A prospective study examining the effects of treatment timing in the management of mandible fractures

Publication date: Available online 10 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M.J.L. Hurrell, M.C. David, M.D. Batstone
The ideal timing for treatment of mandible fractures has not been well established. The objective of this study was to analyse the effects of treatment timing in the surgical management of mandible fractures. A prospective evaluation of 215 continuous patients with a total of 359 mandible fractures was undertaken. Nine outcome variables were analysed in relation to treatment delay by logistic regression modelling: wound dehiscence, hardware exposure, local postoperative infection, malocclusion, trismus, nerve damage, fracture non-union, return to theatre, and radiographic outcome. Nineteen additional variables were included in the analysis to adjust for potential confounding. Delay was measured in days and ranged from 0 to 41days, with a mean delay of 4.6days. The incidence of wound dehiscence, hardware exposure, local postoperative infection, trismus, nerve damage, fracture non-union and return to theatre was 6%, 4%, 11%, 8.5%, 47%, 2% and 8%, respectively. Objective malocclusion and poor radiographic outcomes were evident in 13% and 4.5% of cases, respectively.No statistically significant association was found between treatment delay and treatment outcomes.The findings of this study suggest it may be safe to delay the definitive treatment of mandible fractures. Treatment delay may allow for improved resource distribution and prioritization of more time-dependent interventions.



from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader https://ift.tt/2JBz8Td

Identification of ‘Point A’ as the prevalent source of error in cephalometric analysis of lateral radiographs

Publication date: Available online 10 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): P. Grogger, C. Sacher, S. Weber, G. Millesi, R. Seemann
Deviations in measuring dentofacial components in a lateral X-ray represent a major hurdle in the subsequent treatment of dysgnathic patients. In a retrospective study, we investigated the most prevalent source of error in the following commonly used cephalometric measurements: the angles Sella-Nasion-Point A (SNA), Sella-Nasion-Point B (SNB) and Point A-Nasion-Point B (ANB); the Wits appraisal; the anteroposterior dysplasia indicator (APDI); and the overbite depth indicator (ODI). Preoperative lateral radiographic images of patients with dentofacial deformities were collected and the landmarks digitally traced by three independent raters. Cephalometric analysis was automatically performed based on 1116 tracings. Error analysis identified the x-coordinate of Point A as the prevalent source of error in all investigated measurements, except SNB, in which it is not incorporated. In SNB, the y-coordinate of Nasion predominated error variance. SNB showed lowest inter-rater variation. In addition, our observations confirmed previous studies showing that landmark identification variance follows characteristic error envelopes in the highest number of tracings analysed up to now. Variance orthogonal to defining planes was of relevance, while variance parallel to planes was not. Taking these findings into account, orthognathic surgeons as well as orthodontists would be able to perform cephalometry more accurately and accomplish better therapeutic results.



from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader https://ift.tt/2EBo9Fl

Risk factors for postoperative delirium in patients undergoing free flap reconstruction for oral cancer

Publication date: Available online 10 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): T. Makiguchi, S. Yokoo, J. Kurihara
The aim of this study was to investigate risk factors for postoperative delirium in patients undergoing free flap reconstruction for defects after oral cancer resection. This was a non-randomized, retrospective cohort study involving 102 patients who underwent oral cancer resection and free flap reconstruction. Data were collected from the medical records. Postoperative delirium occurred in 34 patients (33.3%), of whom 27 were male and seven were female. High preoperative total protein and albumin, diabetes mellitus, history of smoking, use of hypnotics or antipsychotics, time until getting out of bed after surgery, and postoperative insomnia were significantly related to delirium in the univariate analysis (P<0.05). In a multiple logistic regression model, high preoperative albumin (odds ratio 4.45), postoperative insomnia (odds ratio 10.72), and history of smoking (odds ratio 2.91) were significant risk factors for delirium (P<0.05). The analysis of laboratory data before and after surgery showed greater decreases in albumin, total protein, and haemoglobin after surgery in patients with postoperative delirium than in those without this condition. These results show that the perioperative maintenance of nutritional status and early postoperative management of the sleep cycle are important to prevent delirium after oral cancer resection and free flap reconstruction.



from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader https://ift.tt/2JBz3yT

Assessing an oral surgery specific protocol for patients on direct oral anticoagulants: a retrospective controlled cohort study

Publication date: Available online 10 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): E. Lababidi, O. Breik, J. Savage, H. Engelbrecht, R. Kumar, C.W. Crossley
Chronic therapy with the new direct oral anticoagulants (DOACs) poses new challenges for dental practitioners assessing the risk versus benefit of cessation versus non-cessation of anticoagulant therapy for dentoalveolar procedures. A retrospective controlled cohort study was designed to evaluate a non-cessation protocol for patients taking DOACs in the setting of dental extractions. A records review covering the period 1 January 2016 to 31 December 2016 identified 43 patients on DOAC therapy; 53 dentoalveolar procedures were performed under local anaesthesia, of which 15 included varying degrees of peri-procedural cessation. A control group of 50 patients on uninterrupted warfarin therapy undergoing 59 dentoalveolar procedures was identified. The incidence, severity, and timing of bleeding events were recorded for each group. Four (10.5%) minor bleeding events were recorded in the non-cessation DOAC group and nine (15.3%) minor bleeding events in the warfarin group. No bleeding events were recorded in the DOAC cessation group. Comparison of the incidence of bleeding events between the non-cessation DOAC group and the warfarin group showed no statistically significant difference (odds ratio 0.65, P=0.56). Within the limitations of this study, dental extractions in the context of continuing DOAC therapy can be performed safely provided extra local haemostatic measures are applied.



from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader https://ift.tt/2IKH6rx

Management of older adults with acute lymphoblastic leukemia: challenges & current approaches

International Journal of Hematologic Oncology, Ahead of Print.


from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader https://ift.tt/2HpYS47

Cerebrovascular Events After Continuous-Flow Left Ventricular Assist Devices

Abstract

Background

Cerebrovascular events (CVE) are among the most common and serious complications after implantation of continuous-flow left ventricular assist devices (CF-LVAD). We studied the incidence, subtypes, anatomical distribution, and pre- and post-implantation risk factors of CVEs as well as the effect of CVEs on outcomes after CF-LVAD implantation at our institution.

Methods

Retrospective analysis of clinical and neuroimaging data of 372 patients with CF-LVAD between May 2005 and December 2013 using standard statistical methods.

Results

CVEs occurred in 71 patients (19%), consisting of 35 ischemic (49%), 26 hemorrhagic (37%), and 10 ischemic+hemorrhagic (14%) events. History of coronary artery disease and female gender was associated with higher odds of ischemic CVE (OR 2.84 and 2.5, respectively), and diabetes mellitus was associated with higher odds of hemorrhagic CVE (OR 3.12). While we found a higher rate of ischemic CVEs in patients not taking any antithrombotic medications, no difference was found between patients with ischemic and hemorrhagic CVEs. Occurrence of CVEs was associated with increased mortality (HR 1.62). Heart transplantation was associated with improved survival (HR 0.02). In patients without heart transplantation, occurrence of CVE was associated with decreased survival.

Conclusions

LVADs are associated with high rates of CVE, increased mortality, and lower rates of heart transplantation. Further investigations to identify the optimal primary and secondary stroke prevention measures in post-LVAD patients are warranted.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader https://ift.tt/2HqS3z4

Antidepression action of BDNF requires and is mimicked by G{alpha}i1/3 expression in the hippocampus [Neuroscience]

Stress-related alterations in brain-derived neurotrophic factor (BDNF) expression, a neurotrophin that plays a key role in synaptic plasticity, are believed to contribute to the pathophysiology of depression. Here, we show that in a chronic mild stress (CMS) model of depression the Gαi1 and Gαi3 subunits of heterotrimeric G proteins are...

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader https://ift.tt/2EAkBmY