RESUMEN
The purpose of this article was to report the clinical and radiographic findings about a case of a man affected by severely atrophic maxilla to demonstrate the clinical proceedings associated with alveolar reconstruction destined for dental implant rehabilitation. The 3-dimensional augmentation of the alveolar ridge with the use of fresh-frozen bone graft, platelet-rich fibrin membrane, and titanium mesh suggests potential benefits to the development of the bone formation physiology. The treatment combination may result in an optimal prognosis and represents an option for reconstruction of bone defects. At 8 months after surgery, no evidence of complications was observed; the clinical examination and computerized tomographic scan revealed bone formation and installed implant stability.
Asunto(s)
Aumento de la Cresta Alveolar/métodos , Trasplante Óseo/métodos , Implantación Dental Endoósea/métodos , Maxilar/cirugía , Enfermedades Maxilares/cirugía , Fibrina Rica en Plaquetas , Anciano , Aloinjertos , Proceso Alveolar/cirugía , Atrofia/patología , Atrofia/cirugía , Implantes Dentales , Humanos , Masculino , Maxilar/patología , Enfermedades Maxilares/patología , Mallas Quirúrgicas , TitanioRESUMEN
Carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) infections are an emerging cause of death after hematopoietic stem cell transplantation (HSCT). In allogeneic transplants, mortality rate may rise up to 60%. We retrospectively evaluated 540 patients receiving a transplant from an auto- or an allogeneic source between January 2011 and October 2015. After an Institutional increase in the prevalence of KPC-Kp bloodstream infections (BSI) in June 2012, from July 2012, 366 consecutive patients received the following preventive measures: (i) weekly rectal swabs for surveillance; (ii) contact precautions in carriers (iii) early-targeted therapy in neutropenic febrile carriers. Molecular typing identified KPC-Kp clone ST512 as the main clone responsible for colonization, BSI and outbreaks. After the introduction of these preventive measures, the cumulative incidence of KPC-Kp BSI (P=0.01) and septic shocks (P=0.01) at 1 year after HSCT was significantly reduced. KPC-Kp infection-mortality dropped from 62.5% (pre-intervention) to 16.6% (post-intervention). Day 100 transplant-related mortality and KPC-Kp infection-related mortality after allogeneic HSCT were reduced from 22% to 10% (P=0.001) and from 4% to 1% (P=0.04), respectively. None of the pre-HSCT carriers was excluded from transplant. These results suggest that active surveillance, contact precautions and early-targeted therapies, may efficiently control KPC-Kp spread and related mortality even after allogeneic HSCT.