Kasvupaikan ja puuston tiheyden vaikutus rauduskoivun ulkoiseen laatuun 30-vuotiaissa istutuskoivikoissa

TutkimusartikkeliSamanikäisten rauduskoivujen pituus ei eronnut pelto- ja metsämailla, mutta läpimitta oli peltomailla keskimäärin 1 cm suurempi. Metsämailla istutuskoivut olivat lähes kaikilta laatuominaisuuksiltaan parempia kuin peltomailla. Vain alaoksien kuivumisessa ja karsiutumisessa ei ollut eroa. Peltokoivujen paksummat oksat ja voimakkaampi kapeneminen selittyivät vain osittain puiden nopeammalla paksuuskasvulla. Pintaviat ja mutkaisuus olivat yleisempiä peltomailla, mutta pystyoksia esiintyi vähän enemmän metsämailla. Tyvimutkia, lenkoutta ja halkeamia oli metsä- ja peltomailla yhtä paljon. Metsämaiden istutuskoivuissa oli vikoja yhtä paljon tai vähemmän kuin aikaisemmin tutkituissa luonnonkoivuissa. Nopeamman kasvun takia istutuskoivujen oksat olivat paksumpia, mutta tyviosan karsiutumisessa ei ollut suurta eroa. §§ Hienojen lajitteiden lisääntyminen maassa vähensi koivun runkomuotovikoja, mutta lisäsi rungon kapenemista ja hidasti alaoksien karsiutumista. Lajittunut hietamaa ja toisaalta hiekkamoreeni osoittautuivat oksaisuuslaadun kannalta parhaiksi kasvupaikoiksi rauduskoivulle, mutta tyvimutkia ja lenkoutta niillä esiintyi tavallista enemmän. Kasvun kannalta moreenimaat olivat edullisimpia. Hiesu- ja savimaat olivat sekä kasvun että oksaisuuden suhteen muita kivennäismaita heikoimpia. Suuri orgaanisen aineksen osuus kivennäismaassa edisti koivun paksuuskasvua, mutta lisäsi oksaisuutta ja haaraisuuta. Maalaji vaikutti koivun kasvuun ja laatuun enemmän metsämailla kuin peltomailla. §§ Rauduskoivun nopea pituuskehitys vähensi koivun oksaisuutta ja paransi ruunkomuotoa, mutta lisäsi hiukan lenkoutta ja tyvimutkaisuutta. Myös kasvatustiheyden kohoaminen paransi koivun laatua vähentämällä rungon kapenemista ja edistämällä alaoksien kuolemista. Saman paksuisten puiden oksanpaksuus aleni runkoluvun kohotessa metsämailla, mutta peltomailla eroa ei havaittu. Harvennusten viivästyminen hidasti kuivien oksien karsiutumista ja supisti elävää latvusta. Tyvimutkia, lenkoutta ja halkeamia esiintyi tiheissä koivikoissa vähemmän kuin harvoissa

Atypical Craniosynostosis with Torticollis and Neurological Symptoms: A Rhombencephalosynapsis Sequence

Purpose. We describe a case of 3-year-old girl with rhombencephalosynapsis, a rare cerebellar anomaly. Patient. A 3-year-old girl was admitted to our hospital due to congenital torticollis and asymmetry of face, skull and trunk. Craniosynostosis was suspected due to abnormal head shape. 3D-CT revealed closure of the sagittal suture without scaphocephalic skull. Due to atypical craniosynostosis with neurological symptoms, brain-MRI was performed revealing rhombencephalosynapsis. Results. Our patient presented with atypical craniosynostosis and balance problems, not typical for scaphocephaly. Operative treatment for craniosynotosis was not carried out because the cause of the problems was the cerebellum instead of the brain. Conclusions. Therefore, we conclude that patients with atypical craniosynostosis should be examined with brain-MRI to exclude the intracranial malformations, which 3D-CT does not reveal. Without brain-MRI, decision (not) to perform surgery could have been different

Somatosensory evoked potentials are abnormal with plagiocephaly

Publisher Copyright: © 2022 Korean Cleft Palate-Craniofacial Association.Background: Deformational plagiocephaly is usually managed conservatively, as it tends to improve over time and with the use of conser-vative measures. However, before the year 2017 we operated on patients with severe plagiocephaly and neurological symptoms at the Helsinki Cleft Palate and Craniofacial Center. Methods: Of the 20 infants with severe deformational plagiocephaly and neurological symptoms referred to us between 2014 and 2016, 10 underwent cranioplasty open reshaping of the posterior cranial vault. The parents of the last 10 patients were given information on the natural history of the condition and the patients were followed up with an outpatient protocol. The aim of this study was to gain information on the brain electrophysiology and recovery of patients after total cranial vault reconstruction by measuring the electroencephalogram (EEG) somatosensory evoked potentials (SEP; median nerve). Results: Of the 10 participants in the operation arm, six had abnormal SEP at least on the affected cerebral hemisphere and all SEPs were recorded as normal when controlled postoperatively. In the follow-up arm, eight out of 10 participants had abnormal SEP at the age of ap-proximately 24 months, and all had normalized SEPs at control visits. Conclusion: Our data suggest that cranioplasty open reshaping of the posterior cranial vault did not affect abnormal SEP-EEG recordings. We have abandoned the operations in deformational plagiocephaly patients due to findings suggesting that expanding cranioplasty is not beneficial for brain function in this patient group.Peer reviewe

Use of black-bone MRI in the diagnosis of the patients with posterior plagiocephaly

Ionising radiation exposure is especially harmful to brain development. The purpose of this study was to evaluate whether black-bone (BB) magnetic resonance imaging (MRI), a non-ionising imaging method, offers an alternative to ionising imaging methods such as computed tomography (CT) in the examination of cranial deformities. From 2012 to 2014, a total of 408 children were referred to the Craniofacial Centre at the Helsinki University Hospital for further examination due to flatness of the posterior skull. Fifteen of these patients required further diagnostic imaging. To avoid ionising radiation, we used an MRI protocol that included sequences for evaluation of both brain anatomy and skull bone and sutures by BB-MRI. A semi-automatic skull segmentation algorithm was developed to facilitate the visualisation. Two patients with scaphocephaly were included in the study to confirm the ability to differentiate synostosis with BB-MRI. We obtained informative 3D images using BB-MRI. Seven patients (7/15, 46.7%) had plagiocephaly on the right side and seven on the left side (7/15, 46.7%). One patient (1/15, 6.7%) had symmetric posterior flatness affecting both sides. Neither structural nor signal-intensity alterations of the brain were detected in visual analysis. BB-MRI provides an alternative to CT when imaging craniofacial deformities. BB-MRI provides not only high-quality 3D-reconstructed imaging of the bony structures and sutures but also information on brain structure in one imaging session. With further development, this method could replace ionising radiation-based methods in analysing deformities of the skull.Peer reviewe

Promoting ossification of calvarial defects in craniosynostosis surgery by demineralized bone plate and bone dust in different age groups

Correction of calvarial defects after calvarial vault reconstruction (CVR) is challenging in craniosynostosis patients of advanced age and typically employs autologous bone. Demineralized bone matrix (DBM) is a potential alternative material for autologous bone, but its use has not been extended to correct calvarial defects. CVR patients operated at the Department of Plastic Surgery, Helsinki University Hospital, during 2008-2010 were retrospectively reviewed. Inclusion criteria of the study were CVR patients who received DBM plate, with or without bone dust, on calvarial defects and who had suitable uncovered defect on the contralateral side as control. This study included 17 craniosynostosis and one positional plagiocephaly patient, whose mean age was 6.9 years (range 0.9-19 years). The mean follow-up time was 5.6 years. The fusion degree of all defects was measured from 1 week to 1 year postoperatively using three-dimensional computed tomography (3D CT) images by the OsiriX (R) method. Medical records were reviewed for DBM-related complications. A total of 26 defects were covered with a DBM plate (mean area 11.1 cm(2)) and 26 control defects were identified (mean area 7.8 cm2). The mean fusion degree of the DBM defects was 74% and 54% for the controls (p 30 months) than in younger patients or when used with bone dust. (C) 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Force measurements during posterior calvarial vault osteodistraction : A novel measurement method

Posterior calvarial vault osteodistraction (PCVO) has become increasingly popular in the correction of craniosynostosis. When compared to cranioplasty, PCVO offers a shorter, less invasive operation, greater intracranial volume advancement and a lower rate of relapse. In general, distraction protocols are based primarily on clinical observations rather than systematic research. Faster distraction protocols may reduce complications. However, distraction protocols producing higher forces can increase complications. Thus, we need to understand these forces in order to improve distraction protocols and devices. We developed a force measurement method that can be used on PCVO devices. Here, we present preliminary data about the forces developed during PCVO. We measured the forces in four bicoronal craniosynostosis patients during PCVO. We observed a linear-like trend between the force increase and the distraction distance within distraction sessions. We also observed a step-wise force increase between distraction sessions and found that the distraction force relaxed rapidly shortly after the distraction session. The mean maximum pre distraction force for one distracter was 20.4 N, while the mean maximum end-distraction force for one distracter was 57.6 N. Our data suggests that current treatment protocols might be re-evaluated favouring shorter distraction distances and more frequent distraction sessions. (C) 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.Peer reviewe