Major Technical Complications Research Articles

#926 Qatar's Assisted Home Hemodialysis Program (AHHD): a new challenge to reach better outcomes for elderly patients

Abstract Background and Aims There are a growing number of patients supported by dialysis in older age. In Qatar, 58% of haemodialysis patients are above 60 years. The dialysis care of these patients can be challenging due to frailty, chronic health conditions, diminished QOL, and function. One important reason to favor Assisted Home Haemodialysis (AHHD), especially in the older population is the greater flexibility in conducting dialysis sessions. Our aim is to assess the efficacy of AHHD program in comparison to in-center dialysis. Method This is retrospective study to evaluate AHHD program in Qatar between July 2021 to December 2023 and compare to in-center haemodialysis in complications, compliance, infectivity and cost. Results The AHHD population increased gradually to 122 patients in December 2023. Patients and families reported great satisfaction 98.9% with the AHHD experience as they reported less fatigue post dialysis, eliminated the burden of transportation, and improved quality of life by having HD provided in a home environment. AHHD patients had a significantly lower infection rate (5%) during the COVID-19 outbreak than those receiving in-center dialysis. AHHD freed up crucial slots in hemodialysis centers, increasing the availability of dialysis slots by 10%. Mortality rate was 20.6% while 5 % of patient returned back to in-center dialysis. No major clinical or technical complications had been reported during follow up. The program had resulted in 25% reduction in total cost mainly due to reduction in ambulance use. Conclusion AHHD service increases access to hemodialysis care for elderly patients. The AHHD in Qatar showed great success over 30 months and there was a remarkable increase in the number of patients who started the AHHD with better outcomes regard to QOL and infectivity. It was cost-effective and showed an obvious outcome of reducing ambulance transport utilization and improving patients’ QOL and satisfaction.

Evaluation of short and mid-term clinical outcomes in patients with aortic coarctation treated with self-expandable stents

The present study aimed to evaluate the outcomes of percutaneous treatment of aortic coarctation using self-expandable uncovered Nitinol stents. We conducted a retrospective clinical data review of all patients with aortic coarctation and treated with self-expandable uncovered Nitinol stents at our institution between 2009 and 2019. The gradient pressure across the coarctation site was measured using aortography. Follow-up echocardiography and computed tomography angiography were performed to assess possible stent complications. A total of 127 stents were successfully implanted in 125 patients (64.8% males) with a mean age of 35.36 ± 11.9 years. The gradient across the coarctation site decreased significantly from 67.48 ± 14.79 to 5.04 ± 3.01 mmHg (P < 0.001) after self-expandable stent implantation. Systolic blood pressure (SBP) decreased significantly from 175.53 ± 15.99 to 147.22 ± 12.83 mmHg (P < 0.001) after self-expandable stenting. There were no major technical or clinical complications, including balloon rupture, aneurysmal formation, infection, secondary stent migration, thrombosis, death during the procedure, and in-hospital mortality. On a mean follow-up of 48 ± 23.6 months (12–120 months), the gradient [from 59.43 ± 15.42 to 3.72 ± 1.38 mmHg (P < 0.001)] and SBP [from 175.53 ± 15.99 to 127.99 ± 7.82 mmHg (P < 0.001)] decreased significantly. There was no mortality, aneurysmal formation in the stent site, dislocation, or aortic re-stenosis requiring intervention during mid-term follow-up. Treatment of aortic coarctation using a self-expandable uncovered nitinol stent is safe and effective with promising mid-term outcomes.

A pilot feasibility study of an ultrasound-based tool to assess muscle mass in children with liver disease

Background: Sarcopenia is associated with adverse outcomes following liver transplantation, and at-risk children must be identified and prehabilitated. The gold standard for assessing sarcopenia in end-stage liver disease (ESLD) is CT assessment of the total Psoas Muscle Area (tPMA). However, radiation exposure and sedation requirements make this approach impractical for children. The bilateral anterior thigh thickness (BATT) is the cumulative measurement of the rectus femoris and vastus intermedius muscles by ultrasound and has been used to identify sarcopenia in adults. There are no studies assessing muscle mass in children using ultrasound. We hypothesized that measuring BATT with ultrasound in children with ESLD is feasible and is associated with sarcopenia. Methods: A prospective pilot feasibility study of patients with ESLD on the liver transplantation waitlist and age-matched healthy controls. BATT was measured by a single operator using ultrasound. tPMA indices were determined by CT imaging, along with clinical and anthropometric data. Results: Thirty children were studied between September 2021 and December 2022, 15 listed patients aged 4–30 months, and 15 controls aged 4–32 months. No major technical challenges or complications were encountered while performing the ultrasounds. Median BATTs of 30.8 mm (interquartile range: 27.9–32.8 mm) versus 32.7 mm (interquartile range: 31.8–36.9 mm) were demonstrated in the ESLD and control groups, respectively, and p = 0.01. A positive correlation (R = 0.603) was demonstrated between BATT and tPMA at the L4-5 level among patients with ESLD. No correlation was observed between BATT and anthropometrics. Conclusions: This study yields novel data on the feasibility of ultrasound to measure mid-thigh thickness in children with ESLD and suggests a correlation between BATT and tPMA, the gold standard for diagnosing sarcopenia. It sets the stage for ultrasound as a simple, noninvasive, and easily repeatable tool for assessing sarcopenia in children.

Outcomes and Complications of 33 Soft-Milled Cobalt-Chromium-Ceramic Full-Arch Screw-Retained Implant-Supported Prostheses: A Retrospective Study with up to 10-Year Follow-up

This retrospective study assessed outcomes and complications related to implants and prostheses in edentulous patients treated with soft-milled cobalt-chromium-ceramic full-arch screw-retained implant-supported prostheses (SCCSIPs). After the final prosthesis was delivered, patients participated in an annual dental check-up program, including clinical and radiographic assessments. Outcomes of implants and prostheses were evaluated, and biological and technical complications were categorized as major or minor. Implant and prosthesis cumulative survival rates were assessed using the life table analysis. A total of twenty-five participants (mean age 63.6 ± 7.3 years) with 33 SCCSIPs were observed for a mean of 68.9 ± 27.9 months (range 1-10 years). A total of 7 out of 245 implants were lost, with no effect on prosthesis survival, leading to cumulative survival rates of 97.1% for implants and 100% for prostheses. The most recurrent minor and major biological complications were soft tissue recession (9%) and late implant failure (2.8%). Among 25 technical complications, porcelain fracture was the only major technical complication, requiring prosthesis removal (1%). Porcelain chipping was the most frequent minor technical complication, affecting 21 crowns (5.4%), which required polishing only. At the end of the follow-up, 69.7% of the prostheses were free of technical complications. Within the limitations of this study, SCCSIP showed promising clinical performance after 1-10 years.

Retroperitoneal robot-assisted laparoscopic nephroureterectomy using the da Vinci Xi and SP systems: Initial experiences in cadaveric models.

To investigate the feasibility and optimal port placements of robot-assisted laparoscopic nephroureterectomy (RANU) via the retroperitoneal approach in the lateral decubitus and supine positions using the da Vinci Xi (DVXi) and da Vinci SP (DVSP) systems. We performed lateral decubitus extraperitoneal RANU on the right side and supine extraperitoneal RANU on the left side using the DVXi and DVSP systems without repositioning in two fresh cadavers. In addition, paracaval and pelvic lymphadenectomies were performed simultaneously during both surgical procedures. The operative time of each procedure was calculated, and the technical details associated with these procedures were evaluated. Lateral decubitus and supine extraperitoneal RANU using the DVXi and DVSP systems were achieved without repositioning. The surgeon console time ranged from 89 to 178 minutes, and no major technical complications were observed. However, carbon dioxide insufflation into the abdominal cavity was observed owing to a peritoneal breach during the creation of the surgical workspace, particularly in the supine position. Compared with the DVXi system, the DVSP system was more suitable for RANU using the retroperitoneal approach, except for renal handling. The DVXi and DVSP systems are feasible for performing lateral decubitus and supine extraperitoneal RANU without patient repositioning. The lateral decubitus position may be better than the supine position, and the DVSP system is more suitable for retroperitoneal RANU than the DVXi system. Nevertheless, further studies should be performed in clinical settings to validate our results.

It is all about peri-implant tissue health.

Healthy peri-implant tissues have become synonymous with implant success and a major challenge in contemporary implant dentistry. Numerous local and systemic factors, as well as iatrogenic and other hitherto underappreciated factors of potential clinical relevance may influence the outcome of implant therapy. In this volume of Periodontology 2000, a group of outstanding experts has elaborated on the latest insights on the prevention and management of major surgical, biological and technical complications, to facilitate the establishment and maintenance of peri-implant health. This volume focusses on factors affecting early and late implant loss and the potential role of systemic diseases and local conditions. It comprehensively discusses the implementation of guided implant surgery to facilitate the cleansibility of implant-supported restorations, as well as iatrogenic factors related to bone augmentation/sinus grafting procedures. The challenges associated with soft-tissue grafting and the prevention of esthetic complications are also reviewed as the paradigm of success in implant dentistry shifts from implant survival towards a greater focus on patient-reported outcomes. Prosthetic failures remain a significant challenge and are discussed in light of new evidence, as is the relevance of the structural dimensions of the peri-implant mucosa. The volume closes with detailed and well-illustrated appraisals of the surgical management of peri-implantitis, the management and sequelae of dental implant removal, and the latest evidence for the oral health related quality of life in patients treated with dental implants.

Survival and success rates of soft-milled cobalt-chromium-ceramic full-arch screw-retained implant-supported prostheses: a 2- to 7-year follow-up retrospective study.

To retrospectively assess implant and prosthesis survival and success and patient satisfaction in edentulous patients treated with soft-milled cobalt-chromium-ceramic full-arch screw-retained implant-supported prostheses (SCCSIPs) over a mean clinical follow-up period of 4years. Twenty-one edentulous patients, aged 47-80years, underwent restoration with 27 SCCSIPs (210 implants, 349 crown units). After definitive prosthesis insertion, patients participated in a yearly dental check-up recall program, including clinical and radiographic examinations. All supporting implants were examined for biological and technical complications, and the restorations were evaluated using modified California Dental Association (CDA) criteria. Life table and Kaplan-Meier survival analyses were performed. Patient satisfaction regarding chewing, esthetics, comfort, and phonetics was evaluated using a visual analog scale (VAS). After a mean of 4years, two implants (3.8%) failed, with no effect on prosthesis survival. The cumulative survival rate was 98.6% and 100% for implants and prostheses, respectively. The most frequent minor biological complication was soft tissue recession (11%). Porcelain fracture was the only major technical complication (0.6% of crown units), while the only minor technical complication was porcelain chipping (4% of crown units), which required only polishing. Overall, 66.7% of the prostheses were free of technical complications. Patient satisfaction was high to very high. Less satisfaction was noted with comfort due to soft tissue recession and food impaction. Within the limitations of this study, we conclude that the survival and success rates of SCCSIPs in edentulous patients were excellent. SCCSIPs should be considered when planning metal-ceramic implant-supported restorations.

A One-Year, Multicenter, Retrospective Evaluation of Narrow and Low-Profile Abutments Used to Rehabilitate Complete Edentulous Lower Arches: The OT Bridge Concept

Purpose: To evaluate preliminary data on survival and success rates of immediately loaded, screw-retained, restorations delivered on lower arches using narrow and low-profile OT Equator abutments. Methods: This retrospective study analyzed data of patients rehabilitated with OT Bridge (fixed prosthetic system built on OT Equator) prosthetic concept from November 2017 to February 2019 in five different centers. Outcome measures were implant and prosthetic survival rates, biological and technical complications, marginal bone loss (MBL), oral health impact profile (OHIP), bleeding on probing, and plaque index. Results: A total of 60 implants were inserted in 12 patients. Patients were followed for a mean period of 15.8 months (range 12–24). All the patients received OT Equator as intermediate abutments. Four out of 60 implants were connected to the prosthetic framework using only the Seeger system, without a screw. One year after loading, three implants failed (implant survival rate of 95.0%) in two patients. No prosthesis failed and no major biological and technical complications were experienced. One year after initial loading, the marginal bone level was 0.32 ± 0.2 mm. The OHIP before treatment was 87.7 ± 6.0. One year after treatment, OHIP was 23.6 ± 1.2. The difference was statistically significant (64.1 ± 7.2; p = 0.0000). One year after loading, 8.9% of the examined implant sites present positive bleeding on probing, while 5.8% of the implant sites presented plaque. Conclusions: The OT Equator abutments showed successful results when used to support mandible fixed dental prosthesis delivered on 4–6 implants. Whole prosthetic survival and success rates, high patient satisfaction, and good biological parameters were experienced one year after function. Further prospective studies are needed to confirm these preliminary results.

Comparison of major biological and technical complications between hybrid resin and zirconia FTI‐FDPs

Comparison of major biological and technical complications between hybrid resin and zirconia FTI‐FDPs

Technical Complications and Prosthesis Survival Rates with Implant-Supported Fixed Complete Dental Prostheses: A Retrospective Study with 1- to 12-Year Follow-Up.

To report the rate of technical complications and prosthesis survival in a cohort of edentulous patients treated with implant-supported fixed complete dental prostheses (IFCDPs) after a mean observation period of at least 1 year. The single-visit examination included clinical and radiographic assessment, occlusal analysis, photographs and questionnaire assessing patient satisfaction in a cohort of 52 patients rehabilitated with 71 IFCDPs (supported by 457 implants). The IFCDPs were assessed for technical complications, number of implants and cantilever extension, retention type and prosthetic material type. Comparison was made between ceramic IFCDPs (Group 1) and metal-resin IFCDPs (Group 2). Kaplan-Meier survival curve analysis was carried out for assessment of prosthesis survival and was done for both Groups 1 and 2 separately. The Cox proportional hazard model was used for survival analysis, adjusting for a number of potential confounders, to evaluate the association between prosthesis survival and several risk factors such as type of opposing occlusion, nightguard use, and presence of bruxism. Responses to patient satisfaction questions were compared with Fisher's exact test. Out of 71 edentulous arches (52 patients) restored with IFCDPs, 6 IFCDPs had failed, yielding a cumulative prosthesis survival rate of 91.6 % after a mean observation period of 5.2 years (range: 1-12 years) after definitive prosthesis insertion. Three IFCDPs were lost due to implant failures after 5.8 to 11 years of functional loading. Additionally, 3 metal-resin IFCDPs failed due to technical complications. Minor complications were the most frequent complications observed, namely wear of the prosthetic material (9.8% annual rate) being the most common, followed by decementation of cement-retained IFCDPs (2.9%), and loss of the screw access filing material of the screw-retained IFCDPs (2.7%). The most frequently observed major complication was fracture of the prosthetic material (1.9% annual rate), followed by fracture of occlusal screw (0.3%), and fracture of framework (0.3%). The annual rate of wear of prosthetic material was 7.3% for porcelain IFCDPs (n = 19/55) and 19.4% for metal-resin IFCDPs (n=13/16), yielding a statistically significant difference between the 2 groups (p = 0.01). After a mean exposure time of 5.2 years, 91.6% prosthesis survival rates were achieved (65 out of 71 IFCDPs). The most frequent minor technical complication was wear of the prosthetic material with estimated 5-year rate of 49.0%, while the most frequent major complication was fracture of the prosthetic material with estimated 5-year dental unit-based rate of 9.5%. The cumulative rates for "prosthesis free of minor complications" at 5- and 10-years were 60.5% (95% CI:47.2-71.3%) and 8.9% (95% CI:2.9-18.0%), respectively. The cumulative rates for "prosthesis free of major technical complications" at 5- and 10-years were 85.5% (95% CI:73.0-92.5%) and 30.1% (95% CI:12.0-50.6%), respectively. Presence of bruxism, and absence of a nightguard were associated with increased risk for chipping of the prosthetic material of the IFCDPs.

Complications and survival rates of 55 metal-ceramic implant-supported fixed complete-arch prostheses: A cohort study with mean 5-year follow-up

Statement of problemLong-term outcomes with metal-ceramic (MC) implant-supported fixed complete dental prostheses (IFCDPs) are scarce. PurposeThe purpose of this retrospective study was to assess the rate of biologic and technical complications in a cohort of edentulous patients treated with MC IFCDPs by residents after a mean clinical follow-up of 5 years (range: 1 to 12 years). Material and methodsForty-one participants with 55 MC IFCDPs underwent a single-visit comprehensive examination that included a medical and dental history review and clinical and radiographic examinations. All supporting implants and prostheses were examined for biologic and technical complications. Life table analysis and Kaplan-Meier survival curves were calculated. ResultsOf 359 moderately rough surface dental implants, 2 had failed in 1 patient after 11 years of functional loading, yielding a cumulative implant survival rate of 99.4%. Owing to the implant failure, 1 of 55 edentulous arches restored with IFCDPs failed, yielding a cumulative prosthesis survival rate of 98.2% after mean observation period of 5.0 years. Soft tissue recession was the most frequent minor biologic complication (annual rate 7.8% at the prosthesis level) for both cement and screw-retained IFCDPs (group C and S), and peri-implantitis (annual rate 1.6% at the implant level) the most frequent major biologic complication. Wear of porcelain (annual rate 8.0% at the prosthesis level) was the most frequent minor technical complication for both groups, and fracture of porcelain (annual rate 0.8% at the dental-unit level) was the most frequent major technical complication. Minor complications were the most frequent in both the groups (cement and screw retained). ConclusionsHigh implant and prosthesis survival rates (above 98%) were achieved, yet substantial complication rates were encountered. The most frequent major biologic complication was peri-implantitis, with a 5-year implant-based rate of 8% (95% confidence interval [CI]: 5.8-11.1), whereas the most frequent major complication was fracture of porcelain with a 5-year dental unit-based rate of 4%. The estimated cumulative rates for “prosthesis free of biologic complications” were 50.4% (95% CI: 36.4% to 63.0%) at 5 years and 10.1% (95% CI: 3.5% to 20.8%) at 10 years, whereas for “prosthesis free of technical complications,” they were 56.4% (95% CI: 41.7% to 68.8%) at 5 years and 9.8% (95% CI: 3.2% to 21.0%) at 10 years.

Double Full-Arch Fixed Implant-Supported Prostheses: Outcomes and Complications after a Mean Follow-Up of 5 Years.

To retrospectively assess complications and clinical and radiographic outcomes of edentulous patients treated with double full-arch implant-supported fixed complete dental prostheses (IFCDPs) after a mean observation period of 5.1 years. The single-visit clinical and radiographic examination included medical and dental history review and clinical assessment of biologic and technical complications encountered with all implants and IFCDPs. Life table analysis and Kaplan-Meier survival curves were calculated. Analysis was conducted to evaluate the association between prosthesis survival and several risk factors such as type of opposing occlusion, nightguard use, and presence of bruxism. Nineteen edentulous patients restored with 38 IFCDPs were included. A total of 249 implants were placed and 2 implants failed after a mean observation period of 5.1 years (range: 1-12 years), yielding an overall implant survival rate of 99.2% and prosthesis survival rate of 92.1%. Three out of 38 IFCDPs were lost, 1 after implant losses and 2 due to technical complications. The most frequent minor biologic complication was soft tissue recession with an estimated 5-year rate of 45.5% (95% CI: 39.4-57.5), while the most frequent major complication was peri-implantitis with an estimated 5-year implant-based rate of 9.5% (95% CI: 6.7-11.3). The most frequent minor technical complication was wear of the prosthetic material with an estimated 5-year rate of 49.0% (95% CI: 37.4-76.4), while the most frequent major technical complication was fracture of the prosthetic material with an estimated 5-year dental unit-based rate of 8.0% (95% CI: 6.6-10.1). After a mean use time of 5.1 years, high implant and prosthesis survival rates were observed. The most frequent major biologic complication was peri-implantitis, and the most frequent major technical complication was fracture of the prosthetic material. The 5-year estimated cumulative rates for "prosthesis free of biologic complications" was 50.7% (95% CI: 33.7-65.4) and for "prosthesis free of technical complications" was 57.1% (95% CI: 39.3-71.5).

Endovascular Management of Microcerebral Aneurysms with Diameter Smaller than 3 mm: Is It Feasible and Safe?

The neurosurgical management of microcerebral aneurysms with diameter smaller than 3 mm remains a great challenge as many complications can occur. Our target was to assess the efficacy and usefulness of endovascular treatment of these lesions. We did a prospective and retrospective gathering of the results of endovascular treatments for a group of 16 patients with 16 microcerebral aneurysms. Four patients were treated by direct coil embolization, and 12 patients were managed by remodeling techniques. Coil embolization was technically accessible in all cases. Initial complete occlusion is achieved in 12 patients. We did not face major technical complications such as aneurysmal rupture or coil migration during the endovascular management in 15 patients. Only in 1 case the second and last coil (2⁄1 mm) migrated distally and could not be retrieved. In this case clinical evidence of neurologic deterioration and weakness in left lower limb due to right anterior cerebral artery territory stroke was evidenced in the follow-up computed tomography scan. Follow-up clinical and radiological studies were available for 9 of 12 surviving patients and showed complete occlusion in 7 cases, and in 1 case aneurysm tiny recanalization was demonstrated after 1 year, which was retreated with complete occlusion, and in another case tiny aneurysm recanalization at the neck appeared after 2 years, which was left under observation. Endovascular treatment is a beneficial and effective therapeutic alternative to microsurgery for microaneurysms. The long-term assessment of endovascular management for these lesions was not included in that study.

A prospective, multi-center study assessing early loading with short implants in posterior regions. A 3-year post-loading follow-up study.

Few prospective studies about early loading of short implant have been available and very little evidence exists on the outcomes longer than 3 years. To assess clinical and radiographic outcomes of 6 mm-short implants placed in the posterior maxilla and mandible applying an early loading protocol. Ninety-five short implants (6 mm-short, Ø 4 mm) were placed in 45 subjects at 3 study sites, 2 or 3 implants per subject, using a one-stage surgical procedure and loaded with a screw-retained splinted fixed prosthesis 6 weeks later. Follow-up took place at 6, 12, 24, and 36 months after loading. Marginal bone level changes, implant survival, clinical variables, and adverse events were assessed. The survival rate for all implants placed was 95.8%. From implant loading to 3 years follow-up, mean marginal bone level changes were minimal (0.07 ± 0.49 mm) and the peri-implant soft tissue status was healthy. No major technical or biological complications occurred except for the 4 early implant losses. Three-year data indicates that the use of splinted 6 mm-short implants is a viable treatment in posterior regions with low marginal bone resorption. Early loading after 6 weeks should be taken cautiously in patients with known risk factors.

Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures \u2013 postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate

BackgroundIn treatment of unstable trochanteric fractures dynamic hip screw and Medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Different treatment protocols are used by two similar Swedish regional emergency care hospitals. Dynamic hip screw is used for fractures considered as stable within the respective treatment protocol, whereas one treatment protocol (Medoff sliding plate/dynamic hip screw) uses biaxial Medoff sliding plate for unstable pertrochanteric fractures and uniaxial Medoff sliding plate for subtrochanteric fractures, the second (intramedullary nail/dynamic hip screw) uses intramedullary nail for subtrochanteric fractures and for pertrochanteric fractures with intertrochanteric comminution or subtrochanteric extension. All orthopedic surgeries are registered in a regional database.MethodsAll consecutive trochanteric fracture operations during 2011–2012 (n = 856) and subsequent technical reoperations (n = 40) were derived from the database. Reoperations were analysed and classified into the categories adjustment (percutaneous removal of the locking screw of the Medoff sliding plate or the intramedullary nail, followed by fracture healing) or minor, intermediate (reosteosynthesis) or major (hip joint replacement, Girdlestone or persistent nonunion) technical complications.ResultsThe relative risk of intermediate or major technical complications was 4.2 (1.2–14) times higher in unstable pertrochanteric fractures and 4.6 (1.1–19) times higher in subtrochanteric fractures with treatment protocol: intramedullary nail/dynamic hip screw, compared to treatment protocol: Medoff sliding plate/dynamic hip screw. Overall rates of intermediate and major technical complications in unstable pertrochanteric and subtrochanteric fractures were with biaxial Medoff sliding plate 0.68%, with uniaxial Medoff sliding plate 1.4%, with dynamic hip screw 3.4% and with intramedullary nail 7.2%.ConclusionsThe treatment protocol based on use of biaxial Medoff sliding plate for unstable pertrochanteric and uniaxial Medoff sliding plate for subtrochanteric fractures reduced the risk of severe technical complications compared to using the treatment protocol based on dynamic hip screw and intramedullary nail.

Screw- vs. Cement-retained Implant-supported Prosthesis in Partially Edentulous Patients: An Oral Health Technology Assessment Report.

Understanding the morbidity events, incidence, and cost associated with each type of retention system used for implant supported prosthesis will help the clinician in better decision making. This study assessed the clinical and cost-effectiveness of the screw- and cement-retained implant-supported single crown and fixed partial denture for the replacement of teeth in partially edentulous jaws, from a health services perspective. A systematic literature search conducted in 10 databases, complemented by 4 journal databases and International Association for Dental Research abstracts, identified 92 studies on the single crown and 40 studies on the fixed partial denture. Minor and major technical complication events, as well as failure events, were extracted from strong- and medium-quality studies. Studies based on similar designs were pooled with a random-effects Poisson regression model. A decision tree was developed to estimate the cost-effectiveness over a 15-y period posttreatment. The initial and maintenance costs to treat technical complication events were based on an American Dental Association survey of 2011 to 2012. Probabilistic sensitivity analysis was used to examine the uncertainty in the data input parameters. Clinical evidence generated from the meta-analysis suggested no statistical difference between the 2 retention systems. The cost-effectiveness is presented as an incremental cost-effectiveness ratio. The evidence from this report suggests that cement retention is the more cost-effective strategy as compared with screw retention prosthesis. Knowledge Transfer Statement: Evidence generated by this study will help clinicians make an appropriate cost-effective treatment decision in choosing the retention system for partially edentulous patients.

Renal artery embolization in severe nephrotic syndrome.

Introduction Severe nephrotic syndrome is associated with increased morbidity and mortality. Renal artery embolization (RAE) has been used in a number of renal diseases such as renal tumors, arteriovenous fistulas etc. However, data regarding benefits of RAE in patients with symptomatic severe proteinuria is limited. We decided to evaluate role of RAE in the setting of severe symptomatic nephrotic syndrome. Methods Eight patients who had undergone transcatheter renal artery embolization with polyvinyl alcohol (PVA) were included. Clinico-demographic characteristics as well as baseline laboratory data including level of proteinuria, serum albumin, C-reactive protein and LDL cholesterol levels were recorded for each patient. After RAE, outpatient clinic control laboratory values were also assessed. Findings All patients except one underwent bilateral RAE (four simultaneous or three sequential). Two patients experienced postembolization syndrome characterized by flank pain, fever, and leukocytosis, which was self-limited and responded to analgesics in all patients. There was no technical complications associated with RAE procedure. All patients became anuric except one. Serum albumin levels increased and serum LDL-cholesterol levels decreased considerably in treated patients. Discussion Renal artery embolization with the purpose of amelioration in nephrotic syndrome complications was effective and free of major technical complications in our patients.

Endovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature

OBJECTIVE Internal carotid artery (ICA) injury is a rare but severe complication of endonasal surgery. The authors describe their endovascular experience managing ICA injuries after transsphenoidal surgery; they review and summarize the current literature regarding endovascular techniques; and they propose a treatment algorithm based on the available evidence. METHODS A retrospective review of 576 transsphenoidal pituitary adenoma resections was performed. Cases of ICA injury occurring at our institution and transfers from other hospitals were evaluated. Endovascular treatments for ICA injury reported in the literature were also reviewed and summarized. RESULTS Seven cases were identified from the institutional cohort (mean age 46.3 years, mean follow-up 43.4 months [1-107 months]) that received endovascular treatment for ICA injury. Five injuries occurred at our institution (5 [0.9%] of 576), and 2 injuries occurred at outside hospitals. Three patients underwent ICA sacrifice by coil placement, 2 underwent lesion embolization (coil or stent-assisted coil placement), and 2 underwent endoluminal reconstruction (both with flow diversion devices). Review of the literature identified 98 cases of ICA injury treated with endovascular methods. Of the 105 total cases, 46 patients underwent ICA sacrifice, 28 underwent lesion embolization, and 31 underwent endoluminal reconstruction. Sacrifice of the ICA proved a durable solution in all cases; however, the rate of persistent neurological complications was relatively high (10 [21.7%] of 46). Lesion embolization was primarily performed by coil embolization without stenting (16 cases) and stent-assisted coiling (9 cases). Both techniques had a relatively high rate of at least some technical complication (6 [37.5%] of 16 and 5 [55.6%] of 9, respectively) and major technical complications (i.e., injury, new neurological deficit, or ICA sacrifice) (5 [31.3%] of 16 and 2 [22.2%] of 9, respectively). Endoluminal reconstruction was performed by covered stent (24 cases) and flow diverter (5 cases) placement. Covered stents showed a reasonably high rate of technical complications (10 [41.7%] of 24); however, 8 of these problems were resolved, leaving a small percentage with major technical complications (2 [8.3%] of 24). Flow diverter placement was also well tolerated, with only 1 minor technical complication. CONCLUSIONS Endovascular treatments including vessel sacrifice, coil embolization (with or without stent assistance), and endoluminal reconstruction offer a tailored approach to ICA injury management after endonasal surgery. Vessel sacrifice remains the definitive treatment for acute, uncontrolled bleeding; however, vessel preservation techniques should be considered carefully in select patients. Multiple factors including vascular anatomy, injury characteristics, and risk of dual antiplatelet therapy should guide best treatment, but more study is needed (particularly with flow diverters) to refine this decision-making process. Ideally, all endovascular treatment options should be available at institutions performing endonasal surgery.

Balloon sinuplasty, an initial assessment: 10 cases, results and follow-up

AbstractIntroduction and aims: Balloon sinuplasty has been the object of recent discussions and papers. It is believed that the use of these tools can bring benefits, when compared with traditional endoscopic sinus surgery. Although there already are papers on the efficacy of this new instrument in the literature, there is no study in our country with a series of cases and follow-up of patients undergoing sinuplasty. Our study aims to review the information of 10 patients who underwent balloon sinuplasty, alone or in combination, discussing the indications, complementary therapy and follow up evaluation. Methodretrospective study. ResultsOf 10 patients, 6 were males and 4 females. Their ages ranged from 7 to 58 years. All patients had chronic rhinosinusitis without nasal polyps, of which 8 are associated with allergic disease. 3 patients underwent sinuplasty only, and 7 had other procedures done during the same procedure. Follow-up ranged from 2 to 7 months. Of the 10 patients, 9 showed symptoms improvement in imaging studies. Conclusionsinuplasty was successfully performed in all patients, without major technical difficulties or complications. This instrument can become an alternative surgical treatment for some groups of patients.

Prehospital utility of rapid stroke evaluation using in-ambulance telemedicine: a pilot feasibility study.

Prehospital evaluation using telemedicine may accelerate acute stroke treatment with tissue-type plasminogen activator. We explored the feasibility and reliability of using telemedicine in the field and ambulance to help evaluate acute stroke patients. Ten unique, scripted stroke scenarios, each conducted 4 times, were portrayed by trained actors retrieved and transported by Houston Fire Department emergency medical technicians to our stroke center. The vascular neurologists performed remote assessments in real time, obtaining clinical data points and National Institutes of Health (NIH) Stroke Scale, using the In-Touch RP-Xpress telemedicine device. Each scripted scenario was recorded for a subsequent evaluation by a second blinded vascular neurologist. Study feasibility was defined by the ability to conduct 80% of the sessions without major technological limitations. Reliability of video interpretation was defined by a 90% concordance between the data derived during the real-time sessions and those from the scripted scenarios. In 34 of 40 (85%) scenarios, the teleconsultation was conducted without major technical complication. The absolute agreement for intraclass correlation was 0.997 (95% confidence interval, 0.992-0.999) for the NIH Stroke Scale obtained during the real-time sessions and 0.993 (95% confidence interval, 0.975-0.999) for the recorded sessions. Inter-rater agreement using κ-statistics showed that for live-raters, 10 of 15 items on the NIH Stroke Scale showed excellent agreement and 5 of 15 showed moderate agreement. Matching of real-time assessments occurred for 88% (30/34) of NIH Stroke Scale scores by ±2 points and 96% of the clinical information. Mobile telemedicine is reliable and feasible in assessing actors simulating acute stroke in the prehospital setting.