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At least 1,531 records · Page 85Linked to original sources

Oversizing of self-expanding stents: influence on the development of neointimal hyperplasia of the carotid artery in a canine model.

BACKGROUND AND PURPOSE: In carotid artery stent placement, marked oversizing of the stent relative to the internal carotid artery lumen is common. This study was performed to determine the influence of using oversized self-expanding nitinol stents on neointimal hyperplasia. METHODS: In six greyhound dogs, 24 self-expanding nitinol stents (eight SMART stents, eight Easy Wallstents, eight Sinus-Flex stents) were inserted into both common carotid arteries (CCAs). In each CCA, two stents were deployed; a stent of the appropriate diameter was implanted distally and an oversized stent proximally. After 4 months, transverse sections of each stent were examined histologically and at computerized image analysis. Neointimal hyperplasia was determined as the proportion of the residual diameter of the patent vessel lumen compared with the stent lumen. RESULTS: The amount of neointimal hyperplasia did not differ between the normal-sized and oversized stents. The mean preserved luminal diameter (+/-SEM) with normal- and oversized stents, respectively, were as follows: Easy Wallstent, 94% +/- 1.0 and 96% +/- 1.5; SMART stent, 92% +/- 1.6 and 93% +/- 1.8; and Sinus-Flex stent, 93% +/- 2.7 and 93% +/- 2.6. The mean preserved patent lumen with the 12 normal-sized stents (93% +/-1.0) was not significantly different from that of the 12 oversized stents (94% +/- 1.1, P =.502). CONCLUSION: Under experimental conditions, use of self-expanding stents oversized by 30-40% appeared to result in neointimal hyperplasia comparable to that caused by normal-sized stents. All three stent types appeared to have similarly low neointimal responses.

Animals↗

[Porous polyethylene (Medpor) orbital implant. Prospective study of 75 primary implantations].

PURPOSE: To examine the incidence of orbital complications in patients who underwent primary placement of a porous polyethylene implant (Medpor) after enucleation. MATERIAL AND METHOD: Prospective non randomized case series of 75 consecutive patients in whom a porous polyethylene (PP) spherical implant wrapped with homologous sclera was implanted after enucleation. RESULTS: The mean age at the time of enucleation was 42.7 years (range, 1.4 to 80 years). The histopathological diagnoses after enucleation included uveal melanoma in 28 patients, retinoblastoma in 11 patients, phthisis bulbi in 23 patients, neovascular glaucoma in 5 patients, endophthalmitis in 3 patients, ruptured traumatic globe in 2 patients, microphthalmos in two patients, and medulloepithelioma in one patient. Thirty-four patients (45%) had had prior ocular surgery. The prosthesis was fitted after a mean interval of 4.5 weeks (range, 3 to 10 weeks). After a mean follow-up of 20 months (range, 3 to 33 months), there was one case (1%) of conjunctival dehiscence with material exposure secondary to massive postoperative orbital hemorrhage 2 weeks after enucleation. There was no case of orbital cellulitis, implant extrusion, or significant inflammatory response. No PP implant was drilled for peg placement. DISCUSSION-CONCLUSIONS: The anteriorly wrapped porous polyethylene orbital (Medpor) sphere appears to be well tolerated by all age groups with no major complication in primary implantation after enucleation.

Adolescent↗

Beyond cementless hemispherical sockets.

One of the major goals of acetabular revision is achieving stability. To achieve intimate contact between the implant and host bone, which is critical for stability since bone ingrowth requires the absence of micromotion, the implant must match the defect or be able to bridge the defect. Hemispherical sockets can achieve long-term implant fixation in acetabular defects that are not extensive, whereas structural allografts are associated with long-term failure and reliance on them dooms the implant to failure. Increasing bone loss requires the use of implants that may not be hemispherical, such as the Oblong Cup, or devices that bridge the defect such as an antiprotrusio cage or Triflange Cup.

Acetabulum↗

Dislocation following revision total hip arthroplasty.

Dislocation is a relatively common complication following revision total hip arthroplasty. Risk factors include surgical approach, gender, underlying diagnosis, comorbidities, surgical experience, and previous surgery; for later dislocations, risk factors include wear/deformation of polyethylene, trauma, and decreased muscle strength. Prevention and precaution are the watchwords for dislocations following revision total hip arthroplasty. For dislocations that do occur, treatment rests first on identifying the source of instability. Most dislocations can be managed by closed reduction. Constrained components may increase success rates, but only for appropriate indications. Prevention and treatment of dislocations following revision total hip arthroplasty are discussed in this article.

Casts, Surgical↗

Mandibular overdentures: professional time for prosthodontic maintenance during the first year of service using three different implant systems.

PURPOSE: The purpose of this study was to evaluate the professional time required for the prosthodontic maintenance events of mandibular implant overdentures during the first year of service using three different implant systems (ITI, Steri-Oss, or Southern). MATERIALS AND METHODS: Seventy-two mandibular implant overdenture patients were allocated to three equal groups, each treated with a different implant system. Data on prosthodontic maintenance events during the first year were categorized and analyzed according to professional time allocation per procedure. RESULTS: The total professional time required to perform all the maintenance events ranged between 29.0 and 34.0 hours and did not differ significantly among the three groups, although there were time differences for matrix activation and replacement. When combining the professional time for all maintenance events for the mandibular overdentures alone, or with the opposing maxillary complete dentures, there were no significant differences between groups. For maintenance of the maxillary dentures, there was an unexplained difference between the Southern group and ITI or Steri-Oss groups (P < .05). CONCLUSION: The prosthodontic maintenance for mandibular implant overdentures required on average 72 to 98 minutes of professional time per patient during the first year of service, depending on the system used.

Aged↗

Real-ear-to-coupler difference predictions as a function of age for two coupling procedures.

The predicted real-ear-to-coupler difference (RECD) values currently used in pediatric hearing instrument prescription methods are based on 12-month age range categories and were derived from measures using standard acoustic immittance probe tips. Consequently, the purpose of this study was to develop normative RECD predicted values for foam/acoustic immittance tips and custom earmolds across the age continuum. To this end, RECD data were collected on 392 infants and children (141 with acoustic immittance tips, 251 with earmolds) to develop normative regression equations for use in deriving continuous age predictions of RECDs for foam/acoustic immittance tips and earmolds. Owing to the substantial between-subject variability observed in the data, the predictive equations of RECDs by age (in months) resulted in only gross estimates of RECD values (i.e., within +/- 4.4 dB for 95% of acoustic immittance tip measures; within +/- 5.4 dB in 95% of measures with custom earmolds) across frequency. Thus, it is concluded that the estimates derived from this study should not be used to replace the more precise individual RECD measurements. Relative to previously available normative RECD values for infants and young children, however, the estimates derived through this study provide somewhat more accurate predicted values for use under those circumstances for which individual RECD measurements cannot be made.

Acoustic Impedance Tests↗

[Initial information on adjustment of speech processor of the cochlear implant].

Adjustment of a speech processor of the cochlear implant is the first procedure in rehabilitation of patients after cochlear implantation. Influence of setting understated and overstated threshold levels of current perception on processing of a speech signal was studied. The results of the study show that only precise estimation of current perception threshold and comfortable loudness allow transmitting maximal acoustic information for each patient.

Cochlear Implantation↗

Intraoperative measurements of male and female distal femurs during primary total knee arthroplasty.

The anteroposterior (AP) and medial-lateral (ML) dimensions of 200 consecutive osteoarthritic knees (100 males and 100 females) undergoing unilateral primary total knee arthroplasty were compared. For all patients, the mean AP dimension was 57.3 mm (range: 49-66 mm) and the dimension was 10.5% taller in height in men than women. The mean ML dimension was 71.6 mm (range: 56-85 mm), and the dimension was 13.7% wider in men than women. The mean AP/ML ratio was 0.8 for all patients, 0.82 (range: 0.73-0.93) for females and 0.79 (range: 0.70-0.89) for males (P<.001). The data suggest that for any given AP femoral dimension, women tend to have a narrower ML dimension than men, independent of AP height, and an AP/ML ratio of 0.80 most closely approximates a standard-sized distal femur across gender. This report documents important gender differences that may serve as a reference for femoral implant designers and knee surgeons.

Adult↗

[Erectile dysfunction in Peyronie's disease. Experience in 132 patients].

BACKGROUND: The exact percentage of sexual dysfunctions resulting from Peyronie's disease remains very difficult to evaluate even today. The purpose of the present paper is to examine the series observed in our Department in order to make an assessment of the erectile function of patients found to be suffering from Peyronie's disease. METHODS: Over the course of 9 years, 132 patients have come to our observation; they were originally examined for sexual function disturbances or for other pathologies of a uro-andrological nature. RESULTS: In all, a total of 208 lesions were observed. Only 21 patients (22.5%) were found to be completely asymptomatic at the time of diagnosis. The most frequent symptom was shaft curvature (alone or in association with pain: 47%). The most commonly observed site for plaques was the back of the corpus cavernosum (43%). Impotentia erigendi was observed in 29 patients (22%) whereas impotentia coeundi was found in 50 (38). The functionally most significant lesions were those affecting the septum or in some way involved with the septum: 19 of 29 patients with impotentia erigendi presented such lesions. CONCLUSIONS: Considering the generally progressive course of the disease, the therapeutic approach taken by our Department is to fit a prosthesis to patients who have been suffering from Peyronie's disease for at least six months; conservative therapy is only undertaken in the rare cases of patients who have a perfectly preserved erection but who suffer from impotentia coeundi (as a result of curvature or pain).

Adult↗