Implant supported dentures: an estimation of chewing efficiency.

BACKGROUND: Treatment of edentulous patients is one of the most demanding tasks the dentist can meet in his everyday practice. Implant based methods help to improve functioning of dentures and life quality of so treated patients. OBJECTIVES: The aim of the study was to evaluate the chewing efficiency of patients treated with lower complete implant-supported overdentures and the simultaneous evaluation of treatment results by patients. MATERIALS AND METHODS: For the investigation were chosen edentulous patients, treated with upper conventional complete dentures and lower complete overdentures supported on two implants. In this group of patients, were conducted investigations of chewing efficiency changes, based on the Optocal test and overdentures functioning evaluation made by patients in the survey. RESULTS: The objective evaluation of the chewing efficiency indicated the decrease of this value in the five years of observations. Lower complete overdentures supported on implants significantly increased the comfort of chewing of edentulous patients. CONCLUSIONS: The results of the study let us to assess positively the result of the therapy using titanium implants and lower complete overdentures. The therapy described significantly increases the life comfort of the edentulous patients. Decreasing chewing efficiency indicated by the research result should be compensated with the dentures maintaining or the prostheses exchange after about five years of use.

The use of DSM-IV and ICD-10 criteria and diagnostic scales for delirium among cardiac surgery patients: results from the IPDACS study.

Diagnostic accuracy of different diagnostic systems in estimating the incidence of delirium among surgery patients has not been investigated to date. Therefore, the authors evaluated the frequency of delirium according to DSM-IV and ICD-10 criteria and the cutoff values of the Memorial Delirium Assessment Scale (MDAS) and Delirium Index in 563 patients undergoing cardiac surgery. DSM-IV criteria were found as more inclusive, while ICD-10 criteria were more restrictive in establishing a diagnosis of postoperative delirium. The cutoff scores of 10 on the MDAS and 7 on the Delirium Index were optimal to the presence or absence of delirium.

Incidence and predictors of delirium after cardiac surgery: Results from The IPDACS Study.

OBJECTIVE: Delirium after cardiac surgery is a serious complication that results in higher morbidity and mortality rates, and prolongs hospitalisation. However, the knowledge base regarding the issue of postoperative delirium is still limited. Therefore, in the current study, we evaluated the incidence and independent perioperative risk factors of delirium after cardiac surgery. METHODS: The IPDACS Study recruited 563 consecutive patients undergoing cardiac surgery with cardiopulmonary bypass. The subjects were preoperatively examined by psychiatrists using the Mini-Mental State Examination and the Mini International Neuropsychiatric Interview to assess psychiatric comorbidity. Additionally, other variables connected to the patients' medical condition and surgical and anaesthetic procedures were evaluated. A diagnosis of delirium following surgical intervention was based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. RESULTS: The incidence of postoperative delirium according to DSM-IV criteria was 16.3% (95% confidence interval: 13.5-19.6). Multivariate stepwise logistic regression analysis revealed that advanced age, preoperative cognitive impairment, an ongoing episode of major depression, anaemia, atrial fibrillation, prolonged intubation and postoperative hypoxia were independently associated with delirium after cardiac surgery. CONCLUSION: According to the current analysis, the aforementioned conditions independently predispose to delirium following cardiac surgery. Since some of these factors can be successfully treated and eliminated preoperatively and postoperatively, this study should be helpful in reducing the risk of delirium and in improving the medical care of patients undergoing cardiac surgery (Clinical Trials Identifier: NCT00784576).

Atrial fibrillation as a nonpsychiatric predictor of delirium after cardiac surgery: a pilot study.

BACKGROUND: Preoperative atrial fibrillation (AF) increases the risk of cardiac surgery and the occurrence of postoperative complications, including arrhythmias, low-output syndrome, delirium, and death. The aim was to evaluate its direct influence on prognosis of patients subjected to cardiac surgery. MATERIAL/METHODS: This is a pilot study of the CODACS trial (COnsciousness Disorders After Cardiac Surgery). Two hundred sixty patients admitted for open-heart surgery were prospectively included in the study. Preoperative AF was diagnosed on the basis of multiple electrocardiographic examinations and confirmed by 24-h Holter monitoring. Diagnosis of delirium following surgical intervention was based on DSM-IV criteria. RESULTS: Preoperative AF was diagnosed in 23 patients (8.8%): in 15 patients in the nondelirious group (7%) and 8 (27.0%) in the delirious group. Preoperative AF was an independent predictor of postoperative delirium (p<0.001), increasing its risk of occurrence over sevenfold (OR=7.2). AF also increased the risk of such postoperative complications as supraventricular arrhythmia (AF: 78.3% vs. non-AF: 22.8%, p<0.001), stroke (8.7% vs. 1.3%, p<0.001), and low-output syndrome (21.7% vs. 17.3%, p=0.033) and worsened prognosis, significantly increasing the risk of death (8.7% vs. 0.8%, p<0.001). CONCLUSIONS: Preoperative AF was an independent risk factor of postoperative delirium (OR=7.2). It was also associated with significantly worse postoperative outcome (supraventricular arrhythmia, stroke, low-output syndrome, and risk of death). These results and data from available studies suggest that preoperative AF should be considered as an important predictor of postoperative outcome. This problem should be the subject of future research to establish beneficial treatment options.

Clinical utility and use of DSM-IV and ICD-10 Criteria and The Memorial Delirium Assessment Scale in establishing a diagnosis of delirium after cardiac surgery.

Authors evaluated the sensitivity and specificity of DSM-IV and ICD-10 criteria and the cutoff value of the Memorial Delirium Assessment Scale (MDAS) in diagnosing postoperative delirium in 260 cardiac surgery patients. Incidence of delirium diagnosed on the basis of DSM-IV and ICD-10 criteria, and with the use of the MDAS was 11.5%, 9.2%, and 6.5%, respectively. The DSM-IV criteria for delirium were found to be more inclusive than those of ICD-10. The cutoff point of 10 of the MDAS was optimal in relation to the presence or absence of delirium after cardiac surgery.

Preoperative predictors of delirium after cardiac surgery: a preliminary study.

Preoperative risk factors of postoperative delirium were evaluated in 260 patients admitted for open heart surgery. The incidence of delirium was 11.5%. Independent predictors included cognitive impairment, atrial fibrillation, a history of peripheral vascular disease major depression and advanced age. Aforementioned factors might be helpful in predicting delirium following cardiac surgery.

L-arginine improves hemodynamic function and coronary flow in an experimental model of ischemia-reperfusion injury.

BACKGROUND: Ischemia and reperfusion injury decrease the release of nitric oxide by vessels endothelial cells, which influences postischaemic coronary flow and return of left ventricle haemodynamic function. The study was conducted to answer the question how addition of L-arginine in cardioplegic and reperfusion fluids influences nitric oxide release, inducing the coronary flow and postischaemic haemodynamic heart function. MATERIALS AND METHODS: The research was conducted on 56 rats, divided randomly into seven groups: control (C) and six experimental groups (E), where L-arginine was administrated in increasing doses of 0.3, 3.0 and 30.0 mM/L to cardioplegic (E1, E2 and E3 group) or reperfusion solution (E4, E5 and E6 group). To simulate a course of cardiac surgery the following stages of experiment were carried out: initial perfusion on the nonworking and working heart, cardioplegia, cold cardioplegic arrest and reperfusion of the non-working and working heart. RESULTS: Level of nitric oxide during cardioplegic perfusion decreased in all groups. During reperfusion on non-working and working heart model we noticed the significant increase of nitric oxide for all groups. Along with nitric oxide increase, coronary flow increases, whereas with the decrease of level of nitric oxide, the coronary flow also diminished. During cardioplegic perfusion coronary flow constantly decreased in all groups and during reperfusion we observed the new increase of coronary flow. In groups E1, E2 and E3 the increase of coronary flow was significant. CONCLUSIONS: Obtained data suggest that administration of L-arginine in the preischaemic and in the initial phase of reperfusion stimulates increase in nitric oxide release what is positively correlated with the increase of coronary flow.

[Evaluation of surgical treatment of mitral valve defect in patients with chronic renal failure]. / Ocena wyników leczenia operacyjnego wady zastawki mitralnej u chorych z przewlekla niewydolnoscia nerek.

UNLABELLED: Renal failure of patients qualified for open-heart surgical treatment seems to be very important problem since years. The operation with extracorporeal circulation is large burden for kidneys and there is huge risk of intensifying of existing failure. The aim of the study was the evaluation of renal parameters, complications occurrence and mortality of patients with chronic renal failure (ChRF) (grade II--mild ChRF) subjected to mitral valve replacement. MATERIALS AND METHODS: To retro- and prospective analysis were subjected 34 patients with severe mitral valve defect, subjected to operation between 1998 and 2002 in Department of Cardiac Surgery in Lodz. All patients included to study had increased level of creatinine--1, 5-3, 0 mg/dl (at least in three measurements). All examined patients were subjected to artificial mitral valve replacement and 13 patients to simultaneous tricuspid valve plastic surgery. Postoperative evaluation of clinical condition and renal parameters was performed twice: early (till 30 day after operation) and long-term (after meanly 14 months). RESULTS: In seven patients, in early postoperative period, it was necessary to implement extracorporeal dialysis with artificial kidney dialysis machine. Among these patients we ascertained three deaths (intrahospital mortality was 8.8%). During long-term observation we noted two cases of infective endocarditis requiring reoperation and re-implantation of mitral valve. During this time of observation only one death was noted (post-hospital mortality was 3.2%). CONCLUSIONS: Dysfunction of kidneys, even in mild degree, causes significant increase of risk of early death (about 2.5 times). In most research population in long-term observation we ascertained the large improvement of kidney functions (significant decrease of creatinine level; p < 0.001). Concomitant tricuspid valve regurgitation, requiring plastic surgery is an additional factor incriminating long-term results of surgical treatment.

[Aortic valve replacement in patients with heart failure]. / Wymiana zastawki aortalnej u chorych z niewydolnoscia miesnia serca.

UNLABELLED: Severe aortic regurgitation and stenosis are urgent indication for aortic valve replacement in patients with left ventricular dysfunction, however the effect of cardiac surgery may differ in both groups. The aim of the study was to evaluate the early changes of haemodynamic parameters of heart: ejection fraction, endsystolic and enddiastolic left ventricle diameters, endsystolic and enddiastolic left ventricular wall thickness and left atrium diameter, depending on ejection fraction value (EF), in patients undergoing aortic valve replacement due to isolated aortic stenosis or regurgitation. MATERIALS AND METHODS: 250 patients engaged to the study were subjected to the mechanical aortic valve replacement in Cardiac Surgery Department in Lodz. All patients were divided into two groups--patients operated due to aortic regurgitation and aortic stenosis. Then each group, depending on EF volume before operation, was divided into two subgroups (A - EF between 35 and 50%; B - EF below 35%). RESULTS: Comparing the pre- and early postoperative period, ejection fraction rose markedly in both subgroups of patients with aortic stenosis and the highest increase was ascertained in subgroups A. Analyzing endsystolic and enddiastolic left ventricle diameters we observed the reduction of left ventricle diameters in all groups. Evaluating endsystolic left ventricular wall thickness we observed the increase of wall thickness in both subgroups B. Analogically enddiastolic left ventricular wall thickness increased in all analyzing groups, whereas in groups with lowest fraction the rise was essential. CONCLUSIONS: Aortic valve replacement both due to aortic stenosis and regurgitation is associated with improved haemodynamic status in early postoperative period.

Blood serum levels of IL-2, IL-6, IL-8, TNF-alpha and IL-1beta in patients on maintenance hemodialysis.

Cytokines are essential mediators of immune response and inflammatory reactions. Patients with chronic renal failure (CRF) commonly present with abnormalities of immune function related with impaired kidney function and the accumulation of uremic toxins in addition to bioincompatibility of dialyzer membranes. During a hemodialysis (HD) session, cytokines are released mainly by monocytes activated by endotoxin-type compounds in dialyzer fluid, complement factors and direct contact with dialyzer membrane. The study included 15 CRF patients, aged 36.4 +/- 2.9 years, on regular HD maintenance therapy for mean 68 +/- 10 months and 15 healthy controls. It was designed to assess serum levels of a panel of inflammatory cytokines: IL-1beta, IL-2, IL-6, IL-8 and TNF-alpha in CRF patients on regular maintenance HD before, 20, 60 and 240 minutes of a single HD session in parallel with C-reactive protein (CRP) as an additional parameter. CRP concentration was increased in HD patients when compared with healthy controls. The concentrations of IL-1, IL-6, IL-8 and TNF-alpha were increased, whereas the serum level of IL-2 was not altered during a single HD session.

Risk factors of atrial fibrillation following coronary artery bypass grafting: a preliminary report.

BACKGROUND: To evaluate the risks factors of atrial fibrillation (AF) following coronary artery bypass grafting (CABG). METHODS AND RESULTS: Twelve hundred patients subjected to CABG were included. Postoperative AF developed in 278 patients (23.2%). Statistical analysis identified 5 independent predictors of AF: advanced age, history of supraventricular arrhythmias, preoperative heart failure, operation with standard CABG technique and repeated revascularization. CONCLUSIONS: Postoperative AF caused a significant increase in mortality and hospitalization length. There were 4 independent risk factors of postoperative AF. Administration of beta-blockers and the OPCAB (off-pump CABG) operating technique were identified as protective factors.

[Prevention and treatment of atrial fibrillation following cardiac surgery]. / Zapobieganie i leczenie migotania przedsionków po operacjach serca.

Atrial fibrillation is the most common complications after cardiac surgery, occurring in 20-60% of patients depending on definition and diagnostic methods. Usually appears between 2 and 4 day after operation and often turns back during first 30 days in postoperative time. Treatment of this complication is often protracted, requiring increased monitoring and hospital resources, and extending hospital length of stay Clinical consequences can be significant and include hemodynamic instability and stroke. Recently we can see the increase of atrial fibrillation's frequency occurrence. It is related both with enlargement of patients qualified to cardiac operations and with more and more severe conditions of patients subjected to surgery. Despite of existence unique guidelines there are still many doubts, regarding to choice of antiarrhythmic agent, optimal time of therapy initiation or performing invasive treatment. Atrial fibrillation influences the worsening of patient's postoperative condition (e.g. significantly increasing postoperative mortality) and considerably increases the costs of hospitalization. Therefore competent prevention and suitable treatment of postoperative atrial fibrillation is one of the most important tasks for cardiac surgeons or clinicians who manage the patients after cardiosurgical operations.

Immunological aspects of the statins' function in patients with heart failure: a report from the Annual Conference of ESC - Heart Failure 2005.

The annual meeting of the Heart Failure Association of ESC in Lisbon, in June 2005, was exceptionally successful. There were many very interesting presentations and workshops with the unique title: Statins in heart failure- Cholesterol-lowering is not the only goal. Heart failure (HF) is a progressive disease with coronary artery disease (CAD) as the most often underlying etiology. Treatment to prevent progression of heart failure has been targeted to reverse the consequences of HF and to a less extent the cause - the atherosclerotic plaque itself. On the average 50% of patients with heart failure are treated with lipid intervention. Lipid-lowering treatment with statins clearly reduces morbidity and mortality of patients with documented CAD. Since the prevalent etiology of heart failure is CAD, its prevention may reduce heart failure progression. However, recent studies suggest that pleiotropic effects of statins are more important than the influence related to their cholesterol lowering mechanism. Furthermore it is suggested that low levels of circulating lipoproteins and cholesterol may be independent predictors of impaired outcome in patients with heart failure. There are some possible explanations for this finding. High levels of cholesterol can be beneficial to heart failure patients; cholesterol-rich serum lipoproteins are able to modulate inflammatory immune function because they bind and detoxify bacterial lipopolysaccharide, a very strong stimulator of the release of proinflammatory cytokines that promote heart failure progression and death. So current recommendations strongly emphasize that the aim of treatment of HF is not to lower cholesterol.

[L-arginine in reperfusion solution as a heart protecting factor]. / L-arginina w plynie reperfuzyjnym jako czynnik dzialajacy protekcyjnie na miesien serca.

UNLABELLED: Ischemia-reperfusion damage causes injury to both cardiomyocytes and endothelial cells. Loss of endothelium function and degeneration of cardiomyocytes can significantly deteriorate postoperative efficiency of cardiac muscle and in this way can threaten patients' life. The goal of the study was examination how addition of L-arginine to the reperfusion solution influences development of ultrastructural exponents of cardiac muscle injury during reperfusion. MATERIAL AND METHODS: The study was conducted with the use of isolated rat's hearts (Wistar strain), undergoing 20-minute introductory perfusion, 30-minute cardioplegic pause, and then reperfusion conducted on non-working and working heart model, with (study group) and without (control group) the use of L-arginine. RESULTS: Microscopic exponents of injury in cardiomyocytes were most pronounced in the control group. After addition of L-arginine to the reperfusion solution, the decrease in the number of construction points, reduction in overhydration of intra- and extracellular spaces, with diminishing of endothelium vessels' pinocytic activity and decrease in the degree of sarcolemma plication were observed in the study group in comparison with the control group. Increasing of L-arginine doses enhanced slightly its protective activity on the ultrastructure of cardiac muscle. CONCLUSION: Addition of L-arginine to the reperfusion fluid protects cardiomyocytes and endothelium vessels. These positive changes are not recorded in all cardiac muscle specimens.

[The role of inflammation in the pathogenesis of atherosclerosis]. / Rola zapalenia w patogenezie miazdzycy.

Inflammation plays an important role in the initiation and progression of coronary artery disease and the precipitation of acute coronary events. However, the inflammatory triggers are still poorly understood. Histologically, unstable atherosclerotic plaque contains activated macrophages and T lymphocytes, adhesion molecules, chemokines and cytokines, matrix-degrading enzymes and prothrombotic factors. Circulating inflammatory markers such as C-reactive protein (CRP), fibrinogen, and interleukins (especially IL-6) are increased in high-risk groups of patients and predict future risk.

[The role of infection in the pathogenesis of atherosclerosis]. / Rola zakazeniaw patogenezie miazdzycy.

Experimental models and human studies have supported a role of infection in the initiation of atherosclerosis. There are many known microorganisms who can play an important role in atherosclerosis, but especially two of them--Chlamydia pneumoniae and Cytomegalovirus are suspected to stimulate the process of atheromatosis. Until antibiotics or vaccines are useful in artery diseases prevention, therapies with proven vascular anti-inflammatory effects (diet, exercise, smoking cessation, aspirin, statins) should be optimized.

[The influence of L-arginine on secretion of nitric oxide and haemodynamic function of isolated rat's heart subjected to cold cardioplegic ischemia and reperfusion]. / Wplyw L-argininy na wydzielanie tlenku azotu i funkcje hemodynamiczna izolowanego miesnia sercowego szczura poddanego zimnemu kardioplegicznemu niedokrwieniu i reperfuzji.

BACKGROUND: L-arginine is a precursor of nitric oxide (NO), which is formed endogenously as a result of reaction catalyzed by synthase NO (NOS). Administration of L-arginine to cardioplegic solution St. Thomas Hospital N 2 or used during reperfusion of heart can facilitate the return of left ventricle function after hypothermic ischaemia through increase of release of nitric oxide and preservation of endothelial cells functions. Positive effects of these researches could have extremely beneficial application in clinical practice, improving results of cardiosurgical operations conducted in extracorporeal circulation. OBJECTIVE: How addition of L-arginine to cardioplegic solution or during reperfusion influences secretion of nitric oxide, coronary flow and haemodynamic function of heart. METHODS: The research was conducted on isolated heart model of rats (Wistar inbreeding). The research was carried out in order: 20-minutes initial perfusion, 30-minutes cold cardioplegic arrest with or without addition of L-arginine and reperfusion with Krebs-Henseleit's solution with or without addition of L-arginine. RESULTS: Addition of L-arginine in the preischemic period and during reperfusion stimulates increase of nitric oxide secretion, what positively correlates with increasing of coronary flow. Addition of L-arginine to cardioplegic solution significantly increases coronary flow and cardiac output what improves postischaemic haemodynamic function of heart.

Effect of L-arginine on overhydration and ultrastructure preservation of rat's heart exposed to cold cardioplegic ischaemia.

UNLABELLED: ISCHAEMIA: Reperfusion damage causes injury both cardiomyocytes and endothelial cells. Loss of endothelium function and heart cells degeneration can be essential for deterioration of postoperative efficiency of heart and in this way can threaten patients' life. OBJECTIVE: How addition of L-arginine to cardioplegic solution influences development of ultrastructural degeneration indications of rat's heart exposed to cold cardiolegic ischemia. METHODS: The research was conducted on isolated heart model of 56 rats, divided into seven equal groups. The hearts were prepared with modified Neely's method and were perfused with the use of apparatus in accordance with modified Langedorf's method. The research was carried out in order: initial perfusion of the non-working and working heart, perfusion with cardioplegic solution, cold cardioplegic arrest with or without addition of L-arginine. RESULTS: In the microscopic preparations of rat's heart in the control group (P) numerous focal performing contraction nodes were found. Intumescent vessels' endothelium included a large number of pinocytal vesicles. In the ultrastructural examination of group DI heart preparations there were less contraction nodes than in control group. The widening of endoplasmatic reticulum's channels and system T was essentially smaller comparing with group P. Less widening of perivascular zone and less number and size of pinocytal vesicles were also observed. In group 2 further decreasing of contraction nodes number was revealed. The structure of capillary was preserved and number of pinocytal vesicles was still decreasing. Further standardization of ultrastructural picture of cardiomyocytes and perivascular zone was found in group 3. CONCLUSION: In control group (P) microscopic degeneration indications of rat's heart were the most intensified. Addition of L-arginine to cardioplegic solution influenced decreasing of intensification of heart degeneration indications. Increasing of L-arginine doses added to cardioplegic solution positive correlates with protective effect of L-arginine on heart ultrastructure.

Effect of L-arginine on oxygen consumption and haemodynamic function of rat's heart exposed to cold cardioplegic ischaemia and reperfusion.

BACKGROUND: Ischaemia--reperfusion damage causes injury of all heart cells. Loss of endothelium function and biologically active substances secreted by it can be essential to development of the damage. Ischaemia and reperfusion decreases the release of nitric oxide, which influences postischaemic coronary flow and return of ventricular function. Administration of L-arginine to cardioplegic and reperfusion solution can improve protection of heart and cause the return of left ventricular function after hypothermic ischaemia through preservation of endothelial cell functions and increase of release of nitric oxide. OBJECTIVE: How addition of L-arginine to cardioplegic solution influences oxygen consumption by myocardium and its postischaemic haemodynamic function. METHODS: The research was conducted on isolated heart model of 56 rats, divided into seven equal groups. The hearts were prepared with modified Neely method and were perfused with the use of apparatus in accordance with modified Langendorf method. The research was carried out in the following order: initial perfusion of the non-working and working heart, perfusion with cardioplegic solution, cold cardioplegic arrest and reperfusion of the non-working heart. RESULTS: During initial perfusion, oxygen consumption was comparable in all groups. During cardioplegic perfusion, oxygen consumption was reduced in every group. At the time of reperfusion of non-working heart model, consumption of oxygen was increased. During reperfusion of the working heart, the lowest oxygen consumption was noted in group P, the highest in group DI. The decrease in cardiac output during postischaemic period was noted in control group and groups where L-arginine was added to reperfusion solution. CONCLUSION: Addition of L-arginine to cardioplegic solution significantly decreases oxygen consumption by myocardium. L-arginine added to cardioplegic solution improves postischaemic haemodynamic function of heart.