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PubMed2002

Disarticulation resections of the mandible: a prospective review of 16 cases.

PURPOSE: This article provides a review of the disarticulation resection of the mandible for various benign and malignant tumors and non-neoplastic processes. In so doing, the author proposes a classification to describe extension of pathology into the condylar region, thereby requiring its sacrifice. Recommendations are also proposed for preservation versus sacrifice of the meniscus when performing a disarticulation resection of the mandible. Finally, complications are evaluated in this type of mandibular resection. PATIENTS AND METHODS: This review is based on the author's accumulated clinical data obtained from performing disarticulation resections on 16 patients who presented with 10 different pathologic diagnoses. Disarticulation resections are performed for 3 different patterns of extension of pathologic processes into the condylar region, designated as type I, type II, and type III by the author. These designations reflect the radiographic involvement of the condyle or subcondylar region of the mandible by the pathologic entity. The designations of type II and type III extensions are diagnosis dependent, whereas type I extension is independent of diagnosis. RESULTS: Five patients in this series presented with type I condylar extension, 2 patients presented with type II condylar extension, and 9 patients presented with type III condylar extension. The meniscus required sacrifice in 3 of the 16 patients. Complications occurred in 3 of 16 patients and included 1 dislocation of the plate into the middle cranial fossa, 1 dislocation of the plate inferiorly and posteriorly to the mastoid process, and 1 cutaneous exposure of the plate. CONCLUSIONS: Disarticulation resections are rarely required variants of segmental resection of the mandible, and they are required by a variety of pathologic processes of the jaws and contiguous structures. The placement of a reconstruction bone plate with an affixed condylar prosthesis is well tolerated by patients and is associated with few complications. These reconstruction bone plates favorably support facial form, symmetry, and occlusion such that many patients delay their definitive bony reconstruction. Because these condyles are temporary prostheses, the surgeon should consider their removal with bony reconstruction of the disarticulation defect as soon as possible after the ablative surgery.

Bone Plates↗

PubMed2005

Visceral sensitivity to gastric stimulation and its correlation with alterations in gastric emptying and accommodation in humans.

BACKGROUND: The aim of this study was to investigate the visceral sensation to gastric stimulation and its correlation with the stimulation-induced alterations in gastric accommodation and gastric emptying. METHODS: The study was performed in 12 healthy human controls. Gastric stimulation was performed using bipolar electrodes attached to the mucosa of the distal stomach under endoscopy. Experiments were conducted on 3 consecutive days to investigate the effects of gastric stimulation with various parameters on visceral sensation, maximum intake of water and gastric emptying of solids. RESULTS: 1) The stimulation energy was 265.6 +/- 134.9 smA 2 for the first sensation and 2,020.0 +/- 865.1 smA2 for the maximum tolerance, and there was a large variation among the subjects; 2) Gastric stimulation with stimulation energy less than 50% of that required to induce the first sensation significantly reduced the maximum intake of water and delayed gastric emptying of solids without inducing symptoms; 3) The stimulation energy of the first sensation was significantly correlated with the stimulation-induced reduction in water intake (r=-0.80, P=0.02) and the stimulation-induced prolongation of gastric emptying (r=-0.78, P=0.003). That is, the inhibitory effects of gastric stimulation were more obvious in those subjects who were viscerally more sensitive to gastric stimulation. CONCLUSIONS: Gastric stimulation via the distal stomach reduces gastric accommodation and delays gastric emptying. These inhibitory effects are correlated with the visceral sensitivity of the individual to gastric stimulation. It is worthy to further investigate whether the outcome of the implantable gastric stimulation (IGS) therapy for obesity may be predicted from the visceral sensitivity of the patient to temporary gastric stimulation using endoscopically placed mucosal electrodes.

Adaptation, Physiological↗

PubMed2000

Self-expanding metallic stent in the treatment of colonic obstruction caused by advanced malignancies.

INTRODUCTION: The treatment of malignant obstruction of the left colon or rectum usually requires emergency surgery on poor-risk patients, and the creation of a stoma is usually inevitable. With the use of self-expanding metallic stents, the prompt relief of large-bowel obstruction without surgery has become possible. This report describes our results in the use of self-expanding metallic stents in the treatment of left-sided colonic obstruction resulting from advanced malignancies. METHODS: From November 1997 to March 1999, insertion of self-expanding metallic stents was attempted in 24 patients with acute left-sided colonic obstruction caused by primary or recurrent malignancies. All the procedures were performed by colorectal surgeons. The guidewire was inserted through the channel of the endoscope, and its position was confirmed with fluoroscopy. Uncovered Wallstent esophageal endoprostheses were used in all except the first case. The insertion and deployment of the stents were under both endoscopic and fluoroscopic guidance. RESULTS: There were 24 patients (15 males) with a mean age of 63.6 (range, 36-98) years. Thirteen patients had primary colorectal cancer and 11 had recurrent cancers (colorectal cancer, 5; gastric cancer, 5; other, 1). In the treatment of primary colorectal cancer, seven procedures were palliative, and no subsequent surgery was planned because of extensive liver metastasis or poor medical risk. The other six patients underwent elective resection after mechanical bowel preparation. There was no mortality related to the procedure. Stenting was successful in the relief of obstruction in 23 patients. Perforation of the colon occurred in one patient, and an emergency Hartmann's operation was performed. Migration of the stents occurred in three patients. Only 3 of the 18 patients in the palliation group required the subsequent creation of stomas. CONCLUSION: The use of the self-expanding metallic stents can achieve rapid and effective nonsurgical means to relieve left-sided colonic obstruction. It provides good palliation for unresectable advanced tumors that cause colonic obstruction. It may also have a role in the temporary relief of obstruction so that subsequent colonic resection can be performed under elective conditions.

Adult↗

PubMed2002

Simulation of carrier-facilitated transport of phenanthrene in a layered soil profile.

The appropriate prediction of the fate of the contaminant is an essential step when evaluating the risk of severe groundwater pollutions-in particular in the context of natural attenuation. We numerically study the reactive transport of phenanthrene at the field scale in a multilayer soil profile based on experimental data. The effect of carrier facilitation by dissolved organic carbon is emphasized and incorporated in the model. Previously published simulations are restricted to the saturated zone and/or to homogeneous soil columns at the laboratory scale. A numerical flow and transport model is extended and applied to understand and quantify the relevant processes in the case of a strongly sorbing hydrophobic organic compound that is subject to carrier facilitation in the unsaturated zone. The contaminant migration is investigated on long- and short-term time scales and compared to predictions without carrier facilitation. The simulations demonstrate the importance of carrier facilitation and suggest strongly to take this aspect into account. By carrier facilitation breakthrough times at the groundwater level decreased from 500 to approximately 8 years and concentration peaks increased by two orders of magnitude in the long-term simulation assuming a temporary spill in an initially unpolluted soil with a non-sorbing carrier.

Carbon↗

PubMed2005

Histologic and histomorphometric analysis of an immediately loaded implant retrieved from man after 14 months of loading.

OBJECTIVE: The aim of this study was a histologic and histomorphometric analysis of the peri-implant tissue reactions and the bone/titanium interface in an immediately loaded titanium implant inserted in a soft bone site and retrieved, in man, after a 14-month loading period. METHODS. A 65-year-old patient presented with a partial edentulism in the left posterior mandible. The patient was rehabilitated with three dental implants inserted in the left first, second, and third molar sites. All these implants were immediately put into a nonfunctional loading mode and joined with the other implants that supported the temporary restorations. After 14 months, the most distal implant and surrounding tissues were retrieved because of psychological problems of the patient. RESULTS: Newly formed, strongly stained, compact, mature cortical bone with few marrow spaces was observed around the implant, especially in the coronal portion. No inflammatory infiltrate was present around the implant. No gaps or dense fibrous connective tissue were found at the bone/metal interface. No apical epithelial migration was found. In the cortical portion, bone remodeling areas were present with many newly formed Haversian canals. Only in a few areas of the interface was it possible to observe an osteoblast rim. In the apical portion, newly formed bone trabeculae were present; these were composed mostly by woven bone, and only a small quantity of preexisting lamellar bone was present. Histomorphometric evaluation showed that the bone/implant contact percentage was 72.6% (+/-2.7%). CONCLUSIONS: We found that, in immediately loaded implants inserted in soft tissue sites, it was possible to find a high percentage of bone-to-implant contact and that osseointegration was maintained for more than 1 year. This fact could be partly explained with the use of an implant with a rough surface.

Aged↗

PubMed2006

[Labour market, occupational health and immigration].

The process of economic and social change that Navarra has undergone in recent decades has been associated with the arrival of a growing flow of immigrants since the start of the new century. They have had a decisive influence as a factor of economic change in terms of production increase and internal demand. A new Navarra is being built thanks to the phenomenon of migration. In the first place, we analyse their impact on demographic growth. Their influence on the labour market, with its highlights and shadows, is evaluated. Foreigners already are about 10% of the active population and their presence in some productive sectors is decisive for their viability. The dysfunctions and problems of the labour market are reviewed, especially the question of accidents. Finally, the behaviour of the indicators of temporary disability of this collective are set out. Although this phenomenon has brought an imbalance in some spheres of social policy (education, housing, health), it can be said that the model of integration in Navarra is based on a generous welfare system, a social climate that is in general tolerant, and sustained economic growth.

Adolescent↗

PubMed1996

Immunotherapy of far-advanced lepromatous leprosy patients with low-dose convit vaccine along with multidrug therapy (Calcutta trial).

This report describes a promising mode of treatment of lepromin-unresponsive, far-advanced, lepromatous (LL) leprosy patients with antileprosy vaccines as an adjunct to multidrug therapy (MDT). The Trial Groups included 50 highly bacilliferous, lepromin-negative, untreated LL patients. They were given MDT for 2 years. Of them, 30 patients were administered a mixed antileprosy vaccine containing killed Mycobacterium leprae of human origin plus M. bovis BCG. The remaining 20 patients were given M. bovis BCG. Depending on the severity of lepromin unresponsiveness, they were given one to six inoculations at 3-month intervals. Another 20 similar LL patients were taken in the Control Group. They were given only MDT for 2 years. From the start of the study, all patients belonging to the Trial and Control Groups were followed every 3 months for clinical, bacteriological and immunological outcomes. Within 2 years all 50 patients of the Trial Groups and 19 of the 20 patients of the Control Group became clinically inactive and bacteriologically negative. However, the clinical cure and the falls of the bacterial and morphological indexes were much faster in those patients receiving the mixed vaccine therapy than in those patients who were given BCG plus MDT or only MDT. The immunological improvements in the patients of the Trial and Control Groups were assessed by: a) lepromin testing at the beginning of the study and at 3-month intervals and also by b) the in vitro leukocyte migration inhibition (LMI) test at both the beginning and end of the study. As the patients were given more and more vaccinations, the incidence of lepromin conversion increased, more so in the patients receiving the mixed vaccine. Thus, 63%, 15% and 5% of the patients became lepromin positive in those patients receiving the mixed vaccine, BCG, and MDT only, respectively. Lamentably, the vaccine-induced lepromin positivity was temporary and faded away within several months. At the beginning of the study, the LMI test against specific M. leprae antigen was negative in all patients of both the Trial and Control Groups. After the end of the chemo-immunotherapy schedule, the LMI test became positive in 50% and 20% of LL patients receiving the mixed vaccine and BCG, respectively. None of the Control Group could show LMI positivity after completion of the MDT schedule. These results show that treatment of LL patients with the mixed vaccine and MDT could quickly reverse the clinical course of the disease, remove immunologic anergy in some patients, and induce a rapid decrease in the bacterial load in them.

Adult↗

PubMed2003

Precursor tissue analogs as a tissue-engineering strategy.

Natural tissues are composed of functionally diverse cell types that are organized in spatially complex arrangements. Organogenesis of complex tissues requires a coordinated sequential transformation process, with individual stages involving time-dependent expression of cell-cell, cell-matrix, and cell-signal interactions in three dimensions. The common theme of temporal-spatial patterning of these cellular interactions is also observed in other physiological processes, such as growth and development, wound healing, and tumor migration. The "precursor tissue analog" (PTA) applies the temporal-spatial patterning theme to tissue engineering. The goal of PTA in tissue engineering is not to fabricate the final transplantable tissue but rather to guide the dynamic organization, maturation, and remodeling leading to the formation of normal and functional tissues. We describe the critical design principles of PTA. First, structural, mechanical, and physiological requirements of the PTA as a temporary scaffold must be met by a fabrication method with flexibility. The fabrication potential incorporating biological materials such as living cells and plasmid DNA has been addressed. Second, the PTA concept is considered suitable for future tissue engineering in light of the use of undifferentiated stem cells, and may possess a capability to guide stem cells toward diverse differentiation characteristics in situ. To this end, the behavior of the engineered cell and tissue must be monitored in detail. The development of a practical phenotype monitoring system such as a DNA microarray may be integral to the fabrication strategies of PTA. Third, the microtopographical and microenvironmental control on the liquid-solid interaction may lead to a critical design for PTA to provide soluble factors, nutrients, and gases to the cells embedded within the scaffold. We suggest that the level set numerical simulation method may be utilized to engineer the consistent circulation of bioactive liquid throughout the PTA microenvironment.

Animals↗

PubMed2005

Reduction of neural and vascular damage by transplantation of VEGF-secreting neural stem cells after cerebral ischemia.

We determined the role of VEGF-transfected neural stem cells (NSCs) transplantation in rat brain subjected to ischemia. Fetal NSCs were cultured from E14 days SD rats and transfected with VEGF121 gene by using lipofectamine technique. Temporary middle cerebral artery occlusion (tMCAO) models were established and randomly divided into 1: control group, 2: PBS transplantation group, 3: NSCs transplantation group and 4: VEGF-secreting NSCs transplantation group. Grafts were transplanted into the penumbra zones 3 days after tMCAO model established. Neurological Severity Score (NSS) was checked in all groups 2-12 weeks after transplantation. By using immunofluorescent staining, VEGF expression of transplanted cells, differentiation and migration of transplanted NSCs after transplantation were detected. VEGF gene-transfected neural stem cells expressed gene products during the first 2 weeks. NSS in this group was significantly lower compared with that in other 3 groups 12 weeks after transplantation. VEGF gene-transfected NSCs migrated and expressed VEGF in hosts' brains, some of them differentiated to neurons 12 weeks after transplantation. VEGF-transfected NSCs expressed gene products during the early time after transplantation, which reduce brain injury through protecting the vascular system against ischemic attack.

Animals↗

PubMed2003

Larval behavioral, morphological changes, and nematocyte dynamics during settlement of actinulae of Tubularia mesembryanthemum, Allman 1871 (Hydrozoa: Tubulariidae).

The marine colonial hydroid Tubularia mesembryanthemum produces a morphologically unique dispersive stage, the actinula larva. Detailed observations were made on the behaviors and nematocyte dynamics of actinula larvae during attachment and morphogenesis by employing microscopic and time lapse video techniques. These observations produced four primary results. (1) Actinula larvae demonstrated two forms of attachment: temporary attachment by atrichous isorhiza (AI)-nematocysts discharged from the aboral tentacle (AT) tips-and permanent settlement by cement secretion from the columnar gland cells of the basal protrusion. (2) During larval settlement, numerous AIs were discharged from the AT tips with sinuous movement and rubbing of the tentacles onto the substrata, leading to "nematocyte-printing" around the settlement site. (3) Simultaneous with the discharge of the AIs, migration of stenoteles, desmonemes, and microbasic mastigophores occurred, resulting in a dramatic change of nematocyte composition in the ATs after larval settlement. This was in parallel with changes in larval behavior and the tentacle function. (4) Nematocyte-printing behavior during settlement could be recognized as metamorphic behavior responsible for irreversible changes in AT function, from attachment to feeding and defense.

Analysis of Variance↗

PubMed1999

Clinical experience with endoscopic stents for treatment of common bile duct stones.

Endoscopic removal of common bile duct (CBD) stones after endoscopic sphincterotomy (EST) is now a widely accepted procedure. Surgery is usually recommended when extraction of stones after EST fails. For patients with major medical problems or who are at high surgical risk, however, endoscopic stent placement may help to prevent stone impaction and cholangitis. In this report, we describe the long-term effects and complications of biliary stent use in elderly patients with CBD stones. From August 1995 to June 1998, 19 patients with CBD stones underwent stent placement by duodenoscopy. Three of these patients underwent this procedure for temporary treatment while awaiting surgery or EST. In the remaining 16 patients (6 men and 10 women, mean age 76 +/- 10 years), invasive management carried a high risk of complications. We used a 7F straight stent for the first patient, while the remaining 15 received 7F pigtail stents. During a mean follow-up period of 34 months, two patients were lost to follow-up and two patients had migration of the stents. Three patients had acute cholangitis with stents in situ. Of these, one underwent stent exchange 8 months later, while the CBD stones were cleared either by endoscopy or surgery in the other two patients. Five patients died of nonbiliary diseases during the follow-up period. Our results show that long-term biliary stent placement is an advisable alternative therapeutic modality for high-risk and debilitated patients with CBD stones.

Aged↗

PubMed1988

Activation of alveolar macrophages from children with the acquired immunodeficiency syndrome-related complex.

The ability of alveolar macrophages (AM) to release hydrogen peroxide (H2O2), an indicator of AM function, was studied in five children with the acquired immunodeficiency syndrome (AIDS) related complex and, for comparison, in 11 children without disorders of the lung parenchyma. In the AIDS-related complex group, pulmonary manifestations were mild, and lung involvement was suspected by moderate clinical and/or radiological features. None had a past history of opportunistic infections; neither did any have lymphopenia. Cytologic study of the bronchoalveolar lavage (BAL) fluid revealed increased cellularity with increased percentage of lymphocytes. The study of H2O2 release was performed on unstimulated AM and on AM stimulated by phorbol myristate acetate (PMA). Under both experimental conditions, the amount of H2O2 accumulated in the medium was significantly increased in the group with AIDS-related complex (P less than 0.001). As no enhanced oxidative activity has been reported in AM from patients with full-blown AIDS, an increased ability of AM to release oxygen metabolites from children with AIDS-related complex may reflect an initial and temporary step in the course of the LAV/HTLV-III pulmonary disease. Determining AM activation might be a reliable method of assessing the evolution of lung disorder in AIDS.

AIDS-Related Complex↗

PubMed1981

Ontogeny of opiate receptors in rat forebrain: visualization by in vitro autoradiography.

The embryonic and postnatal ontogeny of opiate receptors in rat telencephalon was mapped by in vitro autoradiographic localization of [3H]naloxone and [3H]enkephalin binding. Opiate receptors marked by naloxone binding first appear at embryonic day 14 in the striatum, rapidly proliferate to adult densities and at the time of birth, gradually become reorganized into the adult heterogeneous pattern of receptor-rich patches surrounded by sparse, diffuse labeling in the rest of the striatum. The enkephalin binding in the striatum appears later in embryonic development and gradually increases in density to form the rather homogeneous adult pattern. Naloxone binding in the paleocortical olfactory areas appears early also, densely within the molecular layer as soon as it is formed at E16. This density is only temporary, as labeling just after birth falls to low adult levels in all areas except portions of the amygdala. Receptors disappear also in the islands of Calleja and the pallidum. Naloxone binding in the septum and neocortex appears gradually in development. The early appearance of striatal and paleocortical [3H]naloxone-labeled opiate receptors and their localization within the subependymal zones suggest that receptors appear on immature neurons before and during migration and, therefore, may influence the intricate patterns of connections that later form. The delayed appearance of the [3H]enkephalin-labeled receptors may reflect the dependence of the peptide binding on later developing molecules of adenylate cyclase.

Aging↗

PubMed1983

The healing of hamster oral mucosal wounds covered by porcine grafts. A histologic study.

The purpose of this study was to ascertain whether porcine skin grafts are incorporated by the host or act as temporary dressings which are sloughed and to determine the host reaction in terms of inflammatory response. A split-thickness 5-mm square recipient bed was prepared in the cheek pouches of 20 hamsters. Previously frozen, irradiated porcine skin was sutured onto each bed. Animals were killed at 3, 7, 10, 14 and 28 days. Results indicated that at 3 days the graft showed signs of necrosis and host epithelium was migrating under it. Some acute inflammation was evident. By 7 days all 7 grafts had sloughed and epithelialization was complete. The graft bed was maturing collagenous tissue with a mild infiltrate of chronic inflammatory cells. At 10 days healing was almost complete. In all instances the graft appeared to have been sloughed between the 3rd and 7th day and there was no evidence of a massive inflammatory response, foreign body reaction, host incorporation or graft vascularization. These results suggest that porcine skin could be used as a "biologic dressing" in periodontal mucogingival surgery involving grafting.

Animals↗

PubMed1986

Numbers and phenotype of lymphocytes emigrating from sheep bone marrow after in situ labelling with fluorescein isothiocyanate.

In normal young lambs the bone marrow was selectively labelled with fluorescein isothiocyanate by a temporary perfusion of one hind-leg. One day later, the incidence of bone marrow emigrants in different lymph nodes, spleen, Peyer's patches, thymus, non-perfused bone marrow and blood was determined. The emigrants were also phenotyped by the use of monoclonal antibodies and classified into monocytes or lymphocyte subsets. Large numbers of lymphocytes left the bone marrow of the perfused leg during 1 day. Considerable numbers of cells migrated to other bone marrow compartments. Varying numbers of mononuclear emigrants were found in peripheral lymphoid organs, with labelling indices ranging from 1.06% in the blood to 0.004% in the thymus. In the spleen, comparable numbers of B- and T-lymphocyte emigrants from the bone marrow were found, whereas in the blood, lymph nodes and jejunal Peyer's patches many more emigrants were T lymphocytes than B lymphocytes. In the prescapular lymph nodes, for instance, 90.4% of emigrants were T cells but only 9.6% were B cells. Based on the large numbers of lymphocytes emigrating from the bone marrow, their phenotypes and their entry into other bone marrow compartments, it it can be concluded that the bone marrow of young lambs is an integral part of the migratory route of lymphocytes.

Animals↗

PubMedDate not supplied

Development of an autologous connective tissue tube as a small caliber vascular substitute.

A small-caliber vascular graft with good healing properties was developed using an autologous connective tissue tube (ACTT) and in situ heparinization. ACTT is the best material for implantable grafts, but as a small-caliber vascular graft, both the high thrombogenicity and requirement for time to preparation in situ were serious problems. To overcome these difficulties, an ultrafine polyester fiber (UFPF) mesh was used for the framework of the graft. it has been shown that UFPF provides a good framework for fibroblast migration and proliferation both in vivo and in vitro. The granulomatous connective tissue tube could be constructed very rapidly and had numerous capillary blood vessels, which opened onto the luminal surface of the graft when it was implanted as a vascular substitute and provided colonies of endothelial cells. These colonies spread rapidly all over the luminal surface, and the graft developed permanent antithrombogenicity by endothelialization. The next problem was attainment of temporary antithrombogenicity of the graft before complete endothelialization. Since collagen fibrils are highly thrombogenic, the fact that ACTT collagen fibrils face the luminal surface requires greater antithrombogenicity. A new technique for binding heparin to collagen fibrils in situ was also developed. This was proved to be useful in maintaining the antithrombogenicity of the grafts (3 mm in inner diameter, 6 to 7 cm in length) in the animal studies. The graft showed rapid healing of the neonintima with endothelialization and long-term stability of the graft wall.

Angiography↗

PubMed1976

Rationale for stabilization.

1. The subjective separation of the normal and the diseased periodontium for splinting purposes is artificial. With the exception of cases of secondary trauma from occlusion, the diseased periodontium should be treated in the same manner as the normal periodontium with regards to splinting. 2. Retionales for stabilization found to be valid are: I. Prevention of mobility A. Post acute trauma. B. In occlusal therapy. II. Prevention of drifting A. Replacement of missing teeth. B. Postorthodontics. III. In treatment of secondary trauma for occlusion. A. For functional stability. B. With unknown effects on the progression of periodontitis. 3. The relationship of trauma from occlusion and periodontitis is unclear at this time. 4. A need exists for a clinical test correlating histologic signs of trauma from occlusion and clinical findings. 5. Temporary splinting generally is not indicated during the initial or surgical phase of treatment of the periodontal patient, because mobility short of secondary trauma from occlusion does not impair healing.

Dental Occlusion, Traumatic↗

PubMed2005

Hourglass-shaped nitinol prostatic stent in treatment of patients with lower urinary tract symptoms due to bladder outlet obstruction.

OBJECTIVES: To assess the efficacy and safety of the thermoexpandable hourglass-shaped nitinol prostatic stent in the treatment of patients with lower urinary tract symptoms due to bladder outlet obstruction. METHODS: The stents were inserted in an outpatient setting under local anesthesia and direct vision. Five different stent lengths (2.0 to 4.0 cm) were used, depending on the length of the prostatic urethra. Assessment of voiding function and symptom scores was performed at baseline, directly after stent insertion, at 14 days, and 1, 3, 6, and 12 months after stent placement. RESULTS: We enrolled 35 men in the trial. In 5 patients, insertion of the stent failed, mainly because of anatomical limitations. After all placement procedures, minimal temporary hematuria was observed. Spontaneous voiding was achieved in all patients, with immediate significant improvements in voiding parameters and symptom scores. The median indwelling time of the stent was 70 days. Kaplan-Meier survival analysis showed that at 14 days and at 3, 6, and 12 months, the stent was still in situ in 73%, 40%, 33%, and 23% of the patients, respectively. The main reason for removal of the stent was migration (93%), in most cases toward the bladder. Removal was uneventful in all but 1 case. CONCLUSIONS: The placement of the thermoexpandable hourglass-shaped nitinol stent results in relief of outflow obstruction and improvement of symptom scores. Because of the high migration rate, however, this stent design needs further improvement to be suitable for clinical practice.

Aged↗