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PubMed1998

Mobility of the obturator prosthesis in hemimaxillectomy edentulous patients.

In edentulous patients with maxillary defects, it is difficult to obtain sufficient retention, support, and stability of the obturator prosthesis, in addition, its mobility during various functions is considered to be large. A thorough understanding of the mobility of the obturator prosthesis is important to achieve successful results in the patient's oral rehabilitation. In this study, the ranges of movement of the obturator prostheses in three hemimaxillectomy edentulous patients were compared during tapping, chewing (biscuit), and opening and clenching jaw movements by simultaneously conducting three-dimensional measurements of three points that were established on the central incisor and the right and left first molars of the obturator prosthesis with a jaw movement tracking device having six degrees of freedom. This study indicates that the range of movement of the obturator prosthesis varied extensively from individual to individual. The ranges of movement were larger than those of normal complete dentures and differed considerably from each other when categorized according to the three functions and three measuring points in the patients.

Aged↗
PubMed2002

[Preliminary results in the use of polydimethylsiloxane textured elastomers (Bioplastique) in the treatment of leakage around tracheoesophageal voice prosthesis].

Leakage around the prosthesis is one of the worst problems afflicting patients fitted with tracheoesophageal (TE) voice prosthesis. Removing the prosthesis for a few days can reduce the size of the fistula, or the leakage may be eliminated simply by replacing the prosthesis. In cases that are refractory to such treatment, the perifistular injection of different types of autologous, heterologous or alloplastic substances has been proposed. A new kind of silicone, previously available abroad, has recently appeared on the Italian market as well; constituted by polydimethylsiloxane textured elastomers (Bioplastique) for soft tissue implants, it appears to guarantee excellent standards of long-term safety and stability. Three patients fitted with Provox2 tracheoesophageal voice protheses who had been experiencing leakage for about 4 months underwent Bioplastique implant procedures. The correction of the fistula size was easy to accomplish and well tolerated by the patients. There was no sign of inflammation, formation of granulomas or other pathological modifications, and the size of the fistula, together with its fluid-tightness, remained stable in time. From our point of view, the Bioplastique implant appears to provide valid and effective treatment of gaping TE fistulas.

Coated Materials, Biocompatible↗
PubMed2003

[Treatment of erectile dysfunction by implantation of domestic made three-piece inflatable penile prosthesis, a retrospective study of 29 cases].

OBJECTIVE: To evaluate the effect of implantation of domestic made three-piece inflatable penile prosthesis on erectile dysfunction (ED). METHODS: Domestic made three-piece inflatable penile prosthesis were implanted through an incision at the border of penis and scrotum on 29 patients with ED refractory to non-operative treatment, among which 23 being with neurogenic ED, including 18 paraplegia cases and 5 cases of traumatic injury of nervi erigentes; 4 cases with ED caused by arteriovenous fistula; I case with ED caused by fibrosis of corpus cavernosum, and 1 case with ED caused by Klinefelter's syndrome. Follow-up was conducted for 3 - 36 months to survey the clinical effect. RESULTS: Operation was successfully performed upon all 29 patients. Follow-up after operation lasted 3 - 36 months, 18 months on average. Fluid exudation of penile prosthesis and localized infection occurred in 1 patient and mechanic complication occurred in 2 patients. Maintained sexual intercourse rate was 28/29. 3 ED patients with primary arteriovenous fistula made their spouses pregnant after treatment. CONCLUSION: With excellent covertness and at low cost, implantation of domestic made three-piece inflatable penile prosthesis is effective and well accepted by ED patients.

Adult↗
PubMed1992

[Clinical experiences of a new vascular graft prosthesis fabricated from ultrafine polyester fiber (Toray graft)].

A new low porous vascular prosthesis made of a textile of ultra-fine fiber was used clinically in ten patients for whom replacement of the ascending and/or arch aorta were performed. There were no operative deaths after initial operations, but one patient died after a second operation in which replacement of the thoraco-abdominal aorta was performed. Nine survived patients are well for 50 days to 10 months postoperatively. The new vascular graft prosthesis was very soft and pliable in clinical use, and the surgical needle penetrates easily the prosthesis. Although the new graft prosthesis can be used without preclotting under full heparinization, porosity of the graft, 100 ml/min/cm, revealed initial oozing of blood for a while just after releasing an aortic clamp. Therefore, preclotting of the graft is recommended under full heparinization. Because of rapid, even, and stable formation of neo-intima in the new graft confirmed by experimental studies of Noishiki et al., and soft and pliable characteristics of the graft, a wide-spread clinical use of the new graft is recommended in the surgery of aortic aneurysms as well as reconstruction of the congenital malformations.

Adult↗
PubMedDate not supplied

[Tracheal prosthesis].

A prosthesis of the authors' design with various connective elements of knitted Lavsan fabric was tested in experiments on 43 mongrel dogs. Clinical, radiological, radiospirographic, and morphological studies showed that the optimal prosthesis is that in which the connective elements are made of knitted Lavsan fabrics with an average stitch size of 20-23. Granulation tissue grows through the prosthesis which is fastened well to the connective-tissue cuff forming around it. The trachea replaced by the prosthesis ensures adequate gas exchange and lung functioning, causes no essential disorders of pulmonary volumes, ventilation and perfusion of the right and left lungs.

Animals↗
PubMed2003

The reversed Delta shoulder prosthesis in reconstruction of the proximal humerus after tumour resection.

The authors present two series of six and seven patients respectively, with a tumour of the proximal humerus, who were treated at two different institutions with a Delta type inverted shoulder prosthesis (DePuy International Ltd) after a Malawer type Ia or Ib resection. The rationale of using an inverted shoulder prosthesis is the aim to improve the functional outcome in rotator cuff deficient shoulders. This type of prosthesis medializes and lowers the centre of rotation, lengthens the lever arm of the deltoid muscle and improves its function. At one institution the resected part of the humerus was re-implanted after extracorporeal irradiation. It was fixed intramedullarly by cementation of the humeral prosthetic component to facilitate restoration of humeral height. This graft allowed reinsertion of muscles (deltoid, pectoralis, biceps) thus improving power generation postoperatively. The largest glenosphere, size 42, was routinely used to reconstruct the glenoid; this theoretically improves the functional outcome (increased external rotation) and stability. At the other institution no graft augmentation was used except in one patient. The height of the humeral prosthetic component was assessed after resection of the tumour by measurement of the resected part. The prosthetic stem was fitted in the remaining part of the humeral diaphysis, in three cases by cementation and in three cases by press-fit (hydroxyapatite coating). Muscle balance was appreciated intra-operatively. Stability of the prosthesis was directly related to the level of resection. Both techniques resulted in a minimum active abduction of 60 degrees, reaching 90 degrees or more in most patients. When compared to other results in the literature, this is a major functional improvement. The mean adjusted postoperative Constant score was 72.5% (range: 30-90%), and the mean MSTS score was 75.8% (range 36.7-96.7%).

Adult↗
PubMed1992

[Atkinson prosthesis in esophageal carcinoma. Radiologic study: when CT?].

The endoscopic palliative treatment of esophageal and esophagocardial neoplastic stenoses is generally performed in the patients in whom surgery is not indicated for oncological and general reasons and endoscopic dilatation is uneffective. Our experience is reported concerning 92 patients submitted to palliative therapy through placement of Atkinson prostheses; the patients underwent radiologic studies--i.e. (a) plain chest radiographs (before and after intubation), (b) esophagogastric studies with iodate cm, and (c) CT (performed in the last 20 cases only). The mortality rate at 30 days was 6.5% (6 cases), in no case due to specific complications related to intubation. The mean survival was 3.6 months (range: 1-12). As to the complications specifically related to intubation, they were basically 3: perforation, dislocation, and obstruction (of the prosthesis). As to the methods allowing best demonstration of the same: a) CT proved to be superior in revealing perforation, which usually occurs early after intubation. However, considering its low incidence (2 cases only, in our series), the routinary use of CT does not seem justified. CT should be reserved to selected patients in whom the shape of the neoplasm or peculiar anatomical conditions make intubation difficult, with high risks of perforation--e.g., kiphoscoliosis, hiatal hernia, previous surgery or radiotherapy, angulation of the prosthesis, neoplasm of scirrhous or necrotic type or causing luminal deviation; b) if dislocation occurs, as it more often happens (9 cases in our series) in the presence of soft neoplastic tissue or in cases of mild or asymmetrical stenosis, CT seems likewise unnecessary. Conventional radiology proved superior thanks to its more comprehensive view, and therefore sufficient to suggest the correct treatment--e.g. repositioning of the prosthesis by means of fiberoscopy, or withdrawal after gastrostomy; c) CT appeared useless in the cases due to alimentary causes (easily detectable from the clinical history), but proved useful in the cases due to neoplastic overgrowth. In the latter, CT can yield information as to the site and size of the neoplasm, as well as to its relationship to surrounding tissues, and thus help suggest proper treatment--e.g. dilatation and repositioning of the prosthesis, gastrostomy, recanalization by means of NdYAG laser, no treatment at all.

Adult↗
PubMed2004

[Implementation of habituation theory to pulsatile somato-sounds (tinnitus): the heart valve prosthesis sound model].

OBJECTIVES: To evaluate the habituation process to mechanical heart valve prosthesis sound as a model to understand the pulsatile tinnitus or somatosound perception changes. STUDY DESIGN: Transversal descriptive. PATIENTS: One hundred and fifty patients referred to a University Hospital for one or two mechanical heart valve implantation. OUTCOME MEASURES: Questionnaire sent by mail for prosthesis sound loudness and interference in quality of life evaluation. Detection of factors related to habituation process development. RESULTS: Eighty three percent of the patients perceived their prosthesis sound continuously, while only a 17% showed high levels of annoyance. No significative differences in prosthesis type and localization were described. Anxiety was the most important factor for loudness increase. The average of visual analogical scales on sound loudness and annoyance showed mild values (3.7 and 1.9 respectively). CONCLUSIONS: Extensive medical counselling or tinnitus retraining therapy (TRT) program for most severe cases, are proposed for pulsatile tinnitus management when etiological treatment cannot be available.

Adult↗
PubMed1992

[Aorto-bifemoral bypass. Evaluation of Milliknit prosthesis].

Since there is no consensus as to the choice of an optimal prosthesis for aortobifemoral bypass, we have retrospectively evaluated the outcome with 162 Milliknit prostheses laid in cases of obliterating atherosclerosis. Such prostheses were preferentially used when the distal anastomosis were to be located on the deep femoral arteries. Intraoperatively, we noted the absence of fraying and the easy manipulation, owing to the flexibility and thinness of the wall, which are similar to those of the deep femoral artery: however, the blood loss before achieving complete tightness was greater than with most other knitted prostheses, and in 7.4% of the operated patients, defribination on clamp removal caused an additional bleeding averaging 1 litre. There was no graft sepsis during the postoperative period, may be because of the excellent healing of this prosthesis. One prosthesis only presented with excess dilatation accounting for thrombosis. The average length of follow-up was 3.6 years, the primary actuarial patency at 1, 5 and 10 years respectively was 98.7, 93.9 and 92.8%. Secondary patency at the same times was 99, 97.5 and 95.9%. These patency rates are among the best published in the literature. As a conclusion, this prosthesis is perfectly appropriate when the shunts must be located on thin femoral arteries, but a reduction of the intraoperative blood loss through an impregnation process would be desirable.

Actuarial Analysis↗
PubMed2005

Analysis of the effects of different materials in a tooth implant-supported fixed prosthesis using finite element method.

In this study, design optimization of a tooth implant-supported fixed prosthesis was investigated theoretically. A three-dimensional finite element analysis was utilized to simulate the stress distribution and deformation, with an emphasis on the material selection for various parts of the prosthesis. This mandibular prosthesis was supported by six implants. The properties of 3 different materials for implants and 4 different materials for framework were incorporated into 12 different models. For the loading conditions used, it was found that the largest displacements occurred at the far ends of the framework and that the resulting deflection was highly dependent on the material properties of the framework. The simulations showed that the stress in the framework was mainly concentrated near the holes in the lower surface and that the highest values of von Mises stresses occurred in the lingual part of the prosthesis. Furthermore, the modeling results revealed that more rigid frameworks led to a corresponding decreased stress in the retaining screws and that high-stress concentration areas moved from the neck of the implant towards the base of it, as the value of Young's modulus increased. It was concluded that the first best model was the Cr-Co alloy for the framework and the Ti alloy for the implant and the second best choice was the Cr-Co alloy for both the framework and the implant.

Computer Simulation↗
PubMed2006

[Use of L-shaped silicone prosthesis and expanded polytetrafluoraethylene to repair the nasal deformities after repair of unilateral cleft lip: report of 17 cases].

PURPOSE: To evaluate the effect of using L-shaped silicone prosthesis and expanded polytetrafluoraethylene (ePTFE) to correct the nasal deformities after repair of unilateral cleft lip in 17 cases. METHODS: After correction of the malposed nasal cartilages, a chip of ePTFE was added to the tip of the L-shaped silicone prosthesis, and sutured with 5-0 nylon thread, to consolidate and mold the nasal dorsum, tip, ala and nasal columella. RESULTS: Simultaneous use of L-shaped silicone prosthesis and expanded polytetrafluoraethylene could elevate the flat nasal dorsum, tip, ala and nasal columella, which improved the nasal contour significantly. 11 patients achieved excellent esthetic results, and 6 had improvement. CONCLUSION: Use of L-shaped silicone prosthesis and ePTFE to repair the nasal deformities after repair of unilateral cleft lip is a simple and effective method.

Cleft Lip↗
PubMed2006

Clinical outcome of unicompartmental knee arthroplasty and influence of alignment on prosthesis survival rate.

INTRODUCTION: Various factors that affect the longevity of unicompartmental knee arthroplasty (UKA) include patient activity level, habitus, competence of cruciate ligaments, postoperative alignment, implant positioning and ligament balancing. The purpose of this study was to evaluate the clinical outcome of the open standard UKA and establish the influence of radiological alignment on the survivorship of the prosthesis. METHODS: We consecutively reviewed the results of 20 open standard UKAs performed in 17 patients between 1996 and 2000. A single implant type, the Press Fit Condylar Unicompartmental Knee System (DePuy, Leeds, UK), was used in all patients. All patients were evaluated clinically using the Knee Society Rating. Implant positioning and limb alignment were recorded in the standing long leg anteroposterior and lateral radiographs, and various angles were measured. RESULTS: The alignment of the prosthesis was found to be good in 19 out of 20 operated knees. One knee with malalignment of prosthesis had to be revised at 23 months follow-up. There was a significant increase in Knee Society Rating of all patients, at a follow-up of 4-8 years. The Kaplan-Meier survival rate using revision to total knee arthroplasty as an endpoint was 91.7 percent. CONCLUSION: The long-term outcome of UKA is influenced by positioning and alignment of the prosthesis. With proper patient selection and surgical technique, the outcome of UKA can be definitely improved.

Adult↗
PubMed2006

Evaluation of post-operative residual function of corpora cavernosa after soft penile prosthesis implant for Peyronie's disease.

OBJECTIVE: The aim of this study is to evaluate the results of surgical implant with a new soft penile prosthesis, called SSDA, without plaque surgery in the treatment of impotence associated with Peyronie's disease. MATERIALS AND METHODS: This study included 64 men with Peyronie's disease who underwent placement of a penile prosthesis. All the patients were followed for at least one year. RESULTS: The implant of this kind of prosthesis straightened the penile shaft in all cases, restoring sexual satisfaction to the couple, as described in a clinical interview. No operative or postoperative complications occurred and no further operations were needed. Ten patients underwent a further examination with basal and duplex dynamic color Doppler ultrasound to establish the residual function of the corpora cavernosa. DISCUSSION: The outcome is very positive: the penis preserves the ability to enhance the tumescence and the penile girth. We conclude that SSDA penile prosthesis are safe and effective in the treatment of Peyronie's disease associated with impotence.

Adult↗
PubMed1991

Combination of natural teeth and osseointegrated implants as prosthesis abutments: a 2-year longitudinal study.

Twenty-three patients with Kennedy Class I mandibular dentition were supplied with prostheses in the posterior parts of the mandible. On one side they were given a prosthesis supported by two implants (prosthesis Type I) and on the other side they received a prosthesis supported by one implant and one natural tooth (prosthesis Type II). Sixty-nine fixtures were inserted and 46 prostheses constructed. Eight of the fixtures were lost during the observation period. The failure rate of the implants was about the same in the two types of prostheses; five fixtures belonged to prostheses Type I (10.9%) and two fixtures belonged to prostheses Type II (8.7%), while one fixture was lost prior to loading. From a theoretical point of view, the combination of a tooth and an osseointegrated implant should encounter problems with regard to the difference in bone anchorage and there should be a risk of biomechanical complications. However, the results of this study did not indicate any disadvantages in connecting teeth and implants in the same restoration.

Adult↗
PubMed1991

[Total hip prosthesis after high femoral osteotomy].

This study reviews a series of 75 total hip prosthesis (THP) after high femoral osteotomy operated on between 1968 and 1986. The mean delay between osteotomy and THP was 14 years. 53 prosthesis were available for long term follow-up with a mean follow up of 7 years. It was included in the category of total hip prosthesis operations considered as difficult. The lateral view is indispensable to plan the operation. Valgus intertrochanteric osteotomies and moderate internal translations posed no problems. Trochanteric osteotomy did not have to be systematic; it's inconveniences were not neglectible. It was reserved for isolated varizations for it modifies the axis of entry of the stem. The reamer was used in cases of narrowing of the femoral canal; notably after significant medializations. Derotation osteotomy was the last resort when it was impossible to position the stem secondary to a subtrochanteric osteotomy or significant angulation in the sagittal plane. An intertrochanteric osteotomy, when correctly realised, posed few problems during placement of a total hip prosthesis and licits a continued use in young subjects. Results of THP after intertrochanteric osteotomy compared well with primary THP, with 77.5 per cent good results and 15 per cent loosening. In addition to problems posed by etiologies (congenital dislocations), subtrochanteric osteotomies rendered cementing extremely difficult, even impossible. At long term, only 14.5 per cent of the results were good and the loosening rate was 45 per cent. Fortunately subtrochanteric osteotomies are practically abandoned.

Adolescent↗
PubMedDate not supplied

[Tympanic membrane prosthesis using soft magnetoelastomer].

This paper presents a new method for tympanum prosthesis application. The prosthesis is fixed by the interaction of magnetic pondermotive forces between two soft petals of a magnetoelastomer. This type of prosthesis was applied to 30 patients with dry perforative otitis media, aged 51-75 years. The intervention was performed in the outpatient department. Prostheses are recommended to be replaced every 3 months. These patients showed good tolerance of the treatment, which significantly improved their hearing level. The method of prosthesis fixation was reliable and atraumatic.

Aged↗
PubMed1991

[A case report of a thrombosed mitral prosthesis diagnosed by 111In-oxine platelets scintigraphy].

The purpose of this report was to evaluate the efficacy of 111In-oxine labeled platelets scintigraphy for detection of thrombus in the prosthetic valve. A 50-year-old man underwent re-mitral valve replacement with a Björk-Shiley prosthesis because of malfunction of the xenograft in a previous operation. Almost one year later, this patient suffered from peripheral embolism and sight disturbance. There was no evidence of a thrombosed valve although it was suspected. Cineradiography showed the valve almost fully open, and there were no abnormal sounds when the valve closed. 111In-oxine labeled platelets scintigraphy was performed for the detection of thrombus in the mitral position. Hot areas of high quality in the scintigram were demonstrated in the mitral position. As a result, Björk-Shiley prosthesis was replaced with a Duromedics prosthesis. A small thrombus (10mm) surrounded by fresh tiny thrombi was found in a minor orifice of the Björk-Shiley prosthesis.

Heart Valve Prosthesis↗
PubMed1991

[Brucella endocarditis on Starr aortic valve prosthesis].

The authors report the case of a 22 year old patient with brucella endocarditis on a Starr-Edwards aortic valve prosthesis implanted 5 years previously. Six blood cultures were positive for Brucella melitensis biovar I. Antibiotic therapy associating Rifampicin and Tetracycline and then Rifampicin and Ofloxacine did not prevent abscess formation and valve dehiscence. The poor haemodynamic status and persistent infection led to replacement of the valve prosthesis. Culture of the infected prosthesis grew a colony of brucella melitensis resistant to fluoro-quinolones. Valve replacement and antibiotic therapy led to clinical improvement and constant apyrexia with a 12 month follow-up. Brucella endocarditis on a valve prosthesis is a very rare occurrence. The combination of valve replacement and antibiotic therapy is usually required.

Adult↗