Revisional bariatric surgery.

BACKGROUND: Revisional surgery is required in a significant number of patients because of failure to lose weight, loss of quality of life, weight regain, or complications of the previous procedure. It has traditionally been associated with higher complication rates, and there appears to be no standardized surgical approach to revisional surgery. The aim of the study was to review the revisional procedures performed at St George Private Hospital and analyze the outcomes of the different types of revisional surgery. METHODS: We performed a retrospective review of 75 patients who underwent revisional surgery between December 2003 and October 2007. Demographic, anthropometric, perioperative, and clinical follow-up data were collected, and statistical analyses were performed using SPSS version 14.0. RESULTS: Sixty-six of the 75 patients were female. The mean age at the time of revision was 46.32 (22-68) years. Mean initial weight was 119.08 kg, and body mass index (BMI) was 43.42 kg/m(2). The lowest BMI and excess weight loss (EWL) recorded after primary surgery was 36.9% and 53.5%, respectively. At the time of revision, the mean EWL was 24.79. The EWL at 3 months and 6 months were 41.7% and 47.8%, respectively. Revision was performed laparoscopically in 51 patients and via laparotomy in 24 patients. There was no mortality in the cohort, but there were 17.3% minor and 4.0% major perioperative morbidities. CONCLUSION: Our study suggests that revision can be performed safely. Weight loss is satisfactory, and complications of the previous operations were all reversed. Furthermore, revisions may be done laparoscopically, including those who had previous open procedures.

The analgesic efficacy of ibuprofen in periodontal surgery: A multicentre study.

The efficacy of a non-steroidal anti-inflammatory agent, ibuprofen, was evaluated in pain control following periodontal surgery. This type of agent acts peripherally by inhibiting the release of prostaglandins and minimizing the local inflammatory response. Thus there may be an advantage in pre-treatment administration of the drug so as to delay or even prevent postoperative pain. The study was multicentre, involving a Public Hospital Periodontal Unit, two specialist periodontal practices in Sydney, NSW, and two in Canberra, ACT. One hundred and twenty-seven patients who were to undergo periodontal surgery were randomly given either two 200 mg tablets of ibuprofen or two matching placebo tablets at least 30 minutes before administration of local anaesthesia. The procedure was double blind: neither the patient nor the clinician was aware of the tablet identity. Postoperatively, all patients were given labelled ibuprofen for pain relief, but were randomly divided into two groups: As directed who were instructed to take the drug regularly for two days postoperatively, and As required, who were to take the drug only if needed for pain relief. All patients completed a diary recording quantity and time of medication, and regular assessment of pain experience utilizing a visual analogue scale. The As directed group showed no significant difference in pain experience between pre-operative and post-operative only medication, but the As required group experienced significantly less pain and requirement for medication if the ibuprofen was administered pre-operatively.

Oral and dental complications in dieting disorders.

This study investigated the oral status and dental complications in patients with both anorexia and bulimia nervosa. Results revealed that prolonged periods of dietary restraint in anorexic patients did not result in changes to bacteria associated in dental caries. Furthermore, patients did not have lower decay rates or salivary flow but did have more acidic saliva. Moreover, both groups of patients revealed changes indicative of gingivitis and gingival recession but not necessarily of periodontitis when compared to control subjects.

Clinical and microbiological investigations of anorexia nervosa.

Several studies have examined the relationship between anorexia nervosa and oral status. However, none has used control subjects. Furthermore, none has examined bacteriological data in these subjects to determine whether dietary restrictions, particularly of carbohydrates, change the levels of Streptococcus mutans and Lactobacillus species. Fifteen female subjects recently hospitalized for anorexia were studied along with fifteen age- and sex-matched control subjects. The parameters examined included salivary pH and flow rate, levels of S. mutans and Lactobacillus spp., DMFT scores, facial and palatal plaque scores, periodontal pocketing, gingival recession and bleeding following gentle probing. Compared with control subjects, anorexics had significantly lower salivary pH (7.1 +/- 0.4 vs 7.6 +/- 0.3, p less than 0.01), more facial and lingual surfaces with plaque scores of 1 (facial plaque 38 per cent vs 18 per cent, p less than 0.01, lingual plaque 47 per cent vs 29 per cent, p less than 0.01), more surfaces with gingival recession (1 mm-7.9 per cent vs 1.8 per cent, p less than 0.001; 2 mm-1.7 per cent vs 0.2 per cent, p less than 0.001; greater than 2 mm-0.6 per cent vs 0.0 per cent, p less than 0.001), more surfaces with bleeding on probing (16.9 per cent vs 6.5 per cent, p less than 0.001) and fewer sextants with CPITN scores of 0 (1.9 +/- 1.5 vs 3.2 +/- 1.0, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Single-dose concentrations of tinidazole in gingival crevicular fluid, serum, and gingival tissue in adults with periodontitis.

Previous studies have shown that metronidazole is effective in the treatment of subgingival microflora associated with destructive periodontitis. The aim of this study was to determine whether tinidazole, a close analogue of metronidazole, would reach sufficient concentrations in serum, gingival crevicular fluid, and gingival tissue, to inhibit putative periodontopathic bacteria. Ten adult patients with moderate to advanced periodontitis took a single 2-g dose of tinidazole orally. Samples were assayed by high-performance liquid chromatography. The concentrations of tinidazole in serum and GCF were in a similar range (3.2-46.5 micrograms/mL). Tinidazole was not detected in the GCF in three of the patients. The drug was found in gingival tissue obtained at two h (0.17 +/- 0.14 micrograms/mg) and six h (0.15 +/- 0.18 micrograms/mg) after oral administration. The mean concentration of tinidazole in serum at 24 h (13 +/- 3.0 micrograms/mL) is greater than the minimum inhibitory concentration for anaerobic bacteria as reported by others. The present data suggest that a single 2-g oral dose of tinidazole may lead to the presence of potentially bactericidal levels of tinidazole for up to 24 h in the periodontal pockets of some patients with periodontitis.

The natural tooth pontic--a compromise treatment for periodontally involved anterior teeth.

A technique which uses a natural tooth pontic to replace a periodontally compromised tooth is described. Following extraction and root resection of a maxillary central incisor, the crown was bonded to the adjacent teeth using acid-etched composite resin located in proximal cavity preparations. Some advantages of the technique are discussed.

After-hours treatment of anterior dental trauma in Newcastle and western Sydney: a four-year study.

This study investigated anterior dental trauma presenting after-hours in Newcastle and western Sydney. During the four-year period 1983-1986, all patients presenting with anterior dental injuries to the Royal Newcastle Hospital (n = 382) or Westmead Hospital (n = 362) on week nights, weekends or public holidays were studied. In both areas, upper central incisors were the teeth injured most frequently. The mean numbers of teeth injured per patient were 1.9 at Newcastle and 2.0 at Westmead. The frequencies of injury types found in Newcastle and Westmead were similar. Luxations and avulsions accounted for 39.5 per cent of injuries at Newcastle and 39.6 per cent at Westmead. In Newcastle, the rate of occurrence of trauma was highest and relatively uniform in the 6-11, 12-17 and 18-23 year age groups. At Westmead, it was highest in the 6-11 year age group, followed closely by the 12-17 year age group. In both centres, the four main causes of trauma were falls, assaults and fights, sports and bicycle accidents. These accounted for 69 per cent of all injuries in Newcastle and for 69.4 per cent at Westmead. This study found a great similarity between Newcastle and western Sydney in relation to the predominant age and sex groups affected, causes of trauma, injury types and numbers and locations of injured teeth per patient. It is suggested that anterior dental trauma presenting after-hours may be more severe, involve more teeth per patient and affect predominantly older age groups than is the situation during normal hours.

Anterior dental trauma treated after-hours in Newcastle, Australia.

This study investigated the occurrence, causes and types of anterior dental trauma treated outside normal clinic and practice hours in Newcastle, Australia. During a 2 1/2-yr period, 233 patients presented for treatment of traumatic injuries to anterior teeth on week nights, weekends and public holidays. The highest occurrence of trauma was in the 18 to 23 yr group (24.9%), followed by the 6 to 11 (23.6%) and the 12 to 17 (22.3%) yr groups. Men sustained injuries more frequently than women in all age groups. The male/female ratio was 2.6:1. The four main causes of trauma were falls (26.6%), sports (18.0%), bicycle accidents (14.2%) and assaults or fights (13.3%). The 233 patients sustained 488 injuries to 95 primary and 373 permanent teeth (n = 468). Maxillary central incisors were the most frequently injured teeth. The mean number of teeth injured per patient was 2.01. Luxation (46.9%) was the most common injury in the primary dentition. In the permanent dentition, crown fractures without pulp exposures (25.0%), followed by luxation (23.5%), were the most common injuries. Avulsion represented 11.5% of all injuries. The findings of this study indicate that anterior dental trauma treated after-hours may be more severe, involve more teeth and affect predominantly older age groups than traumatic injuries treated during normal hours.