Rescuing“hopeless”avulsed teeth using autologous platelet-rich fibrin following delayed reimplantation:Two case reports

BACKGROUND Tooth avulsion is one of the most severe types of dental trauma.Most avulsed teeth undergo long-term ankylosis and replacement resorption after delayed reimplantation and exhibit a poor prognosis.The aim of this work was to improve the success rate of avulsed teeth after delayed reimplantation using autologous platelet-rich fibrin(PRF).CASE SUMMARY Case 1 was a 14-year-old boy who fell and knocked out his left upper central incisor 18 h prior to his arrival at the department.The diagnoses were avulsion of tooth 21,lateral luxation of tooth 11 and alveolar fracture of teeth 11 and 21.In case 2,a 17-year-old boy fell 2 h prior to his presentation to the hospital,and his left upper lateral incisor was completely knocked out of the alveolar socket.The diagnoses included avulsion of tooth 22,complicated crown fracture of tooth 11and complicated crown-root fracture of tooth 21.The avulsed teeth were reimplanted along with autologous PRF granules and splinted using a semiflexible titanium preshaped labial arch.The root canals of the avulsed teeth were filled with calcium hydroxide paste,and root canal filling was performed 4 wk after reimplantation.The reimplanted teeth showed no symptoms of inflammatory root resorption or ankylosis at the 3-,6-,and 12-mo follow-up examinations after reimplantation with autologous PRF.In addition to the avulsed teeth,the other injured teeth were treated using corresponding conventional treatment methods.CONCLUSION These cases provide examples of the successful use of PRF to reduce pathological root resorption of the avulsed teeth,and the application of PRF may provide new healing opportunities for traditionally“hopeless”avulsed teeth.

Long term outcomes of Cohen’s cross trigonal reimplantation for primary vesicoureteral reflux in poorly functioning kidney

BACKGROUND Open ureteric reimplantation by cross trigonal technique described by Cohen is considered a common surgical option for correction of vesicoureteral reflux(VUR). There is a lack of evidence in literature though for what happens to such kidneys, in the long run, particularly those which are poorly functioning.AIM To assess the long-term outcomes of ureteric reimplantation in poorly functioning kidneys in children with unilateral primary VUR.METHODS Children with unilateral primary VUR and a relative renal function of less than 35% who underwent open or laparoscopic ureteric reimplantation between January 2005 and January 2017 were included in the study. Patients who had a follow up of less than five years were excluded. Preoperative evaluation consisted of a voiding cystourethrogram and Dimercaptosuccinic acid(DMSA) scan. In the follow-up period, patients underwent a diuretic scan at 6 weeks and 6 months.Follow up ultrasound was done for change in grade of hydronephrosis and retrovesical ureteric diameter. Subsequent follow up was done at 6 monthly intervals with evaluation for proteinuria and hypertension and any recurrent urinary tract infection(UTI). For assessment of cortical function, DMSA was repeated annually for 5 years after surgery. A paired-samples t-test was used to test the mean difference of DMSA between pre-post observations.RESULTS During this period, 36 children underwent ureteric reimplantation for unilateral primary VUR. After excluding those with insufficient follow-up, 31 were included in the analysis. Most of the patients were males(n = 26/31, 83.8%). Patient’s age(mean ± SD, range) was 5.21 ± 3.71, 1-18 years. The grades of VUR were grade Ⅱ(1patient), grade Ⅲ(8 patients), grade Ⅳ(10 patients), and grade Ⅴ(12 patients). The pre and postoperative DMSA was 24.064 ± 12.02 and 24.06 ± 10.93, which was almost the same(statistically equal, paired-samples t-test: P = 0.873). The median(range) follow-up duration was 82(60-120)mo. One patient had persistent reflux after surgery(preoperative: grade Ⅳ, postoperative: grade Ⅲ), and the very same patient developed recurrent UTI. The difference in the preoperative and postoperative DRF was less than 10% in 29 patients. In one patient, the DRF decreased by 17%(22% to 05%) while in another patient, the DRF increased by 12%(25% to 37%) after surgery. None of the patients had an increase in scarring after surgery. 15% of patients were hypertensive before surgery and all of them continued to be hypertensive after surgery while none developed hypertension after surgery. None of the patients had significant proteinuria(> 150 mg/d) during the follow-up period.CONCLUSION Children with unilateral primary VUR and poorly functioning kidney maintain the renal function over the long term in most cases. Hypertension and proteinuria do not progress over time in these patients.

Is two-stage reimplantation effective for virulent pathogenic infection in a periprosthetic hip? A retrospective analysis

AIM: To investigate the effectiveness of two-stage reimplantation using antibiotic-loaded bone cement(ALBC) and the risk factors associated with failure to control periprosthetic joint infection(PJI).METHODS: We retrospectively reviewed 38 consecutive hips managed using two-stage reimplantation with ALBC. The mean follow-up period was 5.4 years(range: 2.5-9 years). RESULTS: The causative pathogens were isolated from 29 patients(76%), 26 of whom were infected with highly virulent organisms. Sixteen patients(42%) underwent at least two first-stage debridements. An increased debridement frequency correlated significantly with high comorbidity(P < 0.001), a lower preoperative Harris hip score(HHS; P < 0.001), antimicrobial resistance, and gram-negative and polymicrobial infection(P = 0.002). Of the 35 patients who underwent two-stage reimplantation, 34 showed no signs of recurrence of infection. The mean HHS improved from 46 ± 12.64 to 78 ± 10.55 points, with 7(20%), 12(34%), 11(32%)and 5(14%) patients receiving excellent, good, fair and poor ratings, respectively. CONCLUSION: The current study demonstrated that two-stage reimplantation could successfully treat PJI after hip arthroplasty. However, the ability of ALBC to eradicate infection was limited because frequent debridement was required in high-risk patients(i.e., patients who are either in poor general health due to associated comorbidities or harbor infections due to highly virulent, difficult-to-treat organisms). Level of evidence: Level Ⅳ.

A Rare Case of Late LAD Reimplantation after Arterial Switch Operation

Arterial switch operation(ASO)is a complex neonatal operation in which transfer of the coronary arteries origins is the key to success.Coronary events after a successful ASO are not uncommon.We describe a rare case of a child who underwent an ASO in the neonatal period with one coronary(LAD)described as atretic left in place.At age seven,he developed myocardial ischemia due to retrograde flow with a steal phenomenon from the LAD into the pulmonary artery.The patient underwent a late LAD reimplantation.This case underscores that even very small ostia should be translocated at the time of ASO.

Interventional Radiology Procedures after Pediatric Pyeloplasty and Ureteral Reimplantation in Patients with Postoperative Obstruction

Introduction: Obstructive complication after pyeloplasty or ureteral reimplant surgery is a rare though worrisome problem in pediatric urology. These are often complex patients with complicated post-operative courses that at times require interventional radiology procedures. The current literature is lacking in guiding principles to manage these complications. In this study we have reviewed these difficult to manage patients at our children’s hospital over the past 15 years. Methods: A list of patients who underwent interventional radiology procedures to place nephrostomy tubes or internal double-J ureteral stents was compared a list of patients undergoing pyeloplasty or reimplant procedures. These lists were cross-referenced to a list of patients undergoing cystoscopic removal of double-J stents. This small patient group does not represent all complications but those with radiology intervention. Results: At our institution, during the years 1998-2011 we performed 458 pyeloplasties and 3003 open ureteral reimplant procedures. 14 (0.4%) met all of the inclusion criteria. The long term outcome of these problems showed 11 of these patients went on to stability or improvement with either percutaneous drainage or JJ stent placement alone, and three of the reimplant patients ultimately required redo surgery. Of our pyeloplasty patients only three required percutaneous nephrostomy tube, and one went on to JJ stent placement (0.66% of pyeloplasties). No patients in the pyeloplasty group needed surgical revision. Of patients how had undergone ureteral reimplantation, with or without tapering, seven of them underwent interventional radiology procedures (0.23% of reimplant patients). Conclusion: Pediatric urology patients with persistent obstruction after pyeloplasties and ureteral reimplantation surgery with or without tapering who needed interventional radiology rescue procedure resolved or stabilized in 11 of 14 patients. Surgical revision was performed in only 3 of our 14 patients after months of conservative trial after interventional radiologic procedures.

Facial Nerve Stimulation can Improve after Cochlear Reimplantation and Postoperative Advanced Programming Techniques: Case Report

We had a case of 75-year old man with a history of progressive hearing loss on both side who implanted with a Nucleus 24 Contour Advance in the right ear. After 4 years from implantation, the patient started to complaint of right facial twitching when his cochlear implant was active. Despite undergoing numerous alterations in his implant programming, facial nerve stimulation (FNS) persisted. After increasing the pulse width and changing the stimulation mode, there was no facial nerve stimulation. However there was a deterioration in hearing and speech understanding. CT of the temporal bone showed good position of the implant electrodes und cochleomeatal scintigraphy (CMS) showed a highly positive activity with suspicion of otosclerosis, although the medical history was negative for otosclerosis. The FNS was managed with cochlea reimplantation and advanced programming techniques. FNS in cochlear implant patients may be managed through reimplantation and advanced programming techniques.

Ureterovesical Reimplantation in the Teaching Clinic of Urology and Andrology at HKM National Teaching Hospital of Cotonou: Indications, Techniques and Outcomes: About 36 Cases

Introduction: The presence of an obstacle in upper urinary tract, threatens kidneys and therapeutic arsenal includes an ureterovesical reimplantation especially in the case of lower ureteral obstacles. Ureterovesical reimplantation (UVR) techniques are numerous with each of its advantages and disadvantages. In order to review indications, techniques and the outcomes of the ureterovesical reimplantation in our context of work, we made this study. Material and Method: It was a retrospective, transversal, descriptive and analytic study conducted over a period of 10 years, in the department of urology University Hospital Center Hubert Koutoukou Maga of Cotonou. Patients over 15 years of age who have had a ureterovesical relocation had been included. Results: Thirty-six files were selected. Ureterovesical relocations accounted for 1.8% of surgical procedures. The ligatures iatrogenic ureters and vesico-vaginal fistulas were the most frequently involved in 33.4% and 27.8% respectively. The ureterovesical reimplantation was performed without anti-reflux plasty at 36.1% of patients. The technique of Politano-Leadbetter had been most accomplished, in 82.6% of the cases in which anti-reflux plasty had been made. Suites had been simple in 63.9% of patients. Postoperative complications were dominated by parietal suppurations and vesicocutaneous fistulas in respectively 6 and 4 patients. Conclusion: Ureterovesical reimplantations are interventions that require from the urologist a perfect knowledge given their complexity and the emergency context in which one may be led to practice them. They answer to general principles that reduce operative morbidity.

Surface demineralized freeze-dried bone allograft followed by reimplantation in a failed mandibular dental implant

The removal of a failed implant with high torque causes significant damage to the surrounding tissue,compromising bone regeneration and subsequent osseointegration in the defect area.Here,we report a case of carrier screw fracture followed by immediate implant removal,bone grafting and delayed reimplantation.A dental implant with a fractured central carrier screw was removed using the bur-forceps technique.The resulting three-wall bone defect was filled with granular surface demineralized freeze-dried bone allograft(SD-FDBA).Cone-beam computerized tomography was performed at 1week,6months and 15months postoperatively and standardized for quantitative evaluation.The alveolar bone width and height at 15months post-surgery were about 91%of the original values,with a slightly lower bone density,calculated using the gray value ratio.The graft site was reopened and was found to be completely healed with dense and vascularized bone along with some residual bone graft.Reimplantation followed by restoration was performed 8months later.The quality of regenerated bone following SD-FDBA grafting was adequate for osseointegration and longterm implant success.The excellent osteogenic properties of SD-FDBA are attributed to its human origin,cortical bone-like structure,partly demineralized surfaces and bone morphogenetic protein-2-containing nature.Further investigation with more cases and longer follow-up was required to confirm the final clinical effect.

A potential long-term complication to two-segment total scalp replantation and how to treat it

Total avulsion of the scalp is a serious traumatic injury and an absolute surgical emergency.Despite well-stocked literature on its immediate care,there is insufficient literature regarding its long-term complications.Here,we describe the case of a patient who developed chronic pain 24 months after replantation.The patient underwent several needle rigotomy sessions associated with lipofilling to reconstruct a sliding plane between the scalp and periosteum,followed by nanofat sessions to improve skin elasticity.This autologous fat injection treatment was successful,and the patient is currently pain-free.Therefore,lipofilling followed by nanofat injection is an effective treatment for this complication.

Two-stage revision in periprosthetic knee joint infections

Periprosthetic joint infection(PJI)following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens.The road to efficiently diagnosing and treating PJI is challenging,as there is still no gold standard method to reach the diagnosis as early as desired.There are also international controversies with respect to the best approach to manage PJI cases.In this review,we highlight recent advances in managing PJI following knee arthroplasty surgery and discuss in depth the two-stage revision method.

Determining the Utility of Pathologic Analysis of Ureteral Specimens Obtained from Repair of Vesicoureteral Reflux and Ureterovesical Junction Obstruction in Children: Potential for Physician-Initiated Cost-Reduction

Purpose: Partial resection of the distal ureter is commonly performed during reconstructive surgery in pediatric urology;particularly for correction of vesicoureteral reflux (VUR) and ureterovesical junction obstruction (UVJO). Many hospitals require pathologic examination of all excised tissues. We examined the pathologic findings in such specimens to evaluate the utility of this practice. Methods: We reviewed the findings on pathologic examination of distal ureteral segments excised during surgical correction of VUR and UVJO in children by a single surgeon over a 13-year period. Results: One hundred and ninety-one specimens from 126 patients were reviewed. None were found to have any significant pathologic findings that impacted therapy. Conclusion: Routine pathological examination of distal ureteral segments excised during surgical correction of VUR and UVJO is not warranted. This presents potential for cost and resource reduction in care of these patients.

Arterial mechanical properties after replacement or reconstruction of the aortic root

Background: Alteration of arterial mechanical properties has adverse effects on cardiovascular disease in Marfan syndrome. Design: We compared central pulse pressure, augmentation index adjusted to a heart rate of 75 beats per minute (AIx@HR75) and pulse wave velocity in 25 Marfan patients who had under-gone an aortic valve-sparing reimplantation operation, in 15 Marfan patients after composite valve grafting operation, and in 40 age and sex-matched Mar-fan patients who had not undergone surgery. Results: Central pulse pressure, AIx@HR75 and pulse wave velocity were similar across all three patient groups. Exclusively AIx@HR75 was higher with conduit operations than in persons without any surgery (P = 0.03). Multivariate linear regression analysis documented association of AIx@HR75 with body height (P < 0.001) and with a history of aortic valve-sparing reimplantation operation (P < 0.001) or with a composite valve grafting operation (P = 0.006). Conclusions: Arterial mechanical properties are only mildly altered by surgery of the aortic root without difference between the reimplantation and conduit operation.