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PubMed2000

A study on the development and the deodorizing capability of metal-phthalocyanine processed stump socks for amputees.

The socks which were treated with Metal-Phthalocyanine, a derivative of an artificial enzyme, were developed by the author and called Kobe Stump Socks(KSS). KSS was made of a cotton cloth that had undergone an ammonium salt cationization process and also a Metal-Phthalocyanine process. The study from a bacteriological view and the moisture absorption effect of KSS revealed that the mechanism of the deodorizing ability was bared on the decomposition function of Metal-Phthalocyanine, while the antibacterial function came from the cationization and also that the high water absorption speed and capacity further enhanced these two functions. In this report, the author studied the deodorizing capability of KSS. To measure the adherence of an odor substance, ammonia, a testing device that measured this adherence was used. As a result, the adherence of ammonia to KSS was more than three times that of an unprocessed cloth. KSS had been used as stump socks on the stumps of amputees who were using prosthetic limbs, and a snuff test on the difference of the odor strength inside the socket was done. Of 33 subjects, 32 recognized a deodorizing effect. From these facts, KSS was proven to dry and deodorize the limb surface with the moisture absorption effect and deodorizing capabilities due to the Metal-Phthalocyanine process. These characteristics were never recognized in other stump socks. These date mentioned above suggested that KSS was the best material to deodorize prosthetic limb sockets.

Amputation Stumps↗
PubMedDate not supplied

Comparison of benefits provided by different hearing aid technologies.

The performance of 40 hearing-impaired adults with the GN ReSound digital BZ5 hearing instrument was compared with performance with linear hearing aids with input compression limiting (AGC-I) or two-channel analog wide dynamic range compression (WDRC) instruments. The BZ5 was evaluated with an omnidirectional microphone, dual-microphone directionality, and a noise reduction circuit in combination with dual-microphone directionality. Participants were experienced hearing aid users who were wearing linear AGC-I or analog WDRC instruments at the time of enrolment. Performance was assessed using the Connected Speech Test (CST) presented at several presentation levels and under various conditions of signal degradation and by the Profile of Hearing Aid Benefit (PHAB). Subjective ratings of speech understanding, listening comfort, and sound quality/naturalness were also obtained using 11-point interval scales. Small performance advantages were observed for WDRC over linear AGC-I, although WDRC did not have to be implemented digitally for these performance advantages to be realized. Substantial performance advantages for the dual microphones over the omnidirectional microphone were observed in the CST results in noise, but participants generally did not perceive these large advantages in everyday listening. The noise reduction circuit provided improved listening comfort but little change in speech understanding.

Aged↗
PubMed2000

Placement of the preparation line and periodontal health--a prospective 2-year clinical study.

The aim of this prospective clinical 2-year study was to determine whether the placement of the proximal margins of crowns within the zone of the biologic width results in periodontal alterations. In 41 patients, 116 prepared teeth as well as 82 unrestored, healthy contralateral teeth were examined. The following indices were determined before as well as 3, 6, 12, and 24 months after preparation: hygiene index, papillary bleeding index (PBI), and probing depth. After preparation, the distance between the restoration margins and the alveolar crest was measured with a modified periodontal probe on both proximal aspects of each tooth. These values were classified into 3 groups: I = < or = 1 mm between crown margin and alveolar crest, II = 1 to 2 mm, and III = > 2 mm. In addition, radiographs were taken directly after cementation of each restoration and after 12 and 24 months. The hygiene index did not significantly vary during the investigation, but PBI increased in all groups. The highest PBI increase was found in group I; in this group, the most significant increase was found between 3 and 6 months after preparation. The mean probing depth only increased in group I during the first 3 months after preparation on the mesial aspects. Only minor changes were found on the distal aspects of the teeth in group I and on all aspects in groups II and III. No alterations of the bone levels were diagnosed on the radiographs. These results indicate that the location of the restoration margins within the zone of the biologic width may impair the periodontal health of restored teeth.

Adult↗
PubMed2001

Influence of transesophageal echocardiography on intraoperative decision making for toronto stentless prosthetic valve implantation.

BACKGROUND AND AIM OF THE STUDY: Intraoperative transesophageal echocardiography (TEE) is commonly used during aortic valve surgery. In aortic valve replacement (AVR), this permits measurement of the aortic annulus, study of the anatomy of aortic valve components, and prediction of prosthesis valve size. After cardiopulmonary bypass (CPB), echocardiography is valuable in checking prosthesis function. In this study, we evaluated the impact of intraoperative TEE on the decision-making process of aortic Toronto stentless prosthetic valve (TSPV) implantation. METHODS: Fifty-two consecutive patients undergoing elective AVR were collected prospectively. Multiplane TEE was performed before CPB to determine diameters of the aortic valve annulus and sinotubular junction. This was to evaluate the feasibility of TSPV implantation in the aortic position and to predict prosthesis size. Further TEE evaluation was carried out after CPB to assess prosthetic valve function. RESULTS: TEE allowed measurement of the aortic annulus and sinotubular junction, and enabled correct prediction of prosthesis size. Ultrasonic evaluation also revealed contraindications to TSPV implantation in five patients. In one case, color-Doppler examination led to immediate successful surgical correction of prosthetic incompetence. CONCLUSION: Intraoperative multiplane TEE examination is useful in the decision-making process in AVR with the TSPV by selecting patients suitable for the stentless valve, predicting prosthesis size, and checking prosthesis function.

Aged↗
PubMed2001

Acquired limb deficiencies. 1. Acquired limb deficiencies in children and young adults.

UNLABELLED: This self-directed learning module highlights prosthetic treatment considerations and challenges in children and young adults. It is part of the chapter on acquired limb deficiencies in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on prosthetic considerations for a child experiencing a mutilating traumatic amputation, examines the rationale for limb salvage versus surgical amputation for malignant bone tumors, discusses the unique management options available for patients undergoing hip disarticulation due to a tumor, and highlights the complications associated with amputations resulting from trauma and malignancies. OVERALL ARTICLE OBJECTIVE: To summarize prosthetic treatment considerations and challenges in children and young adults.

Adolescent↗
PubMed2001

Acquired limb deficiencies. 3. Prosthetic components, prescriptions, and indications.

UNLABELLED: This self-directed learning module highlights indications for prosthetic components and prescription formulation for adults with acquired limb deficiency. It is part of the chapter on acquired limb deficiencies in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Advantages and disadvantages of specific components of upper and lower limb prostheses are discussed, and a sample prescription sheet for upper limb devices is included. Recent innovations in terminal devices for upper limb prostheses are reviewed. Special considerations for the adult with acquired multilimb deficiency are also examined. OVERALL ARTICLE OBJECTIVE: To describe indications for prosthetic components and prescription formulation for adults with acquired limb deficiency.

Adult↗
PubMed2001

Acquired limb deficiencies. 4. Troubleshooting.

UNLABELLED: This self-directed learning module offers practical analyses of and solutions for common clinical problems of amputees. It is part of the chapter on acquired limb deficiencies in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The information presented here has been designed to be useful also to other interested professionals, including prosthetists, physical therapists, occupational therapists, and nurses. Topics covered include the management of typical obstacles encountered in upper limb amputees, and the diagnosis and treatment of phantom and residual limb pain. Diagnostic and treatment approaches to skin breakdown in the transtibial amputee and to knee instability in the transfemoral amputee are also presented. OVERALL ARTICLE OBJECTIVE: To analyze common clinical problems of amputees.

Amputation, Surgical↗
PubMed2001

Technology, expectations, and adjustment to hearing loss: predictors of hearing aid outcome.

This study examined the influence of technology, demographic factors, and prefitting expectations, attitudes, and adjustment to hearing loss on hearing aid outcome. Clients obtaining new hearing aids completed questionnaires measuring personal adjustment to hearing loss, expectations of and attitudes toward hearing aids, and hearing aid benefit. Eighty-one percent of the 200 subjects completing the prefitting questionnaires returned questionnaires evaluating hearing aid outcome. Factors affecting hearing aid use, overall satisfaction, and benefit were investigated using regression analyses. Higher use time was associated with higher prefitting expectations and greater acceptance of hearing loss. Greater benefit in easy and difficult listening situations was predicted by higher prefitting expectations. Multiple-memory hearing aids produced higher satisfaction. Benefit was greater for multiple-memory, multiple-channel, and wide dynamic range compression aids. Findings were consistent with previous studies showing positive outcomes for newer technologies but also showed that two subjective factors, prefitting hearing aid expectations and acceptance of hearing loss, significantly influenced hearing aid outcome.

Acoustic Stimulation↗
PubMed2001

Replacement of the left common iliac vein with a custom-made bovine pericardium tubular graft.

To date, venous reconstruction has not been as successful as arterial reconstruction. Prosthetic materials used as venous substitutes produce much lower patency rates with a higher incidence of early thrombosis than those used as arterial substitutes. We describe the case of a 38-year-old obese woman in whom we encountered an unexpected tear of the common iliac vein intraoperatively, during an anterior approach to the lumbar spine. Because of limited options, we replaced the vein with an interposition tubulargraft that was custom-made from bovine pericardium. Two years later, the patient remained asymptomatic with a patent graft. To our knowledge, there has been no other reported case in the world medical literature of replacement of medium-sized veins by this technique.

Adult↗
PubMedDate not supplied

Anterior esthetic fixed appliances for the preschooler: considerations and a technique for placement.

One of the pediatric dentist's greatest restorative challenges is the esthetic rehabilitation of a young toddler who has suffered multiple tooth loss subsequent to rampant early childhood caries or extensive dental trauma. An anterior esthetic appliance may be used to replace lost teeth. The most decisive factor for placing an anterior esthetic appliance is parental desire. Other considerations include: space maintenance, masticatory function, speech development, and tongue habits. However, there is no strong evidence that early loss of maxillary incisors will have any significant, long lasting effect on the growth and development of the child. This paper discusses in detail one type of fixed anterior esthetic appliance and the considerations to be made when deciding when and why to place them.

Child, Preschool↗
PubMedDate not supplied

Cineplasty as a control input for externally powered prosthetic components.

To achieve significant improvement in the function of electric-powered, upper-limb prostheses, we believe it is necessary to develop better control interfaces with inherent sensory feedback. Small cineplasties, or other surgical procedures that also externalize the force and excursion of a muscle, could potentially provide this superior control. Connecting a muscle to a prosthetic component via a controller that embodies the concept of extended physiological proprioception (EPP) would enable the physiological sensory feedback inherent in the skin, muscle, and other tissues of the cineplasty to inform the user of the state of the prosthesis. Multiple miniature forearm tunnel cineplasties, each with an EPP controller, might enable meaningful independent multifinger control of hand prostheses. At higher levels of amputation (e.g., transhumeral), small pectoral or deltoid cineplasties could augment existing control sources to improve control of multifunctional total arm prostheses. To explore the feasibility of these ideas, we quantified the control capabilities of individuals with preexisting biceps muscle tunnel cineplasties with the use of pursuit tracking experiments. A "proof-of-concept" EPP electric hand prosthesis was also successfully developed for a subject with agonist-antagonist, forearm tendon exteriorization cineplasties. The results of the tracking studies demonstrate numerically the efficacy of control by cineplastized muscles relative to other control approaches.

Amputation Stumps↗
PubMedDate not supplied

Mechanical performance of inflatable inserts used in limb prosthetics.

Inflatable insert products used to overcome residual limb shrinkage were evaluated in a bench test environment under compressive loading conditions. Pressure-loss tests under static loading demonstrated that after inserts were inflated to 43.4 to 45.6 kPa, insert pressures reduced from 0.09%/min to 1.36%/min in the first 5 min and from 0.00%/min to 0.27%/min in the subsequent 55 min. As inserts were inflated, they demonstrated at least two phases in their pressure versus thickness curves: A relatively low-slope portion (Phase I) was followed by a high-slope portion (Phase II). The transition from Phase I to Phase II occurred at more than a 12-mm thickness, a thickness greater than that considered acceptable for practical clinical use (10 mm). This result suggests that in a socket, stress to resist insert expansion is taken by the residual limb and socket more than by the insert itself. Cyclic-loading tests under constrained thickness conditions demonstrated that local stiffness was more sensitive to insert pressure than to constraint spacing (insert thickness). The static and dynamic test results help to explain why some users claim that inserts do not provide equal and consistent support unless inflated to a very high insert pressure. An insert that allowed adjustment of the location of the Phase I to Phase II transition point in the pressure versus thickness curve might help to overcome these limitations.

Amputation, Surgical↗
PubMed2000

Management of an infant with cleft lip and palate with phocomelia in dental practice.

Cleft lip and palate is a severe birth defect occurring approximately one in 800-1000 newborn infants. The incidence varies widely among races. Cleft lip and palate together account for approximately 50% of all cases whereas isolated cleft lip and isolated cleft palate occur in about 25% of cases. Many of these congenital anomalies appear to be genetically determined though the majority are of unknown causes or teratogenic influences. Presented here is a 3 day old infant with bilateral cleft lip and palate and phocomelia for whom a feeding obturator was made and delivered to facilitate feeding.

Cleft Lip↗
PubMed2001

Case report: impression and maxillo-mandibular relationship recording for construction of obturator prostheses.

The present case report describes a procedure for obtaining the master impression and the maxillo-mandibular relationship for the definitive prosthesis in a maxillectomy patient. After casting the metal framework, a visible-light-cured tray resin was spread over the resin retention grid and gradually cured. Modelling compound was extended over the resin with functional movements, and finally the margins of the defect were sealed with a dental impression wax. A column of light-cured resin was constructed from the lower face of the resin/compound/wax structure to the opposing dental arch. This column permitted recording of the maxillo-mandibular relationship.

Acrylic Resins↗
PubMed2001

Amputations: no longer the end of the road.

BACKGROUND: The aim of this prospective study was to assess the effect of an intensive in-patient rehabilitation programme upon the mobility of amputees. METHODS: All major lower limb amputations between 1997 and 1999 received a pre-operative mobility assessment and, where appropriate, were referred for a vigorous rehabilitation programme. RESULTS: 92 lower limb amputations were performed in 87 patients (57 below knee, 33 above knee, two hip disarticulations). Overall, 63% of patients were able to ambulate independently following rehabilitation. Univariate analysis revealed that the only predictor of mobility was the level of amputation, below knee gaining better mobility than above knee (p=0.002). CONCLUSION: Lower limb amputees should participate in an aggressive in-patient physiotherapy regimen since reasonable mobility can be achieved in the majority of patients.

Adult↗
PubMed2001

Presenting all the choices: teaching women about breast prosthetics.

It is imperative that women facing breast cancer surgery have all their options for regaining body symmetry presented to them in a nonbiased manner. Today, women are more likely to receive information about breast reconstruction than about external breast prostheses. This may largely be due to the wealth of information available about reconstruction and the comfort level of the medical community in recommending this procedure. Breast prosthetic science is not taught in medical or nursing education programs, and few articles exist on the subject.

Body Image↗