INTRODUCTION: Since there are limited studies about the return-to-work experiences of Filipino amputees, this study will be able to contribute to studies that delve deeper into the lower extremity amputees’ experiences and put into light the factors that may be present in relation to their return to work. METHODS: This study utilized a qualitative phenomenological design. Participants who were willing to join the study were all gathered for a focus group discussion conducted by a hired interviewer. The researchers adapted Colaizzi’s descriptive phenomenological method for analyzing the data. RESULTS: Factors that allowed amputees to have a successful return to work experience were motivation to continue with life, positive impact of lower extremity prosthesis, and rehabilitation. Factors that hindered the successful return to work of amputees were social barriers, work environment, negative self-image, discrimination from the community, and ft of prosthesis. CONCLUSION Employment was possible after amputation among amputees who were provided with prosthesis at UERMMMCI, since most of the respondents of this study were employed. Positive and negative factors that infuenced their return to work were also identifed. Non-compliance to rehabilitation limited the usage of prosthesis resulting in not being able to return to work.
Bioprosthesis

BACKGROUND: In vitro study, normal cardiac prosthetic valve has functional regurgitation due to structural characteristics of prosthetic valve. To evaluate functional regurgitant characteristics of prosthetic valves, we examined patients who had clinically normal mitral prosthesis. METHODS: Transesophageal two-dimensional and color doppler echocardiography were performed to 25 patients who had the clinically normal mitral prosthesis. RESULTS: Seven patients had the mitral bioprosthesis and 18 patients had the mitral mechanical prosthesis. Regurgitation was found in 4 patients(57%) with bioprosthetic valve, and the pattern of regurgitation was central in three patients and unilateral in one patient. But regurgitation was detected in 17 patients(94%) with mechanical prosthesis, and the pattern of regurgitation was bilateral in twelve patients, unilateral in four patients and central in one patient(p=0.0035). The length of regurgitant jets were 22.00+/-6.73(mm) in bioprosthetic valve and 28.65+/-7.33(mm) in mechanical valve. The regurgitant jets were detected in systolic period in most of patients. But in 4 patients who had tachycardia during TEE, regurgitation was detected in systolic and early diastolic period. CONCLUSION: Regurgitation was found in clinically normal cardiac prosthetic valves by TEE. These findings may be useful to differentiate between normal and abnormal cardiac prosthesis.
Bioprosthesis ; Echocardiography, Doppler, Color ; Echocardiography, Transesophageal* ; Humans ; Prostheses and Implants* ; Tachycardia

The Bentall-DeBono operation is the technique of choice for aortic root replacement. When the patients have contraindications for lifelong anticoagulation, the biologic Bentall operation may be a good option. However, complex reoperation may be required when bioprosthetic degeneration occurs. For this reason, a new technique for simple reoperation after the Bentall operation has recently been performed by some surgeons. We performed a similar technique in two patients with aortic root dilation and for whom aortic valve sparing techniques could not be performed because of an unrepairable valve contour, we think this modification seems to be simple and reproducible for reoperation.
Aneurysm ; Aorta ; Aortic Valve ; Bioprosthesis ; Cardiovascular Diseases ; Humans ; Reoperation

BACKGROUND: Bioprosthetic materials have been made using glutaraldehyde fixation of porcine or bovine pericardium during cardiovascular surgery. But these bioprostheses have the problems of calcification and mechanical failure. We determined changes in tensile strength and elasticity of pericardium after glutaraldehyde, solvent, decellularization and detoxification. MATERIAL AND METHOD: Tissues were allocated to four groups: glutaraldehyde with and without solvent, decellularization, and detoxification. We studied tensile strength and strain on tissues. We measured the tensile strength of fresh pericardium stretched in six directions (with 5 mm width), and % strain, which we calculated from the breaking point when we pulled the pericardium in two directions. RESULT: Tensile strength was reduced when we used the usual concentrated glutaraldehyde fixation (n=83, MPa=11.47+/-5.40, p=0.006), but there was no change when we used solvent. Elasticity was increased after glutaraldehyde fixation (n=83, strain (%)= 24.55+/-9.81, p=0.00), but there was no change after solvent. After decellularization of pericardium, the tensile strength was generally reduced. The decrease in tensile strength after concentrated glutaraldehyde fixation for a long time was significantly greater less than after concentrated solvent (p=0.01, p=0.00). After detoxification, the differences in strength and strain were not significant. CONCLUSION: After glutaraldehyde treatment of pericardium there is no loss in tensile strength (even though we did the glutaraldehyde, solvent and detoxification treatments LOGIC IS UNCLEAR). Also, these treatments had a tendency to increase elasticity. Although post-treatment decellularization led to a significant loss in strength, this effect could be attenuated using a low concentration of solvent or hypertonic solution.
Bioprosthesis ; Elasticity ; Glutaral ; Logic ; Pericardium ; Sprains and Strains ; Tensile Strength

Currently, as the key raw material of artificial biological heart valve, bovine pericardium is mainly depend on import and has become a "bottleneck" challenge, greatly limiting the development of domestic biological heart valve. Therefore, the localization of bovine pericardium is extremely urgent. In this study, the pericardium of Sichuan yak was compared with that of Australian cattle in terms of fundamental properties and anti-calcification performance. The results demonstrated that the appearance and thickness of yak pericardium were more advantageous than the Australian one. Sichuan yak pericardium and Australian cattle pericardium had comparable performance in shrinkage temperature, mechanical test and anti-calcification test. This study preliminarily verifies the feasibility of substitution of Australian cattle pericardium by Sichuan yak pericardium and promotes the progression of bovine pericardium localization with data support.
Animals ; Australia ; Bioprosthesis ; Cattle ; Heart Valve Prosthesis ; Pericardium

The structural failure of the glutaraldehyde-treated xenograft valves has been the primary concern about the limited durability as predicted from the beginning of clinical use, and long-term follow-up has shown a significant incidence of primary tissue failure(PTF) from both biological and mechanical reasons. Twenty-seven patients with the low-profile Ionescu-Shiley valves explanted from mitral position for PTF(Group III) were studied on the patient characteristics and valve pathology, and the results were compared with the matched observations of the Hancock(Group I) and of the standard-profile Ionescu-Shiley valves(Group II). Patients were aged 16 to 56 years(mean, 38.0+/-11.0 years), and the size of the failed mitral bioprosthesis was 30.8+/-1.3 mm. The hemodynamic consequences were stenosis in 29.6%, insufficiency in 44.4%, mixed steno-insufficiency in 14.8%, together with normal function for the rest of patients of prophylactic re-replacement. Pathology revealed calcification with or without tissue damage in 63.0% and tissue damage with or without calcification in 58.1%, in contrast with the observations of predominant tissue damage(76.8%) over calcification in Group I and of calcification(76.1%) over tissue damage in group II. Although dystrophic calcification has long and repeatedly dealt with patient's young age as a determinant of valve durability, such a characteristic evidence was not reached even in patients with calcified valves. Moreover, the prolonged explantation periods from the studied on the previous report suggested strongly yet possibly evolving destructive processes among the valves in the remaining patients, and awaits further follow-up. In conclusion, PTF of the xenograft valves seems to result from more complicated biologic and metabolic reasons as well as more complex mecharical factors than the reported, and newer generation prostheses, with tissue preservation with glutaraldehyde, do not likely to provide decisive improvement in the occurrence of structural failurebioprostheses is generally limited to the highly aged.
Bioprosthesis ; Constriction, Pathologic ; Follow-Up Studies ; Glutaral ; Hemodynamics ; Heterografts ; Humans ; Incidence ; Pathology ; Prostheses and Implants ; Tissue Preservation

Current guidelines recommend the use of warfarin in the first 3 months after bioprosthetic valve replacement and suggest long-term anticoagulation only in patients with obvious risk factors for thrombosis. Despite at low risk of thromboembolism, we present a case of a 72-year-old male patient with infected thrombus at bioprosthetic aortic valve with distal arterial embolization after 3 years of replacement surgery. The incidence of asymptomatic bioprosthetic valve thrombosis (BPVT) may be higher than anticipated and active surveillance echocardiography is needed to early detect BPVT before leading to fatal complication.
Aged ; Aortic Valve* ; Bioprosthesis ; Echocardiography ; Endocarditis ; Humans ; Incidence ; Male ; Risk Factors ; Thromboembolism ; Thrombosis* ; Warfarin

BACKGROUND: As cardiovascular operations become more complex and sophisticated, there is an increasing need for various bioprostheses for use as components of blood vessels and heart valves. We developed a fatigue stimuli test instrument to objectively evaluate the mechanical durability of a bioprosthesis, and we tested several currently- known processing methods for bovine pericardium and we then compared the results. MATERIAL AND METHOD: Fresh bovine pericardium was collected at the butcher shop with using aseptic technique, and each piece of pericardium was fixated and/or decellularized by 16 representative methods. We measured the permeability and compliance of the processed bovine pericardium samples, and measured them again after exposure to the fatigue stimuli. All the pieces of pericardium underwent microscopic examinations before and after the fatigue stimuli. RESULT: A mixture of glutaraldehyde and solvent treatment showed better mechanical durability than did the single glutaraldehyde treatment. High concentration glutaraldehyde treatment showed equal or no worse results than did low concentration glutaraldehyde treatment. After SDS (sodium dodecylsulfate) decellularization, the mechanical property of the bioprosthesis became much worse (20~190 times) and the mechanical durability to the fatigue stimuli was also very poor. CONCLUSION: We obtained the basic durability data after various fixation methods with using a home-made fatigue test instrument.
Biomedical Engineering ; Bioprosthesis ; Blood Vessels ; Compliance ; Fatigue ; Glutaral ; Heart Valves ; Pericardium ; Permeability

BACKGROUND: Bioprosthetic devices for treating cardiovascular diseases and defects may provide alternatives to autologous and homograft tissue. We evaluated the mechanical and physical conditions of a porcine pericardial bioprosthesis treated with Glutaraldehyde (GA), Ethanol, or Sodium dodecylsulfate (SDS) before implantation. MATERIAL AND METHOD: 1) Thirty square-shaped pieces of porcine pericardium were fixed in 0.625%, 1.5% or 3% GA solution. 2) The tensile strength and thickness of these and other bioprosthesis, including fresh porcine pericardium, fresh human pericardium, and commercially produced heterografts, were measured. 3) The tensile strength and thickness of the six treated groups (GA-Ethanol, Ethanol-GA, SDS only, SDS-GA, Ethanol-SDS-GA and SDS-Ethanol-GA) were measured. RESULT: 1) Porcine pericardium fixed in 0.625% GA the thinnest and had the lowest tensile strength, with thickness and tensile strength increasing with the concentration of GA solution. The relationship between tensile strength and thickness of porcine pericardium increased at thicknesses greater than 0.1 mm (correlation-coefficient 0.514, 0<0.001). 2) There were no differences in tensile strength or thickness between commercially-produced heterografts. 3) Treatment of GA, ethanol, or SDS minimally influenced thickness and tensile strength of porcine pericardium, except for SDS alone. CONCLUSION: Porcine pericardial bioprosthesis greater than 0.1 mm thick provide better handling and advantageous tensile strength. GA fixation did not cause physical or mechanical damage during anticalcification or decellularization treatment, but combining SDS-ethanol pre-treatment and GA fixation provided the best tensile strength and thickness.
Bioprosthesis ; Cardiovascular Diseases ; Ethanol ; Glutaral ; Handling (Psychology) ; Humans ; Pericardium ; Sodium ; Tensile Strength ; Transplantation, Heterologous ; Transplantation, Homologous

BACKGROUND: In cardiac surgery, especially in the reconstruction of vascular structures and intracardiac defects, glutaraldehyde has usually been used as the reagent for fixing porcine or bovine pericardial tissues. But the well-known problem of calcification or cytotoxicity of glutaraldehyde motivates the search for a replacement. The aim of this study is to investigate the physical, mechanical, and biochemical characteristics of bovine pericardial tissues fixed with genipin, which is known to be a less toxic and more natural fixing reagent. MATERIALS AND METHODS: Bovine pericardial tissues were fixed with different concentrations and conditions of glutaraldehyde and genipin. To determine the physical, mechanical, and biochemical differences among different concentrations and conditions, we divided the tissue into 18 groups by concentration, the addition of organic solvents, and the timing of adding the organic solvents, and compared the characteristics of each group. RESULTS: Tensile strength, physical activity, and thermal stability tests revealed that the tissues fixed with glutaraldehyde were better with regard to mechanical strength and biochemical durability. However, the difference was not significant statistically. CONCLUSION: Genipin can be used as an alternative crosslinking agent for pericardial tissue, considering given its physical, mechanical, biochemical characteristics and low cytotoxicity comparable to glutaraldehyde. However, further studies are needed on the immune reaction and the long term changes in genipin-fixed tissues in the human body.
Bioprosthesis ; Glutaral ; Human Body ; Iridoids ; Motor Activity ; Solvents ; Tensile Strength ; Thoracic Surgery ; Transplantation, Heterologous