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Do atypical antipsychotics effectively treat co-occurring bipolar disorder and stimulant dependence? A randomized, double-blind trial.

Marija Djokovic, MD - Wed, 01/30/2019 - 08:28
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Do atypical antipsychotics effectively treat co-occurring bipolar disorder and stimulant dependence? A randomized, double-blind trial.

J Clin Psychiatry. 2008 Aug;69(8):1257-66

Authors: Nejtek VA, Avila M, Chen LA, Zielinski T, Djokovic M, Podawiltz A, Kaiser K, Bae S, Rush AJ

Abstract
OBJECTIVES: The primary objective was to compare the efficacy and tolerability of quetiapine and risperidone in the treatment of mood symptoms, drug cravings, and drug use in outpatients with concurrent DSM-IV-defined bipolar I or II disorder and cocaine or methamphetamine dependence.
METHOD: Men and women of all ethnic origins, 20 to 50 years of age, were eligible to participate. Persons were excluded if they were inpatients, met DSM-IV criteria for substance-induced mood disorder, had any other substance dependence, were euthymic or suicidal, had any life-threatening illnesses, or were currently receiving antipsychotic medications. Duration of the trial was 20 weeks. Study participants attended weekly visits and were evaluated for mood symptoms, drug cravings, drug use, and medication side effects. Treatment outcomes were analyzed using linear mixed models. Fixed-effects terms for medication group, study week, and group-by-study-week were included in the models. The study was conducted between October 2002 and November 2006.
RESULTS: Of 124 consenting outpatients, an evaluable sample of 80 patients who attended baseline and at least 1 follow-up study visit was formed. The mean +/- SD exit dose for quetiapine was 303.6 +/- 151.9 mg/day and 3.1 +/- 1.2 mg/day for risperidone. Both quetiapine (N = 42) and risperidone (N = 38) significantly improved manic and depressive symptoms and reduced drug cravings (p < .0005) compared to baseline. Decreased drug cravings were related to less frequent drug use (p = .03). The 2 medications did not significantly differ in their effects on mood symptoms, drug craving, or drug use.
CONCLUSIONS: Relative to baseline mood and drug-craving status, both quetiapine and risperidone were associated with manic, mixed, and depressive symptom improvement and reduced drug cravings. Both medications were well tolerated. The interpretation of these results is limited by the absence of a placebo control.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00227123.

PMID: 18681757 [PubMed - indexed for MEDLINE]

Family Medicine and Obstetrics: Let's Stop Pretending.

Levi Sundermeyer, MD - Wed, 01/30/2019 - 08:27
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Family Medicine and Obstetrics: Let's Stop Pretending.

J Am Board Fam Med. 2018 May-Jun;31(3):328-331

Authors: Young RA, Sundermeyer RL

PMID: 29743215 [PubMed - in process]

FPIN's clinical inquiries. Prostaglandins to induce labor in women with asthma.

Levi Sundermeyer, MD - Wed, 01/30/2019 - 08:27
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FPIN's clinical inquiries. Prostaglandins to induce labor in women with asthma.

Am Fam Physician. 2014 Sep 15;90(6):415

Authors: Sundermeyer RL, Persons RK, Carrillo MJ

PMID: 25251237 [PubMed - indexed for MEDLINE]

Transitioning From a Level II to Level I Trauma Center Increases Resident Patient Exposure.

Lena Levine, DPM - Wed, 01/30/2019 - 08:27
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Transitioning From a Level II to Level I Trauma Center Increases Resident Patient Exposure.

J Foot Ankle Surg. 2017 Nov - Dec;56(6):1170-1172

Authors: Carpenter B, Levine L, Niacaris T, Suzuki S

Abstract
Increased patient exposure has been shown to improve residency training as determined by better patient outcomes. The transition of John Peter Smith Hospital from a level II to a level I trauma center in 2009 provided a unique opportunity to investigate the direct effects of increased patient exposure on residency training in a relatively controlled setting. We evaluated the effect of the transition to a level I trauma center on residency training. In 2014, we examined the annual facility reports and separated the data into 2 groups: level II (2001 to 2008) and level I (2010 to 2013). The primary outcome measures were patient volume, surgical volume, patient acuity, and scholarly activity by the residents. The patient volume in all units increased significantly (p < .05 for all) after the transition to a level I center. The surgical volume increased significantly for the general surgery, orthopedics, and podiatry departments (p < .05 for all) but remained unchanged in the gynecology and oral maxillofacial surgery departments. The volume measures were performed on all 98 residents (100%). Patient acuity and scholarly activity increased by 17% and 52%, respectively; however, the differences in these data were not statistically significant. The scholarly activity per resident was measured for the orthopedic and podiatry departments. For those departments, the total number of residents was 30, and scholarly activity was measured for 100% of them. Overall, resident education improved when the hospital transitioned to a level I trauma center, although certain subspecialties benefited more than did others from this transition.

PMID: 28888403 [PubMed - indexed for MEDLINE]

Chest Pain Risk Scores Can Reduce Emergent Cardiac Imaging Test Needs With Low Major Adverse Cardiac Events Occurrence in an Emergency Department Observation Unit.

Kristina Domanski, MD - Wed, 01/30/2019 - 08:27
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Chest Pain Risk Scores Can Reduce Emergent Cardiac Imaging Test Needs With Low Major Adverse Cardiac Events Occurrence in an Emergency Department Observation Unit.

Crit Pathw Cardiol. 2016 12;15(4):145-151

Authors: Wang H, Watson K, Robinson RD, Domanski KH, Umejiego J, Hamblin L, Overstreet SE, Akin AM, Hoang S, Shrivastav M, Collyer M, Krech RN, Schrader CD, Zenarosa NR

Abstract
OBJECTIVE: To compare and evaluate the performance of the HEART, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) scores to predict major adverse cardiac event (MACE) rates after index placement in an emergency department observation unit (EDOU) and to determine the need for observation unit initiation of emergent cardiac imaging tests, that is, noninvasive cardiac stress tests and invasive coronary angiography.
METHODS: A prospective observational single center study was conducted from January 2014 through June 2015. EDOU chest pain patients were included. HEART, GRACE, and TIMI scores were categorized as low (HEART ≤ 3, GRACE ≤ 108, and TIMI ≤1) versus elevated based on thresholds suggested in prior studies. Patients were followed for 6 months postdischarge. The results of emergent cardiac imaging tests, EDOU length of stay (LOS), and MACE occurrences were compared. Student t test was used to compare groups with continuous data, and χ testing was used for categorical data analysis.
RESULTS: Of 986 patients, emergent cardiac imaging tests were performed on 62%. A majority of patients were scored as low risk by all tools (85% by HEART, 81% by GRACE, and 80% by TIMI, P < 0.05). The low-risk patients had few abnormal cardiac imaging test results as compared with patients scored as intermediate to high risk (1% vs. 11% in HEART, 1% vs. 9% in TIMI, and 2% vs. 4% in GRACE, P < 0.05). The average LOS was 33 hours for patients with emergent cardiac imaging tests performed and 25 hours for patients without (P < 0.05). MACE occurrence rate demonstrated no significant difference regardless of whether tests were performed emergently (0.31% vs. 0.97% in HEART, 0.27% vs. 0.95% in TIMI, and 0% vs. 0.81% in GRACE, P > 0.05).
CONCLUSIONS: Chest pain risk stratification via clinical decision tool scores can minimize the need for emergent cardiac imaging tests with less than 1% MACE occurrence, especially when the HEART score is used.

PMID: 27846006 [PubMed - indexed for MEDLINE]

Roles of disease severity and post-discharge outpatient visits as predictors of hospital readmissions.

Kathleen Delaney, MD - Wed, 01/30/2019 - 08:26
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Roles of disease severity and post-discharge outpatient visits as predictors of hospital readmissions.

BMC Health Serv Res. 2016 10 10;16(1):564

Authors: Wang H, Johnson C, Robinson RD, Nejtek VA, Schrader CD, Leuck J, Umejiego J, Trop A, Delaney KA, Zenarosa NR

Abstract
BACKGROUND: Risks prediction models of 30-day all-cause hospital readmissions are multi-factorial. Severity of illness (SOI) and risk of mortality (ROM) categorized by All Patient Refined Diagnosis Related Groups (APR-DRG) seem to predict hospital readmission but lack large sample validation. Effects of risk reduction interventions including providing post-discharge outpatient visits remain uncertain. We aim to determine the accuracy of using SOI and ROM to predict readmission and further investigate the role of outpatient visits in association with hospital readmission.
METHODS: Hospital readmission data were reviewed retrospectively from September 2012 through June 2015. Patient demographics and clinical variables including insurance type, homeless status, substance abuse, psychiatric problems, length of stay, SOI, ROM, ICD-10 diagnoses and medications prescribed at discharge, and prescription ratio at discharge (number of medications prescribed divided by number of ICD-10 diagnoses) were analyzed using logistic regression. Relationships among SOI, type of hospital visits, time between hospital visits, and readmissions were also investigated.
RESULTS: A total of 6011 readmissions occurred from 55,532 index admissions. The adjusted odds ratios of SOI and ROM predicting readmissions were 1.31 (SOI: 95 % CI 1.25-1.38) and 1.09 (ROM: 95 % CI 1.05-1.14) separately. Ninety percent (5381/6011) of patients were readmitted from the Emergency Department (ED) or Urgent Care Center (UCC). Average time interval from index discharge date to ED/UCC visit was 9 days in both the no readmission and readmission groups (p > 0.05). Similar hospital readmission rates were noted during the first 10 days from index discharge regardless of whether post-index discharge patient clinic visits occurred when time-to-event analysis was performed.
CONCLUSIONS: SOI and ROM significantly predict hospital readmission risk in general. Most readmissions occurred among patients presenting for ED/UCC visits after index discharge. Simply providing early post-discharge follow-up clinic visits does not seem to prevent hospital readmissions.

PMID: 27724889 [PubMed - indexed for MEDLINE]

Predictors of mortality among initially stable adult pelvic trauma patients in the US: Data analysis from the National Trauma Data Bank.

Kathleen Delaney, MD - Wed, 01/30/2019 - 08:26
Related Articles

Predictors of mortality among initially stable adult pelvic trauma patients in the US: Data analysis from the National Trauma Data Bank.

Injury. 2015 Nov;46(11):2113-7

Authors: Wang H, Phillips JL, Robinson RD, Duane TM, Buca S, Campbell-Furtick MB, Jennings A, Miller T, Zenarosa NR, Delaney KA

Abstract
OBJECTIVES: Pelvic fractures are associated with increased risk of death among trauma patients. Studies show independent risks predicting mortality among patients with pelvic fractures vary across different geographic regions. This study analyses national data to determine predictors of mortality in initially stable adult pelvic trauma patients in the US.
METHODS: This study is a retrospective analysis of the US National Trauma Data Bank from January 2003 to December 2010 among trauma patients ≥18 years of age with pelvic fractures (including acetabulum). Over 150 variables were reviewed and analysed. The primary outcome was all-cause in-hospital mortality. Logistic regression analysis was used to determine independent risk factors predictive of in-hospital mortality in stable pelvic fracture patients.
RESULTS: 30,800 patients were included in the final analysis. Overall in-hospital mortality rate was 2.7%. Mortality increased twofold in middle aged patients (age 55-70), and increased nearly fourfold in patients with advanced age ≥70. We found patients with advanced age, higher severity of injury, Glasgow Coma Scale (GCS) <8, GCS between 9 and 12, prolonged mechanical ventilation, and/or in-hospital blood product administration experienced higher mortality. Patients transported to level 1 or level 2 trauma centres experienced lower mortality while concomitantly experiencing higher associated internal injuries.
CONCLUSIONS: Geriatric and middle aged pelvic fracture patients experience higher mortality. Predictors of mortality in initially stable pelvic fracture patients are advanced age, injury severity, mental status, prolonged mechanical ventilation, and/or in-hospital blood product administration. These patients might benefit from transport to local level 1 or level 2 trauma centres.

PMID: 26377773 [PubMed - indexed for MEDLINE]

Using the LACE index to predict hospital readmissions in congestive heart failure patients.

Kathleen Delaney, MD - Wed, 01/30/2019 - 08:26
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Using the LACE index to predict hospital readmissions in congestive heart failure patients.

BMC Cardiovasc Disord. 2014 Aug 07;14:97

Authors: Wang H, Robinson RD, Johnson C, Zenarosa NR, Jayswal RD, Keithley J, Delaney KA

Abstract
BACKGROUND: The LACE index has been used to predict the risk of unplanned readmission within 30 days after hospital discharge in both medical and surgical patients. The aim of this study is to validate the accuracy of using the LACE index in CHF patients.
METHODS: This was a retrospective study. The LACE index score was calculated on each patient who was admitted to hospital due to an acute CHF exacerbation. Operational and clinical variables were collected from patients including basic clinical characteristics, length of hospitalization, comorbidities, number of previous ED visits in the past 6 months before the index admission, and the number of post discharge ED revisits at 30, 60, and 90 days. All variables were analyzed by multivariate logistic regression to determine the association between clinical variables and the hospital unplanned readmissions. C-statistic was used to discriminate those patients with high risk of readmissions.
RESULTS: Of the 253 patients included in the study, 24.50% (62/253) experienced unplanned readmission to hospital within 30 days after discharge. The LACE index was slightly higher in patients readmitted versus patients not readmitted (12.17 ± 2.22 versus 11.80 ± 1.92, p = 0.199). Adjusted odds ratios based on logistic regression of all clinical variables showed only the number of previous ED visits (OR 1.79, 95% CI 1.30-2.47, p < 0.001), history of myocardial infarction (OR 2.51, 95% CI 1.02-6.21, p = 0.045), and history of peripheral vascular disease (OR 10.75, 95% CI 1.52-75.73, p = 0.017) increased the risk of unplanned readmission within 30 days of hospital discharge. However, patients with high LACE scores (≥10) had a significantly higher rate of ED revisits (15.04% vs 0%) within 30 days from the index discharge than those with low LACE scores (p = 0.030).
CONCLUSION: The LACE index may not accurately predict unplanned readmissions within 30 days from hospital discharge in CHF patients. The LACE high risk index may have utility as a screening tool to predict high risk ED revisits after hospital discharge.

PMID: 25099997 [PubMed - indexed for MEDLINE]

The accuracy of interqual criteria in determining the need for observation versus hospitalization in emergency department patients with chronic heart failure.

Kathleen Delaney, MD - Wed, 01/30/2019 - 08:26
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The accuracy of interqual criteria in determining the need for observation versus hospitalization in emergency department patients with chronic heart failure.

Crit Pathw Cardiol. 2013 Dec;12(4):192-6

Authors: Wang H, Robinson RD, Coppola M, Fernandez D, Ros F, Zenarosa NR, Burton MJ, Delaney KA

Abstract
McKesson's Interqual criteria are one of the medical screening criteria that are widely used in emergency departments (EDs) to determine if patients qualify for observation or inpatient admission. Chronic heart failure (CHF) is one of the most common yet severe cardiovascular diseases seen in the ED with a relatively higher admission rate. This study is to evaluate the accuracy of Interqual criteria in determining observation versus hospitalization need in CHF patients. From January 2009 till December 2010, data from 503 CHF patients were reviewed. One hundred twenty-two patients were observed and 381 patients were admitted. Only one variable (blood urea nitrogen, ≥30 mg/dL; odds ratio, 2.44) from Interqual criteria had reached statistical significant difference between observation and hospitalization groups. Our results showed that based on the initial review at ED, clinical variables from Interqual criteria did not appear to help accurately predict the level of care in CHF patient in our patient population. Other clinical variables may need to be added in the criteria for better prediction.

PMID: 24240548 [PubMed - indexed for MEDLINE]

Geriatric Trauma Patients With Cervical Spine Fractures due to Ground Level Fall: Five Years Experience in a Level One Trauma Center.

Kathleen Delaney, MD - Wed, 01/30/2019 - 08:26
Related Articles

Geriatric Trauma Patients With Cervical Spine Fractures due to Ground Level Fall: Five Years Experience in a Level One Trauma Center.

J Clin Med Res. 2013 Apr;5(2):75-83

Authors: Wang H, Coppola M, Robinson RD, Scribner JT, Vithalani V, de Moor CE, Gandhi RR, Burton M, Delaney KA

Abstract
BACKGROUND: It has been found that significantly different clinical outcomes occur in trauma patients with different mechanisms of injury. Ground level falls (GLF) are usually considered "minor trauma" with less injury occurred in general. However, it is not uncommon that geriatric trauma patients sustain cervical spine (C-spine) fractures with other associated injuries due to GLF or less. The aim of this study is to determine the injury patterns and the roles of clinical risk factors in these geriatric trauma patients.
METHODS: Data were reviewed from the institutional trauma registry of our local level 1 trauma center. All patients had sustained C-spine fracture(s). Basic clinical characteristics, the distribution of C-spine fracture(s), and mechanism of injury in geriatric patients (65 years or older) were compared with those less than 65 years old. Furthermore, different clinical variables including age, gender, Glasgow coma scale (GCS), blood alcohol level, and co-existing injuries were analyzed by multivariate logistic regression in geriatric trauma patients due to GLF and internally validated by random bootstrapping technique.
RESULTS: From 2006 - 2010, a total of 12,805 trauma patients were included in trauma registry, of which 726 (5.67%) had sustained C-spine fracture(s). Among all C-spine fracture patients, 19.15% (139/726) were geriatric patients. Of these geriatric patients 27.34% (38/139) and 53.96% (75/139) had C1 and C2 fractures compared with 13.63% (80/587) and 21.98% (129/587) in young trauma patients (P < 0.001). Of geriatric trauma patients 13.67% (19/139) and 18.71% (26/139) had C6 and C7 fractures compared with 32.03% (188/587) and 41.40% (243/587) in younger ones separately (P < 0.001). Furthermore, 53.96% (75/139) geriatric patients had sustained C-spine fractures due to GLF with more upper C-spine fractures (C1 and C2). Only 3.2% of those had positive blood alcohol levels compared with 52.9% of younger patients (P < 0.001). In addition, 6.34% of geriatric patients due to GLF had intracranial pathology (ICP) which was one of the most common co-injuries with C-spine fractures. Logistic regression analysis showed the adjusted odds ratios of 1.17 (age) and 91.57 (male) in geriatric GLF patients to predict this co-injury pattern of C-spine fracture and ICP.
CONCLUSION: Geriatric patients tend to sustain more upper C-spine fractures than non-geriatric patients regardless of the mechanisms. GLF or less not only can cause isolated C-spines fracture(s) but also lead to other significant injuries with ICP as the most common one in geriatric patients. Advanced age and male are two risk factors that can predict this co-injury pattern. In addition, it seems that alcohol plays no role in the cause of GLF in geriatric trauma patients.

PMID: 23519239 [PubMed]

Pulmonary tuberculosis in pregnancy.

Kathleen Crowley, MD - Wed, 01/30/2019 - 08:26
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Pulmonary tuberculosis in pregnancy.

Prim Care Update Ob Gyns. 2000 Nov 01;7(6):244-249

Authors: Vo QT, Stettler W, Crowley K

Abstract
Tuberculosis (TB) was once a formidable public health hazard but is now less feared because of the development of an armamentarium of effective drugs. The incidence of TB had been declining for decades until recently when the number of cases of TB began to rise. The most obvious reasons for this trend were the rising rate of human immunodeficiency virus infection and the development of multiple drug-resistant TB. The largest percentage increase in TB cases occurred among persons 25 to 44 years of age; many of them are women. A number of these women will first be diagnosed with TB infection during pregnancy. It is important for the clinician to be aware of the impact of TB on this population. Patients must be screened as recommended by the Centers for Disease Control and Prevention because it is important to quickly diagnose TB. Prompt and effective therapy will benefit the mother and the neonate. This article reviews the diagnosis, prevention, and treatment regimens of TB in pregnancy, as well as the effects on the HIV patient, the neonate, and breastfeeding. Prompt recognition and treatment of TB infection will ensure that the rates of TB cases decline.

PMID: 11077237 [PubMed - as supplied by publisher]

Psychological Attributes of Ultramarathoners.

Katherine Buck, PhD - Wed, 01/30/2019 - 08:25
Related Articles

Psychological Attributes of Ultramarathoners.

Wilderness Environ Med. 2018 03;29(1):66-71

Authors: Buck K, Spittler J, Reed A, Khodaee M

Abstract
INTRODUCTION: As the popularity of ultramarathon participation increases, there still exists a lack of understanding of the unique psychological characteristics of ultramarathon runners. The current study sought to investigate some of the psychological and behavioral factors that are involved in ultramarathon running.
METHODS: We obtained information from participants of the Bear Chase Trail Race via an online survey. This race is a single-day, multidistance race consisting of a 10 k, half marathon, 50 k, 50 mi, and 100 k run in Lakewood, Colorado, at a base altitude of 1680 m with total altitude in climbs ranging from 663 to 2591 m. We correlated information from the Exercise Addiction Inventory and the Patient Health Questionnaire-2 and demographic information with race finish times.
RESULTS: Out of 200 runners who started the race, 98 (48%) completed the survey. Over half of the runners were men (61.2%), and the average age was 39.0 years (SD±8.9; range 21-64 years). A number of respondents (20%) screened positive for exercise addiction concerns. Approximately 20% of our sample screened positive for depressive symptoms (Patient Health Questionnaire-2 score >3). The majority of participants reported receiving strong social support from current partners with regard to their ultramarathon running training time and goals.
CONCLUSIONS: Although only a screening, the number of positive screens on the Exercise Addiction Inventory suggests use of screening measures with an ultramarathon running population. Athletes with positive screening tests should be fully evaluated for depression and exercise addiction because this would enable appropriate athlete support and treatment referral.

PMID: 29336959 [PubMed - indexed for MEDLINE]

StatPearls

Josephine Fowler, MD - Wed, 01/30/2019 - 08:25
Related Articles

StatPearls

Book. 2018 01

Authors:

Abstract
Chorioamnionitis is an infection that can occur before labor, during labor, or after delivery. It can be acute, subacute, or chronic. Subacute chorioamnionitis is associated with chronic lung disease in the infant.[1] Chronic chorioamnionitis is associated with retinopathy of prematurity, very low birth weight, and impaired brain development in the premature infant. Chronic chorioamnionitis is common.[2][3][4] This terminology refers to histologic chorioamnionitis. Histologic chorioamnionitis at term is rarely infectious. In general, the clinical presentation of chorioamnionitis is defined as acute chorioamnionitis. The Greek etymology of the words chorion and amnion mean fetal membrane and itis means inflammation. Further description denotes chorioamnionitis includes the amniotic fluid. Chorioamnionitis may be identified postdelivery or postmortem on a pathologic review of the placenta and cord. In histologic chorioamnionitis, symptoms may be absent, and the placenta or cultures may not show evidence of chorioamnionitis. Most commonly, chorioamnionitis is associated with preterm labor, prolonged rupture of membranes, prolonged labor, tobacco use, nulliparous pregnancy, meconium stained fluid, multiple vaginal exams post rupture of membranes, and in women with known bacterial or viral infections. However, it can occur at term and in women without prior infections. Left untreated, chorioamnionitis can lead to morbidity and mortality for the mother and neonate. Neonatal morbidity and mortality increase in severity and occurrence with earlier gestations. Antibiotic therapy has been shown to reduce the incidence and severity of the infection in both the mother and neonate. However, antibiotics do not eradicate the infection in all cases.


PMID: 30335284

Restoration of the atrophied posterior mandible with transverse alveolar maxillary/mandibular implants: technical note and case report.

John Stella, DDS, FACS - Wed, 01/30/2019 - 08:25
Related Articles

Restoration of the atrophied posterior mandible with transverse alveolar maxillary/mandibular implants: technical note and case report.

Int J Oral Maxillofac Implants. 2002 Nov-Dec;17(6):873-9

Authors: Stella JP, Abolenen H

Abstract
Restoration of the atrophied posterior mandibular alveolus has been a surgical challenge in the past. Many treatment options have been published, each with unique shortcomings. This study will review and compare these techniques to a new type of implant, the transverse alveolar maxillary/mandibular implant (TAMMI). Using modified Nobel Biocare Brånemark System zygomatic implants that were shortened to 11.5, 13, 15, 18, 20, 22.5, or 25 mm, the authors reconstructed atrophied posterior mandibles. These TAMMIs were placed at a 45-degree angle, engaging both the crest of the ridge and the buccal cortex. Using TAMMIs, atrophied posterior mandibular alveoli as small as 9 mm have been successfully restored without complication to the inferior alveolar nerve.

PMID: 12507249 [PubMed - indexed for MEDLINE]

An innovative method for accurate positioning of the proximal segment in sagittal split osteotomies.

John Stella, DDS, FACS - Wed, 01/30/2019 - 08:25
Related Articles

An innovative method for accurate positioning of the proximal segment in sagittal split osteotomies.

Int J Adult Orthodon Orthognath Surg. 2000;15(1):59-63

Authors: Burye MT, Stella JP

Abstract
Ten patients underwent bilateral sagittal split ramus osteotomy for the correction of mandibular retrognathia. Prior to the surgery, predictive cephalometric tracings were completed, utilizing horizontal and vertical reference guides. The anticipated horizontal and vertical changes were determined from the predictive tracings, and these results were recorded on the prediction tracing. During surgery, corresponding reference marks were made on the lateral surface of the mandible. These reference marks were utilized to position the proximal segment during surgery, prior to placement of stabilization screws. A postoperative lateral cephalometric radiograph was taken within 24 hours in each case. The positions of the proximal segments were compared pre- and postsurgically. The results of this study indicate that this simple method results in accurate positioning of the proximal segments.

PMID: 11307224 [PubMed - indexed for MEDLINE]

Predictability of bimaxillary orthognathic surgery using "piggyback" intermediate splints.

John Stella, DDS, FACS - Wed, 01/30/2019 - 08:25
Related Articles

Predictability of bimaxillary orthognathic surgery using "piggyback" intermediate splints.

Int J Adult Orthodon Orthognath Surg. 2000;15(1):25-9

Authors: Stefanova N, Stella JP

Abstract
Ten consecutive patients underwent bimaxillary surgery including segmental Le Fort I and bilateral sagittal split ramus osteotomies. All 10 patients were symmetric skeletal Class II malocclusion with an anterior open bite. Asymmetry cases were excluded. Dimensional changes depicted on the cephalometric prediction tracing were reproduced in the model surgery and then transferred to the patient during the operative procedure using a "piggyback" intermediate splint. All dimensional changes, except vertical, were transferred from the model surgery to the patient intraoperatively by using a "piggyback" intermediate splint. The accuracy of this transfer and final skeletal result was examined. All the data clearly showed that in no case was any discrepancy greater than 2 mm, which demonstrates the predictable results that can be achieved by using a "piggyback" intermediate splint in bimaxillary orthognathic surgery.

PMID: 11307219 [PubMed - indexed for MEDLINE]

The predictability of inferior medial canthus as a stable external vertical reference point in maxillary repositioning surgery.

John Stella, DDS, FACS - Wed, 01/30/2019 - 08:25
Related Articles

The predictability of inferior medial canthus as a stable external vertical reference point in maxillary repositioning surgery.

Int J Adult Orthodon Orthognath Surg. 2000;15(4):305-8

Authors: Stefanova N, Stella JP

Abstract
The purpose of this study was to investigate the predictability of using the inferior medial canthus as a stable external reference point for establishment of the vertical dimension in maxillary orthognathic surgery. Ten consecutive patients with skeletal Class II malocclusion and open bite who underwent orthognathic reconstructive surgery were included in the study. Prediction tracings were completed preoperatively and superimposed on an immediate postoperative lateral cephalometric radiograph. In 7 patients, the vertical positioning of the maxillary incisal edge on the immediate postoperative lateral cephalometric radiograph showed no difference from the superimposed preoperative prediction tracing. One patient showed 1 mm difference and 2 patients showed 2 mm difference from the preoperative prediction tracings. All cases resulted in acceptable maxillary incisal exposure relative to upper lip stomion. It is concluded that the inferior medial canthus can be used as a reproducible external vertical reference for orthognathic surgery when the technique described herein is used.

PMID: 11307188 [PubMed - indexed for MEDLINE]

Sinus slot technique for simplification and improved orientation of zygomaticus dental implants: a technical note.

John Stella, DDS, FACS - Wed, 01/30/2019 - 08:25
Related Articles

Sinus slot technique for simplification and improved orientation of zygomaticus dental implants: a technical note.

Int J Oral Maxillofac Implants. 2000 Nov-Dec;15(6):889-93

Authors: Stella JP, Warner MR

Abstract
The zygomaticus dental implant, designed by Nobel Biocare for the Brånemark System, is indicated primarily for the severely resorbed maxilla. Though the zygomaticus implant has had a remarkable success rate in a very difficult patient population, there are some shortcomings to the protocol for placement. The sinus slot technique described herein provides a simplified approach to zygomaticus implant placement, as compared to the currently recommended protocol.

PMID: 11151591 [PubMed - indexed for MEDLINE]

Geometric considerations when planning an asymmetric genioplasty.

John Stella, DDS, FACS - Wed, 01/30/2019 - 08:25
Related Articles

Geometric considerations when planning an asymmetric genioplasty.

Int J Adult Orthodon Orthognath Surg. 1999;14(3):175-80

Authors: Stefanova N, Stella JP

Abstract
The sliding osteotomy of the inferior border of the mandible, otherwise known as genioplasty, has often been described in the world literature with regard to diagnosis and treatment planning. However, the treatment of the asymmetric chin has received little attention. Moreover, diagnosis and treatment planning of asymmetric chins with concomitant orthognathic surgery is completely lacking from the literature. The complexity of surgically correcting asymmetric chins, compounded with complex, bimaxillary orthognathic surgery, is an extremely challenging task. This article looks at geometric considerations when planning the surgical correction of an asymmetric chin following a protocol of data collection, model surgery, diagnosis, and treatment planning. Clinical experience in the form of a case presentation will demonstrate the millimetric precision that can be achieved when planning corrective genioplasty in an asymmetric patient undergoing concomitant orthognathic surgery.

PMID: 10686841 [PubMed - indexed for MEDLINE]

Modification of sagittal split ramus osteotomy to avoid unfavorable fracture around impacted third molars.

John Stella, DDS, FACS - Wed, 01/30/2019 - 08:25
Related Articles

Modification of sagittal split ramus osteotomy to avoid unfavorable fracture around impacted third molars.

Int J Adult Orthodon Orthognath Surg. 1998;13(3):183-7

Authors: Marquez IM, Stella JP

Abstract
The dental literature recognizes that performing sagittal ramus osteotomy when impacted third molars are present significantly increases the risk of unfavorable fractures of both the proximal and distal segments. Many articles have described how to repair unfavorable fractures of sagittal split segments, but few to date specifically address how to modify the osteotomy design to reduce the potential for unfavorable fractures. Moreover, techniques for removal of impacted third molars after the completion of a sagittal split ramus osteotomy have received little attention in the literature, yet it is obviously a common occurrence. This paper describes a modification of the sagittal split ramus osteotomy when a fully formed impacted third molar is present at the time of the sagittal ramus osteotomy. A technique is also described for removing the impacted third molar after the sagittal split is completed. Clinical experience has demonstrated these techniques to have several advantages.

PMID: 9835817 [PubMed - indexed for MEDLINE]

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