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At least 721 records · Page 40Linked to original sources

PubMed1996

High-resolution T2-weighted MR imaging of the inner ear using a long echo-train-length 3D fast spin-echo sequence.

The purpose of this study was to assess the value of a long echo-train-length 3D fast spin-echo (3D-FSE) sequence in visualizing the inner ear structures. Ten normal ears and 50 patient ears were imaged on a 1.5T MR unit using a head coil. Axial high-resolution T2-weighted images of the inner ear and the internal auditory canal (IAC) were obtained in 15 min. In normal ears the reliability of the visualization for the inner ear structures was evaluated on original images and the targeted maximum intensity projection (MIP) images of the labyrinth. In ten normal ears, 3D surface display (3D) images were also created and compared with MIP images. On the original images the cochlear aqueduct, the vessels in the vicinity of the IAC, and more than three branches of the cranial nerves were visualized in the IAC in all the ears. The visibility of the endolympathic duct was 80%. On the MIP images the visibility of the three semicircular canals, anterior and posterior ampulla, and of more than two turns of the cochlea was 100%. The MIP images and 3D images were almost comparable. The visibility of the endolymphatic duct was 80% in normal ears and 0% in the affected ears of the patients with Meniere's disease (p < 0.01). In one patient ear a small intracanalicular tumor was depicted clearly. In conclusion, the long echo train length T2-weighted 3D-FSE sequence enables the detailed visualization of the tiny structures of the inner ear and the IAC within a clinically acceptable scan time. Furthermore, obtaining a high contrast between the soft/bony tissue and the cerebrospinal/endolymph/ perilymph fluid would be of significant value in the diagnosis of the pathologic conditions around the labyrinth and the IAC.

Adult↗

PubMed2004

[Analysis of Foetal Heart Rate Data using Complex Software: Comparison of Recurrence Plot of Foetal Heart Rate with the Course of Pregnancy -].

BACKGROUND: Is it useful to further analyse foetal heart rate to improve the prediction of pregnancy complications? The analysis of the foetal heart rate is usually based on the variability of the heart rate, i. e. the more variable the heart rate presents - except a decrease - the better the condition of the foetus is. The same concept is applied in our own analysis which differs only in the presentation of the data. MATERIAL AND METHODS: We analysed 25 non-stress-tests from unselected third trimester pregnancies using sophisticated software. The recurrence plot (RP) is able to rearrange data from foetal heart rate monitoring in order to make the heart rate variability visible. We developed criteria for a normal and an abnormal test result describing the structure of the diagram to predict an uneventful and a high-risk pregnancy, respectively. RESULTS: 11 out of 11 patients with uneventful course and outcome of pregnancy showed a coarse and blurred RP pattern. 12 out of 14 (86 %) patients developing either intrauterine growth retardation or preeclampsia and requiring caesarean section because of foetal heart rate abnormalities showed a fine and clear RP pattern. CONCLUSIONS: Our preliminary results show that it makes sense to further evaluate foetal heart rate variability in order to predict pregnancy complications. Computer programs including the algorithms needed (calculation of the recurrence plot) are not expensive and easy to handle. A widespread use of these programs represents the basis requirement for large controlled clinical trials.

Analysis of Variance↗

PubMed1993

[Biomechanics of the knee joint].

The capsular and ligamentous structures as control system of a healthy knee-joint supported by the muscular system are responsible for the rolling and gliding motion of the femoral condyles on the tibial plateau. Both the condyles and the tibial plateau have individually developed but to each other adjusted shapes and fine structures thereby. These structures consist of hyaline cartilage at their three-dimensional surfaces and of closely packed fibrils (lamina splendens) as the final gliding zone for tensile load. The orientation of the collagenous fibres can be made visible by split lines. The chondral surfaces are indirectly in contact to each other and orthogonally stressed at the particular point of contact. The indirect contact of the cartilaginous surfaces happens under interposition of the menisci. The meniscus serves to reduce and equalize the surface pressure by its own projected surface on the one hand and by maintaining of a hydraulic pressure of the synovial fluid on the other hand. Deviations of the condylar position as a result on ligamentous instabilities or ruptures with a following occurring loss of congruence, meniscal lesions or traumatic ruptures lead to a rapid discharge of the synovial fluid under load. The result is a hydraulic head loss with direct contact of the chondral surfaces under stress leading to arthrotic deformations. Severe arthrotic deformations or very much every meniscectomy produce intraarticular lumped loads resulting in a hyper-physiologic chondral pressure and malnutrition thereby. Further on there develop subchondral stress concentrations (caused by the lumped loads) leading to osseous damages, too. MR-pictures can make visible these damages. Chondromalacia, fissure or even chondrolysis are arthroscopically detectable sometimes. As after-effects of deficient knee ligaments occur pathological deviations of the femoral condyles and resulting destructions of the articular surfaces under stress enormously intensified by strongly dynamic stress after ruptures of the cruciate ligaments with a too late muscular compensation. The reconstruction of cruciate ligaments is consequently required from biomechanical view to preserve the physiological position of the articular surfaces.(ABSTRACT TRUNCATED AT 400 WORDS)

Biomechanical Phenomena↗

PubMed1985

Arthrotomography of the wrist: an experimental and preliminary clinical study.

Experimental arthrotomography including posteroanterior and lateral projections was completed in 18 fresh-frozen wrists from cadavers with an average age of 65 years at death. Arthrotomographic findings were correlated with anatomic dissections. Three types of defects of the triangular fibrocartilage complex were clearly defined in 38% of wrists. Chondromalacia was present in 24% of wrists, in all cases on the ulnar half of the proximal surface of the lunate bone. The palmar radiocarpal ligaments (radiocapitate and radiotriquetral) were visible in all specimens. Experimental arthrotomography appears to be useful in defining the nature and location of soft tissue pathology in clinical practice. Clinical arthrotomography was performed in 16 patients, all with a syndrome of chronic wrist pain. Pathologic findings were observed in 11 wrists, including four perforations of the triangular fibrocartilage complex, two cases of chondromalacia of the lunate, one tear in each of the scapholunate and lunotriquetral ligaments, three occult palmar ganglia, and one recurrent dorsal ganglion. The soft tissues in five wrists were normal. The preliminary clinical experience with wrist arthrotomography has yielded results that have significantly affected the care of patients, including the planning of operative treatment and patient counseling.

Adolescent↗

PubMed2002

Drugs, health and the economy: investment, innovation, outcomes, growth.

Sustainability of the Canadian health system is currently foremost in the minds of many stakeholders. Historically, health expenditures have been viewed as ever increasing and with little visible economic return. Recently, economists have recognized the health arena as an important growth area within the total economy and have begun quantitative analyses of the impact of health investments as drivers of innovation and the general economic advance of nations. In particular, evidence has focused on the discovery and diffusion of new drugs as practical reflections of the quality ladder model of innovation, largely through their provision of improved duration and quality of life and accompanying productivity. The rate of return on innovative drug therapy within the universe of patients who could benefit is, however, impeded by under-prescription of, restricted access to, and/or impaired compliance with, newer efficacious drugs. The authors support further research to assist in future health policy decisions, including wider testing of the partnership/measurement model of disease management as a feasible tool to optimize the social rate of return on already-proven drug therapy. They further recommend these partnerships be designed with enough breadth of vision to facilitate their transition to operational projects compatible with evolving public health policies.

Canada↗

PubMed1990

Absence of pulmonary aspiration of sinus contents in patients with asthma and sinusitis.

The frequent association of asthma and paranasal sinusitis has been ascribed to a nasobronchial reflex, aspiration of sinus secretions, or enhanced beta-adrenergic blockade. We investigated possible pulmonary aspiration in a pilot study (eight patients) and follow-up study (13 patients) by means of a radionuclide technique. In the pilot study, the aim was to demonstrate aspiration as well as visibility of the radionuclide in the thorax during a period of 24 hours. The radionuclide was initially placed bronchoscopically in the bronchial tree in four patients and was still clearly visible in the same position after 24 hours in three patients. Aspiration from the nasopharynx was unequivocally demonstrated in two of four patients with depressed consciousness. The follow-up study population consisted of four patients with maxillary sinusitis only and nine patients with sinusitis and asthma. The radionuclide was placed in a maxillary sinus during therapeutic puncture. In the patients with only sinusitis as well as patients with asthma and sinusitis the radionuclide could be demonstrated in the maxillary sinus, nasopharynx, esophagus, and lower gastrointestinal tract during a 24-hour period. However, no pulmonary aspiration of radionuclide could be demonstrated in any patient. We conclude that seeding of the lower airways by mucopurulent secretions is unlikely to account for coexistent pulmonary disease. The association is probably related to generalized mucosal disease affecting both upper and lower airways.

Asthma↗

PubMed2004

Increasing the visibility of coding decisions in team-based qualitative research in nursing.

OBJECTIVES: To examine the use of the multi-rater Kappa measure of agreement (Nonparametric Statistics for the Behavioural Sciences, McGraw Hill, New York, 1988) in team based, mixed method, qualitative nursing research. DESIGN: The article presents an illustrative description of the application of the qualitative coding procedure and associated multi-rater Kappa measurement at four time points in 9 months amongst a five person health services research team. MAIN OUTCOME MEASURES: The multi-rater Kappa statistic. This is a measure of the extent to which observers achieve possible agreement beyond any agreement expected to occur by chance alone. RESULTS: Closeness to primary qualitative research data, working relationships over time, and focused research team discussion can all lead to greater agreement and convergence at the level of descriptive coding. The method of measuring agreement between groups of coders was easily applied and appeared a feasible option for similar research projects wishing to demonstrate transparency in their coding procedures. CONCLUSION: Measuring agreement beyond chance by the multi-rater Kappa statistic has some utility for research teams whose qualitative coding tasks are primarily descriptive. The method offers a standard and transparent approach for demonstrating agreement between coders and should be a feature of qualitative research reporting where appropriate.

Abstracting and Indexing↗

PubMed1998

Long-term follow-up and histological changes of superficial nonmelanoma skin cancers treated with topical delta-aminolevulinic acid photodynamic therapy.

OBJECTIVE: To investigate the immediate and long-term effects of photodynamic therapy with delta-aminolevulinic acid (ALA-PDT) on superficial basal cell carcinomas (BCC) and superficial squamous cell carcinomas (SCC). DESIGN: Retrospective study with 60 months of maximal follow-up. SETTING: University-based hospital in Graz, Austria. PATIENTS: Forty-seven subjects with a total of 95 superficial BCC and 35 superficial SCC. INTERVENTIONS: A compound of 20% delta-aminolevulinic acid was topically applied under an occlusive and light-shielding dressing before exposure to either UV-A or different wave bands of polychromatic visible light (full-spectrum visible light, >515, >570, or >610 nm). MAIN OUTCOME MEASURES: Primary tumor responses and recurrence rates in the long-term follow-up, as well as histological changes associated with ALA-PDT, were studied. RESULTS: The complete primary response rate for all wave bands of light was 86% (82/95) for superficial BCC and 54% (19/35) for superficial SCC. There was no statistically significant difference among the response rates to the different wave bands of light. After a median follow-up of 19 months (range, 3-60 months) for BCC and 8 months (range, 3-47 months) for SCC, the overall recurrence rate was 44% (36/81) and 69% (11/16), respectively. At 36 months after therapy, the projected disease-free rate was 50% (95% confidence interval, 43%-57%) for BCC vs 8% (95% confidence interval, 7%-9%) for SCC (P<.001, log-rank test). Histopathologic studies revealed a significant increase of fibrosis in the dermis after ALA-PDT and appearance of a sharp border between fibrotic and nonfibrotic tissue. In 15 of 16 BCC examined, the border between fibrotic and nonfibrotic tissue was deeper in the dermis than the maximum tumor thickness before therapy (P<.001, Wilcoxon signed rank test). Similar histopathologic observations were made in SCC. CONCLUSIONS: Our study revealed poor long-term cure rates for superficial BCC and SCC treated with topical ALA-PDT and visible light. The histopathologic observations showing remarkable fibrosis in the dermis indicated that the effect of ALA-PDT reached deeper than the initial depth of invasiveness of the neoplastic tissue, suggesting in turn that the poor long-term results of ALA-PDT cannot be explained by insufficient penetration of the therapy effect.

Administration, Topical↗

PubMed1998

Bioengineering in the Millennium, National Institute of Health Symposium, Bioengineering: Building the Future of Biology and Medicine.

This symposium identified the major challenges in biomedical research that will benefit from bioengineering applications. Attention was focused on the important role that bioengineers will play in future advances in biomedical research. There was considerable discussion about how to integrate bioengineering with biological research in meeting the challenges of the twenty-first century. Symposium presenters showcased the accomplishments of NIH-funded bioengineering researches and increased the visibility of bioengineering to NIH leaders, staff and members of the intramural and extramural research community. Recommendations were also made for future NIH-funded research projects. Attention was also placed on how basic bioengineering research can lead to commercialization of new health care technology and therefore maintain the Nation's leadership in this important area. New products, from biotechnology and novel devices for diagnosis and treatment, are marketed through interactions between universities, medical centers, small start-up firms, and larger, more established companies. In the United States the gross revenue of the bioengineering private sector industry involved in the manufacture of health care products already exceeds $40 billion. More than 750 persons attended this bioengineering symposium. Over 110 scientific posters and exhibits relating to biology and medicine were presented. They provided a forum for showcasing NIH-funded bioengineering projects and fostered future collaboration among academic investigators, industry and members of the small business community. The role of bioengineering in the 21st century has already been highlighted by the author as far as research, education and space age technologies are concerned. The contributions of Pugwash bioengineer, Maciej Natecz, a member of the Polish Academy of Sciences, was recognized by the Conference Planning Committee. He was honoured for his work in nuclear disarmament.

Biocompatible Materials↗

PubMed2000

Classification of clinical autofluorescence spectra of oral leukoplakia using an artificial neural network: a pilot study.

The performance of an artificial neural network was evaluated as an alternative classification technique of autofluorescence spectra of oral leukoplakia, which may reflect the grade of tissue dysplasia. Twenty-two visible lesions of 21 patients suffering from oral leukoplakia and six locations on normal oral mucosa of volunteers were investigated with autofluorescence spectroscopy (420 nm excitation, 465-650 nm emission). Pre-scaled spectra were combined with the corresponding visual and histopathological classifications in order to train artificial neural networks. A trained network is mapping input spectra to tissue characteristics, which was evaluated using a blind set of spectra. Abnormal tissue could be distinguished from normal tissue by a neural network with a sensitivity of 86% and a specificity of 100%. Also, classifying either homogeneous or non-homogeneous tissue performed reasonably well. Weak or no correlation existed between spectral patterns and verrucous or erosive tissue or the grade of dysplasia, hyperplasia and hyperkeratosis.

Adult↗

PubMed2001

Frequency and predictors for angiographically improved inflow of contrast medium after carotid angioplasty and stenting.

Percutaneous transluminal carotid angioplasty and stenting (PTAS) can result in immediate improvement in cerebral blood flow (CBF) evident through faster transit of contrast medium on angiography. To evaluate frequency and predictors of changes in inflow of contrast medium before and after PTAS, we reviewed 86 patients (mean age 68.6 +/- 9.1 years) treated for symptomatic or asymptomatic carotid stenosis. Clinical data and lesion characteristics were extracted from charts and digital angiograms, respectively. Perfusion change was assessed qualitatively by comparing pre- and poststenting images matched for projection and time from injection. Improved inflow was defined on the basis of spatial or temporal distribution of contrast medium: grade -1: fewer vessels visible after stenting; 0: no change; 1: more distal small arteries visible; 2: time-matched poststenting image showing a capillary blush; 3: time-matched poststenting image showing small veins, 4 time-matched poststenting image showing large veins and sinuses. Faster inflow of contrast medium was observed in 74% of patients (grades 1: 34%,and 4: 4.7%). In linear regression analysis, higher degrees of ipsilateral stenosis were associated with greater changes in inflow of contrast medium (P < 0.05). Right internal carotid lesions were associated with greater change in inflow than left-sided lesions (P < 0.01). In 31 patients (36%) we initially showed contralateral anterior cerebral artery (ACA) filling, and in 39% of these, normal filling was restored after stenting. Lesser contralateral carotid stenosis was associated with crossed ACA filling and with restoration of normal filling pattern after stenting. Faster appearance of a contrast-medium blush is seen in most cases of carotid angioplasty and stenting and depends on the degree of hemodynamic inflow obstruction relieved by stenting.

Adult↗

PubMed1979

Environmental effects of increased coal utilization: ecological effects of gaseous emissions from coal combustion.

This report is limited to an evaluation of the ecological and environmental effects of gaseous emissions and aerosols of various types which result from coal combustion. It deals with NOx, SOx, fine particulate, photochemical oxidant and acid precipitation as these pollutants affect natural and managed resources and ecosystems. Also, synergistic effects involving two or more pollutants are evaluated as well as ecosystem level effects of gaseous pollutants. There is a brief summary of the effects on materials and atmospheric visibility of increased coal combustion. The economic implications of ecological effects are identified to the extent they can be determined within acceptable limits. Aquatic and terrestrial effects are distinguished where the pollutants in question are clearly problems in both media. At present, acid precipitation is most abundant in the north central and northeastern states. Total SOx and NOx emissions are projected to remain high in these regions while increasing relatively more in the western than in the eastern regions of the country. A variety of ecological processes are affected and altered by air pollution. Such processes include community succession and retrogression, nutrient biogeochemical cycling, photosynthetic activity, primary and secondary productivity, species diversity and community stability. Estimates of the non health-related cost of air pollutants range from several hundred million dollars to $1.7 billion dollars per year. In general, these estimates include only those relatively easily measured considerations such as the known losses to cultivate crops from acute air pollution episodes or the cost of frequent repainting required as a result of air pollution. No substantial nationwide estimates of losses to forest productivity, natural ecosystem productivity which is tapped by domestic grazing animals and wildlife, and other significant dollar losses are available.

Air Pollution↗

PubMed1990

Nonselective preoperative digital subtraction angiography of internal mammary arteries.

In preparation for coronary bypass surgery, digital subtraction angiography (DSA) was used to assess the caliber of the left and right internal mammary arteries and to exclude stenoses of their feeding arteries. In 100 patients (86 males, mean age 56 +/- 9 years) DSA was performed with a Siemens Digitron 2 device. A frontal projection was used in 18 patients, and a 10-20 degree right anterior oblique projection was used in 82 patients. The flow was 10 to 25 ml/sec; 20 ml was injected in 45 patients, 30 ml in 41, 40 ml in 5, 50 ml in 8, and 60 ml in 1 patient. Judged on the proximal third, visualization of the left and the right internal mammary artery was good in 80 and 72, fair in 17 and 20, and bad in 3 and 8 arteries, respectively. The diameter (mm) was 2.7 +/- 0.4 (range 1.8-3.4) and 2.7 +/- 0.3 (range 2.0-3.5), and visible length (cm) was 8 +/- 5 (range 1-24) and 9 +/- 4 (range 2-22) for the two arteries, respectively. The 10-20 degree right anterior oblique view separated the left internal mammary artery better from the descending aorta than the frontal view. In more pronounced right anterior oblique views the ascending aorta interfered with the right internal mammary artery. The quality was not different with 20 ml or 30 ml injections. The feeding arteries could not be assessed in 4 patients. One left subclavian artery was found occluded at the orifice. Incidentally, 2 distal right subclavian stenoses and 2 carotid stenoses were detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography, Digital Subtraction↗

PubMed1988

Selective averaging of argon laser induced pre-pain and pain related cortical responses.

The argon laser was found to be suitable for pre-pain and pain stimulation. The visible (488 and 515 nm) argon laser light penetrates the skin and is absorbed by melanin and haemoglobin. Argon laser stimuli of different intensities were perceived differently, and could be classified into 3 pre-pain and 3 pain classes. The pre-pain sensations were either perceived as warmth, weak pin prick, or weak pin prick followed by warmth. The pain sensations were perceived as painful pin pricks of different intensities. Single cortical responses to argon laser stimuli were averaged selectively, according to this perceptual classification, and characteristic pre-pain and pain related cortical responses were recorded. The sensation of warmth was related to a late cortical deflection, 700-800 ms after stimulus onset, whereas the pin prick related response appeared with a latency of 300-400 ms. Pre-pain related responses were only recorded when selective averaging according to perception was used. The amplitude of the selectively averaged pain related cortical responses correlated with the subjective sensation of pain. Selective averaging of pre-pain and pain related single responses may prove useful in studying the cortical projection of different perceptions or modality patterns, and to investigate the function of the thermal and nociceptive pathways and their interactions.

Adult↗

PubMed2000

Detection of internal organ movement in prostate cancer patients using portal images.

Previous research has indicated that the appearance of large gas pockets in portal images of prostate cancer patients might imply internal prostate motion. This was verified with simulations based on multiple computed tomography (CT) data for 15 patients treated in supine position. Apart from the planning CT scan, three extra scans were made during treatment. The clinical target volume (CTV) and the rectum were outlined in all scans. Lateral portal images were simulated from the CT data and difference images were calculated for all possible combinations of CT scans per patient; each scan was used both as reference and repeat scan but gas pockets in the reference scan were removed. Gas pockets in a repeat CT scan then show up as black areas in a difference image. Due to gravity, they normally appear in the ventral part of the rectum. The distances between the ventral edge of a gas pocket in a difference image and the projection of the delineated ventral rectum wall in the reference scan were calculated. These distances were correlated with the "true" rectum wall shifts (determined from direct comparison of the rectum delineations in reference and repeat scan) and with CTV movements determined by three-dimensional chamfer matching. Gas pockets occurred in 23% of cases. Nevertheless, about 50% of rectum wall shifts larger than 5 mm could be detected because they were associated with gas pockets with a lateral diameter > 2 cm. When gas pockets were visible in the repeat scan, rectum wall shifts could be accurately detected by the ventral gas pocket edge in the difference images (r= 0.97). The shift of the rectum wall as detected from gas pockets also correlated significantly with the anterior-posterior shift of the center of mass of the CTV (r=0.88). In conclusion, the simulations showed that lateral pelvic images contain more information than the bony structures that are normally used for setup verification. If large gas pockets appear in those images, a quantitative estimate of the position of prostate and rectum wall can be obtained by determination of the ventral edge of the gas pocket.

Humans↗

PubMed1999

Intracranial stenoocclusive disease: double-detector helical CT angiography versus digital subtraction angiography.

BACKGROUND AND PURPOSE: To our knowledge, no large-scale studies comparing the accuracy of CT angiography (CTA) to intraarterial digital subtraction angiography (DSA) of intracranial stenosis have been reported. We attempted to determine the diagnostic value of intracranial CT angiography (CTA) of normal vasculature and variants as well as of stenoocclusive disease. METHODS: One-hundred and twelve patients underwent CTA and intraarterial angiography, and 2205 vascular segments were examined to ascertain presence, visibility, and degree of arterial stenoses (n = 105) as well as anatomic variants. Source, maximum intensity projection (MIP), and MIP-generated multiplanar reformatted (MPR) images were evaluated. RESULTS: All 55 anatomic variants were identified correctly. Visibility of small-vessel segments was increased from 75% to 83% by using source images. MPR was helpful in differentiating distal vertebral hypoplasia from stenosis and in overcoming artifacts. All 43 occlusive segments were graded correctly (sensitivity = 100%, predictive value = 93.4%) as follows: severely stenotic ([n = 23], sensitivity = 78%, predictive value = 81.8%); moderately stenotic ([n = 36], sensitivity = 61%, predictive value = 84.6%); and mildly stenotic ([n = 3], sensitivity = 66%, predictive value = 28%). Normal segments (n = 2100) had a sensitivity of 99.5%, and CTA evinced a specificity of 99% for detecting stenoocclusive disease. Approximately one-third of wrong assessments were related to the petrous segment of the carotid artery. CONCLUSION: CTA with double-detector technology and advanced postprocessing algorithms, including MPR, is about as reliable as MRA in depicting the vasculature of the anterior and posterior circulation and in grading intracranial stenoocclusive lesions, with the exception of the petrous segment of the carotid artery. CTA might be superior to MRA in the evaluation of poststenotic low-flow segments.

Angiography, Digital Subtraction↗

PubMed2002

Endoscopy-assisted open treatment of condylar fractures of the mandible: extraoral vs intraoral approach.

By using an endoscopy assisted extraoral and transoral approach for open reduction of condylar mandible fractures with limited incisions, the risk of facial nerve damage and extensive visible scars can be reduced. The endoscopy-assisted treatment of 17 consecutive patients with fractures of the condyle was performed from April 1998 to December 1999. Of the 17 patients, 13 presented with additional mandibular fractures. Nine of the 17 patients were treated by a submandibular approach and eight by a transoral approach. Adequate anatomic reduction was achieved by the submandibular and transoral approach using an endoscopy-assisted technique. The transoral approach proved to be a reliable surgical approach for fractures of the mandibular condyle, even when dislocation with lateral override was present. In four patients, angulated drills and screwdrivers facilitated the transoral treatment of condylar fractures. Transbuccal stab incisions and the use of trochars were not needed in these four patients. The extraoral approach was indicated for severely dislocated fractures such as fractures with medial override or comminution.

Adult↗

PubMed2006

Radiofrequency in the treatment of craniofacial plexiform neurofibromatosis: a pilot study.

BACKGROUND: Neurofibromatosis type 1 manifests itself by the development of plexiform neurofibromas, with craniofacial deformities caused by bone alterations and soft-tissue infiltration. The medical treatment of this disease is disappointing, and the surgical management of these deformities calls for aggressive procedures. There is a strong risk of recurrence. METHODS: A pilot study was performed to test radiofrequency as a minimally invasive method with which to diminish the size of craniofacial neurofibromas either as an adjunct to craniofacial surgery (in cranio-orbital neurofibromas) or to avoid a visible scar in young patients (in infraorbital neurofibromas). Five patients ranging in age from 6 to 18 years were treated by three procedures 2 months apart using radiofrequency performed under local anesthesia or under sedation for the youngest patients. RESULTS: The tolerance of the treatment was excellent, with no major side effects and no pain in the postoperative course. A diminution of the size of the lesion was noted clinically in four patients and on computed tomography in two patients. A biopsy performed in one case illustrated the effect of the treatment. CONCLUSIONS: A partial diminution or stabilization of plexiform neurofibromas may be obtained using radiofrequency. This treatment is well tolerated. The best effect can be observed in the early stages of the disease. The optimal dose and frequency of the procedure require further study.

Adolescent↗