Background: Tuberculous endocarditis is a rare but serious complication of heart valve replacement surgery. We report the case of a 24-year-old patient, who presented with tuberculous endocarditis after mechanical mit...Background: Tuberculous endocarditis is a rare but serious complication of heart valve replacement surgery. We report the case of a 24-year-old patient, who presented with tuberculous endocarditis after mechanical mitral valve replacement, with a favorable clinical course following anti-tuberculosis treatment. Case Presentation: We report a 24-year-old male patient, admitted to the cardiac surgery department of the Fann Hospital (Dakar, Senegal), for the management of severe mixed (rheumatic and endocarditic) mitral insufficiency with associated tricuspid insufficiency. He had a history of recurrent angina and polyarthralgia in childhood, was hospitalized several times for refractory global cardiac decompensation, and for a suspected infective endocarditis a month before his admission. On admission, the clinical examination revealed signs suggestive of mitral and tricuspid insufficiency. Transthoracic echocardiography revealed severe post-endocarditic mitral insufficiency with A3 amputation, highly mobile 15 mm vegetations on the free edge of the large valve, moderate tricuspid insufficiency, and severe pulmonary artery hypertension. Mechanical mitral valve replacement and tricuspid valve annuloplasty using autologous pericardial strip were performed via median sternotomy. After ten days, the patient presented with global cardiac decompensation associated with a clinico-biological infectious syndrome, and tans-oesophageal echography revealed an abscess at the sinotubular junction, communicating with the aorta. A thoraco-abdomino-pelvic CT scan was done, which revealed a bilateral alveolar-interstitial syndrome with mediastinal lymphadenopathy. Anti-tuberculosis treatment with RHZE was initiated for 06 months. The clinical course was favorable. Conclusion: Tuberculous endocarditis in prostheses is a serious complication of heart valve replacement surgery, which may evolve favorably under medical treatment.展开更多
The high frequency of dental extractions creates a high demand for prosthetic rehabilitation. Therefore, this study aimed to describe the profile of consumers of prosthetic care at the Institute of Odontology and Stom...The high frequency of dental extractions creates a high demand for prosthetic rehabilitation. Therefore, this study aimed to describe the profile of consumers of prosthetic care at the Institute of Odontology and Stomatology in Dakar. It was a descriptive and retrospective study of patients who had been consulted at the prosthetic clinic of the Institute of Odontology and Stomatology of Dakar. Data were collected from medical records from 09 November 2019 to 09 June 2020. The tools used to collect and process the information were the Sphinx software and the Excel spreadsheet. Out of the 101 patient records, 51% were male and 48% belonged to the age group of 18 to 39 years. Nearly 38.61% of the patients lived less than 5 km from the health care facility and 70.3% of the respondents had a monthly income of fewer than 100,000 FCFA. Clinically, 96% of patients came for functional reasons, 78.2% for aesthetic reasons, and partial edentulism was the most frequent diagnosis (96%). Chi-square tests were performed to find a dependency or non-dependency relationship between diagnosis and age, but also between income and treatment cost. In sum, age and diagnosis were independent of each other, just as patient income was not related to treatment cost. Proximity to health facilities, income, and cost of treatment are factors that influence accessibility to oral health care. It is important to integrate the profile of the consumer of care into global management.展开更多
Re-screening following methicillin-resistant Staphylococcus aureus(MRSA) decolonization will be helpful to minimize the development of prosthetic joint infection among MRSA colonizers.
Dear editor,Fungal endocarditis is a rare disease with a poor prognosis,suboptimal diagnostic tools responsible for long diagnostic delays in most cases,and poorly defined activity of most antifungal agents in endocar...Dear editor,Fungal endocarditis is a rare disease with a poor prognosis,suboptimal diagnostic tools responsible for long diagnostic delays in most cases,and poorly defined activity of most antifungal agents in endocarditis.^([1])The burden of diagnosis still lies with clinicians:they need a展开更多
We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist(VKA) therapy, the patient underwent mitral valve repl...We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist(VKA) therapy, the patient underwent mitral valve replacement by bioprosthesis. Then, the patient was rehospitalized for jaundice. Suspecting hepatotoxicity, VKA was discontinued and fondaparinux was started. During this treatment, the patient developed a symptomatic atrial thrombus. After exclusion of a hepatic disease, VKA was re-established with hemodynamic and liver enzymes normalization and atrial thrombus resolution. Caution has to be used when considering fondaparinux as an alternative strategy to VKA in patients with multiple thrombotic risk factors.展开更多
To assist an amputee in regaining his or her daily quality of life,based on analysis of the motion characteristics of the human hip,a 2-UPR/URR parallel mechanism with a passive limb was designed.The inverse kinematic...To assist an amputee in regaining his or her daily quality of life,based on analysis of the motion characteristics of the human hip,a 2-UPR/URR parallel mechanism with a passive limb was designed.The inverse kinematics of this mechanism was analyzed based on a closed-loop vector method.The constrained Jacobian matrix and kinematic Jacobian matrix of each limb were then analyzed,and a 6×6 fully Jacobian matrix was constructed.Based on this,kinematic performances were analyzed and summarized.Finally,the dynamic model of the mechanism was constructed based on the virtual work principle,and its theoretical solution was compared with the numerical results,which were obtained in a simulation environment.Results showed that the prosthetic mechanism had a larger rotating workspace and better mechanical performance,which accorded a range of motion and bearing capacity similar to that of the human hip in multiple gait modes.Moreover,the validity of the dynamic model and inverse kinematics were verified by comparing the theoretical and simulation results.Furthermore,with flexion and extension,the torque change in the hip prosthetic mechanism was similar to that of the human hip,which demonstrated the feasibility of the hip prosthetic mechanism and its good dynamic performance.展开更多
BACKGROUND Non-albicans Candida prosthetic joint infections (PJIs) are rare. Optimal treatment involves a two-stage revision surgery in combination with an antifungal agent. However, no clear guidelines have been deve...BACKGROUND Non-albicans Candida prosthetic joint infections (PJIs) are rare. Optimal treatment involves a two-stage revision surgery in combination with an antifungal agent. However, no clear guidelines have been developed regarding the agent or treatment duration. Hence, a broad range of antifungal and surgical treatments have been reported so far. AIM To clarify treatment of non-albicans Candida PJIs. METHODS A literature review of all existing non-albicans Candida PJIs cases through April 2018 was conducted. Information was extracted about demographics, comorbidities, responsible species, duration and type of antifungal treatment, type of surgical treatment, time between initial arthroplasty and symptom onset, time between symptom onset and definite diagnosis, outcome of the infection and follow-up. RESULTS A total of 83 cases, with a mean age of 66.3 years, were located. The causative yeast isolated in most cases was C. parapsilosis (45 cases;54.2%), followed by C. glabrata (18 cases;21.7%). The mean Charlson comorbidity index was 4.4 ± 1.5. The mean time from arthropalsty to symptom onset was 27.2 ± 43 mo, while the mean time from symptom onset to culture-confirmed diagnosis was 7.5 ± 12.5 mo. A two stage revision arthroplasty (TSRA), when compared to one stage revision arthroplasty, had a higher success rate (96% vs 73%, P = 0.023). Fluconazole was the preferred antifungal agent (59;71%), followed by amphotericin B (41;49.4%). CONCLUSION The combination of TSRA and administration of prolonged antifungal therapy after initial resection arthroplasty is suggested on the basis of limited data.展开更多
Patients with prosthetic cardiac valves are at high risk for thromboembolic complications and need life long anticoagulation with warfarin, which can be associated with variable dose requirements and fluctuating level...Patients with prosthetic cardiac valves are at high risk for thromboembolic complications and need life long anticoagulation with warfarin, which can be associated with variable dose requirements and fluctuating level of systemic anticoagulation and may predispose to thromboembolic and or hemorrhagic complications. Prosthetic cardiac valve thrombosis is associated with high morbidity and mortality. A high index of suspicion is essential for prompt diagnosis. Transthoracic echocardiography, and if required transesophageal echocardiography are the main diagnostic imaging modalities. Medically stable patients can be managed with thrombolytic therapy and anticoagulation, while some patients may require surgical thrombectomy or valve replacement. We present a case report of a patient with prosthetic mitral valve and an unusually large left atrial thrombus with both thromboembolic and hemorrhagic complications.展开更多
BACKGROUND Prosthetic joint infection(PJI)is a devastating complication requiring prolonged treatment and multiple operations,leading to significant morbidity for the patient.Patients are routinely tested for methicil...BACKGROUND Prosthetic joint infection(PJI)is a devastating complication requiring prolonged treatment and multiple operations,leading to significant morbidity for the patient.Patients are routinely tested for methicillin-resistant staphylococcus aureus(MRSA)colonisation.MRSA positive patients are given eradication therapy.We hypothesise that patients who are MRSA positive pre-operatively,have increased risk of developing PJI.AIM To identify deep wound infection(PJI)rates in patients who are colonised MRSA positive compared with those who are not colonised;and long term clinical and radiological outcomes.METHODS All patients who underwent total hip and knee replacements(THR/TKR)between December 2009 and December 2019 were identified.Patients who were also identified as being MRSA positive at pre-operative assessment were then selected.Confirmation of prescribing eradication treatment was recorded.Patient records,including consultation letters,operation notes and microbiology results were reviewed retrospectively.Comparison of outcomes for each MRSA positive patient was made with 2 MRSA negative patients undergoing the same operation of a similar age by the same consultant.RESULTS Screening identified 42 knee and 32 hip arthroplasty patients as MRSA positive,84 MRSA negative knee and 64 hip patients were reviewed.Patients were matched with medical co-morbidities in each group.Mean follow up was 5 years.PJI was identified in 4/32(12.5%)of THR MRSA positive and 3/42(7%)of TKR patients.All patients had PJI within one year of surgery.CONCLUSION MRSA positive patients are given eradication therapy routinely.However,no confirmation of eradication is sought.Patients who have MRSA colonisation preoperatively,in our study had a significantly increased risk of PJI,when compared to negative patients.We would recommend establishing true eradication after treatment prior to arthroplasty.展开更多
Prosthetic joint infections(PJIs),although not very common,currently pose a very significant threat since they are associated with severe complications,high morbidity rates and substantial costs.PJIs are most commonly...Prosthetic joint infections(PJIs),although not very common,currently pose a very significant threat since they are associated with severe complications,high morbidity rates and substantial costs.PJIs are most commonly caused by Staphylococcus aureus and coagulase-negative staphylococci.The diagnosis of implant-associated infections is very challenging since no single routinely used laboratory or clinical test has been shown to demonstrate adequate results with respect to sensitivity,specificity and accuracy.In most cases,a sum of clinical signs and symptoms,histopathology,blood tests,radiography,bone scans and microbiological testing is considered to arrive at an accurate diagnosis.Treatment of PJIs is also very difficult since most of the infections are caused by biofilm-producing microorganisms which are significantly more resistant to the hosts natural defense mechanisms and antibiotic treatment.For successful management,a combination of both antibiotic and surgical treatment is most often required,and early diagnosis is of the utmost importance.Thus,a multidisciplinary approach is potentially the best option in dealing with PJI,and should include the involvement of microbiologists,orthopedic specialists,clinicians,pathologists and radiologists in order to improve decision-making processes and ensure overall success.The following review aims at briefly outlining the microbiology,diagnostic and treatment options,and preventive measures associated with such infections.展开更多
<strong>Objective: </strong>The present work aimed to identify the most common edentulousness and prosthesis type (prosthetic treatment), to improve the management in oral prosthetic rehabilitation in DR C...<strong>Objective: </strong>The present work aimed to identify the most common edentulousness and prosthesis type (prosthetic treatment), to improve the management in oral prosthetic rehabilitation in DR Congo. <strong>Material and Methods: </strong>It was a documentary, longitudinal, and retrospective study of the medical records of edentulous patients admitted to the prosthetic service of the Dental Department/Kinshasa University from January 1983 to December 2020. Age, sex, cause of teeth loss, and prosthetic treatment (partial removable prosthesis, complete removable prosthesis) were evaluated. The Chare square test was performed to compare significant differences between the variables and the P-value < 0.05 was set as significant. <strong>Results:</strong> One thousand six hundred and ninety patients in that 901 were men (47 ± 16 years) and 789 women (42 ± 15 years) had undergone prosthetic treatment. One thousand eight hundred and forty-four edentulous teeth were viewed according to the Kennedy classification. Kennedy class 1 was the most predominant (61.4%) followed by Kennedy class 3 (24.8%). Two thousand one hundred and ninety-one prostheses were performed. The removable partial prosthesis with plate (acrylic resin) was the most performed (78.8%;n = 1727) and followed by the joint (17.4%;n = 384). Dental caries (52.6%) and periodontitis (36.4%) were the main causes of these edentulous teeth. <strong>Conclusion: </strong>The present study showed that edentulism is becoming a concern for the implementation of a real oral health policy.展开更多
1.IntroductionAt present,joint prostheses are made ofmetallic materials in combination withpolymers,viz Ti6A14V alloy,CoCrMo alloyor 316 L stainless steel matching withultra-high molecular weight polyethylene(UHMWPE)....1.IntroductionAt present,joint prostheses are made ofmetallic materials in combination withpolymers,viz Ti6A14V alloy,CoCrMo alloyor 316 L stainless steel matching withultra-high molecular weight polyethylene(UHMWPE).In view of function of jointprostheses,the suitable materials shouldhave the following properties:firstly,highwear resistance and low friction展开更多
Natural fibers and their composites are the evolving movements in material science,and with that,the utmost use of plant-based fibers has become the focus of this research.Sisal and cotton natural fibers were used to ...Natural fibers and their composites are the evolving movements in material science,and with that,the utmost use of plant-based fibers has become the focus of this research.Sisal and cotton natural fibers were used to construct a prosthetic socket as an attempt to substitute material currently available in the manufacturing of sockets.The vacuum bagging technique was adopted to produce a below-knee socket.The influence of different fiber layering sequences on the volumetric and mechanical characteristics was estimated experimentally and numerically.Mechanical tensile tests were used to assess laminated specimens,such as tensile strength,young modulus,and elongation percentage.The number and type of reinforcing layers had an effect on mechanical properties,and the best composite specimens were three layers of sisal with two layers of carbon fiber,with tensile strength and modulus of elasticity reaching(261–4760)MPa,respectively.The finite element method(ANSYS-16.1)was used to anatomize by seeing the contours distribution of safety factor,equivalent Von Mises stress,equivalent Von Mises strain,and total deformation.This procedure was executed by building ten models for the socket,which served as three-dimensional structural composite materials.The results of the present study advocate that the arrangement of natural and synthetic reinforcements allow the preparation of bio-composites with enhanced performance.This work revealed the assets of sisal and cotton fiber hybrid reinforced PMMA resin composites(hybridized at diverse volume percentages and lamination layup),which have not been tried up to now.展开更多
Pannus formation is a rare complication and occurs almost exclusively in mechanical prosthetic valves.It consists of fibrous tissue that covers the surface of the prosthesis either concentrically or eccentrically,resu...Pannus formation is a rare complication and occurs almost exclusively in mechanical prosthetic valves.It consists of fibrous tissue that covers the surface of the prosthesis either concentrically or eccentrically,resulting in valve dysfunction.The pathophysiology seems to be associated to a chronic inflammatory process that explains the late and insidious clinical presentation.This diagnosis should be considered in patients with high transvalvular gradients on transthoracic echo,and workup should be completed with fluoroscopy and transesophageal echocardiography.Treatment is always surgical and recurrence is rare.We present a case of pannus formation in a prosthetic aortic valve and a review of the literature regarding this disorder.展开更多
We describe two cases of prosthetic joint infection(PJI) of the hip due to Salmonella. The first patient presented with an early infection 5 d after being discharged following a total hip replacement and the second pa...We describe two cases of prosthetic joint infection(PJI) of the hip due to Salmonella. The first patient presented with an early infection 5 d after being discharged following a total hip replacement and the second patient presented at the emergency ward with a late infection, thirteen years following a total hip replacement. Both cases occurred within one month of each other at our institution and both were successfully treated with a one-stage revision. PJI caused by Salmonella species is very rare: so far only 20 Salmonella PJIs of the hip have been described. Therefore, full consensus on the best treatment approach has not yet been reached. An aggressive two-stage approach is advised because of the virulence of Salmonella, although a limited number of successful one-stage approaches have been describedas well. According to the latest guidelines, one-stage revision has comparable success rates and less morbidity compared to two-stage treatment, when selecting the right patients. In our opinion, PJI caused by Salmonella should be treated just as PJI caused by other bacteria, with consideration of the selection criteria as mentioned in several treatment guidelines. As illustrated by these two cases, one-stage revision can be successful in both early and late Salmonella PJI of the hip.展开更多
Cardiovascular implantable electronic device(CIED) infection and prosthetic valve endocarditis(PVE) remain a diagnostic challenge.Cardiac imaging plays an important role in the diagnosis and management of patients wit...Cardiovascular implantable electronic device(CIED) infection and prosthetic valve endocarditis(PVE) remain a diagnostic challenge.Cardiac imaging plays an important role in the diagnosis and management of patients with CIED infection or PVE.Over the past few years,cardiac radionuclide imaging has gained a key role in the diagnosis of these patients,and in assessing the need for surgery,mainly in the most difficult cases.Both ^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT) and radiolabelled white blood cell single-photon emission computed tomography/computed tomography(WBC SPECT/CT) have been studied in these situations.In their 2015 guidelines for the management of infective endocarditis,the European Society of Cardiology incorporated cardiac nuclear imaging as part of their diagnostic algorithm for PVE,but not CIED infection since the data were judged insufficient at the moment.This article reviews the actual knowledge and recent studies on the use of ^(18)F-FDG PET/CT and WBC SPECT/CT in the context of CIED infection and PVE,and describes the technical aspects of cardiac radionuclide imaging.It also discusses their accepted and potential indications for the diagnosis and management of CIED infection and PVE,the limitations of these tests,and potential areas of future research.展开更多
Using the results of physical and chemical researches and mechanical tests of the Pd-Au-Cu-Sn system alloys, a new palladium-based alloy has been chosen and studied in detail. It has a higher plasticity and a lower ha...Using the results of physical and chemical researches and mechanical tests of the Pd-Au-Cu-Sn system alloys, a new palladium-based alloy has been chosen and studied in detail. It has a higher plasticity and a lower hardness than the Palladent alloy, widely used in prosthetic dentistry: its hardness is lower than 300 MPa, and its specific elongation is 10%~14 %. At the same time, such important practical characteristics of the alloys as the strength of adhesion to ceramics and thermal expansion coefficient are almost similar.展开更多
This study was aimed to determine the mechanical strength of composites made from Agave cantala with an unsaturated polyester matrix and microcrystalline cellulose.Cantala fiber(CF)was treated with 6%Na OH with immers...This study was aimed to determine the mechanical strength of composites made from Agave cantala with an unsaturated polyester matrix and microcrystalline cellulose.Cantala fiber(CF)was treated with 6%Na OH with immersion times of 0 h(UF),3 h(AK3),6 h(AK6),9 h(AK9),and12 h(AK12).Thermogravimetric analysis(TGA)analysis shows that treated CF has higher thermal stability than CF without treatment.Cantala fiber was tested by X-ray diffraction.After alkali treatment with a 6-h soaking,it had a crystallinity index of 73.65%.Scanning electron microscopy(SEM)showed that the fibers were cleaner after alkali treatment because hemicellulose,wax,and other impurities were removed.Examination of the contact angle and surface energy showed that treated CF has smaller contact angles and greater surface energy.展开更多
AIM: To communicate our findings on successful treat-ment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP). METHODS: A retrospective single center study between 19...AIM: To communicate our findings on successful treat-ment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP). METHODS: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with pros-thetic reinforcement. RESULTS: All patients complained about ongoing vaginal infections and febrile episodes. These symptomswere reported after a mean period of 18 mo after POP repair. As a first intervention, three patients underwent ablation of the prosthetic material (PM). As a second intervention, open proctectomy with a primary anas-tomosis, an omental patch, and a protective ileostomy were performed in two patients. One patient required a terminal colostomy due to complete destruction of the anal sphincters. In two other patients, ablation of the PM and proctectomy was performed as a one-step procedure. The postoperative course in all patients was uneventful, with a mean length of hospitalization of 20 d (range: 15-30). Closure of the ileostomy was achieved in all four patients within four months. After a mean period of 35 mo (range: 4-60) of follow-up, no recurrence was observed with normal continence in four patients.CONCLUSION: In our experience, the definitive treat-ment of high RVFs after PM repair for POP necessitates ablation of the PM, proctectomy with a primary colo-rectal anastomosis, an omental patch interposition, and a temporary ileostomy.展开更多
文摘Background: Tuberculous endocarditis is a rare but serious complication of heart valve replacement surgery. We report the case of a 24-year-old patient, who presented with tuberculous endocarditis after mechanical mitral valve replacement, with a favorable clinical course following anti-tuberculosis treatment. Case Presentation: We report a 24-year-old male patient, admitted to the cardiac surgery department of the Fann Hospital (Dakar, Senegal), for the management of severe mixed (rheumatic and endocarditic) mitral insufficiency with associated tricuspid insufficiency. He had a history of recurrent angina and polyarthralgia in childhood, was hospitalized several times for refractory global cardiac decompensation, and for a suspected infective endocarditis a month before his admission. On admission, the clinical examination revealed signs suggestive of mitral and tricuspid insufficiency. Transthoracic echocardiography revealed severe post-endocarditic mitral insufficiency with A3 amputation, highly mobile 15 mm vegetations on the free edge of the large valve, moderate tricuspid insufficiency, and severe pulmonary artery hypertension. Mechanical mitral valve replacement and tricuspid valve annuloplasty using autologous pericardial strip were performed via median sternotomy. After ten days, the patient presented with global cardiac decompensation associated with a clinico-biological infectious syndrome, and tans-oesophageal echography revealed an abscess at the sinotubular junction, communicating with the aorta. A thoraco-abdomino-pelvic CT scan was done, which revealed a bilateral alveolar-interstitial syndrome with mediastinal lymphadenopathy. Anti-tuberculosis treatment with RHZE was initiated for 06 months. The clinical course was favorable. Conclusion: Tuberculous endocarditis in prostheses is a serious complication of heart valve replacement surgery, which may evolve favorably under medical treatment.
文摘The high frequency of dental extractions creates a high demand for prosthetic rehabilitation. Therefore, this study aimed to describe the profile of consumers of prosthetic care at the Institute of Odontology and Stomatology in Dakar. It was a descriptive and retrospective study of patients who had been consulted at the prosthetic clinic of the Institute of Odontology and Stomatology of Dakar. Data were collected from medical records from 09 November 2019 to 09 June 2020. The tools used to collect and process the information were the Sphinx software and the Excel spreadsheet. Out of the 101 patient records, 51% were male and 48% belonged to the age group of 18 to 39 years. Nearly 38.61% of the patients lived less than 5 km from the health care facility and 70.3% of the respondents had a monthly income of fewer than 100,000 FCFA. Clinically, 96% of patients came for functional reasons, 78.2% for aesthetic reasons, and partial edentulism was the most frequent diagnosis (96%). Chi-square tests were performed to find a dependency or non-dependency relationship between diagnosis and age, but also between income and treatment cost. In sum, age and diagnosis were independent of each other, just as patient income was not related to treatment cost. Proximity to health facilities, income, and cost of treatment are factors that influence accessibility to oral health care. It is important to integrate the profile of the consumer of care into global management.
文摘Re-screening following methicillin-resistant Staphylococcus aureus(MRSA) decolonization will be helpful to minimize the development of prosthetic joint infection among MRSA colonizers.
文摘Dear editor,Fungal endocarditis is a rare disease with a poor prognosis,suboptimal diagnostic tools responsible for long diagnostic delays in most cases,and poorly defined activity of most antifungal agents in endocarditis.^([1])The burden of diagnosis still lies with clinicians:they need a
基金Supported by Swiss National Science Foundation,No.310030_118245 and No.32003B_134963/1
文摘We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist(VKA) therapy, the patient underwent mitral valve replacement by bioprosthesis. Then, the patient was rehospitalized for jaundice. Suspecting hepatotoxicity, VKA was discontinued and fondaparinux was started. During this treatment, the patient developed a symptomatic atrial thrombus. After exclusion of a hepatic disease, VKA was re-established with hemodynamic and liver enzymes normalization and atrial thrombus resolution. Caution has to be used when considering fondaparinux as an alternative strategy to VKA in patients with multiple thrombotic risk factors.
基金Supported by Beijing Natural Science Foundation(Grant No.L172021)National Natural Science Foundation of China(Grant No.51875033).
文摘To assist an amputee in regaining his or her daily quality of life,based on analysis of the motion characteristics of the human hip,a 2-UPR/URR parallel mechanism with a passive limb was designed.The inverse kinematics of this mechanism was analyzed based on a closed-loop vector method.The constrained Jacobian matrix and kinematic Jacobian matrix of each limb were then analyzed,and a 6×6 fully Jacobian matrix was constructed.Based on this,kinematic performances were analyzed and summarized.Finally,the dynamic model of the mechanism was constructed based on the virtual work principle,and its theoretical solution was compared with the numerical results,which were obtained in a simulation environment.Results showed that the prosthetic mechanism had a larger rotating workspace and better mechanical performance,which accorded a range of motion and bearing capacity similar to that of the human hip in multiple gait modes.Moreover,the validity of the dynamic model and inverse kinematics were verified by comparing the theoretical and simulation results.Furthermore,with flexion and extension,the torque change in the hip prosthetic mechanism was similar to that of the human hip,which demonstrated the feasibility of the hip prosthetic mechanism and its good dynamic performance.
文摘BACKGROUND Non-albicans Candida prosthetic joint infections (PJIs) are rare. Optimal treatment involves a two-stage revision surgery in combination with an antifungal agent. However, no clear guidelines have been developed regarding the agent or treatment duration. Hence, a broad range of antifungal and surgical treatments have been reported so far. AIM To clarify treatment of non-albicans Candida PJIs. METHODS A literature review of all existing non-albicans Candida PJIs cases through April 2018 was conducted. Information was extracted about demographics, comorbidities, responsible species, duration and type of antifungal treatment, type of surgical treatment, time between initial arthroplasty and symptom onset, time between symptom onset and definite diagnosis, outcome of the infection and follow-up. RESULTS A total of 83 cases, with a mean age of 66.3 years, were located. The causative yeast isolated in most cases was C. parapsilosis (45 cases;54.2%), followed by C. glabrata (18 cases;21.7%). The mean Charlson comorbidity index was 4.4 ± 1.5. The mean time from arthropalsty to symptom onset was 27.2 ± 43 mo, while the mean time from symptom onset to culture-confirmed diagnosis was 7.5 ± 12.5 mo. A two stage revision arthroplasty (TSRA), when compared to one stage revision arthroplasty, had a higher success rate (96% vs 73%, P = 0.023). Fluconazole was the preferred antifungal agent (59;71%), followed by amphotericin B (41;49.4%). CONCLUSION The combination of TSRA and administration of prolonged antifungal therapy after initial resection arthroplasty is suggested on the basis of limited data.
文摘Patients with prosthetic cardiac valves are at high risk for thromboembolic complications and need life long anticoagulation with warfarin, which can be associated with variable dose requirements and fluctuating level of systemic anticoagulation and may predispose to thromboembolic and or hemorrhagic complications. Prosthetic cardiac valve thrombosis is associated with high morbidity and mortality. A high index of suspicion is essential for prompt diagnosis. Transthoracic echocardiography, and if required transesophageal echocardiography are the main diagnostic imaging modalities. Medically stable patients can be managed with thrombolytic therapy and anticoagulation, while some patients may require surgical thrombectomy or valve replacement. We present a case report of a patient with prosthetic mitral valve and an unusually large left atrial thrombus with both thromboembolic and hemorrhagic complications.
文摘BACKGROUND Prosthetic joint infection(PJI)is a devastating complication requiring prolonged treatment and multiple operations,leading to significant morbidity for the patient.Patients are routinely tested for methicillin-resistant staphylococcus aureus(MRSA)colonisation.MRSA positive patients are given eradication therapy.We hypothesise that patients who are MRSA positive pre-operatively,have increased risk of developing PJI.AIM To identify deep wound infection(PJI)rates in patients who are colonised MRSA positive compared with those who are not colonised;and long term clinical and radiological outcomes.METHODS All patients who underwent total hip and knee replacements(THR/TKR)between December 2009 and December 2019 were identified.Patients who were also identified as being MRSA positive at pre-operative assessment were then selected.Confirmation of prescribing eradication treatment was recorded.Patient records,including consultation letters,operation notes and microbiology results were reviewed retrospectively.Comparison of outcomes for each MRSA positive patient was made with 2 MRSA negative patients undergoing the same operation of a similar age by the same consultant.RESULTS Screening identified 42 knee and 32 hip arthroplasty patients as MRSA positive,84 MRSA negative knee and 64 hip patients were reviewed.Patients were matched with medical co-morbidities in each group.Mean follow up was 5 years.PJI was identified in 4/32(12.5%)of THR MRSA positive and 3/42(7%)of TKR patients.All patients had PJI within one year of surgery.CONCLUSION MRSA positive patients are given eradication therapy routinely.However,no confirmation of eradication is sought.Patients who have MRSA colonisation preoperatively,in our study had a significantly increased risk of PJI,when compared to negative patients.We would recommend establishing true eradication after treatment prior to arthroplasty.
文摘Prosthetic joint infections(PJIs),although not very common,currently pose a very significant threat since they are associated with severe complications,high morbidity rates and substantial costs.PJIs are most commonly caused by Staphylococcus aureus and coagulase-negative staphylococci.The diagnosis of implant-associated infections is very challenging since no single routinely used laboratory or clinical test has been shown to demonstrate adequate results with respect to sensitivity,specificity and accuracy.In most cases,a sum of clinical signs and symptoms,histopathology,blood tests,radiography,bone scans and microbiological testing is considered to arrive at an accurate diagnosis.Treatment of PJIs is also very difficult since most of the infections are caused by biofilm-producing microorganisms which are significantly more resistant to the hosts natural defense mechanisms and antibiotic treatment.For successful management,a combination of both antibiotic and surgical treatment is most often required,and early diagnosis is of the utmost importance.Thus,a multidisciplinary approach is potentially the best option in dealing with PJI,and should include the involvement of microbiologists,orthopedic specialists,clinicians,pathologists and radiologists in order to improve decision-making processes and ensure overall success.The following review aims at briefly outlining the microbiology,diagnostic and treatment options,and preventive measures associated with such infections.
文摘<strong>Objective: </strong>The present work aimed to identify the most common edentulousness and prosthesis type (prosthetic treatment), to improve the management in oral prosthetic rehabilitation in DR Congo. <strong>Material and Methods: </strong>It was a documentary, longitudinal, and retrospective study of the medical records of edentulous patients admitted to the prosthetic service of the Dental Department/Kinshasa University from January 1983 to December 2020. Age, sex, cause of teeth loss, and prosthetic treatment (partial removable prosthesis, complete removable prosthesis) were evaluated. The Chare square test was performed to compare significant differences between the variables and the P-value < 0.05 was set as significant. <strong>Results:</strong> One thousand six hundred and ninety patients in that 901 were men (47 ± 16 years) and 789 women (42 ± 15 years) had undergone prosthetic treatment. One thousand eight hundred and forty-four edentulous teeth were viewed according to the Kennedy classification. Kennedy class 1 was the most predominant (61.4%) followed by Kennedy class 3 (24.8%). Two thousand one hundred and ninety-one prostheses were performed. The removable partial prosthesis with plate (acrylic resin) was the most performed (78.8%;n = 1727) and followed by the joint (17.4%;n = 384). Dental caries (52.6%) and periodontitis (36.4%) were the main causes of these edentulous teeth. <strong>Conclusion: </strong>The present study showed that edentulism is becoming a concern for the implementation of a real oral health policy.
文摘1.IntroductionAt present,joint prostheses are made ofmetallic materials in combination withpolymers,viz Ti6A14V alloy,CoCrMo alloyor 316 L stainless steel matching withultra-high molecular weight polyethylene(UHMWPE).In view of function of jointprostheses,the suitable materials shouldhave the following properties:firstly,highwear resistance and low friction
文摘Natural fibers and their composites are the evolving movements in material science,and with that,the utmost use of plant-based fibers has become the focus of this research.Sisal and cotton natural fibers were used to construct a prosthetic socket as an attempt to substitute material currently available in the manufacturing of sockets.The vacuum bagging technique was adopted to produce a below-knee socket.The influence of different fiber layering sequences on the volumetric and mechanical characteristics was estimated experimentally and numerically.Mechanical tensile tests were used to assess laminated specimens,such as tensile strength,young modulus,and elongation percentage.The number and type of reinforcing layers had an effect on mechanical properties,and the best composite specimens were three layers of sisal with two layers of carbon fiber,with tensile strength and modulus of elasticity reaching(261–4760)MPa,respectively.The finite element method(ANSYS-16.1)was used to anatomize by seeing the contours distribution of safety factor,equivalent Von Mises stress,equivalent Von Mises strain,and total deformation.This procedure was executed by building ten models for the socket,which served as three-dimensional structural composite materials.The results of the present study advocate that the arrangement of natural and synthetic reinforcements allow the preparation of bio-composites with enhanced performance.This work revealed the assets of sisal and cotton fiber hybrid reinforced PMMA resin composites(hybridized at diverse volume percentages and lamination layup),which have not been tried up to now.
文摘Pannus formation is a rare complication and occurs almost exclusively in mechanical prosthetic valves.It consists of fibrous tissue that covers the surface of the prosthesis either concentrically or eccentrically,resulting in valve dysfunction.The pathophysiology seems to be associated to a chronic inflammatory process that explains the late and insidious clinical presentation.This diagnosis should be considered in patients with high transvalvular gradients on transthoracic echo,and workup should be completed with fluoroscopy and transesophageal echocardiography.Treatment is always surgical and recurrence is rare.We present a case of pannus formation in a prosthetic aortic valve and a review of the literature regarding this disorder.
文摘We describe two cases of prosthetic joint infection(PJI) of the hip due to Salmonella. The first patient presented with an early infection 5 d after being discharged following a total hip replacement and the second patient presented at the emergency ward with a late infection, thirteen years following a total hip replacement. Both cases occurred within one month of each other at our institution and both were successfully treated with a one-stage revision. PJI caused by Salmonella species is very rare: so far only 20 Salmonella PJIs of the hip have been described. Therefore, full consensus on the best treatment approach has not yet been reached. An aggressive two-stage approach is advised because of the virulence of Salmonella, although a limited number of successful one-stage approaches have been describedas well. According to the latest guidelines, one-stage revision has comparable success rates and less morbidity compared to two-stage treatment, when selecting the right patients. In our opinion, PJI caused by Salmonella should be treated just as PJI caused by other bacteria, with consideration of the selection criteria as mentioned in several treatment guidelines. As illustrated by these two cases, one-stage revision can be successful in both early and late Salmonella PJI of the hip.
文摘Cardiovascular implantable electronic device(CIED) infection and prosthetic valve endocarditis(PVE) remain a diagnostic challenge.Cardiac imaging plays an important role in the diagnosis and management of patients with CIED infection or PVE.Over the past few years,cardiac radionuclide imaging has gained a key role in the diagnosis of these patients,and in assessing the need for surgery,mainly in the most difficult cases.Both ^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT) and radiolabelled white blood cell single-photon emission computed tomography/computed tomography(WBC SPECT/CT) have been studied in these situations.In their 2015 guidelines for the management of infective endocarditis,the European Society of Cardiology incorporated cardiac nuclear imaging as part of their diagnostic algorithm for PVE,but not CIED infection since the data were judged insufficient at the moment.This article reviews the actual knowledge and recent studies on the use of ^(18)F-FDG PET/CT and WBC SPECT/CT in the context of CIED infection and PVE,and describes the technical aspects of cardiac radionuclide imaging.It also discusses their accepted and potential indications for the diagnosis and management of CIED infection and PVE,the limitations of these tests,and potential areas of future research.
文摘Using the results of physical and chemical researches and mechanical tests of the Pd-Au-Cu-Sn system alloys, a new palladium-based alloy has been chosen and studied in detail. It has a higher plasticity and a lower hardness than the Palladent alloy, widely used in prosthetic dentistry: its hardness is lower than 300 MPa, and its specific elongation is 10%~14 %. At the same time, such important practical characteristics of the alloys as the strength of adhesion to ceramics and thermal expansion coefficient are almost similar.
文摘This study was aimed to determine the mechanical strength of composites made from Agave cantala with an unsaturated polyester matrix and microcrystalline cellulose.Cantala fiber(CF)was treated with 6%Na OH with immersion times of 0 h(UF),3 h(AK3),6 h(AK6),9 h(AK9),and12 h(AK12).Thermogravimetric analysis(TGA)analysis shows that treated CF has higher thermal stability than CF without treatment.Cantala fiber was tested by X-ray diffraction.After alkali treatment with a 6-h soaking,it had a crystallinity index of 73.65%.Scanning electron microscopy(SEM)showed that the fibers were cleaner after alkali treatment because hemicellulose,wax,and other impurities were removed.Examination of the contact angle and surface energy showed that treated CF has smaller contact angles and greater surface energy.
基金Supported by The Assistance publique des Hpitaux de Marseille et Université de la Méditerranée Aix Marseille II (faculté de médecine)
文摘AIM: To communicate our findings on successful treat-ment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP). METHODS: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with pros-thetic reinforcement. RESULTS: All patients complained about ongoing vaginal infections and febrile episodes. These symptomswere reported after a mean period of 18 mo after POP repair. As a first intervention, three patients underwent ablation of the prosthetic material (PM). As a second intervention, open proctectomy with a primary anas-tomosis, an omental patch, and a protective ileostomy were performed in two patients. One patient required a terminal colostomy due to complete destruction of the anal sphincters. In two other patients, ablation of the PM and proctectomy was performed as a one-step procedure. The postoperative course in all patients was uneventful, with a mean length of hospitalization of 20 d (range: 15-30). Closure of the ileostomy was achieved in all four patients within four months. After a mean period of 35 mo (range: 4-60) of follow-up, no recurrence was observed with normal continence in four patients.CONCLUSION: In our experience, the definitive treat-ment of high RVFs after PM repair for POP necessitates ablation of the PM, proctectomy with a primary colo-rectal anastomosis, an omental patch interposition, and a temporary ileostomy.
