Orthognathic Surgery in the Young Cleft Patient: Preliminary Study on Subsequent Facial Growth

Purpose: This study evaluated the long-term effects of orthognathic surgery on subsequent growth of the maxillomandibular complex in the young cleft patient. Patients and Methods: We evaluated 12 young cleft patients (9 male and 3 female patients), with a mean age of 12 years 6 months (range, 9 years 8 months to 15 years 4 months), who underwent Le Fort I osteotomies, with maxillary advancement, expansion, and/or downgrafting, by use of autogenous bone or hydroxyapatite grafts, when indicated, for maxillary stabilization. Five patients had concomitant osteotomies of the mandibular ramus. All patients had presurgical and postsurgical orthodontic treatment to control the occlusion. Radiographs taken at initial evaluation (T1) and presurgery (T2) were compared to establish the facial growth vector before surgery, whereas radiographs taken immediately postsurgery (T3) and at longest follow-up (T4) were used to determine postsurgical growth. Each patient's lateral cephalograms were traced, and 16 landmarks were identified and used to compute 11 measurements describing presurgical and postsurgical growth. Results: Before surgery, all patients had relatively normal growth. After surgery, cephalograms showed statistically significant growth changes from T3 to T4, with the maxillary depth decreasing by -3.3° ± 1.8°, Sella-nasion-point A by -3.3° ± 1.8°, and point A-nasion-point B by -3.6° ± 2.8°. The angulation of the maxillary incisors increased by 9.2° ± 11.7°. Of 12 patients, 11 showed disproportionate postsurgical jaw growth. Maxillary growth occurred predominantly in a vertical vector with no anteroposterior growth, even though most patients had shown anteroposterior growth before surgery. The distance increased in the linear measurement from nasion to gnathion by 10.3 ± 7.9 mm. Four of 5 patients operated on during the mixed dentition phase had teeth that erupted through the cleft area. A variable impairment of postoperative growth was seen with the 2 types of grafting material used. No significant difference was noted in the effect on growth in patients with unilateral clefts versus those with bilateral clefts. The presence of a pharyngeal flap was noted to adversely affect growth, whereas simultaneous mandibular surgery did not. After surgery, 11 of 12 patients tended toward a Class III end-on occlusal relation. Conclusions: Orthognathic surgery may be performed on growing cleft patients when mandated by psychological and/or functional concerns. The surgeon must be cognizant of the adverse postsurgical growth outcomes when performing orthognathic surgery on growing cleft patients with the possibility for further surgery requirements. Performing maxillary osteotomies on cleft patients would be more predictable after completion of facial growth. © 2008 American Association of Oral and Maxillofacial Surgeons.

Suriname: the impact of the May 2006 floods on sustainable livelihoods

Includes bibliography

Doppler ultrasonography principles and methods of evaluation of the reproductive tract in mares

Background: Doppler ultrasonography is a non-invasive real time pulse-wave technique recently used for the transrectal study of the reproductive system hemodynamics in large animals. This technic is based in the Doppler Effect Principle that proposes the change in frequency of a wave for an observer (red blood cells) moving relative to the source of the respective wave (ultrasonic transducer). This method had showed to be effective and useful for the evaluation of the in vivo equine reproductive tract increasing the diagnostic, monitoring, and predictive capabilities of theriogenology in mares. However, an accurate and truthful ultrasonic exam requires the previous knowledge of the Doppler ultrasonography principles. Review: In recent years, the capabilities of ultrasound flow imaging have increased enormously. The current Doppler ultrasound machines offer three methods of evaluation that may be used simultaneously (triplex mode). In B-mode ultrasound, a linear array of transducers simultaneously scans a plane through the tissue that can be viewed as a two-dimensional gray-scale image on screen. This mode is primarily used to identify anatomically a structure for its posterior evaluation using colored ultrasound modes (Color or Spectral modes). Colored ultrasound images of flow, whether Color or Spectral modes, are essentially obtained from measurements of moving red cells. In Color mode, velocity information is presented as a color coded overlay on top of a B-mode image, while Pulsed Wave Doppler provides a measure of the changing velocity throughout the cardiac cycle and the distribution of velocities in the sample volume represented by a spectral graphic. Color images conception varies according to the Doppler Frequency that is the difference between the frequency of received echoes by moving blood red cells and wave frequency transmitted by the transducer. To produce an adequate spectral graphic it is important determine the position and size of the simple gate. Furthermore, blood flow velocity measurement is influence by the intersection angle between ultrasonic pulses and the direction of moving blood-red cells (Doppler angle). Objectively colored ultrasound exam may be done on large arteries of the reproductive tract, as uterine and ovary arteries, or directly on the target tissue (follicle, for example). Mesovarium and mesometrium attachment arteries also can be used for spectral evaluation of the equine reproductive system. Subjectively analysis of the ovarian and uterine vascular perfusion must be done directly on the corpus luteum, follicular wall and uterus (endometrium and myometrium associated), respectively. Power-flow imaging has greater sensitivity to weak blood flow and independent of the Doppler angle, improving the evaluation of vessels with small diameters and slow blood flow. Conclusion: Doppler ultrasonography principles, methods of evaluation and reproductive system anatomy have been described. This knowledge is essential for the competent equipment acquisition and precise collection and analysis of colored ultrasound images. Otherwise, the reporting of inconsistent and not reproducible findings may result in the discredit of Doppler technology ahead of the scientific veterinary community.

Recent resolutions adopted by the United Nations General Assembly, and by ECLAC, which may be of special interest to member countries of the CDCC

Includes bibliography

Summaries of resolutions recently adopted by the United Nations General Assembly, the Economic and Social Council and ECLAC which may be of special interest to member countries of CDCC

Summary Summarises selected resolutions adopted by the forty-third session of the United Nations General Assembly which are of special interest to member countries of the Caribbean Development and Cooperation Committee. These include observer status being granted to the ACS; Cooperation between the UN and the Caribbean Community and Implementation of the World Summit for Social Development.

Latin America: availability of data for demographic estimates on the basis of indirect techniques

Includes bibliography

Guías y principios que podrían ser usados para un acuerdo legal regional = Principles and guidelines which may be used for a regional legal agreement

Incluye Bibliografía

Suggestions regarding the principles which may be adopted by the Caribbean countries in negotiating agreements for the avoidance of double taxation with developed countries

Includes bibliography

Recent increases in shipping costs and their impact on exports from Latin America

This issue of the FAL Bulletin is based on a study prepared by ECLAC which works out a provisional approach for estimating the impact of increases in freight rates on exports from Latin America during the last few quarters. The total cost of exports from the region reflects the increases in three different components: the quantities exported, the prices of the goods and the freight charges. The influence of each of these is estimated.The information bases used are comprised of data obtained from the World Trade Organization (WTO), the United Nations Conference on Trade and Development (UNCTAD), the Economic Commission for Latin America and the Caribbean (ECLAC) (International Transport Database) and the authors own direct compilation. The conclusion is that total exports from Latin America varied by US$ 5.72 billion in the first half of 2004 compared with the first half of 2003; of this amount, US$ 2,105,000,000 correspond to the variation in price and quantity and US$ 3,615,000,000 represent the increase in export freight rates. When compared with the first half of 2002, the variation is in excess of US$ 8 billion.

Recuperação e aplicação do dicromato de potássio proveniente do resíduo de sulfocrômica

A simple procedure for recovering potassium dichromate (K2Cr2O7 ) from treatment of residual sulphochromic solution was proposed in the present work by means of cooling crystallization. The decrease of temperature favored the crystallization of K2Cr2O7 due to the decrease of solubility. 5.0 L of sulphochromic wastes containing 48.08 g L-1 of Cr(VI) were treated and the process of crystallization was performed in three steps until crystals were not formed anymore. On each step the content of Crtotal was determined by flame atomic absorption spectrometry and Cr(VI) by colorimetric method with 1,5- diphenylcarbazide, resulting in the removal of 91% and 92% of Crtotal and Cr(VI), respectively. After the last step, the remaining Cr(VI) in the solution was reduced to Cr(III) from the addition of NaHSO3 , recovering via precipitation in pH 8 approximately 36.13 g of Cr(OH)3 . The final supernatant was discarded since chromium content was below the maximum limit established by the Brazilian legislation for effluents discharge, which corresponds to 0.10 and 1.0 mg L-1 of Cr(VI) and Cr(III), respectively. 628.4 g of K2Cr2O7 were recovered and the salt was characterized by X-ray diffraction and differential thermal analysis. Its applicability was compared to the standard K2Cr2O7 when determining the soil organic matter, in which there was no significant difference, thus inferring that the recovered compound may be incorporated on routine analyses. This recovering process allowed the reuse of K2Cr2O7 , thus reducing costs with the acquisition of new reagents and environmental impacts caused by the inadequate discard of sulphochromic solutions.