Hemandibular hypoplasia successfully treated with functional appliances: is it truly hemifacial microsomia?

The literature contains a number of case reports on successful orthopedic treatment of hemifacial microsomia (HFM), with surprising changes in the morphology of the condyles. All of these reports regard patients who have substantially no soft tissue involvement but only severe mandibular ramus and condyle deformities. A number of cases with unexpectedly similar phenotypes diagnosed as HFM are described. The authors suggest that it is possible that all of these cases might be misdiagnosed traumatic injuries of the condyle, which present a normal functional matrix and, therefore, with growth and with the help of functional stimulation, tend to grow toward the original symmetry.

Effects of cardioversion of atrial fibrillation on endothelial function in hypertension or diabetes.

BACKGROUND: Cardioversion (CV) to sinus rhythm corrects endothelial dysfunction secondary to atrial fibrillation (AF). As AF often complicates hypertension and diabetes (disorders associated with impaired endothelial function) the study probed whether these comorbidities to AF produced an additive effect and to what extent CV might be advantageous. MATERIALS AND METHODS: Brachial artery flow-mediated dilatation (FMD) was evaluated before and after CV in 17 lone AF patients (group 1), 16 patients with AF + hypertension (group 2) and 17 patients with AF + diabetes type II (group 3), while in supine and head-up tilting (HUT) positions, as this is when endothelial vasodilation is emphasized as a counterbalance to neurogenic vasoconstriction. RESULTS: After 2 weeks, CV in group 1 increased (P < 0.01) supine FMD (from 7.22-->9.50%) and restored its HUT potentiation (from 9.31-->17.22%). In group 2, FMD also improved significantly with CV (supine from 4.92-->7.11% and HUT from 5.29-->11.83%; P < 0.01). In group 3, CV did not promote significant FMD changes (supine from 5.12-->4.92% and HUT from 4.98-->4.73%). After 3 months, FMD improvement persisted in groups 1 and 2 with enduring sinus rhythm, but not in those with AF relapse. In group 3, FMD remained unchanged regardless of cardiac rhythm. CONCLUSIONS: Cardioversion persistently increases supine shear stress endothelial responsiveness and restores the orthostatic modulation in AF alone or in association with hypertension, but not with diabetes. Differences in background endothelial impairment may explain the presence (hypertension) or the absence (diabetes) of an additive AF effect in comorbidities, as well as CV results.

The behaviour of the flow-mediated brachial artery vasodilatation during orthostatic stress in normal man.

AIMS: Flow-mediated brachial artery vasodilatation is an index of endothelial function. Published literature describes only supine data and no study has been performed during vertical displacement. This subject deserves investigation for two main reasons: humans spend the larger part of their life in the upright position; this position has significant effects on neural vascular regulation. METHODS: In 21 healthy men (25 +/- 2 years) the flow-dependent brachial artery vasodilating response to distal circulatory arrest was assessed by Doppler ultrasound imaging, while supine and during 20 degrees and 60 degrees head-up tilting (HUT). In 11 of these subjects the vasodilating response to nitroglycerine was also explored. RESULTS: Absolute and percentage increments in brachial calibre during hyperaemia after deflation of the occluding cuff became increasingly greater at 20 degrees (+0.44 mm) and 60 degrees (+0.92 mm) HUT (P < 0.01), compared with the horizontal position (+0.27 mm), and the arterial dilatation for an increase in flow (0.98 +/- 0.08 and 1.68 +/- 0.06 mm mL(-1) min(-1) x 1000, respectively) was larger (P < 0.01) than occurred while supine (0.41 +/- 0.05 mm mL(-1) min(-1) x 1000). Nitroglycerine-mediated vasodilatation at 60 degrees HUT was similar to that in the supine position. CONCLUSION: The orthostatic stimulus is associated with an increase of the flow-mediated brachial artery vasodilatation, which is proportional to the degree of displacement. The mechanism of this effect does not consist of changes in nitric oxide sensitivity.