CDIC 系统种植治疗的长期临床效果观察

目的 通过对9084 颗种植体的临床观察分析,评价CDIC 系统种植体植入效果.方法 收集1987 年6 月至2011 年6 月接受种植治疗的患者4215 例,随访观察3 ～18 年,观察分析患者年龄、性别、种植部位及方法,牙龈和牙周状况,X 线平片表现.结果 4108 例患者中男2319 例,女1789 例,年龄22 ～70 岁,平均42.5 岁.上下后牙区植入5021 颗种植体,上前牙区植入3374 颗种植体,下前牙区植入689 颗种植体.上颌窦内提升(经牙槽嵴顶冲顶上颌窦提升)同期种植796 例,组织引导再生植骨同期种植1863 例,早期失败15 颗,均为修复后咀嚼食物不慎致种植体松动,5 年无松动脱落,8 年脱落74 颗,10 年脱落72 颗.结论 CDIC 系统临床应用操作简便,植入效果良好,10 年存留率96.6%.     

Impaired myocardial SPECT imaging secondary to silicon- and saline-containing breast implants

Early detection of coronary artery disease (CAD) in women has been challenging. Women are more likely to present with atypical symptoms, and non-invasive evaluation for CAD has been less accurate. Myocardial SPECT imaging is a well-established technique that provides important physiologic, anatomic, and prognostic information in women. Attenuation artifacts secondary to breast tissue are a common problem in women and can lead to decreased specificity of gated SPECT imaging. Cosmetic breast implants are increasing in popularity. The presence of a foreign object overlying the anterior wall of the heart in addition to native breast tissue can significantly increase attenuation artifacts. There is only one report to date describing attenuation artifact due to silicon breast implants in comparison to control, and there are no reports regarding saline breast implants. Here we report three cases of impaired myocardial SPECT imaging in women with breast implants: one patient with silicone implants, and two with saline-containing implants. Clinicians should be aware of this problem and women should be educated regarding the potential future diagnostic problems that may occur with breast implants before considering this cosmetic surgery.     

1例牙种植体折断后取出并即刻再植术患者的护理

口腔种植修复近年来发展较迅速,临床应用广泛。但应用此种方法较为严重的并发症之一是种植体折断,本文通过总结1例牙种植体折断后取出并即刻再植术前中后的配合护理,针对患者个人情况制定个性化护理方案,取的良好效果,现报道如下。     

两种一段式骨内种植体的远期临床疗效观察

目的 评价两种一段式骨内种植体的的临床效果。方法 对90例108颗前牙应用CDIC纯钛一段式的叶状及螺纹状牙种植体进行常规植入修复．并对两种种植体的存留率进行了比较。结果经8年的临床观察，总成功率为83％，其中叶状种植体的成功率为82％（41／50），螺纹状牙种植体的成功率为84．4％（49／58）。两种种植体的存留率基本相等。结论CDIC纯钛两种一段式种植体在前牙种植中有较高的成功率，是一种有效的前牙缺失修复方法。     

Cementless fixation of radial head implants is affected by implant stem geometry: An in vitro study

Background

Metal radial head implants are widely used for the management of unreconstructible fractures. However, the effect of implant stem design on initial fixation and stability is unknown. This study determined the effects of radial head stem geometry on the initial stability of the uncemented implant. It was hypothesized that cortical contact and hence increased fixation would be achieved with an increased stem diameter, stem length and a tapered shape.

Methods

Eleven radii received five implants with differing stem geometries: short and long undersized, short and long optimally sized and short tapered. Inferiorly-directed compressive loads were applied successively to the anterior, posterior, medial and lateral edges of the implants. Maximum contralateral radial head “lift-off” was quantified by the distance between bone and implant surface markers.

Findings

The short and long undersized implants experienced greater micromotion with approximately 100 μm and 160 μm more lift-off respectively (P < 0.02). The remaining optimally sized and tapered implants averaged 50 μm. There was greater motion for the undersized implants loaded at the lateral position (P ? 0.005).

Interpretation

This study shows that filling the diameter of the medullary canal is more important than filling the length of the canal. The taper did not offer any additional advantages compared to the straight stem, suggesting that reaming of bone to accept the taper did not produce enhanced initial purchase. If rigid initial implant fixation is desired with an uncemented radial head implant, a canal-filling stem reduces initial implant micromotion to less than 50 μm which may enhance bone ingrowth.     

修复牙列缺损的种植体颈周组织的临床指征动态评价

目的：评价Frialit-2、IMZ和新一代好亦特种植体修复牙列缺损后其颈周的组织状况.材料和方法：101颗种植体在1998.3～2001.8间分别植入52名患者颌骨内,修复不同类型的牙列缺损.对种植体在功能负荷后3、6、12、24和36个月的周围组织健康指征进行了评价.结果：94.2%～100%的种植体颈部无牙石沉积,78.2%～79.2%的种植体颈周无明显的菌斑附着,88.5%～100%的牙龈和粘膜组织状况良好,没有炎症发生,94.2%～100%有种植体龈沟深度在3mm以内,绝大部分的种植体周边缘骨的变化较小,种植体负荷3年的累计留存率为95.9%.结论：绝大部分患者的种植体周围组织状况良好,这是达到较高累计留存率的关键.     

The subpectoral pacemaker implant: it isn't what it seems!

The traditional pulse generator implantation site lies subcutaneous on the fascia of the pectoralis major muscle. This article describes a subpectoral pocket approach, which on anatomic investigation is actually "intrapectoral" and offers a much improved cosmetic result with the potential advantage of less erosion. In the authors' experience with over 1000 initial pacemaker implants and pulse generator replacements, the potential concerns of neurovascular and muscular damage have not been realized. There has been no pulse generator damage from the ribs, serious loculated hematomas, or unusual postoperative or chronic pain. From experience with pulse generator recalls, the replacement procedure has not been significantly more difficult than with the subcutaneous approach. The intrapectoral approach has now become the authors' routine in patients without significant adipose tissue overlying the pectoralis major muscle.     

3D打印复合型种植导板在游离端牙缺失种植修复中的应用效果

目的探讨3D打印复合型种植导板在游离端牙缺失种植修复中的应用效果。方法选取2017年5月至2020年5月我院收治的58例游离端牙缺失患者作为研究对象,采用随机数字表法将其分为对照组和观察组,各29例。对照组采用传统种植导板,观察组采用3D打印复合型种植导板。比较两组种植体尖部及颈部的偏离值,美观、满意度及舒适度评分,并发症发生情况。结果观察组种植体尖部及颈部垂直向、颊舌向、近远中向的偏离值均小于对照组,差异具有统计学意义(P<0.05)。观察组美观、满意度及舒适度评分均高于对照组,差异具有统计学意义(P<0.05)。观察组并发症总发生率低于对照组,差异具有统计学意义(P<0.05)。结论3D打印复合型种植导板应用于游离端牙缺失种植修复中的效果较好,可减少种植体偏倚,提高患者满意度及舒适度,安全美观。     

Epicardial Implantation of the Automatic Implantable Defibrillator by Left Subcostal Tboracotomy

Le défibrillateur automatique implantable est un net progrés en ce qui concerne la therapeutique de certains patients présentanfs des tachycardies et/ou fibrillations ventriculaires. La technique initiale nécessitait la pose de deux éléctrodes transveineuses et d'une épicardique par thoracotomie gauche. Nous avons développé avec succés une approche purement épicardique à l'aide d'une thoracotomie sous costale gauche. L'expérience passée de l'implantation des pacemakers épicardiques par cette voie suggérait que celle ci serait bonne pour l'implantation du défibrillateur automatique. Les résultats initiaux nous encouragent à poursuivre son utilisation.     

Active-can implantable cardioverter defibrillator placement from a femoral approach

This report describes a case of an active-can ICD placed in the thigh. A 74-year-old man on chronic renal dialysis had no venous access from cephalic, subclavian, or jugular approaches. Using long active-fixation leads the device was placed from a femoral approach with good sensing, pacing, and defibrillation parameters.     

Transatrial Implantation of Transvenous Pacing Leads is an Alternative to Implantation of Epicardial Leads

BYRD, C.L.: Transatrial Implantation of Transvenous Pacing Leads as an Alternative to Implantation of Epicardial Leads. State-of-the-art pacing modalities are not readily utilized with conventional epicardial pacing lead implantation techniques. A transatrial implantation technique was developed combining a limited surgical approach with transvenous leads. Six patients who were poor candidates for transvenous implants have received DDD or DDDR pacemakers by this approach. The limited surgical approach includes resection of the third or fourth costal cartilage through a small skin incision, reflection of the pleura, and opening of the pericardium. The introducer and transvenous leads are inserted through a right atrial pursestring suture. The leads are positioned in the right ventricle and right atrium using standard fluoroscopic techniques. Through the incision, the subcutaneous tissue pocket is constructed on the right anterior chest wall. The leads are connected to the pacemaker without the need for adaptors or tunneling. There were no procedure-related complications. The magnitude of the surgery and postoperative morbidity are significantly less than for a standard thoracotomy, median sternotomy, and transdiaphragmatic epigastric or subcostal approach. The utility of the transatrial implantation technique is that it allows the use of state-of-the- art bipolar dual chamber pacemakers restoring access to all pacing modalities for those patients not candidates for transvenous implantation.     

Automatic segmentation of intra-cochlear anatomy in post-implantation CT of unilateral cochlear implant recipients

A cochlear implant (CI) is a neural prosthetic device that restores hearing by directly stimulating the auditory nerve using an electrode array that is implanted in the cochlea. In CI surgery, the surgeon accesses the cochlea and makes an opening where he/she inserts the electrode array blind to internal structures of the cochlea. Because of this, the final position of the electrode array relative to intra-cochlear anatomy is generally unknown. We have recently developed an approach for determining electrode array position relative to intra-cochlear anatomy using a pre- and a post-implantation CT. The approach is to segment the intra-cochlear anatomy in the pre-implantation CT, localize the electrodes in the post-implantation CT, and register the two CTs to determine relative electrode array position information. Currently, we are using this approach to develop a CI programming technique that uses patient-specific spatial information to create patient-customized sound processing strategies. However, this technique cannot be used for many CI users because it requires a pre-implantation CT that is not always acquired prior to implantation. In this study, we propose a method for automatic segmentation of intra-cochlear anatomy in post-implantation CT of unilateral recipients, thus eliminating the need for pre-implantation CTs in this population. The method is to segment the intra-cochlear anatomy in the implanted ear using information extracted from the normal contralateral ear and to exploit the intra-subject symmetry in cochlear anatomy across ears. To validate our method, we performed experiments on 30 ears for which both a pre- and a post-implantation CT are available. The mean and the maximum segmentation errors are 0.224 and 0.734 mm, respectively. These results indicate that our automatic segmentation method is accurate enough for developing patient-customized CI sound processing strategies for unilateral CI recipients using a post-implantation CT alone.     

Granulicatella adiacens breast implant-associated infection

The 1st reported case of breast implant-associated infection due to Granulicatella adiacens, formerly known as nutritionally variant streptococci, Streptococcus adiacens, and Abiotrophia adiacens is presented. Microbiology and previously reported cases of infections by this organism are reviewed.     

注射隆乳术后并发顽固性硬结的处理体会

目的：介绍一种处理聚丙烯酰胺水凝胶注射隆乳术后并发顽固性硬结伴有乳房形态异常的手术方法，阐述手术要点等。方法：采用乳晕、腋窝、及双环手术切口入路，剥离腔隙，彻底清胶后置入乳房假体。结果：采用手术切开清除水凝胶的同时置入乳房假体的方法，治疗已穿刺抽吸2次以上、乳房多发性硬结伴乳房形态异常者39例。术后无感染发生，均Ⅰ期愈合，效果满意。结论：对顽固性硬结伴乳房形态异常患者采用切开法清除水凝胶之后同时置入乳房假体，是一种彻底有效的方法，可避免2次手术之苦。     

同种异体冷冻干燥脱钙骨在脊柱侧凸中的应用

目的应用同种异体冷冻干燥脱钙骨植入特发性脊柱侧凸矫形内固定术病人,探讨特发性脊柱侧凸矫形术骨融合问题。方法32例特发性脊柱侧凸患者,Cabb氏角42°～76°,矫形内固定后在植骨区域去骨皮质形成粗糙面,椎板及关节突,横突处植入长条状同种异体冷冻干燥脱钙骨。结果32例病人术后9～18个月随访,摄X线片显示植骨区域骨痂生长,未见假关节形成,内固定拆除术后3个月摄X线片,2例病人回复脊柱侧凸12°。结论同种异体冷冻干燥脱钙骨与植入自体骨一样产生相同的成骨效应。     

内镜下经腋窝径路乳房假体置换术的初步探讨

目的探讨内镜辅助下经腋窝径路乳房假体取除与重置的方法及可行性。方法硅凝胶假体隆乳术后2例,聚丙烯酰胺水凝胶注射隆乳术后1例,符合乳房假体取除及重置的适应证,予腔镜下经腋窝切口游离进入胸大肌前(后)间隙,分离包膜取除假体材料,并重新植入硅凝胶乳房假体。结果手术均获成功。手术时间70￣200min,出血量均少于30mL,住院时间3d。无皮下或纵隔内气肿、血肿或感染及空气栓塞等并发症,随访18个月以上无假体移位或包膜挛缩。结论在熟练掌握腔镜微创外科技术的前提下,内镜下乳房假体置换术是安全可行的。     

Children With Hearing Impairment and Cochlear Implants

Cochlear implants are an effective option for children with hearing impairment. A multidisciplinary approach includes primary care recommendations and expectant management for a useful surgical intervention.     

Evaluation of the effects of thalidomide-loaded biodegradable devices in solid Ehrlich tumor

Regarding thalidomide's effects in cancer and the problems related to its physicochemical characteristics and toxic effects, we proposed a new biodegradable polymeric implant to this drug. In this paper, we evaluate the antiangiogenic activity and antitumor effect of thalidomide when incorporated in poly-lactide-co-glycolide (PLGA) implants in an animal model for Ehrlich tumor. This dosage form permits the prolonged drug release. The biodegradable implants could reduce the blood vessel in a chorioallantoic membrane (CAM) model. When applied to the Ehrlich tumor model, implant also showed to reduce the number of vessels. It was also observed to reduce areas of inflammation and increases the area of necrosis in the group of thalidomide implant. A 47% reduction in tumor volume was observed in the thalidomide implant group, which is discussed in relation to literature reported results of thalidomide conventional administration ways.     

即刻种植与早期种植对上颌前牙缺失患者软组织美学效果的影响比较

目的比较即刻种植与早期种植对上颌前牙缺失患者软组织美学效果的影响.方法选取2017年1月-2019年3月于我院接受上颌前牙缺失修复的74例患者作为研究对象,根据不同治疗方式分为2组,每组37例.对照组施行早期种植,观察组则施行即刻种植,比较两组修复治疗后患者满意度、红色美学指数评分(PES)、白色美学评分(WES)、牙槽骨稳定性.结果治疗后5个月,观察组满意度、PES评分、WES评分及骨吸收均高于对照组,差异有统计学意义(P<0.05).结论即刻种植与早期种植对上颌前牙缺失患者均有较好的修复效果,能保持较好的骨组织稳定性,但即刻种植软组织美学效果和白色美学更好,患者满意度相对更高.     

注射式隆乳术后哺乳期并发急性乳腺炎的临床护理

目的探讨注射式隆乳术后哺乳期急性乳腺炎的临床护理。方法对17例注射式隆乳术后哺乳期急性乳腺炎的患者局麻下在乳腺下皱襞外侧作切口,切开引流时给予生理盐水及双氧反复冲洗,同时留置引流管以彻底引流脓液,并作回奶治疗以减少乳汁分泌。结果患者均能积极配合治疗,住院治疗8～17d痊愈出院。结论术后重视观察病情变化和加强护理对治疗效果和患者康复起到重要的作用。