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At least 793 records · Page 44Linked to original sources
PubMed2000

Usefulness of transesophageal echocardiography during open heart surgery of mitral stenosis.

BACKGROUND: The aim of this study was to verify if the use of intraoperative transesophageal echocardiography (TEE), by detecting mitral insufficiency or residual stenosis during surgery, may improve medium term results in patients with severe mitral stenosis who undergo open heart valvuloplasty. METHODS: This prospective study included twenty-two patients (20 women and 2 men) with a mean age of 49+/-13 years with severe mitral stenosis. Mean follow-up was 32 months (range 12-55 months). All the patients underwent transthoracic echocardiography (TrE) before surgery and intraoperative TEE. Before surgery the mean transmitral gradient was 11+/-6.8 mmHg, the mean pressure half time (PHT) area was 0.89+/-0.19 cm2, the mean echo score was 8.9+/-2.2. Intraoperative TEE before the repair showed a mean echo score of 7.9+/-1.8. RESULTS: Two patients with unsatisfactory repair at TEE underwent immediate valve replacement. In the remaining patients, mean transmitral gradient and PHT valve area before discharge was 5.2+/-3 mmHg and 2.5 cm2. No patients had more than trivial mitral regurgitation. During the follow-up two patients had to be reoperated. Patients with poor immediate (2 patients) or medium term results (2 patients), had a mean echocardiographic score of 12.24, while patients with a satisfactory medium term outcome had a mean score of 7.27 (p<0.001). CONCLUSIONS: Intraoperative TEE may guide the surgeon in the assessment of valvuloplasty. However the absence of mitral regurgitation after repair and at discharge cannot predict the medium term results, which are related to the degree of the disease of the mitral valve.

Adult↗
PubMed2000

Achieving aesthetic excellence through an outcome-based restorative treatment rationale.

The conceptual basis of restorative-driven implant dentistry is well established among clinicians. Its implementation includes the development of a prosthetic blue-print that will serve as a guide throughout therapy. While these concepts may be applied to prosthetic dentistry in general, their benefits are most compelling in the treatment of the aesthetic zone. This article demonstrates a systematic multidimensional approach for the establishment and incorporation of definitive aesthetic objectives throughout the diagnostic, adjunctive, and restorative treatment phases.

Color↗
PubMedDate not supplied

Clinical survey of acrylic resin removable denture repairs with glass-fiber reinforcement.

PURPOSE: The aim of this study was to evaluate clinical usefulness and durability of continuous glass-fiber reinforcement in repair of acrylic resin removable dentures. MATERIALS AND METHODS: Fractured removable dentures without reinforcement, with conventional metal-wire reinforcement, or with mesh reinforcement were collected from two dental schools in Finland. The total number of dentures was 51 and the number of patients was 48. During the repair, the dentures were reinforced with a polymer-preimpregnated E-glass fiber at the region of the fracture. The fibers were used as partial fiber reinforcement, i.e., only the weakest part of the denture was reinforced. Follow-up time varied from 4 months to 4.1 years. After the follow-up period, possible fractures and discoloring were visually inspected. Possible irritation of oral mucosa by glass fibers and the general shape of the denture were also evaluated. RESULTS: In 88% of the cases, there was no need for adjustment at the region of partial fiber reinforcement, and the clinical condition of the dentures was good. Glass fibers did not irritate the oral mucosa. In the case of refracture or hairline fracture, positioning of the partial fiber reinforcement was incorrect or the reinforcement had been used incorrectly (the wetting of the reinforcement with denture base resin was inadequate). CONCLUSION: Polymer-preimpregnated partial fiber reinforcement seems to be useful in eliminating fractures of acrylic resin removable dentures. However, this study emphasizes the importance of correct positioning and accurate laboratory technique when partial fiber reinforcement is used.

Acrylic Resins↗
PubMedDate not supplied

Delivering a fixed restoration: a clinical rationale for creating a routine sequence.

The proper sequence of seating a restoration starts with the evaluation of the shade match. Clinical procedures then follow this sequence: adjustment of proximal contact points, assessment of fit, and occlusal adjustment. Attempts to alter this sequence may cause unnecessary occlusal adjustments and an end result of a hypooccluded restoration.

Clinical Protocols↗
PubMed2002

Ingot selection for aesthetic restorations using contemporary pressed ceramics.

Accurate communication among the patient, clinician, and laboratory technician is critical to the development of a functional, aesthetic restoration. The use of pressed ceramic restorations has provided a durable, consistent alternative for full-coverage crowns, veneers, onlays, and short-span fixed partial dentures. This article discusses the importance of proper ingot selection in the fabrication of aesthetic restorations and in the realization of patients' expectations for smile design. Ceramic ingots are available in a variety of colors and opacities that provide the clinician and laboratory technician with the latitude to select an ingot that will ultimately ensure patient satisfaction.

Aluminum Silicates↗
PubMed2003

Hypertrophic obstructive cardiomyopathy: mechanism of obstruction and response to therapy.

Hypertrophic cardiomyopathy is a primary, usually familial, disorder of heart muscle whose primary feature is muscular hypertrophy without recognized cause that encroaches on the ventricular chamber, reducing chamber area and volume. In roughly 25% of cases, there is associated obstruction to left ventricular outflow (hypertrophic obstructive cardiomyopathy [HOCM]). This article details the mechanism of obstruction in HOCM, focusing on obstruction at the mitral valve level, and reviews the pharmacologic and surgical therapies currently available. Mainstays of pharmacologic therapy include b-blockers, calcium channel blockers (verapamil in particular), and/or disopyramide. Surgical therapies include septal myotomy/myectomy, which has become the gold standard to which other therapies are compared, and mitral valve replacement. During the past 10 years, atrio-ventricular sequential pacing and alcohol septal ablation have been proposed as less invasive alternatives to surgery. A single, optimal therapy for patients with HOCM and refractory symptoms has not been established, and decisions regarding surgical versus noninvasive therapies need to be individualized based on functional status, comorbidities, local expertise in the surgical and nonsurgical techniques, and patient preference.

Adrenergic beta-Antagonists↗
PubMed2004

Conventional visual vs spectrophotometric shade taking for porcelain-fused-to-metal crowns: a clinical comparison.

This study tested the shade match of single porcelain-fused-to-metal restorations with the adjacent dentition when the restorations were fabricated according to data from conventional visual shade matching or from a new spectrophotometric system. The samples of a Vita Classic shade guide were measured with the spectrophotometer to determine the CIE L*a*b* color parameters. Three clinicians independently selected the best match to a maxillary right or left incisor needing a restoration in 10 patients. The 10 incisors were then measured using a reflectance spectrophotometer. CIE L*a*b* coordinates were directly recorded on the spectrophotometer's detector area using a standard light source. Resulting conventional and spectrophotometric restorations were tested intraorally for best match with the adjacent incisor using conventional shade matching versus spectrophotometric measuring. Total color difference was calculated, and all groups were statistically analyzed. Initial shade evaluation matched for all three visual shade selections in two cases. In six cases only two evaluators matched, and in the remaining two cases all three visual selections differed. In contrast, in nine of 10 cases all three spectrophotometric shade selections matched. Additionally, in nine of 10 cases delta E values of visually assessed tooth shades were higher than spectrophotometrically assessed delta E values. Resulting delta E values for conventional crowns compared to spectrophotometric crowns were significantly higher. Finally, in nine of 10 cases spectrophotometric crowns were preferred over conventional crowns for definitive cementation when evaluated visually. Spectrophotometric shade analysis and communication can be used efficiently for fabrication of porcelain-fused-to-metal restorations.

Adult↗
PubMed1994

Doppler echocardiographic study of pulmonary venous flow in mitral stenosis and early after mitral valve replacement.

The aim of the study was Doppler echocardiographic assessment of the effect of mitral stenosis (MS) on pulmonary venous flow (PVF), and of any changes occurring after mitral valve replacement. Fifty patients with MS (22 in atrial fibrillation (AF)) and 28 healthy subjects (control group) underwent transthoracic echocardiographic evaluation of PVF. Fourteen of the 22 patients in AF were submitted in addition to transesophageal echo study before and after mitral valve replacement. Pulmonary wedge pressure was measured in 18 patients. Patients in sinus rhythm (SR) and more than mild MS showed significantly decreased peak velocity and flow velocity time integral of the systolic forward PVF. This finding was more exaggerated in MS with AF. Concerning diastolic forward PVF, patients in SR showed significantly decreased peak velocity and velocity time integral, irrelevant of the degree of MS, while patients with AF exhibited adequate signs of flow. In all patients duration, deceleration time (D-DT) and pressure half-time (D-PHT) of the diastolic forward PVF were significantly increased. The last two parameters correlated with the corresponding variables of mitral flow and with echocardiographically determined mitral valve area and the D-DT of the pulmonary wedge pressure. Concerning reversed PVF, patients with more than mild MS exhibited significantly increased peak velocity and velocity time integral. After mitral valve replacement, a significant increase of diastolic forward peak velocity and velocity time of the PVF were detected. The duration of diastolic forward peak velocity of PVF, D-DT and D-PHT decreased. The systolic forward phase did not change significntly after the valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Echocardiographic features of the normofunctional Labcor-Santiago pericardial bioprosthesis.

Echocardiography was performed in 94 patients with a total of 99 normally functioning Labcor-Santiago bioprostheses, 62 in the aortic and 37 in the mitral position. The following variables were measured: peak and mean transvalvular velocities, peak and mean instantaneous pressure gradients as calculated from the modified Bernoulli equation, pressure half-time, cardiac index, stroke volume and effective orifice area (using continuity and Hatle equations). Regurgitation patterns were sought by transthoracic echocardiography (all valves) and, for selected mitral bioprostheses, by transesophageal echocardiography. Calculated mean aortic pressure gradient ranged from six to 10 mmHg and calculated effective aortic orifice area increased with ring diameter, with means of 1.27 cm2 for the 19 mm valve and 2.58 cm2 for the 27 mm valve. For mitral bioprostheses, mean pressure gradient ranged from 3.0 to 4.5 mmHg and calculated effective orifice area from 2.27 to 2.73 cm2. Only central regurgitation was observed. The Labcor-Santiago pericardial bioprostheses created little resistance to forward flow. In the small aortic root their hemodynamic performance was as good or better than that of other currently available devices. It is hoped that this new design will contribute increased in vivo mechanical durability.

Adult↗
PubMed1994

Hemodynamic assessment of the stentless Toronto SPV bioprosthesis by echocardiography.

Since March 1993 the Toronto SPVTM bioprosthesis has been implanted in 100 patients. Our prospective study evaluated the echocardiographic valve characteristics and the influence of the echocardiographic assessment on surgical technique. Transesophageal echocardiography (TEE) was applied before and during surgery, and transthoracic echocardiography (TTE) postoperatively. The average valve size implanted was 26.5 mm. Follow up was complete in 74 patients at six months and in 38 patients at one year. Pre-cardiopulmonary bypass (CPB) TEE valve sizing was accurate by +/- 1 mm in 81 patients as compared to mechanical sizing. Post-CPB valve closure was concentric in 99 patients. Minimal aortic incompetence was present in seven patients at one week, in two patients at six months and in one patient at one year. Mean pressure gradients ranged from 7.7 to 11.1 mmHg postoperatively. Overall mortality was 4%. One patient with non-structural dysfunction and another with endocarditis at one year postoperatively were reoperated successfully. At follow up there was a significant decrease in transvalvular pressure gradients and an increase in valve orifice areas. In 32 patients a decrease in left ventricular posterior wall (LVPW) hypertrophy was found (p < 0.001). There was a decrease in tissue depth and recurrence of the dynamic movement of the aortic root. It is concluded that TEE valve sizing is reliable for early valve selection. Valve incompetence is not a clinically relevant issue using the oversizing technique. Improved hemodynamics at follow up can be explained by remodeling of the aortic root and by a decrease in left ventricular hypertrophy. The excellent hemodynamic profile, resembling native aortic valve function, is impressive and has to be confirmed by long term evaluation.

Adult↗