (LAVV) replacement had been performed in 19.8% of patients. Among those with native LAVV, 41.2% had ≥ moderate regurgitation. Atrial arrhythmias were present in 34.7% and were associated with later age at repair (P = 0.02) and a high number of prior surgeries (P = 0.005). Estimated systolic pulmonary artery pressure >40 mmHg was seen in 19.8%. Over 4 (IQR: 1-12) years of follow-up, death occurred in 13 (10.7%) patients and reoperation was required in 39.7%. One-third had a LAVV prosthesis by the end of the study. Atrial fibrillation was independently associated with death or hospitalization on multivariable analysis. ConclusionsIn this cohort of adults with pAVSDs repaired in childhood, atrial fibrillation was common at a young age and associated with worse outcomes. Thus, more studies are needed evaluating the cause of this arrhythmia burden and possible associated atrial myopathy. While many require surgery in adulthood, more information is needed regarding indications for and impacts of LAVV intervention as one-third had an LAVV prosthesis by the end of follow-up.

Causes of concomitant strabismus surgery delay in teenagers and adults

ABSTRACT To reveal the reasons for strabismus surgery delay and motivations for seeking surgical treatment in adulthood. Prospective survey among 91 adult patients, suffering from concomitant strabismus acquired in the childhood that underwent delayed strabismus surgery. The mean age of participants was 24 years (from 16 to 58 years); 48 females (52.7%), and 43 males (47.3%). Strabismus surgery has been delayed for about 20 years in adult patients who could potentially benefit of it in childhood. The most common reasons for strabismus surgery delay, reported by patients, included the following: lack of awareness about surgery (37.4%); surgery was recommended but declined by patients’ parents/guardians in their childhood (6.6%); fear of surgery (17.6%); eye specialists affirmation that surgery would not lead to strabismus improvement (27.5%); previous poor surgical experience (6.6%); and non-affordability (4.4%). The main motivations for seeking strabismus surgery in adulthood among our patients were the following: appearance improvement (38.5%), strengthening of self-confidence (30.8%), better social relationship (16.5%), better job opportunities (7.7%), and advice from family and friends (6.6%). About 80% of strabismus surgery delays in teenagers and adults were caused by lack of awareness regarding strabismus surgery and even the misconception among primary health-care practitioners and some eye doctors who considered that surgery would not lead to strabismus correction. The main reasons for seeking strabismus surgery in adulthood were: esthetical ones, self-confidence strengthening, and building better social relationship. All factors mentioned below confirmed the negative impact of oculomotor disorders on patient’s psychological condition. The focus on patient’s individual concerns and needs was especially important for recovery and well-being of adult patients with strabismus and formed a central feature of patient centered medical approach.

Secundum atrial septal defects transcatheter closure versus surgery in adulthood: a 2000-2020 systematic review and meta-analysis of intrahospital outcomes.

Technologically, advances in both transcatheter and surgical techniques have been continuing in the past 20 years, but an updated comprehensive comparison in device-based versus surgery in adults in terms of incidence of in-hospital mortality, perioperative stroke, and atrial fibrillation onset is still lacking. We investigate the performance of transcatheter device-based closure compared to surgical techniques by a systematic review and meta-analysis of the last 20 years literature data. The analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature search was performed based on Cochrane Library, Embase, PubMed, and Google Scholar to locate articles published between January 2000 and October 2020, regarding the comparison between short-term outcome and post-procedural complications of atrial septal defect patients receiving transcatheter or surgical closure. The primary outcome was the comparison of in-hospital mortality from all causes between patients treated with transcatheter closure or cardiac. Secondary outcomes were the onset of post-procedural atrial fibrillation or perioperative stroke. A total of 2360 patients were included of which 1393 [mean age 47.6 years, 952 females (68.3%)] and 967 [mean age 40.3 years, 693 females (71.6%)] received a transcatheter device-based and surgery closure, respectively. In-hospital mortality [OR 0.16 (95% CI (0.66-0.44)), p = 0.0003, I2 = 0%], perioperative stroke [OR 0.51 (95% CI (0.31-0.84)), p = 0.003, I2 = 79%], and post-procedural atrial fibrillation [OR 0.14 (95% CI (0.03-0.61)), p = 0.009, I2 = 0%] significantly favoured transcatheter device-based closure. Transcatheter atrial septal defect closure resulted safer in terms of in-hospital mortality, perioperative stroke, and post-procedural atrial fibrillation compared to traditional surgery.

Pain in Adults With Cerebral Palsy After Single-Event Multilevel Surgery.

The aim of the investigation was to assess the contribution of pain to functional, social, and health-related quality-of-life outcomes in adults with cerebral palsy. This monocentric, prospective study included long-term data for ambulant adults with cerebral palsy and at levels I-III in the Gross Motor Function Classification System who had received orthopedic multilevel surgery in adulthood and in whom preoperative and postoperative three-dimensional gait analysis was conducted, including the Gait Profile Score. A questionnaire including the Visual Analog Scale, Oswestry Disability Index, and European Quality of Life 5 Dimensions 3 Level was analyzed. Twenty-four adults at a mean age of 38.0 yrs were included. Sixteen patients (66.7%) indicated that they experienced pain and 10 patients (41.7%) had pain for more than 6 mos. Overall, 13 patients (54%) experienced both pain and anxiety. There was no correlation of the Gait Profile Score with pain, Gross Motor Function Classification System, and Oswestry Disability Index. The Oswestry Disability Index showed a positive correlation with the Gross Motor Function Classification System (r = 0.39, P = 0.05) and pain (r = 0.57, P = 0.004). Pain and anxiety represent relevant comorbidities in adults with cerebral palsy. The occurrence of pain correlates with the Oswestry Disability Index and is higher than in children with cerebral palsy.

S0753 Children With a History of UC and IPAA Experience a More Rapid Progression to Pouch Failure Compared With Adults and Historical Controls

INTRODUCTION: Though there are significant differences in surgical outcomes between pediatric and adult ulcerative colitis (UC) patients undergoing colectomy1–3, counseling families on outcomes has largely been guided by data from adult cohorts. We compared differences in pouch survival between pediatric and adult patients undergoing total proctocolectomy with ileal-pouch anal-anastomosis (IPAA). METHODS: This is a retrospective single-center study of inflammatory bowel disease (IBD) patients treated with IPAA who subsequently underwent pouchoscopy at the University of Chicago Medical Center between 1980 and 2019. Data were collected for 426 subjects via electronic medical records. We stratified the study population based on age at UC diagnosis or age at IPAA using a cutoff of 19 years. Differences between groups were assessed using t-tests and Chi-square tests. Kaplan Meier curves were used to compare survival probabilities. RESULTS: We identified 111 patients diagnosed with UC before age 19 and 53 patients undergoing IPAA before age 19 (Table 1). Pouch failure in pediatric patients occurred twice as often compared with adult patients (18.3% vs 9.7%, P = 0.1). Pediatric IPAA patients were more likely to require anti-TNF post-colectomy (41.5%) compared to adult patients (25.8%, P < 0.05) and to pediatric counterparts who had surgery in adulthood (22.1%, P = 0.05). Analysis by decade of IPAA surgery revealed that children undergoing IPAA in the 1990s and 2000s had survival estimates above 75% until 12- and 25-years post-colectomy. However, for IPAA performed since 2010, this threshold remains only five-years post-colectomy (P < 0.001) (Figure 1). Comparing pediatric and adult patients with stratification by pre-operative anti-TNF exposure, we observe that pediatric IPAA patients receiving anti-TNF therapies pre-colectomy had the most rapid progression to pouch failure (P = 0.027) (Figure 2). CONCLUSION: There are lower rates of pouch survival for children with UC undergoing IPAA in the anti-TNF era compared to both historical pediatric controls and contemporary adults. While more work is needed to understand the mechanistic underpinnings associated with these findings, anticipatory guidance for pediatric patient families prior to surgery and plans for surveillance after should reflect these outcomes.Table 1.: Study Population Stratified by Age at IPAA (n = 383)Figure 1.: Kaplan Meier Pouch Survival Estimate for Pediatric Patients based on Decade of IPAA.Figure 2.: Kaplan Meier Pouch Survival Estimate for Adult and Pediatric Patients based on Anti-TNF Exposure Prior to IPAA.

Outcomes of pregnancy in operative vs. nonoperative adolescent idiopathic scoliosis patients at mean 30-year follow-up.

Retrospective cohort study. To determine whether patients who underwent surgical treatment of adolescent idiopathic scoliosis (AIS) in childhood would have an increased C-section risk in adulthood. Although the impact of scoliosis on future pregnancy and child delivery is a common question for patients and parents, there is limited data regarding pregnancy outcomes following childhood treatment of AIS. Between 1975 and 1992, 60 female patients underwent treatment for AIS with bracing, surgery, or observation and had data available regarding obstetrical history in the electronic medical record or in paper charts. In childhood, 28 had nonoperative treatment and 32 had fusion surgery. During the follow-up period, 2 nonoperative patients and 1 operative patient had fusion surgery in adulthood, but after childbearing years. Mean age at latest follow-up was 43years (CI 38, 48). Meantime to follow-up since childhood treatment was 31years (CI 26, 35). 29% of nonoperative patients had a C-section with at least one live birth compared to 38% of operative patients (p = 0.464). For surgical patients fused to L3 or lower, 46% required at least one C-section, compared to 32% of patients fused to L2 or higher (p = 0.40). Overall, 33% of the cohort of patients-including those with all scoliosis treatment methods-required at least one C-section, compared to the state weighted C-section rate of 20.5% (p = 0.014). The percentage of patients with operative treatment-including all levels of fusion-requiring at least one C-section was statistically different than the weighted state C-section rate (p = 0.020). In this long-term cohort of 60 US scoliosis patients, childhood operative fusion treatment was associated with a statistically significant increased incidence of C-section compared to the state incidence at both the patient level and the delivery level. III, comparative cohort study.

Scoliosis surgery in adulthood: what challenges for what outcome?

Adolescent idiopathic scoliosis that has progressed over time, de novo scoliosis, and degenerative scoliosis represent different types of adult spinal deformity (ASD). Functional impairment and muscular fatigue are due to sagittal and coronal imbalance of the trunk. Surgical treatment can provide a significant improvement of three-dimensional (3D) thoracolumbar alignment, function, and health-related quality of life (QoL). A patient-specific benefit-risk assessment, including clinical expectations, comorbidities, and the spinal deformity itself, has to be done preoperatively since the risk for mechanical complications is relatively high. Minimal invasive techniques combine posterior percutaneous instrumentation and lateral interbody fusion cages which enables vertebral realignment and indirect foraminal stenosis decompression. This strategy seems appropriate in mild and moderate ASD with a limited number of degenerated segments in the lumbar spine and remaining curve flexibility. Severe ASD needs to be addressed by open surgery, which combines posterior instrumentation, interbody fusion, and osteotomies in stiff deformities. Longer posterior instrumentation of the thoracolumbar spine, the sacrum, and the pelvis carries a risk for mechanical complications such as non-union and proximal junctional kyphosis (PJK). Modern surgical techniques including circumferential lumbosacral fusion and double rods might lower the risk for non-union. Accurate sagittal alignment planning, setting the lumbar sagittal apex according to pelvic incidence, and segmental lordosis distribution, are mandatory for minimizing the risk of PJK.

Adult tetralogy repair: factors affecting early outcome in the current era.

Background The benefits of surgical correction of adult tetralogy of Fallot are well known. The current recommendation is for total correction regardless of age. This study analyzed perioperative factors affecting early outcome after corrective surgery in adulthood in the current era. Methods This was a retrospective chart review of 40 consecutive patients over 18 years of age who underwent total correction of tetralogy of Fallot from September 2006 to June 2013. Patients with pulmonary atresia and absent pulmonary valve were excluded. The mean age at surgery was 26.60 ± 8.69 years (range 18–49 years). Results The mean intensive care unit stay was 3.30 ± 2.29 days (range 0.75–12 days) and hospital stay was 9.97 ± 3.39 days (range 7–22 days). Mortality was 5% (2/40). Multiple parameters indicating immediate postoperative outcomes and their relationships to selected pre-, intra-, and postoperative factors were analyzed. Multivariate analysis showed that postoperative right ventricular dysfunction had a significant influence on mortality ( p &lt; 0.001) and hospital stay ( p = 0.01). Performing zero-balance ultrafiltration decreased the need for renal replacement therapy ( p = 0.034), duration of ventilation ( p = 0.009), incidence of low cardiac output ( p = 0.006), intensive care unit stay ( p = 0.01), and hospital stay ( p = 0.009). Conclusions Total correction of tetralogy of Fallot is a safe option for presentations as late as adulthood. The protective effect of zero-balance ultrafiltration on postoperative morbidity needs to be reassessed in larger studies.

Tracking the Re-organization of Motor Functions After Disconnective Surgery: A Longitudinal fMRI and DTI Study.

Objective: Mechanisms of motor plasticity are critical to maintain motor functions after cerebral damage. This study explores the mechanisms of motor reorganization occurring before and after surgery in four patients with drug-refractory epilepsy candidate to disconnective surgery.Methods: We studied four patients with early damage, who underwent tailored hemispheric surgery in adulthood, removing the cortical motor areas and disconnecting the corticospinal tract (CST) from the affected hemisphere. Motor functions were assessed clinically, with functional MRI (fMRI) tasks of arm and leg movement and Diffusion Tensor Imaging (DTI) before and after surgery with assessments of up to 3 years. Quantifications of fMRI motor activations and DTI fractional anisotropy (FA) color maps were performed to assess the lateralization of motor network. We hypothesized that lateralization of motor circuits assessed preoperatively with fMRI and DTI was useful to evaluate the motor outcome in these patients.Results: In two cases preoperative DTI-tractography did not reconstruct the CST, and FA-maps were strongly asymmetric. In the other two cases, the affected CST appeared reduced compared to the contralateral one, with modest asymmetry in the FA-maps. fMRI showed different degrees of lateralization of the motor network and the SMA of the intact hemisphere was mostly engaged in all cases. After surgery, patients with a strongly lateralized motor network showed a stable performance. By contrast, a patient with a more bilateral pattern showed worsening of the upper limb function. For all cases, fMRI activations shifted to the intact hemisphere. Structural alterations of motor circuits, observed with FA values, continued beyond 1 year after surgery.Conclusion: In our case series fMRI and DTI could track the longitudinal reorganization of motor functions. In these four patients the more the paretic limbs recruited the intact hemisphere in primary motor and associative areas, the greater the chances were of maintaining elementary motor functions after adult surgery. In particular, DTI-tractography and quantification of FA-maps were useful to assess the lateralization of motor network. In these cases reorganization of motor connectivity continued for long time periods after surgery.

Chance of surgery in adult congenital heart disease

Background Young patients with congenital heart disease reaching adulthood face mandatory transition to adult cardiology. Their new cardiologist needs to assess the chances of major future events such as surgery. Using a large national registry, we assessed if patient characteristics at the age of 18 years could predict the chance of congenital heart surgery in adulthood. Design and methods Of 10,300 patients from the CONCOR national registry, we used general patient characteristics at age 18 years, underlying congenital heart defect, history of complications, and interventions in childhood as potential predictors of congenital heart surgery occurring from age 18 years up to age 40 and 60 years. Cox regression was used to calculate hazard ratios with 95% confidence intervals. Analyses were performed separately for all congenital heart surgery and for valvular surgery alone. Results Altogether 2427 patients underwent congenital heart surgery after age 18 years, 1389 of whom underwent valvular surgery. Underlying heart defect, male sex, multiple defects, childhood endocarditis, supraventricular arrhythmia, aortic complications and paediatric cardiovascular surgery, independently predicted adult congenital heart surgery. The mean chance of congenital heart surgery was 22% up to age 40 and 43% up to age 60 years; individual chances spanned from 9-68% up to age 40 and from 19-93% up to age 60 years. Conclusion At the time of transition from paediatric to adult cardiology, an easily obtainable set of characteristics of patients with congenital heart disease can meaningfully inform cardiologists about the patient's individual chance of surgery in adulthood. Our findings warrant validation in other cohorts.

A case of Hirschsprung's disease underwent surgery in adulthood

Abstract Adult Hirschsprung's disease is a rare motor disorder of the gut that is frequently misdiagnosed as refractory constipation. We describe a 30-year-old patient with adult Hirschsprung's disease with a history of chronic constipation requiring daily enema. Barium enema and rectal biopsy showed short segment-type Hirschsprung's disease with a grossly distended sigmoid colon with fecal retention. Staged operations, including the Duhamel-GIA method as a definitive surgery, completely resolved the patient's symptoms. There were no complications by the end of a 7-year follow-up. Adult Hirschsprung's disease should be considered in the differential diagnosis of cases where adult patients present with chronic constipation. Despite technical difficulty of the modified Duhamel-GIA procedure due to chronic fibrous changes of the rectum, it is a feasible surgical option for treating cases of adult Hirschsprung's disease.

Timing of bariatric surgery for severely obese adolescents: a Markov decision-analysis

PurposeAlthough controversial, bariatric surgery is increasingly being performed in adolescents. We developed a model to simulate the effect of timing of gastric bypass in obese adolescents on quantity and quality of life. MethodsA Markov state-transition model was constructed comparing two treatment strategies: gastric bypass surgery at age 16 versus delayed surgery in adulthood. The model simulated a hypothetical cohort of adolescents with body mass index of 45kg/m2. Model inputs were derived from current literature. The main outcome measure was quality and quantity of life, measured using quality-adjusted life–years (QALYs). ResultsFor females, early gastric bypass surgery was favored by 2.02 QALYs compared to delaying surgery until age 35 (48.91 vs. 46.89 QALYs). The benefit was even greater for males, where early surgery was favored by 2.9 QALYs (48.30 vs. 45.40 QALYs). The absolute benefit of surgery at age 16 increased; the later surgery was delayed into adulthood. Sensitivity analyses demonstrated that adult surgery was favored only when the values for adverse events were unrealistically high. ConclusionsIn our model, early gastric bypass in obese adolescents improved both quality and quantity of life. These findings are useful for surgeons and pediatricians when counseling adolescents considering weight loss surgery.

Evolution of adolescent idiopathic scoliosis: Results of a multicenter study at 20 years’ follow-up

IntroductionTo date there is no consensus on therapeutic indications in adolescent idiopathic scoliosis (AIS) with curvature between 30° and 60° at the end of growth. ObjectiveThe objective of this study was to assess outcome in patients with moderate AIS. Material and methodsA multicenter retrospective study was conducted. Inclusion criteria were: Cobb angle, 30–60° at end of growth; and follow-up > 20 years. The data collected were angular values in adolescence and at last follow-up, and quality of life scores at follow-up. ResultsA total of 258 patients were enrolled: 100 operated on in adolescence, 116 never operated on, and 42 operated on in adulthood. Mean follow-up was 27.8 years. Cobb angle progression significantly differed between the 3 groups: 3.2° versus 8.8° versus 23.6°, respectively; P < 0.001. In lumbar scoliosis, the risk of progression to ≥ 20° was significantly higher for initial Cobb angle > 35° (OR=4.278, P=0.002). There were no significant differences in quality of life scores. DiscussionPatients operated on in adolescence showed little radiological progression, demonstrating the efficacy of surgical treatment for curvature greater than 50°. Curvature greater than 40° was progressive and may require surgery in adulthood. Lumbar scoliosis showed greater potential progression than thoracic scoliosis in adulthood, requiring fusion as of 35° angulation. Level of evidenceIV, retrospective study.

Esthetic assessment of class III patients before and after surgical treatment according to the divine proportion

This study was designed to aesthetically assess class III patients before and after surgical treatment according to the divine proportion. Class III or mesio-occlusion, is characterized by the mesial relationship of the mandibular dental arch with respect to the maxillary dental arch taking as reference the mesial buccal cusp of the upper fi rst molar which occludesmesial to groove of the lower fi rst molar. This pathology greatly compromises facial esthetics and psychosocial status and adversely affects the self-esteem of those who suffer from it. It is one of the most diffi cult challenges that the clinician can face; if left untreated it can progress to a degree so severe, that in most cases, the only treatment option is orthognathic surgery in adulthood. Surgical techniques had their origin in the twentieth century from then on, they have been modified into versatile and predictable methods for the correction of maxillofacial malformations. The aesthetic problem is the main reason for consultation in orthodontics. The divine proportion is being studied more and more every day for diagnostic and therapeutic purposes related to facial aesthetics. Materials and methods: Twenty patients were included in the sample for this study. Pre and post-treatment cephalograms and photographs (scale 1.1) were obtained. Seven angular measurements were taken from the pre/post-treatment cephalograms and seven linear measurements were obtained from frontal photographs. Results: An inter-class correlation coeffi cient was conducted as calibration analysis in the measured proportions as well as a Student’s t-test for related samples. Conclusions: It was considered that in twenty-eight studied measurements, sixteen presented a statistically signifi cant difference approximating to the golden number after surgical treatment in class III patients. Key words: Divine proportion, class III patients, surgical treatment.