Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 15.108
Filtrar
1.
Methodist Debakey Cardiovasc J ; 20(3): 49-56, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38765211

RESUMEN

For patients with existing venous thromboembolisms (VTEs), anticoagulation remains the standard of care recommended across multiple professional organizations. However, for patients who developed a deep venous thrombosis (DVT) and/or a pulmonary embolism and cannot tolerate anticoagulation, inferior vena cava (IVC) filters must be considered among other alternative treatments. Although placement of a filter is considered a low-risk intervention, there are important factors and techniques that surgeons and interventionalists should be aware of and prepared to discuss. This overview covers the basics regarding the history of filters, indications for placement, associated risks, and techniques for difficult removal.


Asunto(s)
Remoción de Dispositivos , Diseño de Prótesis , Implantación de Prótesis , Embolia Pulmonar , Filtros de Vena Cava , Trombosis de la Vena , Humanos , Embolia Pulmonar/prevención & control , Trombosis de la Vena/prevención & control , Trombosis de la Vena/terapia , Factores de Riesgo , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversos , Resultado del Tratamiento , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/diagnóstico , Vena Cava Inferior/diagnóstico por imagen , Medición de Riesgo , Anticoagulantes/uso terapéutico , Anticoagulantes/efectos adversos
2.
Isr Med Assoc J ; 26(5): 278-282, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38736341

RESUMEN

BACKGROUND: Long-term support with a HeartMate 3 (HM3) left ventricular assist device (LVAD) has improved outcomes of patients with end-stage heart failure. However, there is a paucity of data on the outcomes of patients who underwent concomitant cardiac surgical procedure (CCSP) during HM3-LVAD implantation. OBJECTIVES: To assess our single-center experience with patients who underwent CCSP during the implantation of an HM3-LVAD. METHODS: From December 2016 until April 2022, 131 adult patients underwent HM3-LVAD implantation. A total of 23 patients underwent CCSP during the HM3-LVAD implantation+CCSP, and 108 underwent only HM3-LVAD implantation (HM3-only). RESULTS: The median age was 59 ± 11 years (range 54-67), 82% (n=108) were male, and 76% (n=100) were implanted as a bridge-to-transplant. The concomitant procedures performed during the implantation included 8 aortic valve repairs/replacements, 14 tricuspid valve repairs, 4 patent foramen ovales or atrial septal defect closures, and 3 other cardiac procedures. The mean cardiopulmonary bypass time was 113 ± 58 minutes for the HM3-only group and 155 ± 47 minutes for the HM3+CCSP group (P = 0.007). The mortality rates at 30 days, 6 months, and 12 months post-implantation were 2 (9%), 5 (22%), and 6 (26%) respectively for the HM3+CCSP group, and 7 (6%), 18 (17%), and 30 (28%) for the HM3-only group (P = 0.658, 0.554, and 1.000). CONCLUSIONS: Our experience demonstrated no significant difference in the 30-day, 6-month, and 12-month mortality rates for patients who underwent a CCSP during HM3-LVAD implantation compared to patients who did not undergo CCSP during HM3-LVAD implantation.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Insuficiencia Cardíaca , Corazón Auxiliar , Humanos , Corazón Auxiliar/estadística & datos numéricos , Masculino , Femenino , Persona de Mediana Edad , Insuficiencia Cardíaca/cirugía , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Anciano , Procedimientos Quirúrgicos Cardíacos/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Implantación de Prótesis/métodos
3.
J Orthop Surg Res ; 19(1): 273, 2024 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-38698477

RESUMEN

BACKGROUND: Talar malignant tumor is extremely rare. Currently, there are several alternative management options for talus malignant tumor including below-knee amputation, tibio-calcaneal arthrodesis, and homogenous bone transplant while their shortcomings limited the clinical application. Three-dimensional (3D) printed total talus prosthesis in talus lesion was reported as a useful method to reconstruct talus, however, most researches are case reports and its clinical effect remains unclear. Therefore, the current study was to explore the application of 3D printed custom-made modular prosthesis in talus malignant tumor. METHODS: We retrospectively analyzed the patients who received the 3D printed custom-made modular prosthesis treatment due to talus malignant tumor in our hospital from February 2016 to December 2021. The patient's clinical data such as oncology outcome, operation time, and volume of blood loss were recorded. The limb function was evaluated with the Musculoskeletal Tumor Society 93 (MSTS-93) score, The American Orthopedic Foot and Ankle Society (AOFAS) score; the ankle joint ranges of motion as well as the leg length discrepancy were evaluated. Plain radiography and Tomosynthesis-Shimadzu Metal Artefact Reduction Technology (T-SMART) were used to evaluate the position of prosthesis and the osseointegration. Postoperative complications were recorded. RESULTS: The average patients' age and the follow-up period were respectively 31.5 ± 13.1 years; and 54.8 months (range 26-72). The medium operation time was 2.4 ± 0.5 h; the intraoperative blood loss was 131.7 ± 121.4 ml. The mean MSTS-93 and AOFAS score was 26.8 and 88.5 respectively. The average plantar flexion, dorsiflexion, varus, and valgus were 32.5, 9.2, 10.8, and 5.8 degree respectively. One patient had delayed postoperative wound healing. There was no leg length discrepancy observed in any patient and good osseointegration was observed on the interface between the bone and talus prosthesis in all subjects. CONCLUSION: The modular structure of the prosthesis developed in this study seems to be convenient for prosthesis implantation and screws distribution. And the combination of solid and porous structure improves the initial stability and promotes bone integration. Therefore, 3D printed custom-made modular talus prosthesis could be an alternative option for talus reconstruction in talus malignant tumor patients.


Asunto(s)
Neoplasias Óseas , Impresión Tridimensional , Diseño de Prótesis , Astrágalo , Humanos , Astrágalo/cirugía , Astrágalo/diagnóstico por imagen , Masculino , Adulto , Femenino , Neoplasias Óseas/cirugía , Neoplasias Óseas/diagnóstico por imagen , Estudios Retrospectivos , Persona de Mediana Edad , Adulto Joven , Implantación de Prótesis/métodos , Implantación de Prótesis/instrumentación , Adolescente , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Oseointegración , Resultado del Tratamiento , Rango del Movimiento Articular , Prótesis e Implantes
4.
Otol Neurotol ; 45(5): 556-563, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38693091

RESUMEN

OBJECTIVE: To investigate the feasibility of early sound processor loading with two separate bone-anchored hearing aid implants 1 to 2 weeks after implantation. Secondary endpoints included registration of any postoperative complications, skin reactions, and any adverse events. STUDY DESIGN: Prospective, nonrandomized, noncontrolled, multicenter clinical trial. SETTING: Tertiary referral center. PATIENTS: Sixty adult patients, eligible for bone-anchored hearing aid surgery, were enrolled. INTERVENTION: Implantation of the bone-anchored hearing aid implants were done using minimally invasive surgery with tissue preservation. MAIN OUTCOME MEASURE: Implant stability quotient (ISQ) values were recorded using resonance frequency analysis. Follow-ups were scheduled 5 to 12 days, 4 to 8 weeks, 6 months, and 12 months postoperatively. Differences between the lowest ISQ values (ISQ low) over time were analyzed by paired-samples t test with a significance level of 0.05. Skin and soft tissue reactions were assessed according to Holger's classification. RESULTS: Loading time of the Ponto Wide implant was 11.6 ± 1.4 days (SD) in average (median, 12 d; range, 7-19 d). Loading of the Ponto BHX implant was done 9.7 ± 3.5 days (SD) postoperatively (median, 9 d; range, 5-19 d). The implant stability increased significantly during the 12-month study period with both implants. One Ponto BHX implant was lost. Skin and soft tissue reactions were few in both groups. Across all planned follow-up visits, no skin and soft tissue reactions were observed in 86% (Ponto BHX implant) and 85% (Ponto Wide implant). CONCLUSION: Very early loading of sound processors after percutaneous bone-anchored hearing system surgery is safe already 1 to 2 weeks postoperatively.


Asunto(s)
Audífonos , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Estudios Prospectivos , Resultado del Tratamiento , Anclas para Sutura , Prótesis Anclada al Hueso , Implantación de Prótesis/métodos , Adulto Joven , Anciano de 80 o más Años
5.
Int J Cardiol ; 407: 132113, 2024 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-38697398

RESUMEN

BACKGROUND: Axillary vein puncture (AVP) is a valid alternative to Subclavan vein puncture for leads insertion in cardiac implantable electronic device implantation, that may reduce acute and delayed complications. Very few data are available about ICD recipients. A simplified AVP technique is described. METHODS: All the patients who consecutively underwent "de novo" ICD implantation, from March 2006 to December 2020 at the University of Verona, were considered. Leads insertion was routinely performed through an AVP, according to a simplified technique. Outcome and complications have been retrospectively analyzed. RESULTS: The study population consisted of 1711 consecutive patients. Out of 1711 patients, 38 (2.2%) were excluded because they were implanted with Medtronic Sprint Fidelis lead. Out of 1673 ICD implantations, 963 (57.6%) were ICD plus cardiac resynchronization therapy, 434 (25.9%) were dual-chamber defibrillators, and 276 (16.5%) were single-chamber defibrillators, for a total of 3879 implanted leads. The AVP success rate was 99.4%. Acute complications occurred in 7/1673 (0.42%) patients. Lead failure (LF) occurred in 20/1673 (1.19%) patients. Comparing the group of patients with lead failure with the group without LF, the presence of three leads inside the vein was significantly associated with LF, and the multivariate analysis confirmed three leads in place as an independent predictor of LF. CONCLUSION: AVP, according to our simplified technique, is safe, effective, has a high success rate, and a very low complication rate. The incidence of LF was exceptionally low. The advantages of AVP are maintained over time in a population of ICD recipients.


Asunto(s)
Vena Axilar , Desfibriladores Implantables , Punciones , Humanos , Desfibriladores Implantables/efectos adversos , Masculino , Femenino , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Vena Axilar/diagnóstico por imagen , Implantación de Prótesis/métodos , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/instrumentación , Resultado del Tratamiento , Factores de Tiempo
6.
Artículo en Inglés | MEDLINE | ID: mdl-38727533

RESUMEN

Preoperative calculations showed that the 9-mm inlet, 6-mm outlet, 25-cc pump chambers and 65-73 bpm would be optimal for a 5-year-old patient suffering from restrictive cardiomyopathy, with a body surface area of 0.59 m2 (1.5 L/min flow for a cardiac index of 2.5). After re-sternotomy and standard bicaval cannulation for cardiopulmonary bypass, the procedure was performed under normothermic conditions and on the beating heart. Biventricular support was established with the Berlin Heart Excor using biatrial cannulation. For left atrial cannulation, induced ventricular fibrillation was used. The 9-mm inlet cannulas were inserted into the left and right atria, respectively. The 6-mm outlet cannulas were implanted using 8-mm interposition vascular grafts for the aorta and the main pulmonary artery, respectively. Cannulas were tunnelled through the epigastric space, with systems crossing outside of the body. The 25-cc chambers were used for both right ventricular assist device and left ventricular assist device support, which subsequently showed full emptying and filling.


Asunto(s)
Cardiomiopatía Restrictiva , Corazón Auxiliar , Humanos , Cardiomiopatía Restrictiva/cirugía , Cardiomiopatía Restrictiva/diagnóstico , Masculino , Preescolar , Atrios Cardíacos/cirugía , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/instrumentación , Insuficiencia Cardíaca/cirugía , Implantación de Prótesis/métodos
7.
Vestn Oftalmol ; 140(2): 72-77, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-38742501

RESUMEN

The modern treatment strategy for keratoconus (KC) involves sequential application of medical technologies aimed at stabilizing pathological changes in the cornea and restoring visual acuity. PURPOSE: This study compares the effect of implantation of intrastromal corneal ring segment (ICRS) and fitting of individual scleral rigid contact lenses (RCLs) on visual functions in patients with stage II-III KC after previously performed corneal collagen cross-linking. MATERIAL AND METHODS: The Helmholtz National Medical Research Center of Eye Diseases examined and treated 34 patients (69 eyes) aged 18 to 33 years with stage II-III KC. The study included patients who had previously undergone standard corneal collagen cross-linking. Depending on the type of optical correction, the patients were divided into two groups: patients in group 1 underwent ICRS implantation using a femtosecond laser; patients in group 2 were fitted with individual scleral RCLs. RESULTS: Improvement in clinical and functional parameters was observed in both groups. A higher clinical and functional result was achieved in group 2. CONCLUSION: For patients with stable stage II-III KC, it is advisable to recommend fitting of individual scleral RCLs for visual rehabilitation.


Asunto(s)
Lentes de Contacto , Queratocono , Esclerótica , Agudeza Visual , Humanos , Queratocono/cirugía , Queratocono/diagnóstico , Queratocono/fisiopatología , Queratocono/terapia , Femenino , Masculino , Adulto , Esclerótica/cirugía , Implantación de Prótesis/métodos , Implantación de Prótesis/instrumentación , Resultado del Tratamiento , Topografía de la Córnea , Prótesis e Implantes , Adulto Joven , Ajuste de Prótesis/métodos , Adolescente , Sustancia Propia/cirugía
8.
Arq Bras Oftalmol ; 87(6): e2021, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38597522

RESUMEN

Implantation of glaucoma drainage devices is a valuable therapeutic option, particularly in children with glaucoma refractory to primary surgical treatment. Glaucoma drainage devices are typically used when conjunctival scarring hampers filtration surgery or prior angle procedures are not effective in controlling intraocular pressure. Despite known complications, the use of glaucoma drainage devices in children has increased in recent years, even as the primary surgical option. In this review, we evaluate the results of recent studies involving the implantation of glaucoma drainage devices in children, discussing new advances, and comparing the success rates and complications of different devices.


Asunto(s)
Enfermedades de la Conjuntiva , Implantes de Drenaje de Glaucoma , Glaucoma , Niño , Humanos , Implantes de Drenaje de Glaucoma/efectos adversos , Glaucoma/cirugía , Presión Intraocular , Implantación de Prótesis/métodos , Estudios Retrospectivos , Resultado del Tratamiento
10.
Sci Rep ; 14(1): 7989, 2024 04 05.
Artículo en Inglés | MEDLINE | ID: mdl-38580783

RESUMEN

Regardless of the species, birds are exposed to injuries that lead to amputation of part of the body structure and often euthanasia. Based on the need for new technologies that improve the quality of life of birds with locomotor problems, the present case reports aimed to describe the development of custom-made three-dimensional (3D) prostheses for domestic and wild birds that suffered amputation or malformation of the hind limb. Using the measurements of the bird, a digital model was created for 3D printing using fused deposition modeling technology (FDM) by the Brazilian company 3D Medicine. In this study we report the use of 3D prosthesis for the rehabilitation of three birds with locomotor disorders in Brazil, the animals adapted to the custom-made prosthesis with an improvement in quality of life, better distribution of body weight, locomotion, and landing. This study describes the development of 3D prostheses for birds in Brazil, the first report of this technology for these species, and the pioneering development of socket prostheses for small birds. 3D prostheses offer a high-efficiency solution to improve the quality of life of animals with amputations and malformations of the hind limbs. In addition, 3D technology provides valuable tools for veterinary medicine, developing custom-made models for the most different anatomical demands of animal patients.


Asunto(s)
Miembros Artificiales , Calidad de Vida , Animales , Aves , Impresión Tridimensional , Implantación de Prótesis
11.
Sci Rep ; 14(1): 7959, 2024 04 04.
Artículo en Inglés | MEDLINE | ID: mdl-38575608

RESUMEN

Cranial reconstructions are essential for restoring both function and aesthetics in patients with craniofacial deformities or traumatic injuries. Titanium prostheses have gained popularity due to their biocompatibility, strength, and corrosion resistance. The use of Superplastic Forming (SPF) and Single Point Incremental Forming (SPIF) techniques to create titanium prostheses, specifically designed for cranial reconstructions was investigated in an ovine model through microtomographic and histomorphometric analyses. The results obtained from the explanted specimens revealed significant variations in bone volume, trabecular thickness, spacing, and number across different regions of interest (VOIs or ROIs). Those regions next to the center of the cranial defect exhibited the most immature bone, characterized by higher porosity, decreased trabecular thickness, and wider trabecular spacing. Dynamic histomorphometry demonstrated differences in the mineralizing surface to bone surface ratio (MS/BS) and mineral apposition rate (MAR) depending on the timing of fluorochrome administration. A layer of connective tissue separated the prosthesis and the bone tissue. Overall, the study provided validation for the use of cranial prostheses made using SPF and SPIF techniques, offering insights into the processes of bone formation and remodeling in the implanted ovine model.


Asunto(s)
Miembros Artificiales , Titanio , Ovinos , Animales , Humanos , Prótesis e Implantes , Implantación de Prótesis , Osteogénesis , Oveja Doméstica , Cráneo/diagnóstico por imagen , Aleaciones , Ensayo de Materiales , Propiedades de Superficie
12.
Int J Pediatr Otorhinolaryngol ; 179: 111938, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38579403

RESUMEN

INTRODUCTION: Endoscopic ossicular chain reconstruction (OCR) in adults has demonstrated equivalent outcomes to the traditional microscopic approach. Less data exist on endoscopic OCR outcomes in children, who have unique considerations including a smaller transcanal corridor and variable pathology. The purpose of this study was to investigate surgical and audiometric outcomes in children undergoing fully endoscopic and endoscopic-assisted OCR in both the short and long-term. METHODS: Retrospective review of all children (<17 years) who underwent endoscopic OCR at one tertiary care center between 2017 and 2021. Children undergoing primary and revision endoscopic OCR with either partial (PORP) and total ossicular reconstruction prostheses (TORP) were included. Children undergoing surgery for juvenile otosclerosis or congenital stapes fixation, or any child receiving a stapes prosthesis were excluded. Primary outcome measures were post-operative change in 4 frequency (500 Hz, 1, 2, 4 KHz) air conduction pure tone average (AC PTA) and change in air-bone gap (ABG). Secondary measures included need for readmission and/or revision surgery, complication rate, and surgery duration. RESULTS: Seventeen patients met inclusion criteria. Average age was 11.3 years (range, 5-17 years); 14 were male. A variety of fixed length, titanium total and partial prostheses were used. The most common prosthesis length was 2 mm (range 2-5 mm), and there were no intra- or perioperative complications. Mean long-term follow-up was 2.6 years. Most common pathology was congenital cholesteatoma (11/17, 64%), followed by chronic otitis media with tympanic membrane perforation (5/17, 29.4%), and extruded prosthesis (1/17, 5.9%). Intraoperatively, the most common finding was incus erosion (10/17, 58.8%), followed by malleus erosion (6/17, 35.3%), stapes erosion (4/17, 23.5%), and stapes absence (4/17, 23.5%). Eight children (47%) were reconstructed with PORPs, and 9 children (52.9%) were reconstructed with TORPs. Average ABG improved from 36.8 dB preoperatively to 19.9 dB postoperatively in the short-term and remained stable at 19.5 dB in the long-term. Average short-term ABG improvement was 4.2 dB for PORPs and 18 dB for TORPs. In the long-term, average ABG improved by 2.3 dB in PORPs and 13.4 dB in TORPs. PORPs had higher rates of ABG closure and lower AC PTAs than TORPs in the long-term. DISCUSSION: Endoscopic ossiculoplasty is a viable option in children presenting with ossicular erosion from various causes. Audiometric improvement following endoscopic partial and total ossicular reconstruction remains stable over time, with a preference towards partial in the long-term, and mirrors published outcomes for microscopic surgery.


Asunto(s)
Prótesis Osicular , Reemplazo Osicular , Adulto , Humanos , Masculino , Niño , Femenino , Titanio , Implantación de Prótesis , Oído Medio , Estudios Retrospectivos , Resultado del Tratamiento
13.
Arch Ital Urol Androl ; 96(1): 12214, 2024 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-38572722

RESUMEN

INTRODUCTION AND OBJECTIVES: Artificial urinary sphincter (AUS) is a treatment option for women with stress urinary incontinence (SUI) after failure of previous surgery or as a primary procedure in severe intrinsic sphincter deficiency (ISD). The aim of the study was to assess the long-term efficacy and risk factors for surgical revision and definitive explantation of AUS laparoscopic implantation in female patients. METHODS: A retrospective review of all women submitted to AUS implantation between April 2005 and March 2023 was conducted. The AUS was implanted via transperitoneal laparoscopic approach, by two experienced surgeons. The primary endpoint was postoperative continence. Continence was defined as no leakage and no pad usage or leakage and/or pad usage with no impact on social life and failure as leakage and/or pad usage impacting social life. As secondary outcomes, clinical predictive factors for AUS revision and definitive explantation were evaluated. RESULTS: In the last 18 years, females with a mean age of 68±12 years-old were submitted to laparoscopic implantation of AUS. Early overall complication rate was 16%, but only one case was Clavien-Dindo ≥3. After a median follow-up of 67 months, 22.2% of the patients needed a device revision, the majority due to mechanical device dysfunction. AUS definitive explantation was performed in 16%, mainly due to urethral/vaginal erosion (9.9%) and infection (6.2%). Patients with age ≥70 years and follow-up ≥10 years significantly predisposed for device revision. At the time of the last follow-up, 72% of the patients were keeping the urinary continency. CONCLUSIONS: Laparoscopic AUS implantation in females is an effective treatment for SUI due to ISD. Meanwhile, adequate patient selection, multidisciplinary evaluation and careful expectation management are essential to achieving good results, concerning their significant complication rate.


Asunto(s)
Laparoscopía , Enfermedades Uretrales , Incontinencia Urinaria de Esfuerzo , Esfínter Urinario Artificial , Humanos , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Esfínter Urinario Artificial/efectos adversos , Resultado del Tratamiento , Incontinencia Urinaria de Esfuerzo/cirugía , Incontinencia Urinaria de Esfuerzo/etiología , Laparoscopía/efectos adversos , Uretra/cirugía , Enfermedades Uretrales/cirugía , Implantación de Prótesis/métodos , Estudios Retrospectivos
14.
J Orthop Surg Res ; 19(1): 210, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38561755

RESUMEN

OBJECTIVE: This study aims to biomimetic design a new 3D-printed lattice hemipelvis prosthesis and evaluate its clinical efficiency for pelvic reconstruction following tumor resection, focusing on feasibility, osseointegration, and patient outcomes. METHODS: From May 2020 to October 2021, twelve patients with pelvic tumors underwent tumor resection and subsequently received 3D-printed lattice hemipelvis prostheses for pelvic reconstruction. The prosthesis was strategically incorporated with lattice structures and solid to optimize mechanical performance and osseointegration. The pore size and porosity were analyzed. Patient outcomes were assessed through a combination of clinical and radiological evaluations. RESULTS: Multiple pore sizes were observed in irregular porous structures, with a wide distribution range (approximately 300-900 µm). The average follow-up of 34.7 months, ranging 26 from to 43 months. One patient with Ewing sarcoma died of pulmonary metastasis 33 months after surgery while others were alive at the last follow-up. Postoperative radiographs showed that the prosthesis's position was consistent with the preoperative planning. T-SMART images showed that the host bone was in close and tight contact with the prosthesis with no gaps at the interface. The average MSTS score was 21 at the last follow-up, ranging from 18 to 24. There was no complication requiring revision surgery or removal of the 3D-printed hemipelvis prosthesis, such as infection, screw breakage, and prosthesis loosening. CONCLUSION: The newly designed 3D-printed lattice hemipelvis prosthesis created multiple pore sizes with a wide distribution range and resulted in good osteointegration and favorable limb function.


Asunto(s)
Neoplasias Óseas , Neoplasias Pélvicas , Humanos , Diseño de Prótesis , Biomimética , Titanio , Implantación de Prótesis/métodos , Neoplasias Pélvicas/cirugía , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Neoplasias Óseas/patología , Estudios Retrospectivos , Resultado del Tratamiento , Impresión Tridimensional
15.
Ann Plast Surg ; 92(4S Suppl 2): S96-S100, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38556655

RESUMEN

PURPOSE: Osseointegration (OI) is a novel alternative to traditional socket-suspended prostheses for lower-limb amputees, eliminating the socket-skin interface and allowing for weight bearing directly on the skeletal system. However, the stoma through which the implant attaches to the external prosthesis creates an ingress route for bacteria, and infection rates as high as 66% have been reported. The aims of this study are to classify infection management and long-term outcomes in this patient population to maximize implant salvage. METHODS: An institutional review board-approved retrospective analysis was performed on all patients who underwent lower-limb OI at our institution between 2017 and 2022. Demographic, operative, and outcome data were collected for all patients. Patients were stratified by the presence and severity of infection. Chi-square and t tests were performed on categorical and continuous data, respectively, using an alpha of 0.05. RESULTS: One hundred two patients met our study criteria; 62 had transfemoral OI and 40 had transtibial OI. Patients were followed for 23.8 months on average (range, 3.5-63.7). Osteomyelitis was more likely than soft tissue infection to be polymicrobial in nature (71% vs 23%, P < 0.05). Infections at the stoma were mostly (96%) managed with oral antibiotics alone, whereas deeper soft tissue infections also required intravenous antibiotics (75%) or operative washout (19%). Osteomyelitis was managed with intravenous antibiotics and required operative attention; 5 (71%) underwent washout and 2 (29%) underwent explantation. Both implants were replaced an average of 3.5 months after explantation. There was no correlation between history of soft tissue infection and development of osteomyelitis (P > 0.05). The overall implant salvage rate after infection was 96%. CONCLUSIONS: This study describes our institution's experience managing infection after OI and soft tissue reconstruction. Although infections do occur, they are easily treatable and rarely require operative intervention. Explantation due to infection is rare and can be followed up with reimplantation, reaffirming that OI is a safe and effective treatment modality.


Asunto(s)
Miembros Artificiales , Osteomielitis , Infecciones de los Tejidos Blandos , Humanos , Oseointegración , Implantación de Prótesis , Estudios Retrospectivos , Infecciones de los Tejidos Blandos/etiología , Miembros Artificiales/efectos adversos , Resultado del Tratamiento , Antibacterianos/uso terapéutico , Osteomielitis/etiología , Osteomielitis/cirugía
17.
J Oral Implantol ; 50(1): 9-17, 2024 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-38579116

RESUMEN

The goal of this clinical report was to present an alternative to traditional flat bone reduction guides, using a custom-designed 3-dimensional (3D)-printed guide according to the future gingival margin of the planned dentition. A 61-year-old woman with concerns regarding her smile appearance was presented. The initial examination revealed excessive gingival show accompanied by excessive overjet. The dentition was in a failing situation. The proposed treatment plan, relying on the sufficient amount of bone and keratinized tissue, consisted of recontouring of the alveolar ridge and gingiva and placement of 6 implants and an FP-1 prosthesis after extraction of all remaining maxillary teeth. Digital smile design was completed, and a fully digitally guided surgery was planned. This consisted of using 3 surgical guides, starting with the fixation pin guide, continuing with the scalloped hard- and soft-tissue reduction guide, and finally the implant placement template. Following the surgery, the patient received a temporary restoration, and on the 4-month follow-up, a new polymethyl meta-acrylate temporary prosthesis was delivered. The patient's 7-month follow-up is presented in the article. The report of this triple-template guided surgery indicated that digital 3D planning is a considerably predictable tool to properly establish and evaluate future occlusal plane, smile line, and lip support. Scalloped guides seem to be an excellent alternative to conventional bone reduction guides since they require less bone removal and improve patient comfort during surgery.


Asunto(s)
Implantación Dental Endoósea , Implantes Dentales , Humanos , Femenino , Persona de Mediana Edad , Implantación Dental Endoósea/métodos , Proceso Alveolar , Encía/cirugía , Implantación de Prótesis , Prótesis Dental de Soporte Implantado
18.
Catheter Cardiovasc Interv ; 103(6): 909-916, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38584525

RESUMEN

BACKGROUND: Utilization of right ventricular mechanical circulatory support (RV-MCS) devices has been limited by a lack of recognition of RV failure as well as a lack of availability and experience with RV-MCS. AIMS: We report a single-center experience with the use of percutaneous RV-MCS and report predictors of adverse outcomes. METHODS: This was a single-center retrospective cohort study. Data from consecutive patients who received RV-MCS for any indication between June 2015 and January 2022 were included. Data on baseline comorbidities, hemodynamics, and laboratory values were collected. The primary outcome was in-hospital mortality analyzed as a logistic outcome in a multivariable model. These variables were further ranked by their predictive value. RESULTS: Among 58 consecutive patients enrolled, the median age was 66 years, 31% were female and 53% were white. The majority of the patients (48%) were hospitalized for acute on chronic heart failure. The majority of the patients were SCAI SHOCK Stage D (67%) and 34 (64%) patients had MCS placed within 24 h of the onset of shock. Before placement of RV-MCS, median central venous pressure (CVP) and RV stroke work index were 20 mmHg and 8.9 g m/m2, respectively. Median serum lactate was 3.5 (1.6, 6.2) mmol/L. Impella RP was implanted in 50% and ProtekDuo in the remaining 50%. Left ventricular MCS was concomitantly used in 66% of patients. Twenty-eight patients (48.3%) died. In these patients, median serum lactate was significantly higher (4.1 [2.3, 13.0] vs. 2.2 [1.4, 4.0] mmol/L, p = 0.007) and a trend toward higher median CVP (24 [18, 31] vs. 19 [14, 24] mmHg, p = 0.052). In the multivariable logistic model, both serum lactate and CVP before RV-MCS placement were independent predictors of in-hospital mortality. Serum lactate had the highest predictive value. CONCLUSION: In our real-world cohort, 52% of patients treated with RV-MCS survived their index hospitalization. Serum lactate at presentation and CVP were the strongest predictors of in-hospital mortality.


Asunto(s)
Insuficiencia Cardíaca , Corazón Auxiliar , Mortalidad Hospitalaria , Recuperación de la Función , Disfunción Ventricular Derecha , Función Ventricular Derecha , Humanos , Femenino , Masculino , Estudios Retrospectivos , Anciano , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/diagnóstico , Resultado del Tratamiento , Persona de Mediana Edad , Factores de Riesgo , Factores de Tiempo , Disfunción Ventricular Derecha/fisiopatología , Disfunción Ventricular Derecha/mortalidad , Disfunción Ventricular Derecha/etiología , Disfunción Ventricular Derecha/terapia , Disfunción Ventricular Derecha/diagnóstico por imagen , Medición de Riesgo , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/mortalidad , Biomarcadores/sangre
20.
Arq Bras Oftalmol ; 87(4): e2022, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38656019

RESUMEN

We present a case report detailing the successful phacoemulsification surgery with artificial iris implantation for two individuals with oculocutaneous albinism. These women suffered from cataracts, resulting in reduced visual acuity and heightened photophobia due to iris pigmentary epithelium deficiency. The patients underwent phacoemulsification along with prosthetic artificial iris implantation into the posterior chamber. This intervention resulted in improved visual acuity, reduced photophobia and glare, and an overall enhanced quality of life. Our report highlights two cases of successful phacoemulsification and artificial iris implantation in patients with oculocutaneous albinism and cataracts, leading to improved visual acuity, reduced photophobia, and enhanced quality of life. Notably, there are no prior records in South American literature of cataract surgery combined with artificial iris implantation for oculocutaneous albinism patients up to the time of this publication.


Asunto(s)
Albinismo Oculocutáneo , Iris , Facoemulsificación , Agudeza Visual , Humanos , Albinismo Oculocutáneo/cirugía , Albinismo Oculocutáneo/complicaciones , Femenino , Iris/cirugía , Facoemulsificación/métodos , Resultado del Tratamiento , Catarata/complicaciones , Catarata/congénito , Calidad de Vida , Adulto , Órganos Artificiales , Implantación de Prótesis/métodos , Persona de Mediana Edad , Fotofobia/cirugía , Fotofobia/etiología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...