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PubMed2000

Osteomyelitis of the spine and abscess formation in the left thigh after stent-graft implantation in the superficial femoral artery.

PURPOSE: To present a rare case of abscess formation around a covered stent in the superficial femoral artery. METHODS AND RESULTS: Two weeks after balloon dilation of a left superficial femoral artery (SFA) occlusion, during which a Hemobahn covered stent had been placed to treat dissection, a 77-year-old nondiabetic male developed intolerable pain and swelling of his left thigh. An abscess had formed around the stent, which was patent; intravenous antibiotic therapy quelled the symptoms, and the patient discontinued his oral antibiotic regimen weeks after discharge. General septicemia ensued. Acute lower limb ischemia and excruciating back pain prompted readmission. The SFA stent-graft occlusion required femoropopliteal bypass; the abscess and spondylodiskitis that had developed in the T12 and L1 vertebrae responded to intravenous antibiotics. The patient is without signs of infection at 6 months. CONCLUSIONS: Local and systemic infections associated with intraluminal prostheses are rare, and prophylactic antibiotic therapy is not commonly employed. Balloon- or device-induced arterial injury may expose the arterial wall to bacterial colonization, suggesting that patients receiving lengthy stents or experiencing arterial injury during angioplasty should receive antibiotics as a precautionary measure.

Abscess↗
PubMed2002

The effect of multicolored machinable ceramics on the esthetics of all-ceramic crowns.

STATEMENT OF PROBLEMS: Computer-aided design/computer-assisted machining systems offer the possibility of fabricating restorations from one machinable ceramic block. Whether multishaded blocks improve esthetic results and are a viable alternative to individually stained ceramics has not been fully determined. PURPOSE: The aim of this investigation was to examine the effect of multishaded blocks on the esthetic appearance of all-ceramic CEREC crowns and compare these crowns with single-shade and stained restorations. MATERIAL AND METHODS: Ten subjects were included in this study. For each subject, 6 different crowns were milled with the use of a CEREC machine. One crown was milled from each of the following machinable ceramic materials: CEREC Vitablocs Mark II in classic colors; Vitablocs Mark II in 3D-Master colors; Vitablocs Mark II in either classic or 3D-Master colors, with additional staining; Megadenta Bloxx multishaded; Mark II experimental multilayer; and an experimental multilayer leucite ceramic. Three independent examiners assessed the esthetic appearance of crowns fabricated to match each subject's anterior tooth shade. A scale of 1 to 6 was used to score the shade match and esthetic adaptation of each crown, with 1 representing excellent characteristics and 3.5 serving as the threshold for clinical acceptability. The examiners' scores were averaged, and the mean values were analyzed with the Wilcoxon signed rank test (P<or=.05). RESULTS: Only individually stained Mark II restorations achieved a mean score below the threshold of 3.5 for all 10 subjects. These restorations were significantly more esthetic (P<or=.05) than restorations fabricated from all other materials except the Mark II experimental multilayer ceramic. The second best results were obtained for crowns made from single-shaded Mark II 3D-Master blocks: 6 out of 10 restorations were scored below 3.5. Two of the layered materials (Mark II experimental and Bloxx) followed with 5 acceptable restorations out of 10. CONCLUSION: Within the limitations of this study, the results provide no evidence that multicolored machinable ceramics improve the esthetics of all-ceramic crowns.

Aluminum Silicates↗
PubMed2003

[Repair of whole auricular defects with implant-plasty and prosthesis].

OBJECTIVE: To repair the whole auricular defects with implant-plasty and prosthesis technique. The indications, complications and implant sites of this method were discussed. METHODS: In reconstruction of the whole auricular defect, the self-developed pure titanium implants, specialized for plastic surgery, were used for intra-osseous fixation for retaining the artificial ear. 10 cases were treated with this method. RESULTS: Follow-up of three years demonstrated that this implant system, with stable function, could generate osseointegration and be used as an abutment of intra-osseous fixation to retain the auricular prosthesis for a long time. CONCLUSION: The operation is simple and convenient with little trauma and short-term of treatment. The artificial ear has lifelike appearance, proper color and satisfactory effects. This technique has wide indications and is worth popularization.

Adolescent↗
PubMed1996

Feasibility evaluation of a new pericardial bioprosthesis with dye mediated photo-oxidized bovine pericardial tissue.

BACKGROUND AND AIMS OF THE STUDY: In an attempt to overcome the problem of calcification of bioprostheses, a novel bovine pericardial tissue valve preserved with a non-aldehyde, dye mediated photo-oxidation process (PhotoFixTM) developed by CarboMedics, Inc. The device was evaluated by implantation in the mitral position of juvenile sheep with a mean age of 3.5 months. MATERIALS AND METHODS: Thirteen valves were evaluated; six experimental valves with photo-oxidized tissue, five identically designed valves with glutaraldehyde-fixed tissue, and two Carpentier-Edwards pericardial valves as controls. RESULTS: Four of the six animals in the photo-oxidized group were free of calcification when electively sacrificed at 152 days, 152 days, one year and 1.5 years respectively. One animal was electively sacrificed at 98 days. Pathologic findings indicated minimal calcification of the valve due to uneven stress distribution from two bent stent posts that most likely occurred during surgical implantation, but the device was still functional. The sixth animal with photo-oxidized tissue died at 131 days due to massive calcification of a single leaflet. There was no pathologic evidence of infection. Explants at five months from additional and still continuing sheep studies per FDA guidelines have not reproduced single leaflet calcification in over forty explanted valves with photo-oxidized tissue. The glutaraldehyde-fixed valves all exhibited some calcification at explant; two of these animals died early due to the mineralization. Both control animals with Carpentier-Edwards valves died early from mitral stenosis due to extensive device calcification. CONCLUSIONS: The fact that four of six valves with photo-oxidized tissue remained free of any signs of calcification for up to 1.5 years, while none of the other valves did, suggests that photo-oxidation is a promising method of preserving and fixing tissue for use in bioprostheses. These results suggest that photo-oxidized bioprosthetic valves may be clinically valuable and warrant further study.

Angiography↗
PubMed1992

Transesophageal color Doppler flow imaging in the evaluation of prosthetic cardiac valves.

To determine the value of transesophageal echocardiography in the assessment of prosthetic cardiac valves, 11 patients with clinically suspected cardiac prosthetic valve dysfunction were studied by transesophageal two-dimensional imaging, as well as by color Doppler flow mapping. Among these 11 patients, there were 10 with biological tissue valves and 3 with metallic valves (1 Bjork-Shiley, 2 St. Jude). Nine patients had replacement of mitral valves alone. The remaining two had received both mitral and aortic prostheses. The degree of mitral regurgitation was graded by transesophageal color Doppler according to the area of the regurgitant jet visualized. The degree of aortic regurgitation was graded by the jet height/left ventricular outflow height ratio method. All transesophageal studies were performed without complication and all were well tolerated. The pathological morphology of the cardiac prosthesis was clearly visualized by transesophageal two-dimensional imaging and subsequently proven at surgery. Of those tested, one patient was found to have a torn leaflet, one had a dislodged leaflet, one patient had paravalvular leakage, four had cusp vegetations, and five patients had prosthetic degeneration for other reasons. Mitral regurgitation was graded as absent in one patient, mild in two patients, moderate in two patients, and severe in six patients. Aortic regurgitation was graded as severe in both patients with aortic prostheses. We conclude that in patients with clinically suspected cardiac prosthetic dysfunction, transesophageal two-dimensional imaging combined with color Doppler can provide reliable information that corresponds to surgical findings.

Adult↗
PubMed2000

[Aortic valve/root replacement using a stentless bioprosthesis (Medtronic Freestyle valve)].

BACKGROUND: The purpose of the study is to assess the clinical and hemodynamic performance of aortic valve replacement (AVR) with the Freestyle bioprosthesis. METHODS: Twenty-one patients received AVR with a Freestyle aortic root bio-prosthesis between May 1998 and October 1999. Eighteen patients underwent AVR with subcoronary method and three patients with aortic root (full root) method. Patients were evaluated postoperatively at discharge by clinical examination and color Doppler echocardiography. RESULTS: There was one death due to multi-organ failure. No patients experienced valve deterioration, paravalvular leak, unacceptable hemodynamic performance, nor thromboembolic event. Excellent function is demonstrated by very low gradient (mean gradient 7.2 +/- 4.7 mmHg) through aortic valve and no significant aortic regurgitation (none: 11, trivial/mild: 10). All patients had been in New York Heart Association Functional Class III and IV preoperatively, and after surgery, 17 patients were in Class I, and 3 were in Class II. CONCLUSION: The Freestyle bioprosthesis has good clinical and hemodynamic performance without Coumadin. Further follow-up is required to evaluated valve durability.

Adult↗
PubMed1996

Transfemoral endovascular repair of abdominal aortic aneurysm: results of the North American EVT phase 1 trial. EVT Investigators.

PURPOSE: This report describes the results of a phase 1 trial of endovascular repair of abdominal aortic aneurysm, conducted under FDA protocol in 13 U.S. medical centers from February 1993 to December 1994. METHODS: Forty-six patients 54 to 84 years of age underwent endovascular repair of abdominal aortic aneurysm (diameter, 3.8 to 7.1 cm). Fifteen were treated with the original device (EGS-I), and 31 with a revised over-the-wire system (EGS-II). All patients were periodically observed with contrast-enhanced computed tomographic scan, color-flow duplex scan, and plain abdominal films to evaluate the stability of prosthetic location and to detect any vascular communication with or entry of blood into the aneurysm sac or change in aneurysm size. RESULTS: Thirty-nine implants (85%) were successful; average operating time was 194 minutes. Seven attempts were unsuccessful and were converted to open repair without complication (EGS-I, 5 of 15; EGS-II, 2 of 31). Conversions were caused by iliac stenosis in four patients, subintimal deployment in one, proximal displacement in one, and short distal neck in one. No patients died within 30 days of surgery. Complications included myocardial infarction in one patient, iliofemoral arterial injury in eight, wound infection in seven, required transfusion in eight, transient unexplained fever in nine, and minor emboli with foot petechiae in two. There were no amputations, major emboli, or episodes of mesenteric ischemia. Contrast enhancement outside the graft but within the aneurysm sac was detected initially in 17 grafts (44%), of which nine (53%) resolved spontaneously. Of eight persistent leaks into the aneurysm sac, one was controlled with transluminal balloon angioplasty and one required surgical explanation because of aneurysm enlargement. Six patients continued to have contrast enhancement, but had no evidence of aneurysm enlargement from 6 to 27 months after surgery. Hospital stay averaged 3.8 days (range, 1 to 13 days). Follow-up extends to 27 months, with one non-device related death of respiratory failure at 6 months. Metallic attachment system fracture, a device-related malfunction, was identified in nine implants (23%), which led to one removal; the remaining eight functioned normally with no untoward sequelae. The program was suspended while the defect was corrected. Preparations are complete for the phase 2 portion of the trial. CONCLUSIONS: Endovascular repair of abdominal aortic aneurysm appears to be safe and efficacious. Long-term results and late consequences of attachment system fracture have yet to be determined. The long-term results of perigraft leak into the aneurysm sac are unknown but worrisome in view of adverse outcomes reported by other investigators.

Aged↗
PubMed1999

Treatment of a TIPS-biliary fistula by stent-graft in a 9-year-old boy.

We report a 9-year-old male cirrhotic patient with acute occlusion of a transjugular intrahepatic portosystemic shunt (TIPS) due to a biliary-to-TIPS fistula which occurred 9 hr after the TIPS procedure. Immediate TIPS revision was performed and the fistula was treated by placement of an endoluminal stent-graft. At 12-month follow-up color Doppler examination demonstrated a patent shunt.

Biliary Fistula↗
PubMed2003

Color Doppler ultrasound guidance during renal angioplasty and stenting.

PURPOSE: To investigate whether an imaging technique combining color Doppler ultrasonography and selective renal artery digital subtraction angiography reduces contrast requirements in patients with progressive renal insufficiency undergoing renal artery angioplasty and stenting. METHODS: Eight patients (5 men; mean age 58 years) with renal artery stenosis and renal insufficiency underwent percutaneous transluminal angioplasty and stenting under color Doppler ultrasound guidance. RESULTS: Color Doppler ultrasound imaging yielded the information necessary for verifying catheter position, stent placement and expansion, and hemodynamics after revascularization. The combined imaging technique considerably reduced contrast requirements to only 10 mL in each case. No worsening of renal function was seen in any patient. CONCLUSIONS: The combined imaging procedure uses low doses of contrast agent and is especially suited to patients with renal dysfunction undergoing percutaneous renal revascularization.

Angiography, Digital Subtraction↗
PubMed2005

Facial prosthetic rehabilitation: preprosthetic surgical techniques and biomaterials.

PURPOSE OF REVIEW: Attention to detail ensuring a successful facial prosthetic rehabilitation must be considered a priority at the time of presurgery, surgery, and at every stage in fabricating the prosthesis. Teamwork between the surgeon and maxillofacial prosthodontist will ensure an optimal surgical preparation and definitive prosthesis. RECENT FINDINGS: Evidence of interaction between team members can most certainly be encouraging to the patient. During the prosthetic phase of treatment, focusing on tissue assessment, impression making, sculpting, mold fabrication, familiarity with materials, appreciation of color, delivery of instructions, and patient education will ensure a satisfactory outcome. With the desire, determination, and encouragement from the restorative team to make the most of this artificial replacement, a patient can have a higher quality of life and a more normalized lifestyle. SUMMARY: This review presents current concepts regarding facial prosthetic rehabilitation of patients with head and neck cancer and facial prosthetic biomaterials.

Biocompatible Materials↗
PubMed1997

Intracranial microembolic signals in 500 patients with potential cardiac or carotid embolic source and in normal controls.

BACKGROUND AND PURPOSE: We undertook this study to evaluate the prevalence and clinical correlations of Doppler microembolic signals (MES) in stroke-prone patients. METHODS: Patients with potential cardiac (n = 300) or carotid (n = 100) embolic source and control subjects (n = 100) were monitored with transcranial Doppler sonography for MES. Transthoracic (n = 192) and/or transesophageal (n = 134) echocardiography and carotid studies (continuous-wave Doppler, n = 181; color-coded duplex, n = 47) were performed in all patients with potential native cardioembolic source. Carotid disease was evaluated by means of continuous-wave Doppler (n = 87), color-coded duplex (n = 70), or intra-arterial angiography (n = 24) in patients with potential carotid embolic source. RESULTS: Overall MES prevalence was 23% in patients with potential native cardioembolic source (infective endocarditis [n = 7] 43%, left ventricular aneurysm [n = 38] 34%, intracardiac thrombus [n = 23] 26%, dilative cardiomyopathy [n = 39] 26%, nonvalvular atrial fibrillation [n = 24] 21%, valvular disease [n = 80] 15%), 55% in patients with prosthetic cardiac valves (mechanical [n = 77] 58%, porcine [n = 7] 43%, homografts [n = 5] 20%), 28% in patients with carotid disease (symptomatic [n = 46] 52%, asymptomatic [n = 54] 7%; P < .01), and 5% in control subjects. No relationship between MES counts and patients' age, sex, or actual medication was noted. The sensitivity and specificity of MES detection in identifying patients with potential embolic sources were 31% and 95%, respectively. CONCLUSIONS: Our study confirmed the reported clinical significance of MES in patients with carotid disease and the high specificity of this technique. The demonstrated low sensitivity of MES detection could be due to short monitoring duration or application of antihemostatic treatment. Prospective large-scale studies are needed to determine the definitive value of MES detection as a diagnostic method in patients with potential cardioembolic source.

Adult↗
PubMedDate not supplied

The assessment of sexual functions in women with male partners complaining of erectile dysfunction: does treatment of male sexual dysfunction improve female partner's sexual functions?

The aims of this prospective study were to compare sexual functioning between women with male partners who have erectile dysfunction (ED) and women without partners with ED and also to investigate the effect of the treatment of male ED on female partner's sexual function. The study included 87 women and their male partners. We divided the women into two groups: 38 women with male partners complaining of ED (ED group) and 49 women with male partners who have no ED (control group). Of the men with ED, 30 were treated with penile prosthesis implantation (n = 17) or oral sildenafil citrate (n = 13). We evaluated all the men with the International Index of Erectile Function (IIEF; Rosen, Cappelleri, Smith, Lipsky, & Pena, 1999), physical examination, and color penile Doppler ultrasound. We evaluated female sexual function with the Female Sexual Function Index (FSFI; Rosen et al., 2000) to assess sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. We compared female sexual function scores between the women of the male partners with and without ED and also compared before both groups and after the treatment of male partners in the ED group. Additionally, we compare the scores according to the type of treatment given to the male partners. Sexual arousal (p = 0.009), lubrication (p = 0.001), orgasm (p = 0.006), satisfaction (p = 0.000), pain (p = 0.039), and total score (p = 0.003) were highly significantly lower in the ED group than in the control group, although sexual desire did not differ between the two groups (p = 0.515). We investigated the effect of male ED on female sexual functions and found no statistically significant differences in the presence of organic type impotence, older age, and lower erection scores on the IIEF (p = 0.53, p = 0.15, and p = 0.1, respectively). After the treatment of male ED, we observed significant improvement in sexual arousal (p = 0.001), lubrication (p = 0.002), orgasm (p = 0.000), satisfaction (p = 0.000), and pain (p = 0.002) in the women. These findings suggest that female sexual function is affected by male erection status and may improve after the treatment of male sexual dysfunction.

Adult↗
PubMed1997

Prosthetic rehabilitation of patients with advanced nonmelanoma skin cancer.

Attention to detail at all stages of treatment can ensure a successful prosthetic rehabilitation. This detail must be considered a priority at presurgery, surgery, and at every stage in fabricating the prosthesis. Teamwork between the surgeon and maxillofacial prosthodontist will ensure an optimal surgical preparation and definitive prosthesis. Evidence of interaction among team members most certainly can be encouraging to the patient. It is important that during the prosthetic phase of treatment, attention be made in terms of tissue assessment, impression making, sculpting, mold fabrication, familiarity with materials, appreciation of color, delivery of instructions, and patient education, which will ensure a satisfactory outcome. With the desire, determination, and encouragement from the restorative team to make the most of this artificial replacement, a patient can have a higher quality of life and a more normalized lifestyle.

Basal Cell Carcinoma↗
PubMed2005

Color duplex ultrasonography is insensitive for the detection of endoleak after aortic endografting: a systematic review.

PURPOSE: To synthesize the available evidence regarding the diagnostic accuracy of color duplex ultrasonography (CDU) versus the accepted gold-standard of contrast-enhanced computed tomography (CT) for the detection and classification of endoleaks after aortic endografting. METHODS: A systematic search of the literature was conducted using electronic bibliographical databases and other means to gather articles published between 1991 and 2004. Articles were scrutinized against inclusion/exclusion criteria that broadly followed the QUADAS quality assessment guidelines. The results of diagnostic CDU were expressed for each study as a 2x2 contingency table, and summary statistics (sensitivity/specificity with 95% confidence intervals [CI]) were calculated. Pooled and random effects meta-analyses were performed. RESULTS: Eight published studies and 2 unpublished studies from Charing Cross and St. George's Hospitals (711 patients, 1355 paired scans performed > or = 1 month after endografting) were eligible for inclusion. From meta-analyses, the pooled sensitivity of CDU (versus CT as the gold standard) was 69% (95% CI 52% to 87%) and the specificity of CDU was 91% (95% CI 87% to 95%). These parameters did not appear to vary over time when a smaller dataset of 117 patients with 239 paired scans was used to compare CT and CDU specifically at 3, 12, and 24 months after endografting. Endoleak classification data, which was derived from only 5 small studies, indicated that CDU appeared to have better diagnostic accuracy in detecting type I or type III endoleaks compared with type II endoleaks; however, the data were insufficient for statistical analysis. CONCLUSIONS: CDU currently does not have sufficient diagnostic accuracy for the detection of all endoleaks in routine clinical practice. The diagnostic accuracy of CDU may improve if type II endoleaks are ignored.

Angioscopy↗
PubMed1997

The use of mechanical prostheses in native aortic valve endocarditis.

BACKGROUND AND AIMS OF THE STUDY: The optimal aortic valve substitute in cases of active native valve endocarditis (NVE) remains controversial. This report summarizes our experience with the surgical treatment of active aortic NVE using only mechanical prostheses. METHODS: Between January 1988 and January 1996, 20 patients underwent aortic valve replacement for active NVE. There were 17 men and three women. Mean age was 46.5 years (range eight to 63 years). Thirteen patients were in NYHA class IV and seven in class V. Streptococci were isolated in eight cases, while no causative micro-organism could be identified in seven patients. All operations were performed on urgent (n = 13) or emergency (n = 7) bases. A mechanical valve was implanted in all cases and radical resection of the infected tissues performed using different techniques. All patients were followed up at our institution. Two-dimensional color Doppler studies were performed one month after surgery and at six-month intervals after the first year. Transesophageal echocardiography (TEE) was performed at discharge, six months after surgery and yearly thereafter. RESULTS: No patient died in hospital. Mean follow up was 30.5 months, during which time three patients died, though none from endocarditis-related causes. Endocarditis recurred only one (5%). TEE demonstrated a normally functioning aortic prosthesis in 15 cases and trivial paravalvular leakage in two. CONCLUSIONS: Mechanical prostheses represent a safe aortic valve substitute in cases of acute native valve endocarditis. When radical resection of all the infected areas is performed, the incidence of endocarditis recurrence is acceptable. The concept that homografts are the valve substitute of choice in endocarditis cases cannot be supported by this study.

Adolescent↗
PubMed2006

Use of Amplatzer fenestrated atrial septal defect device in a child with familial pulmonary hypertension.

In a 4.5-year-old child with refractory pulmonary arterial hypertension, we performed atrial septostomy with the application of an Amplatzer fenestrated device designed to maintain patency. Continuous intravenous epoprostenol infusion was started concomitantly. Forty-two months after the procedure, the patient had no recurrent syncope and remained in New York Heart Association functional class II. Fenestration of the atrial septum is feasible in children with pulmonary artery hypertension. No conclusion regarding the patient's need for an atrial septal defect can be drawn since concomitant prostanoid therapy was administered. The long-term patency of the atrial communication needs further confirmation and the optimal timing for its application has to be determined.

Cardiac Catheterization↗
PubMed1999

Cross-sectional imaging in a case of adventitial cystic disease of the popliteal artery.

Adventitial cystic disease of the popliteal artery is an unusual condition of uncertain etiology, in which a mucin-containing cyst forms in the wall of the artery and produces lower extremity claudication, typically in young and middle-aged men. A diagnosis of adventitial cystic disease of the popliteal artery was made preoperatively in a 47-year-old man by means of several imaging modalities, including angiography, magnetic resonance imaging, and ultrasound. The pathological findings confirmed the suggested diagnosis.

Angiography↗
PubMed2005

Comparison of contrast sensitivity and color discrimination after clear and yellow intraocular lens implantation.

PURPOSE: To compare contrast sensitivity and color vision in patients in whom blue-light filtering and non-yellow-tinted intraocular lenses (IOLs) were implanted. SETTING: Refractive Surgery Unit, Hospital NISA Valencia al Mar, Valencia, Spain. METHODS: Forty eyes of 20 patients were enrolled in a blue-light filtering fellow-eye control study; patients were implanted with a yellow-tinted IOL (AcrySof Natural, Alcon) in 1 eye and a non-yellow-tinted IOL (AcrySof SA60AT, Alcon) in the fellow eye after cataract surgery. Three months postoperatively, monocular contrast sensitivity function was measured with the CSV 1000-E contrast sensitivity chart at distance and the color discrimination with the Farnsworth-Munsell 100 Hue test. RESULTS: Eyes implanted with blue-light filtering IOLs showed similar contrast sensitivity to that in fellow eyes implanted with non-yellow-tinted IOLs (P>.1). Both types of IOLs showed normal contrast sensitivity values (normalized log-contrast sensitivity about 1.0). There were no statistically significant differences in chromatic discrimination between the 2 types of IOLs (P = .56). CONCLUSION: The use of blue-light filtering IOLs is more advisable because they are capable of protecting the retina against ultraviolet light without disturbance of contrast sensitivity and chromatic vision, which produces subjective impairment in visual function.

Aged↗