Chair side measuring instrument for quantification of the extent of a transverse maxillary occlusal plane cant / 대한악안면성형재건외과학회지

BACKGROUND@#Treatment planning the correction of a transverse maxillary occlusal plane cant often involves a degree of qualitative “eyeballing”, with the attendant possibility of error in the estimated judgement. A simple chair side technique permits quantification of the extent of asymmetry and thereby quantitative measurements for the correction of the occlusal plane cant.@*METHODS@#A measuring instrument may be constructed by soldering the edge of a stainless steel dental ruler at 90° to the flat surface of a similar ruler. With the patient either standing in natural head position, or alternatively seated upright in the dental chair, and a dental photographic retractor in situ, the flat under-surface of the horizontal part of this measuring instrument is placed on a unilateral segment of a bilateral structure, e.g. the higher maxillary canine orthodontic bracket hook. The vertical ruler is held next to the contralateral canine tooth, and the vertical distance measured directly from the canine bracket to the flat under-surface of the horizontal part of the measuring instrument.@*RESULTS@#This vertical distance quantifies the overall extent of movement required to level the maxillary occlusal plane.@*CONCLUSIONS@#This measuring instrument and simple chair side technique helps to quantify the overall extent of surgical levelling required and may be a useful additional technique in our clinical diagnostic armamentarium.

The maxillary incisor labial face tangent: clinical evaluation of maxillary incisor inclination in profile smiling view and idealized aesthetics / 대한악안면성형재건외과학회지

BACKGROUND@#To test the hypothesis that in profile smiling view, for ideal aesthetics, a tangent to the labial face of the maxillary central incisor crowns should be approximately parallel to the true vertical line and thereby perpendicular to the true horizontal line.@*METHODS@#An idealized female image was created with computer software and manipulated using the same software to construct an “ideal” female profile image with proportions, and linear and angular soft tissue measurements, based on currently accepted criteria for idealized Caucasian profiles. The maxillary incisor labial face tangent was altered in 5° increments from 70 to 120°, creating a range of images, shown in random order to 70 observers (56 lay people and 14 clinicians), who ranked the images from the most to the least attractive. The main outcome was the preference ranks of image attractiveness given by the observers.@*RESULTS@#The most attractive inclination of a tangent to the labial face of the maxillary incisor crowns in profile view in relation to the true horizontal line was 85°, i.e. 5° retroclined from a perpendicular 90° inclination. The most attractive range appears to be between 80 and 90°. Excessive proclination appeared to be less desirable than retroclination. Beyond 105° most observers recommend treatment.@*CONCLUSION@#In natural head position, the ideal inclination of the maxillary incisor crown labial face tangent in profile view will be approximately parallel to the true vertical line and thereby approximately perpendicular to the true horizontal line.

Predictive factors for residual tumor and tumor upstaging on relook transurethral resection of bladder tumor in non-muscle invasive bladder cancer

Relook transurethral resection of bladder tumor [TURBT] improves the diagnostic and therapeutic efficacy of primary TURBT. However, it is still not established as to which category of patients would benefit most from this repeat invasive procedure. This prospective interventional study was designed to identify the category of patients with non-muscle invasive bladder cancer who may benefit from a routine relook procedure. A total of 52 consecutive patients with biopsy proven non muscle invasive bladder cancer on primary TURBT underwent a relook TURBT between March 2011 and September 2012. The incidence of residual tumor and tumor upstaging on relook procedure was correlated with various histopathological [stage, grade, CIS, presence of muscle] and cystoscopic [type and focality of tumor, any apparent field change] parameters on primary TURBT. Out of the total 52 patients, 23 [44.2%] had a residual tumor on relook TURBT. 12 [23.1%] were upstaged [of these 9 i.e. 17.3% to muscle invasion]. While most of the parameters studied showed a positive correlation with incidence of residual tumor and upstaging to muscle invasion, statistical significance [for both] was reached only for tumor stage [P = 0.028 and 0.010], tumor grade [P = 0.010 and 0.002] and tumor type [solid vs. papillary; P = 0.007 and 0.001]. Carcinoma in situ showed a significant correlation with incidence of residual tumor [P = 0.016] while the absence of muscle in the primary TURBT specimen was significantly associated with upstaging to muscle invasive disease [P = 0.018]. The data was analyzed using SPSS software v. 16.0. Relook TURBT may be especially recommended for high grade and T1 tumors and tumors with a solid/sessile appearance on primary TURBT especially when deep muscle was absent in the primary TURBT specimen

clinical utility of a non-mydriatic retinal camera in a diabetes clinic

we aim to evaluate a non-mydriatic retinal camera as a safe and efficacious screening tool, for diabetic retinopathy, in diabetes centers. 221 consecutive patients attending a Diabetes Center submitted to retinal photographs using a non-mydriatic camera. Patients were included if they had not had previous laser therapy and if they had a formal ophthalmologic consultation within 6 months of the photography Four endocrinologists reviewed the retinal photographs and recommended an interval [urgent referral, early referral, non-referral] for ophthalmologic assessment. Endocrinologists' grades were compared against the gold standard of ophthalmological findings. The endocrinologists were privy only to the patient's age, type and duration of diabetes mellitus. Twenty-seven cases were deemed as requiring early referral by the ophthalmologists. The endocrinologists agreed with ophthalmologist referral times in 27, 26, 23 and 27 cases respectively. Two cases requiring urgent referral according to the ophthalmologists were also judged as requiring urgent referral by all endocrinologists. A mean sensitivity of 95.4% [95% CI 88.5%-100%] was attained. The use of a non-mydriatic camera to determine need for ophthalmologic referral was found to be safe and efficacious, with no serious delays in referral noted. On average this tool can safely defer 53.5% of routine ophthalmologic referrals without any risk to the patient's eyesight

Laparoscopic evaluation of two different anti-reflux techniques of uretero-intestinal anastomosis: metabolic impact

Split-nipple [n=10] and the submucosal tunnel [n=10] antireflux uretero-intestinal anastomotic techniques were performed employing 12 female pigs with average weight ranging from 35 to 40 kg. Preoperative intestinal preparation, both chemical and mechanical, was achieved 48 hours prior to surgery. Renal panel was also performed for all animals pre- and postoperatively. A 5-port trans-peritoneal technique was employed. The procedure comprised bilateral dissection of the ureters, hemicystectomy, isolation of a 20 cm ileal segment, ureter-intestinal anastomosis and ileo-cystoplasty. Animals were followed up for a period ranging from two weeks to three months. Bilateral antireflux uretero-ileal anastomoses were completed in all 10 animals with average total operative time of 4.5 hours and mean blood loss of 40 ml. All technical maneuvers could be performed completely intracorporealy using laparoscopic techniques. Mean pre- and postoperative serum creatinine was 1.1 and 1.2 mg%, respectively. All animals were non refluxing, however, two of the split-nipple uretero-ileal anastomosis had ureteral strictures. There were no significant metabolic effects of using intestinal segments in this procedure

Breast diseases: a histopathological analysis of 3279 cases at a tertiary care center in Pakistan

To know the frequency of breast diseases in Pakistani females. A retrospective analysis of 3279 breast specimens received over a period of 4 years [1993-1996] at the department of pathology, the Aga Khan University Hospital. Out of a total of 3279 breast specimens, common breast lesions included infiltrating duct carcinoma 37%, followed by fibro adenoma 16.95%, fibrocystic change13.96%, mastitis 6.83% and duct ectasia 5.33%. Majority of the cases of infiltrating duct carcinoma were encountered in the 5th and 6th decades of life. Tumour size was 2 or >2 cms. in 93% of cases and 40% of them showed 3 or >3 positive lymph nodes. Grade I tumours were 11.38%, grade II 59.17% and grade III tumours 29.47%. Correlation of grade with lymph node metastases [3 or >3+ve nodes] showed 15 cases [1.53%] of grade I, 178 cases [18.25%] of grade II and 68[6.97%] cases of grade III tumours. This study shows that in Pakistani females, the most commonly encountered lesion in carcinoma of the breast followed by the benign lesions such as fibro adenoma, fibrocystic disease and others. Breast carcinoma occurs at a younger age group with predominance of high-grade lesions and with frequent lymph node metastasis

Male breast cancer

To review cases of male breast cancer. Histopathology Section, Department of Pathology, The Aga Khan University, Karachi. Fifty one cases of male breast cancer specimens, received during a period of 10 years, routinely processed and stained with Haematoxylin and Eosin were analyzed. Special stains and Immunohistochemistry were used in difficult cases. Male breast cancer affected individuals in the sixth and seventh decades of life with a mean age of 56.2 years. Infiltrating ductal carcinoma [IDC] was the predominant type. Skin involvement was seen in 27.45% of the cases. Breast lump was the most common presenting symptom followed by skin ulceration. At the time of presentation 43.13% patients had a tumour size of more than 3 cm. Male breast cancer is a rare disease. Most of our findings correspond to the published local and international data

Morphological pattern of salivary gland tumours

OBJECTIVE: To delineate the spectrum of salivary gland tumors in our setup. SETTING: The Aga Khan University Medical Centre, Karachi. METHOD: Tumors were analysed considering histological type, age and sex of the patients and anatomic location. The diagnosis of individual tumours was based on the 1991 World Health Organisation Classification. During the span of eight years [1991-1998], 379 cases of salivary gland tumours were diagnosed. Of these, 205 [65.7%] were male and 174 [34.3%] were female. The median age at the time of diagnosis was 35 years. The median age for patients with malignant lesions [44 years] was 12 years older than those with benign tumours [34 years]. Overall, malignant tumours were seen more frequently in males, however benign tumours were distributed equally between the two sexes. The most common site was parotid gland [82.85%]. Only five cases of minor salivary gland tumours were seen. The most frequently diagnosed benign salivary gland neoplasm was pleomorphic adenoma [84.5%], followed by Warthin's tumours [6.18%], Mucoepidermoid carcinoma was the most commonly encountered malignant lesion [56.9%], followed by adenoid cystic carcinoma [19.6%]. Plemorphic adenoma was the most common benign salivary gland tumour and mucoepidermoid carcinoma was the most frequent malignant neoplasm. Parotid gland was the most common site of origin in both benign and malignant tumours. The overall relative frequency of salivary gland tumours in this series correlates with that reported in the international literature

Laparoscopic intracorporeally-constructed Ileal conduit after porcine cystoprostatectomy

Introduction and Objectives: ileal conduit urinary diversion following cystoprostatectomy has not been reported by the laparoscopic intrracorporeal technique to date. Herein, we present our technique of laparoscopic ileal conduit following cystoprostatectomy in the porcine model performed in a completely intracorporeal manner. After developing the technique in 5 acute animals, laparoscopic cystoprostatectomy with intracoporeally performed ileal conduit urinary diversion was performed in 10 male survival pigs. A 5-port transperiloneal technique was used. All steps of the technique as applied during open surgery were duplicated intracorporeally, Specifically, cystectomy, isolation of an ileal conduit, restoration of bowel continuity, and mucosa to mucosa, stented bilateral ileoureteral anastomosis were performed with exclusively intracorporeal laparoscopic techniques. Surgery was successful in all 10 study animals without intraoperative or immediate postoperative complications. Blood loss was minimal and operating time 'averaged 290 minutes. An end ileal stoma was formed at the right lower quadrant port site. At euthanasia, renal function was normal in all surviving animals. No ileoureteral anastomotic strictures were noted on pre-euthanasia loopgrams or on post-mortem examination of the anastomotic sites. Laparoscopic ileal conduit urinary diversion .following cystoprostatectomy can be performed completely intracorporeally in the porcine model. Clinical application of this technique is imminent