Malignant melanoma and the sentinel lymph node biopsy.
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All-ceramic restorations in the posterior region are an increasingly important area of dental care. However, no real suitable ceramics or economic processing procedures have been available so far. With the new LAVA system, it will be possible to satisfy these demands in the future. The system is based on the machining of presintered zirconia, which, due to its outstanding mechanical properties, its biocompatibility, and its excellent esthetics in combination with a specially designed veneer ceramic, is the ideal candidate for these applications. In combination with a corresponding CAD/CAM unit, the use of an easy-to-machine presintered ceramic material (which is sintered to full density after shaping, thus eliminating the need for extensive use of diamond tools) allows for the first time reliable, fully-automated and thus fast manufacturing of such restorations.
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Hypertrophic cardiomyopathy is a primary, usually familial, disorder of heart muscle whose primary feature is muscular hypertrophy without recognized cause that encroaches on the ventricular chamber, reducing chamber area and volume. In roughly 25% of cases, there is associated obstruction to left ventricular outflow (hypertrophic obstructive cardiomyopathy [HOCM]). This article details the mechanism of obstruction in HOCM, focusing on obstruction at the mitral valve level, and reviews the pharmacologic and surgical therapies currently available. Mainstays of pharmacologic therapy include b-blockers, calcium channel blockers (verapamil in particular), and/or disopyramide. Surgical therapies include septal myotomy/myectomy, which has become the gold standard to which other therapies are compared, and mitral valve replacement. During the past 10 years, atrio-ventricular sequential pacing and alcohol septal ablation have been proposed as less invasive alternatives to surgery. A single, optimal therapy for patients with HOCM and refractory symptoms has not been established, and decisions regarding surgical versus noninvasive therapies need to be individualized based on functional status, comorbidities, local expertise in the surgical and nonsurgical techniques, and patient preference.
Uterine cervix cancer is an important public health problem in developing countries. In Cambodia, incidence (24. 10-5) and mortality (12,77. 10-5) rates due to this cancer are higher than in other southeast Asian countries. 35 consecutive women with a diagnosis of invasive cervical cancer were identified from the histology laboratory of the Institut Pasteur in Phnom Penh. Information on history, clinical findings, ancillary investigations and treatment were obtained by clinical files review. Patients were from Phnom Penh, the main city and from outlying provinces. The mean age was 50 years, 2 months. They all presented with clinical symptoms at the time of diagnosis, and lesions had spread beyond the uterus in nearly half of the cases. Squamous cell carcinoma (80%) was more frequent than adenocarcinoma (14%). Microinvasive squamous cell carcinomas were rare (2.8%). Treatment was mainly surgical, but lacked standardization, as radical hysterectomy including lymphadenectomy was not systematic, even when the tumor spread beyond the uterine cervix. Few women that required adjuvant radiotherapy received it as this technique has only recently been introduced in Cambodia. Many patients were lost to follow-up. None of the cases was detected by pap smear. This technique is not in general use in the country. Cervical cancer screening could be carried out by visual inspection of the cervix with acetic acid wash that is less expensive and nearly as sensitive as pap smear. Treatments are still insufficiently standardized, due to the lack of technical means, and lack of patient compliance.
Functional mitral regurgitation (MR) frequently develops during the progression of chronic heart failure and predicts poor outcome. Impaired left ventricular (LV) function, LV remodeling associated with papillary muscle apical displacement and annular enlargement result in decreased mitral closing forces and tenting of the mitral valve at closure. Reduced closing forces and tenting both promote MR. Active myocardial ischemia, myocardial asynchronism and excessive loading conditions worsen MR at rest and during exercise. The therapeutic target in functional MR is the left ventricle and not the valve.
We evaluated the effects of dye orange (595 nm) and argon green (514.5 nm) laser energy on the retina and the retinal internal limiting membrane. Moderate retinal coagulation was produced with each wavelength on the macular area of the monkey retina. Acute lesions demonstrated coagulative necrosis of the outer sensory retina, retinal pigment epithelium and choroid. The chronic lesions showed no morphologic evidence of alteration on the retinal surface by scanning electron microscopy. Our study indicated that moderate laser coagulation with these laser energies does not damage the vitreoretinal interface.
We studied the effects of the yellow (577 nm), orange (595 nm) and red (630 nm) dye lasers, the argon blue-green (488, 514.5 nm) and green (514.5 nm) lasers, and the krypton red (647 nm) laser on experimentally produced serous and hemorrhagic retinal detachments and on retinal vessels in rabbits. Retinal detachments were created by either injecting balanced saline solution or partially hemolyzed blood under the retina. All laser wavelengths except the argon blue-green bypassed the sensory retina and produced no damage on either the sensory retina or the underlying retinal pigment epithelium with serous retinal detachment. Each laser wavelength, however, produced a specific effect on the detached retina with hemorrhagic fluid. Blue-green, green, yellow and orange wavelengths damaged the sensory retina more severely than the red wavelengths. Laser coagulation of the retinal vessels with the blue-green, green and orange wavelengths produced vasospasms.
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The longterm follow-up of 38 patients with central serous retinopathy who were recruited into a prospective randomised trial of argon laser photocoagulation is reported. They were reviewed at a mean of 9.3 years after presentation. The results support the original findings that treatment shortens the disease, but does not benefit the final visual outcome.
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