Long-Term Success in Dental Implant Revisions: A 31-Year Case Study of Alveolar Atrophy Management in an Elderly Woman.

BACKGROUND In the early 1980s, Brånemark described the use of cylindrical titanium dental implants integrated with bone. Since then, significant advances in dental implant technology have resulted in improved function and cosmetic appearance. This report describes an 87-year-old woman with a 31-year history of revision implant dentistry, initially for severe alveolar atrophy of the premolar and upper molar teeth. CASE REPORT In 1992, a severe alveolar atrophy of the upper premolar and molar areas was treated with the insertion of 4 fixtures in the frontal sector and a prosthesis superimposed anchored to the fixtures and with a rear support on the only surviving teeth. In 2004, the teeth were extracted and a distal support to the prosthesis was obtained with 2 fixtures in the maxillary tuberosity. In 2018, to eliminate the need for home removal of the prosthesis, 2 zygomatic fixtures were positioned and a fixed prosthesis was made. In 2023, at the last follow-up, satisfactory function and aesthetics of the prosthesis were reported and the bone levels at the fixtures appeared stable. CONCLUSIONS This report demonstrates the improvements in dental implant technology over more than 30 years in a single patient and highlights the importance of improved function and cosmetic appearance.

Heart valve surgery in a very high-risk population: a preliminary experience in awake patients.

BACKGROUND AND AIM OF THE STUDY: Heart valve surgery in high-risk patients is associated with considerable morbidity and mortality. Epidural anesthesia without mechanical ventilation has been proposed to reduce invasiveness. An analysis was conducted in very high-risk heart valve patients of mid-term survival free from complications, and patient satisfaction of regional anesthesia use, without mechanical ventilation. METHODS: A prospective follow up study was conducted in 50 patients (24 females, 26 males; mean age 74 +/- 10 years; range: 43-89 years) who underwent heart valve surgery with epidural anesthesia without endotracheal intubation. Preoperatively, all patients were in NYHA class III or IV; eight patients (16%) had undergone a previous cardiac procedure. The median Additive and Logistic EuroSCORE were 14.5 and 52%, respectively. Twenty-seven patients underwent aortic valve replacement, 10 mitral valve replacement, 10 mitral valve repair, two double valve replacement, and one patient ascending aorta replacement. Associated surgical procedures included coronary artery bypass grafting in 12 patients (24%), ascending aorta replacement in three (6%), and left ventricle reshaping in two (4%). Radiofrequency ablation to treat chronic atrial fibrillation (AF) was performed in 15 patients (30%). All patients were prospectively followed up, and a six-month quality of life assessment was performed in all survivors. RESULTS: Procedures were performed without mechanical ventilation in completely awake and conscious patients. There were two in-hospital and two long-term deaths (8%). Three patients had had previous cardiac surgery (two double valve replacements, two complex mitral valve surgery). Among survivors, 34 (71%) had an uneventful postoperative outcome, except for AF in nine cases. Eight patients required revision for bleeding; two of these were redo cases. The most consistent postoperative complication was acute renal failure in 16 patients, five of whom had previous chronic renal failure. Three patients required mechanical ventilatory support, and none had a cerebrovascular accident. Patients were discharged home after a mean of 10 +/- 5 days (including ICU stay; median 9 h). At follow up, all patients were in NYHA class I/II, and all survivors expressed their satisfaction with epidural anesthesia. CONCLUSION: Heart valve surgery while on cardiopulmonary bypass is feasible and safe using epidural anesthesia. By maintaining autonomic ventilation, a low mid-term morbidity and mortality was observed in patients in whom there was an unacceptable operative risk.

Massive mitral and pulmonary valve incompetence in a patient with left ventricular, non-compacted myocardium.

The case is reported of a patient who underwent cardiac surgery for pulmonary valve stenosis as a child, and presented as an adult with signs and symptoms of severe congestive heart failure. The left ventricle showed an increased trabecular pattern in the region of the apex, the mitral annulus was severely dilated with mitral incompetence, the right ventricular out-flow tract (RVOT) was largely dilated with aneurysm of both pulmonary arteries, and there was evidence of pulmonary valve incompetence. Previously, rare cases have been reported of persistent left ventricular non-compaction in patients with congenital left or RVOT obstruction. Non-compaction of the ventricular myocardium is an inherited autosomal dominant disorder; to date, four genes and one genetic locus have been found to be associated with non-compacted ventricular myocardium. The condition is characterized by arrhythmias, thromboembolic events and heart failure, but affected individuals may not be symptomatic. The present case represented a strange association between non-compacted left ventricle, mitral annular dilation with persistence of a normal leaflet and subvalvular mitral valve apparatus, and RVOT dilation with pulmonary artery aneurysms.

Nanoscale radiofrequency control technology for endoscopic radial artery harvesting: a case report.

A recent revival in the use of the radial artery for bypass surgery stimulated the development of minimally invasive harvesting techniques since the endoscopic approach has several advantages when compared to the open technique. A novel nanoscale radiofrequency-controlled device has been recently introduced in the surgical armamentarium as a vesselsealing system, albeit to date it has been mainly used in the urological setting. To our knowledge, this is the first report in the literature about the use of such an innovative device for endoscopic harvesting of the radial artery, along with a stainless steel resterilizable retractor conventionally used for endoscopic vein harvesting.

Platelet reduction after stentless pericardial aortic valve replacement.

The aim of the study was to investigate the multi-factorial phenomenon of possible postoperative thrombocytopenia after aortic valve replacement (AVR) with the freedom SOLO (FS) bioprosthesis. A total of 254 patients underwent AVR with FS bioprosthesis in two cardiac surgery institutes. Platelet counts were measured preoperatively, immediately postoperatively and daily until the 11th day postoperatively. A multivariate generalized estimating equation model was applied to identify prognostic factors for whether or not patients postoperative platelet counts indicated no thrombocytopenia (platelet count >150 10(3)/mm(3)) versus at least mild thrombocytopenia (≤150 10(3)/mm(3)). Preoperatively, 11.2% of patients showed thrombocytopenia. The preoperative platelet count averaged 233.0 ± 83.2 10(3)/mm(3). The postoperative mean of platelet counts decreased daily reaching a minimum mean of 88.4 ± 58.8 10(3)/mm(3) 3 days after surgery and then started to increase, with the Day 11 postoperative mean of 173.3 ± 51.8 10(3)/mm(3). Compared with patients with no preoperative thrombocytopenia, patients with preoperative thrombocytopenia had an 8.69 increased odds of being in the group with postoperative platelet count <150 10(3)/mm(3). No major haemorrhagic or thromboembolic event was reported during hospitalization. This study shows that thrombocytopenia after the FS bioprosthesis replacement is a transient postoperative phenomenon, largely resolved within a few days after surgery, with no clinical consequences and haemodynamic dysfunction.

Improved graft patency rates and mid-term outcome of diabetic patients undergoing total arterial myocardial revascularization.

OBJECTIVES: Diabetes negatively affects the outcome of patients undergoing percutaneous transluminal coronary angioplasty (PTCA) or coronary surgery. However, data are lacking with respect to the impact of arterial revascularization in the diabetic population. METHODS: Between 1999 and 2003, 100 of 491 diabetics underwent coronary artery bypass graft surgery (CABG) with total arterial grafting (Group 1, G1); these patients were compared with 100 diabetics undergoing conventional CABG with saphenous veins (Group 2, G2), who were matched for Euroscore and other risk factors such as age, obesity, hypertension, left ventricular ejection fraction (LVEF), previous myocardial infarction and chronic obstructive pulmonary disease (COPD). RESULTS: Both groups had a similar number of diseased coronary vessels (G1=2.6 vs G2= 2.7) and received a similar degree of myocardial revascularization (grafted vessels: G1=2.2 vs G2=2.4). Early outcome was comparable between the groups in terms of ventilatory support (G1=10.8±6 vs G2=10.4±5 hours), intensive care unit (ICU) stay (G1=24±12 vs G2=25±14 hours) and major post-operative complications such as atrial fibrillation (G1=26% vs G2=28%), peri-operative myocardial infarction (G1=1% vs G2=2%)and prolonged ventilatory support (G1=6% vs G2=5%). Hospital mortality was 2% in G1 and 3% in G2. Angiography was performed at a mean follow-up of 34 months in 65.9% and 71.1% of hospital survivors of G1 and G2 respectively: patients of G1 showed a significantly higher patency rate (G1=96% vs G2=83.6%, p=0.02). Additionally, patients of G1 showed a significantly lower incidence of recurrent myocardial ischemia (G1=7 pts. vs G2=18 pts., p=0.03), late myocardial infarction (G1=2 pts. vs G2=10 pts., p=0.03) and need for coronary reintervention (G1=1 pt. vs G2=12 pts, p=0.004). CONCLUSIONS: Total arterial grafting in diabetic patients significantly improved the benefits of coronary surgery providing at mid term a higher graft patency rate with a lower incidence of cardiac related events.