ABSTRACT
A maxillofacial patient's quality of life is distorted and social integration becomes difficult. An obturator is a maxillofacial prosthesis used to close a congenital or acquired tissue defect, primarily of the hard palate and/or contiguous alveolar/soft-tissue structures. Subsequently, it restores the esthetics, speech, and function. The present clinical report aimed for the prosthetic rehabilitation of a maxillectomy defect by the incorporation of a semi-precision attachment as PRECI-SAGIX – male part of 2.2 mm on fixed partial denture (#22 and #23 teeth) and matrix – plastic female part of size 2.2 mm and height 4.2 mm of yellow on cast partial in polymer base. It aids in the retention of a hollow lightweight obturator. The technique also described the method to make a bulbless obturator with a hollow self-cured acrylic resin occlusal shim. A patient is quite satisfied with bulb less, lightweight cast partial and hollow shim palatal obturator.
ABSTRACT
Aims: Acute Kidney Injury (AKI) is seen in 15% of hospitalized patients and a renal ultrasound (RUS) is often ordered to exclude an obstructive cause in the initial evaluation of AKI. This study was done to evaluate the usefulness of a RUS in patients with AKI in a developing country. Methods: This was a retrospective study on all patients who were referred to nephrology with AKI and had a RUS, over a one-year period at a tertiary care teaching hospital of Karachi, Pakistan. The patients’ charts were reviewed for clinical characteristics and the RUS findings were documented. Results: A significant number of patients did not have documented risk factors for obstruction based on the medical history. Hydronephrosis was found in 22.5% (25 out of 111) of patients, and in 14 of these cases, the etiology of the acute kidney injury was found to be obstructive uropathy. The presence of nephrolithiasis and/or benign prostatic hypertrophy was associated with and increased likelihood of finding hydronephrosis on RUS. Conclusions: We thus recommend doing a renal ultrasound in all cases of AKI due to the fact that most of the time in a developing country, an accurate history is not available, and the prevalence of stone disease and obstructive uropathy is high.
ABSTRACT
Noninvasive Transthoracic Doppler [TTD] recording is a feasible attractive method to characterize different coronary flow velocity [CFV] patterns, however, its clinical application in the setting of percutaneous coronary intervention [PCI] need to be emphasized. To correlate CFV patterns of left anterior descending artery [LAD] with angiographic data, and to determine its impact on left ventricular [LV] function recovery and clinical outcomes following rescue PCI in patients with anterior myocardial infarction. Forty consecutive patients were studied 12 hours after PCI with stenting using high frequency transducer and 2nd harmonic imaging of LAD, to measure diastolic flow data [peak and mean diastolic velocities [PDV and MDV], deceleration time [DEC], pressure half time [P1/2]], and to record retrograde systolic wave [RSW]. Coronary angiographic data included epicardial flow grade [TIMI], and myocardial blush grade [MB]. LV function recovery was determined by percent changes of Tissue Doppler peak systolic myocardial velocity of middle septum [TDMV]. Clinical outcomes included short term [in hospital-three months], and long term [two years] major cardiac events [MACES]. Following PCI 32 pts achieved TIMI flow grade III flow [80%], while 26 patients had MB grade III [65%]. PDV and MDV were significantly higher in TIMI grade III [43.7 +/- 10.2 vs. 19.9 +/- 4.4 cm/sec p<0.014, and 20.41 +/- 7.8 vs. 11.32 +/- 4.92 cm/sec p<0.007 respectively], while DEC time and P1/2 time were significantly longer in MB grade III [383.96 +/- 82.36 vs. 174.24 +/- 62.92 msec p<0.001, and 134.1 +/- 38.18 vs. 76.9 +/- 15.49 msec p<0.001 respectively]. RSW was recorded in 22 pts [55%]. RSW correlated to lower MB grades than TIMI [14/22 vs. 0/18 P<0.0001 and 4/22 vs. 4/18 p=0.75 respectively], and associated with lower percent changes of TDMV [41.18 +/- 57.81% vs. 160.25 +/- 109.69% p<0.01]. All patients achieved 24 months follow up. Survival free events correlated more to higher grade of myocardial blush and absences of RSW but not correlated with TIMI flow grade [Kaplan-meier survival curve. p=0.0004, 0.007, and 0.32 respectively]. Noninvasive Transthoracic Doppler study of coronary flow provides intimate correlation to essential angiographic, functional, and clinical data in the setting of rescue PCI. Coronary flow velocities correlated with epicardial flow grade while time intervals related to myocardial blush grade. Clear recording of systolic retrograde Have is associated with impaired left ventricular function and poor clinical outcome