OBJECTIVE: To explore the treatment strategy and clinical efficacy for os odontoideum complicated with atlantoaxial dislocation. METHODS: The clinical data of 17 patients with os odontoideum complicated with atlantoaxial dislocation surgically treated from January 2006 to January 2015 were retrospectively analyzed, including 7 males and 10 females, aged 17 to 53 (43.1±11.3) years old;course of disease was 3 to 27(10.2±6.9) months. All patients received cranial traction before operation, 12 of 14 patients with reducible dislocation were treated by posterior atlantoaxial fixation and fusion, and 2 patients with atlantooccipital deformity were treated by posterior occipitocervical fixation and fusion;3 patients with irreducible alantoaxial dislocation were treated by transoral approach decompression combined with posterior atlantoaxial fixation and fusion. The operation time, intraoperative blood loss and perioperative complications were recorded. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were used to evaluate the change of neck pain and neurological function. Atlantoaxial joint fusion rate was evaluated by CT scan. RESULTS: The operation time of posterior fixation and fusion ranged from 86 to 170 (92.2±27.5) min, and the intraoperative blood loss was 200-350 (250.7±65.2) ml. No vertebral artery injury and spinal cord injury were recorded. Among the patients underwent atlantoaxial fixation and fusion, 1 patient with reducible dislocation fixed by C CONCLUSION Surgical treatment of os odontoideum complicated with atlantoaxial dislocation can achieve satisfactory results, improve the patient's neurological function and improve the quality of life, however the surgical options needs to be individualized.
Adolescent ; Adult ; Atlanto-Axial Joint/surgery* ; Axis, Cervical Vertebra ; Female ; Humans ; Joint Dislocations/surgery* ; Male ; Middle Aged ; Quality of Life ; Retrospective Studies ; Spinal Fusion ; Treatment Outcome ; Young Adult

STUDY DESIGN: Retrospective radiological study. PURPOSE: We aimed to determine the prevalence of ponticulus posticus (PP) and high-riding vertebral artery (HRVA) occurring simultaneously on the same side (PP+HRVA) and in cases of PP+HRVA, to assess C2 radio-anatomical measurements for C2 pars length, pedicle width, and laminar thickness. OVERVIEW OF LITERATURE: PP and HRVA predispose individuals to vertebral artery injuries during atlantoaxial fixation. In cases of PP+HRVA, the construct options thus become limited. METHODS: Consecutive computed tomography scans (n=210) were reviewed for PP and HRVA (defined as an internal height of <2 mm and an isthmus height of <5 mm). In scans with PP+HRVA, we measured the ipsilateral pedicle width, pars length, and laminar thickness and compared them with controls (those without PP or HRVA). RESULTS: PP was present in 14.76% and HRVA in 20% of scans. Of the 420 sides in 210 scans, PP+HRVA was present on 13 sides (seven right and six left). In scans with PP+HRVA, the C2 pars length was shorter compared with controls (13.69 mm in PP+HRVA vs. 20.65 mm in controls, p<0.001). The mean C2 pedicle width was 2.53 mm in scans with PP+HRVA vs. 5.83 mm in controls (p<0.001). The mean laminar thickness was 4.92 and 5.48 mm in scans with PP+HRVA and controls, respectively (p=0.209). CONCLUSIONS: The prevalence of PP+HRVA was approximately 3% in the present study. Our data suggest that, in such situations, C2 pedicle width and pars length create important safety limitations for a proposed screw, whereas the translaminar thickness appears safe for a proposed screw.
Axis, Cervical Vertebra ; Cervical Atlas ; Prevalence ; Retrospective Studies ; Vertebral Artery

PURPOSE: To assess the changes in anterior, posterior, and total corneal astigmatism after cataract surgery with on-axis clear corneal incision cataract surgery. METHODS: This study included 48 eyes (24 eyes with 'with-the-rule [WTR]' and 24 eyes with 'against-the-rule [ATR]') that underwent phacoemulsification and intraocular lens insertion through on-axis clear corneal incision. The ATR group with vertically steep axis of posterior corneal astigmatism was divided into subgroups 1 and 2 for the opposite axis. Autorefraction, uncorrected and best-corrected visual acuities were measured. Corneal astigmatism (anterior, posterior and total) was measured using Pentacam(R) preoperatively and 1 week, 1 month, and 2 months postoperatively. RESULTS: Multivariate linear regression analysis of preoperative data showed positive correlations among anterior, posterior and total astigmatism. Anterior corneal astigmatism showed a significant decrease in both WTR and ATR groups in all measured points (all p < 0.05). Posterior corneal astigmatism showed no statistical difference in the WTR group and ATR subgroup 2 (p > 0.05) and significant decrease in the ATR subgroup 1 (p < 0.05) at 2 months postoperatively. Total corneal astigmatism showed significant decrease 2 months after surgery in the WTR group and ATR subgroup 1 (all p < 0.05), but not in the ATR subgroup 2 (p > 0.05). According to correlation analysis based on trend line equations, 1.7 diopters of anterior astigmatism could expect 0.3 diopters of posterior astigmatism and 0.5 diopters of total astigmatism for the WTR group and 0.4 diopters of anterior astigmatism could expect 0.2 diopters of posterior astigmatism and 0.4 diopters of total astigmatism for the ATR group. CONCLUSIONS: Considering the majority of cataract patients have vertically steep posterior corneal astigmatism, temporal incision for ATR patients is generally effective. Moreover, for patients with WTR astigmatism of more than 1.7 diopters or ATR astigmatism greater than 0.8 diopters, additional preoperative correction based on posterior astigmatism is needed for more precise prediction of postoperative total corneal astigmatism.
Astigmatism* ; Axis, Cervical Vertebra ; Cataract* ; Humans ; Lenses, Intraocular ; Linear Models ; Phacoemulsification ; Visual Acuity

PURPOSE: To report a case of recurred iris cyst 11 years after treatment with endodiathermy, which was treated with laser photocoagulation and cystotomy followed by intraocular pressure elevation and underwent anterior chamber irrigation. CASE SUMMARY: A 46-year-old female presented to our department with decreased vision in her left eye that had persisted for several months. The patient had a history of surgical removal of an iris cyst with endodiathermy 11 years ago. Slit lamp examination showed an iris cyst adjacent to the nasal corneal limbus. The cyst was filled with turbid fluid. It distorted the pupil and threatened visual axis. Iris cystotomy (diameter larger than 500 microm) was done with diode laser photocoagulation and a neodymiumdoped yttrium aluminium garnet laser. At the same day, the patient's intraocular pressure elevated to 50 mm Hg in spite of maximal conservative treatment and went through anterior chamber irrigation. After six months, the iris cyst was adhered to corneal endothelium and disappeared. Visual acuity and intraocular pressure was within normal range. CONCLUSIONS: An iris cyst can recur after treatment with endodiathermy. Recurred iris cyst can be successfully treated with laser photocoagulation and cystotomy. However, turbid fluid inside the cyst may outflow to the anterior chamber and cause secondary ocular hypertension after treatment, so careful observation is needed.
Anterior Chamber ; Axis, Cervical Vertebra ; Cystotomy* ; Endothelium, Corneal ; Female ; Humans ; Intraocular Pressure ; Iris* ; Lasers, Semiconductor ; Light Coagulation* ; Limbus Corneae ; Middle Aged ; Ocular Hypertension ; Pupil ; Reference Values ; Visual Acuity ; Yttrium

OBJECTIVE: To assess the intra-rater and inter-rater reliability for measuring femoral anteversion angle (FAA) by a radiographic method using three-dimensional computed tomography reconstruction (3D-CT). METHODS: The study included 82 children who presented with intoeing gait. 3D-CT data taken between 2006 and 2014 were retrospectively reviewed. FAA was measured by 3D-CT. FAA is defined as the angle between the long axis of the femur neck and condylar axis of the distal femur. FAA measurement was performed twice at both lower extremities by each rater. The intra-rater and inter-rater reliability were calculated by intraclass correlation coefficient (ICC). RESULTS: One hundred and sixty-four lower limbs of 82 children (31 boys and 51 girls, 6.3±3.2 years old) were included. The ICCs of intra-rater measurement for the angle of femoral neck axis (NA) were 0.89 for rater A and 0.96 for rater B, and those of condylar axis (CA) were 0.99 for rater A and 0.99 for rater B, respectively. The ICC of inter-rater measurement for the angle of NA was 0.89 and that of CA was 0.92. By each rater, the ICCs of the intrarater measurement for FAA were 0.97 for rater A and 0.95 for rater B, respectively and the ICC of the inter-rater measurement for FAA was 0.89. CONCLUSION: The 3D-CT measures for FAA are reliable within individual raters and between different raters. The 3D-CT measures of FAA can be a useful method for accurate diagnosis and follow-up of femoral anteversion.
Axis, Cervical Vertebra ; Bone Anteversion ; Child ; Diagnosis ; Female ; Femur ; Femur Neck ; Follow-Up Studies ; Gait ; Humans ; Imaging, Three-Dimensional ; Lower Extremity ; Retrospective Studies

Developmental anomalies of the axis are commonly encountered, especially anomalies involving the odontoid process. Anomalies of the posterior elements are uncommon. We describe a unique case of agenesis of posterior elements of C2 with basilar invagination and atlanto-axial dislocation. An obese 8-year-old boy presented with symptoms of cervical myelopathy. Radiological workup revealed a craniovertebral junction anomaly with occipitalised atlas, absent posterior elements of axis, and hypertrophied C3 spinous process. Atlanto-axial instability and basilar invagination was present. Magnetic resonance angiography revealed hypoplastic left vertebral artery. Traction with cervical tongs failed to improve the alignment and symptoms. Anterior trans-oral release, followed by posterior decompression and custom-made instrumentation, was done. The patient recovered completely and was asymptomatic at the end of two years. X-ray and computed tomography scan demonstrated reduction of basilar invagination and maintenance of alignment. This is the first case to be reported of agenesis of posterior elements of axis associated with basilar invagination. One should look for this condition in patients with hypertrophied spinous process of C3. Utilization of hypoplastic pedicle of axis serves as an additional fixation point to increase the stability of the construct.
Axis, Cervical Vertebra ; Child ; Decompression ; Dislocations* ; Humans ; Magnetic Resonance Angiography ; Male ; Odontoid Process ; Spinal Cord Diseases ; Spine* ; Traction ; Vertebral Artery

BACKGROUND: Neck flexion by head elevation using an 8 to 10 cm thick pillow and head extension has been suggested to align the laryngeal, pharyngeal and oral axis and facilitate tracheal intubation. Presently, the laryngeal view and discomfort for tracheal intubation were evaluated according to two different degrees of head elevation in adult patients. METHODS: This prospective randomized, controlled study included 50 adult patients aged 18 to 90 years. After induction of anesthesia, the Cormack Lehane grade was evaluated in 25 patients using a direct laryngoscope while the patient's head was elevated with a 4 cm pillow (4 cm group) and then an 8 cm pillow (8 cm group). In the other 25 patients, the grades were evaluated in the opposite sequence and tracheal intubation was performed. The success rate and anesthesiologist's discomfort score for tracheal intubation, and laryngeal, pharyngeal and oral axes were assessed. RESULTS: There were no differences in the laryngeal view and success rate for tracheal intubation between the two groups. The discomfort score during tracheal intubation was higher in the 8 cm group when the patient's head was elevated 4 cm first and then 8 cm. The alignment of laryngeal, pharyngeal and oral axes were not different between the two degrees of head elevation. CONCLUSIONS: A pillow of 8 cm height did not improve laryngeal view and alignment of airway axes but increased the anesthesiologist discomfort, compared to a pillow of 4 cm height, during tracheal intubation in adult patients.
Adult* ; Airway Management ; Anesthesia ; Axis, Cervical Vertebra ; Head ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngoscopes ; Neck ; Prospective Studies ; Vocal Cords

PURPOSE: Stress activates the sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis and induces the release of glucocorticoids. Saccharin is 300 times sweeter than sucrose, but does not increase blood insulin levels. Thus, this study was designed to evaluate the effect of saccharin intake in restraint-induced stress response reduction in rats. METHODS: Adult male Sprague-Dawley (SD) rats had stress induced by restraint for 2 hours/day for 1 week. Saccharin was provided in sufficient amounts to allow them to intake it voluntarily at 0.1% diluted in water. The Y-maze test and forced swim test (FST) were performed to evaluate cognitive function and the depressive behavior of the rats. The protein expression of the glucocorticoid receptor (GR) in hippocampal cornu ammonis (CA) 1 was investigated by using immunohistochemistry. RESULTS: It was found that, the percentage of alternation in the Y-maze test was significantly (p<.01) higher in the Stress + saccharin group than in the Stress group. Immobility time in the FST was significantly (p<.01) lower in the Stress + saccharin group than in the Stress group. Also, the positive cells of GR in hippocampus CA1 were significantly (p<.05) lower in the Stress + saccharin group than in the Stress group. CONCLUSION: This study showed that there was an effect of saccharin intake in restraint-induced stress response reduction in rats.
Adult ; Animals ; Axis, Cervical Vertebra ; Glucocorticoids ; Hippocampus ; Humans ; Immunohistochemistry ; Insulin ; Male ; Rats* ; Rats, Sprague-Dawley ; Receptors, Glucocorticoid ; Saccharin* ; Sucrose ; Sympathetic Nervous System ; Water

PURPOSE: The purpose of this study was to evaluate the effects of abutment screw length and cyclic loading on the removal torque (RTV) in external hex (EH) and internal hex (IH) implants. MATERIALS AND METHODS: Forty screw-retained single crowns were connected to external and internal hex implants. The prepared titanium abutment screws were classified into 8 groups based on the number of threads (n = 5 per group): EH 12.5, 6.5, 3.5, 2.5 and IH 6.5, 5, 3.5, 2.5 threads. The abutment screws were tightened with 20 Ncm torque twice with 10-minute intervals. After 5 minutes, the initial RTVs of the abutment screws were measured with a digital torque gauge (MGT12). A customized jig was constructed to apply a load along the implant long axis at the central fossa of the maxillary first molar. The post-loading RTVs were measured after 16,000 cycles of mechanical loading with 50 N at a 1-Hz frequency. Statistical analysis included one-way analysis of variance and paired t-tests. RESULTS: The post-loading RTVs were significantly lower than the initial RTVs in the EH 2.5 thread and IH 2.5 thread groups (P<.05). The initial RTVs exhibited no significant differences among the 8 groups, whereas the post-loading RTVs of the EH 6.5 and EH 3.5 thread groups were higher than those of the IH 3.5 thread group (P<.05). CONCLUSION: Within the limitations of this study, the external hex implants with short screw lengths were more advantageous than internal hex implants with short screw lengths in torque maintenance after cyclic loading.
Axis, Cervical Vertebra ; Crowns ; Dental Implant-Abutment Design ; Molar ; Titanium ; Torque*

Laparoscopic completion total gastrectomy following pancreaticoduodenectomy (PD) has not been reported. A 73-year-old male who underwent PD 25 years ago for distal common bile duct cancer visited a surgical department for remnant gastric cancer. A previous reconstruction was performed with pancreaticojejunostomy (PJ), gastrojejunostomy and Braun anastomosis, i.e., jejunojejunostomy (JJ), between the afferent and efferent jejunal limb to prevent bile reflux into the remnant stomach. Adhesiolysis was initially performed to secure the surgical view. Lymph node dissections around the splenic artery, splenic hilum, celiac axis, left gastric artery, and common hepatic artery were performed. The PJ site was well visualized and safely preserved. Esophagojejunostomy was performed with an OrVil system. Specimen retrieval, Roux-limb preparation and JJ were performed through an extended umbilicus trocar site. A final pathologic examination revealed a 5.5-cm serosa-exposed tumor (T4a) without lymph node metastasis. The patient was discharged on postoperative day 7 without any complications.
Aged ; Arteries ; Axis, Cervical Vertebra ; Bile Duct Neoplasms* ; Bile Ducts* ; Bile Reflux ; Bile* ; Common Bile Duct ; Extremities ; Gastrectomy* ; Gastric Bypass ; Gastric Stump ; Hepatic Artery ; Humans ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy ; Splenic Artery ; Stomach Neoplasms* ; Surgical Instruments ; Umbilicus