RESUMEN
Reconstruction and rehabilitation following rhinectomy remains controversial and presents a complex problem. Although reconstruction with local and microvascular flaps is a valid option, the aesthetic results may not always be satisfactory. The aesthetic results achieved with a nasal prosthesis are excellent; however patient acceptance relies on a secure method of retention. The technique used and results obtained in a large series of patients undergoing rhinectomy and receiving zygomatic implants for the retention of a nasal prosthesis are described here. A total of 56 zygomatic implants (28 patients) were placed, providing excellent retention and durability with the loss of only one implant in 15 years.
Asunto(s)
Deformidades Adquiridas Nasales/cirugía , Neoplasias Nasales/cirugía , Nariz/cirugía , Prótesis e Implantes , Retención de la Prótesis , Cigoma/trasplante , Anciano , Prótesis Dental de Soporte Implantado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Diseño Asistido por Computadora , Diseño de Equipo , Cara , Dispositivos de Protección de la Cabeza , Equipo Deportivo , Traumatismos en Atletas/prevención & control , Materiales Biocompatibles/química , Traumatismos Faciales/prevención & control , Humanos , Imagenología Tridimensional/métodos , Polietilenglicoles/química , Tereftalatos PolietilenosRESUMEN
The authors present the clinical results of their method of customized reconstruction of orbital wall defects using titanium mesh or sheet. High resolution computed tomography (CT) data are imported and processed to create a three-dimensional (3D) image which is used to reconstruct the orbital defect. Mirror imaging of the air in the contralateral maxillary sinus is used to overcome artefact defects in the floor. A stereolithographic model is constructed, from which titanium mesh or sheet is shaped and sized to the required contours for implantation. Twenty-two patients were treated using this technique from 2003 to 2008. Postoperatively 10 patients reported early resolution of their diplopia. Six patients noticed significant improvement of their symptoms with mild residual diplopia in one direction only and at the extremes of gaze at final review. One patient required ocular muscle surgery. Enophthalmos resolved in eight of the nine cases. No patients developed enophthalmos or diplopia as a postoperative complication. The use of titanium mesh for orbital floor reconstruction has been shown to be safe and effective. Customized titanium implants accurately reproduce orbital contours thus restoring orbital volume. This reduces operative time and improves the functional and aesthetic outcomes of post-traumatic orbital reconstruction.
Asunto(s)
Materiales Biocompatibles , Órbita/cirugía , Fracturas Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Mallas Quirúrgicas , Titanio , Adolescente , Adulto , Diseño Asistido por Computadora , Diplopía/cirugía , Enoftalmia/cirugía , Movimientos Oculares/fisiología , Femenino , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Modelos Anatómicos , Músculos Oculomotores/cirugía , Diseño de Prótesis , Implantación de Prótesis/métodos , Procedimientos de Cirugía Plástica/instrumentación , Estudios Retrospectivos , Seguridad , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Interfaz Usuario-Computador , Adulto JovenAsunto(s)
Diseño Asistido por Computadora , Tabique Nasal/cirugía , Prótesis e Implantes , Diseño de Prótesis , Tomografía Computarizada Espiral , Medios de Contraste , Gutapercha , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Enfermedades Nasales/cirugía , Elastómeros de Silicona , Tomografía Computarizada Espiral/métodosRESUMEN
This pilot research aims to identify and assess suitable technologies that may be used to capture, create, and produce fine textures and wrinkles that may be incorporated into computer aided prosthesis design and production techniques. A range of suitable technologies is identified and two methods that may be used in different prosthetic rehabilitation situations are assessed: the creation of three-dimensional relief in a computer aided design environment and the capture of facial anatomy and texture using fringe-projection surface scanning. Patterns were produced using the suitable rapid prototyping processes identified, and these were assessed by a qualified and experienced prosthetist. The suitability of the technologies is commented upon, limitations discussed, and future directions identified.
Asunto(s)
Cara/patología , Prótesis Maxilofacial , Modelos Biológicos , Procedimientos de Cirugía Plástica/instrumentación , Diseño de Prótesis/métodos , Procesamiento de Señales Asistido por Computador , Simulación por Computador , Diseño Asistido por Computadora , Análisis de Falla de Equipo/métodos , Cara/fisiopatología , Cara/cirugía , Humanos , Proyectos Piloto , Procedimientos de Cirugía Plástica/métodos , Propiedades de SuperficieRESUMEN
PURPOSE: The aim of this study was to acquire information on the types and longevity of implant-retained facial prostheses and the opinions of patients on several factors related to their prostheses. MATERIALS AND METHODS: A survey of 75 maxillofacial prosthetic patients currently under treatment and review at the Maxillofacial Unit, Morriston Regional Hospital was conducted through a 23-question postal questionnaire. These patients were selected as representative of a group of individuals receiving treatment or under review for the fabrication of maxillofacial prostheses. RESULTS: Of the prosthetic replacements, 83% were ear prostheses, 8% nose, 6% eye, and 2% combination prostheses. Of the 47 respondents, 8 (17%) reported that they were currently wearing their original prostheses. The remaining 39 (83%) respondents had all been provided with at least 1 replacement prosthesis. The mean lifetime of the prostheses was found to be 14 months (range: 4-36 months). The majority of replacement prostheses in this study were provided as a result of color fade or wear of the silicone material of the previous prosthesis. Individuals with no previous experience wearing a prosthesis had an unrealistic expectation of their prosthesis longevity, with a mean value of 17.8 months. In comparison, individuals with previous experience had reduced expectations, with a mean of 14.4 months. In terms of the patients' opinions of the overall quality of their prostheses, the results demonstrated that a large number of patients were satisfied. Thirty-five patients rated their prostheses as excellent and 9 as good. At 7-12 months, 4 patients rated their prostheses as excellent and 8 as good. At 13 months, 4 patients rated their prostheses as excellent and 5 as good. CONCLUSIONS: It is important that advice be given to patients on the expected average longevity of their prostheses, together with information on factors affecting the longevity (i.e., environmental staining, cosmetics, and cleaning regimes). In this study, 26% of the replacement prostheses were provided due to color fading of the original prosthesis. This highlights the need for continuing research in the development of materials used for the construction of facial prostheses with improved properties, and in particular, improved color stability.
Asunto(s)
Oído Externo , Nariz , Implantes Orbitales/psicología , Prótesis e Implantes/psicología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Niño , Ojo Artificial/economía , Ojo Artificial/psicología , Femenino , Costos de Hospital , Humanos , Masculino , Persona de Mediana Edad , Implantes Orbitales/economía , Satisfacción del Paciente , Prótesis e Implantes/economía , Coloración de Prótesis , Ajuste de Prótesis , Implantación de Prótesis/economía , Implantación de Prótesis/psicología , Encuestas y Cuestionarios , GalesRESUMEN
Hernia formation following harvest of bicortical iliac crest bone occurs infrequently as a late complication and may lead to chronic pain at the donor site and rarely to obstruction and strangulation of bowel. We describe the use of a custom-made titanium plate used to reconstruct the iliac donor site following harvest of a DCIA composite free flap. A pre-operative 3D CT and stereolithography model of the ilium are used to fabricate a titanium plate of the desired shape and size. This plate is used to reconstruct the donor site defect at the time of primary surgery. This technique may reduce late complications following DCIA composite free flap harvest.
Asunto(s)
Placas Óseas , Trasplante Óseo/efectos adversos , Ilion/lesiones , Procedimientos de Cirugía Plástica/instrumentación , Recolección de Tejidos y Órganos/efectos adversos , Hernia/etiología , Hernia/prevención & control , Humanos , Arteria Ilíaca/cirugía , Ilion/irrigación sanguínea , Colgajos Quirúrgicos/irrigación sanguínea , TitanioRESUMEN
The active metabolite (2) of the novel immunosuppressive agent leflunomide (1) has been shown to inhibit the enzyme dihydroorotate dehydrogenase (DHODH). This enzyme catalyzes the fourth step in de novo pyrimidine biosynthesis. A series of analogues of the active metabolite 2 have been synthesized. Their in vivo biological activity determined in rat and mouse delayed type hypersensitivity has been found to correlate well with their in vitro DHODH potency. The most promising compound (3) has shown activity in rat and mouse collagen (II)-induced arthritis models (ED50 = 2 and 31 mg/kg, respectively) and has shown a shorter half-life in man when compared with leflunomide. Clinical studies in rheumatoid arthritis are in progress.
Asunto(s)
Acrilamidas/síntesis química , Antiinflamatorios no Esteroideos/síntesis química , Inhibidores Enzimáticos/síntesis química , Oxidorreductasas actuantes sobre Donantes de Grupo CH-CH , Oxidorreductasas/antagonistas & inhibidores , Acrilamidas/farmacocinética , Acrilamidas/uso terapéutico , Animales , Antiinflamatorios no Esteroideos/farmacocinética , Antiinflamatorios no Esteroideos/uso terapéutico , Artritis Experimental/tratamiento farmacológico , Dihidroorotato Deshidrogenasa , Inhibidores Enzimáticos/farmacocinética , Inhibidores Enzimáticos/uso terapéutico , Femenino , Hipersensibilidad Tardía , Cinética , Espectroscopía de Resonancia Magnética , Masculino , Ratones , Ratones Endogámicos DBA , Ratas , Ratas Wistar , Espectrofotometría Infrarroja , Relación Estructura-ActividadRESUMEN
A behaviour rating scale intended primarily for use with mentally retarded children is described that is based on the behavioural descriptions of such children given by Pevsner (1963). A factor analysis showed that these descriptions could be viewed as being representable by two independent factors. The first of these factors, the AD factor may be seen to relate to attention/distractibility aspects of behaviour and shows a reliable correlation with verbal age and verbal quotient as assessed by the English Picture Vocabulary Test (EPVT), such that low EPVT scores predict greater distractibility. The second factor, the inhibition/excitation (IE) factor, did not correlate significantly with verbal age or verbal quotient but has, in other studies, shown relationships with style of social interaction and may be interpreted as relating to aspects of temperament. It is concluded that individual differences in the classroom behaviour of mentally retarded children may not be qualitatively different from those in non-retarded children and that the scale described is a useful instrument for measuring these individual differences.
Asunto(s)
Conducta , Discapacidad Intelectual/psicología , Adolescente , Atención , Niño , Preescolar , Análisis Factorial , Femenino , Humanos , Individualidad , Inhibición Psicológica , Inteligencia , Masculino , Conducta VerbalAsunto(s)
Aprendizaje Discriminativo , Educación de las Personas con Discapacidad Intelectual , Semántica , Conducta Verbal , Niño , Percepción de Color , Femenino , Humanos , Masculino , Aprendizaje por Asociación de Pares , Solución de Problemas , Transferencia de Experiencia en Psicología , Percepción VisualAsunto(s)
Aprendizaje Discriminativo , Educación de las Personas con Discapacidad Intelectual , Extinción Psicológica , Generalización del Estimulo , Adolescente , Nivel de Alerta , Niño , Percepción de Color , Condicionamiento Operante , Humanos , Inhibición Psicológica , Inteligencia , Personalidad , Refuerzo en PsicologíaRESUMEN
The use of discrimination learning paradigms in the study of attentional transfer is discussed. The technique of go/no-go discrimination learning followed by stimulus generalization testing is contrasted with the more familiar simultaneous learning paradigm followed by a shift in the relevant cues. In the former paradigm the effect of training a discrimination on one dimension on the slope of the stimulus generalization gradient on an independent gradient dimension (extra-dimensional training) is assessed. A steepening of the gradient relative to appropriate control procedures is taken as evidence of positive attentional transfer. The relevance of the technique to the detailed study of attentional transfer in educationally subnormal (severely) (ESN(S)) children is considered. In Expt. I nine ESN(S) children were trained in a go/no-go discrimination involving stimuli differing in orientation, and were generalization tested on a dimension that was orthogonal, namely hue. Of the six subjects who learnt the discrimination five showed clear decremental gradients on the hue dimension. In contrast a Pseudo-Discrimination group (PD) of eight subjects matched to those in the TD group showed no gradients. These subjects were not trained in the orientation discrimination, but were reinforced for responding on 50 per cent of each of the S+ and S- stimulus presentations. They thus received equal exposure to, but no differential training on, the orientation dimension. An S+ only group of four subjects who received no exposure to the orientation stimuli showed no gradients when stimulus generalization testing on the hue continuum was carried out. The result is discussed in terms of transfer deriving from stimulus control by relational aspects of the stimuli; in terms of control by constant irrelevant stimuli; and in terms of the study of stimulus control in ESN(S) children. In Expt. II the influence of the codability of the colours on the location of the peak of the stimulus generalization gradients in the TD group is investigated.