Prosthesis Complications in Elderly Patients: A Case of a Swallowed Overdenture.

Swallowed or aspirated dentures may result in serious systemic complications and require multidisciplinary attention or intervention. With an increasing number of edentulous elderly patients, such situations are not uncommon occurrences in everyday dentistry. In fact, dentures are the most ingested foreign body in the elderly patient population, and this is a particular risk if the dentures are lacking in stability. The present case report discusses the swallowing of an overdenture by a 95-year-old patient, who underwent endoscopic removal of the foreign body. The aim of this article is to highlight the risks of prosthetic restoration in older patients and the importance of thorough, scrupulous follow-up.

Minimally invasive approach to esophageal lipoma.

Esophageal lipoma is a rare neoplasm with heterogeneous and sometimes life-threatening clinical presentation. We report the case of two patients, a 77-year-old man and a 69-year-old woman presenting with heartburn and dysphagia, and with recurrent vomiting and asphyxia, respectively. Upper gastrointestinal endoscopy and computed tomography were highly suggestive of the diagnosis of esophageal lipoma and identified an intramural and an intraluminal pedunculated mass originating, respectively, from the distal and the cervical esophagus. The first patient was treated by laparoscopic transhiatal enucleation and the second by transoral endoscopic resection under general anesthesia. Both had an uneventful postoperative course and were discharged home on postoperative day 2. Minimally invasive excision of esophageal lipoma is feasible and effective. It may be life-saving in patients with pedunculated tumors who suffer from intermittent regurgitation of a bulky polypoid mass in the mouth causing asphyxia.

Correct use of the contact angle in the evaluation of the protective action induced from polymer coating on the stone.

The control of the protective efficacy obtained on the stone by treatments with polymers is commonly performed through the measure of the static contact angle as it is described by the norm UNI 10921. However this approach does not allow an easy interpretation of the results, because of the porosity and of the heterogeneity of the stone surface, which represent an obstacle to the analysis. Moreover the commonest interpretation of this technique can often bring to important errors. The measure of the static contact angle substantially corresponds to the measure of the so-called "advancing" contact angle and it allows only to verify if on the surface a hydrophobic material is present; unfortunately it cannot determine if the stone is effectively protected. Vice versa, both, the measure of the "true" equilibrium contact angle obtained through a new technique called VIECA, and the measure of the receding contact angle give more coherent parameters which better correlate with the data of absorption of water by capillarity. The equilibrium contact angle corresponds to an "average" description of the surface, the receding angle corresponds, by excess, to the condition of maximum penetration of the liquid by capillarity. From the knowledge of the equilibrium angle of the protective polymer and from the measure of the advancing and receding angles of the protected stone, it is certainly possible to determine what is the minimum polymer quantity to obtain an almost homogeneous stone protection.

Thoracoscopic removal of dental prosthesis impacted in the upper thoracic esophagus.

Dental appliances are the most common cause of accidental foreign body esophageal impaction, especially in the elderly population with decreased oral sensory perception. A 47-year-old man with history of oligophrenia and recurrent epileptic seizures was referred to our hospital following dislocation and ingestion of his upper dental prosthesis. Endoscopic removal and clipping of an esophageal tear had been unsuccessfully attempted. A chest CT scan confirmed entrapment of the dental prosthesis in the upper thoracic esophagus, the presence of pneumomediastinum, and the close proximity of one of the metal clasps of the prosthesis to the left subclavian artery. A video-assisted right thoracoscopy in the left lateral decubitus position was performed and the foreign body was successfully removed. The patient was then allowed to wear the retrieved prosthesis after dentistry consultation and repair of the wire clasps by a dental technician. At the 6-month follow-up visit the patient was doing very well without any trouble in swallowing.

Covered nitinol stents for the treatment of esophageal strictures and leaks.

AIM: To compare 2 different types of covered esophageal nitinol stents (Ultraflex and Choostent) in terms of efficacy, complications, and long-term outcome. METHODS: A retrospective review of a consecutive series of 65 patients who underwent endoscopic placement of an Ultraflex stent (n = 33) or a Choostent (n = 32) from June 2001 to October 2009 was conducted. RESULTS: Stent placement was successful in all patients without hospital mortality. No significant differences in patient discomfort and complications were observed between the Ultraflex stent and Choostent groups. The median follow-up time was 6 mo (inter-quartile range 3-16 mo). Endoscopic reintervention was required in 9 patients (14%) because of stent migration or food obstruction. No significant difference in the rate of reintervention between the 2 groups was observed (P = 0.8). The mean dysphagia score 1 mo after stent placement was 1.9 +/- 0.3 for the Ultraflex stent and 2.1 +/- 0.4 for the Choostent (P = 0.6). At 1-mo follow-up endoscopy, the cover membrane of the stent appeared to be damaged more frequently in the Choostent group (P = 0.34). Removal of the Choostent was possible up to 8 wk without difficulty. CONCLUSION: Ultraflex and Choostent proved to be equally reliable for palliation of dysphagia and leaks. Removal of the Choostent was easy and safe under mild sedation.

Effects on interfacial properties and cell adhesion of surface modification by pectic hairy regions.

Polystyrene Petri dishes, aminated by a plasma deposition process, were surface modified by the covalent linking of two different enzymatically modified hairy regions (HRs) from pectin containing, for example, rhamnogalacturonan-I and xylogalacturonan structural elements. The two polysaccharide preparations share the same structural elements of apple pectin, but the relative amounts and lengths of the neutral side chains present differ. Surface analysis by X-ray photoelectron spectroscopy, contact angle measurement, and atomic force microscope (AFM) force-separation curves was used to characterize the effects on surface chemistry and interfacial forces of the surface modification process. Cell adhesion experiments using continuous L-929 fibroblasts and primary aortic smooth muscle cells were performed to evaluate the effect of the polysaccharide nature on cell adhesion. Results show that immobilization of the HR affects the interfacial field of forces and the cell behavior: "equilibrium" contact angles, obtained by a recently introduced vibrational approach, decrease after HR immobilization reaching a value close to 20 degrees . AFM force-separation curves show a more extended (or softer) interface in the case of the HR bearing longer side chains. Accordingly, depending on the HR preparation, cells shifted from spread morphology and adhesion behavior quantitatively comparable to that observed on conventional tissue culture polystyrene to rounded morphology and significantly lower adhesion. These data show that engineering of plant pectins can be a valuable tool to prepare novel and finely tuned polysaccharides having different chemico-physical and biological properties, to be used in the surface modification of medical devices and materials.