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At least 37 records · Page 2Linked to original sources

A 29-year-old Harken disk mitral valve: long-term follow-up by echocardiographic and cineradiographic imaging.

An 81-year-old woman was evaluated for prosthetic mitral valve function. She had received a Harken disk mitral valve 29 years earlier due to severe mitral valve disease. This particular valve prosthesis is known for premature disk edge wear and erosion. The patients 2-dimensional Doppler echocardiogram showed the distinctive appearance of a disk mitral valve prosthesis. Color Doppler in diastole showed a unique crown appearance, with initial flow acceleration around the disk followed by convergence to laminar flow in the left ventricle. Cineradiographic imaging revealed normal valve function and minimal disk erosion. We believe this to be the longest reported follow-up of a surviving patient with a rare Harken disk valve. We present images with unique echocardiographic and cineangiographic features.

Aged↗

Shear bond strength of resin bonded ceramic after different try-in procedures.

Final cementation of porcelain laminate veneers may require a previous colour match try-in. The purpose of this in vitro study was to evaluate the effect on shear bond strength of resin bonded to porcelain after the application of different try-in procedures. Forty porcelain specimens were fabricated, flattened with 600 grit SiC, etched with hydrofluoric acid and silane treated. After 24 h the specimens were divided into four groups at random and prior to bonding of a dual cure resin composite button were treated as follows: Group 1, no treatment (control); Group 2, non-activated resin applied for 5 min, cleaned in acetone for 3 min; Group 3, as for Group 2, with silane reapplied; Group 4, as for group 3, but re-etched for 30 s before reapplication of silane. After bonding the specimens were stored in water at room temperature for 7 days. Shear bond strength data were as follows: Group 1, 18.6 +/- 1.6; Group 2, 15.9 +/- 1.7; Group 3, 16.7 +/- 2.6; Group 4, 15.3 +/- 3.0 MPa. Fractured surfaces examined, under light microscopy and scanning electron microscopy (SEM), showed cohesive failure within the porcelain in all cases. The reduction in mean bond strength after application of a try-in resin was significant in Groups 2 and 4 compared with the control (ANOVA P < 0.05). No other significant differences were measured. In conclusion a single reapplication of silane maintained the bond strength of resin to porcelain when final cementation was preceded by a try-in procedure and cleaning.

Acetone↗

The use of protective digit prostheses in management of microangiopathy of fingers.

Small artery occlusive disease (microangiopathy) of the palm and digital arteries may produce ischemia with painful ulcerations on the digits. These ulcerations may contribute to secondary infection and severe intolerance to thermal changes. The use of gauze wrappings to minimize ulceration has been tried; however, it is unhygienic and unsightly. A custom-made digit prosthesis is constructed with medical grade silicone over an artificial finger nail to provide positive seating of the prosthesis. The digit prosthesis is hygienic, esthetically acceptable to the patient and greatly protects ulcerated finger tips.

Arterial Occlusive Diseases↗

A tracheostomy obturator for a patient with hereditary angioneurotic edema.

This article describes a technique for fabrication of a custom tracheostomy obturator for a patient with hereditary angioneurotic edema and a permanent tracheostoma. The impression technique and fabrication of a custom tracheostoma valve retainer for a laryngectomy patient closely mirrors the technique used for fabricating a tracheostomy obturator.

Angioedema↗

Black diaphragm intraocular lens implantation in aphakic eyes with traumatic aniridia and previous pars plana vitrectomy.

PURPOSE: To evaluate the efficacy of secondary black diaphragm intraocular lens (IOL) implantation in aphakic eyes with traumatic aniridia and previous pars plana vitrectomy (PPV). SETTING: Shandong Eye Institute and Hospital, Qingdao, China. METHODS: This retrospective study comprised 15 aphakic eyes with aniridia and no vitreous that had implantation of a secondary black diaphragm IOL 6 to 72 months after PPV. The PPV was performed as a result of trauma to the posterior segment. Before implantation of the IOL, all patients had reduced visual acuity from aphakia and intolerable glare from aniridia. Eyes were aphakic as a result of previous extracapsular cataract extraction (1 eye), lens extrusion during trauma (3 eyes), or simultaneous cataract lensectomy during PPV (11 eyes). Significant iris defects were present, with 9 eyes being aniridic after the injury. The mean follow-up was 17 months (range 3 to 34 months). The postoperative visual acuity, intra- ocular pressure (IOP), endothelial cell density, IOL centration, and intraocular inflammation were monitored. RESULTS: All 15 eyes had improved visual acuity and marked glare reduction after IOL implantation. No major IOL decentration was seen. Five patients had increased IOP 3 to 5 days after IOL implantation; 3 were known to have secondary glaucoma from trauma before surgery and their IOP was controlled preoperatively (< 21 mm Hg) with timolol 0.5% eyedrops. The other 2 patients had normal- appearing angles, and 1 was diagnosed with hemolytic glaucoma after IOL insertion. Postoperative elevated IOP was controlled by timolol eyedrops (4 eyes) or selective laser trabeculoplasty (1 eye). Hyphema was seen in 1 patient on the first day after IOL implantation, but no further bleeding was noted. Vitreous hemorrhage was seen the first day after IOL insertion in 2 patients. One resolved without sequelae; the other required vitreous washout. Retinal detachment and cystoid macular edema did not occur in any patient. CONCLUSIONS: Black diaphragm IOL implantation can be considered in eyes with coexisting aphakia and aniridia and without vitreous. Intraoperative IOP regulation is crucial in vitrectomized eyes to prevent complications such as expulsive hemorrhage. In general, visual function was better after IOL insertion as a result of better visual acuity and glare reduction. Although this IOL appears to be safe, long-term results must be assessed in studies with a longer follow-up and a larger study group.

Adolescent↗

Maxillofacial prosthodontics and reconstruction: a Canadian view.

A craniofacial osseointegration and maxillofacial prosthetic rehabilitation unit in Edmonton, Canada was visited by the author as part of a higher specialist training programme. The unit has an international reputation as a centre of excellence for the treatment of patients with head and neck abnormalities. The report examines the activities of the unit and how it achieves its 'patient centred' approach to care.

Canada↗

Ceramic inlay systems: some clinical aspects.

Due to their inertness and unsurpassed aesthetic properties, ceramic materials are increasingly used as inlay materials. Based on a questionnaire, the frequency and character of complications related to ceramic inlay therapy were assessed and some important pitfalls and clinical relevant factors discussed. A majority of the dentists performed between 1 and 10 ceramic inlays per month using several different ceramic materials. As many as 85% of the dentists had observed complications in connection with ceramic inlays. Most frequency reported was hypersensitivity of a transient nature (15%). The material revealed an overall inlay fracture frequency of 5%, but the individual variations were high. Tooth fracture, loss of retention and other complications such as secondary caries, endodontic envolvement, colour mismatch and a surface and edge deterioration occurred with a varying but lower frequency. Failure analysis revealed a large number of causative factors among which cavity and inlay design, bonding procedures, selection of luting material and proper case selection were regarded as the most important. Due consideration to the strength of remaining tooth substance was found to be important in reducing the problem of hypersensitivity and the risk of tooth and inlay fracture.

Dental Caries↗

Zirconia and alumina ceramics in comparison with stainless-steel heads. Polyethylene wear after a minimum ten-year follow-up.

Although alumina has been used in orthopaedic surgery since the 1970s, the long-term clinical results of zirconia have not been well documented in vivo. We studied hips with these two different ceramics during the same period and with a minimum follow-up of ten years. Because the size of the alumina and zirconia heads was different, hips with 32 mm alumina heads and those with 28 mm zirconia heads were compared with control hips with stainless-steel heads of the same size. Our aim was to compare the two ceramics. There was an increased linear rate of penetration of the femoral heads into the liner between years five and 12 for the zirconia and the stainless-steel groups. This was severe in the zirconia group (0.4 mm/year compared with 0.13 mm/year for the stainless-steel group). During the same 12-year period there was, however, no significant change in the rate of wear in the alumina group (0.07 mm/year). The mean wear at the most recent follow-up was 1360 mm3 for the 28 mm zirconia group, 683 mm3 for the 28 mm stainless-steel group, 755 mm3 for the 32 mm alumina group and 1314 mm3 for the 32 mm stainless-steel group. The monoclinic content rose on the surface of three zirconia heads which were retrieved at revision. This change was associated with an increase in the surface roughness. A change in the roundness with an increase in the sphericity deviation was also observed both in the articular and non-articular parts of the femoral heads. The increase in rate of wear in the zirconia group was only evident after eight years and may be linked to a long-term biodegradation of zirconia in vivo, associated with the altered roughness and roundness which was observed on the retrieved heads.

Aged↗

Prosthetic management of a patient with Treacher Collins syndrome.

Treacher Collins syndrome encompasses a group of closely related defects of the head and neck. It is a rare syndrome characterized by bilaterally symmetrical abnormalities derived from the first and second brachial arches and the nasal placode. It is an autosomal dominant disorder and its occurence ranges from 1 in 25,000 to 1 in 50,000 live births. The facial appearance of these patients can be improved by either surgical or prosthetic rehabilitation. In this case report we are presenting the features of a 13-year-old boy with Treacher Collins syndrome. A multidisplinary approach was followed in managing the situation. The various treatment options and the steps involved in making an auricular prosthesis are also discussed.

Adolescent↗

Aesthetic life-like finger and hand prostheses: prosthetic prescription and factors influencing choices.

This paper reviews the authors' experience with fitting life-like finger and hand prosthesis. The methodology and technical considerations in producing these prostheses, the prosthetic prescription according to the level of amputation and the challenges faced with each level are discussed. In cases where the amputation is sufficiently distal, a thimble prosthesis has been used. This is compared to fitting a full-length finger prosthesis. Besides allowing free range of motion of the proximal finger joints which would otherwise be covered and restricted with fitting a finger prosthesis, a thimble prosthesis minimises skin coverage for optimal sensibility and is easier to don and doff. In cases of amputations where a digital fitting is precluded, a partial or a total hand is prescribed. A comparison between fitting a finger, a partial hand prosthesis and a total hand prosthesis is also discussed. Cases of a digital, transcarpal and a more proximal transmetacarpal amputations are relatively easy to fit with a prosthesis. An incomplete transmetacarpal amputation where much of the breadth of the hand is preserved presents a difficult challenge as it necessitates fitting with a partial hand prosthesis. Besides the need to cover a large area of the intact skin and the associated problems with reduced sensibility and stump perspiration, a partial hand prosthesis is difficult to don and doff.

Fingers↗

Restoration of a single anterior crown.

All-ceramic restorations have gained patient acceptance and are increasingly being used in aesthetic appearance-related restorations. This case report of a single anterior crown matching natural dentition utilizes some of the new special-effect ceramic powders designed for use with the layering technique. These powders help to properly replicate incisal, mamelon, and gingival areas. The clinical procedure is described, using photographs of the case to illustrate the steps involved.

Adult↗

Transesophageal color Doppler echocardiography of the normal St. Jude Medical mitral valve prosthesis.

Transesophageal color flow Doppler findings are reported in 36 patients with a St. Jude Medical mechanical mitral valve prosthesis who had no auscultatory evidence for prosthetic valve dysfunction. Multiple jets consistent with mitral regurgitation originating from the central and lateral portion of the prosthesis were found in all patients. Maximum jet length ranged from 11 to 51 mm (mean 21 +/- 9 mm). Maximum jet area ranged from 0.2 to 4.1 cm3 (mean 1.2 +/- 0.9 cm2). The color M-mode Doppler interrogation showed two distinct components of the regurgitant jet: brief early systolic flow consistent with valve closure followed by holosystolic regurgitant flow consistent with transvalvular leakage. Four patients (11%) had a maximum regurgitant jet length exceeding 30 mm and absence of early systolic closure regurgitant flow by M-mode color imaging, suggesting clinically silent paravalvular leakage. Two pin-sized paravalvular suture line defects were confirmed in one patient at cardiac transplantation. We conclude that transesophageal echocardiography is a highly sensitive method for detection of mitral regurgitation in the St. Jude Medical mitral prosthesis. Clinically silent paravalvular leakage should be suspected if the maximum jet length exceeds 30 mm and color M-mode interrogation fails to demonstrate an early systolic closure regurgitant flow component.

Echocardiography, Doppler↗

[Comparison of color character of VITA shade guide and the custom shade guide].

OBJECTIVE: To compare the color character of VITA shade guide and the custom shade guide with metal substrate. METHODS: Color of 9 sites of 5 series of VITA shade guides and custom shade guides with metal substrate were measured by means of PR-650 spectrophotometer. RESULTS: The color range of VITA shade guide were that L* was 56.86-73.86, a* was-1.29-3.69, b* was 7.09-21.94, and the transparence was 3.20-7.59. The color range of the custom shade guide was that L* was 60.59-78.54, a* was -1.09-4.99, b* was 7.60-22.35, and the transparence was 0.23-10.98. L*, a* and b* of the custom shade guide with metal substrate were higher than VITA shade guide, and the transparence was differet. The color difference of homonymy shade tab between custom shade guide and VITA shade guide was larger than 1.5 NBS. CONCLUSION: There is color difference between VITA shade guide and custom shade guide. Metal substrate has effects on the color of cero-metal prosthesis, and color selection in clinic should be carefully considered.

Color↗