Repair of type II paraesophageal hernia with Nissen fundoplication in a patient with von Willebrand disease and spondylolisthesis - a clinical case report.

Hiatal hernias continue to be fairly common in clinical practice. However, the variety of different symptoms presented by patients may hinder establishing the ultimate diagnosis. Nevertheless, currently, the diagnosis of hiatal hernia can be easily established, based on barium swallow radiography. We would like to present a clinical case report of a patient with complex medical history, including von Willebrand disease, degenerative spinal disease, and chronic sinusitis, who was finally diagnosed with hiatal hernia and treated with a standard laparoscopic Nissen fundoplication. Our case focuses on the significance of comorbidities on patients' symptoms, which sometimes may mislead the therapeutic process.

Evaluation of anterior stability of knee joint following arthroscopic ACL reconstruction with patellar ligament.

BACKGROUND: The aim of the study was to investigate and assess anterior stability of the knee joint before and during 12-month rehabilitation after arthroscopic reconstruction of the anterior cruciate ligament with the central third of the patellar ligament and stabilization with interference screws (Kenneth-Jones method) and to analyse the effectiveness of the surgery and rehabilitation by patient self-assessment of pain and crepitation in the patello-femoral joint. MATERIAL AND METHODS: The study involved a group of 46 patients after arthroscopic ACL reconstruction with the patellar ligament performed in 2005 and 2006. All patients underwent examinations of anterior stability of the knee joint using a KT-1000/S arthrometer. Stability measurements were performed on both knees on the day before surgery, and at 3, 6 and 12 months after the operation. Additionally, the patients subjectively evaluated post-operative pain and crepitation in the patello-femoral joint at 3, 6 and 12 months. RESULTS: Knee stability after ACL reconstruction according to the Mazurkiewicz scale using a KT-1000 arthrometer was rated as good and excellent, while the patients subjectively assessed the treatment process in terms of pain and crepitation in the patello-femoral joint at 12 months after the operation as excellent (10.8%), good (74%), and satisfactory (15.2%). CONCLUSIONS: Arthroscopic ACL reconstruction with the central third of the patellar ligament and stabilization with interference screws fully restored the lost stability of the knee, but the possibility of pain and crepitations in the patello-femoral joint needs to be taken into account. In the course of rehabilitation, it is natural that an ACL graft may extend as a result of remodeling and the impact of rehabilitation being administered.

Early assessment of knee function and quality of life in patients after total knee replacement.

BACKGROUND: The aim of the study was to assess knee function and changes of the perceived quality of life before total knee replacement surgery and after four weeks of post-operative rehabilitation. MATERIAL AND METHODS: The study involved 200 patients with Kellgren III/IV osteoarthritis of the knee who received a total cemented knee endoprosthesis and underwent comprehensive post-operative rehabilitation for four weeks. The Lysholm and Gilquist Knee Scale was used to assess the clinical status of the patients and the SF-36 Questionnaire served to evaluate the quality of life. Patients were evaluated before the operation and after the four-week rehabilitation. RESULTS: A significant improvement in the following knee functions was observed after four weeks of rehabilitation: walking, climbing stairs, stability, and turning around on one leg. The pain, swelling and limp decreased. The quality of life after the four-week rehabilitation was considerably better in the domains of physical function and emotional status. CONCLUSIONS: The positive effects of surgery and rehabilitation on knee function and quality of life can be observed as early as after four weeks of rehabilitation following total knee replacement.

Early rehabilitation after arthroscopic reconstruction of the anterior cruciate ligament.

Background. The purpose of our research was to evaluate the results of early rehabilitation after arthroscopic reconstruction of the anterior cruciate ligament, based on identical rehabilitation methods applied two weeks later. Material and methods. The research involved 30 persons, randomly divided into two groups. Each group received an identical, 12-week program of rehabilitation, differing only in the time of commencement after surgery. We analyzed the range of movement of the knee joint, the circumferences of the knee and hip, and the strength of the flexor and extensor muscle groups in the knee. Results and Conclusions. The outcome for rehabilitation of the knee is not dependent on the time when the rehabilitation process is commenced. However, in view of the occurrence of a greater number of complications when early rehabilitation is applied, individual adjustment of the timing for commencement of rehabilitation procedures would seem to be the optimal solution.