No abstract

Twelve out of 80 implants failed, giving an overall failure rate of 15 per cent. Kaplan-Meier survival curves show a steady decrease in implant survival. The MDT had a positive effect on implant survival and adverse skin reactions, with a higher proportion of patients experiencing no reaction after its introduction. There was a 92.5 per cent response rate to the questionnaire. Overall patient satisfaction was high, both before and after the introduction of the MDT.

Intractable epistaxis is a difficult problem to manage, particularly in a case complicated by Ehlers-Danlos syndrome. This is the first report describing intermittent self-packing of the nasal cavities at home to reduce hospital admissions and control symptoms. Some of the potential problems and complications are highlighted.

performed in guinea pigs bilaterally. Gelfoam was introduced in one of the ears intervened, while the control ear received the same surgical procedure, lacking the use of gelfoam. After an average of 11.6 weeks, temporal bones were harvested and histologically studied. We defined 7 parameters to be studied: avascular necrosis of the autologous prosthesis, adhesions and inflammation around the prosthesis, fibrosis in middle ear space, bone formation, adhesions of the tympanic membrane, and foreign-body reaction focuses.Results: Eighteen adult guinea pigs were operated on; 8 animals died before examination time was achieved. Results from the remaining 10 revealed a tendency of worst scores in the gelfoam group for the majority of the parameters tested, with statistical significance for adhesions of the ossicular chain and foreign-body reaction focuses (P Ͻ 0.05). Nevertheless, the gelfoam group presented better results regarding avascular necrosis than the control group (without statistical significance). Conclusion:We demonstrated that gelfoam negatively affects anatomical results of ossiculoplasty, but at the same time we could observe that the reaction gelfoam generates inside the middle ear protects the autologous prosthesis against avascular necrosis. We theorize that the same chronic inflammatory reaction may provide better conditions for autologous prosthesis survival.Significance: This result represents a dilemma for the surgeon, because gelfoam may have deleterious and, at the same time, beneficial effects on the results of autologous ossiculoplasty.Support: This investigation was supported by the special funds for residents research projects of the Pontificia Universidad Católica de Chile, 2002.