[Applied anatomy of the fontanelles]

OBJECTIVE

To make a description of the anatomy of fontanelles and to update what is currently known about their applications.

METHOD

7 cadaveric heads, 2 dry skulls and 2 frontal bones of foetus were used, and 48 anterior fontanelles from paediatric patients with or without associated pathology were examined. Surgical cases and neurosonography were also used. All the structures were measured and subsequently analysed.

RESULTS

The size, structure and limits of the fontanelles were evidenced in the cadaveric head and skulls, as well as the evaluation of paediatric patients and the size of their fontanelles in different pathologies.

CONCLUSION

Owing to their anatomical characteristics, fontanelles are a true window to the inside of the skull, which determines their multiple clinical and surgical applications.

The effects of heat-induced pain on the detectability, discriminability, and sensation magnitude of vibrotactile stimuli

The effects of heat-induced pain on absolute thresholds, sensation magnitudes and amplitude-difference thresholds were measured at 10 and 100 Hz. Consistent with previous results, heat-induced pain elevated the absolute thresholds by approximately 8.0 dB and lessened the magnitudes of tactile sensations during pain as compared to the non-painful condition. In contrast to these effects, the discriminability of change in the intensity of the vibrotactile stimuli was unaffected by the presence of pain indicating that the effect of pain on tactile sensations is more likely due to sensory rather than cognitive processes (i.e., attention) and that the mechanisms underlying tactile sensitivity as compared to discriminability are different.

Our "idèes fixes" in rhinoplasty: the naso-frontal angle and the alar lateral crus

An examination of the naso-frontal angle shows that a cranial or caudal shift in position affects the dorsum length. The fundamental aspect characterizing the naso-frontal angle is its width: it may be normal, too wide, or too narrow. It's easier to modify a too-narrow angle than a too-wide one. We show surgical techniques, emphasizing their method applied to the over-wide angle. The second "idèe fixe" is the morphology of the alar lateral crus. Every variety of this structure has a peculiar property of shape and relationship with other elements that predetermines the therapeutic action. Diagrams and photographs are shown to describe the surgical techniques and the clinical results. There is also a demonstration of the method for alar lateral crus resection, which we call "the long keel shape," since it resembles the shape of a sailboat keel.

Nonevaluative social support reduces cardiovascular reactivity in young women during acutely stressful performance situations

We tested whether the presence of a stranger reduces cardiovascular responses during stressful tasks if the evaluation potential of the stranger is minimized and whether cardiovascular responses are affected by the quality of support in a friendship. Undergraduate women performed stressful tasks in one of three conditions: Alone, with a same-sex Stranger, or with a same-sex best Friend. The stranger and friend could not hear participants' responses. Alone women had the greatest increases in SBP and HR while women in the Stranger and Friend conditions did not differ in their responses. In the Friend condition, HR responses were smallest in women who were highly satisfied with the support that they generally received from their friend. We conclude that the presence of a nonevaluative friend or stranger can reduce cardiovascular responses and that the quality of supportive ties modulates the impact of those ties on responses to stress.

Primary reconstruction of the ala nasi in cleft Lip

Displacement of the lateral crus of the alar cartilage of the nose in cleft lip is demonstrable in diagrams showing the pathological anatomy of this deformity. An account is given of our method used for several years, whereby the lateral limb is returned to a more natural position, alar convexity is restored, and the angle between the limbs is corrected. Two flaps taken from the inside surface of the nostril are alternated. The caudal one is a full-thickness flap composed of vestibular skin, while the cranial flap comprises the cartilage and the vestibular mucosa; the lateral limb is left attached to the mucosa. Alternation does not require any interruption of cartilage continuity, so there is no risk of surgical damage to the perichondrium and cartilage in young subjects. The two limbs (particularly the lateral one) are positioned in such a way that their normal growth can be expected, as shown by the aesthetic results on follow-up after a period of many years. This method is a primary reconstruction technique of the ala nasi, applied at the same time as the lip repair and compatible with current methods.

Perceptual and coping processes across the menstrual cycle: an investigation in a premenstrual syndrome clinic and a community sample

Patients from a premenstrual symptoms clinic and asymptomatic controls monitored perceived stressors, coping processes, and emotional and physical symptoms daily for a complete menstrual cycle. Within-group comparisons revealed that, premenstrually, the patients reported encountering a greater number of personal competency stressors than they did postmenstrually. Between-group comparisons indicated that the patients encountered more stressors and perceived them as more stressful during the premenstruum than controls did, whereas postmenstrually the groups showed no difference in perceptual style. The patients used situational redefinition as a coping process during the premenstrual phase less frequently than the controls did. We observed positive relationships for patients between daily stressors and emotional and physical symptoms both premenstrually and postmenstrually. For controls, the only relationship demonstrated was that depression was associated with perceived stressfulness of stressors during the premenstrual phase. Results are discussed in the context of psychosocial factors (stressors, appraisal, and coping processes) influencing the manifestation of premenstrual symptoms.

Surgery of the naso-frontal angle

The naso-frontal angle is one of the features that most markedly determines the morphology of the human face. Two main morphological elements must be taken into consideration: the slope of the forehead and the line of nasal dorsum. For a balanced physiognomy, nevertheless, it is necessary to achieve a correct interaction of the length and width of nasal pyramid, the naso-labial angle, and the chin. Closer examination of the naso-frontal angle shows that a cranial or caudal shift in its position affects the length of the dorsum; however, the fundamental aspect characterizing the naso-frontal angle is its width: it may be normal, too wide, or too narrow. Turning to surgical correction, the authors state that it is easier to modify an over-narrow angle, than one that is too wide. The authors show the single surgical techniques adopted for the correction of the angle, emphasizing the personal method applied to the overwide angle.

Psychological aspects of Brazilian women with fibromyalgia

In order to determine the occurrence of psychological disturbances the authors studied 47 women who fulfilled the American College of Rheumatology Criteria for the classification of fibromyalgia and 25 random selected control patients without chronic muscle pain, all of whom live in Sorocaba, SP, Brazil. Personality disturbances were observable in 63.8% of the patients and 8.0% of the control group (p < 0.05); depression in 80.0% of the fibromyalgia group and 12.0% of the controls (p < 0.05) and anxiety in 63.8% of the patients and 16.0% of the controls (p < 0.05). The Hamilton test mean scores showed higher values for depression and anxiety among the fibromyalgia patients when compared to the control group. A significant association between fibromyalgia and depression, anxiety and personality disturbances was studied and recorded.

Psychosocial factors in premenstrual dysphoria: stressors, appraisal, and coping processes

Relationships between event content of daily stressors, appraisal of daily stressors, coping processes, and menstrual cycle phase were examined in women with premenstrual dysphoria (PMD) and controls. Seventy-eight women completed the Daily Rating Form, the Daily Coping Scale and the Multiple Affect Adjective Checklist-Revised on a daily basis during the premenstrual and postmenstrual phases. No premenstrual-postmenstrual differences in frequency of occurrence of stressors were reported. Academic and interpersonal stressors were the most frequently reported stressors during both cycle phases. PMD women appraised daily stressors as being more stressful, undesirable, and changeable premenstrually than postmenstrually as compared to controls. Catharsis was used more frequently premenstrually as compared to postmenstrually by PMD women. Premenstrually, women with PMD sought social support more frequently than controls. Interactive relationships between appraisal and coping style varied as a function of cycle phase for PMD women. A state-dependent model of menstrual-related mood changes is supported.

The nasofrontal angle and profile in rhinoplasty: case presentations

Current anthropometric measurements establish the nasofrontal angle. However, it is unwise to establish the lines and equilibrium of volumes of the face within fixed geometrical parameters. Even the data given by various forms of rhinometers do no seem to be suitable since they do not take into account the inclination and curvature of the forehead. The authors thus prefer to study the individual to be treated within a program of harmonization of the three areas of the face, the upper, middle, and lower thirds. The results of treatment utilizing this concept are depicted.

[Treatment of tumors of some structures of the splanchocranium]

The results of long experience with many methods of reconstructive surgery following destruction of various splanchnocranial structures are presented. Emphasis is placed on the usefulness of cooperation between the oncological and plastic surgeon. Fifteen cases are illustrated. In many of these, endoarterial infusion of chemical antiblastics was first employed. Since tumours may vary considerably in site and histological type, as well in the biotype, age and sex of the patient, and since a variety of radical and reconstructive techniques exist for individual or associated use, therapeutical programmes cannot be put forward with any degree of confidence, but must obviously be determined by the surgeon's personal experience.

[Some elective procedures for cranioplasty]

The literature methods for cranioplasty in the repair of losses of bone substance are described. Autologous bone grafts from the iliac ala or the ribs are used at the Turin University Reconstructive Plastic Surgery Department. A method using solid silicone is also employed and will be discussed in greater detail in a subsequent paper. Three illustrative cases are presented.