Use of a miniplate to provide intermaxillary fixation in the edentulous patient.

A case of severe facial trauma is presented. The fractures were stabilized using wire osteosynthesis and miniplates. Since no dentures were available intermaxillary fixation was achieved with a miniplate from the upper to the lower jaw, which resulted in a very satisfactory stabilization.

Traumatic subarachnoid-pleural fistula.

Subarachnoid-pleural fistula is a rare condition; only 18 cases have been reported. The 19th case of subarachnoid-pleural fistula, which followed a small caliber gunshot wound, is reported. Diagnosis was made via radionuclide scan, and primary operative repair was necessitated by the failure of conservative management. A review of the literature reveals several means of diagnosing this disorder, as well as a number of management alternatives.

Ibuprofen in experimental vascular surgery.

Animal studies have been conducted to determine the effectiveness of ibuprofen in reducing early platelet deposition on small diameter (4 mm) Gore-Tex (polytetrafluoroethylene) arterial grafts and larger (10 mm) Gore-Tex grafts placed in the inferior vena cava. These studies demonstrated a significant reduction in platelet deposition at one and three hours. Additional studies of animals undergoing treatment with ibuprofen and subjected to arterial replacement with 1 or 4 mm Gore-Tex grafts demonstrated enhanced patency at 30 days. Cautious evaluation of ibuprofen as an adjunct in vascular surgery appears warranted.

Inferior vena cava replacement: the role of antiplatelet therapy.

To evaluate the effect of ibuprofen on early thrombus formation following inferior vena cava (IVC) replacement, a 4-cm segment of IVC was replaced with a 5-cm (10-mm-i.d.) segment of reinforced polytetrafluoroethylene (PTFE) graft in 12 dogs. Autologous platelets and canine fibrinogen were labeled with 111In and 125I, respectively, and injected into each animal 24 hr prior to vena cava replacement. Six dogs served as controls and six were treated with 12.5 mg/kg ibuprofen intravenously 1 hr preoperatively. All dogs were heparinized with 100 U/kg intravenous heparin prior to crossclamping the IVC: heparin was not reversed at the end of the procedure. Three hours after normal circulation was restored, the grafts were removed and counts of radioactivity made. All grafts were patent. The mean platelet count for the control group was 12.8 X 10(6)/mm2, while in the grafts from the treated group it was 0.960 X 10(6)/mm2. The decreased platelet deposition was significant in all graft segments (P less than 0.01). Fibrin deposition was reduced from 3.38 micrograms/mm2 to 0.25 micrograms/mm2 (P less than 0.01) by ibuprofen. Although fibrin and red blood cells are the major constituents of venous thrombi, platelet aggregation appears to play an important role if prosthetic material is implanted into the venous system. Ibuprofen not only reduced platelet deposition by 13.5-fold, but also reduced fibrin deposition by 13.5-fold. The ratio of platelets to fibrin in control and treated animals was similar (3.84 and 3.79, respectively). These data suggest that antiplatelet medication combined with heparin therapy might decrease early thrombus formation in venous prostheses.

Quantitative effects of antiplatelet therapy on healing of the endarterectomized canine aorta.

This study was designed to quantitatively evaluate the effects of an antiplatelet agent, ibuprofen, on mural thrombus formation and pseudointimal development in the endarterectomized canine aorta. A 3 cm segment of abdominal aorta was endarterectomized in 18 dogs. Nine dogs served as controls and nine dogs were treated with ibuprofen (12.5 mg/kg) given intravenously 1 hour preoperatively and orally (7.5 mg/kg) three times a day in the postoperative period. Three dogs were killed from each group at 7, 14, and 21 days. Healing of the endarterectomized aortic segment was assessed by means of computer-assisted surface morphometry, light microscopy, and both scanning and transmission electron microscopy. One week postoperatively, the thrombus-free surface in the treated dogs was 75 percent, compared with 20 percent in control animals; at 2 weeks 97 percent, compared with 38 percent and at 3 weeks 98 percent, compared with 38 percent (p less than 0.01 for each group). The thickness of the pseudointima was 9 percent of the aortic wall thickness in treated dogs compared with 60 percent in control animals 1 week postoperatively (p less than 0.001); at 2 weeks 24 percent in treated animals and 64 percent in control animals (p less than 0.001); and at 3 weeks 31 percent in treated animals and 55 percent in control animals (p less than 0.05). Partial reendothelialization was observed 1 week postoperatively and complete reendothelialization at 3 weeks in both the control and treated animals. These data suggest that administration of preoperative and maintenance therapy with ibuprofen significantly reduces mural thrombus formation and pseudointimal thickness in the endarterectomized canine aorta.