Reliability of retrievable cemented implant-supported prostheses.

STATEMENT OF PROBLEM: One of the disadvantages of a cemented implant restoration is the potential difficulty of retrieving it. The restoration may be destroyed during removal. PURPOSE: The purpose of this retrospective clinical study was to assess the long-term survival rates of cemented posterior metal ceramic implant-supported prostheses (ISPs) with a metal screw access hole. MATERIAL AND METHODS: During a 12-year period, 274 cemented ISPs with an abutment screw access hole in the metal framework were assessed and served as the study group, and 119 conventional cemented ISPs (without access hole) served as the control group. Participants were followed every 6 months in the first year and once a year subsequently. Ceramic fracture, screw loosening, and refabrication were the prosthetic outcome parameters evaluated at the recall. The Pearson Chi square and Fisher exact test were used to compare the outcome parameters between the control and study groups. RESULTS: A total of 1005 implants and 393 ISPs were evaluated. Ceramic fracture occurred in 6.6% of the ISPs (6.2% test and 7.6% control). Screw loosening occurred in 3.28% of the test group and 3.36% of the control group. Refabrication of ISPs was done in 2.79% of all restorations, (1.45% test and 6.72% control [P=.012]). CONCLUSIONS: Within the limits of this study, preparing cemented ISPs with a screw access hole in the metal framework improves ISP survival rates over time and lowers the cost of maintenance without increasing the risk for porcelain fracture or screw loosening.

Effectiveness of home rehabilitation after stroke in Israel.

On discharge from an acute general hospital after a stroke, 191 patients were in need of, and were appropriate for, multidisciplinary rehabilitation. One-hundred-and-one patients (52.4%) received it in a rehabilitation institution as inpatients (the institutional rehabilitation group (IR) group) and 91 patients received it at home (the home rehabilitation (HR) group). Patients in the HR group had their mobility, activities of daily living (ADL), range of movements, tonus, coordination and sensation determined on admission to home rehabilitation and on discharge from it, 6 weeks to 2 months later. This group contained more women and more patients able to walk with devices and who were partially independent in ADL. The IR group consisted of more men and more patients with diabetes and marked difficulties in ADL and ambulation. In both groups the Barthel index and the Frenchay activities index were determined 1 year after the stroke by way of a telephone interview and no meaningful differences were found between the two groups. IR was considerably more expensive than HR. In Israel there exists a subpopulation of acute stroke survivors in need of, and appropriate for, multidisciplinary rehabilitation that can be provided at home; such rehabilitation was found to be effective in the short and long term, as well as cost effective.

Allocation and preference of patients for domiciliary or institutional rehabilitation after a stroke.

On discharge from an acute-care hospital after a stroke, 191 patients were told that they needed rehabilitation and were offered the option of receiving care in an institution or in their homes. One hundred and one (52.4%) patients chose an institution and 91 (47.6%) preferred rehabilitation in their own home. A higher number of women than men chose to be rehabilitated at home. Multivariate logistic regression showed that odds for being included in the home rehabilitation group were higher for women and for those who had a stroke in the past. Odds for being included in the institutional rehabilitation group were individuals with diabetes and difficulty in ambulating and those who had a longer stay in the acute-care hospital. Findings of the study suggest that in Israel there is a sub-population of acute stroke survivors who may be appropriate for rehabilitation at home and accept the option when they are offered it.

Cheyne-Stokes respiration during sleep: a possible effect of body position.

BACKGROUND: Cheyne-Stokes Respiration (CSR) is a common finding in Chronic Heart Failure and Stroke patients. The body position effect during sleep on obstructive breathing abnormalities is well known. However, the effect of body position during sleep on breathing abnormalities of central type like CSR has not been well documented. MATERIAL/METHODS: Six sleep studies (two complete Polysomnographic (PSG) evaluations and four Pulse Oximetry recordings (PO)), were carried out in a 57-year-old female patient with a recent Cerebro Vascular Accident (CVA who had both Obstructive Sleep Apnea (OSA) and CSR. RESULTS: The first PSG was carried out two months post-stroke and revealed a severe, continuous CSR pattern during Non Rapid Eye Movements (NREM) sleep (mainly with central apneas), and Obstructive Sleep Apnea (OSA) during Rapid Eye Movements (REM) sleep, independent of body position: Supine Respiratory Disturbance Index (SRDI) = 85.2 and Lateral RDI (LRDI) = 95.4. A second PSG was performed three months later after an overall clinical improvement and showed a complete disappearance of CSR during NREM sleep and OSA during REM sleep in her lateral posture (LRDI = 0), while the RDI in the supine posture was only slightly improved (SRDI = 73.2). The CSR pattern was less severe and was characterized mainly by central hypopneas. Two PO recordings between the PSG studies showed similar improvement trends. Two additional PO recordings, two and three weeks after the last PSG (the first one with the patient lying supine and the second one with the patient lying on her side throughout the night), revealed a further significant improvement in the supine posture (SRDI = 37.5). CONCLUSIONS: The results of this study suggest that body posture may play a role not only in the prevalence and severity of obstructive breathing disorders, but also in CSR, a central type of breathing abnormalities during sleep.