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At least 919 records · Page 51Linked to original sources
PubMed2006

Fibrovascular ingrowth as a cause of Ahmed glaucoma valve failure in children.

PURPOSE: The purpose of this study is to document the presence of fibrovascular ingrowth into the Ahmed glaucoma valve (AGV) as a cause of AGV failure in the pediatric population. DESIGN: Retrospective case series. METHODS: Retrospective study of six children with histologically documented fibrovascular ingrowth of their AGV, with review of relevant demographic, clinical, and surgical factors. RESULTS: Six patients, two males and four females, with a mean age at AGV placement of 27.5 months (range 1 to 122) were identified with AGV failure, AGV removal, and subsequent histology documenting fibrovascular ingrowth into the valve chamber. Etiology of glaucoma included: trauma, aphakia, angle-closure, aniridia, and infantile. Mean time from AGV implantation to explantation was 23 months (range 6 to 65). Mean intraocular pressure at AGV explantation was 35 mm Hg (range 27 to 48). CONCLUSIONS: Fibrovascular ingrowth of both the pediatric and adult size AGV occurs in children and should be considered in the presence of AGV failure.

Child↗
PubMed2005

[Surgical therapy of infective endocarditis].

Therapy of infective endocarditis (IE) remains a particular challenge due to a relative high morbidity and mortality. Cardiac surgery is established as a cornerstone in therapy for native valve endocarditis (NVE) as well as for prosthetic valve endocarditis (PVE) and is required in 30% of patients with active IE. The basic aim of surgery in IE is the radical debridement of infected tissue and reconstruction of valve function either by reconstructive valve surgery or valve replacement. Indication for surgery depends on several clinical variables, the main indication remains heart failure due to severe heart valve defects or prosthetic valve dysfunction. Surgical therapy of NVE can be performed with good clinical results in the early and late follow-up. Surgical therapy of PVE is still associated with quite high mortality up to 80% in some risk groups. This indicates the particular importance of focus evaluation and antibiotic prophylaxis after primary surgery for infective endocarditis.

Antibiotic Prophylaxis↗
PubMed1994

Ten-year results of cemented Weller-type total hip arthroplasties. Analysis using different definitions of failure.

The first 100 consecutive cemented Weller-type total hip arthroplasties carried out between 1976 and 1977 were reexamined. Clinical analysis of 43 implants with more than 10 years follow-up showed that results were excellent in 21 patients (49%), good in 13 (30%), fair in 7 (16%) and poor in 2 (5%). Radiographic analysis revealed 33 (87%) stable femoral and 31 (81%) stable acetabular components. Statistical survivorship analysis of all 100 implants produced a probability of reoperation of 6.2%, a probability of radiographic implant loosening of 28.2% and a probability of radiographic loosening with clinical symptoms of 7.6%. The definition of failure should be "radiographic loosening of the prosthesis with clinical symptoms" because this evaluation seems to have the best clinical relevance. Concerning the fact that the cement fixation was not performed to today's standard, the results after more than 10 years with this total hip system (Weller long stem) are sufficient.

Adult↗
PubMed1988

Incidence of primary tissue valve failure in porcine bioprosthetic heart valves.

This report provides retrospective follow-up data on 324 consecutive patients who received a Hancock-I porcine valve in the aortic or the mitral position, or in both positions, between June, 1974, and December, 1976. This analysis included 319 valves (193 mitral, 126 aortic) available for study of the incidence of primary tissue valve failure after 10 to 12.5 years of follow-up. Of the 319 prostheses at risk, 114 instances of primary tissue valve failure occurred. Seventy-three of the failed valves were in the mitral position, and 41 were in the aortic position. The calculated actuarial probability of freedom from primary tissue valve failure was 52 +/- 5% for the mitral and 58 +/- 6% for the aortic prostheses at 12.5 years of follow-up. For patients older than 40 years at the time of operation, the rate of freedom from primary failure was 68 +/- 8% and 55 +/- 6% for aortic and mitral prostheses, respectively, at 12.5 years. Comparison of both actuarial curves disclosed no meaningful difference. However, a tendency toward greater failure rate was observed in the mitral prosthesis group.

Adolescent↗
PubMed1991

Use of bipolar endoprosthesis and bone grafting for acetabular reconstruction.

Reconstruction operations for severe acetabular defects using bone grafting and a bipolar hemiarthroplasty retrospectively reviewed in 81 hips between 1983 and 1985. The most common indication was failed total hip arthroplasty. Bone grafts consisted of cancellous bone, bone blocks, and wafer-type grafts used singly or in combination. The follow-up period was 12 to 36 months postoperatively (mean, 16 months). There were 22 perioperative complications (27%) and 13 postoperative complications (16.7%). A majority of hips showed some graft resorption and component migration that worsened with time. There were four graft failures with subluxation of the component, one prosthesis dislocation, and one component disassembly. Ten hips had revision (13.3%) for a variety of reasons. Nevertheless, clinically, most patients (83%) believed the procedure had improved their condition. Reconstruction for severe acetabular defects can be achieved successfully using this technique, but long-term follow-up evaluation is needed to fully assess the role of this procedure in relation to other available options.

Acetabulum↗
PubMed1989

Multicenter clinical trials and their value in assessing total joint arthroplasty.

Multicenter clinical trials (MCT) have an important role in the assessment of total joint arthroplasty. The primary reason for such MCT is the need to have access to a large number of patients. In Sweden, failure after total hip arthroplasty has been recorded prospectively since 1979. Medical records from every reoperation are documented and computer analyzed. This MCT has shown that patient-related, surgical, and implant-related parameters are of importance to rates of failure. There were an increasing number of revisions after total hip arthroplasty in Sweden between 1979 and 1986. Male gender and young age increase the risk of revision. The primary diagnosis is very important for type of failure. The risk of deep infection is small but increases with the number of previous operations. Aseptic loosening has emerged as the main problem and is the cause for 74% of all revisions. Prosthetic design is of utmost importance for the rate of failure, and significant differences exist among different prosthesis types with respect to long-term survival. Finally, this MCT has shown that revisions for total hip arthroplasty in patients younger than 70 years of age eventually have failed in Sweden whenever the cemented technique has been used.

Aged↗
PubMed2003

Total wrist arthroplasty in patients with rheumatoid arthritis.

PURPOSE: After very good midterm results with an uncemented total wrist arthroplasty we evaluated the long-term outcome in a retrospective study. METHODS: Forty uncemented anatomic physiologic (APH, Implant-Service Vertreibs-GmbH, Hamburg, Germany) wrist prosthesis implantations performed in 40 patients were reviewed. The mean follow-up period was 52 months (range, 24-73 mo) and the following parameters were examined: radiographs, grip strength, range of motion, and patient's satisfaction. RESULTS: After a good short-term outcome the results deteriorated with time. The following complications occurred: 2 infections, 3 implant failures, 2 prosthesis migrations, and 33 loosenings/dislocations. All patients (39 of 40) underwent revision surgery, and severe titanium wear in the soft tissues was found intraoperatively in all cases. It became clear that even in a non-weight-bearing joint such as the wrist, titanium alloy may wear and result in tissue metallosis when used as a bearing surface of the implant. As a salvage procedure the prosthesis was removed and an arthrodesis was performed in all patients. CONCLUSIONS: Because of the deterioration of the results including an unacceptable revision rate we currently do not consider the anatomic physiologic wrist prosthesis to be a suitable implant in patients with rheumatoid arthritis.

Adult↗
PubMed2006

Clinical field testing of vulcanized Jaipur rubber feet for trans-tibial amputees in low-income countries.

The purpose of this study was to check out the performance and durability of vulcanized Jaipur rubber feet in tropical areas of the developing world. Forty-one MUKTI and 40 NISHA feet were followed for 16 (8 - 17) months. The user compliance was high and nearly all were satisfied. Failure of the prosthetic foot with the need for exchange at the end of the study amounted to 27% (22/81), which is equivalent to a mixed series of rubber feet previously reported (Jensen et al. 2006b). Failures were mostly related to skin fracture and gliding between sponge rubber layers of the heel block.

Adult↗
PubMed1992

Five-year results after valve replacement with the Björk-Shiley 70 degrees convexo-concave prosthesis.

In the 18 months up to July 1983, 120 Björk-Shiley convexo-concave prostheses with 70 degrees opening angle were implanted in 47 women and 61 men aged 19-78 (mean 58.6) years. The prosthetic valves were aortic in 65 cases, mitral in 23 and both aortic and mitral in 20 cases. Emergency operation was required in ten cases, and concomitant surgery was performed in 43 (39.8%). The early mortality was 5.5%. A follow-up study, comprising 498 patient years, revealed 73.1% 5-year survival. There were three mechanical failures of prosthesis, in one of which re-replacement was successful. Elective prosthesis replacement was performed in four other cases judged to be at high risk of strut fracture.

Adult↗
PubMed2001

Long-term results using a piezoelectric semi-implantable middle ear hearing device: the Rion Device E-type.

The Rion Device E-type (RDE) has been applied to 39 patients with severe mixed deafness that could not be rehabilitated by surgical means or the conventional hearing aid. Careful follow-up studies have been conducted on all of them to assess clinical and audiologic results. The device could function more than 10 years, affording natural quality of hearing without howling and wearing discomforts. Functional principles of the device, indications, and surgical methods of implantation are described. The failures and delayed problems were also presented together with the preventive measures.

Adult↗
PubMed2004

Bilateral cobalt alloy femoral component fracture: a case report.

Even though at present femoral component fracture is a rare complication of total hip replacement, conditions still exist that predispose the prosthesis to failure. Component failure should be considered when a patient presents with pain in a previously asymptomatic hip, particularly in complex dysplastic hips requiring small stems, trochanteric osteotomy, and compromised cement technique.

Aged↗
PubMedDate not supplied

[Soft tissue reconstruction following total knee arthroplasty: treatment possibilities and retrospective analysis of plastic surgery therapy treatment possibilities].

AIM: We performed a retrospective analysis of patients with soft tissue defects following total knee arthroplasty and therapy. Furthermore, we described the possibilities of covering soft tissue defects following knee arthroplasty. METHOD: In 5 patients, soft tissue defects following knee arthroplasty were covered with medial M. gastrocneminus flaps. Localisation and size of the defect, microbiology, risk factors, and interval between arthroplasty and the occurrence of the soft tissue defect were retrospectively analysed. RESULTS: On average, defects occurred 9 weeks after prosthesis implantation. In all cases, the soft tissue defect developed in the area of the incision. In 3 cases, wound infection was diagnosed. Four patients exhibited factors associated with wound-healing failure. No prosthesis was lost. CONCLUSION: The gastrocneminus muscle flap provides good quality coverage with small donor site defect, permits early mobilisation, and allows for fast rehabilitation. The risk of flap loss is minimal. Early and adequate defect coverage can reduce both prosthesis loss and amputation rates.

Aged↗
PubMed2002

Influence of voiding dysfunction on the outcome of endoscopic treatment for vesicoureteral reflux.

PURPOSE: Some patients with vesicoureteral reflux also experience voiding dysfunction. Dextranomer/hyaluronic acid copolymer (Deflux, Q-MED AB, Uppsala, Sweden) is an effective endoscopic treatment for vesicoureteral reflux. In an open label study we investigated the effect of voiding dysfunction on the efficacy of endoscopic treatment with dextranomer/hyaluronic acid copolymer in patients with vesicoureteral reflux. MATERIALS AND METHODS: A total of 320 children 3 to 11 years old with grade II to IV vesicoureteral reflux confirmed by voiding cystourethrography underwent endoscopic treatment with dextranomer/hyaluronic acid copolymer. Of the patients 50 were re-treated with dextranomer/hyaluronic acid copolymer because of persistent reflux (grade II or greater). The first implantation technique was recorded on videotape. Voiding cystourethrography and micturition details were recorded at the 3 to 6-month followup visit and compared with baseline measurements. RESULTS: At baseline 13 patients had known voiding dysfunction and 18 were misdiagnosed as not having voiding dysfunction. Of the 50 patients who required re-treatment, the initial implant was correctly positioned in 45 according to the videotape. Endoscopic observation at the time of re-treatment revealed no evidence of the implant in 15 patients. The implant was displaced in 27 patients and remained correctly positioned in 3. A total of 27 patients had voiding dysfunction, the majority of whom had urgency and frequency incontinence, had not received any anticholinergic therapy and had a displaced implant. CONCLUSIONS: Uncontrolled voiding dysfunction contributed to endoscopic treatment failure with dextranomer/hyaluronic acid copolymer in our series. Therefore, we suggest that patients with voiding dysfunction be treated at least 6 months before endoscopic therapy with anticholinergics and/or micturition rehabilitation.

Child↗
PubMed2004

A combined RSA and FE study of the implanted proximal tibia: correlation of the post-operative mechanical environment with implant migration.

There is strong evidence to suggest that inducible displacements, migration and implant loosening are closely related to the initial mechanical environment of the implanted tibia. If this is true, then it should be possible to predict the likelihood of implant migration using patient-specific finite element models. Finite element models of the proximal implanted tibiae were analysed based on pre-operative quantitative computed tomography data of four patients entered into a radiographic migration study. These four patients were also part of an radiostereometric analysis (RSA) study. A variety of load cases were analysed and the risk of bone failure determined for a 2 mm layer of bone immediately beneath the tibial tray. The results were compared with the RSA data measured 1 year post-operatively for each patient. For each patient, an appropriate load case was selected based on patient weight and on the varus-valgus migrations observed in the migration study. The two patients with press-fit implants were predicted to have the highest risk of failure and were found to migrate the most. The two patients with bonded implants (one HA coated and one cemented) were found to have a low risk of failure and these implants migrated the least. This study suggests that the degree of implant migration is dependent on the initial mechanical environment and can be determined using patient-specific finite element analysis.

Aged↗
PubMedDate not supplied

Twenty-two year experience with the omniscience prosthetic heart valve.

This study was designed to evaluate the long-term clinical results of the Omniscience tilting disc valve. Omniscience valves were implanted in 51 patients (mean age, 50 +/- 10 years); 18 had aortic valve, 24 had mitral valve, and 9 had both aortic and mitral valve replacements. Oral warfarin potassium and dipyridamole were prescribed as our anticoagulant therapy. Preoperatively, 42 patients were in New York Heart Association class III or IV, and 23 of 25 surviving patients were in class I or II after operation. There were 2 (3.9%) early deaths and 23 late deaths (3.5 +/- 0.7% per patient-year). Cardiac related mortality including congestive heart failure, sudden death, and thromboembolism, and hemorrhagic complications were seen in 16 patients. Overall survival at 10, 15, and 20 years was 77 +/- 6%, 62 +/- 7%, and 46 +/- 7%, respectively. Thromboembolic complications were seen in 5 patients, for a rate of 0.8 +/- 0.3% per patient-year; similarly, hemorrhagic complications were also seen in 5 patients. Nonstructural prosthetic valve dysfunction was seen in 4 patients, for a rate of 0.6 +/- 0.3% per patient-year, and sudden death was seen in 2, a rate of 0.3 +/- 0.2% per patient-year. The Omniscience prosthesis demonstrated excellent postoperative clinical status with low rates of valve related complications.

Adult↗