Effect of implant connection and restoration design (screwed vs. cemented) in reliability and failure modes of anterior crowns

The mechanical performance of cemented or screw-retained implant-supported crowns with an internal or external configuration is yet to be understood. This in vitro study evaluated the effect of screw-retained and cement-retained prostheses on internal and external implant-abutment connections. Thereby, the reliability and failure modes of crowns were investigated. Eighty-four implants (Emfils; Colosso Evolution system) were divided into four groups (n=21 each): screw-retained and internal connection (Si), screw-retained and external connection (Se), cement-retained and internal connection (Ci), and cement-retained and external connection (Ce). Ti-6Al-4V abutments were torqued (30 Ncm) to the implants, and maxillary central incisor metal crowns were torqued (30 Ncm) or cemented (Rely X Unicem; 3M-ESPE) and subjected to accelerated life-testing in water. Use-level probability Weibull curves and reliability for 50,000 cycles at 150 N were calculated. The β values for Si (1.72), Se (1.50), Ci (1.34), and Ce (1.77) groups indicated that fatigue/damage accumulation accelerated their failure. The Ci group presented the highest reliability, the Se group presented the lowest reliability, and Si and Ce groups presented intermediate reliability. Screw-retained restorations presented mainly abutment fracture. Cement-retained restorations resulted in failures of the screw in the Ce group, but implant/screw fracture in the Ci group.     

Association between prior alcohol use disorders and decreased prefrontal gray matter volumes in bipolar I disorder patients

Up to 50% of bipolar disorder (BD) patients present a lifetime diagnosis of alcohol use disorders (AUD). BD patients with comorbid AUD, even when in remission from the AUD, have a poorer outcome and functional impairment than patients with BD alone. The neurobiological abnormalities that potentially characterize this severe subgroup of BD patients are unknown. Our goal was to investigate gray matter (GM) volume abnormalities in BD I patients with comorbid AUD. Twenty-one BD-AUD patients, 21 BD-nonAUD BD patients, and 25 healthy controls (HC), matched by age, gender, and handedness were studied. The BD-AUD patients were in remission from AUD on average for 6.8 years. 3D SPGR MRIs (TR = 25 ms, TE = 5 ms, slice thickness = 1.5 mm) were acquired from all subjects using a 1.5 T GE Signa Imaging System. We used an optimized voxel-based morphometry protocol to compare GM volumes among the groups. BD-AUD patients presented smaller GM volumes in the left medial frontal and the right anterior cingulate gyri compared to BD-nonAUD patients. BDnon-AUD patients did not present GM volume differences compared to HC. These findings provide evidence for an effect of comorbid AUD on regional brain structure of BD I patients and warrant further research on neurobiological aspects of this prevalent and severe comorbidity.     

Calcineurin inhibitor-free immunosuppression in dual kidney transplantation from elderly donors

BACKGROUND: Kidneys from expanded-criteria donors may be particularly susceptible to calcineurin inhibitor (CI)-mediated vasoconstriction and nephrotoxicity. In the early post-transplant phase, using CI may prolong ischemic injury and, in the long term, chronic CI nephrotoxicity is an even greater concern. To avoid the acute and chronic consequences of CI in kidneys from marginal donors, CI-free protocols have been introduced for maintenance immunosuppressive therapy. A CI-free protocol of anti-thymocyte globulin (ATG) induction, sirolimus, mycophenolate mofetil (MMF) and steroids has been adopted at our center in recipients of dual kidney transplantation (DKT) from elderly donors (EDs). METHODS: Dual kidney transplantations performed since April 2003 on CI-free immunosuppression (group 1 = 31) were compared with earlier DKTs in recipients treated with CI-based therapy (group 2 = 25), retrospectively analyzing patient and graft survival, surgical and medical complications, rejection episodes and renal function. RESULTS: No deaths occurred after a mean follow-up of 10.1 +/- 7.6 (group 1) and 48.2 +/- 17.4 months (group 2). Graft loss occurred in one patient in group 1 (bilateral renal vein thrombosis) and in three patients in group 2 (one primary non-function [PNF], one chronic rejection, one Kaposi's sarcoma). The incidence of acute rejection was 19% in group 1 and 16% in group 2. Delayed graft function (DGF) was recorded in 16% and 48%, respectively. Renal function was better in group 1, with a mean S-Cr of 135 +/- 48 vs. 210 +/- 141 micromol/L at one month and 116 +/- 30 vs. 149 +/- 49 micromol/L at six months. CONCLUSIONS: After DKT from EDs, a CI-free immunosuppressive regimen including ATG induction, sirolimus, MMF and steroids affords excellent results, with a lower DGF rate and a better renal function.     

Surgical timing in bleeding liver adenoma: case report

The diagnosis of liver adenoma, which etiopathogenesis most often involves a prolonged assumption of estrogen (90% of adenomas occurs in women after more than 5 years of estrogen therapy), always imposes a surgical resection. The reason depend from neoplasia characteristics like the malignant evolution (4%) and the high risk of abdominal/intratumoral bleeding (30-50%), that increases during pregnancy and postpartum period. Regression of lesion after discontinuation of hormone therapy is rare and does not remove the degeneration and/or haemorrhagic risk. Liver resection should be performed with appropriate selective endovascular embolization, considering that an inept emergency surgery may impose a greater risk ot the liver, exposing the patient to major risk of morbidity and mortality. The correct timing from embolization to elective surgery is not yet standardized in the literature. The surgeon's personal experience and mainly a careful patient follow-up suggest the timing of surgery after embolization. The authors relate their own experience about the therapeutic strategy and surgical timing in a case of bleeding liver adenoma.     

Sentinel Lymph Node Detection and Evidence of Axillary Lymphatic Integrity After Transaxillary Breast Augmentation: A Prospective Study Using Lymphoscintography

Background  The transaxillary breast augmentation (TBA) technique has gained popularity because of several advantages. However, the impact of the procedure on breast lymphatic drainage and sentinel node (SN) detection remains controversial. The objective of this study was to evaluate the lymphatic patterns and SN detection rates after TBA by using lymphoscintigraphy (LSG). Methods  Twenty patients (40 breasts) who underwent TBA were evaluated by LSG immediately after periareolar injections of phytate-99 mTc at three time points: before TBA (Pre-LSG) and approximately 30 days (Recent-Post-LSG) and 6 months after TBA (Late-Post-LSG). Statistical analysis considered p < 0.05 significant, or p < 0.017 when Bonferroni correction was applied. Results  All breasts drained primarily to the axillary SN. The binomial test did not show statistical differences in lymphatic drainage patterns between Pre-LSG and Recent-Post-LSG (p = 1), Pre-LSG and Late-Post-LSG (p = 0.625), and Recent-Post-LSG and Late-Post-LSG (p = 0.625). The average number of hot SN was 1.28 in Pre-LSG, 1.10 in Recent-Post-LSG, and 1.23 in Late-Post-LSG, without significant differences (p = 0.202). The average time of the first SN appearance was not significantly different (p = 0.186). Analysis of SN uptake percentage showed a significant difference between Pre-LSG and Recent-Post-LSG (p = 0.009), with a reduction of drainage magnitude in Recent-Post-LSG. Conclusion  The preservation of axillary lymphatic drainage after TBA allowed for SN detection in all studied breasts. It seems that the applied surgical technique played an important role in axillary lymphatic integrity.     

Mastopexy After Massive Weight Loss: Extended Chest Wall–Based Flap Associated with a Loop of Pectoralis Muscle

Mammaplasty for patients who have experienced massive weight loss involves some concepts that differ from those that apply to mammaplasty for normal patients. Breast anatomic characteristics make this procedure a very challenging situation. The authors present their experience with a new mammaplasty technique using an extended thoracic wall flap associated with a loop of pectoralis. This procedure is a simple and reproducible method for patients with massive weight loss that results in a pleasing breast shape and long-lasting results.