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At least 865 records · Page 48Linked to original sources
PubMed2004

Understanding the esthetic evaluation for success.

With any restorative procedure, a thorough evaluation, diagnosis, and treatment plan is essential for a positive outcome. When dealing with esthetic dilemmas, the some holds true. Without a sequential esthetic evaluation, diagnosis, treatment plan, and execution, an acceptable outcome is difficult to predict. The treating clinician should be able to visualize the esthetic problem, visualize the proposed changes, and devise a way to achieve the result while still maintaining mechanically, functionally, and biologically sound principles.

Color↗
PubMed1994

Long-term results of plastic reconstructions in acquired aortic valvular disease.

Plastic surgery in acquired aortic valvular disease was performed in 164 patients. Among them, 9 had the isolated aortic valvular injury; 130 mitral-aortic defects; and 25 three-valve injuries. The restoration of the injured valve function was achieved, as a rule, using a combination of surgical methods: commissurotomy or wedge resection of the fibrous tissue in the commissurial area; parietal resection; the aortic root frame plasty; perforation hole plasty; the allogenic valvuloaortic complex sector transplantation; and wedge resection or isometric cusp plication in the commissurial area. Calcinosis was not a contraindication to surgery, if it could be removed completely without the cusp closing function disturbances. The hospital mortality rate was 8%. After hospital treatment all the patients were followed-up: 108 for over 1 year, and the maximum term of the follow-up was 7 years. From 1 to 4 years postoperatively, 4 patients were reoperated due to the appearance of aortic insufficiency. The causes of relapse were: infectious endocarditis (3 patients); active rheumatic process (1 patient); and progressive dilatation of the fibrous ring (1 patient). During the follow-up 8 patients died: 6 of infectious endocarditis with mitral prosthetic injury; and in 2 the cause of death was not clear. The study of immediate and long-term aortic valvuloplasty results based on the clinical experience of 164 operations allows to recommend the elaborated principles of the aortic valve surgical reconstruction for a wide application in cardiac surgery.

Aortic Valve↗
PubMed1997

[Mitral insufficiency simulating aortic stenosis].

We report a patient with a mitral insufficiency due to myxomatous valve change, with a regurgitation murmur heard principally at aortic area and radiating to the neck base. Even though the topography of the murmur seemed to suggest aortic stenosis, the other auscultation findings and the initial clinical tests clearly supported its source in a mitral insufficiency. The echocardiography allowed us not only to confirm our suspicion, but also to explain this auscultation finding mechanism, to show a severe mitral insufficiency with a anterior and medial jet, which struck the aorta and atrial septum. The surgery found a clear aortic vibration, which disappeared after implanting the mitral protheses. Our case illustrates the value of new diagnostic image techniques to complement the semiologic findings.

Aortic Valve Stenosis↗
PubMed1998

Ultraconservative dentistry.

Ultraconservative techniques are providing dentists with new opportunities for the rehabilitation of the debilitated dentition. These techniques involve the use of bonded, reinforced ceramics that restore function and esthetics. The new parameters of ultraconservative treatment include the routine use of supragingival margins, color gradients, and the alteration of the occlusal vertical dimension. The minimally invasive nature of these new techniques makes them more readily acceptable to, and more easily maintainable by, patients.

Adolescent↗
PubMedDate not supplied

A computerized method for evaluating distribution of occlusal load on implant-supported fixed cantilever prostheses.

An investigation was conducted to determine whether Dental Prescale, a material that undergoes a graded color-producing chemical reaction when force is applied, could be used to evaluate occlusal load distribution objectively and quantitatively when combined with computer analysis. Ten patients with an implant-supported fixed cantilever prosthesis and a complete conventional maxillary denture were studied. The results indicated that the system can be used to evaluate occlusal load distribution with sufficient reproducibility. However, in its present form, the system is somewhat cumbersome, and its use must now be considered experimental. Further refinement is necessary to allow easier clinical use.

Adult↗
PubMed1998

Pressurization and centralization enhance the quality and reproducibility of cement mantles.

Cementing technique has a profound influence on the incidence of aseptic loosening of total hip replacements. Two specific measures that seem to have the greatest impact on the longevity of cemented femoral stems are pressurization of cement and control of mantle thickness, typically through the use of modular centralizing devices attached to the tip of the prosthesis. Two laboratory studies are presented that examine the success of these measures in clinical practice. In the first study, the performance of five designs of intramedullary plugs in resisting migration during pressurization of cement was evaluated in human anatomic specimen femurs. Profound differences were observed between the performance of the different plug designs. In canals larger than 12 to 14 mm, most commercial devices failed to resist pressures greater than 30 to 40 pounds per square inch. Overall, it was estimated that between 6% to 76% of these devices would fail to resist cement pressures of 50 pounds per square inch in clinical practice. The second study examined the role of distal centralizers in the accumulation of air bubbles around the distal tip of the prosthesis during insertion of the stem into the femur. Acrylic replicas of a femoral stem were implanted in cavities simulating the femoral canal. Colored dyes, present within the cement, revealed the complex patterns of cement flow. It was shown that cement, dragged from the top of the femur, forms a thin layer that covers the entire surface of the prosthesis and the distal centralizer. Significant voids were present behind the trailing edges of the distal centralizer in 42% of the cases examined. These studies show that improvements in intramedullary plugs and stem centralizers are needed to increase the reproducibility of cement technique in total hip replacement.

Arthroplasty, Replacement, Hip↗
PubMed2003

Hemodynamic evaluation of normally functioning Sulzer Carbomedics prosthetic valves.

The Sulzer Carbomedics prosthetic heart valve (CP) is a commonly used mechanical valve in clinical practice. In the present study, we used conventional and color Doppler echocardiography to assess the hemodynamics of normally functioning CP in the aortic (n = 73) and mitral (n = 127) positions. Our findings demonstrate no significant correlation of Doppler-measured peak and mean pressure gradients and effective orifice area with implanted valve size and actual orifice areas, measured directly by the manufacturer for CPs in both the mitral and aortic positions. However, it is still useful to measure effective orifice area by Doppler because a value in the normal or nonstenotic range points to an unobstructed prosthesis in the aortic or mitral position, in the absence of poor left ventricular ejection fraction. A value in the stenotic range could mean a normally functioning or obstructed prosthesis and, therefore, may need further investigation, such as assessment of valve leaflet motion by transthoracic or transesophageal echocardiography or fluoroscopy. Valve regurgitation as evaluated by color Doppler flow mapping was mild in practically all CPs in the aortic position, and in the majority of CPs in the mitral position.

Aortic Valve↗
PubMed1989

Transesophageal Doppler color flow imaging in the detection of native and Björk-Shiley mitral valve regurgitation.

Regurgitant blood flow of mitral valves was studied by transesophageal Doppler color flow echocardiographic imaging in 11 healthy volunteers (Group 1), 25 cardiac patients with a native mitral valve (Group 2), 10 patients with a normally functioning Björk-Shiley mitral prosthesis without clinical evidence of mitral regurgitation (Group 3) and 10 patients with angiographic or surgical evidence of Björk-Shiley mitral valve regurgitation (Group 4). Holosystolic regurgitant color jets were classified as type I or type II. The data were compared with results obtained with precordial techniques, i.e., continuous wave and Doppler color flow echocardiographic imaging (Groups 1 to 4) and left ventricular angiography or surgery (Groups 2 and 4). In Group 1, transesophageal Doppler color flow imaging revealed no mitral regurgitant flow in 7 of the 11 patients and a type I jet in 4 patients that was detected in only 1 patient by precordial techniques. In Group 2, angiography showed no mitral regurgitation in 20 patients and documented mitral regurgitation in 5. Transesophageal Doppler color flow imaging detected in 4 of the 20 patients a type I jet that was not visualized with precordial techniques in 2 patients. Type II jets were detected by the transesophageal technique in all five patients with proven mitral regurgitation and were also visualized with precordial echocardiography. All patients in Group 3 showed two identical type I jets that were not detected with precordial echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Fluorescence of dental porcelain.

This study of the fluorescence of natural enamel and of dental ceramics shows the fluorescence of ceramics not containing rare earths decreases when the color saturation increases; the fluorescence of samples of the same shade guide are not homogenous; some guides show a strong green fluorescence; and two shade guides of the same origin can present completely different fluorescence. The cementing medium can affect the fluorescence of a ceramic prosthesis.

Analog-Digital Conversion↗
PubMed2003

An implant-retained auricular impression technique to minimize soft tissue distortion.

Achieving adaptation of an auricular prosthesis begins with an accurate impression. It is important to consider how the selection of the impression materials will affect the final outcome of the prosthesis. A procedure is presented to minimize the distortion of the soft tissues caused by the impression materials and procedure. The procedure consists of splinting the implant impression copings, then recording the soft tissue in silicone impression material, followed by the application of acrylic tray resin to provide rigidity.

Acrylic Resins↗
PubMed1987

Oesophageal echocardiography.

The diagnostic value of oesophageal echocardiography is most striking in patients in whom precordial studies are of inadequate quality or fail to establish a definitive diagnosis. Oesophageal studies have excellent image quality, can be completed within 10 minutes without complications and, in most instances, enables the clinical question to be answered. In 50 patients referred for suspected thoracic aorta pathology, oesophageal echocardiography correctly excluded or diagnosed the type of aortic dissection, aortic aneurysm or the site of coarctation. Of 35 patients referred with suspected infective endocarditis, oesophageal echocardiography revealed complications in 18 patients, including vegetation, mycotic aneurysm, abscess or chordal rupture. Oesophageal echocardiography is extremely helpful to visualize intracardiac mass lesions. In 27 patients with a history of systemic or pulmonary embolism, the technique confirmed the presence, size and position of a mass lesion in 11 patients. Oesophageal color Doppler flow imaging further expands the diagnostic capabilities, particularly in patients with mitral valve prosthesis. Our experience indicates that oesophageal echocardiography significantly extends the diagnostic potential of echocardiography. Detailed knowledge of cardiothoracic anatomy and its pathologic sequelae is, however, a prerequisite for the efficient and safe application of this method.

Aorta, Thoracic↗
PubMed1998

Closure of atrial septal defects with the Amplatzer occlusion device: preliminary results.

OBJECTIVES: This study reports our clinical experience with transcatheter closure of secundum atrial septal defects (ASDs) in children, using the Amplatzer, a new occlusion device. BACKGROUND: None of the devices previously used for transcatheter closure of interatrial communications has gained wide acceptance. METHODS: We examined the efficacy and safety of the Amplatzer, a new self-centering septal occluder that consists of two round disks made of Nitinol wire mesh and linked together by a short connecting waist. Sixteen patients with secundum ASD met established two- and three-dimensional echocardiographic and cardiac catheterization criteria for transcatheter closure. The Amplatzer's size was chosen to be equal to or 1 mm less than the stretched diameter. The device was advanced transvenously into a 7F long guiding sheath and deployed under fluoroscopic and ultrasound guidance. Once its position was optimal, it was released. RESULTS: The mean ASD diameter by transesophageal echocardiography was 14.1+/-2.3 mm and was significantly smaller (p < 0.001) than the stretched diameter of the ASD (16.8+/-2.4 mm). The mean device diameter was 16.6+/-2.3 mm. No complications were observed. After deployment of the prosthesis, there was no residual shunt in 13 (81.3%) of 16 patients. In three patients there was trivial residual shunt immediately after the procedure that had disappeared in two of them at the 3-month follow-up. CONCLUSIONS: The Amplatzer is an efficient prosthesis that can be safely applied in children with secundum ASD. However, a study including a large number of patients and a longer follow-up period are required before this technique can be widely used.

Adolescent↗
PubMed2004

Surveillance for endoleaks: how to detect all of them.

Endovascular aneurysm repair has proven to be a valuable alternative to open repair in selected patients. This less invasive procedure, however, requires long-term surveillance for its own set of potential complications, including perigraft leakage, or endoleak. This article focuses on the detection of these leaks, first defining and classifying endoleaks and then describing various means of detecting them, including computed tomographic angiography, magnetic resonance angiography, color-flow duplex ultrasonography, and conventional angiography.

Aortic Aneurysm, Abdominal↗