Digital contracture deformity after implantation of a silicone prosthesis: light and electron microscopic study

Following the implantation of a silicone tendon prosthesis for reconstruction of a deep flexor tendon, an extensive, dense, contractile fibrosis developed rapidly. The resulting flexion deformity ultimately necessitated an amputation. The amputated specimen was examined by light and electron microscopy. A great many myofibroblasts were seen in the new tendon sheath, which, because of their contractile properties, probably caused the deformity.     

Permanent pacemaker implantation after transapical transcatheter aortic valve implantation

The aim of the study was to determine the incidence of permanent pacemaker implantation (PPMI) in a cohort of 358 patients undergoing transapical aortic valve implantation (TAVI) using a balloon-expandable prosthesis between April 2008 and March 2011. After excluding patients who had had a previous PPMI (n=36; 10%), the study group consisted of 322 patients. These were divided into two groups: patients who required PPMI (PPM group) and patients who did not require it (non-PPM group). Preoperative, perioperative and one-year follow-up data were collected prospectively. Twenty (6.2%) patients required PPMI. Previous implantation of an aortic prosthesis (P=non-significant), previous coronary artery bypass grafting (P=0.05) and coronary artery disease (P<0.005) were more common in the non-PPM group. On logistic regression, only patient age seemed to be correlated to PPMI (P=0.05, odds ratio 1.08; CI 0.9-1.1). There was no difference in survival rate between the groups after 30?days (PPM group 95%, non-PPM group 93.6%). Similarly, the survival rate did not differ after one year (PPM group 84%, non-PPM group 80.9%; P=0.3). The PPMI rate after transapical TAVI using a balloon-expandable prosthesis is thus low, and has no impact on early and follow-up mortality.     

Penile prosthesis implantation

The development of effective systemic therapy for the treatment of erectile dysfunction has resulted in a significant increase in the number of men presenting for treatment. Not all men with erectile dysfunction will respond to systemic therapy; those who fail may be candidates for penile prosthesis implantation if second and third lines of treatment also fail or are rejected by the patient and his partner. Penile prosthesis implantation continues to play a role in the treatment of erectile dysfunction. There is a potential for the number of penile prosthesis implantation procedures to actually increase. The ideal penile prosthesis is a three-piece inflatable device that permits good penile flaccidity and increases in size and becomes rigid with inflation.     

Temporary ectopic implantation

Temporary ectopic implantation is a technique designed for extremity salvage in cases of devascularization or amputation of an essentially intact part in conjunction with extensive segmental proximal injury. A case of a traumatic midforearm amputation that survived by ectopic implantation in the abdominal wall, with subsequent replantation eleven weeks later, is presented.     

Autologous chondrocyte implantation

Rationale for the treatment of cartilage damage in younger patients depends on a thorough understanding of the predisposing factors for the chondrosis and the stage of disease. Implantation with autologous cultured chondrocytes allows for resurfacing of larger defect areas with reproducibly good/excellent results in 90% of patients with isolated lesions of the femoral condyle. Patellar lesions also may be successfully treated (approximately 75% improved) but strict attention must be given to correction of malalignment. Results in patients with tibial and salvage lesions are encouraging; however, these results should be viewed with caution due to the small number of patients with 2-year follow-up. Autologous chondrocyte implantation involves an open technique with the inherent disadvantages of adhesions and a more prolonged recovery. However, these disadvantages must be weighed against the procedure's ability to produce a hyaline-type tissue with greater durability than fibrocartilage repairs produced by traditional marrow-stimulation techniques. We recommended matching the treatment procedure to patient expectations and lesion/demographic characteristics. Based on the available literature. algorithms have been published that recommend autologous chondrocyte implantation be reserved as first-line treatment for high-demand patients with large lesions (>2 cm2) and as revision therapy in patients with lesions of all sizes, regardless of patient demand, who have failed alternative marrow stimulation techniques.     

着床丝氨酸蛋白酶-1/2在胚胎着床过程中的作用

着床丝氨酸蛋白酶-1(ISP1)和着床丝氨酸蛋白酶-2(ISP2)是于2001年首次报道的S1丝氨酸蛋白酶家族的新成员,迄今仅在小鼠卵细胞、受精卵和早胚、以及子宫组织中发现这两种蛋白酶的表达,具有较高的细胞和组织特异性.在体和离体实验证实,ISP1和ISP2在小鼠胚胎着床过程中发挥关键作用,是潜在的抗着床药物靶分子.现就10年来对ISP1和ISP2的研究进展作一综述.     

Bone cement implantation syndrome

Bone cement implantation syndrome (BCIS) is characterised by hypotension, hypoxaemia, cardiac arrhythmias, cardiac arrest or any combination of these, leading to death in 0.6–1% of patients. One of the mechanisms suggested to explain these complications is diffuse microembolisation of the lungs as a consequence of extrusion of the bone marrow content by the pressurised bone cement. By reducing intramedullary pressure and changing the operative technique, BCIS can be diminished, but deaths still occur. An anaphylactoid mechanism as a major factor in BCIS is receiving renewed attention since increased plasma histamine levels were recently demonstrated after the implantation of bone cement and a prosthesis. Therefore, we conducted a prospective, randomised study to demonstrate the potential benefit of histamine-receptor-blocking agents in patients undergoing cemented hip arthroplasty. Thirty patients were divided into two groups: group 1, the control group, received no histamine-receptor-blocking agents; group 2, the antihistamine group, received H₁ and H₂-receptor-blocking agents in standard dosages preoperatively. Both groups were comparable concerning age, sex and physical status (ASA criteria). There was no hospital mortality in either group. Thirteen patients of group 1 demonstrated a sudden fall by more than 10% of their blood pressure, level of PaO₂ or both. Fourteen patients of group 2 showed similar changes. The mean decrease of blood pressure in group 1 was 14.6 mmHg (SD 36.8) and in group 2 20.5 mmHg (SD 33.43). The difference is not significant (P = 0.65). The mean decrease of PaO₂ in group 1 was 30.5 mmHg (SD 30.5) and in group 2 33.4 mmHg (SD 34.1). The difference is not significant (P = 0.81). Overall, we found even a slight disadvantage for patients receiving antihistamine drugs (statistically not significant). Therefore, histamine-receptor-blocking agents do not have a prophylactic potential in BCIS.     

Bone cement implantation syndrome

Bone cement implantation syndrome (BCIS) is poorly understood.It is an important cause of intraoperative mortality and morbidityin patients undergoing cemented hip arthroplasty and may alsobe seen in the postoperative period in a milder form causinghypoxia and confusion. Hip arthroplasty is becoming more commonin an ageing population. The older patient may have co-existingpathologies which can increase the likelihood of developingBCIS. This article reviews the definition, incidence, clinicalfeatures, risk factors, aetiology, pathophysiology, risk reduction,and management of BCIS. It is possible to identify high riskgroups of patients in which avoidable morbidity and mortalitymay be minimized by surgical selection for uncemented arthroplasty.Invasive anaesthetic monitoring should be considered duringcemented arthroplasty in high risk patients.