Stent Fractures: New Insights into an Old Issue

Percutaneous coronary intervention (PCI) is a safe and effective procedure performed worldwide providing both symptom relief and sustained improved outcomes for millions of patients [...]

The Importance of Lamina Size Measurement and Proper Implants Selection before Laminoplasty : Two Case Reports

Open door laminoplasty using plates is a safe and effective procedure for multi-level cord compression. To achieve stable laminar arch, various types of plate have been developed and used. Now, we introduce two rare complications related to the laminar shelf of plate. In the first case, we used the wider laminar shelf plate because the elevated lamina did not fit well into the usual laminar shelf. During follow-up, cord compression due to laminar shelf was observed. And in the second case, the laminar shelf of plate did not fit into the elevated lamina, so we inserted it with a little bit of force. But the patient’s symptom was not improved. On CT image, the inner cortical bone of the lamina was fractured. To prevent these complications, surgeons need to consider the thickness of the lamina and the size of the laminar shelf before surgery.

O Glide Path na Endodontia Contemporânea: Revisão de Literatura / The Glide Path in Contemporary Endodontics: Literature Review

Por meio deste estudo é possível analisar que a instrumentação dos canais radiculares após o uso do Glide Path traz inúmeros benefícios, incluindo o melhor deslizamento dos instrumentos, redução do número de fraturas e menor intercorrências intrarradiculares. Além disso, essa preparação inicial do canal radicular com o uso do Glide Path realiza uma desobstrução, criando um “caminho” livre para o melhor deslize dos instrumentos no canal radicular. Os instrumentos possuem características e particularidades que levam ao mesmo objetivo de preparar o conduto para uma segura instrumentação, destaca-se aqui o WaveOne Gold, R-Pilot e o PathFile. É uma técnica que vem sendo difundida e utilizada na endodontia contemporânea com o intuito de realizar um procedimento eficaz.---Abstract: Analyze the use of instruments to prepare the Glide Path and understand how this endodontic instrument brought advantages in instrumentation techniques. This is a literature review with selected articles from the last 10 years, in order to achieve the objectives proposed by the theme. Articles in English and Portuguese were used, with all information pertinent to the topic extracted. Through this study, it is possible to analyze that the instrumentation of root canals after the use of the Glide Path brings numerous benefits, including better sliding of the instruments, reduction in the number of fractures and less intra-radicular complications. In addition, this initial preparation of the root canal using the Glide Path performs clearance, creating a clear “path” for the best glide of the instruments in the root canal. The instruments have characteristics and particularities that lead to the same objective of preparing the conduit for safe instrumentation, the Wave One Gold, R-Pilot and PathFile stand out here. It is a technique that has been disseminated and used in contemporary endodontics with the aim of performing an effective procedure. Through this bibliographical study, it is possible to consider that the use of the Glide Path favors the preparation of the root canal and proves to be effective and safe when used before instrumentation, thus, with the creation of a more favorable environment for instrumentation, the chances of success in endodontic treatment.

Multilevel percutaneous vertebroplasty: safety, efficacy and long-term outcomes

<p><strong>Background:</strong> The pain in vertebral compression fractures is severe, leading to reduced mobility and quality of life. Percutaneous vertebroplasty is a minimally invasive procedure for treating various spinal pathologies. This study evaluated the usefulness and safety of multilevel PVP (two to three vertebrae) in managing VCF.</p><p><strong>Methods:</strong> This retrospective study evaluated 59 vertebral levels in 28 patients with VCF who had been operated on for multilevel PVP (two to three levels). There were 22 females and six males, and their ages ranged from 36 to 79 years, with a mean age of 68.95 years. We had injected two levels in 25 patients and three levels in 3 patients. The visual analogue scale was used for pain intensity measurement, and plain X-ray films, computed tomography scan and magnetic resonance imaging was used for radiological assessment. The mean follow-up period was 13.8 months (range, 11-19).</p><p><strong>Results:</strong> Significant pain improvement was recorded in 26 patients (92.85%). More remarkable improvement in pain was noticed in the immediate postoperative period than in the subsequent follow-ups. Asymptomatic bone cement leakage anteriorly and into the disk spaces in two patients. Isolated anterior leakage has occurred in one patient. There was no encounter of pulmonary embolism.</p><p><strong>Conclusions:</strong> Multilevel PVP for the treatment of VCF is a safe and effective procedure that can significantly reduce pain and improve patient condition without any significant morbidity. It is considered a cost-effective procedure allowing a rapid restoration of patient mobility.</p><p> </p>

Correction of whistle deformity secondary to cleft lip repair by V-Y plasty: a simple and effective technique

Several techniques are available for the surgical repair of the cleft lip, however, avoiding secondary deformities and achieving consistent results remains a challenge. The whistle deformity is a secondary lip deformity characterised by inadequate fullness of the central upper lip with abnormal exposure of the central incisors when the lips are at rest, giving a whistling appearance. The causes include scarring of the vermilion and failure to restore the mucosal or muscular continuity. Various surgical options are available ranging from simple procedures like V-Y plasty and Z-plasty to complex procedures like complete lip redo, locoregional flaps, fillers and grafts. V-Y plasty is a simple, effective procedure for lip lengthening that can be performed under local anaesthesia as an outpatient procedure. It is less technique sensitive and also allows for some degree of muscle repair. We present a case of whistle deformity satisfactorily corrected with V-Y plasty.

Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure

<b><i>Introduction:</i></b> Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with an inexorably progressive course which leads to a progressive neuromuscular weakness. Weight loss is one of the major bad prognostic factors in ALS. The placement of percutaneous endoscopic gastrostomy (PEG) is of paramount importance in patients with dysphagia to improve the disease outcomes, although some fear exists regarding the possible ventilatory complications during the procedure. The aim of this study was to evaluate the safety and effectiveness of PEG tube insertion under non-invasive ventilation (NIV) in patients with ALS and severe ventilatory impairment. <b><i>Methods:</i></b> A retrospective study of all consecutive PEGs placed in our department from May 2011 to January 2018 in patients with ALS was performed. The procedure was performed under non-invasive positive-pressure ventilation for ventilatory support. <b><i>Results:</i></b> We included 59 patients with ALS with severe ventilatory impairment, 58% were female, with a mean age of 67.2 ± 10.1 years and a median follow-up of 6 [2–15] months. The main indication for PEG placement was dysphagia (98%). The median time for PEG tube insertion since the established diagnosis of ALS was 12 [6–25] months and 4 [2–18] months since the beginning of bulbar symptoms. The majority of the patients had placed a 20-Fr PEG (63%) and under mild sedation with midazolam (80%), all under NIV. There were no immediate complications during and after the procedure (no episodes of aspiration or orotracheal intubation) and mortality. <b><i>Conclusion:</i></b> The placement of PEG is a very important procedure in patients with ALS and severe ventilatory impairment. The interdisciplinary department collaboration permitted the placement of PEG under NIV, in a safe and effective procedure in this special population.

The W. Thurston algorithm applied to real polynomial maps

This note will describe an effective procedure for constructing critically finite real polynomial maps with specified combinatorics.