Evaluation of hollow fiberoptic tips for the conduction of Er : YAG laser

Objective: The use of Er:YAG laser operating in the 3 μm range with adjustable power and pulses has become popular for dental and medical practice due to its high photoablative capacity, surgical precision and antimicrobial action. Background data: The existing fiberoptic tips irradiate lasers parallel to the long axes of the tooth limiting its efficiency in the root canal. Methods: We evaluated hollow fiberoptic tips obtained from silicate glass as a means of Er:YAG laser conduction in dental procedures. The fiber tips were molded from capillary tubes with different profiles so that their ends would have cylindric, conical or spherical shapes. The performance of the three fibers as a means of propagation of Er:YAG (λ = 2.94 μm) laser radiation was compared to that of a solid sapphire fiber at 10 Hz and 200 mJ and of 20 Hz and 500 mJ. The profiles of frontal and lateral burning were visualized on thermal paper. Results: Analysis of these profiles demonstrated that the sapphire tip and the hollow fiber of cylindric section did not differ significantly in the profiles of frontal burning, and no lateral burning was detected. The fibers of the conical and spherical sections, although presenting attenuation in the frontal output power, showed a larger burning area in the frontal profile, in addition to producing lateral burning. Conclusions: The results indicate that commercial hollow fiberoptics have advantages such as easy manufacture of the different tip shapes, great adaptability, low cost, and a low loss of transmission. © Mary Ann Liebert, Inc.

The pterional craniotomy: tips and tricks

This review intended to describe in a didactic and practical manner the frontotemporosphenoidal craniotomy, which is usually known as pterional craniotomy and constitute the cranial approach mostly utilized in the modern neurosurgery. This is, then, basically a descriptive text, divided according to the main stages involved in this procedure, and describes with details how the authors currently perform this craniotomy.

Compressive strength of dental composites photo-activated with different light tips

The aim of this study was to evaluate the compressive strength of microhybrid (FiltekTM Z250) and nanofilled (FiltekTM Supreme XT) composite resins photo-activated with two different light guide tips, fiber optic and polymer, coupled with one LED. The power density was 653 mW cm-2 when using the fiber optic light tip and 596 mW cm-2 with the polymer. After storage in distilled water at 37± 2 °C for seven days, the samples were subjected to mechanical testing of compressive strength in an EMIC universal mechanical testing machine with a load cell of 5 kN and speed of 0.5 mm min-1. The statistical analysis was performed using ANOVA with a confidence interval of 95% and Tamhane’s test. The results showed that the mean values of compressive strength were not influenced by the different light tips (p > 0.05). However, a statistical difference was observed (p < 0.001) between the microhybrid composite resin photo-activated with the fiber optic light tip and the nanofilled composite resin. Based on these results, it can be concluded that microhybrid composite resin photo-activated with the fiber optic light tip showed better results than nanofilled, regardless of the tip used, and the type of the light tip did not influence the compressive strength of either composite. Thus, the presented results suggest that both the fiber optic and polymer light guide tips provide adequate compressive strength to be used to make restorations. However, the fiber optic light tip associated with microhybrid composite resin may be an interesting option for restorations mainly in posterior teeth.

Evaluation of degree of conversion and hardness of dental composites photo-activated with different light guide tips

Objective: The aim of this study was to evaluate the degree of conversion and hardness of different composite resins, photo-activated for 40 s with two different light guide tips, fiber optic and polymer. Methods: Five specimens were made for each group evaluated. The percentage of unreacted carbon double bonds (% C=C) was determined from the ratio of absorbance intensities of aliphatic C=C (peak at 1637 cm-1) against internal standard before and after curing of the specimen: aromatic C-C (peak at 1610 cm-1). The Vickers hardness measurements were performed in a universal testing machine. A 50 gf load was used and the indenter with a dwell time of 30 seconds. The degree of conversion and hardness mean values were analyzed separately by ANOVA and Tukey's test, with a significance level set at 5%. Results: The mean values of degree of conversion for the polymer and fiber optic light guide tip were statistically different (P<.001). The hardness mean values were statistically different among the light guide tips (P<.001), but also there was difference between top and bottom surfaces (P<.001). Conclusions: The results showed that the resins photo-activated with the fiber optic light guide tip promoted higher values for degree of conversion and hardness.

Factors predicting mortality after tips for refractory ascites: a single center experience

Introduction: Transjugular intrahepatic porto-systemic shunt (TIPS) is an accepted indication for treating refractory ascites. Different models have been proposed for the prediction of survival after TIPS; aim of present study was to evaluate the factors associated with mortality after TIPS for refractory ascites. Methods: Seventy-three consecutive patients undergoing a TIPS for refractory ascites in our centre between 2003 and 2008, were prospectively recorded in a database ad were the subject of the study. Mean follow-up was 17±2 months. Forty patients were awaiting liver transplantation (LT) and 12 (16.4%) underwent LT during follow-up. Results: Mean MELD at the moment of TIPS was 15.7±5.3. Overall mortality was 23.3% (n=17) with a mean survival after TIPS of 17±14 months. MELD score (B=0.161, p=0.042), AST (B= 0.020, p=0.090) and pre-TIPS HVPG (B=0.016, p=0.093) were independent predictors of overall mortality. On multivariate analysis MELD (B=0.419, p=0.018) and pre-TIPS HVPG (B=0.223, p=0.060) independently predicted 1 year survival. Patients were stratified into categories of death risk, using ROC curves for the variables MELD and HVPG. Patients with MELD<10 had a low probability of death after TIPS (n=6, 16% mortality); patients with HVPG <16 mmHg (n=6) had no mortality. Maximum risk of death was found in patients with MELD score 19 (n=16, 31% mortality) and in those with HVPG 25 mmHg (n=27, 26% mortality). Conclusions: TIPS increases overall survival in patients with refractory ascites. Liver function (assessed by MELD), necroinflammation (AST) and portal hypertension (HVPG) are independent predictors of survival; patients with MELD>19 and HVPG>25 mmHg are at highest risk of death after TIPS

TIPS-pentacene come rivelatore di raggi-X

Il presente lavoro di tesi si inserisce all’interno del progetto europeo i-FLEXIS il cui obiettivo è lo sviluppo di un sensore di raggi X innovativo, affidabile, a basso costo e basato su componenti eterogenei organici. Attualmente, i rivelatori di radiazione ionizzante a stato solido fanno uso di materiali inorganici e sono ampiamente impiegati in ambito medico, industriale e come dispositivi per la sicurezza. Le scoperte scientifiche degli ultimi anni nell'ambito dei semiconduttori organici hanno evidenziato che tali materiali sono sensibili alla radiazione ionizzante e il loro utilizzo permette di realizzare rivelatori diretti di raggi-X, convertendo fotoni in segnale elettrico. Questi dispositivi sono caratterizzati da flessibilità, possibilità di lavorare a temperatura ambiente, basso costo di produzione, poca energia di alimentazione, alta sostenibilità ambientale e dalla possibilità di coprire grandi aree. Tutte queste proprietà concorrono ad incrementare sempre più l’attenzione e l’interesse dei ricercatori in questo relativamente nuovo mondo: i semiconduttori organici. In questa tesi sono stati esaminati cinque diversi campioni di TIPS-pentacene con la finalità di evidenziare quali si prestino meglio come rivelatori di raggi-X. I campioni sono tutti in diverse forme e spaziano dal cristallo singolo ai film sottili, con particolare attenzione al comportamento dei cristalli singoli cresciuti mediante processi di stampa direttamente sul substrato. Per quanto riguarda i semiconduttori organici, la frazione di raggi-X assorbita dai materiali è molto piccola e non è in grado di giustificare il segnale misurato. Si è effettuato inoltre un confronto tra la risposta dei campioni alla luce visibile e alla radiazione ionizzante per comprendere il meccanismo di generazione e rivelazione delle cariche in seguito all’assorbimento di raggi-X.

Studio di fotoconducibilità di cristalli di TIPS-pentacene

I semiconduttori organici presentano proprietà che consentono la produzione di dispositivi impensabili fino a pochi anni fa: sono flessibili, leggeri e robusti, ed inoltre facili ed economici da depositare. La loro capacità di rivelare direttamente la radiazione ionizzante, convertendola in segnale elettrico, li pone come ottimi candidati per una nuova generazione di rivelatori a stato solido per raggi X, utilizzabili in situazioni e luoghi prima inaccessibili a quelli inorganici, o addirittura comodamente indossabili. Tuttavia i fenomeni di fotogenerazione e raccolta di carica in questi materiali non sono ancora completamente compresi. Ottimali per lo studio di queste ed altre proprietà intrinseche sono le forme di impacchettamento a cristallo singolo. Questa tesi analizza e confronta i segnali elettrici di campioni di cristalli singoli di TIPS-pentacene quando esposti a flussi crescenti di radiazione visibile e di raggi X a diversi voltaggi, proponendo dei modelli per la loro interpretazione. Viene inoltre riportato un confronto con le stesse misure effettuate su un campione dello stesso materiale in forma di film sottile.

In vitro temperature evaluation during cement augmentation of proximal humerus plate screw tips

BACKGROUND The treatment of proximal humerus fractures in patients with poor bone quality remains a challenge in trauma surgery. Augmentation with polymethylmethacrylate (PMMA) cement is a possible method to strengthen the implant anchorage in osteoporotic bone and to avoid loss of reduction and reduce the cut-out risk. The polymerisation of PMMA during cement setting leads, however, to an exothermic reaction and the development of supraphysiological temperatures may harm the bone and cartilage. This study addresses the issue of heat development during augmentation of subchondrally placed proximal humerus plate screws with PMMA and the possible risk of bone and cartilage necrosis and apoptosis. METHODS Seven fresh frozen humeri from geriatric female donors were instrumented with the proximal humerus interlocking system (PHILOS) plate and placed in a 37°C water bath. Thereafter, four proximal perforated screws were augmented with 0.5 ml PMMA each. During augmentation, the temperatures in the subchondral bone and on the articular surface were recorded with K-type thermocouples. The measured temperatures were compared to threshold values for necrosis and apoptosis of bone and cartilage reported in the literature. RESULTS The heat development was highest around the augmented tips of the perforated screws and diminished with growing distance from the cement cloud. The highest temperature recorded in the subchondral bone reached 43.5°C and the longest exposure time above 42°C was 86s. The highest temperature measured on the articular surface amounted to 38.6°C and the longest exposure time above 38°C was 5 min and 32s. CONCLUSION The study shows that augmentation of the proximal screws of the PHILOS plate with PMMA leads to a locally limited development of supraphysiological temperatures in the cement cloud and closely around it. The critical threshold values for necrosis and apoptosis of cartilage and subchondral bone reported in the literature, however, are not reached. In order to avoid cement extravasation, special care should be taken in detecting perforations or intra-articular cracks in the humeral head.

Robotic lobectomy: tips, pitfalls and troubleshooting

The robotic approach in thoracic surgery has rapidly gained popularity in recent years. As with the introduction of any new technology, this warrants not only adaptation of the operative technique itself, but also the evolution of appropriate troubleshooting strategies. A selected number of helpful tips and technical procedural manoeuvres have been compiled to prevent intraoperative problems, as well as to overcome challenging situations that can arise during robotic lobectomies. In robotic surgery, as opposed to open surgery or video-assisted thoracic surgery, these tips serve an important purpose for the operating surgeon, as well as the entire surgical team involved in the procedure. All the assembled recommendations have proved their effectiveness and have been successfully used by the authors in many procedures. Furthermore, these manoeuvres have been found to be of great importance in the training and proctoring of thoracic surgeons, fellows and residents (bed-side assistants). This guide of clearly arranged tips and troubleshooting strategies offers surgeons a useful tool to overcome difficult situations in robotic lobectomy and preferably improve the reproducibility and safety of their procedures.