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PubMed1996

Crosslinking characteristics of an epoxy-fixed porcine tendon: effects of pH, temperature, and fixative concentration.

Injury to the anterior cruciate ligament (ACL) often results in functional instability within the knee joint and may induce a severe articular deterioration. Clinically, these patients may require an ACL reconstruction. In an attempt to develop an improved ligament prosthesis, a prototype xenograft--an epoxy-fixed porcine Achilles tendon--was developed. The study was intended to investigate the crosslinking characteristics of the epoxy-fixed porcine tendons fixed at different pHs (4.0, 7.4, 9.0, and 10.5), temperatures (4, 25, and 37 degrees C), and fixative concentrations (1, 2, or 4%). Samples of each group were taken out at various elapsed fixation periods. The crosslinking characteristics-fixation index, denaturation temperature, and moisture content-of each sample were determined. Additionally, the stiffness of the epoxy-fixed tendons under various fixation conditions was qualitatively compared. In the study it was noted that the color of porcine Achilles tendons remained natural after epoxy fixation. With increasing pH, temperature, or fixative concentration, the fixation indices and denaturation temperatures of the epoxy-fixed tendons increased. However, the fixed porcine tendons tended to be stiffer at a higher pH, temperature, or fixative concentration. The moisture contents of the epoxy-fixed tendons were relatively lower than the fresh ones, while they were approximately the same at different pHs, temperatures, and fixative concentrations. The implications of these findings for the epoxy-fixed porcine tendons in ACL reconstruction require further investigation.

Animals↗
PubMed2003

Improvement on the auxiliary total artificial heart (ATAH) left chamber design.

The auxiliary total artificial heart (ATAH) is an electromechanically driven artificial heart with reduced dimensions, which is able to be implanted in the right thoracic or abdominal cavities of an average human patient without removing the natural heart or the heart neurohumoral inherent control mechanism for the arterial pressure. This device uses a brushless direct current motor and a mechanical actuator (roller screw) to move two diaphragms. The ATAH's beating frequency is regulated through the change of the left preload, based on Frank-Starling's law, assisting the native heart in obtaining adequate blood flow. The ATAH left and right stroke volumes are 38 ml and 34 ml, respectively, giving approximately 5 L/min of cardiac output at 160 bpm. Flow visualization studies were performed in critical areas on the ATAH left chamber. A closed circuit loop was used with water and glycerin (37%) at 25 degrees C. Amberlite particles (80 mesh) were illuminated by a 1 mm planar helium-neon laser light. With left mean preload fixed at 10 mm Hg and the afterload at 100 mm Hg, the heart rate varied from 60 to 200 bpm. Two porcine valves were used on the inlet and outlet ports. The flow pattern images were obtained using a color micro-camera and a video recorder. Subsequently, these images were digitized using a PC computer. A persistent stagnant flow was detected in the left chamber inlet port. After improvement on the left chamber design, this stagnant flow disappeared.

Animals↗
PubMed1997

Textured surface, nonsilicone gel breast implants: four years' clinical outcome.

Since the development of smooth silicone breast implants in 1962, more than 1 million women throughout the world have opted for breast augmentation surgery. Although initially successful, smooth implants are prone to develop surrounding scar capsules that may harden and contract, resulting in discomfort, weakening of the shell with rupture, asymmetry, and patient dissatisfaction. This phenomenon has been shown to occur in as many as 70 percent of implanted patients over time. We have reviewed all of our patients and the Medical Device Reporting System for Bioplasty, Inc. (Minneapolis, Minn.) for the history of this device. At 18 months, more textured implants remain soft than the smooth group. After an additional 30 months of follow-up, for a total of 48 months maximum and 18 months minimum, most textured implants still remain soft. Since 1990 we have used AU24K, bio-oncotic hydrogel filling material in molecular impact surface textured implants (MISTI) that is similar to breast tissue in color, radiodensity, and viscosity. Complications have been late leaks, infection, and capsular contracture. Several asymptomatic implants were removed because of anxiety over the FDA controversy. Our experience so far indicates that such a breast implant is a reasonable alternative to the prior art. The longer-term performance of these implants must await the availability of further clinical outcome data.

Breast Implants↗
PubMed1996

Evaluation and treatment of erectile dysfunction.

Erectile dysfunction has an organic etiology in most cases, with vascular disease the single most common cause. In addition to a thorough history and physical examination, clinical evaluation may include hormonal assessment, diabetes screening, nocturnal tumescence testing and color Doppler flow studies of the penile vasculature. Therapy for erectile dysfunction has progressed rapidly during the past decade, with alternatives including hormone supplements, vacuum constriction devices, penile self-injection therapy and penile prostheses. The majority of patients and their partners report satisfactory results with these treatments.

Aphrodisiacs↗
PubMedDate not supplied

Pulmonary function in a non-pulsatile pulmonary circulation.

The authors suggested that a mammal immediately accommodates well to nonpulsatile flow in the systemic circulation. In the current study, nonpulsatile pulmonary blood flow using a centrifugal pump was established in chronic models to analyze its influence on the pulmonary circulation. A pulsatile right ventricular assist device (RVAD) was implanted to draw blood from both the right atrium and ventricle and send blood to the pulmonary artery in six goats. After 2 weeks, the pulsatile pump was quickly replaced with a centrifugal pump without anesthesia, and a 100% non-pulsatile pulmonary blood flow was obtained. Cardiac output was kept at 80-120 ml/kg/min during the experiments. No changes were observed in hemodynamic parameters, including pulmonary arterial pressure, pulmonary vascular resistance index, and blood gas data, after the immediate depulsation of the pulmonary blood flow. There was also no significant change in the ventral to dorsal tissue blood flow ratio of the lower lobe of the right lung, which was calculated by a colored microsphere method, between pulsatile and non-pulsatile pulmonary blood perfusion. These results suggest that pulmonary function, including blood flow distribution, is not affected by non-pulsatile pulmonary circulation for periods up to 14 days.

Animals↗
PubMed2001

Smile analysis and face-bow transfer: enhancing aesthetic restorative treatment.

The objective of current aesthetic dental treatments are to enhance the patient's smile by improving the overall dental appearance. A detailed analysis of the patient's face as it relates to the three-dimensional position, shape, and color of the teeth is required to improve this appearance. A full frontal and lateral evaluation of the patient's facial form is required to successfully complete on aesthetic smile evaluation. Additional considerations include cephalometry and a thorough dental analysis. This article demonstrates a comprehensive smile analysis technique and its communication to the dental technician.

Adult↗
PubMed2006

TIMP-2 modulates neointimal formation in experimental ePTFE arterial grafts.

BACKGROUND: In vascular reconstructive surgery, myointimal hyperplasia contributes to the adverse outcome of synthetic grafts. This phenomenon is because of unregulated extracellular matrix degradation and remodeling, and excessive smooth muscle cell proliferation and migration. Matrix metallopreoteinase 2 (MMP-2) is known as an important contributor to these events. The aims of our study was to investigate the effects of selective MMP-2 inhibitor (TIMP-2) in endothelialization rate, SMC proliferation, and myointimal hyperplasia in experimental ePTFE arterial grafts. METHODS: In 20 male Lewis rats, a 1-cm long ePTFE graft has been inserted at the level of the abdominal aorta. Animals were randomized in two groups (10 animals each): group A received six subcutaneous inoculations of TIMP-2 (2.5 microg) after surgery, group B received only the vehicle of TIMP-2. RESULTS: Neointimal thickness, as well as SMC density, were augmented in group B, whereas endothelial cells density was augmented in group A, and these findings were statistically significant. In group A SMC were better organized, just like SMC of thoracic aorta. In group B SMC were no organized. Furthermore, anti-TIMP-2 and anti-MMP-2 coloration revealed higher levels of TIMP-2 and lower levels of MMP-2 in group A versus group-B. CONCLUSIONS: Use of TIMP-2 affects the neointimal formation of experimental e-PTFE arterial grafts, leading to a better-organized neointima, with improved endothelialization.

Animals↗
PubMed1998

A 5-year clinical evaluation of ceramic inlays (Cerec) cemented with a dual-cured or chemically cured resin composite luting agent.

Sixty-six class-II CAD/CAM-manufactured ceramic inlays (Cerec) were placed in 27 patients. Each patient received at least one inlay luted with a dual-cured resin composite and one inlay luted with a chemically cured resin composite. The inlays were examined 5 years after luting using the California Dental Association (CDA) criteria. Eighty-nine percent of the 66 inlays were rated 'satisfactory'. During the follow-up period replacement was required for 3 inlays because of inlay fractures (4.5%) and 1 inlay because of fracture of the tooth substance (1.5%). All those inlays were luted with the dual-cured resin composite luting agent. Of the remaining 62 inlays the CDA rating 'excellent' was given to 84% for color, 97% for surface, and 81% for anatomic form. 'Excellent' margin integrity was seen in 52% of the dual-cured resin composite luted inlays and in 61% of the chemically cured resin composite luted inlays. No statistically significant (P> 0.05) difference was observed between the two luting agents.

Adolescent↗
PubMed2003

The ZiReal Post: A new ceramic implant abutment.

Restorations in the anterior esthetic zone present significant challenges in both the surgical and prosthetic phases of implant dentistry. Titanium has been established as the material of choice for endosseous implants, resulting in a high degree of predictability. Many types of implants require transmucosal abutments to retain implant restorations. Ceramics may be the ideal material to replace natural teeth, but most transmucosal abutments are made of titanium. However, ceramics may also be used as abutments in implant restorations. This combination of ceramics for abutment and crown provides better translucency for the implant restoration than is available with metal abutments and porcelain-fused-to-metal crowns. Ceramic abutments and implant restorations also minimize the gray color associated with metal components that is transmitted through the peri-implant tissues. Customized emergence profiles also may be obtained with ceramic abutments; this generally improves the predictability and consistency of the esthetics obtainable in implant restorations. Zirconia as a ceramic material offers not only outstanding material properties but also a well-documented biocompatibility.

Crowns↗
PubMed1989

Pulsatile masses surrounding vascular prostheses: real-time US color flow imaging.

A prospective evaluation of color flow mapping and real-time ultrasound was performed to determine if pseudoaneurysms could be distinguished from other causes of masses surrounding vascular grafts of the lower extremities. Twelve palpable pulsatile masses were imaged. Diagnoses were confirmed at angiography (n = 11), computed tomography (n = 7), aspiration biopsy (n = 5), and operative intervention (n = 6). A swirling pattern of blood flow was seen in six of seven cases of pseudoaneurysm. Lack of flow signals was noted in four of the five collections representing hematoma (n = 2) or infection (n = 2). The seventh case was later shown to be an infected, thrombosed pseudoaneurysm. The single false-positive diagnosis was made early in the series when the flow signals detected were due to transmitted arterial pulsations. The authors conclude that color Doppler flow imaging is useful in the differential diagnosis of pulsatile masses associated with prosthetic grafts. Prosthetic graft pseudoaneurysms have a specific appearance of swirling blood flow arising from a wide neck and are distinguishable from traumatic or iatrogenic pseudoaneurysms of the native vascular tree.

Aged↗
PubMed1999

Lengthening shortened penis caused by Peyronie's disease using circular venous grafting and daily stretching with a vacuum erection device.

PURPOSE: We evaluated the results of chronic intermittent stretching with a vacuum erection device after circumferential tunical incision and circular venous grafting in 4 patients with penile shortening from severe Peyronie's disease. MATERIALS AND METHODS: We performed complete circumferential tunical incision and covered the defect with a circular venous graft in 4 patients with shortened penis as a result of Peyronie's disease. Preoperative evaluation included determination of patient and partner expectations, potency status, measurement of penile length after intracavernous injection and color duplex ultrasonography to determine possible vascular communication. Lower saphenous, upper saphenous and deep dorsal veins served as graft materials. We advised patients to use a vacuum device on a daily basis for 6 months starting 1 month after surgery. Postoperative evaluations were done at 6 and 18 months postoperatively. RESULTS: At 6-month followup 1 patient who did not use the vacuum device gained 1 inch in penile length and was not available for further followup. The other 3 patients each gained 2 inches but had decreased erectile rigidity due to narrowing in the grafted area (hourglass deformity). One patient who wanted a more natural erection elected penile prosthesis implantation about 1 year after grafting. The remaining 2 patients gained 3 inches at 18-month followup and regained partial penile rigidity similar to preoperative erections when the hourglass deformity improved. All patients were satisfied and indicated that surgery improved psychological well-being as well as relationships with partners. CONCLUSIONS: The results in this small group are satisfactory. Our technique offers a reasonable solution for correction of penile shortening in patients with Peyronie's disease.

Adult↗
PubMed1991

[Aortic arch replacement by simple hypothermic retrograde cerebral perfusion for long cerebral circulatory arrest--a successful case report].

We have recently discovered that hypothermic cerebral retrograde perfusion can be performed by simply elevating the central venous pressure in Trendelenburg's position during aortic arch surgery. During deep hypothermic perfusion of the lower half of the body with an occlusion balloon in the descending aorta, oxygen saturated venous blood supplied the brain with oxygen. A successful case is reported. A case was 53 y.o. woman of dissecting aortic aneurysm DeBakey type II, with a true aortic arch aneurysm. Under median sternotomy the right atrium and the femoral artery were cannulated for cardiopulmonary bypass. With the brain under retrograde perfusion at a rectal temperature of 16 degrees C and a central venous pressure of 10-15 mmHg, the ascending to the descending aorta was replaced. Blood flowed into the aortic arch from the arch vessels was blackish in color. Brain circulatory arrest time was 81 min. Postoperative course was uneventful. It is suggested that this simple retrograde cerebral perfusion during hypothermic aortic arch surgery protected the brain for an extended brain circulatory arrest time, and eliminated the need for clamping at the aortic arch and the arch vessels, and simplified the operative procedure.

Aortic Dissection↗
PubMed1982

The efficiency of the Sudan-III-staining to identify wear particles of pmma-bone cement in tissue after total endoprostheses.

On the basis of the newly-formed capsular tissue of 80 cemented (Weber-Huggler, Müller-Charnley) and uncemented (ceramic/ceramic/titanium) total hip endoprostheses which had to be reoperated on because of aseptic loosening, the efficiency of the Sudan-III-staining reported in literature to identify polymethylmethacrylate (PMMA) bone cement particles is investigated, because the quantity as well as quality of the various wear products is discussed as possible factors of prostheses loosening. PMMA-, polyethylene and polyester particles show definite sudanophilia and orange-red coloration in the Sudan-III-stained frozen sections, so that only very large wear products utilizing the knowledge of the materials of the artificial joints used can be recognized by their forms, whereas the wear stored in the macrophages cannot be identified. Thus, Sudan-III-staining is not suitable for guaranteeing identification and determination of the amount of PMMA-wear.

Azo Compounds↗
PubMed1991

Hemodialysis grafts: color Doppler flow imaging correlated with digital subtraction angiography and functional status.

Twenty-two patients with hemodialysis grafts were prospectively evaluated with color Doppler flow imaging and digital subtraction angiography (DSA). Eighteen patients had normal functional parameters during hemodialysis, and four had increased venous pressure during hemodialysis. Color Doppler flow imaging allowed identification of nine macroaneurysms related to wall degeneration, two cases of spontaneous fistula formation between the graft and peripheral veins, and 20 stenoses. Use of color Doppler flow imaging led to overestimation of the degree of stenosis at the venous anastomosis when compared with use of angiography. Three cases of subclavian venous stenosis were identified only at angiography. Color Doppler flow imaging appears accurate in the detection of stenoses and seems sufficient for follow-up of normally functioning grafts. However, because of its low sensitivity for identification of proximal stenoses and the necessity of obtaining an angiogram to plan surgical or percutaneous correction, DSA remains the technique of choice.

Angiography, Digital Subtraction↗
PubMed2004

Post concepts are changing.

Use of post-and-core restorations has changed markedly in the past several decades. Current use and research supports techniques using tooth-colored, fiber-reinforced resin-based composite posts or titanium alloy posts cemented with resin cement, followed by resin-based composite build-ups. Although fiber-reinforced resin-based composite posts appear to be very promising, long-term clinical observation is needed. I have made suggestions about when to use posts, what type of post to use and how to use them.

Composite Resins↗
PubMedDate not supplied

Salvaging a porcelain/metal bridge with a bonded porcelain-fused-to-metal overcasting.

Porcelain fractures from ceramo-metal fixed bridges often are troublesome for both dentist and patient, especially when problems occur in the anterior region. Repairing these fractures can be a challenge because the repair must be not only durable but also pleasing esthetically. While repair can be achieved with a composite resin material, matching the color and texture with the surrounding intact porcelain often is difficult and the bonding between the resin and porcelain is susceptible to marginal leakage, which may result in esthetic failure. This article reviews a technique designed to salvage a fractured porcelain-fused-to-metal bridge and return it to form and function by utilizing a porcelain-fused-to-metal overcasting.

Acid Etching, Dental↗
PubMed2000

Expanded polytetrafluoroethylene in external valvuloplasty for superficial or deep vein incompetence.

The authors evaluated the long-term safety of expanded polytetrafluoroethylene (ePTFE) implants used in external valvuloplasty for treatment of incompetence of the long saphenous and common and superficial femoral veins. During a 15-year period patients with superficial and/or deep venous disease and hypertension due to pure superficial or deep vein incompetence underwent an external valvuloplasty with ePTFE sutures, or an ePTFE cardiovascular patch placed as a sleeve around the incompetent vein segment, or an ePTFE tubular graft placed around the venous segment. Postoperative follow-up evaluations consisted of clinical examinations, high-resolution ultrasonography, and color duplex scanning, and a complete blood count performed at 1, 3 and 6 months, and repeated for at least 4 years, every 2 years after the procedure. A total of 101 patients (38 men and 63 women; mean [+/- sd] age, 44+/-12 years) underwent external valvuloplasty between January 1983 and December 1998; 82 of them completed the 4-year follow-up. Forty of the 82 patients had been operated on for superficial vein incompetence, 42 for deep vein incompetence. Overall, the mean follow-up time was 7.8+/-3.6 years (range, 4 to 13). There were no infections, thromboses,foreign-body reactions to the ePTFE implants, or other prosthesis-related complications requiring explantation. One granuloma (noninfected) developed in association with a tubular ePTFE implant around a long saphenous vein, but it did not necessitate implant removal. Seven patients required (at least after 4 years) a second procedure for recurrent or new venous incompetence. Therefore, in this observational study, ePTFE implants used to treat or correct venous incompetence were well tolerated on a long-term basis.

Adult↗
PubMed1994

[Feasibility and accuracy of pulmonary blood flow measurement by Doppler echocardiography. Apropos of 100 consecutive cases].

One of the main advantages of Doppler echocardiography is the possibility of non-invasive measurement of blood flow at each valvular orifice. This method enables quantification of valvular regurgitation, the measurement of Qp/Qs in cardiac disease with atrial or ventricular shunts, and the interpretation of gradients and functional surface areas in valvular stenosis or prosthesis with respect to the underlying haemodynamics. In each of these application, the measurement of pulmonary blood flow is valuable as the reference blood flow, and even indispensible in cases of shunts. The authors' objective was to study the feasibility and accuracy of pulmonary flow measurement in 100 consecutive patients (40 women and 60 men, average age 56.7 +/- 17.5 years) with cardiac disease (82%) or healthy hearts (18%). A grading from A to D was accorded depending on the technical difficulty of the examination, each grade having three degrees: 1) difficulty of recording and poor quality Doppler spectrum, 2) difficulty of measuring orifice diameter by 2D echocardiography, 3) necessity of analysis of color coded anterograde flow to measure the pulmonary valvular orifice. Grade A was distributed to easily recordable measurements with no difficulty; grade B for measurements with one difficulty; grade C for measurements with 2 difficulties and grade D for investigations judged to be impossible or unreliable (3/3 criteria). The feasibility of measurement of the cardiac output at the pulmonary orifice was 88% (A:55%, B:25%, C:8%). The correlation between the pulmonary flow and reference measurements at the aortic and/or mitral valve and/or mitral annulus was 0.96. The average difference between the pulmonary and reference flow was 51 +/- 273 cc/min.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗