Introdução: Reservatórios gastroileais (GI) compostos podem apresentar vantagens em relação a segmentos intestinais isolados em cirurgias de reconstrução urinária em pacientes selecionados. Apresentamos aqui as técnicas laparoscópicas de gastroileocistoplastia (ampliação vesical) e de neobexiga gastroileal ortotópica (substituição vesical), realizadas de forma completamente intracorpórea em um modelo suíno experimental. Avalia-se sua viabilidade técnica e resultados funcionais. Métodos: Após padronização da técnica em estudo piloto (três animais), realizaram-se as cirurgias de gastroileocistoplastia (Grupo I; N = 5) e neobexiga GI ortotópica (Grupo II; N = 10), envolvendo os mesmos princípios de ressecção laparoscópica de cunha gástrica e íleo. No grupo II, a criação da neobexiga GI incluiu reimplante ureteral bilateral no segmento gástrico com técnica antirefluxo e anastomose uretro-ileal. Foram utilizados exclusivamente grampeadores e técnicas de sutura livre laparoscópica, de forma completamente intracorpórea. Análise pré e pós-operatória de dados laboratoriais, capacidade vesical, avaliação histológica e por imagem (uretrocistografia, urografia venosa) dos reservatórios resultantes foi concluída ao final do seguimento de 8 a 12 semanas (Grupo I) e quatro a oito semanas (Grupo II). Resultados: Os segmentos ileal e gástrico alcançaram a pelve do animal em todos os casos. Tempo cirúrgico foi de 5,2 h para o Grupo I e 7,4 h para o Grupo II. Não houve conversões ou óbitos intra-operatórios. Todos os reservatórios GI apresentavam-se viáveis por ocasião da eutanásia em ambos os grupos. No Grupo I, quatro dos cinco animais completaram sem intercorrências o seguimento de 8 (N = 2) e 12 (N = 2) semanas. Um animal apresentou deterioração clínica, sendo levado precocemente à eutanásia por pielonefrite e alcalose metabólica. Houve aumento da capacidade vesical (a uma pressão vesical de 20cmH2O) de 650ml para 1025ml (p < 0,05) após a cirurgia de ampliação vesical. No Grupo II, cinco dos 10 animais completaram o seguimento previsto em quatro (N = 3) e oito (N = 2) semanas, com mínima alteração da função renal (Cr pré e pós-operatório=1,4 e 2,2mg/dl, respectivamente; p = 0,09). Três animais tiveram a eutanásia antecipada devido a obstrução ureteral com pielonefrite (N = 2) e alcalose hipoclorêmica severa (N=1). Dois óbitos foram associados a obstrução ureteral bilateral e sepse. Capacidade vesical média das neobexigas foi de 400ml. Não houve casos de refluxo vesico-ureteral à cistografia. Porém, sete das 20 unidades renais (35%) apresentaram estenose uretero-gástrica. Obstrução intestinal (N = 1), fístula gástrica (N = 1) e urinoma (N = 1) foram outras complicações do Grupo II. Conclusões: A ressecção gástrica laparoscópica para ampliação e substituição vesicais é viável e reprodutível. A gastroileocistoplastia laparoscópica apresenta adequado resultado funcional após três meses no modelo suíno. A neobexiga GI laparoscópica é tecnicamente viável no modelo suíno, apesar de sua complexidade. A descrição inicial é apresentada. Aperfeiçoamento da técnica de reimplante ureteral anti-refluxo laparoscópico é necessário antes de sua aplicação clínica. / Introduction: Composite gastroileal (GI) urinary reservoirs may present advantages over the use of isolated intestinal segments for urinary reconstructive procedures in selected patients. Herein, we present the laparoscopic techniques of gastroileocystoplasty (bladder augmentation) and GI orthotopic neobladder (bladder substitution), performed completely intracorporeally in a porcine model. Technical feasibility and functional results of these procedures are evaluated. Methods: After a pilot study (three animals) to technically standardize the procedures, gastroileocystoplasty (Group I, N = 5) and GI orthotopic neobladder (Group II; N = 10) were performed applying the same principles of wedge gastric resection and ileal resection. In Group II, creation of the neobladder included bilateral ureteral reimplantation into the gastric segment with an anti-reflux technique and an urethro-ileoanastomosis. Staplers and free-hand laparoscopic suture techniques were utilized exclusively, in a completely intracorporeal manner. Preop and postoperative analysis of laboratory data, bladder capacity, image (cystourethrography, intravenous urography) and histological evaluation of the resulting GI reservoirs was concluded at the end of follow-up, at eight and 12 weeks (Group I) and four and eight weeks (Group II). Results: Ileal and gastric patches reached the animal pelvis in all cases. Operative times were 5.2h for Group I and 7.4h for Group II. No conversions or intraoperative deaths occurred. All GI reservoirs were viable by the time of euthanasia in both groups. In Group I, four of the five animals completed the scheduled follow-up of 8 (N = 2) and 12 (N = 2) weeks without complications. One animal received early euthanasia due to pyelonephritis and metabolic alkalosis. Bladder capacity (at a bladder pressure of 20cmH2O) increased from 650ml to 1025ml (p < 0.05) after the bladder augmentation procedure. In Group II, five of 10 animals completed the scheduled follow-up at four (N = 3) and eight (N = 2) weeks, with minimal alteration on renal function (pre and postoperative Cr = 1.4 and 2.2mg/dl, respectively; p = 0.09). Three animals had an early euthanasia due to ureteral obstruction and pyelonephritis (N=2) and severe hipochloremic alkalosis (N = 1). Two deaths were associated to bilateral ureteral obstruction and sepsis. Mean bladder capacity for the neobladders was 400ml. No cases of vesico-ureteral reflux were seen at cystourethrography. However, seven of 20 renal units (35%) presented with uretero-gastric stenosis. Bowel obstruction (N = 1), gastric fistula (N = 1) and urinoma (N = 1) were other complications in Group II. Conclusions: Laparoscopic gastric resection for bladder augmentation and substitution purposes is feasible and reproducible. Laparoscopic gastroileocystoplasty presents adequate functional results after three months in the porcine model. Laparoscopic GI neobladder is technically viable in the porcine model, despite its complexity. The initial report is presented. Refinements of laparoscopic anti-reflux ureteral reimplantation techniques are necessary before its clinical application.

Vinte e cinco pacientes com tempo de evolução pós-operatório médio de 10,6 ± 5,4 anos após a Operação de Jatene foram submetidos à avaliação da função ventricular esquerda pela ecocardiografia em repouso e durante o estresse farmacológico e à avaliação da circulação coronária pela cinecoronariografia e ultra-som intracoronário. O grupo apresentou função sistólica normal, alteração da função diastólica e reserva miocárdica reduzida. O estudo angiográfico, realizado em vinte e dois casos não revelou obstruções das artérias coronárias. Ao estudo ultra-sonográfico observou-se em todos, espessamento da camada íntima sugerindo processo de aterosclerose coronária precoce / Twenty-five patients underwent echocardiographic left ventricular function assessment at rest and during pharmacological stress and coronary circulation evaluation with coronary angiography and intracoronary ultrasound 10 ± 5,4 years after the arterial switch operation for transposition of the great arteries. Echocardiography revealed a normal left ventricular systolic function, impaired diastolic function and reduced myocardial reserve. No coronary obstruction was observed at angiography however intracoronary ultrasound showed intimal thickening in all, suggesting premature arterioscleroses

O desenvolvimento de um método eficiente de avaliação prognóstica precoce seria de grande utilidade na seleção de lactentes com plexopatia braquial obstétrica para cirurgias de reconstrução do plexo braquial. Realizamos uma eletroneurografia bilateral em 33 bebês com plexopatia braquial obstétrica entre 10 e 60 dias de vida. Foram avaliadas e comparadas lado a lado as amplitudes dos potenciais de ação musculares compostos dos nervos axilar, musculocutâneo, radial proximal, radial distal, mediano e ulnar. Os bebês foram seguidos clinicamente até os seis meses de vida, quando foram submetidos a uma avaliação da força de vários grupos musculares e a uma prova funcional. Uma redução da amplitude do potencial de ação muscular composto em qualquer nervo do membro acometido maior ou igual a 90% da amplitude do potencial do membro sadio correlacionou-se com um resultado clínico ruim aos seis meses de idade (p < 0,01). A acurácia prognóstica da eletroneurografia foi de 91% para as lesões do tronco superior, 97% para as lesões do tronco médio e 100% para as lesões do tronco inferior. Nossos resultados indicam que a eletroneurografia parece ser um instrumento útil na avaliação prognóstica precoce de pacientes com plexopatia braquial obstétrica / Early prognostic assessment of obstetric brachial plexopathies would be a major step for rational selection of infants for brachial plexus surgery. We performed bilateral electroneurography of Axillary, Musculocutaneous, proximal Radial, distal Radial, Median and Ulnar nerves in 33 babies (age 10 - 60 days) with obstetrical brachial plexus lesions in order to compare the amplitude of compound muscle action potentials (CMAPs). The babies were followed up for six months and the outcome was classified according to muscle power score and functional performance. A CMAP amplitude reduction in any nerve of the injured side superior or equal to 90% of CMAP amplitude of the normal side was related to an unfavorable clinical result at age of six months (p < 0,01). The prognostic accuracy of electroneurography was 91% for the upper trunk, 97% for the middle trunk and 100% for the lower trunk. Our results indicate that electroneurography seems to be a useful tool for very early prognostic assessment of obstetric brachial plexopathies

Foi realizado um estudo para verificar a ocorrência de leveduras do gênero Rhodotorula, em hemocultura por um período de 8 anos. Os pacientes identificados foram descritos clinicamente segundo variáveis de interesse incluindo dados sobre terapêutica e desfecho. Determinou-se também as concentrações inibitórias mínimas de 20 cepas frente a diferentes antifúngicos de acordo com NCCLS e EUCAST. Realizou-se tipagem molecular através da cariotipagem eletroforética em campo pulsátil / A study was conducted to verify the frequency of occurrence of Rhodotorula spp. from blood cultures over an 8-year period, clinically and microbiologically characterizing patients affected, including data regarding antifungal treatment and outcome. The minimal inhibitory concentrations of antifungal agents were determined against 20 isolates. Molecular typing of the strains were performed using pulsed field gel electrophoresis method

O objetivo deste trabalho foi avaliar comparativamente os resultados tardios da esofagectomia transdiafragmática com gastroplastia e da operação de Serra Dória para o tratamento do megaesôfago avançado. Foi realizado estudo coorte em 44 pacientes. O seguimento tardio no Grupo EG foi de 77,0 meses, e no Grupo SD de 62,1 meses. Utilizou-se interrogatório para queixas gastrointestinais, escalas de Schechter e de Visick, assim como dois questionários. Incluíram-se dados antropométricos, bioquímicos e endoscópicos. A satisfação com a cirurgia medida pela escala de Visick foi equivalente nas duas operações praticadas, sem diferenças estatísticas. Também nos questionários o perfil foi equilibrado. Houve maior a incidência de esofagite no grupo EG; Não houve diferenças significativas com relação à avaliação clínica, nutricional, histológica e de qualidade de vida / The objective of the paper was to carry out a comparative evaluation of the late results of a transdiaphragmatic esophagectomy with an associated gastroplasty and of the Serra Dória procedure, for the treatment of advanced megaesophagus. A cohort study was done on 44 patients. Late follow up for the EG Group was 77.0 months, and for the SD Group, 62.1 months. Several tools were used, such as a series of questions for gastrointestinal complaints, the Schechter and the Visick scales. Anthropometric data were included, as well as the biochemical and endoscopic parameters. Satisfaction with the surgery, as measured by the Visick scale, was equivalent in the two types of surgery, and no statistical differences were observed. There was a higher incidence of the esophagitis in the SD group; There were no significant differences with regards to clinical and nutritional evaluation, histology and quality of life

Abstract Traumatic brain injury can be a catastrophe for an individual and a huge economic burden for a society. Such injuries are common especially among young men and as many as half of the patients are under the influence of alcohol at the time of injury. Traumatic brain injuries can also frequently cause epileptic seizures. On the other hand, epileptic seizures are often caused by alcohol. A significant reduction in the tax on alcohol in Finland in 2004 led to a 10% increase in its consumption at the population level and a considerable increase in mortality rate among patients with alcoholic liver diseases. The risk of subsequent epileptic seizures and traumatic brain injuries among intoxicated head trauma subjects has not been evaluated before. The present cohort consists of all subjects who were admitted to the emergency room at Oulu University Hospital in 1999 on account of head trauma. These subjects were then followed-up for 10 years, which enabled the effect of the tax reduction on the long-term outcome to be observed. The effect of being under the influence of alcohol at the time of the index head trauma on the onset of a new epileptic seizure problem and further traumatic brain injuries was investigated. The mortality rate among head trauma subjects with harmful drinking increased significantly after the reduction in the alcohol tax, and the subjects with recorded alcohol-related seizure problems experienced an increased risk of death after the price reduction. Head trauma under the influence of alcohol predicted both new-onset seizure problems and traumatic brain injury during the follow-up. The results are in accordance with the previous observations of a rapid increase in mortality among heavy drinkers following a sharp reduction in alcohol prices. Inebriated head trauma subjects have an increased risk of subsequent traumatic brain injury and epileptic seizure. / Tiivistelmä Traumaattinen aivovamma voi olla potilaalle katastrofi ja yhteiskunnalle valtava taloudellinen tappio. Aivovammat ovat yleisiä erityisesti nuorilla miehillä, ja jopa puolet niistä tapahtuu alkoholin vaikutuksen alaisena. Aivovammat aiheuttavat usein epileptisiä kohtauksia, jotka toisaalta usein johtuvat alkoholista. Vuonna 2004 Suomessa tapahtunut mittava alkoholiveron alennus lisäsi väestötasolla alkoholin kokonaiskulutusta 10&#160;% vuoden aikana. Kuolleisuus erityisesti alkoholimaksasairauksiin lisääntyi voimakkaasti. Aiemmin ei ole tiedetty humalassa ilmaantuneen pään vamman vaikutuksesta potilaan riskiin saada uusi aivovamma tai uusi epileptinen kohtaus. Tutkimuskohortin muodostivat vuonna 1999 Oulun yliopistollisen sairaalan päivystyksessä hoidetut päähän vammautuneet potilaat. Heitä seurattiin rekisteritietojen avulla vuoden 2009 loppuun, minkä ansiosta voitiin tutkia veronalennuksen vaikutusta potilaiden pitkäaikaisennusteeseen. Tutkimuksessa havainnoitiin humalassa tapahtuneen pään vamman vaikutusta epileptisen kohtauksen ja uuden aivovamman ilmaantumiseen seuranta-aikana. Haitallisesti alkoholia käyttävien päähän vammautuneiden potilaiden kuolleisuus lisääntyi merkitsevästi alkoholiveron alennuksen jälkeen. Myös alkoholiin liittyvän epileptisen kouristuksen sairastaneilla kuolleisuus lisääntyi merkitsevästi. Alkoholin vaikutuksen alaisena tapahtunut pään vamma oli riskitekijä uudelle epileptiselle kohtaukselle sekä uudelle aivovammalle seuranta-aikana. Tulokset vahvistavat aiempia havaintoja siitä, että alkoholin hinnan voimakas lasku lisää nopeasti alkoholin suurkuluttajien kuolleisuutta. Humalassa päätään loukanneella on lisääntynyt riski saada uusi aivovamma sekä uusi epileptinen kohtaus.

Abstract Early risk factors of the antenatal period and infancy have been increasingly linked to psychiatric disorders. The aim of this thesis was to study the associations between very early parental separation and maternal depressed mood in pregnancy on the other hand, and schizophrenia and criminality in the offspring in adolescence and adulthood, on the other, in two data sets. In the Christmas Seal Home Children Study the index cohort consisted of 3 020 subjects born in Finland in 1945–65 who were temporarily isolated from their family immediately after birth to nursing homes, the Christmas Seal Homes, due to tuberculosis in the family. The average separation time was seven months. For every index subject, two reference subjects were matched for sex, year of birth and place of birth. Data were obtained on schizophrenia from the Finnish Hospital Discharge Register (FHDR) in 1971–98 and on criminal offences from Statistics Finland in 1977–98. The 28-year cumulative incidence of schizophrenia was 1.6% both in the index cohort and in the reference cohort (RR 1.0; 95% CI 0.8–1.4). Both male and female index subjects had committed crimes more commonly than the reference subjects (in men RR 1.3; 95% CI 1.2–1.4; in women RR 1.5; 1.2–2.0). Of the male index subjects 12.1% as compared with only 7.1% of the reference cohort had committed violent offences (RR 1.7; 1.4–2.1). In the Northern Finland 1966 Birth Cohort mothers of 12 058 babies were asked at mid-gestation at the antenatal clinic if they felt depressed. This general population birth cohort of the children was followed up for 31 years being record-linked with the FHDR covering the years 1982–97 and with the criminal register of the Ministry of Justice up to 1998. We divided the schizophrenia patients into those having a psychotic first-degree relative (schizophrenia patients with familial risk for psychosis FR) and those without one. The cumulative incidence of hospital-treated schizophrenia was 1.3% among the offspring of depressed mothers and 0.9% among the descendants of non-depressed mothers (RR 1.5; 95% CI 0.9–2.4). The prevalence of antenatal depression was 35% in mothers of schizophrenia patients with FR. The respective prevalence was 14% both in the mothers of schizophrenia patients without FR and in the mothers of other cohort members. Both male and female offspring of antenatally depressed mothers were more commonly criminal offenders than offspring of non-depressed mothers (in men adjusted OR 1.5; 95% CI 1.2–1.9; in women OR 1.5; 0.8–3.0). In males, 6.5% with depressed mothers and 3.2% with non-depressed mothers had committed violent offences (adjusted OR 1.6; 1.1–2.4). Very early separation and mothers' depressed mood in pregnancy are per se unlikely to increase the risk for schizophrenia in the offspring, but seem to be connected to criminal behaviour, especially violent criminality in men. / Tiivistelmä Raskaus- ja imeväisajan varhaiset tekijät on lisääntyvästi yhdistetty lapsen tuleviin mielenterveyshäiriöihin. Tarkoituksena oli tutkia hyvin varhaisen eron (separaation) ja äidin raskaudenaikaisen masentuneen mielialan yhteyttä lasten skitsofreniaan ja rikollisuuteen nuoruudessa ja aikuisuudessa kahdessa eri aineistossa. Joulumerkkikoti-lasten tutkimuksessa indeksikohortti koostui 1945–65 syntyneistä 3 020 tutkittavasta, jotka erotettiin väliaikaisesti perheistään heti syntymän jälkeen hoitokoteihin, Joulumerkkikoteihin, perheen tuberkuloosin takia. Ero vanhemmista kesti keskimäärin seitsemän kuukautta. Jokaiselle indeksitutkittavalle valittiin kaksi sukupuolen, syntymävuoden ja -paikan mukaan kaltaistettua verrokkitutkittavaa. Tieto skitsofreniaan sairastumisesta hankittiin sairaaloiden poistoilmoitusrekisteristä vv. 1971–98 ja rikoksista Tilastokeskuksesta 1977–98. 28 vuoden kumulatiivinen sairastuvuus skitsofreniaan oli 1,6 % sekä indeksi- että verrokkikohortilla (riskisuhde RR 1.0; 95 %:n luottamusväli CI 0,8–1,4). Sekä miehistä että naisista indeksitutkittavat olivat tehneet useammin rikoksia kuin vertailuryhmä (miehillä RR 1,3; 1,2–1,4; naisilla RR 1,5; 1,2–2,0). Miehistä 12,1 % indeksitutkittavista ja vain 7,1 % vertailuryhmästä oli tehnyt väkivaltarikoksen (RR 1,7; 1,4–2,1). Pohjois-Suomen 1966 syntymäkohortin 12 058 lapsen äideiltä kysyttiin keskiraskauden aikana äitiysneuvolassa, kokivatko he mielialansa masentuneeksi. Tämän väestötason syntymäkohortin (siis lasten) tietoja hankittiin 31-vuotisseurannassa sairaaloiden poistoilmoitusrekisteristä vuosilta 1982–97 ja oikeusministeriön rikosrekisteristä vuoteen 1998. Skitsofreniaan sairastuneet jaettiin niihin, joiden 1. asteen sukulainen oli ollut / ei ollut ollut psykoottinen. Sairaalahoitoa vaatineen skitsofrenian kumulatiivinen sairastuvuus oli 1,3 % masentuneiden ja 0,9 % masentumattomien äitien lapsilla (RR 1,5; 0,9–2,4). Raskaudenaikaisen masentuneen mielialan esiintyvyys oli 35 % niiden skitsofreniapotilaiden äideillä, joilla oli ollut lähisuvussa psykoosia. Vastaavasti masentunutta mielialaa esiintyi 14 %:lla sekä niiden skitsofrenia-potilaiden äideistä, joilla ei ollut sukurasitusta, että muiden kohorttitutkittavien äideistä. Sekä masentuneiden äitien pojista että tyttäristä useampi oli tehnyt rikoksen kuin masentumattomien äitien lapset (miehillä vakioitu vedonlyöntisuhde OR 1,5; 1,2–1,9; naisilla OR 1,5; 0,8–3,0). Masentuneiden äitien pojista 6,5 % ja masentumattomien äitien pojista 3,2 % oli tehnyt väkivaltarikoksen (vakioitu OR 1,6; 1,1–2,4). Hyvin varhainen ero ja äidin masentunut mieliala raskauden aikana eivät todennäköisesti sinänsä lisää skitsofrenian vaaraa lapsilla, mutta näyttävät olevan yhteydessä lasten rikolliseen käyttäytymiseen, erityisesti väkivaltarikoksiin miehillä.

Vinte e seis pacientes com cardiomiopatia hipertrófica e fatores de risco de morte súbita, foram submetidos a implante de cardioversor-desfibrilador implantável de dupla-câmara, com seguimento médio de 19 meses. Observou-se quatro choques em arritmias letais, 4 pacientes apresentaram TVNS e 5 taquiarritmias supraventriculares. Ocorreu um óbito.Conclusões: Observamos: TPSV em 19,2%; TVNS em 15,4% e TVS/FV em 15,4%. Nenhuma variável clínica ou demográfica, discriminou o comportamento clínico ou funcional pós-implante de CDI; a recorrência de síncope pós implante de CDI, não se associou à presença de eventos arrítmicos e a hipertrofia maior que 30 mm se associou à choque precoce do CDI (p=0,003). / During 19 months of average follow-up period, we followed 26 patients with hypertrophic cardiomyopathy and high risk for sudden death, all treated by dual chamber implantable cardioverter-defibrillator. 4 patients had received appropriate ICD discharge, 4 patients with NSVT and 5 supraventricular arrhythmias. One death had occurred. Conclusions: we observed: supraventricular arrhythmias in 19,2%; NSVT in 15,4% and VT/VF in 15,4%. The clinical or demographic outcomes did not suggest any clinical or functional results after ICD implantation; syncope may occur after ICD implantation and no arrhythmias recordered by intracardiac electrograms and left-ventricular-wall thickness greater than 30 mm is associated with early ICD shocks (p=0,003).

Although axillary artery injury occurs frequently with dislocations of the shoulder and fractures of the clavicle, it is rarely associated with fractures of the proximal humerus. If the axillary artery is damaged, prompt recognition and treatment are necessary to salvage the involved extremity.

Fixed retainer after orthodontic treatment is an increasing retention appliance. For the mandibular incisors there are two different fixed retainers that are commonly used, either a canine-to-canine retainer bonded only to the canines or a twistflex retainer bonded to each of the mandibular incisors and canines. Increased mandibular incisor irregularity seems to be a continuous process throughout life even in untreated patients. The natural physiological changes during aging causes changes like those that occur after orthodontic treatment and the removal of retainers. There are few long-term studies that have compared patients who have had a mandibular fixed retainer with patients without retention appliance after treatment, and then compared the treated patients with untreated subjects.The overall aim of this thesis was to compare and evaluate two different mandibular fixed retainers and also to compare orthodontically treated cases with untreated long-term. This thesis is based on two studies and a PAR Index evaluation was presented in the frame story:Paper I is a retrospective longitudinal study done on dental casts and lateral head radiographs from patients who had received either a canine-to-canine retainer or a twistflex retainer after treatment. Different variables were measured, were Little’s Irregularity Index was the main outcome measure. The measurements were done at four different occasions, were the last registration was 12 years after treatment, i.e. 9 years after removal of retainer. Paper II is also a retrospective longitudinal study with three different groups, one group received a fixed mandibular retainer, one group did not receive any retention appliance after treatment and the third group was untreated subjects. Measurements were done on dental casts and lateral head radiographs at four different occasions to analyze dental and skeletal changes 12 years after treatment. Also here Little’s Irregularity Index was the main outcome measure. PAR Index evaluation is done to evaluate the stability of orthodontic treatment outcome after treatment and long-term for two different retainer groups and one non-retention group. The following conclusions were drawn: Paper I•Both the canine-to-canine retainer and the twistflex retainer can be recommended since both are equally effective during retention period.•None of the retention types prevent long-term changes of mandibular incisor irregularity or available space for the mandibular incisors after removal of the retainers.•No differences in bonding failures between the two retainers were found. Paper II•There were no differences found 12 years after treatment in Little’s Irregularity Index for the mandibular incisors between the group that had a retainer and the group that had no retainer after treatment•In the untreated group, Little’s Irregularity Index was increased over time but not to the same extent as in the treated groups. •The crowding before treatment did not explain the crowding at the last registration.•The use of mandibular retainers for two to three years does not appear to prevent long-term relapse. •If the patient wants to constrain the changes that come with natural development, then lifelong retention is needed.•The overjet and overbite were stable long-term.PAR Index evaluation•Twelve years after treatment the mean reduction in PAR score was over 70 per cent only for the groups who had a mandibular retainer after treatment. However, the non-retention group had a PAR score of 66 per cent.•There were more cases in the retention groups that were ”greatly improved and/or improved” 12 years after treatment compared to the non-retention group. After treatment between 16 and 23.3 per cent of all the cases were ”worse or not improved”. Twelve years after treatment between 36 and 43.6 per cent of the total cases were ”worse or not improved”.