Second-stage Surgery Research Articles

Improving Outcomes for Infants with Single Ventricle Physiology through Standardized Feeding during the Interstage.

Congenital heart disease is identified as the most common birth defect with single ventricle physiology carrying the highest mortality. Staged surgical palliation is required for treatment, with mortality historically as high as 22% in the four- to six-month period from the first- to second-stage surgical palliation, known as the interstage. A standardized postoperative feeding approach was implemented through an evidence-based protocol, parent engagement, and interprofessional team rounds. Five infants with single ventricle physiology preprotocol were compared with five infants who received the standardized feeding approach. Mann-Whitney U tests were conducted to evaluate the hypotheses that infants in the intervention condition would consume more calories and have a positive change in weight-to-age z-score (WAZ) and shorter length of stay (LOS) following the first and second surgeries compared to infants in the control condition. After the protocol, the change in WAZ during the interstage increased by virtually one standard deviation from 0.05 to 0.91. Median LOS dropped 32% after the first surgery and 43% after the second surgery. Since first- and second-stage palliative surgeries occur within the same year of life, this represents savings of $500,000 to $800,000 per year in a 10-infant model. The standardized feeding approach improved growth in single ventricle infants while concurrently lowering hospital costs.

Single Posterior Approach for En-Bloc Resection and Stabilization for Locally Advanced Pancoast Tumors Involving the Spine: Single Centre Experience.

Study DesignMonocentric prospective study.PurposeTo assess the safety and effectiveness of the posterior approach for resection of advanced Pancoast tumors.Overview of LiteratureIn patients with advanced Pancoast tumors invading the spine, most surgical teams consider the combined approach to be necessary for “en-bloc” resection to control visceral, vascular, and neurological structures. We report our preliminary experience with a single-stage posterior approach.MethodsWe included all patients who underwent posterior en-bloc resection of advanced Pancoast tumors invading the spine in our institution between January 2014 and May 2015. All patients had locally advanced tumors without N2 nodes or distant metastases. All patients, except 1, benefited from induction treatment consisting of a combination of concomitant chemotherapy (cisplatin-VP16) and radiation.ResultsFive patients were included in this study. There were 2 men and 3 women with a mean age of 55 years (range, 46–61 years). The tumor involved 2 adjacent levels in 1 patient, 3 levels in 1 patient, and 4 levels in 3 patients. There were no intraoperative complications. The mean operative time was 9 hours (range, 8–12 hours), and the mean estimated blood loss was 3.2 L (range, 1.5–7 L). No patient had a worsened neurological condition at discharge. Four complications occurred in 4 patients. Three complications required reoperation and none was lethal. The mean follow-up was 15.5 months (range, 9–24 months). Four patients harbored microscopically negative margins (R0 resection) and remained disease free. One patient harbored a microscopically positive margin (R1 resection) and exhibited local recurrence at 8 months following radiation treatment.ConclusionsThe posterior approach was a valuable option that avoided the need for a second-stage operation. Induction chemoradiation is highly suitable for limiting the risk of local recurrence.

Complex Anterior Skullbase Fracture Caused by a Bottle Cap: A Case Report and Review of the Literature

We report a case of foreign body presence in the ethmoid sinus cavity with anterior skull base fracture and visual loss. A 42-year-old male had an uncertain history of trauma and a penetrating wound near the left medial canthus. Computed tomography imaging showed a 3.0-cm bottle cap penetrating into the anterior skull base. He underwent foreign body removal, canalicular repair, ethmoidectomy, and cerebrospinal fluid leakage repair using packing material. Six months after the initial surgery, a second-stage operation for blow-out fracture repair was performed. At the 18-month postoperative follow-up from the initial surgery, the patient had no complaints except anosmia. This is a very rare case of a large, blunt, foreign body penetrating into the anterior skull base without long-term complications after successful removal and skull base repair. Simultaneous repair of cerebrospinal fluid leakage, management of canaliculi injury, and traumatic optic nerve neuropathy should be considered in such cases.

Two-stage posterior correction in the treatment of severe rigid neuromuscular scoliosis: Case report

Background: Treatment of severe rigid scoliosis is challenging. Traditional methods such as combined anterior and posterior surgery with or without perioperative halo-gravity traction, or more aggressive one-stage posterior correction methods carry many drawbacks and potential risks. To overcome this, a staged posterior approach was raised. We report a patient successfully treated with this new method. Case Report: A 15-year-old boy was diagnosed to have neuromuscular scoliosis of unknown origin. The Cobb angle was 110 degrees at T9- L4, and 77 degrees at T2- T9. The preoperative pelvic tilt was 16 degrees. Bending views showed the flexibility about 10%. Two-stage correction was performed. The major curve magnitude reduced 40 degrees or 36.3% after the first-stage surgery, and 25 degrees or 35.7% after the second-stage surgery. The final correction rate was 59.1%. The postoperative pelvic tilt reduced to 6 degrees. No complication such as infection, neurological injury or respiratory compromise was found. Discussion: This two-stage approach has many advantages, including preventing pulmonary function deterioration, no need of halo traction, avoiding too much manipulation of the spinal cord during each surgery, and facilitating curve correction. However, we should also take into consideration of its large blood loss, nutritional demand and potential risk of infection. Conclusion: Two-stage posterior correction is a reasonable and suitable alternative correction strategy in the treatment of severe rigid scoliosis. However, further study is needed to verify its validity and safety.

Should well-fixed uncemented femoral components be revised in infected hip arthroplasty? Report of five trial cases

BackgroundWell-fixed femoral component removal remains difficult and complicated. MethodsWe report herein the outcomes of two-stage surgery involving retention of bone-ingrown uncemented stems, aggressive soft-tissue debridement, and delayed reimplantation of an acetabular component in 5 patients for infected hip arthroplasty. ResultsBy a mean follow-up point of 4.2 years after the second-stage operation, none of the 5 patients experienced recurrence of infection, and the mean Harris hip score had improved from 63 to 86 points by the latest follow-up evaluation. ConclusionTwo-stage revision with retention of well-fixed uncemented stems could be an alternative treatment option in hip periprosthetic infection.

Interaction of titanium, zirconia and lithium disilicate with peri-implant soft tissue: study protocol for a randomized controlled trial.

BackgroundAgainst the background of increasing use of dental implants, and thus an increasing prevalence of implant-associated complications, a deeper understanding of the biomolecular mechanisms in the peri-implant tissue is needed. Peri-implant soft tissue is in direct contact with transmucosal dental implant abutments. The aim of this trial is to distinguish the biomolecular and histological interactions of various dental abutment materials with peri-implant soft tissue.Methods/DesignThe study is designed as a prospective, randomized, investigator-initiated clinical pilot trial with blinded assessment. We will ultimately include 24 eligible patients who opt for implant treatment to replace a single missing posterior tooth. Three months after implantation (submerged procedure), the study begins with the second-stage surgery. Each of the 24 patients will be given three different transmucosal abutments (zirconia, lithium disilicate, titanium) consecutively. The sequence in which the three materials are used is randomized. Peri-implant crevicular fluid is sampled weekly around the respective abutment for biomolecular analyses. After one month of wearing time, the stamping press from the second-stage surgery is used to gain a narrow gingival ring biopsy around the abutment for immunohistochemical analyses. The next abutment is then inserted. The same procedure is used for all three abutments. After sampling is completed, the patients will receive a definitive crown. The primary outcome measure of the trial is biomolecular detection of specific markers in the peri-implant crevicular fluid: matrix metalloproteinase 8, interleukin- 1β, polymorphonuclear elastase, and myeloid-related protein MRP8/14 (calprotectin). Secondary outcome measures include immunohistochemical analyses and clinical parameters.DiscussionThe study design will allow us to perform correlation analyses between the clinical indices with biomarkers’ expression in the interface of the transmucosal abutments and the peri-implant soft tissue. A deeper understanding of the three abutment materials’ interactions with peri-implant soft tissue will help us understand the formation mechanisms of implant-associated complications and then develop prevention strategies.Trial registrationThe trial is registered at the German Clinical Trial Register and the International Clinical Trials Registry Platform by the WHO under DRKS00006555 (Registered on 27 October 2014).

Synchronous double primary cancer of the esophagus and ampulla of Vater successfully treated by a two-stage operation: report of a case

A 68-year-old man was diagnosed with local recurrent cancer of the ampulla of Vater by follow-up endoscopy 3 years after an endoscopic papillectomy. A screening endoscopy found superficial middle thoracic esophageal cancer. The patient required an esophagectomy and pancreatoduodenectomy. We chose a two-stage operation for the esophageal cancer and the local recurrent cancer of the ampulla of Vater, both to reduce surgical invasiveness and to circumvent the lower curability. The first-stage operation consisted of a right transthoracic subtotal esophagectomy with mediastinal and cervical lymph node dissection, external esophagostomy of the neck, and gastrostomy. Forty days after the first surgery, a gastroduodenal artery- and right gastroepiploic vessel-preserving pancreatoduodenectomy with Child’s reconstruction was performed as the second-stage surgery. Esophageal reconstruction was achieved using a gastric tube via the percutaneous route with vascular anastomosis.

Two-Stage Primary Total Knee Arthroplasty with Well-Designed Antibiotic-Laden Cement Spacer Block for Infected Osteoarthritic Knees: The First Case Series from China.

We aimed to assess the efficacy of applying a two-stage primary total knee arthroplasty (TKA) with an antibiotic-laden cement spacer block to treat infected osteoarthritic knees. This retrospective study included 17 cases of severely infected osteoarthritic knees treated with two-stage primary TKA. Open debridement and irrigation with insertion of a well-designed antibiotic cement spacer was performed as the first stage. Systemic antibiotics were used in the interval period. Two-stage TKAs were performed after elimination of infection. The pre- and post-operative Hospital for Special Surgery Knee (HSS) score as well as range of motion (ROM) were assessed. Elimination of infection was achieved in 16 patients. C-reactive protein returned to normal levels in an average of 3.4 wks (range, 1-7 wks), whereas erythrocyte sedimentation rate (ESR) recovered in an average of 11.4 wks (range, 6-19 wks). The average interval between the two-stage operations was 16.8 wks (range, 10-27 wks). Compared with the pre-operative level, the mean HSS score had a substantial increase after the first-stage and second-stage surgery (p<0.05). The post-operative maximum extension degree was smaller and the maximum flexion and ROM degree were larger than the pre-operative degree (all p<0.05). There were no recurrent infections and no patients lost to follow-up. One patient chose to receive arthrodesis because of uncontrolled infection after numerous operations and treatments. Two-stage TKA with open debridement, irrigation, and insertion of a well-designed antibiotic-laden cement spacer at the first stage could provide effective pain relief and function restoration as well as infection control in the interval. This treatment protocol provided an encouraging final clinical outcome, which could be a reliable alternative for patients with infected osteoarthritic knees.

Multilevel thoracic ossification of ligamentum flavum coexisted with/without lumbar spinal stenosis: staged surgical strategy and clinical outcomes

BackgroundThoracic ossification of ligamentum flavum (TOLF) is a progressively disabling disease. Isolated or continuous TOLF has been frequently reported in literature, however there are very few reports of multilevel or non-continuous TOLF. The purpose of the study was to discuss the surgical strategy of multilevel TOLF and evaluate safety and efficacy of a two-stage operation regimen.MethodsFrom October 2007 to May 2014, eleven patients (4 males, 7 females) that underwent two-stage surgery for multilevel spinal stenosis were retrospectively reviewed. The follow-up period lasted at least 12 months. Demographic data, radiological findings as well as operative data were collected. Postoperative functional outcomes evaluated by the modified Japanese Orthopedic Association score (mJOA) and complications were analyzed.ResultsThe patients ranged in age from 30 to 65 years (average, 50.2 ± 11.8 years), and comprised 4 men and 7 women. All patients exhibited significant improvements in neurological deficits. The mJOA score improved from a mean of 3.5 ± 2.2 preoperatively to 4.6 ± 2.3 before second-stage surgery and to 7.5 ± 2.2 at final follow-up. The improvement was statistically significant in the average mJOA improvement rate at final follow-up. No staging-related complications were noted in this study.ConclusionsStaged surgery can effectively achieve neurological functional recovery in patients with multi-segment spinal stenosis in thoracic and lumbar regions, with favorable efficacy and safety. Yet, slight neurological deterioration was observed during the intervals of these two index surgeries.

Retrocardiac lung hernia after thoracic esophagectomy: report of a rare case

A retrocardiac lung hernia is an extremely rare complication after esophagectomy. A 56-year-old man was admitted to our hospital with advanced middle thoracic esophageal cancer and a giant bulla at the apical portion of the right lung. Since it appeared that dissection of the upper mediastinum would most likely require resection of the right bulla, a two-stage operation for esophageal cancer was planned. During the first-stage operation, thoracic esophagectomy and resection of the right giant bulla were performed. Fourteen days after the first-stage operation, the patient underwent laparotomy as the second-stage operation to reconstruct a narrow gastric tube via a retrosternal route. After the second-stage operation, the inflammatory reaction was prolonged. Therefore, a thoracoabdominal computed tomography scan was performed, showing retrocardiac pulmonary atelectasis. The patient was diagnosed with a retrocardiac left lung hernia in which the left lower lobe was displaced into the right thoracic cavity. Because the inflammatory reaction was due to effects of the lung hernia, a repair operation was performed via a left seventh intercostal thoracotomy. At thoracotomy, the left basal segment of the lung was atelectatic and reddish and had herniated into the right thoracic cavity through an opening between the aorta and pericardium. The herniated lung tip adhered strongly to the subcarina, and synechiotomy was performed. We believe that simultaneous removal of the right giant bulla with esophagectomy was the important cause of this complication.

Split pedicle roll envelope technique around implants and pontics: a prospective case series study

Recreating a harmonious gingival contour for contiguous missing teeth in the anterior maxilla is challenging. The aim of this study was to evaluate a split pedicle roll envelope technique designed for pontics. Twelve patients presented a labial flat or concave profile at the implant and pontic sites before second-stage surgery. The contour deficiency was compensated with a palatal split pedicle flap with the implant part rolled into the labial envelope and the pontic part covering the denuded ridge. Interim restorations were screwed in to guide tissue remodelling. The labial convex profile (CPF) and facial mucosal level (FML) at the implant and pontic sites, the Jemt papilla index (PIS) in the different restorative environments, and peri-implant bone levels were recorded at baseline and at 1 week, 3 months, and 6 months postoperative. Results showed that the CPF had increased by 1.4mm at the implant site and 1.5mm at the pontic site at 6 months after surgery. PIS had increased by 2 at the implant–tooth/pontic–tooth sites and by 2.6 at the implant–pontic site. FML was coordinated with that of the contralateral teeth. All indices were favourable at 3 months and then remained stable. Within the limitations identified, this combined therapy can be considered as an alternative to achieve aesthetic success when contiguous maxillary anterior teeth are missing.

The 6 thalamic regions: surgical approaches to thalamic cavernous malformations, operative results, and clinical outcomes.

The ideal surgical approach to thalamic cavernous malformations (CMs) varies according to their location within the thalamus. To standardize surgical approaches, the authors have divided the thalamus into 6 different regions and matched them with the corresponding surgical approach. The regions were defined as Region 1 (anteroinferior), Region 2 (medial), Region 3 (lateral), Region 4 (posterosuperior), Region 5 (lateral posteroinferior), and Region 6 (medial posteroinferior). The senior author's surgical experience with 46 thalamic CMs was reviewed according to this classification. An orbitozygomatic approach was used for Region 1; anterior ipsilateral transcallosal for Region 2; anterior contralateral transcallosal for Region 3; posterior transcallosal for Region 4; parietooccipital transventricularfor Region 5; and supracerebellar-infratentorial for Region 6. Region 3 was the most common location (17 [37%]). There were 5 CMs in Region 1 (11%), 9 in Region 2 (20%), 17 in Region 3 (37%), 3 in Region 4 (6%), 4 in Region 5 (9%), and 8 in Region 6 (17%). Complete resection was achieved in all patients except for 2, who required a second-stage operation. The mean follow-up period was 1.7 years (range 6 months-9 years). At the last clinical follow-up, 40 patients (87%) had an excellent or good outcome (modified Rankin Scale [mRS] scores 0-2) and 6 (13%) had poor outcome (mRS scores 3-4). Relative to their preoperative condition, 42 patients (91%) were unchanged or improved, and 4 (9%) were worse. The authors have presented the largest series reported to date of surgically treated thalamic CMs, achieving excellent results using this methodology. In the authors' experience, conceptually dividing the thalamus into 6 different regions aids in the selection of the ideal surgical approach fora specific region.

Two-stage revision of prosthetic hip joint infections using antibiotic-loaded cement spacers: When is the best time to perform the second stage?

Managing periprosthetic joint infections remains a challenging task, and adequate treatment strategies seem to be mandatory to avoid irreversible damage of the affected joint and/or systemic complications. Two-stage revision arthroplasty includes removing all implants and subsequent implantation of an antibiotic-loaded cement spacer, followed by revision arthroplasty as the second stage. Although this procedure is well described in the literature, results remain unpredictable due to various clinical findings and the absence of prospective randomised trials. We analysed (1) mortality and (2) reinfection rates in a series of patients who underwent two-stage revision surgery for periprosthetic hip joint infections with antibiotic-augmented joint spacers. We maintained a special focus on the spacer retention period and its influence on outcome in order to determine the best time for second-stage surgery. A consecutive series of 76 patients with native and periprosthetic hip joint infections and who underwent two-stage revision surgery with antibiotic-loaded cement spacers were studied between 2005 and 2010. The second-stage operation was performed when it was assumed that infection was eradicated. The further operative procedure depended upon intra-operative findings (frozen section, local status). Mean implant-free period with the antibiotic-loaded spacer in situ was 12.6 weeks. Spacer re-implantation was necessary in 13 cases due to positive signs of acute infection in the frozen section and suspect intra-operative findings. Eight patients were not operated for a second time in the investigated time period due to poor general condition. In 40 patients, the spacer retention period was four to 11 weeks: <four weeks for five and >11 weeks for 23. We observed a significantly higher proportion of women free from reinfection in the four to 11-week group than in patients with the shorter or longer period. According to our findings, the optimal timing for second-stage surgery as a second-stage procedure is between four and 11 weeks. A significantly optimal reinfection rate was seen in patients undergoing revision arthroplasty within that time frame, and 90% of those patients remained infection free until final follow-up.

THE "CHEMICAL OXYGEN DEMAND / TOTAL VOLATILE ACIDS" RATIO AS AN ANAEROBIC TREATABILITY INDICATOR FOR LANDFILL LEACHATES

In some operational circumstances a fast evaluation of landfill leachate anaerobic treatability is necessary, and neither Biochemical Methane Potential nor BOD/COD ratio are fast enough. Looking for a fast indicator, this work evaluated the anaerobic treatability of landfill leachate from Sao Carlos-SP (Brazil) in a pilot scale Anaerobic Sequence Batch Biofilm Reactor (AnSBBR). The experiment was conducted at ambient temperature in the landfill area. After the acclimation, at a second stage of operation, the AnSBBR presented efficiency above 70%, in terms of COD removal, utilizing landfill leachate without water dilution, with an inlet COD of about 11,000 mg.L-1, a TVA/COD ratio of approximately 0.6 and reaction time equal to 7 days. To evaluate the landfill leachate biodegradability variation over time, temporal profiles of concentration were performed in the AnSBBR. The landfill leachate anaerobic biodegradability was verified to have a direct and strong relationship to the TVA/COD ratio. For a TVA/CODTotal ratio lower than 0.20, the biodegradability was considered low, for ratios between 0.20 and 0.40 it was considered medium, and above 0.40 it was considered high.

Initial experience of percutaneous nephrolithotomy combined with retroperitoneal laparoendoscopic single-site partial nephrectomy in one-stage treatment of homolateral renal diseases

This study investigated the feasibility of percutaneous nephrolithotomy (PCNL) combined with retroperitoneal laparoendoscopic single-site partial nephrectomy (LESS-PN) in one-stage treatment of homolateral renal calculi and tumors. Between October 2010 and July 2014 one-stage PCNL combined LESS-PN surgery was performed in 23 patients with homolateral renal calculi and tumors. Patients included 17 male and 8 female, ranged from 31 to 66 years old with a median age of 42.7. Operative parameters and occurrence rate of complications were recorded. In all cases renal tumors were successfully removed without converting to open surgery. One-stage clearance rate for renal calculi was 21/23 (91.3%), leaving two cases for second-stage operation of flexible ureteroscope lithotomy. The operation time was 95–186 min; average 128 min. Intraoperative blood loss was 40–200 mL; average 130 mL. Median warm ischemia time was 23.8 ± 9.5 min. There were no serious post-operative complications such as massive hemorrhage or urine leakage. Length of stay was 5–7 days, average 6 days. There was no recurrence of renal calculus, renal tumors or ureterostenosis and kidney functions were normal. In conclusion, with good practice, one-stage combined operation of PCNL and retroperitoneal LESS-PN in removing homolateral renal tumors and calculi was safe, feasible and would potentially reduce the operative trauma.

Endoscopic endonasal atlantoaxial transarticular screw fixation technique: an anatomical feasibility and biomechanical study.

OBJECT The primary disadvantage of the posterior cervical approach for atlantoaxial stabilization after odontoidectomy is that it is conducted as a second-stage procedure. The goal of the current study is to assess the surgical feasibility and biomechanical performance of an endoscopic endonasal surgical technique for C1-2 fixation that may eliminate the need for posterior fixation after odontoidectomy. METHODS The first step of the study was to perform endoscopic endonasal anatomical dissections of the craniovertebral junction in 10 silicone-injected fixed cadaveric heads to identify relevant anatomical landmarks. The second step was to perform a quantitative analysis using customized software in 10 reconstructed adult cervical spine CT scans to identify the optimal screw entry point and trajectory. The third step was biomechanical flexibility testing of the construct and comparison with the posterior C1-2 transarticular fixation in 14 human cadaveric specimens. RESULTS Adequate surgical exposure and identification of the key anatomical landmarks, such as C1-2 lateral masses, the C-1 anterior arch, and the odontoid process, were provided by the endonasal endoscopic approach in all specimens. Radiological analysis of anatomical detail suggested that the optimal screw entry point was on the anterior aspect of the C-1 lateral mass near the midpoint, and the screw trajectory was inferiorly and slightly laterally directed. The custommade angled instrumentation was crucial for screw placement. Biomechanical analysis suggested that anterior C1-2 fixation compared favorably to posterior fixation by limiting flexion-extension, axial rotation, and lateral bending (p > 0.3). CONCLUSIONS This is the first study that demonstrates the feasibility of an endoscopic endonasal technique for C1-2 fusion. This novel technique may have clinical utility by eliminating the need for a second-stage posterior fixation operation in certain patients undergoing odontoidectomy.

The elephant trunk is freezing: The Hannover experience

The "elephant trunk" (ET) technique traditionally has been performed to treat complex aortic diseases involving the aortic arch and the descending aorta. Despite the fact that, in recent years, the "frozen elephant trunk" (FET) technique has been used increasingly for such pathologies, discussion is still ongoing in the surgical community regarding which of the 2 techniques is better. We compared our results using the classic ET versus the FET technique. From August 2001 to March 2013, a total of 277 patients underwent total aortic arch replacement and either ET (group A) or FET (group B) implantation. In group A, 97 patients (59 men; age 59.7 ± 12.7 years; 44.3% with aneurysm; 55.6% with dissection [48.45% acute]) underwent an ET procedure; 21.64% were reoperations. In group B, 180 patients underwent an FET procedure (126 men; age 59.8 ± 13.2 years; 34.4% with aneurysm; 63.3% with dissection [35% acute]); 30% were reoperations. In group A, in-hospital mortality was 24.7%; postoperative stroke rate was 12.4%. During follow-up, 27.8% underwent a second-stage procedure. In group B, in-hospital mortality was 12.2%; postoperative strokerate was 13.3%. During follow-up, 27.7% patients underwent further interventions in the downstream aorta. In selected patients with combined aortic arch and descending aortic aneurysms limited to the proximal descending aorta, the FET approach potentially allows for single-stage therapy, whereas a second-stage operation is inevitable with the classic ET approach. Moreover, owing to the availability of prefabricated, easy-to-use, FET, hybrid prostheses that result in significantly better outcomes in patients who have acute aortic dissection, type A, and if necessary, and provide an ideal "landing zone" for future endovascular completion, the classic ET procedure is "freezing," in the sense that it is being replaced by the FET approach.

The Digital One-Abutment/One-Time Concept. A Clinical Report.

The digital fabrication of dental restorations on implants has become a standard procedure during the last decade. Avoiding changing abutments during prosthetic treatment has been shown to be superior to the traditional protocol. The presented concept for implant-supported single crowns describes a digital approach without a physical model from implant placement to final delivery in two appointments. A 54-year-old man was provided with a single-tooth implant on his left mandibular first molar. Before wound closure, the implant position was captured digitally with an intraoral scanning device. After bone healing at the time of second-stage surgery the final screw-retained crown fabricated without a physical model was inserted. Soft tissue healing took place at the definitive restoration, avoiding abutment changes or changes of the healing cap. These led to stable soft tissues with a minimum of surgery. The benefits of digital fabrication and the unique way to scan the implant right after placement give an additional value that would not be achieved by analog techniques. In addition to financial benefits it represents a biologically advantageous, one-abutment/one-time approach with customized screw-retained, full-contour crowns or cemented crowns on custom abutments.

Comparison of a Hydroxyapatite-Coated and an Anodic Oxidized Titanium Implant for Experimentally Induced Peri-Implantitis: Macroscopic and Novel Radiographic Evaluations in a Canine Model

This study aimed to compare the response of peri-implant tissue surrounding hydroxyapatite-coated titanium (HA) implants and anodic oxidized titanium (AnO) implants, as well as associated ligature-induced peri-implantitis. The third and fourth premolars (P3, P4) of the mandible were extracted in five beagle dogs. After 2 months, 10 dental implants with different surfaces (HA/AnO) were inserted into the mandible in five beagle dogs. A plaque control program was maintained until the second-stage surgery. Three months after implantation, a healing-cap connection was performed, and silk ligatures were placed in the submarginal position around the neck of the implants to induce peri-implantitis. Macroscopic evaluations including modified plaque index (mPI), modified gingival index (mGI), and probing depth (PD), and radiographic evaluations including dental radiography and multislice computed tomography (MSCT) were conducted for 24 weeks following ligature placement. Bone loss around the implant was evaluated according to the radiolucent area on dental radiographic images and the hyperpermeability area on MSCT images. All macroscopic parameters except PD exhibited a consistent increase for all implants. Over the course of the study, bone loss associated with the HA implant was greater than losses with the AnO implant. Following evaluation of dental radiographs at 20 and 24 weeks after ligature placement, a significant difference was detected between the HA and AnO implants (P < 0.05). The results suggested that the resistance of the HA implant to peri-implantitis was inferior to that of the AnO implant.

2.5 kg以下の新生児・乳児における体外循環非使用肺動脈絞扼術の転帰と問題点

Background: Congenital heart defects have been an important cause for death among low birth weight (LBW) infants. Corrective surgery is not always a favorable solution for these fragile babies, and surgeons may choose palliative surgery, which is technically demanding. We reviewed our 10 years of experience and the outcome of initial pulmonary artery banding (PAB) without cardiopulmonary bypass (CPB) in LBW infants. Patients and methods: Eleven infants (age, 6~78 days; body weight, 1.1~2.5 kg) underwent initial PAB without CPB (9 cases of main PAB and 2 cases of branch PAB). Results: One patient died from a non-cardiac event. Nine patients successfully underwent the second-stage operation, at a mean weight of 4.6 kg, and eight completed the nal stage. One patient experienced ventricular volume overload a er main PAB. e mean Pp/Ps (pulmonary systemic blood pressure ratio) was 0.54 and the circumference of the band for the main PAB was body weight (kg)+18.2 mm, which was a little tighter than Trusler’s rule. e circumference for the branch PAB was body weight (kg)+8.0 mm. Of the patients who weighed less than 2 kg, all ve gained body weight, and four of them successfully reached the nal stage. Conclusion: PAB in LBW infants resulted in fair clinical outcomes with acceptable morbidity and mortality. However, there is a need for speci c guidance, based on accumulated experience, for the procedure and management.