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Biomedical subjects

M van der Elst

Publications and source records attributed to M van der Elst.

11 recordsLinked to original sources
PubMed2006

Problems with technical equipment during laparoscopic surgery. An observational study.

BACKGROUND: This study was designed to investigate the incidence of technical equipment problems during laparoscopic procedures. METHODS: A video-capturing system was used, consisting of an analog video recorder with three camera image inputs and a microphone. Problems with all technical equipment used by the surgical team, such as the insufflator, diathermy apparatus, monitors, light source, camera and camera unit, endoscope, suction devices, and instruments, were registered. RESULTS: In total, 30 procedures were randomly videotaped. In 87% (26/30) of the procedures, one or more incidents with technical equipment (49 incidents) or instruments (9 incidents) occurred. In 22 of those incidents (45%) the technical equipment was not correctly positioned or not present at all; in the other 27 (55%), the equipment malfunctioned as a result of a faulty connection (9), a defect (5), or the wrong setting of the equipment (3). In 10 (20%) cases the exact cause of equipment malfunctioning was unclear. CONCLUSIONS: The incidence of problems with laparoscopic technical equipment is high. To prevent such problems, improvement and standardization of equipment is needed, combined with the incorporation of checklist use before the start of a surgical procedure. Future research should be aimed at development, implementation, and evaluation of these measures into the operating room.

Adult↗
PubMed2005

Bioresorbable fixation devices for musculoskeletal injuries in adults.

BACKGROUND: Bioresorbable implants for musculoskeletal injuries involving bone and ligaments in adults might have significant advantages compared to the conventionally used non-resorbable metal implants because they lead to a gradual transfer of the mechanical load from the implant to the healing bone and do not require a secondary removal operation. Tissue reactions may present a problem and bioresorbable screws are mechanically not as strong as their metal counterparts. OBJECTIVES: To compare bioresorbable implants to non-resorbable implants with respect to functional outcome, wound infections, other complications and reoperation rate,in the fixation of bone fractures or re-attachment of soft tissue to bone. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group Specialised Register (March 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to February 2004), EMBASE (1988 to February 2004), BL Inside (to February 2004), SIGLE (to February 2004), the metaRegister of Controlled Trials at http//:controlled-trials.com/, and reference lists of articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-randomised trials, comparing bioresorbable osteosynthesis with metal osteosynthesis (including titanium and stainless steel implants) were included. DATA COLLECTION AND ANALYSIS: Review authors independently assessed trial quality and extracted data. Data were pooled where relevant and possible. Sub-analyses for specific type of fractures and for specific type of tissue reactions were performed. Requests for more information were sent to trialists. MAIN RESULTS: No significant difference between the bioresorbable and other implants could be demonstrated with respect to functional outcome, infections and other complications. Reoperation rates were lower in some of the groups of people treated with bioresorbable implants. AUTHORS' CONCLUSIONS: In a selected group of compliant patients with simple fractures, the use of bioresorbable fixation devices might be advantageous.

Absorption↗
PubMed2001

Laparoscopic diagnosis and treatment of idiopathic segmental infarction of the greater omentum. Case report.

Acute pain at the right side of the abdomen rarely is caused by idiopathic segmental infarction of the greater omentum (ISIGO). In most cases the patient is presumed to suffer from appendicitis or cholecystitis. Although some radiologic signs might suggest ISIGO, this rare clinical entity mostly is diagnosed perioperatively and confirmed by postoperative pathologic findings. In the reported case, a patient is described with acute right-side abdominal pain of unknown origin, in whom ISIGO was encountered during diagnostic laparoscopy and successfully resected. Because of this minimally invasive approach, the patient was discharged the day after surgery and returned to work after 5 days. The pathogenesis, symptoms, and treatment methods are discussed.

Abdomen, Acute↗
PubMed2000

[Biodegradable implants in fracture fixation: state of the art].

Operative fracture repair in trauma surgery is currently performed using metal implants. These metal implants often are removed during a second, retrieval operation. Biodegradable fracture fixation devices have been used clinically since the late seventies. Most bioresorbable implants are manufactured from polymers. The polylactides, polyglycolides and co-polymers slowly degrade into small components that are excreted from the human body via natural pathways and removal operations after fracture surgery are not necessary. Due to the limited mechanical properties, the polymer screws and pins are mostly used in the treatment of non weight-baring simple fractures of the ankle, elbow, hand and foot. In view of the progressing technical developments, new materials will be developed and tested for clinical use in the coming decades.

Absorbable Implants↗
PubMed1999

Bone tissue response to biodegradable polymers used for intra medullary fracture fixation: a long-term in vivo study in sheep femora.

Since the degradability of the synthetic polymers used for fracture fixation is still unclear, a research project with biodegradable interlocking nails with a longterm implantation period has been started. In 21 female sheep a complete mid-shaft osteotomy of the left femur was performed to mimic a fracture of the femoral shaft. For the fixation, an intramedullary stainless-steel interlocking nail, a PLA rod or a PLA/PGA rod was used. After 30 months of implantation the histological results of these three materials were examined. In contrast to most reports the degradation rate of both polymers was much lower than the suggested ultimate period of two years. Even the tissue response was more pronounced than expected and this reaction can imply certain risks for repulsion. One can conclude that the volume quantity of polymeric implant in the bony tissue must be reduced if possible to avoid severe foreign body responses. The immunologic responses and the clinical consequences need more studies. The degradation behavior of the polymer is still not under control.

Animals↗
PubMed1998

Biodegradable interlocking nails for fracture fixation.

Serious problems such as stress shielding, allergic reactions, and corrosion are associated with the use of metallic fracture fixation devices in fractured long bones. Metal implants often are removed during a second retrieval operation after fracture healing has completed. A biocompatible implant that degrades slowly during implantation would obviate the need for a second operation and save the patient from considerable physical, psychologic, and financial discomfort. The biodegradable implant must provide the fractured limb sufficient support for a certain time, allowing early loading. A gradual transfer of load from the biodegradable implant to the bone would result in a better product of bone healing and avoid stress shielding. In an animal model using adult sheep, two types of biodegradable polymer interlocking nails were tested in comparison with a stainless steel interlocking nail. Fracture healing, mechanical properties of the bones, degradation behavior in vivo and in vitro, and tissue response were monitored during a 2 1/2-year followup study. To detect shifts in acid base relations caused by the release of acid compounds, pH measurements were performed. Fracture healing was unimpaired, and the mechanical test results of all three groups were excellent. Histologic analysis showed a mild inflammatory response, but no pH shifts were observed. The results of this study justify additional research on these promising materials.

Absorbable Implants↗
PubMed1996

The burst phenomenon, an animal model simulating the long-term tissue response on PLLA interlocking nails.

In this in vivo study, low-molecular-weight as-polymerized PLLA powder was placed in the medullary cavity of a porcine femur in order to study the tissue reaction on predegradated PLLA. An attempt was made to simulate the long-term degradation of a large PLLA implant. This phase can be characterized by the release of PLLA particles and acid compounds from a heterogeneously degrading PLLA implant into the surrounding tissues. The clinical consequences and tissue response were studied. The clinical recovery of the experimental animals was favorable. No signs of clinical inflammation could be detected during the eight-week follow-up period. Histological analysis of the bone/PLLA interface showed signs of a mild inflammatory tissue response.

Animals↗
PubMed1995

Tissue reaction on PLLA versus stainless steel interlocking nails for fracture fixation: an animal study.

In order to develop a biodegradable interlocking nail for fracture fixation, polylactic acid (PLLA) rods were implanted in the femoral bone of young pigs. A midshaft osteotomy was performed in order to mimic a fracture. The tissue response to PLLA rods versus stainless steel rods was studied after 1 and 3 months of implantation. Fracture-healing characteristics and chemical and mechanical properties of the PLLA rods were studied after explantation. Mechanical properties deteriorated during implantation and chemical properties changed significantly in 1 and 3 months of implantation. PLLA and stainless steel induced a similar tissue reaction during the studied implantation time of 3 months.

Animals↗