A clinical investigation of root resorption rates in reimplanted young permanent incisors: a five-year study.
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A human embryo in transition between a morula and blastocyst after culture in vitro was reintroduced into the mother's uterus via the cervix. The resulting pregnancy was closely monitored and was found to be located in the oviduct. The ectopic embryo was removed at 13 weeks gestation.
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A new technique for the reconstruction of the disarticulated ramus is presented. From an intra-oral approach the mandible is resected, and if the posterior part of the ramus and the neck of the condyle are not involved by the tumour, this part is preserved. It is then fixed to the bone graft from the iliac crest bridging the remaining defect. The procedure is outlined, based on the experience of 4 cases which have been successfully operated on according to this technique. The earliest of them has been followed-up for seven years.
Due to our good experimental results with an immediate mandibular body-replacement after resections we report our clinical and histological findings of a 35 weeks-lasting transplantation of autoclaved bone. We could not confirm a "foreign body" reaction and absent bone-resorption by osteoclasts, described by Harding in 1957. During metal removal after the 28th week postoperatively we observed clinically a good incorporation of the graft and the histological evaluation of the 28th and 35th week specimens showed an excellent bony bridging of the osteotomy, non-irritant incorporation of the graft and a beginning remodelling of the mineral frame which had functioned as an immediate space retainer.
In multiple finger amputations, microsurgical reconstruction should concentrate on the thumb, index, and middle fingers. The patient in the case report presented in this paper initially sustained an amputation of all of the digits on the left hand and an amputation of the right thumb. Both thumbs were amputated at the metacarpophalangeal joint. Initial replantation of the left thumb, index, and middle fingers and of the right thumb was carried out. The right thumb replantation failed and, after healing, the right great toe was transferred to the right hand. Subsequent to this, the patient developed useful function of all reconstructed digits. Twenty-one months after the first injury, both thumbs sustained new traumatic amputations 1.0 cm distal to the previous amputations. Both thumbs were replanted again successfully.
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BACKGROUND: Abnormal coronary artery anatomy is reported to have a significant influence on the outcome of the arterial switch operation. This study examines the impact of coronary anatomy and the occurrence of late coronary obstruction on left ventricular (LV) function and long-term outcome. METHODS: Coronary artery anatomy, of 170 patients after arterial switch operation (1977-1999), was determined based on operative reports and pre-operative aortograms. Current status was evaluated using ECGs, echocardiograms, scintigraphy, and post-operative coronary angiograms. RESULTS: In 133/170 patients, coronary artery anatomy consisted of an anterior descending (LAD) and circumflex artery (Cx) from the left sinus and the right coronary artery (RCA) from the right or posterior sinus. The left coronary had an intramural initial course in two of these patients. Fifteen patients had the LAD from the left and Cx and RCA from the right sinus; eight had LAD and RCA from one sinus and Cx from the other; four had single ostium; and three had three separate ostia. Four patients had complex patterns and four patients had a supra commissural coronary. To date, follow-up angiography was performed in 59 patients. Surgical coronary sequellae were found in five patients. Two patients had an occluded left ostium. Initially, they were asymptomatic but showed polymorphic ventricular extrasystoles on ECG and moderate LV dysfunction with large irreversible perfusion defects on scintigraphy. Both patients developed ventricular fibrillation at the age of 14 years. One patient did not survive. The other patient required implantation of a defibrillator. One patient has an occluded RCA, one patient has stenosis of the right ostium and one patient has multiple tortuous collaterals without obstruction of a major branch. In the latter three patients, coronary sequellae were not suspected on ECG, echo, or scintigraphy and were only found on follow-up angiography. Retrograde collateral flow was noted in all three occluded coronaries. LV dysfunction, with normal coronaries, was noted in three patients. All, of these patients, had peri-operative ischaemia suggesting failure of myocardial protection. Two are now asymptomatic with mild LV dysfunction. One patient continues to have severe myocardial dysfunction and secondary aortic insufficiency. A Ross-like procedure was performed placing the original aortic valve in the neo-aortic root. Coronary artery anatomy did not influence early survival or late coronary sequellae. CONCLUSION: Abnormal coronary anatomy was not a determinant of outcome in our study. Surgical coronary obstruction is independent of original anatomy. It can be almost silent and is potentially fatal. Follow-up angiography must be considered in all patients after the arterial switch operation.
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We report a case of microsurgical replantation of a degloved finger in a manual worker. Four months following replantation, avascular necrosis of the middle and distal phalanges was apparent. Amputation at the level of the proximal phalanx was performed. Re-plantation is the solution of choice for such degloving injuries, but a different flap can be used if replantation is not possible. Avascular necrosis of bone is an unfrequent complication, but surgeons should be aware of it.
In order to test the soft tissue response to contaminated titanium components, 20 clinically retrieved abutment cylinders were inserted in the abdominal wall of 5 rats. Prior to insertion, 10 of the abutments had been contaminated for 1 min and the remaining components for 2 weeks. Five abutments of either group were ultrasonically cleaned in butanol and ethanol, whereas the remaining abutments were only rinsed in saline before being implanted. As controls, 5 newly manufactured abutments were used. After 6 weeks of healing, specimens were prepared of the components and surrounding tissues for morphological analysis. This showed an accumulation of macrophages and a reduction of the number of fibroblasts around the abutments that had been contaminated, irrespective of cleaning procedure, compared with the controls. It was concluded that the contaminated components induced an altered tissue response and that a similar reaction may occur in the clinical situation.