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At least 1,171 records · Page 65Linked to original sources
PubMed2002

Bovine valved venous xenografts for RVOT reconstruction: results after 71 implantations.

BACKGROUND: Pediatric right ventricular outflow tract (RVOT) reconstruction with homo- or porcine xenografts is problematic because of limited availability, lack of material for reconstruction, early degeneration, and tissue ingrowth. Contegra, a bovine jugular vein graft, might be an interesting alternative to overcome these problems. PATIENTS AND METHODS: Within a Federal Drug Administration controlled study, we implanted 71 Contegra pulmonary valved conduits from May 1999 to September 2001 in 71 patients (male/female 33/38) in the age range 2 days-17.4 years, median 1.2 years. Twenty five were primary repairs, 22 had previous graft implantations, and 24 had other repairs/palliations. Preoperative diagnoses: truncus arteriosus communis (19 patients), tetralogy of Fallot (32), double outlet right ventricle (13), transposition of the great arteries (5), and two rare complex malformations. The size of implanted Contegra conduits ranged from 12 to 22 mm. Echocardiography was performed at 1 and 3 months, and then every 3 months postoperatively. Follow-up time was 27 months (maximal), 80 years in total. Results were compared with our 52 homograft- and 30 Tissuemed porcine xenograft recipients. RESULTS: Contegra enables the surgeon to perform all anastomoses without additional material. Its tissue is very apt for suturing and its insufficiencies are common, but without clinical significance or tendency to increase. We saw no sign of conduit or valve degeneration during the whole follow-up up to 27 months. There were no device related adverse events. Redos: five for peripheral pulmonary arteries, two residual ventricular septum defect (VSD) closures. There were six deaths (five early, one late). The maximal transvalvular gradients of 25-42 mmHg were measured in seven patients; these gradients did not increase further during the follow-up. Six patients with completely intact Contegra conduits developed pressure gradients of more than 70 mmHg immediately distal from the conduit. At 27 months, Contegra grafts were advantageous compared to homografts with respect to survival and freedom from explantation. Right ventricle to left ventricle (RV/LV) ratio development and freedom from explantation/redo were equal for Contegra conduits and homografts. Porcine Tissuemed xenografts were significantly inferior. CONCLUSION: The Contegra conduit offers unique tailoring and suturing options for primary and redo RVOT reconstruction. At 27 months, its durability seems at least equivalent to homografts and is superior to porcine Tissuemed xenografts.

Adolescent↗
PubMed2006

[Functional results after intraocular lens implantation with or without blue light filter: an intraindividual comparison].

BACKGROUND: The new generation of intraocular lenses (IOL) with an additional blue light filter has a slight yellowish colour (compared to the IOLs with only a UV filter) due to its different light transmitting properties. This could have an effect on contrast sensitivity and subjective visual perception. PATIENTS AND METHODS: In this intraindividual prospective comparative study including 14 cataract patients without further ocular pathology, a blue light filtering IOL (SN60AT, Alcon) was implanted in one eye and 1 month later a conventional single-piece IOL (SA60AT, Alcon) was fitted into the fellow eye. The visual acuity and the clinical findings were assessed at one day and four weeks post-operatively. Contrast sensitivity was tested under defined mesopic (6 cd/m(2)) and high mesopic (18.8 cd/m(2)) light conditions in the Ginsburg Box using the Functional Acuity Contrast Test (F.A.C.T.). Furthermore, subjective differences in the visual perception of both eyes were noted. RESULTS: The contrast sensitivity testing 1 day and 1 month postoperatively, revealed no statistically significant differences (P > 0.008) between both IOL types for all spatial frequencies (1.5/3/6/12/18 cpd) and light levels. 13 patients (85 %) reported no differences in the colour perception of both eyes, and none had visual disturbances. CONCLUSION: This intraindividual comparison revealed no relevant differences concerning mesopic contrast sensitivity and the subjective visual perception after implantation of one IOL with or without a blue light filter.

Aged↗
PubMed1995

Percutaneous endoluminal placement of stent-grafts for the treatment of isolated iliac artery aneurysms.

PURPOSE: To evaluate the feasibility of stent-grafts for treatment of isolated iliac artery aneurysms (IAAs). MATERIALS AND METHODS: Nine IAAs in eight patients were treated with transluminally placed endovascular stent-grafts. All patients were men (median age, 72 years). In three, the aneurysm involved both the common and internal iliac arteries. In one, common and external iliac arteries were involved. The other aneurysms involved only the common iliac artery. Two aneurysms were treated with balloon-expandable stents covered with polytetrafluoroethylene (PTFE) graft material, three were treated with self-expanding Z-stents covered with a woven polyester graft, and four were treated with self-expanding Z-stents covered with PTFE. RESULTS: Transluminal placement of the stents was successful in all patients with thrombosis of the aneurysms. There were no distal thromboembolic events, deaths, or infections. The median follow-up period was 8.5 months. CONCLUSION: Initial results suggest that transluminal stent-graft placement for treating isolated IAAs is a safe and effective alternative to surgery in selected patients. Long-term follow-up data are needed before this approach can be recommended for the primary treatment of IAAs.

Aged↗
PubMedDate not supplied

Patient education for women being fitted for breast prostheses.

Women who undergo mastectomy or other types of breast surgery often will be fitted for breast prostheses for therapeutic weight replacement as well as cosmetic purposes. Nurses are instrumental in educating women about issues related to breast surgery and in helping to promote psychosocial adjustment to the diagnosis and subsequent treatment. Nurses often are involved in the referral process for breast prostheses. Prostheses and bras that fit properly can be very important in the recovery process and ultimately improve quality of life for cancer survivors. Unlike in the past, many choices are available today for women who opt to use breast prostheses. Prostheses come in different colors, shapes, and weights, and some adhere to the chest wall. Many options also are available for bras, camisoles, and swimsuits, which are helpful adjuncts to the fit of the prosthesis. The purpose of this article is to describe the fitting process and options currently available for breast prostheses. Nurses can use this information to inform women of available breast prostheses options and help prepare them for a fitting.

Breast↗
PubMed2005

The two-year clinical performance of esthetic restorative materials in noncarious cervical lesions.

BACKGROUND: Materials used in restoration of cervical lesions include resin-modified glass ionomer cements, polyacid-modified resin-based composites and resin-based composites. In this study, the authors evaluated the clinical performance of these materials over a two-year period. METHODS: Thirty patients were enrolled in this study. The authors placed in these patients 130 restorations, 24 of which were Vitremer (3M Dental Products, St. Paul, Minn.), 38 were F2000 Compomer (3M Dental Products), 46 were Dyract AP (Dentsply DeTrey, Konstanz, Germany) and 22 were Valux Plus (3M Dental Products). Enamel margins were not beveled, and no mechanical retention was placed. Two independent, calibrated examiners evaluated the restorations baseline and at one and two years after placement using modified U.S. Public Health Service criteria. RESULTS: Retention rates at the end of two years were 100 percent for Vitremer, 67 percent for F2000 Compomer, 68 percent for Dyract AP and 70 percent for Valux Plus. The retention rate of Vitremer was significantly higher than that of the others (P < .05). In other categories, however, Valux Plus had the most favorable performance (P < .05). No secondary caries was detected around any restoration. CONCLUSION: Vitremer, with its high retention rate, seems to be the most appropriate material for restoration of noncarious cervical lesions, though it does not have the esthetic properties of resin-based composites. All materials used in this study were in need of improvements. CLINICAL IMPLICATIONS: Resin-modified glass ionomer cement, polyacid-modified resin-based composite and resin-based composite behaved differently in the restoration of noncarious cervical lesions. Therefore, clinicians should take factors such as esthetic needs and localization into account in selecting materials for such restorations.

Adult↗
PubMed1992

Echo Doppler principles, techniques and applications for the cardiac surgeon.

Doppler echocardiography is increasingly used not only to identify disease in native heart valves, but also to assess the function of prosthetic valves. The purpose of this paper is to provide a summary of the principles of Doppler echocardiography for the cardiac surgeon which will lead to a discussion of assessment of prosthetic valve function. Solid cardiac structure imaging is first discussed in both one-dimensional (M-mode) and two-dimensional (B-mode) modalities. Measurements of blood cell velocities by conventional spectral Doppler echocardiography are then discussed, leading to two-dimensional flow imaging by color Doppler flow mapping. Assessment of prosthetic valve function is divided into two sections: normal prosthetic valve function and prosthetic valve dysfunction. Subtopics within each of these divisions are discussed in the context of conventional and color Doppler ultrasonography.

Blood Flow Velocity↗
PubMedDate not supplied

Partial ceramic crowns: influence of preparation design and luting material on internal adaptation.

The influence of three different cavity preparations on the marginal integrity of partial ceramic crowns (PCC) luted with four different luting systems was investigated in this in vitro study. PCC preparations were performed in 144 extracted human molars using one of the following preparation designs (n=48/preparation): A--Coverage of functional cusps/butt joint preparation; B--horizontal reduction of functional cusps and C--complete reduction of functional cusps/butt joint preparation. Non-functional cusps were not covered; mesial and distal proximal boxes were extended 1 mm below the cemento-enamel-junction. PCC were fabricated from Vita Mark II ceramic (Vita) with a Cerec 3 Unit (Sirona) and adhesively luted to the cavities using the following luting systems: (VL) Variolink II/Excite (Vivadent), (PA) Panavia F/ED Primer (Kuraray), (DY) Dyract/Prime & Bond NT (DeTrey/Dentsply) and (FU) Fuji Plus/GC Cavity Conditioner (GC). Samples were simultaneously exposed to thermocycling and mechanical loading (TC: 5000x8-55 degrees C, 30 seconds/cycle; ML: 500000x72.5N, 1.6Hz). Marginal adaptation was assessed by evaluating dye penetration on multiple sections by relating the actual penetration distance to the maximal length of the corresponding cavity wall (100%). Ceramic- and tooth-luting material interfaces were evaluated separately. The data were statistically analyzed with the Mann Whitney U-test and Wilcoxon Rank Sumtest. In general, no significant differences could be found between preparations A, B and C. The combination of preparation C and luting material PA showed a tendency for the lowest dye penetration values, especially within dentin (30%). Significant differences could be determined between luting materials: Composite luting materials PA (0%) and VL (1%) revealed less dye penetration than the compomer DY (6%) and resin-modified glass ionomer cement (RMGIC) FU (26%); use of RMGIC caused fractures of the restorations. The dentin/luting material interface showed the highest penetration values, ranging from 17% to 100%. In conclusion, with adhesively bonded partial ceramic crowns, the choice of luting material proved to be more relevant than preparation design under the limitations of this study. Margins below the cemento-enamel junction reveal significant loss of adhesion in spite of subsequent application of adhesive luting techniques. RMGIC cannot be recommended as a luting material for feldspathic PCC.

Acrylic Resins↗
PubMedDate not supplied

[Rupture of voluminous atherosclerotic superficial femoral artery aneurysm].

Atherosclerotic aneurysms of the superficial femoral artery are very uncommon. We report a case of a ruptured superficial femoral artery aneurysm which was successfully treated surgically, and compare our data with those emerging from a review of the literature. We observed a 74-year-old man who presented with a suspected rupture of a superficial femoral artery aneurysm. After confirmation of the diagnosis with angio-CT, we treated the patient by performing an endoaneurysmectomy and replacing the arterial aneurysmatic segment with interposition of a polytetrafluoroethylene prosthetic graft. There has been no evidence of complications in the short to medium-term. In our review of literature, we collected 43 cases of superficial femoral artery aneurysms. These aneurysms were diagnosed after rupture (30-46%) or thrombosis and embolism (12-46%). Other aneurysms are frequently concomitant (27-69%). The best treatment is based on replacing the aneurysmatic segment with a prosthetic graft which may be autologous (saphenic vein) or heterologous (polytetra-fluoroethylene). In patients with obstructive arteriopathies exclusion of the aneurysm by ligation of the proximal and distal artery may be enough. The high incidence of complications suggests that resection and grafting should be performed electively, and the frequent association with aortoiliac or peripheral aneurysms means that thorough investigation and follow-up are mandatory.

Aged↗
PubMed2006

Five-year clinical evaluation of Dyract in small Class I cavities.

PURPOSE: To evaluate the 5-year clinical performance of Dyract in small Class I cavities in non stress-bearing areas. METHODS: On 36 patients, 87 restorations needing small cavity preparations were performed. The lesions were diagnosed macroscopically with a probe. They involved shallow fissures, and had reached dentin but the lateral spread was limited and localized in dentin. Cavities were designed to be on non stress bearing areas. Cavities' average facio-lingual width were prepared to be 1/3 or less than the intercuspal width. At baseline, 1-, 2-, 3-, 4- and 5-year recalls, the restorations were evaluated according to the modified Ryge criteria by two calibrated, experienced examiners. RESULTS: None of the restorations was lost and retention rate was 100% at the end of 1 year. After 2 years, one restoration (1.2%) had to be replaced due to caries lesion adjacent to its margin and the rate of retention was 98.8%. At the 3-year recall, four restorations, at the 4-year, one restoration and at the 5-year, one restoration had caries lesions adjacent to their margins and the cumulative retention rates were 94.2%, 92.9% and 91.5% respectively. Significant differences were detected between all of the evaluation periods in regard to color match rate (P = 0.00001), with the exception of rate between the baseline and 1 year evaluations. In regard to the marginal discoloration rates, there were statistically significant differences (P = 0.00001) between all of the evaluation periods with the exception of rates between the baseline and 1-year, 3- and 4-year, and 4- and 5-year results. Except for the failed restoration, no other restoration was clinically unacceptable in regard to color match, wear or loss of anatomic form, marginal discoloration, caries, marginal adaptation and surface texture.

Adolescent↗
PubMed2006

Repair of a dysplastic tricuspid valve using artificial chordae: case report.

Atrioventricular valve repair with artificial chordal replacement has been widely used for congenital and acquired mitral valve abnormalities, but not for tricuspid valve abnormalities. A case is presented of dysplastic tricuspid valve that was successfully repaired using artificial chordae. A 2-year-old female presented with poor weight gain. Echocardiography revealed severe tricuspid regurgitation due to dysplastic tricuspid valve, poor coaptation by prolapse of the anterior leaflet, and tethering of the septal leaflet by short chordae. The prolapsed anterior leaflet was repaired with three pairs of 6-0 expanded polytetrafluoroethylene sutures. The short chordae of the septal leaflet were detached, and the septal and posterior leaflets were sutured together. Trivial tricuspid regurgitation was noted postoperatively. There was no tricuspid regurgitation during the follow up period of three years. The present case provides further evidence that artificial chordal replacement is a useful technique even for small children with congenitally abnormal tricuspid valves.

Child, Preschool↗
PubMedDate not supplied

Restoration deterioration related to later failure.

The purpose of this study was to determine the relationship between the deterioration and the later failure of a very large number of amalgams and anterior resin composites examined over periods of up to 16 years. Assessments were made of the deterioration of various clinical factors or characteristics of the restorative materials that were thought to predict later failures. True failures, which were directly related to the restorative materials, accounted for 7.5% of the amalgam and 30.4% of the composite restorations. For the amalgams, there was a significant association found between the failures and surface tarnishing. Marginal fracture and marginal staining were not associated significantly with any of the three different failure modes. For the composites there were significant associations found between the failures and surface roughness, marginal fracture, and color mismatch. Surface staining and marginal staining were not associated significantly with any of the three different failure modes. Many restorations assessed as being unsatisfactory continued to function for a further 2.5 to 3.5 years on average before being replaced, often for unrelated reasons. There is a need to define unsatisfactory restorations more clearly in terms of actual adverse effects on dental health, rather than merely in terms of restoration deterioration.

Color↗
PubMed1996

[Acute myocardial infarction in bacterial endocarditis].

The authors report on a 47-years old woman with bacterial endocarditis involving both the mitral and aortic valves. At first echocardiographic examination, the mitral vegetation was small, while the aortic one was large highly mobile. Despite adequate antibiotic therapy, the aortic vegetation had become bigger and the valve regurgitation, initially mild to moderate, resulted severe and was associated with left heart failure. While awaiting surgery, the patient sustained an acute non Q wave myocardial infarction with ST segment elevation in inferior and anterolateral leads, complicated by ventricular arrhythmias. Thirty-six hours later, the patient received mitral and aortic valve replacement: at surgical view, the aortic vegetations was found to be very close to the right coronary orifice. After a period of further antibiotic therapy, the woman discharged and at a six months follow-up, she was fairly well. The authors review the mechanisms of acute coronary insufficiency in infective endocarditis and suggest an embolic pathogenesis in the case reported. Taking into account the possible life threatening embolic complications, it seems reasonable not to delay surgery when antibiotic therapy fails to reduce the size and mobility of valve vegetations.

Aortic Valve↗
PubMed1997

Thrombolysis for prosthetic valve thrombosis: indications and results.

BACKGROUND AND AIMS OF THE STUDY: Prosthetic valve obstruction is caused by thrombi or fibrous tissue overgrowth, or both; thrombolysis avoids reoperation-related risks, but is effective only on clots. Hence, the study aims were to: (i) further assess our indication criteria for thrombolysis in prosthetic valve thrombosis; and (ii) evaluate treatment and follow up in a large patient population. METHODS: Between January 1991 and January 1994, 20 cases of prosthetic thrombosis were treated with thrombolysis using recombinant tissue type plasminogen activator (rt-PA). Indication criteria for thrombolysis were: (i) recent onset of symptoms; (ii) transesophageal echocardiographic (TEE) evidence of clots on the valve or cardiac chambers; and (iii) a partially preserved disc excursion. All patients were fitted with mechanical valves (four caged balls, 10 tilting discs, six bileaflets), with 17 valves located in the mitral and three in the aortic position. Symptoms of obstruction comprised cardiac failure in 11 cases and/or embolism in 10. RESULTS: After rt-PA infusion, normal prosthetic function was restored in all patients, though one underwent successful reoperation five days later. During infusion, five patients had a transient ischemic attack and one a minor transient peripheral embolism. Recurrence of thrombosis occurred in three patients during follow up; subsequent thrombolysis was successful in two, without complication. CONCLUSIONS: As treatment proved satisfactory, the reliability of our indicational criteria was confirmed. Only transient complications arose during treatment with recurrent thrombosis most common in those patients who had more thrombogenic valve prostheses.

Adult↗
PubMed2006

Retrospective comparison of a heparin bonded ePTFE graft and saphenous vein for infragenicular bypass: implications for standard treatment protocol.

AIM: The aim of our study is to assess the clinical effectiveness and therefore the medium-term patency of an ePTFE prosthesis treated with Carmeda BioActive Surface (CBAS) heparin technology. METHODS: From January 2003 to June 2005, 74 infragenicular femoral-popliteal grafts were carried out at our institution. All the patients were subjected to Doppler and color Doppler sonography peripheral angiography diagnostic procedures. Surgical procedures were performed on patients with complete occlusion of the femoral-popliteal axis and subgenicular rehabilitation of at least one vessel with acceptable flow, in advanced stage IIB (claudication, < 30 m walking distance), stage III (resting pain) and stage IV (trophic disorders) of Leriche-Fontaine classification. Follow-up was carried out through surgical and Doppler sonography examinations after 1 month, 3 months and then every 6 months throughout the course of the study. RESULTS: Thirty-seven infragenicular bypass procedures using 6 mm ePTFE Propaten grafts and 37 procedures using devalvulated autologous saphenous veins were carried out. CONCLUSIONS: Based on the results obtained, we clearly cannot draw conclusions that are significant from a strictly statistical point of view, both because the study is retrospective and because, by making the population being analysed as homogenous as possible, a number of observations are excluded. However, we tried to draw conclusions that are acceptable from a clinical point of view. Above all, it is certain that should the autologous saphenous vein not be available, Propaten represents a very valid alternative prosthesis, as shown by the event free curve related graft thrombosis analysis of all the patients.

Aged↗
PubMedDate not supplied

Color-flow duplex hemodynamic assessment of runoff in ischemic lower limb revascularization.

The objective of this study was to evaluate the existence of hemodynamic arterial flow correlation between preoperative duplex scanning (DS) and intraoperative direct outflow resistance (IDOR) measurements in ischemic lower limb revascularization. Sixty-eight ischemic lower limbs were submitted to preoperative DS. Anatomic and hemodynamic arterial characteristics of the outflow system were recorded, and the results were considered in the distal anastomosis placement site decision making. IDOR measurements were obtained at the same arterial segment, and Pearson's correlation coefficient test was performed to study the preoperative DS power in predicting the intraoperative outflow resistance. DS was technically satisfactory and helped define the distal anastomosis site in 93.2% of the cases (supragenicular popliteal artery, 19 [27.9%]; infragenicular popliteal artery, 10 [14.7%]; crural artery, 31 [57.4%]). A positive correlation could be found between preoperative DS and IDOR (0.450; p < .001). This correlation was particularly powerful in the crural artery (0.715; p < .001) when compared with the popliteal arterial segment (0.237; p = .192). Preoperative DS may help define the best distal arterial and outflow segment to be revascularized based on anatomic and hemodynamic parameters. There is a positive flow correlation between preoperative DS and IDOR that seems to be stronger in crural revascularization surgery.

Adult↗