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PubMed2005

Effects of unilateral lateral rectus recession according to the tendon width in intermittent exotropia.

PURPOSE: To verify the effect of unilateral lateral rectus recession for each millimeter according to the tendon width in intermittent exotropia. METHODS: A total of 37 patients (37 eyes) of 7 to 11 years of age with basic-type intermittent exotropia and a deviation of 16-25 Prism Diopters (PD) were included in this study. Under general anaesthesia, the tendon width of the lateral rectus of the deviating eye near insertion was measured with calipers, prior to dissection of the muscle tendon from the sclera. Patients underwent 6.5-10 mm unilateral lateral rectus recession. The effect of lateral recession for each millimeter was the absolute value of the angle of preoperative deviation plus postoperative deviation on the second day divided by the total amount of recession. RESULTS: Mean tendon width of the lateral rectus of a deviating eye was 8.3 mm (range: 6.5-9.5). The mean effect per millimeter of unilateral rectus recession in those 37 patient was 2.98+/-0.42 PD (range: 2.4-4.1). The effect of recession was larger in cases in which the tendon width of the lateral rectus was narrower (P=0.000, r=0.72). CONCLUSION: The tendon width of the lateral rectus muscle can be a useful indicator to estimate the effect of lateral rectus recession in intermittent exotropia.

Child↗
PubMed2000

Evaluation of fluid collection in the pericardial sinuses and recesses: noncontrast-enhanced electron beam tomography.

RATIONALE AND OBJECTIVES: To evaluate the attenuation, size, and volume of the pericardial sinuses and recesses by using electrocardiographically triggered, noncontrast-enhanced electron beam tomography (EBT) and to consider its relation with sex, age, and heart volume. METHODS: Findings in 213 consecutive patients without known pericardial disease were studied. The patients underwent EBT scanning of the heart to evaluate coronary artery calcification. Incremental electrocardiographically triggered noncontrast images were obtained with a 100-ms exposure time and a 3-mm slice thickness. The appearance, density, and volume of the pericardial sinuses and recesses were calculated. RESULTS: Among the 213 patients, 97.2% had at least one of the sinuses or recesses visible on EBT. The sinuses or recesses were seen with the following frequency: transverse sinus (93.9%), oblique sinus (71.8%), and superior aortic recess (51.2%). The mean attenuation and volume were 9.9 +/- 7.3 Hounsfield units (HU), 12.6 +/- 8.1 HU, and 12.6 +/- 8.7 HU, and 1.9 +/- 1.3 mL, 1.3 +/- 1.0 mL, and 0.8 +/- 0.8 mL, respectively. The total volume of the pericardial sinuses (3.3 +/- 2.2 mL) had no significant relation with the total heart volume. CONCLUSIONS: Pericardial sinuses and recesses were frequently and well depicted on noncontrast EBT images. In patients without obvious pericardial effusion, physiological fluid collections were observed in the transverse and oblique sinuses or other recesses. Location, attenuation, and volume were helpful in the differentiation of normal pericardial sinuses from pericardial effusions and mediastinal lymph nodes.

Adult↗
PubMed1982

Free gingival grafts for the treatment of gingival recession. A review of some techniques.

Free gingival grafts can be utilized, alone or in combination with a coronally positioned flap, for the prevention and the treatment of gingival recession. The graft can be placed directly on the denuded root, as first described by Sullivan & Atkins (1968). This technique will provide adequate results, especially in cases with relatively little recession. After placing a free gingival graft in such an area, one can often observe bridging and/or creeping attachment. In the case of bridging, some of the grafted tissue will remain vital over the avascular zone, i.e. the root. Creeping attachment is the result of coronal migration of the grafted gingiva and will take place during the years following surgery. Bridging and creeping are most likely to occur in cases of narrow recession where the grafts had been placed directly over the denuded zone. In a second type of surgical procedure, an enlargement of the attached gingiva is first obtained through the graft. The area of recession is later covered by a coronally positioned flop. Several cases are presented which illustrate the results obtained with this procedure. In children, when there is insufficient attached gingiva, it is often desirable to place grafts before orthodonic therapy. In the prevention or treatment of gingival recessions, four possibilities may be considered: 1) no treatment, 2) placement of a graft to prevent recession, 3) stabilizing an existing recession, 4) attempt to cover the denuded root.

Adolescent↗
PubMed1996

Sublabral recess of the superior glenoid labrum: study of cadavers with conventional nonenhanced MR imaging, MR arthrography, anatomic dissection, and limited histologic examination.

PURPOSE: To evaluate size, location, and appearance of the sublabral recess of the superior glenoid labrum, which mimics a superior labral tear oriented in the anterior to posterior direction (SLAP) lesion with conventional magnetic resonance (MR) imaging, MR arthrography, gross dissection, and limited histologic evaluation. MATERIALS AND METHODS: Twenty-six cadaveric shoulder specimens that were freshly frozen were examined with nonenhanced MR imaging and with MR arthrography after intraarticular injection of dilute contrast material with gadolinium. In all specimens, the appearance of the superior glenolabral junction was categorized and was correlated to that seen at gross anatomic dissection. Histologic sections were obtained of two shoulders with large sublabral recesses in the plane of the MR sections. RESULTS: A sublabral recess was present in 19 (73%) shoulders and was deeper than 2 mm in 10 (39%). MR arthrography better demonstrated the sublabral recess than nonenhanced MR imaging. In 16 of 19 shoulders, the sublabral recess was located in the most anterior section obtained through the superior labrum. There was no definite correlation between subject age and sex and glenolabral junction type. At histologic examination of the two shoulders, a synovial lining of the sublabral recess was seen and there was no evidence of fibrosis to suggest a traumatic cause. CONCLUSION: A sublabral recess is common in cadaveric shoulders and has an appearance similar to that of published examples of SLAP lesions. Histologic findings were consistent with normal anatomic structure rather than with acquired, posttraumatic lesions.

Cadaver↗
PubMedDate not supplied

Cochlear orientation and dimensions of the facial recess in cochlear implantation.

OBJECTIVE: To study the dimensions of the facial recess and the spatial relationship between the facial recess and the cochlea, using CT scanning in cochlear implantees. METHOD: In 29 cochlear implantees, preoperative CT scans of the temporal bone were compared with findings done at surgery. The dimensions of the facial recess and the relationship between the facial recess and the cochlea were both measured on a viewing station and classified on printed films by 3 blinded and independent reviewers. RESULTS: No significant relations could be found between either intuitive classification of facial recess width or electrode array insertion feasibility and the measurements with the viewing station. The 3 reviewers had large interobserver variability. In 5 cases, neither intuitive review of the CT scans nor viewing station measurements could predict any of the problems encountered during surgery. CONCLUSION: Our findings show that intuitive review was not reliable in classifying facial recess width. Viewing station measurements, in classifying the spatial relation between the facial recess and the cochlear basal turn, need a more detailed review in terms of the relationship with the operation direction and the orientation of the basal turn of the cochlea. Advanced imaging techniques, specifically multislice CT, might improve the diagnostic capabilities.

Chorda Tympani Nerve↗
PubMed1992

Azygoesophageal recess: normal CT appearance in children.

The azygoesophageal recess is the interface of the subcarinal portion of the mediastinum and the right lower lobe. The configuration of the recess on CT can be used as a sensitive indicator of abnormality in the mediastinum. In normal adults the recess is concave. A convex contour is a normal variant, particularly in young adults. The normal appearance of the azygoesophageal recess in children has not been studied. Accordingly, we reviewed chest CT examinations performed in 253 children ranging from 1 month to 20 years old. Forty patients were excluded from further analysis either because the recess could not be evaluated properly or because underlying disease caused the mediastinum to have an abnormal configuration. An age-related spectrum of normal configurations was observed in the remaining 213 patients. A convex or straight contour was found in 96% of children less than 3 years old. Scans of children 3-12 years old revealed a spectrum of configurations. The typical adult concave configuration was seen in 78% of adolescents more than 12 years old. Overall, in only 90 (42%) of 213 children in this study was a concave recess observed on CT. Our experience shows a convex azygoesophageal recess on CT should be considered the normal configuration in infants and young children. Recognition of this age-related variation is useful in the CT evaluation of the mediastinum in children.

Adolescent↗
PubMed1989

Pathologic findings after recession and resection of extraocular muscles in rabbits.

A study on the pathologic findings after recession and resection of extraocular muscles in rabbits was performed. Fibrosis of the extraocular muscles increased with time, which showed no difference between the recessed and resected muscles. Inflammation and foreign body reaction decreased with time, which showed no difference between the recessed and resected muscles. Adhesions of extraocular muscles to the sclera were observed from one month after the operation. The resected muscles showed milder adhesion to the sclera than the recessed ones. The operated extraocular muscles showed atrophies at one month, which showed no difference between the recessed and resected muscles. According to our results, when reoperation is needed, fibrosis of the extraocular muscles after recession and resection should be considered when making a decision on the amount of muscle to be recessed and resected.

Animals↗
PubMedDate not supplied

How far can a medial rectus safely be recessed?

Previous studies have suggested that the location of the equator should be important in determining the site of a "safe maximum recession" of a rectus muscle, and that the location of the equator should be a function of axial length. Exactly where in relationship to the equator a muscle can be safely recessed has never been scientifically determined. Over a 4-year period, we measured axial length on all patients we operated on for strabismus. Using a previously derived formula, we were able to calculate the limbus-to-equator distance, given axial length. Based on our analysis of 28 patients in whom we recessed one or both medial recti posterior to the equator, we believe that recessions of the medial recti up to 1.5 mm posterior to the equator should not produce postoperative medial rectus underaction associated with an overcorrection, but recessions that are further than 1.5 mm posterior to the equator may do so. Recessions to a point greater than 11 mm from the limbus do not appear to be associated with late progressive overcorrection provided that the site of recession is not greater than 1.5 mm posterior to the equator. Using our previously determined formula for estimating the location of the equator, given axial length, we have generated easy-to-use reference tables for determining the location of the equator in terms of millimeters posterior to the limbus. Also, based on axial length data from 180 strabismus patients, we have generated an algorithm for predicting axial length, given age, and refractive error, which may be useful to the strabismus surgeon in predicting the location of the equator when A-scan ultrasonography is not available.

Algorithms↗
PubMed1991

[CT evaluation of the anterior epitympanic recess--comparison among non-inflammatory ear, chronic otitis media with central perforation and cholesteatoma].

The structures of the anterior epitympanic recess and its surrounding tissues were examined among non-inflammatory ear, chronic otitis media with central perforation and cholesteatoma, using axial scans of high resolution computed tomography. The length and width of the recess, as well as the number of the slices where the cog was determined, had no significant differences among them. Thus, the bony structure of the recess was considered to be seldom influenced by inflammatory processes. In the non-inflammatory ear, the degree of pneumatization around the recess was similar to that of the petrous apex cells and lower than that of the mastoid cells. In the chronic otitis media with central perforation and cholesteatoma, the pneumatization of the whole temporal bones was suppressed and the tendency was also found that the cells around the recess were less pneumatized than the mastoid cells. When cholesteatoma invaded into the anterior epitympanic recess, the destruction of the bony protrusion of the lateral wall between the recess and the epitympanum was recognized, as well as the disappearance of the cog. The bony protrusion was considered to be an inferior extension of the cog toward the anterior tympanic spine.

Cholesteatoma↗
PubMed2003

Lumbar root compression in the lateral recess: MR imaging, conventional myelography, and CT myelography comparison with surgical confirmation.

BACKGROUND AND PURPOSE: Previous authors have shown that conventional myelography is superior to plain CT in the assessment of root compression in the lateral recess, but this question has never been evaluated with respect to MR imaging of the lumbar level. Our purpose was to assess the accuracy of MR imaging, conventional myelography, and postmyelography CT (CT myelography) of the lumbar level in identifying degenerative lateral recess root compression with surgical confirmation. METHODS: MR imaging, conventional myelography, and CT myelography of the lumbar level were assessed in the imaging of 58 lateral recesses at 38 lumbar levels in 26 patients who underwent surgery for radiculopathy with degenerative lateral recess abnormality. Each lateral recess was graded as normal, small without root compression, small with root compression, or severe root compression. RESULTS: MR imaging underestimated root compression in 28% to 29% of the cases in which root impingement was surgically confirmed. Conventional myelography underestimated root compression in only 5% to 7% of the cases and correctly predicted impingement in 93% to 95%. CT myelography underestimated root compression in 38% of the surgically confirmed cases. CONCLUSION: MR imaging significantly underestimated root compression caused by degenerative changes in the lateral recess. Although MR imaging is a superb study when used in the search for degenerative disk disease and disk protrusion, conventional myelography is a crucial supplemental study that is necessary to confirm degenerative root impingement in the lateral recess as the cause of radiculopathy.

Adult↗
PubMed1992

Recession of periodontal ligament as an indicator of age.

The recession of the periodontal ligament has been used as one of several indicators of age in methods for age estimation. In a sample of 1000 teeth the relationship between age and periodontal recession was studied for each type of tooth. Only a weak correlation was found, the least weak being for premolars. The mean of the periodontal recession measured in mm showed approximately the same correlation as when assessed by scoring systems. Logarithmic transformation of the mean of the recession resulted in a stronger correlation with age. The use of tooth age rather than individual age did not have the same effect. Periodontal recession tended to be more rapid in males than in females. The reason for extraction was not found to be significantly correlated with periodontal recession. In conclusion, periodontal recession was not sufficiently accurate to be used as a sole indicator of age. However, in multiple regression methods for age estimation it might contribute significantly to the age equation, especially for premolars.

Adult↗
PubMed2005

Concha bullosa types: their relationship with sinusitis, ostiomeatal and frontal recess disease.

PURPOSE: To assess the relationship among the concha bullosa types and sinusitis, ostiomeatal and frontal recess disease. MATERIALS AND METHODS: Computed tomography (CT) studies of 76 patients diagnosed with concha bullosa were reviewed retrospectively. All examinations were performed for evaluation of a symptom referable to sinonasal region. Concha bullosa cases were grouped according to the location of pneumatization of middle concha as lamellar, bulbous, and extensive. Each group was compared according to sinus, ostiomeatal and frontal recess disease. We have assessed the location of ostium (frontal recess, air cells along the basal lamella, hiatus semilunaris) with respect to the types of concha bullosa. RESULTS: There was not a significant relationship between concha bullosa types and sinus disease, ostiomeatal disease, and frontal recess disease (p > 0.05). The location of ostium of the bulbous type was the hiatus semilunaris (p < 0.05) and that of the extensive type was the frontal recess (p < 0.05) preferentially. CONCLUSION: There is no statistically significant difference between lamellar, bulbous and extensive type concha bullosas in terms of sinus disease, ostiomeatal disease and frontal recess disease incidence. Bulbous type preferentially drains into the hiatus semilunaris, and extensive into the frontal recess.

Adolescent↗
PubMed1998

Results of large (8-9 mm) bilateral lateral rectus muscle recessions for exotropia.

PURPOSE: Commonly recommended maximum lateral rectus muscle recession for exotropia ranges from as little as 7 mm to as much as 11 mm. Published studies on recessions of 8 mm or more are scarce. Many ophthalmic surgeons still avoid recessions larger than 7 mm because of the fear of creating abduction deficits and surgical overcorrections. Therefore, we sought to determine the incidence of clinically detectable abduction deficits and their correlation with early surgical overcorrection in exotropic patients who had undergone large 8 to 9 mm lateral rectus muscle recessions. SUBJECTS AND METHODS: A retrospective chart review identified 30 patients with exotropia ranging from 35delta to 65delta who were treated with 8 to 9 mm recessions of both lateral rectus muscles. Patients with concurrent oblique muscle surgery were included. Mean followup time was 15 months (range 3-30 mos). RESULTS: Twenty-four patients (80%) required only one operation. The remaining 6 patients (20%) required a second operation, four for overcorrection and two for undercorrection. Nine patients (30%) had mild but persistent abduction deficits postoperatively. However, abduction deficits were not predictive of poor outcome (p=0.959). Other variables that did not significantly affect outcome included age (p=0.894), systemic anomalies (p=0.127), size of preoperative exotropia (p=0.987) and amount of rectus muscle recession (p=0.480). However, concurrent oblique muscle surgery was associated with a higher risk of a poor result. CONCLUSIONS: 8-9 mm lateral rectus recessions are not associated with a poor outcome, except in association with concurrent oblique muscle surgery.

Adolescent↗
PubMed1986

Somatic events unmask recessive cancer genes to initiate malignancy.

A heritable mutation predisposes an individual to certain childhood malignancies, such as retinoblastoma and Wilms' tumor. The chromosomal locations of the genes responsible for the predisposition are known by linkage with chromosomal deletions and enzyme markers. A study of these tumors in comparison to the normal constitutional cells of the patients, using enzyme and DNA markers near the predisposing genes, has shown that these genes are recessive to normal wild-type alleles at the cellular level. Expression of the recessive phenotype (malignancy) involves the same genetic events that were observed in Chinese hamster cell hybrids carrying recessive drug resistance genes. In both the experimental and clinical situations, the wild-type allele is most commonly eliminated by chromosome loss with duplication of the mutant chromosome. Simple chromosome loss and mitotic recombination have been documented in both systems. In the remaining 30% of cases, inactivation or microdeletion of the wild-type allele are assumed to be responsible for expression of the recessive phenotype. Osteosarcoma is a common second tumor in patients who have had retinoblastoma. Studies with markers in osteosarcoma show that these tumors also result from unmasking of the recessive phenotype by loss of the normal allele at the retinoblastoma locus, whether or not the patient had retinoblastoma. Subsequent chromosomal rearrangements and amplification of oncogenes that occur in these homozygous tumors provide progressive growth advantage. In other malignancies, in which studies have so far focused on oncogene amplification and chromosomal rearrangements, unmasking of recessive mutations may also be the critical initiating events.

Animals↗
PubMed2003

The 10 autosomal recessive limb-girdle muscular dystrophies.

Fifteen forms of limb-girdle muscular dystrophies (5 autosomal dominant and 10 autosomal recessive) have already been found. The 10 genes responsible for the autosomal recessive forms, which account for more than 90% of the cases, had their product identified. This review will focus on the most recent data on autosomal recessive-limb-girdle muscular dystrophy and on our own experience of more than 300 patients studied from 120 families who were classified (based on DNA, linkage and muscle protein analysis) in eight different forms of autosomal recessive-limb-girdle muscular dystrophy. Genotype-phenotype correlations in this highly heterogeneous group confirm that patients with mutations in different genes may be clinically indistinguishable. On the other hand, for most forms of autosomal recessive-limb-girdle muscular dystrophy a discordant phenotype, ranging from a relatively severe course to mildly affected or asymptomatic carriers may be seen in patients carrying the same mutation even within the same family. A gender difference in the severity of the phenotype might exist for some forms of autosomal recessive-limb-girdle muscular dystrophy, such as calpainopathy and telethoninopathy but not for others, such as dysferlinopathies or sarcoglycanopathies. Understanding similarities in patients affected by mutations in different genes, differences in patients carrying the same mutations or why some muscles are affected while others are spared remains a major challenge. It will depend on future knowledge of gene expression, gene and protein interactions and on identifying modifying genes and other factors underlying clinical variability.

Animals↗
PubMed2002

Comparative study of Emdogain and coronally advanced flap technique in the treatment of human gingival recessions. A prospective controlled clinical study.

OBJECTIVES: Various surgical techniques have been proposed for coverage of denuded root surfaces. The aim of this study was to evaluate a comparison of coronally repositioned flap procedure with or without the use of enamel matrix proteins in the treatment of recession defects. MATERIAL AND METHODS: This study was an intra-individual longitudinal test of 12 months duration conducted as a blinded, split-mouth, placebo-controlled and randomised design. It was performed in 2 dental schools. 36 patients, aged 22-62 years, with 2 paired buccal recession defects of at least 3 mm participated. Surgical recession coverage was performed as coronally-advanced flap technique at both sites in the same session. One site was additionally treated with commercially-available enamel matrix proteins (Emdogain) and the other site with placebo (propylene glycol alginate) in accordance with the randomisation list. A blinded examiner assessed pre- and post-surgical measurements. Clinical measurements and photographs were taken pre-surgically and after 1 week, 3 weeks, 3 months, 6 months and 12 months, postoperatively. Measurements comprised height and width of the gingival recession, height of keratinized tissue, probing attachment level, probing pocket depth and alveolar bone level by periodontal probe, Florida Probe or caliper to the nearest 0.5 mm. RESULTS: 12 months after therapy, both treatment modalities showed significant root coverage and probing attachment gain. Gingival recession decreased from 3.7 mm to 0.8 mm for the Emdogain treated sites and from 3.9 mm to 1.0 mm for the control sites, corresponding to mean root coverages of 80% and 79%, respectively. This difference was not significant. With the exception of keratinized tissue gain, which was significantly higher (p=0.003) in the Emdogain group, all other clinical variables were not different in the between-group comparison. CONCLUSIONS: As the additional use of Emdogain together with coronally advanced flap technique for recession coverage showed no difference in the overall clinical outcome, there is no clear benefit to combine Emdogain with this surgical technique.

Adult↗
PubMed1994

The association between spontaneous reversal of gingival recession in mandibular incisors and dentofacial changes in children. A 3-year longitudinal study.

In a previous 3-year longitudinal study, reversal of gingival recession in mandibular incisors was observed for 16 out of 28 participating children aged 6-13 years (Andlin-Sobocki et al., 1991). In the present report various dentofacial conditions that might be associated with this reversal were evaluated from dental casts and cephalometric radiographs by comparing the 16 children with spontaneous reversal of gingival recession (Group Rev) to the 12 children with persisting gingival recession (Group Per). Dental casts and cephalometric radiographs were obtained at baseline and after three years. The findings indicate that the children with persisting gingival recession tended to have a particular facial morphology and incisor pattern. They were likely to have a larger basal bone discrepancy between the maxillary and mandibular jaws, with somewhat more proclined and more irregularly positioned mandibular incisors. Although a reduction in incisor irregularity and a slight increase in anterior arch widths occurred for both groups during the observation period, the tooth alignment situation in Group Per at the end of the observation period was similar to that of Group Rev at baseline. Additionally, in Group Rev all facially deviating incisors with recession at baseline had self-corrected at 3 years. This was not the case for Group Per. Thus, spontaneous reversal of gingival recession in mandibular incisors seem to be related to developmental changes in the dentition favouring incisor alignment.

Adolescent↗
PubMed2006

Complete association between a retroviral insertion in the tyrosinase gene and the recessive white mutation in chickens.

BACKGROUND: In chickens, three mutant alleles have been reported at the C locus, including the albino mutation, and the recessive white mutation, which is characterized by white plumage and pigmented eyes. The albino mutation was found to be a 6 bp deletion in the tyrosinase (TYR) gene. The present work describes an approach to identify the structural rearrangement in the TYR gene associated with the recessive white mutation. RESULTS: Molecular analysis of the chicken TYR gene has revealed a major structural difference (Restriction Fragment Length Polymorphism, RFLP) in the genomic DNA of the recessive white chicken. A major size difference of 7.7 kb was found in intron 4 of the TYR gene by long-range PCR. Molecular cloning and sequencing results showed the insertion of a complete avian retroviral sequence of the Avian Leukosis Virus (ALV) family. Several aberrant transcripts of the tyrosinase gene were found in 10 week old recessive white chickens but not in the homozygous wild type colored chicken. We established a rapid genotyping diagnostic test based on the discovery of this retroviral insertion. It shows that all homozygous carriers of this insertion had a white plumage in various chicken strains. Furthermore, it was possible to distinguish heterozygous carriers from homozygous normal chickens in a segregating line. CONCLUSION: In this study, we conclude that the insertion of a complete avian retroviral sequence in intron 4 of the tyrosinase gene is diagnostic of the recessive white mutation in chickens. This insertion causes aberrant transcripts lacking exon 5, and we propose that this insertion is the causal mutation for the recessive white allele in the chicken.

Animals↗