Fibrilación auricular en el postoperatorio de cirugía cardiaca: factores predisponentes y complicaciones

La fibril•lació auricular és una complicació freqüent en el postoperatori de cirurgia cardíaca que empitjora el pronòstic d'aquest procediment. Per aquest motiu decidim realitzar un estudi prospectiu observacional amb la finalitat de detectar factors relacionats amb l'aparició de fibril•lació auricular postquirúrgica, en el qual es van incloure 101 pacients intervinguts de cirurgia cardíaca en un període de 3 mesos. Es van recollir dades preoperatòries i intraoperatòries, així com complicacions postquirúrgiques. Es va objectivar associació estadística entre l'aparició de fibril•lació auricular i el tipus i durada de la cirurgia, així com augment en les complicacions i en l'estada mitjana.

Aïllament epicàrdic de les venes pulmonars amb ultrasons d’alta intensitat per al tractament quirúrgic de la fibril•lació auricular no primària

Aquest és un estudi prospectiu observacional de cohorts de 59 malalts amb fibril•lació auricular no primària tractats amb ablació epicàrdica de venes pulmonars amb ultrasons. Els objectius van ser avaluar l’efectivitat de l’ablació, establir les diferències dels resultats entre una fibril•lació auricular paroxística i una crònica i establir les diferències dels resultats segons la patologia cardíaca primària. L’efectivitat de l’ablació per mantenir ritme sinusal a l’any fou del 65,3%. Per la fibril•lació auricular paroxística l’efectivitat al mes fou del 82,4% i del 41,7% per la crònica (p=0,005) i a l’any del 82,4% i del 56,3% respectivament (p=0,068).

Estudio comparativo de dos estrategias para el tratamiento del dolor durante la ablación de fibrilación auricular: analgesia frente a sedación

Antecedentes: Las aplicaciones de radiofrecuencia durante la ablación de la fibrilación auricular (FA) producen dolor y ansiedad. El tratamiento habitual se basa en la administración de analgésicos y sedación. La sedación intensa puede producir inestabilidad hemodinámica y desaturaciones.Objetivos: Comparar la incidencia de desaturaciones en relación a la utilización de dos protocolos distintos de tratamiento del dolor durante la ablación de FA. Uno de los protocolos está basado en la sedación con propofol (protocolo 1) y el otro en la analgesia intensa (protocolo 2).Resultados: Hemos analizado los datos de recogidos durante el procedimiento en un grupo de 43 pacientes tratados según el protocolo 1 y otro grupo de 43 pacientes tratados según el protocolo 2. Las variables analizadas han sido: la desaturación máxima, la dosis media de propofol y la dosis media de fentanilo. Las dosis de propofol necesarias en los pacientes del protocolo 1 han sido mayores que con el protocolo 2 (2,4±1,4mg/kg vs 1,7±0,5 mg/kg; p=0,005). La dosis de fentanilo en los pacientes del protocolo 1 han sido menores que en los del protocolo 2 (35,4±17,3mg vs 51,1±18,6mg vs; p<0,001). El 83,65% de los pacientes del protocolo 2 se mantuvo por encima del 94% de saturación frente al 58,1% de pacientes del protocolo 1. Conclusiones: Con el tratamiento basado en la analgesia para los procedimientos de ablación de FA se consigue que una menor proporción de pacientes tengan desaturaciones.

Prevalence of complications after the oral rehabilitation with implant-supported hybrid prostheses

Objectives: Assess the main problems referred by the patients and observed by the professionals after the bucodental rehabilitation with an implant-supported hybrid prothesis. Patients and Methods: A retrospective study was carried out in which there were 43 patients included who were visited in the Department of Oral Surgery and Orofacial Implantology of University of Barcelona Dental School for one year. An oral rehabilitation with an implant-supported hybrid prosthesis was made to those patients. The following variables were registered: age, gender, number of inserted implants, type of implant and principal problems produced by the hybrid prosthesis. Results: The rehabilitation with an implant supported hybrid prosthesis was only performed in 43 of 116 cases treated in one year (January, 2006 to January, 2007). They were 26 men and 17 women of ages between 37 and 74 years, being the rate age of 56,5 years. The main complication recorded was the mucositis, associated frequently with a difficulty to carry a correct oral hygiene and to an overextention of the tail of resin of the prosthesis. Other observed problems were the peri-implantitis, the break of the acrylic teeth and the loss of some of the prosthetic screws. Conclusions: The most frequent complication after the laying of an implant supported hybrid prosthesis was the mucositis, associated mainly with a prosthetic tail too long and to the consequent difficulty of carrying a correct oral hygiene. In spite of the high prevalence of observed complications, most of them were mild and resolved on subsequent visits.

Endosseous dental implant fractures an analysis of 21 cases

Implant fracture is an infrequent cause of implant failure. The present study evaluates 21 fractured implants, with an analysis of patient age and sex, the type, length and diameter of the implant, positioning in the dental arch, the type of prosthetic rehabilitation involved, the number of abutments and pontics, the presence or absence of distal extensions or cantilevers, and loading time to fracture. Implant fracture was more common in males than in females (15:4), and the mean patient age was 56.9 years. Most cases (n = 19) corresponded to implant-supported fixed prostheses - 16 with cantilevers of different lengths- while only two fractured implants were supporting overdentures instead of fixed prostheses. The great majority of fractured implants (80.9%) were located in the molar and premolar regions, and most fractured within 3-4 years after loading. It is important to know and apply the measures required to prevent implant fracture, and to seek the best individualized solution for each case - though complete implant removal is usually the treatment of choice

Bacterial adhesion efficiency on implant abutments: a comparative study

The attachment of Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 28213 onto six different materials used to manufacture dental implant abutments was quantitatively determined after 2 and 24 h of contact between the materials and the bacterial cultures. The materials were topographically characterized and their wettability determined, with both parameters subsequently related to bacterial adhesion. Atomic force microscopy, interferometry, and contact angle measurement were used to characterize the materials" surfaces. The results showed that neither roughness nor nano-roughness greatly influenced bacterial attachment whereas wettability strongly correlated with adhesion. After 2 h the degree of E. coli attachment markedly differed depending on the material whereas similar differences were not observed for S. aureus, which yielded consistently higher counts of adhered cells. Nevertheless, after 24 h the adhesion of the two species to the different test materials no longer significantly differed, although on all surfaces the numbers of finally adhered E. coli were higher than those of S. aureus

Thermal increment due to ErCr: YSGG and CO2 laser irradiation of different implant surfaces. A pilot study

Objective: An evaluation and comparison is made of the thermal increment at different implant surfaces during irradiation with CO2 and ErCr:YSGG lasers. Study design: Five threaded and impacted implants with four types of surfaces were inserted in an adult pig rib: two implants with a hydroxyapatite surface (HA)(impacted and threaded, respectively), a machined titanium surface implant (TI mach), a titanium plasma spray surface implant (TPS), and a sandblasted, acid-etched surface implant (SBAE). A 0.5-mm diameter bone defect was made in the implant apical zone, and a type-K thermocouple (Termopar)® was placed in contact with the implant. The implants were irradiated in the coronal zone of each implant with a CO2 (4 W continuous mode) and an ErCr:YSGG laser (1.5 W, pulsed mode) first without and then with refrigeration. The temperature variations at the implant apical surface were recorded. Results: An apical temperature increase was recorded in all cases during CO2 and ErCr:YSGG laser irradiation without refrigeration. However, when the ErCr:YSGG was used with a water spray, a decrease in temperature was observed in all implants. The acid-etched and sandblasted surfaces were those most affected by the thermal changes. Conclusions: The ErCr:YSGG laser with a water spray applied to the sealing cap or coronal zone of the implants does not generate thermal increments in the apical surface capable of adversely affecting osseointegration and the integrity of the peri-implant bone tissue

Oral implant rehabilitation in a patient with Moebius syndrome

Introduction: Moebius syndrome is a rare congenital disorder characterized by unilateral or bilateral involvement of the sixth and seventh cranial nerves, resulting in a lack of facial expression and eye movements. These patients suffer a series of oral manifestations that may complicate their dental treatment, such as facial and tongue muscle weakness, uncontrolled salivation secondary to defi cient lip sealing, micrognathia, microstomia, bifi d uvula, gothic and fi ssured palate, fi ssured tongue, and glossoptosis. The underlying etiology remains unclear, though vascular problems during embryogenesis appear to be involved. Clinical case: We report the case of a woman with Moebius syndrome and total edentulism. Eight years ago she underwent complete oral rehabilitation with the placement of two implants in each dental arch. Discussion: Moebius syndrome has still an unknown etiology, although it is related to disorders during pregnancy. This kind of patient can be rehabilitated using oral implants.

A test of Suchey-Brooks (pubic symphysis) and Buckberry-Chamberlain (auricular surface) methods on an identified Spanish sample: paleodemographic implications

Forensic Anthropology and Bioarchaeology studies depend critically on the accuracy and reliability of age-estimation techniques. In this study we have evaluated two age-estimation methods for adults based on the pubic symphysis (Suchey-Brooks) and the auricular surface (Buckberry-Chamberlain) in a current sample of 139 individuals (67 women and 72 men) from Madrid in order to verify the accuracy of both methods applied to a sample of innominate bones from the central Iberian Peninsula. Based on the overall results of this study, the Buckberry-Chamberlain method seems to be the method that provides better estimates in terms of accuracy (percentage of hits) and absolute difference to the chronological age taking into account the total sample. The percentage of hits and mean absolute difference of the Buckberry-Chamberlain and Suchey-Brooks methods are 97.3% and 11.24 years, and 85.7% and 14.38 years, respectively. However, this apparently greater applicability of the Buckberry-Chamberlain method is mainly due to the broad age ranges provided. Results indicated that Suchey-Brooks method is more appropriate for populations with a majority of young individuals, whereas Buckberry-Chamberlain method is recommended for populations with a higher percentage of individuals in the range 60-70 years. These different age estimation methodologies significantly influence the resulting demographic profile, consequently affecting the biological characteristics reconstruction of the samples in which they are applied.