Incorporation of microporous Teflon tracheal prostheses in rabbits: evaluation of surgical aspects

Because tracheal prostheses made of nonporous silicone rubber develop granulation tissue at the anastomoses, we tested a prosthesis made of a microporous material (polytetrafluoroethylene, Teflon) to see whether this problem could be avoided and the prosthesis could be successfully incorporated (luminal side covered by connective tissue and epithelium). At various times after implantation in the cervical trachea of rabbits, the prostheses were inspected macroscopically for obstruction of the prosthesis lumen (lumen reduced by one-third or more) and microscopically for incorporation and inflammatory reaction (concentration of inflammatory cells) of the prosthesis. The prosthesis was successfully incorporated within 2-4 weeks in most rabbits without granulation tissue at the anastomoses. Two complications were infection of the prosthesis before incorporation was completed and obstruction of the lumen in the center of the prosthesis by granulation tissue or a deformed prosthesis wall. Both problems can be overcome, the first by giving an appropriate antibiotic for a longer period and the second by making a stiffer prosthesis. Thus, the microporous Teflon prosthesis is potentially useful as a tracheal prosthesis in rabbits.     

The surgical treatment of the diastasis recti abdominis: an original technique of prosthesis repair of the abdominal wall

The Authors talk about on the surgical correction of the diastasis recti abdominis and underline its indications and aims. Firstly, they specify the possibilities and define the limits of the traditional surgical method. Secondly, they illustrate the rational of an innovating and original technique of prosthesis repair of the abdominal anterior wall setted up to treat the important diastasis recti abdominis. Particularly, this technique is the result of a kind of eclecticism and integration of some phases of the Quénu's self-plastic surgery and of the Welti-Eudel and Chevrel's technique. Thirdly, the authors describe the sequence of the times of the new technique and present the preliminary clinical experience carried out with it. Therefore, they determine gratifying and encouraging the findings of this method as regards the immediate and enduring curative efficacy (cosmetic and functional), the security and the compliance of the patient. Finally, in accordance with the outcomes, the authors decide to defend the undoubted reliability of the prosthesis repair of the abdominal wall to treat the big diastasis recti abdominis. Moreover, they intend to pass definitive judgement on the method after further clinical experiences on larger series of cases.     

Anamolous Course of Right Common Carotid Artery in a Case of Papillary Carcinoma Thyroid

Anamolous Course of Carotid Artery is one of the rarest of the rare anamoly, we describe one such case of anamolous Course of Right Common Carotid Artery.     

Dislocation into the cardial lumen of a PTFE prosthesis used in the treatment of voluminous hiatal sliding hernia, A case report

The authors report a case in which a PTFE prosthesis, used to treat a voluminous hiatal sliding hernia, dislocated inside the cardial lumen. Within two months the prosthesis had become decubitant and penetrated the cardial lumen, causing dysphagia, inappetence and weight loss. The use of radiological and tomographic imaging failed to provide a clear diagnosis; endoscopy alone was conclusive. Surgery was required to remove the prosthesis by resecting the distal esophagus and reconstructing the continuity of the digestive tract using terminolateral esophagogastric anastomosis (front wall of the stomach) in CEEA 21. The absence of a clear etiopathogenetic sequence of the migration of the prosthesis prompted the authors to stop using this type of surgery.     

Hemodynamic and mechanical performance of arterial grafts assessed by numerical simulation: a design oriented study

The hemodynamic and mechanical characteristics of an end-to-end implanted prosthesis for a small artery were theoretically investigated. The changes in the main physical and geometrical properties of the prosthesis were simulated by means of a numerical model of arterial hemodynamics. Variation in the pressure-radius curve due to changes in lumen size, wall thickness, elasticity, and tapering were considered. The effects of such changes on pressure, flow, and wall stresses during the cardiac cycle were evaluated. To avoid superimposing the effects, only 1 of the graft properties was varied with respect to a reference condition in each simulation. A prosthesis with a reduced lumen size (20%) was subjected to higher shear stress, which was dangerously doubled. Wall thickening (200%) primarily determined decreased circumferential stress (300%) and increased wall shear stress (48%) because it caused a reduction of the graft lumen size. The time averages of flow and pressure over the cardiac cycle were not significantly influenced by the simulated changes, being imposed primarily by the proximal and distal circulations.     

Femoral implant neck fracture following total hip arthroplasty. A report of three cases

Femoral neck fracture following total hip arthroplasty (THA) is an infrequent complication. Of 1808 T-28 and TR-28 THA performed at our clinic, 32 fractures of the femoral stem occurred, but none through the femoral neck. Two femoral neck fractures ten years following Trapezoidal-28 THA have recently been referred to our clinic. A separation of the head and neck of a Dual Lock prosthesis at two years was also referred. Failure of these implants suggests that significant forces are encountered in this region of a femoral component. Newer modular implant designs must consider these loads.     

Use of prosthetic materials in incisional hernias: our clinical experience

Incisional hernias are fairly frequent complications of surgery. Such complications are presented by variable percentages ranging from 1% to 8% for non complicated laparotomies and from 10% to 15% in case of infection. The therapeutic possibilities are abdomino-plastic with direct suture and the use of prosthesis. The percentage of recurrency varies from 30% to 50% and from 0% to 19% respectively. From May 2000 to September 2003, the Authors operated 64 patients. In 30 cases they opted for a direct suture approach, in 34 cases a prosthesis was used. Of the 34 patients, 18 were treated using polypropylene mesh placed below the rectus muscles and above the peritoneum (Rives technique); 10 with PTFEe (Polytetrafluoroethylene expanded) prosthesis placed in intraperitoneal site and 6 were treated with SIS prosthesis (Small Intestine Submucosa), 3 placed using the Rives technique and 3 in intraperitoneal site. Nine patients had associated operations. The use of prosthesis in the management of incisional hernias has brought a considerable reduction in the percentages of recurrency, especially in cases of associated pathologies. The availability of SIS in the market has permitted the use of this prosthesis even in case of contaminated and/or infected fields. In a follow-up ranging from 3 years to 3 months (mean 18 months) the Authors observed 2 cases of recurrence in the group of direct suture. Despite the advantages offered by the use of prosthesis, we can affirm that there is no "universal" prosthesis. Their selection should be evaluated on the bases of the site and the dimensions of the incisional hernia, the possibility of infection, the surgical technique and the site of prosthetic placement in the abdominal wall.     

Delayed rupture of common carotid artery following rugby tackle injury: a case report

Background  

Common Carotid Artery (CCA) is an uncommon site of injury following a blunt trauma, its presentation with spontaneous delayed rupture is even more uncommon and a rugby tackle leading to CCA injury is a rare event. What makes this case unique and very rare is combination of all of the above.     

Structure of the venous wall of the pampiniform plexus in idiopathic varicocele

The Authors discuss about some histologic patterns observed in 100 pampiniform plexus specimens of patients who underwent direct scrotal surgery for idiopathic varicocele. Tunica media was involved in all of 81 specimens in which Authors observed a vascular wall thickening. Out of these, localized hypertrophic phenomena, leading to segmental vascular obliteration, prevailed (74%) on widespread forms (26%). In advanced focal localizations subintimal fibrous pads were demonstrated. In 96% of cases hypertrophy affected the muscular layer too, respectively in focal (41%) and diffuse (59%) way. In 85% of cases fragmentation of lamina elastica interna was associated to media hypertrophy. In 69%, venous lumen was dilated, frequently in association with wall thickening, while only in 12 specimens all vascular layers were reduced. Occlusive endoluminal thrombi were evident in 12%. At last the Authors underline how the wall pathologic modifications do not involve all the veins within the same plexus, and stress on the possible physiopathologic relationships between this fact and different haemodynamic and clinic conditions.     

Radiotherpay and immediate breast reconstruction with myocutaneous flap in breast cancer of reserved prognosis

In France, immediate breast reconstruction (IBR) for infiltrating carcinoma remains controversial. Many teams advocate the possible event of a post mastectomy radiotherapy and its negative effect on IBR. In our Institute we do not exclude infiltrating breast cancer patient from IBR. In the poor prognostic patients who wish IBR, we recommend autologous IBR to obtain the best aesthetic result with minimum revision procedures and best tolerance to adjuvant radiotherapy. From January 1993 to December 1997, we performed 687 IBR with myocutaneous flap for infiltrating carcinomas. In this group only 68 patients needed postoperative chest wall radiotherapy (45 Gy): 27 TRAM flap, 41 latissimus flap. Only one of the TRAM but 39 of latissimus flaps were associated with a prosthesis. The mean follow-up was 24 months. Fourteen patients developed metastatic disease, and ten were dead at the time of the chart revue. The autogenous TRAM flap tolerate radiation quite well and remain soft and mobile. The latissimus flap associated with a prosthesis developed capsular contracture (BAKER II or III) in 71% of cases. In all cases the cosmetic impairment was not important and the result after capsulectomy remained soft. We concluded that IBR could be offered to motivated patients in all stages of the disease regardless of the subsequent chest wall radiotherapy, and we recommend its use for possible autologous reconstruction.     

Schenkelhalsendoprothese nach medialer Schenkelhalsfraktur bei ipsilateraler langstieliger Knietumorendoprothese

Femoral neck fracture in the case of a previously implanted ipsilateral tumour knee-prosthesis represents a challenging situation because of the long proximal stem of the knee implant. Avoiding total femur replacement, we implanted a femoral neck prosthesis (Eska Cut 2000) in a 65 year old patient to preserve as much of the femur free of implant as possible, minimizing the risk of a periprosthetic or interprosthetic fracture. At 2.5 years postoperatively, there were no signs of loosening, migration or periprosthetic fracture with a good functional result.In our case, the femoral neck prosthesis avoided the implantation of a total femur replacement. Nevertheless, this prosthesis must be considered critically and cannot be recommended as the standard implant for femoral neck fracture in the case of an ipsilateral long stem-knee prosthesis.     

股骨质量对人工髋关节置换之影响的三维有限元分析

目的　探讨股骨质量对非骨水泥型人工髋关节置换术后稳定性及应力变化的影响 ,论证三维有限元分析作为个体化假体选择临床前评价手段的可行性及价值。方法　采用三维有限元分析模型 ,对骨质正常骨与骨质疏松骨进行股骨应力、界面位移的计算 ,并与实验值比较。结果　正常骨的股骨应力比疏松骨的股骨应力大 ,非骨水泥有肩托假体 (NCC)能增加股骨矩处压应力 ,但同时大粗隆处应力减少。骨质量不同对应力改变的趋势没有影响。骨质量差者 ,界面位移大。三维有限元分析结果与生物力学实验结果比较接近。结论　三维有限元分析是目前被认为可以根据病人的股骨质量进行个体化假体选择的有前途的研究方法。骨质量是影响假体的初始稳定性及应力变化的因素     

Endoprosthesis of the trachea in the treatment of cicatricial stenosis with tracheomalacia

The authors discuss the results of the first experience in the clinical use of nitinol spiral endoprostheses as an artificial supporting framework of the trachea in local destruction of the tracheal cartilages and loss of rigidity of the tracheal wall. Tracheal endoprosthetics was carried out in 6 patients with cicatrical stenoses and tracheomalacia. The causes of possible complications (growth of granulation tissue into the tracheal lumen and displacement of the endoprosthesis) are analysed and the means of their prevention are suggested. It was established that the nithinol spiral endoprosthesis may be covered by epithelialized tracheal mucosa and provide an adequate rigid lumen for the tracheal area devoid of the framework. The diameter of the implanted prosthesis must be 2-3 mm larger than the diameter of the normal tracheal lumen. Temporary introduction of a protector tube into the repaired trachea may shorten the duration of treatment significantly.     

Late cutaneous fistulae after prosthetic hernia repair of the abdominal wall

Late cutaneous fistulae, after a hernioplasty operation for a hernia in the abdominal wall, represent an unusual complication. They can appear a considerable time after a hernioplasty operation and feature the presence of a fistula between the prosthesis and the cutaneous wall. The Authors report the cases of five patients who developed late cutaneous fistulae after an operation for the repair of a hernia of the abdominal wall and the treatment established in the end to correct the existing complication. All five patients were subjected to a second operation to achieve recovery. In fact, conservative medical treatment, before the operation, using antibiotic-therapy for this purpose proved to be ineffective. Only one patient developed hernia recurrence after surgical treatment. Late cutaneous fistulae represent a complication that is difficult to deal with as their treatment has yet to be clearly identified.     

Penetrating aortic ulcer post migration of thoracic aortic endoprosthesis: Case report

IntroductionThoracic endovascular aortic repair (TEVAR) is the first treatment option for many thoracic aortic pathologies. Especially after aortic dissections, it is possible to have progression during follow-up with appearance of new lesions on arterial wall. Herein, we report a case of Penetrating Aortic Ulcer (PAU) post release of Thoracic endoprosthesis.Presentation of caseA 67-years-old male with hypertension and diabetes mellitus was followed at our hospital after an emergency procedure for Type B aortic dissection (TBAD) complicated by symptomatic large infrarenal AAA and treated with a proximal TEVAR plus chimney for left subclavian artery and PETTICOAT with EVAR for abdominal aortic disease. Follow up at 15 months showed a deep PAU with partial crush of stent in Left Subclavian Artery. Thus, we performed a left carotid-subclavian bypass and subsequently a TEVAR procedure with release of Bolton Relay endoprosthesis (Terumo Aortic, Sunrise, Florida, United States).DiscussionIn literature there are few studeis that focus on migration after TEVAR during follow-up. Elongation, changes of tortuosity on thoracic aorta after TEVAR, can help to determine a migration of prosthesis. In this case Bolton Relay endoprosthesis (Terumo Aortic, Sunrise, Florida, United States) has permitted to improve precision and quality of procedure.ConclusionIn literature there are few studies reporting complications of TEVAR post prosthesis migration. In this case, Bolton Relay endoprosthesis was useful and safe.     

用肺组织瓣重建胸段气管的动物实验与临床应用

目的 探讨用肺组织瓣重建胸段气管的可行性。方法 健康犬15只,切除其长6～8个气管软骨环、周径1／2以上的气管前、后壁,内置镍钛合金网架。游离邻近带血管蒂的肺组织瓣,缝合修补气管壁之缺损。分别于术后2～12个月处死动物,观察气管缺损部位的修复情况,并取材行光学显微镜及电镜检察。临床上用此方法治疗4例患者,其中1例右主支气管因瘢痕狭窄闭锁,1例主气管下段混合瘤恶变,2例左主支气管类癌。结果 实验犬呼吸道通畅、无狭窄及肉芽组织形成,用于修复的肺组织瓣和金属网架表面覆盖有较完整的假复层纤毛柱状上皮。临床治疗的4例患者,均顺利恢复正常呼吸功能,随访疗效稳定。结论 肺组织瓣是较理想的胸段气管重建材料。     

Treatment of post-operative ventral hernia: elementary biomechanical basis. Report of 51 cases treated by mersilene mesh (author's transl)]

Elementary functional anatomy of the normal abdominal wall and following incisional hernia are described. The treatment of postoperative hernia should be based on this: its object is to restore the morphology and functions of the abdominal wall, in particular its respiratory function. It may be necessary to carry out gradual pneumo-peritoneum before parietal repair. A mersilene mesh was used by the authors in 51 cases. Certain rules should be observed when this prosthesis is placed in position so that the abdominal muscles find the conditions closest to their normal function.     

Eight years' experience with an artificial extra-thoracic esophagus

A new type of extra-thoracic esophageal prosthesis or external esophagus is described. The upper end is attached over the esophageal stoma and the lower end is inserted into the gastrostomy opening. The upper portion can be detached and exchanged for an insertion type attachment. With the use of this so called "telescope type" of prosthesis, dilatation of the esophageal stoma due to softening of the tissues with leakage of food or dislodgement of the prosthesis or mechanical injury to the esophageal mucosa when the prosthesis is inserted into the esophageal lumen, is avoided. Our experience with its use for considerable period of time up to 8 years and 2 months has been satisfactory in 25 patients enabling the patients to eat normally. No serious complication arising from its use was observed.