[Perioperative adverse respiratory events in overweight and obese children]. / Atemwegskomplikationen bei übergewichtigen und adipösen Kindern.

BACKGROUND: Overweight and obesity are increasing problems in pediatric anesthesia. This observational study was designed to examine how airway-related complications occur in overweight children and adolescents during general anesthesia and if this is a relevant problem in Germany. METHODS: From October 2008 until August 2009, at the university clinic in Leipzig, 504 in- and outpatients, aged 2-18 years, ASA I-III, undergoing elective procedures (ENT and pediatric surgery), were observed. With the aid of special data sheets, the following parameters were determined: Mallampati Score, difficult mask ventilation and intubation, use of a Guedel/Wendl tube, Cormack-Lehane Score, number of intubation attempts, airway obstructions (broncho- and laryngospasms), coughing as a sign of airway irritation, and decreases in oxygen saturation >10 %. RESULTS: Overweight and obese children had a significantly higher Mallampati Score and a significantly higher prevalence of coughing (p < 0.05). None of the other parameters showed any significant differences between the groups. However, the incidence of desaturation was 9.5 % in overweight children and 6.3 % in children of normal weight, and that of airway obstructions was 4.1 vs 2.7 %. CONCLUSION: This study demonstrated a very low incidence of respiratory problems, which may be caused by the low proportion of morbidly obese children and the older age of overweight children in comparison with other studies.

Automatic fusion of lateral cephalograms and digital volume tomography data-perspective for combining two modalities in the future.

OBJECTIVES: This article investigates the combination of three-dimensional (3D) digital volume tomography data with two-dimensional (2D) cephalograms in dentomaxillofacial imaging. METHODS: An automatic hierarchical method to adjust the geometrical relations of these two modalities is presented. The approach is tested on phantom and patient case data, where the feasibility, usability and potential possibilities of the presented innovative method are highlighted. Digitally reconstructed radiographs are computed by casting rays through the 3D volume to get a 2D projection of the volume to produce realistic simulated cephalograms. Different similarity measures are considered based on variations of statistical and deterministic optimization procedures. Stability, precision and accuracy of the method are investigated. RESULTS: The presented algorithm demonstrates a reasonable solution of the corresponding 2D/3D registration problem. Exemplary results from phantom and patient case data are presented. Tooth movement could be determined, in contrast to the 2D lateral cephalogram, separated for each side in all three spatial directions. CONCLUSIONS: Achieved results are highlighted from a clinical point of view and demonstrate the clinical benefit in daily praxis.

Assessment of apical periodontitis by MRI: a feasibility study.

PURPOSE: The purpose of this clinical feasibility study was to evaluate the applicability of magnetic resonance imaging (MRI) for the assessment of apical periodontitis in direct comparison with cone beam CT (CBCT). MATERIALS AND METHODS: 19 consecutive patients (average age 43 ±â€Š13 years) with 34 lesions in total (13 molars, 14 premolars and 7 front teeth) were enrolled in this feasibility study. Periapical lesions were defined as periapical radiolucencies (CBCT) or structural changes in the spongy bone signal (MRI), which were connected with the apical part of a root and with at least twice the width of the periodontal ligament space. The location and dimension of the lesions were compared between MRI and CBCT. RESULTS: While mainly mineralized tissue components such as teeth and bone were visible with CBCT, complimentary information of the soft tissue components was assessable with MRI. The MRI images provided sufficient diagnostic detail for the assessment of the main structures of interest. Heterogeneous contrast was observed within the lesion, with often a clear enhancement close to the apical foramen and the periodontal gap.  No difference for lesion visibility was observed between MRI and CBCT. The lesion dimensions corresponded well, but were slightly but significantly overestimated with MRI. A heterogeneous lesion appearance was observed in several patients. Four patients presented with a well circumscribed hyperintense signal in the vicinity of the apical foramen. CONCLUSION: The MRI capability of soft tissue characterization may facilitate detailed analysis of periapical lesions. This clinical study confirms the applicability of multi-contrast MRI for the identification of periapical lesions. KEY POINTS: MRI can be applied for the identification of periapical lesions without ionizing radiation exposure. MRI might facilitate more detailed characterization of periapical lesions. MRI might provide more accurate lesion dimensions as X-ray-based methods.

Ultrashort echo time (UTE) MRI for the assessment of caries lesions.

OBJECTIVE: Direct in vivo MRI of dental hard tissues by applying ultrashort echo time (UTE) MRI techniques has recently been reported. The objective of the presented study is to clinically evaluate the applicability of UTE MRI for the identification of caries lesions. METHODS: 40 randomly selected patients (mean age 41 ± 15 years) were enrolled in this study. 39 patients underwent a conventional clinical assessment, dental bitewing X-ray and a dental MRI investigation comprising a conventional turbo-spin echo (TSE) and a dedicated UTE scan. One patient had to be excluded owing to claustrophobia. In four patients, the clinical treatment of the lesions was documented by intraoral pictures, and the resulting volume of the cavity after excavation was documented by dental imprints and compared with the MRI findings. RESULTS: In total, 161 lesions were identified. 157 (97%) were visible in the UTE images, 27 (17%) in the conventional TSE images and 137 (85%) in the X-ray images. In total, 14 teeth could not be analysed by MR owing to artefacts caused by dental fillings. All lesions appear significantly larger in the UTE images as compared with the X-ray and TSE images. In situ measurements confirm the accuracy of the lesion dimensions as observed in the UTE images. CONCLUSION: The presented data provide evidence that UTE MR imaging can be applied for the identification of caries lesions. Although the current data suggest an even higher sensitivity of UTE MRI, some limitations must be expected from dental fillings.