WorldWideScience

Sample records for presurgical nasoalveolar splints

  1. Presurgical nasoalveolar moulding in unilateral cleft lip and palate

    Directory of Open Access Journals (Sweden)

    Mohammed Zuhaib

    2016-01-01

    Full Text Available Context: Presurgical nasoalveolar moulding (PNAM is a non-surgical method of reshaping the cleft lip, alveolus, palate and the nose to minimize the severity of the cleft deformity, before primary cheiloplastyand palatoplasty. In this context, PNAM proves to be an invaluable asset in the management of unilateral cleft lip and palate. Aims: The study was conducted to evaluate the effi cacy of PNAM in the management of unilateral cleft lip and palate with the following objectives: (1 To assess and compare the degree of reduction in the size of cleft palate and alveolus (pre-PNAM and post-PNAM. (2 To evaluate and compare the improvement in columellar length and correction of columellar deviation (pre-PNAM and post-PNAM. (3 To assess the changes in the position of the alar base and the alar cartilages. Settings and Design: Prospective study. Subjects and Methods: A prospective study consisting of, which included 20 patients with complete unilateral cleft lip and palate was conducted. The age at the start of PNAM treatment of the infants ranged from 2 to 44 days of age reporting to our institute between December 2011 and August 2013. All the patients underwent PNAM therapy before primary cheiloplasty at 6 months of age; clinical parameters were assessed pre- and post-therapy using photographs and dental study models of the maxilla. Statistical Analysis Used: Student's t-test for paired comparisons. Results: Results of the study showed a promising reduction in the cleft size before the surgery, signifi cant improvement in nasal symmetry, including the columellar length on the cleft side. Conclusions: PNAM is a valuable adjunct to our surgical armamentarium in dealing with the challenges of primary closure of unilateral cleft lip and palate thereby enhancing the overall surgical outcome. The advantages of this method include the simplicity of the procedure and improving the quality of surgical repair, particularly in obtaining tension free muscle

  2. Tratamiento ortopédico con moldeador nasoalveolar prequirúrgico en la fisura labiopalatina unilateral Orthopaedic treatment with presurgical nasoalveolar moulding in unilateral cleft lip and palate

    Directory of Open Access Journals (Sweden)

    Antonio José España-López

    2012-12-01

    Full Text Available Se describen 2 casos de niños con fisura labiopalatina unilateral total con gran separación de procesos alveolares, remitidos a nuestra unidad. Tras valoración por el equipo multidisciplinar se procede a realizar tratamiento ortopédico mediante moldeamiento nasoalveolar prequirúrgico durante 3,5 meses en un caso y 2 meses en el otro. A los 9 meses se mantiene la coalescencia de ambos procesos alveolares y la simetría nasal en ambos pacientes, existiendo una buena proyección de la punta nasal y longitud de la columela.We present two cases of children with total unilateral cleft lip and palate with a marked separation of alveolar segments. After evaluation by a multidisciplinart team, he children were treated with a presurgical nasoalveolar moulding for 2 months in one of them and 3.5 months in the other. At 9 months after the presurgical nasoalveolar moulding treatment, there was improved dental arch form, the cleft edges moved closer to each other, and improved symmetry of the nose in width, height, and columella lengths in both patients.

  3. Presurgical nasoalveolar molding therapy in cleft lip and palate individuals: Case series and review

    Directory of Open Access Journals (Sweden)

    Narayan H Gandedkar

    2015-01-01

    Full Text Available The nasoalveolar molding (NAM therapy is advocated to reduce the severity of alveolar cleft and nasal deformity. NAM therapy has demonstrated to be an effective method for reducing cleft and improve nose anatomy. This paper presents a case report of three cleft lip and palate individuals treated with NAM therapy. Furthermore, the paper highlights the advantages of NAM therapy along with an enumeration of literature suggesting in favor of NAM therapy and otherwise. Regardless of controversies and divergent views involved with NAM therapy, the immediate success of NAM therapy facilitating primary lip repair surgery cannot be under-emphasized.

  4. RapidNAM: generative manufacturing approach of nasoalveolar molding devices for presurgical cleft lip and palate treatment.

    Science.gov (United States)

    Bauer, Franz Xaver; Schönberger, Markus; Gattinger, Johannes; Eblenkamp, Markus; Wintermantel, Erich; Rau, Andrea; Güll, Florian Dieter; Wolff, Klaus-Dietrich; Loeffelbein, Denys J

    2017-08-28

    Nasoalveolar molding (NAM) is an accepted treatment strategy in presurgical cleft therapy. The major drawbacks of the treatment listed in the literature relate to the time of the treatment and the coordination of the required interdisciplinary team of therapists, parents, and patients. To overcome these limitations, we present the automated RapidNAM concept that facilitates the design and manufacturing process of NAM devices, and that allows the virtual modification and subsequent manufacture of the devices in advance, with a growth prediction factor adapted to the patient's natural growth. The RapidNAM concept involves (i) the prediction of three trajectories that envelope the fragmented alveolar segments with the goal to mimic a harmonic arch, (ii) the extrusion from the larger toward the smaller alveolar segment along the envelope curves toward the harmonic upper alveolar arch, and (iii) the generation of the NAM device with a ventilation hole, fixation pin, and fixation points for the nasal stents. A feasibility study for a vector-based approach was successfully conducted for unilateral and bilateral cleft lip and palate (CLP) patients. A comparison of the modified target models with the reference target models showed similar results. For further improvement, the number of landmarks used to modify the models was increased by a curve-based approach.

  5. 2012 American Board of Pediatric Dentistry College of Diplomates annual meeting: the role of pediatric dentists in the presurgical treatment of infants with cleft lip/cleft palate utilizing nasoalveolar molding.

    Science.gov (United States)

    Ahmed, Mohammad M; Brecht, Lawrence E; Cutting, Court B; Grayson, Barry H

    2012-01-01

    The pediatric dentist plays a crucial role in the treatment and management of infants born with cleft deformities of the lip, alveolus, and palate. At New York University Langone Medical Center in New York City, 70% of infants with cleft lip/cleft palate (CLCP) are detected on prenatal ultrasound analysis. Thus, the role of the pediatric dentist can start as early as prenatal counseling. Nasoalveolar molding (NAM) is delivered during the first 3 to 5 months of life. During this stage of treatment, the pediatric dentist establishes the foundation of the “cleft dental” home and initiates the first stage of anticipatory guidance. Consequently, parents are educated and motivated to initiate oral hygiene care upon eruption of the first primary teeth. The purpose of this paper was to describe the role of the pediatric dentist in performing nasoalveolar molding and also describe its indications, appliance design, fabrication, biomechanics, complications, and patient management.

  6. Bilateral Nasoalveolar Cyst Causing Nasal Obstruction

    Directory of Open Access Journals (Sweden)

    Uzeyir Yildizoglu

    2016-01-01

    Full Text Available Nasoalveolar cysts, which originate from epithelial remnants of nasolacrimal duct, are nonodontogenic soft tissue lesions of the upper jaw. These cysts are thought to be developmental and are presented with fullness in the upper lip and nose, swelling on the palate, and sometimes nasal obstruction. Because of cosmetic problems, they are often diagnosed at an early stage. These lesions are mostly revealed unilaterally but also can be seen on both sides. In this case report, a patient who complained of nasal obstruction and then diagnosed with bilateral nasoalveolar cysts and treated by sublabial excision is presented and clinical features and treatment approaches are discussed with the review of literature.

  7. Presurgical cleft lip and palate orthopedics: an overview

    Directory of Open Access Journals (Sweden)

    Alzain I

    2017-05-01

    Full Text Available Ibtesam Alzain,1 Waeil Batwa,2 Alex Cash,3 Zuhair A Murshid2 1Pediatric Dentistry, 2Orthodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 3Cleft Lip and Palate Orthodontics, Queen Victoria NHS Foundation Trust, South Thames Cleft Service, London, UK Abstract: Patients with cleft lip and/or palate go through a lifelong journey of multidisciplinary care, starting from before birth and extending until adulthood. Presurgical orthopedic (PSO treatment is one of the earliest stages of this care plan. In this paper we provide a review of the PSO treatment. This review should help general and specialist dentists to better understand the cleft patient care path and to be able to answer patient queries more efficiently. The objectives of this paper were to review the basic principles of PSO treatment, the various types of techniques used in this therapy, and the protocol followed, and to critically evaluate the advantages and disadvantages of some of these techniques. In conclusion, we believe that PSO treatment, specifically nasoalveolar molding, does help to approximate the segments of the cleft maxilla and does reduce the intersegment space in readiness for the surgical closure of cleft sites. However, what we remain unable to prove equivocally at this point is whether the reduction in the dimensions of the cleft presurgically and the manipulation of the nasal complex benefit our patients in the long term. Keywords: presurgical orthopedic, nasoalveolar molding, cleft lip and palate

  8. Influence of nasoalveolar molding on skeletal development in patients with unilateral cleft lip and palate at 5 years of age.

    Science.gov (United States)

    Akarsu-Guven, Bengisu; Arisan, Arda; Ozgur, Figen; Aksu, Muge

    2018-04-01

    The aim of this retrospective study was to assess the influence of presurgical nasoalveolar molding (NAM) on skeletal development in patients with operated unilateral cleft lip and palate at 5 years of age. Lateral cephalometric radiographs of 26 unilateral cleft lip and palate patients who had undergone presurgical NAM (NAM group) and 20 unilateral cleft lip and palate patients who did not have any presurgical NAM (non-NAM group) were analyzed. The radiographs were digitally traced using Quick Ceph Studio software (version 3.5.1.r (1151); Quick Ceph Systems, San Diego, Calif). Independent samples t tests were performed for statistical analysis. No significant differences were observed in sagittal and vertical skeletal measurements between the NAM and non-NAM groups. NAM resulted in no significant difference in skeletal development in unilateral cleft lip and palate patients compared with those without NAM in early childhood. Copyright © 2018. Published by Elsevier Inc.

  9. Presurgical cleft lip and palate orthopedics: an overview

    Science.gov (United States)

    Alzain, Ibtesam; Batwa, Waeil; Cash, Alex; Murshid, Zuhair A

    2017-01-01

    Patients with cleft lip and/or palate go through a lifelong journey of multidisciplinary care, starting from before birth and extending until adulthood. Presurgical orthopedic (PSO) treatment is one of the earliest stages of this care plan. In this paper we provide a review of the PSO treatment. This review should help general and specialist dentists to better understand the cleft patient care path and to be able to answer patient queries more efficiently. The objectives of this paper were to review the basic principles of PSO treatment, the various types of techniques used in this therapy, and the protocol followed, and to critically evaluate the advantages and disadvantages of some of these techniques. In conclusion, we believe that PSO treatment, specifically nasoalveolar molding, does help to approximate the segments of the cleft maxilla and does reduce the intersegment space in readiness for the surgical closure of cleft sites. However, what we remain unable to prove equivocally at this point is whether the reduction in the dimensions of the cleft presurgically and the manipulation of the nasal complex benefit our patients in the long term. PMID:28615974

  10. Catapult splint: a foot dorsiflexion assist splint.

    Science.gov (United States)

    Jain, Vineet; Agrawal, Mayank; Dhal, Anil

    2011-12-01

    Loss of dorsiflexion is a common problem in cases where an external fixator or Ilizarov assembly is applied. It results in functional impairment of the foot by affecting the swing phase of gait cycle. We devised a simple dynamic dorsiflexion assist splint for prevention, correction of equinus/cavus deformity and maintenance of normal dorsiflexion of foot. This prospective study used a rubber splint styled in the shape of a catapult, made of discarded car rubber tubes attached to the frame of fixator in 50 patients. In 17 patients there was varying amount of loss of dorsiflexion at the time of application of splint while in 22 patients it was applied soon after the application of the fixator. In the rest of patients it was applied for cavus deformity. Out of 17 patients 10 had complete recovery of dorsiflexion. 22 patients in whom it was applied at the outset had normal range of movement at ankle. Correction was achieved in all 6 cases of cavus deformity and prevented its occurrence in the rest of 5 cases. Catapult splint is a low cost foot dorsiflexion assist splint. Copyright © 2011 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  11. Emergency presurgical visit

    Directory of Open Access Journals (Sweden)

    Alfredo Castro Díaz

    2009-07-01

    Full Text Available The objective has been to create a Protocol of Structured Presurgical Visit applicable to the patients who are undergoing an emergency surgery, to provide the user and his family all the necessary cares on the basis of those nursing diagnosis that prevail in all the cases of surgical emergency interventions. The used method has been an analysis of the emergency surgical interventions more prevalent from February 2007 until October 2008 in our area (a regional hospital, and statistic of those nursing diagnosis that more frequently appeared in these interventions, the previous moment to the intervention and in addition common to all of them. The results were the following ones: the more frequent emergency operations were: Caesarean, ginecological curettage, laparotomy, help in risk childbirth, orthopaedic surgery and appendectomy. The more frequent nursing diagnosis in all the emergency operations at the previous moment of the intervention were: risk of falls, pain, anxiety, deficit of knowledge, risk of infection, movement stress syndrome, risk of hemorrhage, cutaneous integrity deterioration. The conclusion is that users present at the previous moment to an emergency operation several problems, which force to the emergency surgical ward nurse to the introduction of the nursing methodology, in order to identify the problems, to mark results and to indicate the interventions to achieve those results, besides in a humanitarian way and with quality. This can be obtained by performing a Structured Emergency Presurgical Visit.

  12. Positioning, Splinting, and Contracture Management

    Science.gov (United States)

    2011-01-01

    massage , and pressure in the long- term rehabilitation phase.23 Types There are 3 types of splints routinely used with burn patients: static splints...be anchored more effectively.70 Care should be taken, however, to avoid making them so long that baby fat causes pinching with movement at the proximal...instruments out of sight.75 Introducing the splint material to children, allowing them to touch it, or fabri- cating a small splint on a doll or parent

  13. Tips for splinting traumatised teeth

    LENUS (Irish Health Repository)

    Leith, Rona

    2017-11-01

    A splint is required when teeth are mobile or need to be repositioned following a traumatic injury. The aim of splinting is to stabilise the injured tooth and maintain its position throughout the splinting period, improve function and provide comfort. Current best practice guidelines from the International Association for Dental Traumatology (IADT) recommend splinting for luxated, avulsed, root fractured and traumatically loosened permanent teeth.1,2 Splinting of primary teeth is usually not feasible. In general, the prognosis of a traumatised tooth is determined by the type of injury rather than the type of splint.3 However, correct splinting is important to maximise healing of the soft and hard tissues, and prevent further injury.1

  14. Tips for splinting traumatised teeth

    LENUS (Irish Health Repository)

    Leith, Rona

    2017-10-01

    A splint is required when teeth are mobile or need to be repositioned following a traumatic injury. The aim of splinting is to stabilise the injured tooth and maintain its position throughout the splinting period, improve function and provide comfort. Current best practice guidelines from the International Association for Dental Traumatology (IADT) recommend splinting for luxated, avulsed, root fractured and traumatically loosened permanent teeth.1,2 Splinting of primary teeth is usually not feasible. In general, the prognosis of a traumatised tooth is determined by the type of injury rather than the type of splint.3 However, correct splinting is important to maximise healing of the soft and hard tissues, and prevent further injury.1-6

  15. Current status of presurgical infant orthopaedic treatment for cleft lip and palate patients: A critical review

    Science.gov (United States)

    Niranjane, P. Priyanka; Kamble, R. H.; Diagavane, S. Pallavi; Shrivastav, S. Sunita; Batra, Puneet; Vasudevan, S. D.; Patil, Pushkar

    2014-01-01

    Rehabilitation of cleft lip and palate (CLP) patients is a challenge for all the concerned members of the cleft team, and various treatment modalities have been attempted to obtain aesthetic results. Presurgical infant orthopaedics (PSIO) was introduced to reshape alveolar and nasal segments prior to surgical repair of cleft lip. However, literature reports lot of controversy regarding the use of PSIO in patients with CLP. Evaluation of long-term results of PSIO can provide scientific evidence on the efficacy and usefulness of PSIO in CLP patients. The aim was to assess the scientific evidence on the efficiency of PSIO appliances in patients with CLP and to critically analyse the current status of PSIO. A PubMed search was performed using the terms PSIO, presurgical nasoalveolar moulding and its long-term results and related articles were selected for the review. The documented studies report no beneficial effect of PSIO on maxillary arch dimensions, facial aesthetics and in the subsequent development of dentition and occlusion in CLP patients. Nasal moulding seems to be more beneficial and effective in unilateral cleft lip and palate patients with better long-term results. PMID:25593413

  16. Current status of presurgical infant orthopaedic treatment for cleft lip and palate patients: A critical review

    Directory of Open Access Journals (Sweden)

    P Priyanka Niranjane

    2014-01-01

    Full Text Available Rehabilitation of cleft lip and palate (CLP patients is a challenge for all the concerned members of the cleft team, and various treatment modalities have been attempted to obtain aesthetic results. Presurgical infant orthopaedics (PSIO was introduced to reshape alveolar and nasal segments prior to surgical repair of cleft lip. However, literature reports lot of controversy regarding the use of PSIO in patients with CLP. Evaluation of long-term results of PSIO can provide scientific evidence on the efficacy and usefulness of PSIO in CLP patients. The aim was to assess the scientific evidence on the efficiency of PSIO appliances in patients with CLP and to critically analyse the current status of PSIO. A PubMed search was performed using the terms PSIO, presurgical nasoalveolar moulding and its long-term results and related articles were selected for the review. The documented studies report no beneficial effect of PSIO on maxillary arch dimensions, facial aesthetics and in the subsequent development of dentition and occlusion in CLP patients. Nasal moulding seems to be more beneficial and effective in unilateral cleft lip and palate patients with better long-term results.

  17. Long-term effects of presurgical infant orthopedics in patients with cleft lip and palate: a systematic review.

    Science.gov (United States)

    Uzel, Aslıhan; Alparslan, Z Nazan

    2011-09-01

    This study aimed to assess the scientific evidence on the efficiency of presurgical infant orthopedic appliances in patients with cleft lip and palate to shed light on a specific, contemporary discussion of whether the appliances have long-term advantages with respect to treatment outcomes. A systematic review. Two literature surveys from the five electronic databases were performed with a 1-month interval. Randomized controlled trials and controlled clinical trials (controls had no presurgical infant orthopedics) that had follow-up periods of a minimum of 6 years were included in the study. The exceptions to the follow-up limit were studies related to feeding and parent satisfaction. Of the 319 articles retrieved in the literature surveys, 12 were qualified for the final analysis. The level of evidence of these articles ranged from 1b to 4. Eight randomized controlled trials and four controlled clinical trials were available on eight treatment outcomes. The longest follow-up period of the randomized controlled trials was 6 years. No randomized controlled trials were found on active presurgical infant orthopedic appliances and on nasoalveolar molding appliances. Based on the results, presurgical infant orthopedic appliances have no long-term positive effects on seven of the eight studied treatment outcomes in patients with cleft lip and palate. More randomized controlled trials need to be done to have evidence regarding the effects of presurgical infant orthopedics in different surgical protocols. Also, the encouraging results about the effect of nasolaveolar molding appliances on nasal symmetry have to be supported by future randomized controlled trials.

  18. Shin splints - self-care

    Science.gov (United States)

    ... has frequent stops and starts, such as dancing, basketball, or military training. You are more at risk for shin splints if you: Have flat feet or a very rigid foot arches. Work out on ... street or playing basketball or tennis on a hard court. Do not ...

  19. Comparative study of presurgical hand hygiene with hydroalcoholic solution versus traditional presurgical hand hygiene.

    Science.gov (United States)

    López Martín, M Beatriz; Erice Calvo-Sotelo, Alejo

    To compare presurgical hand hygiene with hydroalcoholic solution following the WHO protocol with traditional presurgical hand hygiene. Cultures of the hands of surgeons and surgical nurses were performed before and after presurgical hand hygiene and after removing gloves at the end of surgery. Cultures were done in 2different days: the first day after traditional presurgical hand hygiene, and the second day after presurgical hand hygiene with hydroalcoholic solution following the WHO protocol. The duration of the traditional hand hygiene was measured and compared with the duration (3min) of the WHO protocol. The cost of the products used in the traditional technique was compared with the cost of the hydroalcoholic solution used. The variability of the traditional technique was determined by observation. Following presurgical hand hygiene with hydroalcoholic solution, colony-forming units (CFU) were detected in 5 (7.3%) subjects, whereas after traditional presurgical hand hygiene CFU were detected in 14 subjects (20.5%) (p < 0.05). After glove removal, the numbers of CFU were similar. The time employed in hand hygiene with hydroalcoholic solution (3min) was inferior to the time employed in the traditional technique (p < 0.05), its cost was less than half, and there was no variability. Compared with other techniques, presurgical hand hygiene with hydroalcoholic solution significantly decreases CFU, has similar latency time, a lower cost, and saves time. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  20. Presurgical Orthopedics Appliance: The Latham Technique.

    Science.gov (United States)

    Cruz, Carlos

    2016-05-01

    The Latham appliance is an active presurgical orthopedic device used for cleft defects. Its long-term effects are debated. It was introduced to help surgeons achieve a more predictable surgical outcome; hence, it should be evaluated for its presurgical benefits. The device has been successful in expanding and aligning the maxillary segments; retruding protruded premaxillae; aligning bilateral alveolar ridges; placing less tension on surgical closures; and reducing fistulation rates. However, it has not been shown to have either a positive or negative long-term effect on maxillary development or occlusion. It is a valuable preoperative tool for surgeons treating cleft defects. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Custom Made Pressure Appliance for Presurgical Sustained ...

    African Journals Online (AJOL)

    of Plastic Surgery for the fabrication of ear pressure clip for the left auricular keloid. She complained of swelling ... A case of presurgical size reduction for a large ear keloid with a custom made pressure appliance is presented. ... She was also instructed about use, maintenance of hygiene and regular follow-up for periodic ...

  2. Custom Made Pressure Appliance for Presurgical Sustained ...

    African Journals Online (AJOL)

    Among the most common complications of this therapy is ulceration due to excessive pressure. A case of presurgical size reduction for a large ear keloid with a custom made pressure appliance is presented. This novel design of the appliance allows for better control over the amount and direction of the pressure applied on ...

  3. RapidSplint: virtual splint generation for orthognathic surgery - results of a pilot series.

    Science.gov (United States)

    Adolphs, Nicolai; Liu, Weichen; Keeve, Erwin; Hoffmeister, Bodo

    2014-01-01

    Within the domain of craniomaxillofacial surgery, orthognathic surgery is a special field dedicated to the correction of dentofacial anomalies resulting from skeletal malocclusion. Generally, in such cases, an interdisciplinary orthodontic and surgical treatment approach is required. After initial orthodontic alignment of the dental arches, skeletal discrepancies of the jaws can be corrected by distinct surgical strategies and procedures in order to achieve correct occlusal relations, as well as facial balance and harmony within individualized treatment concepts. To transfer the preoperative surgical planning and reposition the mobilized dental arches with optimal occlusal relations, surgical splints are typically used. For this purpose, different strategies have been described which use one or more splints. Traditionally, these splints are manufactured by a dental technician based on patient-specific dental casts; however, computer-assisted technologies have gained increasing importance with respect to preoperative planning and its subsequent surgical transfer. In a pilot study of 10 patients undergoing orthognathic corrections by a one-splint strategy, two final occlusal splints were produced for each patient and compared with respect to their clinical usability. One splint was manufactured in the traditional way by a dental technician according to the preoperative surgical planning. After performing a CBCT scan of the patient's dental casts, a second splint was designed virtually by an engineer and surgeon working together, according to the desired final occlusion. For this purpose, RapidSplint, a custom-made software platform, was used. After post-processing and conversion of the datasets into .stl files, the splints were fabricated by the PolyJet procedure using photo polymerization. During surgery, both splints were inserted after mobilization of the dental arches then compared with respect to their clinical usability according to the occlusal fitting. Using

  4. Rehabilitation of digital nerve repair: is splinting necessary?

    Science.gov (United States)

    Clare, T D; de Haviland Mee, S; Belcher, H J C R

    2004-12-01

    Forty isolated, sharp digital nerve divisions, which had been repaired by microsurgical techniques, were reviewed between 12 and 36 months postoperatively (mean, 20 months). Half of the repairs had been splinted beyond the immediate postoperative period and half had not. Non-splinted patients returned to work significantly quicker than those who were splinted. Splinted patients reported more stiffness and cold intolerance but splinting made no difference to either the measured sensibility or movement of the digit. We would conclude that, after repair of sharp, uncomplicated digital nerve divisions, splinting beyond the immediate postoperative period is at least unnecessary and may be deleterious.

  5. An overview of pre-surgical evaluation

    Directory of Open Access Journals (Sweden)

    Kurupath Radhakrishnan

    2014-01-01

    Full Text Available The success of an epilepsy surgery program depends upon the early identification of potential surgical candidates and selecting from them, ideal candidates for surgery, who are destined to have a post-operative seizure-free outcome without any unacceptable neurological deficits. Since epilepsy surgery centers in resource-poor countries will lack the full range of state-of-the-art technologies usually available in resource-rich countries to perform pre-surgical evaluation, cost-effectively utilization of the locally available investigative facilities to select the surgical candidates becomes challenging. In the present era of rapid electronic communications and telemedicine, it has become possible for epilepsy surgery centers to pool their technological and human resources and to partner with centers nationally and internationally in implementing pre-surgical evaluation strategies.

  6. Pre-surgical register of tobacco consumption.

    Science.gov (United States)

    Gavilán, Eva; Moreno, Montse; Pérez, Àngels; Castellano, Yolanda; Fernández, Esteve; Martínez, Cristina

    2018-03-24

    Smoking cessation before surgery decreases the risk of complications. The aim of this study was to analyse the smoking register, associated variables and a short talk given to smokers in pre-surgical visits. Cross-sectional study. The pre-surgical records of 680 patients were assessed. We selected patient sociodemographic variables, surgical intervention characteristics, smoking status and consumption pattern. Logistic regression was used to study the variables association with smoking. A percentage of 97.2 of the pre-surgical records include information on tobacco consumption. Overall 20% of surgical patients are smokers. The probability of smoking is higher among men (adjusted odds ratio [aOR] 2.6, 95% confidence interval [CI] 1.7-4.0) and≤60 years (aOR 5.4, 95% CI 3.2-9.1). None of the records had information regarding a short talk given to patients to give up smoking. Smoking consumption was prevalent, but the characterisation of a smoker's profile and short talk given to patient before surgery was practically nonexistent. Ensuring that patients who smokes receives a short talk to give up smoking before surgery is necessary. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

  7. Bone scanning in Shin Splint evaluation

    International Nuclear Information System (INIS)

    Dumont, M.; Lamoureux, F.; Lamoureux, J.; Danais, S.; Lacoste, P.; Duranceau, J.

    1983-01-01

    Jogging is increasingly popular; in U.S.A., in 1979 more than 25 millions people were considered joggers. Lesions of the locomotive system of the lower limbs are very frequent in athletes and the Shin Splint syndrome, for one, is very frequent. However this precise clinical entity, usually X-Ray negative, is ill-known. A bone scan study in a series of 30 athletes suffering from Shin Splints is presented. The bone scans being positive and typical were highly useful in confirming the clinical diagnosis. Moreover, follow-up studies were done in a number of these patients and results correlated well with the clinical evolution [fr

  8. Splinting of Longitudinal Fracture: An Innovative Approach

    Directory of Open Access Journals (Sweden)

    Rashmi Bansal

    2016-01-01

    Full Text Available Trauma may result in craze lines on the enamel surface, one or more fractured cusps of posterior teeth, cracked tooth syndrome, splitting of posterior teeth, and vertical fracture of root. Out of these, management of some fractures is of great challenge and such teeth are generally recommended for extraction. Literature search reveals attempts to manage such fractures by full cast crown, orthodontic wires, and so forth, in which consideration was given to extracoronal splinting only. However, due to advancement in materials and technologies, intracoronal splinting can be achieved as well. In this case report, longitudinal fractures in tooth #27, tooth #37, and tooth #46 had occurred. In #27, fracture line was running mesiodistally involving the pulpal floor resulting in a split tooth. In teeth 37 and 46, fractures of the mesiobuccal cusp and mesiolingual cusp were observed, respectively. They were restored with cast gold inlay and full cast crown, respectively. Longitudinal fracture of 27 was treated with an innovative approach using intracanal reinforced composite with Ribbond, external reinforcement with an orthodontic band, and full cast metal crown to splint the split tooth.

  9. Elastomeric contractile actuators for hand rehabilitation splints

    Science.gov (United States)

    Carpi, Federico; Mannini, Andrea; De Rossi, Danilo

    2008-03-01

    The significant electromechanical performances typically shown by dielectric elastomer actuators make this polymer technology particularly attractive for possible active orthoses for rehabilitation. Folded contractile actuators made of dielectric elastomers were recently described as a simple configuration, suitable to easily implement linear contractile devices. This paper describes an application of folded actuators for so-called hand splints: they consist of orthotic systems for hand rehabilitation. The dynamic versions of the state-of-the-art splints typically include elastic bands, which exert a passive elastic resistance to voluntary elongations of one or more fingers. In order to provide such splints with the possibility of electrically modulating the compliance of the resistive elements, the substitution of the passive elastic bands with the contractile actuators is here described. The electrical activation of the actuators is used to vary the compliance of the system; this enables modulations of the force that acts as an antagonist to voluntary finger movements, according to programmable rehabilitation exercises. The paper reports results obtained from the first prototype implementations of such a type of system.

  10. Splinting of Longitudinal Fracture: An Innovative Approach.

    Science.gov (United States)

    Bansal, Rashmi; Chowdhary, Priyanka; Gurtu, Anuraag; Mehrotra, Nakul; Kishore, Abhinav

    2016-01-01

    Trauma may result in craze lines on the enamel surface, one or more fractured cusps of posterior teeth, cracked tooth syndrome, splitting of posterior teeth, and vertical fracture of root. Out of these, management of some fractures is of great challenge and such teeth are generally recommended for extraction. Literature search reveals attempts to manage such fractures by full cast crown, orthodontic wires, and so forth, in which consideration was given to extracoronal splinting only. However, due to advancement in materials and technologies, intracoronal splinting can be achieved as well. In this case report, longitudinal fractures in tooth #27, tooth #37, and tooth #46 had occurred. In #27, fracture line was running mesiodistally involving the pulpal floor resulting in a split tooth. In teeth 37 and 46, fractures of the mesiobuccal cusp and mesiolingual cusp were observed, respectively. They were restored with cast gold inlay and full cast crown, respectively. Longitudinal fracture of 27 was treated with an innovative approach using intracanal reinforced composite with Ribbond, external reinforcement with an orthodontic band, and full cast metal crown to splint the split tooth.

  11. Splinting of Longitudinal Fracture: An Innovative Approach

    Science.gov (United States)

    Bansal, Rashmi; Chowdhary, Priyanka; Gurtu, Anuraag; Mehrotra, Nakul; Kishore, Abhinav

    2016-01-01

    Trauma may result in craze lines on the enamel surface, one or more fractured cusps of posterior teeth, cracked tooth syndrome, splitting of posterior teeth, and vertical fracture of root. Out of these, management of some fractures is of great challenge and such teeth are generally recommended for extraction. Literature search reveals attempts to manage such fractures by full cast crown, orthodontic wires, and so forth, in which consideration was given to extracoronal splinting only. However, due to advancement in materials and technologies, intracoronal splinting can be achieved as well. In this case report, longitudinal fractures in tooth #27, tooth #37, and tooth #46 had occurred. In #27, fracture line was running mesiodistally involving the pulpal floor resulting in a split tooth. In teeth 37 and 46, fractures of the mesiobuccal cusp and mesiolingual cusp were observed, respectively. They were restored with cast gold inlay and full cast crown, respectively. Longitudinal fracture of 27 was treated with an innovative approach using intracanal reinforced composite with Ribbond, external reinforcement with an orthodontic band, and full cast metal crown to splint the split tooth. PMID:27247808

  12. Adjunctive Intracoronal Splint in Periodontal Treatment: Report of Two Cases

    OpenAIRE

    Mora Octavia; Yuniarti Soeroso; Yulianti Kemal; Airina Airina

    2015-01-01

    Reduction of the amount of tooth roots which are embedded in their periodontium could cause tooth mobility. Splinting a weaker tooth with a more stable one, and using the principle of the multiple-root stabilization is one way to overcome tooth mobility. Temporary splinting aims to prevent pathological migration, restore masticatory function, stabilize teeth before/after surgery, and evaluate the prognosis of periodontal treatment. The use of intracoronal splint is still controversial because...

  13. Adjunctive Intracoronal Splint in Periodontal Treatment: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Mora Octavia

    2015-05-01

    Full Text Available Reduction of the amount of tooth roots which are embedded in their periodontium could cause tooth mobility. Splinting a weaker tooth with a more stable one, and using the principle of the multiple-root stabilization is one way to overcome tooth mobility. Temporary splinting aims to prevent pathological migration, restore masticatory function, stabilize teeth before/after surgery, and evaluate the prognosis of periodontal treatment. The use of intracoronal splint is still controversial because there are only a few studies that have evaluated the effect of splinting on periodontal health. We report two cases to evaluate the effect of intracoronal splint on periodontal treatment. Two periodontal cases that use intracoronal splint before, during, and after periodontal regenerative therapy using bone graft. Causes of tooth mobility were removed and the splinting principles, terms and guidelines were mastered to get the maximum results of periodontal treatment. Both cases were evaluated radiographically 10 months after treatment. In these cases, intracoronal splint has supported the therapy before, during, or after surgery. Splinting is only for adjunctive therapy, and does not serve as the sole method in getting occlusal stability.DOI: 10.14693/jdi.v21i3.193

  14. Dentists' knowledge of occlusal splint therapy for bruxism and ...

    African Journals Online (AJOL)

    2015-10-28

    Oct 28, 2015 ... Trabzon, 1Department of Orthodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey. Access this ... of a previous appliance.[14] Lindfors ..... soft appliances. We found similar frequencies of soft and hard splint type. However, the less common was found as combined splint application. In a survey ...

  15. 21 CFR 872.3740 - Retentive and splinting pin.

    Science.gov (United States)

    2010-04-01

    ...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3740 Retentive and splinting pin. (a) Identification. A retentive and splinting pin is a device made of austenitic alloys or alloys containing 75 percent or greater gold and metals of the platinum group intended to be placed permanently in a tooth to...

  16. Effects of using hallux valgus (HV splint, HV splint plus exercise or HV splint plus electrical stimulation (ES on treatment of flexible HV in Young Population

    Directory of Open Access Journals (Sweden)

    Abbas Rahimi

    2012-10-01

    Full Text Available Background and Aim: The dramatically increased incidence of hallux valgus (HV deformity is more related to the cultural rather than genetic parameters. Satisfaction rate following either conservative or surgical treatments are very low. The current study aimed to compare the effects of three commonly used conservative treatments including hallux valgus (HV splint, HV splint plus electrical stimulation (ES currents, or HV splint plus exercise to treat this deformity. Materials & Methods: Thirty-six university students with a mild to moderate HV deformity were recruited in this study. Before starting the study, anterior-posterior view radiographies were taken from their feet. HV angle (HVA less than 20º was considered as normal, between 21-25º as mild, between 26-40 º as moderate and higher than 40 degrees was considered as a sever HV deformity. Then, the subjects were divided into three groups (n=12 and were randomly placed into Splint, Splint plus Exercise, and Splint plus Exercise plus ES groups for 6 weeks. At the end of week six, the radiographies were repeated and the pre/post treatments HVA were compared. Results: The results of the current study showed a non-significant 4.7% reduction of HVA in Splint group (p=0.12. However, 15.4% reduction of HVA occurred in Splint plus Exercise group, which was significant (p=0.005.The subjects used Splint plus Electrical stimulation showed a significant 13.9% reduction in HVA (p=0.008. Furthermore, AOFAS scores of the subjects revealed no significant differences among treatment groups in terms of pain reduction.Conclusion: Although using a HV splint alone could not significantly reduce the HVA, mixing it with either exercise or ES could significantly expedite its corrective effects. It should be mentioned that correction of the deformity was not always associated with decreasing the subjects’ pain, which might be due to the immediate counter force of the splint. Repeating the study with a long

  17. Nasal septum configuration as a basis for novel septal splints.

    Science.gov (United States)

    Furbish, Nina; Kühnel, Thomas S

    2017-03-01

    The objective is to use anatomical determinations of nasal septum shape and surface area in adults as a design basis for silastic septal splints of universal size and fit and offering maximum possible surface coverage. The objective is also to devise a method of securing the septal splints, so that surface pressure on septal mucosa is distributed as evenly as possible while not interfering with capillary perfusion. Nasal septum area was determined in 21 Caucasian body donors, and nasal septum thickness was measured in 20 CT scans. Septal splints of universal size and shape were prepared from silastic sheeting. The holding force of various neodymium-iron-boron (NdFeB) magnets, and the surface pressure exerted by magnet-containing septal splints was calculated. These septal splints of novel design offer a satisfactory fit in routine clinical practice. The splints can be securely attached with built-in NdFeB magnets, and surface pressure can be distributed evenly across the nasal septum while not interfering with mucosal tissue perfusion. With their simple intranasal insertion, these magnet-containing septal splints of universal size and optimised shape offer maximum possible septum coverage following septoplasty/septorhinoplasty. The absence of interference with septal tissue perfusion means that they are likely to be associated with fewer postoperative complications and better outcomes.

  18. Semirigid Cantilever Extension System for Splinting Implants: A Clinical Report

    Directory of Open Access Journals (Sweden)

    Raissa Micaella Marcello Machado

    2014-01-01

    Full Text Available In mandibular edentulous patients, treatment based on immediate loading with rigid splinting in the mandible is well accepted; however, it is cost and time dependent, which sometimes limits this type of rehabilitation. To overcome these problems, the technique of immediate loading using a semirigid splinting extension system has been developed. Its advantages include low cost, technical feasibility, and reduced clinic time. This clinical report presents the applicability and the predictability of semirigid splinting of implants in the mandibular arch of an edentulous patient using a distal extension bar prosthesis system.

  19. 21 CFR 872.3890 - Endodontic stabilizing splint.

    Science.gov (United States)

    2010-04-01

    ... inserted through the root canal into the upper or lower jaw bone to stabilize a tooth. (b) Classification... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3890 Endodontic stabilizing splint. (a...

  20. Postoperative splinting for isolated digital nerve injuries in the hand.

    Science.gov (United States)

    Vipond, Nicole; Taylor, William; Rider, Mark

    2007-01-01

    Digital nerve injuries in the hand are common and can result in significant impairment and functional restriction. Despite this, there is relatively little literature, particularly with respect to postoperative rehabilitation. Splinting after repair, purported to protect the repaired nerve from excessive stretch is still commonly used. Recent cadaveric studies indicate postoperative rehabilitation is not necessary with resection up to 2.5mm. A randomized controlled trial was therefore undertaken to determine whether splinting after isolated 5th degree digital nerve transection is in fact necessary. Twenty-six subjects were recruited over a two-year period and randomized to either three weeks of hand-based splinting or free active motion. ANCOVA indicated no differences in sensibility at six months between the two groups. Subjects also reported their greatest functional limitations were because of hyperesthesia. Although this study is underpowered, these limited results suggest splinting may not be required postoperatively.

  1. The flexibility controlling study for 3D printed splint

    Science.gov (United States)

    Li, Jianyou; Tanaka, Hiroya

    2017-04-01

    The 3D printed splint's light weight, ventilation and water proof are considered as significant improvement for patients' comfortableness. Somehow, the flexible material is required in the splint to avoid skin friction may cased by its rigid edge, but this would increase the complexity and timeconsuming. In this study, two main techniques to control the infilling densities and printing temperature are applied on printing splint prototype. The gradual increasing of infilling density from splint outside to inside would turn the partial strength from hard to flexible. Besides, higher printing temperature can also achieve stronger hardness after cooling. Such structural can provide high strength in outside surface to keep the immovable function, and give flexible touch of inside surface to decrease friction on the patient's skin.

  2. Ictal PET in presurgical workup of refractory extratemporal epilepsy

    Directory of Open Access Journals (Sweden)

    Javeria Nooraine

    2013-01-01

    Full Text Available Ictal Pet in presurgical workup of refractory epilepsy is seldom performed and limited due to technical difficulties. In carefully selected patient subset with frequent extratemporal seizures, ictal PET depicts ′seizure onset zone′ with high spatial resolution even within a widespread pathology. We here depict a four year old with posterior quadrant dysplasia evaluated with ictal PET.

  3. Multimodal neuroimaging in presurgical evaluation of drug-resistant epilepsy.

    Science.gov (United States)

    Zhang, Jing; Liu, Weifang; Chen, Hui; Xia, Hong; Zhou, Zhen; Mei, Shanshan; Liu, Qingzhu; Li, Yunlin

    2014-01-01

    Intracranial EEG (icEEG) monitoring is critical in epilepsy surgical planning, but it has limitations. The advances of neuroimaging have made it possible to reveal epileptic abnormalities that could not be identified previously and improve the localization of the seizure focus and the vital cortex. A frequently asked question in the field is whether non-invasive neuroimaging could replace invasive icEEG or reduce the need for icEEG in presurgical evaluation. This review considers promising neuroimaging techniques in epilepsy presurgical assessment in order to address this question. In addition, due to large variations in the accuracies of neuroimaging across epilepsy centers, multicenter neuroimaging studies are reviewed, and there is much need for randomized controlled trials (RCTs) to better reveal the utility of presurgical neuroimaging. The results of multiple studies indicate that non-invasive neuroimaging could not replace invasive icEEG in surgical planning especially in non-lesional or extratemporal lobe epilepsies, but it could reduce the need for icEEG in certain cases. With technical advances, multimodal neuroimaging may play a greater role in presurgical evaluation to reduce the costs and risks of epilepsy surgery, and provide surgical options for more patients with drug-resistant epilepsy.

  4. The comparison of designed slipper splints with the splints available on the market in the treatment of hallux valgus

    Directory of Open Access Journals (Sweden)

    babak Mirzashahi

    2011-08-01

    Conclusion: This study showed that despite the contraversies in nonoperative treatment of Hallux valgus, if the Hallux valgus angle of patients are mild to moderate, this splints can be used to treat it.

  5. Comparison of Designed Slippers Splints with the Splints Available on the Market in the Treatment of Hallux Valgus

    Directory of Open Access Journals (Sweden)

    Yadollah Pournia

    2012-02-01

    Full Text Available Hallux valgus or the lateral deviation of the great toe is a complex disease. If it is not treated, it will cause the deviation of other toes. Hallux valgus is three times more common in females and may cause uncomfortable deformity of the foot, problems in putting on unsuitable and narrow toe box shoes, and pain on the medial side of the first metatarsophalangeal joint; therefore, patients seek medical services. Untreated hallux valgus may cause the hammer toe deformity of the second toe. In this cohort study, 30 patients referring to the Orthopedic Clinic of Shohada Ashayer Hospital of Khorramabad, Iran, with a complaint of hallux valgus were randomly divided into two groups. The splints designed by the researches (slippers splints were given to the case group, and the splints on the market including night splints and interdigital pads were given to the control group. The patients were followed every three months for a year and every time the weight bearing anteroposterior radiography of both feet were taken and hallux valgus and inter-metatarsal angles were measured. The data was analyzed by the SPSS software using repeated measure tests. In the case group that used the designed splints regularly, hallux valgus angles decreased more dramatically than in the control group (P<0.001. This study showed that, despite controversies over the nonoperative treatment of hallux valgus, if hallux valgus angle in patient is mild to moderate, the splint can be used as a nonoperative treatment.

  6. Evaluation of the flexural properties of a new temporary splint material for use in dental trauma splints

    Directory of Open Access Journals (Sweden)

    Takahiro Shirako

    2017-09-01

    Full Text Available The present study evaluated the flexural properties of a new temporary splint material, G-Fix, for use in dental trauma splints in comparison with other resin materials. Four types of resin materials were considered in the present study: MI Flow II, light-cured composite resin (MI; G-Fix, light-cured resin for splinting teeth (GF; Super-Bond C&B, adhesive resin cement (SB; and Unifast III, self-cured methyl-methacrylate resin (UF. The flexural properties of these four materials were tested according to ISO 4049. The flexural strength significantly increased in the order of UF (64.9 MPasplint made of GF may be more flexible than a composite splint, which is categorized as a rigid splint.

  7. DENTAL SPLINTS: TYPES AND TIME OF IMMOBILIZATION POST TOOTH AVULSION

    Directory of Open Access Journals (Sweden)

    Samuel Rodrigo de Andrade VERAS

    2017-12-01

    Full Text Available Avulsion is defined as the complete displacement of the tooth out of its socket with disruption of the fibers of periodontal ligament, remaining some of them adhered to the cementum and the rest to the alveolar bone. This condition is more frequent in young permanent teeth, because the root development is still incomplete. Splints are used to immobilize traumatized teeth that suffered damage in their structures of support, preventing their constant movement. The literature has shown that after replantation, it is necessary to use splints in order to immobilize the teeth during the initial period, which is essential for the repair of periodontal ligament; the use of semi-rigid splint is more indicated than the rigid one, and long periods of splinting showed that substitutive resorption or ankylosis is an expected complication. Thus, the aim of this review is to describe the different types of splints; their time of permanency, and its influence on the process of healing and reparation on the occurrence of substitutive resorption or ankylosis. It is very important to keep gathering knowledge about this content, since it has been proved that the approaches and the protocols keep changing over time.

  8. A retrospective evaluation of the survival rates of splinted and non-splinted short dental implants in posterior partially edentulous jaws.

    Science.gov (United States)

    Mendonça, Jose Alfredo; Francischone, Carlos Eduardo; Senna, Plinio Mendes; Matos de Oliveira, Ana Elisa; Sotto-Maior, Bruno Salles

    2014-06-01

    The aim of the present study is to evaluate the survival rate and bone loss around short implants (≤10 mm) supporting splinted or non-splinted posterior prostheses during a follow-up period of 3 to 16 years. A total of 453 implants from 198 patients was divided into splinted or non-splinted groups. Implant survival rate was calculated for each group, and potential risk was represented as odds ratio (OR). The final linear distance from implant platform level to the first bone-to-implant contact was compared to this same reference just after loading by digital periapical radiographs to determine the marginal bone loss (BL). The splinted group comprised 219 implants in 86 patients, whereas the non-splinted group included 234 implants from 112 patients. The mean follow-up period was 9.7 ± 3.7 years. Although different success rates were found for splinted (97.7%) and non-splinted (93.2%) groups, they exhibited similar BL (1.22 ± 0.95 mm and 1.27 ± 1.15 mm, respectively). The success of splinted implants was associated with no other variable, whereas non-splinted implants exhibited higher risk of failure when placed in men (OR = 3.2) and when implants shorter than 10 mm were used (OR = 3.6 and 4.1 for 8.5 mm and 7 mm, respectively). Regardless of group, 71.4% of the unsuccessful implants failed before the end of the first year after loading. Non-splinted posterior short implants had a somewhat lower success rate than splinted short implants, and the failure rate in non-splinted short implants appeared to be greater in males as well as in implants ≤10 mm.

  9. Improving education: just-in-time splinting video.

    Science.gov (United States)

    Wang, Vincent; Cheng, Yu-Tsun; Liu, Deborah

    2016-06-01

    Just-in-time training (JITT) is an emerging concept in medical procedural education, but with few studies to support its routine use. Providing a brief educational intervention in the form of a digital video immediately prior to patient care may be an effective method to reteach knowledge for procedural techniques learned previously. Paediatric resident physicians were taught to perform a volar splint in a small workshop setting. Subsequently, they were asked to demonstrate their splinting proficiency by performing a splint on another doctor. Proficiency was scored on a five-point assessment tool. After 2-12 months, participants were asked to demonstrate their splinting proficiency on one of the investigators, and were divided into the control group (no further instruction) and the intervention group, which viewed a 3-minute JITT digital video demonstrating the splinting technique prior to performing the procedure. Thirty subjects were enrolled between August 2012 and July 2013, and 29 of 30 completed the study. The retest splinting time was not significantly different, but if the JITT group included watching the video, the total time difference was statistically significant: 3.86 minutes (control) versus 7.07 minutes (JITT) (95% confidence interval: 2.20-3.90 minutes). The average assessment score difference was 1.87 points higher for the JITT group, which was a statistically significant difference (95% confidence interval: 1.00-3.00). Just-in-time training is an emerging concept in medical procedural education JITT seems to be an effective tool in medical education for reinforcing previously learned skills. JITT may offer other possibilities for enhancing medical education. © 2015 John Wiley & Sons Ltd.

  10. Bone lesions from overload: shin splint and stress fracture

    International Nuclear Information System (INIS)

    Una Gorospe; Jon Andoni; Isla Gallego, Concepcion; Santana Borbones, Aranzazu; Perera Romero, Carmen; Allende Riera, Ana J

    2005-01-01

    There are many stress injuries in the lower extremities due to exercise, and the case we present is an example of two injuries which may present in children or young adults who train excessively. The patient complains of pain and tightness on exercise. The underlying pathology is probably rupture of insertion fibres of the tibial and soleus (Sharpey's fibres) muscles. Probably, there is also periostitis and myositis. Stress fractures and shin splints are often present at the same time in different stages, and both are typical pathologies due to excessive training. Scintigraphy allows identification and early management of shin splints and stress fractures (au)

  11. The significance of lower jaw position in relation to postural stability. Comparison of a premanufactured occlusal splint with the Dental Power Splint.

    Science.gov (United States)

    Ohlendorf, D; Riegel, M; Lin Chung, T; Kopp, S

    2013-01-01

    The purpose of this study was to investigate the effects on postural stability of two different lower jaw positions held in place by splints with eyes open and eyes closed. The postural stability in 21 healthy adult volunteers was investigated using two different sets of occlusal conditions with the lower jaw being at rest either with the eyes opened or closed. Two occlusal splints (standard splint and DPS splint) were used in order to maintain this lower jaw position. The balance behaviour was recorded using a balance platform. In a comparison of the habitual occlusion with the two occlusal splints, the balance posturographic values with the eyes opened fell between 7-9% and those for weight distribution with the eyes closed between 22-26% (with greater improvement being achieved with DPS) with the result that the variability in the range of fluctuations was reduced. The level of positioning accuracy deteriorated with the wearing of a splint between 13% with the DPS splint and 30% with the standard splint. Gender-specific differences of minor importance in relation to the positioning accuracy were recorded, with there being significant differences in the female participants (P≤0.00). An occlusal change in the stomatognathic system impacts on postural stability. Balance deficits seem to correlate with deteriorated body sway, which, according to the results, can be improved by a myocentric bite position using a DPS splint. This is more the case with the eyes closed than with the eyes opened.

  12. Dentists' knowledge of occlusal splint therapy for bruxism and ...

    African Journals Online (AJOL)

    2015-10-28

    Oct 28, 2015 ... Block SL, Apfel M, Laskin DM. The use of a resilient rubber bite appliance in the treatment of MPD syndrome. J Dent Res 1978;57:92. 21. Quayle AA, Gray RJ, Metcalfe RJ, Guthrie E, Wastell D. Soft occlusal splint therapy in the treatment of migraine and other headaches. J Dent. 1990;18:123-9. 22. Okeson ...

  13. Oral splints: the crutches for temporomandibular disorders and bruxism?

    Science.gov (United States)

    Dao, T T; Lavigne, G J

    1998-01-01

    Despite the extensive use of oral splints in the treatment of temporomandibular disorders (TMD) and bruxism, their mechanisms of action remain controversial Various hypotheses have been proposed to explain their apparent efficacy (i.e., true therapeutic value), including the repositioning of condyle and/or the articular disc, reduction in the electromyographic activity of the masticatory muscles, modification of the patient's "harmful" oral behavior, and changes in the patient's occlusion. Following a comprehensive review of the literature, it is concluded that any of these theories is either poor or inconsistent, while the issue of true efficacy for oral splints remains unsettled. However, the results of a controlled clinical trial lend support to the effectiveness (i.e., the patient's appreciation of the positive changes which are perceived to have occurred during the trial) of the stabilizing splint in the control of myofascial pain. In light of the data supporting their effectiveness but not their efficacy, oral splints should be used as an adjunct for pain management rather than a definitive treatment. For sleep bruxism, it is prudent to limit their use as a habit management aid and to prevent/limit dental damage potentially induced by the disorder. Future research should study the natural history and etiologies of TMD and bruxism, so that specific treatments for these disorders can be developed.

  14. Tibial Stress Injuries: Decisive Diagnosis and Treatment of "Shin Splints."

    Science.gov (United States)

    Couture, Christopher J.; Karlson, Kristine A.

    2002-01-01

    Tibial stress injuries, commonly called shin splints, often result when bone remodeling processes adopt inadequately to repetitive stress. Physicians who are caring for athletic patients must have a thorough understanding of this continuum of injuries, including medial tibial stress syndrome and tibial stress fractures, because there are…

  15. Stereoscopic virtual reality presurgical planning for cerebrospinal otorrhea.

    Science.gov (United States)

    Shen, Ming; Zhang, Xiao-Luo; Yang, De-Lin; Wu, Jin-Song

    2010-07-01

    We present a complicated case of spontaneous cerebrospinal otorrhea, which had not been cured despite undergoing 5 surgical interventions in the past. The disability to identify the location of the fistula was the main crux of the past failures. On this occasion, stereoscopic virtual reality presurgical planning was applied to identify the exact location of the fistula and a surgical simulation was performed, and was later confirmed during the actual operation. Interactive manipulation in a stereoscopic virtual environment makes the decision making process easier in the treatment of cerebrospinal otorrhea.

  16. Improved patient specific seizure detection during pre-surgical evaluation.

    LENUS (Irish Health Repository)

    Chua, Eric C-P

    2011-04-01

    There is considerable interest in improved off-line automated seizure detection methods that will decrease the workload of EEG monitoring units. Subject-specific approaches have been demonstrated to perform better than subject-independent ones. However, for pre-surgical diagnostics, the traditional method of obtaining a priori data to train subject-specific classifiers is not practical. We present an alternative method that works by adapting the threshold of a subject-independent to a specific subject based on feedback from the user.

  17. The effectiveness of occlusal splints for sleep bruxism.

    Science.gov (United States)

    Jagger, Robert

    2008-01-01

    Searches were made using the Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, LILACS (Latin American & Caribbean Health Sciences Literature), Biblioteca Brasileira de Odontologia, and Dissertations, Theses and Abstracts. Hand searches were made of abstracts of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from article reviews about treating sleep bruxism. There were no language restrictions. Randomised controlled trials (RCT) or quasi-RCT were chosen that compared splint therapy concurrently with no treatment, other occlusal appliances, or any other intervention in participants who had sleep bruxism. Data extraction was carried out independently and in duplicate. Validity assessment of the included trials was carried out at the same time as data extraction. Discrepancies were discussed and a third review author consulted. The author of the primary study was contacted when necessary. Thirty-two potentially relevant RCT were identified of which five were eventually included. In these, use of an occlusal splint was compared with palatal splint, mandibular advancement device, transcutaneous electric nerve stimulation, and no treatment. There was just one common outcome (arousal index) which was combined in a meta-analysis. No statistically significant difference between the occlusal splint and control groups were found in meta-analysis. There is not enough evidence to state that the occlusal splint is effective for treating sleep bruxism. Indication of its use is questionable with regard to sleep outcomes, but there may be some benefit with regard to tooth wear. This systematic review suggests the need for further investigation in more controlled RCT that pay attention to method of allocation, outcome assessment, large sample size, and sufficient duration of followup. The study design must be parallel in order to eliminate

  18. Characteristics of cancer patients participating in presurgical lifestyle intervention trials exploring effects on tumor biology

    Directory of Open Access Journals (Sweden)

    John A. Dasher

    2017-12-01

    Conclusion: Similar to other clinical trials, lack of time is a leading barrier to enrollment, and travel/distance appears to be a greater barrier for women in presurgical studies. Larger presurgical lifestyle intervention trials will require tailored strategies to enhance recruitment.

  19. Transient splenium lesions in presurgical epilepsy patients: incidence and pathogenesis

    Energy Technology Data Exchange (ETDEWEB)

    Nelles, M.; Falkenhausen, M. von; Urbach, H. [University of Bonn Medical Center, Department of Radiology/Neuroradiology, Bonn (Germany); Bien, C.G.; Kurthen, M. [University of Bonn Medical Center, Department of Epileptology, Bonn (Germany)

    2006-07-15

    Transient splenium corporis callosi (SCC) lesions are related to rapid reduction of antiepileptic drugs (AEDs). The range of substances with predilection for SCC changes, their pathophysiology and their occurrence are still unknown. In a prospective 2-year study an epilepsy-dedicated MRI protocol supplemented by DWI and ADC maps was performed after AED withdrawal for diagnostic seizure provocation in all patients with pharmacoresistant seizures locally admitted to the Department of Epileptology. Of 891 presurgical epilepsy patients, 6 (0.7%) had SCC lesions with cytotoxic edema on DWI. Carbamazepine combined with other AEDs was administered in five of those patients. In the study period we observed identical lesions in a schizophrenic patient treated with olanzapine and citalopram, in a patient with oropharyngeal carcinoma treated with alkylating agents, and in a hypernatremic patient following neurohypophyseal granular cell tumor surgery. Transient SCC lesions are related to rapid AED reduction but may occur in similar conditions with fluid balance alterations. We contribute further clinical data in this field to better classify the pharmaceuticals that are prone to the described cerebral cytotoxic side effects in the SCC and to clarify their incidence among presurgical epilepsy patients. (orig.)

  20. Digital assessment of occlusal wear patterns on occlusal stabilization splints: a pilot study.

    Science.gov (United States)

    Korioth, T W; Bohlig, K G; Anderson, G C

    1998-08-01

    If masticatory load distribution is task-dependent, then the pattern of wear on an acrylic resin occlusal splint over time may affect clinical outcome. This pilot study quantitatively assessed posterior wear after 3 months on the occlusal surfaces of maxillary stabilization splints. Subjects with known history of nocturnal bruxism were given heat-cured full-arch acrylic resin occlusal stabilization splints to be worn nocturnally for 3 months. Splint occlusion was adjusted at appliance delivery and was refined at the baseline session 1 to 2 weeks later. No further adjustment of the splint surface was performed during the 3-month study period. Sequential impressions of the splint occlusal surface provided epoxy resin models that were digitized and analyzed through specialized software. Changes in the digitized splint surface from baseline to 3 months allowed comparison of wear facets between splint sides and among tooth locations. Splint wear was asymmetric between sides and uneven between dental locations. For full coverage occlusal splints, the appliance wear phenomenon can be site specific and, if left undisturbed, may yield two extremes of high wear and a zone of low wear in-between.

  1. Development of a computer-aided design software for dental splint in orthognathic surgery

    Science.gov (United States)

    Chen, Xiaojun; Li, Xing; Xu, Lu; Sun, Yi; Politis, Constantinus; Egger, Jan

    2016-12-01

    In the orthognathic surgery, dental splints are important and necessary to help the surgeon reposition the maxilla or mandible. However, the traditional methods of manual design of dental splints are difficult and time-consuming. The research on computer-aided design software for dental splints is rarely reported. Our purpose is to develop a novel special software named EasySplint to design the dental splints conveniently and efficiently. The design can be divided into two steps, which are the generation of initial splint base and the Boolean operation between it and the maxilla-mandibular model. The initial splint base is formed by ruled surfaces reconstructed using the manually picked points. Then, a method to accomplish Boolean operation based on the distance filed of two meshes is proposed. The interference elimination can be conducted on the basis of marching cubes algorithm and Boolean operation. The accuracy of the dental splint can be guaranteed since the original mesh is utilized to form the result surface. Using EasySplint, the dental splints can be designed in about 10 minutes and saved as a stereo lithography (STL) file for 3D printing in clinical applications. Three phantom experiments were conducted and the efficiency of our method was demonstrated.

  2. Evaluation of accuracy of multiple dental implant impressions using various splinting materials.

    Science.gov (United States)

    Hariharan, Rasasubramanian; Shankar, Chitra; Rajan, Manoj; Baig, Mirza Rustum; Azhagarasan, N S

    2010-01-01

    The aim of the present study was to compare the accuracy of casts obtained from nonsplinted and splinted direct impression techniques employing various splinting materials for multiple dental implants. A reference model with four Nobel Replace Select implant replicas in the anterior mandible was fabricated with denture base heat-curing acrylic resin. Impressions of the reference model were made using polyether impression material by direct nonsplinted and splinted techniques. Impressions were divided into four groups: group A: nonsplinted technique; group B: acrylic resin-splinted technique; group C: bite registration addition silicone-splinted technique; and group D: bite registration polyether-splinted technique. Four impressions were made for each group and casts were poured in type IV dental stone. Linear differences in interimplant distances in the x-, y-, and z-axes and differences in interimplant angulations in the z-axis were measured on the casts using a coordinate measuring machine. The interimplant distance D1y showed significant variations in all four test groups (P = .043), while D3x values varied significantly between the acrylic resin-splinted and silicone-splinted groups. Casts obtained from the polyether-splinted group were the closest to the reference model in the x- and y-axes. In the z-axis, D2z values varied significantly among the three test groups (P = .009). Casts from the acrylic resin-splinted group were the closest to the reference model in the z-axis. Also, one of the three angles measured (angle 2) showed significant differences within three test groups (P = .009). Casts from the nonsplinted group exhibited the smallest angular differences. Casts obtained from all four impression techniques exhibited differences from the reference model. Casts obtained using the bite registration polyether-splinted technique were the most accurate versus the reference model, followed by those obtained via the acrylic resin-splinted, nonsplinted, and

  3. Occlusal splints for treating sleep bruxism (tooth grinding).

    Science.gov (United States)

    Macedo, C R; Silva, A B; Machado, M A; Saconato, H; Prado, G F

    2007-10-17

    Sleep bruxism is an oral activity characterised by teeth grinding or clenching during sleep. Several treatments for sleep bruxism have been proposed such as pharmacological, psychological, and dental. To evaluate the effectiveness of occlusal splints for the treatment of sleep bruxism with alternative interventions, placebo or no treatment. We searched the Cochrane Oral Health Group's Trials Register (to May 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1); MEDLINE (1966 to May 2007); EMBASE (1980 to May 2007); LILACS (1982 to May 2007); Biblioteca Brasileira de Odontologia (1982 to May 2007); Dissertation, Theses and Abstracts (1981 to May 2007); and handsearched abstracts of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from article reviews about treating sleep bruxism. There were no language restrictions. We selected randomised or quasi-randomised controlled trials (RCTs), in which splint therapy was compared concurrently to no treatment, other occlusal appliances, or any other intervention in participants with sleep bruxism. Data extraction was carried out independently and in duplicate. Validity assessment of the included trials was carried out at the same time as data extraction. Discrepancies were discussed and a third review author consulted. The author of the primary study was contacted when necessary. Thirty-two potentially relevant RCTs were identified. Twenty-four trials were excluded. Five RCTs were included. Occlusal splint was compared to: palatal splint, mandibular advancement device, transcutaneous electric nerve stimulation, and no treatment. There was just one common outcome (arousal index) which was combined in a meta-analysis. No statistically significant differences between the occlusal splint and control groups were found in the meta-analyses. There is not sufficient evidence to state that the occlusal splint is

  4. Establishment of a finite element model of a neonate's skull to evaluate the stress pattern distribution resulting during nasoalveolar molding therapy of cleft lip and palate patients.

    Science.gov (United States)

    Bauer, Franz X; Heinrich, Veronika; Grill, Florian D; Wölfle, Felix; Hedderich, Dennis M; Rau, Andrea; Wolff, Klaus-Dietrich; Ritschl, Lucas M; Loeffelbein, Denys J

    2018-02-02

    Nasoalveolar Molding (NAM) is associated with ambivalent acceptance regarding effectiveness and unknown long-term results. Our purpose was to analyze the stress distribution patterns within the viscero- and neurocranium of neonates during the first phase of NAM therapy. A finite element (FE) model of a healthy four-week-old neonate was generated, derived from a computed tomography scan allowing the implementation of a bone-density-dependent material model. The influence of dental germs with variable material properties, the cleft width and area of expected force application were analyzed in a worst-case scenario. The resulting stress distribution patterns for each situation were analyzed using the software Ansys APDL. The established FE model was verified with a convergence analysis. Overall, stress patterns at the age of four weeks showed von Mises stress values below 60.000 Pa in the viscero- and neurocranium. The influences of the allocation of material properties for the dental germs, the area of force application, and the cleft width were negligible. A workflow to simulate the stress distribution and deformation in neonates attributable to various areas of force application has been established. Further analyses of the skulls of younger and older neonates are needed to describe the stress distribution patterns during NAM therapy. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  5. Adhesive capsulitis and dynamic splinting: a controlled, cohort study

    Science.gov (United States)

    Gaspar, Paul D; Willis, F Buck

    2009-01-01

    Background Adhesive Capsulitis (AC) affects patient of all ages, and stretching protocols are commonly prescribed for this condition. Dynamic splinting has been shown effective in contracture reduction from pathologies including Trismus to plantar fasciitis. The purpose of this study was to examine the efficacy of dynamic splinting on patients with AC. Methods This controlled, cohort study, was conducted at four physical therapy, sports medicine clinics in Texas and California. Sixty-two patients diagnosed with Stage II Adhesive Capsulitis were grouped by intervention. The intervention categories were as follows: Group I (Control); Group II (Physical Therapy exclusively with standardized protocols); Group III; (Shoulder Dynasplint system exclusively); Group IV (Combined treatment with Shoulder Dynasplint and standardized Physical Therapy). The duration of this study was 90 days for all groups, and the main outcome measures were change in active, external rotation. Results Significant difference was found for all treatment groups (p adhesive Capsulitis. Trial Registration Trial Number: NCT00873158 PMID:19735563

  6. Surgical management of proximal splint bone fractures in the horse

    International Nuclear Information System (INIS)

    Peterson, P.R.; Pascoe, J.R.; Wheat, J.D.

    1987-01-01

    Fractures of Metacarpal and Metatarsal II and IV (the splint bones) were treated in 283 horses over an 11 year period. In 21 cases the proximal portion of the fractured bone was stabilized with metallic implants. One or more cortical bone screws were used in 11 horses, and bone plates were applied in 11 horses. One horse received both treatments. Complications of screw fixation included bone failure, implant failure, radiographic lucency around the screws, and proliferative new bone at the ostectomy site. Only two of the horses treated with screw fixation returned to their intended use. Complications of plate fixation included partial fixation failure (backing out of screws), wound drainage, and proliferative bony response around the plate. Six of the 11 horses treated by plate fixation returned to their intended use. The authors recommend consideration of plate fixation techniques for repair of fractures in the proximal third of the splint bone

  7. Surgical Splint Design Influences Transverse Expansion in Segmental Maxillary Osteotomies

    DEFF Research Database (Denmark)

    Stokbro, Kasper; Aagaard, Esben; Torkov, Peter

    2017-01-01

    splint designs on achieving the planned transverse expansion in bimaxillary surgery with segmental maxillary procedures. Materials and Methods: Forty-two participants were included in a retrospective observational study. All participants had completed virtually planned bimaxillary surgery with 3-piece....... To test measurement reliability, all measurements were performed twice by the same observer. The primary predictor variable was the planned expansion according to the virtual surgical plan. The primary covariate with influence on the obtained expansion was the surgical splint design. Other covariates...... of interest included patient age, patient gender, and surgeon. Descriptive and bivariate statistics were performed using Student t tests and linear regression analysis. Results: Measurements showed high reliability, with an intraclass correlation coefficient of 0.99 and Bland-Altman plots without systematic...

  8. Oral splint for temporomandibular joint disorders with revolutionary fluid system

    Directory of Open Access Journals (Sweden)

    Rahul Srivastava

    2013-01-01

    Full Text Available Temporomandibular joint (TMJ diseases and disorders refer to a complex and poorly understood set of conditions, manifested by pain in the area of the jaw and associated muscles and limitations in the ability to make the normal movements of speech, facial expression, eating, chewing, and swallowing. The conventional soft occlusal splint therapy is a much safer and effective mode of a conservative line of therapy in comparison to the surgical therapy for temporomandibular joint disorders (TMD. The purpose of this article is to review the Aqualizer TM , an hydrostatic oral splint, as accurate, effective treatment and differential diagnostic tool in TMD that allow treating the patient′s pain quickly and accurately saving valuable treatment time. The review article has been prepared doing a literature review from the world-wide web and pubmed/medline.

  9. Evaluation of two dental registration-splint techniques for surgical navigation in cranio-maxillofacial surgery.

    Science.gov (United States)

    Venosta, Dominik; Sun, Yi; Matthews, Felix; Kruse, Astrid L; Lanzer, Martin; Gander, Thomas; Grätz, Klaus W; Lübbers, Heinz-Theo

    2014-07-01

    Surgical navigation requires precise registration of the pre-operative image dataset to the patient in the operation theatre. Different marker-based and marker-free registration techniques are available, each of them with advantages and disadvantages regarding precision and clinical handling. In this model study, the precision of two dental splint techniques for marker-based registration is analyzed. A synthetic full-size human skull was registered with its cone beam computed tomography dataset using (a) a dentally-mounted "rapid" occlusal splint with five titanium screws directly attached to the splint, (b) an "extender", a dentally-mounted occlusal splint with similar fiducials fixed to an extension of the splint. The target registration error was measured for 170 landmarks distributed over the viscero- and neurocranium in 10 repeats per splint type using the Vector Vision2 (BrainLAB AG, Heimstetten, Germany) navigation system. Statistical and graphical evaluations were performed per anatomical region. In the periorbital region, the rapid splint, with an average deviation of 1.50 mm (SD = 0.439) showed greater accuracy than the extender with 1.76 mm (SD = 0.525). The viscerocranial results for both splints were similar (extender 1.84 mm, SD = 0.559, rapid occlusal splint 1.86 mm, SD = 0.686). In the cranial vault region, registration with the extender (2.33 mm, SD = 0.685) proved to be more precise than with the rapid splint (2.86 mm, SD = 0.929). Due to the more compact dimension of the rapid occlusal splint, errors close to the splint were smaller compared to the extender technique. The advantage of greater distances between the registration fiducials on the extender is particularly important in areas such as the orbital roof, the cranial vault, and the lateral skull base. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  10. CAD/CAM splints for the functional and esthetic evaluation of newly defined occlusal dimensions.

    Science.gov (United States)

    Edelhoff, Daniel; Schweiger, Josef; Prandtner, Otto; Trimpl, Johannes; Stimmelmayr, Michael; Güth, Jan-Frederik

    2017-01-01

    Pretreatment with occlusal splints is a crucial step in a structured treatment approach for a complex rehabilitation that changes the vertical dimension of occlusion. Meticulous patient compliance is one of the essential prerequisites for overall treatment success. However, patient compliance is all too often insufficient due to esthetic, phonetic, and functional limitations when using conventional occlusal splints in one arch. Modern production technologies now allow the use of tooth-colored occlusal splints made of polycarbonate, whose quality and material properties are quite distinct from those of conventionally manufactured splints made of transparent polymethyl methacrylate (PMMA). These materials, produced under standardized polymerization conditions, are extremely homogenous, which provides benefits such as a greater accuracy of fit by eliminating the polymerization shrinkage, greater long-term stability of shapes and shades, better biocompatibility, less wear, and a more favorable esthetic appearance. In addition, tooth-colored polycarbonate splints can be fabricated very thin without significantly increasing the fracture risk, thanks to the flexibility of the material. The improved wearing comfort combined with acceptable esthetics result in significantly improved patient compliance in terms of a "23-hour splint." By providing separate splints for the maxilla and mandible in the case of major alterations of the vertical dimension of occlusion, the esthetic and functional aspects defined by the wax-up can be completely transferred to the removable splints for a "test drive" by the patient, reversibly, and under realistic conditions. This dual-splint approach additionally facilitates segmental transfer into the definitive restoration.

  11. The effects of splinting periodontally compromised removable partial denture abutments on bone stresses: a three-dimensional finite element study

    Directory of Open Access Journals (Sweden)

    Allahyar Geramy

    2010-03-01

    Conclusion: Splinting a very weak abutment to an adjacent healthy tooth might not be beneficial. The acceptable crown to root ratio for fixed splinting a weak abutment to an adjacent normal tooth was around 1.65-2.

  12. Presurgical Mapping of the Language Network Using Resting State Functional Connectivity

    OpenAIRE

    Tanaka, Naoaki; Stufflebeam, Steven M.

    2016-01-01

    Resting-state functional magnetic resonance imaging (Resting-state fMRI) is a tool for investigating the functional networks that arise during the resting-state of the brain. Recent advances of the resting-state fMRI analysis suggest its feasibility for evaluating language function. The most common clinical application is for presurgical mapping of cortex for a brain tumor or for resective epilespy surgery. In this article, we review the techniques and presurgical applications of resting-stat...

  13. A versatile splint for fractured mandible in infants

    International Nuclear Information System (INIS)

    Swaify, G. A; Dhanrajani, P. J

    1991-01-01

    Jaw fractures in children form a small percentage of the total jaw fractures which occur in the population. The principles involved in the treatment of facial trauma are the same, whatever the age of the patient. However, for children, the techniques used are necessarily modified by certain anatomical, physiological, and psychological factors especially related lo childhood. The aim of this paper is to describe the use of a versatile splint for fixation of displaced fractures of the mandible in children, who are less than one year of age. (author

  14. [STUDY ABOUT PATIENT'S RELIGIOUS NEED IN PRESURGICAL STAGE].

    Science.gov (United States)

    Araújo, Célia Pires de

    1977-04-01

    A study of problems related to nursing assistance of patient's religious need in presurgical stage. Two hundred adult patients of both sexes admitted in three hospitals of São Paulo were interviewed. One hospital was a governmental institution, and two were private. Patient's interviews were made by means of a form containing open questions, which were filled out by the researcher according the patient's answers. Therefore it was able to reinforce the existent thought of the human being having a theological instinct, for almost the totality of the studied patients believed in God and showed their beliefs with unlike religious practices. Patients belonged to different denominations, most of them roman catholics. The common problem found among patients was the fear of surgery, which decreased with religious practices. In such a way, it was pointed out the significance of nursing service of admission, for this was the main nursing problem found in this study: large number of patients were unable to realize their practices while in hospital, given the lack of orientation the main reazon for that. Patients also suggested what they would like to receive from the hospital to attend their religious need. All the suggestions could be solved through the application of nursing process, considering the patient's dependence degree.

  15. Teaching Splinting Techniques Using a Just-in-Time Training Instructional Video.

    Science.gov (United States)

    Cheng, Yu-Tsun; Liu, Deborah R; Wang, Vincent J

    2017-03-01

    Splinting is a multistep procedure that is seldom performed by primary care physicians. Just-in-time training (JITT) is an emerging teaching modality and can be an invaluable asset for infrequently performed procedures or in locations where teaching resources and trained professionals are limited. Our objective was to determine the utility of JITT for teaching medical students the short-arm (SA) volar splinting technique. This was a prospective randomized controlled pilot study. An instructional video on SA volar splinting was produced. Students viewed the video or had access to standard medical textbooks (control group) immediately before applying an SA volar splint. The students were assessed for the quality of the splint via a standard 6-point skills checklist. The times required for presplinting preparation and for completion of the splint were also measured. Just-in-time training group students scored higher on the splint checklist (mean [SD], 5.45 [1.06]; 95% confidence interval [CI], 4.99-5.92 vs mean [SD], 1.58 [1.12]; 95% CI, 1.04-2.12; P < 0.0001), had higher pass rates (73%; 95% CI, 53%-93% vs 0%; P < 0.0001), and required less time (minutes) for presplinting preparation (mean [SD], 7.86 [2.45]; 95% CI, 6.78-8.94 vs mean [SD], 9.89 [0.46]; 95% CI, 9.67-10.12; P < 0.0001) compared with the control group. No difference was seen in the time required to complete a splint, successful or not. In comparison with reading standard textbooks, watching a brief JITT instructional video before splinting yielded faster learning times combined with more successful procedural skills. The use of a JITT instructional video may have potential applications, including globally, as an alternative resource for teaching and disseminating procedural skills, such as SA volar splinting.

  16. The biomechanical analysis of three-dimensional distal radius fracture model with different fixed splints.

    Science.gov (United States)

    Hua, Zhen; Wang, Jian-Wei; Lu, Zhen-Fei; Ma, Jian-Wei; Yin, Heng

    2018-01-30

    The distal radius fracture is one of the common clinical fractures. At present, there are no reports regarding application of the finite element method in studying the mechanism of Colles fracture and the biomechanical behavior when using splint fixation. To explore the mechanism of Colles fracture and the biomechanical behavior when using different fixed splints. Based on the CT scanning images of forearm for a young female volunteer, by using model construction technology combined with RPOE and ANSYS software, a 3-D distal radius fracture forearm finite element model with a real shape and bioactive materials is built. The material tests are performed to obtain the mechanical properties of the paper-based splint, the willow splint and the anatomical splint. The numerical results are compared with the experimental results to verify the correctness of the presented model. Based on the verified model, the stress distribution of different tissues are analyzed. Finally, the clinical tests are performed to observe and verify that the anatomical splint is the best fit for human body. Using the three kinds of splints, the transferred bone stress focus on the distal radius and ulna, which is helpful to maintain the stability of fracture. Also the stress is accumulated in the distal radius which may be attributed to flexion position. Such stress distribution may be helpful to maintain the ulnar declination. By comparing the simulation results with the experimental observations, the anatomical splint has the best fitting to the limb, which can effectively avoid the local compression. The anatomical splint is the most effective for fixing and curing the fracture. The presented model can provide theoretical basis and technical guide for further investigating mechanism of distal radius fracture and clinical application of anatomical splint.

  17. Relative stiffness of 3 bandage/splint constructs for stabilization of equine midmetacarpal fractures.

    Science.gov (United States)

    Lutter, John D; Cary, Julie A; Stephens, Robert R; Potts, Logan B

    2015-01-01

    Determine the relative stiffness of 3 bandage/splint constructs intended for emergency fracture stabilization. Experimental model. A single plane free end deflection model was developed to simulate the forces placed on a bandage/splint construct during stabilization of a complete mid-metacarpal bone fracture. The total deflection of the model in one plane was measured following application of 3 different bandage/splint combinations including a classic, 3 layered Robert Jones Bandage (RJB) with a splint placed on the outside of the bandage (RJB-3), an RJB with splint placed after the first of 3 bandage layers (RJB-1), and a single layer full limb bandage with external splint (SS). Comparisons were made between the deflections of the model with each bandage/splint combinations in an effort to determine the most effective method for field fracture stabilization. Laboratory. No animals were utilized in data collection for this study. Two live horses were utilized during the pilot study. Application of bandage and splint to a model intended to simulate the bending force on a lower forelimb fracture in a horse Deflection was determined by the difference between the height of the model's supported free end before application of a 4.5 kg weight and at the conclusion of the deflection test. There was no significant difference in the amount of deflection between bandage/splint combinations (78 ± 32 mm (RJB-1), 94 ± 44 mm (RJB-3), and 93 ± 33 mm (SS)) CONCLUSIONS: The one-layer bandage with splint was equivalent to either RJB configuration in the mean amount of deflection in the simple model of a fracture. © Veterinary Emergency and Critical Care Society 2015.

  18. Adhesive capsulitis and dynamic splinting: a controlled, cohort study

    Directory of Open Access Journals (Sweden)

    Willis F Buck

    2009-09-01

    Full Text Available Abstract Background Adhesive Capsulitis (AC affects patient of all ages, and stretching protocols are commonly prescribed for this condition. Dynamic splinting has been shown effective in contracture reduction from pathologies including Trismus to plantar fasciitis. The purpose of this study was to examine the efficacy of dynamic splinting on patients with AC. Methods This controlled, cohort study, was conducted at four physical therapy, sports medicine clinics in Texas and California. Sixty-two patients diagnosed with Stage II Adhesive Capsulitis were grouped by intervention. The intervention categories were as follows: Group I (Control; Group II (Physical Therapy exclusively with standardized protocols; Group III; (Shoulder Dynasplint system exclusively; Group IV (Combined treatment with Shoulder Dynasplint and standardized Physical Therapy. The duration of this study was 90 days for all groups, and the main outcome measures were change in active, external rotation. Results Significant difference was found for all treatment groups (p Conclusion The difference for the combined treatment group was attributed to patients' receiving the best PT combined with structured "home therapy" that contributed an additional 90 hours of end-range stretching. This adjunct should be included in the standard of care for adhesive Capsulitis. Trial Registration Trial Number: NCT00873158

  19. Hypnotic efficacy of midazolam in pre-surgical patients

    Science.gov (United States)

    Du Cailar, J.; Holzer, J.; Jullien, Y.; Passeron, D.

    1983-01-01

    1 The hypnotic effect of midazolam on the sleep of pre-surgical patients was studied in 99 patients (53 males, 46 females) due to undergo surgery the following day. 2 One tablet of 15 mg midazolam was administered at 21.00 h and a second was given 45 min later if the subject had not fallen asleep, sleep-onset latency being measured from the time the second tablet was taken. 3 Eighty patients required 1 tablet and 19 required 2 tablets. According to the subjective assessment, patients receiving 1 tablet fell asleep in 22.9 ± 14.9 min and those taking 2 tablets fell asleep in 38.4 ± 25.3 min (difference significant P < 0.05). There was no statistically significant difference between the 1- and 2-tablet groups with regard to sleep duration, number of awakenings, overall assessment of the night's sleep, sleep quality and state on awakening. 4 Factors which had a statistically significant influence on the dosage requirement were (a) sex, 30.4% females requiring a second tablet v. 9.4% males; (b) age, the mean age of the 2-tablet group being 36.5 v. 47 years in the lower dose group; (c) weight, patients with lower body weight requiring the higher dosage, mean 57.5 v. 66 kg; (d) current insomnia or a history of sleeping problems; (e) previous use of hypnotics; (f) degree of insomnia, moderate/severe insomnia needing a higher dosage (42% v. 21%). 5 One tablet of 15 mg midazolam is sufficient to induce sleep in most cases, a higher dose being indicated where insomnia is chronic and in young robust patients. No definite statement as to whether sex affects the dosage needed can be made on the basis of these findings, and this aspect would require further investigation in a study in which sex is the only variable. PMID:6138065

  20. Do clients with acquired brain injury use the splints prescribed by occupational therapists? A descriptive study.

    Science.gov (United States)

    Kuipers, Kathy; Rassafiani, Mehdi; Ashburner, J; Griffin, J; Worley, L; Moes, L; Fleming, Jennifer; Copley, Jodie

    2009-01-01

    Clients with acquired brain injury often demonstrate hypertonicity and decreased function in their upper limbs, requiring appropriate intervention. Splinting is one of the intervention methods that is widely used to address these issues. Literature shows that some clients are not using splints following fabrication. However, there is a paucity of research about the factors that influence clients to use or not use splints. This study aims to investigate these influential factors for clients with upper limb hypertonicity. Two survey tools including therapist and client questionnaires were developed and completed by both therapists and clients. Six therapists and 14 clients participated in this study and completed the relevant questionnaires. The results illustrate that most clients (13 out of 14) were continuing to use their splints four weeks following discharge from hospital. The main goals of choosing splints for both therapists and clients were prevention of contracture and deformity. The most indicated client reasons for adhering to the splint wearing program were therapist-related factors including clients' trust and reliance on their therapists. Further reasons for clients implementing the recommended splint-wearing program and clinical implications are discussed.

  1. Prosthetics socket that incorporates an air splint system focusing on dynamic interface pressure.

    Science.gov (United States)

    Razak, Nasrul Anuar Abd; Osman, Noor Azuan Abu; Gholizadeh, Hossein; Ali, Sadeeq

    2014-08-01

    The interface pressure between the residual limb and prosthetic socket has a significant effect on an amputee's satisfaction and comfort. This paper presents the design and performance of a new prosthetic socket that uses an air splint system. The air splint prosthetic socket system was implemented by combining the air splint with a pressure sensor that the transhumeral user controls through the use of a microcontroller. The modular construction of the system developed allows the FSR pressure sensors that are placed inside the air splint socket to determine the required size and fitting for the socket used. Fifteen transhumeral amputees participated in the study. The subject's dynamic pressure on the socket that's applied while wearing the air splint systems was recorded using F-socket transducers and microcontroller analysis. The values collected by the F-socket sensor for the air splint prosthetic socket system were determined accordingly by comparing the dynamic pressure applied using statically socket. The pressure volume of the air splint fluctuated and was recorded at an average of 38 kPa (2.5) to 41 kPa (1.3) over three hours. The air splint socket might reduce the pressure within the interface of residual limb. This is particularly important during the daily life activities and may reduce the pain and discomfort at the residual limb in comparison to the static socket. The potential development of an auto-adjusted socket that uses an air splint system as the prosthetic socket will be of interest to researchers involved in rehabilitation engineering, prosthetics and orthotics.

  2. [Application of near infrared spectroscopy in study of occlusal splints and resistance of masticatory muscles to fatigue pain].

    Science.gov (United States)

    Jiang, Ting; Huang, Dong-Xu

    2013-10-18

    To analyze the influence of occlusal splint on resistance capability of masticatory muscles to fatigue. In the study, 25 young male volunteers were randomly divided to 5 groups according to different splint placements: (1) no splint, (2) 1.5 mm thick soft splint, (3) 2 mm thick resin stability splint, (4) 4 mm thick resin stability splint, (5) buccolingual mock splint. Near infrared spectroscopy (NIRS) was used to measure blood oxygen content in human masticatory muscles during constant strong biting before and after the splint placement at seven time points: before, baseline after, 1 week after, and 2 weeks after splint placement, and immediately after, 1 week after, and 5 weeks after removing of splints. The strength of the biting force was maintained constantly at 30% level of the maximum biting force of each subject by biofeedback to the displayed value of an electro-myographic monitor. The time points of muscular fatigue and pain that appeared were recorded and the correlation between the subjective feeling and the NIRS measurement result was analyzed. The NIRS measurement curve had a point of inflection that had no significant difference with the time point of the muscle pain that appeared. Two weeks after placement of soft splint, the time point of the muscular fatigue and pain that appeared were 2.75 s and 8.00 s delayed respectively compared with that before placement of splint (P0.05) in the group of mock splint. The metabolic status of human masticatory muscles could be monitored in real time by using NIRS; soft splint delayed the appearing of muscle fatigue and muscle pain after two weeks of placement.

  3. Assessment of ganaxolone's anticonvulsant activity using a randomized, double-blind, presurgical trial design. Ganaxolone Presurgical Study Group.

    Science.gov (United States)

    Laxer, K; Blum, D; Abou-Khalil, B W; Morrell, M J; Lee, D A; Data, J L; Monaghan, E P

    2000-09-01

    A double-blind, randomized, placebo-controlled clinical trial to examine the safety, tolerability, and antiepileptic activity of ganaxolone in patients after withdrawal from other antiepileptic drugs during presurgical evaluations was performed. Fifty-two eligible patients were withdrawn from antiepileptic drugs and randomized to receive ganaxolone (24 patients) or placebo (28 patients) for up to 8 days. Ganaxolone was administered at a dose of 1500 mg/d on day 1 and 1875 mg/d on days 2 to 8. Dosing occurred three times per day: immediately after breakfast, lunch, and dinner. The primary measure of antiepileptic activity was duration of treatment before withdrawal from the trial. Kaplan-Meier curves depicted a clear separation between treatment groups, with 50% of the ganaxolone-treated patients completing the entire study, compared with 25% of patients treated with placebo. Intent-to-treat survival analyses revealed a trend toward efficacy with ganaxolone (p = 0.0795, log rank test). Covariate analyses revealed a significant treatment effect on survival time in men (p = 0.03). Post-hoc chi2 probe analyses focusing on patients who completed the entire study revealed a significant difference (p = 0.04) between treatment groups. The tolerability of ganaxolone was similar to that of placebo, with adverse events being reported by 79% of patients in the ganaxolone group and 68% of patients in the placebo group. Ganaxolone monotherapy was well tolerated for the duration of this clinical trial, and the results provide preliminary evidence that ganaxolone does have antiepileptic activity.

  4. Using the presurgical psychological evaluation to predict 5-year weight loss outcomes in bariatric surgery patients.

    Science.gov (United States)

    Marek, Ryan J; Ben-Porath, Yossef S; Dulmen, Manfred H M van; Ashton, Kathleen; Heinberg, Leslie J

    2017-03-01

    Psychosocial factors contribute to poorer weight loss outcomes following bariatric surgery; however, findings on associations between preoperative psychiatric diagnoses, psychological testing, and weight loss are inconsistent. Examine associations between presurgical psychiatric diagnoses derived from a semi-structured clinical interview and test scores from the Minnesota Multiphasic Personality-Inventory-2 - Restructured Form (MMPI-2-RF) and 5-year Body Mass Index (BMI) outcomes. Cleveland Clinic Bariatric and Metabolic Institute METHODS: 446 consecutively consented patients who underwent a Roux-en-Y gastric bypass (RYGB) at least 5 years prior were included in the study. A majority were women (74.2%) and Caucasian (66.2%). Patients' mean presurgical BMI was 49.14 kg/m 2 [SD = 9.50 kg/m 2 ]. Psychiatric diagnoses were obtained from a presurgical, semi-structured clinical interview and all participants were administered the MMPI-2-RF at their presurgical evaluations. BMIs were collected at 4 postoperative time points across a 5-year trajectory. This prospective design utilized latent growth curve modeling. Older patients evidenced a slower rate of BMI reduction over time. A presurgical diagnosis of Binge Eating Disorder predicted higher BMIs at the 5-year outcome. Scores on MMPI-2-RF measures of emotional and behavioral dysfunction domains incrementally predicted poorer weight loss outcomes. Preoperative indicators of psychopathology, notably indicators that are dimensional in nature, are important in predicting postoperative outcomes. Closer follow-up with patients who evidence presurgical psychological factors, both before and after surgery, may help improve outcomes. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  5. Presurgical Mapping of the Language Network Using Resting-state Functional Connectivity.

    Science.gov (United States)

    Tanaka, Naoaki; Stufflebeam, Steven M

    2016-02-01

    Resting-state functional magnetic resonance imaging (resting-state fMRI) is a tool for investigating the functional networks that arise during the resting state of the brain. Recent advances of the resting-state fMRI analysis suggest its feasibility for evaluating language function. The most common clinical application is for presurgical mapping of cortex for a brain tumor or for resective epilespy surgery. In this article, we review the techniques and presurgical applications of resting-state fMRI analysis for language evaluation, and discuss the use in the clinical setting, focusing on planning for neurosurgery.

  6. Presurgical Mapping of the Language Network Using Resting State Functional Connectivity

    Science.gov (United States)

    Tanaka, Naoaki; Stufflebeam, Steven M.

    2016-01-01

    Resting-state functional magnetic resonance imaging (Resting-state fMRI) is a tool for investigating the functional networks that arise during the resting-state of the brain. Recent advances of the resting-state fMRI analysis suggest its feasibility for evaluating language function. The most common clinical application is for presurgical mapping of cortex for a brain tumor or for resective epilespy surgery. In this article, we review the techniques and presurgical applications of resting-state fMRI analysis for language evaluation, and discuss the use in the clinical setting, focusing on planning for neurosurgery. PMID:26848557

  7. A Method for Direct Fabrication of a Lingual Splint for Management of Pediatric Mandibular Fractures

    Directory of Open Access Journals (Sweden)

    Gerardo P. Romeo, DDS, MD

    2013-10-01

    Full Text Available Summary: Pediatric mandibular fractures have successfully been managed in various ways. The use of a lingual splint is one such option. The typical indirect method for acrylic lingual splint fabrication involves obtaining dental impressions. Dental models are produced from those impressions so that model surgery may be performed. The splint is then made on those models using resin powder and liquid monomer in a wet laboratory and transferred to the patient. Obvious limitations to this technique exist for both patient and operator. We present a technique for direct, intraoperative, fabrication of a splint using commercially available light-cured material that avoids some of the shortcomings of the indirect method. Recommendations are made based on available material safety information.

  8. Static progressive versus dynamic splinting for posttraumatic elbow stiffness: a systematic review of 232 patients

    NARCIS (Netherlands)

    Veltman, Ewout S.; Doornberg, Job N.; Eygendaal, Denise; van den Bekerom, Michel P. J.

    2015-01-01

    The elbow is prone to stiffness after trauma. To regain functional elbow motion, several conservative and surgical treatment options are available. Nonoperative treatment includes physical therapy, intra-articular injections with corticosteroids, and a static progressive or dynamic splinting

  9. Dental impression compound as an effective splint for maintenance of ear elevation in microtia reconstruction

    Directory of Open Access Journals (Sweden)

    Padam Singh Bhandari

    2013-01-01

    Full Text Available Ear projection is an important goal to be achieved after stage two (ear elevation in cases of microtia. This is a retrospective study conducted on patients with microtia who underwent staged reconstruction for the same. This study has been carried out over a period of 10 years with 211 patients. Dental impression compound was used as a splint after ear elevation and split skin grafting to maintain the projection of the ear. Projection of the ear was measured both pre- and post-procedure and at every follow-up using goniometer and photographic documentation was simultaneously done. Statistical analysis was performed using t-test. Patients were reviewed every month and splint was continued until 6 months post-surgery. The splint was very effective in maintaining the ear projection of more than 20° even after prolonged follow-up of upto 2 years. There were no complications associated with the splint application or prolonged use.

  10. A comparison between the effects of simple and traction splints on pain intensity in patients with femur fractures.

    Science.gov (United States)

    Irajpour, Alireza; Kaji, Nariman Sadeghi; Nazari, Fatemeh; Azizkhani, Reza; Zadeh, Akbar Hassan

    2012-11-01

    Fractures of femur are among the most important causes of mortality in musculoskeletal injuries. Owning to lack of adequate research to compare various techniques of fracture stabilization, there has not yet been an agreement over a protocol to utilize a specific type of splint for femoral fracture immobilization. This study was thus conducted to compare the effects of simple and traction splints on pain intensityimmediately after and at the 1(st), 6(th), and 12(th)h after splinting among patients with femur fracture in the centers affiliated to Isfahan University of Medical Sciences (Isfahan, Iran). This quasi-experimental study was performed on 32 patients with femur fractures. Prehospital emergency ambulances were divided into two groups of simple and traction splints using a table of random numbers. Continuous convenient sampling was employed in each group to use either a simple or a traction splint for the patients with femur fractures. Pain intensity of the patients was then measured by a visual analogue scale (VAS) immediately, 1 h, 6 h, and 12 h after splinting. The effects of the two techniques were finally compared. After splinting, pain intensity decreased significantly in both groups (P = 0.0001 in both groups). The reductions were significantly more in the traction splint group at the 1(st), 6(th)(P = 0.0001), and 12(th)h after splinting (P = 0.02) compared with the simple splint group. There was no significant difference in pain intensity immediately after splintingbetween the two groups (P = 0.441). The significant difference in pain reduction between the simple and traction splint groups at the 1(st), 6(th), and 12(th)h after splinting emphasizes the superiority of traction splints.

  11. Measurement of effects on tone with lip-protecting music splints for wind instrument players

    Science.gov (United States)

    Katada, Chigusa; Nozaki, Kazunori; Imai, Miharu; Kawamoto, Masayuki; Shima, Yuko; Tamagawa, Hiroo; Maeda, Yoshinobu; Ohboshi, Naoki; Toda, Tadao

    2004-05-01

    To protect against lip trauma from wind instruments, music splints that cover the sharp edges of incisor teeth are often manufactured by dentists. Wind instrument players who have installed these custom-made music splints often express not only their lip comfort but also changes in their tone quality. In this study, we investigated the effect of the splints to the tone quality. We recorded three types of trumpet sounds such as long tones, arpeggios with perfect fifth, and tonguing tones with and without using a splint, respectively, by a professional trumpet player in an anechoic room. After fast Fourier transform, the higher harmonics was observed more in the splint group than in the nonsplint group, with sharp peaks from 5000 to 8000 Hz. We also examined the differences of these sound groups with recognition tests by two groups of listeners such as professional musicians and nonprofessional persons. Though sound-pressure levels of higher harmonics in two sound groups were lower than those at 400 to 2000 Hz, the musically trained persons recognized the difference perfectly. These results suggest the target of measurement to evaluate the effect of music splints.

  12. Effect of Splinting on Dimensional Accuracy of Impressions Made of Implants with Different Subgingival Alignments.

    Science.gov (United States)

    Beyabanaki, Elaheh; Shamshiri, Ahmed Reza; Alikhasi, Marzieh; Monzavi, Abbas

    2017-01-01

    Placement of implants at deeper levels of gingiva is sometimes inevitable because of issues like esthetics or bone availability. The accuracy of impressions may be affected in these situations. The aim of this in vitro study was to evaluate the effects of splinting and length of impression copings on the accuracy of impressions made of deeply placed implants. A metal model with two parallel implants (Implantium; Dentium) was fabricated. One hundred and twenty impressions were made using the direct impression technique with and without splinting the impression copings (using short and long impression copings). Impressions were made of implants at three subgingival levels (1, 3, and 6 mm) using regular viscosity poly(vinyl siloxane). The impressions were poured with type IV dental stone. Displacements in the x, y, and z axes, as well as rotational discrepancies and interimplant distances were measured with a coordinate measuring machine. Data were analyzed with Kruskal-Wallis, Mann-Whitney, and nonparametric adjusted rank transform tests. There was less rotational displacement using longer impression copings at different subgingival positions of the implants, either with splinted or nonsplinted direct technique (p impressions at different apico-coronal levels of implants than the splinted technique using short impression copings (p impression copings yielded better results than shorter ones in both splinted and nonsplinted techniques. Also, nonsplinted short impression copings produced more accurate impressions than splinted short impression copings. © 2015 by the American College of Prosthodontists.

  13. In Vitro Implant Impression Accuracy Using a New Photopolymerizing SDR Splinting Material.

    Science.gov (United States)

    Di Fiore, Adolfo; Meneghello, Roberto; Savio, Gianpaolo; Sivolella, Stefano; Katsoulis, Joannis; Stellini, Edoardo

    2015-10-01

    The study aims to evaluate three-dimensionally (3D) the accuracy of implant impressions using a new resin splinting material, "Smart Dentin Replacement" (SDR). A titanium model of an edentulous mandible with six implant analogues was used as a master model and its dimensions measured with a coordinate measuring machine. Before the total 60 impressions were taken (open tray, screw-retained abutments, vinyl polysiloxane), they were divided in four groups: A (test): copings pick-up splinted with dental floss and fotopolymerizing SDR; B (test): see A, additionally sectioned and splinted again with SDR; C (control): copings pick-up splinted with dental floss and autopolymerizing Duralay® (Reliance Dental Mfg. Co., Alsip, IL, USA) acrylic resin; and D (control): see C, additionally sectioned and splinted again with Duralay. The impressions were measured directly with an optomechanical coordinate measuring machine and analyzed with a computer-aided design (CAD) geometric modeling software. The Wilcoxon matched-pair signed-rank test was used to compare groups. While there was no difference (p = .430) between the mean 3D deviations of the test groups A (17.5 μm) and B (17.4 μm), they both showed statistically significant differences (p SDR. Sectioning and rejoining of the SDR splinting had no impact on the impression accuracy. © 2015 Wiley Periodicals, Inc.

  14. Design of an Orthopedic Product by Using Additive Manufacturing Technology: The Arm Splint.

    Science.gov (United States)

    Blaya, Fernando; Pedro, Pilar San; Silva, Julia López; D'Amato, Roberto; Heras, Enrique Soriano; Juanes, Juan Antonio

    2018-02-05

    The traditional fabrication process of custom-made splints has hardly undergone any progress since the beginning of its use at the end of the eighteenth century. New manufacturing techniques and the new materials can help to modernize this treatment method of fractures. The use of Additive Manufacturing has been proposed in recent years as an alternative process for the manufacture of splints and there has been an increase in public awareness and exploration. For this reason, in this study a splint model printed in 3D, that replaces the deficiencies of the cast maintaining its virtues, has been proposed. The proposed methodology is based on three-dimensional digitalization techniques and 3D modeling with reverse engineering software. The work integrates different scientific disciplines to achieve its main goal: to improve life quality of the patient. In addition, the splint has been designed based on the principles of sustainable development. The design of splint is made of Polycarbonate by technique of Additive Manufacturing with fused deposition manufacturing, and conceived with organic shapes, customizing openings and closing buttons with rubber. In this preliminary study the final result is a prototype of the 3D printed arm splint in a reduced scale by using PLA as material.

  15. Importance of Presurgical Breast MRI in Patients 60 Years of Age and Older

    Directory of Open Access Journals (Sweden)

    Stamatia V Destounis

    2014-01-01

    Full Text Available Objective: To demonstrate the importance of presurgical bilateral breast Magnetic Resonance Imaging (MRI in women 60 years of age and older. Materials and Methods: Institutional review board approval was obtained with waiver of informed consent for this retrospective review. From December 2003 to December 2011, all patients 60 years and older who had presurgical bilateral breast MRI were reviewed, revealing 1268 presurgical MRI examinations; 310 had a new lesion identified by MRI. Cases were excluded due to incomplete or missing data, resulting in 243 patients with 272 findings eligible for analysis. Data recorded included patient demographics, core biopsy method and pathology, type of surgery, and surgical pathology results. Results: Of 1268 exams performed in this population, 272 (21.5% patients with suspicious MRI findings underwent needle biopsy. Malignancy was found in 114 (42%, benign findings in 127 (47%, and atypia in 31 (11%. Of the malignancies, 83 were in the ipsilateral breast and 31 in the contralateral breast to the original diagnosis. Of the ipsilateral findings, 47 were in the same quadrant as the primary diagnosis, 28 in a different quadrant, and 8 were metastatic lymph nodes. Of the 31 atypical findings, 14 were contralateral to the primary diagnosis and 17 were ipsilateral. Two hundred and thirty-three patients underwent surgical excision; 111 changed their surgical management as a lesion was seen on MRI and was diagnosed as cancer on needle biopsy. Conclusions: Among the patients aged 60 years and above who had presurgical bilateral breast MRI, we found additional cancers in 9.0% (n = 114/1268 and atypia in 2.4% (n = 31/1268. A change in management as a result of the MRI-detected lesion occurred in 8.8% (n = 111/1268. These results demonstrate that performing presurgical bilateral breast MRI is of value in women 60 years of age and above.

  16. Quantitative analysis by MRI on condylar motion of the temporomandibular joint in patients applied with occlusal splints

    International Nuclear Information System (INIS)

    Saito, Hiroki

    1999-01-01

    The purpose of this study was to assess the feasibility of a newly developed quantitative motion analysis method for the mandibular condyle before and after application of occlusal splints. The subjects were 50 consecutive patients with internal derangement. Stabilization type splints were applied in 23 cases (46%), anterior repositioning type in 18 cases (36%) and pivot type in 9 cases (18%). All patients underwent MR imaging with a 1.5-T MR unit with a 3-inch dual surface coil. Pseudodynamic MR study of the opening cycle was obtained using multiplanar GRASS sequence (MPGR). Incremental and decremental sagittal MR images before and after splint application were transferred to the workstation. Software originally developed by Nakasato and Katsuragawa was used to analyze the condylar motion and path. After splint application, normalized position of displaced discs was seen in 11 cases (22%), and occurred most frequently with anterior repositioning type splints. In patients with anterior repositioning type splints, improvement in the condylar motion was most significant, In patients with normalized disc position after application of occlusal splints, abnormal figure-eight-shaped'' condylar paths were corrected in 9 of 10 cases. In the case with normalized disc position after application of anterior repositioning splint, the maximum rotational angle before application of the splint is larger than that of the case without normalized disc position. Rotational function of the condyle in the inferior joint space may be associated with disc recapturing. (K.H.)

  17. Clinical effectiveness of post-operative splinting after surgical release of Dupuytren's contracture: a systematic review

    Directory of Open Access Journals (Sweden)

    Jerosch-Herold Christina

    2008-07-01

    Full Text Available Abstract Background Splinting after contracture release for Dupuytren's disease of the hand is widely advocated. The purpose of this systematic review was to evaluate the quantity and quality of evidence regarding the effectiveness of splinting in the post-surgical management of Dupuytren's contractures. Methods Studies were identified by searching the electronic databases Medline, AMED, CINAHL and EMBASE. Studies were included if they met the following inclusion criteria: prospective or retrospective, experimental, quasi-experimental or observational studies investigating the effectiveness of static or dynamic splints worn day and/or night-time for at least 6 weeks after surgery and reporting either individual joint or composite finger range of motion and/or hand function. The methodological quality of the selected articles was independently assessed by the two authors using the guidelines for evaluating the quality of intervention studies developed by McDermid. Results Four studies, with sample sizes ranging from 23 to 268, met the inclusion criteria for the systematic review. Designs included retrospective case review, prospective observational and one controlled trial without randomisation. Interventions included dynamic and static splinting with a mean follow-up ranging from 9 weeks to 2 years. Pooling of results was not possible due to the heterogeneity of interventions (splint type, duration and wearing regimen and the way outcomes were reported. Conclusion There is empirical evidence to support the use of low load prolonged stretch through splinting after hand surgery and trauma, however only a few studies have investigated this specifically in Dupuytren's contracture. The low level evidence regarding the effect of post-operative static and dynamic splints on final extension deficit in severe PIP joint contracture (>40° is equivocal, as is the effect of patient adherence on outcome. Whilst total active extension deficit improved in some

  18. The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations.

    Science.gov (United States)

    Karatas, Abdullah; Pehlivanoglu, Filiz; Salviz, Mehti; Kuvat, Nuray; Cebi, Isil Taylan; Dikmen, Burak; Sengoz, Gonul

    The main reason for nasal tampon placement after septoplasty is to prevent postoperative hemorrhage, while the secondary purpose is internal stabilization after operations involving the cartilaginous-bony skeleton of the nose. Silicone intranasal splints are as successful as other materials in controlling postoperative hemorrhages of septal origin. The possibility of leaving the splints intranasally for extended periods helps stabilize the septum in the midline. However, there is nothing in the literature about how long these splints can be retained inside the nasal cavity without increasing the risk of infection, postoperative complications, and patient discomfort. The current study aimed to evaluate the association between the duration of intranasal splinting and bacterial colonization, postoperative complications, and patient discomfort. Patients who had undergone septoplasty were divided into three groups according to the day of removal of the silicone splints. The splints were removed on the fifth, seventh, and tenth postoperative days. The removed splints were microbiologically cultured. Early and late complications were assessed, including local and systemic infections, tissue necrosis, granuloma formation, mucosal crusting, synechia, and septal perforation. Postoperative patient discomfort was evaluated by scoring the levels of pain and nasal obstruction. No significant difference was found in the rate of bacterial colonization among the different groups. Decreased mucosal crusting and synechia were detected with longer usage intervals of intranasal silicone splints. Postoperative pain and nasal obstruction were also diminished by the third postoperative day. Silicone splints were well tolerated by the patients and any negative effects on postoperative patient comfort were limited. In fact, prolonged splint usage intervals reduced late complications. Long-term silicone nasal splint usage is a reliable, effective, and comfortable method in patients with

  19. The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations

    Directory of Open Access Journals (Sweden)

    Abdullah Karatas

    Full Text Available Abstract Introduction: The main reason for nasal tampon placement after septoplasty is to prevent postoperative hemorrhage, while the secondary purpose is internal stabilization after operations involving the cartilaginous-bony skeleton of the nose. Silicone intranasal splints are as successful as other materials in controlling postoperative hemorrhages of septal origin. The possibility of leaving the splints intranasally for extended periods helps stabilize the septum in the midline. However, there is nothing in the literature about how long these splints can be retained inside the nasal cavity without increasing the risk of infection, postoperative complications, and patient discomfort. Objective: The current study aimed to evaluate the association between the duration of intranasal splinting and bacterial colonization, postoperative complications, and patient discomfort. Methods: Patients who had undergone septoplasty were divided into three groups according to the day of removal of the silicone splints. The splints were removed on the fifth, seventh, and tenth postoperative days. The removed splints were microbiologically cultured. Early and late complications were assessed, including local and systemic infections, tissue necrosis, granuloma formation, mucosal crusting, synechia, and septal perforation. Postoperative patient discomfort was evaluated by scoring the levels of pain and nasal obstruction. Results: No significant difference was found in the rate of bacterial colonization among the different groups. Decreased mucosal crusting and synechia were detected with longer usage intervals of intranasal silicone splints. Postoperative pain and nasal obstruction were also diminished by the third postoperative day. Conclusions: Silicone splints were well tolerated by the patients and any negative effects on postoperative patient comfort were limited. In fact, prolonged splint usage intervals reduced late complications. Long-term silicone

  20. Pengelolaan Fraktur Dentoalveolar pada Anak-Anak dengan Cap Splint Akrilik

    Directory of Open Access Journals (Sweden)

    Dedy Sigit Nur Cahyo

    2015-12-01

    Management of Dentoalveolar Fractures in Children Using Acrylic Cap Splint. The purpose of fracture treatment in children is basically the same as that in adults with different management, while the choice of treatment method mainly relies on the development of jaws and teeth. It reports two cases of dentoalveolar fractures in children under 5 years old who were treated using acrylic cap splint with circum-mandibular wiring under general anesthetic. Two children, aged 1 year and 3 years old were referred to the emergency department of Dr. Sardjito Hospital with the diagnosis of dentoalveolar fractures. Both cases were treated using cap splint with circum-mandibular wiring-based fixation under general anesthetic. After 3 weeks, the acrylic cap splint and the circum-mandibular wiring were released under sedation. No loose teeth were found in the fracture area. In the following 6 weeks, the teeth were stable with normal occlusion and no infection found. Acrylic cap splint with circum-mandibular wiring is a simple, effective and minimally invasive method for dentoalveolar treatment in children.

  1. Natural tooth pontic with splinting of periodontally weakened teeth using fiber-reinforced composite resin

    Directory of Open Access Journals (Sweden)

    Gauri Srinidhi

    2014-01-01

    Full Text Available Replacement of missing anterior teeth due to periodontal reasons is challenging due to the poor support of abutment teeth. This prevents the use of fixed partial dentures (FPDs. Fiber-reinforced splinting provides a viable alternative to the dentist while choosing a treatment plan in replacing missing anterior teeth in periodontally compromised patients as opposed to conventional modalities like FPDs or removable partial dentures. Replacing missing teeth using either patient′s own tooth or a denture tooth as pontic can be done by splinting adjacent teeth with fiber reinforced composite. The splinting has an additional advantage of stabilizing adjacent mobile teeth. This case report details the case selection, procedure with follow-up of a case where the natural extracted tooth of the patient was used as pontic to replace a missing anterior tooth. The splinting was done with fiber reinforced composite resin. Fiber-reinforced composite resin splinting of patient′s extracted natural tooth is economical, fast, and easy to use chairside technique with the added benefit of periodontal stabilization.

  2. Comparison of Mobilizing and Immobilizing Splints on Hand Motor Function in Stroke Patients: A Randomize Clinical Trial

    Directory of Open Access Journals (Sweden)

    M Heydari

    2012-05-01

    Full Text Available

    Background and Objectives: Among several methods for the treatment of wrist-fingers motor function impairment after stroke, splinting is a method commonly used as complementary option. But there are so many controversies surrounding its efficacy. The aim of this study was to compare the effect of mobilizing and immobilizing splints on wrist-fingers motor function after stroke. Methods: In this experimental study, 31 stroke patients were selected and divided randomly into three groups including: mobilizing splint, immobilizing splint and control group. Participants in intervention groups wore their own splints for eight weeks, five days per week and on average six hours per day. Motor function was measured at baseline and the eighth week by fugl-meyer (FM scale. The one-way ANOVA was used to compare scores of FM scale between three groups. Results: Data analysis showed significant increase in motor function only in mobilizing splint group (p=0/001 and this increase was significant compared with other groups (p=0/001. Conclusion: Based on these findings, using a mobilizing splint compared with immobilizing splint could have better functional results for treating wrist and finger motor impairment in post-stroke patients.

  3. Comparison of Mobilizing and Immobilizing Splints on Hand Motor Function in Stroke Patients: A Randomize Clinical Trial

    Directory of Open Access Journals (Sweden)

    Rahimi Fard H

    2011-01-01

    Full Text Available Background and Objectives: Among several methods for the treatment of wrist-fingers motor function impairment after stroke, splinting is a method commonly used as complementary option. But there are so many controversies surrounding its efficacy. The aim of this study was to compare the effect of mobilizing and immobilizing splints on wrist-fingers motor function after stroke.Methods: In this experimental study, 31 stroke patients were selected and divided randomly into three groups including: mobilizing splint, immobilizing splint and control group. Participants in intervention groups wore their own splints for eight weeks, five days per week and on average six hours per day. Motor function was measured at baseline and the eighth week by fugl-meyer (FM scale. The one-way ANOVA was used to compare scores of FM scale between three groups.Results: Data analysis showed significant increase in motor function only in mobilizing splint group (p=0/001 and this increase was significant compared with other groups (p=0/001.Conclusion: Based on these findings, using a mobilizing splint compared with immobilizing splint could have better functional results for treating wrist and finger motor impairment in post-stroke patients.

  4. The use of cone-beam computed tomography and virtual reality simulation for pre-surgical practice in endodontic microsurgery.

    Science.gov (United States)

    Suebnukarn, S; Rhienmora, P; Haddawy, P

    2012-07-01

    To design and evaluate the impact of virtual reality (VR) pre-surgical practice on the performance of actual endodontic microsurgery.   The VR system operates on a laptop with a 1.6-GHz Intel processor and 2 GB of main memory. Volumetric cone-beam computed tomography (CBCT) data were acquired from a fresh cadaveric porcine mandible prior to endodontic microsurgery. Ten inexperienced endodontic trainees were randomized as to whether they performed endodontic microsurgery with or without virtual pre-surgical practice. The VR simulator has microinstruments to perform surgical procedures under magnification. After the initial endodontic microsurgery, all participants served as their own controls by performing another procedure with or without virtual pre-surgical practice. All procedures were videotaped and assessed by two independent observers using an endodontic competency rating scale (from 6 to 30). A significant difference was observed between the scores for endodontic microsurgery on molar teeth completed with virtual pre-surgical practice and those completed without virtual presurgical practice, median 24.5 (range = 17-28) versus median 18.75 (range = 14-26.5), P = 0.041. A significant difference was observed between the scores for osteotomy on a molar tooth completed with virtual pre-surgical practice and those completed without virtual pre-surgical practice, median 4.5 (range = 3.5-4.5) versus median 3 (range = 2-4), P = 0.042. Pre-surgical practice in a virtual environment using the 3D computerized model generated from the original CBCT image data improved endodontic microsurgery performance. © 2012 International Endodontic Journal.

  5. 3D splint prototype system for applications in muscular rehab by transcutaneous electrical nerve stimulation (TENS)

    Science.gov (United States)

    Saldaña-Martínez, M. I.; Guzmán-González, J. V.; Barajas-González, O. G.; Guzman-Ramos, V.; García-Garza, A. K.; González-García, R. B.; García-Ramírez, M. A.

    2017-03-01

    It is quite common that patients with ligamentous ruptures, tendonitis, tenosynovitis or sprains are foreseen the use of ad hoc splints for a swift recovery. In this paper, we propose a rehabilitation split that is focused on upper-limb injuries. By considering that upper-limb patient shows a set of different characteristics, our proposal personalizes and prints the splint custom made though a digital model that is generated by a 3D commercial scanner. To fabricate the 3D scanned model the Stereolithography material (SLA) is considered due to the properties that this material offers. In order to complement the recovery process, an electronic system is implemented within the splint design. This system generates a set of pulses for a fix period of time that focuses mainly on a certain group of muscles to allow a fast recovery process known as Transcutaneous Electrical Nerve Stimulation Principle (TENS).

  6. Anaesthetic considerations for patients undergoing pre-surgical embolization of intracranial and spinal tumours: An overview

    Directory of Open Access Journals (Sweden)

    Suparna Bharadwaj

    2015-01-01

    Full Text Available Pre-surgical embolization of vascular brain and spinal tumours is an effective method of reducing intraoperative bleeding. Many technological developments of the microcatheters and embolic materials that are used have led to better outcomes in tumour embolization. Pre-operative embolization has become a standard of practice in the management of many vascular brain and spinal tumours. Anaesthesiologists are generally involved with these procedures which may be performed with general anaesthesia, conscious sedation or monitored anaesthesia care. The choice of the anaesthetic technique usually depends on the patient characteristics, tumour location, vascularity of the tumour and most importantly the neuroradiologist and/or institutional preferences. There is limited information in the literature on the anaesthetic considerations for these patients. The aim of this review is to provide a brief overview of the indications, techniques, complications and relevant anaesthetic considerations for patients undergoing pre-surgical embolization of intracranial and spinal tumours.

  7. Clinical Application of Spatiotemporal Distributed Source Analysis in Presurgical Evaluation of Epilepsy

    OpenAIRE

    Tanaka, Naoaki; Stufflebeam, Steven M.

    2014-01-01

    Magnetoencephalography (MEG), which acquires neuromagnetic fields in the brain, is a useful diagnostic tool in presurgical evaluation of epilepsy. Previous studies have shown that MEG affects the planning intracranial electroencephalography placement and correlates with surgical outcomes by using a single dipole model. Spatiotemporal source analysis using distributed source models is an advanced method for analyzing MEG, and has been recently introduced for analyzing epileptic spikes. It has ...

  8. Definitive Presurgical CAD/CAM-Guided Implant-Supported Crown in an Esthetic Area

    OpenAIRE

    Barros, Vinicius de Magalhães; Costa, Natália Rafaela de Assis; Martins, Paulo Henrique Fonseca; Vasconcellos, Walison Arthuso; Discacciati, José Augusto César; Moreira, Allyson Nogueira

    2015-01-01

    This paper describes the digital workflow from cone beam computer tomography (CBCT) to the installation of a definitive presurgical zirconium individual crown in a 19-year-old woman requiring implant replacement of a maxillary right lateral incisor. The patient had agenesis of this tooth and had completed the orthodontic treatment. CBCT was conducted and diagnostic casts were digitized. Virtual planning was completed by defining a prosthetically driven implant and a stereolithographic surgica...

  9. A Study on the Effect of Applying Cast Splints in Treatment of Tennis Elbow

    Directory of Open Access Journals (Sweden)

    A Zarezadeh

    2004-02-01

    Full Text Available Background: Tennis elbow is a common orthopedic disease affecting elbow in middle aged people. Ninety percent of patients are cured using conservative treatments. In the past, emphasis was placed on the use of long arm splints for its treatment; however, recent studies put doubt on the use of this method of treatment for the complications arising from the application of splints. The results of using long arm splints for the treatment of Methods: This was a case series non randomized clinical trial involving 25 patients treated with long arm castsplints, and 25 patients treated without the use of splint. Local corticosteroid injections and oral NSAIDs were administered for all patients. The two groups were compared in the third week, third month and sixth month of their treatment for the presence of local tenderness and pain in passive flexion test of wrist and fingers against resistance. Using SPSS 9.0, data were analyzed via repeated measurements test of ANOVA Results: Patients in case and control groups had mean ages 43.6 ± 7.2 and 43.6 ± 6 years, respectively. Prior to any treatments, all patients in this study suffered from pain and tenderness in the origin of forearm extensor muscles. Their pain exacerbated upon passive flexion of wrist and fingers against resistance. No significant difference was seen in third week, third month and sixth month (P value =0.32, and no significant difference was seen in the results of our tests regarding the presence of local tenderness and pain in passive flexion of wrist and fingers against resistance between the two groups Conclusions: After a follow-up period of six months, this study demonstrated no statistically significant difference between the two groups treated with and without long arm splints. Keywords: Tennis elbow, Conservative treatment, Laterals epicondylitis, Cast splint

  10. Task-free presurgical mapping using functional magnetic resonance imaging intrinsic activity.

    Science.gov (United States)

    Liu, Hesheng; Buckner, Randy L; Talukdar, Tanveer; Tanaka, Naoaki; Madsen, Joseph R; Stufflebeam, Steven M

    2009-10-01

    Low-frequency components of the spontaneous functional MR imaging signal provide information about the intrinsic functional and anatomical organization of the brain. The ability to use such methods in individual patients may provide a powerful tool for presurgical planning. The authors explore the feasibility of presurgical motor function mapping in which a task-free paradigm is used. Six surgical candidates with tumors or epileptic foci near the motor cortex participated in this study. The investigators directly compared task-elicited activation of the motor system to activation obtained from intrinsic activity correlations. The motor network within the unhealthy hemisphere was identified based on intrinsic activity correlations, allowing distortions of functional anatomy caused by the tumor and epilepsy to be directly visualized. The precision of the motor function mapping was further explored in 1 participant by using direct cortical stimulation. The motor regions localized based on the spontaneous activity correlations were quite similar to the regions defined by actual movement tasks and cortical stimulation. Using intrinsic activity correlations, it was possible to map the motor cortex in presurgical patients. This task-free paradigm may provide a powerful approach to map functional anatomy in patients without task compliance and allow multiple brain systems to be determined in a single scanning session.

  11. Presurgical Weight Is Associated with Pain, Functional Impairment, and Anxiety among Gastric Bypass Surgery Patients

    Directory of Open Access Journals (Sweden)

    Sharlene Wedin

    2012-01-01

    Full Text Available Chronic pain and obesity are significant public health concerns in the United States associated with significant levels of health-care expenses and lost productivity. Previous research suggests that obesity is a risk factor for chronic pain, mainly due to excessive weight placed on the joints. However, the obesity-pain relationship appears to be complex and reciprocal. Little work to date has focused on the relationship between weight and pain among patients undergoing gastric bypass surgery for weight loss. Patients scheduled to undergo bariatric surgery for weight loss at a large southeastern academic medical center ( completed the Brief Pain Inventory (BPI, the Center for Epidemiological Studies 10-item Depression scale (CESD-10, and the Beck Anxiety Inventory (BAI. Higher presurgical weight was associated with higher pain-on-average ratings, higher functional impairment due to pain across the domains of physical activity, mood, walking ability, relationships, and enjoyment of life. Higher presurgical weight was associated with higher BAI scores, but weight was not related to depression. Findings suggest that bariatric surgery candidates report a moderate amount of pain prior to surgery and that presurgical weight is associated with higher pain, increased functional impairment due to pain, and increased anxiety. Anxiety was found to mediate the relationship between increased weight and pain.

  12. Functional Magnetic Resonance Imaging in the Presurgical Evaluation of Brain Vascular Malformations

    International Nuclear Information System (INIS)

    Montes, Natalia; Herrera, Diego A; Vargas Sergio A

    2010-01-01

    Objective: To describe our experience in presurgical evaluation of intracranial vascular malformations by means of functional magnetic resonance (fMRI). Method: To evaluate eight patients with cerebral vascular malformations (seven arterio-venous malformation [AVM ] and one cavernous malformation) to send to the eloquent cortex with RMf pre-surgical mapping is assessed. Used a technique that is dependent on the level of oxygen (BOLD) to locate these areas in the cerebral vascular malformation, by applying different paradigms. Results: We found one AVM at the right temporal lobe with activation of the parahipocampal gyrus at the contralateral side using a memory paradigm; another patient with an AVM at the right mesotemporal lobe showed activation of visual and spatial memory of the contralateral hippocampus and parahippocampus. One patient with an AVM at the left parietal lobe without compromise of sensorial and motor cortex; a cavernous malformation at the left angular gyrus with hemispheric language dominance in that side; one right thalamic AVM, one periventricular AVM bilateral language dominance; one left occipital AVM with decreased activation in visual association cortex; one temporoccipital AVM with left language dominance and neurovascular uncoupling. Conclusion: fMRI can delineate anatomically the relationship between the lesion and eloquent cortex, providing useful information for presurgical planning and allowing risk estimation of intervention.

  13. Combined Effect Of Botulinum Toxin And Splinting On Motor Components And Function Of People With Stroke

    Directory of Open Access Journals (Sweden)

    Aryan Shamili

    2017-02-01

    Full Text Available Background and objective: Spasticity is one of the problems following stroke. Due to this increase in muscle tone, patients are confronted to problems in motor control and difficulties in activities of daily living and complications such as shortness and contracture. The aim of this study was to examine the effects of Simultaneous use of both splint and botulinum toxin-A (BTX-A injection on spasticity, range of motion and upper extremity function in a 3-month period. Methods: The design of this study was a comparison between 3 groups of interventions, conducted in rehabilitation clinics in Tehran. Sixty people with chronic stroke were recruited. Based on the inclusion criteria, a total of 39 stroke patients after completing the consent forms were entered to intervention groups; splint or botulinum toxin injection or combined splint/botulinum toxin injection. They were followed up about 3 months and the evaluations were done monthly. Goniometry was the method to measure range of motion, and Modified Ashworth scale was used to examine the spasticity and the upper extremity function was scored based on Fugl-Meyer assessment.   Statistical analysis was done using SPSS 17. And ANOVAs was used for comparison between groups and times.  Significance was set at 0.05. Results: All outcome measures improved within each group but the differences between splint group and BTX-A group and the BTX-A-splint group was not significant in most outcomes during 3 periods (first evaluation until end of the first month, the end of first month until the end of second month, the end of second month until the end of the third month (p> 0 / 05. The results also showed that the changes in elbow`s spasticity {p= 0.05} and wrist`s spasticity {p= 0.007} and upper extremity function { p = 0.04} were obvious between the three groups over the 3-months and the difference in the group of combined use of botulinum toxin and splint was more than other groups. Conclusion: In this

  14. Split-Mouth Comparison of Splinted and Nonsplinted Prostheses on Short Implants: 3-Year Results.

    Science.gov (United States)

    Clelland, Nancy; Chaudhry, Jahanzeb; Rashid, Robert G; McGlumphy, Edwin

    2016-01-01

    To compare splinted and individual restorations supported by short implants featuring an internal connection utilizing a split-mouth design. Splinted and nonsplinted implant crowns were prospectively compared in 18 patients. After verifying the need for at least two consecutive implants bilaterally, computed tomography scans were made, virtual planning was done, and qualifying patients were enrolled. Implants were placed using a two-stage surgical approach. After 3 to 5 months, patients were randomly restored with splinted prostheses on their left or right side. Nonsplinted restorations were made for contralateral sides. Radiographs were taken at prostheses seating and yearly exams. Radiographic bone levels were analyzed and compared (SAS 9.4) to determine differences between splinted and nonsplinted implants. Complications such as screw loosening, screw breakage, or porcelain fracture were assessed at recalls. Eighteen patients (9 men and 9 women) with an age range from 49 to 76 years (mean = 56 years), received ≥ 4 implants in symmetrical posterior locations. Implants (n = 82) ranged in length from 6 to 11 mm with 70 implants ≤ 9 mm and 38 implants = 6 mm. At the time of this report, 3-year examinations and bone level comparisons were completed on 15 patients. One patient was lost to follow-up, one deviated from study protocol by smoking, and one was splinted on both sides due to repeated screw breakage. Screw loosening occurred in five patients on their nonsplinted side. These were 6-mm implants except for one patient. Porcelain chipping occurred for one patient on the splinted side. One 6-mm-length nonsplinted implant was lost after loading; this implant was successfully replaced after grafting. This patient had a total of six implants placed; ongoing bone level measurements included two pairs of implants only. For all implants combined, there was no significant difference (P > .05) at 1, 2, or 3 years for mean bone change around splinted and nonsplinted

  15. Palate Fracture Repair With Light-Cured Resin Splint: Technical Note.

    Science.gov (United States)

    Waldrop, Jimmy; Dale, Elizabeth L; Halsey, Jordan; Sargent, Larry A

    2015-10-01

    Palate fractures are rare, and their treatment is a matter of debate. Although some investigators have favored rigid plate fixation, others have reported successful treatment without it. Sagittal split and comminuted fractures can require rigid fixation to reduce the maxillary width; however, additional stabilization is needed. Also, palate repair without a splint is complicated by prolonged intermaxillary fixation (IMF), causing stiffness to the temporomandibular joint. We introduce a technique using a rapid light-cured resin (TRIAD TranSheet) frequently used by orthodontists for making dental retainers. Its use is similar to the splints traditionally created preoperatively, but obviates the need for making impressions, a model, and a molded splint. A series of 13 patients treated with this technique during a 5-year period is presented. The average duration of IMF was 4.7 weeks (range 3 to 6). The average duration of the palate splint was 8.4 weeks (range 5 to 12). One patient had malocclusion, but none had malunion, infection, or oronasal fistula. Our series has demonstrated a simple, cost-effective, and successful technique. It can be used alone or combined with rigid fixation and allows for a shortened duration of maxillomandibular fixation. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Maxillary overdentures retained by splinted and unsplinted implants : A retrospective study

    NARCIS (Netherlands)

    Narhi, TO; Hevinga, M; Voorsmit, RACA; Kalk, W

    2001-01-01

    The purpose of this retrospective study was to evaluate the clinical performance of and patients' satisfaction with maxillary overdentures retained by splinted and unsplinted implants. Patients who had been treated with maxillary implant-retained overdentures because of functional problems with

  17. [Electrophysiological evaluation of occlusal splint treatment of patients with temporomandibular joint dysfunction].

    Science.gov (United States)

    Nuño Licona, A; Angeles Medina, F; García Ruiz, J; García Moreira, C

    1991-08-01

    Blink reflex time records were obtained from patients with temporomandibular joint disfunction (TMJD), before and after treatment with occlusal splint, since blink reflex time helps to study the trigeminal-facial functional relationship. Results suggest that the impaired sensory-motor function in the trigeminal-facial complex of TMJD patients, may return to normal latency values following such treatment.

  18. Preprosthetic therapy utilizing a temporary occlusal acrylic splint: a case report.

    Science.gov (United States)

    Badel, Tomislav; Kraljeviç, Sonja; Panduriç, Josip; Marotti, Miljenko

    2004-05-01

    This case report describes the complex occlusal rehabilitation of a patient with signs and symptoms of temporomandibular disorders with utilization of an occlusal acrylic splint as a means of initial treatment for neuromuscular reprogramming and repositioning of the condyle within the mandibular fossa for occlusal stability, thus allowing adaptation to a new occlusal vertical dimension.

  19. Summary of: Over-the-counter (OTC) bruxism splints available on the Internet

    NARCIS (Netherlands)

    Wassell, R.W.; Verhees, L.; Lawrence, K.; Davies, S.; Lobbezoo, F.

    2014-01-01

    Background Some individuals may now be bypassing their dentists for treatment of bruxism. Self-diagnosed, self-adjusted and self-monitored consumers can access over-the-counter (OTC) bruxism splints via the Internet. While some may regard this market as benefiting consumers there are potential

  20. Over-the-counter (OTC) bruxism splints available on the Internet

    NARCIS (Netherlands)

    Wassell, R.W.; Verhees, L.; Lawrence, K.; Davies, S.; Lobbezoo, F.

    2014-01-01

    Background Some individuals may now be bypassing their dentists for treatment of bruxism. Self-diagnosed, self-adjusted and self-monitored consumers can access over-the-counter (OTC) bruxism splints via the Internet. While some may regard this market as benefiting consumers there are potential

  1. Influence of abutment tooth position and adhesive point dimension on the rigidity of a dental trauma wire-composite splint.

    Science.gov (United States)

    Zhu, Yuqing; Chen, Hui; Cen, Lian; Wang, Jun

    2016-06-01

    The influence of abutment tooth position and adhesive point dimension on rigidity of wire-composite splints, used in dental trauma, was evaluated in vitro. A commercial artificial resin model was used. The central incisors served as injured teeth with increased mobility (degrees of loosening II tooth 21 and III tooth 11), whereas teeth 12/22 or teeth 13/23 served as non-injured teeth with physiological mobility. Horizontal and vertical tooth mobility before and after splinting was assessed, using a universal testing machine. Teeth were splinted with a wire-composite splint (0.8 mm). Four groups were assigned with respective abutment tooth position and adhesive point dimension: group 1 (13-11-21-23, 2 × 2 mm(2) ), group 2 (12-11-21-22, 2 × 2 mm(2) ), group 3 (12-11-21-22, 3 × 3 mm(2) ), group 4 (12-11-21-22, 4 × 4 mm(2) ). For each group, tooth mobility after splinting was significantly higher than the physiological tooth mobility (P 0.05) were found in tooth mobility after splinting. Significant differences were found in horizontal tooth mobility after splinting of tooth 11 between Group 2 and 3, Group 2 and 4 and Group 3 and 4, respectively (P vertical dimension for tooth 11 only between Group 2 and 4 (P vertical mobility in most cases. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Comparative evaluation of the efficacy of occlusal splints fabricated in centric relation or maximum intercuspation in temporomandibular disorders patients.

    Science.gov (United States)

    Hamata, Marcelo Matida; Zuim, Paulo Renato Junqueira; Garcia, Alicio Rosalino

    2009-01-01

    Fabrication of occlusal splints in centric relation for temporomandibular disorders (TMD) patients is arguable, since this position has been defined for asymptomatic stomatognathic system. Thus, maximum intercuspation might be employed in patients with occlusal stability, eliminating the need for interocclusal records. This study compared occlusal splints fabricated in centric relation and maximum intercuspation in muscle pain reduction of TMD patients. Twenty patients with TMD of myogenous origin and bruxism were divided into 2 groups treated with splints in maximum intercuspation (I) or centric relation (II). Clinical, electrognathographic and electromyographic examinations were performed before and 3 months after therapy. Data were analyzed by the Student's t test. Differences at 5% level of probability were considered statistically significant. There was a remarkable reduction in pain symptomatology, without statistically significant differences (p>0.05) between the groups. There was mandibular repositioning during therapy, as demonstrated by the change in occlusal contacts on the splints. Electrognathographic examination demonstrated a significant increase in maximum left lateral movement for group I and right lateral movement for group II (p0.05) in the electromyographic activities at rest after utilization of both splints. In conclusion, both occlusal splints were effective for pain control and presented similar action. The results suggest that maximum intercuspation may be used for fabrication of occlusal splints in patients with occlusal stability without large discrepancies between centric relation and maximum intercuspation. Moreover, this technique is simpler and less expensive.

  3. Comparative evaluation of the efficacy of occlusal splints fabricated in centric relation or maximum intercuspation in temporomandibular disorders patients

    Directory of Open Access Journals (Sweden)

    Marcelo Matida Hamata

    2009-02-01

    Full Text Available Fabrication of occlusal splints in centric relation for temporomandibular disorders (TMD patients is arguable, since this position has been defined for asymptomatic stomatognathic system. Thus, maximum intercuspation might be employed in patients with occlusal stability, eliminating the need for interocclusal records. This study compared occlusal splints fabricated in centric relation and maximum intercuspation in muscle pain reduction of TMD patients. Twenty patients with TMD of myogenous origin and bruxism were divided into 2 groups treated with splints in maximum intercuspation (I or centric relation (II. Clinical, electrognathographic and electromyographic examinations were performed before and 3 months after therapy. Data were analyzed by the Student's t test. Differences at 5% level of probability were considered statistically significant. There was a remarkable reduction in pain symptomatology, without statistically significant differences (p>0.05 between the groups. There was mandibular repositioning during therapy, as demonstrated by the change in occlusal contacts on the splints. Electrognathographic examination demonstrated a significant increase in maximum left lateral movement for group I and right lateral movement for group II (p0.05 in the electromyographic activities at rest after utilization of both splints. In conclusion, both occlusal splints were effective for pain control and presented similar action. The results suggest that maximum intercuspation may be used for fabrication of occlusal splints in patients with occlusal stability without large discrepancies between centric relation and maximum intercuspation. Moreover, this technique is simpler and less expensive.

  4. 3 Tesla MRI-negative focal epilepsies: Presurgical evaluation, postoperative outcome and predictive factors.

    Science.gov (United States)

    Kogias, Evangelos; Klingler, Jan-Helge; Urbach, Horst; Scheiwe, Christian; Schmeiser, Barbara; Doostkam, Soroush; Zentner, Josef; Altenmüller, Dirk-Matthias

    2017-12-01

    To investigate presurgical diagnostic modalities, clinical and seizure outcome as well as predictive factors after resective epilepsy surgery in 3 Tesla MRI-negative focal epilepsies. This retrospective study comprises 26 patients (11 males/15 females, mean age 34±12years, range 13-50 years) with 3 Tesla MRI-negative focal epilepsies who underwent resective epilepsy surgery. Non-invasive and invasive presurgical diagnostic modalities, type and localization of resection, clinical and epileptological outcome with a minimum follow-up of 1year (range 1-11 years, mean 2.5±2.3years) after surgery as well as outcome predictors were evaluated. All patients underwent invasive video-EEG monitoring after implantation of intracerebral depth and/or subdural electrodes. Ten patients received temporal and 16 extratemporal or multilobar (n=4) resections. There was no perioperative death or permanent morbidity. Overall, 12 of 26 patients (46%) were completely seizure-free (Engel IA) and 65% had a favorable outcome (Engel I-II). In particular, seizure-free ratio was 40% in the temporal and 50% in the extratemporal group. In the temporal group, long duration of epilepsy correlated with poor seizure outcome, whereas congruent unilateral FDG-PET hypometabolism correlated with a favorable outcome. In almost two thirds of temporal and extratemporal epilepsies defined as "non-lesional" by 3 Tesla MRI criteria, a favorable postoperative seizure outcome (Engel I-II) can be achieved with accurate multimodal presurgical evaluation including intracranial EEG recordings. In the temporal group, most favorable results were obtained when FDG-PET displayed congruent unilateral hypometabolism. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. IClinfMRI Software for Integrating Functional MRI Techniques in Presurgical Mapping and Clinical Studies.

    Science.gov (United States)

    Hsu, Ai-Ling; Hou, Ping; Johnson, Jason M; Wu, Changwei W; Noll, Kyle R; Prabhu, Sujit S; Ferguson, Sherise D; Kumar, Vinodh A; Schomer, Donald F; Hazle, John D; Chen, Jyh-Horng; Liu, Ho-Ling

    2018-01-01

    Task-evoked and resting-state (rs) functional magnetic resonance imaging (fMRI) techniques have been applied to the clinical management of neurological diseases, exemplified by presurgical localization of eloquent cortex, to assist neurosurgeons in maximizing resection while preserving brain functions. In addition, recent studies have recommended incorporating cerebrovascular reactivity (CVR) imaging into clinical fMRI to evaluate the risk of lesion-induced neurovascular uncoupling (NVU). Although each of these imaging techniques possesses its own advantage for presurgical mapping, a specialized clinical software that integrates the three complementary techniques and promptly outputs the analyzed results to radiology and surgical navigation systems in a clinical format is still lacking. We developed the Integrated fMRI for Clinical Research (IClinfMRI) software to facilitate these needs. Beyond the independent processing of task-fMRI, rs-fMRI, and CVR mapping, IClinfMRI encompasses three unique functions: (1) supporting the interactive rs-fMRI mapping while visualizing task-fMRI results (or results from published meta-analysis) as a guidance map, (2) indicating/visualizing the NVU potential on analyzed fMRI maps, and (3) exporting these advanced mapping results in a Digital Imaging and Communications in Medicine (DICOM) format that are ready to export to a picture archiving and communication system (PACS) and a surgical navigation system. In summary, IClinfMRI has the merits of efficiently translating and integrating state-of-the-art imaging techniques for presurgical functional mapping and clinical fMRI studies.

  6. Reliability for non-invasive somatosensory cortex localization: Implications for pre-surgical mapping.

    Science.gov (United States)

    Solomon, Jack; Boe, Shaun; Bardouille, Timothy

    2015-12-01

    In patients with epilepsy or space occupying tumors in cortical regions, surgical resection is often considered as the primary treatment. Pre-surgical neuroimaging can provide a detailed map of pathological and functional cortex, leading to safer surgery. Mapping can be achieved non-invasively using magnetoencephalography (MEG), and is concordant with invasive findings. However, the reliability of MEG mapping between sessions is not well established. The inter-session reliability is an important property in pre-surgical mapping to establish resection margins, but repeated scans are impracticable. The present study sought to quantify the intersession reliability of MEG localization of somatosensory cortex (S1). Eighteen healthy individuals underwent MEG sessions on 3 consecutive days. Five participants were excluded due to technical issues during one of the three days. Each session included clinical-style S1 localization using electrical stimuli to each median nerve at sub-motor thresholds. The 35 ms peak of the somatosensory evoked field was used for localizing S1 in each session using a single equivalent current dipole model. Intersession reliability was quantified using two methods. Average Euclidean Distance (AED) quantified the difference in localization between each session and the inter-session mean localization. Session Euclidean Distance (SED) quantified the difference in localization between each pair of sessions. Results showed the AED was 4.8 ± 1.9 mm, whereas the SED was 8.3 ± 3.4mm. While the AED values obtained parallel those reported previously in smaller samples, the SED values were substantially larger. Clinicians should consider up to an 8mm confidence interval around the estimated location of S1 based on MEG pre-surgical mapping. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. IClinfMRI Software for Integrating Functional MRI Techniques in Presurgical Mapping and Clinical Studies

    Directory of Open Access Journals (Sweden)

    Ai-Ling Hsu

    2018-03-01

    Full Text Available Task-evoked and resting-state (rs functional magnetic resonance imaging (fMRI techniques have been applied to the clinical management of neurological diseases, exemplified by presurgical localization of eloquent cortex, to assist neurosurgeons in maximizing resection while preserving brain functions. In addition, recent studies have recommended incorporating cerebrovascular reactivity (CVR imaging into clinical fMRI to evaluate the risk of lesion-induced neurovascular uncoupling (NVU. Although each of these imaging techniques possesses its own advantage for presurgical mapping, a specialized clinical software that integrates the three complementary techniques and promptly outputs the analyzed results to radiology and surgical navigation systems in a clinical format is still lacking. We developed the Integrated fMRI for Clinical Research (IClinfMRI software to facilitate these needs. Beyond the independent processing of task-fMRI, rs-fMRI, and CVR mapping, IClinfMRI encompasses three unique functions: (1 supporting the interactive rs-fMRI mapping while visualizing task-fMRI results (or results from published meta-analysis as a guidance map, (2 indicating/visualizing the NVU potential on analyzed fMRI maps, and (3 exporting these advanced mapping results in a Digital Imaging and Communications in Medicine (DICOM format that are ready to export to a picture archiving and communication system (PACS and a surgical navigation system. In summary, IClinfMRI has the merits of efficiently translating and integrating state-of-the-art imaging techniques for presurgical functional mapping and clinical fMRI studies.

  8. Pre-surgical cortical activation to food pictures is associated with weight loss following bariatric surgery.

    Science.gov (United States)

    Ness, Abigail; Bruce, Jared; Bruce, Amanda; Aupperle, Robin; Lepping, Rebecca; Martin, Laura; Hancock, Laura; Patrician, Trisha; Malley, Steve; Selim, Niazy; Savage, Cary R

    2014-01-01

    Recent research suggests that preintervention functional magnetic resonance imaging (fMRI) data may predict weight loss outcomes among patients who participate in a behavioral weight loss plan. No study has examined whether presurgical brain activation can predict outcomes following bariatric surgery. The aim of the present study was to determine if brain activations during a presurgical fMRI food-motivation paradigm are associated with weight loss 3 and 6 months following laparoscopic adjustable gastric banding (LAGB). Nineteen participants viewed food and nonfood pictures from a well-established food motivation paradigm during an fMRI scanning session before LAGB surgery. Weight was assessed presurgery and 3 and 6 months postsurgery; data for all participants was available at each time point. fMRI data were analyzed using the BrainVoyager QX statistical package. Whole brain voxelwise correlations of presurgery (food-nonfood) brain activation and weight, corrected for multiple comparisons, were performed to analyze the relationship between presurgical brain activation and subsequent weight loss. The settings were a medical university brain imaging center and 2 surgical weight loss centers in a major metropolitan area. Increased activity in frontal regions associated with cognitive control (medial, middle, superior frontal gyrus) and posterior cingulate cortex was associated with weight loss following LAGB. We found that neural activity in previously established regions associated with cognitive and behavioral self-regulation predicts weight loss following bariatric surgery. These preliminary findings highlight the role of neural circuitry in the success and maintenance of weight loss and suggest a possible future use of fMRI in screening LAGB surgery candidates. Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  9. Positron emission mammography in breast cancer presurgical planning: comparisons with magnetic resonance imaging

    OpenAIRE

    Schilling, Kathy; Narayanan, Deepa; Kalinyak, Judith E.; The, Juliette; Velasquez, Maria Victoria; Kahn, Simone; Saady, Matthew; Mahal, Ravinder; Chrystal, Larraine

    2010-01-01

    Purpose The objective of this study was to compare the performance characteristics of 18F-fluorodeoxyglucose (FDG) positron emission mammography (PEM) with breast magnetic resonance imaging (MRI) as a presurgical imaging and planning option for index and ipsilateral lesions in patients with newly diagnosed, biopsy-proven breast cancer. Methods Two hundred and eight women >25 years of age (median age = 59.7 ± 14.1 years) with biopsy-proven primary breast cancer enrolled in this prospective, si...

  10. [Treatment of mallet finger with dorsal nail glued splint: retrospective analysis of 270 cases].

    Science.gov (United States)

    Facca, S; Nonnenmacher, J; Liverneaux, P

    2007-11-01

    Management of mallet finger is both difficult and controversial. Sequelae are not uncommon, particularly after surgical treatment. Many authors advocate orthopedic treatment which is less invasive but requires greater patient participation to implement. Despite the large number of orthopedic methods proposed, none has proven superiority. We report here our experience with a dorsal adhesive splint which preserves digital pulp function and improves observance. This retrospective analysis included 270 mallet fingers presenting 153 tendon injuries and 117 bony injuries in 265 patients aged 42 years on average and treated from 2003 to 2005. Most of the tendon injuries involved the medius (38.7%) and most of the bony injuries involved the ring finger (35.4%). A splint was fashioned for the two distal phalanges and glued to the nail plate filed for this purpose. The splint was fashioned out of an L-shaped plastic sheet of thermo-malleable plastic dipped in hot water (60 degrees C). The L was molded to the dorsal aspect of the phalanges and rolled like a ring around the second phalanx, then glued to the nail. The splint was worn for eight weeks by patients with a tendon injury and six weeks for those with a bony injury. The splint was then worn at night for two weeks. Three criteria were used to analyze outcome: residual extension deficit, joint involvement, complications. Mean follow-up was 18 months. Mean time from trauma to definitive installation of the splint was six days. The complication rate for this orthopedic method was 14.3%, complications being observed in 6% of patients. All complications were transient except for one case of swan neck deformity and one case of painful osteoarthritis. Thirty splints (11%) became unglued but were all reinstalled using the same protocol. Thirty fingers (14%) presented residual deficit of active extension measuring less than 20 degrees. The quality of the result depended on the type of injury: tendon injuries led to extension

  11. Digital radiographic evaluation of alveolar bone loss, density and lamina dura integrity on post splinting mandibular anterior with chronic periodontitis

    Science.gov (United States)

    Rafini, F.; Priaminiarti, M.; Sukardi, I.; Lessang, R.

    2017-08-01

    The healing of periodontal splinting can be detected both with clinical and radiographic examination. In this study, the alveolar bone was evaluated by radiographic digital periapical analysis. Periodontal tooth splinting is periodontal support therapy used to prevent periodontal injury during repair and regeneration of periodontal therapy. Radiographic digital periapical analysis of alveolar bone in the mandibular anterior region with chronic periodontitis and 2/3 cervical bone loss after three months of periodontal splinting. Eighty four proximal site (43 mesial and 41 distal) from 16 patients with chronic periodontitis and treated with spinting were examined by taking periapical digital radiographic at day 1 and 91. The bone loss, bone density and utility of lamina dura were evaluated. The statistical analysis after three months evaluation using T-test for bone loss, Wilcoxon sign rank test for bone density and utility lamina dura showed no significantly differences (palveolar bone loss after three months splinting.

  12. Silicone Foley′s catheter: A useful splint in ear surgeries

    Directory of Open Access Journals (Sweden)

    Karanth Siddharth

    2008-01-01

    Full Text Available Maintenance of ear projection and post auricular sulcus in staged ear reconstruction in microtia is a trying problem. So also is the maintenance of the patency of the external auditory meatus following recanalization and meatoplasty. Numerous splints and dressing techniques have been described for the above situations. Some of the problems encountered include the availability of the materials, cost, expertise in fabrication and compliance. Aims: To devise a simple, reliable, inexpensive and readily available splint for the maintenance of post auricular sulcus and external auditory meatus opening. Settings and Design: A silicone catheter is made out of a soft and inert material that doesn′t cause tissue necrosis or any loss of skin graft. The basic design is that of a simple, self-retaining type of splint that doesn′t dislodge and can be prepared within minutes on the operating table. Materials and Methods: This splint has been used in four cases of microtia reconstruction and one case of congenital external auditory meatus stenosis between June 2006 and August 2007. A 14 or 16 Fr silicone Foley′s catheter was used. The proximal end of a catheter of required length was retained and the distal part was cut off. The catheter was looped into a circle around the base of the reconstructed ear and secured in position with a suture. A similar construct was used in cases of external auditory meatus reconstruction or recanalization. The funnel-shaped distal drainage end was sutured to the circular frame near the region of the tragus. This funnel was inserted into the external auditory canal. Results: The catheter was found to sit snugly in the newly created sulcus, thereby maintaining the sulcus and ear projection. It aided in maintaining the meatal opening of a satisfactory diameter in the case of external auditory canal recanalization. It was never found to slip or get dislodged in any of the cases. There was no skin graft loss or tissue necrosis

  13. The Effect of Two Maxillary Splint Occlusal Guidance Patterns on the Electromyographic Activity of the Jaw Closing Muscles.

    Science.gov (United States)

    1986-05-01

    positive histories for temporomandibular joint pain and dysfunction . In 3 this study an occlusal splint with canine guidance provided anterior guidance. EMG...muscles. Five subjects, all female, were used. Four subjects reported a history of dysfunction or pain associated with the temporomandibular joint. A...guidance on occlusal splints (Figures #1 & #2). Ten subjects without a history of temporomandibular dysfunction and with noncontributory medical

  14. Comparative evaluation of the efficacy of occlusal splints fabricated in centric relation or maximum intercuspation in temporomandibular disorders patients

    OpenAIRE

    Hamata,Marcelo Matida; Zuim,Paulo Renato Junqueira; Garcia,Alicio Rosalino

    2009-01-01

    Fabrication of occlusal splints in centric relation for temporomandibular disorders (TMD) patients is arguable, since this position has been defined for asymptomatic stomatognathic system. Thus, maximum intercuspation might be employed in patients with occlusal stability, eliminating the need for interocclusal records. This study compared occlusal splints fabricated in centric relation and maximum intercuspation in muscle pain reduction of TMD patients. Twenty patients with TMD of myogenous o...

  15. Presurgical language fMRI activation correlates with postsurgical verbal memory decline in left-sided temporal lobe epilepsy.

    Science.gov (United States)

    Labudda, Kirsten; Mertens, Markus; Aengenendt, Joerg; Ebner, Alois; Woermann, Friedrich G

    2010-12-01

    We analysed the association of presurgical language fMRI activations and postsurgical verbal memory changes in 16 left-sided mesial temporal lobe epilepsy patients with initially intact memory. Patients with severe verbal memory decline after surgery (n = 9) had stronger presurgical fMRI activations within the left posterior temporal lobe, compared to those with no decline (n = 7). Language fMRI activation may predict verbal memory outcome, even in patients with a high risk of postsurgical memory deterioration. Copyright © 2010 Elsevier B.V. All rights reserved.

  16. Pre-surgical localisation of epileptogenic zones by the SPECT and MRI

    International Nuclear Information System (INIS)

    Namer, I.J.; Scheiber, C.; Waydelich, R.; Armspach, J.P.; Hirsch, E.; Marescaux, C.; Grucker, D.

    1997-01-01

    The aim of this work is to localize the epileptogenic zones by non-invasive methods in the frame of a pre-surgical examination. Eighty five patients presenting a cryptogenic temporal epilepsy were subject to a complete clinical examination and video-EEG, a quantitative MRI and a SPECT in the inter-critical and critical period (n = 15). The SPECT was performed by means of a double head Elscint camera (900 MBq of 99m Tc-HMPAO or ECR) and the MRI was carried out with a Bruker appliance (0.28 T). The cartography of T 2 relaxation time was effected on a single cross section by means of a spin-echo sequence with 48 echoes (T R = 2000 ms, T E = 15 ms). In the 85 patients studied, the inter-critical SPECT has evidenced a regional hypo-perfusion in 71.9% of cases, the clinical MRI, an anomaly of the meso-temporal structures in 82.4% of cases and the T 2 cartography, an increase in the relaxation time in 87.5% of cases. The association of the two examinations rises this score up to 96.4%, a result quite encouraging for a pre-surgical evaluation. In 74 patients, presenting a unilateral temporal epilepsy the T 2 cartography permitted also to observe anomalous values in 37.5% of cases in the controlateral structures apparently normal, thus making questionable the success of surgical intervention

  17. [Presurgical evaluaton for lateral suboccipital craniotomy using contrast-enhanced CT volumetric imaging].

    Science.gov (United States)

    Oishi, Makoto; Fukuda, Masafumi; Saito, Akihiko; Hiraishi, Tetsuya; Fuji, Yukihiko

    2009-05-01

    To safely and precisely accomplish lateral suboccipital craniotomy (LSOC), we have presurgically evaluated the three-dimensional (3-D) relationships of various vascular structures and cranial landmarks in the occipito-cervical region by volumetric imaging of 3-D contrast enhanced computed tomography (CECT). The 3-D anatomies visualized by adjusting the window width, window level, and opacity level of the specific CT value for each structure were an occpital artery (OA), mastoid and posterior condylar emissary veins (MEV and PCEV), which were useful in dissecting muscles and exposing the cranial surface, and the relationship of the transverse-sigmoid sinus CTSS) and the asterion, which was necessary and decisive for making a key burr hole to perform craniotomy. The morphologic analysis for our 48 cases with cerebello-pontine angle tumor or neurovascular compression syndrome showed running patterns of OA, varieties of MEV and PCEV in their sizes and connections, right dominance of TSS, and the various relationship between the TSS and the asterion. Especially, the exact location of the TSS compared to the astenon was found to be inferior in 56%, right below in 38%, and superior in 6%. In conclusion, presurgical evaluation using volumetric imaging of 3-D CECT is a convenient and valuable method for obtaining the anatomic information required for performing LSOC safely and precisely in individual patients.

  18. Early orthognathic surgery with three-dimensional image simulation during presurgical orthodontics in adults.

    Science.gov (United States)

    Kang, Sang-Hoon; Kim, Moon-Key; Park, Sun-Yeon; Lee, Ji-Yeon; Park, Wonse; Lee, Sang-Hwy

    2011-03-01

    To correct dentofacial deformities, three-dimensional skeletal analysis and computerized orthognathic surgery simulation are used to facilitate accurate diagnoses and surgical plans. Computed tomography imaging of dental occlusion can inform three-dimensional facial analyses and orthognathic surgical simulations. Furthermore, three-dimensional laser scans of a cast model of the predetermined postoperative dental occlusion can be used to increase the accuracy of the preoperative surgical simulation. In this study, we prepared cast models of planned postoperative dental occlusions from 12 patients diagnosed with skeletal class III malocclusions with mandibular prognathism and facial asymmetry that had planned to undergo bimaxillary orthognathic surgery during preoperative orthodontic treatment. The data from three-dimensional laser scans of the cast models were used in three-dimensional surgical simulations. Early orthognathic surgeries were performed based on three-dimensional image simulations using the cast images in several presurgical orthodontic states in which teeth alignment, leveling, and space closure were incomplete. After postoperative orthodontic treatments, intraoral examinations revealed that no patient had a posterior open bite or space. The two-dimensional and three-dimensional skeletal analyses showed that no mandibular deviations occurred between the immediate and final postoperative states of orthodontic treatment. These results showed that early orthognathic surgery with three-dimensional computerized simulations based on cast models of predetermined postoperative dental occlusions could provide early correction of facial deformities and improved efficacy of preoperative orthodontic treatment. This approach can reduce the decompensation treatment period of the presurgical orthodontics and contribute to efficient postoperative orthodontic treatments.

  19. Fiber composites as a method of treatment splinting tooth mobility in chronic periodontitis

    Directory of Open Access Journals (Sweden)

    Dewi Lidya Ichwana

    2016-12-01

    Full Text Available Patients with periodontal disease can lead to severe tooth mobility so often complains of pain when eating, decreased chewing ability and functional occlusion. Tooth mobility is a movement in a horizontal or vertical direction and one of the most unpleased effects from periodontal disease. Basically, tooth mobility is not a disease that requires treatment, but it is a symptom of periodontal tissue morphology changes, so it became a challenge for dentists in making decisions to maintain proper care of the teeth. Recent studies improved the use of periodontal splint with fiber reinforced composite (FRC or fiber composite may lead to a long-term prognosis of teeth mobility due to periodontal disase. The case report describes treatment of chronic periodontitis patients with splinting fiber composites as a method for stabilization of the lower anterior teeth providing aesthetics, comfort, improved functionality occlusion, mastication and a good prognosis.

  20. Intraradicular splinting of a mid-root fracture with a fiber post

    Directory of Open Access Journals (Sweden)

    Viraj S Yalgi

    2014-01-01

    Full Text Available Introduction: Trauma causes fractures of anterior teeth commonly, where extraction is not considered as a part of treatment plan. This case report presents the endodontic management of a horizontally fractured right central incisor involving healing with granulation tissue, using an intraradicular splinting technique. Case Report: A patient complained of pain and mobility of the upper right front teeth since 1 day. The root canal therapy of the upper central incisor was done. The intraradicular stabilization involved placing a fiber post in the canal and luting with resin cement. Discussion: This case demonstrates that intraradicular splinting can be used to manage horizontally fractured teeth with necrotic and mobile coronal segment. The recent improvements in the dental materials resin-based restorative materials with tooth-colored fiber post are of choice because of several advantages such as esthetics, bonding to tooth structure, and low modulus elasticity similar to that of dentin.

  1. Registration strategy using occlusal splint based on augmented reality for mandibular angle oblique split osteotomy.

    Science.gov (United States)

    Zhu, Ming; Chai, Gang; Zhang, Yan; Ma, Xiaofei; Gan, Jiliang

    2011-09-01

    An augmented reality tool allows for visual tracking of real anatomic structures in superposition with volume-rendered computed tomographic or magnetic resonance imaging scans and thus can be used for navigated translocation of important structures during operation. In this feasibility study, ARToolKit was used in mandibular angle oblique split osteotomy to define the cutting planes according to an operative plan. We overlay the operative plan on the model of a mandible made by rapid prototyping technology, and the technology was successfully used in 15 patients. Before the operation, all patients underwent computed tomographic scan, and dental casts were prepared by surgeons. Then, surgeons make the occlusal splint according to a dental cast to fix the marker, which can be recognized by the ARToolKit. The occlusal splint and marker were transformed to three-dimensional data using a laser scanner, and a programmer that runs on a personal computer named Rapidform matches the marker and the mandible image to generate the virtual image. By this step, the virtual image describing the marker, occlusal splint, and the mandible image of the patient are integrated. During the operation, the operative plan was overlaid on the rapid prototyping model of the mandible as soon as the ARToolKit recognized the marker. The technology was successfully used in 15 patients; the virtual image of the mandible and the cutting-plane both overlaid the real model of the mandible. This study has reported a new and effective way for mandibular angle oblique split osteotomy, and using occlusal splint might be a powerful option for the registration of augmented reality. Augmented reality tools like ARToolKit may be helpful for control of maxillary translocation in orthognathic surgery.

  2. PENGARUH PENGGUNAAN LEG-GAITER SPLINT TERHADAP SPASTISITAS KNEE FLEXOR PADA PASIEN ANAK SPASTIC CEREBRAL PALSY

    Directory of Open Access Journals (Sweden)

    Muhammad Syaifuddin

    2016-09-01

    Full Text Available Tujuan: untuk mengetahui adakah pengaruh penggunaan leg-gaiter splint terhadap spastisitas knee flexor pada pasien anak spastic cerebral palsy. Subyek: 20 subyek spastic cerebral palsy. Tempat Penelitian: Pediatric and Neurodevelopmental Treatment Centre, Surakarta. Waktu penelitian: Januari 2016 – Maret 2016. Alat ukur: Modified Ashworth Scale – Bohannon (MAS-B. Desain penelitian: Penelitian ini menggunakan metode pra-eksperimental, dengan menggunakan one group pre-test and post-test design. Hasil: Uji normalitas menggunakan Shapiro-wilk test pada pre-test dan post-test menunjukkan nilai p<0,05, maka data berdistribusi tidak normal. Uji hipotesis menggunakan wilcoxon dengan hasil spastisitas pada tungkai kanan p<0,05 dan hasil spastisitas pada tungkai kiri p<0,05 maka terdapat pengaruh penggunaan leg-gaiter splint pada spastisitas pasien anak spastic cerebral palsy. Kesimpulan: berdasarkan analisis penelitian yang telah dilakukan dapat disimpulkan bahwa penggunaan leg-gaiter splint menurunkan derajat spastisitas knee flexor pada pasien anak spastic cerebral palsy.

  3. Novel technique to accurately measure femoral diameter using a Thomas splint.

    Science.gov (United States)

    Liew, Ignatius; Qureshi, Mobeen; Joseph, Jibu; Bailey, Oliver

    2017-11-01

    During surgical management of femoral shaft fractures, difficulties arise when treating patients with narrow femoral diaphyseal canals, such as young patients and those with dysplastic femurs secondary to underlying pathology. Accurate pre-operative assessment of the femoral diaphyseal canal diameter would allow the surgeon to plan surgical technique and ensure appropriate equipment was available, such as narrow, unreamed or paediatric sized nails. When secured to the patient both longitudinal rods of the main Thomas Splint component lie parallel with the femoral shaft and horizontal to the radiographic x-ray plate. The diameter of these rods are 13mm (Adult and paediatric). Using the calibration tool, we calibrate the diameter of the Thomas Splint to 13mm, accurately measuring any further detail on that radiograph, such as the diaphyseal canal diameter. Accurate knowledge pre-operatively of radiographic measurements is highly valuable to the operating surgeon. This technique can accurately measure femoral canal diameter using the Thomas splint, negates the requirement for a calibration marker, is reproducible, easy to perform, and is indispensible when faced with a patient with a narrow femoral canal in a diaphyseal femoral fracture. (181 words). Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  4. Reconstruction of attached soft tissue around dental implants by acelluar dermal matrix grafts and resin splint

    Science.gov (United States)

    Liu, Changying; Su, Yucheng; Tan, Baosheng; Ma, Pan; Wu, Gaoyi; Li, Jun; Geng, Wei

    2014-01-01

    Objectives: The purpose of this study was to recommend a new method using acellular dermal matrix graft and resin splint to reconstruct the attached soft tissue around dental implants in patients with maxillofacial defects. Materials and methods: Total 8 patients (3 male and 5 female patients) diagnosed with maxillofacial defects and dentition defects caused by tumors, fractures or edentulous jaw, were selected for this study. Dental implants were routinely implanted at the edentulous area. Acellular dermal matrix heterografts and resin splint were used to increase the attached soft tissue. The width of attached gingiva in the labial or buccal surface at edentulous area was measured before surgical procedures and after the completion of superstructures. Paired t-test was applied to assess the change of quantitative variables. All tests were 2-tailed, and P implants could be reconstructed one month after the completion of surgical procedures, and the epithelial cuff around the implant neck established very well. The width of attached gingival tissue in the patients increased significantly from a mean of 0.61 ± 0.75 mm to 6.25 ± 1.04 mm. The patients were fully satisfied with the esthetic and functional results achieved. Conclusions: The acellular dermal matrix graft could be used to increase the attached gingiva around dental implants in these patients with maxillofacial defects. The resin splint could facilitate the healing of graft. PMID:25663964

  5. Effects of a resistance training program performed with an interocclusal splint for community-dwelling older adults: a randomized controlled trial

    OpenAIRE

    Hirase, Tatsuya; Inokuchi, Shigeru; Matsusaka, Nobuou; Nakahara, Kazumi; Okita, Minoru

    2016-01-01

    [Purpose] To examine whether resistance training for elderly community-dwellers performed with an interocclusal splint resulted in greater lower extremity muscle strength and better balance than resistance training performed without an interocclusal splint. [Subjects and Methods] Eighty-eight elderly persons using Japanese community day centers were randomly divided into two groups: an intervention group (n=45), which performed resistance training with an interocclusal splint; and a control g...

  6. Improving fMRI reliability in presurgical mapping for brain tumours.

    Science.gov (United States)

    Stevens, M Tynan R; Clarke, David B; Stroink, Gerhard; Beyea, Steven D; D'Arcy, Ryan Cn

    2016-03-01

    Functional MRI (fMRI) is becoming increasingly integrated into clinical practice for presurgical mapping. Current efforts are focused on validating data quality, with reliability being a major factor. In this paper, we demonstrate the utility of a recently developed approach that uses receiver operating characteristic-reliability (ROC-r) to: (1) identify reliable versus unreliable data sets; (2) automatically select processing options to enhance data quality; and (3) automatically select individualised thresholds for activation maps. Presurgical fMRI was conducted in 16 patients undergoing surgical treatment for brain tumours. Within-session test-retest fMRI was conducted, and ROC-reliability of the patient group was compared to a previous healthy control cohort. Individually optimised preprocessing pipelines were determined to improve reliability. Spatial correspondence was assessed by comparing the fMRI results to intraoperative cortical stimulation mapping, in terms of the distance to the nearest active fMRI voxel. The average ROC-r reliability for the patients was 0.58±0.03, as compared to 0.72±0.02 in healthy controls. For the patient group, this increased significantly to 0.65±0.02 by adopting optimised preprocessing pipelines. Co-localisation of the fMRI maps with cortical stimulation was significantly better for more reliable versus less reliable data sets (8.3±0.9 vs 29±3 mm, respectively). We demonstrated ROC-r analysis for identifying reliable fMRI data sets, choosing optimal postprocessing pipelines, and selecting patient-specific thresholds. Data sets with higher reliability also showed closer spatial correspondence to cortical stimulation. ROC-r can thus identify poor fMRI data at time of scanning, allowing for repeat scans when necessary. ROC-r analysis provides optimised and automated fMRI processing for improved presurgical mapping. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

  7. The Contribution of Functional Near-Infrared Spectroscopy (fNIRS) to the Presurgical Assessment of Language Function in Children

    Science.gov (United States)

    Gallagher, Anne; Beland, Renee; Lassonde, Maryse

    2012-01-01

    Before performing neurosurgery, an exhaustive presurgical assessment is required, usually including an investigation of language cerebral lateralization. Among the available procedures, the intracarotid amobarbital test (IAT) was formerly the most widely used. However, this procedure has many limitations: it is invasive and potentially traumatic,…

  8. Strongly lateralized activation in language fMRI of atypical dominant patients-implications for presurgical work-up.

    NARCIS (Netherlands)

    Wellmer, J.; Weber, B.; Weis, S.; Klaver, P.; Urbach, H.; Reul, J.; Fernandez, G.S.E.; Elger, C.E.

    2008-01-01

    PURPOSE: Functional magnetic resonance imaging (fMRI) is being used increasingly for language dominance assessment in the presurgical work-up of patients with pharmacoresistant epilepsy. However, the interpretation of bilateral fMRI-activation patterns is difficult. Various studies propose

  9. An Intelligibility Assessment of Toddlers with Cleft Lip and Palate Who Received and Did Not Receive Presurgical Infant Orthopedic Treatment.

    Science.gov (United States)

    Konst, Emmy M.; Weersink-Braks, Hanny; Rietveld, Toni; Peters, Herman

    2000-01-01

    The influence of presurgical infant orthopedic treatment (PIO) on speech intelligibility was evaluated with 10 toddlers who used PIO during the first year of life and 10 who did not. Treated children were rated as exhibiting greater intelligibility, however, transcription data indicated there were not group differences in actual intelligibility.…

  10. An electromyographic study to assess the minimal time duration for using the splint to raise the vertical dimension in patients with generalized attrition of teeth

    Directory of Open Access Journals (Sweden)

    Aditi Nanda

    2011-01-01

    Full Text Available Background: To investigate the effect of restoration of lost vertical by centric stabilizing splint on electromyographic (EMG activity of masseter and anterior temporalis muscles bilaterally in patients with generalized attrition of teeth. Materials and Methods: EMG activity of anterior temporalis and masseter muscle was recorded bilaterally for 10 patients whose vertical was restored with centric stabilizing splint. The recording was done at postural rest position and in maximum voluntary clenching for each subject before the start of treatment, immediately after placement of splint and at subsequent recall visits, with splint and without the splint. Results: The EMG activity at postural rest position (PRP and maximum voluntary clench (MVC decreased till 1 month for both the muscles. In the third month, an increase in muscle activity toward normalization was noted at PRP, both with and without splint. At MVC in the third month, the muscle activity without splint decreased significantly as compared to pretreatment values for anterior temporalis and masseter, while with the splint an increase was seen beyond the pretreatment values. Conclusion: A definite response of anterior temporalis and masseter muscle was observed over a period of 3 months. This is suggestive that the reversible increase in vertical prior to irreversible intervention must be carried out for a minimum of 3 months to achieve neuromuscular deprogramming. This allows the muscle to get adapted to the new postural position and attain stability in occlusion following splint therapy.

  11. The effect of implant angulation and splinting on stress distribution in implant body and supporting bone: A finite element analysis

    Science.gov (United States)

    Behnaz, Ebadian; Ramin, Mosharraf; Abbasi, Samaneh; Pouya, Memar Ardestani; Mahmood, Farzin

    2015-01-01

    Objective: The aim of this study was to investigate the influence of implant crown splinting and the use of angulated abutment on stress distribution in implant body and surrounding bone by three-dimensional finite element analysis. Materials and Methods: For this study, three models with two implants at the site of mandibular right second premolar and first molar were designed (1): Both implants, parallel to adjacent teeth, with straight abutments (2): Anterior implant with 15 mesial angulations and posterior implant were placed parallel to adjacent tooth, (3): Both implants with 15 mesial angulations and parallel to each other with 15° angulated abutments. Restorations were modeled in two shapes (splinted and nonsplinted). Loading in tripod manner as each point 50 N and totally 300 N was applied. Stress distribution in relation to splinting or nonsplinting restorations and angulations was done with ABAQUS6.13. Results: Splinting the restorations in all situations, led to lower stresses in all implant bodies, cortical bone and spongy bone except for the spongy bone around angulated first molar. Angulated implant in nonsplinted restoration cause lower stresses in implant body and bone but in splinted models more stresses were seen in implant body in comparison with straight abutment (model 2). Stresses in nonsplinted and splinted restorations in cortical bone of angulated molar region were more than what was observed in straight molar implant (model 3). Conclusion: Implant restorations splinting lead to a better distribution of stresses in implant bodies and bone in comparison with nonsplinted restorations, especially when the load is applied off center to implant body. Angulations of implant can reduce stresses when the application of the load is in the same direction as the implant angulation. PMID:26430356

  12. Exploratory study of pre-surgical medications with dienogest or leuprorelin in laparoscopic cystectomy of endometrial cysts.

    Science.gov (United States)

    Takenaka, Motoki; Yano, Ryuichiro; Hiraku, Yuka; Shibata, Mayuko; Hatano, Kayoko; Yamamoto, Shiori; Sato, Kazuki; Yamamoto, Kazushige; Morishige, Ken-ichiro

    2015-08-01

    The aim of this study was to compare the effects of pre-surgical medication with dienogest or leuprorelin on post-surgical ovarian function. We conducted an exploratory study in two centers in Japan that comprised 30 patients with ovarian endometrial cysts for whom surgical excision was planned. Patients were enrolled and divided into pre-surgical medication groups with dienogest or leuprorelin for 12 weeks. Thereafter, patients were treated by laparoscopic cystectomy. The primary outcome was ovarian function post-surgery, as assessed by serum anti-Müllerian hormone (AMH) level, antral follicle count (AFC) and resumption of menses. Secondary outcome was the effect of pre-surgical medication, as assessed by the size of endometrial cysts and visual analog scale (VAS) score. Serum AMH, AFC, size of endometrial cysts, and VAS scores were measured at baseline (before medication), after medication (1 day before surgery), and at 4 and 12 weeks post-surgery. Serum AMH levels did not change after pre-surgical medication with either dienogest or leuprorelin. Although AMH decreased after surgery, it recovered by 12 weeks post-surgery in both groups with no statistically significant difference. Mean AFC did not change after surgery in either group. Menses returned by 12 weeks post-surgery in all patients except for those who were pregnant. The rate of reduction of endometrial cyst volume did not differ between the groups. Both dienogest and leuprorelin were associated with substantial reductions in VAS scores. There were no statistically significant differences between pre-surgical medication with dienogest and leuprorelin in post-surgical ovarian function. Both medications were effective in reducing endometrial cyst volume and VAS score. © 2015 The Authors. Journal of Obstetrics and Gynaecology Research © 2015 Japan Society of Obstetrics and Gynecology.

  13. Clinical application of spatiotemporal distributed source analysis in presurgical evaluation of epilepsy

    Directory of Open Access Journals (Sweden)

    Naoaki eTanaka

    2014-02-01

    Full Text Available Magnetoencephalography (MEG, which acquires neuromagnetic fields in the brain, is a useful diagnostic tool in presurgical evaluation of epilepsy. Previous studies have shown that MEG affects the planning intracranial EEG placement and correlates with surgical outcomes by using a single dipole model. Spatiotemporal source analysis using distributed source models is an advanced method for analyzing MEG, and has been recently introduced for analyzing epileptic spikes. It has advantages over the conventional single dipole analysis for obtaining accurate sources and understanding the propagation of epileptic spikes. In this article, we review the source analysis methods, describe the techniques of the distributed source analysis, interpretation of source distribution maps, and discuss the benefits and feasibility of this method in evaluation of epilepsy.

  14. Clinical application of spatiotemporal distributed source analysis in presurgical evaluation of epilepsy.

    Science.gov (United States)

    Tanaka, Naoaki; Stufflebeam, Steven M

    2014-01-01

    Magnetoencephalography (MEG), which acquires neuromagnetic fields in the brain, is a useful diagnostic tool in presurgical evaluation of epilepsy. Previous studies have shown that MEG affects the planning intracranial electroencephalography placement and correlates with surgical outcomes by using a single dipole model. Spatiotemporal source analysis using distributed source models is an advanced method for analyzing MEG, and has been recently introduced for analyzing epileptic spikes. It has advantages over the conventional single dipole analysis for obtaining accurate sources and understanding the propagation of epileptic spikes. In this article, we review the source analysis methods, describe the techniques of the distributed source analysis, interpretation of source distribution maps, and discuss the benefits and feasibility of this method in evaluation of epilepsy.

  15. Presurgical language fMRI in patients with drug-resistant epilepsy: effects of task performance.

    Science.gov (United States)

    Weber, Bernd; Wellmer, Jörg; Schür, Simone; Dinkelacker, Vera; Ruhlmann, Jürgen; Mormann, Florian; Axmacher, Nikolai; Elger, Christian E; Fernández, Guillén

    2006-05-01

    To determine whether language functional magnetic resonance imaging (fMRI) before epilepsy surgery can be similarly interpreted in patients with greatly different performance levels. An fMRI paradigm using a semantic decision task with performance control and a perceptual control task was applied to 226 consecutive patients with drug-resistant localization-related epilepsy during their presurgical evaluations. The volume of activation and lateralization in an inferior frontal and a temporoparietal area was assessed in correlation with individual performance levels. We observed differential effects of task performance on the volume of activation in the inferior frontal and the temporoparietal region of interest, but performance measures did not correlate with the lateralization of activation. fMRI, as applied here, in patients with a wide range of cognitive abilities, can be interpreted regarding language lateralization in a similar way.

  16. Evaluation of a pre-surgical functional MRI workflow: From data acquisition to reporting.

    Science.gov (United States)

    Pernet, Cyril R; Gorgolewski, Krzysztof J; Job, Dominic; Rodriguez, David; Storkey, Amos; Whittle, Ian; Wardlaw, Joanna

    2016-02-01

    Present and assess clinical protocols and associated automated workflow for pre-surgical functional magnetic resonance imaging in brain tumor patients. Protocols were validated using a single-subject reliability approach based on 10 healthy control subjects. Results from the automated workflow were evaluated in 9 patients with brain tumors, comparing fMRI results to direct electrical stimulation (DES) of the cortex. Using a new approach to compute single-subject fMRI reliability in controls, we show that not all tasks are suitable in the clinical context, even if they show meaningful results at the group level. Comparison of the fMRI results from patients to DES showed good correspondence between techniques (odds ratio 36). Providing that validated and reliable fMRI protocols are used, fMRI can accurately delineate eloquent areas, thus providing an aid to medical decision regarding brain tumor surgery. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Pre-surgical Pulmonary Rehabilitation in Asthma Patients Undergoing Bariatric Surgery.

    Science.gov (United States)

    Türk, Yasemin; van Huisstede, Astrid; Hiemstra, Pieter S; Taube, Christian; Braunstahl, Gert-Jan

    2017-11-01

    This pilot study was performed to investigate the feasibility of pre-surgical pulmonary rehabilitation (PR) in morbidly obese patients with uncontrolled asthma, undergoing bariatric surgery. Four morbidly obese female patients with asthma participated in a 12-week PR program (exercise, diet, and psychological intervention) before undergoing bariatric surgery, and the outcomes were compared to a matched group of seven female controls (bariatric surgery only). In patients who participated in PR, asthma control and asthma quality of life improved dramatically after 3 months of PR. Besides, asthma control was better at the moment of surgery. The results of this pilot study show that PR is feasible in morbidly obese asthmatics and should be considered for a selected group of patients with uncontrolled asthma before undergoing bariatric surgery.

  18. Change in presurgical diagnostic imaging evaluation affects subsequent pediatric epilepsy surgery outcome.

    Science.gov (United States)

    Rubinger, Luc; Chan, Carol; D'Arco, Felice; Moineddin, Rahim; Muthaffar, Osama; Rutka, James T; Snead, O Carter; Smith, Mary Lou; Widjaja, Elysa

    2016-01-01

    Since 2008, we have changed our presurgical diagnostic imaging evaluation for medically refractory focal epilepsy to include high-resolution epilepsy protocol on 3 T magnetic resonance imaging (MRI), and combined magnetoencephalography and 18-fluorodeoxyglucose-positron emission tomography (FDG-PET) in selected patients with normal or subtle changes on MRI or discordant diagnostic tests. The aim of this study was to evaluate the effectiveness of the change in imaging practice on epilepsy surgery outcome in a tertiary pediatric epilepsy surgery center. The change in practice occurred in early 2008, and patients were classified based on old or new practice. The patient characteristics, surgical variables, and seizure-free surgical outcome were compared, and the trend in seizure-free outcome over time was assessed. There was a trend for increased abnormal MRI (92% vs. 86%, respectively, p = 0.062), and increased utilization of FDG-PET (34% vs. 3% respectively, p 0.05). During the old practice, there was no statistically significant change in yearly trend of seizure-free outcome (odds ratio [OR] 0.960, 95% confidence interval [CI] 0.875-1.053, p = 0.386). The change in practice in 2008 was associated with a significant improvement in seizure-free outcome (OR 1.535, 95% CI 1.100-2.142, p = 0.012). During the new practice, there was a significant positive trend in yearly seizure-free outcome (OR 1.219, 95% CI 1.053-1.411, p = 0.008), after adjusting for age at seizure onset, invasive monitoring, location and type of surgery, histology, MRI, magnetoencephalography, and FDG-PET. We have found an improvement in seizure-free surgical outcome following the change in imaging practice. This study highlights the importance of optimizing and improving presurgical diagnostic imaging evaluation to improve surgical outcome. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  19. American Society of Functional Neuroradiology-Recommended fMRI Paradigm Algorithms for Presurgical Language Assessment.

    Science.gov (United States)

    Black, D F; Vachha, B; Mian, A; Faro, S H; Maheshwari, M; Sair, H I; Petrella, J R; Pillai, J J; Welker, K

    2017-10-01

    Functional MR imaging is increasingly being used for presurgical language assessment in the treatment of patients with brain tumors, epilepsy, vascular malformations, and other conditions. The inherent complexity of fMRI, which includes numerous processing steps and selective analyses, is compounded by institution-unique approaches to patient training, paradigm choice, and an eclectic array of postprocessing options from various vendors. Consequently, institutions perform fMRI in such markedly different manners that data sharing, comparison, and generalization of results are difficult. The American Society of Functional Neuroradiology proposes widespread adoption of common fMRI language paradigms as the first step in countering this lost opportunity to advance our knowledge and improve patient care. A taskforce of American Society of Functional Neuroradiology members from multiple institutions used a broad literature review, member polls, and expert opinion to converge on 2 sets of standard language paradigms that strike a balance between ease of application and clinical usefulness. The taskforce generated an adult language paradigm algorithm for presurgical language assessment including the following tasks: Sentence Completion, Silent Word Generation, Rhyming, Object Naming, and/or Passive Story Listening. The pediatric algorithm includes the following tasks: Sentence Completion, Rhyming, Antonym Generation, or Passive Story Listening. Convergence of fMRI language paradigms across institutions offers the first step in providing a "Rosetta Stone" that provides a common reference point with which to compare and contrast the usefulness and reliability of fMRI data. From this common language task battery, future refinements and improvements are anticipated, particularly as objective measures of reliability become available. Some commonality of practice is a necessary first step to develop a foundation on which to improve the clinical utility of this field. © 2017 by

  20. Pneumatic-type dynamic traction and flexion splint for treating patients with extension contracture of the metacarpophalangeal joint.

    Science.gov (United States)

    Nakayama, Jun; Horiki, Mituru; Denno, Kakurou; Ogawa, Kazunori; Oka, Hisao; Domen, Kazuhisa

    2016-02-01

    Collateral ligament shortening causes extension contractures of the metacarpophalangeal joint, and dynamic flexion splinting has been widely used to treat these contractures; however, there are various problems with these approaches. We developed a novel, pneumatic-type dynamic traction and flexion splint to solve these problems. A total of 25 fingers were treated with the dynamic traction and flexion splint for 8 weeks. Every 2 weeks, the average metacarpophalangeal joint flexion angle, total active motion, grasp strength, and pain scores were assessed. The finger flexion angle was significantly greater at the final evaluation, starting after 6 weeks of treatment (p < 0.05), than prior to treatment. Similarly, the total active motion results improved significantly over 8 weeks. Our results show that use of the dynamic traction and flexion splint improves patient finger functioning and flexural angle. The dynamic traction and flexion (DTF) splint appears to be effective for treating patients. © The International Society for Prosthetics and Orthotics 2015.

  1. Long Term Effects of Volar-Dorsal Wrist/ Hand Immobilization Splint on Motor Components and Function of Stroke Patients

    Directory of Open Access Journals (Sweden)

    Malek Amini

    2015-09-01

    Full Text Available Objectives: This study was designed to determine the effects of Volar-Dorsal Wrist/Hand Immobilization Splint on upper extremity motor components and function of stroke patients. Methods: fourteen patients were participated in this study. The patients were selected based on the inclusion and exclusion criteria, and were given the splint after a primary evaluation. They were re-evaluated after one, two and three months. In order to assess spasticity, the range of motion, and upper extremity function, the Modified Ashworth Scale (MAS, the goniometry, and fugl-meyer assessment were used respectively. The splints were used 2 hours during the day and the whole night in three months. Results: The amount of the upper extremity function changes (P(v=0.07 was not significant: and the amount of the ranges of the motion changes (P(v=0.02 were statistically significant. The changes in range of  motion of other joints and spasticity were not significant (P(v>.05. Discussion: The results of the present study indicated that, volar-dorsal wrist/hand immobilization splints can improve the AROM of metha-carpophalengeal joints. Although spasticity, the range of motion of other joints, and the upper extremity function went through some changes due to  splinting (3month, these changes were not significant, which requires further research.

  2. Conservative treatment for equinus deformity in children with cerebral palsy using an adjustable splint-assisted ankle-foot orthosis.

    Science.gov (United States)

    Chen, Wei; Liu, Xiaoyu; Pu, Fang; Yang, Yang; Wang, Lizhen; Liu, Hong; Fan, Yubo

    2017-10-01

    A novel splint, the assisting ankle-foot orthoses (AFO), was developed to provide adjustable sustained stretching to improve conservative treatment for equinus deformities in children with cerebral palsy (CP). The treatment effect was validated by follow-up visits. This study involved subjects between 2 and 12 years old, including 28 CP children treated with splint-assisted AFO correction, 30 CP children treated with static AFO correction, and 30 normal children with typical development (TD). Quantitative pedobarographic measurements were taken to evaluate the effect of splint-assisted AFO correction. The heel/forefoot ratio was introduced to indicate the degree of the equinus deformity during treatment. The results showed that the heel/forefoot ratios were 1.41 ± 0.26 for the TD children; 0.65 ± 0.41, 1.02 ± 0.44, and 1.24 ± 0.51 for the splint-assisted AFO correction before and after 6-month and 12-month treatments; 0.59 ± 0.37, 0.67 ± 0.44, and 0.66 ± 0.42 for the static AFO correction before and after 6-month and 12-month treatments. This study suggests that correction with the adjustable splint-assisted AFO is an effective treatment for equinus deformity in CP Children.

  3. [Fractures of the lower extremity in the emergency room. Analysis of a new immobilization and x-ray splint].

    Science.gov (United States)

    Kraus, T M; Kirchhoff, C; Martetschläger, F; Braun, K F; Siebenlist, S; Ganslmeier, A; Stöckle, U; Freude, T

    2013-03-01

    Fractures of the lower extremity are a common reason for presentation to an emergency room. The aim of this study was to evaluate a new immobilization and x-ray splint (Andante®, ForMed) in the emergency room. From April 2010 to August 2010 all patients presenting with a fracture of the lower extremity were included in the study. Pain perception (visual analog scale; VAS) was measured before and after splint application. The handling of the splint during radiography was assessed and the quality of the diagnostic x-ray was evaluated. The study comprised 61 patients. Subjective pain perception was reduced significantly (3.96±1.9 vs. 6.38±2.2; p<0.001). The handling of the splint was graded at 1.73±0.96 (1, very good; 5, poor). There was no difference in the diagnostic quality of the x-rays between the Andante® and the control group; however, significantly poorer results were found for x-rays of ankle fractures (p<0.038). The Andante® splint is a useful tool in the emergency room that combines simple handling and pain relief due to immobilization. However, the quality of the diagnostic x-rays was not better compared with the control group.

  4. Gartland type I supracondylar humerus fractures in children: is splint immobilization enough?

    Science.gov (United States)

    Cuomo, Anna V; Howard, Andrew; Hsueh, Sophia; Boutis, Kathy

    2012-11-01

    The primary objective of this study was to determine if Gartland type I supracondylar humerus (SCH) fractures undergo significant displacement resulting in a change in management when treated with a long-arm splint. Secondary objectives included measured changes at follow-up in displacement and/or angulation. This was a retrospective review of children who presented with elbow injuries to a children's hospital. Patients were included if they were diagnosed with a Gartland type I SCH fracture, managed with a long-arm splint, and had at least 1 follow-up visit 2 to 3 weeks from the emergency department visit. The primary outcome was the proportion of cases that required the placement of a circumferential cast and/or an operative intervention. Secondary outcomes included the proportion of cases with significant changes in displacement on any view, Baumann or the lateral humerocapitellar angle, and/or category of position of anterior humeral line relative to capitellum. Of 804 elbow injuries that presented from 2003 to 2008, 53 patients met the inclusion criteria. The median age of the patients was 4.1 years (interquartile range, 3.4-6.1 years) years. Of the 53, there were no cases that required a change in management. One case had a change in the humerocapitellar angle, and another had a change of 1 category in position of the capitellum relative to the anterior humeral line. There were no other cases of significant changes in displacement or angulation. These data support that Gartland type I SCH fractures can be treated effectively with long-arm posterior splinting for the duration of therapy.

  5. Counseling and oral splint for conservative treatment of temporomandibular dysfunction: preliminary study

    Directory of Open Access Journals (Sweden)

    Ana Paula Varela Brown MARTINS

    Full Text Available Abstract Introduction Temporoamndiular Disorders (TMD involve the masticatory muscles, temporomandibular joint (TMJ or both. The most common symptom is pain, which is usually located in the muscles of mastication, pre-auricular region, and / or ATM, especially during mandibular function. The main treatment for TMD is related to pain relief. Objective The purpose of this case report was to evaluate the reduction of pain symptoms using Visual Analogue Scale (VAS of patients with TMD treated with counseling and use of occlusal splint (OS. Material and method 16 subjects had participated in this study, that was composed by 4 appointment with 7-day interval between each (CEP FOP / Unicamp – 137/2009. In the first, an examiner used the Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD to diagnose each patient and delivered a VAS to register the intensity of daily pain. In the second, counseling, molding of both dental arcs to fabricate the OS and the delivery of new VAS were performed. In the third, there was the installation and adjustment of the OS and the delivery of another scale, and in the last, possible adjustments on the OS were done. Data were analyzed by ANOVA two way and Tukey post-test at 5% significance level. Result There was significant difference when comparing the intensity of pain of individuals after installation of splint with the baseline data and after counseling (p = 0.05. Conclusion According to the result of this study, the treatment of TMD associating counseling occlusal splint is effective in reducing pain intensity.

  6. A sectional-splinting technique for impressing multiple implant units by eliminating the use of an open tray

    Science.gov (United States)

    Deogade, Suryakant C.; Dube, Gunjan

    2014-01-01

    Since the inception of root form implant dentistry by P-I Branemark in the early 1980's, so many technical advances have been put forward by several authors. However, the open tray impression technique is still performed for impressing multiple implant fixtures as it was first described in the original Branemark procedure manual. The most critical aspect for a successful implant-supported restoration is the passive and an accurate fit of superstructures to avoid preload and loading stresses. Splinting impression technique in multiple implants has gained popularity. Auto-polymerizing acrylic resin is among the most routinely practiced splinting material for multiple implant units. However, unfortunately, it exhibits shrinkage, which makes an impression quite inaccurate. This case report presents the solution to minimize the shrinkage of resin by utilizing sectional-splinting technique as advocated in the previous implant literature. PMID:24963251

  7. Short-term efficacy of mandibular advancement splint in treatment of obstructive sleep apnea-hypopnea syndrome

    Directory of Open Access Journals (Sweden)

    Calliandra Moura Pereira de Lima

    2013-06-01

    Full Text Available OBJECTIVE: The aim of the present study was to determine the short-term efficacy of treatment for snoring and obstructive sleep apnea-hypopnea syndrome (OSAHS using a mandibular advancement splint. METHODS: The sample comprised 20 patients (13 men and 7 women; mean age = 48 years; mean body mass index = 27.07 with OSAHS. Polysomnograms were performed before and 60 days after mandibular advancement splint therapy. RESULTS: There was a significant reduction in the apnea-hypopnea index (AHI following treatment (mean pretreatment AHI = 20.89 ± 17.9 versus mean posttreatment AHI = 4.43 ± 3.09 (p < 0.05. The snoring reduced and the sleep efficiency improved, as registered by polysomnograms (p<0.05. CONCLUSIONS: The sleep quality improved in patients using mandibular advancement splint. Further studies evaluating long-term effects are needed.

  8. A sectional-splinting technique for impressing multiple implant units by eliminating the use of an open tray

    Directory of Open Access Journals (Sweden)

    Suryakant C. Deogade

    2014-01-01

    Full Text Available Since the inception of root form implant dentistry by P-I Branemark in the early 1980′s, so many technical advances have been put forward by several authors. However, the open tray impression technique is still performed for impressing multiple implant fixtures as it was first described in the original Branemark procedure manual. The most critical aspect for a successful implant-supported restoration is the passive and an accurate fit of superstructures to avoid preload and loading stresses. Splinting impression technique in multiple implants has gained popularity. Auto-polymerizing acrylic resin is among the most routinely practiced splinting material for multiple implant units. However, unfortunately, it exhibits shrinkage, which makes an impression quite inaccurate. This case report presents the solution to minimize the shrinkage of resin by utilizing sectional-splinting technique as advocated in the previous implant literature.

  9. Acrylic splint Herbst and Hanks telescoping Herbst: a retrospective study of emergencies, retreatments, treatment times and failures.

    Science.gov (United States)

    Manni, Antonio; Cozzani, Mauro; Mazzotta, Laura; Fiore, Valerio Pierpaolo; Mutinelli, Sabrina

    2014-03-01

    The Herbst appliance has been reported to be one of the most efficient for the correction of class II malocclusions. However, there are many complications that make its use difficult for clinicians and patients (splint loosening, telescope breakage, splint breakage, low comfort). The aim of this study was to evaluate and compare emergencies, retreatments, failures and overall treatment time of two types of Herbst appliances: the HT Herbst and the acrylic splint Herbst. Two hundred and eight patients with Class II malocclusion were selected consecutively in a private practice. They were treated either with an acrylic splint Herbst (155 pt, mean age 10.3 ± 3.7) or with a HT Herbst (53 pt, mean age 11.3 ± 4.2 years). Tables were used for each patient to record the following complications, if present: detached Herbst, broken and repaired Herbst, broken and rebuilt Herbst (emergencies), Herbst that had to be re-made for lack of patient cooperation (retreatments) and appliances that had to be removed (failed treatment). Results showed that the HT Herbst and the acrylic splint Herbst have the same retreatment probability and the same treatment time. Moreover, the HTH has a lower risk of functional impairment: the acrylic splint Herbst has an emergency probability that is twice as high as the HTH. On the other hand, the HTH has a failure frequency that is nearly 6 times higher than the traditional Herbst although the statistical analysis could not provide any certain conclusion about it. In cases where a higher relative risk of failure for the traditional Herbst was confirmed, the HTH proved to be a better appliance than the traditional Herbst. Copyright © 2014 CEO. Published by Elsevier Masson SAS. All rights reserved.

  10. Treatment for TMD with occlusal splint and electromyographic control: application of the FARC protocol in a Brazilian population.

    Science.gov (United States)

    Vieira e Silva, Carolina A; da Silva, Marco Antônio M Rodrigues; Melchior, Melissa de Oliveira; de Felício, Cláudia Maria; Sforza, Chiarella; Tartaglia, Gianluca M

    2012-07-01

    The purpose of this study was to apply Functional Anatomy Research Center (FARC) Protocol of TMD treatment, which includes the use of a specific type of mandibular occlusal splint, adjusted based on the electromyographic index, in a group of 15 patients with disc displacement, classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and then analyzing the results compared with the control group. The clinical evaluations were completed both before and after the treatment. Electromyographic (EMG) data was collected and recorded on the day the splint was inserted (visit 1), after one week (visit 2) and after five weeks of treatment (visit 3). The control group consisted of 15 asymptomatic subjects, according to the same diagnostic criteria (RDC/TMD), who were submitted to the same evaluations with the same interval periods as the treatment group. Immediately after splint adjustment, masseter muscle symmetry and total muscular activity were significantly different with than without the splint (p < 0.05), showing an increased neuromuscular coordination. After treatment, significant variations (p < .05) were found in mouth opening and in pain remission. There were no significant differences among the three sessions, either with or without the splint. There were significant differences between the TMD and control groups for all analyzed indices of muscular symmetry, activity and torque, with the exception of total muscular activity. The use of the splint promoted balance of the EMG activities during its use, relieving symptoms. EMG parameters identified neuromuscular imbalance, and allowed an objective analysis of different phases of TMD treatment, differentiating individuals with TMD from the asymptomatic subjects.

  11. Crestal Bone Loss Around Adjacent Dental Implants Restored with Splinted and Nonsplinted Fixed Restorations: A Systematic Literature Review.

    Science.gov (United States)

    Al Amri, Mohammad D; Kellesarian, Sergio Varela

    2017-08-01

    The aim of this systematic review was to compare the crestal bone loss around splinted and nonsplinted adjacent implants. To address the focused question, "Is crestal bone loss around adjacent implants different with splinted from that with nonsplinted restorations?," indexed databases were searched from 1965 up to and including May 2016 using various combinations of the following keywords: "implant," "splinted," "nonsplinted," "unsplinted," "connected," "unconnected," "nonconnected," and "bone loss." Letters to the editor, commentaries, historic reviews, case reports, case series, animal studies, and studies on full-arch rehabilitation were excluded. Six studies were included with titanium implants ranging from 114 to 1187 implants. All studies had nonsplinted and splinted restorations that ranged from 20 to 234 restorations and from 60 to 970 restorations, respectively. In all the studies, the follow-up period after the restoration placement ranged between 1 and 22 years, with a mean follow-up ranging between 3 and 10.18 ± 3.18 years. In all studies, the mean crestal bone loss for implants restored with nonsplinted restorations ranged between 0.30 ± 0.65 and 1.3 ± 0.2 mm, whereas the mean crestal bone loss for implants restored with splinted restorations ranged between 0.50 ± 0.8 and 1.22 ± 0.95 mm. Within the limitations of this review it is concluded that adjacent implants restored with splinted and nonsplinted fixed restorations did not exhibit a difference in crestal bone loss. The evidence from this systematic review suggests further investigation. © 2016 by the American College of Prosthodontists.

  12. Manual and manipulative therapy compared to night splint for symptomatic hallux abducto valgus: an exploratory randomised clinical trial.

    Science.gov (United States)

    du Plessis, Morne; Zipfel, Bernhard; Brantingham, James W; Parkin-Smith, Gregory F; Birdsey, Paul; Globe, Gary; Cassa, Tammy K

    2011-06-01

    Hallux abducto valgus (HAV) is a frequent cause of great toe pain and disability, yet common treatments are only supported by mixed or equivocal research findings. Surgery often only provides modest improvement and post-surgery complications may significantly hamper outcomes, implying the need for trials testing conservative treatment, such as manual and manipulative therapy, particularly in cases where surgery may be contraindicated or premature. The purpose of this exploratory trial was to test an innovative protocol of manual and manipulative therapy (MMT) and compare it to standard care of a night splint(s) for symptomatic mild to moderate HAV, with a view gather insight into the effectiveness of MMT and inform the design of a definitive trial. Parallel-group randomised trial set in an out-patient teaching clinic. A convenience sample of 75 patients was assessed for eligibility, with 30 participants (15 per group) being consented and randomly allocated to either the control group (standard care with a night splint) or the experimental group (MMT). Participants in the control group used a night splint(s) and those in the experimental group (MMT) received a structured protocol of MMT, with the participants in the experimental group receiving 4 treatments over a 2-week period. Visual analogue scale (HAV-related pain), foot function index (HAV-related disability) and hallux dorsiflexion (goniometry). There were no participant dropouts and no data was missing. There were no statistical (pmanipulative therapy (experimental group) is equivalent to standard care of a night splint(s) (control group) for symptomatic mild to moderate HAV in the short term. The protocol of MMT maintains its treatment effect from 1-week to 1-month follow-up without further treatment, while patients receiving standard care seem to regress when not using the night splint. Insights from this study support further testing of MMT for symptomatic mild to moderate HAV, particularly where surgery

  13. [Pre-surgical period and non-work-related sickness absence due to inguinal hernia].

    Science.gov (United States)

    Ruiz-Moraga, Montserrat; Catalina-Romero, Carlos; Martínez-Muñoz, Paloma; Cobo-Santiago, María Dolores; González-López, Maite; Cabrera-Sierra, Martha; Porrero-Carro, José Luis; Calvo-Bonacho, Eva

    2014-04-01

    To analyze non-work-related sickness absence (NWR-SA) due to inguinal hernia and the factors related to its duration, paying particular attention to the pre-surgical period of NWR-SA. Prospective cohort study was conducted on 1,003 workers with an episode of NWR-SA due to an inguinal hernia, belonging to the insured population of a mutual insurance company. We assessed the duration of the NWR-SA episodes and the main demographic, occupational and clinical variables potentially related to it. Cox regression analyses were conducted to establish the predictors of NWR-SA duration. The mean duration of NWR-SA due to inguinal hernia was 68.6 days. After multivariate analysis (Cox regression), having a pre-surgical period of NWR-SA (HR = 0.35; 95%CI: 0.28-0.43), manual occupations (HR=0.68; 95%CI: 0.49-0.95), construction sector (HR=0.71; 95%CI: 0.58-0.88), direct payment methods by a Mutual Insurance Company during sick leave in self-employed workers (HR=0.58; 95%CI, 0.41-0.82), or employees (HR=0.51; 95%CI: 0.36-0.72), comorbidity (HR=0.45; 95%CI:0.34-0.59), and surgery performed under an entity other than the Public Health System or a mutual insurance company (HR=0,76; 95%CI: 0.59-0.97) were associated with longer NWR-SA. The Mutual Insurance Company always performed the surgery when a pre-surgery period of NWR-SA existed (mean duration=47 ±39.6 days); that was associated with shorter periods of post-surgical NWR-SA (P=.001). The NWR-SA due to inguinal hernia is a multifactorial phenomenon in which the pre-surgery period plays an important role. The collaboration between organizations involved in the management of NWR-SA seems to be an effective strategy for reducing its duration. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  14. Positron emission mammography in breast cancer presurgical planning: comparisons with magnetic resonance imaging.

    Science.gov (United States)

    Schilling, Kathy; Narayanan, Deepa; Kalinyak, Judith E; The, Juliette; Velasquez, Maria Victoria; Kahn, Simone; Saady, Matthew; Mahal, Ravinder; Chrystal, Larraine

    2011-01-01

    The objective of this study was to compare the performance characteristics of (18)F-fluorodeoxyglucose (FDG) positron emission mammography (PEM) with breast magnetic resonance imaging (MRI) as a presurgical imaging and planning option for index and ipsilateral lesions in patients with newly diagnosed, biopsy-proven breast cancer. Two hundred and eight women >25 years of age (median age = 59.7 ± 14.1 years) with biopsy-proven primary breast cancer enrolled in this prospective, single-site study. MRI, PEM, and whole-body positron emission tomography (WBPET) were conducted on each patient within 7 business days. PEM and WBPET images were acquired on the same day after intravenous administration of 370 MBq of FDG (median = 432.9 MBq). PEM and MRI images were blindly evaluated, compared with final surgical histopathology, and the sensitivity determined. Substudy analysis compared the sensitivity of PEM versus MRI in patients with different menopausal status, breast density, and use of hormone replacement therapy (HRT) as well as determination of performance characteristics for additional ipsilateral lesion detection. Two hundred and eight patients enrolled in the study of which 87% (182/208) were analyzable. Of these analyzable patients, 26.4% (48/182), 7.1% (13/182), and 64.2% (120/182) were pre-, peri-, and postmenopausal, respectively, and 48.4% (88/182) had extremely or heterogeneously dense breast tissue, while 33.5% (61/182) had a history of HRT use. Ninety-two percent (167/182) underwent core biopsy for index lesion diagnosis. Invasive cancer was found in 77.5% (141/182), while ductal carcinoma in situ (DCIS) and/or Paget's disease were found in 22.5% (41/182) of patients. Both PEM and MRI had index lesion depiction sensitivity of 92.8% and both were significantly better than WBPET (67.9%, p PEM and MRI had equivalent sensitivity of various tumors, categorized by tumor stage as well as similar invasive tumor size predictions with Spearman's correlation

  15. Presurgical motor, somatosensory and language fMRI: Technical feasibility and limitations in 491 patients over 13 years

    International Nuclear Information System (INIS)

    Tyndall, Anthony J.; Reinhardt, Julia; Stippich, Christoph; Tronnier, Volker; Mariani, Luigi

    2017-01-01

    To analyse the long-term feasibility and limitations of presurgical fMRI in a cohort of tumour and epilepsy patients with different MR-scanners at 1.5 and 3.0 T. Four hundred and ninety-one consecutive patients undergoing presurgical fMRI between 2000 and 2012 on five different MR-scanners using established paradigms and semi-automated data processing were included. Success rates of task performance and BOLD-activation were determined for motor and somatosensory somatotopic mapping and language localisation. Procedural success, failures and imaging artifacts were analysed. MR-field strengths were compared. Two thousand three hundred fifteen of 2348 (98.6 %) attempted paradigms (1033 motor, 1220 speech, 95 somatosensory) were successfully performed. 100 paradigms (4.3 %) were repetition runs. 23 speech, 6 motor and 2 sensory paradigms failed for non-compliance and technical issues. Most language paradigm failures were noted in overt sentence generation. Average significant BOLD-activation was higher for motor than language paradigms (95.8 vs. 81.6 %). Most language paradigms showed significantly higher activation rates at 3 T compared to 1.5 T, whereas no significant difference was found for motor paradigms. fMRI proved very robust for the presurgical localisation of the different motor and somatosensory body representations, as well as Broca's and Wernicke's language areas across different MR-scanners at 1.5 and 3.0 T over 13 years. (orig.)

  16. Presurgical motor, somatosensory and language fMRI: Technical feasibility and limitations in 491 patients over 13 years

    Energy Technology Data Exchange (ETDEWEB)

    Tyndall, Anthony J.; Reinhardt, Julia; Stippich, Christoph [University Hospital Basel, Division of Diagnostic and Interventional Neuroradiology, Basel (Switzerland); Tronnier, Volker [University Hospital Schleswig-Holstein, Luebeck Campus, Department of Neurosurgery, Luebeck (Germany); Mariani, Luigi [University Hospitals Basel, Department of Neurosurgery, Basel (Switzerland)

    2017-01-15

    To analyse the long-term feasibility and limitations of presurgical fMRI in a cohort of tumour and epilepsy patients with different MR-scanners at 1.5 and 3.0 T. Four hundred and ninety-one consecutive patients undergoing presurgical fMRI between 2000 and 2012 on five different MR-scanners using established paradigms and semi-automated data processing were included. Success rates of task performance and BOLD-activation were determined for motor and somatosensory somatotopic mapping and language localisation. Procedural success, failures and imaging artifacts were analysed. MR-field strengths were compared. Two thousand three hundred fifteen of 2348 (98.6 %) attempted paradigms (1033 motor, 1220 speech, 95 somatosensory) were successfully performed. 100 paradigms (4.3 %) were repetition runs. 23 speech, 6 motor and 2 sensory paradigms failed for non-compliance and technical issues. Most language paradigm failures were noted in overt sentence generation. Average significant BOLD-activation was higher for motor than language paradigms (95.8 vs. 81.6 %). Most language paradigms showed significantly higher activation rates at 3 T compared to 1.5 T, whereas no significant difference was found for motor paradigms. fMRI proved very robust for the presurgical localisation of the different motor and somatosensory body representations, as well as Broca's and Wernicke's language areas across different MR-scanners at 1.5 and 3.0 T over 13 years. (orig.)

  17. Orthoses as enablers of occupation: client-centred splinting for better outcomes.

    Science.gov (United States)

    McKee, Pat; Rivard, Annette

    2004-12-01

    Orthotic intervention (splinting) may have become an end unto itself in the minds of therapists and clients rather than the means to enable optimal occupational performance. Some policy makers and payers seem to hold the belief that orthoses/splints are mere technical aids and as such do not require professional skill and expertise. NARRATIVES: Three client stories demonstrate how iterative collaboration and follow-up help achieve client-identified objectives. Client input is an important component of the process and an orthosis must fit into the person's lifestyle, especially if required for long-term use. Six essential considerations when providing orthoses to meet occupational goals are emphasized: client-centredness, comfort, cosmesis, convenience, less is more and follow-up. Use of the Canadian Occupational Performance Model for intervention planning and as an outcome measure is demonstrated. Orthoses that are thoughtfully designed with client input and carefully constructed can make a difference in a person's life by relieving pain, providing protection and joint stabilization and enabling valued occupations.

  18. Management of sleep-time masticatory muscle activity using stabilisation splints affects psychological stress.

    Science.gov (United States)

    Takahashi, H; Masaki, C; Makino, M; Yoshida, M; Mukaibo, T; Kondo, Y; Nakamoto, T; Hosokawa, R

    2013-12-01

    To treat sleep bruxism (SB), symptomatic therapy using stabilisation splints (SS) is frequently used. However, their effects on psychological stress and sleep quality have not yet been examined fully. The objective of this study was to clarify the effects of SS use on psychological stress and sleep quality. The subjects (11 men, 12 women) were healthy volunteers. A crossover design was used. Sleep measurements were performed for three consecutive days or longer without (baseline) or with an SS or palatal splint (PS), and data for the final day were evaluated. We measured masseter muscle activity during sleep using portable electromyography to evaluate SB. Furthermore, to compare psychological stress before and after sleep, assessments were made based on STAI-JYZ and the measurement of salivary chromogranin A. To compare each parameter among the three groups (baseline, SS and PS), Friedman's and Dunn's tests were used. From the results of the baseline measurements, eight subjects were identified as high group and 15 as low group. Among the high group, a marked decrease in the number of bruxism events per hour and an increase in the difference in the total STAI Y-1 scores were observed in the SS group compared with those at baseline (P sleep stages. SS use may be effective in reducing the number of SB events, while it may increase psychological stress levels, and SS use did not apparently influence sleep stages. © 2013 John Wiley & Sons Ltd.

  19. The value of multichannel MEG and EEG in the presurgical evaluation of 70 epilepsy patients.

    Science.gov (United States)

    Knake, S; Halgren, E; Shiraishi, H; Hara, K; Hamer, H M; Grant, P E; Carr, V A; Foxe, D; Camposano, S; Busa, E; Witzel, T; Hämäläinen, M S; Ahlfors, S P; Bromfield, E B; Black, P M; Bourgeois, B F; Cole, A J; Cosgrove, G R; Dworetzky, B A; Madsen, J R; Larsson, P G; Schomer, D L; Thiele, E A; Dale, A M; Rosen, B R; Stufflebeam, S M

    2006-04-01

    To evaluate the sensitivity of a simultaneous whole-head 306-channel magnetoencephalography (MEG)/70-electrode EEG recording to detect interictal epileptiform activity (IED) in a prospective, consecutive cohort of patients with medically refractory epilepsy that were considered candidates for epilepsy surgery. Seventy patients were prospectively evaluated by simultaneously recorded MEG/EEG. All patients were surgical candidates or were considered for invasive EEG monitoring and had undergone an extensive presurgical evaluation at a tertiary epilepsy center. MEG and EEG raw traces were analysed individually by two independent reviewers. MEG data could not be evaluated due to excessive magnetic artefacts in three patients (4%). In the remaining 67 patients, the overall sensitivity to detect IED was 72% (48/67 patients) for MEG and 61% for EEG (41/67 patients) analysing the raw data. In 13% (9/67 patients), MEG-only IED were recorded, whereas in 3% (2/67 patients) EEG-only IED were recorded. The combined sensitivity was 75% (50/67 patients). Three hundred and six-channel MEG has a similarly high sensitivity to record IED as EEG and appears to be complementary. In one-third of the EEG-negative patients, MEG can be expected to record IED, especially in the case of lateral neocortical epilepsy and/or cortical dysplasia.

  20. The effect of metformin on apoptosis in a breast cancer presurgical trial.

    Science.gov (United States)

    Cazzaniga, M; DeCensi, A; Pruneri, G; Puntoni, M; Bottiglieri, L; Varricchio, C; Guerrieri-Gonzaga, A; Gentilini, O D; Pagani, G; Dell'Orto, P; Lazzeroni, M; Serrano, D; Viale, G; Bonanni, B

    2013-11-26

    Metformin has been associated with antitumour activity in breast cancer (BC) but its mechanism remains unclear. We determined whether metformin induced a modulation of apoptosis by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) overall and by insulin resistance status in a presurgical trial. Apoptosis was analysed in core biopsies and in surgical samples from 100 non-diabetic BC patients participating in a randomised trial of metformin vs placebo given for 4 weeks before surgery. Eighty-seven subjects (45 on metformin and 42 on placebo) were assessable for TUNEL measurement at both time points. TUNEL levels at surgery were higher than that at baseline core biopsy (PKi67 labelling index and TUNEL levels were directly correlated both at baseline and surgery (Spearman's r=0.51, Papoptosis by metformin, although there was a trend to a different effect according to insulin resistance status, with a pattern resembling Ki67 changes. Apoptosis was significantly higher in the surgical specimens compared with baseline biopsy and was directly correlated with Ki67. Our findings provide additional evidence for a dual effect of metformin on BC growth according to insulin resistance status.

  1. Pros and cons in endocrine practice: pre-surgical treatment with somatostatin analogues in acromegaly.

    Science.gov (United States)

    Losa, Marco; Bollerslev, Jens

    2016-06-01

    The aim of this commentary is to balance the pros and cons for pre-surgical SSA treatment in a modern perspective ending up with a pragmatic recommendation for treatment based on the current evidence and expertise of the authors. Even though prospective and randomized studies in this particular area are hampered by obvious limitations, the interpretation of the four published trials has in general been in favor of pre-treatment with SSA, showing a better outcome following surgery. However, major drawbacks of these studies, such as non-optimal diagnostic criteria for cure, potential selection bias, and timing of the postoperative evaluation in SSA pre-treated patients, limit their overall interpretation. Three matched-controlled studies showed remarkably similar results with no apparent beneficial effect of SSA pre-treatment on surgical outcome. Both prospective, randomized studies and retrospective studies did not find any significant difference in the rate of endocrine and non-endocrine complications related to surgery, despite the beneficial clinical effects of SSA treatment in most acromegalic patients. The newly diagnosed patient with acromegaly should be carefully evaluated in the trans-disciplinary neuroendocrine team and treatment individualized accordingly. The issue of SSA pre-treatment to improve surgical outcome is yet to be settled and further methodologically sound studies are probably necessary to clarify this point.

  2. Approach to pediatric epilepsy surgery: State of the art, Part I: General principles and presurgical workup.

    Science.gov (United States)

    Obeid, Makram; Wyllie, Elaine; Rahi, Amal C; Mikati, Mohamad A

    2009-03-01

    In 1990, the National Institute of Health adopted epilepsy surgery in children as an option when medications fail. In the past few years several concepts have become increasingly recognized as key to a successful approach to epilepsy surgery in children. These include the concepts of neuronal plasticity, the epileptogenic lesion, the ictal onset, symptomatogenic, irritative, and epileptogenic zones. In addition, several techniques have increasingly been utilized to delineate the above areas in an attempt to determine, in each patient, the epileptogenic zone, defined as the zone the resection of which leads to seizure freedom. When seizure semiology (which defines the symptomatogenic zone), ictal EEG (which identifies the ictal onset zone), and structural imaging (which identifies the epileptogenic lesion) can be reconciled to infer the location of the epileptogenic zone, surgery is usually, subsequently, undertaken. When these diagnostic modalities are discordant, not definitive, or when the epileptogenic zone is close to eloquent cortex, invasive EEG, complemented by other imaging techniques may be needed. These include magnetoencephalography, single photon emission tomography, various types of positron emission tomography, various magnetic resonance imaging modalities (functional, diffusion weighted, other) and other emerging and experimental techniques. While MRI, video-EEG, and neuropsychological assessments are well established components of the presurgical evaluation, the use of the new emerging imaging technologies is dictated by the degree of anatomo-electro-clinical correlations, and, awaiting multicentric studies and more detailed guidelines, remains center-dependent.

  3. Evaluation of the factors influencing brain language laterality in presurgical planning.

    Science.gov (United States)

    Batouli, Seyed Amir Hossein; Hasani, Nafiseh; Gheisari, Sara; Behzad, Ebrahim; Oghabian, Mohammad Ali

    2016-10-01

    Brain lesions cause functional deficits, and one treatment for this condition is lesion resection. In most cases, presurgical planning (PSP) and the information from laterality indices are necessary for maximum preservation of the critical functions after surgery. Language laterality index (LI) is reliably estimated using functional magnetic resonance imaging (fMRI); however, this measure is under the influence of some external factors. In this study, we investigated the influence of a number of factors on language LI, using data from 120 patients (mean age=35.65 (±13.4) years) who underwent fMRI for PSP. Using two proposed language tasks from our previous works, brain left hemisphere was showed to be dominant for the language function, although a higher LI was obtained using the "Word Generation" task, compared to the "Reverse Word Reading". In addition, decline of LIs with age, and lower LI when the lesion invaded brain language area were observed. Meanwhile, gender, lesion side (affected hemisphere), LI calculation strategy, and fMRI analysis Z-values did not statistically show any influences on the LIs. Although fMRI is widely used to estimate language LI, it is shown here that in order to present a reliable language LI and to correctly select the dominant hemisphere of the brain, the influence of external factors should be carefully considered. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  4. Predicting Postsurgical Satisfaction in Adolescents With Idiopathic Scoliosis: The Role of Presurgical Functioning and Expectations.

    Science.gov (United States)

    Sieberg, Christine B; Manganella, Juliana; Manalo, Gem; Simons, Laura E; Hresko, M Timothy

    2017-12-01

    There is a need to better assess patient satisfaction and surgical outcomes. The purpose of the current study is to identify how preoperative expectations can impact postsurgical satisfaction among youth with adolescent idiopathic scoliosis undergoing spinal fusion surgery. The present study includes patients with adolescent idiopathic scoliosis undergoing spinal fusion surgery enrolled in a prospective, multicentered registry examining postsurgical outcomes. The Scoliosis Research Society Questionnaire-Version 30, which assesses pain, self-image, mental health, and satisfaction with management, along with the Spinal Appearance Questionnaire, which measures surgical expectations was administered to 190 patients before surgery and 1 and 2 years postoperatively. Regression analyses with bootstrapping (with n=5000 bootstrap samples) were conducted with 99% bias-corrected confidence intervals to examine the extent to which preoperative expectations for spinal appearance mediated the relationship between presurgical mental health and pain and 2-year postsurgical satisfaction. Results indicate that preoperative mental health, pain, and expectations are predictive of postsurgical satisfaction. With the shifting health care system, physicians may want to consider patient mental health, pain, and expectations before surgery to optimize satisfaction and ultimately improve clinical care and patient outcomes. Level I-prognostic study.

  5. Clinical characteristics, risk factors and pre-surgical evaluation of post-infectious epilepsy.

    Science.gov (United States)

    Sellner, J; Trinka, E

    2013-03-01

    Epilepsy is a frequent complication of central nervous system (CNS) infections. Post-infectious epilepsy is commonly refractory to medical treatment and plays a pivotal role for the poor long-term outcome of CNS infections. To provide an overview of clinical characteristics and risk factors of seizures associated with CNS infections. In addition, to summarize the state of the art of anticonvulsive treatment and the pre-surgical evaluation process in refractory cases. A comprehensive literature search for articles published between January 1970 and December 2011 was carried out. The occurrence of seizures during the acute course of meningitis, encephalitis and brain abscess is the main risk factor for the development of post-infectious epilepsy. There is a shortage of trials evaluating the efficacy of prophylactic and symptomatic treatment during the course of acute infection. Moreover, there are no randomized-controlled trials studying anticonvulsive drugs and their combinations for the management of post-infectious epilepsy. In a selected group of patients, however, medically refractory focal epilepsy is potentially curable by surgery. Further studies are required to improve the pathogenetic understanding of post-infectious epilepsy in order to develop preventive measures as well as to evaluate additional medical and surgical treatment strategies for the patients currently not considered for surgery. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

  6. A Bayesian non-parametric Potts model with application to pre-surgical FMRI data.

    Science.gov (United States)

    Johnson, Timothy D; Liu, Zhuqing; Bartsch, Andreas J; Nichols, Thomas E

    2013-08-01

    The Potts model has enjoyed much success as a prior model for image segmentation. Given the individual classes in the model, the data are typically modeled as Gaussian random variates or as random variates from some other parametric distribution. In this article, we present a non-parametric Potts model and apply it to a functional magnetic resonance imaging study for the pre-surgical assessment of peritumoral brain activation. In our model, we assume that the Z-score image from a patient can be segmented into activated, deactivated, and null classes, or states. Conditional on the class, or state, the Z-scores are assumed to come from some generic distribution which we model non-parametrically using a mixture of Dirichlet process priors within the Bayesian framework. The posterior distribution of the model parameters is estimated with a Markov chain Monte Carlo algorithm, and Bayesian decision theory is used to make the final classifications. Our Potts prior model includes two parameters, the standard spatial regularization parameter and a parameter that can be interpreted as the a priori probability that each voxel belongs to the null, or background state, conditional on the lack of spatial regularization. We assume that both of these parameters are unknown, and jointly estimate them along with other model parameters. We show through simulation studies that our model performs on par, in terms of posterior expected loss, with parametric Potts models when the parametric model is correctly specified and outperforms parametric models when the parametric model in misspecified.

  7. Psychosocial Moderators of Presurgical Stress Management for Men Undergoing Radical Prostatectomy

    Science.gov (United States)

    Gilts, Chelsea D.; Parker, Patricia A.; Pettaway, Curtis A.; Cohen, Lorenzo

    2013-01-01

    Objective It is important to identify factors that predict who will benefit the most from psychosocial interventions in cancer populations. Methods This study examines the moderating effect of baseline social support (Social Support, SS; Dyadic Adjustment DA), distress (Brief Symptom Inventory, BSI; Impact of Event Scale, IES), and coping style (Brief COPE) on quality of life outcomes (SF-36 Physical Component Summary scores(PCS)) 1 year post surgery derived from a presurgical cognitive behavioral stress management program (SM; n = 23), supportive attention (SA; n = 37), or standard care (SC; n = 29). Results Moderation analyses indicated that men who reported low baseline social support (SS) and were in SM had increased PCS one year after surgery compared to men with low SS in the SC group (β = −0.39, p < .01), with SA having a non-significant intermediate effect. Men who reported high distress (BSI) at baseline and were in the SA group had increased PCS one year after surgery compared to those in the SC group (β = 24.80, p = .01), with SM having a non-significant intermediate effect. Mediation analyses suggested that neither SM nor SA improved QOL simply by increasing social support or decreasing general distress. Conclusions Distressed individuals may benefit more from unstructured discussion of distress whereas those low in social support may benefit more from a structured approach to learning coping skills. PMID:23088178

  8. SECOT-GEDOS consensus on pre-surgical pain management in knee and hip arthrosis.

    Science.gov (United States)

    Ruiz Ibán, M A; Maculé, F; Torner, P; Gil Garay, E; Oteo-Álvaro, A; López Millán, J M; Díaz Heredia, J; Loza, E

    2015-01-01

    To develop recommendations, based on best evidence and experience, on pain management in patients undertaking total knee or hip replacement. Nominal group methodology was followed. A group of experts was selected (5 orthopedics, 1 anesthesiologist), who defined the scope, users, topics, preliminary recommendations, and 3 systematic reviews: efficacy and safety of pre-surgical analgesia regarding to post-surgical pain, efficacy and safety of pre-emptive analgesia and pre-operative factors of post-operative pain. The level of evidence and grade of recommendation was established using the Oxford Centre for Evidence Based Medicine, and the level of agreement with the Delphi technique (2 rounds). The Delphi was extended to 39 orthopedics and anesthesiologists. The whole document was reviewed by all the experts. A total of 21 recommendations were produced. They include specific pharmacological treatment, as well as the evaluation and monitoring of patients on this treatment, and post-operative pre-emptive treatment. Agreement above 70% was reached in 19 recommendations. In patients undergoing total knee or hip replacement, a proper evaluation, follow-up, pharmacological and non-pharmacological treatment of predictors of poor surgical outcomes should be performed, especially those related to pre-operative pain. This can improve post-operative pain and surgery outcomes. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  9. Presurgical Planning for Supratentorial Lesions with Free Slicer Software and Sina App.

    Science.gov (United States)

    Chen, Ji-Gang; Han, Kai-Wei; Zhang, Dan-Feng; Li, Zhen-Xing; Li, Yi-Ming; Hou, Li-Jun

    2017-10-01

    Neuronavigation systems are used widely in the localization of intracranial lesions with satisfactory accuracy. However, they are expensive and difficult to learn. Therefore, a simple and practical augmented reality (AR) system using mobile devices might be an alternative technique. We introduce a mobile AR system for the localization of supratentorial lesions. Its practicability and accuracy were examined by clinical application in patients and comparison with a standard neuronavigation system. A 3-dimensional (3D) model including lesions was created with 3D Slicer. A 2-dimensional image of this 3D model was obtained and overlapped on the patient's head with the Sina app. Registration was conducted with the assistance of anatomical landmarks and fiducial markers. The center of lesion projected on scalp was identified with our mobile AR system and standard neuronavigation system, respectively. The difference in distance between the centers identified by these 2 systems was measured. Our mobile AR system was simple and accurate in the localization of supratentorial lesions with a mean distance difference of 4.4 ± 1.1 mm. Registration added on an average of 141.7 ± 39 seconds to operation time. There was no statistically significant difference for the required time among 3 registrations (P = 0.646). The mobile AR system presents an alternative technology for image-guided neurosurgery and proves to be practical and reliable. The technique contributes to optimal presurgical planning for supratentorial lesions, especially in the absence of a neuronavigation system. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. The Efficacy of Local Injection of Methylprednisolone and Lidocaine with and Without Splint, in Treating Patients with De Quervain's Tenosynovitis

    Directory of Open Access Journals (Sweden)

    Saleh

    2012-02-01

    Full Text Available Introduction: Suffering from de Quervain's tenosynovitis due to repetitive and routine activities leads to considerable referrals to orthopedic clinics and increasing health care costs and wasting of patients' time. The present study aimed to compare the efficacy of local injection of methylprednisolone with and without splint for treatment of patients suffering from de Quervain's tenosynovitis. Methods: In a clinical trial study, 72 patients with de Quervain's tenosynovitis were selected in 2010 and were randomly divided into two groups. Therapeutic intervention in the first group was injection of 40 mg methylprednisone and 1 ml lidocaine with splint, and in the second group it was injection 40 mg methylprednisone and 1ml lidocaine without splint. Both groups followed this treatment for three periods(21 day. The related data were collected by visual analogue scale. Then data was analyzed by SPSS (ver. 16 using Fisher exact test and t test. Results: The findings of this study revealed that after the 3-week period of treatment the mean reduced pain intensity and improvement in the first group was significantly lower than the second group(p<0/05. Conclusion: Therefore, local injection of methylprednisone and lidocaine with splint is an effective method in the treatment of de Quervain's tenosynovitis.

  11. A prospective randomized comparison of neoprene vs thermoplast hand-based thumb spica splinting for trapeziometacarpal arthrosis

    NARCIS (Netherlands)

    Becker, S. J. E.; Bot, A. G. J.; Curley, S. E.; Jupiter, J. B.; Ring, D.

    2013-01-01

    Objective: In patients with trapeziometacarpal arthrosis, we tested the hypothesis that there is no difference in arm-specific disability 5-15 weeks after prescription of a pre-fabricated neoprene or a custom-made thermoplast hand-based thumb spica splint with the metacarpophalangeal joint included

  12. Comparison of implant cast accuracy of multiple implant impression technique with different splinting materials: An in vitro study

    Directory of Open Access Journals (Sweden)

    Sunantha Selvaraj

    2016-01-01

    Conclusion: The master cast obtained by both the splinting material exhibits no difference from the reference model. So bis-GMA can be used, which is easy to handle, less time consuming, less technique sensitive, rigid, and readily available material in clinics.

  13. A new approach of splint-less orthognathic surgery using a personalized orthognathic surgical guide system: A preliminary study.

    Science.gov (United States)

    Li, B; Shen, S; Jiang, W; Li, J; Jiang, T; Xia, J J; Shen, S G; Wang, X

    2017-10-01

    The purpose of this study was to evaluate a personalized orthognathic surgical guide (POSG) system for bimaxillary surgery without the use of surgical splint. Ten patients with dentofacial deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation method. The POSG system was designed for both maxillary and mandibular surgery. Each consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates to guide the osteotomy and repositioning the bony segments without the use of the surgical splints. Finally, the outcome evaluation was completed by comparing planned outcomes with postoperative outcomes. All operations were successfully completed using the POSG system. The largest root-mean-square deviations were 0.74mm and 1.93° for the maxillary dental arch, 1.10mm and 2.82° for the mandibular arch, 0.83mm and 2.59° for the mandibular body, and 0.98mm and 2.45° for the proximal segments. The results of the study indicated that our POSG system is capable of accurately and effectively transferring the surgical plan without the use of surgical splint. A significant advantage is that the repositioning of the bony segments is independent to the mandibular autorotation, thus eliminates the potential problems associated with the surgical splint. Copyright © 2017. Published by Elsevier Ltd.

  14. [The 3D-printed dental splint: a valuable tool in the surgical treatment of malocclusion after polytrauma].

    Science.gov (United States)

    van de Velde, W L; Schepers, R H; van Minnen, B

    2016-01-01

    A 22-year old male was referred to the Department of Oral and Maxillofacial Surgery of a university clinic 2 months after he had sustained multiple traumatic injuries abroad because of an anterior malocclusion. The malocclusion was the sequel of an unrecognised, untreated, already consolidated paramedian mandibular fracture on the right and a fracture of the contralateral mandibular angle on the left. Preoperatively, a cobalt-chrome 3D-printed dental splint was prepared. Surgical correction of the malocclusion was carried out by segmental osteotomies of the mandible at the original fracture sites. This involved a vertical paramedian osteotomy on the right side and a unilateral sagittal split osteotomy on the left mandibular angle side. The mandibular segment was mobilised in the correct occlusion with the aid of the 3D-printed dental splint. The splint was fixed to the teeth with dental composite. The custom made 3D-printed dental splint is considered a promising procedural innovation in oral and maxillofacial surgery.

  15. A THUMB OPPOSITION SPLINT TO IMPROVE MANUAL DEXTERITY AND UPPER-LIMB FUNCTIONING IN CHARCOT-MARIE-TOOTH DISEASE

    NARCIS (Netherlands)

    Videler, Annemieke; Eijffinger, Elianne; Nollet, Frans; Beelen, Anita

    2012-01-01

    Objective: To assess initial efficacy and tolerability of a thumb opposition splint on manual dexterity, perceived upper limb functioning and occupational performance in patients with Charcot-Marie-Tooth disease. Design: One group pre-post design. Patients and methods: Thirteen patients were

  16. Comparison of Stress and Strain Distribution Around Splinted and Nonsplinted 6-mm Short Implants in Posterior Mandible: A Finite Element Analysis Study.

    Science.gov (United States)

    Meimandi, Mansour; Talebi Ardakani, Mohammad Reza; Amid, Reza; Mahmoudi Motlagh, Amir; Beheshti, Shahrzad

    2018-02-01

    This study was designed to compare the biomechanical performance of splinted and nonsplinted short implants, in the posterior mandible, using finite element analysis. Three-dimensional models of short implants with 2 different diameters (4 × 6 mm or 5 × 6 mm) were scanned, and CATIA (R21) was used to simulate the model of an edentulous lower jaw. Experimental groups were designed as follows: (1) D4L6-splinted (three 4 × 6-mm splinted implants), (2) D4L6-nonsplinted, (3) D5L6-splinted, and (4) D5L6-nonsplinted. A 100 N load was applied, and stress and strain values in surrounding bone were analyzed in specific nodes using ANSYS software (16.1). The maximum stress values under axial load were found in D5L6-splinted model, and under oblique load, D5L6-nonsplinted model had the maximum stress values. Under axial load, D4L6-splinted model showed maximum strain values, but when oblique load was applied, D4L6-nonsplinted model had the maximum strain values. Splinting adjacent short implants may provide less bone strain and stress, especially at the presence of lateral forces. Increasing the implant diameter may be effective in strain reduction, but does not seem to reduce the bone stress, regardless of the direction of the load applied.

  17. Design of splints based on the NiTi alloy for the correction of joint deformities in the fingers.

    Science.gov (United States)

    Puértolas, Sergio; Pérez-García, José M; Gracia, Luis; Cegoñino, José; Ibarz, Elena; Puértolas, José A; Herrera, Antonio

    2010-09-13

    The proximal interphalange joint (PIP) is fundamental for the functional nature of the hand. The contracture in flexion of the PIP, secondary to traumatisms or illnesses leads to an important functional loss. The use of correcting splints is the common procedure for treating this problem. Its functioning is based on the application of a small load and a prolonged stress which can be dynamic, static progressive or static serial.It is important that the therapist has a splint available which can release a constant and sufficient force to correct the contracture in flexion. Nowadays NiTi is commonly used in bio-engineering, due to its superelastical characteristics. The experience of the authors in the design of other devices based on the NiTi alloy, makes it possible to carry out a new design in this work--the production of a finger splint for the treatment of the contracture in flexion of the PIP joint. Commercial orthosis have been characterized using a universal INSTRON 5565 machine. A computational simulation of the proposed design has been conducted, reproducing its performance and using a model "ad hoc" for the NiTi material. Once the parameters have been adjusted, the design is validated using the same type of test as those carried out on commercial orthosis. For commercial splint the recovering force falls to excessively low values as the angle increases. Angle curves for different lengths and thicknesses of the proposed design have been obtained, with a practically constant recovering force value over a wide range of angles that vary between 30° and 150° in every case. Then the whole treatment is possible with only one splint, and without the need of progressive replacements as the joint recovers. A new model of splint based on NiTi alloy has been designed, simulated and tested comparing its behaviour with two of the most regularly used splints. Its uses is recommended instead of other dynamic orthosis used in orthopaedics for the PIP joint. Besides, its

  18. Pre-surgical predictors for psychiatric disorders following epilepsy surgery in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis.

    Science.gov (United States)

    Filho, Gerardo Maria de Araújo; Mazetto, Lenon; Gomes, Francinaldo Lobato; Marinho, Murilo Martinez; Tavares, Igor Melo; Caboclo, Luís Otávio Sales Ferreira; Centeno, Ricardo Silva; Yacubian, Elza Márcia Targas

    2012-11-01

    Psychiatric outcomes of patients submitted to epilepsy surgery have gained particular interest given the high prevalence of pre-surgical psychiatric disorders (PD) in this population. The present study aimed to verify the possible pre-surgical predictors for psychiatric disorders following epilepsy surgery in a homogeneous series of patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS). Data from 115 TLE-MTS patients (65 females; 56.5%) who underwent cortico-amygdalohippocampectomy were included. Pre- and post-surgical psychiatric evaluations were performed using DSM-IV criteria. Pre-surgical PD - particularly mood, anxiety and psychotic disorders - were diagnosed in 47 patients (40.8%). Twenty-seven patients (54% of those with pre-surgical PD) demonstrated a remission of psychiatric symptoms on post-surgical psychiatric evaluation. Eleven patients (9.6%) developed de novo PD. The presence of pre-surgical depression (OR=3.32; p=0.008), pre-surgical interictal psychosis (OR=4.39; p=0.009) and epileptiform discharges contralateral to the epileptogenic zone (OR=2.73; p=0.01) were risk factors associated with post-surgical PD. Although epilepsy surgery is considered to be the best treatment option for patients with refractory TLE-MTS, the relatively high psychiatric comorbidities observed in surgical candidates and their possible negative impact on post-surgical outcomes require a careful pre-surgical evaluation of clinical, sociodemographic and psychiatric factors. Copyright © 2012 Elsevier B.V. All rights reserved.

  19. The Effect of Occlusal Splint Pretreatment on Mandibular Movements and Vertical Dimension of Occlusion in Long-Term Complete Denture Wearers.

    Science.gov (United States)

    de Almeida, Rita de Cássia Costa Ribeiro; da Rosa, Wellington Luiz de Oliveira; Boscato, Noéli

    2016-01-01

    This study evaluated the pretreatment influence of occlusal splints and relines on mandibular movements (MM) and vertical dimension of occlusion (VDO) in longstanding complete denture wearers. A total of 30 volunteers were randomly assigned to three groups (n = 10): control (C), relining of old denture (RD), and occlusal splints (OS). Individual extent of MM was assessed via intraoral Gothic arch tracings and the VDO using posed frontal images taken at three time points. The OS group showed statistically significant differences when compared with the other groups (P occlusal splints pretreatment.

  20. Positron emission mammography in breast cancer presurgical planning: comparisons with magnetic resonance imaging

    International Nuclear Information System (INIS)

    Schilling, Kathy; The, Juliette; Velasquez, Maria Victoria; Kahn, Simone; Saady, Matthew; Mahal, Ravinder; Chrystal, Larraine; Narayanan, Deepa; Kalinyak, Judith E.

    2011-01-01

    The objective of this study was to compare the performance characteristics of 18 F-fluorodeoxyglucose (FDG) positron emission mammography (PEM) with breast magnetic resonance imaging (MRI) as a presurgical imaging and planning option for index and ipsilateral lesions in patients with newly diagnosed, biopsy-proven breast cancer. Two hundred and eight women >25 years of age (median age = 59.7 ± 14.1 years) with biopsy-proven primary breast cancer enrolled in this prospective, single-site study. MRI, PEM, and whole-body positron emission tomography (WBPET) were conducted on each patient within 7 business days. PEM and WBPET images were acquired on the same day after intravenous administration of 370 MBq of FDG (median = 432.9 MBq). PEM and MRI images were blindly evaluated, compared with final surgical histopathology, and the sensitivity determined. Substudy analysis compared the sensitivity of PEM versus MRI in patients with different menopausal status, breast density, and use of hormone replacement therapy (HRT) as well as determination of performance characteristics for additional ipsilateral lesion detection. Two hundred and eight patients enrolled in the study of which 87% (182/208) were analyzable. Of these analyzable patients, 26.4% (48/182), 7.1% (13/182), and 64.2% (120/182) were pre-, peri-, and postmenopausal, respectively, and 48.4% (88/182) had extremely or heterogeneously dense breast tissue, while 33.5% (61/182) had a history of HRT use. Ninety-two percent (167/182) underwent core biopsy for index lesion diagnosis. Invasive cancer was found in 77.5% (141/182), while ductal carcinoma in situ (DCIS) and/or Paget's disease were found in 22.5% (41/182) of patients. Both PEM and MRI had index lesion depiction sensitivity of 92.8% and both were significantly better than WBPET (67.9%, p < 0.001, McNemar's test). For index lesions, PEM and MRI had equivalent sensitivity of various tumors, categorized by tumor stage as well as similar invasive tumor size

  1. Electrical source imaging of interictal spikes using multiple sparse volumetric priors for presurgical epileptogenic focus localization

    Directory of Open Access Journals (Sweden)

    Gregor Strobbe

    2016-01-01

    Full Text Available Electrical source imaging of interictal spikes observed in EEG recordings of patients with refractory epilepsy provides useful information to localize the epileptogenic focus during the presurgical evaluation. However, the selection of the time points or time epochs of the spikes in order to estimate the origin of the activity remains a challenge. In this study, we consider a Bayesian EEG source imaging technique for distributed sources, i.e. the multiple volumetric sparse priors (MSVP approach. The approach allows to estimate the time courses of the intensity of the sources corresponding with a specific time epoch of the spike. Based on presurgical averaged interictal spikes in six patients who were successfully treated with surgery, we estimated the time courses of the source intensities for three different time epochs: (i an epoch starting 50 ms before the spike peak and ending at 50% of the spike peak during the rising phase of the spike, (ii an epoch starting 50 ms before the spike peak and ending at the spike peak and (iii an epoch containing the full spike time period starting 50 ms before the spike peak and ending 230 ms after the spike peak. To identify the primary source of the spike activity, the source with the maximum energy from 50 ms before the spike peak till 50% of the spike peak was subsequently selected for each of the time windows. For comparison, the activity at the spike peaks and at 50% of the peaks was localized using the LORETA inversion technique and an ECD approach. Both patient-specific spherical forward models and patient-specific 5-layered finite difference models were considered to evaluate the influence of the forward model. Based on the resected zones in each of the patients, extracted from post-operative MR images, we compared the distances to the resection border of the estimated activity. Using the spherical models, the distances to the resection border for the MSVP approach and each of the different time

  2. Positron emission mammography in breast cancer presurgical planning: comparisons with magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Schilling, Kathy; The, Juliette; Velasquez, Maria Victoria; Kahn, Simone; Saady, Matthew; Mahal, Ravinder; Chrystal, Larraine [Boca Raton Regional Hospital, Radiology Department, Boca Raton, FL (United States); Narayanan, Deepa [Naviscan, Inc., San Diego, CA (United States); National Cancer Institute, Bethesda, MD (United States); Kalinyak, Judith E. [Naviscan, Inc., San Diego, CA (United States)

    2011-01-15

    The objective of this study was to compare the performance characteristics of {sup 18}F-fluorodeoxyglucose (FDG) positron emission mammography (PEM) with breast magnetic resonance imaging (MRI) as a presurgical imaging and planning option for index and ipsilateral lesions in patients with newly diagnosed, biopsy-proven breast cancer. Two hundred and eight women >25 years of age (median age = 59.7 {+-} 14.1 years) with biopsy-proven primary breast cancer enrolled in this prospective, single-site study. MRI, PEM, and whole-body positron emission tomography (WBPET) were conducted on each patient within 7 business days. PEM and WBPET images were acquired on the same day after intravenous administration of 370 MBq of FDG (median = 432.9 MBq). PEM and MRI images were blindly evaluated, compared with final surgical histopathology, and the sensitivity determined. Substudy analysis compared the sensitivity of PEM versus MRI in patients with different menopausal status, breast density, and use of hormone replacement therapy (HRT) as well as determination of performance characteristics for additional ipsilateral lesion detection. Two hundred and eight patients enrolled in the study of which 87% (182/208) were analyzable. Of these analyzable patients, 26.4% (48/182), 7.1% (13/182), and 64.2% (120/182) were pre-, peri-, and postmenopausal, respectively, and 48.4% (88/182) had extremely or heterogeneously dense breast tissue, while 33.5% (61/182) had a history of HRT use. Ninety-two percent (167/182) underwent core biopsy for index lesion diagnosis. Invasive cancer was found in 77.5% (141/182), while ductal carcinoma in situ (DCIS) and/or Paget's disease were found in 22.5% (41/182) of patients. Both PEM and MRI had index lesion depiction sensitivity of 92.8% and both were significantly better than WBPET (67.9%, p < 0.001, McNemar's test). For index lesions, PEM and MRI had equivalent sensitivity of various tumors, categorized by tumor stage as well as similar invasive

  3. 3T phased array MRI improves the presurgical evaluation in focal epilepsies: a prospective study.

    Science.gov (United States)

    Knake, S; Triantafyllou, C; Wald, L L; Wiggins, G; Kirk, G P; Larsson, P G; Stufflebeam, S M; Foley, M T; Shiraishi, H; Dale, A M; Halgren, E; Grant, P E

    2005-10-11

    Although detection of concordant lesions on MRI significantly improves postsurgical outcomes in focal epilepsy (FE), many conventional MR studies remain negative. The authors evaluated the role of phased array surface coil studies performed at 3 Tesla (3T PA MRI). Forty patients with medically intractable focal epilepsies were prospectively imaged with 3T PA-MRI including high matrix TSE T2, fluid attenuated inversion recovery, and magnetization prepared rapid gradient echo. All patients were considered candidates for epilepsy surgery. 3T PA-MRIs were reviewed by a neuroradiologist experienced in epilepsy imaging with access to clinical information. Findings were compared to reports of prior standard 1.5T MRI epilepsy studies performed at tertiary care centers. Experienced, unblinded review of 3T PA-MRI studies yielded additional diagnostic information in 48% (19/40) compared to routine clinical reads at 1.5T. In 37.5% (15/40), this additional information motivated a change in clinical management. In the subgroup of patients with prior 1.5T MRIs interpreted as normal, 3T PA-MRI resulted in the detection of a new lesion in 65% (15/23). In the subgroup of 15 patients with known lesions, 3T PA-MRI better defined the lesion in 33% (5/15). Phased array surface coil studies performed at 3 Tesla read by an experienced unblinded neuroradiologist can improve the presurgical evaluation of patients with focal epilepsy when compared to routine clinical 1.5T studies read at tertiary care centers.

  4. Brain spect in the pre-surgical evaluation of epileptic patients preliminary results

    Directory of Open Access Journals (Sweden)

    Carlos A. Buchpiguel

    1992-03-01

    Full Text Available Pre-surgical evaluation of epileptic patients consists of neurological examination, intensive electroencephalographic (EEG monitoring and anatomical studies (CT and MRI. Functional methods such as PET and SPECT imaging are now used more frequently. We have studied pre-operatively 15 adult epileptic patients (8 female, 7 male using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99mTc_HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas. In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions. Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hyperperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: (a in 4, SPECT findings correlated well with the anatomical findings; (b in 5 instances, SPECT was able to disclose additional functional deficits; (c in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n=10 SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and hete-rogenicity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic patients who are candidates for epilepsy surgery.

  5. Alternative-based thresholding with application to presurgical fMRI.

    Science.gov (United States)

    Durnez, Joke; Moerkerke, Beatrijs; Bartsch, Andreas; Nichols, Thomas E

    2013-12-01

    Functional magnetic reasonance imaging (fMRI) plays an important role in pre-surgical planning for patients with resectable brain lesions such as tumors. With appropriately designed tasks, the results of fMRI studies can guide resection, thereby preserving vital brain tissue. The mass univariate approach to fMRI data analysis consists of performing a statistical test in each voxel, which is used to classify voxels as either active or inactive-that is, related, or not, to the task of interest. In cognitive neuroscience, the focus is on controlling the rate of false positives while accounting for the severe multiple testing problem of searching the brain for activations. However, stringent control of false positives is accompanied by a risk of false negatives, which can be detrimental, particularly in clinical settings where false negatives may lead to surgical resection of vital brain tissue. Consequently, for clinical applications, we argue for a testing procedure with a stronger focus on preventing false negatives. We present a thresholding procedure that incorporates information on false positives and false negatives. We combine two measures of significance for each voxel: a classical p-value, which reflects evidence against the null hypothesis of no activation, and an alternative p-value, which reflects evidence against activation of a prespecified size. This results in a layered statistical map for the brain. One layer marks voxels exhibiting strong evidence against the traditional null hypothesis, while a second layer marks voxels where activation cannot be confidently excluded. The third layer marks voxels where the presence of activation can be rejected.

  6. Modified Thomas splint-cast combination for the management of limb fractures in small equids

    DEFF Research Database (Denmark)

    Ladefoged, Søren; Grulke, Sigrid; Busoni, V.

    2017-01-01

    Objective: To describe the management and outcome of limb fractures in small domestic equids treated with a modified Thomas splint-cast combination (MTSCC). Study Design: Retrospective case series. Animals: Client owned horses and donkeys. Methods: Medical records, including radiographs, were...... reviewed for details of animals diagnosed with a limb fracture and treated by external coaptation using a MTSCC (2001-2012). Follow-up >6 months after discharge was obtained via telephone consultation with owners or veterinarians. Results: Nine horses and 4 donkeys were identified with fractures...... developed obvious external deformation of the affected limb. Conclusion: Selected small equids with long bone fractures, and without athletic expectations, can be managed with external coaptation using an MTSCC. The owner should be informed that the treatment is considered a salvage procedure....

  7. Telescopic magnetic attachment for implant-supported denture: evaluation of splint effect.

    Science.gov (United States)

    Chen, JianRong; Tomotake, Yoritoki; Watanabe, Megumi; Ishida, Yuichi; Nagao, Kan; Ichikawa, Tetsuo

    2011-01-01

    Retrievability, connecting strength, and ease of laboratory work are important but conflicting prerequisites for the success of an implant superstructure, particularly with regard to immediate function. To resolve this issue, a telescopic magnetic attachment system has been developed for implant-supported removable dentures. The splinting effect of the attachment was evaluated for stress distribution and elevation with an in vitro model of three implants in an edentulous mandible. Two types of telescopic magnetic attachments were prepared; the inclination angles of the axial wall of the abutment were 2.5 and 6.0 degrees. Three types of three-unit superstructures--a screw-retained superstructure and two telescopic magnet-retained superstructures--were fabricated. Static loads of 24.5, 49, and 98 N were applied vertically at three loading points on one side of each occlusal table. The elevation was measured as the height at which the magnet-retained superstructure detached from the abutment (on the other side of the prosthesis). In addition, by means of strain gauges, the stress distribution around the implants was evaluated and compared among the superstructures with the same three loads applied at six different points. The magnet-retained superstructure with the axial wall inclined at 2.5 degrees did not detach from the abutment. The differences in stress distribution between the screw-retained and magnet-retained superstructures with a 2.5-degree inclination were found to be statistically insignificant. The magnet-retained superstructure with a 6-degree inclination detached from the abutment, and the stress was concentrated during loading to a cantilever site. Because of its stress distribution and elevation, the new telescopic magnetic attachment, which has properties such as splinting the implants, ease of fabrication, and retrievability, is expected to be a viable alternative for the retention of implant-supported removable dentures.

  8. Strongly lateralized activation in language fMRI of atypical dominant patients-implications for presurgical work-up.

    Science.gov (United States)

    Wellmer, Jörg; Weber, Bernd; Weis, Susanne; Klaver, Peter; Urbach, Horst; Reul, Jürgen; Fernandez, Guillen; Elger, Christian E

    2008-07-01

    Functional magnetic resonance imaging (fMRI) is being used increasingly for language dominance assessment in the presurgical work-up of patients with pharmacoresistant epilepsy. However, the interpretation of bilateral fMRI-activation patterns is difficult. Various studies propose fMRI-lateralization index (LI) thresholds between +/-0.1 and +/-0.5 for discrimination of atypical from typical dominant patients. This study examines if these thresholds allow identifying atypical dominant patients with sufficient safety for presurgical settings. 65 patients had a tight comparison, fully controlled semantic decision fMRI-task and a Wada-test for language lateralization. According to Wada-test, 22 were atypical language dominant. In the remaining, Wada-test results were compatible with unilateral left dominance. We determined fMRI-LI for two frontal and one temporo-parietal functionally defined, protocol-specific volume of interest (VOI), and for the least lateralized of these VOIs ("low-VOI") in each patient. We find large intra-individual LI differences between functionally defined VOIs irrespective of underlying type of language dominance (mean LI difference 0.33+/-0.35, range 0-1.6; 15% of patients have inter-VOI-LI differences >1.0). Across atypical dominant patients fMRI-LI in the Broca's and temporo-parietal VOI range from -1 to +1, in the "remaining frontal" VOI from -0.93 to 1. The highest low-VOI-LI detected in atypical dominant patients is 0.84. Large intra-individual inter-VOI-LI differences and strongly lateralized fMRI-activation in patients with Wada-test proven atypical dominance question the value of the proposed fMRI-thresholds for presurgical language lateralization. Future studies have to develop strategies allowing the reliable identification of atypical dominance with fMRI. The low-VOI approach may be useful.

  9. Role of presurgical targeted molecular therapy in renal cell carcinoma with an inferior vena cava tumor thrombus

    Directory of Open Access Journals (Sweden)

    Peng C

    2018-04-01

    Full Text Available Cheng Peng,1,* Liangyou Gu,1,* Lei Wang,2 Qingbo Huang,1 Baojun Wang,1 Gang Guo,1 Yang Fan,1 Yu Gao,1 Xin Ma,1 Xu Zhang1 1Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Chinese PLA Medical Academy, Beijing, People’s Republic of China; 2Department of Urology, Chinese PLA 534 Hospital, Luoyang, People’s Republic of China *These authors contributed equally to this work Purpose: The clinical benefit of targeted molecular therapy (TMT in renal cell carcinoma (RCC with an inferior vena cava (IVC tumor thrombus remains controversial. The aim of this study was to investigate the effects of presurgical TMT on the heights and levels of IVC thrombi, and to assess its impact on surgical strategy. Patients and methods: We retrospectively reviewed data from 18 patients with RCC involving IVC tumor thrombi who were treated at our hospital with presurgical TMT followed by an IVC thrombectomy. The changes in heights and levels of the IVC thrombi were compared using computed tomography or magnetic resonance imaging. Clinicopathological factors were also evaluated to assess their association with TMT efficacy. Results: The tumor thrombus levels before TMT were stage I in 1 patient (5.6%, II in 12 patients (66.7%, III in 4 patients (22.2%, and IV in 1 patient (5.6%. After a median of two treatment cycles (range: 1–3, the thrombus height decreased measurably in 11 patients (61.1% with an average shrinkage of 17.7%. The thrombus height remained stable in five patients (27.8% and was enlarged in two (11.1%. Downstaging of the thrombus level occurred in four patients (22.2%; the surgical strategy was modified in three patients (16.7% to avoid cardiopulmonary bypass and complicated liver mobilization under robot-assisted laparoscopy. Furthermore, a higher neutrophil count tended to be associated with a worse clinical TMT-associated outcome (P=0.056. Conclusion: Our data suggest a limited influence of presurgical TMT

  10. Patient-specific three-dimensional printing for pre-surgical planning in hepatocellular carcinoma treatment.

    Science.gov (United States)

    Perica, Elizabeth; Sun, Zhonghua

    2017-12-01

    Recently, three-dimensional (3D) printing has shown great interest in medicine, and 3D printed models may be rendered as part of the pre-surgical planning process in order to better understand the complexities of an individual's anatomy. The aim of this study is to investigate the feasibility of utilising 3D printed liver models as clinical tools in pre-operative planning for resectable hepatocellular carcinoma (HCC) lesions. High-resolution contrast-enhanced computed tomography (CT) images were acquired and utilized to generate a patient-specific 3D printed liver model. Hepatic structures were segmented and edited to produce a printable model delineating intrahepatic anatomy and a resectable HCC lesion. Quantitative assessment of 3D model accuracy compared measurements of critical anatomical landmarks acquired from the original CT images, standard tessellation language (STL) files, and the 3D printed liver model. Comparative analysis of surveys completed by two radiologists investigated the clinical value of 3D printed liver models in radiology. The application of utilizing 3D printed liver models as tools in surgical planning for resectable HCC lesions was evaluated through kappa analysis of questionnaires completed by two abdominal surgeons. A scaled down multi-material 3D liver model delineating patient-specific hepatic anatomy and pathology was produced, requiring a total production time of 25.25 hours and costing a total of AUD $1,250. A discrepancy was found in the total mean of measurements at each stage of production, with a total mean of 18.28±9.31 mm for measurements acquired from the original CT data, 15.63±8.06 mm for the STL files, and 14.47±7.71 mm for the 3D printed liver model. The 3D liver model did not enhance the radiologists' perception of patient-specific anatomy or pathology. Kappa analysis of the surgeon's responses to survey questions yielded a percentage agreement of 80%, and a κ value of 0.38 (P=0.24) indicating fair agreement. Study

  11. Surgery is more cost-effective than splinting for carpal tunnel syndrome in the Netherlands: results of an economic evaluation alongside a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Adèr Herman J

    2006-11-01

    Full Text Available Abstract Background Carpal tunnel syndrome (CTS is a common disorder, often treated with surgery or wrist splinting. The objective of this economic evaluation alongside a randomized trial was to evaluate the cost-effectiveness of splinting and surgery for patients with CTS. Methods Patients at 13 neurological outpatient clinics with clinically and electrophysiologically confirmed idiopathic CTS were randomly allocated to splinting (n = 89 or surgery (n = 87. Clinical outcome measures included number of nights waking up due to symptoms, general improvement, severity of the main complaint, paraesthesia at night and during the day, and utility. The economic evaluation was performed from a societal perspective and involved all relevant costs. Results There were no differences in costs. The mean total costs per patient were in the surgery group EURO 2,126 compared to EURO 2,111 in the splint group. After 12 months, the success rate in the surgery group (92% was significantly higher than in the splint group (72%. The acceptability curve showed that at a relatively low ceiling ratio of EURO 2,500 per patient there is a 90% probability that surgery is cost-effective. Conclusion In the Netherlands, surgery is more cost-effective compared with splinting, and recommended as the preferred method of treatment for patients with CTS.

  12. Natural teeth-retained splint based on a patient-specific 3D-printed mandible used for implant surgery and vestibuloplasty: A case report.

    Science.gov (United States)

    Xing, Helin; Wu, Jinshuang; Zhou, Lei; Yang, Sefei

    2017-12-01

    With respect to improving the quality of oral rehabilitation, the management of keratinized mucosa is as important as bone condition for implant success. To enhance this management, a natural teeth-retained splint based on a patient-specific 3-dimensional (3D) printed mandible was used in vestibuloplasty to provide sufficient keratinized mucosa around dental implants to support long-term implant maintenance. A 28-year-old male patient had a fracture of the anterior andible 1 year ago, and the fracture was treated with titanium. The patient had lost mandibular incisors on both the sides and had a shallow vestibule and little keratinized mucosa. In the first-stage implant surgery, 2 implants were inserted and the titanium fracture fixation plates and screws were removed at the same time. During second-stage implant surgery, vestibuloplasty was performed, and the natural teeth-retained splint was applied. The splint was made based upon a patient-specific 3D-printed mandible. At 30-day follow-up, the splint was modified and reset. The modified splint was removed after an additional 60 days, and the patient received prosthetic treatment. After prosthetic treatment, successful oral rehabilitation was achieved. Within 1 year and 3 years after implant prosthesis finished, the patient exhibited a good quantity of keratinized gingiva. The proposed splint is a simple and time-effective technique for correcting soft tissue defects in implant dentistry that ensures a good quantity of keratinized mucosa.

  13. Anxiety, splint treatment and clinical characteristics of patients with osteoarthritis of temporomandibular joint and dental students – a pilot study.

    Directory of Open Access Journals (Sweden)

    Tomislav Badel

    2011-02-01

    Full Text Available The aim of this study was to evaluate the use of splint treatment for therapy of osteoarthritis of temporomandibular joint, and to compare the level of anxiety (State-Trait Anxiety Inventory,STAI and clinical characteristics between 16 patients and 20 asymptomatic dental school students. Magnetic resonance imaging (MRI was used for all subjects. Dental students showed a statistically signiicant higher capacity of mouth opening (p<0.05, and lower level of anxiety (p<0.05 for STAI 1, and p<0.001 for STAI 2 than patients. Patients who had suffered chronic pain before splint treatment had a higher value of anxiety by STAI 1 test (p<0.05.

  14. Efficacy of Esthetic Retainers: Clinical Comparison between Multistranded Wires and Direct-Bond Glass Fiber-Reinforced Composite Splints

    Directory of Open Access Journals (Sweden)

    Andrea Scribante

    2011-01-01

    Full Text Available The purpose of this longitudinal prospective randomized study was to evaluate the reliability of two different types of orthodontic retainers in clinical use: a multistrand stainless steel wire and a polyethylene ribbon-reinforced resin composite. Moreover the level of satisfaction of the patient about the esthetic result was also analyzed by means of a Visual Analogue Scale (VAS. 34 patients (9 boys and 25 girls, mean age 14.3, in the finishing phase of orthodontic treatment, were selected for the study. Since splints were applied the number, cause, and date of splint failures were recorded for each single tooth over 12 months. Statistical analysis was performed using a paired -test, Kaplan Meier survival estimates, and the log-rank test. Kruskal Wallis test was performed to analyze VAS recordings. Differences between the bond failure rates were not statistically significant. Esthetic result of VAS was significantly higher for polyethylene ribbon-reinforced resin retainers than for stainless steel wires.

  15. Monitoring of Serial Presurgical and Postsurgical Changes in the Serum Proteome in a Series of Patients with Calcific Aortic Stenosis

    Directory of Open Access Journals (Sweden)

    Kazumi Satoh

    2015-01-01

    Full Text Available Background. Comprehensive analysis of proteome differentially expressed in response to surgery or drug treatment is useful to understand biological responses to dispensed interventions. Here we investigated expression changes in sera of patients who suffered from calcific aortic stenosis (CAS, before and after surgery for aortic valve replacement. Materials and Methods. Sera obtained before and after surgery with depletion of highly abundant proteins were analyzed with iTRAQ labeling followed by nanoLC-MALDI-TOF/TOF-MS/MS. Results. Fifty-one proteins shared in five patients were identified with differential levels in postsurgical and presurgical sera. Finally, 16 proteins that show statistically significant levels in patients’ sera compared with those in control sera (P<0.05 were identified. Most of the identified proteins were positive acute-phase proteins. Among three proteins other than acute-phase proteins, we confirmed increased levels of antithrombin-III and zinc-α-2-glycoprotein in postsurgical sera by Western blot analysis using other CAS patients’ sera. Furthermore, antithrombin-III and zinc-α-2-glycoprotein were not found among proteins with differential levels in postsurgical and presurgical sera of patients with aortic aneurysms that we identified in a previous study. Conclusions. The results indicated that antithrombin-III and zinc-α-2-glycoprotein would become unique monitoring proteins for evaluating pathophysiological and biochemical processes occurring before and after surgery for CAS.

  16. Stress-strain distribution at bone-implant interface of two splinted overdenture systems using 3D finite element analysis

    OpenAIRE

    Hussein, Mostafa Omran

    2013-01-01

    PURPOSE This study was accomplished to assess the biomechanical state of different retaining methods of bar implant-overdenture. MATERIALS AND METHODS Two 3D finite element models were designed. The first model included implant overdenture retained by Hader-clip attachment, while the second model included two extracoronal resilient attachment (ERA) studs added distally to Hader splint bar. A non-linear frictional contact type was assumed between overdentures and mucosa to represent sliding an...

  17. Metrical analysis of disc-condyle relation with different splint treatment positions in patients with TMJ disc displacement

    Directory of Open Access Journals (Sweden)

    Mu-Qing Liu

    Full Text Available Abstract Objective: To evaluate the effect of bite positions characterizing different splint treatments (anterior repositioning and stabilization splints on the disc-condyle relation in patients with TMJ disc displacement with reduction (DDwR, using magnetic resonance imaging (MRI. Material and Methods: 37 patients, with a mean age of 18.8±4.3 years (7 male and 30 females and diagnosed with DDwR based on the RDC/TMD, were recruited. MRI metrical analysis of the spatial changes of the disc/condyle, as well as their relationships, was done in three positions: maximum intercuspation (Position 1, anterior repositioning splint position (Position 2, and stabilization splint position (Position 3. Disc/condyle coordinate measurements and disc condyle angles were determined and compared. Results: In Position 1, the average disc-condyle angle was 53.4° in the 60 joints with DDwR, while it was −13.3° with Position 2 and 30.1° with Position 3. The frequency of successful "disc recapture" with Position 2 was significantly higher (58/60, 96.7% than Position 3 (20/60, 33.3%. In Positions 2 and 3, the condyle moved forward and downward while the disc moved backward. The movements were, however, more remarkable with Position 2. Conclusions: Anterior repositioning of the mandible improves the spatial relationship between the disc and condyle in patients with DDwR. In addition to anterior and inferior movement of the condyle, transitory posterior movement of the disc also occurred.

  18. The Evolution of Splint Armour in Georgia and Byzantium: Lamellar and Scale Armour in the 10th-12th Centuries

    OpenAIRE

    TSURTSUMIA, Mamuka

    2011-01-01

    Byzantine technology was part of the military technology that existed in vast areas of Eurasia; hence study of the armament of its neighbours is important.The purpose of the present paper is to add new data about Byzantium’s Caucasian neighbour (namely, Georgia). Besides that, it also includes certain views about the stages of the evolution and provenance of splint (scale and lamellar) armour. This paper also attempts to clarify the difference between banded and linear suits of lamellar armou...

  19. Restoration of failing maxillary implant-supported fixed prosthesis with cross arch splinted unilateral zygomatic implant: a clinical report.

    Science.gov (United States)

    Gunaseelan, Rajan; Saravanakumar, Mariappan; Hariharan, Ramasubramanian

    2012-12-01

    Management of one or more failing distal implants in an implant supported fixed prosthesis in a completely edentulous maxilla creates a challenging situation. Restoring immediate function with additional implants in such a situation can be a challenge considering the loss of supporting bone, need for grafting, age, and the patient's desire for immediate fixed dental prosthesis. This clinical report describes a situation where a zygomatic implant has been placed unilaterally and splinted with osseointegrated conventional implants by an immediate fixed provisional restoration.

  20. Stress Distribution in Splinted and Unsplinted Implant-Supported Maxillary Overdentures: A 3D Finite Element Analysis.

    Science.gov (United States)

    Geramy, Allahyar; Habibzadeh, Sareh

    2018-02-01

    This study was accomplished to assess the biomechanical state of splinting in implant-supported maxillary overdentures. Two models of maxillary overdentures were designed in SolidWorks 2011. The first model included 4 separate implants and ball abutments, whereas the second one included 4 splinted implants connected with a bar. Evaluation was performed in ANSYS Workbench software with 200 N load applied at the molar-premolar region, bilaterally. The maximum equivalent stress and strain (von Mises) was recorded and analyzed along a path between the implants in the crestal bone and the prosthetic attachments. First model presented higher values of strain in prosthetic attachment and higher values of von Mises stress in crestal bone. The second model presented higher stress concentration in the gingival tissue of premolar area (near the bar), whereas the peak stress values were reported within the most distal part of the soft tissue support of the prosthesis in the first model (unsplinted). Splinting maxillary overdentures implants is associated with significant lower stress levels in the surrounding bone tissue.

  1. Evaluation of accuracy of complete-arch multiple-unit abutment-level dental implant impressions using different impression and splinting materials.

    Science.gov (United States)

    Buzayan, Muaiyed; Baig, Mirza Rustum; Yunus, Norsiah

    2013-01-01

    This in vitro study evaluated the accuracy of multiple-unit dental implant casts obtained from splinted or nonsplinted direct impression techniques using various splinting materials by comparing the casts to the reference models. The effect of two different impression materials on the accuracy of the implant casts was also evaluated for abutment-level impressions. A reference model with six internal-connection implant replicas placed in the completely edentulous mandibular arch and connected to multi-base abutments was fabricated from heat-curing acrylic resin. Forty impressions of the reference model were made, 20 each with polyether (PE) and polyvinylsiloxane (PVS) impression materials using the open tray technique. The PE and PVS groups were further subdivided into four subgroups of five each on the bases of splinting type: no splinting, bite registration PE, bite registration addition silicone, or autopolymerizing acrylic resin. The positional accuracy of the implant replica heads was measured on the poured casts using a coordinate measuring machine to assess linear differences in interimplant distances in all three axes. The collected data (linear and three-dimensional [3D] displacement values) were compared with the measurements calculated on the reference resin model and analyzed with nonparametric tests (Kruskal-Wallis and Mann-Whitney). No significant differences were found between the various splinting groups for both PE and PVS impression materials in terms of linear and 3D distortions. However, small but significant differences were found between the two impression materials (PVS, 91 μm; PE, 103 μm) in terms of 3D discrepancies, irrespective of the splinting technique employed. Casts obtained from both impression materials exhibited differences from the reference model. The impression material influenced impression inaccuracy more than the splinting material for multiple-unit abutment-level impressions.

  2. THE MANAGEMENT OF LIMITED MANDIBULAR MOVEMENT CAUSED BY CONDYLAR FRACTURE WITH REPOSITIONING SPLINT

    Directory of Open Access Journals (Sweden)

    Ira Tanti

    2015-06-01

    Full Text Available Fractures of the neck of condyle usually are the result of a blow to the mandible. A lateral blow to the body of the mandible commonly causes a contralateral condyle fracture. There are many signs and symptoms of a condylar fracture, for example crepitation, deviation of the mandible to the side of injury, and spasm of the associated group of muscles. These will result in a functional disability, which is usually seen as a limited mandibular movement. This paper reported a patient with a fracture of the condylar neck. Patient had been treated with closed reduction and immobilization for 2 months. After that, she felt that her bite was changed, she could not occlude her teeth well, and she had clicking sound in the right joint when she opened her mouth. Besides that, patient had difficulties to move the mandible to the left side, and she could not open her mouth widely. The patient was treated with a repositioning splint and she had to do some jaw exercises. The purposes were to regain the position of condyle, to reduce the muscle spasm and finally got the normal jaw movement.

  3. Endodontic treatment of dens evaginatus by performing a splint guided access cavity.

    Science.gov (United States)

    Mena-Álvarez, Jesús; Rico-Romano, Cristina; Lobo-Galindo, Ana Belén; Zubizarreta-Macho, Álvaro

    2017-11-12

    Dens evaginatus (DE) is described as an unusual dental malformation. Tooth structure variations attached to this anatomical disturbance complicates the performance of a conservative access cavity for a conventional root canal treatment. Author's purpose is to describe the treatment of a type V DE by using splits as guides to perform access cavity. This clinical case shows a root canal treatment of a type V DE diagnosed by using a cone beam computed tomography (CBCT). Access cavity was planned through an osseointegrated implant planning software and guided by a stereolithographied split. After endodontic treatment, tooth was sculpted for placing a veneer, processed by a chair-side system in a single session. CBCT is an effective method for obtaining internal anatomical information of teeth with anatomical malformations. The osseointegrated implant planning software is an effective method for planning root canal treatment and designing stereolithograped splits (for performing minimally invasive access cavities). Stereolithographed splints allow performing a guided and conservative access cavity of teeth affected by dental malformations whereas digital technology allows us to esthetically reconstruct a tooth in a single session. © 2017 Wiley Periodicals, Inc.

  4. A concept to transfer a therapeutic splint position into permanent occlusion with a customized lingual appliance

    Directory of Open Access Journals (Sweden)

    Sachse Tina

    2012-05-01

    Full Text Available Abstract Introduction The role of occlusion concerning temporomandibular disorder is still unclear but seems to be the only component of the stomathognathic system dentists are able to change morphologically. The aim of the paper is to describe the orthodontist’s approach for transferring and maintaining a therapeutic splint position into permanent occlusion using a fully customized lingual appliance. Methods Fixed acrylic bite planes on lower molars were used to maintain a symptom-free condyle position prior to orthodontic treatment. Silicone impressions of the arches including the fixed bite planes were used for the Incognito laboratory procedure. Two digital setups were made. One setup represents the target occlusion. A second setup including the bite planes was used to fabricate an additional set of lower molar brackets. In the leveling stage all teeth except the lower molars were settled to maintain the therapeutic condyle position. Finally, the fixed bite planes were stepwise removed and molar brackets were replaced to establish the permanent occlusion planned with the first setup. Results and discussion The advantage of an individual lingual appliance consists in the high level of congruence between the fabricated setups and the final clinical result. Both the individual scope for design and the precision of the appliance were vitally important in the treatment of a patient with a functional disorder of the masticatory system.

  5. Class II malocclusion treatment using high-pull headgear with a splint: a systematic review

    Directory of Open Access Journals (Sweden)

    Helder B. Jacob

    2013-04-01

    Full Text Available OBJECTIVE: To systematically review the scientific evidence pertaining to the effectiveness of high-pull headgear in growing Class II subjects. METHODS: A literature survey was performed by electronic database search. The survey covered the period from January 1966 to December 2008 and used Medical Subject Headings (MeSH. Articles were initially selected based on their titles and abstracts; the full articles were then retrieved. The inclusion criteria included growing subjects between 8 to 15 years of age, Class II malocclusion treatment with high-pull headgear, and a control group with Class II malocclusion. References from selected articles were hand-searched for additional publications. Selected studies were evaluated methodologically. RESULTS: Four articles were selected; none were randomized controlled trials. All of the articles clearly formulated their objectives and used appropriate measures. The studies showed that high-pull headgear treatment improves skeletal and dental relationship, distal displacement of the maxilla, vertical eruption control and upper molars distalization. One of the studies showed a slight clockwise rotation of the palatal plane; the others showed no significant treatment effect. The mandible was not affected by the treatment. CONCLUSION: While there is still a lack of strong evidence demonstrating the effects of high-pull headgear with a splint, other studies indicate that the AP relations improve due to distalization of the maxilla and upper molars, with little or no treatment effects in the mandible. Greater attention to the design should be given to improve the quality of such trials.

  6. The PGRIS and parathyroid splinting concepts for the analysis and prognosis of protracted hypoparathyroidism

    Science.gov (United States)

    2017-01-01

    Most patients with hypocalcemia after total thyroidectomy will recover the parathyroid function in a few weeks, but some 20–30% of them will still be in the need for replacement therapy one month after surgery and about 5–10% of those will develop permanent hypoparathyroidism. Although postoperative hypocalcemia has been related to several demographic and metabolic causes, parathyroid hormone (PTH) decline, resulting from autotransplantation, inadvertent excision or devascularization of the parathyroid glands, is the common final pathway. The number of parathyroid glands remaining in situ (PGRIS) is a key variable to understand the pathogenesis of protracted hypoparathyroidism and the chances for restoration of the parathyroid function. Normal-high serum calcium concentration, probably achieved by a more intensive medical treatment at the time of hospital discharge, has been identified as an independent variable favoring recovery of the parathyroid function. This we refer to as parathyroid splinting, a hypothesis holding that putting the injured parathyroid parenchyma at rest after thyroidectomy may improve long-term outcome of protracted hypoparathyroidism. PMID:29322026

  7. Modified Thomas splint-cast combination for the management of limb fractures in small equids.

    Science.gov (United States)

    Ladefoged, Søren; Grulke, Sigrid; Busoni, Valeria; Serteyn, Didier; Salciccia, Alexandra; Verwilghen, Denis

    2017-04-01

    To describe the management and outcome of limb fractures in small domestic equids treated with a modified Thomas splint-cast combination (MTSCC). Retrospective case series. Client owned horses and donkeys. Medical records, including radiographs, were reviewed for details of animals diagnosed with a limb fracture and treated by external coaptation using a MTSCC (2001-2012). Follow-up >6 months after discharge was obtained via telephone consultation with owners or veterinarians. Nine horses and 4 donkeys were identified with fractures of the tibial diaphysis (n = 4), ulna (n = 3), distal metatarsus (n = 2), proximal metacarpus (n = 1), radial diaphysis (n = 1), calcaneus (n = 1), and distal femoral physis (n = 1). Follow-up was available for 12 equids, of which 8 (67%) recovered from the fracture and became pasture sound. Six equids developed obvious external deformation of the affected limb. Selected small equids with long bone fractures, and without athletic expectations, can be managed with external coaptation using an MTSCC. The owner should be informed that the treatment is considered a salvage procedure. © 2017 The American College of Veterinary Surgeons.

  8. High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions.

    Science.gov (United States)

    Weston, Matthew; Weston, Kathryn L; Prentis, James M; Snowden, Chris P

    2016-01-01

    The advancement of perioperative medicine is leading to greater diversity in development of pre-surgical interventions, implemented to reduce patient surgical risk and enhance post-surgical recovery. Of these interventions, the prescription of pre-operative exercise training is gathering momentum as a realistic means for enhancing patient surgical outcome. Indeed, the general benefits of exercise training have the potential to pre-operatively optimise several pre-surgical risks factors, including cardiorespiratory function, frailty and cognitive function. Any exercise programme incorporated into the pre-operative pathway of care needs to be effective and time efficient in that any fitness gains are achievable in the limited period between the decision for surgery and operation (e.g. 4 weeks). Fortunately, there is a large volume of research describing effective and time-efficient exercise training programmes within the discipline of sports science. Accordingly, the objective of our commentary is to synthesise contemporary exercise training research, both from non-clinical and clinical populations, with the overarching aim of informing the development of effective and time-efficient pre-surgical exercise training programmes. The development of such exercise training programmes requires the careful consideration of several key principles, namely frequency, intensity, time, type and progression of exercise. Therefore, in light of more recent evidence demonstrating the effectiveness and time efficiency of high-intensity interval training-which involves brief bouts of intense exercise interspersed with longer recovery periods-the principles of exercise training programme design will be discussed mainly in the context of such high-intensity interval training programmes. Other issues pertinent to the development, implementation and evaluation of pre-operative exercise training programmes, such as individual exercise prescription, training session monitoring and potential

  9. EEG-fMRI correlation patterns in the presurgical evaluation of focal epilepsy: A comparison with electrocorticographic data and surgical outcome measures

    NARCIS (Netherlands)

    van Houdt, P.J.; de Munck, J.C.; Leijten, F.S.S.; Huiskamp, G.J.M.; Colon, A.J.; Boon, P.A.J.M.; Ossenblok, P.P.W.

    2013-01-01

    EEG-correlated functional MRI (EEG-fMRI) visualizes brain regions associated with interictal epileptiform discharges (IEDs). This technique images the epileptiform network, including multifocal, superficial and deeply situated cortical areas. To understand the role of EEG-fMRI in presurgical

  10. Re-examine tumor-induced alterations in hemodynamic responses of BOLD fMRI. Implications in presurgical brain mapping

    International Nuclear Information System (INIS)

    Wang, Liya; Ali, Shazia; Fa, Tianning; Mao, Hui; Dandan, Chen; Olson, Jeffrey

    2012-01-01

    Background: Blood oxygenation level dependent (BOLD) fMRI is used for presurgical functional mapping of brain tumor patients. Abnormal tumor blood supply may affect hemodynamic responses and BOLD fMRI signals. Purpose: To perform a multivariate and quantitative investigation of the effect of brain tumors on the hemodynamic responses and its impact on BOLD MRI signal time course, data analysis in order to better understand tumor-induced alterations in hemodynamic responses, and accurately mapping cortical regions in brain tumor patients. Material and Methods: BOLD fMRI data from 42 glioma patients who underwent presurgical mapping of the primary motor cortex (PMC) with a block designed finger tapping paradigm were analyzed, retrospectively. Cases were divided into high grade (n = 24) and low grade (n = 18) groups based on pathology. The tumor volume and distance to the activated PMCs were measured. BOLD signal time courses from selected regions of interest (ROIs) in the PMCs of tumor affected and contralateral unaffected hemispheres were obtained from each patient. Tumor-induced changes of BOLD signal intensity and time to peak (TTP) of BOLD signal time courses were analyzed statistically. Results: The BOLD signal intensity and TTP in the tumor-affected PMCs are altered when compared to that of the unaffected hemisphere. The average BOLD signal level is statistically significant lower in the affected PMCs. The average TTP in the affected PMCs is shorter in the high grade group, but longer in the low grade tumor group compared to the contralateral unaffected hemisphere. Degrees of alterations in BOLD signal time courses are related to both the distance to activated foci and tumor volume with the stronger effect in tumor distance to activated PMC. Conclusion: Alterations in BOLD signal time courses are strongly related to the tumor grade, the tumor volume, and the distance to the activated foci. Such alterations may impair accurate mapping of tumor-affected functional

  11. All-in-one interictal presurgical imaging in patients with epilepsy: single-session EEG/PET/(f)MRI

    International Nuclear Information System (INIS)

    Grouiller, Frederic; Delattre, Benedicte M.A.; Lazeyras, Francois; Ratib, Osman; Vargas, Maria I.; Garibotto, Valentina; Pittau, Francesca; Spinelli, Laurent; Seeck, Margitta; Vulliemoz, Serge; Heinzer, Susanne; Iannotti, Giannina R.

    2015-01-01

    In patients with pharmacoresistant focal epilepsy, resection of the epileptic focus can lead to freedom from seizures or significant improvement in well-selected candidates. Localization of the epileptic focus with multimodal concordance is crucial for a good postoperative outcome. Beyond the detection of epileptogenic lesions on structural MRI and focal hypometabolism on FDG PET, EEG-based Electric Source Imaging (ESI) and simultaneous EEG and functional MRI (EEG-fMRI) are increasingly applied for mapping epileptic activity. We here report presurgical multimodal interictal imaging using a hybrid PET/MR scanner for single-session FDG PET, MRI, EEG-fMRI and ESI. This quadrimodal imaging procedure was performed in a single session in 12 patients using a high-density (256 electrodes) MR-compatible EEG system and a hybrid PET/MR scanner. EEG was used to exclude subclinical seizures during uptake of the PET tracer, to compute ESI on interictal epileptiform discharges and to guide fMRI analysis for mapping haemodynamic changes correlated with interictal epileptiform activity. The whole multimodal recording was performed in less than 2 hours with good patient comfort and data quality. Clinically contributory examinations with at least two modalities were obtained in nine patients and with all modalities in five patients. This single-session quadrimodal imaging procedure provided reliable and contributory interictal clinical data. This procedure avoids multiple scanning sessions and is associated with less radiation exposure than PET-CT. Moreover, it guarantees the same medication level and medical condition for all modalities. The procedure improves workflow and could reduce the duration and cost of presurgical epilepsy evaluations. (orig.)

  12. All-in-one interictal presurgical imaging in patients with epilepsy: single-session EEG/PET/(f)MRI.

    Science.gov (United States)

    Grouiller, Frédéric; Delattre, Bénédicte M A; Pittau, Francesca; Heinzer, Susanne; Lazeyras, François; Spinelli, Laurent; Iannotti, Giannina R; Seeck, Margitta; Ratib, Osman; Vargas, Maria I; Garibotto, Valentina; Vulliemoz, Serge

    2015-06-01

    In patients with pharmacoresistant focal epilepsy, resection of the epileptic focus can lead to freedom from seizures or significant improvement in well-selected candidates. Localization of the epileptic focus with multimodal concordance is crucial for a good postoperative outcome. Beyond the detection of epileptogenic lesions on structural MRI and focal hypometabolism on FDG PET, EEG-based Electric Source Imaging (ESI) and simultaneous EEG and functional MRI (EEG-fMRI) are increasingly applied for mapping epileptic activity. We here report presurgical multimodal interictal imaging using a hybrid PET/MR scanner for single-session FDG PET, MRI, EEG-fMRI and ESI. This quadrimodal imaging procedure was performed in a single session in 12 patients using a high-density (256 electrodes) MR-compatible EEG system and a hybrid PET/MR scanner. EEG was used to exclude subclinical seizures during uptake of the PET tracer, to compute ESI on interictal epileptiform discharges and to guide fMRI analysis for mapping haemodynamic changes correlated with interictal epileptiform activity. The whole multimodal recording was performed in less than 2 hours with good patient comfort and data quality. Clinically contributory examinations with at least two modalities were obtained in nine patients and with all modalities in five patients. This single-session quadrimodal imaging procedure provided reliable and contributory interictal clinical data. This procedure avoids multiple scanning sessions and is associated with less radiation exposure than PET-CT. Moreover, it guarantees the same medication level and medical condition for all modalities. The procedure improves workflow and could reduce the duration and cost of presurgical epilepsy evaluations.

  13. All-in-one interictal presurgical imaging in patients with epilepsy: single-session EEG/PET/(f)MRI

    Energy Technology Data Exchange (ETDEWEB)

    Grouiller, Frederic; Delattre, Benedicte M.A.; Lazeyras, Francois; Ratib, Osman; Vargas, Maria I.; Garibotto, Valentina [Geneva University Hospital, Department of Radiology and Medical Informatics, Geneva 14 (Switzerland); Pittau, Francesca; Spinelli, Laurent; Seeck, Margitta; Vulliemoz, Serge [Geneva University Hospital, EEG and Epilepsy Unit, Department of Neurology, Geneva 14 (Switzerland); Heinzer, Susanne [Philips AG Healthcare, Zuerich (Switzerland); Iannotti, Giannina R. [Geneva University Hospital, Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, Geneva 14 (Switzerland)

    2015-04-17

    In patients with pharmacoresistant focal epilepsy, resection of the epileptic focus can lead to freedom from seizures or significant improvement in well-selected candidates. Localization of the epileptic focus with multimodal concordance is crucial for a good postoperative outcome. Beyond the detection of epileptogenic lesions on structural MRI and focal hypometabolism on FDG PET, EEG-based Electric Source Imaging (ESI) and simultaneous EEG and functional MRI (EEG-fMRI) are increasingly applied for mapping epileptic activity. We here report presurgical multimodal interictal imaging using a hybrid PET/MR scanner for single-session FDG PET, MRI, EEG-fMRI and ESI. This quadrimodal imaging procedure was performed in a single session in 12 patients using a high-density (256 electrodes) MR-compatible EEG system and a hybrid PET/MR scanner. EEG was used to exclude subclinical seizures during uptake of the PET tracer, to compute ESI on interictal epileptiform discharges and to guide fMRI analysis for mapping haemodynamic changes correlated with interictal epileptiform activity. The whole multimodal recording was performed in less than 2 hours with good patient comfort and data quality. Clinically contributory examinations with at least two modalities were obtained in nine patients and with all modalities in five patients. This single-session quadrimodal imaging procedure provided reliable and contributory interictal clinical data. This procedure avoids multiple scanning sessions and is associated with less radiation exposure than PET-CT. Moreover, it guarantees the same medication level and medical condition for all modalities. The procedure improves workflow and could reduce the duration and cost of presurgical epilepsy evaluations. (orig.)

  14. Treatment Effects of Maxillary Flat Occlusal Splints for Painful Clicking of the Temporomandibular Joint

    Directory of Open Access Journals (Sweden)

    Sung-Wen Chang

    2010-06-01

    Full Text Available Existing therapies for symptoms related to painful clicking of the temporomandibular joint (TMJ have rarely met with complete success and predicting prognosis remains difficult. Few studies have reported the efficacy of maxillary flat occlusal splints (MFOSs for the treatment of painful clicking of the TMJ, and few studies have evaluated the predisposing factors that influence the clinical outcomes of MFOSs. The aim of this study was to investigate the treatment efficacy of MFOSs for painful clicking of the TMJ, and to determine the factors influencing TMJ therapy with MFOSs. We conducted a retrospective study of 109 patients suffering from unilateral clicking concurrent with preauricular area pain for at least 2 months between 2004 and 2008. Seventy-five patients were treated with an MFOS, while 34 patients did not receive MFOS therapy. Clicking score, pain-free maximal mouth opening, pain score, duration of the clicking sounds, age and bruxism were recorded during treatment and involved into the reviews. The degree of joint clicking was determined by a stethoscope placed in the anterolateral area of the external auditory canal and was divided into four grades. Data were analyzed using a Mann-Whitney U test, Fisher's exact test, and Student's t test. Results showed statistically significant differences in treatment outcomes between the MFOS-treated and control groups in clicking index, maximal mouth opening, pain and complete remission rates of symptoms within 1 year. Furthermore, for patients treated with MFOS, there were statistically significant differences in the clinical outcomes between those with a high clicking index and those with a low index before treatment. Factors significantly correlated with successful outcomes of MFOS included nocturnal bruxism, patient age and duration of clicking. MFOSs can be used to treat patients with painful clicking of the TMJ and related symptoms. The severity of clicking, bruxism, age and duration of

  15. Results of a bone splint technique for the treatment of lower limb deformities in children with type I osteogenesis imperfecta

    Directory of Open Access Journals (Sweden)

    Dasheng Lin

    2013-01-01

    Full Text Available Background: Children with osteogenesis imperfecta (OI can suffer from frequent fractures and limb deformities, resulting in impaired ambulation. Osteopenia and thin cortices complicate orthopedic treatment in this group. This study evaluates the clinical results of a bone splint technique for the treatment of lower limb deformities in children with type I OI. The technique consists of internal plating combined with cortical strut allograft fixation. Materials and Methods: We prospectively followed nine children (five boys, four girls with lower limb deformities due to type I OI, who had been treated with the bone splint technique (11 femurs, four tibias between 2003 and 2006. The fracture healing time, deformity improvement, ambulation ability and complications were recorded to evaluate treatment effects. Results: At the time of surgery the average age in our study was 7.7 years (range 5-12 years. The average length of followup was 69 months (range 60-84 months. All patients had good fracture healing with an average healing time of 14 weeks (range 12-16 weeks and none experienced further fractures, deformity, or nonunion. The fixation remained stable throughout the procedure in all cases, with no evidence of loosening or breakage of screws and the deformity and mobility significantly improved after surgery. Of the two children confined to bed before surgery, one was able to walk on crutches and the other needed a wheelchair. The other seven patients could walk without walking aids or support like crutches. Conclusions: These findings suggest that the bone splint technique provides good mechanical support and increases the bone mass. It is an effective treatment for children with OI and lower limb deformities.

  16. [Guiding role of three-column theory in manipulative reduction, small splint fixation and early rehabilitative exercises for Colles fracture].

    Science.gov (United States)

    Dong, Wan-Tao; Lü, Ze-Bin; Song, Min

    2014-06-01

    To explore guiding role of three-column theory in manipulative reduction, small splint fixation and early rehabilitative exercises of Colles fracture. From August 2011 to February 2012,47 patients with Colles fractures were treated by manipulative reduction small splinting fixation and early rehabilitative exercises under the guidance of three-column theory, including 21 males and 26 females aged from 40 to 76 years old with an average of (65.5 +/- 2.3). According to AO fracture classification, 27 patients were type A (including 18 cases with type A2 and 9 cases with type A3) and 20 patients were type C (including 10 cases with type C1, 6 cases with type C2 and 4 cases with type C3). Pain and recovery time of swelling, postoperative complications were observed and recorded, Gartland-Werley scoring system were applied for evaluate functional recovery and biomechanical analysis of wrist joint at 12 weeks after operation. All patients were followed up for 3 to 9 months with average of 5 months. Pain relief time ranged from 5 to 15 d with average of (7.6 +/- 2.2) d,recovery time of swelling of opisthenar was for 6 to 13 d with an average of (8.9 +/- 1.9) d. Two patients occurred tension vesicle within 3 days after operation, but no other complications occurred. According to Gartland-Werley scoring system, 25 cases got excellent results, 18 cases good and 4 cases moderate at 12 weeks after operation. Under the guidance of three-column theory, treating Colles fracture by manipulative reduction, small splinting fixation and early rehabilitative exercises can reduce pain and swelling time, promote union of fracture, effectively rehabilitate wrist function, improve clinical efficacy, and fit for concept of biomechanics.

  17. The Efficiency of Anterior Repositioning Splints in the Management of Pain Related to Temporomandibular Joint Disc Displacement with Reduction

    Directory of Open Access Journals (Sweden)

    Malgorzata Pihut

    2018-01-01

    Full Text Available Background and Objective. Intra-articular temporomandibular disorders are often related to pain in the area of the temporomandibular joint, ear, and temple. The aim of the study was to investigate the efficiency of anterior repositioning splints in decreasing pain related to temporomandibular joint disc displacement with reduction. Methods. The research material consisted of 112 patients, aged 24 to 45 years, of both genders, who reported for treatment at the Consulting Room of Temporomandibular Joint Dysfunctions at the Jagiellonian University in Cracow between 2014 and 2016 due to pain in the area of the temporomandibular joint(s and noise(s of temporomandibular joint(s present during jaw movements with comorbid contracture of masticatory muscles. Subjects were examined according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD protocol and, after diagnosis of painful disc displacement with reduction and masticatory muscle contracture, they were assigned randomly to either the study or control groups (56 patients in each. In the study group, we used an anterior repositioning splint on the full lower arch for about 20 hours usage over a 4-month period. In the control group, a noninvasive therapy was applied using a biostimulation laser over 12 sessions performed every second day on the area of both temporomandibular joints with mouth open and while performing muscle self-exercises with a dominant protrusive position of the mandible. Pain intensity was evaluated using the Verbal Numerical Rating Scale (VNRS immediately before the treatment and then after 4 and 16 weeks. The obtained data were analyzed using the Mann–Whitney U test p≤0.005. Results. The VNRS values reported during the final examination for the study group were significantly lower than for the control group p=0.0004. Conclusions. The anterior repositioning splint is an efficient tool in decreasing pain related to disc displacement with reduction. This trial

  18. Polishability and wear resistance of splint material for oral appliances produced with conventional, subtractive, and additive manufacturing.

    Science.gov (United States)

    Huettig, Fabian; Kustermann, Achim; Kuscu, Ebru; Geis-Gerstorfer, Jürgen; Spintzyk, Sebastian

    2017-11-01

    Occlusal splints to treat bruxism are commonly made from polymethylmethacrylate (PMMA) in a manual workflow (powder-liquid technique). Today digitalization allows a machine-based manufacturing in subtractive (milling) and additive (printing) means using industrial-made PMMA or comparable resins. An in-vitro study should assess the surface finish and screen the wear resistance of conventional and industrial materials. Therefore, a total of 30 specimens made from conventionally PMMA (group C; powder-liquid, Palapress), polycarbonate ingots (group S; innoBlanc splint plus), and light-curing resin (group A; VarseoWax splint) were polished to examine the surface roughness (Ra) by profilometry and further analyzed by SEM. The specimens were loaded with a steatite ball moving 5000 times along 1cm with 5N of surface pressure under constant wetting (artificial saliva). The total height of profile (Pt) was calculated by further profilometry of the specimens. All specimen showed initially comparable Ra values ranging between 0.06 and 0.05µm (SD = 0.01) after polishing. SEM investigations revealed no visual cues for scratches or irregularities in any group. After abrasion test, the comparison of the wear depths, revealed mean Pt values of 111.4µm (SD = 18.5) in C, 85.7µm (SD = 21.5) in S, and 99.1µm (SD = 21.5) in A, whereas the mean of S was statistically different from C (p = 0.025). No signs of abrasion were found on the steatite balls. All materials showed comparable polished surfaces and a similar scale of wear. It remains questionable if the detected statistical differences are of clinical relevance, but indicates the need for tests of novel materials, especially in additive manufacturing. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Evaluation of shrinkage polymerization and temperature of different acrylic resins used to splinting transfer copings in indirect impression technique

    Science.gov (United States)

    Franco, Ana Paula G. O.; Karam, Leandro Z.; Galvão, José R.; Kalinowski, Hypolito J.

    2015-09-01

    The aim of the present study was evaluate the shrinkage polymerization and temperature of different acrylic resins used to splinting transfer copings in indirect impression technique. Two implants were placed in an artificial bone, with the two transfer copings joined with dental floss and acrylic resins; two dental resins are used. Measurements of deformation and temperature were performed with Fiber Braggs grating sensor for 17 minutes. The results revealed that one type of resin shows greater values of polymerization shrinkage than the other. Pattern resins did not present lower values of shrinkage, as usually reported by the manufacturer.

  20. An adult case of temporomandibular joint osteoarthritis treated with splint therapy and the subsequent orthodontic occlusal reconstruction

    Directory of Open Access Journals (Sweden)

    Hanefi Kurt

    2011-01-01

    Full Text Available Herein we report treatment for a 19-year-old female patient with severe osteoarthritis of the temporomandibular joint. The patient had severe open bite with a Class II molar relationship. She had limited mouth opening and pain. Clinical examination and magnetic resonance imaging revealed that she had anterior disc displacement without reduction. By splint therapy, limited mouth opening and pain was eliminated, but an anterior open bite developed after the treatment. By orthodontic treatment, an acceptable occlusion was achieved with a Class I molar relationship.

  1. Finite Element Analysis of Bone Stress in the Posterior Mandible Using Regular and Short Implants, in the Same Context, with Splinted and Nonsplinted Prostheses.

    Science.gov (United States)

    Toniollo, Marcelo Bighetti; Macedo, Ana Paula; Pupim, Denise; Zaparolli, Danilo; da Gloria Chiarello de Mattos, Maria

    The aim of this study was to compare the bone stress generated by rehabilitation using regular and short-length Morse taper implants (11 and 5 mm, respectively) in the same context and allied with splinted (SP) and nonsplinted (NSP) prostheses in the posterior area of the mandible using finite element analysis. Three-dimensional geometric models using regular implants (Ø4 × 11 mm) and short implants (Ø4 × 5 mm) were simulated with a left posterior mandible that had the first premolar tooth and all teeth posterior to that premolar removed. The four experimental groups were as follows: Group 1 NSP (two regular implants and one short implant rehabilitated with nonsplinted prostheses), Group 1 SP (two regular implants and one short implant rehabilitated with splinted prostheses), Group 2 NSP (one regular implant and two short implants rehabilitated with nonsplinted prostheses), and Group 2 SP (one regular implant and two short implants rehabilitated with splinted prostheses). Oblique forces were simulated in molars (365 N) and premolars (200 N). Qualitative and quantitative analyses of the minimum principal stress in bone were performed using the ANSYS Workbench software, version 10.0. The splinted prostheses decreased the stress to the surrounding bone of short implants. Moreover, they also decreased the stress on the surrounding bone adjacent to the tooth. However, the splinted prostheses generated higher stress in the coverage of the surrounding bone for regular intermediate implants and prominently in the bone at the implant cervical region, at the edge crest, compared with the individualized groups. The benefits in the use of splinted prostheses are notable for the preservation of the bone surrounding the short implants and tooth; however, it is necessary to evaluate each clinical situation because, in this context, the regular implants are at higher stress than the individualized implants.

  2. Parallel Randomized Controlled Clinical Trial in Patients with Temporomandibular Disorders Treated with a CAD/CAM Versus a Conventional Stabilization Splint.

    Science.gov (United States)

    Pho Duc, Jean Marc; Hüning, Sandra Vargas; Grossi, Márcio Lima

    2016-01-01

    This parallel randomized controlled trial (RCT) compared the efficacy of a computer-aided design/computer-assisted manufacture (CAD/CAM) splint versus a conventional stabilization splint in patients with temporomandibular disorders (TMD). A sample of 48 age-matched TMD patients from the Ludwig Maximilian University Prosthodontic Department in Munich, Germany, were randomly allocated into groups 1 (CAD/CAM splint) and 2 (conventional splint). The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used for TMD Axis I (groups I, II, and III) and Axis II (chronic pain grade [CPG]) diagnoses. Numeric scales (TMD/NS, 10 cm) were used to measure headaches, face pain, jaw joint pain, jaw joint noises, mastication pain, neck pain, face tension, limitation of mouth opening, complaints during mastication, and teeth sensitivity at baseline and then monthly for 9 months (T₁ to T₁₀). Optical axiography was used to measure right and left condyle movements (mm) at baseline, 3 months, and 6 months (T₁, T₄, and T₇). A total of 32 patients (drop-out rate = 33%; 68.75% women; 28.51 ± 7.13 years old), 16 per group, completed the study. RDC/TMD Axis I showed the following diagnoses: 93.75% muscle disorders, 37.75% disc displacement with reduction, 3.12% disc displacement without reduction, and 56.25% arthralgia. There was a significant reduction in 10 out of 13 items of the TMD/NS in the CAD/CAM splint versus 8 out of 13 in the conventional splint. However, no significant improvement in mandibular movements (ie, increase in range of motion and reduction in asymmetry between right and left condyles) was observed. Both treatments were equally efficacious and no difference was found between them.

  3. Three-Dimensional Planning in Maxillofacial Fracture Surgery: Computer-Aided Design/Computer-Aided Manufacture Surgical Splints by Integrating Cone Beam Computerized Tomography Images Into Multislice Computerized Tomography Images.

    Science.gov (United States)

    Ren, Jiayin; Zhou, Zhongwei; Li, Peng; Tang, Wei; Guo, Jixiang; Wang, Hu; Tian, Weidong

    2016-09-01

    This study aimed to evaluate an innovative workflow for maxillofacial fracture surgery planning and surgical splint designing. The maxillofacial multislice computerized tomography (MSCT) data and dental cone beam computerized tomography (CBCT) data both were obtained from 40 normal adults and 58 adults who suffered fractures. The each part of the CBCT dentition image was registered into MSCT image by the use of the iterative closest point algorithm. Volume evaluation of the virtual splints that were designed by the registered MSCT images and MSCT images of the same object was performed. Eighteen patients (group 1) were operated without any splint. Twenty-one (group 2) and 19 patients (group 3) used the splints designed according to the MSCT images and registered MSCT images, respectively. The authors' results showed that the mean errors between the 2 models ranged from 0.53 to 0.92 mm and the RMS errors ranged from 0.38 to 0.69 mm in fracture patients. The mean errors between the 2 models ranged from 0.47 to 0.85 mm and the RMS errors ranged from 0.33 to 0.71 mm in normal adults. 72.22% patients in group 1 recovered occlusion. 85.71% patients in group 2, and 94.73% patients in group 3 reconstructed occlusion. There was a statistically significant difference between the MSCT images based splints' volume and the registered MSCT splints' volume in patients (P designing was feasible. The volume of the splints designed by MSCT images tended to be smaller than the splints designed by the integrated MSCT images. The patients operated with splints tended to regain occlusion. The patients who were operated with the splints which were designed according to registered MSCT images tended to get occlusal recovered.

  4. Comparison Study of the Use of Absorbable and Nonabsorbable Materials as Internal Splints after Closed Reduction for Nasal Bone Fracture

    Directory of Open Access Journals (Sweden)

    Chang Ryul Yi

    2014-07-01

    Full Text Available Background The authors sought to compare the use of the nonabsorbable polyvinyl alcohol sponge (PVA, Merocel and absorbable synthetic polyurethane foam (SPF, Nasopore Forte plus as intranasal splints after closed reduction of fractured nasal bones during the hospitalization period. Methods The medical records of 111 patients who underwent closed reduction for nasal bone fracture at Sanggye Paik Hospital, Inje University College of Medicine, from 2012 to 2013 were reviewed retrospectively. PVA (group A or SPF (group B was packed as an internal splint after closed reduction. The efficacy of the materials was compared and statistically analyzed. Results PVA was used in 82 patients, and SPF was used in 29 patients. The patients in group B complained significantly more of nasal pain on the first day after operation than the patients in group A. Headaches on the operation day were significantly more painful in group B than in group A. Bleeding on the fourth postoperative day was significantly reduced in group B as compared to group A. The patients in group B exhibited significantly more intensive nasal obstruction on the operation day and the following day than the patients in group A. However, on the third and fourth postoperative days, the nasal obstruction in group B was less than that in group A. The pain and bleeding related to the packing material was significantly reduced in group B as compared to group A. Conclusions The use of SPF as an absorbable packing material is a reasonable substitute for the traditional nonabsorbable material.

  5. Efficacy of Esthetic Retainers: Clinical Comparison between Multistranded Wires and Direct-Bond Glass Fiber-Reinforced Composite Splints

    Science.gov (United States)

    Scribante, Andrea; Sfondrini, Maria Francesca; Broggini, Simona; D'Allocco, Marina; Gandini, Paola

    2011-01-01

    The purpose of this longitudinal prospective randomized study was to evaluate the reliability of two different types of orthodontic retainers in clinical use: a multistrand stainless steel wire and a polyethylene ribbon-reinforced resin composite. Moreover the level of satisfaction of the patient about the esthetic result was also analyzed by means of a Visual Analogue Scale (VAS). 34 patients (9 boys and 25 girls, mean age 14.3), in the finishing phase of orthodontic treatment, were selected for the study. Since splints were applied the number, cause, and date of splint failures were recorded for each single tooth over 12 months. Statistical analysis was performed using a paired t-test, Kaplan Meier survival estimates, and the log-rank test. Kruskal Wallis test was performed to analyze VAS recordings. Differences between the bond failure rates were not statistically significant. Esthetic result of VAS was significantly higher for polyethylene ribbon-reinforced resin retainers than for stainless steel wires. PMID:22114597

  6. Combined treatment with paraffin, manual therapy, pegboard and splinting in a patient with post-traumatic stiff hand.

    Science.gov (United States)

    Santacreu, Eva Santacreu; Cabezas, Núria Villanueva; Graupera, Asunción Bosch

    2016-01-01

    The stiff hand is a still common, severe complication of hand injuries. We report here the case of a 56 year-old woman, professional goldsmith, who suffered a distal radius fracture of her right hand. The patient was treated with surgery followed by four weeks of immobilization, and developed a stiff hand. Physical examination showed mild inflammatory signs, pain and a major limitation in the extension and supination of the wrist, and in the mobility of the II, III, IV and V metacarpophalangeal (-5° and 32° of average passive extension and flexion, respectively) and interphalangeal (-35° and 73° of average passive extension and flexion, respectively) joints. There was a lack of slip of the flexor tendons. The diagnosis of complex regional pain syndrome was considered although it could not be definitely established. After five months of adverse evolution the patient was referred to our center where a combined intervention with paraffin, manual therapy, prolonged active and passive stretch on a pegboard, and splinting was applied. After initiation of this therapy, a marked change in the evolution of the pain, the mobility and functionality of the hand was observed. At the end of the rehabilitation program the patient was able to fully resume her job. The present case illustrates the need of intensive treatment for post-traumatic hand stiffness, and describes, as an original contribution, a combined intervention therapy including paraffin, manual therapy, pegboard and splinting.

  7. Efficacy of Selective Grinding Guided by an Occlusal Splint in Management of Myofascial Pain: A Prospective Clinical Trial.

    Science.gov (United States)

    Fernández-González, Felipe J; Cabero-López, Jorge; Brizuela, Aritza; Suazo, Ivan; Pérez-Pevida, Esteban; Cobo, Teresa; Montalban, Oier; Diéguez-Pereira, Markel; Chávarri-Prado, David; de la Pinta, Iker Bellanco; Jiménez-Garrudo, Antonio

    2017-01-01

    For patients whose centric relation (CR) has not been considered at the start and during treatment, the task of achieving an occlusal scheme that works together with the temporomandibular joint, the muscles, and the structures of the stomatognathic apparatus becomes a major concern. This study aims to describe a reproducible, predictable and to date unreported procedure of selective grinding guided by an occlusal splint and to analyze condylar position (CP) based on the skeletal pattern. A total of 72 symptomatic patients (38 females and 34 males) were classified into three groups: hyperdivergent, intermediate and hypodivergent. CP was quantified by mounted casts on a measures condyle displacement (MCD) device. Helkimo index was also performed in order to assess the severity of the temporomandibular joint (TMJ) disorders attending to clinical dysfunction, occlusal state and anamnestic dysfunction. Once the stability had been obtained, the splint was progressively reduced until the maximum intercuspation (MIC) was achieved. The vertical displacement was found to be significantly different between the hyperdivergent and other two groups ( p <0.01). Comparisons of MCD analysis before and after the selective grinding procedure identified a statistically significant difference in the horizontal and vertical CP ( p <0.01) between the different groups whereas the Helkimo Index showed a clear improvement of TMJ disorders. All facial types, specially the hyperdivergent face type, showed a reduction in condylar displacement (CD) and less craniomandibular symptoms using this procedure, making it an excellent technique for clinicians.

  8. Comparison of Complications in Removable Mandibular Acrylic Splint and Cantilever Herbst for Management of Class II Malocclusion: A Retrospective Study.

    Science.gov (United States)

    Kanuru, R K; Bhasin, Vinny; Khatri, Amit; Dodda, K K; Singh, Era; Grover, Shekhar

    2017-05-01

    Numerous appliances are present for the management of class II malocclusion. We have conducted a study to compare the clinical complications during treatment with either a removable mandibular acrylic splint (RMS) or with a cantilever Herbst (HC) appliance for the management of class II malocclusion. This study consisted of records of 114 patients (61 males, 53 females), who were divided into two groups. Group I received RMS and group II received HC for the treatment of class II, Division 1 malocclusion. They were further subdivided according to the telescopic system used [Dentaurum type I or propulsor mandibular abzil (PMA)] and fixation mode (splint with crowns or GripTite bands). Patients' clinical records were assessed to identify clinical complications. The results of the study showed that the incidence of complications during treatment in both groups was statistically nonsignificant. The complications with either crown or band were also statistically nonsignificant. The Dentaurum group showed more susceptibility to complications than the PMA group. The PMA telescopic system is more efficient as compared with Dentaurum. Complication resulting from Herbst appliance is independent type of appliance used and mode of fixation. Herbst appliance is the treatment of choice for class II malocclusion.

  9. Assessment of the physical and mechanical properties of plaster of Paris bandage cast used as a splinting and casting materials

    Directory of Open Access Journals (Sweden)

    A. J. Parmar

    2014-12-01

    Full Text Available Aim: To assess the physical and mechanical properties of plaster of Paris (POP bandage cast used as a splinting and casting materials. Materials and Methods: POP casts were divided into three Groups A, B and C with 2, 3 and 8 layer for POP bandage, respectively (n=6 in each group. Handling characters, technical easiness or difficulties, setting time, weight, diameter and thickness of the casts were recorded for different groups. The casts were mounted on universal testing machine and axial load was applied @ 10 mm/min until failure. The load deflection graphs were plotted. The maximum force at which failure of the casts occurred was recorded. Stress, strain, modulus of elasticity (MOE and stiffness of casts were calculated. Result: Construction of POP bandage cast was messy and required 45-60 min for hardening. 8 layer POP cast was comparatively heavier in weight and thicker in cross section than 3 layer cast followed by 2 layer cast. Under axial compression, the load bearing capacity of 8 layer POP casts was more than 2 and 3 layer cast. Conclusion: The values of load bearing capacity, stress, stiffness and MOE of cast were the highest for 8 layer POP cast followed by 2 and 3 layer cast. Use if splints with POP cast is recommended due to its poor mechanical properties.

  10. Source reconstruction based on subdural EEG recordings adds to the presurgical evaluation in refractory frontal lobe epilepsy.

    Science.gov (United States)

    Ramantani, Georgia; Cosandier-Rimélé, Delphine; Schulze-Bonhage, Andreas; Maillard, Louis; Zentner, Josef; Dümpelmann, Matthias

    2013-03-01

    In presurgical investigations of refractory frontal lobe epilepsy, subdural EEG recordings offer extensive cortical coverage, but may overlook deep sources. Electrical Source Localization (ESL) from subdural recordings could overcome this sampling limitation. This study aims to assess the clinical relevance of this new method in refractory frontal lobe epilepsy associated with focal cortical dysplasia. In 14 consecutive patients, we retrospectively compared: (i) the ESL of interictal spikes to the conventional irritative and seizure onset zones; (ii) the surgical outcome of cases with congruent ESL and resection volume to cases with incongruent ESL and resection volume. Each spike type was averaged to serve as a template for ESL by the MUSIC and sLORETA algorithms. Results were superimposed on the corresponding pre and post-surgical MRI. Both ESL methods were congruent and consistent with conventional electroclinical analysis in all patients. In 7 cases, ESL identified a common deep source for spikes of different 2D localizations. The inclusion of ESL in the resection volume correlated with seizure freedom. ESL from subdural recordings provided clinically relevant results in patients with refractory frontal lobe epilepsy. ESL complements the conventional analysis of subdural recordings. Its potential in improving tailored resections and surgical outcomes should be prospectively assessed. Copyright © 2012 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  11. Effects of Pre-surgical Vitamin D Supplementation and Ketogenic Diet in a Patient with Recurrent Breast Cancer.

    Science.gov (United States)

    Branca, Jacopo J V; Pacini, Stefania; Ruggiero, Marco

    2015-10-01

    A woman, mother of one at the age of 19 years, was diagnosed with mammary adenocarcinoma in the right breast in 1985 at the age of 37 years. The patient underwent surgery (quadrantectomy), lymphadenectomy and radiotherapy. In 1999, an adenocarcinoma was diagnosed in the left breast, followed by adequate resection, radiotherapy and anti-oestrogen receptor treatment for 6 years. In March 2014, an infiltrating adenocarcinoma was diagnosed in the remaining part of the right breast that had been operated on and irradiated in 1985. The pre-surgical biopsy, showed weak positivity for progesterone receptor (PgR) (10%, score 2+), and high positivity for the nuclear protein Ki67 (30%). In the three weeks between diagnosis and operation, when no other treatment had been planned, the patient decided to self-administer high doses of oral vitamin D3 (10,000 IU/day), and to follow a strict ketogenic diet. Following right mastectomy, analysis of the surgical specimen showed no positivity for HER2 expression (negative, score 0), and significant increase in positivity of PgR (20%). Positivity for ER and Ki67 were unaltered. This observation indicates that a combination of high-dose vitamin D3 and ketogenic diet leads to changes in some biological markers of breast cancer, i.e. negativization of HER2 expression and increased expression of PgR. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  12. Diagnosis and endodontic treatment of type II dens invaginatus by using cone-beam computed tomography and splint guides for cavity access: a case report.

    Science.gov (United States)

    Zubizarreta Macho, Álvaro; Ferreiroa, Alberto; Rico-Romano, Cristina; Alonso-Ezpeleta, Luis Óscar; Mena-Álvarez, Jesús

    2015-04-01

    Dens invaginatus (DI) is defined as a rare dental malformation. The inherent structural variants of this anatomic disorder make it difficult to perform conventional endodontic treatment procedures by means of a conservative access cavity. In this clinical case report, the authors describe the treatment of a type II DI by means of guided splints for cavity access. This is a clinical report of a case of type II DI in a maxillary lateral incisor. The authors established the diagnosis by means of cone-beam computed tomography (CBCT). The authors manufactured 3 splint guides from a Digital Imaging and Communications in Medicine file and a stereolithography file obtained from a plaster model of the patient by using software for guided implant placement, for access opening, and for locating the root canals. CBCT is an effective method for obtaining information about the root canal system in teeth with DI. In addition, guided implant surgery software is effective for manufacturing splint guides for endodontic treatment with conservative pulp chamber access. Information obtained from CBCT allows the clinician to fabricate splint guides for minimally invasive access opening in this type of case, thus reducing the loss of dental tissue. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

  13. Diagnostic performance of magnetic resonance imaging and pre-surgical evaluation in the assessment of traumatic intra-articular knee disorders in children and adolescents: what conditions still pose diagnostic challenges?

    Energy Technology Data Exchange (ETDEWEB)

    Gans, Itai; Ganley, Theodore J. [The Children' s Hospital of Philadelphia, Division of Orthopaedics, 34th and Civic Center Boulevard, Philadelphia, PA (United States); Bedoya, Maria A.; Ho-Fung, Victor [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

    2014-08-31

    Diagnosis of intra-articular lesions in children based on clinical examination and MRI is particularly challenging. To evaluate the diagnostic performance of MRI and pre-surgical evaluation of the knee in pediatric patients relative to arthroscopic evaluation as the gold standard. We report diagnoses frequently missed or inaccurately diagnosed pre-operatively. We conducted a retrospective review of MRI and pre-surgical evaluation in children and adolescents ages 1-17 years who were treated by knee arthroscopy during a 21/2-year period. All MRIs were reviewed by a pediatric radiologist blinded to clinical findings. Pediatric orthopedic clinic notes were reviewed for pre-surgical evaluation (based on physical exam, radiograph, MR images and radiologist's MRI report). Arthroscopic findings were used as the gold standard. We calculated the percentages of diagnoses at arthroscopy missed on both MRI and pre-surgical evaluation. Diagnostic accuracy between children and adolescents and in patients with one pathological lesion vs. those with >1 lesion was analyzed. We performed a second review of MR images of the missed or over-called MRI diagnoses with knowledge of arthroscopic findings. We included 178 children and adolescents. The most common diagnoses missed on MRI or pre-surgical evaluation but found at arthroscopy were: discoid meniscus (8/30, or 26.7% of cases); lateral meniscal tears (15/80, or 18.8% of cases); intra-articular loose bodies (5/36, or 13.9% of cases), and osteochondral injuries (9/73, or 12.3% of cases). Overall diagnostic accuracy of MRI and pre-surgical evaluation was 92.7% and 95.3%, respectively. No significant difference in diagnostic accuracy between children and adolescents was observed. When multiple intra-articular lesions were present, lateral meniscal tears were more likely to be inaccurately diagnosed (missed or over-called) on both MRI (P = 0.009) and pre-surgical evaluation (P < 0.001). Overall diagnostic accuracy of MRI and pre-surgical

  14. Diagnostic performance of magnetic resonance imaging and pre-surgical evaluation in the assessment of traumatic intra-articular knee disorders in children and adolescents: what conditions still pose diagnostic challenges?

    International Nuclear Information System (INIS)

    Gans, Itai; Ganley, Theodore J.; Bedoya, Maria A.; Ho-Fung, Victor

    2015-01-01

    Diagnosis of intra-articular lesions in children based on clinical examination and MRI is particularly challenging. To evaluate the diagnostic performance of MRI and pre-surgical evaluation of the knee in pediatric patients relative to arthroscopic evaluation as the gold standard. We report diagnoses frequently missed or inaccurately diagnosed pre-operatively. We conducted a retrospective review of MRI and pre-surgical evaluation in children and adolescents ages 1-17 years who were treated by knee arthroscopy during a 21/2-year period. All MRIs were reviewed by a pediatric radiologist blinded to clinical findings. Pediatric orthopedic clinic notes were reviewed for pre-surgical evaluation (based on physical exam, radiograph, MR images and radiologist's MRI report). Arthroscopic findings were used as the gold standard. We calculated the percentages of diagnoses at arthroscopy missed on both MRI and pre-surgical evaluation. Diagnostic accuracy between children and adolescents and in patients with one pathological lesion vs. those with >1 lesion was analyzed. We performed a second review of MR images of the missed or over-called MRI diagnoses with knowledge of arthroscopic findings. We included 178 children and adolescents. The most common diagnoses missed on MRI or pre-surgical evaluation but found at arthroscopy were: discoid meniscus (8/30, or 26.7% of cases); lateral meniscal tears (15/80, or 18.8% of cases); intra-articular loose bodies (5/36, or 13.9% of cases), and osteochondral injuries (9/73, or 12.3% of cases). Overall diagnostic accuracy of MRI and pre-surgical evaluation was 92.7% and 95.3%, respectively. No significant difference in diagnostic accuracy between children and adolescents was observed. When multiple intra-articular lesions were present, lateral meniscal tears were more likely to be inaccurately diagnosed (missed or over-called) on both MRI (P = 0.009) and pre-surgical evaluation (P < 0.001). Overall diagnostic accuracy of MRI and pre-surgical

  15. Revised version of quality guidelines for presurgical epilepsy evaluation and surgical epilepsy therapy issued by the Austrian, German, and Swiss working group on presurgical epilepsy diagnosis and operative epilepsy treatment.

    Science.gov (United States)

    Rosenow, Felix; Bast, Thomas; Czech, Thomas; Feucht, Martha; Hans, Volkmar H; Helmstaedter, Christoph; Huppertz, Hans-Jürgen; Noachtar, Soheyl; Oltmanns, Frank; Polster, Tilman; Seeck, Margitta; Trinka, Eugen; Wagner, Kathrin; Strzelczyk, Adam

    2016-08-01

    The definition of minimal standards remains pivotal as a basis for a high standard of care and as a basis for staff allocation or reimbursement. Only limited publications are available regarding the required staffing or methodologic expertise in epilepsy centers. The executive board of the working group (WG) on presurgical epilepsy diagnosis and operative epilepsy treatment published the first guidelines in 2000 for Austria, Germany, and Switzerland. In 2014, revised guidelines were published and the WG decided to publish an unaltered English translation in this report. Because epilepsy surgery is an elective procedure, quality standards are particularly high. As detailed in the first edition of these guidelines, quality control relates to seven different domains: (1) establishing centers with a sufficient number of sufficiently and specifically trained personnel, (2) minimum technical standards and equipment, (3) continuous medical education of employees, (4) surveillance by trained personnel during video electroencephalography (EEG) monitoring (VEM), (5) systematic acquisition of clinical and outcome data, (6) the minimum number of preoperative evaluations and epilepsy surgery procedures, and (7) the cooperation of epilepsy centers. These standards required the certification of the different professions involved and minimum numbers of procedures. In the subsequent decade, quite a number of colleagues were certified by the trinational WG; therefore, the executive board of the WG decided in 2013 to make these standards obligatory. This revised version is particularly relevant given that the German procedure classification explicitly refers to the guidelines of the WG with regard to noninvasive/invasive preoperative video-EEG monitoring and invasive intraoperative diagnostics in epilepsy. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

  16. Mathematic modeling of stress-deformed states of low jaw teeth while using combined removable splint-denture

    Directory of Open Access Journals (Sweden)

    Albert Ye.L.

    2013-06-01

    Full Text Available The article presents the results of mathematical modeling and analysis of the stress-strain states of the lower incisors in the 1-st, 2-nd and 3-d degrees of inflammatory degenerative process in the periodontium; and while using combined splint-denture with continuous vestibular-oral clasp and polyoxymethylene framework. It is proved that reduction in height of interdental septa observed in periodontitis increases tooth mobility by 2.75 times in the first degree of the pathological process; by 6.75 times - in the second degree; and by 9.0 times – in the third degree (p0.05. At the same time, the stress, transmitted on the alveolar bone tissue is near the values of intact periodontium (p>0.05, 1.6±0.50 Mpa on average.

  17. The Evolution of Splint Armour in Georgia and Byzantium: Lamellar and Scale Armour in the 10th-12th Centuries

    Directory of Open Access Journals (Sweden)

    Mamuka TSURTSUMIA

    2011-10-01

    Full Text Available Byzantine technology was part of the military technology that existed in vast areas of Eurasia; hence study of the armament of its neighbours is important.The purpose of the present paper is to add new data about Byzantium’s Caucasian neighbour (namely, Georgia. Besides that, it also includes certain views about the stages of the evolution and provenance of splint (scale and lamellar armour. This paper also attempts to clarify the difference between banded and linear suits of lamellar armour.There is no doubt that the Byzantine military machine exercised considerable influence on its neighbours, though an opposite phenomenon can also be noticed. The article shows that changes in armour were taking place almost simultaneously in the Byzantine Empire and the Georgian kingdoms and that some of the types of armour that were widespread in Byzantium may have originated in Georgia.

  18. Effect of thermocycling on the shear bond strength of different resins bonded to thermoplastic foil applied in occlusal splint therapy.

    Science.gov (United States)

    Wieckiewicz, Mieszko; Boening, Klaus W; Richter, Gert; Wieckiewicz, Wlodzimierz

    2015-04-01

    Temporomandibular disorders are a group of symptoms related to the impaired function of the temporomandibular joints and associated muscles. Occlusal splint therapy is a common treatment in the aforementioned syndrome. One of the methods of manufacturing occlusal splints is to place a polymer on thermoplastic foil. The aim of this study was to evaluate the shear bond strength of light- and self-cured resins bonded to thermoplastic foil dependent on artificial aging. Thirty cylinders composed of light-cured resin and 30 cylinders made of self-cured resin were attached to 60 rectangular thermoplastic plates. All specimens were divided into six groups. A control study was conducted for groups 1 and 2. The other preparation groups were subjected to thermocycling by setting appropriately 1000 cycles for groups 3 and 4 and 3000 cycles for groups 5 and 6 in distilled water. Bond strength was measured in a universal testing machine. The results were subjected to statistical analysis using the Mann-Whitney U test (p ≤ 0.05). The statistics revealed that the values of the shear bond strength for specimens composed of self-cured resin after 1000 and 3000 thermocycles were significantly higher than on those made of light-cured resin (p = 0.003 and p = 0.002). The shear bond strength between the self-cured resin and the thermoplastic foil was higher and more resistant to aging than the shear bond strength between the light-cured resin and the thermoplastic foil. © 2014 by the American College of Prosthodontists.

  19. Immediate and delayed loading of fixed dental prostheses supported by single or two splinted implants: A histomorphometric study in dogs.

    Science.gov (United States)

    Cesaretti, G; Lang, N P; Viganò, P; Bengazi, F; Apaza Alccayhuaman, K A; Botticelli, D

    2018-04-01

    To evaluate presumptive differences in osseointegration at implants supporting crowns that are physiologically loaded either immediately or 3 months after installation. All premolars and first molars were extracted bilaterally in six dogs. After 3 months of healing, three implants were installed on the premolar region and two in the molar region in one side of the mandible. Likewise, after another 3 months, five implants were installed in the contralateral side, and impressions were taken bilaterally. Within 48 hours, two single crowns were screwed bilaterally onto two implants in the premolar region, and two splinted crowns reproducing the shape of the first molar were screwed bilaterally onto the implants in the molar region. The mesial implants were used as no-loaded controls. Sacrifices were performed after 3 months, and histological analyses were performed. At the premolar sites, mineralised bone-to-implant contact (MBIC%) was 78.0 ± 4.0% and 70.9 ± 7.9% at the delayed and immediately loaded sites, respectively. This difference was statistically significant. At the control implants, MBIC% was 61.4 ± 14.7% and 63.1 ± 13.1% at the delayed and the immediately loaded sites, respectively. At the molar sites, MBIC% was 79.2 ± 10.9% and 61.1 ± 10.3% at the delayed and immediately loaded sites, respectively. Applying a delayed loading to fixed dental prostheses supported by single or two splinted implants yielded higher proportions of bone-to-implant contact (osseointegration) compared to immediately loaded implants. Moreover, both types of loading protocols yielded a higher rate of osseointegration compared to unloaded implant sites after 3 months following implant installation. © 2018 John Wiley & Sons Ltd.

  20. Combined EEG/MEG can outperform single modality EEG or MEG source reconstruction in presurgical epilepsy diagnosis.

    Directory of Open Access Journals (Sweden)

    Ümit Aydin

    Full Text Available We investigated two important means for improving source reconstruction in presurgical epilepsy diagnosis. The first investigation is about the optimal choice of the number of epileptic spikes in averaging to (1 sufficiently reduce the noise bias for an accurate determination of the center of gravity of the epileptic activity and (2 still get an estimation of the extent of the irritative zone. The second study focuses on the differences in single modality EEG (80-electrodes or MEG (275-gradiometers and especially on the benefits of combined EEG/MEG (EMEG source analysis. Both investigations were validated with simultaneous stereo-EEG (sEEG (167-contacts and low-density EEG (ldEEG (21-electrodes. To account for the different sensitivity profiles of EEG and MEG, we constructed a six-compartment finite element head model with anisotropic white matter conductivity, and calibrated the skull conductivity via somatosensory evoked responses. Our results show that, unlike single modality EEG or MEG, combined EMEG uses the complementary information of both modalities and thereby allows accurate source reconstructions also at early instants in time (epileptic spike onset, i.e., time points with low SNR, which are not yet subject to propagation and thus supposed to be closer to the origin of the epileptic activity. EMEG is furthermore able to reveal the propagation pathway at later time points in agreement with sEEG, while EEG or MEG alone reconstructed only parts of it. Subaveraging provides important and accurate information about both the center of gravity and the extent of the epileptogenic tissue that neither single nor grand-averaged spike localizations can supply.

  1. Combined EEG/MEG can outperform single modality EEG or MEG source reconstruction in presurgical epilepsy diagnosis.

    Science.gov (United States)

    Aydin, Ümit; Vorwerk, Johannes; Dümpelmann, Matthias; Küpper, Philipp; Kugel, Harald; Heers, Marcel; Wellmer, Jörg; Kellinghaus, Christoph; Haueisen, Jens; Rampp, Stefan; Stefan, Hermann; Wolters, Carsten H

    2015-01-01

    We investigated two important means for improving source reconstruction in presurgical epilepsy diagnosis. The first investigation is about the optimal choice of the number of epileptic spikes in averaging to (1) sufficiently reduce the noise bias for an accurate determination of the center of gravity of the epileptic activity and (2) still get an estimation of the extent of the irritative zone. The second study focuses on the differences in single modality EEG (80-electrodes) or MEG (275-gradiometers) and especially on the benefits of combined EEG/MEG (EMEG) source analysis. Both investigations were validated with simultaneous stereo-EEG (sEEG) (167-contacts) and low-density EEG (ldEEG) (21-electrodes). To account for the different sensitivity profiles of EEG and MEG, we constructed a six-compartment finite element head model with anisotropic white matter conductivity, and calibrated the skull conductivity via somatosensory evoked responses. Our results show that, unlike single modality EEG or MEG, combined EMEG uses the complementary information of both modalities and thereby allows accurate source reconstructions also at early instants in time (epileptic spike onset), i.e., time points with low SNR, which are not yet subject to propagation and thus supposed to be closer to the origin of the epileptic activity. EMEG is furthermore able to reveal the propagation pathway at later time points in agreement with sEEG, while EEG or MEG alone reconstructed only parts of it. Subaveraging provides important and accurate information about both the center of gravity and the extent of the epileptogenic tissue that neither single nor grand-averaged spike localizations can supply.

  2. Reproducibility of EEG-MEG fusion source analysis of interictal spikes: Relevance in presurgical evaluation of epilepsy.

    Science.gov (United States)

    Chowdhury, Rasheda Arman; Pellegrino, Giovanni; Aydin, Ümit; Lina, Jean-Marc; Dubeau, François; Kobayashi, Eliane; Grova, Christophe

    2018-02-01

    Fusion of electroencephalography (EEG) and magnetoencephalography (MEG) data using maximum entropy on the mean method (MEM-fusion) takes advantage of the complementarities between EEG and MEG to improve localization accuracy. Simulation studies demonstrated MEM-fusion to be robust especially in noisy conditions such as single spike source localizations (SSSL). Our objective was to assess the reliability of SSSL using MEM-fusion on clinical data. We proposed to cluster SSSL results to find the most reliable and consistent source map from the reconstructed sources, the so-called consensus map. Thirty-four types of interictal epileptic discharges (IEDs) were analyzed from 26 patients with well-defined epileptogenic focus. SSSLs were performed on EEG, MEG, and fusion data and consensus maps were estimated using hierarchical clustering. Qualitative (spike-to-spike reproducibility rate, SSR) and quantitative (localization error and spatial dispersion) assessments were performed using the epileptogenic focus as clinical reference. Fusion SSSL provided significantly better results than EEG or MEG alone. Fusion found at least one cluster concordant with the clinical reference in all cases. This concordant cluster was always the one involving the highest number of spikes. Fusion yielded highest reproducibility (SSR EEG = 55%, MEG = 71%, fusion = 90%) and lowest localization error. Also, using only few channels from either modality (21EEG + 272MEG or 54EEG + 25MEG) was sufficient to reach accurate fusion. MEM-fusion with consensus map approach provides an objective way of finding the most reliable and concordant generators of IEDs. We, therefore, suggest the pertinence of SSSL using MEM-fusion as a valuable clinical tool for presurgical evaluation of epilepsy. © 2017 Wiley Periodicals, Inc.

  3. Presurgical orthopedics by drink plates does not significantly normalize deglutition in infants with cleft lip and palate.

    Science.gov (United States)

    Knösel, Michael; Fendel, Christine; Jung, Klaus; Sandoval, Paulo; Engelke, Wilfried G

    2016-03-01

    To test the null hypothesis of no significant difference between intraoral pressure characteristics in infants with cleft lip and palate (CLP) with or without presurgical orthopedic (PSO) plates (groups CLP and CLP-PSO), compared with noncleft infants. Intraoral atmospheric pressure assessments were performed on 17 subjects with preoperative CLP (m/f, 11/6; mean/SD, 4.76/0.92 months) and a matched control group (n = 24; m/f, 15/9; mean/SD, 4.88/0.9 months), for 200 seconds, simultaneously at the vestibulum (vestibular space [VS]) and at the palate (subpalatal space [SPS]), using a prepared pacifier connected to a digital manometer. Areas under the pressure curves (AUC), frequencies, durations, and magnitudes of swallowing peaks and pressure resting plateaus were compared between trial groups and locations (VS, SPS) using a two-factor analysis of variance for repeated measures, Kruskal-Wallis test, and Mann-Whitney U-test (α = .05). The null hypothesis was rejected: Globally, there were statistically significant differences in intraoral pressure characteristics between groups CLP, CLP-PSO, and control (all P < .01), with significantly higher negative pressures (AUC) in the control subjects compared with those of CLP or CLP-PSO. There were significant effects by the location of pressure recordings (VS, SPS) and their interaction with all treatment groups. Differences between noncleft and CLP subjects were more pronounced in the VS than in the SPS. There was no significant effect by PSO. PSO does not improve deviated swallowing characteristics during suction in CLP infants.

  4. A Comparison of Cervical Spine Motion After Immobilization With a Traditional Spine Board and Full-Body Vacuum-Mattress Splint.

    Science.gov (United States)

    Etier, Brian E; Norte, Grant E; Gleason, Megan M; Richter, Dustin L; Pugh, Kelli F; Thomson, Keith B; Slater, Lindsay V; Hart, Joe M; Brockmeier, Stephen F; Diduch, David R

    2017-12-01

    The National Athletic Trainers' Association (NATA) advocates for cervical spine immobilization on a rigid board or vacuum splint and for removal of athletic equipment before transfer to an emergency medical facility. To (1) compare triplanar cervical spine motion using motion capture between a traditional rigid spine board and a full-body vacuum splint in equipped and unequipped athletes, (2) assess cervical spine motion during the removal of a football helmet and shoulder pads, and (3) evaluate the effect of body mass on cervical spine motion. Controlled laboratory study. Twenty healthy male participants volunteered for this study to examine the influence of immobilization type and presence of equipment on triplanar angular cervical spine motion. Three-dimensional cervical spine kinematics was measured using an electromagnetic motion analysis system. Independent variables included testing condition (static lift and hold, 30° tilt, transfer, equipment removal), immobilization type (rigid, vacuum-mattress), and equipment (on, off). Peak sagittal-, frontal-, and transverse-plane angular motions were the primary outcome measures of interest. Subjective ratings of comfort and security did not differ between immobilization types ( P > .05). Motion between the rigid board and vacuum splint did not differ by more than 2° under any testing condition, either with or without equipment. In removing equipment, the mean peak motion ranged from 12.5° to 14.0° for the rigid spine board and from 11.4° to 15.4° for the vacuum-mattress splint, and more transverse-plane motion occurred when using the vacuum-mattress splint compared with the rigid spine board (mean difference, 0.14 deg/s [95% CI, 0.05-0.23 deg/s]; P = .002). In patients weighing more than 250 lb, the rigid board provided less motion in the frontal plane ( P = .027) and sagittal plane ( P = .030) during the tilt condition and transfer condition, respectively. The current study confirms similar motion in the

  5. Stability of the anterior maxillary segment and teeth after segmental le fort I osteotomy and postoperative skeletal elastic fixation with or without occlusal splint

    DEFF Research Database (Denmark)

    Blæhr, Tue Lindberg; Jensen, Thomas; Due, Karen Margrethe

    2014-01-01

    OBJECTIVES: To assess the short term dental and skeletal stability of the anterior maxillary segment after segmental Le Fort I osteotomy with postoperative skeletal elastic fixation with or without occlusal splint. MATERIAL AND METHODS: 29 consecutive patients underwent segmental Le Fort I...... osteotomy and elastic skeletal fixation was applied. Patients were divided into two groups according to whether a fixed occlusal splint was used for six weeks (group A) or dismounted perioperatively (group B). Changes in landmarks and reference planes between the two timepoints were estimated on lateral.......83 to 1.69°). There was no statistically significant difference in stability between the two groups at the P value 0.05. CONCLUSIONS: The skeletal anterior fixation with postoperative elastics for eight weeks may not compromise the early postoperative dental and skeletal stability of the anterior segment...

  6. 3D virtual planning in orthognathic surgery and CAD/CAM surgical splints generation in one patient with craniofacial microsomia: a case report

    Directory of Open Access Journals (Sweden)

    Francisco Vale

    2016-02-01

    Full Text Available Objective: In this case report, the feasibility and precision of tridimensional (3D virtual planning in one patient with craniofacial microsomia is tested using Nemoceph 3D-OS software (Software Nemotec SL, Madrid, Spain to predict postoperative outcomes on hard tissue and produce CAD/CAM (Computer Aided Design/Computer Aided Manufacturing surgical splints. Methods: The clinical protocol consists of 3D data acquisition of the craniofacial complex by cone-beam computed tomography (CBCT and surface scanning of the plaster dental casts. The ''virtual patient'' created underwent virtual surgery and a simulation of postoperative results on hard tissues. Surgical splints were manufactured using CAD/CAM technology in order to transfer the virtual surgical plan to the operating room. Intraoperatively, both CAD/CAM and conventional surgical splints are comparable. A second set of 3D images was obtained after surgery to acquire linear measurements and compare them with measurements obtained when predicting postoperative results virtually. Results: It was found a high similarity between both types of surgical splints with equal fitting on the dental arches. The linear measurements presented some discrepancies between the actual surgical outcomes and the predicted results from the 3D virtual simulation, but caution must be taken in the analysis of these results due to several variables. Conclusions: The reported case confirms the clinical feasibility of the described computer-assisted orthognathic surgical protocol. Further progress in the development of technologies for 3D image acquisition and improvements on software programs to simulate postoperative changes on soft tissue are required.

  7. Small hook thread (Quill) and soft felt internal splint to increase the primary repair strength of lacerated rabbit Achilles tendons: biomechanical analysis and considerations for hand surgery.

    Science.gov (United States)

    Buschmann, Johanna; Müller, Angela; Feldman, Kirill; Tervoort, Theo A; Fessel, Gion; Snedeker, Jess G; Giovanoli, Pietro; Calcagni, Maurizio

    2011-07-01

    For the prevention of re-rupture during early healing phase, the primary repair strength of repaired lacerated tendons in hand surgery should be maximal and the reconstructed diameter minimal. Two new repair methods (small hook thread and internal splint) were assessed for strength and reconstructed diameter characteristics. Achilles tendons of 43 female New Zealand White rabbits were sectioned 2 cm above the calcaneus. Specimens were divided into 7 groups and repaired as follows: Kirchmayr method 2-strand with 4.0 polypropylene thread; Becker method 4-strand; 6-strand; internal splint; Kirchmayr method small hook 2-strand; Becker method small hook 4-strand, non-modified tendon. Load until failure, load until gap formation, gap length, cross-sectional area and failure stress were determined. The small hook 2-strand suture had 1.3 fold higher loads until failure compared to a conventional 2-strand suture, P<0.05. The internal splint had a similar load until failure (22 N (SD 6)) as the conventional 2-strand suture (23 N (SD 4)); around half the load until failure of the conventional 4-strand suture (38 N (SD 9)). Load until gap formation correlated positively with load until failure (y=0.65+3.6; r(2)=0.72). The running suture increased the cross-sectional area at the repair site by a factor of 1.3. Using a small hook thread instead of a 4.0 polypropylene thread significantly increases the primary repair strength with the same number of strands. Internal splints may be an alternative to conventional 2-strand sutures for bridging large gaps. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury: a randomised trial

    Directory of Open Access Journals (Sweden)

    Joan Leung

    2014-12-01

    Full Text Available Question: Is a combination of standing, electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe brain injury? Design: A multi-centre randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants: Thirty-six adults with severe traumatic brain injury and ankle plantarflexion contractures. Intervention: All participants underwent a 6-week program. The experimental group received tilt table standing, electrical stimulation and ankle splinting. The control group received tilt table standing alone. Outcome measures: The primary outcome was passive ankle dorsiflexion with a 12 Nm torque. Secondary outcomes included: passive dorsiflexion with lower torques (3, 5, 7 and 9 Nm; spasticity; the walking item of the Functional Independence Measure; walking speed; global perceived effect of treatment; and perceived treatment credibility. Outcome measures were taken at baseline (Week 0, end of intervention (Week 6, and follow-up (Week 10. Results: The mean between-group differences (95% CI for passive ankle dorsiflexion at Week 6 and Week 10 were –3 degrees (–8 to 2 and –1 degrees (–6 to 4, respectively, in favour of the control group. There was a small mean reduction of 1 point in spasticity at Week 6 (95% CI 0.1 to 1.8 in favour of the experimental group, but this effect disappeared at Week 10. There were no differences for other secondary outcome measures except the physiotherapists’ perceived treatment credibility. Conclusion: Tilt table standing with electrical stimulation and splinting is not better than tilt table standing alone for the management of ankle contractures after severe brain injury. Trial registration: ACTRN12608000637347. [Leung J, Harvey LA, Moseley AM, Whiteside B, Simpson M, Stroud K (2014 Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion

  9. Computer-aided design and computer-aided modeling (CAD/CAM) generated surgical splints, cutting guides and custom-made implants: Which indications in orthognathic surgery?

    Science.gov (United States)

    Scolozzi, P

    2015-12-01

    The purpose of the present report was to describe our indications, results and complications of computer-aided design and computer-aided modeling CAD/CAM surgical splints, cutting guides and custom-made implants in orthognathic surgery. We analyzed the clinical and radiological data of ten consecutive patients with dentofacial deformities treated using a CAD/CAM technique. Four patients had surgical splints and cutting guides for correction of maxillomandibular asymmetries, three had surgical cutting guides and customized internal distractors for correction of severe maxillary deficiencies and three had custom-made implants for additional chin contouring and/or mandibular defects following bimaxillary osteotomies and sliding genioplasty. We recorded age, gender, dentofacial deformity, surgical procedure and intra- and postoperative complications. All of the patients had stable cosmetic results with a high rate of patient satisfaction at the 1-year follow-up examination. No intra- and/or postoperative complications were encountered during any of the different steps of the procedure. This study demonstrated that the application of CAD/CAM patient-specific surgical splints, cutting guides and custom-made implants in orthognathic surgery allows for a successful outcome in the ten patients presented in this series. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  10. Correction of facial asymmetry associated with vertical maxillary excess and mandibular prognathism by combined orthognathic surgery and guiding templates and splints fabricated by rapid prototyping technique.

    Science.gov (United States)

    Ying, B; Ye, N; Jiang, Y; Liu, Y; Hu, J; Zhu, S

    2015-11-01

    The facial asymmetry associated with vertical maxillary excess and mandibular prognathism is one of the more complicated types in the field of oral and maxillofacial surgery. The purpose of this study was to investigate the efficacy of combined orthognathic surgeries, together with guiding templates and splints fabricated by rapid prototyping technique, for the correction of facial asymmetry. Fourteen patients with facial asymmetry associated with vertical maxillary excess and mandibular prognathism were included. A maxillary Le Fort I osteotomy, a sagittal split ramus osteotomy on the shorter side of the face, and an intraoral vertical ramus osteotomy on the longer side of the face were performed with the aid of guiding templates and splints fabricated by rapid prototyping technique. Parameters reflecting maxillary canting, ramal inclination, mandibular deviation, and chin inclination were measured before surgery, 7 days after surgery, and 1 year after surgery, and compared. Significant differences in these parameters were found between the two sides preoperatively, whereas no differences were observed postoperatively. Facial asymmetry was corrected in all patients with satisfactory outcomes. In conclusion, combined orthognathic surgery and guiding templates and splints can offer improvements in accuracy, complexity, and duration over traditional procedures for the correction of facial asymmetry associated with vertical maxillary excess and mandibular prognathism. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Clinical Effectiveness of 6.5-mm-Long Implants to Support Two-Implant Fixed Prostheses in Premolar-Molar Region: The Influence of Immediate Loading and the Length of Splinting Implant.

    Science.gov (United States)

    Anitua, Eduardo; Flores, Carlos; Flores, Javier; Alkhraisat, Mohammad Hamdan

    2018-01-28

    The purpose of this retrospective clinical study was to assess the influence of immediate loading and lengths of splinted implants on the clinical effectiveness of 6.5-mm-long implants supporting two-implant fixed prostheses in the premolar-molar regions. A clinical database was reviewed in a private dental center to select those patients who had 6.5-mm-long implants placed to support two-implant fixed partial prostheses in the premolar-molar regions of the maxilla and the mandible. All implants were immediately loaded. The study groups were defined according to the lengths of the implants. Two groups were identified: the short-short splinted group, when both implants had 6.5 mm lengths, and the short-long splinted group, when one implant was longer than 6.5 mm. A total of 48 dental implants were placed in 16 patients to support 24 two-implant fixed prostheses. The mean follow-up time was 14 ± 5 months. The short-short splinted group included 8 patients with 16 implants; the short-long splinted group included 16 patients with 32 implants. The main variable was implant survival, and secondary outcomes were marginal bone stability and prosthesis survival. The statistical analyses indicated an absence of significant differences between the two groups in terms of implant and prosthesis survival (100% for both groups and both variables); however, distal bone loss around the splinted implants was significantly higher in the short-long splinted group. Bone loss was 0.37 ± 0.55 mm in the short-short splinted group and 0.94 ± 0.66 mm in the short-long splinted group. Immediate loading of short (6.5-mm-long) implants in the premolar-molar regions did not jeopardize their survival. Two-implant supported prostheses had the same clinical effectiveness, whether extra-short implants were splinted to another extra-short implant or to a longer one. © 2018 by the American College of Prosthodontists.

  12. Stress-strain distribution at bone-implant interface of two splinted overdenture systems using 3D finite element analysis

    Science.gov (United States)

    2013-01-01

    PURPOSE This study was accomplished to assess the biomechanical state of different retaining methods of bar implant-overdenture. MATERIALS AND METHODS Two 3D finite element models were designed. The first model included implant overdenture retained by Hader-clip attachment, while the second model included two extracoronal resilient attachment (ERA) studs added distally to Hader splint bar. A non-linear frictional contact type was assumed between overdentures and mucosa to represent sliding and rotational movements among different attachment components. A 200 N was applied at the molar region unilaterally and perpendicular to the occlusal plane. Additionally, the mandible was restrained at their ramus ends. The maximum equivalent stress and strain (von Mises) were recorded and analyzed at the bone-implant interface level. RESULTS The values of von Mises stress and strain of the first model at bone-implant interface were higher than their counterparts of the second model. Stress concentration and high value of strain were recognized surrounding implant of the unloaded side in both models. CONCLUSION There were different patterns of stress-strain distribution at bone-implant interface between the studied attachment designs. Hader bar-clip attachment showed better biomechanical behavior than adding ERA studs distal to hader bar. PMID:24049576

  13. Effectiveness of functional hand splinting and the cognitive orientation to occupational performance (CO-OP) approach in children with cerebral palsy and brain injury: two randomised controlled trial protocols

    Science.gov (United States)

    2014-01-01

    Background Cerebral palsy (CP) and brain injury (BI) are common conditions that have devastating effects on a child’s ability to use their hands. Hand splinting and task-specific training are two interventions that are often used to address deficits in upper limb skills, both in isolation or concurrently. The aim of this paper is to describe the method to be used to conduct two randomised controlled trials (RCT) investigating (a) the immediate effect of functional hand splints, and (b) the effect of functional hand splints used concurrently with task-specific training compared to functional hand splints alone, and to task-specific training alone in children with CP and BI. The Cognitive Orientation to Occupational Performance (CO-OP) approach will be the task-specific training approach used. Methods/Design Two concurrent trials; a two group, parallel design, RCT with a sample size of 30 participants (15 per group); and a three group, parallel design, assessor blinded, RCT with a sample size of 45 participants (15 per group). Inclusion criteria: age 4-15 years; diagnosis of CP or BI; Manual Abilities Classification System (MACS) level I – IV; hand function goals; impaired hand function; the cognitive, language and behavioural ability to participate in CO-OP. Participants will be randomly allocated to one of 3 groups; (1) functional hand splint only (n=15); (2) functional hand splint combined with task-specific training (n=15); (3) task-specific training only (n=15). Allocation concealment will be achieved using sequentially numbered, sealed opaque envelopes opened by an off-site officer after baseline measures. Treatment will be provided for a period of 2 weeks, with outcome measures taken at baseline, 1 hour after randomisation, 2 weeks and 10 weeks. The functional hand splint will be a wrist cock-up splint (+/- thumb support or supination strap). Task-specific training will involve 10 sessions of CO-OP provided in a group of 2-4 children. Primary outcome

  14. Reconstruction of white matter fibre tracts using diffusion kurtosis tensor imaging at 1.5T: Pre-surgical planning in patients with gliomas.

    Science.gov (United States)

    Leote, Joao; Nunes, Rita G; Cerqueira, Luis; Loução, Ricardo; Ferreira, Hugo A

    2018-01-01

    Tractography studies for pre-surgical planning of primary brain tumors is typically done using diffusion tensor imaging (DTI), which cannot resolve crossing, kissing or highly angulated fibres. Tractography based on the estimation of the diffusion kurtosis (DK) tensor was recently demonstrated to enable tackling these limitations. However, its use in the clinical context at low 1.5T field has not yet been reported. To evaluate if the estimation of whole-brain tractography using the DK tensor is feasible for pre-surgical investigation of patients with brain tumors at 1.5T. Eight healthy subjects and 3 patients with brain tumors were scanned at 1.5T using a 12-channel head coil. Diffusion-weighted images were acquired with repetition/echo times of 5800/107 ms, 82 × 82 resolution, 3 × 3 × 3 mm 3 voxel size, b-values of 0, 1000, 2000 s/mm 2 and 64 gradient sensitising directions. Whole-brain tractography was estimated using the DK tensor and corticospinal tracts (CST) were isolated using regions-of-interest placed at the cerebral peduncles and motor gyrus. Tract size, DK metrics and CST deviation index (highest curvature point) were compared between healthy subjects and patients. Tract sizes did not differ between groups. The CST deviation index was significantly higher in patients compared to healthy subjects. Fractional anisotropy was significantly lower in patients, with higher mean kurtosis asymmetry index at the highest curvature point in patients. Corticospinal fibre bundles estimated using DK tensor in a 1.5T scanner presented similar properties in patients with brain gliomas as those reported in the literature using DTI-based tractography.

  15. Pre-surgical integration of FMRI and DTI of the sensorimotor system in transcortical resection of a high-grade insular astrocytoma

    Directory of Open Access Journals (Sweden)

    Chelsea eEkstrand

    2016-03-01

    Full Text Available Herein we report on a patient with a WHO Grade III astrocytoma in the right insular region in close proximity to the internal capsule who underwent a right frontotemporal craniotomy. Total gross resection of insular gliomas remains surgically challenging based on the possibility of damage to the corticospinal tracts. However, maximizing the extent of resection has been shown to decrease future adverse outcomes. Thus, the goal of such surgeries should focus on maximizing extent of resection while minimizing possible adverse outcomes. In this case, pre-surgical planning included integration of functional magnetic resonance imaging (fMRI and diffusion tensor imaging (DTI, to localize motor and sensory pathways. Novel fMRI tasks were individually developed for the patient to maximize both somatosensory and motor activation simultaneously in areas in close proximity to the tumor. Information obtained was used to optimize resection trajectory and extent, facilitating gross total resection of the astrocytoma. Across all three motor-sensory tasks administered, fMRI revealed an area of interest just superior and lateral to the astrocytoma. Further, DTI analyses showed displacement of the corona radiata around the superior dorsal surface of the astrocytoma, extending in the direction of the activation found using fMRI. Taking into account these results, a transcortical superior temporal gyrus surgical approach was chosen in order to avoid the area of interest identified by fMRI and DTI. Total gross resection was achieved and minor post-surgical motor and sensory deficits were temporary. This case highlights the utility of comprehensive pre-surgical planning, including fMRI and DTI, to maximize surgical outcomes on a case-by-case basis.

  16. Virtual reality presurgical planning for cerebral gliomas adjacent to motor pathways in an integrated 3-D stereoscopic visualization of structural MRI and DTI tractography.

    Science.gov (United States)

    Qiu, Tian-ming; Zhang, Yi; Wu, Jin-Song; Tang, Wei-Jun; Zhao, Yao; Pan, Zhi-Guang; Mao, Ying; Zhou, Liang-Fu

    2010-11-01

    Resection of gliomas invading primary motor cortex and subcortical motor pathway is difficult in both surgical decision-making and functional outcome prediction. In this study, magnetic resonance (MR) diffusion tensor imaging (DTI) data were used to perform tractography to visualize pyramidal tract (PT) along its whole length in a stereoscopic virtual reality (VR) environment. The potential value of its clinical application was evaluated. Both three-dimensional (3-D) magnetic resonance imaging (MRI) and DTI datasets were obtained from 45 eligible patients with suspected cerebral gliomas and then transferred to the VR system (Dextroscope; Volume Interactions Pte. Ltd., Singapore). The cortex and tumor were segmented and reconstructed via MRI, respectively, while the tractographic PTs were reconstructed via DTI. All those were presented in a stereoscopic 3-D display synchronously, for the purpose of patient-specific presurgical planning and surgical simulation in each case. The relationship between increasing amplitude of the number of effective fibers of PT (EPT) at affected sides and the patients' Karnofsky Performance Scale (KPS) at 6 months was addressed out. In VR presurgical planning for gliomas, surgery was aided by stereoscopic 3-D visualizing the relative position of the PTs and a tumor. There was no significant difference between pre- and postsurgical EPT in this population. A positive relationship was proved between EPT increasing amplitude and 6-month KPS. 3-D stereoscopic visualization of tractography in this VR environment enhances the operators to well understand the anatomic information of intra-axial tumor contours and adjacent PT, results in surgical trajectory optimization initially, and maximal safe tumor resection finally. In accordance to the EPT increasing amplitude, surgeon can predict the long-term motor functional outcome.

  17. PreSurgMapp: a MATLAB Toolbox for Presurgical Mapping of Eloquent Functional Areas Based on Task-Related and Resting-State Functional MRI.

    Science.gov (United States)

    Huang, Huiyuan; Ding, Zhongxiang; Mao, Dewang; Yuan, Jianhua; Zhu, Fangmei; Chen, Shuda; Xu, Yan; Lou, Lin; Feng, Xiaoyan; Qi, Le; Qiu, Wusi; Zhang, Han; Zang, Yu-Feng

    2016-10-01

    The main goal of brain tumor surgery is to maximize tumor resection while minimizing the risk of irreversible postoperative functional sequelae. Eloquent functional areas should be delineated preoperatively, particularly for patients with tumors near eloquent areas. Functional magnetic resonance imaging (fMRI) is a noninvasive technique that demonstrates great promise for presurgical planning. However, specialized data processing toolkits for presurgical planning remain lacking. Based on several functions in open-source software such as Statistical Parametric Mapping (SPM), Resting-State fMRI Data Analysis Toolkit (REST), Data Processing Assistant for Resting-State fMRI (DPARSF) and Multiple Independent Component Analysis (MICA), here, we introduce an open-source MATLAB toolbox named PreSurgMapp. This toolbox can reveal eloquent areas using comprehensive methods and various complementary fMRI modalities. For example, PreSurgMapp supports both model-based (general linear model, GLM, and seed correlation) and data-driven (independent component analysis, ICA) methods and processes both task-based and resting-state fMRI data. PreSurgMapp is designed for highly automatic and individualized functional mapping with a user-friendly graphical user interface (GUI) for time-saving pipeline processing. For example, sensorimotor and language-related components can be automatically identified without human input interference using an effective, accurate component identification algorithm using discriminability index. All the results generated can be further evaluated and compared by neuro-radiologists or neurosurgeons. This software has substantial value for clinical neuro-radiology and neuro-oncology, including application to patients with low- and high-grade brain tumors and those with epilepsy foci in the dominant language hemisphere who are planning to undergo a temporal lobectomy.

  18. Stress distribution in delayed replanted teeth splinted with different orthodontic wires: a three-dimensional finite element analysis.

    Science.gov (United States)

    de Souza, Fernando Isquierdo; Poi, Wilson Roberto; da Silva, Vanessa Ferreira; Martini, Ana Paula; Melo, Regis Alexandre da Cunha; Panzarini, Sonia Regina; Rocha, Eduardo Passos

    2015-06-01

    The aim was to evaluate the biomechanical behavior of the supporting bony structures of replanted teeth and the periodontal ligament (PDL) of adjacent teeth when orthodontic wires with different mechanical properties are applied, with three-dimensional finite element analysis. Based on tomographic and microtomographic data, a three-dimensional model of the anterior maxilla with the corresponding teeth (tooth 13-tooth 23) was generated to simulate avulsion and replantation of the tooth 21. The teeth were splinted with orthodontic wire (Ø 0.8 mm) and composite resin. The elastic modulus of the three orthodontic wires used, that is, steel wire (FA), titanium-molybdenum wire (FTM), and nitinol wire (FN) were 200 GPa, 84 GPa, and 52 GPa, respectively. An oblique load (100 N) was applied at an angle of 45° on the incisal edge of the replanted tooth and was analyzed using Ansys Workbench software. The maximum (σmax) and minimum (σmin) principal stresses generated in the PDL, cortical and alveolar bones, and the modified von Mises (σvM) values for the orthodontic wires were obtained. With regard to the cortical bone and PDL, the highest σmin and σmax values for FTM, FN, and FA were checked. With regard to the alveolar bone, σmax and σmin values were highest for FA, followed by FTM and FN. The σvM values of the orthodontic wires followed the order of rigidity of the alloys, that is, FA > FTM > FN. The biomechanical behavior of the analyzed structures with regard to all the three patterns of flexibility was similar. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Clinical outcomes from a foam wedge splinting program for axillary contracture prevention in the intensive care unit.

    Science.gov (United States)

    Godleski, Matthew; Holden, Mary Sullivan; Luby, Darcie; Weitzenkamp, David; Boimbo, Sandra; Lindberg, Gordon

    2014-01-01

    Preventing scar contracture after burn injury is a critical goal during recovery. Although the need for intervention is well-understood, data on specific techniques are limited. The study's objective is to provide data for the use of a foam abduction wedge in terms of safety, effectiveness, and patient and caregiver satisfaction through a prospective, single-arm trial. All patients presenting with a burn injury that required grafting in the axillary region and placed them at risk for shoulder joint contracture were offered inclusion. Patient outcomes were recorded for the duration of their burn intensive care unit admission. Ten subjects completed the protocol with a mean duration of wedge use of 41.5 ± 32.5 days. At discharge, the mean shoulder abduction was 132° ± 38° on the left and 118° ± 22° on the right. The mean shoulder flexion was 132° ± 31° on the left and 123° ± 29° on the right. As much as 90% of the subjects had greater than 90° of shoulder abduction and flexion at discharge. There were no observations of worsening burn injury wounds, graft failure, or new pressure-related wounds. One patient was found to have an upper-extremity peripheral nerve injury that was not clearly associated with the splint. Patient and nursing surveys indicated areas of satisfaction as well as areas for potential improvement. This study illustrates the anticipated clinical outcomes and care issues associated with the use of a specific contracture prevention method used in the burn intensive care unit setting as well as identifying areas for future research.

  20. Anatomically Based Outcome Predictors of Treatment for Obstructive Sleep Apnea with Intraoral Splint Devices: A Systematic Review of Cephalometric Studies

    Science.gov (United States)

    Guarda-Nardini, Luca; Manfredini, Daniele; Mion, Marta; Heir, Gary; Marchese-Ragona, Rosario

    2015-01-01

    Aims: The aim of this review is to summarize data from the literature on the predictive value of anatomy-based parameters, as identified by cephalometry, for the efficacy of mandibular advancement devices (MAD) for the treatment of obstructive sleep apnea (OSA). Methods: Articles were initially selected based on their titles or abstracts. Full articles were then retrieved and further scrutinized according to predetermined criteria. Reference lists of selected articles were searched for any missed publications. The selected articles were methodologically evaluated. Results: Of an initial 311 references, 13 were selected that assessed correlations between polysomnographic and cephalometric variables. The majority of studies demonstrated a correlation between treatment effectiveness and features as determined by cephalometric analysis, such as the mandibular plane angle, hyoid bone distance to mandible, antero-posterior diameter of the maxilla, tongue area, cranial base, and soft palate. Conclusions: The mandibular plane angle and the distance between hyoid bone and mandibular plane was found to have a predictive value for MAD effectiveness in OSA patients. However, the relative weak and somewhat inconsistent cephalometric data suggest that decisions based solely on these factors cannot be recommended, especially because an integrated analysis of other risk factors (e.g., age, sex, BMI) should also be taken into account. Citation: Guarda-Nardini L, Manfredini D, Mion M, Heir G, Marchese-Ragona R. Anatomically based outcome predictors of treatment for obstructive sleep apnea with intraoral splint devices: a systematic review of cephalometric studies. J Clin Sleep Med 2015;11(11):1327–1334. PMID:25979102

  1. A prospective study of the short-term treatment effects of the acrylic-splint rapid maxillary expander combined with the lower Schwarz appliance.

    Science.gov (United States)

    Wendling, Lisa K; McNamara, James A; Franchi, Lorenzo; Baccetti, Tiziano

    2005-01-01

    This prospective clinical study evaluated the short-term treatment effects of acrylic-splint rapid maxillary expander in conjunction with lower Schwarz appliance (RME-Sz) therapy to the acrylic-splint rapid maxillary expansion alone (RME-only group). Pretreatment and posttreatment lateral cephalograms were analyzed for 25 RME patients and 19 RME-Sz patients. The average time between films ranged between nine and 12 months. Statistical comparisons of the treatment changes in the RME-only and RME-Sz groups were performed by means of independent sample t-tests (P < .05). The largest difference between the two groups was in lower anterior facial height (LAFH). The normally occurring increase in LAFH was not observed in the RME-only group during the treatment period, indicating that the acrylic-splint expander had a posterior "bite block effect" on the developing craniofacial complex. LAFH increased by 1.7 mm in the RME-Sz group, a value similar to that observed in untreated individuals. Slight forward displacement of the maxilla was observed when RME was used alone, and the sagittal position of the maxilla remained unchanged in the RME-Sz group. A significant amount of intrusion of the maxillary molars (-0.8 mm) was noted in the RME-only group, whereas the maxillary molars were prevented from erupting in the RME-Sz group. The lower dentition showed a significantly greater amount of extrusion in the RME-Sz group than in the RME-only group. Finally, the Sz appliance prevented the mesial movement of the lower molars during the treatment period.

  2. [A new orthopedic apparatus for the treatment of congenital equinovarus clubfoot. The active-passive articulated splint. Critical study propos of 72 cases treated in our department].

    Science.gov (United States)

    Lubrano di Diego, J G; Noyer, D; Daudet, M; Kohler, R; Dodat, H; Vidal, P; Louis, D; Chappius, J P

    1979-01-01

    The authors present a new equipment for orthopaedic assesment of club-foot. This "dynamic splint" aims to produce a self-correction of the deformity by the infant at time of each movement of his lower limb. With regard to 72 such deformities, concerning 47 children, they record the results after an average follow-up of more than 2 years. Criterions of results, clinical and chiefly radiological, more objectives, are classified into 3 parts : correction of varus of the foot, correction of adduction of the hind-foot, correction of equinus.

  3. The influence of crown-to-implant ratio on marginal bone levels around splinted short dental implants: A radiological and clincial short term analysis.

    Science.gov (United States)

    Hingsammer, Lukas; Watzek, Georg; Pommer, Bernhard

    2017-12-01

    The amount of marginal bone resorption around dental implants is considered to have a significant impact on implant stability as well as implant survival rates. The aim of this prospective study was to investigate the influence of prosthetic as well as patient specific factors on marginal bone loss around short dental implants. Seventy-six implants, which supported splinted crowns were included for investigation. All implants were from the same type and had an intraosseous length of 6.5 mm and a diameter of 4.0 mm. Twenty implants were additionally splinted onto longer ones. Measurements of marginal bone loss were performed at a mean of 12.38 months after prosthetic loading and the mean follow-up for clinical evaluation was 20.52 months. Overall two implant failures were recorded, revealing a survival rate of 97.3%. Marginal bone resorption around 72 short implants measured 0.71 mm (SD: 0.74 mm) and was found to have a strong correlation with calculated Crown-to-Implant ratio (r = .71; P implant surface area, location, position, bone quality, and insertion torque did not influence peri-implant bone loss after one year of loading. Within the limitations of the study, it is suggested that Crown-to-Implant ratios should not exceed 1.7 to avoid increased early marginal bone loss. © 2017 Wiley Periodicals, Inc.

  4. A long-term evaluation of the mandibular Schwarz appliance and the acrylic splint expander in early mixed dentition patients.

    Science.gov (United States)

    O'Grady, Paul W; McNamara, James A; Baccetti, Tiziano; Franchi, Lorenzo

    2006-08-01

    The aim of this prospective longitudinal clinical study was to evaluate the short-term and long-term changes in dental-arch dimensions in patients treated with either an acrylic splint rapid maxillary expander alone (RME-only) or a rapid maxillary expander combined with a mandibular removable Schwarz plate (RME-Sz) in the early mixed dentition, followed later by fixed appliances in the permanent dentition. The dental casts of 27 RME-only patients were compared with those of 23 RME-Sz patients and 16 untreated controls (CTRL) with constricted maxillary arches at 4 times: pretreatment (T1), after expansion but before fixed appliance therapy (T2), after fixed appliance therapy (T3), and at long-term observation (T4). The mean ages for the treated groups were approximately 9 years at T1, 12 years at T2, 14 years at T3, and 20 years at T4. Arch width, arch depth, arch perimeter, and molar angulation were assessed in all subjects at all observation times. T1-T2, T2-T3, T3-T4, and T1-T4 changes were compared statistically in the treated groups with respect to the CTRL. Treatment with an RME-only or an RME-Sz followed by fixed appliances produced significant short-term and long-term increases in maxillary arch widths compared with the CTRL. The RME-Sz led to significantly more favorable results than the RME-only protocol: (1) significantly greater increases in the transverse width of the mandibular arch and mandibular arch perimeter in the long term, and (2) uprighting of the mandibular posterior teeth buccally, thus allowing for an amount of maxillary expansion that was clinically effective for the correction of moderate tooth size-arch size discrepancies. In the overall observation interval, the significant increases in maxillary and mandibular arch perimeters in the RME-Sz group were 3.8 and 3.7 mm, respectively, when compared with the CTRL. The RME-only protocol produced modest long-term increases in maxillary arch perimeter (2.6 mm); the average long-term increase in

  5. Presurgical functional transcranial Doppler sonography (fTCD) with intravenous echo enhancing agent SonoVue enables determination of language lateralization in epilepsy patients with poor temporal bone windows.

    Science.gov (United States)

    House, Patrick M; Brückner, Katja E; Lohmann, Hubertus H

    2011-03-01

    Presurgical determination of language lateralization is important for planning and outcome estimation of neurosurgical interventions in patients with drug-refractory epilepsy. Functional transcranial Doppler sonography (fTCD) provides an established measure for language lateralization using the temporal bone windows for continuous recording of the cerebral blood flow velocity (CBFV) in both middle cerebral arteries (MCAs). However, because of insufficient temporal bone windows, fTCD cannot be applied properly in every patient. Here, we established stable and sufficient CBFV signals in both MCAs using continuous intravenous application of echo-enhancing agent SonoVue in 7 of 10 patients with poor temporal bone windows and were thus able to determine language lateralization. We conclude that the application of SonoVue can solve one principal disadvantage of fTCD and improves the applicability of the technique as a presurgical functional language lateralization procedure. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

  6. FDG PET/CT diagnostic criteria may need adjustment based on MRI to estimate the presurgical risk of extrapelvic infiltration in patients with uterine endometrial cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sudo, Satoko; Sakuragi, Noriaki [Hokkaido University Graduate School of Medicine, Department of Gynecology, Sapporo (Japan); Hattori, Naoya; Manabe, Osamu; Hirata, Kenji; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Kitaku, Sapporo (Japan); Kato, Fumi; Mimura, Rie; Magota, Keiichi; Sugimori, Hiroyuki [Hokkaido University Graduate School of Medicine, Department of Diagnostic and Interventional Radiology, Sapporo (Japan)

    2015-04-01

    The staging of endometrial cancer requires surgery which carries the risk of morbidity. FDG PET/CT combined with anatomical imaging may reduce the number of unnecessary lymphadenectomies by demonstrating the risk of extrapelvic infiltration. The purpose of this study was to optimize FDG PET/CT diagnostic criteria for risk assessment in endometrial cancer after first-line risk triage with MRI. The study population comprised 37 patients who underwent curative surgery for the treatment of endometrial cancer. First, the risk of extrapelvic infiltration was triaged using MRI. Second, multiple glucose metabolic profiles of the primary lesion were assessed with FDG PET/CT, and these were correlated with the histopathological risk of extrapelvic infiltration including lymphovascular space invasion (LVSI) and high-grade malignancy (grades 2 and 3). The results of histological correlation were used to adjust FDG PET/CT diagnostic criteria. Presurgical assessment using MRI was positive for deep (>50 %) myometrial invasion in 17 patients. The optimal FDG PET/CT diagnostic criteria vary depending on the results of MRI. Specifically, SUVmax (≥16.0) was used to indicate LVSI risk with an overall diagnostic accuracy of 88.2 % in patients with MRI findings showing myometrial invasion. High-grade malignancy did not correlate with any of metabolic profiles in this patient group. In the remaining patients without myometrial invasion, lesion glycolysis (LG) or metabolic volume were better indicators of LVSI than SUVmax with the same diagnostic accuracy of 80.0 %. In addition, LG (≥26.9) predicted high-grade malignancy with an accuracy of 72.2 %. Using the optimized cut-off criteria for LVSI, glucose metabolic profiling of primary lesions correctly predicted lymph node metastasis with an accuracy of 73.0 %, which was comparable with the accuracy of visual assessment for lymph node metastasis using MRI and FDG PET/CT. FDG PET/CT diagnostic criteria may need adjustment based on the

  7. A Three-Dimensional Finite Element Analysis of the Stress Distribution Generated by Splinted and Nonsplinted Prostheses in the Rehabilitation of Various Bony Ridges with Regular or Short Morse Taper Implants.

    Science.gov (United States)

    Toniollo, Marcelo Bighetti; Macedo, Ana Paula; Rodrigues, Renata Cristina; Ribeiro, Ricardo Faria; de Mattos, Maria G

    The aim of this study was to compare the biomechanical performance of splinted or nonsplinted prostheses over short- or regular-length Morse taper implants (5 mm and 11 mm, respectively) in the posterior area of the mandible using finite element analysis. Three-dimensional geometric models of regular implants (Ø 4 × 11 mm) and short implants (Ø 4 × 5 mm) were placed into a simulated model of the left posterior mandible that included the first premolar tooth; all teeth posterior to this tooth had been removed. The four experimental groups were as follows: regular group SP (three regular implants were rehabilitated with splinted prostheses), regular group NSP (three regular implants were rehabilitated with nonsplinted prostheses), short group SP (three short implants were rehabilitated with splinted prostheses), and short group NSP (three short implants were rehabilitated with nonsplinted prostheses). Oblique forces were simulated in molars (365 N) and premolars (200 N). Qualitative and quantitative analyses of the minimum principal stress in bone were performed using ANSYS Workbench software, version 10.0. The use of splinting in the short group reduced the stress to the bone surrounding the implants and tooth. The use of NSP or SP in the regular group resulted in similar stresses. The best indication when there are short implants is to use SP. Use of NSP is feasible only when regular implants are present.

  8. Casting and Splinting

    Science.gov (United States)

    2017-08-21

    article /80165-technigue Self Evaluation Is injured extremity in desired position? »- Empty can position »- Wrist extension 20° );;>- MCP Oexion...periodically throughout the day If cast feels tight despite elevation seek medical assistance Do not scratch under cast; do not get cast wet Get

  9. Displacement and force distribution of splinted and tilted mandibular anterior teeth under occlusal loads: an in silico 3D finite element analysis

    Directory of Open Access Journals (Sweden)

    Allahyar Gerami

    2016-06-01

    Full Text Available Abstract Background Fixed orthodontic retainers have numerous advantages, but it is not known whether they can exert pathological forces on supporting tissues around the splinted teeth. The purpose of this study was to investigate how the inclination of the lower anterior teeth can affect dental displacement and also change the direction of occlusal loads exerted to dental and its supporting tissues. Methods Four three-dimensional finite element models of the anterior part of the mandible were designed. All the models contained the incisors and canines, their periodontal ligament layers (PDLs, the supporting bone (both spongy and cortical, and a pentaflex splinting wire placed in the lingual side of the teeth. Teeth inclination was considered to be 80° (model 1, 90° (model 2, 100° (model 3, and 110° (model 4 to the horizontal plane. The lower incisors were loaded with a 187-N vertical force. Their displacement patterns and the stress in their PDLs were evaluated. Results In incisors with 80° of inclination, less than a 0.1-mm lingual displacement was seen on the incisal edge and a similar distance of displacement towards the labial was seen on their root apices. However, in models with 90°–110° of inclination, the incisal edge displaced labially between about 0.01 and 0.45 mm, while root apices displaced lingually instead. By increasing the angle of the teeth, the strain in the periodontal ligament increased from about 37 to 58 mJ. The von Mises stresses around the cervical and apical areas differed for each tooth and each model, without a similar pattern. Increasing the angle of the teeth resulted in much higher cervical stresses in the incisors, but not in the canines. In the lateral incisor, cervical stress increased until 100° of inclination but reduced to about half by increasing the angle to 110°. Apical stress increased rather consistently in the incisor and lateral incisors, by increasing the inclination. However, in the

  10. Comportamento estrutural de vigas de concreto reforçadas com ripas de bambu cravejadas de pinos Structural behavior of concrete beams reinforced with pinned bamboo-splints

    Directory of Open Access Journals (Sweden)

    Antonio C. Braga Filho

    2010-10-01

    Full Text Available Uma das deficiências do bambu reforçando vigas de concreto armado está relacionada com deslocamentos relativos entre os dois materiais. A investigação aqui reportada teve como objetivo avaliar experimentalmente a possibilidade de se melhorar o trabalho conjunto bambu-concreto, através do cravejamento de pinos nas ripas de bambu usadas como reforço. Para tanto, oito vigas de concreto foram ensaiadas, das quais seis foram reforçadas com ripas de bambu Dendrocalamus giganteus Munro cravejadas de pinos e duas armadas com ripas de bambu sem a presença dos pinos, como referência. Usaram-se dois tipos de pino: de aço ou de bambu, em número de dois, três ou quatro pinos entre nós. Curvas força-deslocamento e força-deformação dos materiais são apresentadas e discutidas, em que os resultados mostraram que a cravação dos pinos produziu um aumento de rigidez das vigas; contudo, o furo feito para colocação do pino reduziu localmente a seção transversal da ripa de bambu e, consequentemente, a resistência última das vigas. Finalmente, resultados similares foram obtidos em vigas reforçadas com pino de aço ou de bambu.One drawback of bamboo as concrete reinforcement beams is the relative displacement between the two materials. The research reported in this paper aimed to experimentally investigate the improvement of bamboo-concrete-bond by means of nailing. Eight concrete beams were tested, six of them reinforced with Dendrocalamus giganteus Munro nailed bamboo-splints and two reference beams, reinforced with bamboo-splints without pins. Steel pins or bamboo pins were used. Two, three and four pins were nailed between bamboo nodes. Load-displacement and load-strain curves are presented and discussed. The results showed that the pins improved the beam stiffness; nevertheless, they reduced locally the transversal section of the bamboo splint and, consequently, the ultimate load. Finally, similar results were showed by beams reinforced

  11. Cranioplasty using presurgically fabricated presterilised polymethyl methacrylate plate by a simple, cost-effective technique on patients with and without original bone flap: study on 29 patients.

    Science.gov (United States)

    Sharavanan, G M; Jayabalan, Suresh; Rajasukumaran, K; Veerasekar, Ganesh; Sathya, G

    2015-06-01

    The purpose of the study was to assess the clinical effectiveness of presurgically fabricated pre-sterilized polymethyl methacrylate (PMMA) plate as a cranioplasty material. The study group consisted of 29 patients with skull defect following decompressive craniectomy. Some patients had their original bone flap preserved and some were without it. In either group pre-sterilized prefabricated PMMA plate was used. On each visit, patients were clinically assessed; CT scans were taken in immediate follow up period but if needed more films were taken in subsequent follow ups. Post-op complications that include infection, post-op hematoma, chronic pain, aesthetic, biocompatibility, post-op dimensional changes of prosthesis were evaluated. Mean follow up was 7 1/2 months. Five patients developed swelling and pain in the subsequent follow ups. One patient was treated conservatively with antibiotics. Tapping was performed in couple of patients. Surgical evacuation of hematoma was performed in one patient. Of the five infected plates, one demanded removal from the patient. One complained of chronic pain. Post-op follow up assessed clinically and by CT scan confirmed good aesthetic result, biocompatibility and dimensional stability of prosthesis. The result of this study support the view that the use of prefabricated pre-sterilized PMMA plate as cranioplasty material is a simple, reliable, convenient way that brings acceptable function and aesthetics to patients who underwent decompressive craniectomy, in an inexpensive way.

  12. Effect of presurgical orthopedics on oral-health related quality of life in Chilean children with cleft lip and palate. A pilot study.

    Directory of Open Access Journals (Sweden)

    Pedro Christian Aravena

    2016-11-01

    Full Text Available The aim of this pilot study was to evaluate the effect of Presurgical Orthopedics (PSO on the oral health-related quality of life (OHRQoL in Children with Cleft Lip and Palate (CLP treated in two hospitals in Chile using the Spanish version of the Child Oral Health Impact Profile (COHIP-Sp. Method: Cross-sectional study, involving 42 children with CLP (mean age 12±2.1 years; 28 men who attended their annual checkup at the main Hospital of Valdivia and at the Hospital Fundacion Gantz in Santiago, Chile, between March and April 2016. Those who met the selection criteria were applied the COHIP-Sp scale. Based on their medical records, patients who used PSO as treatment protocol were classified as "PSO". Those who did not receive treatment with the appliance were classified as "Non-PSO". The score of the COHIP-Sp scale and its domains between the two groups was compared (t-test, p<0.05. Results: Twenty-five patients (59.5% used PSO. COHIP-Sp score was 91.7±26.2 points in the PSO group, and 81.2±30.9 points in the Non-PSO group. There was no statistically significant difference (p=0.24. Conclusion: OHRQoL of patients with CLP treated with PSO was similar to that of patients not treated with PSO.

  13. Endometrial carcinoma: merit of magnetic resonance in pre-surgical staging; Carcinoma de endometrio: valor de la estadificacion prequirurgica por resonancia magnetica

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez, E.; Barrera, M. C.; Gervas, C.; Salvador, E.; Rivero, B. [Hospital Donostia. San sebastian (Spain); Sentis, M. [Corporacio Sanitaria Pare Tauli. Sabadell (Spain)

    2003-07-01

    To evaluate MR capacity in assessing deep myometrial and cervical infiltrations in cases of endometrial carcinoma. A series of 30 consecutively diagnosed endometrial cancer patients was pre-surgically evaluated by means of magnetic resonance (MR). TSE-T2 sequences with fat saturation and dynamic FFe sequence were used after gadolinium administration. A correlation with post-surgical histological stating was made. There were then determined sensitivity (S), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) for the deep myometrial infiltration and cervical invasion. Cases of overestimation and underestimation were analyzed. Values obtained for myometrium and cervix were, respectively, S of 67% and 63%, SP of 89% and 91%, PPV of 80% and 71% and NPV of 80% and 87%. Two cases each were over valued for myometrial infiltration and cervix: four cases and 3 cases, respectively, were undervalues. MR stating in cases of endometrial carcinoma is a highly reliable diagnostic technique, but it does present certain limitations. (Author) 19 refs.

  14. Kappa-splints application for the treatment of pathological dental hard tissues abrasion in combination with dentition defects and dentition deformations

    Directory of Open Access Journals (Sweden)

    Svitlana Petrishin

    2017-03-01

    2. After studying the movements of conventional hinge axis in articulate heads of TMJ with the help of condylograph «Cadiax Compact» and eliminating the symptoms of stress in masticatory muscles of the patients with occlusive disorders at pathological dental hard tissues abrasion, it is the gradual application of a kappa-splints set, made of hard transparent plates of Ercodent Ercodur material (Germany with a thickness of 1.0 to 5.0 mm, which allows prevention of further tooth wear, normalization of occlusive correlations of the jaws, separating a bite with optimum thickness throughout the dentition, thus the lower jaw takes a position at which the state of functional equilibrium of the entire dentition is restored.

  15. A multi-centred clinical audit to describe the efficacy of direct supra-coronal splinting--a minimally invasive approach to the management of cracked tooth syndrome.

    Science.gov (United States)

    Banerji, S; Mehta, S B; Kamran, T; Kalakonda, M; Millar, B J

    2014-07-01

    This audit looked at the use of direct composite splinting to manage cracked tooth syndrome (CTS). Patients who had been assessed as having CTS were offered the treatment of a directly bonded, composite overlay restoration placed in supra-occlusion. Cases were reviewed up to 3 months later. In all, 151 restorations were followed up in the audit of which 131 were successful at 3 months. The remaining 20 restorations failed due to pulp complications (11), failure of the composite (5) or intolerance to the high restoration (4). Of the 131, patients described transient problems with chewing (94), composite breakage (13), TMD (1), phonetics (1), increased mobility (1) and tender to chewing (1). This is a successful non-invasive method of managing CTS in the short term for patients willing to accept transient effects. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Early treatment with the von Rosen splint for neonatal instability of the hip is safe regarding avascular necrosis of the femoral head

    Science.gov (United States)

    Wenger, Daniel; Samuelsson, Hanna; Düppe, Henrik; Tiderius, Carl Johan

    2016-01-01

    Background and purpose — Avascular necrosis of the femoral head (AVN) is a complication in treatment of developmental dysplasia of the hip (DDH). We evaluated the risk of AVN after early treatment in the von Rosen splint and measured the diameter of the ossific nucleus at 1 year of age. Children and methods — All children born in Malmö, Sweden, undergo clinical screening for neonatal instability of the hip (NIH). We reviewed 1-year radiographs of all children treated early for NIH in our department from 2003 through 2010. The diameter of the ossific nucleus was measured, and signs of AVN were classified according to Kalamchi-MacEwen. Subsequent radiographs, taken for any reason, were reviewed and a local registry of diagnoses was used to identify subsequent AVN. Results — 229 of 586 children referred because of suspected NIH received early treatment (age ≤ 1 week) for NIH during the study period. 2 of the 229 treated children (0.9%, 95% CI: 0.1–3.1) had grade-1 AVN. Both had spontaneous resolution and were asymptomatic during the observation time (6 and 8 years). 466 children met the inclusion criteria for measurement of the ossific nucleus. Neonatally dislocated hips had significantly smaller ossific nuclei than neonatally stable hips: mean 9.4 mm (95% CI: 9.1–9.8) vs. 11.1 mm (95% CI: 10.9–11.3) at 1 year (p < 0.001). Interpretation — Early treatment with the von Rosen splint for NIH is safe regarding AVN. The ossification of the femoral head is slower in children with NIH than in untreated children with neonatally stable hips. PMID:26730503

  17. Retrospective study of clinical complications during orthodontic treatment with either a removable mandibular acrylic splint Herbst or with a cantilever Herbst.

    Science.gov (United States)

    Silva, Joelson Fonseca Egidio; Gerszewski, Camila; Moresca, Ricardo Cesar; Correr, Gisele Maria; Flores-Mir, Carlos; Moro, Alexandre

    2015-01-01

    To compare the clinical complications during treatment with either a removable mandibular acrylic splint (RMS) or with a cantilever (HC) Herbst appliance. Records from 159 Class II, division 1, consecutively treated patients with a Herbst appliance were examined. The sample was composed of 82 male and 77 female patients with a mean age of 11.8 years. The Herbst appliance was used for a mean of 12 months (standard deviation 2.15 months). Two main Herbst groups were analyzed: group RMS (n  =  125) and group HC (n  =  34). They were further subdivided according to the telescopic system used (Dentaurum type 1 or PMA) and fixation mode (splint with crowns or Grip Tite bands). Patients' clinical records were assessed to identify clinical complications. The incidence of complications during treatment was 85.3% for the HC group and 88.0% for the RMS group, with no statistically significant difference (Mann-Whitney test, P > .05). The fixation mode (crown or band) also did not show a statistically significant difference (P > .05). Regarding the telescopic system used, the Dentaurum group had 2.9 times more susceptibility to complications than the PMA group, regardless of the Herbst type. On average, approximately 2.5 complications per patient were reported. Most patients had a maximum of three complications during Herbst treatment. Herbst appliance type (RMS or HC) and fixation mode (crowns or Grip Tite bands) did not influence the number of complications. The PMA (without screws) telescopic system seemed to be more reliable (regarding the number of complications) than Dentaurum type 1, regardless of the appliance design (RMS or HC).

  18. Stability of the anterior maxillary segment and teeth after segmental le fort I osteotomy and postoperative skeletal elastic fixation with or without occlusal splint.

    Science.gov (United States)

    Blæhr, Tue Lindberg; Jensen, Thomas; Due, Karen Margrethe; Neumann-Jensen, Bjarne

    2014-07-01

    To assess the short term dental and skeletal stability of the anterior maxillary segment after segmental Le Fort I osteotomy with postoperative skeletal elastic fixation with or without occlusal splint. 29 consecutive patients underwent segmental Le Fort I osteotomy and elastic skeletal fixation was applied. Patients were divided into two groups according to whether a fixed occlusal splint was used for six weeks (group A) or dismounted perioperatively (group B). Changes in landmarks and reference planes between the two timepoints were estimated on lateral cephalometric radiographs. The upper incisor had a mean intrusion of -0.56 mm (SD 0.77; range -2.04 to 1.08 mm) and a mean posterior movement of -0.93 mm (SD 1.03; range -2.52 to 0.96 mm). The mean change in the axial inclination of the upper incisor was -0.33° (SD 2.56; range -6° to 4°) (95% CI: -1.75 to 1.08°). Group B: The upper incisor had a mean intrusion of -0.13 mm (SD 1.36; range -1.92 to 3.6 mm) and a mean anterior movement of 0.11 mm (SD 1.78; range -2.88 to 3.84 mm). The mean change in the axial inclination of the upper incisor was -0.07° (SD 3.05; range -5° to 5°) (95% CI: -1.83 to 1.69°). There was no statistically significant difference in stability between the two groups at the P value 0.05. The skeletal anterior fixation with postoperative elastics for eight weeks may not compromise the early postoperative dental and skeletal stability of the anterior segment in segmental Le Fort I osteotomy.

  19. Stability of the Anterior Maxillary Segment and Teeth after Segmental Le Fort I Osteotomy and Postoperative Skeletal Elastic Fixation With or Without Occlusal Splint

    Directory of Open Access Journals (Sweden)

    Tue Lindberg

    2014-10-01

    Full Text Available Objectives: To assess the short term dental and skeletal stability of the anterior maxillary segment after segmental Le Fort I osteotomy with postoperative skeletal elastic fixation with or without occlusal splint. Material and Methods: 29 consecutive patients underwent segmental Le Fort I osteotomy and elastic skeletal fixation was applied. Patients were divided into two groups according to whether a fixed occlusal splint was used for six weeks (group A or dismounted perioperatively (group B. Changes in landmarks and reference planes between the two timepoints were estimated on lateral cephalometric radiographs. Results: Group A: The upper incisor had a mean intrusion of -0.56 mm (SD 0.77; range -2.04 to 1.08 mm and a mean posterior movement of -0.93 mm (SD 1.03; range -2.52 to 0.96 mm. The mean change in the axial inclination of the upper incisor was -0.33° (SD 2.56; range -6° to 4° (95% CI: -1.75 to 1.08°. Group B: The upper incisor had a mean intrusion of -0.13 mm (SD 1.36; range -1.92 to 3.6 mm and a mean anterior movement of 0.11 mm (SD 1.78; range -2.88 to 3.84 mm. The mean change in the axial inclination of the upper incisor was -0.07° (SD 3.05; range -5° to 5° (95% CI: -1.83 to 1.69°. There was no statistically significant difference in stability between the two groups at the P value 0.05. Conclusions: The skeletal anterior fixation with postoperative elastics for eight weeks may not compromise the early postoperative dental and skeletal stability of the anterior segment in segmental Le Fort I osteotomy.

  20. Pre-surgical study of the biological effects of the selective cyclo-oxygenase-2 inhibitor celecoxib in patients with primary breast cancer.

    Science.gov (United States)

    Martin, Lesley-Ann; Davies, Giles L S; Weigel, Marion T; Betambeau, Nadine; Hills, Margaret J; Salter, Janine; Walsh, Geraldine; A'Hern, Roger; Dowsett, Mitch

    2010-10-01

    Cyclo-oxygenase 2 (COX-2) is implicated in the regulation of aromatase transcription in malignant breast tissue and has been considered as a potential target for tissue specific aromatase suppression. We initiated a randomised controlled pre-surgical study of celecoxib versus no treatment in women with primary breast cancer to determine the effects of COX-2 inhibition on markers of biological response. Postmenopausal women (50-80 years of age) with stage I or II, primary breast cancer, were randomised 2:1 to receive 400 mg/day celecoxib or no treatment for 14 days prior to surgery. A core biopsy was obtained pre- and post-treatment. Paired baseline and endpoint biopsies were analysed for Ki67, apoptosis, COX-2, CD31, estrogen receptor (ER) and progesterone receptor (PgR). Comparisons between the treatment groups were conducted using the Mann-Whitney test with a two-sided 5% significance. Of the 25 patients treated, 23 had evaluable data and 19 (83%) were ER positive. Overall the geometric mean change in Ki67, the primary end point, relative to baseline in the celecoxib arm was -16.6% (P = 0.056). The change in the no-treatment group was -8.1% (P = 0.24). There was no statistically significant difference in the change between the two groups. Celecoxib did not significantly affect apoptosis, COX-2, ER or PgR expression. There is only modest evidence for a biological effect of celecoxib in primary breast cancer. However, the trend towards a reduction in Ki67 in ER-positive breast cancer warrants further investigations in a larger cohort of patients.

  1. Comparison of intra-aortic computed tomography angiography to conventional angiography in the presurgical visualization of the Adamkiewicz artery: first results in patients with thoracoabdominal aortic aneurysms

    International Nuclear Information System (INIS)

    Clarencon, Frederic; Maria, Federico di; Cormier, Evelyne; Sourour, Nader; Gabrieli, Joseph; Iosif, Christina; Chiras, Jacques; Gaudric, Julien; Koskas, Fabien; Jenny, Catherine

    2013-01-01

    The aim of this study was to compare the sensitivity of intra-aortic computed tomography angiography (IA-CTA) to that of regular spinal digital subtraction angiography for the presurgical location of the Adamkiewicz artery (AKA). Thirty patients (21 males, 9 females; mean age 64 years) had an IA-CTA for the location of the AKA before surgery of aneurysm (n = 24) or dissection (n = 6) of the thoracoabdominal aorta. After femoral artery puncture, a pigtail catheter was positioned at the origin of the descending aorta. CT acquisition was performed with an intra-aortic iodinated contrast media injection (15 mL/s, 120 mL). The visualization of the AKA and the location of the feeder(s) to the AKA were independently evaluated by two observers. Interrater agreement was calculated using a kappa test. Spinal angiogram by selective catheterization was systematically performed to confirm the results of the IA-CTA. The AKA was visualized by the IA-CTA in 27/30 cases (90 %); in 26/31 (84 %) cases, the continuity with the aorta was satisfactorily seen. Interrater agreement was good for the visualization of the AKA and its feeder(s): 0.625 and 0.87, respectively. In 75 % of the cases for which the AKA was visualized, the selective catheterization confirmed the results of the IA-CTA. In the remaining 25 % of the cases, the selective catheterization could not be performed due to marked vessels' tortuosity or ostium stenosis. IA-CTA is a feasible technique in a daily practice that presents a good sensitivity for the location of the AKA. (orig.)

  2. Fast presurgical magnetic resonance imaging of meniscal tears and concurrent subchondral bone marrow lesions. Study of dogs with naturally occurring cranial cruciate ligament rupture.

    Science.gov (United States)

    Olive, J; d'Anjou, M-A; Cabassu, J; Chailleux, N; Blond, L

    2014-01-01

    Meniscal tears and subchondral bone marrow lesions have both been described in dogs with cranial cruciate ligament rupture, but their possible concurrence has not been evaluated. In a population of 14 dogs exhibiting signs of stifle pain with surgically confirmed cranial cruciate ligament rupture, a short presurgical 1.5T magnetic resonance (MR) imaging protocol including dorsal proton density, dorsal T1-weighted gradient recalled echo, and sagittal fat-saturated dual echo sequences was tested to further investigate these features and illustrate meniscal tears. Interobserver agreement for detection of medial meniscal tears (k=0.83) and bone marrow lesions (k=0.87) was excellent. Consensus MR reading allowed detection of nine out of 12 surgically confirmed medial meniscal tears and there was no false positive. All dogs had cruciate ligament enthesis-related bone marrow lesions in the tibia, femur or both bones. Additionally, among the 12 dogs with confirmed medial meniscal tears, subchondral bone marrow lesions were present in the caudomedial (9 dogs) and caudoaxial (11 dogs) regions of the tibial plateau, resulting in odds ratios (13.6, p=0.12, and 38.3, p=0.04, respectively) that had large confidence intervals due to the small group size of this study. The other two dogs had neither tibial bone marrow lesions in these locations nor medial meniscal tears. These encouraging preliminary results warrant further investigation using this clinically realistic preoperative MR protocol. As direct diagnosis of meniscal tears remained challenging in dogs even with high-field MR, identification of associated signs such as subchondral bone marrow lesions might indirectly allow suspicion of an otherwise unrecognized meniscal tear.

  3. Presurgical localization of abnormal parathyroid glands using a single injection of technetium-99m methoxyisobutylisonitrile: comparison of different techniques including factor analysis of dynamic structures

    Energy Technology Data Exchange (ETDEWEB)

    Blocklet, D. [Hopital Universitaire Erasme, Univ. Libre de Bruxelles (Belgium); Martin, P. [Hopital Universitaire Brugmann, Univ. Libre de Bruxelles (Belgium); Schoutens, A. [Hopital Universitaire Erasme, Univ. Libre de Bruxelles (Belgium); Verhas, M. [Hopital Universitaire Brugmann, Univ. Libre de Bruxelles (Belgium); Hooghe, L. [Hopital Universitaire Brugmann, Univ. Libre de Bruxelles (Belgium); Kinnaert, P. [Hopital Universitaire Erasme, Univ. Libre de Bruxelles (Belgium)

    1997-01-01

    The aims of this study were to determine which of the analytical techniques described for this method time-activity curves analysis of dynamic structures corresponds best with surgical findings, and to ascertain the potential overall contribution of presurgical scintigraphy. 55P patients were studied, 34 of whom presented with primary hyperparathyroidism (HPT) and 21 with secondary HPT. After a 925 MBq injection of technetium-99m MIBI, a 40-min dynamic acquisition was performed and static images were acquired at 5, 20, 40 and 120 min using a gamma camera equipped with a pinhole collimator. Sensitivity was 84.4%, 74% and 65% in adenoma and 76%, 66.6% and 45% in hyperplasia for 15`-120`, FADS and TACs, respectively. Surgical accuracy was 72%, 56% and 59% in adenoma and 53%, 30% and 22% in hyperplasia for 15`-120`, FADS and TACs, respectively. The visual comparison method scored best in all cases. FADS was found to be sensitive in cases of adenoma but was handicapped by more false-positive localizations. TACs were particular inefficient in hyperplasia. With respect to the detection of adenomas, we found a relationship between the gland weight and scintigraphic positivity. This dependence was not found in hyperplasia. The poorer results obtained with all techniques for surgical accuracy can be explained by the need for a complete scintigraphic description of all pathological glands found by the surgeon in a patient. This study demonstrates that the 15`-120` visual comparison method is more efficient However, it was less efficient than neck exploration by an experienced surgeon. (orig./ vhe) (orig.). With 4 figs., 4 tabs.

  4. Adhesive taping vs. daily manual muscle stretching and splinting after botulinum toxin type A injection for wrist and fingers spastic overactivity in stroke patients: a randomized controlled trial.

    Science.gov (United States)

    Santamato, Andrea; Micello, Maria Francesca; Panza, Francesco; Fortunato, Francesca; Picelli, Alessandro; Smania, Nicola; Logroscino, Giancarlo; Fiore, Pietro; Ranieri, Maurizio

    2015-01-01

    To compare the effectiveness of two procedures increasing the botulinum toxin type A effect for wrist and finger flexor spasticity after stroke. A single-blind randomized trial. Seventy patients with upper limb post-stroke spasticity. Adults with wrist and finger flexor muscles spasticity after stroke were submitted to botulinum toxin type A therapy. After the treatment, the subjects injected were randomly divided into two groups and submitted to adhesive taping (Group A) or daily muscle manual stretching, passive articular mobilization of wrist and fingers, and palmar splint (Group B) for 10 days. We measured spasticity with Modified Ashworth Scale, related disability with Disability Assessment Scale, and fingers position at rest. The measurements were done at baseline, after two weeks, and after one month from the treatment session. After two weeks, subjects in Group A reported a significantly greater decrease in spasticity scores (Modified Ashworth Scale fingers: mean (standard deviation) 1.3±0.6 vs. 2.1±0.6; Modified Ashworth Scale wrist: 1.7 ±0.6 vs. 2.3 ±0.8), and after one month in spasticity and disability scores (Modified Ashworth Scale fingers: mean (standard deviation) 1.9 ±0.7 vs. 2.5 ±0.6; Modified Ashworth Scale wrist: 2.0 ±0.7 vs. 2.6 ±0.6; Disability Assessment Scale: 1.6 ±0.7 vs. 2.1 ±0.7) compared with Group B subjects. Subjects in Group A reported also a significantly improved fingers position at rest compared with Group B subjects after two weeks (2.8 ±0.9 vs. 2.1 ±0.7) and one month (2.3 ±0.7 vs. 1.5 ±0.6). Adhesive taping of wrist and finger flexor muscles appeared to enhance the effect of botulinum toxin type A therapy more than daily manual muscle stretching combined with passive articular mobilization and palmar splint. © The Author(s) 2014.

  5. Presurgical brain mapping of the language network in patients with brain tumors using resting-state fMRI: Comparison with task fMRI.

    Science.gov (United States)

    Sair, Haris I; Yahyavi-Firouz-Abadi, Noushin; Calhoun, Vince D; Airan, Raag D; Agarwal, Shruti; Intrapiromkul, Jarunee; Choe, Ann S; Gujar, Sachin K; Caffo, Brian; Lindquist, Martin A; Pillai, Jay J

    2016-03-01

    To compare language networks derived from resting-state fMRI (rs-fMRI) with task-fMRI in patients with brain tumors and investigate variables that affect rs-fMRI vs task-fMRI concordance. Independent component analysis (ICA) of rs-fMRI was performed with 20, 30, 40, and 50 target components (ICA20 to ICA50) and language networks identified for patients presenting for presurgical fMRI mapping between 1/1/2009 and 7/1/2015. 49 patients were analyzed fulfilling criteria for presence of brain tumors, no prior brain surgery, and adequate task-fMRI performance. Rs-vs-task-fMRI concordance was measured using Dice coefficients across varying fMRI thresholds before and after noise removal. Multi-thresholded Dice coefficient volume under the surface (DiceVUS) and maximum Dice coefficient (MaxDice) were calculated. One-way Analysis of Variance (ANOVA) was performed to determine significance of DiceVUS and MaxDice between the four ICA order groups. Age, Sex, Handedness, Tumor Side, Tumor Size, WHO Grade, number of scrubbed volumes, image intensity root mean square (iRMS), and mean framewise displacement (FD) were used as predictors for VUS in a linear regression. Artificial elevation of rs-fMRI vs task-fMRI concordance is seen at low thresholds due to noise. Noise-removed group-mean DiceVUS and MaxDice improved as ICA order increased, however ANOVA demonstrated no statistically significant difference between the four groups. Linear regression demonstrated an association between iRMS and DiceVUS for ICA30-50, and iRMS and MaxDice for ICA50. Overall there is moderate group level rs-vs-task fMRI language network concordance, however substantial subject-level variability exists; iRMS may be used to determine reliability of rs-fMRI derived language networks. © 2015 Wiley Periodicals, Inc.

  6. Use of the Tübingen splint for the initial management of severely dysplastic and unstable hips in newborns with DDH: an alternative to Fettweis plaster and Pavlik harness.

    Science.gov (United States)

    Kubo, Hannes; Pilge, Hakan; Weimann-Stahlschmidt, Kristina; Stefanovska, Karoline; Westhoff, Bettina; Krauspe, Ruediger

    2018-02-01

    Hip dysplasia is one of the most common skeletal disorders. As a late consequence 20-25% of the patients are at risk to develop secondary osteoarthritis and may require total hip replacement early in life. The treatment principles of hip dislocation are (1) concentric reposition, (2) retention, i.e., plaster in human post or Pavlik harness and (3) maturation in abduction flexion orthesis. The Tübingen splint was introduced as a further development of abduction devices for the treatment of (residual) hip dysplasia with stable hips. The advantages are easy handling, adjustment according to growth and safe limitation of abduction. The aim of this study was to determine the success of treatment of unstable hips with use of the Tübingen splint from early diagnosis until final end of therapy hence normal ultrasound findings. From January 2003 to August 2016 79 children with 109 sonographic unstable hips were treated with the Tübingen splint initially consequently 24 h/day. Inclusion criteria were diagnosis of type D, type III a/b or type IV hips according to Graf and beginning of treatment at an age of less or equal 6 weeks, without limitation of abduction on clinical examination. At the time of diagnosis 51 type D (46.8%), 46 type III (42.2%) and 12 type IV (11.0%) hips were noticed. In 30 patients (38.0%) bilateral hip dysplasia (type D-IV) was diagnosed. 104 of 109 hips (95.4%) treated with the Tübingen splint could be transferred in a type I hip after a mean treatment period of 88.9 days (SD ± 26.0). In 5 cases (4.6%, 1 type III and 4 type IV hips) the treatment failed. Our data show, that successful treatment of unstable hips in neonates with the Tübingen splint is a comparably successful treatment modality relative to the Pavlik harness and Fettweis plaster.

  7. Presurgical assessment of spina bifida

    International Nuclear Information System (INIS)

    Stack, J.P.; Fitzgerald, P.; Redmond, O.; Ennis, J.T.

    1989-01-01

    Twenty-five children (mean age, 8 years) with spina bifida (occult in 10), who were under active consideration for surgical intervention became of clinical deterioration have been assessed with MR imaging. T1-weighted spin-echo (SE) images (500/17 [repetition time msec/echo time msec]) were obtained in at least two planes. T2-weighted SE sequences were reserved for further tissue characterization. Anomalies detected requiring surgical review included diastematomyelia (n = 6), tethered cord (n = 10), hydromyelia (n = 4), and cord cyst (n = 1). Eight were not considered for surgery (cord atrophy and small hydromyelias). Diastem spurs were best identified on CT. MR imaging provided accurate preoperative assessment (11 of 13 cases) and will replace invasive tests, which should now be reserved for those cases where MR imaging does not elucidate the clinical signs

  8. Bilateral diaphyseal bone cysts of the tibia mimicking shin splints in a young professional athlete--a case report and depiction of a less-invasive surgical technique.

    Science.gov (United States)

    Toepfer, Andreas; Harrasser, Norbert; Lenze, Ulrich; Liska, Franz; Mühlhofer, Heinrich; von Eisenhart-Rothe, Rüdiger; Banke, Ingo J

    2015-08-23

    Medial tibial stress syndrome is one of the most common causes of exertional leg pain in runners whereas musculoskeletal tumors and tumor-like lesions are rare encounters in orthopedic sports medicine practice. Unicameral (simple) bone cyst is a well-known tumor-like lesions of the bone typically affecting children and adolescents. Bilateral occurrence is very rare though and has never been reported before in both tibiae. Failing to accurately diagnose a tumorous lesion can entail far-reaching consequences for both patients and physicians. We report the case of large bilateral unicameral bone cysts of the diaphyseal tibiae mimicking medial tibial stress syndrome in a 17-year old professional athlete. This is the first report of symmetric tibial unicameral bone cysts in the literature. The patient complained about persisting shin splint-like symptoms over 5 months despite comprehensive conservative treatment before MRI revealed extensive osteolytic bone lesions in both diaphyseal tibiae. The patient-tailored, less-invasive surgical procedure, allowing the patient to return to his competitive sports level symptom-free 3 months after surgery and to eventually qualify for this years Biathlon Junior World Championships, is outlined briefly. Pathogenesis and various treatment options for this entity will be discussed. This report will help to raise awareness for musculoskeletal tumors as differential diagnosis for therapy-refractory symptoms in young athletes and encourage medical staff involved in sports medicine and athlete support to perform early high quality imaging and initiate sufficient surgical treatment in similar cases. Moreover, our less-invasive surgical procedure aiming for a fast return to sports might be an optimal compromise between traditional open curettage with low risk of recurrence and a soft tissue-saving and bone-sparing minimal-invasive technique.

  9. Influence of the number of layers of paris bandage plasters on the mechanical properties speciments used on orthopedic splints Influência do número de camadas na propriedade mecânica de espécimes fabricados com atadura gessada usados para confeccionar splints ortopédicos

    Directory of Open Access Journals (Sweden)

    Gustavo C. Vieira

    2011-10-01

    Full Text Available OBJECTIVE: To evaluate the effects of varying numbers of layers of plaster of Paris bandages on the mechanical properties of specimens used on the construction of orthopedic splints. METHODS: Rectangular plate-shaped and cylinder-shaped specimens were constructed and assigned to two groups simulating plaster slabs and cast and further divided into six subgroups according to the number of layers used: 3, 6, 8, 10, 12 and 14 layers. The specimens were subjected to either a three-point bending test (plates/slab or compressive strength test (cylinders/cast. The following mechanical properties were evaluated: maximum load, elastic limit load and stiffness. Specimen weight was also calculated. Data was analyzed using Kruskal-Wallis and the least significant difference (LSD tests. RESULTS: Pairwise comparisons of the subgroups 10x12 and 10x14 revealed significant differences for all mechanical properties (pOBJETIVO: Avaliar as propriedades mecânicas de amostras fabricadas a partir de ataduras de gesso que são utilizadas em órteses ortopédicas e que variam quanto ao número de camadas. MÉTODOS: Foram confeccionados espécimes em forma de placa retangular e em forma cilíndrica, divididos em dois grupos que simulavam splint e gesso circular, os quais foram divididos em seis subgrupos de acordo com o número de camadas utilizadas, ou seja, três, seis, oito, dez, 12 e 14 camadas. Os espécimes foram submetidos a um teste de inclinação de três pontos (placas/splint ou teste de resistência à compressão (cilindros/gesso circular. As seguintes propriedades mecânicas foram avaliadas: carga máxima e carga no limite de elasticidade e rigidez. O peso da amostra foi calculado. Os dados foram analisados estatisticamente pelos testes de Kruskal-Wallis e diferença mínima significativa (DMS. Comparações pareadas entre os subgrupos 10x12 e 10x14 revelaram diferenças significativas para todas as propriedades mecânicas (p<0,05. RESULTADOS: Os

  10. Treatment outcomes of pre-surgical infant orthopedics in patients with non-syndromic cleft lip and/or palate: A systematic review and meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Hamid Reza Hosseini

    Full Text Available Non-syndromic clefts lip and/or palate (CL/P defects may have manifold significant and detrimental consequences for the affected individuals and their family environment. Although the use of pre-surgical infant orthopedics (PSIO was introduced as a means to improve management and treatment outcomes, there still remains a controversy.To investigate the effectiveness of PSIO in patients with non-syndromic CL/P and evaluate the quality of the available evidence.Search without restrictions, together with hand searching, until May 2016.Randomized clinical trials investigating the effects of pre-surgical infant orthopedic appliances.Following study retrieval and selection, data extraction and individual study risk of bias assessment using the Cochrane Risk of Bias Tool took place. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach.Finally 20 papers (3 unique trials were identified, involving a total of 118 patients with unilateral complete CL/P and 16 with cleft of the soft and at least two thirds of the hard palate. Eight publications were considered as being of low, four of unclear and eight of high risk of bias. In general, the investigated appliances did not present significant effects when compared to each other or to no treatment in terms of feeding and general body growth, facial esthetics, cephalometric variables, maxillary dentoalveolar variables and dental arch relationships, speech and language evaluation, caregiver-reported outcomes, economic evaluation, as well as, adverse effects and problems. Overall, the quality of the available evidence was considered low.The aforementioned findings could provide initial guidance in the clinical setting. However, given the multitude of parameters, which may have affected the results, good practice would suggest further research, in order to reach more robust relevant recommendations for management decisions in

  11. Treatment outcomes of pre-surgical infant orthopedics in patients with non-syndromic cleft lip and/or palate: A systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Hosseini, Hamid Reza; Kaklamanos, Eleftherios G; Athanasiou, Athanasios E

    2017-01-01

    Non-syndromic clefts lip and/or palate (CL/P) defects may have manifold significant and detrimental consequences for the affected individuals and their family environment. Although the use of pre-surgical infant orthopedics (PSIO) was introduced as a means to improve management and treatment outcomes, there still remains a controversy. To investigate the effectiveness of PSIO in patients with non-syndromic CL/P and evaluate the quality of the available evidence. Search without restrictions, together with hand searching, until May 2016. Randomized clinical trials investigating the effects of pre-surgical infant orthopedic appliances. Following study retrieval and selection, data extraction and individual study risk of bias assessment using the Cochrane Risk of Bias Tool took place. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach. Finally 20 papers (3 unique trials) were identified, involving a total of 118 patients with unilateral complete CL/P and 16 with cleft of the soft and at least two thirds of the hard palate. Eight publications were considered as being of low, four of unclear and eight of high risk of bias. In general, the investigated appliances did not present significant effects when compared to each other or to no treatment in terms of feeding and general body growth, facial esthetics, cephalometric variables, maxillary dentoalveolar variables and dental arch relationships, speech and language evaluation, caregiver-reported outcomes, economic evaluation, as well as, adverse effects and problems. Overall, the quality of the available evidence was considered low. The aforementioned findings could provide initial guidance in the clinical setting. However, given the multitude of parameters, which may have affected the results, good practice would suggest further research, in order to reach more robust relevant recommendations for management decisions in individual

  12. Quantitative comparisons on hand motor functional areas determined by resting state and task BOLD fMRI and anatomical MRI for pre-surgical planning of patients with brain tumors

    Directory of Open Access Journals (Sweden)

    Bob L. Hou

    2016-01-01

    Full Text Available For pre-surgical planning we present quantitative comparison of the location of the hand motor functional area determined by right hand finger tapping BOLD fMRI, resting state BOLD fMRI, and anatomically using high resolution T1 weighted images. Data were obtained on 10 healthy subjects and 25 patients with left sided brain tumors. Our results show that there are important differences in the locations (i.e., >20 mm of the determined hand motor voxels by these three MR imaging methods. This can have significant effect on the pre-surgical planning of these patients depending on the modality used. In 13 of the 25 cases (i.e., 52% the distances between the task-determined and the rs-fMRI determined hand areas were more than 20 mm; in 13 of 25 cases (i.e., 52% the distances between the task-determined and anatomically determined hand areas were >20 mm; and in 16 of 25 cases (i.e., 64% the distances between the rs-fMRI determined and anatomically determined hand areas were more than 20 mm. In just three cases, the distances determined by all three modalities were within 20 mm of each other. The differences in the location or fingerprint of the hand motor areas, as determined by these three MR methods result from the different underlying mechanisms of these three modalities and possibly the effects of tumors on these modalities.

  13. Total mandibular subapical osteotomy and Le Fort I osteotomy using piezosurgery and computer-aided designed and manufactured surgical splints: a favorable combination of three techniques in the management of severe mouth asymmetry in Parry-Romberg syndrome.

    Science.gov (United States)

    Scolozzi, Paolo; Herzog, Georges

    2014-05-01

    Although its pathogenesis remains obscure, Parry-Romberg syndrome (PRS) has been associated with the linear scleroderma en coup de sabre. PRS is characterized by unilateral facial atrophy of the skin, subcutaneous tissue, muscles, and bones with at least 1 dermatome supplied by the trigeminal nerve. Facial asymmetry represents the most common sequela and can involve the soft tissues, craniomaxillofacial skeleton, dentoalveolar area, and temporomandibular joint. Although orthognathic procedures have been reported for skeletal reconstruction, treatment of facial asymmetry has been directed to augmentation of the soft tissue volume on the atrophic side using different recontouring or volumetric augmentation techniques. Total mandibular subapical osteotomy has been used in the management of dentofacial deformities, such as open bite and mandibular dentoalveolar retrusion or protrusion associated with an imbalance between the lower lip and the chin. Management of orthognathic procedures has been improved by the recent introduction of stereolithographic surgical splints using computer-aided design (CAD) and computer-aided manufacturing (CAM) technology and piezosurgery. Piezosurgery has increased security during surgery, especially for delicate procedures associated with a high risk of nerve injury. The present report describes a combined total mandibular subapical osteotomy and Le Fort I osteotomy using piezosurgery and surgical splints fabricated using CAD and CAM for the correction of severe mouth asymmetry related to vertical dentoalveolar disharmony in a patient with PRS. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  14. The Effect of mandible advancement splints in mild, moderate, and severe obstructive sleep apnea-the need for sleep registrations during follow up.

    Science.gov (United States)

    Palotie, Tuula; Riekki, Siru; Mäkitie, Antti; Bachour, Adel; Arte, Sirpa; Bäck, Leif

    2017-10-01

    Our aim was to evaluate the effect of mandible advancement splint (MAS) in mild, moderate, and severe obstructive sleep apnea (OSA). We also determined, if and in which OSA-groups the adequate forward movement in MAS could be quantified without sleep registration for different OSA levels. A retrospective study. The effect of MAS was measured with clinical methods and by sleep registration. The series consisted of 103 patients, 75 males and 28 females (mean age 52 years) suffering from mild (32 per cent), moderate (32 per cent), or severe (36 per cent) OSA, who were treated with MAS at Helsinki University Hospital, Finland during the years 2011-2012. Seventy per cent of the patients had tried continuous positive airway pressure (CPAP) before MAS. The lower the body mass index (BMI) was the bigger the probability was to get apnea/hypopnea index (AHI) values <5 per hour with MAS (P < 0.01). The total AHI decreased significantly from the baseline with MAS: 23 per hour (range 5-89) to 6 per hour (range 0.3-54), (P < 0.001). The mean oxygen desaturation index (ODI4%) improved significantly from 16 per hour (range 1-76) to 5.3 per hour (range 0.2-49), (P < 0.01), and the minimum oxygen saturation improved significantly from 84 per cent (67-91) to 87 per cent (68-93), (P < 0.01). The reduction of AHI with MAS was significantly bigger in patients with a previous CPAP experience (73 per cent) than those who did not tried CPAP therapy. The positive correlation was found between the decrease in AHI and the increase of the protrusion in MAS. Both sleep recordings and subjective indicators demonstrated that MAS therapy was successful in OSA based on ESS, total AHI, ODI4%, and minimum oxygen saturation values. It seems useful to increase the protrusion at its maximal clinical tolerance. An experienced dentist could make therapeutically decision concerning the follow up of MAS efficacy regardless of the result of sleep study. We suggest that MAS is a valuable treatment alternative

  15. How to make a splint

    Science.gov (United States)

    Safety is the best way to avoid broken bones caused by falling. Avoid activities that strain the muscles or bones for long periods as these can cause fatigue and falls. Always use protective gear, such as proper footwear, pads, braces, and a helmet.

  16. Férula quirúrgica intermedia en cirugía ortognática bimaxilar: Un método simple de obtención Intermediate surgical splint in orthognathic bimaxillary surgery: A simple method for obtaining it

    Directory of Open Access Journals (Sweden)

    J.V. Pascual Gil

    2004-12-01

    Full Text Available La utilización de la férula quirúrgica intermedia (FQI en las intervenciones de cirugía ortognática bimaxilar es un procedimiento habitual. La utilidad, ayuda y confianza que aporta es indiscutible. Sin embargo, el procedimiento clásico de obtención de la FQI es complejo. Proponemos simplificar la fabricación de la FQI sin renunciar a su precisión y fiabilidad. Debemos cuestionar algunos conceptos del método de obtención de esta férula y reflexionar sobre el siguiente concepto básico: la dimensión vertical craneomandibular preoperatoria es igual a la dimensión vertical craneomandibular postoperatoria con la férula en posición. Para confeccionarla se ha diseñado un nuevo dispositivo denominado: Posicionador del maxilar.The employment of the intermediate surgical splint in bimaxillary orthognatic surgery is a common procedure. The utility, aid and confidence which are provided are inquestionable. Anyway the classic procedure of attainment of the splint is complex. We propose to simplify the manufacturing of the splint without renouncing to it´s accuracy and reliability. We must question some concepts about the attainment method of this splint and consider the following basic concept: the vertical preoperatory craneomandibular dimension is the same as the vertical postoperatory craneomandibular dimension with the splint in position. To manufacture it we have designed a new device called: Maxillary Placet.

  17. Histologic and histomorphometric evaluation of peri-implant bone of immediate or delayed occlusal-loaded non-splinted implants in the posterior mandible--an experimental study in monkeys.

    Science.gov (United States)

    Stokholm, Rie; Isidor, Flemming; Nyengaard, Jens R

    2014-11-01

    The primary aim of this study was to compare the bone reaction around immediate-loaded non-splinted single implants vs. delayed loaded non-splinted single implants placed in healed ridges in the posterior mandible. Six adult Macaca Fascicularis monkeys were used in this study. The first and second premolars and the first molar were extracted in both sides of the mandible. After 3 months of healing, four implants (Replace Select Tapered; Nobel Biocare, Gothenburg, Sweden) with a moderately rough surface (TiUnite, Nobel Biocare) were placed in the edentulous areas of each monkey, two in each side. The implants had a length of 10 mm and a diameter of 3.5 mm. Four groups of varying time and occlusal loading aspects were created: (i) control group: implant placed non-loaded for 3 months; (ii) immediate loaded: implant placed and loaded immediately for 3 months; (iii) immediate loaded: implant placed and loaded immediately for 6 months; and (iv) delayed loaded: implant placed submerged for 3 months and then loaded for 3 months. At the loaded implants, after a second stage surgery, a composite crown was made directly on an abutment mounted on the implant reinsuring simultaneous occlusal contact on the implant crown and the neighboring teeth. After euthanization of the animals, histologic specimens were quantified in the light microscope. All implants were clinically, radiographically, and histologically osseointegrated at the time of euthanization and with only mild signs of inflammation in the peri-implant mucosa. The histologic marginal bone level was located on average 1.14-1.74 mm apical to the margin of the implants in the various groups. The average bone-to-implant contact (BIC) varied between 55% and 65% and the average bone density (i.e., the proportion of mineralized bone tissue from the implant surface and to a distance of 1 mm lateral to the implant) varied between 30.6% and 34.2%. No statistical significant differences between groups were observed in

  18. Presurgical evaluation of hemifacial spasm and spasmodic torticollis caused by a neurovascular conflict from AICA with 3T MRI integrated by 3D drive and 3D TOF image fusion: A case report and review of the literature.

    Science.gov (United States)

    Alafaci, Concetta; Granata, Francesca; Cutugno, Mariano; Grasso, Giovanni; Salpietro, Francesco M; Tomasello, Francesco

    2014-01-01

    Hemifacial spasm (HS) and spasmodic torticollis (ST) are well-known disorders that are caused by a neurovascular conflict. HS is characterized by irregular, involuntary muscle contractions on one side of the face due to spasms of orbicularis oris and orbicularis oculi muscles, and is usually caused by vascular compression of the VII cranial nerve. ST is an extremely painful chronic movement disorder causing the neck to involuntary turn to the side, upward and/or downward. HS is usually idiopathic but it is rarely caused by a neurovascular conflict with the XI cranial nerve. We present a case of a 36-year-old woman with a 2-year history of left hemifacial spasm and spasmodic torticollis. Pre-surgical magnetic resonance imaging MRI examination was performed with 3TMRI integrated by 3Ddrive and 3DTOF image fusion. Surgery was performed through a left suboccipital retrosigmoid craniectomy. The intraoperative findings documented a transfixing artery penetrating the facial nerve and a dominant left anteroinferior cerebellar artery (AICA) in contact with the anterior surface of the pons and lower cranial nerves. Microvascular decompression (MVD) was performed. Postoperative course showed the regression of her symptoms. Transfixing arteries are rarely reported as a cause of neurovascular conflicts. The authors review the literature concerning multiple neurovascular conflicts.

  19. Narrow implants (2.75 and 3.25 mm diameter) supporting a fixed splinted prostheses in posterior regions of mandible: one-year results from a prospective cohort study.

    Science.gov (United States)

    Grandi, Tommaso; Svezia, Luigi; Grandi, Giovanni

    2017-09-08

    Can multiple splinted narrow-diameter implants be used as definitive implants in patients with insufficient bone ridge thickness in posterior regions of the mandible? With this aim, we evaluated their outcomes in this set up to 1 year after loading. Forty-two patients with a mean age of 61.3 years old (range 49-73) in need of fixed prosthetic implant-supported rehabilitations in the posterior region of the mandible, presenting a thin alveolar crest, were selected. One hundred twenty-four narrow-diameter implants (2.75 and 3.25 mm diameter) were placed and splinted with a bridge. One implant for each missing tooth was requested to be inserted. Outcomes measured were implant survival, complications, and marginal bone level changes up to 1 year after loading. At the 12-month follow-up, three implants failed. Two 2.75 mm diameter implants and one 3.2 mm diameter implant failed. The implant survival rate was 97.6%. Peri-implant bone resorption was 0.20 mm (CI 95% 0.14: 0.26) after 6 months and 0.47 mm (CI 95% 0.29; 0.65) after 12 months of loading, not different between 2.75 and 3.25 mm diameter groups (p = 0.786). Of the 42 cases, three had an episode of peri-implant mucositis (7.1%). Within the limits of this study, preliminary short-term data (1 year post-loading) suggested that narrow-diameter implants (2.75 to 3.25 mm) can be successfully used as a minimally invasive alternative to horizontal bone augmentation in the posterior mandible. However, larger and longer follow-ups of 5 years or more are needed.

  20. Zoomed MRI Guided by Combined EEG/MEG Source Analysis: A Multimodal Approach for Optimizing Presurgical Epilepsy Work-up and its Application in a Multi-focal Epilepsy Patient Case Study.

    Science.gov (United States)

    Aydin, Ü; Rampp, S; Wollbrink, A; Kugel, H; Cho, J -H; Knösche, T R; Grova, C; Wellmer, J; Wolters, C H

    2017-07-01

    In recent years, the use of source analysis based on electroencephalography (EEG) and magnetoencephalography (MEG) has gained considerable attention in presurgical epilepsy diagnosis. However, in many cases the source analysis alone is not used to tailor surgery unless the findings are confirmed by lesions, such as, e.g., cortical malformations in MRI. For many patients, the histology of tissue resected from MRI negative epilepsy shows small lesions, which indicates the need for more sensitive MR sequences. In this paper, we describe a technique to maximize the synergy between combined EEG/MEG (EMEG) source analysis and high resolution MRI. The procedure has three main steps: (1) construction of a detailed and calibrated finite element head model that considers the variation of individual skull conductivities and white matter anisotropy, (2) EMEG source analysis performed on averaged interictal epileptic discharges (IED), (3) high resolution (0.5 mm) zoomed MR imaging, limited to small areas centered at the EMEG source locations. The proposed new diagnosis procedure was then applied in a particularly challenging case of an epilepsy patient: EMEG analysis at the peak of the IED coincided with a right frontal focal cortical dysplasia (FCD), which had been detected at standard 1 mm resolution MRI. Of higher interest, zoomed MR imaging (applying parallel transmission, 'ZOOMit') guided by EMEG at the spike onset revealed a second, fairly subtle, FCD in the left fronto-central region. The evaluation revealed that this second FCD, which had not been detectable with standard 1 mm resolution, was the trigger of the seizures.

  1. Effects of Presurgical Treatment for Prostate Cancer

    Science.gov (United States)

    In this study, men diagnosed with androgen-sensitive prostate cancer with intermediate- or high-risk features will be examined with mpMRI, undergo targeted biopsies, and be treated with neoadjuvant androgen deprivation therapy.

  2. Paediatric PNET: pre-surgical MRI features

    Energy Technology Data Exchange (ETDEWEB)

    Chawla, A. [Department of Neuroradiology, National Neuroscience Institute (Singapore); Emmanuel, J.V. [Department of Neuroradiology, National Neuroscience Institute (Singapore); Seow, W.T. [Department of Neurosurgery, National Neuroscience Institute (Singapore); Lou, J. [Pediatric Medicine, KK Women' s and Children' s Hospital (Singapore); Teo, H.E. [Department of Diagnostic Imaging, KK Women' s and Children' s Hospital (Singapore); Lim, C.C.T. [Department of Neuroradiology, National Neuroscience Institute (Singapore) and Diagnostic Radiology, Yong Loo Lin Medical School, National University of Singapore (Singapore)]. E-mail: tchoyoson_lim@nni.com.sg

    2007-01-15

    Aim: To describe the preoperative magnetic resonance imaging (MRI) characteristics of primitive neuroectodermal tumours (PNETs), in particular the diffusion-weighted imaging (DWI), MR spectroscopy (MRS) features and cerebrospinal fluid (CSF) tumour dissemination. Material and methods: Twelve patients with PNETs were reviewed: nine with medulloblastoma and three with supratentorial PNETs (SPNETs). The MRI examination included contrast-enhanced intracranial and spinal MRI, and in some patients, gradient recalled echo, fluid-attenuated inversion recovery (FLAIR), DWI, and MRS. Results: All PNETs were either hypointense or isointense on T1-weighted images. Ten of the 12 tumours were either isointense or hypointense on T2-weighted images, and 11 were isointense on FLAIR images. Patients with SPNETs had large, vascular and haemorrhagic tumours. On DWI, all PNETs were hyperintense and had restricted apparent diffusion coefficient. MRS (two patients with medulloblastoma and one with a SPNET), showed elevated choline, decreased N-acetyl aspartate, and a small taurine peak in all three patients. Intraspinal tumour dissemination, visible as uniform or nodular enhancement coating the conus medullaris, was detected in six of 12 patients, two of whom also had intracranial dissemination. Conclusion: PNETs have a characteristic imaging appearance on FLAIR, DWI and MRS, which may help in differentiating these highly cellular neoplasms from other tumours. There is CSF tumour dissemination in a high proportion of patients, and spinal imaging is important for disease staging and to formulate treatment protocols.

  3. Paediatric PNET: pre-surgical MRI features

    International Nuclear Information System (INIS)

    Chawla, A.; Emmanuel, J.V.; Seow, W.T.; Lou, J.; Teo, H.E.; Lim, C.C.T.

    2007-01-01

    Aim: To describe the preoperative magnetic resonance imaging (MRI) characteristics of primitive neuroectodermal tumours (PNETs), in particular the diffusion-weighted imaging (DWI), MR spectroscopy (MRS) features and cerebrospinal fluid (CSF) tumour dissemination. Material and methods: Twelve patients with PNETs were reviewed: nine with medulloblastoma and three with supratentorial PNETs (SPNETs). The MRI examination included contrast-enhanced intracranial and spinal MRI, and in some patients, gradient recalled echo, fluid-attenuated inversion recovery (FLAIR), DWI, and MRS. Results: All PNETs were either hypointense or isointense on T1-weighted images. Ten of the 12 tumours were either isointense or hypointense on T2-weighted images, and 11 were isointense on FLAIR images. Patients with SPNETs had large, vascular and haemorrhagic tumours. On DWI, all PNETs were hyperintense and had restricted apparent diffusion coefficient. MRS (two patients with medulloblastoma and one with a SPNET), showed elevated choline, decreased N-acetyl aspartate, and a small taurine peak in all three patients. Intraspinal tumour dissemination, visible as uniform or nodular enhancement coating the conus medullaris, was detected in six of 12 patients, two of whom also had intracranial dissemination. Conclusion: PNETs have a characteristic imaging appearance on FLAIR, DWI and MRS, which may help in differentiating these highly cellular neoplasms from other tumours. There is CSF tumour dissemination in a high proportion of patients, and spinal imaging is important for disease staging and to formulate treatment protocols

  4. Clinical functional MRI. Presurgical functional neuroimaging

    Energy Technology Data Exchange (ETDEWEB)

    Stippich, C. (ed.) [Heidelberg Univ. (Germany). Div. of Neuroradiology

    2007-07-01

    Functional magnetic resonance imaging (fMRI) permits noninvasive imaging of the ''human brain at work'' under physiological conditions. This is the first textbook on clinical fMRI. It is devoted to preoperative fMRI in patients with brain tumors and epilepsies, which are the most well-established clinical applications. By localizing and lateralizing specific brain functions, as well as epileptogenic zones, fMRI facilitates the selection of a safe treatment and the planning and performance of function-preserving neurosurgery. State of the art fMRI procedures are presented, with detailed consideration of the physiological and methodological background, imaging and data processing, normal and pathological findings, diagnostic possibilities and limitations, and other related techniques. All chapters are written by recognized experts in their fields, and the book is designed to be of value to beginners, trained clinicians and experts alike. (orig.)

  5. A prospective study of dynamic treatment of fracture phalanx and metacarpals of the hand with Kirschner-wire fixation/external fixator and finger splint: Daycare management (30 cases

    Directory of Open Access Journals (Sweden)

    Rahul Madhukar Salunkhe

    2016-01-01

    Full Text Available Introduction: Fractures of the phalanx and metacarpals are some of the most frequently encountered orthopedics injuries and constitute between 14-28% of all visits to emergency department which comprises 46% of the hand fracture and out of that mostly involved are the proximal phalanx and metacarpal neck fracture are most common and then the middle and distal phalanx and the base of metacarpal. The commonest complication with surgical treatment were stiff painful joints due to prolonged immobilization at fracture sites. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of metacarpal and phalanx fracture on day care basis. Materials And Methods: In our study we treated 30 patients who came to our hospital by fixation either with K wire or external fixation or hybrid fixation under local anaesthesia depending on the type of fracture between 2013 to 2014 with the average age 28 years with the youngest being 18 years and the oldest being 41 years with transverse, spiral, oblique closed fracture, grade 1 compound fracture, intraarticular, extraarticular, comminuted and non comminuted fracture of phalanx and metacarpals.These were day care treatment. Patient was allowed to begin his daily routine work from post operative day l. During this course the operated site was protected with splinting. Results: Clinical Outcomes were assessed as Excellent, Good, Satisfactory and Poor. Radiological assessment was done by taking x-ray to check radiological union.There were 24 cases had excellent outcome, 5 cases had good outcome and only 1 case had satisfactory outcome which occurred due to mal-union. There were 3 cases of pin-tract infection which subsided with oral antibiotics, and 3 cases of malunion. Conclusion: This was a day care procedure, patient were admitted, treated and discharged on the same day & encouraged to begin mobilization of the joints of hands from day 1.

  6. Three-Dimensional Finite Element Analysis Surface Stress Distribution on Regular and Short Morse Taper Implants Generated by Splinted and Nonsplinted Prostheses in the Rehabilitation of Various Bony Ridges.

    Science.gov (United States)

    Toniollo, Marcelo Bighetti; Macedo, Ana Paula; Pupim, Denise; Zaparolli, Danilo; de Mattos, Maria da Gloria Chiarello

    2016-05-01

    This study used finite element analysis to compare the biomechanical performance of splinted (SP) and nonsplinted (NSP) prostheses to regular and short length Morse taper implants in the posterior side of the mandible. The authors used 3-dimensional geometric models of regular implants (∅4 × 11 mm) and short implants (∅4 × 5 mm) housed in the corresponding bone edges of the posterior left mandibular hemiarch involving tooth 34. The 8 experimental groups were: the control group SP (3 regular implants rehabilitated with SP), group 1SP (2 regular and 1 short implants rehabilitated with SP), group 2SP (1 regular and 2 short implants rehabilitated with SP), group 3SP (3 short implants rehabilitated with SP), the control group NSP (3 regular implants rehabilitated with NSP), group 1NSP (2 and 1 short implants rehabilitated with NSP), group 2NSP (1 regular and 2 short implants rehabilitated with NSP), and group 3NSP (3 short implants rehabilitated with NSP). Oblique forces were simulated in the molars (365 N) and premolars (200 N). Qualitative and quantitative analysis of the distribution of Von Mises equivalent stress (implants, components, and infrastructure) was performed using the AnsysWorkbench10.0 software. The results showed that the use of SP provides several advantages and benefits, reducing the stresses placed on the implant surface, on the transmucosal abutment areas and on the interior region of the infrastructure. The use of NSP was advantageous in reducing the stresses on the abutments and in the distal interproximal area of connection between the crowns.

  7. Titanium Elastic Nails Successfully Splint Subsequent Femoral ...

    African Journals Online (AJOL)

    The current trend in the management of fractures in children with osteogenesis imperfecta (OI) is the use of expandable nails. These may not be widely available in resource- constrained settings. We report a case of a 9 year old female with a peri-prosthetic fracture treated with premeasured pre-contoured titanium elastic ...

  8. Partial time use of anterior repositioning splints in the management of TMJ pain and dysfunction: a one-year controlled study Utilização de placas protrusivas em tempo parcial no tratamento da dor e disfunção da ATM: estudo controlado de um ano

    Directory of Open Access Journals (Sweden)

    Paulo César Rodrigues Conti

    2005-12-01

    Full Text Available This study aimed at evaluating the effectiveness of partial use of anterior repositioning appliances in the management of TMJ pain and dysfunction when compared to stabilization splints and a control group in a one-year follow-up. Sample was initially constituted by 60 patients, randomly divided into three groups: I- stabilization splints, II- repositioning splints and III- no treatment. The whole sample was evaluated by means of TMJ and muscle palpation, mandibular AROM, analysis of occlusal contacts, joint sounds inspection and Visual Analogue Scale (VAS for one year; 52 patients composed the final sample. A significant (after 15 days improvement in pain report (VAS and palpation index was found for group II (pO objetivo desse estudo foi avaliar a efetividade das placas oclusais reposicionadoras no controle de patologias intra-articulares da ATM, quando comparadas a um tratamento convencional (placa estabilizadora e um grupo sem tratamento (controle. A amostra final constou de 52 pacientes portadores de sinais e sintomas de desordens intra-articulares da ATM, divididos, aleatoriamente em três grupos, de acordo com o procedimento empregado: grupo I (n=20, utilizou placa estabilizadora, grupo II (n=18 utilizou placa reposicionadora e grupo III (n=14, sem nenhum tratamento.Toda a amostra foi acompanhada durante um ano, sendo avaliada através de questionários anamnésicos, palpação muscular e da ATM, movimentação mandibular e detecção de sons articulares.Uma avaliação da condição oclusal também foi realizada nos diferentes períodos de exame. Os resultados demonstraram uma maior efetividade das placas reposicionadoras na redução inicial da dor relatada pelo paciente, assim como uma diminuição na sensibilidade a palpação na ATM.Todos os grupos mostraram-se semelhantes após seis meses de controle em relação aos sintomas, assim como em relação aos ruídos articulares. Os índices de palpação muscular mostraram-se melhor

  9. Disorders Incidence and Analysis of a Flat Stabilization Splint as Its Therapy Levantamento de Incidência de DTMS e Análise da Efetividade da Placa de Mordida Plana Como Terapia TMJ

    Directory of Open Access Journals (Sweden)

    João Ricardo T. Milam

    2004-10-01

    Full Text Available In this research, temporomandibular disorder signs and symptoms incidence were detected in two groups of patients. Group I was composed of 40 patients (23,9% who presented TMJ disorders drawn out of a 167 patients universe that were referred to be treated in the Dental Clinics of the State University of Londrina; Group II was composed by 24 individuals (48% which presented TMJ disorders, selected from a larger group of 50 Dental College students of the same University. The clinical and anamnesis examination were performed according to the International Society of Head Symptoms (IHS criteria for diagnosis and classification of headaches, cranial neuralgias and facial pain, associated with the TMJ disorders Research Diagnosis Criteria. The diagnosed signs and symptoms in both groups, supported by the criteria mentioned above, consisted of patients presenting TMJ and/or masticatory muscles pain, movement limitation while opening and closing the mouth, even with mandibular locking, irradiated facial, neck and shoulders pain, a painful click or crepitation while opening the mouth, stimulated pain while yawning, chewing or wide opening the mouth, bruxism and pain related to occlusal problems. Only in Group I it was also analyzed the effectiveness of a hard acrylic flat stabilization splint use in the control of the presented signs and symptoms, as a reversible occlusal therapy, which showed to be efficient in all cases, eliminating pain symptoms. Neste trabalho foram levantadas as incidências de sinais e sintomas de desordens têmporo-mandibulares (DTMs em dois grupos de pessoas: Grupo I: composto de 40 pessoas (23,9% que apresentaram incidência de DTMs em um universo de 167 pacientes pesquisados nos serviços prestados nas clínicas do Curso de Odontologia da Universidade Estadual de Londrina – UEL. Grupo II: composto de 24 pessoas (48% que apresentaram incidência de DTMs de um universo de 50 alunos pesquisados do mesmo Curso. O exame anamn

  10. Efectos del empleo de férulas par la funcionalidad de la mano del niño con parálisis cerebral. Revisión sistemática de la literatura = Effects of the use of the splint for the functionality of the hand of the boy with cerebral paralysis. Systematic review of literature

    Directory of Open Access Journals (Sweden)

    Costa Albuquerque, R

    2007-02-01

    Full Text Available RESUMENObjetivos: realizar una revisión sistemática de la literatura a través de la selección y análisis de artículos científicos que hayan investigado los efectos del empleo de las férulas, para la funcionalidad de la mano del niño que padece parálisis cerebral.Métodos: se efectuó una búsqueda sistemática en la literatura de referencia en el periodo que va de junio a noviembre de 2006, en las bases de datos de Pub Méd y de OT Seeker, publicados en las lenguas inglesa, española y francesa.Resultados: los dos artículos incluidos en esta revisión reunieron todos los requisitos suficientes, aunque no presentan una diferencia estadísticamente significativa para el efecto del empleo de las férulas para la funcionalidad de la mano del niño que sufre parálisis cerebral.Conclusiones: los artículos evaluados en esta revisión se presentan consistentes en relación al diseño metodológico. Sin embargo, los textos abordan el empleo de las férulas asociado a otra intervención o tratamiento y suministran informaciones mínimas en lo referente a la importancia de su empleo. De esta forma, los resultados presentados no son suficientes para soportar el efecto del uso exclusivo de férulas en el niño con parálisis cerebral en la mejoría de la funcionalidad de su mano. ABSTRACTObjectives: to carry through systematic revision of literature through the election and analysis of scientific articles that had investigated the effect of the use of splint for functionality of the hand of the child with cerebral palsy.Methods: a systematic search in literature was carried through in the period of June the November of 2006, in the databases Pub Méd and OT Seeker, published in the languages English, Spanish and French.Results: the two enclosed articles in this revision had filled all the inclusion criteria, however do not present significant difference for the effect of the use of splint for the functionality of the hand of the child with

  11. Avaliação muscular subjetiva como parâmetro complementar de diagnóstico nutricional em pacientes no pré-operatório Subjective muscle assessment as a complementary parameter for the nutritional diagnosis in presurgical patients

    Directory of Open Access Journals (Sweden)

    Ionar Figueredo Bonfim Rezende

    2007-12-01

    Full Text Available OBJETIVO: Comparar a Avaliação Muscular Subjetiva com métodos objetivos de avaliação nutricional em pacientes que serão submetidos à cirurgia. MÉTODOS: Trata-se de um estudo de comparação entre métodos de avaliação nutricional, com características transversais, envolvendo dados primários em pacientes no pré-operatório. Realizaram-se medidas antropométricas, laboratoriais e a Avaliação Muscular Subjetiva para diagnóstico nutricional dos pacientes. Utilizou-se o Coeficiente de Tau-b de Kendall, adotando-se como concordância excelente entre os métodos valores maiores ou iguais a 80%. RESULTADOS: Foram incluídos no protocolo 168 pacientes adultos, de ambos os sexos, com indicação de cirurgia de médio e grande porte. Para a Avaliação Muscular Subjetiva os valores observados no teste de concordância inter e intra-examinador foram 77,0% e 89,0%, respectivamente. Os grupamentos musculares que apresentaram maior percentual de alterações tróficas foram o temporal e masseter para ambos os sexos (feminino=53,5%; masculino=82,0%. Para o sexo feminino, o grau de concordância entre a Avaliação Muscular Subjetiva e os métodos objetivos foi baixo ( ou = 60,0% e OBJECTIVE: This study will compare Subjective Muscle Assessment with objective methods of nutritional assessment in presurgical patients. METHODS: This is a cross-sectional study to compare nutritional assessment methods involving primary data in presurgical patients. Anthropometric measurements, laboratory tests and Subjective Muscle Assessment were carried out to assess the subjects' nutritional status. Kendall's tau-b coefficient was employed and values equal to or above 80.0% were considered excellent in terms of reliability. RESULTS: The protocol included 168 adult patients of both genders who would undergo major surgery. For Subjective Muscular Assessment, inter and intra-rater reliability was shown to be 77.0% and 89.0%, respectively. The muscle groups that

  12. Comparison of two pre-surgical skin preparation techniques.

    OpenAIRE

    Gibson, K L; Donald, A W; Hariharan, H; McCarville, C

    1997-01-01

    A one-step iodophor skin preparation solution was compared to chlorhexidine gluconate application as a pre-operative skin preparation method in 100 animals undergoing elective ovariohysterectomy. Pre-operative and intra-operative skin cultures demonstrated no difference in antiseptic efficacy. No animal in the study demonstrated signs of systemic infection, and no adverse local effects from either antiseptic were seen. The iodophor solution evaluated (DuraPrep) is a safe and effective pre-ope...

  13. Presurgical mapping with magnetic source imaging. Comparisons with intraoperative findings

    International Nuclear Information System (INIS)

    Roberts, T.P.L.; Ferrari, P.; Perry, D.; Rowley, H.A.; Berger, M.S.

    2000-01-01

    We compare noninvasive preoperative mapping with magnetic source imaging to intraoperative cortical stimulation mapping. These techniques were directly compared in 17 patients who underwent preoperative and postoperative somatosensory mapping of a total of 22 comparable anatomic sites (digits, face). Our findings are presented in the context of previous studies that used magnetic source imaging and functional magnetic resonance imaging as noninvasive surrogates of intraoperative mapping for the identification of sensorimotor and language-specific brain functional centers in patients with brain tumors. We found that magnetic source imaging results were reasonably concordant with intraoperative mapping findings in over 90% of cases, and that concordance could be defined as 'good' in 77% of cases. Magnetic source imaging therefore provides a viable, if coarse, identification of somatosensory areas and, consequently, can guide and reduce the time taken for intraoperative mapping procedures. (author)

  14. Functional MRI language mapping in pre-surgical epilepsy patients ...

    African Journals Online (AJOL)

    Background. Functional magnetic resonance imaging (fMRI) is commonly applied to study the neural substrates of language in clinical research and for neurosurgical planning. fMRI language mapping is used to assess language lateralisation, or determine hemispheric dominance, and to localise regions of the brain ...

  15. Presurgical mapping with magnetic source imaging. Comparisons with intraoperative findings

    Energy Technology Data Exchange (ETDEWEB)

    Roberts, T.P.L.; Ferrari, P.; Perry, D.; Rowley, H.A.; Berger, M.S. [Univ. of California, San Francisco, CA (United States)

    2000-07-01

    We compare noninvasive preoperative mapping with magnetic source imaging to intraoperative cortical stimulation mapping. These techniques were directly compared in 17 patients who underwent preoperative and postoperative somatosensory mapping of a total of 22 comparable anatomic sites (digits, face). Our findings are presented in the context of previous studies that used magnetic source imaging and functional magnetic resonance imaging as noninvasive surrogates of intraoperative mapping for the identification of sensorimotor and language-specific brain functional centers in patients with brain tumors. We found that magnetic source imaging results were reasonably concordant with intraoperative mapping findings in over 90% of cases, and that concordance could be defined as 'good' in 77% of cases. Magnetic source imaging therefore provides a viable, if coarse, identification of somatosensory areas and, consequently, can guide and reduce the time taken for intraoperative mapping procedures. (author)

  16. Positron emission tomography in presurgical evaluation of epilepsy

    International Nuclear Information System (INIS)

    Willoch, F.; Arnold, S.; Noachtar, S.; Bartenstein, P.

    1997-01-01

    In a considerable proportion of patients with medically intractable partial epilepsies who are considered for surgery, the detection of a lesion with MRI or CT is not possible. Functional imaging methods can provide clinically useful information in these cases, being methods which enable localisation of functional abnormalities independent from EEG. There is an extensive knowledge about interictal PET-investigations with F-18 FDG. Many centers dealing with preoperative evaluation of epilepsy use this method as part of their diagnostic routine. Most studies report a decrease of glucose metabolism in topographic correlation to the EEG defined seizure origin in temporal lobe epilepsy in 70%-85% of the patients. The sensitivity reported for the detection of extratemporal foci is markedly lower. The mapping of neuronal structures with specific ligands, i.e. benzodiazepine receptor ligands has advantages compared to the detection of changes in flow and metabolism. It enables the differentiation of abnormalities in the neuronal texture of the brain from deactivated cortical areas. This is especially important when surgical procedures other than standard resection techniques are considered. The clinical importance of the functional imaging methods is that they help to decrease the amount of invasive EEG recordings in temporal lobe epilepsy. Furthermore, in extratemporal epilepsies functional imaging techniques facilitate the placement of the electrodes for invasive EEG recording. (orig.) [de

  17. Pre-surgical radiologic diagnostics of pancreas diseases

    International Nuclear Information System (INIS)

    Seifried, C.

    1979-01-01

    At the example of a comparative study with 112 patients it should be demonstrated that the different radiologic techniques are complementary in pancreas diagnostics with respect to their indication and proposition. The study yields the following procedure for the pancreas diagnostics: cysts and pancreatites are diagnosed by means of sonography and computed tomography. Stomach-colon-barium passage and intravenous cholangio cholecystography can be applied for clarification of functional reactions on the stomach-colon regions, respectively the biliary region. Only in a complicated process, e.g. in a sustaining tumor suspicion or before surgery should angiography be used. In pancreatitis also the endoscopic retrograde cholangio-pancreatiography is used. Tumors are generally submitted to angiography for clarification of diagnosis, resiscivity, and vessel conditions. (orig./MG) [de

  18. ORIGINAL ARTICLE CASE REPORT Functional MRI in pre-surgical ...

    African Journals Online (AJOL)

    cognitive task. The number of publications using fMRI has increased exponentially1 since the technique was first introduced over 20 years ago.2 A PubMed search using the keywords 'fMRI OR ('functional. MRI')' at ..... Picht T, Kombos T, Gramm HJ, Brock M, Suess O. Multimodal protocol for awake craniotomy in language.

  19. Electronic roentgenographic images in presurgical X-ray diagnostics

    International Nuclear Information System (INIS)

    Haendle, J.; Hohmann, D.; Maass, W.; Siemens A.G., Erlangen

    1981-01-01

    An essential part of radiation exposure in surgery is due to devices and results from the required radiation time interval for continuous X-ray play-back up to the point at which all diagnostically relevant information can be retrieved from the screening image. With single-image storage and short exposure times as well as instant image play-back, this superfluous i.e. redundant radiation can be avoided. The electronic X-ray image is realized by means of a laboratory prototype and evaluated in hospitals. There is a report on clinical results and new technical developments. Remarkable are: the high radiation reduction that could be obtained, the problem - free instant image technique, and especially the advantages of automated exposure in direct film settings. The positive results yield the basis for the product development. (orig./MG) [de

  20. New presurgical techniques to characterize the focus of epilepsy

    NARCIS (Netherlands)

    Zijlmans, G.J.M.

    2011-01-01

    Patients with focal epilepsy who do not respond to anti-epileptic medication can be eligible for epilepsy surgery, which might cure this disabling disease. However, the question is which brain tissue is epileptogenic and needs to be removed. Information on the epileptogenic zone can be obtained by

  1. Presurgical language fMRI: Mapping of six critical regions.

    Science.gov (United States)

    Benjamin, Christopher F; Walshaw, Patricia D; Hale, Kayleigh; Gaillard, William D; Baxter, Leslie C; Berl, Madison M; Polczynska, Monika; Noble, Stephanie; Alkawadri, Rafeed; Hirsch, Lawrence J; Constable, R Todd; Bookheimer, Susan Y

    2017-08-01

    Language mapping is a key goal in neurosurgical planning. fMRI mapping typically proceeds with a focus on Broca's and Wernicke's areas, although multiple other language-critical areas are now well-known. We evaluated whether clinicians could use a novel approach, including clinician-driven individualized thresholding, to reliably identify six language regions, including Broca's Area, Wernicke's Area (inferior, superior), Exner's Area, Supplementary Speech Area, Angular Gyrus, and Basal Temporal Language Area. We studied 22 epilepsy and tumor patients who received Wada and fMRI (age 36.4[12.5]; Wada language left/right/mixed in 18/3/1). fMRI tasks (two × three tasks) were analyzed by two clinical neuropsychologists who flexibly thresholded and combined these to identify the six regions. The resulting maps were compared to fixed threshold maps. Clinicians generated maps that overlapped significantly, and were highly consistent, when at least one task came from the same set. Cases diverged when clinicians prioritized different language regions or addressed noise differently. Language laterality closely mirrored Wada data (85% accuracy). Activation consistent with all six language regions was consistently identified. In blind review, three external, independent clinicians rated the individualized fMRI language maps as superior to fixed threshold maps; identified the majority of regions significantly more frequently; and judged language laterality to mirror Wada lateralization more often. These data provide initial validation of a novel, clinician-based approach to localizing language cortex. They also demonstrate clinical fMRI is superior when analyzed by an experienced clinician and that when fMRI data is of low quality judgments of laterality are unreliable and should be withheld. Hum Brain Mapp 38:4239-4255, 2017. © 2017 Wiley Periodicals, Inc. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

  2. Increase of condylar displacement between centric relation and maximal habitual intercuspation after occlusal splint therapy Aumento do deslocamento condilar entre relação central e máxima intercuspidação habitual após terapia com placa oclusal

    Directory of Open Access Journals (Sweden)

    Solange Mongelli Fantini

    2005-09-01

    Full Text Available The present study assessed condylar displacement between initial maximal habitual intercuspation (MHI and centric relation (CR, recorded after using a deprogramming occlusal splint for an average period of 7.8 ± 2.1 months prior to any orthodontic treatment. The sample consisted of 22 subjects, 11 male and 11 female, with an average age of 14.2 ± 1.4 years, with Class II malocclusion² and with no apparent signs or symptoms of temporomandibular dysfunction (TMD. Condylar displacement was measured using a Panadent axis position indicator in decimal fractions of a millimeter. The original mean vertical displacements and the corresponding standard deviations were 4.24 ± 2.53 mm and 3.86 ± 2.72 mm, respectively, for the right and left sides. Because a significant negative correlation was observed between original condylar displacements and age factors, the displacement values were statistically adjusted to 2.74 ± 2.00 mm and 2.44 ± 1.93 mm. On the horizontal plane, the mean displacements measured were -0.72 ± 1.53 mm on the right side and -0.51 ± 1.98 mm on the left. The mean displacement on the transversal plane was 0.03 ± 0.87 mm. A comparison between these values and those observed in non-deprogrammed groups, as well as those published in the related literature, indicates that use of occlusal splints results in greater mean condylar displacement values, especially vertically, between CR and MHI positions, which contributed to a more accurate orthodontic diagnosis.O presente estudo avaliou os deslocamentos condilares entre a máxima intercuspidação habitual (MIH inicial e a relação central (RC, registrada após o uso de placa oclusal desprogramadora por período médio de 7,8 ± 2,1 meses antes do tratamento ortodôntico. A amostra consistiu de 22 indivíduos, 11 do gênero masculino e 11 do feminino, com média de idade de 14,2 ± 1,4 anos, com maloclusão de Classe II², sem sinais e sintomas aparentes de disfun

  3. Biopsia por punción con aguja fina sin aspiración en el diagnóstico prequirúrgico del nódulo del tiroides Fine needle biopsy without aspiration in the presurgical diagnosis of thyroid nodule

    Directory of Open Access Journals (Sweden)

    Francisco Ochoa Torres

    2001-12-01

    Full Text Available Se estudió un grupo de 100 pacientes operados de nódulo único del tiroides en el Servicio de Cirugía General del Hospital “Cmdte. Manuel Fajardo”, para validar el método de la biopsia por punción con aguja fina sin aspiración (citopunción en el diagnóstico prequirúrgico de esa afección. A cada paciente se le realizó una citopunción con aguja No. 25 antes de la intervención quirúrgica; los resultados se clasificaron en negativos (benignos y positivos (malignos y sospechosos y la histología posoperatoria, en benigna y maligna, según los intereses de nuestro trabajo y de criterios preestablecidos en el Departamento de Anatomía Patológica del hospital. El 100 % de las muestras fue útil para diagnóstico con una correspondencia entre citopunción e histología del 83 %. Los valores de los indicadores de validación fueron: sensibilidad: 76 %, especificidad: 85 %, valor predictivo positivo: 57 %, valor predictivo negativo: 93 % y eficacia general del método: 85 %. Concluimos que la citopunción es un método diagnóstico útil en el nódulo único del tiroides y que logra iguales resultados que la BAF, pero la primera es más recomendable por ser de más fácil aplicación, menos traumático y más económico.A group of 100 patients operated on of thyroid nodule at the Service of General Surgery of “Comandante Manuel Fajardo” Hospital was studied aimed at validating the method of biopsy by fine needle puncture without aspiration (cytopuncture in the presurgical diagnosis of this disease. Every patient underwent cytopuncture with needle No. 25 before the operation. The results were classified into negative (benign and positive (malignant and suspected, and postoperative histology into benign and malignant, according to the interests of our investigation and to the criteria preestablished at the Department of Pathological Anatomy of the hospital. 100 % of the samples were useful for the diagnosis with a correspondence

  4. Cuidados de enfermagem realizados ao paciente cirúrgico no período pré-operatório Cuidados de enfermería realizados en el paciente quirúrgico en el período preoperatorio Nursing care applied to surgical patient in the pre-surgical period

    Directory of Open Access Journals (Sweden)

    Berendina Elsina Bouwman Christóforo

    2009-03-01

    orientaciones relacionadas con el procedimiento quirúrgico y con los cuidados de enfermería efectuados. Se percibe que algunos de estos cuidados incomodan a los pacientes, por ejemplo: la colocación de la camisa quirúrgica, la retirada de la ropa íntima y de la prótesis dentaria. En fin, este estudio permitió que se identificasen fragilidades en el cuidado del paciente quirúrgico, en el sentido de contribuir para la reflexión sobre la necesidad de introducir cambios en las prácticas de la enfermería en el ambiente hospitalario.This is a descriptive, cross-sectional, qualitative study performed at the surgical units of two hospitals in the city of Ponta Grossa. The purpose was to characterize the nursing care provided to patients in the pre-surgical period of elective surgeries. The studied population, chosen as a convenience sample, consisted of 129 patients, aged 18 to 70 years. Data collection was performed through structured interviews carried out at the hospital after the surgery. The results show that the care provided is mainly focused on the physical preparation of the patient, in which few instructions are provided about the surgical procedure and the nursing care delivered. It was also observed that some types of nursing care embarrass the patients, such as wearing the surgical gown and removing their underwear and dental prosthetics. Eventually, this study allowed for the identification of weaknesses in the care provided to the surgical patients, so as to contribute for the reflection about the need to make changes in the nursing practices performed in the hospital.

  5. Short-Term Evaluation of Intraoral Soft Splints

    Science.gov (United States)

    1994-06-01

    higher than for subjects with myofascial pain syndrome (Schiffman et al. 1988). A study with the PAMP II pressure algometer on extra-oral masticatory...between the normal and myofascial pain syndrome subjects. Chung et al. (1992) corroborated the high inter-rater and intra-rater correlations for the...its over extension into the vestibules or frenum attachments. Care was taken not to overly shorten the posterior lingual flange area and the flanges

  6. [An electro-stimulating oral splint for dry mouth treatment].

    Science.gov (United States)

    Fedele, S; Wolff, A; Strietzel, F P; Granizo López, R M; Porter, S; Konttinen, Y T

    2008-11-01

    Dentists encounter regularly patients with xerostomia, which is the accepted term for dry mouth complaint. Left untreated, xerostomia can lead to psychosocial distress and to impaired quality of life. Oral complications of the most frequent cause of xerostomia, salivary gland hypofunction, include dental caries and candidiasis. In addition, quality of life is significantly hampered. The etiology of xerostomia is multiple, but the most common conditions are Sjögren's syndrome, radiotherapy to the head and neck and use of medications. Current therapies offered by dentists rely on saliva substitutes and stimulants such as chewing gum, and are somewhat limited by their short-term efficacy. Oral mucosal electro-stimulation increases salivary secretion and relieves symptoms of dry mouth in patients with xerostomia. Therefore, intra-oral electronic devices have been developed aimed at stimulating salivary gland function. They offer promise as an optional safe and non-chemical treatment of xerostomia.

  7. 21 CFR 878.3910 - Noninflatable extremity splint.

    Science.gov (United States)

    2010-04-01

    ... (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3910 Noninflatable... limb or an extremity. It is not inflatable. (b) Classification. Class I (general controls). The device...

  8. 21 CFR 878.3900 - Inflatable extremity splint.

    Science.gov (United States)

    2010-04-01

    ...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3900 Inflatable extremity... immobilize a limb or an extremity. (b) Classification. Class I (general controls). The device is exempt from...

  9. Measurement of the flexing force of the fingers by a dynamic splint with a dynamometer Medida da força de flexão dos dedos da mão através de órtese dinâmica com dinamômetro

    Directory of Open Access Journals (Sweden)

    Silmara Nicolau Pedro da Silva

    2005-10-01

    Full Text Available PURPOSE AND METHODS: In order to determine forces acting upon an articular joint during hand rehabilitation, a dynamic splint was built and connected to a dynamometer (capable of measuring forces in the range 0 - 600 gf. Through trigonometric calculation, the authors measured the flexing force in the proximal interphalangeal joint of the middle finger at 30°, 45°, 60°, and 90° of flexion. Measurements were obtained in a population of 40 voluntary adults, 20 females and 20 males, This flexing force was correlated with age, sex, and anthropometric measures. RESULTS: Force in the flexing tendon is maximal at the start of flexion, and decreases as the angle of joint flexion increases. A relationship was observed between finger length and the magnitude of the force exerted on the tendon: the longer the finger, the greater the force exherted upon the tendon. Force is greater at all the measured angles, (except 30° in males and in individuals of higher stature, and bigger arm span. CONCLUSIONS: The flexing force can be effectively measured at all flexing angles, that it correlates with a number of different anthropometric parameters, and that such data are likely to open the way for future studies.OBJETIVO E MÉTODOS: Em virtude do desconhecimento relativo às forças que atuam em uma articulação durante o processo de reabilitação da mão, foi confeccionada uma órtese dinâmica que, acoplada a um dinamômetro, mediu, através de cálculos trigonométricos, a força (entre 0 a 600gf, flexora na articulação interfalângica proximal do terceiro dedo, a 30º, 45º, 60º e 90º de flexão. Estas medidas foram obtidas, em uma população de 40 adultos voluntários, 20 do sexo feminino e 20 do masculino, e confrontadas com idade, sexo e medidas antropométricas como estatura, envergadura e comprimento do dedo. RESULTADOS: Os resultados do estudo demonstraram que o tendão flexor é submetido à máxima força no início da flexão e que a for

  10. Is pre-surgical imaging required for an asymptomatic posterior vertex subcutaneous dermoid? A case report

    Directory of Open Access Journals (Sweden)

    Simon Ho

    2016-09-01

    Full Text Available Scalp dermoid cysts are common etiologies of subcutaneous lump and bump lesions in the pediatric population, with incidence ranging from 15 to 22% (Crawford, 1990; McAvoy & Zuckerbraun, 1976. Midline scalp dermoid cysts have high risk for intracranial extension, with incidence reported to be 39–57% of cases (Wood, Couture, & David, 2012; Posnick, Bortoluzzi, Armstrong, & Drake, 1994. The following case illustrates a healthy thirteen-year-old boy who presented with asymptomatic enlarging subcutaneous posterior scalp mass who was consented for excision of the mass without pre-operative imaging, and was found to have an intracranial dermoid sinus tract intra-operatively. Post-operative imaging found an intracranial dermoid nodule which entailed an otherwise avoidable second-stage surgery to achieve complete resection.

  11. EpiTools, A software suite for presurgical brain mapping in epilepsy: Intracerebral EEG.

    Science.gov (United States)

    Medina Villalon, S; Paz, R; Roehri, N; Lagarde, S; Pizzo, F; Colombet, B; Bartolomei, F; Carron, R; Bénar, C-G

    2018-03-29

    In pharmacoresistant epilepsy, exploration with depth electrodes can be needed to precisely define the epileptogenic zone. Accurate location of these electrodes is thus essential for the interpretation of Stereotaxic EEG (SEEG) signals. As SEEG analysis increasingly relies on signal processing, it is crucial to make a link between these results and patient's anatomy. Our aims were thus to develop a suite of software tools, called "EpiTools", able to i) precisely and automatically localize the position of each SEEG contact and ii) display the results of signal analysis in each patient's anatomy. The first tool, GARDEL (GUI for Automatic Registration and Depth Electrode Localization), is able to automatically localize SEEG contacts and to label each contact according to a pre-specified nomenclature (for instance that of FreeSurfer or MarsAtlas). The second tool, 3Dviewer, enables to visualize in the 3D anatomy of the patient the origin of signal processing results such as rate of biomarkers, connectivity graphs or Epileptogenicity Index. GARDEL was validated in 30 patients by clinicians and proved to be highly reliable to determine within the patient's individual anatomy the actual location of contacts. GARDEL is a fully automatic electrode localization tool needing limited user interaction (only for electrode naming or contact correction). The 3Dviewer is able to read signal processing results and to display them in link with patient's anatomy. EpiTools can help speeding up the interpretation of SEEG data and improving its precision. Copyright © 2018 Elsevier B.V. All rights reserved.

  12. Effects of music treatment on salivary cortisol in patients exposed to pre-surgical stress.

    Science.gov (United States)

    Miluk-Kolasa, B; Obminski, Z; Stupnicki, R; Golec, L

    1994-01-01

    The response of the adrenal cortex to a stressor consisting of information about a surgery to be performed the following day was studied in 34 patients by monitoring changes in salivary cortisol. From those, 18 patients were subjected to an individually selected 1 h music program, applied immediately following receipt of the information, and the remaining 16 patients formed a reference group. Another 10 patients, not awaiting surgery, served as controls. Saliva was sampled before the stressor and 5 more samples were collected at 15 min intervals. The stressor produced a 50% rise in salivary cortisol within 15 min. In patients not exposed to music, cortisol levels gradually decreased but after one hour they were markedly higher than the initial level. Listening to music resulted in a marked reduction in salivary cortisol level and after one hour the relative decrease was similar to that observed in control (non-surgical) patients.

  13. Presurgical mapping with functional MRI. Comparative study with transcranial magnetic stimulation and intraoperative mapping

    Energy Technology Data Exchange (ETDEWEB)

    Kaminogo, Makio; Morikawa, Minoru; Ishimaru, Hideki; Ochi, Makoto; Onizuka, Masanori; Shirakawa, Yasushi; Takahashi, Haruki; Shibata, Shobu [Nagasaki Univ. (Japan). School of Medicine

    1999-05-01

    The thumb movement was evoked by transcranical magnetic stimulation (TCS) for the mapping of the motor cortex. After the placement of the marker determined by TCS on the scalp, fMRI under motor tasks consisting of repetitive grasping was performed. For motor cortex activation, an axial oblique plane to maximize gray matter sampling in the rolandic cortex was employed in order to compare these different mapping techniques more precisely. Sixteen patients with brain tumors were included in this study. In nine patients, fMRI disclosed activation in one restricted gyrus or in the localized area around one restricted sulcus. Of these nine patients, preoperative TCS mapping corresponded closely with fMRI in six, while in the remaining three, the TCS marker fell between 1 and 2 cm apart from the fMRI-activated area. However, in these three patients, intraoperative electrocortical stimulation corresponded with the preoperative mapping with fMRI. In six patients, contiguous two gyri were activated by motor tasks. The TCS marker was disclosed on one of the two activated gyri. Of these six patients, the position of the TCS marker and fMRI-activated site corresponded with each other in four cases. They were found on the same gyrus but there was 1.0-2.0 cm distance between them in two cases. Intraoperative somatosensory evoked potential was monitored in two of these six cases. They corresponded well with the mapping by fMRI and TCS together. In only one patient, no significant activation area was obtained by fMRI because of excessive head motion during motor tasks. The TCS maker in this patients was identical with intraoperative electro-cortical stimulation mapping. (K.H.)

  14. Pre-surgical child behavior ratings and pain management after two different techniques of tonsil surgery.

    Science.gov (United States)

    Ericsson, Elisabeth; Wadsby, Marie; Hultcrantz, Elisabeth

    2006-10-01

    The purpose of this investigation was to compare child behavior before surgery with experience of pain and anxiety in relation to two techniques of tonsil surgery, to relate previous experiences of surgery/tonsillitis with anxiety and pain, and to compare the children's, parent's and nurse's rating of pain. Ninety-two children (5-15 years) with sleep-disordered breathing (SDB) and with or without recurrent tonsillitis were randomized to partial tonsil resection/tonsillotomy (TT) or full tonsillectomy (TE). Parents: Child Behavior Checklist (CBCL). Children: State-Trait-Anxiety Inventory for Children (STAIC) and seven-point Faces Pain Scale (FPS). Parents/staff: seven-point Verbal Pain Rating Scale (VPRS). Pain relievers were opoids, paracetamol and diclophenac. These children with SDB scored significantly higher on CBCL than did normative groups, but no connection was observed between CBCL rating and experience of pain. There was no relation between pre-operative anxiety and pain. The post-operative anxiety level (STAIC) correlated with pain. The TE-group scored higher on STAIC after surgery. Previous experience of surgery or tonsillitis did not influence post-operative pain. The TE-group rated higher experience of pain despite more medication. The nurses scored pain lower than the parents/children and under-medicated. SDB may influence children's behavior, but with no relation to post-operative pain. The surgical method predicts pain better than does the child's behavior rating. The nurses underestimated the pain experienced by the child.

  15. Presurgical language fMRI in patients with drug-resistant epilepsy: effects of task performance.

    NARCIS (Netherlands)

    Weber, B.; Wellmer, J.; Schur, S.; Dinkelacker, V.; Ruhlmann, J.; Mormann, F.; Axmacher, N.; Elger, C.E.; Fernandez, G.S.E.

    2006-01-01

    PURPOSE: To determine whether language functional magnetic resonance imaging (fMRI) before epilepsy surgery can be similarly interpreted in patients with greatly different performance levels. METHODS: An fMRI paradigm using a semantic decision task with performance control and a perceptual control

  16. Pre-surgical treatment planning of maxillary canine impactions using panoramic vs cone beam CT imaging.

    Science.gov (United States)

    Alqerban, A; Hedesiu, M; Baciut, M; Nackaerts, O; Jacobs, R; Fieuws, S; Willems, G

    2013-01-01

    The aim of this prospective study was to compare the impact of using two-dimensional (2D) panoramic radiographs and three-dimensional (3D) cone beam CT for the surgical treatment planning of impacted maxillary canines. This study consisted of 32 subjects (19 females, 13 males) with a mean age of 25 years, referred for surgical intervention of 39 maxillary impacted canines. Initial 2D panoramic radiography was available, and 3D cone beam CT imaging was obtained upon clinical indication. Both 2D and 3D pre-operative radiographic diagnostic sets were subsequently analysed by six observers. Perioperative evaluations were conducted by the treating surgeon. McNemar tests, hierarchical logistic regression and linear mixed models were used to explore the differences in evaluations between imaging modalities. Significantly higher confidence levels were observed for 3D image-based treatment plans than for 2D image-based plans (p panoramic and cone beam CT images.

  17. Quantative pre-surgical lung function estimation with SPECT/CT

    International Nuclear Information System (INIS)

    Bailey, Dale L.; Timmins, Sophi; Harris, Benjamin E.; Bailey, Elizabeth A.; Roach, Paul J.; Willowson, Kathy P.

    2009-01-01

    Full text: Objectives: To develop methodology to predict lobar lung function based on SPECT/CT ventilation 6 k perfusion (V/Q) scanning in candidates for lobectomy for lung cancer. This combines two development areas from our group: quantitative SPECT based on CT-derived corrections for scattering and attenuation of photons, and SPECT V/Q scanning with lobar segmentation from CT Six patients underwent baseline pulmonary function testing (PFT) including spirometry, measurement of DLCO and cardio-pulmonary exercise testing. A SPECT/CT V/Q scan was acquired at baseline. Using in-house software each lobe was anatomically defined using CT to provide lobar ROIs which could be applied to the SPECT data. From these, individual lobar contribution to overall function was calculated from counts within the lobe and post-operative FEVl, DLCO and V02 peak were predicted. This was compared with the quantitative planar scan method using 3 rectangular ROIs over each lung.

  18. Quantitative pre-surgical lung function estimation with SPECT/CT

    International Nuclear Information System (INIS)

    Bailey, D. L.; Willowson, K. P.; Timmins, S.; Harris, B. E.; Bailey, E. A.; Roach, P. J.

    2009-01-01

    Full text:Objectives: To develop methodology to predict lobar lung function based on SPECT/CT ventilation and perfusion (V/Q) scanning in candidates for lobectomy for lung cancer. Methods: This combines two development areas from our group: quantitative SPECT based on CT-derived corrections for scattering and attenuation of photons, and SPECT V/Q scanning with lobar segmentation from CT. Eight patients underwent baseline pulmonary function testing (PFT) including spirometry, measure of DLCO and cario-pulmonary exercise testing. A SPECT/CT V/Q scan was acquired at baseline. Using in-house software each lobe was anatomically defined using CT to provide lobar ROIs which could be applied to the SPECT data. From these, individual lobar contribution to overall function was calculated from counts within the lobe and post-operative FEV1, DLCO and VO2 peak were predicted. This was compared with the quantitative planar scan method using 3 rectangular ROIs over each lung. Results: Post-operative FEV1 most closely matched that predicted by the planar quantification method, with SPECT V/Q over-estimating the loss of function by 8% (range - 7 - +23%). However, post-operative DLCO and VO2 peak were both accurately predicted by SPECT V/Q (average error of 0 and 2% respectively) compared with planar. Conclusions: More accurate anatomical definition of lobar anatomy provides better estimates of post-operative loss of function for DLCO and VO2 peak than traditional planar methods. SPECT/CT provides the tools for accurate anatomical defintions of the surgical target as well as being useful in producing quantitative 3D functional images for ventilation and perfusion.

  19. A Retrospective Analysis of Pre-surgical Incisor Decompensation Attained in an Orthognathic Surgery Population

    Science.gov (United States)

    2016-07-01

    were also evolving during this time period. Edward Angle published his landmark treatise “ Classification of Malocclusion” in 1899, bringing order and...extraction protocol and an MBT™ prescription 0.022 inch slot stainless steel labial orthodontic appliance (3M Unitek, Monrovia, California). 9 T1...results of this study. However, traditionally at TORP, a stainless steel , pre-adjusted 0.022 inch slot, McLaughlin, Bennett and Trevisi (MBT

  20. Brain SPECT in the pre-surgical evaluation of epileptic patients

    International Nuclear Information System (INIS)

    Buchpiguel, C.A.; Cukiert, A.; Hironaka, F.H.; Cerri, G.G.; Magalhaes, A.E.A.; Marino Junior, R.

    1992-01-01

    Fifteen adult epileptic patients were studied pre-operatively using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99 m Tc-HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas). In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions). Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hypoperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: in 4, SPECT findings correlated well with the anatomical findings; in 5 instances, SPECT was able to disclose additional functional deficits; in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n=10) SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and heterogeneity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic who are candidates for epilepsy surgery. (author)

  1. A Presurgical Study of Lecithin Formulation of Green Tea Extract in Women with Early Breast Cancer.

    Science.gov (United States)

    Lazzeroni, Matteo; Guerrieri-Gonzaga, Aliana; Gandini, Sara; Johansson, Harriet; Serrano, Davide; Cazzaniga, Massimiliano; Aristarco, Valentina; Macis, Debora; Mora, Serena; Caldarella, Pietro; Pagani, Gianmatteo; Pruneri, Giancarlo; Riva, Antonella; Petrangolini, Giovanna; Morazzoni, Paolo; DeCensi, Andrea; Bonanni, Bernardo

    2017-06-01

    Epidemiologic data support an inverse association between green tea intake and breast cancer risk. Greenselect Phytosome (GSP) is a lecithin formulation of a caffeine-free green tea catechin extract. The purpose of the study was to determine the tissue distribution of epigallocatechin-3-O-gallate (EGCG) and its effect on cell proliferation and circulating biomarkers in breast cancer patients. Twelve early breast cancer patients received GSP 300 mg, equivalent to 44.9 mg of EGCG, daily for 4 weeks prior to surgery. The EGCG levels were measured before (free) and after (total) enzymatic hydrolysis by HPLC-MS/MS in plasma, urine, breast cancer tissue, and surrounding normal breast tissue. Fasting blood samples were taken at baseline, before the last administration, and 2 hours later. Repeated administration of GSP achieved levels of total EGCG ranging from 17 to 121 ng/mL in plasma. Despite a high between-subject variability, total EGCG was detectable in all tumor tissue samples collected up to 8 ng/g. Median total EGCG concentration was higher in the tumor as compared with the adjacent normal tissue (3.18 ng/g vs. 0 ng/g, P = 0.02). Free EGCG concentrations ranged from 8 to 65.8 ng/mL in plasma ( P between last administration and 2 hours after breast tumor tissue and is associated with antiproliferative effects on breast cancer tissue. Cancer Prev Res; 10(6); 363-9. ©2017 AACR . ©2017 American Association for Cancer Research.

  2. Functional MRI in pre-surgical planning: case study and cautionary ...

    African Journals Online (AJOL)

    Objectives. We explore the potential use of this emerging technique by presenting a neurosurgical case study, as performed at the Cape Universities Brain Imaging Centre (CUBIC), Tygerberg, Cape Town. We conclude with a brief summary of the potential pitfalls of this technique, as well as cautionary guidelines based on ...

  3. Multimodal Image-Based Virtual Reality Presurgical Simulation and Evaluation for Trigeminal Neuralgia and Hemifacial Spasm.

    Science.gov (United States)

    Yao, Shujing; Zhang, Jiashu; Zhao, Yining; Hou, Yuanzheng; Xu, Xinghua; Zhang, Zhizhong; Kikinis, Ron; Chen, Xiaolei

    2018-02-21

    To address the feasibility and predictive value of multimodal image-based virtual reality in detecting and assessing features of neurovascular confliction (NVC), particularly regarding the detection of offending vessels, degree of compression exerted on the nerve root, in patients who underwent microvascular decompression for nonlesional trigeminal neuralgia and hemifacial spasm (HFS). This prospective study includes 42 consecutive patients who underwent microvascular decompression for classic primary trigeminal neuralgia or HFS. All patients underwent preoperative 1.5-T magnetic resonance imaging (MRI) with T2-weighted three-dimensional (3D) sampling perfection with application-optimized contrasts by using different flip angle evolutions, 3D time-of-flight magnetic resonance angiography, and 3D T1-weighted gadolinium-enhanced sequences in combination, whereas 2 patients underwent extra experimental preoperative 7.0-T MRI scans with the same imaging protocol. Multimodal MRIs were then coregistered with open-source software 3D Slicer, followed by 3D image reconstruction to generate virtual reality (VR) images for detection of possible NVC in the cerebellopontine angle. Evaluations were performed by 2 reviewers and compared with the intraoperative findings. For detection of NVC, multimodal image-based VR sensitivity was 97.6% (40/41) and specificity was 100% (1/1). Compared with the intraoperative findings, the κ coefficients for predicting the offending vessel and the degree of compression were >0.75 (P impact on detection of small-caliber offending vessels with relatively slow flow speed in cases of HFS. Multimodal image-based VR using 3D sampling perfection with application-optimized contrasts by using different flip angle evolutions in combination with 3D time-of-flight magnetic resonance angiography sequences proved to be reliable in detecting NVC and in predicting the degree of root compression. The VR image-based simulation correlated well with the real surgical view. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Combining advanced neuroimaqing techniques in presurgical workup of non-lesional intractable epilepsy

    Czech Academy of Sciences Publication Activity Database

    Brázdil, M.; Mikl, M.; Chlebus, P.; Pažourková, M.; Novák, Z.; Chrastina, J.; Prášek, J.; Bolčák, K.; Fojtíková, D.; Horký, Jaroslav; Tomčík, J.; Lžičářová, E.; Rektor, I.

    2006-01-01

    Roč. 8, č. 3 (2006), s. 190-194 ISSN 1294-9361 Institutional research plan: CEZ:AV0Z20650511 Keywords : non-lesional extratemporal epilepsy * SISCOM * ictal FDG-PET * ictal fMRI * VBM * MRS * postictal DWI * SEEG Subject RIV: FH - Neurology Impact factor: 1.202, year: 2006

  5. Effect of medication withdrawal on the interictal epileptiform EEG discharges in presurgical evaluation

    DEFF Research Database (Denmark)

    Andersen, N.B.; Alving, J.; Beniczky, S.

    2010-01-01

    Medication withdrawal (MW) is an important method of provoking seizures and activating epileptiform EEG activity during the diagnostic work-up of patients evaluated for epilepsy surgery. Previously it was suggested that MW might influence the seizure-type and activate cortical areas otherwise...... not producing epileptiform discharges, leading to a false localization of the irritative zone. In order to investigate this we reviewed 42 consecutive cases of MW, of 36 patients, during a 3-year period. We compared seizure frequency, seizure-types and the localization of interictal epileptiform discharges...... MW. In one-third of the patients the interictal EEGs after the MW were different from those recorded before the MW. However, in these discordant cases the EEG findings after the MW (and not before the MW) were concordant with the seizure onset zone and the lesional zone. We conclude that MW...

  6. Pre-surgical irradiation of hypernephroid carcinoma from the urological point of view

    International Nuclear Information System (INIS)

    Rost, A.; Akbar, D.; Besserer, A.

    1981-01-01

    In our clinic since 1967, the routine pre-irradiation propagandized by Riches has been applied for hypernephroid carcinoma: A focal dose of 30 Gy is applied as betatron-pendulum irradiation (42 MeV photones) in fractions of 2.5 Gy, including the paraaortal lymph nodes. After a treatment-free interval of 3 weeks, radical nephrectomy follows. Since 1967, 178 patients have been treated with this method. 47 patients were in tumour stage I, 15 in stage II, 83 in stage III, and 33 in stage IV. The treatment of 99 patients was 5 years ago, 52% of them surviving. For 67% of the patients, the survival time was longer than 3 years. The goals of preirradiation were 1) To devitalise proliferating cells in the tumourous region thus preventing the growth of displaced tumour cells and postoperative local relapses. 2) Shrinking of the tumour thus making the operation easier; In one third of the cases, a change in the tumour took place which could be measured radiologically and which can be explained as being due to the shrinking of the tumour and obliteration of the capsule venes rich in blood. (orig.) [de

  7. Presurgical motivations, self-esteem, and oral health of orthognathic surgery patients.

    Science.gov (United States)

    Yu, Dedong; Wang, Fang; Wang, Xudong; Fang, Bing; Shen, Steve Guofang

    2013-05-01

    The aim of this study was to evaluate motivations, self-esteem, and oral health for undergoing orthognathic patients by gender in China before orthognathic surgery. Using a prospective and control study design, 429 subjects in China were collected from December 2010 to May 2011. The patient group consisted of 210 consecutive healthy patients, and 219 young individuals comprised the control group. All the subjects filled out a questionnaire and were assessed by Self-esteem Scale and Oral Health Impact Profile validated for Chinese patients before surgery. To measure the discrepancy, the Student t test was computed. P motivations for orthognathic surgery are to improve facial appearance (83.33%), occlusion (50%), and self-confidence (48.1%). Females expect to improve facial appearance (83.87%), self-confidence (43.55%), and occlusion (41.94%). Males are for the improvement of facial appearance (82.56%), occlusion (63.95%), and self-confidence (54.65%). Self-esteem in the patient group is obviously lower (P self-esteem in female groups (P motivation. Self-confidence has been more frequently mentioned, while headache far less than other countries. (2) Female patients have less self-esteem than females in the control group. (3) Patients' oral health are worse than those in the control group.

  8. Pre-surgical Provisional Prosthesis for Immediate Non-occlusal-loaded Flapless Implant

    OpenAIRE

    Inbarajan, Athiban; Banu, Fathima; TV, Padmanabhan; Kumar, Anand; Seenivasan, Madhan

    2017-01-01

    A 49-year-old patient reported for immediate replacement of missing maxillary anterior teeth with implant-retained prosthesis. Elevation of flap alters the mucosal level, causes discomfort, and delays the restorative procedure. To maintain the esthetics, flapless surgery was planned. Since placement of an implant is pre-planned in a predetermined site, fabrication of the prostheses before commencement of the surgery, especially when replacing the teeth in the anterior region, could be a viabl...

  9. Management of Horizontal Root Fracture in the Middle Third via Intraradicular Splinting Using a Fiber Post

    Directory of Open Access Journals (Sweden)

    Ishani Karhade

    2016-01-01

    Full Text Available Radicular fractures in permanent teeth are uncommon injuries and account for only 0.5–7% of dental traumas. These fractures commonly result from a horizontal impact and are transverse to oblique in direction. Their incidence is more in the middle third of the root than at the apical and cervical thirds. This paper describes a case of complicated crown fracture of maxillary incisors along with horizontal root fracture at the middle third of maxillary right central and lateral incisor. The fractured root fragments of the upper right central and lateral incisor were united with the help of a glass fiber post after receiving an endodontic treatment. The other two incisors were treated endodontically followed by post endodontic restorations. Eventually the four incisors were restored with porcelain fused to metal crowns. A one-year follow-up revealed a well stabilized assembly of the root fragments and the post.

  10. Development of a behavioural marker system for scrub practitioners' non-technical skills (SPLINTS system).

    Science.gov (United States)

    Mitchell, Lucy; Flin, Rhona; Yule, Steven; Mitchell, Janet; Coutts, Kathy; Youngson, George

    2013-04-01

    Adverse events still occur despite ongoing efforts to reduce harm to patients. Contributory factors to adverse events are often due to limitations in clinicians' non-technical skills (e.g. communication, situation awareness), rather than deficiencies in technical competence. We developed a behavioural rating system to provide a structured means for teaching and assessing scrub practitioners' (i.e. nurse, technician, operating department practitioner) non-technical skills. Psychologists facilitated focus groups (n = 4) with experienced scrub practitioners (n = 16; 4 in each group) to develop a preliminary taxonomy. Focus groups reviewed lists of non-technical-skill-related behaviours that were extracted from an interview study. The focus groups labelled skill categories and elements and also provided examples of good and poor behaviours for those skills. An expert panel (n = 2 psychologists; n = 1 expert nurse) then used an iterative process to individually and collaboratively review and refine those data to produce a prototype skills taxonomy. A preliminary taxonomy containing eight non-technical skill categories with 28 underlying elements was produced. The expert panel reduced this to three categories (situation awareness, communication and teamwork, task management), each with three underlying elements. The system was called the Scrub Practitioners' List of Intraoperative Non-Technical Skills system. A scoring system and a user handbook were also developed. A prototype behavioural rating system for scrub practitioners' non-technical skills was developed, to aid in teaching and providing formative assessment. This important aspect of performance is not currently explicitly addressed in any educational route to qualify as a scrub practitioner. © 2012 Blackwell Publishing Ltd.

  11. Long Term Effects of Soft Splints on Stroke Patients and Patients With Disorders of Consciousness

    Science.gov (United States)

    2017-06-01

    Brain Injuries; Disorder of Consciousness; Stroke; Spasticity as Sequela of Stroke; Contracture; Hypertonic Disorder; Central Nervous System Diseases; Pathologic Processes; Craniocerebral Trauma; Trauma, Nervous System; Neurocognitive Disorders

  12. [Efficacy of intestinal splinting in hostile abdomen secondary to postoperative flanges in pediatric patients].

    Science.gov (United States)

    Bracho-Blanchet, Eduardo; Langarica-Bulos, Mónica; Dávila-Pérez, Roberto; Fernández-Portilla, Emilio; Zalles-Vidal, Cristian; Nieto-Zermeño, Jaime

    2016-10-01

    Objetivo: Mostrar la eficacia de la FI para prolongar el tiempo libre de oclusión intestinal quirúrgica en niños con abdomen hostil secundario a bridas posquirúrgicas. Método: Análisis retrospectivo de FI por abdomen hostil de 2000 a 2011 y su seguimiento a largo plazo. Comparamos el tiempo libre de oclusión quirúrgica antes y después de la FI. Resultados: Se incluyeron 20 FI en 19 pacientes. Predominaron las causas congénitas, la mediana de edad en la cirugía fue de 6 meses, todos tenían cirugías previas con mediana de tres, y dos de ellas fueron por oclusión intestinal previa. La férula se quitó a los 28 días (mediana). Con un seguimiento de 1-183 meses, hubo una recurrencia de oclusión quirúrgica. El tiempo libre de oclusión quirúrgica posferulización fue significativamente mayor que el preferulización mediante la prueba de Wilcoxon, con un valor Z = -3.594; p = el tiempo libre de oclusión quirúrgica.

  13. The PGRIS and parathyroid splinting concepts for the analysis and prognosis of protracted hypoparathyroidism

    OpenAIRE

    Sitges-Serra, Antonio

    2017-01-01

    Most patients with hypocalcemia after total thyroidectomy will recover the parathyroid function in a few weeks, but some 20–30% of them will still be in the need for replacement therapy one month after surgery and about 5–10% of those will develop permanent hypoparathyroidism. Although postoperative hypocalcemia has been related to several demographic and metabolic causes, parathyroid hormone (PTH) decline, resulting from autotransplantation, inadvertent excision or devascularization of the p...

  14. Is wrist splint more effective than forearm band for lateral epicondylitis?

    Directory of Open Access Journals (Sweden)

    Arturo Meissner

    2017-12-01

    Full Text Available Resumen INTRODUCCIÓN La epicondilitis lateral es una causa común de dolor lateral de codo. Existen numerosos tratamientos que han reportado disminuir los síntomas, entre ellos el uso de órtesis. Las principales órtesis disponibles para este efecto son las bandas de antebrazo y las muñequeras. Actualmente no está claro cuál de ellos constituiría la mejor alternativa de tratamiento sintomático. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos tres revisiones sistemáticas que en conjunto incluyen cuatro ensayos aleatorizados pertinentes a esta pregunta. Con esta evidencia, concluimos que podría no haber diferencia en la percepción de mejoría global ni en el umbral mecánico de dolor por presión entre el uso de banda de antebrazo y muñequera, y que no está claro si el uso de muñequera disminuye el dolor en comparación a la banda de antebrazo, porque la certeza de la evidencia es muy baja.

  15. Structural behavior of concrete beams reinforced with pinned bamboo-splints

    OpenAIRE

    Braga Filho, Antonio C.; Lima Júnior, Humberto C.; Barbosa, Normando P.; Willrich, Fabio L.

    2010-01-01

    Uma das deficiências do bambu reforçando vigas de concreto armado está relacionada com deslocamentos relativos entre os dois materiais. A investigação aqui reportada teve como objetivo avaliar experimentalmente a possibilidade de se melhorar o trabalho conjunto bambu-concreto, através do cravejamento de pinos nas ripas de bambu usadas como reforço. Para tanto, oito vigas de concreto foram ensaiadas, das quais seis foram reforçadas com ripas de bambu Dendrocalamus giganteus Munro cravejadas de...

  16. Utility of 3D printed temporal bones in pre-surgical planning for complex BoneBridge cases.

    Science.gov (United States)

    Mukherjee, Payal; Cheng, Kai; Flanagan, Sean; Greenberg, Simon

    2017-08-01

    With the advent of single-sided hearing loss increasingly being treated with cochlear implantation, bone conduction implants are reserved for cases of conductive and mixed hearing loss with greater complexity. The BoneBridge (BB, MED-EL, Innsbruck, Austria) is an active fully implantable device with no attenuation of sound energy through soft tissue. However, the floating mass transducer (FMT) part of the device is very bulky, which limits insertion in complicated ears. In this study, 3D printed temporal bones of patients were used to study its utility in preoperative planning on complicated cases. Computed tomography (CT) scans of 16 ears were used to 3D print their temporal bones. Three otologists graded the use of routine preoperative planning provided by MED-EL and that of operating on the 3D printed bone of the patient. Data were collated to assess the advantage and disadvantage of the technology. There was a statistically significant benefit in using 3D printed temporal bones to plan surgery for difficult cases of BoneBridge surgery compared to the current standard. Surgeons preferred to have the printed bones in theatre to plan their drill sites and make the transition of the planning to the patient's operation more precise. 3D printing is an innovative use of technology in the use of preoperative planning for complex ear surgery. Surgical planning can be done on the patient's own anatomy which may help to decrease operating time, reduce cost, increase surgical precision and thus reduce complications.

  17. Presurgical ketoprofen, but not morphine, dipyrone, diclofenac or tenoxicam, preempts post-incisional mechanical allodynia in rats

    Directory of Open Access Journals (Sweden)

    Prado W.A.

    2002-01-01

    Full Text Available The treatment of pain before it initiates may prevent the persistent pain-induced changes in the central nervous system that amplify pain long after the initial stimulus. The effects of pre- or postoperative intraperitoneal administration of morphine (2 to 8 mg/kg, dipyrone (40 and 80 mg/kg, diclofenac (2 to 8 mg/kg, ketoprofen (10 and 20 mg/kg, and tenoxicam (10 and 20 mg/kg were studied in a rat model of post-incisional pain. Groups of 5 to 8 male Wistar rats (140-160 g were used to test each drug dose. An incision was made on the plantar surface of a hind paw and the changes in the withdrawal threshold to mechanical stimulation were evaluated with Von Frey filaments at 1, 2, 6 and 24 h after the surgery. Tenoxicam was given 12 or 6 h preoperatively, whereas the remaining drugs were given 2 h or 30 min preoperatively. Postoperative drugs were all given 5 min after surgery. No drug abolished allodynia when injected before or after surgery, but thresholds were significantly higher than in control during up to 2 h following ketoprofen, 6 h following diclofenac, and 24 h following morphine, dipyrone or tenoxicam when drugs were injected postoperatively. Significant differences between pre- and postoperative treatments were obtained only with ketoprofen administered 30 min before surgery. Preoperative (2 h intraplantar, but not intrathecal, ketoprofen reduced the post-incisional pain for up to 24 h after surgery. It is concluded that stimuli generated in the inflamed tissue, rather than changes in the central nervous system are relevant for the persistence of pain in the model of post-incisional pain.

  18. Presurgical visualization of the neurovascular relationship in trigeminal neuralgia with 3D modeling using free Slicer software.

    Science.gov (United States)

    Han, Kai-Wei; Zhang, Dan-Feng; Chen, Ji-Gang; Hou, Li-Jun

    2016-11-01

    To explore whether segmentation and 3D modeling are more accurate in the preoperative detection of the neurovascular relationship (NVR) in patients with trigeminal neuralgia (TN) compared to MRI fast imaging employing steady-state acquisition (FIESTA). Segmentation and 3D modeling using 3D Slicer were conducted for 40 patients undergoing MRI FIESTA and microsurgical vascular decompression (MVD). The NVR, as well as the offending vessel determined by MRI FIESTA and 3D Slicer, was reviewed and compared with intraoperative manifestations using SPSS. The k agreement between the MRI FIESTA and operation in determining the NVR was 0.232 and that between the 3D modeling and operation was 0.6333. There was no significant difference between these two procedures (χ 2  = 8.09, P = 0.088). The k agreement between the MRI FIESTA and operation in determining the offending vessel was 0.373, and that between the 3D modeling and operation was 0.922. There were significant differences between two of them (χ 2  = 82.01, P = 0.000). The sensitivity and specificity for MRI FIESTA in determining the NVR were 87.2 % and 100 %, respectively, and for 3D modeling were both 100 %. The segmentation and 3D modeling were more accurate than MRI FIESTA in preoperative verification of the NVR and offending vessel. This was consistent with surgical manifestations and was more helpful for the preoperative decision and surgical plan.

  19. Surgical treatment of lesions in and around the fourth ventricle. Part 3: special reference to pre-surgical anatomical MRI

    International Nuclear Information System (INIS)

    Matsushima, Toshio; Ikezaki, Kiyonobu; Mihara, Futoshi; Fukui, Masashi

    1998-01-01

    MR images are presented to demonstrate how clearly and how much of the structures of the fourth ventricle can be shown. It then is stressed how useful the information obtained from the MR images can be in planning a surgical approach and determining preoperative prospects of the actual surgery. The information includes the location, extension, and original structure of the mass lesion and its infiltration into surrounding tissues. The MR midline sagittal view image showing the tent-like shape and components of the fourth ventricle can demonstrate whether the lesion originates from the roof or the floor of the ventricle, and how far it extends rostrally or caudally. The axial views at the levels of the medulla oblongata and the pons show a fourth ventricle of completely different shape. The former shows the ventricle in the shape of a slit and the latter in the shape of a pentagon. At the level of the medulla oblongata, the tela choroidea with the choroid plexus is seen as a membranous structure just posterior to the medulla oblongata. The space between the two structures is the ventricular space. Because the enhanced MRI clearly demonstrates the choroid plexus in the lateral recess, the cerebellomedullary fissure can be identified. In this view, the lateral extension of a lesion to the cerebellopontine cistern through the cerebellomedullary fissure or the lateral recess easily can be identified. In the coronal views, the floor and the roof of the ventricle appear on different slices. They clearly show the diamond-shaped floor, three cerebellar peduncles, and the lateral recesses. The striae medullares transversely course in the widest area of the floor at the level of the pontomedullary junction, and the lateral recess extends laterally from the widest area. These views demonstrate the lateral and/or inferior extension of a lesion. (author)

  20. Developing a comprehensive presurgical functional MRI protocol for patients with intractable temporal lobe epilepsy: a pilot study

    International Nuclear Information System (INIS)

    Deblaere, K.; Vandemaele, P.; Achten, E.; Backes, W.H.; Hofman, P.; Wilmink, J.; Boon, P.A.; Vonck, K.; Boon, P.; Troost, J.; Vermeulen, J.; Aldenkamp, A.

    2002-01-01

    Our aim was to put together and test a comprehensive functional MRI (fMRI) protocol which could compete with the intracarotid amytal (IAT) or Wada test for the localisation of language and memory function in patients with intractable temporal lobe epilepsy. The protocol was designed to be performed in under 1 h on a standard 1.5 tesla imager. We used five paradigms to test nine healthy right-handed subjects: complex scene-encoding, picture-naming, reading, word-generation and semantic-decision tasks. The combination of these tasks generated two activation maps related to memory in the mesial temporal lobes, and three language-related maps of activation in a major part of the known language network. The functional maps from the encoding and naming tasks showed typical and symmetrical posterior mesial temporal lobe activation related to memory in all subjects. Only four of nine subjects also showed symmetrical anterior hippocampal activation. Language lateralisation was best with the word generation and reading paradigms and proved possible in all subjects. The reading paradigm enables localisation of language function in the left anterior temporal pole and middle temporal gyrus, areas typically resected during epilepsy surgery. The combined results of this comprehensive f MRI protocol are adequate for a comparative study with the IAT in patients with epilepsy being assessed for surgery. (orig.)

  1. Tönnis stage 0 and 1 acetabular rim cartilage injuries: Incidence, grade, location and associated pre-surgical factors.

    Science.gov (United States)

    Más Martínez, J; Sanz-Reig, J; Verdú Román, C M; Bustamante Suárez de Puga, D; Morales Santías, M; Martínez Giménez, E

    Articular cartilage lesions have a direct effect on the success of surgical treatment. The aim of this study was to determine the prevalence rate, location, grade, and factors associated with acetabular rim articular cartilage lesions in patients undergoing hip arthroscopy. A prospective study was conducted by analysing the intraoperative data of 152 hips in 122 patients treated with hip arthroscopy for femoroacetabular impingement from January 2011 to May 2016. The prevalence rate, location, and grade were calculated, as well as the pre-operative factors associated with acetabular rim articular cartilage lesions. The mean age of the patients was 38.6 years. The Tönnis grade was 0 in 103 hips, and 1 in 52 hips. Acetabular rim articular cartilage lesions were present in 109 (70.3%) hips. The location of the lesions was superior-anterior. Independent risk factors for the presence of acetabular rim articular cartilage lesions were an alpha-angle equal or greater than 55°, duration of symptoms equal or greater than 20 months, and Tegner activity scale level equal or greater than 6. Although patients were classified as Tönnis grade 0 and 1, and 3tesla MRI reported acetabular lesions in 1.3% of cases, there was a high frequency of acetabular rim cartilage lesions. Knowledge of the independent risk factors associated with acetabular rim articular cartilage lesions may assist the orthopaedic surgeon with the decision to perform hip arthroscopy. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Comparisons of 13NH3, 18FDG PET and MRS in the presurgical evaluation of intractable epilepsy

    International Nuclear Information System (INIS)

    Cai Li; Gao Shuo; Li Dacheng; Li Zugui

    2004-01-01

    Purpose: Surgery offers a high chance of seizure-free outcome in patients with intractable epilepsy. Other than EEG, several functional and morphologic imaging Methods are used to define the spatial seizure origin. Blood flow perfusion and metabolic abnormalities in those patients are well described respectively. Proton MR spectroscopy (MRS) is still in the early stages in the evaluation of epilepsy. Comparisons with 13NH3 perfusion, 18FDG metabolic PET imaging and MRS in the same patients have rarely been documented. The present study was undertaken to compare the merits of 13NH3 PET, 18FDG PET, magnetic resonance imaging (MRI) and MRS for the lateralization of seizure foci. Methods: Preoperative long-term-EEG, Video-EEG, 13NH3 perfusion PET, 18FDG metabolic PET, MRI, MRS and neuropsychological assessment were performed in 15 patients with intractable epilepsy within 2 weeks(mean age=24.8 years, range 4 to 44 years; mean epilepsy duration=11 years, range 2 to 36 years), who received electrocorticography (ECoG). Antiepileptic drug (AED) was stopped taking at least 2 days before PET scanning. 13NH3 and FDG PET was performed in one day and analyzed with a region of interest template. An absolute asymmetry index, |AI|, greater than 0.15 was considered abnormal. 13 subjects were underwent MRS obtained from the hippocampus bilaterally, who had a presumptive temporal seizure focus based on seizure semiology, video-EEG and MRI. Metabolite ratio of NAA/Cho+Cr was calculated from the relative peak height measurements. An NAA/Cho+Cr ratio of 0.72 or less was regarded as abnormal. All the examination Results were compared with EcoG to evaluate their values of seizure foci lateraliaztion. Results: 1. The results were divided into ictal (n=4) and interictal (n= 11) groups. In the ictal group, the sensitivity of 13NH3 PET and 18FDG PET were both 100%(4/4), and 13NH3 PET showed bilateral hippocampus hyperfusion foci in one case. In the interictal group, 13NH3 PET correctly lateralized 10(90.9%) of 11 scans, FDG PET 81.8%(9/11). False lateralization for 13NH3 PET and 18FDG PET were 1 and 0, respectively. In the cases that 13NH3 and 18FDG PET results were both positive, the rate of correct seizure lateralization reached 93.3%(14/15). 2.The sensitivity of MRS was 76.9%(10/13) in temporal lobe epilepsy (TLE). Bilateral Abnormalities were seen in 15.3%(2/13). PET showed a significantly higher sensitivity than MRS in TLE. When combined MRS with PET results, the accurate rate of seizure lateralization was 100%. Conclusion: 13NH3 perfusion PET was mild more sensitive than 18FDG PET, but had lower specificity. MRS may be used as an adjunct tool in the evaluation of hippocampal sclerosis. Approaches to combining the information provided by ictal and interictal perfusion, metabolic PET and MRS may provide a more valuable approach to localizing epileptogenic foci. The patternization of PET images can assist in designing the surgical protocol for intractable epilepsy. (authors)

  3. Presurgical evaluation of bony implant sites using panoramic radiography and cone beam computed tomography—influence of medical education

    Science.gov (United States)

    Dau, Michael; Edalatpour, Amir; Schulze, Ralf; Al-Nawas, Bilal; Alshihri, Abdulmonem

    2017-01-01

    Objectives: The aim of this study was to compare the subjective quality rating of panoramic radiography (PAN) and CBCT in the planning of dental implant procedures by clinicians with different educational backgrounds. Methods: Radiographic images (PAN and CBCT) of 42 patients were examined as follows: the maxillary (MX) anterior region of patients, the MX posterior region of 16 patients and the mandibular (MD) posterior region of 16 patients. These sites were used for planning of dental implant insertion. Data sets were analyzed by examiners with different training backgrounds: three general practitioners (GP), three oral surgeons (OS) and three maxillofacial surgeons (MS). A standardized questionnaire in a standardized setting was answered by participants. Results: The majority of participants rated an additional CBCT as “required” (14.0%) or “reasonable” (56.1%). These ratings depended strongly on the area of interest (MX anterior region: 31.1 and 58.9%; MX posterior region: 14.6 and 62.5%; and MD posterior region: 2.8% and 47.9%). MS classified CBCT as required more often than GP and OS (23.8 vs 10.3 and 7.9%; p < 0.001). With the additional information of CBCT, “therapy affecting” ratings were stated high in all groups. Conclusions: Especially in the anterior and posterior MX, significant subjective benefits for an additional CBCT were seen for planning of dental implant procedures. Participants with fundamental medical education asked for CBCT more often. The results indicate that an improved education in three-dimensional dental radiology is necessary. PMID:27759998

  4. Breast Cancer: Comparative Effectiveness of Positron Emission Mammography and MR Imaging in Presurgical Planning for the Ipsilateral Breast1

    Science.gov (United States)

    Madsen, Kathleen S.; Schilling, Kathy; Tartar, Marie; Pisano, Etta D.; Larsen, Linda Hovanessian; Narayanan, Deepa; Ozonoff, Al; Miller, Joel P.; Kalinyak, Judith E.

    2011-01-01

    Purpose: To determine the performance of positron emission mammography (PEM), as compared with magnetic resonance (MR) imaging, including the effect on surgical management, in ipsilateral breasts with cancer. Materials and Methods: Four hundred seventy-two women with newly diagnosed breast cancer who were offered breast-conserving surgery consented from September 2006 to November 2008 to participate in a multicenter institutional review board–approved, HIPAA-compliant protocol. Participants underwent contrast material–enhanced MR imaging and fluorine 18 fluorodeoxyglucose PEM in randomized order; resultant images were interpreted independently. Added biopsies and changes in surgical procedure for the ipsilateral breast were correlated with histopathologic findings. Performance characteristics were compared by using the McNemar test and generalized estimating equations. Results: Three hundred eighty-eight women (median age, 58 years; age range, 26–93 years; median estimated tumor size, 1.5 cm) completed the study. Additional cancers were found in 82 (21%) women (82 ipsilateral breasts; median tumor size, 0.7 cm). Twenty-eight (34%) of the 82 breasts were identified with both PEM and MR imaging; 21 (26%) breasts, with MR imaging only; 14 (17%) breasts, with PEM only; and seven (8.5%) breasts, with mammography and ultrasonography. Twelve (15%) cases of additional cancer were missed at all imaging examinations. Integration of PEM and MR imaging increased cancer detection—to 61 (74%) of 82 breasts versus 49 (60%) of 82 breasts identified with MR imaging alone (P breasts without additional cancer, 279 (91.2%) were correctly assessed with PEM compared with 264 (86.3%) that were correctly assessed with MR imaging (P = .03). The positive predictive value of biopsy prompted by PEM findings (47 [66%] of 71 cases) was higher than that of biopsy prompted by MR findings (61 [53%] of 116 cases) (P = .016). Of 116 additional cancers, 61 (53%) were depicted by MR imaging and 47 (41%) were depicted by PEM (P = .043). Fifty-six (14%) of the 388 women required mastectomy: 40 (71%) of these women were identified with MR imaging, and 20 (36%) were identified with PEM (P PEM findings in one, and by PEM and MR findings in five. Thirty-three (8.5%) women required wider excision: 24 (73%) of these women were identified with MR imaging, and 22 (67%) were identified with PEM. Conclusion: PEM and MR imaging had comparable breast-level sensitivity, although MR imaging had greater lesion-level sensitivity and more accurately depicted the need for mastectomy. PEM had greater specificity at the breast and lesion levels. Eighty-nine (23%) participants required more extensive surgery: 61 (69%) of these women were identified with MR imaging, and 41 (46%) were identified with PEM (P = .003). Fourteen (3.6%) women had tumors seen only at PEM. © RSNA, 2010 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100454/-/DC1 PMID:21076089

  5. Breast cancer: comparative effectiveness of positron emission mammography and MR imaging in presurgical planning for the ipsilateral breast.

    Science.gov (United States)

    Berg, Wendie A; Madsen, Kathleen S; Schilling, Kathy; Tartar, Marie; Pisano, Etta D; Larsen, Linda Hovanessian; Narayanan, Deepa; Ozonoff, Al; Miller, Joel P; Kalinyak, Judith E

    2011-01-01

    To determine the performance of positron emission mammography (PEM), as compared with magnetic resonance (MR) imaging, including the effect on surgical management, in ipsilateral breasts with cancer. Four hundred seventy-two women with newly diagnosed breast cancer who were offered breast-conserving surgery consented from September 2006 to November 2008 to participate in a multicenter institutional review board-approved, HIPAA-compliant protocol. Participants underwent contrast material-enhanced MR imaging and fluorine 18 fluorodeoxyglucose PEM in randomized order; resultant images were interpreted independently. Added biopsies and changes in surgical procedure for the ipsilateral breast were correlated with histopathologic findings. Performance characteristics were compared by using the McNemar test and generalized estimating equations. Three hundred eighty-eight women (median age, 58 years; age range, 26-93 years; median estimated tumor size, 1.5 cm) completed the study. Additional cancers were found in 82 (21%) women (82 ipsilateral breasts; median tumor size, 0.7 cm). Twenty-eight (34%) of the 82 breasts were identified with both PEM and MR imaging; 21 (26%) breasts, with MR imaging only; 14 (17%) breasts, with PEM only; and seven (8.5%) breasts, with mammography and ultrasonography. Twelve (15%) cases of additional cancer were missed at all imaging examinations. Integration of PEM and MR imaging increased cancer detection-to 61 (74%) of 82 breasts versus 49 (60%) of 82 breasts identified with MR imaging alone (P breasts without additional cancer, 279 (91.2%) were correctly assessed with PEM compared with 264 (86.3%) that were correctly assessed with MR imaging (P = .03). The positive predictive value of biopsy prompted by PEM findings (47 [66%] of 71 cases) was higher than that of biopsy prompted by MR findings (61 [53%] of 116 cases) (P = .016). Of 116 additional cancers, 61 (53%) were depicted by MR imaging and 47 (41%) were depicted by PEM (P = .043). Fifty-six (14%) of the 388 women required mastectomy: 40 (71%) of these women were identified with MR imaging, and 20 (36%) were identified with PEM (P PEM findings in one, and by PEM and MR findings in five. Thirty-three (8.5%) women required wider excision: 24 (73%) of these women were identified with MR imaging, and 22 (67%) were identified with PEM. PEM and MR imaging had comparable breast-level sensitivity, although MR imaging had greater lesion-level sensitivity and more accurately depicted the need for mastectomy. PEM had greater specificity at the breast and lesion levels. Eighty-nine (23%) participants required more extensive surgery: 61 (69%) of these women were identified with MR imaging, and 41 (46%) were identified with PEM (P = .003). Fourteen (3.6%) women had tumors seen only at PEM. © RSNA, 2010

  6. Presurgical and postsurgical assessment of the neurodevelopment of infants with single-suture craniosynostosis: comparison with controls

    Science.gov (United States)

    Starr, Jacqueline R.; Kapp-Simon, Kathleen A.; Cloonan, Yona Keich; Collett, Brent R.; Cradock, Mary Michaeleen; Buono, Lauren; Cunningham, Michael L.; Speltz, Matthew L.

    2012-01-01

    Object Although most infants with single-suture craniosynostosis (SSC) appear to have neurodevelopmental test scores in the average range, SSC has been associated with cognitive and motor delays during infancy. Whether and when surgery improves such deficits are not yet known. The authors aimed to compare the pre- and postsurgical neurodevelopmental status of patients with SSC with those of control infants without craniosynostosis. Methods The authors conducted a large, multicenter, longitudinal study of 168 infants with craniosynostosis and 115 controls without synostosis who were of similar age, race, sex, and socioeconomic status. The authors assessed participants by using the Bayley Scales of Infant Development, Second Edition (BSID-II) and the Preschool Language Scale, Third Edition (PLS-3) at enrollment, before patients’ intracranial surgery, and when participants were 18 months of age (after surgery for patients). Results After adjusting for potential confounding factors in linear regression analyses, the authors found a tendency for patients to perform similarly to or slightly worse than controls on neurodevelopmental examinations at both visits. After surgery, the patients’ mean scores were 0.6 to three points lower than those of controls on the five BSID-II and PLS-3 scales (p = 0.02–0.07). Compared with controls, patients had 2.3 and 1.9 times the adjusted odds of scoring in the delayed range on either BSID-II scale (Mental Development Index and Psychomotor Development Index) for the first and second visits, respectively (p = 0.001 and p = 0.015, respectively). The patients’ mean adjusted test scores were nearly unrelated to the timing of their surgery. Conclusions These findings support recommendations for neurodevelopmental screening in infants with SSC. Longer follow-up, as is being conducted with the patients in the present study, will be critical for identifying the potential longer-term correlates of SSC and its surgical correction. PMID:18459881

  7. Changes in Swallowing after Anterior Cervical Discectomy and Fusion with Instrumentation: A Presurgical versus Postsurgical Videofluoroscopic Comparison

    Science.gov (United States)

    Muss, Lydia; Wilmskoetter, Janina; Richter, Kerstin; Fix, Constanze; Stanschus, Soenke; Pitzen, Tobias; Drumm, Joerg; Molfenter, Sonja

    2017-01-01

    Purpose: The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies. Method: We retrospectively analyzed both functional measures (penetration-aspiration, residue) and…

  8. Three-dimensional reconstruction of the topographical cerebral surface anatomy for presurgical planning with free OsiriX Software.

    Science.gov (United States)

    Harput, Mehmet V; Gonzalez-Lopez, Pablo; Türe, Uğur

    2014-09-01

    During surgery for intrinsic brain lesions, it is important to distinguish the pathological gyrus from the surrounding normal sulci and gyri. This task is usually tedious because of the pia-arachnoid membranes with their arterial and venous complexes that obscure the underlying anatomy. Moreover, most tumors grow in the white matter without initially distorting the cortical anatomy, making their direct visualization more difficult. To create and evaluate a simple and free surgical planning tool to simulate the anatomy of the surgical field with and without vessels. We used free computer software (OsiriX Medical Imaging Software) that allowed us to create 3-dimensional reconstructions of the cerebral surface with and without cortical vessels. These reconstructions made use of magnetic resonance images from 51 patients with neocortical supratentorial lesions operated on over a period of 21 months (June 2011 to February 2013). The 3-dimensional (3-D) anatomic images were compared with the true surgical view to evaluate their accuracy. In all patients, the landmarks determined by 3-D reconstruction were cross-checked during surgery with high-resolution ultrasonography; in select cases, they were also checked with indocyanine green videoangiography. The reconstructed neurovascular structures were confirmed intraoperatively in all patients. We found this technique to be extremely useful in achieving pure lesionectomy, as it defines tumor's borders precisely. A 3-D reconstruction of the cortical surface can be easily created with free OsiriX software. This technique helps the surgeon perfect the mentally created 3-D picture of the tumor location to carry out cleaner, safer surgeries.

  9. Prospective Pilot Investigation: Presurgical Depressive Symptom Severity and Anesthesia Response in Women Undergoing Surgery for Gynecologic Mass Removal.

    Science.gov (United States)

    Price, Catherine C; Pereira, Deidre B; Andre, Rachel; Garvan, Cynthia Wilson; Nguyen, Peter; Herman, Mary; Seubert, Christoph

    2015-08-01

    Anesthesia depth has been associated with mortality. The association between anesthesia depth and presurgery physical and health status, however, is currently debated. Depression is one comorbid condition that warrants investigation given its association to reduced frontal lobe activity and high prevalence in known surgery samples (e.g., gynecologic mass removal). This pilot study examined the hypothesis that severity of acute depressive symptoms would associate with greater sensitivity to anesthesia as measured by a frontal lobe electroencephalogram (EEG)-based monitor during the anesthesia induction phase among women undergoing gynecologic mass removal. This was a prospective and surgery anesthesia-controlled pilot investigation with 31 women undergoing surgery for removal of pelvic/gynecologic masses. Participants completed the Millon Behavioral Medicine Diagnostic (MBMD) inventory to assess depressive-related symptomatology. A Bispectral Index Score (BIS™) monitor (Aspect Medical Systems Inc., MA) was placed on the left frontal region to measure change in response from a set pre-anesthesia baseline point throughout the induction phase (6.5 min of the anesthetic). BIS™ change was calculated using a modified "area under the curve with respect to ground" formula. Greater sensitivity to anesthesia during induction was significantly associated with higher MBMD future pessimism scores and marginally associated with higher MBMD depression scores. Depressive personality, anxiety severity, tumor type, age, medication use, and comorbidity scores were not found to be predictors of BIS score change. These pilot findings suggest that preoperative psychological health and anesthesia response are not independent. Acute presurgery depression and anesthesia response warrant closer empirical examination.

  10. Presurgical brain mapping in epilepsy using simultaneous EEG and functional MRI at ultra-high field : feasibility and first results

    NARCIS (Netherlands)

    Grouiller, Frédéric; Jorge, João; Pittau, Francesca; Van der Zwaag, W.; Iannotti, Giannina Rita; Michel, Christoph Martin; Vulliémoz, Serge; Vargas, Maria Isabel; Lazeyras, François

    OBJECTIVES: The aim of this study was to demonstrate that eloquent cortex and epileptic-related hemodynamic changes can be safely and reliably detected using simultaneous electroencephalography (EEG)-functional magnetic resonance imaging (fMRI) recordings at ultra-high field (UHF) for clinical

  11. Pre-surgical evaluation of the cerebral tumor in the left language related areas by functional MRI

    International Nuclear Information System (INIS)

    Zou Zhitong; Ma Lin; Weng Xuchu

    2010-01-01

    Objective: To evaluate the application of combination of BOLD-fMRI and diffusion tensor tractography (DTT) in pre-operative evaluation of cerebral tumors located at the left language related areas. Methods: A non-vocal button pressing semantic judging paradigm was developed and validated in 10 right-handed volunteers at 3 T. After validation, this protocol combined with DTI were applied to 15 patients with left cerebral tumor prior to surgical resection, and 3 of them had aphasia. fMRI data analysis was on subject-specific basis by one-sampled t-test. The distance from the tumor to Broca area and pre-central 'hand-knot' area were measured separately. Functional language laterality index (LI) was calculated by taking out Broca area and Wernicke area. Three dimensional architecture of frontal lobe white matter fibers, especially arcuate fasciculus, were visualized using diffusion tensor tractography on Volume-one software. The images demonstrating relationship among tumor, language activation areas and white matter fibers were reviewed by neurosurgeons as part of pre-operative planning. One year after the operation, patients were followed up with MRI and language function test. Results: The non-vocal semantic judging paradigm successfully detect Broca area, Wernicke area and pre-central 'hand-knot' area. In 12 of 15 patients, the relationship of Broca area and pre-central motor area to the left brain tumor in language related areas was identified, which make the pre-operative neurosurgical plan applicable to minimize the disruption of language and motor. 8 patients had the left language dominant hemisphere, 3 patients with the right language dominant hemisphere and 1 patient with bilateral dominance. The other 3 patients' fMRI data were corrupted by patients' motion. Diffusion tensor images were corrupted by motion in 1 patient but demonstrated the impact of tumor on left accouter fasciculus in 14 patients. Diffusion tensor tractography showed disruption of left arcuate fasciculus in 3 patients, deviation/deformation in 6 cases and unaffected by tumor in the remaining 5 cases. Pre-operative review of language activation maps and diffusion tensor tractography of arcuate fasciculus influenced the surgical approach in all 12 patients. Post-operatively, one patient died accidentally, the remaining 14 patients showed no tumor recurrence after one year follow-up. No patient showed deterioration of language function, though 3 patients who had aphasia pre-operation improved slightly. Conclusion: The combination of fMRI and diffusion tensor tractography is helpful for identifying the relationship of brain tumors with language cortex and white matter fibers, which is important for sparing language function during individually surgical plan. (authors)

  12. Developing a comprehensive presurgical functional MRI protocol for patients with intractable temporal lobe epilepsy: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Deblaere, K.; Vandemaele, P.; Achten, E. [MRI Department -1 K12, Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent (Belgium); Backes, W.H.; Hofman, P.; Wilmink, J. [Department of Neuroradiology, University Hospital Maastricht, Postbus 5800, 6202 AZ Maastricht (Netherlands); Boon, P.A.; Vonck, K. [Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent (Belgium); Boon, P. [Department of Medical Psychology, University Hospital Maastricht (Netherlands); Troost, J. [Department of Neurology, University Hospital Maastricht (Netherlands); Vermeulen, J. [S.E.I.N Heemstede, Psychological Laboratory, Achterweg 5, 2103 SW Heemstede (Netherlands); Aldenkamp, A. [Epilepsy Center ' Kempenhaeghe' , Postbus 61, 5900 AB Heeze (Netherlands)

    2002-08-01

    Our aim was to put together and test a comprehensive functional MRI (fMRI) protocol which could compete with the intracarotid amytal (IAT) or Wada test for the localisation of language and memory function in patients with intractable temporal lobe epilepsy. The protocol was designed to be performed in under 1 h on a standard 1.5 tesla imager. We used five paradigms to test nine healthy right-handed subjects: complex scene-encoding, picture-naming, reading, word-generation and semantic-decision tasks. The combination of these tasks generated two activation maps related to memory in the mesial temporal lobes, and three language-related maps of activation in a major part of the known language network. The functional maps from the encoding and naming tasks showed typical and symmetrical posterior mesial temporal lobe activation related to memory in all subjects. Only four of nine subjects also showed symmetrical anterior hippocampal activation. Language lateralisation was best with the word generation and reading paradigms and proved possible in all subjects. The reading paradigm enables localisation of language function in the left anterior temporal pole and middle temporal gyrus, areas typically resected during epilepsy surgery. The combined results of this comprehensive f MRI protocol are adequate for a comparative study with the IAT in patients with epilepsy being assessed for surgery. (orig.)

  13. SU-E-T-776: Use of Quality Metrics for a New Hypo-Fractionated Pre-Surgical Mesothelioma Protocol

    Energy Technology Data Exchange (ETDEWEB)

    Richardson, S; Mehta, V [Swedish Cancer Institute, Seattle, WA (United States)

    2015-06-15

    Purpose: The “SMART” (Surgery for Mesothelioma After Radiation Therapy) approach involves hypo-fractionated radiotherapy of the lung pleura to 25Gy over 5 days followed by surgical resection within 7. Early clinical results suggest that this approach is very promising, but also logistically challenging due to the multidisciplinary involvement. Due to the compressed schedule, high dose, and shortened planning time, the delivery of the planned doses were monitored for safety with quality metric software. Methods: Hypo-fractionated IMRT treatment plans were developed for all patients and exported to Quality Reports™ software. Plan quality metrics or PQMs™ were created to calculate an objective scoring function for each plan. This allows for an objective assessment of the quality of the plan and a benchmark for plan improvement for subsequent patients. The priorities of various components were incorporated based on similar hypo-fractionated protocols such as lung SBRT treatments. Results: Five patients have been treated at our institution using this approach. The plans were developed, QA performed, and ready within 5 days of simulation. Plan Quality metrics utilized in scoring included doses to OAR and target coverage. All patients tolerated treatment well and proceeded to surgery as scheduled. Reported toxicity included grade 1 nausea (n=1), grade 1 esophagitis (n=1), grade 2 fatigue (n=3). One patient had recurrent fluid accumulation following surgery. No patients experienced any pulmonary toxicity prior to surgery. Conclusion: An accelerated course of pre-operative high dose radiation for mesothelioma is an innovative and promising new protocol. Without historical data, one must proceed cautiously and monitor the data carefully. The development of quality metrics and scoring functions for these treatments allows us to benchmark our plans and monitor improvement. If subsequent toxicities occur, these will be easy to investigate and incorporate into the metrics. This will improve the safe delivery of large doses for these patients.

  14. Splint: the efficacy of orthotic management in rest to prevent equinus in children with cerebral palsy, a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Maas Josina C

    2012-03-01

    Full Text Available Abstract Background Range of motion deficits of the lower extremity occur in about the half of the children with spastic cerebral palsy (CP. Over time, these impairments can cause joint deformities and deviations in the children's gait pattern, leading to limitations in moblity. Preventing a loss of range of motion is important in order to reduce secondary activity limitations and joint deformities. Sustained muscle stretch, imposed by orthotic management in rest, might be an effective method of preventing a decrease in range of motion. However, no controlled study has been performed. Methods A single blind randomised controlled trial will be performed in 66 children with spastic CP, divided over three groups with each 22 participants. Two groups will be treated for 1 year with orthoses to prevent a decrease in range of motion in the ankle (either with static or dynamic knee-ankle-foot-orthoses and a third group will be included as a control group and will receive usual care (physical therapy, manual stretching. Measurements will be performed at baseline and at 3, 6, 9 and 12 months after treatment allocation. The primary outcome measure will be ankle dorsiflexion at full knee extension, measured with a custom designed hand held dynamometer. Secondary outcome measures will be i ankle and knee flexion during gait and ii gross motor function. Furthermore, to gain more insight in the working mechanism of the orthotic management in rest, morphological parameters like achilles tendon length, muscle belly length, muscle fascicle length, muscle physiological cross sectional area length and fascicle pennation angle will be measured in a subgroup of 18 participants using a 3D imaging technique. Discussion This randomised controlled trial will provide more insight into the efficacy of orthotic management in rest and the working mechanisms behind this treatment. The results of this study could lead to improved treatments. Trial Registration Number Nederlands Trial Register NTR2091

  15. EXPERIMENTAL STUDY ON THE MODIFICATIONS PRODUCED AT THE INTERFACE BETWEEN THE PERIODONTAL ADHESIVE SPLINTS AND THE DENTAL SURFACE

    Directory of Open Access Journals (Sweden)

    Bogdan VÂSCU

    2016-03-01

    Full Text Available As the market offer for bioadhesive materials is constantly increasing, while the dental surfaces on which they are applied show specific features, different from those commonly resulting from the preparation of carious processes, knowledge on their behavioral characteristics is absolutely necessary for their utilization under optimum conditions, through methods assuming prolongued clinical performances, assured by dimensional and colouristic stability and by a reduced cure contraction, for diminishing as much as possible the space of marginal percolation and fracture of the free enamel-free margins, as well as for delamination of immobilization from the afferent dental structure. Selection of the type of material for periodonthic teeth immobilization and of the technique to be applied is decided on the basis of a systematic, clinical and radiological analysis meant at establishing: the number of affected teeth, the type of occlusion and the possible parafunctions, oral hygiene, the aesthetic requirements of the patient, his/her age and motivation for a periodical monitorization. Numerous modern materials employed in the immobilization of periodonthic teeth are closely related not only to their physical properties and long-term stability, but also to the oral environment in which they are functioning. Modern adhesive materials are well-suited for dental recovery of the remaining healthy structures, due to their capacity of chemically and micromechanically adhering onto them.

  16. Innovative procedure for computer-assisted genioplasty: three-dimensional cephalometry, rapid-prototyping model and surgical splint.

    Science.gov (United States)

    Olszewski, R; Tranduy, K; Reychler, H

    2010-07-01

    The authors present a new procedure of computer-assisted genioplasty. They determined the anterior, posterior and inferior limits of the chin in relation to the skull and face with the newly developed and validated three-dimensional cephalometric planar analysis (ACRO 3D). Virtual planning of the osteotomy lines was carried out with Mimics (Materialize) software. The authors built a three-dimensional rapid-prototyping multi-position model of the chin area from a medical low-dose CT scan. The transfer of virtual information to the operating room consisted of two elements. First, the titanium plates on the 3D RP model were pre-bent. Second, a surgical guide for the transfer of the osteotomy lines and the positions of the screws to the operating room was manufactured. The authors present the first case of the use of this model on a patient. The postoperative results are promising, and the technique is fast and easy-to-use. More patients are needed for a definitive clinical validation of this procedure. Copyright 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Cephalometric assessment of vertical control in the treatment of class II malocclusion with a combined maxillary splint

    Directory of Open Access Journals (Sweden)

    Ivana Uglik Garbui

    2010-03-01

    Full Text Available Vertical control is one of the primary objectives sought by orthodontists when treating malocclusions in hyperdivergent individuals. This investigation aimed at assessing vertical control, by cephalometric measurements, during the treatment of Angle Class II Division 1 malocclusion. Thirty cases, selected from the files of the São Leopoldo Mandic Dental Research Center, Brazil, of subjects with Angle Class II Division 1 malocclusion and facial hyperdivergence, were used in this study. The patients were treated using a combined extraoral appliance during a mean treatment time of 1.1 years. Pre- and posttreatment cephalometric measurements were compared to assess vertical control. The results were submitted to ANOVA (p = 5%. The ANOVA test revealed no statistically significant difference between the pretreatment and posttreatment values of OP (Occlusal plane angle and SN.MP. While there was a decrease in Y-axis, FMA, and PP.MP, there was an increase in SN.PP, Co-Go, AFH, PFH, and FHI. It was concluded that the divergence in the facial lower third of the patients did not increase, suggesting that the combined extraoral appliance with the line of force application directed to the resistance center of the maxilla was effective in treating Angle Class II malocclusion in hyperdivergent subjects.

  18. History of clubfoot treatment, part I: From manipulation in antiquity to splint and plaster in Renaissance before tenotomy.

    Science.gov (United States)

    Hernigou, Philippe; Huys, Maxime; Pariat, Jacques; Jammal, Sibylle

    2017-08-01

    Idiopathic clubfoot is one of the most common problems in paediatric orthopaedics. The treatment is controversial and continues to be one of the challenges in paediatric orthopaedics. The aim of this review is to assess the different methods of clubfoot treatment used over the years in light of the documentation present in the literature and art paintings from the antiquity to the end of the 19th century. The aim of this paper is to review all treatment methods of the clubfoot over the years that were proposed to provide patients a functional, pain-free, normal-looking foot, with good mobility, without calluses, and requiring no special shoes. Hippocrates was the first to write references about treatment methods of clubfoot. After the Middle Ages and the Renaissance where patients were treated by barber-surgeons, quacks and charlatans, bonesetters, and trussmakers, there were more detailed studies on the disease, with the help of famous names in medicine such as Venel and Scarpa.

  19. Usefulness of Computed Tomography in pre-surgical evaluation of maxillo-facial pathology with rapid prototyping and surgical pre-planning by virtual reality

    International Nuclear Information System (INIS)

    Toso, Francesco; Zuiani, Chiara; Vergendo, Maurizio; Bazzocchi, Massimo; Salvo, Iolanda; Robiony, Massimo; Politi, Massimo

    2005-01-01

    Purpose. To validate a protocol for creating virtual models to be used in the construction of solid prototypes useful for the planning-simulation of maxillo-facial surgery, in particular for very complex anatomical and pathologic problems. To optimize communications between the radiology, engineering and surgical laboratories. Methods and materials. We studied 16 patients with different clinical problems of the maxillo-facial district. Exams were performed with multidetector computed tomography (MDCT) and single slice computed tomography (SDCT) with axial scans and collimation of 0.5-2 mm, and reconstruction interval of 1 mm. Subsequently we performed 2D multiplanar reconstructions and 3D volume-rendering reconstructions. We exported the DICOM images to the engineering laboratory, to recognize and isolate the bony structures by software. With these data the solid prototypes were generated using stereolitography. To date, surgery has been preformed on 12 patients after simulation of the procedure on the stereolitography model. Results. The solid prototypes constructed in the difficult cases were sufficiently detailed despite problems related to the artefacts generated by dental fillings and prostheses. In the remaining cases the MPR/3D images were sufficiently detailed for surgical planning. The surgical results were excellent in all patients who underwent surgery, and the surgeons were satisfied with the improvement in quality and the reduction in time required for the procedure. Conclusions. MDCT enables rapid prototyping using solid replication, which was very helpful in maxillofacial surgery, despite problems related to artifacts due to dental fillings and prosthesis within the acquisition field; solutions for this problem are work in progress. The protocol used for communication between the different laboratories was valid and reproducible [it

  20. On the relative merits of invasive and non-invasive pre-surgical brain mapping: New tools in ablative epilepsy surgery.

    Science.gov (United States)

    Papanicolaou, Andrew C; Rezaie, Roozbeh; Narayana, Shalini; Choudhri, Asim F; Abbas-Babajani-Feremi; Boop, Frederick A; Wheless, James W

    2018-05-01

    Cortical Stimulation Mapping (CSM) and the Wada procedure have long been considered the gold standard for localizing motor and language-related cortical areas and for determining the language and memory-dominant hemisphere, respectively. In recent years, however, non-invasive methods such as magnetoencephalography (MEG), functional magnetic resonance imaging (fMRI), and transcranial magnetic stimulation (TMS) have emerged as promising alternatives to the aforementioned procedures, particularly in cases where the invasive localization of eloquent cortex has proven to be challenging. To illustrate this point, we will first introduce the evidence of the compatibility of invasive and non-invasive methods and subsequently outline the rationale and the conditions where the latter methods are applicable. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Preservation of Motor Function After Resection of Lower-Grade Glioma at the Precentral Gyrus and Prediction by Presurgical Functional Magnetic Resonance Imaging and Magnetoencephalography.

    Science.gov (United States)

    Izutsu, Nobuyuki; Kinoshita, Manabu; Yanagisawa, Takufumi; Nakanishi, Katsuhiko; Sakai, Mio; Kishima, Haruhiko

    2017-11-01

    Intra-axial brain tumors located at anatomically eloquent areas are challenging conditions. On one hand, it is often difficult to pursue maximum extent of resection of tumor in these locations. On the other hand, neuroplasticity occurs in some patients with low-grade glioma, and the primary neural functions are known to sometimes shift from conventional "eloquent cortices." In a patient with a lower-grade glioma located at the precentral gyrus, shift of primary motor function from the precentral gyrus to the postcentral gyrus was detected on magnetoencephalography and functional magnetic resonance imaging. Aggressive removal of the pathologic precentral gyrus was accomplished via awake craniotomy without causing obvious motor function deficit. This case highlights the importance of preoperative multimodal neurophysiologic imaging in patients with low-grade gliomas in eloquent areas. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Circulating Apolipoprotein A-IV presurgical levels are associated with improvement in insulin sensitivity after Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Rao, Raghavendra; Roche, Alexander; Febres, Gerardo; Bessler, Marc; Tso, Patrick; Korner, Judith

    2017-03-01

    Apolipoprotein A-IV (ApoA-IV) has been shown to be involved in obesity and diabetes pathogenesis in animal studies, but its role in humans is uncertain. The objective of this study was to determine the relation of ApoA-IV with changes in glucose metabolism and weight after bariatric surgery. University Hospital. The patients (n = 49) included lean controls (n = 8) and patients before and after a mean of 7 months after laparoscopic adjustable gastric banding (LAGB, n = 12), laparoscopic Roux-en-Y gastric bypass (RYGB, n = 22), or laparoscopic sleeve gastrectomy (SG, n = 11). ApoA-IV and other hormone assays were performed in the fasting and the postprandial state. Pearson's correlation analyses controlled for baseline BMI and percent excess weight loss (EWL) were used to determine relationships between ApoA-IV levels and insulin resistance (HOMA-IR). With all bariatric procedures combined, the change in ApoA-IV [533 versus 518 microg/L, P = .813] or ApoA-IV area under the curve (AUC - 1072 versus 1042, P = .939) was not significant. None of the surgeries individually affected levels of fasting or ApoA-IV AUC. Bariatric surgery resulted in a decrease in HOMA-IR (5.3 versus 2.0, PHOMA-IR [r = -.6, P = .008]. This relationship was independent of EWL and was not observed in the LAGB or SG group. There was no association of ApoA-IV levels with EWL, insulin secretion, Peptide-YY, or leptin levels. Preoperative ApoA-IV levels, rather than changes in levels, positively correlate with improvements in insulin sensitivity independent of weight loss after RYGB. Copyright © 2017. Published by Elsevier Inc.

  3. Evaluation of the applicability of territorial arterial spin labeling in meningiomas for presurgical assessments compared with 3-dimensional time-of-flight magnetic resonance angiography

    International Nuclear Information System (INIS)

    Lu, Yiping; Wen, Jianbo; Geng, Daoying; Yin, Bo; Luan, Shihai; Liu, Li; Xiong, Ji; Qu, Jianxun

    2017-01-01

    To prospectively evaluate the application of territorial arterial spin labelling (t-ASL) in comparison with unenhanced three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) in the identification of the feeding vasculature of meningiomas. Thirty consecutive patients with suspected meningiomas underwent conventional MR imaging, unenhanced 3D-TOF-MRA and t-ASL scanning. Four experienced neuro-radiologists assessed the feeding vessels with different techniques separately. For the identification of the origin of the feeding arteries on t-ASL, the inter-observer agreement was excellent (κ = 0.913), while the inter-observer agreement of 3D-TOF-MRA was good (κ = 0.653). The inter-modality agreement between t-ASL and 3D-TOF-MRA for the feeding arteries was moderate (κ = 0.514). All 8 patients with motor or sensory disorders proved to have meningiomas supplied completely or partially by the internal carotid arteries, while all 14 patients with meningiomas supplied by the external carotid arteries or basilar arteries didn't show any symptoms concerning motor or sensory disorders (p = 0.003). T-ASL could complement unenhanced 3D-TOF-MRA and increase accuracy in the identification of the supplying arteries of meningiomas in a safe, intuitive, non-radioactive manner. The information about feeding arteries was potentially related to patients' symptoms and pathology, making it more crucial for neurosurgeons in planning surgery as well as evaluating prognosis. (orig.)

  4. Usage of fMRI for pre-surgical planning in brain tumor and vascular lesion patients: Task and statistical threshold effects on language lateralization

    Directory of Open Access Journals (Sweden)

    Tanvi N. Nadkarni

    2015-01-01

    Conclusion: Our results suggest that the type of task and the applied statistical threshold influence LI and that the threshold effects on LI may be task-specific. Thus identifying critical functional regions and computing LIs should be conducted on an individual subject basis, using a continuum of threshold values with different tasks to provide the most accurate information for surgical planning to minimize post-operative language deficits.

  5. Evaluation of the applicability of territorial arterial spin labeling in meningiomas for presurgical assessments compared with 3-dimensional time-of-flight magnetic resonance angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Yiping; Wen, Jianbo; Geng, Daoying; Yin, Bo [Fudan University, Department of Radiology, Huashan Hospital, Shanghai (China); Luan, Shihai [Fudan University, Department of Neurosurgery, Huashan Hospital, Shanghai (China); Liu, Li [Fudan University, Department of Radiology, Shanghai Cancer Center, Shanghai (China); Xiong, Ji [Fudan University, Department of Pathology, Huashan Hospital, Shanghai (China); Qu, Jianxun [GE Healthcare, Department of MR Research, Shanghai (China)

    2017-10-15

    To prospectively evaluate the application of territorial arterial spin labelling (t-ASL) in comparison with unenhanced three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) in the identification of the feeding vasculature of meningiomas. Thirty consecutive patients with suspected meningiomas underwent conventional MR imaging, unenhanced 3D-TOF-MRA and t-ASL scanning. Four experienced neuro-radiologists assessed the feeding vessels with different techniques separately. For the identification of the origin of the feeding arteries on t-ASL, the inter-observer agreement was excellent (κ = 0.913), while the inter-observer agreement of 3D-TOF-MRA was good (κ = 0.653). The inter-modality agreement between t-ASL and 3D-TOF-MRA for the feeding arteries was moderate (κ = 0.514). All 8 patients with motor or sensory disorders proved to have meningiomas supplied completely or partially by the internal carotid arteries, while all 14 patients with meningiomas supplied by the external carotid arteries or basilar arteries didn't show any symptoms concerning motor or sensory disorders (p = 0.003). T-ASL could complement unenhanced 3D-TOF-MRA and increase accuracy in the identification of the supplying arteries of meningiomas in a safe, intuitive, non-radioactive manner. The information about feeding arteries was potentially related to patients' symptoms and pathology, making it more crucial for neurosurgeons in planning surgery as well as evaluating prognosis. (orig.)

  6. Guided implant surgery with placement of a presurgical CAD/CAM patient-specific abutment and provisional in the esthetic zone.

    Science.gov (United States)

    Mandelaris, George A; Vlk, Scott D

    2014-01-01

    Parallel use of implant treatment planning software and cone-beam computed tomography (CBCT) can, using certain criteria, consolidate steps and streamline tooth replacement strategies. The authors describe such a case in the esthetic zone whereby flapless extraction and immediate implant placement using CT-guided surgery were performed simultaneously, with placement of a computer-aided design/computer-aided manufactured (CAD/CAM) patient-specific abutment and non-occlusal function provisional in a single visit (supporting the "one-abutment, one-time" concept). An over-retained primary cuspid in a periodontally healthy woman with well-controlled type-2 diabetes was replaced with an implant and CAD/CAM patient-specific abutment in the No. 11 position. A necessary implant-axis angle correction was customized using digital information from a CBCT scan and implant treatment planning software, without the need for site development or a conventional impression. This data integration and streamlined workflow enabled fabrication of a CAD/CAM patient-specific abutment before surgical treatment. The abutment remained in place from implant surgery to the prosthetic phase, with minimal soft-tissue changes, enabling preservation of pink esthetics and expediting treatment. The result was a preserved emergence profile in the presence of high esthetic demands. However, due to slight post-extraction soft-tissue changes, digital reformatting of the abutment was required when the final crown was fabricated, thus limiting the disruption of the biologic width to a one-time occurrence. The importance of case selection for this treatment protocol in the esthetic zone cannot be overemphasized. A thick crestal dentoalveolar bone phenotype (> 1 mm, approaching 2 mm in this case), broad zone of attached and keratinized gingiva (3 mm to 4 mm in this case), adequate peri-implant soft-tissue thickness (> 1 mm in this case), and high primary implant stability (ISQ = 80 in this case) were all critical factors influencing outcome.

  7. Presurgical evaluation for partial epilepsy: Relative contributions of chronic depth-electrode recordings versus FDG-PET and scalp-sphenoidal ictal EEG

    Energy Technology Data Exchange (ETDEWEB)

    Engel, J. Jr.; Henry, T.R.; Risinger, M.W.; Mazziotta, J.C.; Sutherling, W.W.; Levesque, M.F.; Phelps, M.E.

    1990-11-01

    One hundred fifty-three patients with medically refractory partial epilepsy underwent chronic stereotactic depth-electrode EEG (SEEG) evaluations after being studied by positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) and scalp-sphenoidal EEG telemetry. We carried out retrospective standardized reviews of local cerebral metabolism and scalp-sphenoidal ictal onsets to determine when SEEG recordings revealed additional useful information. FDG-PET localization was misleading in only 3 patients with temporal lobe SEEG ictal onsets for whom extratemporal or contralateral hypometabolism could be attributed to obvious nonepileptic structural defects. Two patients with predominantly temporal hypometabolism may have had frontal epileptogenic regions, but ultimate localization remains uncertain. Scalp-sphenoidal ictal onsets were misleading in 5 patients. For 37 patients with congruent focal scalp-sphenoidal ictal onsets and temporal hypometabolic zones, SEEG recordings never demonstrated extratemporal or contralateral epileptogenic regions; however, 3 of these patients had nondiagnostic SEEG evaluations. The results of subsequent subdural grid recordings indicated that at least 1 of these patients may have been denied beneficial surgery as a result of an equivocal SEEG evaluation. Weighing risks and benefits, it is concluded that anterior temporal lobectomy is justified without chronic intracranial recording when specific criteria for focal scalp-sphenoidal ictal EEG onsets are met, localized hypometabolism predominantly involves the same temporal lobe, and no other conflicting information has been obtained from additional tests of focal functional deficit, structural imaging, or seizure semiology.

  8. Radial gradient and radial deviation radiomic features from pre-surgical CT scans are associated with survival among lung adenocarcinoma patients

    Science.gov (United States)

    Tunali, Ilke; Stringfield, Olya; Guvenis, Albert; Wang, Hua; Liu, Ying; Balagurunathan, Yoganand; Lambin, Philippe; Gillies, Robert J.; Schabath, Matthew B.

    2017-01-01

    The goal of this study was to extract features from radial deviation and radial gradient maps which were derived from thoracic CT scans of patients diagnosed with lung adenocarcinoma and assess whether these features are associated with overall survival. We used two independent cohorts from different institutions for training (n= 61) and test (n= 47) and focused our analyses on features that were non-redundant and highly reproducible. To reduce the number of features and covariates into a single parsimonious model, a backward elimination approach was applied. Out of 48 features that were extracted, 31 were eliminated because they were not reproducible or were redundant. We considered 17 features for statistical analysis and identified a final model containing the two most highly informative features that were associated with lung cancer survival. One of the two features, radial deviation outside-border separation standard deviation, was replicated in a test cohort exhibiting a statistically significant association with lung cancer survival (multivariable hazard ratio = 0.40; 95% confidence interval 0.17-0.97). Additionally, we explored the biological underpinnings of these features and found radial gradient and radial deviation image features were significantly associated with semantic radiological features. PMID:29221183

  9. Exophytic pilocytic astrocytoma of the brain stem in an adult with encasement of the caudal cranial nerve complex (IX-XII): presurgical anatomical neuroimaging using MRI

    Energy Technology Data Exchange (ETDEWEB)

    Yousry, Indra; Yousry, Tarek A. [Department of Neuroradiology, Klinikum Grosshadern, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich (Germany); Muacevic, Alexander; Olteanu-Nerbe, Vlad [Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians University, Munich (Germany); Naidich, Thomas P. [Department of Radiology, Section of Neuroradiology, Mount Sinai Hospital, New York (United States)

    2004-07-01

    We describe a rare case of adult pilocytic astrocytoma in which exophytic growth from the brain stem presented as a right cerebellopontine angle mass. An initial MRI examination using T2- and T1-weighted images without and with contrast suggested the diagnosis of schwannoma. Subsequent use of 3D CISS (three-dimensional constructive interference in steady state) and T1-weighted contrast-enhanced 3D MP-RAGE (three-dimensional magnetization prepared rapid acquisition gradient echo) sequences led to the diagnosis of an exophytic brain stem tumor, documented the precise relationships of the tumor to cranial nerve VIII, revealed encasement of cranial nerves IX-XII (later confirmed intraoperatively), and provided the proper basis for planning surgical management. (orig.)

  10. The University Münster Model Surgery System for Orthognathic Surgery. Part II -- KD-MMS.

    Science.gov (United States)

    Ehmer, Ulrike; Joos, Ulrich; Ziebura, Thomas; Flieger, Stefanie; Wiechmann, Dirk

    2013-01-04

    Model surgery is an integral part of the planning procedure in orthognathic surgery. Most concepts comprise cutting the dental cast off its socket. The standardized spacer plates of the KD-MMS provide for a non-destructive, reversible and reproducible means of maxillary and/or mandibular plaster cast separation. In the course of development of the system various articulator types were evaluated with regard to their capability to provide a means of realizing the concepts comprised of the KD-MMS. Special attention was dedicated to the ability to perform three-dimensional displacements without cutting of plaster casts. Various utilities were developed to facilitate maxillary displacement in accordance to the planning. Objectives of this development comprised the ability to implement the values established in the course of two-dimensional ceph planning. The system - KD-MMS comprises a set of hardware components as well as a defined procedure. Essential hardware components are red spacer and blue mounting plates. The blue mounting plates replace the standard yellow SAM mounting elements. The red spacers provide for a defined leeway of 8 mm for three-dimensional movements. The non-destructive approach of the KD-MMS makes it possible to conduct different model surgeries with the same plaster casts as well as to restore the initial, pre-surgical situation at any time. Thereby, surgical protocol generation and gnathologic splint construction are facilitated. The KD-MMS hardware components in conjunction with the defined procedures are capable of increasing efficiency and accuracy of model surgery and splint construction. In cases where different surgical approaches need to be evaluated in the course of model surgery, a significant reduction of chair time may be achieved.

  11. The university münster model surgery system for orthognathic surgery. Part II – KD-MMS

    Directory of Open Access Journals (Sweden)

    Ehmer Ulrike

    2013-01-01

    Full Text Available Abstract Background Model surgery is an integral part of the planning procedure in orthognathic surgery. Most concepts comprise cutting the dental cast off its socket. The standardized spacer plates of the KD-MMS provide for a non-destructive, reversible and reproducible means of maxillary and/or mandibular plaster cast separation. Methods In the course of development of the system various articulator types were evaluated with regard to their capability to provide a means of realizing the concepts comprised of the KD-MMS. Special attention was dedicated to the ability to perform three-dimensional displacements without cutting of plaster casts. Various utilities were developed to facilitate maxillary displacement in accordance to the planning. Objectives of this development comprised the ability to implement the values established in the course of two-dimensional ceph planning. Results The system - KD-MMS comprises a set of hardware components as well as a defined procedure. Essential hardware components are red spacer and blue mounting plates. The blue mounting plates replace the standard yellow SAM mounting elements. The red spacers provide for a defined leeway of 8 mm for three-dimensional movements. The non-destructive approach of the KD-MMS makes it possible to conduct different model surgeries with the same plaster casts as well as to restore the initial, pre-surgical situation at any time. Thereby, surgical protocol generation and gnathologic splint construction are facilitated. Conclusions The KD-MMS hardware components in conjunction with the defined procedures are capable of increasing efficiency and accuracy of model surgery and splint construction. In cases where different surgical approaches need to be evaluated in the course of model surgery, a significant reduction of chair time may be achieved.

  12. 15 (No. 2)

    African Journals Online (AJOL)

    mwakagugu

    conform well to the contours of dental arch lying on the neck of each tooth. It is applied only when there are two or more strong teeth on both fragments. Flexible stainless wire splint is used as; plain wire splint clamp, bend plain wire splint conforming to a dental arch defect and inter-jaw plain wire splint with hooked loops.

  13. Rehabilitation of the Atrophic Posterior Maxilla Using Splinted Short Implants or Sinus Augmentation with Standard-Length Implants: A Retrospective Cohort Study.

    Science.gov (United States)

    Pieri, Francesco; Caselli, Ernesto; Forlivesi, Caterina; Corinaldesi, Giuseppe

    2016-01-01

    To retrospectively compare short implants (6 to 8 mm) (short group) to standard-length implants (≥ 11 mm) inserted in combination with a lateral sinus elevation procedure (sinus group), supporting partial fixed prostheses in the atrophic posterior maxilla. Records of 118 patients treated with fluoride-modified implants in the atrophic posterior maxilla between January 2009 and December 2011 were screened in two private practices. Two to four implants were placed in each patient and loaded after 5 to 6 months with partial fixed prostheses. Patients were followed for at least 3 years after implant placement. Patients were contacted and invited for clinical and radiologic follow-up examinations. Outcome measures were implant failures, complications, soft tissue parameters, and marginal bone levels. Fisher exact and unpaired t tests were used to compare proportions and means at the .05 level of significance. A total of 101 patients attended the examination: 53 (112 implants) in the sinus group and 48 (109 implants) in the short group. The mean observation period was 47.03 ± 7.46 months for the sinus group and 44.18 ± 6.42 months for the short group. Ten surgical complications occurred in nine patients of the sinus group versus only one complication in the short group; the difference was statistically significant (P = .01). Six implants failed in five patients of the sinus group versus two implants in two patients of the short group. At follow-up, mean marginal bone loss was 0.64 ± 0.58 mm in the sinus group vs 0.48 ± 0.5 mm in the short group. No significant difference was observed in terms of implant failures, prosthetic complications, soft tissue parameters, or marginal bone loss between the two groups. Within the limitations of this study, both techniques showed similar medium-term outcomes, but short implants provided advantages in terms of a reduced number of surgical complications.

  14. MACAM-MACAM SPLIN PADA PERAWATAN GANGGUAN SENDI TEMPOROMANDIBULA

    Directory of Open Access Journals (Sweden)

    Ira Tanti

    2015-08-01

    Full Text Available Splint or orthopedic appliances is routinely used in the treatment of temporomandibular disorders (TMD. This appliance is used to alter occlusal relationship and to redistribute occlusal forces, to prevent wear and mobility of the teeth, to reduce bruxism and parafunction, to treat masticatory muscle pain and dysfunction, and to alter structural relationship of the TMJ. There are 2 kinds of splint, the permissive and non permissive. Stabilization splint and bite plane are permissive splints, and anterior repositioning appliance is a non permissive splint. Each kind of splint has its own indication. There is strong evidence that splint therapy is successful in the treatment of TMD, but there is no consenses of opinion on how splints work.

  15. Antiproliferative Effect of Lapatinib in HER2-Positive and HER2-Negative/HER3-High Breast Cancer: Results of the Presurgical Randomized MAPLE Trial (CRUK E/06/039).

    Science.gov (United States)

    Leary, Alexandra; Evans, Abigail; Johnston, Stephen R D; A'Hern, Roger; Bliss, Judith M; Sahoo, Rashmita; Detre, Simone; Haynes, Benjamin P; Hills, Margaret; Harper-Wynne, Catherine; Bundred, Nigel; Coombes, Gill; Smith, Ian; Dowsett, Mitch

    2015-07-01

    Not all breast cancers respond to lapatinib. A change in Ki67 after short-term exposure may elucidate a biomarker profile for responsive versus nonresponsive tumors. Women with primary breast cancer were randomized (3:1) to 10 to 14 days of preoperative lapatinib or placebo in a multicenter phase II trial (ISRCTN68509377). Biopsies pre-/posttreatment were analyzed for Ki67, apoptosis, HER2, EGFR, ER, PgR, pAKT, pERK, and stathmin by IHC. Further markers were measured by RT-PCR. Primary endpoint was change in Ki67. HER2(+) was defined as 2+/3+ by IHC and FISH(+). One hundred twenty-one patients (lapatinib, 94; placebo, 27) were randomized; of these, 21% were HER2(+), 78% were HER2(-) nonamplified, 26% were EGFR(+). Paired samples containing tumor were obtained for 98% (118 of 121). Ki67 fell significantly with lapatinib (-31%; P Ki67 reduction with lapatinib was greatest in HER2(+) breast cancer (-46%; P = 0.003), there was a significant Ki67 decrease in HER2(-) breast cancer (-27%; P = 0.017) with 14% of HER2(-) breast cancer demonstrating ≥50% Ki67 reduction with lapatinib. Among HER2(+) patients, the only biomarker predictive of Ki67 response was the EGFR/HER4 ligand epiregulin (EREG) (rho = -0.7; P = 0.002). Among HER2(-) tumors, only HER3 mRNA levels were significantly associated with Ki67 response on multivariate analysis (P = 0.01). In HER2(-) breast cancer, HER2 and HER3 mRNA levels were highly correlated (rho = 0.67, P Ki67 responders having elevated HER3 and HER2 expression. Lapatinib has antiproliferative effects in a subgroup of HER2(-) nonamplified tumors characterized by high HER3 expression. The possible role of high HER2:HER3 heterodimers in predicting response to lapatinib merits investigation in HER2(-) tumors. ©2014 American Association for Cancer Research.

  16. Presurgical Identification of the Central Sulcus Using GE EPI Sequences in Combination with 3D Reconstruction is a Useful and Easy Technique for Functional Identification of the Sensorimotor Cortex.

    Science.gov (United States)

    Lüttich, A; Parrilla, G; Espinosa, M; Zamarro, J; Larrea, J A; Moreno, A

    2012-03-01

    Functional magnetic resonance imaging (fMRI) is a noninvasive neuroimaging technique that enables the visualization of vascular changes originating in the cortex on the execution of a simple motor task. We aimed to assess the usefulness of sensorimotor fMRI using echo-planar imaging (EPI) techniques and assess its clinical usefulness in the identification of the central sulcus. We studied 32 candidates for neurosurgery who had centrally located space-occupying lesions with fMRI using EPI images with blood oxygen level-dependent (BOLD) gradient-echo (GE) sequences acquired on a 1.5T scanner while patients repeatedly opened and closed their hands. Statistical activation images (t images) corresponding to the movements of the right and left hands were compared using cancellation analysis. Three-dimensional reconstruction of the cranium and brain of each patient showed the relative position of the expansive lesion and of non-damaged cortical tissue. Reproducible and selective functional sensorimotor activation was observed in 32 patients. Validation was carried out by intraoperative mapping in 19 patients. Based on intraoperative confirmation data we assumed that functional MR imaging (fMRI) is a valid method for identifying the motor cortex. Nevertheless, a limitation to our study is that not all the patients received invasive cortical stimulation. It is also relevant to indicate that fMRI and intraoperative procedures coincide in the sulcus identified as the sensorimotor cortex. Neurological examination did not reveal postoperative motor/sensitive deterioration in the remaining patients. fMRI using GE EPI sequences in combination with three-dimensional reconstruction is a useful and easy technique for functional identification of the sensorimotor cortex.

  17. Presurgical identification of hibernating myocardium by combined use of technetium-99m hexakis 2-methoxyisobutylisonitrile single photon emission tomography and fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Lucignani, G.; Landoni, C.; Paganelli, G.; Vanoli, G.; Rossetti, C.; Gilardi, M.C.; Colombo, F.; Fazio, F.; Paolini, G.; Zuccari, M.; Di Credico, G.; Mariani, M.A.; Grossi, A.; Galli, L.

    1992-01-01

    We tested the possibility of identifying areas of hibernating myocardium by the combined assessment of perfusion and metabolism using SPET with 99m Tc-MIBI and PET with 18 F-FDG. Segmental wall motion, perfusion and 18 F-FDG uptake were scored in 5 segments in 14 patients with coronary artery disease (CAD), for a total number of 70 segments. Each subject underwent the following studies prior to and following coronary artery-bypass grafting (CABG): First-pass radionuclide angiography, electrocardiography gated planar perfusion scintigraphy and SPET perfusion scintigraphy with 99m Tc-MIBI and, after 16 fasting, 18 F-FDG PET metabolic scintigraphy. Wall motion impairment was either decreased or completely reversed by CABG in 95% of the asynergic segments which exhibited 18 F-FDG uptake, whereas it was unmodified in 80% of the asynergic segments with no 18 Fe-FDG uptake. A stepwise multiple logistic analysis was carried out on the asynergic segments to estimate the postoperative probability of wall motion improvement on the basis of the preoperative regional perfusion and metabolic scores. The segments with the highest probability of functional recovery from preoperative asynergy after revascularization were those with a marked 18 F-FDG uptake prior to CABG. High probabilities of functional recovery were also estimated for the segments presenting with moderate and low 18 F-FDG uptake. A low probability of functional recovery was estimated in the segments with no 18 F-FDG uptake. Despite the potential limitations due to the semiquantitative analysis of the images, the method appears to provide reliable information for the diagnostic and prognostic evaluation of patients with CAD undergoing CABG and confirms that the identification of hibernating myocardium with 18 F-FDG is of paramount importance in the diagnosis of patients undergoing CABG. (orig.)

  18. COMBINATION OF AMPLATZER VASCULAR PLUG 4 IN OCCLUSION OF THE LEFT VERTEBRAL ARTERY, WITH MICROSPHERES PLUS COILS FOR EMBOLIZATION OF THE DEEP CERVICAL BRANCHES FOR PRESURGICAL TREATMENT OF A HYPERVASCULAR C-5 METASTASIS: CASE REPORT AND REVIEW OF THE LITERATURE

    Directory of Open Access Journals (Sweden)

    Antonio Basile

    2017-05-01

    Full Text Available Clinical use of Amplatzer Vascular Plug in central and peripheral vascular system has been extensively described in the literature. We present a case of occlusion of left vertebral artery (LVA performed by deploying an Amplatzer Vascular Plug, in addition to microspheres plus coils for embolization of the deep cervical branches that feed a cervical metastasis involving the left VA. After the endovascular intervention, the patient underwent surgical resection of the lesion. The application of the device, the use of multiple embolic materials, as well as the angiographic and clinical results of the procedure, were evaluated because not previously reported in the literature. Hence, we provide an updated literature review about clinical use of Amplatzer Vascular Plug in supra-aortic vessels.

  19. A Review of In-Office Dynamic Image Navigation for Extraction of Complex Mandibular Third Molars.

    Science.gov (United States)

    Emery, Robert W; Korj, Oxana; Agarwal, Ravi

    2017-08-01

    We performed a retrospective review of in-office removal of complex mandibular third molars with a dynamic image navigation system (DINS). A retrospective review was conducted of cases completed from 2010 to 2014 by a single oral and maxillofacial surgeon. The average age of the patients was 47 years (range, 27 to 72 years). Extraction complexity was classified with Juodzbalys and Daugela's classification system. The included study cases had complexity scores of 9 or greater. Each patient received custom intraoral splints to secure the tracking array and underwent cone beam computed tomography image acquisition. All surgical procedures were performed with a precalibrated tracking straight handpiece under dynamic navigation. All 25 cases were treated successfully with the use of the DINS. Twelve of these cases were associated with pathologic lesions. Three patients were noted to have inferior alveolar nerve paresthesia. One patient sustained a pathologic fracture at week 2. Postoperative infections were noted in 7 cases, 2 of which had a pre-existing infection. One patient reported temporary limitation of mouth opening. A coronectomy was performed in 1 case. We present results using a new technology, the DINS, for removal of complex mandibular third molars. Potential advantages are 1) improved visualization and localization of anatomic structures such as the inferior alveolar nerve, lingual cortical plate, and adjacent roots; 2) improved control during osteotomy; 3) decreased surgical access requirements and reduction in overall bone removal; 4) ability to perform complex procedures successfully in an in-office setting; 5) decreased surgical time resulting from improved visualization; and 6) potential use as a teaching tool. Possible limitations of the use of an in-office DINS include increased cost, increased time attributed to presurgical planning, initial learning curve, and optical array interference by the surgeon or assistants during surgery. Copyright

  20. Immediate loading in the maxilla using flapless surgery, implants placed in predetermined positions, and prefabricated provisional restorations: a retrospective 3-year clinical study.

    Science.gov (United States)

    Rocci, Antonio; Martignoni, Massimiliano; Gottlow, Jan

    2003-01-01

    Immediate loading of dental implants shortens the treatment time and makes it possible to give the patient an esthetic appearance during the whole treatment period. The aim of the present study was to evaluate an immediate-loading treatment protocol, which included flapless surgery, implants placed in predetermined positions and connected to prefabricated provisional restorations, and the 3-year clinical results. A total of 97 Brånemark System Mk IV implants (Nobel Biocare AB, Gothenburg, Sweden) with a machined surface were inserted in the maxillas of 46 patients. A presurgical three-dimensional model of the patients' soft tissue and underlying alveolar bone anatomy was created, which allowed the clinician to place the implants in predetermined positions and connect them to prefabricated provisional restorations. A surgical template with drilling guides corresponding to each implant was used. The apical part of the master guide was equipped with a circular "mucotome," which punched out a 5 mm hole in the mucosa to eliminate the need for flap elevation. The patients received 25 fixed partial prostheses and 27 single-tooth restorations. Bone quality and quantity were assessed. Radiographic examinations were performed on the day of surgery/loading and at the 1-, 2-, and 3-year follow-up visits. All implant sites showed intact buccal and lingual bone walls during surgery, confirming the accuracy of the bone-mapping procedure. The prefabricated temporary restorations fitted, meaning that the implants were positioned clinically in the same way as on the cast. Nine implants in eight patients failed during the first 8 weeks of loading. This resulted in a cumulative survival rate of 91% after 3 years of prosthetic load. The survival rate of splinted implants was 94%. The number of failed implants was significantly higher in cases of single-tooth replacements and placement in soft bone sites and smokers. The failed implants were successfully replaced according to a two

  1. Management of pediatric mandibular fracture using orthodontic ...

    African Journals Online (AJOL)

    ... mandibular symphysis managed by closed reduction using a vacuum formed thermoplastic splint and circummandibular wiring is presented. This article also provides a review of the literature regarding the management of mandibular fracture in young children. Keywords: Orthodontic vacuum‑formed thermoplastic splint, ...

  2. Temporomandibular Joint Involvement in Psoriatic Arthritis

    African Journals Online (AJOL)

    PA, 50 mg of diclofenac sodium 3 times daily was prescribed to patient, and used for one month at the same time with occlusal splint therapy. Occlusal splint was ... is multifactorial and results in an autoimmune mechanism with inflammatory and destructive features. The joint involvements are typically asymmetrical and ...

  3. Cool Cast Facts

    Science.gov (United States)

    ... sleeve to protect it in the bath or shower. A splint does the same thing as a cast: It keeps the broken or injured bone from moving so it can heal. It also usually has a soft layer of cotton inside. A splint can be made from the same materials as a cast or may be a pre- ...

  4. Three-dimensional printing of a microneedle array on personalized curved surfaces for dual-pronged treatment of trigger finger.

    Science.gov (United States)

    Lim, Seng Han; Ng, Jian Yao; Kang, Lifeng

    2017-01-10

    The hand function of patients who suffer from trigger finger can be impaired by the use of traditional splints. There is also a risk of systemic side effects with oral non-steroidal anti-inflammatory drugs (NSAIDs) used for pain relief. Microneedle-assisted transdermal drug delivery offers an attractive alternative for local delivery of NSAIDs. However, traditional microneedle arrays fabricated on flat surfaces are unable to deliver drugs effectively across the undulating skin surface of affected finger(s). In this study, using 3D printing, a dual-function microneedle array has been fabricated on personalized curved surfaces (microneedle splint) for drug delivery and splinting of the affected finger. The novel microneedle splint was assessed for its physical characteristics and the microneedles were shown to withstand up to twice the average thumb force without fracturing. An average skin penetration efficiency of 64% on dermatomed human cadaver skin was achieved and the final microneedle splint showed biocompatibility with human dermal cell lines. A significantly higher amount of diclofenac permeated through the skin by 0.5 h with the use of the microneedle splint as compared to intact skin. The fabricated microneedle splint can thus be a potential new approach to treat trigger finger via personalized splinting without affecting normal hand function.

  5. A pilot study to determine whether external stabilisation of the chest ...

    African Journals Online (AJOL)

    2009-02-02

    Feb 2, 2009 ... Respiratory distress syndrome (RDS), caused by surfactant deficiency, is a ... This small study did not demonstrate any reduction in the need for ventilation with the use of the chest splint. Use of the splint was not associated with any complications and therefore appears to be safe to use. Further studies with ...

  6. APLIKASI SPLIN RELAKSASI PADA GANGGUAN SENDI RAHANG SELAMA PERAWATAN ORTHODONTIK (LAPORAN KASUS

    Directory of Open Access Journals (Sweden)

    R.A. Donna Pratiwi

    2015-08-01

    Full Text Available The increase of pain symptoms in the temporomandibular joint (TMJ challenges the scientists to find a more effective therapy. The popular treatment of the temporomandibular disorders (TMD are eg oclussal splints, orthodontic treatment, electromyographic biofeedback, medication, etc. Among these, splint therapy is more successful than the others, especially in dealing with pain in the TMJ. Orthodontics as a treatment for the TMD quite often creates new complains on TMJ during and/or after treatment. The extrusion of the posterior teeth in reducing anterior deep overbite have been proposed as possible cause of TMD. This paper reported that a relaxation splint was an effective solution to relieve the pain in the TMJ for the orthodontic patients where occlusal factors were related. One month after the splint therapy, the pain in the TMJ was slowly disappeared, and the orthodontic treatment can be continued with the splint as an occlusal height guidance.

  7. Accuracy of a new elastomeric impression material for complete-arch dental implant impressions.

    Science.gov (United States)

    Baig, Mirza R; Buzayan, Muaiyed M; Yunus, Norsiah

    2018-01-18

    The aim of the present study was to assess the accuracy of multi-unit dental implant casts obtained from two elastomeric impression materials, vinyl polyether silicone (VPES) and polyether (PE), and to test the effect of splinting of impression copings on the accuracy of implant casts. Forty direct impressions of a mandibular reference model fitted with six dental implants and multibase abutments were made using VPES and PE, and implant casts were poured (N = 20). The VPES and PE groups were split into four subgroups of five each, based on splinting type: (a) no splinting; (b) bite registration polyether; (c) bite registration addition silicone; and (d) autopolymerizing acrylic resin. The accuracy of implant-abutment replica positions was calculated on the experimental casts, in terms of interimplant distances in the x, y, and z-axes, using a coordinate measuring machine; values were compared with those measured on the reference model. Data were analyzed using non-parametrical Kruskal-Wallis and Mann-Whitney tests at α = .05. The differences between the two impression materials, VPES and PE, regardless of splinting type, were not statistically significant (P>.05). Non-splinting and splinting groups were also not significantly different for both PE and VPES (P>.05). The accuracy of VPES impression material seemed comparable with PE for multi-implant abutment-level impressions. Splinting had no effect on the accuracy of implant impressions. © 2018 John Wiley & Sons Australia, Ltd.

  8. The Effectiveness of a Modified Type of the Mandibular Repositioning Device on the Elimination of Snoring

    Directory of Open Access Journals (Sweden)

    B. Ebadian

    2005-09-01

    Full Text Available Statement of Problem: Snoring is the most common sleep disorder which in itself may only be viewed as an obnoxious disturbance in human society; however it must be considered a potential indicator of significant medical problems such as: hypertension,obstructive sleep apnea, cerebrovascular infarction and ischemic heart disease.Purpose: The purpose of this study was to evaluate the effectiveness of a modified type of Mandibular Repositioning Device (MRD splint on the treatment of snoring.Materials and Methods: This before and after interventional study was carried out on 15 patients (4 females and 11 males who suffered from snoring. All subjects had no upper airway obstruction. Maxillary and mandibular splints were made by clear heatcuredacrylic resin. A special screw connected to the anterior portion of the maxillary splint and an orthodontic wire No 1 positioned on the lower splint. The devices were tried in the mouth and relined with a softliner. This appliance was designed to protrude the mandible by use of a screw system. Snoring grades were detemined before, and 3weeks after treatment with the MRD. Data were analyzed by the Wilcoxon test.Results: A significant difference was observed between the snoring severity, before and after using the splints (P = 0.001.Conclusion: The present study showed this modified type of splint can be effective in decreasing or eliminating snoring. The effectiveness of the splint in the treatment of snoring could be related to its role of widening the upper airway.

  9. Pre: Surgical orthopedic pre-maxillary alignment in bilateral cleft lip and palate patient

    OpenAIRE

    Ellore, Vijaya Prasad Kamavaram; Ramagoni, Naveen Kumar; Taranatha, Mahantesha; Nara, Asha; Gunjalli, Gururaj; Bhat, Ashwin Devasya

    2012-01-01

    Pre-surgical orthopedic appliances are mainly used to retract and align the protruded and deviated pre-maxilla and to facilitate initial lip repair. This article presents a case report of a five year old male child patient with bilateral cleft lip and palate in whom a special custom made pre-surgical orthopedic appliance was delivered. Use of a special custom made presurgical orthopedic appliance for repositioning pre-maxilla in bilateral cleft lip and palate patient is discussed in this arti...

  10. Pre: Surgical orthopedic pre-maxillary alignment in bilateral cleft lip and palate patient

    Directory of Open Access Journals (Sweden)

    Vijaya Prasad Kamavaram Ellore

    2012-01-01

    Full Text Available Pre-surgical orthopedic appliances are mainly used to retract and align the protruded and deviated pre-maxilla and to facilitate initial lip repair. This article presents a case report of a five year old male child patient with bilateral cleft lip and palate in whom a special custom made pre-surgical orthopedic appliance was delivered. Use of a special custom made presurgical orthopedic appliance for repositioning pre-maxilla in bilateral cleft lip and palate patient is discussed in this article.

  11. Circummandibular Wiring of Symphysis Fracture in a Five-Year-Old Child

    Directory of Open Access Journals (Sweden)

    Krishna Priya Vellore

    2013-01-01

    Full Text Available The treatment of pediatric maxillofacial fractures is unique due to the psychological, physiological, developmental, and anatomical characteristics of children. Method. This case report describes the management of symphysis fracture of mandible in a 5-year-old boy. The fracture was treated by acrylic splint with circummandibular wiring. Results. The splint was removed after 3 weeks. The patient had no complaints, and radiograph revealed a healed fracture. Conclusion. The clinical outcome in the present case indicates the management of mandibular fractures in pediatric patients using acrylic splint with circummandibular wiring.

  12. Circummandibular wiring made easy: A case report

    Directory of Open Access Journals (Sweden)

    Jasmeet Singh

    2014-10-01

    Full Text Available Mandibular fractures are less common in children as compared to adults. The treatment plan in children has to be modified as compared to adults considering the presence of tooth buds and potential disturbances in growth. Use of acrylic splints has been one of the popular techniques in children because of its relatively easy placement and reduced risk of hindrances to growth of jaw. These splints have been traditionally been fixed with the help of cements and circummandibular wires. We describe the use of intravenous cannula stilete instead of traditional bone awl to secure the splint in place.

  13. Unilateral intracarotid amobarbital procedure for language lateralization.

    NARCIS (Netherlands)

    Wellmer, J.; Fernandez, G.S.E.; Linke, D.B.; Urbach, H.; Elger, C.E.; Kurthen, M.

    2005-01-01

    PURPOSE: The determination of language dominance as part of the presurgical workup of patients with pharmacoresistant epilepsies has experienced fundamental changes. With the introduction of noninvasive functional magnetic resonance imaging (fMRI), the number of patients receiving intracarotid

  14. Guide to Surgical Specialists

    Science.gov (United States)

    ... in the management of the female bladder and pelvic floor. Disorders managed by this subspecialty include disorders requiring ... through the use of braces, casts, splints, or physical therapy. Specialty certification in orthopaedics includes: Orthopaedic Sports Medicine ...

  15. Brain injury - discharge

    Science.gov (United States)

    ... to keep them loose Watching for joint tightening (contractures) Making sure splints are used in the correct ... for muscle spasms Problems moving their joints (joint contracture) Problems moving around or it is getting harder ...

  16. Stroke - discharge

    Science.gov (United States)

    ... and other joints loose Watching for joint tightening (contractures) Making sure splints are used in the correct ... for muscle spasms Problems moving your joints (joint contracture) Problems moving around or getting out of your ...

  17. Management of functional disturbances of the stomatognathic system

    International Nuclear Information System (INIS)

    Piehslinger, E.

    2001-01-01

    In the management of functional disturbances of the stomatognathic system symptomatic and causal therapeutic methods can be distinguished. Symptomatic therapy encompasses medication, physical methods (heat, cold, radiation, TENS) in combination with physiotherapy and emergency splint. After one or two weeks of symptomatic therapy the patient should be free of pain allowing precise diagnostic procedures followed by causal therapy managing muscular problems, joint pathology and occlusal disturbances. Splint therapy is used to establish a therapeutic joint position according to articulator mounting. After splint therapy prosthodontic and/or orthodontic treatment is needed to restore occlusion. Interdisciplinary management in the therapy of functional disturbances of the stomatognathic system is of utmost importance due to the relationship between chewing muscles, neck muscles and body posture. In addition to splint therapy, physiotherapy, logopedic therapy, myofunctional therapy, psychologic and psychiatric intervention is performed. (orig.) [de

  18. Rheumatoid arthritis

    Science.gov (United States)

    ... treatments Splints or orthotic devices to support and align joints Frequent rest periods between activities, as well ... is important to avoid tobacco and maintain healthy teeth and gums. Proper early treatment can help prevent ...

  19. Conference Support - Surgery in Extreme Environments - Center for Surgical Innovation

    Science.gov (United States)

    2007-01-01

    represent the first survival surgery during space flight. This included exposure and injection of the soleus and extensor digitorum longus ; perfusion...abscess Incision and drainage of thrombosed external hemorrhoid Repair of Extensor Tendon Extremity splinting Needle decompression of pneumothorax

  20. Cast Care: Do's and Don'ts

    Science.gov (United States)

    ... al. Cast care. In: Instructions for Sports Medicine Patients. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2012. https://www.clinicalkey.com. Accessed Jan. 25, 2018. Pfenninger JL, et al. Casts immobilization and upper extremity splinting. In: Pfenninger and Fowler's ...

  1. Eye Injuries in Sports

    Science.gov (United States)

    ... and Sugar Substitutes Exercise and Fitness Exercise Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health ... Splints Home Prevention and Wellness Exercise and Fitness Sports Safety Eye Injuries in Sports Eye Injuries in ...

  2. Temporalis and masseter muscle activity in patients with anterior open bite and craniomandibular disorders

    DEFF Research Database (Denmark)

    Bakke, Merete; Michler, L

    1991-01-01

    values, particularly in subjects with muscular affection, but maximal activity increased significantly when biting on the splint. Maximal voluntary contraction was positively correlated to molar contact and negatively to anterior face height, mandibular inclination, vertical jaw relation and gonial angle...

  3. Continuous passive motion and physical therapy (CPM) versus physical therapy (PT) versus delayed physical therapy (DPT) after surgical release for elbow contractures; a study protocol for a prospective randomized controlled trial

    NARCIS (Netherlands)

    Viveen, Jetske; Doornberg, Job N.; Kodde, Izaak F.; Goossens, Pjotr; Koenraadt, Koen L. M.; The, Bertram; Eygendaal, Denise

    2017-01-01

    The elbow is prone to stiffness after trauma. To regain functional elbow motion several conservative- and surgical treatment options are available. Conservative treatment includes physical therapy, intra-articular injections with corticosteroids and a static progressive or dynamic splinting program.

  4. Leg pain

    Science.gov (United States)

    ... to a muscle cramp (also called a charley horse ). Common causes of cramps include: Dehydration or low ... muscle ( strain ) Hairline crack in the bone (stress fracture) Inflamed tendon ( tendinitis ) Shin splints (pain in the ...

  5. Temporomandibular Disorders Treatment with Correction of Decreased Occlusal Vertical Dimension

    Directory of Open Access Journals (Sweden)

    Ljuben Guguvcevski

    2017-10-01

    CONCLUSION: Occlusal splint is a part of reversible occlusal therapy in cases with decreased occlusal vertical dimension. After reducing the symptoms related to decreased occlusal vertical dimension definitive prosthetic therapy can be done.

  6. Pain Management Task Force

    Science.gov (United States)

    2010-05-01

    contractility resulting in increased cardiac work, myocardial ischemia and infarction . Pulmonary Respiratory and abdominal muscle spasm (splinting...What is drug addiction? What about alcohol and tobacco ? 102: Pain Management for Leaders/Supervisors (Audience: Military Leaders) Understanding

  7. Diagnosis and surgical therapy of pancreas tumors

    International Nuclear Information System (INIS)

    Heid, A.

    1981-01-01

    The efficiency of surgery and presurgical diagnosis on several tumorous diseases of the pancreas is investigated. If there is the clinical suspicion of a pancreas carcinoma, sonography computerized tomography, and endoscopic-retrograde cholangio-pancreaticography (ERCP) bring the best diagnostic results. In case of pancreatogenic hyperinsulinism a selective angiography should be carried out in any case for an exact presurgical localisation. (orig./MG) [de

  8. Influence of the Lower Jaw Position on the Running Pattern.

    Directory of Open Access Journals (Sweden)

    Christian Maurer

    Full Text Available The effects of manipulated dental occlusion on body posture has been investigated quite often and discussed controversially in the literature. Far less attention has been paid to the influence of dental occlusion position on human movement. If human movement was analysed, it was mostly while walking and not while running. This study was therefore designed to identify the effect of lower jaw positions on running behaviour according to different dental occlusion positions.Twenty healthy young recreational runners (mean age = 33.9±5.8 years participated in this study. Kinematic data were collected using an eight-camera Vicon motion capture system (VICON Motion Systems, Oxford, UK. Subjects were consecutively prepared with four different dental occlusion conditions in random order and performed five running trials per test condition on a level walkway with their preferred running shoes. Vector based pattern recognition methods, in particular cluster analysis and support vector machines (SVM were used for movement pattern identification.Subjects exhibited unique movement patterns leading to 18 clusters for the 20 subjects. No overall classification of the splint condition could be observed. Within individual subjects different running patterns could be identified for the four splint conditions. The splint conditions lead to a more symmetrical running pattern than the control condition.The influence of an occlusal splint on running pattern can be confirmed in this study. Wearing a splint increases the symmetry of the running pattern. A more symmetrical running pattern might help to reduce the risk of injuries or help in performance. The change of the movement pattern between the neutral condition and any of the three splint conditions was significant within subjects but not across subjects. Therefore the dental splint has a measureable influence on the running pattern of subjects, however subjects individuality has to be considered when choosing the

  9. Intra-Articular Lubricin Gene Therapy for Post-Traumatic Arthritis

    Science.gov (United States)

    2015-09-01

    disease in human body joints; rheumatoid arthritis (RA), osteoarthritis (OA), and post-traumatic osteoarthritis (PTOA). This study focused on OA, or...regeneration factors, and lubricants for OA cure and treatment. Nowadays, physical therapy and joint splinting and joint replacement surgery are also...introduced drugs such as analgesics, nonsteroidal anti- inflammatory drugs or appropriate exercises and physical therapy or joint splinting or joint

  10. Surgical Services Career Ladder, AFSC 902X2.

    Science.gov (United States)

    1987-09-01

    subluxations change dressings schedule patient appointments prepare patients for removal of plaster or fiberglass casts prepare casting material order x-rays...REMOVE SKIN STAPLES 91 F240 ASSIST DOCTOR IN TREATMENT OF DISLOCATIONS AND SUBLUXATIONS 91 F209 APPLY LONG LEG PLASTER AND FIBERGLASS SPLINTS 91 F223...SPLINTS 97 F240 ASSIST DOCTOR IN TREATMENT OF DISLOCATIOJNS AND SUBLUXATIONS 9 F333 SCREEN RECORDS FOR PATIENT FOLLOW-UP 97 F203 APPLY LONG ARM

  11. Bending Properties of Fiber-Reinforced Composites Retainers Bonded with Spot-Composite Coverage

    Science.gov (United States)

    Gandini, Paola; Tessera, Paola; Lassila, Lippo

    2017-01-01

    Orthodontic and periodontal splints are prepared with round or flat metallic wires. As these devices cannot be used in patients with allergy to metals or with aesthetic demands, fiber-reinforced composite (FRC) retainers have been introduced. Stiffness of FRC materials could reduce physiologic tooth movement. In order to lower rigidity of conventional FRC retainers, a modified construction technique that provided a partial (spot) composite coverage of the fiber has been tested and compared with metallic splints and full-bonded FRCs. Flat (Bond-a-Braid, Reliance Orthodontic Products) and round (Penta-one 0155, Masel Orthodontics) stainless steel splints, conventional FRC splints, and experimental spot-bonded FRC retainers (Everstick Ortho, StickTech) were investigated. The strength to bend the retainers at 0.1 mm deflection and at maximum load was measured with a modified Frasaco model. No significant differences were reported among load values of stainless steel wires and experimental spot-bonded FRC retainers at 0.1 mm deflection. Higher strength values were recoded for conventional full-bonded FRCs. At maximum load no significant differences were reported between metallic splints (flat and round) and experimental spot-bonded FRCs, and no significant differences were reported between spot- and full-bonded FRC splints. These results encourage further tests in order to evaluate clinical applications of experimental spot-bonded FRC retainers. PMID:29130047

  12. Bending Properties of Fiber-Reinforced Composites Retainers Bonded with Spot-Composite Coverage.

    Science.gov (United States)

    Sfondrini, Maria Francesca; Gandini, Paola; Tessera, Paola; Vallittu, Pekka K; Lassila, Lippo; Scribante, Andrea

    2017-01-01

    Orthodontic and periodontal splints are prepared with round or flat metallic wires. As these devices cannot be used in patients with allergy to metals or with aesthetic demands, fiber-reinforced composite (FRC) retainers have been introduced. Stiffness of FRC materials could reduce physiologic tooth movement. In order to lower rigidity of conventional FRC retainers, a modified construction technique that provided a partial (spot) composite coverage of the fiber has been tested and compared with metallic splints and full-bonded FRCs. Flat (Bond-a-Braid, Reliance Orthodontic Products) and round (Penta-one 0155, Masel Orthodontics) stainless steel splints, conventional FRC splints, and experimental spot-bonded FRC retainers (Everstick Ortho, StickTech) were investigated. The strength to bend the retainers at 0.1 mm deflection and at maximum load was measured with a modified Frasaco model. No significant differences were reported among load values of stainless steel wires and experimental spot-bonded FRC retainers at 0.1 mm deflection. Higher strength values were recoded for conventional full-bonded FRCs. At maximum load no significant differences were reported between metallic splints (flat and round) and experimental spot-bonded FRCs, and no significant differences were reported between spot- and full-bonded FRC splints. These results encourage further tests in order to evaluate clinical applications of experimental spot-bonded FRC retainers.

  13. Bending Properties of Fiber-Reinforced Composites Retainers Bonded with Spot-Composite Coverage

    Directory of Open Access Journals (Sweden)

    Maria Francesca Sfondrini

    2017-01-01

    Full Text Available Orthodontic and periodontal splints are prepared with round or flat metallic wires. As these devices cannot be used in patients with allergy to metals or with aesthetic demands, fiber-reinforced composite (FRC retainers have been introduced. Stiffness of FRC materials could reduce physiologic tooth movement. In order to lower rigidity of conventional FRC retainers, a modified construction technique that provided a partial (spot composite coverage of the fiber has been tested and compared with metallic splints and full-bonded FRCs. Flat (Bond-a-Braid, Reliance Orthodontic Products and round (Penta-one 0155, Masel Orthodontics stainless steel splints, conventional FRC splints, and experimental spot-bonded FRC retainers (Everstick Ortho, StickTech were investigated. The strength to bend the retainers at 0.1 mm deflection and at maximum load was measured with a modified Frasaco model. No significant differences were reported among load values of stainless steel wires and experimental spot-bonded FRC retainers at 0.1 mm deflection. Higher strength values were recoded for conventional full-bonded FRCs. At maximum load no significant differences were reported between metallic splints (flat and round and experimental spot-bonded FRCs, and no significant differences were reported between spot- and full-bonded FRC splints. These results encourage further tests in order to evaluate clinical applications of experimental spot-bonded FRC retainers.

  14. Infrared thermographic analysis of craniofacial muscles in military pilots affected by bruxism.

    Science.gov (United States)

    Baldini, Alberto; Nota, Alessandro; Cioffi, Clementina; Ballanti, Fabiana; Cozza, Paola

    2015-04-01

    Due to the physical stresses to which they are subjected, military pilots may experience bruxism, an "oral parafunction." Parafunction can cause masticatory muscle suffering and serious dental, periodontal, and temporomandibular joint damage. The aim of this pilot study was to analyze the temperature distribution in masticatory and upper trapezius muscles in a sample of bruxist air force pilots, to evaluate whether an occlusal splint would be able to induce skin temperature variations in the stomatognathic apparatus using the technology of infrared thermography. A total of 11 male Italian Air Force pilots of high performance aircraft, ages from 27 to 40 yr (mean 34.91 ± 2.15 yr) with 1000-3000 flight hours, were enrolled in the study and analyzed using an infrared camera in order to evaluate the temperature of the masticatory muscles. All the recordings were taken on each subject using the same protocol with and without a temporary occlusal splint. The occlusal splint statistically increased each muscle temperature (0.10-0.20°C) on both the sides of the body. No statistically significant differences were found between the left and right muscles (asymmetries) before or after the wearing of the splint except for the anterior temporalis muscle. No significant improvement or variations in temperature symmetry of this muscle was found after the application of the splint. The use of an occlusal splint could help in increasing muscles temperatures in Air Force pilots with consequent relaxation of their facial muscular system.

  15. Difference in the Surgical Outcome of Unilateral Cleft Lip and Palate Patients with and without Pre-Alveolar Bone Graft Orthodontic Treatment

    Science.gov (United States)

    Chang, Chun-Shin; Wallace, Christopher Glenn; Hsiao, Yen-Chang; Chiu, Yu-Ting; Pai, Betty Chien-Jung; Chen, I.-Ju; Liao, Yu-Fang; Liou, Eric Jen-Wein; Chen, Philip Kuo-Ting; Chen, Jyh-Ping; Noordhoff, M. Samuel

    2016-04-01

    Presurgical orthodontic treatment before secondary alveolar bone grafting (SABG) is widely performed for cleft lip/palate patients. However, no randomized controlled trial has been published comparing SABG outcomes in patients with, and without, presurgical orthodontic treatment. This randomized, prospective, single-blinded trial was conducted between January 2012 and April 2015 to compare ABG volumes 6 months postoperatively between patients with and without presurgical orthodontic treatment. Twenty-four patients were enrolled and randomized and 22 patients completed follow-up. Patients who had presurgical orthodontics before SABG had significantly improved inclination (p < 0.001) and rotation (p < 0.001) of the central incisor adjacent to the defect, significantly improved ABG fill volume (0.81 ± 0.26 cm3 at 6 months compared to 0.59 ± 0.22 cm3 p < 0.05) and less residual alveolar bone defect (0.31 ± 0.08 cm3 at 6 months compared to s 0.55 ± 0.14 cm3 p < 0.001) compared to patients who did not have presurgical orthodontic treatment. In conclusion, orthodontic treatment combined with SABG results in superior bone volume when compared with conventional SABG alone.

  16. Evaluation of the Scrub Practitioners' List of Intraoperative Non-Technical Skills system.

    Science.gov (United States)

    Mitchell, Lucy; Flin, Rhona; Yule, Steven; Mitchell, Janet; Coutts, Kathy; Youngson, George

    2012-02-01

    The Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) system is a new tool for training and assessing scrub practitioner (nurse, technician) behaviours during surgical operations. The aim of the study was to test the psychometric properties including inter-rater reliability of the prototype SPLINTS behavioural rating system. Experienced scrub practitioners (n=34) attended a one-day session where they received background training in human factors and non-technical skills and were also trained to use the SPLINTS system. They then used SPLINTS to rate the scrub practitioners' non-technical skill performance in seven standardized simulated, surgical scenarios. Reliability, measured by within-group agreement (r(wg)) for the three skill categories and six out of nine elements, was acceptable (r(wg)>0.7). Participants were within one scale point of expert ratings in >90% of skill categories and elements, and could use SPLINTS to score performance with a reasonable level of accuracy. There was good internal consistency of the system: absolute mean difference was Mtechnical skills in simulated, standardized, video scenarios. On the basis of these results, the system can now move on to usability testing in the real operating theatre. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. A new method of surgical navigation for orthognathic surgery: optical tracking guided free-hand repositioning of the maxillomandibular complex.

    Science.gov (United States)

    Li, Biao; Zhang, Lei; Sun, Hao; Shen, Steve G F; Wang, Xudong

    2014-03-01

    In bimaxillary orthognathic surgery, the positioning of the maxilla and the mandible is typically accomplished via 2-splint technique, which may be the sources of several types of inaccuracy. To overcome the limitations of the 2-splint technique, we developed a new navigation method, which guided the surgeon to free-hand reposition the maxillomandibular complex as a whole intraoperatively, without the intermediate splint. In this preliminary study, the feasibility was demonstrated. Five patients with dental maxillofacial deformities were enrolled. Before the surgery, 3-dimensional planning was conducted and imported into a navigation system. During the operation, a tracker was connected to the osteotomized maxillomandibular complex via a splint. The navigation system tracked the movement of the complex and displayed it on the screen in real time to guide the surgeon to reposition the complex. The postoperative result was compared with the plan by analyzing the measured distances between the maxillary landmarks and reference planes, as determined from computed tomography data. The mean absolute errors of the maxillary position were clinically acceptable (<1.0 mm). Preoperative preparation time was reduced to 100 minutes on average. All patients were satisfied with the aesthetic results. This navigation method without intraoperative image registration provided a feasible means of transferring virtual planning to the real orthognathic surgery. The real-time position of the maxillomandibular complex was displayed on a monitor to visually guide the surgeon to reposition the complex. In this method, the traditional model surgery and the intermediate splint were discarded, and the preoperative preparation was simplified.

  18. Spot-Bonding and Full-Bonding Techniques for Fiber Reinforced Composite (FRC) and Metallic Retainers

    Science.gov (United States)

    Gandini, Paola; Tessera, Paola; Vallittu, Pekka K.; Lassila, Lippo; Sfondrini, Maria Francesca

    2017-01-01

    Fiber reinforced Composite (FRC) retainers have been introduced as an aesthetic alternative to conventional metallic splints, but present high rigidity. The purpose of the present investigation was to evaluate bending and fracture loads of FRC splints bonded with conventional full-coverage of the FRC with a composite compared with an experimental bonding technique with a partial (spot-) resin composite cover. Stainless steel rectangular flat, stainless steel round, and FRC retainers were tested at 0.2 and 0.3 mm deflections and at a maximum load. Both at 0.2 and 0.3 mm deflections, the lowest load required to bend the retainer was recorded for spot-bonded stainless steel flat and round wires and for spot-bonded FRCs, and no significant differences were identified among them. Higher force levels were reported for full-bonded metallic flat and round splints and the highest loads were recorded for full-bonded FRCs. At the maximum load, no significant differences were reported among spot- and full-bonded metallic splints and spot-bonded FRCs. The highest loads were reported for full bonded FRCs. The significant decrease in the rigidity of spot-bonded FRC splints if compared with full-bonded retainers suggests further tests in order to propose this technique for clinical use, as they allow physiologic tooth movement, thus presumably reducing the risk of ankylosis. PMID:28976936

  19. Proximal Interphalangeal Joint Dislocations and Treatment: An Evolutionary Process

    Directory of Open Access Journals (Sweden)

    Kenneth Michael Joyce

    2014-07-01

    Full Text Available Background Proximal interphalangeal joint (PIPJ dislocations represent a significant proportion of hand clinic visits and typically require frequent follow-ups for clinical assessment, orthotic adjustments, and physiotherapy. There are a large number of treatment options available for PIPJ dislocations, yet no prospective or controlled studies have been carried out, largely due to the diversity of the various types of injuries. Methods We retrospectively reviewed all the PIPJ dislocations in our institution over a five-year period and directly compared the different splinting techniques that we have used over this time frame. Results There were a total of 77 dislocations of the PIPJ (57 men and 20 women that were included in our study. We found that our management has shifted gradually from complete immobilisation to controlled early mobilisation with figure-of-eight splints. Following treatment, the range of motion of the PIPJ in the figure-of-eight group was significantly greater than that in the other three methods (P<0.05 used. There were significantly fewer hospital visits in the figure-of-eight splint group than in the other treatment groups. Conclusions The treatment of PIPJ dislocations has undergone a significant evolution in our experience. Early controlled mobilisation has become increasingly important, and therefore, splints have had to be adapted to allow for this. The figure-of-eight splint has yielded excellent results in our experience. It should be considered for all PIPJ dislocations, but careful patient selection is required to achieve optimum results.

  20. Gnathological postural treatment in a professional basketball player: a case report and an overview of the role of dental occlusion on performance.

    Science.gov (United States)

    Baldini, Alberto; Beraldi, Alessandro; Nota, Alessandro; Danelon, Furio; Ballanti, Fabiana; Longoni, Salvatore

    2012-04-01

    During competitions and training many professional athletes use to wear occlusal splints to improve their sports performance. However, notwithstanding some studies concluded that achieving a balanced cranial-occlusal system could bring to an improvement of sports performances, the results are still contrasting. Probably the gnathological postural treatment of athletes has greater influence on performance when the individual suffers of Temporomandibular Joint Disfunction (TMJ) or physio-postural pathologies owing to the consequent alteration of the "tonic-postural system". This clinical case details a gnathological postural approach to a professional basketball player suffering from muscular problems related to the stomatognathic apparatus and a low back pain unresolved with the only physiotherapy, which limited her performance. Force platform and T-Scan III appliances were used in order to check the postural and occlusal condition of the athlete and as an aid to clinical parameters in achieving a correct splint balance. After the treatment involving inserting an occlusal splint and physiotherapy sessions, the patient no longer complained of low back pain problems and the symptoms associated with the stomatognathic apparatus improved considerably. In particular, after the tests carried out on an isokinetic machine, a force increase related to the quadriceps muscles was detected when the patient was wearing the occlusal splint. All athletes must however be analysed individually and carefully with clinical and instrumental analyses in order to consider the possible real effectiveness of an occlusal splint for improving postural structure and sports performance.

  1. Spot-Bonding and Full-Bonding Techniques for Fiber Reinforced Composite (FRC and Metallic Retainers

    Directory of Open Access Journals (Sweden)

    Andrea Scribante

    2017-10-01

    Full Text Available Fiber reinforced Composite (FRC retainers have been introduced as an aesthetic alternative to conventional metallic splints, but present high rigidity. The purpose of the present investigation was to evaluate bending and fracture loads of FRC splints bonded with conventional full-coverage of the FRC with a composite compared with an experimental bonding technique with a partial (spot- resin composite cover. Stainless steel rectangular flat, stainless steel round, and FRC retainers were tested at 0.2 and 0.3 mm deflections and at a maximum load. Both at 0.2 and 0.3 mm deflections, the lowest load required to bend the retainer was recorded for spot-bonded stainless steel flat and round wires and for spot-bonded FRCs, and no significant differences were identified among them. Higher force levels were reported for full-bonded metallic flat and round splints and the highest loads were recorded for full-bonded FRCs. At the maximum load, no significant differences were reported among spot- and full-bonded metallic splints and spot-bonded FRCs. The highest loads were reported for full bonded FRCs. The significant decrease in the rigidity of spot-bonded FRC splints if compared with full-bonded retainers suggests further tests in order to propose this technique for clinical use, as they allow physiologic tooth movement, thus presumably reducing the risk of ankylosis.

  2. Spot-Bonding and Full-Bonding Techniques for Fiber Reinforced Composite (FRC) and Metallic Retainers.

    Science.gov (United States)

    Scribante, Andrea; Gandini, Paola; Tessera, Paola; Vallittu, Pekka K; Lassila, Lippo; Sfondrini, Maria Francesca

    2017-10-04

    Fiber reinforced Composite (FRC) retainers have been introduced as an aesthetic alternative to conventional metallic splints, but present high rigidity. The purpose of the present investigation was to evaluate bending and fracture loads of FRC splints bonded with conventional full-coverage of the FRC with a composite compared with an experimental bonding technique with a partial (spot-) resin composite cover. Stainless steel rectangular flat, stainless steel round, and FRC retainers were tested at 0.2 and 0.3 mm deflections and at a maximum load. Both at 0.2 and 0.3 mm deflections, the lowest load required to bend the retainer was recorded for spot-bonded stainless steel flat and round wires and for spot-bonded FRCs, and no significant differences were identified among them. Higher force levels were reported for full-bonded metallic flat and round splints and the highest loads were recorded for full-bonded FRCs. At the maximum load, no significant differences were reported among spot- and full-bonded metallic splints and spot-bonded FRCs. The highest loads were reported for full bonded FRCs. The significant decrease in the rigidity of spot-bonded FRC splints if compared with full-bonded retainers suggests further tests in order to propose this technique for clinical use, as they allow physiologic tooth movement, thus presumably reducing the risk of ankylosis.

  3. Comment on “Topically Applied Connective Tissue Growth Factor/CCN2 Improves Diabetic Preclinical Cutaneous Wound Healing: Potential Role for CTGF in Human Diabetic Foot Ulcer Healing”

    Directory of Open Access Journals (Sweden)

    Hongling Li

    2015-01-01

    Full Text Available A recent paper in this journal, presented a novel method by topical application of growth factors in stimulating diabetic cutaneous wound healing that caught our attention. We believe that the experimental method in the article is efficient and creative, but it also has some controversies and shortcomings to be discussed. We noted that the authors used “Tegaderm” as a semiocclusive dressing film and stated that it exerted a “splinting effect” on the wound margins and controlled contraction. Indeed, the “Tegaderm” itself can serve as a dressing film to isolate the wound bed with outside environments while the “splinting effect” is mainly achieved by adding silicone splints around the wound. Considering the unique properties of silicone splints and “Tegaderm,” our experimental group propose an alternative method named “combined-suturing” technique that is not only suturing the silicone splints but also securing the “Tegaderm” around the wound. The specific reasons and operative procedures are explained in detail in this letter.

  4. Contradictions in the treatment of traumatic dental injuries and ways to proceed in dental trauma research

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva Fejerskov; Andreasen, Francis

    2010-01-01

    that short-term splinting with a semi-rigid splint appears to optimize fracture healing. In tooth avulsion with subsequent replantation, cleansing of the root surface for contamination and systemic antibiotics has been considered essential for pulp and periodontal healing. These treatment concepts have been...... dentition. Accepted treatment philosophy is dentin coverage (dental liner and/or dentin bonded restoration) to prevent bacteria penetration into the pulp. Today there is, apart from deep proximal fractures, no evidence that this treatment is necessary to protect the pulp. In case of luxation injuries......, the accepted treatment principles appear to be anatomically correct repositioning, stabilization with a splint and sometimes antibiotic coverage. In clinical studies, these principles could not be proven to optimize either periodontal or pulpal healing, the explanation possibly being that both reposition...

  5. Invisalign(®) treatment of patients with craniomandibular disorders.

    Science.gov (United States)

    Schupp, Werner; Haubrich, Julia; Neumann, Iris

    2010-09-01

    The temporomandibular joint is one of the most complex joint systems in the human body. Craniomandibular disorders (CMD) are a common condition in which symptoms and signs may vary within a single individual and from one person to another. As anatomic and functional aspects of the craniomandibular system (CMS) and the upper cervical spine are closely interconnected, CMD need a close interdisciplinary approach combining orthopedics, manual medicine, orthodontics and dentistry. Splints as a therapeutic treatment instrument in CMD patients are widely accepted. The association of splint therapy and the Invisalign(®) system not only provides comfortable and almost invisible treatment but also constitutes a powerful instrument for the orthodontic treatment of the CMD patient. To this end, precise knowledge of the temporomandibular joint, temporomandibular disorders and treatment using removable and fixed splints is indispensable. Copyright © 2010 CEO. Published by Elsevier Masson SAS. All rights reserved.

  6. A new therapeutic proposal for writer's cramp: a case report

    Directory of Open Access Journals (Sweden)

    Flavia Quadros Boisson Waissman

    Full Text Available CONTEXT: Writer's cramp is a kind of focal hand dystonia that appears when individuals are writing. Since pharmacological treatment has not shown the desired therapeutic response, a study on immobilization of the damaged musculature was performed on two individuals with writer's cramp, using splints with the objective of reducing the handwriting abnormalities. CASE REPORT: Two patients presenting writer's cramp who had previously undergone different therapies, including botulinum toxin, without an adequate response, participated in a body awareness program, followed by immobilization of the hand musculature damaged by dystonia, by means of splints, with handwriting training. At the end of the procedure, objective and subjective improvements in the motor pattern of writing could be observed. The immobilization of the dystonic musculature of the hand by means of splints and the motor training of handwriting helped to improve and consequently to reduce the dystonic component observed in the writer's cramp.

  7. Interdisciplinary management of an orthodontic patient with temporomandibular disorder

    Directory of Open Access Journals (Sweden)

    Tsang Tsang Franklin She

    2017-01-01

    Full Text Available A 21-year-old female patient presented with temporomandibular disorder, skeletal Class II, Angle Class II division 2 malocclusion, gummy smile, and incomplete overbite was managed successfully by splint therapy and orthodontic camouflage with miniscrew anchorage and extraction. She was treated with occlusal splint to alleviate signs and symptoms of anterior disc displacement without reduction and the associated masticatory dysfunction and revealed the true malocclusion before orthodontic treatment. Computer software facilitated the formulation of visual treatment objective (VTO and occlusogram which guided the whole arch intrusion, retraction of the upper anterior segment, mesialization of lower left dentition, and distalization of lower right dentition. In this case report, the rationale and importance of preorthodontic splint therapy and specific considerations in orthodontic mechanics for managing this patient were discussed.

  8. Predictive models for acute kidney injury following cardiac surgery.

    Science.gov (United States)

    Demirjian, Sevag; Schold, Jesse D; Navia, Jose; Mastracci, Tara M; Paganini, Emil P; Yared, Jean-Pierre; Bashour, Charles A

    2012-03-01

    Accurate prediction of cardiac surgery-associated acute kidney injury (AKI) would improve clinical decision making and facilitate timely diagnosis and treatment. The aim of the study was to develop predictive models for cardiac surgery-associated AKI using presurgical and combined pre- and intrasurgical variables. Prospective observational cohort. 25,898 patients who underwent cardiac surgery at Cleveland Clinic in 2000-2008. Presurgical and combined pre- and intrasurgical variables were used to develop predictive models. Dialysis therapy and a composite of doubling of serum creatinine level or dialysis therapy within 2 weeks (or discharge if sooner) after cardiac surgery. Incidences of dialysis therapy and the composite of doubling of serum creatinine level or dialysis therapy were 1.7% and 4.3%, respectively. Kidney function parameters were strong independent predictors in all 4 models. Surgical complexity reflected by type and history of previous cardiac surgery were robust predictors in models based on presurgical variables. However, the inclusion of intrasurgical variables accounted for all explained variance by procedure-related information. Models predictive of dialysis therapy showed good calibration and superb discrimination; a combined (pre- and intrasurgical) model performed better than the presurgical model alone (C statistics, 0.910 and 0.875, respectively). Models predictive of the composite end point also had excellent discrimination with both presurgical and combined (pre- and intrasurgical) variables (C statistics, 0.797 and 0.825, respectively). However, the presurgical model predictive of the composite end point showed suboptimal calibration (P predictive models in other cohorts is required before wide-scale application. We developed and internally validated 4 new models that accurately predict cardiac surgery-associated AKI. These models are based on readily available clinical information and can be used for patient counseling, clinical

  9. Antrum approach planning for removal of impacted tooth using cone-beam computed tomography.

    Science.gov (United States)

    de Mattos, Allex Morelli Heiderich; Queiroz, Christiano Sampaio; Santos, Pablo Leal Teixeira; de Oliviera, Adriana Borges; Oliveira, Camila; Campos, Paulo Sérgio Flores

    2012-01-01

    Due to the great number of structures in the maxillofacial region, cone-beam computed tomography (CBCT) is an important procedure in presurgical planning for removal of impacted teeth. Most of the information provided by this imaging technique cannot be visualized in conventional radiographs. In addition, CBCT reduces patient exposure to radiation in comparison with helical computed tomography and provides dental practitioners with easy access. We report the clinical case of a patient who underwent a surgical procedure for removal of an impacted maxillary premolar. CBCT-assisted presurgical treatment was used, enabling a more conservative surgical access, a less traumatic and less time consuming procedure than conventional surgical intervention.

  10. Integrated Management of the Thick-Skinned Rhinoplasty Patient.

    Science.gov (United States)

    Cobo, Roxana; Camacho, Juan Gabrie; Orrego, Jorge

    2018-02-01

    Patients with thick skin are a challenge in facial plastic surgery. Rhinoplasty is still the most frequently performed facial plastic procedure worldwide and it becomes very difficult to obtain optimal consistent results in these patients. A systematic presurgical skin evaluation is performed dividing skin into type I-III depending on the elasticity, oiliness, presence of skin alterations, size of skin pores, and laxity. Depending on the skin type, presurgical, surgical, and postsurgical management of the epidermis and dermis is defined. Preconditioning and treating thick skin can improve postsurgical results and reduce postsurgical unwanted results. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  11. Utero-vaginal abnormalities: MR imaging in pediatric patients

    International Nuclear Information System (INIS)

    Bailez, Marcela; Daneff, Monica; Balestrini, Maria A.; Gomez Zanetta, Santiago; Rabellino, Martin; Bruno, Claudio H.

    2003-01-01

    Purpose: To correlate the pre-surgical findings in MRI with the surgical results in Muellerian malformations. Material and methods: 14 pediatric patients were studied by MRI. MRI findings were divided in 4 groups according to the classification of the American Fertility Society (modified by Rock). Patient's age ranged between 12-17 years. Results: In our series 4 patients were included in Group I, 4 cases in Group II, 4 in Group III and only 2 in Group IV. All patients underwent reconstructive surgery based on MRI findings. Conclusions: In our series MRI was a useful method for the pre-surgical evaluation of Muellerian malformations. (author)

  12. Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture

    DEFF Research Database (Denmark)

    Lauridsen, Eva; Gerds, Thomas; Andreasen, Jens Ove

    2016-01-01

    AIM: To analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify.......3-3.5), P = 0.003), and age >30 years (HR: 2.3 (95% CI: 1.1-4.6), P = 0.02). The type of splint (rigid or flexible), the duration of splinting (more or less than 4 weeks), and the administration of antibiotics did not affect the risk of PN. CONCLUSION: Teeth involved in alveolar process fractures appear...

  13. Modified Pectoralis Major Tendon Transfer for Reanimation of Elbow Flexion as a Salvage Procedure in Complete Brachial Plexus Injury: A Case Report

    Directory of Open Access Journals (Sweden)

    S Taran

    2013-03-01

    Full Text Available Traumatic brachial plexus injuries rarely recover spontaneously and if the window period for neurotisation has elapsed, the only option for restoration of function lies in a salvage procedure. Many such salvage procedures have been described in the literature with variable functional results. We report the case of a 16-year-old boy who presented after unsuccessful treatment for a complete brachial plexus injury; we performed a pectoralis major tendon transfer to attain elbow flexion. Postoperatively, the elbow was splinted with flexion at 100°. After 4 weeks of immobilization the splint was removed and the patient could actively flex his elbow from 30° to 100°.

  14. A prospective randomized study of conservative versus surgical treatment of unstable palmar plate disruption in the proximal interphalangeal finger joint

    DEFF Research Database (Denmark)

    Werlinrud, Jens Christian; Petersen, Kirstin; Lauritsen, Jens

    2013-01-01

    study in which 83 patients were randomly assigned into 2 groups: (1) conservative treatment with a rigid splint for 2 weeks, (2) surgical reattachment of the palmar plate in local anesthesia followed by 2 weeks of immobilization in a plaster cast. Both groups were thereafter treated by taping...... to the neighboring finger for 3 weeks. With regard to hyperextension instability, stiffness, and pain, there is no significant difference in outcome between patients with traumatic palmar plate lesions and hyperextension instability treated with surgical repair and patients treated conservatively with a splint. We...

  15. Experience of Soviet Medicine in a Great Patriotic War, 1941-1945. Volume 16, Section 4.

    Science.gov (United States)

    1980-10-22

    English. (25). Johns , Grey, Orr. (26). Field infirmary. (27). Franz. (28). Back hospitals. (29). The very same. (30). BowIby, Sincler, Orr. (31). American...English army with 65.0-90.0o/o in 1914-1915 (Jones, Orr and Grey) was lowered into the second half war to 17,5o/o ( BOwlby ) and 12.0o/o (Sinclair-Orr... Bowlby explained a reduction in the lethality by introduction to the use of Thomas’s splint. Americans and in this war extolled Thomas’s splint

  16. Håndens akutte infektioner

    DEFF Research Database (Denmark)

    Søe, Niels H; Jensen, Nina Vendel; Dahlin, Lars

    2009-01-01

    Hand infections can result in significant morbidity if not appropriately diagnosed and treated. Host factors, location and circumstances of the infection are important guides to initial treatment strategies. Many hand infections improve with early splinting, elevation and appropriate antibiotics ...... based on bacterial culture. The basic principles for deep infections are bridement of necrotic and infected tissue and healing by second area intension and antibiotics. Hand therapy is important. Udgivelsesdato: 2009-Mar-30......Hand infections can result in significant morbidity if not appropriately diagnosed and treated. Host factors, location and circumstances of the infection are important guides to initial treatment strategies. Many hand infections improve with early splinting, elevation and appropriate antibiotics...

  17. The Protocol of Fixed Reconstruction for Severely Worn Teeth Combined with Anterior Deep Bite

    Directory of Open Access Journals (Sweden)

    Ya-Wen Zhao

    2017-01-01

    Full Text Available Full mouth reconstruction is one of the most effective methods to restore severe worn teeth that have suffered reduced vertical dimension. Although the use of the overlay splint restoration for a trial period allowing the patient to adapt to an increased vertical dimension is the recognized method, the specific protocol from the transitional splint to the fixed reconstruction is yet to be established. This case report describes a 50-year-old female patient who has severely worn teeth combined with an anterior deep bite and chewing pain. The protocol of the treatment process is described.

  18. A surgical virtual environment for navigating experience.

    NARCIS (Netherlands)

    Luursema, J.M.; Kommers, Petrus A.M.

    2004-01-01

    A computer generated pre-surgical planning and teaching environment is proposed for training and evaluating novice surgeons. Although this environment is generic and can be put into practice in any medical specialisation where such 3D imaging techniques are in use, in this project we specifically

  19. Stimulating Language: Insights from TMS

    Science.gov (United States)

    Devlin, Joseph T.; Watkins, Kate E.

    2007-01-01

    Fifteen years ago, Pascual-Leone and colleagues used transcranial magnetic stimulation (TMS) to investigate speech production in pre-surgical epilepsy patients and in doing so, introduced a novel tool into language research. TMS can be used to non-invasively stimulate a specific cortical region and transiently disrupt information processing. These…

  20. Three-dimensional echocardiography in congenital heart disease : an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography

    NARCIS (Netherlands)

    Simpson, John; Lopez, Leo; Acar, Philippe; Friedberg, Mark; Khoo, Nee; Ko, Helen; Marek, Jan; Marx, Gerald; McGhie, Jackie; Meijboom, Folkert; Roberson, David; Van den Bosch, Annemien; Miller, Owen; Shirali, Girish

    2016-01-01

    Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good

  1. Three-dimensional Echocardiography in Congenital Heart Disease : An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography

    NARCIS (Netherlands)

    Simpson, John; Lopez, Leo; Acar, Philippe; Friedberg, Mark K; Khoo, Nee S; Ko, Helen; Marek, Jan; Marx, Gerald; McGhie, Jackie S; Meijboom, Folkert; Roberson, David; van den Bosch, Annemien E; Miller, Owen; Shirali, Girish

    2017-01-01

    Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good

  2. Cerebral lesions can impair fMRI-based language lateralization.

    NARCIS (Netherlands)

    Wellmer, J.; Weber, B.; Urbach, H.; Reul, J.; Fernandez, G.S.E.; Elger, C.E.

    2009-01-01

    PURPOSE: Several small patient studies and case reports raise concerns that the reliability of functional magnetic resonance imaging (fMRI) may be impaired in the vicinity of cerebral lesions. This could affect the clinical validity of fMRI for presurgical language lateralization. The current study

  3. Use of panoramic radiography to predict postsurgical sensory impairment following extraction of impacted mandibular third molars

    Directory of Open Access Journals (Sweden)

    Chuan-Kuei Huang

    2015-10-01

    Conclusion: There are three radiographic signs: (1 interruption of the radiopaque line; (2 diversion of the IAN canal; and (3 narrowing of the IAN canal. These signs are valuable in presurgical evaluation of the risk of postoperative sensory impairment after surgical removal of impacted mandibular third molar.

  4. The associations of illness perceptions and self-efficacy with psychological well-being of patients in preparation for joint replacement surgery.

    Science.gov (United States)

    Magklara, Eleni; Morrison, Val

    2016-09-01

    Patient well-being on referral to surgery likely affects their surgical experience yet few studies examine pre-surgical correlates of well-being. Guided by the Common Sense Model of Self-Regulation and Social Cognitive theory, this study examined whether illness and emotional representations, general and domain self-efficacy were associated with pre-surgical well-being. The pre-surgical assessment of a three-wave prospective study is reported. Fifty-four hip and knee replacements patients (mean age = 69.33; SD = 8.57) were recruited in the pre-surgery educational clinic at a UK general hospital. Patients completed a questionnaire-pack including the Revised Illness Perceptions Questionnaire, the General Self-Efficacy Scale, the Self-Efficacy for Rehabilitation Outcome Scale, the Falls-Efficacy Scale, and the Short Form of Psychological Well-Being Index. Multiple hierarchical regression analyses showed that above and beyond demographic and clinical characteristics, negative emotional representations were associated with lower psychological well-being while strong general self-efficacy beliefs were positively related to psychological well-being. Independent of demographic and clinical characteristics, joint replacement patients' psychological well-being was associated with their cognitions and emotional reactions to their condition before surgery. Early interventions could potentially target these modifiable factors to improve pre-surgical well-being in this group of patients, with potential for additional post-surgical benefit.

  5. The Impact of Early Infant Jaw-Orthopaedics on Early Speech Production in Toddlers with Unilateral Cleft Lip and Palate

    Science.gov (United States)

    Lohmander, Anette; Lillvik, Malin; Friede, Hans

    2004-01-01

    The purpose of study was to investigate the impact of pre-surgical Infant Orthopaedics (IO) on consonant production at 18 months of age in children with Unilateral Cleft Lip and Palate (UCLP) and to compare the consonant production to that of age-matched children without clefts. The first ten children in a consecutive series of 20 with UCLP…

  6. Source localization of rhythmic ictal EEG activity

    DEFF Research Database (Denmark)

    Beniczky, Sándor; Lantz, Göran; Rosenzweig, Ivana

    2013-01-01

    Although precise identification of the seizure-onset zone is an essential element of presurgical evaluation, source localization of ictal electroencephalography (EEG) signals has received little attention. The aim of our study was to estimate the accuracy of source localization of rhythmic ictal ...

  7. Mediators of a Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients: Response Expectancies and Emotional Distress

    Science.gov (United States)

    Montgomery, Guy H.; Hallquist, Michael N.; Schnur, Julie B.; David, Daniel; Silverstein, Jeffrey H.; Bovbjerg, Dana H.

    2010-01-01

    Objective: The present study was designed to test the hypotheses that response expectancies and emotional distress mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). Method: Women (n = 200) undergoing breast-conserving surgery (mean age = 48.50 years;…

  8. The rare intracellular RET mutation p. S891A in a Chinese Han ...

    Indian Academy of Sciences (India)

    Given these case results, we suggest that screening of RET and pre-surgical Ct levels in the management of MTC patients is essential for earlier diagnosis and more normative initial treatment, that FMTC patients with cervical lymph nodes metastases may be cured by TT with MBiND, and that prophylactic VI compartmental ...

  9. Stress management training for breast cancer surgery patients

    NARCIS (Netherlands)

    Garssen, B.; Boomsma, M.F.; Ede, J. van; Porsild, T.; Berkhof, J.; Berbee, M.; Visser, A.; Meijer, S.; Beelen, R.H.

    2013-01-01

    OBJECTIVE: This study evaluated the psychological effects of a pre-surgical stress management training (SMT) in cancer patients. METHODS: Stress management training comprised four sessions in total: on 5 days and 1 day pre-surgery and on 2 days and 1 month post-surgery. Patients also received audio

  10. THE ROLE OF MRI IN DIAGNOSIS AND PREOPERATIVE STAGING OF DCIS

    Directory of Open Access Journals (Sweden)

    Simone Mennella

    2013-04-01

    Full Text Available The role of magnetic resonance imaging for breast ductal carcinoma in situ was analyzed for its use both for diagnostic and pre-surgical staging aspects. An important comparison with mammographic study was done. Features, views and actual limits of this technique were also analyzed.

  11. [Vacuum therapy in a pre- and postsurgical ulcera crurum].

    Science.gov (United States)

    Mang, R; Kovnerystyy, O; Stege, H

    2004-05-01

    Chronic wounds are often a diagnostic as well as a therapeutic problem. Three case reports depi important differential diagnoses. The importance and efficacy of vacuum assisted closure in a presurgical treatment as well as after mesh graft transplanation will be described.

  12. Skene's gland duct cysts: The utility of vaginal/transperineal imaging ...

    African Journals Online (AJOL)

    We demonstrate that pelvic floor imaging is a useful diagnostic tool and aids in preoperative surgical planning. The real-time nature of this form of imaging and the addition of 3D ultrasonography demonstrate internal architecture and spatial relationships of periurethral pathology, thus aiding presurgical mapping. In this case ...

  13. Radiology of a rare foreign body in the nasal cavity

    Energy Technology Data Exchange (ETDEWEB)

    Schoendorf, J.; Jungehuelsing, M. [Dept. of Otorhinolaryngology, Koeln (Germany)

    2000-08-01

    We report a 76-year-old man referred because of incessant epistaxis. During presurgical investigation a radiodense mass was detected in the left nasal cavity, which turned out to be an iodoform-soaked gauze pack put in by a general practitioner some weeks previously and simply forgotten. (orig.)

  14. Radiology of a rare foreign body in the nasal cavity

    International Nuclear Information System (INIS)

    Schoendorf, J.; Jungehuelsing, M.

    2000-01-01

    We report a 76-year-old man referred because of incessant epistaxis. During presurgical investigation a radiodense mass was detected in the left nasal cavity, which turned out to be an iodoform-soaked gauze pack put in by a general practitioner some weeks previously and simply forgotten. (orig.)

  15. Structural and Resting State Functional Connectivity of the Subthalamic Nucleus: Identification of Motor STN Parts and the Hyperdirect Pathway

    NARCIS (Netherlands)

    Brunenberg, E.J.L.; Moeskops, P.; Backes, W.H.; Pollo, C.; Cammoun, L.; Vilanova, A.; Janssen, M.L.H.; Visser-Vandewalle, V.E.R.M.; Haar Romeny, B.M. Ter; Thiran, J.-P.; Platel, B.

    2012-01-01

    Deep brain stimulation (DBS) for Parkinson's disease often alleviates the motor symptoms, but causes cognitive and emotional side effects in a substantial number of cases. Identification of the motor part of the subthalamic nucleus (STN) as part of the presurgical workup could minimize these adverse

  16. Prevalence of obstructive sleep apnea in patients with squamous cell carcinoma of the tongue following ablation surgery

    Directory of Open Access Journals (Sweden)

    Man-Yee Chan

    2012-09-01

    Conclusion: Incidence of OSA in the patient population with SSC of the tongue was found to be significantly higher than that in the general population. The limitations of this study were the relatively small patient sample size and no presurgical PSG record being obtained from the patients to compare the sleep quality before and after cancer therapy.

  17. Assessing Trauma Care Provider Judgement in the Prediction of Need for Life-saving Interventions

    Science.gov (United States)

    2015-01-13

    other surgery related to trauma such as pelvic stabilization or other orthopaedic surgery, emergent angiography/embolization, and chest tube... pelvic stabilization , orthopaedic surgery, emergent angiography/emboli- zation, and chest tube insertion. Pericardiocentesis was not performed in the...209 casualties included in the survey. One patient had CPR after admission and 11 patients had inflatable splints or pelvic stabilization to control

  18. Randomised controlled trial of local corticosteroid injections