Electrical Potentiometry with Intraoral Applications

Dental implants currently in use are mainly made of titanium or titanium alloys. As these metallic elements are immersed in an electrolytic medium, galvanic currents are produced between them or with other metals present in the mouth. These bimetallic currents have three potentially harmful effects on the patient: micro-discharges, corrosion, and finally, the dispersion of metal ions or their oxides, all of which have been extensively demonstrated in vitro. In this original work, a system for measuring the potentials generated in vivo is developed. Specifically, it is an electrogalvanic measurements system coupled with a periodontal probe that allows measurement of the potentials in the peri-implant sulcus. This device was tested and verified in vitro to guarantee its applicability in vivo. As a conclusion, this system is able to detect galvanic currents in vitro and it can be considered capable of being employed in vivo, so to assess the effects they may cause on dental implants.     

,Retrogades autologes Priming’ verhindert den Anstieg des extravasalen Lungenwassers während der extrakorporalen Zirkulation und verbessert den postoperativen Verlauf bei Patienten nach koronarer Bypassoperation

Zusammenfassung In einer prospektiven, randomisierten Studie sollte der Effekt eines reduzierten Füllvolumens (Priming) für die extrakorporale Zirkulation (EKZ) durch retrogrades autologes Priming (RAP) auf das Ausma? der postoperativen interstitiellen ?dembildung untersucht werden. 20 Patienten, die sich einer elektiven koronaren Bypassoperation unterzogen, wurden entweder einer Gruppe mit Standardpriming (SP, 1602±202ml kristalloide Vorfüllung, n=10) oder einer RAP-Gruppe (395±150ml) zugeordnet. RAP wurde vor Beginn der EKZ durch langsames Ersetzen der kristalloiden Vorfüllung der arteriellen und ven?sen Linien mit Patientenblut durchgeführt. Perioperativ wurden die kardiale und pulmonale Funktion, das extravasale Lungenwasser (EVLW), der plasma kolloidosmotische Druck (KOD), die kristalloide Flüssigkeitsbilanz sowie das K?rpergewicht der Patienten aufgezeichnet. Ergebnisse Hinsichtlich demographischer und operativer Parameter waren die Patienten gleicherma?en auf die Gruppen verteilt. Durch RAP konnte der Abfall des KOD w?hrend der EKZ von 54% in der SP-Gruppe auf 41% signifikant reduziert werden. 2 Std. nach Ende der EKZ war das EVLW im Vergleich zu pr?operativ in der Standard-Gruppe um 21% signifikant erh?ht, w?hrend es in der RAP-Gruppe im gleichen Zeitraum unver?ndert blieb. Die Bilanz der kristalloiden Flüssigkeiten von OP-Beginn bis EKZ-Ende waren in der RAP-Gruppe signifikant niedriger als in der SP-Gruppe (1857±521 gegenüber 28310±637ml). Zwei Tage postoperativ ergab sich für die Standard-Gruppe eine Zunahme des K?rpergewichts um 1,5±1,2kg (p<0,05), w?hrend das Gewicht in der RAP-Gruppe unver?ndert blieb (0,1±0,9kg). Auch die Dauer des station?ren Aufenthaltes war in der RAP-Gruppe signifikant kürzer als in der Standard-Gruppe. Schlussfolgerungen Durch RAP kann die ausgepr?gte H?modilution und der Abfall des KOD mit Beginn der EKZ vermindert werden. Dadurch kann das Ausma? interstitieller ?deme am Beispiel des EVLWs sowie die perioperative Gewichtszunahme signifikant gesenkt werden, was schlie?lich zu einem verkürzten Klinikaufenthalt der Patienten führte. Besonders günstig k?nnte sich RAP auf den postoperativen Verlauf bei Patienten mit eingeschr?nkten Organfunktionen auswirken. Eingegangen: 1. Oktober 2001 Akzeptiert: 3. Januar 2002     

Clinical outcome at ten years after laparoscopic fundoplication: Nissen versus Toupet

Laparoscopic surgery has become the elective approach for the surgical treatment of gastroesophageal reflux disease in the last decade. Outcome data beyond 10 years are available for open fundoplication, with good-to-excellent results, but few studies report long-term follow-up after laparoscopic fundoplication. We performed a retrospective study of all the patients that underwent laparoscopic Nissen and Toupet fundoplications as antireflux surgery between 1995 and 1998 in our institution. To evaluate the long-term results, a face-to-face interview was performed in 2009. One hundred and six patients were included in the study. Surgical techniques performed were Nissen fundoplication (NF) in 56 patients and Toupet (TF) in 50. Complication rate was 4 per cent in both groups (nonsignificant [NS]). Two patients (4%) of NF required reoperation because of dysphagia. After 10 years, 10 per cent of the patients remain symptomatic in both groups. Fifteen per cent of NF take daily inhibitors of the proton pump versus 14 per cent of TF (NS). Twenty per cent of NF refer dysphagia, all of them without evidence of stenosis at endoscopy or contrasted studies. The satisfaction rate of the patients was 96 per cent in NF and 98 per cent in TF. Laparoscopic Toupet fundoplication seems to be as safe and long-term effective as Nissen, but with a lower incidence of postoperative dysphagia. In our experience Toupet fundoplication should be the elective approach for the surgical treatment of gastroesophageal reflux disease.     

BioFoot in-shoe system: Normal values and assessment of the reliability and repeatability

BackgroundBioFoot^® is an in-shoe system to measure plantar pressures at the interface between the shoe and the sole of the foot. Since reliability and good repeatability are necessary to ensure the consistency of measurements on which clinical judgements are based, the aim of the study was to assess the reliability and repeatability of the BioFoot^® system and identify normal values for healthy subjects.Materials and methodsThirty subjects, 18 women and 12 men, were measured twice, with a 7–10 day interval between the sessions, wearing the same kind of shoes. In each session, three trials were recorded. The foot was divided into ten areas: heel, midfoot, whole forefoot, 1st–5th metatarsal heads, hallux, and lesser toes.ResultsThe intra-class correlation coefficients were between 0.76 and 0.96 for all four variables evaluated. The coefficient of variation between two sessions was around 7% (range: 4.6–9%). The mean contact time was 0.81 s, and walking cadence was 101.5 steps per minute. The pressure measurements showed the greatest peak and mean pressures under the second metatarsal head, and the second peak and mean pressures under the third metatarsal head.ConclusionThe plantar pressure measurements showed good to excellent consistency, and it was concluded that the BioFoot^® in-shoe system has good reliability and is repeatable. The highest values were found beneath the forefoot, which is consistent with the literature.     

Leveraging social capital: multilevel stigma,associated HIV vulnerabilities,and social resilience strategies among transgender women in Lima,Peru

Introduction : In Peru, transgender women (TW) experience unique vulnerabilities for HIV infection due to factors that limit access to, and quality of, HIV prevention, treatment and care services. Yet, despite recent advances in understanding factors associated with HIV vulnerability among TW globally, limited scholarship has examined how Peruvian TW cope with this reality and how existing community‐level resilience strategies are enacted despite pervasive social and economic exclusion facing the community. Addressing this need, our study applies the understanding of social capital as a social determinant of health and examines its relationship to HIV vulnerabilities to TW in Peru. Methods : Using qualitative methodology to provide an in‐depth portrait, we assessed (1) intersections between social marginalization, social capital and HIV vulnerabilities; and (2) community‐level resilience strategies employed by TW to buffer against social marginalization and to link to needed HIV‐related services in Peru. Between January and February 2015, 48 TW participated (mean age = 29, range = 18–44) in this study that included focus group discussions and demographic surveys. Analyses were guided by an immersion crystallization approach and all coding was conducted using Dedoose Version 6.1.18. Results : Themes associated with HIV vulnerability included experiences of multilevel stigma and limited occupational opportunities that placed TW at risk for, and limited their engagement with, existing HIV services. Emergent resiliency‐based strategies included peer‐to‐peer and intergenerational knowledge sharing, supportive clinical services (e.g. group‐based clinic attendance) and emotional support through social cohesion (i.e. feeling part of a community). Conclusion : This study highlights the importance of TW communities as support structures that create and deploy social resiliency‐based strategies aimed at deterring and mitigating the impact of social vulnerabilities to discrimination, marginalization and HIV risk for individual TW in Peru. Public health strategies seeking to provide HIV prevention, treatment and care for this population will benefit from recognizing existing social capital within TW communities and incorporating its strengths within HIV prevention interventions. At the intersection of HIV vulnerabilities and collective agency, dimensions of bridging and bonding social capital emerged as resiliency strategies used by TW to access needed healthcare services in Peru. Fostering TW solidarity and peer support are key components to ensure acceptability and sustainability of HIV prevention and promotion efforts.     

Real surgical morbidity and mortality after extrapleural pneumonectomy

As for other major thoracic operations the conventional 30-day morbidity and mortality marker may underestimate the actual surgical risk of extrapleural pneumonectomy. We retrospectively analysed the prolonged follow-up of 78 patients submitted to extrapleural pneumonectomy for pleural mesothelioma (55), lung cancer with associated carcinomatous (7) or purulent (8) pleuritis, empyema/destroyed lung (4), and mediastinal (2) and chest wall (2) tumours with pleuro-pulmonary involvement. Significant rates of surgery-related major complications (19%) and fatalities (6.6%) additionally occurred beyond 30 days and within 6 months of extrapleural pneumonectomy, making a 66% cumulative (early + late) morbidity rate and an 11.5% cumulative mortality rate, which are respectively 50% and 100% greater than the 30-day rate alone. The leading causes of late morbidity and mortality were respiratory/cardiac sequelae (50%) and broncho-pleural fistulas (30%). Strict preoperative functional selection and proper application of the technical learning curve can reduce the occurrence of the adverse events by anything up to 50% (early mortality: 2.3%). If the results of this novel study of long-term surgical outcomes of extrapleural pneumonectomy were to be confirmed, the preoperative risk/benefit balance of the procedure, mainly when performed for thoracic malignancies, should therefore include the entire spectrum of (early and late) potential surgery-related complications.     

Prognostic relevance of early AKI according to pRIFLE criteria in children undergoing cardiac surgery

Background

Acute renal injury increases risk of death after cardiac surgery. The objective of the study was to evaluate the ability of the pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria to characterize the development of postoperative renal damage in children after cardiopulmonary bypass (CPB) and to evaluate the relationship between the severity of kidney injury and mortality, pediatric intensive care unit (PICU) length of stay, and the duration of mechanical ventilation (MV).

Methods

In this retrospective study including children undergoing CPB surgery during a 3-year period in the PICU of a tertiary hospital, demographic, clinical, surgery-related, and postoperative clinical data were collected. Kidney damage was assessed with pRIFLE criteria.

Results

Four hundred and nine patients were included. Early acute kidney injury (AKI) was found in 82 patients (achieving categories Risk 44; Injury 16; Failure 22). Early AKI was associated with younger age (P?=?0.010), longer CPB, deep hypothermic circulatory arrest (DHCA) use, ICU stay >12 days, MV >4 days, and death (P?<?0.001). Controlling the effect of age, CPB, DHCA use, previous cardiac surgeries, and Risk Adjustment in Congenital Heart Surgery Surgical Severity Score (RACHS-1), early AKI development proved to predict ICU stay >12 days [odds ratio (OR) 3.5; 95 % confidence interval (CI) 1.9–6.5, P?<?0.001)] and need of MV >4 days (OR 5.1; 95 % CI 2.6–10.2, P?<?0.001).

Conclusions

Early AKI when evaluated with the pRIFLE criteria can predict prolonged ICU stay, need of prolonged MV, and mortality.     

Cardiovascular risk in obese diabetic patients is significantly reduced one year after gastric bypass compared to one year of diabetes support and education

Background

Roux-en-Y gastric bypass (RYGB) reduces most of the obesity-related comorbidities known to increase the cardiovascular risk in obese subjects. The Framingham risk score (FRS) is designed to be independent of body weight and estimates the 10-year risk for coronary heart disease (CHD), myocardial infarction, stroke, cardiovascular disease (CVD), death from CHD, and death from CVD. Our aim was to evaluate the effectiveness of RYGB on improving the FRS when compared to a matched control group who underwent diabetes support and education program (DSE).

Methods

In a prospective cohort study, we evaluated preoperatively and at 12 months, 61 morbidly obese subjects with diabetes. Thirty underwent laparoscopic RYGB, and 31 received 1 year of DSE, consisting of educational sessions on diet, nutrition, and exercise. Groups were matched for gender, age, weight, blood pressure, and cholesterol and triglyceride levels. Strict gender-specific FRS was used to assess the cardiovascular risk.

Results

Excess weight-loss percentages (%EWL) were 55.6 ± 15.1 in the RYGB group and 1.2 ± 10.8 in the DSE group (P < 0.001). The two groups were matched for baseline FRS. RYGB patients experienced a significant decrease in all FRS, whereas control subjects did not show a significant decrease for the 10-year risk for CHD, CVD and death from CVD. The between-group differences for changes from baseline to 12 months in all FRS were significant. The 10-year risk reductions for CHD, MI, stroke, CVD, death from CHD, and death from CVD in the RYGB group relative to the DSE group were, respectively, 42, 48, 30, 39, 50, and 50 %. No correlations between reduction in FRS and %EWL were found after RYGB.

Conclusions

A significant improvement in the 10 year estimated cardiovascular risk is observed in patients undergoing RYGB, but not in those who were offered usual medical therapy plus DSE. However, the effects of RYGB on FRS are independent of weight loss.     

Diabetes is associated with an increased risk of wound complications and readmission in patients with surgically managed pressure ulcers

The effect of diabetes on postoperative outcomes following surgical management of pressure ulcers is poorly defined despite evidence showing that patients with diabetes are at increased risk for developing pressure ulcers, as well as postoperative wound complications including delayed healing and infection. This study aimed to examine the impact of diabetes on postoperative outcomes following surgical management of pressure ulcers using the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP) database. In this retrospective analysis all CPT codes with ICD‐9 diagnoses of pressure ulcers were reviewed. A total of 3,274 patients who underwent surgical management of pressure ulcers were identified, of which 1,040 (31.8%) had diabetes. Overall primary outcomes showed rates of superficial and deep incisional surgical site infection (SSI) were 2.0 and 4.2%, respectively, while the rate of wound dehiscence was 2.1%. Univariate analysis of primary outcomes stratified by diabetes status showed that patients with diabetes had significantly higher rates of superficial incisional SSI (3.9 vs. 2.3%; p = 0.01), deep incisional SSI (7.0 vs. 4.3%; p = 0.001), wound dehiscence (5.2 vs. 2.7%; p < 0.001), as well as significantly higher rates of readmission (12.8 vs. 8.9%; p = 0.001). Multivariate analysis for significant outcomes between groups on univariate analysis demonstrated that diabetes was an independent risk factor for superficial incisional SSI (OR = 2.7; 95% CI: 1.59–4.62; p < 0.001), deep incisional SSI (OR = 1.85; 95% CI: 1.26–2.70; p = 0.002), wound dehiscence (OR = 4.09; 95% CI: 2.49–6.74; p < 0.001), and readmission within 30 days (OR = 1.38; 95% CI: 1.05–1.82; p = 0.02). These findings emphasize the importance of preoperative prevention, and vigilant postoperative wound care and monitoring in patients with diabetes to minimize morbidity and optimize outcomes. Future prospective studies are needed to establish causality between diabetes and these outcomes.