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At least 721 records · Page 40Linked to original sources
PubMed1994

[Reoperation for heart valve prosthesis. Apropos of 99 cases].

From March 1977 to November 1988, 99 patients were reoperated on after a first valvular replacement. Mean delay between the two operations was 53 months (10 days to 18 years). The patients were reoperated on mainly for mechanical disinsertion (30), bacterial endocarditis (25) and thrombosis (18 patients). Operative mortality was 11%, mainly following reoperation for bacterial endocarditis. Mean follow-up (85 patients) was 49 months (6 months-11 years). 75% were alive and doing well 4 years after reoperation and 66% at 6 years. Eight patients needed a third operation with two deaths.

Adolescent↗
PubMed1994

A progressive treatment protocol for maintaining tissue associated with implants.

This article presents a protocol for the management of the soft and hard tissues surrounding implant-supported prostheses. Treatment requires an evaluation of soft tissues as well as a radiographic interpretation of the hard tissues associated with peri-implant degeneration. As the degree of soft and hard tissue degeneration increases, treatment must become more aggressive. A classification is outlined for diagnostic criteria and appropriate treatment.

Alveolar Bone Loss↗
PubMed1994

Complications of shoulder arthroplasty.

Early and mid-range followup studies of shoulder arthroplasty have been encouraging, showing good and excellent results in > 90% of shoulders. Despite this success, complications in shoulder replacement surgery are inevitable, with an incidence of approximately 14%. Numerous complications have been identified and include the following factors in order of decreasing frequency: instability, rotator cuff tear, ectopic ossification, glenoid component loosening, intraoperative fracture, nerve injury, infection, and humeral component loosening. Successful treatment of these difficulties requires careful identification and subsequent analysis of all factors contributing to the complication, knowing that the etiology is often multifactorial. Failed shoulder arthroplasty can be successfully managed with revision surgery, but the technically challenging surgery and the overall results are inferior compared with other diagnostic categories.

Aged↗
PubMed1994

Early results of total condylar knee arthroplasty.

A total of 109 consecutive total condylar knee replacements in 73 patients were assessed at one to eight years postoperatively. The average age at surgery was 66.9 years and the range was from 52 to 84 years. The primary disease was rheumatoid arthritis in 12 and degenerative osteoarthritis in 97 knees. Out of the 109 prostheses; 101 were Miller-Galante kinematic condylar type I or II prostheses, seven were Insall-Burstern type I or II and one was a Whiteside prosthesis. The fixation technique was hybrid (only the tibial prosthesis cemented) in 63, both components uncemented in two and both components cemented in 44 knees. One hundred and five (96.3%) knees showed significant improvement in the Hospital for Special Surgery score postoperatively. The average preoperative score was 48.1 and the postoperative score was 85.4. Sixty-four patients (100 knees) were satisfied or very satisfied with the result of surgery. One hundred and four (95.4%) knees had achieved either an improvement in the range of motion and/or deformity. Complications included loosening in four (3.7%) knees, infection in three (2.8%), dislocation of the patella in four (3.7%), periprosthetic fracture in one (0.9%) and severe lateral collateral ligamentous laxity in one (0.9%).

Activities of Daily Living↗
PubMed1994

[Chronic low grade endophthalmitis. A growing indication for explantation of intraocular lenses].

The aim of this study was to evaluate the effect of progress made in cataract surgery regarding the indications and results of intraocular lens (IOL) removal. For this purpose, the charts of all patients who had undergone IOL explantation at our institution between January 1990 and December 1992 were reviewed. Indications were divided into six groups: (a) chronic low-grade endophthalmitis; (b) pseudophakic bullous keratopathy; (c) luxation; (d) traumatic expulsion; (e) high-degree aniseikonia; (f) acute endophthalmitis. Visual acuities were grouped according to a good (1.0 to 0.5), acceptable (0.4 to 0.05) and poor (less than 0.05) outcome. Fifty-two IOL were removed from 52 eyes of 52 patients during the period considered in this study. Sixteen were anterior chamber, 5 were iris-fixated, and 31 were posterior chamber lenses. The removal rates were 30.8% for chronic, low-grade endophthalmitis (n = 16), 28.8% for bullous keratopathy (n = 15), 28.8% for luxation (n = 15), 5.8% for traumatic expulsion (n = 3), 3.8% for high-degree aniseikonia (n = 2), and 1.9% for acute endophthalmitis (n = 1). After explantation vision equal to or better than 20/400 was achieved by the vast majority of patients in all groups with the exception of those with bullous keratopathy. The progress made in cataract surgery over the last decade has greatly influenced the rate of complications leading to IOL removal. Continuous monitoring of explanted IOLs is mandatory to evaluate further changes in surgical technique and lens design.

Adolescent↗
PubMed1994

Revision total elbow replacement.

Revision total elbow surgery is technically demanding with high complication rates. It requires precise preoperative planning and a surgeon prepared to use any of several surgical options during surgery. Satisfactory results can be achieved in complex cases.

Arthrodesis↗
PubMed1994

Assessing bacterial risk factors for periodontitis and peri-implantitis: using evidence to enhance outcomes.

This article discusses the use of microbial diagnostics and their relationship to the treatment of periodontal and peri-implant disease. Clinical and microbiologic characteristics are described to help the practitioner recognize patients with periodontitis and peri-implant infections. By using available information (evidence) to guide the choice of therapeutic intervention, the clinician can enhance the outcomes resulting from therapy.

Bacteria, Anaerobic↗
PubMed1993

Management of implant-related problems and infections.

Problem-solving and treating various types of infections that can cause alveolar bone loss or inferior alveolar nerve dehiscences by failed implants or teeth are discussed. The reasons why implants fail from either surgical or prosthetic errors are reviewed. Treatment remedies which have solved numerous implant-related problems are offered. The eclectic, multi-modal implant surgical and prosthetic abilities of the clinician necessary today for successfully treating patients presenting with troubled or infected implants are reviewed.

Blade Implantation↗
PubMed1993

Hybrid total knee arthroplasties in rheumatoid arthritis.

One hundred and sixty-eight total knee arthroplasties (TKA) with cementless femoral components, cemented tibial and patellar components were performed in 98 patients with rheumatoid arthritis (RA) between 1989 and 1992. At 1-4 years followup the hybrid TKA in RA provided satisfactory results when compared to the cemented TKA. There were no signs of loosening about the cementless femoral component. The results indicate that the hybrid TKA is comparable to a fully cemented knee even in the patients with severe RA at one to four years followup.

Adult↗
PubMed1994

[Surgical treatment of pseudoaneurysms of the proximal anastomosis after aortofemoral reconstructions].

The authors discuss surgical treatment of pseudoaneurysms of proximal anastomoses of prostheses with the aorta after reconstructive operations in the aortofemoral zone in 9 patients, whose ages ranged from 32 to 65 years. The time between the formation of the aneurysms and the operation before their diagnosis ranged from 15 days to 6 years. The pseudoaneurysms developed due to infection in 3 patients, poor-quality suture material (silk) in one patient, endarterectomy from the aorta at the proximal anastomosis in one patient, and further development of the principal disease in 2 patients; the cause of the disease in 2 patients could not be identified. Six patients were subjected earlier to bifurcation aortofemoral shunting, one patient to bifurcation aortofemoral prosthetics, and 2 patients to linear prosthetics of the infrarenal part of the aorta. The primary reconstructive operation was conducted for occlusive lesions of the aortofemoral zone in 7 patients (of atherosclerotic genesis in 6 of them and one patient had unspecific aortoarteritis), and for aneurysm of the abdominal aorta in 2 patients (of posttraumatic origin on one). The authors claim resection with repeated replacement of the aorta by a linear or bifurcation prosthesis to be the optimal method for reconstruction in pseudoaneurysms of proximal anastomoses. One patient died in the immediate postoperative period. The immediate and late-term results of repeated operations were good in 8 of 9 patients in follow-up periods of 8 months to 5 years. Recurrences of the disease were not encountered.

Adult↗
PubMed1994

[Mandibular reconstruction using a metallo-acrylic implant prosthesis in oncology. Apropos of 40 cases].

The authors report on 40 cases using acrylic-metal prosthesis after ablative cancer surgery and compare them with the literature. The long-term complications (prosthesis extrusion or infection) are important, but the short-term follow-up (3 months) is more than 80% of success, any material used. The prosthesis keep a physiological position to the mandible, against scar sequelae. The use of soft tissue closure without post-operative radiotherapy increase the success of a simple-used and low-priced device of mandibular reconstruction.

Acrylic Resins↗
PubMed1994

Diagnosis and treatment of peri-implant disease.

With the increased use of osseointegrated implants and with many implants functioning for long periods of time, various complications have been reported. This paper reviews progressive loss of peri-implant bone--one of the major concerns during the function period of implants. The recognition and treatment of peri-implant bone loss around functioning implants is a major challenge for the clinician. Diagnostic techniques, such as probing pocket depth, radiographic tools, and microbial sampling have been modified from the periodontal arena and used during the maintenance phase of the dental implant. The long-term goals in the treatment of peri-implant disease are to arrest the progression of the disease and to achieve a maintainable site for the patient's implant. Recent reports indicate that peri-implant bony defects can be treated with either nonsurgical or surgical techniques. Bone regeneration is possible in selected peri-implant bony defects when appropriate surgical techniques are used, implant surface preparation is achieved, and the cause is eradicated.

Alveolar Bone Loss↗
PubMed1994

Malignant fibrous histiocytoma at the site of hip replacement in association with chronic infection.

A case of malignant fibrous histiocytoma that developed at the site of an infected metallic implant is presented. The total hip endoprosthesis was composed of a cobalt-chromium alloy. There was a relatively short latency period (less than 2 years) between the initial surgery and the development of malignancy in this patient. The authors urge development of a tumor registry to discover if the association between hip replacement and malignancy is coincidental.

Alloys↗
PubMed1994

Stanmore total hip replacement. A 15- to 16-year clinical and radiographic follow-up.

In 1988 we reported a ten-year review of 83 surviving patients from a group of 135 (146 prostheses) who had undergone primary hip replacement using the Stanmore prosthesis. We have now reviewed 44 of these patients at 15 to 16 years. Four patients had undergone revision, but the other 40 were all satisfied with the result of their hip replacement, 36 having little or no pain. Functional activities had decreased, but were still adequate for their average age of 81 years. There had been definite migration of the cup and/or femoral component in three hips, wear of the cup in ten and resorption of the calcar in six. Of the 24 hips inserted with radiopaque cement, eight showed an increase in radiolucent lines at the acetabular interface. The cumulative survival rate of the prosthesis was 91% at 15 to 16 years.

Activities of Daily Living↗
PubMed1993

[Noncemented revision of femoral hip joint prostheses with severe bone defects (preliminary report)].

The authors present an account of their initial experience with Wagner's non-cemented femoral revision prosthesis of the hip joint. After a brief technical description of the implant the mention the indications and contraindications of they revision shaft. They emphasize the necessity of peroperative planning and describe the surgical technique. Since 1992 they used a revision shaft in five patients (three times in aseptic loosening of a TEP of the hip joint, once during septic loosening and once when treating a periprosthetic fracture with extensive bone destruction). Long-term experience will be the subject of a subsequent paper.

Cementation↗
PubMed1993

Peri-implantitis.

Explore the source record for details and available documents.

Dental Implants↗
PubMed1993

Periodontitis and periimplantitis: one and the same?

Research shows that the same anaerobic, gram-negative pathogens are present in the periodontal and implant pocket or crevice. The implants in a partially edentulous case are probably more at risk due to the bacteria being more pathogenic and a seeding mechanism from the tooth pocket to the implant crevice. In the face of a normal microbial flora, retrograde periimplantitis or radiographic bone loss without gingival changes may be due to trauma because of overloading, loading too soon, and/or loading in a lateral direction. Finally, the combination of an infective process (periimplantitis) and noninfective or traumatic process (retrograde periimplantitis) will result in rapid osseous destruction and, possibly, loss of the implant fixture(s).

Alveolar Bone Loss↗
PubMed1993

Infections associated with prosthetic devices: clinical considerations.

The successful development of synthetic materials and introduction of artificial devices into nearly all body systems has been shadowed by the adaptation of microorganisms to the opportunities these devices afford for eluding defenses and invading the host. Clinicians are faced with the task of recognizing the manifestations of device-associated infection, predicting the likely pathogens involved, knowing the appropriate diagnostic methods, and initiating appropriate therapy. Infections associated with prosthetic heart valves are particularly challenging to successfully treat; surgical replacement may be necessary. Infection associated with an artificial joint usually requires removal of the device in addition to appropriate antibiotics. Intravascular associated infections are the leading cause of nosocomial bacteremias and, because of their intravascular location, these infections are often life catheter threatening if not promptly diagnosed and treated. Even contact lenses, external to epithelial surfaces, may give rise to serious sight-threatening infections. Although artificial devices play a paramount role in medicine today, infection is an ever present potential with which clinicians must be familiar.

Catheters, Indwelling↗