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PubMed2005

Conversion of a removable partial denture to a transitional complete denture: a clinical report.

A procedure is described for conversion of an existing removable partial denture into a complete denture using autopolymerizing tooth-colored acrylic resin, acrylic resin denture repair material, and a clear matrix template. The shape, color, and position of the lost natural teeth may be duplicated in the transitional denture, minimizing the psychological concerns of the patient regarding esthetics and social impact. Because the patient is never without teeth, an appropriate healing time can occur before fabrication of the definitive prosthesis.

Dental Prosthesis Design↗
PubMed2006

Whether post-ureteroscopy stenting is necessary or not?

OBJECTIVE: To verify if post-ureteroscopy (URS) stenting is still necessary as a routine strategy, or if some cases can be treated without. METHODS: Between August 2004 and April 2005, 85 patients were admitted to the Urology Department at the Nephrology and Urology Center, Al-Thawra Hospital, Yemen with ureteric stones of different size and site. All were scheduled and treated by the ureteroscopy method. According to prospective pure randomization, 45 patients were left non-stented at the end of the operation (non-stented group), while 40 patients were left with stent (stented group). RESULTS: The ages of the non-stented group ranged between 6-70 years (mean 34.36 +/- 15.53), while the size of the stones ranged between 5-20 mm (mean 8.4 +/- 3.1). They were 33 males and 12 females. Regarding the site, 26 stones were in the right, and 19 in the left ureter. In the stented group, the ages ranged between 14-70 years (mean 39.35 +/- 13.36), while the size of the stones ranged between 6-16 mm (mean 9.9 +/- 3.2). They were 34 males and 6 females. Twenty-five stones were in the right ureter, and 15 in the left. Success was 100% in the non-stented group, while it was 39 out of 40 in the stented group. The 2 groups were compared statistically for postoperative analgesia, color clearance of urine and hospital stay, and found significantly different. However, for operative time, the difference was insignificant. CONCLUSION: When treating ureteric stones by ureteroscopy, postoperative stenting should not be used as routine, but should be limited to those with ureteric injury, bigger sizes and prolonged operative time. The non-stenting method decreases the need for postoperative analgesia, time of color clearance and hospital stay.

Adolescent↗
PubMed2006

[The use of CAD/CAM system with zirconia in modern prosthodontics].

Computer assisted design/computer assisted machining (CAD/CAM) technology has received considerable clinical and research interest from modern dental practices as a means of delivering all-ceramic restorations. Up to now the CAD/CAM system with zirconia has the highest fracture strength in all all-ceramic materials, and consistently enabled the most esthetic, lifelike reproduction of natural dentition. They have been widely received by both dentists and patients. The CAD/CAM system with zirconia is indicated for crowns and bridges in natural teeth or implants and telescope dentures, the CAD/CAM with zirconia can be placed anywhere in the mouth, and can replace the porcelain crowns and bridges for single crown and bridges less than 6 units. This paper described the techniques of CAD/CAM system with zirconia in fabrication of crowns, bridges, telescope dentures and implant dentures with colored illustrations.

Computer-Aided Design↗
PubMed1990

Initial experience with color-flow duplex scanning of infrainguinal bypass grafts.

Seventy-eight infrainguinal grafts were evaluated by means of color-flow duplex imaging to demonstrate its utility in the routine surveillance of leg grafts as well as in the evaluation of grafts in which a problem is already suspected. Stenoses were identified in 15 (20%) of 76 grafts evaluated for screening purposes. Seven of these had confirmatory arteriograms, and five were revised. The remaining eight grafts with suspected stenoses were followed without angiography, and four (50%) subsequently failed. Only two (3.3%) of 61 grafts with normal scan outcomes have thrombosed. Fistulas were identified in 12 (37%) of 32 in situ grafts evaluated. Nine grafts with previously suspected problems based on decreased ankle-brachial indexes were scanned, and an explanation was found, confirmed by angiogram, and corrected in six. Detection of unsuspected stenoses in five grafts requiring revision and four grafts that later thrombosed without revision, as well as identification of fistulas in 37% of in situ grafts, confirms the importance of color-flow imaging as a screening tool.

Blood Flow Velocity↗
PubMed1997

Postoperative color flow duplex scanning in aortic endografting.

PURPOSE: To report the feasibility and sensitivity of duplex sonography compared to computed tomography (CT) for aortic endograft follow-up surveillance. METHODS: In a 26-month period, 113 aortic aneurysm patients received 79 tube and 34 bifurcated stent-grafts. Follow-up used contrast-enhanced CT scanning and duplex sonography with an intravenous ultrasound contrast agent (Levovist). RESULTS: Eleven patients (9.7%) were converted to open repair; 1 died from hemorrhagic shock secondary to retroperitoneal hematoma. The mean follow-up time was 7.2 months (range 1 to 24), during which 5 patients died of unrelated causes. Sixteen primary (within 30 days) and 5 secondary endoleaks were detected by duplex after tube graft implantation. Among 5 endoleaks due to retrograde side-branch perfusion, 3 were detected only with contrast-enhanced duplex scanning. Iliac artery occlusion was also documented using duplex; however, 2 stent fractures could not be seen with ultrasound. Ten primary endoleaks were detected in bifurcated stent-graft patients. One endoleak originating from the distal iliac limb anchoring site was missed by duplex owing to bowel gas. Graft limb thrombosis was clearly identified by lack of a flow signal on duplex. CONCLUSIONS: Duplex sonography could be a valuable, reliable, and economical surveillance tool for endovascular aortic reconstructions. The adjunctive use of an intravenous ultrasound contrast agent increased the sensitivity for detecting endoleak to a level comparable to contrast-enhanced CT scanning. However, stent fractures may not be seen on ultrasound, and bowel gas can interfere with obtaining an adequate image.

Adult↗
PubMedDate not supplied

Endovascular treatment of femoropopliteal aneurysms: a five-year experience.

PURPOSE: To assess the effectiveness of endovascular treatment of femoropopliteal aneurysms (FPAs). METHODS: In the last 5 years, we have treated 17 FPAs (diameter 21-75 cm, mean 38.4 cm; length 27-100 cm, mean 72.5 cm) in 15 patients (age 57-80 years, mean 70.9 years). The diagnosis was obtained by color Doppler ultrasound (CDU) and the procedure was planned by CT angiography (CTA) and preprocedural angiography. Eight FPAs were excluded with only one stent-graft; in 8 patients, two stent-grafts were positioned; and in 1 patient, three stent-grafts were used. In 14 cases we used a Wallgraft endoprosthesis, in 2 cases a Hemobahn, and in 1 case an Excluder contralateral leg. The patients were followed up with CDU and occasionally with CTA. RESULTS: Immediate technical success was obtained in 17 of 17 cases (100%). One patient died during the first year. During a mean follow-up of 26.9 months (range 3-60 months) we observed 6 of 16 (38%) stent-graft occlusions (3 of which were recanalized with locoregional thrombolysis and 3 with mechanical thrombectomy). Two stent-grafts were patent at 12 and 24 months. Four patients experienced subsequent occlusions and recanalizations until corrected by surgical bypass (1 at 14 months, 2 at 18 months, and 1 at 36 months). Therefore the primary patency was 63% and assisted patency was 73%. CONCLUSION: The endovascular approach is a minimally invasive treatment option for FPAs. Moreover endovascular stent-grafting does not necessarily preclude conventional surgical repair, but it can delay it. Longer follow-up will be needed to determine the long-term patency rate.

Aged↗
PubMed2005

One-year clinical experience with the Acorn CorCap cardiac support device: results of a limited market release safety study in Italy and Sweden.

BACKGROUND: The Acorn CorCap cardiac support device (CSD) is a mesh-like device intended to provide end-diastolic support and reduce ventricular wall stress. Animal studies with the CorCap CSD have demonstrated beneficial reverse remodeling, and preliminary safety studies in patients with heart failure have shown that the device is safe and associated with improved left ventricular (LV) structure and function. The objective of the current study was to further evaluate the safety and efficacy of the CorCap CSD in patients with advanced heart failure. METHODS: Twenty-four patients with dilated cardiomyopathy, severe LV dysfunction, and advanced heart failure (NYHA class II-IV) were enrolled at four centers in Italy and Sweden. All patients underwent CorCap CSD implantation either alone (n = 3) or in combination with mitral valve repair/replacement (n = 13), coronary artery bypass surgery (n = 6), combined mitral valve repair/coronary artery bypass surgery (n = 1) or aneurysmectomy (n = 1). RESULTS: The LV end-diastolic diameter decreased from 69.3 +/- 7.2 to 60.1 +/- 9.0 mm at 3 months, 60.9 +/- 9.6 mm at 6 months, and 58.9 +/- 8.0 mm at 12 months (all p < 0.05). A trend toward an improved LV ejection fraction (28.8 +/- 10.5% at baseline and 32.4 +/- 12.7, 33.1 +/- 10.8, and 33.8 +/- 13.9% at 3, 6 and 12 months respectively) was also noted. The NYHA functional class, 6-min walking distance, and quality of life as measured using Uniscale were all improved. There were no differences in response among the patients submitted to the different types of concomitant surgery. CONCLUSIONS: In agreement with earlier safety studies, even the present investigation demonstrated improvements in cardiac structure and function as well as in patient functional status after Cor Cap CSD implantation. Randomized controlled trials are in progress.

Adult↗
PubMed2005

[Analysis of the unsuccessful cases of the porcelain-fused-to-metal-crowns and bridges].

OBJECTIVE: To discuss the unsuccessful reasons and the preventive methods of the unsuccessful clinic cases. METHODS: The retrospective analysis was carried on the 80 prosthesis in 70 patients from 1994 to 2001 which were suffered with unsuccessful results after the restoration of the metal crowns and bridges. RESULTS: There were 68 teeth which had collapsed or broken. 20 teeth had the post loosing or shedding. Root breaking, food impaction, unharmony colors of porcelain and the changing color of gingival were 3, 3, 6 and 2 teeth. CONCLUSION: It is necessary to select suitable repairing materials and operate correctly for preventing the occurring of the unsuccessful results in the porcelain-fused-to-metal-crowns and bridges.

Crowns↗
PubMed2006

White blood cell scintigraphy in the diagnosis of infection of endovascular prostheses within the first month after implantation.

BACKGROUND: 99mTc-HMPAO-labeled leukocyte scintigraphy (WBCs) is useful in the diagnosis of vascular graft infection. However, false positives can occur in the early postoperative period. There are no data concerning the usefulness of WBCs in detecting endovascular prosthesis infection during this period. The aim of our study was to assess the reliability of WBCs in the diagnosis of early infection after endovascular prosthesis implantation. MATERIAL/METHODS: 23 patients treated with endovascular grafts were submitted to preoperative diagnostic screening and to 3 WBCs (1 week before, 1 week after, and 1 month after surgery). After the last WBCs, all patients underwent a 14-month follow-up (range 6-37 months, median 12 months). RESULTS: Three patients died, at 3, 4 and 5 months after surgery respectively. At the end of the follow-up, the presence of infection was demonstrated in one patient. Of the 70 WBCs performed, 4 gave positive results. No positive scintigraphies were obtained in the preoperative period. A positive scintigraphy was found one week after surgery in a patient who showed lymphorrhage at the site of surgical access. In the same patient, the scintigraphic result returned to normal at 1-month scintigraphy. At 12-month follow-up the patient did not present signs of infection. Three positive scintigraphies were obtained in the same patient. In this patient clinical symptoms of graft infection became evident about 19 months after surgery. WBCs was repeated and showed extension of the infection. The infection was confirmed at surgery. CONCLUSIONS: WBCs do not provide false-positives in the first month after endovascular prosthesis implantation.

Aged↗
PubMed2005

Computed tomography versus color duplex ultrasound for surveillance of abdominal aortic stent-grafts.

PURPOSE: To compare the ability of computed tomography (CT) and color duplex ultrasound (CDUS) to detect endoleak and accurately measure aortic aneurysm diameters after endovascular repair. METHODS: Between February 2000 and October 2004, 178 consecutive patients (156 men; mean age 74 years, range 49-89) were treated with aortic stent-grafts (86 Ancure, 55 AneuRx, and 37 Excluder). The follow-up protocol included serial CT and CDUS at 1 month and every 6 months thereafter. Sensitivity, specificity, positive predictive value, negative predictive value, and Kappa statistics (kappa) were calculated using CT as the gold standard; Bland-Altman analysis was used to determine the 95% limits of agreement. Paired and unpaired t tests and correlation coefficients were used to compare the methods. RESULTS: Follow-up ranged from 1 to 53 months (mean 16), during which 367 paired CT and CDUS studies were acquired. The mean diameter of the AAA sac after repair was 5.15 cm by CT versus 4.99 cm by CDUS (p=0.07); 93% of paired studies were somewhat similar (<or=5 mm). Mean pre to postoperative AAA size changes throughout follow-up were -0.60 mm for CT versus -0.58 mm for CDUS (p=0.78). Thirty-four (19%) endoleaks were detected (26 early and 8 late). Versus CT, the sensitivity, specificity, positive predictive value, and negative predictive value of CDUS for detecting endoleaks were 68%, 99%, 85%, and 97%, respectively (kappa=0.73). CDUS was more accurate in detecting type I endoleak than type II (88% versus 50%, p=0.046). CONCLUSIONS: Although CDUS has good correlation to CT in measuring the size of AAAs, it has a lower sensitivity in detecting endoleak, particularly type II. Therefore, CT scans should remain the primary imaging modality for the diagnosis of endoleak.

Aged↗
PubMed2004

Influence of bileaflet prosthetic mitral valve orientation on left ventricular flow--an experimental in vivo magnetic resonance imaging study.

OBJECTIVE: Orientation-related bileaflet mechanical valve flow and velocity studies in the downstream area are limited in mitral valve replacement studies. METHODS: In five sheep, ventricular blood flow was visualized prior to the implantation of a mitral Edwards Mira Bileaflet Mechanical Valve Model 9600. The implant orientation was either anatomic, with a 45 degrees rotation, or anti-anatomic, with a 90 degrees rotation. Sheep were positioned within an 1.5T field strength MR scanner (Magnetom Sonata; Siemens) to assess time-dependent three-dimensional blood flow velocities displayed as color-encoded vectors. RESULTS: The preoperative ventricular velocity profiles presented negligible individual variances. Streamlines passed homogeneously without any spatial differences into the left ventricle. Starting from the anatomical position, the areas with inhomogeneous and accelerated local blood velocities increased in comparison to the preoperative status. Rotating the prosthesis until it was in a 45 degrees position caused a significant increase in turbulence immediately downstream; fluids stagnated longer at the apex. In the anti-anatomic orientation, mean velocities decreased. In all three positions, but less so in the anatomical position, the flow pattern of the blood helix at the apex was disturbed. The intraventricular flow patterns between prostheses in the three orientations were, however, not significant when compared to the differences between physiologic intraventricular flow and any of the postoperative measurements. CONCLUSIONS: To achieve optimal hemodynamics, rotation of the mitral valve has to be considered carefully, as has long been known from aortic valve replacement studies. To this end, a method for qualitative assessment of left ventricular blood flow patterns was developed.

Animals↗
PubMed2003

The hemodynamic effects of internal carotid artery stenting: a study with color-coded duplex sonography.

BACKGROUND: Stenting has been used as an alternative treatment for patients with internal carotid artery (ICA) stenosis. Color-coded duplex sonography (CDS) is able to measure not only the prestenting stenosis but also the poststenting hemodynamic changes. The purpose of this study was to quantify, using CDS, the hemodynamic changes after ICA stenting. METHODS: Both symptomatic and asymptomatic patients were included in this study. The degree of ICA stenosis before stenting was required to be more than 50%. Thirty-two treated ICAs were included to compare the prestenting and poststenting CDS findings, including the diameter and cross-sectional area of the lumen, the flow peak systolic and end-diastolic velocities, the resistivity index and the amount of flow in bilateral extracranial carotid and vertebral arteries. RESULTS: After stenting, the turbulent flow pattern in the stenotic ICA recovered to laminar flow, and the reversed ophthalmic flow direction normalized. Of the CDS parameters applied to evaluate the effect of stenting on ICA stenosis, the diameter, residual area, peak systolic velocity, diastolic velocity and the ration of systolic flow velocity ratio in the ICA to that in the common carotid artery (CCA) were altered significantly. The mean area and residual area of these stenotic ICAs showed increases of 24% (p = 0.005) and 84% (p = 0.001) after ICA stenting, respectively. The mean peak systolic flow velocity significantly decreased by 71%. The mean diastolic flow velocity also significantly decreased (by 77%). Both the systolic and diastolic velocities of the ipsilateral CCA significantly increased after stenting. The amount of flow in the contralateral ICA decreased significantly after stenting. The change in the amount of flow in the vertebral arteries after ICA stenting was insignificant. CONCLUSIONS: The results of this CDS study clearly demonstrated the hemodynamic changes after ICA stenting. The carotid stenting significantly changed the ICA flow pattern, diameter, residual area, peak systolic velocity and ICA to CCA velocity ratio.

Aged↗
PubMed1977

Maintenance procedures for patients after complete fixed prosthodontics.

The philosophy of dental disease control has been discussed. Various devices used in the elimination of plaque have been listed and discussed. These include dentifrices, brushes, flosses, devices for holding and carrying floss, stimulating devices, disclosing solutions, and water irrigating devices. The responsibility for complete and thorough restorative therapy is shared by both dentist and patient. The treatment is not final when the restoration or prosthesis is inserted. Ongoing physiotherapy in the form of a rigid plaque-control program will influence the ultimate success or failure of any restorative treatment.

Coloring Agents↗
PubMed2000

Surgical management of the straddling mitral valve in the biventricular heart.

BACKGROUND: The straddling mitral valve in the biventricular heart is a rare condition that may complicate biventricular repair. METHODS: Treatment and outcomes in 5 consecutive patients who underwent primary repair between 1992 and 1997 were reviewed. Their ages at repair ranged from 2 months to 8 years. Three patients had a double-outlet right ventricle with a subaortic (n = 2) or subpulmonary (n = 1) ventricular septal defect. Two patients had transposition of the great arteries (S,D,D), a ventricular septal defect, and left ventricular outflow tract obstruction. The attachments of the papillary muscles of the straddling mitral valves were located on the right ventricular aspect of the ventricular septum. Four patients underwent baffle partitioning of the ventricular cavity. The baffle suture line was used to secure the chordae tendineae crossing the ventricular septal defect, or was intentionally omitted at the papillary muscle. The right ventricular outflow tract was reconstructed with patch augmentation, an extracardiac conduit, or an arterial switch operation. One patient with transposition who had a giant papillary muscle to the straddling mitral valve associated with abnormal insertion of the tricuspid valve on the conal septum underwent univentricular repair. RESULTS: There were no early or late postoperative deaths. There was no mitral valve dysfunction, left ventricular outflow tract obstruction, or heart block in the 4 patients who underwent biventricular repair. CONCLUSIONS: Although there are several exceptional situations in which ventricular partitioning may result in early and late complications, a straddling mitral valve does not preclude biventricular repair.

Cardiac Catheterization↗
PubMed1997

In vitro endothelialisation of arteriovenous loop grafts for haemodialysis.

OBJECTIVES: To evaluate the feasibility in a pilot study of in vitro endothelialisation of PTFE grafts used as interposition arteriovenous fistulas in uraemic patients. METHODS: Autologous saphenous vein endothelial cells were harvested and cultured on PTFE grafts in seven patients undergoing maintenance haemodialysis. The patients had several previous failures of vascular access sites. The patients were followed with duplex ultrasound, clinical examination and in one case an explanted graft was examined. RESULTS: At the end of follow-up four of the seven patients had patent grafts. One patient occluded the graft immediately postoperatively and another after 3.5 months. The former patient received a second endothelialised graft. In two further patients revision of the outflow was performed. In two patients a functioning graft was excised, in one case because of bleeding of a venous aneurysm and in one case because of suspected infection. The former which was excised 5 weeks postoperatively revealed that 85% of the surface was covered by endothelial cells. CONCLUSIONS: This pilot study shows that in vitro endothelialisation of PTFE grafts used for haemodialysis is possible in uraemic patients. In this highly problematic patient group the results are promising with endothelial cell coverage after 5 weeks of implantation.

Aged↗
PubMed1998

Can cruropedal colour duplex scanning and pulse generated run-off replace angiography in candidates for distal bypass surgery.

PURPOSE: To compare the diagnostic accuracy of duplex scanning (DS) and pulse generated run-off (PGR) with ia-DSA for the assessment of cruropedal outflow and explore the reliability of clinical decision making based on a work-up with DS/PGR in candidates for peripheral bypass surgery. METHODS: Popliteal, crural and pedal arteries were evaluated independently with DS and ia-DSA in 126 limbs of 120 consecutive patients for claudication (16%) or critical ischaemia (84%). Arterial segments were graded with DS and ia-DSA as normal, stenosed, or occluded and compared using weighted kappa (kappa) analysis. PGR was used to select the best crural artery for bypass. Proposed management based on DS/PGR and, if applicable, anastomosis site were compared to definitive treatment based on ia-DSA. RESULTS: Overall agreement between DS and ia-DSA for popliteal and crural arteries was moderate (kappa 0.51, 95% CI 0.48-0.55) with good agreement within the popliteal (kappa 0.67) and anterior tibial (kappa 0.61) arteries. Agreement was moderate within the pedal arterieds (kappa 0.32, 95% CI 0.24-0.40). In 74/126 (59%) limbs proposed management with DS/PGR was identical to ia-DSA. In 23/29 (79%) femoropopliteal and 15/37 (41%) femorocrural bypasses DS/PGR agreed perfectly with ia-DSA with regard to acceptor artery and anastomosis site. CONCLUSION: DS can accurately assess the popliteal and anterior tibial arteries. In a substantial number of patients with severe lower limb ischaemia decisions for conservative management, PTA and femoropopliteal bypass can be based on a DS/PGR work-up.

Adult↗