Immediate rehabilitation of severely atrophic maxilla using trans-sinus nasal protocol and extended-length subcrestal angulated implants. Case series with one-year follow-up

2021 ◽  
Author(s):  
MIchael Zaninovich
Keyword(s):  
Alveolar Bone ◽  
Nasal Bone ◽  
Treatment Protocol ◽  
Case Series ◽  
Patient Comfort ◽  
Implant Design ◽  
The Novel ◽  
Atrophic Maxilla ◽  
Zygomatic Implants ◽  
Extended Length

<p>Immediate fixed full arch rehabilitation of the severely atrophic maxilla eliminates the use of a tissue supported prosthesis during the healing phase and maximises patient comfort and quality of life.<o:p></o:p></p> <p>The surgical treatment options available for immediate rehabilitation of the severely atrophic maxilla are dependent on the location and availability of the residual alveolar ridge. When bone is only available in the inter canine region, a graftless approach using tilted distal implants may not provide adequate distance between implants for favourable biomechanics. Subsequently, zygomatic implants are the alternative to provide adequate posterior occlusal support.  <o:p></o:p></p> <p>The use of extended length sub crestal angulated implants offers an additional implant option for the clinician to restore the severely atrophic maxilla immediately. The treatment protocol involves anchorage of the implant fixture to the lateral wall of the nasal bone. The distally tilted implant transverses an augmented sinus cavity and extends to the site of the first permanent molar. The novel implant sub crestal angulation and use of a multi-unit abutment promotes passivity of fit of a full arch fixed immediate prosthesis.<o:p></o:p></p> <p>Five clinical case reports from private practice are presented which outline the clinical value of the novel implant design in the rehabilitation the severely atrophic maxilla. In each case, the use of zygomatic implants would conventionally have been prescribed due to the absence of residual alveolar bone in the maxilla premolar and molar regions. Alternatively, the use of extended length subcrestally angulated implants with straight of angulated multi-unit abutments have successfully restored the arch immediately.<o:p></o:p></p>

scholarly journals Experience with the novel unifemoral parallel sheath technique in percutaneous intervention of chronic total coronary occlusions

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Joerg Reifart ◽  
Konstanze Schilling ◽  
Christian W. Hamm ◽  
Nicolaus Reifart
Keyword(s):  
Case Series ◽  
Patient Comfort ◽  
Severe Bleeding ◽  
The Novel ◽  
Bleeding Events ◽  
Radial Access ◽  
Vascular Closure Devices ◽  
Feasible Alternative ◽  
Total Coronary Occlusions ◽  
Retrograde Technique

Abstract Background Percutaneous interventions to address chronic coronary occlusions (CTO-PCI) often require simultaneous ipsi- and contralateral coronary injections. Although radial access is increasingly popular, bifemoral artery access is still the preferred choice of CTO operators. The aim of this case series is to demonstrate the feasibility and safety of the unifemoral parallel sheath technique, which avoids two puncture sites, increases patient comfort, and improves procedure ergonomics. It offers rapid second access to the femoral artery adjacent to the first sheath as well as closure by unilateral manual compression without or with 1 or 2 vascular closure devices. Results We retrospectively evaluated the procedure results in 90 consecutive CTO patients where an ipsilateral parallel sheath access was considered. Placement of the second sheath uneventfully failed in two because of severe femoral calcification and narrowing. In 96.6%, the first sheath was 7 F (3.4% 6F), while the second sheath was 4 F in 22.7%, 5 F in 64.7%, and 6 or 7 F in 11.4% each. No major complications nor severe bleeding events occurred, and the mean drop of hemoglobin was low (0.6 g/dL ± 0.86). Conclusion In CTO-PCI requiring contralateral coronary injections or the retrograde technique, the ipsilateral parallel sheath technique might be a feasible alternative to the standard bifemoral or femoral-radial access.

scholarly journals Assessment of quality of life in a retrospective study of total oral rehabilitation of the upper jaw with transzygomatic fixation - Case series

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Luis Pinheiro
Keyword(s):  
Quality Of Life ◽  
Retrospective Study ◽  
Case Series ◽  
Life Questionnaire ◽  
Oral Rehabilitation ◽  
Time Points ◽  
Atrophic Maxilla ◽  
Zygomatic Implants ◽  
The Impact

Purpose: Zygomatic implants are becoming more common in oral rehabilitation of atrophic maxilla. Successful surgery and rehabilitation are mandatory for the achievement of a well-defined criteria of Quality of Life. However, there is a paucity of studies reporting on the Health-Related Quality of Life in patients undergoing oral rehabilitation. This article aims to developing a specific questionnaire for this particular surgical and rehabilitation procedure that could be an objective quality outcome measure of Quality of Life. This should improve our understanding of the impact of zygomatic implant placement on Quality of Life. Materials and Methods: The study was performed involving the Eastman Dental Institute - University College of London, the Faculty of Sciences - University of Lisbon, and two private practices in Portugal, C.E.R.O-Lisboa and Clitrofa. This was a retrospective study, evolving 30 patients undergoing TransZygomatic Surgery. A modification of the University of Washington – Quality of Life Questionnaire was designed for this work. The evaluation was made in three-time points: TP1 – Before surgery, TP2 - After surgery and TP3 - After final rehabilitation. Results: The means of the increased Quality of Life between the different time-points were found to be statistically significance at the level of 0.05, with a confidence interval of 95%. Conclusion: With this Questionnaire, important data was collected which should allow treatment developments to optimise patients Quality of Life.

Extrasinus Zygomatic Implant Placement in the Rehabilitation of the Atrophic Maxilla: Three-Dimensional Finite Element Stress Analysis

2015 ◽  
Vol 41 (2) ◽  
pp. e1-e6 ◽  
Author(s):  
Shihab A. Romeed ◽  
Robert Nigel Hays ◽  
Raheel Malik ◽  
Stephen M. Dunne
Keyword(s):  
Alveolar Bone ◽  
Treatment Options ◽  
Three Dimensional ◽  
Lateral Loading ◽  
Vertical Loading ◽  
Atrophic Maxilla ◽  
Zygomatic Implants ◽  
Von Mises ◽  
Three Dimensional Finite Element ◽  
Von Mises Stresses

Placement of zygomatic implants lateral to the maxillary sinus, according to the extrasinus protocol, is one of the treatment options in the rehabilitation of severely atrophic maxilla or following maxillectomy surgery in patients with head and neck cancer. The aim of this study was to investigate the mechanical behavior of a full-arch fixed prosthesis supported by 4 zygomatic implants in the atrophic maxilla under occlusal loading. Results indicated that maximum von Mises stresses were significantly higher under lateral loading compared with vertical loading within the prosthesis and its supporting implants. Peak stresses were concentrated at the prosthesis-abutments interface under vertical loading and the internal line angles of the prosthesis under lateral loading. The zygomatic supporting bone suffered significantly lower stresses. However, the alveolar bone suffered a comparatively higher level of stresses, particularly under lateral loading. Prosthesis displacement under vertical loading was higher than under lateral loading. The zygomatic bone suffered lower stresses than the alveolar bone and prosthesis-implant complex under both vertical and lateral loading. Lateral loading caused a higher level of stresses than vertical loading.

The novel use of convalescent plasma in patients with COVID 19 in Basra governorate, Case series review

2020 ◽  
pp. 1-10 ◽  
Author(s):  
Saad Hammadi ◽  
Ali Hashim ◽  
Abbas Ali ◽  
Rafid Abbood ◽  
Hassanein Ali ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Case Series ◽  
Passive Immunity ◽  
The Novel ◽  
Efficacy And Safety ◽  
Off Label Use ◽  
Plasma Therapy ◽  
Off Label ◽  
Plasma Donation ◽  
Patient Series

Background: The idea of convalescent plasma usage is to give passive immunity to the patients, so their immune system stands a good chance of combating the virus.this study will review 6 cases of eligible covid 19 patients that had been treated with convalescent plasma therapy in Basra covid 19 quarantine Objectives: to demonstrate efficacy and safety of convalescent plasma in the patient series that had been enrolled . Method: this study had pioneered a new method to collect up to 3,000 mL in one session by an off-label use of Spectra Optia Apheresis systems by TerumoBCT /Exchange set to collect convalescent plasma. In this study 250 mL convalescent plasma had been given each of the 6 patients, from one donor. respose in spo2,dyspnoea and tachypnoea was observed ,any reaction to plasma also had been monitored . Result: Our case series have demonstrated both safety and effectiveness of convalescent plasma. This study was successful in reaching our primary and secondary outcomes in all 6 patients (improvement in SpO2 and symptoms). With negligible difference in time of post transfusion response Conclusion: convalescent plasma is apperantly safe and effective, In this study 250 mL convalescent plasma had been given each of the 6 patients, from one donor using Therapeutic Plasma Exchange (TPE) protocol by Spectra Optia Apheresis system/TerumoBCT. Keywords: convalescent plasma, COVID-19, SARS CoV-2, apheresis, plasma exchange, plasma donation

scholarly journals 63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Lau ◽  
Z Arshad ◽  
A Aslam ◽  
A Thahir ◽  
M Krkovic
Keyword(s):  
Economic Impact ◽  
Treatment Protocol ◽  
Case Series ◽  
Consecutive Series ◽  
Financial Loss ◽  
Patient Demographics ◽  
Tertiary Centre ◽  
The Mean ◽  
Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

scholarly journals The nasal cantilever technique in children undergoing primary cleft lip surgery: novel concepts and review

2020 ◽  
Vol 5 (1-2) ◽  
pp. 53-62
Author(s):  
Badr M. I. Abdulrauf
Keyword(s):  
Learning Curve ◽  
Cleft Lip ◽  
Nasal Bone ◽  
Case Series ◽  
Nasal Deformity ◽  
Challenging Issue ◽  
Primary Surgery ◽  
Novel Concept ◽  
Cleft Nasal Deformity

AbstractBackgroundNasal deformity associated with cleft lip deformity is a challenging issue, encompassing controversies, theories, and a diversity of techniques. Historically, esthetic outcomes have ranged from being below expectations to barely acceptable.MethodBased on the concept that the nasal cartilaginous framework in clefts is similar to that of a collapsing pyramid, a novel suspension technique has been described. The entire cartilaginous structure is lifted from the infratip segment with a loop suture and is secured in a cantilever fashion onto the periosteum overlying the nasal bone. This part of the operation is performed in a semiclosed manner. The technique is applied during primary surgery in bilateral and unilateral nasal cleft lip deformities, with changes in the orientation of the cantilever loop suture. Studies conducted by Masters S. Tajima, H. McComb, H. Thomson, D. Fisher, and J. Mulliken, which are most relevant to this article, have been reviewed and discussed throughout.ResultsThe technique was first applied over 10 years ago. A case series of nine children whose parents consented to the developing technique is presented with follow-up ranging from months to years, along with technical descriptions and illustrative drawings. None of these cases had preoperative orthopedic correction, molding, or postoperative nostril splints. The esthetic outcome was optimal enough; none of the cases requested a secondary correction.ConclusionThe nasal cantilever technique is a novel concept in cleft nasal deformity, which can be used in conjunction with an appropriate lip technique, per the surgeon’s discretion. Other than a learning curve, we believe that it provides a solid correction by securing the cartilaginous structures after they have been mobilized to a stable base, the nasion.

scholarly journals Contrast-Induced Encephalopathy after Cerebral Angiogram: A Case Series and Review of Literature

2021 ◽  
pp. 405-413
Author(s):  
Cecelia Allison ◽  
Vaibhav Sharma ◽  
Jason Park ◽  
Clemens M. Schirmer ◽  
Ramin Zand
Keyword(s):  
Rare Complication ◽  
General Pattern ◽  
Treatment Protocol ◽  
Case Series ◽  
Altered Mental Status ◽  
Cortical Blindness ◽  
Neurological Deficits ◽  
Cerebral Angiogram ◽  
Iodinated Contrast Medium ◽  
Iodinated Contrast

Contrast-induced encephalopathy (CIE) is a rare complication that arises from exposure to iodinated contrast medium and can result in a range of symptoms, including cortical blindness, aphasia, focal neurological deficits, and altered mental status. We present 4 individual cases of CIE who presented with stroke-mimic symptoms following surgery with localized iodixanol or ioversol injection. We outline a clinical timeline of all patients, showing that CIE follows a general pattern of delayed onset, worsening symptomology, and ultimately full recovery. All patients received IV hydration, corticosteroids, or both as part of their treatment protocol.

scholarly journals Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

2021 ◽  
Author(s):  
Francesco Luceri ◽  
Davide Cucchi ◽  
Enrico Rosagrata ◽  
Carlo Eugenio Zaolino ◽  
Alessandra Menon ◽  
...  
Keyword(s):  
Case Series ◽  
Radiographic Evaluation ◽  
Healthy Population ◽  
X Rays ◽  
The Novel ◽  
Level Of Evidence ◽  
Orthopaedic Surgeons ◽  
Joint Congruency ◽  
Radiological Parameters ◽  
The Mean

Abstract Introduction The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. Methods Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon–coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. Results 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3–1.6), the mean ACI was 2.0 ± 0.2 (1.6–3.1) and the mean PCI was 1.3 ± 0.1 (1.0–1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. Conclusion The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. Level of evidence Basic Science Study (Case Series). Clinical relevance The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.

scholarly journals Management challenges in patients with comorbid COVID-19 associated delirium and serious mental illness – A case series

2021 ◽  
pp. 009121742098597
Author(s):  
Saba Syed ◽  
Michael Couse ◽  
Rashi Ojha
Keyword(s):  
Mental Illness ◽  
Serious Mental Illness ◽  
Healthcare Providers ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Active Management ◽  
The Novel ◽  
Psychiatric Facility ◽  
Medical Teams ◽  
Novel Coronavirus

Background There is still a lot unknown about the novel Coronavirus Disease 19 (COVID-19) and its effects in humans. This pandemic has posed several challenging clinical situations to healthcare providers. Objective We hope to highlight the distinctive challenges that COVID-19 presents in patients with serious mental illness and what steps primary medical teams can take to co-manage these patients with the psychiatry consultants. Methods We present a retrospective chart review of four patients who were on psychotropic polypharmacy and admitted to our hospital from the same long-term psychiatric facility with COVID-19 delirium and other associated medical complications. Results We illustrate how the primary medical teams and psychiatrists collaborated in clinical diagnosis, treatment, and management. Conclusions Patients with serious mental illness and COVID-19 infection require active collaboration between primary medical teams and psychiatrists for diagnostic clarification, reduction of psychotropic polypharmacy to avoid adverse effects and drug-drug interactions, prevention of psychiatric decompensation, and active management of agitation while balancing staff and patient safety concerns.

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