Prevention of vascular graft infection by rifampin bonding to a gelatin-sealed dacron graft

This study examines the efficacy of rifampin bonding to a gelatin-sealed knitted Dacron graft to prevent perioperative bacteremic vascular graft infection. Antibiotic bonding was obtained by soaking grafts for 15 minutes in a 1 mg/ml saline solution of rifampin at 37°C. Nineteen dogs had thoracoabdominal aortic bypass: seven (group I) received a rifampin treated graft; six (group II) received an untreated gelatin-coated graft; and six (group III) received an uncoated Dacron graft. Two days later bacteremic challenge was produced by rapid intravenous injection of 5×10 ⁵ colony forming units of methicillin resistantStaphylococcus aureus.Grafts were harvested five days after this challenge and cut into 10 fragments, each submitted to bacterial counts. Results were expressed as CFU/cm ² of graft material. In group I, no graft was infected, whereas all grafts in groups II and III were infected (p<0.05). Median bacterial counts from the infected fragments (median±SD) were similar in groups II (2.5×10⁵ CFU/cm²) and III (4×10⁴ CFU/cm²). Blood cultures at time of sacrifice were negative in all dogs in group I and positive in five of six dogs in groups II and III. Cultures of liver, spleen, kidney, and lung specimens were always negative in group I and positive in 22 of 24 specimens in group II and 23 of 24 specimens in group III. Soaking a gelatin-sealed Dacron graft in rifampin solution evidently prevents early bacteremic graft infection and secondary foci of infection in this model.Presented at the Annual Meeting of the French Vascular Surgery Society, Nancy, France, May 18–19, 1990.     

The albumin-coated knitted dacron aortic prosthesis: A clinical study

Between June 1987 and January 1989, a total of 123 albumin-coated, knitted Dacron aortic prosthetic grafts were used in 120 patients. The aim of this study was to determine the degree of graft impermeability to blood as well as short - and medium-term patency of the graft material. Patients were grouped as follows: group I (64 patients), operation for chronic aortoiliac obliteration; group II (45 patients), operation for abdominal aortic aneurysm; group III (14 patients), operation on the thoracic aorta. Ninety-one bifurcated and 32 albumin-coated grafts were inserted. Abnormal bleeding was seen in five cases but did not lead to any adverse clinical consequences and stopped spontaneously. In group I there were two instances of early thromboses thought to be due to hemodynamic compromise, which were successfully treated surgically. In group III, two patients had early thrombosis due to coagulation disorders. These were treated by thrombectomy and medical therapy. One hundred and fourteen patients (95%) were followed for a mean of 8.2 months (range 1–18 months). Three late complications related to the prosthesis were observed: one patient had a false aneurysm occurring at month 14 and was corrected surgically. Two other patients experienced thrombosis of their graft treated by extraanatomical bypasses. Primary patency at the end of the follow-up period was 93% while secondary patency was 98%. There were no early or late infectious complications. We conclude that albumin-coated Dacron prosthesis is a reliable material for aortic replacement. Intraoperative loss of blood is reduced and short-and medium-term patency is comparable to those of uncoated aortic prosthetic material.Presented at the Annual Meeting of the Society de Chirurgie Vasculaire de Langue Française, Strasbourg, France, June 23–24, 1989.     

阴茎假体植入术的临床应用与手术技巧(附光盘)

阴茎勃起功能障碍患者在接受药物及其他保守治疗后仍不能获得满意勃起时,阴茎假体植入术是理想的选择。阴茎假体植入后,无论患者本人还是其性伴侣都有很高的性生活满意度。近年来,国内接受阴茎假体植入术的患者越来越多。本文主要介绍阴茎假体植入术的临床应用与手术技巧。     

不同材料组配式带膜血管内支架的比较研究

目的　通过比较涤纶 (D)、聚四氟乙烯 (PTFE)及可膨胀性聚四氟乙烯 (ePTFE)覆盖内支架不同组配的漏出量及结合点的阻力 ,确定带膜血管内支架的最佳材料。方法　研究分 5组 ,分别为涤纶组 1 (D1 )、PTFE组 1 (PTFE1 )、涤纶组 2 (D2 )、PTFE组 2 (PTFE2 )及可扩张PTFE组(ePTFE) ,每组含有 5个样本。每一样本由 1个PalmazP2 94内支架和内置、覆盖两段D、PTFE及ePTFE组成。各组以不同的方式进行组配。增加装配内压力 [1 0 0、2 0 0及 30 0mmHg(1mmHg=0 .1 33kPa) ]来验证其外漏 ,在装配两端安置拉力验证其结合点的阻力。方差分析 (ANOVA)用于组间比较。结果　在增加装配内压力时有 4个组配崩溃 (D1 3个 ,D2 1个 )。每 1 5s的漏出量在D1为 (38.4± 2 2 .3)ml,D2为 (40 .4± 1 0 .3)ml;PTFE1、PTFE2及ePTFE无漏出。在牵拉实验中各组在如下拉力下崩溃 ,D1 (4.86± 2 .66)N ,D2 (4.76± 2 .36)N ,PTFE1 (2 0 .49± 2 .80 )N ,PTFE2 (2 2 .0 3± 1 .88)N ,ePTFE (1 8.85± 2 .62 )N。结论　PTFE是带膜血管内支架的较理想材料 ,ePTFE与PTFE有同样的特性但其易于体内组配     

294例充注式硅囊隆乳术后并发症的分析

对观察了3～5年的294例行充注式硅囊隆乳术患者,进行了术后并发症的分析,以探讨其发生情况、临床表现、产生机理及治疗预防措施。常见并发症有出血、感染、包膜挛缩、硅囊破裂、硅囊外露、心理失衡、造型欠佳等7项。     

可膨胀型阴茎假体植入治疗勃起功能障碍(附20例报告)

目的　探讨国产可膨胀型阴茎假体治疗勃起障碍 (ED)的疗效、安全性及可靠性。　方法　使用国产三件套可膨胀型阴茎假体植入治疗 2 0例中重度ED患者 ,其中血管性ED 6例 ,神经性ED 2例 ,混合性ED 12例 ,阴茎纤维化导致ED 1例 ,术后随访观察。　结果　 2 0例患者手术过程顺利 ,术后随访 3～ 40个月 ,平均 30个月。 1例 (5 % )术后 30个月发生感染 ,取出假体 ;3例 (15 % )分别于术后 5、8、14个月发生阴茎圆柱体经尿道戳出而取出假体。本组未见机械性并发症 ,总有效率80 %。　结论　国产可膨胀型阴茎假体植入治疗难治性ED疗效确切 ,机械性能安全、可靠。本组并发症发生率高与病例选择、应用早期的手术操作技术有关     

294例充注式硅囊隆乳术后并发症的分析

对观察了３～５年的２９４例行充注式硅囊隆乳术患者，进行了术后并发症的分析，以探讨其发生情况、临床表现、产生机理及治疗预防措施。常见并发症有出血、感染、包膜挛缩、硅囊破裂、硅囊外露、心理失衡、造型欠佳等７项。     

A prospective randomized radiographic and dual-energy X-ray absorptiometric study of migration and bone remodeling after implantation of two modern short-stemmed femoral prostheses

BackgroundThe aim of this prospective randomized study was to analyze migration and strain transmission of the Metha™ and Nanos™ femoral prostheses.ResultsThere was no significant change of varus−valgus alignment or clinically relevant migration of the Metha™ or Nanos™ prostheses during postoperative follow-up. After 12.3 months, the DEXA scans showed small but significant differences of bone mineral density in Gruen zones 1 (minus ~8 %) and 6 (plus ~9 %) for the Metha™ and in Gruen zone 1 (minus ~14 %) for the Nanos™ (paired t test). Visual analog scale (VAS) and Harris Hip Score (HHS) improved significantly for both implants (Nanos™/Metha™ 12.3 months postoperatively HSS 96.5/96.2; VAS 0.7/0.8, respectively). COR or offset did not change significantly after surgery.ConclusionsNeither implant showed signs of impaired osseointegration. DEXA demonstrated proximally located load transfer with only moderate proximal stress shielding.

Level of evidence

II.     

Catastrophic metallosis after tumoral knee prosthesis failure: A case report

IntroductionMetallosis is a condition characterized by an infiltration of periprosthetic soft tissues and bone by metallic debris resulting from wear or failure of joint arthroplasties.Presentation of caseAuthors describe a case of a 45-year-old man treated for an osteosarcoma of the distal femur with a modular prosthesis when he was 18 years old, he developed massive metallosis with skin dyspigmentation after 17 years. His medical\surgical history was remarkable for a left tumoral knee prosthesis implanted 21 years ago. Two years before revision, the patient had a car accident with a two-points prosthesis breakage and despite the surgeon’s advice, the patient refused surgery. In two years, prosthesis malfunction caused a progressive catastrophic soft tissues infiltration of metallic debris.Discussion and conclusionAuthors suggest that if prosthesis fracture is detected, revision surgery should be attempted as earlier as possible.     

Comparison of the ovine and porcine animal models for biocompatibility testing of vascular prostheses

OBJECTIVE: Evaluation of the pig and sheep models for biocompatibility investigations of vascular prostheses (VP). DESIGN: Comparative analysis of animal experimental investigations involving two different animal models. MATERIALS AND METHODS: Commercially available polyester vascular prostheses (PET-VP) were implanted into two different animal models (infrarenal porcine aorta and ovine carotid artery). The costs, surgical handling, patency rate, and healing on the basis of macroscopic, microscopic, and immunohistochemical criteria were analyzed over a period of 3 months. RESULTS: Handling and operating times (63 +/- 10 versus 76 +/- 16 min; P = 0.125) did not differ significantly. The cost of the two animal models was comparable. Integration of the VP was complete in the sheep model, but varied in the pig model (two complete, four incomplete). Complete endothelialization of all VPs was observed in the pig, which contrasted with the sheep with complete (circular) endothelialization only in the region of the anastomosis. The thickness of neointima in the region of the anastomosis differed insignificantly; immunohistochemically, only periprosthetic Ki67 was significantly reduced (28.7 +/- 9.9 versus 6 +/- 0.9%; P = 0.002) in the sheep. CONCLUSIONS: In the porcine model, extremely good endothelialization of the VP was observed, with formation of a rapid neointimal hyperplasia. The ovine model was characterized by the fact that postoperative follow-up investigations were easy to perform. Complete endothelialization was not observed.     

睾丸假体植入术治疗睾丸缺失的安全性与有效性临床观察(附18例报告)

目的:探讨采用国产中空硅胶睾丸假体实施睾丸假体植入术,治疗睾丸缺失的安全性和有效性。方法:自2009年1月至2011年3月,选择18例睾丸缺失者行睾丸假体植入术,包括:前列腺癌睾丸去势术10例、先天无睾症3例、单侧睾丸萎缩2例、两性畸形2例、隐睾症1例。睾丸假体为YH-G1型国产中空硅橡胶假体,睾丸假体的大小根据患者阴囊可容纳的空间及参照对侧睾丸的体积来选择。结果:18例中有13例一期行假体植入,另5例植入时间在睾丸切除6个月后。平均睾丸假体植入术的手术时间为(22.6±4.6)min(15～30 min),所有患者术后留院观察12 h后即出院,住院时间(1.3±0.4)d。17例术后无感染、出血和排异等并发症发生。1例前列腺癌去势术患者在睾丸假体植入术后3个月时出现排异,最终取出睾丸假体。术后6个月随访:15例对假体的大小感到非常满意,2例认为植入的假体偏小;14例对植入假体的重量感到非常满意,3例认为植入的假体偏轻;17例患者对植入假体后阴囊的形状和假体的位置表示满意;12例患者反映无论是在活动后还是在睡眠中睾丸假体的舒适度良好,5例患者认为植入的假体偏硬。结论:新型YH-G1型国产中空硅胶睾丸假体治疗男性睾丸缺失能满足患者外观及心理的需要,临床实验表明安全有效,并发症少。长期生活质量及并发症还需进一步观察,设计更舒适及有功能的缓释型睾丸假体还需进一步研究。     

Gasless videoendoscopic implantation of aortobifemoral vascular prostheses via transperitoneal versus extraperitoneal approach in an animal model

Background: The goal of this acute experimental study was to demonstrate the practicability and reproducibility of aortobifemoral bifurcational prosthesis implantations via either a transperitoneal or extraperitoneal approach using gasless videoendoscopic instrumentation. The endoscopically sutured end-to-side aortic anastomoses were also examined for fluid tightness. Methods: Eighteen of the 20 domestic pigs in this experimental study received aortobifemoral vascular prostheses in a gasless videoendoscopic procedure. Bursting pressures and leakage (ml/min) were compared for the endoscopically sutured aortic end-to-side anastomoses versus those sutured in conventional techniques using 6-h-old porcine aortas and 6-mm prostheses. Results: The surgical procedures averaged 4 h for the transperitoneal approach (n= 9) and 4.5 h for the extraperitoneal approach (n= 9). However, these times were significantly reduced with increasing routine. Average aortic occlusion times were 1 h for the transperitoneal approach and 1 h 15 min for the extraperitoneal approach; the average iliacofemoral occlusion time ranged from 1 h 45 min with the transperitoneal approach to 1 h 15 min with the extraperitoneal approach, depending on which side was involved. There were no significant differences in in vitro bursting pressure or leakage amounts between endoscopic and conventionally sutured aortic end-to-side anastomoses. Conclusions: Gasless videoendoscopic implantation of aortobifemoral vascular prostheses in animal subjects is both practicable and reproducible using either a transperitoneal or extraperitoneal approach. The extraperitoneal approach has proven advantages over the transperitoneal approach. The in vitro fluid tightness achieved with endoscopically sutured aortic end-to-side anastomoses is comparable to conventionally sutured anastomoses.     

The management of residual curvature after penile prosthesis implantation in men with Peyronie's disease

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

? To report our experience in the management of residual curvature after implantation of a penile prosthesis in men with Peyronie’s disease (PD).

PATIENTS AND METHODS

? From January 1985 to June 2009, 62 (29%) of the 209 patients with PD that have undergone the insertion of a penile prosthesis have required an additional straightening procedure to correct the residual curvature after the insertion of the cylinders of the implant. ? The types of additional manoeuvres, their success in correcting the residual curvature and eventual complications have been reported.

RESULTS

? Among the additional straightening procedures, modelling was more successful in achieving straightening when performed on an inflatable device (84%) than on a malleable implant (54%). ? If the curvature persisted after modelling or if the curvature was ventral, straightening was achieved with tunical plications or incision with or without grafting.

CONCLUSION

? Although it is common for the simple implantation of cylinders alone to straighten the penis, some patients will present a residual curvature that must be successfully corrected with additional straightening procedures.     

Primary versus revision implant for inflatable penile prosthesis: A propensity score-matched comparison

Inflatable penile prosthesis (IPP) provides excellent outcomes after virgin implants. However, few data on IPP after revision surgery are available. This study aimed at comparing the outcomes of IPP in patients undergoing primary or revision implant surgery. Patients who underwent revision implant surgery (Group 1) between 2013 and 2020 were identified. Overall, 20 patients (Group 1) could be matched with a contemporary matched pair cohort of surgery-naive patients (Group 2) in a 1:1 ratio. Patients in Group 2 had a significantly shorter operative time [median (IQR): 84 (65–97) vs. 65 (51–75) min; p = .01] and lower rate of overall complications (25% vs. 10%; p = .01). Of note, mean (SD) scores for the Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire demonstrated high satisfaction and IPP efficacy in both Groups 1 and 2: functional domain [3.9 (1.0) vs. 4.0 (1.2); p = .4], personal [3.9 (1.1) vs. 4.0 (1.1); p = .3], relational [3.8 (1.3) vs. 3.9 (1.1); p = .5] and social [3.9 (1.1) vs. 4.0 (1.2); p = .2]. These results suggest that in experienced hands, IPP offers high satisfaction to both patients and partners even in the setting of revision implant. However, it is mandatory to inform those patients about the increased risk of perioperative complications.     

Clinical comparison of 27 size sorin and medtronic mitral prostheses

Background  This study was aimed to evaluate the merit in clinical and hemodynamic performance of two commonly used tilting disc heart valve prostheses at our center. Methods  Between October 1994 and December 1997, 100 patients who received either Sorin Biomedica (n=50; group I) or Medtronic Hall (N=50; group II) 27 size mitral valve prostheses were included in the study. The two groups were similar with respect to age, sex, body surface area, preoperative rhythm, NYHA class, hemodynamic and operative parameters. Results  The overall early mortality in the entire series was 5.0%. It was not significantly different in the two groups. A cumulative follow-up of 99.83 patient year for group I and 123.83 patient year for group II, revealed late mortality of 6.23% and 6.38% respectively. The valve related events, acturial survival and echocardiographic assessment of trans-valvular gradient demonstrated no significant difference between the two groups. Conclusions  The results of this study 4 years following implantation indicate that the clinical and hemodynamic performance of 27 size Sorin Biomedica and Medtronic Hall were similar. Both the tilting prostheses were in conformity with small mitral annulus particularly in stenotic lesion and in those who had smaller body surface area. The choice of either prostheses entirely depended upon the surgeon’s preference which was linked to other factors such as experience, ease of insertion, availability and cost. Paper presented in the Annual Conference of Indian Association of Cardiovascular and Thoracic Surgeons at Mumbai, India on 8th March 2000.     

Dorsal vein rupture after practice of taqaandan, necrotising cavernositis, penile reconstruction, urethroplasty and penile prosthesis implantation

Penile fracture is an uncommon and emergent urologic condition defined as traumatic rupture of the corpus cavernosum secondary to a blunt trauma of the erect penis. Tunica albuginea is thinned and stretched in the erect state, and a transverse tear in the corpus cavernosums may occur by a buckling force. However, penile dorsal vein tears may mimic penile fracture. Also, corporeal infection and purulent cavernositis are associated with trauma, cavernosography, priapism, intracavernosal injection therapy and penile prosthesis.     

Outcome of penile prosthesis implantation for treating erectile dysfunction: experience with 504 procedures

OBJECTIVE: To evaluate the outcome of penile prosthesis surgery for different types of prosthesis. PATIENTS AND METHODS: The notes of 447 men who had 504 penile prosthesis implanted between August 1975 and December 2000 were evaluated. Of the prostheses inserted, 393 were malleable, 81 were three-piece inflatable and 30 were self-contained hydraulic prostheses. The mean (range) age of the men was 52 (21-78) years; 404 men had primary implants and 43 had revision surgery after operations at other institutions. The mean follow-up was 50 (1-297) months. RESULTS: Of the 447 men, 22 were lost to follow-up immediately after surgery. The most serious postoperative complications were infection (8%) and erosion (5%), which was more common in diabetic patients (10%) and after pelvic trauma with a urethral injury (21%). Of 482 prostheses, 21 failed mechanically (4%) and revision surgery was needed for 5% of the prostheses inserted (24/482). Overall, 89% (377/425) of men could have sexual intercourse and 344 (81%) were satisfied with the results. CONCLUSIONS: Of the men implanted with a penile prosthesis, 81% were satisfied with the outcome and an even higher proportion were satisfied with the inflatable prostheses. Dissatisfaction was mainly due to complications that resulted in removal of the prosthesis.     

Instability, migration and laxity of total hip prostheses: A roentgen stereophotogrammetric study

Roentgen stereophotogrammetric analysis was used in the evaluation of clinical and/or radiographic problems in 28 total hip replacements without suspicion of infection. Instability of the acetabular and/or the femoral component was revealed in 14 cases. In 21 cases, examined twice, migration of the acetabular component was found in eight cases and migration of the femoral component in 15 cases. The method allows instability and migration of the prosthetic components as well as joint laxity to be determined with a high degree of accuracy.     

The biologic fate of Dacron double velour vascular prostheses —A clinicopathological study—

Thirty-one Dacron double velour prostheses removed from 16 patients were studied microscopically in order to elucidate the changes they underwent following implantation. The process of incorporation was divided into three phases. In the initial phase, immediately following the implantation, the prostheses became surrounded by a fibrin meshwork. In the organizing phase, which sets in 10 weeks after the implantation, there was an external fibrous capsular formation around the initially fibrin-infiltrated grafts. There was also fibroblastic ingrowth and granulation formation among the interstices and the prostheses showed firm adhesion to the surrounding tissues. One year following the implantation, after most of the luminal surfaces had been covered with collagen tissues, the cellular infiltration subsided and the graft passed into the stable phase. Foreign body giant cells and lymphocytes were seen throughout the study period. These prostheses were then compared with other prostheses which do not have velour structures. The nonvelour grafts showed less adhesion to the surrounding tissues. Microscopically, cellular reaction and collagenous ingrowth were also less. The velour surface thus seems to stimulate granulation ingrowth and to contribute to the firm adhesion of the graft to the surrounding tissues. This firm adhesion enhances resistance to infection and is considered safer in case of suture aneurysm formation.