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BACKGROUND: Performing rhinoplasty in patients with craniofacial malformations remains a challenge, even for experienced surgeons. Advances in 3D technology and its application in surgical planning and printing of cutting guides and splints have become important tools to improve aesthetic and functional results. OBJECTIVES: To describe an in-house workflow for surgical planning and printing of cutting guides and splints for complex rhinoplasty cases. METHODS: This article describes an in-house workflow for complex rhinoplasty, as used in the maxillofacial department of a children's hospital specialized in the treatment of cleft and craniofacial malformations. RESULTS: Customized surgical guides help the surgeon to harvest and mold potential septal and costochondral grafts more accurately, to reduce surgical time and to verify the dimensions of the sculpted nasal shape following surgical planning templates. Patient satisfaction degree according to Rhinoplasty Outcome Evaluation questionnaire was 18/24. CONCLUSIONS: The presented workflow represents a potential asset in obtaining more accurate and satisfactory results in complex rhinoplasties.
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Myofascial herniations of the lower limb are a rare cause of chronic nerve compression and pain. They may have congenital or traumatic origin, and the tibialis anterior muscle is the most frequent localization. A few cases will require operative management. An unusual case of symptomatic, acquired hernia of the vastus lateralis muscle in a young male basketball player is reported. After drainage of a compressive hematoma, the patient developed chronic pain and myositis of the vastus lateralis by friction against the edge of tensor fascia lata muscle. Secondary surgical reconstruction involved a polypropylene mesh repair 4 years after the initial trauma. This procedure has been described in a very small number of patients after iatrogenic lesions in total hip arthroplasty and on anterolateral thigh perforator flap donor site. Instead of denial and stoicism, this simple intervention could be proposed to patients as a therapeutic option.
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OBJECTIVE: Visualization tools are essential for effective medical education, to aid students understanding of complex anatomical systems. Three dimensional (3D) printed models are showing a wide-reaching potential in the field of medical education, to aid the interpretation of 2D imaging. This study investigates the use of 3D-printed models in educational seminars on cleft lip and palate, by comparing integrated "hands-on" student seminars, with 2D presentation seminar methods. SETTING: Cleft lip and palate models were manufactured using 3D-printing technology at the medical school. PARTICIPANTS: Sixty-seven students from two medical schools participated in the study. DESIGN: The students were randomly allocated to 2 groups. Knowledge was compared between the groups using a multiple-choice question test before and after the teaching intervention. Group 1 was the control group with a PowerPoint presentation-based educational seminar and group 2 was the test group, with the same PowerPoint presentation, but with the addition of a physical demonstration using 3D-printed models of unilateral and bilateral cleft lips and palate. RESULTS: The level of knowledge gained was established using a preseminar and postseminar assessment, in 2 different institutions, where the addition of the 3D-printed model resulted in a significant improvement in the mean percentage of knowledge gained (44.65% test group; 32.16%; control group; p = 0.038). Student experience was assessed using a postseminar survey, where students felt the 3D-printed model significantly improved the learning experience (p = 0.005) and their visualization (p = 0.001). CONCLUSIONS: This study highlights the benefits of the use of 3D-printed models as visualization tools in medical education and the potential of 3D-printing technology to become a standard and effective tool in the interpretation of 2D imaging.
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Labio Leporino/cirugía , Fisura del Paladar/cirugía , Simulación por Computador , Procedimientos de Cirugía Plástica/educación , Impresión Tridimensional , Entrenamiento Simulado/métodos , Competencia Clínica , Educación de Pregrado en Medicina/métodos , Humanos , Kuwait , Modelos Anatómicos , Estudiantes de MedicinaRESUMEN
Supplemental Digital Content is available in the text.
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The upper limit of intra-abdominal pressure after closure of gastroschisis has been suggested around 20 mm Hg. An acute abdominal compartmental syndrome may produce intestinal ischemia with perforation and hepatic or renal failure. We present a case of a baby born with gastroschisis and ileal atresias 2 decades ago. The closure of the defect entailed a borderline abdominal compartmental syndrome with caval occlusion and development of collateral venous circulation. This was evidenced by a phlebographic study at the age of 8. At the age of 19, the patient continued to show a superficial, varicose net and some aesthetic concerns. This minor condition seems not previously reported. The authors intend to raise awareness about current methods for indirect assessment of intra-abdominal pressure when performing abdominal reconstruction for a gastroschisis defect.
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Air-powered guns can cause serious trauma to body structures. We describe a 10-year-old boy who suffered injuries to his gluteal and thenar regions as a result of a single gunshot. Surgical management included cleansing of the gluteal region, as well as an external fixation device and a fasciosubcutaneous flap based on a perforator branch of the distal radial artery. To the best of our knowledge, this case illustrates the youngest patient to benefit from this kind of perforator flap. We also underline the long-term risk of lead toxicity for this kind of injury.
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Fijación de Fractura , Fracturas Conminutas/cirugía , Traumatismos de la Mano/cirugía , Huesos del Metacarpo/lesiones , Colgajo Perforante/trasplante , Procedimientos de Cirugía Plástica/métodos , Heridas por Arma de Fuego/cirugía , Nalgas , Niño , Humanos , Masculino , Huesos del Metacarpo/cirugía , Arteria RadialRESUMEN
UNLABELLED: The authors report the observation of a 43-year-old woman with severe pain on her right upper abdominal quadrant. Differential diagnoses included acute cholecystitis, spontaneous pneumothorax, perforated appendicitis and a recidive of renal calculus. CT-scan showed a huge subdermal gas bubble along her right flank and anterior abdominal wall up to the submammary fold. Only at this point, the patient admitted to have undergone a carboxytherapy procedure on both thighs one day before onset of pain in a paramedical facility. As some of the injection trajects were still patent on CT-scan, she received prophylactic antibiotic coverage. Though there was a complete resorption of gas after 10 days, dysesthesias and muscle contracture persisted for 3 weeks. To the authors' knowledge this migration and coalescence of injected gas in a single bubble has not been previously reported. LEVEL OF EVIDENCE V: 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 http://www.springer.com/00266 .
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Dióxido de Carbono/efectos adversos , Mesoterapia/efectos adversos , Enfisema Subcutáneo/etiología , Adulto , Femenino , Humanos , Índice de Severidad de la EnfermedadRESUMEN
Traumatic hemipelvectomy through the sacroiliac joint is a devastating injury, mainly because of motor vehicle accidents. Recent improvements in prehospital trauma care have increased the chances of survival for victims. Besides amputation of the lower limb, associated complications usually involve digestive and urological systems. We report on 2 pediatric patients from 2 different European countries. PATIENT 1: A 9-year-old boy suffered uprooting of his left lower limb, laceration of the rectum and anal sphincter, as well as an injury to distal urethra with partial loss of cavernous bodies. Initial management included a colostomy and an essay of contention by means of a polypropylene prosthesis that had to be removed in the following months. After several attempts at urethral reconstruction, he underwent a Mitrofanoff derivation. PATIENT 2: An 18-month-old girl lost her left lower limb and suffered severe lacerations of bladder and rectum. Among other measures, management included a colostomy, a skin graft, and 2 attempts at reconstruction of her bladder neck, including a modified Casale procedure (cecum and ileocecal appendix were in a high position that made a Mitrofanoff derivation impossible) and a Malone procedure. To the authors' knowledge, she would be the youngest reported survivor of this kind of injury.
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Amputación Traumática/cirugía , Traumatismo Múltiple , Pelvis/lesiones , Pene/lesiones , Articulación Sacroiliaca/lesiones , Uretra/lesiones , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Accidentes de Tránsito , Amputación Traumática/diagnóstico , Niño , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Prótesis de Pene , Procedimientos de Cirugía Plástica/métodos , Índices de Gravedad del TraumaRESUMEN
A male infant showed a humeral diaphysis fracture at 5 months of age and a distal tibial physis fracture at 2 years of age. A specialized consultant ruled out child abuse. This child had the characteristic features of type I osteogenesis imperfecta: blue sclerae, osseous fragility, and presumably autosomal dominant inheritance, as his father suffered from similar disorders. Later on, multiple painful osteochondromas were also found and some of these were surgically treated. The child's mother showed several peripheral osteochondromas. We describe the follow-up of this patient up to the age of 18 years. To our knowledge, the fortuitous association of these two inherited conditions has not been reported in medical literature.
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Exostosis Múltiple Hereditaria/patología , Osteogénesis Imperfecta/patología , Niño , Preescolar , Exostosis Múltiple Hereditaria/complicaciones , Exostosis Múltiple Hereditaria/genética , Exostosis Múltiple Hereditaria/cirugía , Salud de la Familia , Femenino , Estudios de Seguimiento , Genes Dominantes , Humanos , Fracturas del Húmero/etiología , Fracturas del Húmero/patología , Lactante , Masculino , Osteogénesis Imperfecta/complicaciones , Osteogénesis Imperfecta/genética , Osteogénesis Imperfecta/cirugía , Linaje , Radiografía , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/etiología , Fracturas de la Tibia/patología , Resultado del TratamientoRESUMEN
INTRODUCTION: Oxidant herbicide nitrofen (2,4-dichloro-4'-nitrodiphenyl ether) induces in rat embryos congenital diaphragmatic hernia (CDH) with lung hypoplasia. The present study aims at examining whether antioxidant vitamins A, E, and C reverse the effects of the teratogen in the lungs of exposed rats and how they modify the expression of molecular regulators known to be involved in their pathogenesis. MATERIALS AND METHODS: Wet lung weight-body weight ratio, total DNA, and total protein were determined. Thyroid transcription factor 1 (TTF-1), hepatocyte nuclear factor 3beta (HNF-3beta), and surfactant protein B (SP-B) proteins were measured by immunoblot assay in lung homogenates from rat fetuses exposed in utero to either nitrofen 100 mg intragastrically or vehicle. The coexpression of these factors in the alveolar epithelium was demonstrated by immunohistochemistry. The effects of the addition of vitamins A, C, and E were assessed by comparison with analysis of variance. RESULTS: Nitrofen decreased lung weight, total DNA, and total protein. The addition of antioxidant vitamins had no effect on lung weight, but increased DNA and protein contents. TTF-1, HNF-3beta, and SP-B proteins were decreased in lung homogenates of exposed rats with CDH. The addition of antioxidant vitamins nearly normalized these values. CONCLUSIONS: The effects of nitrofen in fetal rat lungs are reversed in part by antioxidant vitamins by upregulating the expression of TTF-1, HNF-3beta, and SP-B. This approach could help to develop transplacental prenatal interventions for CDH.
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Antioxidantes/farmacología , Herbicidas/efectos adversos , Enfermedades Pulmonares/prevención & control , Pulmón/efectos de los fármacos , Éteres Fenílicos/efectos adversos , Vitaminas/farmacología , Animales , Ácido Ascórbico/farmacología , Femenino , Factor Nuclear 3-beta del Hepatocito/biosíntesis , Hernia Diafragmática/complicaciones , Pulmón/anomalías , Pulmón/cirugía , Enfermedades Pulmonares/inducido químicamente , Enfermedades Pulmonares/patología , Proteínas Nucleares/biosíntesis , Tamaño de los Órganos/efectos de los fármacos , Fragmentos de Péptidos/biosíntesis , Embarazo , Proteolípidos/biosíntesis , Ratas , Ratas Sprague-Dawley , Anomalías del Sistema Respiratorio , Factor Nuclear Tiroideo 1 , Factores de Transcripción/biosíntesis , Regulación hacia Arriba , Vitamina A/farmacología , Vitamina E/farmacologíaRESUMEN
BACKGROUND/AIM: Nitrofen (2,4-dichloro-4 -nitrodiphenyl ether), a teratogen with oxidant properties, induces congenital diaphragmatic hernia (CDH) with lung hypoplasia and delayed lung development and maturation in rat embryos. Several phenotypic features of the alveolar epithelium including surfactant proteins A and B synthesis and its regulation by transcription factors are reproduced in cultured human H441 pneumocytes. The aim of the present study was to test whether vitamins A, E and C with anti-oxidant properties were able to recover the expression of such regulators in an in vitro setting. MATERIALS AND METHODS: Cultured human H441 pneumocytes were treated with nitrofen with or without additional exposure to vitamins A, E and C. Thyroid transcription factor 1 (TTF-1), hepatocyte nuclear factor 3-beta (HNF-3beta) and hepatocyte nuclear factor 3-beta surfactant protein B (SP-B) mRNAs were measured by real-time polymerase chain reaction (RT-PCR). The cells were also immunohistochemically stained for assessment of proliferation (PCNA) and apoptosis (bis-benzimide) status and SP-B and TTF-1 protein expressions. Results were compared by ANOVA with a significant threshold of 5%. RESULTS: Nitrofen severely decreased TTF-1, HNF-3beta and SP-B mRNA expression by H441 pneumocytes in culture. Addition of vitamin E normalized the levels of the three transcripts, while vitamin A normalized only those of TTF-1 and SP-B mRNA. Vitamin C was significantly beneficial only for SP-B transcript. Nitrofen decreased proliferation and TTF-1 and SP-B protein expressions with no apparent effect on apoptosis. Additional exposure to vitamins A, C or E rescued near normal values. CONCLUSIONS: The changes induced by nitrofen in cultured H441 human pneumocytes are reverted in part by anti-oxidant vitamins by upregulating TTF-1, HNF-3beta and SP-B and stimulating proliferation and maturity in nitrofen-treated cells. These effects of anti-oxidant vitamins could be of some interest for developing new transplacental therapeutic strategies aimed at improving lung development and maturation in fetuses with CDH.
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Ácido Ascórbico/farmacología , Pulmón/fisiología , Éteres Fenílicos/farmacología , Vitamina A/farmacología , Vitamina E/farmacología , Células Cultivadas , Cartilla de ADN , Proteínas de Unión al ADN/genética , Factor Nuclear 3-beta del Hepatocito/genética , Humanos , Pulmón/citología , Pulmón/efectos de los fármacos , Reacción en Cadena de la Polimerasa , Proteína B Asociada a Surfactante Pulmonar/genética , Factores de TranscripciónRESUMEN
BACKGROUND/AIMS: Rats with nitrofen-induced congenital diaphragmatic hernia (CDH) have hypoplasia and malformations of the heart. The mechanism of action of nitrofen involves changes in neural crest signaling. Pax3 function is required for cardiac neural crest cells to complete their migration to the developing heart. Vitamin A improves heart hypoplasia. The aims of this study were to examine whether Pax3 expression is decreased in the heart of E13 E15 and E21 rats exposed to nitrofen and if vitamin A reverts this effect. MATERIAL AND METHODS: Pregnant rats received either 100 mg nitrofen or olive oil on E9.5. Each group was divided into 2 subgroups according to the subsequent treatment with intragastric vitamin A (15000 IU) or vehicle on E10.5 to E11.5. The pups were recovered on E13, E15 and E21 and the hearts were dissected out. Pax3 mRNA expression was determined by quantitative real time PCR. Comparisons among groups were made with ANOVA and Bonferroni post hoc tests with a threshold of significance of P < .05. RESULTS: Pax3 mRNA expression was significantly decreased on E13 and E15 in the hearts of nitrofen-treated embryos and it remained decreased although not significantly on E21. Vitamin A recovered this expression on E13, partially on E15 and above normal levels on E21. CONCLUSIONS: Pax3 is underexpressed in the hearts of nitrofen exposed embryonal rats on days 13th and 15th of gestation and tends to be lower than normal near term. Vitamin A up-regulates this expression on the 3 end points. The mechanism of action of Pax3 should be further investigated because it could be one of the targets for future prenatal transplacental intervention.
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Hernia Diafragmática/metabolismo , Miocardio/metabolismo , Factores de Transcripción Paired Box/biosíntesis , Vitamina A/farmacología , Animales , Animales Recién Nacidos , Factor de Transcripción PAX3 , Éteres Fenílicos/farmacología , Ratas , Ratas Sprague-DawleyRESUMEN
Rats with experimental congenital diaphragmatic hernia (CDH) have heart hypoplasia and conotruncal and great vessel malformations that are likely related to disturbed neural crest developmental control. Neural crest cells communicate through intercellular gap junctions whose main protein is Connexin 43 (Cx43). The migration and participation of neural crest cells in heart development is likely influenced by this protein which might be also directly involved in myocardial development. Vitamin A is beneficial for heart hypoplasia in CDH rats. The aims of this study were to examine the status of Cx43 in the heart of embryonal rats exposed to nitrofen and to assess if vitamin A reverts these effects. Pregnant rats received either 100 mg nitrofen or olive oil on E9.5. Each group was divided into two subgroups according to the subsequent treatment with intragastric vitamin A (15,000 i.u.) or vehicle on E10.5 and E11.5. The pups were recovered on E13, E15, and E21 and the hearts were dissected out and pooled. Cx43 mRNA expression was determined by quantitative real-time PCR. Comparisons among groups were made with ANOVA and Bonferroni post hoc tests with a threshold of significance of P<0.05. In control rats Cx43 mRNA was minimally expressed on E13 and E15 and fully expressed on E21. Nitrofen significantly increased Cx43 mRNA on E15. Additional treatment with vitamin A tended to moderate this increase on E15. Cx43 was overexpressed in the hearts of nitrofen-exposed embryonal rats on day E15 of gestation. Vitamin A tended to normalize this expression. The mechanism of action of Cx43 deserves further investigation.
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Anomalías Múltiples/embriología , Conexina 43/metabolismo , Cardiopatías Congénitas/embriología , Hernia Diafragmática/embriología , Hernias Diafragmáticas Congénitas , Vitamina A/farmacología , Análisis de Varianza , Animales , Conexina 43/efectos de los fármacos , Modelos Animales de Enfermedad , Femenino , Corazón/embriología , Cresta Neural/embriología , Cresta Neural/metabolismo , Éteres Fenílicos , Embarazo , Distribución Aleatoria , Ratas , Ratas Sprague-Dawley , Transducción de SeñalRESUMEN
Reports of neuroectodermal primary scrotal tumors are scarce. Primary paratesticular neuroblastomas seem even rarer, and only five infants with this condition have been previously described. To the authors' knowledge, this would be the first report of a neonatal congenital paratesticular neuroblastoma. However, the authors postulate that ischemic compressive features in testis could lead to misdiagnosis as testicular torsion and the condition could usually go undetected. A newborn male baby with a left scrotal tumefaction was referred to the authors in May 2003. Doppler ultrasonography findings were inconclusive, and a diagnosis of intrauterine torsion of the testis was suspected. Surgery showed a paratesticular mass with a small attachment to an intra-abdominal epiploon. Pathologic examination clearly established the diagnosis of neuroblastoma. Cytogenetic findings (no amplification of N-myc oncogene, aneuploidy, and no deletion of chromosome 1p) were favorable. As the tumor was classified as International Neuroblastoma Staging System stage I, no additional chemotherapy was administered. All markers showed a progressive decrease, and herniorrhaphy and orchidopexy of the contralateral side were performed at 4 months of age. The patient was tumor-free at 11 months follow-up.
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Reports of neuroectodermal primary scrotal tumors are scarce. Primary paratesticular neuroblastomas seem even rarer, and only five infants with this condition have been previously described. To the authors' knowledge, this would be the first report of a neonatal congenital paratesticular neuroblastoma. However, the authors postulate that ischemic compressive features in testis could lead to misdiagnosis as testicular torsion and the condition could usually go undetected. A newborn male baby with a left scrotal tumefaction was referred to the authors in May 2003. Doppler ultrasonography findings were inconclusive, and a diagnosis of intrauterine torsion of the testis was suspected. Surgery showed a paratesticular mass with a small attachment to an intra-abdominal epiploon. Pathologic examination clearly established the diagnosis of neuroblastoma. Cytogenetic findings (no amplification of N-myc oncogene, aneuploidy, and no deletion of chromosome 1p) were favorable. As the tumor was classified as International Neuroblastoma Staging System stage I, no additional chemotherapy was administered. All markers showed a progressive decrease, and herniorrhaphy and orchidopexy of the contralateral side were performed at 4 months of age. The patient was tumor-free at 11 months follow-up.