ABSTRACT
@#In the complications of dental implant treatment, the mechanical complications, such as central screw breakage, are often complex and serious. This article analyzes factors that affect the loosening of the central screw. Understanding relevant risk factors can prompt doctors to take corresponding strategies to reduce the possibility of complications in clinical operations. After encountering broken cases, this paper also gives some ideas and methods of treatment, and finally summarizes clinical suggestions for preventing the central screw fracture.
ABSTRACT
Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of acute myocardial infarction. The incidence of VSR has decreased from 1-3% following ST-segment elevation myocardial infarction in the pre-reperfusion era to 0.17-0.31% following primary percutaneous coronary intervention. Survival to 1 month without intervention is 6%. We report a case of a 60-year-old male, admitted in a peripheral hospital with acute anterior wall myocardial Infarction. He was thrombolized with streptokinase. He developed breathlessness at rest and shifted to our hospital for further management. On evaluation in intensive care unit found to have VSR. The patient was in cardiogenic shock. The ventricular septal rupture was successfully closed with a septal occluder device. After which the patient stabilized hemodynamically and was discharged after 8 days.
ABSTRACT
Los aneurismas ventriculares y la ruptura del septum interventricular son complicaciones del infarto agudo del miocardio que pueden acompañarse de alta morbimortalidad. Se reporta el caso de un paciente con formación y ruptura de un aneurisma verdadero de la pared inferior y del septum interventricular inferior después de un infarto agudo de miocardio silente. Se discuten las características clínicas, diagnóstico y manejo de estas complicaciones potencialmente letales.
Ventricular aneurysms and interventricular septal rupture are complications of acute myocardial infarction and thesecomplications may have a high morbidity and mortality. We report the case of a patient with an aneurysm involving theinferior myocardium and the inferior interventricular septum following an acute silent myocardial infarction. The clinicalcharacteristics, diagnosis and management of these potentially lethal complications are discussed.
Subject(s)
Humans , Male , Aged , Heart Aneurysm/diagnosis , Heart Aneurysm/etiology , Costa Rica , Cardiomyopathies/surgery , Cardiomyopathies/complications , Cardiomyopathies/diagnosis , Cardiomyopathies/etiology , Myocardial InfarctionABSTRACT
Objetivo: Conocer las características, estrategia de tratamiento y mortalidad en pacientes con infarto agudo al miocardio y ruptura del septum interventricular posinfarto. Métodos: Se incluyeron 40 pacientes atendidos en un periodo de ocho años por infarto agudo al miocardio complicado con ruptura del septum interventricular posinfarto. Se utilizó ecocardiograma para confirmar la ruptura del septum interventricular posinfarto. Se evaluaron las características clínicas, el tipo de tratamiento y la mortalidad hospitalaria. Las variables se compararon con prueba U de Mann-Withney o prueba exacta de Fisher. Resultados: Edad 64 años (56 a 73), 67% hombres, 53% diabetes, 43% hipertensión, 40% tabaquismo. Los tratamientos fueron: conservador 45%, quirúrgico 38% o dispositivo Amplatzer 17%. La mortalidad general fue de 65%, con manejo conservador 54%, con cirugía 35% y con Amplatzer 12% (p = 0.02), y estuvo asociada a menor tiempo entre infarto agudo al miocardio y ruptura del septum interventricular posinfarto (p <0.001) y menor tiempo entre ruptura del septum interventricular posinfarto y tratamiento de cierre (p <0.001). Todos los pacientes con Killip Kimbal III o IV murieron. Conclusiones: Hasta el momento no existe una estrategia de manejo en la ruptura del septum interventricular posinfarto que demuestre ventajas sobre las demás. El único marcador de buen pronóstico podría ser el mayor tiempo entre la ruptura y el tratamiento de cierre. Es probable que la indicación de manejo de las guías internacionales no aplique para todos los pacientes y estos deban estratificarse de acuerdo a su estado hemodinámico.
Objective: To identify the characteristics, management strategy and mortality of patients with acute myocardial infarction (AMI) and rupture of ventricular septum (RVS). Methods: The study included 40 patients admitted during a period of 8 years, due to AMI complicated with RVS. RVS was confirmed by echocardiogram. The clinical characteristics, type of treatment and hospital mortality were evaluated. Variables were compared by Mann-Withney U tests or Fisher exact test. Results: Patients were 64 years old (56 - 73), 67% men, 53% diabetes mellitus, 43% hypertension, 40% smokers. Treatments were medical (45%), surgical (38%) or Amplatzer (17%). Overall mortality was 65%, in conservative group was 45%, in surgery group 38%, and Amplatzer group 17% (p = 0.02), it was associated to shorter time between AMI and RVS (p <0.001) and shorter time between and treatment (p <0.001). All patients with Killipp Kimbal III or IV died. Conclusions: Currently there is no management strategy in RSV with demonstrated advantage over other strategies. The only marker with good prognosis could be a long time between rupture and treatment. It is likely that the indication of management of International guidelines does not apply to all patients and these should be stratified according to their hemodynamic status.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Ventricular Septal Rupture/diagnosis , Ventricular Septal Rupture/therapy , Myocardial Infarction/complications , Retrospective Studies , Ventricular Septal Rupture/etiologyABSTRACT
Propósito: El presente artículo es un estudio prospectivo de las tasas de éxito implantaria y de las complicaciones mecánicas y biológicas en el tratamiento rehabilitador implanto-asistido del sector posterior de la maxila, mediante provisionalización inmediata. Material y Método: El estudio clínico observó a 21 sujetos desdentados parciales unitarios del sector posterior maxilar, con reborde cicatrizado y antagonista dentario natural, por un período de 6 meses, en los que se insertaron implantes cónicos roscados de conexión interna, con tratamiento de superficie, temporizados inmediatamente después de insertados en el hueso maxilar, mediante la confección de una corona de resina acrílica sobre un pilar temporal de titanio atornillada directa al implante, dejados sin contactos dentarios durante la máxima intercuspidación (MIC) y movimientos excéntricos mandibulares. Todas las restauraciones fueron observadas durante un período de 6 meses, evaluando tasa de éxito implantario, complicaciones biológicas y mecánicas. Resultados: Se insertaron 25 implantes en 21 pacientes, obteniéndose un valor promedio de inserción de torque quirúrgico de 45.6 Nt. Durante el período de observación clínico se presentó un 100 por ciento de éxito de sobrevida implantario, no se detectaron complicaciones biológicas, pero sí se presentaron complicaciones mecánicas por fractura de una cúspide vestibular de una restauración provisional acrílica y dos aflojamientos de tornillos. Conclusiones: La temporización unitaria mediante provisorio atornillado es un protocolo predecible y confiable que permite el proceso de oseointegración y la coexistencia en salud de tejido periimplantario y su sistema protésico.
Purpose: This article is a prospective study of implant success rates and of mechanical and biological complications in the assisted-implant rehabilitation treatment of the posterior maxilla by immediate temporization. Material and Methods: The clinical study observed 21 partially edentulous subjects with lip scar and antagonistic natural teeth in the posterior maxilla for a period of 6 months in which conical threaded internal implant connections were inserted with a surface treatment and timed immediately after being inserted into the jawbone by producing an acrylic resin crown on a temporary titanium abutment screwed directly into the implant and left without tooth contacts during the Maximal Intercuspal (MIC) and mandibular eccentric movements. All restorations were observed over a period of 6 months evaluating implant success rate and biological and mechanical complications. Results: 25 implants were inserted into 21 patients yielding an average surgical insertion torque of 45.6 Nt. During the clinical observation there was 100 percent success of implant survival. No biological complications were detected, but there were mechanical complications - a buccal cusp fracture of an acrylic provisional restoration and two screws loosening. Conclusions: The unit temporization by temporary screwing is a predictable and reliable protocol that allows osseointegration and the coexistence in the health of peri-implant tissue and its prosthetic system.
Subject(s)
Humans , Adult , Dental Implants, Single-Tooth , Immediate Dental Implant Loading , Jaw, Edentulous, Partially , Maxilla/surgery , Crowns , Dental Implantation, Endosseous/methods , Osseointegration , Postoperative Complications , Prospective Studies , Treatment OutcomeABSTRACT
Apesar de comumente citada como complicação mecânica do infarto agudo do miocárdio, a comunicação interventricular (CIV) ocorre com frequência cada vez menor após o advento da terapia trombolítica. Neste relato, os autores descrevem o caso de um homem de 54 anos com CIV após 8 dias de infarto de parede inferior, com características clínicas, eletrocardiográficas e ecocardiográficas peculiares e uma ótima evolução após cirúrgia cardíaca.
Despite being commonly referred to as a mechanical complication of acute myocardial infarction, ventricular septal rupture (VSR) has occurred less andless frequently since the breakthrough ofthrombolytic therapy. In this case report, the authors describe a 65-year-old man with a VSR 8 days after an inferior wall infarction, with particular clinical, electrocardiographic, and echocardiographic features and an excellent outcome after cardiac surgery.