Spinal cord injury is not negligible after TEVAR for lower descending aorta.

OBJECTIVES: To clarify the incidence of spinal cord injury (SCI) after thoracic endovascular aneurysm repair (TEVAR), we investigate the intercostal/lumbar arteries that supply the Adamkiewicz artery (ICA-AKA). PATIENTS: Among 81 patients subjected to TEVAR, we retrospectively reviewed the clinical records of 50 patients (range: 57-86 (median age: 77) years, 41 males) who underwent TEVAR for part of or the whole distal descending aorta (T7 to L2) after identification of ICA-AKA by magnetic resonance angiography (MRA) or computed tomography angiography (CTA). RESULTS: The 50 patients were classified into group A: 17 patients whose patent ICA-AKA was not covered, group B: 24 patients whose ICA-AKA was covered and group C: nine patients in whom no patent ICA-AKA was identified. Only three patients in group B suffered paraplegia and of them two recovered full ambulation. The estimated incidence of permanent and transient paraplegia was 3.7% in all TEVAR patients, 6.0% when part of or the entire distal aorta was covered and 12.5% when the patent ICA-AKA was covered. The length of aortic coverage in patients with paraplegia was >300 mm. CONCLUSIONS: Paraplegia after TEVAR occurred in one of eight patients in whom the stent graft covered ICA-AKA. Long coverage of the aorta including the ICA-AKA was critical. To prevent this serious complication, identification of the ICA-AKA is crucial.

[Infectious tricuspid valve endocarditis in a chronic hemodialysis patient; report of a case].

We report a rare case of isolated infectious tricuspid valve endocarditis. A 67-year-old male patient with chronic renal failure complained of fever up to 38 degrees C after hemodialysis. WBC was not elevated, but CRP was increased. Transthoracic and transesophageal echocardiography for investigating his chest discomfort demonstrated a large 13 x 25 mm vegetation on the tricuspid valve. Blood culture was negative. The tricuspid valve was replaced with a bioprosthetic valve. The extensive vegetation was found in the anterior, septal and posterior cusps and diagnosed as infectious endocarditis pathologically. The postoperative course was uneventful. WBC and CRP remained normal 9 months after surgery and no signs of recurrence were observed. The cause of the infectious endocarditis seemed to be the insertion of a double lumen catheter for dialysis or the puncture of the arteriovenous shunt.

[The occlusal force distribution on the dental arch restored with implants in uni-lateral molars missing].

The object of this study was to discuss the occlusal force distribution on the dental arch before and after wearing implant-supported prostheses. The occlusal force was measured on four patients missing uni-lateral molars restored with 14 dental implants. The occlusal force distribution was represented as the occlusal force bearing rate (B.R.) which is the percentage of occlusal force on each portion to the total occlusal force. B.R. of the implant portion, of the non-implant side molar portion and of the anterior portion were calculated on four patients. B.R. of the premolar implant portion and of the molar implant portion were calculated on two patients. The pressure sensitive sheets and the image scanner (Dental Prescale 50H type R and Occluzer FPD 703, Fuji Photo Film Co.) were used in this study. The results were as follows: 1. The corresponding occlusal force was also born with the implant portion. Therefore, the total occlusal force increased, and the occlusal force distribution was extended to the same degree as the natural dentition after wearing the implant-supported prostheses. 2. The occlusal force and B.R. on the molar implant portion were considerably large regardless of wearing premolar implants. 3. The occlusal force and B.R. on the most distal implant in any molar portion were almost constant. These results suggested that the implant restoration should be useful for recovering occlusal functions, and that the most distal implant on the dental arch should have the sufficient bearing potential.

[Diagnosis for dental implant using computed tomography and precise implantation using modified stent].

The diagnosis of jaw bones using X-ray computerized tomography is effective to decide the method of implantation, the position of the implant, and the direction for the insertion of the implant. However, it is difficult to apply anatomical information to the superstructures of implants, as well as to prepare implant sockets at the proper site by using an ordinary surgical stent. This would affect the effectiveness of the X-ray computerized tomography considerably. The X-ray computerized tomography with a diagnostic stent has been used in our clinic. CT multiplaner reconstruction images with radiopaque markers are useful to examine the adaptability of implant and to determine an appropriate site of implantation for an ideal prosthesis. Moreover, the diagnostic stent is modified to the surgical stent by drilling guide holes to reproduce a precise direction for inserting implant. By applying this stent, it is possible to reproduce the optimal site and direction for the placement of implant. In this report, two cases, which were treated with diagnosis and the placement of implants by using this technique, were studied. One was a case of overdenture and the other was that of upper anterior prostheses. In both cases, precise implantation was achieved by using this technique.