TEN YEARS' EXPERIENCE IN LOW VISION PRACTICE

The Low Vision Clinic at the Palmerston North Hospital has now been oerating for 70 years. Over the course of these ten years a number of factors have emerged which can be as readily applied to general ophthalmological practice as to low vision practice. The philosophy of low vision care is one of which all ophthalmologists should be aware and includes factors to be taken into account when dealing with children, people in the workplace, and everyday factors involved in daily living activities, all of which are equally relevant in routine ophthalmological practice. This paper endeavours to share some thoughts on these factors and also discusses means by which the visually handicapped can be helped in areas where specialist low vision services are not readily available.     

利用阻生智齿预备钛金属冠改善下颌义齿固位的应用观察

目的:利用阻生智齿增加下颌单颌总义齿固位力。方法:通过手术暴露下颌阻生智齿,在智齿冠上预备牙体,制作钛金属套冠将阻生齿牙冠形态转移至口腔中,从而把固位力不足的下颌单颌总义齿修复,转变成有正常基牙固位的可摘局部义齿修复。结果:通过3例利用埋伏阻生智齿接钛金属套冠,对下颌牙槽嵴严重吸患者的可摘局部义齿修复,经2～3年的临床观察,钛套冠固定良好,无松动,牙龈正常。可摘局部义齿固位良好。结论:利用埋伏阻生智齿接钛金属套冠,加强下颌牙槽嵴严重吸收可摘局部义齿固位力的效果明显。     

Clinical outcomes of three Parkinson's disease patients treated with mandibular implant overdentures

Parkinson's disease (PD) often affects the oro-pharyngeal musculature, leading to problems with speaking, chewing and swallowing. The inevitable reduction in food and fluid intake contributes to the further deterioration of neurological symptoms. Parkinson's disease patients have great difficulties in adjusting to the use of complete dentures. It is the purpose of this report to evaluate the benefit of using dental implants combined with overdentures to improve chewing and predigestion capacity in severely handicapped PD patients. Three edentulous PD patients (2 male, 1 female; mean age 75.7 years; mean PD duration 4.3 years; PD severity grade III according to Hoehn and Yahr; mean edentulousness 19.3 years) complaining of poor chewing ability were included in this evaluation. One-stage dental implants were placed in the interforaminal region of the mandible. After completion of healing, new overdentures were fabricated. Custom-made non-rigid (resilient) telescopic attachments were used for retention of the overdentures on the implants. Follow-up examinations of the 3 patients were made between 28 and 42 months after the completion of treatment, and peri-implant tissue conditions as well as the patients' self-assessed satisfaction level were recorded. A modified gastrointestinal symptoms questionnaire, Hoehn and Yahr Scale and body weight measurements were used to monitor gastrointestinal impairment and PD severity. The peri-implant parameters indicated healthy soft tissue conditions and all Periotest values were in the negative range. The patients judged their chewing abilities to be greatly improved. Since placing the implants, PD severity had deteriorated to grade IV (Hoehn and Yahr scale) in 2 patients and was stable in 1 patient. The body weight had improved slightly in all patients (mean 2.2 kg). On the gastrointestinal scale, all patients had improved from a mean score of 8.7 to 5.7. Non-rigid telescopic attachments for overdenture stabilization are particularly suitable for PD patients as they are easy to handle and to clean. The patients reported remarkable improvement in their chewing ability, an assessment which would seem to be supported by the improved gastro-intestinal index. The regimen described appears to be a useful adjunctive treatment in edentulous Parkinson's disease patients and may be considered for patients with diseases similarly affecting motor skills.     

不同外冠材料套筒冠固位力的比较研究

目的 探讨两种外冠材料对套筒冠固位力的影响. 方法 在标准代型上制作全瓷内冠,外冠分别采用钴铬合金和纯钛制作,经循环摘戴后测试其固位力值.使用SPSS13.0软件包对数据进行￡检验. 结果 纯钛外冠组固位力大于钴铬合金外冠组,差异具有显著性(P＜0.05). 结论 外冠材料性能与套筒冠固位力相关,纯钛外冠更能提供长期持久的固位力.     

Experimental examination of the healing process of telescopic esophageal anastomosis

The basis of telescopic anastomosis is old, only the practical details of it have changed and improved. The telescopic anastomosis technique is successfully applied in our practice for reconstruction of gastrectomy and esophageal resection. The reason for this study was that data about the healing process of telescopic anastomosis had not been found in the literature. We used four groups of mongrel dogs for our experiments: Group A (n = 3) received 20 mm-long invaginations with a survival time of 7 days; Group B (n = 3) received 10 mm-long invaginations with a survival time of 21 days; Group C (n = 3) received 20 mm-long invaginations with a survival time of 21 days; Group D (n = 3) received 30 mm-long invaginations with a survival time of 21 days. At the end of the above survival times we removed the anastomosing area, measured the bursting pressures and performed morphological and histological examinations. In each case we also performed an anastomosis exactly the same as a completely healed anastomosis and its pressure tolerance was measured (0 day). The pressure tolerance within the anastomosis rises gradually and independently of the length of the invaginated esophageal part. Anastomosis leakage did not occur. The invaginated esophageal part did not suffer any damage. The muscular wall of the intragastric part of the esophagus became covered by the mucosa of the stomach during the healing process and it joined with the esophageal mucosa at the edge of the free end of the esophagus.     

Telescopic esophageal anastomosis: operative technique, clinical experiences

The authors reconstructed the continuity of the alimentary tract by performing telescopic esophagogastrostoma in 208 patients who underwent either esophageal resection or total gastrectomy. The substance of the telescopic technique is to invaginate the distal section of any oral tubular organ to the lumen of an aboral tubular one and to fix it there. In case of telescopic esophageal anastomosis a 10-15 mm long esophageal segment is invaginated into the gastric tube or jejunum. A 3-4 mm wide serosal surface of the wall of the distal anastomosing organ straps the esophagus circularly. Ninety-six transthoracic and 12 transhiatal esophagectomies, 19 partial esophageal resections, four esophageal bypasses, and 77 total or extended total gastrectomies were reconstructed using telescopic anastomosis. Undisturbed healing could be observed in 67 patients after esophageal operations and in 46 patients of total gastrectomies. Anastomosis leakage occurred in 12 of 108 patients (11.1%) after cervical esophagogastrostomy. Leakage could be observed in 7 of 44 patients (15.9%) after end to side and in 5 of 64 patients (7.8%) in case of end to end esophago gastrostoma. There were no failures after two cases of cervical esophago-ileocolostoma and 21 of esophagogastrostomas in the thoracic position. All of the 59 intra-abdominal anastomoses healed without complication. Thirteen of 131 patients (9.9%) died after esophageal operations and four of 77 (5.2%) after gastrectomies. There were no mortal complications due to anastomotic leakage. The telescopic anastomosis is a safe alternative method in cases of total gastrectomy or esophageal operation.     

Unusual explanation for the death of a car passenger

After collision of a car with the left rearside against a steel mast the 19-year-old front seat passenger was found comatose on the seat. CT imaging showed a depression fracture parietal on the left with an intracerebral haemorrhage on the opposite side. The cause of the injury was unknown to the surgeons at the time of operation. Despite neurosurgical intervention the patient died 24 h after the accident. The post-mortem showed an additional depression fracture at the base of the skull in the right temporal region arousing suspicion of an impalement injury. Only inspection of the car by the forensic pathologists revealed the gas pressure telescopic shock absorber to be the cause of the head injury. Received: 20 January 1997 / Received in revised form: 23 July 1997     

Telescopic suction tube for microsurgery

Summary An adjustable telescopic suction tube has been developed for microsurgery. Owing to this innovation, the surgeon can easily set the suction tube to a suitable length by gently pulling the end of the telescopic tube out or in.     

固定-可摘联合义齿修复牙周病伴牙列缺损的临床观察

目的：采用固定-可摘联合义齿修复治疗牙周病伴牙列缺损患者,观察其临床效果。方法收集10例患牙周炎并伴牙列缺损病例,经牙体、牙髓、牙周治疗完善后,牙周病得到控制进入稳定期,根据患者情况选择合适的固定-可摘联合修复方法。本组采用6例附着体义齿,3例套筒冠义齿,1例附着体与套筒冠联合修复。结果10例患者在6～12个月后复诊,对义齿的咀嚼功能及美观舒适度均表示满意。检查基牙无疼痛,松动度减轻,X线示牙槽骨高度较修复前未见明显变化。结论应用固定-可摘联合修复方法治疗牙周病伴牙列缺损具有良好的临床效果。