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PubMed1994

[Secondary ambulatory voice prosthesis implantation with the argon laser using local anesthesia].

An alternative technique for secondary tracheo-esophageal puncture and voice prosthesis implantation in topical anesthesia on an outpatient basis was developed. With argon laser beam passed through a glass fibre in the instrument channel of a flexible endoscope a secondary puncture of the tracheo-esophageal wall is obtained. A voice prosthesis is fitted subsequently, so that the whole operation is performed in one session in about 30 minutes. We generally administer 7.5 mg Midazolam orally for light sedation; antibiotics are not required. This method expands the possibility of voice prosthesis fitting in patients who are not considered or willing to have general anesthesia for various reasons. In 33 cases we did not see any complication. In two cases the tracheal wall was too tight due to radiation therapy, so that an operation had to be performed later on in general anesthesia. In one case technical problems led to an operation in local anesthesia in two steps. In all cases the patients did not complain of any considerable discomfort.

Ambulatory Surgical Procedures↗
PubMed1998

Outcome after hemiarthroplasty for femoral neck fractures in the elderly.

A prospective outcome study was performed on 270 patients, 65 years of age and older, who sustained a femoral neck fracture and underwent hemiarthroplasty. The treatment compared was the use of a noncemented unipolar versus either a cemented or a press fit bipolar prosthesis. The outcome variables assessed included the occurrence of a postoperative complication, length and cost of hospitalization, and function in various quality of life measurements. Patients who underwent bipolar hemiarthroplasty with either a cemented or a press fit prosthesis had better pain relief and function than patients who had a noncemented unipolar prosthesis at a minimum of 24 months after surgery. However, the mean hospitalization cost for patients who had a bipolar prosthesis was $12,290 compared with $8876 for a unipolar prosthesis.

Activities of Daily Living↗
PubMed1992

An alternative bent-knee prosthesis.

Prosthetic fitting in patients with below-knee amputations and concurrent knee flexion contractures poses inherent difficulties to the prosthetic rehabilitation team. The standard bent-knee prosthesis is bulky and awkward. It treats the patient functionally as a knee disarticulation and yields no potential for improving the patient's degree of contracture. This paper describes a case report with an alternative to the bent-knee prosthesis that not only offered improved function relative to the standard bent-knee prosthesis, but also acted therapeutically by reducing the patient's knee-flexion contracture.

Amputation, Surgical↗
PubMed1995

Revision total knee arthroplasty with use of modular components with stems inserted without cement.

We reviewed the results of seventy-six revision total knee replacements, performed between 1980 and 1988 on the Knee Service at The Hospital for Special Surgery, in seventy-four patients. Sixty-five patients (sixty-seven knees; 88 percent) had a complete clinical examination and radiographic evaluation, and nine patients (nine knees; 12 percent) were only interviewed by telephone. Survivorship analysis was performed for all patients. The average duration of follow-up was three years and six months (range, two to nine years). Only patients who had had revision of the femoral component or the tibial component, or both, because of aseptic failure were included. The tibial component of all prostheses that were used for revision had a metal backing. Cement was placed on the cut surfaces in the metaphyseal region of the femur and tibia. Fluted diaphyseal intramedullary rods were used in all patients and were not cemented. Metal wedges and augments were used to fill osseous defects when necessary. The average preoperative knee score, according to the rating scale of The Hospital for Special Surgery, was 49 points (range, 0 to 62 points). Postoperatively, the knee score improved to an average of 76 points (range, 0 to 97 points). Of the sixty-seven knees that had complete follow-up, fifty-six (84 percent) had an excellent or good result and five (7 percent) had a fair or poor result. In six (8 percent) of the seventy-six knees, the prosthesis failed, necessitating another revision. Failure was defined as removal or a recommendation for removal of the implant.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Strategies to achieve fit in implant prosthodontics: a review of the literature.

PURPOSE: This paper reviews the literature on advanced strategies that attempt to improve fit in implant prosthodontics with reference to the concept of the "distortion equation." MATERIALS AND METHODS: The majority of the articles reviewed were either clinical or technique articles that advocated strategies to improve fit in implant prosthodontics. A limited number of retrospective and prospective clinical trial studies were included as they related to the topic. Reviewed articles were limited to those that addressed advanced strategies to improve fit. All of the scientific studies included in this review used an in vitro experimental design. The advanced strategies were categorized into methods that address intraoral indexing and methods that use the implant master cast. RESULTS: Relatively few methods have been scientifically proven to improve fit in implant prosthodontics. Most of the tested strategies still resulted in a slight misfit of the frameworks to the implant abutments/analogues. CONCLUSION: Multiple factors preclude that the concept of "passive fit" can be achieved in implant prosthodontics, even with the use of advanced strategies. The use of meticulous, accurate implant prosthodontic procedures and the appropriate use of advanced strategies continue to be the recommended means of achieving precise fit of the implant prosthesis to the intraoral abutments.

Animals↗
PubMed2003

A dangerous place to live: from the fog of war to the slime of technology.

This article addresses the need for constant vigilance against clever and adaptive enemies, specifically the battle against infections. Medical devices are susceptible to infection and risk management needs to be considered in the context of the underlying science and common sense.

Bacterial Infections↗
PubMedDate not supplied

Optimal circumference reduction of finger models for good prosthetic fit of a thimble-type prosthesis for distal finger amputations.

The prosthetic fit of a thimble-type esthetic silicone prosthesis was retrospectively reviewed in 29 patients who were fitted following distal finger amputations. The aim was to correlate prosthetic fit with the magnitudes of circumference reduction in the finger models used to produce the prostheses and to identify the optimum reduction for the best outcome. A good fit is achieved primarily by making the prosthesis circumferentially smaller than the segment of the residual finger (residuum) over which it "cups". The percentage reduction in circumference of the finger model against the residuum model was calculated by dividing the difference in circumference between the residuum model and the finger model by the residuum model circumference and multiplying the result by 100. The computed percentage circumference reduction in the finger models ranged from small (1-3), moderate (5-7), to large (8-9). Twelve of 15 patients whose finger models had between one to three circumference reductions had a loose prosthetic fit. Only two of 14 patients who had a larger model circumference reduction of between five to nine had loose-fitting prostheses. Two of five patients who had eight to nine model circumference reduction had an uncomfortably tight prosthetic fit. A 5-7% circumference reduction in the finger model was shown in this study to best translate into good fit of a thimble-type prosthesis for distal finger amputations.

Adult↗
PubMed1998

Fitting a hand-glove prosthesis to enhance the reconstructed mutilated hand.

Microsurgical reconstruction of the severely mutilated hand aimed at improving prehensile functions often does not address the esthetic aspects of the hand. The poor appearance of the reconstructed hand affects its active display and use. A hand-glove prosthesis may be prescribed in this instance to enhance the overall form and function of the mutilated hand. We reviewed 16 cases of mutilating hand injuries in which surgical reconstructions were performed and the patients were subsequently fitted with a hand-glove prosthesis to augment the outcome. An improved appearance was achieved in all patients fitted with the prosthesis. The patients' sense of confidence was also enhanced, which in turn promoted the active and open use of the reconstructed hands. While prescribed primarily to improve the appearance of the reconstructed hands, these prostheses were documented to enhance the physical hand functions in 11 cases by increasing the span of the hand and providing an opposable post and a palmar base for holding and for anchorage. The prosthesis enhanced assistive functions of the reconstructed hands and freed the contralateral normal hand for use in bimanual activities, such as holding a wallet and taking out money, supporting a note pad for writing, and holding a plate at buffet receptions. At the 18-month follow-up visit, 13 (87%) of the patients continued to use their prosthesis. Wear and tear were problems associated with the frequent use of the prosthesis. The expected life span of the prosthesis with daily use ranged from 2 to 3 years. All the patients acknowledged that the prosthesis played a role in their rehabilitation and that it helped them to overcome the initial psychological trauma and to come to terms with their physical loss.

Activities of Daily Living↗
PubMed1996

The accuracy of implant verification casts compared with casts produced from a rigid transfer coping technique.

PURPOSE: Prosthodontic techniques for implant-supported prostheses continue to evolve in an effort to facilitate treatment and minimize costs. Because research has shown no impression transfer technique to be without error, some clinicians have attempted to control the fit of prosthetic frameworks by reorienting sections of patterns or frameworks intraorally, fabricating a verification cast, and completing the prosthesis to fit such a cast. One manufacturer has attempted to meet both impression-making and verification-cast objectives by providing metallic impression copings (MICS) with extensions that allow contact between the copings for rigid fixation with acrylic resin before impression making. The purpose of this study was to determine the accuracy of casts produced from the MICS transfer process compared with casts produced from sectioned frameworks, where both techniques used a low-polymerization-shrinkage acrylic resin polymer to rigidly join the sections. MATERIALS AND METHODS: Using stainless steel measurement spheres as a reference point on each implant analog, the distances between analogs on the experimental casts were compared with the distances measured on the master cast. Seven casts were produced for each group and measured with a machinist's microscope at a 4-micron level of precision. RESULTS: The results revealed that the MICS transfer exhibited a mean error of 41 microns, which was significantly less than the verification-cast group mean error of 57 microns (p < .01, Student's t test). CONCLUSIONS: Given these results, clinicians can consider the rigid transfer technique as provided in the MICS transfer to be more accurate than the verification technique as outlined in this study.

Analysis of Variance↗
PubMed1985

Early fitting of the below knee amputee.

A comparison was made of the rehabilitation of patients undergoing below knee amputation during the calendar year 1982 on the orthopedic, general, and vascular surgical services at Parkland Hospital. Eight of nine trauma patients on the orthopedic service were fit with a temporary prosthesis and subsequently were fitted with a definitive prosthesis. Of the remaining 53 patients, only three were fitted with a temporary prosthesis and eventually 13 were fit with a definitive prosthesis. This experience identified a need for an alternative fitting method, which resulted in the design of a temporary, adjustable below knee prosthesis intended to be useful for a significant portion of the below knee population. Thus early ambulation is encouraged, possibly resulting in a higher percentage of successful ambulators. Gratifying early results with eight patients are described.

Amputation, Surgical↗
PubMed2000

Vertical alignment axis for transtibial prostheses: a simplified alignment method.

BACKGROUND AND PURPOSE: To evaluate a simplified method of alignment for fitting a transtibial prosthesis known as the vertical alignment axis method. METHODS: We measured the relationship between the vertical projection of the prosthetic socket center (geometric center of the cross section of the transtibial prosthetic socket at the level of the patella tendon bar) and the alignment reference center (junction of the middle and posterior thirds of the longitudinal axis of the shoe) in 36 dynamically aligned transtibial prostheses. The prostheses were fabricated by students, and the fit (proper vs improper) was assessed by the faculty. RESULTS: The faculty members found 26 of the 36 prostheses to be properly fitted. The vertical projections of the socket centers of the properly-fitted prostheses were concentrated within a small area of the shoe tracing (a mean value of 1.3 mm medially and 6.4 mm anteriorly from the alignment reference center). Conversely, in the improperly-fitted prostheses, the vertical projections of the socket center were scattered well away from the alignment reference center; the mediolateral deviation was significantly greater for improperly-fitted prostheses than for those that were properly fitted (p < 0.001). CONCLUSIONS: These results demonstrate the usefulness of the vertical alignment axis procedure. This procedure may help clinicians to better understand the alignment of transtibial prostheses and gait deviations associated with improper prosthesis fit.

Adult↗
PubMed1989

Temporary prosthetic fitting for below-knee amputation.

The problems encountered in fitting and using the permanent below-knee prosthesis in developing countries are the high price of the prosthesis, inadequate fitting and lack of proper rehabilitation. In Turkey, the preferred treatment of the stump post-operatively is by the soft dressing method with bandaging for maturation and shrinkage. Generally, the application of the permanent prosthesis is in the sixth month post-operatively. Since in patellar-tendon-bearing (PTB) sockets, stumps have to withstand high pressures in limited areas, the PTB socket can only tolerate small volume changes in the stump. For this reason bandaging over a long period may be insufficient for adequate stump shrinkage and amputees will need another below-knee prosthesis, which most of them cannot afford after only a few weeks use. In the authors' clinic, 19 amputees were fitted with simple, effective and inexpensive temporary prostheses following either conventional immediate post-operative dressing or the soft dressing method. The temporary prosthesis is worn for two months. It produces fast stump shrinkage, helps maturation and permits ambulatory discharge even in bilateral amputees. For economical reasons, only eight of nineteen patients were fitted with permanent prostheses, all wearing them successfully without the necessity of further rehabilitation.

Adult↗
PubMed1987

Fungal colonization of tracheoesophageal voice prosthesis.

Laryngectomized patients fitted with tracheoesophageal (TE) puncture voice prosthesis may experience frequent failures in adequate production of neophonation. In some cases, these phonatory problems result from obstruction of the voice prosthesis with various deposits. The nature of these deposits was studied with mycologic techniques and by light and scanning electron microscopy. Candida albicans and other fungal species were identified.

Candida albicans↗
PubMed1999

A bladder-neck support prosthesis for women with stress and mixed incontinence.

OBJECTIVE: To evaluate the safety and efficacy of a bladder-neck support prosthesis, a vaginal device designed to support the bladder neck, in women with genuine stress and mixed incontinence. METHODS: For enrollment, incontinent women underwent a history, physical examination including cotton-swab test, urinalysis, postvoid residual urine, and multichannel urodynamic testing. Those with genuine stress incontinence or mixed incontinence and urethral hypermobility completed 7-day bladder diaries, the Incontinence Impact Questionnaire, and underwent standardized pad tests. They were fitted with a prosthesis and seen weekly to optimize fit and efficacy. At week 5, they underwent repeat evaluations with the best-fitting prosthesis in place. RESULTS: Seventy women were enrolled and 53 completed the 1-month study (29 genuine stress incontinence, 24 mixed incontinence). The mean ages were 50.4 years for genuine stress incontinence (range 24-76) and 55.7 years for mixed incontinence (range 30-88). A statistically significant reduction in incontinence was noted on pad testing (genuine stress incontinence, mean 46.6-16.6 g; mixed incontinence, mean 31.9-6.8 g) and in the bladder diary (genuine stress incontinence, mean 28.6-7.8 losses per week; mixed incontinence, mean 30.2-15 losses per week). Quality-of-life scores improved in both groups. With the device in place, urodynamic testing indicated normalization of urethral function without evidence of outflow obstruction. Subjects found the device comfortable, easy to use, and convenient. Side effects included five urinary tract infections and 23 cases of vaginal mucosal soreness or mild irritation. CONCLUSION: The bladder-neck support prosthesis significantly reduced involuntary urine loss in women with stress and mixed incontinence.

Adult↗
PubMed2006

Contact lens fitting for keratoconus after Intacs placement.

PURPOSE: To describe a patient with keratoconus who underwent Intacs surgery to one eye with an unsatisfactory result and refused to undergo an Intacs removal procedure. METHODS: Case report. RESULTS: The patient's eye was fitted with a soft contact lens for visual rehabilitation 5 months after Intacs placement. CONCLUSIONS: Intacs, with the help of secondary refractive procedures or contact lenses, may still be considered as effective in postponing penetrating keratoplasty, even in patients with advanced keratoconus.

Adult↗
PubMed2005

Multipurpose conical orbital implant in evisceration.

PURPOSE: To evaluate the safety and efficacy of the porous polyethylene multipurpose conical orbital implant for use in evisceration. METHODS: A retrospective review of 31 eyes that underwent evisceration and received the multipurpose conical orbital implant. The orbits were evaluated at 1 week, 1 month, and 6 months after final prosthetic fitting for implant exposure, superior sulcus deformity, and prosthetic motility. RESULTS: There were no cases of extrusion, migration, or infection. All patients had a good cosmetic result after final prosthetic fitting. Prosthetic motility was good in all patients. Exposure developed in one eye (3%) and a superior sulcus deformity developed in one eye (3%). CONCLUSIONS: Placement of an multipurpose conical orbital implant in conjunction with evisceration is a safe and effective treatment for blind painful eye that achieves good motility and a good cosmetic result.

Blindness↗
PubMed1986

Fitting of an analogue cochlear prosthesis--introduction of a new method and preliminary findings.

A new method is suggested for the fitting of a broad-band analogue cochlear prosthesis in terms of frequency response adjustment. This 'frequency-stepped sweep' (FSS) method employs a feedback loop including the patient's loudness judgement to determine a frequency response for the patient's sound processor with which a continuous sinusoidal stimulus with constant amplitude and small increments in frequency can be heard equally loud at the most comfortable loudness level. The FSS-method has been successfully used for the fitting of the sound processors of 40 cochlear implant users. An evaluation of the FSS-method through speech tests employing five different frequency response adjustments with two implant patients confirms its appropriateness. The importance of proper fitting in terms of the frequency response adjustment for a cochlear prosthesis based on broad-band analogue stimulation is demonstrated. The necessary accuracy for the frequency response adjustment is approximately +/- 2 to +/- 5 dB (depending on the dynamic range of the patient) over the frequency range between 100 and 3000 Hz. For the proper adjustments no significant difference has been found between the results for a male and a female speaker.

Acoustic Stimulation↗