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PubMed1992

Evaluation of a polyepoxy compound fixed biological vascular prosthesis and an expanded polytetrafluoroethylene vascular graft.

Antithrombogenicity is one essential requirement for the successful use of small caliber vascular prostheses. In this study, a polyepoxy compound fixed, heparinized 4 mm diameter Baxter Denaflex vascular graft was evaluated against a 4 mm diameter Gore-Tex expanded polytetrafluoroethylene (ePTFE) vascular graft in the canine model. In addition to the thromboresistant characteristic conferred by heparinization, the crosslinking agent allowed the Denaflex graft to retain the original color of the native artery. Six centimeter long graft segments were implanted into the carotid arteries bilaterally in 5 dogs. The patency rate at 3 months for the Denaflex graft was 100% (five out of five) whereas in the control ePTFE graft, it was 40% (two out of five). The explanted Denaflex grafts exhibited softness and flexibility, and their luminal surfaces maintained a white color like that before implantation. To the contrary, the patent ePTFE grafts felt hard, and red thrombi covered large portions on their inner surfaces. Under microscopic observation, neointima formation was limited to regions near the anastomotic sites for both types of grafts. This experiment showed that the Denaflex vascular graft has an excellent antithrombogenic property and has a compliance similar to native arteries.

Animals↗
PubMed1992

Impression making, sculpting, and coloring of orbital prostheses.

The replacement of any anatomic structure by artificial means remains a challenge. This is particularly true in the facial area. The replacement must be one which blends with the adjacent tissues as well as replaces the missing structures. Careful planning and meticulous attention to detail in fabrication of a prosthesis can enable the maxillofacial prosthodontist to make a major contribution in the rehabilitation of the patient with an orbital defect.

Eye, Artificial↗
PubMed1990

Evisceration implant of Proplast II. A preliminary report.

An evisceration implant made from a highly porous inert, Teflon fluorocarbon, Proplast II, and the surgical technique of implantation is described. The implant was used in four eyes without complications. The implant and technique have many advantages: the ability to absorb antibiotics: the ability to prevent extrusion and infection; the fact that it is lightweight, black in color, and capable of preserving the cornea.

Aluminum Oxide↗
PubMedDate not supplied

Primary stent placement for recanalization of iliac artery occlusions: using a self-expanding spiral stent.

PURPOSE: To report the clinical results for recanalizations of an occluded iliac artery by a self-expanding spiral stent. METHODS: We attempted to recanalize 36 iliac artery occlusions in 34 patients [33 men, 1 woman, aged 51-75 years (average 61.6 years)]. The average lesion length was 6.92 cm (range 1-14 cm). The patients' chief complaints were intermittent claudication and resting pain. Fontaine classification was assigned before and after the procedure. Technical and clinical success were also analyzed. RESULTS: Forty-five stents were successfully deployed in 34 patients. All 36 lesions (13 in the external iliac artery, 12 in the common iliac artery, and 11 in both) were patently recanalized on angiography. The follow-up period ranged from 6 months to 36 months (mean 11.9 months). Fourteen stents (39%) with incomplete expansion were dilated with a balloon catheter. Good technical (100%) and clinical (94%) results were obtained. The only complication was one hematoma at the puncture site. Reocclusions were noted in two lesions (5%) at 1 week and 15 months, respectively. CONCLUSION: A self-expanding spiral stent is a safe and effective device for recanalization of an iliac artery occlusion as the primary stent without any previous intervention.

Aged↗
PubMed1998

Conservative operation for infective endocarditis of the mitral valve.

BACKGROUND: Subvalvular preservation is necessary to maintain left ventricular function, but accidental retention of infected tissue could cause postoperative endocarditis. METHODS: We examined 71 consecutive patients who underwent operation for mitral endocarditis. Endocarditis was uncontrolled and active in 24 patients, partially treated (unfinished antibiotic course) in 17, and healed in 30. RESULTS: Valves were repaired in 17% versus 59% versus 63% and replaced with subvalvular preservation in 25% versus 6% versus 3% of the uncontrolled active, partially treated, and healed groups, respectively. Thirty-day mortality was 29% versus 0% versus 3.3% (p=0.003), total mortality was 46% versus 18% versus 17% (p=0.035), and complications-related mortality was 38% versus 11% versus 13% (p=0.054), respectively. There was a trend toward lower complications-related mortality with subvalvular preservation than without. Postoperative endocarditis occurred in 3 of 30 patients without and 1 of 41 patients with subvalvular preservation. CONCLUSIONS: Postoperative mortality in uncontrolled active mitral endocarditis remains high, but results are good with partially treated or healed endocarditis. Subvalvular preservation improves outcome, does not increase postoperative endocarditis rates, and should be performed whenever feasible.

Anti-Bacterial Agents↗
PubMed2003

Hemodynamics of infrapopliteal PTFE bypasses and adjunctive arteriovenous fistulas.

PURPOSE: Blood flow, pressure and peripheral resistance in patients with established polytetrafluoroethylene (PTFE) grafts and adjunctive arteriovenous fistulas (AVF) have rarely been investigated. To better elucidate the effects of this AVF, we obtained noninvasive measurements of hemodynamic variables in patients with infrapopliteal PTFE grafts and an AVF. METHODS: . Systolic, mean and diastolic arm and toe pressures were measured with an oscillometric technique employed in automatic blood pressure monitors. Peak-systolic velocity, end-diastolic velocity and flow rates at the graft and recipient distal artery were measured with duplex ultrasound. Resistance for the leg and foot in peripheral resistance units ( PRU ) was estimated as mean arm pressure divided by graft flow rate and as mean toe pressure divided by distal artery flow rate respectively. We analyzed data from 21 patients. Toe pressures were measurable in 13 patients. Bypass graft inflow was at the external iliac artery in 11 patients, common femoral in six, common iliac in two and superficial femoral in two. The distal anastomosis was at the anterior tibial artery in 10 patients, peroneal in seven and posterior tibial in four patients. RESULTS: . Graft systolic and diastolic velocities were 91+/-46 (mean+/-sd) and 38+/-31 (mean+/-sd) cm/s respectively. Toe systolic pressure averaged 81+/-28 (mean+/-SD) mmHg with a corresponding toe/brachial index (TBI) of 0.53+/-0.18 (mean+/-SD). The ratio between arm mean pressure, 104+/-20 (mean+/-SD) mmHg, and graft flow rate, 413+/-290 (mean+/-sd) ml/min, yielded an estimated leg resistance of 0.32+/-0.20 peripheral resistance units (PRU) (mean+/-sd). The ratio between mean toe pressure, 51+/-21 (mean+/-SD) mmHg, and distal artery flow rate, 37+/-26 (mean+/-SD) ml/min, produced an estimated foot resistance averaging 1.66+/-1.18 PRU (mean+/-sd). CONCLUSIONS: Average graft flow rate was five times greater than flow reported for standard tibial bypasses. Although distal artery flow rate and graft peak systolic velocity were within reported normal ranges, mean toe pressure and toe-brachial index were below normal. Leg and foot resistances were decreased. These data suggest that bypasses with arteriovenous fistulas have increased flow, desirable for graft patency, but may affect distal perfusion pressure.

Aged↗
PubMed1988

Composite laminate veneers: a clinical study.

A 2-year clinical trial of a composite laminate veneer system for masking discoloration or hypoplasia on the anterior teeth of patients has been undertaken. Three hundred and twenty restorations were placed in seventy-nine patients, of these 273 restorations in sixty-eight patients have been followed over a 2-year period. The technique produced an acceptable improvement in the aesthetics of the patients in the trial. However, the veneers were susceptible to chipping (52% of lateral incisor veneers and 79% of central incisor and canine veneers showed some evidence of material loss after 2 years) and marginal staining (75% of veneers showed some evidence of marginal staining after 2 years) during function. The veneer restorations had a deleterious affect upon the gingival health of the teeth on which they were placed.

Adolescent↗
PubMed2006

Visual outcomes with the yellow intraocular lens.

PURPOSE: To compare postoperative best distance visual acuity (VA), contrast sensitivity and colour perception with the blue light-filtering AcrySof Natural (SN60AT) and AcrySof single-piece (SA60AT) intraocular lenses (IOLs). METHODS: This was a prospective, randomized, comparative, interventional study comparing postoperative performance between the SN60 and SA60 IOLs. There were nine patients (nine eyes) in the SN60 group and 10 patients (10 eyes) in the SA60 group. All patients were operated using phacoemulsification. Postoperative VA (Snellen chart), contrast sensitivity (Pelli-Robson contrast sensitivity chart) and colour perception (Farnsworth-Munsell D-15 panel test) were measured at 1, 3 and 6 months postoperatively. RESULTS: Postoperative best corrected VA after 6 months was 20/20 or better in 89% of SN60 eyes and 100% of SA60 eyes. Postoperative contrast sensitivity scores improved significantly in both groups under both photopic and mesopic conditions. There were no statistically significant differences in contrast sensitivity scores between the SN60 and SA60 groups at any of the postoperative evaluation time-points. Postoperative colour perception improved significantly in both the SN60 and SA60 groups, and there were no statistically significant differences in colour perception performance between the two groups. CONCLUSION: The blue light-filtering AcrySof Natural (SN60) IOL has postoperative visual performance comparable with that of the AcrySof single-piece (SA60) IOL.

Acrylic Resins↗
PubMed1998

High levels of expression of collagenase-3 (MMP-13) in pathological conditions associated with a foreign-body reaction.

A foreign-body-type host response can contribute to the induction and release of collagenolytic tissue-destructive enzymes of pathogenetic significance. Our aim was to analyse collagenase-3 in two conditions with putative involvement of foreign-body reactions. Synovial membrane-like tissue samples were obtained from cases of aseptic loosening of a total hip replacement (THR) and osteoarthritis (OA). The reverse transcription polymerase chain reaction (RT-PCR) disclosed that all the samples from patients contained collagenase-3 mRNA compared with only three out of ten control samples. The identity of the RT-PCR amplification product was confirmed by nucleotide sequencing. Immunohistochemical staining showed that collagenase-3 was present in endothelial cells, macrophages and fibroblasts, including those found in the synovial lining. This finding was confirmed by avidin-biotin-peroxidase complex-alkaline phosphatase-anti-alkaline phosphatase double staining and the specificity of the staining by antigen preabsorption using recombinant human collagenase-3. Collagenase-3 was released into the extracellular space and thus found in the synovial fluid in all patient samples as shown by Western blotting. The similar extent of collagenase-3 expression in aseptic loosening and OA compared with the low expression in control synovial membrane suggests involvement of a similar, foreign-body-based pathogenetic component in both. Comparative analysis of collagenase-3 and of foreign particles indicates that paracrine factors rather than phagocytosis per se are responsible for the induction of collagenase-3. We suggest that due to its localisation and substrate specificity, collagenase-3 may play a significant pathogenetic role in accelerating tissue destruction in OA and in aseptic loosening of a THR.

Adult↗
PubMed1999

Topographic anatomy of the cochlear nuclear region at the floor of the fourth ventricle in humans.

OBJECT: The development of appropriate methods to stimulate the dorsal and ventral cochlear nucleus by means of an auditory brainstem implant in patients with acquired bilateral anacusis requires a detailed topoanatomical knowledge both of the location and extension of the nuclear surface in the fourth ventricle and lateral recess and of its variability. The goal of this study was to provide that information. Anatomically, it is possible to use a midline surgical approach to the fourth ventricle rather than the translabyrinthine and suboccipital routes of access used hitherto. This is especially useful if severe scarring, which occurs as a result of tumor removal in the cerebellopontine angle, make the orientation and placement of an auditory brainstem implant via a lateral surgical approach difficult. There have been only a few studies, involving single cases and small series of patients, in which the focus was the exact extension of the cochlear nuclei, whose microsurgically relevant position in relation to the surface structures is not known in detail. METHODS: Landmarks that are important for the placement of an auditory brainstem implant through the fourth ventricle were examined and measured in a large series of 28 formalin-fixed human brainstems. In all cases, these examinations were supplemented by addition of a histological section series. For the first time values of unfixed fresh brainstem tissue were determined. Anatomical features are discussed with regard to their possible neurosurgical relevance, taking into account inter- and intraindividual variability. CONCLUSIONS: The midline approach would provide an opportunity to stimulate the whole area of the dorsal as well as the ventral cochlear nucleus with an auditory brainstem implant.

Adult↗
PubMedDate not supplied

[The sheep: an animal model for ligament prostheses?].

Ruptures of the anterior cruciform ligament is difficult to repair. Ligament prostheses are sometimes useful. We tested a ligament prosthesis which had the original property of combining a polyester braid with a matrix favouring collagen ingrowth. We implanted this prosthesis in the knee joint of 10 sheep after sectioning the anterior cruciform ligament at it origin. The ligaments were recovered after 6 months. We studied the functional and radiographic results. Tolerance was studied in samples of the articular fluid and synovial tissue. We evaluated bone attachment and fibrous growth using micro-radiography and specific coloration techniques. Samples were examined under electron microscope. No rupture was encountered. We observed a satisfactory functional and radiographic result. No intolerance was observed. The neoligament had a bony or mixed attachment in 60% of the cases and was comprised of oriented tissue in 90% of the cases. Vascular invasion was important. These findings are promising and suggest that long-term studies should be undertaken.

Animals↗
PubMedDate not supplied

Successful endovascular treatment of a left common carotid artery aneurysm following failed surgery of a right common carotid artery aneurysm.

Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions.

Adult↗
PubMed1978

Physical and mechanical behavior of polyurethane elastomer formulations used for facial prostheses.

The initial results of this study of the physical and mechanical behavior of polyurethanes used for facial prostheses are presented. The parameters studied were surface hardness, modulus of elasticity (M), strength (S), percentage of elongation, and S/M ratio. Results showed that the physical and mechanical behavior of the polyurethanes can be altered by variations in the basic composition of the material accomplished through changes in the ratio of Part A to Part B and by the addition of catalysts. Properties of compositions with low quantities of Part B (isocyanate) and no catalyst reached or approximated those parameters proposed as ideal goals to simulate living tissue. When preparing polyurethane material, proper mixing is essential to avoid entrapment of air and phase separation of the catalyst. These conditions, which may render the prostheses less durable, are masked by the addition of colorants in the prearation of a sample for clinical application.

Chemical Phenomena↗
PubMed2003

Usefulness of peak-to-peak pulsatility index in infrainguinal bypass graft surveillance.

PURPOSE: We conducted this study to find out whether the peak-to-peak pulsatility index (PPI) predicted graft failure and which factors affected the PPI. METHODS: Color-duplex sonography was used to take 520 scans of 74 infrainguinal bypasses, 62 of which were femoropopliteal bypasses and 12 of which were femorocrural bypasses. Vessel diameter and velocity waveform were measured in the graft as well as in the proximal and distal arteries. RESULTS: There were 13 cases of graft failure. The PPI in the mid-graft was significantly different in the normal group (12.30 +/- 8.77) and the graft failure group (4.17 +/- 1.79). A PPI of less than 7.0 in the mid-graft was defined as graft failure, with a sensitivity of 96.0% and a specificity of 77.6%. There was no correlation between the graft diameter and the PPI. The average mode frequency was inversely correlated with the PPI (PPI = 44.8 x Mode F(-1) + 3.50, correlation co-efficient: 0.78). CONCLUSION: One point measurement of the PPI in the mid-graft could be a simple and useful parameter for diagnosing graft failure, based on our finding that the waveform was very similar in the proximal artery, the entire graft, and the distal artery. PPI was inversely correlated with average mode frequency because reverse flow decreased or diminished when a significant stenosis existed.

Blood Vessel Prosthesis↗
PubMed2004

Implantation of a second closure device in patients with residual shunt after percutaneous closure of patent foramen ovale.

Percutaneous closure of patent foramen ovale (PFO) in patients with presumed paradoxical embolism yields complete occlusion in > 90% of patients using contemporary closure devices. Patients with a residual shunt after percutaneous PFO closure have been found at increased risk for recurrent paradoxical events. Treatment options for such patients include medical treatment using antiplatelet drugs or oral anticoagulation, surgical device removal and patch closure, and percutaneous implantation of a second closure device. We report our experience with implantation of a second closure device in 10 patients with more than a minimal residual shunt < or = 6 months after percutaneous PFO closure. Procedure and fluoroscopy times were similar for the initial and repeat intervention (32 vs. 30 min and 5 vs. 6 min, respectively; P = NS). There were no procedural complications during implantation of the second closure device. Follow-up transesophageal echocardiography 6 months after the second percutaneous intervention revealed complete PFO closure in nine (90%) patients. Therefore, implantation of a second closure device in patients with persistence of more than a residual shunt after percutaneous PFO closure appears safe and effective.

Adult↗
PubMed2006

Repair of a blunt traumatic inferior vena cava laceration with commercially available endografts.

Endografts have recently been used in the trauma setting for arterial injuries in surgically inaccessible areas or in medically unstable patients. There have been considerably fewer reports on the use of endografts for treatment of traumatic venous injuries. We present the case of an endograft repair of a blunt, traumatic inferior vena cava injury in a patient deemed at high risk for surgical repair.

Blood Vessel Prosthesis↗