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PubMed1986

Doppler ultrasound examination of prosthetic function and ventricular blood flow after mitral valve replacement.

Two-dimensional color Doppler echocardiography enables delineation of the spatial and temporal distribution of blood flow in the heart. In this study, the method was applied for investigation of flow dynamics in multiple planes in the region of prosthetic mitral valves for comparison with that of native mitral valves. In 15 healthy subjects there was normal flow toward the transducer, coded in red, in the left ventricle along the posterolateral wall (left ventricular inflow region) and blue-coded flow away from the transducer in the left ventricular outflow region during diastole. In 40 patients with St. Jude mitral valve prosthesis and 17 with bioprosthesis the flow pattern in the left ventricle was reversed. Mitral inflow was directed against the interventricular septum, accordingly, into the left ventricular outflow region while the outflow pattern was displaced posterolaterally into the left ventricular inflow region during diastole. The angle between the aortic valve ring and the mitral annulus was significantly smaller than in the healthy subjects. The angle between the central axis of the mitral prosthesis and the mitral inflow, which was 0 degrees in healthy subjects, was increased by the medial deviation in particular, in those with mechanical St. Jude prostheses. The maximal transprosthetic velocity, measured in 70 patients, and the maximal pressure gradient calculated according to the Bernoulli equation was substantially greater than the values in healthy subjects. In contrast to findings associated with normally-functioning prostheses, in four patients with prosthetic malfunction there was a diastolic peak velocity of more than 2 m/s as well as marked turbulence in the inflow region.

Bioprosthesis↗
PubMed1990

Intraoperative Doppler color flow mapping for decision-making in valve repair for mitral regurgitation. Technique and results in 100 patients.

Mitral valve repair provides substantial advantages over mitral valve replacement in patients with severe mitral regurgitation. However, because of the possibility of persistent regurgitation, an intraoperative technique is needed to provide an immediate and accurate assessment of the adequacy of the repair before closure of the chest. One hundred patients with pure mitral regurgitation were studied with intraoperative epicardial Doppler color flow mapping immediately before and after valve repair. Intraoperative assessment of the severity of mitral regurgitation showed good agreement with preoperative left ventriculography and with standard precordial Doppler echocardiography before and after surgery. Postrepair intraoperative Doppler studies showed satisfactory surgical results in 92 patients. Postrepair intraoperative Doppler studies in the remaining eight patients demonstrated unsatisfactory results: persistent significant regurgitation in four, systolic anterior motion of the mitral valve with dynamic left ventricular outflow tract obstruction in three, and a persistent flail leaflet in one. In six of the eight patients, further surgery was performed during the same thoracotomy. In two patients, the intraoperative postrepair Doppler findings of persistent regurgitation were confirmed on precordial Doppler studies within 5 days, and mitral reoperation was required. Intraoperative epicardial Doppler color flow mapping provided a "safety net" that ensured a successful outcome in all 100 patients by providing the surgeon with a direct means to assess the success of the operation and the need for further surgery.

Echocardiography, Doppler↗
PubMed1995

Marginal ditching and staining as a predictor of secondary caries around amalgam restorations: a clinical and microbiological study.

Caries at the margins of restorations is difficult to diagnose. In particular, the relevance of both marginal ditching and staining around amalgam restorations is unclear. This clinical study questions the relevance of marginal ditching and color change to the level of infection of the dentin beneath the margins of amalgam restorations. Clinically visible sites (330) on the tooth/restoration margin were selected on 175 teeth. The enamel adjacent to each site was noted as stained (a grey discoloration) or stain-free. One hundred and seventy-eight sites were clinically intact, 83 sites had narrow ditches (< 0.4 mm), and at 49 sites, wide ditches were present (> 0.4 mm). Twenty sites with frankly carious lesions were also included. Plaque was sampled at the tooth-restoration margin, and the dentin was sampled at the enamel-dentin junction below each site. Samples were vortexed, diluted, and cultured for total anaerobic counts, mutans streptococci, lactobacilli, and yeasts. Plaque samples showed that margins with wide ditches (> 0.4 mm) harbored significantly more bacteria, mutans streptococci, and lactobacilli than did clinically intact margins and margins with narrow ditches. There were no significant differences in the degree of infection of the dentin beneath clinically intact restorations and those with narrow ditches, but samples associated with wide ditches and carious lesions yielded significantly more bacteria, mutans streptococci, and lactobacilli. The color of the enamel adjacent to the sample site was irrelevant to the level of infection of the dentin beneath the filling margin, provided a frankly carious lesion was not present.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Virtual reality in 3D echocardiography: dynamic visualization of atrioventricular annuli surface models and volume rendered Doppler-ultrasound.

Knowledge about annuli shape and blood flow patterns, both optimally assessed by transesophageal 3D Doppler echocardiography, can be used in computer assisted surgical planning of heart valve reconstruction. Moreover, information about the individual shape of the annulus anatomy can guide the design of annular prostheses. The problem is that the annulus cannot be easily differentiated from the valve and the myocardium with standard visualization methods. We have developed a nearly automatic method for annulus segmentation. The algorithm provides the annulus shape in a symbolic description, which can be used for surface visualization. Best results to visualize the blood flow from the Doppler signal and the myocardial morphology are obtained by volume rendering. A hybrid visualization technique combining surface rendering and volume rendering enables to dynamically visualize the surface rendered annulus combined with a volume rendered 3D (plus time) reconstruction of either backscatter (morphology) and Doppler information (in original color coding), or together with backscatter only or Doppler only. Visualization of annuli structures combined with blood flow and general myocardial morphology provides a new tool to analyze heart diseases.

Blood Flow Velocity↗
PubMed2005

Endovascular treatment of peripheral vascular lesions with stent-grafts.

PURPOSE: To evaluate our results of stent-graft implantation for the endovascular treatment of peripheral vascular lesions. MATERIALS AND METHODS: Seventeen patients underwent repair of iatrogenic, traumatic, or spontaneous vascular lesions by means of endovascular stent-grafts. The study cases consisted of 10 cardiac catheterization-induced femoral arteriovenous fistulas (AVFs) located between the deep femoral artery and the femoral vein, one iatrogenic AVF between the common iliac artery and vein, one penetrating trauma-induced AVF between the superficial femoral artery and vein, two penetrating trauma-induced pseudoaneurysms in the axillary and popliteal arteries, and three spontaneous or atherosclerosis- related iliac artery aneurysms. Balloon-expandable or self-expandable stent-grafts were used in all 17 cases. RESULTS: All the stent-grafts were deployed successfully. In catheterization-induced femoral AVFs, complete closure of the fistulas was immediately accomplished in 9 of the 10 cases. Blood flow within the pseudoaneurysms of the axillary artery and the popliteal artery, and aneurysms of the iliac arteries were stopped. Partial closure was achieved in two patients with traumatic iliac and femoral AVFs. For the patients who reported subsided complaints, mean follow-up for 24 months with clinical examination and color Doppler ultrasound revealed patency of the stented segments. CONCLUSION: Our results suggest that endovascular treatment of various types of peripheral vascular lesions with stent-grafts is a low-risk procedure, which appears to be less invasive than surgery.

Adult↗
PubMed1993

Photochromic flow visualization for the investigation of artificial heart valves.

A new method for the investigation of hydrodynamics of artificial heart valves is presented. It is a method of flow visualisation. The photochromic flow visualization method is based on activation of color tracers in originally colorless photochromic solutions by pulse laser radiation during 10(-6)-10(-9) seconds. The tracer appears as a straight colored line, which subsequently is deformed by the flow. The methods known so far for the flow visualization give an insight on the general flow but do not provide quantitative data. The method mainly used, the LDA, permits measurements only in one point. The new method combines the precision of the LDA with the clarity of flow visualization.

Blood Flow Velocity↗
PubMed2000

Ceramic abutments--a new era in achieving optimal esthetics in implant dentistry.

In the visible dental region in particular, implant-prosthetic restorations filling single-tooth gaps make exacting demands on function and esthetics. One crucial factor influencing the esthetic outcome is the emergence profile of the restoration. The introduction of aluminum oxide or zirconium oxide abutments, which can be milled to meet individual requirements, provides new opportunities for reconstruction adapted to anatomic findings. Tooth-matched coloring combined with customized preparation and dimensioning make for optimal mucogingival esthetics in implant-supported single-tooth restorations. The aim of the present article is to give a general survey and to illustrate the use of ceramic abutments with clinical case reports.

Adolescent↗
PubMed2004

A zirconia implant-crown system: a case report.

Exposed metal crown margins in the porcelain-fused-to-metal technique might be an esthetic problem. Therefore, all-ceramic crown systems are used for restoring teeth and dental implants. In addition, the gray color of a titanium implant might hamper the esthetic appearance of the entire reconstruction in cases of thin peri-implant soft tissue or tissue retraction. To further improve the esthetic aspect of dental implants, efforts are undertaken to develop implant systems fabricated out of tooth-colored materials that are biocompatible and able to withstand masticatory forces. One such material may be zirconia. The present article presents a case in which an all-ceramic custom-made zirconia implant-crown system was used for the replacement of a single tooth.

Computer-Aided Design↗
PubMedDate not supplied

Procedure for fabrication of an implant-supported auricular prosthesis.

The procedure for fabrication of an implant-supported auricular prosthesis is described. Treatment is started during the preparatory phase of the surgical procedure because a favorable position of the implants for the epithesis must be chosen at that stage. The fabrication of an epithesis requires close collaboration among the prosthodontist, the maxillofacial technician, and the patient. First, a suprastructure is fabricated on the implants. It consists mostly of rings and a bar connecting the implants. The base of the epithesis consists of hard acrylic resin, which contains clips that provide the retention for the epithesis. The epithesis itself consists of silicone rubber. Great care must be taken in shaping and coloring the epithesis.

Ear, External↗
PubMed1999

[Homografts for mitral valve replacement in florid endocarditis--an alternative to prosthetic replacement].

INTRODUCTION: Homografts for valve replacement are indicated in acute valve endocarditis. It is assumed that they possess anti-infective properties. Homografts are an established indication in aortic valve replacement. We present our early results with homografts for mitral valve replacement in acute endocarditis. PATIENTS AND METHODS: Between July 1996 and March 1998 we used cryopreserved homografts for mitral valve replacement in seven patients. In three cases (age 24, 42, and 34 years) the indication was an acute endocarditis with subsequent severe mitral valve insufficiency. The size of the required homograft was measured preoperatively using transesophageal echocardiography. For implantation the technique described by A. Carpentier was used; for stabilization of the mitral anulus a valvular ring (Physio) was implanted. Follow-up was done every six months including clinical and echocardiographical examinations. After the first postoperative year an Ultrafast-CT was done in addition. RESULTS: One patient had complete mitral valve replacement, in the other two cases the diseased parts of the valve were completely excised and the valve was repaired using a partial homograft. There were no perioperative deaths. In the follow-ups, up to 24 months of uneventful homograft function was documented by echocardiography; no insufficiency > degree I was seen on color Doppler echocardiography. At the last follow-up (mean follow-up 16 months, range 12 to 24 months) the average mitral valve orifice was 2.5 +/- 0.5 cm2, the mean pressure gradient 2.8 +/- 0.8 mm Hg. In Ultrafast-CT no morphological abnormalities of the mitral valves and no dilatation of the left ventricle were seen. There were no signs of a recurrence of the endocarditis in any patient during the follow-up period. CONCLUSION: Homografts for mitral valve replacement are an interesting alternative to prosthetic valve replacement, especially in younger patients. In cases with acute endocarditis, in which mechanical prosthesis should not be used, a reconstruction or repair of the mitral valve with preservation of the ventricular geometry is possible even if large parts of the mitral valve are infected.

Adult↗
PubMedDate not supplied

Erectile dysfunction: anatomical parameters, etiology, diagnosis, and therapy.

Functional anatomy of the human penis involves various parameters: cavernous tissue, covering integument, prepuce foreskin, corpora cavernosa, corpus spongiosum, glans, facia, arterial supply, venous drainage, lymph drainage, musculature, and nerve supply. Several factors affect the expression/degree of erectile dysfunction (ED) endocrine profile, aging/senescence, demyelinating diseases, and surgery. Risk factors of ED are: age, vascular factors, metabolic diseases (diabetes mellitus), neurologic diseases, and HIV/AIDS. Several drugs are associated with ED: antiandrogenic, anticholinergic, antidepressants, antihypertensive, major tranquilizers, anxiolytics, and certain medicines/metabolites. The International Index of Erectile Function (IIEF) is a multidimensional scale for assessment of erectile dysfunction. The main structures mediating erection are the corpora cavernosa or "erectile bodies," which are fused distally for approximately three-quarters of their length. They separate proximally to fuse with each ischial tuberosity of the pelvis. On their ventral surface lies the corpus spongiosum, which surrounds the urethra. Coital dysfunction is classified into "erectile dysfunction" (psychosexual and endocrine/neuro-endocrine) and "ejaculatory dysfunction" (psychosexual, and genitourinary surgery). Vasculogenic impotence was evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Cavernosal, alpha-blockade is a technique used to evaluate and treat ED. Another diagnostic procedure for ED involves color floro and spectural Doppler imaging after papaverine-induced erection in impotent men. Color Doppler and duplex ultrasonography are used to evaluate Peyronie's disease. Sildenafil cilrate (Viagra) is an effective therapy of ED in men. Vardenavil is a highly selective phosphodiesterase 5 (PDE5) inhibitor which improved ED. Prostagland E1, vasoactive intestinal polypeptide (VIP), and phentolamine mesylate (administered by autoinjectors) have been applied to treat ED in patients resistant to other intracavernosal agents. Clinical trials were conducted on self-injection of vasoactive drugs, apomorphine SL, and tadalafil in diabetic men. Medical therapy of ED includes: medicated urethral system for erection (MUSE), intravenous pharmacotherapy, arterial revascularization, vacuum devices, two- and three-component inflatable penile prosthesis, semi-rigid penile prosthesis in situ, and inflatable one-piece penile prosthesis. Surgical therapy include procedures to correct Peyronie's penile deformity and penile deformity, procedures to avoid inevitable shortening accompanying Nesbit's disease, and for penile lengthening.

Erectile Dysfunction↗
PubMedDate not supplied

The clinical and radiographic success of bonded resin composite strip crowns for primary incisors.

PURPOSE: The aim of this study was to examine the clinical and radiographic success of the treatment of maxillary anterior primary incisors with composite resin strip crowns placed in a private practice setting. METHODS: This was a retrospective, clinical study of patients who had strip crowns (SC) placed on maxillary primary incisors, returned for at least 1, 6-month recall examination, and whose parents consented to participate in the study. Radiographic and photographic examinations were used for evaluation. Two evaluators rated the images independently. When ratings were not in agreement, the 2 examiners reviewed the photograph or radiograph together and reached a consensus rating. RESULTS: One hundred twelve restorations placed in 40 children were evaluated. The evaluations were performed after the crowns had been in place for an average of 18 months. None of the restorations were totally lost, and only 12% were rated as having lost some resin material, resulting in an 88% overall retention rate. There was no difference in restoration success if the crowns were placed 4 at a time, or if fewer crowns were placed in a single sitting; the failure rates were comparable. Teeth that had pulpal treatment were judged to have far more significant color match discrepancies than those teeth without pulpal treatment. Ninety-one percent of the teeth demonstrated healthy pulps. Eight percent had some pulpal changes but did not require immediate attention. Only 1 tooth showed radiographic evidence of pulpal necrosis. Only 11 teeth had pulpal treatment, but of these, 10 demonstrated clinical success. CONCLUSIONS: Composite resin strip crowns for restoring primary incisors with large or multisurface caries performed well. Color match of these crowns with adjacent teeth may be significantly reduced when placed upon teeth that have undergone pulpectomy treatment and have been obturated with an iodoform paste. However, based upon the results of this study, the strip crown may provide an esthetic and durable restoration for carious primary incisors.

Child, Preschool↗
PubMed1989

[Surgical management of acquired tricuspid valve disease--the effects and comparison of tricuspid annuloplasty (De Vega) and tricuspid valve replacement].

A total of 92 patients with tricuspid valvular disease (TR) had surgical repair of DeVega's annuloplasty in 80 patients (87%) and of valve replacement in 12 patients (13%) from January, 1978, to March, 1988. All of those patients were diagnosed by cardiac catheterization and angiogram, clinical findings and in recent cases, pulsed and color Doppler echocardiography were applied. Eighty-nine of 92 patients (97%) were in NYHA class III or IV before operation. There were 7 early death (8.5%) with DeVega procedure and one death (8.3%) in TVR and late deaths were noted in 3 patients (3.6%) (DeVega's procedure) and one (8.3%) in TVR. Two patients after DeVega procedure at 5 and 6 years were required re-operation of TVR because of recurrent mitral valvular disease. Seventy-seven of 80 survivors were in NYHA class I or II postoperatively. Twenty-seven randomized selected patients after DeVega's annuloplasty were investigated by pulsed and color Doppler echocardiography, 17 of them (63%) had no regurgitation and the remaining 10 patient had mild to moderate regurgitation. This study suggests that DeVega's annuloplasty has a simple and reliable procedure in patients with functional TR and results in excellent hemodynamic and functional effects postoperatively.

Adolescent↗
PubMedDate not supplied

A new custom-made abutment for dental implants: a technical note.

The restoration of four missing maxillary incisors with implants and custom-made abutments is described. Acetal was used to fabricate the custom-made abutments, instead of the conventional metals. This material is resistant to wear, and it is biocompatible and white in color. Acetal meets esthetic requirements, particularly when restoring the anterior region of the dental arches. The white post does not give a grayish appearance to the surrounding soft tissues, and the possible gingival recession around the post will not compromise esthetics. The presented case report indicates excellent esthetic and functional results.

Acetals↗
PubMed2000

Postcatheterization pseudoaneurysms and arteriovenous fistulas: repair with percutaneous implantation of endovascular covered stents.

PURPOSE: To assess the effectiveness and safety of endovascular covered stents in the management of pseudoaneurysms and arteriovenous fistulas after cardiac and vascular catheterization. MATERIALS AND METHODS: Twenty-six endovascular covered stents were used to repair 16 pseudoaneurysms, nine arteriovenous fistulas, and one combined lesion after femoral arterial puncture for diagnostic coronary angiography and/or angioplasty. Fistulas and aneurysms were in the superficial femoral artery in 16 cases, in the deep femoral artery in six cases, and in the common femoral artery in four cases. Implantation was performed from the opposite femoral artery in most cases. It was not possible to treat three additional cases transcutaneously for technical reasons (three of 29 cases). RESULTS: Percutaneous closure of the lesions with an endovascular covered stent was successful in 26 of 29 cases. Initial follow-up showed good stent patency. Two major complications were observed after stent implantation. During follow-up (about 1 year in 23 of 26 patients [88%]), stent thromboses were detected in four of 23 patients (17%) with follow-up color duplex flow imaging. CONCLUSION: Implantation of endovascular covered stents is an effective and safe method for the percutaneous closure of pseudoaneurysms and arteriovenous fistulas. Thus, endoluminal vascular repair with covered stents offers an alternative therapeutic approach to vascular surgery in selected patients.

Aged↗
PubMed1999

[The Procera Allceram all-ceramic system. The clinical and technical laboratory aspects in the use of a new all-ceramic system].

The aim of this article was to present the CAD/CAM-assisted Procera system as a new all-ceramic full-coverage crown system. New technologies need to be evaluated technically and clinically to be able to fulfill the requests for aesthetics, physical strength and biocompatibility when restoring the anterior and posterior region. The Procera AllCeram system offers the opportunity to fabricate densely sintered, high-purity, tooth-colored copings. Mechanical properties of the Procera alumina coping, indications and contraindications and additional applications are discussed. The clinical and technical procedures and any specific limitations and peculiarities are summarized and documented with clinical cases in a step-by-step illustration.

Cementation↗
PubMed1989

Assessment of valvular heart disease with Doppler echocardiography.

The addition of Doppler principles to two-dimensional echocardiography has revolutionized the noninvasive evaluation of valvular heart disease. Doppler techniques allow precise measurements of blood flow velocity at different locations in the heart and great vessels, so that many aspects of hemodynamics can now be measured noninvasively. These techniques are particularly useful for the quantitative assessment of valvular stenosis; both valve areas and transvalvular gradients may be determined. Doppler echocardiography (particularly with color flow mapping) is also useful for the qualitative assessment of valvular regurgitation. By understanding the uses and limitations of Doppler echocardiography, physicians may now confidently follow up patients with mild or moderate valvular disease with serial noninvasive studies, avoiding the risks of cardiac catheterization in many patients.

Blood Flow Velocity↗
PubMedDate not supplied

A computerized physiologic pulse duplicator for in-vitro hydrodynamic and ultrasonic studies of prosthetic heart valves.

A physiologic pulse duplicator for the simultaneous in-vitro hydrodynamic and ultrasonic evaluation of aortic prosthetic heart valves is described. The system is interfaced to a personal computer, which provides greater efficiency over manual techniques in system calibration, data acquisition, and analysis. The data analysis program aids selection of start and end systole and calculates pressure difference across the valve, the closing and regurgitant volumes, flow rates, and the Gabbay and Swanson performance indices. The pulse duplicator is designed to accommodate the ultrasonic measurement of fluid velocities, including pressure difference via the Bernoulli equation, and color-flow imaging. In tests of 19-mm, 23-mm, and 27-mm Bjork-Shiley spherical occluder valves, continuous-wave Doppler ultrasound was found to overestimate by about 50% the pressure difference measured directly by pressure transducers, a finding that is clinically important.

Aortic Valve↗