RESUMEN
At present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery. The purpose of this study was to describe the computer-assisted mandibular reconstruction procedure adopting the customized solution Synthes ProPlan CMF. The study reports five consecutive patients with benign or malignant disease requiring mandibular reconstruction using a microvascular fibular free flap, pre-operative virtual planning, construction of cutting guides and customized laser pre-bent titanium plates. The surgical technique is discussed in a step-by-step fashion. The average post-operative hospital stay was 18 ± 3 days. Ischemia time was recorded in all five cases, with an average of 75 ± 8 min. No problems were encountered in any surgical step and there were no major complications. Excellent precision of cutting guides and a good fit of pre-bent plates were found on both the mandible and fibula. There was excellent precision in bone to bone contact and position between mandible and fibula graft. Measurement data from the pre-operative and post-operative CT scans were compared. The average difference (Δ) between programed segment lengths and CT control segment lengths was 0.098 ± 0.077 cm. Microsurgical mandibular reconstruction using a virtual surgical planning yields significantly shorter ischemia times and allows more precise osteotomies. The technology is becoming increasingly recognized for its ability to optimize surgical outcomes and minimize operating time. Considering that the extent of resection can be wider than predicted, this results in safer modeling of the fibula only after frozen sections have demonstrated the radicality of resection.
Asunto(s)
Peroné/trasplante , Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello/cirugía , Mandíbula , Reconstrucción Mandibular , Complicaciones Posoperatorias/diagnóstico , Interfaz Usuario-Computador , Adulto , Femenino , Humanos , Masculino , Mandíbula/patología , Mandíbula/cirugía , Reconstrucción Mandibular/efectos adversos , Reconstrucción Mandibular/métodos , Persona de Mediana Edad , Osteotomía/métodos , Planificación de Atención al Paciente , Periodo Preoperatorio , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The purpose of the study is to compare the survival of the patients and the drop-out for change of the method in 2 groups of patients (pts) undergoing either CAPD (41 pts) or standard hemodialysis (HD) (45 pts) as first treatment, since November 1981 to August 1988. Distribution per sex (24 males and 17 females in the CAPD group vs 32 males and 13 females in the HD group), mean age (61.3 years vs 56.7) and number of risk factors (57 vs 61) were not significantly different. The total period of observation was significantly higher (1305.8 months vs 780.3, P less than 0.01) and the results seemed to be better in the CAPD group, but the life table analysis showed no significant differences in the incidence of death (10 events vs 13) and of drop-out for change of the method (8 events vs 10) respectively in the CAPD and in the HD group. At the end of the study 51.2% of pts on CAPD and 33.3% on HD were still on first treatment; clinical problems (respectively 62.5% and 70.0%) were the most frequent cause of drop-out. The Authors conclude that CAPD in the medium-term is a valuable method of treatment of end-stage renal failure, competitive with standard HD when patient selection is not biased by a negative selection.
Asunto(s)
Fallo Renal Crónico/terapia , Diálisis Peritoneal Ambulatoria Continua , Diálisis Renal , Adulto , Estudios de Evaluación como Asunto , Femenino , Humanos , Italia/epidemiología , Fallo Renal Crónico/mortalidad , Tablas de Vida , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Diálisis Renal/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
A retrospective survey has been done on 175 chronic patients who underwent dialysis in one center, between January 1982 and June 1992. The purpose of the work was to evaluate the use of the first treatment and the cause which determined a change of treatment. Diffusive haemodialysis and CAPD were the most frequent first choice techniques, respectively in extracorporeal and peritoneal dialysis, whereas changes were conditioned by the need for a more personalized treatment, especially in the filed of extracorporeal dialysis.
Asunto(s)
Diálisis Renal/tendencias , Adulto , Anciano , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Diálisis Peritoneal/estadística & datos numéricos , Diálisis Peritoneal Ambulatoria Continua/estadística & datos numéricos , Diálisis Renal/métodos , Diálisis Renal/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
Mucormycosis (zygomycosis) is an uncommon mycosis which can be contracted from the environment and which is responsible for rhino-orbital, pulmonary, gastrointestinal, cerebral or disseminated infections. Severe immunodepression, such as that caused by leukemia, lymphomata and organ graft, or treatment by desferrioxamine, may predispose to pulmonary and systemic forms. In the present work the authors describe a case of systemic mucormycosis, with unfavourable outcome, which arose in a pediatric peritoneal dialysis patient, then transferred to hemodialysis, without evident predisposing factors. In particular they refer to the CAT reports and to lymphonodal and peritoneal histological lesions which allowed them to attain the diagnosis.
Asunto(s)
Mucormicosis/diagnóstico por imagen , Mucormicosis/patología , Diálisis Renal , Adulto , Humanos , Masculino , Mucormicosis/etiología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: In the course of Continuous Veno-Venous Hemofiltration (CVVH), bicarbonate buffer instead of lactate is suitable for the treatment of combined renal and hepatic failure and for patients suffering from lactic acidosis, type A or B, joined with acute renal failure (ARF). METHODS: We applied the CVVH buffered with bicarbonate for the treatment of two patients affected by ARF and severe lactic acidosis type B (due to biguanide intoxication) and we evaluated its ability to correct the acid-base balance. RESULTS: Clinical and laboratory data show that this technique, performed in standard conditions (plasma flow: 70 ml/min, ultrafiltration: 25 ml/min, bicarbonate concentration in the infusion fluid: 30 mEq/L), was inadequate to compensate for the high requirement of bicarbonate (approximately 280 mEq/hr during the first 6 hours of observation) and the severe metabolic acidosis, thus additional bicarbonate infusion was needed. CONCLUSIONS: In particular, from ascertained data and theoretical considerations, in the course of lactic acidosis caused by biguanide, in order to correct acidosis a positive balance of bicarbonate could be obtained only by means of a bicarbonate-based replacement fluid and of a continuous high flow hemofiltration, such as to assure an ultrafiltrate volume exceeding 150 ml/min.
Asunto(s)
Acidosis Láctica/sangre , Bicarbonatos/sangre , Bicarbonatos/uso terapéutico , Fluidoterapia , Hemofiltración/métodos , Hipoglucemiantes/efectos adversos , Fenformina/efectos adversos , Acidosis Láctica/inducido químicamente , Lesión Renal Aguda/sangre , Lesión Renal Aguda/terapia , Anciano , Bicarbonatos/administración & dosificación , Tampones (Química) , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Quimioterapia Combinada , Resultado Fatal , Femenino , HumanosRESUMEN
The onset of a protein-energy malnutrition represents a real risk for patients on CAPD. In order to verify the nutritional status and the effectiveness of the dietetic surveillance in preventing this complication, dietary intake, anthropometric measurements and biochemical parameters were monitored in 46 patients (27 males, 19 females, mean age: 58.7 +/- 14.8 years), suffering from ESRF and treated with CAPD, for a total observation period of 1731.67 months (mean: 37.64 +/- 25.17 months). The mean glucose concentration in the dialysate was 2.00 +/- 0.36 g/dl, the glucose reabsorption from dialysate per kg of ideal body weight (kg-IBW) was equivalent to 5.1 kcal, the mean dialysate protein loss was 13.08 +/- 5.52 g/day and the incidence of peritonitis episodes was 1 every 30.38 months-patient. The daily total caloric intake (by mouth and dialysate) was 30.8 kcal/kg-IBW with a normal subdivision for each diet component: there were not statistically significant differences in distribution according to age, sex and in the follow-up. The mean daily value of protein intake (PI) evaluated by dietary interviews was 0.99 g/kg-IBW, with a significant increase 1 year since the beginning of CAPD; the PI evaluated from urea nitrogen appearance was 1.22 g/kg-IBW. The PI remained stable later in the follow-up and in patients that made use of dietetic supplements, the mean daily increase by this way was 0.47 g/kg-IBW. Anthropometric measurements showed a statistically significant increase of %RBW after 1 year and of TS and % body fat after 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Fallo Renal Crónico/terapia , Estado Nutricional , Diálisis Peritoneal Ambulatoria Continua , Desnutrición Proteico-Calórica/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Antropometría , Terapia Combinada , Proteínas en la Dieta/administración & dosificación , Femenino , Estudios de Seguimiento , Glucosa/metabolismo , Humanos , Incidencia , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/dietoterapia , Masculino , Persona de Mediana Edad , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/epidemiología , Peritonitis/etiologíaRESUMEN
The purpose of this work is to compare survival and drop-out in 2 groups of patients undergoing either CAPD (42 pts) or standard HD (48 pts) as first treatment, from November 1981 to December 1988. Mean age and number of risk factors were not significantly different. At the end of the study 50.0% of pts on CAPD and 37.5% on HD were still on first treatment; clinical problems were the most frequent cause of drop-out. The total period of observation was significantly higher in the CAPD group (1391.0 months vs 850.4), but the life table analysis showed no significant differences in the incidence of death and of drop-out in the two groups. The follow-up of the CAPD group was subdivided into two periods, due to the fact that a scheme for clinical and social survey of patients undergoing dialysis and a policy of more frequent home visits were introduced at the end of 1985. A significant decrease of peritonitis episodes was observed in the second period.
Asunto(s)
Fallo Renal Crónico/mortalidad , Diálisis Peritoneal Ambulatoria Continua , Diálisis Renal , Femenino , Humanos , Fallo Renal Crónico/etiología , Fallo Renal Crónico/terapia , Tablas de Vida , Masculino , Persona de Mediana Edad , Pacientes Desistentes del Tratamiento , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/etiología , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
A protocol of patient selection and more frequent home visits have significantly reduced peritonitis episodes in CAPD patients using Y-set with Amuchina. However, no change in dropout rates were observed.
Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Ácido Hipocloroso/uso terapéutico , Diálisis Peritoneal Ambulatoria Continua/instrumentación , Peritonitis/prevención & control , Cloruro de Sodio/uso terapéutico , Femenino , Servicios de Atención de Salud a Domicilio , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/epidemiología , Estudios RetrospectivosRESUMEN
Heparin has been proposed following the supposed role of disseminated intravascular coagulation (DIC) in the pathologies associated with the consumption coagulopathies such as obstetric acute renal failure (ARF), whilst antifibrinolytic agents could be advocated to stop a simultaneous triggered fibrinolysis. Out of 26 obstetric ARF DIC may be demonstrated in 10 and supposed in 6 patients who developed severe post-partum uterine bleeding. Therapeutic schedules employing heparin or antifibrinolytic agents early post-partum do not seem to change either the behaviour of laboratory parameters (showing a DIC partial resolution within 48 hours), or heavy bleeding in respect to the patients treated with supportive therapies alone. Furthermore, heparin administered during the following days does not seem to be a crucial factor in the renal recovery, and is often followed by severe haemorrhagic complications. Fresh frozen plasma after aprotinin is able to stop bleeding in the presence of persisting signs of consumption without damaging renal recovery.
Asunto(s)
Lesión Renal Aguda/complicaciones , Coagulación Intravascular Diseminada/etiología , Complicaciones del Embarazo/terapia , Lesión Renal Aguda/terapia , Coagulación Intravascular Diseminada/terapia , Eclampsia/terapia , Femenino , Muerte Fetal , Estudios de Seguimiento , Humanos , Enfermedades Placentarias/terapia , Preeclampsia/terapia , Embarazo , Complicaciones del Embarazo/diagnósticoRESUMEN
Three years' experience in the field of therapeutic cryosurgery is described. During this period, 125 patients were treated and excellent results were achieved. Carcinomas of the oral cavity, leukoplakias, and angiomas formed the bulk of the series. It is submitted that this form of management can be looked upon as the treatment of choice in these forms.
Asunto(s)
Criocirugía , Enfermedades de la Boca/cirugía , Neoplasias de la Boca/cirugía , Lesiones Precancerosas/cirugía , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The medium-term (three years) result of a multidisciplinary association treatment of carcinoma of the oral cavity has been reviewed. Treatment was Cryosurgery-polychemotherapy-ratiotherapy and the technique has been described along with the times of association in an introduction that has already been published in this review (see bibliography). Thirty patients were treated with the association because they refused or could not be submitted to surgery at the intital therapeutic action. All these patients present fairly extensive lesions and a three-year follow-up. Results were positive: 56.6% of patients showed disappearance of any objective or subjective sign of cancer and, in all cases, appreciable remission in terms of both extent and duration. The easiness of the technique is confirmed as well as the excellent conversation of the anatomical structures involved. However, a critical review of cases presenting partial failure suggest a classifications of oral carcinomatous lesions (for therapeutic purposes only) on the basis of which the condition can be treated with cryo-polychemo-radiotherapy alone or with a variation of this which provides for the addition of local exersis.
Asunto(s)
Criocirugía , Neoplasias de la Boca/terapia , Adulto , Anciano , Quimioterapia Combinada , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/mortalidad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/terapia , Estadificación de Neoplasias , RadioterapiaRESUMEN
The paper reports a case of ameloblastoma in a patient aged two and half. The natural history of the disease is described together with therapy used.
Asunto(s)
Ameloblastoma/diagnóstico , Neoplasias Mandibulares/diagnóstico , Ameloblastoma/patología , Ameloblastoma/cirugía , Preescolar , Femenino , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Neoplasias Mandibulares/patología , Neoplasias Mandibulares/cirugía , RadiografíaRESUMEN
Certain general aspects of diabetes mellitus (DM) and the diagnostic procedures for assessing metabolic compensation are reviewed. A series of indications to be followed in dental treatment in the DM patient is then reviewed in order to avoid complications.
Asunto(s)
Operatoria Dental/normas , Diabetes Mellitus/terapia , Procedimientos Quirúrgicos Menores/normas , Extracción Dental/normas , Operatoria Dental/métodos , Complicaciones de la Diabetes , Humanos , Complicaciones Intraoperatorias/prevención & control , Procedimientos Quirúrgicos Menores/métodos , Complicaciones Posoperatorias/prevención & control , Extracción Dental/métodosRESUMEN
A brief survey of the relevant literature is followed by an account of the method and techniques employed in combined radiotherapy and polychemotherapy of 32 cases of cancer of the mouth. The results are described, together with the indications and limitations associated with the method. It is suggested that this form of treatment is sound, though it is pointed out that follow-up of the series has not been long.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias de la Boca/terapia , Adulto , Anciano , Quimioterapia Combinada , Estudios de Evaluación como Asunto , Femenino , Humanos , Iridio/uso terapéutico , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/tratamiento farmacológico , Neoplasias de la Boca/radioterapia , Radioisótopos/uso terapéutico , Radioterapia de Alta Energía , Radio (Elemento)/uso terapéuticoRESUMEN
BACKGROUND: Despite the well-known effectiveness of folate therapy on hyperhomocysteinemia in hemodialysis, its benefits on outcome are still unclear. METHODS: Sixty-five patients on thrice-weekly maintenance hemodialysis lasting more than 3 months were followed up for 1 year after stratification by predialysis homocysteine level (tHcy). Parenteral folate (25 mg quarterly) and cobalamine (1 mg quarterly) therapy was started only if the tHcy levels were > 30 uM/L at baseline or at scheduled retests (every 7 months). End points were overall mortality and new ischemic events (affecting heart, brain, or lower extremities). RESULTS: 58.5% of patients received treatment at baseline and achieved a 60% reduction of tHcy. 38.1% progressed to levels of over 30 tHcy at 6 months and were placed on treatment. No other major changes occurred until the end of the study. An excess of both overall mortality (30.8% versus 12.1%; p = 0.075) and vascular morbidity (38.5% versus 12.1%; p = 0.03) occurred in initially untreated patients,those presenting without baseline intermediate to severe hyperhomocysteinemia. CONCLUSIONS: In undertaking hemodialysis, it appears that treating intermediate to severe hyperhomocysteinemia carries better prognosis for outcome than untreated moderate or absent hyperhomocysteinemia. It is uncertain if the benefit of therapy is valid, or if it is confounded by an association between lower tHhy and hidden malnutrition or concomitant diseases.