Evaluation of Soft Tissue Reaction to Corundum Ceramic Implants Infiltrated with Colloidal Silver.

BACKGROUND: Corundum ceramic is a biomaterial used as a bone graft substitute. Silver is a well known antiseptic substance with many practical, clinical applications. OBJECTIVES: The aim of this study was to estimate soft tissue (in vivo) reaction to a new kind of ceramic implants. In our experiment, we examined the soft tissue reaction after implantation of corundum ceramic infiltrated with colloidal silver in the back muscles of 18 Wistar rats. The use of colloidal silver as a coating for the implant was designed to protect it against colonization by bacteria and the formation of bacterial biofilm. MATERIAL AND METHODS: In our study, based on the experimental method, we performed implantation operations on 18 Wistar rats. We implanted 18 modified ceramic implants and, as a control group, 18 unmodified implants. As a follow up, we observed the animals operated upon, and did postoperative, autopsy and histopathological examinations 14, 30, 90 and 180 days after implantation. RESULTS: We didn't observe any pathological reactions and significant differences between the soft tissue reaction to the modified implants and the control group. CONCLUSIONS: Lack of pathological reaction to the modified implants in the living organism is the proof of their biocompatibility. This is, of course, the first step on the long path to introduce a new kind of biocompatible ceramic implant with antiseptic cottage. Our experiment has an only introductory character and we plan to perform other, more specific, tests of this new kind of implant.

Treatment of camptodactyly using injection of botulinum neurotoxin.

BACKGROUND: Camptodactyly is usually painless, not caused by trauma, often appearing bilaterally, gradually progressive flexion contracture of the proximal interphalangeal joint mainly on the 5th fingers. OBJECTIVES: The aim of the study was to analyze the efficacy injecting botulinum neurotoxin in short muscles of the hand responsible for the contraction of the proximal interphalangeal joint. MATERIAL AND METHODS: The clinical material consisted of 12 patients (8 women, 4 men) treated with injections of botulinum neurotoxin in 2009-2012. Patients were monitored respectively for 2 weeks, 3 and 6 months and then every six months after the procedure. The observation period after injection of toxin ranged from 18 to 36 months. Our proposed method of treatment is inducing a temporary paralysis of muscles (lumbrical, interosseous) by means of botulinum neurotoxin (Botox). RESULTS: In the majority (10) of patients an improvement and stabilization was achieved just after one injection and there were no disease progression in subsequent controlled studies. These patients continued treatment with usage of redressing extensive splints. In case of the other two patients it was required to repeat the injections. CONCLUSIONS: The preliminary results obtained are promising. This method of treatment requires further studies and long-term follow-ups every six months until release of symptoms of the disease will be achieved. The operative treatment is reserved for severe deformities.

Assessment of the usefulness of X-ray myelography and magnetic resonance myelography, performed with an open low-field device, in diagnosing perinatal preganglionic injuries of the brachial plexus.

INTRODUCTION: The goal is to assess the usefulness of diagnostic imaging in diagnosing perinatal preganglionic injuries of the brachial plexus. MATERIAL AND METHODS: The clinical material included 40 children of both genders, aged 2 to 35 months. The authors analysed the results of diagnostic imaging examinations (myelography in 20 cases and magnetic resonance [MR] myelography in 20 cases), intraoperative view and clinical course. RESULTS: In 13 out of 40 (32.5%) examined children, no evidence of avulsion of the roots of the spinal nerves was found either by diagnostic imaging or during the surgery. In 3 cases (7.5%) with avulsed roots of the spinal nerves, the diagnostic imaging and intraoperative appearance were in agreement. Total agreement of the diagnostic imaging and intraoperative view was found in 40% of cases. In 9 patients (22.5%) suspected avulsion of roots of the spinal nerves was not confirmed during the surgery. However, the further clinical course of the disease in these cases indicated high probability of avulsion of roots without their pull-out from the intervertebral foramens. In the remaining cases, the findings were as follows: false positive results - 7 (17.5%), false negative results - 1 (2.5%), results underestimating injury - 3 (7.5%), results overestimating injury - 2 (5%). CONCLUSIONS: It was determined that the usefulness of pre-operative diagnostic imaging is limited. Due to the risk of occurrence of false positive and false negative results, final decisions concerning selection of the surgical technique must be based on the analysis of the intraoperative view and preoperative clinical symptoms.

Expression of MMP-2, TIMP-2, TGF-ß1, and decorin in Dupuytren's contracture.

To investigate the mechanisms underlying matrix deposition in Dupuytren's disease, the expression of gelatinase A (MMP-2), the tissue inhibitor of metalloproteinase-2 (TIMP-2), transforming growth factor beta 1 (TGF-ß1), decorin (DCN), and periostin was studied. The level of relative MMP-2 activation was investigated using zymography. The mRNA expression of MMP-2, TIMP-2, TGF-ß1, and DCN was detected using reverse transcription polymerase chain reaction (RT-PCR), while the presence of protein was detected using immunohistochemical (IHC) and Western blot techniques. The level of MMP-2 activation was significantly elevated in tissues with Dupuytren's contracture. RT-PCR demonstrated significantly higher expression of MMP-2, TIMP-2, TGF-ß1, and DCN mRNA in the pathological tissues; and the IHC and immunoblotting studies revealed elevated expression of TGF-ß1, DCN, and periostin. The balance between MMP-2 and TIMP-2 was disrupted in patients with Dupuytren's disease. TGF-ß1, DCN, and periostin are involved in extracellular matrix (ECM) homeostasis in Dupuytren's contracture.

Our experience with surgical treatment of perinatal brachial plexus palsy--results in different types of lesions.

INTRODUCTION: Perinatal brachial plexus palsies can be divided into upper (C5-C6), upper-middle (C5-C6-C7) and total injuries (C5-Th1). The study aimed to evaluate the results of surgical repair in the different types of palsies. MATERIAL AND METHODS: The patient population comprised 80 children who underwent primary repair of the brachial plexus (external neurolysis, internal neurolysis, direct neurorrhaphy, nerve grafts, extraanatomical intraplexus reconstruction, extraanatomical extraplexus reconstruction). 31 patients were additionally subjected to 39 tenomioplasty procedures. Widely recognised assessment scales were used to evaluate the outcome of surgical treatment of different types of palsies in 70 patients. RESULTS: Good and very good post-operative function of the glenohumeral and elbow joints was demonstrated in all patients with upper palsy. In the group of upper-middle injuries, 61.5% of patients presented good and very good function of the shoulder joint and 76.9% had good function of the elbow. In subjects with total brachial plexus palsy, good function of the glenohumeral was demonstrated by 51.2%, good function of the elbow by 61% and 53.6% presented with a functionally useful hand. CONCLUSIONS: 1. While surgical repair may be indicated in brachial plexus injuries at all levels, it is usually inevitable in total and upper-middle palsies. 2. The surgical outcome depends on the extent of baseline damage to the brachial plexus, with the best prognosis in insolated upper palsies.

Neurolysis of the conducting neuroma-in-continuity in perinatal brachial plexus palsy - evaluation of the results of surgical treatment.

UNLABELLED: The aim of the study was to evaluate the surgical treatment results of cases of perinatal brachial plexus palsy with presence of neuroma-in-continuity. Clinical material included 21 children, aged from 3.5 to 36 months, treated surgically between 1996 and 2005. The control examination included 19 children. The shortest postoperative observation period was 4 years. After surgical treatment during clinical evaluation of function dependent on localization of neuroma-in-continuity we observed the following: in upper injury in 1 child good shoulder and elbow function; in upper-middle injuries with neuroma-in-continuity in upper trunk good elbow function in 66.6%, good shoulder function in 83.3% of cases; in upper-middle injuries with neuroma-in-continuity in upper and middle trunk in 1 examined child good function of elbow, shoulder, and wrist; in total injuries with neuroma-in-continuity in upper trunk good elbow function in 75%, and good shoulder function in 50% of cases; in total injuries with neuroma-in-continuity in upper and middle trunk good elbow function in 66.6%, good shoulder function in 33.3%, good wrist function in 66.6% of cases; in total injuries with neuroma-in-continuity in lower trunk grade 2 of motor hand function and return of sensibility to a level of S3+. CONCLUSIONS: The choice of microsurgical technique during surgical treatment of perinatal brachial plexus palsies with neuroma-in-continuity should be based on the whole clinical and intraoperative view. The best results after neurolysis should be expected when neuroma-in-continuity is localized in the upper trunk, the injury corresponds to third degree on Sunderland's scale, and during electric stimulation a normal motor response can be obtained.

Tenomyoplastic procedures to improve shoulder function in the treatment of perinatal brachial plexus palsy.

BACKGROUND: A contracture of the shoulder joint in the course of perinatal brachial plexus palsy significantly affects the function of the upper limb as a whole. The aim of this paper is to present the authors' experience in surgical procedures carried out to improve shoulder joint function impaired as a result of perinatal brachial plexus palsy and evaluate the treatment outcomes. MATERIAL AND METHODS: The study involved 36 patients who underwent 37 tenomyoplastic procedures (subscapular release, teres major transfer, transfer of a portion of the trapezius). Pre- and postoperative shoulder joint function was assessed with the Gilbert scale. RESULTS: Surgical release of the subscapular muscle improved shoulder function in all patients, usually by 1 degree in the Gilbert scale. Teres major transfer improved shoulder function in all 4 patients (grade IV - 3 children, grade V - 1 child). One patient benefited from tenomyoplasty involving the trapezius. CONCLUSIONS: 1. Indications for tenomyoplasty procedures in the region of the shoulder joint may be present both in children who had previously undergone microsurgery and in those in whom rehabilitation had led to a good outcome of perinatal brachial plexus palsy. 2. The fact that most patients improved following tenomyoplastic procedures justifies their advisability. A visible functional improvement of the upper limb can be achieved with a relatively low risk of complications.

Preganglionic injuries in perinatal brachial plexus palsies - results of surgical treatment.

BACKGROUND AND PURPOSE: The authors report their experience in surgical treatment of preganglionic injuries in perinatal brachial plexus palsies. MATERIAL AND METHODS: Clinical material consisted of 16 children, of both sexes, aged from 2.5 to 33 months (mean 6.2 months), treated surgically between 1994 and 2006. The clinical view of the injury and location of preganglionic lesions was analysed and the description of the performed microsurgical techniques is provided. Control clinical examinations included a group of 14 children. The shortest postoperative observation period was 3 years. The currently accepted scales of evaluation of function of particular joints of the upper limb were used. RESULTS: The following outcome was noted after surgical treatment of perinatal brachial plexus palsies with signs of pre- and postganglionic injuries: good shoulder function in 6 cases, and average in 2 others; good elbow function in 4 cases, and average in 7 patients; functional position of the forearm in 9 cases, and good range of pronation and supination in 1 patient; useful function of wrist (flexion/extension) in 4 cases; good motor hand function in 3 cases, and fair in 6 patients. CONCLUSIONS: In preganglionic perinatal brachial plexus injuries located in the upper-middle part, spinal nerve C7 roots avulsion is the most frequently observed, and in the lower part of the brachial plexus, spinal nerve C8 roots avulsion is the most frequently observed. In preganglionic injuries of the brachial plexus, the number of avulsed spinal nerves has an influence on technical possibilities of performing reconstruction procedures, and then the results of the surgical treatment.

[The employment of synthetic biodegradable polymers in reconstructions of the peripheral nerves]. / Zastosowanie syntetycznych polimerów ulegajqcych biodegradacji w rekonstrukcjach nerwów obwodowych.

In this study we presented the possibility of using a synthetic biodegradable polymers to production a conduits employ in reconstructions of the peripheral nerves in experimental studies and medical practice. The aliphatic polyesters are most common used to this purpose. The poly(phosphoesters) and polyurethanes are used rather rare. In study we presented experiences of many authors in employment of the following polymers in experimental conditions. The obtained results were also described. The cases of clinical using of artificial nerve conduits from PGA--polyglycolic acid and PLCL--poly(DL-lactide-epsilon-caprolactone) were also described. Only PGA and PLCL marked as GEM Neurotube and Neurolac were approved to commercial production. The basic aspects of operating technique during reconstructions with artificial nerve conduits and causes of potential failure in microsurgical reconstructions were described. Still existing limitations in employment of artificial nerve tubes were emphasized and the directions of future progress in studies were presented. The possibility of establish of molecular weight of polymers building a tube scaffold and porosity and degradability of the wall create a chance to production an optimal in clinical applications artificial nerve tube.

[The possibilities of using a non-degradable materials as conduits in peripheral nerve reconstructions]. / Mozliwosci wykorzystania materialów nie ulegajacych degradacji jako tub w rekonstrukcjach nerwów obwodowych.

Rupture of the nerve is indication to perform reconstruction by direct neurorrhaphy or with autogenic nerve grafts. An alternative to using nerve grafts may be employ of an artificial conduits consisted of degradable or non-degradable polymers. In this study we presented the possibilities of using of non-degradable polymers in experimental studies and medical practice. The advantages of these materials were emphasized, but also limitations in its use were described. Directions in future progress and possibilities of enrichment nerve conduits by nerve regeneration facilitating factors such as: Schwann cells, mesenchymal stem cells, neurotrophic factors (NGF, GDNF, CNTF, VEGF, PDGF), extracellular matrix elements (collagen, laminin, fibronectin) and structural elements improving axon regeneration (filaments) were also described. In summary the properties of useful in medical practice neural tube were established. All indicate that future directions of experimental studies on using polymers in peripheral nerve reconstructions will be based on degradable materials. The role of non-degradable materials will be limited to using as control groups in experimental studies and in studies of following nerve regeneration improving factors.

The role of laser biostimulation in early post-surgery rehabilitation and its effect on wound healing.

BACKGROUND: The aim of this paper is to investigate whether laser biostimulation starting on the first day after surgery of the brachial plexus or peripheral nerves has a positive therapeutic effect on wound healing. MATERIAL AND METHODS: Surgical procedures were carried out on 44 male Wistar rats. The animals were divided into a control group (Group 1), where the surgical wounds were allowed to heal spontaneously, and an experimental Group 2, where the wounds were exposed to laser irradiation with the following parameters: wavelength 810 nm, power 100 mW, energy 15 J, laser exposure surface 3 cm(2), single application time 2 min. 30 sec., continuous mode. The results were assessed with pathomorphological tests (gross appearance of the wound, light and electron microscopy studies) and breaking strength examination. Statistical analysis used arithmetic means, standard deviations and Student's t test for independent samples. RESULTS: Low energy infrared laser radiation had a beneficial effect on the covering of the scar with stratified squamous cornifying epithelium and intensified wound healing. CONCLUSIONS: The gross and microscopic findings indicated a beneficial effect of laser stimulation on wound healing. These results underscore the utility of biostimulation lasers in the early post-operative period. Physicomechanical investigations did not reveal an effect of infrared laser biostimulation on the breaking strength of the cutaneous scar.

Comparison of the results of surgical treatment after direct neurorrhaphy and reconstruction with sural nerve grafts in perinatal brachial plexus lesions.

The neurotmesis of elements of the brachial plexus in perinatal lesions requires microsurgical reconstruction. In this study we present our own experiences in surgical treatment of postganglionic lesions in the fifth degree of injury in Sunderland's scale. The clinical material consisted of 14 children aged from 2.5 to 6 months treated surgically due to neurotmesis of the neural elements of the brachial plexus. In 8 cases direct neurorrhaphy and in 6 cases reconstruction with sural nerve grafts were performed. During the operations material from the proximal stumps of the brachial plexus trunks was collected for histopathological examination. The analysis of the material comprised: clinical type of injury, location of postganglionic lesion and type of surgical procedure. The results of surgical treatment were evaluated using generally accepted scales (Gilbert's, Raimondi's, Al-Qattan's and British Medical Research Council scales). Comparison of the results of treatment between the surgical methods was also performed. Better results of surgical treatment were observed after direct neurorrhaphy. In our opinion the indications for these two methods are different and both operative techniques are useful in surgical treatment of perinatal brachial plexus palsy.

The evaluation of the influence of a high injury to brachial plexus elements on the condition of neurons of the anterior horns of the spinal cord--experimental research.

The aim of the experimental research was to assess the impact of a high damage to brachial plexus elements on the condition of neurons of spinal cord anterior horns. The research was conducted on 12 rabbits, in which the ventral branches of spinal nerves C5-Th1 were severed. During dissections carried out 7, 30, 60, 180 days after the operation the cervicothoracic segment of the spinal cord was collected. The material was subjected to microscopic histological and ultrastructural examinations, which showed that where brachial plexus elements had been severed some of the neurons of spinal cord anterior horns had died and that the process intensity depended on the time that had passed after the injury.

[Evaluation of nonabsorbable surgical sutures in tubal anastomoses with use of microsurgical techniques. An experimental study]. / Ocena nici polipropylenowych w zespoleniach jajowodowych z zastosowaniem technik mikrochirurgicznych. Badania eksperymentalne.

In the paper there have been evaluated synthetic nonabsorbable surgical sutures--PROLENE. The valuation concerned their usefulness to carrying out the operations of oviducts with use of microsurgical technique. It consisted in determination of biocompatibility degree of analyzed sutures within tubal tissues and also their technical utility to this kind of procedures. The valuation of the surgical sutures was performed on the ground of experimental studies with use of laboratory animals--New Zealand white female rabbits, in which end to end microsurgical tubal anastomoses were made, with use of analyzed sutures. In further stage, pathomorphological investigations of the animals were performed (in various time after the operation), during which there were conducted microscopic observations of histologic slides derived from tubal anastomoses regions. The purpose of the work was trying to appoint the most adequate suture material for carrying out the operations of oviducts with use of microsurgical technique. It was also an assistance for an operator to take a decission of choice of the proper surgical sutures for surgical treatment of female mechanical infertility and other kind of microsurgical operations which are performed in gynaecology. Generally good technical utility in microsurgical practice of nonabsorbable surgical sutures--PROLENE was stated. They cause the formation of only single peritoneal adhesions, mainly in the regions of tubal anastomoses previously made and produce relatively small tubal tissue reaction, which testifies to high biocompatibility of the sutures, as the implantation material. The analyzed surgical sutures characterize themselves of very good usefulness to microsurgical operations of oviducts.

[Outcome treatment of pseudoarthrosis of long bones with decortication method depends on osteosynthesis]. / Wyniki leczenia stawów rzekomych kosci dlugich konczyny górnej metoda dekortykacji w zaleznosci od rodzaju osteosyntezy.

Purpose of work was estimation of the results of treatment of pseudoarthrosis of the long bone with the method of decortication, with use of autogenic bone depends on kind of pseudoarthrosis and kind of osteosynthesis. In the years 1995-2005 56 patients were treated because of pseudoarthrosis of long bone in our Clinic. Pseudoarthrosis is classified according to Weber-Cech classification. In the methodology of clinical estimation and subjective estimation of the patient Stewart and Hundley and Anderson classification were used. Union was achieved in 51 cases. Time of bone union achievement was 5 months. The results of treatment are depends on morfology of pseudoartrosis and are independs of kind of osteosynthesis.

Experience with surgery for entrapment syndrome of the suprascapular nerve.

BACKGROUND: The suprascapular nerve entrapment syndrome accounts for about 1-2% of all causes of shoulder pain and dysfunction. Entrapment may occur at different levels and a frequent site of compression is the suprascapular notch, the upper border of which is the superior transverse scapular ligament. MATERIAL AND METHODS: We studied 5 patients with entrapment of the suprascapular nerve at the suprascapular notch, analyzing the pathomechanism of the compression syndrome. The outcome of the surgical treatment was evaluated by examining the improvement in strength of the supraspinatus and infraspinatus muscles based on the Narakas method. The degree of recovery of atrophy of the muscles and pain was also evaluated. RESULTS: Following surgical treatment, pain subsided in 4 patients (80%), muscle strength improved in three (60%) and in 1 patients (20%) there was recovery of muscle mass. CONCLUSIONS: The outcomes of surgery for suprascapular entrapment depend on appropriate differential diagnosis, early detection and prompt referral for operative treatment whenever such is necessary.

[Intraneural ganglion of the tibial nerve--a case report]. / Torbiel galaretowata nerwu piszczelowego--opis przypadku.

This paper describes a surgically treated case of gelatinous cyst of extremely rare location within the tibial nerve at the level of the popliteal fossa. The initial diagnosis was based on imaging exams (MRI, ultrasonography) and surgical exploration of the tumour. The intraneural ganglion was completely removed. Neurological motor and sensory deficits were observed neither in the preoperative nor in the postoperative period. The ultimate diagnosis was established based on the histopathological examination.

Entrapment of the suprascapular nerve: anatomy, etiology, diagnosis, treatment.

Entrapment of the suprascapular nerve is a rare peripheral neuropathy, which can be easily overlooked in the differential diagnosis of shoulder pain and dysfunction. Entrapment of the suprascapular nerve can occur at different locations along the pathway of the nerve. The primary symptoms are pain, weakness, and atrophy of the supraspinate and infraspinate muscles. Differential diagnosis should include brachial plexopathy, disorders of the cervical spine, cervical discopathy, glenohumeral pathology, tendonitis, and rotator cuff tear. Accurate diagnosis facilitates appropriate and timely treatment.

Radiation-induced brachial plexus neuropathy - aetiopathogenesis, risk factors, differential diagnostics, symptoms and treatment.

The success of radiation oncology has led to longer patient survival. This provides a greater opportunity for radiation injuries of the peripheral nerves to develop. Brachial plexus neuropathy in cancer patients may result from either tumour recurrence or as a consequence of radiation therapy. Distinguishing between radiation injury and cancer disease recurrence as a cause of brachial plexus dysfunction may be difficult. In this article the most important principles of the differential diagnostics have been presented. Furthermore the aetiopathogenesis of brachial plexus neuropathy after radiotherapy has been discussed as well as main risk factors, symptoms of plexopathy and methods of treatment. It ought to be emphasized that complications of radiation therapy sometimes occur many years after treatment and this may create difficulties in initial diagnostics.

Brachial plexus injuries after radiotherapy - analysis of 6 cases.

Radiation-induced brachial plexus neuropathy is caused by compression of the nerve fibres by dense and inelastic fibrous connective tissue. In this study our own experience in treatment of lesions of the brachial plexus after radiotherapy is presented. The clinical material consisted of 6 patients aged from 40 to 64 years with injuries of the brachial plexus after radiotherapy. The analysis of the material comprised: basic disease, duration of radiotherapy, radiated fields, total dose of radiation, onset and character of symptoms, location and severity of injury. 5 women were qualified for surgical treatment. After neurolysis of the brachial plexus a significant improvement was obtained in 2 cases. In one patient remission of pain and sensory recovery was temporary. No improvement was observed in the remaining 2 patients. Lesions of the brachial plexus after radiotherapy are rare but difficult to prevent. The treatment depends on the grade of severity of injury. Surgical neurolysis is advised for grades 3 and 4 on the LENT-SOMA scale.