Right pneumonectomy syndrome in infancy treated with an expandable prosthesis

Severe respiratory distress developed in a 5-month-old infant approximately ten days after pneumonectomy for complete sequestration of the right lung. Right pneumonectomy syndrome was diagnosed by bronchography, which revealed thinning and obstruction of the left main bronchus during expiration. A right thoracotomy was then performed, and an inflatable tissue expander with a subcutaneous injection port was inserted into the right chest cavity to prevent recurrence of the mediastinal shift and to allow for future growth. The patient has done well, requiring reinjection of the prosthesis with additional volume on one occasion in a 20-month period of follow-up.     

可延长假体研究进展

青少年四肢恶性骨肿瘤的临床治疗现多采用保肢疗法,其最主要的方法是采用人工关节置换术.骨骼未发育成熟患儿关节置换术后肢体生长受到影响,可引起肢体不等长、骨盆倾斜、脊柱侧弯等诸多问题,临床现多主张使用可延长人工假体进行治疗,既使患者肢体功能得以保留,又解决患肢与健肢发育过程中的不等长问题,从而获得良好的临床疗效.该文就组合型可延长假体、微创可延长假体、无创可延长假体的研究应用进展作一综述,近年来还有学者提出生物型可延长假体的概念.     

Limb salvage in pediatric surgery. The use of the expandable prosthesis

Limb sparing in growing children has proved to be very effective from an oncologic perspective, with good, long-term acceptance by the patients. As in the adult, when performed by experienced surgeons, limb sparing neither compromises the survival rate nor significantly increases the local recurrence rate, compared with cross-bone amputation. Discussions include patient evaluation, surgical options, materials and methods, and results.     

Descending aorta substitution with expandable ends prosthesis. Case report.

A case of esophageal cancer infiltrating the left bronchus pars membranacea and the aneurysmal aortic wall was resected en bloc with the bronchial and aortic wall. Descending aorta was substituted by means of a Dacron prosthesis fitted with expandable devices at both ends, allowing a very significant reduction of the clamping time and simplification of this part of the procedure.     

The use of a closed expandable prosthesis for pediatric sarcomas

PURPOSE: The purpose of this paper is to review our experience with a non-invasive expandable prosthesis for skeletally immature patients following limb-salvage for malignant tumors about the knee. MATERIALS & METHODS: Between 1998 and 2002, Repiphysis prostheses (Wright Medical Technology, Memphis, Tenn.) were implanted in 18 patients. 16 patients had at least 12 months follow-up. There were 10 males and 8 females. The diagnosis was Stage IIB osteosarcoma in all patients. Sites included femur 14, and 4 proximal tibias. The average age was 10.7 years (range 8-16); the average age for males was 12 years and females, 9 years. Fifteen of the prostheses were implanted at the time of surgical resection and the remainder was conversions of previous surgery. RESULTS: Follow-up averaged 24.8 months (range 12-47). Fourteen patients have undergone a total of 58 lengthening procedures. Average expansion 38 mm per patient (range, 10-76 mm). An average of 8.5 mm per lengthening procedure. There was only one failure to lengthen. ISOLS functional scores averaged 83.5%. For those with a current functional prosthesis, the ISOLS score averaged 94%. Three patients have reached maximal expansion and converted to a conventional prosthesis. There were complications in 7 patients: 2 expandable component fractures, 1 femoral component fracture, 2 stem fractures, 1 stem loosening and 1 deep infection. Of the two expandable component fractures, 1 patient reached full expansion and was converted to an endoprosthesis. The femoral component fracture and 2 stem fractures were revised to a new prosthesis 13 months post-op and are functioning well. The 1 loose stem was revised to an APC. CONCLUSIONS: The Repiphysis prosthesis utilizes energy stored in a spring that is held compressed by a locking mechanism. Controlled release of the locking mechanism via an external electromagnetic field allows for lengthening of the device. In our early experience, the functional results were excellent similar to conventional modular devices. Complications should be anticipated but are salvageable. This device allows limb salvage in pediatric patients when amputation would be otherwise chosen.     

An expandable anchor for fixation in osteoporotic bone.

With the aging population, osteoporosis and osteoporotic fractures are becoming more prevalent. Adequate screw fixation in this type of bone is difficult. Screws are often cemented in bone to help obtain purchase. However, cement augmentation is not without problems. Here we present an expandable anchor for fixation in osteoporotic bone that does not require cement. We compared the ultimate holding power of this expandable anchor to a standard solid screw of similar dimensions. The solid screw and the expandable anchor were both placed into fresh frozen lumbar vertebral bodies and pulled out using a mechanical testing system. The expandable anchor had a 74% greater holding power compared to the standard screw (P = 0.02). The expandable anchor provides a significant increase in holding power without the problems associated with cement. This prototype anchor is promising for fixation in osteoporotic bone and warrants further evaluation.     

Late-onset chylothorax following extrapleural pneumonectomy for mesothelioma

We report a 64-year-old woman treated with surgical intervention for late-onset chylothorax following a pleuropneumonectomy. The patient underwent an extrapleural pneumonectomy for diffuse malignant mesothelioma and was uneventfully discharged on postoperative day 29. Pleural effusion aspirated on postoperative day 9 was dark red. A chest roentgenogram taken at our outpatient clinic revealed a mediastinal shift on postoperative day 56. No bacterial infection was found in the milky effusion. We made a diagnosis of postoperative late-onset chylothorax based on the laboratory data obtained from tests of the pleural fluid. A repeat thoracotomy to ligate the lymphatic duct was performed because conservative management with chest tube drainage and no oral feeding was unsuccessful. The patient was discharged after the operation with a good clinical course.     

An unusual complication of penile prosthesis following urethroplasty

We report a case of an adult who had undergone transpubic urethroplasty for a 5-cm long posterior urethral stricture. A malleable penile prosthesis (AMS 600R) was implanted 19 months later for the trauma-related impotence. The patient was discovered to develop a complete obliteration of the urethra after removal of infected penile prosthesis 18 months later. Perineal urethroplasty cured his restricture. Suggestions are made to prevent urethral restricture if penile prosthesis is required after urethroplasty.     

Non-invasive expandable prosthesis in musculoskeletal oncology paediatric patients for the distal and proximal femur. First results

Purpose

The non-invasive expandable prosthesis for skeletally immature patients is used after limb salvage surgery following tumor resection. The aim of the study was to assess the effectiveness of this treatment.

Methods

Seven paediatric patients with femoral tumors had resection and limb salvage with an uncemented non-invasive growing prosthesis. Mean age at the time of surgery was 9.8 (range 8–12) years. There were six distal femur osteosarcomas and one proximal femur Ewing sarcoma. Six total knee prosthesis were implanted at the time of primary tumor resection and one bipolar hip prosthesis was a revision from a failed osteoarticular hip allograft. Functional outcomes and emotional acceptance were assessed using the MSTS score.

Results

The mean follow-up was 65.3 months (range 29–91) months. Two patients died of pulmonary metastasis and there was no local recurrence. The mean femoral resection was 18 cm (range 17–19) on the knee, and 24 cm on the hip. Mean total expansion was 36.4 mm (range 12.3–63.5). The mean MSTS score after rehabilitation was 26.3 (range 21–29). There was one lengthening device failure, one late infection and one patient who required iliofemoral bypass grafting surgery for a pelvic metastasis. No local recurrence occurred.

Conclusions

The non-invasive expandable prosthesis reduces the final limb-length discrepancy in growing patients with an acceptable function and appears to have an advantage as compared to invasive expandable prostheses which require multiple surgical procedures, but the complications rate is still high.

     

Strangulation of the heart following intrapericardial pneumonectomy

Two cases of strangulation of the heart following left intrapericardial pneumonectomy are described. The condition presents in the immediate post-operative period by sudden fall of blood pressure associated with a high central venous pressure. The diagnosis is usually made by the characteristic radiographic appearances. Actual strangulation of the ventricles is more common on the left side and can lead to irreversible damage in a short time. The predisposing and precipitating factors are discussed with special reference to prevention. Treatment of the established case is by emergency thoracotomy and reduction of the herniated heart. Recurrence is prevented by repairing the defect or wide excision of the pericardium.