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A clinical study comparing the width of attached gingiva and the prevalence of gingival recessions.

One hundred preclinical year dental students were examined. Oral hygiene status and gingival condition were determined using the Plaque Index score (Silness & Löe 1964) and the Gingival Index score systems (Löe & Silness 1963). The width of the attached gingiva and the depth of the gingival pockets were evaluated. The gingival recessions were recorded and their heights measured from the CEJ to the gingival margin. No significant correlation was found between oral hygiene and gingival recession, oral hygiene and width of attached gingival conditions and width of attached gingiva. Only a negative correlation (P less than 0.05) was found between the width of attached gingiva and the number of gingival recessions. No statistically significant differences were observed in oral hygiene status and gingival conditions among three groups of students (without, with one and with two or more recessions, respectively). The roles of toothbrushing trauma and "adequate" width of attached gingiva in the etiology of gingival recessions are questioned.

Adult↗

Interpretation of spring recession curves.

Recession curves contain information on storage properties and different types of media such as porous, fractured, cracked lithologies and karst. Recession curve analysis provides a function that quantitatively describes the temporal discharge decay and expresses the drained volume between specific time limits (Hall 1968). This analysis also allows estimating the hydrological significance of the discharge function parameters and the hydrological properties of the aquifer. In this study, we analyze data from perennial springs in the Judean Mountains and from others in the Galilee Mountains, northern Israel. All the springs drain perched carbonate aquifers. Eight of the studied springs discharge from a karst dolomite sequence, whereas one flows out from a fractured, slumped block of chalk. We show that all the recession curves can be well fitted by a function that consists of two exponential terms with exponential coefficients alpha1 and alpha2. These coefficients are approximately constant for each spring, reflecting the hydraulic conductivity of different media through which the ground water flows to the spring. The highest coefficient represents the fast flow, probably through cracks, or quickflow, whereas the lower one reflects the slow flow through the porous medium, or baseflow. The comparison of recession curves from different springs and different years leads to the conclusion that the main factors that affect the recession curve exponential coefficients are the aquifer lithology and the geometry of the water conduits therein. In normal years of rainy winter and dry summer, alpha1 is constant in time. However, when the dry period is longer than usual because of a dry winter, alpha1 slightly decreases with time.

Fresh Water↗

Reduced bone mineral density and hyaloid vasculature remnants in a consanguineous recessive FEVR family with a mutation in LRP5.

BACKGROUND/AIMS: Familial exudative vitreoretinopathy (FEVR) is an inherited blinding condition characterised by abnormal development of the retinal vasculature. FEVR has multiple modes of inheritance, and homozygous mutations in LRP5 have recently been reported as underlying the recessive form of this disease. The aim of this study was to examine LRP5 in a consanguineous recessive FEVR family and to clarify the eye and bone phenotype associated with recessive FEVR. METHODS: All family members were examined by slit lamp biomicroscopy and indirect ophthalmoscopy. Linkage to LRP5 was determined by genotyping microsatellite markers, constructing haplotypes and calculating lod scores. Mutation screening of LRP5 was performed by polymerase chain reaction amplification of genomic DNA followed by direct sequencing. Bone mineral density (BMD) was evaluated in all family members using dual energy x ray absorptiometry (DEXA). RESULTS: The clinical features observed in this family were consistent with a diagnosis of recessive FEVR. A homozygous LRP5 missense mutation, G550R, was identified in all affected individuals and all unaffected family members screened were heterozygous carriers of this mutation. Reduced BMD, hyaloid vasculature remnants, and nystagmus were features of the phenotype. CONCLUSION: Recessive mutations in LRP5 can cause FEVR with reduced BMD and hyaloid vasculature remnants. Assessment of a patient with a provisional diagnosis of FEVR should therefore include investigation of BMD, with reduced levels suggestive of an underlying LRP5 mutation.

Adolescent↗

Inferior rectus recession--an effective procedure?

AIMS: To examine the postoperative stability of inferior rectus recession, with particular reference to the incidence of progressive overcorrection. METHODS: The results of consecutive patients undergoing inferior rectus recession over a 3 year period were reviewed. RESULTS: 21 patients underwent inferior rectus recession, using an adjustable suture technique in all but three cases. In 16 patients additional vertical muscle surgery was performed at the time of the inferior rectus recession. All patients were followed for a minimum of 3 months postoperatively, with a mean follow up of 9.3 months. At the final postoperative visit 11 patients were well aligned, eight were undercorrected, and two were overcorrected. In five of the eight undercorrected cases, the residual deviation was the result of postoperative drift in the direction of the preoperative deviation, following an initially good alignment. Review of the results failed to reveal any factor predictive for this postoperative drift. CONCLUSION: The risk of postoperative overcorrection following inferior rectus recession should be considered, but in this study, undercorrection occurred more frequently than overcorrection. The possible reasons for overcorrection and undercorrection are discussed.

Adolescent↗

Vitamin A requirements of alipochromatic ('recessive-white') and coloured canaries (Serinus canaria) during the breeding season.

Six pairs of alipochromatic ('recessive-white') canaries (Serinus canaria) and six pairs of coloured canaries were kept through a complete breeding cycle while being fed a diet providing 12,000 iu vitamin A/kg. The eggs of three pairs (one recessive-white and two coloured) were all unfertilised and there were only 23 hatchlings (14 recessive-white and nine coloured), of which 14 (10 recessive-white and four coloured) were alive after the first moult. However, there was no clinical, biochemical or pathological evidence that the recessive-white canaries were suffering from vitamin A deficiency or that the coloured canaries were suffering from vitamin A toxicity, suggesting that the diet met the vitamin A requirements of both groups.

Animals↗

Oxygen electrode design criteria and performance characteristics: recessed cathode.

A computer simulation of the steady-state operation of recessed (Whalen-type) polarographic oxygen electrodes has been developed to give the design factors important for performance optimization. The simulation makes use of a specially formulated three-dimensional orthogonal coordinate system with the geometry identical to the actual recessed cathode and gives the oxygen concentration field induced by it in the surrounding medium. Equations are presented which allow one to calculate, for any recessed cathode, the current sensitivity, maximum stirring artifact, measurement error, and time constant. Comparisons with analytically obtained expressions for the corresponding quantities for idealized, spherosymmetric cathodes demonstrate the unique aspects of recessed-cathode performance. For commonly used electrodes, a recess length-to-cathode diameter ratio of greater than 10 is found to give a negligible stirring artifact, a negligible measurement error, and a rapid response.

Computers↗

Lack of type VII collagen in unaffected skin of patients with severe recessive dystrophic epidermolysis bullosa.

Type VII collagen, the major structural component of the anchoring fibrils, was assayed in normal unaffected skin of patients with different forms of hereditary epidermolysis bullosa. Immunofluorescence staining with affinity-purified polyclonal antibodies to type VII collagen revealed a complete absence of staining in the skin of patients with severe dystrophic recessive epidermolysis bullosa. In all other forms, localized recessive dystrophic, dominant dystrophic, junctional and simplex forms there was an intense continuous linear staining of type VII collagen at the dermoepidermal junction. Also, obligate heterozygote carriers of the gene for severe dystrophic recessive form showed a normal pattern of staining. As internal controls and to define the clinical diagnosis, staining with antibodies to type IV collagen, laminin and bullous pemphigoid antigen was also performed. All these antibodies showed a normal staining pattern indicating an intact general morphology of the dermoepidermal junction zone. These results suggest that there is a defect of type VII collagen in patients with severe recessive dystrophic epidermolysis bullosa. The data also suggest that the group of recessive dystrophic epidermolysis bullosa may be heterogeneous not only clinically, but also at the molecular level.

Adolescent↗

Endoscopic gastrocnemius recession: evaluation in a cadaver model.

The purpose of this study was to describe a new method of gastrocnemius recession using an endoscopic approach and to determine the accuracy of incision placement during gastrocnemius recession. Fifteen fresh-frozen cadaveric limbs underwent an endoscopic gastrocnemius recession utilizing a two-portal technique. All limbs were anatomically dissected after the procedure and each was examined for injury to the sural nerve. The ability to visualize the sural nerve intraoperatively, improvement in ankle dorsiflexion, time requirement for the procedure, incision size, and appropriateness of placement to facilitate recession were recorded for each specimen. An average of 83% of the gastrocnemius aponeurosis was transected in all 15 cadavers. After modifications of the technique, the final eight cadavers were noted to have had the entire (100%) gastrocnemius aponeurosis transected. Sural nerve injury occurred in one specimen (7%) in which the aponeurosis and the sural nerve were not well visualized. The sural nerve was definitively visualized during the procedure in 5 of 15 specimens (33%). No Achilles tendon injury was noted in any specimen. There was a mean improvement in ankle dorsiflexion of 20 degrees (range, 10 degrees-30 degrees) during full knee extension. The average length of time to perform the procedure was 20 minutes (range, 10-35 minutes). The average medial and lateral incision lengths used in the two-portal technique were 18 mm (range, 14-22 mm) and 17 mm (range, 12-19 mm), respectively, and the average distance from the midpoint of the medial incision to the level of the gastrocnemius-soleus junction was 26 mm (range, 5-60 mm). These results indicate that a complete gastrocnemius aponeurosis transection may be obtained utilizing a modified endoscopic gastrocnemius recession, but visualization of the sural nerve is poor with possible risk of iatrogenic nerve injury.

Cadaver↗

The use of peer monitors to reduce negative interaction during recess.

The negative interactions of a midly retarded child, Dennis, were reduced in three daily recess periods, with the use of a point system. Adult monitors initiated the intervention in the morning recess; reductions achieved during adult monitoring were maintained in that recess during two subsequent conditions: peer monitoring and self-monitoring. Dennis' negative interactions were reduced next in the afternoon recess by peer monitors. Again, reductions were maintained during a subsequent self-monitoring condition. Finally, during the noon recess, Dennis was trained to serve as a peer monitor for Ed, a moderately retarded classmate. Dennis' rate of negative interactions quickly decreased following his appointment as a peer monitor. The results show that a point system, originally designed for adult monitoring, can be adapted without loss of program effectiveness for peer monitoring or self-monitoring. The results also suggest that classmates who serve as peer monitors may benefit significantly from their role. The conditions under which these therapeutic effects occur and the role that treatment order effects may play in this process require further investigation.

Aggression↗

Magnetic resonance imaging of the superior pericardial recesses.

The potential of magnetic resonance imaging (MRI) of the superior pericardial space was evaluated in a retrospective review of MR images of 46 subjects. The superior pericardial space and its two recesses had low signal intensity. The preaortic recess was demonstrated on 82% of nongated transverse scans. The retroaortic recess was demonstrated on 67% of nongated transverse scans. Generally, both recesses were shown with an even higher frequency on ECG-gated and ECG-permutation-gated scans. Knowledge of the location and typical appearance of these pericardial recesses should preclude mistaking them on MRI for a vascular structure, aortic dissection, or an atherosclerotic plaque or mural thrombus within the ascending aorta.

Adolescent↗

Superior oblique recession versus tenotomy: a comparison of surgical results.

Past experience with weakening the superior oblique muscle by tenotomy has been complicated by unpredictable results. Superior oblique recession has been advocated as a more controlled and reliable procedure. We retrospectively studied 20 cases of superior oblique tendon recession and tenotomy from the Bascom Palmer Eye Institute over the last ten years. All cases were compared with respect to the amount of deviation corrected, ability to eliminate "A" pattern strabismus, preservation of muscle function, and complications. Both procedures were equally effective in eliminating "A" pattern strabismus regardless of the initial size of the pattern. Unilateral superior oblique recessions were less erratic than tenotomies but tended to result in a slight undercorrection. The complications were similiar for each procedure. We could not demonstrate a clear advantage of bilateral superior oblique recession over tenotomy. Unilateral recession needs further investigation and may have prove useful when combined with the adjustable suture technique.

Adolescent↗

Measured graduated recession of the superior oblique muscle.

Six patients underwent bilateral superior oblique recession for A-pattern strabismus with overacting superior obliques. The established technique was modified to permit the entire procedure to be carried out through a single nasal fornix incision. The amount of recession was graduated and measured both directly from the point of the original incision anteriorly and indirectly from the nasal of the corner of the superior rectus insertion based on anatomical measurements. A good correlation was found between the amount (measured directly) of recession performed and reduction in the A-pattern. The relationship was linear. By extrapolation the first 8 mm of superior oblique surgery had no effect but thereafter the effect obtained was 2 diopters reduction in A-pattern for every mm of superior oblique surgery. No similar correlation was found for the amount of recession performed measured indirectly. There was no correlation between reduction in superior oblique overaction and the amount of recession performed. This was believed to be due, at least in part, to an inaccurate system of measurement of superior oblique overaction. We now, therefore, measure superior oblique overaction in mm using the corneal light reflexes. There was, however, a good correlation between the amount of preoperative superior oblique overaction and the effect obtained.

Follow-Up Studies↗

Hang-back lateral rectus recessions for exotropia.

The hang-back recession is a simple, safe alternative to conventional recession. We evaluated the surgical results in 23 consecutive patients undergoing bilateral hang-back lateral rectus recessions and 24 consecutive patients undergoing bilateral conventional lateral rectus recessions. The 6-week postoperative success rate was 78% in the hang-back group and 75% in the conventional group. At the time of the most recent follow-up, the success rate was 64% in the hang-back group and 85% in the conventional group. Dose-response curves were similar for both methods. There were more late overcorrections with the hang-back technique. We suggest modified surgical guidelines for the hang-back recession technique.

Child↗

Extraocular muscle fiber morphometry following combined recession-resection procedures in rabbits.

PURPOSE: In earlier studies, we have reported extraocular muscle fiber atrophy following recession and fiber hypertrophy following resection of a horizontal rectus muscle. Changes seen in the operated muscle were mirrored in the antagonist and were thought to be a compensatory response to sustained changes in tension across the muscle pair caused by the surgery and by changes in the rotational position of the globe. The purpose of this study is to examine the effects of combined recession-resection on extraocular muscle fiber diameter. METHODS: In 16 anesthetized rabbits, a 6-mm recession of the medial rectus was combined with a 6-mm resection of the lateral rectus in the left orbit. The horizontal rectus muscles were removed from both orbits of four rabbits at 2-, 4-, 8-, and 16-week postoperative intervals. Cross-sections were cut from the midbelly of each muscle, and muscle fiber diameters were measured with a computerized morphometry unit. Mean fiber diameters from the operated orbit of animals at each postoperative interval were pooled and compared with means from the unoperated orbit using the paired-samples t test. RESULTS: No statistically significant change in fiber diameter was seen in either the global or orbital fiber layers at any postoperative interval examined. CONCLUSIONS: Because resection would be expected to increase and recession to decrease the resting tension across an agonist-antagonist pair, our results suggest that a combined recession-resection yields no significant net change in resting tension, and minimizes compensatory changes in extraocular muscle fiber diameter.

Animals↗

Early and late postoperative alignment following unilateral lateral rectus recession for intermittent exotropia.

PURPOSE: Bilateral lateral rectus recession is useful in the treatment of intermittent exotropia. A unilateral recession may be used in the treatment of small-to-moderate angle intermittent exotropia as well. An early overcorrection following bilateral surgery has been shown to carry the best prognosis for future alignment. The relationship between the early and late postoperative alignment following unilateral surgery is unknown. The current study was designed to establish this relationship. METHODS: Thirty-seven patients undergoing a unilateral lateral rectus recession for intermittent exotropia were prospectively evaluated to determine the relationship between early and late postoperative alignment. Patients were evaluated 1 week and 6 months following surgery. A satisfactory result was considered to be alignment within 8 prism diopters (delta). RESULTS: Of the 37 patients who underwent surgery, 35 completed the study. Overall, 77% of patients achieved a satisfactory result at the 6-month exam (27/35). Satisfactory alignment at 6 months was obtained in all patients who were orthophoric (14/14), 77% (10/13) of patients with an exodeviation less than 9 delta (10/13), and 60% (3/5) of patients with an exodeviation less than 9 delta at the 1-week postoperative exam. Twenty-nine percent of patients changed alignment status during this time period (10/35), and 29% of all patients became more divergent (10/35). The average divergent shift for the entire group was 1.6 delta and was not significant. Among those patients who experienced a divergent shift, the average amount was 6 delta. CONCLUSIONS: There is not a significant difference in early versus late alignment following unilateral lateral rectus recession. Surgeons performing this procedure should not expect a significant divergent shift from the first postoperative week. Unlike bilateral recessions where an early overcorrection is desirable, acceptable alignment in the first week following surgery carries the best prognosis for later alignment.

Adolescent↗

Vertical rectus recession for the innervational upshoot and downshoot in Duane's retraction syndrome.

PURPOSE: To report the results of recession of the vertical rectus muscle for the innervational upshoot and downshoot in Duane's retraction syndrome. METHODS: Ten patients who had Duane's retraction syndrome with innervational upshoot or downshoot underwent recession of the superior and inferior rectus muscle for the upshoot and downshoot, respectively. This procedure was combined with recession of the lateral rectus muscle(s) for exotropia in 6 patients and for the mechanical upshoot-downshoot in one patient. Postoperatively, the effects of surgery on the upshoot/downshoot, and horizontal and vertical deviation in the primary position were recorded. Average follow-up period was 1.2 years. RESULTS: Following surgery, the innervational upshoot/downshoot was eliminated in all patients. Mean vertical deviation in the primal position in 6 patients was reduced from 21.2 to 2.5 prism diopters and none of them developed a consecutive vertical imbalance. Four patients did not have a vertical deviation in the primary position preoperatively and one of them developed 10 prism diopters hypotropia following recession of the superior rectus muscle. CONCLUSIONS: Recession of the superior and inferior rectus muscle is a safe and effective treatment for the innervational upshoot and downshoot, respectively, in Duane's retraction syndrome.

Adolescent↗

Long-term results of unilateral lateral rectus recession in intermittent exotropia.

PURPOSE: Unilateral lateral rectus recession is an alternative procedure in the treatment of moderate angle intermittent exotropia. However, long-term results of unilateral lateral rectus recession have not yet been studied. The aim of this study was to determine the long-term stability of alignment following unilateral lateral rectus recession in patients with intermittent exotropia with a deviation of 25 to 30 PD. PATIENTS AND METHODS: Thirty-two patients with intermittent exotropia with a deviation of 25 to 30 PD were included in this study. All patients underwent 8-mm unilateral lateral rectus recession by conventional techniques. RESULTS: Satisfactory results (+/- 5 PD of orthophoria) were obtained in 77.7% of the patients after a 3-year follow-up period. The mean correction achieved was 22.9 PD. CONCLUSION: Our results indicate that 8-mm unilateral lateral rectus recession is an attractive alternative procedure in the treatment of intermittent exotropia with a deviation of 25 to 30 PD.

Child, Preschool↗

Benign expansile lesions of the sphenoid sinus: differentiation from normal asymmetry of the lateral recesses.

BACKGROUND AND PURPOSE: There is a wide range of normal variation is sphenoid sinus development, especially in the size of the lateral recesses. The purpose of this study was to determine imaging characteristics that may help differentiate between opacification of a developmentally asymmetric lateral recess and a true expansile lesion of the sphenoid sinus. METHODS: Coronal CT was performed in seven patients with expansile or erosive benign lesions of the sphenoid sinus, and results were compared to a control population of 72 subjects with unopacified sphenoid sinuses. The degree of asymmetry of lateral recess development was assessed with particular attention to the separation of vidian's canal and the foramen rotundum (vidian-rotundum distance). The images were also examined for evidence of: erosion, defined as loss of the normal thin bony margin on at least two contiguous sections; apparent thinning of the sinus wall, defined as a focal apparent decrease in thickness again on at least two contiguous sections; and for vidian's canal or foramen rotundum rim erosion or flattening. RESULTS: Of the seven patients with expansile lesions, vidian's canal margin erosion was present in seven, unequivocal sinus expansion in three, wall erosion in three, wall thinning in three, erosion of the foramen rotundum in two, and flattening in the foramen rotundum in four. Forty-one of the 72 controls had lateral recess formation, 28 of which were asymmetric. The distance between vidian's canal and the foramen rotundum (vidian-rotundum distance) relied on the presence or absence of pneumatization, with a significantly larger distance in the presence of greater wing pneumatization. Examination of 24 controls revealed apparent thinning of the sinus wall, typically at the carotid groove, but no flattening, thinning, or erosion of the vidian canal or of the foramen rotundum. CONCLUSION: Examination of controls and patients with expansile or erosive lesions of the sphenoid sinus revealed side-to-side asymmetry in the development of the sinus and lateral recess, making subtle expansion difficult to assess. Furthermore, variability in the vidian-rotundum distance correlated with degree of pneumatization, and did not necessarily reflect expansion. Thus, in the absence of gross sinus wall erosion, flattening or erosion of the rims of vidian's canal or the foramen rotundum provides the most specific evidence of an expansile or erosive process within the sinus.

Adolescent↗