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The aim of the present study was to evaluate and discuss the indications of different splinting methods used in surgical procedures. It was proposed that the use of "semirigid" fixation method could be a more valuable technique in autogenous transplants and dental reimplants.
Authors studied two groups of patients, in which a cardiac valvular prosthesis was reimplanted within 15 years. Data of patients reoperated on (group A) were used to estimate indications, surgical methods, postoperative course and late results. Data of patients which underwent surgery and then requiring reoperation (group B) were used to evaluate the percentage of reoperation falling to 1 patient/1 year according to a primary implanted valvular prosthesis: 42 patients were divided into two groups. 3 perioperative and 12 late deaths (totally 28.3%) were stated in the group A. 5- and 10-year survival rates were 83.3% and 65.6%, respectively. In the group B the lowest percentage of reoperation (1 patient/1 year) were stated in patients with mitral Starr-Edwards 6120 valve (029) and Björk-Shiley aortic valve (0.13). The highest percentage of reoperation was observed in patients with biological prosthetic valves (homograft or heterograft--4.64) and in comparison with patients with primary implanted mechanical prostheses (0.24). Those differences were statistically significant (p less than 0.001).
In experiments with mice, rats, guinea pigs, and dogs subjected to whole-body irradiation a favourable effect of postirradiation explantation, incubation, under suboptimal conditions, and reimplantation of bone marrow cells was shown. The effect was perhaps associated with the enhanced recovery of stem cells, their primary differentiation into a granulocytic series, and activation of bone marrow regeneration.
Clinically retrieved titanium implant cover screws (Brånemark implant system), rinsed in saline or subjected to ultrasonic cleaning and sterilization, as well as unused sterile screws were studied by scanning electron microscopy and implanted in the rat abdominal wall for 6 weeks. Irrespective of cleaning procedure, the heads of the clinically retrieved screws were covered by numerous contaminants not present on the unused screws. The reimplanted screws elicited a different tissue response than the unused screws. The tissue response to the contaminated screws was characterized by a significantly thicker fibrous capsule and by a significantly larger number of macrophages located close to the implant. Moreover, judging from their ultrastructure, studied with transmission electron microscopy, the macrophages appeared to be in a more active state when compared to those located adjacent to unused screws.
A 38-year-old female patient with a long history of bilateral dysplasia of the hip died during a TEP-reimplantation of a hemorrhage due to a lesion in the left external iliac artery. The real extent of the atrophy in the left acetabular fossa could not be detected on the preoperative X-ray photograph. A conspicious secondary finding were fixation screws in the well adapted Judet prosthesis on the right side that were projecting up to 2 cm into the pelvis. The results of the autopsy and the special juridical questions involved are demonstrated and discussed.
Severe nasal trauma produces concomitant lesions of the pyramid and septum. These functional and cosmetic sequelae are inseparable and must be treated during the same operative procedure. Among the procedures for nasal straightening, the method of choice is ablation of the septum, intra-operative reconstruction of a continuous plate followed by reimplantation in an intact perichondro-mucosal sleeve.
We evaluated the results and complications of 85 ureteroneocystostomies performed from 1978 to 1987. These varied according to the etiology of the disorder; the success rate was 100% for malformations, 87.5% for gynecologic ureters, and 80% for stenosis of the end of the ureter. Several surgical techniques were employed. The Politano-Leadbetter procedure was the most widely-used (40% of cases), and the Cohen technique achieved the best results (100% success rate). All the failures (7.1% of the cases) were due to stenosis of the reimplanted ureter.
Since 1973, transposition of the subclavian artery into the common carotid artery has been the technique of choice to treat prevertebral occlusive subclavian lesions. However, the haemodynamic results in the vertebral artery were far from perfect, as shown by immediate post-operative ultrasonic examinations. This has been corrected by a technical modification: the subclavian artery is severed flush with the vertebral artery lying obliquely downward and medially, which is equivalent to reimplanting a "double-barrelled" vessel (the vertebral and subclavian arteries) into the common carotid artery.
Twenty-one infected total knee arthroplasties (TKA) in 21 patients were treated from September 1980 through October 1987. Of these, 15 were followed for more than one year. Treatment of these patients consisted of thorough debridement of all infected tissue and components; a cement spacer was used in ten patients. The cement was impregnated with antibiotics. This procedure was followed for an average of 4.2 weeks with intravenous antibiotics and TKA utilizing antibiotic-impregnated cement. Five patients had rheumatoid arthritis and ten had osteoarthritis. The organisms included Staphylococcus coagulase negative (seven patients), Streptococcus group B (two patients), Streptococcus bovis (one patient), Enterococcus (one patient), Staphylococcus coagulase positive and Bacillus circulans (one patient), Staphylococcus coagulase negative and Enterococcus (one patient), Staphylococcus coagulase negative and Pseudomonas aeuriginosa (one patient), and Clostridium perfringens (one patient). Of the 15 patients, 12 appeared to be free of infection, two were obvious failures and required knee fusion, and one was suspected of having continued infection at five years and was treated elsewhere. Eleven patients with revision TKA were available for follow-up examinations at an average of 2.9 years (range, one to six years). One patient died five years after reimplantation but had been functioning well. One patient functioning at three years postreimplantation did not return for a later follow-up examination. The average knee score (modification of the Hospital for Special Surgery Knee Score) was 75.5 points (range, 48-94); average flexion was 81 degrees (range, 52 degrees-120 degrees), and average extension was +6 degrees (range, 0 degrees-30 degrees).(ABSTRACT TRUNCATED AT 250 WORDS)
Persistence of urinary tract infections after successful ureteric reimplantation for vesico-ureteric reflux has been reported with an incidence varying between 20-30% according to different series. The Authors analyze their own experience with 99 patients successfully operated for primary VUR during a five year period. In 22 patients (22.2%) there was evidence of persistent UTI, which were almost exclusively low and asymptomatic (91%) and occurring within 6-12 months after the antireflux surgery. A single UTI was documented in over 60% of the patients. There was strong female prevalence (21 patients) and 50% were more than 6 years old. No significant relationship was found between grade of VUR, renal scarring, type of germ and number of preoperative infections and incidence of post-operative UTI. On the other end, voiding and continence disorders and cystoscopic evidence of cystitis cystica would both indicate to be predisposing factors. In these specific cases it is mandatory an accurate pre-operative evaluation of the voiding habits, in order to better define the treatment strategy, not only limited to the surgical correction of the associated reflux.
Anatomical reestablishment or orthograde flow into the right subclavian artery in children with arteria lusoria is emphasized. Two infants with arteria lusoria were successfully treated by reimplantation of the aberrant right subclavian artery in the ascending aorta without graft interposition through a right thoracotomy. Several surgical approaches are reviewed.
The replacement of the entire aorta and the aortic valve is the procedure of choice in aneurysms involving the aortic annulus. This method, which necessitate the reimplantation of the coronary arteries, is, however, sometimes difficult and carries a greater operative risk of bleeding problems. Our experience of 15 such cases lead us to propose some modifications (such the use of an independent coronary conduit and the atrial drainage of the peri prosthetic space) in order to make the operation simple and safer.
A total of 83 teeth were reimplanted after extraction and treatment of periapical or pulpoperiodontal lesions in 79 patients, age range 9 to 55 years. Only anterior teeth were immobilized by ligature and self-polymerizable resin. Follow up of from 1 to 5 years showed complete success in 69% clinical success but with root lysis in 11%, as shown by radiologic imaging, and failure of treatment, mainly in patients over 40 years, in 20%. Healing was usually by ankylosis but an alveolodental new ligament formation was noted in only 3 cases. Root lysis occurred in 28% of cases, including 1/3 rd of the compensated type with a very slow course and 2/3 rds of the inflammatory type with resulting failure of treatment.
Some prostatic cancers (T4) spread out along the ureters to the kidneys. Patients, usually arrive with terminal renal failure and bladder retention and have often fast-advancing cancer with massive nodes invading. T.U.R., reimplantation of the ureters into the bladder dome or into a psoïc bladder and the specific treatment of the cancer, have often permitted these patients to survive for some years without any dialysis. In these cases we often find very important lower limbs oedema. With lymphatic nodes radiotherapy and subcutaneous injections of heparin, these oedema may regress completely.
Over the last two years, 15 patients have undergone revascularization surgery to a total of 17 distal extremities at the level of or distal to the last phalangeal joint. Operations were performed by three surgeons trained in microsurgical techniques, making the series a homogeneous one. Results were analyzed using Tamai and Nakamura's scores. Determinant factors, social and economic costs and effects on occupation are emphasized. The mean success rate of 65% is influenced by the total or partial nature of the section, its localization to the thumb or long fingers and the mechanism of section. The good functional results obtained were due to distal forms of amputation, recognized despite the technical difficulties as being an indication of choice for this reimplantation surgery. All patients in this group were able to return to work, with or without adaptation, within a variable lapse of time.
42 cases of ureterocystoneostomy with psoas hitch were performed: 22 boys, 20 girls. The majority of the cases were done between ages 4 and 6. Initially 8 cases presented with reflux, 9 with megaureter and reflux, 20 with megaureter without reflux, 5 cases of ureterocele with duplication. 2 cases were done as a primary procedure, 4 cases as a part of undiversion, 36 after failure of a reimplantation either for reflux (13) or for stenosis (23). The technique is described: four cases were done bilaterally. Another procedure accompanied the psoas hitch: 20 ureteral modelage, 3 transuretero-ureterostomies. Follow up varied from 1 to 13 years with good results in 27 cases, fair results in 10 and poor results in 5.
In the autogenous kidney preserved under conditions of hypothermia the development of a partial no-reflow phenomenon is unavoidable after reimplantation. The phenomenon is ascribed to ischaemic lesions induced by preservation. The consequences are functional disorders in the acute period (temporarily pathologic angiogram, nephrogram and proteinuria) and scars due to chronic focal necrosis. These unavoidable changes of the current preservation procedures are mostly of subclinical importance.
In three children with metastatic tumor uncontrollable by conventional chemo- and radiotherapy, bone marrow was obtained under general anesthesia and cryopreserved according to a carefully developed protocol. The autologous bone marrow cells were reinfused after intensive cytostatic therapy and total body irradiation (2 patients). After an aplastic phase of 7--14 days the peripheral blood leukocyte and thrombocyte count began to recover. The toxicity of the intensive treatment preceding the autologous bone marrow transfusion, and the autologous bone marrow cells themselves were well tolerated. The aplastic phase was easily controlled by the use of granulocytes, thrombocytes and erythrocytes. Except for fever and mucosal ulcerations observed during the phase of extreme leukopenia, the general condition of the patients during partial isolation lasting 26--34 days was astonishingly good. One child died 13 weeks after returning home due to a local relapse. The other two patients survived for 6 + and 11 + weeks and are in complete and partial remission respectively. A further evaluation of the clinical significance of autologous bone marrow reimplantations appears to be feasible in pediatric oncology.