			Home About us Contact

Implanted Patients (implanted + patient)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

The Management of Pain From Collapse of Osteoporotic Vertebrae With Continuous Intrathecal Morphine Infusion

NEUROMODULATION, Issue 2 2007
Maria Rita Saltari MD
ABSTRACT Objectives., Vertebral fractures are the most common consequences of severe osteoporosis. The chronic pain from collapse of osteoporotic vertebrae affects quality of life (QoL) and autonomy of patients. The management of pain with oral or transdermal opiates can cause severe side-effects. Continuous intrathecal administration of morphine through an implantable pump might represent an alternative therapy to conventional oral or transdermal administration of opioids and has some advantages and disadvantages for pain relief and improvement in QoL when compared to conventional opioid delivery. It is our objective to report our experience using intrathecal delivery of analgesics in a population of patients with refractory pain due to vertebral fractures. Materials and Methods., In 24 patients, refractory to conventional delivery of opioids, we used intrathecal analgesic therapy. To test for efficacy and improvement in QoL, we administered the visual analog scale (VAS) for pain and the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Before patients were selected for pump implantation, an intraspinal drug delivery trial was performed to monitor side-effects and responses to intrathecal therapy. Results., Significant pain relief was obtained in all implanted patients. Using the QUALEFFO, we observed significant improvement of all variables such as QDL (quality of daily life), DW (domestic work), ambulation, and PHS (perception of health status), before and after one year after pump implantation. With intrathecal morphine infusion, none of the 24 patients required additional systemic analgesic medication. The mean morphine dose during the spinal trial was 11.28 mg/day, 7.92 mg/day at pump implantation, and 16.32 mg/day at one-year follow-up. Conclusions., Our results show that intrathecal administration of morphine efficiently relieves the symptoms of pain and improves QoL. Continuous intrathecal administration of morphine appears to be an alternative therapy to conventional analgesic drug delivery and has advantages in those patients who have severe side-effects with systemic administration of analgesics. [source]

A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder: Description of the method and preliminary data

NEUROUROLOGY AND URODYNAMICS, Issue 4 2005
Michele Spinelli
Pudendal nerve stimulation has beneficial effects on numerous pelvic floor function impairments such as urinary and/or fecal incontinence, retention, and constipation. In preceding literature the implant technique required a fairly complex and invasive surgery, although recent advances with percutaneous placement of the lead through an introducer have made the procedure much less invasive. We performed staged procedure similar to that of sacral neuromodulation (SNM) to place tined lead near the pudendal nerve, using neurophysiological guidance that allowed accurate pudendal nerve stimulation through either perineal or posterior approach. We have named this approach chronic pudendal nerve stimulation (CPNS). Methods Fifteen neurogenic patients (eight male, seven female) with symptoms of urge incontinence due to neurogenic overactive bladder underwent CPNS. All patients had complete neurophysiological and urodynamic evaluation at baseline and follow-up and were asked to complete voiding and bowel diary for 7 days. Results During screening, average number of incontinent episodes per day decreased from 7,±,3.3 to 2.6,±,3.3 (P,<,0.02, paired t -test). Eight patients became continent, two improved by more than 88% (from 9 to 1 daily incontinence episode) and two patients reduced the number of incontinence episodes by 50%. The implantable pulse generator (IPG) was subsequently implanted in those 12 patients. Three patients without improvement did not continue to second stage. In implanted patients with 6 months follow-up, urodynamic evaluation showed an objective improvement in the maximum cystometric capacity which increased from 153.3,±,49.9 to 331.4,±,110.7 ml (P,<,0.01, paired t -test). The maximum pressure decreased from 66,±,24.3 to 36.8,±,35.9 cmH2O (P,=,0.059, paired t -test). Eight patients reported significant improvement in bowel function. Conclusion Chronic pundedal nerve stimulation is feasible. Neurophysiological guidance is mandatory to place the lead near the pudendal nerve either using perineal or posterior approach. Further studies must be carried out to identify the best stimulation parameters and to verify the long term results. Neurourol. Urodynam. 24:305,309, 2005. © 2005 Wiley-Liss, Inc. [source]

Electrophysiologicai Characteristics of the Atrium in Sinus Node Dysfunction With and Without Postpacing Atrial Fihriliation

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2000
ANTONIO DE SISTI
DE SISTI, A., ET AL.: Electrophysiologicai Characteristics of the Atrium in Sinus Node Dysfunction With and Without Postpacing Atrial Fibrillation . In patients with sinus node dysfunction (SND) with or without associated paroxysmal atrial fibrillation (AF), the effectiveness of atrial pacing in reducing the incidence of AF is not definitive. In addition, despite several studies involving large populations of implanted patients, little attention has been paid to the electrophysioiogicai (EP) atrial substrate and the effect of permanent atrial pacing. The aim of this study is to correlate EP data and the risk of AF after DDD device implantation. We reviewed FP data of 38 consecutive patients with SND. mean age 70 ± 8 years, who were investigated free of antiarrhythmic treatment, for the evaluation of the atrial substrate. We also considered as control group 25 subjects, mean age 63 ± 14 years, referred to our EP laboratory for unexplained syncope or various atrioventricular disturbances. Following pharmacological washout and at a drive cycle length of 600 ms. effective and functional refractory periods (ERP, FRP), Sl-Al and S2-A2 latency, Al and A2 conduction duration, and latent vulnerability index (EHP/A2) were measured. AF induction was tested with up to three extrastimuli at paced cycle lengths of 600 and 400 ms in 20 patients. Induction of sustained AF (> 30 seconds) was considered as the endpoint. P wave duration on the surface ECG in lead II/Vl was also measured. DDD pacing mode was chosen in all patients with the minimal atrial rate programmed between 60 and 75 beats/min (mean 64 ± 4 beats/min). After implantation, the patients were followed-up for 29 ± 17 months and clinically documented occurrence of AF was determined. When comparing patients with SND and subjects of the control group, we did not find any significant statistical differences in terms of ERP (237 ± 33 vs 250 ± 29 ms), FRP (276 ± 30 vs 280 ± 32 ms) and Sl-Al (39 ± 16 vs 33 ± 11 ms) and S2-A2 latency (69 ± 24 vs 63 ± 25 ms). In contrast, we observed significant differences regarding Al (55 ± 19 vs 39 ± 13 ms; P < 0.001), A2 (95 ± 34 vs 57 ± 18 ms; P < 0.001) and P wave duration (104 ± 18 vs 94 ± 15 ms; P < 0.05), and ERP/A2 (2.8 ± 1.2 vs 4.8 ± 1.6; P < 0.001). When comparing patients with (n = 11) or without (n =27) postpacing AF occurrence, we did not find any difference with reference to ERP, FRP. Sl-Al, S2-A2, Al duration, or follow-up duration. In patients with postpacing AF occurrence, A2 was longer (116 ± 41 vs 87 ± 27 ms; P < 0.01), FRP/A2 lower (2.1 ± 0.4 vs 3.1 ± 1.4; P < 0.05), P wave more prolonged (116 ± 22 vs 99 ± 14 ms; P < 0.01), and preexisting AF history predominant (6/11 vs 5/27 patients; P < 0.05). No difference was observed between patients with (n = 8) and without (n = 12) AF induction during the EP study. In patients with SND, the atrial refractoriness appears normal and the most important abnormality concerns conduction slowing disturbances. Persistence of AF despite pacing stresses the importance of mechanisms responsible for AF not entirely brady-dependent. In this setting, more prolonged atrial conduction disturbances, responsible for a low vulnerability index, and a preexisting history of AF enable us to identify a high risk patient group for AF in the follow-up. sinus node dysfunction, atrial fibrillation, electrophysiologicai study, atrial pacing [source]

Representative marketing-oriented study on implants in the Austrian population.

CLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2003

Abstract: Oral implantology is an established subspecialty of restorative dental and oral surgery. While an extensive body of evidence on the fundamentals of osseointegration and associated factors has been published, marketing-oriented analyses based on representative public opinion polls of implant acceptance, patient-perceived cost and patient satisfaction are scarce. In this study, an attempt was made to address these points by questioning a representative sample of 1000 adults in the household setting. The interviewees were presented with 14 questions. Of those familiar with implants as one of the treatment alternatives, 61% reported they would accept implants if the need arose. Implant acceptance was highest among males and interviewees below the age of 30 years. The interest in implants increased with increasing family incomes. Four percent of those questioned already had implants. Twenty-five percent knew someone who had undergone implant treatment. All those questioned found implant-supported rehabilitation to be very expensive. Many of them blamed the dentists for the high cost. One detail was particularly evident: satisfaction among implanted patients was clearly higher than satisfaction rates perceived by them from what they were told about implants by others. First-hand experiences with implants proved to be less biased than reported second-hand information. Résumé L'implantologie buccale est une technique appliquée dans certaines spécialités de médecine dentaire. Tandis que la proportion d'évidences s'accroît en ce qui concerne la recherche sur l'ostéoïntégration et les facteurs associés, les analyses orientées sur le marketing et l'opinion du public sur l'acceptation de l'implant, le prix et la satisfaction se font rares. Cette étude a été réalisée pour analyser ces différents points via un échantillon de 1 000 adultes. Les interviewés ont répondu à quatorze questions. De ceux qui étaient familiers à l'idée que les implants pouvaient être une alternative au traitement, 61 % ont répondu qu'ils pourraient si nécessaire y recourir. L'acceptation de l'implant était plus importante chez les hommes et les personnes âgées de moins de trente ans. L'intérêt à propos des implants augmentait parallèlement aux revenus de la famille. Quatre pour cent des personnes étaient déjà porteurs d'implants. Vingt-cinq pour cent connaîssaient une personne ayant subi un traitement d'implant buccal. Parmi toutes les personnes interrogées, la réhabilitation sur implants semblait trop chère. Beaucoup d'entre-eux rejetaient la responsabilité des prix trop élevés sur les dentistes. Un détail était particulièrement évident : la satisfaction parmi les patients possèdant des implants était clairement plus importante que le taux de satisfaction perçu par ceux n'en portant pas mais ayant reçu l'information par d'autres personnes. L'expérience personnelle était moins déformée que celle obtenue de manière indirecte. Zusammenfassung Die orale Implantologie ist eine etablierte Subspezialität der restaurativen Zahnmedizin und der Oralchirurgie. Während extensive Evidenz über die Grundlagen der Osseointegration und der assoziierten Faktoren publiziert worden ist, sind marketing-orientierte Analysen basierend auf repräsentativen Meinungsumfragen über die Akzeptanz von Implantaten, über die von Patienten empfundenen Kosten und über die Patientenzufriedenheit rar. In dieser Studie wird der Versuch unternommen, diese Punkte mit Hilfe einer Befragung einer repräsentativen Gruppe von 1000 Erwachsenen anzusprechen. Den Befragten wurden 14 Fragen gestellt. Von denen, welche über Implantate als Behandlungsalternative Bescheid wussten, gaben 61% an, sie würden Implantate bei sich akzeptieren, falls die Notwendigkeit dafür besteht. Die Akzeptanz von Implantaten war bei Männern und Befragten unter 30 Jahren am grössten. Das Interesse an Implantaten nahm mit zunehmendem Familieneinkommen zu. Vier Prozent der Befragten hatten bereits Implantate. Fünfundzwanzig Prozent kannten jemanden, der sich einer Implantation unterzogen hat. Alle Befragten empfanden Implantatversorgungen zu kostspielig. Viele davon fanden, der Zahnarzt sei schuld an den hohen Kosten. Ein Detail war von besonderem Interesse: Die Zufriedenheit bei mit Implantaten versorgten Patienten war deutlich grösser als die von anderen Leuten empfundene Zufriedenheit, welche über Implantatversorgung von anderen gehört haben. Erfahrungen mit Implantaten aus erster Hand waren mit weniger Vorurteilen behaftet als Informationen aus zweiter Hand, über die berichtet wurde. Resumen La implantología oral es una subespecialidad establecida de restauración dental y cirugía oral. Mientras que se ha publicado una gran cantidad de evidencias sobre los fundamentos de la osteointegración y factores asociados, los análisis orientados al marketing basados en encuestas representativas de la opinión pública sobre aceptación de los implantes, costo percibido por el paciente y satisfacción del paciente son escasos. En este estudio se hizo un intento de dirigir estos puntos encuestando una muestra representativa de 1000 adultos en su hogar. A los entrevistados se les presentaron 14 preguntas. De aquellos familiarizados con los implantes como una de las alternativas de tratamiento, el 61% respondió que aceptarían los implantes llegada la necesidad. La aceptación de los implantes fue mayor en varones y entrevistados menores de 30 años. El interés en los implantes creció con ingresos familiares crecientes. El 4% de los encuestados ya tenían implantes. El 25% conocía a alguien que se había sometido a tratamiento de implantes. Todos los encuestados encontraron la rehabilitación con implantes demasiado cara. Muchos de ellos culparon a los dentistas del alto costo. Un detalle fue particularmente evidente: La satisfacción entre los pacientes implantados fue claramente mas alta que los índices de satisfacción percibidos por ellos de lo que se les dijo sobre los implantes por otros. Las experiencias de primera mano con implantes demostraron ser menos viciadas que las informaciones reportadas de segunda mano. [source]

Is a morphologically intact anal sphincter necessary for success with sacral nerve modulation in patients with faecal incontinence?

COLORECTAL DISEASE, Issue 3 2008
J. Melenhorst
Abstract Objective, Sacral nerve modulation (SNM) for the treatment of faecal incontinence was originally performed in patients with an intact anal sphincter or after repair of a sphincter defect. There is evidence that SNM can be performed in patients with faecal incontinence and an anal sphincter defect. Method, Two groups of patients were analysed retrospectively to determine whether SNM is as effective in patients with faecal incontinence associated with an anal sphincter defect as in those with a morphologically intact anal sphincter following anal repair (AR). Patients in group A had had an AR resulting in an intact anal sphincter ring. Group B included patients with a sphincter defect which was not primarily repaired. Both groups underwent SNM. All patients had undergone a test stimulation percutaneous nerve evaluation (PNE) followed by a subchronic test over 3 weeks. If the PNE was successful, a permanent SNM electrode was implanted. Follow-up visits for the successfully permanent implanted patients were scheduled at 1, 3, 6 and 12 months and annually thereafter. Results, Group A consisted of 20 (19 women) patients. Eighteen (90%) had a positive subchronic test stimulation. Twelve patients had a successful SNM implant during middle-term follow-up. Group B consisted of 20 women. The size of the defect in the anal sphincter varied between 17% and 33% of the anal circumference. Fourteen (70%) had a positive subchronic test stimulation. Twelve patients had a successful SNM implant during middle-term follow-up. In both groups, the mean number of incontinence episodes decreased significantly with SNM (test vs baseline: P = 0.0001, P = 0.0002). There was no significant difference in resting and squeeze pressures during SNM in group A, but in group B squeeze pressure had increased significantly at 24 months. Comparison of patient characteristics and outcome between groups A and B revealed no statistical differences. Conclusion, A morphologically intact anal sphincter is not a prerequisite for success in the treatment of faecal incontinence with SNM. An anal sphincter defect of <33% of the circumference can be effectively treated primarily with SNM without repair. [source]

Sacral neuromodulation in patients with faecal incontinence: results of the first 100 permanent implantations

COLORECTAL DISEASE, Issue 8 2007
J. Melenhorst
Abstract Objective, Faecal incontinence (FI) is a socially devastating problem. Sacral nerve modulation (SNM) has proven its place in the treatment of patients with FI. In this study, the first 100 definitive SNM implants in a single centre have been evaluated prospectively. Method, Patients treated between March 2000 and May 2005 were included. Faecal incontinence was defined as at least one episode of involuntary faecal loss per week confirmed by a 3-week bowel habit diary. Patients were eligible for implantation of a permanent SNM when showing at least a 50% reduction in incontinence episodes or days during ambulatory test stimulation. Preoperative workup consisted of an X-defaecography, pudendal nerve terminal motor latency measurement, endo-anal ultrasound and anal manometry. The follow-up visits for the permanent implanted patients were scheduled at 1, 3, 6 and 12 months and annually thereafter. The bowel habit diary and anal manometry were repeated postoperatively during the follow-up visits. Results, A total of 134 patients were included and received a subchronic test stimulation. One hundred patients (74.6%) had a positive test stimulation and received a definitive SNM implantation. The permanent implantation group consisted of 89 women and 11 men. The mean age was 55 years (range 26,75). The mean follow-up was 25.5 months (range 2.5,63.2). The mean number of incontinence episodes decreased significantly during the test stimulation (baseline, 31.3; test, 4.4; P < 0.0001) and at follow-up (36 months postoperatively, 4.8; P < 0.0001). There was no significant change in the mean anal resting pressure. The squeeze pressures were significantly higher at 6 months (109.8 mmHg; P = 0.03), 12 months (114.1 mmHg; P = 0.02) and 24 months postoperatively (113.5 mmHg; P = 0.007). The first sensation, urge and maximum tolerable volume did not change significantly. Twenty-one patients were considered late failures and received further treatment. Conclusion, Sacral neuromodulation is an effective treatment for FI. The medium-term results were satisfying. [source]