Craniofacial growth: evolving paradigms.

AIMS: Numerous theories about craniofacial growth have been formulated in the last century. The most influential hypotheses were: genetic, synthetic and functional matrix revisited. Moreover, a large number of experts from different fields tried to explain craniofacial growth and its developmental mechanisms, in order to deliver the best treatment possible to orthodontic patients. The aim of this review is to summarize recent concepts on craniofacial growth, overlap these theories with the development of the general scientific knowledge, and suggest a more integrated multidisciplinary person-based approach. METHODOLOGY: MEDLINE, EMBASE, Pubmed, CINAHL and Google Scholar were screened from inception to February 2014 for relevant papers. Grey literature was considered as part of the search. CONCLUSIONS: The influence of new scientific discoveries and intuitions about craniofacial growth produced further insights in orthodontics care, shifting the paradigm from a pre-determined, sectorial treatment to an individualized, multidisciplinary patient-centered approach aiming to enhance the quality of orthodontic assistance.

Combined hysteroscopic findings and 3-dimensional reconstructed coronal view of the uterus to avoid laparoscopic assessment for inpatient hysteroscopic metroplasty: pilot study.

STUDY OBJECTIVE: To assess the use of 3-dimensional (3D) reconstructed coronal view of the uterus and intraoperative hysteroscopic findings to avoid diagnostic laparoscopy during inpatient hysteroscopic metroplasty. DESIGN: Pilot study (Canadian Task Force classification II). SETTING: University hospital infertility clinic. PATIENTS: Fifty-nine patients with recurrent abortion and double uterine cavity with 3D sonographic diagnosis of septate uterus undergoing inpatient hysteroscopic metroplasty. INTERVENTIONS: Inpatient hysteroscopic treatment of septate uterus without laparoscopic diagnosis. In addition to sonographic observations, 2 intraoperative hysteroscopic criteria were used to confirm the diagnosis: visualization of muscular fibers and myometrial blood vessels. MEASUREMENTS AND MAIN RESULTS: Operative parameters (operative time and fluid absorption), complications (incomplete resection and uterine perforation), requirement for a second intervention, and shape of the uterine cavity at hysteroscopic follow-up. In 56 of 59 patients (94.9%), intervention was performed without complications, and in 3 cases, intervention was suspended because of intraoperative suspicion of bicornate uterus. These 3 patients underwent laparoscopy, which confirmed the diagnosis of septate uterus. In all cases, incision was considered sufficient. Postoperative diagnostic hysteroscopy in all patients showed a normal cavity (fundal notch <1 cm). CONCLUSIONS: Combined use of hysteroscopic confirming criteria and 3D sonography seems to be a reliable and simple strategy for characterizing the presence of septate uterus and to perform inpatient metroplasty usually without laparoscopic visualization of the uterine fundus.

Leptin concentrations in the peritoneal fluid of women with ovarian endometriosis are different according to the presence of a 'deep' or 'superficial' ovarian disease.

Some studies have suggested a possible role of leptin, an active cytokine produced by adipocytes, in the pathogenesis of pelvic endometriosis. The present study was designed to assess leptin levels in the peritoneal fluid (PF) of women with the 'deep' or 'superficial' types of ovarian endometriosis. Twenty-seven women with a single ovarian endometrioma having a mean diameter between 3 and 5 cm were included in the study. Patients were divided into two groups according to the type of ovarian endometriosis: Group A (n = 11) consisted of women with 'superficial' endometriomas located at the ovarian surface; Group B (n = 16) included patients with 'deep' intra-ovarian endometriomas. Women undergoing laparoscopy for unexplained infertility and not affected by pelvic and/or ovarian endometriosis were considered as controls (Group C, n = 10). Patients with an ovarian endometrioma had significantly increased PF leptin concentrations than endometriosis-free controls (Groups A and B vs. Group C, p < 0.01). Patients with 'superficial' endometriomas had significantly higher PF leptin levels compared with patients with 'deep' endometriomas (Group A vs. B, p < 0.01). This difference remained significant after correction for the BMI; moreover, a positive correlation between PF leptin and BMI was observed in Groups B and C, but not in women with 'superficial' endometrioma (Group A). Our observations suggest that: (a) leptin could play an active role in promoting the development of 'superficial' ovarian endometriomas and (b) 'superficial' and 'deep' ovarian endometriomas could have a different pathogenesis.

Compliance and diagnostic efficacy of mini-hysteroscopy versus traditional hysteroscopy in infertility investigation.

OBJECTIVE: The aim of this study was to compare traditional hysteroscopy with mini-hysteroscopy in terms of compliance, side effects and diagnostic efficacy. STUDY DESIGN: We prospectively considered 950 female candidates for an IVF programme. All women underwent outpatient hysteroscopy; in 602 cases (Group A) a mini-hysteroscope was employed; in 348 women (Group B) a 5-mm hysteroscope was adopted. RESULTS: Cavity findings were similar in both groups. Endometrial polyps and uterine septum seem to be more frequent in our infertile patients than in the general population. No significant differences in terms of side effects were found between the groups. Mean visual analogue pain scale score was significantly lower in the patients of Group A than in those of Group B (p<0.001). CONCLUSIONS: Office mini-hysteroscopy is a very effective diagnostic tool in an infertility work-up and is more widely accepted than traditional hysteroscopy. Routine use of the technique should be considered.