A heart supplies bloods of about 15, 000 liters to each human organ in a day. A normal function of heart valves is necessary to this act of heart. The disease of heart valve develops to a narrowness of a closure, resulting in an abnormal circulation of bloods. In an attempt to eliminate the affliction of heart valves, the operation method to repair with artificial heart valves has been developed and saved numerous patients over past 30 years. This replacement operation has been performed since early 1960`s in Korea, but all the artificial heart valves used are imported from abroad with very high costs until recent years. The artificial heart valve using pyrolytic carbon has been developed at KAIST, which was proved to be stable in the mechanical performance and durability. Therefore, the in viva performance of this valve was examined through animal tests. The artificial heart valves used in this study are tilting disc type valves, in which the disc were made of graphite coated with pyrolytic carbon and the cages were made of titanium. In viva testings of these valves were performed in 12 dogs, in which right ventriculo-pulmonary arterial [Croup I] or inter-aortic [Croup IV] valved conduit was implanted using polytetrafluoroethylene conduits containing KAIST valve and aortic valve [Group II] or pulmonary valve [Croup III] was replaced by a KAIST valve with a 21mm or 19mm tissue annulus diameter. In group I and II, pre-and post-operative transvalvular pressure gradient was measured and compared with other prosthetic valves. During post operative period laboratory examination was performed including hemoglobin, hematocrit, red cell count, white cell, lactic acid dehydrogenase and platelet. The eight surviving dogs were sacrificed and autopsy was performed at 2, 6, and 8 weeks. KAIST valve has low transvalvular gradient and relatively high orifice area. Average ventriculo-aortic peak systolic transvalvular gradient was 14 mmHg in 21 mm valve and 19 mmHg in 19 mm valve. The valve has slight intravascular hemolysis effect. Thrombogenic effect of low polishing quality and eddy currents around small orifice is high. The valve has vulnerability of disc movement. These animal tests suggest that the improvement of the heart valve design, surface polishing state and prescription methods.
Excessive stress on the bone-stem interface may cause local micromotion that could produce midthigh pain, interface bone resorption and prevent bony ingrowth. It is important for clinician and prosthetic designer to develop an understanding of the load transfer mechanism, its associated stress pattern and its relationships with the particular mechanical characteristics of the femoral stem designs. Finite element method (FEM) is preeminently suited to provide information in this respect. The authors developed 3-dimensional numerical finite element models implanted with the straight stem which is composed of total 1170 elements of 8 nodes and with the curved stem which is composed of total 885 elements of 8 node, and analysed the relative micromotions between the straight stem and the curved stem in immediate postoperative stage of an uncemented total hip replacement in load simulating the single leg stance. The results showed that the rotational displacement was occupied over 90% of total micromotion in both types of stem and was peak at the proximal medial portion of the stem, but markedly less distally. The curved stem was more stable especially in terms of rotational stability. It is recommended that surgeons do not allow the patient weight bearing until bony ingrowth was achieved. In the future more attention should be drawn to increase initial rotational stability of the two types of femoral stem to prevent loosening from excessive micromotion.
Economides, James M.;DeFazio, Michael V.;Golshani, Kayvon;Cinque, Mark;Anghel, Ersilia L.;Attinger, Christopher E.;Evans, Karen Kim
Archives of Plastic Surgery
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v.44
no.2
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pp.124-135
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2017
Background In cases of total knee arthroplasty (TKA) threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA. Methods A systematic search and meta-analysis were performed to identify patients with TKA who underwent either pedicled muscle or fasciocutaneous flap coverage of periprosthetic knee defects. Studies evaluating implant/limb salvage rates, ambulatory function, complications, and donor-site morbidity were included in the comparative analysis. Results A total of 18 articles, corresponding to 172 flaps (119 muscle flaps and 53 fasciocutaneous flaps) were reviewed. Rates of implant salvage (88.8% vs. 90.1%, P=0.05) and limb salvage (89.8% vs. 100%, P=0.14) were comparable in each cohort. While overall complication rates were similar (47.3% vs. 44%, P=0.78), the rates of persistent infection (16.4% vs. 0%, P=0.14) and recurrent infection (9.1% vs. 4%, P=0.94) tended to be higher in the muscle flap cohort. Notably, functional outcomes and ambulation rates were sparingly reported. Conclusions Rates of limb and prosthetic salvage were comparable following muscle or fasciocutaneous flap coverage of compromised TKA. The functional morbidity associated with muscle flap harvest, however, may support the use of fasciocutaneous flaps for coverage of these defects, particularly in young patients and/or high-performance athletes.
Between January 1986 and June 1994, 23 patients underwent surgical intervention for infective endocarditis at Wonkwang University Hospital. There were 13 male and 5 female, ran ing in age from 13 to 67(mean 43.7 $\pm$ 5.8) years. 21 had native valve endocarditis and 2 had prosthetic valve endocardits. The most common causative organism was streptococci in 9 patients, and the others were staphylococci in 7 patients and unknown in 7 patients. The infection was in the mitral valve in 10 patients, the aortic valve in 6 patients, the aortic and mitral In 5 patients, 2 in tricuspid. Surgical indications for surgery were intractable congestive heart failure, giant growing vegetation and severe valvular insufficiency. There were 3 perioperative death (13%) and no late death. The main causes of death were cerebral embolism in 2 due to recurrent endocarditis and low cardiac output in 1. By NYHA functional classification, all patients were in class III or IV preoperatively, and all patients were improved postoperatively with HYHA functional classification in class I or II. In conclussion, early operative intervention is life-salving in patients with persistent or progres ive congestive heart failure, irrespective of the activity of the infectious process or the duration of antibiotic therapy.
The use of the Angell-Shiley porcine xenograft cardiac valve was limited in number at Seoul National University Hospital chiefly because of the cessation of supply from the manufacturer, Forty-eight Angell-Shiley valves along with the 5 other mechanical or tissue valves were used in 46 patients during the period from 1977 to 1980, and a total of consecutive cases was studied for their early and long-term clinical results. The operative mortality rate was 4.3%; no death after single and 2 deaths after double valve replacement within 30 days of surgery. The 44 early survivors were followed up for a total of 171.6 patient-years and a mean of 46.8$\pm$31.1 months. Four died during the follow-up period with a linealized late mortality rate of 2.33%/patient-year. Four patients had experienced 5 episodes of thromboembolism and one died; a linealized incidence of 2.91% emboli/patient-year. A single case each had a bleeding complication related to the anticoagulants, 0.58% bleeding/patient-year, and prosthetic valve endocarditis, 0.58% endocarditis/patient-year. The clinical improvement was excellent by 70% of the survivors having no cardiac symptoms at the end of the follow-up. The actuarial survival rates were 89.9$\pm$4.9% at 5 years and 69.2$\pm$15.0% at 9 years after surgery. The probabilities of freedom from thromboembolic complication were 92.3$\pm$5.5% and 80.9$\pm$9.0% at 5 and 9 years after surgery. And, the probability of freedom from overall valve failure was 83.4$\pm$6.3% at 5 years and it declined sharply down to 55.9$\pm$22.2% at 9th year of the follow-up. These results are comparable with those in the major reports, except a more accelerated and time-related increases in valve failure after 5 or 6 years after operation with the Angell-Shiley valve. The durability of the xenograft tissue valve remains as the most important debate and the need of more durable tissue valves was also discussed.
Between Feb. 1990 and Aug. 1993, 180 cases of the open heart surgery were performed under cardiopulmonary bypass in the Department of Thoracic & Cardiovascular surgery, Gil General Hospital. There were 83 cases with congenital heart diseases [CHD] and 97 cases with acquired heart diseases [AHD]. The CHD consisted of 78 acyanotic[mortality: 3.8 %] and 5 cyanotic cases with heart anomaly[mortality:l case]. The AHD were 97 cases, which contained 53 valvular, 27 ischemic heart diseases, 10 aortic diseases, 5 cases with myxoma, 1 case with post-infarct VSD, and 1 case with removal of infected pacing wire in right ventricle. In the 53 valvular heart diseases, there were 45 cases with valve replacement[MVR 27, AVR 9,MVR + AVR 9] and 8 cases with valvuloplasty. The number of the implanted prosthetic valves were 53. In MVR, 25 St. Jude, 6 Sorin, 3 Carpentier-Edward and 2 Intact medical valves were used. In aortic position, 13 St. Jude, 3 Sorin and 1 Intact medical valves were applied. The operative mortality was 5.6 % [3/53]. The annuloplasty applying artificial ring was performed in 17 patients[4 cases associated with MVR] and the number of the implanted ring was 19, which included 14 Duran ring[10 mitral, 4 tricuspid] and 5 Carpentier ring [3 mitral, 22 tricuspid]. In the 27 ischemic heart diseases, there were 9 cases with left main coronary artery lesions, 7 one vessel, 5 two vessels, and 6 three vessels. Average number of anastomosis was 2.8 per patient. The operative mortality was 14.3 % [4/27]. Among the 10 patients with aortic diseases, 7 cases were aortic dissection[type A: 5, type B: 2] and 3 cases were descending thoracic aortic aneurysm. The operative morality occurred in 3 cases. The overall mortality and the operative mortality of congenital and acquired heart disease was 7.8 %, 4.8% and 10.4%, respectively.
Pulmonary artery aneurysms are extremely rare conditions usually associated with congenital cardiac defects that cause increased pulmonary blood flow and pulmonary hypertension. The prognosis of pulmonary artery aneurysms is fatal due to the potential for rupture of the aneurysm and the underlying severe pulmonary hypertension. A 40-year old woman was admitted to our hospital with headache following traffic accident. On admission a continuous murmur was heard over the 2nd to 3rd intercostal space along left sternal border and a calcified cystic mass at left hilar portion was incidentally discoverd on chest reontgenogram. Cardiac catherization was diagnostic of a left to right shunt at main pulmoanry artery level and pulmonary hypertension. Pulmonary angiogram demonstrated a large aneurysm of main pulmonary artery extending into proximal left pulmonary artery. The pulmonary artery aneurysm associated with patent ductus arteriosus was diagnosed definitively and the patient was underwent resection of pulmonary artery aneurysm, closure of PDA and Dacron prosthetic graft replacement under cardiopulmonary bypass. The postoperative course was uneventful and the patient was discharged without any problem.
So-Yeon Kim;Hyeong-Gi Kim;Pil-Young Yun;Young-Kyun Kim
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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v.49
no.1
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pp.13-20
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2023
Objectives: Ultra-wide implants may be used as a replacement if existing implants fail. This study was conducted to evaluate the factors influencing the prognosis and failure of ultra-wide implants. Patients and Methods: This study evaluated whether sex, age, site, diameter, length, additional surgery, implant stability (primary and secondary), and reason for ultra-wide implant placement affect the 5-year survival and success rates and marginal bone loss (MBL) of ultra-wide implants. Seventy-eight ultra-wide implants that were placed in 71 patients (39 males and 32 females) from 2008 to 2010 were studied. One-way ANOVA analysis was conducted to evaluate the statistical significance of MBL according to the patient's sex, implant site, and diameter. Independent sample t-tests were used to determine the statistical significance of MBL analysis which was used to determine the significance of the 5-year success and survival rates related to the variables. One-way ANOVA was conducted to evaluate the statistical significance of sex, implantation site, diameter, and MBL. Independent sample t-tests were used to evaluate the correlation between implantability and MBL for implantation reasons, while additional surgery, length, and Kaplan-Meier analysis were used to evaluate 5-year survival and success rates. Results: The mean age of patients was 54.2 years with a survival rate of 92.3% and a success rate of 83.3% over a mean 97.8-month period of observation. MBL averaged 0.2 mm after one year of prosthetic function loading and 0.54 mm at the time of final observation. Success rates correlated with primary stability (P=0.045), survival rates correlated with secondary stability (P=0.036), and MBL did not correlate with any variables. Conclusion: Ultra-wide implants can be used to achieve secure initial fixation in the maxillary and mandibular molar regions with poor bone quality or for alternative purposes in cases of previous implant failure.
Minji Im;Chiwoo Kim;Juyoung Sung;Insung Kim;Ji-Hoon Hwang;Min-Sun Kim;Sung Yoon Cho
Journal of Genetic Medicine
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v.20
no.2
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pp.60-69
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2023
Purpose: Despite enzyme replacement therapy (ERT) and/or allogeneic hematopoietic stem cell transplantation, individuals with mucopolysaccharidosis (MPS) I or II often experience significant growth deficiencies. This study aimed to assess the safety and efficacy of recombinant human growth hormone (hGH) treatment in children diagnosed with MPS I or II. Materials and Methods: A total of nine pediatric patients-four with MPS I and five with MPS II-underwent treatment with ERT and hGH at Samsung Medical Center. Results: The mean hGH dose administered was 0.26±0.03 mg/kg/week. In the MPS I group, three patients showed an increase in height Z-score from -4.09±0.83 to -3.68±0.43 after 1 year of hGH treatment, and to -3.10±0.72 by the end of the hGH regimen. In the MPS II group, while the height Z-score of four patients decreased according to standard growth charts, it improved from 1.61±1.79 to 2.71±1.68 based on the disease-specific growth chart through hGH treatment. Two patients discontinued hGH treatment due to lack of efficacy after 22 and 6 months each of treatment, respectively. No new-onset neurological symptoms or necessity for prosthetic or orthopedic surgery were reported during hGH treatment. Conclusion: This study provides insights into the impact of hGH on MPS patients, demonstrating its potential to reverse growth deceleration in some cases. Further research is needed to explore the long-term effects of hGH on changes in body composition, muscle strength, and bone health in this population.
Tyler J. Humphrey;Colin M. Baker;Paul M. Courtney;Wayne G. Paprosky;Hany S. Bedair;Neil P. Sheth;Christopher M. Melnic
Hip & pelvis
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v.35
no.2
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pp.122-132
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2023
Purpose: The dome technique is a technique used in performance of revision total hip arthroplasty (THA) involving intraoperative joining of two porous metal acetabular augments to fill a massive anterosuperior medial acetabular bone defect. While excellent outcomes were achieved using this surgical technique in a series of three cases, short-term results have not been reported. We hypothesized that excellent short-term clinical and patient reported outcomes could be achieved with use of the dome technique. Materials and Methods: A multicenter case series was conducted for evaluation of patients who underwent revision THA using the dome technique for management of Paprosky 3B anterosuperior medial acetabular bone loss from 2013-2019 with a minimum clinical follow-up period of two years. Twelve cases in 12 patients were identified. Baseline demographics, intraoperative variables, surgical outcomes, and patient reported outcomes were acquired. Results: The implant survivorship was 91% with component failure requiring re-revision in only one patient at a mean follow-up period of 36.2 months (range, 24-72 months). Three patients (25.0%) experienced complications, including re-revision for component failure, inter-prosthetic dual-mobility dissociation, and periprosthetic joint infection. Of seven patients who completed the HOOS, JR (hip disability and osteoarthritis outcome score, joint replacement) survey, five patients showed improvement. Conclusion: Excellent outcomes can be achieved using the dome technique for management of massive anterosuperior medial acetabular defects in revision THA with survivorship of 91% at a mean follow-up period of three years. Conduct of future studies will be required in order to evaluate mid- to long-term outcomes for this technique.
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