Benign radiographic coronal synostosis after sagittal synostosis repair.

Whether cranial vault remodeling surgery for nonsyndromic, isolated sagittal suture synostosis affects the patency of initially normal, unaffected sutures is unknown. The influence of coronal and lambdoidal suture patency after cranial vault remodeling on the trajectory of subsequent cranial growth is also unknown. Disruption of normal sutural anatomy during cranial vault reconstruction could influence the incidence of secondary craniosynostosis and need for reoperation in a small proportion of these patients.We performed a retrospective review of patients younger than 1 year with nonsyndromic sagittal synostosis treated at a single tertiary referral pediatric hospital from September 2005 to January 2010 by an interdisciplinary team. Computed tomographic images obtained preoperatively, immediately postoperatively, and 2 years postoperatively were evaluated for the occurrence of secondary synostosis of initially nonsynostotic sutures. Craniofacial disorders clinic and ophthalmologic follow-up records were also analyzed for the occurrence of radiographic cranial restenosis, clinical or ophthalmologic signs of intracranial hypertension (ICH), and reoperation.Fifty-one patients younger than 1 year underwent primary surgical repair of isolated, nonsyndromic sagittal suture synostosis during the study period. Thirty-seven of these patients (71%) had completed 2-year clinical and radiographic follow-up by the time of analysis, constituting the study population. The average age at surgery was 5.4 months (range, 3.1-11.5 months). Thirty-three (89%) of the 37 study patients showed radiographic evidence of bilateral secondary coronal synostosis (SCS). Five patients (15%) additionally showed partial lambdoid synostosis. One patient with radiographic SCS (3%) required reoperation for radiographic cranial restenosis, clinical signs and symptoms of ICH, and papilledema first noted 1 year after primary cranial vault reconstruction.There is a high incidence of secondary coronal suture synostosis following cranial vault remodeling for isolated, nonsyndromic sagittal synostosis. Postoperative SCS was only rarely associated with secondary radiographic cranial stenosis, clinical or ophthalmologic signs of ICH, and the need for reoperation.

Novel use of osmotic tissue expanders to treat difficult anterior palatal fistulas.

OBJECTIVE: Novel use of osmotic tissue expanders to recruit local palatal mucoperiosteum for the treatment of difficult anterior palatal fistulas. DESIGN: This is a retrospective review of our experience with osmotic tissue expanders for closure of secondary palatal fistulas. SETTING: The study occurred at Oregon Health and Science University, a tertiary care level academic hospital. PATIENTS, PARTICIPANTS: All patients were treated for combined cleft lip and palate by the Oregon Health and Science University Craniofacial Disorders multidisciplinary team. They were determined to be appropriate candidates due to the anterior location of the fistula and symptomatic nature. Patients complained of significant nasal regurgitation of liquid and solids. INTERVENTIONS: All patients underwent a two-stage procedure under general anesthesia. The first stage was placement of the expanders. The second stage was 1 week later, with removal of the expanders, palatal revision, and closure of the oronasal fistula. MAIN OUTCOME MEASURE: The primary outcome measures determined before data collection were treatment of symptoms and decreased size of fistula. RESULTS: Seven patients with palatal fistulas were treated with osmotic tissue expanders. Five patients had complete closure of the fistula. Two patients demonstrated slit-like fistulas that were no longer symptomatic and were amenable to closure at time of alveolar bone grafting. No complications were observed. CONCLUSIONS: The use of osmotic tissue expanders is a viable alternative for repair of large anterior palatal fistulas, especially in a scarred or previously operated palate. Patients were also no longer symptomatic.

Diagnosis of posttraumatic pulmonary embolism: is chest computed tomographic angiography acceptable?

BACKGROUND: Pulmonary angiography (PA-gram) has long been the accepted criterion standard for diagnosing pulmonary embolism (PE). Computed tomographic angiography has recently been advocated as an equivalent alternative to PA-gram. CT angiography is known to be insensitive for peripheral (segmental and subsegmental) emboli. We have previously found that a significant number of posttraumatic PEs occur early. We therefore hypothesized that because of the fragmentation of these early (soft) clots, posttraumatic PEs would be found disproportionately in the lung periphery. METHODS: Trauma patients with PE confirmed by PA-gram were identified from our trauma database and medical records. PA-grams and reports were re-reviewed and the location of all emboli was documented. RESULTS: We identified 45 patients, with an average age of 46 +/- 19 years; two thirds of the patients were men and 82% had a blunt mechanism of injury. Patients had PE diagnosed between days 0 and 57. Overall, PE was confined to segmental or smaller vessels in 27 (60%) patients and to subsegmental vessels in 7 (16%) patients. Twelve patients (27%) had a PE within the first 4 days. Furthermore, 32 patients (71%) had unilateral clot and 22 patients (48.9%) had clot confined to one region. CONCLUSION: PE frequently occurs soon after injury. The majority of PEs after trauma are found peripherally (in segmental or subsegmental vessels). Right/left pulmonary artery embolisms are likely to be found only later in a trauma patient's course. Any diagnostic study used to diagnose pulmonary embolism in trauma patients must have sufficient resolution capacity to reliably detect segmental and subsegmental clot. A diagnostic modality such as CT scanning that is insensitive to peripheral embolisms may miss a significant number of posttraumatic PEs.

A novel, two-component system for cell lethality and its use in engineering nuclear male-sterility in plants.

Ablation of cells by the controlled expression of a lethal gene can be used to engineer plant traits such as male sterility and disease resistance. However, it may not be possible to achieve sufficient specificity of expression to prevent secondary effects in non-targeted tissues. In this paper we demonstrate that the extracellular ribonuclease, barnase, can be engineered into two complementary fragments, allowing overlapping promoter specificity to be used to enhance targeting specificity. Using a transient system, we first show that barnase can be split into two inactive peptide fragments, that when co-expressed can complement each other to reconstitute barnase activity. When a luciferase reporter gene was introduced into plant cells along with genes encoding both partial barnase peptides, a substantial reduction in luciferase activity was seen. Cytotoxicity of the reconstituted barnase was demonstrated by crossing together parents constitutively expressing each of the barnase fragments, then assaying their progeny for the presence of both partial barnase genes. None of over 300 tomato seeds planted resulted in a viable progeny that inherited both transgenes. When expression of the partial barnase genes was instead targeted to the tapetum, male sterility resulted. All 13 tomato progeny that inherited both transgenes were male sterile, whereas the three progeny inheriting only the N-terminal barnase gene were male fertile. Finally, we describe how male sterility generated by this type of two-component system can be used in hybrid seed production.