Leukocytes modulate 11beta-hydroxysteroid dehydrogenase (11beta-HSD) activity in human granulosa-lutein cell cultures

A randomised clinical trial was performed to investigate whether there is a need or advantage to splint two implants in the mandible retaining a hinging overdenture. Furthermore, patient satisfaction was evaluated for different attachment systems retaining the overdenture. Thirty-six edentulous patients were randomised into three groups of equal size and treated with either magnets, ball attachments or straight bars (reference group). After 3 years of observation no implants were lost in any of the groups. Besides, no statistically significant differences were noted for the peri-implant outcome. Although the bar group presented the highest retention force, the general satisfaction of the patients in the three groups did not differ. The patients with bar retentions showed less prosthetic complications of the retention elements but more at the level of the denture-supporting mucosa. Finally, the clinical outcome of all groups confirms that overdenture treatment demands regular controls with limited time intervals.     

Implant-supported overdenture therapy: a retrospective study

All patients (n = 46) treated with implant-supported overdentures at the Department of Prosthetic Dentistry, Dental and Medical Health Centre, Halmstad, Sweden, from 1986 to 1993 were studied. The clinical examination was completed in 1994. The material was divided into two subgroups: Group A had been initially treatment planned for an implant-supported overdenture, and Group B had been planned for fixed prostheses but because of loss of implants before loading, treatment with a fixed prosthesis was not possible. The authors present their experience and patient reactions to overdenture therapy in two defined groups of patients. The implant failure rate before loading for Group A (n = 12) was 15% (six implants out of 39), and the rate before loading for Group B (n = 29) was 43.6% (68 implants out of 156). After prosthodontic treatment in Group A, the implant success rate after loading was 87.9%, and the overdenture stability was 84.6%. In group B, 17 implants placed in the maxillae were lost after overdenture therapy, which resulted in an implant success rate of 79.3%. A total of eight overdentures, all of which had been placed in the maxillae, were lost, resulting in an overdenture stability of 73.3%. In this study "change of retentive clips" was the predominant prosthodontic complication related to the overdentures, especially in Group B. Most of these complications (62%) occurred in patients with clinical signs of bruxism. Patient reactions to treatment with an overdenture were positive regarding esthetics for both groups. More negative views were recorded in Group B than in Group A in response to function and retention of the overdenture.     

Patients with epilepsy who die suddenly have cardiac disease

This paper describes the design and fabrication of a soft liner-retained, implant-supported overdenture used in 10 patients over a period of 1 to 6 years. A final complete denture impression is made of the dental arch, including implant abutments extending 5 mm above the gingival tissue. The master cast is fabricated with actual abutments placed in the impression. After the final wax try-in, the denture is flasked in the usual manner with the metal abutments in place. Before packing with acrylic resin, plastic tubing 1 to 2 mm thick is placed around each abutment. The denture is trial packed and allowed to bench cure over night. The plastic tubing is then removed and a soft denture lining material is placed in these areas only. The flask is closed and cured according to the manufacturer's recommendation. The denture is delivered as a conventional overdenture.     

Implant-supported overdentures: the ZAAG attachment system

It has been amply demonstrated during the last decade that there are significant advantages to implant-supported overdentures beyond conventional complete dentures. Several attachment systems exist for connecting the overdenture to the implants, and practically all of them present notable benefits to the patients. This article discusses the use of the Zest Anchor Advanced Generation (ZAAG). This system, an outgrowth from the original Zest attachment, uses both individual implant attachments and bar attachments, and is compatible with all major implant systems. In addition to the retention, stability, and resiliency the ZAAG implant attachment system provides, it has the advantage of placing the resistance force of the attachment close to the implant body.     

Characterization and specificity of B-cell responses in lupus induced by Mycobacterium bovis in NOD/Lt mice

BACKGROUND: Endoscopic treatment of postoperative benign bile duct strictures (BBDS) is technically challenging, and the long-term outcome after stricture dilation remains poorly defined. METHODS: Forty-eight cases of postoperative BBDS with attempted endoscopic treatment (either transient plastic stenting or definitive metal stent insertion) were reviewed. RESULTS: Endoscopic stricture dilation succeeded in 47 of 48 cases (98%). No procedure-related mortality was observed; 16 (33%) procedure-related or stent-associated complications were observed during treatment. Endoscopic treatment was interrupted in five patients. Stricture relapse occurred in 6 of 6 (100%) and 7 of 36 (19%) patients after metal stent insertion and plastic stent removal, respectively (p < 0.001) (mean follow-up periods 50+/-12 and 44+/-34 months, respectively). After plastic stent removal, stricture relapses were more frequent among patients with strictures related to liver transplantation as opposed to other surgical procedures (p < 0.05); these recurrent strictures were successfully treated by repeated insertion of plastic stents on a temporary basis. At the end of follow-up, all but one patient treated with plastic stents had normal serum alkaline phosphatase values. CONCLUSION: Metal stents proved to be inadequate for treating postoperative BBDS. Temporary insertion of a plastic stent (possibly repeated) provided long-term results equal or superior to those reported for surgical biliary drainage. Repeated insertion of plastic stents was more frequently indicated for strictures related to liver transplantation compared with other surgical procedures.     

Implant overdentures for the geriatric patient

Extensive research has shown that the removable implant overdenture is a suitable treatment modality for edentulism, which may be particularly advantageous in the older patient. Clinical studies, treatment planning considerations, complications and maintenance of the implant overdenture are discussed in this paper. Clinical examples that illustrate several common applications of this prosthesis are presented.     

The dark side of dioxygen biochemistry

The aim of this study was to evaluate the clinical function and long-term prognosis of overdentures retained by a small number of implants in the maxilla and mandible using one of two different attachment systems. Included in the study were all patients referred to specialty clinics in J?nk?ping and Link?ping, Sweden, during the treatment period who needed an overdenture and could be provided with a minimum number of two bilaterally-placed implants. Excluded were patients with bone-grafted jaws, irradiated cancer patients, heavy bruxers, and patients who had lost a fixed prosthesis because of implant losses. The patients were randomly assigned to receive one retentive system, either a round 2-mm-diameter bar with clips or ball attachments (Nobel Biocare). Eighteen overdentures were placed in maxillae and 32 in mandibles, supported by a total of 115 Br?nemark implants. Of the implants placed, 86.1% were continuously osseointegrated. The cumulative implant survival rates after 7 years of loading were 75.4% in the maxillae and 100% in the mandibles. There was no difference in implant survival rate between the attachment systems. Patients with implant losses were characterized by severely resorbed maxillary ridges and inferior bone quality, together with unfavorable loading circumstances such as short implants combined with long leverages. Complications and prosthetic adjustments were mostly resolved early and easily.     

The cost of dental implants as compared to that of conventional strategies

The effectiveness of dental implants is widely studied, especially in terms of their clinical outcomes. However, from the policymaker's point of view, variables other than safety and efficacy, such as the costs and effectiveness of dental implants as compared to other treatment alternatives, are vital in decision making. This paper compares the costs of different treatment strategies in a randomized clinical trial in patients with resorbed mandibles and persistent problems with their conventional dentures: treatment with a mandibular overdenture on permucosal dental implants, an overdenture on a transmandibular implant, new dentures after preprosthetic surgery, and new dentures only. Data were gathered on an individual patient level to gain insight into specific cost episodes. Direct costs were subdivided into labor, material, technique, and overhead. Data concerning these components were gathered during the consecutive treatment phases in the first year. Results show that the resources used to treat a patient with an overdenture supported by a transmandibular implant are seven times those of a complete new set of dentures. Comparison of the cost ratio of an implant-retained overdenture supported by permucosal implants and conventional new prostheses proves less unfavorable: 1:3. New dentures after preprosthetic surgery are almost as expensive as treatment with permucosal implants.     

Cost-saving implant training aids

This article describes a simple step-by-step procedure that uses inexpensive materials to enable those who wish to learn procedures used in the construction of a screw-type implant overdenture to practice these procedures before they use expensive precious metal components. The use of this procedure will result in considerable savings in training costs and affords a greater opportunity to provide practical experience before making this type of an overdenture for patients. It could also provide for a rapid expansion in the number of trained personnel who could make this form of treatment available to a larger number of patients.     

Acute liver failure

PURPOSE: This article reviews the literature on radiographic imaging techniques and image interpretation for dental implant treatment. MATERIALS AND METHODS: MEDLINE was used to identify published peer-reviewed literature for this report. RESULTS: Radiographic images are indispensable in the evaluation of osseous structures when planning treatment for dental implants. Potential bone sites for implant placement can be assessed clinically by means of palpation or probing through the mucosa; however, diagnostic imaging provides the best means for indirectly measuring bone dimensions. After healing of the implant site, the application of radiology is useful to verify the amount of bone adjacent to the implant and that the transmucosal abutments fit the implant. Upon completion of the implant prosthesis, radiology may be used to monitor initial and long-term success of implant treatment. CONCLUSION: Recommendations for the application of radiology over the course of treatment are made for various implant cases ranging from the overdenture to the single-tooth implant.     

Expression of gonadotropin-releasing hormone (GnRH) gene in human uterine endometrial tissue

OBJECTIVE: To determine if adolescent mothers who request early removal of levonorgestrel implants differ from those who do not in ways that might predispose them to repeated conceptions and in their concerns about adverse effects. We hypothesized that adolescent mothers who request removal of levonorgestrel implants within 2 years of insertion have more risk factors for repeated pregnancy than those who do not. METHODS: We studied the prevalence of 21 characteristics associated with repeated adolescent pregnancy and 16 adverse effects of levonorgestrel implants in 181 postpartum, adolescent levonorgestrel implant recipients, 66 (36%) of whom had the levonorgestrel implants removed within 20 months of insertion (hereafter, removers). RESULTS: Removers (n = 66) had significantly more risk factors for repeated pregnancy and reported significantly more adverse effects than did those who continued to use levonorgestrel implants (hereafter, users) (n = 115). Concerns about adverse effects rose in tandem with risk factors for repeated pregnancy (r = 0.26; P = .001) and were the most important determinant of levonorgestrel implant removal (relative risk, 9.72; 95% confidence interval, 4.62-19.49). However, the number of risk factors for repeated pregnancy was also a significant, independent predictor of levonorgestrel implant removal (relative risk, 2.34; 95% confidence interval, 1.10-4.66). Following removal, contraceptive use was poor and conception occurred rapidly; 24 (37%) of the removers conceived again within 2 years of the index delivery. CONCLUSIONS: The study hypothesis was supported. Our findings that concerns about the adverse effects of levonorgestrel implants rise in tandem with risk factors for repeated pregnancy suggest that the efficacy of counseling before and after levonorgestrel implant insertion could be improved by addressing those aspects of the user's life that undermine the motivation to use contraception.     

Temporal aspects of ventromedial hypothalamic progesterone action in the facilitation of estrous behavior in the female rat.

Examined the temporal parameters of progesterone (P) action in the ventromedial nucleus of the hypothalamus (VMN) in the facilitation of estrous behavior in estrogen-primed female Long-Evans rats stereotaxically outfitted with guide cannulae directed towards the VMN. Crystalline P was applied directly to the brain tissue via bilateral insert cannulae. Ss were ovariectomized and estrogen primed with 5% estradiol Silastic capsules. They received a counterbalanced series of 2 experimental tests: one involving a manipulation with a P-filled implant, and another with a blank implant. In Exp I, a significant increase in estrous responsiveness occurred only after 2 hr exposure of the VMN to P, whereas 4 hr were required for a full display of estrous behavior, including solicitation. In Exp II, P was lowered into the brain for either 1, 2, or 4 hr, and testing took place 4 hr after the lowering of the implant. It was found that 2 hr of P exposure was sufficient to facilitate full estrous responsiveness at 4 hr. In Exp III, it was revealed that the duration of estrous responsiveness was directly related to the time the P implant remained in the brain. In Exp IV, the time course of P retention in brain tissue, revealed by determination of –3H-progesterone levels in hypothalamus, agreed with the behavioral findings. Progesterone levels in the region of the VMN remained high while a P implant was in place, but declined rapidly after removal. A dual mechanistic hypothesis for P action in the facilitation of estrous behavior is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The natural history of the patient with an infected total hip replacement

Deep infection, the most serious local complication of total hip replacement, prompted a study of the records of 135 patients (137 hips) thus afflicted in a nationwide survey of Canada. Particular attention has been paid to the natural history of the infection, and the problems of diagnosis are described. Twenty-one patients died after the insertion, or removal, of the prosthesis, and of the survivors of the original 135 patients only eighteen have been able to retain the prosthesis without further problems with the wound. The remaining patients had the prosthesis removed, and most dry wounds. Certain suggestions are made on management. The advice that a second total hip prosthesis should be inserted after a deep infection of the first implant is not supported.     

Metal stents for benign and malignant bile duct strictures stents for benign and malignant bile duct strictures

Self-expanding metal stents provide a much larger diameter--up to 30 Fr--in comparison with plastic stents, which have a maximum diameter of 12 Fr. Although they have consequently been found to be far superior to plastic prostheses, they are not removable, and in benign strictures metal stents should therefore be used only in exceptional situations. Metal stents are the preferred mode of treatment for malignant strictures, provided the patient has a sufficient life expectancy although this is hard to predict in individual cases. Metal stents also seem to be superior in hilar malignancy, but the data here are limited. Future developments may include the use of covered metal stents and self-expanding stents (made of plastic or other materials) that are removable or self-dissolving.     

Permanent endoprostatic prostheses in patient with obstruction caused by benign hyperplasia of the prostate

Presentation of the results obtained using the intraprostatic prosthesis UroLume in 78 patients wit BPH obstruction, 69 of which presented high surgical risk (ASA IV). Mean age was 79.8 years (r: 62-93). All patients carried urethral catheters, except 4 (5.1%) who had a provisional metal coil that required replacement. Prosthesis were implanted successfully in 72 cases (93.3%). The most significant exclusion criterion was an excessive length of prostate urethra. Mean follow-up was 15.3 months (r: 3-38). Mean maximum flow at 1 year after implant was 12.7 mL/sec; mean symptoms score (I-PSS score) was 6.2 points and in most prosthesis, epithelization had taken place. Three patients required implant of another prosthesis, either during the same surgical procedure (1 case) or later due to retention or dysuria (2 cases). Due to acute urine retention (AUR) during the immediate postoperative, resection of the middle lobe was performed in one case while a second case required late resection of intraluminal hyperplastic tissue. Three patients (4.1%) had haematuria that forced hospital admission some months after the implant, and three cases (4.1%) required removal of the prosthesis; at patient's request (1 case), due to calcification (1 case) and for stress incontinence (1 case). After a follow-up of over three years, it can be concluded that the UroLume prosthesis is an effective alternative to TUR in patients at high surgical risk.     

Fixed temporization and bone-augmented ridge stabilization with transitional implants

Utilization of dental implants in full-mouth restorations is now a well-accepted treatment modality, with numerous modifications and implant systems documented in the literature. The efficacy of the treatment procedure generally requires an extended postplacement healing period prior to loading the implant fixture with the stress of mastication. Until recently, clinicians have not been able to address patient comfort requirements during the healing period. The teaching objective of this article is to present and evaluate a transitional implant system used to provide function during the healing phase. The system consists of thin titanium transitional implants and a three-component overdenture that is intended to absorb the pressure during function and protect the augmented implant site and the definitive implant fixtures from the stress of immediate loading. Treatment objectives for the transitional and definitive implants are made during the initial treatment planning. Three cases are presented to document and illustrate the clinical procedure.     

TC1钛合金棒材超声波检测过程中未超标异常波的分析

针对TC1钛合金小规格棒材在超声波探伤检测过程中发现的未超标的3种典型反射信号,用金相分析、扫描电镜分析以及电子探针微区成分分析手段进行了深入分析。结果发现,在3种典型反射信号波处存在高熔点、高密度异金属物夹杂、气孔孔洞以及由富钛偏析引起的孔洞裂纹等内部缺陷。     

Reversibility of medialization laryngoplasty. An experimental study

Medialization laryngoplasty has become a routine procedure for cases of unilateral vocal fold paralysis. In certain clinical situations, it may become desirable to reverse the procedure and remove the implant. This process was studied experimentally in eight dogs in a chronic model of induced canine phonation. A silicone polymer implant was inserted to medialize one normal vocal fold for a period of 1 month, after which it was removed. Motion of the cricoarytenoid (CA) joint and induced phonation were studied weekly while the implant was in place, and for another month following implant removal. Significant abnormalities were found even with this relatively short period of implantation. With the implant in place, impairment of CA joint mobility was found in seven of the eight dogs, precluding phonation. A dense fibrous capsule rapidly developed around the implant, making its removal technically difficult. Following implant removal, a gradual return to normal function was found in only three of the eight dogs. One of the animals had evidence of neural injury, while four had intact neural function but impaired mobility or fixation of the CA joint. Medialization laryngoplasty should not be considered a reversible procedure. The clinical implications of these findings are discussed.     

Evaluation of expanded polytetrafluoroethylene as a soft-tissue filling substance: an analysis of design-related implant behavior using the porcine skin model

Soft-tissue augmentation using the synthetic nonfluid biomaterial expanded polytetrafluoroethylene (ePTFE) has been supported by number of recent reports citing the favorable characteristics of biocompatibility, soft and natural feel, ease of use, and permanent augmentation. Concern has been expressed about this application for ePTFE material because of the proximity of the implants to the skin surface and potential problems with infection and extrusion. We evaluated the behavior of a series of specific ePTFE implant designs using a long-term subcutaneous augmentation model. By using a porcine model, 466 implants of ePTFE in the form of strips, rolls, or tubes were placed using a percutaneous insertion device subcutaneously over the dorsum and face. The animals were divided into three study groups by length of implantation (3 weeks, control; 6 months, intermediate term; and 12 months, long-term) and en-bloc tissue specimens, including skin, implants, and underlying soft tissue, were harvested for gross and histologic examination. Implants were removed at the earliest sign of infection, exposure, or extrusion and the difficulty of removal was ascertained and recorded. These data reveal that ePTFE material elicits acceptable levels of tissue activity with low extrusion rates over the short and long term supporting its use for soft-tissue augmentation. The data show a clear difference, however, in the host response and behavior of the implants for this application based on shape or design. A statistically significant difference in the low, but measurable, extrusion rates was observed amongst these implant designs. ePTFE tubes showed greater stability and predictable augmentation over other implant designs for soft-tissue augmentation and seem to represent a substantial improvement for this application.     

Magnetic resonance imaging lesion analysis in neurofibromatosis type 1

The purpose of this prospective study was to investigate the clinical outcome and marginal bone resorption of three different endosseous implants placed in the anterior mandibles of 15 elderly patients. Eleven women and 4 men (ranging from 65 to 80 years, mean 71 years) had three different endosseous implants placed in the anterior mandible; one titanium plasma-sprayed cylinder implant (4-mm diameter), one titanium cylinder implant with hydroxyapatite coating (4-mm diameter), and one standard threaded titanium implant (3.75-mm diameter). Three months later, at the second-stage surgical procedure, ball abutments were connected and an overdenture was placed. At 12, 24, and 36 months, marginal bone resorption and Periotest values were recorded. None of the implants was lost in this period. An analysis of variance with repeated measurement was performed annually to test the existence of significant differences between the implants. When differences appeared, paired t tests were used to identify which differences were significant. Bonferroni multipliers were used to adjust for multiple testing. When marginal bone resorption was concerned, threaded titanium and hydroxyapatite-coated implants had significantly better scores than titanium plasma-sprayed cylinder implants. Periotest values for hydroxyapatite-coated implants were significantly better than test values for the other implants after 2 years. After 3 years significance was obtained between hydroxyapatite and screw-shaped implants only (P < .05). It was concluded that titanium plasma-sprayed cylinder implants have a less favorable prognosis than the other implants used in this study.