Oral health-related quality of life after prosthodontic treatment for patients with partial edentulism: A systematic review and meta-analysis

Statement of problem

Clinicians are currently unable to quantify the psychosocial, functional, and esthetic effects of prosthetic interventions to replace teeth. Understanding the effects of treatment to replace teeth on oral health-related quality of life (OHRQoL) is important for informed consent. A systematic review of the evidence of OHRQoL improvements with prosthodontic tooth replacement and a comparison of outcomes between treatment modalities is therefore indicated.

Complications following restorative proctocolectomy in children

Background

Adverse outcomes following restorative proctocolectomy (RPC) in adults have been attributed to steroid exposure and use of hand-sutured anastomoses. This study analyses complications in children undergoing RPC.

Methods

This study is a retrospective review of all children undergoing RPC in an English regional center over a 10-year period. The main outcome measure was defined as a complication within 30 days of surgery. Logistic regression analysis was used with possible explanatory variables (eg, steroid use, indication for surgery, weight and height z scores, hematologic indices, degree of blood loss, and use of laparoscopic surgery).

Results

Sixty (33 female) patients underwent RPC at a median age of 13.5 years. Of these, 16 had an operative complication and 17 had a late complication. Only severe acute colitis with inability to induce remission as an indication for surgery was significant in predicting operative complications (odds ratio, 6.8 [95% confidence interval, 1.2-37]; P = .03).

Conclusions

Severe acute colitis resistant to medical therapy but not steroid use or hand-sutured anastomoses appears to be a risk factor for complication. This differs from the adult experience.     

Female infertility following restorative proctocolectomy

Aim Females of child‐bearing age have been reported to have a two to three‐fold increase in infertility after restorative proctocolectomy (RPC). This study aimed to assess aspects of infertility and pregnancy. Method A postal questionnaire was sent to 790 females who had undergone primary RPC in two tertiary centres. Infertility, the number and outcome of pregnancies, delivery method and the use of fertility treatments were determined. Results Three hundred and six (38.5%) females responded (median age 47.9 years at follow up; 35.3 years at the time of RPC). Eighty‐two per cent (n = 250) had ulcerative colitis. Forty‐five per cent (n = 138) had conceived prior to RPC, 5.2% (n = 16) conceived both before and after RPC, 5.5% (n = 17) conceived after RPC only and 44.1% (n = 135) had never conceived. Females delivering before RPC had significantly more vaginal deliveries than those conceiving after (pre‐RPC 69.6%, n = 96 vs post‐RPC 35.3%, n = 6; P = 0.001). Fifty‐seven patients stated they had attempted to conceive after RPC, with 25 (45.5%) being successful. Eighteen females had been referred to a fertility specialist, of whom 16 received in vitro fertilization (IVF). Four (30.7%) females conceived using IVF. Conclusion While RPC is known to be associated with infertility, only a small proportion of patients are referred for fertility management. IVF outcomes and success rates after RPC are similar to the general population. Patients are more likely to have a Caesarean section following RPC.     

齿科常见修复材料微观结构与氧化锆磨损量之间的关系

【目的】通过体外实验,探讨齿科不同牙冠修复材料微观结构与氧化锆磨损量的关系。【方法】采用针-盘式二体磨耗机,以氧化锆为对磨物,电镜观察义获嘉陶瓷、低温水热陶瓷、纳米陶瓷和金钯合金4种牙科常用冠修复材料磨耗面的微观结构,以及称量测定氧化锆的质量损失。【结果】电镜下金钯合金磨耗面呈均质状结构,低温水热陶瓷磨耗后气孔少见,形状规则,无大的裂纹存在,纳米陶瓷磨耗后可见细小裂隙,偶见小气孔,形状规则,义获嘉陶磨耗面粗糙,可见磨损凹陷沟窝及细裂纹,形状不规则。氧化锆与各种材料对磨后质量损失由大到小分别为义获嘉陶瓷组、低温水热陶瓷组、纳米陶瓷组、金钯合金组,且各组间均有显著差异(P<0.05)。【结论】修复材料的微观结构是影响氧化锆耐磨性能的重要因素之一。     

Pouchitis

While restorative proctocolectomy with ileal pouch-anal anastomosis has significantly improved the quality of life in patients with underlying ulcerative colitis who require surgery, complications can occur. Pouchitis as the most common long-term complication represents a spectrum of disease processes ranging from acute, antibiotic- responsive type to chronic antibiotic-refractory entity. Accurate diagnosis using a combined assessment of symptoms, endoscopy and histology and the stratification of clinical phenotypes is important for treatment and prognosis the disease. The majority of patients respond favorably to antibiotic therapy. However, management of chronic antibiotic-refractory pouchitis remains a challenge.     

经尾路巨直肠及乙状结肠切除术在治疗肛门成形术后顽固性便秘中的应用

目的 探讨经尾路行巨直肠及乙状结肠切除术治疗肛门成形术后顽固性便秘的可行性。方法 患儿6例，年龄2～18岁，均为先天性肛门闭锁行会阴肛门成形术后合并顽固性便秘和充盈性大便失禁。钡灌肠示：直肠及乙状结肠高度扩张，蠕动差。6例患儿均经尾路切除直肠及远端乙状结肠，同时行肛门成形术。结果 平均手术时间205min(125min～265min)，切除扩张肠管长度23．3cm(10cm～40cm)。术后2月～4月后，6例患儿均可控制排便：12月～30月随访结果示：患儿便秘均消失。6例中4例患1度污便，另2例2度污便，无其他术后并发症。结论 尾路切除巨直肠及乙状结肠是治疗无肛术后顽固性便秘的有效方法。     

The Fate of the Ileal Pouch in Patients Developing Crohn’s Disease

PURPOSE Recent studies have suggested that a subset of patients with Crohns colitis may have a favorable outcome after ileal pouch-anal anastomosis and have advocated elective ileal pouch-anal anastomosis in selected patients with Crohns disease. We have not offered ileal pouch-anal anastomosis to patients with known Crohns disease, but because of the overlap in clinical presentation of ulcerative colitis and indeterminate colitis, some patients receiving an ileal pouch-anal anastomosis are subsequently found to have Crohns disease. We review our experience with these patients to identify potential preoperative predictors of ultimate pouch failure.METHODS Patients with a final diagnosis of Crohns disease were identified from an ileal pouch-anal anastomosis registry. These patients are followed prospectively. Preoperative and postoperative clinical and pathologic characteristics were evaluated as predictors of outcome. Median (range) values are listed.RESULTS Thirty-two (18 females) patients (4.1 percent) with a final diagnosis of Crohns disease were identified from a registry of 790 ileal pouch-anal anastomosis patients (1980–2002). Patients underwent ileal pouch-anal anastomosis in two stages (11 patients) or three stages (21 patients). The preoperative diagnosis was ulcerative colitis in 24 patients and indeterminate colitis in 8 patients. Median follow-up was 153 (range, 13–231) months. The median time from ileal pouch-anal anastomosis to diagnosis of Crohns disease was 19 (range, 0–188) months. Complications occurred in 93 percent, including perineal abscess/fistula (63 percent), pouchitis (50 percent), and anal stricture (38 percent). Pouch failure (excision or current diversion) occurred in nine patients (29 percent) at a median of 66 (range, 6–187) months. Two of these 9 patients had preoperative anal disease (not significant). Comparing patients with failed pouches (n = 9) to patients with functioning pouches (n = 23), post-ileal pouch-anal anastomosis perineal abscess (67 vs. 26 percent, P = 0.05) and pouch fistula (89 vs. 30 percent, P = 0.01) were more commonly associated with pouch failure. Preoperative clinical, endoscopic, and pathologic features were not predictive of pouch failure or patient outcome. For those with a functional pouch, 50 percent have been or are currently on medication to treat active Crohns disease. This group had six bowel movements in 24 (range, 3–10) hours, with leakage in 60 percent and pad usage in 45 percent.CONCLUSIONS Patients who undergo ileal pouch-anal anastomosis and are subsequently found to have Crohns disease experience significant morbidity. Preoperative characteristics, including the presence of anal disease, were not predictive of subsequent pouch failure. We choose not to recommend the routine application of ileal pouch-anal anastomosis in any subset of patients with known Crohns disease.Reprints are not available.     

Neuromodulation of lower limb motor control in restorative neurology

One consequence of central nervous system injury or disease is the impairment of neural control of movement, resulting in spasticity and paralysis. To enhance recovery, restorative neurology procedures modify altered, yet preserved nervous system function. This review focuses on functional electrical stimulation (FES) and spinal cord stimulation (SCS) that utilize remaining capabilities of the distal apparatus of spinal cord, peripheral nerves and muscles in upper motor neuron dysfunctions. FES for the immediate generation of lower limb movement along with current rehabilitative techniques is reviewed. The potential of SCS for controlling spinal spasticity and enhancing lower limb function in multiple sclerosis and spinal cord injury is discussed. The necessity for precise electrode placement and appropriate stimulation parameter settings to achieve therapeutic specificity is elaborated. This will lead to our human work of epidural and transcutaneous stimulation targeting the lumbar spinal cord for enhancing motor functions in spinal cord injured people, supplemented by pertinent human research of other investigators. We conclude that the concept of restorative neurology recently received new appreciation by accumulated evidence for locomotor circuits residing in the human spinal cord. Technological and clinical advancements need to follow for a major impact on the functional recovery in individuals with severe damage to their motor system.