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At least 127 records · Page 7Linked to original sources
PubMed2003

[Prosthetic pyelovesical and pyelocutanous bypass. A palliative therapy concept in tumor-induced chronic hydronephprosis].

MATERIALS AND METHODS: Since 2/02 to 2/03 a total of 13 patients underwent either pyelovesical bypass (10 patients) or pyelocutaneous bypass (3 patients). A composite implant, consisting of two coaxial tubes internal pure smooth silicone covered by coiled e-PTFE has been designed to serve as the ureteral replacement. This prothesis in inserted percutaneously into the renal pelvis, tunnelled subcutaneously, and introduced through a small suprapubic incision in the bladder or out directly through a cutaneous orifice. RESULTS: One encrustation of the subcutaneous pyelocutaneous bypass was observed, no angulation or dislocation during a mean follow up of 6.2 month. Improvement in the quality of life was stressed in all patients. CONCLUSIONS: The subcutaneous urinary division using a silicone-PTFE prothesis is an efficient and minimal-invasive technique to attend malignant obstructions of the ureter.

Aged↗
PubMed2006

[Rectal perforation as a late complication of ProACT implantation].

Operative approaches to solve severe urinary incontinence following radical prostatectomy include artificial urinary sphincters, bulking agents, urethral sling procedures, and the ProACT device (Uromedica Inc.). Previously reported complications of the ProACT procedure comprise ruptures and dislocations of balloons as well as erosions and perforations of the bladder or urethra. We report the case of a rectal perforation as a late complication of the ProACT procedure after prostatectomy and adjuvant radiotherapy. To the best of our knowledge this complication has not been described before.

Aged↗
PubMed2005

[Procedures for treatment of joint mechanics impairment in the rotating Endo-model knee prosthesis].

In cases of mechanical damage of the Endo model rotating knee prosthesis, it is not necessary to change the complete prosthesis. Isolated replacement of the mechanics is possible. We changed a sled prosthesis of a 66-year-old patient to a rotating knee prosthesis because of ligament instability. After the patient fell and traumatized the operated knee, she experienced pain during weight bearing and instability. Because clinical and fluoroscopic examinations verified instability of the prosthesis, we decided to change the mechanics of the rotating knee prosthesis. In conclusion, mechanical damage of a rotating knee prosthesis is a rare complication. Operative treatment is easy to manage if replacement parts and instruments to change the mechanics have been organized preoperatively.

Aged↗
PubMed2005

[Lumbar disc arthroplasty. Established technique or experimental procedure?].

Lumbar interbody fusion used to be the most common surgical treatment for painful lumbar disc degeneration. With the technical development of total disc prostheses, replacement of the degenerated disc by a motion preserving implant has become a widely discussed alternative. The advantages of such replacement appear to include the prevention of adjacent segment disease as well as less perioperative morbidity. Three types of total disc prostheses are currently in common use. Although numerous studies have been made, a review of the literature reveals only two multicenter randomized studies comparing the outcome of disc prostheses with a control group of fusion patients. After 2 years, the available results show similar improvement after both types of surgery without significant differences. However, there is a trend towards faster recovery and improvement in disc arthroplasty patients. The long-term results of current and future randomized studies, including studies comparing results after disc arthroplasty, with results of standardized conservative therapies will determine the fate of lumbar disc prostheses.

Adolescent↗
PubMed2006

[Cervical disc prostheses].

Endoprosthetic replacement for spinal cord disorders represents an attractive alternative to fusion in those cases where surgery appears necessary for degenerative disc disease. At least in theory it has been proven that placement of an endoprosthesis minimizes undue stress on the adjoining segments and its possible negative consequences. Furthermore, cervical endoprostheses facilitate speedier rehabilitation and the problems involved in removal of the bone chip become irrelevant. Clinical results reported to date for the cervical spine are very encouraging and indicate that endoprosthetic replacement has been quite successful particularly for difficulties in multilevel approaches. However, long-term results for cervical endoprostheses have not yet been published and therefore at present there are no reference values for the viability of the prosthesis with regard to the aseptic loosening rate. There are also no findings available on how the implanted cervical prosthesis will behave when bone quality diminishes at an advanced age.

Biomechanical Phenomena↗
PubMed2001

[Intermediate term outcome of of a hip prosthesis revision system].

The Zweymüller shaft for uncemented total hip arthroplasty was developed in the early 1970s. Encouraged by the clinical results with this stem, which was mainly used in primary arthroplasty, longer fitting stems were added to the line to accommodate bony defects and to allow for an optimal load transfer from proximal to distal. The principal of the design is to allow an optimal distal fixation while allowing the bone to remodel in the proximal part. This study reports on 89 patients who underwent revision surgery of the hip for mostly aseptic loosening. The results after a median follow-up of 36 months show an increase of the modified Harris hip score from 52 points pre- to 82 points postoperatively. Radiographic subsidence was found in nine cases, with eight having progressed for more then 3 mm. Postoperative complications occurred in 11.2%, with seven dislocations. Open revision became necessary in two cases. The stem reviewed here seems to achieve predictable results in cases where a proximal cone is still present to facilitate load transfer, while at the same time the quadrangular stem provides solid distal fixation and ensures rotary stability.

Aged↗
PubMed2004

Prolene tape in the bladder wall after TVT procedure--intramural tape placement or secondary tape migration?

A 55-year-old woman with stress urinary incontinence underwent a tension-free vaginal tape (TVT) procedure. Two months after the procedure she complained of suprapubic pain occurring at the end of micturition. Not until 8 months after surgery was the pain found to be due to intramural position of the prolene tape. The operative method used to remove the tape, thus eliminating this late complication of an otherwise successful procedure, is also described.

Aged↗
PubMed2005

Risk factors for mesh erosion after transvaginal surgery using polypropylene (Atrium) or composite polypropylene/polyglactin 910 (Vypro II) mesh.

The objective of this study was to identify the risk factors associated with the occurrence of mesh erosion (ME) during the first 6 post-operative months in patients having undergone transvaginal repair of pelvic organ prolapse (POP) with Atrium or Vypro II mesh. We retrospectively reviewed the records of 198 consecutive patients who underwent vaginal reconstructive surgery reinforced either by Atrium or Vypro II mesh between February 1999 and July 2003. Univariable and multivariable logistic regression was performed to assess associations between measured covariates and ME. Fourteen patients [7.1%, 95% confidence interval (CI): 3.9-11.6] developed vaginal ME. We found that, in the Vypro II mesh patients, the surgeon experienced in the technique had less erosions than less experienced surgeons (2.9 vs 15.6%, p=0.02). There was no statistically significant difference between the monofilament polypropylene (Atrium) and the composite polypropylene/polyglactin 910 (Vypro II) mesh (7.2 vs 6.9%, p=0.41) when adjusted for surgeon experience and patient age. There was no association between mesh type (Atrium or Vypro II) and vaginal ME following transvaginal repair of POP. Surgeon experience and patient age were associated with ME.

Female↗
PubMed2003

Proximal femoral reconstruction with custom mega prosthesis.

Seventy-seven patients with proximal femoral tumours underwent limb salvage surgery with custom mega prostheses between July 1989 and January 2002. We describe 44 cases with a mean follow-up of 57.8 months. Forty-one patients presented with malignant neoplasms of which 11 were malignant giant cell tumours, eight were chondrosarcoma and five were metastases. Wide margins were achieved for all malignant tumours, and marginal resection was done for all benign and metastatic lesions. Six patients died of disease and two were lost to follow-up. Mechanical complications were observed in six cases, fracture being the most common. Oncological complications occurred in five patients. Functional activity was satisfactory in 79% of patients.

Adolescent↗
PubMed2003

Custom megaprosthetic replacement for proximal tibial tumours.

We analysed 133 patients treated with resection and endoprosthetic proximal tibial replacement from 1988 to 2000. Mean age was 22.3 years and osteosarcoma was the most common tumour. Average follow-up was 59.4 months. An excellent functional result was achieved in 63 patients and a good result in 36. The number of patients who had no evidence of disease was 102. Twenty-four patients died due to disease. Infection was the most common complication, followed by periprosthetic fracture and aseptic loosening. The 5-year limb survival rate was 85.5%.

Adolescent↗
PubMed2001

Cementless cup fixation in total hip arthroplasty after 5-8 years.

A series of 199 total hip arthroplasties was performed using a porous-coated, hemispherical press-fit acetabular cup. At a mean follow-up of 91.5 months 158 cups were available for clinical and radiological review. The mean age of the patients at the time of the index arthroplasty was 62.5 years. The mean Harris Hip score at final follow-up was 87.3. No shells were revised although eccentric polyethylene wear prompted liner replacement in two cases. Osteolysis was noted in six cases but predominantly in relation to the femoral stem. Focal pelvic osteolytic lesions were rare. All the cups were classified as stable on radiography.

Adult↗
PubMedDate not supplied

Another use of the alar cartilaginous flap.

BACKGROUND: Resection of the cephalic or middle portion of lateral crura of alar cartilages is a method for correcting bulbous nose in which the resected cartilages usually are discarded, resulting in a waste of autologous tissues. A silastic implant usually is used to correct saddle nose in Asian countries, but implant extrusion, a severe complication, sometimes occurs. Cartilage flaps were first reported by José to increase the projection of the nasal tip. In this study, the authors used cartilaginous flaps of the lateral crura to wrap the tip of the nasal implant for patients with bulbous and saddle noses. This study aimed to investigate the application of cartilaginous flaps of lateral crura. METHODS: A flap was created from the cephalic portion of the lateral crus of the alar cartilage, leaving the caudal portion intact. The cartilage flap remained attached at the level of the original domal segment of the middle crura. It was rotated over to wrap the tip of the silastic implant, then sutured to the other side flap. RESULTS: From March 2003, 19 patients were treated with this technique. The results were satisfactory without implant extrusion or any other complications except for nonobvious scars. CONCLUSION: The cartilage flap can reduce the incidence of implant extrusion and help to reduce the size of the bulbous tip.

Adult↗
PubMed2001

Angelchik prosthesis revisited.

There are few long-term follow-up reports of the Angelchik prosthesis (AP). We report the longest follow-up series (66-192 months, average 145 months) to date. Between October 1983 and January 1994, 65 patients (45 men and 20 women) aged between 29 and 84 years (mean 52 years) had an AP inserted for gastro-oesophageal reflux (GOR) with or without hiatus hernia (HH). Clinical, radiological, endoscopy, and operative details were reviewed. Postoperative complications, investigations, and follow-up details were critically analyzed. All living patients (n = 53) with an AP in situ were interviewed and symptomatic assessment was carried out using a modified Visick system (I-IV). The average duration of the GOR symptoms before the operation was 5.7 years (range 10 months to 20 years). The average hospital stay was 8 days (range 5-15 days). Postoperatively, five patients developed chest infection/atelectasis, four had superficial wound infection, two had deep vein thrombosis (one with pulmonary embolism), one had urinary retention, and four developed an incisional hernia. Six patients (three with an AP in situ) died of other medical conditions. Ten (15%) patients had removal of the prosthesis. Eight (12%) and 11 (17%) had transient and persistent dysphagia, respectively. Thirteen (20%) and five (8%) patients had distal slippage and proximal migration of the prosthesis, respectively. One patient had erosion of the AP into the stomach, while in another patient, the straps of the prosthesis ruptured. Of the 53 living patients with an AP in situ, 28 (53%) were Visick I, 11 (20%) were Visick II, 11 (20%) were Visick III, and 3 (7%) were Visick IV. We conclude that the AP has poor long-term results, with only 66% attaining Visick I and II, and a prosthesis removal rate of 15% (10/65). Patients with preoperative dysphagia, hypothyroidism, and diabetes tend to do worse with an AP. Obese patients and those with failed previous fundoplication seemed to fare well with an AP. In view of poor long-term results and high incidence of complications as compared to other conventional operations for GOR, we cannot recommend the continued use of the AP.

Adult↗
PubMedDate not supplied

Palliation of pyloric stenosis caused by gastric cancer using an endoscopically placed covered ultraflex stent: covered stent inside an occluded uncovered stent.

A 71-year-old man developed pyloric stenosis caused by gastric cancer. Vomiting and nausea resolved after the insertion of an uncovered Ultraflex stent (length 10 cm, inner diameter 18-23 mm) through a 7-cm-long stenosis, and the patient was able to eat a soft diet. After 6 weeks, stent occlusion occurred due to tumor ingrowth and accumulation of food residue. Endoscopic observation showed a very narrow residual lumen. A covered Ultraflex stent (length 10 cm, inner diameter 18-23 mm) was inserted through the first stent and expanded to its maximum diameter over the next 2 days. The patient's vomiting and nausea improved rapidly. He died 6 months after the second stenting procedure, from metastatic tumor spread, having remained free of nausea and vomiting. In this case, a covered metallic stent prevented tumor ingrowth and maintained gastrointestinal patency.

Aged↗
PubMedDate not supplied

Pneumoperitoneum caused by transhepatic air leak after metallic biliary stent placement.

A self-expanding metallic biliary stent was placed for palliation of a common bile duct obstruction in a 68-year-old male with unresectable pancreatic head cancer 3 days after initial percutaneous right transhepatic catheter decompression. The stent crossed the ampulla of Vater. Three days later, the stent was balloon-dilated and the percutaneous access was removed. At removal, a small contrast leak from the transhepatic tract was seen. Three days later, pneumoperitoneum was found with symptoms of peritoneal irritation and fever. A widely open sphincter of Oddi caused by the metallic stent, accompanied by delayed sealing of the transhepatic tract, may have caused the air and bile leakage into the peritoneal space. This case shows that pneumoperitoneum may occur without ductal tear or bowel injury, with a biliary stent crossing the ampulla of Vater.

Adenocarcinoma↗
PubMedDate not supplied

Treatment of post-stent gastroesophageal reflux by anti-reflux Z-stent.

Severe symptoms of heartburn and retrosternal pain consistent with gastro-esophageal reflux (GER) developed in a patient following placement of a conventional self-expanding 16-24-mm-diameter x 12-cm-long esophageal stent across the gastroesophageal junction to treat an obstructing esophageal carcinoma. A second 18-mm-diameter x 10-cm-long esophageal stent with anti-reflux valve was deployed coaxially and reduced symptomatic GER immediately. Improvement was sustained at 4-month follow-up. An anti-reflux stent can be successfully used to treat significant symptomatic GER after conventional stenting.

Aged↗
PubMed2003

[Experience with orbital implants in particular with porous hydroxyapatite materials].

PURPOSE: Various materials have been developed since the first implantation of a hydroxyapatite sphere in 1985. They are similar to the porous basic structure and imitate the biological behavior of coralline implants. This article presents own clinical experience with hydroxyapatite implants from 1993 to 2003 and compares own results and other porous orbital implants in the international scientific literature. RESULTS: The original hydroxyapatite implant is well tolerated and implant extrusion is rare. A retrospective analysis of 357 patients regarding this complication shows an extrusion rate of 2.6% over 10 years. The subjective positive tolerance of 71.2% corresponds to the results of international studies. After several stages of development the synthetic product (FCI3) is now comparable with the original product with regard to operative complications and subjective compatibility. Both orbital implants should be used with a protective covering to avoid premature extrusion and to facilitate suturing the extraocular muscles anterior. When using material from humane donors the material must be guaranteed to be completely sterile. The use of vicryl as an orbital plomb wrapping leads to contradictory reports in the literature. Hydroxyapatite ceramics in combination with silicone india rubber represent an alternative to the materials listed above and in this case a wrapping of the orbital plomb is unnecessary. Spherical orbital implants made of aluminum oxide (bioceramic implant) are an alternative to corraline hydroxyapatite implants. Because of their porous,crystalline structure bioceramic implants vascularize well. Porous polythylene orbital implants,which are not available in Germany, are economical, but due to their porosity and vascularization properties they are not comparable with pure hydroxyapatite or hydroxyapatite ceramics. FUTURE VIEW: The dynamic development of the infant anopthalmus adapted to the size growth of the orbita and the exact volume replenishment of the adult orbita cannot yet be fulfilled with the presently available porous hydroxyapatite materials and is the subject of future research.

Eye Enucleation↗