Current state of dynamic surgery. A literature review.

BACKGROUND: Recently, dental implant technology has been widely used for oral reconstruction. Dental implants are the treatment of choice for those patients with dental absences. An optimal implant placement is based on the prosthetic driven concept in order to achieve an aesthetic and functional restoration with a long-term prognosis. There are two types of guided implant surgery that are described in the literature: Static Guided Surgery (SGS) and Dynamic Guided Surgery (DGS). The aim of this study is to be aware of the current state of dynamic surgery and compare in the literature the discrepancies between planning and placement of dental implants. MATERIAL AND METHODS: The study consists of a bibliographic review on the topic. The research has been performed in the Medline/Pubmed of articles published by different professional associations and societies in the international context. RESULTS: Twenty two studies out of 100 articles from the initial search were finally included. Our results have been compared with other current available papers in the literature reviewed that obtained similar outcomes. CONCLUSIONS: Dynamic navigation shows a better accuracy and precision of implant placement. To corroborate the results of this review as well as to evaluate the different variables that could influence the accuracy of this technique, future randomized control trials will be needed.

Compliance to the prescribed overall treatment time (OTT) of curative radiotherapy in normal clinical practice and impact on treatment duration of counteracting short interruptions by treating patients on Saturdays.

BACKGROUND AND PURPOSE: To evaluate the compliance of the prescribed OTT in a normal clinical practice and to establish the incidence, duration and causes of unplanned interruptions of radiation therapy. To quantify the impact of an institutional policy to maintain the OTT counteracting some short interruptions by treating patients on Saturday morning. MATERIAL AND METHODS: The treatment charts of all new patients treated with curative intent in a period of one year were reviewed retrospectively. All treatments started on Monday or Tuesday and split-course was not used. The difference between the actual realized and the planned OTT was calculated as a measure of compliance. Recalculations of OTT were made to quantify the impact of compensating short gaps by treating patients on Saturday. The cause of interruption was also recorded and classified. RESULTS: The charts of 478 consecutive patients treated with curative intent were reviewed. The overall incidence of unplanned interruptions was 76.6%. Public holidays and machine maintenance caused most of interruptions, and machine breakdown caused 13%. 17.9% of the interruptions were greater than 5 days and 5.6% greater than 10 days. Only 23.4% of patients finished their radiotherapy in the planned OTT (12.6% if no compensation on Saturday). 48.9% of head and neck cancer patients finished their treatment in the planned OTT (19.5% if no compensation on Saturday). The time in excess ranged up to 44 days, and the average time in excess was 3.3 days for the entire group (4.2 days if no compensation on Saturday). For head and neck cancer patients, the time in excess was 1.9 days (3.9 days if no compensation on Saturday). CONCLUSIONS: This study has documented that the incidence and duration of unplanned interruptions of standard treatment schedules is a major problem in normal clinical practice. Most interruptions are short and due mainly to public holidays and machine maintenance and for these reasons they can be planned. In spite of the extra costs, counteracting some short interruptions by treating patients on Saturday is a good way to maintain the OTT without loss of local control.

Compliance to the prescribed overall treatment time (OTT) of curative radiotherapy in normal clinical practice and impact on treatment duration of counteracting short interruptions by treating patients on Saturdays

BACKGROUND AND PURPOSE: To evaluate the compliance of the prescribed OTT in a normal clinical practice and to establish the incidence, duration and causes of unplanned interruptions of radiation therapy. To quantify the impact of an institutional policy to maintain the OTT counteracting some short interruptions by treating patients on Saturday morning. MATERIAL AND METHODS: The treatment charts of all new patients treated with curative intent in a period of one year were reviewed retrospectively. All treatments started on Monday or Tuesday and split-course was not used. The difference between the actual realized and the planned OTT was calculated as a measure of compliance. Recalculations of OTT were made to quantify the impact of compensating short gaps by treating patients on Saturday. The cause of interruption was also recorded and classified. RESULTS: The charts of 478 consecutive patients treated with curative intent were reviewed. The overall incidence of unplanned interruptions was 76.6%. Public holidays and machine maintenance caused most of interruptions, and machine breakdown caused 13%. 17.9% of the interruptions were greater than 5 days and 5.6% greater than 10 days. Only 23.4% of patients finished their radiotherapy in the planned OTT (12.6% if no compensation on Saturday). 48.9% of head and neck cancer patients finished their treatment in the planned OTT (19.5% if no compensation on Saturday). The time in excess ranged up to 44 days, and the average time in excess was 3.3 days for the entire group (4.2 days if no compensation on Saturday). For head and neck cancer patients, the time in excess was 1.9 days (3.9 days if no compensation on Saturday). CONCLUSIONS: This study has documented that the incidence and duration of unplanned interruptions of standard treatment schedules is a major problem in normal clinical practice. Most interruptions are short and due mainly to public holidays and machine maintenance and for these reasons they can be planned. In spite of the extra costs, counteracting some short interruptions by treating patients on Saturday is a good way to maintain the OTT without loss of local control (AU)

Euthyroid sick syndrome, associated endocrine abnormalities, and outcome in elderly patients undergoing emergency operation.

BACKGROUND: Emergency operation in the elderly carries a high risk of death. We investigated the incidence of euthyroid sick syndrome (ESS) and associated nutritional and endocrine abnormalities and their relationship to postoperative outcome in this population. METHODS: Sixty-six patients older than 70 years of age requiring emergency operations were assessed before any therapeutic intervention. Values for thyroid hormones, catecholamines, cortisol, interleukin-6, interleukin-1, C-reactive protein, and the Acute Physiology and Chronic Health Evaluation II score were determined. Nutritional assessment was carried out. Mortality rates and duration of hospital stay were related to ESS and albumin concentrations. RESULTS: ESS was diagnosed in 34 patients (51.50%) and was associated with worse Acute Physiology and Chronic Health Evaluation II scores (10.9 vs 8.6; p = 0.004), hypoalbuminemia (34.7 vs 40.8 gm/L; p = 0.0001), lower triceps skinfold (11.8 vs 14.6 mm; p = 0.03), and higher cortisol and norepinephrine levels (937 vs 741 nmol/L [p = 0.04] and 358 vs 250 pg/ml [p = 0.02], respectively), interleukin-6 plasma concentrations (347 vs 113 pg/ml; p = 0.01), death rate (20% vs 0%; p = 0.02), and length of hospital stay (17.2 vs 11.8 days; p = 0.03). A serum albumin level less than 35 gm/L was virtually always associated with ESS. CONCLUSIONS: ESS is highly prevalent in the elderly with acute surgical problems and is associated with poor nutrition, higher sympathetic response, and worse postoperative outcome. The serum albumin level at admission is a specific marker of ESS.

A comparison of molar root canal preparations using six instruments and instrumentation techniques.

Six different instruments (Flexofile, Canal Master U, Heliapical, Flexogate, Ultraflex, and Lightspeed) were evaluated in 240 mesial canals of extracted mandibular molars (40 canals per instrument type). After instrumentation, the roots were cross-sectioned 2, 5, and 9 mm from the apex. The cross sections were evaluated to determine the quality of canal preparation (round, oval, irregular). The best results were obtained with nickel-titanium, a short cutting blade and a rotary rather than a filing motion. The Canal Master U, Flexogate, and Lightspeed instruments had significantly more round canals than the Flexofile, Heliapical and Ultraflex instruments at all levels. The Lightspeed had the largest number of round canals at all levels. Instrumentation time was also recorded. The Canal Master U and Flexogate were significantly slower than the Flexofile, heliapical, Ultraflex, and Lightspeed instruments. There were no statistically significant differences within the faster group.

Influence of nutrition, thyroid hormones, and rectal temperature on in-hospital mortality of elderly patients with acute illness.

The present study was undertaken to investigate the interrelation of nutrition, core temperature, and thyroid function and their influence on survival of patients aged > or = 70 y admitted to the hospital with acute conditions. Sixty-seven patients entered the study. Nutritional state, thyroid function, rectal temperature, and the APACHE II score were recorded at admission. The patients were followed until death or hospital discharge. Patients with a serum albumin concentration < 35 g/L showed a lower triiodothyronine (T3) concentration, a higher reverse triiodothyronine (rT3) concentration, and a higher death rate. Prior weight loss (> or = 10%) did not influence thyroid status but increased the mortality rate. Eleven patients were hypothermic (< 36.5 degrees C) and had a higher mortality, lower total T3 concentration, and higher rT3 concentration than the normothermic or hyperthermic subjects. Serum albumin, body weight, and total T3 concentration were higher in survivors (n = 51) than in nonsurvivors (n = 16). Ongoing weight loss and hypoalbuminemia at admission are highly prevalent in elderly people with acute disease, and influence their clinical outcome. Mild hypothermia was a good predictor of death. Hypoalbuminemia and hypothermia were associated with low T3 and high rT3 values.

[Manual instrumentation of root canals. Review of the last decade]. / Instrumentación manual de conductos radiculares. Revisión de la última década.

In this article the authors make a literature review of root canal hand-instrumentation techniques in this decade. To make it possible, they also review the standardized instruments used in endodontics. They remark there are two great groups of files in use, K-type files and H-type files. In the former one there are rhombus section files and triangular section files, both more flexible than old square section files. Also in K-files group they remark the existence of files with a noncutting tip, useful for reaming techniques. In H-files group, they remark the existence of three types, typical H-files, Helifiles and S-files (including Unifiles). When studying the techniques, they remark as actual the flared techniques with anticurvature filing and step-back. New described ways of instrumentation are Crown-Down Pressureless Technique (which is said to reduce the extrusion of debris uses files with noncutting tip in reaming motion; and the Senia-Wildey technique.

[Deformations occurring in the apical third of curved root canals during biomechanical preparation using manual impulsion-traction techniques]. / Deformaciones provocadas en el tercio apical de los conductos radiculares curvos durante su preparación biomecánica mediante tecnicas manuales de impulsión-tracción.

Apical deformations, specially zips and elbows, during instrumentation of the root canals, are studied. The authors study why do they appear, their effect on endodontic therapy, and the way of avoiding them.

Blood volume and right heart haemodynamics in abrupt hypotension following sublingual isosorbide dinitrate in acute myocardial infarction.

Arterial blood pressure and heart rate were measured in 43 patients with acute myocardial infarction and a systolic blood pressure greater than or equal to 120 mmHg during sublingual administration of 5 mg of isosorbide dinitrate. In 25 of them right heart haemodynamics were also measured. Severe (greater than or equal to 25%) hypotension developed in 12 patients (Group 1, systolic blood pressure 158 +/- 28 to 78 +/- 17 mmHg, mean +/- SD) but not in the remaining 31 (Group 2) and was accompanied by a fall in heart rate (82 +/- 20 to 70 +/- 22 beats min-1, P less than 0.05), in cardiac output (4.3 +/- 0.3 to 3.2 +/- 0.41 min-1, P less than 0.02, n = 5) and in systemic vascular resistances (2326 +/- 463 to 1532 +/- 442 dynes sec-1 cm.5, P less than 0.02) not present in Group 2. The reduction in right (Group 1, 8 +/- 3 to 3 +/- 1, vs. Group 2, 10 +/- 3 to 6 +/- 3 mmHg, P less than 0.005) and in left ventricular filling pressures (Group 1, 15 +/- 4 to 8 +/- 2, vs. Group 2, 18 +/- 6 to 13 +/- 5 mmHg, P less than 0.001) was more remarkable in Group 1. In this group there was also a high incidence of anterior infarction (9/12, 75%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Tissue polypeptide antigen (TPA) in non-neoplastic diseases]. / El antígeno polipeptídico tisular (TPA) en patologías no tumorales.

Radioimmunoassay (TPA Prolifigen RIA) was used to determine the serum concentration of TPA in 333 patients with different kinds of non-tumoral diseases. Amounts higher than 90 U/l, that was taken as the upper normal limit, were observed in 40 per 100 of the cases, being higher than 200 U/l in 10 per 100. The frequency of abnormal amounts of TPA in non-tumoral diseases obliges to eliminate them before making a diagnosis of cancer.

[Clinico-diagnostic usefulness of the determination of beta 2 microglobulin in pleural fluids. Preliminary results]. / Utilidad clínico-diagnóstica de la dosificación de beta 2-microglobulina en los líquidos pleurales. Resultados preliminares.

The authors evaluated by RIA the concentration of beta-2-microglobulin in pleural fluids of different origin (neoplastic, tuberculous, and others). They conclude that beta-2-microglobulin is not useful to make an etiological diagnosis.

[The usefulness of the quantitative evaluation of the plasma levels of the carcinoembryonic antigen (CEA) in patients with respiratory neoplasms (author's transl)]. / Utilidad de la valoración cuantitativa de los niveles plasmáticos de antígeno carcinoembriónico (CEA) en patología pulmonar neoplásica.

Plasma concentration of the carcinoembryonic antigen (CEA) was determined by radioimmunoassay in 80 patients affected with different neoplasms of the respiratory system, among which the most predominant was bronchial carcinoma. For this type of tumor the results showed a percentage of positivity of 69 percent, with a greater value in the disseminated neoplasias (81 percent) in comparison with those which were localized (48 percent). The concentrations of the antigen were greater in the metastatic tumors; in 55 percent of the cases levels above 40 ng/ml were observed. On the other hand this figure was reached only by 4 percent of the localized tumors. Values of the antigen higher than 40 ng/ml should lead to the suspicion of the existence of neoplastic widespread. Among the rest of the series the negativity noticed in all the cases of pleural mesothelioma stands out, and indicates that this type of tumors does not produce CEA.