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The number of congenital malformations in the world is increasing every year. One of the first places occupies by the congenital malformation of the urinary system. The incidence of kidney and ureter duplication is 1:125–150 of live+birth newborns, more often in girls, and in 20–40% of cases is bilateral. It can be complete (ureter duplex) and incomplete (ureter fissus). It has often asymptomatical course and is diagnosed accidentally or only after the manifestation of various complications. A clinical case of successful laparoscopic heminephrureterectomy in a girl with a congenital malformation of the urinary system is described, namely the right kidney complete duplication with ectopic ureteric orifice in the external genital organs and permanent urinary incontinence. The child recovered after minimally invasive radical surgery., Количество врожденных пороков развития в мире ежегодно увеличивается. Одно из первых мест занимают пороки развития мочевыделительной системы. Удвоение почек и мочеточников встречается с частотой 1 случай на 125–150 новорожденных, чаще у девочек, и у 20–40% случаев является двусторонним. Бывает полным (ureter duplex) и неполным (ureter fissus). Часто протекает бессимптомно и диагностируется случайно или только после появления различных осложнений. Описан клинический случай успешной лапароскопической геминефруретеректомии у девочки с врожденным пороком развития мочевыделительной системы: полным удвоением правой почки с эктопией устья мочеточника в наружные половые органы и постоянным недержанием мочи. После миниинвазивного радикального оперативного вмешательства ребенок выздоровел., Кількість природжених вад розвитку у світі щороку збільшується. Одне з перших місць посідають вади розвитку сечовидільної системи. Подвоєння нирок і сечоводів зустрічається з частотою 1 випадок на 125–150 новонароджених, частіше у дівчат, і у 20–40% випадків є двобічним. Буває повним (ureter duplex) і неповним (ureter fissus). Часто перебігає безсимптомно і діагностується випадково або лише після появи різноманітних ускладнень. Описано клінічний випадок успішної лапароскопічної гемінефруретеректомії в дівчинки з природженою вадою розвитку сечовидільної системи: повним подвоєнням правої нирки з ектопією устя сечоводу в зовнішні статеві органи та постійним нетриманням сечі. Після мініінвазивного радикального оперативного втручання дитина одужала.

To assess the upper body segment (US), lower body segment (LS) and US:LS ratio for children from birth to 18 y of age and to compare these data with other US:LS ratio norms from previously reported studies. A cross-sectional, observational study was conducted in children [birth to 18 y; n = 5454 children (3158 boys)] residing in Pune city, Western India, from December 2015 through June 2017, to evaluate the US, LS and the US:LS ratio. The mean US:LS ratio in boys at birth was 1.45; at one year of age it was 1.35 that decreased to 0.89 at 14 y. The nadir for the US:LS ratio in boys was reached at 14 y of age (0.89). In girls, the mean US:LS ratio at birth was 1.44, at one year of age it was 1.35 that decreased to 0.89 at 12 y. The nadir for the US:LS ratio in girls was reached at 12 y of age (0.89). From 12 to 18 y the US:LS ratio was fairly constant (for girls: 0.89, for boys: 0.9). On plotting the US and LS against the age in present study population, the US and LS curves crossed each other (US:LS = 1) at 7 to 8 y in boys and at 6 to 7 y in girls. The authors describe data for upper and lower body segments and their ratio in boys and girls from birth to 18 y in children from western Maharashtra. These data may help in the diagnosis of disproportionate short stature in children.

We have developed a method for entering Japanese hiragana characters using a 1-in. circular screen. The circumference of the smartwatch screen is divided every 90°. Hiragana is divided into 10 groups of 5 characters each, so the first half of the group is assigned to the left segment and the second half is assigned to the upper segment.

A 7-year-old male child has been crushed by a train causing the disconnect of the right calf, hospitalized 4 h after the injury, and the child was comatose with severe hemorrhagic shock. The right calf was disconnected 6 cm below the tibial plateau, and the stump was severely crushed (Fig. 25.1). The distal end combined with the middle and upper segment of about 10 cm bone and skin muscle composite tissue defected. The area below the ankle joint was relatively intact, and there was no skin covering above the ankle joint.

Abutment pressure distribution is the decisive factor affecting the stability of coal pillars, which has an important significance in realizing safe and efficient mining. In recent years, many working faces adopting double-roadway arrangement have appeared in the western mining areas in China, which makes coal pillar abutment pressure complex under repeated mining. In order to reveal the distribution pattern of coal pillar abutment pressure under repeated mining, the evolution of a stress field of surrounding rock was analyzed by a numerical method based on the actual situation of a double-roadway arranged mining roadway in Longde Coal Mine, and the distribution characteristics of coal pillar abutment pressure were revealed. The reasonable width of the section coal pillar was given further. The research results showed that (1) the surrounding rock stress is transferred to the working face coal body and section coal pillar between roadways under the influence of mining advance the working face, while the stress is transferred to the section coal pillar between roadways under the mining influence behind the working face. The presence of goaf in the upper segment makes the stress distribution of surrounding rock more complicated. (2) The distribution of coal pillar abutment pressure shows a staged change. The influence of mining advance the working face on the peak abutment pressure is notable, which highlights the significance of temporary reinforcement support in the advanced section of the working face. (3) After the mining of the upper working face is finished, the yield damage width of the coal pillar on the side of the goaf was about 4.0 m. During the second mining period, the yield damage width of the coal pillar was totally about 7.0 m. (4) Taking into account factors such as safe production and economic rationality, it was finally determined that the reasonable section coal pillar width is 12.5 m for this mine.

Retrocaval ureter, which also called circumcaval ureter, is a rare abnormal development where the vena cava compresses the upper segment of ureter leading to different grades of hydronephrosis. We reported a case of a 50-year-old man has a retrocaval ureter with a stone in the loop behind the vena cava. Surgical correction with extraction of the stone was done successfully. On follow up, there was no hydronephrosis. In conclusion synchronized retrocaval ureter with a stone in the ureter is considered a surgical challenge to the urologist and it needs careful investigations to make the diagnosis.

The duplication of the urinary tract is a developmental anomaly of the urinary system, which is represented in 0.8% of the population. In most cases, the duplication is incomplete and clinically insignificant. However, in the case of complete duplication, there is possible both an association with such pathologies as ureterocele, vesicoureteral reflux (VUR), urinary incontinence, ureterohydronephrosis and relation to recurrent urinary tract infections. Depending on the identified pathology it is possible to perform surgical interventions. These are organ-displacing operations (heminephroureterectomy) and reconstructive surgery - ureterocystoplasty of the one ureter or both ureters “as a single unit”, as well as the formation of interureteral anastomoses. Currently, there is the possibility to perform both open and endoscopic surgeries. We present a case report of endoscopic minimal invasive reconstructive intervention, performed to patient with ureterohydronephrosis ectopied in the vagina of the urethra of the duplicated left kidney and complaints of urinary incontinence.

Bagheri, Hassan/0000-0002-6126-9543, WOS: 000498042800020, PubMed: 31660021, The upper segment of sacrum is an important for screw insertions of unstable lumbosacral spine. Measurements of the S1-S2 as sacral wings, pedicles, sacral foraminas and sacral canal were taken from 87 sacrums. the mean depths of S1 pedicle and sacral wing were estimated as 25.8 +/- 2.3 mm and 50.1 +/- 1.7 mm, respectively. Angles screw trajectory of sacral pedicle anteromedial and sacral wing were measured as 29.6 +/- 0.9 degrees and 29.7 +/- 2.1 degrees, respectively. To avoid injury to the vascular structures anteriorly and nerve roots medially, depth and angle of screw trajectory is important for the entrance off pedicular screw placement to the S1.

Knowledge of the pyelocaliceal system anatomy is essential for the safe and successful performance of endourologic procedures. The purpose of this study was to provide a better understanding of the full three-dimensional pyelocaliceal system anatomy. Morphometric parameters of the three-dimensional reconstructions of computed tomography intravenous urography scans (n = 25 scans) were analyzed. Both kidneys were divided into three equal-sized segments (US: upper segment, MS: mid segment, LS: lower segment). Infundibular length (IL), infundibular width (IW), the number of calyces, and the transverse orientation in hours of a clock of each calyx as well as the dimension of the pyelum were determined. The mean upper IL (n = 92) was longer than the middle (n = 154) and lower IL (n = 112) (30.6 ± 7.9 mm vs. 16.4 ± 7.7 mm vs. 16.0 ± 6.0 mm, respectively; P =

Objective: To explore the therapeutic outcome and significance of preoperative percutaneous nephrolithotomy (PCNL) via the central venous catheter in combination with two-step hard ureteroscopic lithotripsy for the treatment of ureteral stones in the middle-upper segment. Methods: The success rate and the occurrence of severe infection and perirenal hematoma were analyzed retrospectively in 37 patients who received preoperative PCNL via the central venous catheter in combination with two-step hard ureteroscopic lithotripsy for the treatment of ureteral stones in the middle-upper segment in our hospital between July 2012 and November 2014. Results: The operation duration was 12–38 min with a mean of 18.5 min. The procedure was performed successfully in all patients without the postoperative occurrence of perirenal hematoma in any patient. No severe infection occurred in any patient according to the Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis (2012). Conclusion: Preoperative PCNL via the central venous catheter can significantly improve the success rate of ureteroscopic lithotripsy for the treatment of ureteral stones in the middle-upper segment, and reduce postoperative occurrences of severe infection and perirenal hematoma.

Background The diagnosis of paraduodenal hernia is still a challenge in clinical practice due to lacking of specific symptoms. Case presentation: An 83-yr-old male patient presented to our department due to severe abdominal pain for 8 h. Abdominal contrast enhanced computerized tomography (CT) scan indicated intussusception in the duodenum and the upper segment of jejunum, as well as internal hernia. He complaint of progression in the abdominal pain, and then laparoscope was carried out, which indicated left-sided paraduodenal hernia. Subsequently, the patient was transferred to celiotomy, during which slight ischemic changes were noticed in the intestinal canal. Meanwhile, a hernial orifice was noticed in the left orifice of the duodenum. Conclusions: In this case, we presented our experiences on the diagnosis of paraduodenal hernia and intussusception. Our study contributed to the understanding, early diagnosis and selection of surgical options for the surgeons.

Background Owing to its unique advantages, 2-level artificial cervical disc replacement (ACDR) is gaining attention. Among artificial discs designed for use in ACDR, the Food and Drug Administration–approved Prestige-LP Cervical Disc is widely used. There are no standard implantation sequences for 2-level ACDR using the Prestige-LP disc, and complications resulting from inappropriate implantation sequences remain unknown. Case Description A 45-year-old woman underwent continuous 2-level ACDR using the Prestige-LP disc and experienced anterior migration of a previously inserted artificial disc after secondary disc implantation at an upper segment owing to an inappropriate implantation sequence during surgery. Intraoperative radiographs showed stable index levels and artificial discs. We tapped the migrated disc back into its correct position and recommended a postoperative functional exercise plan to the patient. We followed the patient for 8 years to verify the safety of our solution. We developed an implantation strategy for 2-level ACDR to avoid this complication in the future. Conclusions During 2-level ACDR, a top-down sequence should be used to implant prostheses. When anterior disc migration occurs, intraoperative radiographs should be obtained to ensure stability of the index levels. If there is no instability, the migrated tab can be tapped back into its correct position. In addition, limiting motion rather than allowing intermittent movement of the neck for at least 3 months is important to promote union between bone and prosthesis.

Based on a companion publication that introduces the theoretical foundations, this paper describes the implemented architecture for formation control of the upper segment vehicles of the MORPH project. We highlight the necessary modifications and additional elements, mainly in terms of control and estimation, to allow for the implementation in real vehicles. We illustrate the performance of the system with results from sea trials in Lisbon and in the Azores, with a number of heterogeneous vehicles from multiple partners involved in the project.

The medial temporal lobe plays a central role in memory processing and is more than just the hippocampus.[1][1] The hippocampal formation, which forms the upper segment of the medial temporal lobe, is a heterogeneous structure consisting of the Ammon horn or Cornus Ammonis (Cornus Ammonis area 1 to

Variations in sacral segmentation may preclude safe placement of transsacral screws for posterior pelvis fixation. We developed a novel automated 3D technique to determine the safe zone size for transsacral screws in the upper two sacral segments in 526 adult pelvis computed tomography scans. Safe zone sizes were then compared by gender and sacral segmentation variations (number of neuroforamen and the presence/absence of lumbosacral transitional vertebrae, ± LSTV). Ten millimeters was used as the safety threshold for a large screw. 3 (0.6%), 366 (70%), and 157 (30%) sacra had 3, 4, or 5 neuroforamen, respectively. Eighty-eight (17%) were +LSTV. Safe zone size depended on gender, number of neuroforamen in -LSTV sacra and presence of LSTV (p < 0.001) but not on the uni- or bilateral nature of the LSTV. 17% of -LSTV sacra were below the safety threshold in S1, 27% in S2, whereas 3% of +LSTV sacra were below in S1, 74% in S2. Of -LSTV sacra that cannot take an S1 screw safely, 77% can do so in S2, leaving only 4% of sacra that cannot accommodate a screw safely in either upper segment. The results demonstrate a predictable pattern of safe zone size based on gender and sacral segmentation variations.

To calculate the gain in bony height and volume of the distracted upper segment using an extraosseous unidirectional device to improve the retention of the future prosthesis.Ten cases with completely or partially edentulous but severely or considerably resorbed anterior mandibles were managed by vertical alveolar distraction osteogenesis. All the patients were evaluated preoperatively, intraoperatively and post-operatively for various parameters clinically and radiographically i.e. on OPG, lateral cephalogram and on CT scan, at different time intervals. In all cases there was increase in vertical bone height.The study showed mean vertical bone gain (VBG) on OPG as 8.2 mm. The mean VBG on lateral cephalogram was 8.1 mm. The mean VBG on CT scan at right canine was 8.35 mm, at left canine was 8.2 mm and at midline was 8.27 mm.Alveolar distraction osteogenesis is a predictable method for restoring alveolar ridges prior to implant placement or prosthesis. Distraction osteogenesis is ideally suited for recreating missing tissue in the anterior esthetic zone by increasing vertical bone height as well as good width and soft tissue growth.

Studies by longitudinal sample to evaluate trends in stature, sitting height, leg length and body proportions together in Japanese children are scarce.Trends in stature, sitting height, leg length and LUR (lower segment and upper segment ratio) were evaluated with a graphical method (Body Proportion Chart).Longitudinal data for 520 boys and 306 girls who had 12 consecutive yearly measurements from 6.5-17.5 years of age were used.Estimated growth rates of leg length were greater than those of sitting height in pre-adolescence in both sexes. Leg length was slightly longer in girls than in boys for a short period early in adolescence, but sitting height in girls exceeded that in boys for a longer period. LUR attained peak values between 12.5-13.5 years in girls (LUR = 85.7) and between 13.5-14.5 years in boys (LUR = 89.2). After attaining maximum LUR, leg length was stable, although sitting height continued to increase slightly in both sexes.The results highlight the usefulness of the Body Proportion Chart method for identifying changes in body proportions during adolescence.

Aim: The determination of body proportions is an important part of the clinical evaluation of children with short stature. The upper segment/lower segment ratio (US/LS ratio) and armspan–height difference is commonly used for this purpose. However, reference data are scarce in this respect, and available standards do not include standard deviations for the measurements. We aimed to establish the normal values for upper segment/lower segment ratio and armspan–height difference in Turkish children. Methods: In the present study, height, upper and lower segment, and armspan were measured in 1302 healthy children (3–18 y). The age-related mean and standard deviation curves of the US/LS ratio and armspan–height difference were constructed for each sex. Results: The mean values of the US/LS ratio in boys were decreased from 1.108 at 3 y to 0.984 at 10 y. The nadir of the US/LS ratio (0.922) was reached at age 15 y. In girls, the mean value of the US/LS ratio gradually decreased to less than 1 at 9 y of age (1 y earlier than in boys). The nadir of the US/LS ratio (0.946) was reached at age 13 y in girls (2 y earlier than in boys). Armspan was shorter than height as expected in younger ages, but became slightly longer at around age 12 in girls and boys. Unlike boys, the armspan–height difference did not change much after puberty in girls. Conclusion: US/LS ratio and armspan–height difference are practical parameters and easy to perform in any setting. We hope that these standards will aid clinicians in the evaluation of children with short stature.

Surgery of the abdominal cavity may lead to postoperative defects to the ventricular segment of the abdominal wall. The reconstruction of these defects, especially in the area of the median line, represents an issue during the course of healing due to the role of the abdominal cavity in respiratory processes. Reconstructive surgical procedure was performed on an infected vast defect to the ventral segment of the abdominal wall in a 77-year-old woman by a modified “Mercedes closure pattern,” i.e., by combining three fasciocutaneous flaps: bipedicle flap of the upper segment of the abdominal wall and two sliding breast flaps. Application of a modified complex Mercedes closure pattern was successful and positively affected the redistribution of pressure forces at the places where the edges of the wound were in contact. The applied and described technique of closing the abdominal cavity decreased the possibility of infection to the prosthetic material, because direct contact between the sutures and the prosthetic no longer existed. 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 www.springer.com/00266 .

A grading into four classes of hypertrophied adenoid rhinopharyngeal obstructions in children on the basis of fiberendoscopic findings to outline an effective therapeutic program according to this classification.Ninety-eight children with chronic nasal obstruction and oral respiration were examined by anterior rhinoscopy, and fiberendoscopy. During the investigation, the fiberendoscopic images of the choanal openings were divided into four segments from the upper choanal border to the nasal floor. In view of clinical findings, 78 patients also underwent active anterior rhinomanometry.In eight patients (8.2%), the fiberendoscopic imaging revealed that the adenoid tissue occupied only the upper segment in the rhinopharyngeal cavity (25%). Therefore, choanal openings were free (first degree obstructions). In 20 patients (20.4%), the adenoid tissue was confined to the upper half (50%) of the rhinopharyngeal cavity (second degree obstructions) and in 63 patients (64.3%) the tissue extended over the rhinopharynx (75%) with obstruction of choanal openings and partial closure of tube ostium (third degree obstructions). Only in seven cases (7.14%), the obstruction was almost total. As a consequence, both the tube ostium and the lower choanal border could not be observed (fourth degree obstructions).In the first two classes of obstructions, characterized by moderate or discrete adenoid hypertrophy, adenoidectomy should not be performed. In these conditions, the causes of possible nasal obstructions are usually due to either dysmorphic, allergic or phlogistic pathologies. For the fourth degree adenoid obstructions, surgery is always recommended. The most important therapeutic problems occur in the third degree obstructions which include most patients who suffered from hypertrophied adenoids. Moreover, the therapeutic strategy can be conditioned not only by nasal respiratory difficulties but also by frequent concomitant complications such as otitis, sinusitis, sleep apnea, etc. These disorders may be caused by both nasal obstruction and/or phlogistic problems (adenoiditis).

X-P evaluation of the upper disc of segments fixed using pedicle screws (PS) was performed on 45 cases available for an over 4-year follow-up, and was compared with the data of cases fixed using anterior fusion (ASF). The overall results of the development of disc degeneration were identical with those of the ASF group, but several cases developed instability or spondylolisthesis, and their results were poor. Four cases underwent operation again, and the number of re-operations is expected to increase in the future. Careful evaluation of pre-operative conditions and considerations of the operation are necessary, and the indication of the PS operation must be selected.

Purpose The right atrium is preferred over the superior vena cava (SVC) for tunnelled dialysis catheter (TDC) tip placement as it offers the best compromise between optimal catheter performance and complications. However, clinical practice guidelines are not all unanimous on this as a universal recommendation. Right atrial tip placement may also fail due to variations in body surface area, venous anatomy or TDC designs and lengths. Moreover, the presence of recurrent long intra-cardiac fibrin sheath or cardiac rhythm management device leads serves as contraindications. Extra-cardiac tip placement in the azygous, hepatic veins and lower segment of the inferior vena cava (IVC) is an alternative but is invariably associated with poor blood flow and shortened patency. Methods We report the concept of extra-cardiac tip placement into the larger calibre hepatic segment IVC via a transjugular approach in two diabetic haemodialysis patients with overestimated TDC length out of 380 insertions. Results Blood flow was maintained above 250 ml/min for 5-6 months and no tip migration ensued. Conclusions The IVC upper segment is a reliable site for extra-cardiac tip placement in select cases but its safety and efficacy need to be further studied in larger clinical trials.

Background. Sickle cell disorders are known to have a negative effect on linear growth. This could potentially affect proportional growth and, hence, Cormic Index.Objective. To determine the Cormic Index in the sickle cell anaemia population in Lagos.Methodology. A consecutive sample of 100 children with haemoglobin genotype SS, aged eight months to 15 years, and 100 age and sex matched controls (haemoglobin genotype AA) was studied. Sitting height (upper segment) and full length or height were measured. Sitting height was then expressed as a percentage of full length/height (Cormic Index).Results. The mean Cormic Index decreased with age among primary subjects (SS) and AA controls. The overall mean Cormic Index among primary subjects was comparable to that of controls (55.0±4.6% versus54.5±5.2%;54.8±4.5% versus53.6±4.9%) in boys and girls, respectively. In comparison with AA controls, female children with sickle cell anaemia who were older than 10 years had a significantly lower mean Cormic Index.Conclusion. There was a significant negative relationship between Cormic Index and height in subjects and controls irrespective of gender. Similarly, a significant negative correlation existed between age, sitting height, subischial leg length, weight, and Cormic Index in both subjects and controls.

An MRI study was conducted to compare the vaginal configuration of women who had undergone sacrospinous fixation with transvaginal needle suspension or abdominal sacrocolpopexy with retropubic colposuspension with that of normal controls. MRI examination demonstrated that in normal controls the lower vagina formed an acute angle (mean 53 degrees) with the pubococcygeal line and intersected the upper vagina at a mean angle of 145 degrees. In the abdominal repair group the lower vagina intersected the pubococcygeal line at a mean angle of 57 degrees and joined the upper segment at a mean angle of 137 degrees. In the vaginal repair group the lower vagina intersected the pubococcygeal line at a mean angle of 54 degrees and joined the upper segment at a mean angle of 220 degrees. Our study demonstrated that abdominal sacrocolpopexy with retropubic colposuspension more closely restored the vagina to its normal configuration, whereas sacrospinous fixation with transvaginal needle suspension creates an abnormal vaginal axis.

An adequate supply of highly qualified workers is a central prerequisite for the ability of peripheral and economically lagging regions to develop. In order to take advantage of endogenous potential, bottlenecks in human knowledge and know-how must be overcome by means of support from outside. An important element in this is migration. Taking as an example the Weser-Ems region in northwestern Germany, the strategies used by local enterprises to motivate managerial staff to move from other regions are shown and the level of success achieved is described. As is shown, the regional labour market has lost significance for the upper segment in the course of structural changes in the economy, which has led to an increase in the necessity for cross-regional searches in order to fill managerial posts. As enterprises in peripheral locations have poor starting conditions in the cross-regional competition for highly qualified workers, this development demands that more and more enterprises mobilize considerable reso...

The needs of the dental treatment in the patients foroud a mutidiscipling work. It report a clinical case of one patient who exhibilidad a advanced periodontal disease, whith migration of the anterior upper teeth after the periodontal treatment (Motivation oral periodontal hygienic, root planning, periodontal autologos bore injerto it mode the orthodontic in the anterior upper tooth. Finally the patient recivea a bridge in the upper segment. Las necesidades de tratamiento odontológico en los pacientes plantea un trabajo multidisciplinario. Se reporta un caso clínico de una persona que presenta enfermedad periodontal avanzada, con secuelas de migración de piezas dentarias en el sector antero superior. Después del tratamiento periodontal (Motivación, raspaje, alisado radicular, cirugía periodontal, injerto óseo autólogo) se realizó el tratamiento ortodóntico en el sector antero superior. Finalmente se realizó el cambio de las coronas del segmento antero superior por unas coronas ferulizadas.

We studied radiological changes of adjacent upper segment in 24 cases after pedicular screw fixation of the lumbar spine. Of these, 14 were male and 10 were female, ranging in age from 21 to 63 years (mean; 46.4 years). The diseases were spondylolysis (2 cases), spondylolysis with spondylolisthesis (6 cases), degenerative spondylolisthesis (8 cases), instability of lumbar spine (2 cases), lumbar disc herniation with spondylolysis (4 cases) and lumbar disc herniation with instability of lumbar spine (2 cases). The follow-up period was 6 months to 3 years and 9 months (mean; 1 year and 9 months).Osteoarthritic changes of the facet were found in 16 cases and slipping of vertebral body were found in 2 cases. The angular displacement increased from 8.7 degrees to 10.4 degrees and the ratio of disk height to that of vertebral body decreased from 0.40 to 0.37.From these results, a relationship was noted between the increase of angular displacement and the follow-up period and between the increase of angular displacement and the decrease of the ratio of disk height to that of the vertebral body.

Reconstruction of the upper pole of the ear requires adequate evaluation and preoperative surgical planning because reconstructing a segment of an ear is extremely difficult. The segment of the superior part of the ear may be missing because of acquired or congenital deformities or skin cancer resection. Each patient presents with individual deformities that require a precise approach to achieve a good balance of the ear and facial contour. Surgical reparation may be performed in one or two surgical stages. To perform it in a single operation one must create chondrocutaneous advancement composite flaps or include a cartilage graft to support the helical cutaneous flap. However, sometimes two stages of operation are necessary. In such circumstances, it is essential to add a new auricular framework, sculpturing it by excavation of the rib cartilage. It is embedded through a subcutaneous tunnel undermined on the temporal region following the surgical planning. Therefore, the new segment of the missing part of the amputated ear is created by cartilage graft. During the second surgical stage the upper segment of the ear is lifted from the temporal area and a skin graft is performed on the posterior aspect of the new ear to cover the raw area.

To investigate the effect of recombinant hGH treatment on the growth rate and proportion of individuals with achondroplasia and hypochondroplasia, we studied 15 individuals with these common skeletal dysplasias. The study lasted 24 months and included 6 months of observation, 12 months of hGH therapy (0.04 mg/kg.day), and 6 months of posttreatment growth rate determination. In achondroplasia, the mean growth rate during the hGH treatment (5.3 +/- 1.6 cm) was significantly increased compared with that during the pretreatment (4.0 +/- 1.0 cm.yr, P < 0.01)) and posttreatment periods (3.1 +/- 1.3 cm; P < 0.001). In the 4 children with hypochondroplasia, the growth rate during hGH treatment was 7.0 +/- 2.4 cm/yr and 4.9 +/- 1.5 cm/yr during the pre- and posttreatment periods, respectively. In achondroplasia, there was a significant increase in growth rate of only the lower segment (from 1.1 +/- 1.6 cm/yr to 3 +/- 1.2 cm/yr, P < 0.02). There was no significant acceleration in the growth of the upper segment and of the scanogram measurements of the long bones. No untoward effects were noted. Recombinant hGH increases short-term growth velocity in children with achondroplasia/hypochondroplasia. Unexpectedly, this treatment does not seem to have a lesser effect on limbs than on trunk growth rate and, therefore, during 1 yr of treatment, does not increase body disproportion.

Background The purpose of this investigation was to determine if epidural analgesia, established during active phase labor, results in elimination or reversal of fundal dominance (lower uterine segment pressure equal to or greater than fundal pressure). Methods Upper and lower uterine segment intrauterine pressures were prospectively evaluated for 50 min before and 50 min after epidural analgesia using 0.25% bupivacaine in 11 nulliparous women in spontaneous active labor. A total of 958 contractions were evaluated. Results No significant differences were found in the number of contractions in the interval before epidural analgesia compared to after epidural analgesia. Significantly greater pressure readings were recorded in the upper segment than in the lower segment (consistent with fundal dominance) both before and after epidural analgesia (P Conclusions Fundal dominance is present both before and after active phase epidural analgesia and is increased during the immediate 50-min postanalgesia period.

Ossification of the fluid spaces of the cochlea occurs often in candidates for cochlear implantation, especially children. When noted before surgery on computerized tomography, ossification previously was thought to contraindicate cochlear implantation because of possible mechanical obstruction and uncertainty about the level of function that could be achieved by stimulating an ossified cochlea. However, during the preceding 6 years, techniques have been developed that permit implantation in ossified cochleas. We present a systematic approach that has been developed to treat the three clinically important categories of cochlear ossification: round window niche obliteration, inferior segment obstruction, and upper segment obstruction. Case reports are presented for each of these three drill-out procedures, demonstrating results often similar to those expected for implantation of the nonossified cochlea.

IntroductionPJK is a well-described post-operative complication associated with long instrumented fusion constructs. The surgical creation of a stiff upper segment along with patient osteoporosis h...

To detect the presence of differences in transverse dimensions in the female iliac blades in comparison to normal population groups. The present study measures the transverse dimensions of female iliac blades from cadavers and dried bone specimens from women in the age group 50–70 years and compares with similar measurements taken from adult male dried hip bones. Five transverse dimensions were recorded in each iliac bone at equidistant positions twice. Once, the dimensions were measured along the upper segment and then along the lower segment of the bone. Both segments corresponded approximately to the directions of placement of screws in the two bolt iliac foundation. Hemi-pelvises from cadavers were sectioned vertically at equidistant planes and the sections were directly measured for the thickness at the cut surfaces in the two segments along the probable route of screw placement. The lower segments were thicker and bulkier along the greater part of their length than the upper ones. The differences of dimensions between the two sides from the same individual and between the two groups were negligible and statistically insignificant. Thickness at the dorsal aspect of the hip-bone (ilium) in elderly females was comparable to male ones. Measurements along the path of screw placements for a two bolt pelvic foundation in elderly females were found to be comparable with dimensions observed in the other samples used in the study.

Anatomic lung segmentectomy is the procedure of choice in a growing number of patients, either because the lesion is small and/or because of poor lung function. The procedure requires a good knowledge of intrapulmonary anatomy. However, the experience for the different types of segmentectomy is not easy to obtain during thoracic surgical training due to the relatively small number of patients. Any help to better visualize and apprehend the anatomy pre- and intraoperatively is useful for training, teaching and for performing safer surgical procedures. This paper describes an anatomic segmentectomy procedure (upper segment of the left lower lobe) performed with the assistance of an iPad tablet used during the intervention to display and manipulate 3D images reconstructed prior to the surgery with the Open Source OsiriX software.

Stiffened Deep Cement Mixed (SDCM) pile technique has provided a new approach for treating soft. soil. The main focus of this paper is the bearing behavior and capacity prediction of single SDCM pile. Static load tests data of 67 piles collected from six different districts in China are analyzed in this paper. The bearing capacity, load-settlement curve and failure modes of SDCM piles are studied. According to the bearing mechanism of SDCM pile, a new approach to predict the capacity, Sectioning and Summarizing method, is proposed. To calculate the capacity, one SDCM pile should be divided into two segments: the upper segment with core pile and the lower segment without the core pile. The total shaft resistance of SDCM pile is the summation of the two segments. Finally the dominate factors influencing the pile resistance are analyzed. The study results show that the capacity of SDCM pile is mainly affected by the parameters of the core pile. The resistance provided by the pile shaft including core pile was 1.0∼2.9 times that of bored and cast-in-place concrete pile. The proposed Sectioning and Summarizing method can be used to estimate the capacity of the SDCM pile and get more logical result than the currently used methods.

This study investigates the feasibility of an alternative deepwater drilling riser concept. The riser consists of two segments: a short upper segment suspending from a MODU, and a long freestanding lower segment that can be disconnected from the upper segment. The entire drilling riser can thus be moved to a new drilling location with the riser upper segment directly moved with the MODU and the disconnected lower segment moved by an AHV or heavy duty tug using a heave compensated landing system. The behaviors of this dis-connectible riser are studied. Numerical results demonstrate the feasibility of the dis-connectible riser concept.Copyright © 2008 by ASME

This retrospective study evaluated clinical characteristics of patients with constitutional delay of growth and puberty (CDGP) at presentation, during puberty and at final height. The records of 151 children (105 boys, 46 girls) with CDGP were reviewed and the results were evaluated with respect to findings in healthy Turkish schoolchildren. CDGP was twice as frequent in boys as in girls. Height and weight deficit and short sitting height of the children were evident at presentation and continued up to final height. Mean age of onset of puberty was retarded by 2.5 years in girls and by 3 years in boys. The time between onset of puberty and pubertal growth spurt was shorter in both girls and boys than in the controls. Peak growth velocity was compromised in both girls and boys. Forty-one patients (30 boys, 11 girls) reached final height (FH). Mean FH was shorter than both target height and predicted adult height. The Bayley-Pinneau method was found to be a better predictor of FH than either the Tanner-Whitehouse method or target height. FH also showed correlation with the father's height. There was no effect of testosterone treatment on final height. Height deficit at onset of puberty, shorter duration between onset of puberty and pubertal growth spurt, compromised peak growth velocity and short upper segment due to delayed puberty, are findings which may explain the decreased final height of children with CDGP.

The following discussion on the physiology of the esophagus includes commentaries on the function of the muscularis mucosa and submucosa as a mechanical antireflux barrier in the esophagus; the different mechanisms of neurological control in the esophageal striated and smooth muscle; new insights from animal models into the neurotransmitters mediating lower esophageal sphincter (LES) relaxation, peristalsis in the esophageal body (EB), and motility of esophageal smooth muscle; differentiation between in vitro properties of the lower esophageal circular muscle, clasp muscle, and sling fibers; alterations in the relationship between pharyngeal contraction and relaxation of the upper esophageal sphincter (UES) in patients with dysphagia; the mechanical relationships between anterior hyoid movement, the extent of upper esophageal opening, and aspiration; the application of fluoroscopy and manometry with biomechanics to define the stages of UES opening; and nonpharmacological approaches to alter the gastroesophageal junction (GEJ).

Objective: To demonstrate the errors in surface electromyogram (EMG) interpretation that can be made when the EMG signal is not normalized. Design: A case study as a proof of principle. Main Outcome Measures: The EMG amplitude between the upper and lower portions of the rectus abdominis in one subject during a trunk curl when the EMG signal was normalized (expressed as a percentage of a maximum voluntary contraction) and the amplitude when the signal was expressed in raw, unnormalized arbitrary units or raw millivolts directly read from the instrumentation. Results: Interpretation of the unnormalized EMG signal suggests that a large difference in neural activation of the upper and lower sections of the rectus abdominis is occurring. In this condition the average activity in the lower rectus is 60.9% of that in the upper portion. This interpretation is incorrect. When the EMG signal is normalized, the differences between the upper and lower segments are reduced. When normalized, the lower segment activity is equal to that of the upper segment. Conclusions: Because of the inherent EMG signal variability, clinical interpretation of surface EMG signals requires normalization of the signal for physiologic interpretation and for comparison between bilateral muscles and between the same muscle on different days and between different subjects. (J Manipulative Physiol Ther 1999;22:444–6)

The EMG activity of the orbicularis oris (upper and lower), and of the mentalis muscles was verified during several movements of the lips, in 18 children ageing from 8 to 12 years, divided into three groups: one with normal occlusion, and two with class II division 1, with atypical swallowing and/or incompetent lips and who had received no orthodontic treatment. In blowing through a straw the muscular activity of the orbicularis oris and the mentalis was significantly greater in the incompetent lips group. The mentalis presented moderate activity in the competent lips group and negligible in normal occlusion. In puffing out of the cheeks, the malocclusion groups developed marked activity of the orbicularis oris and very marked activity of the mentalis, while the normal occlusion presented moderate and negligible activities, respectively. In pursing of the lips, only the incompetent lips group presented a very marked activity of the lower segment. The compression of the lips against the teeth revealed a marked activity of the upper segment of the orbicularis oris in the groups of malocclusion and the mentalis presented greater activity in the competent lips group. The reciprocal compression of the lips presented a hyperactivity of the three muscles.

The pullout force of sublaminar and transspinous wires for segmental instrumentation which had been inserted into different segments of human cadaver spines were campared. Four different types of wiring were tested: single and double sublaminar wires, button-wires according to Drummond's technique and button-wires with the additional use of two crimps for each spinous process. A total of 50 tests were performed. In all attempts the bone proved to be the limiting factor. None of the 300 fixed wires failed. Typical types of fractures appeared with different wiring techniques. There was no statistically significant difference between the sublaminar wiring techniques tested. However, there were significant differences between sublaminar and transspinous wiring. The transspinous techniques achieved between 30% and 45% of the pull-out strength of sublaminar techniques. The forces decreased with increasing cranialisation. In all techniques the values in the upper segment (D5–D3) were almost half those of the lower segment (L5–L3). The differences of the transspinous techniques increased cranially, in favour of the technique with additional crimps. Thus, the crimps have the strongest effect on weak spinous processes. This study demonstrates that in non-dynamic testing, the stability of the bone and not the type of wiring is the limiting parameter in segmental spinal stabilisation. As the wires are inserted in different areas, the transspinous technique shows significantly lower tension forces in comparison with sublaminar wiring.

We undertook a prospective clinical study to test our initial impression that cortical opacities are seldom present in the upper part of the lens. Data analysis revealed that of 174 eyes having cortical opacities, only 15 (8.62%) had opacities in the area of the lens between the 10- and 2-o'clock positions. Lid retraction, defined as upper lid position at or above the limbus, was seen in 13 (88.66%) of these eyes. Our study indicates that in the absence of lid retraction, cortical opacities are very rarely seen in the upper segment of the lens, a segment that is normally covered by the upper lid. This suggests a protective effect of the upper lid against cortical opacities, and indirectly it supports the theory that senile cortical opacities may be the result of thermal damage to the lens.

A 12-year-old girl with vaginal ectopic ureter in a duplex system associated with an extremely dysplastic upper segment who presented with a complaint of vaginal discharge is reported. The diagnostic approach with special reference to ultrasonography and computerized tomography is discussed.