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PubMed2002

[Diagnosis and treatment of pseudoaneurysms after reconstructive interventions with the use of synthetic prostheses].

The author analyses an experience with treatment of 43 patients with false aneurysms of anastomoses after reconstructions in the aorto-femoral zone (5.8% of all the patients operated on). A combination with an infection of the prostheses was registered in 9 patients, two of them had aneurysms of the proximal aorto-prosthetic anastomosis. All the patients were operated upon. In three patients with aorto-prosthetic aneurysm resection of the proximal anastomosis was followed by reprosthesing and formation of a new aorto-prosthetic anastomosis. In combination with infection, the explants were completely ablated, the abdominal part of the aorta was ligated. The extraanatomical bifurcational axillary-femoral shunting was fulfilled with good results. When reconstructing the distal anastomoses the aneurysm was resected and the prosthesis was elongated with a linear insertion followed by the formation of a new distal anastomosis. The main blood flow in the extremity was obtained in all the patients. Lethality was 2.3%.

Anastomosis, Surgical↗
PubMed2003

Cementless revision for infection following total hip arthroplasty.

Eradication of chronic infection complicating total hip arthroplasty requires removal of all infected, devitalized and foreign tissue, including the arthroplasty components. Reimplantation into a sterile bed is the goal of treatment in most patients and successful reimplantation yields better functional results than excision arthroplasty. Reimplantation may be performed at the same stage as débridement as part of a single-stage procedure, using cemented components with antibiotic-loaded cement. Alternatively, a two-stage procedure may be performed so that the débridement and reimplantation are separated by a period of antibiotic delivery, both locally and systemically. The results of these treatment regimens and the rationale for cementless reconstruction at the second stage of a two-stage treatment protocol are important considerations in the treatment of periprosthetic infection.

Anti-Bacterial Agents↗
PubMed2003

Endotoxins and medical devices: the significance of dead bacteria.

There has been some recent speculation that endotoxins, the toxic molecules that are present in the cell wall of certain bacteria, could play a role in the development of tissue reactions to medical devices. This article discusses the basis for this speculation.

Biocompatible Materials↗
PubMed2003

[Experimental examination concerning the efficacy of silver-coated Dacron prostheses in vascular graft infections following subcutaneous implantation in a standardized infection model].

UNLABELLED: It was the aim of the study to examine the efficacy of silver coated prostheses in comparison to Rifampin in impregnated prostheses in the prevention of vascular graft infections. MATERIAL AND METHODS: 24 C3H/HcN mice with a bodyweight between 24 and 27 grams were assigned to four different groups. GROUP I: control gel-sealed Dacron graft (Uni-Graft DV) (6), GROUP II: gel-sealed Dacron graft (Uni-Graft DV) contaminated locally with 2 x 10(7) CFU/1.2 ml Staphylococcus aureus ATCC 25923 (6), GROUP III: silver prosthesis (Intergard Silver) contaminated locally with 2 x 10(7) CFU/0.2 ml Staphylococcus aureus ATCC 25923 (6), GROUP IV: Rifampin impregnated prosthesis contaminated locally with 2 x 10(7) CFU/0.2 ml Staphylococcus aureus ATCC 25923 (6). 14 days after primary operation all animals were euthanized and the grafts harvested. Specimens were examined for signs of infections by histology and microbiology. RESULTS: At termination of the trial on day 14 none of the grafts of group I were contaminated. 6 out of 6 grafts in group II, 6 out of 6 grafts in group III and 1 out of 6 grafts in group IV presented with infected grafts. The use of antimicrobial Rifampin could significantly prevent infection after bacterial challenge in group IV. CONCLUSION: The silver protected prosthesis (Intergard Silver) seems to be not effective in protecting vascular infection in vivo. However, the Rifampin group showed excellent results. In conclusion Rifampin bonded gelatin-sealed Dacron grafts are significantly more resistant to bacteremic infection than are silver/collagen-coated Dacron grafts.

Animals↗
PubMed2003

Presumptive infection of a total hip prosthesis by Mycobacterium tuberculosis: a case report.

Infection of a total hip prosthesis by Mycobacterium tuberculosis (MT) is an uncommon complication. We report a patient with septic loosening of a total hip prosthesis with a presumptive diagnosis of MT infection. His previous history was negative to any form of tuberculosis, and there was no evidence of a primary focus on the radiological study of the chest. He was diagnosed initially as presenting aseptic loosening and revision surgery was performed. Six months after surgery, septic loosening was diagnosed. The prosthesis was then removed. The histological study showed caseum granulomas and acid-fast bacilli, and routine cultures of the synovial fluid were negative. Since only a positive Löwenstein culture would have confirmed the diagnosis with certainty, a presumptive diagnosis of MR infection was made based on the findings in the histological study. Tuberculostatic treatment was administered for 9 months. At six years follow-up no signs of infection are present, neither by clinical or radiological criteria.

Aged↗
PubMed2003

[Total hip replacement prosthesis infected by Mycobacterium tuberculous].

We examined the diagnostic and therapeutic approaches used for two patients with loosened total hip prostheses who developed Mycobacterium tuberculosis infection. Revision total hip arthroplasty (THA) was performed in one patient. The prosthesis was left in situ in the second patient due to lack of sufficient bone stock. Medical treatment was given. The diagnosis was established on direct examination of bacteriological samples and culture on specific media. Polymerase chain reaction identified the Mycobacterium tuberculosis complex. Non-specific granulomas were observed on the histology sections. For us, management of overt tuberculosis involving a THA depends on the quality of the fixation. If the prosthesis remains stable, medical treatment can be sufficient. If the prosthesis loosens, definitive ablation must be considered with possible revision THA later. Exceptionally, a loosened implant may be left in situ if the remaining bone stock is insufficient. Minimal duration of anti-tuberulosis treatment is six months.

Antitubercular Agents↗
PubMedDate not supplied

Acetabular reinforcement rings and bone allografts in the reconstructive treatment of periprosthetic bone loss.

Medium-term results in the treatment of acetabular bone loss using bulk and/or morselized bone allografts supported by acetabular reinforcement rings are reported. A total of 164 hips in 157 patients were treated by means of this reconstruction technique. The devices employed were Müller ARRR in 24 cases and Burch-Schneider APC in 140. Mean follow-up was 67 months (minimum 12, maximum 123). A total of 4 patients developed deep infection that was treated by resection-arthroplasty. Aseptic loosening of acetabular implant following extensive resorption of bone graft was observed in 5 cases: 3 of the cases underwent acetabular revision. Clinical results were evaluated based on the Harris Hip Score: mean values of 35 and 78 were assessed preoperatively and at follow-up, respectively. X-ray signs of incorporation of bone graft were observed in all cases that progressed successfully.

Acetabulum↗
PubMed1992

Plaque-induced inflammation around implants.

This article is a review of plaque-induced inflammation around dental implants. The microflora around successful implants is similar to healthy sulci, while that associated with failing implants is similar to periodontally diseased sites. Implant microflora is similar to the tooth microflora in the partially edentulous mouth. The microflora of implants in partially edentulous mouths differs from that in edentulous mouths. This seems to indicate a bacterial reservoir around the teeth and the possibility of reinfection of the implant sulcus by periodontal pathogens. The maintenance of a tooth microflora consistent with periodontal health in partially edentulous mouths may lead to maintaining an implant microflora consistent with peri-implant health. Thus, periodontal and implant maintenance are linked and neither can be overlooked.

Animals↗
PubMed2003

Use of an intramedullary rod in knee arthrodesis following failed total knee arthroplasty.

A retrospective review was conducted of 20 consecutive patients (10 men and 10 women) with failed total knee arthroplasty (TKA) who underwent arthrodesis using an intramedullary rod. Average patient age was 70.5 years. One patient was lost to follow-up, and the remaining 19 patients were evaluated an average of 4.5 years postoperatively (range: 1-24 years). Three patients without infections achieved a solid arthrodesis without complications. In 16 patients, the indication for fusion was an infection, and 12 of these patients had an uncomplicated postoperative course and achieved a solid arthrodesis. Of the remaining 4 patients, 1 required revision for a nonunion, 1 a skin graft, and 2 had recurrence of their infections in the postoperative period. Both patients had positive cultures at attempted arthrodesis. One patient underwent debridement at 3 months, and a solid fusion was obtained. The other patient required rod removal and currently has a nonunion, uses a brace, and is on suppressive antibiotic treatment. An intramedullary rod is the ideal fixation choice for knee arthrodesis in patients with a failed, noninfected TKA; however, in patients with an infection, the infection must be eradicated prior to rod use.

Aged↗
PubMed2003

Aspergillus infection after total knee arthroplasty.

The literature includes little information about the treatment protocol for Aspergillus infection after total knee arthroplasty. In this article, we describe the case of a nonimmunocompromised patient who lacked predisposing risk factors and who initially presented with aseptic loosening of a total knee prosthesis that postoperatively had grown Aspergillus niger. Intraoperative culture and frozen-section results for the pseudocapsule were negative. Two days postoperatively, culture results showed heavy growth of A niger. The patient was treated with a 6-week course of amphotericin B followed by oral antifungal therapy. She was doing well and had no symptoms 12 months after surgery.

Administration, Oral↗
PubMedDate not supplied

Treatment of implants demonstrating periapical radiolucencies.

This article presents two implant cases where a periapical radiolucency developed, with a sinus tract, while the implants were still submerged. A corrective surgical treatment for these unique lesions is detailed, and the possible etiologies are discussed.

Aged↗
PubMed1992

Original expectations of the Hancock valve and 20 years of clinical reality.

The standard (glutaraldehyde-preserved) Hancock porcine bioprosthesis was introduced into clinical practice in order to provide surgeons with a cardiac valve substitute which would be nonthrombogenic and therefore would not require anticoagulation, and would be durable, anatomically suitable, and noiseless. In the present report we have reviewed our long-term experience with Hancock porcine valve recipients in order to verify the original expectations of this bioprosthesis have been met.

Adolescent↗
PubMed1992

[Revision stapedectomy].

Early and delayed complications in the inner or middle ear may follow stapedectomy and require revision surgery. The records of 72 patients who had undergone revision stapedectomy were analyzed to determine: 1. the causes of failure. 2. how to revise the conditions due to the failure following previous operation. 3. hearing results. These 72 revision operations consisted of 66 case of conductive deafness and 6 sensorineural loss. The commonest cause of failure was dysfunction of prosthesis (23.6 per cent), followed by otosclerotic regrowth (22.2 per cent), incus dislocation (13.9 per cent), reparative granuloma (12.5 per cent), incus necrosis (11.1 per cent), and fibrous adhesions (9.7 per cent). A review of these cases demonstrates that the results of revision stapedectomy are different from those for primary stapedectomy. The revision operations resulted in post-operative air-born gaps of 15 dB or less in 39.4 per cent of cases. Primary stapedectomy resulted in successful closure of the air-bone gap to 15 dB or less in 97.2 per cent of cases. 'Dead ears' were encountered in 9.1 per cent as against 2.1 per cent in the primary cases. Thus the surgeon should be aware of the problems and risks involved in revision stapedectomy.

Female↗
PubMed1992

Clinical performance of the Duromedics bileaflet pyrolite mechanical prosthesis.

The Duromedics (Baxter Healthcare Corp., Edwards CVS Div., Irvine, Calif.) mechanical cardiac valvular prosthesis was implanted in 480 patients between 1984 and 1987 at the Montreal Heart Institute, the Hospital Clinic of Barcelona and the teaching hospitals of the University of British Columbia. The mean age of the patients was 52 years. The early mortality was 7.9% and the late mortality was 4.1% per patient-year. The overall survival at 4 years for aortic valve replacement (AVR) was 87.0% +/- 3.7% and for mitral valve replacement (MVR) was 81.9% +/- 2.9%. There were 16 valve-related reoperations in 14 patients--for prosthetic valve endocarditis in 9 patients, for thromboembolism in 1 patient and for nonstructural dysfunction in 4 patients. The freedom from thromboembolism at 3 and 4 years was 94.3% +/- 3.1% for AVR and 95.1% +/- 1.8% for MVR. The freedom from prosthetic valve endocarditis at 3 and 4 years was 95.3% +/- 2.2% for AVR and 96.2% +/- 1.6% for MVR. The freedom from structural valve deterioration for all positions was 100%. The freedom from reoperation at 4 years was 95.3% +/- 2.1% for AVR and 92.3% +/- 4.3% for MVR and from valve-related death was 98.7% +/- 1.3% for AVR and 96.2% +/- 1.6% for MVR. The freedom from all valve-related complications at 4 years was 87.7% +/- 3.8% for AVR and 85.7% +/- 2.9% for MVR. Long-term evaluation of the Duromedics prosthesis is required to determine the influence of documented structural valve deterioration.

Adolescent↗
PubMed2003

The Quattro valve in rheumatic mitral valve disease: four-year follow up.

BACKGROUND AND AIM OF THE STUDY: There remains a great need for bioprosthetic valves in developing countries where monitoring of anticoagulation therapy is difficult. The study aim was to assess the intermediate outcome following mitral valve replacement with a stentless bovine pericardial quadrileaflet mitral (Quattro) valve. This valve maintains mitral annular-papillary continuity in patients with isolated severe rheumatic mitral valve disease. METHODS: Since December 1996, the Quattro valve has been implanted in 47 patients (mean age 34 +/- 13 years; 16 (34%) aged <25 years) with rheumatic mitral valve disease. All patients were symptomatic, and in NYHA class II (n = 7), III (n = 30) or IV (n = 10). Preoperatively, all patients underwent full clinical and routine echocardiographic assessment, as well as intraoperative transesophageal evaluation after valve implantation. At follow up visits, clinical and echocardiographic evaluations were carried out in each patient. RESULTS: After a mean follow up of 51 +/- 11 months, the overall mortality was 10.6% (five deaths). Five patients did not return for clinical follow up, but three of these are known to be alive and well. Of the 37 patients who returned for regular follow up, 32 remained symptomatically improved. Valve explantation was performed in two patients (4.2%) for prosthetic valve endocarditis. Two patients have deteriorated as a result of left ventricular dysfunction, and one patient has developed severe mitral regurgitation. Thromboembolism or clinically overt hemolysis has not occurred. One patient, who was receiving coumadin therapy for atrial fibrillation, died following a massive hematemesis. Serial one-year echocardiography data at one, two and three-year follow up intervals were available in 28 patients. These data confirmed no significant change in valve area or in mean diastolic gradient. Varying degrees of valve thickening were detected echocardiographically in 10 patients; four patients had clinically significant mitral stenosis (valve area <1.5 cm2). One valve was explanted for structural deterioration. CONCLUSION: Intermediate results after Quattro valve implantation in a relatively young population were satisfactory. However, long-term follow up is mandatory to assess valve durability.

Adult↗