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At least 73 records · Page 4Linked to original sources

Extracorporeal shock-wave lithotripsy for stones in middle third of ureter (overlying pelvic bone).

OBJECTIVE: To compare the results of using Dornier HM3 and Medstone STS lithotriptors to treat a ureteral stone overlying the pelvic bone (mid third of ureter) requiring the patient to be in the prone position. METHOD: The ease of use with each lithotriptor was evaluated and a retrospective review of the results using a Dornier HM3 in 53 patients and a Medstone STS in 143 patients was performed. The chi-square test was used to determine statistical difference. RESULTS: With single stones, the re-treatment rate, the post-ESWL secondary procedure rate, and the stone-free rate were 6 percent, 13 percent, and 75 percent, respectively, with the Dornier, and 6 percent, 8 percent, and 80 percent, respectively, with the Medstone. There was no statistically significant difference between these outcome results (p > 0.05). CONCLUSION: The prone position was difficult to achieve with the Dornier HM3, while the Medstone STS, a tubeless lithotriptor, allowed easy positioning of the patient in the prone position on its flat table. Satisfactory results were achieved using either machine.

Equipment Design↗

[Lesion of the hip joint in osteomyelitis of the pelvic bones and of the proximal portion of the femur in the newborn].

During 14 years the authors observed 52 newborn infants with acute hematogenic osteomyelitis of pelvic bones and proximal femoral portion, complicated with coxitis in 43 patients, pathological dislocation - in 32, phlegmon with burrowing in 37. A septicopyemic form of the disease was noted in 33 subjects, local-focal in 19. The symptomatics and an early topic diagnosis depending on a stage of the process are described in detail. The treatment includes timely surgical intervention on the pathological focus, intensive genaxis and treatment of pathological dislocation of the femur. An early diagnosis and timely complex therapy within recent 5 years provided the opportunity to reduce the mortality and the percentage of disability due to this disease.

Acute Disease↗

[Pelvic bone defects in alloarthroplasty].

Loss of acetabular bone renders secure fixation of an artificial cup difficult. Loss of pelvic bone mainly results from repeated revision of failed THR, tumor resection within the acetabular region and trauma. The main criteria for the method of treatment to be applied are the biomechanical condition of acetabular defects, the bacteriological situation, and the patient himself. In aseptic cases we regard bony reconstruction with homografts as the method of choice. From 1982 to 1986 about 1000 bony reconstructions were performed using more or less extensive facilities for support, i.e. screws, baskets, plates. In septic cases defects are closed using antibiotic-loaded acrylic cement in combination with screws. In the extreme case of bone destruction we recommend the saddle prosthesis as an alternative measure. This type of prosthesis was used in 76 cases from 1979 to 1984. Other methods of treatment, such as resection arthroplasty, arthrodesis, and partial pelvic replacement may be considered.

Acetabulum↗

Percutaneous cementoplasty for pelvic bone metastasis.

The aim of this retrospective study was to prove the effectiveness of percutaneous cementoplasty in pelvic bone metastases. We studied the data entered in a multicenter prospective database on 18 cancer patients (average age 58 years) who underwent percutaneous computed tomography (CT) or fluoroscopy-guided cementoplasty from September 1996 to September 1998. The metastatic sites were: acetabulum (n = 12), iliac bone (n = 2), and sacrum (n = 4). Indications were pain recurrence (n = 9) or no relief (n = 3) after radiotherapy, and 6 procedures were performed before radiation. Mean follow-up was 4.6 months, ranging from 11 days up to 24 months. Improvement in pain and walking was obtained in 81.8% cases, and it was generally maintained, except in 1 patient who experienced pain again at day 15 because of an acetabular fracture. Percutaneous cementoplasty is a safe and efficient technique, and is mandatory when radiotherapy fails or when rapid resolution of pain is requested.

Adult↗

[Design of partial pelvic replacement with calculation of stresses on the pelvic bone using the finite element method].

Although tumors of the pelvic region are relatively rare, with regard to the provision of an individual prosthesis, they make great demands both on the engineer and on the surgeon. In the case of partial pelvic replacement, the main problem is that of fixation. The direction of the preload by the screw and counternut in the anchorage should make possible the introduction of forces into the bone that closely mimic the natural pre-operative situation, in order to keep bone remodeling and stressing to a minimum. A three-dimensional finite element (FE) analysis of the stresses at work in the pelvic bone was performed using an FE model of the pelvis constructed on the basis of computed tomographic data, since with the FE method it is possible to obtain information about deformations, internal stresses and local forces acting on the bone. The results show that the main stressing of the bony pelvis occurs in the region of the acetabulum and the iliosacral joints, and that further points of loading are located in the lower region of the ischium-and this while standing on one leg, on the side of the supporting leg.

Biomechanical Phenomena↗