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Purpose of review As glaucoma surgeons continue to search for an improvement over trabeculectomy, the ExPRESS miniature glaucoma shunt has gained interest as a possible contender. Peer-reviewed literature on ExPRESS is beginning to accumulate allowing an evidence-based review to assess the potential benefits and limitations compared to trabeculectomy. Recent findings The current surgical procedure for ExPRESS implantation will be described followed by results of studies comparing ExPRESS to trabeculectomy, focusing on the following outcomes: success, intraocular pressure, and complications. Case reports of late complications specific to the ExPRESS device will be summarized. Finally, an economic analysis comparing ExPRESS to trabeculectomy will be provided as additional evidence to contribute to the decision matrix on deciding which filtration procedure to recommend. Summary Despite a large number of ExPRESS implant procedures worldwide, there is a paucity of high-quality studies comparing ExPRESS to trabeculectomy. From the available literature to date the outcomes (success and early complications) of ExPRESS are similar to trabeculectomy. Reports of late complications related to device extrusion and malposition are beginning to be published; however, the significantly increased cost for ExPRESS surgery is likely to be the main limitation to widespread adoption of this procedure.

The implantable cardioverter-defibrillator (ICD) has evolved rapidly since its clinical introduction; product life cycles have been exceedingly short. This swift transition from early shock-only devices to small, programmable, tiered-therapy systems has been driven by 2 major factors: minimally invasive implant procedures and technological innovation. Yet, while many new ICD systems have been introduced recently, even more advanced products are on the horizon before the year 2000 and beyond. In general, devices will be smaller and smarter. Certainly, ICD volume will be further reduced without detrimentally affecting longevity. Endocardial lead systems will become smaller and more versatile. Rhythm discrimination algorithms will become more effective. New adaptive-rate pacing systems that limit the maximum paced rate based on hemodynamic indices will become features of tachyarrhythmia products. Pacing schemes for prevention of supraventricular tachyarrhythmias and improvement of hemodynamic function in patients with congestive heart failure will likely be introduced for clinical evaluation. (Am J Cardiol 1996;78(suppl 5A):108–115)

We investigated whether a "yearly" histrelin implant would provide pubertal suppression when left in place for 2 years. Equivalent suppression was observed when comparing 12 and 24 months in 33 children with central precocious puberty. A single implant for 2 years reduces cost and number of implant procedures.

The primary function of the human dentition is preparation and processing of food through a biomechanical process of biting and chewing. This process is based on the transfer of masticatory forces, mediated through the teeth (Versluis & Tantbirojn, 2011). The intraoral environment is a complex biomechanical system. Because of this complexity and limited access, most biomechanical research of the oral environment such as restorative, prosthetic, root canal, orthodontic and implant procedures has been performed in vitro (Assuncao et al., 2009). In the in vitro biomechanical analysis of tooth structures and restorative materials, destructive mechanical tests for determination of fracture resistance and mechanical properties are important means of analyzing tooth behavior. These tests, however, are limited with regard to obtaining information about the internal behavior of the structures studied. Furthermore, biomechanics are not only of interest at the limits of fracture or failure, but biomechanics are also important during normal function, for understanding property-structure relationships, and for tissue response to stress and strain. For a more precise interrogation of oral biomechanical systems, analysis by means of computational techniques is desirable.

The aim of this study was to evaluate whether steroid membrane leads can reduce pacing thresholds and thereby save energy as compared to nonsteroid membrane leads. The study was a random sample, double blind test consisting of 90 patients between 49-94 years of age admitted to seven hospitals in Europe for pacemaker implantation. The two leads compared in this study had contoured activated carbon tips covered with ion exchange membranes. The leads were identical except that 30 micrograms of dexamethasone was dissolved in the ion exchange membrane of one of the leads. Normal lead implant procedures were used. Follow-up procedures were conducted at 2 weeks and 1, 3, 6, and 12 months after lead implantation. The pulse generator was programmed to an amplitude of 2.5 or 5 V and a duration of 0.5 msec. The stimulation threshold was measured using the VARIO function. The threshold was measured a total of three times in order to determine the presence of microdislocations. At the 2- and 4-week follow-ups, the stimulation threshold was significantly lower for the steroid leads than for the membrane leads without steroid (0.54 +/- 0.19 vs 0.76 +/- 0.25 V, P = 0.0005; and 0.59 +/- 0.19 vs 0.74 +/- 0.26 V, P = 0.005), but after 3 months, the threshold values were almost the same for both leads.

BACKGROUND: The Intrastromal Corneal Ring (ICR) is a new investigational medical device designed to alter corneal curvature without surgical intervention in the central cornea. The ring is inserted between the layers of the stroma in the cornea's periphery at two-thirds depth through an approximately 2-millimeter incision. METHODS: To investigate the safety and refractive effect of implanting an ICR of a given thickness (0.30 mm) and outer diameter (7.70 mm) into human corneas, an ICR was implanted into one nonfunctional eye of each of three patients during the period of March to May, 1991. One predesignated ICR was successfully explanted 5 months after implantation to evaluate the feasibility of ICR removal and to observe the effect of ring removal on corneal curvature. Patients were followed for 1 year after the initial implant procedure. RESULTS: The three implant procedures and postoperative courses proceeded without any significant complications. Approximately 2.00 D of central corneal flattening was achieved in all eyes. No adverse reactions or other medically-significant complications were observed over a 1 -year follow-up period. The patient who underwent ICR removal experienced no perioperative complications, and the patient's cornea has remained stable with a return to its preoperative curvature. CONCLUSION: Although this study is preliminary and limited in scope, we have demonstrated that the ICR can be tolerated safely in the human cornea and results in a flattening of the corneal curvature that is stable for up to a year after insertion. The successful removal of the ICR begins to establish reversibility of the procedure and induced refractive effect. Refract Corneal Surg. 1993;9:452-458.) SOMMARIO PREMESSA: L'Anello Corneale lntrastromale (ICR) é un nuovo ritrovato medico, ancora sperimentale, progettato per modificare la curvatura corneale senza intervenire chirurgicamente sulla cornea centrale. L'anello viene inserito tra gli strati stromali periferici, ad una profondità di 2/3 dello spessore corneale, attraverso una incisione di circa 2 mm. METODI: Per valutare la sicurezza e l'effetto refrattivo dell'impianto in cornea umana di un ICR di spessore (0.30 mm) e diametro estemo (7.70 mm) predeterminati, un ICR é stato impiantato in un occhio non vedente di tre diversi pazienti, nel periodo Marzo-Maggio 1991. Un impianto predesignato é stato poi espiantato, con successo, dopo 5 mesi, per valutare le possibilità di rimozione ed i conseguenti effetti sulla curvatura comeale. Ogni paziente é stato seguito e controllato per un anno dopo l'iniziale intervento. RISULTATI: I tre interventi chirurgici ed i relativi decorsi postoperatori sono risultati privi di complicanze. In tutti i pazienti si é ottenuto un appiattimento di circa 2 diottrie della cornea centrale. Nel periodo di osservazione di un anno dopo l'intervento non si sono manifestate reazioni avverse od altre complicanze clinicamente significativo. Il paziente sottoposto ad asportazione dell'ICR non ha sofferto di complicanze postoperatorie e la sua comea é rimasta stabile, con un ritomo alla curvatura preoperatoria.

s S333 537 LONG-TERM SURVIVAL AFTER IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IMPLANTATION: A POPULATION-BASED STUDY M Bennett, D Ayers, L Ding, H Jackson, A Krahn Vancouver, British Columbia BACKGROUND: In the era of potential differences in Implantable Cardioverter Defibrillator (ICD) complexity and longevity, an estimation of patient lifespanmay allow for patient specific device selection that influence both clinical utility and cost-effectiveness of the device.We sought to evaluate patient survival from British Columbia’s Implantable Arrhythmia Device Registry. METHODS: All BC patients aged 20 or older, who underwent ICD implants or generator replacement from 01 January 2000 to 31 December 2012, were included in this study. Patient demographic, clinical, procedural, device-related data were obtained from the BC Cardiac Services Registry. Mortality data were obtained from the Vital StatisticsAgency.Theprobabilities of survivalwere estimatedby the Kaplan-Meier method with all-cause mortality as the end-point. RESULTS: 5241 patients (4282 male, 81.7%; 959 female, 18.3%) underwent 6929 ICD implantations (4369 initial implants; 2560 generator changes) with a total of 268,001 patientyears of follow-up. Five and 10year survival rateswere 76.6%and 60.9% respectively. The median patient age was 66 years (IQR: 57, 73). Patients were divided into 10 year age groups. The percentage of patients surviving greater than 5 years from last procedure in the 41-50, 51-60, 61-70, 71-80, and 81-90 year age groupswas 91.0, 86.2, 78.7, 63.0, and49.0, respectively.The percentage of patients surviving greater than 10 years in the 4150, 51-60, 61-70, 71-80, and 81-90 year age groups was 81.6, 73.5, 58.4, 39.0, and 28.1, respectively. Overall, women had a significantly longer survival thanmen (5 year survival rate 82.9 vs. 75.1%), as a consequence of amarkedly lower age at implantation (median 62 years vs. 66 years, P

The excellent success through many implant systems such as the osseointegrated and others have been directed toward reducing the interest and research effort for removable prosthesis over the past few years.The need to improve the quality of removable partial dentures through research, however, will remain at a high level because the implant procedures will never eliminate removable prosthodontics at an early date.The research for the removable prosthesis, especially the movement of the abutment tooth, has been investigated in various ways such as by strain gauge, photoelastic and finite element methods, including a few experiment executedin vivo. All of them, however, have disadvantages respectively, so more effective methods for observation of the abutment tooth behaviors have been waiting for.Authors have undertaken some experiments on the abutment teeth behaviors under loading by a new analysing method that combined with MKG to the Frechette's method.This study was to analyse and evaluate the movements of the mesial abutment tooth in the tooth-supported segment on Kennedy Class II Modification 1 simulation model by the same method.The results were as follows;1. As the constructred factors were reduced from the original design of the RPD, the abutment tooth movements increased gradually.2. The greatest movements were recognized under the lingual load, and the minimum ones under the vertical load.3. Few movements toward the mesial direction were observed in every design.4. Movements toward the linguo-distal direction were remarkably noticed on almost designs.

A proficient knowledge of oral anatomy is needed to provide effective implant dentistry. This article addresses basic anatomic structures relevant to the dental implantologist. Pertinent muscles, blood supply, foramen, and nerve innervations that may be encountered during implant procedures are reviewed. Caution must be exercised when performing surgery in certain regions of the mouth. Furthermore, numerous suggestions are provided regarding the practical application of anatomy to facilitate successful implant therapy.

For those performing implant treatment, continued research and reports of long-term successful results are essential to evaluating the validity of implants, especially when variables such as design and surface treatment are introduced. The dental profession has enthusiastically embraced the clinical results of implant treatment and its benefits to the patient. However, just as patients who undergo periodontal and restorative treatment must continue a regular long-term routine of maintenance therapy to ensure their dental health, so must those patients who receive dental implants. Both the periodontist who places the implants and the dentist who fabricates the prosthetic replacement must work cooperatively to deliver a healthy restoration that will function for many years.

Objective of the seminar was to present for the common illness backache from the sports orthopaedic, traumatologic, sports medical, from the internal, from the pain therapeutic, neurosurgical and from the physiotherapeutic point of view new ways of looking at, based on physiologic, pathophysiologic knowledge, with relevance for prevention and therapy of the common problem backache.The low back pain as a result of the special quality of the "biped" in the time of hypomobilization and hyperalimentation - lumbar and cervical spine complaints (Udo Schreiber, MD, Frankfurt/Main): The back pain - especially the low back pain - is probably mostly caused by static disorders. In Germany the incidence of back pain within a lifetime is nearly 80 %. Dr. Schreiber explained that the anatomical length difference of the legs leads to a variety of pathological situations in the musculo-sceletal system. The pathologic changes - for instance transversal push to the ileosacral joint - mostly appear at the side of the longer leg with a scoliosis of the spinal column with increased pressure loads on the concave side of the scoliosis in the intervertebral disks and with typical blockings in different vertebral segments. Adequate diagnosis includes anamnesis and extensive clinical examination to recognize functional deficits instead of only imaging diagnostics. Useful therapies are - besides analgetic therapies, like manual therapy, matrix rhythm therapy, water-filtered infrared A (wIRA), ear acupuncture, magnetic field resonance therapy, micro current therapy, injection therapy - primarily the therapeutic preventive procedures stretching of shortened musculature and partial compensation of leg length differences. From an economical point of view static disorders cause immense indirect and direct disease costs, whereas the described adequate therapies are effective as well as economical.A holistic therapy concept with matrix rhythm therapy, hyperthermia, oxygen and anti-acidification - therapy of musculo-sceletal disorders (Bernhard Dickreiter, MD, Nordrach): The costs for the treatment of back pain burden the health insurance companies by diagnostic and therapy costs as well as the companies by sick-times increasingly in the past years. From the point of view of Dr. Dickreiter back school concepts of the past years have not shown the desired effects. Promising new aspects of handling of this clinical picture arise from the current results of the cellbiological basic researches and the new "matrix therapy concept" derived from it: The cause of the musculo-sceletal complaints in the sense of a myo-fascial, myo-ischemic-acidotic and myo-tendinitic pain syndrome is seen in the hardening of the musculature with an energy crisis at a cellular level. Within the new therapy concept there is not an abundance of treatments in the center of attention as before, but a modular concept in line with effectiveness, which affects the cellbiological processes especially at the extracellular matrix level. Essential parts of the concept are the matrix rhythm therapy as depth effective micro extension method, the local warming by water-filtered infrared A (wIRA) or the infrared whole body hyperthermia, the physical activity for the local improvement of oxygen supply, the oxygen therapy including hyperbaric oxygen therapy (HBO) and the orthomolecular substitution and "healthy" nutrition.Conservative, interventional and operative procedures from the point of view of the pain therapist and neurosurgeon: Place value with regard to an integrated medical treatment concept (Volker Ritzel, MD, Offenbach/Main): Backache can be treated successfully with an interdisciplinary therapy concept (general practitioner; orthopedics, neurosurgery, analgesic therapy, physiotherapy, psychotherapy) multimodal with use of conservative, interventional and operative procedures today. Special emphasis has to be laid on a sufficient therapy on time (among others protective, anticipating analgesia) to avoid the development of a pain memory with chronification of the pain and becoming independent from causes. Besides a drug based analgesic therapy in accordance with the WHO step scheme the transcutaneous electrical nerve stimulation (TENS), physiotherapy, psychotherapy, practicing procedures (progressive muscle relaxation by Jakobsen, autogenous training, Göttingen active back program GRAP), ergotherapy, acupuncture and balneotherapy belong to the conservative therapy possibilities. Further pain therapeutic, neurosurgical procedures are the therapeutic regional anesthesia, computed tomography controlled procedures, the percutaneous laser disk decompression, denervational procedures, the endoscopic sequestrectomy, the vertebroplasty, open operative procedures, the microsurgical decompression as well as implant procedures as the minimal-invasive cervical and lumbar spondylodesis. Today, outpatient procedures can be carried out in neurosurgical clinics in the context of a modern integrated care program.Back school for primary, secondary and tertiary prevention - lifestyle change, physiotherapy - in the age of integrated ambulatory care (Monika Kremer, Frankfurt am Main): Modern therapy strategies prefer - as far as possible - a conservative instead of an operative procedure, an active instead of a passive, a multimodal instead of a monotherapeutic procedure. Activities of motion and training therapy (e.g. extended ambulatory physiotherapy EAP as a complex therapy with the components physiotherapy, physical therapy and medical training therapy MTT) are important parts of modern back concepts. The working place conditions are taken into account particularly with an increasing integration of ergonomics training programs. The concept "preventive back school" covers the arrangement and application of effective everyday strategies to avoid great strain on the back to prevent the development of functional and degenerative diseases especially in the area of the spinal column including muscular dysbalances. An everyday behavior suitable for the back (e.g. correct lifting and carrying near the body) is included. Particularly effective are active training programs for the improvement of musculature and endurance in combination with behavior oriented training programs with the objective to improve well-being and quality of life. The concept of the Research and Prevention Center Cologne (FPZ), the Kieser-training, the Baunatal back concept (BRK) and the tergumed® back concept are explained. Frequently backache can be avoided by behaviors suitable for the back and by preventive and rehabilitative back training or a painless stable health status can be reached again in a rehabilitative sense after its occurrence. Ziel des Seminars war es, für die "Volkskrankheit Rückenschmerz" vom sportorthopädisch-traumatologisch-sportmedizinischen, vom internistischen, vom schmerztherapeutisch-neurochirurgischen und vom physiotherapeutischen Standpunkt aus neue, auf physiologisch-pathophysiologischen Kenntnissen basierende Sichtweisen mit Relevanz für Prävention und Therapie des verbreiteten Problems Rückenschmerz zu präsentieren. Der Rückenschmerz als Folge der biomechanischen Besonderheit des "Zweibeiners" im Zeitalter der Hypomobilisation und Hyperalimentation - Lendenwirbelsäulen- und Halswirbelsäulen-Beschwerden (Dr. med. Udo Schreiber, Frankfurt am Main): Der Rückenschmerz - besonders der tiefe Rückenschmerz - des Menschen ist wahrscheinlich meist durch eine Fehlstatik verursacht. In Deutschland beträgt die Inzidenz von Rückenschmerzen während des Lebens fast 80%. Dr. Schreiber legte dar, dass die anatomische Längendifferenz der Beine zu verschiedenen Pathologien im Halte- und Bewegungsapparat führt. Die pathologischen Veränderungen - z.B. transversaler Schub auf das Ileosakralgelenk - treten meistens auf der längeren Beinseite mit einer Skoliose der Wirbelsäule mit erhöhten Druckbelastungen auf der Konkavseite der Skoliose in den Bandscheiben und mit typischen Blockaden in den verschiedenen Wirbelsäulensegmenten auf. Sinnvolle Diagnostik beinhaltet Anamnese und umfangreiche klinische Untersuchung zum Erkennen von Funktionsdefiziten anstelle von nur bildgebender Diagnostik. Sinnvolle Therapien sind - neben analgetischen Therapien, wie manueller Therapie, Matrix-Rhythmus-Therapie, wassergefiltertem Infrarot A (wIRA), Ohrakupunktur, Magnetfeldresonanztherapie, Mikrostromtherapie, Injektionstherapie - vor allem die therapeutisch-präventiven Maßnahmen Dehnen verkürzter Muskulatur und partieller Ausgleich von Beinlängendifferenzen. Wirtschaftlich gesehen verursacht die Fehlstatik immense indirekte und direkte Krankheitskosten, wobei die aufgezeigten sinnvollen Therapien zielführend und zugleich kostengünstig sind.Ein ganzheitliches Therapiekonzept mit Matrix-Rhythmus-Therapie, Hyperthermie, Sauerstoff und Entsäuerung - Therapie von muskulo-skelettalen Beschwerden (Dr. med. Bernhard Dickreiter, Nordrach): Die Kosten zur Behandlung von Rückenschmerzen belasten in den vergangenen Jahren zunehmend die Krankenkassen durch Diagnose- und Therapiekosten sowie die Betriebe durch Ausfallzeiten. Rückenschulkonzepte der vergangenen Jahre zeigen aus Sicht von Dr. Dickreiter nicht den gewünschten Effekt. Vielversprechende neue Sichtweisen für den Umgang mit diesem Krankheitsbild ergeben sich aus den aktuellen Ergebnissen der zellbiologischen Grundlagenforschungen und dem daraus resultierenden neuen "Matrix-Therapie-Konzept": Die Ursache der muskulo-skelettalen Beschwerden im Sinne eines myofaszialen, myo-ischämisch-azidotischen und myotendinitischen Schmerzsyndroms wird in der Verspannung der Muskulatur mit einer Energiekrise auf zellulärer Ebene gesehen. Beim neuen Therapiekonzept steht nicht eine Therapiefülle wie bisher im Vordergrund, sondern ein auf Effektivität ausgerichtetes modulares Konzept, welches die zellbiologischen Prozesse auf extrazellulärer Matrixebene gezielt beeinflusst. Wesentliche Bestandteile des Konzepts sind die Matrix-Rhythmus-Therapie als tiefenwirksame Mikroextensionstechnik, die lokale Wärme mit wassergefiltertem Infrarot A (wIRA) bzw. die Infrarot-Ganzkörperhyperthermie, die körperliche Bewegung zur lokalen Verbesserung der Sauerstoffversorgung, die Sauerstofftherapie einschließlich Hyperbarer Oxygenation (HBO) und die orthomolekulare Substitution und "gesunde" Ernährung. Konservative, interventionelle und operative Verfahren aus der Sicht des Schmerztherapeuten und Neurochirurgen: Stellenwert im Hinblick auf ein integriertes Behandlungskonzept (Dr. med. Volker Ritzel, Offenbach am Main): Mit einem interdisziplinären Therapiekonzept (Hausarzt; Orthopädie, Neurochirurgie, Schmerztherapie, Krankengymnastik/Physiotherapie, Psychotherapie) multimodal mit Nutzung konservativer, interventioneller und operativer Verfahren können heute Rückenschmerzen erfolgreich behandelt werden. Dabei ist besonders auf eine rechtzeitige suffiziente Therapie Wert zu legen (u.a. protektive, antizipierende Analgesie), um die Ausbildung eines Schmerzgedächtnisses mit Chronifizierung und Verselbstständigung des Schmerzes zu vermeiden. Zu den konservativen Therapiemöglichkeiten gehören neben einer medikamentösen Schmerztherapie nach dem WHO-Stufenschema die Transkutane elektrische Nervenstimulation (TENS), Physiotherapie, Psychotherapie, übende Verfahren (Progressive Muskelentspannung nach Jakobsen, Autogenes Training, Göttinger Rücken-Aktiv-Programm GRAP), Ergotherapie, Akupunktur und Balneotherapie. Weitere schmerztherapeutisch-neurochirurgische Verfahren sind die therapeutische Lokalanästhesie, CT-gesteuerte Verfahren, die perkutane Laser-Diskus-Dekompression, denervierende Verfahren, die endoskopische Sequestrektomie, die Vertebroplastie, offen-operative Verfahren, die mikrochirurgische Dekompression sowie Implantatverfahren wie die minimal-invasive zervikale und lumbale Spondylodese. Ambulante/Praxisklinische Operationen können heute in einer neurochirurgischen Praxisklinik im Rahmen des modernen Konzepts der Integrationsversorgung erfolgen. Rückenschule zur primären, sekundären und tertiären Prävention - Lebensstiländerung, Krankengymnastik/Physiotherapie - im Zeitalter integrierter ambulanter Versorgung (Monika Kremer, Frankfurt am Main): Moderne Therapiestrategien bevorzugen - soweit möglich - ein konservatives gegenüber einem operativen Vorgehen, ein aktives gegenüber einem passiven, ein multimodales gegenüber einem monotherapeutischen Vorgehen. Bewegungs- und trainingstherapeutische Maßnahmen (z.B. Erweiterte Ambulante Physiotherapie EAP als Komplextherapie mit den Bestandteilen Krankengymnastik/Physiotherapie, Physikalische Therapie und Medizinische Trainingstherapie MTT) sind wichtige Bestandteile moderner Rückenkonzepte. Die Arbeitsplatzsituation wird besonders berücksichtigt mit zunehmender Integration von Ergonomie-Trainingsprogrammen. Der Begriff "Präventive Rückenschule" umfasst die Vermittlung und Anwendung wirkungsvoller Alltagsstrategien zur Vermeidung hoher Rückenbelastungen, um der Entwicklung funktioneller und degenerativer Krankheiten vornehmlich im Bereich der Wirbelsäule einschließlich muskulärer Dysbalancen vorzubeugen. Hierzu gehört ein rückengerechtes Alltagsverhalten (z.B. richtiges körpernahes Heben und Tragen). Besonders effektiv sind aktive Trainingsformen zum Muskelaufbau und zur Verbesserung der Ausdauer in Kombination mit verhaltensorientierten Trainingsprogrammen mit dem Ziel der Steigerung von Wohlbefinden und Lebensqualität. Erläutert werden das Konzept des Forschungs- und Präventionszentrums Köln (FPZ), das Kieser-Training, das Baunataler Rücken-Konzept (BRK) und das tergumed®-Rückenkonzept. Häufig können Rückenschmerzen durch rückengerechte Verhaltensweisen sowie präventives und rehabilitatives Rückentraining vermieden werden oder es kann nach ihrem Auftreten rehabilitativ wieder ein schmerzfreier stabiler Gesundheitszustand erreicht werden.

Background. Non-surgical implant procedures have been used in facial rejuvenation, whether to improve the physical appearance or to correct asymmetries in the face. These procedures have quite a few advantages over surgical procedures, including an immediate cosmetic result and a short recovery period. Methods: The Briseida technique involves infiltrating a filler (Hyaluronic Acid) in a linear, retrograde and fan-shaped fashion at supraperiosteal or subcutaneous level. 1,000 patients between 25 and 75 years of age, treated during the past 10 years for cheekbone and/or cheek area augmentation with the Briseida technique, have been included in this revision. Results: shorter down-time, less product required, no serious adverse effects, longlasting results. Conclusions: The technique allows the oval of the face to be re-modelled. It is minimally invasive, quickly performed, and produces natural results with few and mild side effects.

Introduction Cardiac rhythm device implantation rates continue to grow, yet procedure complications are inadequately reported. Accurate reporting is necessary to generate quality standards as a benchmark for consultant revalidation. We present complication rates within the first year following de novo pacemaker (PPM), defibrillator (ICD) and cardiac resynchronisation (CRT) implant procedures. Mortality censoring is introduced as a novel method for analysing such data. Methods Between April 2008–March 2011, consecutive virgin PPM, ICD and CRT device implants were prospectively followed for 1 year post implant for pre-defined complications. Results 2614 new devices were implanted. Mean patient follow-ups were 0.94, 0.98 and 0.95 years for PPM, ICD and CRT devices respectively. Mortality at 1 year after PPM, ICD or CRT implant was 9.43%, 4.40% and 10.38%. Conclusion Complication rates for new PPM, ICD and CRT implants are 5.23%, 4.69% and 7.64% at 1-year. Censoring data for mortality aids data interpretation.

We used releasable sutures to minimize immediate postoperative hypotony and flat anterior chamber in 19 cases of refractory glaucoma requiring insertion of a single-plate Molteno implant in a one-stage procedure. A slip knot using 7-0 nylon suture was fashioned around the Molteno tube under a lamellar scleral flap. In 18 of the 19 eyes, anterior chamber depth was normal immediately after surgery.

We report our initial clinical experience with a new tined ventricular endocardial pacemaker lead, the Medtronic model 5034. This lead has a reduced electrode tip size, which provides a higher impedance. Based on early evidence of elevation of pacing lead threshold, we compared our clinical experience with the performance of this lead with that of other similar models with larger surface area (Medtronic models 4024 and 5024). Of 17 implant procedures performed at our institution with the model 5034 lead, two (11.2%) developed high thresholds, versus 0% in 121 implant procedures with models 4024 or 5024 leads (p = 0.014). We conclude that there is evidence of increased failure caused by elevation of pacing threshold in this lead. This increased failure rate needs to be confirmed in a multicenter observational study or randomized trial.

Procedures performed later in the day and on weekends may result in more adverse events due to a variety of factors including operator fatigue, handoffs, reduced staffing, and limited resource availability. We assessed whether patients implanted with ICDs in the afternoon/evening and on weekends/

There is a paucity of information regarding the use of cochlear implants within large populations. This article describes correlates of cochlear implantation procedures using a statewide hospital discharge database. Among the 146 implant procedures, 55% involved female patients, whereas the largest groups of patients were represented by younger and older persons (27% between ages 2 and 9 years and 24% 60 years and older). A bimodal distribution was apparent for average annual age-specific rates of cochlear implantation, with the highest rates among persons aged 2 to 9 years (5.4 implants per 1 million) and persons aged 60 to 69 years (3.7 implants per 1 million). Total hospital charges, excluding professional fees, exceeded $12,000 per implant and were found to vary significantly when examined by length of stay and by calendar year of procedure. The data presented are unique with regard to the total number of cochlear implant procedures included and the large, diverse population used. This study expands knowledge concerning the epidemiology and utilization of cochlear implantation.

Purpose: The limitations of pre‐planned prostate brachytherapy seed implantation can be overcome by intraoperative re‐planning in the OR. Main purpose of this report is to compare geometric parameters between pre‐planed and OR‐panned procedures regarding changes in prostate volume/shape, number of seeds/needles and total activity, to address prostate volume/shape changes observed in the OR when the patient is under anesthesia and to present post‐implant dosimetric results.Methods and materials: In 33 clinical 125I cases, ultra‐sound (US) volume studies and plans were performed for both preplanning and in the OR just before seed implantation. Changes in volume/shape and number of seeds/needles used were compared between the two data‐sets and patient received brachytherapytreatment using the OR plan. For each patient, D90 and V100 were obtained from day one post‐implant CT dosimetry.Results: The mean US volume change observed between pre‐plans and OR‐plans was (5.3 ± 4.4)cc, with a maximum of 20cc. Change in the number of seeds between the plans were (8.9 ± 5.7) on an average and showed excellent correlation with prostate volume change. The number of needles remains relatively unchanged. The average total‐activity changed was (2.7 ± 1.6)mCi, with a maximum of 7mCi. Prostate shape changes (in terms of no. of seeds changed) in the OR was seen mainly in the anterior aspect of prostate. The average D90 and V100 were (90.3 ± 4.6)Gy and (148.7 ± 16.6)% of the prescription dose, respectively. Summary and Discussion: Significant variations of prostate volume changes between pre‐planned and the OR‐planned implants were observed in many cases. Largest change in the no. of seeds was due to change in shape of the prostate in its anterior aspect clearly shows the effect of pelvic muscle relaxation and patient re‐positioning in the OR. This supports the argument in favor of performing intraoperative re‐planning and implant‐dosimetry.

Background: The evolution in implant procedures has helped decrease loading times. Procedures can be optimized in post-extraction implantation with immediate loading. With a decrease in periodical needs for oral rehabilitation, the biological impact and psychological integration may be improved. This study aims to compare immediate versus delayed loading in post-extraction implantation. Materials and Methods: In a private practice of two practitioners, 170 Straumann post-extraction implants (107 immediate and 63 delayed loading) were tracked during a 7-year period. Results: According to Misch criteria, no difference in success rates was found between immediate (96.4%) and delayed (96.8%) loading in post-extraction implants. Conclusion: This retrospective study showed that a post-extraction procedure does not compromise immediate loading success in the short and medium term. Complementary prospective and randomized studies are necessary to validate these results.

Clinical experience with transcutaneous bone conduction implants has demonstrated that they are most beneficial for patients with purely conductive hearing loss in at least one ear. Percutaneous bone conduction implants, however, have been reported to provide adequate benefit for patients with mixed hearing loss with bone conduction pure-tone averages up to 45 dB HL (Tjellstrom, 1989). The results of 24 Xomed Audiant osseointegrated bone conduction hearing devices (including a clinical trial on two patients using a new, larger magnet [Neodynium Iron Boron]), plus the results of eleven patients implanted and fitted with the percutaneous bone-anchored hearing aid are reported. Aided results with these devices will be presented. In addition, general comparisons of benefit obtained with the two devices will be made for patients who exhibit similar hearing losses. Finally, a direct comparison will be made on two patients who have undergone both implant procedures.

Spinal Cord Stimulation (SCS) and Intrathecal Drug Delivery (IDD) Systems have proven efficacy in relieving pain in properly selected patients. One of the devastating complications that can occur with these systems is an infection. An infection usually leads to loss of the device at great expense, increased pain for the patient, loss of the benefit of the device to the patient, and significant expenses for treating the infection. The last 3 years of implant procedures, of a single surgeon at a single institution, both SCS and IDD devices is reviewed. Over 1000 procedures, with breakdown of co morbidities and infection rates for each procedure are identified. Strategies for reduction of infection in implant procedures are discussed.

Cross stimulation refers to the situation in which a pacing lead positioned in one cardiac chambers results in stimulation of another chamber. We report three cases of ventricular cross stimulation observed at the time of pacing system implantation. The cross stimulation occurred through bipolar atrial and ventricular leads connected in bipolar configuration to a dual chamber pacing systems analyzer. Analysis of events during cross stimulation indicated that the current pathway was occurring within the pacing system analyzer itself, due to low resistance internal connections between the ring electrodes of the atrial and ventricular pacing systems analyzer channels. Cross stimulation within the pacing system analyzer can be eliminated by making the ventricular channel unipolar. Awareness of the phenomenon reported here should assist in the avoidance of the mistaken diagnosis of pacing lead migration and malposition during pacing system implant procedures.

Purpose: To discuss radiation safety issues that may arise in the event of death of patients who have received radiopharmaceutical therapy or a radioactive implant and to educate clinical medical physicists in specific procedures performed by pathology personnel, morgue personnel, funeral directors and crematory workers that present radiation safety risks to those workers. Also to provide guidance on lessons learned by the author in communicating appropriate radiation safety procedures to funeral professionals and working with state agencies that regulate funeral homes and crematories. Method and Materials: The author researched pathology, embalming, and cremation procedures and facilities and spent considerable time on‐site in such facilities to gain an understanding of the specific risks presented to personnel and safety precautions that are currently used (or not used). Results: The author prepared instructions to be provided to personnel in the event of the death of radiopharmaceutical therapy or radioactive implant patient to comply with state and federal radiation control regulations and ensure personnel safety. The author also provided education to local funeral directors and spoke on this subject at a state funeral directors conference. Conclusions: It is not a matter of “if” but rather “when” a clinical medical physicist at a facility performing radiopharmaceutical therapy or radioactive implant procedures will receive a call regarding radiation safety procedures for a deceased patient. It is preferable to be prepared with specific instructions and establish a relationship with your pathology laboratory, morgue, and local funeral professionals in advance than to flounder when the event occurs.

Implant dentistry has brought many possibilities for the restoration of edentulous and partially edentulous patients; however, the high cost of dental implant fixtures and components is a major concern. Contemporary infection control practices mandate heat sterilization of reusable dental instruments that have been placed in the oral cavity.l Therefore, the dentist with a busy implant practice must stock numerous duplicate instruments at considerable expense. Slotted screwdrivers are very often used in implant procedures, and the retail cost of an implant

A total of 104 consecutive patients treated with 313 Nobelpharma implants was studied to determine the medical risks associated with dental implants. There did not appear to be an increased implant failure rate or an increase in perioperative morbidity in patients with a compromised medical status. Age; sex; and concurrent use of hypoglycemic agents, supplemental female hormones, or steroids also did not correlate with increased implant failure or perioperative morbidity. Implant procedures using a variety of pain-/anxiety-control agents failed to reveal any increase in anesthetic-related complications. However, the number of implants placed per patient did correlate with implant failure. It appears that implant surgery and the required anesthetic appear to be safe procedures even in the medically compromised patient.

In Reply. —We thank Dr Higgenbotham for her observations and agree with her statement that alternatives to implant procedures do exist for the management of refractory glaucoma. We did not imply that Molteno implantation was the only treatment for refractory glaucoma, and we also believe controlled studies are needed comparing the effectiveness of Molteno implants and filtering surgery with the use of antifibrosis medication, namely mitomycin-C and/or fluorouracil. Dr Rubin has been pursuing the initiation of such a study at the National Institutes of Health. In her statement that "Molteno implantation is certainly not without its own complications," Dr Higgenbotham seems to be implying that filtration surgery with the use of antifibrosis medication is associated with lower morbidity. We do not believe that the complications associated with filtration surgery and antifibrosis medication result in lower morbidity than do those associated with Molteno implantation, and as of yet, there is no

Thatching (simple interrupted suture implant) can be corrected by removing the interrupted sutures. To date, no method has been devised to totally eradicate the problem of multiple suture implants; this is particularly true for knotted-fiber implants. Various corrective methods have been discussed. These techniques were performed to counteract the damage caused by implant procedures. The techniques and their ensuing complications are based on the author's experience with 127 patients. In selected cases, autograft punch and excision with rotation flaps appeared to be the most cosmetically acceptable surgical approach to the hair and fiber implant problem.

Recent improvements in intraocular lens (IOL) design, manufacturing techniques, and surgical techniques have greatly reduced the incidence of complications following implantation, and many authors now consider IOL implantation to be among the most safe and effective major surgical procedures. However, adverse reactions are still seen — some as late sequelae of carlier IOL designs and implantation techniques and some as sequelae of more recent implantations using “state-of-the-art” lenses and surgical techniques. Complications may be due to various factors, including surgical technique, IOL design, or the inability of some eyes with preexisting disease to tolerate an implant. The authors trace the evolution of IOLs since Ridley's first implant, summarizing the modifications in lenses and surgical techniques that were made as complications were recognized. They then review the clinical and histopathological features of selected cases from more than 200 IOLs and/or globes removed due to IOL-related complications and studied in the University of Utah Ocular Pathology Laboratory. It is hoped that this review will provide insights into the pathogenesis of IOL complications, enhancing the current success of implant procedures and stimulating further basic and clinical research in this area.

Experimental experience with aortomyocardial autogenous free vein grafts, artery grafts, and intact posterior internal mammary-artery implants into the ischemic myocardium in dogs has been explored. Ten- to twelve-month follow-up studies of patency and flow were obtained. A patency rate of only 14% was found in the posterior vein-graft implants, 20% in the free artery-graft implants, and 57% in the posterior intact internal mammary-artery implants. It is concluded that the best results for implant procedures into the posterior surface of the heart may be obtained by implanting the intact vessel.

Analysis of pre- and postoperative casts is essential in evaluating the efficacy of hydroxylapatite implant procedures for denture support. Computergraphics have been used to quantitate the changes in anatomic contour of occlusal surfaces of teeth and in the diagnosis and treatment of patients with craniofacial malformations. They may prove to be a useful adjunct in the planning and execution of preprosthetic oral and maxillofacial surgery for ridge augmentation. Thus computergraphics may be useful in surveying pre- and postaugmentation casts and evaluating clinical outcomes. In addition, computergraphics may also be useful in evaluating the utility of various surgical techniques used to augment ridges. In this study, pre- and postsurgical maxillary and mandibular casts were made from tissue displacing, irreversible hydrocolloid impressions. A comparison of pre- and postsurgical ridge contours, surface areas and volumes were derived from computer digitized two-dimensional tracing of casts sectioned in the frontal plane. This was accomplished using a three-dimensional computergraphics program that reconstructed digitized two-dimensional images into a three-dimensional image which displayed ridge contours, surface areas and volumes. The application of computergraphic technology may also prove useful in quantitating and mapping time-dependent morphological changes in ridges supporting the prostheses. Thus this technique may be useful in monitoring resorption patterns in underlying bone as well as in the revision and compaction of implanted materials.

A stereotactic system has been designed based upon a series of interlocking discs secured to the skull with self-tapping screws. Unlike previous skull-mounted systems, this system is a true, advanced imaging based stereotactic device with the capabilities and accuracy of more traditional, frame based devices. It has been used in a range of applications, from simple biopsies to interstitial radiation implant procedures. Well tolerated by the patient, it allows reaccess to the intracranial target without rescanning. It is convenient for the physician to utilize, both mechanically and timewise, is adaptable to MRI, DSA, and conventional X-ray techniques without modification, and is affordable.

An easily constructed and inexpensive bilateral cannula assembly for microinjection of chemicals into neural tissue in small animals is described. It reduces problems sometimes encountered with commercially available units, making it useful in both research and teaching laboratory settings. Suggestions for implant procedures and modifications for use in unique applications are suggested.

Continuous heart rhythm monitoring using implantable cardiac monitors (ICMs) for atrial fibrillation (AF) management is steadily increasing in current clinical practice, even in the absence of an established indication provided by international guidelines. The increasing use of such devices is mainly associated with recent technological improvements including miniaturization, easier implant procedures, and remote monitoring, all of which make this strategy continuously more appealing and promising. For these and other reasons, ICMs have been proven to be a safe and highly effective tool for detecting AF episodes. However, ICMs are not the best option for every patient, as limitations exist. Therefore, it is imperative to weigh the possible benefits against the potential limitations of using these devices when deciding individualized patient care.

The NCDR® ICD RegistryTM and CathPCI Registry® have identified important gaps in appropriate discharge medication prescribing for patients undergoing ICD and PCI procedures. American College of Cardiology Foundation recently submitted medication-prescribing measures from these registries to