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Detachable forceps for flexible fibre-optic surgery: a new technique for phonosurgery in cases where rigid laryngoscopy is contraindicated.

In phonosurgery, in cases where it is not possible to use a rigid laryngoscope, a flexible fibrescope with laryngeal-mask ventilation may be used. In flexible fibreoptic surgery, the forceps are normally inserted through a small channel in the fibrescope. Since only a small forceps tip can pass through this channel, a limited range of forceps has been available for use in fibrescope procedures. We have developed a new type of forceps for flexible fibre-optic surgery that allows this size limitation to be overcome. The new forceps is made up of two parts: (i) the forceps tip and its control wire assembly, and (ii) a detachable handle. A wide range of forceps can be used, including those with tips larger than the biopsy channel. We report a case that was treated with this new technique.

Adult↗

Endosteal implants for posterior single tooth replacement: alternatives, indications, contraindications, and limitations.

Patients frequently need treatment to replace single teeth in the posterior regions. A number of different kinds of therapy have been used to treat this problem, including (1) removable partial denture, (2) acid-etched resin-retained prosthesis, (3) maintenance of the missing space, (4) a fixed partial denture, or (5) an implant-supported prosthesis. The purpose of this article is to assess the strengths and weaknesses of each of these treatments. The author concludes that single tooth implants are generally the best choice for dealing with a missing single tooth in the posterior regions of the mouth.

Adolescent↗

Previous ectopic pregnancy should be considered a contraindication for microsurgery.

BACKGROUND: To estimate the risk of subsequent ectopic pregnancy (EP) after tubal surgery, given that the woman becomes pregnant, by means of a logistic model, a retrospective study was initiated. METHODS: During the period 1986-1990, 221 women with tubal infertility underwent microsurgery. Subsequent fertility was evaluated in 1991. Ninety women conceived, of whom 84 were included in the study (30 with EP and 54 with intra-uterine pregnancy as the only outcome). Clinical background factors of importance, surgical procedures used, scoring systems for tubal lesions, adnexal adhesions and risk of EP were analysed for possible correlation to subsequent EP. These factors were further used in a logistic model to estimate the risk of subsequent EP as only outcome. RESULTS: The risk of EP after microsurgery is minimum 15% without any risk factors. Previous EP and endometriosis could be identified as factors with prognostic power in the logistic model. One previous EP implies a 60% risk, whereas two previous EPs and endometriosis increase the risk to 95%. CONCLUSION: Patients with previous EP should generally not be considered for microsurgery owing to the high risk of recurrence and to the reduced chance of intra-uterine pregnancy.

Adult↗

Is physical training contraindicated in patients with deep vein thrombosis during cardiac rehabilitation?

Deep vein thrombosis is a potential complication in patients admitted to cardiac rehabilitation programs after acute coronary syndromes, episodes of acute congestive heart failure, and cardiac revascularization. A common clinical problem in these patients is to decide whether to start or continue physical training or not, given the risk of pulmonary embolism. Until definite evidence becomes available, careful patient selection and inpatient supervision may avoid the a priori withdrawal of such an important core component of cardiac rehabilitation programs.

Contraindications↗

[Principal indications and contraindications of the use of extracorporeal hemocorrection in psychiatry].

Analysis of different aspects of application of extracorporeal hemocorrection (EH) in psychiatric practice allows to make a conclusion about the necessity of a differential approach to the use of isolated and combined procedures. The latter were assessed by the results of combined treatment of 226 patients. Indications and contra-indications for EH use in psychiatric practice are outlined.

Blood↗

The technique of inserting an intra-aortic balloon pump. Indications, contraindications, advice for avoiding complications.

The intra-aortic balloon pump (IABP) uses the timed inflation and deflation of a balloon placed in the descending aorta to augment coronary perfusion and reduce myocardial work. The IABP is useful in a number of settings, including acute myocardial ischemia, cardiogenic shock, and mechanical complications of acute myocardial infarction; it also provides support to perioperative patients. Because the device can be inserted percutaneously, mechanical circulatory support can be instituted rapidly Complications, most of which are reversible, occur in approximately 30% of patients.

Contraindications↗