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PubMedDate not supplied

[Changes of periprosthetic bone mineral density in cementless bicontact stem implantation; influence of different parameters--a prospective 4-year follow-up].

AIM: This prospective study describes the periprosthetic BMD (bone mineral density) after implantation of the cementless Bicontact stem over a period of 4 years. Additionally, the influence of several relevant parameters like age, sex, BMI (body mass index) and the influence of the stem-size on the periprosthetic BMD course were investigated. METHOD: Measurement of the periprosthetic BMD in 36 patients (15 female, 21 male) in a prospective longitudinal study over 4 years with DEXA (dual energy X Ray absorptiometry) of the proximal Gruen zones 1 and 7. RESULTS: We found a good precision of the method in vivo with a CV (coefficient of variation) of 1.04 %. There was a decline of the periprosthetic BMD at the whole proximal stem (ROI 0) of 20 % in the first 6 months. Afterwards there was a significant increase at the lateral stem (ROI 1) of 3.46 %, in contrast no significant change could be found medially, maybe as a result of a more lateral induction of power. The investigated parameters BMI, age and sex had no influence on the relative course of mineralisation. At stem sizes bigger than 15 the decline of BMD was significantly larger than at the stem sizes smaller than 15. CONCLUSION: DEXA is a sufficiently precise method to investigate periprosthetic BMD. The postoperative periprosthetic course of mineralisation and the extent of BMD loss in the first 6 months after the Bicontact stem is similar to other periprosthetic BMD courses of prosthesis with a similar design. The course of mineralisation in "smaller" stems is obviously more auspicious than the course of "bigger" stems.

Absorptiometry, Photon↗
PubMed2004

Clinical outcomes and complications of intraocular lens exchange in patients with opacified hydrophilic acrylic lenses SC600-2.

BACKGROUND: The purpose of this study was to present the outcomes of intraocular lens exchange in patients with opacified hydrophilic acrylic intraocular lenses. PATIENTS AND METHODS: Fifteen patients, who underwent uncomplicated phacoemulsification and hydrophilic acrylic intraocular lens (model SC600-2) implantation with good visual recovery, were re-referred to our department 76 - 188 weeks post-surgery due to progressive visual loss resulting from opacification of the implant. Intraocular lens exchange followed. The method of lens exchange is described. The effect on the best corrected visual acuity and on their refraction, the operative and postoperative complications are reported. RESULTS: All 15 patients underwent intraocular lens exchange. Twelve patients (80 %) had improvement of their best corrected visual acuity, in two cases (13 %) the best corrected visual acuity did not change, and in one case (7 %) the best corrected visual acuity deteriorated, this being attributed to progression of her age-related macular degeneration. None of the patients developed zonular dehiscence; in one patient the exchange was complicated with posterior capsule rupture, and an anterior chamber intraocular lens was implanted. One patient required cutting of the haptics before removal of the opacified intraocular lens. The mean Snellen (decimal) visual acuity was 0.35 (range 0.1 to 0.6) before lens exchange and 0.49 (range 0.1 to 0.6) six weeks after; the difference was significant (P < 0.05). Excluding the patient with the deterioration of her age-related macular degeneration, mean visual acuity of the remaining fourteen patients after the intraocular lens exchange was even better (0.56). CONCLUSION: Exchange of opacified hydrophilic acrylic intraocular lenses seems to be the only currently available effective treatment, leading to improvement of visual acuity.

Acrylates↗
PubMed2004

[Toric intraocular lenses for compensation of corneal astigmatism].

BACKGROUND: Besides arcuate or straight transverse keratotomies, toric intraocular lenses are of increasing popularity to enhance the visual function in cases of lens opacification for the correction of corneal astigmatism and the following ocular surgery such as penetrating keratoplasty. The purpose of this study was to present a generalized scheme for the calculation of toric intraocular lenses and to demonstrate its potential on a clinical example in a step-by-step approach. METHODS: After providing some helpful approximations for the clinicians, i. e., for a conversion of radii differences to corneal astigmatism, the calculation scheme using vergence transformation in a paraxial space and the dualism of the standard and component notation for the description of spherocylindrical vergences and spherocylindrical refractive surfaces is described. RESULTS: In a clinical example, a toric intraocular lens is calculated step-by-step using the above-mentioned calculation scheme. The methodology is designed in a matrix structure for the direct implementation in a computer language. In a second step, a toric lens similar to the calculated lens in the manufacturing grid is selected and inserted with a small angle of rotation from the ideal implantation axis to demonstrate the effect on postoperative refraction. CONCLUSIONS: The calculation scheme allows the determination of toric intraocular lenses with an astigmatic cornea and enables us to achieve a spherocylindrical target refraction with cylinder axis at random. Furthermore, the postoperative refraction at the spectacle or corneal plane can be simulated by inserting any toric intraocular lens oriented in any axis. The concept can be easily generalized to 'thick' toric intraocular lenses if the geometrical data and the refraction index of the material are known.

Astigmatism↗
PubMed2004

[Tympanoplasty with hybrid prostheses].

BACKGROUND: The retrospective study reviews the hearing results of partial and total ossicular replacement plasties with prostheses composed of a hydroxylapatite head and a trimmable shaft. PATIENTS AND METHODS: 71 patients underwent tympanoplasty type III between January 1996 and January 2002. The partial (PORP) (55 patients) and total ossicular replacement prostheses (TORP) (16 patients) were a composition of a hydroxylapatite head and a trimmable hydroxylapatite-polyethylene composite shaft (HAPEX ). Hearing results were evaluated according to the guidelines of the Committee on Hearing and Equilibrium. RESULTS: In cases with a PORP the residual air-bone gap could be reduced to < or = 20 dB in 73% of the patients. The mean air-bone gap improved from 28 dB preoperatively to 17 dB postoperatively. In cases with a TORP the residual air-bone gap could be reduced to < or = 20 dB in 62% of the patients. The mean air-bone gap improved from 32 dB preoperatively to 20 dB postoperatively. CONCLUSIONS: The hearing results with prostheses composed of a hydroxylapatite head and a trimmable shaft are good and comparable to the results of authors using other synthetic ossicular prostheses. These prostheses are time-saving because the trimmable shaft can be quickly cut and shortened to an individual length.

Audiometry, Pure-Tone↗
PubMed2005

[Correlations between "questionnaire of auditory perception disorders" and "Heidelberger test of phonemic discrimination"].

BACKGROUND: A standardized anamnestic questionnaire of central auditory processing disorders ("Anamnestischer Erhebungs- und Beobachtungsbogen für auditive Verarbeitungs- und Wahrnehmungsstörungen") (FB-AVWS) was developed by German paedaudiologists. The present study examined the relations between this questionnaire and the results of selected auditory-perceptual tests to evaluate the validity of the FB-AVWS. SUBJECTS AND METHOD: As part of a multicentric study, 113 pupils in primary schools were examined by the "Heidelberger Lautdifferenzierungstest", a test of phonemic discrimination and identification (HLAD). Additionally, the parents answered the FB-AVWS. Sensitivity, specificity and correlations with the FB-AVWS were determined referred to the HLAD. RESULTS: We found significant, though moderate correlations, between the scale "auditory discrimination" of the FB-AVWS and the subtests "kinaesthetic/phonemic identification" and "phonemic analysis" of the HLAD. The other subscales of the FB-AVWS showed no significant correlations with the HLAD and its several subtests. The values for the sensitivity of the FB-AVWS were relatively high (93 and 100 %) as where the negatively predictive values for the HLAD as a whole and the subscale 1B (98 and 100 %), referred to HLAD. The specificity and the positive values were relatively low for the HLAD as a whole and for several of its subtests. CONCLUSION: The FB-AVWS is a useful supplementation for the complementary clinical evaluation of central auditory disorders. It allows an assessment of the child's auditory perception and processing skills compared to the general population of primary school children. However, it is not valid as a screening or diagnostic instrument.

Age Factors↗
PubMed2006

[Bottoming out in augmentation mammaplasty--correction and prevention].

Displacement of a breast implant beneath the original submammary fold is known as a rare but, in most cases, difficult to correct complication after augmentation mammaplasty. Suggestions for re-centering the mammary implant range from simple percutaneous sutures to the additional application of expensive alloplastic dermal grafts. Based on the latest findings concerning plastination histology of the fascial system of the breast and in the light of our own clinical experience regarding correction of implant ptosis we have developed a special treatment concept. When placing the implant, the vertical fibers of the submammary fold are saved as a precautionary measure. In cases where there is a risk of possible inferior displacement of the mammary implant, an individually manufactured belt-like bandage is applied for approximately eight weeks postoperatively. In cases requiring the correction of a severe "bottoming out" deformity, we either lift the capsular shell of the implant or, if the fibrous capsule is thin and vulnerable, we use a special capsular flap technique resulting in a hammock that catches the implant at the height of the new submammary fold. Postoperative application of our belt-like bandage is again indispensable.

Bandages↗
PubMed2006

[Impact of TORP diameter on fracture of the footplate].

BACKGROUND: A columella-prosthesis is the typical reconstruction procedure of the ossicular chain in cases with a destroyed stapedial arch. Lightweight titanium prostheses are commonly used for this type of surgery. The smaller the prosthesis foot the lower the risk of dislocation and friction of the prosthesis with the bony rim of the oval niche. However, using a smaller prosthesis foot, fracture of the footplate and penetration of the prosthesis into the inner ear are conceivable. METHODS: Using fresh temporal bone preparations, lacking the stapedial arch, in conjunction with a load cell, the force needed to fracture the footplate was measured. Different prostheses with different foot diameters (0.2 - 0.8 mm) were used in these experiments. Furthermore, a human stapes was evaluated morphologically by scanning electron microscopy. RESULTS: The forces leading to fracture of the footplate were measured to be between 250 mN and 980 mN. Statistical analysis showed no significant difference between 0.2 mm and 0.8 mm prosthesis foots. Moreover, different forces were attributed to varying thickness of the stapes footplate. In scanning electron microscopy the rough and uneven bony surface of the footplate could be demonstrated. CONCLUSION: Due to the uneven footplate, only punctual contact of the prosthesis foot can be achieved. Hence, the risk of footplate fracture is not considerably higher by using smaller diameters. However, the use of smaller feet in upcoming generations of TORPs seems to be appropriate.

Biomechanical Phenomena↗
PubMed2006

[Collagen injection for augmentation of periprosthetic leakage after tracheo-esophageal voice restoration].

After laryngectomy the majority of patients receive a vocal rehabilitation by tracheo-esophageal puncture and insertion of voice prosthesis. Periprosthetic leakage causing aspiration represents a well known complication and is frequently treated by temporary removal of the prosthesis with shrinkage of the shunt. Here we describe 10 patients with such a leakage treated by collagen injection for periprosthetic tissue augmentation. A mean of 1,6 injections were necessary for complete control of the leakage. The injection was well tolerated and was found effective for median period of 9,3 months. In our hands the periprosthetic collagen injection represents an effective and well tolerated procedure for temporary augmentation of tracheo-esophageal leakage in post-laryngectomy patients. However, alternative fillers without pre-testing necessity and longer augmentation intervals should be considered.

Collagen↗
PubMed1998

[Reliable fixation of cochlear implant electrode mountings in children and adults--initial experiences with a new titanium clip].

BACKGROUND: There is a reported 1% incidence of delayed migration of extrusions of the electrode arrays out of the cochlea. METHODS: A titanium clip to fix the electrode array of the MED EL Combi 40 Cochlear Implant System is described. The clip is designed and shaped in a double U configuration. The clip material allows easy adaption to the individual anatomical situation. The clip is fixed to a bony bridge at the incus bar and fixes the electrode in a plane parallel to the chorda facial angle. It is closed around the electrode similarly to a stapes piston around the incus. Additional tests which examined the possible risk of damaging the electrode carrier and clinical findings are described. RESULTS: The clip was used in 23 cases with a follow-up period up to 1 year. No signs for dislocation of the electrode were found. In one revision case the clip was covered with a thin mucosal layer. The electrode array showed no signs of damage. Intraoperative findings confirmed the experimental tests on the electrode fixation. CONCLUSION: The titanium clip facilitates safe and quick fixation of the electrode array and prevents dislocation. its flexibility and shape minimizes the risk of damage.

Adult↗
PubMed1993

[Differential indications of free and pedicled transplants in reconstructive surgery in the head and neck area].

Since the microvascular tissue transfer has been introduced in the reconstructive surgery of the head and neck the question arises repeatedly which free transplant should be favoured and which advantages exist to pedicled flaps. Based on our experiences in 243 reconstructions we discuss the advantages and disadvantages of different operative techniques and their differential indications. Using free as well as pedicled flaps, reconstructions can be performed individually and the decision for a transplant depends on localisation, size and depth of the defect. In contrast to conventional techniques, like the deltopectoral flap, which we performed a decade ago, both new principles allow a one-stage procedure, which reduces the period of hospitalisation and improves the quality of life for the patients. The advantages of free tissue transfer can be seen especially in the reconstruction of the upper digestive tract after laryngopharyngectomy. The existing form of the jejunum segment like a tube allows an easy one-stage reconstruction, as well as better functional and aesthetic results. The radial forearm flap is a nearly ideal transplant in the anterior oral cavity because of the mechanical stability. In contrast the jejunum patch is more vulnerable and less qualified especially when fitting a prosthesis. In the posterior oral cavity we prefer the jejunum patch because it allows more mobility of the tongue. Deep defects, for instance after glossectomy, should be reconstructed with a free latissimus-dorsi-flap or a pedicled myocutaneous pectoralis major flap. In contrast to free tissue transfer, pedicled flaps have the advantage that the difficult technique of microanastomosis is avoided, which reduces the complication rate and the operation time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[The German Society of Orthopedics and Traumatology classification of bone defects in total hip endoprostheses revision operations].

PROBLEM: In revision alloarthroplasty the need for bone allografts increased. The documentation of the defects is not done routinely. METHOD: For better documentation the German Society for Orthopedics and Traumatology (DGOT) developed a new and practical defect classification system. It was tested clinically in the last 6 years. RESULTS: In the acetabulum and femoral shaft seven defect types were distinguished and presented in figures. For the acetabulum: 1 cavitary holes, 2-4 unisegmental, 5 bisegmental, 6 trisegmental, 7 pelvic instability. For the femur: 1 intramedullary 2 trochanter 3 calcar 4 med. shaft 5 lat. shaft 6 part. diaphysis 7 total diaphysis. CONCLUSION: With this classification system we could better compared different reconstruction approaches in endoprosthetic surgery.

Acetabulum↗
PubMed2001

Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents.

BACKGROUND: Endoscopic dilation with stents has been proposed as an alternative to hepaticojejunostomy for management of postoperative biliary strictures. Good long-term results with double 10F plastic stent insertion for 1 year have been reported in 74% to 90% of cases. This is a review of our experience with a more aggressive approach. METHODS: The technique, short-term results, and long-term results of placement of increasing numbers of stents until complete disappearance of the biliary stricture are reported. At each exchange, the maximum possible number of stents in relation to the tightness of the stricture and diameter of the bile duct were inserted. All stents were removed at the end of treatment. RESULTS: The records of 45 of 55 patients with postoperative biliary strictures treated in this manner and observed consecutively were reviewed retrospectively. By intention-to-treat analysis the success rate was 89% (40/45). Early complications developed in 4 (9%) patients (3 cholangitis, 1 pancreatitis) and stent occlusion that required early exchange occurred in 8 (18%) patients. There was 1 death caused by a stroke 2 months after a stent exchange. Forty-two patients completed the protocol (mean number of stents 3.2 +/- 1.3; range 1-6). Mean duration of treatment was 12.1 +/- 5.3 months (range 2-24 months). Two patients died of unrelated causes during follow-up. Among the remaining 40 patients there was no recurrence of symptoms caused by relapsing biliary stricture at a mean follow-up of 48.8 months (range 2-11.3 years). One patient sustained 2 episodes of cholangitis but without stricture recurrence. CONCLUSIONS: This more aggressive approach to endoscopic treatment with stents may improve long-term results for patients with postoperative biliary strictures.

Adolescent↗