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Maximal Improvement (maximal + improvement)

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Medical Sciences	100%

Selected Abstracts

The Corset Platysma Repair: A Technique Revisited

DERMATOLOGIC SURGERY, Issue 3 2002
Carolyn I. Jacob MD
background. Platysma banding along with excess submental adipose tissue and sagging skin can lead to an aged appearance. Several methods for improving neck and submental contours exist, including neck liposuction, bilateral platysma plication, midline platysma plication with transection of distal fibers, necklift with skin excision, and botulinum toxin injection for platysma relaxation. With the current interest in minimally invasive procedures, surgeons and patients are searching for techniques that produce maximal improvement with minimal intervention. objective. To present a modified technique for maximizing neck contouring, discuss possible complications of the procedure, and describe appropriate candidates for the corset platysmaplasty. methods. We performed a retrospective analysis of 10 consecutive patients who underwent neck liposuction with concomitant corset platysmaplasty at our institution. results. All 10 patients achieved good to excellent submental and jawline contouring, determined by both physician and patient assessment, with no visible platysma banding at 6 months follow-up. No major complications were noted. conclusion. Use of corset platysmaplasty is a safe and effective method for neck rejuvenation. This variation of platysmaplasty can be used in conjunction with neck liposuction to maximize jawline and neck contour enhancement. [source]

The intra-oral translocation of periodontopathogens jeopardises the outcome of periodontal therapy

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 6 2001
A review of the literature
Abstract Background: Although periodontitis has a multi-factorial aetiology, the success of its therapy mainly focuses on the eradication/reduction of the exogenous/endogenous periodontopathogens. Most of the species colonise several niches within the oral cavity (e.g. the mucosae, the tongue, the saliva, the periodontal pockets and all intra-oral hard surfaces) and even in the oro-pharyngeal area (e.g., the sinus and the tonsils). Methods: This review article discusses the intra-oral transmission of periodontopathogens between these niches and analyses clinical studies that support the idea and importance of such an intra-oral translocation. Results and conclusions: Based on the literature, the oro-pharyngeal area should indeed be considered as a microbiological entity. Because untreated pockets jeopardise the healing of recently instrumented sites, the treatment of periodontitis should involve "a one stage approach" of all pathologic pockets (1-stage full-mouth disinfection) or should at least consider the use of antiseptics during the intervals between consecutive instrumentations, in order to prevent a microbial translocation of periodontopathogens during the healing period. For the same reason, regeneration procedures or the local application of antibiotics should be postponed until a maximal improvement has been obtained in the remaining dentition. This more global approach offers significant additional clinical and microbiological benefits. Zusammenfassung Grundlagen: Obwohl die Parodontitis eine multifaktorielle Ätiologie hat, konzentriert sich der Erfolg ihrer Therapie hauptsächlich auf die Eliminierung/Reduktion der exogenen/endogenen Parodontalpathogene. Die meisten dieser Spezies kolonisieren verschiedene Nischen innerhalb der Mundhöhle (z.B. die Schleimhäute, die Zunge, den Speichel, die parodontalen Taschen und alle intraoralen Hartgewebe) und sogar den oro-pharyngealen Bereich (z.B. die Nebenhöhlen und die Tonsillen). Methoden: Dieser Übersichtartikel diskutiert die intraorale Übertragung von Parodontalpathogenen zwischen diesen Nischen und analysiert klinische Studien, die die Idee und Wichtigkeit dieser intraoralen Übertragung unterstützen. Ergebnisse und Schlussfolgerung: Auf der Grundlage der Literatur sollte der oro-pharyngeale Bereich in der Tat als eine mikrobiologische Einheit angesehen werden. Weil unbehandelte Taschen die Heilung von kürzlich instrumentierten Stellen gefährden, sollte die Behandlung der Parodontitis ein einzeitiges Vorgehen bei allen pathogenen Taschen beinhalten (einzeitige vollständige Mundhöhlen-Desinfektion). Oder es sollten wenigsten die Verwendung von antiseptischen Mitteln während der Intervalle zwischen aufeinanderfolgenden Instrumentierungen erwogen werden, um die mikrobielle Übertragung von Parodontalpathogenen während der Heilungsphase zu verhindern. Aus dem gleichen Grunde sollten regenerative Maßnahmen oder die lokale Applikation von Antibiotika so lange verschoben werden, bis eine maximale Verbesserung im restlichen Gebiss erzielt wurde. Dieser globalere Ansatz liefert zusätzliche signifikante klinische und mikrobiologische Vorteile. Résumé Origine: Bien que la parodontite ait une étiologie multifactorielle, le succès de son traitement repose principalement sur l'éradication/réduction des bactéries parodontopathogènes exogènes/endogènes. La plupart des espèces colonisent plusieurs niches au sein de la cavité buccale (par exemple, les muqueuses, la langue la salive, les poches parodontales et toutes les surfaces dures intraorales), et même dans la zone oro-pharyngée (par example, les sinus et les amygdales). Méthodes: Cette revue critique discute la transmission intra-buccale des pathogènes parodontaux entre ces niches et analyse les études clinique qui soutiennent l'idée et l'importance d'une telle translocation intra-buccale. Résultats et conclusions: D'après la littérature, la zone oro-pharyngée peut vraiment être considérée comme une entité microbiologique. Puisque les poches non traitées compromettent la cicatrisation des sites récemment instrumentés, le traitement de la parodontite devrait impliquer une approche en une étape de toutes les poches pathologiques (désinfection de toute la bouche en une étape) ou devrait au moins considérer l'utilisation d'antiseptiques pendant les intervals entre deux instrumentations successives, de façon à prévenir une translocation bactérienne des pathogènes parodontaux pendant la période de cicatrisation. Pour la même raison, les procédures de régénération ou les applications locales d'antibiotiques devraient être remises jusqu'à ce qu'une amélioration maximale ait été obtenue sur le reste de la denture. Cette approche plus globale donne des bénéfices cliniques et microbiologiques supplémentaires significatifs. [source]

Temporohyoid Osteoarthropathy in 33 Horses (1993,2000)

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 6 2002
Anne M. Walker
A retrospective study of the medical records of 33 horses was performed to determine the clinical and diagnostic abnormalities associated with temporohyoid osteoarthropathy. Data collected from medical records included signalment, presenting complaints, history, physical examination findings, laboratory data, results of diagnostic imaging studies, and treatments. Follow-up information was obtained from a review of case records; by telephone conversation with the owner, veterinarian, or trainer; or by both methods. Of 33 horses with temporohyoid osteoarthropathy, 29 presented with facial nerve (cranial nerve VII) deficits and 23 presented with vestibulocochlear nerve (cranial nerve VIII) deficits. Guttural pouch endoscopy was more reliable than radiography for diagnosis. Of horses with unilateral clinical signs, 22.6% actually had bilateral disease. Magnetic resonance imaging and computed tomography identified the lesions in all horses in which these tests were performed. Of 30 horses for which follow-up information was obtained, 20 (67%) were alive. Eight horses were euthanized and 1 died because of problems associated with temporohyoid osteoarthropathy. Nineteen of 20 surviving horses (95%) were considered by the owner or trainer to be suitable for athletic use. Twelve surviving horses (60%) had residual facial nerve deficits; 11 horses (55%) had residual vestibulocochlear nerve deficits. Horses with temporohyoid osteoarthropathy have a fair prognosis for return to some type of athletic function, but there is risk of acute death. The majority of horses would be expected to have some residual cranial nerve dysfunction, and it could take a year or longer for maximal improvement to occur. [source]

Tilted disc syndrome may mimic false visual field deterioration

ACTA OPHTHALMOLOGICA, Issue 6 2008
Marja-Liisa Vuori
Abstract. Purpose:, Tilted disc syndrome is a congenital anomaly of the eye characterized by mostly upper temporal visual field defects. The aim of the present study was to evaluate the effect of gradual myopic correction in the improvement of visual field defects associated with tilted disc syndrome. Methods:, The visual field was examined in 38 eyes of 24 patients using standard Goldmann perimetry. The isoptres IV-4e, I-4e, I-3e and I-2e were plotted. The defective isoptres were tested again with gradually increasing myopic correction until no further change was noted. Results:, The most common type of defect was a relative upper temporal defect (19 eyes). Temporal relative defects were found in five eyes, upper altitudinal field defects in six eyes, an enlarged blind spot in four eyes, and an inferior field defect in one eye. The visual field defect partly or totally disappeared with increased myopic correction in 18 (50%) eyes. The mean improvement was 17.0 ± 6.2 degrees and the mean additional myopic correction was 3.1 ± 1.5 D. Conclusions:, Even a small change in near correction during visual field examination may imply worsened or improved visual field defects in tilted disc syndrome. To prevent a false interpretation of field deterioration in a patient with tilted disc syndrome and glaucoma, visual field assessment should include examination with the myopic correction that provides the maximal improvement of the defective visual field. [source]