Skeletal and dental characteristics of subjects with incompetent lips

To evaluate the cephalometric features of subjects with incompetent lips, and to find the most discriminant variables for lip incompetence among the following: dental protrusion and proclination, antero-posterior and vertical skeletal relationships, and lip dimensions. This retrospective study was conducted at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia, between 2011 and 2012. Cephalograms of 84 subjects [22 males and 62 females, aged 20.18 +/- 3.65 years] diagnosed as having incompetent lips were collected [incompetent group [IG]] and compared with the control group [CG], matching in age and gender distribution. Thirty-five measurements were compared between the 2 groups using independent t-test. Stepwise discriminant analysis of lip incompetence was performed. Compared to the CG, subjects in the IG had thinner upper lips, shorter upper and lower lips, more retrognathic facial types, greater angle between nasion-point A and nasion-point B, shorter anterior and posterior cranial bases, shorter palatal length, shorter mandibular body length, shorter ramal length, steeper mandibular plane, less prominent chin, bimaxillary dental protrusion, and smaller inter-incisal angle. The significant discriminant variables, in order, were inter-incisor angle, inclination of upper incisors, ramal height, anterior cranial base, palatal plane to Frankfort horizontal plane angle, lower and then upper anterior dental height, upper lip thickness, and length. The presence of incompetent lips can be attributed to more than one factor and not only bimaxillary protrusion. This should be considered during the treatment planning of such problem

Ceftriaxone induced acute multi-organ failure syndrome in a Saudi boy with sickle cell disease

Multi-organ failure syndrome [MOFS] is a rare life threatening complication of sickle cell disease. It is precipitated by severe vaso-occlusive episodes. We report a Saudi boy with sickle cell anemia, who developed acute MOFS following anaphylaxis to ceftriaxone administration. He had a dramatic recovery after red blood cell exchange transfusion and peritoneal dialysis

'best fit' endotracheal tube in children - comparison of four formulae

Uncuffed endotracheal tubes are still being recommended by most pediatric anesthetists at our institutes. Different algorithms and formulae have been proposed to choose the best-fitting size of the tracheal tube. The most widely accepted is related to the age of the child [inner diameter [ID] in mm= [age in yr/4] +4; the second is a body, length-related formula [ID in mm=2 + height in cm/30]; the third, a multivariate formula [ID in mm=2.44 + age in yr x 0.1 + height in cm x 0.02 + weight in kg x 0.016] [5]; the fourth, the width of the 5[th] fingernail is used for ID prediction of the ETT [ID in mm = maximum width of the 5[th] fingernail]. The primary endpoint of this prospective study was to compare the size of the 'best fit' tracheal tube with the size predicted using each of the above mentioned formulae. With Institutional Ethics Committee approval and parental consent, 27 boys, 23 girls, ASA I-III, 2-10 years, scheduled for different surgical procedures requiring general anesthesia and endotracheal intubation, were enrolled in the study. The size of 'best fit' endotracheal tubes in those children were compared. The internal diameter considered the 'best fit' by the attending pediatric anesthesiologist was compared to age-based, length-based, multivariate-based and 5[th] fingernail width-based formulae. For all test, P<0.05 was considered to be statistically significant. The mean [SD] IDs for the 'best fit', age-based, length-based, multivariate and 5[th] fingernail techniques were 5.31 [0.691], 5.54 [0.622], 5.82 [0.572], 5.71 [0.67] and 5.43 [0.821] mm, respectively. The age-based and 5[th] fingernail width-based predictions of ETT size are more accurate than length-based and multivariate-based formulae in terms of mean value and case matching

Pain relief following thoracoscopic sympathectomy for palmar hyperhidrosis: a prospective randomised double-blind study

Acute pain management following thoracoscopic sympathectomy [TS] has been described in the literature. The combination of interpleural [IP] injection of bupivacaine and intramuscular injection. [I.M] NSAIDs has not been reported. Therefore we conducted this randomized controlled trial to compare this technique to other reported techniques described for postoperative analgesia following TS. 40 patients scheduled to have TS under general anesthesia for the treatment of hyperhidrosis were randomly allocated into 4 groups. Group 1 received 1.5 mg/kg b.w I.M pethidine at end of surgery. Group 2 received ketoprofen 100 mg I.M at end of surgery. Group 3 received 0.4 ml/kg b.w interpleural bupivacaine 0.5%. Group 4 received a combination of I.M ketoprofen [100 mg] in addition to interpleural bupivacaine [0.4 ml/kg]. Postoperative pain was assessed using the 11 point numeric rating score [NRS] at 7 different intervals. First, immediately on admission to PACU, every 2 hours for the next 8 hours then at 12 and at 24 hours. Pain was assessed at rest, during deep inspiration and while coughing. ANOVA was used for statistical analysis and Chi-square test for comparing of the data where P values <0.05 were considered significant. The NRS at rest was 3.2 [1.9], 2.4 [1.6], 3 [1.9] and 0.7 [0.9] at Groups 1, 2, 3 and 4 respectively with significant difference in Group 4 versus other Group [P<0.05] at 2 hours postoperatively and up to 24 hours postoperatively. The same trend was also found during maximal inspiration and while coughing. Opioid consumption in 24 hours was significantly reduced in Group 4 compared to other Groups. Combination of IP bupivacaine and I.M ketoprofen provided superior analgesia when compared to each modality alone and was better than intramuscular pethidine injection in terms of NRS and the consumption of rescue morphine postoperatively. Further studies are needed on large sample size to confirm our results

Neuroleptic-induced tardive dyskinesia among Arab psychotic patients

We carried out a retrospective descriptive study to determine prevalence and risk factors for tardive dyskinesia [TD] among psychotic patients treated with conventional neuroleptics in 4 centres in Saudi Arabia. Records of patients who had been taking

Cardiodynamic monitoring during laparascopic cholecystectomy

With increasing success of laparoscopy, the hemodynamic changes associated pneumoperitoneum [PPM] was described using invasive and non-invasive techniques with variable results. In the present study, we have used non-invasive cardiodynamic monitor to investigate the hemodynamic changes during laparoscopic cholecystectomy. Eleven patients who underwent laparoscopic cholecystectomy under general anesthesia were studied. Cardio dynamic monitor [thoracic bio- impedance] was used to investigate the hemodynamic changes. The following parameters were continuously monitored: Heart Rate [HR], mean arterial blood pressure [MAP], cardiac output [CO] and cardiac index [CI]. For statistical purpose, five phases were identified: [A], pre-PPM, [B], 2 min post-PPM, [C], 10 min post- PPM, [D], 30 min post-PPM, and [E], after gas deflation. SPSS package, Version 9 was used for statistical analysis of the data obtained. Student's t-test for paired observations was used for comparisons of the mean values of the data obtained, where P <0.05 was considered significant. There was significant change of the mean value of MAP in phases A and C. Also significant CI changes of the mean values was found between stages A and B [P <0.05]. The study showed, transient cardiac depression immediately after PPM with partial recovery after ten min, which was associated with increase in MAP