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1.
Braz Dent J ; 31(1): 25-31, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32159701

RESUMEN

The purpose of this study was to evaluate the presence of residues after post space preparation (PSP) and establish whether the apical displacement of the gutta-percha was affected by the moments and methods of PSP in teeth filled by the single-cone technique. The root canals of 20 bovine incisor teeth were instrumented with Reciproc and filled with single-cone and AH Plus. The specimens were divided into 4 groups according to the moment and method of PSP (n=5): immediate with drill, immediate with thermoplasticizer, delayed with drill and delayed with thermoplasticizer. Micro-CT scans were performed before and after the PSP for residues of the root canal filling (1) and analysis of apical displacement (2). Data were analyzed by using 2-way repeated measurement ANOVA (1) and 2-way ANOVA (2) followed by the Tukey's test (a=0.05). Significance effect on the residues percentage remaining for methods (p=0.044), for moments (p=0.006), for thirds repetition (p<0.001), and for interaction between methods and thirds (p<0.001), and moments and thirds (p=0.044). Significance effect on the apical displacement of root canal filing was detected for methods (p=0.008), however no difference was found between moments (p=0.617). In general, PSP using drill resulted in more homogeneous root canal preparation, mainly when made immediately. For all other combinations between methods and moments for PSP, the middle and apical thirds presented significant higher residues remaining. Thermo method performed in both moments and the drill method performed immediately had displacement in the apical direction, representing extrusion of the root filling material.


Asunto(s)
Cavidad Pulpar , Materiales de Obturación del Conducto Radicular , Animales , Bovinos , Gutapercha , Retratamiento , Obturación del Conducto Radicular , Preparación del Conducto Radicular , Microtomografía por Rayos X
2.
Medicine (Baltimore) ; 99(5): e18956, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000420

RESUMEN

Intussusception is common emergency condition in children. Pneumatic or hydrostatic reduction (HR) is considered the first-choice management strategy in cases lacking indications for surgical intervention. Generally, sedatives are not used in children undergoing interventional radiology procedures. Surgical management is associated with long hospitalization durations and high costs, unlike nonsurgical reduction. To avoid surgery, reduction procedures are repeated despite initial treatment failure. However, in cases involving repeated failures, children should be referred for surgery.To ensure good response to reduction, we planned HR under sedation during the third reduction attempt. Sedative reduction (SR) was performed with the administration of ketamine, midazolam, and atropine. All patients with contraindications against HR underwent laparoscopic reduction (LR) without HR.During 3 years, SR was performed in 43 patients, and in 28 (65.1%), the treatment was successful. Among the 15 patients in whom the procedure failed, 14 underwent LR without intestinal resection. There was no significant risk factor contributing to failed reduction under sedation.During the second or third HR attempt, successful reduction may be ensured with the SR procedure with intravenous ketamine, midazolam, and atropine; this procedure may further reduce surgery rates in pediatric intussusception.


Asunto(s)
Hipnóticos y Sedantes/uso terapéutico , Intususcepción/terapia , Administración Intravenosa , Atropina/uso terapéutico , Preescolar , Femenino , Humanos , Lactante , Ketamina/uso terapéutico , Laparoscopía , Masculino , Midazolam/uso terapéutico , Retratamiento , Estudios Retrospectivos , Resultado del Tratamiento
3.
Anticancer Res ; 40(2): 1141-1146, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32014966

RESUMEN

BACKGROUND/AIM: This study aimed to assess the efficacy and toxicity of second-line chemotherapy, especially combination chemotherapy, for advanced or metastatic urothelial cancer. PATIENTS AND METHODS: This retrospective analysis included patients who received second-line chemotherapy after disease progression during first-line chemotherapy between January 2009 to May 2018. Progression-free survival (PFS), overall survival (OS) and toxicity associated with second-line chemotherapy were assessed. RESULTS: In total 25 patients received second-line chemotherapy; 21 patients had combination chemotherapy and 4 had single-agent chemotherapy. Median PFS and OS were 3.6 months (range=0.2-23.5) and 11.9 months (range=0.5-29.0), respectively. Twenty patients (80%) exhibited grade 3 or more severe toxicities. CONCLUSION: PFS and OS benefits of second-line combination chemotherapy corresponded to those of the phase 3 study of pembrolizumab, but adverse events were more severe. Pembrolizumab is potentially a better second-line treatment than combination chemotherapy.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Uretrales/tratamiento farmacológico , Neoplasias Uretrales/patología , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de Neoplasias , Retratamiento , Resultado del Tratamiento , Neoplasias Uretrales/diagnóstico por imagen
4.
Ann R Coll Surg Engl ; 102(2): 141-143, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31660754

RESUMEN

INTRODUCTION: Colonic stent insertion has been shown to be an effective treatment for patients with acute large bowel obstruction, either as a bridge to surgery or as definitive treatment. However, little is known of the role of secondary stent insertion following primary stent failure in patients considered inappropriate or high risk for emergency surgery. METHODS: Fourteen patients presenting with acute large bowel obstruction who had previously been treated with colonic stent insertion were studied. All underwent attempted placement of a secondary stent. RESULTS: Technical deployment of the stent was accomplished in 12 patients (86%) but only 9 (64%) achieved clinical decompression. Successful deployment and clinical decompression of a secondary stent was associated with older age (p=0.038). Sex, pathology, site of obstruction, duration of efficacy of initial stent and cause of primary failure were unrelated to outcome. No procedure related morbidity or mortality was noted following repeated intervention. CONCLUSIONS: Secondary colonic stent insertion appears an effective, safe treatment in the majority of patients presenting with acute large bowel obstruction following failure of a primary stent.


Asunto(s)
Enfermedades del Colon/cirugía , Descompresión Quirúrgica/instrumentación , Obstrucción Intestinal/cirugía , Complicaciones Posoperatorias/epidemiología , Stents , Factores de Edad , Anciano , Anciano de 80 o más Años , Descompresión Quirúrgica/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Retratamiento/instrumentación , Insuficiencia del Tratamiento , Resultado del Tratamiento
5.
J Endod ; 46(1): 44-50, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31740065

RESUMEN

INTRODUCTION: The goal of regenerative endodontic treatment (RET) is to regenerate the pulp-dentin complex in immature teeth with pulp necrosis. There is no consensus in using RET in previously treated teeth. This article reports on long-term outcomes of RET in previously treated immature teeth. METHODS: Previously treated immature teeth with signs/symptoms of failure were included. After local anesthesia and rubber dam isolation, the root canal filling material was removed without the use of chemical solvents. The root canals were irrigated with 6% sodium hypochlorite using an EndoVac (Kerr Endodontics, Culver City, CA), and a creamy mix of metronidazole and ciprofloxacin was placed in the canals for 4 weeks. At the second visit, the antibiotic dressing was removed using 17% EDTA. Bleeding was induced into the root canal space, and SynOss Putty (Collagen Matrix Inc, Oakland, NJ) was placed. Bioceramic putty was placed over the SynOss Putty, and the teeth were restored at a subsequent visit. RESULTS: Five teeth in 4 patients were included. The patients' ages ranged from 14-46 years. Recall examinations were performed from 20 to 72 months with an average of 54.4 months. The apical openings of the teeth ranged from 1-3.7 mm. All teeth were functional and asymptomatic at the recall visits. All periapical lesions resolved with partial or complete mineralization of the root canals, and all teeth showed partial to complete apical closure at the follow-up visits. CONCLUSIONS: RET can be a viable option for nonsurgical retreatment of immature teeth. This article adds a new perspective to the field of regenerative endodontics.


Asunto(s)
Necrosis de la Pulpa Dental , Endodoncia , Endodoncia Regenerativa , Adolescente , Adulto , Necrosis de la Pulpa Dental/terapia , Humanos , Persona de Mediana Edad , Retratamiento , Tratamiento del Conducto Radicular , Adulto Joven
6.
Radiol Med ; 125(1): 98-106, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31583558

RESUMEN

PURPOSE: To evaluate safety and efficacy of degradable starch microspheres (DSMs) TACE in a large clinical cohort of patients with unresectable HCC. MATERIALS AND METHODS: This is a single-center consecutive patients cohort study. The study was approved by local institutional ethics committee. Written informed consent was obtained. From December 2013 to March 2018, 137 cirrhotic patients with unresectable HCC were enrolled. For DSMs-TACE, a mixture of 4 mL of DSMs, 6 mL of non-ionic contrast and doxorubicin at a dose of 50 mg/m2 were used. Primary end point was long-term outcome, in terms of time to progression (TTP) and overall survival (OS). Secondary endpoints were: safety, liver toxicity, 1-month percentage of tumor necrosis according to the modified RECIST criteria. RESULTS: Two hundred and sixty-seven DSMs-TACE were performed in 137 HCC patients (33 patients in BCLC stage A, 84 patients in BCLC stage B, and 20 in stage C). Patients had a mean nodule number of 3.5 ± 1.2 (SD). Major complications were observed in 6.8% of cases. Post-embolization syndrome was common (101 patients 73.7%). According to mRecist criteria, a high objective response rate was obtained even after just one treatment (84.3% of patients showed complete response or partial response). The median TTP and OS after DSMs-TACE were 12 months and 36 months, respectively. OS at 6 months, 1 year, 2 and 3 years was 98%, 81.3%, 57.9%, 34.9%, respectively. CONCLUSION: DSMs-TACE is a safe and effective therapy for patients with HCC, allowing to obtain a good rate of OS with excellent local tumor control.


Asunto(s)
Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/terapia , Almidón/uso terapéutico , Anciano , Anciano de 80 o más Años , Antibióticos Antineoplásicos/administración & dosificación , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/patología , Quimioembolización Terapéutica/efectos adversos , Quimioembolización Terapéutica/mortalidad , Doxorrubicina/administración & dosificación , Femenino , Humanos , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Criterios de Evaluación de Respuesta en Tumores Sólidos , Retratamiento/estadística & datos numéricos , Almidón/efectos adversos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
7.
Int Endod J ; 53(3): 403-409, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31605377

RESUMEN

AIM: To compare the weight of apically extruded debris produced during the removal of root canal filling material using various files in extracted teeth with simulated apical root resorption. METHODOLOGY: The root canals of one hundred and twenty extracted mandibular premolar teeth were prepared with Revo-S files and filled using a cold lateral compaction technique with gutta-percha and a resin-based sealer (AdSeal; Meta-Biomed, Cheongwon, Korea). Sixty teeth were randomly assigned to four control groups (hand file, ProTaper Universal retreatment file, D-RaCe retreatment file, and Reciproc file) for the removal of root canal filling material. The apical portion of the remaining 60 teeth was modified to simulate apical root resoption, and the teeth were then randomly divided into 4 experimental groups (using the same techniques as in the control groups) for the removal of root canal filling material. Apically extruded debris was collected into pre-weighed Eppendorf tubes and then dried. The mean weight of the apically extruded debris was assessed with an analytical balance to an accuracy of 10-4  g. Data were analysed using two-way analysis of variance and a Tukey's post hoc test. RESULTS: In the simulated apical root resorption groups, all file systems were associated with significantly more debris extrusion compared to the groups without simulated resorption (P < 0.05). The amount of apically extruded debris was greatest in the hand file groups compared with the other groups (P < 0.05). In the groups with simulated apical root resorption, the Reciproc system was associated with the least weight of apically extruded debris (P < 0.05), whereas there was no significant difference between the ProTaper Universal retreatment and D-RaCe files (P > 0.05). In the groups without simulated apical root resorption, there was no significant difference between Reciproc, ProTaper Universal retreatment and D-RaCe retreatment files (P> 0.05). The time required to remove the root canal filling material was as follows: hand file > ProTaper Universal retreatment = D-RaCe retreatment > Reciproc (P < 0.05). CONCLUSIONS: The weight of apically extruded debris was significantly greater in teeth with simulated apical root resorption than in those teeth without simulated apical root resorption. Hand files were associated with significantly more apically extruded debris in all groups during removal of root canal filling material.


Asunto(s)
Materiales de Obturación del Conducto Radicular , Resorción Radicular , Cavidad Pulpar , Gutapercha , Humanos , Níquel , República de Corea , Retratamiento , Obturación del Conducto Radicular , Preparación del Conducto Radicular , Titanio
8.
Oncology ; 98(2): 98-101, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31597138

RESUMEN

BACKGROUND: Endometrial cancer currently represents the most frequent gynecologic malignancy in Western countries, and the seventh most common cancer in women. For advanced-stage disease, the recurrence risk is high, and the site of the relapse is heterogeneous with localized or spread peritoneal disease. There are few therapeutic strategies, and the quality of life is poor. CASES PRESENTATION: We present 3 cases of peritoneal-spread recurrences of endometrial cancer in patients with advanced stage at diagnosis. The patients had been subjected to multiple lines of chemotherapy including re-challenging with platinum regimens, pegylated liposomal doxorubicin, and taxane, with progression of disease. These patients came to us with abdominal distension, dyspnea, elevated CA 125, and presence of ascites. After paracentesis with a single administration of intraperitoneal chemotherapy based on carboplatin, all 3 patients showed improvement in their quality of life and breathing as well as reduction of fatigue and anorexia. No complications occurred. CONCLUSION: Although only 3 cases are reported, the exceptional results and the absence of side effects observed strongly warrant future trials to investigate the role intraperitoneal chemotherapy can have both as palliative treatment of refractory ascites and as salvage therapy in advanced endometrial cancer.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ascitis/patología , Neoplasias Endometriales/tratamiento farmacológico , Neoplasias Endometriales/patología , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Biomarcadores de Tumor , Resistencia a Antineoplásicos , Femenino , Humanos , Infusiones Parenterales , Persona de Mediana Edad , Estadificación de Neoplasias , Recurrencia , Retratamiento , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
10.
Oncology ; 98(1): 16-22, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31514200

RESUMEN

PURPOSE: Preclinical studies indicated that imatinib may have single-agent activity in glioblastoma through inhibition of tyrosine kinase activity and also that it might enhance the efficacy of radiotherapy. We therefore sought to investigate clinical efficacy in patients with newly diagnosed and recurrent glioblastoma in combination with radiotherapy. METHODS: We conducted a nonrandomized, 2-arm, open-label phase II trial including patients aged 18 years or older with an ECOG performance status of 0-2 that were either newly diagnosed (arm A) with a measurable tumor (i.e., after incomplete resection or biopsy) or that were diagnosed with progression of a glioblastoma after initial therapy (arm B). Patients in arm A received 600 mg/day imatinib in combination with hypofractionated radiotherapy (2.5 Gy per fraction, 22 fractions). Patients in arm B received 600 mg/day imatinib alone or in combination with re-irradiation at various doses. In case tumor progression occurred, CCNU was added (2 cycles, 100 mg/m2) to imatinib. The primary end point was progression-free survival (PFS). The secondary end point was safety, defined as per Common Terminology Criteria for Adverse Events (version 2.0). Overall survival (OS) was analyzed as an exploratory end point. RESULTS: Fifty-one patients were enrolled, of which 19 were included in arm A and 32 in arm B. The median follow-up was 4 (0.5-30) months in arm A and 6.5 (0.3-51.5) months in arm B. The median PFS was 2.8 months (95% CI 0-8.7) in arm A and 2.1 months (95% CI 0-11.8) in arm B. The median OS was 5.0 (0.8-30) months (95% CI 0-24.1) in arm A and 6.5 (0.3-51.5) months (95% CI 0-32.5) in arm B. The major grade 3 events were seizure (present in 17 patients), pneumonia (11 patients), and vigilance decrease (7 patients). CONCLUSIONS: Imatinib showed no measurable activity in patients with newly diagnosed or recurrent glioblastoma.


Asunto(s)
Antineoplásicos/uso terapéutico , Glioblastoma/tratamiento farmacológico , Glioblastoma/patología , Mesilato de Imatinib/uso terapéutico , Inhibidores de Proteínas Quinasas/uso terapéutico , Adulto , Anciano , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Biopsia , Terapia Combinada , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Glioblastoma/mortalidad , Glioblastoma/cirugía , Humanos , Mesilato de Imatinib/administración & dosificación , Mesilato de Imatinib/efectos adversos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Cuidados Posoperatorios , Pronóstico , Inhibidores de Proteínas Quinasas/administración & dosificación , Inhibidores de Proteínas Quinasas/efectos adversos , Retratamiento , Resultado del Tratamiento
11.
Clin Oral Investig ; 24(1): 405-416, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31104115

RESUMEN

OBJECTIVES: To compare the remaining root canal filling material, dentin removal, apical transportation, and apical extrusion of debris after the retreatment of canals filled with bioceramic or resin-based sealers using the Reciproc or Reciproc Blue instruments. MATERIALS AND METHODS: Sixty mandibular molars with severely curved mesial roots were selected. The samples were initially instrumented with Reciproc (R25) and then divided into four experimental groups according to the endodontic sealer and retreatment instrument (n = 15): BC Sealer/Reciproc (BCRC), BC Sealer/Reciproc Blue (BCRB), AH Plus/Reciproc (AHRC), and AH Plus/Reciproc Blue (AHRB). The procedure time was measured, and an Eppendorf tube was used in each root canal to store the debris extrusion. The samples were scanned by micro-CT before and after retreatment. The apical transportation, volume of dentin, and filling material were evaluated. RESULTS: There were no significant differences in the reduction of the volume of obturator material or dentin removal between groups (p > .05). There were also no differences in the amount of extruded material or apical transportation (p > .05). The retreatment time for the AHRC group was significantly lower than that for the other groups (p = .004). CONCLUSIONS: All tested instruments obtained similar efficacy in filling material removal procedures, although no system completely removed the filling material. Retreatment of canals filled with bioceramic BC Sealer may be more time consuming. CLINICAL RELEVANCE: This study reported that Reciproc and Reciproc Blue can be indicated in retreatment of severely curved root canals filled either with bioceramic or resin-based sealers.


Asunto(s)
Materiales de Obturación del Conducto Radicular , Obturación del Conducto Radicular , Preparación del Conducto Radicular , Instrumentos Dentales , Cavidad Pulpar , Diseño de Equipo , Gutapercha , Humanos , Retratamiento
12.
Tumori ; 106(1): 70-78, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31469058

RESUMEN

BACKGROUND: Patients with intestinal cancer (colorectal, appendiceal, and small bowel) with peritoneal metastases (PM) have a poor prognosis. We assessed whether pressurized intraperitoneal aerosol chemotherapy (PIPAC) together with systemic chemotherapy is an effective treatment option for these entities in palliative intent. METHODS: Between November 2015 and February 2018, prospective data registry was performed (NCT03100708). Thirteen patients with intestinal cancer (median age 61 years [range 49-77]) underwent 26 PIPAC procedures with a median number of 2 interventions per patient (range 1-6). A chemoaerosol consisting of cisplatin/doxorubicin was administered during standard laparoscopy. RESULTS: The median peritoneal carcinomatosis index according to Sugarbaker before the first PIPAC was 14 (range 2-27), and the median ascites volume was 10 mL (range 0-6300 mL). Six patients who received 2 or more PIPAC procedures had decreased and stable ascites volumes, while only 1 patient displayed increased ascites. The median overall survival was 303 days (range 30-490) after the first PIPAC procedure. CONCLUSIONS: PIPAC offers a novel treatment option for patients with PM. Our data show that PIPAC is safe and well-tolerated. Ascites production can be controlled by PIPAC in patients with intestinal cancer. Further studies are required to document the significance of PIPAC within palliative therapy concepts. TRIAL REGISTRATION: NCT03100708.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Intestinales/patología , Neoplasias Peritoneales/secundario , Neoplasias Peritoneales/terapia , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Terapia Combinada , Femenino , Hospitalización , Humanos , Infusiones Parenterales , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/diagnóstico , Neoplasias Peritoneales/mortalidad , Pronóstico , Retratamiento , Resultado del Tratamiento
13.
Radiol Med ; 125(3): 288-295, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31823294

RESUMEN

PURPOSE: High-flow priapism is an incomplete and painless persistent erection caused by trauma. Its diagnosis is performed thanks to clinic and imaging evaluation with detection of fistula/pseudoaneurysm in the cavernous tissue. This paper aims to retrospectively assess the efficacy and safety of superselective arterial embolization in patients with high-flow priapism. MATERIALS AND METHODS: From January 2008 to March 2017, nine patients with high-flow priapism have been treated in a single center with embolization. The main etiology was trauma in eight subjects. The patients were evaluated with laboratory examinations and clinical and imaging findings (color Doppler ultrasonography and angiography). The mean follow-up time after embolization was 24 months. RESULTS: Eleven procedures were performed in nine patients: two of them required a second treatment session because of recurrence after 1-2 weeks. Embolic agents were microcoils, microparticles (300-500 µm) and Spongostan. Restoration of erectile function was monitored by clinical and color Doppler evaluation during follow-up. CONCLUSIONS: Superselective embolization should be the procedure of choice in patients affected by high-flow priapism; this technique appears to be successful in preserving erectile function. The choice of the embolic agent is crucial, and it should be tailored for each patient.


Asunto(s)
Embolización Terapéutica/métodos , Pene/irrigación sanguínea , Priapismo/terapia , Adolescente , Adulto , Angiografía , Niño , Embolización Terapéutica/instrumentación , Procedimientos Endovasculares/métodos , Humanos , Masculino , Persona de Mediana Edad , Erección Peniana , Pene/lesiones , Priapismo/diagnóstico por imagen , Priapismo/etiología , Recurrencia , Flujo Sanguíneo Regional , Retratamiento , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler en Color , Adulto Joven
14.
Clin Oral Investig ; 24(1): 257-263, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31093742

RESUMEN

OBJECTIVES: The aim of this randomized clinical trial was to assess the effect of solvent use during the removal of root canal filling on postoperative pain after retreatment. MATERIALS AND METHODS: Ninety patients scheduled for root canal retreatment were randomly assigned to one of the following two groups according to the root canal filling removal procedure used: ProTaper retreatment (Dentsply Maillefer, Ballaigues, Switzerland) instruments or ProTaper retreatment instruments in combination with gutta-percha solvent. A single operator performed the retreatments in a single visit. The incidence and intensity of the postoperative pain were rated on a numeric rating scale by patients at 24, 48, and 72 h after retreatment. The analgesic tablet intake number was also recorded. Data were analyzed using Mann­Whitney U, Wilcoxon, and chi-square tests. RESULTS: For the intensity of postoperative pain, the difference between the two groups was not statistically significant. Moreover, no statistically significant difference was found between the two groups in terms of analgesic medication intake (P > 0.05). CONCLUSIONS: The processes involving the use and non-use of a solvent in the removal of root canal fillings were found to be equivalent in terms of postoperative pain intensity and analgesic intake. CLINICAL RELEVANCE: Some in vitro studies claimed that the use of a gutta-percha solvent in the removal of root canal fillings tends to reduce postoperative pain since extrusion of debris was significantly less. This randomized clinical trial indicates that the removal of root canal fillings with or without the use of a solvent was associated with equivalent postoperative pain intensity and analgesic intake. This study is registered in the www.ClinicalTrials.gov database with the identifier number NCT03756363.


Asunto(s)
Dolor Postoperatorio , Materiales de Obturación del Conducto Radicular , Obturación del Conducto Radicular , Preparación del Conducto Radicular , Solventes , Adulto , Cavidad Pulpar , Diseño de Equipo , Femenino , Gutapercha , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/prevención & control , Retratamiento , Solventes/uso terapéutico , Suiza
15.
J Prosthet Dent ; 123(1): 54-60, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31027959

RESUMEN

STATEMENT OF PROBLEM: Despite an overall high survival rate for dental implants, the effectiveness of implant retreatment remains unclear. PURPOSE: The purpose of this systematic review was to examine the survival rate of implants placed at sites which had an implant failure and to investigate factors that might affect outcomes after retreatment. MATERIAL AND METHODS: A search of electronic databases limited to English language articles was conducted using the following MeSH terms: "dental implants," "dental implantation," or "dental restoration failure," combined with "retreatment," "replacement," or "reoperation." A hand search of selected journals was also performed. Of the retrieved 668 publications, 8 retrospective clinical studies met the inclusion criteria, providing the survival outcome for 673 implants in 557 patients after retreatment. Implant- and patient-related characteristics related to implant failures were assessed. RESULTS: The weighted mean survival rate for implants after retreatment was 86.3%, with follow-up ranging from less than 1 year to over 5 years. The survival rates of smooth-surfaced and rough-surfaced implants were compared in 217 retreated implants, revealing a significantly higher survival rate for rough-surfaced implants than for smooth-surfaced implants (90% versus 68.7%). Insufficient data were available to evaluate the effect of patient- or treatment-related characteristics on the survival of implants after retreatment. CONCLUSIONS: The survival rate of retreated implants is lower than that generally reported after initial implant placement. Higher survival rates were reported with rough-surfaced implants than with smooth-surfaced implants in retreatment. An overall implant survival rate of 86.3% after retreatment suggests that most initial implant failures are likely attributable to modifiable risk factors, such as implant architecture, anatomic site, infection, and occlusal overload.


Asunto(s)
Implantes Dentales , Implantación Dental Endoósea , Fracaso de la Restauración Dental , Humanos , Retratamiento , Estudios Retrospectivos
16.
Eur J Ophthalmol ; 30(1): 26-33, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30421618

RESUMEN

PURPOSE: To describe long-term outcomes with intravitreal Bevacizumab for choroidal neovascularization secondary to Sorsby fundus dystrophy. MATERIALS/METHODS: Observational case series. RESULTS: Two sisters of the same family formally diagnosed with Sorsby fundus dystrophy were followed-up for 12 years. The elder sister (S1) presented with significant decline in vision due to choroidal neovascularization in her right eye (OD). She developed choroidal neovascularization 3 years later in her left eye (OS). She was treated with Bevacizumab intravitreal injections on a on a pro-re-nata (PRN) until April 2015, when a treat-and-extend (T&E) approach was adopted. Best corrected visual acuities at the time of switch to T&E were 1.09 OD and 0.85 LogMar OS. Best corrected visual acuities at the last follow-up were LogMar 1.1 OD and 0.82 OS. Her younger sister (S2) presented with best corrected visual acuities of LogMar 0.1 OD and 0.0 OS. She developed choroidal neovascularization 5 years later in both eyes. OS developed choroidal neovascularization 18 months after her right eye. She received Bevacizumab on a pro re nata basis until April 2015 when a switch to a T&E was performed. Best corrected visual acuity in the left eye at the switch to T&E was 0.34 LogMar. At the last follow-up, best corrected visual acuities were LogMar 1.2 OD and 0.29 OS. CONCLUSION: Bevacizumab is an effective therapy for choroidal neovascularization secondary to Sorsby fundus dystrophy. A T&E protocol appears more effective compared to pro re nata protocol in minimizing recurrence of choroidal neovascularization with potential secondary scar formation or atrophy.


Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Neovascularización Coroidal/tratamiento farmacológico , Degeneración Macular/complicaciones , Adulto , Neovascularización Coroidal/diagnóstico , Neovascularización Coroidal/etiología , Protocolos Clínicos , Femenino , Angiografía con Fluoresceína , Humanos , Inyecciones Intravítreas , Degeneración Macular/diagnóstico , Persona de Mediana Edad , Imagen Multimodal , Retratamiento , Estudios Retrospectivos , Hermanos , Tomografía de Coherencia Óptica , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/fisiología
17.
Ann Vasc Surg ; 62: 30-34, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31201976

RESUMEN

BACKGROUND: The Heli-FX EndoAnchor (EA) system is a transmural aortic fixation device with Federal Drug Administration (FDA) approval for treatment of endoleaks, endograft migration, or high-risk seal zones. Published data are primarily from industry-sponsored registries highlighting safety and efficacy. Our objective is to evaluate real-world outcomes of EA usage after FDA approval across a variety of stent grafts and indications at a single institution. METHODS: We retrospectively reviewed our prospectively maintained aneurysm database for patients undergoing endovascular aortic repair (EVAR) with Heli-FX EAs. Technical success was defined as successful EA deployment, while procedural success was defined as absence of endoleak on completion aortogram. Cohorts were divided by indication and outcomes assessed via review of clinical and radiographic data. RESULTS: From 2016 to 2018, 37 patients underwent EA fixation. We divided the cohort by indication: Group A (prior EVAR with endoleak), B (intraoperative type 1A endoleak), C (high-risk seal zone), and D (thoracic EVAR). In Group A (n = 11), all endoleaks were type 1A and a mean of 10 EAs were deployed with 100% technical and 45.4% procedural success. Two perioperative reinterventions were performed (translumbar coil embolization and proximal graft extension with bilateral renal artery stents). At a mean 10.6 months of follow-up, 45.4% of patients had persistent endoleaks, with 100% aortic-related survival. In Group B (n = 10), a mean of 8.7 EAs were used with 100% technical and procedural success. One immediate adverse event occurred (right iliac dissection from wire manipulation, treated with a covered stent). At 13.6-month mean follow-up, there was significant sac regression (mean 9.75 mm) with no type 1A endoleaks. In Group C (n = 10), a mean of 9.5 EAs were deployed with 100% technical and procedural success. At 11.2-month mean follow-up, there were no residual endoleaks and significant sac regression (mean 3.4 mm). Overall survival was 100%. In Group D (n = 6), a mean of 8.3 EAs were used with 83.3% technical and 66.6% procedural success. One immediate adverse event occurred, in which an EA embolized to the left renal artery. At 9.4-month mean follow-up, overall survival was 83.3% with a mean 2.2-mm increase in sac diameter. CONCLUSIONS: Early experience suggests that EAs effectively treat intraoperative type 1A endoleaks and high-risk seal zones, with significant sac regression and no proximal endoleaks on follow-up. In patients treated for prior EVAR with postoperative type 1A endoleaks, fewer than half resolved after EA attempted repair. Further experience and longer term follow-up will be necessary to determine which patients most benefit from postoperative EA fixation.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Stents , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Implantación de Prótesis Vascular/efectos adversos , California , Bases de Datos Factuales , Endofuga/etiología , Endofuga/terapia , Procedimientos Endovasculares/efectos adversos , Femenino , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/terapia , Humanos , Masculino , Diseño de Prótesis , Retratamiento , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
18.
Ann Vasc Surg ; 62: 213-222, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31382008

RESUMEN

BACKGROUND: Fenestrated/branched endovascular aneurysm repair (F/B-EVAR) achieves more extensive proximal seal than conventional infrarenal devices, thereby increasing aneurysm exclusion durability. Optimal seal zone length remains undefined. We assessed relative risks and benefits of extending the proximal seal above the celiac artery. METHODS: The prospective database of all complex endovascular aortic aneurysm repairs at a single institution (institutional review board-approved, physician-sponsored investigational device exemption trial, 10/2010-6/2017) was used to classify repairs according to the number of target visceral-renal arteries incorporated: 4-vessel versus <4-vessel. Comparisons of aneurysm characteristics, perioperative details, and postoperative complications were performed, stratified by repair type. One-year survival, target artery patency, freedom from type 1 or 3 endoleak, and freedom from reintervention were estimated with Kaplan-Meier analysis. RESULTS: Among 175 F/B-EVARs, 38% (n = 67) were 4-vessel and 62% (n = 108) were <4-vessel. Intraoperatively, there was no difference in mean contrast use (76 mL vs. 74 mL, P = non significant [NS]) or dose area product (63,428 mGy cm2 vs. 96,015 mGy cm2), but there was increased median procedure time (4.8 hr, interquartile range [IQR] = 4.1-5.8 versus 3.6 hr, IQR = 2.9-4.1, P < 0.0001) and mean operating room direct costs ($52,532, standard deviation [SD] = 18,640 versus $40,128, SD = 15,135, P < 0.0001) in 4-vessel repairs. There were no differences in mortality (1.9% vs. 4.5%), paraparesis (0% vs. 3.0%), or paralysis (0.9% vs. 0%), all P = NS. There were no differences in one-year survival, target artery patency, or freedom from reintervention. There was a lower 1-year freedom from type 1 or 3 endoleak with 4-vessel repairs (82% vs. 94%, log-rank P = 0.02), driven by an increased rate of type 3 endoleaks. Endoleak resolution after treatment was equivalent in both groups (4-vessel, 10 of 12, 83% resolved; <4-vessel, 7 of 7, 100% resolved, P = NS). CONCLUSIONS: With F/B-EVAR, utilization of a supraceliac seal zone, compared with an infraceliac seal zone, is associated with statistical differences in operative characteristics/resource utilization, but with negligible clinical significance. Further innovation to eliminate type 3 endoleaks at fenestrations/branches remains an unmet need. To achieve adequate F/B-EVAR proximal seal zone length, one should have a low threshold to incorporate the celiac artery.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Arteria Celíaca/cirugía , Procedimientos Endovasculares/instrumentación , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Abdominal/fisiopatología , Implantación de Prótesis Vascular/efectos adversos , Arteria Celíaca/diagnóstico por imagen , Arteria Celíaca/fisiopatología , Bases de Datos Factuales , Endofuga/etiología , Endofuga/terapia , Procedimientos Endovasculares/efectos adversos , Femenino , Humanos , Masculino , Massachusetts , Supervivencia sin Progresión , Diseño de Prótesis , Retratamiento , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Grado de Desobstrucción Vascular
19.
J Pediatr Orthop ; 40(1): 29-35, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31815859

RESUMEN

BACKGROUND: The prevention and treatment of relapsed clubfoot remained challenging tasks. There were controversies as to treatment options and management, such as complete subtalar release, application of an Ilizarov external frame, or repeated Ponseti method; and different options were available in different treatment centers. This study was designed to evaluate the clinical outcome of relapsed clubfeet treated by repeated Ponseti method in comparison with the cases without relapse in term of gait analysis and to clarify the clinical efficacy of repeated Ponseti method in treating the relapsed clubfeet. METHODS: Thirty-seven patients (53 feet) were retrospectively identified from our database according to the inclusion and exclusion criteria. Among the 37 patients, 17 cases (25 relapsed clubfeet) were assigned to group I, whereas 20 cases (28 clubfeet without relapse) were assigned to group II. Clinical examination, gait analysis, and kinematic gait deviation criteria from Texas Scottish Rite Hospital for Children were used for evaluation. RESULTS: There was statistically significant difference in the parameters of foot length, stride length, and single limb support time (%gait cycle) between the 2 groups (P<0.05). No statistically significant difference was found in the kinematic parameters of total hip, knee, and ankle excursion, peak knee and ankle flexion and extension, and internal foot progression (P>0.05). There was no statistically significant difference in peak hip, knee, and ankle flexion moment, peak knee valgus moment, and peak ankle power (P>0.05). No statistically significant difference was found in equinus and calcaneus gait, increased ankle dorsiflexion, foot drop, and internal foot progression angle (P>0.05). CONCLUSIONS: Repeated Ponseti method for relapsed clubfeet can yield good or excellent clinical results. We recommend repeated Ponseti method as the treatment choice for relapsed clubfeet in the early stage. LEVEL OF EVIDENCE: Level III-retrospective comparative study.


Asunto(s)
Articulación del Tobillo/fisiopatología , Pie Equinovaro/fisiopatología , Pie Equinovaro/terapia , Pie/fisiopatología , Articulación de la Rodilla/fisiopatología , Fenómenos Biomecánicos , Moldes Quirúrgicos , Femenino , Análisis de la Marcha , Articulación de la Cadera/fisiopatología , Humanos , Lactante , Recién Nacido , Masculino , Manipulación Ortopédica , Rango del Movimiento Articular , Recurrencia , Retratamiento , Estudios Retrospectivos , Resultado del Tratamiento
20.
Int Endod J ; 53(1): 19-26, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31454090

RESUMEN

AIM: To determine retrospectively the long-term radiographic outcome of root canal treatments and root canal retreatments with unintentional root canal overfilling. METHODOLOGY: A total of 220 root canal treatments (143 primary/77 retreatments) with postoperative unintentional canal overfilling and performed by two endodontists during their 45 years of private practice were included in the study. Lateral condensation techniques and nine different sealers were used. Overfilling was confirmed with a postoperative periapical radiograph and patients were scheduled regularly for recall visits. Average recall time was 4.86 years (maximum = 30 years). Two calibrated observers evaluated the radiographs and determined the long-term outcome using the PAI score pooled in a 3-category scale. The persistence or resorption of the extruded material was registered. The Kappa coefficient (K) was calculated and a logistic regression was used for further analysis. Odds ratios and their 95% CI were estimated. RESULTS: The level of inter-observer agreement was 66.1%. Primary root canal treatments had a significantly (P = 0.015) greater rate of success (91.6%) than retreatments (81.8%). Tooth location (P = 0.019) was the only other factor that significantly affected the outcome. The type of extruded material, and its resorption or persistence did not relate to the outcome. Persistence of extruded material was significantly affected by tooth location and recall time after treatment. CONCLUSION: The outcome of root canal treatment with unintentional canal overfilling was not associated with the type of extruded material or its resorption or persistence. The persistence of extruded material did not relate to a favourable or unfavourable outcome.


Asunto(s)
Materiales de Obturación del Conducto Radicular , Diente , Cavidad Pulpar , Humanos , Retratamiento , Estudios Retrospectivos , Tratamiento del Conducto Radicular , Resultado del Tratamiento
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