Our experience with aortic root replacement using hand-sewn composite valve graft

Background The purpose of this study is to examine our experience with aortic root replacement using composite valve grafts in patients with proximal aortic disease. Methods and Results Since 1986, 16 patients underwent aortic root replacement using composite valve grafts for various indications which were Marfan's syndrome with annuloaortic ectasia (n=2), aortic regurgitation with ascending aortic aneurysm (n=3), aortic stenosis with regurgitation with poststenotic dilatation (n=9) and progressive aortic dilatation following AVR (n=2). There were 12 males and 4 females. The age range varied between 19 years and 52 years. The choice of conduit was a custom made valved graft using a monoleaflet tilting disc valve (Medtronic Hall valve=11, St Vincent's valve=3, TTK Chitra=1 and Bjork Shiley Valve=1) placed in a Dacron graft (Hemashield=13, Verisoft Cooley=3) prepared using a 4-0 polypropylene suture. The average time taken to construct a valved graft was 20 min±8 min. The coronary implantation was by isolated button technique. There was no size mismatch encountered in any patients. Postoperative bleeding necessitated a delayed sternal closure in 3 patients and re-exploration in another 2. The immediate operative mortality was 2, the cause being ventricular arrhythmia in one and cerebrovascular accident in other. Follow-up period ranged from 2 months to 16 years with a median follow-up of 12 months. One patient had an asymptomatic perigraft collection and no intervention was needed. There was no valve related complications in any of these patients. There was one late death of unknown cause. Conclusions Aortic root replacement using a custom made composite graft offers excellent long-term results, with negligible mortality rate and prosthesis related complications. Custom made grafts make this conduit easily affordable in our country and their performance is comparable to other available composite grafts.     

Augmentation Mammaplasty: Where Should the Implant Be Placed?

Malposition of the prosthesis is one complication of augmentation mammaplasty. The most projected point of the prosthesis should be placed just behind the nipple to create a natural-looking breast. However, in some cases, when a textured surface cohesive silicone gel prosthesis with an inframammary approach is used, low displacement of the prosthesis is encountered within 1 year. This phenomenon can be seen both in subpectoral augmentation with severing of the muscle at the level of the inframammary fold and in subglandular augmentation when the patients breast and skin are very soft and easily stretchable. Therefore, the elasticity of the breast should be evaluated before surgery. If the patients breast and skin are very soft and easily stretchable, the pocket for the prosthesis should be created 1 to 1.5 cm superiorly to the usual pocket for the prosthesis. The design of the pocket for the prosthesis should be different depending on the shape of the prosthesis and the elasticity of the patients breasts.     

Inguinal hernia repair with beta glucan-coated mesh: Prospective multicenter study (115 cases)—Preliminary results

Prosthetic reinforcement is now routine in the management of inguinal hernia, and it significantly reduces the risk of recurrence. However, there may be postoperative pain and discomfort of late onset, the intensity of which appears to be related to the rigidity of the material and its ability to integrate with tissues. We have evaluated the results of implantation with beta glucan-coated polypropylene mesh both objectively (early recurrence) and functionally (pain and quality of life). The mass of the coated mesh is reduced by 50% compared to a typical polypropylene implant. Beta glucan is an entirely natural plant product that eliminates the risk of viral or prion contamination associated with the use of collagen of animal origin. One hundred fifteen patients with a mean age of 55 years with a primary or recurrent inguinal hernia were treated with a prosthesis (Glucamesh). Fifty-eight patients underwent a Lichtenstein procedure, and 57 had a laparoscopic procedure (TEP, TAPP). Mean operative time was 40 min. There was no mortality, and morbidity was 8.6%. At 3 months follow-up, no recurrences were observed. The characteristics of the prosthesis were considered to be good or excellent in 93.9–100% of cases. Residual postoperative pain (analogue pain score less than 2) occurred in 4.3% of cases at day 15 and in 2.7% at day 90. The quality-of-life health score of the SF36 questionnaire preoperatively and postoperatively showed a significant improvement (P<0.05) in the scores and a quality of life equivalent to healthy control subjects. This prosthesis is associated with a rapid and significant resolution of postoperative pain and a quick return to normal activity with an improved quality of life. In addition, the plant origin of the prosthesis eliminates any risk of viral or prion contamination.     

Treatment of a Humeral Metastasis with a Composite Allograft-Prosthetic Reconstruction

Abstract Background: The treatment of impending pathological fractures and symptomatic metastases involving the upper extremity articulations remains a challenge for the trauma surgeon. While the goals of treatment of bony metastases are clearly defined (early restoration of function, excellent pain control and minimal surgical trauma), these are not always easy to realize in upper extremity periarticular metastases. Case Study: A patient with a metastasis of a mediastinal nerve sheet tumor, involving the proximal 12 cm of the right humerus, including the whole head and both the tubercles, is described. A complete resection up to the level of the deltoid insertion was performed. In order to restore maximal function, the shoulder joint was reconstructed using a reversed total shoulder prosthesis. A fresh frozen cadaver proximal humerus was used as an allograft to obtain a secure stabilization of the prosthesis. Short-term results were very promising with restoration of ADL (activities of daily living) functionality within 3 months. Abduction and elevation > 100°, exorotation up to 20° and gluteal endorotation could be performed at that time. Conclusion: To the authors knowledge, this report is the first to describe reconstruction of the shoulder joint using a reversed shoulder prosthesis-allograft construction in case of a resection for malignancy.     

Percutaneous treatment of superior vena cava syndrome using metallic stents

The purpose of this study was to evaluate the results of treatment of superior vena cava syndrome (SVCS) in patients with benign and malignant disease using expandable metallic stent. From January 1995 to April 2000, 87 expandable stents were implanted in 82 patients (59 men, 23 women; mean age 57.8 years, age range 39–79 years) for the treatment of SVCS. The SVCS was defined as symptomatic bilateral obstruction of venous drainage from head, neck and upper extremities. In 68 patients SVCS was due to malignant neoplasia, and in 14 cases it was due to benign aetiology. All patients were treated with expandable stent. We implanted 81 Wallstent prostheses and 6 Palmaz stents. Adjuvant thrombolysis was applied in 12 patients who required fibrinolysis. After recanalization, the stent was implanted in all cases in SVC (infra- or supra-azygos vein). All patients were treated with heparin of low molecular weight (HBPM) during 6 months. Patency was analyzed according to clinical symptoms and Doppler US or venograms exploration. Technical success was observed in all cases. Clinical success was reached in 78 of 82 patients (95.1%) (absence of symptoms in 2 or 3 days). Four patients suffered immediate thrombosis which required fibrinolitic treatment with a new prosthesis placement in 1 case. The follow-up for the malignant process was of 7.1 months (range 1–39 months) and in benign cases was 31.2 months (range 11–61 months). Sixty-two (91.1%) patients with malignancy died without SVCS symptomatology. All the patients with benign pathology are alive. Clinical primary patency in malignant cases was 87% with assisted patency of 96.2%. Endovascular therapy using metallic stent and thrombolysis is a successful method to treat SVCS due to benign or malignant aetiology. Electronic Publication     

高密度多孔聚乙烯片填充治疗爆裂性眼眶骨折

目的：评估高密度多孔聚乙烯片填充治疗爆裂性眼眶骨折的有效性。方法：选择2003年6月至2006年1月，在浙江大学附属第一医院眼科中心就诊的23例眼眶爆裂性骨折患者，进行高密度多孔聚乙烯片修复眶壁缺损并纠正眼球内陷。观察患者手术前后视力、眼球突出度、复视和眼位变化。结果：23例患者术后均未出现患眼视力明显下降和视力丧失，眼球内陷度数为（1．7&#177;0．5）mm，与术前（3．9&#177;1．2）mm比较，差异有统计学意义（P〈0．05）。术后1个月10例患者复视完全消失，11例患者第一眼位无复视，但仍有周边复视，2例术后第一眼位复视仍存在。术后22例患者眼球各方向运动基本正常，但有1例患者术后出现眼位上移，下转轻度受限，2周后恢复正常。结论：高密度多孔聚乙烯片填充治疗爆裂性眼眶骨折安全有效。     

非手术防治人工假体周围骨溶解的研究进展

人工关节置换术后假体周围骨溶解所引起的假体无菌性松动是影响其使用寿命的主要原因之一。晚期患者必须行关节翻修手术,但手术难度大、风险高、费用多,非手术治疗人工假体周围骨溶解已成为目前关节研究领域研究的热点。目前药物主要从抑制破骨细胞的骨吸收、作用于炎症过程及细胞因子、促进成骨三方面来防治骨溶解;基因治疗骨溶解和其他方法也在研究中。     

大转子髋关节融合术治疗全(半)髋关节置换后假体松动

目的:探讨针对人工全(半)髋关节置换术后因假体松动而采取补救性的关节融合手术的适应症与禁忌症。方法:6例人工全(半)髋关节置换术后假体松动的患者应用大转子髋关节融合术予以治疗。结果:经术后12~36个月,平均16个月随访,X线片示髋关节均获骨性融合,融合时间为5~8个月,平均6.5个月。Harris髋关节评分由术前的26~41分,平均31分,提高到术后56~80分,平均72分。结论:本手术是一种疗效可靠、简单实用、切实可行的补救性治疗方法。     

人造血管在治疗四肢大血管损伤中的初步应用

目的作者自1995-2002年采用人造血管移植修复四肢大血管损伤23例，进行回顾性研究人造血管在治疗四肢大血管损伤中的应用。方法23例中男19例，女4例。年龄：21～47岁，平均34．7岁。手术清创和探查后，针对不同的情况选择人造血管移植修复方法。结果采用人造血管移植23例，肢体全部保存，肢体功能恢复较佳。结论四肢大血管损伤救治应快速诊断、快速救治，采用人造血管移植修复四肢主要血管损伤是一种快捷有效的方法。     

等离子喷涂羟基磷灰石涂层人工股骨柄的研制

目的 :研制新型羟基磷灰石涂层人工关节。方法 :采用等离子喷涂及外送粉装置对人工股骨柄进行全柄喷涂。运用X线衍射仪、X线表面能谱仪、红外线光谱仪、扫描电镜及力学实验对涂层进行分析。结果 :涂层成分主要为羟基磷灰石 ,基本上未发生热分解 ,涂层与金属基体之间的平均结合强度为 2 9 71MPa。结论 :国产等离子喷涂羟基磷灰石涂层基本保持了羟基磷灰石材料的特性 ,结合强度能够满足关节假体的需要。