The Impact of Unplanned Reoperation Following Adult Spinal Deformity Surgery: A Prospective Longitudinal Cohort Study with 5-Year Follow-up.

BACKGROUND: The long-term impact of reoperations following adult spinal deformity (ASD) surgery is still poorly understood. Our aim was to identify the relationship between unplanned reoperation and health-related quality of life (HRQoL) gain at 2 and 5 years of follow-up. METHODS: We included patients enrolled in a prospective ASD database who underwent surgery ≥5 years prior to the start of the study and who had 2 years of follow-up data. Adverse events (AEs) leading to an unplanned reoperation, the time of reoperation occurrence, invasiveness (blood loss, surgical time, hospital stay), and AE resolution were assessed. HRQoL was measured with use of the Oswestry Disability Index, Scoliosis Research Society-22, and Short Form-36. Linear models controlling for baseline data and index surgery characteristics were utilized to assess the relationships between HRQoL gain at 2 and 5-year follow-up and the number and invasiveness of reoperations. The association between 5-year HRQoL gain and the time of occurrence of the unplanned reoperation and that between 5-year HRQoL gain and AE resolution were also investigated. RESULTS: Of 361 eligible patients, 316 (87.5%) with 2-year follow-up data met the inclusion criteria and 258 (71.5%) had 5-year follow-up data. At the 2-year follow-up, 96 patients (30.4%) had a total of 165 unplanned reoperations (1.72 per patient). At the 5-year follow-up, 73 patients (28.3%) had a total of 117 unplanned reoperations (1.60 per patient). The most common cause of reoperations was mechanical complications (64.9%), followed by surgical site infections (15.7%). At the 5-year follow-up, the AE that led to reoperation was resolved in 67 patients (91.8%). Reoperation invasiveness was not associated with 5-year HRQoL scores. The number of reoperations was associated with lesser HRQoL gain at 5 years for all HRQoL measures. The mean associated reduction in HRQoL gain per unplanned reoperation was 41% (range, 19% to 66%). Reoperations resulting in no resolution of the AE or resolution with sequelae had a greater impact on 5-year follow-up HRQoL scores than reoperations resulting in resolution of the AE. CONCLUSIONS: A postoperative, unplanned reoperation following ASD surgery was associated with lesser gain in HRQoL at 5 years of follow-up. The association did not diminish over time and was affected by the number, but not the magnitude, of reoperations. Resolution of the associated AE reduced the impact of the unplanned reoperation. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Translation, Adaptation, and Validation of a Spanish Version of the Japanese Orthopaedic Association Cervical Myelopathy Questionnaire.

STUDY DESIGN: Translation and psychometric testing of a questionnaire. OBJECTIVE: Translation, adaptation, and validation of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) to the Spanish language. SUMMARY OF BACKGROUND DATA: Degenerative cervical myelopathy (DCM) has a clear impact on quality of life (QoL). The JOACMEQ is a self-administered questionnaire used to assess DCM-related disability and its impact on QoL. It is compound of five domains: Cervical Function, Upper Extremity Function, Lower Extremity Function, Blader Function, and QoL. Despite its increasing use, the JOACMEQ has not yet been translated and validated for Spanish-speaking patients. METHODS: A total of 180 patients completed the Spanish version. Of these, 145 (80%) had DCM (mean age: 62.53; SD: 9.92), while 35 had neck pain without DCM (age: 52.71; SD: 10.29). The psychometric properties measured were construct validity, internal consistency, reproducibility, concurrent validity, and discriminatory ability. RESULTS: We recruited 145 patients with DCM (mean age: 62.5) and 35 with cervical pain (mean age: 52.7). After factor analysis, our data showed very strong construct validity, with questions strongly loaded and clustered for five factors. Internal consistency proved high (Cronbach's α coefficient of 0.912). The intraclass correlation coefficient showed very good reproducibility for all domain (intraclass correlation coefficient range between 0.85 and 0.95). A high correlation between the JOACMEQ QoL domain and neck disability index was also found (Spearman's ρ=-0.847, P <0.01) confirming concurrent validity. The receiver operating characteristic curves proved to be significant in the upper (area under the curve=0.65, P =0.006) and lower (area under the curve=0.661, P =0.003) extremities, confirming discriminatory ability. CONCLUSIONS: Our proposed Spanish version of the JOACMEQ retains the psychometric characteristics of the original JOACMEQ and could prove useful for the evaluation of patients with DCM in Spanish-speaking countries.

Myelopathy disability index: establishing criteria for mild, moderate and severe impairment in patients with degenerative cervical myelopathy.

PURPOSE: To find the cut-off values in the Myelopathy Disability Index (MDI) that will allow us to classify the severity of Degenerative Cervical Myelopathy (DCM) into mild, moderate and severe. METHODS: Cross-sectional study with prospective data collection, with a total of 64 patients diagnosed with Degenerative Cervical Myelopathy (DCM). Anthropometric, diagnostic, neurological, functional and quality of life variables were collected. A Receiver Operating Curve (ROC) was performed. The cut-off points were validated by comparing the functional status of patients in the 3 groups and their Nurick scores. RESULTS: Sixty-four patients (23 women) with a mean age of 61.97 (SD 11.57) participated in this study. The majority of patients were Nurick I (28.13%) and Nurick II (32.81%). The medium MDI was 7.36 (SD 6.66) and the mJOA was 14.08 (SD 2.57). The mild-moderate cut-off value was between 4 and 5, with an Area Under the Curve (AUC) of 0.805, sensitivity of 0.853 and specificity of 0.6. For moderate-severe, the cut-off value obtained was between 7 and 8, with an AUC of 0.862, sensitivity of 0.857 and specificity of 0.684. Patients with greater severity had significantly lower functionality, with a P-value of 0.004 in the 30 Metre Walking Test and 0.005 in the Nine-Hole Peg Test. Established severity groups were also significantly related to the different categories of the Nurick score (P-value = 0.000). CONCLUSION: MDI values between 0 and 4 correspond to mild DCM, between 5 and 7 would be moderate DCM and from 8 to 30 indicate severe DCM.

Diastereomeric Separation of Chiral fac-Tricarbonyl(iminopyridine) Rhenium(I) Complexes and Their Cytotoxicity Studies: Approach toward an Action Mechanism against Glioblastoma.

A series of new (tricarbonyl)rhenium(I) complexes were synthesized using chiral bidentate ligands (+)/(-)-iminopyridines (LR/LS). The reaction yielded a mixture of mononuclear Re(I) diastereoisomers, formulated as fac-[Br(CO)3Re(S/R)L(S/R)]. Each single diastereoisomer was isolated and fully characterized. X-ray crystallography and circular dichroism spectra verified their enantiomeric nature. The cytotoxicity of each complex was evaluated against six cancer cell lines. The effect of the two complexes on viability, proliferation, and migration was analyzed on glioblastoma cell lines (U251 and LN229). Changes in the expression of histones, apoptotic, and key signaling proteins, as well as alterations in DNA structure, were also observed. These experiments showed that the chirality associated with both metal and ligand has a strong influence on cytotoxicity.

Enfermedad de Kawasaki en pediatría: caso clínico

la enfermedad de Kawasaki (EK) es una vasculitis multisistémica que se presenta en la infancia. Por lo general es una afección aguda, febril, autolimitada, de etiología desconocida y puede desarrollar alteraciones cardiovasculares; su expresión clínica es variable: presenta inflamación de los vasos de mediano calibre y de múltiples tejidos: pulmonar, meníngeo, cardiaco, urinario, gastrointestinal, musculoesquelético, neurológico o linfático. El diagnóstico y el tratamiento buscan disminuir la duración de los síntomas y prevenir la presencia de aneurismas coronarios.

Kawasaki disease (KD) is a multisystemic vasculitis that presents in childhood. It is usually an acute, febrile, self-limited disease of unknown etiology and may develop cardiovascular alterations; its clinical expression is variable as it presents inflammation of medium caliber vessels and multiple tissues: pulmonary, meningeal, cardiac, urinary, gastrointestinal, musculoskeletal, neurological or lymphatic. Diagnosis is clinical, and treatment aims to reduce the duration of clinical symptoms and prevent the presence of coronary aneurysms. Objective: to describe the clinical case of an infant patient with KD, in which clinical criteria characteristic of this pathology were identified. Case report: a 22-month-old male patient was admitted to the emergency room with a 14-day evolutionary clinical picture consisting of fever, emetic episodes, abdominal pain, unresponsive to acetaminophen, and diarrheal episodes. Two days later, he manifested generalized exanthema in the inguinal region that spread to the right testicle, back, and thorax. Subseguently, he presented bilateral nonpurulent conjunctivitis for three days. He received treatment with topical steroids and oral antihistamines; partial improvement with subseguent evolution in right testicularedema and bilateral desquamation in hands and feet. KD was suspected, a transthoracic echocardiogram was sent without coronary aneurysmal dilatations, and treatment with ASA was started without indication, given the evolution of immunoglobulin. Conclusions: KD is infrequent in childhood and should be suspected in patients with prolonged febrile symptoms unresponsive to conventional treatments and in whom the presence of other pathologies is ruled out.

a doença de Kawasaki (DK) é uma vasculite multissistêmica que ocorre na infância. Geralmente é uma doença aguda, febril, autolimitada, de etiologia desconhecida, podendo desenvolver alterações cardiovasculares; sua expressão clínica é variável, apresentando inflamação de vasos de médio porte e de múltiplos tecidos: pulmonar, meníngeo, cardíaco, urinário, gastrointestinal, musculoesquelético, neurológico ou linfático. O diagnóstico é clínico e o tratamento visa reduzir a duração dos sintomas clínicos e prevenir a presença de aneurismas coronábanos. Objetivo: descrever o caso clínico de um paciente infantil com DK, no qual foram identificados critérios clínicos característicos dessa patologia. Caso clínico: paciente do sexo masculino, 22 meses de idade meses de idade, admitido no departamento de emergência com um curso clínico de 14 dias, consistindo em febre, episódios eméticos e dor abdominal, sem resposta ao acetaminofeno, além de episódios diarreicos. Dois dias depois, ele desenvolveu uma erupção cutánea generalizada na região inguinal que se espalhou para o testículo direito, costas e tórax. Posteriormente, ele apresentou conjuntivite bilateral não purulenta por três dias. Ele foi tratado com esferoides tópicos e anti-histamínicos orais; houve melhora parcial com posterior evolução do edema testicular direito, descamação bilateral nas mãos e nos pés. Suspeitou-se de DK, portanto foi realizado ecocardiograma transtorácico sem dilatações aneurismáticas coronarianas e iniciado tratamento com AAS, sem indicação devido ao tempo de evolução da imunoglobulina. Conclusões: a DK não é frequente na infância e deve ser suspeitada em pacientes com sintomas febris prolongados que não respondem aos tratamentos convencionais e nos quais a presença de outras patologias é descartada.

Inter- and intra-observer agreement using the new AOSpine sacral fracture classification, with a comparison between spine and pelvic trauma surgeons.

BACKGROUND: Sacral fractures treatment frequently involves both spine and pelvic trauma surgeons; therefore, a consistent communication among surgical specialists is required. We independently assessed the new AOSpine sacral fracture classification's agreement from the perspective of spine and pelvic trauma surgeons. METHODS: Complete computerized tomography (CT) scans of 80 patients with sacral fractures were selected and classified using the new AOSpine sacral classification system by six spine surgeons and three pelvic trauma surgeons. After four weeks, the 80 cases were presented and reassessed by the same raters in a new random sequence. The Kappa coefficient (κ) was used to measure the inter-and intra-observer agreement. RESULTS: The inter-observer agreement considering the fracture severity types (A, B, or C) was substantial for spine surgeons (κ= 0.68 [0.63 - 0.72]) and pelvic trauma surgeons (κ= 0.74 (0.64 - 0.84). Regarding the subtypes, both groups achieved moderate agreement with κ= 0.52 (0.49 - 0.54) for spine surgeons and κ= 0.51 (0.45 - 0.57) for pelvic trauma surgeons. The intra-observer agreement considering the fracture types was substantial for spine surgeons (κ= 0.74 [0.63 - 0.75]) and almost perfect for pelvic trauma surgeons (κ= 0.84 [0.74 - 0.93]). Concerning the subtypes, both groups achieved substantial agreement with, κ= 0.61 (0.56 - 0.67) for spine surgeons and κ= 0.68 (0.62 - 0.74) for pelvic trauma surgeons. CONCLUSION: This classification allows an adequate communication for spine surgeons and pelvic trauma surgeons at the fracture severity type, but the agreement is only moderate at the subtype level. Future prospective studies are required to evaluate whether this classification allows for treatment recommendations and establishing prognosis in patients with sacral fractures.

An independent inter- and intraobserver agreement assessment of the AOSpine sacral fracture classification system.

BACKGROUND CONTEXT: The AOSpine sacral classification scheme was recently described. It demonstrated substantial interobserver and excellent intraobserver agreement in the study describing it; however, an independent assessment has not been performed. PURPOSE: To perform an independent inter- and intraobserver agreement evaluation of the AOSpine sacral fracture classification system. STUDY DESIGN: Agreement study. METHODS: Complete computerized tomography (CT) scans, including axial images, with coronal and sagittal reconstructions of 80 patients with sacral fractures were selected and classified using the morphologic grading of the AOSpine sacral classification system by six evaluators (from three different countries). Neurological modifiers and case-specific modifiers were not assessed. After a four-week interval, the 80 cases were presented to the same raters in a random sequence for repeat assessment. We used the Kappa coefficient (κ) to establish the inter- and intraobserver agreement. RESULTS: The interobserver agreement was substantial when considering the fracture severity types (A, B, or C), with κ=0.68 (0.63-0.72), but moderate when considering the subtypes: κ=0.52 (0.49-0.54). The intraobserver agreement was substantial considering the fracture types, with κ=0.69 (0.63-0.75), and considering subtypes, κ=0.61 (0.56-0.67). CONCLUSION: The sacral classification system allows adequate interobserver agreement at the type level, but only moderate at the subtypes level. Future prospective studies should evaluate whether this classification system allows surgeons to decide the best treatment and to establish prognosis in patients with sacral fractures.

Treatment strategies for managing cervical spine injuries in rugby players.

BACKGROUND: Cervical spine fractures are potentially catastrophic injuries in rugby players. Here, we reviewed seven patients who sustained rugby-related cervical spine fractures. Notably, three of seven fractures were missed on initial X-rays, but were ultimately documented on CT studies obtained an average of 10 days later. METHODS: Seven patients sustained cervical spine fracture attributed to rugby (2009-2016) and were followed an average of 52 posttrauma months. Most injuries occurred at the C6-C7 level, and six of seven patients required surgery. Further, only two of seven patients exhibited resultant neurological deficits (e.g., one myelopathy and one radiculopathy). RESULTS: Although the rugby injury was sufficiently documented on initial X-rays in four patients, three initial X-rays missed fractures, which were documented on the CT studies obtained an average of 10 days later. CONCLUSION: Rugby-related cervical fractures must be considered where players continue to complain of pain following trauma. Notably, routine X-rays may miss fractures in 3 of 7 cases (43%), thus warranting supplemental CT examinations to definitively rule out fractures.

Colletotrichum Gloesporioides Inhibition In Situ by Chitosan-Ruta graveolens Essential Oil Coatings: Effect on Microbiological, Physicochemical, and Organoleptic Properties of Guava (Psidium guajava L.) during Room Temperature Storage.

Guava is a fruit appreciated worldwide for its high content of bioactive compounds. However, it is considered a highly perishable fruit, generally attacked by pathogenic species such as the fungi Colletotrichum gloeosporioides, which causes anthracnosis. To diminish the losses caused by pathogenic fungi, coatings of chitosan (CS) with Ruta graveolens essential oil (RGEO) in different concentrations (0.5, 1.0, 1.5% v/v) were applied in situ and their effects on the physical properties and microbiological quality of the guavas were studied. The CS+RGEO coated fruits exhibited better physicochemical behavior and lower microbiological decay as compared to the uncoated guavas, demonstrating the effectiveness of the coatings, especially those with 1.5% of RGEO content. All the fruits coated had greater acceptance and quality than the controls, being more those with essential oil incorporation. In situ investigation of C. gloesporioides infection of guavas demonstrated that the CS+RGEO coated guavas showed a high percentage of inhibition in the development of anthracnose lesions. In the present investigation, an alternative method has been proposed to extend the stability of the guavas fruit up to 12 days with application in the food industry.

Palladium-Catalyzed Regioselective C-Benzylation via a Rearrangement Reaction: Access to Benzyl-Substituted Anilines.

An unprecedented C-benzylation rearrangement reaction, catalyzed by palladium, is reported. The reaction proceeds by rearrangement leading to the direct synthesis of para or ortho benzyl-substituted N-methylanilines. The product is obtained in high regioselectivity, without the need to use a ligand for the catalytic process.

Regioselective Alkoxycarbonylation of Allyl Phenyl Ethers Catalyzed by Pd/dppb Under Syngas Conditions.

A simple and regioselective synthesis of phenoxy esters and phenylthio esters is reported. The products are obtained by selective alkoxycarbonylation catalyzed by Pd2(dba)3, 1,4-bis(diphenylphisphino)butane (dppb), and syngas (CO/H2) in chloroform/alcohol. This methodology affords bifunctional products in good yield with excellent n-selectivity and without the need to use additives.

Pd-Catalyzed Regioselective Alkoxycarbonylation of 1-Alkenes Using a Lewis Acid [SnCl2 or Ti(O(i)Pr)4] and a Phosphine.

The phosphine ligand mediated palladium catalyzed alkoxycarbonylation of alkenes was investigated with the objective of attaining good linear selectivity for the ester. The effect of various parameters such as solvents, additives, palladium precursors, CO pressures, and alkenes of various structural complexities were examined. The results revealed the importance of using a Lewis acid such as SnCl2 or Ti(O(i)Pr)4 in combination with a monodentate ligand such CYTOP 292 or P(p-anisyl)3 to enhance the regioselectivity for the linear isomers in the range of 70-96%.

Cervical paravertebral osteolipoma: case report and literature review.

Lipomas are the most frequent soft tissue tumors. Osteolipomas are a rare variant that can be difficult to diagnose. We report the case of a 66-year-old man consulting with a tumor of 2 years development in the right paravertebral cervical region. Neurologically, the patient had no sign of myelopathy or neurological focality. Magnetic resonance imaging showed a mass with a lipid component and calcifications inside within the right paravertebral musculature with a possible origin in the right C3 posterior root. A computed tomography scan and guided biopsy were performed, revealing hematic material and small bone spicules with no apparent neoplastic element. The tumor was totally removed, including the right C3 posterior branch, and was confirmed to be an osteolipoma on biopsy. The patient remains asymptomatic at 6-month follow-up. The osteolipoma is a benign tumor of soft tissue, characterized by lipoma areas with mature bone tissue differentiation, and even with hematopoietic marrow.

PdI2-catalyzed regioselective cyclocarbonylation of 2-allyl phenols to dihydrocoumarins.

A simple, efficient, and regioselective synthesis of 3-methyl-3,4-dihydrocoumarins is reported. The reaction of 2-allyl phenols with synthesis gas was catalyzed by PdI2, and 1,3,5,7-tetramethyl-6-phenyl-2,4,8-trioxa-6-phosphaadamantane (L1) and 1,3,5,7-tetramethyl-6-tetradecyl-2,4,8-trioxa-6-phosphaadamantane (L2) were effective as ligands, affording good product selectivity in all cases.

Should age be a contraindication for degenerative lumbar surgery?

INTRODUCTION AND PURPOSE: The purpose of this study was to evaluate and compare disability, quality of life and satisfaction outcomes between young people and elderly who were operated on for degenerative lumbar disease. MATERIAL AND METHODS: A database of 263 patients undergoing lumbar surgery for degenerative conditions was collected. There were 74 patients who were 65 years old or above and 189 who were below 65 who had complete preoperative and 2-year postoperative HRQOL data measures: ODI, SF-36 and COMI. RESULTS: There were no significant differences in the outcomes between the two age groups (p > 0.05). An improvement from baseline in all quality of life measures in the two age groups was observed. A median improvement of 6.0 points was found in the ODI in the younger patients versus 12.0 in older ones. A median improvement in the SF36 physical component score of 6.95 was seen in the younger group while improvement was reported at 6.36 points in patients over 65. The SF36 mental component score improved by 4.48 points and 4.96 points, respectively. COMI improved a median of 1.2 points in both groups. In terms of satisfaction, 66.9 % of the younger patients were pleased or very pleased whereas this was found to be 59.7 % for the older group. CONCLUSION: Older patients can see substantial clinical improvement after degenerative lumbar disease surgery similar to that obtained in younger patients in terms of quality of life and satisfaction. The improvement in terms of the disability is greater for older patients. Thus, age should not be a contraindication for this procedure.

Spatial analysis of condyle position according to sagittal skeletal relationship, assessed by cone beam computed tomography.

BACKGROUND: The study aims to compare the condylar position in patients with different anteroposterior sagittal skeletal relationships through a cone beam computed generated tomography (CBCT) imaging generated space analysis. METHODS: This was a retrospective study of clinically justified, previously taken CBCT images of 45 subjects. Based on a proper sample calculation, three groups of 15 CBCT images each were made according to their ANB angle and facial pattern: class I (normo facial pattern) and class II and III (long facial pattern). The CBCT images were of adult patients between 18 and 35 years old, with full permanent dentition at maximum occlusal intercuspidation. Anatomical references previously used by Ricketts for the condyle position inside the glenoid fossae were measured digitally through the EzImplant software. Analysis of variance, Tukey's, Kruskal-Wallis, and Mann-Whitney U statistical tests were used. RESULTS: The upper distance of the condyle to the glenoid fossa was smaller in the class II and class III compared with the class I group. The anterior distance of the condyle to the articular eminence showed significant differences when comparing the class I with the class II and class III groups. No statistically significant difference was noted in the posterior condylar distance between the groups. The angle of the eminence showed differences between the three groups, while the eminence height showed significant difference when comparing the class I with class III group. CONCLUSIONS: Spatial differences existed for the condylar position in relation to the glenoid fossa for skeletal class I, class II, and class III, but these spatial differences may not be clinically relevant.

Variações anatômicas e posicionais da ATM por tipo facial vertical na tomografia computadorizada cone-beam / Anatomia and positional TMJ variations according to vertical facial type on Cone beam Computed Tomography

Introdução: a Tomografia Computadorizada Cone-beam(TCC8) é uma ferramenta útil que permite estudar a ATMcom precisãoe em três dimensões do espaço. Proposição: o objetivo da presenteinvestigação foi avaliar e determinar as variações anatômicas e posicionaisda ATM por cada tipo facial vertical. Métodos: foi selecionada umamostra de 55 tomografias em máxima oclusão de pacientes adultosjovens entre 15 e 35 anos: 15 com tipo facial longo, 15 com tipo facialmédio e 25 com tipo facial curto, sem tratamento prévio de Ortodontiae com aparente simetria facial. Foram analisadas as imagens dos côndilosdo lado direito mediante o software EZ Implant para estabelecera correlação entre as variáveis largura condilar, longitude condilar,distância côndilo fossa superior, altura da eminência articular, ânguloda eminência articular, posição vertical e anteroposterior do côndiloem cada tipo facial vertical. As diferenças entre as médias para cadauma das variáveis em cada tipo facial vertical foram avaliadas por meiodos testes estatísticos Anova, Kruskal Wallis e qui-quadrado, comocorrespondia. Resultados: encontraram-se diferenças significativasentre o tipo facial curto e longo em relação à distância côndilo fossasuperior (p < 0,05) e com respeito à altura da eminência articular(p < 0,01). Conclusão: a distância superior côndilo fossa e a alturada eminência articular apresentam variações de acordo ao tipo facialvertical, encontrando-se a distância superior côndilo fossa e a alturada eminência articular aumentadas no tipo facial curto e diminuídasno tipo facial longo.

Introduction: Cone Beam Computed Tomography (CBCT),is a useful tool for an accurate and three dimensional study of TMJ.Objective: the purpose of this study was to assess and determine theanatomical and positional changes of the TMJ depending on verticalfacial type. Methods: a sample of 55 tomography scans in maximumocclusion of patients aged 15 to 35 years: 15 long facial type, 15medium facial type and 25 short facial type, no previous orthodontictreatment and apparent facial symmetry were selected. Right condylesimages were analyzed on fZ Implant Software to establish correlationbetween variables condylar width, condylar length, superior condylefossadistance, height of articular eminence, articular eminence angle,vertical and anteroposterior position of the condyle by vertical facialtype. Differences among the means for each of the variables accordingto the vertical facial type were evaluated by Anova Kruskal Wallis andChi square statistical tests, as appropriate. Results: significant differenceswere found among the short and long facial type with respectto superior condyle fossa distance (p < 0.05) and with respect to theheight of the articular eminence (p < O.01). Conclusions: there is a statisticalsignificant variation among the superior condyle-fossa distanceand articular eminence height with vertical facial type, as the superiorcondyle-fossa distance and articular eminence height increased in theshort facial type and decreased in long facial type.

(Z)-Ethyl 3-(2,6-diisopropyl-anilino)but-2-enoate.

The title compound, C(18)H(27)NO(2), crystallizes as the enamine form with Z geometry. The ß-enamino-ester fragment forms a dihedral angle of 87.5 (1)° with the isopropyl-phenyl frame. The structure exhibits an intra-molecular N-H⋯O hydrogen bond. In addition, in the crystal, mol-ecules are linked by a centrosymmetric inter-molecular N-H⋯O hydrogen bond.

(Z)-Ethyl 3-(2,4,6-trimethyl-anilino)but-2-enoate.

The title compound, C(15)H(21)NO(2), was obtained by the reaction of acetoacetate with 2,4,6-trimethyl-aniline using Mexican bentonitic clay as a catalyst. It crystallizes in the enamine form. The ß-enamino ester residue is almost perpendicular to the aromatic ring [dihedral angle = 88.10 (6)°]. The mol-ecular conformation is stabilized by a strong intra-molecular N-H⋯O hydrogen bond. In addition, the N-H group forms a weak inter-molecular N-H⋯O hydrogen bond linking the mol-ecules into centrosymmetric dimers.