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Sample records for mysterium ligamentum alare

  1. Alar

    Integrated Risk Information System (IRIS)

    Alar ; CASRN 1596 - 84 - 5 Human health assessment information on a chemical substance is included in the IRIS database only after a comprehensive review of toxicity data , as outlined in the IRIS assessment development process . Sections I ( Health Hazard Assessments for Noncarcinogenic Effects ) a

  2. [Traumatology of the alar ligaments].

    PubMed

    Saternus, K S; Thrun, C

    1987-10-01

    A postmortem study of craniocerebral traumas of varying severity was done to determine the pattern of injury of the alar ligaments. It was found that in the entire group of patients (n = 30) the alar ligaments were ruptured or suffused with blood 11 times. No close relationship was found between the massive nature of the cranial trauma and the severity of the injury of the alar ligaments. In some cases the alar ligaments were not at all involved even though the skull had suffered extensive osseous lesions, whereas on the other hand the ligaments were injured even though only soft parts had been involved (e.g., haematoma or dehiscent wounds of the scalp). Ruptures of the alar ligaments were typically involved in extended ruptures of the ligamentous apparatus (see Figure 6a involving the ligamentum apicis dentis, ligamentum transversum atlantis, m.atlanto-occipitalis anterior, m.tectoria, m.atlanto-axialis anterior et posterior). In some cases the pattern of injury of the alar ligaments was found to be decisive in enabling reconstruction of the course of the accident. Damage to the alar ligaments near the dens axis represent rotation injuries. On the other hand, insertion tears out of the condyli occipitales must be related to a lateral thrust tendency in indirect fracture of the skull (bursting fracture). Within this overall framework a new mechanism of fracture of the condylus occipitalis is described. As a matter of principle, the alar ligaments can become involved in consequence of rotation, traction and compression of the cranium.

  3. "mysterium Cosmographicum", for Orchestra, Narrator/actor, and Computer Music on Tape. (with Original Composition)

    NASA Astrophysics Data System (ADS)

    Keefe, Robert Michael

    Mysterium Cosmographicum is a musical chronicle of an astronomy treatise by the German astronomer Johannes Kepler (1571-1630). Kepler's Mysterium Cosmographicum (Tubingen, 1596), or "Secret of the Universe," was a means by which he justified the existence of the six planets discovered during his lifetime. Kepler, through flawless a priori reasoning, goes to great lengths to explain that the reason there are six and only six planets (Mercury, Venus, Earth, Mars, Jupiter, and Saturn) is because God had placed one of the five regular solids (tetrahedron, cube, octa-, dodeca-, and icosahedron) around each orbiting body. Needless to say, the publication was not very successful, nor did it gain much comment from Kepler's peers, Galileo Galilei (1564-1642) and Tycho Brahe (1546-1601). But hidden within the Mysterium Cosmographicum, almost like a new planet waiting to be discovered, is one of Kepler's three laws of planetary motion, a law that held true for planets discovered long after Kepler's lifetime. Mysterium Cosmographicum is a monologue with music in three parts for orchestra, narrator/actor, and computer music on tape. All musical data structures are generated via an interactive Pascal computer program that computes latitudinal and longitudinal coordinates for each of the nine planets as seen from a fixed point on Earth for any given time frame. These coordinates are then mapped onto selected musical parameters as determined by the composer. Whenever Kepler reads from his treatise or from a lecture or correspondence, the monologue is supported by orchestral planetary data generated from the exact place, date, and time of the treatise, lecture, or correspondence. To the best of my knowledge, Mysterium Cosmographicum is the first composition ever written that employs planetary data as a supporting chronology to action and monologue.

  4. [Correction of severe alar retraction with alar rotation flap].

    PubMed

    Hong, Chun; Zheng, Dongxue; Lu, Lixin

    2015-01-01

    To investigate the therapeutic effect of alar rotation flap for severe alar retraction. Patients with severely retracted alar underwent ala reconstruction using alar rotation flaps and autogenous cartilage batten grafts. First, costal cartilage was used to reshape the nasal tip and nasal dorsum. Then cartilage patch was used to extend and thicken the retracted alar. Then the alar rotation flap was transferred to correct retracted alar. Fourteen patients with severe alar retraction underwent alar reconstruction with alar rotation flap and alar batten grafts. The alar retraction was corrected in all cases, with improvements functionally and aesthetically. No recurrence of alar retraction was noted. The incision healed with acceptable cosmetic results, with obvious scar in only one patient (one side). The alar rotation flap is an effective and reliable surgical option to correct severe alar retraction. Scar can be kept inconspicuous by precise placement of the incision within the junction of the ala and the nasal dorsum, following principles of the aesthetic nasal subunits.

  5. Ligamentum teres tendinopathy and tears

    PubMed Central

    Kraeutler, Matthew J.; Garabekyan, Tigran; Pascual-Garrido, Cecilia; Mei-Dan, Omer

    2016-01-01

    Summary Background The ligamentum teres (LT) consists of two bands that originate on the ischial and pubic sides of the acetabular notch and insert on the fovea capitis of the femoral head. Recent studies have established the LT as an important hip stabilizer in a squatting position, particularly in patients with osseous instability. Purpose This review aims to concisely present the literature on LT tendinopathy and tears in order to guide health care professionals in the appropriate diagnosis and treatment of these disorders. Methods We reviewed the literature on the diagnosis and surgical management of ligamentum teres tendinopathy and tears. Conclusions The ligamentum teres is an important stabilizer to the hip joint, particularly with hip flexion and external rotation. Older age and acetabular bony pathomorphology are two of the known risk factors for LT tears. Symptoms of LT tendinopathy are largely non-specific, mimicking a wide range of other hip disorders including impingement and instability. Debridement of LT tears or reactive tissue has been reported with good outcomes, with more recent studies describing reconstruction of a completely torn, nonfunctional, or absent LT using various graft sources including synthetic grafts, autografts, and allografts. Level of evidence II. PMID:28066738

  6. Alar Rim Deformities.

    PubMed

    Totonchi, Ali; Guyuron, Bahman

    2016-01-01

    The alar rim plays an important role in nasal harmony. Alar rim flaws are common following the initial rhinoplasty. Classification of the deformities helps with diagnosis and successful surgical correction. Diagnosis of the deformity requires careful observation of the computerized or life-sized photographs. Techniques for treatment of these deformities can easily be learned with attention to detail. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Calcification of the ligamentum arteriosum in adults: CT features

    SciTech Connect

    Wimpfheimer, O.; Haramati, L.B.; Haramati, N.

    1996-01-01

    The present study describes the frequency and pattern of ligamentum arteriosum calcification seen on chest CT in adults. We retrospectively reviewed 402 sequential unenhanced chest CT studies for ligamentum arteriosum calcification, atherosclerotic cardiac or aortic calcification, and granulomatous calcification. The pattern of calcification was characterized as curvilinear, punctate, or clumped. Mean patient age was 60 ({+-}18, range 18-97) years with 214 women (53%) and 188 men (47%). Of these patients 194 (48%) had calcification in the ligamentum arteriosum including 26 (6%) with calcification in the ligamentum arteriosum alone, 108 (27%) with atherosclerotic calcification, 11 (3%) with granulomatous calcification, and 49 (12%) with both. A total of 100 patients (25%) had no calcifications. In the study population 169 patients (42%) had atherosclerotic calcification, 32 (8%) had granulomatous calcification, and 75 (19%) had both. The patterns of calcification for the 26 patients with calcification of the ligamentum arteriosum alone were curvilinear (7 patients, 27%), punctate (17 patients, 65%), and clumped (2 patients, 8%). The pattern of ligamentum arteriosum calcification for the 108 patients with only atherosclerotic and ligamentum arteriosum calcification was curvilinear (28 patients, 26%), punctate (32 patients, 30%), and clumped (48 patients, 44%). The patients without any calcifications and the patients with ligamentum arteriosum calcification formed one group (based on their similarity in age, mean 47 years) with a prevalence of ligamentum arteriosum calcification of 21%. The patients with atherosclerotic and ligamentum arteriosum calcification formed a second group (mean age 71 years) with a prevalence of ligamentum arteriosum calcification of 65%. On unenhanced chest CT calcification of the ligamentum arteriosum is a common finding in adults and increases in prevalence with increasing age and atherosclerosis. 6 refs., 4 figs., 1 tab.

  8. Reconstruction of the alar groove.

    PubMed

    Chait, L A; Fayman, M S

    1989-05-01

    The obliteration of a well-defined alar groove is common after nasal alar reconstruction. A method is described that can be used at the time of reconstruction to ensure the continued definition of the groove or to restore it in cases where it has been obliterated. The technique is based on the natural tendency of the skin to tube itself. Cheek skin is advanced beneath the posterior free edge of the reconstructed ala so that this edge now comes into contact with an epidermal surface. As this edge now tends to tube itself, a natural alar groove is produced. This method has been used successfully in six cases.

  9. An Alternative Alar Cinch Suture

    PubMed Central

    Rauso, Raffaele; Freda, Nicola; Curinga, Giuseppe; Del Pero, Claudio; Tartaro, Gianpaolo

    2010-01-01

    Nasal widening is commonly associated to maxillary osteotomies, but it is only partially dependent on the amount of skeletal movement. Techniques for controlling lateralization of the ala, including the alar base cinch technique, originally described by Millard, have been well reported by Collins and Epker and later modified by others. In this article, authors report the effect of a new alar cinch suture technique on a sample of 32 patients. PMID:21187940

  10. Alar retraction: etiology, treatment, and prevention.

    PubMed

    Alexander, Ashlin J; Shah, Anil R; Constantinides, Minas S

    2013-01-01

    The effect of different rhinoplasty maneuvers on alar retraction remains to be elucidated. To determine the etiology and treatment of alar retraction based on a series of specific rhinoplasty maneuvers. Retrospective review of a single surgeon's rhinoplasty digital photo database, examining preoperative alar retraction from January 1, 2002, to December 31, 2005, in 520 patients. Patients with more than 1 mm of alar retraction on preoperative photographs were identified. Postoperative photographs were examined to determine the effect of specific rhinoplasty maneuvers on the position of the alar margin; these maneuvers included cephalic trim, cephalic positioning of the lower lateral cartilage, composite grafts, alar rim grafts, alar batten grafts, and overlay of the lower lateral cartilage. Tertiary care academic health center. Forty-five patients with alar retraction met inclusion criteria, resulting in 63 nasal halves with alar retraction. Intraoperative findings, postoperative results. Forty-seven percent of the patients (n = 21) had prior surgery; 47% also had cephalically positioned lower lateral cartilages. Among patients with less than 4 mm of cartilage width at the outset, 46% of those who received supportive grafts achieved target correction vs only 7% for patients who did not undergo supportive cartilage grafting. In patients who underwent more than 4 mm of cephalic trim, those who received supportive grafts achieved 46% of target correction vs 11% among those who did not. Ninety-five percent of composite grafts, 69% of alar strut grafts, 47% of alar rim grafts, 43% of vertical lobule division, and 12% of alar batten grafts achieved their target correction values. Alar retraction is a highly complex problem. It can be seen de novo and is associated with cephalically positioned lower lateral cartilages. Structurally supportive grafting-including composite grafts, alar strut grafts, alar rim grafts, vertical lobule division, and alar batten grafts

  11. Quantitative Anatomic Analysis of the Native Ligamentum Teres

    PubMed Central

    Mikula, Jacob D.; Slette, Erik L.; Chahla, Jorge; Brady, Alex W.; Locks, Renato; Trindade, Christiano A. C.; Rasmussen, Matthew T.; LaPrade, Robert F.; Philippon, Marc J.

    2017-01-01

    Background: While recent studies have addressed the biomechanical function of the ligamentum teres and provided descriptions of ligamentum teres reconstruction techniques, its detailed quantitative anatomy remains relatively undocumented. Moreover, there is a lack of consensus in the literature regarding the number and morphology of the acetabular attachments of the ligamentum teres. Purpose: To provide a clinically relevant quantitative anatomic description of the native human ligamentum teres. Study Design: Descriptive laboratory study. Methods: Ten human cadaveric hemipelvises, complete with femurs (mean age, 59.6 years; range, 47-65 years), were dissected free of all extra-articular soft tissues to isolate the ligamentum teres and its attachments. A coordinate measuring device was used to quantify the attachment areas and their relationships to pertinent open and arthroscopic landmarks on both the acetabulum and the femur. The clock face reference system was utilized to describe acetabular anatomy, and all anatomic relationships were described using the mean and 95% confidence intervals. Results: There were 6 distinct attachments to the acetabulum and 1 to the femur. The areas of the acetabular and femoral attachment footprints of the ligamentum teres were 434 mm2 (95% CI, 320-549 mm2) and 84 mm2 (95% CI, 65-104 mm2), respectively. The 6 acetabular clock face locations were as follows: anterior attachment, 4:53 o’clock (95% CI, 4:45-5:02); posterior attachment, 6:33 o’clock (95% CI, 6:23-6:43); ischial attachment, 8:07 o’clock (95% CI, 7:47-8:26); iliac attachment, 1:49 o’clock (95% CI, 1:04-2:34); and a smaller pubic attachment that was located at 3:50 o’clock (95% CI, 3:41-4:00). The ischial attachment possessed the largest cross-sectional attachment area (127.3 mm2; 95% CI, 103.0-151.7 mm2) of all the acetabular attachments of the ligamentum teres. Conclusion: The most important finding of this study was that the human ligamentum teres had 6

  12. Anatomy, biomechanics, imaging, and management of ligamentum teres injuries.

    PubMed

    Cerezal, Luis; Kassarjian, Ara; Canga, Ana; Dobado, María Carmen; Montero, Juan Antonio; Llopis, Eva; Rolón, Alejandro; Pérez-Carro, Luis

    2010-10-01

    The ligamentum teres has traditionally been viewed as an embryonic remnant with no role in the biomechanics or vascularity of adult hips. However, the ligamentum teres is a strong intraarticular ligament that is anatomically and biochemically similar to the anterior cruciate ligament of the knee. It is composed of two bands that originate from the acetabular transverse ligament and the pubic and ischial margins of the acetabular notch. Among other functions, the ligamentum teres is an important stabilizer of the hip, particularly in adduction, flexion, and external rotation. Abnormalities of the ligamentum teres account for 4%-15% of sports-related injuries and should be considered in the differential diagnosis of patients with hip pain. Lesions of the ligamentum teres include partial or complete traumatic tears, degenerative tears, avulsion fractures of the ligament at its insertion into the fovea capitis femoris, and a congenital absence of the ligament. Magnetic resonance arthrography and computed tomographic arthrography are the preferred modalities for precise preoperative diagnosis of ligamentum teres injuries and may be used to rule out other associated intraarticular injuries. Treatment of these lesions is still evolving; at present, treatment of most injuries is limited to arthroscopic débridement. © RSNA, 2010.

  13. Dynamics of the alar rim graft.

    PubMed

    Guyuron, Bahman; Bigdeli, Yaas; Sajjadian, Ali

    2015-04-01

    The purpose of this study was to review the dynamics and frequency of the use of the alar rim graft. The recorded intraoperative information for the purpose of rhinoplasty research was reviewed to investigate the frequency of the use of alar rim grafts. Intraoperative observations were also made while inserting the alar rim graft to identify the changes that occur in the structures that could be influenced by placement of this graft. The data were tabulated in an Excel file and analyzed. Of the 1427 patients who underwent nose reconstruction or rhinoplasty in this study, 565 (39.56 percent) received alar rim grafts. This included 73 primary nose reconstructions, 20 secondary nose reconstructions, two revision nose reconstructions, 304 primary rhinoplasties, 107 secondary rhinoplasties, 43 revision operations following primary rhinoplasties, and seven revision operations following secondary rhinoplasties. However, when 100 more recent consecutive cases were reviewed, 88 percent of primary rhinoplasty patients and 67 percent of secondary rhinoplasty patients received alar rim grafts. The observed dynamic changes after insertion of each graft included (1) correction of the concavity of the ala, (2) caudal advancement of the alar rim, (3) elongation of nostril, and (4) widening of the nostril. The majority of patients who undergo rhinoplasty would benefit from the alar rim graft, and this study demonstrates a steady increase in its use. Placement of an alar rim graft results in elongation of the short nostril, correction of the alar concavity, widening of the nostril, and slight caudal transposition of the alar rim.

  14. Anatomy of the alar ligament.

    PubMed

    Iwanaga, Joe; Sardi, Juan P; Laws, Tyler; Chapman, Jens R; Oskouian, Rod J; Tubbs, R Shane

    2017-08-18

    There are four layers of ligamentous stabilizers at the cranio-cervical junction and the second layer is comprised of the apical and paired alar ligaments. The purpose of this study is to establish the tensile strength of the alar ligaments for better understanding the implications that can arise from trauma and other pathologies in the craniocervical region. Nineteen sides from ten fresh frozen adult cadaveric Caucasian heads were used in this study. The specimens were derived from six males and four females, and the age of the cadavers at death ranged from 67 to 90-years-old to measure the tensile strength, a tensile testing machine (M2-200, Mark-10 corporation, USA) was used in this study. The force (N) necessary until failure for all alar ligaments ranged from 87 to 346 N with a mean of 186.9±69.7 N. There was a significant difference when comparing tensile strength between males and females. Further studies will be needed to determine their importance as secondary stabilizers and measure their ability to support similar forces when subject to rotation and lateral bending forces, as well as with flexion-extension. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Femoral neuropathy secondary to ossification of the ligamentum flavum.

    PubMed

    Debiais, F; Bataille, B; Debiais, P; Azais, I; Bontoux, D; Alcalay, M

    2000-05-01

    Radiculopathy resulting from ossification of the ligamentum flavum (OLF) is extremely rare and concerns only intercostal neuralgias. We describe a 37-year-old Caucasian woman with a lumbar radiculopathy revealing an OLF. Her symptoms were completely and definitively relieved by surgery.

  16. Update in alar base reduction in rhinoplasty.

    PubMed

    Lima, Leila Freire Rego; Arroyo, Helena Hotz; Jurado, José Roberto Parisi

    2016-08-01

    The purpose of this article is to further explore the techniques available for alar base reduction by a recent review in this topic, focusing in the current advances in the field, in a clear and readable format. Among the numerous techniques available, the management of cases with wide nasal base and alar flaring remains limited to three options: cinching sutures to pull in the alae together; or to use alar base excisions that remove tissue from the alar lobule to decrease flare and from inside the nostril to decrease width; and flap advancement. Surgical modification of the nasal base is not a routine part of rhinoplasty and should be performed in a conservative manner to prevent complications like nasal stenosis. Moreover, this maneuver should always be the last one in rhinoplasty, as alar base modifications cannot be properly assessed until all other steps have been carried out. VIDEO ABSTRACT.

  17. First report of perforation of ligamentum flavum by sequestrated lumbar intervertebral disc

    PubMed Central

    Ozdemir, Bulent; Kanat, Ayhan; Batcik, Osman Ersegun; Erturk, Cihangir; Celiker, Fatma Beyazal; Guvercin, Ali Riza; Yazar, Ugur

    2017-01-01

    Disc fragments are well known to migrate to superior, inferior, or lateral sites in the anterior epidural space, posterior epidural migrated lumbar disc fragments is an extremely rare disorder, 61 cases have been reported to date. However, there were no cases with perforated ligamentum flavum (LF). We report a different case with perforation of ligamentum ligamentum by disc fragment. To the best of our knowledge, this is the first report of perforation LF by a posterior epidural migrated sequester disc. PMID:28250640

  18. Amyloid deposits derived from transthyretin in the ligamentum flavum as related to lumbar spinal canal stenosis.

    PubMed

    Yanagisawa, Akihiro; Ueda, Mitsuharu; Sueyoshi, Takanao; Okada, Tatsuya; Fujimoto, Toru; Ogi, Yasuhiro; Kitagawa, Keisuke; Tasaki, Masayoshi; Misumi, Yohei; Oshima, Toshinori; Jono, Hirofumi; Obayashi, Konen; Hirakawa, Kei; Uchida, Hitoshi; Westermark, Per; Ando, Yukio; Mizuta, Hiroshi

    2015-02-01

    Amyloidosis is a protein conformational disorder with the distinctive feature of extracellular accumulation of amyloid fibrils that come from different proteins. In the ligamentum flavum of the lumbar spine, amyloid deposits were frequently found in elderly patients with lumbar spinal canal stenosis and were at least partially formed by wild-type transthyretin. However, how amyloid deposits in the ligamentum flavum affect lumbar spinal canal stenosis has remained unclear. In this study, we analyzed clinical, pathologic, and radiologic findings of patients with lumbar spinal canal stenosis who had amyloid deposits in the ligamentum flavum. We studied 95 ligamentum flavum specimens obtained from 56 patients with lumbar spinal canal stenosis and 21 ligamentum flavum specimens obtained from 19 patients with lumbar disk herniation. We evaluated histopathologic findings and clinicoradiologic manifestations, such as thickness of the ligamentum flavum and lumbar spinal segmental instability. We found that all 95 ligamentum flavum specimens resected from patients with lumbar spinal canal stenosis had amyloid deposits, which we classified into two types, transthyretin-positive and transthyretin-negative, and that transthyretin amyloid formation in the ligamentum flavum of patients with lumbar spinal canal stenosis was an age-associated phenomenon. The amount of amyloid in the ligamentum flavum was related to clinical manifestations of lumbar spinal canal stenosis, such as thickness of the ligamentum flavum and lumbar spinal segmental instability, in the patients with lumbar spinal canal stenosis with transthyretin-positive amyloid deposits. To our knowledge, this report is the first to show clinicopathologic correlations in transthyretin amyloid deposits of the ligamentum flavum. In conclusion, transthyretin amyloid deposits in the ligamentum flavum may be related to the pathogenesis of lumbar spinal canal stenosis in elderly patients.

  19. New classification for correction of alar retraction using the alar spreader graft.

    PubMed

    Kim, Jae Hoon; Park, Sung Wan; Oh, Won Suk; Lee, Joo Heon

    2012-08-01

    Identifying the cause of alar retraction is essential for proper correction of this deformity. In secondary surgery, aimed primarily at cephalic orientation and medialization of the lateral crus, corrections involving spreading and lateralization of the lateral crus can achieve a more horizontal orientation. In their clinic, the authors have practiced the use of an alar spreader graft to support the spread of the lateral crus. For the lateral crus to move freely without any resistance, it is critical to release the nasal hinge and pyriform ligament. A frontal view of the alar notching and the direction of the lateral crus are highly important factors needed to determine the cause of alar retraction. This report describes a new classification system for alar retractions viewed from the front to aid in determining the cause of the retraction and the surgical management. From March 2008 to July 2010, 31 alar retractions were corrected using alar spreader grafts for patients showing clear alar retractions in frontal views. Satisfactory results without severe complications were obtained in 30 cases, with undercorrection in only 1 case. The alar cartilage was completely released to facilitate lateralization and caudal mobilization. An alar spreader graft then was used to support the lateral crus until a biologic scar cast was formed. The use of alar spreader grafts to correct alar retractions provided consistently good results. The attempt also was made to enhance the treatment strategy based on this classification system derived from frontal views of alar retraction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266 .

  20. Alar flap combined with free auricular composite flap for the reconstruction of nasal alar defect.

    PubMed

    Lin, Wentao; Qing, Yong; Liu, Jia; Cen, Ying

    2015-03-01

    The nasal ala plays an important role in the aesthetic appearance of the nose. Repairing the nasal alar defect, especially full-thickness alar defect, is one of the difficulties of plastic surgeons. In this article, a new surgical method is introduced about repairing full-thickness alar defect with free auricular composite flaps and local nasal alar rotation and advancement tissue flaps. We retrospectively reviewed 6 patients with a diagnosis of full-thickness alar defect between 2010 and 2013. All of them accepted this new surgical method. The patients were followed up for 6 to 12 months. The method used local nasal alar rotation and advancement tissue flap to form new nasal rim and made the defect of nasal rim shift to alar groove region. After that, we harvested free auricular composite flap to repair the new defect. All patients attained relatively symmetrical nostrils with a natural, smooth, integrated alar rim and inconspicuous scars. All the reconstructed nasal alae were aesthetically satisfactory. Slight atrophy of grafts was observed in all patients. The shape of the donor ear changed a little. Two patients experienced hyperpigmentation change and one patient presented slight hypertrophic scar in the suture site. No other complications were observed. This simple method not only reconstructed almost normal nasal alar rims and alar grooves but also improved the survival rate of the composite grafts without any free edges. This method also changed the traditional free auricular tissue flap location from the nasal alar rim to the upper alar groove region, which would help achieve more aesthetic appearance. This new method is a creative and useful technique for the repair of full-thickness alar defect.

  1. Anterior septal deviation and contralateral alar collapse.

    PubMed

    Schalek, P; Hahn, A

    2011-01-01

    Septal deviation is often found in conjunction with other pathological conditions that adversely affect nasal patency. Anterior septal deviation, together with contralateral alar collapse, is a relatively rare type of anatomical and functional incompetence. In our experience, it can often be resolved with septoplasty, without the necessity of surgery involving the external valve. The aim of this paper was to verify this hypothesis prospectively. Twelve patients with anterior septal deviation and simultaneous alar collapse on the opposite side were prospectively enrolled in the study. Subjective assessment of nasal patency was made on post-operative day 1, and again 6 months after surgery, using a subjective evaluation of nasal breathing. The width of the nostril (alar-columellar distance) on the side with the alar collapse was measured during inspiration pre-operatively, 1 day after surgery and again 6 months after surgery. Immediately after surgery, all patients reported improved or excellent nasal breathing on the side of the original septal deviation. On the collapsed side, one patient reported no change in condition. With the exception of one patient, all measurements showed some degree of improvement in the extension of the alar-columellar distance. The average benefit 6 months after surgery was an improvement of 4.54 mm. In our group of patients (anterior septal deviation and simultaneous contralateral alar collapse and no obvious structural changes of the alar cartilage) we found septoplasty to be entirely suitable and we recommend it as the treatment of choice in such cases.

  2. Ossified Ligamentum Longitudinale Anterius in Adult Human Dry Vertebrae

    PubMed Central

    Venumadhav, Nelluri; KS, Siddaraju

    2014-01-01

    Background: The ligamentum longitudinale anterius is a broad and strong band of fibrous tissue that runs along the anterior surfaces of the bodies of the vertebrae. Aim: The study was undertaken to evaluate the incidence of ossified ligamentum longitudinale anterius in adult dry human vertebra. Materials and Methods: This study was carried out on 95 sets of dry human vertebral columns irrespective of age and sex at Mayo Institute of Medical Sciences- Barabanki,-UP, Melaka Manipal Medical College-Manipal University and Department of Anatomy, KMCT Medical College, Manassery- Calicut, India. All the sets of vertebral columns were macroscopically inspected for the ossified ligamentum longitudinale anterius. Results: It was observed that out of 95 sets of vertebral columns, 27 (28.42%) vertebral columns showed ossification. Out of 27 vertebral columns, 17 (17.89%) vertebral columns showed segmental type of ossification, 2 (2.11%) vertebral columns showed continuous type of ossification and 8 (8.42%) vertebral columns showed mixed type of ossification at different vertebral level. Conclusion: Such type of ossification will affect the biomechanics of the spine and may result in stiff neck, low back pain, dysphagia, odynophagia, compression of the brachial plexus, aphonia, immobility or mucosal thickening of larynx. Hence, knowledge of such abnormalities should be kept in mind to minimise serious complications in any surgical intervention or investigative procedures in the region. PMID:25302180

  3. Ossified ligamentum longitudinale anterius in adult human dry vertebrae.

    PubMed

    Kosuri, Kalyan Chakravarthi; Venumadhav, Nelluri; Ks, Siddaraju

    2014-08-01

    The ligamentum longitudinale anterius is a broad and strong band of fibrous tissue that runs along the anterior surfaces of the bodies of the vertebrae. The study was undertaken to evaluate the incidence of ossified ligamentum longitudinale anterius in adult dry human vertebra. This study was carried out on 95 sets of dry human vertebral columns irrespective of age and sex at Mayo Institute of Medical Sciences- Barabanki,-UP, Melaka Manipal Medical College-Manipal University and Department of Anatomy, KMCT Medical College, Manassery- Calicut, India. All the sets of vertebral columns were macroscopically inspected for the ossified ligamentum longitudinale anterius. It was observed that out of 95 sets of vertebral columns, 27 (28.42%) vertebral columns showed ossification. Out of 27 vertebral columns, 17 (17.89%) vertebral columns showed segmental type of ossification, 2 (2.11%) vertebral columns showed continuous type of ossification and 8 (8.42%) vertebral columns showed mixed type of ossification at different vertebral level. Such type of ossification will affect the biomechanics of the spine and may result in stiff neck, low back pain, dysphagia, odynophagia, compression of the brachial plexus, aphonia, immobility or mucosal thickening of larynx. Hence, knowledge of such abnormalities should be kept in mind to minimise serious complications in any surgical intervention or investigative procedures in the region.

  4. Nasal base narrowing: the alar flap advancement technique.

    PubMed

    Ismail, Ahmed Soliman

    2011-01-01

    To evaluate the role of creating an alar-based advancement flap in narrowing the nasal base and correcting excessive alar flare. Case series with chart review. This is a retrospective record review study. The study included 35 cases presenting with a wide nasal base and excessive alar flaring. The surgical procedure combined the alar base reduction with alar flare excision by creating a single laterally based alar flap. Any caudal septal deformities and any nasal tip modification procedures were corrected before the nasal base narrowing. The mean follow-up period was 23 months. The mean alar flap narrowing was 6.3 mm, whereas the mean width of sill narrowing was 2.9 mm. This single laterally based advancement alar flap resulted in a more conservative external resection, thus avoiding alar wedge overresection or blunting of the alar-facial crease. No cases of postoperative bleeding, infection, or keloid were encountered, and the external alar wedge excision healed with no apparent scar that was hidden in the depth of the alar-facial crease. The risk of notching of the alar rim at the sill incision is reduced by adopting a 2-layer closure of the vestibular floor. The alar base advancement flap is an effective technique in narrowing both the nasal base and excessive alar flare. It adopts a single skin excision to correct the 2 deformities while commonly feared complications were avoided.

  5. Novel technique and simple approach for supra-alar region and supra-alar crease correction by supra-alar cinching

    PubMed Central

    Selvaraj, Loganathan

    2016-01-01

    This technical report describes a simple and innovative surgical technique for supra-alar sidewall region constriction and supra-alar crease attenuation by cinching technique through intraoral approach. PMID:28163492

  6. Novel technique and simple approach for supra-alar region and supra-alar crease correction by supra-alar cinching.

    PubMed

    Selvaraj, Loganathan

    2016-01-01

    This technical report describes a simple and innovative surgical technique for supra-alar sidewall region constriction and supra-alar crease attenuation by cinching technique through intraoral approach.

  7. Assessment of Alar Flare and Efficacy of Alar Cinch Suture in the Management of Alar Flare Following Le Fort 1 Superior Repositioning: A Comparative Study.

    PubMed

    Mustafa, K; Shehzana, Fatima; Bhat, H Hari Kishore

    2016-12-01

    To prospectively analyze the amount of alar flare, factors contributing to alar flare and efficacy of cinch suture as an adjunctive procedure for alar flare reduction. Thirty adult patients with vertical maxillary excess, who underwent Le Fort 1 impaction, were divided into 2 groups of 15 each. Alar cinch was performed as an adjunct procedure in group 2 patients and results were compared to group 1 which was the control group. Measurements were made on the patients and on 1:1 standardized photographs. Group 2 showed a near pre-operative alar position compared to group 1. The alar flare resulting from every millimeter of impaction was significantly less in group 2 compared to group 1. Alar cinch suture restores the normal alar width by preventing the lateral drift of the naso-labial muscle and thereby reducing the postoperative nasal flare significantly.

  8. The Articulated Alar Rim Graft: Reengineering the Conventional Alar Rim Graft for Improved Contour and Support.

    PubMed

    Ballin, Annelyse C; Kim, Haena; Chance, Elizabeth; Davis, Richard E

    2016-08-01

    Surgical refinement of the wide nasal tip is challenging. Achieving an attractive, slender, and functional tip complex without destabilizing the lower nasal sidewall or deforming the contracture-prone alar rim is a formidable task. Excisional refinement techniques that rely upon incremental weakening of wide lower lateral cartilages (LLC) often destabilize the tip complex and distort tip contour. Initial destabilization of the LLC is usually further exacerbated by "shrink-wrap" contracture, which often leads to progressive cephalic retraction of the alar margin. The result is a misshapen tip complex accentuated by a conspicuous and highly objectionable nostril deformity that is often very difficult to treat. The "articulated" alar rim graft (AARG) is a modification of the conventional rim graft that improves treatment of secondary alar rim deformities, including postsurgical alar retraction (PSAR). Unlike the conventional alar rim graft, the AARG is sutured to the underlying tip complex to provide direct stationary support to the alar margin, thereby enhancing graft efficacy. When used in conjunction with a well-designed septal extension graft (SEG) to stabilize the central tip complex, lateral crural tensioning (LCT) to tighten the lower nasal sidewalls and minimize soft-tissue laxity, and lysis of scar adhesions to unfurl the retracted and scarred nasal lining, the AARG can eliminate PSAR in a majority of patients. The AARG is also highly effective for prophylaxis against alar retraction and in the treatment of most other contour abnormalities involving the alar margin. Moreover, the AARG requires comparatively little graft material, and complications are rare. We present a retrospective series of 47 consecutive patients treated with the triad of AARG, SEG, and LCT for prophylaxis and/or treatment of alar rim deformities. Outcomes were favorable in nearly all patients, and no complications were observed. We conclude the AARG is a simple and effective method for

  9. Bilateral alar cartilage reduction rhinoplasty allows primary repair of alar defects in the bulbous nose.

    PubMed

    Al-Benna, Sammy

    2012-01-01

    Plastic surgeons have many reconstructive options for lower nasal skin defects, but given the unique aesthetic features of nasal skin the best source for reconstruction is nasal skin itself, when sufficient quantity exists. The purpose of this study is to determine the outcome of bilateral alar cartilage reduction rhinoplasty in combination with a nasal flap to facilitate immediate reconstruction of defects of the nasal tip, soft triangle and alar margin. This prospective study analyzed the aesthetic outcome after reconstruction with bilateral alar cartilage reduction rhinoplasty to reduce the nasal rim and create an excess of skin sufficient to facilitate immediate reconstruction of defects of the nasal tip, soft triangle and alar margin. All wounds healed primarily and patient satisfaction was achieved. Bilateral alar cartilage reduction rhinoplasty allows single-stage reconstruction of defects of the nasal tip, soft triangle, and medial alar rim in the bulbous nose. By placing incisions along the borders of the aesthetic subunits, this novel approach to primary reconstruction of the nasal tip, soft triangle, and medial alar rim provides skin with a superior color and texture match, maintains a satisfactory contour of the nasal rim, and optimizes the likelihood of good scar quality.

  10. Rhinoplasty: the lateral crura-alar ring.

    PubMed

    Daniel, Rollin K; Palhazi, Peter; Gerbault, Olivier; Kosins, Aaron M

    2014-05-01

    Rhinoplasty surgeons routinely excise or incise the lateral crura despite nostril rim retraction, bossa, and collapse. Given recent emphasis on preserving the lateral crura, a review of the lateral crura's anatomy is warranted. The authors quantify specific anatomical aspects of the lateral crura in cadavers and clinical patients. This was a 2-part investigation, consisting of a prospective clinical measurement study of 40 consecutive rhinoplasty patients (all women) and 20 fresh cadaver dissections (13 males, 1 female). In the clinical phase, the alar cartilages were photographed intraoperatively and alar position (ie, orientation), axis, and width were measured. Cadaver dissections concentrated on parts of the lateral crura (alar cartilages and alar ring) that were inaccessible clinically. Average clinical patient age was 28 years (range, 14-51 years). Average cadaver age was 74 (range, 57-88 years). Clinically, the distance of the lateral crura from the mid-nostril point averaged 5.9 mm, and the cephalic orientation averaged 43.6 degrees. The most frequent configuration of the axis was smooth-straight in the horizontal axis and a cephalic border higher than the caudal border in the vertical axis. Maximal lateral crura width averaged 10.1 mm. In the cadavers, average lateral crural dimensions were 23.4 mm long, 6.4 mm wide at the domal notch, 11.1 mm wide at the so-designated turning point (TP), and 0.5 mm thickness. The accessory cartilage chain was present in all dissections. The lateral crura-alar ring was present in all dissections as a circular ring continuing around toward the anterior nasal spine but not abutting the pyriform. The lateral crura (1) begins at the domal notch and ends at the accessory cartilages, (2) exhibits a distinct TP from the caudal border, (3) has distinct horizontal and vertical vectors, and (4) should have a caudal border higher than the cephalic border. Alar malposition may be associated with position, orientation, or configuration.

  11. Rhinoplasty: congenital deficiencies of the alar cartilage.

    PubMed

    Kosins, Aaron M; Daniel, Rollin K; Sajjadian, Ali; Helms, Jill

    2013-08-01

    Congenital deficiencies of the alar cartilages are rare and often visible at birth but can occasionally present later. The authors review the anatomical development and discuss the incidence and treatment of congenital defects within the alar cartilages seen in rhinoplasty cases. The charts of 869 consecutive patients who underwent open rhinoplasty were retrospectively reviewed, and 8 cases of congenital defects of the alar cartilage within the middle crura were identified. Intraoperative photographs were taken of the alar deformities, and each patient underwent surgical correction. To simplify analysis, a classification of the defects was developed. A division was a cleft in the continuity of the alar cartilage with the 2 ends separate. A gap was a true absence of cartilage ranging from 1 to 4 mm, which can be accurately assessed in unilateral cases. A segmental loss was a defect greater than 4 mm. The 8 cases of deformity could be classified as 4 divisions, 3 gaps, and 1 segmental loss. None of the patients had a history of prior nasal trauma or nasal surgery. Six patients were women and 2 patients were men. In all cases, adequate projection and stability were achieved with a columellar strut. Asymmetry was minimized through concealer or tip grafts. There were no complications. Surgeons performing rhinoplasty surgery will encounter and should be prepared to deal with unexpected congenital defects of the alar cartilage. These defects within the middle crura will require stabilization with a columellar strut and, often, coverage with a concealer tip graft. We speculate that the cause of these defects is a disruption of the hedgehog signals that may arrest the condensation or block the differentiation of the underlying neural crest cells.

  12. Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report.

    PubMed

    Gazzeri, Roberto; Galarza, Marcelo; Gorgoglione, Leonardo; Bisceglia, Michele; D'Angelo, Vincenzo

    2005-10-01

    A patient with progressive gait disturbance resulting from a cyst of the cervical ligamentum flavum associated with C7-T1 listhesis is reported. Surgical removal of the cyst improved the patient's myelopathy. Intraspinal degenerative cysts are preferentially located in the lumbar region:unusual is the cervical localization. Differential diagnosis includes ligamentum flavum cyst, synovial and ganglion cysts. Association between degenerative intraspinal cysts and listhesis is discussed. To our knowledge, this is the first case of cyst of the ligamentum flavum associated with cervical subluxation.

  13. Alar Contour Grafts in Rhinoplasty: A Safe and Reproducible Way to Refine Alar Contour Aesthetics.

    PubMed

    Unger, Jacob G; Roostaeian, Jason; Small, Kevin H; Pezeshk, Ronnie A; Lee, Michael R; Harris, Ryan; Rohrich, Rod J

    2016-01-01

    Alar rim deformities such as retraction, notching, collapse, and asymmetry are common problems in rhinoplasty patients. Although alar rim deformities may be improved through rhinoplasty, this area is prone to late changes because of scarring of the soft triangles and a paucity of native structural support. The purpose of this study was to analyze the effect of alar contour grafts on primary rhinoplasty. Fifty consecutive primary rhinoplasty patients with preoperative and postoperative photographs who received alar contour grafts were evaluated for alar aesthetics; 50 consecutive primary rhinoplasty patients without such grafts served as controls. Differences among alar retraction, notching, collapse, and asymmetry from anterior, lateral, and basal views were evaluated. Follow-up ranged from 1 to 4 years and was graded on a four-point scale. The average difference between the two groups' aggregate preoperative scores was 0.21 (p = 0.24). The average preoperative and postoperative scores in the nongraft group were significant for worsening retraction, notching, and collapse but insignificant for asymmetry. The preoperative and postoperative scores for the graft group were insignificant for retraction but improved significantly for notching, collapse, and asymmetry. Postoperatively, the aggregate average of the scores in the nongroup was 0.32 points worse (p < 0.01), whereas the graft group had a 0.33-point improvement (p < 0.01). Alar contour grafts have a clear and important impact on cosmetic results of primary rhinoplasty. Use of alar contour grafts has been shown to improve aesthetics, whereas there is a worsening of the measured parameters postoperatively without use of these grafts. Therapeutic, III.

  14. Functional anatomy of the alar ligaments.

    PubMed

    Dvorak, J; Panjabi, M M

    1987-03-01

    Nineteen upper cervical spine specimens were dissected to examine the macroscopic and functional anatomy of alar ligaments. They are on both sides, symmetrically placed, approximately 10-13 mm long and elliptical in cross-section 3 X 6 mm in diameter. The fiber orientation is dependent on the height of dens axis, mostly in the cranial caudal direction. In 12 specimens there was a ligamentous connection between dens and lateral mass of the atlas as a part of the alar ligament. In 2 specimens anterior atlanto-dental ligament was identified. The computerized tomographic (CT) images can clearly show alar ligaments in axial, coronal, and sagittal planes. The ligaments limit the axial rotation in the occipito-atlanto-axial complex (to the right by left alar and vice versa) as well as in side bending. The ligament is most stretched, and consequently most vulnerable, when the head is rotated and in addition flexed. This mechanism, common in whiplash injuries, could lead to irreversible overstretching or rupture of the ligaments especially as the ligaments consist of mainly collagen fibers.

  15. [Calcification of the cervical ligamentum flavum. Case report and review of the literature].

    PubMed

    Guesmi, H; Lamouchi, T; Mlaiki, A; Ksira, I; Tlili, K; Krifa, H

    2005-12-01

    Calcification of the cervical ligamentum flavum is a rare entity observed exclusively in Japanese people. We report a new case in a 65-year-old man from Tunisia who presented with symptoms of cervical myelopathy with mild tetra paresis, sensory abnormalities and dysuria. Magnetic resonance imaging (MRI) showed a posterior compression of the spinal cord at C3-C4. CT-scan showed a calcification of the ligamentum flavum at level C3-C4, compressing the left postero-lateral aspect of the spinal cord. C3-C4 laminectomy was performed with removal of abnormal ligamentum flavum tissue. The postoperative course was uneventful and all symptoms resolved. Calcification of the cervical ligamentum flavum is a rare entity; the diagnosis is easy but the pathogenesis remains unclear. Literature regarding this pathology is reviewed.

  16. Absence of Ligamentum Teres in Developmental Dysplasia of the Hip.

    PubMed

    Li, TianYou; Zhang, MinGang; Wang, HengBing; Wang, YanZhou

    2015-01-01

    Ligamentum teres is hypertrophied and should be resected in developmental dysplasia of the hip (DDH). We have observed a relatively high prevalence of absence of ligamentum teres (ALT) in severe DDH. The purpose of this study was to determine: (1) the percentage of ALT in DDH; (2) the risk factors correlating with ALT; and (3) the pathologic characteristics of DDH with ALT. In 2012, 123 patients were hospitalized for open reduction of DDH. Clinical records were retrospectively reviewed. The distribution of ALT was discerned. The risk factors correlating with ALT were analyzed. The pathologic changes of the DDH with ALT were observed. For the 123 patients, there were 14 males and 109 females with a mean age of 2.2±1.7 years old. Forty-one cases were diagnosed with bilateral DDH, and 27 of them had open reduction for both hips. Thus, 150 hips were included. According to the Tonnis grading, there were 1 grade I, 43 II, 67 III, and 39 IV patients. During operation, the ligamentum teres was confirmed absent in 24 patients (28 hips, 18.67%), 22 of the hips with ALT was Tonnis grade IV (78.57%). It was present in the other 99 patients (122 hips). The difference of ALT among different grade (χ2=43.959, P=0.000) and different age (χ2=10.748, P=0.008) showed statistical significance, respectively. Logistic regression revealed only grading was the correlation factor of ALT (P=0.000). Pathologically, the femoral head was extremely small. The cartilage surface showed erosion-like change. The acetabulum was also diminutive but could match the femoral head well. At our institution, 18.67% of DDH needing open reduction was combined with ALT. The degree of dislocation was the only correlation factor of ALT. If the Tonnis grade was high, the hip was often associated with ALT. This study defines the prevalence of ALT and its risk factor in DDH, which will help to better understand the imaging, pathologic findings, and clinical outcome of DDH.

  17. Tissue transglutaminase is involved in mechanical load-induced osteogenic differentiation of human ligamentum flavum cells.

    PubMed

    Chao, Yuan-Hung; Huang, Shih-Yung; Yang, Ruei-Cheng; Sun, Jui-Sheng

    2016-07-01

    Mechanical load-induced osteogenic differentiation might be the key cellular event in the calcification and ossification of ligamentum flavum. The aim of this study was to investigate the influence of tissue transglutaminase (TGM2) on mechanical load-induced osteogenesis of ligamentum flavum cells. Human ligamentum flavum cells were obtained from 12 patients undergoing lumbar spine surgery. Osteogenic phenotypes of ligamentum flavum cells, such as alkaline phosphatase (ALP), Alizarin red-S stain, and gene expression of osteogenic makers were evaluated following the administration of mechanical load and BMP-2 treatment. The expression of TGM2 was evaluated by real-time PCR, Western blotting, and enzyme-linked immunosorbent assay (ELISA) analysis. Our results showed that mechanical load in combination with BMP-2 enhanced calcium deposition and ALP activity. Mechanical load significantly increased ALP and OC gene expression on day 3, whereas BMP-2 significantly increased ALP, OPN, and Runx2 on day 7. Mechanical load significantly induced TGM2 gene expression and enzyme activity in human ligamentum flavum cells. Exogenous TGM2 increased ALP and OC gene expression; while, inhibited TG activity significantly attenuated mechanical load-induced and TGM2-induced ALP activity. In summary, mechanical load-induced TGM2 expression and enzyme activity is involved in the progression of the calcification of ligamentum flavum.

  18. Nasal base narrowing: the combined alar base excision technique.

    PubMed

    Foda, Hossam M T

    2007-01-01

    To evaluate the role of the combined alar base excision technique in narrowing the nasal base and correcting excessive alar flare. The study included 60 cases presenting with a wide nasal base and excessive alar flaring. The surgical procedure combined an external alar wedge resection with an internal vestibular floor excision. All cases were followed up for a mean of 32 (range, 12-144) months. Nasal tip modification and correction of any preexisting caudal septal deformities were always completed before the nasal base narrowing. The mean width of the external alar wedge excised was 7.2 (range, 4-11) mm, whereas the mean width of the sill excision was 3.1 (range, 2-7) mm. Completing the internal excision first resulted in a more conservative external resection, thus avoiding any blunting of the alar-facial crease. No cases of postoperative bleeding, infection, or keloid formation were encountered, and the external alar wedge excision healed with an inconspicuous scar that was well hidden in the depth of the alar-facial crease. Finally, the risk of notching of the alar rim, which can occur at the junction of the external and internal excisions, was significantly reduced by adopting a 2-layered closure of the vestibular floor (P = .01). The combined alar base excision resulted in effective narrowing of the nasal base with elimination of excessive alar flare. Commonly feared complications, such as blunting of the alar-facial crease or notching of the alar rim, were avoided by using simple modifications in the technique of excision and closure.

  19. Isolated unilateral rupture of the alar ligament.

    PubMed

    Wong, Sui-To; Ernest, Kimberly; Fan, Grace; Zovickian, John; Pang, Dachling

    2014-05-01

    Only 6 cases of isolated unilateral rupture of the alar ligament have been previously reported. The authors report a new case and review the literature, morbid anatomy, and pathogenesis of this rare injury. The patient in their case, a 9-year-old girl, fell head first from a height of 5 feet off the ground. She presented with neck pain, a leftward head tilt, and severe limitation of right rotation, extension, and right lateral flexion of the neck. Plain radiographs and CT revealed no fracture but a shift of the dens toward the right lateral mass of C-1. Magnetic resonance imaging of the cervical spine showed signal hyperintensity within the left dens-atlas space on both T1- and T2-weighted sequences and interruption of the expected dark signal representing the left alar ligament, suggestive of its rupture. After 12 weeks of immobilization in a Guilford brace, MRI showed lessened dens deviation, and the patient attained full and painless neck motion. Including the patient in this case, the 7 patients with this injury were between 5 and 21 years old, sustained the injury in traffic accidents or falls, presented with marked neck pain, and were treated with external immobilization. All patients had good clinical outcome. The mechanism of injury is hyperflexion with rotation. Isolated unilateral alar ligament rupture is a diagnosis made by excluding associated fracture, dislocation, or disruption of other major ligamentous structures in the craniovertebral junction. CT and MRI are essential in establishing the diagnosis. External immobilization is adequate treatment.

  20. Alar base reduction: the boomerang-shaped excision.

    PubMed

    Foda, Hossam M T

    2011-04-01

    A boomerang-shaped alar base excision is described to narrow the nasal base and correct the excessive alar flare. The boomerang excision combined the external alar wedge resection with an internal vestibular floor excision. The internal excision was inclined 30 to 45 degrees laterally to form the inner limb of the boomerang. The study included 46 patients presenting with wide nasal base and excessive alar flaring. All cases were followed for a mean period of 18 months (range, 8 to 36 months). The laterally oriented vestibular floor excision allowed for maximum preservation of the natural curvature of the alar rim where it meets the nostril floor and upon its closure resulted in a considerable medialization of alar lobule, which significantly reduced the amount of alar flare and the amount of external alar excision needed. This external alar excision measured, on average, 3.8 mm (range, 2 to 8 mm), which is significantly less than that needed when a standard vertical internal excision was used ( P < 0.0001). Such conservative external excisions eliminated the risk of obliterating the natural alar-facial crease, which did not occur in any of our cases. No cases of postoperative bleeding, infection, or vestibular stenosis were encountered. Keloid or hypertrophic scar formation was not encountered; however, dermabrasion of the scars was needed in three (6.5%) cases to eliminate apparent suture track marks. The boomerang alar base excision proved to be a safe and effective technique for narrowing the nasal base and elimination of the excessive flaring and resulted in a natural, well-proportioned nasal base with no obvious scarring.

  1. Optimizing the Soft Tissue Triangle, Alar Margin Furrow, and Alar Ridge Aesthetics: Analysis and Use of the Articulate Alar Rim Graft.

    PubMed

    Goodrich, Jennifer L; Wong, B J F

    2016-12-01

    The alar lobule, alar margin, and soft triangle facet are receiving more attention in the literature as critical elements to address both preoperatively and during rhinoplasty. We have found that the use of the articulated alar rim graft (AARG) corrects deficiencies in these areas as well as provides mechanical stability to the external valve. In this article, we describe indications for AARG, describe in detail the procedure for AARG placement, and highlight the transformation AARGs can achieve in two illustrated case studies. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Alar and Apples: Newspaper Coverage of a Major Risk Issue.

    ERIC Educational Resources Information Center

    Friedman, Sharon M.; And Others

    A study reviewed coverage in 13 newspapers during 1989 of the issue of spraying the pesticide Alar on apples. Using VU/TEXT, a newspaper database, 297 articles in 13 newspapers that included the specified code words "Alar" with or without "apple" or "apples" were retrieved and analyzed using a 33-question coding…

  3. Clinical outcome of lumbar spinal stenosis based on new classification according to hypertrophied ligamentum flavum.

    PubMed

    Sakai, Yoshihito; Ito, Sadayuki; Hida, Tetsuro; Ito, Kenyu; Harada, Atsushi; Watanabe, Ken

    2017-01-01

    The ligamentum flavum hypertrophy is considered to be one of the important causes of development of lumbar spinal stenosis (LSS). Several histologic and biologic mechanisms in hypertrophied flavum have proposed. However, no study that investigated the relationship between clinical outcome and ligamentum flavum hypertrophy has been published. The purpose of this study was to identify a new classification of LSS, in ligamentous and nonligamentous stenosis, according to the cutoff value of the area proportion of the ligamentum flavum in the spinal canal, and to assess the value of surgical and conservative treatments for LSS based on the classification of the ligamentous stenosis. A total of 230 surgical patients with LSS were evaluated based on the cross-sectional area and intraoperative findings of the ligamentum flavum. LSS was classified as ligamentous or nonligamentous stenosis, according to the cutoff value of the proportion of the ligamentum flavum in the spinal canal. Based on the classification, the results of 234 surgical patients (103 patients with spinal fusion surgery and 131 patients with spinal decompression) and 191 patients under conservative treatment with prostaglandin E1 were evaluated, 1 year after treatments. ROC analysis revealed that the area under the curve for the cutoff value of the proportion of the ligamentum flavum in the spinal canal was 0.4275 (sensitivity = 0.861, specificity = 0.854). Based on these criteria, ligamentous and nonligamentous stenoses were 115 and 119 in surgical patients, 97 and 94 in conservative patients, respectively. In the surgical treatment group, no significant difference was found in any of the evaluations conducted for the group with ligamentous and nonligamentous stenosis. However, in the conservative treatment group, the patients with ligamentous stenosis showed significant improvement compared with patients with nonligamentous stenosis. Ligamentous stenosis in LSS patients had favorable outcome on

  4. The Seesaw Technique for Correction of Vertical Alar Discrepancy.

    PubMed

    Hyun, Sang Min; Medikeri, Gaurav Shankar; Jung, Dong-Hak

    2015-09-01

    Alar vertical discrepancy including alar base has been viewed as one of the most challenging reconstructive problems in rhinoplasty. The authors have created a simple technique that consistently gives aesthetically acceptable results. The authors have designed the seesaw technique to correct alar discrepancy (type 1 to 3). Type 1 has been used in 14 patients, type 2 has been used in three patients, and type 3 has been used in seven patients. Alar discrepancy was corrected satisfactorily in all cases, with good cosmetic outcome. One case required scar revision and another case required revision for overcorrection; satisfactory results were ultimately achieved in both cases. This new technique is quite easy to design and is effective in the correction of alar discrepancy. It yields good postoperative results along with satisfactory aesthetic outcomes.

  5. Ossification in the caudal attachments of the ligamentum flavum: an anatomic and computed tomographic study

    SciTech Connect

    Williams, D.M.; Gabrielson, T.O.; Latack, J.T.

    1982-12-01

    A review of anatomic specimens and routine computed tomographic (CT) scans of the chest and abdomen demonstrated that ossification in the caudal attachments of the ligamentum flavum is a common anatomic finding, but a much less common CT finding. Its characteristic location should help prevent confusion with other entities. The present study was prompted by a case of thoracic spine trauma, reported here, in which areas of bone density in the spinal canal simulated fracture fragments. The true nature of these bony projections, namely ossification in the ligamentum flavum, was established by computer reconstruction of axial CT images.

  6. Experimental Mouse Model of Lumbar Ligamentum Flavum Hypertrophy

    PubMed Central

    Saito, Takeyuki; Yokota, Kazuya; Kobayakawa, Kazu; Hara, Masamitsu; Kubota, Kensuke; Harimaya, Katsumi; Kawaguchi, Kenichi; Hayashida, Mitsumasa; Matsumoto, Yoshihiro; Doi, Toshio; Shiba, Keiichiro; Nakashima, Yasuharu; Okada, Seiji

    2017-01-01

    Lumbar spinal canal stenosis (LSCS) is one of the most common spinal disorders in elderly people, with the number of LSCS patients increasing due to the aging of the population. The ligamentum flavum (LF) is a spinal ligament located in the interior of the vertebral canal, and hypertrophy of the LF, which causes the direct compression of the nerve roots and/or cauda equine, is a major cause of LSCS. Although there have been previous studies on LF hypertrophy, its pathomechanism remains unclear. The purpose of this study is to establish a relevant mouse model of LF hypertrophy and to examine disease-related factors. First, we focused on mechanical stress and developed a loading device for applying consecutive mechanical flexion-extension stress to the mouse LF. After 12 weeks of mechanical stress loading, we found that the LF thickness in the stress group was significantly increased in comparison to the control group. In addition, there were significant increases in the area of collagen fibers, the number of LF cells, and the gene expression of several fibrosis-related factors. However, in this mecnanical stress model, there was no macrophage infiltration, angiogenesis, or increase in the expression of transforming growth factor-β1 (TGF-β1), which are characteristic features of LF hypertrophy in LSCS patients. We therefore examined the influence of infiltrating macrophages on LF hypertrophy. After inducing macrophage infiltration by micro-injury to the mouse LF, we found excessive collagen synthesis in the injured site with the increased TGF-β1 expression at 2 weeks after injury, and further confirmed LF hypertrophy at 6 weeks after injury. Our findings demonstrate that mechanical stress is a causative factor for LF hypertrophy and strongly suggest the importance of macrophage infiltration in the progression of LF hypertrophy via the stimulation of collagen production. PMID:28060908

  7. Experimental Mouse Model of Lumbar Ligamentum Flavum Hypertrophy.

    PubMed

    Saito, Takeyuki; Yokota, Kazuya; Kobayakawa, Kazu; Hara, Masamitsu; Kubota, Kensuke; Harimaya, Katsumi; Kawaguchi, Kenichi; Hayashida, Mitsumasa; Matsumoto, Yoshihiro; Doi, Toshio; Shiba, Keiichiro; Nakashima, Yasuharu; Okada, Seiji

    2017-01-01

    Lumbar spinal canal stenosis (LSCS) is one of the most common spinal disorders in elderly people, with the number of LSCS patients increasing due to the aging of the population. The ligamentum flavum (LF) is a spinal ligament located in the interior of the vertebral canal, and hypertrophy of the LF, which causes the direct compression of the nerve roots and/or cauda equine, is a major cause of LSCS. Although there have been previous studies on LF hypertrophy, its pathomechanism remains unclear. The purpose of this study is to establish a relevant mouse model of LF hypertrophy and to examine disease-related factors. First, we focused on mechanical stress and developed a loading device for applying consecutive mechanical flexion-extension stress to the mouse LF. After 12 weeks of mechanical stress loading, we found that the LF thickness in the stress group was significantly increased in comparison to the control group. In addition, there were significant increases in the area of collagen fibers, the number of LF cells, and the gene expression of several fibrosis-related factors. However, in this mecnanical stress model, there was no macrophage infiltration, angiogenesis, or increase in the expression of transforming growth factor-β1 (TGF-β1), which are characteristic features of LF hypertrophy in LSCS patients. We therefore examined the influence of infiltrating macrophages on LF hypertrophy. After inducing macrophage infiltration by micro-injury to the mouse LF, we found excessive collagen synthesis in the injured site with the increased TGF-β1 expression at 2 weeks after injury, and further confirmed LF hypertrophy at 6 weeks after injury. Our findings demonstrate that mechanical stress is a causative factor for LF hypertrophy and strongly suggest the importance of macrophage infiltration in the progression of LF hypertrophy via the stimulation of collagen production.

  8. Modified versus classic alar base sutures after LeFort I osteotomy: a systematic review.

    PubMed

    Liu, Xianwen; Zhu, Songsong; Hu, Jing

    2014-01-01

    The purpose of this systematic review is to evaluate the efficacy of a new modified alar base cinch suture by comparing it with the commonly used classic alar base suture after LeFort I osteotomy. A comprehensive search strategy was performed to include interventional studies involving the comparisons of alar base suturing methods after LeFort I osteotomy. Data analyses were conducted using the random-effects model. Three studies with 146 participants undergoing LeFort I maxillary osteotomy were included in this review. The results showed that, compared with the classic method, both modified transseptal alar base suture and modified reinsertion sutures significantly decreased postoperative alar and alar base widening. The modified alar base cinch suture was more effective than the classic alar base suture in maintaining preoperative alar and alar base width after LeFort I osteotomy. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Preventing alar retraction by preservation of the lateral crus.

    PubMed

    Gruber, Ronald P; Zhang, Andrew Y; Zang, Andrew; Mohebali, Khashayar

    2010-08-01

    Resecting the cephalic component of the lateral crus in an attempt to reduce tip bulbosity has the potential to aggravate and/or cause alar retraction. It is a more serious problem for those patients who exhibit borderline alar retraction. Fourteen primary rhinoplasty patients with borderline alar/columellar relationships for alar retraction formed the study. They did not warrant frank treatment of alar retraction but did exhibit tip bulbosity. An "island" of cephalic lateral crus was developed by an intercartilaginous incision and another 6 mm cephalic to the caudal border of the lateral crus. One or more mattress sutures were placed in the main body of the lateral crus to stiffen and straighten it. The "island" of cephalic crus was then slipped under the main body of the lateral crus. At 11 months to 2(1/2) years, 13 of the 14 patients demonstrated no significant change in their preoperative alar/columellar relationships. Bulbosity was corrected in all patients. One patient, however, required a revision using an alar contour rim graft. The mean preoperative alar-nostril axis measurement was 1.48 mm (range, 1.3 to 1.9 mm) in contrast to a mean postoperative measurement of 1.71 mm (range, 1.5 to 2.2 mm). A one-tailed paired t test indicated no statistically significant difference between preoperative and postoperative values. The cephalic part of the lateral crus can act as a lateral crural strut to maintain the ala in a more caudal position. The technique is useful for borderline alar retraction and when lengthening the short nose for which there is a need to preserve side wall length.

  10. Simple Correction of Alar Retraction by Conchal Cartilage Extension Grafts.

    PubMed

    Jang, Yong Jun; Kim, Sung Min; Lew, Dae Hyun; Song, Seung Yong

    2016-11-01

    Alar retraction is a challenging condition in rhinoplasty marked by exaggerated nostril exposure and awkwardness. Although various methods for correcting alar retraction have been introduced, none is without drawbacks. Herein, we report a simple procedure that is both effective and safe for correcting alar retraction using only conchal cartilage grafting. Between August 2007 and August 2009, 18 patients underwent conchal cartilage extension grafting to correct alar retraction. Conchal cartilage extension grafts were fixed to the caudal margins of the lateral crura and covered with vestibular skin advancement flaps. Preoperative and postoperative photographs were reviewed and analyzed. Patient satisfaction was surveyed and categorized into 4 groups (very satisfied, satisfied, moderate, or unsatisfied). According to the survey, 8 patients were very satisfied, 9 were satisfied, and 1 considered the outcome moderate, resulting in satisfaction for most patients. The average distance from the alar rim to the long axis of the nostril was reduced by 1.4 mm (3.6 to 2.2 mm). There were no complications, except in 2 cases with palpable cartilage step-off that resolved without any aesthetic problems. Conchal cartilage alar extension graft is a simple, effective method of correcting alar retraction that can be combined with aesthetic rhinoplasty conveniently, utilizing conchal cartilage, which is the most similar cartilage to alar cartilage, and requiring a lesser volume of cartilage harvest compared to previously devised methods. However, the current procedure lacks efficacy for severe alar retraction and a longer follow-up period may be required to substantiate the enduring efficacy of the current procedure.

  11. Simple Correction of Alar Retraction by Conchal Cartilage Extension Grafts

    PubMed Central

    Jang, Yong Jun; Kim, Sung Min; Lew, Dae Hyun

    2016-01-01

    Background Alar retraction is a challenging condition in rhinoplasty marked by exaggerated nostril exposure and awkwardness. Although various methods for correcting alar retraction have been introduced, none is without drawbacks. Herein, we report a simple procedure that is both effective and safe for correcting alar retraction using only conchal cartilage grafting. Methods Between August 2007 and August 2009, 18 patients underwent conchal cartilage extension grafting to correct alar retraction. Conchal cartilage extension grafts were fixed to the caudal margins of the lateral crura and covered with vestibular skin advancement flaps. Preoperative and postoperative photographs were reviewed and analyzed. Patient satisfaction was surveyed and categorized into 4 groups (very satisfied, satisfied, moderate, or unsatisfied). Results According to the survey, 8 patients were very satisfied, 9 were satisfied, and 1 considered the outcome moderate, resulting in satisfaction for most patients. The average distance from the alar rim to the long axis of the nostril was reduced by 1.4 mm (3.6 to 2.2 mm). There were no complications, except in 2 cases with palpable cartilage step-off that resolved without any aesthetic problems. Conclusions Conchal cartilage alar extension graft is a simple, effective method of correcting alar retraction that can be combined with aesthetic rhinoplasty conveniently, utilizing conchal cartilage, which is the most similar cartilage to alar cartilage, and requiring a lesser volume of cartilage harvest compared to previously devised methods. However, the current procedure lacks efficacy for severe alar retraction and a longer follow-up period may be required to substantiate the enduring efficacy of the current procedure. PMID:27896189

  12. [Thoracic spinal cord compression at two levels due to ligamentum flavum calcification. Case report].

    PubMed

    Gondim, J; Ramos Júnior, F

    1998-06-01

    Calcification and/or ossification of the ligamenta flava is a well reported clinicopathologic entity causing narrowing of the spinal canal cord compression. It has been described almost exclusively in Japanese people. The authors present the case of a non Japanese patient with thoracic myelopathy caused by ossification of the ligamentum flavum.

  13. Change of Lumbar Ligamentum Flavum after Indirect Decompression Using Anterior Lumbar Interbody Fusion

    PubMed Central

    Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Aoki, Yasuchika; Nakamura, Junichi; Miyagi, Masayuki; Suzuki, Miyako; Kubota, Gou; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Fujimoto, Kazuki; Shiga, Yasuhiro; Abe, Koki; Kanamoto, Hiroto; Inoue, Gen; Takahashi, Kazuhisa; Furuya, Takeo; Koda, Masao

    2017-01-01

    Study Design Retrospective case series. Purpose The purpose of this study was to examine changes in the ligamentum flavum thickness and remodeling of the spinal canal after anterior fusion during a 10-year follow-up. Overview of Literature Extreme lateral interbody fusion provides minimally invasive treatment of the lumbar spine; this anterior fusion without direct posterior decompression, so-called indirect decompression, can achieve pain relief. Anterior fusion may restore disc height, stretch the flexure of the ligamentum flavum, and increase the spinal canal diameter. However, changes in the ligamentum flavum thickness and remodeling of the spinal canal after anterior fusion during a long follow-up have not yet been reported. Methods We evaluated 10 patients with L4 spondylolisthesis who underwent stand-alone anterior interbody fusion using the iliac crest bone. Magnetic resonance imaging was performed 10 years after surgery. The cross-sectional area (CSA) of the dural sac and the ligamentum flavum at L1–2 to L5–S1 was calculated using a Picture Archiving and Communication System. Results Spinal fusion with correction loss (average, 4.75 mm anterior slip) was achieved in all patients 10 years postsurgery. The average CSAs of the dural sac and the ligamentum flavum at L1–2 to L5–S1 were 150 mm2 and 78 mm2, respectively. The average CSA of the ligamentum flavum at L4–5 (30 mm2) (fusion level) was significantly less than that at L1–2 to L3–4 or L5–S1. Although patients had an average anterior slip of 4.75 mm, the average CSA of the dural sac at L4–5 was significantly larger than at the other levels. Conclusions Spinal stability induced a lumbar ligamentum flavum change and a sustained remodeling of the spinal canal, which may explain the long-term pain relief after indirect decompression fusion surgery. PMID:28243378

  14. Feasibility and accuracy of nasal alar pulse oximetry.

    PubMed

    Morey, T E; Rice, M J; Vasilopoulos, T; Dennis, D M; Melker, R J

    2014-06-01

    The nasal ala is an attractive site for pulse oximetry because of perfusion by branches of the external and internal carotid arteries. We evaluated the accuracy of a novel pulse oximetry sensor custom designed for the nasal ala. After IRB approval, healthy non-smoking subjects [n=12; aged 28 (23-41) yr; 6M/6F] breathed hypoxic mixtures of fresh gas by a facemask to achieve oxyhaemoglobin saturations of 70-100% measured by traditional co-oximetry from radial artery samples. Concurrent alar and finger pulse oximetry values were measured using probes designed for these sites. Data were analysed using the Bland-Altman method for multiple observations per subject. Bias, precision, and accuracy root mean square error (ARMS) over a range of 70-100% were significantly better for the alar probe compared with a standard finger probe. The mean bias for the alar and finger probes was 0.73% and 1.90% (P<0.001), respectively, with corresponding precision values of 1.65 and 1.83 (P=0.015) and ARMS values of 1.78% and 2.72% (P=0.047). The coefficients of determination were 0.96 and 0.96 for the alar and finger probes, respectively. The within/between-subject variation for the alar and finger probes were 1.14/1.57% and 1.87/1.47%, respectively. The limits of agreement were 3.96/-2.50% and 5.48/-1.68% for the alar and finger probes, respectively. Nasal alar pulse oximetry is feasible and demonstrates accurate pulse oximetry values over a range of 70-100%. The alar probe demonstrated greater accuracy compared with a conventional finger pulse oximeter. © The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. Alar Pinning in Rigid External Distraction for Midfacial Hypoplasia.

    PubMed

    Yu, Jenny L; Woo, Albert S

    2017-09-01

    Distraction osteogenesis with a rigid external distractor is a widely accepted treatment for midfacial hypoplasia. In this study, the authors introduce the utilization of alar pinning with the external halo distractor for maxillary advancement, in place of an oral splint. A retrospective chart review was conducted of 7 patients who successfully underwent distraction osteogenesis using the alar pinning technique. Midfacial hypoplasia was secondary to Crouzon syndrome (n = 4), Apert syndrome (n = 1), Pfeiffer syndrome (n = 1), or bacterial meningitis (n = 1). Three patients were managed with monobloc osteotomies, 2 with Le Fort III osteotomies, 1 with Le Fort III osteotomy and frontoorbital advancement, and 1 with Le Fort I osteotomy alone. Patient charts were analyzed for postoperative course and complications relating to the alar pins. Two patients had minor complications specifically related to the alar pins. One patient had concern for a mild skin infection at a pin site that resolved with oral antibiotics. The other patient had loosening of an alar pin, which did not require operative management. Retrospective chart review indicated that all patients were pleased with their results from the distraction, and no patients opted for further advancement. Utilization of alar pin sites for external distraction is a feasible and reasonable option for treatment of midfacial hypoplasia involving a Le Fort osteotomy or monobloc procedure. Fixation sites within the alar crease minimize the visibility of pin site scars and eliminate the need for a custom-made oral splint, which prevents usage of the upper dentition and frequently requires consulting a dentist or orthodontist for fabrication. Alar pinning with an external halo distraction system for management of midfacial hypoplasia has minimal complications and is an alternative to using a custom-made oral splint.

  16. Revisiting the clinical anatomy of the alar ligaments.

    PubMed

    Osmotherly, Peter G; Rivett, Darren A; Mercer, Susan R

    2013-01-01

    The morphology of the alar ligaments has been inconsistently described, particularly with regard to the existence of an atlantal portion. Despite these inconsistencies, these descriptions have been used to develop physical tests for the integrity of these ligaments in patients with cervical spine problems. The purpose of this study was to describe the detailed macrostructure of the alar ligaments. The alar ligaments of 11 cervical spine specimens from embalmed adult cadavers were examined by fine dissection. A detailed description of the macrostructure of these ligaments and their attachment sites was recorded. Measurements were performed with respect to ligament dimensions and relations with selected bony landmarks. No atlantal portion of the alar ligament was viewed in any specimen. The attachment of the ligaments on the odontoid process occurred on its lateral and posterolateral aspects, frequently below the level of the apex. The occipital attachment was on the medial surface of the occipital condyles in close proximity to the atlanto-occipital joints. The orientation of the ligaments was primarily horizontal. The presence of transverse bands extending occiput to occiput with minimal or no attachment to the odontoid process was a common variant. The absence of findings with respect to the atlantal portion of the alar ligament suggests that it may be considered an anatomical variant, not an essential component for stability of the craniocervical complex. These findings may inform the use and interpretation of clinical tests for alar ligament integrity.

  17. Alar setback technique: a controlled method of nasal tip deprojection.

    PubMed

    Foda, H M

    2001-11-01

    To describe an alar cartilage-modifying technique aimed at decreasing nasal tip projection in cases with overdeveloped alar cartilages and to compare it with other deprojection techniques used to correct such deformity. Selected case series. University and private practice settings in Alexandria, Egypt. Twenty patients presenting for rhinoplasty who had overprojected nasal tips primarily due to overdeveloped alar cartilages. All cases were primary cases except for one patient, who had undergone 2 previous rhinoplasties. An external rhinoplasty approach was used to set back the alar cartilages by shortening their medial and lateral crura. The choice of performing a high or low setback depended on the preexisting lobule-to-columella ratio. Following the setback, the alar cartilages were reconstructed in a fashion that increased the strength and stability of the tip complex. Subjective evaluation included clinical examination, analysis of preoperative and postoperative photographs, and patient satisfaction. Objective evaluation of nasal tip projection, using the Goode ratio and the nasofacial angle, was performed preoperatively and repeated at least 6 months postoperatively. A low setback was performed in 16 cases (80%) and a high setback in 4 (20%). The mean follow-up period was 18 months (range, 6-36 months). The technique effectively deprojected the nasal tip as evidenced by the considerable postoperative decrease in values of the Goode ratio and the nasofacial angle. No complications were encountered and no revision surgical procedures were required. The alar setback technique has many advantages; it results in precise predictable amounts of deprojection, controls the degree of tip rotation, preserves the natural contour of the nasal tip, respects the tip support mechanisms, increases the strength and stability of nasal tip complex, preserves or restores the normal lobule-to-columella proportion, and does not lead to alar flaring. However, the technique requires

  18. Ligamentum teres hepatis patch enhances the healing of pancreatic fistula after distal pancreatectomy.

    PubMed

    Wu, Chun-Tao; Xu, Wen-Yan; Liu, Liang; Long, Jiang; Xu, Jin; Ni, Quan-Xing; Liu, Chen; Yu, Xian-Jun

    2013-12-01

    Pancreatic fistula is one of the most common complications after the distal pancreatectomy. Many methods have been tried to solve the problem, but no one is optimal, especially for the soft pancreatic stump cases. This study used ligamentum teres hepatis as a patch to cover the pancreatic stump. Between October 2010 and December 2012, seventy-seven patients who had undergone distal pancreatectomy with a soft pancreatic stump were divided into two groups: group A (n=39, patients received conventional ligated main pancreatic duct method) and group B (n=38, patients underwent a coverage procedure). Patients in group A had a longer recovery from postoperative pancreatic fistula than those in group B (16.4+/-3.5 vs 10.8+/-1.6 days, P<0.05). The coverage procedure with ligamentum teres hepatis is a safe, effective and convenient method for patients with a soft pancreas remnant during distal pancreatectomy.

  19. Postlaminectomy synovial cyst formation: a possible consequence of ligamentum flavum excision.

    PubMed

    Walcott, Brian P; Coumans, Jean-Valery

    2012-02-01

    Ligamentum flavum is generally resected with impunity when a laminectomy is performed; it is a strong ligament and its removal may not be inconsequential. We sought to examine the consequence of resection of ligamentum flavum as it pertains to the formation of synovial cysts. Following IRB approval, we retrospectively reviewed the charts of consecutive patients who underwent a laminectomy for any diagnosis during the years 2009-2010. Exclusions were made for patients undergoing resection of a synovial cyst, laminectomy done as part of a fusion, and microdiscectomy. A total of 201 laminectomies were performed. 10 instances of post-laminectomy synovial cyst occurred in only the lumbar spine. Synovial cysts occurred exclusively after surgery for stenosis (n=10). Laminectomy and resection of the ligament flavum is a risk factor for the subsequent formation of a synovial cyst. Secondary synovial cyst formation should be suspected in individuals who develop radiculopathy after laminectomy for stenosis.

  20. A potential mechanism of dural ossification in ossification of ligamentum flavum.

    PubMed

    Li, Bo; Guo, Shigong; Qiu, Guixing; Li, Wenjing; Liu, Yongsheng; Zhao, Yu

    2016-07-01

    Ossification of the ligamentum flavum (OLF) mostly occurs in the thoracic spine, leading to thoracic spinal stenosis. Surgical treatment is considered as the best option for OLF patients. When the dura mater ossifies, the difficulty of surgery and the risk of complications significantly increase. The cause of dural ossification (DO) is still unknown. Based on the existing research and clinical studies, we propose a potential mechanism of DO in OLF. Firstly, with the progression of OLF, it will compress the dura mater and even the spinal cord. Then, with flexion and extension of spine, relative movement (friction) between the ossified ligamentum flavum and compressed dura mater will lead to local inflammation, subsequently causing dural adhesion. Finally, the adhesion tissue can serve as a pathway for the transportation of osteogenic cytokines (BMP for example) from the ossified ligamentum flavum to the compressed dura mater. Dura will ossify under exposure of these osteogenic cytokines. If this hypothesis is confirmed, it will contribute to the prevention and management of DO. For progressive OLF patients, early surgical treatment before DO should be recommended.

  1. Decreased elastic fibers and increased proteoglycans in the ligamentum flavum of patients with lumbar spinal canal stenosis.

    PubMed

    Yabe, Yutaka; Hagiwara, Yoshihiro; Tsuchiya, Masahiro; Honda, Masahito; Hatori, Kouki; Sonofuchi, Kazuaki; Kanazawa, Kenji; Koide, Masashi; Sekiguchi, Takuya; Itaya, Nobuyuki; Itoi, Eiji

    2016-07-01

    Elastic fibers and proteoglycans are major components of the extracellular matrix and their changes have been reported in some pathological conditions. Further, recent studies have indicated that some glycosaminoglycans and proteoglycans inhibit elastic fiber assembly. The purpose of this study was to investigate changes of the elastic fibers and proteoglycans in the ligamentum flavum and analyze their relationships to thickening of the ligamentum flavum from lumbar spinal canal stenosis (LSCS). Ligamentum flavum samples were collected from 20 patients with LSCS (thickened flavum group) and 10 patients with lumbar disc herniation (non-thickened flavum group) as a control. Elastica-Masson staining and alcian blue staining were used to compare the relationship between the changes in the elastic fibers and proteoglycans. Gene and protein expressions of the elastic fibers and proteoglycans were analyzed by quantitative reverse transcription polymerase chain reaction and immunohistochemistry. Histological changes indicated that proteoglycans mainly increased on the dorsal side of the ligamentum flavum in accordance with the decreased elastic fibers in the thickened flavum group. The gene and protein expressions of fibrillin-2 and DANCE were significantly lower and decorin, lumican, osteoglycin, and versican were significantly higher in the thickened flavum group. Our study shows that elastic fibers decrease and proteoglycans increase in the thickened ligamentum flavum. Decreased gene expression of elastogenesis and disrupted elastic fiber assembly caused by increased proteoglycans may lead to a loss of elasticity in the thickened ligamentum flavum. Decreased elasticity may cause buckling of the tissue, which leads to thickening of the ligamentum flavum. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1241-1247, 2016. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  2. The narrowing of the lumbar spinal canal during loaded MRI: the effects of the disc and ligamentum flavum.

    PubMed

    Hansson, Tommy; Suzuki, Nobuyuki; Hebelka, Hanna; Gaulitz, Arne

    2009-05-01

    Load and activity changes of the spine typically cause symptoms of nerve root compression in subjects with spinal stenosis. Protrusion of the intervertebral disc has been regarded as the main cause of the compression. The objective was to determine the changes in the size of the lumbar spinal canal and especially those caused by the ligamentum flavum and the disc during loaded MRI. For this purpose an interventional clinical study on consecutive patients was made. The lumbar spines in 24 supine patients were examined with MRI: first without any external load and then with an axial load corresponding to half the body weight. The effect of the load was determined through the cross-sectional areas of the spinal canal and the ligamentum flavum, the thickness of ligamentum flavum, the posterior bulge of the disc and the intervertebral angle. External load decreased the size of the spinal canal. Bulging of the ligamentum flavum contributed to between 50 and 85% of the spinal canal narrowing. It was concluded that the ligamentum flavum, not the disc had a dominating role for the load induced narrowing of the lumbar spinal canal, a finding that can improve the understanding of the patho-physiology in spinal stenosis.

  3. Paraparesis in a black man brought on by ossification of the ligamentum flavum: case report and review of the literature.

    PubMed

    Wiseman, Diana Barrett; Stokes, John K; Toselli, Richard M

    2002-12-01

    We present the second case of paraparesis secondary to ossification of the ligamentum flavum at the midthoracic region in a black man. Ossification of the ligamentum flavum is frequently described in the Japanese population where the presentation is often in the lower thoracic region. The patient is a 37-year-old black man who, over the 6 months before admission, noticed progressive paraparesis. CT myelogram revealed severe thoracic stenosis by an ossified ligamentum flavum from T4 to T7 with most severe involvement at the T5, T6, and T7 levels. The patient underwent multilevel laminectomies and medial facetectomies from T4 to T7. Over the past decade, ossification of the ligamentum flavum has been reported with increasing frequency in non-Asian patients. This is the third case report in a black man. In addition, ossification of the ligamentum flavum in this particular location is rarely reported. The increased use of advanced neuroimaging techniques in the evaluation of "back pain" may reveal that the prevalence of this condition is higher than expected in non-Asian populations. Improvement in neurologic symptoms secondary to decompressive laminectomies will depend on the degree and duration of spinal cord compression.

  4. Correction of Alar Retraction Based on Frontal Classification.

    PubMed

    Kim, Jae Hoon; Song, Jin Woo; Park, Sung Wan; Bartlett, Erica; Nguyen, Anh H

    2015-11-01

    Among the various types of alar deformations in Asians, alar retraction not only has the highest occurrence rate, but is also very complicated to treat because the ala is supported only by cartilage and its soft tissue envelope cannot be easily stretched. As patients' knowledge of aesthetic procedures is becoming more extensive due to increased information dissemination through various media, doctors must give more accurate, logical explanations of the procedures to be performed and their anticipated results, with an emphasis on relevant anatomical features, accurate diagnoses, detailed classifications, and various appropriate methods of surgery.

  5. Correction of Alar Retraction Based on Frontal Classification

    PubMed Central

    Kim, Jae Hoon; Song, Jin Woo; Park, Sung Wan; Bartlett, Erica; Nguyen, Anh H.

    2015-01-01

    Among the various types of alar deformations in Asians, alar retraction not only has the highest occurrence rate, but is also very complicated to treat because the ala is supported only by cartilage and its soft tissue envelope cannot be easily stretched. As patients' knowledge of aesthetic procedures is becoming more extensive due to increased information dissemination through various media, doctors must give more accurate, logical explanations of the procedures to be performed and their anticipated results, with an emphasis on relevant anatomical features, accurate diagnoses, detailed classifications, and various appropriate methods of surgery. PMID:26648808

  6. Alar Suspension Sutures in the Management of Nasal Valve Collapse.

    PubMed

    Manickavasagam, Jaiganesh; Iqbal, Isma; Wong, Smeeta; Raghavan, Ullas

    2015-09-01

    This study assesses the efficacy of alar suspension sutures in the management of nasal valve collapse causing nasal obstruction. These sutures are inserted between the vestibular skin and lateral crura and hitched to the periosteum of the medial inferior orbital margin; this is a variation of the alar (change everywhere) suspension suture technique. A retrospective review of patients who underwent alar suspension suture insertion between January 2009 and December 2010 in the management of nasal obstruction was undertaken. Symptoms of nasal obstruction were assessed using the Visual Analogue Scale (VAS) and peak inspiratory flow rate (PIFR). This was measured preprocedure and repeated at 3, 6, and 12 months postoperatively. A total of 35 patients were identified, and 26 were included in the study; 90% of patients were satisfied with the outcome of surgery, supported by improvement in the VAS and PIFR scores. The mean difference in VAS preprocedure and postprocedure was 4.97 (P value = 0.00), and the average improvement in PIFR was 25.5 L/min (P value = 0.00). Our study shows a significant improvement in patient's symptoms following insertion of alar suspension sutures. It is, therefore, a reliable, safe, and effective technique in treating nasal obstruction secondary to nasal valve collapse. © The Author(s) 2015.

  7. Grafting the alar rim: application as anatomical graft.

    PubMed

    Gruber, Ronald P; Fox, Paige; Peled, Anne; Belek, Kyle A

    2014-12-01

    Alar rim contour and alar rim grafts have become essential components of rhinoplasty. Ideally, grafts of the nose should be anatomical in shape. So doing might make grafts of the alar rim more robust. The authors considered doing that by applying the graft as a continuous extension of the lateral crus. Twelve patients (two men and 10 women) constituted the study group (seven primary and five secondary cases). Of those, there were five concave rims, two concave rims with rim retraction, two boxy tips, and three cephalically oriented lateral crura. Surgical technique included the following: (1) an open approach was used; (2) a marginal incision that ignored the caudal margin of the lateral crus (the incision went straight posteriorly to a point 5 to 6 mm from the rim margin) was used; (3) a triangular graft was made to cover the exposed vestibular skin; (4) it was secured end to end to the caudal border of the lateral crus; and (5) the poster end was allowed to sit in a small subcutaneous pocket. Follow-up was 11 to 19 months. All 12 patients exhibited good rims as judged by a blinded panel. Rim retraction was not fully corrected in one patient, but no further treatment was required. One patient did require a secondary small rim graft for residual rim concavity. The concept of grafting the alar rim is strongly supported by the authors' results. The modifications the authors applied by designing the graft to be anatomical in shape has been a technical help.

  8. Ligamentum Flavum Buckling Causing immediate Post-operative neurologic deterioration after an Anterior Cervical Discectomy: a case report.

    PubMed

    Taghvaei, Mohammad; Tayebi Meybodi, Keyvan; Zeinalizadeh, Mehdi

    2016-05-05

    Neurological injury is a potential complication of anterior cervical discectomy (ACDF). Iatrogenic trauma, hypoxic-ischemic damage during surgery or epidural hematoma could cause neurologic deterioration after surgery. This is the first case being reported of neurologic deterioration after an anterior cervical discectomy due to ligamentum flavum buckling. The case illustrated an uncommon cause of cord compression after ACDF. Therefore, ligamentum flavum buckling should be considered as one of the potential causes for acute neurologic deterioration after an anterior cervical discectomy. While keeping this rare complication in mind, obtaining a quick post-operative imaging seems mandatory in early detection and establishing an appropriate management.

  9. Histopathological changes in supraspinous ligaments, ligamentum flava and paraspinal muscle tissues of patients with ankylosing spondylitis.

    PubMed

    Zhang, Ying; Xu, Hongfei; Hu, Xu; Zhang, Chao; Chu, Tongwei; Zhou, Yue

    2016-04-01

    To examine the histopathological changes in spinal tissues of ankylosing spondylitis (AS) patients. Tissue samples from 10 AS patients and 10 control subjects were obtained. Hematoxylin and eosin, picrosirius, Masson and van Gieson stainings were utilized to determine the pathological changes in tissues. Ultrastructural alterations were examined by electronic microscopy. Proteoglycan levels were assessed by enzyme-linked immunosorbent assays (ELISA). Matrix metalloproteinase-3 (MMP-3), transforming growth factor-β1 (TGF-β1) and tumor necrosis factor-α (TNF-α) levels were evaluated by immunohistochemistry. Our results demonstrate that the density of collagen fibrils was reduced in the supraspinous ligaments of AS tissue and fibrils were loosely and irregularly organized as compared to a regular distribution of collagen fibrils in controls. In ligamentum flava from AS patients, activated fibroblasts with enlarged nuclei were detected, while the number of elastic fibers was greatly decreased. Paraspinal muscle tissues of AS patients exhibited increased collagen fibril accumulation and atrophy. Significantly decreased proteoglycan and elevated MMP-3 levels were found in supraspinous ligament samples from AS patients (P < 0.01). Additionally, the levels of TGF-β1 in ligamentum flava and paraspinal muscle tissues of AS patients were increased (P < 0.01). The expression of TNF-α was also upregulated in the ligamentum flavum (P < 0.01), with no significant difference in the paraspinal muscle between control and AS patients (P > 0.05). Our findings reveal histopathological changes that occur in certain spinal tissues of AS patients and suggest that increased levels of MMP-3 and TGF-β1 may contribute to the pathogenesis of AS. © 2014 The Authors. International Journal of Rheumatic Diseases published by Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  10. Umbilical and paraumbilical veins in ligamentum teres. Their significance as collaterals in portal hypertension.

    PubMed

    Lin, G; Lunderquist, A; Hägerstrand, I

    1984-01-01

    Twenty-two postmortem specimens of the liver (18 normal livers, three with liver metastases, and one with liver cirrhosis) with attached ligamenta teres were investigated using silicone rubber injection technique. In all cases, the paraumbilical veins were demonstrated. They were usually divided into 2 groups, one on the right and one on the left side of the ligamentum teres, and they terminated in a variable manner into small peripheral portal vein branches in the liver parenchyma. A patent segment of the umbilical vein was found in 7 of the 22 cases. Connections between the umbilical vein and paraumbilical veins were supposed to represent one of the collateral channels in portal hypertension.

  11. Editorial Commentary: Ligamentum Teres Tears and Femoroacetabular Impingement: Complex Coexistence of Impingement and Instability.

    PubMed

    Larson, Christopher M

    2016-07-01

    In a large Level IV case series of 2,213 hip arthroscopies with the diagnosis of femoroacetabular impingement, the intraoperative status of the ligamentum teres (LT) was recorded as normal in 11%, frayed and/or partially torn in 88%, and completely torn in 1.5% of hips. Although specific physical examination maneuvers for detecting LT tears were not available early in the study period, thus limiting a detailed assessment of such tests, the authors identified that female gender, a lower lateral center edge angle, a higher Tonnis angle, and capsular laxity were all associated with complete LT tears. This study further supports the complex coexistence of impingement and instability.

  12. Anatomy of the Alar Ligament: Part II: Variations of Its Attachment onto the Dens.

    PubMed

    Sardi, Juan P; Iwanaga, Joe; Schmidt, Cameron; Rustagi, Tarush; Chapman, Jens R; Oskouian, Rod J; Tubbs, R Shane

    2017-08-09

    Various authors have described the morphology of the alar ligaments; however, there are no reports of a cadaveric study focusing on their attachments onto the dens. The purpose of this study was to use fresh cadaveric specimens to describe in detail different attachment patterns of the alar ligaments onto the dens. This study used 22 sides from 11 fresh frozen cadaveric heads. Specimens were obtained from 8 men and 3 women who were 67-99 years old at death. Dissection of the exact attachment of the alar ligaments onto the dens was observed from posterior, superior, and anterior views under the surgical microscope. From a posterior view, 6 alar ligaments passed over the tip of the dens, and 16 alar ligaments attached onto the posterolateral part of the dens; the right and left ligaments had no continuity. From a superior view, the alar ligament was classified in 2 ways: depending on the covered area of the dens (entirely or posterior two thirds) and continuity of the alar ligament (transversely, separately, or combination). Fourteen alar ligaments covered the posterior two thirds of the dens. From an anterior view, in 1 specimen, the alar ligament extended to the anterior surface of the dens. Wide posterolateral anchoring to the dens coupled with the nearly horizontal trajectory explains the biomechanical advantage of the alar ligaments in undertaking a stabilizing function in limiting head rotation that would otherwise be ineffective in the case of weaker attachments or a more vertical orientation. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Reconstruction of nasal alar defects in asian patients.

    PubMed

    Han, Doo Hee; Mangoba, Dennis Cristobal S; Lee, Doh Young; Jin, Hong Ryul

    2012-01-01

    To present the aesthetic and functional outcomes of nasal alar reconstruction in Asian patients and to propose a working surgical algorithm. Seventeen patients underwent nasal alar reconstruction at a university-based facial plastic surgery practice from March 1, 1998, through February 28, 2010. The male-female ratio was 10:7, with a median age of 59 years (range, 34-78 years), and the mean follow-up duration was 64 months. The defect was mostly caused by basal cell carcinoma resection (14 of 17 [82%]), followed by the resection of squamous cell carcinoma, trauma, and excision of a previous scar. The mean defect size was 1.71 cm (range, 1-4 cm). The full-thickness defects were noted for 8 patients, whereas 9 had partial-thickness defects. The choice of reconstruction method was primarily based on the size and depth of the surgical defect. Most of the defects 1 to 2 cm in diameter needed nasolabial flaps (10 of 17 [59%]), whereas full-thickness defects larger than 2 cm needed forehead flaps (3 of 17 [18%]) to reconstruct the external defect. Smaller defects less than 1 cm were reconstructed with composite grafts (2 of 17 [12%]), a bilobed flap (1 of 17 [6%]), or primary closure (1 of 17 [6%]). Seven of 8 full-thickness defects had the internal nasal lining reconstructed using a septal mucoperichondrial flap, and 1 case was reconstructed using a cutaneous turn-in flap. Reinforcement cartilage graft was used in 8 patients. No flap failure occurred except in 1 case, in which necrosis of the internal lining flap caused contraction of the external flap with resultant alar rim elevation. An elevation of the alar margin and alar groove blunting occurred in 3 cases. No functional problems emerged. Subjective surgical outcome on a 4-point satisfaction scale revealed that 5 patients (29%) were much satisfied, 10 patients (59%) were satisfied, 1 patient (6%) was fairly satisfied, and 1 patient (6%) was dissatisfied. The choice of reconstruction method of nasal alar defect in

  14. The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres

    PubMed Central

    van Arkel, R. J.; Amis, A. A.; Cobb, J. P.; Jeffers, J. R. T.

    2015-01-01

    In this in vitro study of the hip joint we examined which soft tissues act as primary and secondary passive rotational restraints when the hip joint is functionally loaded. A total of nine cadaveric left hips were mounted in a testing rig that allowed the application of forces, torques and rotations in all six degrees of freedom. The hip was rotated throughout a complete range of movement (ROM) and the contributions of the iliofemoral (medial and lateral arms), pubofemoral and ischiofemoral ligaments and the ligamentum teres to rotational restraint was determined by resecting a ligament and measuring the reduced torque required to achieve the same angular position as before resection. The contribution from the acetabular labrum was also measured. Each of the capsular ligaments acted as the primary hip rotation restraint somewhere within the complete ROM, and the ligamentum teres acted as a secondary restraint in high flexion, adduction and external rotation. The iliofemoral lateral arm and the ischiofemoral ligaments were primary restraints in two-thirds of the positions tested. Appreciation of the importance of these structures in preventing excessive hip rotation and subsequent impingement/instability may be relevant for surgeons undertaking both hip joint preserving surgery and hip arthroplasty. Cite this article: Bone Joint J 2015; 97-B:484–91. PMID:25820886

  15. Cardiac-MRI demonstration of the ligamentum arteriosum in a case of right aortic arch with aberrant left subclavian artery

    PubMed Central

    Paparo, Francesco; Bacigalupo, Lorenzo; Melani, Enrico; Rollandi, Gian Andrea; De Caro, Giovanni

    2012-01-01

    Right-sided aortic arch with aberrant left subclavian artery (RAA/ALSC) is the second most common mediastinal complete vascular ring. Adult presentation of dysphagia lusoria due to a RAA/ALSC is uncommon with fewer than 25 cases reported in the world literature. The left lateral portion of this vascular ring is not a vessel, but an atretic ductus arteriosus, the ligamentum arteriosum, which has been identified in different cases as the major cause of tracheo-esophageal impingement. Surgical division of the ligamentum arteriosum allows the vessels to assume a less constricting pattern decreasing dysphagic symptoms. Clear visualization of the ligamentum arteriosum by diagnostic imaging has not been obtained in previously reported cases. We demonstrated, using magnetic resonance imaging, the location and the complete course of a left-sided ligamentum arteriosum in a patient with adult-onset dysphagia due to a RAA/ALSC with a small Kommerell’s diverticulum, providing, during the same session, a complete assessment of both mediastinal vascular abnormalities and esophageal impingement sites. PMID:22761985

  16. Relationship between Hyperactivity of Depressor Septi Nasi Muscle and Changes of Alar Base and Flaring during Smile

    PubMed Central

    Beiraghi-Toosi, Arash; Rezaei, Ezatollah; Zanjani, Elham

    2016-01-01

    BACKGROUND Hyperactivity of depressor septi nasi muscle leads to smiling deformity and nasal tip depression. Lateral fascicles of this muscle help in widening the nostrils. The purpose of this study was to evaluate the relationship between the nasal length changes and the alar base and the alar flaring changes during smile. METHODS Standard photographs are performed in the face and lateral views with forward gaze in the repose and maximum smile. Nasal length, alar base, and alar flaring were measured on the prints of the photographs. To decrease possible errors in the size of the printed photographs, middle face height from glabella to ANS was measured in the lateral view and the interpupil distance in the face view to standardize the measurements. RESULTS Fifty cases were enrolled in this study. In 39 cases (78%), the nasal length was increased during smile. Forty-six cases (92%) had an increase in alar base diameter during smile. Alar flaring during smile increased in 48 cases (96%). Nasal length and alar base changes during smiling were not significantly correlated. Nasal length and alar flaring changes during smiling were not significantly related too. On the other hand, alar base and alar flaring changes during smile showed correlation. Alar base and alar flaring changes during smile were not significantly different in hyperactive and non-hyperactive cases. CONCLUSION Nasal length change during smiling and hypertrophy of the medial fascicles of depressor septi nasi were not related to alar base or alar flaring change during smile. PMID:27308240

  17. Relationship between Hyperactivity of Depressor Septi Nasi Muscle and Changes of Alar Base and Flaring during Smile.

    PubMed

    Beiraghi-Toosi, Arash; Rezaei, Ezatollah; Zanjani, Elham

    2016-01-01

    Hyperactivity of depressor septi nasi muscle leads to smiling deformity and nasal tip depression. Lateral fascicles of this muscle help in widening the nostrils. The purpose of this study was to evaluate the relationship between the nasal length changes and the alar base and the alar flaring changes during smile. Standard photographs are performed in the face and lateral views with forward gaze in the repose and maximum smile. Nasal length, alar base, and alar flaring were measured on the prints of the photographs. To decrease possible errors in the size of the printed photographs, middle face height from glabella to ANS was measured in the lateral view and the interpupil distance in the face view to standardize the measurements. Fifty cases were enrolled in this study. In 39 cases (78%), the nasal length was increased during smile. Forty-six cases (92%) had an increase in alar base diameter during smile. Alar flaring during smile increased in 48 cases (96%). Nasal length and alar base changes during smiling were not significantly correlated. Nasal length and alar flaring changes during smiling were not significantly related too. On the other hand, alar base and alar flaring changes during smile showed correlation. Alar base and alar flaring changes during smile were not significantly different in hyperactive and non-hyperactive cases. Nasal length change during smiling and hypertrophy of the medial fascicles of depressor septi nasi were not related to alar base or alar flaring change during smile.

  18. [Injuries of the alar ligaments in children and adolescents].

    PubMed

    Briem, D; Linhart, W; Dickmann, C; Rueger, J M

    2002-06-01

    Cervical spine trauma most commonly involves the lower parts in adults. In children lesions of the cervical spine can predominantly be found in the region of C1/C2 including ligament injuries at this level. However such injuries are difficult to detect and only few data are available concerning therapy and prognosis of atlantoxial ligament lesions. We report on two children suffering from isolated rupture of the alar ligaments. Both injuries were proven by magnetic resonance imaging which is recommended as the resource of choice for the evaluation of the cervical spine soft tissues in children. Although the biomechanic properties of the alar ligaments remain unclear non-operative treatment for the rupture of these ligaments seems to be adequate. In order to avoid neurologic symptoms or long term complications an immediate diagnosis is indispensable.

  19. Alar and apples: newspapers, risk and media responsibility.

    PubMed

    Friedman, S M; Villamil, K; Suriano, R A; Egolf, B P

    1996-01-01

    During 1989, a major environmental and health risk issue, the spraying of Alar on apples, created a furor among the American people. After hearing charges from the Natural Resources Defense Council (NRDC) that eating Alar-laden apples significantly increased a child's risk of developing cancer, numbers of school districts dropped apples from their menus and parents poured apple juice down the drains. Apple sales plummeted. The NRDC's charges, which were disseminated by a well-planned and effective public relations campaign, brought counter-charges from the US environmental Protection Agency, which accused the NRDC of basing its study on poor data, among other things. The core of the dispute was in the risk figures and risk interpretations being used by each organization.

  20. Radiologic misunderstanding of cutaneous angiomyolipoma in the alar base.

    PubMed

    Han, Hyun Ho; Choi, Jong Yun; Seo, Bommie F; Mun, Suk Ho; Rhie, Jong Won; Ahn, Sang Tae; Oh, Deuk Young

    2014-07-01

    In this article, we will examine a case of cutaneous angiomyolipoma in the right nasal alar base area of a 36-year-old man. Generally, angiomyolipoma occurs in the kidney and, histologically, has features that are similar to cutaneous angiomyolipoma: smooth muscle cells, mature adipose cells, and a convoluted thick-walled blood vessel. Clinically, renal angiomyolipoma is related to tuberous sclerosis, but cutaneous angiomyolipomas occur very rarely, with a total of only 23 cases documented in the literature, with 39% (9/23) of those cases occurring in the ear or surrounding areas. In particular, the abundance of blood vessels inside a cutaneous angiomyolipoma produces good enhancement on computed tomographic image, making it easy for the tumor to be mistaken for a vascular tumor. In this particular case, we will report about a previously unheard case of cutaneous angiomyolipoma occurring in the nasal alar base that was mistaken for a vascular tumor.

  1. Delayed diagnosis of isolated alar ligament rupture: A case report.

    PubMed

    Kaufmann, Robin A; Marzi, Ingo; Vogl, Thomas J

    2015-10-28

    Ligament disruptions at the craniovertebral junction are typically associated with atlantoaxial rotatory dislocation during upper cervical spine injuries and require external orthoses or surgical stabilization. Only in few patients isolated ruptures of the alar ligament have been reported. Here we present a further case, in which the diagnosis was initially obscured by a misleading clinical symptomatology but finally established six month following the trauma, demonstrating the value of contrast-enhanced high resolution 3 Tesla magnetic resonance imaging in identifying this particular lesion.

  2. Aesthetic Outcomes of Alar Base Resection in Asian Patients Undergoing Rhinoplasty.

    PubMed

    Kim, Ji Heui; Park, Joon Pyo; Jang, Yong Ju

    2016-12-01

    Combined sill and alar excision is a useful procedure for correcting a wide nasal base and flared alar lobules. However, the aesthetic outcomes of this technique remain poorly reported. To evaluate the aesthetic outcomes of combined sill and alar excision in Asian patients undergoing rhinoplasty. A retrospective cohort study of 73 consecutive patients who underwent combined sill and alar excision from March 1, 2004, to January 31, 2013, was conducted at a tertiary referral hospital in Korea. Combined sill and alar excision. Changes in the ratio of the interalar distance to intercanthal distance and frequencies of alar flaring, nostril symmetry, and nostril shape, as measured by reviewing photographs taken before and after the surgery. Among the 73 patients (50 men and 23 women; mean [SD] age, 36.5 [12.3] years) the mean (SD) ratio of interalar distance to intercanthal distance changed significantly from 1.07 (0.11) to 1.04 (0.08) (P < .001). Of the 60 patients with alar flaring, 45 (75%) no longer had flaring after the procedure. The frequency of nostril symmetry increased from 38 patients (52%) to 46 (63%) (P < .001). The frequency of horizontally shaped nostrils decreased from 21 patients (29%) to 2 (3%), while the frequency of the preferred pear-shaped nostrils increased from 20 patients (27%) to 35 (48%) (odds ratio, 1.16; 95% CI, 0.63-2.14; P = .02). There were 4 cases of complications, namely, alar deformity (1 patient [1%]), unsatisfactory correction of asymmetrical nostrils (1 [1%]), and unsatisfactory correction of alar flaring (2 [3%]). Combined sill and alar excision was a useful technique with a low complication rate for correcting wide alar base, alar flaring, nostril asymmetry, and nostril shape. 4.

  3. [The anatomical structure similarity research on auricular cartilage and nasal alar cartilage].

    PubMed

    Chen, Changyong; Fan, Fei; Li, Wenzhi; Li, Binbin; You, Jianjun; Wang, Huan

    2015-09-01

    There are many scaffold materials of repairing nasal alar cartilage defects. Auricuiar cartilage was used extensively in terms of its abundant tissues, good elasticity, little donor-site malformation, good plasticity etc. The authors dissected auricular cartilage and nasal alar cartilage, measured cartilage's morphous data and found some similar territories with nasal alar cartilage in the structure of auricular cartilage. An anatomical study was performed using 10 adult cadavers acquired through Plastic Surgery Hospital, Peking Union Medical College, Beijing, China. Seven male and three female cadav-ers were included in the study. Harvest 20 auricular cartilage specimens and 20 nasal alar cartilage specimens. Then, Computed Tomography Scan on the auricular cartilage and nasal alar cartilage were performed. The datas were imported into mimics and three-dimensional reconstructions of the auricular cartilage and nasal alar cartilage were carried on. Parts of the auricular cartilage, such as conchal fossa, tragus, intertragic notch, and cymba of auricular concha, curs of helix and curs of helix, triangular fossa, are ana-tomically similar to nasal alar cartilage. This study reports the anatomy of auricular cartilage and nasal alar cartilage, found some territories in the auricular cartilage, such as conchal fossa, tragus, intertragic notch, and cymba of auricular concha, curs of helix and curs of helix, triangular fossa, are anatomically similar to nasal alar cartilage. This research provides the anatomical basis that auricular cartilage was used to repair the nasal cartilage defect.

  4. Is the Pyriform Ligament Important for Alar Width Maintenance After Le Fort I Osteotomy?

    PubMed

    Peacock, Zachary S; Susarla, Srinivas M

    2015-12-01

    To determine whether identification and incorporation of the pyriform ligament in the alar cinch results in decreased alar base widening compared with standard alar cinch techniques. This was a retrospective case series and the sample was composed of patients undergoing Le Fort I osteotomy. Intraoperatively, the pyriform ligament was identified and incorporated in the alar cinch suture. Greatest alar width (GAW) measured immediately after closure was compared with GAW measured at least 5 months postoperatively. The change in alar base width was compared with that reported in the literature using other alar cinch techniques. Two case examples are reported. The sample was composed of 15 patients (mean age, 27.1 yr; 27% female). The mean postoperative change in GAW was 1.0 ± 0.6 mm (2.59 ± 1.59%). Postoperative change in alar base width reported in the literature ranged from 0.5 to 10.8%. The pyriform ligament is easily identified during exposure of the maxilla and pyriform aperture and can be used to control widening of the alar base after Le Fort I osteotomy. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Correction of unilateral cleft lip nose deformity using nasal alar rim flap.

    PubMed

    Wang, Huan; Fan, Fei; You, Jianjun; Wang, Sheng

    2012-09-01

    The objective of this study was to show the use and effectiveness of nasal alar rim flap on the correction of unilateral cleft lip nasal deformity. Thirty-one patients (age range, 10-29 years; mean, 15.1 years; 14 male and 17 female patients) with unilateral cleft lip underwent rhinoplasty surgery using alar rim flap. The excessive skin of nasal alar was marked, then a skin flap was raised. This flap can be transferred medially (type 1) or laterally (type 2) to narrow the nostril or to augment the nasal sill and, of course, to correct the alar web deformity. Preoperative and postoperative photographs were measured for photogrammetric analysis in 16 patients. The alar rim flap used in patients with unilateral cleft lip made the nostrils more symmetrical. The nostril sill was augmented with flap type 1. The alar base width was narrowed with flap type 2 (P = 0.03). The alar web deformity was corrected. The alar rim flap could be an ideal treatment option for correction of alar web deformity in patients of unilateral cleft lip.

  6. The alar rim flap: a novel technique to manage malpositioned lateral crura.

    PubMed

    Kemaloğlu, Cemal Alper; Altıparmak, Mehmet

    2015-11-01

    Alar cartilage malposition is a common anatomic variation in which the axis of the lateral crus lies cephalically and may be parallel to the cephalic septum. Malposition of the lateral crura may produce inward collapse of the alae that is observable on deep inspiration. The authors performed the alar rim flap technique to treat patients with alar malposition and assessed functional and aesthetic outcomes. Twelve patients who underwent primary open rhinoplasty with the alar rim flap technique were evaluated in a prospective study. A 2- or 3-mm caudal portion of the lateral crus was elevated from the underlying mucosa, pulled caudally, and extended with a cartilage graft. This extension of the alar rim flap was placed through the pyriform aperture for additional support. Patients completed pre- and postoperative questionnaires addressing nasal obstruction and underwent paranasal computed tomography. Patients received follow-up for an average of 16 months (range, 8-27 months). Patients with alar cartilage malposition and external valve insufficiency experienced aesthetic and functional improvements after rhinoplasty with the alar rim flap technique. No patients developed alar rim collapse or flap displacement. The alar rim flap technique is effective for the correction of malpositioned lateral crura and external valve insufficiency. Because this technique does not damage the scroll area, disruption of the internal valve area is avoided. 4 Therapeutic. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  7. Alar web in cleft lip nose deformity: study in adult unilateral clefts.

    PubMed

    Agarwal, Rajiv; Chandra, Ramesh

    2012-09-01

    The correction of alar webbing in unilateral cleft lip nose deformity is challenging because of progressive distortions in the alar web region during the period of growth. Alar webbing is a persistent universal deformity in both the primary and secondary cleft lip noses. The purpose of this article is to study the alar web deformity in adult patients with unilateral cleft lip noses. Twenty-five patients aged 13 years and older presenting with unilateral cleft nasal deformity were included. Preoperative and postoperative measurements of the nose, along with detailed intraoperative recording of the deformed anatomy, were done. Preoperative magnetic resonance imaging was also done in selected cases. Transcolumellar open rhinoplasty was performed in all the cases, and nasal septal straightening with centralization was done. Cleft alar base augmentation was done using bone graft to restore symmetry of the nasal tripod. Both the cleft and noncleft alar cartilages were extensively mobilized from the skin and mucosal sides. The overgrown and caudally slumped cleft-side alar cartilage was resected caudally and was then resuspended in a symmetrical position with the noncleft alar cartilage. A midline-strut septal cartilage extension graft was used to restore the tip aesthetics. The skin overlying the alar web was in-rolled after semilunar cartilage resection, and skin excision was also done to restore symmetry with the opposite vestibule. The remaining secondary cleft nasal and lip deformities were corrected depending upon the specific presenting pathologic abnormality. The cleft alar cartilage was found to be caudally displaced in all the cases. The caudal border of the lateral crus was prolapsing in the cavity of the vestibule on the superomedial aspect and was tenting the skin in the area of the weak triangle, producing the characteristic alar web deformity. In the study group, the maximum width of the cleft alar cartilage at the level of the lateral crus was increased by

  8. [Alar ligaments: radiological aspects in the diagnosis of patients with whiplash injuries].

    PubMed

    Muhle, C; Brossmann, J; Biederer, J; Jahnke, Th; Grimm, J; Heller, M

    2002-04-01

    Post-traumatic changes of the alar ligaments have been proposed to be the cause of chronic pain in patients after whiplash injury of the cervical spine. In addition to an asymmetric dens position, widening of the atlantodental distance to more than 12 mm can be an indirect sign of an alar ligament rupture. CT is recommended for detection of a avulsion fracture of the occipital condyle. Isolated ruptures of the alar ligaments are best visualized on MRI. In patients with chronic impairments after whiplash injuries changes of the alar ligaments on MRI must be differentiated from normal variants in healthy individuals.

  9. The ligamentum capitis femoris: anatomic, magnetic resonance and computed tomography study.

    PubMed

    Perez-Carro, Luis; Golano, Pau; Vega, Jordi; Escajadillo, Natalia F; Rubin, Carlos G; Cerezal, Luis

    2011-01-01

    The objective of the study was to describe the normal anatomy of the ligamentum capitis femoris and to determine the neurovascular structures potentially at risk during its reconstruction. Ten cadaveric specimens of the ligamentum capitis femoris (LCF) were dissected and photographed. Magnetic resonance (MR) and Computed tomography (CT) arthrography evaluation of the anatomy of the LCF in 30 hips were performed to measure length of the ligament and to study the proximity of neurovascular structures. The anatomical study showed that the LCF has a pyramidal structure and a banded appearance. The thickness of the medial wall of the acetabulum 3 mm superior to the inferior acetabular boundary was found to be 6.7 mm (4-9 mm) at point 1 (anterior), 4.1 mm (3-7 mm) at point 2 (central), and 6.5 mm (4-9 mm) at point 3 (posterior). Central anchors or screws were found to lie within 1.7 cm (1.6-1.9 cm) of the external iliac vein and artery. Angulation of anchors in the anterior and posterior columns in the axial plane with respect to acetabular fossa floor (the Optimal Angulation Angle or OAA), is safer (0 to 45º the safest optimal angles). The sagittal angulation created by the safe pathway in the anterior and posterior columns with respect to the plane of the facies lunata in this area was also measured and termed the Optimal Angle of Penetration (OAP) with normal values being: 110º (102-123º) for the posterior column and 90º (85-94º) for the anterior column. Our results suggest that reconstruction of the LCF can be safely performed if these guidelines are followed.

  10. Calcification of the alar ligament of the cervical spine in a patient with rheumatoid arthritis

    PubMed Central

    Soubai, Rahma Boussaadani; Tahiri, Latifa; Abourazzak, Fatima Zahra; Tizniti, Siham; Harzy, Taoufik

    2012-01-01

    Calcification of the alar ligament is rare. It usually develops as a result of traumatic injury and is especially prominent in the elderly. CT scanning is the gold standard of the diagnosis. We report a case of a calcification of the transverse and alar ligament in a patient with rheumatoid arthritis. PMID:23330032

  11. [Influence of different surgeries on growth and development of alar cartilage in young-rabbit].

    PubMed

    Jiang, Lian; Dong, Xiqian; Song, Qinggao; Chen, Shang; Zou, Sihai

    2011-01-01

    The purpose of this study is to observe the affection of different clinical surgeries on alar nasal cartilages' growth and development. The experimental results can provide some theory basis for clinical surgeries. Twenty-eight New Zealand immature rabbits were used in this study, and divided into normal control group, hidden dissection group and cutting off alar nasal cartilages group randomly, which included 4,12 and 12 rabbits, separately. Arc incision were made on the mucous membrane of nasal cavity,and then dissect the alar nasal cartilages hidden or cut off the alar nasal cartilages, separately. The growth and development of the alar cartilage were observed at different stages after the surgery using histological and immuno-histochemical methods. Four weeks, eight weeks, twelve weeks and sixteen weeks after surgery, there were no significant differences in the indexes of chondrocytes between hidden dissection group and control group. In cutting off alar nasal cartilages group, fiber tissue were observed in the vacancy left after being cut off cartilages, and even mucous membrane tissue could be seen in some slices. There is no adverse influence on the growth and development of the alar cartilage after being hidden dissected. Contrarily, the restoring capability of transparent cartilage cannot counteract the injury resulted form the surgery after the alar nasal cartilages being cut off.

  12. Defining the Morphology and Distribution of the Alar Fascia: A Sheet Plastination Investigation.

    PubMed

    Scali, Frank; Nash, Lance G; Pontell, Matthew E

    2015-10-01

    This study aims to delineate the morphology, integrity, and distribution of the alar fascia using dissection and E12 sheet plastination. This is the first study that employs E12 sheet plastination to investigate the alar fascia and its adjacent potential spaces. Twenty-nine manual dissections and 3 sets of E12 sheet plastinations were used to examine the posterior pharyngeal region for the architecture and distribution of the alar fascia. Specimens were examined from the inferior nuchal line to C6. The alar fascia originated as a well-defined midline structure at the level of C1 and could be identified down to C6. There was no evidence of the alar fascia between the inferior nuchal line and the base of the skull. Notably, the alar fascia permitted resistance to manual traction. E12 sheet plastination allowed for visualization of the alar fascia's superior attachments within the deep cervical region. Resistance to traction suggests that the alar fascia may be more than just a loose fibroareolar matrix. The findings in this study suggest an alternative point of entry into the danger space. Understanding the continuity of this fascial layer is critically important with regard to the pathophysiology of deep neck space infections. © The Author(s) 2015.

  13. Delayed diagnosis of isolated alar ligament rupture: A case report

    PubMed Central

    Kaufmann, Robin A; Marzi, Ingo; Vogl, Thomas J

    2015-01-01

    Ligament disruptions at the craniovertebral junction are typically associated with atlantoaxial rotatory dislocation during upper cervical spine injuries and require external orthoses or surgical stabilization. Only in few patients isolated ruptures of the alar ligament have been reported. Here we present a further case, in which the diagnosis was initially obscured by a misleading clinical symptomatology but finally established six month following the trauma, demonstrating the value of contrast-enhanced high resolution 3 Tesla magnetic resonance imaging in identifying this particular lesion. PMID:26516433

  14. Anatomy of the alar ligamentPart I: Morphometrics and variants.

    PubMed

    Iwanaga, Joe; Sardi, Juan; Voin, Vlad; Chapman, Jens R; Oskouian, Rod J; Tubbs, R Shane

    2017-08-18

    The alar ligaments are one of the primary ligamentous structures contributing to craniovertebral stability. The purpose of this study is to clarify the morphology of the alar ligament using fresh cadaveric specimens. Twenty-two fresh frozen cadaveric alar ligaments were used in this study. The occiput, C1 and C2 were removed en bloc from each specimen and various measurements and observations, including variations, were documented. The angle formed by both alar ligaments was measured in a neutral position (149±24.19°), as well as during forced flexion (134.18±27.08°) and extension (163.81±24.54°). The current cadaveric evaluation offers an interesting window into better understanding the anatomy of the alar ligaments. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Ultrasonographic measurement of the ligamentum flavum depth; is it a reliable method to distinguish true and false loss of resistance?

    PubMed

    Pak, Michael Haejin; Lee, Won Hyung; Ko, Young Kwon; So, Sang Young; Kim, Hyun Joong

    2012-04-01

    Previous studies have shown that if performed without radiographic guidance, the loss of resistance (LOR) technique can result in inaccurate needle placement in up to 30% of lumbar epidural blocks. To date, no study has shown the efficacy of measuring the depth of the posterior complex (ligamentum flavum, epidural space, and posterior dura) ultrasonographically to distinguish true and false LOR. 40 cervical epidural blocks were performed using the LOR technique and confirmed by epidurograms. Transverse ultrasound images of the C6/7 area were taken before each cervical epidural block, and the distances from the skin to the posterior complex, transverse process, and supraspinous ligament were measured on each ultrasound view. The number of LOR attempts was counted, and the depth of each LOR was measured with a standard ruler. Correlation of false and true positive LOR depth with ultrasonographically measured depth was also statistically analyzed. 76.5% of all cases (26 out of 34) showed false positive LOR. Concordance correlation coefficients between the measured distances on ultrasound (skin to ligamentum flavum) and actual needle depth were 0.8285 on true LOR. Depth of the true positive LOR correlated with height and weight, with a mean of 5.64 ± 1.06 cm, while the mean depth of the false positive LOR was 4.08 ± 1.00 cm. Ultrasonographic measurement of the ligamentum flavum depth (or posterior complex) preceding cervical epidural block is beneficial in excluding false LOR and increasing success rates of cervical epidural blocks.

  16. [Mystery of alar ligament rupture: value of MRI in whiplash injuries--biomechanical, anatomical and clinical studies].

    PubMed

    Bitterling, H; Stäbler, A; Brückmann, H

    2007-11-01

    Whiplash injury of the cervical spine is a frequent issue in medical expertise and causes enormous consequential costs for motor insurance companies. Some authors accuse posttraumatic changes of alar ligaments to be causative for consequential disturbances. Review of recent studies on biomechanics, anatomical and clinical MR imaging. Biomechanical experiments can not induce according injuries of alar ligaments. Although MRI provides excellent visualization of alar ligaments, the range of normal variants is high. Biomechanical studies give no evidence of alar ligament involvement in whiplash disease. Using MRI, signal alterations of alar ligaments can hardly be differentiated from common normal variants. Functional MRI provides no diagnostic yield.

  17. Three-dimensional evaluation of the alar cinch suture after Le Fort I osteotomy.

    PubMed

    van Loon, B; Verhamme, L; Xi, T; de Koning, M J J; Bergé, S J; Maal, T J J

    2016-10-01

    Orthognathic surgery has an influence on the overlying soft tissues of the translated bony maxillomandibular complex. Improvements in both function and facial appearance are the goals of surgery. However, unwanted changes to the soft tissues, especially in the nose region, frequently occur. The most common secondary change in the nasolabial region is widening of the alar base. Various surgical techniques have been developed to minimize this effect. The purpose of this study was to evaluate the changes in the nasal region due to orthognathic surgery, especially the alar width and nasal volume, using combined cone beam computed tomography (CBCT) and three-dimensional (3D) stereophotogrammetry datasets. Twenty-six patients who underwent a Le Fort I advancement osteotomy between 2006 and 2013 were included. From 2006 to 2010, no alar base cinch sutures were performed. From 2010 onwards, alar base cinch sutures were used. Preoperative and postoperative documentation consisted of 3D stereophotogrammetry and CBCT scans. 3D measurements were performed on the combined datasets, and the alar base width and nose volume were analyzed. No difference in alar base width or nose volume was observed between patients who had undergone an alar cinch and those who had not. Postoperatively the nose widened and the volume increased in both groups. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Correction of an alar web with a feather-edge rolled-in flap.

    PubMed

    Park, Jong Lim; Oh, Chang Hyun; Hwang, Kun; Kim, Dae Joong; Jeong, Ji Myeong; Heo, Won Young; Park, Chul Gyoo

    2014-11-01

    The aim of this study was to see the histological nature of the alar web and to introduce a featheredged rolled-in flap to reduce the alar web.On a cadaver, the perpendicular section of the alar web revealed a thickened dermis portion on both the skin side and the nasal side distal to the alar cartilage. According to histological results, we thought the thinning and rolling in of the distal margin of the end of the open rhinoplasty incision could reduce the alar web. An open rhinoplasty incision was made just distal to the hair-bearing vestibular skin and a V-Y shape incision created at the alar base. After the cartilage work, the skin of the distal end of the flap was featheredged to a 0.5-mm thickness. The distal margin was rolled in and sutured to the nasal lining. A bolster dressing was applied using a 4-0 nylon suture.Thirteen patients (8 males, 5 females) were operated on, and 8 patients were followed up for more than 12 months. Their preoperative and postoperative worm's eye views were compared. Four anthropometric distances were measured preoperatively and postoperatively. The columellar length increased significantly after the operation (P = 0.001 [independent 2-sample t test]) on the cleft side. Preoperatively, the alar width was significantly greater (P = 0.02 [paired-samples t test]) on the cleft side (0.17 ± 0.03 of an intercanthal distance) than the noncleft side (0.14 ± 0.03). After the operations, they became similar (0.16 ± 0.03 on cleft side, 0.16 ± 0.04 on the noncleft side; P = 1.00 [paired-samples t test]).We think this featheredged rolling-in flap might be a good method for the correction of an alar web since this technique increased the columellar length and decreased the alar width on the cleft side.

  19. A Composite Buccal Flap for Alar Based Defect Reconstruction: A Technical Note

    PubMed Central

    Pourdanesh, F.; Khojasteh, A.

    2011-01-01

    It is difficult to reconstruct an alar defect with cartilage involvement. Here in the authors report a case of traumatic alar loss during childhood in which an alar reconstruction was carried out with a composite auricular graft put over the pedicle buccal flap which was rotated and passed through the intraoral side. The lining skin and auricular cartilage for the flap was obtained from the auricular region which was acceptable for the patient. All procedures were performed under general anesthesia. One year follow up revealed satisfactory results with minimal contracture of the graft. PMID:22509460

  20. Age-related decrease of the phosphorus content in the ligamentum capitis femoris of monkeys.

    PubMed

    Tohno, Yoshiyuki; Tohno, Setsuko; Oishi, Takao; Minami, Takeshi; Khanpetch, Pongsak; Azuma, Cho; Quiggins, Ranida

    2014-10-01

    To elucidate compositional changes of the ligament with aging, the authors investigated age-related changes of elements in the ligamentum capitis femoris (LCF) of monkeys with a wide range of ages by direct chemical analysis. Used rhesus and Japanese monkeys consisted of 9 males and 22 females, ranging in age from newborn to 31 years (average age = 10.4 ± 10.9 years). After incineration with nitric acid and perchloric acid, element contents were determined by inductively coupled plasma-atomic emission spectrometry. It was found that the P content decreased significantly in the LCFs of monkeys with aging, but other six element contents, Ca, S, Mg, Zn, Fe, and Na, did not change significantly with aging. Assuming that the P content indicated the active cell density and the S content indicated the protein amount, an age-related change of the mass ratio of P/S was examined in the LCFs. The mass ratio of P/S decreased significantly in the LCFs in childhood. Regarding the relationships among elements, significant direct correlations were found among the Ca, P, S, and Mg contents in the LCFs. It was suggested that the active cell density of the connective tissue cells might decrease significantly in the LCF in childhood.

  1. Sliding alar cartilage (SAC) flap: a new technique for nasal tip surgery.

    PubMed

    Ozmen, Selahattin; Eryilmaz, Tolga; Sencan, Ayse; Cukurluoglu, Onur; Uygur, Safak; Ayhan, Suhan; Atabay, Kenan

    2009-11-01

    Congenital anatomic deformities or acquired weakness of the lateral crura of the lower lateral cartilages after rhinoplasty could cause alar rim deformities. As lower lateral cartilages are the structural cornerstone of the ala and tip support, deformities and weakness of the alar cartilages might lead to both functional and esthetic problems. In this article, we are introducing sliding alar cartilage flap as a new technique to reshape and support nasal tip. One hundred sixty consecutive patients between 18 and 55 years of age (mean age: 27.51) were included in the study between January 2007 and May 2008. Of the total number of patients 60 were male and 100 of them were female. None of the patients had rhinoplasty procedure including lower lateral cartilage excision previously. Sliding alar cartilage technique was used in an open rhinoplasty approach to shape the nasal tip in all patients. This technique necessitates about 2 to 3 minutes for suturing and undermining the alar cartilages. The follow-up period was between 4 and 18 months. In no patients any revision related to the sliding alar cartilage technique was required. Revision was applied in 3 patients due to thick nasal tip skin and in one patient due to unpleasant columellar scar. In this article, we are presenting the "sliding alar cartilage flap" as a new technique for creating natural looking nasal tip. This technique shapes and supports nasal tip by spontaneous sliding of the cephalic portion of the lower lateral cartilage beneath the caudal alar cartilage, with minimal manipulation, without any cartilage resection, or cartilage grafting.

  2. Resonant photoionization spectroscopy of refractory metal-rare gas complexes: AlAr

    NASA Astrophysics Data System (ADS)

    Gardner, John M.; Lester, Marsha I.

    1987-06-01

    Mass-resolved resonance-enhanced multiphoton ionization is used to probe AlAr complexes in the spectral region about the Al 2S 1/2- 2P 1/2 transition. Analysis of a vibrational progression in the AlAr 2Σ +state provides lower limits for binding energies in the X 2Π 1/2and B 2Σ + states of 133 and 373 cm -1, respectively.

  3. Function of the ligamentum teres in limiting hip rotation: a cadaveric study.

    PubMed

    Martin, Hal D; Hatem, Munif A; Kivlan, Benjamin R; Martin, RobRoy L

    2014-09-01

    The purpose of this cadaveric study was to evaluate the function of the ligamentum teres (LT) in limiting hip rotation in 18 distinct hip positions while preserving the capsular ligaments. Twelve hips in 6 fresh-frozen pelvis-to-toes cadaveric specimens were skeletonized from the lumbar spine to the distal femur, preserving only the hip ligaments. Hip joints were arthroscopically accessed through a portal located between the pubofemoral and iliofemoral ligaments to confirm the integrity of the LT. Three independent measurements of hip internal and external rotation range of motion (ROM) were performed in 18 defined hip positions of combined extension-flexion and abduction-adduction. The LT was then arthroscopically sectioned and rotation ROM reassessed in the same positions. A paired sample t test was used to compare the average internal and external hip rotation ROM values in the intact LT versus resected conditions in each of the 18 positions. P < .0014 was considered significant. A statistically significant influence of the LT on internal or external rotation was found in 8 of the 18 hip positions tested (P < .0014). The major increases in internal and external rotation ROM occurred when the hip was in 90° or 120° of flexion. The major function of the LT is controlling hip rotation. The LT functions as an end-range stabilizer to hip rotation dominantly at 90° or greater of hip flexion, confirming its contribution to hip stability. Ruptures of the LT contribute to hip instability dominantly in flexed hip positions. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  4. Dural ossification associated with ossification of ligamentum flavum in the thoracic spine: a retrospective analysis

    PubMed Central

    Li, Bo; Qiu, Guixing; Guo, Shigong; Li, Wenjing; Li, Ye; Peng, Huiming; Wang, Chu; Zhao, Yu

    2016-01-01

    Objectives To investigate the incidence, distribution and radiological characteristics of dural ossification (DO) associated with ossification of ligamentum flavum (OLF) in the thoracic spine. Design A retrospective radiographical analysis. Setting This study was conducted at a single institution in China. Participants 53 patients with OLF who underwent posterior decompression surgery between January 2011 and July 2015 in a single institution were enrolled in this study. The decompression segments were grouped according to imaging evaluation and intraoperative evidences. Outcome measures The demographic distribution, radiological data and detailed surgical records were collected. First, preoperative CT images of decompressed segments were evaluated to identify imaging signs of DO. The ‘tram tack sign’ (TTS), ‘comma sign’ and ‘bridge sign’ were considered as characteristic imaging findings of DO in OLF. 4 kinds of confusing signs (false TTS) were identified and excluded. Then detailed surgical records were reviewed to finally identify segments with DO. Results The incidence of DO in patients with OLF was 43.4%. The incidence of DO in OLF segments was 21.5%. OLF was more common in the lower thoracic spine, and more than half (53.8%) of the DO was located in T9-T12. TTS was the most common sign, but it might be misdiagnosed. After excluding 4 kinds of false TTS, the sensitivity and specificity of imaging diagnosis were 94.23% and 94.21%, respectively. Conclusions DO was relatively common in thoracic OLF, especially in T9-T12. TTS might be misdiagnosed. After excluding 4 kinds of false TTS, the accuracy of imaging diagnosis was relatively high. PMID:27998902

  5. Histopathological Analysis of Ligamentum Flavum in Lumbar Spinal Stenosis and Disc Herniation

    PubMed Central

    Yüksel, Kasım Zafer

    2017-01-01

    Study Design Histopathological analyses were performed in ligamentum flavum (LF) hypertrophy patients with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH). Purpose The aim of the present study was to evaluate histopathological changes in LF patients with LSS and LDH. Overview of Literature LSS is the most common spinal disorder in elderly patients. This condition causes lower back and leg pain and paresis, and occurs as a result of degenerative changes in the lumbar spine, including bulging of the intervertebral discs, bony proliferation of the facet joints, and LF thickening; among these, LF thickening is considered a major contributor to the development of LSS. Methods A total of 71 patients operated with the surgical indications of LSS and LDH were included. LF samples were obtained from 31 patients who underwent decompressive laminectomy for symptomatic degenerative LSS (stenotic group) and from 40 patients who underwent lumbar discectomy for LDH (discectomy group). LF materials were examined histopathologically, and other specimens were examined for collagen content, elastic fiber number and array, and presence of calcification. Results The stenotic and discectomy groups did not differ with regard to mean collagen concentration or mean elastic fiber number (p=0.430 and p=0.457, respectively). Mean elastic fiber alignment was 2.36±0.99 in the stenotic group and 1.38±0.54 in the discectomy group (p<0.001). Mean calcification was 0.39±0.50 in the stenotic group, whereas calcification was not detected (0.00±0.00) in the discectomy group; a statistically significant difference was detected (p<0.001) between groups. Conclusions LF hypertrophy in spinal stenosis may occur as a result of elastic fiber misalignment along with the development of calcification over time. Further studies determining the pathogenesis of LSS are needed. PMID:28243372

  6. Spinal Cord Kinking in Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

    PubMed Central

    Wang, Ting; Pan, Min; Yin, Chu-Qiang; Zheng, Xiu-Jun; Cong, Ya-Nan; Wang, De-Chun; Li, Shu-Zhong

    2015-01-01

    Background: Ossification of the ligamentum flavum (OLF) is being increasingly recognized as a cause of thoracic myelopathy. This study was to describe a rare clinical entity of spinal cord kinking (SK) in thoracic myelopathy secondary to OLF. Methods: The data of 95 patients with thoracic myelopathy secondary to OLF were analyzed retrospectively. The incidence and location of SK were determined using preoperative magnetic resonance imaging (MRI). The clinical presentation and radiological characteristics in patients with SK were analyzed. Posterior en bloc laminectomy with OLF was performed, and the surgical results were evaluated. Results: SK was found in seven patients (7.4%) based on preoperative MRI. The patients included one male and six females with an average age of 55.6 years (range, 48–64 years). Five patients presented with radiculomyelopathy and two presented with typical thoracic myelopathy of spastic paraparesis. In all cases, the kinking was located just above the end of the spinal cord where the conus medullaris (CM) was compressed by the OLF. The degree of SK varied from mild to severe. The tip of the CM was located between the upper third of T11 to the lower third of L1, above the lower edge of L1. With an average follow-up of 30.4 months, the modified Japanese Orthopedic Association score significantly improved from 5.7 ± 1.8 preoperatively to 8.9 ± 1.4 postoperatively (t = 12.05; P < 0.0001) with an improvement rate of 63.1 ± 12.3%. Conclusions: SK is a rare radiological phenomenon. It is typically located at the thoracolumbar junction, where the CM is compressed by the OLF. Our findings indicate that these patients may benefit from a posterior decompressive procedure. PMID:26415796

  7. A geometrical model of vertical translation and alar ligament tension in atlanto-axial rotation.

    PubMed

    Boszczyk, B M; Littlewood, A P; Putz, R

    2012-08-01

    While allowing the greatest range of axial rotation of the entire spine with 40° to each side, gradual restraint at the extremes of motion by the alar ligaments is of vital importance. In order for the ligaments to facilitate a gradual transition from the neutral to the elastic zone, a complex interaction of axial rotation and vertical translation via the biconvex articular surfaces is essential. The aim of this investigation is to establish a geometrical model of the intricate interaction of the alar ligaments and vertical translatory motion of C1/C2 in axial rotation. Bilateral alar ligaments including the odontoid process and condylar bony entheses were removed from six adult cadavers aged 65-89 years within 48 h of death. All specimens were judged to be free of abnormalities with the exception of non-specific degenerative changes. Dimensions of the odontoid process and alar ligaments were measured. Graphical multiplanar reconstruction of atlanto-axial rotation was done in the transverse and frontal planes for the neutral position and for rotation to 40° with vertical translation of 3 mm. The necessary fibre elongation of the alar ligaments in the setting with and without vertical translation of the atlas was calculated. The mean diameter of the odontoid process in the sagittal plane was 10.6 mm (SD 1.1). The longest fibre length was measured from the posterior border of the odontoid enthesis to the posterior border of the condylar enthesis with an average of 13.2 mm (SD 2.5) and the shortest between the lateral (anterior) border odontoid enthesis and the anterior condylar enthesis with an average of 8.2 mm (SD 2.2). In graphical multiplanar reconstruction of atlanto-axial rotation to 40° without vertical translation of C1/C2, theoretical alar fibre elongation reaches 27.1% for the longest fibres, which is incompatible with the collagenous structure of the alar ligaments. Allowing 3 mm caudal translation of C1 on C2 at 40° rotation, as facilitated by the

  8. Alar soft-tissue techniques in rhinoplasty: algorithmic approach, quantifiable guidelines, and scar outcomes from a single surgeon experience.

    PubMed

    Warner, Jeremy P; Chauhan, Nitin; Adamson, Peter A

    2010-01-01

    To describe various techniques, including alar base reduction, alar flaring reduction, and alar hooding reduction and present a decision-making treatment algorithm and quantifiable guidelines for soft-tissue excision, along with scar outcomes from a single-surgeon practice. The soft tissue of the nasal tip, ala, and nostrils is important in overall nasal tip dynamics. Excisional alar contouring is an essential part of many successful cosmetic rhinoplasty outcomes. The various soft-tissue excision techniques are described in detail and an algorithm is provided. Quantitative analysis of excision parameters was performed using statistical analysis. Finally, qualitative scar analysis was performed and scar outcomes were statistically derived. Seventy-four patients were female and 26 were male. Of the procedures reviewed, 47% involved alar soft-tissue excision. Alar base reduction was performed in 46 patients (46%). Alar flare reduction was performed in 16 patients (16%). Alar hooding reduction was performed in 2 patients (2%). Mean scar outcome scores ranged from 0.55 to 0.69. Alar soft-tissue techniques are often necessary to achieve a balanced outcome and superior results when performing rhinoplasty surgery. Therefore, they should be an integral part of every rhinoplasty evaluation and surgical plan as indicated.

  9. Comparative analysis of two different alar base sutures after Le Fort I osteotomy: randomized double-blind controlled trial.

    PubMed

    Ritto, Fabio G; Medeiros, Paulo José; de Moraes, Márcio; Ribeiro, Danilo Passeado Branco

    2011-02-01

    The aim of this prospective study was to analyze the efficacy of a new alar base cinch suture by comparing it with the commonly used cinch suture described by Schendel and Delaire in Dr. William Bell's book. Thirty-five patients submitted to maxillary impaction and/or advancements of ≥ 3 mm were randomly divided into 2 groups. Group 1 received an extra oral alar base cinch suture, and patients from group 2 received the classic intraoral suture. Alar and alar base width were measured before and after surgery in digital photographs, with the patient's head in a submental oblique view. Data were reported as means and standard deviations, and difference between groups were determined using Welch t test. A P value of <.05 was considered to be statistically significant. Mean alar base widening was 1.38 mm in group 1 and 2.5 mm in group 2, and mean alar widening was 1.40 mm in group 1 and 2.31 mm in group 2. The difference was statistically significant (P < .05). Extraoral alar base cinch suture was more effective in maintaining preoperative Alar and alar base width compared with classic intraoral nasal suture. Copyright © 2011 Mosby, Inc. All rights reserved.

  10. Evaluation of modified nasal to oral endotracheal tube switch-For modified alar base cinching after maxillary orthognathic surgery.

    PubMed

    Shaik, Taj Nizam Shakeel; Meka, Sridhar; Ch, Pavan Kumar; Kolli, Naga Neelima Devi; Chakravarthi, P Srinivas; Kattimani, Vivekanand S; L, Krishna Prasad

    2017-01-01

    Soft tissue changes secondary to Maxillary orthognathic surgery are many fold. The alar flare is one among them, which affects the appearance of the patient. Cinch suture has been used to prevent alar flare; but the presence of anaesthetic tube hinders cinching. So, the study was aimed to assess an efficacy of modified nasal to oral tube switch technique for modified alar cinching to prevent alar flare after orthognathic and nasal corrective surgeries. Patients were randomly allocated in each group, who underwent modified alar base cinching with and without nasal to oral tube switch. Changes in alar base width, upper lip length was measured with Digital Vernier Caliper and nasolabial angle (Cotg-Sn-Ls) on lateral cephalogram at 1st, 3rd, 6th, and 12th months after surgery. The time taken and ease of tube switch were noted. The data obtained were tabulated and interpreted using a test of significance. Study results showed no statistical significant difference in perinasal soft changes among both groups. But tube switch appears to be beneficial to prevent alar flare. Modified alar base cinching was performed effectively in patients with a modified tube switch technique. It increased positive results in comparison with non-shift. The technique of tube switch used is effective in prevention of alar flare. Because of small sample size and limited period of follow up, our study suggests multi centre, randomized studies to know the technical difficulties of tube switch for cinching and aesthetic results with varying anaesthetist and the surgeon's experience.

  11. Adult Onset Dysphagia: Right Sided Aortic Arch, Ductus Diverticulum, and Retroesophageal Ligamentum Arteriosum Comprising an Obstructing Vascular Ring

    PubMed Central

    Raheja, Hitesh; Kamholz, Stephan; Shetty, Vijay

    2017-01-01

    A 49-year-old African American male patient with no past medical history was admitted because of 3 months of difficulty swallowing solid and liquid foods. He had constant retrosternal discomfort and appeared malnourished. The chest radiograph revealed a right sided aortic arch with tracheal deviation to the left. A swallow study confirmed a fixed esophageal narrowing at the level of T6. Contrast enhanced Computed Tomography (CT) angiogram of the chest and neck revealed a mirror image right aortic arch with a left sided cardiac apex and a prominent ductus diverticulum (measuring 1.7 × 1.8 cm). This structure extended posterior to and indented the mid esophagus. A left posterolateral thoracotomy was performed and the ductus diverticulum was resected. A retroesophageal ligamentum arteriosum was found during surgery and divided. This rare combination of congenital anatomical aberrations led to severe dysphagia in our patient. Successful surgical correction in the form of resection of the ductus diverticulum and division of the retroesophageal ligamentum arteriosum led to complete resolution of our patient's symptoms.

  12. A potential method for identifying dural ossification by measuring the degree of spinal stenosis in thoracic ossification of ligamentum flavum.

    PubMed

    Li, Bo; Qiu, Guixing; Zhao, Yu

    2016-11-01

    Ossification of ligamentum flavum (OLF) is increasingly recognized as the major cause of thoracic spinal stenosis. The dura mater beneath ossified ligamentum flavum may also ossify when the spinal stenosis develops to a certain degree. Preoperative diagnosis of dural ossification (DO) is beneficial for surgical management of OLF. However, currently, accurate diagnosis method still could not be obtained. Based on the association between spinal stenosis and OLF/DO, a potential diagnosis method is proposed in this paper: identifying DO by measuring the degree of spinal stenosis in thoracic OLF. In the early stage of OLF, there is only mild spinal stenosis and no DO. With the progression of OLF, dura may also ossify and further compress the spinal cord, aggravating spinal stenosis. Before DO, the dura mater is presented as a low signal intensity. Once ossifying, the dura mater will be shown as a high signal intensity in CT. It will lead that the degree of spinal stenosis measured in axial CT scan obviously increases. Thus, it provides a possibility to find a critical value of it for distinguishing OLF patients with or without DO. Copyright © 2016. Published by Elsevier Ltd.

  13. Variability of morphology and signal intensity of alar ligaments in healthy volunteers using MR imaging.

    PubMed

    Lummel, N; Zeif, C; Kloetzer, A; Linn, J; Brückmann, H; Bitterling, H

    2011-01-01

    Evaluation of alar traumatic injuries by using MR imaging is frequently performed. This study investigates the variability of morphology and signal intensity of alar ligaments in healthy volunteers so that pathology can be more accurately defined. Fifty healthy volunteers were examined on a 1.5T MR imaging scanner with 2-mm PD-weighted sequences in 3 planes. Delineation of the alar ligaments in 3 planes and signal-intensity characteristics on sagittal planes were analyzed by using a 4-point grading scale. Variability of courses and morphologic characteristics were described. Delineation of alar ligaments was best viewed in the coronal plane, followed by the sagittal and axial planes. In the sagittal view, 6.5% of alar ligaments appeared homogeneously dark. Hyperintense signal intensity in up to one-third of the cross-sectional area was present in 33% of cases; in up to two-thirds of the cross-sectional area, in 45% of cases; and in more than two-thirds of the cross-sectional area, in 15% of cases. Of alar ligaments, 58.5% ascended laterally, 40.5% ran horizontally, and 1% descended laterally. The cross-sectional area was round in 41.5%, oval in 51.5%, and winglike in 6.5%. On 1.5T MR imaging, the alar ligaments can be delineated best in the coronal and sagittal planes. Our data indicate a remarkable variability of morphology and course as well as signal intensity. This finding is contradictory to former publications assigning such alterations exclusively to patients with trauma.

  14. MR investigation in evaluation of chronic whiplash alar ligament injury in elderly patients.

    PubMed

    Chen, Jianqiang; Wang, Wei; Han, Guibin; Han, Xiangjun; Li, Xiangying; Zhan, Yuefu

    2015-01-01

    To observe the imaging features for chronic whiplash alar ligament injury in elderly patients and to provide an effective diagnostic method for long-term neck pain and headaches due to alar ligament injury in elderly patients. A total of 134 elderly patients, who engaged in the work or activities related to whiplash motion and suffered from chronic neck pain, were enrolled for the study. All patients were performed comprehensive health examination (CT, MR, ultrasound and laboratory examination) and high resolution PDWI. The patients were divided into 2 groups according to the results of comprehensive health examination: a clear etiology group(CE group, n=96) and an unknown etiology group(UE group, n=38). Th e characteristics of PDWI signal in the ligament were analyzed between the 2 groups. Th e anatomy and signal characteristics of the alar ligament were clearly displayed by high resolution PDWI. Th e alar ligaments were effectively displayed by oblique coronal image. In the CE group, 7 patients (7/96) showed the positive sign of ligament injured, while 21 (21/38) patients showed positive sign of ligament injured in the UE group (P<0.01). Chronic whiplash ligament injury was proved to be the reason for long-term neck pain and headaches in 15.7% patients. Th e whiplash injury of alar ligament is an important reason for chronic neck pain in elderly patients. High resolution PDWI is an effective method to evaluate the image features of alar ligament and can provide an accurate diagnosis for chronic neck pain and headaches caused by the alar ligament whiplash injury.

  15. Versatility of three-dimensional total alar cartilage dissection in aesthetic rhinoplasty.

    PubMed

    Yun, In Sik; Rah, Dong Kyun; Kim, Sung Min

    2010-11-01

    In many cases, Asians' noses are shorter; their nasal tips have a bulbous shape and typically lack the projection. To correct these problems, we completely dissected the alar cartilage in a three-dimensional manner by which the alar cartilage could be repositioned. Thus, no external force was exerted to the alar cartilage. For approximately 4 years, a total of 502 patients were treated with this surgical method. Using the open rhinoplasty, the alar cartilage was dissected in such a manner that it should be completely isolated from the skin, nasal mucosa, and upper lateral cartilage in 3 layers. Thereafter, using various nasal tip plasty techniques, the alar cartilage was reshaped and then repositioned. Patients were followed up for a mean period of 18 months. Then, the degree of subjective satisfaction of patients was analyzed with the use of 4-point visual analog scale scores. On the assessment of the degree of subjective satisfaction of patients, of a total of 502 patients, 87% responded as "very satisfactory" or "satisfactory." Through an analysis of the photographs taken before and after surgery, in patients with a short nose, the current surgical procedure was effective in extending the length of nose without the septal extension graft. The nasolabial angle was ideally expressed. Through meticulous cartilage manipulation, the tip projection improved and a bulbous shape of the nasal tip was resolved. In an aesthetic rhinoplasty for Asians, if plastic surgery of the nasal tip should be performed using a three-dimensional dissection of the alar cartilage, it would be helpful for surgeons to effectively and freely manipulate the alar cartilage according to their plans.

  16. [Static-dynamic computerized tomography in the diagnosis of traumatic lesions of alar ligaments. Preliminary results].

    PubMed

    Urso, S; Pacciani, E; Ascani, E; Salsano, M L; Randisi, F; Fassari, F M

    1994-12-01

    The patients affected with cervical injuries often complain of cervical pain, headache and dizziness even when no bone fractures are detected. Such patients are likely to have a post-traumatic injury of the cervical ligaments. Twenty-five symptomatic patients (19 women and 6 men) were examined with upper spine CT and functional CT scans (right and left rotation) to detect ligament injuries and hypermotility of the craniocervical junction, both related to traumatic events. Eleven patients showed no alterations, while unilateral densitometric alterations of the alar ligaments were observed in 14 cases and thought to be related to trauma. On axial CT scans, the normal alar ligaments were identified as paramedian, quadrangular soft-tissue structures at the apex of the dens epistrophei and right above it. In 14 patients with alar ligament injuries, CT showed incomplete ligament interruption and thinning in 12 cases and its total absence on all images in 2 cases. The laterodental space in the affected side was hypodense due to fat tissue replacement. Of 14 patients with alar ligament injuries, only 14 patients with alar ligament injuries, only 4 exhibited rotatory hypermotility at C0-C1 and C1-C2. The low frequency of rotatory hypermotility is probably due to the high rate of incomplete alar ligament injuries as well as to cervical muscle stiffness, which is marked in some subjects. In conclusion, static and functional CT of the upper spine is not only useful to predict trauma outcome, but also allows the detection of the alar ligaments, of their morphodensitometric changes and of the segmental instability of the craniocervical junction.

  17. A new modification of Doyle splint (Hemi-split Doyle) in rhinoplasty with alar base reduction.

    PubMed

    Koçak, İlker; Şentürk, E

    2017-08-09

    Patients perceive the pulling of a nasal splints as the most feared and stressful part of nasal surgery. Even the incisions made for alar base surgery can partly or entirely dehisce. So, we have been using modified Doyle silicone splints. We compared the modified Doyle silicone splints with conventional Doyle silicone splint. Included in the study were 64 patients undergoing alar base surgery together with open septorhinoplasty. Group 1 (n = 32) patients received a conventional Doyle intranasal silicone splint and group 2 (n = 32) received modified splint that we call a hemi-split Doyle splint. The pain felt by the patients during the removal of the splints was recorded according to the visual analogue scale (VAS). On days two and four postoperatively, the nasal stuffiness score (NOSE) was recorded. On day four postoperatively an intranasal examination was conducted to establish if dehiscence had occurred on the alar base incision line. In group 2, the pain scores during splints removal were significantly lower than those in group 1. Whereas no dehiscence on the alar base incision line was observed after tampon removal in group 2, the incision dehisced in eight patients in group 1. The NOSE scores on postoperative days two and four showed no difference between the groups. The hemi-split Doyle splint causes less pain during removal and particularly does not lead to dehiscence of incisions made during alar base surgery in rhinoplasty patients.

  18. Three-dimensional virtual simulation of alar width changes following bimaxillary osteotomies.

    PubMed

    Liebregts, J; Xi, T; Schreurs, R; van Loon, B; Bergé, S; Maal, T

    2016-10-01

    The aim of this study was to evaluate the accuracy of three-dimensional (3D) soft tissue simulation of nose width changes following bimaxillary osteotomies and to identify patient- and surgery-related factors that may affect the accuracy of simulation. Sixty patients (mean age 26 years) who underwent bimaxillary osteotomies participated in this study. Cone beam computed tomography scans were acquired preoperatively and at 1-year postoperative. The 3D hard and soft tissue rendered preoperative and postoperative virtual head models were superimposed, after which the maxilla and mandible were segmented and aligned to the postoperative position. The postoperative changes in alar width were simulated using a mass tensor model (MTM)-based algorithm and compared with the postoperative outcome. 3D cephalometric analyses were used to quantify the simulation error. The postoperative alar width was increased by 1.6±1.1mm and the mean error between the 3D simulation and the actual postoperative alar width was 1.0±0.9mm. The predictability was not correlated to factors such as age, sex, alar cinch suture, VY closure, maxillary advancement, or a history of surgically assisted rapid maxillary expansion. The MTM-based simulation model of postoperative alar width change was found to be reasonably accurate, although there is room for further improvement. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  19. The Effects of Secondary Cleft Procedures on Alar Base Position and Nostril Morphology in Patients with Unilateral Clefts.

    PubMed

    Power, Stephanie M; Matic, Damir B

    2017-07-01

    To compare effects of secondary cleft procedures on alar base position and nostril morphology. Retrospective review. Multidisciplinary cleft clinic at tertiary center. Seventy consecutive patients with unilateral clefts were grouped according to secondary procedure. Alveolar bone graft versus total lip takedown with anatomic muscle repair versus single-stage total lip with cleft septorhinoplasty (nose-lip) versus rhinoplasty alone. Anthropometric measurements were recorded from pre- and postoperative photographs. Ratios of cleft to noncleft side were compared within and across groups pre- and postoperatively using parametric and nonparametric tests. Within the bone graft group, no differences were seen postoperatively in alar base position in long-term follow-up. The total lip group demonstrated greater symmetry at the alar base (P < .001), increased vertical lip dimension (P < .001), and decreased nostril height (P = .004) postoperatively. Within the nose-lip group, increased vertical dimension and alar base support (P < .001) were also seen postoperatively. Across groups, the single-stage nose-lip group demonstrated greatest alar base symmetry on worm's-eye view (P < .04). Alar base asymmetry in patients with unilateral clefts may be related to soft tissue deficiency and was not affected by alveolar bone grafting. Total lip takedown with anatomic muscle reapproximation was associated with increased alar base symmetry and vertical lip dimension on cleft to noncleft side. Greatest symmetry at the alar base was seen following single-stage nose-lip reconstruction, which may be an effective technique for correcting the secondary cleft lip nasal deformity.

  20. Forensic Facial Reconstruction: Relationship Between the Alar Cartilage and Piriform Aperture.

    PubMed

    Strapasson, Raíssa Ananda Paim; Herrera, Lara Maria; Melani, Rodolfo Francisco Haltenhoff

    2017-03-29

    During forensic facial reconstruction, facial features may be predicted based on the parameters of the skull. This study evaluated the relationships between alar cartilage and piriform aperture and nose morphology and facial typology. Ninety-six cone beam computed tomography images of Brazilian subjects (49 males and 47 females) were used in this study. OsiriX software was used to perform the following measurements: nasal width, distance between alar base insertion points, lower width of the piriform aperture, and upper width of the piriform aperture. Nasal width was associated with the lower width of the piriform aperture, sex, skeletal vertical pattern of the face, and age. The current study contributes to the improvement of forensic facial guides by identifying the relationships between the alar cartilages and characteristics of the biological profile of members of a population that has been little studied thus far. © 2017 American Academy of Forensic Sciences.

  1. Z-plasty of the alar subunit to correct nasal vestibular stenosis.

    PubMed

    Choudhury, Natasha; Hariri, Ahmad; Saleh, Hesham

    2014-04-01

    Nasal vestibular stenosis can result in a challenging cosmetic deformity, for which a variety of techniques have been described, including scar excision and replacement with local flaps, composite or cartilage grafts, with or without stents. We describe the Z-plasty technique to widen the alar base and assess patient satisfaction from the surgery. A retrospective review of patients who underwent Z-plasty to the alar subunit for nasal vestibular stenosis over a 4-year period was conducted. Demographic data and patient satisfaction were evaluated using pre- and postoperative visual analog scores and Rhinoplasty Outcome Evaluation questionnaires. Eight patients underwent the procedure, and all confirmed significant improvement in their esthetic outcome. We describe our Z-plasty technique to the alar base and review patient satisfaction.

  2. The dissociation energies of AlH 2 and AlAr

    NASA Astrophysics Data System (ADS)

    Partridge, Harry; Bauschlicher, Charles W., Jr.; Visscher, Luuk

    1995-11-01

    The D0 values for AlH 2 and AlAr are computed using the coupled cluster approach in conjunction with large basis sets. Basis set superposition and spin-orbit effects are accounted for, as they are significant due to the small binding energy. The computed dissociation energy ( D0) for AlAr is 114 cm -1, which is 93% of the experimental value (122.4 cm -1). Our best estimate for the AlH 2 binding energy is 38 ± 26 cm -1.

  3. The Dissociation Energies of AlH2 and AlAr

    NASA Technical Reports Server (NTRS)

    Ricca, Alessandra; Partridge, Harry; Bauschlicher, Charles W., Jr.; Visscher, Luuk; Langhoff, Stephen R. (Technical Monitor)

    1995-01-01

    The D(sub 0) values for AlH2 and AlAr are computed using the coupled cluster approach in conjunction with large basis sets. Basis set superposition and spin-orbit effects are accounted for as they are sizeable due to the small binding energy. The computed dissociation energy for AlAr is 101 /cm , which is 83% of the experimental value (122.4/ cm). Our best estimate for the H2 binding energy in AlH2 is 40 +/- 28 /cm.

  4. A modified nasolabial flap for reconstruction of transfixing alar wing defects.

    PubMed

    Bouhassira, J; Hersant, B; Noel, W; Aguilar, P; Niddam, J; Meningaud, J-P

    2017-08-22

    Reconstruction of an entire alar wing is a frequently encountered reconstructive challenge in onco-dermatologic surgery. The aim of this technical note was to describe a surgical technique total for reconstruction of the alar wing, with a modified nasolabial flap with an inferior pedicle associated with a cartilaginous graft. This rapid procedure seems to be a well alternative for elderly people and patients who do not want a forehead flap. The aesthetic and functional outcomes of the donor and recipient sites were satisfactory. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. Nasal alar necrosis following hyaluronic Acid injection into nasolabial folds: a case report.

    PubMed

    Manafi, Ali; Barikbin, Behrooz; Manafi, Amir; Hamedi, Zahra Sadat; Ahmadi Moghadam, Shokoofeh

    2015-01-01

    Injection of synthetic fillers for soft tissue augmentation is increasing over the last decade. One of the most common materials used is hyaluronic acid (HA) that is safe and temporary filler for soft tissue augmentation. We present a case of 54-year-old female who experienced vascular occlusion and nasal alar necrosis following HA injection to the nasolabial folds. She suffered from pain, necrosis, infection, and alar loss that finally required a reconstructive surgery for cosmetic appearance of the nose. The case highlights the importance of proper injection technique by an anesthesiologist, as well as the need for immediate recognition and treatment of vascular occlusion.

  6. Nasal Alar Necrosis Following Hyaluronic Acid Injection into Nasolabial Folds: A Case Report

    PubMed Central

    Manafi, Ali; Barikbin, Behrooz; Manafi, Amir; Hamedi, Zahra Sadat; Ahmadi Moghadam, Shokoofeh

    2015-01-01

    Injection of synthetic fillers for soft tissue augmentation is increasing over the last decade. One of the most common materials used is hyaluronic acid (HA) that is safe and temporary filler for soft tissue augmentation. We present a case of 54-year-old female who experienced vascular occlusion and nasal alar necrosis following HA injection to the nasolabial folds. She suffered from pain, necrosis, infection, and alar loss that finally required a reconstructive surgery for cosmetic appearance of the nose. The case highlights the importance of proper injection technique by an anesthesiologist, as well as the need for immediate recognition and treatment of vascular occlusion. PMID:25606480

  7. The Dissociation Energies of AlH2 and AlAr

    NASA Technical Reports Server (NTRS)

    Ricca, Alessandra; Partridge, Harry; Bauschlicher, Charles W., Jr.; Visscher, Luuk; Langhoff, Stephen R. (Technical Monitor)

    1995-01-01

    The D(sub 0) values for AlH2 and AlAr are computed using the coupled cluster approach in conjunction with large basis sets. Basis set superposition and spin-orbit effects are accounted for as they are sizeable due to the small binding energy. The computed dissociation energy for AlAr is 101 /cm , which is 83% of the experimental value (122.4/ cm). Our best estimate for the H2 binding energy in AlH2 is 40 +/- 28 /cm.

  8. Iatrogenic Spinal Cord Injury during Removal of the Inferior Articular Process in the Presence of Ossification of the Ligamentum Flavum

    PubMed Central

    Burke, Shane M.; Hwang, Steven W.; Safain, Mina G.; Riesenburger, Ron I.

    2016-01-01

    Ossified ligamentum flavum (OLF) is a condition of heterotopic lamellar bone formation within the yellow ligament. Some patients with OLF can be asymptomatic. However, asymptomatic OLF may not be obvious on preoperative MRI and could increase the risk of iatrogenic injury during treatments for unrelated spinal conditions. This report describes a case of spinal cord injury caused by the indirect transmission of force from an osteotome to an asymptomatic OLF during the resection of a thoracic inferior articular process (IAP). To prevent this outcome, we urge careful review of CT imaging in the preoperative setting and advocate the use of a high-speed drill instead of an osteotome during bone removal in the setting of an adjacent area of OLF. PMID:26885431

  9. Laminoplasty and Laminectomy Hybrid Decompression for the Treatment of Cervical Spondylotic Myelopathy with Hypertrophic Ligamentum Flavum: A Retrospective Study

    PubMed Central

    Ding, Huairong; Xue, Yuan; Tang, Yanming; He, Dong; Li, Zhiyang; Zhao, Ying; Zong, Yaqi; Wang, Yi; Wang, Pei

    2014-01-01

    Objective To report the outcomes of a posterior hybrid decompression protocol for the treatment of cervical spondylotic myelopathy (CSM) associated with hypertrophic ligamentum flavum (HLF). Background Laminoplasty is widely used in patients with CSM; however, for CSM patients with HLF, traditional laminoplasty does not include resection of a pathological ligamentum flavum. Methods This study retrospectively reviewed 116 CSM patients with HLF who underwent hybrid decompression with a minimum of 12 months of follow-up. The procedure consisted of reconstruction of the C4 and C6 laminae using CENTERPIECE plates with spinous process autografts, and resection of the C3, C5, and C7 laminae. Surgical outcomes were assessed using Japanese Orthopedic Association (JOA) score, recovery rate, cervical lordotic angle, cervical range of motion, spinal canal sagittal diameter, bone healing rates on both the hinge and open sides, dural sac expansion at the level of maximum compression, drift-back distance of the spinal cord, and postoperative neck pain assessed by visual analog scale. Results No hardware failure or restenosis was noted. Postoperative JOA score improved significantly, with a mean recovery rate of 65.3±15.5%. Mean cervical lordotic angle had decreased 4.9 degrees by 1 year after surgery (P<0.05). Preservation of cervical range of motion was satisfactory postoperatively. Bone healing rates 6 months after surgery were 100% on the hinge side and 92.2% on the open side. Satisfactory decompression was demonstrated by a significantly increased sagittal canal diameter and cross-sectional area of the dural sac together with a significant drift-back distance of the spinal cord. The dural sac was also adequately expanded at the time of the final follow-up visit. Conclusion Hybrid laminectomy and autograft laminoplasty decompression using Centerpiece plates may facilitate bone healing and produce a comparatively satisfactory prognosis for CSM patients with HLF. PMID:24740151

  10. Study of the human ligamentum flavum in old age: a histological and morphometric study.

    PubMed

    Zaki, S M

    2014-11-01

    Ageing is associated with many changes in the ligamentum flavum (LF): ossification, diminish of the cross-sectional area of the elastic fibres, increase of the collagen fibres and change in its mineral and matrix elements. There are limited data about the influence of the ageing process on the structure of the LF at different spinal levels. The aim of the study was to clarify the effect of the ageing process on the LF at different spinal levels. This was done through histological study and morphometric analysis using the image analyser. Vertebral column specimens were obtained from 10 human cadavers preserved in a mixture of formaldehyde and carbol. Their average age ranged 60-70 years. The vertebral blocks included 4 vertebrae at cervical level (C 3, 4, 5, 6), thoracic level (T 5, 6, 7, 8) and lumbar level (L 2, 3, 4, 5). Sections were stained with haematoxylin and eosin, Masson's trichrome, Orcein and Verhoeff stains. The morphometric measurements included the relative collagen area, relative elastic area, collagen area [%] and elastic area [%]. The relative elastic areas reduced in all the spinal levels. The relative collagen areas increased to become 46.1 ± 2.9 in the cervical region, 51.8 ± 1.3 in the thoracic region, and 49.7 ± 2.5 in the lumbar region. The average elastic area was highest in the cervical region, and lowest in the thoracic region. The ratio of elastic area to collagen area was 1.16:1 in the cervical region, 1.01:1 in the lumbar region and 0.93:1 in the thoracic region. The elastic fibres were regular, diffuse and organised in parallel order in the cervical and thoracic regions. Their orientations were craniocaudal with a variation of some fibres in the cervical region. Most of the elastic fibres in the lumbar region were regular and organized in parallel order. Nevertheless, rupture, fragmentation, and abnormal organization of the elastic fibres were discovered in a few specimens of the lumbar region. Increase of the vasculature and

  11. Comparison between the classical and a modified trans-septal technique of alar cinching for Le Fort I osteotomies: a prospective randomized controlled trial.

    PubMed

    Nirvikalpa, N; Narayanan, V; Wahab, A; Ramadorai, A

    2013-01-01

    The aim of this prospective randomized control trial was to analyse the efficacy of a new trans-septal alar base cinch suture in controlling alar width in patients undergoing maxillary intrusion and setback by comparing it with the traditional cinch suture. Statistical evaluation was carried out in 62 of 76 patients. Group I (31 patients) received the traditional alar base cinch suture, and group II (31 patients) received the alar base cinch suture with an anchoring bite taken through the nasal septum 10mm behind its anterior edge. In both groups the accurate identification of alar fibroareolar tissue was facilitated by an 18 gauge green needle passed extra orally. Alar base width was measured before and 6 months after surgery using Vernier callipers. Preoperative alar base width for group I was 29.76 mm (1.901SD) and for group II 29.79 mm (3.141SD); the postoperative values were 32.42 mm (1.858SD) and 29.94 mm (2.568SD), respectively. Mean alar base widening was 2.661 mm (0.800SD) in group I and 0.145 mm (2.050) in group II. The difference in alar widening was statistically significant (p<0.001). In conclusion, the trans-septal modified alar cinch suture offers better control of alar base architecture in maxillary intrusion and setback. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Refinement of Nasal Reconstruction with a V/Y-alar-perforator Flap

    PubMed Central

    Langer, Martin F.; Roldán, J. Camilo

    2017-01-01

    Background: The ala of the nose is vascularized by a dense net of perforators originating from the lateral nasal artery or the angular artery. These vessels reach the ala in a cascade fashion from the alar groove/lateral nasal wall. Based on these vessels, a V/Y flap can be dissected with a wide range of mobility. Materials and Methods: Nineteen patients underwent reconstruction of the nose by means of a V/Y-alar-perforator flap alone or in combination with a myocutaneous rotation flap from the lateral nasal wall and/or from the nasal dorsum for reconstruction of defects at the nasal tip, ala of the nose, and/or lateral nasal wall. All patients were followed up 8 months after surgery in average. Results: There was no prolonged congestion or any tissue loss. All patients presented postoperatively with excellent aesthetic results, and no nasal distortion was observed. Conclusion: The V/Y-alar-perforator flap alone or in combination with a myocutaneous rotation flap proved to be a reliable tool in the armamentarium for reconstruction of nasal tip and alar defects providing good aesthetic results. PMID:28203497

  13. Refinement of Nasal Reconstruction with a V/Y-alar-perforator Flap.

    PubMed

    Feinendegen, Dominik L; Langer, Martin F; Roldán, J Camilo

    2017-01-01

    The ala of the nose is vascularized by a dense net of perforators originating from the lateral nasal artery or the angular artery. These vessels reach the ala in a cascade fashion from the alar groove/lateral nasal wall. Based on these vessels, a V/Y flap can be dissected with a wide range of mobility. Nineteen patients underwent reconstruction of the nose by means of a V/Y-alar-perforator flap alone or in combination with a myocutaneous rotation flap from the lateral nasal wall and/or from the nasal dorsum for reconstruction of defects at the nasal tip, ala of the nose, and/or lateral nasal wall. All patients were followed up 8 months after surgery in average. There was no prolonged congestion or any tissue loss. All patients presented postoperatively with excellent aesthetic results, and no nasal distortion was observed. The V/Y-alar-perforator flap alone or in combination with a myocutaneous rotation flap proved to be a reliable tool in the armamentarium for reconstruction of nasal tip and alar defects providing good aesthetic results.

  14. Reconstruction of Congenital Isolated Alar Defect Using Mutaf Triangular Closure Technique in Pediatric Patients.

    PubMed

    Temel, Metin; Gunal, Ertan; Kahraman, Serif Samil

    2016-06-01

    Congenital isolated alar defects are extremely rare, occurring in approximately 1 in 20,000 to 40,000 live births. The patients are presented here of 2 pediatric patients operated on for congenital isolated alar defect. The reconstruction of congenital isolated alar defects was made in a 3-layered fashion. The skin defects were covered using the Mutaf triangular closure technique in which 2 cutaneous local flaps are designed in an unequal Z-plasty manner. Conchal cartilage graft was used between the skin and mucosal closure to replace the missing part of the lower lateral cartilage in these patients. The early results were promising in Patient 1, but sufficient improvement was detected in the alar cartilage postoperative follow-up period in Patient 2. Hence, this patient required revision 1 to 2 years postoperatively. This technique provides excellent aesthetic and functional results, except for this problem in Tessier 2 cleft patients. The use of the Stair step flap technique with Mutaf triangle closure technique achieved cosmetically and functionally excellent results in the reconstruction and repair of a large, irregular, narrow cleft, in the inadequate rotation of the lateral part of the lower lateral cartilage. However, because of this problem, evaluation of the long-term follow-up of patients is necessary.

  15. New anatomical profile of the nasal musculature: dilator naris vestibularis, dilator naris anterior, and alar part of the nasalis.

    PubMed

    Hur, Mi-Sun; Hu, Kyung-Seok; Youn, Kwan-Hyun; Song, Wu-Chul; Abe, Shinichi; Kim, Hee-Jin

    2011-03-01

    The aim of this study was to clarify the morphology and topography of the dilator naris vestibularis, dilator naris anterior, and alar part of the nasalis. Anatomical variations in the topographic relationships are also described to provide critical data for understanding nasal muscular functions. Anatomical and histological examinations were performed on 40 specimens of embalmed Korean adult cadavers. The dilator naris vestibularis muscle (named by the present authors) was located between the external and vestibular skin of the alar lobule. The muscle fibers radiated along the dome-shaped nasal vestibule. The dilator naris anterior muscle originated from the frontal surfaces of the lateral half of the lateral crus and the accessory alar cartilage adjacent to the lateral crus. The extent of the lower insertion of the dilator naris anterior muscle was at the alar groove. The alar part of the nasalis originated with the transverse part of nasalis from the maxilla. It ascended to attach to the alar crease and the adjacent deep surface of external skin of the alar lobule. These findings may provide anatomical knowledge required to understand the structure and function of these nasal muscles such as during rhinoplasty or other surgery of the face. Copyright © 2010 Wiley-Liss, Inc.

  16. Delineation of alar ligament morphology: comparison of magnetic resonance imaging at 1.5 and 3 Tesla.

    PubMed

    Schmidt, Peter; Mayer, Thomas E; Drescher, Robert

    2012-11-01

    Rupture of the alar and transverse ligaments due to whiplash injury can lead to upper cervical spine instability and subsequent neurological deterioration. The purpose of this study was to evaluate the normal anatomical variability of the alar ligaments in asymptomatic individuals with 3-T magnetic resonance imaging (MRI) and to compare the findings with standard 1.5-T examinations. Thirty-six participants underwent 3-T and 1.5-T MRIs. Magnetic resonance imaging findings were analyzed by classifying the alar ligaments with regard to the features detectability, signal intensity compared with muscle tissue, homogeneity, shape, spatial orientation, and symmetry. Delineation of the alar ligaments was significantly better on 3-T images, which were subjectively preferred for evaluation. The alar ligaments showed great variability. In the majority of participants, the alar ligaments were hypointense to muscle tissue, inhomogeneous, and different in shape and orientation. A statistically significantly higher number of ligaments appeared symmetric on 3-T imaging, indicating that 1.5-T imaging may underestimate the proportion of patients with normal, symmetric ligaments. This study demonstrates that high-field 3-T MRI provides better visualization of the alar ligaments compared with 1.5-T MRI. The higher signal-to-noise ratio allows detection of small signal changes. A great interindividual variety of the MRI morphology of the alar ligaments was found in participants with no history of neck trauma. Further studies with more participants are necessary to evaluate alar ligament pathologies in patients with a history of whiplash injury. Copyright 2012, SLACK Incorporated.

  17. Evaluation of soft tissue morphologic changes after using the alar base cinch suture in Le Fort I osteotomy in mandibular prognathism with and without asymmetry.

    PubMed

    Moroi, Akinori; Ishihara, Yuri; Sotobori, Megumi; Nakazawa, Ryuichi; Higuchi, Masatoshi; Nakano, Yoshio; Marukawa, Kohei; Ueki, Koichiro

    2014-09-01

    The purpose of this study was to investigate the effects of alar base cinch suture in Le Fort I osteotomy in mandibular prognathism with and without asymmetry. Forty patients who underwent Le Fort I osteotomy were divided into an asymmetry group and a symmetry group (n = 20 each). Computed tomography (CT) was taken in all patients before and 1 year after surgery. The CT-3D volume rendering data with Aquarius Net (TeraRecon, Foster City, CA, USA) was reconstructed and the soft tissue was measured as follows, the distance between the bilateral alar base (Alar base width), the distance between the bilateral alar (Alar width), the angles between the FH plane and the line between the bilateral alar base (Alar base angle), the angle between the FH plane and the line between the bilateral alar (Alar angle), the angle between the FH plane and the line between the bilateral corners of the mouth (Lip angle), and the angle between the perpendicular line to the FH plane and the Philtrum (Philtrum angle). Significant differences were observed in the Alar width (P = 0.0448), the Alar angle (P = 0.0044), the Lip angle (P < 0.0001), and the Philtrum angle (P = 0.0057) between before and after surgery in the asymmetry group. This study suggested that the alar base cinch suture could prevent increases in the alar base width in both groups and help to improve the angle of soft tissue in the asymmetry group, although alar width significantly increases after surgery. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  18. Characterization of the hypothalamus of Xenopus laevis during development. I. The alar regions.

    PubMed

    Domínguez, Laura; Morona, Ruth; González, Agustín; Moreno, Nerea

    2013-03-01

    The patterns of expression of a set of conserved developmental regulatory transcription factors and neuronal markers were analyzed in the alar hypothalamus of Xenopus laevis throughout development. Combined immunohistochemical and in situ hybridization techniques were used for the identification of subdivisions and their boundaries. The alar hypothalamus was located rostral to the diencephalon in the secondary prosencephalon and represents the rostral continuation of the alar territories of the diencephalon and brainstem, according to the prosomeric model. It is composed of the supraoptoparaventricular (dorsal) and the suprachiasmatic (ventral) regions, and limits dorsally with the preoptic region, caudally with the prethalamic eminence and the prethalamus, and ventrally with the basal hypothalamus. The supraoptoparaventricular area is defined by the orthopedia (Otp) expression and is subdivided into rostral and caudal portions, on the basis of the Nkx2.2 expression only in the rostral portion. This region is the source of many neuroendocrine cells, primarily located in the rostral subdivision. The suprachiasmatic region is characterized by Dll4/Isl1 expression, and was also subdivided into rostral and caudal portions, based on the expression of Nkx2.1/Nkx2.2 and Lhx1/7 exclusively in the rostral portion. Both alar regions are mainly connected with subpallial areas strongly implicated in the limbic system and show robust intrahypothalamic connections. Caudally, both regions project to brainstem centers and spinal cord. All these data support that in terms of topology, molecular specification, and connectivity the subdivisions of the anuran alar hypothalamus possess many features shared with their counterparts in amniotes, likely controlling similar reflexes, responses, and behaviors. Copyright © 2012 Wiley Periodicals, Inc.

  19. The Shark Alar Hypothalamus: Molecular Characterization of Prosomeric Subdivisions and Evolutionary Trends.

    PubMed

    Santos-Durán, Gabriel N; Ferreiro-Galve, Susana; Menuet, Arnaud; Quintana-Urzainqui, Idoia; Mazan, Sylvie; Rodríguez-Moldes, Isabel; Candal, Eva

    2016-01-01

    The hypothalamus is an important physiologic center of the vertebrate brain involved in the elaboration of individual and species survival responses. To better understand the ancestral organization of the alar hypothalamus we revisit previous data on ScOtp, ScDlx2/5, ScTbr1, ScNkx2.1 expression and Pax6 immunoreactivity jointly with new data on ScNeurog2, ScLhx9, ScLhx5, and ScNkx2.8 expression, in addition to immunoreactivity to serotonin (5-HT) and doublecortin (DCX) in the catshark Scyliorhinus canicula, a key species for this purpose since cartilaginous fishes are basal representatives of gnathostomes (jawed vertebrates). Our study revealed a complex genoarchitecture for the chondrichthyan alar hypothalamus. We identified terminal (rostral) and peduncular (caudal) subdivisions in the prosomeric paraventricular and subparaventricular areas (TPa/PPa and TSPa/PSPa, respectively) evidenced by the expression pattern of developmental genes like ScLhx5 (TPa) and immunoreactivity against Pax6 (PSPa) and 5-HT (PPa and PSPa). Dorso-ventral subdivisions were only evidenced in the SPa (SPaD, SPaV; respectively) by means of Pax6 and ScNkx2.8 (respectively). Interestingly, ScNkx2.8 expression overlaps over the alar-basal boundary, as Nkx2.2 does in other vertebrates. Our results reveal evidences for the existence of different groups of tangentially migrated cells expressing ScOtp, Pax6, and ScDlx2. The genoarchitectonic comparative analysis suggests alternative interpretations of the rostral-most alar plate in prosomeric terms and reveals a conserved molecular background for the vertebrate alar hypothalamus likely acquired before/during the agnathan-gnathostome transition, on which Otp, Pax6, Lhx5, and Neurog2 are expressed in the Pa while Dlx and Nkx2.2/Nkx2.8 are expressed in the SPa.

  20. The Shark Alar Hypothalamus: Molecular Characterization of Prosomeric Subdivisions and Evolutionary Trends

    PubMed Central

    Santos-Durán, Gabriel N.; Ferreiro-Galve, Susana; Menuet, Arnaud; Quintana-Urzainqui, Idoia; Mazan, Sylvie; Rodríguez-Moldes, Isabel; Candal, Eva

    2016-01-01

    The hypothalamus is an important physiologic center of the vertebrate brain involved in the elaboration of individual and species survival responses. To better understand the ancestral organization of the alar hypothalamus we revisit previous data on ScOtp, ScDlx2/5, ScTbr1, ScNkx2.1 expression and Pax6 immunoreactivity jointly with new data on ScNeurog2, ScLhx9, ScLhx5, and ScNkx2.8 expression, in addition to immunoreactivity to serotonin (5-HT) and doublecortin (DCX) in the catshark Scyliorhinus canicula, a key species for this purpose since cartilaginous fishes are basal representatives of gnathostomes (jawed vertebrates). Our study revealed a complex genoarchitecture for the chondrichthyan alar hypothalamus. We identified terminal (rostral) and peduncular (caudal) subdivisions in the prosomeric paraventricular and subparaventricular areas (TPa/PPa and TSPa/PSPa, respectively) evidenced by the expression pattern of developmental genes like ScLhx5 (TPa) and immunoreactivity against Pax6 (PSPa) and 5-HT (PPa and PSPa). Dorso-ventral subdivisions were only evidenced in the SPa (SPaD, SPaV; respectively) by means of Pax6 and ScNkx2.8 (respectively). Interestingly, ScNkx2.8 expression overlaps over the alar-basal boundary, as Nkx2.2 does in other vertebrates. Our results reveal evidences for the existence of different groups of tangentially migrated cells expressing ScOtp, Pax6, and ScDlx2. The genoarchitectonic comparative analysis suggests alternative interpretations of the rostral-most alar plate in prosomeric terms and reveals a conserved molecular background for the vertebrate alar hypothalamus likely acquired before/during the agnathan-gnathostome transition, on which Otp, Pax6, Lhx5, and Neurog2 are expressed in the Pa while Dlx and Nkx2.2/Nkx2.8 are expressed in the SPa. PMID:27932958

  1. Nasolabial-alar crease: a natural line to facilitate transposition of the nasolabial flap for lower nasal reconstruction.

    PubMed

    Bi, Hongda; Xing, Xin; Li, Junhui

    2014-11-01

    Nasolabial flaps have been widely used for nasal reconstruction. However, transposition of the nasolabial flap to lower nasal defects may be challenging because of functional and aesthetic concerns. The upper part of the alar crease joins with the nasolabial fold seamlessly, forming the nasolabial-alar crease line, which provides a natural strategy for easy concealment of the surgical scar. In this article, we would like to introduce a method for transferring a nasolabial flap along the nasolabial-alar crease to reconstruct lower nasal defects. Incision was made along the nasolabial-alar crease, and the nasolabial flap was transferred for lower nasal reconstruction in 9 patients. Subcutaneously based nasolabial flaps were designed, and undermining of the superolateral skin was made along the nasolabial-alar crease to obtain a robust subcutaneously based pedicle, so as to readily achieve flap transposition without tension and concealment of the subcutaneous pedicle. The nasolabial fold could be reproduced by closing the donor site. Lower nasal defects were successfully repaired with nasolabial flap in 9 patients. Good nasal contour and appropriate symmetry of the reconstructed nasolabial fold were achieved, and there were no conspicuous scars in the 9 cases. The natural nasolabial-alar crease can serve as a useful incision line to facilitate the nasolabial flap transposition for lower nasal reconstruction while minimizing the scar.

  2. Spectroscopy of AlAr and AlKr from 31 000 cm-1 to the ionization limit

    NASA Astrophysics Data System (ADS)

    Heidecke, Scott A.; Fu, Zhenwen; Colt, John R.; Morse, Michael D.

    1992-08-01

    Spectra of jet-cooled AlAr and AlKr have been collected over the range from 31 000 cm-1 to the ionization limit, using the technique of resonant two-photon ionization spectroscopy with mass spectrometric detection. Adiabatic ionization potentials have been accurately measured for both molecules, and have been estimated for AlAr2 and AlAr3. The spin-orbit splittings in the X 2Π ground state have been determined for both AlAr and AlKr, and ground-state bond strengths have been accurately measured as D0[AlAr, X1 2Π1/2(3p)] =122.4±4 cm-1 and D0[27Al 84Kr, X1 2Π1/2(3p)] =194.7±0.8 cm-1. These values have also been combined with the measured ionization potentials to derive D0(Al+-Ar)=982.3± 5 cm-1 and D0(Al+-Kr)=1528.5±2 cm-1.

  3. [Reconstruction of full-thickness nasal alar defect with combined nasolabial flap and free auricular composite flap].

    PubMed

    Peng, Weihai; Rong, Li; Wang, Wangshu; Liu, Chao; Zhang, Duo

    2014-05-01

    To investigate the technique and its effect of combined nasolabial flap and free auricular composite flap for full-thickness nasal alar defect. From March 2010 to March 2013, 9 patients with full-thickness nasal alar defects were treated with combined nasolabial flaps and free auricular composite flaps. Composite auricular flap was used as inner lining and cartilage framework. The nasolabial flap at the same side was used as outer lining. All the patients were followed up for 6-18 months (average, 12 months). All the 9 composite auricular flaps survived completely. Epidermal necrosis happened at the distal end of 1 nasolabial flap. Alar rim was almost normal and symmetric nose was achieved in 6 cases. The arc and the thickness of the alar rim was not enough in 3 cases, resulting in asymmetric appearance. The survival area of auricular composite flap can be enlarged with nasolabial flap. The auricular helix edge can be reserved to reconstruct nasal alar rim with smooth and natural arc. Large full-thickness nasal alar defedts can be reconstructed with combined nasolabial flaps and free auricular composite flaps.

  4. Biliary architecture of livers exhibiting right-sided ligamentum teres: an indication for preoperative cholangiography prior to major hepatectomy.

    PubMed

    Nishitai, Ryuta; Shindoh, Junichi; Yamaoka, Toshihide; Akahane, Masaaki; Kokudo, Norihiro; Manaka, Dai

    2016-11-01

    To obtain information about the basic biliary anatomy of livers with right-sided ligamentum teres (RSLT). RSLT is a relatively rare anomaly with a reported incidence of 0.2-1.2%. Although the portal/hepatic venous and arterial anatomy of livers with RSLT has already been established, the biliary architecture of such livers remains unclear. RSLT was detected in 48 patients during 12,071 consecutive image readings (0.4%). Of these patients, the cholangiograms of 46 patients were analyzed, and their intrahepatic biliary tree confluence patterns were classified. The following four unique biliary confluence patterns were identified in livers with RSLT: the symmetrical type (23/46), independent right lateral type (13/46), total left type (6/46), and total right type (1/46). Analyses of the portal and arterial branching patterns of these livers showed that there were no correlations between their biliary confluence patterns and their portal or arterial ramification patterns. The basic biliary architecture of livers with RSLT was clarified. As the RSLT patients' anomalous biliary confluences differed from those seen in normal livers and were difficult to predict, preoperative cholangiography should be performed prior to complex hepatobiliary surgery involving livers with RSLT to ensure patient safety. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  5. Macrophage Infiltration is a Causative Factor for Ligamentum Flavum Hypertrophy through the Activation of Collagen Production in Fibroblasts.

    PubMed

    Saito, Takeyuki; Hara, Masamitsu; Kumamaru, Hiromi; Kobayakawa, Kazu; Yokota, Kazuya; Kijima, Ken; Yoshizaki, Shingo; Harimaya, Katsumi; Matsumoto, Yoshihiro; Kawaguchi, Kenichi; Hayashida, Mitsumasa; Inagaki, Yutaka; Shiba, Keiichiro; Nakashima, Yasuharu; Okada, Seiji

    2017-09-18

    Ligamentum flavum (LF) hypertrophy causes lumbar spinal canal stenosis, leading to leg pain and disability in activities of daily living in elderly individuals. Although there have been previous studies on LF hypertrophy, its pathomechanisms have not been fully elucidated. In this study, we demonstrated that infiltrating macrophages were a causative factor for LF hypertrophy. Induction of macrophages into the mouse LF by applying a micro-injury resulted in LF hypertrophy along with collagen accumulation and fibroblasts proliferation at the injured site, which were very similar to the characteristics observed in the severely hypertrophied LF of human. However, we found that macrophage depletion by injecting clodronate-containing liposomes counteracted LF hypertrophy even with micro-injury. For identification of fibroblasts in the LF, we utilized collagen type 1 alpha 2 linked to green fluorescent protein (COL1a2-GFP) transgenic mice, and selectively isolated GFP-positive fibroblasts from the micro-injured LF using laser microdissection (LMD). A quantitative RT-PCR on LMD samples showed that the gene expression of collagen markedly increased in the fibroblasts at the injured site with infiltrating macrophages compared to the uninjured location. These results suggested that macrophage infiltration was crucial for LF hypertrophy by stimulating collagen production in fibroblasts, providing better understanding the pathophysiology of LF hypertrophy. Copyright © 2017. Published by Elsevier Inc.

  6. Evaluating Osteogenic Potential of Ligamentum Flavum Cells Cultivated in Photoresponsive Hydrogel that Incorporates Bone Morphogenetic Protein-2 for Spinal Fusion

    PubMed Central

    Chiang, Chih-Wei; Chen, Wei-Chuan; Liu, Hsia-Wei; Wang, I-Chun; Chen, Chih-Hwa

    2015-01-01

    Regenerative medicine is increasingly important in clinical practice. Ligamentum flava (LF) are typically removed during spine-related surgeries. LF may be a source of cells for spinal fusion that is conducted using tissue engineering techniques. In this investigation, LF cells of rabbits were isolated and then characterized by flow cytometry, morphological observation, and immunofluorescence staining. The LF cells were also cultivated in polyethylene (glycol) diacrylate (PEGDA) hydrogels that incorporated bone morphogenetic protein-2 (BMP-2) growth factor, to evaluate their proliferation and secretion of ECM and differentiation in vitro. The experimental results thus obtained that the proliferation, ECM secretion, and differentiation of the PEGDA-BMP-2 group exceeded those of the PEGDA group during the period of cultivation. The mineralization and histological staining results differed similarly. A nude mice model was utilized to prove that LF cells on hydrogels could undergo osteogenic differentiation in vivo. These experimental results also revealed that the PEGDA-BMP-2 group had better osteogenic effects than the PEGDA group following a 12 weeks after transplantation. According to all of these experimental results, LF cells are a source of cells for spinal fusion and PEGDA-BMP-2 hydrogel is a candidate biomaterial for spinal fusion by tissue engineering. PMID:26426006

  7. Predictors of surgical outcome in thoracic ossification of the ligamentum flavum: focusing on the quantitative signal intensity.

    PubMed

    Zhang, JingTao; Wang, LinFeng; Li, Jie; Yang, Peng; Shen, Yong

    2016-03-10

    The association between intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) and surgical outcome in thoracic ossification of the ligamentum flavum (OLF) remains controversial. We aimed to determine the impact of signal change ratio (SCR) on thoracic OLF surgical outcomes. We retrospectively reviewed 96 cases of thoracic OLF surgery and investigated myelopathy severity, symptom duration, MRI and computed tomographic findings, surgical technique and postoperative recoveries. Surgical outcomes were evaluated according to the modified Japanese Orthopaedic Association (JOA) score and recovery rate. JOA recovery rate <50% was defined as a poor surgical outcome. By multivariate logistic regression analysis, we identified risk factors associated with surgical outcomes. Forty patients (41.7%) had a recovery rate of <50%. In receiver operating characteristic (ROC) curves, the optimal preoperative SCR cutoff value as a predictor of poor surgical outcome was 1.54. Multivariate logistic regression analysis revealed that a preoperative SCR ≥1.54 and symptom duration >12 months were significant risk factors for a poor surgical outcome. These findings suggest that preoperative SCR and duration of symptoms were significant risk factors of surgical outcome for patients with thoracic OLF. Patients with preoperative SCR ≥1.54 can experience poor postoperative recovery.

  8. Predictors of surgical outcome in thoracic ossification of the ligamentum flavum: focusing on the quantitative signal intensity

    PubMed Central

    Zhang, JingTao; Wang, LinFeng; Li, Jie; Yang, Peng; Shen, Yong

    2016-01-01

    The association between intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) and surgical outcome in thoracic ossification of the ligamentum flavum (OLF) remains controversial. We aimed to determine the impact of signal change ratio (SCR) on thoracic OLF surgical outcomes. We retrospectively reviewed 96 cases of thoracic OLF surgery and investigated myelopathy severity, symptom duration, MRI and computed tomographic findings, surgical technique and postoperative recoveries. Surgical outcomes were evaluated according to the modified Japanese Orthopaedic Association (JOA) score and recovery rate. JOA recovery rate <50% was defined as a poor surgical outcome. By multivariate logistic regression analysis, we identified risk factors associated with surgical outcomes. Forty patients (41.7%) had a recovery rate of <50%. In receiver operating characteristic (ROC) curves, the optimal preoperative SCR cutoff value as a predictor of poor surgical outcome was 1.54. Multivariate logistic regression analysis revealed that a preoperative SCR ≥1.54 and symptom duration >12 months were significant risk factors for a poor surgical outcome. These findings suggest that preoperative SCR and duration of symptoms were significant risk factors of surgical outcome for patients with thoracic OLF. Patients with preoperative SCR ≥1.54 can experience poor postoperative recovery. PMID:26960572

  9. Repair of Full-Thickness Nasal Alar Defects Using Nasolabial Perforator Flaps.

    PubMed

    Durgun, Mustafa; Özakpınar, Hülda Rıfat; Selçuk, Caferi Tayyar; Sari, Elif; Seven, Ergin; İnözü, Emre

    2015-10-01

    The repair of full-thickness nasal alar defects presents difficulties because of their complex 3-dimensional structure. Reconstructions using inappropriate methods may lead to asymmetries and dissatisfying functional results. In this study, our aim was to present the repairs of full-thickness alar defects performed using cartilage-supported nasolabial perforator flaps. Eight patients who presented to our clinic between January 2011 and April 2014 with full-thickness defects in the alar wings were included in this study. The nasolabial perforator flap was prepared on the basis of the closest perforator to the defect area and in a way to include 2 to 3 mm of subcutaneous adipose tissue. The medial section of the flap was adapted to form the nasal lining. In the 7 patients in whom cartilage support was used, the cartilage graft was obtained from the septum nasi. After the cartilage was placed on the flap, the lateral section of the flap was folded over the medial section and the defect was repaired. In 1 patient in whom cartilage support was not required, the flap was folded over itself before the repair was performed. The flap donor area was primarily repaired. No detachment around the suture lines, infection, venous insufficiency in the flap, or partial or total flap losses were observed in any of the patients. Retraction developed in 1 patient in whom no cartilage support was used. No retraction was observed in any of the patients in whom cartilage support was used. The results were functionally and esthetically satisfying in all the patients. The greatest advantage of perforator-based nasolabial flaps is the greater mobilization achieved in comparison with the other nasolabial flaps. Thus, full-thickness defects can be repaired in 1 session in some patients, no revision is required around the flap pedicle, and much less donor area morbidity occurs. Nasal alar reconstructions performed using this type of flap lead to both esthetically and functionally satisfying

  10. Sacral-Alar-Iliac Fixation in Children with Neuromuscular Scoliosis: Minimum 5-Year Follow-Up.

    PubMed

    Jain, Amit; Sullivan, Brian T; Kuwabara, Anne; Kebaish, Khaled; Sponseller, Paul D

    2017-09-05

    The aim of our study was to investigate the 5-year outcomes of children with neuromuscular scoliosis treated with sacral-alar-iliac screws. We reviewed clinical and radiographic records of patients ≤18 years old treated by 1 pediatric orthopaedic surgeon for neuromuscular scoliosis with spinal fusion using sacral-alar-iliac pelvic anchors. Thirty-eight patients, with a minimum 5-year radiographic follow-up (6.0 ± 1.2 years), were studied. Mean patient age was 13 ± 2.0 years and 47% were female. The mean number of levels fused was 18 ± 0.7. The diagnosis was cerebral palsy in 66% of patients. Between the preoperative period and final follow-up there was a mean 79% correction of the major coronal curve (85° to 18°) and 57% correction of the pelvic obliquity (16° to 7°). Patients maintained correction of mean pelvic obliquity from the early postoperative period (6°) to final follow-up (7°). Preoperatively, 76% of patients had pelvic obliquity of >10°compared with 26% after surgery. There were no cases of neurologic or vascular complications or pseudarthrosis. Radiographs revealed bilateral sacral-alar-iliac screw lucency in 8 patients; 4 of these patients had deep wound infections, and the other 4 were asymptomatic. Unilateral screw fracture was found in 1 patient with an 8-mm screw diameter (1.3%, 1 of 76 screws); the patient was observed and remained asymptomatic. There were no cases of set screw displacement, screw back-out, or rod dislodgement. Sacral-alar-iliac screws are safe and effective pelvic anchors for use in children with neuromuscular scoliosis. Copyright © 2017. Published by Elsevier Inc.

  11. [Middle third of the nose and internal valve. Alar wall and external valve].

    PubMed

    Duron, J B; Nguyen, P S; Jallut, Y; Bardot, J; Aiach, G

    2014-12-01

    To many surgeons, nasal airway obstruction is synonymous with either septal deviation or inferior turbinate hypertrophy. The role of internal and external nasal valves is often less known by surgeons even if it is crucial in nasal breathing and strongly interrelated with esthetic of the middle third of the nose and alar wall. Therefore, precise examination of the two valves and conservative surgery should help to avoid many functional and esthetic problems. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  12. Management of the droopy tip: a comparison of three alar cartilage-modifying techniques.

    PubMed

    Foda, Hossam M T

    2003-10-01

    The droopy tip is a common nasal deformity in which the tip is inferiorly rotated. Five hundred consecutive rhinoplasty cases were studied to assess the incidence and causes of the droopy tip deformity and to evaluate the role of three alar cartilage-modifying techniques--lateral crural steal, lateral crural overlay, and tongue in groove--in correcting such a deformity. The external rhinoplasty approach was used in all cases. Only one of the three alar cartilage-modifying techniques was used in each case, and the degree of tip rotation and projection was measured both preoperatively and postoperatively. The incidence of droopy tip was 72 percent, and the use of an alar cartilage-modifying technique was required in 85 percent of these cases to achieve the desired degree of rotation. The main causes of droopy tip included inferiorly oriented alar cartilages (85 percent), overdeveloped scrolls of upper lateral cartilages (73 percent), high anterior septal angle (65 percent), and thick skin of the nasal lobule (56 percent). The lateral crural steal technique increased nasal tip rotation and projection, the lateral crural overlay technique increased tip rotation and decreased tip projection, and the tongue-in-groove technique increased tip rotation without significantly changing the amount of projection. The lateral crural overlay technique resulted in the highest degrees of rotation, followed by the lateral crural steal and finally the tongue-in-groove technique. According to these results, the lateral crural steal technique is best indicated in cases with droopy underprojected nasal tip, the lateral crural overlay technique in cases of droopy overprojected nasal tip, and the tongue-in-groove technique in cases where the droopy nasal tip is associated with an adequate amount of projection.

  13. Primary rhinocheiloplasty: Comparison of open and closed methods of alar cartilage reposition

    PubMed Central

    Yasonov, S. A.; Lopatin, A. V.; Kugushev, A. Yu.

    2016-01-01

    Aims: To establish which rhinoplasty method for primary repairing of unilateral cleft lip (UCL) is better. Settings and Design: Two patient groups with cleft lip were compared. Each group was operated on either by McComb's technique as closed rhinoplasty method or by Vissarionov–Kosin technique as an open method. Subjects and Methods: First group included 29 patients and the second consisted of 31. All patients were operated on by single surgeon over 10 years. Randomization was based on wishes and intention of surgeon to use one of two methods. Evaluation of results was based on impartial data, and subjective information collected from respondents with different levels of knowledge about UCL. The objective scale was based on the evaluation of five noticeable residual deformations of nose that usually appear after primary lip-nose surgery: Alar flattening, low position of alar, widening or narrowing of nostril, and deformation of the upper part of nostril rim. Subjective evaluation was based on the opinion of respondents who were ranged every case depending on own judgment. Statistical Analysis: Was performed using Fisher method and Chi-square by Statistica 10.0, StatSoft Inc. Results: Approach with general analysis indicated no difference between two methods. Despite of absence of clear differences between two groups we consider the closed rhinoplasty more favorable due to less damage to alar cartilages and no scars inside nostrils. Conclusions: We think that mentioned scarring may complicate secondary rhinoplasty, which is often needed to correct nose deformation. PMID:27563601

  14. MRI and Additive Manufacturing of Nasal Alar Constructs for Patient-specific Reconstruction.

    PubMed

    Visscher, Dafydd O; van Eijnatten, Maureen; Liberton, Niels P T J; Wolff, Jan; Hofman, Mark B M; Helder, Marco N; Don Griot, J Peter W; Zuijlen, Paul P M van

    2017-08-30

    Surgical reconstruction of cartilaginous defects remains a major challenge. In the current study, we aimed to identify an imaging strategy for the development of patient-specific constructs that aid in the reconstruction of nasal deformities. Magnetic Resonance Imaging (MRI) was performed on a human cadaver head to find the optimal MRI sequence for nasal cartilage. This sequence was subsequently used on a volunteer. Images of both were assessed by three independent researchers to determine measurement error and total segmentation time. Three dimensionally (3D) reconstructed alar cartilage was then additively manufactured. Validity was assessed by comparing manually segmented MR images to the gold standard (micro-CT). Manual segmentation allowed delineation of the nasal cartilages. Inter- and intra-observer agreement was acceptable in the cadaver (coefficient of variation 4.6-12.5%), but less in the volunteer (coefficient of variation 0.6-21.9%). Segmentation times did not differ between observers (cadaver P = 0.36; volunteer P = 0.6). The lateral crus of the alar cartilage was consistently identified by all observers, whereas part of the medial crus was consistently missed. This study suggests that MRI is a feasible imaging modality for the development of 3D alar constructs for patient-specific reconstruction.

  15. Paradox of mistranslation of serine for alanine caused by AlaRS recognition dilemma.

    PubMed

    Guo, Min; Chong, Yeeting E; Shapiro, Ryan; Beebe, Kirk; Yang, Xiang-Lei; Schimmel, Paul

    2009-12-10

    Mistranslation arising from confusion of serine for alanine by alanyl-tRNA synthetases (AlaRSs) has profound functional consequences. Throughout evolution, two editing checkpoints prevent disease-causing mistranslation from confusing glycine or serine for alanine at the active site of AlaRS. In both bacteria and mice, Ser poses a bigger challenge than Gly. One checkpoint is the AlaRS editing centre, and the other is from widely distributed AlaXps-free-standing, genome-encoded editing proteins that clear Ser-tRNA(Ala). The paradox of misincorporating both a smaller (glycine) and a larger (serine) amino acid suggests a deep conflict for nature-designed AlaRS. Here we show the chemical basis for this conflict. Nine crystal structures, together with kinetic and mutational analysis, provided snapshots of adenylate formation for each amino acid. An inherent dilemma is posed by constraints of a structural design that pins down the alpha-amino group of the bound amino acid by using an acidic residue. This design, dating back more than 3 billion years, creates a serendipitous interaction with the serine OH that is difficult to avoid. Apparently because no better architecture for the recognition of alanine could be found, the serine misactivation problem was solved through free-standing AlaXps, which appeared contemporaneously with early AlaRSs. The results reveal unconventional problems and solutions arising from the historical design of the protein synthesis machinery.

  16. Alar-columellar and lateral nostril changes following tongue-in-groove rhinoplasty.

    PubMed

    Shah, Ajul; Pfaff, Miles; Kinsman, Gianna; Steinbacher, Derek M

    2015-04-01

    Repositioning the medial crura cephalically onto the caudal septum (tongue-in-groove; TIG) allows alteration of the columella, ala, and nasal tip to address alar-columellar disproportion as seen from the lateral view. To date, quantitative analysis of nostril dimension, alar-columellar relationship, and nasal tip changes following the TIG rhinoplasty technique have not been described. The present study aims to evaluate post-operative lateral morphometric changes following TIG. Pre- and post-operative lateral views of a series of consecutive patients who underwent TIG rhinoplasty were produced from 3D images at multiple time points (≤2 weeks, 4-10 weeks, and >10 weeks post-operatively) for analysis. The 3D images were converted to 2D and set to scale. Exposed lateral nostril area, alar-columellar disproportion (divided into superior and inferior heights), nasolabial angle, nostril height, and nostril length were calculated and statistically analyzed using a pairwise t test. A P ≤ 0.05 was considered statistically significant. Ninety-four lateral views were analyzed from 20 patients (16 females; median age: 31.8). One patient had a history of current tobacco cigarette use. Lateral nostril area decreased at all time points post-operatively, in a statistically significant fashion. Alar-columellar disproportion was reduced following TIG at all time points. The nasolabial angle significantly increased post-operatively at ≤2 weeks, 4-10 weeks, and >10, all in a statistically significant fashion. Nostril height and nostril length decreased at all post-operative time points. Morphometric analysis reveals reduction in alar-columellar disproportion and lateral nostril shows following TIG rhinoplasty. Tip rotation, as a function of nasolabial angle, also increased. These results provide quantitative substantiation for qualitative descriptions attributed to the TIG technique. Future studies will focus on area and volumetric measurements, and assessment of long

  17. An Analysis of Lateral Crural Repositioning and Its Effect on Alar Rim Position.

    PubMed

    Paquet, Christian A; Choroomi, Sim; Frankel, Andrew S

    2016-01-01

    Cephalically malpositioned lateral crura are a frequent cause of alar rim retraction during both primary and revision rhinoplasty. To demonstrate the efficacy of lateral crural repositioning as an isolated maneuver as and combined with adjunctive grafts for lowering the alar rim. From August through December 2014, we retrospectively reviewed the cases of 54 patients (102 hemi-noses) who had lateral crural repositioning performed by the same surgeon between 2007 and 2013. Only patients with standardized photographs taken preoperatively and at least 6 months postoperatively were included in the study. All primary and revision cases were completed via an open rhinoplasty approach and had lateral crural repositioning performed. Preoperative and postoperative photographs were compared using Adobe Photoshop CS via a modified Gunter technique to measure the degree of alar rim retraction on lateral views. The change in angle was then calculated, and statistical analysis conducted using a paired t test. A total of 54 patients (102 hemi-noses) met inclusion criteria; 42 (79%) were women, and the average patient age was 41.3 years. Forty-five (83%) of the cases were revision rhinoplasties, and the average time to obtaining postoperative photographs was 11.3 months. The mean (SD) anterior nostril apex angles preoperatively (31.3° [8.9°]) and postoperatively (24.5° [6.8°]) indicated a net decrease of 6.8° (P < .001). Excluding patients who had other rim-lowering grafts (alar rim and/or composite grafts), we saw a similar result comparing preoperative (31.1° [8.2°]) and postoperative (24.5° [6.7°]) angles, with a net decrease of 6.6° degrees (P < .001). When examining patients who underwent lateral crural repositioning alone compared with those who also had lateral crural strut grafts, we saw a decrease of 6.9° (P < .001) and 6.7° degrees (P < .001), respectively. Repositioning of the lower lateral cartilages results in a statistically significant

  18. Microendoscopic posterior decompression for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum: a technical report.

    PubMed

    Baba, Satoshi; Oshima, Yasushi; Iwahori, Tomoyuki; Takano, Yuichi; Inanami, Hirohiko; Koga, Hisashi

    2016-06-01

    Ossification of the ligamentum flavum (OLF) is a common cause of progressive thoracic myelopathy in East Asia. Good surgical results are expected for patients who already show myelopathy. Surgical decompression using a posterior approach is commonly used to treat OLF. This study investigated the use of microendoscopic posterior decompression for the treatment of thoracic OLF. Microendoscopic posterior decompression was performed on 9 patients with myelopathy. Patients had a mean age of 59.8 years and single-level involvement, mostly at the T10-11 and T11-12 vertebrae. Computed tomography and magnetic resonance imaging were used to classify the OLF. A tubular retractor and endoscopic system were used for microendoscopic posterior decompression. Midline and unilateral paramedian approaches were performed in 2 and 7 patients, respectively. Intraoperative motor evoked potentials (MEPs) of 7 patients were monitored. Pre- and postoperative neurological status was evaluated using the modified Japanese Orthopaedic Association (mJOA) score. Thoracic OLF for all patients were classed as bilateral type with a round morphology. Improvement of MEPs at least one muscle area was recorded in all patients following posterior decompression. A dural tear in one patient was the only observed complication. The mean recovery rate was 44.9 %, as calculated from mJOA scores at a mean follow-up period of 20 months. Microendoscopic posterior decompression combined with MEP monitoring can be used to treat patients with thoracic OLF. The optimal surgical indication is OLF at a single vertebral level and of a unilateral or bilateral nature, without comma and tram track signs, and a round morphology.

  19. Atraumatic tears of the ligamentum teres are more frequent in professional ballet dancers than a sporting population.

    PubMed

    Mayes, Susan; Ferris, April-Rose; Smith, Peter; Garnham, Andrew; Cook, Jill

    2016-07-01

    To compare the frequency of atraumatic ligamentum teres (LT) tear in professional ballet dancers with that of athletes, and to determine the relationship with clinical and imaging findings. Forty-nine male and female professional ballet dancers (98 hips) and 49 age and sex-matched non-dancing athletes (98 hips) completed questionnaires on hip symptoms and physical activity levels, underwent hip rotation range of movement (ROM) and hypermobility testing, and 3.0-Tesla magnetic resonance imaging (3 T MRI) on both hips to detect LT tears, acetabular labral tears, and articular cartilage defects, and to measure the lateral centre edge angles (LCE). A higher frequency of LT tear was found in dancers (55 %) compared with athletes (22 %, P = 0.001). The frequency and severity of LT tears in dancers increased with older age (P = 0.004, P = 0.006, respectively). The Hip and Groin Outcome Score (HAGOS) pain scores or hip rotation ROM did not differ significantly among participants with normal, partial, or complete tears of LT (P > 0.01 for all). Neither the frequency of generalised joint hypermobility (P = 0.09) nor the LCE angles (P = 0.32, P = 0.16, left and right hips respectively) differed between those with and those without LT tear. In most hips, LT tear co-existed with either a labral tear or a cartilage defect, or both. The higher frequency of atraumatic LT tears in professional ballet dancers suggests that the LT might be abnormally loaded in ballet, and caution is required when evaluating MRI, as LT tears may be asymptomatic. A longitudinal study of this cohort is required to determine if LT tear predisposes the hip joint to osteoarthritis.

  20. Human Lumbar Ligamentum Flavum Anatomy for Epidural Anesthesia: Reviewing a 3D MR-Based Interactive Model and Postmortem Samples.

    PubMed

    Reina, Miguel A; Lirk, Philipp; Puigdellívol-Sánchez, Anna; Mavar, Marija; Prats-Galino, Alberto

    2016-03-01

    The ligamentum flavum (LF) forms the anatomic basis for the loss-of-resistance technique essential to the performance of epidural anesthesia. However, the LF presents considerable interindividual variability, including the possibility of midline gaps, which may influence the performance of epidural anesthesia. We devise a method to reconstruct the anatomy of the digitally LF based on magnetic resonance images to clarify the exact limits and edges of LF and its different thickness, depending on the area examined, while avoiding destructive methods, as well as the dissection processes. Anatomic cadaveric cross sections enabled us to visually check the definition of the edges along the entire LF and compare them using 3D image reconstruction methods. Reconstruction was performed in images obtained from 7 patients. Images from 1 patient were used as a basis for the 3D spinal anatomy tool. In parallel, axial cuts, 2 to 3 cm thick, were performed in lumbar spines of 4 frozen cadavers. This technique allowed us to identify the entire ligament and its exact limits, while avoiding alterations resulting from cutting processes or from preparation methods. The LF extended between the laminas of adjacent vertebrae at all vertebral levels of the patients examined, but midline gaps are regularly encountered. These anatomical variants were reproduced in a 3D portable document format. The major anatomical features of the LF were reproduced in the 3D model. Details of its structure and variations of thickness in successive sagittal and axial slides could be visualized. Gaps within LF previously studied in cadavers have been identified in our interactive 3D model, which may help to understand their nature, as well as possible implications for epidural techniques.

  1. The correction of alar-columella web deformities in unilateral cleft-lip nasal deformities with web graft technique.

    PubMed

    Go, Ju Young; Mun, Goo-Hyun; Bang, Sa Ik; Oh, Kap Sung; Lim, So Young

    2014-10-01

    Among the many secondary deformities in cleft-lip nose, the alar-columella web is unsightly and is a recurrent deformity. The purpose of this article is to revisit the correction of alar web deformity in patients with cleft-lip nasal deformities and to introduce our web graft technique. Thirteen patients with alar webbing underwent surgery between June 2012 and February 2013. The age range of the patients at the time of surgery was 14-29 years. An open rhinoplasty incision, including a reverse-U incision, was made and cartilage work was performed. After the cleft side was equalized with the dome angle of the healthy side, we used contralateral alar or auricular cartilage grafts as a stiff batten to stabilize the converted web skin. The web graft was fixed to the cleft-side web skin's inner side with at least three sutures to maintain the tucking of the vestibular skin. The follow-up period ranged from 1 to 20 months. The postoperative frontal and basal views showed that the nostrils and columella had better shape. Most patients demonstrated correction of the drooping alar rim and satisfactory symmetry of the nostrils. A web graft supports the vestibular lining of the reverse-U incision and increases the strength of the new concavity of the tucked skin. We expect that a long-lasting concave web contour could be achieved with this technique.

  2. Large Auricular Chondrocutaneous Composite Graft for Nasal Alar and Columellar Reconstruction

    PubMed Central

    Kwak, Minho; Yun, Sangho; Yeo, Hyeonjung; Kim, Junhyung; Han, Kihwan

    2012-01-01

    Background Among the various methods for correcting nasal deformity, the composite graft is suitable for the inner and outer reconstruction of the nose in a single stage. In this article, we present our technique for reconstructing the ala and columella using the auricular chondrocutaneous composite graft. Methods From 2004 to 2011, 15 cases of alar and 2 cases of columellar reconstruction employing the chondrocutaneous composite graft were studied, all followed up for 3 to 24 months (average, 13.5 months). All of the patients were reviewed retrospectively for the demographics, graft size, selection of the donor site and outcomes including morbidity and complications. Results The reasons for the deformity were burn scar (n=7), traumatic scar (n=4), smallpox scar (n=4), basal cell carcinoma defect (n=1), and scar contracture (n=1) from implant induced infection. In 5 cases of nostril stricture and 6 cases of alar defect and notching, composite grafts from the helix were used (8.9×12.5 mm). In 4 cases of retracted ala, grafts from the posterior surface of the concha were matched (5×15 mm). For the reconstruction of the columella, we harvested the graft from the posterior scapha (9×13.5 mm). Except one case with partial necrosis and delayed healing due to smoking, the grafts were successful in all of the cases and there was no deformity of the donor site. Conclusions An alar and columellar defect can be reconstructed successfully with a relatively large composite graft without donor site morbidity. The selection of the donor site should be individualized according to the 3-dimensional configuration of the defect. PMID:22872834

  3. Tissue engineering of human nasal alar cartilage precisely by using three-dimensional printing.

    PubMed

    Xu, Yihao; Fan, Fei; Kang, Ning; Wang, Sheng; You, Jianjun; Wang, Huan; Zhang, Bo

    2015-02-01

    Tissue engineering strategies hold promise for the restoration of damaged cartilage. However, the results of most studies report irregularly shaped beads of cartilage, which are not precise enough. Thus, a precise shape of cartilage graft must be taken into consideration. The goal of this study was to develop a simple method of creating a precisely predetermined nasal alar shape with the aid of three-dimensional printing. Lower lateral cartilage from cadavers was observed and scanned by computed tomography. Molds of the lower lateral cartilage were achieved by using three-dimensional printing. Human nasal cartilage was obtained and chondrocytes were harvested. Then, the mixture of cells and poly(glycolic acid)/poly-L-lactic acid was cultured in vitro and implanted into the subcutaneous tissue of nude mice. After subcutaneous implantation, the length and width of the samples were measured, and the results were not statistically significantly different from the native lower lateral cartilage (p > 0.05). Their thickness was measured and the results were statistically different from the native lower lateral cartilage (p < 0.05). Histologic examination of the engineered constructs revealed that both the cell and tissue morphologic features of engineered cartilage were similar to those of native lower lateral cartilage. The biomechanical properties of the engineered cartilage exceeded those of native cartilage. This study demonstrates that three-dimensional printing-aided tissue engineering can achieve precise three-dimensional shapes of human nasal alar cartilage. To our knowledge, this is the first reported creation of a precise nasal alar cartilage with a tissue-engineering strategy and three-dimensional printing technique.

  4. Securing aesthetic outcomes for composite grafts to alar margin and columellar defects: A long term experience.

    PubMed

    Ahuja, Rajeev B; Gupta, Rajat; Chatterjee, Pallab; Shrivastava, Prabhat

    2014-01-01

    Composite grafts for nasal reconstruction have been around for over a century but the opinion on its virtues and failings keeps vacillating with a huge difference on the safe size of the graft for transfer. Alar margin and columellar defects are more distinct than dorsal nasal defects in greater difficulty in ensuring a good aesthetic outcome. We report our series of 19 consecutive patients in whom a composite graft was used to reconstruct a defect of alar margin (8 patients), alar base (7 patients) or columella (4 patients). Patient ages ranged from 3-35 years with 5 males and 14 females. The grafts to alar margin and base ranged 0.6-1 cm in width, while grafts to columella were 0.7-1.2 cm. The maximum dimension of the graft in this series was 0.9 mm x 10 mm. Composite grafts were sculpted to be two layered (skin + cartilage), three layered wedges (skin + cartilage + skin) or their combination (two layered in a portion and three layered in another portion). All grafts were cooled in postoperative period for three days by applying an indigenous ice pack of surgical glove. The follow up ranged from 3-9 months with an average of 4.5 months. All of our 19 composite grafts survived completely but they all shrank by a small percentage of their bulk. Eleven patients rated the outcome between 90-95% improvement. We noticed that composite grafts tended to show varied pigmentation in our patients, akin to split skin grafts. In our opinion, most critical to graft survival is its size and the ratio of the marginal raw area to the graft bulk. We recommend that graft width should not exceed 1 cm to ensure complete survival even though larger sized grafts have been reported to survive. We recommend cooling of the graft and justify it on the analogy of 'warm ischemia time' for a replantation, especially in warmer climes like ours in India. We have outlined several considerations in the technique, with an analysis of differing opinions that should facilitate a surgeon in making an

  5. Securing aesthetic outcomes for composite grafts to alar margin and columellar defects: A long term experience

    PubMed Central

    Ahuja, Rajeev B.; Gupta, Rajat; Chatterjee, Pallab; Shrivastava, Prabhat

    2014-01-01

    Introduction: Composite grafts for nasal reconstruction have been around for over a century but the opinion on its virtues and failings keeps vacillating with a huge difference on the safe size of the graft for transfer. Alar margin and columellar defects are more distinct than dorsal nasal defects in greater difficulty in ensuring a good aesthetic outcome. We report our series of 19 consecutive patients in whom a composite graft was used to reconstruct a defect of alar margin (8 patients), alar base (7 patients) or columella (4 patients). Patients and Methods: Patient ages ranged from 3-35 years with 5 males and 14 females. The grafts to alar margin and base ranged 0.6-1 cm in width, while grafts to columella were 0.7-1.2 cm. The maximum dimension of the graft in this series was 0.9 mm x 10 mm. Composite grafts were sculpted to be two layered (skin + cartilage), three layered wedges (skin + cartilage + skin) or their combination (two layered in a portion and three layered in another portion). All grafts were cooled in postoperative period for three days by applying an indigenous ice pack of surgical glove. The follow up ranged from 3-9 months with an average of 4.5 months. Results: All of our 19 composite grafts survived completely but they all shrank by a small percentage of their bulk. Eleven patients rated the outcome between 90-95% improvement. We noticed that composite grafts tended to show varied pigmentation in our patients, akin to split skin grafts. Conclusion: In our opinion, most critical to graft survival is its size and the ratio of the marginal raw area to the graft bulk. We recommend that graft width should not exceed 1 cm to ensure complete survival even though larger sized grafts have been reported to survive. We recommend cooling of the graft and justify it on the analogy of ‘warm ischemia time’ for a replantation, especially in warmer climes like ours in India. We have outlined several considerations in the technique, with an analysis of

  6. Follow-up MR imaging of the alar and transverse ligaments after whiplash injury: a prospective controlled study.

    PubMed

    Vetti, N; Kråkenes, J; Ask, T; Erdal, K A; Torkildsen, M D N; Rørvik, J; Gilhus, N E; Espeland, A

    2011-01-01

    The cause and clinical relevance of upper neck ligament high signal intensity on MR imaging in WAD are controversial. The purpose of this study was to explore changes in the signal intensity of the alar and transverse ligaments during the first year after a whiplash injury. Dedicated high-resolution upper neck proton attenuation-weighted MR imaging was performed on 91 patients from an inception WAD1-2 cohort, both in the acute phase and 12 months after whiplash injury, and on 52 controls (noninjured patients with chronic neck pain). Two blinded radiologists independently graded alar and transverse ligament high signal intensity 0-3, compared initial and follow-up images to assess alterations in grading, and solved any disagreement in consensus. The Fisher exact test was used to compare proportions. Alar and transverse ligament grading was unchanged from the initial to the follow-up images. The only exceptions were 1 alar ligament changing from 0 to 1 and 1 ligament from 1 to 0. The prevalence of grades 2-3 high signal intensity in WAD was thus identical in the acute phase and after 12 months, and it did not differ from the prevalence in noninjured neck pain controls (alar ligaments 33.0% versus 46.2%, P = .151; transverse ligament 24.2% versus 23.1%, P = 1.000). Alar and transverse ligament high signal intensity in patients with WAD1-2 observed within the first year after injury cannot be explained by the trauma. Dedicated upper neck MR imaging cannot be recommended as a routine examination in these patients.

  7. Association of Skin Thickness With Alar Base Reduction in Patients Undergoing Lateral Crural Repositioning and Strut Grafting.

    PubMed

    Ilhan, A Emre; Sozen, Tevfik; Caypinar Eser, Basak; Cengiz, Betul

    2017-07-27

    Knowing the operation plan is important for rhinoplasty surgeons to prevent unpredictable results. To investigate the frequency of alar base resection in patients with different skin thickness who underwent lateral crural repositioning and lateral crural strut graft and to evaluate the results in the context of the current literature. This retrospective case series study included 621 patients who underwent primary open septorhinoplasty by the same surgeon between January 1, 2012, and June 30, 2015. From the surgical notes, operation type (lateral crural repositioning [LCrep] with lateral crural strut grafting [LCSG] and with or without alar base resection) and skin type were recorded. Study participants' skin types were determined intraoperatively and divided into 3 groups: (1) thick skin (the tip definition was limited by skin thickness and subcutaneous tissue), (2) thin skin (the tip cartilage was visible and could be observed despite overlying soft tissue and skin), and (3) normal skin (the tip cartilage during the procedure had no effect on the tip definition). Of the 621 patients in the study, 95 (15.3%) were men and 526 (84.7%) were women. Lateral crural repositioning with LCSG was performed in 319 surgical procedures (51.4%), and alar base reduction was performed in 329 (53.0%). The rate of alar base resection differed significantly on the basis of whether LCrep with LCSG was performed (odds ratio [OR], 1.82; 95% CI, 1.32-2.50; P < .001). In patients with thin skin, there was no significant difference in the incidence of alar base resection associated with LCrep with LCSG (OR, 2.034; 95% CI, 0.912-4.539; P = .08). In patients with thick skin, a significant difference in the frequency of alar base resection was associated with the application of LCrep with LCSG (OR, 1.995; 95% CI, 1.228-3.241; P = .005). In patients with normal skin, LCrep with LCSG had no significant association with the frequency of alar base resection (OR, 1.557; 95% CI, 0

  8. MicroRNA-221 Regulates Hypertrophy of Ligamentum Flavum in Lumbar Spinal Stenosis by Targeting TIMP-2.

    PubMed

    Xu, Yun-qiang; Zhang, Zhen-hui; Zheng, Yong-fa; Feng, Shi-qing

    2016-02-01

    A study of lumbar ligamentum flavum (LF). The aim of this study was to identify LF hypertrophy related microRNAs (miRNAs) expression profile and to investigate the role of miRNAs in the development of LF hypertrophy in lumbar spinal stenosis (LSS). Although histologic and biologic literature on LF hypertrophy is available, the pathomechanism is still unknown. Accumulating evidence suggests that microRNAs (miRNAs) participate in many physiologic processes, including cell proliferation, differentiation, and fibrosis, but the role of specific miRNAs involved in LF hypertrophy remains elusive. An initial screening of LF tissues miRNA expression by miRNA microarray was performed using samples from 10 patients and 10 controls, respectively. Subsequently, differential expression was validated using qRT-PCR. Then, functional analysis of the miRNAs in regulating collagens I and III expression was carried out. Western blotting and luciferase reporter assay were also used to detect the target gene. In addition, the thickness of the LF at the level of the facet joint was measured on axial T1-weighted magnetic resonance images. We identified 18 miRNAs that were differentially expressed in patients compared with controls. Following qRT-PCR confirmation, miR-221 was significantly lower in LF tissues of patients than controls. The LF was significantly thicker in patients than that in controls. Bioinformatics target prediction identified tissue inhibitors of matrix metalloproteinase (TIMP)-2 as a putative target of miR-221. Furthermore, luciferase reporter assays demonstrated that miR-221 directly targets TIMP-2 and affects the protein expression of TIMP-2 in fibroblasts isolated from LF. Of note, miR-221 mimic reduced mRNA and protein expression of collagens I and collagen III in fibroblasts isolated from LF. The downregulation of miR-221 might contribute to LF hypertrophy by promoting collagens I and III expression via the induction of TIMP-2. Our study also underscores the

  9. Rhinoplasty. The difficult nasal tip: total resection of the alar cartilages.

    PubMed

    Rodriguez-Camps, Salvador

    2009-01-01

    There are many ways to reconstruct and make nasal tips more attractive. Sometimes we cannot find the best way unless we at least remove all surplus from the tip. This may occur in primary or secondary rhinoplasty. In principle, anything is possible when relocating and reconstructing. However, sometimes we face reality when we uncover the tip: broken or bulging cartilages that are difficult to put right. For this reason, in 1987 we thought of totally resectioning the alar cartilages in a case of secondary rhinoplasty with an unsightly appearance. After a year the result was seen to be correct from an aesthetic and a functional perspective and is still so today. Aesthetically, it kept its shape and did not collapse with nasal respiratory failure. We covered the end of the crus medialis with a small, temporary, one- to two-layered fascia patch. Except in exceptional cases, we now use this procedure: Total sectioning of the alar cartilages including the domes, or maintenance of them by preserving the fibroadipose tip tissue with a suture in the middle of the end of the crus medialis and by covering this with temporary fascia, which usually has two layers depending on the thickness of the skin of the tip. This procedure is indicated mainly in secondary rhinoplasty when the cartilages of the tip are completely destroyed, and in primary rhinoplasty when the tip is excessively wide and bulbous. Our philosophy is, therefore, elegance and beauty of the nasal tip with a solid and equilateral base without prejudices.

  10. Postoperative alar base symmetry in complete unilateral cleft lip and palate:A prospective study.

    PubMed

    Vyloppilli, Suresh; Krishnakumar, K S; Sayd, Shermil; Latheef, Sameer; Narayanan, Saju V; Pati, Ajit

    2017-06-09

    In the evolution of cleft lip repair, there have been continuous attempts to minimize local trauma and to improve lip and nasal appearances. In order to obtain an aesthetically balanced development of midface, the primary surgical correction of the nasolabial area is of paramount importance. In this study, the importance of a back-cut extending cephalically above the inferior turbinate at the mucocutaneous junction which elevates the nostril floor on the cleft side for the purpose of achieving symmetry of the alar bases are analyzed by pre and postoperative photographic anthropometry. This study comprised of fifty cases of the unilateral complete cleft lip. At the time of surgery, the patient age ranged from 3-9 months. The surgeries, performed by a single surgeon, employed the standard Millard technique, incorporating Mohler modifications of lip repair. Anthropometric analysis revealed that the preoperative mean difference between the normal side and the cleft side was 0.2056 with a standard deviation of 0.133. In the postoperative analysis, the mean difference was reduced to 0.0174 with a standard deviation of 0.141. The paired t-test showed that the p-value is <0.001, indicating high statistical significance. To conclude, in complete unilateral cleft lip and palate, the geometrically placed nasal back-cut incision has a definite role in the correction of the alar base symmetry during primary surgery. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Functional results in airflow improvement using a "flip-flap" alar technique: our experience.

    PubMed

    Di Stadio, Arianna; Macro, Carlo

    2017-02-21

    Pinched nasal point can be arising as congenital malformation or as results of unsuccessfully surgery. The nasal valve alteration due to this problem is not only an esthetic problem but also a functional one because can modify the nasal airflow. Several surgical techniques were proposed in literature, we proposed our. The purpose of the study is the evaluation of nose airway flow using our flip-flap technique for correction of pinched nasal tip. This is a retrospective study conducted on twelve patients. Tip cartilages were remodeled by means of autologous alar cartilage grafting. The patients underwent a rhinomanometry pre and post-surgery to evaluate the results, and they performed a self-survey to evaluate their degree of satisfaction in term of airflow sensation improvement. Rhinomanometry showed improved nasal air flow (range from 25% to 75%) in all patients. No significant differences were showed between unilateral and bilateral alar malformation (p=0.49). Patient's satisfaction reached the 87.5%. Our analysis on the combined results (rhinomanometry and surveys) showed that this technique leads to improvement of nasal flow in patients affected by pinched nasal tip in all cases. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  12. Designing and Implementing Collaborative Improvement in the Extended Manufacturing Enterprise: Action Learning and Action Research (ALAR) in CO-IMPROVE

    ERIC Educational Resources Information Center

    Coghlan, David; Coughlan, Paul

    2006-01-01

    Purpose: The purpose of this article is to provide a design and implementation framework for ALAR (action learning action research) programme which aims to address collaborative improvement in the extended manufacturing enterprise. Design/methodology/approach: This article demonstrates the design of a programme in which action learning and action…

  13. Is Early Nasal Shaping With a Limited Alar Base Incision Possible in the Repair of Cleft Lips?

    PubMed

    Kapi, Emin; Bozkurt, Mehmet; Ozer, Torun; Celik, Mehmet Yusuf

    2016-05-01

    The repair of cleft lips has an important place in plastic and reconstructive surgery. In the treatment of these deformities, the aim was to restore the normal lip morphology in the cleft area as well as repairing any coexisting nasal deformities. Various methods are in use for this purpose. One of the most commonly employed surgical methods is Millard repair. However, this method may lead to additional scarring in the alar base on the cleft side subsequent to the incision. In this study, the results obtained from a group who have been applied alar base incisions during the modified Millard repair are compared to a group who have undergone intranasal wide dissections.The patients enrolled in the study were randomized into 2 groups. The first group were applied the modified Millard repair. In the second group, the rotation, advancement, and C-flaps were prepared according to Millard surgical repair technique; however, instead of an alar base and nasofacial groove incision on the cleft side, a nasal and maxillary supraperiosteal wide dissection was made through the incision in the mucosa of the nostril.The intranasal dissection performed during the study was observed to provide the targeted outcome and a more satisfactory cosmetic result through the modified Millard repair. In conclusion, the authors are of the opinion that the limited alar base incision and the wide supraperiosteal dissection performed in patients with cleft lips is an alternative method that can be employed in a wide range of patients.

  14. [Repair of middle and lower face scars using alar thin expanded cervical flap with pedicle in anterior neck].

    PubMed

    Xu, Lisi; Li, Yangqun; Tang, Yong; Chen, Wen; Yang, Zhe; Zhao, Muxin; Ma, Ning; Feng, Jun

    2014-04-01

    To explore the application of alar thin expanded cervical flap with pedicle in anterior neck for large scars on middle and lower face. From February 2000 to July 2013, 26 patients with scars on the middle and lower face were treated with the alar thin expanded cervical flaps with pedicle in anterior neck. After the skin of anterior neck was expanded by implanting skin expanders, alar thin expanded cervical flap with pedicle in anterior neck was obtained with size of 163-275 cm(2). Then the scars on the middle and lower face with the size of 135-196 cm(2) were excised, with the area of excision allowing full coverage of the expanded flap. The flap was rotated and advanced to the middle and lower face, and the incision was closed in layers. The 26 patients were followed up for 2 to 24 months. Twenty-one flaps survived, with good appearance and function. Four flaps showed venous retardation at distal part, and only one flap showed necrosis of the right edge. They were healed by free skin grafting. The alar thin expanded cervical flap not only makes maximum use of expanded flap on the premise of ensuring blood supply, but also guarantees good color, texture, and contour of face and neck.

  15. A Novel Approach for Full-Thickness Defect of the Nasal Alar Rim: Primary Closure of the Defect and Reduction of the Contralateral Normal Ala for Symmetry.

    PubMed

    Choe, Yun Seon; Kim, Min-Woo; Jo, Seong Jin

    2015-12-01

    In full-thickness defects of the nasal alar rim, to achieve projection and maintain airway patency, cartilage graft is frequently needed. However, cartilage graft presents a challenge in considerations such as appropriate donor site, skeletal shape and size, and healing of the donor area. To avoid these demerits, we tried primary closure of alar rim defects by also making the contralateral normal ala smaller. We treated two patients who had a full-thickness nasal alar defect after tumor excision. Cartilage graft was considered for the reconstruction. However, their alar rims were overly curved and their nostril openings were large. To utilize their nasal shape, we did primary closure of the defect rather than cartilage graft, and then downsized the contralateral nasal ala by means of wedge resection to make the alae symmetric. Both patients were satisfied with their aesthetic results, which showed a smaller nostril and nearly straight alar rims. Moreover, functionally, there was no discomfort during breathing in both patients. We propose our idea as one of the reconstruction options for nasal alar defects. It is a simple and easy-to-perform procedure, in addition to enhancing the nasal contour. This method would be useful for patients with a large nostril and an overly curved alar rim.

  16. The Wave Flap: A Single-Stage, Modified Nasal Sidewall Rotation Flap for the Repair of Defects Involving the Mid-Alar Groove.

    PubMed

    Bryan, Zachary T; Garrett, Algin B; Lavigne, Kerry; Trace, Anthony; Maher, Ian A

    2016-02-01

    Reconstruction of defects straddling the alar groove presents the dual challenges of resurfacing the nasal sidewall and alar subunits while simultaneously recreating the alar groove. The wave flap (WF) is a modified, medially based, nasal sidewall rotation flap that uses locally recruited tissue from the nasal sidewall to facilitate color and texture match and permit camouflage of scars. To detail a surgical repair for defects in the horizontally oriented middle third of the alar groove. This retrospective case series describes a technique for repair of defects involving the alar groove. Using postoperative photographs, outcomes were assessed by blinded noninvestigator dermatologist raters using the Observer Scar Assessment Scale. Between February 2012 and June 2013, 10 patients were reconstructed using a WF design. Subjective assessment of scar vascularity, pigment, pliability, relief, and thickness by 3 independent reviewers yielded an overall cosmesis score of 11.1 (out of 50). No complications were noted. The WF provides an excellent reconstructive option for Mohs defects of the middle third of the alar groove by recruiting local tissue and permitting maximum scar camouflage. A well-designed and executed WF provides cosmetically exceptional results for defects of the alar groove.

  17. A Novel Approach for Full-Thickness Defect of the Nasal Alar Rim: Primary Closure of the Defect and Reduction of the Contralateral Normal Ala for Symmetry

    PubMed Central

    Choe, Yun Seon; Kim, Min-Woo

    2015-01-01

    In full-thickness defects of the nasal alar rim, to achieve projection and maintain airway patency, cartilage graft is frequently needed. However, cartilage graft presents a challenge in considerations such as appropriate donor site, skeletal shape and size, and healing of the donor area. To avoid these demerits, we tried primary closure of alar rim defects by also making the contralateral normal ala smaller. We treated two patients who had a full-thickness nasal alar defect after tumor excision. Cartilage graft was considered for the reconstruction. However, their alar rims were overly curved and their nostril openings were large. To utilize their nasal shape, we did primary closure of the defect rather than cartilage graft, and then downsized the contralateral nasal ala by means of wedge resection to make the alae symmetric. Both patients were satisfied with their aesthetic results, which showed a smaller nostril and nearly straight alar rims. Moreover, functionally, there was no discomfort during breathing in both patients. We propose our idea as one of the reconstruction options for nasal alar defects. It is a simple and easy-to-perform procedure, in addition to enhancing the nasal contour. This method would be useful for patients with a large nostril and an overly curved alar rim. PMID:26719646

  18. Fractional photothermolysis improves a depressed alar scar following Mohs micrographic surgery.

    PubMed

    Schulz, Kimberly K; Walling, Hobart W

    2010-01-01

    Fractional photothermolysis (FPT; Fraxel SR laser) is a 1550 nm non-ablative erbium laser device with a variety of clinical applications. FPT has been used to treat photodamage, photoaging, melasma, actinic keratoses and acne scarring. We present the case of a 49-year-old woman with a depressed 0.7 x 0.5 cm alar scar resulting from Mohs micrographic surgery for basal cell carcinoma with secondary intention healing. She was treated with FPT initially eight weeks post-operatively. FPT was performed a total of five times at four-week intervals. At the completion of FPT, the scar was nearly imperceptible and has remained so eighteen months later. To the authors' knowledge, treatment of facial scars resulting from Mohs micrographic surgery for cutaneous malignancy has not previously been reported.

  19. S2 Alar-iliac Fixation: A Powerful Procedure for the Treatment of Kyphoscoliosis.

    PubMed

    Liu, Zhen; Qiu, Yong; Yan, Huang; Hu, Zong-shan; Zhu, Feng; Qiao, Jun; Xu, Lei-lei; Wang, Bin; Yu, Yang; Qian, Bang-ping; Zhu, Ze-zhang

    2016-02-01

    The purpose of this study was to introduce a powerful technique for the treatment of kyphoscoliosis. There are currently multiple techniques for sacropelvic fixation, including trans-iliac bars and iliac and iliosacral screws. Several studies have documented the use of these instrumentation techniques; however, a ubiquitous problematic issue concerns the need for separate incisions for the use of offset connectors, which add to surgical time and morbidity. Any additional dissection of the skin, subcutaneous tissue or muscle in this area is believed to increase the incidence of complications of wound healing. However, as stated above, the above-mentioned techniques require separate incisions for the use of offset connectors, which add to surgical time and morbidity. The novel technique of S2 alar-iliac (S2AI) pelvic fixation has been developed to address some of these issues. However, a technique for achieving correction of kyphoscoliosis with pelvic obliquity in adult patients with spinal deformity has not previously been described. Our entry point is based on the S1 foramen and is typically up to 5 mm caudal and 2 to 3 mm lateral to that foramen. Once the S1 foramen has been identified, a blunt instrument can be used to probe the alar ridge. The screw trajectory is 40°-50° from horizontal and 20°-30° caudal, aimed toward the greater trochanter and rostral to the sciatic notch. A 36-year-old female patient presented with a 3-year history of low back pain, and progressive thoracolumbar kyphoscoliosis. In this typical case, we performed S2AI fixation with transforaminal lumbar interbody fusion and hemivertebra resection technique to treat her lumbosacral kyphoscoliosis. Satisfactory improvement in her preoperative lumbar kyphoscoliosis was found at 3-month follow-up. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  20. Arthroscopic lateral acromion resection (ALAR) optimizes rotator cuff tear relevant scapula parameters.

    PubMed

    Altintas, Burak; Kääb, Max; Greiner, Stefan

    2016-06-01

    The acromion index (AI), critical shoulder angle (CSA) and lateral acromion angle (LAA) are predictive for degenerative rotatory cuff tears. Their unfavorable values are associated with a suboptimal deltoid force vector. The aim of this study was to evaluate whether an optimization of the radiological parameters could be achieved through a specific arthroscopic lateral acromion resection (ALAR). The procedure was performed in eight fresh frozen cadaver shoulders. True a.p. and axial radiographs were taken before and after the intervention for radiological evaluation. The anterior and posterior acromion edges were marked with a spinal needle. Then 1 cm of the lateral acromion was resected with a 5.0 acromionizer (Arthrex Inc., Naples, FL, USA) beginning from the anterior aspect. The resection was completed over the total width of 1 cm from anterior to posterior. Finally the deltoid insertion was dissected via an open approach to ensure its integrity. The fluoroscopy images were evaluated regarding the pre- and postinterventional parameters AI, CSA and LAA. After the intervention, the mean AI could be significantly reduced from 0.62 ± 0.11 to 0.40 ± 0.15 (p = 0.012). Also the mean CSA was significantly reduced from 35.0° ± 7.65° to 25.12° ± 8.29° (p = 0.018). The LAA could not be significantly changed (76.5° ± 14.02° vs. 82.13 ± 8.93; p = 0.107). There was no injury to the deltoid insertion. The radiographic parameters AI und CSA can be optimized significantly by ALAR without macroscopic discontinuity of the deltoid insertion. Level IV, case series without comparison group.

  1. Toward less misleading comparisons of uncertain risks: the example of aflatoxin and alar.

    PubMed Central

    Finkel, A M

    1995-01-01

    Critics of comparative risk assessment (CRA), the increasingly common practice of juxtaposing disparate risks for the purpose of declaring which one is the "larger" or the "more important," have long focused their concern on the difficulties in accommodating the qualitative differences among risks. To be sure, people may disagree vehemently about whether "larger" necessarily implies "more serious," but the attention to this aspect of CRA presupposes that science can in fact discern which of two risks has the larger statistical magnitude. This assumption, encouraged by the indiscriminate calculation of risk ratios using arbitrary point estimates, is often incorrect: the fact that environmental and health risks differ in unknown quantitative respects is at least as important a caution to CRA as the fact that risks differ in known qualitative ways. To show how misleading CRA can be when uncertainty is ignored, this article revisits the claim that aflatoxin contamination of peanut butter was "18 times worse" than Alar contamination of apple juice. Using Monte Carlo simulation, the number 18 is shown to lie within a distribution of plausible risk ratios that ranges from nearly 400:1 in favor of aflatoxin to nearly 40:1 in the opposite direction. The analysis also shows that the "best estimates" of the relative risk of aflatoxin to Alar are much closer to 1:1 than to 18:1. The implications of these findings for risk communication and individual and societal decision-making are discussed, with an eye toward improving the general practice of CRA while acknowledging that its outputs are uncertain, rather than abandoning it for the wrong reasons. Images Figure 1. Figure 2. PMID:7607139

  2. Subcutaneous C Shape Muscular Flap for Correcting the Depression of Alar Base in Affected Side in Patients With Unilateral Complete Cleft Lip/Palate During Primary Surgery.

    PubMed

    Wu, Dandan; Wang, Guomin; Ouyang, Ningjuan; Lin, Yuhen; Chen, Yang; Dai, Jiewen

    2017-06-01

    The depression of alar base in affected side in patients with unilateral complete cleft lip/palate (CL/P) is one of common clinical features. In this study, the authors try to explore the effect of subcutaneous C shape muscular flap for correcting the depression of alar base in affected side in patients with unilateral complete CL/P during primary surgery. A total of 30 patients with unilateral complete CL/P who received primary correction of the lip nose deformity were included in this study. The C flap was used to drop and lengthen the height of upper lip in unaffected side, and the subcutaneous muscular flap was dissected from the C flap and positioned at the alar base in the affected side of upper lip to correct the depression. Then the surgical effect was evaluated based on clinical examination during follow-up. Alar base symmetry was obtained in 26 patients of this case series, and 4 patients showed slight improvement in alar base symmetry. No major complications such as flap necrosis, infection, or hypertrophic scars were observed during surgery and follow-up. No additional incisions and operative time were necessary. The subcutaneous C shape muscular flap described in this article could offer enough muscular support and markedly correct the depression of nostril and alar base in affected side in primary lip nose repair with no additional incisions and operative time for patients with unilateral complete CL/P.

  3. Feasibility, repeatability, and safety of ultrasound-guided stimulation of the first cervical nerve at the alar foramen in horses.

    PubMed

    Mespoulhès-Rivière, Céline; Brandenberger, Olivier; Rossignol, Fabrice; Robert, Céline; Perkins, Justin D; Marie, Jean-Paul; Ducharme, Norm

    2016-11-01

    OBJECTIVE To develop and assess the feasibility, repeatability, and safety of an ultrasound-guided technique to stimulate the first cervical nerve (FCN) at the level of the alar foramen of the atlas of horses. ANIMALS 4 equine cadavers and 6 clinically normal Standardbreds. PROCEDURES In each cadaver, the FCN pathway was determined by dissection, and any anastomosis between the first and second cervical nerves was identified. Subsequently, each of 6 live horses underwent a bilateral ultrasound-guided stimulation of the FCN at the alar foramen 3 times at 3-week intervals. After each procedure, horses were examined daily for 5 days. RESULTS In each cadaver, the FCN passed through the alar foramen; a communicating branch between the FCN and the accessory nerve and anastomoses between the ventral branches of the FCN and second cervical nerve were identified. The anastomoses were located in the upper third of the FCN pathway between the wing of the atlas and the nerve's entry in the omohyoideus muscle. Successful ultrasound-guided electrical stimulation was confirmed by twitching of the ipsilateral omohyoideus muscle in all 6 live horses; this finding was observed bilaterally during each of the 3 experimental sessions. No complications developed at the site of stimulation. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that ultrasound-guided stimulation of the FCN at the alar foramen appears to be a safe and straightforward procedure in horses. The procedure may have potential for use in horses with naturally occurring recurrent laryngeal neuropathy to assess reinnervation after FCN transplantation or nerve-muscle pedicle implantation in the cricoarytenoideus dorsalis muscle.

  4. Do the gaps in the ligamentum flavum in the cervical spine translate into dural punctures? An analysis of 4,396 fluoroscopic interlaminar epidural injections.

    PubMed

    Manchikanti, Laxmaiah; Malla, Yogesh; Cash, Kimberly A; Pampati, Vidyasagar

    2015-01-01

    Cervical interlaminar epidural injections are performed frequently in managing chronic neck and upper extremity pain, although less commonly than lumbar interlaminar epidural injections. Recently, the US Food and Drug Administration warnings and safeguards to prevent neurologic complications. These were developed by the Multi-Society Pain Workgroup have taken center stage for all types of epidural injections, including cervical interlaminar epidural injections. The recommendations of safeguards to prevent neurologic complications after epidural steroid injections include that cervical interlaminar epidural injections must be performed utilizing fluoroscopy with anteroposterior, lateral, or oblique views with injection of contrast medium and that entry be limited to the C7-T1 epidural space or occasionally the C6-C7 with requirements for magnetic resonance imaging assessment of the epidural space. To assess the incidence of dural puncture associated with fluoroscopically directed cervical interlaminar epidural injections. A retrospective assessment of patients undergoing cervical interlaminar epidural injections from January 2013 through February 2015. A private interventional pain management practice; a specialty referral center in the United States. The data were collected for 4,396 consecutive cervical interlaminar epidural injections performed from January 2013 through February 2015. The procedures were all performed under fluoroscopic visualization under posteroanterior view with contrast medium injection with lateral view confirmation when indicated. The procedures were performed by one of 2 physicians; the dural puncture and subsequent postoperative complications with level of epidural entry were determined. The outcome was assessment of dural puncture. A review of multiple manuscripts showed that defects in the ligamentum flavum may extend to as much as 100% of the population. However, it also has been shown that among the levels with a gap, the location of

  5. Full-Thickness Entire Nasal Alar Reconstruction Using a Forehead Flap in Asians: No Cartilaginous Infrastructural Lining Is Necessary.

    PubMed

    Funayama, Emi; Yamamoto, Yuhei; Furukawa, Hiroshi; Murao, Naoki; Shichinohe, Ryuji; Yamao, Takeshi; Hayashi, Toshihiko; Oyama, Akihiko

    2017-05-01

    Full-thickness defects of the entire nasal ala, including the rim, can be challenging to reconstruct. A forehead flap may provide a more imperceptible and natural-appearing reconstructed nasal ala. Previously, many authors have insisted adding cartilaginous infrastructural support for an entire, full-thickness defect to keep the postoperative alar structure symmetrical. They finally use a forehead flap after thinning of the distal covering portion subcutaneously, possibly for a Caucasian-type nasal ala. However, Asian skin has a thicker and more compact dermis than that of Caucasian skin, and the Asian ala is rounder and thicker. There may be another approach for an Asian-type nasal ala. The authors propose the possibility of nasal alar reconstruction for an entire, full-thickness defect in Asians using a forehead flap without structural support. Six patients with entire full-thickness nasal alar defects treated with full-thickness forehead flaps above the periosteum without structural support were reviewed. Five patients demonstrated esthetically good to excellent outcomes in color, texture, and symmetry. Their nasal linings were reconstructed using mucoperiosteal flaps or mucosal grafts. One patient treated with a nasal lining using a local flap showed a fair result esthetically. Asians forehead above the periosteum has adequate thickness and supportability to reconstruct the entire full-thickness nasal ala in Asians. No cartilage support is necessary.

  6. Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders: a meta-analysis of case-control studies.

    PubMed

    Li, Quan; Shen, Hongxing; Li, Ming

    2013-01-01

    Hypothesis that loss of integrity of the membranes in the craniocervical junction might be the cause of neck pain in patients with whiplash-associated disorders (WADs) has been proposed. In recent years, with development of more detailed magnetic resonance imaging (MRI) techniques, morphologic changes of the ligaments and membranes in the craniocervical junction, especially alar and transverse ligaments have been discussed. A meta-analysis was performed to evaluate the relationship of MRI signal changes of alar and transverse ligaments and WADs. A systematic search of EMBASE, PUBMED, and Cochrane Library and references from eligible articles were conducted. Comparative studies reporting on evaluating the relationship between MRI high-signal changes of alar and transverse ligaments and WADs were regarded eligible. A pooled estimate of effect size was produced. Alar ligaments: Six studies (total n = 622) were included. MRI signal changes of alar ligaments did not appear to be related with WADs (P = 0.20, OR = 1.54, 95 % CI = 0.80-2.94). Heterogeneity was present (I (2) = 46 %, P = 0.10), which was eliminated upon sensitivity analysis bringing the OR to 1.27 (95 % CI = 0.87-1.86, I (2) = 0 %). Transverse ligaments: Four studies (total n = 489) were included. MRI signal changes of transverse ligament did not appear to be related with WADs (P = 0.51, OR = 1.44, 95 % CI = 0.49-4.21). Heterogeneity was present (I (2) = 77 %, P = 0.005), which was eliminated upon sensitivity analysis bringing the OR to 0.79 (95 % CI = 0.49-1.28, I (2) = 0 %). MRI signal changes of alar and transverse ligaments are not supposed to be caused by whiplash injury, and MRI examination of alar and transverse ligaments should not be used as the routine workup of patients with WADs.

  7. A novel approach to navigated implantation of S-2 alar iliac screws using inertial measurement units.

    PubMed

    Jost, Gregory F; Walti, Jonas; Mariani, Luigi; Cattin, Philippe

    2016-03-01

    The authors report on a novel method of intraoperative navigation with inertial measurement units (IMUs) for implantation of S-2 alar iliac (S2AI) screws in sacropelvic fixation of the human spine and its application in cadaveric specimens. Screw trajectories were planned on a multiplanar reconstruction of the preoperative CT scan. The pedicle finder and screwdriver were equipped with IMUs to guide the axial and sagittal tilt angles of the planned trajectory, and navigation software was developed. The entry points were chosen according to anatomical landmarks on the exposed spine. After referencing, the sagittal and axial orientation of the pedicle finder and screwdriver were wirelessly monitored on a computer screen and aligned with the preoperatively planned tilt angles to implant the S2AI screws. The technique was performed without any intraoperative imaging. Screw positions were analyzed on postoperative CT scans. Seventeen of 18 screws showed a good S2AI screw trajectory. Compared with the postoperatively measured tilt angles of the S2AI screws, the IMU readings on the screwdriver were within an axial plane deviation of 0° to 5° in 15 (83%) and 6° to 10° in 2 (11%) of the screws and within a sagittal plane deviation of 0° to 5° in 15 (83%) and 6° to 10° in 3 (17%) of the screws. IMU-based intraoperative navigation may facilitate accurate placement of S2AI screws.

  8. Ossification of the cervical ligamentum flavum and osseous brown tumor: late manifestations of primary hyperparathyroidism misdiagnosed in a case of parathyroid carcinoma

    PubMed Central

    Sampanis, Nikolaos; Gavriilaki, Eleni; Paschou, Eleni; Kalaitzoglou, Asterios; Vasileiou, Sotirios

    2016-01-01

    Summary Parathyroid carcinoma represents an extremely rare neoplasm with diverse clinical manifestations. Herein we aimed at presenting an unique case of a young patient with late manifestations of parathyroid cancer and reviewing the relevant literature. A 45-year-old male patient presented in the Outpatient Clinic with an episode of nephrolithiasis. His personal medical history includes: recurrent episodes of nephrolithiasis, laminectomy in the cervical spine due to ossification of the cervical ligamentum flavum and surgical resection of a giant cell tumor of the brain. Laboratory testing revealed findings of primary hyperparathyroidism (serum calcium 16,0 mmol/l phosphorus 1,46 mg/dl and parathyroid hormone/PTH 8560 pg/ml). Neck ultrasound and technetium-99 m sestamibi scan were performed showing a parathyroid tumor. Due to the persistently high serum calcium and PTH levels, the high alkaline phosphatase levels (440 IU/L) and the late manifestations of HPT, surgical excision of the tumor was performed. The tumor was identified as parathyroid carcinoma. Immediately after surgery serum calcium and phosphorus levels were normalized. The patient is on a regular follow-up program with no signs of recurrence or metastasis one year after the excision. We describe the coexistence of rare late manifestations of HPT, which had not been adequately investigated at their onset in this young patient. Therefore, increased awareness is needed in order to recognize and further investigate signs or symptoms of HPT. PMID:27252748

  9. Fetal development of the transverse atlantis and alar ligaments at the craniovertebral junction.

    PubMed

    Abe, Hiroshi; Ishizawa, Akimitsu; Cho, Kwang Ho; Suzuki, Ryoji; Fujimiya, Mineko; Rodríguez-Vázquez, Jose Francisco; Murakami, Gen

    2012-09-01

    Although the fetal development of the craniovertebral junction has long been of major interest to embryologists from the viewpoint of segmentation, development of the associated ligaments has received scant attention. Using semiserial horizontal sections from 18 embryos and fetuses (six embryos with a crown-rump length (CRL) of 20-26 mm or ~6-7 weeks of gestation; five fetuses with a CRL of 32-58 mm or 8-9 weeks; seven fetuses with a CRL of 90-115 mm or 14-15 weeks) without any abnormalities of cartilage configuration such as atlas assimilation, we studied the ligamentous structures along and around the odontoid process of the axis. The transverse atlantis and alar ligaments originated from a common mesenchymal condensation possibly corresponding to the proatlas segment: the former started to develop slightly earlier than the latter, and the morphologies of both were established at 7 weeks of gestation. Development of the joint cavitation around the odontoid process began in the mid-anterior area at 6 weeks, but was not fully completed even at 15 weeks (115 mm CRL). The presumptive joint cavity expressed vimentin and CD34 and contained abundant CD68-positive macrophages. We always found a mid-anterior joint cavitation facing the basi-occipital, but the embryological meaning remained unclear. The apical ligament appeared most likely to originate from the notochord sheath. The notochord was exposed from the tip of the odontoid process toward the loose epidural tissue and entered the occipital bone, but was difficult to trace to the anterior surface of the basi-occipital. Copyright © 2011 Wiley Periodicals, Inc.

  10. Are MRI high-signal changes of alar and transverse ligaments in acute whiplash injury related to outcome?

    PubMed Central

    2010-01-01

    Background Upper neck ligament high-signal changes on magnetic resonance imaging (MRI) have been found in patients with whiplash-associated disorders (WAD) but also in non-injured controls. The clinical relevance of such changes is controversial. Their prognostic role has never been evaluated. The purpose of this study was to examine if alar and transverse ligament high-signal changes on MRI immediately following the car accident are related to outcome after 12 months for patients with acute WAD grades 1-2. Methods Within 13 days after a car accident, 114 consecutive acute WAD1-2 patients without prior neck injury or prior neck problems underwent upper neck high-resolution proton-weighted MRI. High-signal changes of the alar and transverse ligaments were graded 0-3. A questionnaire including the impact of event scale for measuring posttraumatic stress response and questions on patients' expectations of recovery provided clinical data at injury. At 12 months follow-up, 111 (97.4%) patients completed the Neck Disability Index (NDI) and an 11-point numeric rating scale (NRS-11) on last week neck pain intensity. Factors potentially related to these outcomes were assessed using multiple logistic regression analyses. Results Among the 111 responders (median age 29.8 years; 63 women), 38 (34.2%) had grades 2-3 alar ligament changes and 25 (22.5%) had grades 2-3 transverse ligament changes at injury. At 12 months follow-up, 49 (44.1%) reported disability (NDI > 8) and 23 (20.7%) neck pain (NRS-11 > 4). Grades 2-3 ligament changes in the acute phase were not related to disability or neck pain at 12 months. More severe posttraumatic stress response increased the odds for disability (odds ratio 1.46 per 10 points on the impact of event scale, p = 0.007) and so did low expectations of recovery (odds ratio 4.66, p = 0.005). Conclusions High-signal changes of the alar and transverse ligaments close after injury did not affect outcome for acute WAD1-2 patients without previous

  11. Keystone Perforator Island Flap as an Alternative Reconstructive Option for Partial Thickness Alar Defects Up to 1.5 Centimeters.

    PubMed

    Kostopoulos, Epameinondas; Agiannidis, Christos; Konofaos, Petros; Kotsakis, Ioannis; Champsas, Grigorios; Frangoulis, Marios; Papadopoulos, Othon; Casoli, Vincent

    2016-07-01

    The ala is a unique landmark of the nose disposing aesthetic and functional properties. The head and neck area is the main site of appearance of nonmelanoma skin cancer. One third of them are located in the nose with an alar preponderance compared with other nasal subunits. Correction of alar defects is a challenging reconstructive task. The keystone perforator island flap (KPIF) was introduced as an alternative in nasal reconstruction by senior authors. In the present case series, KPIFs' application is introduced into the alar subunit as an alternative, versatile, and reproducible reconstructive option, even for the novice plastic surgeon. From April 2014 to September 2015, patients presenting with partial thickness alar defects (≤1.5 cm) secondary to tumor extirpation sustained reconstruction with different types of KPIF. A total of 31 patients (mean age of 72 years) were treated with various types of KPIF. The mean diameter of the defect was 1.14 cm. The vast majority of reconstructions concerned a type IV KPIF (18/31 or 58.1%). Sometimes an upward alar retraction was noted. A minimal rim wedge excision was performed (≤0.3 mm) using counterbalancing correcting sutures. All flaps survived without any sign of venous congestion, whereas the rim healed uneventfully. The mean follow-up period was 6.5 months. KPIF was introduced as a single-stage alternative reconstructive option for partial thickness alar defects, completing author's experience with this flap into such a challenging and aesthetically critical anatomic area.

  12. The sudden death of Alaric I (c. 370-410AD), the vanquisher of Rome: A tale of malaria and lacking immunity.

    PubMed

    Galassi, Francesco M; Bianucci, Raffaella; Gorini, Giacomo; Paganotti, Giacomo M; Habicht, Michael E; Rühli, Frank J

    2016-06-01

    Alaric I (c. 370-410AD), King of the Visigoths, sacked Rome for the second time in over eight centuries of history. Historians suggest that malaria, probably contracted either in Rome or in the Pontine Marshes, was responsible for his sudden death in Cosenza (Calabria) in the autumn of 410AD, where he was allegedly buried in the River Busento. In this article, we aim to examine this hypothesis through a full pathographic reassessment of the most likely cause of Alaric's demise. To achieve this, we resorted to a dual philological-medical approach: clinical likelihood and malaria seasonality coupled with primary historical sources (mainly Jordanes' work De origine actibusque Getarum) and the reconstruction of the itineraries followed by Alaric and his army after the sack of Rome. Sudden death is caused by several factors. The possibility that Alaric died of a cardiovascular disease was discarded since no description of potentially pathological signs emerged from the available sources. Given his lack of semi-immunity, falciparum malaria was considered as the most likely cause of his demise. It took him over two months to reach the coasts of Calabria during the peak of malaria's transmission (summer-autumn). During the march, Alaric did not suffer from recurrent fevers or other ailments, which would have been reported by historians. The scenario emerging from this multidisciplinary reanalysis allows us to hypothesise that Plasmodium falciparum malaria, contracted during his journey through Calabria, was the most likely candidate responsible for Alaric's unexpected demise. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  13. The Clinical Significance of Ossification of Ligamentum Nuchae in Simple Lateral Radiograph : A Correlation with Cervical Ossification of Posterior Longitudinal Ligament

    PubMed Central

    Kim, Duk-Gyu; Eun, Jong-Pil

    2015-01-01

    Objective Ossification of the ligamentum nuchae (OLN) is usually asymptomatic and incidentally observed in cervical lateral radiographs. Previous literatures reported the correlation between OLN and cervical spondylosis. The purpose of this study was to elucidate the clinical significance of OLN with relation to cervical ossification of posterior longitudinal ligament (OPLL). Methods We retrospectively compared the prevalence of OPLL in 105 patients with OLN and without OLN and compared the prevalence of OLN in 105 patients with OPLL and without OPLL. We also analyzed the relationship between the morphology of OLN and involved OPLL level. The OPLL level was classified as short (1-3) or long (4-6), and the morphologic subtype of OLN was categorized as round, rod, or segmented. Results The prevalence of OPLL was significantly higher in the patients with OLN (64.7%) than without OLN (16.1%) (p=0.0001). And the prevalence of OLN was also higher in the patients with OPLL (54.2%) than without OPLL (29.5%) (p=0.0002). In patients with round type OLN, 5 of 26 (19.2%) showed long level OPLL, while in patients with larger type (rod and segmented) OLN, 22 of 42 (52.3%) showed long level OPLL (p=0.01). Conclusion There was significant relationship between OLN and OPLL prevalence. This correlation indicates that there might be common systemic causes as well as mechanical causes in the formation of OPLL and OLN. The incidentally detected OLN in cervical lateral radiograph, especially larger type, might be helpful to predict the possibility of cervical OPLL. PMID:26713144

  14. Analysis of the Relationship between Ligamentum Flavum Thickening and Lumbar Segmental Instability, Disc Degeneration, and Facet Joint Osteoarthritis in Lumbar Spinal Stenosis

    PubMed Central

    Yoshiiwa, Toyomi; Notani, Naoki; Ishihara, Toshinobu; Kawano, Masanori; Tsumura, Hiroshi

    2016-01-01

    Study Design Cross-sectional study. Purpose To investigate the relationship between ligamentum flavum (LF) thickening and lumbar segmental instability and disc degeneration and facet joint osteoarthritis. Overview of Literature Posterior spinal structures, including LF thickness, play a major role in lumbar spinal canal stenosis pathogenesis. The cause of LF thickening is multifactorial and includes activity level, age, and mechanical stress. LF thickening pathogenesis is unknown. Methods We examined 419 patients who underwent computed tomography (CT) myelography and magnetic resonance imaging after complaints of clinical symptoms. To investigate LF hypertrophy, 57 patients whose lumbar vertebra had normal disc heights at L4–5 were selected to exclude LF buckling as a hypertrophy component. LF thickness, disc space widening angulation in flexion, segmental angulation, presence of a vacuum phenomenon, and lumbar lordosis at T12–S1 were investigated. Disc and facet degeneration were also evaluated. Facet joint orientation was measured via an axial CT scan. Results The mean LF thickness in all patients was 4.4±1.0 mm at L4–5. There was a significant correlation between LF thickness and disc degeneration; LF thickness significantly increased with severe disc degeneration and facet joint osteoarthritis. There was a tendency toward increased LF thickness in more sagittalized facet joints than in coronalized facet joints. Logistic regression analysis showed that LF thickening was influenced by segmental angulation and facet joint osteoarthritis. Patient age was associated with LF thickening. Conclusions LF hypertrophy development was associated with segmental instability and severe disc degeneration, severe facet joint osteoarthritis, and a sagittalized facet joint orientation. PMID:27994791

  15. Semi-Circumferential Decompression: Microsurgical Total en-bloc Ligamentum Flavectomy to Treat Lumbar Spinal Stenosis with Grade I Degenerative Spondylolisthesis

    PubMed Central

    Choi, Jun Cheol; Oh, Sang Hun; Park, Sub Ri; Park, Sang Jun; Cho, Nam Ik

    2015-01-01

    Background To describe and assess clinical outcomes of the semi-circumferential decompression technique for microsurgical en-bloc total ligamentum flavectomy with preservation of the facet joint to treat the patients who have a lumbar spinal stenosis with degenerative spondylolisthesis. Methods We retrospectively analyzed the clinical and radiologic outcomes of 19 patients who have a spinal stenosis with Meyerding grade I degenerative spondylolisthesis. They were treated using the "semi-circumferential decompression" method. We evaluated improvements in back and radiating pain using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). We also evaluated occurrence of spinal instability on radiological exam using percentage slip and slip angle. Results The mean VAS score for back pain decreased significantly from 6.3 to 4.3, although some patients had residual back pain. The mean VAS for radiating pain decreased significantly from 8.3 to 2.5. The ODI score improved significantly from 25.3 preoperatively to 10.8 postoperatively. No significant change in percentage slip was observed (10% preoperatively vs. 12.2% at the last follow-up). The dynamic percentage slip (gap in percentage slip between flexion and extension X-ray exams) did not change significantly (5.2% vs. 5.8%). Slip angle and dynamic slip angle did not change (3.2° and 8.2° vs. 3.6° and 9.2°, respectively). Conclusions The results suggested that semi-circumferential decompression is a clinically recommendable procedure that can improve pain. This procedure does not cause spinal instability when treating patients who have a spinal stenosis with degenerative spondylolisthesis. PMID:26640630

  16. Prevalence, Distribution, and Significance of Incidental Thoracic Ossification of the Ligamentum Flavum in Korean Patients with Back or Leg Pain : MR-Based Cross Sectional Study

    PubMed Central

    Moon, Bong Ju; Kuh, Sung Uk; Kim, Sungjun; Kim, Keun Su; Cho, Yong Eun

    2015-01-01

    Objective Thoracic ossification of the ligamentum flavum (OLF) is a relatively rare disease. Because of ambiguous clinical symptom, it is difficult for early diagnosis of OLF and subsequent treatment can be delayed or missed. Therefore, the purpose of this study is to comprehensively assess the prevalence and distribution of thoracic OLF by magnetic resonance imaging (MRI) and coexisting spinal disease in Korean patients with back pain or leg pain. Methods The sample included 2134 Korean patients who underwent MRI evaluation for back pain. The prevalence and distribution of thoracic OLF were assessed using lumbar MRI with whole spine sagittal images. Additionally, we examined the presence of coexisting lumbar and cervical diseases. The presence of thoracic OLF as well as clinical parameters such as age, sex, and surgery were retrospectively reviewed. Results The prevalence of thoracic OLF in total patients was 16.9% (360/2134). The prevalence tended to increase with aging and was higher in women than in men. The lower thoracic segment of T10-11 was the most frequently affected segment. Of the 360 patients with OLF, 31.9% had coexisting herniated thoracic discs at the same level. Approximately 74% of the patients with OLF had coexisting lumbar and cervical disease. Nine (2.5%) of 360 OLF patients underwent surgery for thoracic lesion. Conclusion The prevalenceof thoracic OLF was relatively higher than those of previous reports. And coexisting lumbar and cervical disease were very frequent. Therefore, we should check coexisting spinal diseases and the exact diagnostic localization of ossification besides lumbar disease. PMID:26361526

  17. Short Segment Stabilization by Protecting the Alar Ligaments in a Case of Eosinophilic Granuloma Involving the C2 Spine.

    PubMed

    Ilik, Mustafa Kemal; Tumturk, Abdülfettah; Ulutabanca, Halil; Kücük, Ahmet; Koc, Rahmi Kemal

    2016-07-01

    The craniocervical junction is a complex anatomic location that contains the occipital bone, atlas, axis, and important complex ligamentous structures. The stability of this region is ensured only with the help of ligaments. A 6-year-old boy was admitted to our clinic for neck pain. Computed tomography and magnetic resonance imaging revealed a lytic bone lesion involving the C2 vertebral body and pedicle without odontoid tip. The tumor was resected using an anterior retropharyngeal approach and a wide marginal resection method. The odontoid tip and alar ligaments were protected, and the costal autografts were located between the C1-odontoid tip and the C3 body. The costal graft was stabilized in the C3 body with a miniplate. Then, C1-C3 posterior fixation with fusion was performed. The craniocervical junction was not considered unstable because the occipital bone was not involved in the fusion. Histologic examination confirmed the diagnosis of eosinophilic granuloma. Fusion was detected on a 1-year postoperative cervical computed tomography scan. The occiput should not be involved in the fusion area when the alar ligaments are preserved during surgery for a C2 lesion. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Morphology of the transverse ligament of the atlas and the alar ligaments in the silver fox (Vulpes vulpes var)

    PubMed Central

    2013-01-01

    Background Recent new anatomical and histological features of craniocervical junction in dogs and cats were described providing evidence of differences between the carnivore species. No information on these structures in foxes exists. Results Two parts of the alar ligaments were found. A longer one aroused from dens of axis to the internal (medial) surface of the occipital condyles and was called apical part. A shorter part originated from the entire length of the lateral edge of the dens of axis and terminated on the internal wall of the vertebral foramen of atlas and thus was called the lateral part. The transverse ligament of the atlas was widened in the mid region, above the dens of axis, and thickened at enthesis. Periosteal fibrocartilage was detected in the transverse ligament of the atlas at the enthesis, and sesamoid fibrocartilage was present on periphery in the middle of the ligament. Conclusions The craniocervical junction in foxes differs in part from other carnivores such as dogs and cats but resembles that of mesaticephalic dogs. The sesamoid and periosteal fibrocartilage supports the transverse ligament of the atlas whereas the alar ligaments have no cartilage. PMID:23557095

  19. A Refined Technique for Management of Nasal Flaring: The Quest for the Holy Grail of Alar Base Modification.

    PubMed

    Agrawal, Kapil S; Pabari, Mansi; Shrotriya, Raghav

    2016-11-01

    "A smile is happiness you'll find right under your nose"- Tom Wilson. This quote holds true just for patients, not for surgeons. The correction of the nose always poses a challenge to the cosmetic surgeon. Deformities of the external and internal nose may be congenital or acquired and may be secondary to soft tissue and/or osseo-cartilaginous abnormalities, leading to aesthetic and/or functional consequences. Alar flare poses a common problem, sometimes alone and sometimes in conjunction with other external deformities. Alar base reduction is generally considered when the interalar distance exceeds the intercanthal distance. It has been well documented that this simple additional procedure brings about a substantial enhancement in the nose. Various techniques have been described and used in the past, each having their benefits and drawbacks, with the modified Weir wedge excision, Aufricht nasal sill excision, and Bernstein V-Y advancement being the common ones. We hereby describe a technique that is simple yet effective in achieving the desired results and at the same time aims at preventing relapse to obtain satisfactory long term results.

  20. Wnt signal specifies the intrathalamic limit and its organizer properties by regulating Shh induction in the alar plate.

    PubMed

    Martinez-Ferre, Almudena; Navarro-Garberi, Maria; Bueno, Carlos; Martinez, Salvador

    2013-02-27

    The structural complexity of the brain depends on precise molecular and cellular regulatory mechanisms orchestrated by regional morphogenetic organizers. The thalamic organizer is the zona limitans intrathalamica (ZLI), a transverse linear neuroepithelial domain in the alar plate of the diencephalon. Because of its production of Sonic hedgehog, ZLI acts as a morphogenetic signaling center. Shh is expressed early on in the prosencephalic basal plate and is then gradually activated dorsally within the ZLI. The anteroposterior positioning and the mechanism inducing Shh expression in ZLI cells are still partly unknown, being a subject of controversial interpretations. For instance, separate experimental results have suggested that juxtaposition of prechordal (rostral) and epichordal (caudal) neuroepithelium, anteroposterior encroachment of alar lunatic fringe (L-fng) expression, and/or basal Shh signaling is required for ZLI specification. Here we investigated a key role of Wnt signaling in the molecular regulation of ZLI positioning and Shh expression, using experimental embryology in ovo in the chick. Early Wnt expression in the ZLI regulates Gli3 and L-fng to generate a permissive territory in which Shh is progressively induced by planar signals of the basal plate.

  1. Morphology of the transverse ligament of the atlas and the alar ligaments in the silver fox (Vulpes vulpes var).

    PubMed

    Kupczynska, Marta; Barszcz, Karolina; Janczyk, Pawel; Wasowicz, Michal; Czubaj, Norbert

    2013-04-04

    Recent new anatomical and histological features of craniocervical junction in dogs and cats were described providing evidence of differences between the carnivore species. No information on these structures in foxes exists. Two parts of the alar ligaments were found. A longer one aroused from dens of axis to the internal (medial) surface of the occipital condyles and was called apical part. A shorter part originated from the entire length of the lateral edge of the dens of axis and terminated on the internal wall of the vertebral foramen of atlas and thus was called the lateral part. The transverse ligament of the atlas was widened in the mid region, above the dens of axis, and thickened at enthesis. Periosteal fibrocartilage was detected in the transverse ligament of the atlas at the enthesis, and sesamoid fibrocartilage was present on periphery in the middle of the ligament. The craniocervical junction in foxes differs in part from other carnivores such as dogs and cats but resembles that of mesaticephalic dogs. The sesamoid and periosteal fibrocartilage supports the transverse ligament of the atlas whereas the alar ligaments have no cartilage.

  2. A Refined Technique for Management of Nasal Flaring: The Quest for the Holy Grail of Alar Base Modification

    PubMed Central

    Agrawal, Kapil S; Pabari, Mansi

    2016-01-01

    “A smile is happiness you'll find right under your nose”– Tom Wilson. This quote holds true just for patients, not for surgeons. The correction of the nose always poses a challenge to the cosmetic surgeon. Deformities of the external and internal nose may be congenital or acquired and may be secondary to soft tissue and/or osseo-cartilaginous abnormalities, leading to aesthetic and/or functional consequences. Alar flare poses a common problem, sometimes alone and sometimes in conjunction with other external deformities. Alar base reduction is generally considered when the interalar distance exceeds the intercanthal distance. It has been well documented that this simple additional procedure brings about a substantial enhancement in the nose. Various techniques have been described and used in the past, each having their benefits and drawbacks, with the modified Weir wedge excision, Aufricht nasal sill excision, and Bernstein V-Y advancement being the common ones. We hereby describe a technique that is simple yet effective in achieving the desired results and at the same time aims at preventing relapse to obtain satisfactory long term results. PMID:27896197

  3. Effects of two alar base suture techniques suture techniques on nasolabial changes after bimaxillary orthognathic surgery in Taiwanese patients with class III malocclusions.

    PubMed

    Chen, C Y-H; Lin, C C-H; Ko, E W-C

    2015-07-01

    A randomized controlled trial was designed to assess the effectiveness of two alar base cinch techniques on the changes in nasolabial morphology after bimaxillary orthognathic surgery. Sixty patients requiring a Le Fort I osteotomy to correct skeletal discrepancies were selected randomly to receive either conventional or modified alar base cinching during the intraoral wound closure procedure. Conventional cinching passed through nasalis muscle and anterior nasal spine. Modified cinching also passed through dermis tissue to increase the anchorage. Postoperative hard and soft tissue changes were evaluated using cone beam computed tomography and three-dimensional stereophotogrammetry at predefined time points. Forty-eight patients with a skeletal class III malocclusion were included. In the conventional group, there was an increase of 0.31 ± 1.31 mm in nasal width and an increase of 0.97 ± 1.60mm in columellar length. In the modified group, there was an increase of 0.81 ± 1.87 mm in the cutaneous height of the upper lip and a decrease of 0.76 ± 1.56 mm in lower prolabial width. Patients with an initial narrow nasal width, alar base width, and less vertical nostril show were more susceptible to a greater degree of change after surgery. Both alar base suture techniques are effective at controlling nasolabial form changes resulting from class III dual-jaw orthognathic surgery. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  4. Long-term stability of limiting nasal alar base width changes with a cinch suture following Le Fort I osteotomy with submental intubation.

    PubMed

    Raithatha, R; Naini, F B; Patel, S; Sherriff, M; Witherow, H

    2017-06-29

    The aim of this study was to assess the effectiveness of the nasal alar base cinch suture following Le Fort I osteotomy at long-term follow-up. One hundred and forty participants (89 female, 51 male) aged between 16 and 51 years underwent Le Fort I osteotomy with submental intubation. Anthropometric measurements of the nose were taken intraoperatively, immediately postoperative, and for up to 3 years postoperative: the maximum lateral convexity of the alae (Al-Al) and the lateral extremity of the alar base curvature at the alar groove (Ac-Ac). The use of a cinch suture was recorded. The results were analysed using a linear mixed-effects model analysis. One hundred and six participants had cinch sutures and 34 had no cinch sutures. Following Le Fort I osteotomy, there were significant increases in Ac-Ac (by 4.29mm) and Al-Al (by 3.70mm) (both P<0.0001). Cinch sutures significantly reduced the widths back to preoperative values (P<0.0001). Alar width remained stable over 3 years, with an increase of 0.36mm for Al-Al (P>0.05) and 1.03mm for Ac-Ac (P<0.05) compared to the postoperative measurement. In conclusion, a cinch suture was helpful in reducing the unwanted alar base width changes, which were found to be relatively stable at 3 years. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Angiopoietin-Like Protein 2 Induced by Mechanical Stress Accelerates Degeneration and Hypertrophy of the Ligamentum Flavum in Lumbar Spinal Canal Stenosis

    PubMed Central

    Nakamura, Takayuki; Okada, Tatsuya; Endo, Motoyoshi; Kadomatsu, Tsuyoshi; Taniwaki, Takuya; Sei, Akira; Odagiri, Haruki; Masuda, Tetsuro; Fujimoto, Toru; Nakamura, Takafumi; Oike, Yuichi; Mizuta, Hiroshi

    2014-01-01

    Chronic inflammation and subsequent fibrosis induced by mechanical stress play an important role in ligamentum flavum (LF) hypertrophy and degeneration in patients with lumbar spinal canal stenosis (LSCS). Angiopoietin-like protein 2 (Angptl2) is a chronic inflammatory mediator induced under various pathological conditions and increases the expression of TGF-β1, which is a well-characterized mediator in LF hypertrophy. We investigated whether Angptl2 is induced by mechanical stress, and whether it contributes to LF hypertrophy and degeneration by activating the TGF-β1 signaling cascade. In this study, we investigated human LF tissue and LF fibroblasts isolated from patients who underwent lumbar surgery. We found that Angptl2 was abundantly expressed in fibroblasts of hypertrophied LF tissues at both the mRNA and protein levels. This expression was not only positively correlated with LF thickness and degeneration but also positively correlated with lumbar segmental motion. Our in vitro experiments with fibroblasts from hypertrophied LF tissue revealed that mechanical stretching stress increases the expression and secretion of Angptl2 via activation of calcineurin/NFAT pathways. In hypertrophied LF tissue, expression of TGF-β1 mRNA was also increased and TGF-β1/Smad signaling was activated. Angptl2 expression in LF tissue was positively correlated with the expression of TGF-β1 mRNA, suggesting cooperation between Angptl2 and TGF-β1 in the pathogenesis of LF hypertrophy. In vitro experiments revealed that Angptl2 increased levels of TGF-β1 and its receptors, and also activated TGF-β1/Smad signaling. Mechanical stretching stress increased TGF-β1 mRNA expression, which was partially attenuated by treatment with a calcineurin/NFAT inhibitor or Angptl2 siRNA, indicating that induction of TGF-β1 expression by mechanical stretching stress is partially mediated by Angptl2. We conclude that expression of Angptl2 induced by mechanical stress in LF fibroblasts

  6. Angiopoietin-like protein 2 induced by mechanical stress accelerates degeneration and hypertrophy of the ligamentum flavum in lumbar spinal canal stenosis.

    PubMed

    Nakamura, Takayuki; Okada, Tatsuya; Endo, Motoyoshi; Kadomatsu, Tsuyoshi; Taniwaki, Takuya; Sei, Akira; Odagiri, Haruki; Masuda, Tetsuro; Fujimoto, Toru; Nakamura, Takafumi; Oike, Yuichi; Mizuta, Hiroshi

    2014-01-01

    Chronic inflammation and subsequent fibrosis induced by mechanical stress play an important role in ligamentum flavum (LF) hypertrophy and degeneration in patients with lumbar spinal canal stenosis (LSCS). Angiopoietin-like protein 2 (Angptl2) is a chronic inflammatory mediator induced under various pathological conditions and increases the expression of TGF-β1, which is a well-characterized mediator in LF hypertrophy. We investigated whether Angptl2 is induced by mechanical stress, and whether it contributes to LF hypertrophy and degeneration by activating the TGF-β1 signaling cascade. In this study, we investigated human LF tissue and LF fibroblasts isolated from patients who underwent lumbar surgery. We found that Angptl2 was abundantly expressed in fibroblasts of hypertrophied LF tissues at both the mRNA and protein levels. This expression was not only positively correlated with LF thickness and degeneration but also positively correlated with lumbar segmental motion. Our in vitro experiments with fibroblasts from hypertrophied LF tissue revealed that mechanical stretching stress increases the expression and secretion of Angptl2 via activation of calcineurin/NFAT pathways. In hypertrophied LF tissue, expression of TGF-β1 mRNA was also increased and TGF-β1/Smad signaling was activated. Angptl2 expression in LF tissue was positively correlated with the expression of TGF-β1 mRNA, suggesting cooperation between Angptl2 and TGF-β1 in the pathogenesis of LF hypertrophy. In vitro experiments revealed that Angptl2 increased levels of TGF-β1 and its receptors, and also activated TGF-β1/Smad signaling. Mechanical stretching stress increased TGF-β1 mRNA expression, which was partially attenuated by treatment with a calcineurin/NFAT inhibitor or Angptl2 siRNA, indicating that induction of TGF-β1 expression by mechanical stretching stress is partially mediated by Angptl2. We conclude that expression of Angptl2 induced by mechanical stress in LF fibroblasts

  7. MiR-21 promotes fibrosis and hypertrophy of ligamentum flavum in lumbar spinal canal stenosis by activating IL-6 expression.

    PubMed

    Sun, Chao; Tian, Jiwei; Liu, Xinhui; Guan, Guoping

    2017-08-26

    The molecular mechanism underlying the fibrosis of ligamentum flavum(LF) in patients with lumbar spinal canal stenosis(LSCS) remains unknown. MicroRNAs are reported to play important roles in regulating fibrosis in different organs. The present study aimed to identify fibrosis related miR-21 expression profile and investigate the pathological process of miR-21 in the fibrosis of LF hypertrophy and associated regulatory mechanisms. 15 patients with LSCS underwent surgical treatment were enrolled in this study. For the control group, 11 patients with lumbar disc herniation(LDH) was included. The LF thickness was measured on MRI. LF samples were obtained during the surgery. Fibrosis score was assessed by Masson's trichrome staining. The expression of miR-21 in LF tissues were determined by RT-PCR. Correlation among LF thickness, fibrosis score, and miR-21 expression was analyzed. In addition, Lentiviral vectors for miR-21 mimic were constructed and transfected into LF cells to examine the role of miR-21 in LF fibrosis. Types I and III collagen were used as indicators of fibrosis. IL-6 expression in LF cells after transfection was investigated by RT-PCR and ELISA. Patients in two groups showed similar outcomes regarding age, gender, level of LF tissue. The thickness and fibrosis score of LF in the LSCS group were significantly greater than those in LDH group (all P < 0.05). Similarly, the expression of miR-21 in LSCS group was substantially higher than that in LDH group(P < 0.05). Furthermore, the miR-21 expression exhibited positive correlations with the LF thickness (r = 0.595, P < 0.05) and fibrosis score (r = 0.608, P < 0.05). Of note, miR-21 over-expression increased the expression levels of collagen I and III (P < 0.05). Also, IL-6 expression and secretion in LF cells was elevated after transfection of miR-21 mimic. MiR-21 is a fibrosis-associated miRNA and promotes inflammation in LF tissue by activating IL-6 expression, leading to LF fibrosis and

  8. Signal changes of the alar ligament in a healthy population: a dispositional or degenerative consequence?

    PubMed

    Wenz, Holger; Kerl, Hans Ulrich; Maros, Mate Elod; Wenz, Ralf; Kalvin, Kira; Groden, Christoph; Nölte, Ingo

    2015-07-17

    OBJECT The alar ligaments (ALs) are vital for stabilizing the craniocervical junction. In terms of morphology, their appearance varies and is visible on MRI. Dark signal of the AL on proton-density (PD)-weighted images is generally considered the norm, but the etiology of frequently observed signal hyperintensities is poorly understood. Using spectral fat suppression, signal hyperintensities can be differentiated into fat- and nonfat-related hyperintensities (NFH). Although signal hyperintensities have no evident association with whiplash-associated disorder, age-related degeneration has often been theorized. Therefore, this study investigates the signal intensities of the ALs on 3.0-T MRI with special reference to age. Expanding thereon, the authors investigated the relationship between signal hyperintensities and patient characteristics, such as height, weight, and sex. METHODS Sixty-six healthy volunteers were scanned using 3.0-T PD-weighted MRI, including spectral fat suppression of the craniocervical junction. The study population was separated into 2 groups (old vs young) using 2 approaches: dichotomization at the median age (40.0 years) and the calculated threshold (28.5 years) using receiver operating characteristics (ROC). The AL was independently characterized with respect to continuity, course, shape, signal intensity, and graduation of homogeneity by 2 experienced neuroradiologists. Signal intensity was differentiated into fat-related hyperintensity and NFH. Univariate and multivariate logistic regression models were employed to investigate the relationship between patient characteristics and signal intensities. RESULTS Two different AL patterns were observed: inhomogeneous (33.3%) and homogeneous (66.7%). The latter pattern was mostly surrounded by a small dark rim (56.8%). Fat could be identified in 15.9% of all ALs (21 of 132 patients), and NFH was identified in 17.4% of all ALs (23 of 132 patients). Here, 28.5 years was the preferred threshold

  9. Three-dimensional image-guided placement of S2 alar screws to adjunct or salvage lumbosacral fixation.

    PubMed

    Nottmeier, Eric W; Pirris, Stephen M; Balseiro, Sarah; Fenton, Douglas

    2010-07-01

    Achieving fusion across the lumbosacral junction is challenging because of the unfavorable biomechanics associated with ending a fusion at this level. Bicortical placement of S1 pedicle screws can increase the construct stability at the lumbosacral junction; however, construct failure and pseudoarthrosis can still result. Iliac screws have been shown to increase the stiffness of lumbosacral constructs, but disadvantages include difficulty in connecting the iliac screw to adjacent sacral screws, painful screw loosening or prominence requiring removal, and the inability to place the screws in some patients with previous iliac crest autograft harvest. The purpose of the study is to describe a technique of S2 alar screw placement using three-dimensional image guidance. The study design is a retrospective analysis. Twenty patients undergoing lumbosacral fusion had 32 screws placed using this technique. An independent radiologist graded screw placement and lumbosacral fusion on thin-cut postoperative computed tomographic (CT) scans. Image guidance in this study was accomplished with the Medtronic Stealth Station Treon (Medtronic Inc., Littleton, MA, USA) used in conjunction with the O-ARM (Medtronic Inc.). Indications for placement of S2 alar screws included the following: to adjunct S1 pedicle screws in multilevel fusion cases; as an adjunct or alternative to S1 pedicle screws in pseudoarthrosis revision cases in which the S1 screws had loosened; as an alternative to S1 pedicle screws in cases where medial trajectory of an S1 pedicle screw was difficult to obtain because of a low-set lumbosacral junction; and a combination of the above. The entry point of the screw was typically chosen lateral and superior to the S2 dorsal foramen with the trajectory directed anterior, inferior, and lateral. Attempt was made to place the screw with the tip purchasing, but not penetrating through, the triangular area of cortical bone that can be found at the anterior, inferior, and

  10. Haplopacha (Lepidoptera: Lasiocampidae) reviewed: four new species, first descriptions of the genitalia of both sexes, and unique alar scale organs.

    PubMed

    Dupont, Steen; Simonsen, Thomas J; Zilli, Alberto

    2016-05-10

    The collection of five specimens of Haplopacha at Ndumo Nature Reserve in South Africa highlights unknown species diversity in the monotypic genus. A total of four new species; H. riftensis sp. nov., H. tangani sp. nov., H. lunata sp. nov. and H. ndoumoi sp. nov., were identified in the Natural History Museum of London collection and the study of fresh specimens also revealed the presence of uniquely characteristic alar scale patches absent from the original species description of the genus type species H. cinerea. Based on the new species the descriptions of Haplopacha is amended. The identification of the new species was done using conventional light microscopy and scanning electron microscopy of the general morphology, wing venation and genitalia observations.

  11. Ablation of porcine ligamentum flavum with Ho:YAG, q-switched Ho:YAG, and quadrupled Nd:YAG lasers.

    PubMed

    Johnson, Matt R; Codd, Patrick J; Hill, Westin M; Boettcher, Tara

    2015-12-01

    Ligamentum flavum (LF) is a tough, rubbery connective tissue providing a portion of the ligamentous stability to the spinal column, and in its hypertrophied state forms a significant compressive pathology in degenerative spinal stenosis. The interaction of lasers and this biological tissue have not been thoroughly studied. Technological advances improving endoscopic surgical access to the spinal canal makes selective removal of LF using small, flexible tools such as laser-coupled fiber optics increasingly attractive for treatment of debilitating spinal stenosis. Testing was performed to assess the effect of Ho:YAG, Q-switched Ho:YAG, and frequency quadrupled Nd:YAG lasers on samples of porcine LF. The objective was to evaluate the suitability of these lasers for surgical removal of LF. LF was resected from porcine spine within 2 hours of sacrifice and stored in saline until immediately prior to laser irradiation, which occurred within an additional 2 hours. The optical absorbance of a sample was measured over the spectral band from 190 to 2,360 nm both before and after dehydration. For the experiments using the Ho:YAG (λ = 2,080 nm, tp  = 140 µs, FWHM) and Q-Switched Ho:YAG (λ = 2,080 nm, tp  = 260 ns, FWHM) lasers, energy was delivered to the LF through a laser-fiber optic with 600 µm core and NA = 0.39. For the experiment using the frequency quadrupled Nd:YAG laser (λ = 266 nm, tp  = 5 ns FWHM), rather than applying the laser energy through a laser-fiber, the energy was focused through an aperture and lens directly onto the LF. Five experiments were conducted to evaluate the effect of the given lasers on LF. First, using the Ho:YAG laser, the single-pulse laser-hole depth versus laser fluence was measured with the laser-fiber in direct contact with the LF (1 g force) and with a standoff distance of 1 mm between the laser-fiber face and the LF. Second, with the LF remaining in situ and the spine bisected

  12. Two-photon excitation of the 2Π(4p)-X2Π(3p) transition of AlAr

    NASA Astrophysics Data System (ADS)

    Mascaritolo, Kyle J.; Antonov, Ivan O.; Heaven, Michael C.

    2014-03-01

    The 2Π(4p)-X2Π(3p) band system of AlAr has been observed using two-photon excitation. The spectrum consists of a short progression of doublet bands, with spin-orbit intervals that are close to that of Al(4p). Potential energy curve fitting yielded a bond dissociation energy for 2Π(4p) of De = 495(5) cm-1 and an approximate bond length of Re = 3.33(4) Å.

  13. Ablative fractionated erbium:YAG laser for the treatment of ice pick alar scars due to neodymium:YAG laser burns.

    PubMed

    Cohen, Joel L; Babcock, Michael J

    2009-01-01

    The authors present a case of ice pick scars forming in the nasal alar grooves of a patient who was treated with a 1064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for facial telangiectasias. Treatment options for these types of scars are reviewed and specifically we report the success of an ablative fractionated 2940-nm erbium:yttrium-aluminum-garnet (Er:YAG) laser.

  14. Anatomical variations of the anterior atlanto-dental joint and relations to the apical and alar ligaments in a geriatric population.

    PubMed

    Rustagi, Tarush; Iwanaga, Joe; Sardi, Juan P; Alonso, Fernando; Oskouian, Rod J; Tubbs, R Shane

    2017-08-17

    Degenerative changes in the upper cervical spine may be age related degeneration or a pathological process such as rheumatoid arthritis. However, to our knowledge, the relationship between the apical and alar ligaments and these anomalies has not been discussed. We present anatomical variations of the anterior atlanto-dental joint observed during cadaveric dissection of adult craniovertebral junctions, the relationship with the alar and apical ligaments and discuss possible origins and clinical implications. The upper cervical spine including part of the occiput was dissected from cadavers whose mean age at death was 78.9 years-old. The anterior atlanto-dental joint and apical and alar ligaments were observed and any atypical findings were noted. In eleven specimens, seven had a dens corona, three had an os odontoideum and one had a dens aureola, which arose from the upper part of the anterior arch of the atlas. Only four specimens had an apical ligament. The possible etiologies and the clinical applications of these craniovertebral anomalies in a geriatric population should be appreciated by the clinician treating patients with disease in this area or interpreting imaging in the region. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. The influence of a Le Fort I impaction and advancement osteotomy on smile using a modified alar cinch suture and V-Y closure: a prospective study.

    PubMed

    Muradin, M S M; Rosenberg, A J W P; van der Bilt, A; Stoelinga, P J W; Koole, R

    2012-05-01

    A previous report from the authors' department showed that a modified alar cinch suture combined with a muco-musculo-periosteal V-Y closure (mACVY) improves nasolabial mobility. To test if the improvements were equal to the range of nasolabial mobility in non-dysgnathic persons, a prospective study was carried out in 56 patients: 31 with mACVY, 25 with simple closing sutures (SCS) and 18 non-operated, angle class I volunteers. Standardized full facial frontal photographs, taken immediately preoperatively and 18 months postoperatively were used. The landmarks, alare, crista philtri and cheilion were analysed. The test has a standard deviation of 0.9 mm. Intra-group changes, paired t-test, and inter-group differences, unpaired t-test (p<0.05) were statistically analysed. The results show significant preoperative differences in nasolabial mobility compared with the control group, for both groups. Postoperative mobility improved in both groups, but significantly with mACVY with horizontal movement of cheilion and alare, and the vertical movement of crista philtri and less so for the vertical movement of crista philtri with SCS. Postoperative inter-group differences in mobility were small and significant for SCS vs the control group. It can be concluded that using mACVY improves orofacial movement to the level of normal class I volunteers. Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. Measurement and evaluation of the alar base in unilateral secondary lip nasal deformities by three-dimensional computed tomography.

    PubMed

    Wu, Yilai; Yang, Yusheng; Chen, Yang; Zhang, Yong; Wang, Guomin

    2013-11-01

    Objective : This study aimed to analyze the asymmetry of the pyriform aperture and alar base in patients with unilateral secondary nasal deformities by three-dimensional computed tomography (3D-CT). Methods : 3D-CT images of the subject group of 101 adult patients and of a control group of 65 normal adults were examined. Sixty-nine patients without alveolar bone grafting (ABG) were classified as Group A, and 32 patients with ABG were classified as Group B. Seven landmarks (INM, LPA, IPA, Gbase, Gsup, Glat, and Sbal) were measured for both the subject and control groups, and comparative analyses were done to assess the degree of asymmetry in the subject group. Results : For over 95% of Group A and 80% to 85% of Group B, the index of LPA and IPA showed asymmetry or marked asymmetry. The index of Gbase, Glat, Gsup, and Sbal showed symmetry for around 50% of Group A and about 60% of Group B. In Group A, dorsal, lateral, and caudal translocation was found on the cleft side in LPA and IPA, while all soft landmarks showed dorsal translocation. In Group B, caudal translocation was found in both LPA and IPA, but only LPA appeared dorsal on the cleft side, while Glat showed dorsal and caudal translocation. Conclusion : The results indicated that the degree of asymmetry of hard tissue landmarks far exceeded that of the soft tissue landmarks, and the degree of asymmetry of pyriform aperture was higher than expected for patients after ABG.

  17. Utilization of a Technique of Percutaneous S2 Alar-Iliac Fixation in Immunocompromised Patients with Spondylodiscitis.

    PubMed

    Funao, Haruki; Kebaish, Khaled M; Isogai, Norihiro; Koyanagi, Takahiro; Matsumoto, Morio; Ishii, Ken

    2017-01-01

    Spondylodiscitis still remains a serious problem, especially in immunocompromised patients. Surgery is necessary when nonsurgical treatment is unsuccessful. Although minimally invasive spine stabilization (MISt) with percutaneous pedicle screws is less invasive, percutaneous sacropelvic fixation techniques are not common practice. Here, we describe 2 cases in which spondylodiscitis in the lumbosacral spine was treated with percutaneous stabilization using an S2 alar-iliac (S2AI) screw technique. Case 1 is a 77-year-old man who presented with low back pain and high fever. He was diagnosed with spondylodiscitis at L4-5. He had a history of lung cancer, which was complicated by the recurrence. Because nonsurgical treatment failed, MISt with percutaneous S2AI screws was performed. The patient's low back pain subsided markedly 1 week after surgery, and there was no screw/rod breakage or recurrence of infection during the follow-up period. Case 2 is a 71-year-old man who presented with hemiparesis because of a stroke. He also developed high fever and was diagnosed with spondylodiscitis at L5-S1. Because nonsurgical treatment failed, the patient was treated by MISt with percutaneous S2AI screws while being maintained on anticoagulants for stroke. Although his clinical symptoms had markedly improved, a postoperative lumbar computed tomography scan demonstrated a bone defect at L5-S1. An anterior spinal fusion with an iliac bone graft at L5-S1 was performed when a temporary cessation of anticoagulants was permitted. Both patients tolerated the procedures well and had no major perioperative complications. MISt with percutaneous S2AI screws was less invasive and efficacious for lumbosacral spondylodiscitis in providing rigid percutaneous sacropelvic fixation. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. AlAr3(THF): highly efficient reagents for cross-couplings with aryl bromides and chlorides catalyzed by the economic palladium complex of PCy3.

    PubMed

    Ku, Shih-Lun; Hui, Xin-Ping; Chen, Chien-An; Kuo, Yi-Ying; Gau, Han-Mou

    2007-10-07

    Novel and highly efficient cross couplings of aryl bromides and chlorides with AlAr3(THF) (Ar = Ph, 2,4,6-Me3C6H2, 2-naphthyl or 4-Me3SiC6H4) catalyzed by the economic palladium catalyst of PCy3 are reported without the use of a base and under mild reaction conditions at room temperature or temperatures < or = 60 degrees C even for couplings of bulky aryl halides and the Al(2,4,6-Me3C6H2)3(THF) reagent.

  19. Modified alar base cinch suture fixation at the bilateral lower border of the piriform rim after a maxillary Le Fort I osteotomy.

    PubMed

    Yen, C Y; Kuo, C L; Liu, I H; Su, W C; Jiang, H R; Huang, I G; Liu, S Y; Lee, S Y

    2016-11-01

    Classic cinch suture narrowing of the nasal alar base by medially suturing the bilateral nasolabial soft tissue with one long suture has a limited effect. The modified cinch method described in the present study anchors non-absorbable sutures to the bilateral lower border of the piriform rim and provides optimal direction, position, and stability. The sutures can be shortened and the strength kept stable while the surgical wounds heal. Separate bilateral sutures can also reduce interference and distortion from nasotracheal intubation and make the nasolabial profile more symmetrical. Seventeen consecutive cases of maxillary Le Fort I osteotomy were analyzed. The nasal and alar base width changes were 0.4±1.2mm and 0.1±1.1mm, respectively, and the widening rate was only 1.1%. Compared with the results of other studies, postoperative nasal flaring was well controlled using the modified cinch suture anchored to the bilateral lower border of the piriform rim described in this study. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. Nostril and alar reshaping.

    PubMed

    Planas, J; Planas, J

    1993-01-01

    The authors recommend, when necessary, the use of external excisions for correcting variations in the shape of the nostrils and alae in the cleft lip-nose deformity, in primary rhinoplasties, and in secondary rhinoplasties. Their experience in the use of external incisions was originally stimulated by Millard's paper of 1960 which recommended different types of remodeling external excisions in his analysis of how to handle variations in the shape of the nostrils and alae.

  1. Spectroscopy of the AlAr van der Waals complex: Rotationally resolved B 2Σ+←X 2Π1/2 electronic transitions

    NASA Astrophysics Data System (ADS)

    McQuaid, Michael J.; Gole, James L.; Heaven, Michael C.

    1990-03-01

    Rotationally resolved spectra were recorded for six bands of the AlAr B 2Σ+←X 2Π1/2 transition. Vibrational and rotational constants derived from these spectra were used to determine the upper and lower state potential energy curves. The accuracy of these potentials was assessed through calculations of the spectroscopic constants and Franck-Condon factors. Dissociation energies of D'e=440+35-8 cm-1 and D'e=180+40-10 cm-1 were obtained for the B and X states, respectively. The interaction between X 2Π1/2 and the low-lying A 2Σ+ state has been characterized by analysis of the ground-state lambda doublet splitting.

  2. Calcification of the Alar Ligament Mimics Fracture of the Craniovertebral Junction (CVJ): An Incidental Finding from Computerised Tomography of the Cervical Spine Following Trauma

    PubMed Central

    Che Mohamed, Siti Kamariah; Abd. Aziz, Azian

    2009-01-01

    When performing a radiological assessment for a trauma case with associated head injury, a fragment of dense tissue detected near the craniovertebral junction would rapidly be assessed as a fractured bone fragment. However, if further imaging and evaluation of the cervical spine with computerised tomography (CT) did not demonstrate an obvious fracture, then the possibility of ligament calcification would be considered. We present a case involving a previously healthy 44-yearold man who was admitted following a severe head injury from a road traffic accident. CT scans of the head showed multiple intracranial haemorrhages, while scans of the cervical spine revealed a small, well-defined, ovoid calcification in the right alar ligament. This was initially thought to be a fracture fragment. Although such calcification is uncommon, accident and emergency physicians and radiologists may find this useful as a differential diagnosis in patients presenting with neck pain or traumatic head injury. PMID:22135515

  3. Calcification of the Alar Ligament Mimics Fracture of the Craniovertebral Junction (CVJ): An Incidental Finding from Computerised Tomography of the Cervical Spine Following Trauma.

    PubMed

    Che Mohamed, Siti Kamariah; Abd Aziz, Azian

    2009-10-01

    When performing a radiological assessment for a trauma case with associated head injury, a fragment of dense tissue detected near the craniovertebral junction would rapidly be assessed as a fractured bone fragment. However, if further imaging and evaluation of the cervical spine with computerised tomography (CT) did not demonstrate an obvious fracture, then the possibility of ligament calcification would be considered. We present a case involving a previously healthy 44-yearold man who was admitted following a severe head injury from a road traffic accident. CT scans of the head showed multiple intracranial haemorrhages, while scans of the cervical spine revealed a small, well-defined, ovoid calcification in the right alar ligament. This was initially thought to be a fracture fragment. Although such calcification is uncommon, accident and emergency physicians and radiologists may find this useful as a differential diagnosis in patients presenting with neck pain or traumatic head injury.

  4. Do Ligamentum Teres Tears Portend Inferior Outcomes in Patients With Borderline Dysplasia Undergoing Hip Arthroscopic Surgery? A Match-Controlled Study With a Minimum 2-Year Follow-up.

    PubMed

    Chaharbakhshi, Edwin O; Perets, Itay; Ashberg, Lyall; Mu, Brian; Lenkeit, Christopher; Domb, Benjamin G

    2017-09-01

    Arthroscopic surgery in borderline dysplastic hips remains controversial, but the role of the ligamentum teres (LT) has not been studied in this setting. Borderline dysplastic patients with LT tears have worse short-term outcomes than those without LT tears. Cohort study; Level of evidence, 3. Data were prospectively collected on patients who underwent arthroscopic surgery between February 2008 and April 2014. The inclusion criteria were borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and labral tears; arthroscopic treatments including labral preservation and capsular plication; and preoperative patient-reported outcome scores including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale, and visual analog scale for pain. Patients were excluded for preoperative Tönnis osteoarthritis grade >0, workers' compensation claims, previous ipsilateral hip surgery and conditions, or frank dysplasia (LCEA <18°). Patients with LT tears were pair-matched to patients without tears for sex, age at surgery ±10 years, body mass index (<30 kg/m(2) vs ≥30 kg/m(2)), labral treatment type, and microfracture. Of 68 eligible patients, 63 (93%) had a minimum 2-year follow-up, and 30 (48%) had LT tears. Twenty patients in each group were pair-matched. The mean follow-up time was 54.3 months (range, 24.2-83.8 months) for the LT tear group and 38.6 months (range, 24.6-70.6 months) for the control group ( P = .002). Ninety percent were female. There were no significant differences regarding demographics or intra-operative procedures. The LT tear group trended toward lower postoperative mHHS ( P = .09) and NAHS ( P = .09) values. Mean satisfaction was 8.1 for the LT tear group and 7.9 for the control group. Preoperative and follow-up scores were not significantly different between the groups. The LT tear group had 5 revisions, with 1 revision in the control group. Three patients (15%) in the LT tear group

  5. Single-stage reconstruction of a full-thickness alar defect using a folded nasolabial flap combined with a redundant skin turnover flap.

    PubMed

    Takeda, Akira; Akimoto, Minekatsu; Park, Keiichi; Kounoike, Natsuko; Shimakura, Yasuhito; Nemoto, Mitsuru; Uchinuma, Eiju

    2014-11-01

    The reconstructive strategy for full-thickness nasal skin defects should include recreation of a cutaneous cover, support, and internal nasal lining. The most challenging aspect of this procedure is provision of the nasal lining. These reconstructions typically require a 2-step process. Satisfactory nasal skin reconstruction in a single operation is ideal. We used a folded nasolabial flap combined with a turnover flap for reconstruction of full-thickness alar defects. The donor material of the lining flap was a combination of the distal portion of the nasolabial flap and redundant skin resected during its transposition. The redundant skin flap was turned upside down, with the skin surface inside the nasal cavity. The remaining portion of the defect was covered with a folded nasolabial flap. This procedure was successful in all 5 patients. All flaps survived completely without evidence of necrosis or narrowing of airways. Aesthetic concerns, including effacement of the nasofacial sulcus, were minor. This method has the advantage of providing well-vascularized tissue of appropriate color, texture, and thickness for external coverage, as well as a satisfactory internal lining in a single-stage procedure.

  6. Free Hand Insertion Technique of S2 Sacral Alar-Iliac Screws for Spino-Pelvic Fixation: Technical Note, Acadaveric Study

    PubMed Central

    Park, Jong-Hwa; Kim, Ki-Jeong; Jahng, Tae-Ahn

    2015-01-01

    A rigid spino-pelvic fixation to anchor long constructs is crucial to maintain the stability of long fusion in spinal deformity surgery. Besides obtaining immediate stability and proper biomechanical strength of constructs, the S2 alar-iliac (S2AI) screws have some more advantages. Four Korean fresh-frozen human cadavers were procured. Free hand S2AI screw placement is performed using anatomic landmarks. The starting point of the S2AI screw is located at the midpoint between the S1 and S2 foramen and 2 mm medial to the lateral sacral crest. Gearshift was advanced from the desired starting point toward the sacro-iliac joint directing approximately 20° angulation caudally in sagittal plane and 30° angulation horizontally in the coronal plane connecting the posterior superior iliac spine (PSIS). We made a S2AI screw trajectory through the cancellous channel using the gearshift. We measured caudal angle in the sagittal plane and horizontal angle in the coronal plane. A total of eight S2AI screws were inserted in four cadavers. All screws inserted into the iliac crest were evaluated by C-arm and naked eye examination by two spine surgeons. Among 8 S2AI screws, all screws were accurately placed (100%). The average caudal angle in the sagittal plane was 17.3±5.4°. The average horizontal angle in the coronal plane connecting the PSIS was 32.0±1.8°. The placement of S2AI screws using the free hand technique without any radiographic guidance appears to an acceptable method of insertion without more radiation or time consuming. PMID:26819698

  7. [Reconstruction of superficial defects from the crossroad of nasal subunits, tip, alar lobule and lateral side wall: Study of 36 patients].

    PubMed

    Grandpierre, X; Sartre, J Y; Duteille, F

    2016-08-01

    Conventionally, articles dealing with nasal defects plan reconstructions regarding the aesthetic subunits, imposing their systematic respect. We propose to study the reconstruction of a crossroad region of three subunits, tip, alar lobule and lateral sidewall, where that full compliance is not possible, in our experience of 36 patients. Our retrospective study from January 2011 to December 2012 focused on patients with a defect in this crossroad region that was repaired by skin graft or flap. We described the population of the study, histological type of the lesions, surgical procedures and complications. We evaluated the reconstructions performed with a photographic review 1 year post-surgery according to the criteria of symmetry, discoloration, thickness, shrinkage, and rating on the Vancouver Scar Scale, which helped create an overall aesthetic score for the reconstruction. Of 144 patients with a nasal defect, 36 of them (25%) were included, presenting a defect in our study area. The reconstruction was made by eight hatchet flaps, eight frontal flaps, seven bilobed flaps, five advanced-rotated lateronasal flaps, four nasolabial flaps, two Rybka flaps and two total skin grafts. The advanced-rotated flap, hatchet flap and bilobed flap had the highest results and scores, according to the criteria assessed. Rybka flap and total skin grafts had the lowest results. The occurrence of a defect in the crossroads seems common. In this indication, specific local flaps had a favourable outcome, including review of the overall esthetic score which was created to standardize the assessment of reconstructions. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  8. Combined S-1 and S-2 sacral alar-iliac screws as a salvage technique for pelvic fixation after pseudarthrosis and lumbosacropelvic instability: combined S-1 and S-2 sacral alar-iliac screws as a salvage technique for pelvic fixation after pseudarthrosis and lumbosacropelvic instability: technical note.

    PubMed

    Mattei, Tobias A; Fassett, Daniel R

    2013-09-01

    Lumbosacropelvic pseudarthrosis after long spinal fusions for treatment of adult degenerative scoliosis remains a challenging condition. Moreover, although pelvic fixation with iliac screws is widely used in deformity surgery to provide a biomechanically strong distal anchor for long thoracolumbar constructs, there are very few options available after failed pelvic fixation with iliac screws. The authors conducted a retrospective review of the surgical charts and imaging findings of patients subjected to revision surgery for lumbosacropelvic pseudarthrosis from August 2011 to August 2012. This review identified 5 patients in whom a salvage technique combining both S-1 and S-2 sacral alar-iliac (SAI) screws had been performed. In this technical note, the authors present a detailed anatomical discussion and an appraisal of the sequential intraoperative steps of this new technique involving a combination of S-1 and S-2 SAI screws. The discussion is illustrated with a surgical case in which this technique was used to treat a patient with pseudarthrosis that had developed after fixation with classic iliac screws. In conclusion, although S-2 SAI screws have previously been reported as an interesting alternative to classic iliac wing screws, this report is the first on the use of combined S-1 and S-2 SAI screws for pelvic fixation as a salvage technique for lumbosacropelvic instability. According to the reported experience, this technique provides a biomechanically robust construct for definitive pelvic fixation during revision surgeries in the challenging scenarios of pseudarthrosis and instability of the lumbosacropelvic region.

  9. Reconstruction of Alar Nasal Cartilage Defects Using a Tissue Engineering Technique Based on a Combined Use of Autologous Chondrocyte Micrografts and Platelet-rich Plasma: Preliminary Clinical and Instrumental Evaluation

    PubMed Central

    Scioli, Maria G.; Bielli, Alessandra; Orlandi, Augusto; Cervelli, Valerio

    2016-01-01

    Background: Developing cartilage constructs with injectability, appropriate matrix composition, and persistent cartilaginous phenotype remains an enduring challenge in cartilage repair. The combined use of autologous chondrocyte micrografts and platelet-rich plasma (PRP) is an alternative that opens a new era in this field. Methods: At the Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Italy, 11 patients underwent nasal alar reconstruction with chondrocyte micrografts gently poured onto PRP in solid form. A computed tomographic scan control was performed after 12 months. Pearson’s Chi-square test was used to investigate difference in cartilage density between native and newly formed cartilages. Results: The constructs of chondrocyte micrografts–PRP that were subcutaneously injected resulted in a persistent cartilage tissue with appropriate morphology, adequate central nutritional perfusion without central necrosis or ossification, and further augmented nasal dorsum without obvious contraction and deformation. Conclusion: This report demonstrated that chondrocyte micrografts derived from nasal septum poured onto PRP in solid form are useful for cartilage regeneration in patients with external nasal valve collapse. PMID:27826462

  10. A comparative study to find out the relationship between the inner inter-canthal distance, interpupillary distance, inter-commissural width, inter-alar width, and the width of maxillary anterior teeth in Aryans and Mongoloids

    PubMed Central

    Mishra, Meena Kumari; Singh, Raj Kumar; Suwal, Pramita; Parajuli, Prakash Kumar; Shrestha, Pragya; Baral, Dharanidhar

    2016-01-01

    Background One of the most confusing and difficult aspects of complete denture prosthodontics is the selection of appropriately sized maxillary anterior denture teeth. Various guidelines have been suggested for determining the size of anterior teeth, but different opinions have been reported regarding their significance. In the study reported here, the relationships between facial measurements and the width of maxillary anterior teeth in two ethnic groups, namely Aryans and Mongoloids, were determined. Objective The aims of the study were to determine the inner inter-canthal distance (ICAD), inter-pupillary distance (IPD), inter-commissural width (ICOW), inter-alar width (IAW), and the combined width of maxillary anterior teeth (CW) in Aryans and Mongoloids and to determine the relationships between these measurements. Materials and methods Impressions of the teeth of 170 dentulous subjects (85 males and 85 females) were made with alginate then Type IV gypsum product was poured in. Measurements of the cast maxillary anterior teeth at their widest dimension (contact areas) were made with the Boley gauge. ICAD, IPD, ICOW, and IAW distances were also measured with a Boley gauge. Results For all 170 subjects, 85 Aryans and 85 Mongoloids, Pearson’s correlation coefficient (r) for IAW, IPD, ICOW, ICAD, and CW was calculated. In Aryans, highly significant (P<0.001) but weak correlations were found between CW and IAW, IPD, and ICOW. In Mongoloids, a highly significant (P<0.001) and weak correlation was found only between CW and IPD. Conclusion Within the limitations of this study, the results suggest that the IAW, IPD, and ICOW for Aryans and IPD for Mongoloids can be used as a preliminary method for determining the width of the maxillary anterior teeth in edentulous patients. PMID:26955292

  11. Ossification of the ligamentum flavum in a Caucasian: case report.

    PubMed

    Parekh, H C; Gurusinghe, N T; Perera, S S; Prabhu, S S

    1993-01-01

    Ossification of the ligamenta flava (OLF) and posterior longitudinal ligament (OPLL) of the spine causing spinal cord compression is described mainly in Japanese patients and is often termed as 'Japanese disease'. We are reporting a case of OLF of the thoracic spine seen in a male Caucasian who presented with an intractable intercostal pain. This is the first case report of OLF in a Caucasian.

  12. Syringomyelia due to thoracic spinal stenosis with ossified ligamentum flavum--case report.

    PubMed

    Arai, Atsushi; Aihara, Hideo; Miyake, Shigeru; Hanada, Yusei; Kohmura, Eiji

    2011-01-01

    A 50-year-old male presented with back pain and numbness of the lower extremities persisting for 10 years. He had played volleyball for a long period until recently. He had no history of meningitis or traumatic injury. Magnetic resonance imaging revealed a syringomyelia located in the region from T8 to T9 without contrast enhancement or Chiari malformations. Computed tomography showed T9-10 spinal stenosis caused by the right enlarged ossified yellow ligament. Decompressive laminectomy was performed and the ossified ligament removed. Due to the finding of arachnoid thickening and adhesions during the intradural operation, shunting was also performed. Postoperatively, the neuroimaging and clinical findings improved. Syringomyelia is often associated with Chiari malformations, trauma, spinal tumor, hemorrhaging, and meningitis. We suggest that repeated minor mechanical damage caused by physical exercise in addition to long-standing compression of the spinal cord due to spinal spondylosis could induce severe arachnoid fibrotic change similar to adhesive arachnoiditis, which may be one of the main triggers of syringomyelia. Extradural decompressive surgery is considered to be the initial treatment for syringomyelia associated with spinal spondylosis.

  13. Contribution to the study of functional architecture of ligamentum venosum in adult man.

    PubMed

    Ferraz de Carvalho, C A; Rodrigues, A J

    1975-01-01

    Seventeen specimens, removed at necropsy from adult individuals, were submitted to different methods: a) dissection under stereomicroscope; b) 100 mum panorganographic sections stained by Azan, Weigert's resorcin-fucsin; c) total preparations to be examined under polarized light; d) 10 mum thick histological sections stained by Verhöff-van Gieson; e) silver impregnation after CAJAL-DE CASTRO. The AA. refer the constitution of the ligament as an integration of two opposite directed systems which are made up by collagenous and mioelastic elements disposed like a twisted cord in the middle portion and enlarged like a fan toward more or less extensive areas of the left branch of portal vein and of the ensemble formed by left hepatic vein and inferior vena cava. The bundles are mainly spread by the most external layers of these vessels, and also it has been observed fibrous components that from the vessels directed to the ligament. They call attention for the amount of nerves and nerve fibers in that structure. The AA. remark, on functional bases, taking as probable the participation of the ligament on the control of the changes in the bend made up by portal vein, "pars transversa trunci sinistri" and "pars umbilicalis trunci sinistri".

  14. Genetic differences in osteogenic differentiation potency in the thoracic ossification of the ligamentum flavum under cyclic mechanical stress.

    PubMed

    Ning, Shanglong; Chen, Zhongqiang; Fan, Dongwei; Sun, Chuiguo; Zhang, Chi; Zeng, Yan; Li, Weishi; Hou, Xiaofei; Qu, Xiaochen; Ma, Yunlong; Yu, Huilei

    2017-01-01

    Mechanical stress and genetic factors play important roles in the occurrence of thoracic ossification of ligament flavum (TOLF), which can occur at one, two, or multiple levels of the spine. It is unclear whether single- and multiple-level TOLF differ in terms of osteogenic differentiation potency and osteogenesis-related gene expression under cyclic mechanical stress. This was addressed in the present study using patients with non‑TOLF and single‑ and multiple‑level TOLF (n=8 per group). Primary ligament cells were cultured and osteogenesis was induced by application of cyclic mechanical stress. Osteogenic differentiation was assessed by evaluating alkaline phosphatase (ALP) activity and the mRNA and protein expression of osteogenesis‑related genes, including ALP, bone morphogenetic protein 2 (BMP2), Runt‑related transcription factor‑2 (Runx‑2), osterix, osteopontin (OPN) and osteocalcin. The application of cyclic mechanical stress resulted in higher ALP activity in the multiple‑level than in the single‑level TOLF group, whereas no changes were observed in the non‑TOLF group. The ALP, BMP2, OPN and osterix mRNA levels were higher in the multiple‑level as compared to the single‑level TOLF group, and the levels of all osteogenesis-related genes, apart from Runx2, were higher in the multiple‑level as compared to the non‑TOLF group. The osterix and ALP protein levels were higher in the multiple‑level TOLF group than in the other 2 groups, and were increased with the longer duration of stress. These results highlight the differences in osteogenic differentiation potency between single‑ and multiple‑level TOLF that may be related to the different pathogenesis and genetic background.

  15. Genetic differences in osteogenic differentiation potency in the thoracic ossification of the ligamentum flavum under cyclic mechanical stress

    PubMed Central

    Ning, Shanglong; Chen, Zhongqiang; Fan, Dongwei; Sun, Chuiguo; Zhang, Chi; Zeng, Yan; Li, Weishi; Hou, Xiaofei; Qu, Xiaochen; Ma, Yunlong; Yu, Huilei

    2017-01-01

    Mechanical stress and genetic factors play important roles in the occurrence of thoracic ossification of ligament flavum (TOLF), which can occur at one, two, or multiple levels of the spine. It is unclear whether single- and multiple-level TOLF differ in terms of osteogenic differentiation potency and osteogenesis-related gene expression under cyclic mechanical stress. This was addressed in the present study using patients with non-TOLF and single- and multiple-level TOLF (n=8 per group). Primary ligament cells were cultured and osteogenesis was induced by application of cyclic mechanical stress. Osteogenic differentiation was assessed by evaluating alkaline phosphatase (ALP) activity and the mRNA and protein expression of osteogenesis-related genes, including ALP, bone morphogenetic protein 2 (BMP2), Runt-related transcription factor-2 (Runx-2), osterix, osteopontin (OPN) and osteocalcin. The application of cyclic mechanical stress resulted in higher ALP activity in the multiple-level than in the single-level TOLF group, whereas no changes were observed in the non-TOLF group. The ALP, BMP2, OPN and osterix mRNA levels were higher in the multiple-level as compared to the single-level TOLF group, and the levels of all osteogenesis-related genes, apart from Runx2, were higher in the multiple-level as compared to the non-TOLF group. The osterix and ALP protein levels were higher in the multiple-level TOLF group than in the other 2 groups, and were increased with the longer duration of stress. These results highlight the differences in osteogenic differentiation potency between single- and multiple-level TOLF that may be related to the different pathogenesis and genetic background. PMID:28004120

  16. AlAr X 2П1/2 Aluminum - argon (1/1)

    NASA Astrophysics Data System (ADS)

    Hüttner, W.

    This document is part of Subvolume A1 'Diamagnetic Diatomic Molecules. Part 1' of Volume 29 'Molecular Constants Mostly from Microwave, Molecular Beam, and Sub-Doppler Laser Spectroscopy' of Landolt-Börnstein - Group II 'Molecules and Radicals'.

  17. Ablation of Porcine Ligamentum Flavum with Ho:YAG, Q-Switched Ho:YAG, and Quadrupled Nd:YAG Lasers

    DTIC Science & Technology

    2015-10-07

    laminectomy;  nerve  pain; spinal canal.      INTRODUCTION    Lumbar  spinal stenosis (LSS) is a condition where a narrowing of the spinal canal causes...Nd:YAG laser was shown to  ablate LF with no gross visible indication of thermal damage to surrounding LF.    Key words:   lumbar  spinal stenosis; LSS...the  compression of important neural structures such as the spinal cord and  nerve  roots. The result is a  spectrum of disorders that can include painful

  18. Transformation of the plant growth regulator daminozide (Alar) and structurally related compounds with CuII ions: oxidation versus hydrolysis.

    PubMed

    Huang, Ching-Hua; Stone, Alan T

    2003-05-01

    As part of a study of metal ion effects on chemical transformations of nitrogen-containing agrochemicals, conversion of daminozide to succinate via cleavage of the hydrazide C-N bond was examined in the presence and absence of divalent metal ions. No conversion was observed in metal ion-free solutions or in the presence of 1.0 mM NiII, ZnII, and PbII. CuII, in contrast, markedly increased rates of daminozide to succinate conversion. Halide ions (CI-, Br-) had no effect on daminozide conversion in the absence of metal ions but markedly increased conversion rates observed in the presence of CuII. The nitrogen-donor ligands ethylenediamine, N-(2-hydroxyethyl)ethylenediamine, and 1,4,7,10-tetraazacyclododecane decreased rates of CuII-facilitated conversion, while 1,5,9-triazacyclododecane actually increased rates of conversion. H NMR and UV spectroscopy provide evidence for the formation of 1:1 CuII-daminozide complexes. Halide ion effects and nitrogen-donor ligand effects point to an oxidative mechanism for CuII-facilitated daminozide breakdown, rather than hydrolysis. The structurally related compound butyric acid 2,2-dimethylhydrazide (BH) is subject to the same CuII-facilitated breakdown via an oxidative mechanism. N,N-Dimethylsuccinamic acid (SA), in contrast, breaks down via a hydrolytic mechanism.

  19. Kepler's Use of Archetypes in his defence against Aristotelian Scepticism

    NASA Astrophysics Data System (ADS)

    Martens, Rhonda M.

    In 1621, looking back over an impresive career, Johannes Kepler commented that "almost every book on astronomy which I have published since that time could be referred to one or another of the important chapters set out in this little book (the Mysterium Cosmographicum) and would contain either an illustration or a completion of it". Kepler viewed the Mysterium, his first book, as the genesis of hist later works; Here the author is focusing on the conceptual foundations it provided for his approach to physical astronomy and the Aristotelian dominant during his time. It turns out that despite Kepler's arowedly Platonic and Pythagorean sympathies, his physical astronomy comports with Aristotle's directives in the Posterior Analytics. Perhaps paradoxically, his arhetypal cosmology as expressed in the Mysterium enabled the merging Platonic and Aristotelian intuitions in his construction of the new astronomy.

  20. A HEL Testbed for High Accuracy Beam Pointing and Control

    DTIC Science & Technology

    2009-07-01

    43  4.1.4.  ALAR ...n wG w f f s w s w π ξ ξ = = = + + = 4.1.4. ALAR The ALAR which is direct drive rotary stage, provides superior angular positioning and velocity...vibrations. Applications of the ALAR include single and multi-axis electro optical sensor testing, missile seeker testing, antenna testing

  1. Interatomic potentials for van der Waals complexes of group 13 metal atoms: AlAr, AlKr, and AlXe

    NASA Astrophysics Data System (ADS)

    Callender, C. L.; Mitchell, S. A.; Hackett, P. A.

    1989-05-01

    Interatomic potential parameters for the ground X1,2 2Π1/2,3/2 and excited B 2Σ+1/2 states of jet-cooled van der Waals complexes of Al atoms with rare gases have been determined from fluorescence excitation and emission spectra. Vibrational numbering in the B states is established from isotopic and rotational broadening of fluorescence excitation line shapes. Bond distances are estimated by comparison with analogous states of alkali-rare gas molecules, and by modeling observed relative emission intensities with calculated Franck-Condon factors. Morse potentials are found to adequately describe the data for the ground states, but for the excited states there are indications of departures from Morse functions at large internuclear distances. Dissociation energies De are estimated from Birge-Sponer extrapolations. Multiplet splittings in Al-rare gas complexes are compared to those in In-rare gas complexes and are discussed in terms of an empirical treatment of spin-orbit coupling, which assumes that the spin-orbit coupling constant for the molecule is the same as that for the atom. The ground X1 state of each Al-rare gas molecule is more stable than that of the analogous In complex, whereas the spin-orbit excited X2 state is less stable. This is explained by the greater mixing between the X1 state and the dissociative A 2Σ+1/2 state for indium over aluminum, caused by the greater spin-orbit coupling constant for the heavier metal.

  2. Range of motion, sacral screw and rod strain in long posterior spinal constructs: a biomechanical comparison between S2 alar iliac screws with traditional fixation strategies

    PubMed Central

    Field, Antony; Ferrara, Lisa A.; Freeman, Andrew L.; Phan, Kevin

    2016-01-01

    Background S1 screw failure and L5/S1 non-union are issues with long fusions to S1. Improved construct stiffness and S1 screw offloading can help avoid this. S2AI screws have shown to provide similar stiffness to iliac screws when added to L3–S1 constructs. We sought to examine and compare the biomechanical effects on an L2–S1 pedicle screw construct of adding S2AI screws, AxiaLIF, L5–S1 interbody support via transforaminal lumbar interbody fusion (TLIF), and to examine the effect of the addition of cross connectors to each of these constructs. Methods Two S1 screws and one rod with strain gauges (at L5/S1) were used in L2–S1 screw-rod constructs in 7 L1-pelvis specimens (two with low BMD). ROM, S1 screw and rod strain were assessed using a pure-moment flexibility testing protocol. Specimens were tested intact, and then in five instrumentation states consisting of: (I) Pedicle screws (PS) L2–S1; (II) PS + S2AI screws; (III) PS + TLIF L5/S1; (IV) PS + AxiaLIF L5/S1; (V) PS + S2AI + AxiaLIF L5/S1. The five instrumentation conditions were also tested with crosslinks at L2/3 and S1/2. Tests were conducted in flexion-extension, lateral bending and axial torsion with no compressive preload. Results S2A1 produces reduced S1 screw strain for flexion-extension, lateral bending and axial torsion, as well as reduced rod strain in lateral bending and axial torsion in comparison to AxiaLIF and interbody instrumentation, at the expense of increased rod flexion-extension strain. Cross-connectors may have a role in further reduction of S1 screw and rod strain. Conclusions From a biomechanical standpoint, the use of the S2AI technique is at least equivalent to traditional iliac screws, but offers lower prominence and ease of assembly compared to conventional sacroiliac stabilization. PMID:28097243

  3. Correlation consistent basis sets for molecular core-valence effects with explicitly correlated wave functions: The atoms B-Ne and Al-Ar

    NASA Astrophysics Data System (ADS)

    Hill, J. Grant; Mazumder, Shivnath; Peterson, Kirk A.

    2010-02-01

    Correlation consistent basis sets have been optimized for accurately describing core-core and core-valence correlation effects with explicitly correlated F12 methods. The new sets, denoted cc-pCVnZ-F12 (n =D, T, Q) and aug-cc-pCF12VnZ (n =D, T, Q, 5), were developed by augmenting the cc-pVnZ-F12 and aug-cc-pVnZ families of basis sets with additional functions whose exponents were optimized based on the difference between all-electron and valence-electron correlation energies. The number of augmented functions added is fewer, in general, than in the standard cc-pCVnZ and cc-pwCVnZ families of basis sets. Optimal values of the geminal Slater exponent for use with these basis sets in MP2-F12 calculations are presented and are also recommended for CCSD-F12b calculations. Auxiliary basis sets for use in the resolution of the identity approximation in explicitly correlated calculations have also been optimized and matched to the new cc-pCVnZ-F12 series of orbital basis sets. The cc-pCVnZ-F12 basis sets, along with the new auxiliary sets, were benchmarked in CCSD(T)-F12b calculations of spectroscopic properties on a series of homo- and heteronuclear first and second row diatomic molecules. Comparing the effects of correlating the outer core electrons in these molecules with those from conventional CCSD(T) at the complete basis set limit, which involved calculations with new cc-pCV6Z basis sets for the second row elements that were also developed in the course of this work, it is observed that the F12 values are reasonably well converged already at just the triple-ζ level.

  4. Effects of Conducting Plane on Band and Choral Musicians' Perceptions of Conductor and Ensemble Expressivity

    ERIC Educational Resources Information Center

    Silvey, Brian A.; Fisher, Ryan A.

    2015-01-01

    The purpose of this study was to examine whether one aspect of conducting technique, the conducting plane, would affect band and/or choral musicians' perceptions of conductor and ensemble expressivity. A band and a choral conductor were each videotaped conducting 1-min excerpts from Morten Lauridsen's "O Magnum Mysterium" while using a…

  5. Effects of Conducting Plane on Band and Choral Musicians' Perceptions of Conductor and Ensemble Expressivity

    ERIC Educational Resources Information Center

    Silvey, Brian A.; Fisher, Ryan A.

    2015-01-01

    The purpose of this study was to examine whether one aspect of conducting technique, the conducting plane, would affect band and/or choral musicians' perceptions of conductor and ensemble expressivity. A band and a choral conductor were each videotaped conducting 1-min excerpts from Morten Lauridsen's "O Magnum Mysterium" while using a…

  6. After liber novus.

    PubMed

    Shamdasani, Sonu

    2012-06-01

    This paper reflects on the conference question concerning the clinical and theoretical significance of Jung's Liber Novus, two years after its initial publication, and looks at how Jung himself reflected upon it and how it informed his turn to alchemy, with particular attention to the theme of opposites and their reconciliation in Liber Novus, later taken up in Mysterium Coniunctionis.

  7. Biomechanical analysis for the epidural needle insertion.

    PubMed

    Furuya, K; Naemura, K; Nagai, K; Okubo, N; Saito, H

    2013-01-01

    In order to test the hypothesis about reduction in the deformation of the ligamentum flavum due to tension inside the ligamentum flavum, nonlinear finite element (FE) analysis was employed. As a preliminary analysis of natural tissue, nonlinear FE analysis was applied to a rubber plate. Assuming that the rubber is third-order Mooney-Rivlin model, the analysis and the experimental curves overlap with each other until pierced point. The maximum major strain calculated by FE analysis was feasible to predict pierced point. To apply nonlinear FE analysis for the porcine ligamentum flavum, the Mooney-Rivlin coefficient of the porcine ligamentum flavum was identified from the tensile test data. Assuming that the sharp bar pierced the ligamentum flavum when the maximum major strain reached a constant value, the required displacement became shorter by 1.0mm by applying the initial tension.

  8. Evaluation and Improvement of Spectral Features for the Detection of Buried Explosive Hazards Using Forward-Looking Ground-Penetrating Radar

    DTIC Science & Technology

    2012-07-01

    ROC) curves, and Section 5 is the conclusion. 1.1 ALARIC FLGPR The FLGPR images we use in this paper were collected using a system called ALARIC ...classifier Figure 1. FLGPR explosive hazard detection block diagram The ALARIC system is equipped with an accurate GPS system. As a result, it...the 32 T/R images which adaptively suppresses artifacts such as sidelobes and aliasing ghosts. Table 1 contains the parameters of the ALARIC FLGPR

  9. Mästlin, Michael (1550-1631)

    NASA Astrophysics Data System (ADS)

    Murdin, P.

    2000-11-01

    Born in Göppingen, Germany, taught by, and an assistant to, PETER APIAN, became professor of astronomy at Tubingen, where he taught the Copernican as well as the Ptolemaic system. He taught KEPLER, and helped him to publish his first work, Mysterium Cosmographicum (1596). He made his own astronomical instruments. He was one of the first three or four astronomers to see in Cassiopeia what is now ...

  10. In Vitro and In Vivo Studies of Alar-Nasal Cartilage Using Autologous Micro-Grafts: The Use of the Rigenera® Protocol in the Treatment of an Osteochondral Lesion of the Nose

    PubMed Central

    Ceccarelli, Gabriele; Gentile, Pietro; Marcarelli, Marco; Balli, Martina; Ronzoni, Flavio Lorenzo; Benedetti, Laura; Cusella De Angelis, Maria Gabriella

    2017-01-01

    Cartilage defects represent a serious problem due to the poor regenerative properties of this tissue. Regarding the nose, nasal valve collapse is associated with nasal blockage and persistent airway obstruction associated with a significant drop in the quality of life for patients. In addition to surgical techniques, several cell-based tissue-engineering strategies are studied to improve cartilage support in the nasal wall, that is, to ameliorate wall insufficiency. Nevertheless, there are no congruent data available on the benefit for patients during the follow-up time. In this manuscript, we propose an innovative approach in the treatment of cartilage defects in the nose (nasal valve collapse) based on autologous micro-grafts obtained by mechanical disaggregation of a small portion of cartilage tissue (Rigenera® protocol). In particular, we first analyzed in vitro murine and human cartilage micro-grafts; secondly, we analyzed the clinical results of a patient with pinched nose deformity treated with autologous micro-grafts of chondrocytes obtained by Rigenera® protocol. The use of autologous micro-graft produced promising results in surgery treatment of cartilage injuries and could be safely and easily administrated to patients with cartilage tissue defects. PMID:28608799

  11. Biomechanical Comparison of Sacral Fixation Characteristics of Standard S1-Pedicle Screw Fixation versus a Novel Constrained S1-Dual-Screw Anchorage in the S1-Pedicle and S1-Alar Bone.

    PubMed

    Mayer, Michael; Stephan, Daniel; Resch, Herbert; Augat, Peter; Auffarth, Alexander; Blocher, Martina; Ernstbrunner, Lukas; Hitzl, Wolfgang; Defossez, Henri; Rouge, Renaud; Koller, Heiko

    2015-12-01

    Biomechanical Laboratory Study. Analysis of the biomechanical characteristics of a novel sacral constrained dual-screw fixation device (S1-PALA), combining a S1-pedicle screw and a S1-ala screw, compared to a standard bicortical S1-pedicle screw (S1-PS) fixation. Instrumented fusions to the sacrum are biomechanically challenging and plagued by a high risk of nonunion when S1-PS is used as the sole means of fixation. Thus, lumbopelvic fixation is increasingly selected instead, although associated with a reasonable number of instrumentation-related complications. Around 30 fresh-frozen human sacral bones were harvested and embedded after CT scans. Instrumentation was conducted in alternating order with bicortical 7.0 mm S1-PS and with the S1-PALA including a S1-PS screw and a S1-ala screw, of 7.0 and 6.0 mm diameter, respectively. Specimens were subjected to cyclic loading with increasing loads (25-250 N) until a maximum of 2000 cycles or displacement >2 mm occurred. All implant sacral units (ISUs) were subject to coaxial pullout tests. Failure load, number of ISUs surpassing 2000 cycles, number of cycles, and loads at failure were recorded and compared. Donors' age averaged 77 ± 14.2 years, and BMD was 115 ± 64.8 mgCA-HA/ml. Total working length of screws implanted was 90 ± 8.6 mm in the S1-PALA group and 46 ± 5 mm in the S1-PS group (P = 0.0002). In the S1-PALA group, displacement >2 mm occurred after 845 ± 325 cycles at 149 ± 41 N compared to 512 ± 281 cycles at 106 ± 36 N in the S1-PS group (P = 0.004; P = 0.002). In coaxial pull-out testing, failure load was 2118.1 ± 1166 N at a displacement of 2.5 ± 1 mm in the S1-PALA group compared to 1375.6 ± 750.1 N at a displacement of 1.6 ± 0.5 mm in the S1-PS group (P = 0.0007; P = 0.0003). The novel sacral constrained dual-screw anchorage (S1-PALA) significantly improved holding strength after cyclic loading compared to S1-PS. The S1-PALA demonstrated mechanical potential as a useful adjunct in the armamentarium of lumbosacral fixations indicated in cases that need advanced construct stability, but where instrumentation to the ilium or distal dissection to S2 should be avoided. N/A.

  12. Locally Adaptive Detection Algorithm for Forward-Looking Ground-Penetrating Radar

    DTIC Science & Technology

    2011-02-22

    the ground. This results in an excessive number of FAs. The FLGPR images we present in this paper were collected by a system called ALARIC . This...intelligence, surveillance and reconnaissance (ISR) applications. The ALARIC system is equipped with an accurate GPS system. As a result, we are capable...effective system for improving the detection capabilities of the ALARIC system. Figure 5 showed that the locally- adaptive prescreener not only enabled

  13. Detection of Explosive Hazards Using Spectrum Features From Forward-Looking Ground Penetrating Radar Imagery

    DTIC Science & Technology

    2011-01-01

    applications such as a vehicle traveling a road in which mines are buried. The data used for this paper was collected in this way. A system called ALARIC ...research. The ALARIC system used to collect the data for our research is still under development. Currently, more field tests are being conducted to...improve the system. Our algorithms were developed using the limited amount of data so far collected by ALARIC . These data have given us a chance to

  14. Application of the Flexible CO2 Laser in Minimally Invasive Laminectomies: Technical Note

    PubMed Central

    Perez-Cruet, Mick

    2016-01-01

    Background Minimally invasive laminectomy is a very effective surgical method for treating lumbar stenosis. However, this technique can be technically difficult, especially in patients suffering from severe stenosis. The contralateral decompression from a unilateral approach can result in durotomy during removal of the hypertrophied ligamentum flavum. This complication can be difficult to treat through a small working channel. Objective To detail our group’s operative experience with the CO2 laser and discuss our results and previous studies in the literature reporting results.  Methods The CO2 laser (Omniguide, Boston, MA) was investigated in the surgical ablation of the contralateral ligamentum flavum during minimally invasive laminectomies. Forty levels have been investigated thus far. The amount of voltage needed to adequately desiccate and remove the ligamentum flavum safely as well as the effectiveness of this technique were investigated. Results The contralateral ligamentum flavum could be removed effectively using the 9 to 11 watt continuous wavelength (10,600 nanometer) power setting on the CO2 laser. Shrinkage of the contralateral ligamentum flavum facilitated its removal using a number 2 Kerrison Punch. No durotomies occurred, and the use of the laser did not significantly lengthen operative times.  Conclusions The CO2 laser appears to be a useful tool in the armamentarium of instruments available to the minimally invasive spine surgeon and may help to reduce the incidence of durotomies when performing minimally invasive laminectomies. PMID:27433407

  15. An unusual course of the left recurrent laryngeal nerve.

    PubMed

    Khaki, Amir A; Tubbs, R Shane; Shoja, Mohammadali M; Zarrintan, Sina

    2007-04-01

    Variation in the course of the left recurrent laryngeal nerve is seemingly very rare. During the routine dissection of an adult male cadaver, the entire left recurrent laryngeal nerve after branching from the left vagus nerve was noted to travel medial to the ligamentum arteriosum. We hypothesize that this rare variation may occur, if the left recurrent laryngeal nerve passes inferior to the fifth rather than the sixth aortic arch during embryological development. As our case report demonstrates, the relationship between the ligamentum arteriosum and the left recurrent laryngeal nerve is not absolute. Although seemingly rare, cardiothoracic surgeons must consider variations of the left recurrent laryngeal nerve during surgical procedures in the region of the ligamentum arteriosum in order to minimize potential postoperative complications.

  16. Johannes Kepler and David Fabricius: Their Discussion on the Nova of 1604

    NASA Astrophysics Data System (ADS)

    Granada, Miguel A.

    David Fabricius (1564-1617) was one of the most important astronomers in the period between 1596, the year of publication of Kepler's Mysterium cosmographicum, and 1609, the year of publication of the Astronomia nova.1 Kepler praised Fabricius as the most accurate observational astronomer after Tycho Brahe's death in 1601.2 Fabricius was a Reformed pastor in Ostfriesland (East Frisia), his remote natal region, and a vocational astronomer. He published nothing in the field of astronomy except for the short treatises between 1604 and 1606 concerning the nova that appeared in October 1604 in Serpentarius.

  17. Kepler-Astronomer in Astrology and Astrologer in Astronomy

    NASA Astrophysics Data System (ADS)

    Fempl-Madjarevic, Jasna

    The author is discussing a very complicated subject: the astrological aspects in the scientific activity of Johannes Kepler. Sometimes Kepler is considered the last astronomer which confused astrology with astronomy. In fact he composed horoscopes, but he was conscious finally that the astrology was a confusion. The author is discussing also the mistic aspects of the scientifc creation by Kepler. Particularly she emphasized that the "Mysterium Cosmographicum" is one of such works. Meanwhile, that work led to discovery of famous third laws of planets motion.

  18. [Significance of umbilical and paraumbilical veins as collaterals in portal hypertension].

    PubMed

    Lin, G

    1989-08-01

    Twenty-one postmortem specimens of the liver (18 normal livers, 3 liver metastases) with attached ligamentum teres were investigated using silicone rubber injection technique. In all cases, the paraumbilical veins were demonstrated. They were usually divided into 2 groups, one on the right and the other on the left side of the ligamentum teres, and they terminated in a variable manner into small peripheral portal vein branches in the liver parenchyma. A patent proximal segment of the umbilical vein was found in 7 of the 21 cases. Connections between the umbilical vein and paraumbilical veins were supposed to represent one of the collateral channels in portal hypertension.

  19. A Flexible Distributed Scheduling Scheme for Dynamic ESG Environments

    DTIC Science & Technology

    2006-06-01

    Branke, and H. Abbass, “Multi-objective opti- mization for dynamic environments”, The Artificial Life and Adaptive Robotics Laboratory ALAR Technical...Report Series TR- ALAR -200504007, Northcott Drive, Campbell, Canberra, Aus- tralia, 2005. [27] K. Yamasaki, “Dynamic Pareto optimum GA against the changing

  20. Improved Detection and False Alarm Rejection Using FLGPR and Color Imagery in a Forward-Looking System

    DTIC Science & Technology

    2010-01-01

    called ALARIC . This system is an FLGPR system that is composed of a physical array of sixteen receivers and two transmitters. In the past decade...for airborne intelligence, surveillance and reconnaissance (ISR) applications. The ALARIC system is equipped with an accurate GPS system. As a result

  1. A visit paid to Jung by Alwine von Keller.

    PubMed

    Bernardini, Riccardo; Quaglino, Gian Piero; Romano, Augusto

    2011-04-01

    In the winter of 1943-1944, Jung had suffered a coronary thrombosis which almost cost him his life. During his illness, Jung experienced a series of visions, described in his Memories, Dreams, Reflections, which were also to influence significantly the development of his theoretical thinking. On 27(th) September 1944, Alwine von Keller (1878-1965) paid a visit to Jung, while he was still convalescing, in Zurich and documented her meeting with him in a series of notes, recently discovered, which testify to the fact that, at the time of their meeting, Jung was engaged in writing the 'Salt' chapter of Mysterium coniunctionis and investigating the alchemistic symbolism of the 'sea'. This theme seems to testify to a continuity of interests on Jung's part with the seminar he held at Eranos the previous year on the cartographic art of Opicinus de Canistris (1296-c.1352). With its addition of many unpublished details, Alwine von Keller's notes supplement the report which Jung made of his visions experienced during his sickness in MDR. In particular, these attest to the fact that Jung had attributed the terrible experience which he had endured to the problem of the conjunctio, which was confronting him from the theoretical point of view in his writing of Mysterium coniunctionis. © 2011, The Society of Analytical Psychology.

  2. Right aortic arch with aberrant left subclavian artery symptomatic in adulthood.

    PubMed

    Bashar, Abul Hasan Muhammad; Kazui, Teruhisa; Yamashita, Katsushi; Terada, Hitoshi; Washiyama, Naoki; Suzuki, Kazuchika

    2006-07-01

    Congenital malformations of the aortic arch are rarely found in adulthood. We describe three cases of right aortic arch with aberrant left subclavian artery with left-sided ligamentum arteriosum presenting in adulthood as vascular rings with symptoms of tracheal compression. Varying presentation as well as surgical strategy which was individualized according to the pathological anatomy of each case are discussed.

  3. Lower lateral crural reverse plasty.

    PubMed

    Kubilay, Utku; Azizli, Elad; Erdoğdu, Suleyman

    2013-11-01

    The lateral crus plays a significant role in the aesthetic appearance of the nose. Excessive concavities of the lower lateral crura can lead to heavy aesthetic disfigurement of the nasal tip and to insufficiencies of the external nasal valve. The lateral crus of the alar cartilage may also cause a concavity of the alar rim and even collapse of the alar rim in severe cases. Surgical techniques performed on the lateral crus help to treat both functional and aesthetic deformities of the lateral nasal tip. We present a reverse plasty technique for the lateral crus, and we evaluated the advantages and disadvantages of the technique.

  4. Yes You Can! Personal Experience of Writing for "School Science Review"

    ERIC Educational Resources Information Center

    Thompson, Alaric; Auty, Geoff

    2013-01-01

    Alaric Thompson describes his experience of writing for "School Science Review" for the first time in the hope that his experience will encourage others. Geoff Auty introduces his piece and explains how it came about.

  5. Yes You Can! Personal Experience of Writing for "School Science Review"

    ERIC Educational Resources Information Center

    Thompson, Alaric; Auty, Geoff

    2013-01-01

    Alaric Thompson describes his experience of writing for "School Science Review" for the first time in the hope that his experience will encourage others. Geoff Auty introduces his piece and explains how it came about.

  6. A Journal of travel of an astrophysicist

    NASA Astrophysics Data System (ADS)

    Gaina, Alex B.

    2015-06-01

    The authors is descibing personal impressions from a number of scientific conferences took between 1993 and 1998 in Trieste (ICTP,with the participation of 2 Nobel Laureats Winners: Professor Abdus Salam (1926-1996) and Professor Gert t'Hooft), Catania astrophysical Observatory and University (1995-JENAM 1995), Athens Observatory and University (1996-Wide Field Spectroscopy), Prague Technicke Museum (1996- Symposium "Mysterium Cosmographicum"),Prague technical University (1998 -JENAM 1998),which in fact contained also a trip to Nicolaus Copernicus Astronomical Center in Torun (Poland). Besides,some details on trips through Ukraine, Poland, Serbia, where a kind meeting with astronomers from Belgrade took place in 1995, former Yugoslav Countries: Monetnegro, Slovenija and Croatia, Bulgaria, where another meeting with physicists from the Academy of Sciences of Bulgaria took place has been given also.

  7. Cosmological Theories at the time of Tycho Brahe

    NASA Astrophysics Data System (ADS)

    Hadravova, Alena; Hadrava, Petr

    The basic task of astronomy till the epoch of Kepler was to create a model of the Solar system which would agree with observations and simultaneously be self -consistent. From the observational point of view the geocentric and heliocentric theories were equivalent and for a suitable choice of free parameters represented by the system of epicicles they could agree with Kepler's laws to any accuracy. The main advantage of Copernicus'system was its deeper consistency manifesting itself by smaller number of free parameters. This was achieved on behalf of intuitively accepted physical ideas. The comromising system of Tycho was able to save an essential part of these ideas and, moreover, to overcome the disageement of Copernicus's system with observational limits on stellar parallaxes. On the other hand, the Kepler's model from Mysterium cosmographicum was an attempt to derive all free parameters from very basic geometric symmetries. Such an idea provides deep motivation even for today's cosmology.

  8. Jung's quest for the Aurora consurgens.

    PubMed

    Haaning, Aksel

    2014-02-01

    The paper focuses on the year 1929 when Jung published 'A European commentary' to Richard Wilhelm's German translation of the Taoist text The Secret of the Golden Flower. This shows that Jung had already started on the track of European alchemy by following up Conrad Waldkirch's preface in Artis Auriferae (1593); and it raises the question of whether this could be the possible missing link to Jung's subsequent research in Alchemy and Hermetic Philosophy in the years to come. It is argued that here was the beginning of Jung's quest for the Aurora consurgens, the publication of which concludes the Mysterium Conuinctionis more than twenty years later. It is further maintained that this choice of the Aurora is a profound expression of Jung's ambition to revitalize the past from within the individual, and helps explain Jung's deep concern with the welfare and future of modern society.

  9. Kepler's response to the Mystery: a New Cosmographical Epistemology

    NASA Astrophysics Data System (ADS)

    Bennett, Bryce

    The author is pointing out that "Mysterium Cosmographycum" was the first major publication after Copernicus'"De Revolutionibus" to argue for heliocentrism. Expanding on the arguments of Copernicus and Rheticus, Kepler emphasizes the logical simplification and causal interconnnectedness of the individual planetary hypotheses afforded by heliocentrism. Kepler calls himself a follower of Copernicus, and this is accurate insofar as he adopts the Copernican tenets of the immobility of the sun and the multiple motions of the Earth. The scope of the arguments in support of heliocentrism is vastly expanded by Kepler. For he realizes that a consistent unification of the principles of physics and astronomy, and the subsequent constraining of hypotheses to these combined principles, is the means of distinguishing the true form of the world from those that are true in respect to appearences only. A similar epistemological analysis of the "Astronomia Nova" has been given also. Throughout the paper the author is citing also "Apologia".

  10. From Cosmos to Confession: Kepler and the Connection Between Astronomical and Religious Truth

    NASA Astrophysics Data System (ADS)

    Rothman, Aviva

    In October of 1595, Johannes Kepler joyfully conveyed to Tübingen the news that he had completed his first book, the Mysterium cosmographicum. "I truly desire," he wrote to Michael Maestlin, his former professor of mathematics, "that these things are published as quickly as possible for the glory of God, who wants to be known from the Book of Nature […]. I wanted to be a theologian; for a long time I was distressed: behold God is now celebrated too in my astronomical work."1 Unable to devote himself to the Book of Scripture directly,2 Kepler had turned his focus to God's other book - the Book of Nature - which, he believed, also revealed God's providential plan.

  11. Jung and the Kabbalah.

    PubMed

    Drob, S L

    1999-05-01

    Jung's use of Kabbalistic symbols and ideas as well as his personal Kabbalistic vision are critically examined. It is argued that as great as Jung's acknowledged affinity is to the Kabbalah, his unacknowledged relationship was even greater. Jung has been accused of being a contemporary Gnostic; however, the interpretations Jung placed on Gnosticism and the texts Jung referred to on alchemy were profoundly Kabbalistic, so much so that one would be more justified in calling the Jung of the Mysterium Coniunctionis and other late works a Kabbalist in contemporary guise. Although Jung, at least during the 1930s, appears to have had powerful motives that limited his receptivity to Jewish ideas, his highly ambivalent and at times reproachable attitude toward Judaism should not prevent one from appreciating the affinities between Jungian psychology and Jewish mystical thought.

  12. Kepler's Theory of Highly Symmetric Plane Figures and Solids

    NASA Astrophysics Data System (ADS)

    Betsch, Gerhard

    The main idea of Kepler's Mysterium Cosmographicum of 1596 involves the five regular "Platonic" polyhedra. Hence it seems appropriate to discuss Kepler's considerations on, or his "theory" of regular plane figures and solids. This is a key aspect of his "geometrical cosmology". In modern mathematics the regularity of figures and solids is normally expressed in terms of symmetries and symmetry groups. Although Kepler himself does not speak of symmetries, the author is applying at some points the modern, admittedly anachronistic terminology. This seems to be justified, because here is presented a mathematician's view rather than a historical discourse. The tradition of plane regular figures and regular solids, from antiquity to Kepler's time, and the sourses of Kepler's mathematics have been thoroughly investigated by Hofmann and Fields.

  13. Kepler's winding Path to true Heliocentrism

    NASA Astrophysics Data System (ADS)

    Bialas, Volker

    The paper concerns the evolution of concepts by Johannes Kepler from Aristotelian conception of the Universe to Heliocentrism. Already as young Magister in Tubingen Kepler has taken an active part in Physical disputations of the candidates and has defended the doctrines of Copernik (1). In the Mysterium Cosmographicum he refers the planetary distances no longer to the center of the earth's orbit, but to the center of the true sun. But just by working out his Astronomia Nova Kepler succeeds in creating a strictly heliocentric astronomy as his handwriting Manuscripts give detailed information (2). Notes: 1) fragmentum orations de motu terrae. In Keppler Gesammelte werke Vol. 20.1, Munich 1988, p. 147-149 2) Commentaria in Theoriam Martis. Edition in: Kepler Gessamelete Werke Vol. 20.2 (in preparation)

  14. Kepler's Cosmos And The Lathe Of Heaven

    NASA Astrophysics Data System (ADS)

    Brecher, Kenneth

    2011-01-01

    Johannes Kepler's Mysterium Cosmographicum, published in 1596, presented his vision of the geometrical structure of the solar system. Kepler sought to account for the number of planets, thought to be six, as well as their orbital radii. He assigned orbits to the planets in three-dimensional space. Kepler proposed that the planets move on six spheres inscribed within and circumscribed around the five platonic solids. How did he arrive at his model? By his own account reported in the book, the central idea occurred to him while giving a lecture about planetary conjunctions. But was this revelation the origin of the model? In this presentation, we discuss the artistic, scientific and mathematical environment in which Kepler was immersed in late 16th century Europe. Examples will be shown of some of the readily available inscribed polyhedra that he may have seen - printed in widely circulated books, included in well-known paintings and engravings, and displayed as three dimensional ornamentally turned sculptures. It is highly likely that he saw such physical models five years later while in the employ of Rudolf II who was an avid ornamental turner. Layered polyhedral ivory turnings were made by the nobility with what were then fairly common lathes. Kepler himself wanted to have his own celestial model made into a punch bowl! Therefore, it seems plausible that Kepler had seen models of inscribed platonic solids well before 1596. Later in life Kepler reprinted the Mysterium Cosmographicum with very little fundamental change in its outlook, even after having found what we now call Kepler's three laws of planetary motion. His interest in nested polyhedra may well have preceded any astronomical evidence or geometrical reasoning, arising from artistic and aesthetic encounters that occurred early in his life. Project LITE is supported by the NSF through DUE Grant # 0715975.

  15. "Don juan-fracture" as a hint to aortic isthmus rupture.

    PubMed

    Suksompong, Sirilak; von Bormann, Benno

    2014-01-01

    We report a case of thoracic aortic rupture after blunt trauma in a 23-year-old male patient. The initial investigation found no external injury or bleeding, only a slightly widened mediastinum and a broken left calcaneus. Abdominal lavage was negative, biochemistry was normal, and breathing and oxygenation were not compromised. When changing his position during diagnostics, the patient all of a sudden developed cardiac arrest and typical signs of hypovolemic shock. An immediate sternotomy was done without any further diagnostics on suspicion of aortic isthmus injury. A circular avulsion at the ligamentum arteriosum was found as assumed and repaired under cardiopulmonary bypass. The patient left the hospital for rehabilitation after 12 days in adequate health status. Biodynamics of blunt trauma after high-speed frontal impact and the relationship between calcaneus fracture, called "Don-Juan fracture," and aortic rupture at the site of ligamentum arteriosum are discussed.

  16. The posterior ligamentous complex inflammatory syndrome: spread of fluid and inflammation in the retrodural space of Okada.

    PubMed

    Lehman, V T; Murthy, N S; Diehn, F E; Verdoorn, J T; Maus, T P

    2015-05-01

    The retrodural space of Okada is situated dorsal to the ligamentum flavum in the interlaminar space, and provides communication between contralateral facet joints. MRI will often demonstrate heterogeneous signal abnormality with contrast enhancement in this space and several communicating compartments of the posterior ligamentous complex: bilateral facet joints, adventitial interspinous bursae, or retrodural cysts penetrating the ligamentum flavum. Pars interarticularis defects are frequently present. This imaging pattern may be associated with axial low back pain and/or radicular pain. Recognition of this pattern at MRI has distinct implications for image interpretation, unifying prior reports of involvement of individual components of the posterior ligamentous complex. Its recognition will also affect planning for therapeutic interventional pain procedures. We refer to this constellation of imaging and clinical findings as posterior ligamentous complex inflammatory syndrome (PLCIS). Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  17. An arthroscopic hip documentation form.

    PubMed

    Gokhale, Satesh; Khan, Munir; Kuiper, Jan-Herman; Richardson, James B; Davies, Jonathan P

    2008-07-01

    Hip arthroscopy is becoming increasingly popular. A simple, precise, and practical means of recording arthroscopic findings will be useful for diagnostic, research, and audit purposes. Basic principles of cartography exist to produce two-dimensional paper representations of our spherical planet. We used the same principles to produce a two-dimensional map of the acetabulum and femoral head. The resulting hip diagram shows the acetabulum as viewed from the side and the femoral head as viewed from above. The ligamentum teres is attached to the medial margin of the head. The head-neck junction and part of the femoral neck is shown at the opposite margin of the ligamentum teres. The hip documentation form is simple, precise, and accurate. We use it to record our findings at hip arthroscopy, which we have used to assist us in our practice.

  18. “Don Juan-Fracture” as a Hint to Aortic Isthmus Rupture

    PubMed Central

    Suksompong, Sirilak; von Bormann, Benno

    2014-01-01

    We report a case of thoracic aortic rupture after blunt trauma in a 23-year-old male patient. The initial investigation found no external injury or bleeding, only a slightly widened mediastinum and a broken left calcaneus. Abdominal lavage was negative, biochemistry was normal, and breathing and oxygenation were not compromised. When changing his position during diagnostics, the patient all of a sudden developed cardiac arrest and typical signs of hypovolemic shock. An immediate sternotomy was done without any further diagnostics on suspicion of aortic isthmus injury. A circular avulsion at the ligamentum arteriosum was found as assumed and repaired under cardiopulmonary bypass. The patient left the hospital for rehabilitation after 12 days in adequate health status. Biodynamics of blunt trauma after high-speed frontal impact and the relationship between calcaneus fracture, called “Don-Juan fracture,” and aortic rupture at the site of ligamentum arteriosum are discussed. PMID:25478249

  19. [Kommerell diverticula associated with dysphagia: a clinical case and review of the literature].

    PubMed

    Ferreira, Ricardo; Gallego, Javier; Roque, J; Pereira, R A; Mendes, M; Nobre, A; Cravino, J

    2008-01-01

    We report the case of a young female with disphagia and weigth loss caused by a vascular ring associated with right aortic arch, Kommerell diverticula, and left retroesophageal ligamentum arteriosum (ductus arteriosus). The patient underwent surgical treatment. A left thoracotomy was performed. Surgical technique included diverticulum ressection and an aortopexia. There were no major complications. We also discuss the incidence, pathology, diagnosis, clinical features and treatment of this rare disease.

  20. Thoracoscopic correction of a congenital persistent right aortic arch in a young cat

    PubMed Central

    Plesman, Rhea; Johnson, Matthew; Rurak, Sarah; Ambrose, Barbara; Shmon, Cindy

    2011-01-01

    A 9-week-old kitten was diagnosed with a congenital vascular ring anomaly by means of an esophageal contrast study. At 6 mo of age, a non-selective vascular study was used to diagnose a persistent right aortic arch (PRAA). Left-sided thoracoscopic surgery was performed, using a Liga-Sure vessel sealant device to seal and transect the ligamentum arteriosum. PMID:22467970

  1. Cervical Laminoplasty for Multilevel Cervical Myelopathy

    PubMed Central

    Sayana, Murali Krishna; Jamil, Hassan; Poynton, Ashley

    2011-01-01

    Cervical spondylotic myelopathy can result from degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multi-level myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Laminoplasty was major surgical advancement as laminectomy resulted in kyphosis and unsatisfactory outcomes. Hirabayashi popularised the expansive open door laminoplasty which was later modified several surgeons. Laminoplasty has changed the way surgeons approach multilevel cervical spondylotic myelopathy. PMID:21991408

  2. Surgical management in paediatric patients with left abnormal subclavian artery and right aortic arch.

    PubMed

    Sodian, R; Rassoulian, D; Kaczmarek, I; Kozlik-Feldmann, R; Huber, A; Reichart, B; Daebritz, S

    2007-06-01

    Left abnormal subclavian artery and right aortic arch is described as a rare cause of dyspnoea and dysphagia in paediatric patients. The optimal surgical management of such cases is not clearly established. We propose a single-stage repair by transection of the patent ductus arteriosus or ligamentum arteriosum and an additional transection of the left abnormal subclavian artery with reimplantation into the common carotid artery.

  3. Spinal cord injury after blunt cervical spine trauma: correlation of soft-tissue damage and extension of lesion.

    PubMed

    Martínez-Pérez, R; Paredes, I; Cepeda, S; Ramos, A; Castaño-León, A M; García-Fuentes, C; Lobato, R D; Gómez, P A; Lagares, A

    2014-05-01

    In patients with spinal cord injury after blunt trauma, several studies have observed a correlation between neurologic impairment and radiologic findings. Few studies have been performed to correlate spinal cord injury with ligamentous injury. The purpose of this study was to retrospectively evaluate whether ligamentous injury or disk disruption after spinal cord injury correlates with lesion length. We retrospectively reviewed 108 patients diagnosed with traumatic spinal cord injury after cervical trauma between 1990-2011. Plain films, CT, and MR imaging were performed on patients and then reviewed for this study. MR imaging was performed within 96 hours after cervical trauma for all patients. Data regarding ligamentous injury, disk injury, and the extent of the spinal cord injury were collected from an adequate number of MR images. We evaluated anterior longitudinal ligaments, posterior longitudinal ligaments, and the ligamentum flavum. Length of lesion, disk disruption, and ligamentous injury association, as well as the extent of the spinal cord injury were statistically assessed by means of univariate analysis, with the use of nonparametric tests and multivariate analysis along with linear regression. There were significant differences in lesion length on T2-weighted images for anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum in the univariate analysis; however, when this was adjusted by age, level of injury, sex, and disruption of the soft tissue evaluated (disk, anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum) in a multivariable analysis, only ligamentum flavum showed a statistically significant association with lesion length. Furthermore, the number of ligaments affected had a positive correlation with the extension of the lesion. In cervical spine trauma, a specific pattern of ligamentous injury correlates with the length of the spinal cord lesion in MR imaging studies

  4. The hip joint: the fibrillar collagens associated with development and ageing in the rabbit

    PubMed Central

    BLAND, YVETTE S.; ASHHURST, DOREEN E.

    2001-01-01

    The fibrillar collagens associated with the articular cartilages, joint capsule and ligamentum teres of the rabbit hip joint were characterised from the 17 d fetus to the 2-y-old adult by immunohistochemical methods. Initially the putative articular cartilage contains types I, III and V collagens, but when cavitation is complete in the 25 d fetus, type II collagen appears. In the 17 d fetus, the cells of the chondrogenous layers express type I collagen mRNA, but not that of type II collagen. Types III and V collagens are present throughout life, particularly pericellularly. Type I collagen is lost. In all respects, the articular cartilage of the hip joint is similar to that of the knee. The joint capsule contains types I, III and V collagens. In the fetus the ligamentum teres contains types I and V collagens and the cells express type I collagen mRNA; type III collagen is confined mainly to its surface and insertions. After birth, the same distribution remains, but there is more type III collagen in the ligament, proper. The attachment to the cartilage of the head of the femur is marked only by fibres of type I collagen traversing the cartilage; the attachment cannot be distinguished in preparations localising types III and V collagens. The attachment to the bone at the lip of the acetabulum is via fibres of types I and V collagens and little type III is present. The ligament is covered by a sheath of types III and V collagens. Type II collagen was not located in any part of the ligamentum teres. The distribution of collagens in the ligamentum teres is similar to that in the collateral ligaments of the knee. Its insertions are unusual because no fibrocartilage was detected. PMID:11215763

  5. Adaptive spatial compounding for improving ultrasound images of the epidural space on human subjects

    NASA Astrophysics Data System (ADS)

    Tran, Denis; Hor, King-Wei; Kamani, Allaudin; Lessoway, Vickie; Rohling, Robert N.

    2008-03-01

    Administering epidural anesthesia can be a difficult procedure, especially for inexperienced physicians. The use of ultrasound imaging can help by showing the location of the key surrounding structures: the ligamentum flavum and the lamina of the vertebrae. The anatomical depiction of the interface between ligamentum flavum and epidural space is currently limited by speckle and anisotropic reflection. Previous work on phantoms showed that adaptive spatial compounding with non-rigid registration can improve the depiction of these features. This paper describes the development of an updated compounding algorithm and results from a clinical study. Average-based compounding may obscure anisotropic reflectors that only appear at certain beam angles, so a new median-based compounding technique is developed. In order to reduce the computational cost of the registration process, a linear prediction algorithm is used to reduce the search space for registration. The algorithms are tested on 20 human subjects. Comparisons are made among the reference image plus combinations of different compounding methods, warping and linear prediction. The gradient of the bone surfaces, the Laplacian of the ligamentum flavum, and the SNR and CNR are used to quantitatively assess the visibility of the features in the processed images. The results show a significant improvement in quality when median-based compounding with warping is used to align the set of beam-steered images and combine them. The improvement of the features makes detection of the epidural space easier.

  6. Dysphagia after arteria lusoria dextra surgery: Anatomical considerations before redo-surgery

    PubMed Central

    Mayer, Judith; van der Werf-Grohmann, Natascha; Kroll, Johannes; Spiekerkoetter, Ute; Stiller, Brigitte; Grohmann, Jochen

    2017-01-01

    Aberrant right subclavian artery (arteria lusoria) is the most common congenital root anomaly, remaining asymptomatic in most cases. Nevertheless, some of the 20%-40% of those affected present tracheo-esophageal symptoms. We report on a 6-year-old previously healthy girl presenting with progressive dysphagia over 4 wk. Diagnostics including barium swallow, echocardiography and magnetic resonance angiography (MRA) revealed a retro-esophageal compression by an aberrant right subclavian artery. Despite the successful, uneventful transposition of this arteria lusoria to the right common carotid via right-sided thoracotomy, the girl was suffering from persisting dysphagia. Another barium swallow showed the persistent compression of the esophagus on the level where the arteria lusoria had originated. As MRA showed no evidence of a significant re-obstruction by the transected vascular stump, we suspected a persisting ligamentum arteriosum. After a second surgical intervention via left-sided thoracotomy consisting of transecting the obviously persisting ligamentum and shortening the remaining arterial stump of the aberrant right subclavian artery, the patient recovered fully. In this case report we discuss the potential relevance of a persisting ligamentum arteriosum for patients with left aortic arch suffering from dysphagia lusoria and rational means of diagnosing, as well as the surgical options to prevent re-do surgery. PMID:28289534

  7. Unusual vascular ring anomaly associated with a persistent right aortic arch in two dogs.

    PubMed

    House, A K; Summerfield, N J; German, A J; Noble, P J M; Ibarrola, P; Brockman, D J

    2005-12-01

    An unusual vascular ring anomaly consisting of a persistent right aortic arch and a left ligamentum arteriosum extending from the main pulmonary artery to an aberrant left subclavian artery and left aortic arch remnant complex was identified in a German shepherd dog and a great Dane. The left subclavian artery and left aortic arch remnant complex originated at the junction between the right distal aortic arch and the descending aorta and coursed dorsal to the oesophagus in a cranial direction. The attachment of the ligamentum arteriosum to the aberrant left subclavian artery was approximately 5 cm cranial to the point of origin of the aberrant left subclavian artery and left aortic arch remnant complex from the descending aorta in both dogs. This anomaly observed in both dogs is similar to an anomaly reported in humans, in which a persistent right aortic arch is found in conjunction with an aberrant left subclavian artery and a left aortic arch remnant (Kommerell's diverticulum). Surgical ligation and division of the left ligamentum arteriosum in both dogs, along with division of the left subclavian artery in the great Dane, resulted in resolution of clinical signs in both of the dogs in this report.

  8. Auto-Rim Flap Technique for Lateral Crura Caudal Excess Treatment.

    PubMed

    Çakır, Barış; Küçüker, İsmail; Aksakal, İbrahim Alper; Sağır, Hacı Ömer

    2017-01-01

    There are many variables that influence nose tip harmony. Even in a rhinoplasty that appears successful in profile, one may see nostril asymmetries, alar retractions, or irregularities in the soft triangle, and patients express their dissatisfaction with these simple deformities. In this study, we define the ratio of caudal and cephalic excess of the lower lateral cartilage. We evaluate whether it is possible to eliminate nostril asymmetries and alar retractions by means of supporting the facet polygon with the help of a lower lateral cartilage auto-rim flap, a technique we have developed in our rhinoplasties. The auto-rim flap was used successively on 498 primary rhinoplasty patients on whom the same surgeon operated between May 2013 and June 2015, performing marginal incisions. Of the 498 patients in the series, only 1 of the first 10 required a revision due to tip asymmetry related to the auto-rim flap. A minimal nostril asymmetry that did not require intervention occurred in 10 patients. In none of the patients could an increased alar retraction be seen postoperatively. All patients exhibited alar cartilage in the anatomically correct position. With the auto-rim flap technique, a part of the caudal excess of the alar cartilage remains as a flap in the facet region; therefore, there is no need in the cephalic region to perform more of an excision than what is strictly necessary. 4 Therapeutic. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  9. [Standard rhinoplasty].

    PubMed

    Bardot, J; Jallut, Y; Nguyen, P-S

    2014-12-01

    Most patients who consult a surgeon for rhinoplasty do not want a radical change in their nose. They seek a reduction in the volume of the nasal pyramid and correction of a precise element that they judge to be ungainly--most often an osteocartilaginous hump. The procedure that we qualify as "standard" will eliminate the osteocartilaginous hump, decrease the dimensions of the septum and reduce the size of the alar crus of the alar cartilage. Although the required technical maneuvers are simple, their sequence must be coherent with a few basic rules that are simple but rarely explained in order to avoid defects linked to excessive, or on the contrary, insufficient corrections.

  10. Long-term outcomes of complete vascular ring division in children: a 36-year experience from a single institution.

    PubMed

    Naimo, Phillip S; Fricke, Tyson A; Donald, Julia S; Sawan, Elie; d'Udekem, Yves; Brizard, Christian P; Konstantinov, Igor E

    2017-02-01

    Complete vascular rings are rare and cause tracheoesophageal compression. Following surgical division, some patients have persisting tracheomalacia. We aim to assess the long-term outcomes of complete vascular ring division. All patients (n = 132) who underwent surgical division of a complete vascular ring between 1978 and 2014 were identified from the hospital database and retrospectively reviewed. Complete vascular rings consisted of a double aortic arch (n = 80), right aortic arch with an aberrant subclavian artery and left ligamentum arteriosum (n = 50), right aortic arch with mirror image branching and left ligamentum arteriosum (n = 1), and a left aortic arch with right descending aorta and right ligamentum arteriosum (n = 1). Kommerell's diverticulum was identified in 10 patients. Preoperative tracheomalacia was identified via bronchoscopy in 25 patients. Concomitant tracheal reconstruction was not performed in any patient. Kommerell's diverticulum was resected in 1 patient. The hospital mortality rate was 1.5% (2/132). There were no late deaths. The overall survival rate was 98.3 ± 1.2% (95% CI: 93.4, 99.6) at 20 years. Postoperatively, persistent tracheal compression was reported in 3 patients, and tracheomalacia in 16 patients. The rate of freedom from reoperation was 88.6 ± 4.0% (95% CI: 77.9, 94.3) at 20 years. No patient required tracheal surgery during the follow-up period. Follow-up was 92% (121/132) complete, with a median follow-up of 11.4 years (range 44 days to 36 years). At the last follow-up, 7 patients had mild tracheomalacia. Outcomes of division of a complete vascular ring are excellent. Tracheomalacia often improves following division of the vascular ring. Respiratory symptoms following complete vascular ring division are uncommon.

  11. Rare Skeletal Complications in the Setting of Primary Hyperparathyroidism

    PubMed Central

    Sabanis, Nikos; Gavriilaki, Eleni; Paschou, Eleni; Kalaitzoglou, Asterios; Papanikolaou, Dimitrios; Ioannidou, Pinelopi; Vasileiou, Sotirios

    2015-01-01

    Parathyroid carcinoma represents an extremely rare neoplasm with diverse clinical manifestations which vary from asymptomatic patients to severe complications of hypercalcemia or parathyrotoxicosis while skeletal involvement is rather common. Herein we aimed at presenting a unique case of a young patient with rare aggressive skeletal complications of parathyroid cancer that initially were misdiagnosed. Ossification of the cervical ligamentum flavum and skull tumor illustrates erosive bonny lesions of hyperparathyroidism that in association with previous medical history of recurrent nephrolithiasis and biochemical findings guide the diagnosis. We suggest that increased awareness and holistic approach are needed in order to recognize and further investigate signs and symptoms of hyperparathyroidism. PMID:26664767

  12. Prevalence of Onchocerca species and Thelazia lacrimalis in horses examined post mortem in Normandy.

    PubMed

    Collobert, C; Bernard, N; Lamidey, C

    1995-05-06

    The umbilical skin and ligamentum nuchae of 368 horses were examined post mortem for Onchocerca species. Only four of the horses were infected and pathological changes were observed on the skin of two of them. Thelazia lacrimalis was recovered from 38 (10.3 per cent) of the horses, and animals aged six months to two years were more frequently infected. No ocular lesions were observed. The prevalences of these two nematodes were low when compared with the infection rates reported in the United Kingdom and North America.

  13. [Surgical treatment of hip osteoarthritis: hpdete on hip arthroscopy].

    PubMed

    Ilizaliturri Sánchez, Víctor M; Camacho Galindo, Javier

    2007-10-01

    Arthroscopic surgery of the hip is a routine procedure in an increasing number of institutions around the world. Indications for this procedure increase as more experience is developed. Thanks to hip arthroscopy some intraarticular lesions like labral or ligamentum teres tears and cartilage lesions have been recognized. All of these have the potential to develop hip osteoarthritis. Open techniques for the treatment of femoroacetabular impingement have been transformed to arthroscopic techniques. Femoroacetabular impingement has the potential to cause hip osteoarthritis. The role of hip arthroscopy in the treatment of formally established hip osteoarthritis is limited and has better results in young patients with early degenerative changes.

  14. Time-resolved measurements of the optical properties of fibrous media using the anisotropic diffusion equation

    NASA Astrophysics Data System (ADS)

    Simon, Emanuel; Krauter, Philipp; Kienle, Alwin

    2014-07-01

    Transmittance and reflectance from spruce wood and bovine ligamentum nuchae as two different fibrous media are examined by time-of-flight spectroscopy for varying source detector separations and several orientations of the fibers in the sample. The anisotropic diffusion theory is used to obtain the absorption coefficient and the diffusion coefficients parallel and perpendicular to the fibers. The results are compared to those obtained with the isotropic diffusion theory. It is shown that for increasing source detector separations, the retrieved optical properties change as expected from Monte Carlo simulations performed in a previous study. This confirms that the anisotropic diffusion theory yields useful results for certain experimental conditions.

  15. Dynamic lumbar spinal stenosis : the usefulness of axial loaded MRI in preoperative evaluation.

    PubMed

    Choi, Kyung-Chul; Kim, Jin-Sung; Jung, Byungjoo; Lee, Sang-Ho

    2009-09-01

    Two cases of dynamic lumbar spinal stenosis were identified by the authors using axial loaded magnetic resonance image (MRI). In both cases, the patients presented with neurogenic claudication but MRI in decumbency showed no definite pathologic condition associated with their symptoms. In contrast, axial loaded MRI demonstrated constrictive spinal stenosis and a significantly decreased dural sac caused by epidural fat buckling and thickening of the ligamentum flavum in both cases. In the second case, a more prominent disc protrusion was also demonstrated compared with decumbent MRI. After decompressive surgery, both patients had satisfactory outcomes. Axial loaded MRI can therefore give decisive information in dynamic spinal disorders by allowing simulation of an upright position.

  16. The Epidural Ligaments (of Hofmann): A Comprehensive Review of the Literature

    PubMed Central

    Tardieu, Gabrielle G; Loukas, Marios; Moisi, Marc; Chapman, Jens; Oskouian, Rod J; Tubbs, R. Shane

    2016-01-01

    The epidural space contains the internal vertebral venous plexus, adipose, and other connective tissues. In the anatomical literature, there are nonspecific descriptions of varying fibrous connective tissue bands in the epidural space, mainly mentioned in the lumbar region, that tether the dural sac to the posterior longitudinal ligament, the vertebral canal, and the ligamentum flavum. These ligaments have been termed as Hofmann’s ligaments. This review expands on the anatomy and function of Hofmann’s ligaments, increasing the awareness of their presence and serves as an impetus for further study of their histology, innervation, and function.  PMID:27752405

  17. Hip arthroscopy.

    PubMed

    de Amorim Cabrita, Henrique Antônio Berwanger; de Castro Trindade, Christiano Augusto; de Campos Gurgel, Henrique Melo; Leal, Rafael Demura; de Souza Marques, Ricardo da Fonseca

    2015-01-01

    Hip arthroscopy is a safe method for treating a variety of pathological conditions that were unknown until a decade ago. Femoroacetabular impingement is the commonest of these pathological conditions and the one with the best results when treated early on. The instruments and surgical technique for hip arthroscopy continue to evolve. New indications for hip arthroscopy has been studied as the ligamentum teres injuries, capsular repair in instabilities, dissection of the sciatic nerve and repair of gluteal muscles tears (injuries to the hip rotator cuff), although still with debatable reproducibility. The complication rate is low, and ever-better results with fewer complications should be expected with the progression of the learning curve.

  18. Neck ligament strength is decreased following whiplash trauma

    PubMed Central

    Tominaga, Yasuhiro; Ndu, Anthony B; Coe, Marcus P; Valenson, Arnold J; Ivancic, Paul C; Ito, Shigeki; Rubin, Wolfgang; Panjabi, Manohar M

    2006-01-01

    Background Previous clinical studies have documented successful neck pain relief in whiplash patients using nerve block and radiofrequency ablation of facet joint afferents, including capsular ligament nerves. No previous study has documented injuries to the neck ligaments as determined by altered dynamic mechanical properties due to whiplash. The goal of the present study was to determine the dynamic mechanical properties of whiplash-exposed human cervical spine ligaments. Additionally, the present data were compared to previously reported control data. The ligaments included the anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. Methods A total of 98 bone-ligament-bone specimens (C2–C3 to C7-T1) were prepared from six cervical spines following 3.5, 5, 6.5, and 8 g rear impacts and pre- and post-impact flexibility testing. The specimens were elongated to failure at a peak rate of 725 (SD 95) mm/s. Failure force, elongation, and energy absorbed, as well as stiffness were determined. The mechanical properties were statistically compared among ligaments, and to the control data (significance level: P < 0.05; trend: P < 0.1). The average physiological ligament elongation was determined using a mathematical model. Results For all whiplash-exposed ligaments, the average failure elongation exceeded the average physiological elongation. The highest average failure force of 204.6 N was observed in the ligamentum flavum, significantly greater than in middle-third disc and interspinous and supraspinous ligaments. The highest average failure elongation of 4.9 mm was observed in the interspinous and supraspinous ligaments, significantly greater than in the anterior longitudinal ligament, middle-third disc, and ligamentum flavum. The average energy absorbed ranged from 0.04 J by the middle-third disc to 0.44 J by the capsular ligament. The ligamentum flavum was the stiffest ligament, while the

  19. [Soluble elastin and antibody formation].

    PubMed

    Stoklasová, A; Randová, Z; Wimmerová, J; Ledvina, M

    1991-01-01

    In the present study, we have obtained antibodies in rabbits to peptides prepared by digestion of elastin with either oxalic acid or phosphoric acid. By Elisa assay, we have shown the lowest production of antibodies against elastin-derived peptides prepared by digestion of N-elastin with phosphoric acid. We have found a strong cross-reactivity between antibodies obtained to peptides prepared by different digestion of insoluble elastin from bovine ligamentum nuchae or aorta and these antigens. A less pronounced cross-reactivity was observed in case of elastin-derived peptides from porcine aorta.

  20. Thoracic paraplegia due to missed thoracic compressive lesions after lumbar spinal decompression surgery. Report of three cases.

    PubMed

    Takeuchi, Akihiko; Miyamoto, Kei; Hosoe, Hideo; Shimizu, Katsuji

    2004-01-01

    The authors discuss the cases of three patients in whom thoracic paraplegia developed after lumbar spinal decompressive surgery for slight lumbar spinal canal stenosis. Careful computerized tomography myelography and magnetic resonance imaging examination of the thoracic spine revealed another compressive lesion (spinal cord tumor, disc herniation, osteophyte of vertebral body, and ossification of the ligamentum flavum). Additional thoracic decompressive surgery provided partial amelioration of each patient's neurological condition. The authors suggest that to avoid such a complication physical and radiographic examination of the thoracic spine should be performed preoperatively if the lumbar imaging is inconclusive.

  1. Reflecting on a Leadership Development Programme: A Case Study in South African Higher Education

    ERIC Educational Resources Information Center

    Louw, Ina; Zuber-Skeritt, Ortrun

    2009-01-01

    Leadership development in higher education is of vital importance to South Africa's future. We present a case study that focuses on a leadership development programme (LDP) through action learning and action research (ALAR) for women academics in South Africa during 2000 and 2001. It identifies the effects of the LDP on participants five years…

  2. Traumatic vertical atlantoaxial dislocation.

    PubMed

    Payer, M; Wetzel, S; Kelekis, A; Jenny, B

    2005-08-01

    We present a case of traumatic vertical atlantoaxial dislocation of 16 millimetres with a fatal outcome. We hypothesize that this extremely rare traumatic vertical atlantoaxial dislocation results from insufficiency of the C1/C2 facet capsules after rupture of the tectorial membrane and the alar ligaments.

  3. Atlantoaxial rotatory dislocation. A case report.

    PubMed

    Niibayashi, H

    1998-07-01

    Report of a child who sustained an acute atlantoaxial rotatory dislocation, associated with fractures of the clavicle and the temporal bone, and rupture of the alar ligament demonstrated by magnetic resonance imaging. To describe the radiographic and pathoanatomic characteristics of the injury process. Only five cases of traumatic atlantoaxial rotatory dislocation associated with fracture of the clavicle have been reported previously. This is the first report of a ruptured alar ligament demonstrated on magnetic resonance imaging in a patient with atlantoaxial rotatory dislocation associated with fractures of the clavicle and the temporal bone. Computed tomography revealed the Type 1 rotatory dislocation described by Fielding and Hawkins, and magnetic resonance imaging delineated the ruptured alar ligament. Traction in a halter, followed by 6 weeks of immobilization with a cervical collar, was successful in the management of the injury. Concomitant fractures of the right temporal bone and the right clavicle may yield excessive left rotation of the atlas on the axis, resulting in the rupture of the right alar ligament. Awareness of this condition allows early diagnosis and effective conservative treatment.

  4. CT-functional diagnostics of the rotatory instability of upper cervical spine. 1. An experimental study on cadavers.

    PubMed

    Dvorak, J; Panjabi, M; Gerber, M; Wichmann, W

    1987-04-01

    Twelve specimens of the upper cervical spine were functionally examined by using radiography, cineradiography and computerized tomographic (CT) scan. The range of rotation was measured from CT images after maximal rotations to both sides. The left alar ligament was then cut and the examination repeated. The alar and transverse ligaments could be differentiated on CT images in axial, sagittal, and coronal views. Rotation at occiput-atlas was 4.35 degrees to the right and 5.9 degrees to the left and at atlas-axis it was 31.4 degrees to the right and 33 degrees to the left. After one-sided lesion of the alar ligament, there was an overall increase of 10.8 degrees or 30% of original rotation to the opposite side, divided about equally between the occiput-atlas and the atlas-axis. It is concluded that a lesion (irreversible overstretching or rupture of alar ligaments) can result in rotatory hypermobility or instability of the upper cervical spine.

  5. Reflecting on a Leadership Development Programme: A Case Study in South African Higher Education

    ERIC Educational Resources Information Center

    Louw, Ina; Zuber-Skeritt, Ortrun

    2009-01-01

    Leadership development in higher education is of vital importance to South Africa's future. We present a case study that focuses on a leadership development programme (LDP) through action learning and action research (ALAR) for women academics in South Africa during 2000 and 2001. It identifies the effects of the LDP on participants five years…

  6. The Learning Conference: Knowledge Creation through Participation and Publication

    ERIC Educational Resources Information Center

    Louw, Ina; Zuber-Skerritt, Ortrun

    2011-01-01

    Purpose: The aim of this paper is to identify the principles and characteristics of a learning conference which uses action learning and action research (ALAR) processes to create: optimal learning for all participants through a collaborative, inclusive conference culture; further knowledge creation in publishing conference papers post-conference…

  7. Descending Mediastinitis in Epstein-Barr Virus Infection

    PubMed Central

    van Driel, E. M.; Janssen, M. J. F. M.

    2015-01-01

    Our case report describes a previously healthy 34-year-old male who develops a descending mediastinitis as a complication of an Epstein-Barr virus (EBV) infection. The mediastinitis was suspected to have developed by a breakthrough of a peritonsillar abscess through the space between the alar and prevertebral space. PMID:25740774

  8. Lower lateral crural turnover flap in open rhinoplasty.

    PubMed

    Janis, Jeffrey E; Trussler, Andrew; Ghavami, Ashkan; Marin, Vincent; Rohrich, Rod J; Gunter, Jack P

    2009-06-01

    Lower lateral crural deformities are common problems in rhinoplasty. The shape and position of the lower lateral crura directly influence the alar contour and external valve function. This study reviews an extensive experience with the lower lateral crural turnover flap, which represents a versatile and reproducible technique for correction of lower lateral crural deformities and improvement of external valve function. A retrospective review of our experience with the lateral crural turnover flap in consecutive primary (n = 21), secondary (n = 2), and tertiary (n = 1) open rhinoplasties was conducted to evaluate the indications, contraindications, and long-term outcomes of this technique. Patient case examples are used to illustrate this technique and its results. The lower lateral crural turnover flap is beneficial for deformities, weakness, and collapse of the lower lateral crura. It can also be used to improve lower lateral crural strength during tip reshaping. It is contraindicated when there is insufficient width of the lower lateral crura. A lower lateral crural turnover flap can complement other external valve and alar arch supporting techniques, such as placement of alar contour grafts and/or alar batten grafts. The shape and position of the lower lateral crural turnover flaps have had long-lasting results (>1 year) after open rhinoplasty. The lower lateral crural turnover flap is a useful and reproducible technique in rhinoplasty with enduring results. The use of adjacent cartilage provides a local source of viable tissue to correct and support the lower lateral crura in both primary and revision rhinoplasty.

  9. Pelvic Fixation in Adult and Pediatric Spine Surgery: Historical Perspective, Indications, and Techniques: AAOS Exhibit Selection.

    PubMed

    Jain, Amit; Hassanzadeh, Hamid; Strike, Sophia A; Menga, Emmanuel N; Sponseller, Paul D; Kebaish, Khaled M

    2015-09-16

    Achieving solid osseous fusion across the lumbosacral junction has historically been, and continues to be, a challenge in spine surgery. Robust pelvic fixation plays an integral role in achieving this goal. The goals of this review are to describe the history of and indications for spinopelvic fixation, examine conventional spinopelvic fixation techniques, and review the newer S2-alar-iliac technique and its outcomes in adult and pediatric patients with spinal deformity. Since the introduction of Harrington rods in the 1960s, spinal instrumentation has evolved substantially. Indications for spinopelvic fixation as a means to achieve lumbosacral arthrodesis include a long arthrodesis (five or more vertebral levels) or use of three-column osteotomies in the lower thoracic or lumbar spine, surgical treatment of high-grade spondylolisthesis, and correction of lumbar deformity and pelvic obliquity. A variety of techniques have been described over the years, including Galveston iliac rods, Jackson intrasacral rods, the Kostuik transiliac bar, iliac screws, and S2-alar-iliac screws. Modern iliac screws and S2-alar-iliac screws are associated with relatively low rates of pseudarthrosis. S2-alar-iliac screws have the advantages of less implant prominence and inline placement with proximal spinal anchors. Collectively, these techniques provide powerful methods for obtaining control of the pelvis in facilitating lumbosacral arthrodesis.

  10. Urea Unfolding Study of E. coli Alanyl-tRNA Synthetase and Its Monomeric Variants Proves the Role of C-Terminal Domain in Stability

    PubMed Central

    Banerjee, Baisakhi; Banerjee, Rajat

    2015-01-01

    E. coli alanyl-tRNA exists as a dimer in its native form and the C-terminal coiled-coil part plays an important role in the dimerization process. The truncated N-terminal containing the first 700 amino acids (1–700) forms a monomeric variant possessing similar aminoacylation activity like wild type. A point mutation in the C-terminal domain (G674D) also produces a monomeric variant with a fivefold reduced aminoacylation activity compared to the wild type enzyme. Urea induced denaturation of these monomeric mutants along with another alaRS variant (N461 alaRS) was studied together with the full-length enzyme using various spectroscopic techniques such as intrinsic tryptophan fluorescence, 1-anilino-8-naphthalene-sulfonic acid binding, near- and far-UV circular dichroism, and analytical ultracentrifugation. Aminoacylation activity assay after refolding from denatured state revealed that the monomeric mutants studied here were unable to regain their activity, whereas the dimeric full-length alaRS gets back similar activity as the native enzyme. This study indicates that dimerization is one of the key regulatory factors that is important in the proper folding and stability of E. coli alaRS. PMID:26617997

  11. A peculiar new Helina Robineau-Desvoidy (Diptera: Muscidae) from Mexico and Panama.

    PubMed

    Couri, M S

    2012-12-01

    Helina sinaloensis n. sp. (Diptera: Muscidae) is described and illustrated from Mexico and Panama. The new species shows a unique combination of characters and can be distinguished from the other species of the genus by the prosternum with lateral cilia, pre-alar seta absent, anepimeron bare, katepimeron setulose, postalar wall setulose and scutellum with setulae on lateroventral margin.

  12. The Learning Conference: Knowledge Creation through Participation and Publication

    ERIC Educational Resources Information Center

    Louw, Ina; Zuber-Skerritt, Ortrun

    2011-01-01

    Purpose: The aim of this paper is to identify the principles and characteristics of a learning conference which uses action learning and action research (ALAR) processes to create: optimal learning for all participants through a collaborative, inclusive conference culture; further knowledge creation in publishing conference papers post-conference…

  13. Unilateral cleft nasal deformity correction using conchal cartilage lily flower graft.

    PubMed

    Hwang, Kun; Kim, Han Joon; Paik, Moo Hyun

    2012-11-01

    We present a conchal cartilage lily flower graft for correcting depressed and laterally displaced alar cartilage for correction of unilateral cleft nasal deformity.After making a V incision at the base of the columellar and then marginal incisions, the alar cartilages were exposed. A fusiform-shaped cartilage larger than 2.5 cm in length and 1 cm in width was obtained. The midline long axis was scored with a No. 15 knife, and the lateral one third was split. Two-thirds length portions were folded in half, and they became straightened in the shape of a stalk of a lily flower. Two symmetrical one-third length portions were fanned out bilaterally in the shape of the leaf of a lily flower. The stalk portion was positioned in a pocket between the medial crura, and the 2 leaf portions were placed on the dome of the alar cartilages. The marked points of the cleft side and contralateral side were secured with sutures. The V incision at the base of the columellar and the marginal incisions were closed with a V-Y shape. In this technique, the 2 leaf portions were placed on the dome of the alar cartilages and sutured; therefore, the suture holds the dome of the cleft side to the contralateral side without peaking.Thirteen patients (6 male and 7 female subjects; age range, 13-30 years) were operated. Among them, 6 patients were very satisfied, and 5 patients were satisfied with the results. Two patients felt they were improved.We think the conchal cartilage lily flower graft might be a good method for correction of depressed and laterally displaced alar cartilage in unilateral cleft nasal deformity.

  14. A 3D analysis of Caucasian and African American facial morphologies in a US population.

    PubMed

    Talbert, Leslie; Kau, Chung How; Christou, Terpsithea; Vlachos, Christos; Souccar, Nada

    2014-03-01

    This study aimed to compare facial morphologies of an adult African-American population to an adult Caucasian-American population using three-dimensional (3D) surface imaging. The images were captured using a stereophotogrammetric system (3dMDface(TM) system). Subjects were aged 19-30 years, with normal body mass index and no gross craniofacial anomalies. Images were aligned and combined using RF6 Plus Pack 2 software to produce a male and female facial average for each population. The averages were superimposed and the differences were assessed. The most distinct differences were in the forehead, alar base and perioricular regions. The average difference between African-American and Caucasian-American females was 1·18±0·98 mm. The African-American females had a broader face, wider alar base and more protrusive lips. The Caucasian-American females had a more prominent chin, malar region and lower forehead. The average difference between African-American and Caucasian-American males was 1·11±1·04 mm. The African-American males had a more prominent upper forehead and periocular region, wider alar base and more protrusive lips. No notable difference occurred between chin points of the two male populations. Average faces were created from 3D photographs, and the facial morphological differences between populations and genders were compared. African-American males had a more prominent upper forehead and periocular region, wider alar base and more protrusive lips. Caucasian-American males showed a more prominent nasal tip and malar area. African-American females had broader face, wider alar base and more protrusive lips. Caucasian-American females showed a more prominent chin point, malar region and lower forehead.

  15. World species of the genus Platyscelio Kieffer (Hymenoptera: Platygastridae)

    PubMed Central

    Taekul, Charuwat; Johnson, Norman F.; Masner, Lubomír; Polaszek, Andrew; Rajmohana K.

    2010-01-01

    Abstract The genus Platyscelio Kieffer (Hymenoptera: Platygastridae, Scelioninae) is a widespread group in the Old World, found from West Africa to northern Queensland, Australia. The species concepts are revised and a key to world species is presented. The genus is comprised of 6 species, including 2 known species which are redescribed: Platyscelio africanus Risbec (Benin, Cameroon, Central African Republic, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Kenya, Mozambique, Nigeria, Sierra Leone, South Africa, Tanzania, Togo, Uganda, Yemen, Zimbabwe); and Platyscelio pulchricornis Kieffer (Australia, Bangladesh, China, India, Indonesia, Japan, Malaysia, Papua New Guinea, Philippines, Solomon Islands, Taiwan, Thailand, Vanuatu, Vietnam). Five species-group names are considered to be junior synonyms of Platyscelio pulchricornis: Platyscelio abnormis Crawford syn. n., Platyscelio dunensis Mukerjee syn. n., Platyscelio mirabilis Dodd syn. n., Platyscelio punctatus Kieffer syn. n., and Platyscelio wilcoxi Fullaway. The following species are hypothesized and described as new taxa: Platyscelio arcuatus Taekul & Johnson, sp. n. (Western Australia); Platyscelio mysterium Taekul & Johnson, sp. n. (Zimbabwe, Botswana, South Africa); Platyscelio mzantsi Taekul & Johnson, sp. n. (South Africa); and Platyscelio striga Taekul & Johnson, sp. n. (Western Australia). PMID:21594118

  16. Kepler, Galilei, the telescope and the consequences. (German Title: Kepler, Galilei, das Fernrohr und die Folgen)

    NASA Astrophysics Data System (ADS)

    Gaulke, Karsten; Hamel, Jürgen

    The papers of this volume are dedicated to Johannes Kepler, the astronomy of his time, and the consequences of his researches. They deal with the reception on the Copernican system of the world at the court of landgrave William IV in Kassel and the use of astronomy at a princely court in the 16th century, exemplified by the Kassel residence. Two contributions discuss a text fragment in Kepler's Astronomia Nova and the dimensions of the geo- and heliocentric systems of the world in Kepler's Mysterium Cosmographicum. Other contributions deal with mathematical aspects un Kepler's exchange of letters, the biography of Kepler's discussion partner Ph. Feselius, as well as the early reception of the Tabulae Rudolphinae in the calendar literature, telescopes in Kepler's time, Chr. Scheiner's optical theory of the eye, and finally in the continuation of the heliocentric world system by Otto von Guericke's natural philosophy and science. In conclusion, the documents of the planned call of Kepler to Rostock university, as well as the first publication of a recently found, hitherto unknown letter by Kepler.

  17. Jung and Kabbalah: imaginal and noetic aspects.

    PubMed

    Joseph, Steven M

    2007-06-01

    Jung made use of kabbalistic images and motifs in various parts of his opus, including in his alchemical studies, in Aion, and extensively in Mysterium Coniunctionis. He also recorded an important dream after his heart attack which made use of kabbalistic symbolism in Memories, Dreams, Reflections. In this paper I explore Jung's ideas in relation to Kabbalah, first, by differentiating between Jung's imaginal approach to kabbalistic symbolism and the noetic intention of the Kabbalah itself in its use of imaginal material. Second, I present a number of typical examples of how Jung understands (and sometimes misunderstands) kabbalistic material that he cites. Third, I briefly survey the development of the Kabbalah as an imaginal noetic system, and present a core self-understanding of kabbalists--as engaged in inner 'self-work' which intends to 'sweeten the harsh judgments of existence in their very roots'. Finally, I differentiate Jung's understanding of the psychical living symbol from the kabbalistic understanding of the mystical symbol. In this fourth section of the paper, I conclude by presenting a basic Hasidic/kabbalistic teaching on the nature and function of verbal contemplative prayer--as an illustration of the difference between the two understandings of symbolism. The four sections of the paper are framed by a 'Prelude' and a 'Coda'.

  18. Where East meets West: in the house of individuation.

    PubMed

    Stein, Murray

    2017-02-01

    The psychological process of individuation as experienced in Jungian work may lead to states of consciousness that resemble advanced spiritual developments across religious traditions and cultures. This is where Westerners may reach a common ground with the East. In the essentials and with respect to the final goal there is little difference among the many ways to the self, even if the cultural features in the landscape are disparate. In late stage Jungian analysis and individuation and in what Erich Neumann calls 'centroversion', the personal and the impersonal aspects of the personality accumulate around the ego-self axis to form a composite identity. In this complex structure the ego does not vanish but is joined to the impersonal archetypal levels of the psyche and identity thus becomes at once individual and archetypal. This is the third stage of conjunction as described by Jung in Mysterium Coniunctionis and it is identical to the type of consciousness depicted in the final scenes of Zen Buddhism's Ten Ox-Herding Pictures.

  19. Large interarcuate spaces in the cervical vertebral column of the tyrolean mountain sheep.

    PubMed

    Turkof, E; Jurasch, N; Grassberger, M; Schwendenwein, S; Habib, D; Knolle, E; Losert, U

    2003-02-01

    Large interarcual spaces have been described between the arcus vertebrae C5/C6 and C6/C7 in the cervical vertebral column of Nubian goats. This aperture enables direct access to spinal cord and rootlets without the need to perform a hemilaminectomy. The present study was performed in order to determine whether these large interarcual spaces can also be found in the vertebral column of the Tyrolean mountain sheep, as this small ruminant, which is anatomically very similar to the Nubian goat, is frequently used for experimental purposes at the Surgical University Clinic in Austria. The carcasses of 10 sheep (six females, four males; range of age: 2.5-6 years, range of weight: 52-89 kg) were dissected and the vertebral column was exposed. All 10 sheep showed elliptic openings between the fourth cervical and the first thoracal vertebrae. Three sheep had additional openings between the first and the second thoracal vertebrae. All openings were covered solitarily by the ligamentum flavum and under this ligamentum lay the spinal cord without any further osseous or ligamentous protection. These findings are not mentioned in the common textbooks of veterinary anatomy and deserve attention, as they can be a step forward towards non-traumatic experimental surgery on the spinal cord.

  20. Degenerative diseases of the lumbar spine. Comparison of the multiecho data image combination sequence with magnetization transfer saturation pulse versus lumbar myelography/postmyelographic computed tomography.

    PubMed

    Dorenbeck, U; Schreyer, A G; Grunwald, I Q; Held, P; Feuerbach, S; Seitz, J

    2004-12-01

    To compare a T2* weighted 2D spoiled gradient echo multiecho sequence (MEDIC) with magnetization transfer saturation pulse versus lumbar myelography and postmyelographic computed tomography (pCT). 84 disk levels in 27 patients were examined. The vertebral bodies, intervertebral disks, neural foramina, cauda equina, ligamentum flavum, and narrowing of the spinal canal were investigated using an evaluation scale. In addition, the pCT and the MEDIC sequence were evaluated for assessing the narrowing of the neural foramina in a phantom study using a cadaver preparation of the lumbar spine. A total of 28 disk herniations, 11 cases of osteophytes narrowing the spinal canal or the neural foramina, and 7 spinal canal stenoses were detected. The pCT was significantly better in visualizing the cauda equina. The MEDIC sequence was significantly superior in visualizing the extension of the ligamentum flavum. No statistical differences between either image modality were found concerning assessment of the narrowing of the neural foramina and the spinal canal, nor regarding evaluation of the vertebral disk and the vertebral body. Measurements of the phantom study showed that the MEDIC sequence did not overestimate narrowing of the neural foramina. The T2* MEDIC sequence has proved to be as accurate as pCT in evaluating osteophytes and narrowing of the neural foramina. In doubtful standard magnetic resonance imaging findings, this means that an additional axial T2* MEDIC sequence may be of value in reaching the same accuracy as pCT.

  1. Percutaneous Endoscopic Removal of a Lumbar Epidural Angiolipoma via Interlaminar Approach: A Technical Report.

    PubMed

    Ying, Guang-Yu; Yao, Ying; Shen, Fang; Ren, Yu-Cheng; Chen, Chien-Min; Zhu, Yong-Jian

    2017-03-01

    Although percutaneous endoscopic technique has been routinely used in the treatment of disk herniation, there are few reports on its application in the management of intraspinal tumors. We present a case report of lumbar epidural angiolipoma that was totally removed by percutaneous endoscopic technique. A 63-year-old man presented with a 4-month history of progressively worsening low back pain. No abnormal neurologic finding was noted on physical examination, and magnetic resonance imaging demonstrated a dorsally located L2-3 epidural lesion, suggestive of a noninfiltrating angiolipoma. During the operation, an 8-mm skin incision was made, and a dilator was bluntly inserted toward the interlaminar space, followed by insertion of a working cannula onto the ligamentum flavum and placement of the endoscope. The interlaminar space was enlarged by resection of part of the lower rim of the right L2 vertebral laminae, and the right side of the interlaminar ligamentum flavum was removed to expose the tumor. The tumor was totally removed piecemeal under endoscopic guidance, and pathologic examination confirmed the diagnosis of angiolipoma. This report supports the application of percutaneous endoscopic technique in the surgical resection of noninfiltrating extradural lumbar angiolipoma. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Peritoneal manifestations of fascioliasis on CT images: a new observation.

    PubMed

    Song, Kyoung Doo; Lim, Jae Hoon; Kim, Mi Jeong; Jang, Yun Jin; Kim, Jae Woon; Cho, Seung Hyun; Kwon, Jung Hyeok

    2013-08-01

    To describe peritoneal manifestations of fascioliasis on CT. We reviewed CT images in 31 patients with fascioliasis confirmed by enzyme-linked immunosorbent assay (ELISA) (n = 24) or surgery (n = 7). Image analyses were performed to identify hepatic, biliary, and peritoneal abnormalities. Hepatic abnormalities were seen in 28 (90.3 %) of the 31 patients. The most common finding was caves sign, which was present in 25 (80.1 %) patients. Three patients (9.7 %) presented with biliary abnormalities exhibiting dilatation and enhancing wall thickening of the bile duct, wall thickening of the gallbladder, and elongated structures in the bile duct or gallbladder. Peritoneal abnormalities were seen in 14 (45.2 %) of the 31 patients. The most common peritoneal abnormality was mesenteric or omental infiltration, which was seen in 9 (29.0 %) patients. Other peritoneal findings included lymph node enlargement (n = 7), ascites (n = 7), thickening of ligamentum teres (n = 2), and peritoneal mass (n = 2). Peritoneal manifestations of fascioliasis are relatively common, and CT findings include mesenteric or omental infiltration, lymph node enlargement, ascites, thickening of the ligamentum teres, and peritoneal masses.

  3. The right-sided aortic arch with unusual course of bilateral recurrent laryngeal nerves: a report of rare variations.

    PubMed

    Yan, Jun; Kanazawa, Jun; Numata, Norio; Hitomi, Jiro

    2017-02-01

    We describe a rare case of the right-sided aortic arch, the unusual origin of the main arterial vessels and the unusual courses of bilateral recurrent laryngeal nerves in a Japanese cadaver. Chiefly, the right-sided aortic arch turned to the left side from the dorsal part of the trachea and esophagus, and Kommerell's diverticulum was found at the end of the arch. The right common carotid artery arose from the end part of the ascending aorta, but the left common carotid artery arose from the proximal portion of the ascending aorta. The right subclavian artery arose from the upper edge of the aortic arch, but the left one arose from the front wall at the upper side of the ligamentum arteriosum. The right recurrent laryngeal nerve hooked around the aortic arch (but not the right subclavian artery) dorsoventrally, and the left recurrent laryngeal nerve hooked around the ligamentum arteriosum and arose from the ventral side (but not dorsal) of the aortic arch. These variations are very rare, and understanding them is useful and important for clinical research.

  4. New theory of uterovaginal embryogenesis.

    PubMed

    Makiyan, Zograb

    2016-01-02

    The explanation of uterine and vaginal embryogenesis in humans still poses many controversies, because it is difficult to assess early stages of an embryo. The literature review revealed many disagreements in Mullerian theory, inciting some authors to propose new embryological hypotheses. In the original Mullerian theory: the paramesonephral ducts form the Fallopian tubes, uterus and vagina; the mesonephral ducts regress in female embryos. The aim of this article is to investigate the development of Mullerian ducts in humans, using comparative analysis of fundamental embryological theory and various utero-vaginal anomalies. Between 1998 and 2015, 434 patients with various uterovaginal malformations had been operated on at the Scientific Centre of Obstetrics Gynaecology and Perynatology in Moscow. The anatomies of the uterovaginal malformations in these patients were diagnosed with ultrasound and MRI and then verified during surgical correction by laparoscopy. A systematic comparison of uterovaginal malformations to those in the literature has allowed us to formulate a new theory of embryonic morphogenesis. The new theory is significantly different: ovary, ovarian ligamentum proprium, and ligamentum teres uteri derive from gonadal ridges; Fallopian tubes and vagina completely develop from mesonephral ducts. The uterus develops in the area of intersection between the mesonephral ducts with gonadal ridges by the fusion of the two. The new theory may to induce future embryological studies. The hypothetic possibility that the ovary and endometrium derive from the gonadal ridges could be the key to understanding the enigmatic aetiologies of extragenital and ovarian endometriosis.

  5. Penile anatomy and hypotheses of erectile function in the American alligator (Alligator mississippiensis): muscular eversion and elastic retraction.

    PubMed

    Kelly, D A

    2013-03-01

    The intromittent organs of most amniotes contain variable-volume hydrostatic skeletons that are stored in a flexible state and inflate with fluid before or during copulation. However, the penis in male crocodilians is notable because its shaft does not seem to change either its shape or bending stiffness as blood enters its vascular spaces before copulation. Here I report that crocodilians may have evolved a mechanism for penile shaft erection that does not require inflation and detumescence. Dissections of the cloaca in sexually mature male American alligators (Alligator mississippiensis) show that the cross section of the proximal shaft of the alligator penis contains dense collagenous tissues that do not significantly change shape when fluid is added to the central vascular space. The large amount of collagen in the wall and central space of the alligator penis stiffen the structure so it can be simply everted for copulation and rapidly retracted at its completion. Because no muscles insert directly onto the penis, eversion and retraction must be produced indirectly. My results suggest that the contraction of paired levator cloacae muscles around the anterior end of the cloaca rotates the penis out of the cloacal opening and strains the ligamentum rami that connect the base of the penis to the ischia. When the cloacal muscles relax, the elastic recoil of the ligamentum rami can return the penis to its original position inside the cloaca. Copyright © 2012 Wiley Periodicals, Inc.

  6. Gross anatomy of the female genital organs of the domestic donkey (Equus asinus Linné, 1758).

    PubMed

    Renner-Martin, T F P; Forstenpointner, G; Weissengruber, G E; Eberhardt, L

    2009-04-01

    Although donkeys play an important role as companion or pack and draught animals, theriogenological studies and anatomical data on the genital organs of the jenny are sparse. To provide anatomical descriptions and morphometric data, the organa genitalia feminina, their arteries and the ligamentum latum uteri of 10 adult but maiden jennies were examined by means of gross anatomical and morphometric techniques. In comparison with anatomical data of horses obtained from literature the genital organs of jennies appear to be more voluminous in relation to the body mass and the position of the ovaries is slightly further cranial than in mares. In asses, the ovaries contain large follicles reaching a diameter of up to 40 mm. The mesosalpinx is much wider than in the horse forming a considerably spacious bursa ovarica. The asinine ligamentum teres uteri reveals a very prominent cranial end, the 'appendix'. Tortuous mucosal folds occur in the wall of the jenny's cervical channel. The vascularization of the female genital organs of asses is very similar to that of horses. One of the examined specimens reveals a large mucosal fold dividing the cranial part of the vagina into a left and right compartment.

  7. Cervical myelopathy due to degenerative spondylolisthesis.

    PubMed

    Koakutsu, Tomoaki; Nakajo, Junko; Morozumi, Naoki; Hoshikawa, Takeshi; Ogawa, Shinji; Ishii, Yushin

    2011-05-01

    To investigate clinical-radiological features of cervical myelopathy due to degenerative spondylolisthesis (DSL). A total of 448 patients were operated for cervical myelopathy at Nishitaga National Hospital between 2000 and 2003. Of these patients, DSL at the symptomatic disc level was observed in 22 (4.9%) patients. Clinical features were investigated by medical records, and radiological features were investigated by radiographs. Disc levels of DSL were C3/4 in 6 cases and C4/5 in 16 cases. Distance of anterior slippage was 2 to 5 mm (average 2.9 mm) in flexion position. Space available for the spinal cord (SAC) was 11 to 15 mm (average 12.8 mm) in flexion position and 11 to 18 mm (average 14.6 mm) in extension position; 11 cases were reducible and 11 cases were irreducible in extension position. Myelograms demonstrated compression of spinal cord by the ligamentum flavum in extension position. Compression of spinal cord was not demonstrated in flexion position. C5-7 lordosis angle was lower than control. C5-7 range of motion (ROM) was reduced compared to controls. These alterations were statistically significant. DSL occurs in the mid-cervical spine. Lower cervical spine demonstrated restricted ROM and lower lordosis angle. Pathogenesis of cervical myelopathy due to DSL is compression of spinal cord by the ligamentum flavum in extension position and not by reduced SAC in flexion position.

  8. Numerical Simulation of Asymmetrically Altered Growth as Initiation Mechanism of Scoliosis

    PubMed Central

    van der Plaats, A.; Veldhuizen, A. G.

    2007-01-01

    The causes of idiopathic scoliosis are still uncertain; buckling is mentioned often, but never proven. The authors hypothesize another option: unilateral postponement of growth of MM Rotatores or of ligamentum flavum and intertransverse ligament. In this paper, both buckling and the two new theories of scoliotic initiation are studied using a new finite element model that simulates the mechanical behavior of the human spine. This model was validated by the stiffness data of Panjabi et al. (J. Biomech. 9:185–192, 1976). After a small correction of the prestrain of some ligaments and the MM Rotatores the model appeared to be valid. The postponement in growth was translated in the numerical model in an asymmetrical stiffness. The spine was loaded axially and the resulting deformation was analyzed for the presence of the coupling of lateral deviation and axial rotation that is characteristic for scoliosis. Only unilateral postponement of growth of ligamentum flavum and intertransverse ligament appeared to initiate scoliosis. Buckling did not initiate scoliosis. PMID:17415662

  9. Thorns and dermal denticles of skates Atlantoraja cyclophora and A. castelnaui: Microscopic features and functional implications.

    PubMed

    Rangel, Bianca de Sousa; Wosnick, Natascha; Magdanelo Leandro, Rafael; Amorim, Alberto Ferreira de; Kfoury Junior, José Roberto; Rici, Rose Eli Grassi

    2016-12-01

    Some batoid species are covered with dermal denticles (or placoid scales) that occasionally develop into thorns. In sexually mature males, sharp teeth and alar thorns found on the apex of the lateral disc are used to hold the female during copulation. This study set out to analyze microscopic features of modified dermal denticles and thorns and to investigate sexual dimorphism in Atlantoraja cyclophora and A. castelnaui species. Skin samples collected from areas covered with thorns were fixed in 10% formaldehyde, processed and analyzed using scanning electron microscopy. Alar thorn morphology varied within species, while caudal thorn, rostral and caudal dermal denticle morphology varied within and between species. These structures play an important role in the protection and reproduction of the species studied and constitute important taxonomic information, given they are often the only elements preserved in archaeological sites and fossil records.

  10. Description of Lutzomyia (Helcocyrtomyia) tolimensis, a new species of phlebotomine sandfly (Diptera: Psychodidae) from Colombia

    PubMed Central

    Carrasquilla, María C; Munstermann, Leonard; Marín, Dairo; Ocampo, Clara; Ferro, Cristina

    2016-01-01

    A description is presented of Lutzomyia tolimensis sp. nov., a new species of the subgenus Helcocyrtomyia, series sanguinaria. It was collected in dwellings, peridomestic environment and in nearby forest patches located in the foothills of the Andean Central Cordillera, where in 2004–2006 occurred the largest epidemic ever recorded of leishmaniasis in Colombia. The male of this species is differentiated from other members of the series sanguinaria based on the following combination of characters: (i) base of coxite with 0–3 subequal setae, (ii) spines of gonostyle organized in positions 2.1.2, (iii) spines inserted on distal half of gonostyle and (iv) relationship of alar indices. The female is recognized principally by the following characters: (i) palpomere V longer than III, (ii) length of labro-epipharynx and (iii) relationship of the alar indices. PMID:23295748

  11. Embryonic rationale for the primary correction of classical congenital clefts of the lip and palate.

    PubMed Central

    Millard, D. R.

    1994-01-01

    Primary correction of congenital clefts of the lip and palate should be designed to carry the interrupted embryonic process to normal completion. This is best accomplished by maxillary alignment with presurgical orthodontics, stabilisation of the maxillary alignment, obliteration of the alveolar cleft and construction of the nasal floor with periosteoplasty. This allows early construction of the lip by rotation and advancement and correction of the nose with columella lengthening, alar cartilage positioning and alar base cinching. This can be accomplished before school age. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 PMID:8017808

  12. Dynamic Mechanical Properties of Intact Human Cervical Spine Ligaments

    PubMed Central

    Ivancic, Paul C.; Coe, Marcus P.; Ndu, Anthony B.; Tominaga, Yasuhiro; Carlson, Erik J.; Rubin, Wolfgang; (FH), Dipl-Ing; Panjabi, Manohar M.

    2009-01-01

    BACKGROUND CONTEXT Most previous studies have investigated ligaments mechanical properties at slow elongation rates of less than 25 mm/s. PURPOSE To determine the tensile mechanical properties, at a fast elongation rate, of intact human cervical anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. STUDY DESIGN/SETTING In vitro biomechanical study. METHODS A total of 97 intact bone-ligament-bone specimens (C2–C3 to C7-T1) were prepared from six cervical spines (average age: 80.6 years, range, 71 to 92 years) and were elongated to complete rupture at an average (SD) peak rate of 723 (106) mm/s using a custom-built apparatus. Non-linear force vs. elongation curves were plotted and peak force, peak elongation, peak energy, and stiffness were statistically compared (P<0.05) among ligament. A mathematical model was developed to determine the quasi-static physiological ligament elongation. RESULTS Highest average peak force, up to 244.4 and 220.0 N in the ligamentum flavum and capsular ligament, respectively, were significantly greater than in the anterior longitudinal ligament and middle-third disc. Highest peak elongation reached 5.9 mm in the intraspinous and supraspinous ligaments, significantly greater than in the middle-third disc. Highest peak energy of 0.57 J was attained in the capsular ligament, significantly greater than in the anterior longitudinal ligament and middle-third disc. Average stiffness was generally greatest in the ligamentum flavum and least in the intraspinous and supraspinous ligaments. For all ligaments, peak elongation was greater than average physiological elongation computed using the mathematical model. CONCLUSIONS Comparison of the present results with previously reported data indicated that high speed elongation may cause cervical ligaments to fail at a higher peak force and smaller peak elongation and may be stiffer and absorb less energy, as compared to a

  13. The morphology and clinical significance of the dorsal meningovertebra ligaments in the cervical epidural space.

    PubMed

    Shi, Benchao; Zheng, Xuefeng; Min, Shaoxiong; Zhou, Zhilai; Ding, Zihai; Jin, Anmin

    2014-11-01

    The dural sac is anchored within the vertebral canal by connective tissue called meningovertebral ligaments in the epidural space. During flavectomy and laminectomy, inadvertent disruption of the dorsal meningovertebral ligaments may lead to dura laceration and cerebrospinal fluid (CSF) leaks. All the described dorsal meningovertebral ligaments were located in the lumbar region. A rare study is available about dorsal meningovertebral ligaments of the cervical spinal dura to the adjacent vertebrae. To identify and describe the dorsal meningovertebral ligaments at each cervical level and discuss their clinical significance. A dissection-based study of 22 embalmed cadavers. The anatomy was studied in 22 whole cervical cadavers (11 females, 11 males), prepared with formaldehyde, whose ages at the time of death ranged from 55 to 78 years. The vertebral canal was divided to expose the dural sac and the spinal nerve roots. At all levels of the cervical vertebra, the morphology, quantity, origin, insertion, and spatial orientation of the dorsal meningovertebral ligaments were determined and the length, width or diameter, and thickness of the ligaments were measured with vernier calipers. The dorsal meningovertebral ligaments in the cervical region anchored the posterior dural sac to the ligamentum flavum or laminae. The number of attachment points on the ligamentum flavum was relatively larger than that on the lamina, and the occurrence rate of dorsal meningovertebral ligaments was 100% at C1-C2 and C4--C5. The thickest ligaments were observed at the C1 and C2 vertebrae. The length of the ligaments varied from 1.50 to 35.22 mm, and the orientation of the ligaments mostly was craniocaudal. The morphology of the dorsal meningovertebral ligaments was divided into four types: strip type, cord type, grid type, and thin slice type. In the cervical spine, the dorsal meningovertebral ligaments exist between the posterior dural sac and the ligamentum flavum or lamina. The dorsal

  14. Assessment of MRI as a Modality for Evaluation of Soft Tissue Injuries of the Spine as Compared to Intraoperative Assessment

    PubMed Central

    Vasu, Chembumkara; Kanthila, Mahesha; Ravichandra, Gopalakrishna; Acharya, Koteshwar Devadasa; Hussain, Mohamed Musheer

    2016-01-01

    Introduction Traumatic injuries of the spine and spinal cord are potentially devastating as they may lead to significant neurological damage as the clinical and prognostic spectrum of the effects of spinal injuries is vast. Timely imaging studies can help mitigate these possibly life threatening complications. There is a dearth of studies that directly compare MR imaging findings to surgical findings. Aim Hence, this study was undertaken to assess the sensitivity of MRI in identifying injuries to the soft tissue structures of the spine. Materials and Methods MRI scans were performed on 31 cases of acute spinal injuries that presented within 72 hours of the trauma and underwent surgical fixation by either an anterior or posterior approach. The non-osseous structures namely; Anterior Longitudinal Ligament (ALL), Posterior Longitudinal Ligament (PLL), Intervertebral Disc, Ligamentum Flavum, Interspinous Ligament (ISP) and the Spinal Cord were evaluated. They were classified as ‘True Positive’ if an injury was found to correlate with intraoperative findings and as ‘False Negative’ when diagnosed falsely as normal. The statistical sensitivity of MRI in diagnosing injuries to the non-osseous structures of the spine were thus calculated. Results Of the 31 patients, in 51.6% of patients the site of injury was to the cervical spine (n=16), thoracic spine was the next highest in occurrence of 39% (n=12) and lumbar spine accounted for the least. In correlating the imaging findings to the intraoperative findings, MRI was highly sensitive in detecting injuries to the Posterior Longitudinal Ligament (94.4%) and the Spinal cord (93%) and fairly high in detecting injuries to the Intervertebral disc. However coming to the ligamentum flavum and interspinous ligaments, the sensitivity of the MRI dropped to 62.5% and 63.6% respectively. Conclusion MRI was found to be highly sensitive in detecting injuries to the spinal cord and the posterior longitudinal ligament and

  15. Modeling the Biodynamical Response of the Human Head for Injury Analysis

    DTIC Science & Technology

    2001-09-01

    Human Spine. From Ref. [3]. .......................6 Figure 3. Occiput-Atlas-Axis Articulation. The Attachment of the Alar Ligaments to the...Figure 6. Intervertebral Disk Sectioned to Expose the Annular Organization. From Ref. [3]. .............11 Figure 7. Ligaments of the Spine. From Ref...sacral vertebrae, which are fused. The vertebrae and disks along with seven intervertebral ligaments spanning each set of adjacent vertebrae, and two

  16. A structure-based design approach for the identification of novel inhibitors: application to an alanine racemase

    NASA Astrophysics Data System (ADS)

    Mustata, Gabriela Iurcu; Briggs, James M.

    2002-12-01

    We report a new structure-based strategy for the identification of novel inhibitors. This approach has been applied to Bacillus stearothermophilus alanine racemase (AlaR), an enzyme implicated in the biosynthesis of the bacterial cell wall. The enzyme catalyzes the racemization of l- and d-alanine using pyridoxal 5'-phosphate (PLP) as a cofactor. The restriction of AlaR to bacteria and some fungi and the absolute requirement for d-alanine in peptidoglycan biosynthesis make alanine racemase a suitable target for drug design. Unfortunately, known inhibitors of alanine racemase are not specific and inhibit the activity of other PLP-dependent enzymes, leading to neurological and other side effects. This article describes the development of a receptor-based pharmacophore model for AlaR, taking into account receptor flexibility (i.e. a `dynamic' pharmacophore model). In order to accomplish this, molecular dynamics (MD) simulations were performed on the full AlaR dimer from Bacillus stearothermophilus (PDB entry, 1sft) with a d-alanine molecule in one active site and the non-covalent inhibitor, propionate, in the second active site of this homodimer. The basic strategy followed in this study was to utilize conformations of the protein obtained during MD simulations to generate a dynamic pharmacophore model using the property mapping capability of the LigBuilder program. Compounds from the Available Chemicals Directory that fit the pharmacophore model were identified and have been submitted for experimental testing. The approach described here can be used as a valuable tool for the design of novel inhibitors of other biomolecular targets.

  17. Job Language Performance Requirements for MOS 13B, Cannon Crewman. Volume I & II.

    DTIC Science & Technology

    1982-10-01

    broken manage . brought medic S but mouth to mouth resuscitation causes obstruction certain pause checking pinched check pliable * chest position... woods super user vehicle I \\S 51 • o - M OS : TASK: 031-503-1006 TASK TITLE: GIVE VOCAL, VISUAL AND OR SOUND ALAR.MS FOR CHL11CAL OR BIOLOGCAL ATTACK...examine handcrank holes insulating inspection insulation I.N’ knot pliers maintenance reels rt/splice operator section sections pass (v) sets perform

  18. The tripod graft: nasal tip cartilage reconstruction during revision rhinoplasty.

    PubMed

    Pedroza, Fernando; Pedroza, Luis Fernando; Achiques, Maria Teresa; Felipe, Edgar; Becerra, Felix

    2014-01-01

    IMPORTANCE Nasal tip revision remains one of the most challenging surgical procedures for facial plastic surgeons to perform. OBJECTIVE To describe preoperative and postoperative findings related to nasal tip functional and aesthetic aspects following revision rhinoplasty using the "tripod" technique. DESIGN, SETTING, AND PARTICIPANTS A retrospective descriptive study was performed in patients who underwent revision rhinoplasty between 2007 and 2012 at a clinic in Bogota, Colombia. A preoperative diagnosis of nasal tip deformity was made on the basis of photographic records and compared with postoperative nasal tip findings in patients who required the tripod technique. Photographs were evaluated before and after surgery every month for the first 3 months, and after 6, 9, and 12 months postoperatively. MAIN OUTCOMES AND MEASURES Nasal projection, tip rotation, columellar and alar retraction, alar pinch, lack of tip definition, and nasal tip asymmetry. RESULTS Sixty-four of the 69 patients who received revision rhinoplasty using the tripod technique during the study period were enrolled in the study. The tripod technique improved all of the following aesthetic and functional parameters (all P < .001). Nasal tip definition improved in 43 of 49 patients (88%). After surgery, projection was normal in 28 of 40 patients (70%) who had underprojection and overprojection preoperatively, and rotation improved in 29 of 38 patients (76%) who had overrotation or underrotation preoperatively. Columellar retraction improved after surgery in 18 of 24 patients (75%). The alar region improved in 41 of 52 patients (79%) who had alar retraction and/or pinch preoperatively, and inspiratory collapse improved in 49 of 50 patients (98%). CONCLUSIONS AND RELEVANCE The tripod technique is an efficient surgical alternative for nasal tip reconstruction during revision rhinoplasty. This technique allows the destroyed cartilaginous framework to be recreated and returns original nasal tip

  19. Offpost Operable Unit Remedial Investigation and Chemical Specific Applicable or Relevant and Appropriate Requirements, Version 3.1. Volume 3

    DTIC Science & Technology

    1988-12-01

    3 Sodium cabomate,..I.........................................3 Sodium methy late, alcohol mixture...Potential Biota ARAR: No 53. P•PTARY NAME: Sodium methylate, alcohol mixture CERCL,\\ Hazardous Substance: Yes Ranking on ATSDR Priority List: No Air Aralyte...ARARs for Chromium Ill. Whether these potential ARARs merit selection as AlARs will be determined in the context of the Feasibility Study/Endan- erment

  20. Aesthetic proportions of the nasal aperture in 3 different racial groups of men.

    PubMed

    Abdelkader, Maged; Leong, Samuel; White, Paul S

    2005-01-01

    To define baseline aesthetic dimensions of the nasal aperture in 3 different racial groups. Healthy volunteers from 3 different racial groups (15 white, 15 Chinese, and 15 Indian men) were enrolled in the study at the Department of Otolaryngology, University of Dundee, Dundee, Scotland. Those with a history of nasal or facial surgery or trauma were excluded from the study. Images were obtained and stored in a digital format. The dimensions of nasal aperture were defined by the length of the columella at the narrowest point, the width of the columella at the narrowest point, the length of the nasal aperture at the maximum length, the width of the nasal aperture at the maximum width, and the width of the alar cartilage base. There was no significant difference in the length or the width of the columella for the 3 racial groups. There was no significant difference in the length of the nasal aperture between the Chinese and the white groups. The nasal aperture was longer in the Indian group compared with the other 2 groups (P<.002). The nasal aperture at the maximum width was narrower in the Chinese group compared with the other groups (P<.002); there was no significant difference between the white and Indian groups. The nasal alar width was slightly narrower at the alar base in the Chinese group compared with other racial groups (P<.001). The aesthetic dimensions of the nasal aperture differ between racial groups. The nasal aperture and the alar base were narrower in the Chinese group, and the nasal aperture was longer in the Indian group. The aesthetic surgeon should ideally have an understanding of these ethnic variations.

  1. A Literature Review of Musculoskeletal Injuries to the Human Neck and the Effects of Head-Supported Mass Worn by Soldier

    DTIC Science & Technology

    2005-10-01

    1298-1310. Panjabi, M.M., Crisco, J.J., Lydon, C., and Dvorak, J. (1998) The Mechanical Properties of Human Alar and Transverse Ligaments at Slow and...Biomechanics Laboratory, Department of Mechanical Engineering 460 Turner Street CR-2006-01 Blacksburg, VA 24061 9. SPONSORING/MONITORING AGENCY NAME(S) AND...develop a complete model of the biomechanical mechanism or structure of interest. Each of these rigid bodies may have different inertial or stiffness

  2. Depicting the inner and outer nose: the representation of the nose and the nasal mucosa on the human primary somatosensory cortex (SI).

    PubMed

    Gastl, Mareike; Brünner, Yvonne F; Wiesmann, Martin; Freiherr, Jessica

    2014-09-01

    The nose is important not only for breathing, filtering air, and perceiving olfactory stimuli. Although the face and hands have been mapped, the representation of the internal and external surface of the nose on the primary somatosensory cortex (SI) is still poorly understood. To fill this gap functional magnetic resonance imaging (fMRI) was used to localize the nose and the nasal mucosa in the Brodman areas (BAs) 3b, 1, and 2 of the human postcentral gyrus (PG). Tactile stimulation during fMRI was applied via a customized pneumatically driven device to six stimulation sites: the alar wing of the nose, the lateral nasal mucosa, and the hand (serving as a reference area) on the left and right side of the body. Individual representations could be discriminated for the left and right hand, for the left nasal mucosa and left alar wing of the nose in BA 3b and BA 1 by comparing mean activation maxima and Euclidean distances. Right-sided nasal conditions and conditions in BA 2 could further be separated by different Euclidean distances. Regarding the alar wing of the nose, the results concurred with the classic sensory homunculus proposed by Penfield and colleagues. The nasal mucosa was not only determined an individual and bilateral representation, its position on the somatosensory cortex is also situated closer to the caudal end of the PG compared to that of the alar wing of the nose and the hand. As SI is commonly activated during the perception of odors, these findings underscore the importance of the knowledge of the representation of the nasal mucosa on the primary somatosensory cortex, especially for interpretation of results of functional imaging studies about the sense of smell.

  3. n-3 Fatty acids preserve muscle mass and insulin sensitivity in a rat model of energy restriction.

    PubMed

    Galmiche, Guillaume; Huneau, Jean-François; Mathé, Véronique; Mourot, Jacques; Simon, Noémie; Le Guillou, Céline; Hermier, Dominique

    2016-10-01

    In obese subjects, the loss of fat mass during energy restriction is often accompanied by a loss of muscle mass. The hypothesis that n-3 PUFA, which modulate protein homoeostasis via effects on insulin sensitivity, could contribute to maintain muscle mass during energy restriction was tested in rats fed a high-fat diet (4 weeks) rich in 18 : 1 n-9 (oleic acid, OLE-R), 18 : 3 n-3 (α-linolenic acid, ALA-R) or n-3 long-chain (LC-R) fatty acid and then energy restricted (8 weeks). A control group (OLE-ad libitum (AL)) was maintained with AL diet throughout the study. Rats were killed 10 min after an i.v. insulin injection. All energy-restricted rats lost weight and fat mass, but only the OLE-R group showed a significant muscle loss. The Gastrocnemius muscle was enriched with ALA in the ALA-R group and with LC-PUFA in the ALA-R and LC-R groups. The proteolytic ubiquitin-proteasome system was differentially affected by energy restriction, with MAFbx and muscle ring finger-1 mRNA levels being decreased in the LC-R group (-30 and -20 %, respectively). RAC-α serine/threonine-protein kinase and insulin receptor substrate 1 phosphorylation levels increased in the LC-R group (+70 %), together with insulin receptor mRNA (+50 %). The ALA-R group showed the same overall activation pattern as the LC-R group, although to a lesser extent. In conclusion, dietary n-3 PUFA prevent the loss of muscle mass associated with energy restriction, probably by an improvement in the insulin-signalling pathway activation, in relation to enrichment of plasma membranes in n-3 LC-PUFA.

  4. Classification of Chronic Whiplash Associated Disorders With Artificial Neural Networks

    DTIC Science & Technology

    2007-11-02

    J. Hayek, T. Ettlin, “"Whiplash" injury of the cervical spine: value of modern diagnostic imaging ”, Schweiz -Med- Wochenschr, vol 127, pp 1643-51...standard X-ray. Instead other imaging techniques e.g., MRT can in some instances show changes [10]. Despite absence of abnormal imaging findings, patients...1997. [11] C.W. Pfirrmann, C.A. Binkert, M. Zanetti, N. Boos, J. Hodler, “Functional MR imaging of the craniocervical junction. Correlation with alar

  5. The same Arabidopsis gene encodes both cytosolic and mitochondrial alanyl-tRNA synthetases.

    PubMed Central

    Mireau, H; Lancelin, D; Small, I D

    1996-01-01

    In plants, all aminoacyl-tRNA synthetases are nuclearly encoded, despite the fact that their activities are required in the three protein-synthesizing cell compartments (cytosol, mitochondria, and chloroplasts). To investigate targeting of these enzymes, we cloned cDNAs encoding alanyl-tRNA synthetase (AlaRS) and the corresponding nuclear gene, ALATS, from Arabidopsis by using degenerate polymerase chain reaction primers based on highly conserved regions shared between known AlaRSs from other organisms. Analysis of the transcription of the gene showed the presence of two potential translation initiation codons in some ALATS mRNAs. Translation from the upstream AUG would generate an N-terminal extension with features characteristic of mitochondrial targeting peptides. A polyclonal antibody raised against part of the Arabidopsis AlaRS revealed that the Arabidopsis cytosolic and mitochondrial AlaRSs are immunologically similar, suggesting that both isoforms are encoded by the ALATS gene. In vitro experiments confirmed that two polypeptides can be translated from AlATS transcripts, with most ribosomes initiating on the downstream AUG to give the shorter polypeptide corresponding in size to the cytosolic enzyme. The ability of the presequence encoded between the two initiation codons to direct polypeptides to mitochondria was demonstrated by expression of fusion proteins in tobacco protoplasts and in yeast. We conclude that the ALATS gene encodes both the cytosolic and the mitochondrial forms of AlaRS, depending on which of the two AUG codons is used to initiate translation. PMID:8672889

  6. Nose tip refinement using interdomal suture in caucasian nose

    PubMed Central

    Pasinato, Rogério; Mocelin, Marcos; Berger, Cezar Augusto Sarraf

    2012-01-01

    Summary Introduction: Refinement of the nose tip can be accomplished by a variety of techniques, but currently, the use of sutures in the nasal tip with conservative resection of the alar cartilage is the most frequently recommended approach. Objective: To classify the nasal tip and to demonstrate the interdomal suture applied to nasal tip refinement in the Caucasian nose, as well as to provide a simple and practical presentation of the surgical steps. Method: Development of surgical algorithm for nasal tip surgery: 1. Interdomal suture (double binding suture), 2. Interdomal suture with alar cartilage weakening (cross-hatching), 3. Interdomal suture with cephalic removal of the alar cartilage (McIndoe technique) based on the nasal tip type classification. This classification assesses the interdomal distance (angle of domal divergence and intercrural distance), domal arch width, cartilage consistency, and skin type. Interdomal suture is performed through endonasal rhinoplasty by basic technique without delivery (Converse-Diamond technique) under local anesthesia. Conclusion: This classification is simple and facilitates the approach of surgical treatment of the nasal tip through interdomal suture, systematizing and standardizing surgical maneuvers for better refinement of the Caucasian nose. PMID:25991963

  7. The transverse occipital ligament: anatomy and potential functional significance.

    PubMed

    Tubbs, R Shane; Griessenauer, Christoph J; McDaniel, Jenny Gober; Burns, Amanda M; Kumbla, Anjali; Cohen-Gadol, Aaron A

    2010-03-01

    Knowledge of the anatomy of ligaments that bind the craniocervical junction is important for treating patients with lesions of this region. Although the anatomy and function of these ligaments have been well described, those of the transverse occipital ligament (TOL) have remained enigmatic. To describe the anatomy and functions of the transverse occipital ligament. Via a posterior approach, 9 cadaveric specimens underwent dissection of the craniocervical junction with special attention to the presence and anatomy of the TOL. The TOL was identified in 77.8% of the specimens. The ligament was found to be rectangular with fibers running horizontally between the lateral aspects of the foramen magnum. The attachment of each ligament near the occipital condyle was consistent, and each ligament was found superior to the transverse portion of the cruciform ligament and inserted just posterior to the lateral attachment sites of the alar ligaments. The average width, length, and thickness of the TOL was 0.34, 1.94, and 0.13 cm, respectively. The TOL in some specimens also had connections to the alar and transverse ligaments. The TOL was found in the majority of our specimens. The possible functions of this ligament when attached to the alar ligaments include providing additional support to these structures in stabilizing lateral bending, flexion, and axial rotation of the head. Knowledge of this ligament may aid in further understanding craniocervical stability and help in differentiating normal from pathology via imaging modalities.

  8. Mesencephalic basolateral domain specification is dependent on Sonic Hedgehog

    PubMed Central

    Martinez-Lopez, Jesus E.; Moreno-Bravo, Juan A.; Madrigal, M. Pilar; Martinez, Salvador; Puelles, Eduardo

    2015-01-01

    In the study of central nervous system morphogenesis, the identification of new molecular markers allows us to identify domains along the antero-posterior and dorso-ventral (DV) axes. In the past years, the alar and basal plates of the midbrain have been divided into different domains. The precise location of the alar-basal boundary is still under discussion. We have identified Barhl1, Nhlh1 and Six3 as appropriate molecular markers to the adjacent domains of this transition. The description of their expression patterns and the contribution to the different mesencephalic populations corroborated their role in the specification of these domains. We studied the influence of Sonic Hedgehog on these markers and therefore on the specification of these territories. The lack of this morphogen produced severe alterations in the expression pattern of Barhl1 and Nhlh1 with consequent misspecification of the basolateral (BL) domain. Six3 expression was apparently unaffected, however its distribution changed leading to altered basal domains. In this study we confirmed the localization of the alar-basal boundary dorsal to the BL domain and demonstrated that the development of the BL domain highly depends on Shh. PMID:25741244

  9. Fetal anatomy of the lower cervical and upper thoracic fasciae with special reference to the prevertebral fascial structures including the suprapleural membrane.

    PubMed

    Miyake, Naritomo; Takeuchi, Hiromi; Cho, Baik Hwan; Murakami, Gen; Fujimiya, Mineko; Kitano, Hiroya

    2011-07-01

    The aim of this study was to find basic rules governing the fetal anatomy of the deep cervical fasciae and their connections to the mediastinal fasciae. We examined the histology of paraffin-embedded preparations of 18 mid-term fetuses (5 between 9 and 12 weeks of gestation, 3 between 15 and 18 weeks, and 10 between 20 and 25 weeks). The prevertebral lamina of the deep cervical fasciae (PLDCF) developed as an intermediate aponeurosis for the bilateral bellies of the longus colli muscles. In contrast, the alar fascia developed as a connecting band between the bilateral adventitiae of the common carotid artery. The retropharyngeal fascia became evident much later than the latter two fasciae. The fascia covering the thymus was thicker than the fascia for the strap muscles (the pretracheal lamina of the cervical fascia). The primitive suprapleural membrane, or Sibson's fascia, contained veins and fatty tissues, and was composed of the alar fascia rather than the PLDCF, tranversalis fascia, or endothoracic fascia. The prevertebral two-laminar configuration was rather evident in the early stages of development because, in the later stages, the fasciae together provided a multilaminar structure, especially in the lateral area in front of the longus colli, which suspended the cupula pleurae. To consider a continuation from the base of the neck to the upper mediastinum, the alar fascia seems to be a key structure for connecting the vascular sheath to the parietal pleura.

  10. The selective tRNA aminoacylation mechanism based on a single G•U pair.

    PubMed

    Naganuma, Masahiro; Sekine, Shun-ichi; Chong, Yeeting Esther; Guo, Min; Yang, Xiang-Lei; Gamper, Howard; Hou, Ya-Ming; Schimmel, Paul; Yokoyama, Shigeyuki

    2014-06-26

    Ligation of tRNAs with their cognate amino acids, by aminoacyl-tRNA synthetases, establishes the genetic code. Throughout evolution, tRNA(Ala) selection by alanyl-tRNA synthetase (AlaRS) has depended predominantly on a single wobble base pair in the acceptor stem, G3•U70, mainly on the kcat level. Here we report the crystal structures of an archaeal AlaRS in complex with tRNA(Ala) with G3•U70 and its A3•U70 variant. AlaRS interacts with both the minor- and the major-groove sides of G3•U70, widening the major groove. The geometry difference between G3•U70 and A3•U70 is transmitted along the acceptor stem to the 3'-CCA region. Thus, the 3'-CCA region of tRNA(Ala) with G3•U70 is oriented to the reactive route that reaches the active site, whereas that of the A3•U70 variant is folded back into the non-reactive route. This novel mechanism enables the single wobble pair to dominantly determine the specificity of tRNA selection, by an approximate 100-fold difference in kcat.

  11. The selective tRNA aminoacylation mechanism based on a single G•U pair

    PubMed Central

    Naganuma, Masahiro; Sekine, Shun-ichi; Chong, Yeeting Esther; Guo, Min; Yang, Xiang-Lei; Gamper, Howard; Hou, Ya-Ming; Schimmel, Paul; Yokoyama, Shigeyuki

    2015-01-01

    Ligation of tRNAs with their cognate amino acids, by aminoacyl-tRNA synthetases, establishes the genetic code. Throughout evolution, tRNAAla selection by alanyl-tRNA synthetase (AlaRS) has depended predominantly on a single wobble base pair in the acceptor stem, G3•U70, mainly on the kcat level. Here we report the crystal structures of an archaeal AlaRS in complex with tRNAAla with G3•U70 and its A3•U70 variant. AlaRS interacts with both the minor- and major-groove sides of G3•U70, widening the major groove. The geometry difference between G3•U70 and A3•U70 is transmitted along the acceptor stem to the 3′-CCA region. Thus, the 3′-CCA region of tRNAAla with G3•U70 is oriented to the reactive route that reaches the active site, whereas that of the A3•U70 variant is folded back into the “non-reactive route”. This novel mechanism enables the single wobble pair to dominantly determine the specificity of tRNA selection, by an approximate 100-fold difference in kcat. PMID:24919148

  12. Investigation of whiplash injuries in the upper cervical spine using a detailed neck model.

    PubMed

    Fice, Jason B; Cronin, Duane S

    2012-04-05

    Whiplash injuries continue to have significant societal cost; however, the mechanism and location of whiplash injury is still under investigation. Recently, the upper cervical spine ligaments, particularly the alar ligament, have been identified as a potential whiplash injury location. In this study, a detailed and validated explicit finite element model of a 50th percentile male cervical spine in a seated posture was used to investigate upper cervical spine response and the potential for whiplash injury resulting from vehicle crash scenarios. This model was previously validated at the segment and whole spine levels for both kinematics and soft tissue strains in frontal and rear impact scenarios. The model predicted increasing upper cervical spine ligament strain with increasing impact severity. Considering all upper cervical spine ligaments, the distractions in the apical and alar ligaments were the largest relative to their failure strains, in agreement with the clinical findings. The model predicted the potential for injury to the apical ligament for 15.2 g frontal or 11.7 g rear impacts, and to the alar ligament for a 20.7 g frontal or 14.4 g rear impact based on the ligament distractions. Future studies should consider the effect of initial occupant position on ligament distraction. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. 400 years astronomical observatory in Jena

    NASA Astrophysics Data System (ADS)

    Schielicke, Reinhard E.

    ``Nam cum aliquod observatorium mihi comparaverim, ... '': ``As I have equiped my observatory now'', Georg Limnaeus, professor of mathematics in Jena from 1588 to 1611, wrote on 24 April 1598, ``I have decided to make friends with some experts by letter; I know from your Prodromus that you are one of them''. The letter was addressed to Johannes Kepler and was related to his first work about the ``Mysterium cosmographicum''. Kepler sent some copies of his paper to Galileo Galilei, Tycho Brahe, Reimar Ursus and also to Limnaeus in Jena from the Frankfurt Book Fair in 1597. Limnaeus gave him - apart from the words expressing praise but which actually were meaningless concerning Kepler's ideas - the information about Brahe Kepler had asked for and which may have promoted his move to Prague. The above mentioned observatory is considered to be the first one in Jena. Astronomy had already been established as a subject since the establishment of the ``Hohe Schule'' in 1548 and since the foundation of the university ten years later. Nothing is known about the instruments and the location of the observatory. Limnaeus did not belong to the taxpaying house-owners of which there exists an index; he obviously rented a flat. To all appearances the correspondence announced was not continued either. For the following centuries the professors Heinrich Hoffmann, Erhard Weigel, Georg Albrecht and Georg Erhard Hamberger are named in the literature running the observatory in Jena. The ``Herzogliche Sternwarte'' fitted out under Goethe's overall supervision in 1813 eventually developed into the university institute of today.

  14. Extra-hepatic bile duct hamartoma in a 10-month-old with a morgagni hernia and multiple anatomical anomalies: a rare and incidental finding.

    PubMed

    Shah, Adil A; Karass, Michael; Page, Andrew J; Shehata, Bahig M; Durham, Megan M

    2013-07-01

    Von Meyenburg complexes (VMCs), also known as bile duct hamartomas, are a part of a group of ductal plate malformations. They are typically present intrahepatically. In this case, we present to our knowledge the first report of an extra-hepatic VMC in the pediatric population. The patient presented as a 10-month-old infant with a weeklong history of progressive breathing difficulty. A chest radiograph was obtained, showing intestinal loops in the thoracic cavity consistent with a Morgagni's hernia, unrelated to his breathing difficulty. The patient then underwent an elective repair of his congenital diaphragmatic defect. During the operation, the bile duct hamartoma was found adherent to the accessory lobe of the liver, present to the left of the ligamentum teres.

  15. Spinalis capitis, or an accessory paraspinous muscle?

    PubMed Central

    Martin, A

    1994-01-01

    A unilateral muscle, the location and dimensions of which do not exactly conform to existing descriptions, was found during dissection of the suboccipital region. The muscle in question extended from the spine and transverse process of the 6th cervical vertebra to the base of the skull. At its rostral attachment it blended with the insertion of the left rectus capitis posterior minor muscle on the inferior nuchal line. The caudal attachment arched over the semispinalis cervicis, separated from that muscle by an extensive venous complex. Medially, along the length of the muscle, weak fascial attachments to the ligamentum nuchae were present. Arterial branches from the occipital artery entered the muscle near its rostral end and nerve fibres and vascular channels from the lower cervical region entered the deep surface of the muscle. Images Figs 1-3 Fig. 4 PMID:7559114

  16. Ossification of thoracic ligamenta flava

    SciTech Connect

    Kudo, S.; Minoru, O.; Russell, W.J.

    1983-07-01

    Although ligamentum flavum ossification (LFO) often occurs in normal persons, there are no reports of its detection on lateral chest radiographs made during screening examinations. Review of 1,744 consecutive lateral chest radiographs identified LFO in 6.2% of males and 4.8% of females. LFO occurred mainly at the intervertebral segments from T9-T10 through T12-L1. Most prevalent was the hook-shaped LFO, protruding inferoirly from the inferior facets into the projections of the intervertabral foramina. Though LFO can cause severe neurologic symptoms, none of the affected persons in this study reported such symptoms. LFO was first visualized radiographically when the subjects were 20-40 years old, and it may be a physiologic condition. The LFO in these cases existed independent of thoracic posterior longitudinal ligament ossification, diffuse idiopathic skeletal hyperostosis, and degenerative osteoarthritis.

  17. Differences in ligamenta flava among some mammals.

    PubMed Central

    Ponseti, I. V.

    1995-01-01

    The ligamenta flava of the thoracolumbar spine of mammals with great spinal mobility have a larger content of elastin than in animals with little spinal motion. The elastin content is also higher in the ligamenta flava of mammals with arched backs and prolonged sitting posture than in nonsitting mammals with the vertebral column in the shape of a flat bow. The ligamentum flavum appears to be important; a) in the control of intervertebra movements, b) in providing intrinsic stability to the spine in the sitting and standing postures and c) in maintaining a smooth surface in the posterior wall of the spinal canal and neural foraminae. Images Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 PMID:7634024

  18. Reversible and irreversible interactions between elastin and plasma lipoproteins.

    PubMed

    Winlove, C P; Parker, K H; Ewins, A R

    1985-03-08

    The interactions between radiolabeled, human plasma lipoproteins and elastin derived from bovine ligamentum nuchae were investigated using a washout technique. The interaction was characterised by Ki, a coefficient of irreversible binding, and Kr, the reversible partition coefficient. For both low-density lipoproteins (LDL) and high-density lipoproteins (HDL) the Ki values decreased as total lipoprotein concentration increased, suggesting that the binding is saturable, and were similar in magnitude to those measured by other workers using elastin derived from the human aorta. For both LDL and HDL the Kr values were independent of lipoprotein concentration in the range 0.1 microgram/ml-1.5 micrograms/ml. At a total protein concentration of 1.5 mg/ml in the incubation medium, the reversible interactions were comparable in magnitude to the irreversible.

  19. Dynamic Lumbar Spinal Stenosis : The Usefulness of Axial Loaded MRI in Preoperative Evaluation

    PubMed Central

    Choi, Kyung-Chul; Jung, Byungjoo; Lee, Sang-Ho

    2009-01-01

    Two cases of dynamic lumbar spinal stenosis were identified by the authors using axial loaded magnetic resonance image (MRI). In both cases, the patients presented with neurogenic claudication but MRI in decumbency showed no definite pathologic condition associated with their symptoms. In contrast, axial loaded MRI demonstrated constrictive spinal stenosis and a significantly decreased dural sac caused by epidural fat buckling and thickening of the ligamentum flavum in both cases. In the second case, a more prominent disc protrusion was also demonstrated compared with decumbent MRI. After decompressive surgery, both patients had satisfactory outcomes. Axial loaded MRI can therefore give decisive information in dynamic spinal disorders by allowing simulation of an upright position. PMID:19844630

  20. Spinal stenosis with meralgia paraesthetica.

    PubMed

    Jiang, G X; Xu, W D; Wang, A H

    1988-03-01

    Of 232 patients with evidence of lumbar spinal stenosis, 13 had symptoms of meralgia paraesthetica. Myelography demonstrated that in all but one of these 13 cases the L3-4 level was involved by stenosis; in 12 matched control patients with spinal stenosis, none had involvement at this level. We found that both the ligamentum flavum and the laminae at L3-4 level were thicker than in a control group. Decompressive laminectomy at the L3-4 level significantly reduced the area of hypo-aesthesia in the thigh, effecting complete cure in seven of the 11 cases. Meralgia paraesthetica is not uncommon in patients with spinal stenosis and is referable to changes at the L3-4 level. It seems that many cases of meralgia may have a spinal origin.

  1. LUMBAR DISC HERNIATION

    PubMed Central

    Vialle, Luis Roberto; Vialle, Emiliano Neves; Suárez Henao, Juan Esteban; Giraldo, Gustavo

    2015-01-01

    Lumbar disc herniation is the most common diagnosis among the degenerative abnormalities of the lumbar spine (affecting 2 to 3% of the population), and is the principal cause of spinal surgery among the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (four to six weeks). The initial treatment should be conservative, managed through medication and physiotherapy, sometimes associated with percutaneous nerve root block. Surgical treatment is indicated if pain control is unsuccessful, if there is a motor deficit greater than grade 3, if there is radicular pain associated with foraminal stenosis, or if cauda equina syndrome is present. The latter represents a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces the risk of recurrence over the long term. PMID:27019834

  2. Modern approach to an old technique: Narrative revision of techniques used to locate the epidural space.

    PubMed

    Brogly, N; Guasch Arévalo, E; Kollmann Camaiora, A; Alsina Marcos, E; García García, C; Gilsanz Rodríguez, F

    2017-03-16

    Since the first description of the epidural technique during the 1920s, the continuous progress of knowledge of the anatomy and physiology of the epidural space has allowed the development of different techniques to locate this space while increasing both the safety and efficacy of the procedure. The most common techniques used today are based on the two main characteristics of the epidural space: the difference in distensibility between the ligamentum flavum and the epidural space, and the existence of negative pressure within the epidural space. However, over recent years, technological advances have allowed the development of new techniques to locate the epidural space based on other physical properties of tissues. Some are still in the experimental phase, but others, like ultrasound-location have reached a clinical phase and are being used increasingly in daily practice.

  3. Multi-drug-resistant hypertension caused by severe aortic coarctation presenting in late adulthood.

    PubMed

    Meller, Stephanie M; Fahey, John T; Setaro, John F; Forrest, John K

    2015-04-01

    Aortic coarctation, a congenital narrowing in the region of the ligamentum arteriosium, is a rare etiology for multi-drug-resistant hypertension in adulthood; however, advances in stenting modalities may offer long-term improvements in morbidity and possibly even cure. We report on a female patient in her late 50s presenting with refractory hypertension and severely elevated renin levels, ultimately diagnosed with aortic coarctation and treated with percutaneous stent implantation, which resulted in successful blood pressure control with verapamil monotherapy. This case highlights the efficacy of endovascular stent implantation for the treatment of coarctation and the need for clinicians to consider this disease entity in the differential diagnosis of refractory hypertension even in late adulthood.

  4. Vascular deprivation-induced necrosis of the femoral head of the rat. An experimental model of avascular osteonecrosis in the skeletally immature individual or Legg-Perthes disease.

    PubMed

    Norman, D; Reis, D; Zinman, C; Misselevich, I; Boss, J H

    1998-06-01

    The blood supply of rats' femoral heads was severed by cutting the ligamentum teres and stripping the periostium. Histologically, necrosis of the marrow was apparent on the 2nd postoperative day, necrosis of the bone on the 5th postoperative day and fibrous ingrowth on the 7th postoperative day. During the following 5 weeks, progressive resorption of the intertrabecular necrotic debris and necrotic bony trabeculae and subchondral bone plate and, concurrently, appositional and intramembranous new bone formation resulted in remodeling of the femoral heads. In 2 of 7 femoral heads, replacement of the necrotic bone by viable bone was complete at the 42-day postoperative interval. Also, the articular cartilage of the deformed and flattened femoral heads was undergoing degenerative changes. Reduplicating the pathogenically inferred clinical settings of blood supply deprivation, it is proposed that this model, in a small laboratory animal, satisfies the requirements sought for preclinical studies of treatment modalities of avascular osteonecrosis in man.

  5. Protecting a Patellar Ligament Reconstruction after Proximal Tibial Resection: A Simplified Approach

    PubMed Central

    Titus, Vijay

    2008-01-01

    Limb salvage in tumor surgery has encouraged the development of megaprostheses. However, reattaching the ligamentum patellae poses a particular problem: avulsion and/or extensor lag may lead to poor function. We describe a new technique of patellar ligament reconstruction. The technique involves reattachment of the patellar ligament to the tibial tuberosity of the proximal tibial megaprosthesis, which has a porous surface created, and the repair is protected with a cerclage wire through the patella and the prosthesis. In 10 consecutive patients, the range of motion averaged 95° (median, 90°; range, 70°–120°), and the mean extension lag averaged 4° (median, 0°; range, 0°–20°). We had one case of patellar ligament avulsion. This technique resulted in good quadriceps function and a low incidence of complications. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18425561

  6. Dorsoscapularis triangularis: embryological and phylogenetic characterization of a rare variation of trapezius

    PubMed Central

    Tuli, Anita; Raheja, Shashi

    2016-01-01

    The muscle trapezius shows considerable morphological diversity. Variations include an anomalous origin and complete or partial absence of the muscle. The present study reported, a hitherto undocumented complete bilateral absence of the cervical part of trapezius. Based on its peculiar origin and insertion, it was named dorsoscapularis triangularis. The embryological, phylogenetic and molecular basis of the anomaly was elucidated. Failure of cranial migration of the trapezius component of the branchial musculature anlage to gain attachment on the occipital bone, cervical spinous processes, ligamentum nuchae between 11 mm and 16 mm stage of the embryo, resulted in this anomaly. A surgeon operating on the head and neck region or a radiologist analyzing a magnetic resonance imaging of the cervical region would find the knowledge of this morphological variation of trapezius useful in making clinical decisions. PMID:27722016

  7. Elastofibromatous changes in tissues from spinal biopsies. A degenerative process afflicting a small but important subset of patients operated for spinal canal compression: report of 18 cases.

    PubMed

    Daum, Ondrej; Ferda, Jiri; Curik, Romuald; Choc, Milan; Mukensnabl, Petr; Michal, Michal

    2010-12-01

    Elastofibroma is a tumorlike lesion occurring usually in the subscapular region of elderly females. In this study, 18 cases of elastofibromatous tissue retrieved from the spinal canal were analyzed to elucidate its frequency and possible clinical associations. The patients included 8 men and 10 women with a mean age of 63.4 years (range, 40-84 years). The elastic nature of the material was confirmed by Weigert's elastic stain and immunohistochemically. Elastofibroma was diagnosed in 6 patients, and elastofibroma-like tissue was found in 11 samples. The finding of elastofibromatous tissue was associated with clinical diagnosis of juxtaarticular cysts (3 cases), thickening of ligamentum flavum (4 cases), extradural expansion (2 cases), metastatic involvement of the dorsal spine (3 cases), and a vertebral fracture (1 case). Two cases were located above the transpedicular fixation. Elastofibromatous tissue may be found in approximately 2.6% of all spinal biopsies and it may take part in compression of spinal cord and nerve roots.

  8. Soluble elastins, their preparation and characterization.

    PubMed

    Stoklasová, A; Randová, Z; Rocková, V; Ledvina, M

    1992-01-01

    We followed amino acid composition, sugar content, immunological reactivity and thermal coacervation of elastin-derived peptides in order to show whether the preparation procedure influenced the properties. Insoluble elastin was prepared by alkaline hydrolysis (N-elastin) or cyanogen bromide cleavage (C-elastin) of bovine ligamentum nuchae. The insoluble elastins were solubilized in oxalic acid, phosphoric acid or trifluoroacetic acid. The differences in properties were found in the case of trifluoroacetic hydrolysis only in comparison with soluble elastin-derived peptides prepared by oxalic or phosphoric acids hydrolysis. Trifluoroacetic acid probably breaks down the structure markedly including the antigenic determinants, which results in a low reactivity with antibodies. The ability of these peptides to form coacervates is also decreased.

  9. Technique of fiber optics used to localize epidural space in piglets.

    PubMed

    Ting, Chien-Kun; Chang, Yin

    2010-05-24

    Technique of loss-of-resistance in epidural block is commonly used for epidural anesthesia in humans with approximately 90% successful rate. However, it may be one of the most difficult procedures to learn for anesthesia residents in hospital. A two-wavelength (650 nm and 532 nm) fiber-optical method has been developed according to the characteristic reflectance spectra of ex-vivo porcine tissues, which are associated with the needle insertion to localize the epidural space (ES). In an in-vivo study in piglets showed that the reflected lights from ES and its surrounding tissue ligamentum flavum (LF) are highly distinguishable. This indicates that this technique has potential to localize the ES on the spot without the help of additional guiding assistance.

  10. Three dimensional laser scan assessment of the Oriental nose with a new classification of Oriental nasal types.

    PubMed

    Aung, S C; Foo, C L; Lee, S T

    2000-03-01

    The Oriental nose, which has been broadly classified as mesorrhine, differs in anatomy and morphology from other racial groups. The objective of this study is to carry out anthropometric measurements in the nose region, in order to establish norms for the Oriental nose and also to identify the variations that might occur within this group. Knowledge of the unique shape, anatomy and dimensions of the Oriental nose would be very useful for surgeons undertaking repair and reconstruction of Oriental noses. Ninety, normal Oriental subjects were scanned using a laser surface scanner, and the assessments were then carried out on the laser scan images. The 3-D laser scan images permit adjustment and positioning to achieve the correct standard views for assessment. Subjective assessment of the nose shape, as well as linear and angular measurements were carried out. Depending on the fullness and roundness of the nasal tip and the prominence of the alar lobules on either side, the Oriental nasal base may take on varied shapes and accordingly, three distinct shapes have been identified. They have been classified into types A, B and C where type A has a very prominent alar lobule and a full and rounded nasal tip. In type B, the alar lobule was less prominent and the nasal tip was more defined while in type C the alar lobule was the least prominent resulting in the lateral walls forming a relatively straight slope from the tip to the alar base. The linear and angular measurements for Oriental noses were also obtained and compared to values for other racial groups. The proportion indices for the Oriental nose showed that it was broader in relation to the nose height, and had less tip protrusion in relation to both the height and width of the nose. The data collected from this study can be used as norms for Oriental cases and the simple classification of the nose shape will serve as a guide for quick reference, when planning aesthetic or reconstructive rhinoplasties for the

  11. Preliminary evaluation of a differential effect of an α-linolenate-rich supplement on ketogenesis and plasma ω-3 fatty acids in young and older adults.

    PubMed

    Hennebelle, Marie; Courchesne-Loyer, Alexandre; St-Pierre, Valérie; Vandenberghe, Camille; Castellano, Christian-Alexandre; Fortier, Mélanie; Tessier, Daniel; Cunnane, Stephen C

    2016-01-01

    The aim of the present study was to compare the effects of an α-linolenic acid-rich supplement (ALA-RS) on the ketogenic response and plasma long-chain ω-3 polyunsaturated fatty acid in healthy young adults and older individuals. Ten young (25 ± 0.9 y) and 10 older adults (73.1 ± 2.2 y) consumed a flaxseed oil supplement providing 2 g/d of ALA for 4 wk. Plasma ketones, nonesterified fatty acids (NEFA), triacylglycerols, glucose, and insulin were measured over 6 h, before and after supplementation. Total body fat mass was assessed before and after the ALA-RS. The ALA-RS did not significantly modify fasting ketones but postprandial production of β-hydroxybutyrate was increased by 26% (P = 0.037) only in the young adult group. Fasting plasma ketones were positively correlated to fasting plasma NEFA (P < 0.01) in both groups. However, the relation was shifted to the right in the older group, suggesting that older adults needed higher plasma NEFA levels to achieve the same ketone amounts as young adults. At baseline, the older group had 47% higher total plasma fatty acids than the young group (P = 0.007). After the ALA-RS, plasma ALA doubled in both groups (P < 0.01), an effect that was associated in the older group with a 40% higher eicosapentaenoic acid (EPA; P = 0.004), but no difference in docosahexaenoic acid. The postsupplementation increase in plasma ALA correlated positively with percent total body fat, especially in the older group (r(2) = 0.77; P = 0.0016). In young adults, ALA-RS mildly stimulated postprandial ketogenesis, whereas in the older group, it favored increased plasma ALA and EPA. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Mesenchymal Stem Cell Levels of Human Spinal Tissues.

    PubMed

    Harris, Liam; Vangsness, C Thomas

    2017-09-06

    .: Systematic Review. .: The aim of this study was to investigate, quantify, compare and compile the various mesenchymal stem cell tissue sources within human spinal tissues to act as a compendium for clinical and research application. .: Recent years have seen a dramatic increase in academic and clinical understanding of human mesenchymal stem cells (MSCs). Previously limited to cells isolated from bone marrow, the past decade has illicited the characterization and isolation of human MSCs from adipose, bone marrow, synovium, muscle, periosteum, peripheral blood, umbilical cord, placenta and numerous other tissues. As researchers explore practical applications of cells in these tissues, the absolute levels of MSCs in specific spinal tissue will be critical to guide future research. .: The PubMED, MEDLINE, EMBASE and Cochrane databases were searched for articles relating to the harvest, characterization, isolation and quantification of human mesenchymal stem cells from spinal tissues. Selected articles were examined for relevant data, categorized according to type of spinal tissue, and when possible, standardized to facilitate comparisons between sites. .: Human mesenchymal stem cell levels varied widely between spinal tissues. Yields for Intervertebral disc demonstrated roughly 5% of viable cells to be positive for MSC surface markers. Cartilage endplate cells yielded 18,500- 61,875 cells/ 0.8 mm thick sample of cartilage end plate. Ligamentum flavum yielded 250,000- 500,000 cells per gram of tissue. Annulus fibrosus FACS treatment found 29% of cells positive for MSC marker Stro-1. Nucleus pulposus yielded mean tissue samples of 40,584-234,137 MSCs/gram of tissue. .: Numerous tissues within and surrounding the spine represent a consistent and reliable source for the harvest and isolation of human mesenchymal stem cells. Among the tissues of the spine, the annulus fibrosus and ligamentum flavum each offer considerable levels of mesenchymal stem cells, and may

  13. NMR studies of protonation and hydrogen bond states of internal aldimines of pyridoxal 5'-phosphate acid-base in alanine racemase, aspartate aminotransferase, and poly-L-lysine.

    PubMed

    Chan-Huot, Monique; Dos, Alexandra; Zander, Reinhard; Sharif, Shasad; Tolstoy, Peter M; Compton, Shara; Fogle, Emily; Toney, Michael D; Shenderovich, Ilya; Denisov, Gleb S; Limbach, Hans-Heinrich

    2013-12-04

    Using (15)N solid-state NMR, we have studied protonation and H-bonded states of the cofactor pyridoxal 5'-phosphate (PLP) linked as an internal aldimine in alanine racemase (AlaR), aspartate aminotransferase (AspAT), and poly-L-lysine. Protonation of the pyridine nitrogen of PLP and the coupled proton transfer from the phenolic oxygen (enolimine form) to the aldimine nitrogen (ketoenamine form) is often considered to be a prerequisite to the initial step (transimination) of the enzyme-catalyzed reaction. Indeed, using (15)N NMR and H-bond correlations in AspAT, we observe a strong aspartate-pyridine nitrogen H-bond with H located on nitrogen. After hydration, this hydrogen bond is maintained. By contrast, in the case of solid lyophilized AlaR, we find that the pyridine nitrogen is neither protonated nor hydrogen bonded to the proximal arginine side chain. However, hydration establishes a weak hydrogen bond to pyridine. To clarify how AlaR is activated, we performed (13)C and (15)N solid-state NMR experiments on isotopically labeled PLP aldimines formed by lyophilization with poly-L-lysine. In the dry solid, only the enolimine tautomer is observed. However, a fast reversible proton transfer involving the ketoenamine tautomer is observed after treatment with either gaseous water or gaseous dry HCl. Hydrolysis requires the action of both water and HCl. The formation of an external aldimine with aspartic acid at pH 9 also produces the ketoenamine form stabilized by interaction with a second aspartic acid, probably via a H-bond to the phenolic oxygen. We postulate that O-protonation is an effectual mechanism for the activation of PLP, as is N-protonation, and that enzymes that are incapable of N-protonation employ this mechanism.

  14. Patterns of hypothalamic regionalization in amphibians and reptiles: common traits revealed by a genoarchitectonic approach

    PubMed Central

    Domínguez, Laura; González, Agustín; Moreno, Nerea

    2015-01-01

    Most studies in mammals and birds have demonstrated common patterns of hypothalamic development highlighted by the combination of developmental regulatory genes (genoarchitecture), supporting the notion of the hypothalamus as a component of the secondary prosencephalon, topologically rostral to the diencephalon. In our comparative analysis we have summarized the data on the expression patterns of different transcription factors and neuroactive substances, used as anatomical markers, in the developing hypothalamus of the amphibian Xenopus laevis and the juvenile turtle Pseudemys scripta. This analysis served to highlight the organization of the hypothalamus in the anamniote/amniotic transition. We have identified supraoptoparaventricular and the suprachiasmatic regions (SCs) in the alar part of the hypothalamus, and tuberal and mammillary regions in the basal hypothalamus. Shared features in the two species are: (1) The supraoptoparaventricular region (SPV) is defined by the expression of Otp and the lack of Nkx2.1/Isl1. It is subdivided into rostral, rich in Otp and Nkx2.2, and caudal, only Otp-positive, portions. (2) The suprachiasmatic area contains catecholaminergic cell groups and lacks Otp, and can be further divided into rostral (rich in Nkx2.1 and Nkx2.2) and a caudal (rich in Isl1 and devoid of Nkx2.1) portions. (3) Expression of Nkx2.1 and Isl1 define the tuberal hypothalamus and only the rostral portion expresses Otp. (4) Its caudal boundary is evident by the lack of Isl1 in the adjacent mammillary region, which expresses Nkx2.1 and Otp. Differences in the anamnio-amniote transition were noted since in the turtle, like in other amniotes, the boundary between the alar hypothalamus and the telencephalic preoptic area shows distinct Nkx2.2 and Otp expressions but not in the amphibian (anamniote), and the alar SPV is defined by the expression of Otp/Pax6, whereas in Xenopus only Otp is expressed. PMID:25691860

  15. Lipid II-independent trans editing of mischarged tRNAs by the penicillin resistance factor MurM.

    PubMed

    Shepherd, Jennifer; Ibba, Michael

    2013-09-06

    Streptococcus pneumoniae is a causative agent of nosocomial infections such as pneumonia, meningitis, and septicemia. Penicillin resistance in S. pneumoniae depends in part upon MurM, an aminoacyl-tRNA ligase that attaches L-serine or L-alanine to the stem peptide lysine of Lipid II in cell wall peptidoglycan. To investigate the exact substrates the translation machinery provides MurM, quality control by alanyl-tRNA synthetase (AlaRS) was investigated. AlaRS mischarged serine and glycine to tRNA(Ala), as observed in other bacteria, and also transferred alanine, serine, and glycine to tRNA(Phe). S. pneumoniae tRNA(Phe) has an unusual U4:C69 mismatch in its acceptor stem that prevents editing by phenylalanyl-tRNA synthetase (PheRS), leading to the accumulation of misaminoacylated tRNAs that could serve as substrates for translation or for MurM. Although the peptidoglycan layer of S. pneumoniae tolerates a combination of both branched and linear muropeptides, deletion of MurM results in a reversion to penicillin sensitivity in strains that were previously resistant. However, because MurM is not required for cell viability, the reason for its functional conservation across all strains of S. pneumoniae has remained elusive. We now show that MurM can directly function in translation quality control by acting as a broad specificity lipid-independent trans editing factor that deacylates tRNA. This activity of MurM does not require the presence of its second substrate, Lipid II, and can functionally substitute for the activity of widely conserved editing domain homologues of AlaRS, termed AlaXPs proteins, which are themselves absent from S. pneumoniae.

  16. The principle of rotation advancement for repair of unilateral complete cleft lip and nasal deformity: technical variations and analysis of results.

    PubMed

    Mulliken, J B; Martínez-Pérez, D

    1999-10-01

    This is an assessment of one surgeon's 15-year experience (1981-1995) using the Millard rotation-advancement principle for repair of unilateral complete cleft lip and nasal deformity. All infants underwent a prior labio-nasal adhesion. Since 1991, dentofacial orthopedics with a pin-retained (Latham) appliance was used for infants with a cleft of the lip and palate. Technical variations are described, including modifications in sequence of closure. A high rotation and releasing incision in the columella lengthens the medial labial element and produces a symmetric prolabium with minimal transgression of the upper philtral column by the advancement flap. Orbicularis oris muscle is everted, from caudad to cephalad, to form the philtral ridge. A minor variation of unilimb Z-plasty is used to level the cleft side of Cupid's bow handle, and cutaneous closure proceeds superiorly from this junction. The dislocated alar cartilage is visualized though a nostril rim incision and suspended to the ipsilateral upper lateral cartilage. Symmetry of the alar base is addressed in three dimensions, including maneuvers to position the deviated anterior-caudal septum, configure the sill, and efface the lateral vestibular web. Secondary procedures were analyzed in 105 consecutive patients, both revised (n = 30) and unrevised (n = .75). The possible need for revision in the latter group was determined by panel assessment of six indicators of nasolabial asymmetry, documented by frontal and submental photographs. In the entire study period, a total of 80 percent of children required or will need nasal revision, and a total of 42 percent required or will require labial revision. In the last 5 years, as compared with the earlier decade, there was a significantly diminished incidence of patients requiring labial revision (54 percent to 21 percent) and alar suspension (63 percent to 32 percent). These improvements are attributable to technical refinements and experience, although dentofacial

  17. Head position and impact direction in whiplash injuries: associations with MRI-verified lesions of ligaments and membranes in the upper cervical spine.

    PubMed

    Kaale, Bertel Rune; Krakenes, Jostein; Albrektsen, Grethe; Wester, Knut

    2005-11-01

    In the present study, we compared magnetic resonance imaging (MRI) findings of soft tissue structures in the upper cervical spine between whiplash-associated disorder (WAD) patients and population-based control persons, and examined whether MRI-verified abnormalities in WAD patients were related to accident-related factors hypothesized to be of importance for severity of injury. A total of 92 whiplash patients and 30 control persons, randomly drawn, were included. Information on the accident-related factors (i.e., head position and impact direction) was obtained by a questionnaire that was answered within 1 week after the accident. The MRI examination was performed 2-9 (mean 6) years after the accident. Focus was on MRI abnormalities of the alar and the transverse ligaments, and the tectorial and posterior atlanto-occipital membranes, graded 0-3. For all neck structures, the whiplash patients had more high-grade lesions (grade 2 or 3) than the control persons (Chi-square test, p < 0.055). An abnormal alar ligament was most common (66.3% graded 2 or 3). Whiplash patients who had been sitting with their head/neck turned to one side at the moment of collision more often had high-grade lesions of the alar and transverse ligaments (p < 0.001, p = 0.040, respectively). Severe injuries to the transverse ligament and the posterior atlanto-occipital membrane were more common in front than in rear end collisions (p < 0.001, p = 0.001, respectively). In conclusion, the difference in MRI-verified lesions between WAD patients and control persons, and in particular the association with head position and impact direction at time of accident, indicate that these lesions are caused by the whiplash trauma.

  18. A Collaborative Study of Source Apportionment and Total City Emissions of CH4 from Indianapolis

    NASA Astrophysics Data System (ADS)

    Hajny, K. D.; Davis, K. J.; Franklin, J. E.; Harvey, R. M.; Lavoie, T. N.; Miles, N. L.; Richardson, S.; Salmon, O. E.; Sarmiento, D. P.; Shepson, P. B.; Stirm, B. H.; Wofsy, S.

    2016-12-01

    Methane (CH4) is the second most important greenhouse gas emitted in the United States, accounting for about 11% of all US greenhouse gas emissions in 2014. Over 60% of CH4 emissions globally are due to human activity and two of the largest anthropogenic sources of CH4 are waste decomposition in landfills and losses from the energy sector. Indianapolis has been a testbed site for development of methods for quantitative urban-scale greenhouse gas emissions measurements, through the Indianapolis Flux Experiment (INFLUX) since 2010. Multiple airborne mass balance experiments with Purdue University's Airborne Laboratory for Atmospheric Research (ALAR) have been performed in the area to quantify greenhouse gas emissions, since 2008. Previous research has shown that the large landfill in Indianapolis is the only significant point source, emitting 45 ± 14 mols CH4/s or roughly 1/3 of all CH4 emissions. Propane/methane ratios have indicated that all other CH4 emissions were due to leaks in the natural gas distribution system in the city, but not all the sources have been identified. A recent collaborative effort aimed to investigate this further using tower based inversions from INFLUX data, ground based Lagrangian transport modeling using Fourier Transform Spectrometers, and airborne based mass balance experiments using ALAR. Within the 2-week long project there were 4 days with atmospheric conditions that allowed for simultaneous airborne and ground based measurements. Here we will discuss selected outcomes from this effort, including city-wide mass balance measurements from ALAR, our results in light of the FTS observations, and how the results compare to the historical data base for Indianapolis.

  19. Topography of Somatostatin Gene Expression Relative to Molecular Progenitor Domains during Ontogeny of the Mouse Hypothalamus

    PubMed Central

    Morales-Delgado, Nicanor; Merchan, Paloma; Bardet, Sylvia M.; Ferrán, José L.; Puelles, Luis; Díaz, Carmen

    2010-01-01

    The hypothalamus comprises alar, basal, and floor plate developmental compartments. Recent molecular data support a rostrocaudal subdivision into rostral (terminal) and caudal (peduncular) halves. In this context, the distribution of neuronal populations expressing somatostatin (Sst) mRNA was analyzed in the developing mouse hypothalamus, comparing with the expression pattern of the genes Orthopedia (Otp), Distal-less 5 (Dlx5), Sonic Hedgehog (Shh), and Nk2 homeobox 1 (Nkx2.1). At embryonic day 10.5 (E10.5), Sst mRNA was first detectable in the anterobasal nucleus, a Nkx2.1-, Shh-, and Otp-positive basal domain. By E13.5, nascent Sst expression was also related to two additional Otp-positive domains within the alar plate and one in the basal plate. In the alar plate, Sst-positive cells were observed in rostral and caudal ventral subdomains of the Otp-positive paraventricular complex. An additional basal Sst-expressing cell group was found within a longitudinal Otp-positive periretromamillary band that separates the retromamillary area from tuberal areas. Apart of subsequent growth of these initial populations, at E13.5 and E15.5 some Sst-positive derivatives migrate tangentially into neighboring regions. A subset of cells produced at the anterobasal nucleus disperses ventralward into the shell of the ventromedial hypothalamic nucleus and the arcuate nucleus. Cells from the rostroventral paraventricular subdomain reach the suboptic nucleus, whereas a caudal contingent migrates radially into lateral paraventricular, perifornical, and entopeduncular nuclei. Our data provide a topologic map of molecularly defined progenitor areas originating a specific neuron type during early hypothalamic development. Identification of four main separate sources helps to understand causally its complex adult organization. PMID:21441981

  20. Patterns of hypothalamic regionalization in amphibians and reptiles: common traits revealed by a genoarchitectonic approach.

    PubMed

    Domínguez, Laura; González, Agustín; Moreno, Nerea

    2015-01-01

    Most studies in mammals and birds have demonstrated common patterns of hypothalamic development highlighted by the combination of developmental regulatory genes (genoarchitecture), supporting the notion of the hypothalamus as a component of the secondary prosencephalon, topologically rostral to the diencephalon. In our comparative analysis we have summarized the data on the expression patterns of different transcription factors and neuroactive substances, used as anatomical markers, in the developing hypothalamus of the amphibian Xenopus laevis and the juvenile turtle Pseudemys scripta. This analysis served to highlight the organization of the hypothalamus in the anamniote/amniotic transition. We have identified supraoptoparaventricular and the suprachiasmatic regions (SCs) in the alar part of the hypothalamus, and tuberal and mammillary regions in the basal hypothalamus. Shared features in the two species are: (1) The supraoptoparaventricular region (SPV) is defined by the expression of Otp and the lack of Nkx2.1/Isl1. It is subdivided into rostral, rich in Otp and Nkx2.2, and caudal, only Otp-positive, portions. (2) The suprachiasmatic area contains catecholaminergic cell groups and lacks Otp, and can be further divided into rostral (rich in Nkx2.1 and Nkx2.2) and a caudal (rich in Isl1 and devoid of Nkx2.1) portions. (3) Expression of Nkx2.1 and Isl1 define the tuberal hypothalamus and only the rostral portion expresses Otp. (4) Its caudal boundary is evident by the lack of Isl1 in the adjacent mammillary region, which expresses Nkx2.1 and Otp. Differences in the anamnio-amniote transition were noted since in the turtle, like in other amniotes, the boundary between the alar hypothalamus and the telencephalic preoptic area shows distinct Nkx2.2 and Otp expressions but not in the amphibian (anamniote), and the alar SPV is defined by the expression of Otp/Pax6, whereas in Xenopus only Otp is expressed.

  1. A Reliable Method to Measure Lip Height Using Photogrammetry in Unilateral Cleft Lip Patients.

    PubMed

    van der Zeeuw, Frederique; Murabit, Amera; Volcano, Johnny; Torensma, Bart; Patel, Brijesh; Hay, Norman; Thorburn, Guy; Morris, Paul; Sommerlad, Brian; Gnarra, Maria; van der Horst, Chantal; Kangesu, Loshan

    2015-09-01

    There is still no reliable tool to determine the outcome of the repaired unilateral cleft lip (UCL). The aim of this study was therefore to develop an accurate, reliable tool to measure vertical lip height from photographs. The authors measured the vertical height of the cutaneous and vermilion parts of the lip in 72 anterior-posterior view photographs of 17 patients with repairs to a UCL. Points on the lip's white roll and vermillion were marked on both the cleft and the noncleft sides on each image. Two new concepts were tested. First, photographs were standardized using the horizontal (medial to lateral) eye fissure width (EFW) for calibration. Second, the authors tested the interpupillary line (IPL) and the alar base line (ABL) for their reliability as horizontal lines of reference. Measurements were taken by 2 independent researchers, at 2 different time points each. Overall 2304 data points were obtained and analyzed. Results showed that the method was very effective in measuring the height of the lip on the cleft side with the noncleft side. When using the IPL, inter- and intra-rater reliability was 0.99 to 1.0, with the ABL it varied from 0.91 to 0.99 with one exception at 0.84. The IPL was easier to define because in some subjects the overhanging nasal tip obscured the alar base and gave more consistent measurements possibly because the reconstructed alar base was sometimes indistinct. However, measurements from the IPL can only give the percentage difference between the left and right sides of the lip, whereas those from the ABL can also give exact measurements. Patient examples were given that show how the measurements correlate with clinical assessment. The authors propose this method of photogrammetry with the innovative use of the IPL as a reliable horizontal plane and use of the EFW for calibration as a useful and reliable tool to assess the outcome of UCL repair.

  2. Short-term evaluation of tegumentary changes of the nose in oral breathers undergoing rapid maxillary expansion.

    PubMed

    Badreddine, Fauze Ramez; Fujita, Reginaldo Raimundo; Cappellette, Mario

    2017-06-26

    Rapid maxillary expansion is an orthodontic and orthopedic procedure that can change the form and function of the nose. The soft tissue of the nose and its changes can influence the esthetics and the stability of the results obtained by this procedure. The objective of this study was to assess the changes in nose dimensions after rapid maxillary expansion (RME) in oral breathers with maxillary atresia, using a reliable and reproducible methodology through computed tomography. A total of 30 mouth-breathing patients with maxillary atresia were analyzed and divided into a treatment group who underwent RME (20 patients, 10 of which were male and 10 female, with a MA of 8.9 years and a SD of 2.16, ranging from 6.5 to 12.5 years) and a Control Group (10 patients, 5 of which were male and 5 female, with a MA of 9.2 years, SD of 2.17, ranging from 6.11 to 13.7 years). In the treatment group, multislice computed tomography scans were obtained at the start of the treatment (T1) and 3 months after expansion (T2). The patients of the control group were submitted to the same exams at the same intervals of time. Four variables related to soft tissue structures of the nose were analyzed (alar base width, alar width, height of soft tissue of the nose and length of soft tissue of the nose), and the outcomes between T1 and T2 were compared using Osirix MD software. In the TG, the soft tissues of the nose exhibited significant increases in all variables studied (p<0.05), whereas, changes did not occur in the control group (p>0.05). In the treatment group, mean alar base width increased by 4.87% (p=0.004), mean alar width increased by 4.04% (p=0.004), mean height of the soft tissues of the nose increased by 4.84% (p=0.003) and mean length of the soft tissues of the nose increased by 4.29% (p=0.012). In short-term, RME provided a statistically significant increase in the dimensions of the soft tissues of the nose. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e

  3. Spectroscopic Characterization of Metal-Based Complexes and Metal-Based Complex Oxidation Processes.

    NASA Astrophysics Data System (ADS)

    McQuaid, Michael James

    The entrainment in carbon monoxide of metal (M) vaporized from an oven based source was used to create M(CO)_{rm x} complexes. The optical signatures associated with their oxidation to form chemiluminescing reaction products were analyzed to evaluate the nature of the M(CO)_{rm x } adducts and study MOcdotCO solvation complexes. The study was facilitated by comparing the optical signatures for the chemiluminescent oxidation of rare gas entrained metal atoms. Oxidation processes involving vanadium, chromium, and aluminum complexes were studied. In the case of vanadium, transitions associated with two previously unreported states of vanadium monoxide (VO) were observed and characterized. Transitions which may be associated with a VOcdotCO complex were also observed. For the case of chromium, three previously unreported states of chromium monofluoride (CrF) were characterized. Two band systems, which are tentatively ascribed to Cr_2F, were also observed. For the case of aluminum, the differences in the AlO B state population distribution formed in the Al+CO+O_3 and Al+Ar+O_3 systems provided a means of evaluating the binding energy of the Al(CO)_2 complex. Laser induced fluorescence (LIF) was used to probe the van der Waals complex AlAr formed in a free jet expansion. Based on rotationally resolved B^2Sigma ^{+} >=ts X^2 Pi_{1/2} electronic transitions, definitive interatomic potential parameters were developed for the AlAr B^2Sigma^{+ } state. AlAr X^2Pi_ {1/2} state interatomic potential parameter were developed assuming a Morse potential. Lambda doubling of the X^2Pi_ {1/2} state is evident, consistent with the presence of an unobserved repulsive AlAr A ^2Sigma^{+} state. Finally, the LIF excitation and emission spectra obtained for Fe/Ar and photolyzed Fe(CO)_5 /Ar matrices were compared. Previously unreported transitions associated with matrix-isolated Fe atoms were observed in the range from 500 to 1600 nm. Differences were observed in the spectra characterizing

  4. Electronic spectroscopy of the Al +-Ar complex

    NASA Astrophysics Data System (ADS)

    Lei, Jie; Dagdigian, Paul J.

    1999-05-01

    The laser fluorescence excitation spectrum of the Al +-Ar complex near the Al + ion 3s3p 1P ← 3s 2 1S resonance transition is reported. An excited-state ( v', 0) progression and the (0, 1) hot band were observed. Rotational analysis revealed that these bands involve an electronic transition from the Al +-Ar X 1Σ+ ground state to the 1Σ+ state correlating with the Al +( 1P)+Ar asymptote. Rotational constants and upper-state vibrational constants and the dissociation energy were determined. The spectroscopic constants of the two observed Al +-Ar electronic states are compared with those for neutral AlAr states.

  5. Fire Protection System for Hardened Aircraft Shelters. Volume 1. Discussion and Appendixes A-C

    DTIC Science & Technology

    1987-10-01

    in any configuration, for exanple IR, lR-lR, UV -IR, UV , UV -IR- UV . The advantage of multiwavelength detectors is a reduced likelihood of false alarm. B...11late is ,ai led the work function if the metal. Th, operating envelope of a UV detector is . function u (i) the Inc-tal used fir the cathode, and Ŗ...second or two longer. E. DI1AL-CHANNEL UV /IR JETIT .OIRS iiarmy false alar.m sources for UV and IR detectors are mutally exclusive. Th -. has led to the

  6. A Model for Predicting Late Prehistoric Architectural Sites at the Pinon Canyon Maneuver Site in Southeastern Colorado

    DTIC Science & Technology

    2007-01-01

    Topography in the project area consists of flat-topped hills, grassy steppes dissected by numerous canyons, and an igneous hogback ridge (Schuldenrien et al...are steppe, Hogback , arroyo/canyon, and hill. I predict that site elevation will be an easily patterned variable linked to food and water resources...Cedar Hills and on the Hogback . Lower elevations, like those between 4,400 and 4,800 ft, were recorded inside the canyons. 60 50 S40 0 30 10 oW v 0 .0

  7. Easy removal of nasal magnets.

    PubMed

    Starke, Lori

    2005-09-01

    This article uses a case report and discussion to demonstrate the removal of magnets which have become lodged in the nasal cavity as a result of using magnet-backed earrings to decorate the alae. If bi-alar decoration is used, removal of nasal magnets can present more of a challenge than other nasal foreign bodies. This is because of their attraction to each other through the septum and because of the edema that can form around the magnets. This case discusses that removal of magnets lodged in the nares can be easily achieved with minimal trauma, by the use of a household pocket magnet.

  8. Three-dimensional nasal changes following maxillary advancement in cleft patients.

    PubMed

    Stewart, A; McCance, A M; James, D R; Moss, J P

    1996-06-01

    Three-dimensional laser surface scanning of the face was performed before and after Le Fort I maxillary advancement in 24 patients with replaced clefts of the lip and palate. The surgery resulted in advancement of the upper lip and para-alar tissues and an increase in the relative prominence of the nose within the face. These changes were produced at the expense of an increase in nasal width and a reduction in nasal tip protrusion. The changes in nasal morphology showed significant variation among patients.

  9. Characterization of ultradispersed aluminum

    SciTech Connect

    Simpson, R.L.; Maienschein, J.L.; Swansiger, R.W.; Garcia, F.; Darling, D.H.

    1994-12-08

    Samples of ultradispersed Al were received, which were produced by electrically exploding Al wires in argon. These samples comprised very small particles that were not significantly oxidized and that were stable in air. Particle morphology were studied with SE, micropycnometry, and gas adsorption surface area. Composition were determined using various techniques, as were thermal stability and reaction exotherms. The inexplicable reports of an Al-Ar compound and of an exothermic reaction were not confirmed. The material is a stable, nonoxidized, small-particle, highly reactive form of aluminum that is of interest in energetic materials formulations.

  10. Comparing Ada and FORTRAN Lines of Code: Some Experimental Results

    DTIC Science & Technology

    1993-11-01

    34"yseidued predisute IA ohilews’ fhey usually eam"d resuts sfts 0is "let 11h14h (8) haew a direst bud"e SO decIsIons a1146t10g MWjo 1 0ra, (hi addrees...or IDA Document are nsed for the cowaveniene of the spoases or the analysts ( a ) to record substantive work done in quick reaction studies, (h) to...orm &j rey alar Ia i I* a embedo., -d w~ma. in"Ag suagaulbota Worduutg thills d , Wasllhirtgb d•ead s ft8mseewbas. 01 N IVm -1 sadm O W R9e 1216

  11. Digital Servocontroller System. Volume 1. Operations Manual.

    DTIC Science & Technology

    1985-02-01

    8217Op fw c Ian , A ftP ate error lop rate,el"Or VA, bre. CWt I* I Tr V dump rate x/S Obd abort W. 0 ,,vtvgral oad c 󈧬. Lrkln Cm f ST&TIK oad abort X...14.0?04V _Z(.W -k047 44 -load alar% X -M.0 _ W. 0 -%. D -ft. 0-load abort Z JDO G . J00.0 100.0 -tD-D. 0 zuwm LLILL Cyn f RTATHK LL = error abort Z LO.0

  12. A New Classification System for Unilateral Cleft Lip and Palate Infants to assist Presurgical Infant Orthopedics.

    PubMed

    Daigavane, P S; Hazarey, P V; Niranjane, P; Vasudevan, S D; Thombare, B R; Daigavane, S

    2015-01-01

    The proposed advantages of pre-surgical naso-alveolar moulding (PNAM) are easy primary lip repair which heals under minimum tension reducing the scar formation and improving the aesthetic results in addition to reshaping of alar cartilage and improvement of nasal symmetry.However, the anatomy and alveolar morphology varies for each cleft child; the procedure for PNAM differs accordingly. In an attempt to categorize unilateral cleft lip and palate cases as per anatomical variations, a new classification system has been proposed. This classification aims to give an insight in unilateral cleft morphology based on which modification in PNAM procedure could be done.

  13. The incidence and risk factors of postoperative neurological deterioration after posterior decompression with or without instrumented fusion for thoracic myelopathy

    PubMed Central

    Wang, Hui; Ma, Lei; Xue, Rui; Yang, Dalong; Wang, Tao; Wang, Yanhong; Yang, Sidong; Ding, Wenyuan

    2016-01-01

    Abstract The aim of this study was to explore the incidence and risk factors of postoperative neurological deterioration after posterior decompression with or without instrumented fusion for thoracic myelopathy, and hope to provide references in decision-making and surgical planning for both spinal surgeon and thoracic stenosis patients. By retrieving the medical records from January 2001 to November 2015, 168 patients were retrospectively reviewed. According to the occurrence of postoperative neurological deterioration, patients were divided into 2 groups: neurological deterioration (ND) group and non-ND group. To investigate risk values for the occurrence of ND, 3 categorized factors were analyzed statistically: patient characteristics—preoperative data of age, sex, body mass index, bone mineral density, the duration of disease (from first symptoms to operation), the preoperative neurological function (Frankel grade), and diagnosis; surgical variables—surgery time, the amount of bleeding, mean arterial pressure, intervertebral fusion or not, and instrumentation or not; radiographic parameters—the spinal canal occupancy ratio, location of the lesion, thoracic kyphosis, and kyphosis correction. Postoperative neurological deterioration was developed in 23 of 168 patients (13.7%), and were enrolled as ND group. There was no statistically significant difference between the 2 groups in age at operation, sex composition, body mass index, and bone mineral density. The preoperative diagnosis presented significant difference between the 2 groups, because ossification of posterior longitudinal ligament combined with ossification of the ligamentum flavum was more common in ND group, whereas ossification of the ligamentum flavum alone was more common in non-ND group. There was no difference between the 2 groups in mean surgery time, the incidence of intraoperative direct trauma, and the number of patients that received instrumentation. The mean bleeding was much more in

  14. On the size of the ptolemaic system of the world - a study based on two figures by Johannes Kepler. (German Title: Über die Gröszlig;e des ptolemäischen Weltsystems - Eine Studie, veranlasst durch zwei Bilder bei Johannes Kepler)

    NASA Astrophysics Data System (ADS)

    Oberschelp, Arnold

    It is well known that the geocentric system according to Ptolemy is almost twice as large as the heliocentric planetary system of Copernicus. There are, however, two pictures, given by Kepler in his «Mysterium Cosmographicum» of 1596 which - at first glance - seem to contradict this. The first picture of the heliocentric system is drawn to scale. The second picture shows a geocentric system, which seems to be too small. The puzzle about the size is solved rather trivially by the fact - which is not mentioned by Kepler and which may be overlooked - that the geocentric picture is not drawn to scale and that the angles do not correspond to the degrees noted at them. In order to get a geocentric picture drawn to scale - taking Kepler's degrees for granted - it is necessary to discuss some details of the ptolemaic system. The result is, however, a geocentric system which is too big. The solution of this new puzzle is not obvious. It turns out that one of Keplers degrees (for Mars) does not correspond to the parameters of Ptolemy. Actually, in his book of 1596, Kepler's topic is not the ptolemaic system nor the copernican distances, but his heliocentric model with the five regular polyhedra. While it is interesting to note all these facts, Kepler's pictures and degrees, for the size of the ptolemaic system, lead to a dead end. Using the parameters from the «Almagest» and the principle of nested spheres from the «Planetary Hypotheses» a distance scale (Tab. 10) for the geocentric system is derived. This distance scale, however, is somewhat different from the well known ptolemaic distance scale (Tab. 1). This puzzle is not resolved, but due to the fact that different sources («Almagest» and «Planetary Hypotheses») of Ptolemy are involved. The distances of Tab. 10 correspond better to the ptolemaic system, since the relative thickness of the spheres is computed from the rather precise parameters (eccentricities and epicycle radii) of the «Almagest». The

  15. 400th Anniversary of Marius's Book with the First Image of an Astronomical Telescope and of Orbits of Jovian Moons

    NASA Astrophysics Data System (ADS)

    Pasachoff, Jay M.; Leich, Pierre

    2015-01-01

    Simon Mayr's (Marius's) Mundus Iovialis Anno M·DC·IX Detectus Ope Perspicilli Belgici (The World of Jupiter...) was published in Nuremberg in 1614; Marius was the Ansbach court mathematician. The frontispiece includes not only a portrait of Marius (1573-1624) himself but also, in the foreground, a long tube labelled "perspicillum," the first known image of a telescopic device used for astronomy; the name "telescope" came later. A schematic diagram of Jupiter with four moons orbiting appears at upper left; Marius, following a suggestion from Kepler, gave these Galilean satellites the names now still in use: Io, Europa. Ganymede, and Callisto. The title continues Hoc est, Quatuor Joviali cum Planetarum, cum Theoria, tum Tabulae, Propriis Observationibus Maxime Fundate.... A pair of conferences was held in Germany in 2014 to commemorate the 400th anniversary of Marius's book and to discuss Marius's work and its relation to Galileo's work (http://www.simon-marius.net; http://www.simon-marius.net/index.php?lang=en&menu=1 28 languages are available). Marius (Mayr) had independently discovered the four satellites of Jupiter, apparently one day after Galileo, on December 29 O.S., 1609; by the time he published his work four years later (a local-circulation publication had appeared in Nuremberg in 1611 in Prognosticon Astrologicum auf das Jahr 1612), Galileo had gained fame and priority, and Galileo accused Marius of plagiarism in Il Saggiatore (1623). With his Belgian telescope, Marius also noted the tilt of the orbital plane of Jupiter's moons, sunspots (1611), and the Andromeda Nebula (1612). He claimed to have worked out a system of cosmology similar to the Tychonic system in 1596, contemporaneously to Kepler's Mysterium Cosmographicum. A crater, the Marius Hills, and the Rima Marius on the Moon are named for him by the I.A.U., as well as, to celebrate the quadricentennial, a main-belt asteroid, now (7984) Marius. Acknowledgment: JMP thanks Seth Fagen, PRPH Books in

  16. 316 Magnetic Resonance Imaging Analysis of the Combined AOSpine North America and International Studies, Part I: The Prevalence and Spectrum of Pathologies in a Global Cohort of Patients With Degenerative Cervical Myelopathy.

    PubMed

    Nouri, Aria; Martin, Allan R; Tetreault, Lindsay; Nater, Anick; Kato, So; Nakashima, Hiroaki; Nagoshi, Narihito; Reihani-Kermani, Hamed; Fehlings, Michael G

    2016-08-01

    Degenerative cervical myelopathy (DCM) encompasses a spectrum of age-related conditions that result in progressive spinal cord injury through static and dynamic injury mechanisms. Through detailed review of MRIs from prospective AOSpine multicenter studies, the global prevalence of degenerative cervical pathologies of surgically treated DCM patients is reported. MRIs of 458 patients were obtained from North America (n = 197), Europe (n = 92), Latin America (n = 57), and Asia-Pacific (n = 112) and assessed for the type of pathology, source of stenosis, level of maximum cord compression, levels of spinal cord compression (SCC), presence of signal changes on T2-weighted images (T2WI) and T1-weighted images, and the levels of T2WI signal change. The proportion of degenerative changes present alongside other diagnoses was computed as well as the prevalence of pathologies per geographical region. The prevalence of degenerative changes was separated by sex and assessed using χ analysis. Spondylosis was the most frequent cause of SCC (89.7%) and it was frequently accompanied by enlargement of the ligamentum flavum (59.85%). Ossification of the posterior longitudinal ligament (OPLL) was accompanied by spondylosis in 91.7%. Single-level disc pathology, OPLL, and spondylolisthesis had a prevalence of ∼10%. Klippel-Feil syndrome was observed in 2.8%. Single-level pathology was less common in North America, and OPLL was more common and spondylolisthesis less common in Asia-Pacific. Females presented more commonly with single-level disc pathology (P = .013), and males with spondylosis (P = .017) and enlargement of ligamentum flavum (P = .012). Globally, C5-6 was the most frequent maximum compressed site (39.7%) and region for T2WI hyperintensity (38.9%). T2WI hyperintensity more commonly presented in males (P < .001). DCM pathologies, including OPLL, are highly interrelated and rarely present in isolation. Females presented with milder evidence of DCM on MRI. There are also

  17. Three-column ligamentous extension injury of the thoracic spine: a case report and review of the literature.

    PubMed

    Elgafy, Hossein; Bellabarba, Carlo

    2007-12-01

    This is a report of a patient with a rare unstable 3-column ligamentous injury of the thoracic spine. To illustrate a rare unstable thoracic spine injury that required internal fixation despite its potentially benign clinical and radiologic presentation. Extension injury of the thoracolumbar spine is uncommon. Although there have been several reports of hyperextension injuries in the thoracolumbar spine, the radiologic findings of the present case was different from those in the previously reported cases. The clinical findings, roentgenographic appearance, treatment, were presented and the mechanism of this lesion was analyzed. Physical examination revealed mild weakness in his left hip flexor and quadriceps, ASIA-D motor score of 96. There was no tenderness or step deformity on assessment of his back. The initial roentgenograms showed no evidence of fracture or malalignment. However, evaluation of his computed tomography scan axial images showed a lateral superior endplate fracture, small fracture fragment from T11 right inferior articular process, widening of the left facet joint, and deformed T11 spinous process. The computed tomography scan sagittal images showed a vertical fracture fragment in the central spinal canal. The fragment may have arisen from the posterior cortex of the vertebral body, possibly due to elevation of the PLL. Magnetic resonance imaging (MRI) was obtained due to the suspicion that a much more severe underlying injury was present. The MRI demonstrated disc disruption and high intensity signals in the region of ALL, PLL, ligamentum flavum, supraspinous, and interspinous ligaments as well as in the spinal cord at T11-T12. The MRI also showed high intensity signals in the facet joints at T11-T12. Intraoperative assessment confirmed disruption of the supraspinous and interspinous ligaments, facet capsules and the ligamentum flavum, which was avulsed from its insertion on the underside of the T11 lamina on both sides. There was a tendency

  18. Multifactorial Approaches for Correction of the Drooping Tip of a Long Nose in East Asians

    PubMed Central

    Jeong, Hoijoon; Ye, Choon Ho

    2014-01-01

    A long nose with a drooping tip is a major aesthetic problem. It creates a negative and aged appearance and looks worse when smiling. In order to rectify this problem, the underlying anatomical causes should be understood and corrected simultaneously to optimize surgical outcomes. The causes of a drooping tip of a long nose are generally classified into two mechanisms. Static causes usually result from malposition and incorrect innate shape of the nasal structure: the nasal septum, upper and lower lateral cartilages, and the ligaments in between. The dynamic causes result from the facial expression muscles, the depressor septi nasi muscle, and the levator labii superioris alaeque nasi muscle. The depressor septi nasi depresses the nasal tip and the levator labii superioris alaeque nasi pulls the alar base upwards. Many surgical methods have been introduced, but partial approaches to correct such deformities generally do not satisfy East Asians, making the problem more challenging to surgeons. Typically, East Asians have thick nasal tip soft tissue and skin, and a depressed columella and alar bases. The authors suggest that multifactorial approaches to static and dynamic factors along with ancillary causes should be considered for correcting the drooping tip of the long noses of East Asians. PMID:25396173

  19. [Morphometric analysis of nasal shapes and angles in young adults].

    PubMed

    Uzun, Ahmet; Ozdemir, Fikri

    2014-01-01

    The size, angle, shape and type of nose are a signature indicating race, age and sex. Describe and compare nasal angles, nose types, nostril models, and nasal profiles in young Turkish males and females. The study group consisted of university students, 56 males and 59 females. Nasal measurements were obtained from all subjects, using anthropometric methods. The nose types of females and males were 78% and 70% narrow nose, respectively. The means of females' nasofrontal, nasal tip, nasolabial, and alar slope angles were 133.16° ± 8.88°; 77.91° ± 9.80°; 98.91° ± 10.01°, and 80.89° ± 8.33°, respectively. The means of males' nasofrontal, nasal tip, nasolabial, and alar slope angles were 123.85° ± 13.23°; 82.16° ± 9.98°; 97.91° ± 8.78° and 85.98° ± 8.72°, respectively. The average values of the nose in this population may be used as a guide to plan corrective esthetic-cosmetic surgery and for burn scars of the nose. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  20. Analysis of rapid maxillary expansion effects on nasal soft tissues widths.

    PubMed

    Santariello, C; Nota, A; Baldini, A; Ballanti, F; Cozza, P

    2014-09-01

    The aim of this study was to analyze the variations in nasal dimensions in prepubertal patients associated with RME therapy compared with an untreated age matched control group. A group of 61 subjects (26 F, 35 M; mean age 10.5±1.8 years) was enrolled in the study to undergo a rapid maxillary expansion therapy; 41 subjects (26 F, 15 M; mean age 10.7±2.2 years) were enrolled as a control group. Both groups underwent nasal soft tissues width measurements using a caliper at three separate time points: T0 - prior to the placement of RME; T1 - after completion of active expansion phase; T2 - at the removal of the expander (nearly 6 months after T1). The ANOVA showed statistically significant increments (P<0.0001) of the greater alar cartilage (GAC) measurement (0.8±0.2 mm) in the study group, differences for the AB measurements were not statistically significant (P=0.0784). The treatment of rapid maxillary expansion can induce an increase in GAC soft tissues width of about 1 mm in prepubertal patients. This increase could not be considered of clinical impact. The alar base width increase less than GAC, this increase is without statistical significance.

  1. A 20 year audit of nose-tip symmetry in patients with unilateral cleft lip and palate.

    PubMed

    Timoney, N; Smith, G; Pigott, R W

    2001-06-01

    The purpose of this study was to audit the process and outcome in terms of nasal-tip symmetry of the first 20 patients with unilateral complete cleft lip and palate treated by the Pigott alar leapfrog primary nasal correction in the early 1970s and followed for 20 years. Symmetry was assessed using the Coghlan computer-based analysis of frontal and basal views to determine the stability of the correction. The Abyholm technique of alveolar bone grafting was performed in 12 of the 20 patients. Various other secondary procedures have been performed on the nose tip and septum to improve the airway or appearance. Photographs were taken within one year of ages 5, 10, 15 and 20 years, and the lower border of the nose, the alar domes and the nostrils were assessed. To assess the overall change from 5 years to 20 years, both views were available for 17 patients. No significant change was found in the lower border or nostril symmetry, but significant deterioration at the P< 0.01 level was found on the basal view. We assessed the 10, 15 and 20 year views of all 12 patients who had undergone alveolar bone grafting to determine early and late changes. No significant benefit was found from alveolar bone grafting or minor secondary procedures for appearance. Consequently, our criteria for undertaking minor adjustments to improve appearance have become more stringent. We consider that objective reporting of appearance should become essential in peer-reviewed journals.

  2. [A nasal congenital malformation not published in the literature: About 5 cases].

    PubMed

    Colson, T R; Bertrand, B; Degardin, N; Bardot, J; Casanova, D

    2017-02-01

    Five cases of the same congenital malformation of the nose, affecting the nasal dorsum and the supra-tip, were supported in our university plastic surgery center. This malformation has not been described in the literature known to the authors. The aim of this study is to analyze this nasal deformity. Five children presented this congenital deformity between 1994 and 2014. The patients were examined and the malformation precisely described. Genetic and histological examinations were carried on. The diagnosis and treatment of this pathology were discussed. This malformation associated 4 anomalies: hypertrophy of soft tissue of the dorsum located in the middle third of the nasal bridge, deformed alar cartilages turned back downward and outside, advanced support default and median skin brand similar to a scar. These patients showed no other abnormalities of the midline or respiratory disorders. No genetic disorder was found for these five patients, and no histological arguments were found. Three patients were operated, one until adulthood with a satisfying cosmetic result. Bibliographic research has not allowed us to make an accurate diagnosis of this malformation that appears to be non-syndromic and to have a genetic origin. Our therapeutic approach became more clear and it now seems legitimate to propose early excision of fat mass to prevent alar deformations, associated with a cortico-cancellous graft, which in our experience grows with age, to support the tip. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  3. Measuring the nose in septorhinoplasty patients: ultrasonographic standard values and clinical correlations.

    PubMed

    Stenner, Markus; Koopmann, Mario; Rudack, Claudia

    2017-02-01

    Although septorhinoplasty is the most commonly performed operation in plastic surgery, and the surgical plan as well as its outcome is directly related to the configuration of the anatomical structures in the nose, these are not routinely assessed preoperatively. The aim of our study was to evaluate the nasal soft tissue and cartilaginous structures by means of high-resolution ultrasonography to set up clinical correlations and standard values. We examined 44 patients before septorhinoplasty by high-resolution ultrasonography in noncontact mode. All pictures were quantitatively evaluated by measuring 13 lengths and 4 ratios. All patients underwent a rhinomanometry measuring the nasal air flow. Besides others, men as well as older patients have a significantly thicker alar cartilage. Patients with thinner alar cartilages have a significantly smaller interdomal distance as well as significantly thinner upper lateral cartilages. The soft tissue above the bony dorsum was significantly thicker in older patients. Younger patients have significantly thicker soft tissue in relation to their cartilage. Patients with thicker soft tissue and thinner cartilage have a smaller tip. The interdomal distance and the thickness of the cartilaginous septum significantly correlated with the nasal air flow. We set up standard values of nasal structures in septorhinoplasty patients which can be used as reference values. By judging cartilage and soft tissue characteristics preoperatively, relevant factors for distinct procedures could be analyzed and the surgical steps can be better planned. Visualization by ultrasonography enables the surgeon to achieve treatment goals in a more predictable fashion.

  4. Rigid Posterior Lumbopelvic Fixation without Formal Debridement for Pyogenic Vertebral Diskitis and Osteomyelitis Involving the Lumbosacral Junction: Technical Report.

    PubMed

    Mazur, Marcus D; Ravindra, Vijay M; Dailey, Andrew T; McEvoy, Sara; Schmidt, Meic H

    2015-01-01

    Pelvic fixation with S2-alar-iliac (S2AI) screws can increase the rigidity of a lumbosacral construct, which may promote bone healing, improve antibiotic delivery to infected tissues, and avoid L5-S1 pseudarthrosis. To describe the use of single-stage posterior fixation without debridement for the treatment of pyogenic vertebral diskitis and osteomyelitis (PVDO) at the lumbosacral junction. Technical report. We describe the management of PVDO at the lumbosacral junction in which the infection invaded the endplates, disk space, vertebrae, prevertebral soft tissues, and epidural space. Pedicle involvement precluded screw fixation at L5. Surgical management consisted of a single-stage posterior operation with rigid lumbopelvic fixation augmented with S2-alar-iliac screws and without formal debridement of the infected area, followed by long-term antibiotic treatment. At 2-year follow-up, successful fusion and eradication of the infection were achieved. PVDO at the lumbosacral junction may be treated successfully using rigid posterior-only fixation without formal debridement combined with antibiotic therapy.

  5. Ontogenetic Expression of Sonic Hedgehog in the Chicken Subpallium

    PubMed Central

    Bardet, Sylvia M.; Ferran, José L. E.; Sanchez-Arrones, Luisa; Puelles, Luis

    2010-01-01

    Sonic hedgehog (SHH) is a secreted signaling factor that is implicated in the molecular patterning of the central nervous system (CNS), somites, and limbs in vertebrates. SHH has a crucial role in the generation of ventral cell types along the entire rostrocaudal axis of the neural tube. It is secreted early in development by the axial mesoderm (prechordal plate and notochord) and the overlying ventral neural tube. Recent studies clarified the impact of SHH signaling mechanisms on dorsoventral patterning of the spinal cord, but the corresponding phenomena in the rostral forebrain are slightly different and more complex. This notably involves separate Shh expression in the preoptic part of the forebrain alar plate, as well as in the hypothalamic floor and basal plates. The present work includes a detailed spatiotemporal description of the singular alar Shh expression pattern in the rostral preoptic forebrain of chick embryos, comparing it with FoxG1, Dlx5, Nkx2.1, and Nkx2.2 mRNA expression at diverse stages of development. As a result of this mapping, we report a subdivision of the preoptic region in dorsal and ventral zones; only the dorsal part shows Shh expression. The positive area impinges as well upon a median septocommissural preoptic domain. Our study strongly suggests tangential migration of Shh-positive cells from the preoptic region into other subpallial domains, particularly into the pallidal mantle and the intermediate septum. PMID:20700498

  6. Ontogeny of gamma-aminobutyric acid-immunoreactive neurons in the rhombencephalon and spinal cord of the sea lamprey.

    PubMed

    Meléndez-Ferro, Miguel; Pérez-Costas, Emma; Villar-Cheda, Begoña; Rodríguez-Muñoz, Rolando; Anadón, Ramón; Rodicio, María Celina

    2003-09-08

    The development of neurons expressing gamma-aminobutyric acid (GABA) in the rhombencephalon and spinal cord of the sea lamprey (Petromyzon marinus) was studied for the first time with an anti-GABA antibody. The earliest GABA-immunoreactive (GABAir) neurons appear in late embryos in the basal plate of the isthmus, caudal rhombencephalon, and rostral spinal cord. In prolarvae, the GABAir neurons of the rhombencephalon appear to be distributed in spatially restricted cellular domains that, at the end of the prolarval period, form four longitudinal GABAir bands (alar dorsal, alar ventral, dorsal basal, and ventral basal). In the spinal cord, we observed only three GABAir longitudinal bands (dorsal, intermediate, and ventral). The larval pattern of GABAir neuronal populations was established by the 30-mm stage, and the same populations were observed in premetamorphic and adult lampreys. The ontogeny of GABAergic populations in the lamprey rhombencephalon and spinal cord is, in general, similar to that previously described in mouse and Xenopus. Copyright 2003 Wiley-Liss, Inc.

  7. Unilateral cleft lip/nose repair using an equal bows /straight line advancement technique - A preliminary report and postoperative symmetry-based anthropometry.

    PubMed

    Hakim, Samer George; Aschoff, Horst Heinrich; Jacobsen, Hans-Christian; Sieg, Peter

    2014-04-01

    In the evolution of cleft lip repair there has been continuous attempt to minimize local trauma, improve lip and nasal appearance and, especially, prevent conspicuous scars. The surgical technique presented meets these criteria, resulting in an appropriate scar course in children with a specific philtral ridge shape. Postoperative digital anthropometry was performed in 18 patients who underwent unilateral cleft lip repair using the equal bows/straight line advancement technique and in matched healthy control individuals. Symmetry values were assessed for lip length, philtral ridge length, vermilion height, width of the alar base, nasocanthal length, circumference of the nostrils, nostril width and height in both cleft and control groups. Evaluation revealed no significant differences in the symmetry values between cleft patients and control group (lip length: p = 0.71, philtral ridge length: p = 0.52, vermilion height: p = 0.23, alar base width: p = 0.69, nasocanthal length: p = 0.25, nostril circumference: p = 0.17, nostril width: p = 0.34, nostril height: p = 0.33). Principles of cleft lip repair can be achieved using the described technique which provides adequate lip length and natural nasal appearance in patients with a parallel-shaped philtral ridge.

  8. Nasal Soft Tissue Change Following Bimaxillary Orthognathic Surgery.

    PubMed

    Jeong, Hye-In; Lee, Ho-Sung; Jung, Young-Soo; Park, Hyung-Sik; Jung, Hwi-Dong

    2017-05-31

    The purpose of this study is to identify the correlation between maxillary movement and nasal soft tissue changes on three-dimensional reconstructed cone beam computed tomography (CBCT) images after Le Fort I osteotomy. The authors also investigate the long-term change of alar base width (ABW) to determine the effect of cinch suture. The authors retrospectively studied 52 subjects (14 males and 38 females) who were treated by bimaxillary orthognathic surgery including Le Fort I osteotomy and mandibular ramus surgery. The landmarks and planes were established on three-dimensional reconstructed CBCT images. The authors measured each parameters preoperatively, 1 month postoperatively, and 1 year postoperatively. There was no significant correlation between the horizontal movement of A-point and the widening of ABW (P < 0.038), nor was there a significant correlation between the vertical movement of A-point and the change of ABW (P < 0.61). There was no significant correlation between horizontal and vertical movement of anterior nasal spine and the widening of ABW, nor was there a significant correlation between the nasal tip length and the vector of maxillary movement. There was no significant correlation between the ABW widening and the vector of surgical maxillary movement. The effect and stability of the alar base cinch suture is difficult to determine and require further investigation.

  9. Facial surface changes after cleft alveolar bone grafting.

    PubMed

    Krimmel, Michael; Schuck, Nils; Bacher, Margit; Reinert, Siegmar

    2011-01-01

    The aim of this study was to assess the 3-dimensional facial surface changes after cleft alveolar bone grafting with digital surface photogrammetry. In a prospective study, 22 patients with cleft lip and palate underwent alveolar bone grafting. Before the procedure and 6 weeks postoperatively and before the continuation of orthodontic treatment, 3-dimensional images were taken with digital surface photogrammetry. Seven standard craniofacial landmarks on the nose and the upper lip were identified. Their spatial change because of bone grafting was assessed. Statistical analysis was performed with analysis of variance and t test. A significant increase in anterior projection on the operative side (P < .05) was found for the labial insertion points of the alar base (subalare). No significant changes were detected for the position of the labial landmarks. Our results show 3-dimensionally that there is a positive influence of the alveolar bone graft on the projection of the alar base on the cleft side. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  10. [Acoustic behavior of Fenestra bohlsii Giglio-Tos (Orthoptera: Acrididae: Gomphocerinae)].

    PubMed

    Lorier, Estrellita; Clemente, Maria E; García, Maria D; Presa, Juan J

    2010-01-01

    The acoustic behavior of Fenestra bohlsii Giglio-Tos is described for the first time. The sounds and behaviors were observed and registered in captivity. The signals were digitized with the Sound-Blaster AWE64 Gold program and analysed with the Avisoft SAS Lab Pro 30 PC for MS Windows software. Seven different types of sounds are described as produced by males: spontaneous song (also used during the courtship), two different types of courtship song, assault song, tapping associated to the courtship, interaction between males and fly crackling. For each one, the characteristic oscillograms and frequency spectra are given. Sounds are produced by different mechanisms: femoro-tegminal stridulation, typical for Gomphocerinae, fly crackling, hind tarsi tapping and alar beat, the last produced by the beat and clash of hind alae, that is, the castanet method which up to now was only known, among Orthoptera, in Stenobothrus rubicundulus Kruseman & Jeekel. A description of the stridulatory file of male and female is given, as well as that of the alar special structures. Behavioral units and their sequence during the courtship are defined. There, in addition to the acoustic signals, visual signals are present, referring to positions, hind legs, antennae and palpi movements and body vibrations.

  11. Analysis of the cleft-lip nose in submental-vertical view, Part I--reliability of a new measurement instrument.

    PubMed

    Nagy, Krisztián; Mommaerts, Maurice Y

    2007-01-01

    Objective evaluation of nasal form and symmetry in cleft patients is difficult. The aim of this study was to establish a computer analysis of nasal form and symmetry (intranasal symmetry and symmetrical position of the nose), in order to evaluate primary and secondary cleft rhinoplasty outcomes. Indirect anthropometric measurements were performed on digital photographs processed by Photoshop 7.0 (Adobe Systems Inc., San Jose, California) with the help of Scion Image software (National Institutes of Health, Maryland, USA). For assessing intranasal symmetry, the ratio of nasal tip projection to total nasal width, the ratio of nostril widths, the ratio of nostril heights, the ratio of mid-alar widths and nostril symmetry were determined. Bifidity of the nose, columellar deviation and angulations of the nostrils were also measured. For assessing the symmetrical position of the nose, the ratio of the distances of alar points to the endocanthial lines and nasal base inclination were determined. The reliability of this analysis was tested by using submento-vertical photographs of bilateral cleft noses, of which the lips were primarily operated on by different techniques and different surgeons in Zurich and Bruges. There were highly significant intraobserver (ICC=0.994) and interobserver reliabilities (ICC=0.893). This nasal analysis is appropriate for comparing results of different surgical techniques.

  12. Seagull wing graft: a technique for the replacement of lower lateral cartilages.

    PubMed

    Pedroza, Fernando; Anjos, Gustavo Coelho; Patrocinio, Lucas Gomes; Barreto, Jose M; Cortes, Jorge; Quessep, Suad H

    2006-01-01

    To present and evaluate outcomes with the seagull wing technique, which was designed to replace the lower lateral cartilages and to reconstruct the nasal tip. The seagull wing technique is illustrated and described in detail. Sixty patients who underwent surgery 1981 and 2002 were retrospectively evaluated. A preoperative diagnosis of tip deformities was made based on photographs, which were compared with the postoperative results. Patient satisfaction was subjectively evaluated. The postoperative results showed a significant statistical improvement in the following tip deformities: underprojected tip (P<.001), poorly defined tip (P<.001), alar retraction (P<.001), alar pinch (P<.001), overrotated tip (P<.001), and tip ptosis (P<.01). The average follow-up period was 14.6 months. Fifty-five patients (92%) stated that they were very satisfied with the surgical results; they required no additional revision surgery. The seagull wing technique is a safe and efficient reconstructive treatment for the aesthetic and functional problems that were caused by the overresection of the nasal tip cartilaginous framework. The outcomes were pleasing, and the results were stable during the follow-up period. Patient satisfaction was high.

  13. Aesthetic and functional restoration using dorsal saddle shaped Medpor implant in secondary rhinoplasty.

    PubMed

    Turegun, Murat; Acarturk, Tahsin Oguz; Ozturk, Serdar; Sengezer, Mustafa

    2008-06-01

    Functional disorders due to alar valve collapse and cosmetic unsatisfactory results can be seen after rhinoplasty operation in some patients. Because of overresection of the upper and lower lateral cartilages, nasal lateral walls may collapse during inspiration pressing against the septum and obstructing airway. On the other hand, overresection may result in several cosmetic deformities. Fourteen patients presenting with nasal deformation and functional insufficiency, were treated using thin sheet porous polyethylene (Medpor). Cottle sign was positive in all patients. On examination, collapse during inspiration, depression at the supratip area, and asymmetry were common findings. Saddle shaped implants, 1.2 x 40 mm in dimension, were introduced into pouches prepared via bilateral rim incision. After suturing incisions, bandage and cast were applied. In the mean 14-month follow-up period, 1 implant malposition was seen in a patient because of larger planning the pocket that was corrected by a subsequent shaving of the implant. Asymmetries of the noses were totally corrected. No exposition was found. Alar collapse and respiration impairment had disappeared in all patients. Although, autologous tissue is known as the best material, Medpor can be used safely regarding its low complication rate because of its porotic architecture and low morbidity in donors. Medpor implant provides functional improvement by its strength body. Its smooth surface helps to correct the asymmetry by filling the defects. Using a saddle shape enabled us to treat different components of the postrhinoplasty deformity with a single implant.

  14. Evidence that tRNA synthetase-directed proton transfer stops mistranslation.

    PubMed

    Waas, William F; Schimmel, Paul

    2007-10-30

    To prevent mistranslation, aminoacyl-tRNA synthetases (AARSs) discriminate against noncognate amino acids and cellular metabolites. Defects in specificity produce statistical proteins which, in mammalian cells, lead to activation of the unfolded protein response and cell death. Because of inherent limitations in amino acid discrimination by a single active site, AARSs evolved a separate domain to clear mischarged amino acids. Although the structure of a widely distributed editing domain for ThrRS and AlaRS is known, the mechanism of amino acid clearance remains elusive. This domain has two motifs that together have four conserved residues in the pocket used to clear serine from mischarged tRNAs. Here, using ThrRS as an example, rapid single-turnover kinetics, mutagenesis, and solvent isotope analysis show that a strictly conserved histidine (between ThrRS and AlaRS) extracts a proton in the chemical step of the editing reaction. Three other conserved residues, and two additional residues in the editing pocket, are not directly implicated in the chemical step. These results are relevant to the previously reported mutagenesis of the homologous editing pocket of alanyl-tRNA synthetase, where even a mild defect in editing causes neurodegeneration in the mouse. Thus, a single proton-transfer event needed to prevent mistranslation can have profound implications for disease.

  15. External rhinoplasty: a critical analysis of 500 cases.

    PubMed

    Foda, Hossam M T

    2003-06-01

    The study presents a comprehensive statistical analysis of a series of 500 consecutive rhinoplasties of which 380 (76 per cent) were primary and 120 (24 per cent) were secondary cases. All cases were operated upon using the external rhinoplasty technique; simultaneous septal surgery was performed in 350 (70 per cent) of the cases. Deformities of the upper two-thirds of the nose that occurred significantly more in the secondary cases included; dorsal saddling, dorsal irregularities, valve collapse, open roof and pollybeak deformities. In the lower third of the nose; secondary cases showed significantly higher incidences of depressed tip, tip over-rotation, tip asymmetry, retracted columella, and alar notching. Suturing techniques were used significantly more in primary cases, while in secondary cases grafting techniques were used significantly more. The complications encountered intra-operatively included; septal flap tears (2.8 per cent) and alar cartilage injury (1.8 per cent), while post-operative complications included; nasal trauma (one per cent), epistaxis (two per cent), infection (2.4 per cent), prolonged oedema (17 per cent), and nasal obstruction (0.8 per cent). The overall patient satisfaction rate was 95.6 per cent and the transcolumellar scar was found to be unacceptable in only 0.8 per cent of the patients.

  16. [Characteristics and distribution of normal human epidural fat].

    PubMed

    Reina, M A; Pulido, P; Castedo, J; Villanueva, M C; López, A; Sola, R G

    2006-01-01

    Epidural fat provides sufficient cushion for the pulsatile movements of the dural sac, protects nerve structures, facilitates the movement of the dural sac over the periosteum of the spinal column during flexion and extension, and forms a pharmacologic reservoir of lipophilic substances. We review epidural fat and related structures, including their development during the fetal period when the epidural space is filled by undifferentiated loose, areolar mesenchymal tissue that surrounds the dural sac. In the adult, epidural fat has a continuous distribution and follows a certain metameric pattern. It is located mainly on the dorsal side of the epidural space, where it is organized in triangular capsules joined to the midline of the ligamentum flavum by a vascular pedicle. We consider the distribution of epidural fat in the axial and sagittal planes; its presence in the anterior, lateral and posterior epidural space; its presence in the cervical, thoracic and lumbar portions of the spinal column; and its characteristics and variations according to differing body habits and sex. Finally, we speculate on the possible anesthetic implications of epidural fat in terms of the pharmacokinetics of drugs injected into the epidural space and the tasks of locating the epidural space and inserting an epidural catheter during anesthetic procedures.

  17. Tubular surgery with the assistance of endoscopic surgery via midline approach for lumbar spinal canal stenosis: a technical note.

    PubMed

    Mikami, Yasuo; Nagae, Masateru; Ikeda, Takumi; Tonomura, Hitoshi; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2013-09-01

    We devised a tubular surgery with the assistance of endoscopic surgery via midline approach to the spinal canal to preserve the bilateral facet joints and the paravertebral muscles when treating lumbar spinal canal stenosis. We report details of this operative procedure. A 2-cm incision is made in the skin in the midline of the intervertebral level to be decompressed. The spinous process on the cranial side is partially excised, and incisions along the ligament fiber are made in the midline of the supraspinous and interspinous ligaments to expose the ligamentum flavum. After the lamina and the inferior parts of the bilateral facet joints are adequately excised, the microendoscopic discectomy system is inserted. With this procedure, no muscular tissue is seen in the surgical site. The portal approach is small, but if full advantage is taken of the spinal microendoscope's merits, the bilateral facet joints are preserved and wide decompression of deep parts is possible. The microendoscope is positioned above the spinal canal to provide a good symmetrical field of view to enable easy anatomical orientation. Bilateral intervertebral joints were satisfactorily preserved in ten patients who received this surgery. All became ambulatory on the day after surgery and the clinical results remained favorable 3 years after the operation. Tubular surgery with the assistance of endoscopic surgery via a midline approach is a minimally invasive surgical procedure with favorable results that enables preservation of paravertebral muscles and bilateral facet joints.

  18. Current insights and controversies in the pathogenesis and diagnosis of disc-associated cervical spondylomyelopathy in dogs.

    PubMed

    De Decker, S; da Costa, R C; Volk, H A; Van Ham, L M L

    2012-11-24

    Disc-associated cervical spondylomyelopathy (DA-CSM) is the most common cause of cervical spondylomyelopathy in dogs. In this condition, progressive caudal cervical spinal cord compression is typically caused by protrusion of one or more intervertebral discs. This disc-associated compression is sometimes seen in combination with mild vertebral abnormalities and dorsal compression resulting from ligamentum flavum hypertrophy. The intervertebral disc space between the sixth (C6) and seventh (C7) cervical vertebrae is most commonly affected. Although several large breed dogs can be affected, the adult to older dobermann is overrepresented. Clinical signs vary from cervical hyperaesthesia to tetraplegia. Dogs can present with a chronic progressive or an acute onset of clinical signs. Many aspects of this multifactorial neurological syndrome are not completely understood and are the subject of controversy and debate. Although several factors have been proposed, the underlying pathology and aetiology remain unknown. Recently, new insights have been gained in the pathogenesis, diagnosis and treatment of this challenging neurological syndrome. This review outlines current controversies and new developments concerning the pathogenesis and diagnosis of DA-CSM.

  19. Cervical Spinal Cord Injury without Computed Tomography Evidence of Trauma in Adults: Magnetic Resonance Imaging Prognostic Factors.

    PubMed

    Martinez-Perez, Rafael; Munarriz, Pablo M; Paredes, Igor; Cotrina, Javier; Lagares, Alfonso

    2017-03-01

    Spinal cord injury (SCI) without computed tomography evidence of trauma is underreported in adults and is considered a subtype of SCI with relatively good outcome. Despite this, few studies have been performed to determine specific imaging-related prognostic factors. Our objective is to describe the imaging characteristics of patients experiencing blunt cervical spine trauma with neurologic deficits, but without radiologic abnormalities and associated prognostic factors. A retrospective review of all adult patients with cervical SCI admitted to the emergency room of 2 university hospitals from January 2004 to December 2013 was performed. Only patients with a magnetic resonance imaging (MRI) performed within 72 hours after trauma were included for further analysis. All patients with bony injury or traumatic malalignment were excluded. Data gathered on the remaining patients included demographics, mechanism of injury, severity of SCI, long-term patient outcome, improvement in neurologic condition, and MRI results. There were 48 patients who met the inclusion and exclusion criteria, and 40 who demonstrated improvement in the neurologic examination at follow-up. Disruption of either the anterior longitudinal ligament or ligamentum flavum and larger lesions in the MRI were predictors of lack of neurologic improvement. Early MRI has prognostic value in patients suffering SCI without computed tomography evidence of trauma. Lesion length is a powerful predictor of outcome in this subgroup of patients. Soft tissue injury plays a role in the severity of injury and the ability to recover in this subgroups of patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Degenerative diseases of the cervical spine: comparison of a multiecho data image combination sequence with a magnetisation transfer saturation pulse and cervical myelography and CT.

    PubMed

    Dorenbeck, U; Schreyer, A G; Schlaier, J; Held, P; Feuerbach, S; Seitz, J

    2004-04-01

    Assessing degenerative disease in the cervical spine remains a challenge. There is much controversy about imaging the cervical spine using MRI. Our aim in this prospective study was to compare a T2*-weighted 2D spoiled gradient-echo multiecho sequence (MEDIC) with a magnetisation transfer saturation pulse with cervical myelography and postmyelographic CT. Using an assessment scale we looked at the vertebral bodies, intervertebral discs, neural foramina, anterior and posterior nerve roots, grey matter, ligamentaflava, oedema in the spinal cord and stenosis of the spinal canal. We also evaluated postmyelography CT and the MEDIC sequence for assessing narrowing of the neural foramina in a cadaver cervical spine. We examined 67 disc levels in 18 patients, showing 18 disc prolapses and 21 osteophytes narrowing the spinal canal or the neural foramina. All MRI studies showed these abnormalities findings equally well. Postmyelography CT was significantly better for showing the bony structures and the anterior and posterior nerve roots. The MEDIC sequence provided excellent demonstration of soft-tissue structures such as the intervertebral disc and ligamentum flavum. No statistical differences between the imaging modalities were found in the assessment of narrowing of the neural foramina or the extent of spinal stenosis. The cadaver measurements showed no overestimation of abnormalities using the MEDIC sequence.

  1. Spinal epidural abscess as a result of dissemination from gluteal abscess secondary to intramuscular analgesic injection.

    PubMed

    Sasani, Mehdi; Aydin, Ozlem; Aydin, Ahmet Levent; Oktenoglu, Tunc; Ozer, Ali Fahir; Ercelen, Omur

    2009-01-01

    Spinal epidural abscess is a collection of suppurative material that forms between the dura mater and the ligamentum flavum. If not recognized early and treated correctly, it can lead to life-threatening sepsis. Here we report the case of a female patient, 51 years of age, with difficulty walking and bilateral leg pain after having had degenerative discogenic pain for many years. The patient had occasionally received intramuscular non-steroidal anti-inflammatory drug injections. The current report is that of an unusual case of epidural abscess that formed following multiple dose of intramuscular non-steroidal anti-inflammatory drug over a 1-year period. Hematogenous or direct dissemination is the suspected cause. To prevent serious morbidity and mortality, early diagnosis is essential. Patients with localized back pain who are at risk for developing such epidural spinal abscesses should receive a magnetic resonance imaging scan with contrast enhancement without delay. The existence of predisposing factors such as intramuscular injections should be considered in the assessment of suspected spinal epidural abscess.

  2. Ultrasound visibility of spinal structures and local anesthetic spread in children undergoing caudal block.

    PubMed

    Shin, Seokyung; Kim, Ji Young; Kim, Won Oak; Kim, Seung Hyun; Kil, Hae Keum

    2014-11-01

    This study assessed ultrasound visibility of spinal structures in children and observed the extent of local anesthetic spread within the epidural space during caudal block. Spinal structures were evaluated with ultrasound from the sacral area to the thoracic area in 80 children, and drug spread levels were observed after caudal injection of 0.5, 1.0, 1.25 and 1.5 mL/kg local anesthetic. The conus medullaris, dural sac and dura mater were easily identified with ultrasound in most children. However, ligamentum flavum visibility declined with increasing vertebral level and markedly decreased at the thoracic level in children older than 7 mo or heavier than 8.5 kg. Drug spread was higher with increasing volume (p < 0.001) and in children ≤12 mo more than children >12 mo (p < 0.001); drug spread was significantly correlated with age (R(2) = 0.534). Spread levels assessed with ultrasound were roughly two to three segments lower than those in previous radiologic studies. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  3. Acute paraplegia in a patient with spinal tophi: a case report.

    PubMed

    Wang, L C; Hung, Y C; Lee, E J; Chen, H H

    2001-03-01

    A 28-year-old man with a 5-year history of gouty arthritis suffered from an acute episode of lower back pain. He visited a rehabilitative clinic and received physical therapy following his examination. Weakness and numbness of both lower legs developed rapidly after physical therapy. He was sent to our hospital with complete paralysis of both lower limbs and complete sensory loss below the umbilicus 3 hours after the physical therapy. No peripheral tophi were found. Myelography showed an extrinsic compression of the dura sac at T10. Emergency decompressive laminectomy of T9 to T11 was performed. During the surgery, caseous material was found deposited in the ligamentum flavum and the left T9 to T10 facet joint, with indentation of the dura sac. The pathologic diagnosis was spinal tophi. After surgery, the patient's neurologic function recovered rapidly. It was suspected that inappropriate physical therapy might have aggravated acute inflammation of spinal gout and resulted in a rapid deterioration of neurologic function. Though gout is a chronic medical disease, an acute attack of spinal gout may be disastrous and requires emergency neurosurgical intervention.

  4. A Systematic Review of the Soft-Tissue Connections Between Neck Muscles and Dura Mater: The Myodural Bridge.

    PubMed

    Palomeque-Del-Cerro, Luis; Arráez-Aybar, Luis A; Rodríguez-Blanco, Cleofás; Guzmán-García, Rafael; Menendez-Aparicio, Mar; Oliva-Pascual-Vaca, Ángel

    2017-01-01

    Systematic review. To elucidate the existence of soft tissue connections between the neck muscles and cervical dura mater. Several studies discuss the existence of a cervical myodural bridge; however, conflicting data have been reported. Searches were conducted in the PubMed, Web of Science, Cochrane Library, and PEDro databases. Studies reporting original data regarding the continuity of non-post-surgical soft tissue between the cervical muscles and dura mater were reviewed. Two reviewers independently selected articles, and a third one resolved disagreements. Another two researchers extracted the methodology of the study, the anatomical findings, and evaluated the quality of the studies using Quality Appraisal for Cadaveric Studies Scale. A different third researcher resolved disagreements. Twenty-six studies were included. A soft tissue connection between the rectus capitis posterior minor, the rectus capitis posterior major, and the obliquus capitis inferior muscles seems to be proved with a strong level of evidence for each one of them. Controversy exists about the possible communication between the dura mater and the upper trapezius, rhomboideus minor, serratus posterior superior, and splenius capitis by means of the ligamentum nuchae. Finally, there is limited evidence about the existence of a soft tissue connection between rectus capitis anterior muscle and the dura mater. There is a continuity of soft tissue between the cervical musculature and the cervical dura mater; this might have physiological, pathophysiological, and therapeutic implications, and going some way to explaining the effect of some therapies in craniocervical disorders. N/A.

  5. Hand and foot remains from the Gran Dolina Early Pleistocene site (Sierra de Atapuerca, Spain).

    PubMed

    Lorenzo, C; Arsuaga, J L; Carretero, J M

    1999-01-01

    We report here the study of the 22 hand and foot remains from the Early Pleistocene level TD6 of the Gran Dolina site at Sierra de Atapuerca (Burgos, Spain) recovered from 1994 to 1996. These remains are paratypes of Homo antecessor. All of the elements are briefly described and compared with other fossil hominids. The capitate has a constricted neck, well developed head, strong attachment for the ligamentum interosseum trapezoid-capitate, a palmarly placed trapezoid facet with a distinctive small dorsal trapezoid facet, a highly curved and oblique orientation of the second metacarpal facet, and a transversally oriented dorsodistal border. A hamate with a moderately projecting and lightly built hamulus; an inferred reduced styloid process on the third metacarpal base; a wide second metacarpal head; and middle phalanges with well marked insertions for the flexor digitorum superficialis muscle and wide heads. The morphology and dimensions of the pedal remains from TD6 are very similar to modern humans; but the base, proximal articular surface and shafts of the proximal hallucal phalanges are more rounded and the midshaft of the proximal toe phalanx is wider.

  6. Esophageal dysfunction in four alpaca crias and a llama cria with vascular ring anomalies.

    PubMed

    McKenzie, Erica C; Seguin, Bernard; Cebra, Christopher K; Margiocco, Marco L; Anderson, David E; Löhr, Christiane V

    2010-08-01

    3 alpaca crias and cadavers of an alpaca cria and a llama cria were evaluated for evidence of esophageal dysfunction. All 5 crias were between 3 and 5 months of age when clinical signs developed, and all had a thin body condition when examined. Clinical signs included coughing, regurgitation, and grossly visible esophageal peristaltic waves. A barium esophagram was used to diagnose esophageal obstruction, megaesophagus, and a vascular ring anomaly (VRA). Fluoroscopy was used to evaluate deglutition, esophageal peristalsis, and the extent of esophageal dilation in 1 alpaca cria. A persistent right aortic arch was identified in 1 alpaca cria, and a left aortic arch with right ductus arteriosus or ligamentum arteriosum and an aberrant right subclavian artery were identified in the 4 remaining crias. Surgical correction of the VRA was attempted in the 3 live alpaca crias. It was complicated by the conformation and location of each VRA and inaccurate anatomic diagnosis of the VRAs before surgery. Treatment was universally unsuccessful because of intraoperative complications and the persistence of clinical signs after surgery. Megaesophagus is typically an idiopathic condition in camelids. However, these findings suggested that camelids with esophageal dysfunction during the neonatal period may have a VRA. The prognosis is grave for camelids with VRA, and accurate anatomic diagnosis of the VRA via the use of advanced imaging techniques (eg, angiography, computed tomography, or magnetic resonance imaging) may improve the success of surgical intervention.

  7. Growth characteristics of the fetal ligament of the head of femur: significance in congenital hip disease.

    PubMed Central

    Walker, J. M.

    1980-01-01

    Measurement of the length and width of the ligament of the head of femur (ligamentum teres) in 140 normal human fetuses between 12 weeks and term provides limits for growth changes in this structure. These observations provide no morphological evidence of a significant difference between males and females, or between the right and left sides, to explain the female and left hip preponderance reported in congenital hip disease. The ligament is shown to be variable in length, width, and shape, and it is not a distinctly linear structure through linearity may increase with age. Tests of femoral head mobility support the opinion that this ligament must play a role in fetal and neonatal hip joint stability. Weak correlation only was demonstrated between the ligament variables and acetabular depth, which suggests that ligament shape and socket shape are not closely related. Comparison of measurements from normal and 12 dysplastic or subluxated joints provides no evidence to support previous observations that this structure is unusually long in abnormal hip joints which are not frankly dislocated. Images FIG. 1 PMID:7445537

  8. [DiGeorge syndrome and vascular ring. An unusual association with multidisciplinary approach].

    PubMed

    Garcia, Pedro; Anjos, Rui; Abecassis, Miguel; Santos, José A Oliveira; Martins, F Maymone

    2009-01-01

    Velo-cardio-facial syndrome/DiGeorge/CATCH 22 is a spectrum of association, characterized by unusual face, cleft or incompetent palate, congenital heart disease with defects of the outflow tracts, absence of the thymus and parathyroid glands, often associated with developmental and behavioral disorders. This association is caused by a microdeletion in chromosome band 22q11.2. In a 4-month-old infant, with obstructive lower respiratory distress and poor weight gain since 2 months of age, truncus arteriosus was diagnosed and surgically corrected. On the postoperative period maintained dependency on mechanical ventilation, with persistent hypoventilation of the left lung. Fiberoptic bronchoscopy revealed complete obstruction of the left main bronchus by an extrinsic compression due to a vascular ring diagnosed by cardiac catheterization that showed a common anomalous origin of both right and left subclavian arteries and the ligamentum arteriosum. A second surgery by left lateral thoracotomy corrected the vascular ring. The maintenance of the collapse of the left main bronchus led to selective endobronchial stenting. The migration of the stent to the trachea, with acute respiratory distress, required emergent endoscopic removal of the stent. Thereafter, the evolution was uneventful. The association of DiGeorge syndrome with vascular ring is unusual. Unexpected evolution in these patients require a multidisciplinary technical approach for diagnosis and eventual emergent intervention.

  9. Microprobe analysis of element distribution in bovine extracellular matrices and muscle

    SciTech Connect

    Engel, M.B.; Catchpole, H.R. )

    1989-09-01

    The concentrations of some essential elements, Na, K, P, S and Cl were determined by microprobe analysis in bovine extracellular matrices of cartilage, tendon and elastic tissue (ligamentum nuchae) and in muscle cells. The values for the different tissues were compared and related to the blood electrolyte concentrations. Among the connective tissues the highest Na and lowest Cl values were found for cartilage which bears a high negative charge. The lowest concentrations of these elements occurred in elastic tissue which is relatively non-polar. In the three extracellular matrices sodium levels exceeded potassium. In myofibers potassium was the major cation at 30 times the blood value and about 3 times the concentration of sodium. Chlorine values were around 0.4 that of blood. Sulfur and phosphorus are components of the tissue macromolecules. The negative charge on the extracellular matrices is a function of carboxyl and sulfate radicals. In the myofiber this property is largely attributable to carboxyl and phosphate groups. Differences in potassium-sodium distribution in cells and extracellular matrices are attributed partly to the microtrabecular lattice and to the ordered state of cell water. In general the element concentrations and selective distribution can be related to the chemical composition and organization of the tissue, the net immobile charge, the nature of the dispersion medium (water) and changes in its dielectric constant, and to the physico-chemical properties of the individual ions.

  10. Ozone solubilizes elastin and increases its susceptibility to elastase

    SciTech Connect

    Winters, R.S.; Johnson, D.A. )

    1991-03-11

    Ozone is a powerful oxidant gas that may contribute to lung diseases such as emphysema. Because the hallmark of emphysema is destruction of the elastin rich alveoli of the lung, ozonization of elastin was studied in vitro to examine the effects of ozone on elastin structure and susceptibility to proteolysis. Samples of bovine ligamentum nuchae elastin were suspended in 15 ml PBS and bubbled with 13.7 ppm ozone in argon at a flow rate of 3.5 ml/min. Ozone treatment resulted in the solubilization of elastin as evidenced by a visual decrease in turbidity and an increase in the 225 nm absorbance of the supernatant fraction after centrifugation to pellet the insoluble elastin. Insoluble elastin recovered from exposed suspensions was examined for proteolytic susceptibility with human neutrophil elastase (HNE), by incubating 600 {mu}g samples in 1 ml of 50 mM Tris-HCl, 200 mM NaCl, pH 8.0 with 3 {mu}g HNE for various times at room temp. Elastin proteolysis was followed by measuring the 225 nm absorbance of solubilized peptides in supernatant fractions. Ozone exposed elastin, which had been previously ozonized to 5% solubility was found to be approximately twice as susceptible to proteolysis as native elastin.

  11. Ligament of the head of femur: A comprehensive review of its anatomy, embryology, and potential function.

    PubMed

    Perumal, Vivek; Woodley, Stephanie J; Nicholson, Helen D

    2016-03-01

    The functional significance of the ligament of the head of femur (LHF), or ligamentum teres has often been debated. Having gained recent attention in clinical practice, it is suggested to partly provide some mechanical stability to the hip joint. However, the anatomy of this ligament is not well studied. This paper systematically reviews the anatomy of the LHF with the aim of exploring our current understanding of this structure and identifying any gaps in knowledge regarding its morphology and function. A systematic search of Medline, Embase, ProQuest, Web of Science, and Scopus databases was undertaken and relevant data extracted, analyzed. A total of 69 references were obtained, that included 53 full text articles, three published abstracts, and 13 textbooks. Many publications related to clinical studies (n = 11) rather than gross anatomy (n = 7), with one report on variation of the LHF. Considerable inconsistency in the naming and description of the LHF morphology was observed. Variable attachment sites were reported except for the acetabular notch, transverse acetabular ligament, and the femoral fovea. Presence and patency of the ligamental arteries supplying the head of the femur and their exact location were variably described and were often incomplete. The LHF is believed to be taught in extreme hip adduction, but there is little evidence to support this. In conclusions, further investigation of the anatomy of the LHF is recommended, particularly to clarify its mechanical role, innervation, and vascular contribution to the developing and adult femur, so to better inform clinical practice.

  12. Characterisation and classification of the neural anatomy in the human hip joint.

    PubMed

    Gerhardt, Michael; Johnson, Keith; Atkinson, Roscoe; Snow, Brian; Shaw, Colin; Brown, Ashley; Vangsness, C Thomas

    2012-01-01

    Hip arthroscopy remains a useful surgical intervention for labral injuries. The literature has predominantly focused on structural and vascular considerations of the hip joint, with few studies examining the neurohistology of the surrounding periarticular tissues. We mapped and identified the periarticular neural anatomy, to identify the presence of sensory nerve fibres and mechanoreceptors within the hip joint. Eight human cadaveric hips were dissected into a total of ten specimens per hip. Histological staining was used to identify neural structures taken from the superolateral, anterior, inferior, and posterior positions of the hip joint. The frozen sections were analyzed by light microscopy to calculate relative concentrations of mean neural fibres per high power field (mnf/hpf). Neural end organs were found in the hip capsule, acetabular labrum, ligamentum teres and transverse acetabular ligament. The highest levels of mechanoreceptors were found in the superolateral aspect of the hip capsule (9.6 mnf/hpf). The labrum showed highest levels of sensory fibres (3.4 mnf/hpf) and mechanoreceptors (4.3mnf/hpf) within the anterior zone. Sensory fibres and mechanoreceptors densely populate the acetabular labrum, capsule and transverse acetabular ligament. The anterior zone of the labrum contained the highest relative concentration of sensory fibres, specifically Ruffini corpuscles.

  13. [Enlargement in managment of lumbar spinal stenosis].

    PubMed

    Steib, J P; Averous, C; Brinckert, D; Lang, G

    1996-05-01

    Lumbar stenosis has been well discussed recently, especially at the 64th French Orthopaedic Society (SOFCOT: July 1989). The results of different surgical treatments were considered as good, but the indications for surgical treatment were not clear cut. Laminectomy is not the only treatment of spinal stenosis. Laminectomy is an approach with its own rate of complications (dural tear, fibrosis, instability... ).Eight years ago, J. Sénégas described what he called the "recalibrage" (enlargement). His feeling was that, in the spinal canal, we can find two different AP diameters. The first one is a fixed constitutional AP diameter (FCAPD) at the cephalic part of the lamina. The second one is a mobile constitutional AP diameter (MCAPD) marked by the disc and the ligamentum flavum. This diameter is maximal in flexion, minimal in extension. The nerve root proceeds through the lateral part of the canal: first above, between the disc and the superior articular process, then below, in the lateral recess bordered by the pedicle, the vertebral body and the posterior articulation. With the degenerative change the disc space becomes shorter, the superior articular process is worn out with osteophytes. These degenerative events are complicated by inter vertebral instability increasing the stenosis. The idea of the "recalibrage" is to remove only the upper part of the lamina with the ligamentum flavum and to cut the hypertrophied anterior part of the articular process from inside. If needed the disc and other osteophytes are removed. The surgery is finished with a ligamentoplasty reducing the flexion and preventing the extension by a posterior wedge.Our experience in spine surgery especially in scoliosis surgery, showed us that it was possible to cure a radicular compression without opening the canal. The compression is then lifted by the 3D reduction and restoration of an anatomy as normal as possible. Lumbar stenosis is the consequence of a degenerative process. Indeed, hip

  14. Effect of ligamenta flava hypertrophy on lumbar disc herniation with contralateral symptoms and signs: a clinical and morphometric study

    PubMed Central

    Yildizhan, Ahmet; Atar, Elmas K.; Yaycioglu, Soner; Gocmen-Mas, Nuket; Yazici, Canan

    2010-01-01

    Introduction The purpose of this study was to determine whether ligamentum flavum hypertrophy among disc herniated patients causes contralateral pain symptoms. For this reason we measured the thickness of the ligament in disc herniated patients with ipsilateral or contralateral symptoms. Material and methods Two hundred disc herniated patients with ipsilateral symptoms as group I were compared with five disc herniated patients with only contralateral symptoms as group II. Ligamenta flava thicknesses and spinal canal diameters of both groups were measured on magnetic resonance imaging (MRI) with a micro-caliper. Results Both groups underwent surgery only on the disc herniated side. The total thicknesses of the ligamenta flava in group II was thicker than in group I. There was no spinal stenosis in either group and no significance difference between the groups. Statistically significant differences were found for both ipsilateral and contralateral thickness of the ligament flava in both groups. We also compared thickness of the ligamenta flava for each level of disc herniation in group I; ligamenta flava hypertrophy was more common at L3-L4 and L4-L5 levels of vertebrae in females. Conclusions Aetiology of contralateral sciatica among disc herniated patients may be related to hypertrophy of the ligamenta flava, especially on the opposite side. Surgical approaches of the disc herniated side alone may be sufficient for a good outcome. PMID:22371809

  15. A rare form of persistent right aorta arch in linkage disequilibrium with the DiGeorge critical region on CFA26 in German Pinschers.

    PubMed

    Philipp, Ute; Menzel, Julia; Distl, Ottmar

    2011-01-01

    Persistent right aortic arch (PRAA) is a congenital vascular ring anomaly common in several dog breeds. In German Pinscher, the disorder is characterized by a left retroesophageal subclavian artery in combination with a ligamentum arteriosum originating at the aberrant left subclavian artery (PRAA-SA-LA). In this study, we genotyped 38 microsatellite markers on canine chromosome 26 (CFA26) in German Pinschers and tested them for linkage and association. We found a chromosome-wide significantly linked genomic region on CFA26, which corresponds to the human DiGeorge syndrome critical region (DGCR). Therefore, we analyzed sequences from 13 genes of DGCR and the canine t-box gene TBX1. We identified a total of 26 polymorphisms in German Pinschers. Three of these SNPs located within TBX1 and one in the mitochondrial ribosomal protein L40 gene (MRPL40) were associated with the PRAA-SA-LA phenotype in German Pinscher. Despite linkage and association between PRAA-SA-LA and the canine DGCR, none of these mutations appeared responsible for PRAA-SA-LA. As the orthologue human region on HSA22q11.2 is known for high susceptibility to genomic rearrangements, we suspect that in German Pinschers, chromosomal aberrations might cause PRAA-SA-LA.

  16. Cervical cord injury in patients with ankylosed spines: progressive paraplegia in two patients after posterior fusion without decompression.

    PubMed

    Sugimoto, Yoshihisa; Ito, Yasuo; Tanaka, Masato; Tomioka, Masao; Hasegawa, Yasuhiro; Nakago, Kie; Yagata, Yukihisa; Ozaki, Toshifumi

    2009-11-01

    Case report and clinical discussion. To describe technical pitfall to treat 2 cervical cord injuries, including dislocations in patients with ankylosed spine due to diffuse idiopathic skeletal hyperostosis (DISH) or ossification of the posterior longitudinal ligament (OPLL). DISH and OPLL are disease processes similar in pathology, which can lead to unexpected fractures due to low-energy trauma. In reported cases of fracture of the ankylosed spine in patients with DISH or OPLL, increasing lever arm and a grossly unstable fracture occurred. However, the actual surgical intervention for these fractures and spinal cord injuries was not discussed. We report 2 cervical cord injuries, including dislocations in patients with ankylosed spine due to DISH or OPLL. Two patients underwent posterior fusion without decompression; however, postoperative progressive paraplegia still occurred. There were 3 points in common: these patients had ankylosed spines due to DISH or OPLL; they were elderly and had spinal canal stenosis; and after undergoing posterior fusion without decompression, their bilateral, lower extremity palsies worsened after surgery. Cervical alignment was slightly different after posterior fusion, and this change concentrated in one segment because adjacent vertebral bodies were ankylosed, and thus, immoveable. Additionally, this stress caused infolding of the ligamentum flavum with resultant spinal cord compression. In these cases, we recommend posterior fusion and decompression such as laminoplasty to avoid worsening palsy.

  17. Persistent right aortic arch and aberrant left subclavian artery in a white Bengal tiger (Panthera tigris).

    PubMed

    Ketz, C J; Radlinsky, M; Armbrust, L; Carpenter, J W; Isaza, R

    2001-06-01

    A 3-mo-old male white Bengal tiger (Panthera tigris) presented with the chief complaint of regurgitation of solid food since weaning at 2 mo of age. Compared with its littermates, the tiger was in poor body condition and weighed only 10.3 kg when its littermates were estimated at 20-25 kg. Thoracic radiographs showed a megaesophagus cranial to the heart base. A contrast esophagram more clearly outlined the megaesophagus, and fluoroscopy demonstrated normal motility of the caudal esophagus. Endoscopic examination revealed a structure coursing dorsally from right to left over the esophagus and a constrictive band on the left of the esophagus at the heart base. Nonselective angiography confirmed the presence of a persistent right aortic arch, as well as an aberrant left subclavian artery. A left fourth intercostal thoracotomy was performed, and the ligamentum arteriosum was double ligated and divided. The left subclavian artery did not cause significant compromise of the esophagus and was not manipulated at surgery. The tiger recovered well from anesthesia and surgery. Solid food was slowly introduced over a 2-mo period without any regurgitation. The cub gained weight rapidly after surgery.

  18. Prevalence and pathogenesis of some filarial nematodes infecting donkeys in Egypt

    PubMed Central

    Radwan, A. M.; Ahmed, N. E.; Elakabawy, L. M.; Ramadan, M. Y.; Elmadawy, R. S.

    2016-01-01

    Aim: The primary objective of the present study is to determine the commonness of filarial parasites in donkeys in Egypt, identification of the filarial species tainting them and the delivered pathogenic impact connected with the infestation. Materials and Methods: A total of 188 donkeys were examined for filarial infection. The blood samples and scraping of the cutaneous bleeding lesions were collected, stained, and inspected for microfilariae all through the period from March 2011 to October 2013. The adult worms were perceived in tissue samples acquired from skin scraping, testes, eyes, tendons, peritoneal and pleural cavities, and the ligamentum nuchae. Results: On the basis of morphological identification, 163 of 188 donkeys (86.70%) were infected with Onchocerca cervicalis (82.98%), Setaria equina (31.11%), Parafilaria multipapillosa (5.32%), and Onchocerca reticulata (4.26%). There was no significant effect of the sex on the incidence of all the encounteredfilarial worms except for S. equina, where the infection rate prevailed in males versus females (40.82% vs. 35.90%). In addition, age group of 5-15 years old exhibited a fundamentally higher predominance (p< 0.05) of the recognized filarial worms versus those of < 5 years old and >15 years old. Conclusion: The preliminary results add to our comprehension of filarial species infecting donkeys in Egypt, their impact on animal execution and production. Accentuation must be taken for avoidance, control of filarial disease, and improvement of the management system of donkeys. PMID:27651679

  19. C2 nerve dysfunction associated with C1 lateral mass screw fixation.

    PubMed

    Huang, Da-geng; Hao, Ding-jun; Li, Guang-lin; Guo, Hao; Zhang, Yu-chen; He, Bao-rong

    2014-11-01

    The C1 lateral mass screw technique is widely used for atlantoaxial fixation. However, C2 nerve dysfunction may occur as a complication of this procedure, compromising the quality of life of affected patients. This is a review of the topic of C2 nerve dysfunction associated with C1 lateral mass screw fixation and related research developments. The C2 nerve root is located in the space bordered superiorly by the posterior arch of C1 , inferiorly by the C2 lamina, anteriorly by the lateral atlantoaxial joint capsule, and posteriorly by the anterior edge of the ligamentum flavum. Some surgeons suggest cutting the C2 nerve root during C1 lateral mass screw placement, whereas others prefer to preserve it. The incidence, clinical manifestations, causes, management, and prevention of C2 nerve dysfunction associated with C(1) lateral mass screw fixation are reviewed. Sacrifice of the C2 nerve root carries a high risk of postoperative numbness, whereas postoperative nerve dysfunction can occur when it has been preserved. Many surgeons have been working hard on minimizing the risk of postoperative C2 nerve dysfunction associated with C1 lateral mass screw fixation. © 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  20. Surgical management of intrauterine devices migrated towards intra-abdominal structures: 20-year experience of a tertiary center.

    PubMed

    Adiyeke, M; Sanci, M; Karaca, I; Gökçü, M; Töz, E; Ocal, E

    2015-01-01

    To share surgical management experiences of intra-abdominal intrauterine devices (IUDs) in tertiary center. A total of 27 patients were retrospectively analyzed. This retrospective study was conducted between September 1992 and April 2013 at Department of Obstetrics and Gynecology Tepecik Research and Training Hospital, Izmir, Turkey. Demographic findings, diagnostic methods, and operative notes of patients were obtained from the patient file. Of the 27 IUDs, nine (33.3%) were in omentum, four (15%) were in Douglas pouch, one in left sacrouterine ligament, one in uterovesical space and one in fundus posterior, six (22%) in left adnexial region, one in abdominal wall, one was subdiaphragmatic, one in ligamentum latum, and one in jejunum. Almost all of the patients had TCu-380 A IUDs. Seventeen patients (63%) were managed by laparoscopy, whereas laparotomy was required in ten (37%). Adhesions were found in 23 of 27 (85%) patients with varying degrees. In four cases the incision was extended due to adhesions. A missing string was the first finding of an intra-abdominal IUD. Pelvic ultrasonography, X-ray, and hysteroscopy methods should be performed in order to detect the localization of IUD in case of a missing string. Surgical approach should be the first treatment option for intra-abdominal IUDs.

  1. Persistent ductus arteriosus in the Brown-Norway inbred rat strain.

    PubMed

    Bökenkamp, Regina; Gittenberger-De Groot, Adriana C; Van Munsteren, Conny J; Grauss, Robert W; Ottenkamp, Jaap; Deruiter, Marco C

    2006-10-01

    Persistent ductus arteriosus (PDA) is a common cardiovascular anomaly in children caused by the pathologic persistence of the left sixth pharyngeal arch artery. The inbred Brown-Norway (BN) rat presents with increased vascular fragility due to an aortic elastin deficit resulting from decreased elastin synthesis. The strikingly high prevalence of PDA in BN rats in a pilot study led us to investigate this vascular anomaly in 12 adolescent BN rats. In all BN rats, a PDA was observed macroscopically, whereas a ligamentum arteriosum was found in adult controls. The macroscopic appearance of the PDA was tubular (n = 2), stenotic (n = 8), or diverticular (n = 2). The PDA had the structure of a muscular artery with intimal thickening. In the normal closing ductus of the neonatal controls, the media consisted of layers of smooth muscle cells (SMCs) intermingled with layers of elastin. The intima was thin and poor in elastin. By contrast, the media of PDA in BN rats elastin lamellae were absent and the intima contained many elastic fibers. The abnormal distribution of elastin in the PDA of BN rats suggests that impaired elastin metabolism is related to the persistence of the ductus and implicates a genetically determined factor that may link the PDA with aortic fragility.

  2. Unexpected death caused by rupture of a dilated aorta in an adult male with aortic coarctation.

    PubMed

    Leth, Peter Mygind; Knudsen, Peter Thiis

    2015-09-01

    Aortic coarctation (AC) is a congenital aortic narrowing. We describe for the first time the findings obtained by unenhanced post mortem computed tomography (PMCT) in a case where the death was caused by cardiac tamponade from a ruptured aneurysmal dilatation of the ascending aorta and the aortic arch without dissection combined with aortic coarctation. The patient, a 46-year-old man, was found dead at home. PMCT showed haemopericardium and dilatation of the ascending aorta and the aortic arch. This appearance led to the mistaken interpretation that the images represented a dissecting aneurysm. The autopsy showed instead a thin-walled and floppy dilatation of the ascending aorta and aortic arch with a coarctation just proximal to the ligamentum arteriosum. A longitudinal tear was found in the posterior aortic wall just above the valves. Blood in the surrounding soft tissue intersected with a large haematoma (1000ml) in the pericardial sac. Cardiac hypertrophy (556g) was observed in the patient, though no other cardiovascular abnormalities were found. Histological analysis showed cystic medial necrosis of the ascending aortic wall. A ruptured aneurysmal dilatation of the ascending aorta and the aortic arch without aortic dissection associated with AC is an uncommon cause of haemopericardium that has only been described a few times before. The case is discussed in relation to other reported cases and in the context of the present understanding of this condition.

  3. Ultrastructure of the bovine nuchal ligament.

    PubMed Central

    Morocutti, M; Raspanti, M; Ottani, V; Govoni, P; Ruggeri, A

    1991-01-01

    Nuchal ligament is composed almost exclusively of elastic fibres and collagen fibrils, interwoven very closely and lying parallel to the main ligament axis. Elastic fibres are very large, straight and roughly cylindrical; the collagenous matrix consists of septa of diminishing size forming a 3-dimensional matrix that envelops fibre bundles as well as individual elastic fibres. In all areas examined, collagen fibrils are of very uniform size and, on replicas, they reveal a spiral subfibrillar arrangement with an inclination angle of 17 degrees. Collagen fibrils appear to adhere to the elastic fibres very closely, conforming to their irregular shape. Sometimes they impinge directly upon the elastic fibres, while in other cases a space is visible between collagen fibrils and elastic fibres that contains a rich fabric of intermediate filaments. The collagen-elastin complex of the ligamentum nuchae may be considered a fibre-reinforced composite material comprising tough fibres immersed in an amorphous elastic matrix. Its mechanical behaviour is the result of the combined properties of its components and their interactions. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 PMID:1810923

  4. Vascular rings.

    PubMed

    Backer, Carl L; Mongé, Michael C; Popescu, Andrada R; Eltayeb, Osama M; Rastatter, Jeffrey C; Rigsby, Cynthia K

    2016-06-01

    The term vascular ring refers to congenital vascular anomalies of the aortic arch system that compress the esophagus and trachea, causing symptoms related to those two structures. The most common vascular rings are double aortic arch and right aortic arch with left ligamentum. Pulmonary artery sling is rare and these patients need to be carefully evaluated for frequently associated tracheal stenosis. Another cause of tracheal compression occurring only in infants is the innominate artery compression syndrome. In the current era, the diagnosis of a vascular ring is best established by CT imaging that can accurately delineate the anatomy of the vascular ring and associated tracheal pathology. For patients with a right aortic arch there recently has been an increased recognition of a structure called a Kommerell diverticulum which may require resection and transfer of the left subclavian artery to the left carotid artery. A very rare vascular ring is the circumflex aorta that is now treated with the aortic uncrossing operation. Patients with vascular rings should all have an echocardiogram because of the incidence of associated congenital heart disease. We also recommend bronchoscopy to assess for additional tracheal pathology and provide an assessment of the degree of tracheomalacia and bronchomalacia. The outcomes of surgical intervention are excellent and most patients have complete resolution of symptoms over a period of time. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Thoracic spondylolisthesis and spinal cord compression in diffuse idiopathic skeletal hyperostosis: a case report.

    PubMed

    Takagi, Yasutaka; Yamada, Hiroshi; Ebara, Hidehumi; Hayashi, Hiroyuki; Iwanaga, Takeshi; Shimozaki, Kengo; Kitano, Yoshiyuki; Kagechika, Kenji; Tsuchiya, Hiroyuki

    2017-04-01

    Diffuse idiopathic skeletal hyperostosis has long been regarded as a benign asymptomatic clinical entity with an innocuous clinical course. Neurological complications are rare in diffuse idiopathic skeletal hyperostosis. However, if they do occur, the consequences are often significant enough to warrant major neurosurgical intervention. Neurological complications occur when the pathological process of ossification in diffuse idiopathic skeletal hyperostosis extends to other vertebral ligaments, causing ossification of the posterior longitudinal ligaments and/or ossification of the ligamentum flavum. Thoracic spondylolisthesis with spinal cord compression in diffuse idiopathic skeletal hyperostosis has not previously been reported in the literature. A 78-year-old Japanese man presented with a 6-month history of gait disturbance. A magnetic resonance imaging scan of his cervical and thoracic spine revealed anterior spondylolisthesis and severe cord compression at T3 to T4 and T10 to T11, as well as high signal intensity in a T2-weighted image at T10/11. Computed tomography revealed diffuse idiopathic skeletal hyperostosis at T4 to T10. He underwent partial laminectomy of T10 and posterior fusion of T9 to T12. The postoperative magnetic resonance imaging revealed resolution of the spinal cord compression and an improvement in the high signal intensity on the T2-weighted image. We report the first case of thoracic spondylolisthesis and spinal cord compression in diffuse idiopathic skeletal hyperostosis. Neurosurgical intervention resulted in a significant improvement of our patient's neurological symptoms.

  6. Physiologic strains in the lumbar spinal ligaments. An in vitro biomechanical study 1981 Volvo Award in Biomechanics.

    PubMed

    Panjabi, M M; Goel, V K; Takata, K

    1982-01-01

    For understanding of the mechanical causes of low-back pain, knowledge of the biomechanics of the various spinal elements is essential. In this in vitro biomechanical study, in situ behavior of spinal ligaments of the L3-4 and L4-5 functional spinal units during physiologic activities was studied in a three-stage procedure. First, 72 load-displacement curves were obtained to determine the three-dimensional flexibility characteristics of the spinal units. Second, three-dimensional morphometric measurements were made of all the spinal ligament attachment points. Finally, a mathematical model was constructed to combine the flexibility and morphometric data and compute the ligament length changes and strains as functions of various spinal movements. In flexion movement, the interspinous and supra-spinous ligaments were found to be subjected to the highest strains, followed by the capsular ligaments and the ligamentum flavum. During extension, it is the anterior longitudinal ligament that has the maximum strain. In lateral bending, the contralateral transverse ligaments carried the highest strains, while the interspinous and supraspinous ligaments were relatively unstrained. In rotation, the capsular ligaments were by far the most strained ligaments.

  7. The effects of enoxaparin on the reparative processes in experimental osteonecrosis of the femoral head of the rat.

    PubMed

    Norman, Doron; Miller, Yoav; Sabo, Edmund; Misselevich, Ines; Peskin, Bezalel; Zinman, Chaim; Levin, Daniel; Reis, Daniel N; Boss, Jochanan H

    2002-03-01

    The blood supply of one femoral head of 6-month-old rats was severed by incising the periosteum of the neck and cutting the ligamentum teres. The rats were killed on the 30th postoperative day and the femoral bones were obtained for semiquantification of the reparative processes in the necrotic heads. Fourteen rats were treated with enoxaparin and 14 untreated animals served as controls. Statistically, the amounts of necrotic bone in the epiphysis were less, the extent of remodeling of the femoral heads was milder, and the articular cartilage degeneration was slighter in the enoxaparin-treated than untreated rats. There was no significant difference in the quantities of newly formed bone in femoral heads of treated and untreated rats. These findings are in agreement with the known effects of unfractionated and low-molecular-weight heparins which enhance osteoclastic bone resorption and angiogenesis and decrease osteoblastic bone formation. The former activities, operative in minimizing the structural distortion of the femoral head, oppose the crucial event in the pathogenesis of post-osteonecrotic osteoarthritis.

  8. Transphyseal osseous bridges in experimental osteonecrosis of the femoral head of the rat. Histologic study of the bony bridges connecting the epiphyseal with the metaphyseal bony trabeculae through gaps in the physeal cartilage.

    PubMed

    Peskin, B; Shupak, A; Misselevich, I; Zinman, C; Levin, D; Jacob, Z; Reis, D N; Boss, J H

    2001-07-01

    In view of the lifelong persistence of the physis, the femoral head of rats may serve to model Perthes disease and slipped capital femoral epiphysis. To produce osteonecrosis, the blood supply of one femoral head of 133, 6-month-old animals was severed by circumferentially incising the periosteum of the neck and cutting the ligamentum teres. The rats were killed 7 days to 90 days postoperatively. Associated with resorption of the necrotic bone and marrow, remodeling of the epiphysis was characterized by an ingrowth of vascularized fibrous tissue, formation of new bone and some cartilage, architectural deformation and flattening of the head. In 22 of 83 rats killed 30 days or more postoperatively, gaps in the continuity of the physeal cartilage were occupied by osseous bridges, connecting newly formed epiphyseal bony trabeculae with either the preexisting or newly formed metaphyseal osseous trabeculae. This healing mode may follow ischemic death of physeal chondrocytes or be owing to another mechanism, e.g., release of mediatory substances of inflammation. These findings raise the possibility that fixation of the healing epiphysis of a child's previously necrotic femoral head to the metaphysis occurs by transphyseal osseous growth in cases in which the physis is involved in the necrotic process.

  9. Osteoarthritis-like disorder in rats with vascular deprivation-induced necrosis of the femoral head.

    PubMed

    Levin, D; Norman, D; Zinman, C; Misselevich, I; Reis, D N; Boss, J H

    1999-01-01

    The reparative processes following vascular deprivation-induced necrosis of the femoral head were studied histologically in rats sacrificed 2, 7, 14, 21, 42 and 92 days postoperatively. The blood supply was severed by incision of the periosteum at the neck of the femoral head and transection of the ligamentum teres. Granulation tissue and a well-vascularized fibrous tissue originating from the joint capsule invaded the necrotic marrow spaces. With progressive resorption of the necrotic tissues and osteoneogenesis, both appositional and intramembranous, within the fibrotic intertrabecular spaces, the remodeling process led to a shift of the normal spongy architecture of the femoral head to a compacta-like one. In a few cases, osseous bridges bisected a necrotic physeal cartilage at the latest time intervals. The remodeling was associated with flattening of the femoral heads as well as with degenerative, regenerative and reparative alterations of the articular cartilage. In one of the two femoral heads obtained three months postoperatively, cystic spaces developed in the fibrous subchondral zone. Our findings are consistent with the view that ineffective attempts at restoring the prenecrotic state of the femoral head by replacing the necrotic with viable tissue triggers the collapse of the femoral head. Thickening and condensation of the subchondral bone, leading to increased stiffness of the subchondral zone, result in the osteoarthritis-like disorder. Mimicking the well-known phases of human osteonecrosis, the model readily allows for preclinical studies of therapeutic regimens.

  10. Design of mulitlevel OLF approach ("V"-shaped decompressive laminoplasty) based on 3D printing technology.

    PubMed

    Ling, Qinjie; He, Erxing; Ouyang, Hanbin; Guo, Jing; Yin, Zhixun; Huang, Wenhua

    2017-07-27

    To introduce a new surgical approach to the multilevel ossification of the ligamentum flavum (OLF) aided by three-dimensional (3D) printing technology. A multilevel OLF patient (male, 66 years) was scanned using computed tomography (CT). His saved DICOM format data were inputted to the Mimics14.0 3D reconstruction software (Materialise, Belgium). The resulting 3D model was used to observe the anatomical features of the multilevel OLF area and to design the surgical approach. At the base of the spinous process, two channels were created using an osteotomy bilaterally to create a "V" shape to remove the bone ligamentous complex (BLC). The decompressive laminoplasty using mini-plate fixation was simulated with the computer. The physical model was manufactured using 3D printing technology. The patient was subsequently treated using the designed surgery. The operation was completed successfully without any complications. The operative time was 90 min, and blood loss was 200 ml. One month after the operation, neurologic function was recovered well, and the JOA score was improved from 6 preoperatively to 10. Postoperative CT scanning showed that the OLF was totally removed, and the replanted BLC had not subsided. 3D printing technology is an effective, reliable, and minimally invasive method to design operations. The technique can be an option for multilevel OLF surgical treatment. This can provide sufficient decompression with minimum damage to the spine and other intact anatomical structures.

  11. Giant thoracic osteophyte: a distinct clinical entity.

    PubMed

    Coumans, Jean-Valery C E; Neal, Jonathan B; Grottkau, Brian E; Nahed, Brian V; Shin, John H; Walcott, Brian P

    2014-09-01

    Calcified lesions described within the neural axis are classified as either an ossification of the posterior longitudinal ligament, diffuse idiopathic skeletal hyperostosis, or ossification of the ligamentum flavum. We aim to describe a unique pathologic entity: the giant thoracic osteophyte. We identified four patients who were surgically treated at the Massachusetts General Hospital from 2006 to 2012 with unusual calcified lesions in the ventral aspect of the spinal canal. In order to differentiate giant thoracic osteophytes from calcified extruded disc material, disc volumetrics were performed on actual and simulated disc spaces. All patients underwent operative resection of the calcific lesion as they had signs and/or symptoms of spinal cord compression. The lesions were found to be isolated, large calcific masses that originated from the posterior aspect of adjacent thoracic vertebral bodies. Pathological examination was negative for tumor. Adjacent disc volumes were not significantly different from the index disc (p=0.91). A simulated calculation hypothesizing that the calcific mass was extruded disc material demonstrated a significant difference (p=0.01), making this scenario unlikely. In conclusion, giant thoracic osteophyte is a unique and rare entity that can be found in the thoracic spine. The central tenant of surgical treatment is resection to relieve spinal cord compression.

  12. Development of a high frequency single-element ultrasound needle transducer for anesthesia delivery

    NASA Astrophysics Data System (ADS)

    Ameri, Golafsoun; Son, Jungik; Liang, Jingwei; Foster, F. Stuart; Ganapathy, Sugantha; Peters, Terry M.

    2017-03-01

    Epidural anesthesia is one of the most commonly used and yet challenging techniques employed for pain management and anesthesia delivery. The major complications of this procedure are due to accidental dural puncture, with an incidence of 1-3%, which could lead to both temporary and irreversible permanent neurological complications. Needle placement under ultrasound (US) guidance has received increasing interest for improving needle placement accuracy. However, poor needle visibility in US, difficulties in displaying relevant anatomical structure such as dura mater due to attenuation and bone shadowing, and image interpretation variability among users pose significant hurdles for any US guidance system. As a result, US guidance for epidural injections has not been widely adopted for everyday use for the performance of neuraxial blocks. The difficulties in localizing the ligamentum flavum and dura with respect to the needle tip can be addressed by integrating A-mode US, provided by a single-element transducer at the needle tip, into the B-mode US guidance system. We have taken the first steps towards providing such a guidance system. Our goal is to improve the safety of this procedure with minimal changes to the clinical workflow. This work presents the design and development of a 20 MHz single-element US transducer housed at the tip of a 19 G needle hypodermic tube, which can fit inside an epidural introducer needle. In addition, the results from initial transducer characterization tests and performance evaluation of the transducer in a euthanized porcine model are provided.

  13. Human cervical spine ligaments exhibit fully nonlinear viscoelastic behavior.

    PubMed

    Troyer, Kevin L; Puttlitz, Christian M

    2011-02-01

    Spinal ligaments provide stability and contribute to spinal motion patterns. These hydrated tissues exhibit time-dependent behavior during both static and dynamic loading regimes. Therefore, accurate viscoelastic characterization of these ligaments is requisite for development of computational analogues that model and predict time-dependent spine behavior. The development of accurate viscoelastic models must be preceded by rigorous, empirical evidence of linear viscoelastic, quasi-linear viscoelastic (QLV) or fully nonlinear viscoelastic behavior. This study utilized multiple physiological loading rates (frequencies) and strain amplitudes via cyclic loading and stress relaxation experiments in order to determine the viscoelastic behavior of the human lower cervical spine anterior longitudinal ligament, the posterior longitudinal ligament and the ligamentum flavum. The results indicated that the cyclic material properties of these ligaments were dependent on both strain amplitude and frequency. This strain amplitude-dependent behavior cannot be described using a linear viscoelastic formulation. Stress relaxation experiments at multiple strain magnitudes indicated that the shape of the relaxation curve was strongly dependent on strain magnitude, suggesting that a QLV formulation cannot adequately describe the comprehensive viscoelastic response of these ligaments. Therefore, a fully nonlinear viscoelastic formulation is requisite to model these lower cervical spine ligaments during activities of daily living. Copyright © 2010 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  14. Nonlinear viscoelasticty plays an essential role in the functional behavior of spinal ligaments.

    PubMed

    Troyer, Kevin L; Puttlitz, Christian M

    2012-02-23

    Despite the significant role ligament viscoelasticity plays in functional spinal biomechanics, relatively few studies have been performed to develop constitutive models that explicitly characterize this complex behavior. Unfortunately, the application and interpretation of these previous models are limited due to the use of simplified (quasi-linear) viscoelastic formulations or characterization techniques that have been shown to affect the predictive accuracy of the fitted coefficients. In order to surmount these previous limitations, the current study presents the application of a novel fitting technique (applied to stress relaxation experiments) and nonlinear viscoelastic constitutive formulation to human cervical spine anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL) and ligamentum flavum (LF). The fitted coefficients were validated by quantifying the ability of the constitutive equation to predict an independent cyclic data set across multiple physiologic strain amplitudes and frequencies. The resulting validated constitutive formulation indicated that the strain-dependent viscoelastic behavior of the longitudinal ligaments (ALL and PLL) was dominated by both the short-term (t=0.1s) and the steady-state (as t→∞) behavior. Conversely, the LF exhibited consistent relaxation behavior across the investigated temporal spectrum. From these data, it can be hypothesized that the unique strain-dependent temporal behavior of these spinal ligaments may be a functional adaptation that minimizes muscular expenditure during quasi-static postures while maximizing structural stability of the spine during transient loading events. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Hip arthroscopy: evolution, current practice and future developments.

    PubMed

    Griffiths, Emmet J; Khanduja, Vikas

    2012-06-01

    Arthroscopic examination and treatment is an ever-increasing part of modern orthopaedic practice in this age of minimally invasive surgery. Arthroscopic procedures have been widespread in surgery of the knee and the shoulder for many years; however, the hip until relatively recently, has been largely neglected. Even now hip arthroscopy is not widely available; this may be due to the complexity of the procedure, the requirement of specialist equipment and a reportedly long learning curve. On the other hand, it has gone through a period of rapid growth over the last decade and is being performed in large numbers routinely in some centres around the world. Hip arthroscopy now provides excellent visualisation of not only the articular surfaces of the hip joint but also of the peritrochanteric or extra-articular space around the hip. Pathology of both the femoral head and the acetabulum along with the soft tissues of the hip, namely the ligamentum teres, the acetabular labrum, the synovial folds and synovium, is readily diagnosed. Modern techniques provide therapeutic options for a myriad of conditions and allow modulation of pathological processes early. Additionally hip arthroscopy is a relatively safe procedure with few complications and contraindications. However, the key to good outcomes is in the careful selection of patients and meticulous surgical technique. The aim of this review is to bring the reader up to date with an overview of the evolution of arthroscopy of the hip, review the current practice and explore possible future developments.

  16. Spinal dural attachments to the vertebral column: An anatomic report and review of the literature.

    PubMed

    Kimmell, Kristopher T; Dayoub, Hayan; Shakir, Hakeem; Sincoff, Eric H

    2011-01-01

    The spinal dura is anchored within the vertebral canal by connective tissue in the epidural space as well as the spinal roots. Inadvertent disruption of these dural attachments may lead to durotomy and cerebrospinal fluid (CSF) leaks. We observed well-developed connective tissue ligaments connecting the lumbar dura to the spinal column and examined these tissues microscopically. Intraoperative images were obtained during lumbar laminectomy procedures. They demonstrated connective tissue attachments, linking the lumbar dura to the spinal column in the dorsal midline and dorsolaterally. Tissue samples were obtained and examined microscopically. We then conducted a search of the literature to find references to dural attachments to the spinal column. Histological examination of the samples showed minimal cellular fibrous tissue. To date no references to these attachments have been made in neurosurgical literature. Previous studies, including live, cadaveric, and radiographic examinations, have demonstrated a dorsomedian fold of dura attached to the junction of the ligamentum flavum, and dorsolateral ligaments that divide the dorsal epidural space into an anterior and posterior compartment. Epidural fibrous connections or ligaments between the dura and the lumbar spinal column may be of clinical importance to the neurosurgeon. Care should be taken during lumbar procedures not to disrupt or tear these ligaments as this may cause dural tears and CSF leaks. Identifying these ligaments and cutting them sharply may prevent inadvertent durotomies.

  17. Topological analysis of the brain stem of the frogs Rana esculenta and Rana catesbeiana.

    PubMed

    Opdam, R; Kemali, M; Nieuwenhuys, R

    1976-02-01

    The ventricular sulcal pattern and the cytoarchitectonic organization of the brain stem of the frogs Rana esculenta and Rana catesbeiana have been studied in transversely cut, Nissl stained serial sections. Four longitudinal sulci, the sulcus medianus inferior, the sulcus intermedius ventralis, the sulcus limitans and the sulcus medianus superior could be distinguished in both species. A fifth longitudinal groove, the sulcus intermedius dorsalis, was found only in Rana esculenta. With the aid of the usual cytoarchitectonic criteria 25 cell masses have been delineated in Rana esculenta and 27 in Rana catesbeiana. These cell masses can be distributed over the following categories (numbers added in brackets for Rana catesbeiana, if different from those in Rana esculenta): primary efferent or motor, 8; primary afferent or sensory, 4(6); "relay" centers, 7. Contrary to statements in the literature the reticular formation can be divided into six separate cell groups. The majority of the nuclei form part of the central gray, which constitutes a rather wide zone in anurans; three reticular nuclei lie partly within the stratum griseum and partly within the stratum album; six nuclei are entirely embedded in the stratum album. The morphological pattern of the cell masses and their relationship to the ventricular sulci were studied with the aid of a graphical reconstruction procedure termed topological analysis (cf. Nieuwenhuys, '74 and figs. 15, 16). This analysis yielded the following results: The sulcus limitans extends throughout the rhombencephalon, dividing this brain part into a basal plate and an alar plate. The cell masses in the basal plate fit into two longitudinal zones, a medial area ventralis and a lateral area intermedioventralis. The area ventralis contains three somatic motor nuclei (IV, VI and XII) and the rhombencephalic medial reticular zone. The latter may be primarily considered as a somatic motor coordinating center. The area intermedioventralis contains

  18. Quantifying Optimal Columellar Strut Dimensions for Nasal Tip Stabilization After Rhinoplasty via Finite Element Analysis.

    PubMed

    Gandy, Jessica R; Manuel, Cyrus T; Leary, Ryan P; Wong, Brian J F

    2016-05-01

    The contribution of columellar strut grafts (CSGs) to nasal tip support has not been determined via structural mechanics. Optimal graft dimensions have yet to be objectively determined. To use a finite element model (FEM) of the human nose to (1) determine the effect of the CSG on nasal tip support and (2) identify how suture placement contributes to tip support. A multiple-component FEM of the human nose consisting of bone, skin/soft tissue, and cartilage was rendered from a computed tomographic scan. Then, CSGs of varying sizes were created, ranging from 15 × 4 × 1 mm to 25 × 8 × 1 mm, and placed in the model between the medial crura. Two FEMs were constructed for each strut size: (1) CSGs that were physically attached to the nasal spine, medial crura, and caudal septum and (2) CSGs that were not in direct contact with these structures and free to move within the soft tissue. A control model was also constructed wherein no graft was placed. Nasal tip support for each model was assessed, and the resultant distribution of von Mises stress, reaction force, and strain energy density with respect to the alar cartilages were calculated. Compared with the control, the reaction force increased with increasing strut volume, while the strain energy density (calculated over the alar cartilages) generally decreased with increasing CSG volume. Simulations with struts that had suture attachments along the entire length of the graft generated a larger reaction force than the models without any suture attachments. Models with anteriorly placed sutures generated reaction forces similar to that of the fully sutured model, whereas the models with posterior sutures showed reaction forces similar to the fully disconnected model. Insertion of CSGs does effect the amount of force the nasal tip can withstand post rhinoplasty. Moreover, anteriorly placed sutures incur reaction forces similar to struts that are fully connected to the alar cartilage. Thus, our

  19. Integration and Testing of a Disjunct Eddy Accumulation VOC Flux Measurement System in a Research Aircraft

    NASA Astrophysics Data System (ADS)

    Garman, K.; Everly, M.; Wyss, P.; Carlsen, M.; Zimmerman, J.; Stirm, B.; Carney, T.; Santini, R.; Shepson, P.

    2005-12-01

    Biogenic Volatile Organic Compound (BVOC) fluxes can now be measured using Disjunct Eddy Accumulation (DEA). This method is primarily applied from fixed towers above forest canopies to study biosphere-atmosphere exchange processes. To expand these tower-based BVOC measurements to spatial scales beyond the tower footprint, an aircraft-based DEA platform is required. Among the significant challenges to such an approach is the capability to determine the vertical component of atmospheric wind from the aircraft with adequate precision and accuracy. The design of a suitable airborne sampling system is another significant challenge. The development of the Airborne Laboratory for Atmospheric Research (ALAR) is described herein. We describe the DEA design and installation along with calibration results which characterize the uncertainties of the vertical wind component measurement. We also describe initial tests of the DEA sampling system, the capabilities of the final installation, and the expected flux uncertainties.

  20. Computed tomography of the craniocervical junction in rheumatoid arthritis.

    PubMed

    Castor, W R; Miller, J D; Russell, A S; Chiu, P L; Grace, M; Hanson, J

    1983-02-01

    Thirty-three patients with rheumatoid arthritis had computed tomographic examination of the craniocervical junction. This demonstrated soft tissue features which have not previously been described in published reports. A low attenuation lesion between the odontoid and the transverse ligament shown in 11 patients was considered a premonitory sign of rupture of the transverse ligament or a manifestation of active disease. Computed tomography revealed spinal cord compression in 3 patients and ligamentous changes in the transverse ligament and the alar and spinal ligaments in 26 patients. Erosion of the odontoid was shown in 19 patients and subluxation in 20 patients. No relationship could be found between the clinical signs and symptoms and the radiological abnormalities except in the case of cord compression.

  1. Value of cephalic part of lateral crus in functional rhinoplasty.

    PubMed

    Sazgar, Amir A; Amali, Amin; Peyvasty, Mina Najarzad

    2016-12-01

    Reshaping of the nasal tip is the most difficult part of rhinoplasty. Over the years, there have been many advances in the field of rhinoplasty, including tip plasty. The goal of these continuous refinements in existing procedures has been to improve both aesthetic and functional outcomes. The cephalic part of the lateral crus of the lower lateral cartilage is what mainly contributes to nasal tip deformity. Various surgical techniques have been reported that used the cephalic part of lateral crus to refine the nasal tip and preserve alar integrity and nasal breathing function. In this review article, we have attempted to show the evolution of these methods while focusing on development of approaches that are basic for "modern rhinoplasty" and presenting our personal preferences. We have also endeavored to categorize these methods and clarify some misconceptions and inaccuracies in their descriptions.

  2. Nasal reconstruction using porous polyethylene implants.

    PubMed

    Romo, T; Sclafani, A P; Jacono, A A

    2000-01-01

    Nasal reconstruction presents a significant challenge to the facial plastic surgeon. The dual goals of reconstruction are restoration of the desired aesthetic nasal contour and an improved nasal airway. Autologous cartilage and bone are considered optimal grafting material, but their supply is often limited and harvesting entails additional morbidity. Many synthetic materials have been introduced in nasal reconstruction, but high infection and extrusion rates limited their use. Porous high density polyethylene implants present an alternative to autologous material as they allow for fibrovascular ingrowth, leading to stability of the implant and decreased rates of infection. Herein we describe the use of porous high density polyethylene implants for reconstruction of the platyrrhine nose and in revision rhinoplasty. The use of preformed nasal-dorsal tip and alar batten implants are described, as well as the use of columellar strut and premaxillary plumper implants. We believe that porous high density polyethylene implants provide a safe, desirable alternative in functional and aesthetic nasal reconstruction.

  3. A comparison of aesthetic proportions between the Oriental and Caucasian nose.

    PubMed

    Leong, S C L; White, P S

    2004-12-01

    Differences in aesthetics between the Oriental and Caucasian nose were examined from a cohort of 118 healthy volunteers of which 61 had an Oriental and 57 had a Caucasian racial origin. The oriental nose projected less from the face, and was broader at the intercanthal level (P < 0.001) and the alar base (P < 0.001), but not at the bony base. The oriental nose projected less at all levels: nasion projection (P < 0.001) and tip projection (P < 0.001). The naso-labial angles for the Orientals in this study exhibited a wider range of variation than the Caucasians, with the oriental male exhibiting the most acute angle (average 86.2 degrees ), because of the forward angulation of the upper lip. Many of the average aesthetic parameters obtained from these two cohorts of healthy subjects did not conform to the published aesthetic standards, set out as the ideal goals for rhinoplasty.

  4. Three-dimensional analysis techniques--Part 4: Three-dimensional analysis of bone and soft tissue to bone ratio of movements in 24 cleft palate patients following Le Fort I osteotomy: a preliminary report.

    PubMed

    McCance, A M; Moss, J P; Fright, W R; Linney, A D; James, D R; Coghlan, K; Mars, M

    1997-01-01

    The three-dimensional changes in the bone and the ratio of soft tissue to bone movement were investigated in a group of 24 cleft palate patients following Le Fort I osteotomy. CT scans were taken for each patient preoperatively and 1 year postoperatively. The scans were superimposed, radial measurements calculated, and the changes illustrated by two separate color scales. In all of the groups, there was a fairly consistent pattern of movement over the mandible. The soft tissues moved in a 1.25:1 ratio over the chin and canine regions, and reduced to 1:1 over the body. In the maxilla, there was a 1:1 movement in the midline increasing to 1.25:1 bilaterally over the alar bases for both the bilateral clefts and clefts of the secondary palate groups. In the unilateral cleft group, however, there was a greater degree of movement over the cleft than over the noncleft side.

  5. Expression of chick Fgf19 and mouse Fgf15 orthologs is regulated in the developing brain by Fgf8 and Shh.

    PubMed

    Gimeno, L; Martinez, S

    2007-08-01

    Fibroblast growth factors (Fgfs) constitute a family of signaling molecules that play essential roles in development. We have studied the expression pattern of mouse Fgf15 in the developing brain. Fgf19 is another member of the FGF family that has been suggested as the chick and human ortholog of mouse and rat Fgf15. Here, we compare the expression pattern during neural development of chick Fgf19 with mouse Fgf15. Unlike Fgf15, Fgf19 presents an expression in the isthmic alar plate, diencephalic and mesencephalic parabasal plates, hindbrain basal plate, as well as in the zona limitans intrathalamica (zli). Moreover, we explored the regulation between Fgf19 and the signaling molecules of the isthmic and zli organizers: Fgf8 and Shh, respectively. Considering the possibility that Fgf19 plays a similar role in humans and chicks, this finding could explain the significant diencephalic phenotypic differences between humans and mice in models and diseases where the Shh pathway is affected.

  6. Nasolabial Cyst Associated with Odontogenic Infection

    PubMed Central

    Martini, Eveline Claudia; Coppla, Fabiana Madalozzo; Campagnoli, Eduardo Bauml; Bortoluzzi, Marcelo Carlos

    2016-01-01

    The nasolabial cyst or Klestadt cyst is a relatively uncommon nonodontogenic cyst that develops in the nasal alar region; it has uncertain pathogenesis. This lesion has slow growth and variable dimensions and is characterized clinically by a floating tumefaction in the nasolabial fold area around the bridge of the nose, causing an elevation of the upper lip and relative facial asymmetry. Diagnosis is primarily made clinically; if necessary, this is complemented by imaging. This paper reports the case of a 39-year-old male patient who complained of pain in the right upper premolar region and poor aesthetics due to a firm tumor in the right wing of the nose. Initially, this was thought to be due to an odontogenic abscess; however, the differential diagnosis was that a nasolabial cyst was communicating with the apex of teeth 14 and 15. Surgical treatment was carried out, followed by histopathological examination and concomitant endodontic treatment of the teeth involved. PMID:26904312

  7. An assessment of grafts in the posterior cricoid lamina.

    PubMed

    Strome, M; Norris, C M; Joseph, M P; Brodsky, G; Eavey, R D

    1982-10-01

    Subglottic stenosis is a recognized complication of prolonged intubation. To date, there is no uniformly successful operative procedure for severe subglottic stenosis, fulfilling the criteria of decannulation and a serviceable voice. The surgical ideals for such a procedure should include the use of autogenous grafting material, avoidance of internal stenting, and limited manipulation of the mucosa. This study was intended to assess the fate of isolated hyoid and thyroid alar grafts interposed in the posterior cricoid lamina. Additionally, anterior/posterior splits with and without anterior grafting were evaluated. Seventeen dogs were used in the determinate animal model. Vocal cord mobility was evaluated by direct laryngoscopy prior to sacrifice. Graphic gross anatomical specimens depict the effects of anterior/posterior splitting on the cricoid cartilage. Clinical correlations are suggested.

  8. Infiltrating intramuscular spindle cell lipoma of the face.

    PubMed

    Mandal, Rajni V; Duncan, Lyn M; Austen, William G; Nielsen, G Petur

    2009-10-01

    Spindle cell lipoma is a benign lipomatous tumor, which usually arises on the back of the neck, shoulder or upper back of males in the third to seventh decade of life. We report herein an unusual infiltrating intramuscular spindle cell lipoma arising in the nose of a 53-year-old man. The patient presented with a 0.5-cm 'cyst' of the nose, just above the right alar crease, which was removed. Four years later, the lesion recurred and was re-excised. Histologically, a proliferation of mature adipocytes, ropey collagen fibers and spindle cells within a myxoid stroma was present in the subcutaneous tissue and infiltrated between skeletal muscle fibers. Nine cases of intramuscular spindle cell lipoma with histological examination have previously been reported and have involved the oral cavity and muscles of the extremities. To our knowledge, this is the first report of an infiltrating intramuscular spindle cell lipoma arising on the face.

  9. Intra And Extra Nasal Laser Surgery

    NASA Astrophysics Data System (ADS)

    Selking, Stuart G.

    1988-06-01

    The author describes his experience with 400 intranasal laser surgical procedures done with the carbon dioxide laser and the surgical microscope. Procedures include excision and vaporization of polyps, turbinates, tumors, telangiectasia, synechia, nasal stenosis, intranasal cysts, papillomata, and septal spurs. The author describes a suction speculum and drape of his own design which provide smoke free access to the internal nose, and protection of the alar rim and the face from laser energy. Relief of obstruction is comparable to that obtained from the more traditional means of intranasal surgery. Intraoperative and early and delayed post operative bleeding is less with laser surgery than with any other means. Avoidance of technical problems is emphasized in this manuscript, since intranasal laser surgery is in some respects difficult to perform. Included are practical suggestions about patient positioning, use of protective devices, and patient selection.

  10. [Nasal mucosa in patients with diabetes mellitus].

    PubMed

    Müller, Maciej; Betlejewski, Stanisław

    2003-01-01

    Diabetes mellitus is the most common endocrinologic disease all over the world. 150 million people suffer from this disease, in Poland about 2 million. The disease on the basis of the onset and pathophysiology may be divided into type I and type II. Pathophysiologic changes include diabetic microangiopathy, macroangiopathy and neuropathy. The most common presentations in head and neck are otitis externa, hypoacusis, vertigo, disequilibrium, xerostomia, dysphagia, fungal and recurrent infections. The changes in nasal mucosa are not very well known. Only few papers concerned the problem. The main complaints of patients regarding the nose are xeromycteria, hyposmia and various degree of decreased patency of the nose. Chronic atrophic rhinitis, septal perforation, ulceration of nasal mucosa, alar necrosis, symptoms of staphylococcal or fungal infection can be found during otolaryngologic examination. The treatment in this group of patients should consist of systemic therapy of diabetes mellitus and on the other hand focal therapy with the use of a solution to moisten the nasal mucosa.

  11. Prime Contractors with Awards Over $25,000 by Name, Location, and Contract Number, Fiscal Year 87. Part 9. Pacific Coast Sales & Service-Rockwell International Corporation.

    DTIC Science & Technology

    1987-01-01

    8217 ID W E (1 0 ~ Ecc 0 ’-’GE N4 cc cc~ c- cc c 1ALar T . 6z- -%L __ !L S :a *4m to~’) 00IN 4 m (n4 CnO WC N 0 - F - -N LC to C >c 0 ID a I > U- R) I6 L...I 44 Hot D0-D 3 o 00 00 2 0 HOMO MO M 00C 0.. C C0U 00 0*0 0 4o rF. 0 010eW 23 - ixI - - 8w~d IO 0 U)LIko0 LOO W c 0000 080W0).0000 oomo r- 0 m 5 I

  12. Humans are born too soon: impact on pediatric otolaryngology.

    PubMed

    Bluestone, Charles D

    2005-01-01

    Humans are born 12 months too early. Gestation should be 21 months. Humans evolved to become the pre-eminent animal in the world, but our big brain, bipedalism, and small female pelvic outlet have caused us to pay the price of being born too soon with all of its disadvantages. Early birth has an impact on diseases and disorders encountered by the otolaryngologist, including otitis media, laryngomalacia, tracheomalacia, congenital vocal cord paralysis, subglottic and tracheal stenosis, gastroesophageal reflux, congenital micrognathia, and congenital nasal alar collapse. Many of these conditions improve or resolve completely in the first year of life as an infant's immune system and anatomy matures. Knowledge of this evolutionary process can help us understand why some infants will grow out of certain diseases and disorders encountered in pediatric otolaryngology, while others will not.

  13. Aesthetic and functional outcome following nasal reconstruction.

    PubMed

    Mureau, Marc A M; Moolenburgh, Sanne E; Levendag, Peter C; Hofer, Stefan O P

    2007-10-01

    Few reports on outcome of aesthetic nasal reconstruction exist. Therefore, subjective and objective aesthetic and functional outcome following nasal reconstruction was assessed. Outcome was assessed in 38 consecutive patients treated for subtotal nasal defects using standardized semistructured interviews. Standardized physical examination forms and photographs were used. In six patients, one aesthetic subunit was involved; in 14, two; and in 18, three or more. Defects were classified as skin only (13 percent), skin/cartilage (21 percent), and full thickness (66 percent). Some defects (32 percent) involved adjacent aesthetic units. Inner lining was reconstructed with local mucosa or turnover skin flaps. Support was provided with regional cartilage grafts and/or composite septal flaps. Skin defects were reconstructed with forehead, nasolabial, cheek advancement, Abbé, facial artery perforator, or free radial forearm flaps. Nasal reconstructions required 116 procedures. Thirty-three patients participated in the follow-up study. Mucosal crusting was noted in 36 percent, passage difficulties in 31 percent, and worse olfaction in 16 percent. Phonation was unchanged. Eighty-one percent were very satisfied with nasal function. Flap color match was moderate to good in 97 percent; hair growth occurred in 61 percent. At critical inspection, a thicker flap (58 percent), smaller ostium nasi (77 percent), thicker alar rim (86 percent), and minor alar rim retraction (46 percent) were noted. Seventy-nine percent were very satisfied with total nasal appearance. Although objective functional and aesthetic outcome following nasal reconstruction sometimes shows impairment compared with the normal situation, it gives high subjective patient satisfaction with function and aesthetics.

  14. Functional magnetic resonance imaging--video diagnosis of soft-tissue trauma to the craniocervical joints and ligaments.

    PubMed

    Volle, E

    2000-01-01

    Patients suffering from distortion of the cervical spine after an acceleration trauma present problems with respect to the correct diagnostic recognition of the existing injuries. To define instability of the craniocervical junction, attention should be given to the position of the dens and the dimension of its subarachnoid space during the entire rotational maneuver. Our diagnosis via functional magnetic resonance imaging (fMRI) with video did not focus on injuries to the ligamentous microstructure as visualized with high-resolution MRI. Our purpose was to demonstrate the cause of instability of the craniocervical junction by direct visualization during fMRI-video technique. Between December 1997 and March 1999, 200 patients were studied using fMRI on a 0.2-Tesla Magnetom Open. Routine evaluation of the extracranial vertebral circulation by MRI angiography as an additional preinvestigative requirement is recommended. The earliest examination time from injury to MRI evaluation was 3 months and the maximum, 5 years (average, 2.6 years). Among the 200 patients investigated, 30 showed instability of the ligamentous dens complex. Of the same 200, 8 (4%) had a complete rupture and 22 (11%) an incomplete rupture of the alar ligament, with instability signs. In another 45 patients (22.5%), fMRI-video showed evidence of instability, and all these patients had coexisting intraligamentous signal pattern variation, probably due to granulation tissue. Eighty patients of the 200 (40%) had signal indifference without demonstrable video instability signs, and 43 patients (21.5%) showed no evidence of instability and no signal variation in the alar ligaments. On the basis of recognition of instability and the malfunction of the ligaments, the fibrous capsula, and the tiny dens capsula, we now can distinguish between lesions caused by rotatory trauma to the craniocervical junction and those from classic whiplash injury.

  15. MRI video diagnosis and surgical therapy of soft tissue trauma to the craniocervical junction.

    PubMed

    Volle, E; Montazem, A

    2001-01-01

    We evaluated objective diagnostic methods for patients with possible upper cervical spine instability caused by trauma and correlated them with subsequent neurosurgical findings and outcomes. Between November 1995 and May 1998, we investigated 420 patients with functional magnetic resonance imaging (MRI) of the craniocervical junction. We evaluated the extracranial vertebral circulation by MRI angiography, with focus on the position of the dens and on the subarachnoid space during entire rotational maneuvers. We documented 72 cases (17.1%) of injuries to the alar ligaments that were accompanied by signs of instability. Twenty patients (4.8%) had a complete alar ligament rupture, and 52 (12.4%) had an incomplete rupture with coexisting instability. We referred these patients to a neurosurgeon. Surgery was eventually chosen for 42 patients (10.0%) with the intention of obtaining dorsal occipitocervical stabilization. The duration of time between the MRI evaluation and surgery ranged from 1 week to 1.5 years (mean: 3.5 mo). After the fifth postoperative day, almost all symptoms had disappeared. One year following surgery, 34 of the 42 patients (80.9%) still demonstrated successful fusion and an alleviation of their sensation of instability. Twenty-five of these patients (59.5%)--all of whom were unemployed before surgery--were able to resume a professional activity. In the eight patients (19.0%) who still had a loss of stability during the second and 14th weeks, we noticed that there were some negative effects of rehabilitation. Six of these patients developed pseudarthrosis or osteolysis of their bone grafts during the first 3 months after fusion, and three required a repeat operation. We conclude that functional MRI with lateral tilting and rotatory evaluation is a useful tool for investigating craniocervical instability. For patients who are recalcitrant to following a program of conservative therapy, surgical stabilization of the craniocervical junction appears to

  16. Clone and functional analysis of Seryl-tRNA synthetase and Tyrosyl-tRNA synthetase from silkworm, Bombyx mori.

    PubMed

    Hu, Jingsheng; Tian, Jianghai; Li, Fanchi; Xue, Bin; Hu, Jiahuan; Cheng, Xiaoyu; Li, Jinxin; Shen, Weide; Li, Bing

    2017-01-30

    Aminoacyl-tRNA synthetases are the key enzymes for protein synthesis. Glycine, alanine, serine and tyrosine are the major amino acids composing fibroin of silkworm. Among them, the genes of alanyl-tRNA synthetase (AlaRS) and glycyl-tRNA synthetase (GlyRS) have been cloned. In this study, the seryl-tRNA synthetase (SerRS) and tyrosyl-tRNA synthetase (TyrRS) genes from silkworm were cloned. Their full length are 1709 bp and 1868 bp and contain open reading frame (ORF) of 1485 bp and 1575 bp, respectively. RT-PCR examination showed that the transcription levels of SerRS, TyrRS, AlaRS and GlyRS are significantly higher in silk gland than in other tissues. In addition, their transcription levels are much higher in middle and posterior silk gland than in anterior silk gland. Moreover, treatment of silkworms with phoxim, an inhibitor of silk protein synthesis, but not TiO2 NP, an enhancer of silk protein synthesis, significantly reduced the transcription levels of aaRS and content of free amino acids in posterior silk gland, therefore affecting silk protein synthesis, which may be the mechanism of phoxim-silking disorders. Furthermore, low concentration of TiO2 NPs showed no effect on the transcription of aaRS and content of free amino acids, suggesting that TiO2 NPs promotes silk protein synthesis possibly by increasing the activity of fibroin synthase in silkworm.

  17. Clone and functional analysis of Seryl-tRNA synthetase and Tyrosyl-tRNA synthetase from silkworm, Bombyx mori

    PubMed Central

    Hu, Jingsheng; Tian, Jianghai; Li, Fanchi; Xue, Bin; Hu, Jiahuan; Cheng, Xiaoyu; Li, Jinxin; Shen, Weide; Li, Bing

    2017-01-01

    Aminoacyl-tRNA synthetases are the key enzymes for protein synthesis. Glycine, alanine, serine and tyrosine are the major amino acids composing fibroin of silkworm. Among them, the genes of alanyl-tRNA synthetase (AlaRS) and glycyl-tRNA synthetase (GlyRS) have been cloned. In this study, the seryl-tRNA synthetase (SerRS) and tyrosyl-tRNA synthetase (TyrRS) genes from silkworm were cloned. Their full length are 1709 bp and 1868 bp and contain open reading frame (ORF) of 1485 bp and 1575 bp, respectively. RT-PCR examination showed that the transcription levels of SerRS, TyrRS, AlaRS and GlyRS are significantly higher in silk gland than in other tissues. In addition, their transcription levels are much higher in middle and posterior silk gland than in anterior silk gland. Moreover, treatment of silkworms with phoxim, an inhibitor of silk protein synthesis, but not TiO2 NP, an enhancer of silk protein synthesis, significantly reduced the transcription levels of aaRS and content of free amino acids in posterior silk gland, therefore affecting silk protein synthesis, which may be the mechanism of phoxim-silking disorders. Furthermore, low concentration of TiO2 NPs showed no effect on the transcription of aaRS and content of free amino acids, suggesting that TiO2 NPs promotes silk protein synthesis possibly by increasing the activity of fibroin synthase in silkworm. PMID:28134300

  18. The Structural, Functional, and Molecular Organization of the Brainstem

    PubMed Central

    Nieuwenhuys, Rudolf

    2011-01-01

    According to His (1891, 1893) the brainstem consists of two longitudinal zones, the dorsal alar plate (sensory in nature) and the ventral basal plate (motor in nature). Johnston and Herrick indicated that both plates can be subdivided into separate somatic and visceral zones, distinguishing somatosensory and viscerosensory zones within the alar plate, and visceromotor and somatomotor zones within the basal plate. To test the validity of this “four-functional-zones” concept, I developed a topological procedure, surveying the spatial relationships of the various cell masses in the brainstem in a single figure. Brainstems of 16 different anamniote species were analyzed, and revealed that the brainstems are clearly divisible into four morphological zones, which correspond largely with the functional zones of Johnston and Herrick. Exceptions include (1) the magnocellular vestibular nucleus situated in the viscerosensory zone; (2) the basal plate containing a number of evidently non-motor centers (superior and inferior olives). Nevertheless the “functional zonal model” has explanatory value. Thus, it is possible to interpret certain brain specializations related to particular behavioral profiles, as “local hypertrophies” of one or two functional columns. Recent developmental molecular studies on brains of birds and mammals confirmed the presence of longitudinal zones, and also showed molecularly defined transverse bands or neuromeres throughout development. The intersecting boundaries of the longitudinal zones and the transverse bands appeared to delimit radially arranged histogenetic domains. Because neuromeres have been observed in embryonic and larval stages of numerous anamniote species, it may be hypothesized that the brainstems of all vertebrates share a basic organizational plan, in which intersecting longitudinal and transverse zones form fundamental histogenetic and genoarchitectonic units. PMID:21738499

  19. The effect of Le Fort I maxillary impaction on nasal airway resistance.

    PubMed

    Guenthner, T A; Sather, A H; Kern, E B

    1984-04-01

    To evaluate the effect of maxillary superior movement via Le Fort I osteotomy on nasal airway resistance, eleven Caucasian patients whose surgical orthodontic treatment included Le Fort I impaction (range 2 to 8 mm, mean 5.3 mm) were selected. Nasal airway resistance in these patients was determined a few days before and approximately 8 weeks after the Le Fort I surgical procedure. Nasal airway resistance was determined by means of a uninasal active mask rhinomanometric technique. Contrary to the predicted negative effects of maxillary superior movement on nasal airway function, there was a statistically significant improvement in nasal airway resistance (P less than 0.01) after maxillary superior movement. This rather unexpected finding can be explained by examining the effect of maxillary superior movement on the nasal valve area in the anterior nose. The nasal valve area is a teardrop-shaped area bordered by the nasal septum, the caudal end of the upper lateral nasal cartilage, the floor of the nose, and the soft fibrofatty tissue on the lateral aspect of the nose. The apex of the teardrop-shaped area (the angle between the nasal septum and the upper lateral cartilage) is called the nasal valve. In the Caucasian type of nose, the nasal valve accounts for most of the inspiratory resistance to airflow. Maxillary superior movement increases the alar width. It is proposed that this increase in alar width is transmitted at least partially to the nasal valve angle, causing it to widen slightly, paradoxically reducing nasal airway resistance while reducing skeletal intranasal dimensions.

  20. Biomechanical characterisation of the human nasal cartilages; implications for tissue engineering.

    PubMed

    Griffin, M F; Premakumar, Y; Seifalian, A M; Szarko, M; Butler, P E M

    2016-01-01

    Nasal reconstruction is currently performed using autologous grafts provides but is limited by donor site morbidity, tissue availability and potentially graft failure. Additionally, current alternative alloplastic materials are limited by their high extrusion and infection rates. Matching mechanical properties of synthetic materials to the native tissue they are replacing has shown to be important in the biocompatibility of implants. To date the mechanical properties of the human nasal cartilages has not been studied in depth to be able to create tissue-engineered replacements with similar mechanical properties to native tissue. The young's modulus was characterized in compression on fresh-frozen human cadaveric septal, alar, and lateral cartilage. Due to the functional differences experienced by the various aspects of the septal cartilage, 16 regions were evaluated with an average elastic modulus of 2.72 ± 0.63 MPa. Furthermore, the posterior septum was found to be significantly stiffer than the anterior septum (p < 0.01). The medial and lateral alar cartilages were tested at four points with an elastic modulus ranging from 2.09 ± 0.81 MPa, with no significant difference between the cartilages (p < 0.78). The lateral cartilage was tested once in all cadavers with an average elastic modulus of 0.98 ± 0.29 MPa. In conclusion, this study provides new information on the compressive mechanical properties of the human nasal cartilage, allowing surgeons to have a better understanding of the difference between the mechanical properties of the individual nasal cartilages. This study has provided a reference, by which tissue-engineered should be developed for effective cartilage replacements for nasal reconstruction.

  1. Airborne Observations of Urban-Derived Water Vapor and Potential Impacts on Chemistry and Clouds

    NASA Astrophysics Data System (ADS)

    Salmon, O. E.; Shepson, P. B.; Grundman, R. M., II; Stirm, B. H.; Ren, X.; Dickerson, R. R.; Fuentes, J. D.

    2015-12-01

    Atmospheric conditions typical of wintertime, such as lower boundary layer heights and reduced turbulent mixing, provide a unique environment for anthropogenic pollutants to accumulate and react. Wintertime enhancements in water vapor (H2O) have been observed in urban areas, and are thought to result from fossil fuel combustion and urban heat island-induced evaporation. The contribution of urban-derived water vapor to the atmosphere has the potential to locally influence atmospheric chemistry and weather for the urban area and surrounding region due to interactions between H2O and other chemical species, aerosols, and clouds. Airborne observations of urban-derived H2O, carbon dioxide (CO2), methane, nitrogen dioxide (NO2), ozone, and aerosols were conducted from Purdue University's Airborne Laboratory for Atmospheric Research (ALAR) and the University of Maryland's (UMD) Twin Cessna research aircraft during the winter of 2015. Measurements were conducted as part of the collaborative airborne campaign, Wintertime INvestigation of Transport, Emissions, and Reactivity (WINTER), which investigated seasonal trends in anthropogenic emissions and reactivity in the Northeastern United States. ALAR and the UMD aircraft participated in mass balance experiments around Washington D.C.-Baltimore to determine total city emission rates of H2O and other greenhouse gases. Average enhancements in H2O mixing ratio of 0.048%, and up to 0.13%, were observed downwind of the urban centers on ten research flights. In some cases, downwind H2O concentrations clearly track CO2 and NO2 enhancements, suggesting a strong combustion signal. Analysis of Purdue and UMD data collected during the WINTER campaign shows an average urban-derived H2O contribution of 5.3%, and as much as 13%, to the local boundary layer from ten research flights flown in February and March of 2015. In this paper, we discuss the potential chemical and physical implications of these results.

  2. The conserved barH-like homeobox-2 gene barhl2 acts downstream of orthodentricle-2 and together with iroquois-3 in establishment of the caudal forebrain signaling center induced by Sonic Hedgehog.

    PubMed

    Juraver-Geslin, Hugo A; Gómez-Skarmeta, José Luis; Durand, Béatrice C

    2014-12-01

    In this study, we investigated the gene regulatory network that governs formation of the Zona limitans intrathalamica (ZLI), a signaling center that secretes Sonic Hedgehog (Shh) to control the growth and regionalization of the caudal forebrain. Using loss- and gain-of-function, explants and grafting experiments in amphibians, we demonstrate that barhl2 acts downstream of otx2 and together with the iroquois (irx)-3 gene in establishment of the ZLI compartment initiated by Shh influence. We find that the presumptive (pre)-ZLI domain expresses barhl2, otx2 and irx3, whereas the thalamus territory caudally bordering the pre-ZLI expresses barhl2, otx2 and irx1/2 and early on irx3. We demonstrate that Barhl2 activity is required for determination of the ZLI and thalamus fates and that within the p2 alar plate the ratio of Irx3 to Irx1/2 contributes to ZLI specification and size determination. We show that when continuously exposed to Shh, neuroepithelial cells coexpressing barhl2, otx2 and irx3 acquire two characteristics of the ZLI compartment-the competence to express shh and the ability to segregate from anterior neural plate cells. In contrast, neuroepithelial cells expressing barhl2, otx2 and irx1/2, are not competent to express shh. Noteworthy in explants, under Shh influence, ZLI-like cells segregate from thalamic-like cells. Our study establishes that Barhl2 activity plays a key role in p2 alar plate patterning, specifically ZLI formation, and provides new insights on establishment of the signaling center of the caudal forebrain.

  3. When Aesthetics, Surgery, and Psychology Meet: Aesthetic Nasal Proportions in Patients Having Rhinoplasty and Normal Adults.

    PubMed

    Naraghi, Mohsen; Atari, Mohammad; Asadollahi, Hossein

    2016-03-01

    The aesthetic nasal proportions have played a significant role in rhinoplasty practice. On the other hand, psychological variables also play a crucial role in rhinoplasty. It is of paramount importance for facial plastic surgeons to consider both sides to achieve a more satisfactory outcome. The present study aimed to compare aesthetic nasal proportions between primary rhinoplasty candidates and a demographically matched control group to determine whether patients having rhinoplasty have different aesthetic nasal proportions compared with healthy adults who are not interested in rhinoplasty. Sixty patients having rhinoplasty were selected consecutively from a surgical clinic. A control group ( n  = 60) with the same demographic characteristics was selected. Photographs were taken using a digital camera on a fixed zoom setting. All images were captured at a distance of 1.5 m. Frontal and right lateral views were used to compare nasolabial angle, nasofrontal angle, nasofacial angle, alar width, intercanthal distance, nasal length, and width-to-length ratio. Independent t tests were used for comparisons. Independent t tests verified that nasofrontal angle, nasal length, and width-to-length ratio were significantly different between the two groups ( p  < 0.01). Effect sizes ranged between 0.11 and 0.69. Aesthetic proportions were not significantly different in four factors. Nasolabial angle, nasofacial angle, alar width, and intercanthal distance were not different ( p  > 0.05). Four major aesthetic nasal proportions were statistically similar in a group of patients having rhinoplasty and a control group with no interest in rhinoplasty. Surprisingly, the patients having rhinoplasty showed a mean width-to-length ratio closer to aesthetic ideal. Therefore, applying for rhinoplasty may have strong psychological reasons (e.g., body dysmorphic symptoms) compared with realistic aesthetic appraisals.

  4. When Aesthetics, Surgery, and Psychology Meet: Aesthetic Nasal Proportions in Patients Having Rhinoplasty and Normal Adults

    PubMed Central

    Naraghi, Mohsen; Atari, Mohammad; Asadollahi, Hossein

    2016-01-01

    The aesthetic nasal proportions have played a significant role in rhinoplasty practice. On the other hand, psychological variables also play a crucial role in rhinoplasty. It is of paramount importance for facial plastic surgeons to consider both sides to achieve a more satisfactory outcome. The present study aimed to compare aesthetic nasal proportions between primary rhinoplasty candidates and a demographically matched control group to determine whether patients having rhinoplasty have different aesthetic nasal proportions compared with healthy adults who are not interested in rhinoplasty. Sixty patients having rhinoplasty were selected consecutively from a surgical clinic. A control group ( n  = 60) with the same demographic characteristics was selected. Photographs were taken using a digital camera on a fixed zoom setting. All images were captured at a distance of 1.5 m. Frontal and right lateral views were used to compare nasolabial angle, nasofrontal angle, nasofacial angle, alar width, intercanthal distance, nasal length, and width-to-length ratio. Independent t tests were used for comparisons. Independent t tests verified that nasofrontal angle, nasal length, and width-to-length ratio were significantly different between the two groups ( p  < 0.01). Effect sizes ranged between 0.11 and 0.69. Aesthetic proportions were not significantly different in four factors. Nasolabial angle, nasofacial angle, alar width, and intercanthal distance were not different ( p  > 0.05). Four major aesthetic nasal proportions were statistically similar in a group of patients having rhinoplasty and a control group with no interest in rhinoplasty. Surprisingly, the patients having rhinoplasty showed a mean width-to-length ratio closer to aesthetic ideal. Therefore, applying for rhinoplasty may have strong psychological reasons (e.g., body dysmorphic symptoms) compared with realistic aesthetic appraisals. PMID:28824980

  5. Eppur Si Muove: Evidence for an External Granular Layer and Possibly Transit Amplification in the Teleostean Cerebellum

    PubMed Central

    Biechl, Daniela; Dorigo, Alessandro; Köster, Reinhard W.; Grothe, Benedikt; Wullimann, Mario F.

    2016-01-01

    The secreted signaling factor Sonic Hedgehog (Shh) acts in the floor plate of the developing vertebrate CNS to promote motoneuron development. In addition, shh has dorsal expression domains in the amniote alar plate (i.e., in isocortex, superior colliculus, and cerebellum). For example, shh expressing Purkinje cells act in transit amplification of external granular layer (EGL) cells of the developing cerebellum. Our previous studies had indicated the presence of an EGL in anamniote zebrafish, but a possible role of shh in the zebrafish cerebellar plate remained elusive. Therefore, we used an existing zebrafish transgenic line Tg(2.4shha-ABC-GFP)sb15; Shkumatava et al., 2004) to show this gene activity and its cellular localization in the larval zebrafish brain. Clearly, GFP expressing cells occur in larval alar zebrafish brain domains, i.e., optic tectum and cerebellum. Analysis of critical cerebellar cell markers on this transgenic background and a PH3 assay for mitotic cells reveals that Purkinje cells and eurydendroid cells are completely non-overlapping postmitotic cell populations. Furthermore, shh-GFP cells never express Zebrin II or parvalbumin, nor calretinin. They are thus neither Purkinje cells nor calretinin positive migrating rhombic lip derived cells. The shh-GFP cells also never correspond to PH3 positive cells of the ventral cerebellar proliferative zone or the upper rhombic lip-derived EGL. From this marker analysis and the location of shh-GFP cells sandwiched between calretinin positive rhombic lip derived cells and parvalbumin positive Purkinje cells, we conclude that shh-GFP expressing cells qualify as previously reported olig2 positive eurydendroid cells, which are homologous to the amniote deep cerebellar nuclei. We confirm this using double transgenic progeny of shh-GFP and olig2-dsRed zebrafish. Thus, these zebrafish eurydendroid cells may have the same role in transit amplification as Purkinje cells do in amniotes. PMID:27199681

  6. Fifteen-Year Follow-Up Results of Presurgical Orthopedics Followed by Primary Correction for Unilateral Cleft Lip Nose in Program SEHATI in Indonesia.

    PubMed

    Sulaiman, Farida Kamil; Haryanto, Inge Gustiningsih; Hak, Syafrudin; Nakamura, Norifumi; Sasaguri, Masaaki; Ohishi, Masamichi

    2013-03-01

    Objective : To assess long-term effects of nasal correction in infancy on nasal form and growth in patients with unilateral cleft lip, alveolus, and palate (UCLP). Design : Retrospective longitudinal study. Patients : Seventeen patients with complete UCLP treated in Program SEHATI in Harapan Kita Children and Maternity Hospital, Indonesia, and followed for approximately 15 years were enrolled. Interventions : Subjects received presurgical orthopedics using a Hotz's plate and simultaneous primary lip and nose repair in which the lower lateral cartilage was repositioned through a reverse-U incision. Main Outcome Measures : Preoperative and postoperative nasal forms, including the nostril height and width ratio, the ratio of the height of the top of the alar groove, and the ratio of nostril surface areas were analyzed using color photos taken serially. One-way analysis of variance was used for statistical analyses. Results : The nostril height and width ratio and the height of the alar groove were significantly improved postoperatively and maintained for 15 years. The mean ratio of nostril surface areas was 1.01 ± 0.12 fifteen years postoperatively, and there was no significant difference from the ratio 1 year postoperatively. The major persistent deformities were septal deviation and a small skin web on the nostril rim. Conclusions : Our primary cleft lip nose correction has provided an acceptable nose form and absence of disturbance of the nasal growth in patients with UCLP. However, the repositioning of the nasal cartilage at infancy might not eliminate the need for secondary correction after puberty.

  7. Presurgical nasoalveolar moulding in unilateral cleft lip and palate.

    PubMed

    Zuhaib, Mohammed; Bonanthaya, Krishnamurthy; Parmar, Renu; Shetty, Pritham N; Sharma, Pradeep

    2016-01-01

    Presurgical nasoalveolar moulding (PNAM) is a non-surgical method of reshaping the cleft lip, alveolus, palate and the nose to minimize the severity of the cleft deformity, before primary cheiloplastyand palatoplasty. In this context, PNAM proves to be an invaluable asset in the management of unilateral cleft lip and palate. The study was conducted to evaluate the efficacy of PNAM in the management of unilateral cleft lip and palate with the following objectives: (1) To assess and compare the degree of reduction in the size of cleft palate and alveolus (pre-PNAM and post-PNAM). (2) To evaluate and compare the improvement in columellar length and correction of columellar deviation (pre-PNAM and post-PNAM). (3) To assess the changes in the position of the alar base and the alar cartilages. Prospective study. A prospective study consisting of, which included 20 patients with complete unilateral cleft lip and palate was conducted. The age at the start of PNAM treatment of the infants ranged from 2 to 44 days of age reporting to our institute between December 2011 and August 2013. All the patients underwent PNAM therapy before primary cheiloplasty at 6 months of age; clinical parameters were assessed pre- and post-therapy using photographs and dental study models of the maxilla. Student's t-test for paired comparisons. Results of the study showed a promising reduction in the cleft size before the surgery, significant improvement in nasal symmetry, including the columellar length on the cleft side. PNAM is a valuable adjunct to our surgical armamentarium in dealing with the challenges of primary closure of unilateral cleft lip and palate thereby enhancing the overall surgical outcome. The advantages of this method include the simplicity of the procedure and improving the quality of surgical repair, particularly in obtaining tension free muscle closure in unilateral clefts.

  8. Cognitive deficits and ALA-D-inhibition in children exposed to multiple metals.

    PubMed

    do Nascimento, Sabrina N; Barth, Anelise; Göethel, Gabriela; Baierle, Marília; Charão, Mariele F; Brucker, Natália; Moro, Angela M; Bubols, Guilherme B; Sobreira, Johanna S; Sauer, Elisa; Rocha, Rafael; Gioda, Adriana; Dias, Ana Cristina; Salles, Jerusa F; Garcia, Solange C

    2015-01-01

    Children are especially vulnerable to adverse effects of multiple metals exposure. The aim of this study was to assess some metals concentrations such as lead (Pb), arsenic (As), chromium (Cr), manganese (Mn) and iron (Fe) in whole blood, serum, hair and drinking water samples using inductively coupled plasma-mass spectrometry (ICP-MS) in rural and urban children. In addition, evaluate the adverse effects of multiple metals exposure on cognitive function and δ-aminolevulinate dehydratase (ALA-D) activity. The cognitive ability assessment was performed by the Raven's Colored Progressive Matrices (RCPM) test. The ALA-D activity and ALA-D reactivation index (ALA-RE) activity with DTT and ZnCl2 also were determined. Forty-six rural children and 23 urban children were enrolled in this study. Rural children showed percentile IQ scores in the RCPM test significantly decreased in relation to urban children. According to multiple linear regression analysis, the Mn and Fe in hair may account for the cognitive deficits of children. Manganese and Fe in hair also were positively correlated with Mn and Fe in drinking water, respectively. These results suggest that drinking water is possibly a source of metals exposure in children. ALA-D activity was decreased and ALA-RE with DTT and ZnCl2 was increased in rural children in comparison to urban children. Moreover, ALA-D inhibition was correlated with Cr blood levels and ALA-RE/DDT and ALA-RE/ZnCl2 were correlated with levels of Cr and Hg in blood. Thus, our results indicated some adverse effects of children's exposure to multiple metals, such as cognitive deficits and ALA-D inhibition, mainly associated to Mn, Fe, Cr and Hg. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. The Occupancy of the Components in the Cervical Spine and Their Changes with Extension and Flexion.

    PubMed

    Sayıt, Emrah; Aghdasi, Bayan; Daubs, Michael D; Wang, Jeffrey C

    2015-10-01

    Study Design Retrospective case series. Objectives The kinematics of the cervical spine has been investigated by many researchers. However, the occupancy of the disk bulges, spinal cord, ligamentum flavum, and the rest of the canal as well as the changes of these structures with motion have not yet been investigated. The goal of this study is to investigate these dynamic changes. Methods The kinetic magnetic resonance images of 248 patients (124 men and 124 women) were evaluated, and the occupancy of each structure for each cervical level at neutral, flexion, and extension were calculated. Results Whole canal anteroposterior (AP) diameters showed significant differences between neutral-extension and flexion-extension at the C4-C5 and C5-C6 levels (p < 0.05). The mean disk bulges showed significant differences between neutral-flexion and flexion-extension at the C4-C5, C5-C6, C6-C7, and C7-T1 levels (p < 0.01). The mean spinal canal AP diameter showed significant differences between flexion-extension and neutral-extension at the C3-C4, C4-C5, C5-C6, and C6-C7 levels (p < 0.05). There were significant differences between neutral-flexion at the C4-C5, C5-C6, and C6-C7 levels (p < 0.05). The mean thickness of the ligamentum flavum showed significant differences between flexion-extension at the C3-C4, C4-C5, C5-C6, and C6-C7 levels (p < 0.001). There were significant differences between neutral-extension at the C3-C4 and C5-C6 levels (p < 0.05). There were significant differences between neutral-flexion at the C5-C6 and C6-C7 levels (p < 0.05). The mean thickness of the spinal cord showed significant differences between neutral-flexion at the C2-C3 and C3-C4 levels (p < 0.05). There were significant differences between flexion-extension at the C3-C4 and C4-C5 levels (p < 0.01). The rest of the canal showed significant differences between neutral-extension and flexion-extension at the C3-C4, C4-C5, C5-C6, and C6-C7 levels (p

  10. Multiple Myeloma-Like Spinal MRI Findings in Skeletal Fluorosis: An Unusual Presentation of Fluoride Toxicity in Human

    PubMed Central

    Quadri, Javed Ahsan; Alam, Mohd Meraj; Sarwar, Saba; Ghanai, Ashraf; Shariff, A.; Das, Taposh K.

    2016-01-01

    Endemic fluorosis is a worldwide environmental problem due to excessive fluoride, commonly due to increased drinking water fluoride levels but sometimes due to other sources such as food with high fluoride content. In India, 21 of the 35 states are known to have health problems associated with fluoride toxicity. The present report is a case of a 50-year-old female who was seen with progressive spinal complications and a MRI of the spine suggestive of multiple myeloma. The MRI of the lumbosacral spine showed a diffuse and heterogeneous marrow signal of the lower dorsal and lumbosacral vertebrae. The MRI was also suggestive of coarse trabeculation and appeared predominantly hypointense on the T1W image and had mixed signal intensity on the T2W image. These findings were suggestive of neoplastic bone marrow infiltration and the presence of a proliferative disorder, with multiple myeloma being the most likely. During the patient workup, it was found that other family members were also having similar complications and, after investigation of these family members, it was found that they are suffering from systemic fluorosis. The patient was then evaluated for skeletal fluorosis, and this condition was found to be present. Multiple myeloma was ruled out by the finding of a negative serum protein electrophoresis. The spinal complications appeared to be mainly due to the compression of the spinal cord and nerve roots by protruding osteophytes, thickening of the posterior longitudinal ligament, and thickening of the ligamentum flavum resulting in a compressive myeloradiculopathy and compressive myelopathy. The finding of multiple myeloma-like findings on the spinal MRI in association with skeletal fluorosis was considered to be a very rare event. This case report underlines the need to consider the presence of spinal skeletal fluorosis when evaluating spinal complications with unusual pseudo-multiple myeloma-like changes on the spinal MRI. PMID:27917370

  11. Comparison of mechanoreceptor quantities in hip joints of developmental dysplasia of the hip patients with normal hips.

    PubMed

    Desteli, Engin Eren; Gülman, Ali Birol; Imren, Yunus; Kaymaz, Figen

    2014-01-01

    Joint mechanoreceptors are afferent neural elements involved in pain sensation and tactile sense. We aimed to detect the free nerve endings (FNE) and other types of mechanoreceptors and to compare their quantities in human hip joint capsule (HJC) and ligamentum capitis femoris (LCF) of babies with developmantal dysplasia of hip (DDH) and intrauterine ex foetuses (control group) to find out whether there is an increase in the amount of mechanoreceptors in hip joint due to the occured anatomical chages. We took 15 LCF and HJC biopsies from 15 patients undergoing hip surgery for DDH, and 15 HJC and LCFs from intrauterine ex fetuses. Total of 60 specimens were investigated. The mean age of the babies was 10.3 months (6-18 months) at the time of surgery. Full thickness 1 × 1 cm HJC and LCF portions were taken as biopsy specimens. An immunohistochemical technique was performed for neurogenic protein S-100 and examined under light microscopy. FNEs were detected in all four different tissues (type IVa). Other types of mechanoreceptors (Type I-II and III) were not detected in any of the specimens. The positive rates of FNE staining in the control group were % 2.60 ± 1.24 for the LCF and % 2.67 ± 1.11 for the HJC respectively and FNE staining in the DDH group were found to be % 2.67 ± 1.11 for the LCF and % 2.73 ± 1.16 for the HJC. We did not find a statistically significant difference in number of FNEs between the specimens of the DDH group and the control group (p>0.05), also there was no statistically significant difference in number of FNEs between the HJC and LCF within each group (p>0.05). Our results suggest that the number of FNEs does not increase in HJC and LCF of DDH patients even though LCF hypertrophy and capsular elongation occurs.

  12. Influence of Magnetic Resonance Imaging Features on Surgical Decision-Making in Degenerative Cervical Myelopathy: Results from a Global Survey of AOSpine International Members.

    PubMed

    Nouri, Aria; Martin, Allan R; Nater, Anick; Witiw, Christopher D; Kato, So; Tetreault, Lindsay; Reihani-Kermani, Hamed; Santaguida, Carlo; Fehlings, Michael G

    2017-09-01

    We conducted a survey to understand how specific pathologic features on magnetic resonance imaging (MRI) influence surgeons toward an anterior or posterior surgical approach in degenerative cervical myelopathy (DCM). A questionnaire was sent out to 6179 AOSpine International members via e-mail. This included 18 questions on a 7-point Likert scale regarding how MRI features influence the respondent's decision to perform an anterior or posterior surgical approach. Influence was classified based on the mean and mode. Variations in responses were assessed by region and training. Of 513 respondents, 51.7% were orthopedic surgeons, 36.8% were neurosurgeons, and the remainder were fellows, residents, or other. In ascending order, multilevel bulging disks, cervical kyphosis, and a high degree of anterior cord compression had a moderate to strong influence toward an anterior approach. A high degree of posterior cord compression had a moderate to strong influence, whereas multilevel compression, ossification of the posterior longitudinal ligament, ligamentum flavum enlargement, and congenital stenosis had a moderate influence toward a posterior approach. Neurosurgeons chose anterior approaches more and posterior approaches less in comparison with orthopedic surgeons (P < 0.01). Of note, 59.8% of respondents were equally comfortable performing multilevel (3 or more levels) anterior and posterior procedures, whereas 61.5% did not feel comfortable in determining the surgical approach based on MRI alone. Specific DCM pathology influences the choice for anterior or posterior surgical approach. These data highlight factors based on surgeon experience, training, and region of practice. They will be helpful in defining future areas of investigation in an effort to provide individualized surgical strategies and optimize patient outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. A segmental partial laminectomy for cervical spondylotic myelopathy: anatomical basis and clinical outcome in comparison with expansive open-door laminoplasty.

    PubMed

    Otani, Koji; Sato, Katsuhiko; Yabuki, Shoji; Iwabuchi, Masumi; Kikuchi, Shinichi

    2009-02-01

    A comparative study regarding the clinical outcome of the 2-different surgical procedures for patients with cervical spondylotic myelopathy (CSM). To describe the anatomic basis of a segmental partial laminectomy (SPL) for the treatment of cervical spondylotic myelopathy and to compare the clinical outcome with traditional C3 to C7 expansive open-door laminoplasty (ELAP). Laminoplasty has been widely accepted for the treatment of CSM. However, some disadvantages have also been recognized. To resolve these problems, a SPL was performed. No previous studies have been reported regarding this surgical procedure. A total of 13 human cadavers were studied to analyze the spinal cord compression of cervical spondylosis. Twenty-six patients who underwent a SPL and 13 age- and gender-matched patients who underwent traditional C3-C7 ELAP were analyzed for their Japanese Orthopedic Association score, axial neck pain, and radiographic parameters (lordotic angle and ROM of cervical spine). Based on cadaver studies, compression of the spinal cord was present in the articular segment, but not in the intraosseous segment. The removal of the ligamentum flavum and the superior edge of the lower lamina was sufficient for minimum posterior decompression of the cervical spinal cord.In comparison with the ELAP, the patients who underwent an SPL showed a similar recovery of the Japanese Orthopedic Association score, but the maintenance of the sagittal alignment and the range of motion were better after the SPL and postoperative neck and/or shoulder complaints also seemed to be reduced. A SPL, may therefore, be a useful and effective surgical procedure for cervical spondylotic myelopathy.

  14. Articular soft tissue anatomy of the archosaur hip joint: Structural homology and functional implications.

    PubMed

    Tsai, Henry P; Holliday, Casey M

    2015-06-01

    Archosaurs evolved a wide diversity of locomotor postures, body sizes, and hip joint morphologies. The two extant archosaurs clades (birds and crocodylians) possess highly divergent hip joint morphologies, and the homologies and functions of their articular soft tissues, such as ligaments, cartilage, and tendons, are poorly understood. Reconstructing joint anatomy and function of extinct vertebrates is critical to understanding their posture, locomotor behavior, ecology, and evolution. However, the lack of soft tissues in fossil taxa makes accurate inferences of joint function difficult. Here, we describe the soft tissue anatomies and their osteological correlates in the hip joint of archosaurs and their sauropsid outgroups, and infer structural homology across the extant taxa. A comparative sample of 35 species of birds, crocodylians, lepidosaurs, and turtles ranging from hatchling to skeletally mature adult were studied using dissection, imaging, and histology. Birds and crocodylians possess topologically and histologically consistent articular soft tissues in their hip joints. Epiphyseal cartilages, fibrocartilages, and ligaments leave consistent osteological correlates. The archosaur acetabulum possesses distinct labrum and antitrochanter structures on the supraacetabulum. The ligamentum capitis femoris consists of distinct pubic- and ischial attachments, and is homologous with the ventral capsular ligament of lepidosaurs. The proximal femur has a hyaline cartilage core attached to the metaphysis via a fibrocartilaginous sleeve. This study provides new insight into soft tissue structures and their osteological correlates (e.g., the antitrochanter, the fovea capitis, and the metaphyseal collar) in the archosaur hip joint. The topological arrangement of fibro- and hyaline cartilage may provide mechanical support for the chondroepiphysis. The osteological correlates identified here will inform systematic and functional analyses of archosaur hindlimb evolution and

  15. Factors Affecting the Nonlinear Force Versus Distraction Height Curves in an In Vitro C5-C6 Anterior Cervical Distraction Model.

    PubMed

    Wen, Junxiang; Xu, Jianwei; Li, Lijun; Yang, Mingjie; Pan, Jie; Chen, Deyu; Jia, Lianshun; Tan, Jun

    2017-06-01

    In vitro biomechanical study of cervical intervertebral distraction. To investigate the forces required for distraction to different heights in an in vitro C5-C6 anterior cervical distraction model, focusing on the influence of the intervertebral disk, posterior longitudinal ligament (PLL), and ligamentum flavum (LF). No previous studies have reported on the forces required for distraction to various heights or the factors resisting distraction in anterior cervical discectomy and fusion. Anterior cervical distraction at C5-C6 was performed in 6 cadaveric specimens using a biomechanical testing machine, under 4 conditions: A, before disk removal; B, after disk removal; C, after disk and PLL removal; and D, after disk and PLL removal and cutting of the LF. Distraction was performed from 0 to 10 mm at a constant velocity (5 mm/min). Force and distraction height were recorded automatically. The force required increased with distraction height under all 4 conditions. There was a sudden increase in force required at 6-7 mm under conditions B and C, but not D. Under condition A, distraction to 5 mm required a force of 268.3±38.87 N. Under conditions B and C, distraction to 6 mm required <15 N, and further distraction required dramatically increased force, with distraction to 10 mm requiring 115.4±10.67 and 68.4±9.67 N, respectively. Under condition D, no marked increase in force was recorded. Distraction of the intervertebral space was much easier after disk removal. An intact LF caused a sudden marked increase in the force required for distraction, possibly indicating the point at which the LF was fully stretched. This increase in resistance may help to determine the optimal distraction height to avoid stress to the endplate spacer.</