74 research outputs found
The new transperineal-prerectal approach in posterior urethroplasty
No full textObjective: A new posterior urethroplasty is suggested for patients with pelvic fracture urethral distraction defect (PFUDD). Methods: 12 men, with PFUDD were treated with an anastomotic urethroplasty, using a transperineal-prerectal approach. All patients had a suprapubic tube in place and were impotent after pelvic trauma. The goal of this approach was to facilitate an extensive removal of the scar tissues around the prostatic apex to promote successful bulbo-prostatic anastomosis. Results: No patients had intraoperative, perioperative or postoperative complications. Urinary incontinence or rectourethral fistula was never observed. In 11 patients the postoperative mean peak flow was 20 ml/sec. The recurrence of the stricture occurred in 1 patient. Conclusions: The transperineal-prerectal approach to the posterior urethra facilitated a free tension posterior end-to-end anastomosis, as an alternative to the transpubic anastomotic procedure
Implantoplasty associated with the regenerative treatment of peri-implantitis = L’implantoplastica associata al trattamento rigenerativo della perimplantite
No full textObiettivi In questo studio è stata analizzata l’efficacia dell’implantoplastica come metodo di decontaminazione associata alla terapia rigenerativa della perimplantite.
L’implantoplastica è una procedura che consiste nel rendere liscia la porzione di impianto esposta dal processo infiammatorio mediante l’utilizzo di frese ad abrasività decrescente montate su strumenti rotanti. L’obiettivo di tale procedura è rimuovere lo strato più superficiale di titanio contaminato da batteri e, al contempo, ridurre la ruvidità del corpo implantare così da renderlo meno ritentivo di placca batterica, dunque meno soggetto a recidive.
Materiali e metodi Sono stati selezionati 5 pazienti tra i 50 e i 77 anni, per un totale di 6 impianti affetti da perimplantite. I pazienti erano stati trattati con riabilitazione implanto-protesica in un periodo compreso tra 7 e 10 anni prima e tutti gli impianti presentavano superficie ruvida. I difetti perimplantari erano di tipo infraosseo e sono stati trattati con terapia rigenerativa; la superficie implantare esposta dal riassorbimento osseo è stata trattata con tecnica di implantoplastica. Prima dell’intervento chirurgico i pazienti sono stati sottoposti a terapia causale che prevede l’utilizzo di curette in teflon, punta ultrasuoni rivestita in plastica e contestuale irrigazione di clorexidina 0,2% collutorio e l’ausilio di uno strumento di air-polishing e polvere a base di eritritolo, silice amorfa e clorexidina 0,3%. A ogni paziente è stata prescritta una terapia antibiotica con amoxicillina e acido clavulanico o, in caso di allergie, con claritromicina. La procedura chirurgica ha previsto l’allestimento di un lembo mucoperiosteo con incisioni di rilascio verticali laddove necessarie per ridurre la tensione del lembo, degranulazione del difetto perimplantare mediante curette in teflon e punta ultrasuoni e decontaminazione del difetto mediante lavaggi di clorexidina 0,2% collutorio.
La porzione di impianto che aveva perso tessuto osseo di supporto è stata sottoposta a implantoplastica, fin dove l’accesso chirurgico lo consentiva, mediante l’uso di frese diamantate a granulometria decrescente e gommini da lucidatura. In sede del difetto infraosseo sono state eseguite microperforazioni della midollare, cui è seguito il riempimento dello stesso mediante sostituto osseo eterologo a base di osso bovino deproteinizzato (Bio-Oss®, Geistlich, Wolhusen, Svizzera) e successivo posizionamento di una membrana in collagene riassorbibile.
A 7 giorni è stato effettuato il controllo della guarigione e una radiografia endorale, mentre le suture sono state rimosse a 14 giorni. Tutti i pazienti sono stati inseriti in un protocollo di follow-up che prevedeva visite di controllo a 1, 3, 6 e 12 mesi.
Risultati e conclusioni Le profondità di sondaggio dei 6 impianti registrate al baseline (t0) in alcuni casi superavano i 10 mm, e nel 66,6% erano >5 mm, con una media pari a 6,71±2,42 mm. A 6 mesi dal trattamento chirurgico (t1) in nessun sito è stato registrato un valore di PD >5 mm, con una media pari a 3,92±0,83 mm; BoP sempre <25%. Le radiografie endorali di controllo mostravano un livello osseo stabile se paragonato a quello post-chirurgico; inoltre, l’igiene orale domiciliare è risultata migliorata in tutti i pazienti. A 1 anno dalla chirurgia (t2) i valori di PD registrati in ogni sito implantare erano <5 mm con una media pari a 3,38±0,58 mm; non si evidenziavano segni di infiammazione e le radiografie endorali non mostravano riassorbimento osseo.
Significato clinico Nonostante il numero ridotto del campione, e l’impossibilità di valutare istologicamente il sito perimplantare, l’implantoplastica associata al trattamento rigenerativo della perimplantite costituisce un approccio terapeutico promettente.OBJECTIVES In this study the effectiveness of implantoplasty was analyzed as a method of decontamination associated with regenerative therapy of peri-implantitis. Implantoplasty is a procedure that aim to make the implant portion exposed by the inflammatory process smooth by using decreasing abrasive burs mounted on rotating instruments. The goal of this procedure is to remove the superficial layer of titanium contaminated by bacteria and at the same time reduce the roughness of the implant body so as to make it less retentive of bacterial plaque, therefore less prone to recurrence. MATERIALS AND METHODS Five patients were selected aged between 50 and 77 years, for a total of 6 implants affected by peri-implantitis. The patients had been treated with implant rehabilitation in a period between 7 and 10 years before and all the im-plants had a rough surface. The peri-implant defects were of the intra-osseous type and were treated with regenerative therapy; the implant surface exposed by bone resorption was treated with implantoplasty. Before surgery, the patients underwent causal therapy with the use of teflon curettes, ultrasonic tip coated in plastic and simultaneous irrigation of chlorhexidine 0.2% mouthwash and the aid of an air-polish-ing tool and powder (erythritol, amorphous silica and 0,3% chlor-hexidine). Each patient was prescribed antibiotic therapy with amoxicillin and clavulanic acid or, in case of allergies, with clarithro-mycin. The surgical procedure consists in the preparation of a mucoperiosteal flap with vertical release incisions where necessary to reduce the flap tension, de-granulation of the peri-implant defect by means of teflon curettes and ultrasound tip and decontamination of the defect by use of 0.2% chlorhexidine washes. The implant portion that had lost sup-porting bone tissue was treated with implantoplasty as far as sur-gical access allowed, using dia-mond drills with decreasing gran-ulometry and polishing pads. Mi-croperforations of the bone marrow were performed in the intra-osseous defect, followed by the filling of the same with a het-erologous bone substitute based on deproteneized bovine bone (Bio-Oss®, Geistlich, Wolhusen, Switzerland) and subsequent placement of a resorbable collagen membrane. At 7 days the healing check and an intraoral radiograph was performed, and the sutures were removed at 14 days. All patients were included in a follow-up protocol that included 1, 3, 6 and 12 month control visits. RESULTS AND CONCLUSIONS The probing depths of the 6 implants recorded at the baseline (t0) in some cases exceeded 10 mm, and in 66.6% were >5 mm, with an average of 6.71±2.42 mm. At 6 months from the surgical treatment (t1) at none of the site a value of PD >5 mm was recorded, with an aver-age of 3.92±0.83 mm; BoP al-ways <25%. The intraoral radiographs showed a stable bone level compared to the post-surgical bone level; in addition, home oral hygiene was found to be improved in all patients. At 1 year from surgery (t2) the PD values recorded at each implant site were <5 mm with an average of 3.38±0.58 mm; no signs of inflammation were noticed and the intraoral radiographs showed no bone resorption. CLINICAL SIGNIFICANCE Despite the small number of the sample, and the impossibility to evaluate the peri-implant site histologically, implantoplasty associated with the regenerative treatment of peri-implantitis is a promising therapeutic approach
Color Doppler echocardiographic assessment of atrial septal defect size : correlation with surgical measurements
No full textIn patients with atrial septal defect (ASD), color flow Doppler echocardiography provides visualization of the transseptal jet, the maximal dimension of which can be assumed to correspond to the maximal dimension of the true orifice. To test whether color flow Doppler echocardiography can provide an alternative method for measurement of ASD size, we studied 63 consecutive patients with echocardiographic evidence of ASD. In 48 patients the maximal dimension of the jet was measured in the parasternal, apical, or subcostal four-chamber view or in the parasternal short-axis view. In the remaining 15 patients transesophageal echocardiography was performed because of transthoracic views were inadequate. The transesophageal studies also measured, from two-dimensional images, the maximal transverse discontinuity in the atrial septum. All patients underwent surgical repair, during which the surgeon directly measured the maximal dimension of ASD. Linear regression equations were performed to compare transthoracic and transesophageal dimensions to those measured at operation. Correlation coefficients were as follows for transthoracic versus surgical measurements: r = 0.745, standard error = 4.35, p less than 0.001. Transesophageal measurements derived from both two-dimensional images and echocardiographic jet width showed similar excellent correlation with surgical measurements (n = 0.91, standard error = 4.33, p less than 0.001; and r = 0.919, standard error = 4.42, p less than 0.001, respectively). We conclude that ASD size derived from color flow Doppler echocardiography shows a good correlation with the anatomic maximal dimension observed at operation. Both transesophageal color flow Doppler echocardiography of jet width and direct surgical measurement of the defect provide an accurate estimation of ASD size
Difetti del setto interatriale: correzione chirurgica senza esame emodinamico. Analisi su 145 casi operati
No full textSurgical correction of ostium secundum atrial septal defects may be performed, in most cases, without cardiac catheterization, on the ground of clinical and two-dimensional echocardiographic (2D echo) findings. Consequently it's useful to identify the reliability of 2D echo and the indications for angiography in these patients (pts). One hundred forty-five patients operated in "A. De Gasperis" Division of Cardiac Surgery in Milan from January 1982 to December 1986 are reviewed. Patients with ostium primum atrial septal defects or subjected to cardiac catheterization and angiography in other institutions are excluded. Altogether two-dimensional echocardiography was performed in 131 pts, cardiac catheterization in 78. Sixty-four pts were studied with both 2D echo and angiography. In 35 pts (with only 2D echo examination) radionuclide angiocardiography was performed. The results of the different techniques were compared with intra-operative findings, defining sensitivity and specificity in relation to detection of the site of the defect and of the pulmonary venous return. There were no statistically significative differences between echo 2D and cardiac catheterization (Figs. 1 and 2). Two-dimensional echocardiography confirms its cost effective and psychological advantages, especially in younger patients. Hemodynamic and angiographic assessment should be performed as follows: 1) when associated anomalies are suspected; 2) in cases of non-satisfying quality of the 2D echo examination; 3) when diagnostic incoherence between clinical and instrumental data is present; 4) in patients with pulmonary hypertension
Laparoscopic treatment of renal cysts
No full textFour patients underwent laparoscopic resection of extensive (8–15 cm) inferior and medio-renal polar cysts of the kidney. The average operating time was 2 h. The operation is performed with the patients lying in a lateral decubitus position, and requires four incisions for access. The laparoscopic resection of renal cysts can be proposed as a valid alternative to standard surgical treatment as well as percutaneous hollow-needle aspiration
Extracorporeal shock-wave lithotripsy with MPL9000 for the treatment of urinary stones in pediatric patients
No full textExtracorporeal shock-wave lithotripsy (ESWL) is now applied as the treatment of choice in most cases of urinary stones. Its acceptance in pediatry, however has been only gradual despite numerous positive studies. We report on fourteen young patients (mean age: 9.7 years) who were all treated by ESWL with the MPL9000 lithotriptor for renal stones. Each patient received an average of 1440 shocks with generator energy set at 14.4 Kv. Six of these patients required either analgosedation or anesthesia. No observable complications of treatment occurred. At one-month follow up, the kidneys of twelve patients were found to be stone-free, while two still presented fragments that could pass spontaneously. At three-month follow-up, thirteen patients were stone-free and a single patient retained some fragments. From this data we infer that ESWL with the MPL9000 lithotriptor may be used safety and efficiently to treat urolithiasis in younger patients
Terapia chirurgica della malattia di la peyronie, mediante incisione di placca su tutore endocavernoso soffice a rigidità assiale, con innesto libero di vena safena secondo tecnica di austoni. Studio multicentrico con risultati di follow-up a 6 anni.
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