Successful salvage of an infected breast prothesis by changing from continuous to intermittent suction under continuous irrigation

IntroductionImplant-based breast reconstruction is a widely performed procedure. However, prostheses are susceptible to infection and there are currently no established guidelines on treatment. In the present case, a prosthesis was salvaged by changing from continuous irrigation and suction to continuous irrigation and intermittent suction. This case report has been reported in line with the SCARE criteria [1].Presentation of caseA 50-year-old female patient underwent implant-based breast reconstruction following surgery for breast cancer. One month later, the left breast prosthesis was infected with abscesses. Surgical treatment and continuous irrigation were performed as postoperative therapy. However, recurrent infection was detected a few days after surgery. Continuous irrigation was changed to continuous irrigation with intermittent aspiration, which successfully controlled the infection.DiscussionFactors that limit the effectiveness of continuous irrigation and aspiration have not yet been identified. Inflow/discharge shunt routes may be established in continuous aspiration, and, thus, sufficient cleaning may not be possible. On the other hand, the storage of water throughout the wound in intermittent aspiration may facilitate cleaning.ConclusionIntermittent suction worked well in this patient and, thus, warrants further study.     

Immediate rehabilitation of a rheumatoid arthritis patient with single-piece implants

Introduction and importanceThe aim of this article is to report the long-term outcome of full mouth rehabilitation with single piece, smooth surface implants following immediate loading protocol on a patient suffering with RA and severe unilateral condylar resorption.Case presentationHere, we present a challenging case of a patient suffering from Rheumatoid Arthritis who was stabilized and completed successfully with a 4 year follow-up period. Prosthetic management optimized the inter-occlusal relationship to maintain both function and esthetic integrity. Single piece implants are designed to engage and take support from the cortical bone low in metabolic activities thus promoting the force transmission through apical threads that are engaged in the cortical bone.DiscussionRheumatoid Arthritis [RA] is an auto-immune inflammatory condition in which the inflamed and hypertrophic synovial membrane grows into the articulation surfaces. The Temporomandibular Joints [TM] are frequently involved in rheumatoid arthritis. According to the literature on RA, due to frequent periodontitis, decreased salivary secretion, medication, as well as decrease in bone regenerative potential, RA is often considered as a relative contraindication in the use of implants. Atrophic jaws and cases with comorbidities like osteoporosis, diabetes, rheumatoid arthritis, periodontally infected cases are restored with high success by single piece smooth surface.ConclusionTo the best of our knowledge, this may be the first case of immediate functional loading by bi-cortical single piece implants.     

On the secondary stability of coated cementless hip replacement: parameters that affected interface strength

Unlike primary stability of coated cementless implants, their secondary stability has been poorly studied. This paper considers some theoretical aspects of the secondary stability of a coated cementless hip implant in a human femur. The bone is separated from the implant by a thin layer of microscopic peaks and troughs formed on the surface of the coating. The size of the peaks and troughs is very small compared with the macrosize of the implant stem and bone in contact. The study of the bone–stem contact by direct application of the finite element method is prohibitively costly. A two-scale asymptotic homogenisation procedure that takes into account the microgeometry of the interface layer and mechanical properties of bone and the implant material is applied to obtain effective, homogenised contact parameters. These parameters can be used in finite element analyses involving smooth interfaces, which require hundreds of times fewer finite elements. With the homogenisation technique and finite element analyses for a simplified design, two parameters were found to be most important—the normal contact stiffness and the friction coefficient. They both increase several times as bone grows into the rough surface of the implant and mineralises, thus providing a stronger interface and resulting in reduced micromotions.     

Role of anterior retinal cryoablation in the management of neovascular glaucoma

In a prospective study, the effect of anterior retinal cryoablation (ARC) in the management of neovascular glaucoma (NVG) was evaluated over two years, in 72 patients (74 eyes). The outcome of trabeculectomy/seton surgery preceded by 360° ARC was also analysed in 12 eyes of 12 patients (6 eyes in each group). Following ARC, pain relief with dramatic regression of anterior chamber inflammatory reaction was observed in 95% of the patients (59 eyes). At the end of the follow up, as confirmed by iris fluorescein angiography, regression of neovascularization of the iris was documented in 93.5% (58 eyes) of the cases. Intraocular pressure control (22 mm Hg) was achieved in 82.3% (51 eyes) cases. IOP control of 22 mm Hg was achieved in all the 6 eyes with the seton surgery following ARC. Similarly, control of IOP was successfully achieved in all the 6 eyes of patients with NVG with trabeculectomy with post operative course of 5-fluorouracil following ARC. ARC is strongly recommended in NVG, especially in eyes with media opacities and as a preliminary procedure for filtering surgery or drainage implant surgery.Abbreviations ARC Anterior retinal cryoablation - NVG Neovascular glaucoma - NVI Neovascularization of the iris     

Embracing fixator for treating periprosthetic femoral fractures

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Study on Relevance of Endothelin to Abnormal Uterine Bleeding Associated with Long-Term Subdermal Implants Use

Objective To investigate the relationship between estradiol, progesterone and endothelin (ET) and abnormal uterine bleeding after using sub-dermal contraceptive implant Materials & methods A prospective self-control clinical trial was conducted in 29 women in the self-control group. Blood samples were obtained on four occasions across the different phases of menstrual cycle before and after using implant. A blood sample was taken for a single determination in another 59 women in the already-use implant group. Plasma of estradiol, progesterone and endothelin were determined by using radioimmunoassays (RIA) in both groups.Results The level of estradiol and progesterone had no significant differences in women before and after using implant in self-control group. The level of estradiol,progesterone had no differences between women with normal and abnormal menstrual cycle in both groups. The levels of plasma endothelin (ET) in women with abnormal bleeding pattern were higher than women with normal bleeding pattern, but difference was not significant. Women with abnormal bleeding pattern had significantly higher ET level than that in women with normal bleeding pattern before using implants,especially in early-proliferative phase and mid-proliferative phase. the level of plasma endothelin was significantly higher in women with disturbed bleeding pattern than that in normal women in the already-use group.Conclusion High serum concentrations of ET are likely to be correlated with abnormal uterine bleeding in long-term subdermal contraceptive implants users.     

人工耳蜗电极植入耳蜗入口的定位

目的 :确定人工耳蜗电极植入耳蜗入口的位置。方法 :对 2 5具尸头 50耳标本进行人工耳蜗植入手术有关的解剖数据测量。结果 :人工耳蜗电极植入耳蜗鼓阶入口与前庭窗最近距离为 2 .77mm。结论 :该解剖参数为蜗窗难以找到的人工耳蜗植入病例提供了定位参考     

多道听觉脑干植入的临床应用

目的　探讨多道听觉脑干植入的手术方法及其对恢复双侧听神经瘤所致全聋患者听力的效果。方法　 7例双侧听神经瘤患者 ,在肿瘤摘除后将 2 1道听觉脑干植入 (auditorybrainstemimplant,ABI)电极植入于第四脑室外侧隐窝内 ,直接刺激脑干耳蜗核 ,术中以面神经电图、舌咽神经肌电图及电诱发听觉脑干反应 (electricallyevokedauditorybrainstemresponses,EABR)确定电极的正确位置。术后 6周开通装置并调试 ,定期行言语识别能力测试。结果　 6例患者术中均能准确定位外侧隐窝 ,并能记录到典型的EABR ;术后均能获得不同程度的言语识别能力 ,其中 2例获得开放句识别能力。另 1例患者术中解剖定位困难 ,术中未能记录到EABR。术后电极刺激 1例无非听觉反应、5例部分电极产生非听觉反应、1例全部电极均产生非听觉反应 ,有非听觉反应的相应电极被关闭。结论　多道听觉脑干植入能使因双侧听神经瘤而全聋的患者产生有意义的听觉 ,术中正确定位脑干耳蜗核为手术成功的关键。     

多通道人工耳蜗在语前聋儿童及青少年中的应用

目的　通过对植入人工耳蜗的语前聋儿童和青少年的听力和语言能力的评估 ,探讨我国儿童在使用人工耳蜗后的听力和言语能力发展规律及影响因素。方法　 2 5例行人工耳蜗植入的语前聋儿童及青少年患者参与本组测试。选用《聋儿听觉言语康复评估方法》作为测试材料 ,分别进行声音、言语声和环境声的辨别 ,数词、单字词、双字词、3字词、韵母、声母、声调、封闭项列短句的识别 ,开放项列字词和开放项列短句识别 ,语言清晰度 ,模仿句长 ,听话识图和看图说话等方面测试。结果　受试者术后均能感知到声音 ,辨别不同类别的声音。封闭项列测试结果全部大于机会水平 ,正确识别率随人工耳蜗使用时间而不断增加 ,随植入时年龄的增长而呈下降趋势。术后约半年显现开放项列识别能力 ,使用人工耳蜗后对患儿的言语发育具有较大帮助。结论　尽早对语前聋患儿植入人工耳蜗及进行术后康复 ,以达改善听力 ,提高语言能力 ,促进身心全面发展的目的。     

Holmium: YAG laser surgery in obliterated cochleas: an experimental study in human cadaver temporal bones

A pulsed holmium: YAG laser ( = 2120 nm) was used to reopen the basal turn of artificially obliterated human cochleas in freshly dissected cadavers. This allowed intracochlear insertion of the stimulation electrode of a cochlear implant under simulated surgical conditions. Laser energy was transmitted through a 400-m nylon fiber via the opened facial recess directly to the round window niche. At an energy level of 500 mJ per 2.5 s pulse, a repetition rate of 2 Hz, and an exposure time of 20–30 s, the photo-ablative mechanism of laser-bone interaction led to a 8–10 mm recanalization of the basal turn of the cochlea without damaging surrounding structures. The artificial bony occlusion and the recanalized basal turn of the cochlea were visualized by means of computed tomography and studied under light microscopy, using a histologic thin-section technique.Presented at the XVth World Congress of Otorhinolaryngology, Istanbul, Turkey, 23 June 1993