Cause analysis and coping strategy of early bioprosthesis failure: A report of three cases and literature review / 第二军医大学学报

Objective To analyze the causes of early bioprosthesis failure(EBF) and to discuss its coping strategy. Methods The clinical data of patients who received bioprosthesis replacement in Changhai Hospital between Jan. 2001 and Jan. 2014 were reviewed. We also searched PubMed for related articles which were published from 1994 to 2014 using “bioprosthesis”, “heart valve prosthesis”, “early failure” and “bioprosthesis failure“ as the keywords. Results Only three EBF cases (0.5%) were found among a total of 650 cases who received bioprosthesis replacement in our hospital, and the reasons for EBF in the 3 cases were: native valve attachment, early calcification caused by metabolic syndrome, and early valve thrombosis. PubMed searched identified 14 EBF case reports, and the reasons for these 14 cases were as follows: native valve attachment in 6(42.9%) cases, metabolic abnormalities in 3(21.4%) cases, early valve thrombosis in 2(14.3%) cases, chronic inflammation in 2(14.3%) cases, and improper operation in 1 (7.1%) case. Conclusion EBF is a rare but serious complication after bioprosthesis replacement, with complicated causes. Appropriate preventive measures should be applied according to the different conditions of patients.

Analysis of early dental implant failure and retreatment of 6 cases / 实用口腔医学杂志

Objective:To analyse the causes of early implantation failure and the therapeutic measures with re-implantation after the failures.Methods:6 cases of implantation failure including early infections,loosening and non-osteointegration were reviewed and trea-ted by re-implantation therapy,and the causes of failure were discussed and the effects of re-treatment were evaluated.Results:2 cases were found to be with infection of adjacent teeth after implantation and were treated by removal of the implant,socket curettage,root ca-nal therapy(RCT)and antibiotics followed by reimplantation.Implant loosening and non-osteointegration were observed in 4 cases, which were treated by the similar methods for the implant socket.Reimplantation was successful in all 6 cases followed-up for 1 -3 years.Conclusion:Preventive measure for implantation failure should include indication selection,control of infections in adjacent teeth and periodontosis,use of GBR technic and so on.Re-implantation following proper treatment of adjacent teeth and the socket of implant is effective for the treatment of implantation failure.

Causes and Treatments of the Early Failure after Unicompartmental Knee Arthroplasty

PURPOSE: We wanted to evaluate the causes, treatments and preventive measures for early failure of unicompartmental knee arthroplasty (UKA) by performing an analysis of the cases. MATERIALS AND METHODS: We retrospectively analyzed 687 cases of UKA that had been performed from January 2002 to December 2006. There are 622 cases of the meniscal bearing type, 31 cases of the tracked bearing type and 34 cases of the fixed bearing type. All of the cases were performed by minimally invasive surgery. RESULTS: Early failures after UKA were seen in 36 cases, and these failures occurred from 4 months postoperatively to 5 years 7 months postoperatively. There were 20 mobile bearing dislocations, 18 femoral or tibial component loosenings, 4 infections, 1 medial tibial condylar fracture and 1 case of pain of unknown origin. The most common cause of the failed cases of the meniscal bearing type was bearing dislocation. All of the failed cases of the tracked and fixed types were from loosening of the component. Simple dislocations of bearing were treated by bearing change. All of the other cases were treated with revision TKA or UKA. CONCLUSION: Selection of an appropriate prosthesis and accurate surgical technique are needed to improve the clinical results and reduce failures. Open bearing change can be done for the cases of simple bearing dislocation, and revision TKA is needed if this is accompanied by other complications.

Analysis of Early Failure after Trabeculectomy

PURPOSE: Among the patients with increased intraocular pressure (IOP) after primary trabeculectomy, we evaluated the factors which might influence the surgical results in early failure cases. METHOD: We retrospectively reviewed the charts of the patients who had undergone primary trabeculectomies. Surgical failures were defined as the eyes with the increased IOPs (> or =21 mmHg), and early failure cases were defined as the elevated IOP within 2 months after surgeries, and as late failures thereafter. The early failure cases were then divided into the recovery group (IOP was decreased by digital massages or releasable suture removals) and non-recovery group. RESULTS: Thirty-eight cases among 78 eyes experienced elevated IOPs during the mean follow-up period of 25.3 months, and 28 cases had experienced early failures. Among the early failure cases, 12 eyes belonged to the recovery group and 16 eyes to the non-recovery group. Sex, age, preoperative IOP, mitomycin C use, systemic diseases, types of glaucoma, triple surgeries, numbers of preoperative medications, and types of scleral flap were similar between the recovery and non-recovery groups. However, the mean failure time was shorter in the recovery group than in the non-recovery group (0.4 vs 1.0 months; p= 0.0017, t-test). CONCLUSIONS: Our results suggest that there is greater probability in recovery of increased IOP with earlier digital pressures or releasable suture removals for the early postoperative increased IOP than with the managements of the later postoperative increased IOP.

A Clinical Significancy of Evoked Thrill Test in the Arteriovenous Fistula

PURPOSE: Arteriovenous fistula at the wrist has remained the procedure of choice for long-term chronic hemod ialysis since its development by Brecia and Cimino in 1966. Thrombosis is the most common cause of early failure after arteriovenous fistula procedure, should be reconized preoperatively or intraoperatively, but no consensus exits regarding the ideal preoperative or intraoperative screening method for access surgery. We describe a simple intraoperative maneuver that can be used to detect proximal stenotic vein segments. METHODS: From September 1998 to September 1999, a total of 117 arteriovenous fistulas were performed for permanent hemodialysis in patients with chronic renal failure. Of them, a intraoperative evoked thrill test was performed in 61 patients (A group), in 56 patients (B group or control group) was not. RESULTS: Early failure rate (<30 days) was 12.5% in A group, 9.8% in B group or control group. In this study, the specificity and positive predictive value of the evoked thrill test was 100%, indicating that this maneuver is highly accurate in predicting early failure. CONCLUSION: Evoked thrill test is a simple and useful intraoperative method for improving the patency rate of autologous arteroiovenous fistula.