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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.

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 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.

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.

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).

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.

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.

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.

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 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.

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.

Transplantation surgery, which is limited by the supply and short-term viability of fresh donor organs, would be revolutionized if these could survive freezing, but early claims of cryopreservation were never realized. Here we describe the successful transplantation in rats of ovaries, fallopian tubes and the upper segment of the uterus en bloc after storage in liquid nitrogen.

BAS is a protein generated by aortic rings isolated from rats. Our previous results clearly established that BAS inhibits platelet aggregation and modifies vascular tone. We have now examined the effect of separated segments of thoracic aorta and the effect of sex on the release of the BAS and PGI 2 . We evaluated three different segments of thoracic aorta: A= aortic arch, B= the upper segment and C= the lowest segment of the thoracic aorta. We measured the release of BAS and PGI 2 from them. The BAS production increased in the first segment (A) when compared with the other two (B and C), whilst PGI 2 production was the same along the thoracic aorta. On the other hand female and male thoracic aorta produced the same levels of BAS and 6-keto PGF 1α .

The clinical histories and films of 50 patients having roentgenographic evidence of injury to the cervical spine were reviewed.Over half of these patients were noted to have injuries involving the upper cervical spine. This finding is at variance with some other series in which more injuries to the lower cervical spine were reported.14,16Any history of head trauma, particularly those incidents in which force was applied to the vertex or anteroposterior aspect of the skull, should alert the physician to the possibility of associated injury to the cervical spine.The majority of cervical spine injuries with accompanying head trauma involved the upper segment (C1-C2).

We report an unusual case of a ureterocele in a duplex system, which was associated with an ectopic (vulval) upper moiety ureter. This is the second case reported in the literature of a ureterocele arising from the lower pole ureter. Surgical treatment consisted of removal of the upper segment of the kidney and its ureter. The ureterocele was excised and the lower pole ureter was reimplanted in the bladder. At followup 14 years postoperatively the patient was cured and free of urinary infection.

Total body length and body segments (crown-rump length, sub-ischeal length) of 78 children with myelomeningocele were measured at regular intervals during growth for a mean duration of 4.4 years. These children were shown to have defective growth, with an increased upper segment/lower segment ratio. It was found that the higher the level of the meningocele the greater the growth defects. However, the relationship was statistically significant only for the first seven years of life. It is concluded that neurological damage was mainly responsible for defective growth during the first years of life, but that other factors independent of the level of the meningocele also come into play in later years.

The correlation between nine anthropometric variables and six different measurements of the Y heterochromatic regions of 146 young Mexican adults was investigated. Only the absolute heterochromatic width showed a significant correlation at the 0.02 level with the upper segment/lower segment ratio, but the biological significance of this finding is strongly questioned.

In the present work one hundred and eighty healthy school children of either sex in the age group of 8 to 10 yr were studied for pulmonary functions and compared with other investigators. The values of pulmonary functions were found increased with increase in age. However all the values were higher in boys than girls. Higher values of pulmonary functions were reported by western investigators thismight be because of more height in the same age group and socioeconomic status. It was also observed in the present study that significant positive correlation exists between pulmonary functions (FVC, FEV1 and PEFR) and anthropometric parameters like height, weight and upper segment of the body.

The presence of a growth abnormality may be documented by determination of growth velocity, calculation of the upper segment/lower segment ratio or the AF/AT ratio, and measurement of head circumference. Important considerations in differential diagnosis of specific malformation syndromes are birth weight, limb and truck alterations, head size, physical features, and presence or absence of mental retardation. Additional clinical measurements, such as measurement of chest circumference and of finger and hand length, may be useful in selected cases. These data, combined with historical information, can indicate a specific diagnosis and facilitate the choice of confirmatory laboratory studies.

pH and Mg, Ca, P, Na, K, Cl- and HCO-3 contents of digesta in the stomach, the small intestine, the caecum, the colon were determined in the rats to study the effects of pH on absorption of Mg, Ca and P in the gastro-intestinal tract. Acidification in the stomach (pH3.46), sudden pH rise in the upper segment of the small intestine (pH6.52), sudden alkalization from pH6.89 to pH7.41 in the defined site of the lower segment of the small intestine, acidification in the caecum (pH6.91) and sudden alkalization in the colon (pH7.97) were observed. The positive correlations among Cl-, HCO-3, Na and K contents suggested that these minerals neutralized the low pH by HCl secreted in the stomach and organic acids produced by fermentation in the caecum. The significant negative correlations between pH and the ratio of Mg, Ca or P contents (Sup %) in supernatant fraction to total contents showed the possibility that the insoluble salts of these minerals precipitated as pH rose. The sudden increase of P content in the caecum might be due to the accumulation of P into multiplied bacteria. These results suggested that the sudden alkalization of digesta might decrease the absorptions of Mg, Ca and P in the intestine.

1. 1. Some criticisms are raised of the usual explanation of the mechanism by which descent of the fetal head in pregnancy is effected. The usual textbook account does not explain satisfactorily the frequent failure of the head to enter the pelvis before labor in multigravidas. 2. 2. Arguments are given for the existence of some retraction of the upper segment in late pregnancy and for the importance of this in producing descent of the fetal head. 3. 3. A brief account of the uterine moorings is given, showing that they provide countertraction by which the upper segment is enabled to drive the fetus down the birth canal. The frequent occurrence of a high presenting part at term in multigravidas can be attributed to the slackness in these moorings produced by previous labors. 4. 4. Consideration is given to the role of the uterine attachments in causing strain on the lower segment in labor. The bearing of this on the management of cases of contracted pelvis in the multigravida or after previous lower segment cesarean section is discussed.

Summary Since 1932 a total of 194 women who had 253 pregnancies after rupture of the pregnant uterus have been listed, including the 28 patients with 36 such pregnancies who are the subject of this report. Twenty-five of the women (12·8 per cent) had a repeat rupture. Two patients died. The risk of repeated rupture is least if the scar is confined to the lower uterine segment; greater if the scar extends into the upper segment; and greatest in patients who have had previous rupture of a classical Caesarean section scar. The management of these patients is discussed in the light of these findings.

Summary An unusual case of a large marginal circular haematoma of the placenta is described. Over a large area the haematoma disrupted the placenta, separating the chorionic plate with its great vessels and the insertion of the umbilical cord from the rest of the placental chorion. It is thought that the haematoma was produced by a prolonged strong contraction of the upper segment in which the major portion of the placenta was sited.

A study was undertaken to determine the effects of PGs (prostaglandins) F1alpha F2alpha E1 and E2. A total of 54 muscle strips of the myometrium from 29 uteri of women undergoing cesarean section at or near term were used in the study. On upper myometrial strips PGF1alpha in the 50-100 ng./ml. range produced mild stimulation and PGF2alpha in the 50-100 ng./ml. range produced strong and consistent contractions. Effects of the F prostaglandins were more variable on lower segment myometrial strips. Effects of PGE2 in the 80-100 ng./ml. range were more variable. This substance produced strong consistent contractions of upper segment muscle. Other PGE substances produced moderate spasmogenic responses to no response. These findings contrast with previously reported behavior of PGs on nonpregnant myometrium tissue whose contractility is usally stimulated by PGFs and inhibited by PGEs. Selectivity of action was noted in that the lower segment was relatively inactive in comparison with upper segment muscles.

The author has made a longitudinal biometric study of the growth in height of the upper and lower segments of the body in 45 girls. He concludes that growth after the menarche is almost exclusively in the upper segment. In 80 per cent of cases, the growth of the lower segment was less than 1.5 cms. The author shows that this residual growth depends on the maturity of the skeleton at the time of puberty. It is greater when skeletal maturity is delayed. Other important factors were the height of the child at the age of 8 and the growth rate between the ages of 8 and 10 years: the bigger the child, the smaller will be the amount of growth after the menarche. The first menstruation appeared earlier when the growth rate between the ages of 8 and 10 years was greater.

• Leiomyosarcoma of vascular origin are rare tumors arising most frequently from the inferior vena cava (IVC). We report on three patients one of whom underwent definitive resection. These tumors most commonly involve the upper segment of the IVC, and appear with manifestations of the Budd-Chiari syndrome. Lesions at this level are not amenable to surgical therapy. Tumors of the middle and lower segments of the IVC usually cause right-sided pain. Diagnosis is difficult, but is best approached preoperatively by angiography and vena cavography. Optimal therapy of lesions at these levels is surgical resection. Resection of the IVC below the hepatic veins is possible with renal function preserved by collateral drainage of the left renal vein. (Arch Surg 111:1081-1085, 1976)