Repair of distal biceps tendon acute ruptures with two suture anchors and anterior mini-open single incision technique: clinical follow-up and isokinetic evaluation.

BACKGROUND: All the techniques described in literature for treatment of acute distal biceps tendon ruptures provide good functional outcomes. The purpose of this study is to report the results of a single limited-incision technique for repair of acute distal biceps ruptures using two suture anchors. MATERIALS AND METHODS: Fourteen patients, all man, were treated consecutively from one author between January 2009 and December 2011 and evaluated at a mean follow-up of 26 months. All patients were evaluated clinically, through DASH and MEPS score questionnaires, and with isokinetic biomechanical tests. RESULTS: All patients achieved complete elbow flexion and extension. Deficit for supination of the forearm was found in only two patients (7° and 13°). Mean DASH score was 4.7 points, and mean MEPS was excellent (96.8 points). There was no nervous complication involving posterior interosseous nerve (PIN) and no case of failure of the sutures. The isokinetic evaluation detected an average flexion strength increase by 10.2 % compared to the opposite arm not operated. CONCLUSION: Our study shows that mini-open access and fixation with two suture anchors achieved in medium-term excellent functional and cosmetic results needed short rehabilitation times and is minimally invasive.

One-stage revision for patients with a chronically infected reverse total shoulder replacement.

We retrospectively reviewed 11 consecutive patients with an infected reverse shoulder prosthesis. Patients were assessed clinically and radiologically, and standard laboratory tests were carried out. Peroperative samples showed Propionbacterium acnes in seven, coagulase-negative Staphylococcus in five, methicillin-resistant staphylococcus aureus in one and Escherichia coli in one. Two multibacterial and nine monobacterial infections were seen. Post-operatively, patients were treated with intravenous cefazolin for at least three days and in all antibiotic therapy was given for at least three months. Severe pain (3 of 11) or severe limitation of function (3 of 11) are not necessarily seen. A fistula was present in eight, but function was not affected. All but one patient were considered free of infection after one-stage revision at a median follow-up of 24 months, and without antibiotic treatment for a minimum of six months. One patient had a persistent infection despite a second staged revision, but is now free of infection with a spacer. Complications included posterior dislocation in one, haematoma in one and a clavicular fracture in one. At the most recent follow-up the median post-operative Constant-Murley score was 55, 6% adjusted for age, gender and dominance. A one-stage revision arthroplasty reduces the cost and duration of treatment. It is reliable in eradicating infection and good functional outcomes can be achieved.

[Malignant melanoma of the cornea after blunt trauma]. / Malignes Melanom der Kornea nach stumpfem Trauma.

We report the case of a 67-year-old woman who presented with a persisting corneal erosion after blunt injury. Six years later, a highly prominent corneal tumor had developed at the site of the initial erosion. Histological analysis revealed a malignant melanoma. This case provides evidence that malignant melanoma may be a long-term complication of corneal epithelial disorders.

Algorithm for the treatment of calcific tendinitis in the rotator cuff: indications for arthroscopy and results in our experience.

Calcific tendinitis of the rotator cuff is a relatively frequent pathology and at times, in some phases, it is a disabling one: for this reason, numerous therapeutic options have been proposed. The authors propose an algorithm for the classification and treatment of calcific tendinitis and report their experience with arthroscopic treatment over a three-year period from 2001 to 2004. Based on the algorithm proposed, out of a total of 126 shoulders affected with calcific tendinitis of the rotator cuff for which debridement was indicated, 106 us-guided percutaneous surgeries (EPT), and only 20 arthroscopies were performed. Arthroscopy is indicated, on the basis of the algorithm that we followed, in patients affected by chronic and persistent calcific tendinitis who did not benefit from the execution of previous types of non-surgical treatment for a period of at least 6 to 12 months. Shoulder instability was found to be present in 8 patients out of 20 treated arthroscopically. After arthroscopy, short- and medium-term results were always positive with the exception of one case that evolved into adhesive capsulitis. Based on an analysis of this series, we were able to confirm the usefulness and clinical applicability of an algorithm to classify and treat calcific tendinitis of the rotator cuff; we also confirmed the role of arthroscopic treatment that in cases which did not respond to conservative procedures proved to be effective in resolving symptoms.

Bilateral endogenous Candida endophthalmitis after induced abortion.

AIM: Analysis of the development and treatment of bilateral Candida endophthalmitis after induced abortion in a healthy 31-year-old patient. METHOD: A diagnosis of bilateral Candida endophthalmitis was established on the basis of positive vaginal culture, serological finding, and culture for Candida hyphae from the vitreous aspirate. The treatment of the disease consisted of prolonged systemic therapy with amphotericin B and fluconazole and pars plana vitrectomy with intravitreal amphotericin B injection. RESULTS: After the combined systemic therapy with antibiotics, fungistatics, and corticosteroids proved to be insufficient, pars plana vitrectomy with intravitreal instillation of amphotericin B was performed, which led to the improvement of visual function. After surgery, visual function was maintained with prolonged systemic therapy with fluconazole and methylprednisolone. CONCLUSION: Complicated induced abortion may cause bilateral Candida endophthalmitis in a young healthy woman. Elimination of the cause of fungemia and adequate systemic treatment did not cure bilateral endophthalmitis. Pars plana vitrectomy with intravitreal instillation of 5-microg amphotericin B proved as a method of choice in treating this severe ophthalmic disease.

Types of central serous retinopathy, analysis of shape, topographic distribution and number of leakage sites.

The analysis of 212 fluorescein angiograms of the same number of eyes showed that Type I is by far the most prevalent form of central serous retinopathy. Type I appeared in 92.45%, Type II in 6.60% and the Intermediate type in 0.95% of the examined eyes. The patients were mostly male (81.13%) between 30 and 49 years of age (95.28%). The number of leakage sites in Type I central serous retinopathy varied from 1 (83.67%) to 5 (1.02%). Solitary leakage appeared in 83.67%, while uniform spreading of fluorescein into the subretinal blister in Type I central serous retinopathy appeared in 85.71% of eyes. Most leakage sites (32.50%) were located in the upper nasal quadrant, while the lower temporal quadrant was least affected (15.83%). The foveal avascular zone was affected in 4.14% and the papillomacular bundle in 20.83% of the examined eyes.

Brachytherapy--optional treatment for choroidal neovascularization secondary to age-related macular degeneration.

Age-related macular degeneration (ARMD) presents the main cause of irreversible loss of central vision in older population, due to a progressive neuroretinal damage and damage of retinal pigment epithelium of foveal area. This observation emphasizes the insufficiency of all presently used therapeutic procedures. Therefore, investigation has been conducted at the University Eye Clinic Zagreb for the last three years testing the effects of brachytherapy with direct episcleral application of ruthenium applicators to the posterior pole of the globe. Forty-two patients aged 58-79 were followed for a min. of 12 months. During this period their central visual acuities remained stable. Six patients showed one-line improvement of visual acuity and 8 patients showed no changes. Twenty-one patient lost 1-2 lines of visual acuity and 7 patients lost more than 2 lines. According to this we can conclude that patients treated with brachytherapy showed significantly better results compared to the control subjects, which is very encouraging.

Surgical treatment of war lesions to the posterior segment of the eye.

OBJECTIVE: The aim of this study was to assess the outcome of surgical treatment of war lesions to the posterior eye segment. METHODS: During a 1-year period, 96 patients with severe eye lesions, 54 of them with intraocular foreign bodies (56.2%), were operated on at the Institute for Posterior Eye Segment Diseases and Trauma, Zagreb Clinical Hospital. Surgical procedures performed included high-quality primary microsurgery of the wound, extraction of intraocular foreign bodies, treatment of double perforating wounds by silicone oil tamponade and gas, and emergency vitrectomy when necessary. RESULTS: A varying degree of vision function improvement was achieved in 67 patients (69.7%). Most of the foreign bodies removed were metal and nonmagnetic. Only six foreign bodies were made of glass, and two 2 were of plastic material. In 29 patients (30.3%), the vision function remained unchanged or deteriorated after vitrectomy. CONCLUSION: Although satisfactory results were achieved, definitive evaluation of the procedures will be possible only after long-term follow-up.

Choroidal leiomyoma of vascular origin.

A 38-year-old female patient was admitted for serious retinal detachment. Clinical examination revealed detachment in the lower half of the retina, with a suspect hemispherical tumorous formation. Echography did not positively demonstrate the presence of tumor. Vitrectomy was performed and a tumor fragment was taken for histologic analysis. The finding indicated the presence of leiomyoma choroideae, a very rare and benign smooth muscle tumor.

Hearing levels and age in cleft palate patients.

Tonal audiometry was used to compare hearing levels in patients with bilateral cleft lip and palate (BCLP) (57 patients). unilateral cleft lip and palate (UCLP) (124 patients) and isolated cleft palate (ICP) (62 patients), and according to age groups. Patients with isolated cleft palate showed greater improvement in hearing level with age than patients with UCLP and BCLP; as adults they showed the lowest frequency of ears with hearing level of less than 40 dB, and the highest frequency of ears with hearing levels of 11-20 dB. Patients with BCLP had a higher frequency of ears with a hearing level of 21-40 dB during early childhood and adult age than patients with ICP. Patients with UCLP and BCLP showed a slower decrease with age in the frequency of ears with hearing loss than patients with ICP; the hearing level in patients with UCLP and BCLP improved only in groups with hearing levels of 21-40 dB, while those with hearing levels above 40 dB showed no significant improvement with age.

Pierre Robin syndrome: characteristics of hearing loss, effect of age on hearing level and possibilities in therapy planning.

Hearing loss was studied in 22 patients with Pierre Robin syndrome (PRS) aged three to 12 years (median 5.0 years). The results were compared to those obtained in 62 patients with isolated cleft palate (ICP) aged one to 27 years (median 5.5 years). Hearing loss was more frequently found in PRS (73.3 per cent) than in ICP (58.1 per cent) patients (p = 0.02). PRS patients had more ears with moderate (21-40 dB) and severe (> 40 dB) hearing loss, disturbing their social contact, with no tendency to normalization with age (Spearman r = 0.065). In contrast to PRS, ICP patients showed a significant tendency to hearing level normalization with ageing (Spearman r = -0.453; p = 0.001). Planigraphs of temporal bones showed inadequately developed pneumatization of the mastoid bone in all PRS patients and in most ICP patients. No malformation of the inner or middle ear was found in either group. PRS patients have a significantly higher risk of conductive hearing loss than those with ICP. Use of tympanostomy (ventilation) tubes is therapy of choice in patients with Pierre Robin syndrome, and it should be introduced as early as possible, even at the same time as palatoplasty.

A new approach to surgical treatment of diabetic retinopathy.

Results of surgical treatment performed in 48 patients with proliferative diabetic retinopathy are presented. The technique of excision and vitrectomy of the posterior cortex and neovascular membranes was used in a single act. The authors are inclined to believe that membranes can be more completely and with less bleeding removed using this technique than with the technique of circumcision and segmentation. The procedure was most frequently complicated by perioperative formation of posterior ruptures (13 patients) and peripheral ruptures (11 patients). All ruptures were treated by endolaser photocoagulation. Additional or panretinal photocoagulation was carried out when necessary. During the postoperative period, retina remained attached in 33 patients, whereas in 15 patients complications in terms of reproliferation and neovascular glaucoma occurred.

[Eye injuries in traffic accident traumatology]. / Ozljede oka u prometnoj traumatologiji.

The authors discuss traffic eye injuries on the basis of their own clinical patients. A total of 334 patients were treated surgically or conservatively. Reviewing the results of the cure, they point out new possibilities and perspectives of treatment.