Stage Surgical Approach Research Articles

Single stage surgical approach for synchronous large symptomatic CRLM causing mass effect with carcinoma right colon in our centre

Single stage surgical approach for synchronous large symptomatic CRLM causing mass effect with carcinoma right colon in our centre

Locator vs telescopic crown attachments for maxillary implant overdenture. A within-subject study of chewing efficiency and maximum bite force

Aim: This within-subject study report to investigate masticatory efficiency and maximum bite force of Locator and telescopic crown attachments used to retain maxillary implant overdentures. Materials and methods: Six edentulous patients (3 males and 3 females) received 4 implants in the anterior maxillary region between the maxillary sinuses using a standardized 2 stage surgical approach. Six months after osseointegration, the implants were loaded either by Locator or telescopic maxillary overdentures in a cross-over study design. Masticatory efficiency was performed using the 2-colored gum mixing ability test. The gum was chewed for 5, 10, 20, 30, and 50 cycles, and the images of the chewed gum were analyzed using a Photoshop program to calculate the unmixed fraction (UF). Also, maximum bite force was evaluated using a bite-force transducer. Chewing efficiency and maximum bite forces were evaluated 3 months after wearing each overdenture. Results: The success rate was 100% in both groups. There was a trend for a decrease in UF (ie improved masticatory efficiency) with the increase in the number of masticatory cycles. Telescopic maxillary overdentures showed significantly lower UF (ie higher masticatory efficiency) and higher maximum bite force than Locator maxillary overdentures Conclusion: Telescopic attachments are recommended for maxillary implant overdentures as it had improved masticatory efficiency and maximum bite force than Locator attachments

Bar versus Locator attachments for maxillary implant overdentures opposed by implant supported mandibular overdentures. Clinical and radiographic evaluation

Purpose: The aim of this short-term clinical trial was to evaluate clinical and radiographic outcomes of Bar and Locator attachments used to retain maxillary implant overdentures opposed by implant supported mandibular overdentures. Material and methods: Ten patients wearing conventional maxillary denture and implant supported mandibular overdentures received 4 implants in the maxillary arch using 2 stage surgical approach. Six months later maxillary overdentures were connected to the implants with locator (group 1) or bar (group 2) attachments. Plaque index, bleeding index, probing depth, implant stability, and marginal bone loss (using Cone beam computerized tomography) were evaluated at time of overdenture delivery, 6 months and 12 months later. Results: Plaque and gingival indices increased significantly with time in bar group only. Bar overdentures recorded significant higher plaque and gingival scores than locator overdentures. No significant difference in pocket depth and implant stability was noted between time intervals or groups. Total marginal bone loss for locator group was significantly higher than bar group after 6 and 12 months. For both groups, marginal bone loss around canine implants was significantly higher than bone loss around premolar implantsConclusion: Within the limits of this study, it could be concluded that both locator and bar retained maxillary overdentures are successful treatment options for patients complaining from instability of maxillary dentures opposed by implant retained mandibular denture. However, locator attachments are advantageous in terms of peri-implant soft tissue health and bar attachments are advantageous regarding peri-implant alveolar bone preservation.

Stage surgical and catheter approach to the treatment of long-persistent atrial fibrillation

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Su1715 PREOPERATIVE COLONIC STENTING IS NOT ASSOCIATED WITH AN INCREASED RISK OF RECURRENT DISEASE OR OSTOMY RATE COMPARED TO UPFRONT SURGERY IN PATIENTS WITH OBSTRUCTIVE COLORECTAL CANCER

Colorectal cancer (CRC) is a leading cause of cancer death in the United States. Some patients present obstructed from CRC. Preoperative stenting as a bridge to surgery is routine and may allow for a one stage surgical approach. European guidelines have suggested that in younger patients, preoperative stenting is associated with postoperative recurrent abdominal disease and have discouraged this practice. In this investigation, we evaluated our institutional experience with preoperative stenting with regards to cancer recurrence and ostomy rates. We also assessed surgical complications in these groups.

Clinicopathologic analysis of urothelial carcinoma of bladder with squamous differentiation

Objective To investigate the clinical feature , pathologic characteristics and prognosis of urothelial carcinoma of bladder with squamous differentiation . Methods From Jan.2010 to Jun.2013, the pathological and clinical data of 96 cases of urothelial carcinoma of bladder with or without squamous dif-ferentiation were compared .Of the group with squamous differentiation , there were 39 males and 9 females with a median age of 70 （29 to 87） years.44 cases presented with painless gross hematuria .4 cases presen-ted with finding of bladder tumors in annual physical examination .TURBT, partial cystectomy and radical cystectomy were performed in 25, 8 and 13 cases, respectively.In addition, one case was only underwent bi-lateral ureteral skin gastrostomy .The last one only performed cystoscopy .In accordance with sex , age, path-ological stage and classification and surgical approach , 48 controls were selected .For the other group , there were 40 males and 8 females with a median age of 68 （39 to 86） years.45 cases presented with painless gross hematuria.3 cases presented with finding bladder tumors by annual physical examination .TURBT, par-tial cystectomy and radical cystectomy were performed in 28, 7 and 13 cases, respectively.All patients with retaining bladder had postoperative intravesical instillation for one year .Some patients with or without bladder performed 3-6 cycles chemotherapy with the GC protocol . Results In squamous differentiation group , there were 1 （2.1%） pTa, 25 （52.1%） pT1, 17 （35.4%） pT2, 4 （8.3%） pT3 and 1 （2.1%） pT4 tumors. Whereas, 1 （2.1%） pTa, 28 （58.3%） pT1, 16 （33.3%） pT2, 2 （4.2%） pT3 and 1 （2.1%）pT4 tumors were selected in the control group .There were 2 （4.2%） cases with low grade and 46 （95.8%） cases with high grade carcinomain in both groups .Patients were followed up with a mean duration of 16 and 12 months in squamous differentiation and control group , respectively .In squamous differentiation group , eight recur-rences were recorded with a mean follow-up of 12 months.Of the 3 died patients, only one died from bladder cancer.In control group, seven recurrences were recorded with a mean follow-up of 22 months, and no pa-tient died.For patients with TURBT, 3 year recurrence rate of patients with squamous differentiation was 49.5%, while the control was 34.8%.The difference was statistically significant （P〈0.05）. Conclusions Urothelial carcinoma of bladder with squamous differentiation is at a high level of malignant and recurrence . The rate of myometrial invasion with squamous differentiation is higher than pure urothelial bladder cancer . Patients with squamous differentiation should be closely followed up . Key words: Bladder; Urothelial carcinoma; Squamous differentiation; Treatment; Outcome

Evaluation of immediately loaded dental implants bioactivated with platelet-rich plasma placed in the mandibular posterior region: A clinico-radiographic study

Background and Objectives:The purpose of the present study was to clinically and radiographically assess the soft and hard tissue changes around the immediately loaded single tooth implants bioactivated with platelet-rich plasma (PRP), placed in the mandibular posterior region.Materials and Methods:A total of 11 patients having single tooth edentulous space in the mandibular posterior region were selected. An endosseous implant was placed after clinical and radiographic examination in each selected site using single stage surgical approach. The patients were followed up at 3, 6, 9, and at 12 months of post implant insertion. The patients were subjected to recording of clinical parameters like modified plaque index, modified gingival index, probing depth, and clinical implant mobility scale. Radiographs made at different intervals were subjected to assessment of bone level mesial and distal to each implant using computer assisted image analysis.Results:Scores for clinical parameters were minimal and comparable. The probing depth around the implant was measured during the follow-up period and the changes observed were statistically non-significant. None of the implants were clinically mobile during the follow-up period. Radiographically, the peri-implant bone resorption both on mesial and distal sides was within normal limit after one year of immediate loading. Finally, the overall success rate for the immediately loaded bioactivated implant placed in the mandibular posterior region was recorded as 100%.Interpretation and Conclusion:The use of platelet-rich plasma may lead to improved early bone apposition around the implant; and thus, results in increased rate of osseointegration. Single stage implant procedure with the adjunctive use of PRP enhances the ability of peri-implant healing tissue to create favorable soft and hard tissue relationships. It also gives the added advantage of psychological boost for the patient by getting fixed replacement of tooth within a short time period.

Long‐term survivability of hydroxyapatite‐coated implants: a meta‐analysis

AbstractObjective: Numerous studies have showed a primary stability of dental implant coated with hydroxyapatite (HA). However, over the long‐term stability of the HA‐coated implant the discussion is still controversial. Present study focuses on literature analysis in order to evaluate the long‐term clinic outcome of HA‐coated implants.Materials and methods: Concerning the survival of HA‐coated implants a systematic search for English literature over clinical trials (published from 1996 to 2009) was performed. On the basis of the inclusion criteria, nine studies were selected for final data analysis, which included 1051 patients with 3470 HA‐coated dental implants. Clinical treatment followed a two stage surgical approach with an unloaded healing period of 3–6 months. The period of clinical follow‐up ranged from 3 to 10 years. The obtained data were statistically analysed using chi‐square test. Cumulative survival rate (CSR) and success rate were calculated.Results: The overall cumulative survival rate over 5 years was 93.15% compared with the success rate of 86.12%. The 10‐year CSR was 87.39% compared with the 10‐year success rate of 63.84%. There was significant difference between CSR and success rate (P < 0.05). Considering the time factor, the 5‐year CSR is better than the 10‐year results, but there was no significant difference (P > 0.05).Conclusions: The 5‐year CSR is better than the 10‐year results, but without significant difference; the survival rates reported for HA‐coated implants were similar to the other implants, but the success rates were significantly lower than the overall survival rates.

A systematic multiple stage surgical approach for attainment of satisfactory and favourable surgical results in an extremely severe von Recklinghausen's disease, elephantiasis neurofibromatosa

This disease was first described by von Recklinghausen and Festscher and has been known as the von Recklinghausen's disease or neurofibromatosis (NF). Numerous articles have been published on this subject where majority of the authors have stressed their difficulty in achieving favourable surgical results. This disease is pathologically accepted to be of neuroectodermal origin with a positive family history in approximately 50% of the cases, autosomal dominant trait and is known to involve the periorbital regions, orbit (preoperative CT scan: upper left and right photographs), temporal region to a variable extent, mid-facial region to the mandibular region. The indicated treatment for this disease is surgery including cranio-maxillofacial surgery even though re-evaluation of the conventional methods of surgery should be considered. This particular case is an extremely difficult and challenging case for any reconstructive plastic surgeon and required extensive preoperative planning. The systematic multiple stage surgical approach for an extremely severe von Recklinghausen's disease, elephantiasis neurofibromatosa is presented and discussed in detail.

Tratamento do aneurisma de arco e aorta descendente: abordagem cirúrgica em uma etapa

Paciente de 61 anos procurou atendimento médico com quadro clínico de infecção pulmonar. O estudo radiológico de tórax revelou aneurisma de aorta descendente com comprometimento do arco aórtico. Ressalta-se a correção cirúrgica em uma única etapa, por meio de abordagem operatória não convencional, que possibilitou a correção total do aneurisma.

Single stage surgical approach for arch and descending thoracic aorta aneurysm]

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Two Stage Surgical Treatment of Acute Traumatic Knee Dislocation

Purpose: The purpose of this study was to determine the effectiveness of a new two stage surgical treatment for acute traumatic knee dislocation. Materials and Methods: The study involved 15 knees in 14 patients treated between October 1997 and November 2001. The mean follow-up period was 24 months. In the first surgical stage, medial and/or lateral ligament complexes were repaired or reconstructed within two weeks of the injury. In the second surgical stage, once full range of motion was obtained 3-6 months later, anterior or posterior cruciate ligaments (ACL or PCL) were reconstructed if significant laxity was present. The final outcomes were assessed using stress X-rays, range of motion and Lysholm score. Results: There were ten cases of MCL tear and eight cases of LCL tear. All MCL and LCL injuries were either repaired or reconstructed. All cases had both ACL and PCL tears. Following the first stage of MCL/LCL surgery, the second stage surgery of ACL or PCL reconstructions was deemed to be necessary in three and seven cases, respectively. Five cases did not require ACL or PCL reconstruction. In stress X-rays at the last follow up examination, MCL, LCL, ACL and PCL instability was graded as 0 or 1 in 15, 14, 15 and 11 cases, respectively. PCL instability was graded as 2 in four cases. The mean postoperative Lysholm score was 87.6 points. Conclusion: The two stage surgical approach described here resulted in good outcomes for patients suffering from acute knee dislocation patients in terms of range of motion and stability.

The role of enterostomy in the management of colonic injuries

The circumstances, evaluation and results of the management of 67 colonic and rectal injuries during the period 1992-2003 in Clinical Centre of Podgorica are presented. In 32 war and 37 civilian injuries to colon, several systems of the severity trauma determination, as well as systems of grading and classification of injuries of colon were evaluated, and the surgical access according to achieved results was investigated in order to determine the use of enetrostomy in the management of these inuries. From the presented and statistically evaluated results, it can be concluded that Flintzs 3 grade classification can be used as the most reliable indicative and prognostic system. For the succes of One stage surgical procedure, the most critical fact is differentiation between Flintzs Grade I and II (Chi Square 4.514; P) as well between Grade II and III. That means that by using One stage procedure, unfavourable results may be expected not only in Grade II, but as well in border cases between II and III. Also, according to the presented results, there were not differences observed in the success of management between Grade II and III (Chi Square 0.678; P0.05). That means that using Two stage procedure, unfavourable results can be prevented not only in the borderline cases between Grades II and III, but also in the Grade III. Two stage surgical approach in the repair of injuried colon remains valuable and usefull surgical procedure, even in spite of success of surgical technology and operative technique, in cases with severe and multiple abdminal injuries, and in borderline decision making. These procedures are also inevitable in the management of any complication of primary repair of the colonic wound. Using rational evaluation and good surgical techniqe, primary repair of can be used in almost 50% of civilian and war injuries injuries of colon.

Surgical Management of Multi-Organ Visceral Tumors In Patients With Von Hippel-Lindau Disease: A Single Stage Approach

We assessed surgical feasibility of a 1-stage multi-organ approach for multiple visceral tumors in patients with von Hippel-Lindau disease. A total of 14 men and 15 women with von Hippel-Lindau disease underwent simultaneous multi-organ surgery for multiple adrenal, renal and pancreatic tumors at the National Cancer Institute between 1988 and 2001. Perioperative and followup data were analyzed retrospectively. The Mann-Whitney U test was used for statistical analysis. Surgery involving 2 or more organs (mean 2.4 procedures per patient, range 2 to 4) was performed in all patients and concurrent pancreatic operations were performed in 12 (41%). Overall a combined 71 procedures, were performed including 4 cases (13%) treated laparoscopically. Mean +/- SD operative time and estimated blood loss were 464 +/- 142 minutes (range 206 to 830) and 2,798 +/- 4,285 cc (300 to 20,000), respectively. In 16 patients (55%) blood transfusion was administered intraoperatively. At a median followup of 21 months (range 5 to 151) renal tumors recurred in 8 patients (28%), requiring further kidney operations, but no patient had pancreatic or adrenal recurrence. The overall complication rate was 38%, and there was no operative mortality. A single stage surgical approach for multi-organ visceral tumors is a viable option for patients with von Hippel-Lindau disease. With careful patient selection and surgical planning combined procedures can be safely performed in 1 operative setting.

A prospective study of single stage surgery for implant supported overdentures.

To investigate the clinical and psychological outcomes with ball attachment supported mandibular overdentures on Branemark implants placed in a single stage surgical approach. MATERIAL AND METHODS Sixteen edentulous patients aged 32-74, with atrophic (flat) mandibular residual alveolar ridges, and a history of having difficulty coping with technically adequate mandibular dentures made within the last 2 years were recruited. Mark II Branemark implants were placed using a single stage surgical technique with healing abutments placed at time of surgery. Mandibular complete dentures were modified by relieving the areas over the abutments and a resilient liner was placed. After a period of 3 months, healing abutments were replaced with ball abutments and new complete dentures were made and the patients followed for a period of 2 years. Patients completed the General Health Questionnaire (GHQ) and answered further questions relating to the functional and psychological impact of complete denture wearing before treatment and 3 months after the dentures were provided. Patients additionally completed the GHQ 2 years after overdenture insertion. Six patients suffered from loss of one of their two implants in the first 2 years after placement. Three of the implants had failed to osseointegrate, which was detected at initial loading 3 months after placement. General Health Questionnaire scores were statistically significantly reduced after treatment and the improvement was maintained over 2 years. Responses to the functional and psychological questions were similarly improved. Single stage surgery led to a higher rate of implant failure than expected. Patients showed significant psychological health benefits from the treatment provided.

Guided bone regeneration for immediate non-submerged implant placement using bioabsorbable materials in Beagle dogs.

The aim of the present study was to evaluate the combined application of different bioabsorbable materials for healing of residual peri-implant defects after placement of non-submerged implants into fresh extraction sockets. Second and third mandibular premolars were extracted from 10 Beagle dogs, the coronal part of the distal sockets were surgically enlarged and this was followed by immediate placement of specially designed hollow-screw non-submerged dental implants. For each animal, the coronal peri-implant defects were further treated with one of the 4 following procedures: 1) no treatment, control site; 2) grafting with porous hydroxyapatite (HA); 3) collagen membrane tightly secured around the implant and over the defect and 4) grafting with HA covered with a collagen membrane. After 16 weeks of healing, specimens were removed from the mandibule and prepared for a histomorphometric evaluation. The bone-to-implant contact length (BIC) was measured and compared amongst the different treatment modalities. In the defect area, the irregular bone regeneration was similar between all the treatment procedures (P > 0.10). In the sites covered with a collagen membrane alone, the total BIC (47%) was greater than in control sites (28.7%, P < 0.05) or sites grafted with HA (22.2%, P < 0.02). Total BIC in sites treated with the HA-membrane combination (43%) was only significantly different from sites treated with HA (P < 0.05). It is concluded that the use of bioabsorbable materials results in a limited increase of osseointegration when used in conjunction with immediate placement of non-submerged implants, although the principle of the one stage surgical approach can be maintained.