Three-dimensional echocardiographic measurement of right ventricular volume in children with congenital heart disease validated by magnetic resonance imaging.

Measurement of right ventricular volume and function by two-dimensional echocardiography is unreliable because of the asymmetric shape of the right ventricle. The purpose of this study was to validate the accuracy of transthoracic three-dimensional echocardiography in assessing right ventricular volumes in children with congenital heart disease after surgical repair of the defects, by comparison with those measured by magnetic resonance imaging. We examined 13 children after repair of tetralogy of Fallot (10), hypoplastic left heart syndrome (2), or atrial septal defect (1). Each underwent magnetic resonance imaging followed by three-dimensional echocardiography done with a transthoracic 5 MHz, prototype internally rotating omniplane transducer. In both methods, endocardial borders were manually traced and volumetric slices were summated. Close correlation was observed between the two methods (R2 0.91 for end-systolic volumes, 0.90 for end-diastolic volumes, 0.64 for ejection fraction, and 0.92 for interobserver variability). A limits-of-agreement analysis showed no adverse trend between the two methods under values of 100 ml and low variation around the mean values. We conclude that three-dimensional echocardiography measurement of right ventricular volumes correlates closely with magnetic resonance imaging in children with operated congenital heart disease and may allow accurate serial evaluation in these patients.

Determinants of endothelium-dependent femoral artery vasodilation in youth.

OBJECTIVE: Decreased endothelium-dependent arterial dilation to reactive hyperemia has been shown in adults to be associated with various manifestations of cardiovascular diseases and cardiovascular risk factors. In a sample of children, we examined the relationships between flow-mediated femoral artery dilation and anthropometric, demographic, cardiovascular, and serum lipid variables that have been associated with cardiovascular diseases. METHOD: Thirty-three asymptomatic, healthy 11 to 14 years olds were randomly selected from participants in a longitudinal cardiovascular health study. There were 17 boys and 16 girls; 21 whites and 12 blacks. Sixteen had documented family history of premature myocardial infarction (ie, < or = 55 years of age) in first-degree relatives and 17 did not. Measurements included fasting lipids, anthropometrics, blood pressure and heart rate at rest and during supine exercise, postural change, and forehead cold stimulation. Femoral artery dilation to reactive hyperemia was measured via high resolution ultrasound. RESULTS: Bivariate analyses indicated flow-mediated dilation was negatively correlated with systolic pressure increases to postural change, forehead cold stimulation and dynamic exercise, greater average skinfold thickness, and body fat via dual x-ray absorptiometry and positively correlated with cardiovascular fitness (all ps < .05). Stepwise multiple regression revealed that cardiovascular fitness and systolic pressure reactivity to exercise significantly predicted flow-mediated dilation accounting for 31% of the variance (p < .01). CONCLUSIONS: Decreased flow-mediated dilation is associated with decreased cardiovascular fitness, increased systolic pressure reactivity to various stressors, and increased indices of body fatness in asymptomatic youth. Further research is warranted to better understand early relationships between this noninvasive measure of endothelial function and cardiovascular risk factors in youth.

Anthropometric, demographic, and cardiovascular predictors of left ventricular mass in young children.

Left ventricular (LV) mass is a strong independent predictor of cardiovascular morbidity and mortality. Few longitudinal studies have examined predictors of LV mass in children. This study assessed the contributions of anthropometric, demographic, and cardiovascular parameters (at rest and after exposure to laboratory stressors) as predictors of LV mass 3.6 years after the initial examination in a sample of 68 Caucasian and African-American children 7.9 +/- 0.7 years old. At the initial examination, all subjects had standard anthropometrics measured and hemodynamics assessed at rest and during 3 stressors: postural change, forehead cold stimulation, and treadmill exercise. On the follow-up examination 3 to 4 years later, echocardiographic evaluations were conducted to estimate LV mass and related LV geometry. LV mass and LV internal diameter in diastole were adjusted for linear growth (LV mass/height2.7 and LV internal dimension during diastole/height0.80, respectively). Hierarchical stepwise multiple regression analyses were conducted using parameters significant in univariate comparisons (p < 0.05). Initial weight (R2 = 0.38), height (R2 = 0.42), and cardiac output reactivity to standing and treadmill exercise (final model R2 = 0.55) were significant predictors of LV mass, whereas LV mass/height2.7 was predicted by initial adiposity (R2 = 0.07) and cardiac output and systolic pressure reactivity to postural change (final model R2 = 0.25). Follow-up relative wall thickness was significantly predicted by ethnicity (African-Americans greater than Caucasians, R2 = 0.15), adiposity (R2 = 0.20), and systolic pressure reactivity to postural change (final model R2 = 0.28). These findings suggest the potential benefit of weight control in childhood as a primary prevention for later onset of cardiovascular disease.

Blindness after facial trauma.

Blindness after facial fractures has been reported to occur with an incidence that ranges between 0.67% and 3% depending on the reporting institution. To verify this finding we undertook a retrospective chart review of 5936 patients with facial fractures that occurred over a 12 1/2-year period. We found that vision in 19 eyes were lost in 18 patients. Vision loss was more frequently encountered in Le Fort III level fractures (2.2%) followed distantly by Le Fort II level fractures (0.64%), and zygomatic fractures (0.45%). The cause of blindness was most frequently associated with motor vehicle accidents and gunshot injuries. Injuries of this type require immediate and prompt consultation by the ophthalmologic surgery service.

The alterations in sensitivity of the infraorbital nerve following fractures of the zygomaticomaxillary complex.

52 patients with fractures of the zygomaticomaxillary complex associated with hypoaesthesia of the infraorbital nerve were evaluated as to the degree of residual impairment in sensitivity. Those with minor displacements or no displacements at all showed complete recovery. Early treatment was associated with better results, while no correlation was found between the degree of anatomical reduction and the improvement in nerve sensitivity. The results appeared to be better when the lateral orbital approach was part of the treatment.

The pattern and aetiology of maxillofacial injuries in Greece. A retrospective study of 25 years and a comparison with other countries.

In comparison with other countries, Greece demonstrates a high incidence of road traffic accidents (RTA's). Most are the result of violation of the highway code. Violence as a causative agent of fractures of the facial skeleton is still a minor factor in comparison with other countries. Most of the people involved are young. In a 25-year period we have treated 6,847 fractures of the facial skeleton. Fractures of the mandibular condyle, the genial symphysis and the zygomatico-maxillary complex were the most numerous. 25% of the patients were women and 75% men. 56% were treated conservatively; an open reduction was the treatment of choice in 37%, while no treatment was considered necessary in 7%. In the period under study, K.A.T. Hospital admitted 60% of the maxillofacial trauma in the whole country.

Fractures of the facial skeleton in children.

Among 3,908 patients with fractures of the facial skeleton hospitalized in a 25-year period, 202 were children. 69% were boys and 31% girls. A child is most active at the age of fourteen. Fractures of the upper alveolar bone and the condyle were the most common. We compared the pattern of fractures in children and those in adults recorded at the same period of time.

[Intraoral embryonal rhabdomyosarcoma]. / Endostomatiko embryiko rabdomyosarkoma.

The embryonal rhabdomyosarcoma is a very rare entity particularly when it occurs intraorally. We are reporting such a case in a 16-month old child.

Traumatic carotid-cavernous sinus fistula.

Traumatic carotid-cavernous sinus fistula is an uncommon situation resulting from severe trauma, with less than 40 cases having been reported. It is usually associated with a skull base, frontal or mid-facial fracture, but it may also be a spontaneous phenomenon of congenital, infective or degenerative origin. The blood shunts from the internal carotid to the cavernous sinus resulting in pulsating exophthalmos, orbital headache, pain, orbital or frontal bruit, loss of visual acuity, diplopia, ophthalmoplegia and the differential diagnosis should include superior orbital fissure syndrome, orbital apex syndrome and cavernous sinus thrombosis. Several modes of treatment have been proposed. We were recently faced with such a case, who had sustained fractures of the facial skeleton and developed the fistula despite an initial non-contributory angiogram. The patient remained in a permanent coma.

Plasma cell myeloma of the jaws.

Solitary myeloma may be the first manifestation of the disseminated form, known as multiple myeloma, and characterized by multiple skeletal lesions, general metabolic alterations, impairment of renal function and eventually death. Involvement of the jaws is not unusual, although infrequently reported. We present 2 cases, where oral involvement was the first indication of the disease.

Orbital apex syndrome.

The orbital apex syndrome is a very rare complication of fractures of the facial skeleton, as well as other conditions and is characterized by blindness, fixed dilated pupils, proptosis, ptosis of the eye and ophthalmoplegia. We are reporting such a case we had the opportunity of treating.

Benign neurogenic tumors of the oral cavity.

Neurogenic tumors are rare in the oral cavity, particularly so when malignant. Traumatic neuroma, although usually included with neurogenic tumors, is a reactive process rather than a true neoplasm. Neurofibroma and schwannoma derive from nerve fibers, the perineurium, the endoneurium and the neurolemmomal cells. They present histological differences. The neurofibroma may present in solitary and generalized types; the latter also known as neurofibromatosis or von Recklinghausen's disease of the skin. We here report typical cases of benign neurogenic tumors of the oral cavity.

Chondrosarcoma of the orofacial region. Review of the literature and report of two cases.

Chondrosarcoma of the jaws arises from vestigial rests and is considered a rare entity, although it is more common than its benign counterpart. Occasionally it may be extremely difficult under the microscope to decide whether a case is benign or malignant. The treatment of choice is surgical with wide margins. In our review of the literature we found 169 cases of oro-facial chondrosarcoma including two from our Institution. There was a 2:1 male/female ratio and the maxilla was involved twice as frequently as the mandible. Over half of the cases were between 20 and 50 years old.

Aneurysmal bone cyst of the jaws. Review of the literature and report of 2 cases.

Strictly speaking, the aneurysmal bone cyst is not a true cyst. It is a lesion characterized by replacement of bone by fibro-osseous tissue containing blood-filled cavernous spaces. It is usually treated by surgical curettage, and access within the jaws may sometimes be difficult. We reviewed the world literature and found 63 cases of aneurysmal bone cysts involving the face, 22 reported in the maxilla, and 63 in the mandible. One was found in the zygomatic arch. Of the patients reported, 88% were younger than 30 years old; there was an equal sex distribution. Included in this report, are two cases of our own, one involving the maxilla and one the mandible.

Traumatic Le Fort III osteotomy.

A case of a Le Fort III type of fracture is described which resulted after its reduction, in the correction of pre-existing Class III skeletal relationship.

The superior orbital fissure syndrome.

The superior orbital fissure syndrome is a very rare condition, characterized by a fixed dilated pupil, ptosis and proptosis of the eye and ophthalmoplegia. We have had the opportunity to observe a number of such cases, and now report four of them.

Fractures of the coronoid process of the mandible. An analysis of 52 cases.

Fractures of the coronoid process occur infrequently. In the present study, 52 cases of fracture of the coronoid process are presented and analysed and the relevant literature is reviewed. Coronoid fractures constituted 2.9% of all facial fractures. Of the 52 cases, 12 were isolated coronoid fractures (23%), whereas in the remaining 40 cases, coronoid fractures coexisted with other maxillofacial injuries. The clinical picture, diagnosis and therapeutic modalities of coronoid fractures are discussed.

Fractures of the facial skeleton in the edentulous patient.

An evaluation was made of 112 fractures that occurred in 66 edentulous patients in a 10 year period. There was an average of 1.7 fractures per person. 104 fractures occurred in the mandible and 75% of these were treated without intermaxillary fixation or were not treated at all. In 28.5% of the cases no treatment was provided other than soft or liquid diet and appropriate instructions. As a group, the condylar fractures were those that were left with no treatment to a greater extent than any other group, apart from the Le Fort type of fracture; the latter being very few in absolute numbers. The age group associated with the edentulous state quite often suffers from conditions that may prohibit aggressive treatment. These conditions may be aggravated by the accident and, by the time the patient is ready for maxillofacial surgery, one has to contemplate (and discuss with the patient) the advantages and disadvantages of a procedure. It appears that aesthetics are of minor importance (to a certain degree) for elderly patients and small deviations from the normal (both in appearance and function) are acceptable to them, considering the prospect of an operation or of the prolonged discomfort, such as that associated with intermaxillary fixation. The advisability of the latter should be assessed carefully in view of the respiratory impairment that it may cause in patients whose airway may already be compromised.(ABSTRACT TRUNCATED AT 250 WORDS)