Single-stage surgery for implant placement: a retrospective study

Single-stage implant placement surgery offers patients a number of advantages. These include reduced cost and time commitments and greater comfort, function, and convenience. This article reports on the results of using a single-stage technique with 58 patients fitted with 240 implants. No implant failures were detected in any patients prior to the final attachment of a Dolder bar. Among the 27 patients and the 125 implants followed for a longer period of time, 99.2% exhibited no signs of implant mobility or pain. Indicators of gingival health and oral hygiene ranged in quality from acceptable to ideal.     

Neurological outcome after surgery for thoracolumbar fractures. A retrospective study of 93 consecutive cases, treated with dorsal instrumentation

Surgical reconstruction and fusion form the treatment of choice for unstable thoracolumbar fractures. It remains difficult, however, to prove that surgical treatment provides an increased potential for neurological recovery. Also, the role of a decompressive laminectomy is still unclear. To address these issues, 93 consecutive cases of thoracolumbar fractures treated with dorsal instrumentation were reviewed. The neurological status at the time of admission and at a mean of 26 months postinjury was graded according to a modified Frankel scale. By using preoperative radiographs and computed tomography scans, we differentiated between fracture-dislocation lesions, dislocation lesions, flexion-distraction lesions, complete and incomplete burst fractures. Spinal stenosis was classified from grade 0 (no stenosis) to grade 3 (> 66% stenosis). All thoracolumbar fractures were treated with posterior instrumentation, using Dick's fixateur interne and Steffee's VSP plates and screws. During this procedure, laminectomy was performed in 33 patients (35%). In 17 cases (52% of the laminectomies), a surgically treatable lesion (dural tear, trapped nerve root, etc.) was found, especially in patients with a combination of a neurological deficit and a dislocation lesion, a fracture-dislocation lesion or a complete burst fracture with spinal stenosis grade 2 or 3. The neurological and functional outcome was excellent: none of the patients deteriorated, 68% made a complete neurological recovery, and 61% regained their previous level of activity.     

Perioperative antibiotic prophylaxis in abdominal surgery for hernia repair: retrospective study of 1,524 consecutive patients

In the surgical units of our Division, from January 1979 to December 1989, the infection rate in surgical groin hernia repair was much higher than expected, in comparison to other reports in the literature. In order to evaluate if correct preoperative antibiotic prophylaxis could decrease the incidence of postoperative infections (wound, urinary and respiratory tract) after abdominal wall hernia repair surgery, a total of 1,524 consecutive patients undergoing this type of procedure were reviewed between January 1990 and December 1996. The patients were divided in three different groups, according to the antibiotic prophylaxis regimen: i) group A: 606 patients (39.8%) treated with ceftriaxone; ii) group B: 408 patients (26.8%) treated with pefloxacin; and iii) group C: 510 patients (33.4%) treated with different regimens using either cephalosporins or quinolones other than ceftriaxone and pefloxacin. Only 1 surgical wound infection was observed (0.06%). The tolerability was good: no significant side effects related to antibiotic prophylaxis were recorded in our experience. In this study, even though retrospective, single-dose ceftriaxone proved to be a valid and cost-effective choice in antibiotic prophylaxis.     

Neoplastic transformation of chronic ulcers in leprosy patients--a retrospective study of 23 consecutive cases

The costimulatory CD80 and CD86 molecules were measured by flow cytometry on cerebrospinal fluid (CSF) and blood lymphocytes from patients with possible first attacks of multiple sclerosis (MS, n = 25), clinically definite MS (n = 16), and noninflammatory neurological disease control subjects (n = 30). In patients with demyelinating diseases more CSF B cells expressed CD80 than in control subjects whereas the expression of CD86 by T cells in CSF was low in patients with demyelinating disease and highly variable in the control subjects. In patients with possible first attacks of MS the expression pattern of CD80 and CD86 differed significantly between patients with or without intrathecal synthesis of IgG. Increased expression of the CD80 molecule on CSF B cells may be of importance in the pathogenesis of MS. In contrast, CSF T cell expression of CD86 may be associated with protection from MS.     

Changes in the diagnosis and treatment of traumatic splenic rupture: a retrospective analysis of 99 consecutive cases

From January 1986 to January 1995, 99 consecutive cases with a ruptured spleen were analysed retrospectively. Diagnostic peritoneal lavage was replaced by abdominal ultrasound as a routine screening investigation in blunt abdominal trauma after 1991. An abdominal computed tomography scan carried out in stable circulatory conditions provided additional information in 80% of the cases. The choice of treatment was related to the extent of the splenic damage and associated injuries. Even in degree IV ruptures splenorrhaphy was carried out successfully in 38% (five out of 12). The Hospital Trauma Index-Injury Severity Score (HTI-ISS) was significantly lower (17.7; n = 43) in conservative treatment than in cases treated by splenorrhaphy (27.6; n = 25) or splenectomy (33.6; n = 31). Conservative treatment (n = 43) resulted in a secondary intervention in 19%, whereas primary splenorrhaphy (n = 25) failed once (4%). Clinical morbidity was 26%, with no significant differences between conservative treatment, splenorrhaphy and splenectomy. Early mortality (0-30 days post-trauma) reached 14%, and was related to extensive injuries in all cases. The mean HTI-ISS in patients with a fatal outcome was 50.5. Overall, 62% of the injured spleens were saved, with the rate of splenic preservation improving throughout the study period. A conservative policy was increasingly treatment of first choice in patients with stable circulatory parameters with major concomitant injuries.     

Transarterial brachial plexus anesthesia for hand surgery: a retrospective analysis of 346 cases

STUDY OBJECTIVES: To study the safety and efficacy of the transarterial approach to brachial plexus block with 60 to 70 ml of local anesthetic solution, and to compare the success and complication rates of this block performed by experienced or inexperienced anesthesiologists. DESIGN: Retrospective analysis of 346 records of ASA physical status I-IV patients who underwent elective unilateral orthopedic upper limb surgery with transarterial plexus anesthesia. SETTING: University teaching hospital. MEASUREMENTS AND MAIN RESULTS: Blood pressure (BP) and heart rate were measured at 5-minute intervals. Analgesia was registered as successful, incomplete, or failed. Any patient complaints or adverse reactions were recorded. The first 60 ml of local anesthetic provided surgical analgesia to 64% of patients. With a supplemental 10 ml of anesthetic, the overall success rate was 94%, with only 19 of 346 patients requiring general anesthesia. Experience in performing the block increased the success rate from 90% to 98% (p < 0.001). Six patients experienced either nausea or a transient BP decrease that did not require medication. There was no record of toxic or other serious adverse reaction. CONCLUSIONS: Transarterial brachial plexus block administered with a 60 to 70 ml dose of local anesthetic provides surgical analgesia for hand surgery with an excellent success rate and without serious adverse effects.     

Magnetic resonance imaging: a useful tool for evaluation of bone prior to implant surgery

OBJECTIVE: To illustrate the potential for use of magnetic resonance imaging (MRI) to gain full sectional information before placement of osseo-integrated dental implants, with no patient exposure to ionising radiation. MATERIALS AND METHODS: Four typical cases are illustrated, the patients being imaged in a one tesla MRI scanner. The setting up of the sequences is explained, along with the use of an imaging/surgical template with gadolinium markers. RESULTS: MRI clearly shows full sectional detail of available bone for safe implant placement, and allows the delineation of cortical and cancellous bone to attain maximum implant length and stability. Vital structures and the floor of the maxillary sinus are clearly shown. CONCLUSIONS: MRI allows the surgeon to assess cases for suitability to place dental implants with confidence. The ability to scan directly at any desired plane, with no reformatting, and to relate this information to a surgical template gives predictable surgery. MRI is a sectional imaging modality giving information about the 3-dimensional relationship of the vital structures, without using ionising radiation. It therefore deserves consideration as an alternative to computed tomography. However, further work is indicated to investigate the relative technical merits of the two imaging modalities.     

The pectoralis major myocutaneous flap in oral and maxillofacial reconstruction: a retrospective analysis of 50 cases

PURPOSE: This article retrospectively reviews 50 consecutive pectoralis major flaps used in oral and maxillofacial reconstruction with respect to reliability and complications. PATIENTS AND METHODS: Fifty patients had reconstruction of postcancer resection defects of the oral cavity and maxillofacial region. The age and sex of the patients and site of defect were analyzed. The design of the pectoralis major flap and complications encountered were documented. RESULTS: There were three cases (6%) of flap failure and an additional three cases (6%) in which 40% or more of the skin paddle sloughed. Orocutaneous fistula was rare. The use of an osteomyocutaneous flap with a rib gave poor results for mandibular reconstruction. CONCLUSION: The pectoralis major flap is reliable, and the complications seen in this series were comparable to other large series in the literature. Despite the increased use of microvascular flaps, the pectoralis major flap remains an excellent reconstructive choice for large soft tissue defects in the oral cavity.     

Secondary alveolar bone grafting--five-year periodontal and radiographic evaluation in 100 consecutive cases

A prospective study of secondary alveolar bone grafting based on the Norwegian (Oslo) team approach has been conducted by the CLP Unit at the Princess Margaret Hospital for Children in Perth, Australia, since 1982. The 5-year results of 100 consecutive cases of uni- and bilateral cases are presented according to periodontal and radiographic parameters of tooth support. The vast majority of cases grafted (98%) resulted in the eventual eruption of the cleft side cuspid/lateral incisor within acceptable parameters of tooth support. The results confirm the predictability of this safe procedure when utilized within a strict clinical protocol involving the whole CLP team.     

Acute opiate overdose: characteristics of 190 consecutive cases

AIMS: To characterize the population of drug users consulting the Emergency Room (ER) of a university hospital with acute opiate overdose (AOO) and to assess rate of referral to specialized treatment programme. DESIGN: Survey of a 12-month sample of AOO patients. MEASUREMENTS: Medical and psychosocial features of the drug users, details of emergency treatment and referral by a mobile resuscitation team (SMUR) and the ER of our hospital (CHUV-Lausanne, Switzerland). In addition fatal AOO cases were collected by the Institute of Forensic Medicine (IFM) during the same period. FINDINGS: One hundred and eighty-four cases of AOO (134 patients) were treated. The files of the IFM detailed six additional deceased cases. This population of drug users was characterized by an over-representation of men (73%), by young age (27.4 years), by a high rate of multi-drugs use (90%) and by a high rate of multiple previous overdoses (2.6). Average length of stay was 20.1 hours but 41% of cases stayed less than 8 hours. Only one patient was readmitted within an 8-hour period. When discharged, 78% returned home. Unexpectedly, 67% of patients were not referred to any therapeutic programme for drug addiction. CONCLUSION: This study shows the low mortality of AOO when treated but also demonstrates the need to improve psychosocial evaluation and referral of drug addicts admitted with AOO.     

Aesthetic outcome of breast implant removal in 85 consecutive patients

As we began to see increasing numbers of women concerned about their gel-filled breast implants, we became aware that we could not advise them with any degree of confidence what they might expect in terms of aesthetic result after implant removal. We decided to review the records and outcomes over a 2-year period of a number of patients who underwent implant removal. Eighty-five consecutive patients were reviewed, 69 of whom had undergone cosmetic augmentation and 16 of whom had breast reconstruction with silicone gel implant(s). Thirty-nine of the 69 cosmetic augmentation patients had removal of implants alone, and 27 had removal accompanied by mastopexy. Three had reaugmentation with saline-filled implants; one had replacement with saline-filled implants. Fifteen of the 16 reconstruction patients underwent autogenous tissue transfer. Preoperative and postoperative photographs of all patients were mixed randomly and rated by two independent raters in four aesthetic categories on a five-point scoring system. Repeatability was measured several weeks later, when each rater scored randomly selected photographs from this patient pool. The patients also performed their own outcome evaluations by means of questionnaire. We discovered that cosmetic augmentation patients who undergo implant removal only often suffer adverse aesthetic results. The postremoval appearance of many cosmetic augmentation patients actually will be improved over their preoperative appearance when mastopexy is performed in conjunction with implant removal. The study demonstrated that patients with certain body types could expect a particular outcome; i.e., women with asthenic builds and older patients with lax, striated breast skin generally had unsatisfactory aesthetic outcomes with implant removal only. Patients selected for autogenous breast reconstruction had favorable results, with extended latissimus dorsi and TRAM flaps yielding equally good outcomes. The study allows us to offer patients an optimistic view of postoperative results following breast implant removal. We have begun to advise selected patients that implant removal accompanied by mastopexy provides a more pleasing aesthetic outcome than implant removal alone.     

Surgical treatment of aneurysms of the left ventricle. Immediate and long-term results. Apropos of a consecutive series of 121 cases

From 1978 to 1992, 121 cases of postinfarction left ventricular aneurysm (99 males, 22 females, mean age 60 years) were operated on. The authors insist on a high rate of clinical arhythmogenicity (31.4%) and associated mechanical complications (21%). 76% of patients were in functional NYHA class III or IV. Resection was performed in 90% of patients, plication in 10%. 58% underwent coronary artery bypass grafting (1.7 graft/patient), 16% encircling ventriculotomy, 8% mitral valve replacement and 13% closure of ventricular septal defect. Operative mortality was 14.9% (10% when other mechanical complications where excluded). 5-year survival is 67.9%. Late cardiac deaths are as follow: left ventricular failure (1.8% A/P), Sudden death (1.4% A/P), Myocardial infarction (0.6% A/P). 82% of survivals are in functional NYHA class I or II. Only functional class NYHA III or IV is predictive of late death. We conclude that postinfarction left ventricular aneurysm remains a high risk complication especially when associated with other mechanical complications. When arhythmogenicity is present we suggest rhythmologic surgery and in all cases, complete revascularization.     

The rape victim: a review of 117 consecutive cases

The case records of 117 women examined at University Hospital for the complaint of alleged rape have been reviewed. The usual victim was white, single, under the age of 25 years, and attacked by a single assailant. Fifteen patients sustained serious physical injury, and 60 received minor injuries. Six children required hospitalization for reparative surgery. One patient required hospitalization for 9 days secondary to severe emotional stress. The number of attacks was lowest in the daytime and highest from midnight to 6:00 AM. Cultures from the endocervix were positive for gonorrhea in 12% of rape victims. Unfortunately, it would appear from public records that there is little hope of the attackers being convicted.     

Glass-ionomer cement: evaluation as an orbital implant

BACKGROUND: Chronic constipation is one of the most common disorders in Western countries and despite numerous clinical, pathophysiologic, and epidemiologic studies its cause is still unclear. Several hypotheses have been proposed and according to experimental studies and clinical observation, fiber intake could play a role in its pathogenesis. The purpose of this case-control study was to examine the possible correlation of idiopathic chronic constipation in children and dietary intake, particularly fiber intake. METHODS: A randomized sample of children (291 children with constipation and 1602 controls) aged 2 to 14 years was taken from three of the 52 counties of Greece. Stratification was performed on the basis of urban, rural, or suburban location and socioeconomic status. The nutritional data were obtained from a 3-day dietary record and a dietary history. Statistical analysis was performed with multivariate tests, multivariate analysis of variance, discriminant analysis, and chi-square analysis according to the characteristics of the correlated variables. RESULTS: Constipated children had a lower caloric and nutrient intake (p < 0.001), lower body weight/height (p < 0.001), and higher prevalence of reported anorexia (p < 0.001). Discriminant analysis indicated that dietary fiber alone was independently negatively correlated with chronic constipation, despite the age and the age of onset of constipation. Relative risk also had a negative correlation with fiber intake (p < 0.001). Of the main fiber fractions only cellulose and pentose were independently correlated with chronic constipation. CONCLUSIONS: Lack of fiber may play an important role in the etiology of chronic idiopathic constipation in children.     

Carotid surgery in the community hospital: 467 consecutive operations

Over a 12-year period, 467 consecutive operations for carotid disease were performed on 424 patients in community hospitals. Of all the patients, 0.2% died within 30 days of surgery and 3% had a stroke within 30 days. One third of these strokes were disabling. No cerebral monitoring equipment was used and an indwelling carotid shunt was only rarely used.     

Fatal poisoning with propoxyphene: report from 100 consecutive cases

The first 100 deaths caused by propoxyphene and recorded by the Chief Medical Examiner of North Carolina were studied. Victims ranged evenly in age from the second to the seventh decade. Over 65% were suicides with a female to male ratio of 2:1. Blood propoxyphene concentrations of 0.2 mg/dl were fatal, representing rapid ingestion of approximately ten capsules. In North Carolina, deaths due to propoxyphene have increased from five in 1969 to 49 in 1975. Raising physician-awareness of propoxyphene's toxicity and placing the drug in Schedule II are two of the author's recommendations for reducing the number of propoxyphene deaths.     

General anesthesia for rhytidectomy: a review of 100 consecutive cases

Although local anesthesia will, and should, continue to be the principal method of anesthesia for most face lift operations, we believe that general endotracheal anesthesia, supplemented by local anesthesia with epinephrine, offers significant advantages in a selected group of patients. We review 100 consecutive rhytidectomies done under this combination of anesthetics. These patients had no significant intraoperative or postoperative problems, and the results compare favorably with the usual technique of local anesthesia plus basal sedation. Good cooperation between surgeon and anesthesiologist, and a thorough understanding of the principles involved in such anesthesia administrations (particularly when relatively large volumes of local anesthesia with epinephrine are going to be used) are necessary for the patient's safe course during the procedure.     

Reconstruction of mandibular discontinuity defects using autogenous grafting and a mandibular reconstruction plate: a prospective evaluation of nine consecutive cases

This article presents the clinical results of a prospective evaluation of nine cases of mandibular discontinuity that were reconstructed using autogenous grafting and a reconstruction plate. All patients were allowed to function immediately postsurgery. Acceptable esthetic and functional results were obtained with minimal donor and recipient site complications. All cases showed complete graft incorporation and restoration of osseous continuity.