Total Replacement Research Articles

Class III Congenital Middle Ear Anomalies: Refining the Teunissen-Cremers Classification Based on Stapes Suprastructure Viability.

This study aims to evaluate the surgical outcomes of partial ossicular replacement prosthesis (PORP) and total ossicular replacement prosthesis (TORP) in class III congenital middle ear anomalies (CMEAs) based on stapes suprastructure integrity and to propose a refined Teunissen-Cremers classification. A retrospective cohort study. A tertiary academic medical center. Forty-nine ears from 46 patients with class III CMEAs who underwent ossiculoplasty from 2012 to 2024 were included. Patients were categorized into the viable suprastructure group (26 ears), with intact or mildly dysplastic suprastructures requiring PORP, and the non-viable suprastructure group (23 ears), with severely dysplastic or absent suprastructures requiring TORP. Exclusion criteria included revision surgeries, other types of CMEAs, and a follow-up period of <6 months. Preoperative demographics and hearing thresholds were comparable between groups. Postoperative air-bone gap (ABG) closure within 10 dB was significantly more frequent in the viable group (80.8%) compared to that in the non-viable group (52.2%, P = .033). ABG closure within 20 dB was achieved in 100% of the viable group and 91.3% of the non-viable group (P = .215). Postoperative complications, including sensorineural hearing loss and prosthesis extrusion, were similar between groups (P > .05). Ossiculoplasty with PORP in viable cases demonstrated better ABG closure compared to TORP in non-viable cases. Further investigation is warranted to determine the influence of baseline hearing differences on these outcomes. A refined Teunissen-Cremers classification, subdividing class IIIa into IIIa1 (viable) and IIIa2 (non-viable) based on stapes suprastructure integrity, may improve prosthesis selection and prognostic assessment.

Thoracic Endovascular Aortic Repair for Aortic Arch Penetrating Atherosclerotic Ulcer Using Castor Single-Branched Stent-Graft With Zone 2 Landing.

This study evaluated the feasibility and safety of thoracic endovascular aortic repair (TEVAR) for aortic arch penetrating atherosclerotic ulcer (PAU) using Castor single-branched stent-graft with zone 2 landing. Between May 2020 and April 2022, a total of 25 aortic arch PAU patients were treated by TEVAR with Castor single-branched stent-graft. Outcomes included technical success, perioperative and follow-up morbidity and mortality, and patency of left subclavian artery (LSA). All patients had aortic arch PAU with intramural hematoma (IMH). The proximal landing zone for all patients was in zone 2, which was between the distal edge of the left common carotid artery and proximal edge of LSA, in all cases. Technical success was achieved in all cases. During hospitalization after the operation, 1 patient died of gastrointestinal bleeding, and 2 patients (8.0%) had ischemic stroke. At a median follow-up of 29 months (interquartile range [IQR], 24-30 months), 2 (8.0%) patients died, including 1 ischemic stroke and 1 hemorrhagic stroke. One patient (4.0%) had reintervention owing to retrograde type A aortic dissection (RTAD) 2 months after the operation, and was successfully treated with aortic root remodeling, ascending aorta and total aortic arch replacement and frozen elephant trunk procedure. No endoleak or LSA occlusion occurred. The maximal diameter of aorta at proximal (30.2±2.4 mm vs 31.2±3.0 mm; p>0.05) and distal (25.7±2.8 mm vs 24.5±2.3 mm; p>0.05) landing zone showed no significant difference before and after the operation. The TEVAR for aortic arch PAU using Castor single-branched stent-graft is a safe and efficient option with zone 2 landing. For patients with diagnosis of PAU with IMH, TEVAR with Castor single-branched stent-graft presents low mid-term mortality and morbidity rate, which should be considered as an optimal option when proximal landing zone is insufficient and revascularization of left subclavian artery (LSA) is needed. With Castor single-branched stent-graft, LSA could be revascularized easily and accurately.

Stochastic event-based probabilistic earthquake risk assessment framework for Uganda: towards informing the National Policy for Disaster preparedness and management

Abstract Catastrophic earthquakes in Uganda have the potential for detrimental consequences on the socio-economic welfare and resilience of communities. Despite considerable efforts in predicting earthquake risk across Africa, a national comprehensive seismic risk study for Uganda does not exist. With increasing population, urbanisation and rapid construction, seismic risk is escalating fast and is compounded by the high vulnerability of buildings and scanty disaster prevention and mitigation strategies. This study uses the probabilistic event-based risk calculator of the OpenQuake-engine to assess potential risks resulting from future earthquakes. Although the building exposure model is largely inferred and projected from the national population and housing census of 2014, total replacement costs are obtained by performing series of interviews with local engineering practitioners. Analytical vulnerability curves are selected from Global Earthquake Model (GEM) database. Seismic hazard studies confirm that western Uganda is exposed to the highest level of seismicity where peak ground accelerations on rock ground can reach up to 0.27 g over a 475-year return period. Relative to Uganda’s gross domestic product, the associated seismic risk estimates indicate mean economic loss ratios of 0.36%, 2.72% and 4.94% over 10, 50 and 100-year return periods respectively; with mean annual economic loss of US$ 74.7 million (0.34% relative to the total replacement value) and annual deaths averaging 71 persons across the whole country. It is envisaged that the findings will inform strategic land use planning patterns, earthquake insurance pricing and foster the continuous improvement of Uganda’s National Policy for Disaster Preparedness and Management.

Single-Institution Experience With Nononcologic Total Femoral Replacement.

Revision hip and knee arthroplasty volume continues to rise, and total femur replacement (TFR) remains a key salvage option in patients with extensive bone loss. Prior research has demonstrated mixed results of this procedure, and this study aimed to characterize the outcomes of nononcologic TFR in one of the largest single-center modern series. A retrospective analysis was conducted on 23 nononcologic TFR procedures performed on 22 patients between 2012 and 2021. Primary outcomes included TFR revision rate and indication for revision, while secondary outcomes included overall reoperation rate, complications, patient ambulatory status, and assistive device requirements. The average age at time of TFR was 65.7 years, with periprosthetic fracture (65.2%) and periprosthetic joint infection (34.8%) as predominant indications. More than half of patients (52.2%) required TFR revision, primarily due to periprosthetic joint infection (75.0%). Despite a high complication profile, only 1 patient underwent limb amputation and there was only 1 mortality during the study period. Overall, 63.6% of patients were ambulating (assisted or unassisted) at final follow-up. Nononcologic TFR remains a viable limb-salvage option for patients undergoing revision arthroplasty with extensive bone loss. Despite a notable revision rate and infection risk, the majority of patients maintain or regain ambulatory function, emphasizing the procedure's role in preserving limb function. Clinicians should weigh potential complications when considering TFR, emphasizing patient counseling and risk mitigation strategies.

Impact of Curing Temperature and Steel Slag Aggregates on High-Strength Self-Compacting Alkali-Activated Concrete

There is a growing demand for sustainable solutions in civil engineering concerning the carbon footprint of cementitious composites. Alkali-Activated Binders (AAB) are materials with great potential to replace ordinary Portland cement (OPC), with similar strength levels and lower environmental impact. Despite their improved environmental performance, their durability remains a gap in the literature, influenced by aspects of mechanical behavior, physical properties, and microstructure. This paper aims to assess the impact of steel slag aggregates and curing temperature of a proposed AAB based concrete formulation by characterizing fresh state, mechanical behavior, and microstructure. The proposed AAB is composed of fly ash (FA) and basic oxygen furnace (BOF) steel slag (SS) as precursors, sodium silicate and sodium hydroxide solution as activators, in total replacement of OPC, using baosteel slag short flow (BSSF) SS as aggregate in comparison with natural aggregate. The concrete formulation was designed to achieve a high-performance concrete (HPC) and a self-compacting concrete (SCC) behavior. Mechanical characterization encompassed hardened (compressive strength and Young’s modulus), fresh state (J-ring, slump flow, and T50), and durability tests (scanning electronic microscopy, water penetration under pressure, and chloride ion penetration). The compressive strength (64.1 ± 3.6 MPa) achieves the requirements of HPC, while the fresh state results fulfill the SCC requirements as well, with a spread diameter from 550 mm to 650 mm (SF-1 class). However, the flow time ranges from 3.5 s to 13.8 s. There was evidence of high chloride penetrability, affected by the lower electrical resistance inherent to the material. Otherwise, there was a low water penetration under pressure (3.5 cm), which indicates a well-consolidated microstructure with low connected porosity. Therefore, the durability assessment demonstrated a divergence in the results. These results indicate that the current durability tests of cementitious materials are not feasible for AAB, requiring adapted procedures for AAB composite characterization.

Aortic Valve Stenosis-Like Symptoms Caused by Pseudoaneurysm Following Total Arch Replacement

Aortic Valve Stenosis-Like Symptoms Caused by Pseudoaneurysm Following Total Arch Replacement

Impact of RAP as recycled aggregate on durability-related parameters of structural concrete

Impact of RAP as recycled aggregate on durability-related parameters of structural concrete

Arthroscopic Single-anchor Repair of Isolated Subscapularis Tendon Tears – Results after Ten Years Follow-up

The subscapularis muscle is the strongest and largest from the rotator cuff complex and provides over half of its strength. However, isolated subscapularis tendon tears are more frequently reported nowadays. With comparable outcomes to open surgery and a low complications rate, arthroscopic repair of these lesions is being utilized more often. Additionally, authors describe different techniques with similar results. The aim of this study was to discover the long-term results of arthroscopic single-anchor repair of isolated subscapularis tendon tears. This is a single-centre retrospective study involving 41 patients with isolated subscapularis tendon tears. All the participants underwent arthroscopic single-anchor repair and were re-evaluated after 121 ± 2 months. Demographic data, functional scores, complications rate, re-tear rate, and reoperations were recorded. Statistical analysis was performed. The study involved 24 male patients (58.5%). Ninety-three percent of the patients were over 52 years old (range 49–63). The University of California Los Angeles (UCLA) scores improved from 13.7 ± 2 preoperatively to 30.2 ± 1 postoperatively (p &lt; 0.05). The American Shoulder and Elbow Surgeons (ASES) scores changed from 38.1 to 88.5 (p &lt; 0.05). Complications rate was 4.8% with two patients undergoing a total shoulder replacement surgery 89 and 101 months postoperatively. Arthroscopic single-anchor repair is a safe and viable option for treating isolated subscapularis tendon tears. The procedure has shown good to excellent results with high rates of patient satisfaction, decreased pain, and improved function after long-term follow-up.

Hybrid technique and total arch replacement combined with frozen elephant trunk in acute aortic dissection involving the aortic arch: a multi-center propensity-matched cohort study

BackgroundThe aim of this study was to investigate whether the hybrid technique yields superior outcomes in comparison with the total arch replacement combined with frozen elephant trunk (TAR + FET) for acute aortic dissection (AAD) involving the aortic arch.MethodsThis retrospective cohort study using propensity-score matching included patients with AAD involving the aortic arch admitted to Nanjing First Hospital and Shanghai General Hospital from January 2015 to June 2020. The in-hospital and mid-term outcomes were compared between patients who received hybrid treatment (n = 136) and those who received TAR + FET (n = 415). Study end points included in-hospital mortality and morbidity, and mid-term rates of death from all causes, stroke, and aortic re-intervention.ResultsA total of 121 pairs were formed after matching. In-hospital mortality did not differ between hybrid versus TAR + FET groups (5.8% vs. 7.9%, P = .860). Up to 6 years, patients treated with TAR + FET were associated with reduced rate of aortic re-intervention (HR 0.21, 95% CI 0.05–0.97; P = .023). There was no difference in death from all causes and stroke.ConclusionsHybrid technique and TAR + FET showed comparable mid-term survival. Hybrid technique showed higher rate of aortic re-intervention and should therefore be applied with great caution in patients with AAD involving the aortic arch.

Reconstruction of anterior talofibular ligament and posterior tibiotalar ligament enhance ankle stability after total talus replacement by finite element analysis

Total talus replacement has been demonstrated to increase ankle instability. However, no studies have explored how to enhance postoperative stability. This study aims to explore the effect of collateral ligament reconstruction on ankle stability by finite element analysis. The results identify that the reconstruction of the posterior talofibular ligament or anterior tibiotalar ligament has little effect on ankle stability. Besides, the reconstruction of the posterior tibiotalar ligament can significantly enhance the eversion stability. Additionally, the traction force of the fibula on the total talar prosthesis after reconstruction of the anterior talofibular ligament can significantly enhance ankle inversion and anterior stability.

Revisiting ascending aortic resection in the elective valve-sparing root replacement: assessing the benefits and necessity of hemiarch replacement at three centres.

The aim of this study was to determine the indication and optimal timing for performing a hemiarch procedure in patients undergoing valve-sparing root replacement (VSRR). We conducted a retrospective study on 986 patients undergoing VSRR at three tertiary care centres. Inclusion criteria were all patients undergoing elective VSRR. Exclusion criteria were age <18 years, Stanford type A dissection, dissection in the arch, total aortic arch replacement or previous aortic arch replacement. We performed propensity score matching in a 1:1 ratio. The primary endpoint is a composite outcome that includes mortality, aortic arch reintervention, new aortic dissection during follow-up, and cerebrovascular incidents within the first 30 days. A total of 401 patients (41%) had a hemiarch replacement, while 585 (59%) did not. Root phenotype was present in 565 (57%). The mean follow-up time was 4.7 years (SD ± 4.6).In the matched population, there was no significant difference in the 10-year freedom from the composite outcome between the non-hemiarch and hemiarch groups (87.3% vs. 85.0%, p > 0.999). Similarly, no difference was found for aortic reinterventions (p = 0.13) or survival (p = 0.5). This was also true for patients with heritable thoracic aortic disease. However, in patients with a bicuspid aortic valve, the intervention rate was significantly higher in the hemiarch group (10.8% vs. 0%, p = 0.016).There was no significant difference in the 30-day incidence of cerebrovascular accidents between the groups (5% vs. 2.7% in the hemiarch group, p = 0.117). Only the distal ascending diameter showed a tendency with better outcome over 45mm for the hemiarch procedure, otherwise we found no reliable cut-off values based on asecending length, diameter-to-height index, or ascending length-to-height index. Our findings conclusively demonstrate that concomitant hemiarch replacement does not increase the perioperative risk in young patients undergoing VSRR. However, concomitant replacement does not seem to protect from aortic reinterventions during medium term follow-up.

Impact of mild hypothermic circulatory arrest on surgical outcomes in acute type a aortic dissection patients: a single-centre study

BackgroundAs hypothermic circulatory arrest (HCA) is being more frequently induced in patients undergoing aortic arch surgery, its safety at different degrees has become a crucial area of study. The aim of this study was to assess the surgical outcomes of mild hypothermic circulatory arrest (MI-HCA) during aortic arch surgery.MethodsAcute type A aortic dissection (ATAAD) patients who underwent total arch replacement (TAR) and frozen elephant trunk (FET) surgery between January 2014 and December 2023 were enrolled in this study. The patients were divided into two groups according to the minimum nasopharyngeal temperature: the moderate hypothermic circulatory arrest (MHCA) group (20–28 °C) and the MI-HCA group (> 28 °C). The inverse probability of treatment weighting (IPTW) was used to balance differences in the baseline characteristics. Perioperative variables were analysed via pairwise comparisons, multivariable logistic regression, and subgroup forest plots to assess the impact of MI-HCA on surgical outcomes.ResultsA total of 447 patients were included in this study, and the mean minimum nasopharyngeal temperature was 24.80 (23.98, 27.30) °C in the MHCA group and 30.10 (29.80, 30.70) °C in the MI-HCA group. The incidence of acute kidney injury (AKI) in the MI-HCA group was lower than that in the MHCA group (52% vs. 78%, p < 0.01). In the multivariable logistic regression analysis, MI-HCA was identified as an independent protective factor for AKI (OR = 0.354, 95% CI 0.177–0.689; p = 0.003). Additionally, compared with MHCA, MI-HCA was not associated with an increased incidence of stroke, spinal cord injury, or in-hospital mortality. After IPTW, the preoperative and intraoperative data of the patients were balanced, and the incidence of AKI in the MI-HCA group was still lower than that in the MHCA group (83.26% vs. 53.61%, p = 0.004). The subgroup forest plot also demonstrated that MI-HCA was a protective factor for postoperative AKI.ConclusionsThe surgical outcomes of MI-HCA in ATAAD patients were satisfactory. Compared with MHCA, MI-HCA provided sufficient protection for distal organs, the brain, and the spinal cord, with a significantly lower incidence of AKI. These results indicate that MI-HCA could be a better approach for ATAAD surgery.

Total Arch Replacement for a Patient with Cold Agglutinin

Total Arch Replacement for a Patient with Cold Agglutinin

Intraoperative aortic dissection in a patient with cervical aortic arch.

Cervical aortic arch (CAA) is a rare malformation. Herein, we report a 58-year-old female patient diagnosed with left CAA with descending aortic aneurysm. Initially, the descending aorta replacement was planned via left rib-cross thoracotomy. However, because of intraoperative aortic dissection during mobilization, total arch replacement was performed via emergent median sternotomy first. The main body of the synthetic graft was then guided to the left thoracotomy view, and the peripheral anastomosis of the descending aorta was performed. The surgery was successfully completed. The surgical management of CAA remains unstandardized due to its rarity and complex abnormalities. As aortic wall thinning can easily lead to aortic dissection, careful manipulation is required during mobilization.

The Management of the Aortic Arch in Type A Aortic Dissection: Replace, Repair with the AMDS, or Leave for Another Day?

Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires emergent surgical intervention. Numerous surgical approaches exist for ATAAD, and controversy remains regarding the optimal arch interventions for ATAAD patients. Aortic Arch Interventions: Approaches to ATAAD repair include hemiarch repair or extended arch repairs, including the hemiarch with a hybrid stent implantation, such as the AMDS hybrid Prosthesis, total arch replacement (TAR), and the use of an elephant trunk and frozen elephant trunk. While indications for each procedure exist, such as entry tears in the arch, arch aneurysms, and head vessel communications for TAR and malperfusion and a reduced risk of distal anastomotic new entry tears in Debakey I aortic dissection for the AMDS and frozen elephant trunks, the optimal intervention depends on numerous factors. Surgeon and center experience, resource availability, patient risk, and anatomy all contribute to the decision-making process. TAR has improved in safety over the years and has been demonstrated to be comparable to the hemiarch repair in terms of safety in many settings. TAR may also prevent adverse remodeling and can effectively treat more distal diseases, the presence of arch tears, arch aneurysms, and branch vessel involvement or malperfusion. Numerous surgical approaches exist to manage ATAAD, allowing for the surgeon to tailor the repair to the individual patient and pathology. TAR allows for single or staged repair of extensive pathologies and can address distal entry tears, the aneurysmal arch, and head vessel pathologies. In cases with malperfusion, an AMDS can be used in many cases. The management strategy for ATAAD should always involve performing the best surgery for the patient, although in cases where a total arch is indicated but cannot be performed safely by a non-aortic surgeon, the safest approach may be to perform a hemiarch initially and to plan for an elective arch reoperation in the case it is required following close surveillance.

Effect of Total and Partial Meal Replacements on Factors Related to Glucose Metabolism: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Although some evidence shows the beneficial effects of meal replacements (MRs) on glucose metabolism as one of the main factors of diabetes, there are still no comprehensive findings in this field. We investigated the effects of total and partial MRs on fasting blood sugar (FBS), insulin, glycated hemoglobin (HbA1c), and homeostatic model assessment for insulin resistance (HOMA-IR) in this comprehensive study and meta-analysis. To find pertinent randomized controlled trials (RCTs) up to March 2024, databases including PubMed/Medline, Web of Science, Scopus, and Embase were searched. This study included all RCTs investigating the effects of MRs on factors related to glucose metabolism. The pooled weighted mean difference (WMD) and 95% CIs were computed using the random-effects model. The findings from 52 studies indicated significant reductions in FBS (WMD: -3.10 mg/dL; 95% CI: -4.99, -1.20; P < .001), insulin (WMD: -1.79 μU/mL; 95% CI: -3.51, -0.08; P = .40), HOMA-IR (WMD: -0.86; 95% CI: -1.68, -0.04; P = .040), and HbA1c (WMD: -0.24%; 95% CI: -0.35%, -0.13%; P < .001) levels following MR consumption compared with the control group. The findings obtained from the subgroup analysis showed that MRs cause a greater decrease in FBS, insulin, and HOMA-IR in the >50-years age group compared with those aged ≤50 years and also during interventions ≤24 weeks compared with >24 weeks. In conclusion, it appears that MRs, along with other lifestyle factors, can lead to significant improvements in glucose metabolism.

Partial or total replacement of blast furnace slag with palm oil fuel ash in high-volume slag cement: hydration characteristics, compressive strength, and carbonation resistance

Partial or total replacement of blast furnace slag with palm oil fuel ash in high-volume slag cement: hydration characteristics, compressive strength, and carbonation resistance

High perioperative lactate levels as a potential predictor for severe acute kidney injury following aortic arch surgery.

Acute type A aortic dissection (ATAAD) is a life-threatening condition that often requires total aortic arch replacement (TAR) combined with frozen elephant trunk (FET) implantation. Despite advancements in surgical techniques and preoperative management, postoperative acute kidney injury (AKI) remains a prevalent complication that significantly affects patient prognosis, particularly severe AKI. The aim of this study was to investigate the predictive value of perioperative lactate levels in severe postoperative AKI after TAR. A cohort analysis of 328 patients who underwent TAR with frozen elephant trunk implantation at Xijing Hospital, Xi'an, China, between September 2019 and September 2023 was conducted. Patients were categorized according to AKI severity into non-AKI, mild-AKI, and severe-AKI cohorts, and lactate levels were measured at nine perioperative time points. The primary endpoint was severe AKI (Kidney Disease: Improving Global Outcomes stage 3). Uni-and multivariate logistic regression analyses were performed to identify risk factors for severe AKI. Subgroup analysis substantiated the robustness of lactate levels in predicting severe AKI. In total, 45.4% of patients developed mild AKI postoperatively and 20.7% developed severe AKI. Patients with severe postoperative AKI exhibited higher preoperative lactate levels. Multivariate stepwise backward logistic regression analysis identified lactate levels at 12 h postoperatively ([Lacpo12h], cutoff value: 3.3 mmol/L; sensitivity: 63.2%; specificity: 72.3%) as an independent predictor of severe AKI. The subgroup analysis underscored the consistent predictive capacity of Lacpo12h. The 30-day mortality rate was markedly elevated in the severe-AKI cohort, with deceased patients exhibiting a significantly higher Lacpo12h. Among patients with acute type A aortic dissection undergoing TAR, high perioperative lactate levels were closely associated with postoperative AKI. Lacpo12h is a reliable and effective predictor of severe postoperative AKI, highlighting its clinical utility in risk stratification and management strategies.

Поражение костей у взрослых пациентов с болезнью Гоше I типа: распространенность, клинические особенности, костно-суставные осложнения и проблемы инвалидизации

BACKGROUND. Although highly effective enzyme replacement therapy (ERT) for Gaucher disease (GD) is accessible and affordable, orthopedic issues in patients appear often to be the main factor leading to their disability. Bone lesions are essentially observed in 100 % of GD patients. The nature and severity of bone and joint changes, however, are reported to be extremely heterogeneous, whereas their incidence and clinical features have until now remained underresearched. AIM. To assess the incidence and clinical value of bone and joint lesions which complicate the course of GD type 1 with bone involvement. MATERIALS &amp; METHODS. This trial enrolled 267 GD type 1 patients aged 17–85 years (median 38 years), who were followed-up at the National Research Center for Hematology from 2004 to 2024. There were 109 men and 158 women. The analysis focused on the following MRI findings: bone marrow infiltration (BMI), Barnett-Nordin cortical index (BNI), bone deformity, osteolytic and osteonecrotic lesions, as well as orthopedic pathologies progressing to disability. RESULTS. BMI was identified in 213/267 (79.8 %) patients. Erlenmeyer flask-like femoral expansion was observed in 95 % patients (n = 254). The mean BNI was 42.9 % (the normal BNI in adult population exceeds 45 %). Low BNI values were associated with osteolytic lesions, disability, and BMI. No significant association of decreased BNI was seen with osteonecroses. The incidence of osteolytic lesions was 11.2 % (n = 30). New osteolytic lesions were reported neither in ERT nor in substrate reduction therapy recipients. Medullary osteonecrosis was detected in 206/267 (77.15 %) patients, and epiphyseal osteonecrosis was identified in 74/267 (27.72 %) patients. Along with osteonecroses, in contrast to osteolytic manifestations, new lesions (n = 8) were reported to occur under long-term (&gt; 5 years) ERT. The rate of bone fractures was 6.7 % (n = 18). In 18 patients, 64 fractures were observed at various locations. Disability associated with bone and joint complications of GD occurred in 58/267 (21.72 %) patients. After reconstructive surgery, including total articular replacement arthroplasties, 37 patients achieved complete functional recovery. CONCLUSION. Bone changes are essentially observed in all adult patients with GD type 1. However, clinical severity and disability of patients depend on secondary bone and joint complications, among them arthroses resulting from epiphyseal osteonecrosis, pathologic fractures, bone and joint infections. These complications developing on effective ERT were identified in 67/267 patients, which accounted for 25 %.

Preemptive frozen elephant trunk technique for hemostatic use in total arch replacement

Preemptive frozen elephant trunk technique for hemostatic use in total arch replacement