Aesthetic Parameters and Patient-Perspective Assessment Tools for Maxillary Anterior Single Implants.

BACKGROUND: This review aimed to concisely describe the current aesthetic objective indices for a single-implant maxillary anterior crown. The secondary aim was to propose introducing a unified, standardized questionnaire for adequately collecting patient-reported outcome measures (PROMs) in implant dentistry. MATERIALS AND METHODS: A literature review was conducted using both EMBASE/Ovid and MEDLINE/PubMed databases by combining keywords and Emtree/Mesh terms related to "Esthetics," "Self-Assessment or Surveys and Questionnaires," and "Single-Tooth Dental Implants." RESULTS: The most meaningful aesthetic objective indices for single implants in the literature are the Pink Esthetic Score (PES), the Papilla Presence Index (PPI), Peri-Implant and Crown Index (PICI), PES/White Esthetic Score (PES/WES), the Implant Crown Aesthetic Index (ICAI), and a modified version of the ICAI (mod-ICAI) index. Clearly, PES/WES is still the most widely accepted tool. It is encouraging to observe that there is an increasing tendency in recent years to report PROMs more frequently in the implant dentistry literature. We proposed the implementation of a unified, standardized questionnaire using a self-administered visual analogue scale (VAS) scoring system, which evaluates overall satisfaction, comfort, tooth appearance, gingival appearance, function, and hygiene complexity. This tool should be validated in the oral implantology research context for its regular implementation or further development. CONCLUSIONS: Conducting qualitative studies among dental implant patients who received few implants or single-tooth implant reconstructions in the aesthetic zone may help dental researchers understand better how to efficiently develop and validate a quantitative instrument. This standard tool would reduce heterogeneity bias by providing comparable data between studies.

Patient Satisfaction in Medicine and Dentistry.

Health professionals, such as medical and dental clinicians, have scant understanding of patients' experiences and perceptions of satisfaction. Nevertheless, implementing a patient-reported outcome measures (PROMs) research practice in surgical sciences is necessary. Hence, the objective of this article was to better understand patients' satisfaction with their medical and dental care. The methods of the current article are based on a narrative review of the literature strategy. A literature review was conducted using both EMBASE and Medline databases up to July 12, 2020, by combining keywords and terms related to "satisfaction theories" and "patient satisfaction," and "medicine" or "dentistry/stomatology/odontology." Patient satisfaction's multidimensional nature has been established since the perceived reasons for satisfaction varied widely among patients. Many aspects of treatment influence participant satisfaction at different stages of the intervention process. An improved understanding of the basis for managing patients' expectations with information reiteratively and efficiently may ultimately reduce patients' potential for negative feelings toward the medical and dental treatment experience. Lastly, the consumerist method may misrepresent the still undertheorized concept of satisfaction in health service.

Knowledge, attitude, and practice regarding prosthodontic rehabilitation and factors affecting the patients visiting private clinics in Riyadh, Saudi Arabia: A cross-sectional study.

BACKGROUND: Prosthodontic rehabilitation maintains the esthetics, functional support, and the masticatory function of the oral cavity. The main aim of the present study was to explore the knowledge, attitude, and practice towards prosthodontic rehabilitation and factors affecting the KAP of patients. MATERIALS AND METHODS: The present research is a cross-sectional descriptive questionnaire study conducted among the patients visiting private hospitals in Riyadh City, Saudi Arabia. The city was divided into five directions; south, north, east, west, and central. From each direction, one hospital was included randomly with more than 50 patients in OPD per day. The interview was conducted among 121 patients from each hospital which made the sample size of 605. RESULTS: Among all study participants in the present study, majority (252 [41.67%]) of them were more than 50 years of age. Female study participants (318 [52.57%]) were more than (287 [47.43%]) the male participants. It was reported that 458 (75.70%) of the study participants have missing teeth ranging from 6 to 10. The main reason reported for absence of prosthesis was money constraints among the 121 (38.90%) study participants. Inadequate knowledge regarding prosthodontic rehabilitation was significantly associated (P-value ≤ 0.05*) with attitude and practice of the study participants. CONCLUSION: It was concluded that financial constraints were the major factors for not availing prosthodontic rehabilitation. Moreover, inadequate knowledge regarding prosthodontic rehabilitation significantly affects the attitude and practice of the study participants.

Efficacy of Artificial Salivary Substitutes in Treatment of Xerostomia: A Systematic Review.

AIM: To provide an update on artificial saliva used to maintain the health of the oral cavity of patients with severe hyposalivation. MATERIALS AND METHODS: A literature search was conducted in April 2018 in three electronic databases (The Cochrane Central Register of Controlled Trials [CENTRAL], PubMed, and Embase) by combining key words and terms related to the population and intervention of the topic. RESULTS: The databases search resulted in 455 titles and abstracts. Of these, 21 were judged to meet inclusion criteria and full texts were read. Finally, 10 clinical trials were included for qualitative synthesis. CONCLUSION: Published evidence suggests that all the artificial saliva products tested in included studies reduced symptoms of xerostomia. These products should specifically be selected according to the patients' concerns and needs. However, the included studies presented a wide range of products and suffered from high risk of bias. Therefore, long-term randomized controlled trials on effects of various products are required.

A reconstructive algorithm for plastic surgery following extensive chest wall resection.

Chest wall reconstruction following extensive resection is greatly facilitated by the use of vascularised flaps and prosthetic material. Plastic surgeons are often asked to assist with coverage of large chest wall defects. However, in addition to soft tissue coverage, we need to address other important issues such as the status of the pleural cavity, and the requirement for skeletal support. The purpose of this report is to analyse our experience, provide a reconstructive algorithm following the ablative procedure and review the literature. Two hundred chest wall resections were performed from 1975 to 2000. Defect location was divided into anterior (n = 73) lateral (n = 36) anterior-lateral (n = 36) posterior-lateral (n = 19) posterior (n = 22) and forequarter (n = 14) Average number of ribs resected was four. One hundred and fifty-eight patients (79%) required chest wall reconstruction with either prosthetic material and/or flap closure. Mesh closure was required in 85 cases (43%), being highest for lateral defects (61%), and lowest for anterior defects (31%). Vascularised flaps were needed in 112 patients (56%), more common in anterior defects (79%), and less common for the posterior-lateral defects (26%). Inpatient complication rate was 27% (43/158) following reconstruction, with a mortality of 6% (10/158). Chest wall reconstruction is common following extensive resection. This includes management of the pleural cavity, skeletal support and soft tissue coverage. A better understanding of the respiratory mechanics and local thoracoabdominal anatomy is crucial for managing these complex defects. The need for skeletal support was more prevalent in lateral and posterior-lateral defects. Flap reconstruction was required more often to cover large anterior defects, with regional flaps predominating.

Transesophageal echocardiography: not an innocuous procedure.

We report 3 patients who sustained intrathoracic esophageal perforations due to transesophageal echocardiography encountered during the past 2 years. Lack of suspicion of this complication led to delay in diagnosis. Surgical management led to survival of all 3 patients.

Neuroendocrine tumors of the thymus: a clinicopathological and prognostic study.

BACKGROUND: Neuroendocrine tumors of the thymus are rare, histologically diverse neoplasms with an unpredictable clinical behavior. This study provides a useful clinicopathological classification and determines the relevance of specific prognostic factors. METHODS: Ten neuroendocrine tumors of the thymus were analyzed for specific clinical and pathological features. Prognostic factors of these cases and 71 previously published cases were evaluated by Kaplan-Meier survival curves and Cox multivariate hazard model. RESULTS: There were 7 males and 3 females, with ages ranging from 26 to 77 years. Cases were classified as carcinoid tumor (2), atypical carcinoid tumor (6), and small cell carcinoma (2). An advanced clinical stage was evident in all instances with frequent recurrence (4) and metastases (8), and a short disease-free survival. Overall mortality was 60%. Statistical analysis of current and previously published cases (n = 81 total) revealed that unresectability (p = 0.0001), extent of surgical resection (p = 0.0002), and advanced clinical stage at presentation (p = 0.03) were associated with higher mortality. By multivariate Cox regression analysis, unresectability (p = 0.02) and advanced clinical stage (p = 0.03) were associated with decreased survival. CONCLUSIONS: Neuroendocrine tumors of the thymus can be classified into distinct clinicopathological entities, and specific factors have prognostic relevance.

Predictors of outcome in thymectomy for myasthenia gravis.

BACKGROUND: Factors determining predictability of response to thymectomy for myasthenia gravis (MG) vary in the literature. METHODS: A 25-year retrospective review (1974 to 1999) of all thymectomies performed at a single institution was undertaken. RESULTS: In 113 consecutive thymectomies for MG, women comprised 79% (89 of 113 patients), and mean age was 40+/-15 years. Complications occurred in 14% of patients (16 of 113). In-hospital mortality was 0, but 90-day hospital mortality was 0.88% (1 of 113 patients). Follow-up was obtained in 81% (92 of 113 patients) at a mean of 51+/-59 months postoperatively. Complete remission was achieved in 21% of patients (19 of 92), and marked improvement of MG in 54% (50 of 92), for a total benefit rate of 75%. Fourteen percent (13 of 92) were unchanged, and 11% (10 of 92) were worse. Using univariate analysis, sex, age, and pathology correlated significantly with outcome (p < 0.05): 80% of women (57 of 70) benefited from the procedure, versus 57% of men (12 of 21). Eighty percent (57 of 70) of patients less than 51 years of age were improved or in remission, versus 57% (12 of 22) older than 50. Twenty-three percent (5 of 22) of patients with thymoma deteriorated, versus 7.1% (5 of 70) without thymoma. Sex did not significantly correlate in the multivariate model. CONCLUSIONS: Sex, age, and thymic pathology are potential predictors of outcome in thymectomy for MG, and may shape treatment decisions and target higher-risk patients.

The surgical spectrum of pulmonary neuroendocrine neoplasms.

OBJECTIVES: The purpose of this study is to review our experience with the spectrum of neuroendocrine neoplasms of the lung with emphasis on the histopathologic classification and surgical therapy of each class of neoplasm. DESIGN: This retrospective review covers the entire spectrum of neuroendocrine neoplasms of the lung over an 11-year period (January 1985 to December 1995) in a university hospital setting. Only patients who underwent surgical resection were included in this review. PATIENTS: During this period, a total of 77 patients underwent lung resection for the following neuroendocrine neoplasms: typical carcinoid (TC), 50 patients; atypical carcinoid (AC), 5 patients; large cell neuroendocrine carcinoma (LCNEC), 9 patients; mixed large-small cell neuroendocrine carcinoma (LSNEC), 4 patients; or small cell neuroendocrine carcinoma (SCC), 9 patients. There were 37 men (48.1%) and 40 women (51.9%) among the patients, with a mean age of 57.9 years (range, 14 to 87 years). INTERVENTIONS: Primary surgical resection consisted of the following procedures: 52 lobectomies (67.5%); 10 pneumonectomies (13%); 13 limited resections (16.9%); 1 left main bronchus sleeve resection; and 1 carinal resection. Six patients had the following concomitant procedures: pericardiectomy, 2 patients; mediastinoscopy, 1 patient; chest wall resection, 1 patient; stapling blebs, 1 patient; and transdiaphragmatic liver biopsy, 1 patient. Four patients underwent bilobectomies, and two patients underwent multiple wedge resections. RESULTS: The hospital mortality rate was 2.6% (2 of 77 patients), and both patients died of pulmonary failure. Follow-up was obtained in 62 of 77 patients (80.9%) for an average of 38.1 months (range, 2 to 132 months). There were a total of 13 deaths, and 8 were disease-related (LCNEC, 4 deaths; SCC, 2 deaths; LSNEC, 1 death; and AC tumor, 1 death. The mean disease-free intervals for patients with these neoplasms were the following: TC tumor, 41.3 months; AC tumor, 20 months; LCNEC, 20.4 months; LSNEC, 25 months; and SCC, 48 months. The overall 3-year survival rate was 45.2% (28 of 62 patients). CONCLUSION: This report will emphasize the classification, surgical management, and treatment considerations of pulmonary neuroendocrine neoplasms. Despite the poor overall prognosis in high-grade neuroendocrine tumors of the lung, surgery remains a viable adjunct in the early stages of this disease.

Glomus tumor of the trachea.

Extracutaneous glomus tumors are unusual and their occurrence in the trachea has been recognized with extreme rarity. We present a case of surgically resected glomus tumor of the trachea in a 34-year-old man who presented with hemoptysis and who was initially diagnosed as having a carcinoid tumor.

Ewing's sarcoma presenting as a posterior mediastinal mass: a lesson learned.

Thoracic vertebral body hemicorpectomy and chest wall resection was performed in a 17-year-old male patient with a posterior mediastinal tumor thought to be neurogenic in origin. No preoperative tissue diagnostic endeavor was made. Final pathologic diagnosis showed this tumor to be Ewing's sarcoma. This communication alerts the thoracic surgeon to the need for definitive diagnosis of posterior mediastinal masses with vertebral body involvement, particularly in children. Induction chemotherapy is the accepted standard of management of these sarcomas.

Evaluation of treatment modalities for thoracic empyema: a cost-effectiveness analysis.

BACKGROUND: Empyema thoracis is treated with a multitude of therapeutic options. Optimal therapy and cost-containment requires selection of the most appropriate initial intervention. METHODS: A retrospective review of treatment modalities was performed on 77 patients diagnosed with empyema thoracis from 1990 to 1997 at one institution. Mean age was 59 years (range, 21 to 90 years); 52 were men and 25 were women. RESULTS: Sixty-five percent (50/77) were parapneumonic and 68% (52/77) were multiloculated. Treatment modalities were as follows: group 1, antibiotics only (n = 4); group 2, primary intervention: image-directed catheter (n = 20) or tube thoracostomy (n = 24); and group 3, secondary intervention: decortication (n = 17), rib resection or muscle interposition (n = 12). Thirty-four percent (9/20 image-directed catheter and 8/24 tube thoracostomy) had failure of initial intervention. Patients undergoing decortication more often had multiloculated empyema thoracis (16 of 17) compared with those undergoing image-directed catheters (8 of 20) or tube thoracotomy (16 of 24). Length of stay was reduced for decortication patients (17 days) compared with those having image-directed catheters (21.8 days), failed image-directed catheters (29.7 days), or tube thoracostomies (19.6 days). Hospital charges per patient between decortication and image-directed catheter ($34,770.79 versus $37,869.41) were comparable, but charges were significantly decreased in decortication patients as compared with failed image-directed catheters ($55,609.32; p < 0.05). CONCLUSIONS: Our series revealed that early decortication has charges similar to those of primary intervention (image-directed catheter or tube thoracostomy) but is more cost-effective than failed image-directed catheter. We advocate the use of early surgical intervention as the most optimal and cost-effective initial modality for the treatment of empyema thoracis.

Angiogenesis as a predictor of survival after surgical resection for stage I non-small-cell lung cancer.

OBJECTIVES: Some patients with surgically resected stage I non-small-cell lung cancer eventually have metastatic disease. A histologic marker of metastatic potential and diminished survival for stage I non-small-cell lung cancer may distinguish this patient population. This study evaluates the degree of angiogenesis as a predictor of cancer-related death after operation for stage I non-small-cell lung cancer. METHODS: Demographic, surgical, and histopathologic data, including presence of vascular invasion, were reviewed for 106 patients with stage I non-small-cell lung cancer from 1985 through 1990. Visual quantitation of microvessels immunostained with factor VIII-related antigen and CD31 in 5 microm sections from the paraffin blocks of tissue defined rumor angiogenesis. RESULTS: Follow-up was 95.1% complete, mean 5.2 +/- 3.0 years. Lung cancer-related mortality rate was 24.4% at 5 years. Mean microvessel counts were 20.7 +/- 11.2 for FVIII and 29.6 +/- 18.1 for CD31. Univariate analysis revealed an FVIII count of at least 20 (p = 0.025) and blood vessel invasion (p = 0.017) to be significant predictors of disease-related death. After adjustment for other patient and tumor characteristics, multivariate Cox regression analysis found an FVIII count of at least 20 (hazard ratio 2.9) and blood vessel invasion (hazard ratio 3.7) to be significant independent correlates of lung cancer death (p = 0.018 and p = 0.011, respectively). CD31 quantitation did not predict survival on univariate or multivariate analyses and did not correlate strongly with FVIII quantitation (Spearman's rank correlation r = 0.19). CONCLUSIONS: This analysis reveals a significant association between tumor neovascularization and cancer-related mortality rate among patients with stage I non-small-cell lung cancer. Microvessel quantitation of FVIII, as an indicator of tumor angiogenesis and metastatic potential, may define a subset of patients with stage I non-small-cell lung cancer who could benefit from adjuvant therapy after surgical resection.

Primary malignant melanoma of the trachea.

Only three primary malignant melanomas have been identified among large series of tracheal resections. Pertinent clinical and histopathologic features of these rare malignancies, however, have rarely been presented. We present the case of a young woman who underwent tracheal resection for a primary malignant melanoma with clinical and histopathologic verification.

Pathologic findings in lung volume reduction surgery.

PURPOSE: Lung volume reduction surgery (LVRS) has re-emerged as an alternative in the management of patients with chronic, debilitating, emphysematous lung disease. This has permitted the formal evaluation of pathologic pulmonary changes present in these patients. This study seeks to describe systematically the pathologic findings present in patients undergoing LVRS. METHODS: Tissue sections stained with hematoxylin-eosin, as well as special stains, were retrospectively reviewed from the specimens of 65 nonconsecutive LVRS patients (male patients, 66%; female patients, 31%; mean age, 63.2+/-6.76 yr). All operations were conducted via an open technique (bilateral, 83%; unilateral, 17%). RESULTS: Histologic emphysema grade was mild in 9%, moderate in 72%, and severe in 19% of patients. Microscopic bullae were noted in 75% of specimens. Three patients, each with radiographic evidence of a lesion preoperatively, had small (1.1 to 2.8 cm) adenocarcinomas. Granulomatous bronchiolitis and pneumonitis were noted in one patient who postoperatively developed progressive respiratory compromise. An old, inactive aspergilloma was found in the specimen of another patient. Additional findings of potential clinical significance included bronchiolitis (54), bronchiolectasis (6), and bronchoalveolar metaplasia (1). Incidental findings included interstitial fibrosis and scar (55), interstitial inflammation (20), calcification (20), and ossification (11), bone marrow emboli (4), chemodectoma (2), and carcinoid tumorlets (1). CONCLUSION: This systematic analysis of the resected specimens from patients undergoing LVRS describes a wide range of pathologic findings, including those clinically relevant, as well as incidental. As the application of LVRS continues to expand, the likelihood of discovering clinically significant pathologic lesions (eg, carcinoma) will undoubtedly increase.

Pulmonary malakoplakia diagnosed by fine needle aspiration. A case report.

BACKGROUND: Pulmonary malakoplakia is an uncommon disorder, with 24 previously reported cases, only 4 of which were diagnosed by bronchial washings, bronchial brushings or aspiration cytology. We report a case that was diagnosed initially by computed tomography (CT)-guided fine needle aspiration (FNA) cytology. CASE: A 56-year-old male with follicular small cleaved cell lymphoma had a 10-cm left lower lobe mass compressing the main bronchus to that lobe. A transthoracic, CT-guided FNA specimen consisted predominantly of foamy macrophages, many of which contained typical Michaelis-Gutmann bodies. Microbiologic cultures identified Rhodococcus equi. A subsequent transbronchial biopsy and left pneumonectomy specimen confirmed the cytologic diagnosis. CONCLUSION: Pulmonary malakoplakia associated with R equi pneumonia is a rare lesion that is essentially limited to immunocompromised hosts. Awareness of the FNA cytomorphology of this lesion permits resolution of the typical clinical differential diagnosis of pulmonary masses in the immunocompromised host and can facilitate treatment.

Bowel interposition for esophageal replacement: twenty-five-year experience.

BACKGROUND: From 1972 to 1996, bowel interposition reconstruction after esophagectomy for benign and malignant conditions was performed in 129 of 131 patients. The indication for operation was benign disease in 94 patients (72.9%) and malignant disease in 35 patients (27.1%). Benign stricture was the most common presentation in the benign group (41 patients), and adenocarcinoma was the most common indication in the malignant group (19 patients). METHODS: One hundred thirty-three conduits were performed in the 129 patients. Four patients (3.1%) required reoperative reconstruction. Of the 97 conduits employed for reconstruction of benign disease, the right colon was used in 70 patients, the left colon in 9 patients, and the transverse colon in 4 patients. A jejunal interposition graft was employed in 11 patients and a free jejunal autograft in 3 patients. The right colon was used in 15 patients with malignant disease, the left colon in 9 patients, and the jejunum in 12 patients. RESULTS: The mean age of the population was 54.5 years (range, 14 to 72 years) with a male-to-female ratio of 1.3:1. The average number of prior thoracic or abdominal procedures was 2.9 (range, 1 to 8) with 50.9% of patients undergoing reoperation. The mean length of stay was 21.7 days (range, 8 to 290 days). Complications occurred in 37.1% of patients with anastomotic leak occurring in 14.8% and ischemic colitis in 3.0% of conduits performed. The in-hospital mortality was 5.9%. CONCLUSIONS: Bowel interposition reconstruction after esophagectomy for benign and malignant disease can be performed with an acceptable morbidity and mortality, despite prior operative procedures in the abdomen or chest. Colonic and jejunal conduits, employed alone or in combination, can effectively restore gastrointestinal continuity.

Belsey Mark IV antireflux procedure for complicated gastroesophageal reflux disease.

BACKGROUND: Over the past 20 years, medical management of gastroesophageal reflux disease has met with increasing success, but a proportion of patients continue to have symptoms or complications requiring surgical treatment. The variety of operations available attests to the general lack of satisfaction with any single procedure. METHODS: A retrospective study was conducted of 276 patients who underwent the Belsey Mark IV antireflux procedure at our institution between 1979 and 1995. The indication for operation was gastroesophageal reflux disease refractory to medical therapy in 137 patients, gastroesophageal reflux disease with symptomatic stricture or Schatzki's ring in 36, achalasia or epiphrenic diverticulum in 74, paraesophageal hernia in 27, and esophageal mass in 2. Fifteen patients (5.4%) had undergone prior antireflux operations. RESULTS: There was one perioperative death (0.4%) resulting from an apparent myocardial infarction in an 87-year-old woman who underwent operation for paraesophageal hernia with volvulus. Two patients had contained leaks diagnosed by routine postoperative contrast studies; both were managed successfully without operation. Two patients required early reoperation for recurrent symptoms: 1 underwent a repeated Belsey Mark IV procedure and the other underwent an esophagogastrectomy. An additional 7 patients experienced late recurrence of symptoms requiring surgical management. The overall complication rate was 10.1%, with minor pulmonary complications (2.1%) and atrial arrhythmias (1.8%) occurring most commonly. CONCLUSIONS: The Belsey Mark IV procedure is a safe and effective operation for the management of gastroesophageal reflux disease with complications, and it compares favorably with other antireflux procedures.