Eduardo Cotecchia Ribeiro

Craniofacial Asymmetry in Development: An Anatomical Study

The purpose of this study was to evaluate the occurrence of craniofacial asymmetries in four areas of human skulls of various age groups to test the hypothesis that there is craniofacial symmetry before the chewing habit is established. The data were obtained from 95 skulls of fetuses, infants, children, and adults, from the collection of Federal University of São Paulo. The following measurements were taken on each skull with a digital caliper: from the infraorbital foramen to the anterior nasal spine (IOF); from the greater palatine foramen to the posterior nasal spine (GPF); from the spinous foramen to the basion (SF); and from the spinous foramen to the zygomatic arch (ZA). On different occasions, each measurement was taken three times on both sides of the skull in random order. The mean of the right-side measurements were subtracted from the mean of the left-side measurements, and the differences were transformed into percentages. Comparisons were made by analysis of variance. The presence of cranial asymmetry was statistically significant throughout the whole sample. The minimum value found was 2.8% and the maximum 6.5%. All age groups presented the same degree of asymmetry of distances IOF, GPF, and SF. The group of infants presented a higher degree of asymmetry on distance ZA, followed by the groups of fetuses, children, and adults. This study confirmed statistically significant craniofacial asymmetry in fetuses and infants (before dentition). Therefore, the hypothesis that craniofacial asymmetry only appears after establishment of the chewing habit was not supported.

Pubovaginal sling with a low-cost polypropylene mesh

OBJECTIVE The aim of this study was to present the results of pubovaginal sling with a low-cost polypropylene mesh in the treatment of stress urinary incontinence. MATERIALS AND METHODS 118 women diagnosed with stress urinary incontinence (SUI) due to urethral hypermobility or intrinsic sphincteric deficiency, treated with pubovaginal sling (PVS) with a low-cost polypropylene mesh confectioned by the surgeon, were analyzed. All patients had a basic evaluation that included a medical history, physical examination, stress tests and urodynamic investigation. RESULTS The average follow up was of 42 months. Urethral hypermobility was observed in 67% of the cases. The process was carried out on an outpatient basis on 67 patients. Intra-operative complications included 4 vesical injuries, treated with catheterization for 3 days. There were 13 early complications, of which 8 were urinary retentions treated with vesical drainage for 1 to 3 weeks and 3 vaginal extrusions of the mesh treated with covering of the sections with mucous membrane. There was a need for 6 urethrolysis in patients who presented irritative and postoperative obstructive symptoms; 81.3% of the patients were considered cured, while 9.3% had significant improvement. Three initially unsuccessful cases required sling reconfiguration. All cases were eventually cured. CONCLUSION The construction of a pubovaginal sling using a low-cost polypropylene mesh is a safe and effective technique for the relief of SUI. It should be considered an alternative, especially for patients in public health systems with low financial resources.

Biometric Study of the Optic Canal during Cranial Development

To study optic canal dimensions and symmetry during cranial development, 146 silicon rubber left- and right-side models of the optic canal were cast from 51 dry skulls and 22 individual bones. The sample was divided in three age groups: fetuses (including newborns), children and adults with ages ranging from seven months of fetal life to 68-year-old. A digital caliper was used to measure the optic canal orbital and cranial diameters as well as model length. Results for the right and the left sides were, respectively, in millimeters: a) Maximum diameter of the orbital opening: fetuses, 4.68/4.47—children, 5.51/5.41—adults, 5.43/5.34; b) Minimum diameter of the orbital opening: fetuses, 2.89/2.84—children, 3.54/3.61—adults, 3.78/3.73; c) Diameter of the cranial opening: fetuses, 3.79/3.76—children, 4.67/4.72—adults, 5.24/5.43; d) Length of the optic canal: fetuses, 3.27/3.05—children, 3.93/3.71—adults 4.94/5.21. The diameter of the cranial opening of the optic canal increases significantly (p < 0.001) during the fetal period and throughout child and adulthood. The greater and smaller orbital apertures increase during the fetal period and during childhood, keeping the same size in adulthood. Optic canal length increases at some point between childhood and adulthood. Concerning symmetry, the only significant difference found was greater right than left optic canal diameter on the orbital side.

Assessment of stage T1 (TNM 1997) for renal cell carcinoma: is recommended the subdivision in T1a and T1b?

INTRODUCTION Classification TNM 1997 defines renal cell carcinoma smaller than 7 cm and confined to the kidney as stage T1. Our goal is to discuss if tumors smaller than 4 cm have the same behavior characteristics then tumors between 4 and 7 cm, to compose the same stage of the disease. MATERIALS AND METHODS Retrospective assessment of 138 patients in stage T1 (TNM - 97), divided into 2 groups; group-1: composed of 65 patients (47%) with tumors < 4 cm, and group-2: composed of 73 patients (53%) with tumors between 4 and 7 cm. The following prognostic factors were assessed in the recurrence of the disease and survival of patients: nuclear degree, microvascular invasion, sarcomatous degeneration, and involved lymph nodes. Statistical evaluation has been accomplished through the log rank test, chi-square test, and Fishers exact text. RESULTS Average tumor size was 2.5 cm for group-1, and 5.3 cm for group-2. In group-2, there was the predominance of worse prognostic factors, with high-grade tumors (p = 0.01) and presence of microvascular invasion (p = 0.001). Sarcomatous tumors and involvement of lymph nodes did only happen in group-2. Disease-free survival for group-1, analyzed in the median period of 36 months, was 100%, and for group 2, in the median period of 31 months, was 81% (p = 0.008). CONCLUSION The results obtained allow the conclusion that the present stage T1 for renal cell carcinoma gathers tumors of different evolution, being therefore recommendable the stratification in T1a for tumors smaller than 4 cm, and T1b for tumors between 4 and 7 cm.

Shape and Symmetry of Human Condyle and Mandibular Fossa

El objetivo del estudio fue determinar y clasificar la forma de la fosa mandibular y condilo correspondiente en diferentes tipos, relacionandolos con el sexo y la simetria en craneos humanos adultos en perspectivas laterales, posteriores y superiores. La muestra incluyo 50 craneos humanos de 32 hombres y 18 mujeres entre 23 a 82 anos. Fueron fotografiados el condilo y moldes de silicona de la fosa para evaluar la forma en los tres puntos. Se clasificaron las formas, validadas por el analisis intra e inter-evaluador, la frecuencia, distribucion por sexo y simetria verificada. Las formas fueron clasificadas como redondeada, en angulo, aplanada y mixtas en las vistas lateral y posterior; y como biconvexa, convexo-plana, y mixta en la vista superior. En las vistas laterales el condilo y la fosa redondeada fueron mas frecuentes (57% y 66%, respectivamente), mientras que en la vista posterior (53% y 83%). En la vista superior, la forma mixta presento mayor frecuencia en el condilo (59%), mientras que en la fosa la forma biconvexa (46%) fue mas comun. No hubo diferencia significativa en la distribucion de laforma por sexo. La misma forma (simetrica o no-simetrica) en el condilo lateral derecho e izquierdo y la fosa fueron evaluadas por separado, y se observaron varias combinaciones.

Frequency and Location of Referred Pain in Patients with Temporomandibular Disorder

Basado en la encuesta de registros relativos a la ubicacion y frecuencia de dolor referido en pacientes con trastorno temporomandibular al palpar ciertas areas preestablecidas, propusimos una division topografica anatomica de cabeza y cuello para permitir la estandarizacion y reproducibilidad de los lugares de dolor referido. Al examinar los graficos de 835 sujetos, 419 un (50,2%) de los pacientes reportaron dolor referido a la palpacion de las regiones sobre la base de los Criterios Diagnosticos para la Investigacion de Trastornos Temporomandibulares (CDI/TTM) y palpacion de la region cervical, con analisis de frecuencia con prueba de Cochran Q. El coeficiente de concordancia de Kendall examino la correlacion entre las regiones de dolor referido en relacion a los sitios palpados. Las regiones nuevas fueron definidas como, pre-auricular, facial lateral, temporoparietal, cabeza posterior, posterior y lateral cervical, cervical anterior y boveda craneal. La region de palpado en la cual se origino el dolor mencionado con mayor frecuencia, corresponde al musculo masetero, seguido por la region del musculo esternocleidomastoideo, independientemente del lado palpado. Durante la palpacion de las regiones establecidas por los CDI/TTM, la zona mas frecuente de dolor referido fue la region facial lateral. A la palpacion del cuello, el dolor referido se reporto en la parte posterior y en las regiones cervicales laterales. Los sitios en los que se origino el mayor dolor referido a la palpacion, fueron los musculos maseteros, musculos temporales, esternocleidomastoideo y trapecio.