:이 절차는 Aequalis 더 자세한 정보를 위해 Tornier 주식 회사를 참조하시기 바랍니다 Tornier 주식 회사에 의해 보철물 총 어깨를 레버 스드 사용하여 수행되었습니다 <a href="http://www.tornier-us.com/">http://www.tornier-us.com/</a> .

1. 소개 : glenohumeral 공동은 복잡한 관절이다. 그것은 최소한의 뼈다귀 제약을 가지고 있으며, 일반적인 기능에 부드러운 조직을 지원하는 사이에 긴장의 복잡한 균형에 의존합니다. 이 필수적인 관계는 어깨 운동의 큰 기능 범위를 가지고 있습니다. 이 균형이 uncoupled 때, 장애의 정도를 변화하면 발생합니다. 이러한 큰 눈물로 회전 즉석의 기능 손실, glenoid에 상박 골의 머리 우수한 번역을 일으킬 수 있습니다. 이 변경 glenohumeral 공동의 회전의 중심과 후, 남아있는 근육의 긴장과 순간 팔, 감소 기능. 또한, 상박 골의 머리와 접촉 압력의 후속 변경 내용의 위치의 변화는 관절 연골과 통증 관절염을 발생하는 진취적인 손상을 초래할 수 있습니다. 이러한 경우의 표준 어깨 arthroplasty의 사용은 하위 최적 때로는 치명적인 결과를 제공하고 있습니다. 역방향 총 어깨 arthroplasty (RTSA)는 운동과 기능의 고통, 범위의 상당한 개선을 제공하는 이러한 복잡한 문제에 대한 솔루션을 제공합니다. RTSA 디자인 회전의 중심을 medializes하고보다 열등한 위치로 상완골을 제공합니다. biomechanics에이 변경 사항은 공간에 팔을 이동 deltoids 능력을 향상, 삼각근의 복부와 기능 레버암의 긴장을 복원합니다. 또한, 고통 arthritic 연골은 크게 환자의 고통을 향상 과정 제거됩니다. 2. 사례 발표 : 이 환자는 십오년 전에 &quot;미니 열기&quot;회전 커프스의 역사를 가진 71 세의 건강한 여성입니다. 지난 1 년 동안, 그녀는 자신의 운동 범위의 감소와 연관된 그녀의 어깨 증가 고통과 약점을 이루었습니다. 그녀의 적극적인 납치가 30 ° 되었음 활성 앞으로 굴곡이 40 ° 되었음 적극적인 외부 회전은 10 °와 gluteus 활성 내부 회전했다. 그녀의 수정된 베어 - 포옹 테스트 subscapularis 힘줄에 최소한의 약점을 보여준 그녀는 부정적인 호른 - 송풍기의 서명과 부정 지연 테스트를했다. 모션 그녀의 수동적 범위는 긍정적인 드롭 암 검사와 함께 앞으로 굴곡 75 °를 보여주었다. neurovascular 시험 달리 정상이고 이전의 회전 커프의 수리와 관련된 감염의 흔적이 없었다. 3. 치료 / 진단 절차 : 이 환자의 초기 radiographic 평가 견갑골 아울렛보기 Grashey보기, 그리고 겨드랑보기를 포함해야합니다. glenoid의 모양에 따라 CT 촬영에 대한 추가 연구는 뼈가 침식, dysplasia의 존재와 사용 가능한 뼈 주식의 양을 평가해야 할 수 있습니다. 우리의 환자에서 초기 radiographs은 감소 acromio - 상박 골의 거리에 의해 입증 상완골의 뛰어난 마이 그 레이션과 함께 적당한 퇴행성 변화를 전시. glenoid와 관련된 중요한 뼈가 손실이되지 않았습니다. 환자의 역사, 신체 검사와 radiographic 분석의 결합 pseudoparalysis와 함께 회전 커프 관절증과 일치하고 있습니다. 또한 진단 연구는이 환자에 표시되지 않을 것입니다. 전에 어떤 환자에서 주요 arthroplasty 고려하는 보수적인 조치의 과정은 수​​행되어야합니다. 이들은 안티 - 염증 약물과 의료, 통신 subacromial 및 intracapsular 공간과 강화 운동 범위에 대한 물리 치료로 corticosteroid 주사를 포함해야합니다. 치료의 과정 후, 환자는 그들의 고통, 현재 기능, 현실 기능적 요구와 욕망, 삶의 질 및 관련 comorbidities에 대한 평가해야합니다. 절차와 관련된 위험이 혜택을 기대 환자에 대한 허용으로 결정하는 경우, 역방향 총 어깨 arthroplasty에 대한 다음과 기법을 사용할 수 있습니다. 4. 총 숄더 Arthroplasty를 역방향 <ol><li> 환자는 beachchair 위치에 배치되고 팔을 준비 및 표준 방식으로 무료로 draped 있습니다. </li><li> 표준 deltopectoral 절개와 접근 방식은 회전 수갑을 채워 subacromial 공간을 노출 이루어집니다. 무딘 절개는 어떠한 adhesions의 기본 조직으로 열등 표면 델타자 모양의를 무료로하는 데 사용됩니다. </li><li> 회전 커프스는 눈물에 대한 검사 및 복구의 가능성에 대해 평가됩니다. 조직은 고칠수 것으로 나타날 경우, 수리 및 기존 arthroplasty을 고려할 수 있습니다. 그렇지 않으면, 어떤 쓸모없는 즉석는 excised 수 있습니다 </li><li> 겨드랑 신경은 식별 및 subscapularis 힘줄은 출처를 해제하지 않고 식별하고 덜 tuberosity에서 발표와 힘줄이 어떤 adhesions에서 proximally 해제됩니다 보호 </li><li> 열등 캡슐은 근위 상완골에서 출시되고 상완골은 외부 T를 탈구 회전공동에서 그는 상박 골의 머리 </li><li> 골수의 운하가있는 상박 골의 머리 절제술 가이드로 교체 및 근위 상박 골의 컷이 버전의 0 °에서 이루어집니다. 진입 송곳을 사용하여 위치 intramedullary 가이드는 절단을 완료하기 위해 제거되어야합니다 </li><li> Metaphyseal과 diaphyseal reaming은 환자의 해부학에 적합한 크기로 이루어집니다 </li><li> 시험 구성 요소는 다음 glenoid 준비를위한 컷 보호대와 함께 적절한 버전에서 조립과 상완골에 배치됩니다 </li><li> labrum가 excised이며, 앞쪽에 및 하부 캡슐은 glenoid에서 출시되며 견인기는 glenoid을 노출 배치됩니다 </li><li> 드릴 가이드는 6mm 드릴을 사용하여 중앙 드릴 구멍을 배치하는 데 사용됩니다 </li><li> glenoid은 말초 홈을 만드는 기본 접시 준비 reamed입니다 </li><li> 중앙 구멍은 다음 8mm 중앙​​ 말뚝에 대한 7.5mm로 확대하고 기초 판은 위치, reamed glenoid을 잔뜩 영향 </li><li> 나사는 다음 트랜스 대뇌 피질의 고정과베이스 플레이트에 게재됩니다. 앞쪽에 및 사후 나사가 게재 위치를 30 ° 아크를 표준​​ 피질 나사입니다. 우수와 열등 나사가 각각 우수와 열등 비행기에서 30 ° 아크와 나사 잠금 고정 아르 </li><li> glenosphere 그런 다음 기본 판에 영향을하고 중앙 나사는 glenosphere 확보 강화됩니다 </li><li> 재판 라이너는 다음 재판 상박 골의 줄기에 위치하며 어깨가 줄어 듭니다. ROM 및 안정성 시험은 이루어졌다 및 조정이 필요로 이루어집니다 </li><li> 트라이얼 임플란트는 다음 상완골에서 제거됩니다, 최종 구성 요소는 해당 버전의 조립 및 삽입 상완골에 영향을 </li><li> 어깨가 감소되고 ROM과 안정성의 최종 시험이 끝났습니다 </li><li> subscapularis 힘줄은 다음 근위 상완골에 수리되고 상처가 표준 방식으로 폐쇄 </li></ol> 5. 결과 : 6 개월 후속이 환자는 열 제로 밖으로 시각 아날로그 척도 그녀 포스트 수술 고통을 선정했습니다. 모션 그녀의 적극적인 범위는 140 ° 그녀 gluteus에 25 ° 및 내부 회전 적극적인 외부 회전 앞으로 굴곡이 포함되어 있습니다. 이 환자는 후속 마지막으로 전혀 내부 수술이나 POST 수술 합병증 없었다. 6. 결론 : 저자의 경험에서, RTSA는 안정적인 통증과 운동 및 기능 결과의 범위에서 개선 회전 커프 관절증을 가진 환자를 제공합니다. 이 환자는이 수술의 결과에 만족했다.

<ol>
	<li>Boileau, P., Sinnerton, R. J., Choinard, C., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arthroplasty+of+the+Shoulder.">Arthroplasty of the Shoulder.</a> J Bone Joint Surgery Br. 88, 562-575 (2006).</li><li>Boileau, P., Watkinson, D., Hatzidakis, A. M., Hovorka, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neer+Award+2005:+The+Grammont+reverse+shoulder+prosthesis:results+in+cuff+tear+arthritis,+fracture+sequelae,+and+revision+arthroplasty.">Neer Award 2005: The Grammont reverse shoulder prosthesis:results in cuff tear arthritis, fracture sequelae, and revision arthroplasty.</a> J Shoulder Elbow Surg. 15, 527-540 (2006).</li><li>Boileau, P., Watkinson, D. J., Hatzidakis, A. M., Balg, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Grammont+reverse+prosthesis:+design,+rationale,+and+biomechanics.">Grammont reverse prosthesis: design, rationale, and biomechanics.</a> J Shoulder Elbow Surg. 14, 147S-161S (2005).</li><li>Cuff, D., Pupello, D., Virani, N., Levy, J., Frankle, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+shoulder+arthroplasty+for+the+treatment+of+rotator+cuff+deficiency.">Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency.</a> J Bone Joint Surg Am. 90, 1244-1251 (2008).</li><li>Edwards, T. B., Boulahia, A., Kempf, J. F., Boileau, P., Nemoz, C., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+influence+of+rotator+cuff+disease+on+the+results+of+shoulder+arthroplasty+for+primary+osteoarthritis:+results+of+a+multicenter+study.">The influence of rotator cuff disease on the results of shoulder arthroplasty for primary osteoarthritis: results of a multicenter study.</a> J Bone Joint Surg Am. 84, 2240-2248 (2002).</li><li>Frankle, M., Siegal, S., Pupelo, D., Saleem, A., Mighell, M., Vasey, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=There+reverse+shoulder+prosthesis+for+glenohumeral+arthritis+associated+with+severe+rotator+cuff+deficiency.+A+minimum+two-year+follow-up+study+of+sixty+patients.">There reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients.</a> J Bone Joint Surg Am. 87, 1697-1705 (2005).</li><li>Guery, J., Favard, L., Sirveaux, F., Oudet, D., Mole, D., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty.+Survivorship+analysis+of+eighty+replacements+followed+for+five+to+ten+years.">Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years.</a> J Bone Joint Surg Am. 88, 1742-1747 (2006).</li><li>Martin, T. G., Lanotti, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty+for+acute+fractures+and+failed+management+after+proximal+humerus+fractures.">Reverse total shoulder arthroplasty for acute fractures and failed management after proximal humerus fractures.</a> Orthop Clin North Am. 39, 451-457 (2008).</li><li>Wall, B., Nove-Josserand, L., O'Conner, D. P., Edwards, T. B., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty:+a+review+of+results+according+to+etiology.">Reverse total shoulder arthroplasty: a review of results according to etiology.</a> J Bone Joint Surg Am. 89, 1476-1485 (2007).</li><li>Werner, C. M., Steinmann, P. A., Gilbart, M., Gerber, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+painful+pseudoparesis+due+to+irreparable+rotator+cuff+dysfunction+with+the+delta+III+reverse-ball-and-socket+total+shoulder+prosthesis.">Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the delta III reverse-ball-and-socket total shoulder prosthesis.</a> J Bone Joint Surg Am. 87, 1476-1486 (2005).</li></ol>

관심 없음 충돌 선언하지 않습니다.

회전 커프 관절증을위한 RTSA의 사용은 운동 및 기능적 결과 점수의 고통, 범위의 상당한 개선을 제공합니다. 전체 환자의 만족도는 현재 문학의 80~95%에서 원거리했다. 모든 절차와 마찬가지로, RTSA 위험없이하지 않습니다. 합병증의 초기 보고서는 60 %로 높이되었습니다. 기법 향상으로 합병증 률은 감소했습니다.

<table border="1"><tbody><tr><td> 시약의 이름 </td><td> 회사 </td><td> 카탈로그 번호 </td><td> 댓글 </td></tr><tr><td> Aequalis는 어깨를 레버 스드 </td><td> Tornier 주식 회사 </td><td> 없음 </td><td> 자세한 내용은 방문을위한 <a href="http://www.tornier-us.com/">http://www.tornier-us.com/</a> </td></tr></tbody></table>

reverse total shoulder arthroplasty

역방향 총 어깨 arthroplasty은 초기 회전 커프 관절증에 사용 승인을 잘 힘줄이 전송 reconstructions에 해당되지 않은 환자에서 관절염없이 만성 pseudoparalysis로했다. 이러한 환자에 대한 전통적인 수술 옵션이 제한되었으며 기능 결과 하위 최적되었으며 시간 재앙에. 반대로 어깨 arthroplasty의 사용이 효과적으로 이러한 환자의 기능을 복원하고 자신의 질환과 관련된 증상을 완화하는 것으로 확인되었습니다. 절차는 두 가지 방법, deltopectoral 또는 superolateral을 통해 수행할 수 있습니다. 보철물의 사용과 관련된 합병증 요금 8~60%에서 경험을 얻은이므로 낮은 동향 최근 보고서였다있다. 제한 보철물 실패 역방향 어깨 옵션을 건져내 종종 상당한 관련 장애가있다. 이 보철물의 사용에 대한 징후가 개정 arthroplasty, 근위 상박 골의 골절 및 종양에 대한 사용을 포함하여 평가를 진행합니다. 주의 환자를 선택하기 때문에 절차와 관련된 중요한 위험 필수적입니다.

Watch this Scientific Journal Video about Reverse Total Shoulder Arthroplasty at JoVE.com

Reverse Total Shoulder Arthroplasty

역방향 총 어깨 arthroplasty은 기존 arthroplasty 또는 기타 절차를 취급 수없는 조건의 치료에 표시됩니다. 이들은 주로 어깨의 정상적인 biomechanical 커플링의 돌이킬 회전 수갑을 채워 손실과 퇴행성 및 incapacitating 조건을 포함합니다.

총 숄더 Arthroplasty를 역방향

Reverse total shoulder arthroplasty was initially approved for use in rotator cuff arthropathy and well as chronic pseudoparalysis without arthritis in ...

Research

JoVE Journal

Medicine

43.0K 조회수.  Case Western Reserve University. 역방향 총 어깨 arthroplasty은 기존 arthroplasty 또는 기타 절차를 취급 수없는 조건의 치료에 표시됩니다. 이들은 주로 어깨의 정상적인 biomechanical 커플링의 돌이킬 회전 수갑을 채워 손실과 퇴행성 및 incapacitating 조건을 포함합니다.

비디오: Reverse Total Shoulder Arthroplasty

Implantation of the Syncardia Total Artificial Heart

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of such patients are generally well served by left ventricular assist devices (LVADs). However, a subset of patients with late stage biventricular failure or other significant anatomic lesions are not adequately treated by isolated left ventricular mechanical support. Examples of concomitant cardiac pathology that may be better treated by resection and TAH replacement includes: post infarction ventricular septal defect,&#160;aortic root aneurysm / dissection, cardiac allograft failure, massive ventricular thrombus, refractory malignant arrhythmias (independent of filling pressures), hypertrophic / restrictive cardiomyopathy, and complex congenital heart disease. Patients often present with cardiogenic shock and multi system organ dysfunction. Excision of both ventricles and orthotopic replacement with a total artificial heart (TAH) is an effective, albeit extreme, therapy for rapid restoration of blood flow and resuscitation. Perioperative management is focused on end organ resuscitation and physical rehabilitation. In addition to the usual concerns of infection, bleeding, and thromboembolism common to all mechanically supported patients, TAH patients face unique risks with regard to renal failure and anemia. Supplementation of the abrupt decrease in brain natriuretic peptide following ventriculectomy appears to have protective renal effects. Anemia following TAH implantation can be profound and persistent. Nonetheless, the anemia is generally well tolerated and transfusion are limited to avoid HLA sensitization. Until recently, TAH patients were confined as inpatients tethered to a 500 lb pneumatic console driver. Recent introduction of a backpack sized portable driver (currently under clinical trial) has enabled patients to be discharged home and even return to work. Despite the profound presentation of these sick patients, there is a 79-87% success in bridge to transplantation.

The purpose of this manuscript is to briefly review indications, management, and outcomes for the total artificial heart. Video operative techniques for device implantation are presented.

에 SynCardia 총 인공 심장의 이식

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of ...

연구

의학

Implantation of Total Artificial Heart in Congenital Heart Disease

In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital heart disease (CHD), the malformed heart presents a challenge to TAH implantation. 
In the case presented here, a 17 year-old patient with congenital transposition of the great arteries (CCTGA) experienced progressively worsening HF due to his congenital condition. He was hospitalized multiple times and received an implantable cardioverter defibrillator (ICD). However, his condition soon deteriorated to end-stage HF with multisystem organ failure. 
Due to the patient's grave clinical condition and the presence of complex cardiac lesions, the decision was made to proceed with a TAH. The abnormal arrangement of the patient's ventricles and great arteries required modifications to the TAH during implantation.
With the TAH in place, the patient was able to return home and regain strength and physical well-being while awaiting a donor heart. He was successfully bridged to heart transplantation 5 months after receiving the device. This report highlights the TAH is feasible even in patients with structurally abnormal hearts, with technical modification.

This is a case report of a patient with congenitally corrected transposition of the great arteries (CCTGA) who received a total artificial heart (TAH) as a bridge to heart transplant. The TAH was successfully implanted with modifications to accommodate the patient's congenitally malformed heart.

선천성 심장 질환의 총 인공 심장의 이식

In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital ...

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of arthroplasty. Infection requires complex treatment, may result in long hospitalization and causes considerable costs. Multiple surgical revisions can be necessary in these patients, with a loss in function as well as in quality of life.
The routine preoperative diagnostics include blood examination for C-reactive protein (CRP) and other biomarkers, as well as joint aspirate analysis for cell count, differentiation, and culture. Intraoperative specimens for histology and microbiology are also standard procedure. The microbiological examination of removed implants with sonication, in combination with the implementation of molecular biology techniques in microbiology, represent two novel techniques currently employed to enhance the differential diagnostics of PJI.
We present here the step-wise procedure of analyzing joint aspirate and sonication fluid, using a cartridge-based multiplex polymerase chain reaction (PCR) system. Results were matched against conventional cultures and consensus criteria for PJI. Conventional microbiological cultures from tissue biopsies, joint aspirate and sonication fluid showed a sensitivity of 66.7%, 66.7%, and 88.9%, respectively, and a specificity of 82.3%, 54.6%, and 61.5%, respectively. The PCR diagnostic of the sonication fluid and the joint fluid showed a sensitivity of 50.0% and 55.6%, respectively, and both a specificity of 100.0%. Both PCR diagnostics combined had a sensitivity of 66.7% and a specificity of 100.0%. The multiplex PCR therefore presents a rapid diagnostic tool with moderate sensitivity but high specificity in diagnosing PJI.

Differential diagnostics in painful arthroplasty is crucial for treatment success. Joint aspiration is routinely performed preoperatively. Multiplex polymerase chain reaction of the joint aspirate and the sonication fluid, a feasible tool for quick pathogen detection from these samples is described.

개정 공동 교체에 새로운 진단: 쥡니다 및 다중 연쇄 반응 임 플 란 트

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of ...

Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ventricular assist devices (VADs) for support of the left ventricle. However, certain clinical scenarios warrant biventricular mechanical support. One strategy for some patients is the excision of both ventricles and the implantation of two VAD pumps as a total artificial heart (TAH). This has recently been made possible by the improvements in device design and the small profile of centrifugal devices. This TAH approach remains experimental with many important challenges such as the device settings to balance the right and left circulation, the orientation of the devices and the outflow graft with their influence on hemolysis and stability, and the outcome of chronic support using such an orientation. This protocol aims to provide a reproducible approach for total artificial heart replacement with two intracorporeal centrifugal VADs in a cow model.

Here, we present a protocol using two centrifugal pumps as a total artificial heart replacement.

총 인공 심장으로 두 Intracorporeal 심 실 지원 장치의 사용

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ...

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

Bone- and soft-tissue sparing short stems are increasingly used in total hip arthroplasty (THA). However, there are a large variety of models of short stems, differing in design and function. Calcar-guided short stems provide an anatomical curvature in the medial calcar region, thus, positioning is done individually alongside the calcar in the "round-the-corner" technique. Depending on the level of the neck's osteotomy, stems can be aligned individually in a large bandwidth of varus- and valgus anatomies. This differs from conventional total hip arthroplasty and potentially includes a severe learning curve. Given that a great variety of caput-collum-diaphyseal (CCD)-angles can be retained, the reconstruction of femoro-acetabular offsets can be achieved precisely. However, particularly extensive varus- and valgus positioning has raised concerns in regard to stability and bone remodeling. The purpose of the present manuscript is to showcase the implantation technique in calcar-guided short-stem THA and to summarize short-term clinical and radiological results.

This protocol describes the round-the-corner technique and the individualized stem-positioning of calcar-guided short stems alongside the medial calcar, depending on the level of the osteotomy. This differs from conventional total hip arthroplasty and includes a learning curve.

개별적인 줄기 Calcar 기반 짧은 줄기 총 엉덩이 관절 교체에 위치

Bone- and soft-tissue sparing short stems are increasingly used in total hip arthroplasty (THA). However, there are a large variety of models of short ...

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

Fluid retention is the most common risk factor for mortality and cardiovascular complications in patients with volume-overloaded disease states. The extent of diuresis or fluid removal is frequently determined by physical examination which is subject to inaccuracies.
Bedside ultrasound (US) is a portable tool that brings real-time diagnostic imaging to the patient's bedside. This versatile modality makes it possible for the clinician to investigate patients' extravascular and intravascular volume states. The extravascular volume, particularly in the case of pulmonary edema, can be quantitatively assessed by US of the anterior chest. Intravascular volume is estimated by visualizing the inferior vena cava (IVC) caliber. Taken together, the degree of extravascular lung water and the IVC caliber provide objective data that can guide the clinician to determine the level of diuresis needed to effectively yet safely treat pulmonary edema. 
The objective of this article is threefold: 1) to summarize the findings of previous studies on the efficacy of portable US to guide fluid management, 2) to describe a proposed ultrasound protocol to help guide fluid management, and 3) to elucidate techniques that address the measurement of intravascular and extravascular volumes using portable US.

We describe an imaging protocol that enables the clinician to visualize, in real-time, the patient&#39;s intravascular and extravascular space volumes and set diuresis and fluid removal parameters accordingly for the safe and efficient treatment of pulmonary edema.

폐 부 종 환자에서 지도 액체 제거를 위한 머리 맡 초음파: 리버스 폭포 프로토콜

Fluid retention is the most common risk factor for mortality and cardiovascular complications in patients with volume-overloaded disease states. The ...

Studying Left Ventricular Reverse Remodeling by Aortic Debanding in Rodents

To better understand the left ventricular (LV) reverse remodeling (RR), we describe a rodent model wherein, after aortic banding-induced LV remodeling, mice undergo RR upon removal of the aortic constriction. In this paper, we describe a step-by-step procedure to perform a minimally invasive surgical aortic debanding in mice. Echocardiography was subsequently used to assess the degree of cardiac hypertrophy and dysfunction during LV remodeling and RR and to determine the best timing for aortic debanding. At the end of the protocol, terminal hemodynamic evaluation of the cardiac function was conducted, and samples were collected for histological studies. We showed that debanding is associated with surgical survival rates of 70-80%. Moreover, two weeks after debanding, the significant reduction of ventricular afterload triggers the regression of ventricular hypertrophy (~20%) and fibrosis (~26%), recovery of diastolic dysfunction as assessed by the normalization of left ventricular filling and end-diastolic pressures (E/e&#39;&#160;and LVEDP). Aortic debanding is a useful experimental model to study LV RR in rodents. The extent of myocardial recovery is variable between subjects, therefore, mimicking the diversity of RR that occurs in the clinical context, such as aortic valve replacement. We conclude that the aortic banding/debanding model represents a valuable tool to unravel novel insights into the mechanisms of RR, namely the regression of cardiac hypertrophy and the recovery of diastolic dysfunction.

Here we describe a step-by-step protocol of surgical aorta debanding in the well-established mice model of aortic-constriction. This procedure not only allows studying the mechanisms underlying the left ventricular reverse remodeling and regression of hypertrophy but also to test novel therapeutic options that might accelerate myocardial recovery.

설치류에서 대동맥 탈밴드에 의해 왼쪽 심실 역 리모델링 공부

To better understand the left ventricular (LV) reverse remodeling (RR), we describe a rodent model wherein, after aortic banding-induced LV remodeling, ...

An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery

Anesthesia is a routine component of cancer care that is used for diagnostic and therapeutic procedures. The anesthetic technique has recently been implicated in impacting long-term cancer outcomes, possibly through modulation of adrenergic-inflammatory responses that impact cancer cell behavior and immune cell function. Emerging evidence suggests that propofol-based total intravenous anesthesia (TIVA) may be beneficial for long-term cancer outcomes when compared to inhaled volatile anesthesia. However, the available clinical findings are inconsistent. Preclinical studies that identify the underlying mechanisms involved are critically needed to guide the design of clinical studies that will expedite insight. Most preclinical models of anesthesia have been extrapolated from the use of anesthesia in in vivo research and are not optimally designed to study the impact of anesthesia itself as the primary endpoint. This paper describes a method for delivering propofol-TIVA anesthesia in a mouse model of breast cancer resection that replicates key aspects of clinical delivery in cancer patients. The model can be used to study mechanisms of action of anesthesia on cancer outcomes in diverse cancer types and can be extrapolated to other non-cancer areas of preclinical anesthesia research.

An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery

This paper describes a method for modeling total intravenous anesthesia (TIVA) during cancer resection surgery in mice. The goal is to replicate key features of anesthesia delivery to patients with cancer. The method allows investigation of how anesthetic technique affects cancer recurrence after resection surgery.

암 절제 수술 중 전체 정맥 마취의 생체 내 마우스 모델

Anesthesia is a routine component of cancer care that is used for diagnostic and therapeutic procedures. The anesthetic technique has recently been ...

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex procedures. The high-quality 3-D visual, multijoint arm and natural tremor filtration allow the surgeon to expose and dissect more accurately with minimal invasion. Total mesorectal excision is the standard surgical technique for the treatment of resectable rectal cancer. To reduce the lateral recurrence rate, lateral pelvic lymph node dissection can be performed, as it is a safe and feasible procedure for locally advanced middle-low rectal cancer with a high possibility of metastasis to the lateral lymph nodes. However, the complexity of the anatomic structures and the high postoperative complication rate limit its application. Recently, several surgeons have increasingly used robotic techniques for total mesorectal excision and lateral pelvic lymph node dissection. Compared with open and laparoscopic surgery, the robotic technique has several advantages, such as less blood loss, fewer blood transfusions, minimal trauma, shorter postoperative hospitalization, and quicker recovery. A robotic approach is generally regarded as a reasonable alternative for complicated procedures such as lateral pelvic lymph node dissection, although there are a limited number of high-quality prospective randomized controlled studies reporting direct evidence. Here, we provide the detailed steps of robot-assisted total mesorectal excision and lateral pelvic lymph node dissection performed at the First Affiliated Hospital of Xi&#39;an Jiaotong University.

The robotic technique described herein aims to detail a stepwise approach to robot-assisted total mesorectal excision and lateral pelvic lymph node dissection for locally advanced (T3/T4) rectal cancer located below the peritoneal reflection.

로봇 보조 총 중각 절제술 및 측면 골반 림프절 해부 국소 고급 중간 낮은 직장 암

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex ...

The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed reality were used to perform complex revision hip arthroplasty in January 2019. The use of mixed reality allowed for a very good visualization of the structures and resulted in precise implant fixation. According to the authors' knowledge, this is the first described case report of the combined use of these two innovations. The diagnosis preceding the qualification for the procedure was the loosening of the left hip's acetabular component. Mixed reality headset and holograms prepared by engineers were used during the surgery. The operation was successful, and it was followed by early verticalization and patient rehabilitation. The team sees opportunities for technology development in joint arthroplasty, trauma, and orthopedic oncology.

A complex revision hip arthroplasty was performed using a custom-made implant and mixed reality technology. According to the authors&#39; knowledge, this is the first report of such procedure described in the literature.

맞춤형 개정 고관절 치환술에서 혼합 현실 사용: 첫 번째 사례 보고서

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed ...