Clinical practice. Aortic regurgitation.
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We describe two patients in whom mitral valve prosthetic inflow mimicked severe aortic regurgitation. Repeat transthoracic echocardiography using multiple transducer angulations and a narrow color Doppler sector angle in one patient and a color Doppler M-Mode study in the second patient proved useful in excluding the presence of severe aortic regurgitation.
Takayasu's arteritis (TA) is a granulomatous vasculitis of medium and large arteries, which most often presents as pulseless disease due to widespread arterial stenoses. Only the minority of TA patients have aortic valve insufficiency, which is due to aortic root dilatation following aortitis and aneurysm formation. No other cardiac valve is involved. We report a case of Takayasu's disease-related severe aortic insufficiency (AI) in a Filipino woman, which necessitated aortic valve replacement. It is important to consider TA in the differential diagnosis of AI in young women, particularly those with early-onset systemic hypertension and pulse deficits. Early diagnosis and therapy of TA can improve outcomes.
PURPOSE: The purpose of this study was to compare the color of resin composites of white, translucent, and conventional shades with shade guides, based on the analysis of the color distribution of shade guides. The influence of color measuring mode, specular component included (SCI) or excluded (SCE), was also determined. MATERIALS AND METHODS: The labial portions of shade guide tabs (Vita and Chromascop) were polished flat with up to 2400-grit SiC paper. Color coordinates were measured according to CIE L*a*b* color scale on a reflection spectrophotometer with both the SCE and SCI modes. The color coordinates of white, translucent, and conventional shades of two brands of resin composites were measured and compared with those of the shade guides. RESULTS: There was no logical order in the color distribution of the two shade guides. The color of white and translucent shades of resin composites was located on the low CIE a* and CIE b* value area. The CIE L*, a*, b* values of resin composite with the same color designations were different, depending on the brand of material. The color difference (deltaE*) of shade guides by the measuring mode (SCE vs. SCI) was between 3.2 and 6.5.
BACKGROUND: The purpose of this investigation was to study mitral valve 3D geometry and dynamics by using a coordinate-free system in normal and ischemic hearts to gain mechanistic insight into normal valve function, valve dysfunction during ischemic mitral regurgitation (IMR), and the treatment effects of ring annuloplasty. METHODS AND RESULTS: Radiopaque markers were implanted in sheep: 9 in the ventricle, 1 on each papillary tip, 8 around the mitral annulus, and 1 on each leaflet edge midpoint. One group served as a control (n=7); all others underwent flexible Tailor partial (n=5) or Duran complete (n=6) ring annuloplasty. After an 8+/-2-day recovery, 3D marker coordinates were measured with biplane videofluoroscopy before and during posterolateral left ventricular ischemia, and MR was assessed by color Doppler echocardiography. Papillary to annular distances remained constant throughout the cardiac cycle in normal hearts, during ischemia, and after ring annuloplasty with either type of ring. Papillary to leaflet edge distances similarly remained constant throughout ejection. During ischemia, however, the absolute distances from the papillary tips to the annulus changed in a manner consistent with leaflet tethering, and IMR was observed. In contrast, during ischemia in either ring group, those distances did not change from preischemia, and no IMR was observed. CONCLUSIONS: This analysis uncovered a simple pattern of relatively constant intracardiac distances that describes the 3D geometry and dynamics of the papillary tips and leaflet edges from the dynamic mitral annulus. Ischemia perturbed the papillary-annular distances, and IMR occurred. Either type of ring annuloplasty prevented such changes, preserved papillary-annular distances, and prevented IMR.
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The color stability of polyvinyl chloride, polyurethane, and silicone polymers for maxillofacial applications was determined after accelerated aging using reflectance spectrophotometry. On the basis of color stability after accelerated aging, and ease of processing, several silicone materials were the most promising.
Mechanical properties and color of a plasticized polyvinyl chloride (PVC) maxillofacial elastomer were evaluated at processing temperatures from 140 to 190 degrees C. The properties were dependent on processing temperature. Specimens prepared at 170 degrees C had optimum mechanical properties with minimal discoloration.
The new generation of dentin bonding materials can withstand the contraction shrinkage of composite materials. A two-year clinical trial of one material showed an excellent retention rate.
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After observing spikes in the Doppler signal of cerebral arteries of patients with neurologic symptoms and prosthetic heart valves, we then studied two groups of patients with prosthetic heart valves: seven patients with neurologic symptoms and 65 asymptomatic patients. Using transcranial Doppler sonography of the middle cerebral artery, we found Doppler spikes in six symptomatic and 24 asymptomatic patients with mechanical heart valves. No spikes were found in one symptomatic and 21 asymptomatic patients with biological valves or in 20 asymptomatic patients with mechanical valves. We concluded that gas cavitation during the opening or closure of the valve, producing bubble emboli, is the most probable explanation for these Doppler spikes in patients with mechanical prosthetic heart valves.
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Increased use of the ovine animal model in cardiovascular surgical research has created a salient need for standardized echocardiography techniques. To demonstrate a reproducible image in this species and confirm the validity of echocardiography as a diagnostic tool, we implanted 10 sheep with a pulmonary valve homograft and monitored them through weekly echocardiographic examinations until 20 weeks after implantation. We obtained good images from the left cranial and the left caudal transducer windows without needing to sedate the animals. Sedated sheep yielded adequate views from the right apical window. Echocardiographic data on the implanted homografts (including functional capacity, presence of calcification, and hemodynamic information and measurements), completely agreed with the results of the post-explantation examinations.
The purpose of this article is to demonstrate the advantages and benefits of utilizing The Dry Powder Technique during the fabrication of ceramic restorations. This article explains how to create esthetically superior restorations using an unlimited number of porcelain powders while conserving time and materials. By utilizing dry powder storage containers, kolinsky sable brushes, capillary attraction and multiple oven firing procedures, a ceramist may control grain size distribution, color and contour with a minimum of effort and maximum of results.
A technique for replacing existing porcelain veneers has been presented. Technique for smile design, tooth preparation, and cementation were described. The objective was to meet the patient's aesthetic expectations while also meeting functional requirements.
Precise color communication is integral to the development of aesthetic harmony and overall restorative success. While traditional shade-taking procedures have enabled a degree of shade transfer, contemporary digital shade analysis devices allow standardized, repeatable shade determinations for increased accuracy. This article presents a clinical case report and contrasts two technology-based shade selection systems (SpectroShade, MHT International, Newtown, PA; ShadeScan, Cynovad, Montreal, Canada) in the retrospective verification of shade during the restoration of a maxillary right central incisor compared to conventional methods.