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PubMed2002

[Unilateral forearm agenesis and prosthesis].

PURPOSE OF THE STUDY: Antebrachial agenesis is a congenital deformity which is not invalidating for the children who have a level of independence comparable to that of other children of the same age. Although the appropriateness of a prosthesis is rarely questioned by healthcarers, it is clear that it is the healthcarers' own representation of this condition (their knowledge of the deformity and of the prosthesis proposed) that leads to the indication. The purpose of this study was to better understand the respective representations of unilateral antebrachial agenesis to help determine appropriate health care proposals. MATERIAL AND METHODS: An intensive survey using semi-directive interviews was conducted in 16 families. Group interviews with three healthcare teams were then conducted. RESULTS: Three leading topics appeared: worry about the social integration of the child, a paradoxical representation of the child perceived as independent but handicapped, and a largely negative image of the prosthesis. There was a rather important difference in the representations formulated by the parents and by the healthcarers. DISCUSSION: The discussion focused on awareness of the narcissistic content of the expectations and the plastic and functional implications of prosthesis fitting, perceived differently by parents and healthcarers. CONCLUSION: The nature of the expected result involves a change in the representation of the child more than a change in the child's body, a concept which in itself is not a true objective of healthcare. Taken the understandably difficult position of healthcarers, it might be useful to propose a different scheme for the first consultation.

Adolescent↗
PubMed2002

Regeneration of an osseous peri-implantitis lesion.

This case report concerns the loss of osseous tissue around two hydroxyapatite (HA) Biovent implants, placed in 1993, at sites #30 and #31. The implant in site #31 was positioned with a distal angle, resulting in an ill-fitting prosthesis. This permitted bacterial colonization to set up a periimplantitis. The rough HA coating on the implants further exacerbated the resultant bone loss. In an attempt to rectify the pathology, surgical debridement, antibiotic therapy, bone grafting, and guided tissue regeneration with a barrier membrane were utilized. This case report documents a successful partial repair of osseous housing around these implants.

Adult↗
PubMed2003

[Experience of implantation of prefitted Palmaz Corinthian stents].

We report our recent experience with the Palmaz Corinthian stent in children. Since 1/10/01 to 1/11/02 we implanted 18 Palmaz Corinthian stents in 12 children. Median age and weight of patients were 5.6 years (range 0.25-13) and 17.9 kg (range 3-36), respectively. Primary diagnosis were: pulmonary atresia with ventricular septal defect (n = 7), complex transposition of the great arteries (n = 2) and others (n = 3). Indications to stent implantation were: pulmonary branches stenosis (n = 9), stenosis of the ductus arteriosus (n = 1), stenosis of systemic veins (n = 2). All stents were pre-mounted and co-axially advanced over a standard guidewire across the stenotic site, using a 6F short introducer. Stent deployment was performed by hand inflation of the balloon. Final angiography confirmed correct positioning and ruled out complications. Median fluoroscopy time was 18 minutes (range 12-56). All stents reached their nominal diameter; 2 were post-dilated to 125 and 150%. No procedural complications occurred. Despite the impossibility of distal injection, stent positioning was always correct. In conclusion, due to the availability of pre-mounted stents, and the need of short 6F sheaths, the use of the Palmaz Corinthian stent in children is relatively simple. Primary results are generally good in terms of adequate delivery and absence of complications. However, the impossibility of distal injection makes more difficult the choice of the deployment site. Due to the limited possibility of over-dilation, the use of this stent has to be limited to the stenosis of peripheral pulmonary branches or to lesions that can be surgically treated during further surgical procedures.

Adolescent↗
PubMed2003

Treatment of lower extremity injuries due to antipersonnel mines: blast resuscitation and victim assistance team experiences in Cambodia.

The two teams comprising the fiscal year 2001 Blast Resuscitation and Victim Assistance mission had the opportunity to learn from and practice mine injury treatment principles with experienced local and international war surgeons in Cambodia. Treatment principles were modifications of International Committee of the Red Cross recommendations. A total of 14 acute lower extremity mine injuries were treated. Surgery generally consisted of an open amputation or thorough irrigation and debridement using equipment readily available in any U.S. military field hospital. The surgical techniques will be described in detail. Delayed primary closure occurred 5 days later followed by prosthesis fitting (for amputees) in an International Committee of the Red Cross facility 12 weeks later. Other options and techniques will be discussed with an emphasis on applicability to U.S. military field surgery.

Amputation, Surgical↗
PubMed1992

Hydroxylapatite-coated hip implants. Multicenter three-year clinical and roentgenographic results.

The application of a thin coating of hydroxylapatite to total hip implants has provided the opportunity to realize stable fixation of a press-fit prosthesis without a porous coating or an intervening fibrous tissue layer. This series consists of 436 total hip arthroplasties, of which 320 cases have a minimum two-year follow-up period and 142 cases have a minimum three-year follow-up period. The femoral prosthesis used was a roughened titanium alloy with a 50-microns surface treatment of hydroxylapatite applied to the proximal one third. The acetabular components implanted included porous-coated implants (132), hydroxylapatite-coated acetabular shells of varying geometries (285), and bipolar implants (16). Analysis of the clinical results demonstrates a mean Harris Hip Score of 93 at six-months postarthroplasty, 95 at one and two years, and 96 at three years. At the three-year follow-up evaluation, 4.2% of patients complained of mild to moderate pain in the operative limb, whereas only 2.2% at two years and 1.4% at three years complained of activity-related thigh pain. The femoral mechanical loosening rate representing stems revised for aseptic loosening (two) plus roentgenographically unstable stems (zero) is 0.46%. Three hydroxylapatite-coated acetabular cups (1%) have shown measurable migration at two years, but none have been revised for aseptic loosening. The roentgenographic evaluation provides evidence for excellent proximal femoral fixation with distal stress transfer. Radiolucencies typically occur around the uncoated distal tip of the femoral stem (74%), but rarely in the proximal hydroxylapatite-coated anterior (3%) and lateral (2%) zones. Femoral cancellous condensation characteristically is seen at the transition zone of hydroxylapatite coated-to-uncoated stems (86%), whereas up to 32% of cases show cortical hypertrophy at the medial distal stem. These roentgenographic changes are progressive from one through three years postoperatively.

Adolescent↗
PubMedDate not supplied

The surgical treatment of fecal incontinence with artificial anal sphincter implant. Preliminary clinical report.

BACKGROUND/AIMS: Fecal incontinence has a serious impact upon patients' quality of life. Several treatment methods are possible according to the pathophysiology of the disease. METHODOLOGY: Between March 1999 and February 2002 eight artificial anal sphincters (American Medical System - AMS) were implanted in seven patients affected with severe fecal incontinence; in one case the device was positioned in a patient who had previously undergone a Miles' resection. All cases were carefully selected according to appropriate diagnostic evaluation. The follow-up varies between 3 and 40 months. RESULTS: The prosthesis had to be removed in two cases; in one patient infection of the implant area occurred, while in the other case persistent perianal pain due to the presence of the device could not be tolerated by the patient. In the six patients that could be successfully treated with the artificial anal sphincter implant, it dramatically improved their quality of life. CONCLUSIONS: The success of the procedure allows the consideration that the artificial anal sphincter implant is the best treatment for severe fecal incontinence that cannot be solved with conservative therapy.

Adult↗
PubMed2004

Pressfit ceramic arthroplasty of the first metatarsophalangeal joint: a short-term review.

Several prostheses are available for replacement of the first metatarsophalangeal joint. The aim of our study was to review our results with the Moje press-fit ceramic implant. Our study included seven procedures in six patients with a mean age of 60.2 years followed for a mean of 35 months (range: 24 to 43 months). We found a significant (p < 0.001) improvement of the Visual Analogue Score from 7-8 to 1-2 and of the Foot Function Index from 75.6 to 8.6. We recorded a mean postoperative dorsiflexion of 29.2 degrees and plantar flexion of 12.1 degrees. Apart from slight cortical recession in one case, probably related to overuse, there was little evidence of osteolysis or loosening of implants and no major complication has been noted in any of the patients. The pressfit design seems to have overcome the disadvantages of the previous screw fit prosthesis which had been reported to have complications related to metallosis around the titanium screw.

Aged↗
PubMed2005

[System of dynamic neutralization in the lumbar spine: experience on 94 cases].

OBJECTIVE: To assess the results obtained using the Dynesys system (Dynamic Neutralisation System for the spine), in a group of 94 patients. This new system for treating lumbar degenerative pathologies is based on lumbar stabilisation and preservation of articular function, as opposed to traditional arthrodesis restrictions. MATERIAL AND METHODS: We analyze series of 94 patients in whom this system was used. 62 were males and 32 females with an average age of 46.4 years. The pathologies treated were disc herniation in 27 cases, degenerative discopathy in 54 cases and lumbar channel stenosis in 13 cases. Follow-up was carried out between 14 and 24 months, assessing the clinical picture according to the Oswestry scale and the return to work. RESULTS: The final results on the Oswestry scale were 21.4% with respect to 56.8% prior to the treatment and the return to work was 82%. There was a remission of the sciatica symptoms in almost all the cases, as well as of the lumbar pain, and there was a 60% improvement in the claudication cases. With regard to complications, we would like to point out two cases due to the technique, one because of the wrong positioning of the screws and the other due to the rupture of the pedicle. There were two cases of subcutaneous seroma and two late subclinical infections. CONCLUSIONS: The dynamic neutralisation obtained using this system, should not be considered as an arthrodesis. Treatment using Dynesys enlarges the population of patients candidates for surgery to who initially do not apparently need a standard fixation, but who raise doubt regarding the application of techniques without instrumental support, incorporating the functionality concept as opposed to restricting movement. This system can be defined as a disc prosthesis fitted externally to the disc. We have obtained good results in the majority of our patients, although we believe that the follow-up should be increased.

Adult↗
PubMed2006

Initial clinical experience with telemetrically adjustable gastric banding.

BACKGROUND: The feasibility and safety of laparoscopic adjustable gastric banding for treatment of morbid obesity has been demonstrated in a large number of studies. Access port-related complications constitute a significant part of all complications related to gastric banding. Further, adjustment of hydraulic gastric bands can be fairly lengthy, uncomfortable, and is not a precise procedure. A study was performed to assess the usefulness and efficacy of a new type of band adjusted telemetrically without the need for an access port. The initial worldwide results of the first telemetrically adjustable gastric band for morbid obesity (EASYBAND EndoArt Medical Technologies, Switzerland) in two German academic centers are described herein. METHODS: EASYBAND is a purely mechanical gastric band, in which adjustment is achieved by means of an embedded micromotor, controlled by an external control unit using telemetry. The exact band diameter is displayed continuously during adjustment on the external control unit screen. Thirty-seven patients, means 36 +/- 8 (range: 22-60) years, 7 (19%) men and 30 (81%) women, with a mean body mass index (BMI) of 44.1 +/- 4.5 (range: 35.6-59.6), were implanted using the standard laparoscopic technique during the period from June 2005 to October 2005. Prospective data were collected on all morbidly obese patients who underwent laparoscopic telemetrically adjustable gastric banding (LTAGB). RESULTS: No serious adverse events occurred during the operative period or immediately postoperatively in relation to the device. A mean of 3.0 +/- 0.6 adjustments per patients were performed during the follow-up schedule at one, three and six months. The band diameter was set to 29 mm (fully open) at implantation, 24.5 mm +/- 0.5 mm at one month, 23.3 mm +/- 0.7 mm at three months, and 23.0 mm +/- 1.0 mm at six months. The mean percent excess weight loss was 10.2% +/- 4.5% at one month, 23.8% +/- 8.8% at three months, and 30.2% +/- 10.5% at six months. CONCLUSION: This initial study shows that the new telemetrically adjustable gastric banding device is implanted and operated safely, allows for atruamatic band adjustments with superior patient comfort, and leads to early excess weight loss comparable to that achieved by other gastric bands. Longer-term follows and larger population studies are needed to establish the final safety and performance profile of the telemetric gastric band.

Adult↗
PubMed1990

Dental implants. Permanent replacement for lost teeth.

Implant complications are rare, but they can include nerve injury, bone loss, infection, injury to adjacent teeth and their supporting structures, premature loss of implants or the prosthesis fitted on the implant, bone fracture, and oroantral (ie, mouth, maxillary sinus) and oronasal (ie, mouth, nose) fistulae. Oral implants represent a new technological possibility. Whether it is used to replace a single tooth, several missing teeth, or an entire dentition, dental implants restore the feeling of having one's own natural teeth. This can improve the patient's physical and psychological health.

Dental Implantation↗
PubMed1989

[Rehabilitation of amputees].

An optimal rehabilitation result following amputation in each individual case depends on the smooth cooperation of the surgery department and the rehabilitation clinic. Equally important ist the good cooperation between physicians, physical therapists and orthopedic technicians. A decisive influence on the outcome of rehabilitation is already exercised with the choice of height of the amputation site and the operative technique. A positive development can be intensified by an early prosthesis fit and practice. It is imperative that the amputation be seen as the beginning of the patient's rehabilitation and not as a failure and the end of efforts to preserve the extremity. The degree of mobility achievable depends very decisively on the patient's remaining ability and will to succeed.

Amputation, Surgical↗
PubMed1989

Preliminary results of an off-the-shelf press-fit stem. The anthropometric total hip femoral component using exact-fit principles.

The use of custom-manufactured femoral prostheses as part of routine total hip arthroplasty (THA) has been suggested. However, there are several disadvantages, including possible inaccuracy of fit, inadequate instrumentation, and high cost. A series of 28 THAs (including 18% for revision of failed, cemented THA) using a press-fit prosthesis of contemporary design were investigated. The average follow-up period was 28 months (range, 12-49 months). Clinical results were overall very good, even in revision cases. Roentgenographic changes included rapid femoral remodeling, which may increase component stability. Given the clinical and roentgenographic results obtained in this complex-problem patient population, it is difficult to justify the use of custom femoral components in routine THA.

Adult↗
PubMed1987

Enucleation techniques: the Iowa implant.

The Iowa implant is a quasi-integrated implant with four mounds on its anterior surface. The rectus muscles are imbricated between the mounds, resulting in a socket with four protrusions that articulate with a custom-fitted prosthesis having four concavities. This imparts excellent motility and support for the prosthesis. This article describes the indications for enucleation, the Iowa implant, surgical technique, and postoperative complications.

Eye Enucleation↗
PubMed1986

Nucleus 22-channel cochlear implant: preliminary observations.

A carefully designed study was undertaken in 1982 to evaluate the performance of individuals who received the Nucleus 22-channel cochlear implant. All patients were profound-totally deaf, adults with a postlingual onset of impairment. The preoperative evaluation, prosthesis fitting, training, and postoperative testing were consistent across clinics. Single-subject studies, where each patient acted as his/her own control, revealed that of the 37 subjects, 16-24 obtained significant improvement (P less than or equal to 0.001) on unpracticed, unfamiliar recorded speech tests from the Minimal Auditory Capabilities (MAC) Battery, when using hearing alone (no lipreading). In addition, virtually all patients showed improvement in recognition of speech material with lipreading. The data support the efficacy of a feature extraction coding system where specific formant and amplitude information are transmitted via direct electrical stimulation to the cochlea.

Adult↗
PubMed1985

Pathology of an orbital dermis-fat graft.

A patient had an orbital dermis-fat graft implanted for a secondary socket reconstruction. The graft shrank only minimally and a portion had to be excised to permit better prosthesis fitting. The pathologic findings are presented. Although a generalization cannot be made on the basis of one case, prudence should be exercised with regard to the degree that such grafts are oversized in socket reconstruction.

Adipose Tissue↗