Magnetic retrieval of prosthetic heart valves for redo-TAVI

Bioprosthetic aortic heart valves are known to degenerate within 7–15 years of implantation. Currently, the options for treating a failing valve are (a) redo surgical aortic valve replacement or, increasingly, (b) valve-in-valve transcatheter aortic valve implantation (ViV-TAVI). The ViV-TAVI procedure is referred to as redo-TAVI when the failing valve is a TAVI device. Repeated procedures, such as two or three valve-in-valves, significantly reduce the effective valve flow area, putting a limit on recurrent treatments. With increasing life expectancy and the use of TAVI in younger, lower-risk patients, the demand for multiple replacement procedures will inevitably increase. Against this background, we describe a novel valve system named exchangeable-TAVI (e-TAVI) in which an electromagnetic catheter is used to remove and retrieve a failed exchangeable valve, followed by the immediate deployment of a new valve. The e-TAVI system comprises (i) an exchangeable valve, (ii) a permanent holding member that anchors the exchangeable valve and (iii) a dedicated catheter with electromagnets for removal of the exchangeable valve. Simulations have been performed to determine the forces, frame design and electromagnetic parameters required to crimp and retrieve a 26 mm diameter valve. An optimum configuration was found to comprise a 12 cell self-expanding frame with circular ferromagnetic regions of 1 mm radius and 0.5 mm thickness, along with eight electromagnets of 1 mm radius and 2 mm thickness. A force of 2.87 N and a current of 2.52 A per electromagnet were required to partially crimp the frame to an envelope radius of 11 mm. While this amount of force allowed the frame to be crimped solely through magnetic attraction, re-sheathing of the frame was not possible due to the weaker shear holding force of the magnets. Also, the current was close to the fusing current of the copper wire needed to fit sufficient windings into the available volume. These issues led to the conclusion that, in addition to the magnetic coupling, a mechanical mating between the removal catheter and the exchangeable valve is needed. This would decrease both the force that the electromagnets had to exert during crimping and the current required to generate this force

Vücut kitle indeksi ve yaralanma süresinin menisküs tamiri sonrası sonuçlara etkisi]

Aim: Our study was to assess the outcome of meniscal repair surgery with anterior cruciate ligament reconstruction, focusing in particular on meniscal healing. Material and Method: We analyzed whether the time elapsed between the injury and the surgery affected the activity scores as measured by the Tegner Activity Scale, Modified Lysholm Knee Scoring, and Barrett criteria. Similarly, we analyzed whether body mass index (BMI) affected the activity scores. Result: The average BMI of the patients was 23.99 +/- 3.64 kg/m2 (range: 19.9-34). BMI was graded as underweight (18.5 kg/m2 or less), normal weight (18.5 kg/m2 to 24.99 kg/m2), overweight (25 kg/m2 to 29.99 kg/m2), or obese (30 kg/m2 to 39.99 kg/m2). Patients were divided into two groups. Overweight and obese patients were included in one group, and patients of normal weight or underweight were included in the other group. Out of a total of 34 patients, 3 (8.8%) were underweight, 20 (58.8%) were normal weight, 9 (26.5%) were overweight, and 2 (5.9%) were obese. Based on the BMI there was no significant difference between the two groups for results of the Tegner Activity Scale, Modified Lysholm Knee Score, and Barrett criteria. BMI of the patients was not a risk factor for the post-operative score scale (P>0.05). There was no significant difference between the injury period (the time elapsed between the injury and the surgery) and activity scores (P>0.05). The injury period had no effect on the post-operative scores. Discussion: BMI of the patients and injury time of the meniscus tear had no negative effect on the functional results of the operation. Meniscal lesions with ACL tear should be repaired when diagnosed

Nontraumatic Myositis Ossificans of Hip: A Case Presentation

In most of the cases trauma is the leading etiology and the nontraumatic myositis ossificans (MO) is a very rare condition. We present an MO case without any trauma occurring. A 36-year-old female patient with a history of pain and restriction of range of motion of the left hip was admitted. Hip motions were restricted with 10–60° of flexion, 10° of internal rotation, 20° of external rotation, 10° of abduction, and 10° of adduction. There was no history of trauma and familial involvement. The biopsy of the lesion revealed mature bone tissue confirming our diagnosis of MO. The mass was removed surgically and postoperatively the patient was treated with a single dose radiotherapy with 800 gyc. MO is a benign and well differentiated bone formation or in other words heterotopic ossification of the muscle tissue. It has a prevalence of less than 1/1 million. Trauma is the most frequent etiological factor seen in almost 60–75% of the cases. Nontraumatic MO is very rare in the literature. Our patient had no history of trauma or familial involvement. Combination of the surgical excision with radiotherapy in the treatment of the MO of the hip may give satisfactory results

Volar Locking Plating Treatment Results in Fragmented Intraarticular Distal Radius Fractures / Rezultati Tretmana Metodom “Zakljucavanja” Rucja Kod Višestruktih Distalnih Intraartikularnih Preloma Radijusa

Volar locking plating treatment results in fragmented intra-articular distal radius fractures in adults

An Observational 1-Month Trial on the Efficacy and Safety of Promerim for Improving Knee Joint

Objective: This study was conducted to evaluate the efficacy and tolerability of the oral intake of promerim in the elimination of acute pain and discomfort associated with knee osteoarthritis (OA). Methods: Single-center, 1-month, prospective, observational clinical trial. A total of 92 patients not older than 70 years were included. Patients were offered to use 720-mg promerim for the first 15 days after admission after breakfast and then 360 mg for the second 15 days. All patients were analyzed with the visual analog scale (VAS) for pain, which ranges from 0 to 10, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score before the start of treatment and 1 month after the start. Statistical analysis was performed by SPSS 15.0 software. An α level of P  < .05 was assumed to be statistically significant. Results: This study comprised 92 patients (69 women and 23 men) with a mean age of 51.5 (range: 40-69) years. Before treatment, the mean VAS score was 5.6 ± 1.1, and after treatment, the mean VAS score was 2.6 ± 1.7. Treatment with promerim consistently showed a significant decrease in the VAS score ( P  < .001). The mean WOMAC score of the patients was 46.4 ± 8.2 before treatment. After treatment, the mean WOMAC score was 72.1 ± 14.4. Treatment with promerim consistently showed a significant increase in the WOMAC score ( P  < .001). Conclusions: The results of this single-center, open-label clinical study demonstrate that promerim is a viable natural treatment option for treating knee OA. We recommend that 720-mg promerim taken once daily for the first 15 days after admission and 360 mg taken once daily for the next 15 days significantly and rapidly reduced composite pain and stiffness in the knee OA within 1 month

Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A Retrospective Cohort Study

Introduction: Most of the ACL reconstruction is done with isometric single-bundle technique. Traditionally, surgeons were trained to use the transtibial technique (TT) for drilling the femoral tunnel. Our study compared the early postoperative period functional and clinical outcomes of patients who had ACL reconstruction with TT and patients who had ACL reconstruction with anatomical single-bundle technique (AT)