Right coronary artery-pulmonary artery arteriovenous fistula secondary to open heart surgery

A patient is described who underwent atrial septal defect repair at age 12 and presented 16 years later with angina. Coronary angiography revealed a right coronary artery to pulmonary artery fistula that had developed at the site of the previous thoracotomy. This is the first report of an acquired fistula of this type developing secondary to trauma associated with open heart surgery. Diagnosis, shunt quantification and treatment are discussed.     

Desmoplastic fibroma of the maxilla

A case of desmoplastic fibroma of the right maxilla is reported. The lesion presented as a painless mass in the right posterior alveolar ridge of a 22-year-old white man. Histologically, the lesion was composed of interlacing fascicles of benign-appearing fibroblasts in a varying ground substance of collagenous and myxoid tissue. The lesion was not encapsulated histologically and was invading between bone trabeculae resulting in resorption of the bone. A review of the literature reveals that a total of 30 cases of desmoplastic fibroma of the jaws have been reported. All of the mandibular lesions except two were reported to have occurred in the left side, with the molar-ramus region favored. The case reported here is, to the best of our knowledge, the first reported case of desmoplastic fibroma occurring in the maxillary alveolar process.     

Creation of a 3-dimensional virtual dental patient for computer-guided surgery and CAD-CAM interim complete removable and fixed dental prostheses: A clinical report

This clinical report proposes a digital workflow using 2-dimensional (2D) digital photographs, a 3D extraoral facial scan, and cone beam computed tomography (CBCT) volumetric data to create a 3D virtual patient with craniofacial hard tissue, remaining dentition (including surrounding intraoral soft tissue), and the realistic appearance of facial soft tissue at an exaggerated smile under static conditions. The 3D virtual patient was used to assist the virtual diagnostic tooth arrangement process, providing patient with a pleasing preoperative virtual smile design that harmonized with facial features. The 3D virtual patient was also used to gain patient’s pretreatment approval (as a communication tool), design a prosthetically driven surgical plan for computer-guided implant surgery, and fabricate the computer-aided design and computer-aided manufacturing (CAD-CAM) interim prostheses.     

Proprietary hospitals in cost containment

Any effort to control the rise in health care costs must start with analyzing the causes, which are really quite simple. Most cost control efforts fail because they do not address the causes. The causes are large subsidies in several forms that send a false message that health care is free and should be used abundantly, and expansive reimbursement programs that reward inefficient providers with higher payments. This combination of demand stimulation and cost-plus reimbursement produced the world's most expensive health care delivery system and strident calls for reform. A long overdue change in public policy took effect October 1, 1983, when Medicare payments moved from cost-plus reimbursement to fixed, prospectively determined prices. Because it addressed one of the causes of medical inflation, this change has been effective in slowing the rise in Medicare expenditures. Sponsorship of a hospital is not a determinant of its cost-effectiveness. There are examples of efficient and inefficient hospitals in both the voluntary and the investor-owned or taxpaying hospitals. The determining factor is the will of management to keep costs under control.     

Desmoplastic melanoma of the anus

To date a desmoplastic melanoma, an unusual variant of malignant melanoma, has been described only in the skin. The present report describes a case of desmoplastic melanoma that arose in the anal canal. The patient was without evidence of recurrence or metastases 18 months after surgical removal of the lesion.