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PubMedDate not supplied

Clinical evaluation of and parental satisfaction with resin-faced stainless steel crowns.

PURPOSE: This study evaluated the clinical success and parental acceptance of anterior primary dentition caries treatment with prefabricated resin-faced stainless steel crowns. METHODS: A retrospective analysis of maxillary anterior primary dentition caries treatment using Whiter Biter II Crowns was performed. Each crown was evaluated for retention, fracture, interface failure, color match, marginal integrity, and surface texture. Parental satisfaction regarding the esthetics of the crowns was evaluated by survey. RESULTS: Thirty-eight crowns were evaluated in 12 children. The average crown age at time of examination was 20.7 months. Three teeth were lost to trauma with all other crowns remaining intact. Twelve crowns (32%) showed loss of at least some facial resin. Nine crowns (24%) had complete loss of the resin facing. Overall parental satisfaction with the treatment was excellent, however, satisfaction with crown esthetics received the lowest rating. CONCLUSIONS: While parental satisfaction with treatment of anterior primary dentition caries with prefabricated resin-faced stainless steel crowns is excellent, the high failure rate of the resin facings is problematic.

Child↗
PubMed2001

Mycotic aneurysm of the palmar artery associated with infective endocarditis. Case report and review of the literature.

A 26-year-old man was diagnosed with mycotic aneurysm of the left hand associated with active infective endocarditis. Preoperative arteriography of the hand revealed aneurysm of the radial side of the deep arch of the palmar artery. We approached the aneurysm from the dorsal side of the hand in order to avoid damage to the collateral vascular supply of the superficial arch of the palmar artery and neurological structures. As a result, the aneurysm was excised simply by proximal and distal ligation of the vessel. During follow-up over 14 months, no evidence of recurrent aneurysm formation or ischemia of the fingers has been obtained.

Adult↗
PubMed2006

Optical behavior of current ceramic systems.

The restoration of anterior teeth is a difficult task, even for an experienced operator. Currently there are many different ceramic systems that can be used to achieve highly esthetic results. These include metal-ceramics with porcelain margins, Dicor, In-Ceram, Cerestore, Hi-Ceram, IPS-Empress, Cerapearl, Optec, and CAD/CAM ceramics. While metal-ceramics have been used for more than four decades, the quest for a material that transmits and refracts light like a natural tooth has inspired research into all-ceramic restorations. The purpose of this paper is to briefly discuss the properties of each of the above-mentioned materials and clinically evaluate the optical behavior of: (1) metal-ceramic crowns with castings 2 mm short of the shoulder preparation and 360-degree porcelain margins; (2) In-Ceram Spinell restorations; and (3) IPS Empress restorations, and to compare these with metal-ceramic crowns with copings to the shoulder preparation and 180-degree porcelain margins. Light transmission characteristics and color matching were subjectively evaluated by five experienced prosthodontists who did not participate in this clinical study.

Aluminum Oxide↗
PubMed1994

[Transesophageal echocardiography in cardiogenic shock in acute posterior wall infarct with rupture of the papillary muscles].

A 63-year-old male patient suffered an acute myocardial infarction entirely confined to the posterior wall. As symptoms persisted and cardiogenic shock developed immediate heart catheterization was performed, which demonstrated an occlusion of the left circumflex branch. Right-heart catheterization demonstrated an enlarged v-wave. Thus, acute infarct associated mitral regurgitation was suspected. In the catheterization laboratory transesophageal echocardiography including Doppler- and contrast echocardiography was then performed, which revealed the diagnosis of posterior papillary muscle rupture. The patient proceeded immediately to emergency surgery during which mitral valve replacement with a St. Jude prothesis was performed in addition to venous bypass revascularization of the occluded and a further stenosed coronary artery. The postoperative follow-up was without any complications and the patient recovered satisfactorily from the acute event. This case demonstrates the excellent diagnostic utility of emergency transesophageal echocardiography in the situation of infarct related myocardial rupture, which has to precede the life-saving operation.

Cardiac Catheterization↗
PubMed1996

Evaluation of lower extremity bypass grafts with use of color duplex sonography.

This article reviews the wide variety of graft procedures currently used to bypass lower extremity atherosclerotic disease and the means used to evaluate the grafts, which can be biologic, synthetic, or a combination of both. Graft failure rate can be as high as 10% within the first 10-14 days after placement, leveling off to approximately 2%-4% per year thereafter. Many of the early complications associated with graft placement can be attributed to technical errors in bypass construction. Although angiography remains the standard of reference for the evaluation of these grafts, duplex ultrasound is increasingly being utilized to document patency and detect suspected complications such as intimal flap, perigraft collection, arteriovenous fistula, pseudoaneurysm, and stenosis or occlusion. Sonography is able to clearly depict the echogenic walls of synthetic grafts and demonstrate whether blood flow wave-forms and blood flow velocity in both synthetic and biologic grafts are normal, thus enabling a more accurate diagnosis of suspected complications to be made. Familiarity with the normal sonographic appearance of these grafts, their anastomoses, potential complications, and the pitfalls in making a diagnosis is essential if an accurate diagnosis is to be made.

Arteriosclerosis↗
PubMed2002

"Pseudoendoleak"--residual intrasaccular contrast after endovascular stent-graft repair.

PURPOSE: To present a unique demonstration of postoperative perigraft contrast masquerading as an endoleak following endovascular abdominal aortic aneurysm (AAA) repair. CASE REPORT: A 66-year-old man underwent endovascular stent-graft repair of a 4.6-cm infrarenal AAA. The procedure was uncomplicated, and intraoperative completion angiography demonstrated good proximal and distal fixation of the stent-graft without an endoleak. A spiral computed tomographic (CT) angiogram obtained on postoperative day 2 revealed a large amount of extrastent contrast along the posterior aspect of the aneurysm sac. This defect had the appearance of an endoleak, but it was also present on the non-contrast images. A color-flow duplex examination performed on the same day showed a widely patent stent-graft with no evidence of extrastent flow. CONCLUSIONS: Contrast trapped in the aneurysm sac during endovascular aneurysm repair may be misinterpreted as an endoleak on postprocedural CT scans. "Pseudoendoleaks" can be distinguished from true endoleaks by examination of prebolus, noncontrast CT images, as well as by duplex ultrasound scanning.

Aged↗
PubMedDate not supplied

[Policy guidelines and practical considerations for the development of technology at the Instituto Nacional de Cardiología de México].

In order to face the current economical problems of the country, our Institute has intensified its efforts to replace the imports of medical goods by developing its own medical technology. This article summarizes what we have achieved in this field and describes the rules to be followed in the future. We describe the program on the designing and development of heart valve prosthesis together with an hydraulic-electrical system to test them. In the field of computed instruments, we have developed a system of "synchronos color pictures" to be applied in nuclear medicine. In the field of electrocardiography; an EKG paste, a computed program for automatic EKG interpretation and a "filter" of the 60 cycle interference. The Institute is engaged in the designing of a sophisticated EKG machine at low cost, and EKG tracing simulator for teaching purposes. These programs have been shared with others institutions of the country.

Academies and Institutes↗
PubMed2003

Endovascular exclusion of iatrogenic femoral artery pseudoaneurysm with the Wallgraft-Endoprosthesis.

Development of femoral artery pseudoaneurysm represents a continuing problem after percutaneous peripheral interventional procedures as well as coronary angioplasty. We report a case of symptomatic, expanding femoral artery pseudoaneurysm in a 60-year-old man who underwent percutaneous transluminal coronary angioplasty and stenting for acute myocardial infarction. A self-expanding Wallgraft Endoprosthesis (Boston Scientific, USA) was delivered under fluoroscopic guidance via contralateral percutaneous femoral approach to the site, resulting in immediate complete exclusion of the pseudoaneurysms. Follow-up color duplex scanning confirmed false aneurysm exclusion 1 year postprocedure. Endovascular treatment of iatrogenic pseudoaneurysm appears to be an attractive alternative to surgical repair in critically ill patients, with a high degree of technical success, low morbidity and short hospital stay.

Aneurysm, False↗
PubMed1999

Use of contrast-enhanced ultrasound in follow-up after endovascular aortic aneurysm repair.

PURPOSE: To investigate the use of contrast-enhanced ultrasound in the detection of endoleak after endovascular repair of abdominal aortic aneurysm. MATERIALS AND METHODS: Eighteen patients underwent follow-up on 20 occasions after endovascular aortic aneurysm repair by arterial-phase contrast-enhanced spiral computed tomography (CT). All patients had unenhanced color Doppler ultrasound and Levovist-enhanced ultrasound on the same day. The ultrasound examinations were reported in a manner that was blind to the CT results. CT was regarded as the gold standard for the purposes of the study. RESULTS: There were three endoleaks shown by CT. Unenhanced ultrasound detected only one endoleak (sensitivity, 33%). Levovist-enhanced ultrasound detected all three endoleaks (sensitivity, 100%). Levovist-enhanced ultrasound indicated an additional six endoleaks that were not confirmed by CT (specificity, 67%; positive predictive value, 33%). In one of these six cases, the aneurysm increased in size, which indicates a likelihood of endoleak. Two of the remaining false-positive results occurred in patients known to have a distal implantation leak at completion angiography. CONCLUSION: In this small group of patients, contrast-enhanced ultrasound appears to be a reliable screening test for endoleak. The false-positive results with enhanced ultrasound may be due to the failure of CT to detect slow flow collateral pathways. Although the number of patients in this study is small, enhanced ultrasound may be more reliable than CT in detecting endoleak.

Aged↗
PubMed2000

Aortic aneurysm size and graft behavior after endovascular stent-grafting: clinical experiences and observations over 3 years.

PURPOSE: To assess the long-term safety and efficacy of aortic endografts in terms of clinical outcome, continuing aneurysm exclusion, and changes of aneurysm size and graft configuration. METHODS: Between August 1994 and July 1997, 190 patients (176 men; mean age 68.7 years, range 40-87) with aortic and aortoiliac aneurysms were treated with endovascular stent-grafts (Stentor, Vanguard, and EGS) in a tertiary care municipal hospital setting. Follow-up involved clinic visits every 3 to 6 months with contrast-enhanced computed tomography (CT), color duplex, and plain abdominal radiographs at regular intervals; angiography was used selectively. All data were collected prospectively and entered into a computerized database. RESULTS: Implantation was possible in 188 (98.9%) patients. Early conversion to open surgical repair was required in 14 (7.4%) patients. Primary endoleaks were detected in 32 (16.8%) patients. Perioperative mortality was 0.53% (1/190). During follow-up, 17 (8.9%) additional patients were converted to open repair over a mean 20.9 months. Thirty-seven secondary procedures to treat endoleaks and pelvic outflow occlusions were performed in 30 (15.8%) patients. Changes in stent configuration suggestive of endograft disintegration were observed in 31 (29.8%) of 104 abdominal radiographs. Intraluminal layering of thrombus was seen on contrast-enhanced CT images in 20 patients. A significant trend (chi(2)4 = 12.34, p < 0.025) toward aneurysm enlargement was seen in patients with persistent endoleaks at a mean 18-month follow-up. CONCLUSIONS: Although endoleaks after aortic stent-graft placement tend to cause ongoing aneurysm growth, we have also observed aneurysm shrinkage despite ongoing endoleak. The presence or absence of an endoleak in itself may be a poor predictor of successful stent-graft therapy. Lifelong surveillance is needed to assure successful aneurysm exclusion and stability or shrinkage of the aneurysm sac. Technical improvements in stent materials and design are necessary to guarantee long-term stability and safety of the device.

Adult↗
PubMed2004

What exactly was wrong with the Trilucent breast implants? A unifying hypothesis.

Trilucent soybean oil-filled breast implants were initially announced as the ultimate prostheses for breast augmentation. However, after an increasing number of reports of local complications and hazardous metabolites attributable to lipid oxidation, first the United Kingdom Medical Devices Agency and later the Belgian National Ministry of Health urged all plastic surgeons to contact their patients and advise them to have the implants removed and, if desired, replaced with another type of prosthesis. In our plastic surgery department, 13 patients received bilateral implants with triglyceride-filled prostheses between February and July of 1996, for primary breast augmentation or replacement of previously implanted prostheses. For 12 of those 13 patients, the prostheses have been explanted, because of unilateral breast enlargement attributable to a ruptured prosthesis for five patients and following the recommendation of the Belgian National Ministry of Health for the other seven patients. Before explantation, all patients underwent standard clinical examinations, with assessments of breast shape, volume, and firmness. Blood analyses were performed, with a special focus on liver enzymes, as were urinalyses. Magnetic resonance imaging scans were obtained before explantation; for two patients, the scans revealed a fluid level separating two liquid layers in an intact prosthesis. This is the first report of such a finding. The removed implants were examined for any damage or shell deterioration and for changes in color and viscosity, the weights and volumes were measured and compared with the initial values for the implanted prostheses, and complete biochemical analyses of the accumulated fluid in cases of ruptured prostheses and of the filler material in cases of intact prostheses were performed. This small but well-documented series illustrates the multitude of problems associated with triglyceride-filled implants, including bleeding of the triglyceride filler; shell deterioration, as indicated by a loss of texture and extreme fragility of the implant (with rupture or delamination with a simple finger touch); an increase in osmotic pressure exerted by the degraded filler material; progressive weakening of the outer silicone shell, with influx of plasma proteins of up to 750 kDa, eventually resulting in rupture of the prosthesis; a lack of oxidative stability and the formation of toxic oxidation products; a lack of biocompatibility, with the formation of insoluble organic soap-like material; and a pronounced inflammatory reaction. It is concluded that the sequential and/or simultaneous occurrence of (1) implant bleeding, (2) lipid infiltration of the silicone elastomer, and (3) inflammation attributable to oxidation products provides an overall explanation or unifying hypothesis for the wide variety of adverse events related to soybean oil-filled implants.

Biocompatible Materials↗
PubMed1989

Surgery of right-sided endocarditis: valve preservation versus replacement.

Surgical treatment of right-sided endocarditis has in the past been centered on valve resection or resection with valve replacement. From 1981 to 1989, we attempted tricuspid valve repair in 19 patients with right-sided endocarditis. Fourteen of these were successful. The methods of valve repair and classification of the lesions that allow evaluation for repair are discussed, including the use of transesophageal echo and a hand-held color Doppler unit for intraoperative assessment.

Echocardiography↗
PubMed1992

[Skin expansion. A new weapon in the therapeutic arsenal of plastic surgeons].

Skin expansion is a revolutionary technique for plastic surgery. Its principle is based on the observation of clinical facts, such as pregnancy, in which the skin can readily become distended. The technique consists in implanting a silicon prosthesis, connected to a filling valve through a tube, under the skin. The inflation of this prosthesis takes 3 months. At the end of this time, good-quality skin with the same features as normal skin (color, hairs, sensation) is available. There are many indications for this technique, including substance losses, removal of congenital tumors and of scars, breast reconstruction or scalp surgery.

Alopecia↗
PubMed2006

Diagnostic value of color duplex ultrasonography in the follow-up of endovascular repair of abdominal aortic aneurysm.

PURPOSE: To systematically review the findings of diagnostic value of color duplex ultrasound (US) in the follow-up of endovascular repair of abdominal aortic aneurysms (AAAs). MATERIALS AND METHODS: A search of PubMed and Medline databases for English-language literature was performed to find studies published between 1991 and 2005. Studies comparing the diagnostic accuracy of color duplex US with that of computed tomographic (CT) angiography were included, and analysis was performed of the detection of endoleaks and measurement of aneurysm diameter. RESULTS: Twenty-one studies (39 separate comparisons) met the criteria and were included for analysis. Pooled estimates of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of color duplex US compared with CT angiography (with 95% CIs) were 66% (52%-81%), 93% (89%-97%), 76% (65%-87%), 90% (86%-95%), and 91% (86%-97%), respectively, for unenhanced color duplex US; and 81% (52%-100%), 82% (68%-97%), 58% (26%-90%), 95% (87%-100%), and 98% (91%-100%), respectively, for enhanced color duplex US. The sensitivity in the detection of endoleak was significantly improved with contrast material-enhanced color duplex US compared with unenhanced color duplex US (P < .05); however, no significant difference was found regarding the specificity, PPV, NPV, and accuracy between unenhanced and enhanced color duplex US (P > .05). Color duplex US was insensitive in measurement of aneurysm diameter compared with CT angiography in most situations. CONCLUSIONS: Color duplex US is not as accurate as CT angiography and cannot replace CT angiography in the follow-up of endovascular aortic repair of AAAs. However, the use of contrast material-enhanced color duplex US resulted in improvement of diagnostic accuracy in the detection of endoleak and warrants further study.

Angiography↗
PubMedDate not supplied

Venous microemboli in patients with artificial heart valves.

BACKGROUND: Detection of microemboli signals (MES) in patients with artificial heart valves has been extensively described, but the underlying material remains unclear. We assumed that the detection of MES in the jugular vein of patients with prosthetic valves would clearly argue for gaseous embolic material, since formed emboli are unable to cross through the capillaries. METHODS AND RESULTS: Twenty-five patients with artificial heart valves, 15 patients with asymptomatic carotid artery disease, and 25 normal controls were examined. Monitoring was performed simultaneously over the dominant jugular vein and the ipsilateral middle cerebral artery for 30 min per subject, using 2-MHz transducers of a color duplex scanner for the jugular vein and a pulsed-wave Doppler for the middle cerebral artery. Data were harvested in an eight-channel digital recorder and MES counts evaluated by two separate observers. MES prevalence in the middle cerebral artery was 100, 13 and 0% in patients with artificial heart valves, asymptomatic carotid artery disease, and normal controls, respectively. No MES were detected in the jugular veins of patients with carotid artery disease or in normal controls, while their prevalence was 68% in patients with artificial heart valves. The interobserver agreement was satisfactory. CONCLUSION: Our results suggest that the embolic material of at least a part of MES in patients with artificial heart valves is gaseous.

Cerebral Arteries↗